Supplement to

GLOBAL HEART
Volume 9 • Issue 1S • March 2014 Official Journal of the World Heart Federation

Volume 9 • Issue 1S • March 2014

World Congress of Cardiology Scientific Sessions 2014
Incorporating the
Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand

Elsevier

ISSN 2211-8160

GHEART_v9_i1_sS_COVER.indd 1 4/11/2014 6:11:29 PM

 World Congress of Cardiology Scientific Sessions 2014
Incorporating the
Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand

ISSN 2211-8160

GHEART_v9_i1_sS_TITLEPAGE.indd i 4/11/2014 4:37:10 PM

EDITOR-IN-CHIEF
JAGAT NARULA USA
Official Journal of the World Heart Federation
DEPUTY EDITORS
Andrew Moran USA
Volume 9  Issue 1S  March 2014
Y. Chandrashekar USA
Nathan D. Wong USA
Ragaven Baliga USA SPECIAL ISSUE
ASSOCIATE EDITORS WORLD CONGRESS OF CARDIOLOGY SCIENTIFIC SESSIONS 2014
Eloisa Arbustini Italy INCORPORATING THE
Sameer Bansilal USA ANNUAL SCIENTIFIC MEETING OF THE CARDIAC SOCIETY OF
Mark Huffman USA
Prashant P. Joshi India AUSTRALIA AND NEW ZEALAND
R. Krishna Kumar India
Gregory A. Roth USA
Rajesh Vedanthan USA

SENIOR ADVISORY COUNCIL

Valentin Fuster USA, Chair
K. Srinath Reddy India,
Co-Chair
George Alleyne USA
Robert D. Bonow USA
Arun Chockalingam USA
Prakash Deedwania USA
Michael Engelgau USA
Edward L. Kaplan USA
Patrick Kelley USA
Bridget Kelly USA
Vanessa Kerry USA
Darwin Labarthe USA
Philip Landrigan USA
Steve Leeder Australia
Daniel Levy USA
Yan Lijing China
Donald Lloyd-Jones USA
Bongani Mayosi South Africa
Shanthi Mendis Switzerland
George A. Mensah USA
Rachel A. Nugent USA
Neil Poulter UK
Dorairaj Prabhakaran India
Pekka Puska Finland
Robert Roberts Canada
Samin K. Sharma USA
Richard Smith UK
Sidney Smith USA
Anne E. Sumner USA
Kathryn Taubert Switzerland
Mark Woodward Australia
Yang Feng Wu China
Magdi Yacoub UK
Salim Yusuf Canada
William A. Zoghbi USA
SECTION EDITORS
GLOBAL HERITAGE
Majid Ezzati UK
GLOBAL INTELLIGENCE
J.C. Mohan India
GLOBAL LEARNING
Rizwan Afzal Canada
Paolo Boffetta USA
GLOBAL ORPHANS
Javier Guzman Colombia
Nitish Naik India
GLOBAL SOLUTIONS
Kanav Kahol USA
Scott Lear Canada
GLOBAL TRACKING
Vamadevan S. Ajay India
Ambuj Roy India
GLOBAL VIGILANCE
Stuart J. Pocock UK
Nupoor Narula USA
GLOBAL VOICES
Mohammad Ali USA
Chowdhury Ahsan USA
GLOBAL WATCH
Rupa Iyengar Grenada
Sumeet Mitter USA
e1 Oral Abstracts
e62 Poster Abstracts
e337 Author Index
EDITORIAL BOARD
Deewan Alam Bangladesh
Samir Alam Lebanon
Eric Alexanderson Mexico
Wael Almaheed UAE
Alvaro Avezum Brazil
Andres Budaj Poland
Jonathan Carapetis Australia
Beatriz Champagne USA
Cheng-Wen Chiang Taiwan
Solveig A. Cunningham USA
Anna Dominiczak UK
Shah Ebrahim UK
Maria Grazia Franzosi Italy
Gordon Galea Denmark
Thomas Gaziano USA
Abdul Ghaffar Switzerland
Stephen Harrap Australia
Rodney Jackson New Zealand
Kay Tee Khaw UK
Jaspal Kooner UK
Shyam S. Kothari India
Henry Krum Australia &
New Zealand
Fernando Lanas Chile
Prasart Laothavorn Thailand
Ramanan Laxminarayan India
Basil Lewis Israel
Jean Claude Mbanya Cameroon
Dary Mozaffarian USA
K.M. Venkat Narayan USA
Jane W. Newburger USA
Sania Nishtar Pakistan
Churchill Onen Botswana
Kaushik Ramaiya Tanzania
Anthony Rodgers Australia
Matthew Roe USA
Adolfo Rubenstein Argentina
Kui-Hian Sim Malaysia
Bambang Siswanto Indonesia
K. K. Talwar India
Nikhil Tandon India
Simon Thom UK
Abani Updhaya Nepal
PUBLISHER
Koos Admiraal The Netherlands
JOURNAL MANAGERS
Ryan Hastings USA
Camanie Naraine UK
 ORAL ABSTRACTS
O001
Is Geography Destiny? Pre-hospital Delay in Primary Percutaneous Coronary
Intervention (PCI) and Correlation with Area of Residence
Arul Baradi*1, Nick Andrianopoulos2, Angela L. Brennan2, Damon K. Jackson1, Andrew Teh1,
Thomas Yip3, Ernesto Oquiel4, Louise Roberts1, Gishel New1, Melanie Freeman1
1
Cardiology, Eastern Health, Box Hill, 2Cardiology, CCRET - Monash University, Melbourne,

web 3C=FPO
3
Cardiology, Barwon Health, Geelong, 4Cardiology, Ballarat Health, Ballarat, Australia
Introduction: Delay in access from first medical contact (system delay), resulting in increased
symptom to balloon time (STBT), affects outcomes in primary PCI. Guidelines recommend a
door-to-balloon-time (DTBT) of
90 minutes and now suggest a first medical contact to door
time of
30 minutes. Socioeconomic status (SES), including area of residence, has been
shown to impact on symptom to door time (STDT) in the USA and New Zealand.
Objectives: We evaluated whether area of residence impacts on pre-hospital delay utilising
a large multicenter registry.
Methods: We identified 3205 consecutive patients undergoing primary PCI from the Mel-
bourne Interventional Group registry between 2005-2011. Patients were categorised by SES
derived from patient postcode using the Socio-Economic Indexes for Areas compiled by the
Australian Bureau of Statistics. Patients were divided into quintiles; the most disadvantaged as
Quintile 1 and the least disadvantaged as Quintile 5. Baseline data, STEMI timings and outcomes
were described as a function of socioeconomic quintile, using the non-parametric trend test.
Results: Those who were least disadvantaged were older, with lower BMI. Those who were
more disadvantaged were more likely to have diabetes, hyperlipidaemia, and a previous MI.
There were no other differences in baseline characteristics between the quintiles, including
gender. Patients of lower SES were more likely to initially present to a non-PCI capable
hospital and, when transferred for PCI, had significantly longer transfer times.
Conclusion: Lower SES is correlated with increased symptom to door time, and hence

web 3C=FPO
STEMI timings and outcomes as a function of SES
Median
minutes Lowest SES Highest SES
(IQR) Quintile1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 p value
STEMI 100 (64,188) 120 (75,224) 119 (75,203) 110 (75,180) 96 (64,165) 0.01
timings
STDT
Conclusion: Although improving adherence to cardiovascular medications will be central
STBT 200(147,276) 202(157,286) 200(149,285) 192(150,267) 188(144,260) <0.01 to achieving the World Health Organization’s goal of 25x25, evidence about the effec-
DTBT 80 (53,110) 75 (50,109) 72 (45,100) 74 (45,102) 80 (56,107) 0.78 tiveness and cost-effectiveness of interventions to boost adherence in low- and middle-
MACE (%) 11 11 9 9 10 0.49 income countries is disappointingly sparse. Prospective randomized trials addressing this
30-day critical issue are urgently needed.
12-month 21 19 19 17 16 0.04 Disclosure of Interest: None Declared

symptom to balloon time, in patients undergoing primary PCI in Victoria, as well as greater
likelihood of requiring transfer to a PCI-capable hospital. Lower SES was associated with
increased 12-month MACE. The apparent inequity for patients of different areas of resi-
dence and SES in Victoria suggests a role for public health measures including health
education and improvement in system delays in lower socioeconomic areas.
Disclosure of Interest: None Declared
O002
Roadmap to 25x25: A Systematic Review of the Effectiveness and Cost-Effectiveness
of Interventions to Improve Adherence to Cardiovascular Medications in Low- and
Middle-Income Countries
Arul Thangavel*1, Reto Auer2, Dhruv S. Kazi1,2,3
1
Medicine, 2Epidemiology and Biostatistics, University of California San Francsico, 3Medicine/
Cardiology, San Francisco General Hospital, San Francisco, United States
Introduction: Improving adherence to cardiovascular medications will be critical to
achieving the World Health Organization’s target of 25 % reduction in premature mortality
from non-communicable diseases by 2025. Whether educational or m-health interventions
can improve medication adherence in low- and middle-income countries is unclear.
Objectives: We conducted a systematic review of all published, randomized clinical trials
to evaluate the effectiveness and cost-effectiveness of interventions to boost adherence to
cardiovascular medications in low- and middle- income countries.
Methods: The Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase,
CINAHL, WHO regional databases, PsychInfo and Web of Science were searched for
eligible trials. Randomized controlled trials of community or home-based interventions to
improve medication adherence in cardiovascular disease among adults in low- or middle-
income contries (as defined by the IMF) were included.
Results: Out of 7684 abstracts identified by the search strategy, nine trials (including 1666
patients) fulfilled inclusion criteria after full-text review. Eight trials were from Asia and one
was from Africa; there were no trials from Latin America. Interventions studied included
counseling (7 studies), pill-diaries (1 study), and combined interventions (1 study); no
studies examined mobile phone-based interventions. Most studies were small with short
follow-up (median, 6 months; IQR: 3-6months). Studies were of low quality (Jadad score:
Median, 3; IQR: 2-3), with substantial differences in study definition of adherence.
Quantitative synthesis of effectiveness data (see figures) showed extremely large hetero-
geneity between trials (I2>90%), and small, if any, improvements in adherence with the
interventions. No studies evaluated cost-effectiveness.
O003
Vitamin D levels are associated with the presence and severity of coronary artery
disease but not peripheral vascular disease in patients undergoing coronary
angiography
Jonathan Liew*1, Stella Sasha2, Josephine Warren2, Philip Ngu3, Anthony Dart3, James Shaw3
1
Cardiology, Monash University, Alfred Hospital Baker IDI Heart and Diabetes Institute,
2
Cardiology, Monash University, Alfred Hospital, 3Cardiology, Alfred Hospital Baker IDI Heart
and Diabetes Institute, Melbourne, Australia
Introduction: Although multiple risk factors for coronary artery disease (CAD) are well
established, novel risk factors continue to emerge. Recent studies have shown the asso-
ciation between vitamin D deficiency (VDD), cardiac risk factors and CAD. Globally, VDD
is a re-emerging public health problem as it is present in upto 50% of the general
population.
Objectives: The goal of this study is to investigate the association between VDD and extent
of CAD, peripheral vascular disease (PVD) and arterial stiffness.
Methods: 375 patients undergoing coronary angiography at Alfred Hospital Cardiac
Catheterisation Laboratory between the period of November 2012 to Sept 2013 were
prospectively recruited. We measured 25-hydroxyvitamin D (25OHD) serum levels, per-
formed ankle brachial index (ABI) and pulse wave velocity (PWV) tests. Based on the
findings of the coronary angiogram, patients were divided into subgroups: Absent, Single,
Double and Triple Vessel Disease (as defined by >50% stenosis in each major coronary
artery). All data are presented as mean  SEM unless stated.
Results: 265 patients not taking vitamin D supplements were included in the analysis. Mean
age was 66.0  11.2 (mean  SD). Levels of 25(OH)D were significantly lower in patients
with CAD when compared with patients without CAD (57.0  1.73 versus 70.1  2.46
nnmol/L; p <0.01). One way ANOVA revealed triple vessel disease patients had significantly
lower 25(OH)D levels when compared to single vessel disease patients (50.6  2.84 nmol/L
versus 61.3  3.16 p<0.01)and trended to be lower when compared to double vessel disease
patients (50.6  2.84 versus 59.0  2.99 nmol/L; p¼ 0.06). Patients with CAD had negative
correlation with serum 25(OH)D levels (r¼ -0.263; p<0.01), positive correlation with age
(r¼ 0.205; p<0.01) and pulse wave velocity (r¼ 0.198 and 0.252 respectively; p <0.01).
However, there was no correlation between 25(OH)D levels, ABI and PWV (p > 0.05).
Conclusion: Low levels of Vitamin D are associated with the presence and extent of
angiographic CAD but not arterial stiffness or PVD. Further studies should be conducted to
determine whether vitamin D supplementation prevents the development and progression
of CAD.
Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e1

 O005
ORAL ABSTRACTS
Essential Service Standards for Equitable National Cardiovascular CarE for
Aboriginal and Torres Strait Islander People – An Exemplar Approach to Closing the
Gap
Alex Brown*1,2,3, Rebekah O’Shea1,3,4, Kathy Mott1,3, Katharine Brown1,3, Tony Lawson5,
Garry Jennings6, on behalf of the members of the Essential Service Standards for Equitable
National Cardiovascular Care for Aboriginal and Torres Strait Islander people (ESSENCE)
Steering Committee
1
Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research
Institute, Adelaide, 2Central Australia, Baker IDI Heart and Diabetes Institute, Alice Springs,
3
School of Population Health, University of South Australia, 4Central Australia, Baker IDI Heart
and Diabetes Institute, 5Tony Lawson Consulting, Adelaide, 6Baker IDI Heart and Diabetes
Institute, Melbourne, Australia
Introduction: Cardiovascular diseases (CVD) constitute the biggest cause of death for Aboriginal
and Torres Strait Islander people and a most critical target for reducing the life expectancy
gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
Objectives: The ESSENCE (Essential Service Standards for Equitable Cardiovascular CarE
for Aboriginal and Torres Strait Islander people) project sought to identify disparities in
CVD and address these by developing a strategy to improve care across the health care
system. In doing so, the objective was to build the foundations on which the disparities in
care experienced by Aboriginal and Torres Strait Islander people could be reduced, and
develop an exemplar approach to closing the gap.
Methods: Utilising 25 years of national mortality data (1986-2010), the project mapped
secular trends in CVD mortality in Australia and differentials in rates of mortality, by
Indigenous status. Essential service standards were developed to identify elements of care
and service delivery that should be accessible to all people with or at risk of CVD. These
standards focused on prevention and management extending across the life course and
continuum of care - including primary prevention, risk identification and management, and
the management of disease in specialist, acute and post-acute care settings. Utilising this
conceptual framework to guide the process, the standards were informed by a targeted
literature review of existing evidence and service standards. Standards then underwent a
process of review and validation by external experts prior to final review by the Steering
Committee (comprising of leaders in the field of CVD from Australia).
Results: The ESSENCE secular trend data shows that whilst absolute CVD mortality rates
for Aboriginal and Torres Strait Islanders has decreased significantly, in relative terms the
disparity has increased compared to non-Indigenous Australians. Most alarming is the
differential in mortality rates in young age groups. 61 service standards were identified,
articulating elements of care necessary to reduce disparity in access and outcomes for five
critical cardiovascular conditions. The standards were presented in alignment with 10
policy relevant health reform targets.
Conclusion: The ESSENCE Project has demonstrated differentials in burden of disease and
developed a structured and comprehensive approach to improving CVD care in order to
reduce disparities experienced by Aboriginal and Torres Strait Islander people.
Disclosure of Interest: None Declared
O006
Investigating the extent and explanations of in-hospital disparities experienced by
Aboriginal and Torres Strait Islander people admitted for Acute Coronary Syndrome
in South Australia
Wendy Keech1, Rosanna Tavella2,3, Katharine Brown*4,5, Chris Zeitz2,3, John Beltrame2,3,
Alex Brown4,5
1 risk, with use in this cohort increasing since the introduction of newer and safer DES.
Heart Foundation (SA), 2Discipline of Medicine, The University of Adelaide, 3Division of
Medicine, The Queen Elizabeth Hospital, 4Wardliparingga Aboriginal Research Unit, South
Australian Health and Medical Research Institute, 5School of Population Health, University of
South Australia, Adelaide, Australia
Introduction: The unacceptable disparity between Aboriginal and non-Aboriginal Aus-
tralians in cardiovascular outcomes is well recognised. Acute coronary syndrome (ACS)
burden is improved with diagnostic coronary angiography and revascularisation during
acute admission. Differences in utilisation of these procedures may contribute to poorer
outcomes amongst Aboriginal Australians.
Objectives: To identify if there was a difference in angiography receipt and subsequent
revascularisation between Aboriginal and non-Aboriginal South Australians presenting to
major metropolitan public hospitals with ACS.
Methods: Admissions to the four major South Australian (SA) public hospitals between
2007-2012 with a principal diagnosis of ACS were sourced from an administrative dataset.
Aboriginal and Torres Strait Islander status, demographics and cardiac procedures were
determined. Logistic regression modelling identified predictors of: coronary angiography;
and, revascularisation in those who receive angiography.
Results: Of the 13,701 admissions identified, 274 (2%) were Aboriginal and Torres Strait
Islander people, who were younger (5311 vs 7014, p<0.001) and more often female
compared to non-Aboriginal people (43% vs 35%, p¼0.009). Unadjusted data showed
angiography was performed in 49% of Aboriginal and Torres Strait Islander patients and
46% of non-Aboriginal patients. In multi-variable logistic regression, Aboriginal and Torres
Strait Islander status was a significant independent predictor of angiography: 40% less
likely to receive angiography compared to non-Aboriginal people (OR 0.61, (0.46-0.81),
p¼0.001), following adjustment for age, past history of coronary heart disease (CHD),
renal failure, heart failure, airways disease, and interaction effects of age and CHD. This
disparity was similar when admissions were analysed in consecutive two-yearly blocks. In
angiography patients, 63% of non-Aboriginal patients proceeded to revascularisation
e2
compared to 66% of Aboriginal and Torres Strait Islander patients. Regression modelling
did not reveal ethnicity as a predictor of revascularisation.
Conclusion: Aboriginal patients admitted to SA public hospitals with an ACS are 40% less
likely to undergo coronary angiography then their non-Aboriginal counterparts when age
and other clinical factors are considered. The reasons for this disparity need to be examined
and mechanisms to ameliorate this difference addressed, as this would improve cardio-
vascular outcomes in these patients.
Disclosure of Interest: None Declared
O008
Use of drug eluting stents (DES) as a function of predicted benefit
Matthew J. Brooks1, Nick Andrianopoulos2, Jeffrey Lefkovits1, Andrew E. Ajani1, David Clark3,
Christopher Reid2, Stephen Duffy4, Angela Brennan2, Martin Sebastian5, Ronen Gurvitch*1
1
Cardiology Department, The Royal Melbourne Hospital, 2Monash University, 3Cardiology
Department, Austin Hospital, 4Cardiology Department, Alfred Hospital, Melbourne, 5Cardiology
Department, Geelong Hospital, Geelong, Australia
Introduction: With the improved safety and efficacy profile of newer generation DES their
use is again on the rise. It remains unclear however if this increase is clinically justified. Given
that DES confer only a modest reduction in target vessel revascularisation (TVR) in patients at
low risk of in stent restenosis, cost considerably more than BMS and necessitate prolonged
dual antiplatelet therapy, routine use in patients at low instent restenosis risk may not be ideal.
Objectives: To determine the pattern of DES use in a large Australian PCI population, and
examine the use of DES as a function of TVR risk.
Methods: We prospectively collected data on 6,937 patients undergoing PCI with a DES at
7 Australian public hospitals from 1st January 2005 to 31st December 2012 and estimated
the 1-year TVR assuming treatment with BMS using a validated prediction model devel-
oped from MassDAC database. This model has been demonstrated to be superior to the
commonly used 3-variable model of diabetes, stent diameter, and stent length in predicting
TVR (c statistic, 0.66 vs 0.60, p < 0.001). TVR risk was categorized into 3 clinically
relevant groups of low (<10%), moderate (10-20%) and high (20%). Use of DES as a
function of pre-procedure predicted benefit was assessed.
Results: In patients eligible for DES (stent size  2.25mm &
4.00mm) a significant
increase in DES use has occurred from 2007 to 2012 (34.1% vs 52.0% p trend < 0.001). A
majority (52.6%) of all DES use occurred in patients at low TVR risk. In the era of newer
generation DES, the proportion of patients who receive DES and who are at low TVR risk
has continued to increase from 47.4% in 2007 to 54.8% in 2012 (p trend < 0.001).
DES use as a function of TVR risk 2005 – 2012
Low Moderate High
Patients, % 3,650 (52.6%) 2,529 (36.5%) 758 (10.9%)
Conclusion: Most DES use occurs in patients who are at low as opposed to high restenosis
Whether this pattern and trend in use is sustainable in todays challenging economic
environment requires further evaluation.
Disclosure of Interest: None Declared
O009
Iron deficiency in a multi-ethnic Asian population with heart failure
Tee Joo Yeo1, Raymond C. C. Wong1, Poh Shuan Daniel Yeo2, David Sim3, Gerard Kui Toh Leong4,
Hean Yee Ong5, Fazlur Jaufeerally*6, Tze Pin Ng7, A. Mark Richards1,8, Carolyn S. P. Lam1
1
National University Heart Centre Singapore, 2Tan Tock Seng Hospital, 3National Heart Centre
Singapore, 4Changi General Hospital, 5Khoo Teck Puat Hospital, 6Singapore General Hospital,
7
National University Health System, 8Cardiovascular Research Institute, SINGAPORE, Singapore
Introduction: Recent heart failure (HF) guidelines emphasize that iron deficiency (ID) is a
common and important therapeutic target in HF. However, it is uncertain if HF itself, or
underlying age-related comorbidities, contribute to iron deficiency. Prior studies did not
include age- or comorbidity- matched controls without HF, and none have examined the
prevalence of iron deficiency in Asian populations.
Objectives: In a multi-ethnic Asian population, we aimed to study the prevalence and de-
terminants of ID in patients with HF, compared to community-based controls without HF.
Methods: Serum ferritin and transferrin saturation (Tsat) were measured in 751 patients
with HF (62.012.2 y, 75.5% men, 64.7% Chinese, 23.9% Malay, 10.2% Indian) and 601
controls (56.910.4 y, 49.8% men, 70.9% Chinese, 21.5% Malay, 7.2% Indian) in the
prospective nation-wide Singapore Heart Failure Outcomes & Phenotypes Study. ID was
defined as ferritin < 100mg/dL or ferritin 100 – 300 mg/dL and Tsat<20%.
Results: ID was present in 39.3% of controls and 61.4% of patients with HF
(p<0.001)(Figure). This difference remained highly significant even after adjusting for age,
sex, body size and comorbidities (OR 3.5, 95% CI 2.5-4.9). Among controls, Indians
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
 (OR 3.7, 95% CI 1.8-7.7 vs Chinese) and younger women (OR for age 0.96, 95% CI 0.94-
0.98; OR for women 5.8, 95% CI 3.7-9.3) were more likely to have ID. Among patients
with HF, independent predictors of ID were Indian race (OR 3.0, 95% CI 1.5-6.0 vs
Chinese), female sex (OR 3.0, 95% CI 1.8-5.1), larger body mass index (OR 1.05, 95% CI
1.01-1.09), and decreased left ventricular ejection fraction (OR 0.97, 95% CI 0.96-0.98).
web 3C=FPO
Conclusion: The majority of Asian patients with HF have ID, which cannot be accounted
for by age or comorbidities alone. The striking predisposition of Indian patients to ID
suggests that ethnicity-specific approaches to iron replacement in HF may be warranted.
Disclosure of Interest: None Declared
O010
The relationship between intrathoracic fat depots, circulating inflammatory
biomarkers and coronary artery disease suggests a local atherogenic effect of the
pericoronary adipose tissue compartment
Pal Maurovich-Horvat*1,2, Kimberly Kallianos2, Leif-Christopher Engel2, Jackie Szymonifka3,
Christopher L. Schlett2,4, Wolfgang Koenig5, Udo Hoffmann2, Quynh A. Truong2
1
MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, SEMMELWEIS
UNIVERSITY, Budapest, Hungary, 2Cardiac MR PET CT Program, Division of Cardiology and
Department of Radiology, Massachusetts General Hospital and Harvard Medical School,
3
Department of Biostatistics, Massachusetts General Hospital, Boston, United States, 4Department of
Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, 5Department
of Internal Medicine II - Cardiology, University of Ulm Medical Center, Ulm, Germany
Introduction: An influence of various thoracic fat depots on development of coronary
artery disease has been suggested. However, the local and systemic relationship of thoracic
adipose tissue depots and coronary atherosclerosis is unclear.
Objectives: To determine the relationship of various thoracic fat depots to the presence
and extent of coronary artery plaques and circulating biomarkers.
Methods: In 342 patients (5211 years, 61% male, body mass index [BMI] 29.15.9 kg/
m2) who coronary computed tomography angiography, we measured the adipose tissue
volume in four thoracic fat depots (pericoronary, epicardial, periaortic, extracardiac),
examined for the presence and extent of coronary plaque and determined the circulating
level of C-reactive protein (CRP), tumor necrosis factor alpha (TNFa), plasminogen acti-
vator inhibitor-1 (PAI-1), monocyte chemoattractant-1 (MCP-1) and adiponectin. Extent of
coronary plaque was classified based on a 17-segment model and stratified into 3 groups:
0 segments, 1-3 segments, >3 segments. Multivariable analyses were adjusted for age,
gender, diabetes, hypertension, dyslipidemia, smoking, BMI, aspirin use, and statin use.
Results: Patients with plaque (n¼169, 49%) had higher volumes of all 4 fat depots as
compared to patients without plaque (all p<0.01), despite similar BMI (p¼0.18).
Extracardiac fat was most strongly correlated with BMI (r¼0.45, p<0.001), while peri-
coronary fat was least (r¼0.21, p<0.001). Only pericoronary fat remained associated with
presence of coronary plaques in adjusted analyses. Inflammatory biomarkers showed a
weak positive correlation with the pericoronary fat depot (all p<0.0001), whereas adi-
ponectin was not associated to this fat compartment (p¼0.60). However, adiponectin
showed a weak negative correlation with all other fat depots (all p<0.001).
Conclusion: Of the thoracic fat depots, pericoronary fat is associated with coronary
atherosclerosis. Its correlation with inflammatory biomarkers but not adiponectin, a marker
of visceral fat, suggests that while systemic inflammation plays a role in the pathogenesis of
coronary atherosclerosis, there are additional local effects that exist.
Disclosure of Interest: P. Maurovich-Horvat Grant/research support from: TÁMOP 4.2.4.
A/-11-1-2012-0001 ‘National Excellence Program’, K. Kallianos: None Declared, L.-C.
Engel: None Declared, J. Szymonifka: None Declared, C. Schlett: None Declared, W.
Koenig: None Declared, U. Hoffmann: None Declared, Q. Truong Grant/research support
from: NIH grant K23HL098370 and L30HL093896
O012
Tavi Karlsruhe (Tavik) – 3 Year Results of A Transapical versus Transfemoral Tavi In
A Real World Population of 1,000 Patients with Severe Aortic Stenosis
Gerhard Schymik*1, Peter Bramlage2, Alexander Würth3, Martin Heimeshoff4, Lothar Pilz5,
Jan S. Schymik6, Rainer Wondraschek1, Armin Luik1, Bernd-Dieter Gonska3, Herbert Posival4,
Claus Schmitt1, Holger Schroefel4
1 with age at operation above 60 years had a hazard ratio of 1.5 (1.1; 2.0). There was no
Cardiology, Municipal Hospital Karlsruhe, Karlsruhe, 2IPPMED, Mahlow, 3Cardiology,
Vincentius Hospital Karlsruhe, 4Cardiac Surgery, Cardiac Surgery Clinic, Karlsruhe, 5Medical
Faculty Mannheim, University Heidelberg, Mannheim, 6Munich Graduate School of Economics,
LMU München, Munich, Germany
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
Introduction: There are two commonly used routes for TAVI and TA is generally perceived
to be associated with increased risk. We aimed to evaluate access-related complications
ORAL ABSTRACTS
between transfemoral (TF) and transapical (TA) transcatheter aortic valve implantation
(TAVI) and to compare survival.
Objectives: Single center registry of 1000 consecutive patients undergoing TA and TF TAVI
between May 2008 and April 2012. TA was performed in 413 patients and TF in 587 patients.
Methods: Both groups were compared using Propensity Score Matching.
Results: Patients with TA access were less often women and less had pulmonary hyper-
tension. Peripheral arterial disease, coronary artery disease, carotid stenosis and recurrent
surgery was more often and patients had a higher logistic EuroSCORE I (24.3% vs. 22.2%;
p<0.006). After Propensity Score Matching of a total of 708 patients baseline characteristics
were comparable. There was no difference in 30 day mortality (7.1%), the rate of MI (2.3%)
or stroke (2.2%), bleeding complications, pacemaker implantation rates or moderate aortic
insufficiency. Stage 1 renal complications were less common in TF patients (OR0.36; 95%
CI 0.24-0.52) while major vascular complications remained elevated (OR7.20; 95%CI
3.50-14.81). Survival probability over more than 3 years was virtually identical in either
group (Log-Rank-Test p¼0.5335).
web 3C=FPO
Conclusion: There was no incremental mortality risk using either TA or TF. Major vascular
complications were more common in patients with TF and stage 1 acute renal complica-
tions in those with TA. The data demonstrate that in an experienced multidisciplinary heart
team either access route can be safely performed and recommended.
Disclosure of Interest: G. Schymik Consultancy for: Edwards Lifesciences, Honorarium
from: Edwards Lifesciences, Speakers bureau: Edwards Lifesciences, Medtronic, P. Bram-
lage Grant/research support from: Edwards Lifesciences, Consultancy for: Edwards Life-
sciences, A. Würth: None Declared, M. Heimeshoff: None Declared, L. Pilz: None Declared,
J. Schymik: None Declared, R. Wondraschek: None Declared, A. Luik: None Declared, B.-
D. Gonska: None Declared, H. Posival: None Declared, C. Schmitt: None Declared, H.
Schroefel Consultancy for: Edwards Lifesciences, Symetis SA, Honorarium from: Edwards
Lifesciences, Symetis SA, Philips, Speakers bureau: Edwards Lifesciences, Symetis SA,
Philips
O013
Long term mortality in adult patients with atrial septal defect
Camilla Nyboe*1, Vibeke E. Hjortdal1
1
Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
Introduction: Long-term survival of patients with atrial septal defects is still believed to be
reduced –especially in patients without closure or closure of their defect late in life.
Objectives: In this nationwide cohort study we describe the mortality in patients with
closed or medically treated atrial septal defects diagnosed in adulthood compared with the
background population.
Methods: Patients registered in Denmark between 1977 and 2009 with an ASD were
included. Exclusions: present age <18 yrs., other congenital heart disease, PFO and diagnose
before the age of 18 years and birth outside Denmark. Controls: 10 persons from the Danish
Civil Registration per patient matched on sex and age. Data from the Danish National
Patient Registry was used. All included patients hospital records were validated to secure
correct diagnosis and treatment. Mortality after closure was registered as 30 days mortality
and long-term mortality defined as death occurring more than 30 days after the closure
procedure.
Results: Patients with closure of their defect (n¼960) had a 30 day mortality of 0.5% and
an increased > 30 day mortality compared to healthy controls with a hazard ratio of 1.7
(1.4; 2.0). Patients operated between the age of 18 and 39 years had a hazard ratio of 1.7
(1.5; 2.7), those operated between 40 and 59 had a hazard ratio of 1.9 (1.5; 2.5) and those
significant difference between these hazard ratios. Patients without closure (n¼307) also
had an increased mortality with a hazard ratio of 3.1 (2.6; 3.8) compared to the healthy
controls. By excluding those with pulmonary arterial hypertension and Eisenmenger
Syndrome (n¼79) the risk was reduced to 2.6 (2.1; 3.3).
e3
 Conclusion: Adult patients with ASD have an increased mortality compared to healthy
controls. The risk does not change with age at operation. Those without closure of an ASD
ORAL ABSTRACTS
have a significantly higher mortality compared to those with closure. Even adult patients with
ASDs that are considered hemodynamically un-important seem to carry an increased mortality
risk.
Disclosure of Interest: None Declared
O014
Can E/e’ by Echocardiography Differentiate Patients with Group 1 from Group 2
Pulmonary Hypertension?
Tim Roberts*1,2, Andre La Gerche1,2, Stuart Murch1, Andrew MacIsaac1,2, David Prior1,2,
Andrew Burns1,2
1
Cardiac Investigation Unit, St Vincent’s Hospital, 2Department of Medicine, University of
Melbourne, Melbourne, Australia
Introduction: Differentiating pre-capillary from post-capillary pulmonary hypertension
(PH) is essential for its classification and treatment, requiring evaluation with right heart
catheterisation (RHC). Whilst pulmonary artery systolic pressure can be estimated non-
invasively by transthoracic echocardiography, the accuracy of E/e’ in PH patients to di-
agnose elevated left sided filling pressures is less certain.
Objectives: To study the relationship between non-invasive and invasive measurements of
left sided filling pressure in a series of patients referred for RHC.
Methods: Breathless patients with suspected PH undergoing RHC between 2006 and
2013 were included if a TTE was performed immediately before or during RHC.
Echocardiographic measurements of peak early mitral inflow velocity (E) and septal
peak early mitral annular velocity (e’) were made by standard methods. Invasive
measurements were recorded using a Swan-Ganz catheter. PH was defined as an
invasive mean pulmonary artery pressure (mPAP) 25 mmHg. The accuracy, specificity
and sensitivity of E/e’ in predicting an elevated pulmonary arterial wedge pressure
(PAWP) – defined as >15 mmHg – was assessed using receiver operator characteristic
curves.
Results: Thirty-three patients (average age 60  11 years, 82 % female, average BMI
28.2  5.4) were included. Underlying diagnoses included 18 scleroderma, 9 heart
failure with preserved ejection fraction, 2 mitral valve disease, 2 interstitial lung disease,
1 mixed connective tissue disease, and 1 normal subject. Seventeen patients had PH
(mPAP 30.8  7.0 mmHg, PAWP 16.6  5.5 mmHg, E/e’ 17.3  7.5) and 16 did not
(mPAP 16.4  3.6 mmHg, PAWP 7  2.9 mmHg, E/e’ 11.1  3.0). In total there was
a modest correlation between E/e’ and PAWP (r ¼ 0.64, p<0.0001 – see Figure 1). In
those without PH, none had PAWP
15 and this was accurately predicted by an E/e’

15 (specificity 94 %). However, in those with PH the specificity was less and the
sensitivity for identifying those with PAWP >15 mmHg was also only modest (see
Table 1).
web 3C=FPO
Conclusion: We observed a moderate overall correlation between non-invasive and
invasive markers of elevated left sided filling pressures, however the specificity and accu-
racy in the PH group was reduced. This data suggests that in PH patients, non-invasive
surrogates of raised left heart pressures cannot be accurately relied upon and that invasive
RHC remains the definitive means of identifying and ruling out PH associated with left
heart disease.
Disclosure of Interest: None Declared
e4
O015
Diastolic function as a predictive marker of left ventricular myocardial scar size,
function and early remodelling in PCI treated acute ST elevation myocardial
infarction
Tuan L. Nguyen*1,2, Justin Phan1,2, Jarred Hogan2, Daniel Moses2,3, Hany Dimitri1,2,
Rohan Rajaratnam1,2,4, Craig Juergens1,2, John French1,2, David Richards1,2, Liza Thomas1,2
1
Department of Cardiology, Liverpool Hospital, Liverpool, 2University of New South Wales,
Sydney, 3Department of Radiology, Liverpool Hospital, Liverpool, 4University of Western Sydney,
Sydney, Australia
Introduction: Left ventricular (LV) ejection fraction (LVEF), increased LV end systolic
(LVESV) and end diastolic volumes (LVEDV) are well described predictors of adverse
cardiovascular events post acute myocardial infarction (AMI).
Objectives: The purpose of this study was to evaluate the relationship of diastolic
dysfunction grade with MI scar size, LV systolic function and early LV remodelling.
Methods: The study enrolled patients presenting with acute STEMI, treated with percu-
taneous coronary intervention. Cardiac magnetic resonance imaging (CMRI) and trans-
thoracic echocardiograms (TTE) were performed at 5.03.3 days (baseline) and 62.114.9
days (follow up) post STEMI. LV volumes and LVEF were measured by TTE and CMRI.
TTE LV diastolic parameters were determined: function grade (0¼normal; 1¼impaired
relaxation; 2¼pseudonormal; and 3¼restrictive filling); E/E’ ratio, E/A ratio, A wave
duration and deceleration times. MI scar size was calculated using planimetry on delayed
gadolinium enhancement images.
Results: We prospectively recruited 101 consecutive patients (mean age 5610 years; 90%
males). 15.8% had diabetes mellitus; 85% were first presentations of MI, with CMRI LVEF
44.69.6% (baseline); and 48.011% (follow up). At baseline study, initial diastolic grade
correlated negatively with CMRI LVEF (R¼ -0.37, p<0.001) and TTE LVEF (R¼ -0.30;
p¼0.002);) and positively with LV scar percentage (R¼0.24; p¼0.015) and LV scar volume
(R¼0.25; p¼0.013), but not with LV volumes. During the follow up study, diastolic grade
correlated positively with CMRI LVESV (R¼0.28; p¼0.005)/ TTE LVESV (R¼0.21;
p¼0.03), negatively with CMRI LVEF (R¼ -0.45; p<0.001)/ TTE LVEF (R¼ -0.41;
p<0.001), and positively with LV scar size percentage (R¼0.35; p<0.001)/scar volume
(R¼0.31; p¼0.002). For patients who had worsening of their diastolic grade, between
baseline and follow up studies, this correlated with lower CMRI/TTE LVEF (R¼ -0.23;
P¼0.023 and R¼ -0.26; P¼0.009) and larger LV scar percentage (R¼0.22; P¼0.028) at
follow up.
Conclusion: Diastolic dysfunction, at follow up, correlated with lower LVEF, larger MI scar
size and early negative LV remodelling changes. Diastolic dysfunction may contribute
further useful information, in addition to LVEF and scar size, to help further stratify ‘high
risk’ patients post AMI.
Disclosure of Interest: None Declared
O016
AliveCor Heart Monitoring: Is it a practical alternative to a traditional ECG monitor
for a developing nation?
Caroline A. Volgman*1, Stephanie Wang2, Devin Mehta3, Noreen Nazir4, Sarah Alexander4,
Kousik Krishnan4, Richard Trohman4, Annabelle S. Volgman4
1
Latin School of Chicago, 2Rush Global Health Program, 3Internal Medicine, 4Cardiology, RUSH
UNIVERSITY MEDICAL CENTER, Chicago, United States
Introduction: The Dominican Republic (DR) is considered to be a developing nation with
35% of its population living in extreme poverty. Nevertheless, DR mobile phone teledensity
(subscriptions/capita) is approximately 91%. The AliveCor Heart Monitor (AC) is a device
that can function as an alternative to a traditional ECG monitor. It is a plastic iPhone case
with electrodes that transmit electrocardiographic data to an application that produces an
interpretable rhythm. In addition, AC has the capability to send the strips using the iPhone.
Objectives: We assessed the ease of use and the quality of the AC during a trip to a DR
mountain town, Peralta, where time available to see patients (pts) is usually <15 minutes
and there is limited communication through landlines or faxes.
Methods: Thirty-seven pts were asked to record their heart rhythm. This required pts to
hold the iPhone for 30 secs. Rhythm strips were stored in an iPhone. The recorded strips
were downloaded for evaluation by 5 doctors (2 electrophysiologists, 2 cardiology fellows
and a medical resident). Each doctor was asked to evaluate the strips for clarity and
interpretability. The scales used for evaluation were as follows: For baseline sway/artifact
0¼none, 1¼ trivial, 2¼ minor, 3¼ moderate, 4¼significant but still interpretable and 5¼
severe and uninterpretable. For p-waves 0¼ not visible, 1¼ possibly visible, but obscured
by sway or artifact, 2¼ intermittent, 3¼ small, but discernible, 4¼ nearly always clear and
Table 1. Average and SD scores of rhythm strips recordings by all physician readers
Baseline Artifact p waves Overall
Reader sway (0-5) (0-5) (0-5) Quality (0-5)
Electrophysiologist 1 0.8 0.7 3.7 3.9
Electrophysiologist 2 2.1 2.1 2.5 3
Fellow 1 1 0.7 2.9 4
Fellow 2 0.8 1.1 3.6 3.9
Medical resident 1.4 1.3 3 2.8
Average  S.D. 1.2  0.5 1.2  0.6 3.1  0.5 3.5  0.6
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
 present, and 5¼ uniformly present and clear. For overall quality -¼unacceptable, 1¼ barely
acceptable, 2¼ acceptable, but below expectations 3¼ acceptable meets expectations, 4¼
exceeds expectations, 5¼ outstanding.
Results:
web 3C=FPO
Conclusion: 1) The AC was easy to use and instructions were readily explained to indigent
pts in a busy clinical setting. 2) Baseline sway and artifact were considered trivial. 3) P-waves
and overall quality were rated from acceptable to exceeding expectations, and tracings were
easily interpreted by physicians with various levels of experience. 4) The AC provided quick,
accurate assessment of cardiac rhythm in a remote area without land telecommunications.
Disclosure of Interest: None Declared
O017
Beneficial Effects Of Renal Sympathetic Denervation On Pulmonary Vascular
Remodeling And Right Ventricular Function In Experimental Pulmonary Artery
Hypertension
Qingyan Zhao*, xuejun jiang, zixuan dai, xiaozhan wang, zongwen guo, xule wang,
congxin huang
renmin hoapital of wuhan university, wuhan, China
Introduction: The sympathetic nervous system and RAAS have been reported to be acti-
vated and leading to deterioration in PAH.
Objectives: We hypothesis that renal sympathetic denervation (RSD) decrease renin-
angiotensin-aldosterone system (RAAS) activity and inhibit the progression in pulmonary
arterial hypertension (PAH).
Methods: Nineteen beagles were randomized into control (n¼6), PAH (n¼7) and
PAHþRSD (n¼6) groups. Animals underwent percutaneous pulmonary artery catheteri-
zation to measure pulmonary hemodynamics before and 8 weeks after injection of 0.1 ml/
kg dimethylformamide (Control dogs) or 2 mg/kg dehydromonocrotaline (PAH and
PAHþRSD dogs). The dogs in the PAHþRSD group received renal artery ablation after
injection. Eight weeks after injection, levels of Angiotensin II (Ang II) and pulmonary tissue
morphology were measured.
Results: The levels of Ang II in plasma and AngII type 1 receptor expression (1.020.11 vs
0.390.04, 0.380.05; P <0.01) in pulmonary arterial tissue were significantly increased
in PAH group compared with control and PAHþRSD groups. Dehydromonocrotaline
increased mean pulmonary arterial pressure (16  3.4 mmHg vs. 33  7.3 mmHg, P
<0 .01), and this increase was prevented by RSD (14  3.6 mmHg vs. 17  3.9 mmHg,
P¼0.19). Pulmonary smooth muscle cell proliferation were less in the PAHþRSD group
than in the PAH group. Right ventricular end-diastolic diameter was significantly larger in
the PAH group compared with the PAHþRSD group.
Conclusion: RSD suppressed the pulmonary vascular remodeling and decrease the pul-
monary arterial pressure in experimental PAH.
Disclosure of Interest: None Declared
O018
Intradialytic hypertension in end-stage renal disease patients treated by maintenance
hemodialysis – a dynamic analysis
Adrian G. Tase*1, Claudiu Neacsu2, Valentina Georgescu3, Iuliana Ciocanea3, Anca Seica3,
Paul Gusbeth-Tatomir3
1
Cardiology, University of Pitesti, Emergency Hospital Pitesti, 2Nephrology, Emergency Hospital
Pitesti, 3Dialysis, Fresenius Nephrocare Center, Pitesti, Romania
Introduction: Intradialytic hypertension (IH) has been recently associated with increased
morbidity and mortality in patients (pts) treated by conventional maintenance hemodialysis
(HD). However, the characteristics of IH are currently less well described, although volume
overload, hormonal and sympathetic activation, endothelial cell dysfunction, drug removal,
and electrolyte imbalances have been proposed as culprits.
Objectives: The goal of this study was to determine the dynamics of blood pressure (BP)
related to biochemical values in this population.
Methods: All clinically stable pts from our dialysis center, on HD for at least 3 months and
with valid body composition monitoring (BCM) were included. We recorded BP at
entrance, hourly BP, and BP at the end of the HD session for 6 consecutive sessions. IH has
been defined as an systolic BP increase of 10 mmHg from pre- to post-HD. Pts- and
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
dialysis-related parameters were recorded. We also noted actual dry body weight (DBW)
and “ideal” body weight (G0) as derived from BCM.
ORAL ABSTRACTS
Results: We analyzed 139 pts (M/F ratio 84/55, mean age 56.6 12.6 yrs, dialysis vintage
60.2 54.1 mo, 10.8% diabetics). Mean blood flow (BF) was 343 55.7 mL/min, mean
dialysate flow (DF) was 603.6 122.3 mL/min, dialysate sodium (dNa) was 135.91.2
mmol/l, mean dialysate bicarbonate (dBic) 30.816.2 mmol/l. Within this group of pts,
100 pts (71.9%) were using antihypertensive medication at home (1 drug 29%, 2 drugs
37%, 3 - 21%, 4 or more 13%). Mean pre-dialysis systolic BP (sBP) was 143.619.7
mmHg, and post-dialysis sBP was 142.519.2 mmHg. 22.5% pts had some degree of IH,
whereas 2.3% had severe IH (arbitrarily defined as 20 mmHg increase of 6-sessions mean
sBP post versus pre-HD). Moreover, 36% pts experienced at least one session with a
postHD peak of 20mmHg. 42.4% pts needed intradialytic antihypertensive medication
for at least 2 sessions. The t-test did not find any differences between pts with and without
IH in respect of BF, DF, ultrafiltration volume, dBic and pts characteristics. Pts with IH had
a lower mean dNa by 0.6 mmol/l (t¼ -2.5, p<0.01). There were no differences between pts
with and, respectively, without IH regarding the pre- and post-HD hydration status as
determined by BCM.
Conclusion: IH is frequent and might be clinically important in many HD pts. Solely lower
dialysate sodium appears to be a significant contributor to IH in this study population. This
finding warrants for further prospective investigation.
Disclosure of Interest: None Declared
O019
Evaluation of Lesion Characteristics and Thermodynamics for Symplicity and
EnligHTN Renal Denervation Systems Using a Thermochromic Liquid Crystal Model
Sara Al Raisi*, Jim Pouliopoulos, Tony Barry, Aravinda Thiagalingam, Stuart Thomas,
Gopal Sivagangabalan, Clara Chow, James Chong, Eddy Kizana, Pramesh Kovoor
Cardiology, WESTMEAD HOSPITAL/ UNIVERSITY OF SYDNEY, Sydney, Australia
Introduction: Radiofrequency renal artery denervation is used to treat resistant hyper-
tension. The two widely utilized systems are Symplicity and EnligHTN. However, lesion and
thermodynamic characteristics for each platform have not been previously described.
Objectives: We aimed to assess lesion dimensions and ablation characteristics for Sym-
plicity and EnligHTN renal denervation systems using current recommended clinical
parameters.
Methods: A total of 39 ablations were performed on a phantom renal artery model using
Symplicity (n¼17) and EnligHTN (n¼22). The phantom model was constructed with a
block of hollowed gel surrounding a vertical disc of thermochromic liquid crystal (TLC)
film, with a temperature sensitivity between 50-78 C. Renal artery flow, at 500ml/min, was
simulated using saline with impedance equal to blood at 37 C. Radiofrequency ablations
for duration of 120sec and 90sec for Symplicity and EnligHTN respectively were delivered,
with optimal contact between electrode tip and gel interface. Lesion size was defined as a
TLC zone with temperature rise of  51 C.
Results: Mean lesion depth was 3.815mm  0.04 versus 3.440mm  0.03 (p-value
<0.001) for Symplicity and EnligHTN respectively. Mean width was 7.17mm  0.08 versus
6.23mm  0.07 (p-value < 0.001), respectively. Mean ablation power was 6.23W  0.7
versus 5.18W  0.5 (p-value ¼ 0.26) for Symplicity and EnligHTN respectively. With
EnligHTN, steady state temperature was achieved 20 seconds earlier, and was 150C higher
than Symplicity.
web 3C=FPO
Conclusion: In thermochromic liquid crystal model, Symplicity formed larger lesions
compared to EnligHTN with lower catheter temperature. The difference in lesion size could
partially be attributed to ablation duration. The clinical significance of our findings needs to
be further explored.
Disclosure of Interest: None Declared
O020
Novel role for the large-conductance Ca2+-activated K+ channel (BKCa) as a
determinant of cardiac function
Vesna Nikolova-Krstevski*1, Arie Jacoby1, Inken Martin1, Gunjan Trivedi1, Halina Dobrzynski2,
Diane Fatkin1
1
Molecular Cardiology, Victor Chang Cardiac Research Institute, Sydney, Australia,
2
Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
e5
 Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major
cause of heart failure and thromboembolic stroke. Genetic factors contribute to the path-
ORAL ABSTRACTS
ogenesis of AF, but the causative variants and the underlying molecular mechanisms are
incompletely understood. The first familial AF locus was mapped to a region on chro-
mosome 10 (10q22-q24), but to date, no disease-causing genes have been identified. The
KCNMA1 gene that encodes the a-subunit of the large conductance Ca2+-activated K+
channel BKCa is positioned within this locus, but its potential role as a candidate gene is
limited by the paucity of data regarding its role in normal cardiac function.
Objectives: The objective of this study was to characterise BKCa channel distribution in
human tissue and to determine the functional effects of BKCa deficiency in BKCa knockout
zebrafish.
Methods: Immunofluorescence and immunogold labelling with electron microscopy
studies were performed to assess BKCa distribution in human tissue biopsies. Quantitative
RT-PCR analysis of the KCNMA1 mRNA and Western blots were used to identify BKCa
isoforms present in the human atrium. Translation-blocking morpholinos were used for
generation of BKCa knockout zebrafish that were subjected to cardiophysiological evaluation.
Results: BKCa is abundantly expressed in the sinoatrial node and in atrial and ventricular
myocytes. In the atrial tissue specifically, BKCa was localised to the sarcoplasmic reticulum,
mitochondria, nucleus and cell membrane. A number of different BKCa isoforms were
identified in atrial tissue ranging in size from 50-110 kDa. Altered levels of expression of
these isoforms were observed in the atrial tissue from patients with AF. Expression patterns
of the zebrafish orthologs of KCNMA1, kcnma1a and kcnma1b, were evaluated in 72 hpf fish.
Both genes were expressed in the heart. Knockdown of the kcnma1b gene resulted in cardiac
abnormalities in 84% of embryos. Zebrafish morphants showed decreased heart rate (123 vs
140 beats/min compared with controls), increase in atrial end-diastolic diameter (108 vs 79
mm) and mild ventricular dysfunction (reduced fractional shortening: 18% vs 30%).
Conclusion: BKCa has diverse subcellular localisation and isoforms in the human atrium
and morpholino zebrafish knockout of the KCNMA1 gene results in a predominant atrial
phenotype with bradycardia and atrial dilatation. Our data highlights an unrecognised role
for BKCa in cardiac function and supports KCNMA1 as a promising candidate gene for AF.
Disclosure of Interest: None Declared
O021
Ventricular tachycardia reentrant circuits arise early after myocardial infarction and
are amenable to cure with radiofrequency ablation: Validation in a chronic ovine
model
Calvin H. C. Hsieh*, Ee-May Chia, Kaimin Huang, Jim Pouliopoulos, Juntang Lu, Michael Barry,
David L. Ross, Stuart Thomas, Pramesh Kovoor
Cardiology, Westmead Hospital, Sydney, Australia
Introduction: Ventricular tachycardia (VT) accounts for the majority of sudden deaths
following myocardial infarction (MI).
It is accepted that VT develops late after MI. Implantation of a defibrillator (ICD) within
40 days post-MI has not been of value unless based on programmed ventricular stimulation
(PVS). Early post-MI PVS studies have suggested early development of the VT arrhyth-
mogenic substrate. Also, post-MI VT is considered not amenable to cure with radio-
frequency ablation (RFA), thus requiring life-long palliative ICD therapy.
Objectives: To determine that the:
1. Macro-reentrant circuit and substrate of VT develop within 8 days post-MI
2. Post-MI day-8 RFA can abolish or diminish post-MI VT
Methods:
1. Experiment 1. MI was induced in 36 sheep. In 21 survivors, serial electro-
anatomical mapping was performed pre-infarct and days 3, 8 and 100 post-MI and
PVS at days 8 and 100.
2. Experiment 2. MI was induced in 35 sheep. In 25 survivors, RFA was performed if VT
was induced day-8. All animals were followed by repeat PVS day-100 and day-200.
Results:
1. Experiment 1. 9/21 and 12/21 were VT inducible and non-inducible respectively
on both day-8 and day-100. Earliest endocardial activation, and other character-
istics of VT were similar between days. There was no statistical difference in
substrate (low voltage, or slowed conduction velocity) between days 3 to 100, but
there was continued increase in electrogram fractionation with time.
2. Experiment 2. Of the 25 survivors, 12 had inducible VT at day-8. There was 100%
success with day-8 RFA in VT inducible animals. One animal was euthanized for
non-arrhythmic reasons. Remaining 11 ablated and 13/25 non-inducible animals
remained arrhythmia-free on PVS day-100 and day-200 (p<0.001). There was a
sustained decrease in split (p¼0.013), late (p<0.001) and fractionated (p¼0.006)
electrograms within the left ventricular endocardium at day-100 and day-200
compared to day-8 following RFA.
Conclusion:
1. Experiment 1. The stability of VT characteristics and substrate between days 8 to
100 suggest development of VT prior to day-8 post-MI, supporting the role of early
PVS for risk stratification post-MI, and raising the potential for early intervention
with RFA.
2. Experiment 2. Day 8 RFA resulted in high acute and chronic success suggesting
cure of post-MI VT. If confirmed in human studies, this could revolutionise the
management of post-MI VT with early curative RFA rather than life-long palliative
ICD implantation.
Disclosure of Interest: None Declared
e6
O022
Striking Differences In The Role of Distinct Endothelial Progenitor Cell Populations
In Ischaemia-Mediated Neovascularisation And Coronary Collateral Formation -
Implications On Therapeutic Angiogenesis
Sui Ching G. Yuen*1,2, Kim H. Chan1,2,3, Philippa Simpson1, Zoe Clayton1,2,
Ashanti Dantanarayana1, Laura Lecce1,2, Louise Dunn4, Andy Yong2,5, Chi-Jen Hsu1,2,3,
Matt Guillou1, Shisan Bao6, Chirapan Chawantanpipat3, David Celermajer2,3,7, Joseph Wu8,
Martin Ng1,2,3
1
Translational Research Group, Heart Research Institute, Newtown, 2Sydney Medical School,
University of Sydney, 3Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
4
Vascular Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, 5Department
of Cardiology, Concord Repatriation General Hospital, 6School of Medical Sciences, University of
Sydney, Sydney, 7Clinical Research Group, Heart Research Institute, Newtown, Australia,
8
Department of Medicine & Radiology, Stanford Cardiovascular Institute, Stanford, United States
Introduction: Endothelial progenitor cells (EPCs) are implicated in angiogenesis. However,
the use of EPCs in clinical trials has had underwhelming and contradictory results, possibly
due to the use of unselected cell populations. Two distinct EPC populations (early EPCs
and late-outgrowth endothelial cells, OECs) have been found to exhibit different angiogenic
properties in vitro but have rarely been compared in vivo.
Objectives: To compare properties of two distinct EPC populations in murine models and
patients with coronary artery disease (CAD).
Methods: EPCs were assessed in preclinical studies using two murine hindlimb ischaemia
models: 1)in vivo tracking of EPCs from transgenic L2G mice (expressing FLuc) trans-
planted into syngeneic mice by bioluminescent imaging (BLI); 2)xenotransplantation of
human EPCs into nude mice. In patients with isolated left anterior descending artery
disease we evaluated the relationship between EPCs and the extent of coronary collater-
alisation (invasively assessed by collateral flow index, CFI).
Results: Assessment of the in vivo biokinetics of intravenously transplanted L2G OECs and
early EPCs using BLI showed comparable homing to ischaemic sites on days 2-4. BLI showed
that OECs and early EPCs exhibit similar cell survival in ischaemic tissue (EarlyEPC vs OEC
BLI, p0.42) with some cell survival 6 weeks. Nevertheless, in intravenous and intramus-
cular EPC transplantation studies, OECs were superior to early EPCs for enhancement of
perfusion recovery (0.500.04vs0.390.06,p<0.01 and 0.650.05vs0.350.04,p<0.0001
respectively) and ischaemia-induced angiogenesis, showing 36% increase in capillary den-
sity (13816vs919 and 12917vs9511,p>0.05 respectively). Similar findings were
observed in the xenotransplantation model (0.300.02vs0.210.02,p<0.05). In patients
with CAD (n¼26,age¼6310,male¼81%) there was a positive correlation between the extent
of coronary collateralisation and OEC numbers (r¼0.405,p¼0.045), migration
(r¼0.578,p¼0.006) and tubulogenesis (r¼0.65,p¼0.005). Patients with adequatevsinade-
quate collateralisation (CFI0.25vs<0.25) had better OEC characteristics (p<0.02). No
correlation was found with early EPCs.
Conclusion: Despite similarities in cell homing and survival, OECs are markedly superior
to early EPCs for improvement of ischaemia-mediated neovascularisation. Furthermore,
adequate coronary collateralisation in CAD is associated with enhanced OEC but not early
EPC characteristics. Selection for OECs may enhance cell therapies for augmentation of
angiogenesis.
Disclosure of Interest: None Declared
O023
Does transtelephonic electrocardiography improve in-hospital mortality rate of
patients with acute coronary syndrome?
Gyorgy Papai1, Daniel Czuriga2, Ildiko Racz2, Gabor T. Szabo*2, Istvan Edes2
1
Hungarian National Ambulance Service, 2Institute of Cardiology, University of Debrecen,
Medical and Health Science Center, Debrecen, Hungary
Introduction: The transtelephonic electrocardiography (TTECG) system is a fast and
convenient tool for transmission of locally recorded ECG, as well as for patient referral to
relatively remote cardiac centers.
Objectives: We examined the efficacy of the TTECG system in the management of ST
segment elevation myocardial infarction (STEMI) with regard to the ambulance service
contact and transport times, percutaneous coronary intervention (PCI)-related delay times,
prehospital medical therapy and in-hospital mortality rate.
Methods: The study was conducted between January 1, 2009 and December 31, 2010 in
the north-eastern region of Hungary (approximately 1.5 million residents) as a collaborative
effort between the University of Debrecen, Hungary and the Hungarian National Ambu-
lance Service. Altogether 776 patients were recruited in our study. The TTECG group
comprised 397 patients, while 379 patients transported to the PCI center without TTECG
served as controls.
Results: Significantly more patients received sodium heparin (84.3% vs. 59.1% in TTECG
and Control groups, respectively; p<0.0001) and narcotics (56.99% vs. 13.76% in TTECG
and Control groups, respectively; p¼<0.0001) in the TTECG group than among controls.
The PCI-related delay times revealed that the door to sheath insertion and door to balloon
times were both significantly shorter for the TTECG group than for controls. In addition,
the in-hospital mortality rate was significantly lower in the TTECG group compared to
controls (4.28% vs. 8.44% in TTECG and Control groups, respectively; p¼0.0350).
Conclusion: The findings clearly illustrate the value of TTECG in the regional management
of STEMI patients, with significant shortening of the PCI-related delay times and im-
provements of the prehospital medical therapy and in-hospital mortality rate.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O024
Public knowledge of heart attack symptoms and prevalence of self reported
cardiovascular risk factors in Ilorin, Nigeria
Philip M. Kolo*1, James A. Ogunmodede1, Halima S. bello2, Maruf S. gbadamosi2,
Bolade F. Deleojo2, Ibrahim A. Katibi1, ayodele B. Omotoso1
1 (LVAWd 0.770.05 mm vs 0.990.04 mm and HW/BW 0.450.01 vs 0.640.06); 2)
Department of Medicine, University of Ilorin, Nigeria, UNIVERSITY OF ILORIN, NIGERIA,
2 upregulation of fetal genes ANP, BNP and b-MHC; 3) 3-fold increase in fibrosis around
Department of Medicine, University of Ilorin, Nigeria, UNIVERSITY OF ILORIN TEACHING
HOSPITAL, NIGERIA, Ilorin, Nigeria
Introduction: The level of public knowledge of cardinal symptoms of heart attack corre-
lates with the speed the individuals seek medical attention if they experience heart attack.
Early thrombolysis or reperfusion improves the outcome of patients with acute coronary
syndromes.
Objectives: This study aimed at evaluating knowledge of heart attack and prevalence of self
reported cardiovascular diseases among public servants in Ilorin, Nigeria
Methods: A pretested structured questionnaire designed for the purpose of this study was
administered to study participants in Ilorin. Information on the ability of participants to
identify chore symptom of heart attack such as chest pain or discomfort was obtained.
Respondent perception of heart attack symptoms and actions to be taken if the individual
or a close relative is affected by the condition were elicited
Results: Six hundred and one subjects consisting of 312 (51.9%) males and 289 (48.1%)
females were interviewed; and their mean age was 31.4 11.1 years. The mean age of the
male participants was similar to that of the females (p¼0.7). Although, 78% of the re-
spondents have heard about heart attack, only 44.4% could discriminate heart attack from
other conditions. Similarly, knowledge of heart attack was higher in participants who were
40 years and older (48.3%) than those younger than 40 years (42.9%) of age. Higher
proportion of women (50.2%) than men (39.1%) could identify a core symptom of heart
attack. However, women reported higher prevalence of hypertension, diabetes, dyslipi-
daemia, obesity, stroke and probable heart attacks than men. On the other hand, cigarette
smoking was fourfold more common in males than females.
Conclusion: There was low knowledge of heart attack symptoms among the participants
studied. Women were more knowledgeable about symptoms of heart attack than males but
the former reported a higher prevalence of cardiovascular diseases than the latter. There is
need for public education on symptoms of the disease in Nigeria and importance of seeking
urgent medical attention in affected persons.
Disclosure of Interest: None Declared
O025
Exposure to secondhand smoke and risk of peripheral arterial disease in Southern
Chinese non-smokers: The Guangzhou Biobank Cohort Study-Cardiovascular
Disease Subcohort
Liya Lu*
Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
Introduction: Active smoking is an established risk factor for peripheral arterial disease
(PAD) but few studies have examined the association with secondhand smoke (SHS).
Objectives: The aim of this study was to examine the association between SHS exposure
and PAD among Chinese non-smokers.
Methods: We conducted a cross-sectional study using baseline data from the Cardiovas-
cular Disease Sub-cohort Study; a sub-group of the Guangzhou Biobank Cohort Study
(GBCS-CVD). Guangzhou residents aged 50 years were recruited between 2003 and
2008. Baseline data collection included measurement of ankle brachial pressure index
(ABPI) and self-reported smoking status and SHS exposure. Univariate and multivariate
logistic regression analyses were used to analyse the association between SHS and PAD
(defined as ABPI<0.9).
Results: Of the 1,507 non-smokers, 24 (1.6%) had PAD. Exposure to SHS at home of 25
hours per week, was reported by 16.7% of individuals with PAD compared with only 3.8%
of those without PAD (c2 test, p¼0.016). After adjustment for potential confounders,
exposure to 25 hours per week at home was still associated with PAD (adjusted OR 7.96,
95% CI 2.09-30.34, p¼0.002). There was suggestion of a linear dose relationship among
those exposed at home.
Conclusion: As with coronary heart disease and stroke, SHS exposure is an independent
risk factor for PAD in China. Continued enforcement of smoke-free legislation is needed to
protect the general public from exposure.
Disclosure of Interest: None Declared
O026
Cardiomyocytes Secreted Mir-378 Is An Essential Regulator of Cardiac Hypertrophy
And Cardiac Fibrosis Under Pressure Overload
1 1 1 2 1 1
Jie Yuan* , Chaoneng Wu , Yong Ye , Zhiwen Ding , Xiaoyi Zhang , Gui Gong , Yunzeng Zou
1
Shanghai Institute of Cardivascular Diseases, Zhongshan Hosptial, 2Institutes of Biomedical
Sciences, Fudan University, Shanghai, China
Introduction: Recent studies showed that microRNAs play essential roles in cardiovascular
diseases.We found that miR-378 has a high expression pattern in the heart. Its level was
markedly down-regulated in pressure overload-induced hypertrophic heart but was
increased in circulation.
Objectives: We hypothesized that miR-378 would be a critical regulator inpressure
overload-induced cardiac remodeling.
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
Methods: To investigate its roles, we constructedcardiac remodeling models by TAC in
C57B/L6 mice. Chemicallymodified oligonucleotides miRNA mimics (miR-378-Agomir)
ORAL ABSTRACTS
and inhibitors (miR-378-Antagomir) treatment started 24h after TAC by intravenous in-
jections on two consecutive days (n¼8/group). After two-week acute pressure overload, we
examined left ventricular (LV) remodeling.
Results: Comparing to sham, TAC group exhibited significant (p<0.05): 1) hypertrophy
blood vessels; 4) upregulation of protein col I, col III, MMP9. However, compared to TAC
group, TAC-Agomir group had significant (p<0.05): 1) suppression of hypertrophy
(LVAWd 0.800.07mm and HW/BW 0.570.01); 2) downregulation of fetal genes; 3)
alleviation of fibrosis. In contrast, miR-378-Antagomirgroup caused sustained cardiac
hypertrophyand fibrosis, associated with a reinduction of fetal gene expression and
collagen generation. Moreover, we found that miR-378 was only expressed in car-
diomyocytes but not in cardiac fibroblasts. In primary cultures of caridomyoctyes, over-
expression of miR-378 by transfecting miR-378 mimics can effectively prevent mechanic
stretch-stimulated fetal genes and p-ERK upregulation (p<0.05). Deficiency of miR-378
alone by inhibitors was sufficient to inducefetal genes expression. In cultured cardiac fi-
broblasts, overexpression of miR-378 significantly suppressedcol I, col III, MMP9 levels
induced by mechanic stretching (p<0.05). Furthermore, we observed increased level of
miR-378 inthe supernatant of stretching cardiomyocytes (p<0.05). When culturingcardiac
fibroblasts with the supernatant, induction of col I, col III, MMP9 by mechanic stretching
was significantly inhibited (p<0.05).
Conclusion: These findings reveal orchestrating regulatory roles for miR-378 in pressure-
overload induced cardiac remodeling. It shows that miR-378 not only suppresses cardiac
hypertrophy endogenously but also controls cardiac fibrosis by paracrine.
Disclosure of Interest: J. Yuan Grant/research support from: National Natural Science
Funds of China (Grant No. 81200185), C. Wu: None Declared, Y. Ye: None Declared, Z.
Ding: None Declared, X. Zhang: None Declared, G. Gong: None Declared, Y. Zou: None
Declared
O027
Novel GATA4 Binding Proteins, RbAp48/46 Is a Key Regulator of Post-
Transcriptional Modification of GATA4 during Cardiomyocyte Hypertrophy
Yoichi Sunagawa*1,2, Yasufumi Katanasaka1,2, Hidetoshi Suzuki1, Hiromichi Wada2,
Akira Shimatsu3, Koji Hasegawa2, Tatsuya Morimoto1
1
Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka,
Shizuoka, 2Division of Translational Research, 3Clinical Research Institute, Kyoto Medical
Center, Kyoto, Japan
Introduction: Cardiac hypertrophy is being recognized as a critical event during the
development of heart failure. A zinc finger protein GATA4 associates an intrinsic histone
acetyltransferase p300 and regulates myocardial transcriptional activities in response to
hypertrophic stimuli. We previously have reported that Retinoblastoma protein (Rb)-
associated protein 48 and 46 (RbAp48/46) are novel component of the p300/GATA4
complex and form a repressor complex with HDACs in cardiomyocytes. However, precise
functional regulation by RbAp48/46 during hypertrophic responses is still unknown.
Objectives: We investigate that RbAp48/46 regulate hypertrophic responses by modulating
post-translational modification GATA4 in cardiomyocyte.
Results: RbAp48/46 inhibited phenylephrine (PE)-induced hypertrophic responses such as
acetylation of GATA4, activation of the ANF and ET-1 promoters, and increase in cell size.
On the contrary, knockdown of RbAp48/46 by shRNA augmented such responses.
Knockdown of HDAC1/2 augmented PE-induced hypertrophy and failed to inhibitory
effects by RbAp48/46. GST pull down assay showed that RbAp48/46 interacted with
N-terminal domain of GATA4, which was near its S105 phosphorylation site. IP-WB assay
using HEK293T cells demonstrated that active form of MEK1 induced S105 phosphory-
lation of GATA4, the dissociation of RbAp48/46 with GATA4, the increase of p300-induced
GATA4-acetylation, and synergistic activation of ANF and ET-1 promoters with p300/
GATA4. S105A mutant of GATA4 reversed these changes. Stimulation of cardiomyocytes
with PE induced S105 phosphorylation of GATA4, the dissociation of GATA4 with
RbAp48/46 and HDAC1/2, and the decrease of RbAp48/46 recruitments onto the GATA
element of the ANF promoter. Conversely, PD98059, a MEK1 inhibitor, treatment
inhibited GATA4-phosphorylation and this dissociation.
Conclusion: In this study, we demonstrate that phosphorylation of GATA4 has a critical
role on the dissociation of GATA4/RbAp48/46/HDAC repressor complex, the formation of
300/GATA4 activator complex, and the increase of GATA4 acetylation and hypertrophic
responses. These findings suggest that RbAp48/46 may regulate hypertrophic responses
involved in modulating the posttranslational modification crosstalk of GATA4.
Disclosure of Interest: None Declared
O028
1,2 Role of Technology In Creating Rheumatic Heart Disease Awareness Among
School-Going Children In Kenya
Duncan M. Matheka*1, Mellany Murgor2, Edward Kibochi2, Steve Nigel2, Joseph Nderitu2,
Gary Selnow3
1
Department of Medical Physiology, 2University of Nairobi, Nairobi, Kenya, 3WiRED
International, New York City, United States
Introduction: Rheumatic heart disease (RHD) is the most common cardiovascular disease
in Kenya and mainly affects school-going children. As a preventable disease, its incidence
may be significantly reduced by educating the community on preventive measures.
e7
 Educating children is crucial in combating the disease since they are especially vulnerable >130ms and %QLV <70%, 70-80%, 80-90%, >90%. Mean change in ejection fraction
to streptococcal infection. The role of innovative training approaches (technology-based) (EF) for each parameter and each quartile was recorded.
ORAL ABSTRACTS

among school-going children remains unverified. Results:

Objectives: The current project therefore sought to train school-going children on RHD
using an interactive digital module from WiRED international, a US based non-profit or-
ganization working in Kenya. ECGd (ms) ECGd <130ms 130-150ms 150-170ms >170ms.
Methods: The module offered simplified animated presentations linking sore throat, rheu-
EF Change 9.1  4.8 11.2  6.4 12.5  6.9 13.2  9.2
matic fever and RHD, as well as ways of their prevention. The module also introduced ques-
tions throughout the presentation and provided instant feedback to reinforce key concepts. IEGM (ms) IEGM< 90ms 90-110ms 110-130ms >130ms
Upper primary pupils from two schools were randomly assigned into control (n¼100) EF Change 7.8  5.9 10.3  8.8 14.3  6.4 18.3  8.1
and experimental (n¼100) groups. The experimental group was trained using the module,
while the control group did not have any teaching. Both groups then answered 23 multiple %QLV %QLV<70% 70-80% 80-90% >90%
choice questions (MCQs). During a follow-up visit one week later, the students were re- EF Change 2.9  4.0 12.5  10.2 14.3  6.8 16.5  7.5
administered with the same final exam. The results were analyzed using SPSS version 16.0.
Results: The mean age of the pupils was 12.71 years. On the first visit test, the experimental
group had higher average scores compared to the control group (16.32.5 vs. 10.52.3
marks; p<0.001). The follow-up test results were 15.72.7 for experimental and 10.42.4 An increasing quartile of each parameter was a univariate predictor of improved ejection
marks for the control, p<0.001. Age, class level or gender did not affect performance. fraction. On multivariate analysis the increasing quartiles of IEGM were the best predictors
Conclusion: The use of interactive digital modules to train school-going children on RHD of response. A %QLV < 70 was the most powerful differentiator of poor response.
increases knowledge, awareness and is feasible, efficacious and sustainable. This approach Conclusion: Implant electrical characteristics are fundamental in maximising response to
is beneficial, and could potentially reduce the toll of RHD if tailored to the specific learning CRT. Whilst baseline prolongation of QRSd predicts response to CRT, the lead parameters
needs of the children and applied more widely. at implant can predict response with greater certainty.
Disclosure of Interest: None Declared Disclosure of Interest: H. Sugumar: None Declared, M. Flannery Grant/research support
from: Medtronic, A. Teh: None Declared, D. O’Donnell Grant/research support from:
Medtronic and St Jude Medical, Consultancy for: Medtronic and St Jude Medical
O029
O032
Patterns And Clinical Manifestations Of Tuberculous Myocarditis: A Systematic
Review Of Cases Severe symptomatic mitral regurgitation: real world cost of conservative and surgical
treatment.
Brian N. Michira*, Faraj O. Alkizim, Duncan M. Matheka
School of Medicine, University of Nairobi, Nairobi, Kenya Peace Tamuno, John Newland*, Sanjeevan Pasupati, Samuel Whittaker, Gerard Devlin,
Rajesh Nair
Introduction: Tuberculosis is a rare cause of myocarditis. It is, however, associated with a
Cardiology, Waikato Hospital, Hamilton, New Zealand
high mortality when it occurs and is often diagnosed at post-mortem. Although case re-
ports have been documented, comprehensive reviews compiling the patterns and clinical Introduction: Severe symptomatic MR (ssMR) is treated conservatively due to high
manifestations of tuberculous myocarditis are lacking. operative risks in up to 50% of patients. Percutaneous mitral valve repair using MitraClip
Objectives: The low incidence, late diagnosis, and under-reporting of tuberculous has been shown to be clinically effective and safe in selected patients and may be cost
myocarditis have with time created a knowledge gap among health care workers. This effective in this cohort.
review therefore seeks to restore awareness among the practitioners, to promote a high Objectives: To evaluate clinical outcomes and healthcare cost implications of current
index of suspicion for early diagnosis, and thereby timely management of TB myocarditis. management strategies for ssMR in a single centre.
Methods: A Pubmed search using the key words: “Tuberculous myocarditis” or “Tuber- Methods: Patients deemed unsuitable for conventional surgery were screened using
culosis myocarditis” and limited to the time frame between 2000 and 2013, was conducted. transoesophageal echocardiography to ascertain suitability for MitraClip (group 1, n¼28)
Out of 136 articles retrieved, 23 case reports were found to be highly relevant to the review. and prospectively followed up from March 2011 to March 2013. Retrospective analysis was
There was no geographical focus in consideration of the case reports selected. done for patients undergoing mitral valve surgery for predominant MR (group 2, n¼91;
Results: Most of the reported cases of tuberculous myocarditis were predominantly in group 2(a) Euroscore < 6%, n ¼ 80, group 2(b) Euroscore 6%, n¼11). In hospital cost
immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty was obtained from accounts department.
one percent (81%) occurred in the ‘young’ patients (below 45years). Of all these cases, 80% Results: Patients in group 1 were older (p<0.05), had higher Euroscore (p<0.001), lower
were females. Left ventricular involvement was seen in all the cases of sudden cardiac death. left ventricular ejection fraction (p<0.0001) and were more likely to have functional MR
Tuberculous myocarditis with concomitant pulmonary infection was reported in 56% of the (46% vs 15%). 57 % of patients in group 1 had 2 hospital admissions with a mean
cases; whereas concomitant pericarditis was recorded in 47% of the cases. Antituberculosis cumulative length of hospital stay of 277 days. Mortality was higher in the conservative
drug therapy did not appear to offer mortality benefit against sudden cardiac deaths. Elec- arm (group 1 - 39 % vs. group 2 - 5.5%). Patients undergoing mitral valve surgery with a
trical conduction abnormalities in the myocardium did not seem to be entirely dependent on high surgical risk stayed longer in hospital when compared to low risk patients (group 2(a)
serum electrolyte levels, as two case reports with similar clinical presentation of S3 heart 1215 vs. group 2(b) 2117, p 0.06).
sound with sinus tachycardia recorded significantly different serum electrolyte levels. High risk patients undergoing surgery had higher mortality rate (group 2(a) 2.5 % vs
Conclusion: Tuberculous myocarditis has a multifaceted clinical presentation and is often group 2(b) 27%) and higher mean in-hospital costs (group 2(a) NZ$35,708.36 vs group
undiagnosed. Sudden cardiac death mostly occurred in the young (below 45years), with 2(b) NZ$ 63552.71). Mean cost of conservative treatment (group 1) was NZ$
twice as many females affected as males. In TB endemic areas, a high index of suspicion is 36,8147,818. Projected cost for MitraClip procedure is NZ$ 36,000.
necessary in patients presenting with unexplained non-ischemic arrhythmias, congestive
heart failure or cardiogenic shock, to make the diagnosis.
Disclosure of Interest: None Declared Group 1 (n[28) Group 2 (n[91) p value
Age (years) 712 6411 0.0011
O031 Female Gender % 32(N¼9) 46(N¼42) -
Predicting response to CRT: Intracardiac EGM, QRS duration or %QLV Functional MR % 46(N¼13) 15(N¼14) -
Hariharan Sugumar*, Michael D. Flannery, Andrew Teh, David O’Donnell Mean LVEF % 442 6011 <0.0001
Cardiology, Austin Health, Melbourne, Australia Mean Euroscore II % 123 3.23.2 <0.0001

Introduction: Predicting response to cardiac resynchronisation therapy (CRT) is difficult

and imprecise. A number of clinical, imaging and electrical methods of predicting response
have been proposed. Our previous analysis has demonstrated the value of ECG and
intracardiac electrogram measures at the time of implant to predict response, however the
relative importance of these measures has not previously been assessed.
Objectives: We sought to determine which electrical parameters at implant are best at
predicting response to CRT.
Methods: One hundred consecutive patients undergoing CRT between 2011 and 2012
using multipolar LV leads were enrolled. At implant a 12 lead ECG was performed and the
longest QRS duration recorded. Intracardiac EGM (IEGM) recordings were measured be-
tween the right ventricular electrogram and latest activated left ventricular electrogram
during intrinsic rhythm. % QLV was defined as the time from first surface ECG deflec-
tion(ECGd) to LV electrogram peak during sinus rhythm as a % of total QRS dura-
tion(QRSd). Echocardiographic measurement of ejection fraction was preformed prior to
implant and at six months post implant. Each variable was divided into quartiles ECGd
<130ms, 130-150ms, 150-170ms, >170ms. IEGM < 90ms, 90-110ms, 110-130ms,
Conclusion: Patients with ssMR treated conservatively have recurrent hospital admissions
and poor prognosis. Surgery for high-risk patients is associated with higher mortality and
expense. Percutaneous repair of mitral valve using MitraClip may be cost effective for high
risk and surgically unsuitable patients in a New Zealand setting.
Disclosure of Interest: None Declared
O034
Association of amino-terminal-B-type natriuretic peptide levels with structural heart
disease in a community cohort at increased risk of heart failure - the SCREEN-HF
study
Jennifer M. Coller*1,2, Duncan J. Campbell2, Henry Krum3, Michele McGrady4, Louise Shiel3,
Chris Reid3, Umberto Boffa5, Rory Wolfe4, Simon Stewart6, David L. Prior7
1
Department of Medicine, St Vincent’s Hospital, 2St Vincent’s Institute, 3Centre for

e8 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

Cardiovascular Research and Education in Therapeutics, 4Monash University, Melbourne,
5
University of Adelaide, Adelaide, 6Baker IDI, 7St Vincent’s Hospital, Melbourne, Australia
Introduction: Both amino-terminal-B-type natriuretic peptide (NT-proBNP) levels and
echocardiographic evidence of structural heart disease predict heart failure, but the utility
of NT-proBNP levels to identify individuals with structural heart disease, without heart
failure, is uncertain.
Objectives: To evaluate the utility of serum NT-proBNP levels in predicting structural
heart disease in participants from the Screening Evaluation of the Evolution of New Heart
Failure (SCREEN-HF) study.
Methods: Inclusion criteria were age 60 years with one or more heart failure risk factors
including self-reported cardiac or cerebrovascular disease, renal impairment, or treatment
for hypertension or diabetes for 2 years. Exclusion criteria were known heart failure or
left ventricular dysfunction on echocardiography. NT-proBNP was measured in 3994
participants, of whom 3046 attended for echocardiographic examination. The relationships
between echocardiographic abnormalities and NT-proBNP quintiles were analysed by lo-
gistic regression and receiver-operator characteristic (ROC) curve analysis.
Results: Structural heart disease was identified in 861 of 3047 participants (28%). For
participants in the highest quintile, in comparison with the lowest NT-proBNP quintile, the
odds ratio (OR, 95% CI) for left ventricular ejection fraction (LVEF) <50% and/or LV wall
motion abnormality was 5.2 (3.2, 8.4); for LVEF <40% was 36.1 (4.9, 268.2); for LV
hypertrophy was 2.6 (1.8, 3.7); and for moderate-severe diastolic dysfunction with LVEF
50% was 5.1 (3.0, 8.9). The OR for any structural heart disease for the highest quintile
was 4.9 (3.7, 6.5) before adjustment and 3.5 (2.6, 4.8) after adjustment for age, sex, history
of heart disease and blood pressure. In ROC curve analysis for prediction of any structural
heart disease by serum NT-proBNP level, the C statistic was 0.64 (0.61, 0.67) for men and
0.61 (0.57, 0.64) for women.
Conclusion: Serum NT-proBNP levels were associated with structural heart disease in a
community population at increased heart failure risk, and this association was independent
of age, sex, history of heart disease and blood pressure. However, in this population with
28% prevalence of structural heart disease, serum NT-proBNP levels demonstrated only
poor accuracy for the prediction of structural heart disease.
Disclosure of Interest: None Declared
O035
Current Victorian antenatal detection rates of congenital heart disease in infancy
Natalie Soszyn*1, Darren Hutchinson1,2, Ricardo Palma-Dias2,3, Michael Cheung1,4,5, Bryn Jones1,2,4,5
1
Department of Cardiology, The Royal Children’s Hospital, 2Fetal Medicine Unit, The Royal
Women’s Hospital, 3Department of Obstetrics and Gynaecology, 4Department of Paediatrics,
The University of Melbourne, 5The Murdoch Childrens Research Institute, Parkville, Australia
Introduction: Early prenatal detection of severe forms of congenital heart disease
(CHD) has been associated with lower peri-natal mortality and morbidity. In addition
to improved outcomes, it also benefits families by enabling prenatal counseling
regarding diagnosis, management, and pregnancy options. With technical advances and
increased availability of foetal echocardiography over the last 30 years, antenatal
screening for and detection of CHD has become well established with a high diag-
nostic accuracy. Prenatal diagnosis of severe forms of CHD should now be possible in
almost all cases.
Objectives: We aimed to establish the contemporary antenatal detection rates in infants
presenting to The Royal Children’s Hospital (RCH) in Victoria with selected severe
congenital heart defects.
Methods: All infants referred to RCH born between 1 January 2009 and 31 December
2011 with significant CHD were identified. Patients were included if they had one of 7
sentinel defects: transposition of the great arteries (TGA), truncus arteriosis, pulmonary
atresia, coarctation of the aorta (CoA), hypoplastic left heart syndrome (HLHS), atrio-
ventricular septal defect (AVSD), and tetralogy of fallot (TOF). Patients were excluded if
they were born or had their antenatal care outside of Victoria.
Results: Between January 2009 and December 2011, 247 patients were diagnosed with one
of the seven sentinel defects in Victoria. Of those identified, 139 were diagnosed antenatally
over the study period (56.2%; 95% CI, 47.2 – 59.9). Malformation-specific analysis
showed that the highest antenatal detection rate was associated with infants diagnosed with
HLHS (96.8%; 95% CI, 77.1 – 99.8) followed by those with pulmonary atresia (68.8%;
95% CI, 49.9 - 83.9). Coarctation had the lowest rate of antenatal detection (24.4%; 95%
CI, 11.1 – 39.3).
Figure 1: Antenatal detection rates for the seven sentinel defects in our study (2011)
compared with a previous Victorian study (Chew et al 2006).
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
Conclusion: This study showed improvement in the overall antenatal detection of CHD in
Victoria. In addition, significant development has been made in the detection of outflow
ORAL ABSTRACTS
tract lesions including TGA, HLHS, and TOF. However, despite this progression, just
under half of infants still present without an antenatal diagnosis demonstrating the need for
further improvement in routine obstetric screening in Victoria.
Disclosure of Interest: None Declared
O036
Impact of Fetal Heart Maturity in Brain Development and later Neurocognitive
Functioning in Adolescents with Congenital Heart Disease
Maria Emília G. Areias*1, Anabela Estrela1,2, Samantha Matos1,2, Sofia Sarmento1,2,
Sara Moreira1,2, Jorge Quintas3, Bruno Peixoto1,2, José Carlos Areias4,5,6
1
Department of Psychology, Instituto Superior de Ciências da Saúde (CESPU), 2UNIPSA/CICS
(CESPU), Gandra-Paredes, 3Criminology, Faculty of Law, University of Porto, 4Pediatric
Cardiology, Hospital S. João, 5Pediatrics, Faculty of Medicine, University of Porto, 6Unidade de
Investigação Cardiovascular, Faculty of Medicine, University of Porto, Porto, Portugal
Introduction: Patients with congenital heart disease (CHD) show neuropsychological
deficits in pre-school and school ages in a very high rate. Surgeries and anoxia have been
studied as main variables but recently the focus has been turned to fetal cardiac and cir-
culatory conditions that may affect neurodevelopment.
Objectives: The purpose of this investigation was to evaluate the neurocognitive perfor-
mance in adolescents with CHD and to determine whether parameters of fetal development
evaluated in neonates, such as head circumference, length, weight and Apgar scores, are
somehow related to their neurocognitive performance.
Methods: 95 CHD patients (55 males), 13 to 18 years old (M¼14.991.70), 55 cyanotic
(31 Tetralogy of Fallot, 24 Transposition of the Great Arteries) and 40 acyanotic (Ven-
tricular Septal Defect), enrolled in this study. We assessed also a control group with 16
healthy children (11 males and 5 females) ages ranging from 13 and 18 (mean¼15.69 
1.45). All assessment measures for CHD patients were once obtained in a tertiary hospital;
the control group was evaluated in school. Demographic information and clinical history
were collected. Neuropsychological assessment included Wechsler’s Digit Test (direct and
reverse) and Symbol Search, Rey’s Complex Figure, BADS’s Key Searching Test, Color-
Word Stroop Test, Trail Making Test (A and B) and Logical Memory Task.
Results: CHD patients compared to control group showed lower scores in the Wechsler’s Digit
Test (direct:u¼304.000;p<0,001; reverse:u¼188.000;p<0.001), Rey’s Complex Figure
(copy:u¼165.000; p<0,001;memory:u¼204.000;p<0.001),Symbol Search(u¼1099.000;
p¼0.004),BADS (u¼162.000;p<0.001), Stroop Test, words (u¼162.000; p<0.001), colors
(u¼247.500; p<0.001), interference (u¼157.000; p<0.001) and Trail Making Test, A
(u¼1426.500; p<0.001) and B (u¼1379.500; p<0.001). Several correlations were apparent
between fetal/ neonatal parameters (mainly, the head circumference at birth) and neuropsycho-
logical abilities in CHD. However, cyanosis and the Head circumference at birth stand as main
correlations with cognitive development later on in CHD (R¼0.408;R2¼0.167;
F¼5.203;p¼0.009;HC:b¼0.256;t¼1.979;P¼0.053;Cyanosis:b¼-0.270;t¼-2.086; P¼0.042).
Conclusion: Adolescents with CHD have worse neuropsychological performance than the
control group, and the cyanotic worse than the acyanotic patients. The fetal anomalies in
heart and circulation seem to have impact in delaying cerebral and somatic growth, pre-
dicting cognitive impairment in adolescents with CHD.
Disclosure of Interest: None Declared
O037
Myocardial fibrosis – histological validation of assessment with magnetic resonance
imaging and impact on symptoms and prognosis in non-ischaemic cardiomyopathy
Leah M. Iles*1,2, Andris H. Ellims1,2, Huw Llewellyn3, Catherine Jaworski1, David M. Kaye1,2,
James L. Hare1,2, Catriona A. McLean3, Andrew J. Taylor1,2
1
Dept of Cardiovascular Medicine, The Alfred Hospital, 2Baker IDI Heart and Diabetes Institute,
3
Anatomical Pathology, The Alfred Hospital, Melbourne, Australia
Introduction: Myocardial fibrosis is fundamental in the development of heart failure. Late
gadolinum enhancement (LGE) with cardiac magnetic resonance (CMR) imaging is
commonly assumed to represent regional myocardial fibrosis however comparative human
histological data are limited, especially in non-ischaemic cardiomyopathy (NICM). Diffuse
myocardial fibrosis is increasingly recognized as central in the pathogenesis of all forms of
cardiomyopathy and can be quantified using CMR post-contrast T1 mapping.
Objectives: To evaluate the relationship of CMR assessment of myocardial fibrosis with
human histology, and to assess the value of myocardial fibrosis to predict symptoms and
prognosis in NICM.
Methods: CMR assessment of fibrosis was compared with histology in 19 patients, con-
sisting of 11 explanted hearts following heart transplantation and 8 surgical myectomy
specimens for obstructive hypertrophic cardiomyopathy. Fibrosis was quantified digitally,
using masson-trichrome staining for histological specimens and compared with CMR
quantification of both regional (using LGE) and diffuse fibrosis (by CMR T1 mapping). A
further 77 patients with NICM underwent CMR to assess the clinical impact of both
patterns of fibrosis.
Results: There was a strong correlation between LGE and histological fibrosis in the
explanted hearts (R¼0.91, p<0.001). Post-contrast T1 time demonstrated a significant
correlation with histology on both a segmental (R¼-0.64 p¼0.002) and per patient (R¼-
0.78 p¼0.003) analysis. At baseline, post-contrast T1 time, left ventricular ejection fraction
(LVEF) and end-diastolic volume index (LVEDVI) predicted NYHA class (p<0.05 for all
comparisons), with post-contrast T1 time the only independent predictor after multivariate
analysis (p¼0.02). At a median follow up of 4.2 years (interquartile range 2.6-5.2 years), 22
e9
 patients reached the primary endpoint of death, heart transplant or appropriate defibrillator
therapy. Post-contrast T1 time, age, LVEDVI and LGE were all univariate predictors of
ORAL ABSTRACTS
outcome (p<0.05 for all comparisons), however only post-contrast T1 time and LGE
independently predicted prognosis (both p<0.05).
Conclusion: CMR provides accurate, non-invasive assessment of both regional and
diffuse myocardial fibrosis. Whilst both patterns of fibrosis are associated with a worse
prognosis, diffuse myocardial fibrosis correlates most strongly with heart failure
symptoms.
Disclosure of Interest: None Declared
O038
Diffuse myocardial fibrosis evaluated by post-contrast T1 mapping correlates with
left ventricular stiffness
Andris H. Ellims*1, James A. Shaw1, Dion Stub1, Leah M. Iles1, James L. Hare1,
Glenn S. Slavin2, David M. Kaye1, Andrew J. Taylor1
1 4
Heart Centre, Alfred Hospital and Baker IDI Heart & Diabetes Institute, Melbourne, Australia,
2
GE Healthcare, Bethesda, United States
Introduction: Myocardial fibrosis is a fundamental event in the development of cardiac
failure, regardless of its aetiology. Diffuse myocardial fibrosis may be relevant in the
pathogenesis of heart failure with a normal left ventricular (LV) ejection fraction (HFNEF),
which accounts for up to half of all cases of heart failure and carries a comparable
morbidity/mortality profile. The precise mechanism of LV diastolic dysfunction in the
presence of myocardial fibrosis has not previously been established.
Objectives: The purpose of this study was to utilise cardiac magnetic resonance (CMR)
imaging and invasive LV pressure-volume (PV) measurements to explore the relationship
between diffuse myocardial fibrosis and indices of diastolic performance in a cohort of
cardiac transplant recipients.
Methods: We performed CMR with T1 mapping and obtained invasive LV PV mea-
surements via a conductance catheter in twenty cardiac transplant recipients at the time
of clinically-indicated coronary angiography. Right heart catheterization was also
performed.
Results: Despite normal intra-cardiac pressures, both post-contrast myocardial T1 time
and extracellular volume fraction correlated with b, the load-independent passive LV
stiffness constant (r ¼ -0.71, p ¼ 0.001 and r ¼ 0.58, p ¼ 0.04, respectively).
Following multivariate analysis, post-contrast myocardial T1 time remained the only
independent predictor of b. No significant associations were observed between
myocardial T1 time and s, the active LV relaxation constant, or other load-dependent
parameters of diastolic function.
Conclusion: Diffuse myocardial fibrosis, assessed by post-contrast myocardial T1 time,
correlates with invasively-determined LV stiffness in cardiac transplant recipients. In pa-
tients with increased diffuse myocardial fibrosis, abnormal passive ventricular stiffness may
be a major contributor to diastolic dysfunction. The ability to non-invasively evaluate
diffuse myocardial fibrosis using T1 mapping in a variety of cardiomyopathies may enhance
our understanding of the pathogenesis and natural history of these conditions, and enable
the therapeutic trials of putative anti-fibrotic agents.
Disclosure of Interest: None Declared
O039
Cerebral Blood Flow, Endothelial Function In Patients With Coronary Artery Disease
And Arterial Hypertension Receiving Ivabradine In Combination With Perindopril
Natalia Musikhina, Ludmila Gapon, Alena Utesheva, Tatiana Petelina, Vadim Kuznetsov*
tyumen Cardiology Center, Tyumen, Russian Federation
Introduction: Arterial hypertension (AH) in patients with coronary artery disease (CAD) is
usually accompanied by significant morphological changes of cerebral arteries, and as a
result the resistance of cerebral vessels. Normalization of heart rate (HR) is one of the
mechanisms that provide beneficial effects on vascular remodeling. Selective If channel
inhibitor ivabradine leading to isolated HR reduction is involved in the modulation of HR
by the sympathetic and parasympathetic nervous system.
Objectives: To investigate the effects of ivabradine in combination with perindopril on
cerebral blood flow and endothelial vasomotor function in patients with CAD and AH.
Methods: 64 patients with CAD and AH were examined. Patients were divided into two
groups: I (n¼38) received ivabradine (mean dose 6.70.4 mg) in combination with per-
indopril (mean dose 4.10.8 mg), II (n¼26) received metoprolol (mean dose 43.55.3
mg). Groups were matched for age, office blood pressure (143/832.0/1.8 mmHg in I and
139/852.4/1.5 mmHg in II), HR (85.61.0 bpm in I and 82.12.1 bpm in II). 24-hour
blood pressure monitoring, Doppler cerebral blood flow measurement, endothelium-
depended vasodilatation (EVD) and nitroglycerin tests – non-endothelium-dependent
vasodilatation (NEVD), level of nitrites were evaluated initially and after 8 weeks of therapy.
Results: At 8-week follow-up both groups showed a comparable decrease in blood pres-
sure and HR and a decrease in peak systolic velocity of blood flow in the internal carotid
arteries (73.84.4 vs 61.24.0 mm/s in I and 70.88.8 vs 63.16.1 mm/s in II (p<0.05).
Group I had a reduction in pulsatility index (PI) 1.90.1 vs 0.70.1 and systolic/diastolic
ratio (ISP) 2.50.1 vs 2.00.1 (p<0.05). After 8 weeks there was a significant increase in
NEVD (13.61.3% vs 15.30.7%) and blood flow velocity in the brachial artery
(0.360.11 sm/s vs 0.410.12 sm/s) in I, an increase in EVD (8.20.7% vs 9.71.1%) in
II. In both groups increased reactive hyperemia in the brachial artery was observed.
Negative correlations were found between reactive hyperemia and PI (r¼-0.45, p¼0.02) in
group I, between reactive hyperemia and ISP (r¼-0.41, p¼0.03) in II.
e10
Conclusion: With similar effects on endothelial vasomotor function, ivabradine in com-
bination with perindopril compared to metoprolol has more favorable effects on blood flow
velocity and resistance of cerebral vessels in patients with CAD and AH.
Disclosure of Interest: None Declared
O040
Changes in plaque composition with a novel apolipoprotein A-I inducer: insights
from the assure study
Yu Kataoka*1, Rishi Puri2, Kathy Wolski3, Christie M. Ballantyne4, Philip J. Barter5,
Bryan Brewer6, John J. Kastelein7, Allan Gordon8, Jan Johansson8, Norman Wong8,
Steven E. Nissen2, Stephen J. Nicholls1
1
Heart Health Theme, South Australian Health & Medical Research Institute, Adelaide,
Australia, 2Department of Cardiovascular Medicine, 3C5 Research, Cleveland Clinic, Cleveland,
Section of Cardiovascular Research, Baylor College of Medicine and the Methodist DeBakey
Heart and Vascular Center, Houston, United States, 5University of New South Wales,
Kensington, Australia, 6Medstar Research Institute, Hyattsville, United States, 7Department of
Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands, 8Resverlogix
Corporation, Calgary, Canada
Introduction: Apolipoprotein A-I (apoA-I) induction represents a novel approach to
promoting the functionality of high-density lipoproteins (HDL). The impact of apoA-I
induction on plaque composition is unknown.
Objectives: To evaluate the impact of the apoA-I inducer, RVX-208, on plaque compo-
sition using radiofrequency analysis of intravascular ultrasound (IVUS).
Methods: 323 patients with angiographic coronary artery disease and low HDL-C levels
were treated with RVX-208 100 mg twice daily or placebo (3:1 allocation) for 26
weeks. IVUS imaging was performed in matched coronary artery segment at baseline
and at end of the study. Radiofrequency analysis of the IVUS signal was evaluated to
determine the changes in fibrotic, fibrofatty, necrotic and calcific components of plaque
imaged.
Results: Compared with baseline, RVX-208 increased apoA-I by 12.8% (P<0.001) and
HDL-C by 11.1% (P<0.001). This associated with reductions in percent atheroma
volume by 0.40% (P¼0.08) and total atheroma volume by 4.2mm3 (P<0.001).
Compared with baseline, RVX-208 administration was associated with increases in the
proportion of fibrous (P¼0.04), necrotic (P¼0.007) and calcific (P¼0.002) and a
decrease in fibrofatty (P<0.001) material. The increase in necrotic material is often
observed surrounding increasing calcium signal as an artifact on radiofrequency anal-
ysis. The difference in change in fibrous components was significant compared with
placebo. (Table)
Placebo RVX-208 P Value Between
Parameter (n[26) (n[61) Groups
Fibrous -1.3% +1.6% 0.04
P¼0.27 P¼0.04
Fibrofatty -0.4% -4.0% 0.09
P¼0.84 P<0.001
Necrotic +0.8% +1.5% 0.46
P¼0.37 P¼0.007
Calcific +0.5% +1.1% 0.37
Conclusion: Short-term administration of an apoA-I inducer may promote favourable
changes in plaque components. The clinical effects of these changes require further
investigation.
Disclosure of Interest: Y. Kataoka: None Declared, R. Puri: None Declared, K. Wolski: None
Declared, C. Ballantyne Grant/research support from: Abbott, Amarin, Amgen, Eli Lilly,
GlaxoSmithKline, Genentech, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi-Synthelabo,
Takeda, National Institutes of Health and American Heart Association, Consultancy for:
Abbott, Aegerion, Amarin, Amgen, Arena, Cerenis, Esperion, Genentech, Genzyme, Kowa,
Merck, Novartis, Omthera, Pfizer, Resverlogix, Regeneron, Roche and Sanofi-Synthelabo,
Speakers bureau: Abbott., P. Barter Grant/research support from: Merck and Pfizer, Con-
sultancy for: AstraZeneca, CSL Behring, Kowa, Eli Lilly, Merck, Novartis, Pfizer and Roche,
Honorarium from: Amgen, AstraZeneca, ISIS, Kowa, Merck, Novartis, Pfizer and Roche, B.
Brewer Consultancy for: Merck, AstraZeneca, Eli Lilly, Roche, Amgen and Sanofi., J. Kastelein
Grant/research support from: Dutch Heart Foundation , Honorarium from: AstraZeneca,
Novartis, Eli Lilly, Anthera, Roche, Resverlogix, Pfizer, Merck, Omthera, Sanofi-Aventis,
Regeneron, Amgen, AtheroNova, CSL Behring, Boehringer Ingelheim, Aegerion, the Medi-
cines Company, Isis Pharmaceuticals, Genzyme, Amarin, Xenon Pharma, Servier and Cer-
enis., A. Gordon Employee from: Resverlogix, J. Johansson Employee from: Resverlogix, N.
Wong Employee from: Resverlogix, S. Nissen Grant/research support from: AstraZeneca, Eli
Lilly, Pfizer, Takeda, Sankyo, and Sanofi-Aventis, S. Nicholls Grant/research support from:
AstraZeneca, Novartis, Eli Lilly, Anthera, LipoScience, Roche and Resverlogix, Honorarium
from: AstraZeneca, Roche, Esperion, Abbott, Pfizer, Merck, Takeda, LipoScience, Omthera,
Novo-Nordisk, Sanofi-Aventis, Atheronova, Anthera, CSL Behring and Boehringer
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O042
Coronary sinus filling and emptying time: a new parameter to assess coronary
microcirculation by a simple angiographic frame count
Sangareddi Venkatesan*1, Dhandapani Velala Elumalai2, M. S. Ravi2
1 Disclosure of Interest: None Declared
Cardiology, 2Government General Hospital, Chennai, India
Introduction: Functional assessment of coronary microcirculation has been difficult for
various reasons. Nuclear imaging, PET scan have been used to assess the viability of
microcirculation and myocyte perfusion . Digital frame counting of coronary angiograms
(CAG) has been used to measure the transit time of dye across the coronary artery .
Myocardial blush scores is an subjective method to assess myocardial perfusion based on
visual acuity .There is no simple method available to assess the integrity of the coronary
microcirculation. The transit time between the coronary artery to the coronary sinus(CS)
would indicate the microcirculatory time. Video images obtained during routine CAG
provides us an opportunity to measure this time
Objectives: We hypothized , coronary sinus filling time(CFT) , coronary sinus emptying
time(CET), Coronary sinus emptying velocity(CEV) will give a simple index of micro
circulatory state.
Methods: Patients who were undergoing routine CAG in our cath lab were the subjects of
the study . Twenty normal angiograms with well delineated CS were analysed. ( Ten
without CAD and ten with positive stress test). CAG was done and assessed with Philips
digital Integris workstation. CAG was performed with 12.5 frames/sec. Coronary sinus filling
time(CFT) was estimated by the difference between the frames of maximum LAD system
opacification to maximal opacificaton of CS . Coronary sinus emptying time (CET)was the
difference in frame count between maximal visualization of CS to complete emptying of CS.
The Coronary sinus emptying velocity (CEV) was calculated by estimating the time taken
for the dye to traverse two reference points across CS. The normal values were defined.
Results:
Control n 10 ( No CAD) (TMT positive) CAD no 10
Mean & Range Mean & Range P value
CFT Frame count 46 (38-56) 62 (52-68) <.05
Time in sec 3.68(3.4-4.48) 4.96
CET Frame count 48(42-55) 66 (58-70) <.05
Time in sec 3.84(3.36-4.4) 5.28(4.64-5.6)
CEV cm/sec 48(36-56) 30(12-40) <.05
Conclusion: We conclude CFT and CET are simple parameters that can be easily derived
from routine CAG to assess coronary microcirculation and it’s integrity. It is useful in the
evaluation of patients with syndrome X and to assess the successful reperfusion following
PCI especially in slow flow and low flow states . Further refining of this concept and
methodology may be required.
Disclosure of Interest: None Declared
O043
Task-shifting for cardiovascular disease management – results from a cluster
randomised control trial in rural India
Rohina Joshi*1, Krishnam Raju2, Clara K. Chow1, on behalf of the APRHI Collaboration
1
Cardiovascular, The George Institute for Global Health, University of Sydney, Sydney,
Australia, 2Cardiology, CARE Hospital, Hyderabad, India
Introduction: Rural Andhra Pradesh has a large disease burden attributable to cardiovascular
disease (CVD) with significant under-utilisation of evidence based low-cost preventive med-
ications.[1] Primary care physicians are first point of contact and the main providers of
healthcare for individuals with CVDs. In low and middle income countries too few doctors
exist and physician workforce disparities for rural and remote regions are very substantial.[2, 3]
Objectives: In response to the health workforce shortage in rural regions, we designed,
implemented and evaluated a CVD prevention strategy that could be delivered by non-
physician healthcare workers (NPHWs)
Methods: This study was a cluster–randomised control trial done in 44 villages located in
the Godavari districts of Andhra Pradesh, India. Villages were randomised to receive the
intervention package which involved the use of an algorithm designed to increase the
identification and treatment of individuals at high-risk of CVD and to be used by NPHWs.
High-risk individuals were referred to physicians for initiation of treatment. The primary
outcome was the proportion of high-risk individuals identified.
Results: Outcomes were assessed between 12 and 24 months amongst 1135 high-risk
individuals. The clinical algorithm increased the proportion of high-risk individuals
identified (63.3% versus 51.4%, p¼0.028). By following the algorithm, NPHWs were able
to make clinical care recommendations identical to those of physicians in 87% of cases
studied.
Conclusion: Models of care that train and empower NPHWs to diagnose and treat high-
risk individuals appear to have considerable potential for the management of CVD in
resource poor settings.
References:
1. Joshi R, et al., Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for
Secondary Prevention in a Rural Region of India. Circulation, 2009. 119(DOI:
10.1161/CIRCULATIONAHA.108.819201): p. 1950-1955.
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
2. World Health Organization, World Health Report 2006: Working together for health
2006, WHO: Geneva.
ORAL ABSTRACTS
3. Ministry of Health and Family Welfare, Rural Health Statistics Bulletin, March 2010.
2010, Government of India: New Delhi.
O045
Safety And Effect of Adipose Tissue-Derived Stem Cell Implantation In Patients With
Critical Limb Ischemia: A Pilot Study
Han Cheol Lee*1, Jin-Sup Park1, Jae Hoon Choi2
1
Cardiology, Pusan National University Hospital, 2Cardiology, Busan Medical Center, Busan,
Korea, Republic of
Introduction: Adipose tissue-derived mesenchymal stem cells (ADSCs) are potent and
effective for inducing regeneration of damaged tissue. Treatment of critical limb ischemia
(CLI) is occasionally difficult through bypass operation or percutaneous vascular
intervention.
Objectives: ADSC transplantation shows proangiogenic action in animal hindlimb
ischemia models. We performed multiple intramuscular ADSC injections in CLI patients to
treat diabetic foot and thromboangiitis obliterans (TAO) and assessed its safety and efficacy.
Methods: The study included 15 CLI patients (15 men, median age: 52 years, range: 24–73
years) with ischemic resting pain in one limb with/without nonhealing ulcers and necrotic
foot (Rutherford class II-4: n ¼ 3, III-5: n ¼ 9, III-6: n ¼ 3) who did not undergo
nonsurgical or surgical revascularization. ADSCs were isolated from adipose tissue of TAO
patients (B-ADSCs), diabetes patients (D-ADSCs), and healthy donors (control ADSCs) by
using 0.075% collagenase digestion. In a colony forming unit (CFU) assay using stromal
vascular fraction, B-ADSCs and D-ADSCs yielded lesser colonies than normal ADSCs.
Results: Culture-expanded B-ADSCs showed normal proliferation ability compared to
control ADSCs. Adipogenic and osteogenic differentiation potential did not differ between B-
ADSCs and control ADSCs. Culture-expanded D-ADSCs showed lower proliferation ability
and osteogenic differentiation and higher adipogenic differentiation than control ADSCs.
Multiple intramuscular ADSC injections cause no complications during the follow-up
period (mean follow-up time: 6 months). Clinical improvement occurred in 66.7% of
patients. Five patients required minor amputation during follow-up. All amputation sites
healed completely. At 6 months, significant improvement was noted on pain rating scales
and in claudication walking distance. Digital subtraction angiography (DSA) before and 6
months after ADSC implantation showed formation of numerous vascular collateral net-
works across affected arteries.
Conclusion: Multiple intramuscular ADSC injections may be a safe alternative to achieve
therapeutic angiogenesis in patients with CLI who are refractory to other treatment
modalities
Disclosure of Interest: None Declared
O046
Rheumatic Fever in Indigenous Populations: a Brazilian Challenge!
Regina E. Muller*1, Fabiana F. do Nascimento1, Celeste M. Aquino1,
Maria Cristina C. Kuschnir2, Vanessa Beatriz P. Espíndola1, Melissa C. Yaakoub1,
Marcia Cristina C. M. Pinheiro1, Vitor Manuel P. Azevedo1, Aline S. Maior3,
Regina Maria A. Xavier1
1
Education and Research Department, National Institute of Cardiology - Rio De Janeiro - Brazil,
2
Adolescence Care and Research, State University of Rio de Janeiro, 3Department of Social
Services, National Institute of Cardiology - Rio De Janeiro - Brazil, Rio de Janeiro, Brazil
Introduction: Rheumatic fever (RF) remains the most common cause of acquired heart
disease in children and young adults in Brazil and accounts for ca. 1000 acute rheumatic
fever (ARF)/ 600 rheumatic heart disease RHD) admissions/year (Datasus, 2013). Amazon
region represents 59% of Brazilian territory, with ca. 20 million inhabitants and 896,900
Indians living 63.8 % in rural areas (IBGE, 2010). There are 305 indigenous ethnic groups
and 274 different languages.
Objectives: To identify the current practice adopted for ARF diagnosis and treatment
among indigenous populations in Amazon Region.
Methods: A qualitative survey was conducted with interview of 26 physicians experts in RF
in 5 regions of the country, from which two pediatric cardiologists in Amazon region.
Results: Difficulties in access to health services appear as an important factor to impact
diagnosis, treatment and prophylaxis adherence for this population, because of complex
geographic area. They may take several days traveling by boat or through flooded roads to
reach a reference center. Children usually arrive in severe condition, because of lack of
recognition of symptoms, and a bad nutritional state. Among language and cultural bar-
riers, it is difficult to have an anamnesis because of the language, habit and regularity of
health services use, and unawareness of illness. The mother speaks Portuguese more
commonly, but not always stays with the child. Tablets as captopril are not understood as
being for a children treatment. Some therapies such as cardiac surgery request not only the
parents’ but also the shamans consent. ARF diagnosis through clinical exam, lab inflam-
matory markers, echocardiography, chest XR and ECG. Treatment is similar to other pa-
tients: hospitalization, bed rest and antiinflammatory drugs. Mild carditis: AAS; moderate/
severe: Prednisone 2mg/Kg (21 days); heart failure therapy, vasoactive drugs if necessary;
nutritional support and valve surgery. After discharge they remain with nurse care in
“Indian House” (FUNASA) for 6 months. Difficulties are related in prophylaxis with
Benzathine Penicillin when return to community in remote areas, even with the support by
the Brazilian Army health care system.
e11
 Conclusion: Indigenous health status seems similar today to other impoverished groups in
our country. Access to health services and prophylaxis adherence are the major challenge
ORAL ABSTRACTS

for indigenous with RF. More research about epidemiologic RF rates is needed in Brazilian
indigenous populations.
Disclosure of Interest: None Declared

O047
Comparing Contemporary Coronary Artery Bypass Grafting Across Six Main Ethnic
Groups of New Zealand: Another Example of Inequalities In Cardiovascular Disease
Tom Kai Ming Wang*1, Tharumenthiran Ramanathan1, Sue Crengle2, Greg Gamble3,
Ralph Stewart1,3, Harvey White1,3
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2School of Population Health,
3
Department of Medicine, University of Auckland, Auckland, New Zealand
Introduction: Important ethnic differences in New Zealand (NZ) exist for cardiovascular
risk factors, events and access to cardiac interventions. Some ethnic groups worldwide have
been reported to have worse outcomes after coronary artery bypass grafting (CABG).
Objectives: We compared characteristics and outcomes of CABG by ethnicity in a
contemporary New Zealand cohort.
Methods: All patients undergoing isolated CABG at Auckland City Hospital during July
2010-June 2012 were categorised by ethnicity for analyses.
Results: There were 339 (41.4%) NZ Europeans, 82 (10.0%) Maori, 120 (14.7%)
Pacific, 111 (13.6%) Indians, 49 (6.0%) “Other Asians” and 117 (14.3%) “Others”.
Follow-up was 1.6+/-0.6 years. NZ Europeans and “Other” were older (p<0.001) and
had the highest EuroSCORE (p¼0.002). Maori and Pacific ethnicities had the highest
body mass index (p<0.001), socioeconomic deprivation NZDep2006 (p<0.001),
highest prevalence of congestive heart failure (p<0.001), smoking (p<0.001), impaired
ejection fraction (p¼0.015), renal impairment (p<0.001) and longest cardiopulmonary Conclusion: Patients with CHF-REF had a poor prognosis in China despite under current
bypass time (p¼0.004). They also had the highest 30-day mortality (p¼0.008), standard therapies, especially in patients with DCM. Predictors for all-cause mortality and
composite morbidity (p¼0.014), and worst survival during follow-up (p¼0.004). Even SCD might be identified and in order to for evaluate the prognosis of these patients.
after adjusting for baseline differences, Maori and Pacific ethnicities were independently Disclosure of Interest: None Declared
associated with higher 30-day mortality, odds ratio 5.13, 95% confidence interval 1.41-
18.7, p¼0.013; and composite morbidity OR 1.63, 1.03-2.57, p¼0.037. There was
also a trend towards higher medium-term mortality, hazards ratio 2.13, 0.99-5.40,
p¼0.053. O050
Conclusion: Despite being younger, Maori and Pacific ethnicities had the most cardio-
vascular risk factors, and were also independently associated with worse outcomes after Prior history of falls and risk of cardiovascular outcomes in atrial fibrillation:
CABG. Further research is required to identify underlying causes and strategies to reduce The Loire Valley Atrial Fibrillation Project
this disparity.
Amitava Banerjee*1, Laurent Fauchier2, Gregory Y. Lip1
Disclosure of Interest: None Declared 1
Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom,
2
Service de Cardiologie, Pôle Coeur Thorax Vasculaire, Centre Hospitalier, Universitaire
Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
O048
Introduction: Patients with non-valvular atrial fibrillation (NVAF) are often denied oral
Abstract Withdrawn anticoagulation(OAC) due to falls risk (FR). However, FR is variably defined and existing
studies have not compared the associated risk of bleeding with other cardiovascular events.
There are no data regarding outcomes in individuals with NVAF with a prior history of
falls.
O049
Objectives: To evaluate the risk of cardiovascular outcomes associated with previous falls
Clinical characteristics and long-term prognosis in patients with chronic heart failure in patients with NVAF in a contemporary ‘real world’ cohort.
and reduced ejection fraction in China Methods: Patients with NVAF in a four-hospital-institution between 2000 and 2010 were
included. Excessive FR was defined by prior history of falls. Stroke/TE event rates were
Xiaoyan Liu*, Haiiyun Yu, Juanhui Pei, Cuihong Hou, Jianmin Chu, Jielin Pu, Shu Zhang calculated according to excessive FR. Risk factors were investigated by Cox regression.
Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for Results: Among 7156 NVAF patients, prior history of falls/trauma was uncommon (n¼76;
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical 1.1%) and compared with patients without history of falls, these patients were older, less
College, Beijing, China likely to be on OAC and had higher risk scores for stroke/thromboembolism(TE) but not
for bleeding.
Introduction: Chronic heart failure with reduced ejection fraction (CHF-REF) remains to Compared with no prior history of falls, rates of stroke/TE (p¼0.01) and all-cause
be a major public health problem with high morbidity and mortality. The recent data in mortality (p<0.0001) were significantly higher in patients with previous falls. In multi-
Caucasian populations within the developed countries showed improvement in prognosis variable analyses, prior history of falls was associated with stroke/TE (hazard ratio, HR 5.19,
of patients with CHF-REF, and the etiologies of CHF had impact on mortality. However, 95% CI 2.1-12.6;p<0.0001), bleeding (HR 4.01, 1.49-10.8;p¼0.006) and all-cause mor-
the data in China were still missing. tality (HR 3.69, 1.52-8.95; p¼0.04), but not haemorrhagic stroke (HR 4.20, 0.58-30.48;
Objectives: To reveal the current treatment status, assess the long-term survival, and p¼0.16) in patients on OAC (Table 1).
identify independent predictors for all-cause mortality and sudden cardiac death (SCD) in
patients with CHF-REF due to different etiologies. Table 1. Falls and risk of cardiovascular events
Methods: Among prospectively recruited 2368 patients with CHF-REF in 10 hospitals,
2154 patients provided complete followed data. Two etiology subgroups (dilated cardio-
myopathy, DCM and ischaemic cardiomyopathy, ICM) were classified. Clinical data and Stroke and
Excessive thromboembolism Haemorrhagic stroke Bleeding All-cause mortality
long-term prognosis were analyzed.
risk of falls
Results: After a median follow-up of 52 months, 850 (39.46%) patients died, of HR (95% CI) HR (95% CI) HR (95% CI) HR (95% CI)
whom 302 (35.53%) were SCD. Unadjusted rates of all-cause mortality and SCD were Overall 1.60(0.89-2.85);p¼0.11 2.82(0.88-9.04);p¼0.08 1.53(0.75-3.10); p¼0.31 1.67(1.07-2.62);p¼0.03
higher in DCM than that in ICM (p<0.001 for both mode of death, Figure 1), but On OAC 5.19(2.1-12.6);p<0.0001 4.20(0.58-30.48); p¼0.16 4.01(1.49-10.8);p¼0.006 3.69(1.52-8.95); p¼0.04
mortalities were comparable after adjustment for co-variables (p¼0.387 and p¼0.483 No OAC 0.88(0.38-2.01); p¼0.75 3.35(0.79-14.16); p¼0.10 1.16(0.43-3.15);p¼0.77 1.28(0.74-2.21);p¼0.37
respectively). ACEIs/ARBs, aldosterone receptor antagonists, b-blockers and diuretics
were dominant prescribed drugs with the rates of 65.97%, 74.61%, 68.29% and
74.37% respectively (Figure 2). Multivariable analysis identified co-morbidities (eg,
hypertension), NHYA class, ventricular tachycardia/fibrillation (VT/VF), QRS duration, Conclusion: In this large ‘real world’ NVAF cohort, prior history of falls was un-
left ventricular EF and creatinine as independent predictors of mortalities, whereas common, but independently increased risk of stroke/TE, bleeding and mortality, but
ACEIs/ARB, b-blockers and statins were associated with better prognosis. Survived not haemorrhagic stroke in the presence of anticoagulation. Prior history of falls may be
from sustained VT/VF episodes had the highest predictive value for SCD (HR, 4.230; a more clinically useful risk prognosticator than “excessive FR”. Further study of the
95% CI, 2.500-7.157; p<0.001). The predictors for mortalities in DCM and ICM impact of falls and FR on outcomes in AF is warranted, particularly in the novel
were different. anticoagulant era.

e12 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

 Disclosure of Interest: A. Banerjee: None Declared, L. Fauchier Consultancy for: Bayer, O053
Medtronic and Sanofi Aventis , Honorarium from: Boehringher Ingelheim, Bayer, Med-

tronic, and Sanofi Aventis. , G. Lip Consultancy for: Bayer, Astellas, Merck, AstraZeneca,
Sanofi Aventis, Biotronik, BMS/Pfizer, and Boehringher Ingelheim , Speakers bureau: Bayer,
BMS/Pfizer, Boehringher Ingelheim, and Sanofi Aventis
O051
Abstract Withdrawn
O052
Model of Hypoplastic Left Heart In The Fetal Lamb Created Using A Percutaneous
Transhepatic Catheter Technique - Preliminary Experience
Andrew Edwards*1, Alex Veldman2, Ilias Nitsos1, Yuen Chan3, Nadine Brew1, Mark Teoh4,
Samuel Menahem1, Mary Jane Black5, Dietmar Schranz2, Flora Wong1
1 Objectives: We aimed to assess LV torsional function, regional deformation and diastolic
The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne,
Australia, 2Pediatric Heart Center, Justus-Liebig University, Giessen, Germany, 3Department of
Pathology, 4Perinatal Services, Monash Health, 5Department of Anatomy and Developmental
Biology, Monash University, Melbourne, Australia
Introduction: Reduced blood flow into the fetal left ventricle (LV) may lead to develop-
ment of Hypoplastic Left Heart Syndrome (HLHS), for which palliative surgery is the only
treatment option. Currently there is no large fetal animal model of HLHS for testing and
clinical translation of new therapies. We have recently published a percutaneous trans-
hepatic technique of cardiac catheterisation in a fetal lamb model, which could be utilised
to produce an animal model of HLHS.
Objectives: To use a percutaneous transhepatic catheter technique to deliver an occluder
into the foramen ovale (FO) of the fetal heart, with the aim of creating a fetal lamb model of
HLHS.
Methods: Three fetal lambs (110-117days, term¼147days) under maternal general anaes-
thesia were used. Under ultrasound guidance, the fetal hepatic vein was percutaneously
punctured through the maternal abdomen using a 14GA IV-cannula. A coronary catheter and
guidewire were inserted and advanced into the fetal IVC and right atrium. An Amplatzer Duct
Occluder II (4x4mm, St Jude Medical) was delivered to occlude the fetal FO. In 2 fetuses, a
self-expandable stent (8x12 mm Superflex-DS, 4Fr deliverable stent, OptiMed Inc., Ger-
many) was positioned across the FO first, and the ADO II was anchored within the stent. Serial
ultrasounds were performed to monitor cardiac development. Euthanasia and postmortem
examination was performed after 3 weeks. A twin fetus, which did not undergo the procedure,
was used as control. Morphometric measurements were made on digital images (Image
J1.48b, NIH) of transverse sections of the heart at the level of the atrioventricular valves.
Results: All fetal lambs survived, without evidence of compromise, until the planned
euthanasia. At postmortem examination, the LV lumen was markedly reduced (Fig 1a) with
lower LV/right ventricular (RV) chamber volume ratio and LV/RV lumen area ratio, as well
as increased septal thickness at the level of the atrioventricular valves (Table 1), in com-
parison to the control fetal heart (Fig 1b).
ORAL ABSTRACTS
Enhanced diastolic untwisting and attenuated systolic twisting rate at rest in a large
homogenous cohort of elite athletes: features of the athletes heart independent of left
ventricular morphology
Thomas G. Von Lueder*1,2, Anders Hodt3, Gard F. Gjerdalen4, Thor E. Andersen5,
Erik E. Solberg6, Kjetil Steine3
1
Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway, 2Centre of
Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne,
Australia, 3Department of Cardiology, Akershus University Hospital, 4Section of Vascular
Investigations, Oslo University Hospital Aker, 5Sports Trauma Research Center, Norwegian
School of Sport Sciences, 6Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway
Introduction: Chronic exercise may alter left ventricular (LV) filling, deformation, and
torsional function and thus augment exertional contractile reserve. Data in athletes are
conflicting and likely vary with type of cardiac conditioning. Novel tissue Doppler (TDI),
Colour M-mode (CMM), and speckle-tracking echocardiography (STE)-based techniques
may elucidate LV filling behaviour, global and regional deformation, and twist mechanics.
function in a large homogenous cohort of elite athletes.
Methods: 103 male professional football players and 46 age-matched healthy controls
underwent echocardiography including TDI, STE and CMM. STE was employed to
compute LV twist, twisting (TWR) and untwisting (UTWR) rates, and LV peak systolic
longitudinal strain (LS). LV inflow propagation velocity (Vp) by CMM, and mitral inflow
and mitral annulus velocities by Doppler and TDI, respectively, were used to evaluate LV
filling behaviour.
Results: Age, BMI, body surface area, and blood pressure were similar in both groups.
Players had lower heart rate, greater LV mass and enddiastolic volumes; all P<0.001 vs
controls. At similar Vp, Tei index and E/A ratios, players had increased ratio of early-to-
late mitral annulus velocities. Despite similar values of LV midwall and global LS,
players displayed lower basal and higher apical LS values. An incremental base-to-apex
gradient of LS was only observed in players. Peak systolic twist (TW) did not differ, but
peak systolic twist rate (TWR) was significantly lower in players (863 vs controls
1025 deg/s, P<0.01) despite slightly higher LV ejection fraction and stroke volume.
Diastolic untwisting rate (UTWR) peaked significantly earlier during the cardiac cycle
(1131 vs 1172% of systole duration, P<0.02) and was augmented in players
(-1254 vs -1077 deg/s, P<0.05), further corroborated by enhanced untwisting
performance (¼UTR/TW; -9.30.3 vs -7.40.4 s-1, P<0.01). Neither torsional me-
chanics, LV flow propagation nor systolic strains were correlated with LV wall thickness
or cavity dimensions.
Conclusion: We here show incremental basal-to-apex gradient of regional systolic LV
deformation, enhanced early-to-late diastolic mitral anular velocities and enhanced and
accelerated diastolic UTWR in elite soccer players. These myocardial biomechanical
properties at rest may reflect augmented exertional cardiac function in athletes, and may be
less dependent on LV morphology than previously anticipated.
Disclosure of Interest: None Declared

Ratio of heart Ratio of LV/RV Ratio of Septal

weight/body chamber LV/RV lumen thickness O054
Fetal hearts weight (g/kg) volume area (cm) Incremental Value of LV Strain in the Prediction of 30-day Readmission in Patients
Occluded FO 1 3.7 0.63 0.79 0.44 with Heart Failure
Occluded FO 2 4.5 0.30 0.88 0.45 Makoto Saito*1, Kazuaki Negishi1, Mehdi Eskandari2, Srikanth Koneru3, Joshua Hawson2,
Occluded FO 3 4.7 0.23 1.02 0.53 Alice Moore2, Simon Foster4, Power Janette2, Dwyer Nathan2, Thomas H. Marwick1
1
Menzies Research Institute Tasmania, 2Royal hobart hospital, Hobart, 3Launceston General
Control (n¼1) 4.1 1.0 1.54 0.23
Hospital, Launceston, 4Department of Health and Human Services, Hobart, Australia

Introduction: Heart failure (HF) readmissions are a common and serious problem of
heterogeneous etiology. Recently, LV strain has been shown to predict a variety of
outcomes.
Objectives: We set up this study to examine the hypothesis that strain would have in-
cremental value in the prediction of 30-day HF readmission over clinical and basic
echocardiographic parameters.
web 3C=FPO

Conclusion: Occlusion of the fetal lamb FO, using a percutaneous catheter technique, leads
to a phenotype which simulates HLHS, and has potential for the development of a large animal
model critical for understanding HLHS pathophysiology and devising new therapies.
Disclosure of Interest: None Declared
Methods: 482 pts who underwent echocardiography at the time of the 1st admission for
HF from July 2009 to June 2012 were studied. The clinical risk was assessed with the
coded database. We measured standard echo parameters and three strain parameters
(global longitudinal strain (GLS), global circumferential strain and right ventricular free
wall global longitudinal strain) using speckle tracking (Research Arena, Tomtec, Germany).
In pts with atrial fibrillation (AF), strain parameters were measured if the ratio of preceding
and pre-preceding intervals was 1. Pts were followed for 30-day hospital readmission or
death, and the association of several parameters with outcome was assessed using Cox
proportional hazard models.
Results: HF readmission was reported in 87 pts (18%), associated with male gender,
ischemic etiology, AF, lower LVEF and greater impairment of LV strain. In a multivariable
regression, GLS was an independent predictor of readmission. In sequential models for the
prediction of readmission, a model based on clinical parameters, LVEF and left atrial
volume was significantly improved by GLS (Figure).

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e13


ORAL ABSTRACTS
web 3C=FPO
Conclusion: GLS provides incremental value over clinical and basic echocardiographic
parameters for the prediction of HF readmission.
Disclosure of Interest: None Declared
O055
The effect of right ventricular pacing site on left ventricular myocardial deformation
Makoto Saito*1, Kazuaki Negishi1, Gerry Kaye2, Nick Linker3, Michael Gammage4,
Thomas H. Marwick1
1
Menzies Research Institute Tasmania, Hobart, 2Princess Alexandra Hospital, Brisbane,
Australia, 3James Cook University Hospital, Cleveland, 4University of Birmingham, Birmingham,
United Kingdom
Introduction: Previous studies have suggested that long-term right ventricular apex (RVA)
pacing causes dyssynchronous left ventricular (LV) contraction, promoting heart failure
and increasing mortality. Placing a lead against the right ventricular high septum (RVHS)
allows closer proximity to the His-Purkinje system and therefore may allow more physi-
ological depolarisation of the left ventricle. However, recent clinical studies regarding the
influence of pacing sites on LV function have produced conflicting results.
Objectives: We hypothesized that RVA pacing would worsen myocardial deformation
more than than RVHS pacing.
Methods: In this multicenter, randomized controlled trial of 240 pts (7411yrs, 67%
males) with preserved LVEF and implanted pacemaker due to high grade atrioventricular
block, deformation imaging was possible in 148 pts, of whom 78 were randomized to RVA
and 70 to RVHS. We measured LVEF and global longitudinal strain (GLS) using speckle
tracking (EchoPAC PC BT11: GE Healthcare, QLAB version 9.1: Philips Medical Systems)
at baseline (post pacemaker implantation) and at two years.
Results: In the RVA group, the mean LVEF at baseline was 56.88.5% and at two years
was 53.69.6 (p¼0.002) and in the RVHS baseline LVEF was 55.810.1 and at two years
53.210.4 (p¼0.013). In the RVA group, the mean GLS at baseline was -15.94.0% and
at two years was -13.94.0 (p<0.001) and in the RVHS baseline LVEF was -16.54.8 and
at two years -15.64.6 (p¼0.050). There was no significant change in LVEF between RVA
and RVHS lead position for two years (5.217.9 vs 4.423.5 %, p¼0.871), but the change
in GLS was significantly larger in RVA than that in RVHS (10.723.6 vs 3.423.2 %,
p¼0.045) (Figure).
web 3C=FPO
e14
Conclusion: RVA pacing worsens longitudinal myocardial deformation more than RVHS
pacing.
Disclosure of Interest: M. Saito: None Declared, K. Negishi: None Declared, G. Kaye
Grant/research support from: Medtronic, N. Linker Grant/research support from: Med-
tronic, M. Gammage Grant/research support from: Medtronic, T. Marwick Grant/research
support from: Medtronic
O056
Left ventricular geometry and function assessed by three-dimensional
echocardiography immediately refer to volume overload in patients on hemodialysis
Attila Kovács*1, Astrid Apor1, Andrea Nagy1, Mária Faludi2, Klára Berta2, Mihály Tapolyai2,
Béla Merkely1
1
Heart and Vascular Center, Semmelweis University, 2Fresenius Medical Care, Budapest,
Hungary
Introduction: Increasing volume load during the interdialytic period may grossly influence
cardiac volumes and performance in end-stage renal disease patients.
Objectives: We sought to investigate the instant effects of overhydration and hemodialysis
(HD) on left ventricular volumes, shape and function assessed by three-dimensional
echocardiography.
Methods: Forty-four patients (mean age 4813 years, 54% men) with end-stage renal
disease in thrice-a-week HD program, without diabetes and any significant cardiac disease
were investigated just before and immediately after HD, and were compared with 46
healthy controls (4812 years, 48% men). Beside conventional transthoracic echocardio-
graphic protocol, three-dimensional recordings were obtained using multi-beat recon-
struction from 6 consecutive cardiac cycles (GE Vivid E9). Left ventricular end-diastolic
(EDVi) and end-systolic (ESVi) volumes indexed to body surface area, ejection fraction (EF)
and sphericity were measured using dedicated software (GE 4D Auto LVQ). Serum brain-
type natriuretic peptide (BNP) levels and overhydration by bioimpedance (Fresenius Body
Composition Monitor) were measured before HD and the ultrafiltration fluid removal was
registered. Data are presented as median(interquartile range).
Results: Pre-HD EDVi, ESVi and sphericity were higher, whilst EF was lower compared to
post-HD values [pre- vs. post-HD; EDVi: 57.8(23.1) vs. 53.4(29.8), ESVi: 22.7(16.4) vs.
19.9(14.4) ml/m2, sphericity: 0.37(0.12) vs. 0.31(0.15), EF: 63(9.5) vs. 66(10) %, all
p<0.001]. Compared to controls, sphericity of the left ventricle in HD patients was
significantly higher before HD, but was similar after it [controls’ sphericity: 0.32(0.05),
p<0.01]. The volume of fluid removal correlated with the decrease in EDVi (Spearman’s
r¼0.66) and ESVi (r¼0.67, both p<0.01). Pre-HD BNP levels correlated with sphericity
(r¼0.49) and overhydration (r¼0.48, both p<0.01). In a multivariate linear regression
model (R2¼0.61, p<0.0001), BNP (b¼-0.46) and sphericity (b¼-0.46) were found to be
independent predictors of EF.
Conclusion: Left ventricular shape and function are significantly influenced by over-
hydration between hemodialysis treatments. Assessment of cardiac volumes and perfor-
mance by three-dimensional echocardiography can be useful for monitoring and
optimization of hemodialysis by reflecting volume status and thus, cardiac burden.
Disclosure of Interest: None Declared
O057
Feasibility of Perflutren Microsphere Contrast Transthoracic Echocardiography in
Assessment of Right Ventricular Endocardial Definition During VenoVenous Extra
Corporeal Membrane Oxygenation in a Validated Ovine Model
David Platts*1, Beatrice Sim1, Matthew Tunbridge1, Sara Diab1, Kimble Dunster1,
Kiran Shekar1, Darryl Burstow2, Jonathan Chan3, Charles McDonald1, John F. Fraser1
1
Critical Care Research Group, University of Queensland, 2Echocardiography Department,
3
The Prince Charles Hospital, Brisbane, Australia
Introduction: Assessment of right ventricular (RV) function is important during ECMO.
Contrast echocardiography (CE) can enhance endocardial definition, improving ventricular
function evaluation. However, with access/return cannulae in close proximity to the right
heart, adequate contrast concentration may not be delivered to the RV. Contrast microspheres
are hydrodynamically labile structures prone to destruction from shear forces/turbulent flow,
which exist within an Extra Corporeal Membrane Oxygenation (ECMO) circuit. Bubble
destruction primarily occurs within the rotor housing, where hydrodynamic pressure changes
& propulsion at several thousand RPM, collectively increase microsphere destruction.
Objectives: This study sought to assess the feasibility of contrast echocardiography (CE) in
visualising RV endocardium during Venovenous (VV) ECMO in an ovine model &
compare endocardial definition scores (EDS) with unenhanced transthoracic echocardi-
ography (UE).
Methods: Using a validated ovine model, VV ECMO was commenced with an infra-dia-
phragmatic IVC access cannula & return cannula in the RA-SVC region. A modified par-
asternal long axis (Plax) view was obtained to maximise the right ventricular cavity, pre &
post contrast, whilst on VV ECMO, using a Siemens SequoiaÔ scanner, 4V1 transducer &
contrast specific imaging. DefinityÔ contrast was diluted to 50mls with normal saline &
infused via a central venous line at rates of 200-300 mls/hr to optimise image quality. EDS
per segment (free wall¼3 segments; septum¼2 segments) were graded: 1¼excellent,
2¼good, 3¼suboptimal, 4¼not seen. Global endocardial border definition score index
(GEBDSI) was calculated and endocardial length (RV free wall & RV septal endocardium)
was also measured.
Results: 21 sheep received contrast. Mean ECMO flow¼2.750.13 l/min (range 1.46–
3.79), mean rotation¼2599107 RPM (range 1460–3290). EDS for UE vs CE imaging:
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
 1¼48vs47, 2¼30vs53, 3¼14vs3, 4¼13vs2 respectively. Wilcoxon matched-pairs rank Results: As the oxygen concentration levels increased from 150 psi to 650 psi the mean
sign test was performed, showing a significant ranking difference (improvement) pre & bubble size and number increased. The half life peaked at around 350- 450 psi and later on

post contrast (p¼0.003). GEBDSI for UE TTE was 1.920.16 and for CE TTE
1.620.11 (p¼0.06). Combined endocardial length (RV free wall+RV septum) showed a
significant difference (p<0.0001) between UE (35.92.0 mm) and CE imaging
(51.31.3 mm).
ORAL ABSTRACTS
showed a decreasing trend which is most likely explained due to the fact that as the bubble
size increases the bubbles tend to easily ascend to the top of the container, disintegrating
more quickly when compared to lower pressures. Similar results were obtained using the
strobe light microscopy which showed that the mean half life of the micro bubbles was
between 10-16 seconds, which when compared to agitated saline (AS) boluses were be-
tween 20-40 seconds. The CNSS echo contrast was used in anesthetized swine without any
adverse hemodynamic effects.
Conclusion: CNSS generated micro bubbles are biocompatible and have improved echo
contrast with longer chamber opacification. It is faster and is safer in patients with shunts,
pulmonary hypertension due to smaller bubble size and absence of nitrogen
Disclosure of Interest: None Declared

O059
Right ventricular systolic and diastolic function are impaired with normal aging and
in the presence of pulmonary vascular disease
Ee-May Chia*1, Edmund Lau2, Calvin Hsieh3, Phuong Pham1, Jane Vidaic1, Dominic Leung1,
David Celermajer2, Liza Thomas1
1
Cardiology, Liverpool Hospital, 2Cardiology, Royal Prince Alfred Hospital, 3Cardiology,
Westmead Hospital, Sydney, Australia
Introduction: The adaptability of the right ventricle (RV) is a crucial determinant of
symptoms, exercise capacity and survival in pulmonary hypertension (PHT). Reports on
the effect of exercise on the RV are currently lacking.
Objectives: To determine the effect of exercise on measures of RV systolic and diastolic
function in 3 groups: Healthy volunteers; Patients with connective tissue disease (CTD)
with and without PHT (pulmomonary artery pressure (PAP) >40mmHg).
Methods: In 121 healthy volunteers, 28 CTD patients without, and 12 CTD patients with
PHT, resting and post symptom limited treadmill exercise transthoracic echocardiograms
with expired gas analysis was performed.
RV reserve (D) is defined as the difference between post-exercise and rest values. RV
contractile reserve was measured as D RV fractional area change, tissue Doppler S’ velocity,
RV lateral wall strain and S strain rate (SSr). RV diastolic reserve was measured as D tissue
Doppler e’ and a’ velocities, ESr and ASr.
web 3C=FPO

PAP was estimated from the tricuspid regurgitant velocity plus central venous pressure.
Results:
1. RV contractile reserve measured as DS’ and DSSr but not DFAC declined signifi-
cantly with age . RV diastolic reserve declined significantly with age across all
parameters (table 1).
2. Patients with CTD with PHT had impaired RV contractile and diastolic reserve and
a higher PAP compared to healthy normals (table 2).
3. Patients with CTD without PHT had a less profound impairment of RV contractile
and diastolic reserve compared to CTD with PHT (significant DS, DSSr, DASr only)
4. Age, DS and DSSr were identified as independent predictors of absolute PAP at rest
(r¼0.52, p<0.001) and lower exercise tolerance measured as METs (r¼0.67,
Conclusion: Despite exposure to destructive hydrodynamic forces, CE is a feasible RV p<0.001)
imaging technique in an ovine VV ECMO model. CE results in significantly improved EDS
& increased length of visualised endocardium within the RV.
Disclosure of Interest: None Declared Table 1
Variable Mean R value P value
D FAC (cm2) 10.97.7 -0.072 NS
O058 D S’ (cm/s) 8.63.0 -0.31 0.004

Controlled Nucleation from Gas Supersaturated Solutions, A Novel Bio-compatible D S-Sr (s-1) 1.40.8 -0.31 0.004
Echo Contrast Agent D E-Sr (s-1) 0.970.84 -0.20 0.04
Ibrahim Shaik*1, Lakshmi Muthukumar2, Hasan Arrat3, Neelima Katukuri1, Yazan Khouri1, D ASr (s-1) 0.980.88 -0.36 0.001
Kiran Mangalpally1, Agarwal Subbashish1, Petar Prcevski1, James R. Spears1 D PAP (mmHg) 7.38.8 0.32 0.003
1
Cardiology, Oakwood Hospital and Medical Center, 2cardiology, Oakwood Hospital, 3Geriatrics,
Oakwood Hospital and Medical Center, Dearborn, United States
Introduction: Echo contrast agents like agitated saline and perflutren lipid spheres have Table 2
limitations. Micro bubbles less than 30 microns can be generated for echo contrast without Variable Controls CTDnoPHT CTDPHT
the need of surfactant, by the technique of Controlled Nucleation from Gas Supersaturated
Solutions (CNSS). Strobe light microscopy at high magnification has been used to confirm DFAC 10.97.7 8.410.4 -0.36.2*y
the mean bubble size, generated by CNSS which is cumbersome DS 8.73.0 6.22.4* 1.92.9*y
Objectives:
DS-Sr 1.20.8 0.70.7* 0.040.2*y
1. To develop an echo contrast agent which is bio-compatible
2. To study the effects of oxygen concentration on mean bubble size and density DE-Sr 0.91.0 0.71.0 0.50.6
when generated by CNSS DA-Sr 1.00.9 0.50.8* 0.40.7*
Methods: Prototype catheters coated with Galistan were used for generation of micro bubbles DPAP 2.99.3 6.99.9 11.627*
by the technique of controlled nucleation. Dissolved oxygen at high pressures ranging from
150 psi to 650 psi, was delivered through the catheter into a 500 ml container with water
generating micro bubbles with the above catheters. Echographic recording were obtained 10
different times of the echo contrast generated by the infusion of the micro bubbles at 6 different Conclusion: The ability to augment RV systolic and diastolic function decreases signifi-
pressure levels. Photometer was used to study the echo contrast density in the form of intensity cantly with age. Patients with CTD with PHT demonstrate impaired RV systolic and dia-
of light using flux units. Computerized graphs were generated for the echo contrast levels at stolic reserve, while more subtle changes are seen in CTD patients without PHT likely
baseline, peak and time taken to reach half of the density from peak. The echo contrast half life suggesting early asymptomatic but measurable changes.
was compared to the one measured using strobe light under similar conditions. Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e15

 O060 Methods: A total of 10 patients underwent serial imaging with intravascular ultrasound
(IVUS) at baseline (used as a ‘gold standard’ comparator), followed by OCT. The OCT
ORAL ABSTRACTS

Clinical Significance of Dynamic Left Ventricular Outflow Tract Obstruction during measurements were acquired during incremental intracoronary infusions of salbutamol as a
Dobutamine Stress Echocardiography in Women with Chest Pain: Chest Pain in proven microvascular vasodilator. Each IVUS and OCT runs were matched and analyzed as
Korean Women’s Registry 4mm segments using echoPlaque software. To evaluate the effects of contrast load, we
Seong-Mi Park*1, Wan-Joo Shim1, Yong-Hyun Kim2, Mi-Seung Shin3, Sung-Hee Shin4, dichotomised the groups into small and large lumen groups divided around the IVUS
Mina Kim1, Sua Kim1, Korean women’s heart disease research working group segmental lumen volume (SLV) median. Comparison between these groups were per-
1 formed with repeated measures one way ANOVA. Statistical analysis was performed with
Cardiology, Korea University College of Medicine, Seoul, 2Cardiology, Korea University College
GraphPrism.
of Medicine, Ansan, 3Cardiology, Gil hospital, 4Cardiology, Inha university, Incheon, Korea, Results: A total of 49 matched segments were available for analysis. The mean SLV of all
Republic of segments with IVUS was 79.29  4.78mm3 compared with corresponding mean SLV of all
segments with OCT, 73.52  4.56mm3. OCT measurements in the small lumen group
Introduction: Although dobutamine stress echocardiography (DSE) is frequently associ-
increased in response to incremental salbutamol dose (baseline 49.22 [30.76-69.15],
ated with dynamic left ventricular outflow tract obstruction (LVOTO), its clinical signifi-
0.3mcg salbutamol 62.47 [38.40-72.35], 0.6 mcg salbutamol 64.35 [43.85-68.56], p ¼
cance in women with chest pain is little known.
0.0077) (Figure 1) however this response was not observed in the large lumen group
Objectives: We assessed provked clinical significance of dynamic left ventricular outflow
(baseline 102.6 [78.83-115.1], 0.3mcg salbutamol 89.28 [83.39-103.3], 0.6mcg salbuta-
tract obstruction (LVOTO) by dobutamine stress echocardiography (DSE) in women with
mol 90.88 [81.36-107.2], p ¼ 0.205).
chest pain.
Methods: Of 880 women patients from chest pain in Korean women’s registry (which was
a multicenter registry of Korean women who visited in clinic for chest pain, 102 patients
(5710 years) without DSE-provoked ischemia were included. LVOTO was defined by the
presence of a systolic flow with dagger-shaped late peaking and peak LVOT pressure
gradient equal to or greater than 30mmHg in the LVOT or the midventricular area, not
present at baseline and that disappeared after the recovery phase. The presence of CAD was
defined as any epicardial coronary artery stenosis 50%. Treadmill test was also performed
in all patients and Duke treadmill score (DTS) was calculated.
Results: Fifty of 102 patients had no provoked LVOTO (group 1) and 52 (51%) had
provoked LVOTO (group 2). Group 2 were older than group 1 (p¼0.001). Group 2
had smaller LV diameter but had larger LV mass index and relative wall thickness (all
p<0.05). LV diastolic parameters including A velocity, DT and the ratio of E velocity
and early diastolic mitral annular velocity (E/e’) were worse in group 2 (all p<0.05).
In addition, peak LVOT pressure gradient was mostly related to the LV relative wall
thickness (r¼0.405, p<0.001) and DT (r¼0.328, p¼0.001) even with adjusted by
age. Of 102 patients, 83 had no CAD and all these findings were consistent with
those of all patients. There were no differences of peak LVOT pressure gradient
(p¼0.24) and prevalence of LVOTO (p¼0.73) between patients with CAD and with
no CAD, but patients with LVOTO had lower DTS (3.904.14 vs 6.323.99,
p¼0.02).

No LVOT LVOT obstruction

obstruction (n[50) (n[52) p
Conclusion: Volumetric lumen assessment with OCT is increased by 25% in response to
Early diastolic mitral inflow 64.114.7 59.310.8 0.07
contrast injection in small vessels in the setting of a reduction in microvascular resistance.
velocity (E), cm/s
As lumen size reduction and microvascular resistance occurs with significant epicardial
Late diastolic mitral inflow 59.615.4 70.117.2 0.002 coronary stenoses, this finding may have implications on stent sizing.
velocity (A), cm/s Disclosure of Interest: None Declared
deceleration time 18534 22249 <0.001
(DT), ms
E/e’ 9.12.3 10.43.1 0.01 O062
Resting LVOT pressure 6.93.4 7.73.9 0.25
Smoking and perioperative cardiovascular and medical outcomes in patients
gradient, mmHg
undergoing non-cardiac surgery
Peak LVOT pressure 18.85.0 85.339.5 <0.001
gradient, mmHg
Clara Chow*1,2, Matthew Chan3, Richard Halliwell2, Pramesh Kovoor2, Vincent Lee2,
John Mooney2, Aravinda Thiagalingam2, Severine Bompoint4, P. J. Devereaux5,
Graham Hillis6,7, The VISION investigators
1
Medicine, The George Institute, University of Sydney, 2Westmead Hospital, Sydney, Australia,
3
Conclusion: Our results demonstrate that DSE-provoked LVOTO is related to LV The Chinese University of Hong Kong, Hong Kong, Hong Kong, 4The George Institute for Global
concentric remodeling and LV diastolic dysfunction and is related to the limiting exercise Health, Sydney, Australia, 5Population Heallth Research Institute, McMaster University,
tolerance in Korean women with chest pain. Hamilton, Canada, 6Concord Hospital, 7The George Institute, University of Sydney, Sydney,
Disclosure of Interest: None Declared Australia
Introduction: Smoking is a major health hazard. Some researchers have suggested that
cessation of tobacco smoking within 8 weeks prior to surgery may increase post-operative
O061 complications.
The impact of luminal size and microvascular resistance on OCT measurements Objectives: The current study examines the importance of timing of smoking cessation
prior to surgery on major postoperative outcomes.
Samuel L. Sidharta*1, Rishi Puri1, Scott Willoughby2, Lachlan Frost1, Yu Kataoka3, Methods: The VISION study is a prospective, international cohort study that enrolled
Adam Nelson1, Angelo Carbone1, Stephen Nicholls3, Stephen Worthley1, Matthew Worthley1 16,081 patients from August 6, 2007, to January 11, 2011. Eligible patients were aged 45
1 years and older and required at least an overnight hospital admission after having
Department of Medicine, Royal Adelaide Hospital, University of Adelaide, Cardiovascular
Research Centre, 2Cardiovascular Investigation Unit, Centre for Heart Rhythm Disorders, 3South noncardiac surgery. Roche 4th generation Troponin T (TnT) was measured in all patients at
Australian Health & Medical Research Institute, Adelaide, Australia 6 to12 hours, day 1, 2 and 3 after surgery. Outcomes were assessed to 30 days. The
primary outcome in this analysis was the occurrence of death, nonfatal myocardial injury
Introduction: Optical Coherence Tomography (OCT) is a catheter based intravascular after noncardiac surgery (MINS) or nonfatal stroke. The secondary outcome was a com-
imaging modality which provides a very high resolution image of vessel wall. In acquiring posite of the primary outcome plus pneumonia, sepsis or DVT/PE. In addition, we assessed
OCT images, angiographic contrast media is injected via an injection pump (total of 14mls, each of these outcomes separately. We examined the relationship of timing to outcomes
over 4 seconds, 300psi) to achieve effective intracoronary clearance of blood for optimal using a categorical model and checked our findings using a linear trend model.
image acquisition. While at standard conditions the impact of this contrast injection may be Results: In the current analyses 15,835 (98.5%) had data on smoking, 51% had never smoked,
minimal, it has been reported that contrast media may induce vasodilation through various 30% were ex-smokers (>1 year) and 18% were current smokers (within the past year). Among
mechanisms. The influence of dye load and subsequent luminal measurements may also current smokers, 22.4% smoked on the day of surgery, 28.9% had abstained for 1 day prior to
vary at differing macro and micro vascular conditions. surgery, 23.7% for 2-14 days, 8.9% for 2 to 8 weeks and 16.1% for 9 weeks to 1 year. After
Objectives: To investigate the impact of luminal dimensions and differing microvascular adjusting for potential confounding variables, patients who stopped smoking at any time in the
resistance on human coronary artery luminal measurements acquired by OCT. year prior to surgery had a similar incidence of all post-operative outcomes examined to those

e16 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

who discontinued on the day of surgery. Fifty-one percent of current smokers resumed communities. An endgame vision of ‘No More Tobacco in the 21st’ can be realized through
smoking in the year after surgery, with 80% of these resuming within 2 weeks. youth-led tobacco-free generations in future.

Conclusion: The timing of smoking cessation prior to surgery does not impact on car-
diovascular, major medical outcomes or death in the perioperative period. Therefore,
physicians seeing a patient even within 8 weeks of surgery should have no reservations
about encouraging abstinence. Resumption of smoking after surgery is common and in-
dicates that there are opportunities to encourage more sustained abstinence.
Disclosure of Interest: None Declared
O063
Is a Heart attack really a wake up call? Rates and correlates of smoking cessation
following PCI for Acute Coronary Syndrome (ACS)
Arul Baradi*1, Nick Andrianopoulos2, Angela L. Brennan2, Andrew Teh1, Alex Huang3,
Stephen J. Duffy3, David J. Clark4, Louise Roberts1, Gishel New1, Melanie Freeman1
1
Cardiology, Eastern Health, Box Hill, 2Cardiology, CCRET - Monash University, 3Cardiology,
Alfred Hospital, Melbourne, 4Cardiology, Austin Hospital, Heidelberg, Australia
ORAL ABSTRACTS
Methods: NMT 21C or ‘No More Tobacco in the 21st Century’, a global, youth-led
campaign was adopted as the global symbol of a movement for the elimination of tobacco
in the Conference Declaration of the International Conference on Public Health Priorities in
the 21st Century in Sept. 2013, in India in presence of 600 delegates from 52 countries.
The campaign envisions a global movement empowering youth with skills to counter to-
bacco industry tactics and advocacy skills to affect radical tobacco control policies. Youth
groups will be mobilized globally to unite through innovative social media strategies, to
speak up against the tobacco industry and rally for tobacco elimination.
Results: Policy initiatives around tobacco-free youth will be explored and tested. Evidence-
based advocacy campaigns around tobacco control will be led by youth as messengers of
tobacco-free society.

Introduction: Up to 50% of smokers continue smoking following presentation with ACS.

Predictors of successful smoking cessation have not been well described in this setting.
Objectives: We sought to describe smoking cessation rates as well as predictors correlated
with successful smoking cessation in a large multicentre Australian registry.
Methods: We identified 2804 patients undergoing PCI for ACS who were currently smoking
from the Melbourne Interventional Group registry between 2005 and 2011. After exclusion of
patients who did not survive to 12 months and patients in whom data was incomplete, 1888
patients were included. Smoking cessation status was identified for these patients at 30-day
and 12-month follow up. Successful cessation was defined as cessation at 30 days, persisting
to 12 months; Delayed cessation was defined as persistent smoking at 30 days, but cessation at
12 months; Temporary cessation was defined as cessation at 30 days but relapse at 12 months;

web 3C=FPO
Unsuccessful cessation was persistent smoking at 30 days and 12 months.
Results: Successful cessation was achieved in 45% of patients, delayed cessation in 10%,
temporary cessation in 13%, while 32% were unsuccessful. Acute presentations with ST
elevation MI, cardiogenic shock and out of hospital cardiac arrest (OHCA) are associated
with higher rates of successful smoking cessation. Correlates of lower rates of cessation
were lower socioeconomic status (SES), diabetes, peripheral vascular disease (PVD), and
history of previous myocardial infarction (MI) or PCI.

Conclusion: In current tobacco use trends continue, one billion people could die in the
21st century. Youth must take this battle forward to ensure a tobacco-free society within
this century.
Disclosure of Interest: None Declared

O065
Exposing the Tobacco Industry influence in the Middle East
Wael Abd El Meguid*
Technical lead, Coalition for Tobacco Control, Cairo, Egypt

Introduction: There are greater efforts to make antismoking efforts more effective espe-
cially after adoption of the international treaty FCTC. Tobacco companies recognize the
impact of these strong tobacco control policies and globally they spend billions of dollars
working to defeat such measures in order to maintain their corporate profits.
Conclusion: Smoking cessation continues to be a difficult component of secondary pre- The industry is constantly interfering in tobacco control policies through a continuous,
vention to implement following acute coronary syndrome with nearly half of all patients systematic, and highly sophisticated multi-layer strategy that is constantly innovated.
relapsing within the first 12 months. It resorts to a variety of tactics, employ them at different levels and violate several
Disclosure of Interest: None Declared number of FCTC provisions. The type and combination of interference practices vary
depending upon how comprehensive the legislation is and if it is effectively enforced.
O064 TI tactics can be observed as either;

Mobilizing Youth for a Tobacco-Free Society: NMT 21C (No More Tobacco in the 1 practices aiming to advertise, promote and market tobacco or,
21st Century) 2 part of a strategy to weaken a government plan to improve or amend tobacco
control legislation or hold back/slow down effective initiatives.
Manjusha Chatterjee*1, Monika Arora2, Amit Yadav1, Radhika Shrivastav3, Nikunj Sharma3, Objectives: the coalition of Tobacco control and other regional partners conducted moni-
K. Srinath Reddy4 toring for the TI in order to screen tobacco industry vested interests that hamper development
1
Health Promotion, 2Director-Health Promotion, Public Health Foundation of India(PHFI), of tobacco control and health policies in order to help in planning to face them to save lives.
3
HRIDAY, 4President, Public Health Foundation of India(PHFI), New Delhi, India Methods: Common tactics known to be conducted by the TI has been identified in a
checklist and customized into 6 main categories mainly legislative, strategies against the
Introduction: A quarter of the world’s population is youth, 10-24 years of age. Everyday following policies; Ban of Tobacco Advertisement, Promotion and Sponsorship, packaging
80,000 to 100,000 young people initiate smoking, most of them in the developing countries. and labeling, Smoke Free places and Taxation rise as well as using Public relations. other 3
Of 1000 teenagers who smoke today, 500 will eventually die of tobacco related diseases- 250 partners has been identified to participate in that regional effort.
in their middle age and 250 in their old age. The tobacco industry spends millions on mar- Results:
keting strategies to reach youth and capture potential users and studies have shown that
tobacco advertising is positively related to tobacco use amongst youth, especially girls.
Objectives: Youth involvement is critical to the vision to de-normalize tobacco use and the Packaging Advertisement,
industry. Globally, children and adolescents contribute energy and creativity to catalyze a and Promotion and Smoke Free Raise Public
movement like tobacco control, that can save lives. With 10 years of the WHO FCTC, Country Legislative Labeling Sponsorship implementation Taxation relation
several countries adopting targets for minimal prevalence and availability of tobacco use
Egypt 2 6 18 9 3 4
(Norway, Finland) and others contemplating innovative and radical strategies: tobacco-free
future generations (Singapore, Tasmania), plain packaging (Australia, New Zealand), to- Lebanon 4 6 22 5 2 7
bacco-free films, gutkha ban (India), it is imperative to build youth interest in tobacco Turkey 4 3 13 10 5 7
control. Young people have been instrumental in promoting policies, programs and atti-
Pakistan 2 9 22 11 4 7
tudes to reduce the use of tobacco among their peers and within their families, schools and

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e17

 Conclusion: the TI harms the public health globaly by influencing the health policies.
Monitoring of the intererences and exposing these tactics helps a lot in facing that danger.
ORAL ABSTRACTS
Monitoring of these identified TI tactics on a regular basis is an important step as tactics
change or increase in intensity depending on the TI’s goal and local context.
Disclosure of Interest: None Declared
O066
Mechanisms of BNP interactions with neutrophil superoxide release: attenuation in
acute and chronic heart failure
Saifei Liu*1,2, Doan Ngo3, Cher-rin Chong1, Yuliy Chirkov3, Simon Stewart4, John Horowitz3
1 knockdown further reduced cell viability with H2O2 treatment (400mM, 72.71.8%;
Cardiology, University of Adelaide, 2Cardiology, Basil Hetzel Institute, 3Cardiology, The Queen
Elizabeth Hospital, Adelaide, 4Preventative Cardiology, Baker IDI Heart & Diabetes Institute,
Melbourne, Australia
Introduction: B-type natriuretic peptide (BNP) is upregulated in heart failure (HF). Although
BNP is considered cardioprotective, the net response to endogenous BNP is insufficient to
restore cardiovascular hemeostasis in HF . Equivocal clinical benefit associated with admin-
istration of a recombinant BNP, nesiritide, raises the possibility of BNP resistance in HF patients.
Objectives: To test the hypothesis that tissue responsiveness to BNP is impaired in patients
with HF.
Methods: HF patients admitted to hospital were studied both at acute presentation and
after 3 weeks’ HF therapy. Isolated neutrophils were pre-incubated with either BNP
(1mmol/L) or the cell permeable cGMP analog 8-pCPT-cGMP (500mmol/L). Superoxide
(O2-) generated in response to N-Formyl-Methionyl-Leucyl-Phenylalanine (fMLP) (1mmol/
L) and phorbol 12-myristate 13-acetate (PMA) (100nmol/L) was quantitated by EPR
spectroscopy in both healthy and HF patients. BNP effects on fMLP induced phosphory-
lation of p47phox was measured via western blot.
Results: In healthy subjects both PMA and fMLP -associated O2- production was inhibited by
BNP by 234% (n¼32, P<0.001) and 299% (n¼23, P<0.01) respectively. This effect was
not age dependent. Also, BNP suppressed fMLP induced phosphorylation of the NAD(P)H
oxidase subunit p47phox on serine345 by 7617% (n¼6, P<0.01). In acute HF patients,
there was significant attenuation of BNP effects (P<0.05 versus healthy subjects: Figure A) for
both PMA- and fMLP-induced O2- release. Treated HF patients showed no significant sensi-
tization of neutrophils to BNP (Figure B). Importantly, 8-pCPT-cGMP inhibited neutrophil
O2- release in healthy subjects, with no attenuation of this effect in acute HF patients.
Conclusion: BNP inhibits the phosphorylation of p47phox-Ser345 and neutrophil O2-
release. This effect is impaired at the level of cGMP-formation in both acute and treated HF,
potentially contributing to increased redox stress in HF.
Disclosure of Interest: None Declared
O067
STARS SiRNA knockdown altered cardiac hypertrophy associated gene expression in
cardiac myoblasts and rendered cells susceptible to hydrogen peroxide induced cell
death
Daniel P. Fothergill, Nelson W. Chong*
Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
Introduction: Changes in calcium signalling and reactivation of foetal genes is frequently
associated with maladaptive cardiac hypertrophy and heart failure. Striated muscle activator
of Rho signalling (STARS) is highly enriched in muscles. Ventricular STARS is transiently
upregulated (1 hr) after pressure overload by aortic banding, prior to detectable increase in
left ventricular mass. Transgenic mouse studies indicated STARS is involved in the tran-
sition from left ventricular hypertrophy to heart failure. STARS knockdown in zebrafish
resulted in severe cardiac abnormalities and ectopic over-expression of STARS led to
cellular hypertrophy in cardiac myoblasts. However, the mechanism of STARS is still
unclear.
Objectives: To examine the effect of STARS knockdown on gene expression and cyto-
protection in cardiac myoblasts (H9c2) using two established cell model systems of
oxidative stress [simulated ischemia-reperfusion and hydrogen peroxide (H2O2)].
Methods: Simulated ischemia-reperfusion (I/R) was done by preincubating H9c2 cells
with "ischemic buffer" (which includes sodium dithionite and 2-deoxyglucose in PBS) for
1 hr. Thereafter cells were washed and incubated with complete DMEM for the indicated
times. Gene expression was measured using quantitative PCR. STARS SiRNA were trans-
fected into cells and left for 72 hrs. Non-targeting SiRNA was used as the negative control.
e18
SiRNA targeted cells were exposed to H2O2 (16 hrs) and cell viability measured using a
MTT assay.
Results: Simulated I/R induced STARS expression with high levels at 1-2 hr post-reper-
fusion (80.8 fold, n¼4) and decreased to 2.50.2 fold at 4 hr. Elimination of sodium
dithionite abolished STARS induction. Hypertrophy associated genes were significantly
increased during reperfusion: Anp (2.51 fold), Bnp (3.50.8 fold) and Rcan1 (5.81.1
fold). STARS SiRNA reduced STARS mRNA expression by w90% and decreased expression
of b-MHC, Anp, Bnp and the anti-apoptotic gene Bcl2 by w35% (p<0.05, n¼3). STARS
knockdown attenuated Rcan1 induction during I/R (5.8 to 2.5 fold, p<0.05, n¼3) but had
no effect on Anp and Bnp expression. Hydrogen peroxide had no effect on cell viability at
400 mM but at 600 mM reduced viability to 76.24.3% (p<0.05, n¼3). However, STARS
600mM, 58.93.6%, p<0.05, n¼3).
Conclusion: STARS could play a role in cardiac hypertrophy and protection against
oxidant stress via the regulation of hypertrophic associated and anti-apoptotic genes.
Disclosure of Interest: None Declared
O068
Loss of myocardial protection against myocardial infarction in middle-aged
transgenic mice overexpressing cardiac thioredoxin-1
Virginia Perez, Verónica DAnnunzio, Cristian Garmendia, Clara Llamosas, Anabella Gómez,
Natalia Wulf, Eliana Cicale, Verónica Casanova, Ricardo J. Gelpi*
Departament of Pathology, Institute of Cardiovascular Physiopathology, Faculty of Medicine,
University of Buenos Aires, Buenos Aires, Argentina
Introduction: Thioredoxin-1 (Trx1) protects the heart from ischemia/reperfusion (I/R)
injury but this protection is abolished in elderly mice. However, it’s not clear whether this
also occurs in middle-age, when the deleterious effects of aging are already taking place.
This absence of studies in middle-aged patients is striking, since it’s known that ischemic
episodes in patients start manifesting themselves during middle-age and they are not
exclusive of advanced age.
Objectives: The present study was designed to determine whether Trx1 expression and activity,
as well as p-Akt, are altered in young and middle-aged (MA) transgenic mice overexpressing
cardiac Trx1, in a way that may contribute to increased susceptibility to myocardial I/R.
Methods: Langendorff-perfused hearts were subjected to 30 minutes of global ischemia
followed by 120 minutes of reperfusion. We used 3 and 12 month-old male wild type
(WT) mice (WT-Y, n¼8 and WT-MA, n¼7 respectively) and 3 and 12 month-old mice
overexpressing cardiac Trx1 (Trx1-Y, n¼7 and Trx1-MA, n¼6 respectively). Infarct size
(TTC) was measured. Trx1, Akt and p-Akt (Ser473) expression (western blot), Trx1 activity
(insulin reduction assay), and nitration (western blot) were also measured.
Results: Infarct size was 46.84.1% in WT-Y, 52.65.2% in WT-MA, 27.33.5% in
Trx1-Y (p<0.05), and 49.16.3% in Trx1-MA. Although Trx1 expression in Trx1-Y and
Trx1-MA was the same, Trx1 activity was significantly reduced by 57.05.2% (P< 0.05) in
Trx1-MA. The reduction in activity in Trx1-MA was accompanied by an increase in
nitration by 17.50.9% (p<0.05). The expression of p-Akt showed a significant increase
during reperfusion, with respect to the pre-ischemic values in Trx1-Y (1.550.05 AU vs.
0.960.06 AU, p< 0.05), while it did not increase during reperfusion in Trx1-MA
(0.900.08 AU vs. 0.870.10 AU).
Conclusion: As expected, Trx1 cardiac overexpression reduced infarct size in young but
not in middle-aged mice. The lack of protection in transgenic middle-aged mice even with
normal Trx1 expression may be associated to decreased Trx1 activity, increased nitration
and inhibition of p-Akt (Ser473).
Disclosure of Interest: None Declared
O069
New Zealand’s Unique Experiment: Primary prevention of rheumatic fever with a
focus on schools
Diana Lennon1, on behalf of Rheumatic Fever Epidemiology Group: Te Aro Moxon*1,
Clair Mills2, John Malcolm3, Vicki Pennock4, Margot McLean5, Peter Reed6, Neil Poskitt7,
Sue Crengle8, Catherine Jackson9, Rheumatic Fever Epidemiology Group
1
Department of Paediatrics: Child & Youth Health, The University of Auckland, Auckland,
2
Public Health, Northland District Health Board, Whangarei, 3Paediatrics, Whakatane Hospital,
Whakatane, 4Paediatrics, Waikato Hospital, Waikato, 5Public Health, Hutt Valley District
Health Board, Wellington, 6Children’s Research Centre, Starship Children’s Hospital, Auckland,
7
Lakes General Practice, Rotorua, 8Waitemata District Health Board, 9Public Health, Auckland
District Health Board, Auckland, New Zealand
Introduction: Acute rheumatic fever (ARF) incidence data is scarce. Reduction of ARF is a
NZ government priority aiming for 2/3’s reduction by 2017 using hospital discharge data.
Prospective surveillance process (Auckland Regional RF Register (ARRFR) provides free
nurse-delivered benzathine penicillin.
Objectives: An audit of ARF surveillance processes in Auckland, NZ.
Application of best surveillance method in ARF endemic areas for 10 years of retro-
spective ARF epidemiology as baseline prior to primary prevention.
Methods: Cases for 1998-2010 for children resident in Auckland aged <15 years, was
compared from the ARRFR register, hospital admissions (ICD codes I00-I02), and EpiSurv
(national notifiable disease database). Clinical records were reviewed; a consistent definition
was applied to all data sources including grading of diagnostic certainty (www.heartfoundation.
org.nz). The same methodology was applied retrospectively to other endemic areas.
Results: A total of 555 confirmed (definite and probable) Auckland ARF cases aged <15
years (mean age 9.9y) were identified from the ARRFR, including 7 recurrences. Hospital
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
admission data: 497 (91%) first presentation cases in the ARRFR, (249 cases not on the Methods: We linked data for the period 2008-2012 from a patient information system, a
register with 3 which met the case definition). The EpiSurv database found zero additional database of death certificates, the national disease control programme’s (NDCP) register, and

cases. 70% (384) of cases on the ARRFR were found on EpiSurv. An audit of 2010 RF cases
missing on EpiSurv found all had been notified to ARPHS. All but one of the ARRFR cases
were hospitalised. Annual RF rates (5-14y) were 45.2/100,000, 64.7 and 1.6 for Maori,
Pacific and all other respectively.
For 2002 to 2011 (12 health regions: 68% NZ population) cases from 3 sources found
897 cases (definite and probable) under 15y (mean age 10.0y), including 12 recurrences.
The overall annual RF rate (5-14y) was 21.4/100,000; 56.6/100,000, 65.7 and 1.3 for
Maori/Pacific/Other respectively.
Conclusion: The ARRFR is producing high quality surveillance data for Auckland. Hospital
admission and EpiSurv data are not precise surveillance tools. A limitation is case detection
in general practice. Applying the same surveillance tools outside Auckland, persisting high
rates of ARF justify the NZ Government’s primary prevention programme. Awareness
among health practitioners of a free prophylaxis service can lead to high quality epide-
miologic data for planning.
Disclosure of Interest: None Declared
O070
Echocardiographic screening for rheumatic heart disease in high-risk and low-risk
children: results of the Australian gECHO study
Kathryn Roberts1, Graeme Maguire2,3, Alex Brown2,4, David Atkinson5,6, Bo Remenyi1,7,
Marcus Ilton7, Gavin Wheaton8, Andrew Kelly8, Raman K. Kumar9, Jonathan Carapetis*10
1
Child Health, Menzies School of Health Research, Darwin, 2Baker IDI Central Australia, Alice
Springs, 3Cairns Clinical School, James Cook University, Cairns, 4Aboriginal Research Program
Leader, South Australian Health and Medical Research Institute, Adelaide, 5Rural Clinical
School, University of Western Australia, 6Kimberley Aboriginal Medical Services Council,
Broome, 7Cardiology, Royal Darwin Hospital, Darwin, 8Paediatric Cardiology, Women’s and
Children’s Hospital, Adelaide, Australia, 9Pediatric Cardiology, Amrita Institute of Medical
ORAL ABSTRACTS
information collected from echocardiography clinic registers. The numerator for the incidence
rate comprised new presentations in 2012 and for prevalence survivors to the end of 2012.
Results: In total, 4,934 records were linked to identify 2,060 RHD patients. The rate of
new presentations declined as the study progressed, consistent with a trend towards the
truly incident disease.
In 2012, 141 patients presented for the first time giving a crude national incidence rate of
16.4 per 100,000 person-years (95% CI 13.8-19.4). Echocardiographic data were available
for 88 (62%). In the Central and Eastern Divisions, where ascertainment was more com-
plete, 85 patients presented (echocardiographic data available for 76%) giving an crude
regional incidence rate of 21.7 (95% CI 17.4-26.9, Figure 1A).
In total, 1785 patients survived to the end of the study giving a crude national prevalence
of 2.1 per 1,000 persons (95% CI 2.0-2.2). Echocardiographic data were available for 1000
(56%). In the Central and Eastern Divisions, there were 1,120 survivors (711 confirmed by
echocardiography) giving a crude regional prevalence of 2.9 (95% CI 2.7-3.1, Figure 1B),
but this was higher in the iTaukei (Indigenous Fijian) population at 3.1 (95% CI 2.9-3.3)
than in the population of Indian Descent at 2.5 (95% CI 2.2-2.8).
Figure 1: Estimated A) Prevalence and B) Incidence by age in the Central and Eastern
Divisions

web 3C=FPO
Sciences, Kochi, India, 10Telethon Institute for Child Health Research, Perth, Australia

Introduction: Indigenous Australians have amongst the highest rates of rheumatic heart
disease in the world, as documented through registers of clinical cases, but an epidemio-
logic survey has never been undertaken.
Objectives: To establish the prevalence of RHD in high-risk Indigenous Australian children
in four regions of northern Australia, compare the findings with a group of Australian children
at low risk for RHD, and to determine whether echocardiographic screening is cost effective.
Methods: Portable echocardiography was performed on 3946 Aboriginal and Torres Strait
Islander children aged 5-15 years living in remote communities of the Top End of the
Northern Territory, Central Australia, Far North Queensland, and the Kimberley region of
Western Australia. A comparison group of 1053 low-risk, non-Indigenous children living
in two urban centres in the same regions was also screened. Abbreviated echocardiograms
were performed, followed by comprehensive studies in those with possible abnormalities.
Screening echocardiograms were reported off-site in a blinded, standardised fashion by
cardiologists. RHD was defined according to the 2012 World Heart Federation criteria.
Economic analysis was performed using a modified Markov model.
Results: Of 3946 remote Indigenous children screened, 34 met WHF criteria for definite
RHD (prevalence 8.6 per 1000; 95% CI 6.0-12.0), of whom 18 (53%) were previously
undiagnosed cases. 66 children met criteria for borderline RHD (prevalence 16.7 per 1000;
95% CI 13.0-21.2). Of 1053 low-risk children, none met criteria for Definite RHD, and 5
met criteria for Borderline RHD. The prevalence of Definite RHD was significantly higher in
the Top End region of the Northern Territory (15.0 per 1000, 95% CI 8.4-24.6) than the

web 3C=FPO
other 3 regions (adjusted OR 2.3, p¼0.02), and almost double that of previous register-based
estimates. There was no difference in the age, gender or BMI of the subjects to explain this
difference. Economic analysis of a screen versus no-screen approach is underway.
Conclusion: The prevalence of Definite RHD in Indigenous children in northern Australia is
similar to that of developing countries, with the highest prevalence of 1.5% observed in the
Top End. Over half of the cases of Definite RHD were previously undiagnosed. Echocar-
diographic screening for RHD in remote Indigenous Australian children may be cost effective.
Disclosure of Interest: None Declared

O071
Prevalence and incidence of rheumatic heart disease known to clinical services in Fiji:
a national historic data-linkage cohort study
Tom Parks*1,2, Samantha M. Colquhoun3,4,5, Joseph Kado6, Anne E. Miller7, Brenton Ward5,
Rachel C. Heenan3, Isimeli Tukana6, Andrew C. Steer3,5,7
1
Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, 2Faculty
of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London,
United Kingdom, 3Centre for International Child Health, University of Melbourne, Melbourne,
4
Menzies School of Health Research, Charles Darwin University, Darwin, 5Murdoch Children’s
Research Institute, Melbourne, Australia, 6Fiji Ministry of Health, Suva, Fiji, 7Royal Children’s
Hospital, Melbourne, Australia
Introduction: Rheumatic heart disease (RHD) is considered a major public health problem
in developing countries. Echocardiographic screening has demonstrated the condition af-
fects at least 8.4 per 1,000 schoolchildren in Fiji but, reflecting the situation in developing
countries worldwide, knowledge of the prevalence and the incidence across the age-
spectrum is limited.
Objectives: We aimed to estimate the number of patients who had at least one contact with
clinical services in Fiji using nationwide sources of routine clinical and administrative data.
Conclusion: There is an important burden of clinically significant RHD across the age-
spectrum in Fiji, the proportion of the population affected approaching the prevalence
reported in screening studies. With few such data available worldwide, these results have
important implications for global summary estimates of disease burden, and consequently
for public health policy.
Disclosure of Interest: None Declared
O073
The diagnostic value of chest pain and ECG changes in the assessment of dobutamine
stress echocardiography (DSE) in women and men
Karina Wierzbowska-Drabik*, Kamila Cygulska, Agnieszka Budek-Sydor,
Jarosław D. Kasprzak
Cardiology Department, Medical University of Lodz, Lodz, Poland
Introduction: Despite important position of dobutamine stress echocardiography in the
detection of coronary artery disease (CAD) the diagnostic value of chest pain and ECG

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e19

 changes recorded during DSE is poorly established especially separately in women Results: The 74 positive response patients (54.5  8.9 years; 74% females) were of similar
and men. age to the 95 negative response patients (53.1  10.7 years; 79% females) (p¼0.43).
ORAL ABSTRACTS

Objectives: To assess sensitivity, specificity, positive and negative predictive values and Differences between groups were not statistically significant apart from gender differences
accuracy of chest pain and ST segment depression above 1 mm recorded during DSE in in those with a negative response.
subjects of both sexes with clinical symptoms suggesting coronary artery disease and Conclusion: The results suggest that males without obstructive epicardial coronary disease
compare them in men and women. have increased resting microvascular resistance compared with females only when there is a
Methods: We examined 238 patients by DSE with atropine administration, 105 female, negative response to Acetylcholine provocation. This may suggest that in the absence of
mean age 629. In the whole group after DSE the status of the coronary arteries was epicardial coronary artery spasm, an increased microvascular resistance in males is
evaluated in time window of three months by angiography or computed tomography. The responsible for their presentation with chest pain.
stenosis 50% in main left and 70% in others coronary arteries were regarded as sig- Disclosure of Interest: None Declared
nificant. We recorded any chest pain reported by patient during dobutamine infusion or
recovery phase. The presence of ST segment depression was assessed according to 12-lead
ECG performed at the peak of test - immediately after discontinuation of dobutamine
because of symptoms or heart rate limit.
Results: We observed rather limited diagnostic value of isolated chest pain and ECG O075
changes during DSE in detection of CAD with slightly higher accuracy of chest pain.
Influence of high intensity training in endothelial function and oxidative stress in
Nevertheless both parameters showed moderate, exceeding 70% negative predictive value
in women and positive predictive value in men, see table. patients with heart failure
Vitor G. Angarten1, Almir Schmitt Netto1, Anderson Z. Ulbrich1, Sabrina W. Sties1,
Table 1. Diagnostic value of chest pain and ECG changes during dobutamine stress Lourenço S. de Mara1, Fernanda A. Cruz1, Edson L. da Silva2, Tales de Carvalho*1
1
echocardiography in the whole group and in women and men. Cardiology and Exercise Medicine Center, Santa Catarina State University, 2Federal University
of Santa Catarina, Florianópolis, Brazil
Introduction: There is consensus regarding the influence of exercise on morbidity and
Women Men mortality in patients with heart failure (HF), however there are doubts about the advantage
Parameter/diagnostic value All subjects N[105 N[133 of high intensity training.
Objectives: Evaluate the effect of high intensity exercise on functional capacity, circulatory
Chest pain/ECG changes oxidative stress (OS) and quality of life (QOL) in patients with high HF.
Sensitivity 58.3/59.1% 51.4/73.0% 61.1/53.3% Methods: Twenty patients with stable HF, randomized into 2 groups, underwent 12 weeks
Specificity 64.9/51.4% 64.7/44.1% 65.1/55.8% of exercise training, three times per week: moderate continue training (MCT) in target zone
of heart rate (HR) corresponding to anaerobic threshold (first ventilatory threshold) and in
Positive predictive value 65.5/58.1% 44.2/41.5% 78.6/71.6% high-intensity training (HIT) with HR corresponding to respiratory compensation point
Negative predictive value 58.1/52.3% 72.1/75.0% 44.4/36.4% (second ventilatory threshold) alternating with HR corresponding to anaerobic threshold
(recovery period). Outcomes of study: peak oxygen consumption (VO2peak) determined
Accuracy 61.3/55.5% 60.0/54.3% 62.4/54,1%
by cardiopulmonary exercise test, left ventricular ejection fraction (LVEF) and endothelial
function (EF) (flow - mediated dilation FMD) assessed by Doppler echocardiography;
superoxide dismutase (SOD) by spectrophotometry; blood pressure (BP) by auscultation
Conclusion: Chest pain and ECG changes during DSE showed moderate and gender - method; QOL by Minnesota questionnaire.
dependent diagnostic utility. Results: The VO2peak increased more in HIT (HIT: 21.2  3.9 to 24.1  4.8, p¼0,000;
Disclosure of Interest: K. Wierzbowska-Drabik Grant/research support from: The State MCT: 18.59  3.09 to 20.31  3.08, p¼0,08); LVEF increased more in HIT (HIT: 34.81 
Committee for Scientific Research, number N N402 5002 40, K. Cygulska : None Declared, 6.86 to 39.75  8.1, p¼0,01; MCT: 31,29  7,22 to 34,51  10,60, p¼0,227); FMD
A. Budek-Sydor: None Declared, J. Kasprzak Grant/research support from: The State increased significantly in the MCT (MCT: 0”: 38,825,66; 60”: 39,845,92 to 0”:
Committee for Scientific Research, number N N402 5002 40 38,985,62; 60”: 41,785,10, p¼0,03; HIT: 0”: 47,659,26; 60”: 51,029,55 to 0”:
47,447,32; 60”: 50,645,23, p¼0,063); SOD activity more increased with the HIT (HIT:
0.30  0.12 to 0.51  0.17, p¼ 0.025; MCT: 0.36  0,12 to 0.42  0.15, p¼0,456);
systolic BP decreased more in HIT (HIT: 126,5026,15 to 111,2517,36, p¼0,02; MCT:
114,2215,80 to 105,5513,66, p¼0,093).
O074 Conclusion: The HIT was superior than MCT to improve functional parameters (VO2 peak
Gender differences in coronary angiographic flow in patients without obstructive and PAs) and antioxidant activity, while the MCT was superior to improve circulatory
epicardial coronary artery disease undergoing coronary spasm provocation testing parameter (FMD), and quality of life improved without differences in both groups.
Disclosure of Interest: None Declared
David Di Fiore*1, Christopher Zeitz1, Margaret Arstall2, Abdul Sheikh1, John Beltrame1
1
Department of Cardiology, The Queen Elizabeth Hospital, Woodville, 2Department of
Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia

Introduction: It is speculated that differences in coronary microvascular disease exists O076

between gender groups who present with chest pain without obstructive epicardial coro-
nary artery disease. Functional and Structural Changes in Soccer Players and the Risk for Sudden Cardiac
Objectives: To assess coronary angiographic flow indices in patients without obstructive Death
epicardial coronary disease undergoing Acetylcholine (ACh) coronary provocation testing. Ayman Azoz*
Methods: We undertook ACh provocation testing in 169 patients where no significant Cardiac Technology, University of Dammam, Dammam, Saudi Arabia
coronary artery disease was found. Patients were administered escalating doses of intra-
coronary ACh (25mcg, 50mcg, 100mcg) until either a positive response was achieved, Introduction: Regular exercise in athletes is associated with cardiac acclimation in the form
defined as >90% vasoconstriction, or the maximum dose was given. TIMI Frame Count of functional and structural changes. Its effect on the cardiac functions still debated.
(TFC) analysis was performed on baseline images. Objectives: To detect the impact of long-term regular physical exercise on the cardiac
systolic and diastolic function of soccer players.
Methods: Thirty professional soccer players were examined twice, the first examina-
TIMI Frame Count (Frames) LAD LCx RCA Overall
tion was made during the passive resting period before the beginning of the season
(measurement I) and the second examination during the peak of the season (mea-
Positive Response (N¼74) surement II). At both examinations players underwent ECG, conventional Echo-
Males 24.8+5.5 25.7+7.5 31.5+13.3 26.3+0.3 Doppler, Pulsed TDI on both septal and lateral sides of the mitral annulus and lateral
tricuspid annulus. The (Vp) values were measured. Paired t-test was used for
Females 26.4+10.0 N/A 30.4+12.0 28.7+11.2
comparison.
P Value 0.59 N/A 0.87 0.35 Results: The following changes between measurement I and measurement II were
Negative Response (N¼95) found: The mitral E/E` ratio increased from 6.18  1.27 to 6.91  1.18; the Vp
decreased from 56.3  9.23 to 50.67  8.6; the tricuspid valve E/A ratio decreased
Males 24.2+6.6 35.3+9.4 36.8+16.6 32.9+ 12.8 from 1.67  0.23 to 1.54  0.23 while the E`/A` ratio decreased from 1.67  0.53 to
Females 23.2+7.2 31.0+12.3 26.9+9.3 27.3+10.5 1.28  0.49; the (IVRT) of the RV increased from 52.4  11.33 to 58.17  10.73;
the (IVCT) decreased from 70.47  9.9 to 65.2  7.9. All changes were statistically
P Value 0.59 0.09 <0.001 0.001
significant at P < 0.001.

e20 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals


Conclusion: Long term regular exercise in soccer players is associated with cardiac alter-
ations in the form of bradycardia, concentric LVH, and a tendency towards diastolic
impairment of both ventricles.
Disclosure of Interest: None Declared
O077
Myocardial oxygenation in hibernating myocardium: insights from blood oxygen
level dependent imaging pre and post revascularization
Suchi Grover*1,2,3, Darryl P. Leong1, Craig Bradbrook2, Angela Walls2, Jawad Mazhar3,
Joseph B. Selvanayagam1,2,3
1
Flinders University, 2Flinders Cardiovascular Magnetic Resonance Imaging, 3Cardiology,
Flinders Medical Centre, Bedford Park, Australia
Introduction: The mechanisms underlying hibernating myocardium are controversial.
Whether de-oxygenation occurs at rest and/or stress in severely dysfunctional viable (i.e.
hibernating) myocardium is currently unknown. By utlising the paramagnetic properties of
deoxy-haemoglobin, blood oxygen level dependent magnetic resonance imaging (BOLD-
MRI) can detect oxygenation and myocardial ischemia.
Objectives: We applied BOLD imaging to examine the pathophysiological relationship
between coronary stenosis, regional wall motion abnormalities (RWM), ventricular scar and
myocardial oxygenation in hibernating myocardium.
Methods: BOLD imaging was acquired at rest and stress after 5 minutes of administration
of adenosine (140mg/kg/min) and assessed quantitatively (using a BOLD signal intensity
index [stress/resting signal intensity] in 11 patients pre and median of 8 months (207, 299
days) post revascularisation. Late gadolinium (LGE) images were acquired using a T1
weighted segmented inversion recovery sequence and RWM were scored pre and post
revascularization using standard criteria. All segments were matched for BOLD, RWM and
LGE analysis. Significant stenosis were classed as >50% by QCA.
Results: BOLD signal intensity (SI) for the overall group improved from -5.117.0 at
baseline to 4.511.2%, post revascularization (p ¼ 0.001). 32% of segments evaluated did
not have a significant coronary stenosis, 45% had significant stenosis and 23% had stenosis
with collaterals. There was an inverse relationship between delta BOLD SI (difference be-
tween stress and rest BOLD SI) and the presence of significant coronary stenosis (p ¼
0.03). Post revascularization, there was an improvement in the RWM score ( p<0.001).
72% of total myocardial segments were dysfunctional (RWM score 1) before revascu-
larization, and 46% of segments improved contraction post revascularisation. Significantly,
segments that showed an improvement in RWM score of 1 post-revascularization (‘hi-
bernating segments’) also demonstrated a significant improvement in delta BOLD SI from
-3.7  11.2 to 4.5 14 (p¼ 0.03). There was no change when we excluded segments with
>75% transmural hyperenhancement.
Conclusion: The noninvasive assessment of myocardial oxygenation by BOLD imaging
offers valuable insights into the pathophysiology of hibernating myocardium. Although
preliminary, our results indicate that the BOLD response is impaired in hibernating
myocardium and that oxygenation is not down regulated in these myocardial segments.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O078
ORAL ABSTRACTS
Diagnostic Accuracy of CT Angiography vs Stress ECG in a Large Randomized
Prospective Study of Suspected Acute Coronary Syndrome Chest Pain in the ED -
“CTCOMPARE”
Christian Hamilton-Craig*1,2, Mark Hansen3, Allison Fifoot4, Johanne Neill3, Jonathan Chan3,
Matthew Pincus3, Darren L. Walters3, Kelley E. Branch5, CTCOMPARE
1
University of Queensland, Brisbane, Australia, 2University of Washington, Seattle, United
States, 3Heart & Lung Institute, 4Emergency Department, The Prince Charles Hospital, Brisbane,
Australia, 5Regional Heart Center, University of Washington, Seattle, United States
Introduction: Coronary CT Angiography (CCTA) has high sensitivity to rule out coronary
artery disease (CAD), with 3 recent ranzomised trials comparing CCTA mainly to nuclear
SPECT. Exercise stress ECG, remains the cheapest and most widely available standard of
care worldwide for chest pain assessment.
Objectives: We compared the accuracy and diagnostic performance of CCTA to exercise
stress ECG (ExECG) in a large, randomized trial.
Methods: Randomized, prospective, non-blinded single-center study conducted in a large
tertiary academic Australian hospital. Enrolled subjects with low-intermediate risk chest
pain were randomized after the first negative serum troponin to either CTCA or ExECG.
From March 2010 to April 2011, 707 low-to-intermediate risk patients with chest pain
were eligible to be enrolled. 148 patients were excluded, leaving 565 patients undergoing
randomization; 332 to CTCA and 237 to ExECG. CTCA was perfomred on dual-source CT
(Siemens Definition or Siemens Flash). ExECG was pefromred on GE-Marquette using the
Bruce Protocol. Two independent cardiologists adjudicated diagnosis using all available
data including 30 day follow up.
Results: The ExECG arm had 210 negative studies and 27 positive studies, 22 of which
were false-positive. The CCTA arm had 287 negative studies [195 with <50% stenosis and
93 with no disease] and 34 positive studies. Sensitivity and specificity are presented in
table1:
Trial arm Sensitivity Specificity PPV NPV ROC AUC
ExECG 22 100 19 98 0.59
CTCA>50 100 94.4 51.4 100 0.97
CTCA>70 94.4 99.3 89.5 99.7 0.97
ROC analysis showed an area-under-the-curve (AUC) for the prediction of ACS of 59% for ExECG, which
improved to 94% for CTCA >50% stenosis, and further improved to 97% for CTCA >70% stenosis
(figure 1). Length of stay was significantly reduced in the CCTA arm [13.5 hours (95%CI 11.2-15.7)]
compared to the SOC [20.5 hours (95%CI 17.9-23.1), p<0.0001]. Per-patient cost was significantly
lower in the CCTA arm [$2193 vs $2704, P<0.001]
web 3C=FPO
Conclusion: This represents the largest prospective, randomized trial of CCTA compared
to the least expensive and most widely available alternative standard-of-care, treadmill
exercise ECG. . Coronary CT angiography is faster, cheaper, and with superior diagnostic
accuracy than ExECG in appropriately selected patients at low-intermediate risk of coro-
nary artery disease.
Disclosure of Interest: None Declared
O079
Rapid blood pressure lowering in acute intracerebral haemorrhage: relationship of
time and intensity of treatment on haematoma growth in the INTERACT2 trial
John Chalmers*1, Christian Stapf2, Candice Delcourt1, Xia Wang1, Hisatomi Arima1,
Emma Heeley1, Yoichiro Hirakawa1, Richard Lindley1, Craig Anderson1
1
The George Institute for Global Health, Sydney, Australia, 2Department of Neurology, APHP–
Hôpital Lariboisière and DHU NeuroVasc Paris–Sorbonne, Université Paris Diderot–Sorbonne
Paris Cité, Paris, France
Introduction: The pilot phase of the INTEnsive blood pressure Reduction in Acute
Cerebral haemorrhage Trial (INTERACT1) suggested rapid blood pressure (BP) lowering
attenuates hematoma growth in acute intracerebral haemorrhage (ICH).
Objectives: This study seeks to confirm the effects of early intensive BP lowering on
haematoma growth in the main phase INTERACT2 trial. We conducted observational
e21
 analyses to investigate the effects of the degree of reduction in systolic BP (SBP), time to
achieve target SBP, and consistency of BP control on haematoma growth.
ORAL ABSTRACTS
Methods: INTERACT2 was an international, open, blinded endpoint, randomised
controlled trial. Eligible patients with spontaneous ICH within 6h of onset and elevated SBP
(150-220 mm Hg) were allocated to receive intensive (target SBP <140 mm Hg within 1h
using intravenous agents) or guideline-recommended (SBP <180 mm Hg) BP lowering
treatment. In a predefined CT substudy, 964 selected patients underwent baseline and
repeat CTs at 24h using standardised techniques with anonymised digital images analysed
centrally. Outcome was increase in haematoma volume at 24h.
Results: Mean SBP was 14.3 mm Hg lower in the intensive group than in the guideline
group during 1-24h. Absolute increase in mean haematoma volume was 3.7 ml in the
guideline group and 2.3 ml in the intensive group with an overall difference of 1.4 ml. In
observational analyses, greater reductions in SBP (<10, 10-20, 20-40 and 40 mm Hg)
were associated with lower degrees of haematoma growth (10.7, 3.1, 2.7 and 2.2 ml,
respectively; P trend<0.01). In observational analyses of 491 patients in the intensive
group alone, the lowest absolute haematoma growth was observed among patients who
achieved target SBP levels of <140 mm Hg within 1h (1.2 ml) compared to those requiring
1-6h (3.6 ml) or more than 6h (4.1 ml). Likewise, the least haematoma growth (0.4 ml) was
observed among patients who achieved the target SBP levels consistently, compared to
those who did so occasionally (1.6 ml) or rarely (3.6 ml).
Conclusion: The INTERACT2 CT substudy confirmed the effects of intensive BP lowering
on haematoma growth observed in INTERACT1. Intensive BP lowering appears to provide
maximal protection against haematoma growth, with greater degrees of SBP reduction,
achieved early and maintained consistently.
Disclosure of Interest: None Declared
O080
Impact of Blood Pressure on Retinal Microvasculature Architecture Across the Life
Course: the Young Finns Study
Robyn Tapp*1, Monira Hussain1,2, Josephine Battista1,3, Nina Hutri-Kähönen4,
Terho Lehtimäki5, Alun Hughes6, Simon McG Thom6, Andrew Metha1, Olli Raitakari7,
Mika Kähönen8
1
Department of Optometry and Vision Sciences, The University of Melbourne, 2Department of
Epidemiology and Preventive Medicine, Monash University, 3The National Vision Research
Institute, The Australian College of Optometry, Victoria, Australia, 4Department of Pediatrics,
University of Tampere, 5Department of Clinical Chemistry, Fimlab Laboratories and School of
Medicine, University of Tampere, Tampere, Finland, 6International Centre for Circulatory Health,
NHLI, St Mary’s Hospital & Imperial College, London, United Kingdom, 7Research Centre of
Applied and Preventive Cardiovascular Medicine, University of Turku and Department of Clinical
Physiology and Nuclear Medicine, University of Turku and Turku University Hospital , Turku,
8
Department of Clinical Physiology, Tampere University Hospital and the University of Tampere,
Tampere, Finland
Introduction: High blood pressure, a leading risk factor for cardiovascular disease has been
associated with adverse changes in retinal microvascular architecture. Limited research has
been conducted across the life course.
Objectives: The present study examined the impact of blood pressure from childhood to
adulthood on retinal microvascular architecture.
Methods: The Cardiovascular Risk in Young Finns Study included children aged 3 to 18
years, from five Finnish University cities, with participants chosen randomly from the
national population registrar from those areas. Complete data were available for 657 par-
ticipants with a gestation 37 weeks. Measures of retinal microvasculature architecture
included diameters, tortuosity, optimality-ratio (a measure of endothelial function),
bifurcation angles and length/diameter ratios.
Results: The mean age of the participants was 40 years (range 34 – 49 years) at the time of
retinal photography. Regression analysis showed a strong negative association between
childhood systolic blood pressure and adult arteriolar diameter (regression coefficient (b)
-0.300; p<0.001) and with change in systolic blood pressure from childhood to adulthood
(b¼-0.249; p<0.001). While for arteriolar tortuosity, there was a strong positive associ-
ation between childhood systolic blood pressure and adult arteriolar tortuosity (b¼0.154;
p<0.001) and no association with change in systolic blood pressure from childhood to
adulthood (b¼0.072; p¼0.110). Adjustment for cardiovascular risk factors risk factors in
adulthood (age, sex, body mass index, blood pressure medication, total cholesterol and
smoking) had little impact on the estimated regression coefficients.
Conclusion: High blood pressure in childhood and increased blood pressure from
childhood to adulthood appear to have a detrimental effect on retinal microvascular
architecture.
Disclosure of Interest: None Declared
O081
The use of a continuous subcutaneous infusion of Frusemide ( CSI-F) in patients with
decompensated heart failure
Jane Hannah*1, Janes Pemberton1, Helen McGrinder1, Robyn Dixon2
1
Cardiology, Auckland District Health Board, 2Nursing, University of Auckland, Auckland, New
Zealand
Introduction: Heart failure is a major health and economic burden, which is increasing
along with the aging of populations around the world. It is associated with significant
e22
mortality and morbidity with a clinical course of stable symptoms interspersed with fre-
quents hospitalisations for worsening symptoms. As symptoms of congestion progress
(weight gain, peripheral oedema, and increasing breathlessness) patients are usually
admitted to hospital for intravenous diuretics. Subcutaneous Frusemide is a possible
alternative to intravenous Frusemide.
Objectives: The purpose of this single centre, prospective pilot study was to observe the
effectiveness of a CSI-F in patients admitted to hospital with decompensated heart failure.
Methods: Fifteen patients with decompensated heart failure admitted to a Cardiology ward
at a large tertiary hospital were recruited into the study. Informed consent was obtained.
Patients were administered a CSI- via a syringe driver into the subcutaneous tissue in the
pectoral area. Dose of subcutaneous frusemide was matched to their current equivalent
daily oral dose and given over a 24 hour period. Intravenous frusemide was not given
concurrently.
Primary outcome measures consisted of weight change, 24 hour urine output, urine
sodium concentration, breathlessness and peripheral oedema scores. Safety measures were
changes in serum creatinine and skin site reactions.
Results: CSI-F was given from 12 hours to 3 days .Weight loss was achieved in all fifteen
patients with the mean daily weight loss of 1.8kg. The mean 24 hour urine volume was
3151mls/24 hours. All participants self reported a symptomatic improvement in breath-
lessness and in New York Heart Association score. No patients experienced paroxysmal
nocturnal dyspnoea after three days on the infusion. Peripheral oedema decreased also.
Five patients had a decrease in Creatinine over the period with the ten remaining patients
experiencing a transient rise only. Over the study period, all subcutaneous sites appeared
healthy with no signs of infection. One participant reported mild pain at the infusion site.
Conclusion: This pilot study has demonstrated that a CSI-F is effective in achieving a good
diuresis and is safe and acceptable to patients presenting with acute decompensated heart
failure. Further research is required to determine the utility of this mode of delivery of
frusemide for patients with heart failure in multidisciplinary management programmes
such as in an out patient environment.
Disclosure of Interest: None Declared
O082
Evidence for declining trends in sudden cardiac death in men and women from 1995
to 2010
Jia-Li Feng*1, Siobhan Hickling1, Lee Nedkoff1, Matthew Knuiman1, Christopher Semsarian2,
Jodie Ingles3, Tom Briffa1
1
School of Population Health, The University of Western Australia, Perth, 2Department of
Cardiology, Royal Prince Alfred Hospital, Sydney, 3Agnes Ginges Centre for Molecular
Cardiology, Centenary Institute, Newtown, Australia
Introduction: Out-of-hospital cardiovascular death, particularly where there is a history of
cardiovascular disease (CVD) captures an indirect estimate of sudden cardiac death (SCD).
Whether SCD rates have fallen in line with total fatal CVD rates, with and without prior
CVD - suggesting improved secondary and primary prevention respectively - is unknown.
Objectives: We examined 16-year trends in age-standardised rates for out-of-hospital
cardiovascular death in men and women without a history of hospitalisation for any cause
versus those with a CVD hospitalisation history.
Methods: Men and women were analysed separately. Hospital morbidity and death records
covering the Western Australian population aged 20 to 84 years were linked through the
statutory Data Linkage System from 1985 to 2010. International Classification of Diseases
versions 9 and 10 codes on discharge and death records were used. Age-standardised rates
calculated by the direct method using 5-year age groups. A 10-year look back was applied
to exclude any hospitalisation history and separately to define prior CVD hospitalisation.
Estimated average annual changes in rates were obtained from age-adjusted Poisson
regression models.
Results: From 1995 to 2010, 11,940 out-of-hospital cardiovascular deaths (21% no
hospitalisation history; 66% men) were identified. Mean age was 68.9 years (12.1) in men
and 74.8 years (10.0) in women, with neither changing significantly over the study
period.
Conclusion: These findings support falling age-standardised rates for SCD in men and
women from 1995 to 2010 which is consistent with previously reported total CVD trends.
Our results indicate that primary and secondary prevention interventions are reducing rates
of out-of-hospital cardiovascular death as well as total cardiovascular death. The signifi-
cantly larger annual fall in mortality in women with no hospitalisation history compared to
male counterparts merits further investigation.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O083 O085

Family Function And Congenital Heart Disease
Michelle Goldsworthy*1,2, Sharon Kinney3,4, Candice Franich-Ray5,6,7, Julia Gunn7,8,
John Beca9, Lara Shekerdemian10
1
Nursing, Melbourne University, Melbourne, Australia, 2Pediatrics, Baylor College fo Medicine,
Houston, United States, 3Pediatrics, Royal Children’s Hospital, 4Nursing, Melbourne Univeristy,
5
Psychology, Royal Children’s Hospital, 6Paediatrics, Melbourne University, 7Murdoch Children’s
Research Institute, 8Neonatology, Royal Children’s Hospital, Melbourne, Australia, 9Critical care,
Starship Children’s Hospital, Auckland, New Zealand, 10Pediatrics, Baylor College of Medicine,
Houston, United States
ORAL ABSTRACTS
Anti- tobacco TV advertising effect evaluation about local people’s tobacco controls in
Chongqing, China
XiangLong Xu1, Tao Gong1, Yong Zhang1, Chenbin Wu2, Yao Jie Xie3, Harry HX. Wang4,
Yong Zhao1, Wentao Li*5
1
School of public health and management, Chongqing Medical University, 2Chongqing Health
Education Institute, Chongqing Health Education Institute, ChongQing, 3School of Public Health,
Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China, 4General Practice
and Primary Care, University of Glasgow, Glasgow, United Kingdom, 5School of Nursing, Dalian
University, Liaoning, China

Introduction: Congenital heart disease (CHD) is one of the most common birth defects. Introduction: There are more than 300 million Chinese adult smokers, and 740 million
The most complex defects often require cardiac surgery followed by intensive care unit non-smokers exposure to secondhand smoking. It is urgent and important to carry out
admission in early infancy. The ongoing effect on the family of having a baby with CHD effective measures to control smoking. TV, a popular mass media in China, plays a sig-
that involves surgery in early infancy has been incompletely defined. nificant role in initiation as well as in tobacco control.
Objectives: To describe family function (family dynamics) and the burden of having an Objectives: To probe smoking-related behaviors influenced by tobacco ads broadcast,
infant with operated CHD (family burden), in the families of two year-olds who underwent provide the basis for further intervention, and explore an effective and suitable way of
surgery for CHD in early infancy. implementation via mass media to promote smoking control.
Methods: The primary caregivers of 99 young infants (less than 8 weeks of age) Methods: The advertisement was aired in five period of time per day in 12 channels of
that required cardiac surgery in Melbourne, Australia and Auckland, New Zealand Chongqing TV from May 15 to June 15 in 2011. A total of 1,342 local people aged
completed a series of psychosocial questionnaires assessing family function, family from 18 to 45 were selected through probability proportionate sampling and simple
burden, significant life stress, and coping style when their child with CHD was 2 random sampling. Subjects were investigated through questionnaires in late June after
years old. Data was collected regarding initial surgery complexity (RACHS-1), need the advertisement. We used chi-square tests and logistic regression analysis to analyze
for reoperation, maternal education, timing of diagnosis, and intensive care length the data.
of stay. Results: Smoking ratios are 50.9% and 6.0% in male and female, respectively. Statistically,
Results: Healthy family function was present in the majority (79%). Unhealthy family there are significant differences of smoking ratio between different age (c2¼85.72, P
function related to significant life stress (separate to that caused by CHD) (p < 0.02) <0.005); and education levels (18w25-year-old; c2¼61.44, P<0.005; 26w35-year-old:
and less adaptive (avoidance) coping style (p < .02). Unhealthy family function did not c2¼19.82, P<0.005; 36w45-year-old: c2¼4.59, P>0.100). Lower education level ac-
relate to complexity of surgery, diagnostic class, need for reoperation, intensive care companies with higher smoking ratio in
35-year-old male group and
25-year-old fe-
length of stay, or maternal education. A higher level of maternal education was asso- male group. 22.8% of smokers attempted to quit smoking as a result of seeing the
ciated with an adaptive style of coping, whereas a lower level of maternal education was advertisement. 34.6% of Smokers who have watched the advertisement contemplated to
associated with a less adaptive style of coping. There was a greater (p < .02) family reduce smoking, which is higher than that (23.8%) of smokers who didn’t see the
burden for those that required more complex surgery (RACHS-1 4, 5 & 6) compared to advertisement.
less complex surgery (RACHS-1 2 & 3) and for those that required cardiac re-operation Conclusion: Tobacco advertisement propaganda has a certain role in promoting tobacco
(p < .01). cessation and people’s perception of the dangers of tobacco and tobacco control has
Conclusion: The majority of families of two year-olds with operated CHD had healthy improved much. Since smoking is a very serious public problem in China, even a little
family function. Diagnosis or complexity of surgery was not a key factor in determining achievement in tobacco control may greatly benefit public health. Such campaign should be
family function. Family burden was greater for those that required reoperation and had a considered as a highly cost-effective and successful approach.
greater surgical complexity. A high-risk subgroup of families was identified that may Disclosure of Interest: None Declared
warrant earlier intervention with additional family support. Further research into the effects
of care giver coping style and significant life stress on the outcome of those with CHD is
warranted.
Disclosure of Interest: None Declared O088
Ventricular-vascular coupling in genetic aortopathy
Richmond Jeremy*1, Jantine Oosterhuis2
1
O084 Medicine, Unversity of Sydney, Sydney, Australia, 2Medicine, Erasmus University, Rotterdam,
Netherlands
Is A Telephone Support Program For Rural And Remote Heart Failure Patients
Cost-Effective? Introduction: Aortic stiffness is increased in genetic aortopathies, but effects on ventric-
1 2 3 3
ular-vascular coupling (VVC) are not defined. Evidence of impaired ventricular function in
Andrea Driscoll* , Danny Liew , Andrew Tonkin , Henry Krum some patients with Marfan syndrome suggests VVC may be abnormal.
1
School of Nursing and Midwifery, Deakin University/Austin health, 2Univeristy of Melbourne, Objectives: This study compared aortic stiffness, ventricular function and VVC between
3
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Marfan (MFS) and non-Marfan (non-MFS) aortopathies.
Australia Methods: Echocardiography in 97 normal controls (46 M, 51 F), 52 MFS (24 M, 28 F),
and 60 non-MFS aortopathy patients (39 M, 21 F). No patient was taking a beta-blocker.
Introduction: Telephone support for rural and remote patients with heart failure (HF) is Left ventricular and aortic geometry and ventricular ejection velocities were recorded, with
aimed at improving patient outcomes, but its cost-effectiveness is unknown. measurement of cardiac index (CI) and ejection time (ET). Aortic stiffness SAo, end-systolic
Objectives: To determine if a telephone support program for patients with HF in rural and pressure volume relation slope (Ees) and arterial elastance (Ea) were calculated, with the
remote Australia is cost-effective. index ratio Ea/Ees ¼ VVI, according to published methods. Data comparisons were by
Methods: We conducted an economic evaluation of a cluster randomised control trial of ANOVA.
405 patients diagnosed with HF in primary care practices throughout Australia. Practices Results: Aortopathy of non-Marfan type was more frequent in males (Table 1). Blood
were randomised to either telephone support in addition to usual care (n¼188) or usual pressure did not differ between groups. Aortic dilatation was principally in the aortic
care only (n¼217). Costs were estimated in both groups for HF-related care over 12 sinuses (AoSV) in Marfan, but extended into ascending aorta (AoAsc) in non-Marfan dis-
months. QOL was measured by Minnesotta Living with heart failure questionnaire and ease, with increased stiffness index. Ejection times were prolonged for both Marfan and
QALYs from the EuroQOL. Both questionnaires were completed by all patients at baseline non-Marfan, but ejection rate and Ees more impaired in Marfan than in non-Marfan
and 12 months disease (Table 2).
Results: The mean cost of the telephone support intervention was $1051over 12
months above the cost of usual care. Costs in the intervention group were higher for
medications (mean $1893 vs $990), all-cause hospitalisations (mean $4837 vs $4747) Table 1
and cardiologist fees (mean 1.85 visits and $127 vs 1.63 visits and $112). General Controls Controls MFS MFS Non-MFS Non-MFS
practitioner fees were lower in the telephone support group with fewer visits (mean
5.85 visits and $368 vs 12.55 visits and $395). Despite the higher cost of all-cause Male Female Male Female Male Female
hospitalisations in the telephone support group, there were fewer hospitalisations (74 vs Age years 37  21 41  18 32  20 36  13 46  15 a
46  14
114, adjusted HR 0.67 [95% CI 0.50-0.89], p¼0.06). The higher cost of all-cause
AoSV mm 30  4 28  3 38  6 c
40  6 c
42  5 c
38  5 c
hospitalisation was attributable to more defibrillator implantations, which accounted for
20% of the hospitalisation costs. Telephone support over the 12-month study period AoAsc mm 27  5 27  4 30  7 a
31  6 b
38  6 c
36  7 c

was estimated to be associated with an additional 0.031 QALYs at an additional cost of Psys mmHg 123  13 119  16 119  14 114  14 127  14 127  17
$2031 per patient, equating to an incremental cost-effectiveness ratio of $65,516 per Pdias mmHg 75  8 74  8 72  7 71  7 79  8 a
79  8 a
QALY gained.
Conclusion: Telephone support is likely to represent a cost-effective means of improving SAo index 9.3  6.9 8.3  4.9 20  18 c
20  10 c
26  16 c
23  18 c

outcomes among HF patients. a

p<0.05, b
p<0.01, c p<0.001 vs Controls
Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e23

 Table 2 Methods: Endothelium-dependent vasodilatation (EDV) to acetylcholine (ACh) was
measured in rat aorta and MA pre-contracted with phenylephrine (PE). Particularly in MA,
ORAL ABSTRACTS

Controls Controls MFS MFS Non-MFS Non-MFS

EDV to ACh were measured before and after pretreatment with indomethacin (cyclo-
Male Female Male Female Male Female oxygenase inhibitor), L-NAME (nitric oxide synthase (NOS) inhibitor), or barium chloride
CI l/min 2.8  0.6 2.9  0.5 2.8  0.6 2.8  0.5 2.9  0.6 3.0  0.6 (KIR blocker) plus ouabain (Na+-K+-ATPase inhibitor). Endothelium-derived NO release
ET msec 336  28 331  31 355  30 b
378  35 c
343  22 c
352  30 c was measured by monitoring contractile responses to PE before and after L-NAME treat-
ment in both aorta and MA. Finally, the mRNA expressions of endothelial NOS (eNOS)
Ea mmHg.ml -1
1.5  0.4 1.5  0.4 1.4  0.3 1.3  0.3 a
1.3  0.3 b
1.5  0.3 and subunits of NADPH oxidase (Nox) were determined.
E slope m.sec-2 19.4  6.7 17.9  5.7 11.3  3.8c 10.9  3.3c 16.8  8.6 16.0  6.0 Results: We demonstrated that diabetes impaired EDV to ACh to a greater extent in female
Ees mmHg.ml-1 2.3  0.7 2.6  0.8 1.9  0.6 a
1.8  0.5 c
1.9  0.6 a
2.4  0.6 aorta and MA than in males. In diabetic female MA, the relative importance of NO to
vascular regulation was enhanced, while the endothelium-derived hyperpolarizing factor
VVI 0.690.15 0.630.17 0.760.20a 0.780.26b 0.700.14 0.630.11
(EDHF) was reduced. The incubation of aorta and MA with L-NAME potentiated PE re-
a b
p<0.05, p<0.01, c p<0.001 vs Controls sponses in all groups. In aorta, diabetes reduced the extent of PE potentiation after L-
NAME in females to the same levels as seen in males. In contrast, in MA, diabetes enhanced
the extent of PE potentiation after L-NAME in females. The changes in PE potentiation after
Conclusion: Ventricular-vascular coupling differs between Marfan and non-Marfan dis- NOS inhibition, indicator of NO release, were correlated with the changes in eNOS mRNA
ease, with impaired systolic ejection indices in Marfan aortopathy, consistent with reduced expression in the respective tissues. Finally, the mRNA expression levels of aortic and
ventricular function. mesenteric Nox were significantly enhanced only in diabetic females.
Disclosure of Interest: None Declared

O089
In Hospital and Short Term Outcome of Hybrid Endovascular Repair of Aortic Arch
Aneurysms

web 3C=FPO
Maniyal Vijayakumar*, Naveen Mathew, Rajiv Chandrasehkar
Cardiology, Amrita Institute of Medical Sciences Kohi, Kochi, India

Introduction: The hybrid technique of open surgical supra-aortic extra-anatomic bypasses

along with simultaneous or staged thoracic endovascular grafting is less invasive than open
surgery in the treatment of complex aortic arch aneurysms. The hybrid technique allows for
an adequate proximal landing zone. The aim of the study is to report our hybrid experience
and in hospital and short term.
Objectives: To assess in hospital and short term outcome of hybrid repair of arch
aneurysms
Methods: Retrospective review of prospectively collected computerized database. All pa-
tients had regular clinical as well as computed tomography follow up.
Results: 7 patients (7 males) with mean age of 59 yrs ( Range 44-62 ) were treated with the
hybrid technique between 2012 - 2013. There were 6 elective and 1 emergency procedures. 6

web 3C=FPO
patients had arch or proximal descending aortic aneurysms and 1 had aortic dissection. All
extra-anatomic bypasses were done simultaneously with a mean operating time of 2.5 hours.
One patient underwent Type I hybrid procedure while 5 patients required partial
debranching Last patient underwent type III repair. All patients received Medtronic Devices (
Captiva / Endurant ). Deployment success was 100 % with no endoleak on completion
angiogram. There was 1 mortality. 1 patient had post-operative debilitating stroke and none of
them patient had paraplegia. The mean follow up period was 4.5 months.
The Extra-anatomic bypasses performed were:
Conclusion: These data suggest that in rat MA, the predisposition of female to vascular
No of Aneurysm injury in diabetes may be due to a shift away from EDHF, initially the major vasodilatory
cases location Extra anatomic bypass factor, toward a greater reliance on NO, and subsequent interaction of superoxide with
1 Arch Trifurcating graft from Ascending aorta to right common elevated NO. However, in rat aorta, a decrease in NO levels resulting from either decreased
carotid, left common carotid and left subclavian eNOS expression or elevated superoxide may partially contribute to the susceptibility of
females to injury in early diabetes.
1 Arch distal to Bifurcating graft from Ascending aorta to left common Disclosure of Interest: None Declared
brachiocephalic carotid and left subclavian
1 Extensive Type III Replacement of arch and arch vessels followed by
thoracic stent graft to distal thoracic aneurysms
O091
4 Arch involving Partial de branching Subclavian to subclavian
Selenium Treatment Attenuates Cardiac Fibrosis By Inhibiting Ros- Smad- Ctgf
left subclavian
Signaling Pathway In Diabetic Rats
Jiahong Xue1, Zhongwei Liu*2, Xiaolin Niu1
1
Department of Cardiology, 2Department of Cardiology, 2nd Affiliated Hospital of Xi’an Jiaotong
Conclusion: Supra-aortic hybrid procedures are a safe and effective mode of treatment for University, Xi’an, China
complex aortic disease. Our experiences with this procedure with respect to the early and
mid-term results have been encouraging. Introduction: Myocardial fibrosis is mentioned one of the hall markers of diabetic car-
Disclosure of Interest: None Declared diomyopathy, contributing to cardiac dysfunctions. Increased cardiac reactive oxidative
species (ROS) was described as the initiator of cardiac fibrosis to enhance collagen synthesis
and fibroblasts proliferation by up- regulating TGF-beta 1/ Smad signaling. As an essential
O090 trace element, selenium (Se) has cardioprotective effects because of its antioxidant property.
Shifts in Rat Aortic and Mesenteric Endothelial Responses to Streptozotocin-Induced However, its role in diabetic cardiomyopathy against myocardial fibrosis has not been
Diabetes with Respect to Sex: the Role of EDRFs and Superoxide elucidated.
Objectives: Cardiac protective effects of Se on myocardial fibrosis and its possible
Rui Zhang1, Xiaoyuan Han1, Mitra Esfandiarei1, Leigh Anderson2, Roshanak Rahimian*1 mechanisms were investigated in this study.
1
Physiology and Pharmacology, Thomas J. Long School of Pharmacy and Health Sciences, Methods: I.p. injection of streptozotocin (STZ) at 50mg/Kg was administrated to induce
University of the Pacific, Stockton, 2Physiological Sciences, Arthur A. Dugoni School of Dentistry, type 1 diabetes in rats. Supplementation of Se was performed by i.p. injection of sodium
University of the Pacific, San Francisco, United States selenite. Animals were divided into 4 groups: control group (Ctrl), diabetic group (D),
normal animal with Se treatment (N+Se) and diabetic animal with Se treatment (D+Se).
Introduction: Diabetes affects male and female vascular beds differently. However, the Intracellular generation of ROS was detected by 2’7- dichlorofluorescein staining. Activity
mechanisms underlying the interaction of sex and diabetes remain to be investigated. of cellular glutathione peroxidase (GPx) was measured by spectrophotometrical method.
Objectives: The objectives of this study were to investigate 1) whether there were sex Sirius red and Masson staining, gene expression examination of collagen type I (Coll-I)
differences in the development of abnormal vascular responses, 2) shifts in the role of and fibronectin (FN) were employed to detect myocaridal fibrosis. Gene expression ex-
endothelium-derived relaxing factors (EDRFs) in modulating vascular reactivity and 3) the amination of TGF-beta 1, phosphorylated- Smad2, Smad2, phosphorylated- Smad3,
potential role of superoxide in rat aortic and mesenteric arteries (MA), eight weeks after the Smad3 and CTGF was aimed to demonstrate the expression of Smad- CTGF signaling
induction of diabetes with streptozotocin. pathway.

e24 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

Results: Significant myocardial fibrosis characterized by Mason staining, Sirius red stain- Introduction: Patients with atrial fibrillation (AF) are commonly referred to electrophys-
ing, up-regulation of Coll-I and FN gene expression was found in diabetic rats (D), which iologists (EP) for management, which may include radio-frequency catheter ablation (RFA),

ORAL ABSTRACTS
was then attenuated by Se treatment (D+Se). Mechanically, accompanied by myocardial drug therapy or both.
fibrosis, intracellular GPx activity decreased significantly in D compared with Ctrl and Objectives: We sought to determine whether EPs who perform AF-RFA are more
N+Se, resulting in increased formation of intracellular ROS. Meanwhile, activation of Smad- likely to refer patients for this procedure compared to EPs who do not do this
CTGF signaling pathway marked by up- regulation of TGF- beta 1, phosphorylated- procedure.
Smad2/Smad2, phosphorylated- Smad3/Smad3 and CTGF was detected in D. However, Methods: The study was performed in the outpatient arrhythmia clinic of a Canadian
after treatment of Se, down- regulation of Smad- CTGF signaling pathway in D+Se tertiary care University hospital which performs 20 AF-RFA procedures per month. Patients
compared with D resulted in alleviation of myocardial fibrosis. referred for management of AF were initially seen by one of 5 EPs (3 performing AF-RFA
Conclusion: These results demonstrate that Se supplementation ameliorates myocardial and 2 who did not). All 5 EP practice in a single group. Assignment of physicians to
fibrosis in diabetic cardiomyopathy through modulating GPx/ ROS/ Smad/ CTGF signaling consecutive patients was performed by randomization of physicians. The primary outcome
pathway, whose activation may participate in myocardial fibrosis in diabetes. measure was whether or not the patient was referred for AF-RFA at the time of the initial
Disclosure of Interest: None Declared consultation.
Results: There were 128 patients seen for consultation during 10 months; 72(56%) by EP
who performed AF-RFA. Patients who were seen by an AF-RFA performing EP were
similar to those seen by a non-RFA EP regarding baseline characteristics including age,
O092 history of diabetes or hypertension. They had similar CHADS2, and HAS-BLED scores,
Presentation and Management of Acute Coronary Syndromes In Australian similar rates of prior anti-arrhythmic drug failures and previous cardioversion. Of the
Aboriginal Patients patients seen by an AF-RFA performing EP, 30 (42%) were referred for ablation
compared to 5 (9%) who were seen by EP who did not perform AF-RFA
Chris Zeitz*1, Rosanna Tavella1,2, Margaret Arstall1,3, Derek Chew4,5, Stephen Worthley1,6, (p<0.0001).Patients referred for ablation by AF-RFA EPs were older (59 vs 50 years, P¼
Matthew Worthley1,6, John Beltrame1,2 0.8), had larger LA diameter (40 vs. 37mm P ¼ 0.6) and were less likely to have failed
1
Discipline of Medicine, The University of Adelaide, 2Department of Cardiology, The Queen more than 1 anti-arrhythmic drug prior to consultation (80 vs. 100% P¼ 0.01) than
Elizabeth Hospital, 3Department of Cardiology, Lyell McEwin Hospital, 4School of Medicine, patients referred by non-AF-RFA, EPs.
Conclusion: In a randomized evaluation, EPs performing AF-RFA were 4 times more
Flinders University, 5Department of Cardiovascular Medicine, Flinders Medical Centre,
6 likely to refer a patient for RFA than EPs not performing the procedure. This difference
Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia occurred even though the participating physicians shared a group practice at an academic
Introduction: It is well recognised that Aboriginal Australians have poorer cardiovascular university hospital. These data indicate that physician bias has a major impact on clinical
outcomes compared to non-Aboriginal Australians. Evaluation of contemporary manage- decision-making and that there is a need for tools to make clinical decisions more
ment practices may provide insights into potential service improvements that could pro- consistent.
mote better outcomes.
Objectives: To compare the clinical features and hospital management of Aboriginal and Disclosure of Interest: None Declared
non-Aboriginal Australian patients undergoing coronary angiography in public hospitals in
South Australia (SA) following acute coronary syndrome (ACS).
Methods: The Coronary Angiogram Database of South Australia (CADOSA) is a O096
comprehensive registry of all public cardiac catheterization procedures performed in SA.
Data for procedures undertaken in 2012 following an ACS, were used to detail the man- Can CHADS2 score predict complications in catheter ablation of atrial fibrillation?
agement of these patients. Comparisons between Aboriginal and Torres Strait Islander Ri-Bo Tang*, Chang-Sheng Ma, Jian-Zeng Dong, De-Yong Long, Rong-Hui Yu
patients with non-Aboriginal patients were age adjusted where appropriate.
Beijing An Zhen Hospital, Beijing, China
Results: In 2012, 3,014 coronary angiogram procedures were undertaken for ACS pre-
sentation and of these, 144 (5%) were undertaken on Aboriginal and Torres Strait Introduction: CHADS2 score is widely used for evaluation of stroke risk in patients with
Islander patients. Compared to non-Aboriginal ACS patients, these patients were signif- atrial fibrillation (AF).
icantly younger (5011 vs 6413 years, p<0.01) and more likely to be female (38% vs Objectives: This study sought to explore if CHADS2 score can predict complications in
30%, OR¼2 (1.4-2.9) p<0.05). Despite their younger age, Aboriginal and Torres Strait catheter ablation of AF.
Islander patients were more likely to present with acute myocardial infarction (72% vs Methods: In this retrospective study, 251 patients undergoing catheter ablation of AF were
60%, OR¼1.6 (1.1-2.4), p¼0.012), however they were less likely to undergo percuta- enrolled. CHADS2 score was calculated as follows: two points were assigned for a history of
neous coronary intervention (PCI) (34% vs 43%, OR¼0.6 (0.4-0.8) p<0.01). CABG was stroke or transient ischemic attack and 1 point each was assigned for age 65, a history of
observed in 13% of Aboriginal and Torres Strait Islander patients; similar to non- hypertension, diabetes, recent cardiac failure.
Aboriginal patients (10%, OR¼1.4 (0.9-2.4) p¼0.214). Discharge medications are Results: Of the 251 patients, 109 patients had CHADS2 ¼0, 75 patients had CHADS2 ¼1,
described below. 67 patients had CHADS2 2. There are no differences of AF duration, AF type, left atrial
diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and
p, OR 95%CI, age ejection fraction among the three groups. There were 27 complications (10.7%). CHADS2
Presentation and Aboriginal Non-Aboriginal adjusted score was significantly higher in the patients with complications (1.41.3 VS.0.91.0,
Management P¼0.042), The incidence rate were 8.3%, 8.0%, 17.9% among the groups with
N[144 (5%) N[2870 (95%) CHADS2¼0, 1, 2, respectively (P¼0.087). The thrombotic and bleeding complications
STEMI 24% 25% 0.7 (0.5-1.1) p¼0.12 was significantly increased with CHADS2 score with the complication rate 2.8%, 6.7%,
NSTEMI 48% 35% 2.1 (1.4-2.9) p<0.01 14.9% among the five groups (P ¼ 0.023). The complication rate was significantly higher
in the patients with diabetes (32.1 VS. 8.1%, P<0.001) and previous stroke (29.4% VS.
Unstable Angina 28% 40% 0.6 (0.4-0.9) p¼0.01 9.4%, P¼0.010) than those without.
Aspirin at Discharge 87% 81% 1.4 (0.9-2.4) p¼0.17 Conclusion: CHADS2 score had an important role in the prediction of complication in
catheter ablation of AF.
Beta Blockers at Discharge 69% 52% 2.4 (1.7-3.5) p<0.01
Statin at Discharge 86% 80% 1.7 (1.1-2.8) p¼0.04 Disclosure of Interest: None Declared

Conclusion: Aboriginal ACS patients undergoing angiography are younger, more often
female and more often present with AMI compared to non-Aboriginal ACS patients.
Discharge medications are similar, however significantly less PCI procedures were un-
dertaken in Aboriginal patients. Further investigation is required to evaluate the cause of
this important disparity.
Disclosure of Interest: None Declared
O095
Referral Bias among Electrophysiologists performing atrial fibrillation
radio-frequency ablation (AF-RFA) vs electrophysiologists not performing
AF-RFA: A randomized evaluation
Naeem Alshoaibi*, Janice Kwasney, Syamkumar Divakaramenon, Jeffrey Healey, Carlos Morillo,
Stuart Connolly
Eectrophysiology, McMaster University, Hamilton, Canada
O097
World Heart Federation evidence-based echocardiographic criteria for rheumatic
heart disease allows for reproducible diagnosis
Bo Remenyi*1, on behalf of Working group on international standardization of echocardiographic
criteria for Rheumatic Heart Disease: Jonathan Carapetis2, Nigel Wilson3, Working group on
international standardization of echocardiographic criteria for Rheumatic Heart Disease
1
Menzies School of Health Research, Charles Darwin University, Darwin, 2Telethon Institute
of Child Health Research, University of Western Australia, Perth, Australia, 3Green Lane
Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland,
New Zealand
Introduction: Different echocardiographic definitions of RHD have been used for
screening for RHD. This led to the 2012 evidence-based World Heart Federation (WHF)
echocardiographic criteria for RHD.1

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e25

 Objectives: The objective of this study is to determine if the WHF criteria allow for O099
consistent and reproducible differentiation of normal echocardiographic findings from mild
ORAL ABSTRACTS

RHD and therefore to assess the usefulness of the diagnostic criteria as a clinical and Impact of High-dose Statins on Plaque Microstructures in Stable Patients with
epidemiologic tool. Coronary Artery Disease: Frequency-Domain Optical Coherence Tomography
Methods: Participants consisted of 15 international cardiologists / physicians with Analysis
considerable experience with RHD. A standard set of 100 echocardiograms was collated Yu Kataoka*1, Kiyoko Uno2, Rishi Puri2, E. Murat Tuzcu2, Steven E. Nissen2,
from population-based surveys of high risk school-aged children of Australia and New Stephen J. Nicholls1
Zealand. Echocardiograms were uploaded for blinded web-based reporting. Inter-observer 1
Heart Health Theme, South Australian Health & Medical Research Institute, Adelaide,
variability in categorizing echocardiograms as normal, borderline or definite RHD, as per
WHF criteria, was measured by comparing the individual readings made by 15 participants Australia, 2Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland,
with a reference reading. United States
Results: Of the 100 echocardiograms 99 were considered suitable for reporting. A
Introduction: Potent statin therapy has been demonstrated to reduce cardiovascular event
total of 1485 reports were analysed. Based on the reference readings distribution of
rates and induce plaque regression. While statins have been proposed to stabilize
cases were: 33 borderline RHD, 20 definite RHD and 46 normal or congenital heart
atherosclerotic plaque, this effect with potent statin therapy has not been well character-
disease. Overall agreement in categorising echocardiograms as normal, borderline and
ized in vivo. High resolution imaging with frequency domain optical coherence tomog-
definite RHD (primary end-point) was good, kappa 0.68 (95%CI 0.65-0.72) with
raphy (FD-OCT) enables visualization of microstructures associated with plaque
overall accuracy of 76.77% (95% CI 0.75-0.79). The agreement over secondary end-
vulnerability.
points, the presence of pathologic degrees of aortic and mitral valve regurgitation
Objectives: To investigate the impact of potent statin therapy on plaque microstructures by
were excellent, kappa of 0.87 (95%CI 0.8 –0.90) and 0.83 (95%CI 0.79-0.86)
using FD-OCT imaging.
respectively.
Methods: We analyzed 197 non-culprit lipid plaques in the target vessel of 187 stable
Conclusion: WHF echocardiographic criteria for RHD allows for satisfactory level of
patients with coronary artery disease who underwent FD-OCT imaging in the setting of
agreement over the diagnosis of RHD when utilized by experienced physicians. The ability
percutaneous coronary intervention. FD-OCT derived features associated with plaque
of less experienced physicians and community health workers to diagnose RHD by
vulnerability in patients treated with a low-dose (n¼77) and a high-dose statin (n¼110)
echocardiography needs to be further evaluated if echocardiographic screening is to have a
were compared.
role in RHD control in resource poor settings. Intra-observer studies of the WHF criteria are
Results: Patients treated with high-dose statin therapy were more likely to be male
in progress.
(80.0% vs. 64.9%, p¼0.03) and less likely to have hypertension (65.5% vs. 79.2%,
References:
p¼0.01). The average duration of low and high dose statin use was 447.2  600.9 and
1. Remenyi B, Wilson W, Steer A, et al. World Heart Federation criteria for
532.3  620.7, respectively (p¼0.63). Predictably, lower levels of LDL-C (81.0  35.5
echocardiographic diagnosis of rheumatic heart disease – an evidence-based
mg/dL vs. 98.4  41.8 mg/dL, p¼0.01) and total cholesterol (158.4  35.4 mg/dL vs.
guideline. Nature Reviews Cardiology 2012;9:297-309.
174.5  46.8 mg/dL, p¼0.01) were observed in patients treated with a high-dose statin.
Disclosure of Interest: None Declared
Lesion-based analysis demonstrated that lipid plaques in the high-dose statin group
exhibited smaller lipid arc (162.3  86.1 vs. 212.7  100.4 , p¼0.02) and lipid index
(866.9  747.2 vs. 1372.1  1125.5 mm , p¼0.005), and thicker fibrous cap thickness
(112.1  37.2 um vs. 91.5  31.3 um, p¼0.01), a lower frequency of microchannel
O098 (46.9% vs. 67.3%, p¼0.01) and thin-cap fibroatheroma (26.0% vs. 41.6%, p¼0.03).
Evaluation of Circulating Markers of Collagen Metabolism in Rheumatic heart valve While the benefit of a high-dose statin for fibrous cap thickness was observed in plaques
disease in Indian Subpopulation with smaller lipid index (142.2  31.1um vs. 106.6  43.6um, p¼0.004), this efficacy
was diminished in plaques with larger lipid index (89.1  34.1um vs. 79.8  43.6um,
Arun Bandyopadhyay*1, Tanima Banerjee1, Somaditya Mukherjee1, Monodeep Biswas2, p¼0.22, Figure).
Sudip Ghosh1, Santanu Dutta3, Sanjib Pattari4, Shelly Chatterjee1, Navin C. Nanda5
1
Cell Biology and Physiology, CSIR-Indian Institute of Chemical Biology, Kolkata, India,
2
Mercy Hospital, Scranton, Temple University, PA, USA, Mercy Hospital, Scranton, Temple
University, PA, USA, Scranton, United States, 3Department of Cardio-thoracic and Vascular
Surgery, Institute of Post Graduate Medical Education and Research, SSKM Hospital,
4
Department of Pathology, Rabindra Nath Tagore Institute of Cardiac Sciences, Kolkata, India,
5
Division of Cardiovascular Diseases, University of Alabama at Birmingham, Alabama,
United States

Introduction: Rheumatic Heart Disease , a common health problem in developing coun-

tries affects around 12 million people worldwide. In India, rheumatic heart disease (RHD)
is responsible for 30 to 40% of cardiovascular disease related hospital admissions. It is
primarily a hypersensitive reaction to streptococcal antigens and affects heart valves. In
general, mitral valve is affected and shows thickening and fibrosis with or without calci-
fication. Management involves medical and surgical interventions for symptom alleviation
and periodic clinical monitoring with echocardiography.
Objectives: The present study was conducted to investigate clinical implications of
extracellular matrix remodelling of mitral valve in rheumatic heart disease.
Methods: The study involved subjects with rheumatic heart disease before and after valve
replacement surgery and age and sex matched controls in Indian subpopulation. RHD was
evaluated by 2-dimensional transthoracic echocardiography. Circulating levels of markers
of collagen turnover were monitored by immunoassay. Histopathology was conducted on
excised mitral valve leaflets to examine tissue architecture and altered abundance of fibrillar
collagens.
Results: Plasma level of C terminal propeptide of type I collagen (PICP) in rheumatic heart
disease subjects (n¼75) was 400% higher than in controls (P<0.0001). Levels significantly
decreased one month after valve replacement surgery (240 %, P<0.0001). PICP was un-
detectable in control urine but was detected in urine of RHD subjects. ROC curve analysis
demonstrates PICP as the best performing marker with an AUC of 0.95. Circulating level of
matrix metalloproteinase 1 and tissue inhibitor of matrix metalloproteinase were also Conclusion: Potent statin therapy is associated with less vulnerable plaque features on
significantly higher in RHD subjects. Strong clinical associations between markers of OCT imaging. This benefit varies according to the size of plaque lipid content, with large
collagen metabolism and disease severity parameters were observed in RHD using uni- lipidic plaques appearing to be resistant to the benefits of potent statin therapy. These
variate regression analysis. Occurrence of fibrosis and inflammatory cells were clear from findings highlight the presence of plaque features on imaging that may identify patients
histopathology analysis. Arrangement and abnormal distribution pattern of collagen 1 was requiring more intensive risk factor modification.
shown in mitral valve sections. Disclosure of Interest: Y. Kataoka: None Declared, K. Uno: None Declared, R. Puri: None
Conclusion: Although fibrosis is predominantly focal valve related RHD, the rate of Declared, E. Tuzcu: None Declared, S. Nissen Grant/research support from: Pfizer,
collagen turnover is high suggesting the role of an ongoing chronic inflammation resulting AstraZeneca, Novartis, Roche, Daiichi-Sankyo, Takeda, Sanofi-Aventis, Resverlogix, and Eli
in significant elevation of biomarkers of collagen metabolism. Therefore, monitoring Lilly, S. Nicholls Grant/research support from: AstraZeneca and Lipid Sciences, Consul-
plasma PICP may guide new strategies to disease management and provide new oppor- tancy for: AstraZeneca, Pfizer, Merck Schering-Plough, Takeda, Roche, NovoNordisk,
tunities to mitigate fibrosis as a specific therapy of rheumatic heart disease. LipoScience and Anthera, Honorarium from: AstraZeneca, Pfizer, Merck Schering-Plough
Disclosure of Interest: None Declared and Takeda

e26 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

O100
Comparison of quantitative coronary angiography (QCA) with optical coherence
tomography (OCT) in the assessment of coronary artery lesion dimensions
Jawad Mazhar*, Elizabeth Shaw, Usaid K. Allahwala, Peter S. Hansen, James A. Cockburn,
Gemma A. Figtree, Ravinay Bhindi
Cardiology, Royal North Shore Hospital, Sydney, Australia
Introduction: Previous studies report a satisfactory correlation between OCT and QCA in
assessment of coronary lumen dimensions; however some variability in measurements
exists and the agreement between the two modalities by Bland-Altman plot has not been
assessed.
Objectives: Our aim was to see how well the two modalities correlate and to test for
agreement by Bland-Altman analysis.
Methods: Patients undergoing OCT for assessment of coronary artery lesions were
reviewed. Two dimensional QCA was performed on these lesions. Minimum luminal
diameter (MLD), proximal reference diameter (PRD) and distal reference diameter (DRD)
were measured for each lesion. PRD was defined as the diameter of the normal vessel
proximally but within 10 mm of the lesion and DRD as the diameter of the normal vessel
distally but within 10 mm of the lesion.
Results: OCT was performed in 64 patients between November 2010 and August 2012. 40
lesions in 38 patients were suitable for analysis by QCA and OCT. There was good cor-
relation between QCA and OCT for proximal and distal reference diameter (r¼0.72,
p<0.0001 and r¼0.87, p<0.0001 respectively) with no significant difference between the
mean PRD and mean DRD (3.18 vs. 3.25, p¼0.70 and 3.33 vs. 3.36, p¼0.90 respectively).
There was good agreement on Bland-Altman analysis; the PRD and DRD measured by QCA
were on average 0.06 mm (95% CI, -1.0 to 0.88 mm) and 0.03mm (95% CI, -0.91 to 0.85
mm) smaller than OCT respectively. There was a satisfactory correlation (r¼0.63,
p¼<0.0001) between QCA and OCT for MLD. The mean MLD by QCA was significantly
lower than by OCT (1.49 vs. 1.90, p¼0.001). On average the MLD by QCA was 0.49 mm
(95% CI, -1.576 to 0.59mm) smaller than OCT, on Bland-Altman analysis.
Conclusion: There is a good correlation and agreement between QCA and OCT for
measurement of PRD and DRD. However, the MLD was underestimated by QCA.
Disclosure of Interest: None Declared
O101
Pregnancy Outcomes After Fontan Operation
Mary Canobbio*1, Frank Cetta2, candice silversides3, Carole Warnes4, Jamil Aboulhosn5,
Jack Colman6
1 pital between 2009 -2013. Patients with diabetes, renal chronic failure and cardiac disease
Ahmanson/UCLA ACHD Center, UCLA, Los Angeles, 2Pediatric Cardiology, Mayo Clinic,
Rochester , United States, 3cardiology, University of Toronto, Toronto, Canada, 4cardiology,
Mayo Clini, Rochester, 5Cardiology, UCLA , Los Angeles, United States, 6Cardiology, Univeristy
of Toronto, Toronto, Canada
Introduction: The Fontan procedure is the definitive operation for patients with single
ventricle physiology. As more women with Fontan operations reach childbearing age, it is
important to determine the impact pregnancy has on short and long-term outcomes.
Objectives: The primary objective of this multicenter study was to determine outcomes
during and after pregnancy in women following Fontan operation.
Methods: A retrospective chart review was performed at 13 North American centers of 47
women who reported a pregnancy after Fontan operation.
Results: There were 73 pregnancies which resulted in 53 (73%) live births (12 sponta-
neous abortions, 3 therapeutic abortions, 2 fetal demise). Of the live births, the mean
gestational age was 34 (range 24-40) weeks and the median birth weight was 2169 gm
(760-3572) gms. Thirty-three percent (n¼17) of pregnancies were complicated by an
adverse maternal cardiac event; including heart failure (n¼5), arrhythmias (n¼12: atrial 10,
ventricular 2). There were no maternal deaths during pregnancy. One woman had a cardiac
arrest during delivery, but was successfully resuscitated and discharged to home. Eleven of
the adverse cardiac events occurred in the early post partum period and 1 occurring 8
month post-delivery. There was one neonatal death due to prematurity (760 gm infant).
Two children were born with CHD (ASD, VSD). Obstetrical events occurred during
pregnancy or delivery in 25/48 (52%) and 6 events occurred during the post-partum
period. Late follow up was available for 67% (29/45) of the women. The mean follow up
time after pregnancy was 7.74years (range 1-23 years). There were 5 late deaths. The mean
interval from delivery to death was 12.8 years (range 3-18 years). Cause of death included
thromboembolism (n¼2), ventricular failure (n¼2) and unknown(n¼1).
Conclusion: Pregnancy in women with Fontan circulation is associated with risk for the
mother and the baby. While there were no maternal deaths during pregnancy in this series,
it is unclear from this data if long-term maternal morbidity or mortality is affected. These
findings should form part of preconception counseling in women post-Fontan.
Disclosure of Interest: None Declared
O102
Yield of Left Ventricular Dyssynchrony as Assessed with Phase Analysis by Gated
Myocardial Perfusion SPECT in Patients with ICD or CRTD: Prediction of Cardiac
Outcome
Nili Zafrir*
Cardiology, Beilinson Campus, Rabin Medical Center, Petach Tikva, Israel
Introduction: Patients with heart failure and LVEF  35% receive implantable cardiac
defibrillator (ICD) as primary prevention although it is not activated in the majority of
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
them. In addition, among patients with heart failure and wide QRS who receive cardiac
resynchronization therapy (CRT), third of them do not demonstrate clinical improvement.
ORAL ABSTRACTS
Objectives: The aim of this study was to investigate whether mechanical LV dyssynchrony
(MLVD) by phase analysis from gated SPECT myocardial perfusion imaging (MPI), can also
be used to identify who might benefit from receiving ICD or CRTD therapy.
Methods: In a prospective study, patients post MI with LVEF  35 % who were scheduled for
ICD or CRTD underwent MPI study within a month prior procedure. The patients underwent
gated SPECT MPI with technetium 99m sestamibi (rest or rest/stress). Data for analysis
included: demographic and clinical characteristics, NYHA class.ECG criteria: Q waves, BBB,
QRS width, MPI data: MI size, ischemia size, LVEF, EDV, ESV and MLVD measured by phase
analysis including ; phase standard deviation (SD), histogram bandwidth.
Results: The study cohort consisted of 108 pts, 58 with ICD and 50 pts with CRTD. Mean age
was 68.710 and 69.012, LVEF was 25.76 and 23.77, phase SD was 61.818 and
56.719, all similar respectively. Among all variables, NYHA class and QRS width were
significantly lower in ICD versus CRTD pts: NYHA, 2.30.75 and 2.70.6 (p¼ 0.03), QRS
width 11533 and 13932 (p ¼ 0.001). The patients were followed up for mean of 439 days
(median 470 days), for cardiac death, CHF deterioration, VT/VF shock. There were 32 (29.6%)
cardiac events which were similar in both groups (P<0.09). From them 14 cardiac deaths; 10
deaths in CRTD patients compared to 4 deaths in ICD (p >0.02). By Cox proportional hazard
regression, NYHA class was the only predictor for cardiac death (p <0.003).Kaplan-Meier
curves of phase SD value of 60 significantly identified patients with and without cardiac deaths.
Conclusion: LVEF, infarct size, LV dyssynchrony were similar in ICD post MI and CRTD
patients. NYHA class was the only predictor for cardiac death in patients with ICD or
CRTD. MLVD might identify cardiac death in these patients.
Disclosure of Interest: None Declared
O103
NT-pro-BNP Levels as a Marker of Adverse Clinical Outcomes in Pregnancy
Marcela C. Cabo Fustaret*, Ana M. Escobar, Fernando F. Novo, Carlos Rivas, Ricardo Illia,
Matias Uranga Imaz, Guillermo Lobenstein, Patricia Olejnik, Roberto Mayer,
Martin De Anchorena
Cardiology-Obstetrician, Hospital Aleman, Buenos Aires, Argentina
Introduction: NT-pro-BNP probed to be a useful prognostic marker of unfavorable
outcome in cardiac failure. There were few data about its clinical significance in pregnant
women (PW) and maternal health prognosis, correlated to hard events during pregnancy.
Objectives: Evaluate the correlation between NT-pro-BNP levels and primary end-points:
death, HELLP, preeclampsia and cardiac failure in PW.
Methods: We analyzed prospectively 180 asymptomatic PW who consulted Private Hos-
were excluded.
We performed: clinical and cardiological evaluation, blood and urine determinations
included NT-pro-BNP. PW were followed-up during pregnancy and post-delivery.
Association between: death, HELLP, preeclampsia and cardiac failure, as combined end-points
were evaluated during follow-up and confronted by statistical analysis with NT-pro-BNP levels
during follow-up. The best cutoff point value for NT-pro-BNP was 125pg/ml. Statistical analyses
was performed: chi-square test for parametrical nominal data, test de Fisher with Yates’ correction.
Results: PW average age was 33.6 years, 97 PW had Hypertensive Gestational Syndromes
(HGS), in this group: gestational age at delivery 35.2 weeks, birth average weight 2466.7 gr,
first pregnancy 50.5%, fetal growth restriction 18.5%, oligoamnios 22%, stillbirth 5.1%,
maternal cardiac failure 5%, peripartum cardiopathy 1%. NT-pro-BNP average in HGS:
625.6pg/ml, non HGS: 59.9pg/ml. In this population: in 132 PW (73.3%) NT-pro-BNP
was below 125pg/ml, and 48 PW (26.7%) above this value. In the second group: 37
PW(77%) showed combined end-point vs. 20 PW (15%) in the NT-pro-BNP normal value
group, with a significant statistical association (p 0.001) by chi-square correlation 59.56 df
1, Cramer’s V 0.5887, OR 0.76 (CI 0.56-0.92) showing a negative predictive value in the
prospective follow-up. There was no correlation between NT-pro-BNP and fetal health.
web 3C/FPO
e27
 Conclusion: NT-pro-BNP levels were strongly associated with serious clinical events
during pregnancy. Its early determination could be a successful tool in high risk pregnancy
ORAL ABSTRACTS
diagnosis, even for post-delivery events.
Disclosure of Interest: None Declared
O104
Influence of the Long Interdialytic Break on the Incidence of Serious Arrhythmias and
Sudden Cardiac Death in Patients with Chronic Kidney Disease (CKD) undergoing
Haemodialysis
1,2 2 1,3 1,3 4 Effect Of A Multi-Faceted Quality Improvement Intervention To Improve
Michael Wong* , Joseph Morton , Eugenia Pedagogos , Nigel Toussaint , Stephen Joseph ,
Karen Halloran2, Jitendra Vohra1,2, Paul Sparks2, Jonathan M. Kalman1,2
1
Department of Medicine, University of Melbourne, Parkville, 2Department of Cardiology,
3
Department of Nephrology, Royal Melbourne Hospital, 4Department of Cardiology, Western
Hospital, Melbourne, Australia
Introduction: Chronic kidney disease (CKD) patients on haemodialysis (HD) have a high risk
of sudden cardiac death (SCD). Traditional SCD risk factors do not adequately explain this but
a unique risk factor may be a longer interval between HD sessions (interdialytic period, IDP).
Inherent in conventional HD (thrice-weekly) are two 48-hour (short) breaks and one 72-hour
(long) break between the start of HD sessions. Changes in electrolyte balance, ventricular
repolarization (VR) and autonomic tone (AT) may be more profound after the longer IDP.
Objectives: We used an implantable loop recorder (ILR) to define the incidence and timing
of significant arrhythmias in a HD population, comparing the impact of the long vs short
IDP (event time distribution-ETD). We used Ambulatory 24-hour Holter monitoring to
evaluate markers of arrhythmic risk according to ETD.
Methods: 50 CKD patients undergoing thrice-weekly conventional HD were recruited &
underwent ILR insertion with regular fortnightly device follow-up. Pts with left ventricular
ejection fraction < 35% were excluded. The combined primary end-point was SCD or
significant arrhythmia according to the ETD during 6 months follow-up. Ambulatory 24-
hour Holter measurements of ventricular repolarization (QT, T wave alternans (TWA)) and
autonomic tone (heart rate variability & turbulence (HRV; HRT)) were studied comparing
the long IDP vs short IDP (ETD). Serum potassium was compared according to ETD.
Results: Patients mean age 662 years; 72% male. After mean follow-up of 73 months,
there were 3 SCD (6%). All occurred during the long IDP with the terminal event being
severe bradycardia with asystole in all 3. Significant arrhythmias were seen in 14 pts (28%)
including: bradycardia (persistent rate 40bpm 4 beats) in 6 (12%); sinus arrest (pauses
3 seconds) in 3 (6%); second degree AV block in 1 (2%); & non-sustained ventricular
tachycardia (NSVT, >16 beats <30sec) in 7 (14%). The combined primary end point
occurred in 14 pts (28%) with 385/615 (63%) events occurring during the long IDP
(p<0.001). No episodes of long QT related polymorphic VT were observed.
e28
Conclusion: The risk of SCD and significant arrhythmias in this selected CKD
population undergoing HD was greatest during the long IDP. Abnormalities in serum
potassium, VR and AT resulting from the long IDP may be predisposing factors. The
mechanism and prevention of severe lethal bradycardia in these patients deserves further
evaluation.
Disclosure of Interest: None Declared
O105
Cardiovascular Disease Risk Identification And Management In Australian Primary
Health Care: The Torpedo Cluster-Randomised Trial
David Peiris*1, Tim Usherwood2, Katie Panaretto3, Mark Harris4, Jenny Hunt5, Nicholas Zwar4,
Julie Redfern1, Alan Cass6, Stephen Colagiuri2, Noel Hayman7, Anushka Patel1, TORPEDO
Study Investigators
1
George Institute for Global Health, 2University of Sydney, Sydney, 3Queensland Aboriginal
and Islander Health Council, Brisbane, 4University of New South Wales, 5Aboriginal Health
and Medical Research Council, Sydney, 6Menzies School of Health Research, Darwin, 7Inala
Indigenous Health Service, Brisbane, Australia
Introduction: Cardiovascular diseases (CVD) are the major causes of death worldwide.
Despite well-established evidence on what works to reduce CVD risk, the uptake of this
evidence into practice is limited.
Objectives: To determine whether a multifaceted quality improvement (QI) interven-
tion comprising point-of-care electronic decision support, audit and feedback tools,
and clinical workforce training improves CVD risk management when compared with
usual care.
Methods: TORPEDO was a parallel arm cluster-RCT, involving 60 Australian primary
healthcare services (40 general practices and 20 Aboriginal Medical Services). Primary
outcomes were: (1) proportion of patients receiving guideline-indicated risk factor mea-
surements; and (2) proportion of patients at high CVD risk prescribed guideline-indicated
medicines. A patient-level analysis was conducted by intention-to-treat using generalised
estimating equations to account for clustering within services. (Australian Clinical Trials
Registry No.12611000478910).
Results: 38,725 patients (mean age 61.0 (SD 12.5) years, 27% high CVD risk, 42%
men) were followed for a mean of 16 months. Median service size was 495 patients
and 45% participated in other QI programs at baseline. The intervention was associ-
ated with improvements in CVD risk factor measurements (62.8% vs 53.4% risk ratio
[RR], 1.25 [95% CI, 1.04- 1.50, p¼0.02]). In the high-risk cohort (n¼10,308), there
was a non-significant improvement in appropriate medication prescription (56.8% vs
51.2%, RR 1.11 [95% CI, 0.97 - 1.27, p¼0.13]), however, for those not prescribed
appropriate treatment at baseline (n¼5,090), the intervention was associated with a
large improvement (38.3% vs. 20.9% RR 1.59 [95% CI, 1.19 - 2.13], p<0.001). The
intervention was also strongly associated with intensification of medications for pa-
tients at high risk (new prescriptions or increased numbers of CVD medications) for
antiplatelet medications (17.9% vs 2.7%, RR 4.8 [95% CI 2.47-9.29]), lipid-lowering
medications (19.2% vs 4.8%, RR 3.22 [95% CI 1.77-5.88]) and blood pressure (BP)-
lowering medications (23.3% vs 12.1%, RR 1.89 [95% CI 1.08-3.28]). There were
significant improvements in the proportion at high risk attaining guideline BP targets
(61.0% vs 55.0%, RR 1.10 [95% CI 1.00-1.20, p¼0.05] but not lipid targets (44.3%%
vs 44.8%, RR 0.97 [95% CI 0.87-1.09], p¼0.61).
Conclusion: A multifaceted QI intervention improved CVD risk management in Australian
primary healthcare.
Disclosure of Interest: None Declared
O106
Vascular Hyper-Reactivity in Women With and Without Coronary Artery Disease
Amenah Jaghoori*1, Rachel Jakobczak2, Robert Stuklis3, Michael Worthington3, James Edwards3,
David Wilson4, John Beltrame1
1
Medicine, University of Adelaide, 2Vascular disease and Therapeutics Research group, Basil
Hetzel Institute, Basil Hetzel Institute, The Queen Elizabeth Hospital, 3Cardiothoracic surgical
unit, Royal Adelaide Hospital, 4School of Medical sciences, University of Adelaide, Adelaide,
Australia
Introduction: Women have increased in-hospital mortality following coronary artery
bypass grafting (CABG). Multiple mechanisms are implicated but sex-differences in
vascular reactivity have not been examined.
Objectives: Sex-dependent differences in vasoreactivity were assessed in isolated large- and
micro-vasculature including: 1) internal mammary artery (IMA), 2) saphenous vein (SV)
and 3) subcutaneous arteries (z250mm) from patients undergoing CABG and elective non-
cardiac surgery.
Methods: Vascular wire myography was used to determine concentration-response curves
from which half maximal effective concentration (EC50) was calculated for; endothelin-1
(Et-1), phenylephrine (PE), noradrenaline (NA), serotonin (5HT) and the thromboxane-
mimetic, U46619.
Results: Compared with men, women undergoing CABG demonstrated increased
constrictor responses to PE and 5HT in the IMA but no difference in SV (data not shown)
or subcutaneous arteries. In contrast, subcutaneous arteries in women without a history of
cardiovascular disease (healthy controls) show increased sensitivity to U46619, 5HT and
PE, compared with men. *p < 0.05.
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
 intervention (HBI) reduces hospital readmissions, future cardiac events and death in pa-
Controls (undergoing
tients at high risk of chronic heart disease.

ORAL ABSTRACTS
EC50 Coronary Artery Disease non-cardiac surgery;
Methods: Multicentre, randomised trial involving privately insured, hospitalised cardiac
(Mean±SEM) (undergoing CABG; n[80) n[43)
patients (n¼602; aged 45 years). Subjects were randomised into HBI (n¼306) or usual
IMA Large vessel Subcutaneous Subcutaneous care (UC; n¼296). HBI comprised at least one home visit (7-14 days post discharge) by a
Vasculature segments microvessels microvessels cardiac nurse, regular telephone calls and referrals to primary care physicians, pharmacists
and medical services. Baseline screening for potential depression using the PHQ-2 and The
Male Female Male Female Male Female
Centre for Epidemiologic Studies Depression Scale (CESD) was applied. Health outcomes
Et-1 (nM) 11.91.7 12.92.2 8.21.4 14.73.9 10.31.4 9.51.3 during an average of 2.5 years follow-up were then compared according to depression
U46619 (nM) 6.5  1.2 3.40.9 9.93.6 5.21.0 39.78.6 11.32.1* status.
Results: The HBI and UC groups were well matched by age (69.59.9 versus 69.89.3
5HT (mM) 0.8  0.3 0.10.03* 0.10.04 0.10.02 6.93.0 0.30.2*
years), gender (males, 70.3% versus 73.0%) and risk of depression (CESD16, 16.1%
NA (mM) 0.3  0.1 0.2  0.1 0.20.1 0.20.1 0.70.1 0.50.1 versus 13.9%). After adjusting for age, gender, smoking status and alcohol risk, logistic
PE (mM) 3.8  1.8 1.1  0.3* 1.00.2 0.80.2 8.71.4 2.90.5* regression analysis showed that, depressive status in the HBI group was associated with
increased risk of all-cause mortality (CESD16, 16.3% versus 7.0% adjusted odds ratio
[OR]¼3.9, 95%CI 1.4-10.6, p<0.01), a future cardiac event (e.g. acute myocardial
Mechanistic studies evaluating female hypersensitivity to PE in IMA segments, demon- infarction, unstable angina; PHQ-2, 62.7% versus 42.9% OR¼2.8; 95%CI 1.5-5.2,
strated (1) no sex difference in total a1 and b2 adrenoreceptor abundance by Western blot p<0.01) and an unplanned hospital readmission (PHQ-2, 57.3% versus 39.4% OR¼2.3;
analysis, (2) persistence of the observed sex-difference following nitric oxide synthase in- 95%CI 1.3-4.1, p<0.01). Additionally, male HBI depressive status was associated with
hibition by L-NAME, (3) the cyclooxygenase inhibitor indomethacin abolished the sex increased risk of all-cause mortality (PHQ-2, 20.0% versus 7.6% OR¼4.2; 95%CI 1.4-12.0,
difference in vascular reactivity. p<0.01) and future cardiac events (PHQ-2, 68.9% versus 35.9% OR¼4.5; 95%CI 2.1-9.4,
Conclusion: For the first time, female vascular hyper-reactivity in both large graft arteries p<0.001). No such observations were made in those randomised to UC.
(IMA) and microvessels has been demonstrated. In part, this may be due to sex-differences Conclusion: Screening for depression in cardiac patients receiving HBI has the potential to
in prostanoid activity. The IMA hyper-reactivity in women may contribute to their poorer predict, but not attenuate, poor health outcomes, particularly in male patients. Future
outcomes following CABG and microvascular differences amongst patients without programs need to be modulated accordingly to respond to this elevated risk.
documented cardiovascular disease may pre-dispose them to hypertension. Disclosure of Interest: None Declared
Disclosure of Interest: None Declared
O110
O107
High Sensitivity-Troponin Elevation Secondary to Other Diagnosis and Major
Depressive symptoms mediate the relationship between sleep quality and health- Adverse Cardiac Event at 12-months
related quality of life in heart failure
Nasser J. Alhammad*1, Matthew Horsfall2, Julia Zhou3, Pey Wen Lou4, Penelope Coates5,
An-Yun Yeh*1, Susan J. Pressler1, Seongkum Heo2, Debra K. Moser3, Sandra B. Dunbar4, Ian Scott6, Tom Briffa7, David Brieger8, John French9, Derek P. Chew4
JinShil Kim5, Eun Kyeung Song6, Terry A. Lennie3 1
Medicine, Flinders Medical Centre, 2Cardiovascular Clinical Trials, South Australian Health
1
School of Nursing, University of Michigan, Ann Arbor, Michigan, 2Medical Center, University of and Medical Research Institute, 3Flinders University, 4Cardiology, Flinders Medical Centre,
Arkansas, Little Rock, Arkansas, 3College of Nursing, University of Kentucky, Lexington, 5
Pathology, South Australian Pathology, Adelaide, 6Medicine, Princess Alexandra Hospital,
Kentucky, 4School of Nursing, Emory University, Atlanta, Georgia , United States, 5Department Brisbane, 7School of Population Health, The University of Western Australia, Perth, 8Cardiology,
of Nursing Science, Sunchon National University, Jeollanam-do, 6Department of Nursing, Concord Hospital, 9Cardiology, Liverpool Hospital, Sydney, Australia
University of Ulsan, Ulsan, Korea, Republic Of
Introduction: Myonecrosis provoked by acute illness but unrelated to acute coronary
Introduction: Sleep disturbances occur in over 50% of heart failure (HF) patients. Poor occlusion signifies a poor prognosis, but uncertainty about a cause and effect relationship
health-related quality of life (HRQL) is a predictor of hospitalization and mortality in HF with future events challenges the appropriateness of initiating therapies known to be
patients. Sleep disturbances are associated with HRQL; but the role of gender, depressive effective for type 1 MI.
symptoms, and NYHA class in this relationship is unclear. Objectives: We assessed the strength of association and concordance between secondary
Objectives: Purposes were to 1) examine the relationship between sleep disturbances, gender, myonecrosis during the index admission and new MI or death at 12-months for several
depressive symptoms, and NYHA class and HRQL in HF patients and 2) evaluate the role of acute diagnoses.
depressive symptoms as a mediator of the relationship between sleep disturbances and HRQL. Methods: All hospitalised patients within South Australia undergoing troponin testing
Methods: Data were obtained from 206 HF patients (male: 67%; mean age: 61.6; NYHA I/ using a high-sensitivity troponin T (hs-TnT) assay over a 12-month period were examined.
II/III /IV: 11.2%/51.0%/31.1%/6.8%; ejection fraction [EF]: 34.4%). Sleep disturbances These values were merged to a combined administrative and pathology database enabling
were measured by Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale identification of the principal and secondary diagnoses at index admission, and subsequent
(ESS). Higher PSQI and ESS scores indicate poorer sleep quality and more daytime readmission for MI and death by 12-months. Using ICD-10AM codes, and peak hs-TnT
sleepiness, respectively. HRQL was measured by Minnesota Living with Heart Failure levels >14 pg/mL during the index admission, patients were classified as troponin positive
Questionnaire (LHFQ). Depressive symptoms were measured by Beck Depression In- ACS (ACS[+]), troponin negative ACS(ACS[-]), troponin positive non-ACS (non-ACS[+]),
ventory (BDI). Higher LHFQ and BDI scores indicate poorer HRQL and more depressive and troponin negative non-ACS (non-ACS[-]). The peak troponin levels during index
symptoms, respectively. Descriptive statistics and multiple regression analyses were con- hospitalisation were subject to spline transformation and a logistic regression model which
ducted. PSQI, ESS, gender, BDI, and NYHA class were entered as independent variables adjusted for age, gender, renal function and haemoglobin, was used to define the associ-
and LHFQ as the dependent variable. Multiple regression analyses and Sobel test were ation between the magnitude of myonecrosis and rate of new MI or death by 12-months.
conducted to test mediator effect of depressive symptoms. Results: 38,894 patients were identified, of whom 2,951(7.6%), 8,883 (22.8%) 7,306
Results: The correlation between PSQI and ESS was significant but small (r ¼0.18, p ¼.01). (18.8%) and 19,754 (50.8), were ACS[+], ACS [-], non-ACS[+] and non-ACS[-], respec-
PSQI, BDI, and NYHA class explained 53% of the variance in LHFQ scores (p .001); ESS and tively. Crude mortality by 12 months was highest amongst the non-ACS[+] group (non-
gender were not significant explanatory variables. Poorer sleep quality, more depressive ACS[+]: 29.9%; ACS[+]: 12.0%; non-ACS[-]: 6.6%; ACS [-]: 1.3%vs p<0.001). The
symptoms, and increased HF severity were associated with poorer HRQL. BDI score partially adjusted hazard ratio (HR) for mortality associated with elevated hs-TnT was concordant
mediated the relationship between PSQI and LHFQ (p-value of Sobel test .001). Poorer sleep across the prevalent acute diagnoses (ACS HR: 3.4 [3.0-3.8] vs sepsis HR: 2.9 [1.1-8.0] vs
quality was associated with poorer HRQL directly and partially through depressive symptoms. stroke HR: 4.2 [2.4-7.4] vs respiratory HR: 3.8 [2.8-5.2] vs Renal HR: 3.2 [1.6-6.1] vs
Conclusion: Further intervention studies for improving sleep need to consider the effect of Gastrointestinal HR: 4.0 [2.5-6.6]). Increasing peak troponin levels demonstrated a uni-
depressive symptoms in HF patients. modal association to recurrent MI in both contexts.
Disclosure of Interest: None Declared

O109
Potential impact of depression on health outcomes in a randomised control trial of
multidisciplinary, nurse-led, home based intervention (HBI) to reduce secondary
cardiac events
Christina E. Kure*1, Chantal F. Ski1, Simon Stewart2, Yih-Kai Chan2, Melinda J. Carrington2,
David R. Thompson1, the Young @ Heart Investigators
1
Cardiovascular Research Centre , Australian Catholic University, 2Preventative Health, Baker
IDI Heart and Diabetes Institute, Melbourne, Australia

Introduction: Routine screening for depression is mandated for all individuals following an
acute cardiac event. However, the potential to subsequently improve health outcomes is
unknown.
Objectives: To examine whether screening for depression using the Patient Health
Questionnaire-2 (PHQ-2) in combination with a nurse-led, multidisciplinary home-based

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e29

 Conclusion: Myonecrosis secondary to other diseases is more frequent and associated with
more than a 2-fold increased risk of new MI and late death compared to spontaneous MI.
ORAL ABSTRACTS
Whether established therapies for MI decrease this risk deserves to be evaluated in clinical
trials.
Disclosure of Interest: None Declared
O111
Assessment Of The Effectiveness Of Early Risk Stratification Using A New Cardiac
Marker - Heart-Type Fatty Acid-Binding Protein In Patients With Suspected Non-St-
Elevation Acute Coronary Syndromes
Konstantin Y. Nikolaev*1,2, Mikhail Voevoda1,3, Natalia Yarokhno2, Alexander Balabushevich2
1
Internal Medicine, Novosibirsk State University, 2emergency treatment, 3Internal Medicine,
Institute of Internal Medicine, Novosibirsk, Russian Federation
Introduction: In patients with non-ST-elevation acute coronary syndrome (ACS), early
risk stratification is of critical importance. Among others, the Thrombolysis in
Myocardial Infarction (TIMI) risk score is the most validated and the most extensively
used in patients with non-ST-elevation ACS. However, this score does not utilize re-
sults of evaluation of early markers of myocardial necrosis such as heart-type fatty acid-
binding protein (hFABP).
Objectives: The aim of this study was to estimate the effectiveness of new cardiac
marker - hFABP in the protocol of early risk stratification during rendering emergency
medical care for patients with suspected non-ST-elevation acute coronary syndromes
(NSTEACS).
Methods: The study included two groups of patients. The first group included 442 patients
(6713 years) with suspected NSTEACS who underwent early risk stratification and the
second (control group) consist of 491 patients (5916 years) with suspected NSTEACS
but without pre-operative risk stratification. We stratificated patient from first group
accordind Modified TIMI risk score which was constructed with included results of hFABP
evaluation. This evaluation was provided by a novel, sensitive assay that is based on the
immunochromatographic test-strip technique has been recently developed for rapid
qualitative detection of hFABP in whole blood (BioTest Co., Novosibirsk, Russia). The
procedure requires approximately 100 microliters of whole blood and can be completed
within 20 min in any in-patient or out-patient settings without any special equipment. The
analytical sensitivity of this test is 15 ng/ml.
Results: A preliminary diagnosis of myocardial infarction (MI) was adjudged in 52 (11.8%)
patients from the first group and 64 (13.0%) from the second, and a preliminary diagnosis
of unstable angina was adjudged in 390 (88.2%) and 427 (87.0%) patients, respectively.
The accuracy of diagnosis of myocardial infarction in the first group was higher in the first
group than the second (86,5% and 60,9% respectively, p¼0,003). The sensitivity of the
hFABP assay within the first 12 hours was 84% for the detection of MI and the corre-
sponding specificity was 93%.
Conclusion: Using of new cardiac marker - hFABP is effective in early risk stratification for
patients with suspected non-ST-elevation acute coronary syndromes during rendering
emergency medical care.
Disclosure of Interest: None Declared
O112
How much does a non-physician healthcare worker based model of care for
cardiovascular disease management cost?
Rohina Joshi*1, Beverley Essue2, Krishnam Raju3, Stephen Jan2, Clara K. Chow1, on behalf of the
APRHI Collaboration
1
Cardiovascular, 2Economics, The George Institute for Global Health, University of Sydney,
Sydney, Australia, 3Cardiology, CARE Hospital, Hyderabad, India
Introduction: Cardiovascular disease (CVD) is the leading cause of mortality and disability
in rural India but few individuals have their risk assessed or appropriately managed. CVD
management is a challenge in rural India because of the shortage of healthcare workforce
and the costs of care.
Objectives: To assess the costs of a task-shifting intervention for the treatment of car-
diovascular disease in primary care settings in rural Andhra Pradesh, India
Methods: The study was a cluster randomised control trial done in 44 villages in Andhra
Pradesh. Villages were randomised to receive an intervention based on a clinical algorithm
designed to enhance the identification and treatment of high risk individuals (previous
history of CVD) compared to usual care. The algorithm was designed to be used by non-
physician healthcare workers (NPHWs) in the community and for opportunistic screening
in the clinics with referral to physicians for prescription of medications. We adopted a top-
down costing approach to cost three alternative NPHW-based models of care: a) NPHW
only; b) NPHW and the provision of free drugs and c) NPHW, provision of free drugs and a
part-time physician. Cost categories included: training and salaries, CVD risk assessment
equipment, and secondary prevention medications. The assumptions made for costing,
based on published studies, is that each village has an adult population (>30 years) of 1500
with 5% at high risk of CVD.
Results: The annual costs for the basic model which included salary and training of
NPHW and materials for physical measurements was 833 USD for the intervention
villages. The annual cost of the basic model plus provision of drugs for CVD pre-
vention was 906 USD. The third model which included the basic model, drugs, and
physician time was estimated to cost 1029 USD. The total cost per high-risk individual
in the village was 11 USD, 12 USD and 14 USD for the basic model, case 2 and case 3
respectively.
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Conclusion: The cRCT trial results demonstrated that the clinical algorithm (corre-
sponding to the first case scenario) is an effective model of care for CVD screening and
management. This is the first study from rural India that provides a detailed explanation of
the costs required to implement and run a NPHW based CVD management model of care
in this setting. These results demonstrate that this model of care is an effective and low cost
alternative to current practice which at present, does not routinely incorporate NPHWs in
CVD management.
Disclosure of Interest: None Declared
O113
Is Transcatheter Closure Better Than Medical Therapy For Cryptogenic Stroke With
Patent Foramen Ovale? A Meta-Analysis Of Randomized Trials
Vinayak Nagaraja*1, Jwalant Raval2, Guy D. Eslick3, David Burgess2, A. Robert Denniss2
1
Cardiology, Prince of Wales Hospital, University of Sydney, 2Blacktown Hospital, 3Cardiology,
The University of Sydney, Sydney, Australia
Introduction: The prevalence of patent foramen ovale among patients with cryptogenic
stroke is higher than that in the general population. Closure with a percutaneous device is
often recommended in such patients, but it is not known whether this intervention reduces
the risk of recurrent stroke.
Objectives: Recently three randomized trials have reviewed the benefit of closure over
optimal medical therapy. We synthesized the available evidence from the randomized trials
on secondary stroke prevention in patients with patent foramen ovale and cryptogenic
stroke and primarily focus on the comparison of the 2 strategies.
Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Cur-
rent Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of
Science. Original data was abstracted from each study and used to calculate a pooled event
rate (ER), odd ratio (OR) and 95% confidence interval (95% CI).
Results: Only 3 randomized trials comprising of 2303 patients met full criteria for analysis.
Procedural success (ER: 94.20%, 95% CI: 87.6%>97.4%) and effective closure (ER:
92.70%, 95% CI: 85.9%>96.4%) of closure therapy were good.
The odds ratio for stroke (OR: 0.654, 95% CI: 0.358-1.193) and transient ischemic
attack (OR: 0.768, 95% CI: 0.413-1.429) did not confer a benefit of PFO closure over
medical therapy. Age {<45 years (OR: 0.449, 95% CI: 0.117-1.722), >45 years(OR:0.707 ,
95% CI:0.27-1.856)}, gender {males (OR: 0.498, 95% CI: 0.247-1.004), females (OR: 1.16,
95% CI:0.597-2.255)},substantial shunt size (OR: 0.354, 95% CI: 0.089-1.406) and the
presence of atrial septal aneurysm (OR: 0.7, 95% CI:0.21-2.33) did not influence the
treatment effect of PFO closure. However, the adverse events like major vascular compli-
cation (OR: 10.905, 95% CI: 1.997-59.562) and atrial fibrillation (OR: 3.297, 95% CI:
0.874-12.432) were significantly higher in the closure group.
Conclusion: In patients with cryptogenic stroke or TIA who had a patent foramen ovale,
closure with a device does not confer an advantage over medical therapy and is associated
with adverse events like major vascular complication and atrial fibrillat.
Disclosure of Interest: None Declared
O114
The cost-of-illness of rheumatic heart disease: a national estimation in Fiji
Rachel C. Heenan*1, Till Bärnighausen2, Jennifer O’Brien2, Tom Parks3, Joseph H. Kado4,
David E. Bloom2, Andrew C. Steer1,5
1
Centre for International Child Health, University of Melbourne, Melbourne, Australia,
2
Department of Global Health and Population, Harvard School of Public Health, Boston, United
States, 3University of Oxford, Oxford, United Kingdom, 4Paediatrics Department, Colonial War
Memorial Hospital, Suva, Fiji, 5Royal Children’s Hospital, Melbourne, Australia
Introduction: Rheumatic heart disease (RHD) is an important cause of morbidity and
mortality in the Pacific region. Notwithstanding its sizable health burden, little is known
about the full economic impact of the disease, which includes costs of diagnosis, treatment,
and care as well as lost income. RHD is likely a high-cost disease, given its premature
mortality and morbidity, its associated complications, and the frequent requirement for
cardiac surgery. Because RHD typically leads to heart failure in middle age, when pro-
ductivity and earnings normally peak, the lost income associated with RHD is also likely
high.
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
 Objectives: This cost-of-illness (CoI) study estimates the full economic impact of RHD in
Fiji 2008-2012.
Methods: Total direct costs and indirect costs of acute rheumatic fever (ARF) and RHD are
estimated using prevalence and incidence estimates derived from the disease control program
register and summaries of hospital inpatient and outpatient cases, and bottom-up costing of
unit costs per case with and without surgery and complications (heart failure, stroke, or
endocarditis). We follow standard CoI methodology and attribute the cost of death due to ARF/
RHD to the period of time in which the death occurred, i.e. 2008-2012. We estimate pro-
ductivity losses using data on absenteeism due to heart failure. All costs are discounted at 3%.
Results: The total costs of ARF and RHD in Fiji are estimated at USD$62,291,067 over the
five-year study period.
The total direct costs were USD$2,143,709. This equates to direct costs of on average
USD$196 per patient annually. Surgical costs constituted 17.0% of total direct costs, with
the remainder of the direct costs attributable to inpatient and outpatient care.
The indirect costs of these diseases, however, dwarfs the direct costs. The indirect costs
of ARF/RHD total USD$60,147,358 over the study period, which equates to an average of
USD$5500 per patient annually, or 1.29 times the average annual GDP per capita. Of these
indirect costs, 81.5% are due to premature mortality of patients with RHD, with the
remaining 18.5% being due to work absenteeism and health care utilization.
Conclusion: The full economic costs of ARF and RHD are relatively large in Fiji, which is
also likely the situation in other RHD-endemic countries. The majority of the costs resulting
from RHD are attributable to lost income associated with premature mortality and
morbidity. These data add further weight to the need for implementation of effective
prevention and treatment strategies for RHD.
Disclosure of Interest: None Declared
O115
Prognostic value of Red Blood Cell Distribution Width in the Patients with Heart
Failure: A Meta-analysis
Tong Liu*, Qingmiao Shao, Guangping Li
Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
Introduction: Red blood cell distribution width (RDW) is a quantitative measure of
variability in the size of circulating erythrocytes with higher values reflecting greater het-
erogeneity in cell sizes. Recent studies have shown that higher RDW levels were associated
with increased risk of mortality or re-hospitalization in the patients with clinically signif-
icant heart failure (HF).
Objectives: The aim of the study was to evaluate the potential association between RDW
levels and clinical outcome in the patients with HF. We therefore performed a systematic
literature search and meta-analysis of prospective cohort studies regarding RDW levels and
the risk of mortality or re-hospitalization in HF patients.
Methods: We conducted a systematic literature published August 2013 or earlier using
electronic database (PubMed, Ovid, Embase and Web of Science). Prospective cohort
studies which evaluate the possible association between RDW and poor outcomes in HF
patients were included in meta-analysis. We used both fix-effects and random-effects
models to calculate the overall effect estimate. The heterogeneity across studies was tested
by both Q statistic and I2statistic. Begg’s funnel plot and Egger’s regression test were used to
assess the potential publication bias.
Results: We retrieved 20 prospective cohort studies, involving a total of 41,959 par-
ticipants. Median RDW values varied across studies from 13.1% to 15.6%. For every
1% increment in RDW, total mortality or re-hospitalization risk increased by 18.6%
(adjusted HR: 1.186, 95% CI: 1.127–1.248; test for overall effect z-score ¼ 6.57, p <
0.001) (Figure). The heterogeneity test showed that there were significant differences
among individual studies (p < 0.001; I2 ¼ 91.4%). Subgroup analysis showed the
association between RDW and all-cause death or re-hospitalization in the patients with
acute HF was stronger (HR¼1.249 per +1%, 95%CI: 1.129-1.382, p<0.001) compared
with that in patients with chronic HF (HR¼1.164 per +1%, 95%CI: 1.101-1.230,
p<0.001). Further analysis revealed that differences types of HF possibly account for
this heterogeneity.
web 3C/FPO
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
Conclusion: Our meta-analysis of prospective cohort studies suggests that high levels
of RDW predicts the increased mortality or re-hospitalization risk in the patients
ORAL ABSTRACTS
with HF.
Disclosure of Interest: None Declared
O116
Does aspirin interfere with the clinical benefits of the mineralocorticoid receptor
antagonist eplerenone in systolic chronic heart failure?: Analysis of the EMPHASIS-
HF study
Henry Krum*1, Bertram Pitt2, John McMurray3, Karl Swedberg4, Dirk van Veldhuisen5,
Stuart Pocock6, Tim Collier6, John Vincent7, Eva Turgonyi7, Faiez Zannad8
1
Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, 2University of
Michigan, Michigan, United States, 3University of Glasgow, Glasgow, United Kingdom,
4
University of Gothenburg, Goteborg, Sweden, 5University of Groningen, Groningen,
Netherlands, 6London School of Hygiene and Tropical Medicine, London, United Kingdom,
7
Pfizer , New York, United States, 8CHU and University Henri Poincaré, Nancy, France
Introduction: There is considerable evidence for an aspirin/ACE inhibitor interaction in
patients with chronic heart failure (CHF), on the basis of interference with ACE inhibitor-
generated vasodilatory prostaglandins. However, the interaction between mineralocorticoid
receptor antagonists (MRAs) and aspirin has been less well studied.
Objectives: We therefore analysed aspirin/eplerenone interactions in the EMPHASIS-HF
study of patients with systolic CHF and mild symptoms.
Methods: Patients were analysed according to baseline aspirin use. Primary endpoint event
rate (time to first event of CV death or HF hospitalisation) was analysed for baseline aspirin
use (yes/no) as well as eplerenone vs placebo according to baseline aspirin use. Unadjusted
hazard ratios with 95% confidence intervals were generated and P value for interaction
analysed.
Results: Patients receiving aspirin (n¼1605) in EMPHASIS-HF had higher systolic blood
pressure, lower heart rate and higher rate of ischaemic etiology of their HF (all P<0.0001)
than those not receiving aspirin (n¼1132). Furthermore, aspirin patients had higher rates
of previous MI, angina, hypertension, CABG and PCI but lower rates of atrial fibrillation/
flutter and digoxin use (all P<0.0001). There was no difference in the primary endpoint
event rate according to baseline aspirin use (HR 1.04 [0.90, 1.22], P¼0.58). Furthermore,
the beneficial effect of eplerenone was similar whether patients were or were not taking
aspirin at baseline (HR 0.74 [0.61, 0.90], P¼0.003; 0.63 [0.49, 0.80], P<0.001, respec-
tively). Interaction P value was 0.27.
Conclusion: Baseline use of aspirin does not appear to offset the beneficial clinical effects of
the MRA eplerenone in mild systolic CHF patients. Therefore, the putative interfering effect
of aspirin on ACE inhibitor clinical benefit is not similarly observed with MRAs in this
setting.
Disclosure of Interest: H. Krum Consultancy for: Pfizer, B. Pitt Consultancy for: Pfizer, J.
McMurray Consultancy for: Pfizer, K. Swedberg Consultancy for: Pfizer, D. van Veldhuisen
Consultancy for: Pfizer, S. Pocock Consultancy for: Pfizer, T. Collier Consultancy for:
Pfizer, J. Vincent Employee from: Pfizer, E. Turgonyi Employee from: Pfizer, F. Zannad
Consultancy for: Pfizer
O117
Cardiovascular disease and impoverishment averted due to a salt reduction program
in South Africa: an extended cost-effectiveness analysis
David Watkins*1,2, Zachary Olson3, Stephane Verguet3, Dean Jamison3, Rachel Nugent3
1
Department of Medicine, University of Cape Town, Cape Town, South Africa, 2Department of
Medicine, 3Department of Global Health, University of Washington, Seattle, United States
Introduction: In response to the increasing burden and cost of hypertension-related
cardiovascular disease (CVD) in South Africa, the Government set targets for popu-
lation salt reduction in 2011 and is currently implementing mandatory limits on salt in
processed foods. While available evidence suggests that salt reduction could reduce
CVD substantially, little is known about the policy’s impact on household and public
finances.
Objectives: The objective of this study is to estimate the health gains, financial risk pro-
tection, and reduced government expenditures on CVD that could be achieved by South
Africa’s salt policy.
Methods: We construct a cohort sample of 1 million South African adults using socio-
demographic, salt intake, and blood pressure data from surveys. We estimate changes in
age- and sex-specific stroke and ischemic heart disease deaths and incidence from 2.9 - 3.3
gram lower salt intake per person daily using published effect sizes and epidemiologic
studies. Using facility drug prices and official fee schedules published by the South African
Government, we calculate average out-of-pocket (OOP) treatment costs for CVD over 1
year for each income quintile and estimate the amount of OOP expenditures and gov-
ernment subsidies averted by the policy. We estimate household economic effects in two
ways: cases of catastrophic OOP spending averted, defined as exceeding 10 percent of total
household annual income, and cases of poverty averted, defined by 3 poverty lines ranging
from $36-78 (USD 2012) per person monthly.
Results: South Africa’s salt target could avert 3363 deaths and 6563 new cases of CVD
per year in the general population, with health gains concentrated in the middle 3
income quintiles. Approximately US$4 million in OOP expenditures and US$11
million in government subsidies per year could be saved. The policy could avert 963
cases of catastrophic health expenditure per year, mostly in upper income groups.
e31
 However, it could also avert 228-713 cases of poverty per year, mostly in lower income
groups.
ORAL ABSTRACTS
web 3C/FPO
Conclusion: Reducing salt consumption in South Africa could lead to substantial health
gains in all socioeconomic groups, protect many from the financial risks of CVD, and create
fiscal space for the government to invest further in CVD policies.
Disclosure of Interest: None Declared
O118
Macroreentrant Atrial Tachycardias Utilizing The Ligament Of Marshall And
Pulmonary Vein-left Atrial Appendage Ridge As A Critical Isthmus Of Reentry After
Single Ring Pulmonary Vein Isolation
William Chik*1, Kit Chan2, David Ross1, Jim Pouliopoulos1, Jackie Wagstaff3, Eddy Kizana1,
Gopal Sivagangabalan1, Aravinda Thiagalingam1, Pramesh Kovoor1, Stuart Thomas1
1
Cardiology, Westmead Hospital, Westmead , Australia, 2Cardiology, Ruttonjee and Tang Shiu
Kin Hospital, Hong Kong , Hong Kong, 3Cardiology, Westmead Private Hospital, Westmead,
Australia
Introduction: Organized atrial tachycardias (OAT) after pulmonary vein isolation (PVI)
procedure are common.
Objectives: In this series, we describe a novel mechanism of arrhythmia utilizing the ridge
between left pulmonary vein (PV) and left atrial appendage (LAA) in the region of the
Ligament of Marshall (LOM).
Methods: Seven tachycardias involving the LOM region were identified from a group
of 240 patients who underwent PVI for symptomatic atrial fibrillation between 11/
19/2010 to 06/27/2012. Single Ring Isolation was used to isolate all 4 PVs and the
Left Atrial (LA) posterior wall. Endocardial contact mapping and entrainment map-
ping were used to localize the OATs. Sites of electrically conducting gap were
identified.
Results: OATs involving the LOM region were identified in 7/240 pts (Aged 676). AF
was persistent in 2 and intermittent in 5. Mean duration of AF mean 84.4  75.2 months.
Common characteristics of these tachycardias were the endocardial breakout over a broad
area adjacent to the LOM region, presence of pre-systolic or mid-diastolic potentials and
abolition by ablation of the pre-systolic or mid-diastolic potentials remote from the
endocardial breakout site. In six cases, tachycardias were present after isolation of the veins
and posterior left atria. All demonstrated characteristic areas of very slow conduction in the
LOM region highlighted by the presence of either low voltage, long duration fractionated
potentials or mid diastolic potentials with a fixed temporal relationship to the subsequent
endocardial activation. The pattern of activation and termination of tachycardia during
ablation were consistent with an arrhythmia utilizing an electrically insulated tract within
LOM and the PV-LAA ridge region.
e32
web 3C/FPO
Conclusion: We identified a novel mechanism of Organised Atrial Tachycardias charac-
terized by the following:
1) Tachycardias in the presence of documented isolation of all PVs and LA posterior wall;
2) Re-entrant mechanism suggested involving the PV-LAA Ridge in LOM region;
3) Slow conduction in the LOM region with low voltage, long duration, fractionated
potentials or discrete mid-diastolic potentials;
4) Concealed pre-systolic and mid-diastolic components;
5) Broad endocardial breakout site related to the LOM region;
6) Successful termination by ablating pre-systolic or mid-diastolic potentials remote
from the earliest endocardial breakout site.
Disclosure of Interest: None Declared
O119
A Randomized Controlled Trial of a Minimal or Maximal Ablation Strategy to
Achieve Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: Long Term
Follow-Up (the Minimax Trial)
Alex J. Mclellan*1,2, Liang-Han Ling1, Martin K. Stiles3, Nigel A. Lever4, Simon P. Fynn5,
Patrick M. Heck5, Prashanthan Sanders6, Joseph B. Morton2, Jonathan M. Kalman2,
Peter M. Kistler1
1
The Alfred Hospital/ Baker IDI, 2Royal Melbourne Hospital, Melbourne, Australia, 3Waikato
Hospital, Waikato, 4Auckland City Hospital, Auckland, New Zealand, 5Papworth Hospital,
Cambridge, United Kingdom, 6Royal Adelaide Hospital, Adelaide, Australia
Introduction: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation of
atrial fibrillation (AF). The intervenous ridge (IVR) may be incorporated into ablation
strategies to achieve individual PVI however data is lacking.
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
 Objectives: We performed a randomized international multicenter study to compare
outcomes post (1) circumferential antral PVI alone (minimal) versus (2) circumferential
antral PVI with IVR ablation to achieve individual PV isolation (maximal).
Methods: 200 patients (age 599years, mean AF duration 6055 months, left atrial
area 24.65.9cm2) with paroxysmal AF were randomized to a minimal or maximal
ablation strategy to achieve circumferential PVI. Patients had regular clinical review and
7 day Holter monitors 6 monthly. Segmented left atriograms from pre-procedural
cardiac MRI or CT were utilised to assess for differences in left atrial anatomy between
groups.
Results: Pulmonary vein isolation was achieved in all patients with 42% of the minimal
ablation strategy group requiring IVR ablation to obtain electrical isolation. At mean follow
up of 125 months there was no significant difference in freedom from AF off medication
on intention to treat analysis (minimal 74% vs. maximal 69%; p¼0.39). In the minimal
ablation strategy group, patients who did not require ablation on the IVR had a higher
freedom from AF compared to those who did require IVR ablation to achieve electrical
isolation (81% vs. 64%; p¼0.05). Minimal ablation strategy patients who required IVR
ablation to achieve electrical isolation had left intervenous ridges that were significantly
greater in area (1.30.5cm2 vs. 1.00.7cm2; p¼0.04) and length (164mm vs. 143mm;
p¼0.004) compared to minimal ablation strategy patients who did not require IVR
ablation.
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Conclusion: Patients who undergo a minimal or maximal ablation strategy to achieve PVI
have equivalent outcomes. However patients who require IVR ablation to achieve PVI have
an increase in recurrent AF which may in part be explained by anatomic differences.
Disclosure of Interest: None Declared
O121
Mortality Prediction Of Four Risk Models For Isolated Aortic Valve Replacement In
The Current Era
Tom Kai Ming Wang*1, David H.-M. Choi1, Ralph Stewart1,2, Greg Gamble3, David Haydock1,
Peter Ruygrok1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
3
Medicine, University of Auckland, Auckland, New Zealand
Introduction: Risk stratification for aortic valve replacement (AVR) is an important area
given the increased demand for intervention and the introduction of transcatheter aortic
valve implantation.
Objectives: We compared the prognostic utility of EuroSCORE, EuroSCORE II, Society
of Thoracic Surgeon’s (STS) Score and an Australasian model (Aus-AVR Score) for
AVR.
Methods: We retrospectively calculated the four risk scores for patients undergoing iso-
lated AVR at Auckland City Hospital during 2005-2012, and assessed their discrimination
and calibration for short and long-term mortality.
Results: A total of 620 patients were followed-up for 3.8+/-2.4 years, with operative
mortality of 2.9% (18). Mean EuroSCORE, EuroSCORE II, STS Score and Aus-AVR Scores
were 8.7%+/-8.3%, 3.8%+/-4.7%, 2.8%+/-2.7%, 3.2%+/-4.8%. C-statistics and 95% con-
fidence intervals for operative mortality were 0.752 (0.652-0.852), 0.711 (0.607-0.815),ˇ
0.716 (0.593-0.837) and 0.684 (0.557-0.811). Hosmer-Lemeshow test P-values (c 2) for
calibration were 0.007 (21.1), 0.125 (12.6), 0.753 (5.041) and 0.468 (7.652), while the
Brier Scores were 0.0348, 0.0278, 0.0276 and 0.0294. Independent predictors of operative
mortality included critical pre-operative state, atrial fibrillation, extracardiac arteriopathy
and mitral stenosis. C-statistics and 95% confidence intervals for mortality during follow-
up were 0.707 (0.652-0.761), 0.697 (0.642-0.753), 0.704 (0.650-0.759) and 0.713
(0.658-0.768). Log-rank test P-values were all <0.001 for mortality during follow-up for all
four scores by quintiles.
Conclusion: All four risk scores discriminated short and long-term mortality after isolated
AVR. EuroSCORE had poor calibration over-estimating operative mortality, whilst the
other three scores fitted well to contemporary outcomes. STS score was the best calibrated
in the highest quintile of operative risk.
Disclosure of Interest: None Declared
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O122
Tavi Karlsruhe (Tavik) – A Comparison Of Minimal Invasive And Surgical Aortic
ORAL ABSTRACTS
Valve Replacement In Patients With Severe Symptomatic Aortic Stenosis And
Intermediate Risk For Conventional Surgery
Holger Schroefel*1, Martin Heimeshoff1, Peter Bramlage2, Alexander Wuerth3, Lothar Pilz4,
Jan S. Schymik5, Rainer Wondraschek6, Bernd-Dieter Gonska3, Claus Schmitt6, Herbert Posival1,
Gerhard Schymik6
1
Cardiac Surgery, Cardiac Surgery Clinic, Karlsruhe, 2IPPMED, Mahlow, 3Cardiology,
Vincentius Hospital Karlsruhe, Karlsruhe, 4Medical Faculty Mannheim, University Heidelberg,
Mannheim, 5Graduate School of Economics, LMU Munich, Munich, 6Cardiology, Municipal
Hospital Karlsruhe, Karlsruhe, Germany
Introduction: Surgical aortic valve replacement (SAVR) is the standard procedure for
symptomatic aortic stenosis while the minimally invasive procedure (TAVI) is the method
of choice in inoperable patients or those at high risk. It is gaining increasing importance in
intermediate risk patients but to date there are limited data to assess benefits and risks.
Objectives: Analyses were based on the TAVI Karlsruhe (TAVIK) registry of patients un-
dergoing TAVI or SAVR between 2007 and 2012. For this analysis only patients with a
logistic EuroSCORE 15 were considered.
Methods: Both groups were compared using Propensity Score Matching.
Results: As of April 2012 a total of 1,825 patients were included into TAVIK; 1,003 into the
TAVI and 822 patients into the SAVR group. Of these 1,141 had a logistic EuroSCORE 15
(419 TAVI, 722 SAVR). The mean logistic EuroSCORE I was 10.12.8 in the TAVI group and
5.73.2 in the SAVR group (p<0.0001). Survival probability over three years was higher in
patients undergoing surgery (Log-Rank test p¼0.0023). A total of 432 patients were
considered for the matched-pairs analysis based on the propensity score (216 in either group).
The mean logistic EuroSCORE I was 8.72.7 and 8.82.8 respectively (p¼0.52). Major
vascular complications (10.6% vs. 0.0%; p<0.0001), new pacemaker implantation (13.9%
vs. 4.6%; p<0.001) and moderate aortic insufficiency (3.2% vs. 0.5%; p¼0.03) were more
frequent in patients undergoing TAVI. Major (20.8% vs. 4.2%; p<0.0001) and life-threat-
ening (14.5% vs. 2.3%; p<0.0001) bleeding complications were more frequent in those
undergoing surgery. Survival probability over three years in the propensity matched cohort
comparable between both groups (Log-Rank test p¼0.2196).
web 3C=FPO
Conclusion: Based on one of the largest single center “real world” datasets (TAVIK), we
were not able to show a differential prognosis for intermediate risk patients undergoing
transcatheter or surgical aortic valve replacement after adjusting for baseline risk.
Disclosure of Interest: H. Schroefel Consultancy for: Edwards Lifesciences, Symetis SA,
Speakers bureau: Edwards Lifesciences, Symetis SA, Philips, M. Heimeshoff: None
Declared, P. Bramlage Grant/research support from: Edwards Lifesciences, Consultancy for:
Edwards Lifesciences, Honorarium from: Edwards Lifesciences, A. Wuerth: None Declared,
L. Pilz: None Declared, J. Schymik: None Declared, R. Wondraschek: None Declared, B.-D.
Gonska: None Declared, C. Schmitt: None Declared, H. Posival: None Declared, G.
Schymik Consultancy for: Edwards Lifesciences, Speakers bureau: Edwards Lifesciences,
Medtronic
O123
Early Myocardial Dysfunction In Patients With Fabry Disease, Assessed By Tissue
Doppler Imaging
Emil Manov*1, Nikolay Runev1, Svetlin Tzonev1, Rabhat Shabani1, Temenuga Donova1,
Emil Paskalev2
1
internal medicine "Kirkovich"; clinic of cardiology, 2clinic of kidney transplantation, university
hospital "Alexandrovska", Sofia, Bulgaria
Introduction: Fabry disease is a rare X linked recessive disorder resulting from a deficiency
of the lysosomal enzyme a galactosidase. The enzymatic defect in this lysosomal storage
e33
 disease leads to the accumulation of globotriaosylceramide in several organs including the IRMA 2 suggests that high-dose irbesartan treatment confers long-term renoprotective ef-
skin, kidney, nervous system, cornea, and the heart. fects, irrespective of blood pressure reduction.
ORAL ABSTRACTS

Objectives: To investigate the changes in cardiac function and morphology in patients with
Fabry disease using 2D-Echocardiography (2D-EchoCG) and Tissue Doppler Imaging
(TDI).
Methods: In Bulgaria there are altogether twelve patients with Fabry disease. Six of them (4
men and 2 women, aged 19-60 years) with histologically confirmed chronic glomerulo-
nephritis and preserved renal function were involved in this study. Four patients had a well
controlled and treated according to the Guidelines arterial hypertension (AH), 2 suffered
from bronchial asthma and 1 – from small joints polyarthritis and angiokeratoma. All
patients underwent M-mode, 2D-EchoCG, Doppler and TDI analysis.
Results: In the group of six evaluated patients the Echo-CG findings could be summarized
as follows:
(1) All of them, irrespective of sex, age and concomitant diseases, had mild left
ventricular (LV) hypertrophy (mean interventricular septum thickness - 12.4 mm;
mean LV posterior wall thickness – 12.0 mm) and preserved LV ejection fraction
(EF, average 61%)
(2) Abnormal LV relaxation was found only in patients with LV hypertrophy and AH
(3) In all six patients a significantly decreased global longitudinal strain (GLS, average
-6%) was detected by 2D-EchoCG. The average peak velocities of the medial and
lateral mitral annulus, assessed by TDI, were also diminished:
Objectives: To evaluate the effect of irbesartan on the urinary albumin excretion in the
normotensive T2DM patients, in a 26-week, randomized, double-blinded, placebo-
controlled multicenter study.
Methods: 226 patients with type 2 diabetes, albuminuria, with or without hypertension
were assigned to receive irbesartan 300 mg/day or placebo. A subset of patients with
normal blood pressure was analyzed (irbesartan, n¼39 vs. placebo, n¼48, Fig 1). The
primary endpoint was change in UAER from baseline at week 24. Secondary endpoints
included changes from baseline in blood pressure, triglyceride, high density lipoprotein
(HDL), low density lipoprotein (LDL) and HbA1c.
Results: The mean change at week 24 from baseline in the mean UAER was -0.000.28
mg/min in the placebo arm and -0.180.38 mg/min in the irbesartan arm (P<0.05, pla-
cebo vs. irbesartan). Irbesartan decreased UAER by 21.35% at week 4 and 10.89% at week
24 from baseline. By contrast, UAER decreased 0.98% in the placebo arm at week 4 and
increased 9.04% at week 24 from baseline. No significant difference was found in systolic
or diastolic blood pressure decrease, when compared to placebo-treated group
(6.3813.12 and 2.467.22 mmHg, respectively, in the irbesartan arm P>0.05 vs. pla-
cebo) (Fig. 2). Also there was no significant difference in changes in triglyceride, HDL, LDL
and HbA1c between the two arms from baseline. The incidence of adverse events was
30.77% in the irbesartan arm and 31.25% in the placebo arm.

Parameter e` a` s`
Average velocity of the lateral mitral annulus (cm/s) 4.1 0.94 1.41
Average velocity of the medial mitral annulus (cm/s) 3.05 1.99 1.29

Conclusion: In all studied patients with Fabry disease and preserved global LVEF signif-
icantly reduced GLS and average velocities of medial and lateral mitral annulus were
demonstrated. These findings could be a marker of early myocardial dysfunction in Fabry
disease.
Disclosure of Interest: None Declared

O124
Persistent Retinal Vascular Changes In Kawasaki Syndrome - Potential Role In
Coronary Risk Stratification
Terence C. W. Lim*1, Inez B. Wong2, Audrey Pang3, Carol Cheung4, Kim Tolentino1,
Seo Wei Leo3, Swee Chye Quek1, Cindy Hia1, Tien Yin Wong2, Kawasaki Disease Retinal
Vasculopathy Study Group
1
Paediatrics, 2Opthalmology, National University Hospital, 3Opthalmology, Tan Tock Seng
Hospital, 4Opthalmology, Singapore Eye Research Institute, Singapore, Singapore

Introduction: Kawasaki Syndrome(KS) a multisystem vasculitis of childhood is the com-

monest cause of acquired coronary artery disease in children. We hypothesize that the
inflammatory effects of KS causes longstanding changes in the retinal vasculature akin to
traditional coronary risk factors like diabetes mellitus and hypertension.
Objectives: We compared the retinal vascular dimensions of children with a history of KS
to a matched cohort.
Methods: All subjects underwent high resolution digital retinal photography in which the
diameters of all arterioles and venules coursing through a specified area one-half to one disc
diameter from the optic disc were measured with a computer program (IVAN), according
to a published standardized protocol. Central retinal arteriolar equivalent (CRAE), central
retinal venular equivalent (CRVE), arteriole-to-venule ratio (AVR) were calculated for each
retina photo.
Results: 78 patients with KS and 234 controls were examined. KS subjects had a mean
CRAE of 153.68 mm, a mean CRVE of 217.61 while controls had mean CRAE of 148.89 (p
0.002), and a mean CRVE of 224.06 (p 0. 001). Cases were controlled for age, gender,
ethnicity, body surface area and fellow caliber.
web 3C/FPO
Conclusion: KS results in independent, persistent and significant enlargement in the
retinal arterioles and narrowing of the retinal venules. This may be related to endothelial
dysfunction and serve as a potential marker for incipient coronary vasculopathy.
Disclosure of Interest: None Declared

O125
Effect Of Irbesartan On The Reduction Of Urinary Albumin In Normotensive Type 2
Diabetic Patients: A Subgroup Analysis Of Prime Study
Wenyi Zong*1, Wenying Yang2, Guang Ning3, Changyu Pan4, on behalf of PRIME Investigators
1
The General Hospital of People’s Liberation Army(301) Hospital, 2China-Japan Friendship
Hospital, Beijing, 3Shanghai Ruijin Hospital, Shanghai, 4The General Hospital of People’s
Liberation Army (301) Hospital, Beijing, China
Introduction: In a multinational, double blind, randomized study of hypertensive patients
with type 2 diabetes (T2DM) and microalbuminuria (IRMA 2) has demonstrated that
irbesartan attenuates the deterioration of renal function in hypertensive patients with overt
nephropathy, which is independent of their blood pressure-lowering effects. The persistent
reduction of microalbuminuria after withdrawal of irbesartan treatment in a substudy of the

e34 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

Conclusion: The effect of irbesartan on the significant reduction of UAER is in-
dependent of blood pressure-lowing effect. Irbesartan is well tolerated and benefi-
cial for the reduction of albuminuria in Chinese T2DM patients with or without
hypertension.
Disclosure of Interest: W. Zong Grant/research support from: Sanofi., W. Yang Grant/
research support from: Sanofi. , G. Ning Grant/research support from: Sanofi., C. Pan
Grant/research support from: Sanofi.
O126
Arterial hypertension and psoriatic arthritis have a mutual potentiating effect on
increase of arterial stiffness
I. Gaydukova*, A. Rebrov
Saratov state medical university, Saratov, Russian Federation
Introduction: Psoriatic arthritis (PsA) is an inflammatory disease characterized by
increased morbidity and mortality. In recent epidemiological studies was shown the higher
number of hypertensive persons in PsA patients as compared with total population. PsA
and arterial hypertension (AH) may have a mutual potentiating effect on the development
of atherosclerosis.
Objectives: Is to evaluate if arterial hypertension (AH) in PsA patients is associated with
increased arterial stiffness (AS) comparative with AH patients without arthritis, non-hy-
pertensive patients with PsA and healthy persons.
Methods: 86 PsA patients (47 with AH, age 42.210.3 yrs and 39 without AH, age
44.22.2 yrs), 16 patient with AH (age 46.410.2 yrs) and 26 healthy persons (46.012.6
yrs) were involved. Patients and controls were matched by cardiovascular risk factors and
had no cardiovascular diseases (except AH). Pulse wave analysis was performed (Then-
siomed): aortic and brachial augmentation indexes (AixAo, AixB) were calculated. Pa-
rameters were recorded at baseline and after 6-month.
Results: AS in hypertensive PsA patients exceeded AS in non-hypertensive PsA patients, in
AH without arthritis and in controls. In non-hypertensive PsA patients AixAo¼12.54
[7.23,26.21]%, AixB¼-47.25[-59.25,-17.5]%; in hypertensive PsA patients AixAo¼31.13
[18.2,38.3]%, AixB¼-4.11[- 40.2,12.77]%; in AH patients AixAo¼21.92[15.68,29.23]%,
AixB¼-25.0 [-39.83, -7.86]%; in controls AixAo¼15.5[8.71,24.07]%, AixB¼-40.48
[-56.27,-19.03]%,p<0.05. In 6-month follow-up there was recorded the improvement of
arterial stiffness in patients with beneficial treatment of PsA without AH: AixAo¼12.5
[7.6,26.7]%, AixB¼-47.3[-59.7;-17.6]%, p<0.05 with baseline. In PsA+AH AS increased
despite of beneficial PsA and AH treatment: AixAo¼31.2[18.3,38.3]%, AixB¼-3.8
[-40.7,12.8]%, p<0.05.
Conclusion: PsA and AH increase negative effects of each other on the vascular wall that
determines the increase of AS which progress over time despite of clinical improvement of
arthritis. Beneficial PsA treatment leads to decrease of arterial wall stiffness in non-hyper-
tensive PsA patients.
Disclosure of Interest: None Declared
O127
Determining the functionally relevant reactive cysteines on the human L-type calcium
channel protein in response to oxidative stress
Padmapriya Muralidharan*1, Henrietta Cserne Szappanos1, Evan Ingley2, Livia Hool1
1
School of Anatomy, Physiology and Human Biology, The University of Western Australia, 2Cell
Signalling Research, Western Australian Institute of Medical Research, Perth, Australia
Introduction: An increase in reactive oxygen species and calcium contribute to the
development of cardiac hypertrophy. The L-type calcium channel (LTCC) is the major
route for calcium influx into cardiac myocytes. We have shown that oxidative stress is
associated with persistent glutathionylation of the LTCC that results in an increase in
intracellular calcium and protein synthesis consistent with the development of myocyte
hypertrophy.
Objectives: The purpose of this study was to identify the cysteines on the alpha subunit of
the channel responsible for modulating channel function during oxidative stress.
Methods: Human long and short N terminal (NT) isoforms of Cav1.2 (alpha subunit) were
expressed in HEK cells. Cysteines were mutated to a serine or an alanine. The channel
protein was purified by histidine tag purification and incorporated in liposomes for
functional analysis by patch-clamp technique.
Results: Exposing the long NT isoform to 200mM of the thiol-specific oxidising
compound 5,5’-dithio-bis(2-nitrobenzoic acid) (DTNB) increased open probability (Po)
of the channel from 0.0320.003 to 0.0750.011 and subsequent exposure to the
thiol reducing agent dithiothreitol DTT (1mM) decreased Po to 0.0320.014 (n¼12;
p<0.05). Consistent with these results, addition of 2mM oxidised glutathione to the
long NT isoform increased Po from 0.0260.008 to 0.088 0.014 without altering the
magnitude of the current or the current–voltage relationship (n¼6; p<0.05) while
1mM reduced glutathione decreased Po from 0.0290.007 to 0.0100.007 (n¼5;
p<0.05). Similar results were obtained with the short NT isoform that lacks the first 46
amino acids of the N terminus (n¼5) and after truncation of the C terminus (n¼7).
This suggests that the N terminal and C terminal domains are not the reactive regions.
In contrast, DTNB and DTT had little effect on Po of the long NT isoform containing
mutated cysteines at C519S, C543S and C547A in the alpha interacting domain (AID)
region (n¼14).
Conclusion: We conclude that three critical cysteines on the alpha interacting domain of
Cav1.2 appear to be required for alterations in the function of the channel during oxidative
stress.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O128
ORAL ABSTRACTS
Cardiomyocyte mineralocorticoid receptor signalling contributes to sex specific
ischemic injury responses and reduces functional recovery post-ischemia/reperfusion
Laura A. Bienvenu*1,2, Melissa E. Reichelt1, James Morgan2, Lea M. Delbridge1,
Morag J. Young2,3
1
Department of Physiology, University of Melbourne, 2Cardiovascular Endocrinology
Laboratory, Prince Henrys Institute, 3Department of Physiology, Monash University,
Melbourne, Australia
Introduction: Cardiomyocyte mineralocorticoid receptor (MR) activation is involved in the
development and progression of heart failure. Experimental studies have demonstrated that
cardiomyocyte specific deletion of MR can ameliorate cardiac fibrotic and inflammatory
responses caused by excess mineralocorticoids. Recent experimental and clinical evidence
suggests that sex differences observed in heart failure may have an MR-dependent
mechanism.
Objectives: The aim of this study was to characterize the role of cardiomyocyte MR
signaling in ischemia/reperfusion injury and recovery and to identify MR-modulated dif-
ferences in sex-specific regulation of cardiac function.
Methods: At 8 weeks of age, male and female, wild type (WT) and cardiomyocyte MR
knockout (myo-MRKO) mice underwent uninephrectomy and were maintained on either
(i) high salt (VEH: 0.9% NaCl, 0.4% KCl) or (ii) high salt plus deoxycorticosterone pellet
(DOC: 0.3mg/day, 0.9% NaCl, 0.4% KCl). Following 8 weeks of treatment hearts were
Langendorff perfused, subjected to 20 minutes global ischemia and 45 minutes reperfusion
(n¼7-9 per group).
Results: Recovery of left ventricular developed pressure (LVDevP) post-ischemia/reperfu-
sion was greater in myo-MRKO hearts vs. wild type (% basal LVDevP: male WT; VEH:
735 mmHg, DOC: 782 mmHg vs, myo- MRKO; VEH: 886 mmHg, DOC: 903
mmHg, female WT; VEH: 669 mmHg, DOC: 697 mmHg vs myo-MRKO; VEH: 865
mmHg, DOC: 855 mmHg, p<0.05.). During ischemia, mineralocorticoid excess
increased peak contracture in males hearts regardless of genotype (male WT; VEH: 358
mmHg, myo-MRKO; VEH: 464 mmHg vs WT DOC:534 mmHg, myo-MRKO:DOC:
534 mmHg, p<0.05). Interestingly, genetically manipulated suppression of myo-MR
reduced peak contracture in female hearts even in the presence of excess mineralocorticoids
(female WT; VEH: 355 mmHg, DOC: 423 mmHg vs myo-MRKO; VEH: 224 mmHg,
DOC: 336 mmHg, p<0.05).
Conclusion: These data demonstrate that cardiomyocyte MR signaling contributes to post-
ischemia/reperfusion dysfunction in male and female hearts. Sex differences observed
during the ischemic period suggest that mineralocorticoid status modulates peak ischemic
injury in male hearts; in female hearts it appears that MR activation is critical for peak
ischemic injury. Further studies are examining the molecular mechanisms involved in sex-
and MR-regulation of cardiac injury and function.
Disclosure of Interest: None Declared
O129
Developmental patterns of Wnt-signalling pathway intermediates in the ovine heart
between mid-gestation and the neonatal period
Nikita Gupta*1,2, Ramona Krauss1,2, Joseph Smolich1,2, Michael Cheung1,2,3, Salvatore Pepe1,2
1
Heart Research, Murdoch Childrens Research Institute, Melbourne, 2Paediatrics, University of
Melbourne, Parkville, 3Cardiology, Royal Children’s Hospital, Melbourne, Australia
Introduction: The canonical and the non-canonical Wnt signalling pathways are critical in
early cardiogenesis and growth and have been extensively studied in drosophila, xenopus
and mice, but not large animals such as sheep. In particular, it is unknown how these
pathways change during fetal and neonatal development or whether differences exist be-
tween ventricles, given that a right ventricular (RV) functional dominance occurs in utero,
but a left ventricular (LV) dominance after birth.
Objectives: To characterise changes in LV and RV expression of 7 key proteins in the Wnt
signalling pathway (Wnt3a, Wnt5a, Dvl-1, phospho-GSK3b, cdc42, ROCK2 and TCF7L2)
during fetal development and after birth in sheep.
Methods: LV and RV myocardial samples were collected at post-mortem from mid-
gestation (age¼78-80 days, term¼147 days; n¼4), pre-term (age¼128-129 days; n¼7)
and near-term fetal lambs (age¼139-141 days; n¼4), as well as neonatal lambs (age¼5-7
days;n¼8). Tissues were stored at -80 C until batch-processing for immunohistochemistry
and western immunoblots.
Results: Three main developmental patterns were evident in ventricular expression of
Wnt-related proteins. In the first pattern, the relative LV and RV expression of Wnt3a, Dvl-
1, phospho-GSK3b and cdc42 increased during fetal development (P<0.05 – P<0.001),
with higher RV expression of phospho-GSK3b and cdc42 (P<0.05 – P<0.005). However,
changes after birth were heterogenous, with falls in Dvl-1 and phospho-GSK3b (P<0.02 –
P<0.001), but not Wnt3a or cdc42. In the second pattern, fetal and newborn Wnt5a and
ROCK2 expression was relatively constant, but with RV expression 2-3 fold higher
(P<0.025 – P<0.001). On the other hand, TCF7L2 expression decreased progressively
in both ventricles from mid-gestation to neonatal stages, with greater levels in LV compared
to RV.
Conclusion: These data demonstrate that distinct developmental patterns exist in the
ventricular expression of a number of key proteins within the Wnt signalling pathway
during fetal growth, with evidence of differential expression between ventricles.
However, no consistent change in expression of these proteins was apparent with
birth.
Disclosure of Interest: None Declared
e35
 O130
ORAL ABSTRACTS
A Novel Method To Calculate Fractional Flow Reserve In The Presence Of Serial
Stenosis Without Wedge Pressure Measurement
Andy Yong*1,2, Hong Seok Lim3, Bon-Kwon Koo4, Myeong-Ho Yoon3, Hack-Lyoung Kim4,
Martin K. C. Ng5, Seung-Jea Tahk3, Chang-Wook Nam6, William F. Fearon2
1 where PCI procedures are performed. Costs were assigned using diagnostic related
Cardiology, Concord Repatriation General Hospital, Sydney, Australia, 2Cardiovascular
Medicine, Stanford University Medical Center, Stanford, United States, 3Cardiology, Ajou
University Medical Center, 4Cardiology, Seoul National University Hospital, Seoul, Korea,
Republic Of, 5Cardiology, Royal Prince Alfred Hospital, Sydney, Australia, 6Cardiology,
Keimyung Univeristy Dongsan Medical Center, Seoul, Korea, Republic Of
Introduction: Fractional flow reserve (FFR) measurement enables functional assessment of
coronary stenoses in the cardiac catheterisation laboratory, and the use of FFR to guide
revascularisation results in improved outcomes. However, in the presence of serial stenoses,
the proximal stenosis will affect FFR measurement of the distal stenosis and vice versa.
Accurate FFR assessments of individual lesions in series require measurement of the cor-
onary wedge pressure (Pw) to account for collateral flow.
Objectives: We aim to validate the use of a novel algorithm to calculate FFR in the
presence of serial stenoses without Pw measurement.
Methods: Patients from 5 tertiary referral centres who underwent FFR guided percuta-
neous coronary intervention of 2 separate coronary stenoses in series were included in this
study. Patients underwent a “pullback” FFR measurement of the target vessel before
intervention and after intervention of the first treated lesion. The proximal pressure (Pa),
distal pressure (Pd), and pressure between the 2 stenoses (Pm) were measured during
hyperaemia using a pressure-sensor guidewire. The apparent FFR (FFRapp) was compared
with the true FFR (FFRtrue) for the second treated stenosis. In order to ensure accurate
FFRtrue of the second stenosis, patients with significant residual pressure gradients across
the first treated stenosis were excluded from the study. The calculated FFR (FFRcalc:
[1.34Pd – 0.32Pa]/[1.34Pd – 0.32Pa + Pa – Pm] for the proximal stenosis and [1.34Pd –
0.32Pa]/[1.34Pd – 0.32Pa + Pm – Pd] for the distal stenosis) were derived by modifying an
equation that we previously developed to calculate coronary microcirculatory resistance
without Pw.
Results: A total of 53 patients were included in the study (32 who had proximal lesions
treated first and 21 who had distal lesions treated first). FFRapp (Pm/Pa for the proximal
stenosis, and Pd/Pm for the distal stenosis) measured prior to intervention was consistently
higher than the FFRtrue which was measured after intervention of the first lesion
(0.920.06 vs. 0.880.07, P<0.001). There was no significant difference (0.890.06 vs.
0.880.07, P¼0.112) between FFRcalc and FFRtrue (figure attached).
Conclusion: The individual FFR of each stenosis in the setting of serial stenoses can be
derived without the need for Pw. This method aids in the functional assessment of serial
stenoses prior to coronary intervention.
Disclosure of Interest: A. Yong: None Declared, H. S. Lim: None Declared, B.-K. Koo:
None Declared, M.-H. Yoon: None Declared, H.-L. Kim: None Declared, M. Ng: None
Declared, S.-J. Tahk: None Declared, C.-W. Nam: None Declared, W. Fearon Grant/
research support from: Research Support from St Jude Medical.
O131
Index and coronary heart disease related readmission costs for percutaneous
coronary intervention in Western Australia
Christian Gardner*1, Elizabeth Geelhoed1, Jamie Rankin2, Matthew Knuiman1,
Michael Nguyen3, Mark Newman4, Donald Cutlip5, Michael Hobbs1, Thomas Briffa1,
Frank Sanfilippo1
1
School of Population Health, University of Western Australia, 2Department of Cardiology, Royal
Perth Hospital, 3Department of Cardiology, Fremantle Hospital, 4Department of Cardiothoracic
Surgery, Sir Charles Gairdner Hospital, Perth, Australia, 5Beth Israel Deaconess Medical Centre,
Harvard Medical School, Boston, United States
Introduction: Following the introduction of drug-eluting stents (DES) in Western Australia
in 2002, the proportion of percutaneous coronary interventions (PCI) using these stents
increased rapidly to 96% in 2005. Although DES are associated with significant reductions
in the risk of target vessel revascularisation, they remain considerably more expensive than
bare metal stents (BMS).
e36
Objectives: To assess the costs of index admissions and readmissions for coronary heart
disease (CHD) related diagnoses over 2 years by type of stent for the total population of
patients undergoing PCI in Western Australia between 2000-2004.
Methods: Clinical and linked administrative data (inpatient admissions and death)
were merged for all patients who had their first PCI in Western Australia between
2000-2004. The clinical data were collected from all hospitals in Western Australia
groups (DRGs) for public and private hospitals using versions 4.2 and 5.1 of
Australian Refined DRGs published by the Australian Institute of Health and Welfare.
Costs were inflated to 2012-2013 Australian dollars using health price indexes pub-
lished by the Australian Institute of Health and Welfare. We calculated mean indi-
vidual costs by year and type of stent for index admissions and cumulative
readmissions for CHD related diagnoses (ICD 10-AM codes I20-I25) within 2 years of
the index admission.
Results: Over the five years, there were 9,593 index PCIs (5174 BMS, 53.9% and
4419 DES, 46.1%). The mean age was 65 for patients undergoing PCI with both BMS
and DES. The proportion of males was 74% and 68% for BMS and DES patients
respectively. 59% of procedures were performed in public hospitals. Index costs were
similar for both types of stent and remained relatively constant between 2000-2004 at
about AU$9000 (see Figure 1) per patient. Two-year costs for CHD-related read-
missions were stable for BMS patients, but increased slightly over the period for DES
patients. The total 2-year costs (including cost of the stents) were significantly greater
for DES, driven almost entirely by the higher cost of the DES device compared with
BMS.
Conclusion: Stent cost is the main driver of increased total 2-year costs of PCI procedures
employing DES compared with BMS. Longer follow-up is required to determine if the
increased initial cost of DES is offset by decreased subsequent costs associated with lower
rates of target vessel revascularisation, and possibly better long-term outcomes.
Disclosure of Interest: None Declared
O132
Outcomes Of Intravascular Ultrasound Guided-Percutaneous Coronary Intervention
Versus Conventional Percutaneous Coronary Intervention: A Meta-Analysis Of
Randomized Controlled Trials
Kathy Lou Tomandao*1
1
Section of Adult Cardiology, Perpetual Succour Hospital, Cebu, Philippines
Introduction: Coronary Angiography has been the standard test in evaluating coronary
artery disease however this procedure has its limitations. Intravascular ultrasound is a more
sensitive tool for correct assessment of true lumen dimensions. The use of IVUS during
percutaneous coronary intervention (PCI) may therefore optimize the results of PCI,
particularly of stent implantation.
Objectives: To compare the outcomes of patients who underwent intravascular ul-
trasound guided-PCI versus conventional percutaneous coronary intervention at 12
months.
Methods: Published randomized controlled trials on IVUS guided-PCI versus con-
ventional PCI were searched through Pubmed, ClinicalTrials.gov, HighWire. A total of
six randomized clinical trials were included in this meta-analysis with a total of 5,921
patients.
Results: Primary endpoint of target lesion revascularization (TLR) at 12 months were lower
in patients who underwent IVUS-guided PCI (RR 0.74; [95% CI 0.61; 0.89]; P 0.002).
Death and all-cause mortality (RR 0.84; [95% CI 0.66; 1.08; P 0.181), myocardial
infarction (RR 0.97; [95% CI 0.69; 1.37; P 0.879) and any MACE (RR 1.01; [95% CI 0.89;
1.15; P 0.856) showed no significant difference at 12 months between IVUS-guided PCI
and conventional PCI.
Conclusion: This meta-analysis has showed that IVUS-guided PCI resulted in lower target
lesion revascularization at 12 months compared with conventional PCI. In terms of death,
myocardial infarction and any MACE at 12 months, there was no significant difference
between two groups.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O133
Endothelial Function And Platelet Reactivity In Patients After Percutaneous Coronary
Intervention: Clopidogrel Vs Prasugrel
Gerasimos Siasos1, Dimitris Tousoulis*1, Eleni Kokkou2, Stamatios Kioufis2,
Evangelos Oikonomou2, Marina Zaromitidou2, Konstantinos Maniatis2, Nikolaos Gouliopoulos2,
Panagiotis Tourikis2, Konstantinos Zisimos2, Savvas Mazaris2, Theodosia Konsola2,
Vasiliki Genimata3, Christodoulos Stefanadis2
1
1st Cardiology Department, University of Athens Medical School, “Hippokration” Hospital,
Athens, Greece, 21st Cardiology Department, 3University of Athens Medical School,
“Hippokration” Hospital, Athens, Greece
Introduction: The clinical benefit of clopidogrel and prasugrel has been attributed to their
antiplatelet effects. Though, clopidogrel treatment has also pleiotropic vasoprotective
effects, such as modulation of vascular tone, improvement of endothelial function, as well
as inhibition of inflammation and oxidative stress.
Objectives: We examined the impact of clopidogrel and prasugrel treatment on endothelial
function and platelet reactivity in coronary artery disease (CAD) patients after percutaneous
coronary intervention (PCI).
Methods: We consecutively enrolled 12 patients with stable CAD receiving prasugrel
regimen (10mg/d) and 12 aged and sex matched CAD patients receiving clopidogrel
regimen (75mg/d), one month after PCI. Flow mediated dilation (FMD) was used as a
measured of endothelial function. High on treatment platelet reactivity was evaluated using
VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU) and the
diagnostic cut-off value is 230 PRU.
Results: There was no difference between CAD patients on clopidogrel and prasugrel
treatment in age (5610 years vs. 5610 years, p¼0.88), smoking habits (20% vs. 33%,
p¼0.11), in the presence of diabetes mellitus (42% vs. 11%, p¼0.12), arterial hyper-
tension (87% vs. 82%, p¼0.89),hyperlipidemia (90% vs. 85%, p¼0.25) and in the
presence of multivessel CAD (40% vs. 30%, p¼0.24). Subjects on prasugrel treatment
compared to subjects on clopidogrel treatment had significantly lower PRU (11180 vs.
23480, p¼0.001). The presence of patients with high on treatment platelet reactivity
was significantly lower in prasugrel group, compared to clopidogrel group (8% vs. 50%,
p¼0.03). Interestingly, subjects on prasugrel group had significantly improved endothelial
function compared to subjects on clopidogrel group (9.823.63% vs. 6.721.39%,
p¼0.01).
Conclusion: Prasugrel, compared to clopidogrel treatment, showed a greater effect on
endothelial function and inhibition of platelet activation in CAD patients after PCI. Further
studies are needed to elucidate the impact of prasugrel and clopidogrel treatment on
vascular function and atherosclerosis progression.
Disclosure of Interest: G. Siasos: None Declared, D. Tousoulis: None Declared, E. Kokkou
Grant/research support from: State Scholarship Foundation, S. Kioufis: None Declared, E.
Oikonomou: None Declared, M. Zaromitidou: None Declared, K. Maniatis: None Declared,
N. Gouliopoulos: None Declared, P. Tourikis: None Declared, K. Zisimos: None Declared,
S. Mazaris: None Declared, T. Konsola: None Declared, V. Genimata: None Declared, C.
Stefanadis: None Declared
O134
GAS emm-types probably involved in acute rheumatic fever
1 1 2,3
Noémie Baroux , Eric D’Ortenzio , Pierre Smeesters , Andrew Steer* 3,4
1
Epidemiology of infectious diseases, Institut Pasteur de Nouvelle-Calédonie, Noumea, New
Caledonia, 2Laboratoire de Génétique et Physiologie Bactérienne, Institut de Biologie et de
Médecine Moléculaires, Faculté des Sciences, Université Libre de Bruxelles, Gosselies, Belgium,
3
Group A Streptococcus, Murdoch Childrens Research Institute, 4Centre for International Child
Health, University of Melbourne, Melbourne, Australia
Introduction: Group A streptococcal (GAS) is responsible for the chain leading to acute
rheumatic fever (ARF) and rheumatic heart disease (RHD). That certain GAS strains may be
more rheumatogenic than others is a concept widely believed. However, there has only
been a single review of predominant serotypes involved in streptococcal outbreaks asso-
ciated with ARF between 1939 and 1971. This review of US studies found the following
emm-types to be associated with ARF: 1, 3, 5, 6, 14, 18, 19, 24, 27 and 29. However, a
review of GAS emm-types associated with ARF in developing countries, where ARF is
endemic, has never been undertaken.
Objectives: The aim of this systematic review was to provide the most comprehensive list
of emm-types associated with ARF cases.
Methods: We searched, for all reports of original research in the PubMed database (http://
www.ncbi.nlm.nih.gov/pubmed/) from the 1st January 1944 (first publication of Jones
criteria) to the 31rd December 2012 using combinations of the following terms
STREPTOCOCCUS PYOGENES, GROUP A STREPTOCOCCI, RHEUMATOGENIC,
EMM, M, OUTBREAK and ACUTE RHEUMATIC FEVER. Grey literature was also
reviewed. All articles reporting emm-type of GAS isolated or antibodies against emm-type
from children or adults with ARF were selected.
A probable rheumatogenic GAS was defined as a GAS isolate typed from the throat of an
ARF case with Jones criteria reported, while a possible rheumatogenic GAS one in which
the ARF case was defined without Jones criteria.
Results: The PubMed search yielded 357 potentially relevant articles. Finally, we selected
28 relevant studies. In total, 57 different GAS emm-types or anti-M antibodies were clas-
sified as a probable or a possible GAS emm-type: 45.1% of these emm-types were known as
classical rheumatogenic GAS. In 11 studies, 52 GAS isolates were reported as probable
rheumatogenic strains corresponding to 18 different emm-types. Among them, 30.1% were
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
already identified as classical rheumatogenic strains and the 5 most prevalent GAS were
M12 (n¼10), M18 (n¼10), M75 (n¼5), M1 (n¼5), M29 (n¼3).
ORAL ABSTRACTS
Conclusion: Our study revealed a large number of GAS emm-types associated with ARF,
greater than the number of classical rheumatogenic strains previously described. Thereby,
the concept of ”rheumatogenicity” should be extended to strains other than those classically
described in the USA. In the context of the development of a GAS vaccine, this study
reframes the GAS emm-types involved in the occurrence of ARF.
Disclosure of Interest: None Declared
O135
Newer insights on prognosis of reversible peripartum cardiomyopathy
Cecily Mary Majella Jayaraj*, venkatesan sangareddi, gnanavelu ganesan, v. e. dhandapani,
m. s. ravi, k. m. meenakshi, d. m muthukumar, n swaminathan, g. ravisankar,
g. prathapkumar
Cardiology, Madras Medical College and Research Institute, Chennai, India
Introduction: Peripartum cardiomyopathy (PPCM) which was first described in the 1800s,
yet its etiology is still unclear. Its diagnosis is often delayed because its symptoms closely
resemble those within the normal spectrum of pregnancy and the postpartum period.-
Earlier diagnosis favours a better outcome.
Objectives: To evaluate the clinical profile and prognosis of peripartum cardiomyopathy .
Methods: Patients in the last month of pregnancy and 5 months postpartum referred for
cardiac evaluation from september 1, 2011, to august 31,2012 were included in this
study.Clinical and serial echocardiographic evaluation were done and followed up at 1, 3,
and 6 months on these patients.
Results: Among 5475 patients 14 patients[0.25%] were diagnosed as peripartum car-
diomyopathy.Mean age:253years,time of presentation [last month of conception-4
[28%],first month of postpartum -10[72%],preceding h/o of viral fever- 2[14%]pregnancy
induced hypertension [PIH]on betablockers-4[28%] ,mean ejectionfraction at presentation
308%,mean fractional shortening 224%,mean end-diastolic dimension [5.91.8cm]
biventricular thrombi -2[14%]pulmonary embolism -3[21%][1-saddle type ,2- proximal
left pulmonary artery]. Mortality-3/14[21%].Mortality was high among patients with
massive pulmonary embolism and those with preceding viral fever.Follow up echo was
done at discharge and after 1,3 and 6 months .Echocardiographic features at diagnosis were
unable to predict individually who would eventually recover, although a statistically sig-
nificant difference occurred at diagnosis between the recovered group and nonrecovered
group for mean ejection fraction (28% vs 23%; P<.001) and fractional shortening (18% vs
14%; P¼.004).of leftventricle,whereas mean end-diastolic dimension (6.1 vs 5.7 cm;
P¼.08)was not statistically significant,Patients with pregnancy induced hypertension[4-
28%] had earlier [3months vs 6months ] and complete recovery of ejection fraction [58.6vs
36.8 p¼0.02].
Conclusion: We conclude PPCM when associated with PIH shows relatively a better
outcome .The reason could be earlier exposure to betablockers may moderate the disease
progression and make it more likely,that full recovery will occur.Gestational hypertension
brings patients for medical and cardiac evaluation earlier resulting in earlier and better
prognosis.
Disclosure of Interest: None Declared
O136
Diffuse Atrial and Ventricular Fibrosis Measured by T1 Mapping on Cardiac MRI
Predicts Success of Atrial Fibrillation Ablation
Alex J. Mclellan*1,2, Liang-Han Ling2, Andris H. Ellims2, Leah M. Iles2, Sonia Azzopardi2,
Joseph B. Morton1, Jonathan M. Kalman1, Andrew J. Taylor2, Peter M. Kistler2
1
Royal Melbourne Hospital, 2The Alfred Hospital/ BakerIDI, Melbourne, Australia
Introduction: Atrial fibrillation may be associated with atrial and ventricular fibrosis.
Contrast enhanced T1 mapping using Cardiac Magnetic Resonance imaging (CMR) pro-
vides a method to quantitate diffuse atrial and ventricular fibrosis.
Objectives: The aim of the present study was to investigate the relationship between post
contrast atrial and ventricular T1 relaxation times and freedom from AF following pul-
monary vein isolation(PVI).
Methods: 121 patients with atrial fibrillation (63% paroxysmal AF; age 57.510.4 years;
LA area 26.96.5cm2; LVEF 58.78.2%) underwent CMR with a 1.5T scanner prior to
PVI and post contrast atrial and ventricular T1 relaxation times were determined at the
inter-atrial septum and mid short axis left ventricle respectively. Freedom from AF post
ablation was documented by clinical review and 7 Day Holter monitoring at 6 monthly
intervals.
Results: At a mean follow up of 167 months, 91 of 121 (75%) patients were in sinus
rhythm off antiarrhythmic medication. Recurrent AF was associated with a significant
shortening of both the atrial T1 time (21733ms vs. 24342ms in no AF recurrence;
p¼0.003) and the ventricular T1 time (36673ms vs. 42890ms in no AF recurrence;
p¼0.002). Univariate predictors of AF recurrence included post contrast atrial T1 time
(p¼0.002), post contrast ventricular T1 time (p¼0.005), AF group (paroxysmal vs.
persistent, p¼0.019), AF duration (p¼0.029), left atrial ejection fraction (p¼0.012), and
intraprocedural DCR (p¼0.005). Following multivariate analysis post contrast atrial T1
time was the only independent predictor of AF recurrence (p¼0.023). On receiver oper-
ating characteristic curve analysis, an atrial T1 time of 235ms (Area Under Curve (AUC)
0.64; p¼0.02), a ventricular T1 time of 380ms (AUC 0.67; p¼0.009) and the combination
of both an atrial T1 time of 235ms and a ventricular T1 time of 500ms (AUC 0.71;
p¼0.002) were the best performing cut-offs (Kaplan Meier analysis using these cut-offs are
presented in the figure below).
e37

ORAL ABSTRACTS
Conclusion: CMR T1 mapping provides a non-invasive measure of cardiac structural
remodeling. Shortening of the post contrast atrial or ventricular T1 relaxation time as a
representation of tissue fibrosis is associated with a significant increase in recurrent AF
following PVI and may have implications for patient selection and ablation strategies.
Disclosure of Interest: None Declared
O137
Pioglitazone attenuates atrial remodeling and vulnerability to atrial fibrillation in
alloxan-induced diabetic rabbits
Changle Liu*, Guangping Li, Huaying Fu, Jian Li, Lijun Cheng, Xinghua Wang, Tong Liu
Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical
University, Tianjin, China
Introduction: Due to anti-inflammatory properties of pioglitazone, a peroxisome pro-
liferator-activated receptor (PPAR)-g activator, it might exert beneficial effects on diabetes-
related atrial remodeling.
Objectives: We aimed to investigate the potential effects of pioglitazone, a peroxisome
proliferator-activated receptor (PPAR)-g activator, on atrial remodeling and atrial fibrilla-
tion (AF) promotion in alloxan-induced diabetic rabbits.
Methods: 72 alloxan-induced diabetic rabbits were randomly divided into three groups
(n¼24 for each): diabetic pioglitazone treatment A group (DPA group, 4mg/day/kg), diabetic
pioglitazone treatment B group (DPB group, 8mg/day/kg) and diabetic group (DM group), 24
healthy rabbits served as controls. 8 rabbits in each group were respectively used to elec-
trophysiological and histological study, patch-clamp study and western blotting analysis. 8
rabbits in each group were monitored hemodynamics and recorded SBP, DBP and LVEDP and
underwent transthoracic echocardiographic examination. After 8-week treatment, isolated
Langendorff perfused rabbit hearts were used to evaluate atrial electrophysiological param-
eters and vulnerability to AF which examined by burst and S1S2 pacing. CVF was calculated
by Sirius-Red (SR) staining. Whole-cell patch-clamp technique was used to measure APD and
atrial ionic currents (ICaL and INa). Western-blot analysis was applied to assess atrial protein
expression of ERK2, pERK, TGFb1, TLR4, NF-kB p50 and HSP70 in left atrial tissue.
Results: LAD, IVST and PWT were significantly increased in DM group compared with
controls, which were markly reduced by pioglitazone. SBP and DBP of DPI group were
significantly lower than DM group (P<0.05). IACT and AERPD were prolonged and AF
inducibility was increased in DM group (6/8 vs. 1/8, P<0.05) compared with controls,
which were markly reduced by pioglitazone. Pioglitazone attenuated atrial structural
remodeling, with significant reductions in CVF. APD90 and APD50 were prolonged in DM
group (P<0.05 vs. control), the densities of INa were reduced and the densities of ICaL
were increased in DM group (P<0.01 vs. control), which were attenuated by pioglitazone.
Western-blot analysis revealed DM increased expression of pERK, TGF-b1, TLR4, NF-kB
p50 and HSP70, which were reduced by pioglitazone.
Conclusion: Pioglitazone prevented DM-related arrhythmogenic atrial remodeling and
reduced vulnerability to AF, which may be due to its anti-inflammatory and anti-oxidative
characteristics.
Disclosure of Interest: None Declared
O138
Assessment Of Severity Of Mitral Stenosis Before And After Percutaneous
Transvenous Mitral Commissurotomy By Using Mitral Leaflet Separation Index
Md. Toufiqur Rahman* Dr.
Cardiology, National Institute Of Cardiovascular Diseases, Dhaka, Dhaka, Bangladesh
Introduction: Rheumatic fever and rheumatic heart disease continue to be the major health
problem in all developing countries including BangladeshRheumatic mitral stenosis is a
very common problem in our population having an incidence of 54 percent among
rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral
commissurotomy (PTMC) is appealing because the mechanism of valve dilation closely
parallels the mechanism of surgical mitral commissurotomy. Mitral leaflet separation (MLS)
index is a novel method to assess the severity of mitral stenosis.
Objectives: The aim of this study is to correlate the MLS index with 2D echo planimetry
method and Doppler PHT method in patients undergoing PTMC.
e38
Methods: A prospective study was done in National Institute of Cardiovascular Diseases,
Dhaka, Bangladesh , Al- Helal Heart Institute, Mirpur, Dhaka and Uro-Bangla Heart
Hospital , Lalmatia, Dhaka during the period of August 2006 to June 2012. Two hundred
and seventy five (275) patients with rheumatic mitral stenosis who underwent PTMC were
evaluated clinically , by echocardiography and by catheter during and after procedure. The
severity of Mitral Stenosis was assessed using 2D mitral valve area; pressure half time and
MLS index. The MLS index was estimated by measuring the maximal separation of tip of
the mitral leaflets in end-diastole in PLAX view and in apical 4-chamber view (A4C view).
Results: Mean age of the study population was 23.51  13.22 years. Most of the popu-
lation are female (83%). After PTMC mean mitral valve area increased from 0.83  0.14
cm2 to 1.69  0.39 cm2 as measured by echocardiography(2D Planometry). Pre-PTMC,
mean MVA (PHT) was 0.80  0.35 cm2 and MLS index was 5.97 mm. A good correlation
was observed between MVA (2D) and MLSI (r ¼ 0.36, p¼0.0132) and also between MVA
(PHT) and MLSI (r ¼ 0.54, p ¼ 0.0001).
Post-PTMC, mean MVA (PHT) was 1.62  0.39 cm2 and MLSI was 11.24 mm. Here also, a
good correlation was observed between MLSI and MVA (2D) (r ¼ 0.39, p ¼ 0.0084); how-
ever, a poor correlation was observed between MLSI and MVA (PHT) (r ¼ 0.15, p ¼ 0.27).
Conclusion: MLSI can be used as a complementary method for the assessment of Mitral
Stenosis severity before as well as after PTMC
Disclosure of Interest: None Declared
O140
Pulmoaary Hypertension in Adult Congenital Heart Disease – The ANZ PAH-CHD
Registry
Geoff Strange*1, Michelle Rose2, Fiona Kermeen3, Anne Keogh4, Clare O’Donnell5,
Leeanne Grigg6, Patrick Disney7, Andrew bullock8, Helen Whitford9, Chris Frampton10,
Robert Weintraub11, David Celermajer1
1
Cardiology, Royal Prince Alfred Hospital, Sydney, 2Cardiology, Royal Children’s Hospital ,
Melbourne, 3Transplant, The Prince Charles Hospital, Brisbane, 4Cardiology, St. Vincent’s
Hospital, Sydney, Australia, 5Cardiology, Auckland City Hospital, Auckland, New Zealand,
6
Cardiology, Royal Melbourne Hospital, Melbourne, 7Cardiology, Royal Adelaide Hospital,
Adelaide, 8Cardiology, Royal Perth Hospital, Perth, 9Respiratory , The Alfred Hospital,
Melbourne, Australia, 10University of Ontago, Christ Church, New Zealand, 11CArdiology, Royal
Childrens Hospital, Melbourne, Australia
Introduction: There are now more adults (>16 years) than children with Congenital Heart
Disease (CHD) in Australasia. Previous data suggest that up to 5% may have Pulmonary
Arterial Hypertension (PAH) however registry data are lacking; the prevalence, character-
istics, treatment patterns and outcomes are not well characterized. We therefore established
a bi-national registry (Australia and New Zealand, ANZ) to address some of these questions.
Objectives: To characterise this emergent population.
Methods: A comprehensive database was developed and subjects from all the major Adult
CHD Units in ANZ were identified. Patients were included if they had been seen at least once
after 1 Jan 2000, over age 16 years, with an established diagnosis of PAH complicating CHD.
Results: 360 subjects with 2936 patient years of follow up have been entered into in the
Registry (60% female, 85% Caucasian). Patients had their first diagnosis of CHD at age 8 
15 years. Age at first visit to the Adult CHD centre was 31  14 years. Patients recognised
their first symptom of PAH at age 24.6  16.5 exposing a median 2.2 (IQR: 0.2 - 10) year
interval between symptom recognition and adult centre diagnosis of PAH. Dyspnoea was
the primary presenting symptom in 85% of patients. PAH diagnosis was based on right
heart study in 58% of patients, echo only in 32% and clinical findings in 2%. At PAH
diagnosis, 65% of patients had established RVH and dilation on echocardiogram.
Underlying CHD diagnoses in these subjects were ASD (21%), PDA (15%), VSD (34%)
and AVSD (14%); the others had more complex CHD lesions (18%). 34% of patients had
had some form of surgical repair. 68% had Eisenmenger Syndrome and 24% had Down
syndrome. Functional Class (FC) at first ACHD centre visit was FC III in 56% of cases and
FC II in 34%. Mean 6MWT was 364 metres at PAH diagnosis. Survival estimates were 88%,
79% and 69% respectively at 5, 10 and 15 years of follow up. Lower baseline walk test had
a significant adverse impact on survival (P ¼ 0.029).
Conclusion: The ANZ PAH-CHD database is one of the largest international registries
addressing this population. Substantial delays in diagnosis exist. Lower baseline exercisability
evaluated at diagnosis in the adult centre adversely impacts survival. Significant collaboration
is warranted to address this delay in presentation which may impact long term outcomes.
Disclosure of Interest: None Declared
O141
Sex Differences in Acute and Prodromal Symptoms of Chinese Patients with Acute
Coronary Syndrome
Libin An*1, Wentao Li1, Hongling Shi2, Bolun Zhao1, Xiaohua Zhou1, Xin Peng2, Shuqin Fan2,
Nan Zheng2, Liwei Yang2
1
School of Nursing, Dalian University, Dalian, 2School of Nursing, Jilin University, Changchun,
China
Introduction: The incidence rate of acute coronary syndrome (ACS) is continuously
increasing every year in China. Accurately identifying the acute and prodromal symptoms
of ACS is essential for the diagnosis and treatment. Some studies have indicated different
genders may have different symptoms among some diseases. Few studies about sex dif-
ference in acute and prodromal symptoms of Chinese patients with ACS were found.
Objectives: The purpose of this study is to find the gender differences in acute and
prodromal symptom of Chinese patients with ACS.
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
 Methods: The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey
(MAPMISS) was applied in this study. 101 first time diagnosed ACS patients (34 men and
67 women) were surveyed at Jilin province in China.
Results: The average acute score was 15.287.033. No sex difference was found. All
patients experienced pain or discomfort when ACS occurred, common locations were
centered in high chest, back or between/under shoulder blades, left breast, neck/throat, top
of shoulders, generalized chest and both arms. Men described more generalized chest pain
or discomfort than women (P<0.05). Women experienced more neck/throat pain or
discomfort than men (P<0.05). Crushing, sharpness, fullness and tightness were more
common in male group. Women experienced more burning, pressure, ache and tingling.
The most frequent general symptoms for ACS patients were weakness, cold sweat, short-
ness of breath/difficulty breathing, arms weak/heavy, dizzy or faint, unusual fatigue and
nausea. Women reported more weakness than men (P<0.01) .
The average proromal score was 18.9615.184. There was significant difference between
men and women (P<0.05). Women reported more pain or discomfort than men (P<0.001).
The main locations of pain or discomfort centered in high chest, left breast, neck/throat, back
or between/under shoulder blades. Women experienced more high chest, neck/throat pain
or discomfort than men prior to ACS (P<0.05). In addition to, 83.2% patients reported
general symptoms before ACS, but with no statistically significant sex differences.
Conclusion: This study indicated that there were gender differences for Chinese patients
with ACS in general symptoms, location and nature of pain or discomfort when acute
symptoms appeared. The incidence rate and location of prodromal symptoms had also
significant statistic difference by gender.
Disclosure of Interest: None Declared
O142
The use of journey mapping and persona creation to inform design of an e-health
strategy to support cardiovascular disease prevention
Genevieve Coorey*1, Lis Neubeck1,2, David Peiris3,4, Fred Hersch5, Bindu Patel1,
Marilyn Lyford1, Jax Wechsler6, Lauren Tan6, Julie Redfern1,4
1
Cardiovascular Division, The George Institute for Global Health, Australia, 2Sydney Nursing
School, The University of Sydney, Sydney, Australia, 3Primary Health Care Research, The
George Institute for Global Health, Australia, 4Sydney Medical School , The University of Sydney,
Sydney, Australia, 5Essential Healthcare, The George Institute for Global Health, Oxford, United
Kingdom, 6Sticky Design Studio, Sydney, Australia
Introduction: Consumer use of technology for health purposes is pervasive and could
support cardiovascular disease (CVD) prevention. Understanding the audience or users of
an e-health strategy improves the design and potential effectiveness of a mobile application
and companion website.
Objectives: To use qualitative design methods (including interactive workshops and in-
terviews) to develop journey maps and personas as visual representations about a target
group, so as to understand how an e-health strategy can best be designed as an effective risk
reduction intervention.
Methods: Workshops with health researchers were led by two consultants with expertise in
user-centred design. In a 2-hour workshop, nine researchers, including two cardiac
rehabilitation specialists, co-designed a journey framework of post-hospital care after a
cardiovascular event and described contextual insights into high-risk individuals. During
two separate one-to-one interviews and one small workshop with patients (both with CVD
and at high risk) the journey maps were refined to reflect personal experiences. These maps
framed conversation during the interviews about consumer experiences. A 3-hour work-
shop with seven researchers generated personas (profiles) which were refined during later
testing with actual patients from the demographic of potential users of the e-health strategy.
Results: The resulting 4 personas had diverse risk profiles, needs, backgrounds, ages, digital
literacy, health motivation and frustrations, relationships with their care providers, and other
influences on their health behaviour. Ways identified for an e-health strategy to meet patient
needs included: “to support me to make bigger changes to my lifestyle”; “help me understand
my risk of CVD”; “help motivate me”; “give me tips”. Two journey maps were created: one for
patients with CVD (see diagram) and one for those at high risk. Researchers used these maps
to identify time points and patient-provider interactions where an e-health tool could
augment face-to-face and print resources for cardiac rehabilitation.
web 3C/FPO
Conclusion: Personas are a medium for understanding the needs of technology users in
relation to their lifestyle and motivations. Journey maps illustrate the healthcare experi-
ences of patients over time. Both are means by which designers and researchers gain insight
into consumer needs to inform features that improve relevance and utility of an e-health
strategy for optimising lifestyle-related changes for CVD prevention.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O143
ORAL ABSTRACTS
Healthy Active By Design: Health In All Policies Through Active Planning
Trevor R. Shilton*1,2, Fiona Bull2, Paula Hooper2, Robina Crook3, Chris Melsom3, Jo Appleby1
1
Cardiovascular Health, National Heart Foundation of Australia, 2Population Health, University
of Westren Australia, 3Hassell Studio, Perth, Australia
Introduction: Many of the solutions to noncommunicable disease problems lie in sectors other
than health. Effective urban design policy and practice can make a difference to how people use
buildings, open spaces and the movement network – therefore urban design can impact on
population physical activity levels. Physical inactivity remains a prevalent and important
contributor to rising NCDs. Healthy Active by Design (HABD) is a web-based urban planning tool
launched in Western Australia in February 2014. A key feature of HABD is that it was developed
in partnership by the Heart Foundation with key Government Departments of Planning,
Transport, Sport and Recreation and Health, and otehr key ptrofedssional stakeholders.
Objectives:
 For Health sector organizations to forge stronger partnerships with planners
 To advocate for the provision of environments that encourage people to be more active
 To develop an online resource that provides up to date and flexible guidance and
tools to assist planners, designers and developers in how to integrate evidence on
health impact into the master planning and design process.
 To implement the resource in a way that affects planning policy and practice
Methods: HABD was developed in three phases: (1) Policy scoping and desktop review and
consultation with key stakeholders; (2) Design, development and production; and (3)
Implementation, dissemination and evaluation. In response to stakeholder (end user)
feedback, the HABD tool provides several key components (1) the latest scientific evidence
(2) practical guidance on how to implement (3) quick links to policy (4) examples and case
studies (5) user friendly tools and check lists.
Results: The HABD project has achieved strong buy-in form key Government Departments
and stakeholders and is an outstanding example of the application of health-in-all-policies
principles. The final HABD tool covers nine design features which were selected based on
available evidence and alignment with existing local planning policies. As a design tool,
HABD is a practical application of evidence to practice translation and of high relevance to
the primary end users across the built environment professions.
Conclusion: Following launch in February 2014 an ongoing maintenance and implementation
strategy (phase 3) ensures adoption and implementation of HABD. This includes ongoing
advocacy, professional development and training, web maintenance and enhancement.
Disclosure of Interest: None Declared
O144
Pregnancy Complicated by Heart Disease in Nepal
Shailaja Chhetri1, Nikesh R. Shrestha*2, Thomas Pilgrim3
1
Obstetrics and Gynecology, 2Cardiology, B.P. Koirala Institute of Health Sciences, Dharan,
Nepal, 3Cardiology, Bern University Hospital, Bern, Switzerland
Introduction: During pregnancy, the changes of cardiovascular physiology can impose an
additional load on the cardiovascular system of women with underlying heart disease.
Timely diagnosis and adequate medical management may be delayed in emerging countries
due to absence of routine prenatal examinations and delayed presentation.
Objectives: To investigate the prevalence, characteristics and maternal and perinatal out-
comes of pregnancies complicated by heart disease in Eastern Nepal.
Methods: Between 1st March 2012 and 31st March 2013 women with pregnancy
complicated by heart disease presenting to the antenatal clinic and/or labour room of a
teaching hospital in Eastern Nepal were consecutively included into a single-center registry.
Results: Among 9463 deliveries between 1st March 2012 to 31st March 2013 53 women
(0.6%) with a mean age of 255 years were detected to have cardiac disease during preg-
nancy or at the time of delivery. Proportions of acquired, congenital and arrhythmic heart
disease amounted to 89%, 9%, and 2%, respectively (Table 1). Rheumatic heart disease
(RHD) was the most frequent cardiac disease complicating pregnancy (n¼47). Among 45
women with RHD continuing pregnancy until delivery, 30 (67%) were primigravidae. The
predominant valvular pathology was mitral stenosis (62%), followed by mitral regurgitation
(21%) and aortic regurgitation (13%). Twenty women (44%) underwent elective or emer-
gency cesarian section. Seven babies were born preterm (<37 weeks), the mean duration of
gestation amounted to 382 weeks. The mean weight of the babies at birth was 2.60.5 kg
(percentile <10 for gestational age). Maternal and fetal/perinatal mortality of pregnancies
complicated by RHD amounted to 4% and 16%, respectively (Table 2). NYHA functional
class III or IV (HR 6.0, 95% CI 1.2-29.1; p¼0.026), pulmonary hypertension (HR 9.1, 95%
CI 1.6-51.5, p¼0.012) and severe mitral stenosis (HR 7.0, 95% 1.4-34.4; p¼0.017) were
identified as predictors of maternal or fetal/perinatal mortality in a univariate analysis.
e39

ORAL ABSTRACTS
Conclusion: Rheumatic mitral stenosis was the most frequent heart disease complicating
pregnancy in a consecutive cohort from a teaching hospital in Nepal. Exercise intolerance,
pulmonary hypertension and severe mitral stenosis were identified as predictors of
maternal or fetal/perinatal mortality.
Disclosure of Interest: None Declared
O145
Dipeptidyl peptidase-4 inhibitors and cardiovascular outcomes: Meta-analysis of
randomized clinical trials
Ingrid Hopper*, Shiying Wu, Marina Skiba, Henry Krum
CCRE, Monash University, Melbourne, Australia
Introduction: The association between glucose-lowering in subjects with diabetes mellitus
and major cardiovascular (CV) outcomes is weak. Furthermore, some oral hypoglycaemic
agents are associated with increased CV events. Dipeptidyl peptidase-4 inhibitors (DPP-4
inhibitors) are a new class of oral hypoglycemic agent that may have beneficial CV effects.
Objectives: We undertook a systematic review to appraise the CV safety and efficacy of
DPP-4 inhibitors.
Methods: A comprehensive search for published and unpublished prospective trials
comparing DPP4i with placebo and active comparators was performed. Trials were eligible
for inclusion if they reported on at least one of the outcomes examined, recruited minimum
100 patients and follow-up was a minimum of 24 weeks. We performed a meta-analysis of
the relative risk (RR) using the Mantel-Haenszel random effects model for mortality and
major cardiovascular (CV) outcomes.
Results: 50 trials met inclusion criteria, enrolling 55,232 patients with a mean follow-up of
42.8 weeks. When DPP4i were compared to all comparators (placebo and active), there was
no difference in all-cause mortality (n¼51,073, RR 1.01, 95% CI 0.91-1.13, p¼0.81), CV
mortality (n¼48,242 RR 0.98, 95% CI 0.85-1.12, p¼0.70, acute coronary syndrome
(n¼53,125 RR 0.97, 95% CI 0.87-1.08, p¼0.61) or stroke (n¼42,737, RR 0.98, 95% CI
0.81-1.18, p¼0.80). There was statistically significant increase in heart failure outcomes
(clinically significant HF and hospitalisations) (n¼34,573, RR 1.19, 95% CI 1.01-1.39,
p¼0.03), also seen when DPP-4 inhibitors were compared to placebo (RR 1.20, 95% CI
1.02-1.40, p¼0.03).
Conclusion: Treatment with DPP-4 inhibitors compared with placebo shows a nominally
statistically significant trend towards increased risk of HF outcomes. Against active
comparator, DPP-4 inhibitors demonstrated a reduction in ACS and stroke. It will be
important to see if these findings are also observed in other large-scale CV outcome studies
with these agents.
Disclosure of Interest: None Declared
O146
Prediction of reversibility of cardiotoxicity caused by immunotherapy with
trastuzumab
Ivo Darko Gabric*1, Ljubica Vazdar2, Hrvoje Pintaric3, Danijel Planinc1, Matias Trbusic1,
 Conclusion: SRs had a significantly lower appropriate therapy event rate compared to non-
Marijana Jazvic4, Ozren Vinter1, Zeljko Soldic4, Diana Delic-Brkljacic5
1 SRs in our cohort of patients who received BiV-ICDs, with no appropriate events occurring
Cardiology 2, 2Oncology Institute, 3Laboratory for invasive cardiology, 4Oncology and Nuclear
Medicine, 5Cardiology 1, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
Introduction: Cardiotoxicity is the most important side effect of trastuzumab, humanized
monoclonal antibody to the HER2 protein in use for immunotherapy of breast cancer. It is
mainly manifested as a reduction in left ventricular contractility without myocardial ne-
crosis and the process is therefore mostly reversible. However, sometimes the disease can
progress to irreversible dilated cardiomyopathy.
Objectives: Aim of the study is to distinguish factors that can at first appearance of car-
diotoxicity, with a certain probability, determine whether the process is reversible or
irreversible.
Methods: In this prospective study, we have analyzed 387 patients (pts) with non-meta-
static breast cancer, treated with trastuzumab for one year with the standard adjuvant
therapy protocol. Cardiotoxicity was defined with the reduction of left ventricular ejection
fraction (LVEF) by 15% from the baseline or by 10% of normal values. Echocardiography
was performed before the beginning and in three months period during therapy. If car-
diotoxicity was established, pts were suspended from the trastuzumab therapy, with
monthly echocardiography controls.
Results: Cardiotoxicity was established in 51 pts (13.17%) and they were divided in two
groups. Complete recovery of the cardiac function was found in 28 pts (54.9%, assorted to
group A) and they managed to finish trastuzumab protocol. Due to only partial recovery of
e40
the cardiac function or cardiotoxicity after readministration, trastuzumab therapy was not
finished in 23 pts (45.1%, assorted to group B).
Pts in group B had significantly greater reduction of LVEF (A:B¼27:15 %, p<0,0001)
and in those pts trastuzumab was started earlier after prior chemotherapy (A:B¼33,5:27
days, p¼0,037). As expected the mean NT-proBNP level in the serum was significantly
higher in group B (A:B¼92,3:134,7 ng/L, p¼0,01).
There was no significant effect of age, body mass, hypertension, stage, histology grade or
the side of the tumor, expression of the estrogen or progesterone receptors and the ACE
gene polymorphism on recovery of the cardiac function.
Conclusion: Trastuzumab induced cardiotoxicity is more likely to be irreversible in pts
with more extensive fall of the EFLV. If the drop is more than 25% we suggest not to
readminister trastuzumab. Time between prior chemotherapy and administration of tras-
tuzumab shorter than 30 days is more often associated with irreversible cardiac
impairment.
Disclosure of Interest: None Declared
O149
Low need for ICD Therapy in Biventricular Pacing Super-Responders
John L. Fitzgerald*1,2, Paul T. Martin1,2, Karin K. M. Chia1,2
1
Cardiology Department, Royal Brisbane and Women’s Hospital, 2School of Medicine, University
of Queensland, Brisbane, Australia
Introduction: Super-responders (SRs) to biventricular pacing (BiV) have been variously
defined by increase in ejection fraction (EF), decrease in left ventricular end diastolic
volume (LVEDV) or LVEDV index (LVEDVi). Recent studies point to low tachyarrhythmic
event rates requiring implantable cardioverter defibrillator (ICD) therapy in these patients.
This raises the possibility of downgrading the system to a BiV pacemaker at the time of
generator change with its associated economic healthcare benefits.
Objectives: We aimed to characterise ICD therapy rates in SRs defined as patients with
normalised EF (50%) following BiV-ICD implantation at our institution.
Methods: Review of all patients with available device interrogation data of minimum
duration 6 months post-device, with at least 1 available post-device follow-up echocardi-
ography (echo) result, was undertaken to detect events and appropriate therapies including
shocks and anti-tachycardia pacing (ATP) in patients with BiVs-ICDs implanted at our
institution.
Results: We studied 98 consecutive patients who had BiV-ICDs implanted from
November 2004 until February 2013. Thirty-four patients were excluded because of
absence of echo or interrogation data, leaving a total of 64 patients with available follow-
up from both our and peripheral referral centres, with a mean age of 67  11 years at
implant, 83% male. Fifteen patients (23%) were SRs, with mean follow-up EF as assessed
25  17 months post-implant in the SR group of 56%  5% compared to 32%  10%
in the non-SR group. Device data was available for a mean of 31  18 months post-
implant. Inappropriate therapy was delivered in 1 SR and 1 non-SR only (inappropriate
ATP in both cases). No appropriate ATPs or shock therapies were delivered in the SR
group, with 17 appropriate therapies delivered (in 11 patients) in the non-SR group
(p ¼0.003).
web 3C=FPO
amongst our SR group. These results have implications for future device replacement
planning with its attendant economic impact to the community and warrant ongoing
follow-up and study.
Disclosure of Interest: None Declared
O150
Long term efficacy and safety of transseptal endocardial left ventricular lead
implantation in failed conventional CRT implantations
László Gellér*, Levente Molnár, Szabolcs Szilagyi, Endre Zima, Gabor Szeplaki,
Istvan Osztheimer, Tamas Tahin, Emin Evren Ozcan, Bela Merkely
Heart Center, Semmelweis University, Budapest, Hungary
Introduction: Transvenous left ventricular (LV) lead positioning might be challenging or in
some cases impossible, in these patients alternative methods are needed.
Objectives: The aim of this study was to investigate the effectiveness and safety of
transseptal endocardial left ventricular lead implantation (TELVLI) in heart failure patients,
and evaluate the long term follow-ups of the patients.
Methods: TELVLI was performed in 31 patients (26 men, 626 years, NYHA III-IV stage).
Transseptal (TS) puncture was performed via the femoral vein. Intracardiac ulrasound was
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
used to guide the puncture in 23 pts. The site of the puncture was dilated with a 6mm
(3 pts), later with an 8 mm balloon (28 pts). After the puncture of the left subclavian vein,
an electrophysiological deflectable CS catheter was introduced into the CS sheath. The CS
catheter was used to reach the left atrium and the left ventricle through the dilated
transseptal puncture hole. At the latest LV activation site 65 cm active fixation bipolar lead
was screwed into the LV wall.
Results: The lead was fixed in the left ventricle in all cases with good pacing threshold values
(0,850,4 V;0,4 ms). Puncture complication, pericardial effusion was not observed. Because
of intraoperatively started anticoagulation therapy, pocket haematoma was observed post-
operatively in three (10%) and needed evacuation in one case (3%). Follow-up is longer than
one month in 30 patients (3212 months). Significant improvement of the NYHA class was
observed in all but one case (97%), on the first month control LV EF was 308% vs 377%.
Early lead dislocation was noticed in two cases (6%), reposition was performed using the
original puncture site in one, and transvenous implantation was succesfully carried out in
the other case. Explantation of the system was necessary because of pocket infection in four
cases (12%), in two of these cases TELVLI was carried out succesfully 3 months later. All
patients were maintained on anticoagulation therapy either with warfarine or cumarine with
INR between 2-3. No thromboembolic complication was noticed during the follow up. 2
patients were lost, one of them died five years after the implantation in renal failure, the other
patient died in malignant tumor 4 years after the implantation.
Conclusion: TELVLI approach might be a very promising alternative technique of the
surgical epicardial procedure when transvenous implantation could not be applied, how-
ever more evidences and multicenter studies are needed to evaluate this method.
Disclosure of Interest: L. Gellér Consultancy for: Biotronik, Speakers bureau: Medtronic,
Biotronik, St. Jude, Biosense, L. Molnár: None Declared, S. Szilagyi: None Declared, E.
Zima: None Declared, G. Szeplaki: None Declared, I. Osztheimer: None Declared, T. Tahin:
None Declared, E. Evren Ozcan: None Declared, B. Merkely: None Declared
O151
Fluoroscopy time is a poor predictor of radiation dose during biventricular device
implantation; proposed diagnostic reference levels from a large U.K. case series
Gwilym M. Morris*1,2, Zena Salih3, Gareth J. Wynn4, Fozia Ahmed5, Benjamin D. Brown6,
Jay Wright4, Amir Zaidi7
1
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia, 2Faculty of
Human and Medical Sciences, University of Manchester, 3Cardiology, Central Manchester
Foundation Trust, Manchester, 4Department of Cardiology, Liverpool Heart and Chest,
Liverpool, 5Department of Cardiology, Central Manchester Foundation Trust, Melbourne,
6
Department of Cardiology, University Hospital of South Manchester, 7Department of
Cardiology, Central Manchester Foundation Trust, Manchester, United Kingdom
Introduction: Implantation of biventricular devices (BiV) with a transvenous left ventric-
ular lead is complex procedure requiring a significant fluoroscopy time and radiation dose
to the patient and operator. Coronary sinus anatomy is very variable and so procedure
times and radiation dose is also variable. In the United Kingdom, the Health Protection
Agency (HPA) collects data regarding radiographic procedures and sets national diagnostic
reference levels (DRL) at the 75th percentile of the distribution of doses for a wide range of
procedures. The HPA has published the largest available dataset, but insufficient data were
returned to allow them to set DRL for BiV devices at the last publication in 2010 (335
patients, mean dose area product (DAP) 30 Gy cm2, mean screening time 24.5 min). Other
currently published datasets vary from 14 to 104 patients.
Objectives: Due to the large variation of published data and small datasets for BiV pro-
cedures we aimed to collect a large dataset to guide standards for implantation. Operators
are often guided by the fluoroscopy time during the procedure, we therefore also aimed to
investigate the correlation between screening time and radiation dose for BiV implantation
procedures.
Methods: We collected retrospective data (fluoroscopy time and radiation dose) for new
BiV devices for the three years 2009 - 2011 from three high volume tertiary centres in the
North West of England (H1, H2, H3). Databases were scrutinised to ensure the quality of
the data.
Results: From a total of 1374 implants we identified data for 1319 patients for fluoroscopy
time and 1316 for DAP (figure 1). The mean fluoroscopy time for all three centres com-
bined was 18.70.3 min. The 75th percentile fluoroscopy time for the combined data was
24.2 min. The mean DAP for the three centres combined was 25.11.3 Gy cm2. The 75th
percentile DAP for the combined data was 27.7 Gy cm2.
There were 1301 patients with complete data for both fluoroscopy time and radiation
dose allowing analysis of correlation; the correlation was poor (R2¼0.126, figure 2).
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
ORAL ABSTRACTS
Conclusion: We present a large dataset of new biventricular device implants, this will be
useful to guide operator’s practice during the implantation of difficult LV leads. Based on
the 75th percentile data we suggest a DRL of 24.2 min for fluoroscopy and a radiation dose
of 27.7 Gy cm2. Fluoroscopy is a poor indicator of patient dose so the operator should also
take note of the radiation dose during procedures.
Disclosure of Interest: None Declared
O152
Intraoperative right to left ventricular interlead delay predicts outcome in de novo
CRT recipients
Béla Merkely*, Laszlo Geller, Endre Zima, Szabolcs Szilagyi, Attila Roka, Klaudia Vivien Nagy,
Annamaria Kosztin, Levente Molnar, Gabor Szeplaki, Valentina Kutyifa
Heart and Vascular Center, Semmelweis University, Budapest, Hungary
Introduction: Previous studies suggested that right to left ventricular interlead sensed
electrical delay (RL-IED) is predictive of echocardiographic response to cardiac resynch-
ronization therapy (CRT).
Objectives: However, there is no data available on the effect of RL-IED on mortality in
patients with de novo CRT implantation.
Methods: Patients with RL-IED data available at implantation were evaluated with regard of
their baseline clinical and echocardiographic data. Data on all-cause mortality was assessed
using the Hungarian National Healthcare Fund Death Registry and our clinic follow-up
data. Kaplan-Meier survival analyses and multivariate Cox proportional hazards regression
analysis were used to analyze mortality in patients stratified by the median RL-IED (105.5
ms).
Results: From 2000 to 2011, 418 patients (37%) of 1122 CRT implantation had RL-IED
measurements available. Patients with RL-IED >105.5 ms were younger, had longer QRS
duration at baseline, and more dilated left ventricles. Left ventricular ejection fraction was
similar in both groups (RL-IED  105.5 ms 27.5  7.4 % vs. RL-IED > 105.5 ms 27.4 
6.3%, p>0.5). During the median follow-up of 25 months, 118 (28%) patients died, 68
patients (32%) with RL-IED > 105.5 ms, and 50 patients (24%) with RL-IED  105.5 ms.
RL-IED > 105.5 ms was associated with significant, 54% risk reduction in all-cause
mortality (95% CI: 0.25-0.84, p¼ 0.01) after adjustment for clinical covariates (Figure).
Each 10 ms increase in RL-IED was associated with 14% risk reduction in death of any
cause (p¼0.008).
Conclusion: In patients with de novo CRT implantation, RL-IED > 105.5 ms is associated
with a mortality benefit as compared to those with shorter RL-IED. RL-IED is an inde-
pendent predictor of all-cause mortality in patients with de novo CRT implantations.
Disclosure of Interest: None Declared
O153
Public access defibrillation- Results from the Victorian Ambulance Cardiac Arrest
Registry (VACAR)
Marijana Lijovic*1,2, Stephen Bernard1,2,3, Ziad Nehme1,2, A/Prof Tony Walker1,
A/Prof Karen Smith1,2,4, on behalf of the Victorian Ambulance Cardiac Arrest Registry Steering
Committee
1
Ambulance Victoria, 2Epidemiology and Preventive Medicine, Monash University, 3Alfred
Hospital, Melbourne, 4Emergency Medicine, University of Western Australia, Perth, Australia
Introduction: Since 2002, Ambulance Victoria (AV) has maintained a public access defi-
brillation (PAD) program across Victoria. AV has allocated and maintains 89 AEDs in 25
areas of high public attendance around the state, such as railway stations, airports, tourist
attractions and sporting venues. AV also maintains a registry of other automated external
defibrillator (AED) locations around Victoria via an “opt in” online registration system.
Objectives: To assess the impact of public AED use by bystanders in Victoria on survival-
related outcomes for adults suffering an out-of-hospital cardiac arrest (OHCA) compared to
e41
 those first defibrillated by emergency medical services (EMS), which includes AV para-
medics, firefighters and community emergency response teams.
ORAL ABSTRACTS
Methods: OHCA adult cases (>15 years) which occurred in a public location and were
attended by AV during the period 1 July 2002 to 30 June 2013 were extracted from the
Victorian Ambulance Cardiac Arrest Registry (VACAR). These cases were either in a
shockable rhythm (VF/VT) on EMS arrival and received defibrillation by EMS or were
defibrillated by bystanders with an AED prior to EMS arrival (at an AV PAD site or other
site). No arrests were witnessed by EMS and all cases had attempted resuscitation by EMS.
Results: During the study period, there were 2116 adults first defibrillated by EMS and
127 adults first defibrillated by a bystander with an AED. Median time to defibrillation was
significantly shorter for individuals first defibrillated by bystanders at sites with AEDs (5.5
mins, IQR 4.0-9.0 mins) compared to patients first defibrillated by EMS (10.0 mins, IQR
8.0-13.0 mins), p<0.001. Significantly more individuals who were first defibrillated by a
bystander at sites with AEDs survived to hospital (63%) compared to those first defibril-
lated by EMS (51%), p¼0.006. Significantly more individuals who were first defibrillated
by a bystander at sites with AEDs survived to hospital discharge (41%) compared to those
first defibrillated by EMS (31%), p¼0.020. After adjusting for other factors known to in-
fluence survival, defibrillation by a bystander with an AED increased the chance of survival
to hospital discharge by 51% compared to individuals first defibrillated by EMS (odds ratio
1.51, 95% CI: 1.01-2.25, p¼0.045).
Conclusion: Survival to hospital discharge favoured individuals first defibrillated by by-
standers with a public AED. These findings support continued resource allocation towards
PAD programs.
Disclosure of Interest: None Declared
O154
Minimisation of the Effects from Ablation Catheter Sliding Movements during
Radiofrequency (RF) Ablations by Electrogram Gated RF Delivery
William Chik*, Michael A. T. Barry, Jim Pouliopoulos, Abhishek Bhaskaran, Christine Midekin,
Gopal Sivagangabalan, Stuart Thomas, David Ross, Alistair McEwan, Pramesh Kovoor,
Aravinda Thiagalingam
Cardiology, Westmead Hospital, Westmead, Australia
Introduction: Cardiac respiratory movements causes catheter instability. Lateral catheter
sliding over target endocardial surface lead to poor tissue contact and unpredicatable lesion
creation.
Objectives: We describe a novel method of overcoming the effects of lateral catheter
sliding movements by delivering the same average power as a conventional ablation in an
electrogram-gated pulsed power ablation.
Methods: The myocardial phantom was constructed from a sheet of thermochromic liquid
crystal film. Varying degrees of catheter tip lateral sliding distances (0, 3, 6, 9mm) were
generated against the ablation interface. RF energy delivery was gated to an electrogram
(EGM) signal. Ablation settings were randomized to a conventional (non-gated) 30W vs an
EGM-Gated 150W @20% duty cycle ablation at each of the four lateral sliding distances.
Results: Forty-eight RF ablations were performed. Deeper lesions were created in EGM-Gated
vs. Conventional ablations at 6mm (4.30mm vs. 3.18mm, p¼0.008) and 9mm (4.35mm vs.
2.72mm, p¼0.004) sliding distances. Lesion length lengthened in Conventional but not
EGM-Gated ablations (xx) with greater sliding distances. EGM-Gated ablations created
consistent lesions at a quicker rate of growth in depth compared to Conventional ablations.
web 3C/FPO
Conclusion:
(1) Lesion DEPTH DECREASES and WIDTH INCREASES in Non-EGM Gated ab-
lations with greater degrees of lateral catheter movements;
(2) EGM-Gated pulsed RF delivery NEGATED the effects from lateral catheter
movement by creating consistently deeper lesions irrespective of the degree of
catheter movement;
e42
(3) Target lesion depths were reached significantly quicker in EGM-Gated than Non-
EGM-Gated ablations;
(4) Maximum substrate temperatures were higher in EGM-Gated than Non-EGM-
Gated ablations.
Disclosure of Interest: None Declared
O155
Wave Intensity Analysis of the Pulmonary Circulation in Health and DIsease
Edmund Lau1, Kaipa T. Srinivas*1, David Abelson1, Nathan Dwyer2, Martin Ng1,
David Celermajer1
1
Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, 2Department of
Cardiology, Royal Hobart Hospital, Hobart, Australia
Introduction: Wave Intensity Analysis (WIA) is a time-domain based model of blood flow
that allows quantification of wave power, wave speed and separation of forward and
backward travelling waves. It has not previously been applied to the human pulmonary
arterial circulation in vivo.
Objectives: To determine the feasibility of invasive WIA of the pulmonary circulation and
compare wave properties in controls and subjects with pulmonary arterial hypertension (PAH).
Methods: Simultaneous invasive pressure and Doppler flow-velocity measurements were
undertaken in Controls (n¼7) and PAH subjects (n¼7) in the pulmonary artery. WIA
modelling was performed offline using custom MatLab software. In 5 PAH subjects,
adenosine infusion was given for pulmonary vasoreactivity testing.
Results: Controls (age: 699 yrs) had normal pulmonary haemodynamics (PVR: 1.50.7
WU) vs. PAH subjects (age: 5712 yrs) with moderate-severe disease (PVR: 6.94.4 WU).
Total forward compression wave intensity was higher in PAH subjects compared to controls
(159.538.6 vs. 88.320.7x102 W.m-2, p<0.001), consistent with increased RV ejection
workload. Importantly, PAH subjects displayed a markedly enhanced systolic backward-
travelling (reflected) compression wave (59.214.7 vs. 10.75.6 x102 W.m-2, p<0.001 vs.
controls) representing 38  10% of the total forward compression wave intensity. Furthermore,
the backward-travelling wave arrived earlier in PAH during ventricular systole (4518 vs.
8930 ms, p<0.001) due to higher wave speed from arterial stiffening (7.21.6 vs. 3.80.8
m.s-1, p<0.001). The estimated reflection site in PAH patients was 165 cm from the mea-
surement point. No PAH subjects were vasoreactive by clinical criteria. Adenosine infusion was
associated with insignificant increases in average blood flow velocity (15.75.5 vs. 21.45.6
cm.s-1, p ¼ 0.2) and heart rate (747 vs. 8414 bpm, p ¼ 0.08). No significant changes in WIA
parameters occurred during adenosine challenge including reflection coefficient.
Conclusion: WIA in the pulmonary circulation is feasible and reveals important patho-
physiological changes in PAH. In particular, markedly enhanced backward compression
waves together with faster wave speeds considerably raise right ventricular afterload, with
significant implications for understanding right-sided ventriculo-vascular coupling.
Disclosure of Interest: None Declared
O156
Influence Of Atrioventricular Junction Ablation On Survival Of Patients With
Congestive Heart Failure And Atrial Fibrillation Receiving Cardiac
Resynchronisation Therapy In Real Clinical Practice
Vadim Kuznetsov*1, Tatiana Vinogradova1, Tatiana Enina1, Grigoriy Kolunin1,
Vsevolod Kharats1, Dmitriy Krinochkin1, Elena Gorbatenko1
1
Tyumen Cardiology Center, Tyumen, Russian Federation
Introduction: The influence of atrioventricular junction ablation (AVJA) on survival after
cardiac resynchronisation therapy (CRT) in patients with congestive heart failure (CHF)
still remains debatable.
Objectives: To compare long-term survival in patients with CHF receiving CRT stratified
according to heart rhythm and AVJA.
Methods: 130 patients with CHF and CRT (NYHA class II-IV), left ventricular ejection
fraction 35%, intraventricular and/or interventricular dyssynchrony were included in the
study. Patients were divided into three groups: I – 63 patients with sinus rhythm (mean age
549 years, 83% male), II – 28 patients with atrial fibrillation (AF) without AVJA (mean age
5711 years, 89% male), III – 39 patients with AF and AVJA (mean age 557 years, 95%
male). Ischemic cardiomyopathy was found in 59% patients of I group, in 64% of II and in
67% of III group. Mean follow-up was 30 months (interquartile range 14-45 months).
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
Results: Groups were comparable with regards to baseline characteristics. The duration of Disclosure of Interest: C. Pappone: None Declared, Z. Calovic: None Declared, A. Cuko:
QRS complex was significantly lower in III group (11728 ms) compared to II group None Declared, L. Mcspadden Shareholder of: St. Jude Medical, Employee from: St. Jude

(15446 ms, p<0.001) and I group (15130 ms, p<0.001). Left bundle branch block was
more frequently found in I group compared to III group (65% vs 36%, p¼0.004) and did not
differ with II group (61%, p¼0.6). The rate of effective biventricular capture was significantly
higher in III group compared to II group (976% vs 8821%, p¼0.012) and had no dif-
ference with I group (9515%, p¼0.3). The best survival rate calculated by Kaplan-Meier
method was found in patients of III group. At the end of follow-up period the survival rate
was 60% in I group, 58% in II, 97% in III group (p I-II¼0.46, p I-III¼0.00007, p II-
III¼0.0005). Multivariate Cox regression analysis revealed that AVJA was an independent
predictor of lower mortality in patients with CRT (HR 0.035, CI 0.004-0.288, p¼0.002).
Conclusion: In real clinical practice in patients with CHF and CRT survival was signifi-
cantly better in subjects with AF who underwent AVJA compared to subjects with AF
without AVJA probably because of the best rate of complete biventricular capture. Patients
with AF and AVJA showed better survival even compared to patients with sinus rhythm.
Disclosure of Interest: None Declared
ORAL ABSTRACTS
Medical, K. Ryu Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, E.
Romano Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, M. Saviano:
None Declared, R. Vitale: None Declared, G. Vicedomini: None Declared, V. Santinelli:
None Declared
O158
Wave reflection from aortic coarctation augments carotid pressure: Insights from a
computer model and wave intensity analysis
Jonathan P. Mynard*1, Remi Kowalski1,2,3, Joseph J. Smolich1,3, Michael M. Cheung1,2,3
1
Heart Research, Murdoch Childrens Research Institute, 2Department of Cardiology, Royal
Children’s Hospital, 3Department of Paediatrics, University of Melbourne, Parkville, VIC,
Australia

O157
Multipoint left ventricular pacing provides similar acute hemodynamic improvement
regardless of QRS duration or lead location in cardiac resynchronization therapy
patients
Carlo Pappone1, Zarko Calovic1, Amarild Cuko1, Luke C. Mcspadden2, Kyungmoo Ryu*2,
Enrico Romano3, Massimo Saviano1, Raffaele Vitale1, Gabriele Vicedomini1, Vincenzo Santinelli1
1
Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA),
Italy, 2St. Jude Medical, Sylmar, CA, United States, 3St. Jude Medical, Milan, Italy
Introduction: Cerebral aneurysms are approximately five times more common in patients
with aortic coarctation than the general population (Connolly, HM et al, Mayo Clin Proc,
78:1491-1499, 2003). Although genetic factors may be involved, it is thought that hy-
pertension, which is commonly associated with aortic coarctation, may lead to increased
risk of aneurysm formation. Another possibility that has not been widely considered is that
the presence of aortic coarctation may directly influence cerebral haemodynamics, for
example, through transmission of a reflected wave into the cerebral vasculature.
Objectives: With the aid of a computer model, to assess the direct haemodynamic in-
fluence of aortic coarctation on common carotid artery (CCA) haemodynamics and thereby
provide clues to a possible mechanistic link between cerebral aneurysm formation and the
presence of coarctation per se.

Introduction: Patients (pts) with QRS duration <150 ms or non-lateral left ventricular
(LV) lead position have low response to conventional cardiac resynchronization therapy
(CRT).
Objectives: The aim of this study was to investigate if CRT with multipoint left ventricular
(LV) pacing (MultiPointÔ Pacing [MPP], St. Jude Medical) in a single coronary sinus
branch can produce a similar acute hemodynamic response in pts with QRS duration <150
ms vs. 150 ms and in pts with non-lateral vs. lateral LV lead position.
Methods: Forty-four consecutive pts receiving a CRT implant (Unify Quadra MPÔ or Quadra
Assura MPÔ CRT-D and QuartetÔ LV lead, St. Jude Medical) underwent LV hemodynamic
assessment using a pressure-volume (PV) loop system (Inca, CD Leycom). PV loops were
recorded during biventricular pacing with each of two conventional CRT (CONV) settings and
4-7 MPP settings. Each pacing intervention was performed twice in a randomized order with
DDD-mode right ventricular pacing (BASELINE) repeated after every test configuration.
Results: Valid recordings were obtained in 42 pts. Pts were separated into groups based on
QRS duration (150 ms: 21 pts vs. <150 ms: 21 pts) and LV lead location (‘lateral’ [lateral
or posterolateral]: 32 pts vs. ‘non-lateral’ [anterolateral]: 10 pts). No pts had anterior LV
lead location. The hemodynamic improvement with the best MPP configuration over the
best CONV configuration was not significantly different for pts with QRS duration <150
ms vs. 150 ms for dP/dtMax (<150 ms: +2.53.9%, 150 ms: +2.32.8%, p ¼ 0.87, Fig
1A), stroke work (SW, <150 ms: +3.618.6%, 150 ms: +24.534.2%, p ¼ 0.18, Fig
1B), stroke volume (SV, <150 ms: +4.17.3%, 150 ms: +8.516.3%, p ¼ 0.27, Fig 1C),
or ejection fraction (EF, <150 ms: +4.17.8%, 150 ms: +6.413.2%, p ¼ 0.49, Fig 1D).
Similarly, the hemodynamic improvement was not significantly different for lateral vs. non-
lateral LV lead positions for dP/dtMax (non-lateral: +1.53.1%, lateral: +2.73.4%, p ¼
0.33, Fig 2A), SW (non-lateral: +14.017.4%, lateral: +6.021.6%, p ¼ 0.29, Fig 2B), SV
(non-lateral: +6.46.2%, lateral: +6.314.2%, p ¼ 0.98, Fig 2C), or EF (non-lateral:
+7.47.2%, lateral: +4.511.7%, p ¼ 0.48, Fig 2D).

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Conclusion: The acute hemodynamic benefit of MPP is similar in pts with QRS duration
<150 ms vs. 150 ms and in pts with non-lateral vs. lateral LV lead position. Additional
studies are needed to validate these findings in a larger population.

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e43

 Methods: A computer model of the entire cardiovascular system of a normal neonate
(Mynard JP, PhD Thesis, University of Melbourne, 2011) was modified to incorporate
ORAL ABSTRACTS
aortic coarctation. CCA haemodynamics and wave intensity were assessed for coarctation
severities between 0% and 90%. Augmentation index (AI) was calculated by dividing the
total pressure rise following the initial inflection point by overall pulse pressure. To eval-
uate the effect of elevated arterial stiffness, wave speed of all precoarctation arteries was
increased by up to 250%.
Results: Simulated pressure and wave intensity in the CCA are shown in Fig. 1 for a
normal aorta and for 90% coarctation. A single forward compression wave (FCW1) was
present in the case of a normal aorta. Coarctation led to partial reflection of the FCW1, and
the reflected wave was partially transmitted into the CCA, giving rise to a second forward
compression wave (FCW2) whose wave area increased progressively with coarctation
severity (Fig. 2). The FCW2 augmented CCA pressure (Fig. 1), producing an increase in AI
from 0.22 for 0% coarctation to 0.50 for 90% coarctation, with the most prominent rise
occurring when the severity was >50%. Increasing wave speed reduced the FCW1-FCW2
time delay (Fig. 2) and the two waves merged at high wave speeds.
Conclusion: Computer modelling data suggest that a reflected wave arising from the site of
aortic coarctation may be transmitted into the carotid artery and lead to a substantial
pressure augmentation. These wave dynamics may play a role in the higher risk of cerebral
aneurysm formation in patients with aortic coarctation.
Disclosure of Interest: None Declared
O160
Prospective memory in chronic heart failure
Tina Habota*1, Jan Cameron2, Skye N. McLennan1, Chantal F. Ski2, David R. Thompson2,
Peter G. Rendell1
1
School of Psychology, 2Cardiovascular Research Centre, Australian Catholic University,
Melbourne , Australia
Introduction: Chronic heart failure (CHF) is a debilitating condition that often results in poor
quality of life, reduced survival rates, frequent hospitalisation, and psychopathology. Global
cognitive impairment is prevalent in this group. However, no study has investigated one of the
arguably most relevant specific memory processes: prospective memory (PM). This is the
memory to carry out future intentions and is involved in a range of important daily tasks such
as taking medication, and may therefore be particularly important for CHF patients.
Objectives: To assess the PM abilities of CHF patients compared to healthy controls.
Methods: The CHF group, attending a nurse-led management program at one of three
hospital sites in Metropolitan Melbourne, included predominantly male adults (n¼29;
mean age¼69.93, SD¼12.08). The healthy control group was recruited from the general
community and matched to the CHF group on age, gender, years of education, and pre-
morbid intelligence. Testing of controls is ongoing (currently n¼11). All participants were
screened for dementia. Participants underwent a battery of neuropsychological testing; the
primary assessment tool was the well-established behavioural measure of PM, Virtual
Week. In a computerised board game that simulates daily activities, participants were asked
to remember to perform tasks that closely represent PM tasks in daily life. Two key task
distinctions were assessed – whether a task is completed at a set time or at a specific event,
and whether there were low or high memory demands for the content of the task.
Results: Preliminary findings using t-tests indicated that, compared to controls (M¼.70,
SD¼.22) the CHF group (M¼.51, SD¼.27) had significantly lower proportions of correct
PM responses, overall (Cohen’s d¼.76). The deficits were substantial for the time-based
tasks and modest for tasks cued by an event. Deficits in tasks involving high memory
demands were also substantial compared to low memory demands.
Conclusion: Preliminary findings indicated that the CHF group have deficits in PM that
vary according to the task type. In this group, poorest performance was evident in tasks
requiring time-monitoring. However, minimising demands of the task content was found
to reduce deficits.
Disclosure of Interest: None Declared
O161
Using DCE to assess adherence and treatment preferences for combination therapies
for cardiovascular disease
Tracey-Lea Laba*1, Kirsten Howard2, John Rose3, Stephen Jan1, PEAK team
1 O163
Health Economics, The George Institute for Global Health, 2School of Public Health, 3Institute
for Transport and Logistics, University of Sydney, Sydney, Australia
Introduction: Discrete Choice Experiment (DCE) is a preference elicitation method used to
value healthcare technologies. Kanyini-GAP (KGAP), a pragmatic clinical trial, assessed a
polypill-based strategy on patient adherence to cardiovascular disease (CVD) treatment in
Indigenous and non-Indigenous Australians. In this context DCE could help understand
patient preferences for treatment, assisting with clinical evidence translation.
Objectives: To assess the influence of treatment attributes and patient characteristics on
treatment adherence in CVD prevention.
Methods: A DCE was administered to KGAP patients completing end-of-study visits
involving choices between two unlabelled treatment options of equivalent efficacy and side
effects, as recommended for CVD prevention. Respondents made a choice between the
treatments or no treatment given a high CVD risk diagnosis. Treatment preferences were
assessed for out-of-pocket costs ($AUD), tablet number, administration time, and prescriber
visit frequency. Odds ratios for preferring treatment to no treatment, trade-off between
treatment attributes, and the predicted probability of treatment uptake were evaluated.
Results: 332 of 487 eligible patients completed a survey (response 68%, mean age 65
(SD ¼11)). Adherence to treatment was chosen 93% compared to no treatment. Preference
e44
to adhere decreased with increased out-of-pocket treatment costs (OR¼0.95 95%CI 0.94-
0.96) and tablet number (OR¼0.83 95%CI 0.71-0.98), but decreased frequency of pre-
scriber visits (OR¼0.84 95%CI 0.75-0.94). In valuing individual treatment attributes,
respondents were willing to pay up to $136.65 per month and accept up to 3 additional
tablets per dose to reduce administration frequency, with no clear preference for morning
over night administration. Respondents with a weekly household income of $400-799 and
those with a university-related higher education were less likely to prefer treatment. The
predicted probability of uptake of a polypill was greater than for standard individualised
combination therapy. Previous experience with CVD medication, including the polypill-
based strategy increased adherence preference.
Conclusion: Given the scenario in which respondents were at a high CVD risk, most
expressed a preference for preventive treatment. Assuming equal efficacy and toxicity of
treatment options, a polypill-based strategy should increase CVD preventive therapy uptake
especially in treatment-experienced patients. Additional strategies targeting specific socio-
economic groups are warranted.
Disclosure of Interest: None Declared
O162
Effect of a periodontal intervention on pulse wave velocity in Indigenous Australians
with periodontal disease: the PerioCardio randomized controlled trial
Kostas Kapellas*1, Louise J. Maple-Brown2, Peter M. Bartold3, Alex Brown4, Kerin O’Dea5,
Gary D. Slade6, David S. Celermajer7, Lisa M. Jamieson1, Michael R. Skilton8, on behalf of
PerioCardio Study
1
ARCPOH, School of Dentistry, University of Adelaide, Adelaide, 2Division of Medicine, Royal
Darwin Hospital, Darwin, 3CACDRC, School of Dentistry, University of Adelaide, 4Aboriginal
Health, South Australian Health and Medical Reseach Institute, 5Sansom Institute, University of
South Australia, Adelaide, Australia, 6Department of Dental Ecology, University of North
Carolina, Chapel Hill, United States, 7Depatrment of Medicine, 8Boden Institute of Obesity,
Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
Introduction: Indigenous Australians have high rates of premature cardiovascular disease
and high prevalence of periodontitis, an inflammatory disease of the tissues surrounding
teeth. Periodontitis has been associated with arterial stiffening and incident cardiovascular
events and. periodontal bacteria have been isolated from atheromatous plaques.
If periodontitis contributes causally to cardiovascular disease, periodontal treatment may
confer important benefits to the health of Indigenous Australians.
Objectives: To determine if a single episode of periodontal treatment improved arterial
stiffness in otherwise healthy Indigenous Australian adults.
Methods: Participants were 273 Indigenous Australian adults (57% male; age 40.3years
[SD 10.2]) with moderate or severe periodontal disease in the Northern Territory, Australia.
Participants were randomized into intervention (n¼138) or control (n¼135) groups. The
intervention involved removal of sub- and supra-gingival calculus and plaque biofilm by
scaling and root-planing once, at randomization. Pulse wave velocity (PWV) was assessed
by applanation tonometry (SphygmoCor- PVMx device, AtCor Medical, Sydney, Australia)
between the carotid and dorsalis pedis arteries, at baseline and again 3-months (n¼169)
and 12-months (n¼171) post randomization. Comparison of randomized groups was by
complete case analysis using ANCOVA adjusted for baseline measures.
Results: At baseline, the average carotid-dorsalis pedis PWV was 8.34 m/s (SD 1.25). The
mean reduction in periodontal pocketing from enrollment to 3-months was 0.14 mm
greater [95% CI 0.24 to 0.05] in the intervention group compared to control, P¼0.004).
This was less marked at 12-months, mean reduction in periodontal pocketing 0.09 mm
greater [95% CI -0.01 to 0.18] in the intervention versus control, P¼0.08). In contrast, the
intervention did not affect PWV at 3-months [the primary endpoint] (between-group
difference in means +0.06 m/s [95% CI -0.17 to 0.29] intervention vs. control, P ¼ 0.59),
although there was some evidence that the intervention increased PWV at 12-months, this
was not statistically significant (between-group difference in means +0.21 m/s [95% CI
-0.01 to 0.43] intervention vs. control, P¼0.06).
Conclusion: A single episode periodontal intervention in Indigenous Australians with
periodontal disease provides short-term improvement in periodontal health, but did not
significantly influence arterial stiffness as measured by pulse wave velocity.
Disclosure of Interest: None Declared
Post-discharge ECG Holter monitoring in recently hospitalised individuals with
chronic atrial fibrillation to enhance therapeutic monitoring and identify potentially
high risk phenotypes
Jocasta Ball*1, Melinda Carrington1, David Thompson2, John Horowitz3, Simon Stewart1, on
behalf of the SAFETY Study Investigators
1
Preventative Health, Baker IDI Heart and Diabetes Institute, 2Cardiovascular Research Centre,
Australian Catholic University, Melbourne, 3The Queen Elizabeth Hospital, Adelaide, Australia
Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia managed in
clinical practice. Maintenance of intended AF control (rate or rhythm) following an acute
hospitalisation is a key therapeutic goal.
Objectives: To determine the value of post-discharge ECG Holter monitoring to assess
maintenance of intended AF control and enhance the management of patients with AF.
Methods: Sub-study of a multicentre randomised controlled trial of AF-specific post-
discharge management in typically older individuals with chronic AF. Continuous 24-hour
ECG Holter monitoring was undertaken at a home visit 7-14 days post-discharge. Intended
versus detected rate and rhythm control was compared to ECG Holter data. Frequency
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
distribution of mean hour-to-hour differences was also used to identify those with
particularly labile heart rates (HR).
Results: A total of 133 patients with a mean age 71+10 years, 50% male, 14% with a
pacemaker and a mean hourly HR 72+14 bpm were studied. Most (89%) had persistent
AF (median time in AF - 39%, IQR 0, 100%). Overall, 19 of 44 patients intended for
rhythm control (43%) were in AF >10% of the recording time. Of these, 14 (32%)
were in AF for 100% of the time. Among a number of identified correlates, increasing
thrombo-embolic risk was associated with less rhythm control (adjusted OR 0.39; 95%
CI 0.23 to 0.68 per CHA2DS2-VASc score). Of 89 patients with intended rate control,
63 (71%) patients achieved a HR target of <90 bpm for >90% of recording time with
22 patients (25%) recorded in sinus rhythm for the entire recording. Those patients in
the upper quartile of mean hour-to-hour HR variability were identified as persistently
labile (n¼33); mean HR 82+14 bpm. A further group (n¼22) with periodically labile
HRs (17%) predominantly during the day were identified; mean HR 72+12 bpm. On
an adjusted basis, those with coronary artery disease (OR 0.34; 95% CI 0.13 to 0.91)
or renal disease/dysfunction (OR 0.24; 95% CI 0.06 to 0.98) were significantly less
likely to demonstrate stable HR control (n¼78 - mean HR 67+12 bpm; p<0.001 versus
labile groups).
Conclusion: Post-discharge ECG Holter monitoring of AF patients represents a valuable
tool to identify deviations in intended rhythm/rate control and adjust therapeutic man-
agement accordingly. It may also identify particularly high risk individuals who demon-
strate labile HRs and require more intensive surveillance and management to obtain clinical
stability.
Disclosure of Interest: None Declared
O187
The Effects Of Cashew Consumption On Serum Glucose,Insulin And Lipoprotein In
Type 2 Diabetic Patients
Farzad Shidfar*1, Reyhaneh darvish1, Asadolah Rajab2, Vida Mohammadi1, Sharieh Hosseini3
1
Nutrition, Iran University of Medical Sciences, 2Iranian diabetic association, Iranian diabetic
association, Tehran, 3chemistry, Islamic Azad University,Sari Branch, Sari, Iran, Islamic
Republic Of
Introduction: One of the diabetes complications is diabetic dyslipidemia. Several studies
have demonstrated that nut consumptions exert beneficial effects on serum lipid profile.
Objectives: We designed an intervention study to evaluate the effects of cashew on Fasting
serum glucose, insulin and lipoprotein in type 2 diabetic patients.
Methods: In an 8 weeks randomized parallel clinical trial, 50 diabetic patients (34 women
and 16 men) were randomly assigned to two groups: intervention (cashew) and control
(regular diet) group. Cashews replaced 10% of total daily calorie intake in the intervention
group. Blood samples were collected from fasting subjects at entry to the study and at the
end of the study. All dietary data were obtained using 24-hours recalls at baseline, in the
middle and at the end of the study.
Results: Mean HDL-C and insulin concentration were statistically different between
intervention and control group (p¼0.01, p¼0.023, p¼0.043 and p¼0.023 respectively),
while other biochemical indices such as serum glucose and other lipoproteins, were not
different statistically.
Conclusion: The results indicated that replacing 10% of daily calorie intake with cashew in
patients with type 2 diabetes may prevent HDL-C reduction and also decrease serum in-
sulin, so possibly have an important role in decreasing cardiovascular risk factors in dia-
betic patients.
Disclosure of Interest: None Declared
O188
Baseline quality of life and all-cause mortality in 10-year follow-up in a Chinese
population-based cohort
Gaoqiang Xie*1, Daniel T. Laskowitz2, Elizabeth L. Turner3,4, Joseph R. Egger3, Ying Li5,
Liancheng Zhao5, Ping Shi6, Fuxiu Ren6, Wei Gao7,8, Yangfeng Wu1,9,10
1
Peking University Clinical Research Institute, Beijing, China, 2Department of Neurology, Duke
University Medical Center, 3Duke Global Health Institute, 4Department of Biostatistics and
Bioinformatics, Duke University, Durham, United States, 5Department of CVD Prevention and
Control Network, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, 6Shijingshan Center for Disease Control and
Prevention, 7Department of Cardiology, Peking University Third Hospital, 8Key Laboratory of
Molecular Cardiovascular Sciences, Ministry of Education, 9Department of Epidemiology and
Biostatistics, Peking University School of Public Health, 10The George Health Institute, Peking
University Health Science Center, Beijing, China
Introduction: The relationship between QOL and mortality has been reported in western
populations. However, it has not been rigorously studied in the Chinese population-based
cohort.
Objectives: To explore the effects of baseline quality of life on long-term all-cause mortality
in a Chinese population-based cohort.
Methods: A prospective cohort study was conducted from 2002 to 2012 on 1739 par-
ticipants in 11 villages of Beijing. Baseline data on quality of life (QOL), demographics,
cardiovascular disease risk factors and diseases(stroke, etc) were collected in either 2002
(n¼1290) or 2005 (n¼449). The validated QOL-35 instrument, which comprises six
domains specific to a Chinese population, was used to measure QOL. Scores for each item
in the QOL-35 instrument were each scaled to the range from 0 (indicating the worst QOL)
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
to 100 points (indicating the best QOL). From these, scores for each of the six domains
were calculated as the mean of the items in the corresponding domain. Total QOL score was
ORAL ABSTRACTS
calculated as the mean of all 35 items on the QOL-35. Participants were followed through
the end of the study period, or until they were censored due to death or loss to follow-up,
whichever came first. Cox proportional-hazard regression models were used to assess the
effect of QOL on all-cause mortality through 2012.
Results: During the follow-up period (median 10.10 years, interquartile range:6.95 to
10.13 years), 141 deaths (8.1%) were recorded. The multivariable Cox regression showed
that the Total QOL score lower than 70 points had more than three times the risk of all-
cause mortality, compared to the top score (90-100 points) (Hazard Ratio[HR],3.26; 95%
conference interval [CI], 1.52-6.96), after adjusting for sex, age, retirement status, smoking
status, fruit consumption >¼250g/week, and history of a stroke. Among the six QOL
domains, the Independence domain had the largest influence on all-cause mortality (decline
1 standard deviation, HR¼1.40,95% CI:1.25-1.57), which was followed by General
(HR¼1.30,95%CI: 1.09-1.54), Psychological(HR¼1.28,95%CI:1.09-1.50), Physical
(HR¼1.20, 95%CI: 1.03-1.40), Environmental (HR¼1.14,95%CI:0.97-1.36), and Social
domain(HR¼1.10, 95%CI: 0.97-1.36) after adjusting for sex, age, retirement status,
smoking status, fruit>¼250 g/week, and history of stroke.
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Conclusion: Lower quality of life, especially the inability to live independently, was
associated with significantly increased risk of all-cause mortality in a Chinese population-
based cohort.
Disclosure of Interest: G. Xie Grant/research support from: National Natural Science
Foundation of China(No. 30872168), Duke University,Medical Center,and Health Sys-
tem(Exchange Visitor Program Number:P-1-00242)(Grand No.: NIH 1D43-TW008308-
01), D. Laskowitz Grant/research support from: NIH 1D43-TW008308-01, E. Turner:
None Declared, J. Egger: None Declared, Y. Li: None Declared, L. Zhao: None Declared, P.
Shi: None Declared, F. Ren: None Declared, W. Gao: None Declared, Y. Wu Grant/research
support from: National Natural Science Foundation of China(grant no: 30471494), Peo-
ple’s Republic of China National 10th Five-Year Plan Science and Technology Key Projects
(grant no: 2001BA703B01).
O189
Out of Hospital Cardiac Arrests and Exposure to Fine Particulate Matter Air Pollution
(PM2.5) during 2006-2007 Bushfires in Victoria, Australia
Anjali Haikerwal*1, Michael J. Abramson1, Malcolm R. Sim1, Mick Meyer2, Karen Smith3,
Muhammad Akram1, Martine Dennekamp1
1
School of Public Health and Preventive Medicine, Monash University, 2CSIRO Division of
Marine and Atmospheric Research, CSIRO, 3Strategy & Planning, Ambulance Victoria,
Melbourne, Australia
Introduction: Epidemiological studies investigating the role of fine particulate matter
(PM2.5: aerodynamic diameter < 2.5mm) in triggering acute ischemic heart disease events
including cardiac arrests, have been inconclusive. Recent bushfires in Victoria have pro-
vided an opportunity to investigate this research question further during periods of high
PM2.5 concentrations.
Objectives: To investigate the association between out of hospital cardiac arrests (OHCA)
and PM2.5 concentrations during 2006-2007 bushfires in rural and urban Victorian
communities.
Methods: The 2006-2007 bushfire period was one of the most extensive in Australian
history with high levels of PM2.5 recorded at all monitored regions. OHCA data was ob-
tained for the study period (December 2006-January 2007) from the Victorian Ambulance
Cardiac Arrest Registry (VACAR) which documents information on all OHCAs attended by
ambulance personnel in Victoria. Modelled air exposure data (daily average PM2.5, tem-
perature, relative humidity) were obtained from the CSIRO Division of Marine and At-
mospheric Research. Modelled data provides a better temporal-spatial coverage as they
allow for projections of air quality in areas with no monitors. A time stratified case cross
over study design was used to investigate the association between daily average PM2.5
concentrations and OHCA. This design controls for confounding by day of week, month
and seasonal trends. Lag periods (lag 1, lag 2, lag 3 including the average of lag 0-1) were
also investigated to test for latency following exposure.
Results: In total 457 OHCAs were analysed of primary cardiac etiology in individuals
35 years old. After adjusting for temperature and relative humidity an interquartile
e45
 range increase of 9.07 mg/m3 in PM2.5 over 2 days (average of lag 0-1) was associated with
an increase in risk for an OHCA of 6.9% (95% CI:1.03%,13.29%) with men showing a
ORAL ABSTRACTS
higher risk of 9.05% (95% CI:1.63%,17.08%).Other lag periods did not show any
association.
Conclusion: A significant association was found between increased PM2.5 concentration
and risk of OHCA during the Victorian 2006-2007 bushfire period. Given that OHCA has a
poor prognosis, air pollution control and an effective health management strategy during
intense bushfire events could help to prevent future cardiovascular mortality from exposure
to fine particles in bushfire smoke.
Disclosure of Interest: None Declared
O164
The Association Of Older Age On Receipt Of Care And Outcomes In Patients With
Non-St Elevation Myocardial Infarction: A Cohort Analysis Of The England And
Wales Minap (Myocardial Ischaemia National Audit Project) Registry
Mohammed Justin Zaman*1,2, Lee Shepstone2, Sue Stirling2, Alisdair Ryding1,3,
Max Bachmann2, Phyo K. Myint2
1
Cardiology, James Paget University Hospital, Great Yarmouth, 2Norwich Medical School,
University of East Anglia, 3Cardiology, Norfolk and Norwich University Hospital, Norwich,
United Kingdom
Introduction: Older patients increasingly constitute a large proportion of the acute cor-
onary syndrome (ACS) population, and clinical trials of therapies such as coronary
revascularisation and secondary prevention medicines have demonstrated effectiveness
even in the oldest patients. There is a need for evidence from real-world data that more
accurately depicts both receipt of treatment and outcomes in the older patient.
Objectives: To explore the relationship of age group with receipt of invasive man-
agement and secondary prevention medicine in patients with non-ST elevation
myocardial infarction (NSTEMI), and the association of invasive management over a
non-invasive strategy on time to death by age group, adjusted for confounding
prognostic factors.
Methods: This was a cohort analysis of 87,793 patients admitted to hospital with NSTEMI
followed up for all-cause mortality of mean follow-up 2.12 years. Logistic regression an-
alyses analysed the odds of receipt of treatments for ACS and to investigate the association
of invasive management compared to a non-invasive strategy on time to death, Cox pro-
portional hazards regression models were used.
Results: Older patients were incrementally less likely to receive secondary prevention
medicines and invasive management. Regarding receipt of a statin, the odds ratio for pa-
tients 85 years receiving this at discharge compared to patients in those aged 18-<65
years was 0.46 (0.49,0.51)). In patients 85 years, 14% received coronary angiography
compared to 83% in those aged 18-<65 (odds ratio 0.03 (95% CI 0.03,0.04)). Not
receiving invasive management was associated with worse survival in all age groups
(adjusted for sex, cardiovascular risk factors, co-morbidities, healthcare factors and case
severity) but there was a incremental reduction in survival benefit from invasive manage-
ment with increasing age: in patients aged 18-64, 65-74, 75-84 and 85, adjusted hazard
ratios (HRs) for non-invasive treatment compared to angiography were 4.37 (4.00,4.78),
3.76 (3.54,3.99), 2.79 (2.67,2.91) and 1.90 (1.77,2.04).
Conclusion: We found an incremental reduction in the use of evidence-based therapies
with increasing age in NSTEMI patients using a national registry cohort. Whilst survival
benefit from invasive management reduced with older age, survival was improved with
invasive management at all ages highlighting the requirement to improve standard of care
in older patients with NSTEMI.
Disclosure of Interest: None Declared
O165
Relative contribution of clinical, system and geographical factors to Acute Coronary
Syndrome (ACS) care in Australia and New Zealand
Tom Briffa*1, Jeffrey Lefkovits2, Neville Broad3, Gerard Devlin4, Julie Redfern5, Chris Ellis6,
Bridie Carr7, John French8, David Brieger9, Derek Chew10, Snapshot ACS Investigators
1 cardiovascular disease is high, but availability of and access to appropriate healthcare is
Population Health, University of Western Australia, Perth, 2Cardiology, Royal Melbourne
Hospital, Melbourne, 3Information Strategy & Safety in eHealth, Australian Commission on
Safety and Quality in Health Care, Sydney, Australia, 4Cardiology, Waikato Hospital, Waikato,
New Zealand, 5Cardiovascular Division, The George Institute for Global Health, Sydney,
Australia, 6Cardiology, Auckland City Hospital, Auckland, New Zealand, 7Agency for Clinical
Innovation, NSW Health, 8Cardiology, Liverpool Hospital, 9Cardiology, Concord Hospital,
Sydney, 10Cardiovascular Medicine, Flinders University, Adelaide, Australia
Introduction: Increasing clinical expertise in underserved regions, expanding regional
invasive services and appropriate alignment of funding can potentially improve ACS care in
Australia and New Zealand.
Objectives: We investigated the contribution of clinical, system and geographic de-
terminants associated with variation in ACS care at the first hospital attended.
Methods: Patients recruited into the bi-national SNAPSHOT ACS diagnosed with definite
ACS during 2 weeks in May 2012 were analysed. Components of care (invasive manage-
ment, prescription 34 discharge medicines, referral to rehabilitation) were examined using
logistic regression models including clinical diagnosis, patient risk, co-morbidities known
to influence provision of care, local availability of cardiology and catheter-laboratory ser-
vices and geographic factors. Probability of receiving evidence-based therapies was plotted
against GRACE score. Variation in care was estimated using population attributable fraction
(PAF) indicating the proportional increase in therapies that would occur if the factor were
eliminated.
e46
Results: In total, 2,365 ACS patients had a median GRACE score of 108 (95% CI, 84-133)
45% were clinically complex, 56% presented to a major metropolitan hospital and 50% to
an onsite catheter-facility. The variation in angiography rates was greater among ACS pa-
tients with higher GRACE scores (Figure 1), for ACS diagnosis [PAF: NSTEMI vs. STEMI:
9.8% (6.9-12.6%); UA vs. STEMI: 44.4% (38.9-49.4%)], clinical complexity in the
NSTEMI group [PAF: complicated vs uncomplicated: 16.6% (11.8-21.1)] and onsite
catheter-facility in the NSTEMI group [PAF: no vs yes: 4.6% (3.5-8.6%)]. Within diagnostic
groups, clinical complexity accounted for a greater fraction of the variation in angiography
than system or geographic factors. Clinical, system and geographic factors accounted for
smaller and non-significant PAFs against patients receiving 34 discharge medicines and
referral to rehabilitation.
web 3C=FPO
Conclusion: Variation in patient clinical characteristics impacted most on the provision of
guideline-recommended therapies, with those at highest risk least likely to receive care.
These observations support National policy attempts to define minimum clinical standards
to improve patient level ACS care.
Disclosure of Interest: None Declared
O195
A Cluster-randomized Controlled Trial of a Simplified High Cardiovascular Risk
Management Program in Rural Tibet, China
Maoyi Tian*1, Cong Li1,2, Danzeng Dunzhu3, Zhong Liu4, Hao Chen5, KaWing Cho6, Ruilai Li1,
Xingshan Zhao7, Dorairaj Prabhakaran8, Vamadevan S. Ajay8, Eric D. Peterson9,
Elizabeth R. DeLong10, Mohammed K. Ali11, Yangfeng Wu1,2, Lijing L. Yan1,12
1
The George Institute for Global Health at Peking University Health Science Center, 2Department
of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, 3Office of
Academic Affairs, 4Office of Academic Research, Tibet University, Lhasa, 5Department of
Cardiology, Beijing Hospital, Beijing, China, 6Children’s Hospital Los Angeles, Los Angeles,
United States, 7Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China, 8CoE-
CARRS, Public Health Foundation of India, New Delhi, India, 9Department of Medicine,
10
Department of Biostatistics and Bioinformatics, Duke University, Durham, 11Rollins School of
Public Health, Emory University, Atlanta, 12Department of Preventive Medicine, Northwestern
University, Chicago, United States
Introduction: In resource-constrained areas such as rural Tibet, China, the burden of
limited.
Objectives: This study aims to evaluate the effects of a simplified, low-cost high cardio-
vascular risk (HCR) management program in rural Tibet delivered by ‘village doctors’ on
the primary outcome of the proportion of patients taking cardiovascular-risk lowering
medications and the secondary outcome of the changes in blood pressure pre-and-post the
intervention.
Methods: The year-long cluster-randomized controlled trial was conducted in 27 vil-
lages from 12 townships in Tibet, China. Villages were randomized with stratification
by township to receive either intervention (n¼14) or usual care (n¼13). At the
baseline screening, only participants identified as at HCR (aged 40 years or older,
having heart disease, stroke, diabetes, or measured systolic blood pressure of 160
mmHg or higher) were recruited. Village doctors in the intervention villages were
equipped with a customized electronic decision support system installed on a smart-
phone and trained to manage their HCR patients monthly following a ‘2+2’ inter-
vention model: 2 lifestyle recommendations and prescription of low-dose diuretics and
aspirin (where applicable). Paired t-tests and chi-square tests were used to evaluate the
effects of the intervention. Intra-cluster correlations were estimated for each outcome
and intent-to-treat analyses using last observation carried forward were performed with
adjustment for cluster effects.
Results: Out of 2,236 participants screened at baseline, 1,035 individuals were iden-
tified as HCR (age: 59.411.5 years; 71.1% women; body mass index: 23.73.7 kg/
m2). 43 people died during the course of the study and 926 subjects were followed-up
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
at the end of intervention. No difference in low-dose diuretics or aspirin was observed
at baseline between the intervention and control groups while significant differences
were found post-intervention (Table 1). Net between-group reduction in systolic blood
pressure was significant without adjustment for cluster effect but not significant with
(Table 2).
Conclusion: The simplified HCR management program in rural Tibet substantially
increased the proportions of patients treated with diuretics and aspirin while no significant
difference in blood pressure was observed. Larger studies with longer follow-up are needed
to verify the results and assess cost-effectiveness.
Disclosure of Interest: None Declared
O166
Inhibition of miRNA-652 Using LNA-antimiRs Improves Cardiac Function in a
Mouse Model of Pressure Overload and is Associated with Preserved Angiogenesis
and Upregulation of Jagged 1
Bianca C. Bernardo*1, Sally S. Nguyen1, Xiao-Ming Gao1, Esther J. Boey1, Yow Keat Tham1,
Helen Kiriazis1, Xiao-Jun Du1, Ruby C. Lin2, Julie R. McMullen1
1
Baker IDI Heart and Diabetes Institute, Melbourne, 2Ramaciotti Centre for Gene Function
Analysis, University of New South Wales, Sydney, Australia
Introduction: microRNAs are dysregulated in different diseases and their potential as
therapeutic drug targets is being widely explored. We previously identified mmu-miR-
652-3p as being upregulated in a mouse model of cardiac stress (myocardial infarction)
and downregulated in a mouse model of cardiac protection (physiological hypertro-
phy). Thus, targeting microRNAs differentially regulated in settings of stress and
protection could represent a new therapeutic approach for the treatment of heart
failure.
Objectives: To assess the therapeutic potential of inhibiting miR-652 in a mouse model
with established pathological hypertrophy due to pressure overload.
Methods: Mice were subjected to transverse aortic constriction (TAC) for 4 weeks to
induce hypertrophy and systolic dysfunction, then subcutaneously administered a locked
nucleic acid (LNA)-antimiR-652 or LNA-control (325mg/kg). Cardiac function was
assessed by echocardiography. Molecular and histological analyses were performed on
heart tissue 8 weeks post treatment.
Results: miR-652 expression increased in hearts subjected to TAC compared to sham-
operated mice (2.9-fold,n¼5,P<0.05) and was silenced in hearts of sham and TAC mice
administered LNA-antimiR-652 (95% decrease,n¼3-7,P<0.05). TAC mice administered
LNA-control had depressed systolic function (fractional shortening, 30% decrease from
baseline,n¼7,P<0.05), developed significant hypertrophy (50% increase in heart weight/
tibial length ratio vs. sham,n¼7,P<0.01) and atrial enlargement. This was associated with
increased fibrosis (13-fold,n¼5,P<0.01), cardiomyocyte size (1.6-fold,n¼6,P<0.001) and
B-type natriuretic peptide expression (3.6-fold,n¼5,P<0.001) and decreased angiogenesis
measured by capillary density (14% decrease vs. sham,n¼5,P<0.05). Each of these pa-
rameters were attenuated by antimiR-652 treatment. Fractional shortening increased by
21% with treatment (291% at 4-weeks post-TAC compared to 351% post-
treatment,n¼7, P<0.001). AntimiR-652 treatment was associated with increased expres-
sion of a predicted gene target, Jagged 1, at mRNA (1.7-fold,n¼7,P<0.01) and protein level
(1.6-fold,n¼7,P<0.1).
Conclusion: Administration of antimiR-652 in a mouse model of pressure overload
improved cardiac function and this was associated with preserved angiogenesis, decreased
fibrosis and upregulation of Jagged 1. As Jagged 1 is known to activate Notch signalling,
essential for cardiomyocyte repair, upregulation of Jagged 1 may explain in part the car-
dioprotection achieved by antimiR-652 treatment.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O167
ORAL ABSTRACTS
Pharmacological Sirt1 Activation In Apoe-/- Mice Provides Atheroprotection By
Reducing Hepatic Pcsk9 Secretion And Enhancing Ldl-R Expression
Melroy X. Miranda*1, Lambertus Van Tits1, Christine Lohmann1, Anne Tailleux2, James Ellis3,
Kristina Schoonjans4, Bart Staels5, Thomas F. Lüscher1,6, Christian Matter1,6
1
Department of Cardiovascular Research, University of Zurich, Institute of Physiology, Zurich,
Switzerland, 2Inserm U1011, Laboratoire de Biochimie, Institut Pasteur de Lille, Lille, France,
3
Sirtris Pharmaceutical, Boston, Massachusetts, United States, 4Laboratory of Integrative &
Systems Physiology, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland,
5
Institut Pasteur de Lille, Université Lille Nord de France, INSERM, Lille, France, 6Cardiology
Clinic, University Hospital Zurich, Zurich, Switzerland
Introduction: Increased plasma levels of low-density lipoprotein cholesterol (LDL-C) are a
driving force of atherogenesis. The hepatic low-density lipoprotein receptor (LDL-R)
confers atheroprotection by removing LDL-C from the blood stream. The deacetylase
SIRT1 exerts beneficial effects in lipid metabolism. However, its role in LDL-C regulation is
unexplored, and reports about its effects in atherosclerosis are controversial.
Objectives: We investigated the effects of SIRT1 activation on cholesterol metabolism and
plaque formation by applying a pharmacological SIRT1 activator (S1A) in a mouse model
of atherosclerosis.
Methods: Apolipoprotein E (ApoE)-/- mice and Low-density lipoprotein (LDL-R)-/- mice
were fed a high-cholesterol diet supplemented with or without the S1A SRT3025 (3.18 g/
kg diet) for 12 weeks. The animals were sacrificed, plasma lipids measured and aorta
sections examined using oil red O staining’s and immunohistochemistry. Hepatic LDL-R
and PCSK9 expression were determined by q-PCR and western blotting. Furthermore we
applied SIRT1 overexpression and SIRT1 knock-down in AML12 hepatocytes in vitro to
verify drug specificity and assess PCSK9 secretion and LDL-R expression and function
upon SIRT1 activation.
Results: ApoE-/- mice supplemented with SRT3025 showed a decrease in atherosclerosis
and plasma levels of LDL-C and total cholesterol compared with placebo-treated mice. S1A
treatment increased expression of hepatic LDL-R while plasma PCSK9 levels were
decreased. Similarly, in vitro S1A administration to AML12 hepatocytes diminished PCSK9
secretion and its binding to LDL-R, thereby preventing PCSK9-mediated LDL-R degrada-
tion, increasing LDL-R expression and activity. Co-administration of exogenous PCSK9 and
S1A abolished these effects. S1A therapy of LDL-R-/- mice for 12 weeks neither had an effect
on plasma cholesterol levels nor on atherosclerosis.
Conclusion: Our findings identify PCSK9 regulation as a novel target of SIRT1
activation and reveal LDL-R protein as a prerequisite for SIRT1-mediated atheroprotection
in mice. Our data underline the anti-atherosclerotic potential of pharmacological SIRT1
activation.
Disclosure of Interest: None Declared
O168
Prospective investigation of psychological distress and incident cardiovascular
disease hospitalisation and all-cause mortality, accounting for baseline physical
impairment in 203,500 participants in the 45 and Up Study
Emily Banks*1, Alex Brown2, John Attia3, Grace Joshy1, Rosemary Korda1, Prasuna Reddy4,
Ellie Paige1
1
National Centre for Epidemiology and Population Health, Australian National University,
Canberra, 2South Australian Health and Medical Research Institute, University of Adelaide,
Adelaide, 3University of Newcastle, Newcastle, Australia, 4Centre for Rural and Remote Mental
Health, University of Newcastle, Newcastle, Australia
Introduction: The risk of incident cardiovascular disease (CVD) increases with increasing
psychological distress, including depression. It is unclear whether this is causal due to
difficulties accounting fully for baseline disease/disability.
Objectives: To investigate the relationship of psychological distress to CVD hospitalisation
and all-cause mortality, accounting for baseline CVD and disability.
Methods: Prospective population-based Australian study of 266,777 individuals aged
45y joining the 45 and Up Study from 2006-2009 by completing a postal questionnaire,
including data on psychological distress [Kessler-10(K10)], physical functioning (MOS-PF)
and other potential confounders. Questionnaire data were linked with hospitalisation and
death data up to end December 2011 and June 2012, respectively. There were 203,500
participants, following exclusions. Cox proportional-hazards models examined the rela-
tionship of baseline psychological distress to all-cause mortality and first hospitalisation
since baseline with a CVD primary diagnosis, adjusting for age, sex, education, region,
smoking, alcohol, body-mass-index, diabetes and treatment for hypertension and/or
hypercholesterolaemia. Analyses were stratified by baseline CVD and functional limitation.
Results: Overall, 19,999 CVD (7,066 ischaemic heart disease (IHD) hospitalisations and
5,983 deaths occurred during a follow-up. Adjusted hazards ratios (HRs) for IHD and all-
CVD hospitalisation and mortality increased with increasing baseline psychological distress,
in people with and without previous CVD. Among those without previous CVD, HRs(95%
CI) for incident IHD were 1.16(1.07-1.26), 1.29(1.15-1.45), 1.30(1.08-1.57) and
1.31(0.99-1.74) for K10 scores of 12-<16, 16-<22, 22-<30, 30-50 versus <12, respec-
tively (p(trend)<0.0001). Corresponding HRs for all-cause mortality were 1.15(1.05-1.26),
1.57(1.38-1.78), 1.67(1.37-2.03) and 2.67(2.10-3.39) (p(trend)<0.0001). However, HRs
were attenuated when restricted to able-bodied participants (MOS-PF75) at baseline; for
IHD they were 1.16(1.06-1.28), 1.25(1.08-1.46), 1.17(0.89-1.54) and 0.88(0.51-1.52) for
K10 scores of 12-<16, 16-<22, 22-<30, 30-50 versus <12, respectively; corresponding
HRs for all-cause mortality were 0.96(0.86-1.09), 1.13(0.92-1.38), 0.89(0.59-1.36) and
2.02(1.26-3.24).
e47
 Conclusion: In this study, the observed increase in risk of incident IHD and all-cause Increasing trends for awareness, treatment and control with ES was observed for hyper-
mortality with increasing psychological distress was accounted for, at least in part, by tension, diabetes, hypercholesterolemia and ex-smoking rates (X2 for trend, p<0.05). Odds
ORAL ABSTRACTS

confounding with baseline physical disability. ratios for awareness, treatment and control in high ES group as compared to low ES were:
Disclosure of Interest: None Declared hypertension A 1.42 (1.17-1.72), T 1.28 (0.80-2.04) and C 1.16 (0.97-1.38), diabetes A
1.12 (0.90-1.39), T 1.05 (0.54-2.06), and C 0.96 (0.80-1.16), hypercholesterolemia A 1.91
O169 (1.36-2.67), T 0.25 (0.08-0.74) and C 0.68 (0.34-1.37), and ex-smoking rates was 2.48
(1.42-4.31).
Psychosocial Factors and Drug Therapy Adherence in a Comprehensive Primary Care Conclusion: There are significant educational status related inequities in awareness,
Hypertension Program Providing Free Access to Care treatment and control of major cardiovascular risk factors among urban subjects in India.
Low ES is associated with lower awareness and poorer control of major cardiovascular risk
Daniela Sandoval*1, Javier Chacón1, Javiera Garrido1, Ivonne Ahlers1, Isabel Segovia1,
factors.
Eleana Oyarzún1, Reinaldo Muñoz1, Patricia Vargas1, Tomás Romero2 Disclosure of Interest: None Declared
1
Department of Primary Care and Health Family, University of Chile, Santiago, Chile, 2School of
medicine, University of California, San Diego, California, United States O171
Introduction: Poor adherence to antihypertensive drug therapy (Rx) is a factor in un- CXCR4 Antagonism is protective against the cardiac consequences of dilated
controlled blood pressure (BP) (140/90 mm/Hg). cardiomyopathy
Objectives: To assess the relative influence of socio-economic status and psychosocial
factors in achieving adherence to Rx in hypertensive patients followed in Chilean primary Mandar S. Joshi*, Po-Yin Chu, David M. Kaye
care centers. Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Methods: A weighted randomized sample of 513 patients (371 women) from a universe
of 1,484 hypertensive patients (average age 55.7 years) was analyzed. Free medical care, Introduction: Dilated cardiomyopathy (DCM) is a progressive disease characterized by
Rx and life style modification counseling was provided throughout a government ventricular dilatation with impaired left ventricular (LV) function and diffuse interstitial
subsidized multidisciplinary program (Cardiovascular Health Program, CHP). Rx fibrosis. Recently in the setting of mineralocorticoid-induced cardiac fibrosis, we demon-
adherence was evaluated using a Morisky-Green-Levine test. Previously validated strated that activation of the SDF-1:CXCR4 signalling pathway plays a central role in the
questionnaires for patient-physician relation, family income, education, emotional stress pathogenesis of cardiac fibrosis in DCM.
–depression, family cohesion and social network were utilized to assess psychosocial Objectives: In this study we tested the hypothesis that the SDF-1:CXCR4 axis is implicated
factors. Multiple Rx and years of awareness of hypertension were analyzed. Odds ratio in the pathogenesis of cardiac fibrosis and LV dysfunction of DCM (heart failure mice
(OR) were obtained after multivariable logistic regression analysis (adjusted for all model, Mst1 mice).
variables). Methods: DCM with fibrosis was induced in Mst1 transgenic mice. The effect of the
Results: Adherence was documented in 36.3% of the study group (women 38.4 %, men CXCR4 antagonist (AMD3100, 6 mg/kg/d) on cardiac fibrosis (quantitative Masson’s stain)
28.9%, p<0.001). No adherence was significantly associated to male gender, low family was examined. After 12 weeks, LV compliance was studied using Langendorff isolated heart
income, low education, inadequate patient-physician relation, and high emotional stress- preparation. LV systolic and diastolic function was assessed after increasing the LV balloon
depression score. Multiple Rx, and years of awareness of hypertension showed no influence pressure in small increments (10mmHg).
on Rx adherence. Results: Mst1 mice demonstrated significant cardiac fibrosis as compared to control
(2.80.2% vs. 12.30.3%; p<0.05). AMD3100 significantly attenuated the development
of left ventricular fibrosis (5.90.4%; p<0.01). Furthermore, as shown in the table, Mst1
Table. Multivariable adjusted odds ratio for no adherence risk to antihypertensive Rx in mice showed a significant impairment in LV systolic function and diastolic function in
513 hypertensive patients followed in the Cardiovascular Health Program. response to increased LV balloon pressure and AMD3100 treatment protected the LV
function.
No Adherence Odds Ratio*
n (%) (CI 95%) p-value
Baseline LV Balloon pressure (10mmHg) LV Balloon pressure (20mmHg)
Male Sex 101 (71.1) 1.58 (1.11 – 2.26) 0.01 -dP/dt +dP/dt -dP/dt +dP/dt -dP/dt
Groups
Low Education (<8 years of education) 114 (69.5) 1.93 (1.33 – 2.81) 0.002 +dP/dt (mmHg/s) (mmHg/s) (mmHg/s) (mmHg/s) (mmHg/s) (mmHg/s)

C57BL6 4717216.3 -3305.0143.7 4693.7238.9 -3336.7113 4601320.9 -3357.2172.6

Low Family Income (< US$ 95 per 92 (75.4) 1.84 (1.25 – 2.70) 0.002
Mst1 3367.6113.9* -2670137.1* 3492.9104* -2511.1155.5 3258.8111.7* -2344.8129.3*
person month)
Mst1+AMD3100 4145.2306.8y -3217.3140.1y 4188181.6y -3141.699.2y 3677.6233.3 -2966.6111.1y
Multiple antihypertensive RX 133 (55.6) 0.97 (0.71 – 1.33) 0.701
*p<0.05 vs. C57BL6; y p<0.05 vs. Mst1
Inadequate patient –physician relation 75 (74.3) 1.76 (1.22 – 2.55) 0.005
High emotional stress-depression score 101 (72.7) 2.24 (1.48 – 3.40) <0.001
Years of awareness of hypertensionz 7.3 (1-35) 0.97 (0.94 – 1.01) 0.057 Conclusion: CXCR4/SDF-1 signalling pathway plays a central role in the pathogenesis
z Expressed as mean value and (range); * Adjusted for all variables listed of LV dysfunction and cardiac fibrosis in DCM. CXCR4 antagonism in DCM signifi-
cantly decreased fibrosis with a significant improvement in LV systolic and diastolic
function.
Conclusion: A multidisciplinary team approach may provide opportunities to identify Disclosure of Interest: None Declared
psychosocial and socioeconomic factors that compromise adherence to Rx in hypertensive
patients and for life style counseling leading to a better BP control. O172
Disclosure of Interest: None Declared
In-Hospital Mortality Of Takotsubo Cardiomyopathy: A Systematic Review And
Meta-Analysis
O170
Kuljit Singh*1, Kristin Carson2, Balwinder Singh3, Zafar Usmani2, Ajay Parsaik4,
Educational-status related inequities in awareness, treatment and control of
John Horowitz5
cardiovascular risk factors in India: Cross-sectional study 1
Cardiology, 2Respiratory, Queen Elizabeth Hospital, Adelaide, Australia, 3Department of
Rajeev Gupta*1, Krishnakumar Sharma1, Balkishan Gupta2, Raghuvir S. Khedar1, Clinical Neurosciences, University of North Dakota School of medicine & health sciences,, Fargi,
Prakash C. Deedwania3 4
Department of Psychiatry & behavioral sciences, University of Texas, Houstan, United States,
1
Medicine, Fortis Escorts Hospital, Jaipur, Jaipur, 2Medicine, SP Medical College, Bikaner, India, 5
Cardiology, University of Adelaide, Adelaide, Australia
3
Cardiology, University of California San Francisco, Fresno, United States
Introduction: Takotsubo cardiomyopathy (TTC) is associated with acute complications
Introduction: Low socioeconomic status is important determinant of cardiovascular such as shock and cardiac arrest. Furthermore, physical stressors and critical illness can
mortality. This could be due to poorer awareness and control of risk factors. precipitate TTC. The incidence of mortality among TTC patients because of these acute
Objectives: To determine association of educational status with awareness, treatment and complications and underlying medical illness is not known.
control of major cardiovascular risk factors among urban subjects in India. Objectives: To perform a systematic review and meta-analysis of studies on TTC to identify
Methods: The study was performed at eleven cities in India using cluster sampling. 6198 the incidence and cause of in-hospital mortality among patients diagnosed with TTC.
Subjects (men 3426, women 2772, response 62%, age 48+10 years) were evaluated for Methods: A comprehensive search of four major databases (EMBASE, OVID Medline,
socio-demographic, lifestyle, anthropometric and biochemical factors. Educational status PubMed and Google Scholar) was performed from their inception to first week of July
(ES) was categorized according to years of schooling <10y, 11-15y, and >15y into low, 2013. To minimize the publication bias, references cited in potentially eligible articles and
middle and high. Risk factors were diagnosed according to current guidelines. Awareness conferences proceeding of major cardiology conferences were hand searched. We included
(A), treatment (T) and control (C) status were determined for hypertension, diabetes and original research studies, recruiting > 10 participants, published in any language, that
hypercholesterolemia, for smoking, quit rates were determined. Descriptive statistics are reported data on mortality and/or cause of death in patients with TTC. Studies were
reported. identified and data extracted by two independent investigators to minimise bias and
Results: Age- and sex-adjusted prevalence (%) of various risk factors in low, middle and improve validity.
high ES subjects was hypertension 31.8, 29.5 and 34.1, diabetes 14.5, 15.3 and 14.3, Results: Out of 382 studies searched, 37 cohorts (studying 2120 TTC patients), 22
hypercholesterolemia 24.0, 23.9 and 27.3, and smoking/tobacco use 24.3, 14.4 and 19.0. retrospective, 13 prospective and 2 both retrospective and prospective from 11

e48 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

different countries were included in the analyses. The mean age of the cohort was 68 Results: Left ventricular parameters (end-diastolic/systolic volumes and LVEF), pulse wave
years (95% confidence interval [CI], 67-69 years) with female predominance (87%). velocity, tagged MRI, and global longitudinal strain were normal in all the hypertensive

ORAL ABSTRACTS
Acute in-hospital mortality among patients with TTC was 4.1% (95% CI, 3.1%>6.2%). patients and in controls. However, hypertensive patients had significantly longer pre-
Significant heterogeneity was observed in the mortality analysis (I-square 60.8%). TTC contrast T1 time (104940 vs. 94019 ms, p<0.0001) and shorter pre-contrast T2* time
related cardiac complications (shock and cardiac arrest) contributed to 38% of all in- (253 vs. 33.54 ms, p<0.0001) compared to controls (table 1). Post-contrast T1 was
hospital deaths, while the rest were related to TTC precipitating critical illness. On sub- short at 44930ms in the hypertensive group, indicating interstitial fibrosis.
group analysis, acute mortality in men diagnosed with TTC was much higher 12.1%
(95%CI 8.2%>16.7%) compared to women with 3.6% (95%CI 2.3%>5.9%; I-squared Healthy volunteers Hypertensive patients
60.8%).
Conclusion: TTC is not as benign as once thought. In-hospital mortality due to TTC is Pre-contrast Pre-contrast Post-contrast (10 mins)
higher in men as compared to women. TTC related cardiogenic shock and cardiac arrest are T1 (MOLLI) T2* T1 (MOLLI) T2* T1 (MOLLI) T2*
serious complications and major cause of cardiac mortality in patients with TTC and
should be managed closely to improve survival. overall 94019 33.54 104940 26.54.5 44930 26.73.9
Disclosure of Interest: None Declared p<0.0001 p<0.0001

O173
The influence of job stress on 16-th years risk of an arterial hypertension and

web 3C/FPO
myocardial infarction in female population aged 25-64 years in Russia (based on
WHO epidemiological program “MONICA-psychosocial”)
Valery Gafarov, Dmitriy Panov*, Elena Gromova, Igor Gagulin, Almira Gafarova
Collaborative laboratory of cardiovascular diseases epidemiology SB RAMS, FSBI Institute of
Internal Medicine SB RAMS, Novosibirsk, Russian Federation
Introduction: Role of job stress in prediction risk of cardiovascular diseases is studied
insufficiently in Russian female population.
Objectives: To study the influence of job stress on relative risk of an arterial hypertension
(AH) and myocardial infarction (MI) in female population aged of 25-64 years in Russia Conclusion: CMR T1 and T2* relaxometry allow detection of subclinical myocardial al-
over 16 years of follow-up. terations in hypertensive patients with otherwise normal systolic and diastolic function,
Methods: Under the third screening of the WHO "MONICA-psychosocial" program normal strain and normal pulse wave velocity. This represents early interstitial fibrosis, as
(MOPSY) random representative sample of women aged 25-64 years (n¼870) were confirmed with post-contrast T1 times. Noncontrast T1 and T2* relaxometry identify pre-
surveyed in Novosibirsk. Questionnaire “Awareness and attitude towards the health” clinical myocardial abnormalities at an earlier stage than other imaging techniques, offering
proposed by MOPSY protocol was used to estimate levels of job stress. From 1995 to a potential role in the very early identification of myocardial dysfunction in hypertension.
2010 women were followed for the incidence of AH and MI with using “Myocardial Disclosure of Interest: None Declared
Infarction Registry” data. Cox regression model was used for relative risk assessment (HR)
of AH and MI. O180
Results: The prevalence of high job stress level in women aged 25-64 years was 31.6%.
Quantitation Of Mitral Regurgitation After Percutaneous Mitraclip Repair Using
HR of AH over 16 years of follow-up in women with high job stress was 1.39-fold
Cardiac Magnetic Resonance - Reproducibility And Comparison With
higher (95.0%CI:1.08-1.78, p¼0.01) compared to those with lower levels of job stress.
Echocardiography
HR of MI in women with high job stress was 3.22-fold higher (95.0%CI:1.15-9.04,
p<0.05). There were tendencies of increasing AH and MI rates in married women Christian Hamilton-Craig*1,2, Niranjan Gaikwad1, Matthew Ischenko1, Vicki Speranza1,
experienced stress at work compared to unmarried, divorced and widowed with the Wendy E. Strugnell1, Jonathan Chan1,3, David G. Platts1, Gregory M. Scalia1,
same stress level. AH significantly higher developed in women with university Darryl J. Burstow1, Darren L. Walters1
(c2¼8.23 df¼1 p<0.01), college (c2¼3.98 df¼1 p<0.05) and high school education 1
Heart & Lung Institute, The Prince Charles Hospital, 2School of Medicine & Center for
(c2¼5.29 df¼1 p<0.05) having job stress compared to those with elementary school
education and stress at work. With regard to occupational class higher AH rates was Advanced Imaging, University of Queensland, Brisbane, 3Heart Research Institute, Griffith
found for “physical workers” with job stress compared to pensioners without it University, Gold Coast, Australia
(c2¼5.47 df¼1 p<0.05) and AH rates were tend to be higher in “managers” experi-
Introduction: Percutaneous valve intervention for severe mitral regurgitation (MR) using
enced stress at work (c2¼3.24 df¼1 p¼0.07). There were tendencies of increasing MI
the MitraClip is a novel technology. Quantitative assessment of residual MR by trans-
rates in “engineers” with stress at work.
thoracic echocardiography is challenging, with multiple eccentric jets and artifact from the
Conclusion: There is high prevalence of stress at work in female population aged 25-64
clips. Cardiovascular Magnetic Resonance (CMR) is the reference standard for left and right
years ant high job stress level is 31.6% in Russia. Women with high job stress have
ventricular volumetric assessment. CMR phase-contrast flow imaging has superior repro-
significantly higher relative risk of AH and MI over 16-th years of follow-up. Rates of AH
ducibility for quantitation of mitral regurgitation compared to echo.
and MI development were more likely in married women with middle and high educational
Objectives: To establish the feasibility and reproducibility of CMR in quantitating residual
level and high job stress in professional class “managers” and “physical workers”.
mitral regurgitation after MitraClip insertion.
Disclosure of Interest: None Declared
Methods: 12 patients following successful MitraClip insertion underwent a comprehensive
CMR examination at 1.5T (Siemens Aera) with mutiplanar SSFP cine imaging, T1mapping
O179 with MOLLI, and phase-contrast flow acquisitions at the mitral annulus atrial to the MitraClip,
Early Detection of Hypertensive Myocardial Fibrosis by Cardiac Magnetic Resonance proximal aorta and main pulmonary artery. Same-day echocardiography was performed with
Relaxometry 2D, Doppler, and speckle-tracking strain imaging. CMR and Echo data were independently,
blindly analyzed by expert readers. Inter-rater comparison was made by concordance corre-
Qurain Alshammari*1,2, Graham J. Galloway3, Mark W. Strudwick4,5, William Wang6, lation coefficient (CCC) with 95% confidence intervals, and Bland-Altman (BA) methods.
Arnold Ng6, Christian Hamilton-Craig3,6,7 Results: Mean age 7610 years, LVEF 4015% by CMR and 4816% by Echo. Inter-
1
Medical Imaging, College of Applied Medical sciences, Ha’il, Saudi Arabia, 2Centre for Advanced observer reproducibility of echo visual categorical grading by expert readers was poor;
Imaging & School of Medicine, 3Centre for Advanced Imaging, The University of Queensland, CCC 0.47 (-0.7,0.74). Echo Doppler regurgitant fraction reproducibility was also poor,
CCC 0.48 (-0.02,0.78), BA mean difference -4.5% (-38,29%). CMR regurgitant fraction
Brisbane, 4Dept of Medical Imaging and Radiation Science, Monash University, Melbourne,
5 reproducibility was excellent, CCC 0.948 (0.83,0.95), BA mean difference -2.5% (-13.2
School of Information Technology and Electrical Engineering, 6School of Medicine, The ,8.2%), with lower mean difference and narrower limits of agreement compared to
University of Queensland, Brisbane, Australia, 7University of Washington, Seattle, United States Echo (figure 1). Categorical severity grading by CMR using published ranges had good
inter-observer agreement CCC 0.86 (0.62,0.95). T1mapping of LV myocardium was
Introduction: Hypertension leads to end-organ cardiac damage and interstitial myocardial
102562 ms in MitraClip patients compared to 96225ms in healthy controls
fibrosis. The degree of myocardial fibrosis can be quantitated using Cardiac Magnetic
(P¼0.004).
Resonance (CMR) relaxometry.
Objectives: To quantify the burden of interstitial fibrosis by T1 and T2* mapping in
patients with recently established hypertension and normal left ventricular ejection fraction
(LVEF) with normal diastolic function, compared to healthy controls.
Methods: Subjects underwent a comprehensive CMR exam at 1.5T; SSFP imaging for LV
web 3C/FPO

function and LVmass, pre- and post-contrast T1 MOLLI and T2* mapping, myocardial
tagging SPAMM, aortic pulse wave velocity, adenosine stress perfusion and late gadolinium
enhancement. 30 patients with recently diagnosed hypertension (mean age ¼ 62.69,
duration of hypertension 1.040.2 years) with normal LVEF and normal diastolic function
by echocardiography were compared to 41 healthy controls (mean age ¼ 52.81 years).
Relaxometry maps were calculated using MRmap in basal, midcavity and apical slices using
a 16 segment model (figure 1).

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e49

 Conclusion: CMR performs extremely well in the quantitation of MR after MitraClip left ventricle(LV) mass index, LV systolic function (Ejection Fraction by Simpson biplane),
insertion, with excellent reproducibility of regurgitant fraction using mitral annular phase- LV diastolic function (E/E’ Lateral), pulmonary pressure estimate, left atrial (LA) volume
ORAL ABSTRACTS

contrast flow imaging, superior to echocardiographic visual and quantitative Doppler index, right ventricular (RV) systolic function (Fractional Area Contraction-FAC). Analysis
methods. MitraClip patients have abnormal myodardial tissue properties despite relatively was also performed after dividing the patients into three cohorts depending on whether the
preserved LVEF, as evidenced by T1mapping. CMR is optimal for the comprehensive post-TAVR AR was less than, similar to or greater than pre-TAVR.
evaluation and reliable quantitation of residual regurgitation in patients after MitraClip. Results: Sixty patients who underwent successful TAVR were included (mean age 84.2 years,
Disclosure of Interest: None Declared mean Logistic Euroscore 22.1%). Peak and mean aortic gradient were reduced from
8530mmHg to 20 10mmHg and from 5318mmHg to 104mmHg respectively
O175 (p<0.001). AR was less than pre-TAVR in 17 patients, similar in 19 patients and greater in 19
patients. The table below illustrates the changes in cardiac remodelling indices with time.
Quantitative Analysis of Paravalvular Leak of Transcatheter Aortic Valves Using
Cardiac MR
Pre-TAVR 1mth 6mth 12mth
Gareth Crouch*1, Jayme Bennetts2, Ajay Sinhal3, Craig Bradbrook4, Amy Swan3, Majo Joseph3,
Carmine Depasquale3, Rob Baker2, Joseph Selvanayagam1 LV mass 126.6(37)g/m2 111.5(28)g/m2* 111.3(37)g/m2* 110.0(30)g/m2*
1
Flinders Centre for Cardiovascular Magnetic Resonance Research, Flinders University, Index
2
Cardiothoracic Surgery, 3Cardiology, Flinders Medical Centre, 4Flinders Centre for EF 57.1(10.3)% 59.1(12.3)% 62.1(8.0)*% 59.7(9.9)%
Cardiovascular Magnetic Resonance, Flinders University, Adelaide, Australia E/E’ Lateral 25.5 (19) 26.6 (13) 21.0 (13) 18.0 (9)
Introduction: There is extensive registry and clinical trial data demonstrating an increased Index LA 53.8(15)ml/m2 49.2(20)ml/m2 47.1(17)*ml/m2 50.5(14)ml/m2
incidence of paravalvular leak following transcatheter aortic valve implantation (TAVI) volume
when compared with aortic valve replacement (AVR). Despite recent improvements in both PASP 44.0(18.9)mmHg 42.6(16.9)mmHg 42.7(14.0)mmHg 39.0(13.0)mmHg
hardware and software, echocardiographic measurement of aortic regurgitation (AR) largely
remains qualitative in nature. Cardiovascular magnetic resonance (CMR) is able to directly RV FAC 40.3(10.5)% 39.3(10.2)% 43.0(10.3)% 39.3(11.7)%
quantify AR with high accuracy and reproducibility by using the technique of phase- * p<0.05 compared to baseline
contrast velocity mapping.
Objectives: We sought to compare CMR quantitative analysis of AR with concurrently
collected TTE measurements in patients undergoing both TAVI and AVR. Patients with less AR compared to baseline had significantly greater remodelling
Methods: 45 patients with severe aortic stenosis undergoing either TAVI (29 patients) or compared to those with similar or greater AR (Reduction in LV mass 26g/m2 vs 10g/m2,
high-risk AVR. CMR (1.5T Siemens Aera) and transthoracic echocardiography (TTE, GE p¼0.024).
Vivid E9) were carried out pre-operatively and <2 weeks post-operatively. In addition to Conclusion: Post TAVR there is significant reduction in LV mass seen within the first 1
the standard CMR protocol, forward and regurgitant aortic flow images using through- month, especially if associated with reduction in AR. There is a trend to positive remod-
plane phase-contrast velocity mapping were obtained. The image plane was placed z0.5 elling in all other aspects which warrants a larger study to confirm.
cm above the AV at end-diastole. None/Trivial, Mild, moderate, moderate-severe and severe Disclosure of Interest: None Declared
AR by CMR was defined as regurgitation fractions of <5%, 15%, 16–25%, 26–48%, and
>48% respectively. O177
Results: STS scores were similar between groups. Post-operative CMR and TTE were con-
ducted at a median of 4.7 days for TAVI and 5.8 days for AVR. Mean preoperative left ven- TAVI valve sizing based on aortic annular area determined by transoesophageal
tricular (LV) and right ventricular (RV) ejection fractions (EF) were similar in the 2 groups echocardiography and multi-slice CT
using CMR. Post-operative LVEF was also similar. Post-procedure regurgitant fraction using Eliza Teo*1, Nigel T. Lewis1, Matias Yudi1, Khoa Phan1, James Wong1, Subodh Joshi1,
CMR was higher in the transcatheter group when compared to the AVR group (TAVI 1616% Marco Larobina2, John Goldblatt2, Vanessa Ogden1, Roderic Warren1, Ronen Gurvitch1
vs AVR 42%, p¼0.005). Comparing CMR and qualitative echo, TTE significantly under- 1
Cardiology, 2Cardiothoracics, Royal Melbourne Hospital, Melbourne, Australia
estimated the number of TAVI patients with greater than mild AR (p¼0.02).
Introduction: Valve sizing for transcatheter aortic valve implantation using the Edwards
SAPIEN XT valve has traditionally been based on annular diameter measured by trans-
oesophageal echocardiography (TOE), which assumes the annulus has circular geometry.
AVR None/Triv Mild Moderate Mod-Sev Severe Multi-slice computerised tomography (MSCT) has demonstrated that the annulus is
CMR 93.8% 6.2% 0% 0% 0% generally oval and therefore aortic annular area is now the preferred method used for valve
TTE 93.8% 6.2% 0% 0% 0% selection. Limited data is available relating to the incidence of altered valve size selection
based on the different imaging modalities.
TAVI Objectives: To compare MSCT annular area with TOE diameter and annular areas and
CMR 13.8% 41.4% 20.7% 17.2% 6.9% assess their impact on valve sizing.
Methods: 52 patients underwent TAVI Edwards SAPIEN-XT valve. Patients had annular
TTE 34.5% 44.8% 17.2% 3.4% 0%
diameters measured using TOE and aortic annulus area was measured from MSCT. Valve
sizing and selection was determined for each method utilizing currently accepted cutoffs.
Results: The mean aortic annular area by MSCT was significantly larger than area derived
from TOE (4.7  0.81cm vs 4.19  0.95 cm, p<0.001). Valve selection determined by TOE
Conclusion: When compared to CMR based quantitative analysis, TTE consistently
area significantly undersized the valve in comparison to MSCT (p<0.001) which would have
underestimated the degree of paravalvular aortic regurgitation, likely due to image
resulted in 27% of patients receiving a smaller valve. Overall however, and while MSCT areas
degradation associated with the implanted valve and/or poor echocardiographic windows.
were primarily relied upon for sizing, the final valve selection was not significantly different.
This underestimation may in part explain the recent findings of the PARTNER trial, which
This was due to other clinical factors resulting in different valve sizes than those predicted
showed that ‘mild’ paravalvular leak (as defined by TTE) was a predictor of medium-term
based on area alone, including degree of annular calcification, overall patient size and height
mortality (AR assessed as mild by may in fact be more severe).
of the coronary ostia origins. There were no cases of Grade III or IV aortic regurgitation.
Disclosure of Interest: G. Crouch: None Declared, J. Bennetts: None Declared, A. Sinhal
Conclusion: While MSCT annular dimensions are often larger than TOE, other clinical
Consultancy for: Proctor - Edwards Lifesciences, C. Bradbrook: None Declared, A. Swan:
factors influence clinical valve size selection such that not all patients in whom a larger
None Declared, M. Joseph: None Declared, C. Depasquale: None Declared, R. Baker: None
valve is suggested based on MSCT receive a different valve.
Declared, J. Selvanayagam: None Declared
Disclosure of Interest: None Declared
O176
O178
Cardiac remodelling post transcatheter aortic valve replacement – a single-centre
Prevalence, Surrogates And Determinants Of Insulin Resistance In Congolese Black
Echocardiographic study
Hypertensive Patients
Kalilur Anvardeen*1, Gerald Yong1, Kaitlyn Lam1, Robert Larbalestier2, Deepan Krishnasivam1,
Kianu Phanzu Bernard*1,2,3, Longo-Mbenza Benjamin4, Kasiam Lasi On’Kin Jean Bosco3,
Xiao-Fang Xu1
1 Mbuilu Pukuta Jody5, Masolo Muze Kianu Nanoue6, Bidingija Mabika Joseph3
Cardiology, 2Cardiothoracic, Royal Perth Hospital, Perth, Australia 1
Centre Médical de Kinshasa (CMK), 2LOMO MEDICAL, 3Internal Medicine, University Clinics
Introduction: Transcatheter aortic valve replacement (TAVR) has emerged as an alternative of Kinshasa, Kinshasa, Congo, The Democratic Republic of the, 4Faculty of Health Sciences,
to surgical valve replacement in patients with symptomatic severe aortic stenosis (AS) who Walter Sisulu University, Mthatha 5117, 5Department of Family Medicine, University of
are at high surgical risk. There is limited data on the effect of TAVR on cardiac remodelling. Witwatersrand, Johannesburg, South Africa, 6University of Kinshasa, Kinshasa, Congo, The
Objectives: To characterise the cardiac remodelling on patients who have undergone Democratic Republic of the
TAVR. To determine the interaction of the change in aortic regurgitation (AR) after TAVR
on cardiac remodelling. Introduction: Hypertensive patients with insulin resistance (IR) are at greater risk of
Methods: A retrospective analysis of all echocardiograms by a single observer was un- cardiovascular disease and may represent a particular subset of hypertension that requires
dertaken on consecutive patients who underwent TAVR. Echocardiograms were performed special medical attention. Quantitative measurements of the IR are not used in daily clinical
pre-TAVR, then at 1 month, 6 months and 12 months post-TAVR. Data analysed includes practice. Thereby, it is generally considered that subjects with metabolic syndrome (MetS)

e50 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

or abdominal obesity are caring IR. The validity of this approach has never been evaluated Objectives: To conduct a systematic review of the literature to determine the availability,
in Congolese hypertensive patients. use, and barriers to CR in LMIC.

ORAL ABSTRACTS
Objectives: The aim of this study is to determine the prevalence, evaluate the performance Methods: Electronic databases (Cochrane, EMBASE, PubMed, Web of Science) were
of some surrogates and identify independent determinant of IR among Congolese hyper- searched from 1980 to May 2013 for articles on CR in LMIC. English-language articles
tensive patients. dealing with availability, use, and/or barriers to CR were screened by title, abstract, and full
Methods: A cross-sectional study was conducted at the Heart of Africa Cardiovascular text. Additional references were identified by review of reference lists of the included ar-
Center LOMO MEDICAL of Kinshasa, Limete, DRCongo, between January 2007 and ticles. Data were summarized by region/country to determine the status and characteristics
January 2010. It was based on interviews, physical and chemistry measurements among of CR in LMIC, and gaps in the literature.
163 consecutive Congolese hypertensive patients. Homeostatic model assessment (HOMA) Results: Our search yielded 5208 citations, of which 20 satisfied full inclusion/exclusion
index was calculated to determine IR. The MetS was defined according to NCEP-ATPIII criteria. Notably, there was a dearth of literature from Asia and Africa. The number of CR
criteria. Abdominal obesity was defined according to the IDF definition (WC 94 Cm in programs available ranged from one in Paraguay to over 50 in Serbia. Referral rates for CR
men and 80 Cm in women). Multivariate logistic regression analysis was used to assess ranged from 7.3% in Turkey to 90.3% in Lithuania. Attendance rates ranged from 31.7% in
the independent determinants of IR. Bulgaria to 95.6% in Lithuania. CR attendance was correlated with older age, female sex,
Results: Men represented the majority of the enrolled patients: 105 (64.4%) and the mean higher education, and non-smoking status. Barriers to CR participation in LMIC and
age of all participants was 57  11 years. IR was found in 79.1% of the study population proposed solutions are in the Table.
with 88.7%, 82.2%, 60.3 and 44.8 respectively among patient with NCEP-ATP define
MetS, obese, diabetic and non-obese non-diabetic hypertensive. MetS used has a surrogate Table. Barriers to CR in LMIC and proposed solutions
to diagnose IR carried 42.6% of sensitivity and 79.4% of specificity whereas abdominal
obesity performed at 86.4% of sensibility and 29.4% of specificity. After adjustment for age, Category Barriers Proposed Solutions
gender, weight and BMI, the risk of IR was independently and significantly (p<0. 05) Physician Lack of - Incorporate CR into educational curriculum; expand referral
associated to cigarette smoking, elevated LDL-c, and MetS, according to the equation: Y¼ - factor referral base
1.404+1.054 cigarette smoking + 0.872 LDL-c + 0.983 MetS + 0.852 abdominal obesity.
Conclusion: IR was found to be prevalent in our study population. Use of the MetS by the Patient Transportation - Home-based CR and development of portable CR technology
NCEP-ATPIII definition provided good specificity but low sensitivity, whereas the factors Time, - Counseling by clinicians; public education; weekend/evening
abdominal obesity provided good sensitivity but low specificity to diagnose IR in Congolese motivation sessions
hypertensive patients. Cigarette smoking, elevated LDL-c, MetS and abdominal obesity
magnify IR. Further study in wider group is indicated to validate our findings. Affordability - Multi-tiered programs; alternate reimbursement and
Disclosure of Interest: None Declared insurance policies
Systems Not - Align incentives with service delivery; improved revenue
O181 factors profitable collection
Human - Task redistribution
Projected benefits of a home-based approach to chronic heart failure management:
resources
Long-term data from the multicentre Which Intervention is most cost-effective and
Consumer friendly in reducing Hospital stay Trial Lack of - Use existing physical infrastructure; subsidization; portable
resources monitors
Simon Stewart*, Melinda Carrington, Yih-Kai Chan, on behalf of the WHICH? Study
Investigators
Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia Conclusion: Our results illustrate the heterogeneity of CR availability and use in LMIC. In
many countries, CR is insufficiently available and under-utilized. There are several barriers
Introduction: Chronic heart failure management programs represent the gold-standard for to CR in LMIC; however, strategies can be pursued to improve this. Further character-
optimising health outcomes for hospitalised patients with CHF. However, the most cost- ization of CR in LMIC is necessary to develop targeted strategies to improve availability and
effective form of management is yet to be determined. utilization.
Objectives: We examined the likely long-term impact of a home-based (HBI) versus clinic- Disclosure of Interest: None Declared
based intervention (CBI) approach to CHF management on survival and rehospitalisation
using data from the Which Intervention is most cost-effective and Consumer friendly in O183
reducing Hospital stay (WHICH?) Trial.
Methods: We followed-up this multi-centre randomized controlled trial cohort of hospi- Probucol Prevents Atrial Remodeling By Inhibit Oxidative Stress And Tnf-A/Nf-Kb/
talized patients with CHF randomized to HBI (n¼143) or CBI (n¼137) for an extended Tgf-B Signal Transduction Pathway In Alloxan-Induced Diabetic Rabbits
period of 1368216 days and then used observed mortality and morbidity data to project
health outcomes up to 10-years. Huaying Fu*, Changle Liu, Guangping Li, Xinghua Wang, Tong Liu
Results: Observed and projected survival in the HBI group (annual case-fatality 17% in year 1 Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
then 10% per annum thereafter) and CBI group (annual case-fatality 24% and 17% in years 1
Introduction: Diabetes mellitus (DM) is an independent risk factor for AF. However, the
and 2 and then 14% per annum thereafter) were applied. In the CBI group observed (0-5 years)
underlying mechanisms for the increased propensity for AF in DM and the effects of
and projected (6-10 years) rates of all-cause and emergency hospitalization were 1.5 and 0.85
probucol on atrial remodeling remain unclear.
(mean length of stay 7.7 and 5.9 days [32% and 31% in specialist intensive/coronary care]) and
Objectives: This study sought to assess the effects of probucol on atrial remodeling and
0.70 (8.9 days) and 0.65 (6.8 days) per patient/annum, respectively. Equivalent observed rates
atrial fibrillation (AF) promotion in alloxan-induced diabetic rabbits and to elucidate the
of hospitalization during initial 5-year follow-up for the HBI group were 1.3 all-cause (4.3 days
underlying mechanisms.
[45% intensive/coronary care]) and 0.72 emergency hospitalizations (4.8 days) per patient/
Methods: 40 Japanese rabbits were randomly assigned to a normal control group (C,
annum. Equivalent projected rates of hospitalization for the HBI group were 0.79 (4.8 days
n¼10), a alloxan-induced diabetic group (DM, n¼10), probucol-treated group (CPR,
[26% intensive/coronary care]) and 0.85 (4.8 days) per patient/annum. Overall, during pro-
n¼10) and probucol-treated diabetic group (DPR, n¼10). Rabbits in the DPR and CPR
jected 10-year follow-up, for every 100 HBI vs. 100 CBI patients, there were 153 more all-cause
groups were orally administered Probucol (1000mg/day) for 8 weeks. Plasma malonalde-
(671 vs. 518) and 162 more (517 vs. 355) unplanned admissions. However, this largely reflects
hyde (MDA) superoxide dismutase (SOD) myeloperoxidase(MPO) and catalase (CAT)
a more favourable (36% vs. 20%) survival profile for the HBI group. Moreover, it was projected
levels were measured by chemical colourimetric methods. The protein expression of NF-kB
that HBI patients would require 445 days less of all-cause hospitalisation (3,437 vs. 3,882 days)
and TGF-b in left atrial tissue were analysed by western blot, the mRNA expression levels of
comprising 308 less days (979 vs. 1,287) spent in costly/intensive care units.
TNF-a were analysed by RT-PCR methods. Isolated Langendorff perfused rabbit hearts
Conclusion: These projected data from the unique WHICH? Trial comparing HBI to CBI
were prepared to evaluate atrial refractory effective period (AERP) and its dispersion
to optimise the post-discharge management of typically old and fragile CHF patients
(AERPD), interatrial conduction time (IACT) and vulnerability to AF. Atrial interstitial
suggest significant benefits (with large cost-savings) in favour of a HBI approach.
fibrosis was evaluated by Sirius-Red staining.
Disclosure of Interest: None Declared
Results: The DPR rabbits exhibited significant alleviation of oxidative stress displayed as
decreased plasma MDA compared with diabetic rabbits (P<0.05). Probucol significantly
O182 downregulated atrial NF-kB, TGF-b protein expression and TNF-a mRNA expression in
left atrial tissue of alloxan-induced diabetic rabbits . Probucol administrationdescreases the
Availability, use, and barriers to cardiac rehabilitation in low- and middle-income inducibility of AF in diabetic rabbits (P<0.05). Moreover, probucol attenuated atrial
countries: A systematic review structural remodeling reducing the interatrial activation time (IACT) and the atrial inter-
stitial fibrosis Finally, AERPD was reduced in DPR rabbits compared to diabetic rabbits.
Loheetha Ragupathi1, Rajesh Vedanthan*2, Judy Stribling3, Valentin Fuster2,
Mary Ann McLaughlin2
1 DM group Control group control-Probucol DM-Probucol
Thomas Jefferson University Hospital, Philadelphia, 2Icahn School of Medicine at Mount Sinai,
3 (n[10) (n[10) (n[10) (n[10)
Weill Cornell Medical College, New York City, United States
MDA(nmol/ml) 22.174.15# 17.693.59 18.142.62* 18.321.63*
Introduction: Cardiovascular disease (CVD) is the leading cause of death in low- and
IACT(ms) 36.556.4# 25.752.76 26.622.32* 23.871.64*
middle-income countries (LMIC). Cardiac rehabilitation (CR), a cornerstone of secondary
prevention, is critically important given the burden of CVD in LMIC. However, the AERPD(ms) 28.377.52# 11.625.60 13.666.48* 15.627.65*
availability of CR in LMIC is not systematically known. AF inducibility 8/10# 1/10 2/10* 3/10*

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals e51

ORAL ABSTRACTS

Conclusion: The ambulatory AF service reduces length of stay and frequency of hospital
admission by providing intensive and safe outpatient care.
Disclosure of Interest: None Declared
web 3C/FPO

O185
miR-199b induces iPS cell differentiation into endothelial cells by targeting JAG1 and
VEGF signaling pathway
li zhang*, Ting Chen, zhoubin li, yutao wu, hui yan, jianhua zhu
zhejiang university china , cardiology department, hangzhou, China

Introduction: The discovery of reprogramming induced pluripotent stem (iPS) cells from
somatic cells could pave the way for advances in regenerative medicine. iPS cells have the
capacity for unlimited growth and self-renewal and the ability to differentiate into all types
of mature tissue cells. MicroRNAs have been implicated in the regulation of many biological
processes, including the stem cells self-renewal pluripotency and differentiation
Objectives: In order to determine the role of miR-199b during endothelium cell (ECs)
differentiation from iPS cell.
Methods: Mouse iPS cell were seeded on mouse collagen IV-coated flasks and cultured in
ECs differentiation medium to allow ECs differentiation . After transfecteing with miR-199b
precursor and miRNA inhibitor , real-time quantitative PCR , immunoblotting analysis,
indirect immunofluorescent staining for cells or frozen sections were used to determine the
mRNA and protein level of EC specific marker . luciferase assay was used to confirmed the
target gene(JAG-1). matrigel plug angiogenesis assay was designed for tube formation, the
JAG-1 knockdown and anti-miR-199b were co-transfected into cell to test the mechanism.
Results: miR-199b expression is steadily increased during differentiation of mouse iPS cell
to ECs. Loss-of-function approaches uncovered that miR-199b is required for ECs lineage
differentiation, as evidenced by down egulation of EC-specific markers and upregulation of
endothelium cell specific marker, consistently, miR-199b mimic induced the expression of
EC-specific markers . In addition, we have documented for the first time that JAG-1 is a novel
target of miR-199b and mediates miR-199b function during iPS cell–EC differentiation.
Additionally, repression of the miR-199b expression by miR-199b inhibitor can reverse JAG-
1 downregulation during iPS cell–EC differentiation, which subsequently inhibits EC dif-
ferentiation. Luciferase experiments confirmed that miR-199b directly targets JAG-1. JAG-1
knockdown induced EC specific marker expression and EC morphology similar to

Conclusion: Probucol prevented atrial remodeling and suppressed AF development in

alloxan-induced diabetic rabbits. Its inhibition of oxidative stress, NF-kB, TGF-b and
TNF-a over-expression may contribute to its anti-remodeling effects.
Disclosure of Interest: None Declared

O184
Ambulatory management of symptomatic atrial fibrillation in acute medical admissions
Muhammad Rashid*, John D. Hung, Hossam Elsayed, Paula Dawson, Paul Nugent,
Paula McCarten-Twiss, Homeyra Douglas
Cardiology, Aintree Hospital, Liverpool, United Kingdom
Introduction: Atrial fibrillation (AF) is most common cause of hospital admission for
web 3C/FPO

cardiac arrhythmia1. The rate of hospitalisation due to symptomatic AF is on the rise2.

Frequently an inpatient admission is triggered for rate control and anticoagulation. A third
of patients with new onset AF can be managed safely in the emergency department (ED)
without the need for hospitalisation.3
Objectives: The ambulatory AF service was set up to reduce the length of stay or avoid
admission in patients presenting with acute symptomatic AF.
Methods: All patients with acute primary AF are assessed by one of the three AF specialist
nurses in acute admission areas. Depending on the patient’s symptoms or clinical status,
they are then either discharged home with follow up within 24 hours with the AF nurses,
or admitted to hospital for further management.
We compared admission rates and the average length of stay (LOS) before and after the
establishment of AF service in 2011.
Results: The average length of stay was significantly reduced from 7.3 days to 2.6 days
since the introduction of the AF service.
Whereas previously all of the acute symptomatic AF patients would be admitted for
ongoing management, 33% of patients referred to the ambulatory AF service were dis-
charged on the same day. (table 1).
There were no reported deaths or major adverse cardiac events (MACE) and the read-
mission rate was 1% (table 2).

e52 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals


web 3C/FPO
miR-199b overexpression. Futhermore, we found that the effect of Jagged-1 on iPS cell-EC
differentiation can be contract by miR-199b inhibitor. meanwhile, we also found that miR-
199b can regulate the ips differentiation into ECs through VEGF signalling pathway.
Conclusion: we conclude that miR-199b plays a critical role in the determination of EC
fate during iPS cell–EC differentiation by target JAG-1, which may indicate that miR-199b
has a role to promote EC differentiation.
Disclosure of Interest: None Declared
O186
Nucleosome Assembly Protein 1-Like 1 Knockdown Promotes Cardiomyocytes
Differentiation By Notch Signaling In Mouse Induced Pluripotent Stem Cells
Hui Gong*, Yuan Yan, Yuanyuan Xue, Bo Fang, Peipei Yin, Guoping Zhang, Chunjie Yang,
Yunzeng Zou
Zhongshan hospital, Fudan University, Shanghai, China
Introduction: Although induced pluripotent stem cells (iPSCs)-derived cardiomyocytes are
expected as the potential source of cell-based therapy for heart diseases, the rate of deri-
vation is too low for clinical application. Recently, we used a functional proteomic analysis
to screen out nucleosome assembly protein 1-like 1 (Nap1l1) which was downregulated
during the differentiation of P19CL6 cells into cardiomyocytes.
Objectives: Here, we attempted to study the role of Nap1l1 in the cardiogenesis of iPSCs.
Methods: To evaluate the differentiation efficiency, iPSCs cultured on 96-well plates were
monitored everyday under a microscope to detect the appearance of spontaneously con-
tracting cardiomyocytes, and the incidence of the EBs that exhibited spontaneous
contraction was counted every day. More than 200 wells were observed at each time- point.
Results: We observed Nap1l1 was downregulated during the differentiation of iPSCs.
Knockdown of Nap1l1 dramatically enhanced the differentiation of iPSCs into car-
diomyocytes characterized by the increased number of beating embryonic bodies (EBs), the
larger alpha-myosin heavy chain (a-MHC)-stained area and the upregulation of cardiac
transcription factors (Nkx2.5, GATA4, Mef2c, Tbx5). The effects were sharply inhibited by
Nap1l1 overexpression in iPSCs. Cardiomyocytes derived from Nap1l1-knockdown-iPSCs
exhibited proper cell biological characteristics judged from subcellular structure and their
response to neurohormonal triggers. Further study revealed that Nap1l1 negatively induced
mesoderm (Flk-1, Brachyury and Mesp1) development. However, the same number of
mesoderm stem cells (Flk-1 positive cells) from Nap1l1-knockdown-, Nap1l1-overex-
pressed- or their-control-iPSCs didn’t show obvious difference in cardiomyocyte differen-
tiation. Next study indicated that Nap1l1 positively regulated Notch intracellular domain
(NICD) and downstream genes during differentiation of iPSCs. Notch signaling inhibitor
greatly rescued the inhibitory effects of Nap1l1 on mesoderm induction and cardiogenesis.
Conclusion: These findings demonstrate that downregulation of Nap1l1 significantly en-
hances mesodermal induction and subsequently promotes cardiogenesis from mouse iPSCs
via regulating Notch signaling, which will facilitate application of iPSCs to heart diseases.
Disclosure of Interest: None Declared
O174
Accelerated Age-Related Increases In Arterial Stiffness In American Vs Japanese Women
Hrofumi Tanaka*1, Motohiko Miyachi2, Haruka Murakami2, Seiji Maeda3, Jun Sugawara4
1
Kinesiology and Health Education, University of Texas at Austin, Austin, United States,
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
2
National Institute of Health and Nutrition, Tokyo, 3University of Tsukuba, 4National Institute of
Advanced Industrial Science and Technology, Ibaraki, Japan
ORAL ABSTRACTS
Introduction: The United States spends more money on health care than any other industrialized
countries. Yet life expectancy has been lagging behind other developed countries. Currently, Japan
has the highest life expectancy at birth. It is not clear why the two countries with similar standards
of living, health care system, and industrialization have such divergent life expectancies both at
birth and at later ages (50 or 65 years old). Unfortunately, this divergent trend in life expectancy
has gone unexplained to date. Arterial stiffness has been widely regarded as a barometer of bio-
logical or physiological aging and could provide insight into the inter-country differences.
Objectives: The experimental aim of the present proposal is to determine whether the
increases in arterial stiffness across the adult age range are greater in the US adults
compared with the Japanese adults.
Methods: A total of 800 adults with wide age range were studied both in Japan (n¼400) and in the
US (n¼400). In an attempt to isolate the impact of “primary” (intrinsic) aging, we excluded patients
with cardiovascular and other chronic disease and focus on apparently healthy non-smoking
adults. Indices of arterial stiffness, including carotid-femoral and brachial-ankle pulse wave velocity
(cfPWV and baPWV) were measured along with a variety of ancillary measures. The measurement
technique and protocol were standardized and identical between US and Japanese facilities.
Results: Both cfPWV and baPWV increased progressively with advancing age in all sub-
groups (Japanese men and women, US men and women). The rate of age-related increases
in arterial stiffness was not different between US men and Japanese men. However, age-
associated increases in both cfPWV and baPWV were significantly greater in US women
compared with Japanese women, widening the gap in arterial stiffness between US and
Japanese women at older age ranges.
Conclusion: US women demonstrated accelerated rates of age-related increase in arterial
stiffness compared with Japanese women. The differential rates of age-related increases in
arterial stiffness may contribute to differential life expectancies observed in the two countries.
Disclosure of Interest: None Declared
O190
A Meta-Analysis Of Randomized Controlled Trials Comparing Warfarin And Aspirin
Therapy In Heart Failure Patients With Reduced Ejection Fraction In Sinus Rhythm
Neil Wayne C. Salces*
Adult Cardiology, Chong Hua Hospital, Cebu, Philippines
Introduction: Heart failure is common and remains a major cause of morbidity and
mortality despite significant advances in its management. It is associated with both sudden
death and death resulting from progressive heart failure that may be caused by unrecog-
nized atherothrombotic events. There is no guideline that recommends routine use of an
anticoagulant or antiplatelet agents in these patients in sinus rhythm.
Objectives: To determine the outcome of warfarin and aspirin in patients with chronic heart
failure and reduced ejection fraction (HFREF) in sinus rhythm as to the composite of all-cause
mortality, non-fatal myocardial infarction and non-fatal ischemic strokes. The secondary
outcomes were all-cause hospitalizations, all stroke events, and major and minor bleeding.
Methods: Medical literature databases were screened to identify randomized controlled
trials comparing warfarin and aspirin in heart failure patients with reduced ejection fraction
in sinus rhythm using PubMed databases, Cochrane Central Register of Controlled Trials,
and citations from eligible studies. The following keywords were used in the engine search:
heart failure, anticoagulation, warfarin, aspirin, and sinus rhythm. Four trials met the in-
clusion criteria – the WASH, HELAS, WATCH, and WARCEF trials.
Results: Overall, there was no significant difference in the primary composite endpoint of
all-cause mortality, non-fatal myocardial infarction and non-fatal ischemic stroke when
warfarin was compared with aspirin (n ¼ 4368, RR 0.97, 95% CI 0.87-1.08, p ¼ 0.61). For
the secondary endpoint, there was no significant difference in all-cause hospitalizations
with warfarin versus aspirin (n ¼ 4368, RR 0.96, 95% CI 0.85-1.09, p ¼ 0.52). However,
there was a significantly lower rates of all-stroke events (n ¼ 4368, RR 0.61, 95% CI 0.43-
0.88, p ¼ 0.008), but there was a significant increase in all hemorrhages (n ¼ 4368, RR
1.46, 95% CI 1.31-1.64, p ¼ <0.001) with warfarin versus aspirin.
Conclusion: In patients with HFREF in sinus rhythm, there is no overall benefit of warfarin
therapy over aspirin in the primary outcome of all-cause mortality, non-fatal myocardial
infarction and non-fatal ischemic stroke. There is however, a reduction benefit of all stroke
events with warfarin but is associated with higher risk of bleeding when compared with aspirin.
Disclosure of Interest: None Declared
O192
Clinical reality of coronary prevention in Europe: A comparison of EUROASPIRE II,
III and IV surveys
Kornelia Kotseva*1, Dirk De Bacquer2, Catriona Jennings3, Viveca Gyberg4, Guy De Backer2,
Lars Ryden4, David A. Wood3
1
Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London,
United Kingdom, 2University of Ghent, Ghent, Belgium, 3National Heart and Lung Institute,
Imperial College London, London, United Kingdom, 4Department of Medicine Solna, Karolinska
Institutet, Stockholm, Sweden
Introduction: Three EUROASPIRE surveys were conducted over 14 years in 9 countries –
Belgium, Czech Republic, Finland, France, Ireland, The Netherlands, Poland, Slovenia and
the United Kingdom- under the auspices of European Society of Cardiology, Euro Heart
Survey and subsequently the EURObservational Research Programme.
Objectives: To describe time trends in the lifestyle, risk factor and therapeutic management
in patients with coronary disease across Europe.
e53
 Methods: 12775 patients ( 70 years) with coronary disease – CABG, PCI or an acute
coronary syndrome - were identified over 14 years and 8456 were interviewed and examined
ORAL ABSTRACTS
at least 6 months later using standardized methods and instruments across all surveys.
Results: Prevalence of smoking remained unchanged overall in the three surveys (21.0%,
19.9%,18.2%; p¼0.55) but increased in younger patients. Prevalence of obesity (BMI  30
kg/m2) and central obesity (waist circumference  102 cm men and  88 cm women)
increased (31.9%, 33.3%, 38.5%; p¼0.007) and (50.5%, 50.5%, 57.2%; p¼0.04) respec-
tively. Prevalence of high blood pressure  140/90 mmHg ( 140/80 mmHg in diabetes)
decreased (53.5%, 52.4%, 44.5%; p¼0.01) as the therapeutic control in patients on blood
pressure lowering medication improved from 45.7% to 55.3% (p¼0.01). The proportions
with elevated LDL cholesterol 1.8 mmol/l decreased (95.7%, 80.3%, 75.3%; p<0.001) as
therapeutic control in patients on lipid lowering medication improved from 6.1% to 25.6%
(p<0.0001). Prevalence of self-reported diabetes increased across the three surveys: 18.5%,
23.8%, 27.2%) but there was no significant change in the prevalence of undetected diabetes:
10.5%, 11.1%, 11.5%. Prescriptions for cardioprotective medications increased between the
first and second surveys, with no further significant changes between the second and third
surveys; antiplatelet therapies (85.2%, 94.2%, 94.8%), beta-blockers (62.6%, 81.6%,
80.6%), ACE/ARB’s (42.3%, 71.5%; 70.7%), statins (55.2%, 88.8%, 88.6%).
Conclusion: Adverse lifestyle trends among European coronary patients with alarming
increases in obesity, central obesity and diabetes, are a cause for concern. Despite the high
use of cardioprotective medication, substantial proportions of patients still remain above
the recommended blood pressure and lipid targets. All coronary patients require a modern
preventive cardiology programme to help them achieve the lifestyle, risk factors and
therapeutic targets for CVD prevention.
Disclosure of Interest: K. Kotseva Grant/research support from: Travel grants to attend
scientific meetings from F Hoffman-La Roche and Boehringer Ingelheim, D. De Bacquer:
None Declared, C. Jennings: None Declared, V. Gyberg Grant/research support from:
Research Grants from the Swedish Heart Lung Foundation, G. De Backer Consultancy for:
Abbott, MSD and Astra Zeneca, L. Ryden Grant/research support from: Research Grants from
the Swedish Heart Lung Foundation, the Swedish Diabetes Association, AFA insurance and
from Roche, Consultancy for: Bayer, Roche, BMS and SanofiAventis, D. Wood Grant/research
support from: Pfizer, Consultancy for: Astra Zeneca, Glaxo Smith Kline, Menarini and MSD
O193
After the breakup: ischemic heart disease in the former Soviet Union countries, 1990-
2010. The Global Burden of Disease 2010 Study
Adrianna Murphy1, Mohammad H. Forouzanfar2, Gregory Roth3, Nana Pogosova4,
Majid Ezzati5, George Mensah6, Mohsen Naghavi2, Andrew E. Moran*7
1 hospital admission increased from U$568.10 in 2001 to U$ 697.57 in 2011 (+22.8%).
Department of Health Services Research and Policy, London School of Hygeine and Tropical
Medicine, London, United Kingdom, 2Institute for Health Metrics and Evaluation, 3Medicine,
University of Washington, Seattle, United States, 4Department of secondary prevention of
noncommunicable diseases, National Research Centre of Preventative Medicine, Moscow, Russian
Federation, 5Schoo of Public Health, Imperial College London, London, United Kingdom,
6
National Heart, Lung and Blood Institute, United States National Institutes of Health, Bethesda,
7 O196
Medicine, Columbia University Medical Center, New York, United States
Introduction: Since the dissolution of the former Soviet Union (fSU) in 1991, evidence
suggests that some former member countries have fared better than others in terms in terms
of ischemic heart disease (IHD). The Global Burden of Disease 2010 Study (GBD) offers a
unique opportunity to compare standardized data on IHD, its sequelae and risk factors
from each fSU country and to examine patterns over time.
Objectives: Using GBD 1990 and 2010 age- and population-standardized data, we set out to
compare current mortality and disability adjusted-life years (DALYs) due to IHD and related risk
factors, across fSU countries and GBD regions (Central Asia, Central Europe and Eastern Europe).
Methods: IHD mortality data were gathered from national vital statistics and surveillance
studies and annual IHD death rate and mortality trends were estimated in ensemble models
that incorporated country, region, risk factor, and contextual factor (e.g. per capita income
and access to health services) covariates. Non-fatal myocardial infarction, angina, and
ischemic heart failure prevalence were estimate from systematic review study data,
adjusting for differences in measurement method, using the DisMod-MR meta-regression
tool. IHD attributable to risk factors was estimated based on each country’s risk factor
prevalence and the association between the risk factor and risk of developing IHD. Out-
comes were IHD deaths (age-standardized to the world-standard population) and DALYs.
Results: For men, age standardized IHD death rates increased from 1990 to 2010 by 1.3% in
Central Asia and by 10.4% in Eastern Europe, but decreased in Central Europe (-29.5%). For
women, rates decreased in Central Asia (-7.5%) and in Central Europe (-27.4%), but
web 3C/FPO
e54
increased in Eastern Europe (4.8). However, there was significant heterogeneity among
countries within regions - for example, among fSU countries in Eastern Europe, while men in
Estonia experienced a 42.0% decrease in IHD mortality, those in Belarus experienced a 26.3%
increase. A similar pattern was observed for percentage changes in IHD DALYs (Fig.1) and
IHD sequelae. In most countries that experienced increases in IHD mortality and morbidity,
alcohol use increased in rank as a contributing factor to IHD DALYs.
Conclusion: The burden of IHD has increased in some, but not all fSU countries, and
increases were associated with high alcohol consumption. Research is needed on the up-
stream social factors that are responsible for this variation in disease trajectories.
Disclosure of Interest: None Declared
O194
Heart failure in Brazilian population. An overview about the last 11 years official
epidemiological data
Renato Kaufman1, Vitor M. P. Azevedo2, Mauro Geller3, Regina E. Müller*2,
Regina Maria Aquino Xavier2, Marcia B. Castier4
1
Cardiology, State Institute of Cardiology Aloisio de Castro, 2Research, National Institute of
Cardiology, 3Cardiology, Rio de Janeiro Federal University, 4Cardiology, State University of Rio
de Janeiro, Rio de Janeiro, Brazil
Introduction: Heart failure (HF) is the final stage of all heart diseases. Technological ad-
vances in medications, procedures and implantable devices, improved cardiac survival. At
the same time, an increased incidence of heart failure is observed. Although, there are few
data regarding the evolution of technology and its real impact on mortality of these patients.
Objectives: Temporal analysis of 11 years in relation to admissions, cost, and mortality of
adult patients hospitalized for heart failure in Brazil.
Methods: All data were obtained from the Brazilian Ministry of Health databases. It was
analysed total hospital admissions number, average length of stay, mortality rate, and cost
of hospitalization from 2001 to 2011. Some of these variables were divided between
genders, age groups, and geographic region of hospitalization.
Results: There were 90,436,795 total hospital admissions and of them, 3,374,592 were for
heart failure. Male patients accounted for 50.76% (1,712,875); the region with the highest
number of hospitalizations was southeast, which is the most developed region in Brazil, with
1,394,330 (41.3%) admissions. The absolute number of hospitalizations for HF decreased
from 379,463 in 2001 to 257,068 in 2011 (-32.2%). The overall average length of stay was
5.8 days in 2001 and increased to 6.5 days in 2011 (+12.0%), with the highest rates in the
Southeast (6.2 in 2001 and 7.2 in 2011, +16.1%). The mortality rate increased from 6.58%
in 2001 to 9.35% in 2011 (+42.1%), remaining higher in the Southeast. The average cost of
Conclusion: Even with the decrease in hospitalizations, heart failure is a syndrome with a
high cost to the Brazilian National Health System, with high mortality rates, which para-
doxically increased over time, despite the technological advances.
Disclosure of Interest: None Declared
Urban rural difference in daily salt intake estimated from 24 hour urinary excretion
of sodium in Bangladesh
Sohel R. Choudhury*1, Mohammad A. Mamun1, Jasimuddin Ahmed2, Mahfuzur R. Bhuiyan1,
Abdur Rouf2, R. K. Khandaker3, Abdul Malik3
1
Dept of Epidemiology and Research, 2Dept of Pathology, 3Dept. of Cardiology, National Heart
Foundation Hospital & Research Inst, Dhaka, Bangladesh
Introduction: To have a strategy for reduction of salt intake, the current level of salt
consumption need to be clarified.
Objectives: This study was done to estimate the daily salt intake in middle aged urban and
rural population of Bangladesh.
Methods: Study was carried out among 418 volunteers aged 40 to 59 years, residents of a
middle class urban area of Dhaka city and a rural area 60 km south of Dhaka. Information
regarding respondent’s demographic characteristics, history of diseases were collected by a
questionnaire. 24-hour urine was collected and volume measured in clinics by interviewers.
All samples were analyzed in a single laboratory for urinary sodium (Na), potassium (K) and
creatinine by using auto analyzer (Easylyte, Medica). Multiple regression analysis was done to
identify independent associations of urinary Na and K excretion with blood pressure (BP).
Results: In total 374 respondent’s (Urban: 184, Rural: 190) data were analyzed. 44 re-
spondents’ data were excluded due to incomplete collection or for either total urine volume
above or below 95th percentile (<0.94 liter/day and or >4.15 liter/day). The mean (SD) age
was 48.4 (6.3) years and 25% of the subjects had hypertension. Mean body mass index (BMI),
systolic and diastolic BP in urban and rural areas were 26.2 vs. 21.4 kg/m2, 124.0 vs.110.5
mmHg, 82.0 vs. 62.2 mmHg respectively. The average 24-hrs urinary excretion of Na and K in
urban and rural areas were 179.9 vs. 88.0 meq/day and 39 vs. 30.2 meq/day respectively.
Mean 24-hour salt excretion was 10.6 gm /day (95% CI: 9.6–11.6) in urban population and
5.1 gm /day (95% CI: 4.6 – 5.7) in rural population. Similar difference persisted when data
were analyzed excluding those with hypertension. The average ratios of 24-hour Na and K
(Na/K) excretion in urban and rural sites were 4.9 vs.3.1. Age, BMI and Na/K ratio in urine
were independently associated with SBP and DBP in total population.
Conclusion: This study documents high consumption of salt which is double the rec-
ommended level of daily intake of 5 gm in urban population, however in rural population
salt intake was close to the recommended level. The low intake of salt in this rural pop-
ulation might be due to overall low calorie intake as well as lower exposure to processed
foods in villages. Further large scale surveys are required to clarify these differences in salt
intake to formulate appropriate strategies for salt reduction.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
O086
Does HIV infection modify the risk of RHD? Initial echocardiographic screening
experience at the Joint Clinical Research Centre in Kampala, Uganda
Brigette Gleason*1,2, Grace Mirembe3, Judith Namuyonga4, Chris T. Longenecker1,2,
Emmy Okello4,5, Robert Salata1,2, Peter Mugyenyi3, Victor Musiime3, Marco Costa1,2, Cissy Kityo3
1
University Hospitals Case Medical Center, 2Case Western Reserve University, Cleveland, Ohio,
United States, 3Joint Clinical Research Centre, 4Makerere University College of Health Sciences,
5
Uganda Heart Institute, Kampala, Uganda
Introduction: The prevalence of rheumatic heart disease (RHD) is estimated to be 10-fold higher
in developing than in developed nations; however, accurate epidemiological data is limited by the
lack of echocardiography to detect subclinical RHD. Because of the immunologic basis of RHD,
there is reason to suspect that HIV/AIDS may affect the prevalence and/or severity of RHD.
Objectives: To describe the prevalence of subclinical RHD among HIV-infected children in
Kampala, Uganda and to compare our findings with previously published and unpublished
studies from Uganda.
Methods: This was a cross-sectional study of HIV-infected children enrolled in care at the
Joint Clinical Research Centre in Kampala. Screening echocardiograms were performed by
two physician-sonographers trained in RHD screening using 2012 World Heart Federation
criteria. All children with abnormal screening echocardiograms were referred for a
confirmatory echocardiogram at the Uganda Heart Institute. Clinical information including
age, gender, CD4 count, and use of antiretroviral therapy was obtained by chart review.
Results: Screening echocardiograms were performed on 266 children (see Table). Thirteen
children(4.9%) had a positive screen for definite or borderline RHD of the mitral valve and none
was positive for aortic valve disease. The overall prevalence of 4.9% (definite and borderline
RHD) is higher than the published prevalence of 1.5% (definite, probable, or possible RHD)
among 5,000 similarly aged Kamapla school children, and higher than the 0.7% prevalence
(definite only) in a previous unpublished study of 285 HIV-infected children on ART in Kampala.
Table: Baseline characteristics of HIV-infected subjects with suspected RHD.
Data presented as median (interquartile range) or frequency (%)
Overall Suspected RHD No RHD
n[266 n[13 n[253 p-value
Age (years) 10 (7-13) 13 (8.5-18) 10 (7-13) 0.03
Sex 0.99
Male 126 (47%) 6 (46%) 120 (47%)
Female 140 (53%) 7 (54%) 133 (53%)
Current CD4 (cells/mm3) 639 (371-922) 579 (211-851) 637 (371-932) 0.48
ART use 251 (94%) 12 (92%) 239 (95%) 0.54
Conclusion: The prevalence of suspected RHD among HIV-positive children in Kampala
was higher than previously reported in this population. Confirmatory testing and clinical/
echocardiographic follow-up will be required to verify these RHD diagnoses and to quantify
the extent of valvular abnormalities. Further epidemiologic and mechanistic studies are
needed to determine the effect of concurrent HIV infection and antiretroviral treatment on
RHD susceptibility or disease progression.
Disclosure of Interest: None Declared
O087
Leveraging existing HIV/AIDS infrastructure for rheumatic heart disease care in
Uganda: a collaborative disease surveillance and management program
Chris T. Longenecker*1,2, Peter Lwabi3, Cissy Kityo4, Marco Costa1,2, Grace Mirembe4,
Emmy Okello3,5, Robert Salata1,2, Peter Mugyenyi4, Moses Kamya5, Daniel Simon1,2
1
Case Western Reserve University, 2University Hospitals Case Medical Center, Cleveland, Ohio,
United States, 3Uganda Heart Institute, 4Joint Clinical Research Centre, 5Makerere University
College of Health Sciences, Kampala, Uganda
Introduction: Both rheumatic heart disease (RHD) and HIV/AIDS are leading causes of
morbidity and mortality among children and young adults in sub-Saharan Africa. Over the
past decade, substantial domestic and foreign investment has successfully scaled-up HIV/
AIDS healthcare infrastructure in these countries; however, spending on HIV/AIDS has
overshadowed spending on endemic non-communicable diseases such as RHD.
Objectives: We aimed to leverage existing HIV/AIDS infrastructure and longstanding USA-
Uganda collaborations to create a RHD surveillance and treatment program in Uganda.
Methods: Case Western Reserve University has collaborated with the Joint Clinical Research
Centre (JCRC, a national network of HIV clinics), the Uganda Heart Institute (UHI), and
Makerere University with funding from the Medtronic Foundation to: 1) create a joint RHD
treatment registry to monitor disease progression and adherence to treatment, 2) provide a
reliable supply of high quality benzathine penicillin, 3) conduct echocardiographic screening
for subclinical RHD, 4) conduct patient and community programs to raise RHD awareness
and improve adherence to therapy, 5) build cardiovascular disease care capacity at the JCRC.
Results: The program began in February, 2013. Consensus treatment protocols were adopted
in March, 2013. 593 active patients with RHD were identified from existing registries and are
being consented to participate in a secure online registry. A cardiac lab and clinic have been
constructed at the JCRC-Kampala site, and 25 patients have been transitioned to receive care at
this location. Training of JCRC staff in echocardiography and the clinical care of RHD has been
conducted at the UHI. 266 HIV-infected children at the JCRC-Kampala site have been screened
for RHD as part of routine care. 1,000 school children will be screened for RHD in September
and October, 2013. The program will expand to JCRC regional centers Gulu and Mbarara in
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
2014. Patients do not currently have access to cardiac surgery services in Uganda, although our
team has now performed 4 successful percutaneous balloon mitral valvuloplasties at the UHI.
ORAL ABSTRACTS
Conclusion: Existing HIV/AIDS infrastructure can be successfully leveraged to provide quality
care for patients with RHD in Uganda. This program could serve as a model for the management
of other chronic cardiovascular (and other non-communicable) diseases in resource limited
settings where infrastructure for HIV/AIDS is robust, but other health infrastructure is lacking.
Disclosure of Interest: None Declared
O197
Healthcare Providers’ Awareness Of The Information Needs Of Their Cardiac
Rehabilitation Patients Throughout The Program Continuum
Gabriela L. D. M. Ghisi*1,2, Sherry L. Grace1,3, Scott Thomas2, Michael F. Evans4, Paul Oh1
1
Cardiac Rehabilitation and Secondary Prevention Program, University Health Network,
2
Faculty of Kinesiology and Physical Education, University of Toronto, 3School of Kinesiology and
Health Science, York University, 4Health Design Lab, St Michael’s Hospital, Toronto, Canada
Introduction: To be effective, patient education should be comprehensive, planned,
supportive and, in particular, patient-centered. Unfortunately, much previous literature on
cardiac patient education has demonstrated that healthcare providers’ are often unaware or
inaccurately-perceive patients’ educational needs. Clearly, this can result in less engaged
and informed patients, and thus potentially negatively impact their health outcomes.
Accordingly, understanding what patients identify as information needs and concerns,
especially early in CR, can ensure that education provided is relevant to the learner.
Objectives: To: (1) describe cardiac rehabilitation (CR) participant information needs, (2)
investigate whether CR providers are cognizant of patient’s information needs and preferred
delivery formats, and (3) whether patient information needs change over the course of CR.
Methods: In this cross-sectional study, 306 CR patients and 28 CR providers completed a
survey. It consisted of the psychometrically-validated Information Needs in CR (INCR)
survey, and questions about preferred education delivery formats. The INCR assesses 10 areas
of information needs using a 5-point Likert-type scale: the heart, nutrition, exercise/physical
activity, medication, work/vocational/social, stress/psychological factors, general/social
concerns, emergency/safety, diagnosis and treatment, and risk factors. To test for differences
between samples, non-parametric tests (Mann-Whitney U) were applied, due to difference in
size between samples. Pearson’s correlation, t-tests and ANOVAs were used as applicable.
Results: Low-income CR participants had significantly greater information needs than high-
income participants. CR providers were cognizant of patient information needs, except
patients did desire more information on diagnosis and treatment than providers perceived
(p<.01). Books, lectures and discussion were identified as the preferred delivery formats by
both patients and providers. There were some significant differences in patient information
needs over the course of the program, particularly in relation to concerns and risk factors.
Conclusion: CR patients desire information in many areas, particularly regarding emer-
gency/safety and diagnosis/treatment. CR providers were highly cognizant of patient in-
formation needs; however, these do change over time. These findings could inform
evaluation and improvement of CR education programming, to ensure programs are
meeting patient information needs across all stages of recovery.
Disclosure of Interest: None Declared
O199
Early adoption of an aggressive post dilatation strategy for bioresorbable vascular
scaffolds – a single centre experience
Alastair Carlyle*1, Nigel Jepson2, Mark Pitney2
1
Cardiology, 2Eastern Heart Clinic, Sydney, Australia
Introduction: The AbbottÒ AbsorbÔ bioresorbable vascular scaffold (BVS) is a recent
addition to the stent armamentarium but has quite different properties from a normal metallic
stent. Original instructions from the manufacturer suggested implantation at low pressure with
optional post dilatation but despite these suggestions, our institution adopted a strategy of
aggressive post-dilatation to ensure adequate deployment, even if delivered at low pressure, in
order to lower the chances of acute scaffold thrombosis due to scaffold strut malapposition.
Objectives: We set out to show that aggressive post-dilatation is safe and effective in the BVS and
increases acute luminal diameter as measured by quantitative coronary angiography (QCA).
Methods: We performed QCA analysis on all patients who received a BVS in our insti-
tution before predilatation, after scaffold deployment and after post dilatation and
compared luminal diameter at the level of the lesion. Deployment pressure, post-dilatation
size and pressure, lesion characteristics, length of scaffold, number of lesions and number
of scaffolds were also recorded for each patient.
Results: 130 lesions were treated in 85 patients with 137 scaffolds (mean of 1.61 scaffolds/
pt). 5 patients underwent multiple procedures. 38% were treated for acute coronary syn-
dromes, 69% of patients were male and average age was 61.7 years. Lesions were 14% type A,
50% type B1 or B2 and 36% were type C. Average length of scaffold per patients was 36.9mm
(range 12-110mm). Scaffolds were deployed at a mean of 13.73atm, 96% of scaffolds were
post-dilated. QCA data was available for 119 of 132 scaffolds. A 2.5mm scaffold increased
from 2.23 to 2.66mm by QCA, an average increase of 19%. A 3.0mm scaffold increased from
2.7 to 3.14mm by QCA, an average increase of 15.5% and a 3.5mm scaffold increased from
2.93 to 3.36mm by QCA, an average increase of 12.3%. Overall, there was a 15.6% increase in
diameter of the scaffold after post-dilatation. There were no adverse outcomes from post
dilatation – no edge dissection, no side branch loss, no scaffold occlusion and a single inci-
dence of slow flow after post-dilatation. Medium term outcomes are excellent with no cardiac
deaths, one non-cardiac death and no target lesion or target vessel revascularisation.
Conclusion: Post dilatation in the Absorb BVS is safe and effective, increases vessel lumen
acutely when assessed by QCA and appears to compromise neither scaffold safety nor
efficacy with durable medium term clinical results.
Disclosure of Interest: None Declared
e55
 O200
ORAL ABSTRACTS
Bifurcation Lesion PCI Strategy with a Drug-Eluting-Stent in a Main Branch and a
Drug-Eluting-Balloon in a Side Branch is Safe and Effective in Real Life Conditions
Mariusz Zadura*, Frank Szigat, Barnaba Hejazin, Claudia Bischoff, Peter Szigat, Ronald Bittner,
Wolfgang Motz
Dept. of Cardiology, Klinikum Karlsburg, Heart and Diabetes Center of Mecklenburg-
Vorpommern, Karlsburg, Germany
Introduction: Due to the high rate of restenosis, interventional therapy of bifurcation le-
sions (BIF – PCI) remains still a challenge. Many different strategies were used with un-
satisfactory results in recent years.
Objectives: Since very promising studies with drug eluting balloons (DEB) were reported
in respect of restenosis, we studied the outcome of patients (PTS) who had been treated by
deployment of a drug eluting stent (DES) in the main branch (MB) in combination with a
DEB in the side branch (SB).
Methods: We analyzed prospectively the outcome of our first 53 consecutive PTS with
BIF – PCI, except left main – BIF-PCI, (40 men and 13 women, mean age 74 years) treated
in our institution from Nov. 2009 till Dec. 2012 with the DES (Xience VÒ, Abbot Vascular,
USA) in MB and DEB (Sequent PleaseÒ, B. Braun Melsungen, Germany) in SB (n ¼ 42
(79%) LAD-, n ¼ 6 (11%) CX- and n ¼ 5 (10%) RCA– BIF – PCI). After 6 – 9 months
either control coronary angiography was performed (40 PTS, 76%) or clinical outcome was
completed (13 PTS, 24%).
Results: In the control angiography we found restenosis of  50% with a need of clinically
driven target lesion revascularization in only 1 PTS in SB (TLR rate 1,8%) and in 2 PTS in
MB (TLR rate 3,7%). All restenoses we found in LAD – BIF. Since 1 PTS died 6 months
after BIF-PCI (cause of death unknown), MACE rate was 5,7%.
Conclusion: The BIF - PCI strategy “DES in MB and DEB in SB” is safe and highly effective
in real life conditions. Randomized studies with larger groups of PTS are mandatory to
confirm these preliminary results.
Disclosure of Interest: None Declared
O201
Youth Advocacy to Strengthen Smoke Free Policy: Lessons From India
Urvashi Kaushik*1, Vinay K. Gupta2, Monika Arora2
1 (Smokers) or diabetics but not Smokers (Diabetics). The collected data for each group were
Health Promotion and Tobacco Control, Public Health Foundation of India, Hyderabad, 2Health
Promotion and Tobacco Control, Public Health Foundation of India, New Delhi, India
Introduction: Cardiovascular diseases are the largest cause of mortality in India (WHO).
Tobacco poses an enormous public health challenge as the most prevalent risk factor with
worsening youth tobacco use patterns including increasing use among girls (GYTS India).
India prohibited smoking in defined public places through legislation (COTPA) in 2003,
including restaurants, to reduce youth access.
Objectives: To strengthen enforcement of prohibition on smoking is public places by
promoting youth engagement and ownership through enhancing youth advocacy and self-
efficacy skills.
Methods: 80 School and college going youth were oriented through a social behavioral
intervention. Youth launched a campaign to monitor and advocate for compliance with
prohibition on smoking in restaurants. The youth observed 281 randomly selected res-
taurants in urban states of Andhra Pradesh and Gujarat. The youth visited each restaurant
thrice in one month; first to make observations on compliance status, second to orient the
owners/ managers on legal provisions, and third to monitor if the restaurant complied after
last visit. Crucial aspects of compliance were observed and analyzed by using McNemar’s
test to inform impact assessment.
Results: While only 21.59% of restaurants displayed any tobacco warning at first visit,
80.68% of the restaurants had displayed a warning board. The youth also observed a six
times increase in restaurants which displayed a warning board on each entrance; five times
increase in restaurants displaying warning board at each floor; six times increase in res-
taurants displaying the board at each staircase; and while no restaurant displayed a warning
board at each elevator before intervention, over 8.42% restaurants did at third visit
(p<0.001).
83.47% restaurants displayed prescribed sized boards post intervention as against
12.81% restaurants at pre intervention. Restaurants displaying boards as specified and carry
authorized person’s name to report violations increased from 18.94% and 12.40%
respectively to 85.06% and 81.82%. Youth categorized twice as many restaurants as
‘completely smoke free’ after campaign (p<0.001).
web 4C/FPO
e56
web 4C/FPO
Conclusion: Youth led smoke free restaurant campaign achieved significant impact in
enhancing enforcement of smoke free public places. Youth advocates, empowered through
advocacy skills building combined with ownership in targeted intervention can be powerful
in improving public health.
Disclosure of Interest: None Declared
O202
Trends For Smoking Versus Diabetes Mellitus Among Acute Coronary Syndrome
Patients Over A 15-Year Period
Ayman El-Menyar*, A. A. Gehani, Hajar AlBinAli, Rajvir Singh, Emad Ahmed,
Jassim Al Suwaidi
cardiology, Hamad General Hospital, Doha, Qatar
Introduction: Diabetes mellitus and smoking habit, separately or in combination, are well-
known major risk factors for coronary artery disease (CAD).
Objectives: To study the trend for non-diabetic smoking versus non-smoking diabetes
mellitus in patients presenting with acute coronary syndromes (ACS) over a 15-year period
in a single cardiology center in a rapidly developing Middle Eastern country.
Methods: All patients hospitalized with ACS between January 1995 and December 2010
were included and categorized based on whether they were smokers but not diabetic
analyzed and compared. The study was divided by a 4- year apart into 4 eras.
Results: During the study period, 14,975 ACS cases were admitted, of them 3903 (45%)
were Smokers and 4711 (55%) were Diabetics. In comparison to Diabetics, Smokers were
11 years younger , had more STEMI (54% vs 29%, p< 0.001), had fewer rates of hy-
pertension, dyslipidemia, obesity and prior revascularizations (p¼0.001 for all). The
hospital use of Beta blockers (55% vs 47%), antiplateles (97% vs 95%), thrombolytics (40%
vs 17%) and coronary angiography(21% vs 17%) were more frequent among Smokers in
comparison to Diabetics (p¼0.001 for all). Whereas, ACE inhibitors use was higher among
Diabetics (37% vs 29%, p¼0.001). The rates of hospital stroke and mortality were
significantly higher among Diabetics group (0.6% vs 0.1% and 8% vs 3%, respectively).
There was upward trend for smoking from 16% in (1995-1998) reaching 39% in (2007-
2010) and for diabetes from 9% in (1995-1998) reaching 41% in (2007-2010). However
the mortality rates showed downward trends from 4.3% to 1.5% for smoking group and
from 15.3% to 5% for diabetics group between (1995-1998) and (2007-2010).
Conclusion: The rate of each risk factor (smoking or diabetes mellitus) is increasing
substantially in patients with ACS. Although the mortality rate differs in each group, DM
alone is associated with higher mortality with insufficient use of evidence –based therapies.
Disclosure of Interest: None Declared
O203
Awareness of Harms of Second-hand Smoke among Employees at Hospitality Venues
Ankur Singh*, Vinay Gupta, Monika Arora
Department of Health Promotion and Tobacco Control, Public Health Foundation of India(PHFI),
New Delhi, India
Introduction: There is no dearth of scientific evidence that highlights that the exposure to
Second-hand smoke (SHS) affects health and worsens the existing health problems among
non-smokers (WHO, 2009). Studies have also highlighted that employees exposed to SHS in
workplace have harmful levels of cotinine compared to those working in smokefree venues.
Employee’s knowledge and awareness about SHS and its harmful effects could lead to an
increased demand for smoke free workplaces and prevent them from the harm of SHS.
Objectives: To assess the awareness level of employees at hospitality venues regarding
harms of SHS according to their socio-economic status.
Methods: A survey was conducted among 804 hospitality venues in selected districts of
Gujarat and Andhra Pradesh, India under Project STEPS (Strengthening of Tobacco control
Efforts through innovative Partnerships and Strategies). In the selected ‘hospitality venues’,
the employees were interviewed using a pre tested structured interview schedule.
Results: Overall only (15%) of males and (10%) females had ever heard about SHS. A clear
educational gradient was observed in knowledge about SHS highlighting that with increasing
educational qualification awareness regarding SHS increased (P<0.001). It was also observed
that fewer non-smoker employees were aware that SHS harms people other than smokers
themselves (65.99%) compared to the employees (78.43%) who smoked (P¼0.068). Similarly
it was observed that with regard to awareness about SHS causing heart diseases it was observed
that high levels of knowledge was associated with increasing age (P¼0.55) and educational
qualification (P<0.001). More employees who were smokers (39.22%) believed SHS causes
heart disease compared to the employees who were non-smokers (25.14%) (P¼0.02).
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
Conclusion: Overall low awareness about SHS was reported among respondents. Social
inequalities in awareness about SHS were also observed highlighting lower awareness levels
among youth and lesser-educated respondents compared to the more educated respondents.
Hence to protect employees from SHS, smoke free laws should be strictly implemented.
Disclosure of Interest: None Declared
O204
Clinical Presentation, Management, And In-Hospital Outcomes Of Patients Admitted
With Decompensated Heart Failure In Trivandrum, Kerala, India
1 1 2 3
Harikrishnan Sivadasanpillai* , Sanjay Ganapathy , C. G. Bahuleyan , D. Dalus ,
Madhu Sreedharan4, Rao Asok Chandra5, Sunitha Viswanathan6, Suresh Krishnan7, Tiny Nair8,
Vijayaraghavan Govindan9
1
Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum,India,
2
Cardiology, Ananthapuri Hospital, 3Medicine, Medical college, Trivandrum, 4Cardiology,
NIMS,Neyyattinkara, 5Cardiology, SUT Hospital, 6Cardiology, Medical college, Trivandrum,
7
Cardiology, SK Hospital, 8Cardiology, PRS Hospital, 9Cardiology, KIMS, Trivandrum, India
Introduction: Heart failure (HF) is emerging as a leading cause of hospitalization in India. There
is hardly any data regarding HF from India. The Trivandrum Heart Failure Registry (THFR) is the
first registry in the country supported by the Indian Council of Medical Research (ICMR).
Objectives: Is to collect data regarding consecutive HF admissions and outcomes in all the
hospitals in Trivandrum city (n¼11) and a selected rural area(n¼5) in the suburbs.
Methods: THFR enrolls consecutive patients who are admitted with a diagnosis of HF
(satisfying European Society of Cardiology 2012 Criteria). Data regarding diagnosis,
treatment and in-hospital outcomes were captured. The registry is running in the year 2013
and the first 6 months data is being presented.
Results: Total of 624 patients (428, 68.6% males, mean age 60+/- 13.9 years) were enrolled
during the 6 month period. The most common etiology was coronary artery disease (CAD)
(69.5%) followed by dilated cardiomyopathy (14.5%) and rheumatic heart disease (8%). Dia-
stolic heart failure constituted 3% of the population. Isolated right heart failure (cor-pulmonale,
pulmonary embolism) constituted 1% of the total cohort. 14.1% were in Atrial Fibrillation(AF).
Of the patients who had CAD, 55% presented with HF related to an acute coronary
syndrome (ACS) and the rest 45% had ischemic cardiomyopathy. 268 of the 624 patients
(43%) presented with acute de-novo heart failure, 233 (37%) with acute on chronic heart
failure and 123(37%) had chronic heart failure. Risk factor profile - Diabetes 52%, hy-
pertension 55%, smoking 44%, chronic kidney disease (CKD) 15.5%.
The mean duration of hospitalization was 7.99 +/- 6.2 days. The total in-hospital
mortality was 9.3% (58 patients). Mortality was higher in females than males (12.7% vs
7.7%). Discharge medications were as follows – Beta-blockers (56%), ACEI/ARB (49%),
Diuretics(77%), Aldosterone blockers (48%), Digoxin (27%) and anticoagulants (13%).
Conclusion: Compared to data from the west, Indian patients are younger; have male
predominance, more have CAD and very few present with diastolic HF. Prevalence of
hypertension, AF and CKD were lesser. In-hospital stay was longer and mortality was
higher, especially among females. Usage of evidenced based therapy was not very different.
The possible explanations will be discussed.
Disclosure of Interest: None Declared
O205
Assessing Knowledge Attitude and Behaviour of Kiosk Owners Selling Tobacco
Products to School Children
Ankur Singh*, Vinay Gupta, Monika Arora
1
Department of Health Promotion and Tobacco Control, Public Health Foundation of
India(PHFI), New Delhi, India
Introduction: With evidence supporting association of restriction in access to tobacco
products and lower prevalence of tobacco use among youth it is important to know the
kiosk owner’s perspective regarding sale of tobacco products to youth.
Objectives: The study was conducted in states of Andhra Pradesh and Gujarat to un-
derstand kiosk owner’s knowledge, attitude and practice of Tobacco Control Law;
restricting sale within radius of 100 yards of any educational institution and its variation
according to socio-demographic variables.
Methods: A scale was created for awareness about tobacco control law and its implications
by summing up eight questions with binary options such that higher score on scale is
protective, Cronbac’s alpha ¼ 0.68.
Associations between awareness score and kiosk setup and their sociodemographic
profile were tested through nonparametric test. Association of kiosk setup and their
sociodemographic profile with kiosk owners’ opinion on having a shop and kiosk owners’
practice on selling tobacco products to children were assessed through chi-square test.
Results: Overall awareness was high with median value 6 (IQR¼ 5-6). Kiosk set ups, gender,
area, age and education were significantly associated with awareness level. 51.56% male as
compared to 61.21% females scored the median awareness level, p¼0.015. More kiosk owners
in urban areas were at median awareness level (64.57%) than in semi urban (47.5%) area and in
rural area (50.97%). Proportion of kiosk owners who had awareness at median level or more
was significantly more in higher education groups, p¼0.002.
Age and education were significantly associated with kiosk owners’ opinion on having a
shop located Also, 50.79% of illiterates in comparison with 38.17% educated up to primary/
middle school, 42.94% secondary school and 33.33% higher secondary and above reported
that it is economic advantage to have a shop within 100 yards of school, p<0.05.
Selling tobacco product to children
Selling tobacco product to children was significantly associated with education only and
showed no trend (Table 4). Overall, 22.76% of illiterates, 31.15% educated up to primary/
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
middle school, 33.53% educated up to secondary school and 18.07%% educated up to
higher secondary and above were reportedly selling tobacco products to children, p<0.05.
ORAL ABSTRACTS
Conclusion: Social inequalities in knowledge and attitude of Kiosk Owners was observed
highligting the need for stricter policies to address the wider determinants in order to
reduce access to tobacco products among youth.
Disclosure of Interest: None Declared
O206
Association Of Physical Inactivity, Low Fitness And Sedentary Behaviors With Blood
Pressure In 8-10 Year Old Children
Gilles Paradis*1, Marie-Eve Mathieu2, Katerina Maximova3, Tracie A. Barnett4,
Arnaud Chiolero5
1
Epidemiology, Biostatistics and Occupational Health, McGill University, 2Kinesiology, Universite
de Montreal, Montreal, 3School of Public Health, University of Alberta, Edmonton, 4Exercise
Science, Concordia University, Montreal, Canada, 5Institut Universitaire de médecine sociale et
préventive, Université de Lausanne, Lausanne, Switzerland
Introduction: High blood pressure (BP) in youth is associated with early markers of car-
diovascular diseases and BP levels track from childhood to adulthood. Although sedentary
behaviors, physical inactivity and decreased fitness predict high BP in adults, their rela-
tionship in children is not well established.
Objectives: To assess the relationship of physical inactivity, sedentary behaviors and fitness
with BP in 8 to 10 year-old children at high risk of obesity.
Methods: Baseline data from a cohort of 630 children (343 boys and 287 girls), originally
aged 8-10 years, with at least one obese biological parent (BMI30kg/m2 or waist circum-
ference >102cm in men and >88cm in women). Five consecutive BP readings at 1-min in-
tervals at rest, were obtained with an oscillometric device (Dinamap XL CR9340). Physical
activity was assessed with 7-day accelerometry (Actigraph LS7164) as well as with validated,
self-reported questionnaires which also collected information on sedentary behaviors (TV
viewing, computer use, video game playing, studying and reading). Fitness was assessed by
VO2peak using a standard incremental exercise test on an electromagnetic bicycle (Oxycon
Pro, Jaeger) with continuously measured indirect calorimetry, and was categorized in tertiles
(low, middle and high). Height, weight and sexual maturation (Tanner) were measured and
parental self-reports of history of high BP and of socio-economic information were collected.
The Odds of elevated systolic (SBP) or diastolic (DBP) BP (defined as age, sex and height
specific SBP or DBP 90th percentile from cohort distribution) was assessed with logistic
regression, adjusted for BMI, Tanner stage, parent education and parent history of high BP.
Results: Mean (SD) SBP/DBP were 94.4 (8.3)/48.3 (5.3) and 93.1 (7.9)/48.9 (5.0) mmHg
for boys and girls, respectively. 40% of boys and 31% of girls practiced >2 physical ac-
tivities per day for at least 15 min and they spent an average of 3.1 and 2.4 hours per day
respectively being sedentary. Multivariate logistic regression models showed that >2 hours
per day of TV viewing was associated with an 80% increase in the odds of elevated DBP
(OR (95%CI) 1.8 (1.1-3.1)). This association was more pronounced among overweight and
obese youth. The OR for elevated BP among low (vs high) fitness children was 3.4 (1.2-
9.6). BP was 97/51 vs 92/47 mmHg in the low vs the high fitness group.
Conclusion: Watching TV for more than 2 hours per day and low fitness is associated with
an increased odds of elevated BP in 8-10 year-olds.
Disclosure of Interest: None Declared
O207
Readmissions after first heart failure hospitalization in Aboriginal versus non-
Aboriginal patients in Western Australia, 2000-2007
Tiew-Hwa Katherine Teng*1, Judith M. Katzenellenbogen1, Elizabeth Geelhoed2,
Matthew Knuiman2, Derrick Lopez1, John A. Woods1, Frank Sanfilippo2, Michael Hobbs2,
Joseph Hung3, Sandra C. Thompson1
1
Combined Universities Centre for Rural Health, 2School of Population Health, 3Sir Charles
Gairdner Hospital Unit, The University of Western Australia, Perth, Australia
Introduction: Heart failure (HF) is a leading cause of rehospitalizations. Readmission rates
and hospital length of stay (LOS) have major implications for quality of care and resource
utilization.
Objectives: To compare the readmission patterns of Aboriginal versus non-Aboriginal
patients aged 20-84 years who were discharged alive following a first (index) HF hospi-
talization between 2000 and 2007.
Methods: Patients were followed for three years from first admission date for HF read-
missions only using the WA Hospital Morbidity Database. Risk-adjusted Poisson regression
models were used to examine the rate ratios (RR) of HF readmissions between Aboriginal
and non-Aboriginal patients.
Results: Of 12,947 patients surviving index HF hospitalization, 727 (5.6%) were Aboriginal
with 77% residing in rural/remote areas. Aboriginal compared to non-Aboriginal patients
were younger (mean age: 54 years vs 71 years), and had higher prevalence of hypertension,
diabetes, chronic kidney disease, rheumatic valvular heart disease (all p<0.05).
Compared with non-Aboriginal patients, a higher proportion of Aboriginal patients had a
HF readmission within 3-year follow-up (60.7% vs 49.5%, p<0.001) with a greater propor-
tion being emergency readmission (89.2% vs 70.8). The interval from index separation to first
HF readmission was shorter for Aboriginal patients aged under 55 years (162.6 vs 199.2 days,
p¼0.048). Mean HF readmissions was higher in Aboriginal patients (3.33.3 vs 2.53.6,
p<0.001). The shorter average LOS during index HF admission (4.54.9 vs 5.67.6 days,
p<0.01) in Aboriginal patients might predispose to a greater need for readmission.
Risk-adjusted rate ratio of HF readmits was higher in Aboriginal patients (RR 1.17,
p<0.001). Age, Charlson comorbidity index, rural residence, no private insurance, rural
e57
 hospital, ischaemic heart disease, valvular heart disease and chronic kidney disease were all one and two years were 19.1% (n¼201) and 28.4% (n¼300) respectively. On multivariate
significant predictors of increased HF readmissions. Cox regression analysis, significant predictors of two-year mortality were prior myocardial
ORAL ABSTRACTS

Conclusion: Aboriginal HF patients despite being younger have higher readmission rates infarction (HR 1.849; 95% CI 1.411-2.422; p<0.001), previous stroke (HR 1.377; 95% CI
and a shorter interval to first HF readmission compared with non-Aboriginal patients. 1.042-1.819; p¼0.024), increased age (HR 1.017; 95% CI 1.004-1.029; p¼0.009) and
Possible contributory factors include remoteness, a higher patient comorbidity burden, increased serum creatinine (HR 1.002; 95% CI 1.001-1.003; p<0.001). Higher systolic
inferior multidisciplinary and coordinated before care after hospital discharge and sub- blood pressure (HR 0.993; 95% CI 0.988-0.998; p¼0.011), higher hemoglobin levels (HR
optimal secondary prevention. 0.899; 95% CI 0.844-0.958; p¼0.001) and use of aspirin (HR 0.763; 95% CI 0.592-0.984;
Disclosure of Interest: None Declared p¼0.037) and warfarin (HR 0.576; 95% CI 0.382-0.868; p¼0.008) and lipid-lowering
drugs (HR 0.655; 95% CI 0.511-0.839; p¼0.001) resulted in significantly less mortality.
Amongst others, sex, ethnicity, use of beta-blockers and angiotensin-converting-enzyme
O208
inhibitors/angiotensin II receptor blockers had no significant effect on mortality.
Comparison of NZ European and NZ Maori of Patients Hospitalised for Heart Failure: Conclusion: In our Asian population presenting with heart failure and LVEF  40%, two-
New Zealand Heart Failure Registry year mortality was 28%. Prior myocardial infarction, previous stroke, increased age and
increased serum creatinine resulted in significantly higher mortality. Higher systolic blood
Karthigesh (Kat) Sree Raman*1, Richard Troughton2, Mayanna Lund3, Rob Doughty4, pressure and hemoglobin levels, use of aspirin and lipid-lowering drugs resulted in
Gerard Devlin1, New Zealand Heart Failure Registry (NZHFR) significantly lower mortality.
1
Cardiology, Waikato Hospital, Hamilton, 2Cardiology, Christchurch Hospital, Christchurch, Disclosure of Interest: None Declared
3
Cardiology, Middlemore Hospital, 4Cardiology, Auckland Hospital, Auckland, New Zealand
O210
Introduction: Prior reviews of the New Zealand Heart Failure Registry (NZHFR) showed
that NZ-Maori present at a younger age with heart failure and have higher prevalence of LV Risk factors for congestive heart failure in patients with chronic kidney disease: the
systolic dysfunction. CRIC study
Objectives: We aim to revisit and compare outcomes for NZ-Maori (NZM) and NZ-
Europeans (NZE), based on updated NZHFR data. Jiang He*1, Wei Yang2, Amanda Anderson2, Harold Feldman2, John Kusek3, Akinlolu Ojo4,
Methods: NZHFR is a national, prospective, observational, web-based registry. All hospitals Dominic Raj5, Mahboob Rahman6, Michael Shlipak7, Lee Hamm8, CRIC Investigators
1
in New Zealand admitting patients with acute heart failure have been invited to participate. Department of Epidemiology, Tulane University, New Orleans, 2Biostatistics and Epidemiology,
Results: A total of 1904 patients are enrolled from July 2006 to September 2013, and 90- University of Pennsylvania, Philadelphia, 3Kidney & Urology Branch, NIDDK, Bethesda, 4Internal
day follow up data is available in 90% (1705/1890). There are 446 NZM (mean-age 62 Medicine, University of Michigan, Ann Arbor, 5Medicine, George Washington University, Washington
years, 69.5% males) and 1094 NZE (mean-age 79.1 years, 61% males). Hypertension and DC, 6Medicine, Case Western Reserve University, Cleveland, 7Medicine, University of California, San
atrial fibrillation are the major aetiological factors for heart failure in both groups. Higher Francisco , San Francisco, 8Internal Medicine, Tulane University, New Orleans, United States
prevalence of severe valvular disease (24.4% vs. 19.6%, p<0.0383) and diabetes (44% vs.
29.5%, p<0.0001) in NZM group with ischemic heart disease more prevalent in NZE Introduction: Congestive heart failure (CHF) is common in patients with chronic kidney
(22.5% vs. 12.3%, p<0.0001). Predisposing factors for hospital admission for NZM are disease (CKD).
uncontrolled hypertension (11.4% vs. 4.8%, p<0.0001) and non-compliance with medi- Objectives: We studied the prospective relationship of novel cardiovascular risk factors
cation (16.1% vs. 3.2%, p<0.0001). NZM have high prevalence of impaired left ventricular with the event rate of CHF among 3,939 CKD patients from the Chronic Renal Insuffi-
systolic function (LVEF<50%, 83.5% vs. 66.7%, P<0.0001). A higher proportion of NZM ciency Cohort (CRIC) Study.
have been referred to heart failure nurse on discharge (59.4% vs. 44.8%, p<0.0001). Methods: Kidney function was assessed by estimated glomerular filtration rate (eGFR)
Discharge medications and 90 days follow up as shown in table: using the CKD-EPI equation, serum cystatin C, and 24-hour urinary excretion of albumin.
During an average of 3.6 years of follow up, 390 individuals were hospitalized for CHF.
Results: After adjustment for age, gender, race, self-reported history of CHF and clinical site, the
Discharge medications NZ European NZ Maori p value hazard ratio (HR, 95% CI) for CHF associated with 1 standard deviation (SD) lower eGFR (13.5
Diuretics 96.4% (1001/1037) 98.2% (426/434) 0.12 mL/min/1.73 m2) was 1.53 (1.35,1.73), 1 SD higher cystatin C (0.55 mg/L) was 1.61 (1.47,1.75),
Beta-blockers 76.9% (797/1037) 80.2% (348/434) 0.16 and 1 SD higher log[urine albumin (0.52 mg/24 h)] was 1.62 (1.48, 1.76), all p<0.001. When all
3 kidney function measures were simultaneously included in the model, only cystatin C (HR,
ACE-i/ARBs 78.4% (813/1037) 88.0% (382/434) <0.0001* 1.53, 95% CI 1.34, 1.74) and log(urine albumin) (HR 1.47, 95% CI 1.35, 1.61) were significantly
Aldosterone antagonist 28.5% (296/1037) 41.0% (178/434) <0.0001* associated with increased risk of CHF. These associations remained statistically significant after
further adjustment for other known risk factors including education, physical activity, cigarette
smoking, alcohol consumption, history of myocardial infarction and diabetes, body mass index,
systolic blood pressure, HDL and LDL cholesterol. After adjustment for all above mentioned risk
Outcomes NZ European NZ Maori p value factors, the relationships of novel risk factors (1 SD higher) with CHF are given in the table below:
Median length of stay 6 days 7 days

In-hospital mortality 5.2% (57/1094) 2.7% (12/446) 0.0298* HR (95% CI) p-value

Mortality at 90-day follow up 13.1% (128/975) 8.1% (33/407) 0.0076* Blood hemoglobin, 1.78 g/dL 0.82 (0.72, 0.94) 0.004

Hospital readmission at 90-days 16.9% (165/975) 15.0% (61/407) 0.425 Hemoglobin A1c, 1.56% 1.28 (1.14, 1.43) <0.001

Compliance with treatment 87.4% (852/975) 82.6% (336/407) 0.0217*
Conclusion: NZ-Maori present at a much younger age with heart failure and have increased
prevalence of systolic dysfunction. They are more likely to receive evidence based care with ACE-
i/ARBs and aldosterone antagonists but higher compliance is noted in the NZE group. There is no
difference in at 90-day readmission but NZE have higher in-hospital and 90-day mortality.
Disclosure of Interest: None Declared
O209
Asian Patients With Heart Failure and Ejection Fraction ‡40%: Predictors of Two-
Year Mortality
1 2 2 2 2 2
Andy Neo* , Jonathan Yap , Shaw Yang Chia , Ling Ling Sim , David Sim , Chi Keong Ching
1 with Chronic Kidney Disease: the Chronic Renal Insufficiency Cohort study
Yong Loo Lin School of Medicine, National University of Singapore, 2National Heart Centre,
Singapore General Hospital, Singapore, Singapore
Introduction: Despite advances in care, there is a high mortality seen in patients with heart
failure and left ventricular ejection fraction (LVEF)  40%. Of note, data from Asia is scarce.
Objectives: Our objective is to analyse the predictors of two-year mortality in these patients.
Methods: Consecutive patients admitted to 2 Asian institutions for heart failure with LVEF
 40% on transthoracic echocardiogram from 1 January 2008 to 31 December 2009 were
included. Clinical demographics, risk factors, laboratory and imaging results and medication
history were obtained. All patients were followed-up for 2 years. Overall mortality was
obtained from the national registry of deaths in our country.
Results: A total of 1055 patients were included. Mean age was 72.4 (standard deviation
10.9) years old and there were 407 (39%) males. 771 (73.1%) patients were Chinese, 143
(13.6%) Malay, 123 Indian (11.7%) and 18 (1.7%) were of other ethnicities. There were
819 (77.6%) patients with LVEF  50% and 236 (22.4%) with LVEF 40-49%. Mortality at
Uric acid, 1.92 mg/dL 1.14 (1.02, 1.28) 0.025
Log(C-reactive protein, 0.87 mg/L) 1.12 (1.01, 1.25) 0.038
Log(Interleukin-6, 17.1 pg/mL) 1.16 (1.07, 1.26) <0.001
Conclusion: Our study indicated that cystatin C and urine albumin are better predictors
for risk of CHF compared to eGFR. Furthermore, anemia, inflammation, higher uric acid,
and poor glycemic control are independent risk factors for the development of CHF among
patients with CKD.
Disclosure of Interest: None Declared
O211
Urinary Sodium and Potassium Excretion and Cardiovascular Diseases in Patients
Katherine T. Mills*1, Lawrence J. Appel2, Jing Chen1,3, Patrice Delafontaine3, John Kusek4,
Akinlolu Ojo5, Mahboob Rahman6, Raymond R. Townsend7, Peter Yang8, Jiang He1,3, the
Chronic Renal Insufficiency Cohort (CRIC) Investigators
1
Department of Epidemiology, Tulane University, New Orleans, 2Welch Center for Prevention,
Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore,
3
Department of Medicine, Tulane University, New Orleans, 4Division of Kidney, Urologic, and
Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, NIH ,
Bethesda, 5Department of Internal Medicine, University of Michigan, Ann Arbor, 6Department of
Medicine, Case Western Reserve University, Cleveland, 7Department of Medicine, 8Department
of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, United States
Introduction: Chronic kidney disease (CKD) patients are at an increased risk of cardio-
vascular disease (CVD) compared to the general population. Prior work has produced

e58 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

contradictory results for the associations of sodium and potassium intake with CVD
incidence, and these associations have not been investigated in patients with CKD.
Objectives: To assess the prospective associations between urinary sodium and potassium
excretion and CVD incidence among patients with CKD.
Methods: The Chronic Renal Insufficiency Cohort Study (CRIC) is a prospective cohort
study of 3,939 participants with CKD from seven locations in the United States. Dietary
sodium and potassium intake are averaged from three 24-hour urine samples, and the ratios
of sodium and potassium to urinary creatinine are used. Composite CVD is defined as
incident myocardial infarction (MI), stroke, or congestive heart failure (CHF). CVD events
are reported every six months and confirmed by medical record adjudication.
Results: Over an average 6.5 years of follow-up, 660 CVD events occurred. The highest
quartile (>199.5 mmol/1,374 mg) of the sodium-to-creatinine ratio had a hazard ratio
(HR) of 1.58 (95% confidence interval 1.27, 1.97; p for trend across quartiles <0.0001) for
composite CVD events compared to the lowest quartile (129.0 mmol/1,374 mg) after
adjustment for important covariates. Similarly, the highest quartile (>69.8 mmol/1,374
mg) of the potassium-to-creatinine ratio had a HR of 1.61 (1.28, 2.03; p for trend across
quartiles 0.0002) for composite CVD events compared to the lowest quartile (42.3 mmol/
1,374 mg). When modeled continuously, every 100-mmol higher sodium to 1,374 mg
creatinine ratio was associated with an increased HR of 1.23 (1.12, 1.35) for composite
CVD events, 1.23 (1.11, 1.37) for CHF, 1.35 (1.11, 1.64) for stroke, and 1.12 (0.96, 1.32)
for MI. In addition, every 50-mmol higher potassium to 1,374 mg creatinine ratio was
associated with an increased HR of 1.27 (1.11, 1.44) for composite CVD events, 1.35 (1.17,
1.56) for CHF, 1.14 (0.82, 1.59) for stroke, and 1.03 (0.81, 1.32) for MI.
Conclusion: Our study found that dietary sodium and potassium are both associated with an
increased risk of CVD among patients with CKD. These findings suggest that reductions in
dietary sodium and potassium might reduce the incidence of CVD among patients with CKD.
Disclosure of Interest: None Declared
O212
Predictive Value of Lipoprotein Parameters on the Risk of Chronic Kidney Disease in
Patients with Coronary Heart Disease
Prakash C. Deedwania*1, Andrei Breazna2, David A. DeMicco2, John C. LaRosa3,
James Shepherd4, Matti J. Tikkanen5, Ingar Holme6, Anders G. Olsson7, Terje R. Pedersen8
1
VACCHCS/UCSF Fresno, Fresno, United States, 2Pfizer Inc, New York, United States, 3State
University of New York Health Science Center, Brooklyn, United States, 4Western Infirmary,
Glasgow, United Kingdom, 5Institute of Clinical Medicine University of Helsinki, Helsinki,
Finland, 6Oslo University Hospital, Oslo, Norway, 7University Hospital of Linköping, Linköping,
Sweden, 8Ullevål University Hospital, Oslo, Norway
Introduction: Dyslipidemia occurs in more than half of patients with chronic kidney
disease (CKD). In patients with coronary heart disease and CKD, studies and meta-analyses
have demonstrated that statins have a renoprotective effect. However, data on the rela-
tionship between lipids and CKD are sparse.
Objectives: To investigate whether lipoprotein parameters at screening/baseline are pre-
dictive for CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) in
statin treated coronary patients using a combined data set from two large clinical trials.
Methods: Data from the Treating to New Targets (TNT: atorvastatin [ATV] 10 mg vs. ATV
80 mg) and the Incremental Decrease in End Points Through Aggressive Lipid Lowering
(IDEAL: simvastatin 20–40 mg vs. ATV 80 mg) studies were analyzed. Age-adjusted and
multivariable-adjusted odds ratios and 95% confidence intervals for CKD were calculated
using logistic regression by categories of TC, HDL-C, LDL-C, non–HDL-C, TC/HDL-C, and
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
ApoB/ApoA-1 at screening/baseline. Multivariable Model 1 adjusted for age, smoking sta-
tus, diabetes (history or developed during follow-up), BMI, history of hypertension, and
ORAL ABSTRACTS
treatment assignment. Multivariable Model 2 adjusted each lipid measure separately for all
variables in Model 1 plus the development of CV disease during follow-up.
Results: In the pooled population (z19,000 coronary patients), age-adjusted screening/
baseline TC, LDL-C, non–HDL-C, and TC/HDL-C were consistently and significantly
associated with an increased risk of CKD (Table). Across all 3 models (age adjusted and
multivariable models 1 and 2), the lipoprotein components associated with the highest risk
of CKD were elevated TC, high LDL-C, high non–HDL-C, and a high ratio of TC/HDL-C.
Conclusion: In this large pooled population of coronary patients, screening/baseline li-
poprotein levels were significantly associated with an increased risk of CKD. Age-adjusted
and multivariate analyses identified TC, LDL-C, HDL-C, non–HDL-C, TC/HDL-C ratio,
and ApoB/ApoA-1 ratio as significant predictors of an increased risk of CKD.
Disclosure of Interest: P. Deedwania Consultancy for: Pfizer Inc., AstraZeneca, and
Amgen, Honorarium from: Pfizer Inc. and AstraZeneca, A. Breazna Employee from: Pfizer
Inc, D. DeMicco Employee from: Pfizer Inc, J. LaRosa Consultancy for: Amgen, J. Shepherd
Consultancy for: AstraZeneca, GlaxoSmithKline, Merck, Oxford Biosensors, Pfizer, Nicox,
Roche, and Schering-Plough, Speakers bureau: AstraZeneca, Merck, Abbott, Schering-
Plough, and Pfizer, M. Tikkanen Consultancy for: Amgen, Honorarium from: Pfizer Inc.
and Abbott, I. Holme Consultancy for: Pfizer, Merck/Schering-Plough, AstraZeneca, and
Roche, Honorarium from: Pfizer, Merck/Schering-Plough, AstraZeneca, and Roche, A.
Olsson Grant/research support from: Amgen, AstraZeneca, Karo Bio, Merck Sharp and
Dohme, Pfizer Inc, Roche, and Sanofi-Aventis, Consultancy for: AstraZeneca, Karo Bio,
Merck & Co, Pfizer Inc, and Roche, T. Pedersen Consultancy for: Merck & Co., Speakers
bureau: Merck & Co, Pfizer Inc, and AstraZeneca
O213
Use of a Hydrophilic Sheathless Catheter: A Novel Technique to Overcome Radial
Spasm, Perforation and Anatomic Anomalies
Sonya Burgess*, Michael Liang, Ian Webb, Phillip Matsis, Mark Simmonds, Scott Harding
Cardiology, Wellington Hospital, Wellington, New Zealand
Introduction: Transradial access (TRA) in percutaneous coronary intervention is recom-
mended as the preferred access for percutaneous coronary intervention by the European
cardiac societies. Two randomized trials, the RIVAL study, and the RIFLE-STEACS trial both
found a significant mortality benefit with TRA in STEMI patients. Despite this worldwide use
of TRA varies considerably. We report barriers to TRA; radial spasm, perforation and
anatomical abnormalities, can be overcome with use of a hydrophilic sheathless catheter.
Objectives: We investigated the use of a hydrophilic sheathless catheter to facilitate TRA.
Methods: We studied outcomes in 33 consecutive patients undergoing transradial coronary
procedures with severe radial spasm  perforation, despite use of vasodilators and sedation,
in which we elected to use a hydrophilic sheathless catheter (Sheathless Eaucath, Asahi Intecc)
in an attempt to overcome the spasm. Radial angiography was performed to document the
presence of spasm, anatomic anomalies and perforation prior to use of the sheathless catheter
and upon completion of all procedures. Clinical characteristics, angiographic outcomes,
procedural outcomes and in-hospital complications were recorded.
Results: The mean age was 619 years, 55% were male. Procedural indications were stable
angina (15%), unstable angina (3%), non-ST elevation myocardial infarction (42%), ST-
elevation myocardial infarction (30%) and diagnostic (10%). Radial angiography demon-
strated severe spasm in all cases and radial perforation in 8 (24%). Radial anomalies were
common in our cohort with a high origin of the radial artery occurring in 16 (48%), a full
radial loop in 3(9%), moderate radial tortuosity in 3(9%) patients, and extreme tortuosity
of the brachiocephalic artery in one patient. A hydrophilic sheathless catheter was used to
complete angiography alone in 4, planned PCI in 2 and diagnostic coronary angiography
followed by ad hoc PCI in the remaining 27 cases. A hydrophilic sheathless catheter passed
through the area of spasm and anatomic anomalies easily in all cases. All cases were
completed successfully using the Eaucath. Radial angiography performed following
completion of the procedures demonstrated that all perforations had sealed and no evi-
dence of vascular complications. There were no in-hospital complications.
Conclusion: Use of a hydrophilic sheathless catheter appears to be a safe and simple
strategy to overcome the radial artery spasm, anatomic anomalies and perforation during
transradial procedures.
Disclosure of Interest: None Declared
O214
State Variation in Adoption of Radial Access and Comparison of Outcomes to
Femoral Access in Percutaneous Coronary Intervention
Matthew Worthley*1, Rosanna Tavella1, Philippa Loane2, Angela Brennan2, Chris Zeitz1,
David Clark3, Stephen Duffy2, John Beltrame1
1
The University of Adelaide, Adelaide, 2Monash University, 3Austin Hospital, Melbourne,
Australia
Introduction: There are several well-established clinical registries in Australia which can
inform on practice trends in invasive cardiac procedures. In particular, radial artery access
for percutaneous coronary intervention (r-PCI) has seen a rapid uptake within the past few
years. This technique has been shown to have less vascular complications. There is however
little Australian data examining uptake trends between regions and in comparing outcomes
between radial and femoral approaches.
Objectives: To evaluate trends in r-PCI and compare procedural outcomes between r-PCI
and femoral PCI in both Victorian and South Australian public hospitals.
Methods: The Melbourne Interventional Group (MIG) is a PCI Registry collecting stand-
ardised procedural and follow up data on consecutive patients across multiple sites in
e59
 Victoria since 2004. The Coronary Angiogram Database of South Australia (CADOSA) is a Disclosure of Interest: M. Huisman Grant/research support from: Boehringer Ingelheim,
comprehensive registry of all public cardiac catheterization procedures performed within Bayer Healthcare, Pfizer, GSK and Actelion , Honorarium from: Boehringer Ingelheim, Bayer
ORAL ABSTRACTS

South Australia since 2011. Data from MIG and PCI data from CADOSA was utilised to Healthcare, Pfizer, GSK and Actelion. , C. Ma Consultancy for: Boehringer Ingelheim, H.-C.
assess the prevalence of r-PCI and vascular complications of radial and femoral access Diener Grant/research support from: AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim,
approaches for procedures undertaken in 2012. Lundbeck, Novartis, Janssen-Cilag, Sanofi-Aventis, Syngis and Talecris. The Department of
Results: In 2012, there were 1358 PCI procedures across the four public hospitals in SA Neurology at the University Duisburg-Essen received research grants from the German
and 2203 PCI procedures across the 6 public hospitals in Victoria. SA had a considerably Research Council (DFG), German Ministry of Education and Research (BMBF), European
higher proportion of r-PCI than Victoria (55% vs. 21%). In SA, r-PCI was performed in Union, National Institute of Health, Bertelsmann Foundation and Heinz-Nixdorf Foundation ,
78% of acute coronary syndromes cases compared to 71% in Victoria. The vascular and Honorarium from: Abbott, Allergan, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim,
bleeding outcomes were similar and favoured radial approach in both states. See table. CoAxia, Daichii-Sankyo, D-Pharm, EV3, Fresenius, GlaxoSmithKline, Janssen Cilag, Knoll,
MSD, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion,
Parke-Davis, Pfizer, Sanofi-Aventis, Schering-Plough, Servier, Solvay, Thrombogenics, Wyeth
SA-Radial VIC-Radial SA-Femoral VIC-Femoral and Yamanouchi , S. Dubner Grant/research support from: St. Jude Medical , Consultancy for:
Access Prevalence n[744 (55%) n[466 (21%) n[614 (45%) n[1737 (79%) Boehringer Ingelheim , J. Halperin Grant/research support from: Bayer Healthcare, Boehringer
Age/Female Gender 63  13/21% 65  12/22% 63  13/28% 65  12/25% Ingelheim, Daiichi-Sankyo Pharma, Janssen Pharmaceuticals, Johnson & Johnson, and Sanofi-
Aventis , K. Rothman Employee from: RTI Health Solutions , C. Teutsch Employee from:
Stable angina 17% 21% 11% 22%
Boehringer Ingelheim , A. Clemens Employee from: Boehringer Ingelheim , K. Zint Employee
STEMI 31% 25% 39% 36% from: Boehringer Ingelheim , E. Kleine Employee from: Boehringer Ingelheim , D. Bartels
Cardiogenic Shock 1% 1% 3% 4% Employee from: Boehringer Ingelheim , G. Lip Consultancy for: Bayer, Astellas, Merck, Sanofi,
BMS/Pfizer, Daiichi-Sankyo, Biotronik, Portola, and Boehringer Ingelheim , Speakers bureau:
Bleeding Complication 0.3% 0.6% 3% 4% Bayer, BMS/Pfizer, Boehringer Ingelheim, and Sanofi Aventis
Bleed at Access Site 0.1% 0.2% 2% 1%
CVA/Stroke 0.3% 0.4% 0.7% 0.5% O216
Patterns of saturated and polyunsaturated fat intake: Trends from 48 countries, 1960-
Conclusion: Recent Australian registry data show a substantial adoption of radial access for 2000
PCI. Radial PCI accounts for almost 40% of PCIs performed, with SA showing a more Masoud Mirzaei*1, Sophia Lin2, Richard Taylor2
prevalent trend. In both regions, radial access is associated with less vascular complication, 1
Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd,
with less than 1% of r-PCI procedures developing bleeding events.
Iran, Islamic Republic Of, 2School of Public Health and Community Medicine, University of New
Disclosure of Interest: None Declared
South Wales, Sydney, Australia
O215 Introduction: Diets high in saturated fatty acids (SFA) are consistently linked with
increased total and low density lipoprotein cholesterol levels that contribute to athero-
Results of the 1st Phase of the International GLORIA-AF Registry Program: Regional
matous coronary heart disease (CHD). Population changes in dietary fat intake can have
Treatment Differences Before the Era of Novel Anticoagulants
significant effects on mean population cholesterol and CHD events and mortality.
Menno Huisman1, Changsheng Ma2, Hans-Christoph Diener3, Sergio Dubner4, Objectives: To examine patterns of SFA and CHD in 48 countries between 1960 and 2000.
Jonathan Halperin5, Kenneth Rothman6, Christine Teutsch7, Andreas Clemens7, Kristina Zint8, Methods: Annual total age-standardised CHD mortality (35-74 years, both sexes) was
Eva Kleine9, Dorothee Bartels8, Gregory Y. H. Lip*10, on behalf of GLORIA AF Working Group obtained from the World Health Organization and plotted. Discrepant data due to coding
1 artefact were deleted. Trends of SFA (expressed as proportion of total calories) were derived
Medicine, Leiden University Medical Centre, Leiden, Netherlands, 2Cardiology, Beijing An Zhen
from food balance sheets from the Food and Agriculture Organization (FAO). Countries
Hospital Peking, Beijing, China, 3Neurology, Universitatsklinikum Essen, Essen, Germany, were grouped into High Income Countries (HIC) and Low-to-Middle Income Countries
4
Medicine, Clinica y Maternidad Suizo Buenos Aries Avenida Pueyrredon, Buenos Aires, (LMIC) and into geographical groups.
Argentina, 5Clinical Cardiology Services, Mount Sinai School of Medicine, New York,
6
Epidemiology and Medicine, Boston Medical School, Boston, United States, 7Medical,
8
Epidemiology, 9Statistics, Boehringer Ingelheim Inc., Ingelheim, Germany, 10Haemostasis
Thrombosis & Vascular Biology Unit, University of Birmingham Centre for Cardiovascular
Sciences, Birmingham, United Kingdom

Introduction: The introduction of novel oral anticoagulants (NOACs) has changed the
approach to stroke prevention in atrial fibrillation (AF).
Objectives: GLORIA-AF is a prospective, global registry program created to describe the
clinical epidemiology of newly diagnosed AF patients and the selection of antithrombotic
treatment.
Methods: The program comprises 3 phases: 1st Phase, before the introduction of NOACs;
2nd Phase, following the introduction of dabigatran, and 3rd Phase, comparative effec-
tiveness research that begins when propensity score analysis show that characteristics of
patients treated with dabigatran and vitamin K (VKA) have sufficient overlap.
Results: In the 1st Phase, 1063 patients were enrolled (54.3% male; median age 70) from the
following regions: Asia (67.1%), Europe (EU 27.4%) and Middle East (ME 5.6%). Of those
patients 78.7% had a CHA2DS2-VASc of 2 and 21.3% had a score of 1. Most (80.9%) had a
HAS-BLED score of 0-2 and the majority (83.9%) had symptomatic AF. A higher proportion
of those with high stroke risk were on VKA therapy (CHA2DS2-VASc 2; 36.1%) compared
with those with moderate stroke risk (CHA2DS2-VASc ¼1; 20.1%). VKA use was higher in
persistent/permanent AF than for paroxysmal AF (47.7% vs. 23.9% respectively). web 4C/FPO
There were regional differences in treatment patterns. Most patients in Asia (China) were
treated with antiplatelet agents (53.7%) vs. 27.1 and 28.8% in the EU and ME, respectively;
in the EU and ME, more patients were treated with VKA (63.9% and 30.5% respectively).
In total, 25.9% of patients in Asia had no antithrombotic therapy compared with 8.6% and
8.5% in the EU and ME respectively.

Treatment Asia (n[713) Middle East (n[59) Europe (n[291)

VKA 20.3% 30.5% 63.9%
Antiplatelet therapy 53.7% 28.8% 27.1%
None 25.9% 8.5% 8.6%

VKA, Vitamin K antagonist; 20 patients were on NOACs

Conclusion: In conclusion, the 1st Phase of GLORIA AF shows lower VKA use in those
with paroxysmal AF, and in those with low stroke risk. Furthermore, these results from
GLORIA-AF show meaningful geographical differences in the use of VKA therapy in the era
before the availability of NOACs, including a notably lower use of VKA in Asia. In this
region, most patients are treated with antiplatelet agents or do not get any antithrombotic
treatment. The shift to more VKA use in patients with AF can be seen when “going West”.

e60 GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals

Results: There is a positive correlation between SFA and CHD mortality in both HIC
(Figure 1) and LMIC (Figure 2). With the exception of Russia, CHD mortality trends in
HIC are decreasing. Patterns of SFA in HIC is divergent with Southern Europe and East
Asia (excluding China) showing increasing trends (but from a low base), compared to
Australia/New Zealand, Northern and Western Europe and North America where trends
are falling (from high levels). Eastern Europe and Russian SFA increases to around 1990,
from when consumption falls. CHD mortality trends in LMIC have increased, particularly
in Central Asia. SFA intake in LMIC has changed little, except China where SFA intake has
increased significantly (from a low base).
Conclusion: Changes in SFA consumption and CHD mortality patterns are generally
similar. SFA patterns reflect changes in global food production that have occurred over the
past half century. A 2008 FAO publication reported per capita/per day supply of vegetable
oils increased 112% in HIC and 191% in LMIC between 1961 and 2003. Per capita/per day
supply of animal fats decreased 26% in HIC and increased 109% in LMIC. However,
consumption of vegetable oils was still 1.9 times higher and animal fats 3.4 times higher in
HIC than LMIC, reflected in the higher (x2) CHD mortality and SFA consumption in HIC
than LMIC. Despite reductions in HIC SFA consumption, it is still a significant population
determinant for CHD. Increasing SFA consumption in LMIC will likely correspond with
increasing CHD. Research is currently underway to examine time lag relationships between
population changes in dietary fat intake and CHD mortality.
Disclosure of Interest: None Declared
O217
Assessment of clinical value of standardized, questionnaire-based history evaluation
in the diagnosis of syncope
1 1 1 1
Artur Z. Pietrucha* , Irena B. Bzukala , Danuta Mroczek-Czernecka , Mateusz Wnuk ,
Jadwiga Nessler1, Wieslawa Piwowarska2
1
Department of Coronary Disease, Medical College of Jagiellonian University, John Paul II
Hospital, 2Department of Coronary Disease, Medical College of Jagiellonian University, Cracow,
Poland
Introduction: The aim of our study was evaluation of clinical usefulness of standardized,
questionnaire-based history evaluation in the diagnosis of syncope in patients admitted to
Syncopal Unit.
Objectives: We observed 920 consecutive pts. with syncope (552 women, 60%, aged 12-
89 yrs., median of age 41 yrs.), diagnosed in our Syncopal Unit of our Department during
last 3 years.
Methods: In all patients a of standardized questionnaire for history evaluation (SQfHE) was
used during initial evaluation together with physical examination, ECG evaluation,
orthostatic BP measurement and carotid sinus massage in pts. over 40 years of age. SQfHE
included question regarding circumstances of syncopal episodes, prodroms and syncope
course according to last ESC guidelines for diagnosis and treatment of syncope. Calgary
Syncope Symptom Score (CSSS) proposed by Sheldon as well as OESIL Score (OS) were
implemented into SQfHE. If CSSS was -2 or more reflex syncope was diagnosed or sus-
pected – if concomitant disorders were presented. If OS was higher than 0 - additional
diagnosis was performed.
Results: Based on initial evaluation diagnosis of syncope was done in 42,4% of pts.,
Suspected diagnosis of syncope was made in further 39,6% of pts. Only 18 % of patient
had no established the reason of syncope based on initial evaluation. Hospitalization rate,
longer than 1 day was 8,2%
Conclusion:
1. Standardized, questionnaire-based history evaluation allow to make diagnosis,
based only on initial evaluation in over 40% of patients
2. The ratio of undiagnosed syncope based on initial evaluation was only 18% – in
these patients the additional diagnosis was performed
3. Standardized, questionnaire-based history evaluation is also useful in limitation of
hospitalization rate needed for diagnosis of patients with syncope
Disclosure of Interest: None Declared
O218
Comparison of 4-year outcomes following percutaneous or surgical coronary artery
revascularization procedures in patients with diabetes
Michael Nguyen*1, Jamie Rankin2, Matthew Knuiman3, Lee Nedkoff3, Tom Briffa3,
Mark Newman4, Don Cutlip5,6, Elizabeth Geelhoed3, Michael Hobbs3, Frank Sanfilippo3
1
Cardiology, Fremantle Hospital, 2Cardiology, Royal Perth Hospital, 3School of Population
Health, University of Western Australia, 4Cardiothoracic Surgery, Sir Charles Gairdner Hospital,
Perth, Australia, 5Harvard Clinical Research Institute, 6Beth Israel Deaconess Medical Centre,
Harvard Medical School, Boston, United States
Introduction: Coronary artery revascularization procedures (CARP) are the cornerstone of
treatment for patients with coronary artery disease. However, patients with diabetes have a
greater risk of adverse outcomes following CARPs. Long-term outcomes for percutaneous
coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) require
further investigation in a real world cohort of diabetic patients.
Objectives: Comparison of 4-year outcomes in a population cohort of patients with dia-
betes who had PCI or CABG in 2000-2004.
Methods: Clinical data and linked hospital admissions and death data from the Western
Australian Data Linkage System were merged for all patients who had their first CARP with
PCI or CABG in 2000-2004. A history of diabetes was identified from the linked data using
a 10-year lookback period. Clinical data were collected from all hospitals in Western
GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals
Australia where all CARP procedures are performed. We calculated the unadjusted
(Kaplan-Meier) and adjusted (Cox regression) risks for 4-year death (all-cause), admission
ORAL ABSTRACTS
for myocardial infarction (MI), subsequent CARP and the composite outcome of death/MI
admission/subsequent CARP (MACE).
Results: There were 3427 patients with diabetes (72% males, mean age 64 years, age range
27-93) who were treated with CARP during 2000-2004 (62% PCI vs 38% CABG). The
unadjusted risk of death at 4 years for PCI vs CABG was 13.7% vs 13.6% (log-rank p¼0.94),
for MI was 10.3% vs 2.5% (p<0.0001), and for repeat revascularization was 23.0% vs 3.3%
(p<0.0001) respectively. MACE at 4 years was 36.8% vs 18.0% (p<0.0001), respectively.
After adjustment for age, gender, co-morbidities and other covariates, there was no difference
in 4-year mortality between the PCI and CABG cohorts (HR 0.92, 95% CI 0.72-1.19).
However, the PCI cohort still had higher adjusted risks of MI (HR 4.46, 95% CI 2.84-7.00)
and subsequent revascularization (HR 8.24, 95% CI 5.78-11.74). Overall, MACE was
significantly higher in the PCI cohort (HR 2.39, 95% CI 1.98-2.88).
Conclusion: Diabetic patients whose first CARP is PCI rather than CABG have equivalent
adjusted risk of mortality, but increased risk of MI and repeat revascularization at 4 years. Further
studies are needed to determine if this is due to residual confounding by selection factors.
Disclosure of Interest: None Declared
O219
Should Clopidogrel be Discontinued Prior to Coronary Artery Bypass Graft Surgery
for Patients with Acute Coronary Syndrome? – A Systematic Review and Meta-
analysis of Randomized and Non-randomized Trials
Praveen Indraratna*, Christopher Cao, Su Ang
Cardiothoracic Surgery, St George Hospital, Kogarah, Australia
Introduction: Patients presenting with acute coronary syndrome (ACS) are treated with
dual antiplatelet agents including aspirin and clopidogrel. However, those who require
CABG may have increased postoperative bleeding and bleeding-related adverse outcomes.
Objectives: The present meta-analysis aimed to examine the evidence on clopidogrel in the
treatment of patients presenting with ACS requiring CABG, with focus on the timing of
medication cessation prior to surgery.
Methods: A systematic review of 9 electronic databases was performed to identify all
relevant studies with comparable outcomes for patients treated with clopidogrel prior to
CABG. Endpoints included reoperation, major bleeding, mortality and composite end-
pointincluding mortality and recurrent myocardial infarction.
Results: Five relevant studies were identified. Patients treated with clopidogrel had a
significantly lower incidence of composite endpoints compared to those who were not
treated with clopidogrel. However, patients who underwent CABG less than 5 days after
the last dose of clopidogrel were found to have significantly higher incidences of reoper-
ation, major bleeding and combined adverse outcomes than those who had more than 5
days washout.
Conclusion: The present meta-analysis confirms that patients should be treated with dual
antiplatelet therapy including clopidogrel. However, for patients subsequently referred for
CABG, a minimum washout period of 5 days should be observed to minimize perioperative
bleeding and bleeding-related complications unless emergency indications exist. These
results differ from previous studies and guidelines.
Disclosure of Interest: None Declared
O220
Performance Of Euroscore I, Euroscore Ii And Society Of Thoracic Surgeon’S Risk
Models To Predict Adverse Outcomes After Isolated Coronary Artery Bypass Grafting
Tom Kai Ming Wang*1, Acrane Li1, Tharumenthiran Ramanathan1, Greg Gamble2,
Ralph Stewart1,2, Harvey White1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: EuroSCORE and the Society of Thoracic Surgeon’s (STS) risk models are the
most widely used models in the pre-operative risk assessment of cardiac surgery.
Objectives: We assessed how the performance of STS risk models compared to both
EuroSCORE I and its revised version EuroSCORE II for coronary artery bypass grafting
(CABG).
Methods: All patients undergoing isolated CABG during July 2010-June 2012 at Auckland
City Hospital had these scores retrospectively calculated. We compared the discrimination
and calibration of scores for surgical outcomes.
Results: Mean EuroSCORE I, EuroSCORE II and STS score (for operative mortality) of 818
patients were 4.5+/-5.0%, 2.6+/-3.1% and 3.6+/-3.7%. Corresponding c-statistics for oper-
ative mortality, which occurred in 1.6% (13), were 0.675 (95% confidence interval 0.531-
0.819), 0.642 (0.503-0.780) and 0.641 (0.507-0.775), while the Hosmer-Lemshow (H-L)
test for calibration p¼0.061, 0.150 and 0.243 respectively. Their c-statistics for mortality at
follow-up (2.9%) were 0.639 (0.525-0.752), 0.604 (0.483-0.752) and 0.666 (0.564-0.769),
and for composite morbidity or mortality (18.3%) were 0.642 (0.591-0.692), 0.632 (0.582-
0.682) and 0.584 (0.532-0.635). The best models for discriminating stroke and ven-
tilation>24 hours were EuroSCORE I (c¼0.736 and 0.712), mediastinitis and return to
theatre were EuroSCORE II (c¼0.720 and 0.626), and renal failure was STS Score (c¼0.707).
Calibrations were satisfactory for all STS complication models (H-L p¼0.181-0.803), but
discriminations of complications weren’t significantly better than other scores.
Conclusion: Risk model revision allows improvement of calibration more easily than
discrimination of contemporary surgical outcomes. STS risk models have limited additional
prognostic value to EuroSCOREs, except for estimating rates of post-operative complications.
Disclosure of Interest: None Declared
e61
 PM001
POSTER ABSTRACTS
Randomized Placebo Controlled Study To Assess Valsartan Efficacy In Preventing
Left Ventricle Remodeling In Patients With Dual Chamber Pacemaker - Rationale
of The Trial
Andrzej Tomasik*1, Wojciech Jachec1, Damian Kawecki1, Celina Wojciechowska1,
Grzegorz Kubiak2, Katarzyna Wozniak2, Beata Bialkowska1, Zbigniew Kalarus3,
Ewa Nowalany-Kozielska1
1
II Dept. of Cardiology in Zabrze, Medical University of Silesia, 2Cardiology Department,
Specialistic Hospital in Zabrze, 3Clinica Dept. of Cardiology, Chair of Cardiology, Congenital
Heart Diseases and Electrotherapy, Medical University of Silesia, Zabrze, Poland
Introduction: Dual chamber pacing is known to increase left ventricle end systolic volume, to
reduce left ventricle ejection fraction, eventually leading to heart failure. Experimental model
of pacing in dogs revealed significant stimulation of activity of matrix metalloproteinase 9
along with severe derangement of synchronous contractility of myocardium. Studies on
experimental ischemia/reperfusion injury have shown efficacy of valsartan to inhibit activity
of matrix metalloproteinase 9, to increase the activity of tissue inhibitor of matrix metal-
loproteinase 3 and preserve global contractility and left ventricle ejection fraction.
Objectives: To assess whether 12 month long administration of valsartan will prevent left
ventricle remodeling in patients with first implantation of dual chamber pacemaker.
Methods: In this trial we plan to enroll 100 patients divided in three equal arms: placebo,
valsartan 80mg/daily and valsartan 160mg/daily added to previously used drugs. PLacebo,
valsartan 80mg and valsartan 160mg tablets in a blinded packages are provided by Pol-
pharma Pharmaceutical Company. Patients with first implantation of dual chamber pace-
maker will be assigned to respective arms randomly. The primary endpoint will be
assessment of valsartan efficacy to prevent left ventricle remodeling during 12 months follow
up. The secondary endpoints are assessment of correlation between left ventricle diastolic
function and its remodeling during dual chamber pacing, assessment of correlation between
activity of matrix metalloproteinase, tissue inhibitor of matrix metalloproteinase, tumor
necrosis factor alpha, troponin and left ventricle remodeling, assessment of correlation be-
tween left ventricle remodeling and NTproBNP concentration, assessment of atrial
arrhythmia from pacemaker memory. Left ventricle function and remodeling is assessed
echocardiographically: left ventricle and diastolic and end systolic volumes using biplane
Simpson’s technique, mitral inflow velocities with pulsed wave doppler, E’ and S’ velocities
od septal and lateral parts of mitral annulus in tissue doppler. MMP9, TIMP3, TNFalpha are
measured in blood plasma using ELISA kits in Dept. of Biochemistry, Medical University of
Silesia, troponin and NTproBNP are measured in our hospital laboratory.
Results: Baseline characteristics of the enrolled patients and initial data will be presented at WCC.
Conclusion: Conclusions of this randomized study (RCT registry #NCT01805804) are to
be formulated.
Disclosure of Interest: None Declared
PM002
Is a specially designed pre-formed stylet easier to implant the RV pacemaker lead on
the RV septum than a hand formed stylet?
Benjamin J.-M. Pang*1, Irene H. Stevenson1, Harry G. Mond1
1
Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Introduction: It is hypothesized that right ventricular (RV) “septal” pacing is more phys-
iological and less likely to lead to pacing induced heart failure than RV apical pacing.
However positioning the RV lead on the septum can be technically challenging and typi-
cally requires a specially designed “swan neck-like” stylet with a large proximal curve
followed by a shorter posteriorly orientated curve.
Objectives: We sought to investigate the technical ease of using a specially designed pre-
formed stylet (model 4140, St. Jude Medical, St. Paul, MN, USA) versus a hand formed stylet.
Methods: Two experienced implanters, (HM) and (IS), rated the ease to (A) advance a hand
formed stylet past the tricuspid valve, and (B) attach the pacemaker lead onto the septum;
from 1 (very difficult) to 5 (very easy). Anterior RV free wall pacing was avoided by
ensuring a lead tip angle in the 40 degree left anterior oblique (LAO) view of less than 90
degrees. Lead tip angle was measured from a line in the long axis of the lead tip to a
horizontal line. QRS duration from the paced 12-lead ECG was also recorded.
Results: 60 patients were recruited: 36 in the hand-formed group and 24 in the pre-formed
stylet group. There was no statistical difference between the hand and pre-formed stylets
with ease of implantation (A and B) as well as paced QRS duration and lead tip angle on
fluoroscopy (see Table). One hand formed stylet was unable to place the lead on the septum
and was exchanged for a pre-formed stylet. In two cases, the pre-formed stylet was
exchanged for a hand formed stylet with a tighter proximal curve and more posteriorly
directed distal curve to allow positioning of the pacing lead in a smaller cavity right ventricle.
QRS duration Lead tip angle
Stylet A B (msec) (degrees)
Hand formed (n¼36) 4.36
0.68 4.25
1.08 151
20 37
22
Pre-formed (n¼24) 4.25
1.03 4
1.18 143
16 48
16
A ¼ ease of manoeuvring the pacing lead pass the tricuspid valve, B ¼ ease of placing the pacing lead
on the RV septum. In A and B, the technical ease was graded from 1 (very difficult) to 5 (very easy)
Conclusion: There was no significant difference in ease of using a pre-formed specially
designed or hand formed stylet for implanting RV septal pacemaker leads. In rare cases,
individual cardiac anatomy required changing the shape of the pre-formed stylet.
Disclosure of Interest: None Declared
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PM003
Assessment of developing heart failure after pacemaker implantation by means of
thoracic impedance and cytokines
Yoichi Ajiro*1,2, Haruki Sekiguchi3, Haruki Sekiguchi4, Kazunori Iwade1
1
Department of Cardiology, National Hospital Organization Yokohama Medical Center,
Yokohama-city, 2Department of Cardiology, Tokyo Women’s Medical University, 3Department of
Cardiology, Aoyama Hospital Tokyo Women`s Medical University, 4Department of Cardiology,
Aoyama Hospital Tokyo Women’s Medical University, Tokyo, Japan
Introduction: Even for the patients with normal or mildly depressed left ventricular
function, the brady-pacing therapy may elicit heart failure (HF).
Objectives: To assess the development of heart failure after brady-pacemaker implantation
by measuring thoracic impedance (Optivol, Medtoronic Co.) and cytokines.
Methods: This study consists of two parts: (1) The patients who were implanted the brady-
pacing devices with Optivol function in four facilities in Japan between May 2010 through
April 2011 were enrolled. Optivol fluid index, percent of ventricular pacing (%VP) and
BNP is measured at implantation and 3, 6, 9, 12 months after implantation. The HF-
hospitalization rate and BNP were analyzed according to %VP and ventricular pacing site.
(2) Among enrolled patients, 11 patients were assessed serum cytokine levels at around
three months and at 12 months after the implantation.
Results: (1) 39 patients were enrolled. In the patients with right ventricular (RV) septal
pacing and/or with %VP less than 40%, no statistically significance was found regarding
BNP and HF-hospitalization rate throughout the observation period. In contrast, in the RV-
apex-pacing patients with %VP more than 40%, both BNP and HF-hospitalization rate
were significantly higher. Among limited patient population with RV apex pacing and %VP
more than 40%, the sensitivity and the specificity of Optivol positivity (defined by fluid
index more than 100) for HF-hospitalization were 100% and 91.7%, respectively. (2)
Cytokines were assessed 11 patients among enrolled 39 patients. Interestingly, coenzyme
Q10, protective biomarker for oxidative stress, was significantly reduced at 1 year after the
implantation comparing with those at 3 months (599.3
58.3 vs. 735.3
37.3, p¼0.043).
MMP3 (85.4
9.7 vs. 69.5
9.0, p¼0.0051), the biomarker of extracellular matrix cycle
was elevated significantly, while TGF-beta1 (1.43
0.13 vs. 1.67
0.09, p¼0.059), the
biomarker of fibrosis was reduced at 1 year after implantation with significant tendency.
The other cytokines including TNF-alpha, soluble TNF receptor1, procollagen III, and
urine 8OHdG were not changed significantly.
Conclusion: It is demonstrated that the RV apex pacing with %VP more than 40% 40%
would be the risk factor of HF. In such patients group, Optival might be useful as screening
tool for the early detection of newly developing HF.It is also implied that the reduced
protective capacity against oxidative stress and silent remodeling might play an important
role for developing HF in those patients.
Disclosure of Interest: None Declared
PM007
Vernakalant versus Flecainide and Propafenone in acute atrial fibrillation
Nicolas Lalor*1, Diego Conde1, Milagros Caro1, Leandro Rodriguez1, Pablo Elissamburu1
1
Cardiology Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Introduction: Vernakalant is a new, safe and effective drug used intravenously. It has
proven to be more rapid in converting recent onset atrial fibrillation (AF) to sinus rhythm
compared to placebo, amiodarone, propafenone and flecainide in clinical studies with few
patients. At present no study has been conducted comparing these three drugs with a more
substantial number of patients.
Objectives: The objective of our study is to compare the time to conversion to sinus
rhythm, hospital stay and adverse events between vernakalant versus flecainide and
propafenone in patients with a recent-onset AF.
Methods: 150 hemodynamically stable patients with recent onset AF without structural heart
disease were prospectively included. A single oral dose of propafenone 600 mg was admin-
istered to 50 patients; 50 patients received intravenous vernakalant; and 50 patients received a
single oral dose of flecainide 300 mg. Clinical and laboratory variables were recorded.
Results: Baseline characteristics were similar in the three groups.Time to conversion to
sinus rhythm was 12 minutes in the vernakalant group versus 151 minutes in the prop-
afenone group and 162 minutes in flecainide group (p< 0.01)
The hospital stay was 243 minutes in the vernakalant group versus 422 minutes in the
propafenone group and 410 minutes in flecainide group (p<0.01)(Figure 2).
No adverse events were reported.
Conclusion: The time to conversion to sinus rhythm and hospital stay were statistically
shorter in vernakalant group compared to flecainide and to propafenone. There were no
adverse events in the three groups.
Disclosure of Interest: None Declared
PM009
Atrial fibrillation in Africa: Clinical Characteristics and Management Patterns in
Uganda
James Kayima*1, Lugero Charles1
1
Medicine, Makerere University College of Health Sciences, Kampala, Uganda
Introduction: Atrial fibrillation is the commonest cardiac arrhythmia which contributes
substantially to morbidity and mortality of the affected individuals. While studies in
multiethnic societies have stressed the variation in risk factors and of atrial fibrillation in
different racial groups, there is paucity of data on atrial fibrillation in Africa.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: To describe the pattern of atrial fibrillation of the cardiovascular wards of a
National referral hospital in Uganda and to document practice patterns regarding anti-
coagulation in this patient population.
Methods: Data was collected on subjects with diagnosed atrial fibrillation attending the
Cadiology service of a National Referral Hospital in Uganda. This data included the socio-
demographics of the subjects and their medical history (including prior diagnosis of atrial
fibrillation and use of anticoagulation). Physical examination of the subjects included
anthropometric measurements and cardiovascular exam. Echocardiography was done to
determine underlying cardiac disease. Data was was summarized into frequencies and
proportions. Chi square tests were used to determine significant association between
variables.
Results: Between March 2012 and April, 2013, 241 subjects with a diagnosis of atrial
fibrillation were enrolled. Of these, more than two-thirds (68.4%) were newly diagnosed.
Of the patients with a previous diagnosis of atrial fibrillation, only 17.5% were on anti-
coagulation despite their high-risk of stroke assessed by the CHADS2 score. Thirty one
subjects (18%) were diagnosed with incident stroke during admission. While most of the
patients were aware of the high risk of stroke engendered by atrial fibrillation, they did not
know about the potential benefits of anti-coagulation. Hypertension (42.2%), rheumatic
heart disease (32.4%), dilated cardiomyopathy (13.7) and ischemic heart disease (10.8%)
and diabetes (9.8%) were the principal cardiovascular diagnoses among these patients.
Conclusion: Atrial fibrillation is inadequately diagnosed in this setting. The suboptimal
utilization of anticoagulation may translate in high rates of complications. The pattern of
cardiovascular disease association with atrial fibrillation is similar to that in other African
countries and the challenges of management and the poor outcomes are comparable in
most African countries. Formulation of tailored treatment guidelines, physician education
and patient empowerment are necessary tenets in the improvement of outcomes of patients
with atrial fibrillation.
Disclosure of Interest: None Declared
PM012
Economic evaluation of the new anticoagulant drugs for the prevention of
thromboembolic events: a cost-minimization analysis
Milena Marcolino*1, Carísi A. Polanski2, Ana Carolina C. Bovendorp3, Naiara S. Marques3,
Lilian A. da Silva3, Cintia P. B. Turquia3, Antonio L. Ribeiro1,4
1
Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, 2Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto
Alegre, 3Hospital Municipal Odilon Behrens, 4Telehealth Network of Minas Gerais, Belo
Horizonte, Brazil
Introduction: Due to significant limitations related to treatment with vitamin K antago-
nists, alternative anticoagulants have been evaluated in recent years. Clinical trials have
shown that these agents have at least a similar impact on reducing thromboembolic events
compared to warfarin with comparable or improved safety profiles. There is little data
investigating actual clinical practice costs.
Objectives: To conduct an economic evaluation of the new oral anticoagulants (NOACs)
vs. warfarin from the Brazilian healthcare and societal perspectives, using real-patient data
from a public anticoagulation clinic.
Methods: A cost-minimization analysis was conducted to compare NOACs with warfarin.
A cohort of patients on oral anticoagulation attending the anticoagulation clinic of Hospital
Municipal Odilon Behrens, in Southest Brazil, was used to provide real clinical practice
costs. For this cohort, patients were enrolled from August to October 2011. Operational
and non-operational costs were computed. All costs were corrected to 2013 and converted
to US dollars.
Results: This study included 633 patients (median age 62 years, interquartile range 49-73
years, 59% women), and the mean follow-up time was 64
28 days. The average cost per
patient per month was $ 73.33. Operational costs account for 33% of the total cost, as
shown on Table 1. Both dabigatran and rivoraxaban are sold to the Brazilian Health
Department at an average price of $ 84.98 per month.
There is a price difference of $ 11.65 per patient per month. Considering the population
of 198.7 million, and an estimated prevalence of atrial fibrillation of 1%, around 2 million
patients need to use anticoagulants, so the difference becomes $ 280 million a year.
Table 1. Operational and non-operational costs related to patients taking warfarin in a
public anticoagulation clinic for 12 months (N¼633)
Operational costs
INR tests $ 39,410.70
Healthcare professionals $ 125,773.94
Warfarin $ 15,717.32
Non-operational costs
Work absenteism $ 197,004.88
Transportation $ 179,134.87
Total $ 557,041.70
Conclusion: This cost-minimizing analysis with real patient data observed that in the
Brazilian context, the price difference is still substantial. If there is a price reduction on the
NOACs, this strategy may become economically viable.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM013
POSTER ABSTRACTS
Empowering atrial fibrillation patients with a decision support tool
Parag Sharma*1, Jack Dowie2, Glenn Salkeld3, David Brieger4
1
Medicine, University of Sydney, Sydney, Australia, 2Public Health and Policy Department,
London School of Hygiene and Tropical Medicine, London, United Kingdom, 3Public Health,
University of Sydney, 4Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
Introduction: Individual patient values and preferences in the treatment they receive are
significant factors for physicians to consider when in search of the ideal management for
each patient. ANNALISA is a decision support tool where each patient’s individual values
may be applied to display an opinion as to the best treatment for that person.
Objectives: To create an ANNALISA to help patients with atrial fibrillation decide on their
preferred antithrombotic treatment strategy.
Methods: We produced an ANNALISA with the following attributes: preventing stroke,
avoiding bleeding, minimizing side effects, and minimizing inconvenience. Ratings for each
treatment’s attribute were derived from literature. As a baseline, untreated patients with
atrial fibrillation were presumed to have a 5% risk of stroke each year. For the anticoag-
ulants, the objective data for the first three attributes listed were taken from a network
meta-analysis comparing dabigatran, apixaban, and rivaroxaban to warfarin. For aspirin,
the values were obtained from the American College of Chest Physicians guideline on
Antithrombotic therapy for Atrial Fibrillation. The values for minimizing inconvenience
were elicited with a questionnaire using each individual drug’s attributes.
The questionnaire also asks the patients to ‘weight’ each attribute in order to incorporate
personal preference for that individual into the decision making process. Weighting a certain
attribute higher results in that attribute having a greater impact on the final score, and vice
versa. The final score for each drug is a combination of the subjective weightings and objective
ratings. The treatment with the greatest score is the ANNALISA as to the best therapy.
Results: Results from this study are still pending.
web 3C=FPO
Conclusion: The input of the patients’ values and preferences with the use of ANNALISA en-
gages patients in the therapeutic decision making process. This has the potential to improve long
term adherence. Pilot data on the implementation of this tool in clinical practice will be presented.
Disclosure of Interest: None Declared
PM014
Symptom rhythm correlation in implantable cardiac devices following atrial
fibrillation ablation
Paula Rae1, Matthew Swale2, Michael D. Flannery*1, David O’Donnell1
1
Cardiology, Austin Health, 2Heartcare Victoria, Melbourne, Australia
Introduction: The success of ablation procedures for atrial fibrillation (AF) is often defined
by patient symptoms. A number of groups have used prolonged non invasive monitoring
techniques and have demonstrated a poor correlation between documented episodes of AF
and symptoms.
Objectives: The aim of this analysis was to obtain symptom rhythm correlation following
AF ablation in patients with previous implanted cardiac rhythm devices.
Methods: A consecutive series of 1329 patients undergoing ablation for atrial fibrillation
are enrolled in a prospective database. Of these, 35 had implantable cardiac devices prior to
ablation: cardiac resynchronization devices in 15, dual chamber pacemakers in 15 and
implantable loop recorder in 5. In the 12 months following ablation, patients recorded
symptomatic episodes of AF. Device interrogation was performed to correlate patient
symptoms and device recorded episodes of atrial arrhythmia.
Results: 35 patients were enrolled in the analysis utilizing maximal EGM storage capacity.
13 patients had self recorded 144 episodes of symptomatic AF. 11 patients had 87 episodes
of documented AF on device interrogation. 2 patients had 3 documented episodes in the
absence of symptoms. 4 patients had 54 symptomatic episodes of AF with documented
sinus rhythm. Overall accuracy of symptoms correlating with AF was 65% with a positive
predictive value of 62% and a negative predictive value of 96%.
Conclusion: Symptom rhythm correlation following AF ablation in patients with
implantable cardiac devices is poor. In this series, patients without symptoms had a low
risk of documented AF.
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 Disclosure of Interest: P. Rae: None Declared, M. Swale Grant/research support from:
POSTER ABSTRACTS
Medtronic and St Jude Medical, Consultancy for: Medtronic and St Jude Medical, M.
Flannery Grant/research support from: Medtronic, D. O’Donnell Grant/research support
from: Medtronic and St Jude Medical, Consultancy for: Medtronic and St Jude Medical
PM015
AF symptom severity and physical health status: Personality and psychology are
more powerful predictors than cardiac function and cardiovascular co-morbidities
Tomos E. Walters*1,2, Megan Mearns1, Karen Halloran1, Eliza Teo1, AiVee Ng1,
Dominica Zentner1, Kate Wick3, Christina Bryant4, Jonathan Kalman1,2
1 Suresh Chandran6, Asif Ahmed7
Department of Cardiology, Royal Melbourne Hospital, 2Department of Medicine, University of
Melbourne, 3Centre for Women’s Mental Health, Royal Women’s Hospital, 4School of
Psychological Sciences, University of Melbourne, Melbourne, Australia
Introduction: The influence of psychological factors on the patient experience of AF has
been demonstrated to be in excess of the objective burden of AF. The balance between
psychological factors and cardiac function in governing AF symptom severity has not been
explored.
Objectives: We aimed to analyse the severity of AF symptoms and of health-related quality
of life in patients with preserved left ventricular (LV) systolic fucntionin the context of both
psychological factors and of variables of left atrial (LA) and LV function.
Methods: 84 participants with paroxysmal/persistent AF (n¼61) or longstanding/perma-
nent AF (n¼23) and preserved LV systolic function completed the AF Symptom Severity
Score (AFSS) and SF-36 Quality of Life questionnaires. Underlying personality type was
assessed with the Perceived Stress Scale (PSS), Type D Personality Scale (TDPS) and Trait
Anxiety Index (STAI-2). Anxiety and depression symptoms were assessed with the Beck
Depression Index (BDI), the Hospital Anxiety and Depression Scale (HADS) and the State
Anxiety Index (STAI-1). Baseline clinical factors were measured and a 2-D transthoracic
echocardiogram performed for assessment of LV diastolic function and LA strain variables.
Results: Younger age, paroxysmal AF, OSA and increased BMI predict more severe AF
symptoms. Diabetes predicts less severe symptoms. No variable of LV diastolic function or
LA strain is associated with AF symptom status. A personality tendency towards negative
affectivity and social inhibition (TDPS), towards a tendency to perceive stress (PSS) and
towards a chronic anxiety state (STAI-2) strongly predict more severe symptoms. The
presence of anxiety and depression symptoms also strongly predicted more severe symp-
toms. The most powerful independent predictor of more severe AF symptoms on multi-
variate analysis was the presence of symptoms of depression. A poorer overall physical
health status is predicted by hypertension, OSA, elevated BMI and enlarged LA area but not
by any variable of LV diastolic dysfunction or LA strain. Again negative affectivity and social
inhibition, higher perceived stress, higher levels of trait and state anxiety and more
depression symptoms strongly predict poorer overall physical health status.
Conclusion: In patients with AF and preserved LV systolic function underlying personality
type and the presence of anxiety or depression symptoms rather than LV diastolic
dysfunction or left atrial dysfunction predict more severe AF symptoms and poorer
physical health status.
Disclosure of Interest: None Declared
PM016
Mortality Following STEMI – Possible Need for Early Implantable Cardioverter
Defibrillator
Justin A. Cole*1, Justin Mariani1, Nick Andrianopoulos2, Anthony Dart1, Philippa Loane2,
Melanie Freeman2, Ernesto Oqueli2, Bryan P. Yan2, Stephen Duffy1
1
Cardiology, Alfred Health, 2Cardiology, Melbourne Interventional Group, Melbourne, Australia
Introduction: Implantable cardioverter defibrillator (ICD) insertion is recommended
following ST-elevation myocardial infarction (STEMI) in patients with severe left ventricular
(LV) dysfunction for the primary prevention of sudden cardiac death. However, most
guidelines advise a “waiting period” of between 40 days to 3 months. This time frame spares
patients invasive and costly medical therapy in whom LV function may improve with time.
Nevertheless, there may be early (<3 months) morbidity and mortality with this practice,
including the risk of sudden cardiac death. Commercially available wearable, reusable cardiac
defibrillators could act as a non-invasive bridge to therapy during this “waiting period”.
Objectives: To determine the mortality rate and the predictors of mortality following
STEMI in a contemporary cohort of patients undergoing percutaneous coronary inter-
vention (PCI).
Methods: The MIG registry prospectively collects demographic, clinical and procedural
characteristics of consecutive patients undergoing PCI, and their in-hospital, 30-day and
12-month outcomes. We analysed data from all patients presenting with STEMI (including
late presenters [i.e. >12 hours]), with a LV ejection fraction (LVEF) 45%, from 2005 to
2011. Characteristics were compared between patients who were alive or dead at 12
months, and predictors or 12-month mortality were determined by logistic regression.
Results: The cohort consisted of 1,669 patients with STEMI and an LVEF 45%. Twelve-
month all-cause mortality was 11.3% amongst the cohort. An in-hospital arrhythmia
(defined as ‘a new episode or acute recurrence of an atrial or ventricular arrhythmia
requiring treatment or a new episode of high-level atrioventricular block’) occurred in 367
patients (22%), and 31% of these patients were dead at 12 months (P<0.001). In-hospital
arrhythmia was a univariate predictor of 12-month mortality (OR 5.0; 95% CI: 3.1-8.1,
P<0.001).The strongest multivariate predictors of 12-month mortality were severe renal
impairment (6.2; 3.2-12.1, P<0.001), cardiogenic shock (5.6; 3.7-8.6, P<0.001), out-of-
hospital cardiac arrest (2.9; 1.7-4.9, P<0.001), arrhythmia post-PCI (2.4; 1.6-3.5,
P<0.001) and diabetes (2.2; 1.5-3.4, P<0.001).
e64
Conclusion: These data suggest that patients with STEMI and LVEF 45% who have high-
risk characteristics for 12-month mortality (including in-hospital arrhythmia) might benefit
from a wearable cardiac defibrillator as a bridge to decision regarding ICD insertion.
Disclosure of Interest: None Declared
PM017
ICD insertion is the only predictor of reduced mortality and improved survival
in patients with Ischaemic Cardiomyopathy: Real-life data from Manchester, UK,
2000-2013
Rahul Potluri*1, Amir Aziz2, Hardeep Uppal3, Raj Bhayani4, Deepthi Lavu5, Hardeep Uppal3,
1
ACALM Study Unit in collaboration with School of Medical Sciences, Aston University,
Birmingham, 2Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds,
3
Department of Psychiatry of Learning Disability, Brooklands Hospital, Birmingham, 4Pennine
Acute Hospitals NHS Foundation Trust, Manchester, 5Keele University, Stoke-On-Trent,
6
Training Programme Director in Acute Medicine, North Western Deanery, Manchester, 7Aston
University, Birmingham, United Kingdom
Introduction: Ischaemic cardiomyopathy (ICM) is associated with adverse mortality. A
high percentage of deaths from ICM are sudden, mostly due to ventricular arrhythmias.
Multiple randomised controlled trials have shown that insertion of implantable cardioverter
defibrillators (ICD) reduce mortality in these patients. However, the insertion of these
devices in the UK is still directed by national guidelines and cost. Real-life data showing the
mortality benefit of ICD insertions in patients with ICM in the UK is not well studied.
Objectives: We aimed to evaluate long term mortality and survival in patients with ICM
from a large sample from Manchester, UK.
Methods: Anonymous information on patients with ICM, co-morbidities and procedures
attending seven hospitals in Manchester, United Kingdom in the period 2000-2013 was
obtained from the local health authority computerised hospital activity analysis register
using ICD-10 and OPCS coding systems. Predictors of mortality were analysed by means of
logistic regression analysis and survival was determined by Kaplan-Meier curves
Results: Over the time period, there were 280 patients with ICM; mean age 67.1 years

12.0(S.D); Male (530, 77.1%), Female (64, 22.9%). Of these 115 patients died (41.1%). The
main co-morbidities were Heart Failure (182; 65.0%), Atrial Fibrillation (87; 31.1%), Hyper-
tension (133; 47.5%), Myocardial Infarction (38; 13.6%), Type 2 Diabetes Mellitus (92; 32.9%),
Chronic Kidney Disease (42; 15.0%). 32 patients (11.4%) had ventricular tachyarrhythmias and
50 patients (17.9%) had ICD inserted. A logistic regression model showed that only insertion of
ICD (RR 0.07; C.I 0.03-0.21) predicts mortality in these patients. ICD-insertion confers 15-fold
mortality benefit in these patients. No other factor significantly affected mortality. Figure 1 shows
the improved 5 year survival in ICM patients with ICD insertion.
web 3C=FPO
Conclusion: In a large real-life patient dataset covering a 13 year period, we have shown
that ICD insertion improves long-term survival and is the only predictor of improved
mortality in patients with ICM. We acknowledge the limitations of these data, such as lack
of patient specific information including ejection fraction, symptoms and functional status.
Nevertheless, clinicians should take note that the presence of an ICD in these patients with
ICM overwhelmingly confers real-life mortality benefits.
Disclosure of Interest: None Declared
PM018
Impact of Respiration Gating on Image Integration Guided Atrial Fibrillation
Ablation
Emin E. Ozcan*1,2, Gabor Szeplaki1, Tamas Tahin1, Istvan Osztheimer1, Szabolcs Szilagyi1,
Astrid Apor1, Pal Maurovich Horvath1, Hajnalka Vago1, Bela Merkely1, Laszlo Geller1
1
Cardiology, Semmelweis University, Heart Center, Budapest, Hungary, 2Cardiology, Sifa
University Hospital, Izmir, Turkey
Introduction: Radiofrequency (RF) catheter ablation guided by electroanatomic mapping
systems is an effective therapy for atrial fibrillation (AF). Unfortunately, respiration
movements may cause significant changes in left atrium (LA) and pulmonary vein (PV)
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 anatomy. In previous studies, respiratory compensated electroanatomical maps showed PM020

better correlation with pre-acquired computed tomography and magnetic resonance im-
ages. However, better correlation does not always mean better ablation results and impact
of respiratory gating on AF ablation hasn’t been studied yet.
Objectives: The aim of this study was to determine the impact of respiratory gating on
procedural outcome in patients undergoing catheter ablation of AF.
Methods: One-hundred-twenty-eight consecutive patients undergoing pulmonary vein
isolation were enrolled to study. All procedures were performed with Carto3 system and
image integration. Respiratory gating module (Accuresp algorithm, Carto3, Biosense
Webster) was enabled in 42 patients and disabled in 85 patients during procedures.
Results: A significant reduction in total procedure times [median 72, interquartile range
(IQR) 64-95 min vs median 84 (IQR) 71-104 min, p<0.05] and fluoroscopy times [median
13.6(IQR) 8.5-15.8 min vs median 15.7(IQR) 11.8-22.4 min, p<0.05] were observed in the
respiratory gated group. Although ablation times (duration between the first and last ablation)
were significantly shorter in respiratory gated group [median 38 (IQR) 34-54 min vs median
48 (IQR) 39-65 min, p<0.05], total RF application times (total value of automatically
calculated application durations) were not different between the two groups[median 1547
(IQR) 1169-2250 second vs median 1847 (IQR) 1350-2451 second, p¼0.094].Difference in
electroanatomical map reconstruction times were not significant between the two groups
[median 14 (IQR) 12-17 min vs median 13 (IQR) 10-17 min, p¼0.138].
web 3C=FPO
POSTER ABSTRACTS
Impedance as a surrogate marker for myocardial temperature- Gel tank observations
using a novel visualization catheter
Tony Barry1, William chik1, Abhishek Bhaskaran*1, Alistair McEwan2, Pramesh Kovoor1,
Aravinda Thiagalingam1
1
Cardiology, Westmead Hospital, Sydney, 2Engineering, University of Sydney, Sydney, Australia
Introduction: Visual ablation catheters are a giant leap forward in cardiac ablations as it is
expected to improve safety and efficacy. Temperature monitoring is not practical in the
design of visual ablation catheters as direct contact of metal electrode to the tissue obscures
field of vision. Hence the need for reliable surrogate markers for myocardial temperature.
Impedance drop have previously been demonstrated as a marker of lesion formation in
cardiac ablation.Our novel visualisation catheter(Iris, Voyager), delivers RF energy through
a saline hood which minimizes loss of energy to blood pool.
Objectives: To correlate impedance drop with temperature change in the gel tank during
RF ablation.
Methods: 2.7mm hood IRIS catheter was used. Impedance was measured at the start and
27s(when stabilized). 16 observations were made in the gel tank.
Results: Very high correlation is observed between the impedance drop and temperature rise.

web 3C=FPO
Conclusion: Respiratory gating provides faster AF ablation procedures with less radiation
exposure. On the other hand, total RF time applied to isolate PVs was not influenced by respi-
ratory gating. These results are attributable to realistic LA geometry construction and uninter-
rupted ablation applications in respiratory gated group. Beside these advantages, using automatic
respiratory gating module does not prolong mapping times. To the best of our knowledge this
study is the first to investigate the impact of respiration gating on atrial fibrillation ablation.
Disclosure of Interest: None Declared

PM019
Successful ablation of the arrhythmogenic substrate in the epicardial right ventricular
outflow tract in a patient with Brugada syndrome refusing implantable cardioverter
defibrillator therapy
Gábor Széplaki*1, Emin E. Özcan1, Béla Merkely1, László Gellér1
1
Heart and Vascular Center, Semmelweis University, Budapest, Hungary

Introduction: Epicardial ablation of the substrate at the right ventricular outflow tract
(RVOT) was shown to reduce the risk of ventricular fibrillation (VF) in Brugada syndrome

web 3C=FPO
patients living with an ICD.
Objectives: A 31-year old male patient with recurrent short lasting paroxysmal palpita-
tions, once leading to syncope was referred to our Electrophysiology Department for
evaluation. Twelve-lead resting ECG showed Type II Brugada pattern, but later Type I ECG
was also recorded. According to the results and history the patient (spontaneous Type I
ECG, unknown family history and presyncope) was diagnosed with Brugada syndrome and
classified as moderate risk for sudden cardiac death (SCD). Implantable cardioverter
defibrillator (ICD) therapy was offered to the patient, however he refused the implantation.
Methods: After obtaining permission from the local ethical committee we offered to Conclusion: The new catheter shows high correlation of impedance drop with lesion
perform the procedure to the patient, clearly explaining that there is currently no literature growth. The current nonvisual ablation catheters did not show this high correlation be-
data available on the outcome in patients who do not have an implanted ICD. The patient tween these parameters.
accepted the ablation therapy. This visualisation catheter design seems to be an effective one for energy delivery to the
Results: Endocardial and epicardial substrate mapping of the right ventricle was performed endocardium with minimal wastage. This is reflected by the strong correlation between
with a magnetic field based electroanatomical mapping system. Than epicardial ablation impedance fall and temperature rise in the gel tank. As temperature monitoring is
was performed by an irrigated tip catheter in the area of fragmented late potentials (max 35 impractical in visual catheters impedance monitoring seems an effective alternative.
W, total ablation time: 28 min). A slight change in the ST-T segments of V1-V3 leads could Disclosure of Interest: T. Barry Consultancy for: Voyage medical, W. chik: None
be immediately detected. No complications occurred during the procedure, the total Declared, A. Bhaskaran: None Declared, A. McEwan: None Declared, P. Kovoor: None
procedure time was 191 min, fluoroscopy: 22 min. At the 3 months follow-up Brugada Declared, A. Thiagalingam Consultancy for: Scientific advisory board member
pattern totally disappeared from the 12-lead resting ECG, the patient was completely
asymptomatic, and no arrhythmia was detected at the control 24-hours Holter monitoring. PM021
Conclusion: Brugada syndrome is associated with a high risk of SCD and the cornerstone of
therapy is currently implantation of an ICD. The novel approach to preventively ablate the Comparative Response To Cardiopulmonary Exercise Testing During Transient Left
substrate located in the anterior epicardial region of the RVOT showed promising results by Bundle Branch Block And Normal Intra-Ventricular Conduction In Female Athletes
reducing the number of VF episodes in patients with ICD therapy. However at present there
Alfio Stuto.*1, Armaro Biagio1, Gaetano Bottaro1, Egidia Cosentino1, Alessandro Ambu1,
is no data available, which indicates that prophylactic ablation is able to replace ICD therapy.
According to our best knowledge this is the first case-report that described substrate ablation Alessandro Armaro1, Luana Vitale1, Giovanni Canonico1, Adriana Lo Giudice1, Giuseppe Basile1
in a patient with Brugada syndrome without having an ICD, however further studies are
1
needed to assess the clinical value and future of this promising procedure. STAR FOR LIFE - Cardiac Prevention and Rehabilitation Centre - Siracusa, Studio di
Disclosure of Interest: None Declared Cardiologia Dr. Armaro Biagio sas - Siracusa, Siracusa, Italy

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e65

 Introduction: Up to now there are not studies on comparative response to cardiopul-
POSTER ABSTRACTS

monary exercise testing (CPET) during transient left bundle branch block (LBBB) and
normal intra-ventricular conduction (NIVC) in female athletes.
Objectives: The aim of this study is to fill the gap existing to date for comparative studies
on the response to CPET during transient LBBB and NIVC in female athletes.
Methods: From January 2004 to April 2013 two cases of transient LBBB were detected on
10107 (0.02%) consecutive female athletes referred for cardiac preventive screening to
competitive sports activity,. According to protocol both athletes, respectively a 25 years old
roller skater and a 27 years old water-polo player, performed a CPET, and were invited to come
back every six months for control. Have been made twenty-six CPET, respectively twelve during
LBBB and fourteen during NIVC. The rest and peak oxygen uptake (VO2), oxygen pulse (O2
pulse), heart rate (HR), blood pressure, and the peak work load (PWL) sustained, measured
during CPET performed in LBBB and NIVC were compared using the primer software.
Results: The CPET data collected during LBBB and normal conduction expressed as mean
plus/minus standard deviation (SD), and the P value were shown on the table. During the
follow up the LBBB spontaneously disappear after fifty-four months in both females.

Table 1. CPET results during LBBB vs NIVC

CPET measure LBBBvsNIVC atRest Pvalue LBBBvsNIVCatPeak ofexercise Pvalue
Heart Rate 73.9+/-8.6 vs 73.1+/-7.9 P¼0.820 176.7+/-4.02 vs 176.3+/-3.7 P¼0.798
SBP 128.1+/-2.3 vs 128.2 +/-2.3 P¼0.915 182.2+/-2.3 vs 221.7+/-2.3 P¼0.000
Conclusion: Aerobic exercise has benefic effects in Walker tumor-bearing rats partly
restoring the ventricular function (similar QT-c), but did not prevent the increased cardiac
DBP 83.18+/-2.3 vs 81.07 +/-1.9 P¼0.019 102.7+/-4.2 vs 91.4+/-3.3 P¼0.000
biomarkers related to thrombogenesis processes.
VO2 ml/Kg/min 8.3+/-1.9 vs 8.2+/-1.8 P¼0.863 50.3+/-9.06 vs 50.1+/-8.05 P¼0.954 Reference
O2 pulse ml/beat 6.01+/-1.3 vs 5.87+/-1.4 P¼0.802 13.06+/-2.3 vs 12.8+/-2.4 P¼0.790 1. SALOMÃO et al, Nutrition and Cancer, 2010, 62(8), 1095.
PWL 166.8+/-2.3 vs 167.1+/-2.3 P¼0.749 Disclosure of Interest: None Declared

Conclusion: This study is the first to compare the CPET response in female athletes with
transient LBBB during the transitory conduction disturbance and NIVC. The above results
support the notion that except the minor increase in peak SBP, the peak HR as well as the
overall functional capacity expressed as peak VO2 achieved and PWL sustained in NIVC
remain unchanged during LBBB.
Disclosure of Interest: None Declared
PM023
Aerobic Exercise Altered Electrocardiogram And Cardiac Biomarkers In Cachectic
Tumor-Bearing Rats
1 1 1 1
Aline Toneto , Luiz Alberto F. Ramos* , Emiliane Salomão , Miguel A. Areas ,
Maria Cristina C. Gomes-Marcondes1
1
Biology Structural and Physiology, STATE UNIVERSITY OF CAMPINAS - UNICAMP,
Campinas, Brazil
Introduction: Cancer-cachexia state promotes intense involuntary weight loss, wasting
skeletal muscle protein due to higher proteolysis and/or decreased protein synthesis.
Physical exercise can delay the onset of anorexia and cachexia, inhibiting tumor growth and
maintain the body sources associated to less fatigue and skeletal muscle mass, being an
alternative of co-adjuvant cancer treatment1.
Objectives: This work evaluated exercise effects on electrocardiogram (ECG) and cardiac
biomarkers in the cachectic rats bearing Walker-256 tumor (W) subjected to mild aerobic
exercise.
Methods: Adult rats were distributed into 4 groups: C–control rats; W- tumor-bearing;
EC–exercised rats (swimming for 9 weeks) and EW–exercised tumor-bearing rats (5 ani-
mals per group). The electrocardiogram was evaluated after anesthesia (ketamine 100mg/
Kg. plus xelazine 7mg/Kg intramuscular) during pre-agonic state assayed by LabChart
software. Cardiac biomarkers (MPO, TIMP, PAI-total) were evaluated in heart muscle
homogenate analysed by multiplex assay (Millipore-Luminex). Difference among groups
assayed using one-way ANOVA followed by Bonferronis test (P<0.05).
Results: ECG parameters: Heart rate decrease in W and WE groups. QT-c interval tended
toincreased only in W rats (P¼0.109); recovering in EW. T wave amplitude increased in
EW group.Cardiac biomarkers: MPO and TIMP increasedespecially in W group; PAI-total
increased in both tumor-bearing groups, especially in EW rats.
PM024
The Common Genotypes of Long Qt Syndrome And The Role Of Electrocardiogram
Prediction—The China Experience
Cuilan Li1, Yuanfeng Gao2, Wenling Liu*2, Li Zhang3, Dayi Hu2, and For Chinese
Channelopathy Register Investigators
1
Heart Center, 2Peking University People’s Hospital, Beijing, China, 3Lankenau Medical Center,
Lankenau Institute for Medical Research, Jefferson Medical College, Philadelphia, United States
Introduction: LQTS is an inherited cardiac disorder characterized by QT prolongation and
increased risks of sudden death. Mutations in 13 genes have been identified in hereditary
LQTS. However, only 60% to 70% of the individuals affected with LQTS could be detected
to have mutations in these genes. Approximately 90% of known mutations were on
LQTS1-3 causing genes.
Objectives: Since the vast majority of mutation carriers of LQT1-3 presented with geno-
type-specific ECG patterns, in this study we tested its utility in targeted genotyping in a
large cohort of Chinese patients with LQTS.
Methods: The ECG-pattern-guided genotyping was conducted in 74.3% (107/144) pro-
bands with LQTS enrolled in the Chinese Channelopathy Register Study. Probands with
atypical ECG patterns were excluded from this study (n¼37). The initial 12-lead ECG of
each patient was evaluated. Individuals were considered affected if they have a prolonged
QT interval (QTc > 450ms in male and > 470 ms in females). Patients were predicted as
possible LQT1, 2 or 3 based on the presence of ECG patterns typical to each genotype.
Based on the ECG predictions, mutational screening were performed using PCR and direct
DNA sequence analysis. DNA samples from 50 healthy Han Chinese served as controls.
Results: A total of 67 mutations, including 29 novel mutations, were identified. Of which 26
were KCNQ1, 39 KCNH2 and 2 SCN5A mutations, respectively. Among the 107 patients, the
ECG-diagnosis results showed that there were 38 LQT1, 65 LQT2 and 4 LQT3, while gene
screening results showed that 26, 48 and 2 patients could be diagnosed genetically as LQT1,
LQT2 and LQT3, respectively. The mutational positive rate was 71.0% (76/107) for all
patients. To be specific, the ECG predicted genotype matched the mutation results in 68.4%
(26/38), 73.8% (48/65) and 50.0% (2/4) for LQT1, LQT2 and LQT3, respectively.
Conclusion: This study shows that most mutations harbored by LQTS patients are on LQT1-
3 causing genes while LQT2 the most common in Chinese. ECG prediction-guided
genotyping is proven time and economically efficient, except for a low predictable rate of ECG-
diagnosis in LQT3. Our experience sheds lights in LQTS studies in developing countries.
Disclosure of Interest: None Declared

PM025
A Severe Type of Long QT Syndrome and Cardiovascular Anomaly in a Homozygous
Carrier of a Novel KCNH2 Mutation and Findings in Family Screening
Khalfan S. Al-Senaidi*1, Guoliang Wang2, Li Zhang3, Dominik A. Beer4,
Abdullah M. Al-Farqani5, Salim N. Al-Maskaryi5, Daniel J. Penny2, Peter R. Kowey3,
Yuxin Fan2
1
Cardiology, Sultan Qaboos Univ. Hospital, Muscat, Oman, 2Section of Cardiology, Department
of Pediatrics, John Welsh Cardiovascular Diagnostic Laboratory, Baylor College of Medicine,
Houston, 3Cardiology, Lankenau Medical Center, Lankenau Institute for Medical Research,
Jefferson Medical College, 4Philadelphia College of Osteopathic Medicine, Philadelphia, United
States, 5Cardiology, Royal Hospital, Muscat, Oman
Introduction: Patients with inherited long QT syndrome (LQTS), especially if carrying
homozygous mutations, are prone to torsade de pointes (TdP) and sudden death (SD).
Identifying individuals with LQTS is of particular importance for SD prevention.

e66 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Objectives: The aim of this study is to determine the genotype-phenotype characteristics of
a large LQTS family in the Sultanate of Oman.
Methods: The proband, with a history of fetal dysarrhythmias and hydrops fetalis,
developed her first cardiac event at age 3.5 years after 1 day of fever, vomiting, diarrhea,
and acetaminophen intake. TdP was revealed on ambulatory ECG. Echocardiogram (echo)
was performed on the proband. Family screening and ECG-pattern-guided genotyping
were also conducted.
Results: The ECG of the proband at age 5 showed sinus bradycardia/arrhythmia with
rate-dependent incomplete right bundle branch block (IRBBB), 2:1 AV block, markedly
prolonged QTc (608 ms) and inverted T waves in most of the 12 leads. Echo revealed
dilatation of the ascending aorta and pulmonary artery, as well as left ventricular hy-
pertrophy with hypertrabeculation. Her parents were first cousins. The mother showed T
wave patterns typical to LQT2, and the father had IRBBB. Genetic testing identified a
novel homozygous KCNH2 mutation c.3504delC (p.T1019Pfs38) in the proband. Her
parents and other 8 affected family members were heterozygous. Overall, the heterozy-
gous mutation carriers (n¼10) presented with a mild QT phenotype in comparison to 10
age-matched blood relatives who did not carry the mutation (QTc 464
35 ms vs.
403
33 ms, p < 0.001); they were all asymptomatic and 2/10 had a completely normal
QT interval.
Conclusion: ECG-pattern-guided genotyping has achieved a high efficiency in a cost
effective manner. A novel KCNH2 mutation c.3504delC (p.T1019Pfs38) is identified in a
large LQT2 family in Oman. Consanguineous marriages results in a homozygous mutation
carrier showing a severe LQTS phenotype. Genetic testing is proven very important
especially in identifying affected individuals with a concealed LQTS phenotype. Further
investigation is warranted to determine if there is a causative relationship between this
novel KCNH2 mutation and cardiovascular anomaly.
Disclosure of Interest: None Declared
PM026
Mitral Isthmus Linear Ablation Does Not Affect Mitral Valve Function
Chrishan J. Nalliah*1, Choon H. Koay1, Stuart Thomas1
1
Cardiology, Westmead Hospital, Sydney, Australia
Introduction: Mitral isthmus linear ablation (MIL) is utilized to prevent mitral annulus
dependent flutter in patients with atrial fibrillation (AF) undergoing pulmonary vein
isolation. However, the effect MIL on mitral valve (MV) function is not known.
Objectives: To characterize the effect of MIL ablation on MV function.
Methods: Two hundred and twelve consecutive highly symptomatic patients (females 37,
age 59
10) referred for AF ablation (paroxysmal 132, persistent 45, permanent 35) were
randomly assigned to have MIL (n¼113) versus no MIL (n¼99) ablation during pulmonary
vein isolation of AF. Transthoracic echocardiography was performed before ablation, 1 day
after ablation, 3 months and 6 months after ablation. All studies were carefully evaluated
for mitral regurgitation (MR) and graded for severity (mild, moderate or severe) utilizing
standard American Society of Echocardiography criteria. Serial echocardiogram results
were compared (among patients with (16 patients) and without (196 patients) significant
MR) to determine the impact of MIL ablation on MV function.
Results: Among patients with initially normal MV function, 3 (3%) patients with MIL and
4 (4%) patients without MIL developed significant MR following the procedure (P¼0.72).
Sixteen patients had significant MR pre-procedurally (13 MIL vs 3 no MIL). Following the
procedure, MR improved significantly in 9 (69%) patients with MIL and in 2 (66%)
without MIL (P¼1.0). MV function did not deteriorate significantly following MIL in pa-
tients with pre-existing MV regurgitation (0 (0%) MIL vs 1 (33%) no MIL; P¼0.19).
Conclusion: MV function is not affected by MIL ablation regardless of pre-existing MR.
This has important implications for selection of ablative strategies in patients with AF,
especially in patients with pre-existing MR.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM027
POSTER ABSTRACTS
Posterior Left Atrial Isolation In Impaired Diastolic Function Results In Better
Arrhythmia Free Survival
Chrishan J. Nalliah*1, Choon Koay1, Stuart Thomas1
1
Cardiology, Westmead Hospital, Sydney, Australia
Introduction: Patients with impaired diastolic function (IDF) who develop atrial fibrillation (AF)
develop more severe symptoms. They also have a greater recurrence of AF after catheter ablation.
Objectives: We attempted to characterize patients with diastolic dysfunction referred for
AF ablation and assess the effect of posterior isolation.
Methods: Two hundred and twenty consecutive consenting patients referred for catheter
ablation of AF (paroxysmal 132, persistent 46, permanent 37) were recruited (male 177,
mean age 59
10 years). Patients were randomized to either posterior isolation of the left
atrium (PLAI) or to a conventional isolation strategy. Transthoracic echocardiography
identified 50 (23%) patients with diastolic impairment and preserved LV systolic function
(ejection fraction>50%). Logistic regression analysis was utilized to identify predictors of
diastolic impairment. Cox regression analysis was used to determine predictors of of atrial
arrhythmia recurrence after ablation.
Results: Independent predictors of diastolic impairment using linear regression analysis were
age (HR 1.07 [95% CI 1.02-1.13], P¼0.005), BMI (1.12 [1.03-1.21], P¼0.007), LA volume
(1.15 [1.10-1.20], P<0.001) and permanent AF (2.64 [1.06-6.61], P¼0.038). Arrhythmia
recurrence was similar in patients with and without diastolic impairment. Patients with impaired
diastolic function having PLAI had better arrhythmia free survival than patients randomized to
conventional ablation (Log rank P¼0.028). The only independent predictor of recurrence uti-
lizing Cox regression analysis was ablation strategy (2.3 [1.15-4.74], P¼0.026). Importantly,
markers of severity/grade of diastolic dysfunction were not predictive of arrhythmic recurrence.
Conclusion: Posterior isolation of the LA resulted in superior arrhythmia free survival in
patients with isolated diastolic impairment. This implicates the posterior LA as an
arrhythmic culprit in patients with impaired diastolic function.
Disclosure of Interest: None Declared
PM028
Aging related changes of small conductance calcium activated potassium channel in
Human with chronic Atrial Fibrillation
Miaoling Li1, xianhong ou*2, Hua Wang2, Xiaohong Bin2, Luzhen Wang2, Tao Li2, yan yang2,
xiaorong zeng2
1
luzhou medical college, 2Institute of Cardiovascular Research, luzhou, China
Introduction: The incidence of atrial fibrillation in aged patients has been increasing.
Small-conductance Ca2+-activated K+ channels (SK2) are one of the new therapeutic targets
of patients with Atrial Fibrillation.
Objectives: The purpose of this study was to confirm whether the characterization of SK2
with aging provides a substrate for atrial structural and electrical remodeling in Atrial
fibrillation.
Methods: Right Atrial appendages were obtained from human Cardiac surgery,which
divided into four groups :young group (<40 years old) and aged(>50 years old) in Sinus
rhythm (SR); Adult (<40 years old) and aged (>50 years old) in Atrial Fibrillation (AF).
The ionic currents were recorded using whole-cell Conventional patch clamp techniques
(45 appendages from patients with SR and 27 appendages from patients with CAF). SK2
channel expressions were assayed by RT-PCR and western blot analysis (36 appendages
from patients with SR and 21 preparations from patients with CAF).
Results: Our results indicated that the SK2 channel current densities were significantly
increased in CAF(n¼24,[Ca2+]i¼500nmol/L,p<0.01) compare to SR (n¼49,
[Ca2+]i¼500nmol/L),which identified with SK2 channel blocker apamin (100nmol/L) . But
the RT-PCR and Western bloting result demonstrated that SK2 mRNA and protein
expression are significant decrease in CAF(n¼24, p<0.05) than in SR(n¼12).Further we
found the increased proportion of SK2 channel current densities in AF (n¼8,
[Ca2+]i¼1000nmol/L, p<0.05) were larger than in SR (n¼10,[Ca2+]i¼1000nmol/L). it
maybe manifested that SK2 is more sensitive to higher intracellular Ca2+ in CAF than in SR.
In SR groups there were no changed about the channel activation, mRNA level and protein
level of SK2 with aging.In AF group, the SK channel activation increased concomitant the
decreased (p<0.05) of mRNA and protein level.The activation of SK2 channel was
increased significant with higher intracellular Ca2+ in CAF with aging.
Conclusion:
1. Our result show that the activation of SK2 channel in CAF were significantly in-
crease than in Compared with SR.The protein level of SK2 were down-regulation in
Patients atrial with CAF. Calcium sensitivity augmentation of SK2 maybe lead to
increase SK2 channels activity in CAF .
2. SK2 channels current density were not changed with aged in SR group. Higher
intracellular Calcium level lead to increase SK2 channels activity in aged with CAF.
Disclosure of Interest: None Declared
PM030
Ventricular repolarisation and non-invasive heart rate measures during exercise and
recovery in diabetes
Anna Mullins1, Simon van Rosendal2, Jemima Young3, Tony Forshaw*3, Julian Sacre4,
Jeff Coombes2
1
School of Medicine, 2School of Human Movement Studies, University of Queensland, 3Hearts 1st,
Brisbane, 4Baker IDI Heart and Diabetes Institute, Melbourne, Australia
e67
 Introduction: The chronotropic response to exercise and the heart rate recovery (HRR) Introduction: Cardiac Resynchronization Therapy (CRT) with a quadripolar left ventric-
POSTER ABSTRACTS

following exercise are non-invasive measures of autonomic function, which are easily
measured during maximal exercise stress testing. Both measures are independent predictors of
sudden cardiac death. Abnormal ventricular repolarization, evidenced clinically by corrected
QT interval (QTc) prolongation, may represent the mechanism leading to fatal sequelae.
Objectives: The current study aimed to delineate relationships between the resting and
post-exercise QTc with the HRR and chronotropic response during treadmill exercise stress
testing. The study compared these associations in patients with and without diabetes.
Methods: Data of 95 patients (34 with diabetes; mean age 61 years) referred for exercise
stress testing were analysed retrospectively for QTc interval, chronotropic response and
HRR. The QT interval was measured at rest and 30, 120, 210 and 300 s post-exercise, and
was rate corrected using the Bazett, Fridericia, Framingham and Hodges formulae. No
patients had evidence of cardiac ischaemia.
Results: Significant inverse relationships were found between (1) resting Hodges QTc
interval and HRR; (2) post-exercise QTc intervals and HRR at 30, 120, 210 and 300 s; and
(3) resting and post-exercise QTc intervals and chronotropic index. Multivariate regression
analysis using the entire patient group identified an independent association between the
Bazett QTc interval 120 s and HRR 120 s (r¼-0.40, p<0.001). Diabetic patients showed
significantly lengthened QTc intervals at rest and post-exercise and both attenuated
chronotropic response and HRR compared to the control group. The strength of associa-
tions between the QTc, HRR and chronotropic response were similar in patients with and
without diabetes.
Conclusion: The findings suggest abnormal ventricular repolarisation may be a mecha-
nistic link by which blunting of the heart rate recovery and chronotropic response are
related to sudden cardiac death. The inclusion of these non-invasive autonomic measures
in routine exercise stress testing may provide additional risk stratification.
Disclosure of Interest: None Declared
ular (LV) lead offers more pacing vectors as compared to conventional bipolar LV leads.
Objectives: We studied the programmability of quadripolar pacing vectors compared to
bipolar and tripolar equivalents to determine any incremental benefits of additional elec-
trodes on the quadripolar LV lead.
Methods: Capture threshold and presence of phrenic stimulation (PS) for 10 pacing vectors
in a quadripolar LV lead (QuartetÔ, St. Jude Medical, Fig1A) were tested at pre-discharge in
330 CRT recipients enrolled in four published clinical trials. We defined programmable
pacing vectors (PPVs) as those without PS and with capture threshold 2.5V. Program-
mability was evaluated in three different sets of electrodes configurations utilizing Quartet: 1)
Quartet with all 4 pacing electrodes (D1, M2, M3, and P4); 2) Quartet with 3 pacing elec-
trodes simulating tripolar configurations by sequentially eliminating each of the four elec-
trodes; and 3) Quartet with 2 pacing electrodes simulating adjacent-bipolar configurations
(Fig1B). The number of PPVs for each patient was then determined in the presence of 2, 3,
and 4 pacing electrodes. The distance between the two furthest pacing electrodes among
each patient’s PPVs was calculated using Quartet’s inter-electrode spacings (Fig1A).
Results: Quartet provided the most PPVs (mean 5.6; median 6; IQR 3-8) as compared to the best
tripolar configuration D1-M2-P4 (mean 4.1; median 4; IQR 3-5) and the best bipolar configu-
ration D1-M2 (mean 2.2; median 3; IQR 2-3) (Fig 2). In the tripolar configuration, elimination of
the M3 electrode (D1-M2-P4) resulted in the greatest number of PPVs (mean 4.1; median 4; IQR
3-5) vs. D1-M2-M3 (mean 3.2; median 3; IQR 2-5), M2-M3-P4 (mean 3.4; median 3; IQR 1-5),
and D1-M3-P4 (mean 2.9; median 3; IQR 2-4). In the bipolar configuration, the most distal
electrodes (D1-M2) showed the greatest number of PPVs (mean 2.2; median 3; IQR 2-3) vs. M3-
M2 (mean 1.7; median 2; IQR 1-3) and M3-P4 (mean 1.4; median 1; IQR 0-2). The average
distance between the two furthest programmable pacing electrodes was 25.6
16.9mm for
Quartet and 22.0
18.0mm for the best tripolar configuration (D1-M2-P4) (p<0.05).

PM031

web 3C=FPO
Carotid intima media thickness is associated with reduced heart rate recovery time in
patients with low cardiovascular risk profile
Caglar E. Cagliyan*1, Ibrahim H. Kurt2, Gokhan Soker3, Serdar Turkmen4, Rabia E. Akıllı5,
Halil Aktas5, Onur S. Deveci5, Ali Deniz5, Mehmet Balli2, Mesut Demir5, Ayhan Usal5
1
Cardiology, Cukurova University Faculty of Medicine, 2Adana Numune Training and Research
Hospital, Adana, Turkey, 3Radiology, Adana Numune Training and Research Hospital, Adana,
4
Cardiology, Sanko University, Gaziantep, 5Cukurova University Faculty of Medicine, Adana,
Turkey

Introduction: Carotid intima media thickness (CIMT) is a well-known entity associated

with increased cardiovascular mortality and morbidity. On the other hand, most of the
studies investigating CIMT, point to its relationship with atherosclerosis and endothelial
dysfunction as a risk factor.
Heart rate recovery (HRR), the decrease in maximum heart rate immediately after ex-
ercise is a simple and accurate sign of autonomic status. Impairment in HRR is associated
with increased mortality.
Carotid bulbus is rich from baroreceptors modulating cardiac autonomic function via
parasympathetic activity. Increase in CIMT may be associated with decreased sensitivity of
the carotid bulbi.
Objectives: The aim of this study is to investigate the association between in CIMT and
HRR in patients with low atherosclerotic risk profile.
Methods: Patients younger than 55 years without any cardiovascular risk factors have been
included in our study. Treadmill exercise stress test was performed in all patients. Carotid

web 3C=FPO
intima thickness was measured at the bifurcation level by an expert radiologist. Patients with
a positive stress test and/or carotid plaque formation have been excluded from the study.
Results: A total of 80 patients were included in our study. The median value of CIMT was
0.80 mm and patients were grouped according to this value. Patients with normal CIMT
(42 patients, mean: 0.65
0.12 mm) was named as Group 1, whereas patients with
increased CIMT (38 patients, mean: 1.03
0.12 mm) was named as Group 2. Heart rate
recovery values were significantly impaired in Group 2 patients in the first (10.9
9.5 vs
16.8
10.9 beats; p¼0.011) and second minutes (36.6
13.7 vs 42.9
13.8 beats;
p¼0.044). In the logistic regression analysis, CIMT was significantly associated with
impaired first minute HRR (OR: 14.7 [7.3-275, 95% CI], p¼0.001). Conclusion: Quartet quadripolar LV lead provides more viable programmable pacing
Conclusion: Increase in CIMT seems to be associated with impaired HRR, a sign of vectors and wider spatial coverage than bipolar and tripolar equivalents, potentially facil-
decreased vagal activity, in patients with low atherosclerotic risk profile. Reduction in the itating increased CRT delivery by enabling optimal LV pacing.
sensitivity of carotid bulbus may be one of the underlying mechanisms. Further and well- Disclosure of Interest: D. O’Donnell Grant/research support from: Medtronic, Consul-
developed studies are required for more precise results. tancy for: St. Jude Medical, Speakers bureau: St. Jude Medical, Medtronic, B. Thibault:
Disclosure of Interest: None Declared None Declared, C. A. Rinaldi Grant/research support from: St. Jude Medical, Honorarium
from: St. Jude Medical, Speakers bureau: St. Jude Medical, C. Pappone: None Declared, K.-
J. Gutleben: None Declared, C. Leclercq: None Declared, H. Razavi Shareholder of: St. Jude
PM033 Medical, Employee from: St. Jude Medical, K. Ryu Shareholder of: St. Jude Medical,
Benefits of the Additional Electrodes in Quadripolar Left Ventricular Leads in Employee from: St. Jude Medical, A. Fischer Shareholder of: St. Jude Medical, Employee
Providing More Programmable Pacing Options for CRT Programming from: St. Jude Medical, G. Tomassoni: None Declared

David O’Donnell*1, Bernard Thibault2, C. Aldo Rinaldi3, Carlo Pappone4, PM034

Klaus-Jürgen Gutleben5, Christopher Leclercq6, Hedi Razavi7, Kyungmoo Ryu7, Avi Fischer7,
Gery Tomassoni8
1 cardiac resynchronization therapies?
Cardiology, Austin Health, Melbourne, Australia, 2Montreal Heart Institute, Montreal, Canada,
3
Cardiology, Guy’s and St Thomas’ Hospitals, London, United Kingdom, 4Arrhythmology, Maria
Cecilia Hospital, Cotignola, Italy, 5Herz- und Diabeteszentrum NRW, Bad Oeynhausen,
Germany, 6CHU Pontchaillou, Rennes, France, 7St. Jude Medical, Sylmar, 8Baptist Health,
Lexington, United States
Is there a threshold for increasing electromechanical delays in patients undergoing
Michael D. Flannery*1, Andrew Teh1, Hariharan Sugumar1, Tina Lin2, Matthew Swale3,
David O’Donnell1
1
Cardiology, Austin Health, Melbourne, Australia, 2St Georg, Hamburg, Germany, 3Heartcare
Victoria, Melbourne, Australia

e68 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Introduction: Multiple analyses have demonstrated that targeting left ventricular (LV) leads
to sites of increasing electromechanical delay can improve echocardiographic parameters
and clinical outcomes in patients undergoing cardiac resynchronization therapy. Most
studies have included a wide spectrum of electrical delay. Computer modelling of
resynchronization would argue that a threshold of electromechanical delay should exist and
beyond a certain level increasing delays will not improve and may even worsen resynch-
ronization parameters.
Objectives: We sought to quantify the effect of increasing electromechanical delays on
echocardiographic parameters of resynchronization in patients with multipolar leads
positioned only in areas of significant electrical delay.
Methods: Patients undergoing cardiac resynchronization therapy using multipolar leads
were evaluated between 2011 and 2012. A 12 lead ECG was performed and the longest QRS
duration recorded. %QLV was defined as the time from first surface ECG deflection to LV
electrogram peak during sinus rhythm as a % of total QRS duration. %QLV was measured to
each of the 4 LV electrodes. Significant electrical delay was defined as a %QLV > 85% which
represents the upper tertile or quartile of previously published analysis. Only patients with
four electrodes recording of %QLV > 85% were enrolled. Echo measures including dys-
synchrony index (DI), were recorded during pacing from each of the LV electrodes.
Results: Fifteen patients had %QLV > 85%. There was no correlation in the group as a
whole between measures of electrical delay and the optimal DI. Using interquartile analysis %
QLV 85 -90 gave optimal DI in 6 patients, %QLV 90-95 gave optimal DI in 5 patients, %QLV
95-100 gave optimal DI in 2 patients and %QLV > 100 gave optimal DI in 1 patient. In this
group of most delayed LV leads the optimal DI was seen with a mean %QLV of 91+-4%.
Conclusion: In the areas of most delayed electrical activation, increasing delays correlate
poorly with improved echocardiographic parameters of resynchronization. Targeting
extreme %QLVs beyond 85% may result in suboptimal resynchronization.
Disclosure of Interest: M. Flannery Grant/research support from: Medtronic, A. Teh:
None Declared, H. Sugumar: None Declared, T. Lin Grant/research support from: Med-
tronic, M. Swale Grant/research support from: Medtronic and St Jude Medical, Consultancy
for: Medtronic and St Jude Medical, D. O’Donnell Grant/research support from: Medtronic
and St Jude Medical, Consultancy for: Medtronic and St Jude Medical
PM035
Remodelling defined by multipolar lead activation sequence
Michael D. Flannery*1, Andrew Teh1, Hariharan Sugumar1, Matthew Swale2, Tina Lin3,
David O’Donnell1
1
Cardiology, Austin Health, 2Heartcare Victoria, Melbourne, Australia, 3St Georg, Hamburg,
Germany
Introduction: Structural remodelling following Cardiac Resynchronization Therapy (CRT)
is the hallmark of response. Electrical remodelling has also been shown to occur but the
mechanism of remodelling is uncertain.
Objectives: This study evaluated intracardiac electrograms (EGM) from multipolar leads to
assess the uniformity of electrical remodelling and its clinical correlation.
Methods: Thirty-five patients undergoing CRT using quadripolar LV leads were assessed at
implant, 24 hours, 3 months and 6 months. EGM recordings were measured from the 4 LV
electrodes during intrinsic rhythm and during RV pacing. In sinus rhythm the activation
sequence across all four electrodes from earliest to latest was recorded. Significant change in
activation sequence between implant and six months was defined as a change in the relative
activation sequence of greater than 10ms between two or more adjacent electrodes.
Response to CRT was defined as an improvement in ejection fraction of 5% and reduction
in left ventricular end diastolic diameter of 10%.
Results: Overall, 25 (68%) patients were responders to CRT. Eight 8 patients (22%) had a
change in activation sequence. Seven out of these 8 patients (88%) were responders
compared with 18 of 27 (67%) without a change in activation sequence. The mean
reduction in total EGM difference across the 4 electrodes was 21
11 ms in the patients
with a change in activation sequence compared with 12
7 ms in the patients without
(p<0.05). The mean improvement in EF was 14
10% in patients with a change in
activation compared with 8
7% (p<0.05) in those without. The mean improvement in
LVEDD was 13
7 mm in patients with an activation change compared with 10
7 mm
(p¼NS) in those without an activation change.
Conclusion: Change in ventricular activation sequence can be documented in a group of
patients following CRT. These patients are more likely to be responders and have greater
electrical and structural remodeling. The change in activation sequence is further evidence
of the non-uniformity of ventricular remodeling. Identifying patients who are more likely to
undergo electrical remodeling may have a role in patient selection.
Disclosure of Interest: M. Flannery Grant/research support from: Medtronic, A. Teh:
None Declared, H. Sugumar: None Declared, M. Swale Grant/research support from:
Medtronic and St Jude Medical, Consultancy for: Medtronic and St Jude Medical, T. Lin
Grant/research support from: Medtronic, D. O’Donnell Grant/research support from:
Medtronic and St Jude Medical, Consultancy for: Medtronic and St Jude Medical
PM036
RV paced LV activation sequence predicts non response to CRT
Michael D. Flannery*1, Andrew Teh1, Hariharan Sugumar1, Paula Rae1, Tina Lin2,
David O’Donnell1
1
Cardiology, Austin Health, Melbourne, Australia, 2St Georg, Hamburg, Germany
Introduction: Increasing evidence has questioned the role of right ventricular (RV) pacing
in response rates to cardiac resynchronisation therapy CRT.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: This study evaluated intracardiac electrograms (EGM) from multipolar leads to
POSTER ABSTRACTS
determine the different ventricular activation sequences in intrinsic rhythm and during
right ventricular pacing and its correlation to patient outcomes.
Methods: Thirty seven patients undergoing CRT using multipolar LV leads between 2011
to 2012 were assessed at implant and at 6 months. All patients had the RV lead implanted
in the mid septum and were programmed to receive BiVentricular pacing according to our
usual optimisation schedule. EGMs were measured from each of the 4 LV electrodes,
during intrinsic rhythm and during RV pacing. The activation sequence from earliest to
latest activated electrode in sinus rhythm and RV pacing was noted. Patients were divided
into two categories; those with identical intrinsic and RV paced activation (Unchanged
EGM) and those with a difference in RV paced EGM (Delta EGM)
Results: At implant, 11 (30%) patients were defined as delta EGM. The delta EGM patients
were more likely to be non-responders 45% vs 23%, p ¼NS) The mean improvement in EF
was 12
9% in the unchanged EGM compared with 6
4% in the delta EGM patients
(p<0.05). The mean improvement in LVEDD was 13
8 mm vs 6
5 mm (p<0.05).
Conclusion: A change in ventricular activation sequence between intrinsic and RV paced
rhythm can be documented in a group of patients undergoing CRT. These patients are
more likely to be non-responders and have less structural remodelling. This finding has
implications for device based minimisation of RV pacing.
Disclosure of Interest: M. Flannery Grant/research support from: Medtronic, A. Teh:
None Declared, H. Sugumar: None Declared, P. Rae: None Declared, T. Lin Grant/research
support from: Medtronic, D. O’Donnell Grant/research support from: Medtronic and St
Jude Medical, Consultancy for: Medtronic and St Jude Medical
PM037
Long-Term Survival In Patients With Congestive Heart Failure And Different Qrs
Duration Receiving Cardiac Resynchronisation Therapy In Real Clinical Practice
Vadim Kuznetsov*1, Tatiana Vinogradova1, Tatiana Enina1, Dmitriy Krinochkin1,
Elena Gorbatenko1
1
Tyumen Cardiology Center, Tyumen, Russian Federation
Introduction: According to assessment of several multicenter clinical trials better result
from cardiac resynchronisation therapy (CRT) was achieved in patients with congestive
heart failure (CHF) who had wide QRS complex (150 ms).
Objectives: To compare long-term survival in patients with CHF receiving CRT according
to the duration of QRS complex.
Methods: 130 patients with CRT devices (64% CRT-D) and NYHA class II-IV CHF, left
ventricular ejection fraction 35%, intraventricular and/or interventricular dyssynchrony
were included in the study. Patients were divided into two groups: I – 74 patients with QRS
<150 ms (mean age 53
8 years), II - 56 patients with QRS 150 ms (mean age 57
10 years).
Ischemic cardiomyopathy was found in 58% patients of I group, in 68% of II group (p¼0.3).
The survival rate was calculated by Kaplan-Meier method with the use of multivariate Cox
regression analysis. Mean follow-up was 30 months (interquartile range 14-45 months).
Results: The prevalence of males was higher in group I compared to group II (96% vs 77%,
p¼0.001) as well as the rate of atrial fibrillation (53% vs 27%, p¼0.003). The frequency of left
bundle branch block was 28% in I group vs 89% in II (p<0.001). Atrioventricular junction
ablation was more frequently performed in I group (43% vs 13%, p<0.001). Digoxin was
more frequently used by I group patients (58% vs 34%, p¼0.006). Significant difference in
survival between patients of I and II groups was not detected (66% vs 71%, p¼0.26).
Multivariate analysis showed that ablation of atrioventricular junction was an independent
predictor of survival, but not the duration of QRS complex (HR 1.013, CI 0.998-1.027).
Conclusion: In real clinical practice survival in patients with CHF and CRT did not depend
on the duration of QRS complex on resting ECG.
Disclosure of Interest: None Declared
PM038
A Systematic Program To Train Lay Public In CardioPulmonary Resuscitation In
India
Srinivas Ramaka*1,2
1
Cardiology, Srinivasa Heart Centre, 2Srinivasa Heart Foundation, Warangal, India
Introduction: Despite major advances in medical science, cardiac arrest particularly Out-
Of Hospital Cardiac Arrest remains an important public health problem. To improve the
survival rate from Out-Of Hospital Cardiac Arrest various organizations throughout the
world have been imparting training in Cardiopulmonary Resuscitation to lay public also.
With the awareness on CPR and cardiac arrest less than 1 % in India, there is a need to train
more Indians in CPR. Though a few organizations have been conducting such CPR
Training sessions in India, they have not targeted the entire population systematically.
Objectives: Understanding the need for a systematic training program in CPR, Srinivasa Heart
Foundation/Srinivasa Heart Centre initiated a systematic free CPR training program in Warangal
district,Andhra Pradesh,India in 2009 and extended the program after 2010 to the entire pop-
ulation.This project is aimed at improving the first three links in the Chain of Survival concept.
Methods: Group sessions involving High school students,teachers,staff of police,railways,bus
stations,banks,press, government and private offices, NCC cadets,university and college stu-
dents,members of NGOs were conducted.In 2012, the district administration of Warangal made
this CPR TRAINING PROGRAM official to all government employees, high school students and
college students in Warangal district, making it the first district in the country where such pro-
gram is started targeting the entire population.Each session is conducted as per AHA guidelines
involves a half an hour lecture/video in the local language on cardiac arrest,causes,Chain of
Survival concept,principles of CPR,Hands only CPR,practice on mannekins and use of an AED. A
followup protocol is being formulated to assess retention skills among all attendees.
e69
 Results: Until now, 3585 persons have been trained in 35 group sessions.To create more
POSTER ABSTRACTS
awareness, a mass event on CPR was held at Kakatiya Medical College,Warangal on 12/12/12
-6 am to 8 pm training 4000 persons making it the largest CPR Training program in India.
Conclusion: The project of training lay public in India in CPR which was initiated by
Srinivasa Heart Foundation in Warangal would be extended to all other states throughout
India.This is a systematic capacity building project in Lay Rescuer CPR training which
would Improve the survival rate from Out Of Hospital Cardiac Arrest.
Disclosure of Interest: None Declared
PM041
Tilt testing safety in the diagnosis of syncope
Juarez N. Barbisan*1, Vitor B. Pedrozo2, Patrícia S. Sant’Anna2, Isabella D. A. Dossin2,
Bruna H. Suzigan2
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, Porto Alegre, Brazil
Introduction: Tilt testing (TT) in the investigation of reflex syncope (RS) has been
considered safe in different samples. However, TT is not exempt of complications and more
studies are necessary to evaluate its safety.
Objectives: To evaluate the safety of the TT and its complications.
Methods: A cross-sectional study evaluating the TT exams performed in an Institution of
Cardiology between 2001 and June of 2012. All the patients referred to the exam took part
of this research. We looked for complications and symptoms, physical exam alterations and
ekg abnormalities that were unexpected for a TT. Protocols: Heart rate and blood pressure
were monitored in a real time by COLIN’ s PILOT monitory th. All the patients rested in
the supine position for 20min. Then, they were leaned to 70 for 46 min – passive phase.
After that, the patients were maintained at this position for another 20 min and received an
infusion of 1-3 mg/min of isoproterenol, to raise the heart rate for at least 25%, or a
sublingual spray of 400 mic of nitroglicerine- active phase, for another 20min. Positivity
was defined by the occurrence of syncope or presyncope accompanied by hypotension.
Data were analyzed using percentages, means, standard deviations and qui square or t test.
Results: 1677 exams from 1653 patients were reviewed. The majority of the patients were
women (60.3%). The mean age for women was 41.7 years (6 to 90 years) and 48.1 years (6
to 93 years) for men. Ten complications occurred: chest pain suggesting angina (5); sinusal
tachycardia (1); ventricular extrasystoles and ST segment depression accompanied by chest
pain (1); syncope with convulsion, accompanied by complete AV block with no ventricular
escape rhythm (1); second-degree heart block Mobitz type I (1); hypotension and brady-
cardia (1); and anxiety crisis (1). The mean age among the patients who had complications
were superior than among other patients (p¼ 0,05). There was a tendency on angina and
age superior to 50 years old to be associated (p¼ 0,09).
Conclusion: TT has been proven safe in the analyzed sample. Complication rate was only
0.6%, being angina the most frequent.
Disclosure of Interest: None Declared
PM045
Outcomes of Patients with Acute Decompensated Heart Failure Stratified by Left
Ventricular Ejection Fraction: an Australian tertiary centre experience
Ken J. Lu*1,2, Michelle Ord1, Leighton Kearney1, Gerard Smith3, Ruth Lim3, Elizabeth Jones1,
Louise M. Burrell2,4, Piyush M. Srivastava1,2
1
Cardiology, Austin Health, Heidelberg, 2Medicine, The University of Melbourne, Melbourne,
3
Radiology, 4Medicine, Austin Health, Heidelberg, Australia
Introduction: Heart failure (HF) can be classified based on left ventricular ejection fraction
(LVEF) into heart failure with reduced ejection fraction (HFREF: LVEF <40%) and heart
failure with preserved ejection fraction (HFPEF: LVEF >40%). There are limited Australian
data comparing the clinical, biomarker and non-invasive imaging profiles and health
outcomes in the 2 cohorts.
Objectives: To compare clinical characteristics, biochemical and non-invasive imaging
profiles (echocardiographic (TTE) and cardiac magnetic resonance imaging (CMR)) and
health outcomes in patients admitted with HF according to LVEF.
Methods: Patients admitted with HF were prospectively studied from 2011-2013. We collected
medical history, baseline investigations (including TTE and CMR) and health outcomes.
Results: 101 patients (56 HFREF, 45 HFPEF) were studied. Mean follow up was 412 (23-766)
days. Patients with HFPEF were older (67.5 vs 73 yrs, p<0.05), more likely female (65 vs 33%,
p<0.002) and had higher body mass index (35 vs 29 SI units, p<0.05). They were less likely to
have coronary artery disease or diabetes but more likely to have hypertension and atrial fibrillation
(p>0.05). HFPEF subjects had higher admission blood pressure but lower heart rate (p<0.05).
There was no difference in haemoglobin, glomerular filtration rate, creatinine kinase, highly sen-
sitive troponin, serum potassium and sodium. Admission NTproBNP (3333 vs 5693 pm/ml,
p<0.05) and uric acid (0.40 vs 0.47mmol/L, p<0.05) were lower in the HFPEF group. On TTE,
patients with HFPEF had higher LVEF (54 vs 26%), lower E/e’ (18 vs 22) and less impaired LV
global longitudinal strain on speckle tracking TTE (-14.5 vs -7.5%) (all, p<0.05). On CMR, there
was no difference in late gadolinium enhancement. On discharge, patients with HFPEF were less
likelyto beprescribed beta-blockers (72 vs 92%) and aldosterone inhibitors (25 vs 52%),and lower
diuretic doses were used ( all p<0.05). Use of renin angiotensin inhibition was similar. During
follow-up, cardiac readmission (HF, acute coronary syndrome, arrhythmia and pacemaker/defi-
brillator) and overall mortality was 47% and 12% respectively, and was similar in the 2 groups.
Conclusion: HF is associated with high morbidity and mortality. There are clinical,
biochemical and echocardiographic differences between HFREF and HFPEF. Further
research is required to explore these pathophysiological differences.
Disclosure of Interest: None Declared
e70
PM046
The early use of hemofiltration increases survival in patients with acute renal failure
in the setting of intensive cardiac care unit
Pranas Serpytis*1,2, Akvile Smigelskaite2, Robertas Katliorius2, Antanas Griskevicius2
1
Faculty of Medicine, Vilnius University, 2Clinic of Cardiac and Vascular Diseases, Vilnius
University Hospital Santariskiu Klinikos, Vilnius, Lithuania
Introduction: Hemofiltration is a renal replacement therapy, that is used mainly in the
setting of intensive care unit. Though it is not clear what is exact impact of hemofiltration in
patients with heart diseases and acute renal failure.
Objectives: 1. To investigate the impact of the start of hemofiltration on patient survival.2.
Identify the number of survivors and non-survivors. 3. Determine whether there is a sta-
tistically significant relation between the onset of hemofiltration and patient survival.
Methods: A retrospective analysis of 130 patients medical histories, from year 2007 to
2011, treated in Vilnius University Hospital Santariskiu Klinikos. Out of these, 85 patients
had cardiogenic or septic shock, accompanied by acute renal failure. Based on the onset of
hemofiltration, patients were divided into two groups: group 1 – 42(49,4%) patients, who
received hemofiltration during 12 hours after the diagnosed anuria; group 2 – 43 (50,6%)
patients, who received hemofiltration later than 12 hours. In both groups patients survival
rates were compared. The statistical analysis was performed using SPSS. The differences
were calculated using Chi-Square test.
Results: The average age was 72 years (SD ¼
9,264). In group 1 the number of survivors
was 12 (28,6%), non-survivors 30 (71,4%). In group 2, the number of survivors was 4
(9,3%) and non-survivors - 39 (90,7%). The calculation revealed statistically significant
relation between patients’ survival and the onset of hemofiltration ( p ¼ 0,028).
Conclusion: 1. Number of survived patients was higher in group, where hemofiltration
was started during 12 hours from the beginning of anuria comparing with the the group
where hemofiltration was started later. The earlier start haemofiltration increases the patient
survival with anuria and acute renal failure.
Disclosure of Interest: None Declared
PM049
Bioengineering Stents With Proactive Biocompatibility
Thamarasee Jeewandara*1, Steven G. Wise2, Alexey Kondyurin3, Anthony Weiss4,
Marcela M. Bilek3, Martin K. C. Ng5
1
Medical School, The University of Sydney, 2Translational/Bioengineering, The Heart Research
Institute, 3School of Physics, 4School of Molecular Bioscience, The University of Sydney, 5Central
Clinical School, Royal Prince Alfred Hospital, Sydney, Australia
Introduction: Commercially available stents are only sub optimally biocompatible. We
have utilized and optimized, a graded plasma activated polymer layer (GPAC) that can
activate/modify a 316 L stainless steel (316 L SS), enhance surface hydrophilicity, hae-
mocompatibility and covalently bind a protein, tropoelastin (TE) in its bioactive state.
Objectives: Conduct in vitro assays; contact angle goniometry, surface free energy for hydro-
philicity, blood assays for haemocompatibility, SDS-Eliza to test covalent attachment of TE on
GPAC vs. 316 L SS surfaces. An animal study with a rabbit iliac artery model conducted to assess
thrombogenicity and endothelialization of GPAC stents vs. Bare metal stents (BMS), in vivo.
Methods: Contact angles measured for GPAC surface and 3 liquids (deionized water, diiodo-
methane, formamide) using Kruss contact angle analyzer DS10. Surface energy calculated with
the Owens-Wendt-Rabel-Ström kinetic model. Platelet rich plasma (PRP) isolated (from centri-
fuged, 0.5 U/mL heparinized blood) incubated with GPAC vs. 316 L SS samples for 30 minutes.
Samples incubated with tropoelastin, washed with SDS-ELIZA (900C, 10 mins) for covalent
binding. Iliac artery stent implantation via femoral access in a rabbit model, stents explanted to
assess clot weight for thrombogenicity and in vivo interactions via histopathology.
Results: Water contact angle of GPAC was 57.86
0.478 post deposition and 79.4
1.6
after one week of exposure to air. In correlation surface energy was 52.02
0.05 mJ/m2
and 40.36
0.37 mJ/m2 within a week of exposure to air (figure 1 a,b respectively). The
presence of protein in platelet-rich plasma prevents platelets adhering to the surface of the
hydrophilic GPAC surface, fibrinogen fibrils and platelets adhere to the stainless steel
surface (figure 2 a, b, respectively, 300x magnification). Higher absorbance of tropoelastin
after SDS wash on GPAC vs 316L SS surfaces, observed. Stents explanted from the
thrombogenicity animal model randomized for clot weights and in vivo interactions
assessed with histology techniques.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

web 3C/FPO
Conclusion: Our novel coating technology is robust, haemocompatible and can covalently
bind a bioactive molecule to its surface. This has profound potential to improve stent ef-
ficacy in vivo.
Disclosure of Interest: None Declared
PM050
Apoptotic markers in diagnosing inflammatory dilated cardiomyopathy
Daiva Bironaite*1, Dainius Daunoravicius2, Julius Bogomolovas3, Arturas Jakubauskas4,
Dalius Vitkus5, Edvardas Zurauskas2, Ieva Zasytyte6, Kestutis Rucinskas6, Algirdas Venalis7,
Virginija Grabauskiene2,6
1
Department of Stem Cell Biology, State Research Institute, Center for Innovative Medicine,
2
Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, Faculty of
Medicine, Vilnius, Lithuania, 3Department of Integrative Pathophysiology, Universitätsmedizin
Mannheim, Mannheim, Germany, 4Center of Immunogenetics, Hematology, Oncology and
Transfusion Medicine, Vilnius University, 5Department of Physiology, Biochemistry and
Laboratory medicine, 6Clinic of Cardiovascular Diseases, Vilnius University, Faculty of Medicine,
7
State Research Institute, Center for Innovative Medicine, Vilnius, Lithuania
Introduction: Inflammatory dilated cardiomyopathy (iDCM) is a common debilitating
disease with poor prognosis that often requires heart transplantation. It often starts as a
myocarditis and is caused by a variety of toxic agents initiating inflammation. The chronic
exposure of myocardium to inflammatory insults might subsequently initiate apoptosis or
necrosis processes leading to a final destruction of heart tissue.
Objectives: This study aimed to test serum and biopsy samples from iDCM patients with
the purpose to investigate underlying molecular mechanisms and find reliable prognostic
biomarkers for the timely diagnosis of iDCM facilitating purposeful cardio therapy.
Methods: A total of 32 (25 males, 7 females; mean age 43.14
11.86 years) serum and
biopsy samples from patients with iDCM were investigated. Patients were separated in to
inflammatory- positive and -negative groups according to expression of inflammatory in-
filtrates (CD3, CD45Ro, and CD68). Inflammatory (TNF-a, IL-6, IL-1b) and apoptosis
(Caspases 3, 9, 8, Bax, Bcl2, Hsp60) were assayed by the ELISA method, whereas inflam-
matory infiltrates (CD3, CD45Ro, CD68) were assayed immunohistochemicaly. Statistical
significance of data was analyzed by the Student t test (significance was set at p < 0.05).
Results: Data show that inflammatory cytokine IL-6 in serum from patients diagnosed with
iDCM was significantly increased (from 3.3 to 10.98 mg/ml; p < 0.05). Another inflam-
matory cytokine, TNF-a, was also upregulated (from 7.9 – 14.03 mg/mg protein). In-
flammatory infiltrates, such as CD3, CD45Ro and CD68, were upregulated (2.38, 2.1 and
1.63 times; p < 0.05), respectively, in biopsy from iDCM-diagnosed patients. Apoptotic
serum markers, such as caspase 9, 8, and 3 were also significantly higher (6.1, 25.6, and
3.55 times; p < 0.05), respectively. Additionally, the increase of Hsp60 in serum was
statistically significant (0.419 – 0.36 ng/mg; p < 0.05) supporting the role of an apoptotic
myocardial death mechanism in iDCM.
Conclusion: Our data show that inflammatory processes induce apoptotic cardiomyocyte
death in iDCM. Circulating apoptotic and inflammatory markers, such as caspases 8, 9, 3,
Hsp60 and IL-6, respectively, might be a good prognostic tool and signal preventing
further heart tissue destruction. Clinically applied anti-inflammatory drugs, together with
inhibitors of apoptosis might improve the efficiency of iDCM therapy.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Disclosure of Interest: None Declared
POSTER ABSTRACTS
PM051
The role of collagen in virus-positive dilated cardiomyopathy
Daiva Bironaite1, Dainius Daunoravicius2, Julius Bogomolovas3, Arturas Jakubauskas4,
Dalius Vitkus5, Edvardas Zurauskas2, Ieva Zasytyte6, Kestutis Rucinskas6, Algirdas Venalis7,
Virginija Grabauskiene*2,6
1
Department of Stem Cell Biology, State Research Institute, Center for Innovative Medicine,
2
Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, Faculty of
Medicine, Vilnius, Lithuania, 3Department of Integrative Pathophysiology, Universitätsmedizin
Mannheim, Mannheim, Germany, 4Hematology, Oncology and Transfusion Medicine Center,
Vilnius University Hospital Santariskiu Klinikos, 5Department of Physiology, Biochemistry,
Microbiology and Laboratory medicine, 6Clinic of Cardiovascular Diseases, Vilnius University,
Faculty of Medicine, 7State Research Institute, Center for Innovative Medicine, Vilnius,
Lithuania
Introduction: Myocarditis may be induced by various bacteria or virus, autoimmune
diseases, vasculitis, and chemicals. The progress of acute viral myocarditis is mainly
related to the inflammatory response with subsequent deleterious effects, including
dilated cardiomyopathy (DCM) which often can be treated only by heart trans-
plantation. Therefore, it is clinically important to identify biomarkers that are pre-
dictive for viral heart pathology.
Objectives: The aim of this study was to investigate prognostic biomarkers of virus-
induced cardiomyopathy that might assist in prevention of heart lesion.
Methods: We investigated a total of 32 patients (25 males, 7 females; mean age
43.14
11.86 years), admitted consecutively, and without undergoing further selection, to
a tertiary referral centre for clinically suspected inflammatory DCM. Myocardial biopsies
and sera samples from virus-positive and -negative patients were analyzed by the ELISA
method for collagen synthesis/degradation (PICP, ICTP, TGF-b1, MMP9, and TIMP1),
adiponectin-expression, inflammation (IL6, IL1B, and TNFa) and apoptosis/necrosis
(caspases 3, 8, 9, APO1/Fas/CD95, Fas L, Bcl2, Bax, Hsp60 and hsTnT).
Results: Our data indicate that myocardial viral infection is related to dysfunction of
collagen synthesis and decrease of adiponectin-expression in serum samples, but not to
induction of inflammation, apoptosis, necrosis or fibrosis. Actually, markers of the intrinsic
and extrinsic apoptotic pathways: Bax, caspase 8, 9, and APO1/Fas/CD95, FasL as well as
the myocardial necrotic marker hsTnT, and the inflammatory cytokine IL-6 showed a
significant (p < 0.05) decrease in virus-positive heart, suggesting induction of myocarditis
subsequent to collagen destruction. In parallel, significant decreases of the N-terminal
propeptide of collagen I (PICP) (control - 0.159, virus positive - 0.079 ng/mg protein; p <
0.05) and adiponectin (control - 28.34, virus positive - 15.01 mg/mg protein; p < 0.05) in
serum correlated with viral infection.
Conclusion: Our data suggest that significant decrease in the serum levels of PICP and
adiponectin from virus-infected patients is an informative and prognostic marker of
myocarditis and ensuing dilated cardiomyopathy. Drugs stimulating collagen synthesis
might be indicated for these patients together with antiviral therapy.
Disclosure of Interest: None Declared
PM052
The effect of high-intensity exercise and testosterone supplementation in men with
heart failure
Lourenço S. de Mara1, Alexandra A. Lineburge1, Anderson Z. Ulbrich1, Juliano A. Pacheco2,
Jamil M. Valente Filho1, Eduardo P. Ribeiro2, Sabrina W. Sties1, Ana I. Gonzáles1,
Tales de Carvalho*1
1
Cardiology and Exercise Medicine Center, Santa Catarina State University, 2Federal University
of Santa Catarina, Florianópolis, Brazil
Introduction: Heart failure involves endothelial and sexual disorders being considered
predictors of poor prognosis. Recently, high-intensity training (HIT) has been considered
more effective to improve cardiovascular and respiratory functions.
Objectives: To evaluate the effects of HIT and testosterone supplementation therapy in
erectile and cardiorespiratory function.
Methods: Nineteen heart failure patients (age¼58
10 years; ejection fraction¼34
8%)
were randomised to either a high-intensity exercise group (control; n¼9) or a high-
intensity exercise group with hormonal supplementation (intervention; n¼10). All of the
patients exercised (40 minutes at 90% maximal oxygen consumption) for 12 weeks, three
times weekly, and the intervention group received testosterone in the first and sixth weeks.
Before and after the study period, cardiopulmonary test measurements, erectile and
endothelial function were obtained.
Results: Within each group, there was an increase in the maximum oxygen uptake
(12% control and 15% intervention; p<0.05, both groups), and in the OUES (22%
control and 14% intervention; p<0.05, both groups), a decrease in the VE/VCO2 slope
(5%; p<0.05, intervention group). There was an increase in erectile function scores
(110.7%; control and 98.8% intervention; p <0.05, both groups) and in the per-
centage of flow-mediated dilation (56.3% control and 92,3% intervention; not signif-
icant in both groups).
Conclusion: Testosterone treatment, in addition to HIT, does not have an added beneficial
effect compared with exercise alone on the improvement of cardiorespiratory and erectile
function.
Disclosure of Interest: None Declared
e71
 PM054
POSTER ABSTRACTS
Myocardial Mechanics in Hypertrophic Cardiomyopathy: Is There a Difference
between Subtypes?
Ada Lo*1, Mark Dooris2, Sandhir Prasad1, Julie McGaughran3, Arun Dahiya2, Arnold Ng4,
John Younger2, William Parsonage2, John J. Atherton2
1
Cardiology Department, Royal Brisbane and Women’s Hospital, 2Cardiology Department,
3
Genetic Health Queensland, Royal Brisbane and Women’s Hospital, 4Cardiology Department,
Princess Alexandra Hospital, Brisbane, Australia
Introduction: Myocardial Mechanics in Hypertrophic Cardiomyopathy: Is There a Dif-
ference between Subtypes?
Objectives: We compared global longitudinal strain (GLS) derived by 2-dimensional
speckle tracking echocardiography (STE) using the EchoPAC workstation (GE,
Horton, Norway) in HCM patients categorised according to the distribution of
hypertrophy.
Methods: We prospectively assessed GLS in 86 HCM patients attending a quaternary
cardiomyopathy clinic: 53 with asymmetrical septal hypertrophy (ASH), 21 with concentric
hypertrophy (cHCM) and 12 with apical hypertrophy (ApHCM). Overall group differences
were assessed with one-way ANOVA with the post-hoc Tukey test for three-way com-
parisons. To correct for the impact of afterload, the analysis was repeated for patients with
no evidence of dynamic left ventricular obstruction either at rest or post Valsalva
manoeuvre (n¼ 54).
Results: Mean age was 49
15 years; 68 % were males. Mean age was similar in ASH,
cHCM and ApHCM groups respectively (48
13 vs. 51
15 vs. 49
19 years). There was a
significant difference between the 3 groups in the GLS: ApHCM (-12.8
2.6%) vs. ASH
(-16.9
3.6%) vs. cHCM (-18.4
2.7%), one-way ANOVA P <0.001 (see figure). The
post-hoc Tukey test showed that the differences were due to significantly reduced GLS in
the ApHCM group compared to the ASH and cHCM groups, with no significant differences
between the latter 2 groups. Similar findings were noted when the patients with dynamic
obstruction were excluded.
web 3C=FPO
Conclusion: Patients with ApHCM appear to have disproportionately impaired myocardial
mechanics compared to patients with ASH and cHCM. These results offer further mech-
anistic insights into ApHCM and suggest that ApHCM may not be as benign as previously
thought.
Disclosure of Interest: None Declared
PM055
Twisting Myocardial Mechanics are Impaired in Apparently Unaffected Hypertrophic
Cardiomyopathy Mutation Carriers
Ada Lo*1, Arun Dahiya2, Louise McCormack3, Lauent Hunt4, Arnold Ng5, Julie McGaughran4,
Sandhir Prasad3, John J. Atherton3
1
Cardiology Department, Royal Brisbane and Women’s Hospital, 2Cardiology Department,
3
Cardiology, 4Genetics, RBWH, 5Cardiology, PAH, Brisbane, Australia
Introduction: Previous studies using speckle-tracking echocardiography (STE) have
demonstrated increased basal rotation and torsion in hypertrophic cardiomyopathy (HCM)
patients. The utility of these measurements to distinguish genotype positive/ phenotype
negative (G+P-) from genotype negative/ phenotype negative (G-P-) at-risk HCM relatives
has not been assessed.
Objectives: We compared STE-derived basal rotation and torsion in an unselected series of
at-risk HCM relatives with normal echocardiograms who had undergone predictive genetic
testing to determine whether they carried the family mutation.
Methods: STE was performed using GE EchoPac software on 13 G+P- and 15 G-P- HCM
relatives who were identified during family screening through a quaternary cardiomyop-
athy clinic. Unpaired t-test was used for statistical analysis.
Results: The median age and sex distribution of G+P- (28 yrs, 38% male) and G-P- (26 yrs,
33% male) individuals were similar. Conventional echocardiographic measures were
similar in both groups (see table). Basal rotation (-5.5
3.0 vs. -2.2
4.1 , P¼0.028)
and torsion (-15.8
7.8 vs. -10.0
6.7 , P¼0.050) were increased in the G+P- group
compared to the G-P- group.
e72
Conclusion: We report increased basal rotation and a trend towards increased torsion in
apparently unaffected HCM mutation carriers compared with non-carriers. This finding
may be of clinical value in distinguishing carrier status in at-risk HCM relatives.
Disclosure of Interest: None Declared
PM056
A Specialised Clinic for Hypertrophic Cardiomyopathy Improves Patient
Management
Anna Beale*1, Alexander Olaussen2, Ivan Macciocca3, Andris Ellims1
1
HCM Clinic @ The Alfred, The Alfred Hospital, 2Medicine, Nursing and Health Sciences,
Monash University, 3Victorian Clinical Genetics Services, Murdoch Childrens research institute,
Melbourne, Australia
Introduction: Hypertrophic cardiomyopathy (HCM) is an inherited condition defined by
the presence of otherwise unexplained left ventricular hypertrophy (LVH). Patterns of LVH,
degrees of outflow tract obstruction, clinical symptoms, and prognoses vary markedly
between patients. Management may include: lifestyle modification; pharmacotherapy and
septal reduction therapy for symptom control; defibrillator implantation for prevention of
sudden cardiac death; and family screening. A specialised HCM clinic may improve the
management of patients with this complex condition.
Objectives: To characterise patients referred to our specialised HCM clinic, and to assess
our clinic’s impact on HCM management including optimisation of pharmacotherapy, co-
ordination of necessary diagnostic tests, referrals for septal reduction therapy and defi-
brillator insertion, and screening of at risk first-degree relatives.
Methods: Clinical information was obtained at initial assessment from all patients referred
to the HCM Clinic @ The Alfred during its first 12 months of operation. Additionally,
details of management plans instituted by the clinic were recorded.
Results: 61 patients (age 57
14 years, 61% male) with HCM attended the clinic during
the study period. The initial diagnosis of HCM had most commonly been made during the
investigation of HCM-related symptoms (45%). 64% of patients experienced current
symptoms attributable to HCM, most commonly dyspnoea (51%). 54% and 38% of pa-
tients were receiving b-blocker and/or calcium channel blocker therapy, respectively. Of
302 identified living first-degree relatives, only 80 (26%) had previously been screened for
HCM. Following clinic assessment, pharmacotherapy was adjusted in 45% (commenced in
15%; increased in 25%; reduced in 5%). New referrals for stress echocardiography (28% of
patients), cardiac MRI (30%) and 24-hour Holter monitor (54%) were made. 8 patients
were referred for septal myectomy, and 1 patient for defibrillator implantation. 222 family
relatives were recommended to be screened for HCM.
Conclusion: A specialised HCM clinic improves the management of patients by optimising
pharmacotherapy, organising necessary investigations, streamlining referrals for septal
reduction therapy, defibrillator implantation, and facilitating family screening.
Disclosure of Interest: None Declared
PM057
Clinical evaluation of DCM patients, an observational study from Nepal
Samir Gautam*1, Mani P. Gautam1
1
Cardiology, College of Medical sciences, Bharatpur, Nepal
Introduction: DCM arises from variety of conditions resulting in dilatation of ventricles
and reduced systolic function. In underdeveloped countries and resource poor setting
many cases of DCM are being treated as diagnosis of COPD with background presentation
of dyspnoea.
Objectives: To evaluate the clinical presentation, etiology and complications associated
with dilated cardiomyopathy
Methods: It was a cross-sectional observational study conducted in the year 2011-2012 at
Bharatpur,Nepal.
Results: 126 cases were evaluated, 67% were males and 33% females.Commonest
symptom at presentation was dyspnoea 92%, others included chest pain (33%) and
edema(17%). Evaluation showed that 25% were hypertensive and 85 diabetic. 58% were
smokers and 42% alcoholic. 26% were at NYHA class II, 48% at class III and 26% at class
IV dyspnoea.ECG abnormalities revealed 71% LAD, 42% LVH, 25% LBBB, 21% AF, 8%
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
RBBB.Echo revealed dilated LA in 83%, Severe MR 42%, TR 42%, AR 8%, LVDD 83%.
Prescribed medications included aspirin 88%, BB 80%, ACE-I 92%, Warfarin 8%, statin
42%, Diuretic 92%, Aldosterone antagonist 92%, PPI 83%.
Conclusion: DCM was more common in males (2:1), commonest symptom dyspnoea,
associated disease HTN.Most cases had dyspnoea class III, ECG showed LAD as most
common abnormality and AF prevalent in 21.PPI was commonly prescribed.
Disclosure of Interest: None Declared
PM058
Mitral regurgitation caused by noncompaction cardiomyopathy: distinct clinical,
echocardiographic and pathological features of an under diagnosed entity
Sulafa Ali*1, Riyadh M. Abu-Sulaiman2, RIhab B. Agouba2
1
Pediatric Cardiology, Sudan Heart Istitute, Khartoum, Sudan, 2Pediatric Cardiology, King
Abdulaziz Cardiac Center, RIyadh, Saudi Arabia
Introduction: Ventricular noncompaction (VNC) is a primary genetic cardiomyopathy
with variable clinical manifestations. Mitral regurgitation (MR) has been reported to be
associated with VNC, however the clinical, echocardiographic and pathological features of
this association has not been well described.
Objectives: To describe the clinical, echocardiographic and pathological features of MR
associated with VNC.
Methods: The authors reviewed all the patients seen in the period from 2002-2013
with the diagnosis of VNC and MR in 2 cardiac centers (King Abdul-Aziz Cardiac
Centre-Riyadh- Kingdom of SaudiArabia and Sudan Heart Institute- Khartoum-Sudan).
Strict echocardiographic criteria were used. A literature search was performed (under
the title VNC-MR from 1990-2012) and all patients who fullfilled inclusion criteria
were enrolled.
Results: Twenty five cases were identified (70% were females). 14% had relapses and
remission of heart failure, in 2 patients ejection fraction improved after mitral valve surgery.
Echocardiographic features include preserved ejection fraction (88%), leaflet retraction and
malcoaptation (76%), a zigzag deformity of anterior leaflet (61%) and ruptured chordae
with flail MV leaflet (14%). Pathological features include myxomatous degeneration,
sclerotic and calcific changes. Papillary muscles were found to be friable and fibrosed and
chordal rupture had been documented.
Conclusion: VNC can lead to significant MR with identifiable clinical, echocardiographic
and pathological features.
Disclosure of Interest: None Declared
PM059
The impact of sleep disordered breathing (SDB) on the occurrence of heart failure in
the patients with hypertrophic cardiomyopathy of benign pathophysiology
Yoichi Ajiro*1,2, Haruki Sekiguchi3, Kazunori Iwade1
1
Department of Cardiology, National Hospital Organization Yokohama Medical Center,
Yokohama-city, 2Department of Cardiology, Tokyo Women’s Medical University, 3Department of
Cardiology, Aoyama Hospital Tokyo Women’s Medical University, Tokyo, Japan
Introduction: It is considered that non-obstructive hypertrophic cardiomyopathy (HCM)
and/or apical and mid-ventricular HCM has relatively benign pathophysiology. On the
other hand, it is suggested the possible interfere of sleep disordered breathing (SDB) on
resistant symptoms and/or disease progression in HCM.
Objectives: To assess the relationship between SBD and heart failure (HF) occurrence in
the patients with relatively benign HCMs.
Methods: (1) Among consecutive 50 HCM patients who were treated at Yokohama Medical
Center between May 2009 through Aptril 2012, 44 patients excluding obstructive left-
ventricular outflow tract HCM, end-staged HCM (defined with LVEF<50%), malignancy,
inflammatory diseases, or endocrine diseases were enrolled in this study. The biomarkers
including brain-natriuretic peptide (BNP), plasma rennin activity, aldosterone, adrenalin,
nor-adrenalin, dopamine, soluble tumor necrosis factor receptor 1 (sTNFR1), tumor ne-
crosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), transforming growth factor-beta1
(TGF-beta1), urine 8-hydroxydeoxyguanosine (8-OHdG) were measured at the period of
HF compensation. All patients were also assessed apnea hypopnea index (AHI), and were
divided into two groups with the AHI20 (n¼20) or AHI<20 (n¼24). The rate of HF
hospitalization history, clinical indices, and above mentioned biomarkers were compared
between two groups; (2) In the patients who were started continuous positive airway
pressure (CPAP) treatment, above-mentioned biomarkers were re-assessed after 1 year
CPAP treatment.
Results: (1) Among enrolled 44 HCM patients, SBD (defined as AHI more than 5.0) was
observed in 33 (75%) patients. No statistically significant difference was found between
two groups regarding age, gender, LVEF, maximum LV wall thickness. The HCM patients
with AHI20 had statistically significant high prevalence rate of HF-hospitalization history
(11/20(55%) vs 4/24(16.7%), p¼0.0067) and higher TGF-beta1value (2.29
0.37 vs.
1.57
0.08, p¼0.0479) comparing with those with AHI<20. The other biomarkers did not
show any significant difference between two groups. (2) After 1 year CPAP treatment,
significant decrease of TGF-beta1 was observed with the mean percent reduction of
18.7
8.2% (p¼0.014).
Conclusion: It is demonstrated the high prevalence of SBD in HCM, and is suggested the
relationship between SBD and HF occurrence in HCM. High TGF-beta1value implies the
possible involvement of activated fibrosis in HCM patients with SBD even though the
compensated period of HF.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM061
POSTER ABSTRACTS
Relationship between ventilatory efficiency and functional capacity evaluated by the
six minute walking test in heart failure patients
Raquel R. Britto*1, Roseane S. Rodrigues1, Giane A. Samora1, Dayane Montemezzo1,
Danielle G. Pereira1, Maria Clara N. Alencar2, Veronica F. Parreira1, Labcare UFMG, CNPq,
FAPEMIG and CAPES
1
Physiotherapy, 2Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte,
Brazil
Introduction: Stress tests are widely used to assess functional capacity, prognosis and
effectiveness of therapeutic interventions in heart failure (HF) patients. The cardiopul-
monary exercise testing (CPET) provides the maximal functional capacity and variables
related to the ventilatory efficiency, which has been considered to risk stratification and
prognostic. Although the six-minute walking test (6MWT) is a valid instrument to evaluate
the functional capacity, it is not clear if it is able to identify patients with ventilatory
efficiency.
Objectives: To evaluate the relationship between the distance walked on the 6MWT and
the ventilatory efficiency.
Methods: Twenty-six male patients diagnosed with systolic (n¼15) or diastolic (n¼7) HF
(51.30
12.1 years of age; New York Heart Association Class: 2.26
0.7, left ventricular
ejection¼32.07
9.0%) underwent a 6MWT and a symptom-limited CPET. Ventilation ⁄
carbon dioxide production - VE/VCO2 higher or equal to 34 was considered as ventilatory risk.
Results: The 6MWT distance correlated (p<0.05) with peak oxygen consumption - VO2
(r¼0.75) and oxygen uptake efficiency slope – OUES (r¼0.54). The magnitude of the VO2
correlation with OUES was higher (r¼0.88) and VO2 also correlated with VE/VCO2
(r¼-0.52). Comparison between patients with or without ventilatory risk showed differ-
ences (p<0.05) for the VO2 (18.82
6.10 vs 25.34
7.81mlO2kg-1min-1) and for the
distance walked on the 6MWT (548
83 vs 621
96m).
Conclusion: This study reinforces the ability of the CPET to better characterize the
functional capacity considering the ventilatory risk. However, the distance walked on the
6MWT can be used to identify patients with higher probability of ventilatory risk.
Support: CAPES, CNPq, FAPEMIG
Disclosure of Interest: None Declared
PM062
Atorvastatin add-on therapy lowers the risk of incident heart failure in epirubicinum
recipients for breast cancer
Adrian G. Tase*1, Anca Tase2, Ovidiu Tetiu3, Gheorghe Savoiu4, Marius Mihaila3, Mihai Man5,
Ion Iorga-Siman6
1
Cardiology, University of Pitesti, Emergency Hospital Pitesti, 2Medical Oncology, 3Cardiology,
Emergency Hospital Pitesti, 4Statistics, University of Pitesti, 5Anatomopathology, University of
Pitesti, Emergency Hospital Pitesti, 6Physics, University of Pitesti, Pitesti, Romania
Introduction: Even prolonged cancer-related survival in patients (pts) treated with anthracy-
clines is reported, the treatment related cardiotoxicity remains a major concern. Inside the
anthracycline class there are some experimental and clinical evidences supporting statins in
doxorubicin induced cardiotoxicity, but the data in the literature are still poor with epirubicinum.
Objectives: The purpose of this study was to assess the effect of continuous statin treat-
ment (CST) on new-onset heart failure (HF) in pts with breast cancer (BC) treated with
epirubicinum.
Methods: We analysed retrospectively starting with 01/01/2005, a number of 432 adult pts
newly diagnosed with biopsy confirmed BC who underwent anthracycline based chemo-
therapy with epirubicinum standard doses (60-89 mg/m2 b.s., < cumulative dose of 1000
mg/m2 b.s.). The study group had 144 pts and received CST for usual indications. Their
counterparts did not receive CST. The date of the BC confirmatory diagnosis was
considered the study enter date. Demographycally: mean age of pts was 51,2 +/-10,9 yrs.,
female gender predominance 99,31%. The primary outcome was incident HF hospital-
isation, and the follow-up period 5,37 +/- 2,65 yrs.
Results: After propensity matching (1:2) the 144 pts receiving CST were combined with
288 controls. New onset symptomatic HF was diagnosed in 33 pts, 4,86% within the study
group (28,6% IV NYHA class) and 9,03% in their counterparts (30,8% IV NYHA class).
New onset left ventricular systolic dysfunction was found in 135 pts, 41 within the CST
group (7,83% with LVEF < 40%) and 99 in comparator group (9,61% with LVEF < 40%).
The proportions in the 2 groups were 4,8611 and 9,0277, and the dispersion 0.046248,
and 0.082127, respectively. Due to poor representation of men we could not afford to look
for any statistical outcomes between genders.
Conclusion: In our study, atorvastatin co-medication was associated with lower risk for
incident HF in pts with BC treated with epirubicinum. This finding warrants for further pro-
spective investigation. Since the mechanism of anthracycline cardiotoxicity seems to be corre-
lated with oxygen free radicals, the pleiotropic effects of atorvastatin may mitigate cardiotoxicity.
Disclosure of Interest: None Declared
PM063
Hemodynamic Effect of Ivabradine Used To Reduce Sinus Tachycardia During Intra
Aortic Conterpusation In Patiente Whit Advanced Cardiac Failure
Rafael Porcile*1, Osvaldo Fridman2, Ricardo Levin1, Gabriel Perez Baztarrica1,
Botbol Alejandro1, Milanino Ana3
1
Cardiology and Physiology Dep, U.A.I Universitary Hospital, 2Cardiology, C.O.N.I.C.E.T.,
3
Programmatic, Ramos Mejia Hospital, Buenos Aires, Argentina
e73
 Introduction: In patients whit advanced cardiac failure under inotropes drugs therapy(IT)
POSTER ABSTRACTS
the use of negative chronotropic agents like beta blockers, digoxyn or calcium blockers is
very restricted
Tachycardia above 100 beats pm reduce diastolic time and efficiency of intra aortic
baloon conterpusation (IABP).
We present our experience with oral ivabradine used to improve the efficiency of IABP in
tachycardic acute heart failure patients.
Objectives: To evaluate with Swan Ganz catether (SG) the hemodynamic effect of ivab-
radine used to reduce sinus tachycardia during IT and IABP.
Methods: Between January 2011 and August 2013 were prospectively included patients in
sinus rhythm with more than 100 heart beat pm admitted in to the U.A.I. critical cardi-
ology unite with decompensated dilated ischemic cardiomyopathy.
All patients treated with at least 10gmas/Kg/min of one or more IT (unchanged during
measurement period).
No less than 2,2 liters/m2 SG measered cardiac index.
Optimized IABP setting remain unchanged durin measurement period.
Were excluded patients in schock of others causes, infections, renal failure, anemia,
requiring or mechanical ventilation support or whith acute digestive desease.
SG measurements were performed one hour before and three hours after a single oral
dosis of 15mg ivabradine.
Results: The study included 22patients (12men).
All whith miocardial infarction history.
Age average of 65.5 years.
Left ejection fraction average was 27.3%.
Dose of intravenous inotropic drug average was 17.2Kg/w/min.
Three hours after ivabradine heart rate decreased from 123+/-5 to 97+-5 (P0.0003)
Increase cardiac output of 4452+-550 ml minute at 4925+-535 ml/min(p0.031).
Increase in cardiac index without statistical significance of 2.21+/-0.3 to 2.37+/-0.3
liters/m (p0.08).
The average stroke volume increased significantly from 33.9 +-5 to 52.3 +-8 ml(p0.0007).
The left ventricule work index increased from 12.9 +-3 to 17.3 +-4 (p0.00003).
No differences were observed in the records of right atrial pressure, wedge, systemic
vascular and pulmonary resistance.
After five ivabradine half-lives suspension no ecg or clinical adverse effects were observed.
Conclusion: Ivabradine is useful to moderate sinus tachycardia an and improve efficiency
of IABP in advanced heart failure.
Ivabradine use did not interfere with IT showing an improvement in some cardiac
output parameters.
No changes were observed in preload and afterload parameters in this set of patients.
No electrocardiographic or clinical adverse effects were observed.
Disclosure of Interest: None Declared
PM064
The introduction of individualised milrinone doses as a cost containment strategy for
heart failure patients under a hospital-in-the-home service
Rochelle M. Gellatly*1,2, Cia Connell2, Peter Bergin3
1 was done at 14 weeks after SAC. To test the effect of LVH and diastolic dysfunction on LV
PSPDU, Monash University, Parkville, 2Pharmacy, 3Cardiology, The Alfred Hospital,
Melbourne, Australia
Introduction: Milrinone can be used as a continuous ambulatory intravenous infusion for
heart failure patients unable to wean from inotropic support as a bridge to heart transplant.
By administering milrinone at home, patients can be discharged from hospital without
disruption to drug therapy. Historically, the Hospital-In-The-Home (HITH) service pre-
pared and changed a standard milrinone 0.6 mg/mL in 100mL 5% dextrose bag during a
daily clinical assessment at home. After several patients were commenced on ambulatory
milrinone, significant drug wastage and expenditures were noted. A cost containment
strategy that facilitated ongoing, high level patient care was therefore required.
Objectives: To develop a safe and effective method to deliver home milrinone therapy
while minimising excess expenditures.
Methods: Patients were transitioned from the standard concentration and volume bag to a
standard concentration but individualised volume bag. This individualised volume was
calculated from the patient’s weight and prescribed dose over a 24 hour period. Using this
volume, the pharmacy department prepared milrinone daily. The prepared bag was
delivered to the patient during the daily HITH visit for use the following day. Patients were
taught how to independently change the milrinone bag on a GemstarÒ pump.
Results: Between October 2011 and January 2013, three patients have successfully utilised
the individualised milrinone dosing method. The introduction of this strategy reduced
overall costs of the medication by 48%, without compromising patient care. This translated
into cost savings of $39,464 over 343 patient days. No adverse events were recorded as a
result of the change.
Conclusion: An individualised milrinone dosing strategy can significantly reduce drug
expenditures while maintaining a high level of patient care in the home setting.
Disclosure of Interest: None Declared
PM065
Uptake of guidelines recommended therapy in heart failure – A report-card from the
western suburbs of Melbourne
Victoria Cheng*1, Kath Cowie1, Kean H. Soon1, Chiew Wong1
1
Department of Cardiology, Western Health, Footscray, Melbourne, Australia
Introduction: Dismal 5-year outcomes for heart failure led to trials confirming the benefits
of neurohumoral blockade with angiotensin converting enzyme inhibitors(ACEi),
e74
angiotensin receptor blockers (ARB), ß-blockade and aldosterone antagonists (AA).
Appropriate therapy not only improve outcomes but also lead to economic savings.
However, uptake of therapy appears to be lagging.
Objectives: We examined the uptake of appropriate therapy in heart failure related
admission.
Methods: Retrospective data on 156 patients with a discharge diagnosis of congestive
cardiac failure (CCF) in October 2012 was reviewed. 96 patients with symptoms and
physical examination or radiological findings of fluid overload were included. The cohort
was divided into two subgroups according to treating unit :(1) Cardiology and (2) Others.
Results: The mean age was 77.1
12.3 years. Majority had at least stage 2 chronic kidney
disease (96%) based on estimated glomerular filtration rate. Patients admitted under group
2 were older, had worse renal function and cognitive impairment. The overall uptake of ß-
blockers, ACEi, ARB and AA were 71.9%, 44.8%, 16.7% and 27.1% respectively. Subgroup
analysis showed ß-blocker use was 90% in group 1 versus 62.9% in group 2 (p < 0.007).
ACEi was used in 61.5% of group 1 and 54.5% of group 2 (p < 0.01). Only 42% of group
2 had documented transthoracic echocardiograms within 6 months of admission compared
to 80% of group 1 (p<0.001). In patients with reduced ejection fraction, prescription of
cardio-selective ß-blockade was 87.5% versus 66.7% in group 2 (p¼0.2).The proportion of
patients with moderate to severe systolic dysfunction receiving a combination of an
appropriate ß-blocker, ACEi and AA was low; 16.7% in group 1 and 40% in group 2
(p¼0.4). Inhospital deaths and 30-day readmission rates with heart failure showed a trend
favouring group 1 though not statistically significant (3.3% versus 9.1%, p¼0.3 and 13.3%
versus 9.1%, p¼0.8 respectively).
Conclusion: Implementing heart failure therapy according to guideline recommendations
in the real world can be challenging. Major limitations were concurrent comorbidities such
as renal impairment, cognitive impairment, falls risk and lack of resources. More needs to
be done to optimize a Physician-Cardiologist coordinated heart failure management pro-
gram which embraces cardiac imaging, a dedicated heart failure services and guideline
implementation.
Disclosure of Interest: None Declared
PM066
The Effect of Left Ventricular Hypertrophy and Associated Diastolic Dysfunction on
Left Ventricular Remodeling and Exercise Capacity in a Murine Model of Mitral
Regurgitation
Kyung-Hee Kim*1, In-Hyun Jung1, Dal-Su Lim1, Suk-Jin Lee1, Jin-Sik Park1
1
Division of cardiology, Sejong general hospital, Bucheon, Korea, Republic Of
Introduction: Degenerative mitral regurgitation (MR) is often accompanied by left ven-
tricular hypertrophy (LVH) and diastolic dysfunction.
Objectives: This study determined the contribution of LVH and associated diastolic
dysfunction on LV remodeling and exercise capacity in rats with significant MR.
Methods: LVH and diastolic dysfunction were created by suprarenal aortic constriction
(SAC) in SD rats. Serial echocardiographic studies and exercise were performed at 2-week
intervals and invasive hemodynamic examination by a pressure-volume catheter system
remodeling and exercise capacity, the rats were divided into 3 groups [SAC+MR ¼SAC
followed by MR operation, MR¼laparotomy followed by MR operation, Control]. MR was
created by introducing a needle through LV apex under the guidance of TEE and making a
hole on anterior mitral leaflet. MR was considered significant if a regurgitant jet area
occupied more than 45% of the left atrium. SAC was done at 2 weeks before MR formation
in SAC+MR group.
Results: During the LVH and diastolic dysfunction experiment, LV wall thickness
increased in LVH group compared to control group whereas LV ejection fraction (EF) and
E/E’ did not change. In hemodynamic analysis, LV end diastolic pressure and the EDPVR
slope were greater in LVH group than in control group. Next, when we compared LV
remodeling and exercise capacity between above 3 groups, LV dilatation and exercise
intolerance were developed first in SAC+MR group. However, MR group showed a catch-
up of remodeling and exercise intolerance at 10 weeks after MR formation (LV ESD at 10
weeks after MR formation, 4.33
0.26 vs. 6.50
0.40 vs. 6.59
1.38 mm for control vs. MR
vs. SAC+MR, P<0.05; LV EDD, 7.68
0.15 vs. 10.48
0.46 vs. 10.20
1.26 mm, P<0.05;
exercise duration, 765.3
130.1 vs. 487.8
49.0 vs. 434.0
80.3 seconds, P<0.05; no
statistical differences between SAC+MR and MR). In neurohormonal activity, the level of
BNP was not different between 3 groups. However interstitial fibrosis is greater in SAC+MR
compared with MR and control.
Conclusion: We successfully set up two small animal models of LVH accompanied with
diastolic dysfunction and significant MR. LVH and associated diastolic dysfunction did not
affect LV remodeling and exercise capacity over time in rats with significant MR.
Disclosure of Interest: None Declared
PM067
Therapeutic low-dose oral Triiodo-L-thyronine treatment markedly improves left
ventricular function and cardiac remodeling following myocardial infarction in rats
Viswanathan Rajagopalan*1, Alessandro Pingitore2, Youhua Zhang1, Yuefeng Chen1,
Christiana J. Pol1, Debra Saunders3, Krithika Balasubramanian3, Rheal Towner3, A. M. Gerdes1
1
Department of Biomedical Sciences, New York Institute of Technology (COM), Old Westbury,
United States, 2C.N.R. Clinical Physiology Institute, Pisa, Italy, 3Oklahoma Medical Research
Foundation, Oklahoma City, United States
Introduction: Recent rodent studies show that Cardiovascular diseases, including
Myocardial Infarction (MI), activate cardiac D3 deiodinase contributing to low tissue
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Triiodo-L-thyronine (T3) and Heart Failure (HF). We have previously shown that 3 days of
T3 treatment in rats following MI resulted in decreased myocyte apoptosis and increased
left ventricle (LV) contractility. In addition, a supraphysiologic dose of Thyroxine (T4)
improved long-term LV function and myocyte survival.
Objectives: We hypothesized that a therapeutic T3 treatment/monitoring regimen (e.g.
translatable to humans) will achieve similar cardioprotection in rats following MI-induced
HF.
Methods: Adult female Sprague–Dawley rats underwent MI by ligation of the LAD coro-
nary artery. T3 (4-5 mg/kg/day) in drinking water was started after MI and continued for 2
months (Mo). Vehicle (V) was used in MI controls (n¼16-20/group).
Results: Infarct size was similar in both MI groups. Preliminary findings confirmed an
increase in D3 Deiodinase mRNA expression by real-time PCR in MI+V (2.7-fold), which
was reversed in MI+T3 (0.49-fold). Compared to MI+V, MI+T3 markedly improved
Magnetic Resonance Imaging (MRI)-based ejection fraction (EF) by 51% at 1 week (Wk)
and 1 Mo, and 47% at 2 Mo post-MI (Table). Mean MRI wall thickness was increased at
both latter time-points. Histologically, non-infarct viable tissue area and wall thickness
increased significantly (30% and 18% respectively). Non-infarct length was also increased
(p¼0.05, not shown). Remarkably, following MI, the incidence of atrial tachyarrhythmias
that persisted following discontinuation of experimental atrial tachypacing was significantly
diminished by 63% following T3 treatment. In addition, the incidence of right ventricular
hypertrophy (RVH) in MI+V (25%) was dramatically decreased by 78% following T3
(5.5%). The T3 treament regimen did not affect heart rate. Correspondingly, the selected
dose led to slight but non-significant feedback inhibition of T4 and Thyroid-Stimulating
Hormone (TSH).
Conclusion: Results demonstrate a safe and effective post-MI/HF T3 treatment strategy
that dramatically improves LV function, RVH, atrial arrhythmogenesis, non-infarct tissue
remodeling, and hence myocyte survival (likely via an anti-apoptotic mechanism) with no
adverse effects. For the first time, this study describes an effective treatment/monitoring
protocol for T3 treatment of MI that is easily translatable to humans.
Disclosure of Interest: None Declared
PM068
A Self-Management Program For Older People With Heart Failure: A Randomized
Trial
Junghua Shao*1, Su-Hui Chen2, Li-Yu Chien2
1
School of Nursing, College of Medicine, Chang Gung University, 2Department of Nursing, Chang
Gung University of Science and Technology, Taoyuan, Taiwan, Province of China
Introduction: Heart failure (HF) is a chronic, disabling disorder which is mainly found in
older people is one of the leading causes of hospitalisation and readmission around the
world. Unfortunately, the mortality and morbidity rates for HF remain high. Self-man-
agement is an approach to care of those with chronic illness and therefore has potential to
decrease heart failure patients’ hospitalization, and also to enhance these patients’ quality of
life, self-care, and self-efficacy.
Objectives: The study aims to develop and determine the effects of a self-management
(SM) program in patients with Heart failure (HF) in Taiwan.
Methods: A randomized controlled trial with data collection at baseline and after
months 3, 6 and 12 were applied to the effects among heart failure patients. Total 120
HF outpatients in the medical center were randomly assigned to two groups. The SM
intervention is developed based on Bundura’s self-efficacy model, which provides four
sources of information for SM. The strategies of the SM consist of appraisal, goal
setting and self-monitoring of diet control, symptoms and daily weight. The “diet
control” strategy in this study is focused on sodium and fluid restriction. In order to
examine the effects of SM intervention, data were following seven health-related
outcomes: self-efficacy for salt and fluid control, HF SM behavior, HF-related symp-
toms, depressive symptoms, daily weight monitoring, and HF-related health services
utilization.
Results: There were differences for older Taiwanese HF patients’ self-efficacy for salt and
fluid control, HF SM behaviour, HF-related symptoms, depressive symptoms, daily weight
monitoring, and HF-related health services utilization for participants who received a self-
management intervention compared to those who did not.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: This paper will present preliminary findings on the effectiveness of the SM
POSTER ABSTRACTS
program for older Taiwanese with HF by comparing the intervention and control groups’
levels of seven health-related outcomes.
Disclosure of Interest: None Declared
PM069
A Systematic Approach To Chronic Heart Failure Care
Rebecca Lee1, on behalf of Improving Systems of Care for Chronic Heart Failure Roundtable:
Robert Grenfell2, on behalf of Improving Systems of Care for Chronic Heart Failure Roundtable:
Karen Page*3, on behalf of Improving Systems of Care for Chronic Heart Failure Roundtable,
Improving Systems of Care for Chronic Heart Failure Roundtable
1
Heart Care - Secondary Prevention, 2National Director, Cardiovascular Health, 3National
Manager, Health Equity and Secondary Prevention, National Heart Foundation of Australia,
Melbourne, Australia
Introduction: Chronic heart failure remains a major public health issue. Despite significant
advances in management, prevalence remains high, clinical outcomes are poor and asso-
ciated healthcare costs are rising. The prevalence of the disease is higher among the most
disadvantaged populations – Aboriginal and Torres Strait Islander peoples, those from non-
metropolitan and lower socio-economic areas, and people from culturally and linguistically
diverse backgrounds. The management of chronic heart failure remains a pressing problem
with many apparent indicators of poor case detection, discordant management, recurrent
hospital admission and disconnected care.
Objectives: To achieve expert consensus on the key principles and action-based recom-
mendations required to guide a systematic approach to heart failure care, informing policy
and driving system change.
Methods: An expert consensus approach was facilitated by the National Heart Foundation
of Australia. A comprehensive literature review was undertaken, which informed an expert
roundtable discussion identifying core principles and action-based recommendations.
Results: Consensus was reached on a set of core principles and associated action-based
recommendations. These were grouped under four key themes:
1. The Care model needs to be patient focused and multidisciplinary.
2. Access to quality data to enable benchmarking; the preferred outcome metric was
12-month event-free survival.
3. Workforce planning to develop capacity across geographical and network
boundaries for delivery of evidence-based care.
4. Ongoing research and dissemination of results to improve outcomes.
Conclusion: There is opportunity for significant positive change with limited investment.
The Heart Foundation recommends that the core principles should be addressed in the
various chronic heart failure systems of care operating across state and territory jurisdic-
tions. This approach would limit the impact of heart failure on our ageing population and
deliver cost efficiencies across the health system.
Disclosure of Interest: None Declared
PM070
Outcomes and Treatment of Patients Hospitalised for Heart Failure: The New
Zealand Heart Failure Registry
Karthigesh (Kat) Sree Raman*1, Richard Troughton2, Mayanna Lund3, Rob Doughty4,
Gerard Devlin1, New Zealand Heart Failure Registry (NZHFR)
1
Cardiology, Waikato Hospital, Hamilton, 2Cardiology, Christchurch Hospital, Christchurch,
3
Cardiology, Middlemore Hospital, 4Cardiology, Auckland Hospital, Auckland, New Zealand
Introduction: The New Zealand Heart Failure Registry (NZHFR) started enrolment in July
2006 with the primary aim to improve the medical care of heart failure patients, through a
better understanding of patient demographics, management, and in-hospital and post-
discharge outcomes.
Objectives: We report our observations and outcomes over the last seven years.
Methods: The NZHFR is a national, prospective, observational web-based registry. All
hospitals in New Zealand admitting patients with acute heart failure have been invited to
participate with a minimum and maximum requirement of 5 and 15 consecutive patients
recruited per month respectively.
Results: A total of 1904 patients were enrolled until Sept 2013 with case reports completed
for 1890 patients and 90-day follow up data available in 90% (1705/1890). The mean age is
73.5 years with 1201(63.1%) men. Chest x-ray was performed in 1843(97.5%) of patients
and B-type Natriuretic Peptide assessed in 1142(60.4%) patients. Echo was performed in
1472(77.9%) patients either during the index admission or in the previous 3 months and
1061(72%) of these patients had impaired left ventricular systolic function with ejection
fraction <50%. Median hospital stay was 6 days and 76(4%) of patients died in hospital.
Discharge medications are shown below. At 90-day follow-up 88.7% (1512/1705) were
alive with 267(15.7%) readmitted with heart failure. Compliance to treatment was reported
in 86.3% (1471/1705).
Medications on discharge Patient numbers (%)
ACE Inhibitors
ARB 1482/1814 (81.7%)
Beta-blockers 1432/1814 (78.9%)
Aldosterone antagonist 594/1814 (32.7%)
Diuretics 1755/1814 (96.7%)
e75
 Conclusion: NZHFR results compare favourably with international data with an evidence-
POSTER ABSTRACTS
based approach to management and low 90-day readmission rates.
Disclosure of Interest: None Declared
PM071
Central Type Sleep Apnea Syndrome Presents Spear-Shaped Abnormal Power
Increase in Fractal Analysis of Heart Rate Variability
Manabu Fujimoto*1, Tatsunori Ikeda1
1
Cardiology, Kouseiren Takaoka Hospital, Takaoka, Japan
Introduction: It is well known that many patients with heart failure have sleep apnea
syndrome (SAS). we could confirm the existence of SAS by fractal analysis of heart hate
variability (HRV). (Fig.)
Objectives: In this study, we investigated whether the type of SAS influences this abnormal
power.
Methods: We studied 77 consecutive patients that performed 24-hour ambulatory elec-
trocardiographic recordings and sleep apnea examination for the same period between
April 2004 and September 2007 (mean age 68 years, 14 female). The basic heart rhythm
was sinus rhythm in 61 cases, atrial fibrillation (Af) in 16 cases. HRV analysis performed by
fast Fourier transform analysis and displayed results by the method to calculate a fractal
dimension. We reviewed presence of the abnormal power in frequency band from 0.01Hz
to 0.04Hz.
Results: Central type SAS (CSAS) showed spear-shaped abnormal power increase.
Obstructive or Mixed type SAS showed more broad shape abnormal power. Hypopnea
dominate SAS tended to present no abnormal power. Patients with Af also tended to
showed no abnormal power.
web 3C=FPO
Conclusion: CSAS presents spear-shaped abnormal power increase in fractal analysis of
HRV. In any type of SAS, the abnormal power increase was affected by high ratio of
hypopnea and Af.
Disclosure of Interest: None Declared
PM072
The music therapy in patients with heart failure and acute myocardial infarction;
13-year experience
Predrag Mitrovic*1, Branislav Stefanovic1, Aleksandra Paladin2, Mina Radovanovic1,
Nebojsa Radovanovic1, Dubravka Rajic1, Gordana Matic1, Ana Novakovic1, Ida Subotic1,
Zorana Vasiljevic1
1 extraction
Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade,
2
Serbian National Broadcasting Agency, Belgrade, Serbia
Introduction: Patients who have clinical evidence of congestive heart failure (CHF) after
acute myocardial infarction (AMI) have a poor prognosis. The anxiety can produce an
increase in sympathetic nervous system activity leading to an increase in cardiac workload.
Objectives: The purpose of this study was to evaluate the effectiveness of music therapy for
reduction of new coronary events (NCE) in patients with CHF and AMI.
Methods: 782 patients (males 80.6%, mean age 59.2
6.0 yrs) with AMI have been
selected from the patients consecutively submitted from April 1990 to August 2013. CHF
was registered in 284 (36.3%) pts with AMI. All patients with CHF were randomized and
divided in 2 groups: Study group of 142 patients treated with music therapy and Control
group of 142 patients with no music therapy. Each patient in study group underwent two
sessions of medical therapy (12 minutes) in a day. Both groups were similar in baselines,
post-AMI characteristics and post-AMI medical therapy.
Results: Comparing parameters of Study and Control group of patients in 13-year follow-
up period, Study group had lower anxiety score (r¼-0.10, p¼0.08) with statistically
e76
significant reduction in systolic blood pressure (p¼0.0078), diastolic blood pressure
(p¼0.0102), heart rate (p¼0.0198), angina (p¼0.0092), reinfarction (p¼0.0205) and
sudden deaths (p¼0.0359).
Conclusion: This study sugessted support for the use of musical therapy in patients with
CHF and AMI after previous revascularization to reduce blood pressure, heart rate and new
coronary events expression. These effects of music therapy are probably because of
decreasing in sympathetic nervous system activity.
Disclosure of Interest: None Declared
PM073
Can we predict the improvement of Cheyne-Stokes respiration with central sleep
apnea in hospitalized heart failure patients?
Yosuke Nishihata*1, Yoshifumi Takata2, Kota Kato2, Kazuki Shiina2, Yasuhiro Usui2,
Akira Yamashina2
1
Department of Cardiology, St. Luke’s International Hospital, 2Department of Cardiology, Tokyo
Medical University, Tokyo, Japan
Introduction: Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) has been
recognized as a prognostic factor and also a target for heart failure (HF) treatment. Some
studies reported that an optimal medical treatment (OMT) for HF including b-blockers
suppressed CSR-CSA. However, we often find residual CSR-CSA despite the OMT, and
consider treating with positive airway pressure devices additionally.
Objectives: We conducted this study to evaluate the predictors for the improvement of
CSR-CSA in hospitalized patients due to acute HF.
Methods: We studied hospitalized patients due to acute HF, and enrolled 25 HF patients
with CSR-CSA (apnea-hypopnea index [AHI]  15/h and central apnea index [CAI]  5/h)
evaluated by a fully-attended polysomnography just before discharge. After 3 months of the
OMT, the sleep study, the echocardiography and blood test were performed again for all
patients.
Results: Patient’s characteristics at discharge were as listed: mean age, 62 years old; body
mass index (BMI), 26.5; brain natriuretic peptide (BNP), 364 pg/ml; mean left ventricular
(LV) end-diastolic dimension, 62 mm; mean LV ejection fraction, 31%. On the whole, the
OMT decreased AHI (46.6
18.3/h to 34.8
6.9/h, p ¼ 0.05), CAI (16.3
13.1/h to 7.8

13.1/h, p < 0.05), and also obstructive apnea index (13.2
15.8/h to 7.9
7.5/h, p <
0.05). In 17 patients, CSR-CSA vanished accompanied by significant improvement of
plasma BNP levels and LV ejection fraction after 3 months. By univariate analyses, BMI and
relative wall thickness (RWT) at discharge were related to the improvement of CSR-CSA,
but plasma BNP level, LV ejection fraction, LV mass index, severity of sleep apnea, and dose
of b-blockers were not. Multivariate analysis revealed that BMI (odds ratio [OR], 1.68; 95%
confidence interval [CI], 1.04 to 3.59; p < 0.05) and RWT (OR, 1.35; 95%CI, 1.08 to 2.15;
p < 0.01) were independent determinants of the improvement of CSR-CSA.
Conclusion: In hospitalized HF patients, greater BMI and RWT were the clinical predictors
for the improvement of CSR-CSA. Considering the introduction of positive airway pressure
therapy for HF patients with CSR-CSA, we should pay attention to these factors.
Disclosure of Interest: None Declared
PM074
Culture negative implantable electronic cardiac device related infections requiring
Nigel Lewis1, Sandeep Prabhu*1, Nisha S. Rao1, Matias B. Yudi1, Neil F. Strathmore1
1
Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Infection rate and subsequent need for device extraction following im-
plantation of cardiovascular implantable electronic devices (CIED) continues to remain
high despite routine use of prophylactic antibiotics. It is known that wound swab and
peripheral blood cultures have a low sensitivity for detecting infection in these patients.
Whether patients who are culture negative have more indolent and less severe infection is
unclear.
Objectives: The aim was to evaluate the presentation and features of infection severity in
patients with and without culture positive microbiology undergoing CIED extraction for
infection.
Methods: A retrospective evaluation was performed of consecutive patients who under-
went CIED extraction at The Royal Melbourne Hospital between January 2012 and
February 2013. Patient and device related data was reviewed from the clinical notes and
pathology server for analysis. Patients were divided into three groups: 1. Positive wound
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 swab
blood culture, 2. Positive pocket swab
lead culture, taken at the time of concentration release of either procollagen propeptide was not observed in these patients.

extraction and 3. Culture negative.
Results: 53 patients underwent CIED extraction for proven or suspected infection. 25
patients had positive cultures at presentation, 13 had cultures after extraction and 15 were
culture negative. Culture negative patients prior to extraction had significantly lower white
cell counts (7.0
2.5 vs 9.3
3.0, p¼0.007), were more likely to present with localized
pocket infection (p¼0.001) and CIED erosion (p¼0.001) rather than with systemic illness
(p<0.001) and lead endocarditis (p<0.001) [Graph 1]. In addition they had significantly
shorter average hospital stay (9.4 v 3.4 nights, p¼0.03). Staphlococcus species was the
prominant organism grown, being found in 30 patients (79%) [Table 1]. 8 patients (32%)
were found to have 2 or more organisms cultured.
Table 1
POSTER ABSTRACTS
Levels of PINP, however, did correlate with invasively-determined intra-cardiac and,
thereby, pulmonary vascular pressures. The relatively small contribution of myocardial
collagen metabolism to the body’s overall activity, increased collagen metabolism at non-
cardiac sites, and temporal variations in the synthesis of myocardial collagen may account
for these findings. Regardless, peripheral levels of collagen biomarkers turnover do not
reliably reflect myocardial collagen metabolism or content in patients with HCM.
Disclosure of Interest: None Declared
PM076
Determinants of acute uptake of the myocardial metabolic modulator perhexiline into
human myocardium

Patient Wound Blood Pocket Lead

Cher-Rin Chong*1,2, Nigel E. Drury3, Giovanni Licari1,2, Michael Frennaux4, John Horowitz1,2,
Organism grown Numbers (%) Swab Culture swab Culture
Domenico Pagano3, Benedetta Sallustio1,2
1
Dept of Clin Pharmacology and Cardiology, Basil Hetzel Institute, 2Univ of Adelaide, Adelaide,
Staphlococcus Aureus 10 (26) 4 8 2 3
Australia, 3Dept of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, 4Univ of
Staphlococcus Epidermidis 8 (21) 3 3 5 4 Aberdeen, Aberdeen, United Kingdom
Other Staphlococcus 12 (32) 3 3 5 4
Introduction: Perhexiline (Px) is a prophylactic anti-anginal agent which is under inves-
Pseudomonas 3 (8) 2 0 2 2 tigation for treatment of heart failure, hypertrophic cardiomyopathy, and acute ischemia. It
Candida species 3 (8) 0 2 0 1 improves myocardial energetics but is also a weak L-calcium channel antagonist. Px ex-
hibits complex pharmacokinetics with potential neuro- and hepato-toxicity at concentra-
Other species 7 (18) 2 3 2 1
tion above the therapeutic range of 0.15-0.6mg/L. Racemic Px consists of (+) and (-)
No Growth 15 (28) 31 33 34 35 enantiomers which may exert distinct cardioprotective effects.
Objectives: We sought to identify clinical correlates of acute uptake of (+) and (-)Px into
human myocardium.
Methods: Data from patients (n¼94) undergoing CABG surgery treated with Px 200mg/
day for 8
3 (SD) days were utilised. Px concentrations (measured via HPLC assay) of
atrial (n¼94) and LV biopsy (n¼30) obtained at CABG, were correlated with plasma drug
concentrations.
Results: As summarised in Table 1, concentrations of (-)Px were lower than (+)Px. For
both enantiomers, atrial and plasma concentrations were directly correlated (r¼0.92,
p<0.0001 for both). Following multivariate analysis, ventricular uptake of both enantio-
mers was dependent on duration of treatment (b¼0.29 for (+)Px and 0.33 for (-)Px;
p<0.05 for both) and plasma concentrations (b¼0.67 for (+)Px and 0.74 for (-)Px;
p<0.0001 for both). Atrial:plasma concentration ratio varied negatively with plasma
web 3C=FPO

concentration (b¼-0.29 for (+)Px and -0.37 for (-)Px; p<0.01 for both). There was also a
negative correlation (b¼-0.11; .p<0.05 ) between atrial (-)Px and heart rate (HR).

Conclusion: Culture-negative CIED infection is notably common and appears to be

associated with more localized presentation and less severe clinical features of infection.
However the sensitivity of wound and blood cultures remains low and so the absence of
finding an organism does not obviate the need for complete extraction, when there is
clinical CIED pocket infection.
Disclosure of Interest: None Declared

PM075
Evaluating the utility of circulating biomarkers of collagen synthesis in hypertrophic Conclusion:
cardiomyopathy (1) Myocardial uptake of Px is greater for LV than atria, with evidence of saturability
and of more rapid clearance of (-)Px.
Andris H. Ellims*1, Andrew J. Taylor1, Justin A. Mariani1, Liang-Han Ling1, Leah M. Iles1, (2) HR reduction with (-)Px may reflect predominant calcium antagonist effect.
Micha T. Maeder1, David M. Kaye1
1 Disclosure of Interest: None Declared
Heart Centre, Alfred Hospital and Baker IDI Heart & Diabetes Institute, Melbourne, Australia

Introduction: In hypertrophic cardiomyopathy (HCM), accumulation of myocardial

collagen may play a central role in the pathogenesis of diastolic dysfunction and
arrhythmia. Previous studies have suggested that peripheral levels of byproducts of collagen
synthesis are reflective of myocardial extracellular matrix metabolism although this has not
been validated in detail.
Objectives: Given the potential clinical utility of such biomarkers, we sought to validate
the assumed relationship between peripheral markers and myocardial fibrosis in HCM.
Methods: Fifty patients with HCM and twenty-five healthy control subjects underwent
peripheral venous sampling to determine the plasma concentrations of key collagen pre-
cursors (procollagen I and III N-terminal propeptides [PINP, PIIINP]). Contrast-enhanced
cardiac magnetic resonance (CMR) imaging was performed to quantify regional (by late
gadolinium enhancement [LGE]) and diffuse (by T1 mapping) myocardial fibrosis. Nineteen
subjects also underwent simultaneous arterial and coronary sinus blood sampling (to derive
transcardiac concentration gradients of PINP and PIIINP) and right heart catheterization.
Results: Despite CMR evidence of regional (LGE quantity: 6.4
8.0%) and diffuse (T1 time:
478
79 ms) myocardial fibrosis in HCM patients, peripheral levels of collagen precursors
were similar compared to control subjects (PINP 45.9
22.9 mg/L vs. 53.4
25.9 mg/L,
p¼0.21; PIIINP 4.8
1.7 mg/L vs. 4.4
1.1 mg/L, p¼0.26). While PINP levels correlated
with intra-cardiac pressures, no significant net positive transcardiac concentration gradient
was detected for either biomarker.
Conclusion: In patients with HCM, peripheral levels of key ECM precursors, PINP or
PIIINP, do not correlate with either CMR-derived measures of myocardial fibrosis or
echocardiographic indices of diastolic dysfunction. Additionally, a net myocardial
PM077
Is The same expression receptor of Peroxisome proliferator-activated receptor gamma
(PPARg) mRNA in human aorta and left ventricle in patients with coronary artery
diease ?
Izabela Wojtkowska*1, Janusz A. Siedlecki2, Zbigniew Juraszynski3, Andrzej Tysarowski2,
Janina Stepinska1
1
ICCU, National Institute of Cardiology, 2Department of Molecular Biology, Department of
Molecular Biology, 3Departament of Cardiosurgery, National Institute of Cardiology, Warsaw,
Poland
Introduction: Cardiovascular disease is considered to be the leading cause of death and
loss of disability-adjusted lifetime. Previous research in animal studies has shown that
PPARg activators may inhibit an array of deleterious mechanisms occurring in the heart
and related to ischemia/reperfusion injury and leads to infarct size reduction and
contractility improvement. This results cannot be confirmed in human trials
Objectives: The aims of this study was to comparison for the first time the expression
receptor of PPARg mRNA in human aorta and left ventricles in patients with coronary
artery disease.
Methods: 150 patients were recruited and follow-up until 31 December 2011. The mean
age was 63 years, 76%were men. Patients with diabetes mellitus and valvular disease were
excluded. During the surgical intervention ( CABG) a small slice of the aorta and left

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e77

 ventricle were collected and placed immediately into a solution of “RNA later” (Qiagen,
POSTER ABSTRACTS
Hilden, Germany) and stored until RNA isolation. All the subjects agreed to participate in
the study after being informed of its nature and purpose. Patient’s confirmed consent and
the protocol of the study were approved by the Institutional Local Ethics Committee.The
level of expression was measured using TagMan method.
Results: The results show that the average expression of PPARg is almost identical in the
aorta and left ventricle.
Figure 1. Relative quantification of PPARg expression in aorta and left ventricle (Wil-
coxon Rank Sum Test p ¼ 0,235).
Conclusion: PPARg receptor expression in aortic and left ventricular tissue samples of
patients with ischemic heart disease is similar.
Disclosure of Interest: None Declared
PM078
Is the correlation between TNF-308 ( rs 1800629) peroxisome proliferator-activated
receptor gamma(rs1801282) polymorphisms and development of heart failure in
patients with ischemic heart disease after coronary bypass grafting ? Preeliminary
data
Izabela Wojtkowska*1, Janusz A. Siedlecki2, Janina Janas3, Zbigniew Juraszynski4,
Andrzej Tysarowski2, Janina Stepinska1
1 Methods: 34 patients (age: 45.53
8.75y) with asymptomatic non-diabetic stage III CKD
ICCU, National Institute of Cardiology, 2Department of Molecular Biology, Institute of
Oncology, 3Department of Clinical Biochemistry, 4Departament of Cardiosurgery, National
Institute of Cardiology, Warsaw, Poland
Introduction: It is commonly knows that both TNF alpha and peroxisome proliferator-
activated receptor g (PPARg) affects the myocardium through inhibition of inflammatory
cytokines and metabolic modulation but their effect in the progression of heart failure is
unclear. The aim of the study was to assess the influence of the TNF-308 (rs1800629) and
PPARg (rs1801282) of polymorphisms in patients with ischemic heart disease after cor-
onary bypass grafting on the risk development of heart failure.
Methods: 57 patients were recruited and followed-up. All patients who underwent CABG
had multi-vessel ischemic heart disease. Mean age of patients was 63
8.8 years, 85% were
men. Patients with diabetes mellitus, prior heart failure and valvular disease were excluded.
TNF-308 (rs1800629) and PPARg (rs1801282) of polymorphisms were assayed using
TaqMan method. The samples of follow-up were taken before CABG and 1-month, 12-
months and 24- month after. During CABG all patients had left ventricle and aortic wall
specimen collected for the assessment of PPAR g expression. HF was defined as ejection
fraction <40% or NT-proBNP >400pg/ml, or six-minute walk test <400m.We divided all
patients into two groups: with heart failure (HF) and without heart failure (NHF).
Results: None of the patients had HF before CABG. Preeliminary data of 57 pts shows
presents of polymorphism Pro 12 Ala in PPARg in 26 pts (45%) and polymorphism G308
A in the promoter of the TNF-alpha in 16 (28%) pts. Only six pts had both polimorphic
changes.
Conclusion: So far we did not find correlation between TNF-308 ( rs 1800629)peroxisome
proliferator-activated receptor gamma(rs1801282) polymorphisms and development of
heart failure in patients with ischemic heart disease after coronary bypass grafting.
Disclosure of Interest: None Declared
PM079
Prognostic significance of Tissue Doppler and deformation parameters in
asymptomatic typ 2 diabetic patients
Angelina Stevanovic*1, Milica Dekleva2, Radosava Cvjetan3, Snezana Trajic4,
Nevena Paunovic1, Vesna Andric1, Goran Podnar1
1
Cardiology department, Railway Health Care Institute, 2Cardiology department, University
Clinical Center Zvezdara, 3Cardiology department, Zemun Medical Centre, 4Cardiology
department, Dedinje Cardiovascular Institute, Belgrade, Serbia
Introduction: Subclinical left ventricular (LV) systolic and diastolic dysfunction has been
reported to be prevalent in diabetic subjects. This patients are at risk of future cardiac
events.
Objectives: The aim of this study was to explored the prognostic role of Tissue Doppler
and derived deformation parameters for the primary cardiac events in asymptomatic pa-
tients with type 2 diabetes mellitus.
Methods: The study included 50 asymptomatic typ 2 diabetic patients and 35 age and sex
matched healthy subjects.
Left atrial dimension, left atrial volume index and parameters of left ventricular geom-
etry, including left ventricular mass index, were estimated by echocardiography. Maximal
velocity of early and late diastolic LV filling (E, A, E/A), deceleration E time (DTE) and
isovolumic relaxation time (IVRT) were measured from transmitral Doppler. Tissue
Doppler velocities were measured from medial and lateral annulus (e, a, e/a, s) including
isovolumic contraction velocity (IVCv) and acceleration during isovolumic contraction
(IVA), E/e and Doppler tissue myocardial performance index.
Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking.
All patients were followed up for three years. The end point was cardiac event
(myocardial infarction, coronary revascularization procedures, stabile or nonstabile new-
onset angina and heart failure).
Results: There was close correlations between values of GLS and E/e (r¼0.488,
p¼0.0002), and IVCv (r ¼ -0.429, p¼0.0004) with significantly lower values of GLS
(-17.8
2.8 vs -26,9
2.9; p¼0.0007) and IVCv (0.07
0.023m/s vs 0.09
0.025m/s;
p¼0.005) and significantly higher value of E/e (9.11
2.24 vs 7.12
1.52; p¼0.0006) in
group of diabetic patients. Diabetic patients with E/e 12 (Long Rank 6.11, p¼0.013) and
e78
with IVCv  0.06 (Long Rank 4.25, p¼0.039) were at most at risk of cardiac event in the
following three years.
Conclusion: Diabetes mellitus is asociated with subclinical LV diastolic and systolic
dysfunction. Isovolumic contraction velocity and E/e represents a simple, effective tools for
assessing cardiac risk in asymptomatic typ 2 diabetic patients, but prognostic value of GLS
may need to be verified through prospective study in a larger group of patients.
Disclosure of Interest: None Declared
PM080
Diastolic Stiffness As Assessed By Diastolic Wall Strain In Patients With Chronic
Kidney Disease
Feiqiong Huang*1, Thu Thao Le1, Nadira Hamid1, Ru San Tan1
1
Cardiology, National Heart Centre Singapore, Singapore, Singapore
Introduction: Increased left ventricular (LV) diastolic stiffness plays a key role in heart
failure. The diastolic wall strain (DWS) index is based on the linear elastic theory, which
predicts that impaired diastolic wall thinning reflects resistance to deformation in diastole
and thus, increased diastolic myocardial stiffness
Objectives: We aim to examine LV diastolic stiffness in patients with chronic kidney
disease (CKD) without cardiovascular disease.
(creatinine clearance was 39-50ml/min) without cardiovascular disease and 30 age matched
controls (age:46.51
10.46y) were included in our study. Transthoracic echocardiography
was performed and left ventricular systolic and diastolic functions were analyzed. DWS was
calculated as (LV posterior wall thickness at the end of systole - LV posterior wall thickness
at the end of diastole)/ LV posterior wall thickness at the end of systole.
Results: DWS index was significantly decreased (0.32
0.10 vs 0.44
0.10; p<0.0001),
whereas LV mass and deceleration time of mitral flow E increased (167.64
61.01 vs
115.25
39.54, p<0.0001 and 225.03
49.60 vs 170.66
39.55, p<0.0001, respectively)
in patients with stage III CKD compared with normal controls.
Table 1. Echocardiography parameters in 2 groups
CKD (n[34) Normal (n[30)
LVEF (%) 62.53
9.16 65.26
5.26
LV mass (g) 167.64
61.01* 115.25
39.54
E/E’ 7.39
1.88 6.81
2.23
E/A 1.31
0.37 1.24
0.48
DT (ms) 225.03
49.60* 170.66
39.55
LA volume index (ml/m2) 20.39
6.21 21.56
5.48
DWS 0.32
0.10* 0.44
0.11
* p<0.001 compared with normal controls
Conclusion: DWS decreased which reflect increased LV diastolic stiffness in patients with
stage III CKD although the cardiac function is normal. DWS maybe a simple and useful tool
in assessing diastolic stiffness in patients with stage III CKD.
Disclosure of Interest: None Declared
PM082
A High Index of Suspicion of Tuberculous Pericarditis
Erwin Jannino O. Ybanez*1, Antonio S. Sibulo1
1
Heart Institute, St. Luke’s Medical Center, Quezon City, Philippines
Introduction: Tuberculous pericarditis is life threatening and elusive, which necessitates a
high index of suspicion and prompt management.
Objectives: To present a case of acute tuberculous pericarditis due to high index of clinical
suspicion.
Methods: This is a case of a 46 year old male, Filipino, hypertensive, who came in due to
persistent high grade fever for 2 weeks associated with body malaise and weight loss. He
denies cough, difficulty of breathing and chest pain. He had history of recurrent shingles
for 2 years and denies any sexual history. He came in awake, febrile, normotensive and
tachycardic. Pertinent physical examination revealed anicteric sclera, no cervical lymph-
adenopathy, left axillary lymphadenopathy, clear breath sounds, muffled heart sounds,
pericardial friction rub, no organomegaly on abdominal palpation and had bilateral
inguinal lymphadenopathies.
Results: The following diagnostic examinations were done. Complete blood count showed
hemoglobin of 10.2 g/dl, haematocrit 30.6%, wbc 4580 mm3, neutrophil 32%, lympho-
cyte of 55% and platelet count of 185,000. Test for Dengue Fever and Typhoid Fever were
negative. Chest X-ray revealed cardiomegaly with no active infiltrates. ECG showed sinus
tachycardia. 2D echocardiogram showed moderate pericardial effusion with no tamponade
physiology. Thyroid function tests were normal. ESR 119 mm/hr and C-reactive protein
were elevated. ANA showed speckled pattern, and normal anti-ds DNA, negative for Anti-
Smith, anti-ribonucleoprotein and anti-cardiolipin antibody IgM and positive for anti-
cardiolipin antibody IgG. Lupus anticoagulant was weakly present (LAC (DRVVT) 1.3).
Peripheral blood smear shows normochromic and normocytic anemia. Chest computer
tomography scan showed subcentimeter non-calcified nodules in both upper and right
upper lobes, subcarinal lymphadenopathy and minimal pericardial effusion. Abdominal
computer tomography scan showed bilateral external iliac lymphadenopathies. Left axillary
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
lymph node biopsy showed no immunophenotypic evidence of lymphoma (CD20, Pax5, outcome on changes in LVEF (31.5
4% vs 34.9
8%; P ¼0.128 for lateral wall scar, and

POSTER ABSTRACTS
CD3, CD10, Bcl-2, CD30 and Ki-67). Mycobacterium tuberculosis DNA was negative. No 31.8
2.8% vs 39.8
4%; P ¼0.001 for non-scarred lateral wall).
growth of Myobacterium tuberculosis culture. The patient responded well to peri- Conclusion: CMR is superior to gated SPECT in detection of scar burden. Lateral wall scar
cardiocentesis and subsequent anti-tuberculous chemotherapy. He was discharged has unfavorable impact on CRT response. Phase analysis changes were not predictors of
improved after a week and remains asymptomatic after nine months of anti-TB therapy. echocardiographic response.
Conclusion: In areas with high prevalence of tuberculosis, a high index of suspicion for TB Disclosure of Interest: None Declared
pericarditis should be entertained.
Disclosure of Interest: None Declared PM088
Heart Failure with Normal Ejection Fraction: A Single Centre Experience in a
PM085 Southeast Asian Cohort
Gender differences of patients implanted with a Cardiac Resynchronization Therapy Caroline W. S. Hoong*1, Choon Pin Lim1, Fei Gao2,3, Lee Wah Teo4, Chia Lee Neo4,
device Elaine S. L. Ng4, David K. L. Sim1,3
1
Vadim Kuznetsov*1, Fawzia Yousef Al Kandari2, Iftikar Ebrahim3, Aparna Jaswal4, Rita Ibarra5, Cardiology, 2Biostatistics, National Heart Centre, 3Duke-NUS Graduate Medical School,
4
Ekaterina Ostern6, Milan Sepsi7 Nursing Development Unit, National Heart Centre, Singapore, Singapore
1
Ultrasound Diagnosis, Tyumen Cardiology Center, Tyumen, Russian Federation, 2Kuwait
Introduction: Heart failure with normal EF (HF-NEF) is recognised as separate entity from
Cardiac Center, Kuwait, Kuwait, 3Netcare Unitas Hospital, Pretoria, South Africa, 4Fortis heart failure with reduced EF (HF-REF). Its prognosis has shown to be better or equivalent
Escorts Heart Institute, New Delhi, India, 5Hospital Carlos Andrade Marin, Quito, Ecuador, to HF-REF.
6
Medtronic LLS Russia, Moscow, Russian Federation, 7University Hospital Brno, Brno, Czech Objectives: We aimed to analyse the characteristics and outcome of HF-NEF in a multi-
Republic ethnic South East Asian cohort.
Methods: 312 patients were admitted with decompensated heart failure over a 1 year
Introduction: Literature indicates that there are differences in cardiovascular risk factors, period in 2009 to a tertiary institute in Singapore. This is a retrospective analysis in an in-
clinical presentation of cardiovascular diseases and treatment between men and women. patient setting comparing the clinical characteristics and outcomes of patients with LVEF
Objectives: The purpose of this study is to see if clinical differences can be noticed between 50% and <50%. Outcomes were defined by 1 year mortality and 90-day re-hospital-
female and male patients implanted with a first Cardiac Resynchronization Therapy (CRT) isation rates for heart failure.
device, and whether different factors are predictive for receiving a CRT-D. Results:
Methods: Data were obtained from PANORAMA, a long-term, prospective, observa-
tional study including 8586 patients from 34 countries. Gender differences were
analyzed in 1204 patients (868 male, 336 female) implanted with the first CRT device Characteristic Preserved EF (N[68) Reduced EF (N[244) P value
(660 CRT-P, 544 CRT-D). Age (year) 74 (65-80) 66 (57-75) <0.001
Results: The percentage of CRT-P versus CRT-D devices was higher in women than in men
(63% vs. 37% and 51% vs. 49% respectively, p<.0001). Female compared to male CRT-D Male sex 25 (36.8) 159 (65.2) <0.001
recipients smoked less (p¼0.0001), had less hypertension (P¼0.02) and known coronary Diabetes 36 (52.9) 122 (50.2) 0.690
artery disease (CAD) (p<0.001), more LBBB (p¼0.001), and were less treated with Hypertension 57 (83.8) 167 (68.4) 0.013
amiodarone (p¼0.05) and aspirin (p¼0.004). The CRT-P female patients smoked less
(p<.0001), had less known CAD (p<.0001), higher LVEF (less patients with LVEF 30, Coronary artery disease 46 (67.6) 218 (89.3) <0.001
p¼0.04), and were treated less with ACE inhibitors/ARB (p¼0.003), aspirin (p<.0001), Atrial fibrillation 29 (42.6) 48 (19.7) <0.001
beta blockers (p¼0.02), diuretics (p¼0.02) and statins (p¼0.005). The prevalence of
Serum creatinine (mmol/l)220 5 (7.4) 19 (7.8) 0.906
diabetes, atrial fibrillation and age at the time of first CRT implant showed no statistical
significant differences.
Multivariate analysis showed the following factors to increase the likelihood of receiving
a CRT-D over a CRT-P: male gender (OR 1.16, P¼0.39), coronary artery disease (OR 1.79,
p ¼0.0003), LVEF 30 (OR 2.5, p<.0001), LBBB (OR 1.4, p¼0.03), and treatment with The median age was 68 years and prevalence of HF-NEF was 21.8%. Age, female gender,
ACE inhibitors/ARB (OR 1.85, p¼0.0002), beta blockers (OR 1.79, p¼0.0001), and aspirin hypertension, atrial fibrillation, the absence of coronary artery disease and no smoking
(OR 1.37, p¼0.03). history were factors associated with HF-NEF. Patients with HF-NEF were less often pre-
Conclusion: In the PANORAMA study we found that female compared to male CRT re- scribed anti-platelets, ACEi/ARB, aldosterone-receptor antagonists, digoxin and loop di-
cipients differed in many clinical characteristics, and females received less of some drugs uretics. There was no significant difference in 1 year mortality between the HF-NEF and
and CRT-D devices. The different implant rate of CRT-P/CRT-D in men compared to HF-REF groups (5.9% vs 11.3% respectively, p¼0.195), nor in their 90-day rehospitali-
women didn’t independently relate to gender, and is to a large extent explained by the high sation rates (16.2% vs 17.6% respectively, p¼0.780). 1 year mortality after adjustment for
prevalence of CAD in men and other differences in clinical characteristics. significant prognostic factors was still not significantly lower in the HF-NEF group
Disclosure of Interest: None Declared compared to HF-REF group (HR 1.66, 95% CI 0.53 to 5.19, p¼0.386). Poor prognostic
factors for HF-REF patients included increased age, diabetes and renal impairment, but not
in patients with HF-NEF. LVEF was not a prognostic factor in the whole cohort of heart
PM086 failure patients.
Assessment of LV scar burden cardiac magnetic resonance and phase analysis gated
SPECT and impact on cardiac resynchronization therapy
Walid Kamel*1, Wael Samy1, Osama Tayeh1, Alia Abd El Fattah1
1
Critical Care Medicine, Kasr el Aini, Cairo, Egypt

Introduction: Cardiac resynchronization therapy (CRT) is an established tool in improving

dyssynchrony in chronic heart failure. Scar burden assessment plays an important role in
predicting response to CRT implantation.
Objectives: Compring gated SPECT to CMR in asudying sessment of LV scar burden and
lateral wall involvement and studying effect of lateral wall scar on outcome of CRT.
Methods: Twenty patients underwent CRT implantation. Pre-implantation delayed
hyperenhancement cardiac magnetic resonance (DHE-CMR) was done to document scar
burden and lateral wall involvement. Also 99mTc-MIBI gated SPECT and echocardio-
graphic examination were done pre-implantation and 3 months after CRT implantation to
assess LV volumes, and LVEF. Degree of dyssynchrony was assessed through phase analysis
measurements; Histogram bandwidth BW, Standard deviation SD and entropy. The extent
of rest perfusion defects on gated SPECT were assessed on a standard 17-segment model.
Results: Twenty patients received CRT (mean age 56.7
13.9, 14 males). CRT implanta-
tion had a favorable prognosis on cardiac functions (LVEF pre-implantation: 30
5% versus
37
7% post-implantation; P¼0.017). Echocardiographic response, defined as relative
increase in LVEF by 15%, was documented in 16 patients (80%). Dyssynchrony pa-
rameters for responders were significant pre-implantation versus post-implantation; BW
171.2
60.2 vs 99.
73.6; P¼0.001, SD 44.8
19.2 vs 26.5
13.2; P¼0.005, entropy
67.5
8.1 vs 38.6
20.4; P<0.001. Dyssynchrony parameters for non-responders; BW
141.8
57.8 vs 74.2
38.2; P¼0.108, SD 41
20.2 vs 23.5
21.6; P¼0.019, entropy
66.3
9.8 vs 34.5
20.5; P¼0.112. Changes in phase analysis parameters were not Conclusion: HF-NEF is a separate clinical syndrome from HF-REF, with different risk
correlated to changes in LVEF (BW P¼0.99, SD P¼0.691; entropy P¼0.918). CMR was factors and prognostic factors. It has considerable mortality and morbidity no less than in
superior to gated SPECT in detection of scar burden (78.5
17.8% vs 41.2
13.1%; P¼ HF-REF.
0.001). Presence of lateral wall scar detected by DHE-CMR (65%) had unfavorable Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e79

 PM089
POSTER ABSTRACTS
A novel, simplified diastolic scoring system better classifies subjects into diastolic
grades with increasing cardiovascular risk than EAE/ASE recommendations
Jennifer M. Coller*1,2, Duncan J. Campbell2, Henry Krum3, Michele McGrady4, Louise Shiel3,
Chris Reid3, Umberto Boffa5, Rory Wolfe4, Simon Stewart6, David L. Prior7
1
Department of Medicine, St Vincent’s Hospital, 2St Vincent’s Institute, 3Centre for
Cardiovascular Research and Education in Therapeutics, 4Monash University, Melbourne,
5
University of Adelaide, Adelaide, 6Baker IDI, 7St Vincent’s Hospital, Melbourne, Australia
Introduction: EAE/ASE recommendations for diastolic evaluation are complex and may
not offer optimal cardiovascular (CV) risk stratification. There exists a need to develop a
simpler approach to diastolic grading which identifies subjects at increased mortality risk.
Objectives: To compare the ability of the EAE/ASE recommendations and a novel,
simplified diastolic score to identify subjects at increased CV risk, reflected by elevated
serum NT-proBNP levels.
Methods: Detailed evaluation of diastolic function was undertaken in 3046 asymptomatic
subjects >60 years with 1 risk factors for heart failure. Algorithms were constructed to
grade subjects according to EAE/ASE recommendations and a novel scoring system (three
grades: normal (E/A ratio>0.75 with 1 feature of abnormal diastolic function), mild
dysfunction (E/A ratio<0.75) and moderate-severe dysfunction (E/A ratio>0.75 with 3
abnormal features)). Abnormal diastolic features included left atrial enlargement (LAV-
I>34mL/min), average E’<8cm/s, average E/E’>13, or S/D reversal. Serum NT-proBNP
levels are reported as median (25th,75th centile). NT-proBNP levels in each grade were
compared with levels in the Normal group using analysis of variance.
Results: Diastolic function could be assessed in most subjects (EAE/ASE: 2870, 94%; novel
scoring system: 2806, 92%). The EAE/ASE recommendations definitively classified only
40% of subjects, fewer than the novel scoring system (73%). Using the EAE/ASE schema,
serum NT-proBNP levels were significantly higher in Athlete’s Heart, Grade I and II-III
categories than in the Normal category, but NT-proBNP levels decreased from Grade I to
Grades II-III. Using the novel scoring system for grading, NT-proBNP levels increased
progressively with worsening diastolic grade.
EAE/ASE recommendations
Diastolic grade(n) Normal (489) Athlete’s Grade I (177) Grades II-III Indeterminate (1617)
Heart(201) (281)
Serum NT-proBNP 8(4,16) 12 (6,21) 14 (8,24) 12 (7,24)
(pmol/L)
p<0.001 p<0.001 p<0.001
Novel scoring system
Diastolic grade(n) Normal (1169) NA Mild (714) Mod-Severe (173) Indeterminate (749)
Serum NT-proBNP 9 (5,17) NA 11 (6,20) 16 (8,32)
(pmol/L)
NA p<0.001 p<0.001
Conclusion: The novel diastolic scoring system allocated more subjects to definitive dia-
stolic grades than EAE/ASE recommendations. Progressively increasing NT-proBNP levels
with worsening grade by this system suggests it also more effectively differentiates between
groups at differing CV risk than EAE/ASE recommendations.
Disclosure of Interest: None Declared
PM090
Is there any correlation between Brain Natriuretic and the left ventricular diastolic
dysfunction in patients with acute coronary syndrome
Leila Abid Trigui*1, Salma Charfeddine1, Mona Turki2, Fatma Ayedi2, Samir Kammoun1
1
Cardiology Departement, Hedi Chaker Hospital, Sfax (Tunisia), Medecine University Sfax,
2 cantly higher in animals receiving MYO as compared with DOX, with trend towards better
Biochemistry Departement, Habib Bourguiba Hospital, Sfax, Tunisia
Introduction: The utility of Brain Natriuretic Peptide (BNP) for detecting leftventricular
(LV) diastolic dysfunction in patients presenting an acute coronary syndrome without heart
failure symptoms is unclear
Objectives: we investigated the relation between BNP plasma levels and LV diastolic
dysfunction in patients with postmyocardial infarction with preserved systolic function
Methods: We studied 81 patients admitted for STMI ou NSTMI. Patients with heart failure
symptoms or abnormal systolic function were excluded. Patients were divided in three
groups according to E/E’ ratios < 10 (groupI), E/E’ ratios between 10 and 15 (group II) and
E/E’ ratios > 15 (group III)
Results: The BNP blood levels were positively correlated significantly with E/E’ ratio (p <
0.02). Patients with elevated LV end diastolic pressure (LVEDP), defined as E/E’ > 15 (n ¼
27) had highest BNP (302
68 pg/ml) levels. E/E’ 10 to 15 group (n ¼ 24) had a mean
BNP level of 136.4 +/- 27 pg/ml, and those with E/E’ < 10 (n ¼ 29) had 82 +/- 20 pg/ml. A
BNP value of 107.8 pg/ml had a sensitivity of 89%, a specificity of 61% for predicting E/E’
> 15. The area under the ROC curve for BNP to detect any diastolic dysfunction was
0.757. A BNP value of 72.7 pg/ml had a sensitivity of 82.2% and a specificity of 66.7% for
detecting a diastolic dysfunction
Conclusion: A rapid assay for BNP can detect the presence of diastolic abnormalities on
echocardiography in patients with preserved systolic function post myocardial infarction
Disclosure of Interest: None Declared
e80
PM091
Is restrictive filling post ST elevation myocardial infarction (STEMI) treated by
primary percutaneous intervention a predictor for development of heart failure?
Leia Hee*1, Kim Munk2, Niels H. Andersen2, Chrisian J. Terkelsen2, Hans E. Botker2,
Sandy Prasad3, Pramesh Kovoor4, Liza Thomas1, Steen H. Poulsen2
1
Cardiology, Liverpool Hospital/ UNSW, Sydney, Australia, 2Cardiology, Aarhus University
Hospital, Aarhus C, Denmark, 3Cardiology, Royal Brisbane Hospital, Brisbane, 4Cardiology,
Westmead Hospital/University of Sydney, Sydney, Australia
Introduction: Restrictive filling after STEMI treated by thrombolysis is a known predictor
of future heart failure (HF). However, primary percutaneous intervention (PCI) results in
early revascularization of myocardium and improved recovery.
Objectives: We hypothesized that restrictive filling post STEMI treated by PCI, may not
result in development of HF.
Methods: 680 patients STEMI patients treated by PCI from3 high volume centres (Aarhus
hospital, Denmark; Liverpool and Westmead Hospitals, Australia) who underwent an
echocardiogram within 1 week of STEMI. Restrictive filling was defined as E/A ratio  2
and/or deceleration time <140ms (as per MERGE analysis). All patients were prospectively
followed for the development of HF (in patient or outpatient).
Results: 105/680 patients (15%) had restrictive filling on ECHO. At 32 (
24) months
follow up, a significantly greater number of patients in the restrictive filling group devel-
oped HF (10.5% vs 5.7%; p<0.05). We examined determinants of restrictive filling at
baseline. Neither age, gender, hypertension, diabetes or previous ischemic heart disease,
were determinants of restrictive filling. Symptom to reperfusion time was similar in both
groups; although a greater proportion of patients were observed the LAD as the culprit
artery in the restrictive filling group (60% vs 43%; p¼0.01). Of the echocardiographic
parameters, only baseline left ventricular ejection fraction (LVEF) was significantly lower
(44
11 vs 50
10 %; p<0.001) in the restrictive filling group.
Conclusion: Despite early and improved revascularization by PCI, the presence of
restrictive filling post STEMI increases the incidence of HF. A reduced LVEF post STEMI
was the only determinant of restrictive filling.
Disclosure of Interest: None Declared
PM092
Left and right ventricular systolic and diastolic dysfunction assessed by cardiac
magnetic resonance imaging during cytostatic therapy
11 (6,20)
Marianna Gyongyosi*1, Christian Geier1, Gerald Maurer1, Jutta Bergler-Klein1
1
p<0.001 Cardiology, Medical University of Vienna, Vienna, Austria
Introduction: Current chemotherapy using anthracycline and its derivates, such as
doxorubicin (DOX) or the liposome–encapsulated doxorubicin–citrate complex Myocet
12 (6,21) (MYO) have significantly improved survival in cancer patients. However, besides myelo-
suppression, cardiotoxicity in terms of clinical or subclinical left ventricular dysfunction is
p<0.001 the primary clinical concern when anthracycline is used, leading to increased cardiovas-
cular morbidity and mortality in cancer survival patients.
Objectives: The main objective of the present study is to recognize of early signs of cardiac
abnormalities using late gadolinium enhancement (LE) cardiac magnetic resonance imaging
(cMRI) during cytostatic treatment under experimental conditions.
Methods: Fifteen pigs received either DOX (n¼6) or MYO (n¼9) in 3 cycles of cytostatic
treatment of human dose, with 3 weeks between the treatments. cMRI with LE were per-
formed before treatment start and at 3 weeks after the last dose application. The left (LV) and
right (RV) ventricular systolic (ejection fraction, EF), and diastolic (peak filling rate, PFR)
function were automatically calculated. Myocardial fibrosis was assessed as hyperintensity in
LE diastolic phase images. Routine blood parameter such as number of leukocytes, red blood
cells and thrombocytes were counted and liver, kidney parameter and electrolytes were
measured before each treatment cycle and at the final follow-up. Left and right myocardial
segments were stained with Picrosirius red to quantify cardiac fibrosis via histology.
Results: Five of 6 of DOX and 6 of 9 MYO animals completed the study. The baseline
cMRI and laboratory parameter were similar in the groups. LV EF (56.4
5.6% vs
41.9
13.5%, p¼0.039) and RV EF (42.1
2.8% vs 28.9
8.9%, p¼0.009) were signifi-
LV diastolic function in MYO group (PFR: 10.7 +/- 4.8 vs 7.9+/-2.5 ml/s). Myocardial
fibrosis was found in 33% vs 60% of the animals in MYO vs DOX groups. Histology
confirmed the presence of myocardial fibrosis in the myocardium (LV: 5.8
4.1% vs
6.6
2.9% of the entire LV; and RV: 6.2
1.9% vs 8.6
3.9% of the entire RV).
Conclusion: The liposomal-encapsulated doxorubicin-citrat (MYO) proved to be less
cardiotoxic as compared with DOX, resulting in higher LV systolic and better diastolic
function with trend towards less LV and RV myocardial fibrosis in an experimental model
of cardiotoxic therapy.
Disclosure of Interest: None Declared
PM095
Atrial Fibrillation Independently Predicts Short And Long-Term Mortality After
Aortic Valve Replacement
Tom Kai Ming Wang*1, David H.-M. Choi1, Tharumenthiran Ramanathan1, Peter Ruygrok1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia, becoming
increasing prevalent as the population ages, and an important risk factor for stroke. There is
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
conflicting results around whether AF is associated with adverse outcomes after aortic valve PM098

POSTER ABSTRACTS
replacement (AVR) amongst the few studies that have investigated this.
Objectives: We compared the characteristics and outcomes of patients undergoing AVR by Development of A Novel, Fenestrated Aortic Arch Stent Graft With A Preloaded
history of AF. Catheter For Protecting Branch Arteries: An Experimental Study In Swine
Methods: Isolated AVR patients at Auckland City Hospital 2005-2012 were divided into Han Cheol Lee*1, Jae Hoon Choi2, Jin-Sup Park1
those with and without pre-operative AF for comparative analyses. 1
Cardiology, Pusan National University Hospital, 2Cardiology, Busan Medical Center, Busan,
Results: Amongst 620 patients, 19.2% (119) had permanent or paroxysmal AF pre-
Korea, Republic Of
operatively. Patients with AF were significantly older (70.5 vs 63.4 years, p<0.001),
had higher proportion of New Zealand European (82.4% vs 68.1%, p¼0.004), urgent Introduction: TEVAR shows limitations in cases where the aortic pathology involves
or emergency operation (62.1% vs 48.3%, p¼0.016), NYHA class III-IV (55.4% vs the aortic arch and only a short proximal landing zone is thereby available for the stent
37.4%,p¼0.004), history of stroke (10.9% vs 5.0%, p¼0.031), pulmonary hyperten- graft.
sion (27.8% vs 16.2%, p¼0.002), lower creatinine clearance (73 vs 82, p¼0.001) and Objectives: In this study, we developed a fenestrated aortic arch stent graft (FASG) with a
higher EuroSCORE II (5.2% vs 3.4%, p<0.001). Operative mortality (6.7% vs 2.0%, two preloaded catheter for protecting branch arteries and performed a preclinical study
p¼0.012) and composite morbidity (27.7% vs 16.5%, p¼0.006) were also higher in with this device in swine.
AF. After adjusting for significant variables, pre-operative AF remained an independent Methods: The FASG is a self-expandable nitinol-PTEF stent graft with round shape
predictor of operative mortality odds ratio 3.38 (95% confidence interval 1.18-9.69), fenestration and preloading catheter that is designed to access carotid and subclavian
mortality during follow-up 2.36 (1.44-3.87) and prolonged ventilation>24 hours 2.48 artery safely. We design a round shape fenestration and preloading catheter placed
(1.32-4.69). inside the stent graft to save blood flow to the carotid and subclavian artery. After
Conclusion: AF was associated with a number of cardiovascular and cardiac surgery risk FASG is partially deployed, 0.035 inch guidewire is placed into the carotid artery,
factors, but remained independently associated with short and long-term mortality. AF assembling round shape fenestration into carotid artery, and then stent graft is fully
should be incorporated into cardiac surgery risk models and AF ablation be considered deployed. Following seperate stent grafts for carotid arteries are deployed. Six FASGs
when AVR is performed. with 1 preloaded catheter and 1 side branch stent graft (1-branch FASG) and 5 FASGs
Disclosure of Interest: None Declared with 2 preloaded catheters and 2 side branch stent grafts (2-branch FASG) were
advanced through the iliac artery in 11 swines weighing 70–80 kg. The presence of
PM096 endoleaks and the patency and deformity of the grafts were examined with computed
tomography (CT) at 4 weeks postoperatively. A postmortem examination was per-
Warfarin and Post-Discharge Survival After Acute Pulmonary Embolism in formed at 8 weeks to evaluate the gross morphology, patency, and deformity of the 1-
Octogenarians branch and 2-branch FASGs.
John P. Moutzouris*1, Austin C. C. Ng1, Vincent Chow1, Tommy Chung1, Results: The mean procedure time for the 1-branch and 2-branch FASG groups was 31.0
Vasikaran Naganathan2, Leonard Kritharides1
5.0 and 45.8
9.6 minutes, respectively. Meanwhile, the mean time for the selection of
1 the carotid artery was 4.8
0.7 minutes and 6.8
2.5 minutes, respectively. There was a
Cardiology, 2Geriatric Medicine, Concord Hospital, Sydney, Australia
major adverse event in the 11 pigs. One pig died at 4 weeks after the CT examination, likely
Introduction: The clinical characteristics of octogenarians or older (age 80-years) with because of the effects of the high dose of ketamine used for the CT examination, while the
acute PE remain poorly defined and predictors of short-term mortality in these patients are remaining 10 pigs survived the 8-week observational period. For both the 1-branch and 2-
unknown. branch FASG groups, no endoleaks, no disconnection of the stent grafts, and no occlusion
Objectives: Examine the outcomes of octogenarians following an acute PE event. of the stent grafts for the carotid arteries were observed in the CT findings at 4 weeks.
Methods: Clinical details of all patients admitted to a tertiary institution from Moreover, no disconnection or tearing of the stent grafts, no fractures in the stent grafts,
2000–2007 with acute PE were retrieved retrospectively. Outcomes were tracked and no occlusion of the stent graft for carotid arteries were found in the postmortem gross
from a statewide death registry and analyses performed using binary regression findings.
modelling. Conclusion: The FASG with the preloaded catheter developed here was found to be safe
Results: Of the 1023 patients included in this study, 273 (26.7%) were aged 80-years. and convenient to use in this preclinical study with swine.
Patients 80-years were more likely to be females (66% vs. 51%), had higher rates of Disclosure of Interest: None Declared
ischaemic heart disease (34% vs. 16%), heart failure (24% vs. 9%), atrial fibrillation (26%
vs. 12%) and neurodegenerative disease (15% vs. 3%), and were less likely to present with
chest pain (48% vs. 64%), compared to patients <80-years (all P0.01). Table 1 shows the
cohort’s outcomes. PM099
Clinical presentation and prognosis of patients with acute aortic intramural
Table 1. All-cause mortality – no.(%, 95% confidence interval [CI])
hematoma
Study cohort (n¼1023) Age<80 (n¼750) Age80 (n¼273) Jovan P. Perunicic*1, Bosiljka Vujisic Tesic2, Ratko Lasica1, Nebojsa Radovanovic1,
In-hospital mortality 31 (3.0,2.1-4.3) 20 (2.7,1.7-4.1) 11 (4.0,2.3-7.1) Igor Mrdovic2, Marko Milanov1, Mladen Kocica3, Igor Koncar4, Lazar Davidovic4, Petar Djukic3
1
30-day mortality 41 (4.0,3.0-5.4) 27 (3.6,2.5-5.2) 14 (5.1,3.1-8.4) Emergency center, 2Clinical of cardiology, 3Cardiosurgery clinic, 4Clinic of vascularsurgery,
Clinical center of Serbia, Belgrade, Serbia
3-month mortality 85 (8.3,6.8-10.2) 57 (7.6,5.9-9.7) 28 (10.3,7.2-14.4)
Introduction: Acute aortic intramural hematoma (IMH) is an important subgroup of aortic
dissection.
Objectives: To evaluate clinical presentation, early and late prognosis of patients with acute
Survival did not differ significantly between patients 80-years and <80-years. Amongst aortic IMH.
patients 80-years, univariate predictors of all-cause mortality at 3-months included a Methods: 297 consecutive patients with acute aortic syndrome diagnosed in our hospital
history of hypertension (hazard ratio [HR] 0.22), malignancy (HR 4.42), presenting with from 1988-1999 were evaluated. Of these patients, 25 (8.4%) had IMH ( 7 type A [28%],
chest pain (HR 0.20), oxygen saturation <90% (HR 4.18), and not being discharged on 18 type B [72%]).
warfarin (HR 6.36) (all P0.05). Multivariate analysis showed patients 80-years who Results: Patients with IMH were older (67,36
13,51 years vs 54,7
11,9 years;
survived to discharge, but were not discharged on warfarin, had an 11.8-fold increased risk p<0.001). Clinical characteristics of patients with IMH did not differ significantly from AD
of all-cause mortality at 3-months (Table 2). except the absence of neurological symptoms at initial presentation.
Initially five patients with IMH type A and only one with type B IMH were managed
surgically and all of them survive. Two patients with IMH type B were managed with
Table 2. Multivariate analysis (only univariate predictors with P<0.10 were included) endovascular stent-grafting because of aortic rupture and pseudoaneurysm.
Early progression of IMH in AD (2 patients), persistent pain with coronary malperfusion
Variables Adjusted HR 95% CI P-value
(2 patients) and aneurysmatic dilatation of aorta were indications for early surgical inter-
Not discharged on warfarin 11.76 1.75-78.84 0.01 vention in type A IMH.
Chest Pain 0.19 0.03-1.07 0.06 Intrahospital survival of patients with IMH is better than in AD irrespective of type
(85.7% vs 45.8% in type A and 94.5% vs 78.5% in type B). In long-term follow-up (mean
Hypertension 0.15 0.01-1.31 0.09 39 months), complete resolution or regression occurs in about half of patients with IMH
Malignancy 2.56 0.54-12.53 0.23 (47.6%) while the progression of aortic diameter and aortic dissection were noted in 52.4%
Oxygen saturation <90% 1.81 0.33-9.94 0.50 patients.
Late complications of IMH – further dilatation of aorta, progression to aortic dissection
or aortic rupture were present only in patients with aortic diameter at presentation >
50mm and IMH thickness >11mm.
Conclusion: Elderly patients with PE have a greater burden of cardiovascular and Conclusion: Acute IMH has similar presentation to classic AD. In opposite of classic AD,
neurodegenerative diseases and more commonly present without chest pain. Absence of IMH type B is more prevalent than type A. Intrahospital survival of patients with IMH,
anti-coagulant treatment at discharge was independently associated with a significantly irrespective of type, is better than in classic AD. Older age, larger diameter of diseased aortic
increased short-term mortality in this population. segment and thicker IMH are predictors of unfavorable long-term prognosis.
Disclosure of Interest: None Declared Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e81

 PM100 PM102
POSTER ABSTRACTS

Systemic inflammatory activation and endothelial dysfunction predict development
of aortic valve stenosis in bicuspid aortic valve
Thanh H. Nguyen*1, Onn A. Ali2, Matthew Chapman2, Juan Mundisugih1, Tamila Heresztyn1,
Yuliy Chirkov1, John D. Horowitz2
1 3
Cardiology, Basil Hetzel Institute, The University of Adelaide, Australia, 2Cardiology, The
Queen Elizabeth Hospital, Adelaide, Australia
Introduction: Aortopathy and valvular stenosis/regurgitation are frequent complications in
patients with bicuspid aortic valve (BAV). However, both the occurrence and progression of
the complications vary markedly between individuals, and the biochemical/physiological
factors modulating this heterogeneity remain unidentified.
Objectives: The objective of the current study was to identify biochemical correlates of
aortopathy and valve dysfunction among BAV patients.
Methods: 41 BAV patients aged 45
16 (SD) years were evaluated clinically and with echo/
MRI. Inflammatory activation was assessed via hs-CRP and myeloperoxidase (MPO) levels,
endothelial function/NO responsiveness via flow-mediated dilatation (FMD), plasma
asymmetric dimethylarginine (ADMA) levels, inhibition of platelet aggregation by SNP, and
endothelial progenitor cell counts (EPCs). Biochemical/physiological correlates of valve
dysfunction and aortic dimensions were sought via univariate and multiple linear regres-
sion analyses.
Results: Extent of aortic stenosis, measured via AV max and velocity ratio (DPI), were
significantly correlated with hs-CRP (r¼0.49, p¼0.001), MPO (r¼0.5, p¼0.001),
FMD (r¼0.45, p¼0.003) (see Figure), and ADMA (r¼0.43, p¼0.006) on univariate
analysis. On multivariate analysis, plasma MPO (b¼0.47; p¼0.001), ADMA concen-
trations (b¼0.44; p¼0.003), and FMD (b¼0.47; p¼0.003) were independent pre-
dictors of extent of severity of aortic valve stenosis. The only significant correlate of
increasing aortic dimensions on multivariate analysis was increasing age (b¼0.47;
p¼0.03).
Approaches For Transcatheter Aortic Valve Replacement: A Systematic Review And
Meta-Analysis
Vinayak Nagaraja*1, Jwalant Raval2, Guy D. Eslick3, A. Robert Denniss2
1
Cardiology, Prince of Wales Hospital, University of Sydney, 2Cardiology, Blacktown Hospital,
The University of Sydney, Sydney, Australia
Introduction: Retrograde transfemoral and antegrade transapical approaches are mostly
used for transcatheter aortic valve replacement.
Objectives: This meta-analysis is designed to assess the performance of the transfemoral
and transapical approach.
Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Cur-
rent Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of
Science. Original data was abstracted from each study and used to calculate a pooled odd
ratio (OR) and 95% confidence interval (95% CI).
Results: Only 14 studies comprising of 6965 patients met full criteria for analysis.
The mean duration of hospitalisation and procedure duration were similar among the 2
cohorts. The 30 days mortality (OR:0.70, 95% CI:0.531-0.921), major bleeding incidence
rates (OR:0.77, 95% CI: 0.488-1.225), coronary obstruction (OR:0.74, 95% CI:0.234-
2.311), myocardial infarction (OR: 0.75, 95% CI: 0.28-2.00), conversion to open cardiac
surgery (OR: 0.29, 95% CI: 0.062-1.343), successful implantation (OR: 0.67, 95% CI:
0.394-1.149), the need for haemodialysis (OR: 0.29, 95% CI:0.157-0.525) and one year
mortality (OR:0.72, 95% CI: 0.564-0.927) were lower in the transfemoral cohort. The
frequency of stroke at 30 days and new pacemaker insertion were comparable. However,
the prevalence of aortic regurgitation (OR: 1.25, 95% CI: 0.844-1.855), vascular compli-
cation (OR: 2.88, 95% CI: 1.821-4.563) and valve embolization (OR: 2.00, 95% CI: 0.622-
6.448) was higher in the transfemoral group.
Conclusion: In the absence of a randomized controlled study, the ability to discriminate
true differences is challenging. Even though the complications rate was much lower in
transfemoral group as compared to transapical group, the current literature does not
support a clear superiority of one approach to TAVR over the other.
Disclosure of Interest: None Declared

PM103
Diastolic Pressure Gradient: A Predictor of Residual Pulmonary Hypertension And
Vascular Stiffness After Endarterectomy For Chronic Thromboembolic Pulmonary
Hypertension
Juan C. Grignola*1, María José Ruiz Cano2, Miguel Angel Gómez Sánchez2, Pilar Escribano2
1
Pathophysiology, Hospital de Clinicas, Universidad de la República, Montevideo, Uruguay,
2
Pulmonary Hypertension and Heart Transplantation Unit, Hospital Universitario 12 de
Octubre, Madrid, Spain
Conclusion: In patients with BAV, development of aortic stenosis is correlated with both
inflammatory activation and endothelial dysfunction. However, these parameters do not Introduction: Elevated diastolic pulmonary pressure gradient (DPG) was associated with
explain the development of aortopathy, for which other pathophysiological mechanisms more advanced pulmonary vascular disease and increased mortality in patients (p) with
must be sought. reactive pulmonary hypertension (PH) due to left-sided heart disease. Pulmonary endar-
Disclosure of Interest: None Declared terectomy (PEA) offers a substantial decrease in right ventricular (RV) dynamic afterload
and an increase in cardiac index (CI) in p with chronic thromboembolic PH (CTEPH).
Objectives: We hypothesized that a persistent increase of DPG is associated with a residual
PH and vascular stiffness after ’successful’ PEA in p with CTEPH.
PM101 Methods: Twenty four CTEPH p (16 men, 51
15 years) who underwent PEA between
Transcatheter Vs. Surgical Aortic Valve Replacement: A Systematic Review And 2004 and 2010 were studied. RV catheterization was performed preoperatively (Pre-PEA)
Meta-Analysis Of Randomized And Non-Randomized Trials and Post-PEA (22
16 months). We analyzed pulmonary arterial resistance (Rp), capaci-
tance index (Cp: stroke volume/pulse pressure), transpulmonary gradient (TPG), DPG
Vinayak Nagaraja*1, Jwalant Raval2, Guy D. Eslick3, Andrew T. Ong4 (mean pulmonary arterial pressure-PA occlusion pressure; Pm-Paop) and time constant
1
Cardiology, Prince of Wales Hospital, University of Sydney, 2Cardiology, Blacktown Hospital, (Tau: RpCp). The study population was split into two groups according to the upper
3
The University of Sydney, 4Cardiology, Westmead Hospital, Sydney, Australia limit of normal DPG (DPG<6 mmHg and DPG6 mmHg). We defined residual PH and
residual vascular stiffness as Rp>3 wood U and Cp<2.5 ml/mmHg, respectively.
Introduction: Many patients deemed inoperable for surgical aortic valve replacement Results: PEA improved NYHA Functional Class (2.8
0.5 vs 1.8
0.5) and 6MWD
(SAVR) have been treated successfully by transcatheter aortic-valve replacement (TAVR). (340
108 vs 460
83 m), increased CI (2.3
0.5 vs 2.8
0.5 l/m) and Cp and reduced Pm,
Objectives: This meta-analysis is designed to evaluate the performance of TAVR in com- Rp, TPG and DPG (p<0.05). Paop did not show significant changes. The group of DPG<6
parison with SAVR. mmHg showed the highest Rp decrease and Cp increase, with a significant Tau decrease.
Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Cur- Accordingly, only 9% of p persisted with residual PH and pulmonary stiffness, with a 73%
rent Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of of TPG normalization. However, this was not associated with a higher improvement in
Science. Original data was abstracted from each study and used to calculate a pooled odd functional status with respect to DPG6 group. A persistent abnormal DPG after PEA
ratio (OR) and 95% confidence interval (95% CI). showed a ROC area of 0.954 (0.86-1.047) and 0.846 (0.676-1.016) for discriminating
Results: Among the two randomized controlled trials (RCTs): the frequency of stroke (OR: residual PH and vascular stiffness, respectively (93% and 91% of sensitivity and 100% and
1.94, 95% CI: 0.813-4.633) was higher in the TAVR cohort, while the incidence of 77% of specificity, respectively).
myocardial infarction, (OR: 0.765, 95% CI: 0.05-11.76) 30 day mortality rate and acute
kidney injury incidence rate were comparable.
The results of the 36 non RCTs demonstrated that the TAVR group had an amplified DPG<6 (11) DPG‡6 (13)
frequency of pacemaker insertion (OR: 3.169, 95% CI: 2.338-4.294), major vascular Pre-PEA Post-PEA Pre-PEA Post-PEA
complication (OR: 7.117, 95% CI: 2.287-22.149) and aortic regurgitation at discharge
(OR: 7.412, 95% CI: 3.695-14.868). While the incidence rate of 30 day mortality and Pm, mmHg 46
13 22
7x 47
16 34
12x{
myocardial infarction were comparable. A lower incidence of new-onset atrial fibril- TPG, mmHg 36
13 11
6x 38
14 25
9x{
lation, patients needing transfusion and was observed in the TAVR cohort. The sub-
DPG, mmHg 14
10 1.0
2.4x 17
7 12
4x{
group analysis of statistically sound studies did not differ from the crude analysis
considerably. Rp, wood U 8.4
4.2 2.0
1.3x 9.7
3.7 5.4
2.4x{
Conclusion: Results demonstrate both the future promise and current problems of the Cp,ml/mmHg 1.1
0.5 3.6
1.4x 1.0
0.5 1.9
0.9x{
TAVR approach. The future is expected to be more prosperous as new developments and
data from ongoing trials will provide the background to expand TAVR applications and Tau, s 0.45
0.1 0.34
0.1x 0.53
0.1 0.54
0.1{
establish their position in a broader spectrum of patients. Mean
SD. xP<0.05 vs Pre-PEA, {P<0.05 vs DPG<6
Disclosure of Interest: None Declared

e82 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: DPG is an important predictor of incomplete dynamic afterload recovery Post- diagnosis was confirmed on transesophageal echocardiogram (TOE), however all these

PEA. Whether this is related to surgically inaccessible chronic thromboembolic disease or
to a distal vasculopathy is uncertain.
Disclosure of Interest: None Declared
PM104
Melatonin Protects Against Hemodynamic Alterations In Rats With Pulmonary
Arterial Hypertension (Pah) Induced By Monocrotaline
Luiz Alberto F. Ramos*1, Felix G. R. Reyes1,2, Dora M. Grassi-Kassisse1, Miguel A. Areas1
1
Biology Structural and Physiology, 2Food of Toxicology, State University of Campinas -
Unicamp, Campinas, Brazil
Introduction: Pulmonary Arterial Hypertension (PAH) is characterized by thickening of
vascular smooth muscle cells, affecting the cardio respiratory system. Monocrotaline (MCT)
is an alkaloid and an animal model of PAH in rats by cardiovascular alterations. Melatonin
(MEL) is a hormone produced by pineal gland, can reduce the smooth muscle vascular
tone, and also modulate the hemodynamic parameters.
Objectives: To evaluate the effect of melatonin in the treatment of monocrotaline-induced PAH.
Methods: Male Wistar rats (250g.) were divided into four groups: CO (control), MCT
(monocrotaline, MEL (melatonin), five animals per group (n¼5). MCT was administered as
a single dose intraperitoneal (ip) (60mg/Kg ip) to induce PAH. Melatonin was administered
(10mg/Kg ip) during 28 days of experimental period, after this phase, the animals were
anesthetized (ketamin 100mg/Kg. plus xilazine 7mg/Kg intramuscular) to obtain the he-
modynamic parameters and molecular analysis of the heart. Statistical procedure: Analysis
of Variance (ANOVA) followed by Tukey test for comparison between groups (p<0.05).
Results: Reduced mean arterial pressure (Diastolic pressure, Systolic Pressure); Reduction
the ventricular pressure(max dP/dt, min Dp/dt, Tau);
POSTER ABSTRACTS
patients had suboptimal views or valvular structural abnormalities on TTE.
Tricuspid valve (TV) IE occurred in 51%, Mitral valve (MV) 26%, Aortic valve (AV) 21%, left
ventricular outflow tract 2% with no pulmonic valve IE. Aortic root abscess occurred in 6%.
Vegetations greater than 1cm were seen in 85% of TV IE compared to 46% of left sided IE (p <
0.01). Perforation of the valve or severe regurgitation occurred in 44% of left sided IE and 44% TV
IE. Embolism was associated with 40% of left sided IE compared to 78% of TV IE (p < 0.03). The
majority of TV IE embolised to the lung (67%), 28% of left sided IE embolised to the brain, of
which 57% had vegetations less than 1cm (p < 0.03). Surgery was performed in 26% with 39%
of left sided IE requiring surgery compared to 15% of TV (P < 0.051). Predictors for surgery were
aortic root abscess (100%), severe regurgitation/perforation (57%), size of vegetation greater than
1cm (64%), prosthetic valve IE (67%) and embolism (50%) (P < 0.01). At 1 year 13% died, with
85% within 30 days. 1 year mortality was 27% for AV IE, 7% for MV and 11% for TV.
Conclusion: In our cohort IVDU was the strongest risk factor for developing MSSA IE. In a
normal TTE with optimal views and without underlying valvular pathology a TOE may not
be indicated. MSSA IE is highly virulent with valvular destruction often requiring surgery
and a high rate of systemic embolism irrespective of vegetation size. The majority of TV IE
had severe regurgitation, however were medically treated without requiring surgery and
had a good outcome at 1 year.
Disclosure of Interest: None Declared
PM106
What Is The Morbimortality of The Infective Endocarditis Associated Cardiovascular
Implantable Electronic Devices?
Gabriel Perez Baztarrica1, Flavio Salvaggio1, Sebastian Villecco1, Rafael Porcile*1,
Norberto Bornancini1, Ricardo Levin1, Ramiro Acevedo2, Fernando Bosio2, Luis Llanos Mestra1
1
Department of Cardiology and Physiology, 2Universitary Hospital, Universidad Abierta
Interamericana, Faculty of Medicine, Buenos Aires, Argentina

Introduction: Infective endocarditis (IE) associated to permanent implantable electronic

dispositive (PIED) is a complication with variability mortality according different authors.
Some questions based on this information when: What is the current mortality? What
disparity explains mortality?
Objectives: The objectives were to evaluate in-hospital and long term mortality and
morbidity with the current algorithms for management and analyzed some factors that
explain the differences with published mortality.
Methods: Patients were studied retrospectively between May/2002 and March/2011 once a
diagnosis of IE associated to PIED had been established. Basal characteristics, diagnosis,
therapeutical, in-hospital and long term outcomes were analyzed. Continuous variables
were expressed as median and interquartile ranges (RIC), and discrete variables were
expressed by absolute values and percentages. Statistical data management was performed
using the statistics pack Microsoft Excel version 2010.
Results: Included 26 cases treated in our hospital, 23 of whom were referred from other centers
for diagnosis and treatment. The average age was 67.5 years. All patients received antibiotics for six
weeks and were removed system completely. Transvenous removal was performed in the 95%
patients and in 2 patients was required median sternotomy, atriotomy and epicardial pacemaker
placement. Median time until removal of an infected device was 44 hs (42.5-51.5. Median time to
reimplantation was 43 days (RIC 42-44). In-hospital mortality was 4% and the follow-up was nil.
The hospital morbidity was 31%. In the follow-up there was no reinfection or other complication.
Conclusion: Melatonin treatment was able to reduce the changes in peripheral resistance
and cardiovascular alterations in rats with PAH.
Reference:
Paulis L., Simko F., Blood Pressure Modulation and Cardiovascular Protection by Mela-
tonin: Potential Mechanisms Behind. Physiol. Res. 56: 671-684, 2007.
Garvan C. Kane, Hilal Maradit-Kremers, Josh P. Slusser, Chris G. Scott. Integration of
Clinical and Hemodynamic Parameters in the Prediction of Long-term Survival in
Patients with Pulmonary Arterial Hypertension. CHEST / 139 / 6 / JUNE, 2011
Disclosure of Interest: None Declared

PM105
Characteristics of Methicillin Sensitive Staphylococcus Aureus Infective
Endocarditis: Eight-Year Retrospective Study
Abdul Rahman Ihdayhid*1, Owen Robinson2,3, Imran Sheikh1, Muhammad Shoaib1,
Gabrielle Sicari1, Carl Schultz1,4, Xiao-Fang Xu1
1
Cardiology Department, 2Microbiology and Infectious Diseases Department, PathWest
Laboratory Medicine, Royal Perth Hospital, 3ACCESS Typing and Research, School of Biomedical
Sciences, Curtin University, 4School of Medicine and Pharmacology, University of Western
Australia, Perth, Australia
Introduction: Methicillin Sensitive Staphylococcus aureus (MSSA) is a common cause of
infective endocarditis (IE).
Objectives: The aim of the study was to understand the risk factors for developing MSSA
IE and the subsequent complications and outcomes.
Methods: Blood culture positive MSSA was routinely recorded in a database from 2005-
2012. We retrospectively identified all patients who developed IE. We reviewed de-
mographic, risk factors, echocardiogram findings, complications and outcome.
Results: A total of 53 patients with MSSA IE were included. The median age was 41 years.
91% were community acquired. The main risk factors were Intravenous Drug Use (IVDU)
(64%), previous IE (15%), previous staphylococcus infection (13%) and prosthetic valve
(11%). Transthoracic echocardiogram (TTE) failed to show vegetations in 19% of IE whose

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e83

 Conclusion: In conclusion, has a high morbidity with a prolonged hospitalization but PM109
POSTER ABSTRACTS

mortality is low. The explanation may lie in the percutaneous techniques, experience,
complete extraction, the time of reimplantation of the new device and early treatment Do patients with congenital bicuspid aortic valves have different aortic root
between other factors. geometry? Implications for transcatheter aortic valve implantation (TAVI)
Disclosure of Interest: None Declared Laura Dobson1, Robert Gooley2, Ian Agahari*1, Philip Mottram1, Stuart Moir1
1
Non-Invasive Imaging, MonashHeart, 2Monash Cardiovascular Research Centre, Melbourne,
Australia
PM107
Introduction: Bicuspid aortic valve (cBAV) is the most common adult congenital cardiac
Abstract Withdrawn malformation and is associated with aortopathy. Recently presented data has found that
although technically feasible, TAVI in patients with cBAV is associated with a higher rate of
relevant aortic regurgitation when compared to patients with a trileaflet valve.
Objectives: We sought to determine whether there were differences between the size and
PM108 degree of eccentricity of the left ventricular outflow tract (LVOT), aortic root, aortic sinuses
and ascending aorta in patients with cBAV compared to age, sex and size matched controls
Rising Injecting Drug Use Associated Endocarditis - A Major Regional Centre
using cardiac CT derived measurements.
Experience from the Last Decade
Methods: We evaluated 34 consecutive patients (76% male, aged 21 to 83, mean (SD) 49
Matthew K. Y. Tung*1, Rinky Giri2, Melanie Light2, Alan Appelbe1, Stephen Lane3, (13) years) with an echocardiographically confirmed cBAV who underwent 320 slice CTCA
Eugene Athan4 evaluation at our centre over a 5 year period. LVOT and aortic root diameters were
1
Geelong Cardiology Group, Barwon Health, 2Deakin University, 3Barwon Health, Geelong, measured by using double oblique reconstruction from axial source images. Eccentricity
Index was calculated with the following calculation: maximum diameter/minimum diam-
Australia, 4Department of Infectious Diseases, Barwon Health, Geelong, Australia
eter. Measures were compared with controls matched for age, sex and body surface area.
Introduction: Infective endocarditis (IE) is associated with high morbidity and mortality. Results: See Tables.
Injecting drug use (IDU) is an established risk factor for IE. Semi-quantitive measures of
IDU in our region point to a trend of increasing rates of IDU. A contemporary under-
standing of the evolving epidemiology of IE and IDU is vital for optimal planning and Tricuspid aortic valve Bicuspid aortic valve P Value
delivery of health care for this disease. Max/min LVOT 29.42
4.24 / 20.06
2.77 31.66
4.93 / 23.05
4.20 0.04/<0.001
Objectives: To examine the relationship between IDU and IE over a 10-year period in a dimension (mm)
single tertiary referral centre.
Methods: We retrospectively analysed two cohorts of consecutive patients (n¼226) LVOT area (mm2) 463
127 588
188 0.002
admitted to the Geelong hospital diagnosed with Duke definite IE. We utilized the In- Max/min annular 27.53
3.31 / 22.03
2.41 30.28
4.66 / 25.24
4.30 0.007/<0.001
ternational Collaboration on Endocarditis (ICE) dataset from 2002-2013. Numbers of dimension (mm)
cases and rates of IE (both IDU and non-IDU related) were compared between two Annular area (mm2) 470
105 603
177 <0.001
cohorts of patients (Cohort 1 2002-2006, Cohort 2 2009-2013). Case data was not Max/min sinus 34.16
4.67 / 31.66
4.17 40.37
6.58 / 34.96
7.14 <0.001/0.02
available for 2007-2008 and the first third of 2009. The at risk population for the dimension (mm)
calculation of IE and IDU associated IE was taken to be the 2006 Geelong (SA4) sta-
tistical area for the first cohort, and 2011 for the second cohort. Rate ratios and con- Sinus area (mm2) 854
224 1159
436 <0.001
fidence intervals were calculated using Poisson distributions. Poisson regression was used Max/min annular 29.51
3.33 / 28.75
3.38 38.84
8.17 / 37.52
7.89 <0.001/<0.001
to further examine the relationship over time of the number of IDU associated IE cases dimension (mm)
over the study period, with an offset adjusting for the total number of IE cases per year LVOT eccentricity 1.47
0.13 1.39
0.17 0.03
and the fraction of the year observed.
Annular eccentricity 1.25
0.09 1.21
0.16 0.19
Results: 130 cases of duke definite endocarditis were seen in the first observation
period (6 IDU associated) and 96 in the second observation period (15 IDU associated). Sinus eccentricity 1.08
0.07 1.17
0.12 <0.001
The estimated rate of IE in the region has fallen from 16.78 to 11.91 per 100000 Ascending aorta 1.03
0.02 1.04
0.03 0.14
person-years (rate ratio 0.71 for Cohort 2 compared with Cohort 1, 95% CI 0.54, eccentricity
0.93). However, the estimated rate of IDU associated IE has risen from 0.77 to 1.86
(rate ratio 2.40, 95% CI 0.94, 6.30). Based on annualised rate regression for each
increase of 1 year, the number of IDU associated IE cases is expected to increase by a Conclusion: Consistent with known aortopathy, patients with cBAV had significantly
factor of 1.25 (95% CI 1.09-1.44). larger annular, trans-sinus and ascending aorta dimensions when compared to controls,
although there was no difference in eccentricity at the annular level. Interestingly cBAV
patients had a larger, but less eccentric LVOT. These geometrical differences should be
taken into consideration when assessing TAVI suitability in patients with bicuspid aortic
valve.
Disclosure of Interest: None Declared

PM110
Novel Hematologic Inflammatory Parameters In Prediction of Prosthetic Valve
Thrombosis
Mustafa O. Gürsoy1, Süleyman Karakoyun1, Macit Kalçık1, Tayyar Gökdeniz1, Mahmut Yesin1,
Sabahattin Gündüz1, Mehmet Ali Astarcıoglu1, Mehmet Ozkan*1
1
Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey

Introduction: Prosthetic valve thrombosis (PVT) is a life-threatening complication of heart

valve surgery. Novel hematologic parameters, neutrophil/lymphocyte (NLR) and platelet/
web 3C=FPO

Conclusion: In a large regional centre over the last ten years there has been a decrease in
the rate and total number of cases of IE but a rise in the rate and number of cases associated
with IDU. This alarming change may be a signal of increasing IDU or increased rates of
endocarditis in intravenous drug users in this region. This finding may provide useful
information to inform clinical and public health care planning in the region.
Disclosure of Interest: None Declared
lymphocyte ratio (PLR), are recently studied as inflammatory biomarkers in coronary artery
diseases. However, data regarding valvular heart disease are lacking.
Objectives: To evaluate the role of NLR and PLR in patients with PVT.
Methods: The study population (n¼316) included patients with mitral PVT (n¼ 152)
versus control subjects (n¼164) with functional mitral prosthesis. Transesophageal echo-
cardiography was performed to diagnose PVT. NLR and PLR were calculated using data
obtained from the complete blood count which was taken at the time of admission before
the administration of any fibrinolytic therapy. CRP levels were also analyzed.
Results: The mean age of the study population was 49
14.6 years. There was no
significant difference between age and sex among 2 groups. Neutrophil and platelet levels
did not differ between the groups (4.9
2.0 vs 4.7
1.5, p¼ 0.84 and 254.8
89.7 vs
241.5
62.8 p¼0.36, respectively), but lymphocytes were significantly lower in PVT
patients than the control subjects (1.8
0.7 vs 2.2
0.6; p< 0.001). NLR, PLR and CRP
levels were significantly higher in PVT patients when compared with control subjects
(3.2
2.1 vs 2.2
0.8; p< 0.001, 163
77.5 vs 114.9
37.3; p <0.001, 1.97
3.02 vs
1.02
1.22, p¼0.01, respectively). A strong positive correlation was observed between
NLR and PLR (r¼528, p<0.001). NLR level of >2.23, measured upon admission,
yielded an AUC value of 0.659 (CI 95%: 0.582-0.736, sensitivity: 66%, specificity: 60%;

e84 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

p<0.001) and PLR level of >117.78 yielded an AUC value of 0.707 (CI 95%: 0.636-
0.777, sensitivity: 70%, specificity: 58%; p< 0.001). Multivariate analysis showed that
increased PLR and inadeaquate anticoagulation were independent predictors for throm-
bosis in patients with PVT.
Conclusion: This was the first study that evaluated NLR and PLR in patients with PVT.
PVT patients had increased NLR, PLR and CRP levels when compared with subjects with
normofunctional prosthesis. Furthermore, multivariate analysis showed that increased PLR
was an independent predictor for thrombosis in patients with PVT. Further studies are
needed to confirm these findings.
Disclosure of Interest: None Declared
PM111
Mitral Valve Perforation Among Patients Seen At The Uganda Heart Institute: A
Series of Twelve Cases
Twalib O. Aliku*1, Emmy Okello2, Sulaiman Lubega3, Peter Lwabi3
1
Paediatrics and Child Health, Gulu University, Gulu, 2Adult Cardiology, 3Paediatric
Cardiology, Uganda Heart Institute, Kampala, Uganda
Introduction: Mitral valve perforation is a rare complication of infective endocarditis that is
associated with significant morbidity, especially in those receiving inadequate therapy. In
Africa few centres routinely perform valve surgeries.
Objectives: We describe the clinical presentation and outcomes of patients with echo-
cardiographically diagnosed mitral valve perforations that have not undergone valve
surgery.
Methods: We reviewed the clinical and echocardiographic data of patients diagnosed to
have mitral valve perforation and on medical followed up at the Uganda Heart Institute
paediatric cardiology division from July 2011 to August 2013.
Results: A total of 12 patients were diagnosed to have mitral valve perforation, 9 being
female. The age range was from 15 months to 26 years. None had had previous cardiac
surgery, chest trauma or cardiac catheterization procedure. A suspected clinical diagnosis
of infective endocarditis was present in five patients prior to initial echocardiography
evaluation. All patients were treated for a febrile illness prior to referral. A positive blood
culture was present in only one patient. Two patients had no predisposing heart lesion;
one had subaortic membrane causing severe left ventricular outflow obstruction and mild
aortic regurgitation, while nine patients had underlying rheumatic heart disease. Mitral
valve perforation was attributable to infective endocarditis in 11 patients who met the
Dukes Criteria, while the twelfth patient had severe aortic regurgitation that could also
cause mitral valve perforation. Only four patients had visible vegetations; in 3 patients
the vegetations were on the mitral valve leaflets and in the other patient on the aortic
valve. Five patients (42%) died within two months of diagnosis. Five of the survivors
have had repeated admissions to hospital for worsening heart failure, including one with
recurrence of infective endocarditis while the other two have NYHA class II heart failure
symptoms.
Conclusion: Rheumatic heart disease is a major underlying cause of infective endocarditis
and mitral valve perforation in our setting. Many patients with mitral valve perforation have
high immediate mortality and significant morbidity without valve surgery.
Disclosure of Interest: None Declared
PM116
First Utilization of the Paieon’s C-THV Guiding System for Transcatheter Aortic
Valve Implantation (TAVI) in an Australian Setting
Matias Yudi*1, Khoa Phan1, Nigel Lewis1, Eliza Teo1, Matthew Brooks1, Caitlin Cheshire1,
James Wong1, Subodh Joshi1, Vanessa Ogden1, Ronen Gurvitch1
1 groups with respect to age (83.7
4.6 vs 84.9
4.6 years, p¼0.45), STS score (6.7%
3.5%
Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Accurate device positioning during transcatheter aortic valve implantation
(TAVI) is essential for optimal results. Recent advances in multimodality imaging have
resulted in adjuvant positioning tools beyond traditional fluoroscopy and echocardiogra-
phy. Paieon’s C-THV system is a real-time image acquisition and processing system
designed to facilitate Edwards-SAPIEN TAVI. The system focuses on four aspects: obtaining
optimal projection, ideal valve diameter selection, accurate positioning for deployment and
post-implantation analysis.
Objectives: Our aim was validation and evaluation of the Paieon C-THV system.
Methods: We describe the first twenty-two patients in Australia who underwent Edward-
SAPIEN-XT TAVI using the Paieon’s C-THV system in conjunction with fluoroscopy,
aortography and echocardiography.
Results: Twenty-two high risk patients underwent TAVI utilizing the Paieon C-THV
guiding system. The mean age was 85
5 years, the mean STS score was 7.5%
2.7%,
74% were female and 82% had TAVI via transfemoral access. Fourteen (64%) patients
required a 23mm valve. In conjunction with aortography and fluoroscopy, the C-THV
system was used to aid optimal deployment. The aorta-LV partition was calculated prior to
deployment and visually correlated with the actual deployment in 21 of 22 cases. The
Paieon C-THV system was found to be a useful adjunct, correctly determining the implant
depth, 3-D implant projections and minimizing the use of contrast media. There were no
cases of valve embolization and no cases requiring a second valve implant secondary to
malposition.
Conclusion: The Paieon C-THV system was successfully used for the first time in an
Australian setting as an adjunctive real time imaging modality to optimise TAVI. It can
successfully predict and guide valve positioning and appears to simplify the procedure.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM117
POSTER ABSTRACTS
Predictors of Prolonged Hospital Stay Following Transcatheter Aortic Valve
Implantation
Matias Yudi*1, Khoa Phan1, Nigel Lewis1, James Wong1, Vanessa Ogden1, Subodh Joshi1,
Roderic Warren1, Marco Larobina1, John Goldblatt1, Ronen Gurvitch1
1
Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Transcatheter Aortic Valve Implantation (TAVI) is an alternative to tradi-
tional aortic valve replacement in high-risk surgical patients. One of the proposed ad-
vantages of TAVI is reduced post-procedural length of stay. Length of hospitalization has an
important role in determining the economic viability of this relatively new procedure.
Objectives: To determine the predictors of prolonged hospitalization (more than 4 days) in
patients undergoing TAVI in a single institution.
Methods: The first fifty patients undergoing successful TAVI with Edward Sapien-XT
valves at Royal Melbourne Hospital were included in this analysis. Patients were divided
into two groups depending on their length of stay, with the early group discharged within 4
days and the prolonged group discharged thereafter. Clinical, echocardiographic, proce-
dural and post-procedural characteristics were evaluated and compared between the
groups.
Results: Of the fifty patients included, 18 (32%) underwent either a trans-apical (17) or
trans-aortic (1) TAVI. 36% of patients were discharged within 4 days, all of which un-
derwent trans-femoral TAVI. Patients with prolonged hospital stay, when compared to the
early discharge group, were more likely to have non-femoral approach (56% vs 0%,
p <0.01), be admitted directly to ICU post-procedure (78% vs 11%, p <0.01) and require
blood transfusions (31% vs 0%, p¼0.02). They also had higher pre-procedural RVSP
(40mmHg vs 22mmHg, p¼0.01) and lower post-procedural ejection fraction (54% vs
59%, p¼0.02).
Conclusion: In the early experience of a new TAVI program at a major tertiary centre, early
discharge was only achieved in patients with a trans-femoral approach. Associations with
prolonged stay include transapical or direct aortic approach, direct admission to ICU,
requirement for blood transfusion, and a higher pre-procedural RVSP.
Disclosure of Interest: None Declared
PM118
Predictors of Early Discharge After Trans-Femoral Transcatheter Aortic Valve
Implantation
Khoa Phan1, Matias Yudi*1, Nigel Lewis1, James Wong1, Subodh Joshi1, Roderic Warren1,
Vanessa Ogden1, Marco Larobina1, John Goldblatt1, Ronen Gurvitch1
1
Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Transcatheter aortic valve implantation (TAVI) performed via the trans-
femoral approach has consistently been associated with earlier hospital discharge when
compared to the trans-aortic and trans-apical approaches. Furthermore, increased operator
experience and improvements in technology have also led to a decrease in post-procedural
hospital stay.
Objectives: We aim to determine predictors of early discharge (within 4 days of procedure)
in patients who underwent trans-femoral TAVI.
Methods: Patients undergoing trans-femoral TAVI with Edward Sapien XT valves at Royal
Melbourne Hospital were included in this analysis. Patients were divided into two groups:
the early discharge group (discharged within 4 days) and the delayed discharge group
(discharged after 4 days). Clinical, echocardiographic, procedural and post-procedural
characteristics were evaluated and a comparison between the groups was undertaken.
Results: Of the thirty-two patients included, 18 (56%) were discharged within 4 days of
the procedure. There were no statistical differences between the early and delayed discharge
vs 8.4%
3.1%, p¼0.12), BMI (27.2
5.5 vs 26.4
4.5, p¼0.64) and eGFR (66.1
19.4 vs
55.8
22.3, p¼0.64). Patients who were discharged early had significantly less pulmonary
hypertension (17% vs 57%, p<0.01) and less moderate-to-severe mitral regurgitation at
baseline (33% vs 75%, p¼0.03). Post-procedure, the early discharge group were signifi-
cantly less likely to be in the intensive care unit (6% vs 39%, p¼0.02) and receive blood
transfusions (0% vs 36%, p¼ 0.02).
Conclusion: In the early experience of a relatively new TAVI program at a major tertiary
centre, early discharge was achieved in a more than half of patients who underwent trans-
femoral TAVI. Potential predictors of early discharge may include lower pulmonary pres-
sures, mild/trivial mitral regurgitation and direct transfer to a general cardiology ward post
procedure as opposed to ICU.
Disclosure of Interest: None Declared
PM119
Initial Results of Percutaneous Trans-Septal Balloon Aortic Valvuloplasty Using
Inoue Balloon In High Risk Aortic Stenosis
Nobuhito Yagi*1, Tetsuya Asato1, Ryosyu Taira1, Asako Fukuyama1, Jun Nakazato1,
Takanori Takahashi1, Minoru Wake1, Kazuhito Hirata1
1
Department of Internal Medicine, Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan
Introduction: Many inoperable patients with severe aortic stenosis (AS) are not eligible for
transcatheter aortic valve replacement (TAVR) in Japan.
Objectives: The aim of this study was to evaluate the role of antegrade trans-septal
percutaneous balloon aortic valvuloplasty (BAV) in this setting.
e85
 Methods: A cohort of 8 patients with severe aortic stennosis underwent 9 BAV procedures.
POSTER ABSTRACTS
Intra-cardiac echocardiography (ICE) guided trans-septal puncture and BAV using Inoue
balloon were performed antegradely. Clinical, hemodynamin, and follow-up mortality data
were collected.
Results: The mean age was 81.0
9.2 years, and the vast majority of patients had
comorbidities and high-risk features including 4 hemodialysis patients(50%). The mean
Society of Thoracic Surgeons and EuroSCOREII (European System for Cardiac Operative
Risk Evaluation) was 10.6
5.2 and 16.0
7.8, respectively. BAV was performed for
symptom relief in all patients (100%). The mean aortic valve area (AVA) increased from
0.69
0.32 cm(2) to 1.17
0.4 cm(2) (p < 0.001). Of these, 5(62.5%) had final AVA >1
cm(2), and in 7 patients (88%), AVA increased by >50%. There was no death, stroke,
coronary occlusion, severe aortic regurgitation, cardiac tamponade. One patient developed
sepsis and worsening of renal failure. During median follow-up of 194 days, the mortality
rate was 25% (n ¼ 2).
Conclusion: In severe AS patients who have high risk for surgical AVR, antegrade BAV
using Inoue balloon may be feasible with good initial and mid-term outcomes.
Disclosure of Interest: None Declared
PM120
Sex influence on the results of the self expanding aortic prosthesis implantation
according the criteria of the valve academic research consortium
Raquel del Valle1, Pablo Avanzas*1, Isaac Pascual2, Alfonso Suarez1, Benjamín Camacho1,
Emma Suarez1, Lourdes Figueiras1, Maria Martín1, Cecilia Corros1, Ana Garcia1,
Jesus de la Hera1, Jose Rubin1, David Calvo1, Diego Perez1, Cesar Morís1
1 Cardiology, Hospital Universitario Central de Asturias, Oviedo, 2Cardiology, Hospital
Cardiology, Hospital Universitario Central de Asturias, Oviedo, 2Cardiology, Hospital
Universitario Arnau Vilanova, Lleida, Spain
Introduction: Transcatheter aortic valve implantation (TAVI) is a consolidated procedure
that has become an alternative option to treat severe symptomatic aortic stenosis in those
patients with high surgical risk.
Objectives: To analyze the results of the TAVI depending on the sex of the patient,
following the standardized definitions of security and efficacy recently proposed by the
Academic Research Consortium to facilitate comparisons among different studies.
Methods: Results analysis depending on the sex of a total of 116 patients with severe aortic
stenosis in which TAVI was performed. Statistical analysis with SPSS 19.0 (percentages, x2
and Fisher’s test for discrete variables, mean and standard deviation and Student t for
continue variables; p minor to 0.05 indicates statistical significance).
Results: The 56% of the patients were female. Male patients showed more comorbidity:
previous coronary revascularization 21.6 vs 6.2% (p ¼ 0.015), chronic obstructive pul-
monary disease (COPD) 29.4 vs 7.7% (p ¼ 0.002), chronic treatment with bronchodilators
or esteroids 27.5 vs 12.3% (p ¼ 0.034), dyslipemia 43.1 vs 27.7% (p ¼ 0.082), previous
conduction abnormalities 43.4 vs 28% (p ¼ 0.095) and need for percutaneous coronary
intervention previously or during the TAVI (13.7 vs 4.6%, p ¼ 0.081). Female patients
tended to have more frequent major complications at the vascular access point (12.3 vs 2%,
p ¼ 0.038) and percutaneous seal failure (13.8 vs 3.9%, p ¼ 0.065), but there was not any
difference in the major vascular complications appearing (6.2 vs 2%, p ¼ 0.27). Acute
failure was more frequent in male (19.6 vs 1.5%, p ¼ 0.001). There were no differences
concerning the device success (86.3 vs 93.8%, p ¼ 0.14), nor the 30 days mortality (7.8 vs
4.3%) nor the security combined outcome (86.3 vs 83.1%).
Conclusion: We have not found differences between male and female patients according to
the success of the device nor the security combined outcome to 30 days. Male patients had
more incidence of acute renal failure post-procedure and female patients had more com-
plications at the vascular access point.
Disclosure of Interest: None Declared
PM121
Incidence and predictors of events following TAVI with a self-expanding valve:
immediate and mid-term outcomes
Raquel del Valle1, Pablo Avanzas*1, Isaac Pascual2, Alfonso Suarez1, Benjamín Camacho1,
Emma Suarez1, Lourdes Figueiras1, Maria Martín1, Cecilia Corros1, Ana Garcia1,
Jesus de la Hera1, Jose Rubin1, David Calvo1, Diego Perez1, Cesar Morís1
1
Cardiology, Hospital Universitario Central de Asturias, Oviedo, 2Cardiology, Hospital
Universitario Arnau Vilanova, Lleida, Spain
Introduction: Transcatheter aortic valve implantation (TAVI) constitutes a therapeutic
alternative for high operative risk patients with severe aortic stenosis who have been
rejected for surgery.
Objectives: To evaluate immediate and long term results of TAVI with the CoreValve
System and identify predictors of poor outcome.
Methods: Retrospective analysis of 142 consecutive patients (p) who underwent TAVI in
our center from 2007 to December 2012.
Results: Age was 82.5
6.1 years, mean log Euroscore 14.9
11.27, and 43% of the P were
male. 22% with diabetes, 23% had prior coronary revascularization, 10% myocardial
infarction, 11% stroke or transient ischemic attack and 7% extra-cardiac arteriopathy.
Chronic renal failure was present in 14% and chronic obstructive pulmonary disease in
18%. 25% had moderate or severe mitral regurgitation and 6.3% had a LVEF 40%.
Vascular access was femoral in 95% of the P, and planned vascular closure was successful in
92%. Procedural success rate was 95% and postprocedural aortic regurgitation was 2 in
95% of the patients. In hospital mortality was 5.6%, and the in-hospital combined safety
endpoint according to the VARC definition: 1.4% rate of major stroke, 4.9% major
e86
bleeding, 2.1% acute kidney injury stage 3 (RIFLE criteria) and 4.9% major vascular
complications. Permanent pacemaker was implanted in 32.3%.
Median follow-up (FUP) was 343 days: 10% died (38% from cardiac causes) and 17%
were admitted to hospital for cardiac reasons (52% of them for heart failure/prosthesis
related issues). Cerebrovascular event rate at follow up is 6% and pacemaker implantation
rate 4.5%. Kaplan-Meier estimates of freedom from total mortality at 1 and 2 years were
91% and 84% and from cardiac mortality 96% and 92%, respectively. Freedom from
hospital admission for cardiac causes was 90% at 1 year and 78% at two years.
Mortality after discharge was related to: liver cirrhosis (66 vs. 8.4%, p¼0.025), failure of
percutaneous closure device (33.3% vs. 8.4%, p¼ 0.048), post-procedural complications
(16.2 vs. 1.7%, p¼0.004), pacemaker implantation (18.8 vs. 4.7%, p¼0.011) and heart
failure admission (33.3% vs. 7.4%, p¼0.017). Predictors of hospital admission for heart
failure were pacemaker implantation (16.7% vs. 4.7%, P¼0.024) and renal failure stage 1
(66.7 vs. 7.6%, p¼0.021).
Conclusion: TAVI with the Corevalve system is safe and associated with low mortality rate
at follow up. Death after hospital discharge is related to baseline comorbidities, in-hospital
complications and cardiac readmissions.
Disclosure of Interest: None Declared
PM122
Clinical focal neurological impairment after transcatheter aortic valve implantation
Pablo Avanzas*1, Raquel del Valle1, Isaac Pascual2, Alfonso Suarez1, Benjamín Camacho1,
Emma Suarez1, Lourdes M. Filgueiras1, Maria Martín1, Cecilia Corros1, Ana Garcia1,
Jesus de la Hera1, Jose Rubin1, David Calvo1, Diego Perez1, Cesar Morís1
1
Universitario Arnau Vilanova, Lleida, Spain
Introduction: Very limited information is available in relation to the problem of cerebral
embolism in patients undergoing transcatheter aortic valve implantation (TAVI).
Objectives: The aim of this study was the prospective investigation of clinical neurological
impairment after TAVI.
Methods: The study included patients with severe symptomatic aortic stenosis. Other
inclusion criteria were: aortic valve area <1 cm2 (<0.6 cm2/m2); aortic valve annulus
diameter in the range 20-27 mm; diameter of the ascending aorta at the level of the
sinotubular junction 40 mm (26 mm prosthesis) or 43 mm (29 mm prosthesis), and
femoral artery diameter >6 mm. The endpoint of the study was the presence of any clinical
focal neurological impairment until discharge.
Results: We included 100 patients with a mean age of 79.9
6.3 years, a mean aortic valve
area of 0.67
0.2 cm2 and a mean logistic EuroSCORE of 15%
13.6%. All patients un-
derwent aortic valvuloplasty. After valve implantation, the maximum echocardiographic
transaortic valve gradient decreased from 83
19 to 12.2
4 mm Hg. No patient presented
with greater than grade-2 residual aortic regurgitation on angiography. The procedural
success rate was 100%. No patient died during the procedure. Definitive pacemaker im-
plantation was carried out for atrioventricular block in 25 patients (25%). Regarding
neurological evaluation, the endpoint presented in two patients (2%) that developed
cerebellar ataxias; one of them transient and another persistent.
Conclusion: Our early experience indicates that percutaneous aortic valve replacement is a
safe therapeutic option for patients with severe aortic stenosis who are at a high surgical
risk. The incidence of clinical neurological impairment due to the procedure is low.
Disclosure of Interest: None Declared
PM124
Prognostic value of echocardiographic time-velocity integral index of the aortic flow
in idiopathic pulmonary arterial hypertension
Qianqian Liu*1, Qinhua Zhao1, Rong Jiang1, Lan Wang1, Jing He1, Zhicheng Jing2
1
cardio-pulmonary circulation, Shanghai Pulmonary Hospital, Tongji University, School of
Medicine, Shanghai, China, Shanghai, 2State Key Laboratory of Cardiovascular Disease, Fu Wai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences &
Peking Union Medical College, Beijing, China
Introduction: In idiopathic pulmonary arterial hypertension (IPAH) and right heart failure,
right ventricular dilatation also causes abnormal left ventricular filling and decreased cardiac
output. However, whether changes in left heart morphological and functional characteristics
in idiopathic PAH have prognostic value and will predict the response to therapy is unknown.
Objectives: The aim of this study was to determine the prognostic value of a single
quantitative echocardiographic criterion, the time-velocity integral index (TVII) of the
aortic flow in idiopathic PAH.
Methods: We prospectively studied 122 consecutive patients with IPAH who were referred
for a clinical indicated right heart catheterization, transthoracic echocardiography and TVI
of the aortic flow measurement. Clinical, RHC and echocardiographic variables were ob-
tained at baseline at the time of study entry.
Results: The demographic and hemodynamic data of the patients were summarized and
echocardiographic features of all patients at the time of study entry were analysed. In the overall
cohort, a TVI index of less than 12.38 cm/m2 was associated with greater right ventricle systolic
dysfunction (TAPSE, 1.4 vs. 1.7 cm, P ¼0.001), versus a TVI index of 12.38 cm/m2 or greater.
During the mean follow-up period of 24
11 months, 24 out of 122 patients (19.7%) died from
cardiopulmonary causes. Left heart morphological and functional characteristic changes, caused
by the right heart dilation were analyzed as predictors of mortality. A low time-velocity integral
index, right atrium dilation and decreased left atrium area independently predicted mortality. Cox
proportional hazards multivariable analysis showed that TVI index (Hazard ratio ¼ 0.881, P ¼
0.017), right atrium area index (Hazard ratio ¼ 1.247, P ¼ 0.007) and right atrium area index
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
(Hazard ratio ¼ 0.517, P ¼ 0.043) at baseline were independent predictors of prognosis in
idiopathic PAH. According to Kaplan-Meier survival curves, survival was lower in patients with an
inframedian TVI index < 12.38 cm/m2 (log-rank test, P¼0.001).
Conclusion: The time-velocity integral index of the aortic flow powerfully reflects the
influence of right ventricle to left ventricle and may serve as an independent predictor of
prognosis in patients with idiopathic PAH.
Disclosure of Interest: None Declared
PM125
Rheumatic Heart Disease Challenges in Tanzania
1
Dr Harun E. Nyagori*
1 1
General Cardiology, Ministry of Health and Social welfare/Afya Medicare specialized clinic,
Morogoro Region, Tanzania, United Republic of
Introduction: Developing countries are facing challenges related to health poverty diseases
whereby Tanzania is not an exception. Rheumatic heart disease is among such diseases,
mostly affecting children and young adults, along with other non- communicable diseases
which are not receiving much attention from the government.
Objectives: The study was undertaken to find out challenges facing patients suffering from
rheumatic heart disease in Tanzania, focusing on Morogoro Referral Hospital and Afya
Medicare Specialized clinic located in Morogoro region. Specifically, the study aimed at
investigating challenges related to awareness of the disease, access to treatment and
availability of fund when seeking solution to the disease.
Methods: A total of 240 respondents consisting of both diagnosed patients consulting the
clinic and the hospital for treatment as well as people who are responsible for taking care of
such patients were interviewed. Also, questionnaires and observation techniques were used
to find out the challenges facing them.
Results: The results show that, most of the patients are not aware of the symptoms and the
existence of rheumatic fever as the major cause of the disease due to lack of education on
the prevention and treatment of the disease. Also, medical facilities are not adequate to
meet the demand for the existing problem. Furthermore, the patients are faced with
financial difficulty when accessing treatment from various health centers, the condition
which intensifies the problem.
Conclusion: Due to shortage of facilities, lack of awareness and financial difficulty facing the
patients; individuals, local and international organizations are advised to invest in rheumatic heart
disease projects, specifically, in conducting research and funding medical facilities such as
echocardiography and building more catheter labs. Also, support should be directed towards
private practitioners who are engaging in the cardiology field, so as to reduce and eliminate the
challenges facing the patients, in an attempt to improve the health sector in Tanzania.
Disclosure of Interest: None Declared
PM126
Mechanical valves in Rwanda: Challenges to warfarin anticoagulation therapy
following mechanical valve implantation in patients with rheumatic heart disease in
resource-limited settings
Joseph Mucumbitsi*1, JaBaris Swain2, Bonnie Greenwood3, Alex Katabarwa4, Suellen Breakey5,
Egidia Rugwinzangoga6, Nathan Ruhamya7, Abel Kagame8, Emmanuel Rusingiza9,
R. Morton Bolman10
1
Pediatric Cardiology, King Faisal Hospital, Kigali, Rwanda, 2Surgery, 3Pharmacy, Brigham and
Women’s Hospital, Boston, United States, 4Nursing, Kigali University Teaching Hospital, Kigali,
Rwanda, 5Massachusetts General Hospital Institute of Health Professions, Charlestown, 6Nursing,
Brigham and Women’s Hospital, Boston, United States, 7Cardiology, King Faisal Hospital,
8
Cardiology, 9Pediatric Cardiology, Kigali University Teaching Hospital, Kigali, Rwanda,
10
Cardiac Surgery, Brigham and Women’s Hospital, Boston, United States
Introduction: As access to open cardiac surgery is extended to more patients with critical
rheumatic heart disease (RHD) in sub-Saharan Africa, there has been a parallel increase in
mechanical valve implantation (MVI) where advanced disease has rendered native valve
repair prohibitive. MVI in this region raises important medical and ethical considerations;
among these, challenges of lifetime anticoagulation are foremost.
Objectives: We sought to review our clinical experience with Warfarin anticoagulation in MVI
patients in District and Teaching hospitals and determine specific factors hindering outcomes.
Methods: A retrospective chart review of MVI patients who presented for follow-up at one
District and two University Teaching Hospitals (Kigali and Butare) from 2010-2013. International
normalized ratio (INR) Tests were performed with a portable machine (Alere INRatioÒ2).
Demographics, INR values, Warfarin doses, thromboembolic and bleeding events were reviewed.
Consented patients were interviewed on medication knowledge and compliance.
Results: Data analysis captured 101 patients treated with Warfarin, following MVI. Mean age was
27.1 years old. Fifty-three patients were female (52.4%). Featured patients presented from >5
different Districts throughout the country. Warfarin dose range was 2.5-12 mg; with a mean of 6.0
mg. Mean INR level was 2.7 (therapeutic goal: 2.5-3.5). No significant difference was noted in INR
levels between genders, though female patients tended to require higher Warfarin dosing on
average. Thirty-day mortality was found to be <5%, with early events (n¼4) attributed to supra-
therapeutic INR (> 5.0). Most common factors cited as barriers to long-term anticoagulation
therapy included financial constraints, inconsistent countrywide medication supply, and desire to
conceive among childbearing women.
Conclusion: Sub-optimal anticoagulation follow up can lead to life-threatening compli-
cations in MVI patients in resource-limited settings. Challenges of life-long anticoagulation
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
include financial burden to patients, limited resources for follow up, inconsistent medi-
POSTER ABSTRACTS
cation supply and education deficiencies. As a Rwanda Comprehensive Cardiovascular
Care Program is being finalized, efforts for improvement include decentralized INR clinics,
supervised through a countrywide nurse coordinator and an outreach program by cardi-
ologists, availability of Warfarin on the list of essential drugs, standardized anticoagulation
guidelines and information for patients in native language.
Disclosure of Interest: None Declared
PM127
Major manifestations of Acute Rheumatic Fever in Nepalese patients
Prakash R. Regmi*1
Cardiology, National Academy of Medical Sciences, BIR Hospital, Kathmandu, Nepal
Introduction: Polyarthritis, Carditis, Sydenham’s Chorea (SC), Subcutaneous nodules(SN)
and Erythema marginatum(EM) are the known major manifestations of Acute Rheumatic
Fever ( ARF) . The common manifestations are Polyarthritis, Carditis and SC, whereas SN and
EM are quite rare. SC is the only evidence of ARF in approximately 20% of cases. There are no
published reports on prevalence of the major manifestations of ARF in Nepalese patients.
Objectives: The objective of this study was to describe the frequency of the major man-
ifestations of ARF in Nepalese patients.
Methods: Five years ( June 2007- May 2012) data of patients with ARF ( diagnosed by modified
Jones criteria) from the RF/RHD registers of National RF/RHD prevention & control programme
managed by government of Nepal, Ministry of Health and Population and Nepal Heart Foun-
dation in 34 hospitals were analyzed for major clinical manifestations in patients with ARF. There
were altogether 694 patients with ARF on secondary prophylaxis.
Results: Out of the 694 patients with ARF, 315 (45.38%) were males and 379 (54.62%) were
females. 178 (25.64%0 were <10 years age,414 (59.65%) were 10-16 years age and 102
(14.69%) >16 years age. 562 (80.97%) patients presented with Arthritis. Among them 496
(71.46% ) had Polyarthritis and 66 (9.51%) had Monoarthritis . 410 (59.07 %) had Carditis, 28
(4.03%) had Sydenham’s Chorea, 12 (1.7%) had Subcutaneous nodules and 7 (1.0 %) had
Erythema Marginatum as major manifestation. 406 (58.50 %) patients presented with two major
manifestations: 376 (54.17 %) with arthritis and carditis, 18 (2.59% ) with Chorea and Carditis,
12 (1.7%) with subcutaneous nodules and Carditis, 4 (0.57%) patients had three major mani-
festations: Chorea, Carditis and Arthritis. 6 (0.86%) patients presented with chorea as the only
manifestation of ARF.
Conclusion: It was concluded that the most frequent major manifestation of ARF in
Nepalese patients was polyrthritis followed by carditis. SC, SN and EM were rare mani-
festations.Majority of ARF patients presented with two major manifestations which were
Arthritis and carditis. The incidence of SC in Nepalese ARF patients was found to be quite
low in comparision to that reported in other countries.
Disclosure of Interest: None Declared
PM128
Biventricular pressure/volume registration during exercise in patients with chronic
thromboembolic pulmonary hypertension – A cardiac magnetic resonance imaging study
Guido Claessen*1, Andre La Gerche1,2, Piet Claus3, Steven Dymarkowski4, Marion Delcroix5,
Hein Heidbuchel1
1
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium, 2St Vincent’s Hospital
Department of Medicine, University of Melbourne, Melbourne, Australia, 3Cardiovascular
Imaging and Dynamics, University of Leuven, 4Department of Radiology, 5Department of
Pneumology, University Hospitals Leuven, Leuven, Belgium
Introduction: Patients with pulmonary hypertension are often relatively asymptomatic at
rest whilst developing symptoms during exercise. Nonetheless, cardiac function and he-
modynamics are generally evaluated at rest. Assessment of the heart during exercise may
provide more insights into the mechanisms that limit exercise capacity.
Objectives: To evaluate left and right ventricular (LV and RV) volumes using a novel real-
time cardiac magnetic resonance (CMR) imaging sequence, both at rest and during in-
cremental exercise, with simultaneous invasive pressure measurements.
Methods: Nine subjects (age 56
11 years, 8 male) with chronic thromboembolic pul-
monary hypertension (CTEPH) underwent CMR during free-breathing, both at rest and
during supine exercise on a programmable cycle ergometer. Using in-house developed
software, images were synchronized with the respiratory signal, enabling measurement of
end-diastolic and end-systolic volumes (EDVi and ESVi) from endocardial tracings of bi-
plane cine stacks with compensation for respiratory motion. Simultaneously, radial and
pulmonary artery pressures (PAP) were measured.
Results: The volume changes during exercise were different for both ventricles (P<0.0001
for interaction; see Figure). Whilst LVEDVi and LVESVi were reduced (P¼0.02 and
P¼0.003, respectively), RVEDVi and RVESVi increased significantly during incremental
exercise (P¼0.001 and P¼0.02, respectively). As a result, LVEF augmented during exercise
(P¼0.001), whereas RVEF remained unchanged (P¼0.42). Cardiac index (CI) increased
from rest to maximal exercise (2.8
0.7 vs. 4.3
1.1; P<0.0001). The total increase in CI
was mediated by a 51% increase in heart rate (P<0.0001), whilst LV and RV stroke volume
did not change. Mean pulmonary artery pressures (45
10 vs. 65
14 mmHg; P<0.0001)
and mean arterial pressures (89
7 vs. 108
18 mmHg; P¼0.009) increased from rest to
maximal exercise. The relative increase in pulmonary artery pressure was greater than the
increase in mean arterial pressure (+43% vs. +20%; P¼0.002). Total systemic vascular
resistance decreased during exercise (P¼0.001), whilst total pulmonary resistance (tPVR)
remained unchanged (P¼0.886).
e87
 Objectives: To assess the correlation of aortic valve CIB scores between two different ul-
POSTER ABSTRACTS

trasound platforms using machines from GE and Philips.

Methods: A cohort of 20 subjects with suspected heart disease without aortic stenosis was
assessed for aortic valve CIB. Each patient was scanned twice on the same day, once with a
GE machine (Vivid-i, GE, Norway) and once with a Philips machine (cx50, Philips,
Netherlands). Aortic valve CIB scores were derived using six regions of interest along aortic
valve cusps, calibrated against blood pool. Images were analysed using GE EchoPac and
Philips QLAB.
Results: Mean age of our cohort was 56.0 years with 10% female. Mean aortic valve CIB
derived from GE was 13.4
4.0 dB, consistent with values in the literature. Mean back-
scatter scores derived from Philips was 87.0
21.1 dB. There was very strong correlation
between values derived from GE and Philips ultrasound machines (p< 0.0001, r¼0.81).
Conclusion: Our study demonstrates strong correlation between GE and Philips aortic
valve CIB scores. The results allow for future research to be conducted using machine from
different ultrasound platforms.
Disclosure of Interest: None Declared

PM135
web 3C=FPO

Safe and Effective Early Discharge for Low to Intermediate Risk Acute Coronary
Syndrome (ACS) Patients – The SEED Observational Study
David Tong*1, Louise Roberts1, Jamie Choong1, Shane Parfrey1, Taufik Fetahovic1,
Andrew Nixon1, Damon Jackson1, Arul Baradi1, Melanie Freeman1, Gishel New1
1
Cardiology, Eastern Health, Box Hill, Australia
Introduction: Despite increasing evidence that low risk ACS patients can be safely dis-
Conclusion: In patients with CTEPH, using simultaneous gold-standard invasive pressure charged within 72 hours with no increase in adverse clinical outcomes, many patients
and CMR-derived volume measurements, we demonstrate that RV ejection cannot increase remain in hospital longer.
during exercise due to the unaltered tPVR. As a consequence, RV dilation and a blunted RV Objectives: To identify low to intermediate risk non-ST elevation myocardial infarction
stroke volume response compromise LV filling and CI during exercise. (NSTEMI) and low risk ST elevation myocardial infarction (STEMI) patients who under-
Disclosure of Interest: None Declared went successful PCI or were treated medically following coronary angiography using
validated risk scores, and to evaluate their length of stay and 30-day clinical outcomes.
Methods: We retrospectively collected data on 642 ACS patients who presented to Eastern
PM129 Health between July 2011 and June 2012. We identified low risk STEMI and low to in-
termediate risk NSTEMI as having a Zwolle score 3 and GRACE score 140. Thirty day
Detection Of Post-Operative Complications After Aortic Valve Replacement By mortality, MACE, procedural complications, emergency department (ED) presentations
Contemporary Risk Models and unplanned readmissions were evaluated.
Tom Kai Ming Wang*1, David H.-M. Choi1, Ralph Stewart1,2, Greg Gamble3, David Haydock1, Results: 239 patients were identified as low to intermediate risk ACS. The mean length of
Peter Ruygrok1,2 stay in the NSTEMI group was 90 hours and only one MACE for sub acute stent
1 thrombosis in the setting of early cessation of clopidogrel for a minor surgical procedure.
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
3 There were 6 ED presentations (2 atypical chest pain, 2 upper respiratory tract infection, 1
Medicine, University of Auckland, Auckland, New Zealand knee pain, 1 puncture site hematoma) and 8 unplanned 30-day readmissions (1 subacute
Introduction: Risk assessments for predicting post-operative complications after cardiac stent thrombosis, 4 chest pain, 1 cerebrovascular event, 1 vasovagal event, 1 urinary
surgery are rarely studied compared to mortality. retention). The mean length of stay in the low risk STEMI group was 91 hours. There were
Objectives: We compared EuroSCORE, EuroSCORE II, and Society of Thoracic Surgeon’s 2 ED presentations with atypical chest pain and one readmission for chest pain not
(STS) Score and an Australasian model (Aus-AVR Score) for predicting morbidities after requiring invasive investigation. There were no deaths at 30 days in either group.
aortic valve replacement (AVR), and also evaluated seven STS complications models in this
context. Low to intermediate risk NSTEMI Low risk STEMI
Methods: We retrospectively calculated all risk scores for the 620 patients undergoing
N[139 N[100
isolated AVR at Auckland City Hospital during 2005-2012, and assessed their discrimi-
nation and calibration for post-operative complications. Patients discharged <72 hrs 33.8% 14.0%
Results: Amongst the mortality scores, EuroSCORE was the best at discriminating stroke Length of Stay Mean
SD (hrs) 90
33 91
16
(c-statistic 0.845); EuroSCORE II at deep sternal wound infection (c¼0.748); and STS
Score at composite morbidity or mortality (c¼0.666), renal failure (c¼0.634), ventilation 30-day Death 0% 0%
>24 hours (c¼0.732), return to theatre (c¼0.577) and prolonged hospital stay >14 days 30-day MACE 0.7% 0%
post-operatively (c¼0.707). The individual STS complications models had slightly higher ED presentation 5.0% 2.0%
c-statistic (c¼0.634-0.846) for all complications except deep sternal wound infection, and
had good calibration (Hosmer-Lemeshow test P-value 0.123-0.915) for all complications, Unplanned 30-day readmission 5.7% 1.0%
including when divided in quintiles. Independent predictors for composite morbidity
outcomes were age, critical pre-operative state, urgent surgery and dialysis.
Conclusion: The STS Score was overall the best at discriminating post-operative compli- Conclusion: The majority of low to intermediate risk ACS patients were hospitalised for
cations and their composite for AVR. All STS complications model except for deep sternal more than 72 hours. ED presentations and unplanned readmissions were infrequent. The
wound infection had good discrimination and calibration for post-operative complications. zero 30-day death and low MACE rates indicate early discharge may be safe. Prospective
Operation and complications specific models improve the detection of these outcomes studies to evaluate this model of care are required.
in AVR. Disclosure of Interest: None Declared
Disclosure of Interest: None Declared
PM136

PM130 Predictors of mortality in patients with Acute Coronary Syndrome - A hospital

admissions study: 2000-2013
Correlation of Echocardiographic Aortic Valve Calibrated Integrated Backscatter
Values Between Different Ultrasound Platforms Mohammed Wasim1, Niece Khouw1, Jason S. McMinn2, Mudassar Baig3, Sarah Rose2,
1,2 2,3 2,3 Amir Aziz4, Hardeep Uppal5, Suresh Chandran6, Rahul Potluri*7
Masoumeh G. Shirazi* , Arnold C. T. Ng , William Y. S. Wang 1
1 Pennine Acute Hospitals NHS Foundation Trust, Manchester, United Kingdom, 2Department of
Cardiology, Royal Adelaide Hospital, Adelaide, 2School of Medicine, University of Queensland,
3 Cardiology, Pennine Acute Hospitals NHS Foundation Trust, Manchester, 3Department of
Cardiology, Princess Alexandra Hospital, Brisbane, Australia
Cardiology, Blackpool Hospitals, Blackpool, 4Division of Cardiovascular and Diabetes Research,
Introduction: Aortic sclerosis is common age related phenomena which results from University of Leeds, Leeds, 5Department of Psychiatry of Learning Disability, Brooklands
degeneration and thickening of the aortic valves, and may be a precursor to clinically significant Hospital, Birmingham, 6Training Programme Director, Acute Medicine, North Western Deanery,
aortic stenosis. Aortic valve ultrasonic calibrated integrated backscatter (CIB) is an objective Manchester, 7ACALM Study Unit in collaboration with School of Medical Sciences, Aston
tool in assessing aortic sclerosis which is gaining increasing interest. Unlike measurements of University, Birmingham, United Kingdom
dimensions and motion, tissue characterisation methods, such as CIB, are highly dependent on
properties in internal signal and data processing of ultrasound platforms. However, publica- Introduction: Acute Coronary Syndrome is a common condition that has been well
tions of aortic valve CIB have all used ultrasound machines from one vendor, General Electric studied. However, the predictors of mortality in patients with Acute Coronary Syndrome
(GE), making the values derived from other platforms difficult to interpret. have not been well studied in a large hospital population in the UK.

e88 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Objectives: We investigated the predictors of mortality in patients with Acute Coronary
Syndrome from a large sample of hospital admissions.
Methods: Anonymous information on patients with Acute Coronary Syndrome, co-mor-
bidities and procedures attending large multi-ethnic general hospitals in Manchester,
United Kingdom in the period 2000-2013 was obtained from the local health authority
computerised hospital activity analysis register using ICD-10 and OPCS coding systems.
Statistical analysis was performed using SPSS version 20.
Results: Out of 1221216 patients admitted, there were 25322 (2.1%) patients with Acute
Coronary Syndrome; mean age 66.6 years
14.4 (S.D); Male (64.2%), Female (35.8%). The
main co-morbidities were Hypertension (11397;45.0%), Previous Myocardial Infarction
(9184;36.3%), Hyperlipidaemia (6271;24.8%), Type 2 Diabetes Mellitus (4759;18.8%),
Heart Failure (4670;18.4%), Chronic Kidney Disease (1612;6.4%). A multi-nominal logistic
regression model accounting for variations in age, sex and ethnic group showed that
Hypertension (RR0.8;C.I0.7-0.9), Previous Myocardial Infarction RR1.2;C.I1.1-1.3),
Hyperlipidaemia (RR0.5;C.I0.4-0.6), Type 2 Diabetes Mellitus (RR1.5;C.I1.3-1.6), Heart
Failure (RR2.9;C.I2.6-3.2) and Chronic Kidney Disease (RR2.3;C.I1.9-2.7) as significant
predictors of mortality (p <0.05).
Conclusion: We have shown that Previous Myocardial Infarction, Type 2 Diabetes Mellitus,
Heart Failure and Chronic Kidney Disease are significant predictors of mortality in patients
with Acute Coronary Syndrome from a large hospital based sample in the UK. A diagnosis of
Hypertension and Hyperlipidaemia seem to confer improved mortality possibly reflecting
mortality benefit of drugs such as beta blockers and ACE-inhibitors. Our improved under-
standing of these predictors will guide clinicians to focus on these high risk groups to improve
clinical practice and outcomes in patients with Acute Coronary Syndrome.
Disclosure of Interest: None Declared
PM137
Toll like receptor 2 (TLR-2) but not TLR-4 and TLR-9 is significantly increased in
platelets from patients with acute coronary syndrome
Ingo Ahrens*1, Madlin Albrecht1, Daniel Duerschmied1, Christian Colberg1, Andreas Zirlik1,
Karlheinz Peter2, Christoph Bode1
1
Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany,
2
Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne,
Australia
Introduction: Platelets contribute to innate immunity, the pathogenesis of atherosclerosis
and ACS. Several functionally active immune receptors of the toll-like receptor (TLR) family
including TLR-2, which has been linked to the development of atherosclerosis, are
expressed in platelets. Furthermore, platelets are capable of de novo protein synthesis via
platelet specific mRNA. We hypothesized that platelet TLRs are involved in the patho-
genesis of atherosclerosis and ACS.
Objectives: We hypothesized that platelet TLRs are involved in the pathogenesis of
atherosclerosis and ACS.
Methods: We established a method to generate highly purified platelets for the quantitative
assessment of platelet mRNA. Platelets were sampled from patients with NSTEMI, STEMI and
patients without coronary artery disease (CAD) after coronary angiography. Analysis of hu-
man TLR-2, TLR-4, and TLR-9 mRNA expression was done by plasmid-based quantitative
real-time PCR with beta-actin as house-keeping gene. Soluble TLR-2 was assessed by ELISA.
Results: Patient’s mean age was 59.4 +/- 2.9 years. Mean platelet count was 236 +/- 21.25
K/ml (NSTEMI, n¼14), 251 +/- 76 K/ml (STEMI, n¼24) and 227 +/- 12.06 K/ml for non-
CAD patients (n¼13). Mean CK and CK-MB levels for patients with NSTEMI were 321.8
+/- 108.9 U/l and 76.33 +/- 28.02 U/l respectively. Platelet TLR-4 and -9 mRNA levels did
not differ in patients with ACS (NSTEMI or STEMI) versus non-CAD patients. TLR-2
mRNA was significantly elevated in NSTEMI patients (12.10 e-005 +/- 2.391e-005 copies
in relation to platelet beta-actin) versus non-CAD controls (4.738e-005 +/- 7.128e-006
copies in relation to platelet beta-actin, p¼0.012). In STEMI patients TLR-2 was not-
significantly increased (p¼0.061 for non-CAD versus STEMI). There was no difference in
plasma soluble TLR-2 (NSTEMI: 0.38 +/- 0.17 ng/ml, non-CAD: 0.52 +/- 0.21 ng/ml,
p¼0.679).
Conclusion: Platelet TLR-2 mRNA was highly up-regulated in patients with NSTEMI
compared to non-CAD patients. This was not accompanied by increased serum soluble
TLR-2. Elevated TLR-2 mRNA in platelets indicates a crucial role of platelet mediated
innate immunity in the pathogenesis of ACS. Further exploration of platelet TLR-2 function
in atherosclerosis is warranted and may lead to platelet targeted anti-inflammatory thera-
pies as a novel therapeutic approach in the preventive treatment of ACS.
Disclosure of Interest: None Declared
PM138
A systematic review investigating whether gender differences in risk stratification
profile explain lower rates of angiography among women compared to men with
non-ST elevation acute coronary syndrome
Linda Worrall-Carter1, Samantha McEvedy2, Lisa Kuhn2, Andrew MacIsaac3,
Muhammad Aziz Rahman*1
1 Influence of Tirofiban Duration on Patients With Acute Myocardial Infarction
St Vincent’s Centre for Nursing Research (SVCNR) and The Cardiovascular Research Centre
(CvRC), Faculty of Health Sciences, 2St Vincent’s Centre for Nursing Research (SVCNR), Faculty
of Health Sciences, Australian Catholic University, 3Department of Cardiology, St Vincent’s
Hospital, Melbourne, Australia
Introduction: Literature review suggests a gender disparity in the use of coronary angi-
ography among patients with acute coronary syndrome (ACS). Guidelines recommend use
of angiography for all high-risk patients with non-ST elevation ACS (NSTEACS),
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
irrespective of gender; whilst a more conservative approach is recommended for lower-risk
POSTER ABSTRACTS
patients. Therefore, investigating risk stratification profiles according to gender may pro-
vide an explanation for lower rates of angiography amongst women.
Objectives: To test the hypothesis that women with NSTEACS are less likely than men to
be stratified into the high-risk category by reviewing studies reporting risk stratification of
NSTEACS patients by gender.
Methods: PubMed, Scopus and Web of Science databases were searched using pre-
determined search criteria to extract studies published in peer-reviewed scientific literature
until August 2013. The search revealed 248 articles, from which seven articles were
selected to increase the current understanding of the relationship between risk stratification
and gender and the influence of these factors on the provision of angiography.
Results: Studies involved retrospective analyses of prospective registries from a range of
countries. Three risk stratification methods were used: Global Registry of Acute Cardiac
Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI) and Physician’s Risk
Assessment (PRA). Using GRACE score, two studies found that women were more likely to
be high-risk than men (one study: 38% vs. 29%, p<0.001; another study: 35% vs. 26%,
p<0.001) and two studies found no statistically significant difference (56% vs. 49%,
p¼0.22; 30% vs. 27%, p¼0.55). Paradoxically, high-risk patients, categorised by GRACE
scores, were less likely to receive angiography than lower-risk patients (p<0.001). Using
TIMI score, there was no significant gender difference in the proportion of high-risk pa-
tients in two studies (women 17% vs. men 14%, p¼0.13; both 15%, p¼0.87). Classifi-
cation by PRA in two studies also found no gender difference (women 22% vs. men 23%,
p¼0.75; both 40%, p¼0.87).
Conclusion: Current published research does not provide conclusive evidence regarding
risk stratification profiles by gender. Further research designed to profile male and female
NSTEACS patients using the guideline risk stratification paradigm is required to better
understand the relationship between gender and the paradoxical use of angiography.
Disclosure of Interest: None Declared
PM139
A systematic review investigating whether the presence of severe co-morbidities
explains lower rates of angiography among women compared to men with non-ST
elevation acute coronary syndrome
Linda Worrall-Carter1, Samantha McEvedy2, Lisa Kuhn2, Andrew MacIsaac3,
Muhammad Aziz Rahman*1
1
St Vincent’s Centre for Nursing Research (SVCNR) and The Cardiovascular Research Centre
(CvRC), Faculty of Health Sciences, 2St Vincent’s Centre for Nursing Research (SVCNR), Faculty
of Health Sciences, Australian Catholic University, 3Department of Cardiology, St Vincent’s
Hospital, Melbourne, Australia
Introduction: Literature review suggests a gender disparity in the use of coronary angi-
ography among patients with acute coronary syndrome (ACS). This is despite guidelines
recommending the use of angiography for all high-risk patients with non-ST elevation ACS
(NSTEACS), irrespective of gender. An exception to this guideline is made in the presence
of severe co-morbidities. Therefore, investigating co-morbidity profiles according to gender
may provide an explanation for lower rates of angiography use amongst women.
Objectives: To test the hypothesis that women with NSTEACS are more likely to have
severe co-morbidities than men by reviewing studies reporting co-morbidities of NSTEACS
patients by gender.
Methods: PubMed, Scopus and Web of Science databases were searched using pre-
determined search criteria to extract studies published in peer-reviewed scientific literature
until August 2013. The search revealed 47 articles, from which five were selected to in-
crease the current understanding of the relationship between co-morbidities and gender in
NSTEACS patients, and the influence of these factors on the provision of angiography.
Results: Studies were from the USA, Germany and Spain. All studies involved retrospective
analyses, usually of prospective hospital registries, although one analysed a health insur-
ance database. One study reporting an average Charlson co-morbidity index by gender
found that women scored higher than men (women 2.22
1.5 vs. men 2.07
1.5,
p<0.001). Another study using a simplified co-morbidity index did not find any significant
gender difference for the highest co-morbidity group (women 23% vs. men 21%, p¼0.5).
Other selected studies did not report a summary or co-morbidity index, instead considered
differences between men and women for individual co-morbidity. Compared to men,
women were consistently more likely to have diabetes and heart failure. Women were also
more likely to be overweight and hypertensive than men. On the other hand, women were
less likely than men to have suffered previous myocardial infarction.
Conclusion: We found nothing conclusive to support the hypothesis that women are more
likely to suffer severe co-morbidities or the notion that this could explain the gender
disparity in angiogram usage. Future research needs to include a more systematic approach
to the definition of severe co-morbidities in NSTEACS and, in particular, how this relates to
gender.
Disclosure of Interest: None Declared
PM140
Managed By Percutaneous Coronary Intervention
Zhen-Guo Ji1,2, Zhi-Hong Liu*1, Hong-bin Liu1
1
Cardiology, The Third Hospital of Shijiazhuang City, 2Cardiology, The First Hospital of Hebei
Medical University, Shijiazhuang, Hebei, China
Introduction: Clinical randomized trials and observational studies have demonstrated
that adjunctive infusion of glycoprotein (GP) IIb/IIIa inhibitors (intravenous and
e89
 intracoronary bolus administration) is associated with improved clinical outcomes and
POSTER ABSTRACTS
further reduce the mortality of the patients with STEMI. Standard tirofiban regimen
consists of an intravenous (IV) bolus followed by an intracoronary (IC) bolus adminis-
tration and 12-72h IV infusion. However, whether more duration of tirofiban IV infusion
would result in improved clinical outcomes and do not increase the incidence of com-
plications, it is unknown.
Objectives: The aim of this pilot study was to compare intracoronary bolus followed by
different duration of IV maintenance infusion of tirofiban with respect to improvement in
outcomes and complications after PCI
Methods: A total of 125 patients with acute STEMI were enrolled in the trial. They were
randomly divided into 2 groups:tirofiban group (n¼64)and control group (n¼61). The
tirofiban was used by intracoronary and intravenous application in tirofiban group which
was randomly divided into 3 sub-groups again according to the duration of tirofiban by
persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in
myocardial infarction flow (TIMI flow) and myocardial perfusion grades were recorded
immediately after PCI. The adverse cardiac events and cardiac death within 180 days of
PCI, and the adverse effects (hemorrhage and thrombocypenia) were compared between
the 2 groups and within tirofiban sub-groups.
Results: Grade 3 in myocardial perfusion was significantly better in tirofiban group
(85.50%) than control group (72.13%, P¼0.046) after PCI. There was one cardiac death in
control group in 180 days after PCI. The adverse cardiac event rates between two groups
was significant difference (16 patients in control group and only 8 in tirofiban group,
P¼0.047 by survive analysis). There was no significant difference in occurrence of hem-
orrhage complications and platelet counts between two groups. Nevertheless, hemorrhage
complications in the 12 and 24-hour groups were less than 36-hour group within tirofiban
groups (P¼0.01).
Conclusion: Intravenous tirofiban treatment reduced the composite occurrence of the
adverse cardiac events and improved short term prognosis without increasing the adverse
reactions of the drugs in patients undergoing PCI. The less hemorrhage complication can
be achieved in less duration of tirofiban by intravenous injection after PCI.
Disclosure of Interest: None Declared
PM141
Patients with acute anterior myocardial infarction who have 4G alleles in
plasminogen activator inhibitor1 gene have higher angiographic SYNTAX scores
Caglar E. Cagliyan*1, mehmet balli2, ozge yuregir3, serdar turkmen4, rabia akilli5,
kamuran tekin2, sevcan bozdogan3, mahmut yilmaz2, murat cayli6, mehmet kanadasi5,
mustafa demirtas5
1 PM143
cardiology, cukurova university faculty of medicine, 2adana numune training and research
hospital, adana, Turkey, 3genetics, adana numune training and research hospital, adana, 4sanko
university, gaziantep, 5cukurova university faculty of medicine, 6cardiology, adana numune
training and research hospital, adana, Turkey
Introduction: Plasminogen activator inhibitor-1 (PAI-1) is one of the main inhibitors of
plasmin, the main enzyme degrading fibrin. High PAI-1 levels are blamed for increased
susceptibility to thrombosis. Circulating PAI-1 levels are partially determined by a
common polymorphism of the promoter region of the gene encoding this protein.
Presence of 4G alleles in this region is independently associated with higher plasma
PAI-1 levels.
Objectives: In this study, we aim to investigate angiographic SYNTAX score (SS), a pre-
dictor of complex coronary artery disease, in patients with different PAI-1 genotypes
presenting with acute anterior myocardial infarction (MI).
Methods: Patients with acute anterior MI undergoing primary percutaneous intervention
had been included in our study.PAI-1 genotypes were studied from peripheric venous
samples. Patients were grouped according to their PAI-1 genotypes (4G/4G, 4G/5G and 5G/
5G). Angiographic SS of the infarct related lesion (IRL) and total SS were calculated by SS
calculator. The groups were compared by oneway-ANOVA test.
Results: A total of 95 patients (21 with PAI-1 4G/4G, 52 with PAI-1 4G/5G and 22 with
PAI-1 5G/5G genotypes) were included in our study. Mean ages of patients were similar
between groups (Table 1). SYNTAX score of the infarct related artery (p¼0.022) and total
SYNTAX score was significantly lower in patients with PAI-1 5G/5G genotype.
PAI-1 4G/4G PAI-1 4G/5G PAI-1 5G/5G
Parameter Group Group Group p value
Age (years) 55.6
13.9 58.3
12.3 58.2
13.6 .697
IRA SYNTAX Score 15.2
6.6 14.8
6.1 10.7
5.7 .022
Total SYNTAX Score 17.3
8.9 18.8
6.5 14.3
6.4 .047
Conclusion: Patients presenting with PAI-1 genotypes including 4G alleles (4G/4G
and 4G/5G) seem to have more complex lesions associated with acute anterior
MI. Their total coronary SS, which resembles disease severity seem to be higher, too.
Angiographic SS is a good predictor of coronary disease severity, which is also
associated with long term outcomes. Our study is the first one investigating associ-
ation between angiographic SS and PAI-1 genotypes in patients presenting with
acute MI.
Disclosure of Interest: None Declared
e90
PM142
The Main Factors of Delayed Primary Percutaneous Coronary Intervention And Its
Consequences - The Initialization Of The Hungarian Infarction Campaign
Dávid Becker*1, György Bárczi1, Hajnalka Vágó1, Ágnes Becker1, György Szabó1, Endre Zima1,
Krisztina Heltai1, Pál Maurovich-Horvat1, Béla Merkely1
1
Heart and Vascular Center, Semmelweis University, Budapest, Hungary
Introduction: The primary percutaneous coronary intervention (pPCI) is the preferred
therapy of the ST segment elevation myocardial infarction. According to the ESC STEMI
guideline the usage of the pPCI is also recommended between 12 and 24-hour. The hesitation
time of the patients in Hungary has significantly exceeded compared to the surrounding
countries. According to the national data collection ‘Stent for Life, 2011’, the average delay
time is still over 3 hours from the symptoms onset to the first medical contact.
Objectives: The investigation of the hypothetical factors that lead to delay and the analysis
of consequences in patients with ST elevation myocardial infarction treated with primary
PCI in Hungary.
Methods: The analysis of 955 consecutive, pPCI treated patients divided into two groups:
within 12 hours, and between 12 and 24-hour time window. The analyzed parameters were:
diabetes mellitus, hypertension, hyperlipidemia, age, gender, previous myocardial infarction,
previous PCI – as possible factors of delay; the short- (30-day) and long-term (12-month)
mortality and the left ventricular ejection fraction – as the consequences of the delay.
Results: 776 patients (81,3%) arrived within 12 hours, and 179 patients (18,7%) were
admitted after 12 hours. The early-comers were younger (64,8
2,41 years vs. 69,6

4,97 years p<0,001) than the late-comers. The incidence of diabetes was significantly
higher among the late-comers (150/776¼ 19,3% vs. 58/179¼ 32,4% p<0,001), the rate of
women was higher (271/776¼35,1% vs. 86/179¼48,01% p<0,001). However the rate of
hypertension (500/776 ¼ 64,4% vs. 58/179 32,4%), hyperlipidemia (241/776¼33,1%
vs.55/179¼30,7%), previous myocardial infarction (67/776¼8,6% vs. 16/179¼8,9%), and
previous PCI (61/776¼7,9% vs. 16/1769¼8,9%) did not differ significantly. Both the 30
days (44/776¼ 5,7% vs. 25/179¼ 13,9% p<0,001) and the 12-month mortality rate (108/
776¼ 13,9% vs. 51/179¼ 28,5% p<0,001) were significantly higher in late-comers, and
also the post-MI ejection fraction was lower (49,8% vs. 39,7% p<0,001)
Conclusion: Both the short- (30-day) and long-term (12-month) mortality rate of the pPCI
treated late-comer-patients is more than twice as high as in the early-comer-patients. The
late-comers are older, the proportion of women are higher, and the incidence of diabetes is
more common in this group. According to these data the Hungarian Society of Cardiology
has launched a national campaign to decrease the hesitation time.
Disclosure of Interest: None Declared
Peak high sensitivity Troponin T predicts adverse cardiac magnetic resonance
imaging markers in ST elevation myocardial infarction
Justin Phan*1,2, Tuan Nguyen1,2, Jarred Hogan2, Daniel Moses2,3, Rohan Rajaratnam1,2,4,
Craig Juergens1,2, John French1,2, Hany Dimitri1,2, Liza Thomas1,2, David Richards1,2
1
Department of Cardiology, Liverpool Hospital, 2University of New South Wales, 3Department of
Radiology, Liverpool Hospital, 4University of Western Sydney, Sydney, Australia
Introduction: High sensitivity troponin T (hs-TnT) is a newer biomarker used to diagnose
acute myocardial infarction. Recent evidence suggests that hs-TnT outperforms conven-
tional troponins as a prognostic marker in non-STE elevation myocardial infarction (non-
STEMI).
Objectives: This study evaluates the relationship between peak hs-TnT with known
adverse prognostic markers on cardiac magnetic resonance imaging (CMRI).
Methods: 85 consecutive patients with first presentation STEMI, undergoing percutaneous
coronary intervention (PCI) at Liverpool Hospital, were prospectively enrolled. Serial hs-
TnT measurements were performed to determine peak levels. CMRI was performed at 6
3
days (early) and 61
15 days (follow up) post STEMI. Left ventricular ejection fraction
(LVEF) and mass were determined on cine MRI images by standard techniques. Infarct size
was determined by planimetry on delayed gadolinium enhancement images.
Results: Peak hs-TnT negatively correlated with early LVEF (R¼ -0.52, p<0.001) and
follow up (R¼-0.49, p<0.001) LVEF. Peak hs-TnT positively correlated with early (R¼0.4,
p<0.001) and late (R¼0.44, p<0.001) infarct size (percentage). There was a positive
correlation with early (R¼0.28, p¼0.011) and late (R¼-0.35, p¼0.001) LV end-systolic
volume. Peak hs-TnT correlated with change in LV mass (R¼0.27, p¼0.013).
Parameter Value Parameter Value
Male sex, n (%) 78 (91%) LV mass (early), grams 139
36*
Age (years) 56.0
10.8 LVEF CMRI (early) 45.9
9.2%*
BMI (kg/m2) 27.4
4.2* LV scar size (early) 20.4
10.6%*
Peak hs-TnT (ng/L) 4762
3948* LV mass (follow up), grams 124
28*
Anterior STEMI, n (%) 48 (56%) LVEF CMRI (follow up) 50.2
9.6%*
*mean
SD LV scar size (follow up) 16.4
9.0%*
Conclusion: Peak hs-TnT is an inexpensive cardiac biomarker that associated with adverse LV
volumetric and functional parameters during early LV remodelling post STEMI. With appro-
priate follow up, this may be a useful surrogate marker of adverse prognosis in STEMI patients.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM144
Electrocardiographic characteristics of patients presenting with left main coronary
artery ST-elevation myocardial infarction or its equivalent
kelvin chua*1, choong hou koh1, jonathan yap1, jenn rong chiam1, ling ling sim1, jack tan1,
aaron wong1, soo teik lim1, tian hai koh1, khung keong yeo1
1 ventricular (LV) contractile function recovery at 6 month in patients with STEMI under-
Cardiology, National Heart Centre Singapore, Singapore, Singapore
Introduction: Left main coronary artery (LMCA) ST-elevation myocardial infarction
(STEMI) is associated with high mortality. Electrocardiographic (ECG) characteristics have
not been well described for these patients.
Objectives: To describe the ECG characteristics of patients presenting with LMCA STEMI
or its equivalent to a single tertiary cardiology centre.
Methods: Patients who presented with LMCA STEMI or its equivalent to a single tertiary
referral centre from January 2007 to December 2011 were included. LMCA STEMI was
defined as STEMI secondary to a culprit LMCA stenosis of more than 80% or acute
thrombosis based on angiography. LMCA STEMI equivalent was defined as cardiogenic
shock, ventricular tachycardia/fibrillation (VT/VF) or sudden cardiac arrest due to a culprit
lesion in the LMCA defined above. Patients with a non-culprit LMCA stenosis or prior
coronary artery bypass grafting (CABG) were excluded. ECG characteristics and in-hospital
mortality are described.
Results: Of the 47 patients identified, 7 (14.9%) patients presented with VT/VF or sudden
cardiac arrest and 32 (68.1%) patients presented with ST-segment elevation in aVR with
ST-segment elevation in aVR more than V1 and ST-depressions of at least 0.5mm in 6 or
more leads. VT/VF events were documented in 18 (38.3%) patients and 22 (46.8%) pa-
tients had a cardiac arrest while in hospital. Angiographically, 15 (31.9%) patients had a
completely occluded LMCA. In-hospital mortality was seen in 16 (34.0%) patients. Uni-
variate analysis showed that an ST-elevation in aVR more than V1 was associated with a
complete LMCA occlusion (p¼0.0223). Other than the presence of VT/VF (p¼0.0125),
there was no unique ECG characteristic that was associated with in-hospital mortality.
Conclusion: In patients presenting with LMCA STEMI or its equivalent, the majority had
an ECG showing ST-segment elevation in aVR with ST-segment elevation in aVR more than
V1 and ST-depressions of at least 0.5mm in 6 or more leads. An ST-elevation in aVR more
than V1 was associated with a complete LMCA occlusion.
Disclosure of Interest: None Declared
PM145
Effects of ischemia on distribution of Speckle Tracking derived deformation
parameters according to long term progression of regional kinetics in acute and
chronic myocardial infarction
Krasimira Hristova*1
1
National Heart Hospital, Sofia, Bulgaria
Introduction: Ischemic tissue is characterized not only by reduced peak deformation, but
also by an altered deformation pattern.
Objectives: The aim of the study was to examine the effects of ischemia on distribution of
myocardial deformation imaging parapameters - longitudinal, circumferential and radial
strain for assessment of myocardial function in patients with STEMI by 2 dimensional
speckle tracking and compare these parameters with 4 months follow up after a PCI.
Methods: 20 normal volunteers (31y
5) and 30 patients (63y
13) with AMI in the first
24 hours after PCI, were enrolled. Standard echocardiography was performed in first hours
and 4 months follow up -(4mFU) and B- mode gray scale (65
7 frames/s) were acquired
and strain (ε) was analyzing, using a commercial speckle tracking tool in infarct, perinfarct
and remote regions. The i.c. ECG was performed during PCI procedure, placing the cor-
onary guidewire tip in all branches >1.5mm, making a “map” of residual ischemic region
expressed in same 18 segment model. ST-segment resolution less than 70% was accepted
as a marker of necrosis in a given segment.
Results: After infarct, adverse remodeling (progressive increase in LV size, mass and reduced
EF) was found. The radial and circumferential strain decreased in the infarct, perinfarct and
remote regions acutely comparable with normals.The reduction was numerically lower for all
types of strain (radial, circumferential and longitudinal).The longitudinal strain was only
significantly decreased in infarct regions at baseline and 4mFU. Circumferential and radial
strain after 4mFU were reduced in the infarcted segments too, but in periinfarcted were
bellow normals, in remote - close to the normals . There was a significant correlation
between the infarct size (31,1
3,4 %) and longitudinal strain (r¼ -0.49, p< 0.01), radial
strain (r ¼-0.37, p<0,01) and circumferential strain ( r¼-0.39, p< 0.05).
Conclusion: All indices of myocardial function demonstrate reduced systolic deformation
in infarcted myocardium. The deformation gradually reduces with increasing infarct size
and transmural distribution. The longitudinal strain measured early after mechanical
reperfusion may predict infarct size and LV remodeling, radial and circumferential strain in
perinfarct and remote regions demonstrate early after AMI may cause to adverse left
ventricular remodeling and progression to ischemic cardiomyopathy.
Disclosure of Interest: None Declared
PM146
The value of fractional flow reserve in predicting myocardial recovery in patients with
ST elevation myocardial infarction
Manuel J. Vargas-Torres*1, Francisco Bosa-Ojeda2, Martín J. García-Gonzalez1,
Geoffrey Yanes-Bowden1, Alejandro Sanchez-Grande Flecha1, Juan Lacalzada-Almeida1
1
Cardiology, Hospital Universitario de Canarias, Tenerife, 2Cardiology, Hospital Universitario de
Canarias, La Laguna, Tenerife, Spain
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: It has been widely demonstrated the relationship between fractional flow
POSTER ABSTRACTS
reserve (FFR) and myocardial viability in patients with prior myocardial infarction and
significant residual coronary stenosis. However, no studies have evaluated this issue in ST
elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI).
Objectives: The aim of the study was to evaluate the relationship between FFR with left
going primary PCI.
Methods: Study population consisted of 79 consecutive patients (mean age 56 +/- 10 years,
77.8% male, 16.3% diabetics, 40.2% hypertension, 42.4% smokers, 42.4% dyslipidemia)
with STEMI and significant coronary stenosis undergoing primary PCI of infarct-related
coronary artery. We evaluated basal and post-adenosine FFR pre- and post- primary PCI.
FFR Index was defined according the following formula*:
Echocardiographic evaluation of contractility and global ejection fraction (biplane
Simpson method) was done in the first 24 hours and 6 months after the acute ischemic
event. Contractile echocardiographic index was calculated adding the contractile score of
each LV segments (total contractile score) and divided by the number of segments
studied.
Results: Total ischemic time was 286,8 minutes . The infarct location was Anterior in
47.1%, Inferior in 43.5% and lateral in 7.1% of the patiens. Baseline and 6 months
echocardiographic index averages were 1.54
0.32 and 1.37
0.29, respectively.
Spearman’s rho correlation coefficient between echocardiographic index and Index FFR
was r ¼ -0.38: p ¼ 0.034 (see figure)
web 3C=FPO
Conclusion: FFR Index provide significant complementary data on the improvement
in myocardial function in patients with STEMI undergoing primary PCI. The evalu-
ation of FFR before and after angioplasty identifies viable myocardium that may
recover following revascularization and may be used as an alternative to non-invasive
testing.
Disclosure of Interest: None Declared
PM147
Newer generation drug eluting stent (DES) use in STEMI PCI
Matthew J. Brooks1, Jeffrey Lefkovits1, Andrew E. Ajani1, Nick Andrianopoulos2, David Clark3,
Matias Yudi1, Angela Brennan2, Martin Sebastian4, David Tsang5, Ronen Gurvitch*1
1
Cardiology Department, The Royal Melbourne Hospital, 2Monash University, 3Cardiology
Department, Austin Hospital, Melbourne, 4Cardiology Department, Geelong Hospital, Geelong,
5
The Royal Melbourne Hospital, Melbourne, Australia
Introduction: The use of DES in STEMI PCI remains controversial. While newer gener-
ation DES have been shown to have improved efficacy and safety performance little is
known about their use in STEMI PCI.
Objectives: To determine the pattern of DES use in STEMI PCI in a large Australian PCI
population, and to evaluate safety and efficacy outcomes of newer generation DES
compared to BMS and first generation DES in STEMI PCI.
Methods: We prospectively collected data on 2,534 patients undergoing PCI for acute
STEMI at 7 Australian public hospitals from 1st January 2005 to 31st December 2011.
Patients ineligible for DES (stent size <2.25 or >4.0mm) and those presenting with
cardiogenic shock and/or out of hospital cardiac arrest were excluded. 12-month safety and
efficacy outcomes of newer generation DES were evaluated and compared to BMS and first
generation DES (Taxus and Cypher).
Results: A bimodal trend in DES use in STEMI was observed with an initial peak of 43.2%
in 2005, a trough of 21.5% in 2007 (corresponding stent thrombosis [ST] concerns with
first generation DES) and a subsequent gradual increase in use in the era of newer gen-
eration DES to 29.2% in 2011 (p trend 2007 to 2011 <0.001).
e91
 PM149
12-month BMS First generation Newer generation
POSTER ABSTRACTS

outcomes (n [ 1,764) DES (n [ 418) DES (n [ 352) Association of Sex in the Management of STEMI: Equivalent door to balloon times do
TVR n, % 121 (6.9%) 26 (6.2%) 10 (2.8%)* not equal identical total ischemia time

MACE n, % 209 (11.9%) 47 (11.2%) 21 (6.0%)* Sarah J. Gutman*1,2,3, Adam W. Hutchison1,2,3, James Cameron1,2,3, Yuvaraj Malaiapan1,2,3,
Mortality n, % 66 (3.7%) 17 (4.1%) 7 (2.0%) Paul Antonis1,2,3, Nitesh Nerlekar1,2,3, Dennis Wong1,2,3, Richard W. Harper1,2,3,
Ian T. Meredith1,2,3
ST n, % 23 (1.3%) 8 (2.0%) 0 (0%)* 1
MonashHeart, Monash Health, 2Department of Medicine, Monash Medical Centre, 3Monash
*p value < 0.05 compared to BMS or first generation DES. Cardiovascular Research Centre, Monash University, Melbourne, Australia
Introduction: Historically female sex has been associated with worse prognosis after
ST elevation myocardial infarction (STEMI). Equivalent door to balloon times (D2BT) in
females and males with STEMI has been extensively reported in the literature. Total
While first and newer generation DES groups had comparable clinical and procedural ischaemic time is recognised as equally important in determining outcome.
characteristics, both differed significantly from the BMS group. When these differences Objectives: To determine if sex related differences in total ischaemic time exist in a
were taken into account on M-V analysis, newer generation DES was an independent contemporary cohort of patients presenting with STEMI to a major primary percutaneous
predictor of reduced 12 month MACE (OR 0.42 [95% CI 0.26-0.69]) whereas first gen- coronary intervention (PPCI) centre.
eration DES was not. Methods: A total of 1314 consecutive patients presented with ST elevation to our hospital
Conclusion: Newer generation DES appear to have significant advantage over both BMS network comprising a STEMI receiving centre and two non-PCI capable STEMI referral
and first generation DES in STEMI PCI with improved efficacy and lower adverse hospitals, between December 2007 and December 2012. Patients were excluded from the
outcomes. analysis if there was a resolution of pain and ST elevation in the ED (threatened STEMI), if
Disclosure of Interest: None Declared they received treatment with thrombolysis, if they were current inpatients or if data
regarding onset of pain was incomplete. We report here median [Interquartile Range] total
ischaemic time and D2BT in the remaining patients (84%).
Results: Of 1086 patients in the cohort, 20% (218) were female. Females experienced a
PM148 longer total ischaemic time (209[181] minutes) compared to males (194 [136] minutes),
P¼0.03, whilst D2BT was similar (72[62] and 77[55] minutes, females and males
Differences in the presentation, management and outcomes among patients respectively, P¼0.72). Mean catheter laboratory door to balloon time was identical in the
presenting to cardiologists and non-cardiologists in Kerala, India. Results from the sexes (31 minutes). There was no statistically significant correlation between age and total
Kerala Acute Coronary Syndrome Registry ischaemic time.
S. Harikrishnan*1, Panniyammakal Jeemon2, Dorairaj Prabhakaran2, G. Vijayaraghavan3,
C. G. Bahuleyan4, K. Suresh5, Tiny Nair6, Sunitha Viswanathan7, Mark Huffman8,
P. P. Mohanan9, For the Kerala ACS Registry
1
Sree Chitra Tirunal Institute of Medical SCiences and Technology, Trivandrum, 2Centre for
Chronic Disease Control, New Delhi, 3Kerala Institute of Medical Sciences, 4Ananthapuri
Hospital, 5SK Hospital, 6PRS Hospital, 7Government Medical College, Trivandrum, India,
8
Northwestern University Feinberg School of Medicine, Chicago, United States, 9West Fort
Hi-Tech Hospital, Trissur, India

Introduction: Optimal in-hospital and discharge medical therapy improves patient out-
comes in acute coronary syndrome (ACS).
Objectives: To evaluate differences in patient characteristics, treatment, and outcomes of
patients with ST-segment elevation myocardial infarction (STEMI) who seek care from
cardiologists and non-cardiologist physicians in Kerala.
Methods: The data were restricted to STEMI patients (n¼9,568) in the Kerala Acute
Coronary Syndrome Registry of 25,718 consecutive admissions. The optimal in-hos-
pital ACS medical therapy was defined as receiving the following 5 medications:
aspirin, clopidogrel, heparin, b-blocker, and statin. Similarly the optimal discharge
ACS medical therapy was defined as receiving all of the above therapies except hep-
arin. The patient characteristics, treatment, and outcomes were compared between
these two groups. A multiple logistic regression model was used to estimate the risk
for total in-hospital mortality in both patient groups and adjusted for age, sex, body
mass index (BMI) hypertension, diabetes, smoking and prior history of myocardial
infarction (MI).
Results:

Cardiologists Non-Cardiologists
Variables (N[6617) (N[2951) P value
Age, years (mean, SD) 60.63 (12.17) 59.78 (12.03) 0.001
Body Mass Index, Kg/m2 (mean, SD) 22.96 (3.59) 23.34 (3.67) <0.001
Symptom to door time, >6 hours (n, %) 3133 (47.66) 782 (26.72) <0.001
Hypertension, (n, %) 3173 (47.94) 1081 (36.63) <0.001 Conclusion: In this prospectively collected cohort, women with STEMI exhibited longer
Diabetes, (n, %) 2456 (37.11) 858 (29.07) <0.001 total ischaemic times despite similar D2BTs. Further research is required to determine the
Smoking, (n, %) 2424 (36.63) 952 (32.26) <0.001 causes for longer pain to door times in women. This may be a contributing factor to worse
outcomes in women with STEMI.
Prior Myocardial Infarction, (n, %) 962 (14.54) 295 (10.00) <0.001 Disclosure of Interest: None Declared

The unadjusted in-hospital death rate were higher in patients seeking care from cardi-
ologists (8.7%) compared to patients seeking care from non-physician cardiologists (5.2%).
However, after accounting for the patient characteristics and risk factor profile the prob-
ability of death during hospitalization was significantly lower in patients seeking treatment
from cardiologists (adjusted OR¼0.54; 95% CI: 0.35, 0.72).
Conclusion: Despite adverse risk profile, STEMI patients who presented to cardiologists
were more likely to receive optimal in-hospital and discharge medical care, which likely
contributed to lower adjusted mortality rates compared with patients presenting to non-
cardiologist physicians.
Disclosure of Interest: None Declared
PM150
Pre-Catheterisation High-Sensitivity Troponin T Level Predicts Major Adverse
Cardiovascular Events After St-Elevation Myocardial Infarction
Tom Kai Ming Wang*1, Timothy Snow1, Timothy Watson1,2, James Stewart1, Mark Webster1,2,
Peter Ruygrok1,2, Harvey White1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: Cardiac troponins have limited use in the context of ST-elevation myocardial
infarction (STEMI) given the urgency for intervention. Recently developed high-sensitivity
troponin (hs-TnT) assays have increased sensitivity and enable more rapid diagnosis for MI.

e92 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Objectives: We assessed whether admission hs-TnT levels predict major adverse cardio-
vascular events (MACE) after STEMI.
Methods: Patients admitted for acute coronary catheterisation for presumed STEMI
diagnosis between October 2010-September 2011 at Auckland City Hospital were included
if hs-TnT levels were measured before cardiac catheterisation. Characteristics and major
adverse cardiovascular events (MACE: death, myocardial infarction and revascularisation)
at 30 days and 1 year were collected from clinical records.
Results: Median pre-catheterisation hs-TnT level in the 173 STEMI patients studied was
59ng/L (lower quartile 19, upper quartile 310). Incidences of MACE at 30 days and 1 year
were 10% (17) and 18% (31) respectively. C-statistics and 95% confidence interval (95%
CI) for hs-TnT on admission at detecting MACE at 30 days and 1 year were 0.800 (0.696-
0.904) and 0.750 (0.655-0.845) respectively, with the optimal cut-point of 225ng/L giving
sensitivities/specificities of 76.5%/75.6% and 64.5%/78.2% respectively. Pre-catheterisation
log(hs-TnT) independently predicted both MACE at 30 days with odds ratio 7.61, 95%CI
(2.33-24.8) and 1 year with hazards ratio 2.88, 95%CI (1.79-4.63), as did age and
cardiogenic shock. Age, Maori or Pacific ethnicity and chronic respiratory disease were
independent predictors of hs-TnT>225ng/L on admission.
Conclusion: Pre-catheterisation hs-TnT level in STEMI patients independently predicted
MACE at 30 days and 1-year. This has implications for future STEMI risk stratification and
model development.
Disclosure of Interest: None Declared
PM151
Comparison of late vascular response after Everolimus-Eluting Stents and Bare Metal
Stents implantation in ST-segment Elevation Myocardial Infarction; An Optical
Coherence Tomography Study
Tomoko Tohda*1, Yasushi Ino1, Takashi Kubo1, Takashi Tanimoto1, Yoshiki Matsuo1,
Takashi Yamano1, Tomoyuki Yamaguchi1, Kumiko Hirata1, Atsushi Tanaka1, Toshio Imanishi1,
Takashi Akasaka1
1
Cardiovascular medicine, Japan/Wakayama Medical Universiy, Wakayama, Japan
Introduction: Implantation of drug-eluting stents (DES) in patients with ST-segment
elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary inter-
vention (PCI) reduces in-stent restenosis compared with bare metal stents (BMS), however,
the long-term risk of DES use in STEMI has been pointed. Previous pathological and optical
coherence tomography (OCT) study reported that first generation DES use in STEMI resulted
in higher rates of uncovered and malapposed stent struts at follow-up. The long-term safety of
second generation everolimus-eluting stents (EES) use in STEMI remains unknown.
Objectives: We used OCT to examine vascular response including strut coverage and
malapposition in patients with STEMI treated with EES and BMS.
Methods: We enrolled 102 patients with STEMI who underwent primary stenting and 10-
month follow-up OCT (EES: 61 patients and BMS 41 patients).
Results: A total of 21366 stent struts were analyzed. There were no significant differences
in the percentage of uncovered and apposed struts and the percentage of uncovered and
malapposed struts between 2 stents (1.6
2.3 % versus 1.2
2.0 %, P¼0.379 and 0.6

1.2 % versus 0.4
0.9 %, P¼0.596, respectively). The mean neointimal thickness was
smaller in EES lesions (104
39 mm vs. 388
148 mm, P<0.001). Intra-stent thrombus
was observed in 13 % of EES lesions and 10 % of BMS lesions (p ¼ 0.758). The frequencies
of in-stent binary restenosis and target lesion revascularization were higher in EES compaed
with BMS (3 % vs. 17 %, p ¼ 0.028 and 2 % vs. 12 %, p ¼ 0.037, respectively).
Conclusion: In STEMI patients undergoing primary PCI, there are no significant differ-
ences in the percentage of uncovered struts and malapposed struts, and the incidence of
intra-stent thrombus at 10-month follow-up between EES and BMS. On the other hands,
EES as compared with BMS significantly reduces neointimal hyperplasia. EES has a po-
tential to achieve low late loss without sacrificing safety.
Disclosure of Interest: None Declared
PM154
Effect of Low-Dose Atorvastatin on Hmgb1 In Patients With Unstable Angina
Jian Yang*1, Jun Yang1, Jia W. Ding1, Song Li1, Xin X. Li1
1
Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges
University, Yichang, China
Introduction: High mobility group box 1 (HMGB1) protein has emerged as a very
important pro-inflammatory cytokine in coronary heart disease. Our previous study
demonstrated that serum HMGB1 level was correlated with the severity of coronary
artery stenosis. Anti-inflammatory effects of statins have attracted considerable interest in
reducing coronary events.
Objectives: In the present study, we will evaluate the effect of low-dose atorvastatin
treatment on HMGB1 and clinical outcomes in patients with unstable angina.
Methods: Sixty-nine patients with unstable angina were randomly divided into two groups.
Group A (n¼35) received atorvastatin 10 mg/day for six weeks in addition to standard anti-
anginal treatment. Group B (n¼34) received standard anti-anginal treatment without
atorvastatin. Serum HMGB1 level was determined with a commercially available ELISA kit.
Serum high-sensitivity CRP (hsCRP) concentration was measured by chemiluminescence
immunoassay. Blood samples were taken from the patients at 0, 1 and 6 weeks of this
study. Meanwhile, the incidence of major adverse cardiovascular events (MACEs):
myocardial infarction (MI), recurrent angina, cardiac death and treatment emergent adverse
effects were recorded.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: Initially there were no significant differences in the HMGB1 and hsCRP levels (P
POSTER ABSTRACTS
both>0.05) between groups A and B. After one week, atorvastatin reduced HMGB1 from
baseline by 19.4% compared with 8.7% in group B (P <0.05). However, there was still no
significant change in hsCRP levels between the two groups (P >0.05). At six weeks, the
HMGB1 and hsCRP concentrations were similarly decreased in both atorvastatin-treated
and control groups (P both <0.01). MACEs in group A were not different from those in
group B (6.1% atorvastatin vs. 6.9% without atorvastatin; P >0.05). Furthermore, there
was no rhabdomyolysis or liver dysfunction (aminotransferase increase) observed in either
group during the six weeks follow-up period.
Conclusion: The use of low-dose atorvastatin (10 mg/day) can provide an attractive
approach for early treatment of patients with unstable angina. Moreover, Short-term low-
dose atorvastatin therapy does not reduce MACEs or increase adverse effects despite its
influence on HMGB1 concentrations. These data suggest that serum HMGB1 level could
serve as an earlier and more efficient indicator than hsCRP of low-dose atorvastatin anti-
inflammatory activity.
Disclosure of Interest: None Declared
PM155
Discharge diagnoses and use of aspirin in men and women with chest pain referred
for elective coronary angiography and without obstructive coronary artery disease
Karin G. Schenck-Gustafsson*1, Nina Johnston1, Clara Thörn2
1
Dept. of Meciine, Centre for Gender Medicine, Cardiac Unit, Karolinska Instiutet, Stockholm,
2
Dept. of Cardiology, 2Dept. of Medical Sciences and Cardiology, Uppsala University, Uppsala,
Sweden
Introduction: Chest pain is a common reason for healthcare visits. Coronary artery disease
(CAD) is an important differential diagnosis to exclude. Coronary angiography is seen as
the gold standard method to confirm CAD. However when obstructive disease is not
present speculations flourish as to the etiology of chest pain and proper treatment.
Objectives: To investigate the diagnoses and recommendations for use of aspirin at
discharge in men and women with chest pain referred for elective coronary angiography
and without obstructive CAD.
Methods: 65 men and 35 women admitted because of chest pain during 2010-2012 for a
first time elective coronary angiography at Uppsala University Hospital, Sweden were
included. All patients were free of previous heart disease, stroke and peripheral artery
disease. Among these, 21.5% of the men and 54.3% the women were without obstructive
CAD (defined as <50% stenosis in any epicardial artery). Journal charts were examined for
diagnoses and use of aspirin at discharge.
Results: In the whole patient cohort, the median time for investigation from referral for a
first non-invasive test to coronary angiography was 5 months. The most frequent discharge
diagnosis in patients without obstructive CAD was unspecified chest pain (ICD:R07.4) in
57.1% of men and 36.8% of women followed by angina (ICD:I20.8, I20.9) in 21.4% of
men and 31.6% of women. At discharge 63% men and 29% of women with unspecified
chest pain compared to 100% of men and 83% of women with an angina diagnosis were
recommended continued use of aspirin.
Conclusion: We found that in chest pain patients referred for diagnostic coronary angi-
ography and without obstructive CAD, investigation times were lengthy, in many patients
resulted in an unclear diagnosis and recommendations for continued use of aspirin despite
lack of indication. In patients receiving an angina diagnosis less women than men were
discharged with aspirin. More research needs to be focused on the etiology of chest pain
and reasons for underuse of recommended therapy in women with non-obstructive CAD.
Disclosure of Interest: None Declared
PM156
Does Low on Treatment Platelet Reactivity Identify Acs Patients At Increased Risk of
Bleeding?
Lisa Johnston*1,2, Ana Holley1,2, Michael Chen-Xu2, Ali Al-Sinan2, Peter Larsen2, Scott Harding2
1
School of Biological Sciences, Victoria University of Wellington, 2Wellington Cardiovascular
Research Group, Wellington, New Zealand
Introduction: The use of antiplatelet and antithrombotic therapy in acute coronary syn-
dromes (ACS) has shown to be effective at decreasing ischaemic risk. However, this benefit
is negated in some patients by an increase in bleeding risk and bleeding is associated with
worse short and long-term outcomes. Low on treatment platelet reactivity (LPR) has been
associated with an increase in bleeding in patients undergoing PCI. The CRUSADE
bleeding score has also been shown to predict bleeding risk in ACS patients. Whether LPR
adds additional value to a risk score such as CRUSADE is unknown.
Objectives: To investigate the predictive nature of LPR and the CRUSADE bleeding score,
in a New Zealand ACS population.
Methods: Patients with ACS on dual antiplatelet therapy (aspirin and clopidogrel) treated
with an invasive strategy were enrolled into this prospective observation study. Platelet
reactivity was measured on treatment using the Multiplate analyser. CRUSADE risk score
was calculated in all patients at admission and BARC type 2, 3 and 5 bleeding (BARC 4
CABG-related bleeding excluded) was examined at 30 days. Patients pretreated with GPIIb/
IIIa inhibitors or undergoing primary PCI were excluded from the study.
Results: We enrolled 553 patients, mean age 62, 24% STEMI, 66.3% NSTEMI, 60% had
PCI and in 80% a radial access site was used. We observed bleeding in 36 patients (6.5%).
The majority of bleeding events were a BARC 2 bleed (91%) with the remainder being type
e93
 3 (9%). Neither CRUSADE score nor residual platelet reactivity were predictive of bleeding
POSTER ABSTRACTS
risk in this cohort. Half (50%) of the observed bleeding was due to access site complica-
tions. The only statistical predictor of bleeding was access site, where femoral access
was associated with higher rates of bleeding compared to radial access (13.2% vs. 6%,
p¼0.02).
Conclusion: In our ACS cohort, neither CRUSADE score nor LPR were predictors of
increased 30-day bleeding risk. Overall there was a low bleeding rate in our population,
and this may be due to the high rate of radial access.
Disclosure of Interest: None Declared
PM157
“Use of New Antiplatelet Agents in Patients with Acute Coronary Syndrome in the
real word”
Nicolas Lalor*1,2, Leandro Rodriguez1,2, Pablo Elissamburu1,2, Gerardo Nau1,2,
Fernando Cura1,2, Diego Conde1,2, Marcelo Trivi2
1
Clinical cardiology, Sanatorio Anchorena, 2Clinical cardiology, Instituto Cardiovascular de
Buenos Aires, Buenos Aires, Argentina
Introduction: Clopidogrel associated with aspirin is the more experienced antiplatelet
combination for patients suffering from acute coronary syndrome (ACS). Inhibition of
platelet activity plays a paramount role in the treatment of such pathology. At present, the
introduction of new antiplatelet agents (NA: prasugrel or tricagrelor) allows for a strong
platelet inhibition, reducing thrombotic events, but increasing hemorrhagic risk compared
with clopidogrel.
Objectives: To compare clinical results (in terms of ischemic and hemorrhagic events) of
patients with ACS treated with clopidogrel or new antiplatelet agents.
Methods: 422 ACS patients who underwent PCI with stent implantation were recruited.
The sample was divided in 2 groups: Clopidogrel group (CL) New Antiplatelet group
(prasugrel or ticagrelor). All patients recive aspirin 100 mg/ day, 240 patients recive CL and
182 patients recive NA.
Of 422 included patients, 127 (30%) had STEMI and 295 (70%) non-STEMI. NA group
patients were younger (59.5 yr. vs 65.3 yr. p<0.001) and had less hypertension (56.6% vs
67.1%, p¼0.01) than CL group. No gender, weight, diabetes rate, dyslipemia or smoking
differences were observed.
Selected clinical variables were analyzed to detect uni and multivariate predictors of
adverse events (cardiovascular death, ischemic and hemorrhagic events) during 12 months
follow-up.
Results: No differences in cardiovascular related deaths were observed in both groups (NA
2.8% vs CL 2.5%, p¼ns). NA group showed less re-infraction (1.7% vs 6.8%, p<0.01)
with more total bleedings (19% vs 8.5%, p<0.001) and minor bleedings (12.4% vs 3.4%,
p<0.001) with no differences in major and life threatening bleedings ( p¼ns). Multivariate
analysis showed that independent predictors of cardiovascular mortality were age (OR
1.08, CI 95% 1.01-1.16) and renal failure (OR 6.98, CI 95% 1.23-39.71). Use of clopi-
dogrel was the only infarction independent predictor (OR 1.31, CI 95% 4.64-16.44). In-
dependent predictors for total bleeding were age (OR 1.06, CI 95% 1.02-1.09), STEMI (OR
1.99, CI 95% 1.05-3.79), renal failure (OR 3.32, CI 95% 1.62-6.78) and new antiplatelet
agents use (OR 4.05, CI 95% 1.96-8.39).
Conclusion: Among patients presenting STEMI or non-STEMI who underwent percuta-
neous revascularization in the real word, use of new antiplatelet agents is associated with
lower myocardial re-infraction rate and higher minor bleeding with 1 year follow-up.
Disclosure of Interest: None Declared
PM158
Acute Myocardial Infarction With or Without St-Segment Elevation, Do They
Definitely Have A Different Prognosis? Results of The Castuo Registry
Daniel Fernandez-Berges*1, Luciano Consuegra-Sanchez2, Francisco J. Felix-Redondo3,
Luis Lozano4, Paula Alvarez-Palacios5, Yolanda Morcillo5, Isabel Miranda6,
Federico Soria Arcos7, Veronica Tejero5, Ana B. Hidalgo5, GRIMEX
1
Internal Medicine-Cardiology, Sistema Extremeño de Salud, Don Benito-Villanueva,
2
Cardiology, Hospital Universitario de Santa Lucia, Cartagena-Murcia, 3Primary Care, Sistema
Extremeño de Salud, Villanueva de la Serena, 4Primary Care, Sistema Extremeño de Salud,
Merida, 5Investigation Unit, GRIMEX, 6Investigation Unit, Fundesalud, Villanueva de la Serena,
7
Cardiology, Hospital Universitario de Santa Lucia, Cartagena- Murcia, Spain
Introduction: The prognosis of patients with an ST-segment acute myocardial infarction
(STE – MI) compared to those with a non ST-segment elevation MI (NSTEMI) is still
controversial. Previously published registries and the Nationwide spanish registry
-MASCARA-, have reported that those patients with STEMI exhibits a higher in-hospital
mortality compared to NSTEMI patients; however, at 6-months follow-up, mortality is
similar between both groups. Whether this statement is real in regional or secondary
hospitals without catheterization facilities is not completely known.
Objectives: We aimed at describing the in-hospital and 1-year all-cause mortality in pa-
tients with a ST-segment elevation or non-elevation myocardial infarction in a regional
Spanish hospital. As a secondary objective we compared the mortality rates with the
MASCARA registry.
Methods: The CASTUO registry is an observational, retrospective and contemporaneous
registry, of patients admitted to the Hospital Don Benito, Villanueva de la Serena (Spain),
with a diagnosis of acute MI. We recruited a total of 2177 patients, 965 with STEMI, 1096
e94
NSTEMI and 116 unclassifiable MI (uMI). We obtained data on follow-up in all patients
and assessed survival with a Kaplan-Meier method.
Results: In-hospital mortality was higher in STEMI compared to NSTEMI (14.3 vs. 8.9 %,
p<0.05), being the highest for uMI (20.7 %, 95% CI 13.3-28.1, p< 0.05). These mortality
rates were uniformly higher in CASTUO, compared to MASCARA for each category
(STEMI 14.3 vs 7.6 %, p < 0.05; NSTEMI 8.9 vs. 3.9%, p < 0.05; uMI 20.7 vs. 8.8 %, p <
0.05). At 1-year follow-up, cumulative mortality rate was similar between STEMI and
NSTEMI patients (20,2 vs. 19,8%). Still, patients with uMI showed a significant higher
mortality (35%, 95% CI 26-44).
Conclusion: In a secondary hospital without catheterization facilities, the mortality rate is
higher than that reported in registries. Those patients with a uMI show a high in-hospital
and 1-year mortality rate. STEMI patients show a higher in-hospital mortality rate but
similar at 1-year follow-up to those with NSTEMI.
Disclosure of Interest: None Declared
PM159
The relation between silent Ischemia and coronary artery disease severity in diabetics
El Sayed Farag*1, Mohammad Al-Daydamony1
1
Cardiology department, Zagazig university, Zagazig, Egypt
Introduction: Patients with coronary heart disease (CAD) complain of angina pectoris
(AP). However, most CAD patients will have episodes of silent myocardial ischemia.The
relation between the relation between the angiographic severity of CAD and the severity of
silent ischemic episodes detected by ambulatory ECG recording (frequency of episodes,
maximum ST- depression, and total duration of ST-depression) was not fully elucidated.
Objectives: The aim of this work was to examine the relation between the severity of silent
ischemic episodes detected by ambulatory ECG recording and the angiographic severity of
coronary artery disease (CAD).
Methods: Fifty patients with chronic stable angina pectoris and type 2 diabetes mellitus
were enrolled in the study.Among the study group, there were 33 males and 17 females;
and their mean age was 61
6.5 years. All patients were submitted to 24-hours ambulatory
ECG recording and coronary angiography with estimation of Gensini score. According to
the frequency of silent ST-segment depression episodes, patients were classified into two
groups.
Group I: 24 patients with ST-segment depression frequency <8.
Group II: 26 patients with ST-segment depression frequency 8.
Results: In patients with ST-segment depression frequency 8, there were significantly
higher number of left main coronary artery (LMCA)disease, and significantly higher
Gensini score (Table 1). Sensitivity of ST-segment depression frequency  8 in predicting
Gensini score 20 was 60 %, specificity was 56 %, positive predictive value was 58 %,
negative predictive value was 58 %, and overall accuracy was 58 % (Kappa ¼ 0.412, p ¼
0.014). Gensini score showed significant positive correlation with ST-segment depression
frequency (r ¼ 0.391, p ¼ 0.005), with maximum ST-segment depression (r ¼ 0.346, p ¼
0.014), and with total ST-segment depression duration (r ¼ 0.495, p ¼ 0.0003).
ST-depression Frequency ST-depression Frequency
< 8 (n [ 24) ‡ 8 (n [ 26) P
LMCA disease 2 (8.3 %) 8 (30.8 %) 0.048
Gensini Score 21.3
10.75 35.4
17.3 0.001
Conclusion: Patients with type 2 diabetes mellitus who had more frequent silent
myocardial ischemia by ambulatory ECG recording were found to have angiographically
more extensive CAD as assessed by Gensini score. Gensini score was found to be signifi-
cantly correlated to the frequency of silent ST-depression, maximum ST-depression, and
total ST-depression duration.
Disclosure of Interest: None Declared
PM161
Coronary artery disease in patients undergoing regular hemodialysis: A 5-year
prospective observational study
Hassan Al-Thani*1, Ayman El-Menyar2
1
vascular surgery, 2cardiology, Hamad General Hospital, Doha, Qatar
Introduction: The reasons for increased cardiovascular diseases in renal failure patients
who are on replacement therapy are not entirely clear.
Objectives: We aimed to study the frequency and outcome of coronary artery disease in
patients who were on regular hemodialysis (HD) for end-stage renal failure (ESRF).
Methods: A prospective cohort study was conducted for patients undergoing regular HD in
the middle of 2007 with a 3 and 5- year follow up. Demographics, clinical profiles, and
outcomes were analyzed in patients whether they have coronary artery disease (CAD) or
not.
Results: A total of 252 consecutive HD patients were enrolled. The median HD duration
was 5 (1-31) yrs. Overall 5-year mortality was 47% (118 cases). Across the 5 years, there
were 130 cases (52%) had CAD, of them 44 cases (37% of total deaths) died. During the
first 3 years, there were 66 cases (26%) had CAD, of them 3 cases died. Among the CAD
cases, 62 cases developed myocardial infarction and 24 cases underwent PCI. In
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
comparison to non-CAD, patients with CAD were older (62
12 vs 53
17 yrs), more likely to
have DM (75% vs 45%), diabetic nephropathy (61% vs 34%) and PAD (60% vs 35.5 %),
(p¼0.001 for all). There was no significant difference for hypertension (81% vs 86%), dys-
lipidemia (28% vs 23%) and smoking (4% vs 6%). The presence of diabetic retinopathy (77%
vs 42%) and foot ulcer (26% vs 7%) was significantly higher among CAD patients. The
number of vascular access for HD was higher in the CAD patients (median 3[1-19] vs 2[1-12].
Logistic regression multivariate analysis showed that independent predictors for CAD in
HD patients were presence of foot ulcer (aOR 3.0; 95% CI 1.23-7.55), retinopathy (aOR
2.05; 95% CI 1.04-4.04) and age (aOR1.02; 95% CI 1.001-1.051).
Conclusion: Our study confirms and expands the impact of ESRF on regular HD therapy
on the incidence and outcome of CAD disease.
Disclosure of Interest: None Declared
PM162
Short and intermediate-term prognostication of the Canada Acute Coronary
Syndrome Risk Score in the Gulf RACE-2 registry
Hussam Alfaleh*1, Khalid AlHabib1, Tarek Kashour1, ahmed Hersi1, anhar ullah1,
Jassim AlSuwaidi2, Kadhim Sulaiman3, Alawi AlsheikhAli4, Ahmed Al-Motarreb5,
Haitham Amin6, Wael Almahmeed7, Nidal Alasaad2, Shukri Alsaif8
1
Cardiac Sciences, King Saud University, King Khalid university Hospital, riyadh, Saudi Arabia,
2 performed in 106 (48.6%) patients, PCI in 60 (27.5%) patients. The composite of death,
Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar, 3Department of
Cardiology, Royal Hospital, Muscat, Oman, 4Division of Cardiology, Institute of Cardiac Sciences,
Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 5Faculty of Medicine, Sana’s
University, sanaa, Yemen, 6Mohammed Bin Khalifa Cardiac Center, Cardiac Center, manama,
Bahrain, 7Department of Cardiology, Sheikh Khalifa Medical City, abu dhabi, United Arab Emirates,
8 with CABG and PCI groups. Revascularization might not have been used due to physician’s
Saud AlBabtain Cardiac Center, Saud AlBabtain Cardiac Center, dammam, Saudi Arabia
Introduction: The use of acute coronary syndrome (ACS) prognostic risk scoresis limited by
their complexity and their inability to be used at first medical contact either at pre-hospital or in
the emergency room. The Canada Acute Coronary Syndrome (C-ACS) Risk Score is a simple
risk assessment tool that was recently shown to provide early and rapid risk assessment.
Objectives: Our objective was to test whether C-ACS risk score can predict short and
intermediate-term mortality in real world ACS registry
Methods: 7929 patients enrolled in the Gulf RACE-2 registry, from 6 Arab gulf countries
were prognosticated using the C-ACS risk score. The score ranged from 0 to 4, with 1 point
assigned for the presence of each of these variables: age 75 years, Killip >1, systolic blood
pressure <100 mm Hg, and heart rate >100 beats/min. C-Statistic was used to test the
predictive power of the C-ACS risk score for 30-day and 1-year mortality in the entire ACS
cohort, and in STEMI and NSTEMI groups separately.
Results: The C-ACS score predicated 30 days, and 1-year mortality. The predictive power
of C-ACS for 30-day mortality in all ACS patients, STEMI and NSTEMI groups was
however modest (C-Statistic 0.69 95% CI 0.66-0.71, 0.68 95% CI 0.65-0.71, and 0.70
95% CI 0.66-0.73 respectively). The predictive power for 1-year mortality for all ACS
patients, STEMI and NSTEMI groups was also modest (C-Statistic 0.67 95% CI 0.65-0.69,
0.68 95% CI 0.65-0.71, 0.67 95% CI 0.64-0.70 respectively).
Conclusion: Although the simple C-ACS risk score possessed good predictive values for
short and intermediate mortality in a western ACS registry, its predictive power in a
contemporary Middle Eastern ACS population was suboptimal. This raises concerns about
the accuracy and generalizability of this ACS risk assessment tool.
Disclosure of Interest: None Declared
PM163
Affectation of The Anterior Descending Artery In Patients With Chronic Stable
Angina And Coronary Angioplasty Multivessels
1 1 1 Cytochrome P450 (CYP) enzymes play a vital role in the metabolism of clopidogrel, however
Ricardo A. Costantini* , Cristian García , Juan M. Telayna
1
Interventional Cardiology, Austral University Hospital, Pilar, Argentina
Introduction: The compromises of the anterior descending artery in the context of cor-
onary multiple diseases can make determine the strategy of revascularization.
Objectives: Determines the results of the treatment under coronary angioplasty in multiple
vessels and compromise of anterior descending artery (ADA) in patients with chronic stable
angina.
Methods: Patient (n¼331) with chronic stable angina received consecutively percutaneus
complete revascularization. Of these there was presenting affectation of ADA 59 patients
(Group A) and without affectation of ADA 272 patients (Group B). Presented the following
basal characteristics, A and B n (%), respectively: age 64,8
10 years vs 63,6
10 years;
diabetes 17pts (29) vs 88pts (32); prior infarct 19pts (32) vs 90pts (33); previous coronary
angioplasty 18pts (30) vs 103pts (38), previous by pass surgery 6pts (10) vs 56pts (20);
media left ventricular function 59,9
16,6% vs 60,5
18,4%. The clinical status was:
silent ischemia 42pts (71) vs 196pts (72); chronic stable angina CF II: 12pts (20) vs 57pts
(21); CF III 4pts (7) vs 16pts (6); CF IV stabilized 1 pt (2) vs 3pts (1). The angiographic
findings was: media length lesion 19,9
4,6 mm vs 21,2
9 mm; media length stent 53,9

33,7mm vs 47,9
31,7mm, stent / patient 2,4 vs 2,1; use drugs eluting stents 36 (61) vs
161 (59); dye volume 311,7
99,5 ml vs 273,1
98,2 ml – p¼ 0,007 – and fluoroscopy
time 26,5
15,1 vs 23
14,2 minutes p¼ 0,09.
Results: Intrahospitalary results, A vs B, respectively n(%): technical success 58 (98) vs 261
(96); total mortality 0 vs 0; total myocardial infarct 3 (5) vs 7 (2,5) - p¼ 0,3. During the follow-up
to 22
15 months of 86 % of the population: total mortality 1 (1,6) vs 4 (1,4); cardiac mortality
0 vs 0; myocardial infarct 0 vs 1 (0,3) and coronary total reintervention 10 (17) vs 45 (16).
Conclusion: The strategy of percutaneous multivessels revascularization with affectation the
ADA, in patients with chronic stable angina did not demonstrate superior cardiovascular
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
major events in opposite of patients with disease of multiple vessels without affectation of
POSTER ABSTRACTS
ADA. Therefore, the decision of the strategy of revascularization in this clinical status must not
be weighed according to the affectation the ADA.
Disclosure of Interest: None Declared
PM164
Left Main Coronary Artery Disease: Comparison of Coronary Artery Bypass Surgery,
Percutaneous Coronary Intervention, And Medical Therapy In “Real-World” Clinical
Practice
Vadim Kuznetsov*1, Ivan Bessonov1, Igor Zyrianov1, Elena Samoylova1, Elena Gorbatenko1
1
Tyumen Cardiology Center, Tyumen, Russian Federation
Introduction: Coronary artery bypass surgery is considered as the gold standard treatment
of unprotected left main coronary artery (ULMCA) disease. Recent data suggest that ULMCA
percutaneous coronary interventions (PCI) with drug-eluting stents may be safe and effec-
tive. However, in "real-world" clinical practice some patients receive medical therapy only.
Objectives: To evaluate long-term results in patients with ULMCA disease in a "real-world"
practice.
Methods: Between January 2006 and June 2011, 218 stable patients were diagnosed with
de novo ULMCA stenosis. 52 (23.9%) patients received medical therapy only, CABG was
myocardial infarction, and stroke were defined as major adverse cardiac and cerebrovas-
cular events (MACCE) and target vessel revascularization (TVR) were defined as primary
endpoints. The median follow-up period was 4 years.
Results: Baseline clinical and descriptive morphology of coronary artery disease revealed
more comorbidities and more complex anatomies in the medical therapy group compared
decision (operative risk considered excessive) in 24 (46.2%) cases or when patients refused
revascularization in 28 (53.8%) cases. The median time from diagnosed ULMCA disease to
revascularization was significant shorter in PCI group compared with CABG group (4 days
vs 68 days; p<0.001). At 4-year follow-up MACCE rate was higher in nonsurgical group
compared with CABG (34.6% vs 13.2%; p¼0.002) and PCI (34.6% vs 14.5%; p¼0.016)
groups, but there was no difference between CABG and PCI groups. Survival in CABG
(4.7%; p<0.001) and PCI (5.5%; p¼0.009) groups was higher compared with nonsurgical
group (23.1%). According to the multivariable Cox regression analysis, coronary revas-
cularization (CABG and PCI) was independent predictor of long-term survival (HR 3.49;
95% CI 1.39-8.75; p <0.001).
Conclusion: PCI like CABG improves survival for patients with unprotected left main
coronary artery disease compared with medical therapy only in "real-world" clinical
practice. Unprotected left main coronary artery disease requires mandatory, fastest possible
revascularization strategy.
Disclosure of Interest: None Declared
PM165
Association between CYP2C19*2/*3 Polymorphism and Cardiovascular Events in a
Chinese Han Population
Ying-Ying Zhang1, Xin Zhou1, Wen-Jie Ji1, Rui-Yi Lu1, Rui Shi1, Shan Zeng1, Tie-Min Jiang1,
Yu-Ming Li1, Zhao-Zeng Guo*1
1
Institute of Cardiovascular Disease and Heart Center, Tianjin Key Laboratory of Cardiovascular
Remodeling and Target Organ Injury, Pingjin Hospital, Logistics University of CPAPF, Tianjin,
China
Introduction: The dual antiplatelet therapy using aspirin and clopidogrel is now the
cornerstone to prevent the ischemic cardiovascular events in coronary heart disease (CHD).
multiple cohort studies have linked the CYP2C19*2, CYP2C19*3 polymorphism and other
loss-of-function allelic variants of this gene to major adverse cardiovascular events in patients
taking clopidogrel. The distributions of CYP2C19 polymorphisms in whites, blacks, East
Asians are approximately 30%, 40%, and 55%, respectively. Additionally, CYP2C19*3 allele
had been regarded as an Asian-specific variant allele that accounts for the poor metabolism
and a risk factor influencing CHD in Chinese Uighur population.
Objectives: To explore the relationship between Cytochrome P450 2C19 (CYP2C19)*2/*3
polymorphism and cardiovascular events in Chinese Han people.
Methods: A total of 231 consecutive patients underwent coronary angiography who were
suspected for CHD were enrolled. Genotyping for CYP2C19*2(681G>A) and
*3(636G>A) alleles were performed by polymerase chain reaction restriction fragment
linked polymorphism method. The adverse clinical events were defined as cardiovascular
death, myocardial infarction, stent thrombosis, stroke and rehospitalization for acute
coronary syndrome (ACS) during a 14-month follow-up period.
Results: Compared with CYP2C19*2 non-carriers, the CHD% was significantly higher
(P¼0.025) in CYP2C19*2 carriers group, and similar result was also observed in the
incidence of adverse cardiovascular events (21.6% vs. 6.3%, P¼0.019). No difference of
CHD% was observed in CYP2C19*3 determined groups. Stepwise binary logistic regres-
sion analysis showed that CYP2C19*2 carries (OR 1.94, P¼0.028, 95%CI 1.076 to 3.504)
and male gender (OR 2.74, P¼0.001, 95%CI 1.577 to4.758) were independent predictors,
and CYP2C19*2 loss-of-function was the only independent factor to predict the coronary
events via multivariate Cox proportional hazards analysis (HR¼3.653, P¼0.036, 95% CI
1.089 to 12.248). CYP2C19*3 genotype had no obvious impact on cardiovascular events.
Conclusion: CYP2C19*2 polymorphism independently predictor adverse cardiovascular
events in a Chinese Han population.
Disclosure of Interest: None Declared
e95
 PM166
POSTER ABSTRACTS
Evaluation of Platelet Reactivity in Coronary Heart Disease Patients on Clopidogrel
Treatment by Sonoclot Coagulation and Platelet Function Analyzer
Hai-Ying Sun1, Xin Zhou1, Wen-Jie Ji1, Rui Shi1, Shan Zeng1, Tie-Min Jiang1, Yu-Ming Li1,
Zhao-Zeng Guo*1
1 1
Institute of Cardiovascular Disease and Heart Center, Tianjin Key Laboratory of Cardiovascular
Remodeling and Target Organ Injury, Pingjin Hospital, Logistics University of CPAPF, Tianjin,
China
Introduction: Sonoclot analysis is a point-of-care method for assessment of coagulation
and platelet function in whole blood. Previous studies reported that it was a sensitive
method to monitor effects of heparin. However, the usefulness of it in detecting clopidogrel
responsiveness is poorly understood.
Objectives: To investigate the effectiveness of two-channel Sonoclot analyzer in testing the
clopidogrel responsiveness in patients with coronary heart disease (CHD).
Methods: A total of 80 consecutive CHD patients with unstable angina were
enrolled. All patients took loading dose of clopidogrel before the test. Platelet
reactivity was determined by three methods [ADP-induced platelet aggregation
(PAG), measured by LTA. Platelet reactivity index (PRI), measured by VASP analysis
and activated clotting time (ACT), clot rate (CR) and platelet function (PF),
measured by Sonoclot analysis].
Results: All subjects were dichotomized according to PRI (normal-responders: PRI<50%,
n ¼ 35 and low-responders: PRI 50%, n ¼ 45) and PAG medians (normal-responders:
PAG70.05%, n ¼ 41 and low-responders: PAG>70.05, n¼39). Compared with PRI-
determined normal responders, in low responders there was an increasing difference of PF
in two channels (adjusted OR¼1.882, 95% C.I. [1.047, 3.384], P¼0.035), and it
contributed to an area under curve (AUC) of 0.648 (P¼0.024), with a sensitivity and
specificity of 68.89% and 57.14%, respectively. In addition, the low-responders deter-
mined by PAG, the difference of CR between ADP- and NON-channels as well as increased
(adjusted OR 1.269 95% C.I. [1.002, 1.608], P¼0.048); Moreover, the difference of CR in
two channels contributed to an AUC of 0.635 (P¼0.039) with a sensitivity and specificity
of 48.72% and 82.93%.
Conclusion: There is an association between Sonoclot analysis and platelet VASP phos-
phorylation and light transmission aggregometry. Sonoclot analysis could be used to
evaluate clopidogrel responsiveness in patients with CHD. But these three methods in
detecting platelet functions are not interchangeable.
Disclosure of Interest: None Declared
PM167
Monocyte Subsets and Monocyte-Platelet Aggregates in Patients with Troponin
Negative Non-ST-Elevation Acute Coronary Syndrome: Potential Role in Risk
Stratification
Xin Zhou1, Wen-Jie Ji1, Lan Ge1, Rui-Yi Lu1, Zhao-Zeng Guo*1, Tie-Min Jiang1, Yu-Ming Li1
1 patients world wide receive a combination of one internal mammary (IMA) graft and
Institute of Cardiovascular Disease and Heart Center, Tianjin Key Laboratory of Cardiovascular
Remodeling and Target Organ Injury, Pingjin Hospital, Logistics University of CPAPF, Tianjin,
China
Introduction: Acute coronary syndrome (ACS) patients without troponin elevation were
admitted with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) and has
a heterogeneous prognosis. In contrast with troponin positive ACS patients these risk
stratification remains obscure, because routine clinical parameters alone are not enough to
stratify patients with suspected ACS. Many studies show that Monocyte subsets and
monocyte-platelet aggregates (MPAs) play an important role in ACS.
Objectives: We sought to investigate whether or not there is an imbalance among the three
monocyte subsets as well as their relative contribution to MPA formation in troponin
negative NSTE-ACS patients, and explore their predictive values for discriminating between
low risk and moderate-to-high risk troponin negative NSTE-ACS patients based on the
Global Registry of Acute Coronary Events (GRACE) score.
Methods: In this cross-sectional case-control study, GRACE score was determined in 95
NSTE-ACS patients who were troponin negative. 57 age-and-sex matched healthy subjects
served as control group. Mon1 (CD14++CD16-), Mon2 (CD14++CD16+) and Mon3
(CD14+CD16++) monocytes, and subset-specific MPAs were measured by flow cytometry.
GRACE score was calculated on the basis of admission characteristics (age, heart rate,
systolic blood pressure, serum creatinine concentration, Killip class, cardiac arrest, presence
of ST-segment deviation, and elevated cardiac enzymes/markers) using online GRACE risk
calculator.
Results: Increased counts (OR 1.228, 95% CI 1.118 to 1.348, P<0.001) and percent (OR
2.537, 95% CI 1.723 to 3.735, P<0.001) of CD16-positive monocytes independently
associated the presence of NSTE-ACS after adjustment by traditional risk factors.
Compared with GRACE score determined low risk patients (GRACE Score108, n¼70),
intermediate-to-high risk patients (GRACE Score>108, n¼25) had higher levels of Mon2
subset and MPAs. Adjusted binary logistic regression analysis revealed that increased Mon2
subset counts (OR 1.076, 95% CI 1.020 to 1.135, P¼0.007) and Mon2 subset percent (OR
1.632, 95% CI 1.193 to 2.233, P¼0.002), and elevated MPA percent (OR 1.274, 95% CI
1.100 to 1.467, P¼0.001) independently discriminated GRACE score determined low risk
and intermediate-to-high risk patients.
Conclusion: Our work demonstrates that Mon2 subset and MPAs independently
discriminate between GRACE score determined low-risk and intermediate-to-high risk
NSTE-ACS patients who are troponin negative in a Chinese population.
Disclosure of Interest: None Declared
e96
PM168
Influence of Different Anticoagulants and Time Delay on Monocyte Subsets and
Monocyte-Platelet Aggregation Analysis
Rui-Yi Lu1, Xin Zhou1, Wen-Jie Ji1, Rui Shi1, Shan Zeng1, Tie-Min Jiang1, Yu-Ming Li*1,
Zhao-Zeng Guo1
Institute of Cardiovascular Disease and Heart Center, Tianjin Key Laboratory of Cardiovascular
Remodeling and Target Organ Injury, Pingjin Hospital, Logistics University of CPAPF, Tianjin, China
Introduction: Circulating monocyte-platelet aggregates (MPAs) are increasingly regarded
as a marker of platelet activation and can be readily quantified using flow cytometry. A
number of variables including choice of anticoagulant, handling and processing techniques,
even excises and diurnal variations, are reported to have different impact on MPA for-
mation, which may cover difference in clinical studies and blur interpretation of different
findings between studies, while the influence of the above factors on measured levels of
MPAs remains incompletely characterized.
Objectives: To detect how variability in different anticoagulants and time delay processing
influence measurements of circulating monocyte subsets and MPAs, and assess the effects
of time delay on the sample stability prior to flow cytometric analysis.
Methods: Blood collected from healthy individuals was placed in different tubes containing
sodium citrate (3.8%) and EDTA (2.0mg/ml). Three monocyte subsets, CD14++CD16-
(Mon1), CD14++CD16+ (Mon2), CD14+CD16++ (Mon3), and MPAs were analyzed by
flow cytometry. The samples were processed at 0h and 2h after blood collection, and
reanalyzed at 1h, 3h, 7h after the initial analysis.
Results: Blood in EDTA had lower MPAs than that with sodium citrate (P <0.01).
Compared with the blood specimen processed immediately, a delay of up to 2 h in sample
processing results in lower proportion of Mon1 both in EDTA blood and sodium citrate
blood (P<0.05). Although there was a trend towards a higher proportion of MPAs by 2 h
after blood collection, only the proportion of MPAs associated with Mon1 in sodium citrate
blood and MPAs associated with Mon2 in EDTA blood showed a significant change (all P
<0.05). Additionally, there were no differences in the level of MPAs in EDTA blood at
different time point after immunolabling and agreement of data was excellent.
Conclusion: The study has methodological implications that a choice of anticoagulants
influence the level of MPAs. EDTA can retain sample stability and should be used in sit-
uations where there may be a substantial delay prior to analyzing.
Disclosure of Interest: None Declared
PM169
Disease free patency of radial artery, internal mammary artery and saphenous vein
grafts at a minimum of 10 years post coronary surgery
Alistair Royse*1, Colin Royse1, David Eccleston2, Andrew Ajani2
1
Surgery, The University of Melbourne, 2Cardiology, Royal Melbourne Hospital, Melbourne,
Australia
Introduction: Total arterial revascularisation remains uncommon in most centres. The
radial artery (RA) is variably used but most centres rarely use this conduit. Thus most
supplementary vein (SVG) grafts for multivessel coronary bypass surgery. Most angio-
graphic studies are symptom driven, retrospective studies. Most also analyse patency using
Kaplan-Meier estimates of patency at a defined period of time postoperative, which often
include patient from early, intermediate and late periods within the study duration. The
mode of conduit failure for arterial grafts in the early period reflect “competitive flow” and
this is distinct from the development of progressive conduit atherosclerosis leading to
failure; and data from the early period postoperative should not be used to calculate the late
behaviour of a conduit. Thus most angiographic series are inherently flawed.
Objectives: The objective was to report conduit disease and patency where all patients
included are at least 10 years after surgery. Conduit disease was defined as angiographic
lumen irregularity.
Methods: Selection criteria included each patient having at least one of each conduit RA, IMA,
SVG and a minimum of 10 years postoperative. Thus for each patient, the affects of genetic
and environmental factors was the same for all three conduits. Selection was via a research
protocol and was irrespective of symptoms. Conventional angiography was performed, and
patency and conduit irregularity was recorded. Where sequential grafting was performed,
each graft segment was considered as a separate graft. A composite graft was where two
conduits were joined with one conduit receiving blood inflow from the other conduit.
Results: 21 male patients with an average of 3.5 grafts each, had 74 grafts reviewed at an
average of 14.1 years postoperative. Patency was IMA 96%, RA 100% and SVG 81%. Of
patent grafts, the lumen was entirely normal in IMA 100%, RA 96% and SVG 0%.
Conclusion: Late data of patients having each of the three conduits reveals minimal evi-
dence of progressive conduit atherosclerosis in arterial conduits, but not in venous con-
duits. Consideration should be made to perform total arterial coronary revascularisation.
Disclosure of Interest: None Declared
PM170
A Simple Bedside Tool for Predicting Postoperative Mediastinits in Patients
Undergoing Cardiac Surgery
Fernando Fedor Novo*1, Claudio C. Higa1, Gimena Gambarte1, Maria S. Donato1,
Natalia Rizzo1, Ignacio Noges1, Graciana Ciambrone1, Diego Lowenstein2, Rocio Piccininni1,
Paula Catalano1, Victorino Carosella3
1
cardiologia, Hospital Aleman, 2cardiologia, Fundacion Favaloro, 3cardiologia, FLENI, buenos
aires, Argentina
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: Mediastinitis is still a feared complication in post cardiac surgery. Its inci- Methods: Vascular biological properties of SE were assessed by standard in vitro assays.

dence is variable, ranging from 0.6 to 3.3%. To date there is no predictive score available of
post cardiac surgery mediastinitis.
Objectives: Our aim was construct a predictive score of post cardiac surgery mediastinits
from a nationwide multicenter survey.
Methods: Derivation set was the multicenter CONAREC XVI survey which included
consecutive patients over 18 years undergoing cardiac surgery between September 2007 to
October 2008. After adjustment by multivariable regression model independent predictors
of post cardiac surgery mediastinitis were identified. A simple score was constructed and its
discrimination power was analyzed by C Statistics and Goodness of fit (calibration) by
Hosmer Lemeshow test. Validation set was a different prospective survey of patients who
undergone cardiac surgery (FLENI cohort).
Results: Mediastintis was defined by clinical signs and/or positive blood cultures. Deri-
vation set was the multicenter survey CONAREC XVI developed in 49 academic centers in
16 states in Argentina which included 2553 consecutive patients. Incidence of mediastinitis
was 1.88%. After adjustment by a multivariable regression model independent predictors
of post cardiac surgery mediastinitis were: post operative renal failure OR 5.5 (CI 95% 2.6-
11) p ¼ 0.0001, reoperation OR 4.3 (CI 1.9-9.6) p ¼ 0.0001, smoking OR 2.8 (CI 95%
1.1-5.1) p ¼ 0.02 and severe left ventricular dysfunction OR 2.8 (CI 1.3-6.2) p ¼ 0.001. 2
points were adjudicated to reoperation and postoperative renal failure and 1 point to severe
left ventricular dysfunction and for smoking. C Statistics was 0.72 (CI 95% 0.64-0.81) p ¼
0.0001. Calibration was acceptable: p > 0.05. C Statistics of this score in the validation set
POSTER ABSTRACTS
Results: Compared to BSA-coated plastic, SE enhanced endothelial cell (EC) attachment by
3-fold (p<0.001) & proliferation by 54.7
1.1% (p<0.001). SE exhibited low thrombo-
genicity characterised by: 1) reduced contact activation (60.4
8.2%; (p<0.001); 2) reduced
In111-labelled platelet attachment (53.4
6.5%; p<0.01) and; 3) whole-blood clotting times
not different to saline control by APTT assay. Similarly, in an ovine carotid interposition
model of graft compatibility, SE-coated ePTFE grafts showed enhanced endothelialisation
(94.23
2.2% vs. 68.58
5.2%, p<0.05) and a significant reduction in neointimal thickness
compared to controls, reduced from 406.1
85.73 mm to 72.18
31.26 mm (p<0.05).
Multilayered synthetic conduits were produced by electrospinning (Fig.A). The outer layers
comprised hybrids of SE and polycaprolactone (compliance), while the inner layer was 100%
SE (biocompatibility). Our SE conduit exhibited biomechanical properties superior to ePTFE
and identical to IMA (elastic modulus 320
24kPa; burst pressure 1922
197mmHg). SE
conduits implanted in a rabbit carotid interposition model sutured well, did not leak and
were well tolerated up to 30d (Fig.B). Further evaluation in a rat aortic interposition grafting
model will determine the immune response, degradation rate, re-endothelisation and neo-
intimal hyperplasia in SE-based grafts up to 24 weeks post-implantation.

web 3C=FPO
was 0.7 (CI 95% 0.58-0.80) p < 0.05 with an acceptable calibration: p > 0.05.
Conclusion: This externally validated predictive score of post cardiac surgery mediastinitis may
be considered in the future for early detection and management of this catastrophic complication.
Disclosure of Interest: None Declared

PM171
Undesirable effect on lipoprotein profile by cardiovascular surgery
Haruki Sekiguchi*1, Hideki Ohno2, Yoichi Ajiro3, Fujio Tatsumi4, Kazunori Iwade4, Conclusion: Synthetic human elastin, by mimicking the properties of the arterial wall, has
physical and biologic properties that make a highly suitable building block for the engineering of
Naohide Tanaka4, Ken Shimamoto5, Masatoshi Kawana5
1 synthetic arterial conduits. Ultimately, this may lead to the development of SE-based grafts for a
Cardiology, Aoyama Hospital, Tokyo Women`s Medical University, Tokyo, 2Cardiac surgery, wide of vascular applications, thereby meeting a large unmet need in cardiovascular medicine.
National Hospital Organization Yokohama Medical Center, Yokohama, 3Cardiology, National Disclosure of Interest: None Declared
Hospital Organization Yokohama Medical Center, Tokyo, 4Cardiology, National Hospital
Organization Yokohama Medical Center, Yokohama, 5Cardiology, Aoyama Hospital, Tokyo PM173
Women’s Medical University, Tokyo, Japan
Association between anthropometry, cardiovascular risk factors, and early life factors
Introduction: Apolipoproteins and lipoprotein(a); Lp(a) are identified as risk factors for and adult measures of endothelial function: Results from the New Delhi Birth Cohort
atherosclerotic conditions such as coronary heart disease and stroke. Cardiovascular sur-
gery is a major form of treatment and often improves prognosis. In the postoperative Mark D. Huffman*1, Anita Khalil2, Dorairaj Prabhakaran3, Clive Osmond4, Caroline Fall4,
patient, it is important that postoperative risk management includes that of perioperative Nikhil Tandon5, Ramakrishnan Lakshmy6, Poornima Prabhakaran7, S. K. Dey Biswas8,
complications. However, the relationship between changes in lipoprotein profiles and Siddharth Ramji9, Harshpal S. Sachdev10, Santosh K. Bhargava11
1
cardiovascular surgery is largely unknown. Preventive Medicine, Northwestern University Feinberg School of Med, Chicago, United States,
2
Objectives: This study was designed to examine the effect of cardiovascular surgery on The Heart Centre, 3Centre for Chronic Disease Control, New Delhi, India, 4MRC Lifecourse
lipoprotein profiling. Epidemiology Unit, University of Southampton, Southampton, United Kingdom, 5Endocrinology,
Methods: We studied 123 consecutive patients (mean age 65
9) undergoing cardiovascular 6
Biochemistry, All India Institute of Medical Sciences, 7Public Health Foundation of India, 8Indian
surgery. Patients were evaluated for serum Apolipoprotein A1(ApoA-1), Apolipoprotein
Council for Medical Research, 9Pediatrics, Maulana Azad Medical College, 10Pediatrics and
B(ApoB), Lp(a), total cholesterol, triglyceride, and high density lipoprotein cholesterol before
surgery, 1 day following, and 20 days following the operation. We analyzed data before and Clinical Epidemiology, Sitaram Bhartia Institute for Science and Research, 11Pediatrics, Sunder
after multiple procedures including coronary artery bypass graft (CABG, n¼78), blood vessel Lal Jain Hospital, New Delhi, India
prosthesis implantation (n¼16), aortic valve replacement (AVR, n¼10), and mitral valve
Introduction: Abnormal endothelial function represents a preclinical marker of atherosclerosis.
replacement (MVR, n¼19). We performed a paired t-test for each procedure and analysis of
Objectives: Our objective was to evaluate the association between anthropometry, car-
variance (Tukey method) for the differences among procedures.
diovascular risk factors, and early life factors and adult measures of endothelial function in
Results: There was no difference in the serum lipoprotein levels at baseline. One day after the
a young urban Indian cohort free of clinical cardiovascular disease (CVD).
operation, serum lipoprotein levels were decreased compared to baseline in all procedures. 20
Methods: Using B-mode ultrasound, we evaluated the absolute change in brachial artery
days following surgery, ApoA-1 levels were generally found to increase, and ApoB and Lp(a)
diameter following blood pressure cuff inflation and sublingual nitroglycerin (400 mcg) to
were generally found to decrease. Notably, in the CABG procedure, ApoA-1 levels decreased
evaluate endothelium-dependent and -independent measures of endothelial function in 600
significantly as compared to levels at baseline (106.3
24.1 vs. 96.0
17.5mg/dl, P<0.05).
study participants (362 men; 238 women) from the New Delhi Birth Cohort (2006-2009). Data
However, for patients undergoing MVR, Lp(a) levels were found to increase (though not sta-
on anthropometry, CVD risk factors, medical history, socio-economic position, and lifestyle
tistically significant) as compared to the baseline (30.2
19.0 vs. 43.1
25.3mg/dl).
habits were collected concurrently. Height and weight were recorded at birth, 2 and 11 years of
Conclusion: Cardiovascular surgery affected the lipid profiling in perioperative period. Each
age. We created age- and sex-adjusted linear regression models to evaluate these associations.
procedure tended to contribute to arteriosclerosis. It may be useful to use antilipidemic agents
Results: The mean (SD) age of study participants was 36 (1) years for both men and
immediately following cardiovascular surgical procedures, especially in high risk patients.
women. One out of every five men (22%) and four women (29%) were obese (BMI 30
Disclosure of Interest: None Declared
kg/m2). Mean (SD) systolic blood pressure was 131 (14) and 119 (13) mmHg for men and
women, respectively. Diabetes prevalence was 12% for men and 8% for women. Brachial
PM172 artery diameter was higher for men compared with women both before (3.48 [0.37] and
2.95 [0.35]) cm) and after hyperemia (3.87 [0.37] vs. 3.37 [0.35] cm). A similar trend was
Bioengineering synthetic elastin conduits for arterial revascularisation seen before nitroglycerin (men¼3.51 [0.36] cm; women¼3.00 [0.35] cm) and after
Steven G. Wise*1,2, Juichien Hung1, Michael J. Byrom1, Paul G. Bannon2, Anthony S. Weiss3, nitroglycerin (men¼4.32 [0.36] cm; women¼3.81 [0.33] cm). Markers of increased
Martin K. Ng1,4
1
Translational and Bioengineering Group, The Heart Research Institute, 2Sydney Medical School,
3
School of Molecular Bioscience, The University of Sydney, 4Department of Cardiology, Royal
Prince Alfred Hospital, Sydney, Australia
Introduction: There are currently no effective synthetic conduits for small diameter
vascular grafting e.g. coronary artery bypass surgery. Elastin, a major structural component
of the vasculature, provides critical mechanical and biological properties, favourably
influencing many facets of vascular compatibility. We hypothesise that synthetic human
elastin (SE), by mimicking the properties of the arterial wall, can be engineered into
vascular conduits for arterial revascularisation.
Objectives: We sought to engineer SE into a durable and effective small diameter vascular
graft to fill a significant unmet need for a biocompatible vascular substitute.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e97

 adiposity, smoking, systolic blood pressure, and metabolic syndrome were inversely monocyte chemoattractant protein-1(MCP-1) has been referred to as a promoter of
POSTER ABSTRACTS

associated with endothelial function after adjustment for age and sex (Table). However, inflammation.Recently coronary plaque components can be evaluated by virtual-histology
there were no associations between early life growth and endothelial function. intravascular ultrasound (VH-IVUS).
Conclusion: These are the first prospective data from India showing that cardiometabolic Objectives: An investigation whether malondialdehyde modified LDL (MDA-LDL) and
risk factors, but not early life growth, are inversely associated with endothelial function. MCP-1 were associated with the formation of vulnerable plaque in patients with ischemic
The high cardiometabolic risk factor burden in this cohort may have attenuated any po- heart disease was performed.
tential associations between early life growth and endothelial function. Methods: 60 patients with stable angina were enrolled. 106 coronary plaques were analyzed
Disclosure of Interest: None Declared by conventional and virtual histology intravascular ultrasound (VH-IVUS). % necrotic core
volume (%NCV) of each plaque was measured. We defined thin capped fibroatheroma (TCFA)
PM175 as having %NC area >15% in multiple slices with a component of the NC in contact with the
luminal area. Serum levels of MDA-LDL and MCP-1 were determined. Plaques were divided
Reproducibility of dermal microvascular blood flow changes in response to reactive into two groups based on the presence (A group, 33 lesions) or absence (B group, 73 lesions) of
and thermal hyperaemia utilising laser skin doppler TCFA with a comparison relating to inflammatory markers performed. A further analysis was
undertaken to determine the correlation between %NCV and inflammatory markers.
David Di Fiore*1, Christopher Zeitz1, Margaret Arstall2, Abdul Sheikh1, Sharmalar Rajendran1,
Results: Both MCP-1 value and MDA-LDL value were determined to be significantly higher
John Beltrame1 in the A group (278
82 vs 220
74, p¼0.002, and 120
35 vs 100
38, p¼0.03). No
1
Department of Cardiology, The Queen Elizabeth Hospital, Woodville, 2Department of significant difference was determined between the Hs-CRP value between group A and B
Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia (0.19
0.22% vs 0.16
0.20%, respectively, p¼0.4). Patients with plaques of high %NCV
(defined as %NCV>25%) had significantly higher MDA-LDL to LDL-cholesterol ratio and
Introduction: Laser Skin Doppler can non-invasively measure dermal microvascular MCP-1 level than those with low %NCV (defined as %NCV<25%) (1.43
0.52 vs.
changes in response to post-occlusive reactive hyperaemia (PORH) and local heating of the 1.10
0.36, p¼0.02, and 270
84 vs. 217
75, p¼0.04, respectively). VH-IVUS analyses
skin (thermal hyperaemia (TH). There is minimal data in the literature regarding the showed that MDA-LDL to LDL-C ratio and MCP-1 level positively correlated with %NCV
reproducibility of microvascular perfusion changes induced by these two stimuli. (r¼0.424, p¼0.004, and r¼0.32, p¼0.04, respectively).
Objectives: The aim of the study was to assess and compare the reproducibility of Conclusion: Both the one type of inflammatory marker, MCP-1, and the oxidation marker,
microvascular perfusion changes by these stimuli. MDA-LDL, was significantly higher in the group having TCFA (A group). These results
Methods: Thirty-seven patients with various cardiac conditions and cardiovascular risk suggest that the measurement of MDA-LDL and MCP-1 level may be useful for assessing
factors were studied. Changes in skin microcirculation in response to PORH utilising 2 vulnerable plaque in patients with ischemic heart disease. MDA-LDL and MCP-1 level may
minute inflations and TH utilising 20 minutes heating to 44oC on consecutive mornings be important predictors for the risk of cardiovascular disease.
were assessed in all subjects. We measured three parameters: time to peak perfusion (TP), Disclosure of Interest: None Declared
peak perfusion ratio (PPR) (¼ peak perfusion/baseline) and area under curve (AUC).
Results:
PM179
PORH (Flux Units) TH (Flux Units) Fosinopril Sodium Pretreatment Combined With Ischemic Postconditioning
Attenuates Myocardial Ischemia-Reperfusion Injury By Inhibition Of Toll-Like
Mean ± SD CV (%) Mean ± SD CV (%)
Receptors Pathway
TP (secs) 10.4
2.3 12.3% 1023.7
203.4.4 12.0%
Dawu Zhang*1, lei zhang1, jiangang liu1, chenglong wang1, dazhuo shi1
PPR 3.6
1.3 20.0% 15.1
6.1 23.3% 1
Department of Cardiovascular disease, Xiyuan Hospital, China Academy of Chinese Medical
AUC 2070
1112 34.8% 197461
88101 27.2% Sciences, Beijing, China

Introduction: Ischemic postconditioning (IPoC) can attenuate the ischemic reperfusion (I/
R) injury of myocardium, similarly, angiotensin converting enzyme inhibitor (ACEI) has
the same effect. However, it remains unknown whether both IPoC and ACEI have additive
protecting effect on myocardium with I/R injury.
Objectives: To observe the effects of IPoC on the protein expression of Toll-like receptor
(TLR) signaling pathway and downstream inflammatory factors in myocardial tissue of the
rats with I/R injury which were pretreated with fosinopril sodium.
web 3C=FPO

Methods: Sprague-Dawley rats were randomly divided into sham group (the suture around
the left anterior descending coronary artery was not tied), ischemic reperfusion group (30
minutes of in situ of transient occlusion of the left anterior descending artery, followed by 1
hour of reperfusion), IPoC group (30 minutes occlusion of the left anterior descending
artery, followed by 3 cycles of 10 seconds of reperfusion/10 seconds of ischemia before 1
hour of reperfusion) and fosinopril sodium group (pretreated with fosinopril sodium for 14
days, established into I/R model 2 hour after the last gavage, and treated with IPoC during
I/R). Serum cardiac troponin T (cTnT) and creatine kinase (CK)-MB levels were detected,
Myocardial infarct size was measured, the protein expression of the TLR pathway upstream
links(TLR2, TLR4) and intermediate links(c-Jun NH2-terminal kinase (JNK), nuclear factor
(NF)- kappa B) were detected, as well as cytokines expression in the myocardial tissue was
detected.
Results: Compared with the rats underwent I/R injury, myocardial enzyme cTnT and
CK-MB levels and infarct size significantly decreased in the rats with IPoC (P < 0.01).
The expressions of TLR2 and TLR4 in the ischemic myocardium were inhibited signifi-
cantly (P < 0.01). In addition, the expressions of JNK, NF-kappa B and cytokines also
web 3C=FPO

Conclusion: We have shown that microcirculatory changes in blood flow as measured by
time to peak perfusion is the most reproducible parameter, followed by the peak perfusion
ratio and the area under the curve. These results are similar to published data.
Disclosure of Interest: None Declared
PM177
Impact of Inflammatory Markers on Coronary Plaque Morphology: Virtual Histology
Intravascular Ultrasound Study
Motohiro Miyagi*1, Toko Mitsui1, Kenichiro Nomoto1, Manabu Kokubo1, Atsuya Shimizu1
1 3
Cardiology, National center for geriatrics and gerontology, Obu, Japan
Introduction: Recent studies have demonstrated that modifications to LDL such as
oxidation have been linked to the pathogenesis of atherosclerosis and one of the cytokines,
significantly decreased (P < 0.05, P < 0.01, respectively). Compared with the rats treated
with IPoC, the combination of fosinopril sodium and IPoC further reduced infarct size and
CK-MB levels (P < 0.05), as well as the expressions of TLR2, TLR4, JNK and NF-kappa B
in myocardial tissue (P < 0.05, P < 0.01, respectively). Cytokine tumor necrosis factor-a
level also decreased significantly (P <0.05).
Conclusion: Fosinopril sodium enhanced the protective effect of IPoC in a rat model of
myocardial I/R injury. These mechanisms could be related to inhibition of the TLR signal
pathway and proinflammatory reactions.
Disclosure of Interest: None Declared
PM180
Characteristics and outcome of Nonagenarians undergoing Percutaneous Coronary
Intervention
David Tong*1, Arul Baradi1, Andrew Teh1, Philippa Loane2, Hariharan Sugumar1, Thomas Yip3,
Damon K. Jackson1, Louise Roberts1, Melanie Freeman1, Gishel New1
1
Cardiology, Eastern Health, Box Hill, 2Cardiology, CCRET - Monash University, Melbourne,
Cardiology, Barwon Health, Geelong, Australia
Introduction: Age is an important determinant of outcome in patients with coronary artery
disease, yet data on elderly patients, particularly nonagenarians, are under-represented in

e98 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

the literature. A few small studies suggest that high procedural success rates and acceptable
short and long-term outcomes may be achieved following PCI in selected nonagenarians,
however data is limited.
Objectives: We aimed to evaluate the clinical characteristics and outcomes of nonage-
narians undergoing PCI utilising a large multicentre Australian PCI registry.
Methods: We analysed 95 patients 90 years undergoing PCI who were prospectively
enrolled in the Melbourne Interventional Group registry between 2005 and 2012. The
number of nonagenarians represents 0.7% of the patients in our database. Clinical and
procedural characteristics and in-hospital, 30-day and 12-month outcomes are
described.
Results: The cohort had more females (58%) with a mean age of 91
1 years. and BMI of
25.0
4.2 . Comorbidities included diabetes (23%), previous MI (41%), previous cere-
brovascular disease (16%), and peripheral vascular disease (15%), while mean serum
creatinine was 110
43 mmol/L and mean ejection fraction was 46
12%. Presentation
with STEMI, non STEMI and unstable angina were 55%, 18% and 18% respectively while
cardiogenic shock was present in 3%. There were no out of hospital cardiac arrests. 70%
had multivessel disease; 28% received glycoprotein IIbIIIa inhibitors and 22% drug eluting
stents. Procedural success rate was 94% while in-hospital bleeding complications occurred
in 4%. In-hospital and 30-day mortality was 13.7% and 16.0% respectively. 12-months
follow up was completed in 67 patients, with 28% mortality and 33% MACE rates. Those
who died at 12 months were more likely to have presented with STEMI (78.0% vs 47.9%,
p ¼ 0.02), and have lower ejection fractions (36.8
12 % vs 46.5
12%, p¼0.008) than
those who survived.
Conclusion: This registry included a select group of nonagenerians who untreated have a
high mortality from ACS. Although high procedural success rates may be achieved in
nonagenarians undergoing PCI, major adverse cardiac events and mortality remains high in
this subset but may be acceptable. Randomized trials of medical therapy vs PCI in this
subgroup are required to determine if these “heroic” measures are appropriate.
Disclosure of Interest: None Declared
PM181
DoeS ACC lesion class pRedict outcomE in STEMI? (SCORE-STEMI)
Dinesh K. Natarajan*1, Christopher S. W. Wang1, Nadim Shah1, Anis Taeed1, Soe K. Ko1,
Rifly Rafiudeen1, Peter Y. Chan1, Nicholas Cox1, Kean Soon1
1
Department of Cardiology, Western Health, Melbourne, Australia
Introduction: The ACC lesion classification system categorizes lesions into types (A, B1, B2
and C) based on 11 angiographic variables. This system predicts the angiographic success
of PCI but the German Cypher Registry failed to show any significant association with
clinical outcomes at 6 months.
Objectives: Our objective was to determine if the ACC lesion classification system pre-
dicted 30-day outcome in the setting of ST-Elevation Myocardial Infarction (STEMI).
Methods: From 1 August 2012 till 23 July 2013, all STEMI cases that presented to our
hospital were included in this study. Patient demographics, procedural characteristics, ACC
lesion class, TIMI flow pre and post intervention and 30-day MACE composite endpoints
(death, recurrent MI, TVR, stroke) were prospectively collected. Chi-Square and Kruskal-
Wallis tests were used for statistical analyses.
Results: 177 patients (139 males, 38 females, mean age¼61years) were treated with primary
PCI (Class A¼22%, Class B1¼32%, Class B2¼6%, Class C¼40%). The median age for Class
A¼57 years, Class B1¼59.5 years, Class B2¼65 years and Class C¼62.5 years. Post inter-
vention, TIMI III flow was achieved in 100% of Class A, B1 and B2 cases compared to 94% of
C cases (p¼0.115). There were no 30-day MACE observed in the Class A group, whereas it
was observed in 6% of Class B1, 11% of Class B2 and 20% of Class C (p¼0.034).
Conclusion: In STEMI, a higher ACC lesion class predicted a worse 30-day MACE
outcome and this was statistically significant.
Disclosure of Interest: None Declared
PM182
Impact of socioeconomic status on 30-day and 12-month outcomes following
percutaneous coronary intervention
Jessica O’Brien*1, Nick Andrianopoulos2, Angela Brennan3, Andrew Ajani4, Martin Sebastian5,
Lisa Lefkovits1, Chris Reid3, David J. Clark6, Harini Bala1, Stephen J. Duffy1
1
Cardiology, The Alfred Hospital, 2Centre of Research Excellence in Patient Safety, 3Centre of
Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University,
4
Cardiology, Royal Melbourne Hospital, Melbourne, 5Cardiology, Geelong Hospital, Geelong,
6
Cardiology, Austin Hospital, Melbourne, Australia
Introduction: Previous studies have consistently demonstrated a link between socioeco-
nomic status (SES) and cardiovascular outcome, with higher rates of medication non-
compliance and baseline co-morbidities assumed to contribute.
Objectives: We sought to determine if SES affects 30-day and 12-month cardiovascular
outcome and medication compliance following percutaneous coronary intervention (PCI).
Methods: We determined 30-day and 12-month major adverse cardiac events (MACE)
among 15,826 patient procedures prospectively registered in the Melbourne Interventional
Group registry. Patients were categorised into quintiles of SES group using the Index of
Relative Socioeconomic Disadvantage (IRSD) system, developed by the Australian Bureau
of Statistics from 2011 census data. Each residential area (postcode) is allocated an IRSD
value based on a combination of factors that includes residents’ educational level,
employment status, income, motor vehicle ownership and fluency in English.
Results: The number of patients in each quintile from lowest SES to highest was 3364,
2229, 2552, 3379 and 4302. Patients in the lower SES groups were more likely to be
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
female, have diabetes, dyslipidaemia, hypertension, peripheral vascular disease, be current
POSTER ABSTRACTS
smokers, have COPD, obstructive sleep apnoea, previous myocardial infarction (MI) and
lower left ventricular ejection fraction (all p0.002). However, patients in the higher SES
groups were more likely to be older, have ST- or non-ST-segment elevation MI as the
indication for the index PCI, and receive glycoprotein IIb/IIIa-inhibitors and drug-eluting
stents (all p <0.001). Despite dissimilarities in baseline and procedural characteristics,
there was no difference in 30-day or 12-month mortality or overall MACE among the SES
groups. Patients in the lower SES groups had higher rates of ongoing smoking at 30 days
and 12 months (p<0.0001). However, there was no difference in the use of aspirin, clo-
pidogrel or statins amongst the groups, though patients in the higher SES groups had
higher rates of ACE-inhibitor and angiotensin receptor blocker use at both 30-days and 12-
months.
Conclusion: Despite higher rates of baseline co-morbidities, patients from lower SES
backgrounds have similar cardiovascular outcomes following PCI as their higher SES
counterparts. These data suggest that patients with lower SES are not predetermined to
have poorer outcomes if evidence-based therapies are prescribed following PCI.
Disclosure of Interest: None Declared
PM183
Cardiovascular outcomes of patients with diabetes mellitus undergoing primary PCI
for STEMI
Jessica O’Brien*1, Nick Andrianopoulos2, Angela Brennan3, Chris Reid3, David J. Clark4,
Melanie Freeman5, Andrew Ajani6, Chin Hiew7, James Shaw1, Stephen J. Duffy1
1
Cardiology, The Alfred Hospital, 2Centre of Research Excellence in Patient Safety, 3The Centre
of Cardiovascular Research & Education (CCRE) in Therapeutics, Monash University,
4
Cardiology, Austin Hospital, 5Cardiology, Box Hill Hospital, 6Cardiology, Royal Melbourne
Hospital, Melbourne, 7Cardiology, Geelong Hospital, Geelong, Australia
Introduction: Patients with diabetes mellitus (DM) undergoing percutaneous coronary
intervention (PCI) generally have worse outcomes owing to more extensive coronary artery
disease, delayed presentation with acute coronary syndromes and a higher incidence of in-
stent restenosis.
Objectives: We sought to evaluate whether DM independently predicts cardiovascular
outcomes following primary PCI for ST-elevation myocardial infarction (STEMI).
Methods: The outcomes following STEMI in 450 patients with DM (65
12 years; 27%
female) enrolled in the Melbourne Interventional Group registry were compared to 2,356
patients without DM. In a secondary analysis, patients were propensity-matched by major
predictors of outcome following PCI: age, disease extent, cardiogenic shock, previous
revascularisation, renal impairment and ejection fraction.
Results: Patients with diabetes were more likely to be older, female, have renal impairment,
dyslipidaemia, hypertension, higher BMI, prior heart failure, peripheral and cerebrovas-
cular disease, previous revascularisation, lower left ventricular ejection fraction, multi-
vessel disease, and cardiogenic shock (all p0.04). There was no difference in the use of
drug-eluting stents, glycoprotein IIb/IIIa inhibitors, or in stent diameter and length.
However, STEMI symptom-to-door, door-to-balloon, and symptom-to-balloon times were
all longer for diabetics (91 versus 98, 77 versus 80, and 179 versus 196 minutes,
respectively; all p0.04). Patients with diabetes had higher rates of 30-day and 12-month
recurrent MI, revascularisation, hospital re-admission, mortality and overall major adverse
cardiac events (MACE); all p<0.01. However, when compared to a propensity-matched
cohort, 30-day and 12-month outcomes were similar in patients with DM. Medication use
was similar in both groups at 30 days and 12 months. The presence of diabetes was a
predictor of 30-day MACE in the unmatched cohort, but not in the propensity-matched
cohort.
Conclusion: Despite the presence of diabetes being associated with significant co-mor-
bidities, it is not an independent predictor for cardiovascular outcome following primary
PCI for STEMI.
Disclosure of Interest: None Declared
PM184
Challenges in selection of drug eluting stents in patient’s undergoing percutaneous
coronary intervention (PCI) at a tertiary Australian hospital from 2005-2012
Michael Stokes*1, Jay Ramchand1, Peter Scott1, Kerrie Charter1, Mark Horrigan1, David Clark1,
Omar Farouque1
1
Cardiology, Austin Health, Melbourne, Australia
Introduction: Victorian Government Department of Human Services Guidelines recom-
mend that Drug Eluting Stent (DES) use be limited to those patients at high risk for
restenosis with at least one of the following: (i) diabetes; (ii) vessel diameter 2.5mm; (iii)
lesion length 20mm; (iv) bifurcation lesion; (v) ostial lesion; (vi) in-stent restenosis (ISR);
and (vii) chronic total occlusions (CTO’s). These guidelines estimate that with appropriate
guideline based selection, DES use will be appropriate in 40% of PCI cases. However,
hospital budgetary constraints have provided clinicians with challenges in utilising this
technology.
Objectives: We sought to assess what proportion of patient’s undergoing PCI at a tertiary
referral cardiology centre in Australia over the period 2005-2012 had a guideline based
indication for a DES and whether this correlated with the recommended proportion of
patient’s by the Victorian Department of Human Services Guidelines.
Methods: Using the Melbourne Interventional Group (MIG) Registry, a search was
conducted of all patients having PCI at the Austin Hospital from 2005-2012. Data was
collected on demographic, clinical and procedural characteristics of this cohort, spe-
cifically on whether there was a guideline based criterion for DES selection. Stent
e99
 diameter and length were used as surrogate markers of lesion length and vessel clopidogrel therapy after drug-eluting stent (DES) implantation increases the risk of
POSTER ABSTRACTS

diameter. recurrent cardiovascular events. New combination drugs such as Co-Plavix may assist
Results: A total of 4640 PCI procedures occurred during the study period, of which 1919 compliance by simplifying treatment regimens and reducing patient expenses. Also,
(41.4%) received a DES. The total number of patients with at least one criterion for a DES was although registries have evaluated outcomes after percutaneous coronary intervention (PCI)
3061 (65.6%). Of these criteria, 1316 (28.4%) where diabetic and 296 (6.4%) had ISR. With in the USA, few data exist regarding Quality of life (QOL) after PCI in Australia.
regard to vessel diameter and lesion length, 1233 (26.6%) were 2.5mm and 1051 (22.7%) Objectives: This study aims to assess the impact of combination drug therapy and
were 20mm respectively. Of the other lesion criteria, 226 (4.9%) were ostial lesions, 500 coaching to improve compliance post-PCI using the Heart Care Group PCI Registry.
(10.8%) were bifurcation lesions and 207 (4.5%) were CTO’s. The number of patients who We also aim to report the effect of combination therapy on long-term QOL This will
had at least one indication for a DES and received a DES was only 1600 (52.3%). allow comparison of clinical and PCI outcomes with international standards, and
Conclusion: The data presented provides a large sample of patient’s undergoing PCI over improve patient management by facilitating the appropriate application of clinical
an 8 year period our institution. Of patients who had a guideline recommended criterion guidelines
for DES, almost half did not received receive this technology. These data suggest that Methods: We prospectively enrolled 500 consecutive patients undergoing PCI at 8
increased rates of DES use in patients at high risk for restenosis may be more appropriate Australian private hospitals from November 2012 to August 2013 using a cluster ran-
and result in optimal percutaneous treatment of coronary disease. domisation design to combination (Co-plavix) or usual individual anti-platelet therapy.
Disclosure of Interest: None Declared Nurses provided compliance support if non-compliance with Co-Plavix treatment was
noted at follow-up; control patients received usual care only. Baseline patient/procedural
PM185 data, 1 year clincal outcomes, compliance (using the Morisky tool and prescription
counting) and QOL (using the EQ5D scale) were recorded and stored electronically in the
Trends in Mortality following Percutaneous Coronary Intervention Department of Epidemiology at Monash University.
Results: The mean age was 67
12 years. Females comprised 25.1 %, diabetics 23.3%,
Arul Baradi*1, Nick Andrianopoulos2, Angela L. Brennan2, Andrew Teh1, David Tong1,
35.3% were obese (BMI>30) and 37.2% had acute coronary syndromes. At least one DES
Andrew E. Ajani3, Damon Jackson1, Louise Roberts1, Melanie Freeman1, Gishel New1 was used in 64.9% of PCI. Procedural success rates were 97%. In patients not taking
1
Cardiology, Eastern Health, Box Hill, 2Cardiology, CCRET - Monash University, Melbourne, Warfarin, 99.0% were taking aspirin and 97.7% clopidogrel at discharge.
3
Cardiology, Royal Melbourne Hospital, Parkville, Australia
Introduction: We have previously described in-hospital (1.6%), 30-day (2.1%), 12-month
(3.9%) and long-term (8.2%) mortality rates following PCI in the Melbourne Interventional
Group Registry. While 80% of in-hospital mortality was due to cardiac causes, this declined Co-Plavix Usual therapy
to 50% in the long-term. Similar registry data has been described internationally, with Outcome at 1 year % n[247 n[253
observation of increased longer term cardiac mortality following NSTEMI compared to
STEMI. Aspirin 97.7 96.1
Objectives: To describe mortality rates and trends following PCI for different indications Clopidogrel/Prasugrel/Ticagrelor 81.1 71.1
utilising a large multicenter registry. Statin 89.0 94.3
Methods: We identified 14265 patients undergoing PCI between 2005 and 2011 from the
Melbourne Interventional Group registry. After exclusion of patients receiving rescue PCI DES 75.0 68.7
or presenting with out of hospital cardiac arrest or cardiogenic shock, 14184 patients were Death - overall 0.002 0.004
included in the study. We analysed trends in overall mortality and differences in mortality
Unplanned cardiac readmission 11.8 9.3
rates according to indication for PCI.
Results: See tables 1 and 2 Quality of Life (moderate-severe anxiety or depression) 18.7 19.8

Conclusion: Combination drug therapy achieved superior anti-platelet medication

compliance one-year post-PCI compared to individual drug therapy. Quality of life was not
improved possibly due to the higher risk profile of the active treatment group.
Disclosure of Interest: None Declared

Conclusion: Over time, there was no significant change in in-hospital, 30-day or 12-
month overall mortality following PCI. Both cardiac and overall mortality were highest
amongst STEMI patients at all time points. Longer term follow up is planned to assess
whether this increased risk persists.
Disclosure of Interest: None Declared
PM187
Do Drug-Eluting Stents Reduce 1-year Readmission rates after Percutaneous
Coronary Intervention in Australian Private Hospitals? Results from a National
Multi-Centre Registry
David Eccleston*1
1
Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Up to 10% of US patients are readmitted within 30 days of Percutaneous
Coronary Intervention (PCI), and readmission is associated with increased one-year mor-
tality. Rates of 30 day readmission may be reduced in high-volume centres. However little
Australian data exist on potential predictors of late readmission such as use of Drug-eluting
Stents (DES) and the implications of late readmission.
Objectives: We aimed to report the incidence and predictors of readmission up to 12
months post-PCI from the Genesis Heart Care Group Registry.
Methods: We prospectively collected data on 5002 consecutive patients undergoing PCI to
6837 lesions at 8 Australian private hospitals from November 2009 - August 2013 and
analysed predictors of readmission and long-term outcomes.
Results: Australian PCI patients had a 1-year cardiac readmission rate of 13.0%; this was
11.5% if planned PCIs were excluded. The mean age was 67
12 years. Females comprised
25.1 %, diabetics 24.5%, 32% were obese (BMI>30) and 37.2% initially underwent PCI for
an acute coronary syndrome. At least one DES was used in 64.9%.

PM186
Are Medication Compliance and Quality of Life after Percutaneous Coronary Variable – Clinical / Procedural OR p 95% CI
Intervention improved by using Combination drug therapy? Diabetes 1.70 0.003 1.20-2.42
David Eccleston*1, Tony Rafter2, Geoff Holt2, Peter Sage3, Alan Whelan4, Donald Latchem4, Prior PCI 1.41 0.036 1.02-1.93
Mark Horrigan5 Renal failure (Cr > 0.2 mmol/l) 0.45 0.016 .23-.86
1
Cardiology, Royal Melbourne Hospital, Melbourne, 2Cardiology, Heart Care Partners, Brisbane, Dyslipidaemia 1.64 0.069 .96-2.81
3
Cardiology, Adelaide Cardiology, Adelaide, 4Cardiology, Heart Care WA, Perth, 5Cardiology,
Hypertension 1.92 0.002 1.28-2.89
Heart Care Victoria, Melbourne, Australia
DES 0.88 0.44 .65-1.20
Introduction: Treatment compliance remains a major barrier to improving patient care
Clopidogrel 1.47 0.02 1.05-2.06
following percutaneous coronary intervention (PCI). Poor compliance with aspirin and

e100 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: The incidence of late readmission after PCI in Australia is low, and only 9.4%
Discharge 30 Days 1 Year

POSTER ABSTRACTS
of these patients require further revascularisation. DES have no significant independent
impact on readmission after correcting for patient and lesion variables, as patient rather Outcome % n[5002 n[ 4145 n[3199
than procedural factors predict readmission. This may offer targets for intervention to Death - overall 0.002 0.003 0.003
improve outcomes. Unplanned cardiac readmission - 2.89 9.39
Disclosure of Interest: None Declared
Aspirin 99.2 97.7 95.8
Clopidogrel/Prasugrel/Ticagrelor 97.2 95.3 78.1
PM188 Statin 93.9 95.0 92.8
Quality of Life - major anxiety or depression 18.7 - 19.9
Long-term Trends in Coronary Risk Factor Prevalence and Adherence to Guideline
Therapies in Australians with Coronary Heart Disease: A Comparison with European
Outcomes
David Eccleston*1, Peter Sage2, Tony Rafter3, Geoff Holt3, Alan Whelan4, Mark Horrigan5
1
Cardiology, Royal Melbourne Hospital, Melbourne, 2Cardiology, Adelaide Cardiology, Adelaide,
3
Cardiology, Heart Care Partners, Brisbane, 4Cardiology, Heart Care WA, Perth, 5Cardiology, Conclusion: Clinical practices and long-term outcomes after PCI in Australian Private
Heart Care Victoria, Melbourne, Australia Hospitals are consistent with those reported in international registries. Compliance with
guideline therapy is high.
Introduction: Cardiovascular prevention continues to demonstrate significant gaps be- Disclosure of Interest: None Declared
tween guidelines and clinical practice. Recent European data suggests increasing rates of
obesity, diabetes and smoking in patients with coronary heart disease (CHD).
Objectives: We aimed to assess potential variations over the past 5 years in the prevalence
of traditional risk factors and guideline compliance in Australians with CHD and compare PM190
these to a large European cohort.
Methods: We prospectively collected data on two cohorts of patients undergoing percu- Does SYNTAX Study open the door wide to the expansion of unprotected left main
taneous intervention (PCI) at 8 Australian private hospitals between October 2008-June coronary artery Stenting? The experience of Tunisian centers of cardiology
2009 (n¼865) and January - June 2013 (n¼ 898). These data were compared to Euroaspire
Leila Abid Trigui*1, salma charfeddine1, morched marwene2, mohamed sahnoun2,
III, a survey of 2392 patients with CHD from 2006-7.
Results: sahar ben kahla1, samir kammoun1
1
cardiology departement, Hedi Chaker Hospital, Sfax (Tunisia), Medecine University SFAX,
2
ibn nafiss private clinic, private clinic, sfax, Tunisia

Introduction: There is little data for a Tunisian regional center of cardiology on therapeutic
strategies of unprotected left main coronary artery stenting (ULMCA). The SYNTAX ran-
Euroaspire III HCG 2009 HCG 2013 P value domized trial is an attempt to provide an evidence-base to determine whether this
Risk factor % n [ 2392 n [ 865 n [ 898 HCGs vs E III approach, which is already currently practiced, is valid.
Smoking 18.2 12.7 10.0 0.09
Objectives: The aim of the study is to evaluate the syntax study’s impact on our
therapeutic strategy of percutaneous coronary intervention (PCI) in ULMCA
Hypertension 60.9 79.3 62.7 <0.0001 disease.
Elevated lipids 46.2 86.3 58.8 <0.0001 Methods: Angiographic and clinical data were collected retrospectively for all patients who
underwent emergent or planned therapeutic PCI for unprotected LMCA disease between
Diabetes mellitus 28.0 26.6 23.3 0.79
2002 and 2013. We compare the PCI of ULMCA before and after September 2008, the
Antiplatelet therapies 93.2 98.7 99.2 0.0016 publication’s date of SYNTAX trial’s first outcomes. Group 1 included patients who have
All Blood pressure drugs 96.8 90.8 92.1 0.0005 had ULMCA stenting from January 2002 to September 2008 and group 2 included patients
after 2008.
All Lipid lowering drugs 88.8 93.3 93.9 0.09 Results: The study first group enrolled 24 consecutive patients with a mean age of 55.5
years
11.28. Whereas, group 2 included 62 patients, the mean age was 65 years

11.3. There was an increase in the number of patients with multi-vessels CAD who had
PCI of ULMCA stenosis. The majority of patients of group 1 presented an isolated
LMCA disease or associated to one vessel (successively 37.5% and 33.3% in group1 vs.
Conclusion: The prevalence of adverse coronary risk factors continues to rise in Europeans 17.7% and 27.4% in group2). 54.9% of the second group patients had LMCA stenosis
with CHD despite increases in the use of and high rates of medical therapies. Australians associated to two or three vessels disease while only 29.2% of group 1 patients had
smoke less and are less obese, however both groups still have a significant treatment gap multi – vessels disease (p¼0.04). There was no significant difference between the 2
with regard to guideline therapies that warrants further targeted intervention. groups regarding the LMCA stenosis site with a predominace of ostial and distal ste-
Disclosure of Interest: None Declared nosis (50% and 41.7% successively in group 1, 45.2% and 41.9% in group 2; p¼
0.68).In addition, there was an increase in the use of drug - eluting stents (54% in
group 2 vs. 8.3% in group 1; p¼0.01).
Conclusion: Although ULMCA disease is considered by contemporary guidelines to be an
PM189 indication for surgery, The SYNTAX Study outcomes open the door wide to the expansion
Outcomes of the first 5000 patients from a National Percutaneous Coronary of LMCA Stenting in selected patients.
intervention Registry in Australian Private Hospitals Disclosure of Interest: None Declared

David Eccleston*1, Tony Rafter2, Geoff Holt2, Peter Sage3, Stephen Worthley3, Alan Whelan4,
Donald Latchem4, Peter Thompson4, Mark Horrigan5
1
Cardiology, Royal Melbourne Hospital, Melbourne, 2Cardiology, Heart Care Partners, Brisbane,
3 PM191
Cardiology, Adelaide Cardiology, Adelaide, 4Cardiology, Heart Care WA, Perth, 5Cardiology,
Heart Care Victoria, Melbourne, Australia
Introduction: Several large registries have evaluated outcomes after percutaneous coronary
intervention (PCI) in the USA, however long-term data exist regarding the outcomes of
patients in Australian Private hospitals.
Objectives: This study aims to report the in-hospital and long-term results after PCI from
the Genesis Heart Care Group Multi-centre Registry.
Methods: We prospectively enrolled consecutive patients (n¼5002) undergoing PCI to
6837 lesions at 8 Australian private hospitals from November 2008 to August 2013.
Baseline patient/procedural data, in-hospital, 30 day, and 1 year outcomes were
recorded and stored electronically in the Department of Epidemiology at Monash
University.
Results: The mean age was 67
12 years. Females comprised 25.1 %, diabetics
23.3%, 35.3% were obese (BMI>30) and 37.2% had acute coronary syndromes. At
least one DES was used in 73.5% of PCI. Procedural success rates were 98%. In
patients not taking Warfarin, 99.0% were taking aspirin and 97.7% clopidogrel at
discharge. Obese patients were more likely to be readmitted by 12 months
(p¼0.002)
Early And Intermediate Results of Unprotected Left Main Coronary Artery Stenting
In Tunisian Cardiology Centers
Leila Abid Trigui*1, salma charfeddine1, morched marouène2, med sahnoun2, sahar ben kahla1,
Samir kammoun1
1
cardiology departement, Hedi Chaker Hospital, Sfax (Tunisia), 2ibnnafiss private hospital sfax
tunisia, Medecine University Sfax, Sfax, Tunisia
Introduction: Recently, PCI is an increasingly utilized method of revascularization in
patients with ULMCA. Several reports on unprotected LMCA stenting, suggested the
possibility of percutaneous intervention.
Objectives: The aim of the study was to evaluate early and late outcomes after percuta-
neous coronary intervention (PCI) of unprotected left main coronary artery disease
(ULMCA).
Methods: This is a retrospective study including all patients with a significant (>50%)
ULMCA stenosis in two Tunisian cardiology centers (Hedi chaker hospital, ibn nafiss
private hospital). MACE including death, Q-wave myocardial infarction, or repeat target
lesion revascularization were followed.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e101

 Results: The study group comprised 86 consecutive patients between 2002 et 2013
POSTER ABSTRACTS
with a mean age of 64 years
11.8 (extreme 37 and 88 years); the sex ratio was 3/1.
54.7 % of the patients had diabetes. The clinical presentation was unstable angina in
67.4%, acute myocardial infarction (MI) in 10.5 % and stable angina in 16.3% of cases.
59.6% of the patients had a syntax score less than 22 and only 2.1% had a score more
than 33. Fifty seven percent of the procedures were performed with bare metal stents
and 41.9% with drug-eluting stents. Procedural success was achieved in 100% of cases.
Angiographic restenosis occurred in six patients (6.9%). Cumulative death occurred in
16 patients (18.6%). MACE at 30 day and 6-month was 8.3% and 22.2% respectively.
The use of drug eluting stents was associated with lower rates of target vessel revas-
cularization and major adverse cardiac events than use of bare metal stents. Variables
that correlated with increased mortality or MACE were emergent PCI, ejection fraction
<35% and renal failure.
Conclusion: Stenting of LMCA stenosis may be a safe and effective alternative to CABG in
carefully selected patients.
Disclosure of Interest: None Declared
PM192
Hba1c Modified Clinical Syntax Score As A Prognostic Tool In Patients With
Diabetes Mellitus And Multi-Vessel Coronary Artery Disease Treated With
Primary Pci
Natasa M. Milic*1, Marija Mirkovic2, Emilija M. Nestorovic3, MIljko R. Ristic3,
Vesna D. Garovic4, Milan A. Nedeljkovic5
1 Concordance investigators
Department for Medical statistics and informatics, Medical Faculty University of Belgrade,
Belgrade, 2Department for Cardiology, ZC Valjevo, Valjevo, 3Department for Cardac Surgery,
Clinical Center of Serbia, Belgrade, Serbia, 4Department for nephrology and hypertension, Mayo
Clinic, Rochester, United States, 5Department for Cardiology, Clinical Center of Serbia, Belgrade,
Serbia
Introduction: Clinical SYNTAX score (CSS) obtained by combination of clinical and
angiographic parameters is the main score nowadays for MACCE risk assessment in pa-
tients treated with percutaneous coronary intervention (PCI), but the relation between
glycosylated hemoglobin and prognosis in these patients has not been explained yet.
Objectives: The aim of the study was to determine the prognostic value of CSS modifi-
cation by HbA1c in patients with diabetes mellitus and multivessel coronary artery disease
(CAD) treated with primary PCI.
Methods: This is a prospective cohort study. All the examinees were treated by primary
PCI, had diabetic treatment for longer than one year, and had multivessel CAD. CSS
was calculated as the product of SYNTAX score and modified ACEF score. For the
purpose of SYNTAX score calculation each lesion of coronary arteries with diameter
stenosis 50% was scored in a blood vessel 1,5mm. Modified ACEF score was
calculated using the formula: years/EF+1 point for every 10ml/min reduction in ClCr
lower than 60ml/min to 1.73 m2. Prior to procedure glycosylated hemoglobin HbA1c
was measured. MACCE (major cardiovascular and cerebrovascular adverse event) was
defined as occurrence of IM, repeat revascularization, stroke or death during one year
follow up period.
Results: Survival analysis was determined in 136 patients. Univariate and multivariate
Cox regression analysis demonstrated that both CSS and HbA1c were significant
predictors of one year MACCE (p<0.001; RR¼5.449; 95%CI¼2.629-11.295 and
p<0.001; RR¼2.434; 95%CI¼1.269-4.669, respectively for multivariate). The HbA1c
modified CSS obtained by combination of CSS>27.5 and HbA1c>8 was the most
significant predictor of one-year MACCE (p<0.001; RR¼ 5.292; 95%CI¼ 2.997-
9.343). Patients with CCS>27.5 and HbA1C>8 have median survival free of MACCE
of 5 months.
Conclusion: Calculation of HbA1c modified CSS leads to a better risk assessment for one
year MACCE free survival in patients with diabetes and multivessel coronary disease treated
by PCI.
Disclosure of Interest: None Declared
PM193
Defining peri-procedural myocardial injury following percutaneous coronary
intervention using high-sensitive troponin T assay
1 1 1 1 1 1
Kevin Liou , Petrina Kellar* , Julia Isbister , Mark Pitney , Nigel Jepson , Robert Giles ,
Daniel Friedman1, Antony Lau1, Roger Allan1, Sze-Yuan Ooi1
1 Rohan Rajaratnum7, Derek Chew8, Fiona Turnbull9, David Brieger3, the CONCORDANCE
Cardiology, Prince of Wales Hospital, Sydney, Australia
Introduction: The Third Universal Definition of Myocardial Infarction defines peri-pro-
cedural myocardial injury (PMI) by post procedural elevation of biomarkers of myocardial
injury that is five times the 99th percentile or more of the respective upper reference limit
(URL). While worse clinical outcome has been demonstrated in those meeting the criteria
for PMI with CKMB and conventional troponin I and T, such relationship to our knowl-
edge has not been demonstrated in practice with the high-sensitive troponin T assay
(hsTnT).
Objectives: To determine the level at which an elevated hsTnT level becomes clinically
significant after percutaneous coronary interventions (PCI).
Methods: hsTnT was introduced at our institution in March 2011. A retrospective review
of our angiographic database between May 2011 and April 2012 was performed. Cases
were restricted to patients undergoing elective PCI to remove confounding effects of acute
e102
coronary syndrome on long term outcome. Data were analysed using SPSS. Statistical
significance was defined as p<0.05.
Results: Overall, 273 patients underwent elective PCI at our institution between May
2011 and April 2012. The mean age was 70.2 (+/- 9.9). 34% of the PCI were multi-
vessel interventions, and procedural success to at least one, if not all lesions were
achieved in 95.3% of patients without major complications. All patients were on
adequate dual anti-platelet therapy at the time of the procedure. Post procedural hsTnT
were available in 258 (92.5%) patients. The median hsTnT level was 36.5 (Range: 836)
ng/L. Overall 78 (30.2%) patients had a post procedural hsTnT of more than 70 ng/L
(5 times the URL). Follow up data was available for 263 (94.3%) patients. The com-
posite end point of all cause mortality, myocardial infarction and stroke at 12 months
occurred in 12 (4.6%) patients overall, and is significantly more common in patients
with a post procedural hsTnT elevation to more than 70 ng/L (8% v.s. 2.4%; p ¼
0.048).
Conclusion: A hsTnT level of 70 ng/L appears to be a reasonable cut off for identifying PMI
in patients undergoing elective PCI.
Disclosure of Interest: None Declared
PM195
Assessment of HbA1c levels in diabetic patients with Acute Coronary Syndromes is
associated with improved outcomes
Afik D. Snir*1, Karice Hyun2, Victoria Miller3, Mark Ryan4, Eric Yamen5, Rohan Rayasinghe6,
Johnathon Waites7, Timothy Harrison8, Bernadette Aliprandi-Costa3, David Brieger3, the
1
Faculty of Medicine, University of Sydney, 2The George Institute for Global Health, 3Concord
Hospital, Sydney, 4Shoalhaven Hospital, Shoalhaven, 5Sir Charles Gairdner Hospital, Perth, 6The
Gold Coast Hospital, Southport, 7Coffs Harbour Hospital, Coffs Harbour, 8Flinders Medical
Centre, Adelaide, Australia
Introduction: Assessment of HbA1c levels in Diabetic Mellitus (DM) patients
following an ACS has been associated with optimisation of DM management.
However, the association between assessment of HbA1c and ACS outcomes has not
been described.
Objectives: In this study we evaluate the frequency, predictors and outcomes following
HbA1c assessment in DM patients presenting with an ACS in Australia.
Methods: Demographic and clinical data were evaluated using the CONCORDANCE
registry, obtained from 23 Hospitals across Australia. The analysis included 809
patients with a final diagnosis of ACS and admitted with a history of DM.
Multilevel logistic regression was used to determine the independent predictors of
HbA1c assessment. Patients outcomes were compared using Chi-squared tests, and
adjusted odds ratios (OR) and 95% confidence intervals (CI) following multivariable
analysis.
Results: 351 (43.4%) of DM patients presenting with ACS had HbA1c levels measured
in hospital. There was large variability observed between hospitals (range 9.5% to 88%
of presenting patients). After adjusting for the clustering effect of hospital, patient
factors independently associated with HbA1c assessment were younger age (OR 0.81,
95% CI 0.71-0.92 per 10yr interval) and undergoing cardiac catheterisation (OR 2.24,
95% CI 1.51-3.33). Assessment of HbA1c was not significantly associated with
revascularisation or in-hospital or discharge therapies. After adjusting for GRACE risk
score there was no association between HbA1c assessment and in hospital mortality
(OR 0.34, 95% CI 0.10-1.12) or other major cardiovascular adverse events. However,
HbA1c assessment was significantly associated with adjusted 6 month mortality (OR
0.20, 95% CI 0.04-0.998).
Conclusion: In Australia, measurement of glycaemic control in diabetic patients with ACS
varies greatly between centres. After adjusting for this, assessment of HbA1c is more likely
in younger patients and is associated with higher frequencies of cardiac catheterisation.
Assessment of HbA1c is not associated with greater revascularisation, medical therapies or
improved in hospital outcomes, but in this analysis is associated with lower mortality in the
6 months following discharge.
Disclosure of Interest: None Declared
PM196
Recent glycaemic control has no relationship with short term outcomes in diabetic
patients with Acute Coronary Syndrome
Afik D. Snir*1, Karice Hyun2, Heather Luker3, Jens Kilian4, Joseph Hung5, Jamie Rankin6,
investigators
1
Faculty of Medicine, University of Sydney, 2The George Institute for Global Health, 3Concord
Hospital, 4Bankstown Hospital, Sydney, 5Sir Charles Gairdner Hospital, 6Royal Perth Hospital,
Perth, 7Campbelltown Hospital, Sydney, 8Flinders Medical Centre, Adelaide, 9The George
Institute for International Health, Sydney, Australia
Introduction: Elevation of glycosylated haemoglobin (HbA1c) levels in Diabetes
Mellitus (DM) patients is an independent risk factor for symptomatic Coronary
Artery Disease (CAD) including presentation with an Acute Coronary Syndrome
(ACS). Both a history of DM and elevated admission blood glucose levels have been
associated with a worse prognosis following ACS. However, the prognostic value of
recent glycaemic control in diabetic patients following ACS presentation has not
been established.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: In this study we evaluate the relationship between recent glycaemic
control (measured as %HbA1c) and hospital outcomes in DM patients presenting
with an ACS.
Methods: Demographic and clinical data were evaluated using the CONCORDANCE
registry, obtained from 23 Hospitals across Australia. The analysis included 351 patients
with a final diagnosis of ACS, previous history of DM and HbA1c level measured during
admission. Patient characteristics and hospital events were analysed using Chi-square
tests. Patient outcomes were compared using Chi-squared tests, and adjusted odds ratios
(OR) and corresponding 95% confidence intervals (CI) using multivariable logistic
regression.
Results: 114 (32.5%) patients had good glycaemic control (HbA1c <7%), 128 (36.5%)
had suboptimal control (HbA1c 7-9%) and 109 (31%) had poor control (HbA1c >9%).
Patients with HbA1c >9% were significantly more likely to be current smokers, indige-
nous, have non-English speaking background, present at younger age and have higher
admission levels of blood glucose and total cholesterol. Patients with HbA1c >9% were
significantly more likely to receive statins in hospital, compared to patients with HbA1c
<7%. No significant association was found between %HbA1c and other measures of in-
hospital management (Table). In hospital deaths were infrequent in this cohort (n¼9)
and, after adjusting for GRACE risk score, no difference in hospital mortality was found
between patients with HbA1c 7% and patients with HbA1c <7% (OR 1.75, 95% CI
0.22-13.65).
Conclusion: Diabetic patients with poor glycaemic control present with ACS at an earlier
age with greater prevalence of cardiovascular risk factors. However, no association was
found between recent glycaemic control and hospital outcomes following ACS in diabetic
patients.
Disclosure of Interest: None Declared
PM197
Clinical Characteristics, Trends and Outcomes in Elderly Patients with Acute
Coronary Syndromes Undergoing PCI
Matias Yudi*1, Nick Andrianopoulos2, Melanie Freeman3, Chin Hiew4, Bryan Yan5,
David Tsang1, Julian Yeoh1, Sandeep Prabhu1, Caitlin Cheshire1, Andrew Ajani1
1
Cardiology Department, Royal Melbourne Hospital, 2Monash University, 3Cardiology
Department, Austin Hospital, 4Geelong Hospital, Melbourne, Australia, 5Cardiology Department,
Chinese University Hong Kong, Hong Kong, Hong Kong
Introduction: Elderly patients (aged 75 years) presenting with acute coronary syndromes
(ACS) and treated with percutaneous coronary intervention (PCI) generally have a higher
burden of co-morbidities and more complex coronary lesions. Yet despite the ageing
population, limited data is available from randomized interventional trials as this subset of
patients are often excluded.
Objectives: The aims of this study are: to assess the yearly trend in elderly patients with
ACS being treated with PCI; and to compare the clinical characteristics and outcomes of the
elderly with the younger population (age <75 years).
Methods: The Melbourne Interventional Group Registry was analyzed from 1st January
2005 until 31st December 2011. Consecutive patients presenting with ACS were included
and divided into two groups: the elderly (aged 75 years) and the young (aged <75 years).
Clinical characteristics and outcomes were obtained. The yearly trend of elderly patients
with ACS undergoing PCI was also analyzed. The primary efficacy end points were 30-day
and 12-month mortality, myocardial infarction (MI), target vessel revascularization (TVR)
and major adverse cardiovascular events (MACE). The primary safety endpoint was in-
hospital bleeding complications.
Results: 8009 patients were included in the analysis with the elderly making up 24% of the
cohort. There was no significant increase in the percentage of elderly ACS patients un-
dergoing PCI between 2005 and 2011. Elderly patients were more likely to be females
(40% vs. 21%, p<0.01) presenting with NSTEMI (44% vs. 39%, p<0.01) and have multi-
vessel coronary artery disease (68% vs. 53%, p<0.01). Furthermore, the elderly have a
significantly higher incidence of hypertension, diabetes, chronic renal failure, stroke, pre-
vious MI and previous coronary bypass surgery (all with p<0.01). The elderly have
significant worse short and medium-term outcomes in all endpoints except TVR with a
12-month mortality of 11% (vs. 4%, p<0.01), an MI rate of 8% (vs. 5%, p<0.01) and a
MACE rate of 21% (vs. 13%, p<0.01).
Conclusion: In a contemporary PCI cohort, there was not a significant trend towards a
higher percentage of elderly patients with ACS undergoing PCI over a 6-year period. The
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
elderly have a higher rate of comorbidities and have worse short and medium term out-
POSTER ABSTRACTS
comes when compared to younger patients.
Disclosure of Interest: None Declared
PM198
Prediction of Outcome Following Percutaneous Coronary Intervention based on
Angiographic Evaluation and Fractional Flow Reserve Measurements
Ali H. Al-Fiadh*1, Matthew J. Chan2, Ryan J. Spencer3, Kerrie Charter3, David J. Clark1,
Omar Farouque1, Robert K. Chan4
1
Cardiology, Austin Health / University of Melbourne, 2Cardiology, Heart Care Victoria,
3
Cardiology, Austin Health, 4Cardiology, Austin Health / Heart Care Victoria, Heidelberg,
Australia
Introduction: A fractional flow reserve (FFR) of 0.80 indicates a functionally sig-
nificant coronary stenosis that may benefit from percutaneous coronary intervention
(PCI).
Objectives: Evaluation of whether post-PCI FFR of >0.80 or FFR increment of >0.10 may
enhance angiographic assessment in predicting outcome in the current drug eluting stent
(DES) era.
Methods: Patients with stable coronary artery disease (CAD) and stenoses of intermediate
severity angiographically were recruited from two hospitals. FFR was measured utilising a
coronary pressure guidewire during intravenous adenosine induced coronary hyperaemia
(140 or 180mg/kg/min). Those with FFR 0.80 (n¼50) proceeded to PCI and FFR was
reassessed. Major adverse cardiovascular events (MACE) including death, myocardial
infarction and target vessel revascularization (TVR) following PCI were determined at 6
months and thereafter.
Results: Mean age of the cohort was 66
11 years with 79% being male. Eighteen
patients were diabetic (36%) and more than half of the patients had 3 coronary risk
factors. Two-thirds of the target vessels were LAD (67%). Baseline FFR prior to PCI
was 0.69
0.08. Second generation DES was used in 85% of cases, with mean stent
diameter being 3.0
0.5mm and stent length of 19.8
8.7mm. Stent deployment based
on angiographic criteria was satisfactory and all patients had either post-PCI FFR
>0.80 (0.85
0.06) or FFR increment >0.10 (0.17
0.08). Two patients (4%) had
post-PCI troponin >1mg/L and there were no clinically significant in-hospital com-
plications. Thirty-four (71%) patients had completed 6 months of follow-up. Three
patients (9%) underwent TVR one of whom had post-PCI FFR of 0.76 and FFR
increment of 0.11, and was found to have suboptimal stent expansion by intravascular
ultrasound examination. Preliminary comparison of patients with MACE (n¼3) with
those without (n¼31) revealed no significant differences in pre-PCI FFR (0.67
0.03 vs
0.69
0.08; p¼0.80), post-PCI FFR (0.84
0.87 vs 0.85
0.07; p¼0.75) and FFR
increment (0.17
0.05 vs 0.17
0.09; p¼0.99).
Conclusion: In this preliminary experience of patients with functionally significant CAD
undergoing physiologically guided PCI with high DES usage, satisfactory angiographic
outcome combined with favourable FFR measurements (post-PCI FFR >0.80 or FFR
increment >0.10) predict low adverse event rate in short to medium term follow-up.
Ongoing recruitment and clinical follow-up is planned.
Disclosure of Interest: None Declared
PM199
Embolic protection in graft intervention: Still severely underused
Hussian Hussain1, Omar Aldalati2, Ahmed Hailan3, Adrian Ionescu3, Zia Ulhaq*2
1
Cardiology, ABMU-LHB, Swansea, 2Cardiology, ABMU-LHB, Morriston, 3ABMU-LHB,
Swansea, United Kingdom
Introduction: Saphenous vein graft (SVG) percutaneous intervention is associated with
worse outcomes than intervention in native vessels. One of the few guideline-recom-
mended measures to improve outcomes is the use of embolic filter devices to reduce the
risk of no-reflow and of periprocedural MI. However, preliminary data from the literature
suggest these devices have not been widely adopted.
Objectives: We sought to define the degree to which the usage of embolic filter devices
during SVG PCI in our center complies with current guidelines.
Methods: We data-mined our interventional database looking at all SVG PCI in vessels and
whether a Filter Wire(St Jude Medical) was used between 01/01/2006 and 01/04/2013.
Results: There were 8240 entries for coronary interventions in our database during the
specified period. 4.8% (399 cases, mean age 70 years, 80% male) of these were on patients
with previous CABG. Graft intervention occurred in 41% (166/399) of the cases. FilterWire
was used in 48 cases (28.9% of graft PCI group, 0.58% of all the cases).
The mean vessel diameter in this group was 3.7mm (2.75-6.0) and mean length of stent
used was 23.1mm (12-38). FilterWire was not used in 118 graft PCI cases. In this group,
the mean vessel diameter was 3.23mm (2.0-5.5, P<0.05 vs. cases where FilterWire was
used). The filter was used less frequently in multivessel PCI cases than when the SVG was
the only target.
There was no statistical difference between the two groups with regards to age, sex, TIMI
flow, lesion AHA class, the use of GP IIb/IIIa drugs or procedural success.
Conclusion: Embolic protection is used in less than 30% of graft intervention. Further
education of operators is warranted.
Disclosure of Interest: None Declared
e103
 PM200
POSTER ABSTRACTS
Australian Experience with AbsorbTM Bioresorbable Scaffold Technology in "Real-
World" Coronary Disease
Michael C. Nguyen*1, Nigel Jepson2, Paul Chia1, Mark Pitney2,3, Alan Whelan1, Liam Back2,
Randall Hendriks4, Sze-yuan Ooi5, Rajesh Kanna1, Arman Ahmadi6
1
Cardiology, Fremantle Hospital, Perth, 2Prince of Wales Hospital, 3Cardiology, Sutherland
Hospital, Sydney, 4Fremantle Hospital, Perth, 5Cardiology, Prince of Wales Hospital, Sydney,
6 Objectives: To observe the protective effect of ischemia postconditioning during the first
Medicine, Notre Dame University, Perth, Australia
Introduction: Coronary metallic stents have been the cornerstone of treatment for coro-
nary arterial disease. Bioabsorbable coronary scaffolds represent a novel treatment option
that allows the initial restoration of coronary flow and support of the vessel, however with
subsequent resorption of the scaffold, the risks of stent thrombosis and need for long- term
antiplatelet therapy can be potentially reduced. “Real world” data on the use of this
technology in a more complex subset of patients and lesions is lacking.
Objectives: We aimed to study the safety and efficacy of the AbsorbÔ bioabsorbable
scaffold (ABRS) out to 30 days for the treatment of patients presenting with acute coronary
syndrome (ACS) and stable angina, in a wide range of lesion subsets including primary PCI,
chronic total occlusions (CTOs), bifurcations, long lesions and multi-vessel disease.
Methods: Data was prospectively collected from 3 major tertiary hospitals in Australia
(Fremantle Hospital, Western Australia, and Prince of Wales Public Hospital and Suther-
land Hospital, New South Wales) between December 2010 and August 2013. Baseline
demographics, presentation, as well as procedural data were collected. Both in-hospital and
30 day safety and efficacy outcomes were analysed.
Results: In total, 155 patients were treated with 245 scaffolds (mean age 60yrs, 60% male)
with 52% presenting with ACS (6% STEMI) and 10% undergoing multi-vessel interven-
tion. There was a mean of 1.6 scaffolds/patient (range 1 to 5) with LAD, LCX, RCA and
SVG treated in 39%, 22%, 35%, and 2.3% respectively. There was 100% procedural
success and 99% device success (2 device delivery failures with subsequent successful
treatment with drug-eluting stents). There were 2 in-hospital myocardial infarcts (Non Q
wave, 1.3%) with no mortality. At 30 days, there were a total of 3 myocardial infarcts
(1.9%) including 1 scaffold thrombosis (0.6%) requiring target vessel revascularization
(0.6%). There was no mortality.
Conclusion: This early local experience has demonstrated ABRS therapy to be highly safe
and efficacious in a cohort of real-world patients with complex presentations and disease
(including ACS, long lesions, multi-vessel disease and CTOs).
Disclosure of Interest: None Declared
PM202
Establishing Chronic Total Occlusion Programme in a Tertiary Australian Centre -
Description of Early Experience
Vimalraj Bogana Shanmugam*1, Dennis Wong2, Peter Psaltis2, Sujith Seneviratne3,
Ian Meredith2, Yuvaraj Malaiapan2
1
Monash Heart, Interventional Cardiology, Monash Health, Monash Medical Centre, 2Monash
Heart, Interventional Cardiology, 3Monash Health, Monash Medical Centre, Melbourne,
Australia
Introduction: Chronic total occlusions (CTO) represent a unique set of lesions for
percutaneous coronary intervention (PCI) because of the complexity of techniques required
to treat them, prompting recommendations for institutions to adopt dedicated CTO
revascularisation programs.
Objectives: The aim of our study was to investigate the baseline, Procedural characteristics
and in-hospital outcomes during the initiation phase of establishment of a dedicated CTO
programme.
Methods: We retrospectively reviewed the CTO-PCI experience between January 2010 and
December 2012 in a multi-operator single centre, which is one of the largest volume PCI
centres in Australia. Data were collected for patient, lesional and procedural characteristics,
including procedural success and in-hospital outcomes.
Results: 82 CTO-PCI procedures were performed. Mean age of the overall cohort was
62.6
11.3 years with 85% males. Multivessel disease was present in 78%. The most
common site of CTO was RCA (44%), followed by LCX (30%) and LAD (26%). By lesional
QCA analysis, the frequencies of complex CTO angiographic features were: 13% for
moderate-to-severe calcification, 26% for blunt or ambiguous proximal cap, 16% for
angulation of the distal vessel greater than 45 and 34% for the presence bridging collat-
erals. Mean lesional length was 10.1+7.7 mm. Retrograde Rentrop grade III collaterals were
observed in 30%. Adopting the Japanese CTO scoring system, 34% of lesions were clas-
sified as easy, 37% intermediate, 23% difficult and 6% very difficult. Procedures were
undertaken by ten different operators with varying levels of experience, with all cases
performed by antegrade guide-wire approach. Selected procedural characteristics included:
re-attempt procedure,10%; mutiple access sites, 21%; more than one guide wire, 77%;
additional support modality, 60%; DES, 97%; stent number, 1.6
0.9; total stent length,
40.1
24.5mm; fluroscopy time, 31.7
17.5 min; contrast volume, 257.2
110.9 mL.
Overall CTO success rate was 60%. In-hospital adverse outcomes, included: 3% mortality,
28% peri-procedural myocardial infarction, 17% emergency bypass surgery, 3% tampo-
nade and 7% contrast-induced nephropathy.
Conclusion: Modest success rates were achieved in a relatively conservative CTO cohort,
in this single centre experience, prior to the initiation of a dedicated CTO revascularisation
program. These results emphasise the need for Australian centres to adopt a systematic and
specialised approach to CTO-PCI.
Disclosure of Interest: None Declared
e104
PM203
The Protective Effect Of Ischemic Postconditioning On Reperfusion Injury In Patients
With St-Segment Elevation Acute Myocardial Infarction
Yue-Xi Wang*1, Rong A1
1
Cardiology, 1th Hospital affiliated to Inner Mongolia Medical University, Huhhot, China
Introduction: To observe the protective effect of ischemia postconditioning.
minutes of reperfusion for the myocardial reperfusion injury in ST segment elevation acute
myocardial infarction(STEMl) patients undergoing emergency percutaneous coronary
intervention(PCI).
Methods: STEMI patients undergoing emergency PCI in affiliated hospital of Inner
Mongolia Medical University between Jan.2005 and Jan.2012, Were randomly divided into
the control group(n¼40) without any intervention after PCI and the postconditioning(Pocs
C) group(n¼50) with ischemia postconditioning within first 5 minutes of fellow by 3
episodes of 30 seconds inflation and 30 seconds deflation with the angioplasty balloon.
Reperfusion arrhythmias, cTnT and CK-MB. corrected TIMI frame count(CTFC), wall
motion score index(WMSI) and left ventricular ejection fraction(LVEF) by echocardiog-
raphy were compared between the two groups. MI areas were evaluated with the ECT and
myocardial blush grade(MBG) was measured.
Results: The incidence of reperfusion arrhythmias-frequent ventricular premature 30%(12/40)
in Pocs C group vs 46%(23/50) in control group, P<0.05, and short array ventricular
tachycardia beat22.5%(9/40) vs 38%(19/50) in the two groups, P<0.05, as well as values of
peaks cTnt[(0.84
0.21)ng/;L vs(1.27
0.48)u/L, P<0.01], CK-MB[(94.5
51.4)u/L vs
(171.8
79.3)u/L, P<0.01]. CTFC(34.1
8.7vs29.2
7.5, P<0.05). WMSI(1.74
0.9 vs
2.1
0.6, P<0.05), and infarction area determined by ECT (17.2%
3.6% vs 25.5%
2.9%,
P<0.05) were all significantly higher in the control group than in PostC group, while
LVEF(49.3%
4.7% vs 43.4%
5.2%, P<0.05) and MBG(2.54
1.3 vs 1.41
1.1, P<0.05)
were significantly higher in the PostC group than in control group.
Conclusion: Ischemic postconditioning can significantly reduce myocardial reperfusion
injury in patients with STEMI.
Disclosure of Interest: Y.-X. Wang Consultancy for: No, R. A: None Declared
PM204
Association Of Cardiac Ischemic Score And Coronary Collateral Circulation
Jahanara Arzu*1, Abu Siddique1, Sajal K. Banerjee1, Akm F. Rahman1, Syed A. Ahsan1,
MdMukhlesur Rahman1, Md A. Salim1, Manzoor Mahmood1
1
Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
Introduction: Coronary collateral circulation maintains myocardial perfusion in coronary
atherosclerotic disease. The indicators of cardiac ischemia: -Angina pectoris (AP) on
exertion, during emotion, previous myocardial infarction (MI) and prior coronary inter-
vention are associated with presence of coronary collateral circulation.
Objectives:
1) To assess the correlation between cardiac ischemic score and coronary collaterals.
2) To provide an attractive treatment option, in patients with ischemic heart disease,
who are unsuitable for conventional revascularization therapies.
Methods: In this observational cross sectional study in Bangabandhu Sheikh Mujib Medical
University, 128 patients with history of angina pectoris (AP) on exertion, emotion and or
MI and or previous coronary intervention were enrolled. The cardiac ischemic score (range
1-4) was calculated by adding 1 point for each of the above four clinical factors, which can
be easily assessed. Presence of coronary collaterals in coronary angiogram was defined as
Rentrop grade 1. Patients were divided into two groups. Group A patients having Rentrop
grade 0 and Group B patients are with collateral circulation, having Rentrop grade 1-3.
Patients having cardiac ischemic score (range 1-4) are compared in these groups.
Results: Maximum (83.3%) patients of Group B with coronary collateral circulation had
cardiac ischemic score 2-4, but majority (86.4%) of Group A patients without collaterals
showed the score only 1 (p < 0.001). All the components of cardiac ischemic score like AP
on exertion, during emotions, previous MI and h/o PTCA or CABG were significantly
higher in Group-B than those in Group-A (p ¼ 0.005, p < 0.001, p ¼ 0.007 and p ¼
0.048 respectively). The mean duration of AP until index CAG or PTCA was also stag-
geringly higher in Group-B than that in Group-A (40.8
25.8 vs. 13.1
17.4, p < 0.001).
The mean duration since MI until index CAG or PTCA was also much higher in the former
group than that in the later group (39.6
32.9 vs. 11.6
23.0, p ¼ 0.003). The incidence
of multi vessel coronary disease was significantly higher in Group-B (66.7%) than that in
Group-A (40.9%) (p ¼ 0.005).
Conclusion: The cardiac ischemic score is strongly associated with the presence of coro-
nary collaterals.
Disclosure of Interest: None Declared
PM205
Is there a long-term prognostic significance of the new-onset atrial arrhythmias in
patients with acute myocardial infarction treated with thrombolytic therapy? 15-year
follow-up
Branislav S. S. Stefanovic*1, Predrag Mitrovic1, Gordana Matic2, Aleksandra Milosevic2,
Mina Radovanovic1, Nebojsa Radovanovic1, Gordana Krljanac1, Ana Karadzic2,
Ana Novakovic2, Aleksandra Janicijevic2
1
Cardiology Clinic, Belgrade University Medical Faculty, 2Cardiology Clinic, Clinical Center of
Serbia, Belgrade, Serbia
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: The new-onset atrial arrhythmias have great influence on hospital survival of
patients (pts) with STEMI (ST-segment elevation myocardial infarction).
Objectives: The objective of this study is to determine whether the new-onset atrial ar-
rhythmias have prognostic significance during long-term follow-up of STEMI pts treated
with thrombolytic therapy who discharged alive.
Methods: Study group consisted of 1112 pts (20.5% female and 79.5% male) with STEMI
who survived to hospital discharge. All pts were treated with thrombolytic therapy and
followed-up to 15 years (median 9.9 y). The new-onset atrial arrhythmias (atrial flutter and/
or atrial fibrillation) had 62 pts (5.6%)-group I, and 1050 pts (94.4%) had no atrial ar-
rhythmias-group II. Logistic regression analysis including age, gender, infarct location,
maximal CK level, left ventricular EDV, ESV, EF, TIMI flow of infarct-related artery (IRA)
and number of diseased coronary arteries showed that independent predictors of the new-
onset atrial arrhythmias are older age (OR 1.06 95%CI 1.03-1.1, p¼0.000), anterior infarct
location (OR 4.0 95%CI 1.8-8.6, p¼0.004), and occluded IRA (OR 3.3 95%CI 1.3-7.8,
p¼0.008).
Results: During follow-up 25/62 pts died in group I, 245/1050 pts in group II (40.3% vs.
23.3%), chi-square¼9.19, p¼0.002. Kaplan¼Meier curves comparing groups with and
without the new-onset atrial arrhythmias differed significantly after 1st, 5th, 10th and 15th
years, respectively: 88.2
4.3% vs.94.4
0.8%; 64.7
7.2% vs. 82.3
1.2%; 55.6
8.9% vs.
71.4
1.7%; 45.5
10.2 vs.62.9
2.7 (long rank 8.9, p¼0.004).
Conclusion: Older age, anterior infarcts and occluded IRA are independent predictors of
the new-onset atrial arrhythmias. During long-term follow-up of pts with STEMI dis-
charged alive the new-onset atrial arrhythmias had worse clinical outcome.
Disclosure of Interest: None Declared
PM206
Beck’s depression inventory score correlation with clinical, biochemical and
haemostatic parameters in postmyocardial infarction patients

Nebojsa M. Antonijevic*1, Ivana D. Zivkovi c1, Ljubica Jovanovic1, Jovan Perunicic1,
Nebojsa Radovanovic1, Aco Radanovic2, Milan Gajic3, Dragan M. Matic1,
Dragana Vukosavljevic4, Jecka Stojanovic4, Branka Terzic1
1
Clinic of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia, 2Cardiology, Health Centre
Trebinje, Trebinje, Bosnia and Herzegovina, 3Institute for Statistcs and Medical Informatics,
School of Medicine, University of Belgrade, 4Institute of Medical Biochemistry, Clinical Centre of
Serbia, Belgrade, Serbia
Introduction: The depressive symptoms assessed using Beck’s Depression Inventory (BDI)
scores are related to increased cardiovascular morbidity and mortality rates, though
pathogenetic mechanisms and antidepessive drugs impact have not yet been fully
elucidated.
Objectives: Identifying the depressive symptom correlation with coronary risk factors,
specific biochemical, hemostatic and echocardiographic parametres as well as clinical
course and outcome in postmyocardial infarction patients.
Methods: The study involved a group of 174 postmyocardial infarction patients older than
45 as well as 64 equivalent controls. We investigated depression symptoms determined by
the BDI, presence of standard coronory risk factors, acute phase reactants, blood count
parametres hemostatic markers (antithrombin, protein C, FVII, FVIII, vWF, FX, FXII),
troponin level and ejection fraction, major adverse coronary events. The statistical analysis
was done using Spearman’s correlation test and Mann Whitney-U test.
Results: The average patient age was 61.28
10,38 years. There was detected a postive
correlation between the BDI scores and number of cigarettes per day (p¼0,005, r¼0,279),
cigarette packets per year (p¼0,02, r¼0,229), troponin levels (p¼0,017, r¼0,35). The
BDI scores correlated negatively with ejection fraction (p¼0,004, r¼-0,256), haemoglobin
levels (p¼0,009, r¼-0,279), hematocrit levels (p¼0,011, r¼-0,196), total cholesterol
(p¼0,019, r¼-0,191), HDL (p¼0,036, r¼-0,162), (p¼0,011, r¼-0,196) and LDL
(p¼0,026, r¼-0,173). No correlation was found between BDI scores and other examined
parametres (CRP, fibrinogen, sedimentation rate, Lp(a), ApoA1, ApoB, FVII, FVIII, FXII,
vWF, antithrobin and protein C, as well as major adverse cardiologic events.
Conclusion: The data confirming that the BDI scores correlate positively with the
myocardial necrosis marker, smoking and negatively with the anemia degree, ejection
fraction, total cholesterol, HDL and LDL may contribute to gaining a more comprehensive
insight into the complex issue of interrelation between depression symptoms and
myocardial infaraction.
Disclosure of Interest: None Declared
PM208
Achievement of LDL-cholesterol goal with statins after an ST segment elevation
myocardial infarction in a developing country
1
Wiwun Tungsubutra* , Banthita Iaocharoen 1
1 comes for STEMIs, the Glasgow algorithm was implemented and termed pre-hospital
medicine, Siriraj Hospital, Bangkok, Thailand
Introduction: In patients with very high cardiovascular risk, low-density lipoprotein
cholesterol (LDL-C) less than 70 mg/dL or at least 50% reduction of LDL-C are recom-
mended targets. Only high-dose atorvastatin has been shown to reduce death and ischemic
events among patients with acute coronary syndrome. There are limited data on the
practice of LDL-C goal attainment in patients after STEMI in developing countries.
Objectives: To evaluate the proportion of STEMI patients that achieve LDL-C goal after
hospital discharge in a real-world setting. To determine if the type of statin prescribed
affected the LDL-C goal achievement.
Methods: We retrospectively analyzed data in a cohort of patients with STEMI enrolled
from June 1, 2008 through May 31, 2011. Patients who survived, were prescribed a statin
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
on discharge and had LDL-C data at follow-up were analyzed. The formulation of statin
POSTER ABSTRACTS
was categorized as simvastatin or other statin (atorvastatin or rosuvastatin) group. 1-year
clinical follow-up was obtained.
Results: There were 97% (n¼265 of 272) of patients with STEMI who were prescribed a
statin at discharge. Of these, 216 patients had LDL-C data during follow-up, 75% were
men, the mean age was 60.5 years old and the mean baseline LDL-C was 118.1 mg/dL.
73% (n¼157) of patients received simvastatin and 27% (n¼59) received other statins. At
discharge, the median dose of simvastatin, atorvastatin and rosuvastatin were 20, 20, 10,
respectively. At follow-up, target LDL-C <70 mg/dL or LDL-C reduction  50% was
achieved in 30.1% (n¼ 65) of patients, 27.4% (n¼43) on simvastatin and 37.3% (n¼22)
on other statins, (p¼0.16, simvastatin versus other statins). When stratified by the dose
intensity of statin, a significantly greater proportion of patients on moderate to high in-
tensity statin attained LDL-C goals than those on low intensity statin (36.3% versus 24.3%,
p¼0.038). There were no significant differences in one-year mortality or major adverse
cardiac events among the statin groups but the sample size was too small to detect such a
difference.
Conclusion: From this observational study, most patients with STEMI are prescribed statin
therapy at discharge. Despite this, the target LDL-C <70 mg/dL is attained in a minority of
the patients due to suboptimal statin dosing. The type of statin did not affect LDL-C goal
attainment. Moderate to high-intensity statin should be given in patients with STEMI to
achieve guideline LDL-C goals and prevent future morbidity and mortality.
Disclosure of Interest: None Declared
PM209
Correlation Of The Ecg Changes (St Segment Depression With Or Without T Wave
Inversion In Lateral Leads 1, Avl.V4-V6) With Coronary Angiographic Findings In
Acs Patients
Syed M. E. Al Baker*1, Golam Azam1, Fazlur Rahman1, Md M. Rahman1,
K. M. H. S. S. Haque1
1
Department of Cardiology, Government, Dhaka, Bangladesh
Introduction: Value of ECG in lateral leads to predict the occlusion site of the LMCA or
LMECA.
Objectives: This study was conducted to find out the correlation of initial ECG changes of
ACS patient with culprit lesion of coronary artery by CAG findings.
Methods: Prospective consecutive studies conducted in BSMMU on 2006.Total 60patient
of ACS were enrolled in this study. On the basis of ECG findings we divided the patient in
2 groups. In group1, ST segment depression with T wave inversion in lateral leads and
group2, ST segment depression without T wave inversion in same leads. ECG were
correlate with CAG findings.
Results: In this study the mean age were in group-1 53.4
9.2 and group 2, 48.8
10
years. Among those patient in group-1, 24 (80%) had Unstable angina, 6 (20%)had ST
elevated myocardial infarction and in group-2,27 (90%) had Unstable angina, 3 (10%) had
Non ST elevated myocardial infarction. Analysis revealed that mean systolic and diastolic
BP higher in group 2 compared to group1. Regarding risk factor smoking were (63.3%).
Hypertension (56.7%). Diabetes mellitus (46.7%), Dyslipidemia (36.7%) and family history
of IHD(13.3%). CAG findings shown in group-1, 70% had Left main coronary artery
disease (group2, 3.3%) and statistically highly significant found between 2 groups
(p<0.001), sensitivity 95%, specificity 76.6%, accuracy 83.3%. In group1, DVD 16.7%,
SVD 13.3%, no normal vessel or TVD were found. In group2, 43.4% had normal vessel,
DVD 27.6%, TVD and Left main coronary artery disease 3.3%.
Conclusion: In ECG ST depression with T wave inversion in 1, avl, V4-V6 of ACS patient
is useful predictor of LM/LMECAD with high sensitivity specificity and predictive accuracy.
Thus the present study showed that patient of ACS careful attention in lead 1, avl, V4-V6
and clinically important to early diagnosis and selecting treatment strongly to reduce the
mortality and morbidity.
Disclosure of Interest: None Declared
PM210
Comparing Outcomes of Primary Percutaneous Coronary Interventions For ST
Elevation Myocardial Infarcts Assessed Via The Pre-Hospital Assessment For Primary
Angiogram (PAPA) Program and In The Emergency Department At A Regional New
South Wales Hospital Without Onsite Cardiac Surgery
Daniel Devenney*1, Giuseppe Femia1, Antonio Tiberio1, Prathap Hegde1, Nguyen Dang1,
WIlliam McKenzie1, Dwain Owensby1, Pratap Shetty1, Aaron Yeung1, Astin Lee1
1
The Wollongong Hospital Cardiology Department, Wollongong, Australia
Introduction: The Wollongong Hospital Cardiology Department provides primary
percutaneous coronary intervention (PPCI) service to approximately 350 000 residents. To
improve first medical contact to lab and balloon (FMCL/FMCB) and cardiovascular out-
assessment for primary angiogram (PAPA). In this program, pre-hospital ECGs are pre-
formed for patents with chest pain and those that satisfy the ST elevation algorithm are
reviewed by the on call interventionist. Patients deemed appropriate are brought directly to
the catheterization lab without attending the emergency department.
Objectives: To compare first medical contact to lab and balloon times and cardiovascular
outcomes of PPCI for STEMIS assessed with the PAPA program and in the emergency
department (ED).
Methods: This study was conducted at a center where PPCI is routinely performed for all
STEMIs. All PPCI assessed via PAPA and in the ED between March 31st and August 1 2013
were retrospectively evaluated. In hospital patients, hospital transfers and out of hospital
cardiac arrests were excluded. Primary outcomes include in hospital death, cardiogenic
e105
 shock and recurrent MI at 30 days. Secondary outcomes include acute kidney injury and
POSTER ABSTRACTS
bleeding.
Results: During the study, 40 STEMIs (22 PAPA and 18 ED) presented to the catheteri-
zation lab; 30 (75%) underwent PPCI, 6 (15%) required emergency coronary artery bypass
surgery and 5 (12.5%) had non-obstructive coronary disease and treated medically. Of the
30 PPCIs, 19 (47.5%) presented via PAPA and 11 (27.5%) via ED. Patient demographics
and vessel characteristics were similar between the two groups. Mean FMCL/FMCB times
for the PAPA and ED groups were 41 +/- 9 vs. 83 +/- 80 minutes (p¼<0.05) and 76 +/- 17
vs. 105 +/- 79 minutes (p¼0.29). Clinical follow up at 30 days was available for 39 pa-
tients; primary outcomes occurred in 4 (18.2%) PAPA cases and 7 (38.9%) ED cases
(p¼0.17) with 1 death in the PAPA group and 3 deaths in the ED group. Secondary
outcomes occurred in two (9.1%) PAPA cases and seven (38.9%) ED cases (p¼0.06). No
patient required target vessel revascularization at 30 days.
Conclusion: There was a non-significant trend towards less primary and secondary out-
comes in the PAPA group associated with significantly shorter FMCL and FMCB times. The
novel PAPA program could be a safe and effective method to reduce both lab times and
outcomes in PPCI for STEMIs in regional areas of Australia.
Disclosure of Interest: None Declared
PM211
Pre Hospital Thrombolysis - An Examination of Clinical Outcomes
Trent Williams1, Peter Fletcher*1, Paul Stewart2, Steven Faddy2, Lindsay Savage1
1 variables were comparable between two groups.
Cardiology Stream, Hunter New England Health, Newcastle, 2New South Wales Ambulance
Service, Ambulance, Sydney, Australia
Introduction: The importance of reducing time to thrombolysis in the treatment of STEMI
is well known. The greatest potential benefits are gained when reperfusion is achieved at a
time closest to first medical contact. NSW Ambulance began pre-hospital thrombolysis of
patients with confirmed STEMI in 2008. We sought to examine outcome data from this
group of patients.
Objectives: The study sought to determine patient’s clinical outcomes following admin-
istration of thrombolysis in the prehospital setting. Time to access to reperfusion, length of
stay, mortality, reinfarction and 3 month readmission rate were reviewed.
Methods: Consecutive patients who received thrombolysis administered by NSW Ambu-
lance paramedics between 2008 to May 2013 were retrospectively examined using a
prospectively collected database administered by hospital staff. This clinical information
was matched with data from the Ambulance service of NSW. Categorical variables were
examined using Pearson Chi square and Fishers exact test. Continuous variables were
analyzed by two tailed student t tests. Data is reported as means and standard deviations
(SD). Significance is set as a p value <0.05. Mortality information was gathered from
hospital records and registry.
Results: The sample consisted of 150 patients who were administered thrombolysis for
STEMI by NSW Ambulance between 2008 and August 2013. Demographic data included
mean age (61), 80% male and 44% anterior STEMI. Parameters included time from first
medical contact to thrombolysis (median 1hour 24 min) and time to hospital (2 hours 10
minutes). End point data (MACE) including cardiac mortality at 30 days (3.3%), rate of re
infarction (1%), and mean hospital length of stay (3.7 days). One month readmission with
ACS was reviewed. All patients progressed to angiography within 30 days of STEMI.
Conclusion: The examination of this group demonstrates that thrombolysis administered
in the pre hospital setting by NSW paramedics is a safe and effective method of facilitating
early reperfusion.
Disclosure of Interest: None Declared
PM212
Change in plasma phospholipase A2 mass and activity in subjects undergoing elective
coronary stenting
Chris Judkins*1, Andrew Wilson1, Sonny Palmer1, Amy Wilson-O’brien2, Paul Williams1,
Andrew MacIssac1, Robert Whitbourn1
1
SVHM, 2Uni Melbourne, Melbourne, Australia
Introduction: Plasma phospholipase A2 (PLA2) enzymes are associated with cardiovas-
cular (CV) risk and are involved with plaque progression. PLA2 enzymes are involved in
atherosclerosis pathogenesis and endothelial dysfunction and may correlate with outcomes
following percutaneous coronary intervention (PCI).
Objectives: To define baseline and post PCI PLA2 levels in relation to clinical, angio-
graphic and biochemial factors.
Methods: We prospectively collected arterial (n¼79) and aortic/coronary sinus plasma
(n¼20 (results for 11)) for lp-PLA2 mass and activity assay and sPLA2 activity in subjects
undergoing elective PCI. Patient, procedural, and angiographic characteristics and post
procedural troponin were assessed.
Results: At baseline lp-PLA2 mass trended lower in more obese subjects (F 2.41, p¼0.08)
who were more likely to be on a statin. Greater lp-PLA2 mass increase post-PCI was seen in
diabetics (173+/-338 vs 391+/-313, p¼0.039). Subjects on chronic dual antiplatelet ther-
apy (DAPT) had a trend to lower lp-PLA2 release (306.7 vs 146.3, p¼0.11). s-PLA2 activity
at baseline and change in trans-coronary lp-PLA2 activity with PCI correlated with troponin
rise post PCI (r ¼ 0.48 and r ¼0.61).
Conclusion: Lp-PLA2 mass and s-PLA2/lp-PLA2 activity correlate with baseline procedural
characteristics and may predict those at greater risk of post PCI myocardial ischemia.
Diabetics and older subjects demonstrate greater PLA2 release and DAPT may lower lp-
PLA2 release during PCI.
Disclosure of Interest: None Declared
e106
PM213
Role of N-Acetylcysteine In The Prevention of Contrast Induced Nephropathy After
Coronary Angiogram And Percutaneous Coronary Intervention
Md. Mukhlesur Rahman*1, Manzoor Mahmood1, Jahanara Arzu1, Md A. Salim1,
Shamimum Nahar1
1
Cardiology, Banglabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Introduction: Contrast induced nephropathy (CIN) is a recognized complication after
coronary angiogram (CAG) and percutaneous coronary intervention (PCI). Inspite of use
less nephrotoxic contrast agents, risk of nephropathy continue to be higher particularly in
high risk patients.
Objectives: To determine whether oral N-acetylcysteine can prevent CIN in patients with
mild renal insufficiency whom undergo CAG can PCI.
Methods: The study was done in Bangabandhu Sheikh Mujib Medical University, during
July 2010 to June 2012. Total 1130 patients having mild renal insufficiency (serum
creatinine level between 1.3 to 2.5 mg/dl) underwent elective CAG and PCI were enrolled
in this study. Patients were divided into two groups. Group-A (n¼560) received hydration
by normal saline alone (1 ml/kg/hour) for 24 hours at least 12 hours before the procedures
as premedication. Group B (n¼570) received hydration by normal saline as group A plus
oral N-acetyl cysteine (600 mg 12 hourly) for 3 days at least two days before the procedure.
Serum creatinine level were measured before procedure, 24 hours and 48 hours after CAG/
PCI. Age, sex, hypertension, diabetes mellitus, heart failure, amount of dye used and other
Results: 49 patients (8.9%) in group A developed CIN whereas 8 patients (1.4%) in group
B developed CIN. The difference were statistically significant (P<0.05). It was also
observed that CIN developed more in diabetic than non diabetic patients 8.5% vs 2.2%
(P<0.05).
Conclusion: N-Acetyl cysteine as premedication can play significant role to prevents CIN
in patients with mild renal impairment during CAG and PCI.
Disclosure of Interest: None Declared
PM215
Effect of Remote Ischemic Preconditioning In Periprocedural Myocardial Injury
Events In Elective Percutaneous Coronary Intervention
Novi anggriyani*1, Sodiqur Rifqi2
1
Cardiology and Vascular Medicine Department, Diponegoro University, 2Cardiology and
Vascular Medicine Department, Kariadi Hospital, Semarang, Indonesia
Introduction: Periprocedural myocardial injury occurred in at least a third of patients who
underwent elective percutaneous coronary intervention (PCI). Periprocedural myocardial
injury as evidenced by an increase in creatine kinase myocardial band (CK-MB) post PCI
procedure, has been associated with subsequent cardiovascular events. Remote ischemic
preconditioning (RIPC), is a method of applying sublethal ischemia in organs distant from
the target (in this study the upper arm) which has the effect of cardioprotection by
increasing ischemic tolerance, thereby reducing the disadvantages caused by myocardial
injury.
Objectives: To investigate whether remote ischemic preconditioning has an influence on
periprocedural myocardial injury in elective PCI, based on the differences in mean levels of
CK-MB at 18-24 hours after PCI between control and RIPC groups.
Methods: There were 42 patients with stable coronary artery disease who underwent
elective PCI, randomized into treatment group with RIPC (n ¼ 20) and control group (n ¼
22). RIPC protocol performed by 4 cycles of inflation - deflation using blood pressure cuff
20 mmHg above the systolic blood pressure in one of the upper arm. Assessment of
periprocedural myocardial injury is determined by cardiac enzyme rise using differences of
mean levels of CK-MB at 18-24 hours after PCI between control and RIPC groups. Peri-
procedural myocardial injury was defined as any elevation of CK-MB above the upper limit
normal (ULN) post PCI.
Results: Post procedural mean levels of CK-MB was significantly lower in the RIPC group
(25.15
5.46 mg/mL) compared to the control group (40.59
21.16 mg/mL); p ¼ 0.003.
Median of delta CK-MB was significantly lower in the RIPC group (5 mg/mL) compared to
the control group (16 mg/mL); p ¼ 0.001. Incidence of periprocedural myocardial injury
was significantly lower in the RIPC group 2.3% and 19.04% in the control group; p ¼
0.022.
Conclusion: Remote ischemic preconditioning reduces periprocedural myocardial injury in
elective percutaneous coronary intervention.
Disclosure of Interest: None Declared
PM216
Nanofiber-hydrogel composite for a combined delivery of NO and ROS Scavenger
against CAD
Byeongtaek Oh*1, Chi H. Lee1
1
Division of Pharmaceutical Science, School of Pharmacy, University of Missouri - Kansas City,
Kansas City, United States
Introduction: Mast cell (MC) plays a critical role in allergic diseases including ventricular
fibrosis, renal fibrosis and host defense. Activated mast cell (a-MC) stimulates subcellular
signaling cascade. A vast majority of physiological stimuli trigger the granular decompo-
sition of MCs, potentially reversing the atheroprotective function into atherogenetic one.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

We explore the combination of nitric oxide (NO) and reactive ROS scavengers loaded in
nanofiber as an efficient strategy to treat coronary artery diseases (CAD) through prevention
of the granular decomposition (i.e., stabilizing) of MCs.
Objectives: To evaluate the effects of a combination of NO and ROS scavengers on the
degranulation rate of a-MC and, subsequently, viability of coronary artery endothelial cell
(hCAEC).
Methods: hCAECs (1.0x105 cells/well) were seeded on the nanofibers containing NO-donor
drug (GSNO) (1.0 mM) and ROS scavenger (i.e., Edaravone) (0.5 mM) in a 12-well plate. The
amount of hydrogen peroxide (H2O2; ROS) generated from RBL-2H3 upon exposure to the
compound 48/80 (150 ng/ml) was measured using Amplex Red. The degranulation rate of a-
MCs (i.e., as a stabilization index) and its cytotoxic effects on hCAECs were evaluated using
the co-culture plate containing RBL-2H3 cells (3.0x104 cells/well) in the insertion well and
determined using b-hexosaminidase assay and LDH assay (CytoTox-ONEÔ, Promega),
respectively, at pre-determined time intervals (24 hr and 48 hr).
Results: The amount of H2O2 from a-MCs upon exposure to the compound 48/80
significantly increased (about 2 folds) as compared to the control group. The level of b-
hexosaminidase increased as a function of exposure time (41.3
6.2 % for 24 hr and
67.8
3.7 % for 48 hr incubation). The degranulation rates of a-MCs for 48 hr were
lowered by GSNO or a mixture of GSNO and Edaravone (55.8
5.4 % and 50.6
0.6 %,
respectively). The viability of hCAECs against a-MCs for 48 hr displayed 73.8
1.3 % and
76.5
6.1 % in the presence of GSNO or a mixture of GSNO and Edaravone, respectively,
as compared with the control (56.8
10.1%).
Conclusion: Since hydrogen peroxide released from a-MCs is permeable through the
hCAECs membrane, the enhanced degranulation of a-MCs may exert the cytotoxic effects
on hCAECs. GSNO and Edaravone stabilize a-MCs and reduced its cytotoxic effects on
hCAECs, supporting that NO donors in combinations with ROS scavengers had immune-
suppressive effects on a-MCs and, subsequently, maintained cell viability of hCAECs.
Disclosure of Interest: None Declared
PM220
Hyperglycaemia, rather than diabetes per se, engenders impaired platelet nitric oxide
signaling
Cher-Rin Chong*1,2, Saifei Liu1,2, Vivek B. Nooney1,3, Nicola Hurst1,2, Giovanni Licari1,2,
Doan T. Ngo2, Yuliy Chirkov1,2, John D. Horowitz1,2
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
1
Dept of Clin Pharmacology and Cardiology, Basil Hetzel Institute, 2University of Adelaide,
POSTER ABSTRACTS
3
University of South Australia, Adelaide, Australia
Introduction: Diabetes mellitus (DM) is associated with increased risk of coronary
occlusive events, but this association appears to be stronger in poorly controlled diabetics.
Furthermore, there is evidence that correction of hyperglycaemia associated with acute
myocardial ischaemia reduces subsequent coronary risk.
Objectives: We have now compared the impact of diabetes
hyperglycaemia on platelet
responsiveness to nitric oxide (NO), an independent marker of long-term coronary event/
mortality risk.
Methods: Two cohorts of patients with symptomatic myocardial ischaemia were studied:
(1) Patients (diabetic/non-diabetic) evaluated prior to coronary stent insertion (2) Diabetic
patients admitted to hospital with severe hyperglycaemia (BSL > 11.1 mmol/L) and active
ischaemia, whose treatment included correction of hyperglycaemia with intravenous
infusion of insulin. Whole blood platelet aggregation utilizing adenosine diphosphate
(ADP; 2.5uM), with sodium nitroprusside utilized as NO donor, facilitated determination
of NO response. In patients with elevated BSL, whole blood reactive oxygen species (ROS)
content was determined by electroparamagnetic resonance.
Results: Platelet aggregation in response to ADP (Figure A) was virtually identical for all
three patient groups, while SNP response (Figure B) diminished below population norms
(>25% response) in all three groups, was lowest for hyperglycaemic diabetic patients
(Figure B). After 12 hours insulin infusion, BSL fell from 16.6
5.6 to 8.7
5.0 mmol/L
(p<0.001) while SNP response rose significantly (p<0.001). Simultaneous whole blood
ROS content fell from 1.1x106
2.4x10 to 9.4x105
2.910 (p<0.05).
Conclusion: (1) These data confirm that all patient group with symptomatic myocardial
ischaemia tend to demonstrate platelet NO resistance, but in the absence of hyper-
glycaemia, diabetes per se does not aggravate this condition.
(2) Hyperglycaemia is associated with elevation of ROS release, which represents a basis
for NO resistance corrected by insulin infusion.
Disclosure of Interest: None Declared
e107
 PM222
POSTER ABSTRACTS
Early Clinical Outcomes In Patients Electively Implanted With Everolimus And
Non-Everolimus Drug Eluting Stents: Impact Of Platelet Function Testing
Following Pretreatment With Aspirin And Clopidogrel
Khai Liy Kong*1, Alan Y. Y. Fong1,2, Melissa Mejin1,3, Felicia Y. Y. Chin1, Lee Len Tiong1,3,
Jerry Gerunsin1, Melissa S. H. Lim1,3, Tiong Kiam Ong2
1
Clinical Research Centre, 2Department of Cardiology, 3Department of Pharmacy, Sarawak
General Hospital, Kuching, Malaysia
Introduction: Drug-eluting stents (DES) reduce in stent restenosis by local delivery of
antiproliferative drugs embedded onto their metallic backbone. Antiproliferative drugs
have also been thought to cause a local inflammatory effect that could lead to stent
thrombosis. The risk of stent thrombosis is greatest in the first month following elective
DES implantation. Double antiplatelet therapy (DAPT) prescribed prior to DES im-
plantation and recommended for 12 months after. DAPT is associated with an increased
risk in bleeding, therefore platelet function testing (PFT) is utilized to assess their ef-
ficacy. Everolimus-eluting (EES) are amongst the most common DES used at our
centre.
Objectives: We aimed to compare elements of DAPT by PFT to assess if there are more
adverse clinical events in patients implanted with EES compared with non-EES.
Methods: From 474 consecutive patients undergoing elective percutaneous coronary
intervention (PCI), 137 patients were implanted with DES having had pretreatment of
Aspirin 75mg OD and Clopidogrel 75mg OD for 4 days. PFT was assessed with
multiple electrode aggregometry (MEA, Multiplate) within 24 hours of PCI. The primary
endpoint was major adverse cardiac events (MACE) and bleeding rates up to 1 month
post-PCI.
Results: We noted that 80 patients were implanted with EES and 57 patients with non-
EES. Both groups were well matched for gender, age and established cardiac risk factors.
Mean PFT levels for Aspirin were 212.18
98.48 AU*min and 196.3
90.17 AU*min for
EES and non-EES groups, respectively. Mean PFT levels for Clopidogrel were
408.65
188.56 AU*min and 466.67
241.74 AU*min for EES and non-EES groups,
respectively. There were 12.7% versus 10.5% Aspirin non-responders, 32.9% versus 45.6%
Clopidogrel non-responders, in the EES compared with non-EES groups. There was 1
MACE in the EES group, compared with 2 MACE in the non-EES groups. There were 4
minimal bleed events in the EES group compared with the non-EES group. There was no
relationship between MACE and Aspirin MEA levels, and no relationship between MACE
and Clopidogrel MEA levels, between both groups.
Conclusion: Comparing patients implanted with EES or non-EES, neither Aspirin nor
Clopidogrel MEA levels were associated with adverse clinical events following 1 month
after elective PCI.
Disclosure of Interest: None Declared
PM223
Prevalence of High On-Treatment Platelet Reactivity To Aspirin In Patients With
Stable Coronary Artery Disease
Lee Len Tiong*1,2, Yanti N. Sani1,2, Pui Pui Sim2, Kent Ter Lau1, Siti Nadiah Rusli2,
Ming Ying Ku2, Alan Y. Y. Fong1,3, Lawrence Anchah2, Tiong Kiam Ong3
1
Clinical Research Center, Sarawak General Hospital, Kuching, 2Department of Pharmacy,
3
Department of Cardiology, Sarawak General Hospital Heart Center, Kota Samarahan,
Malaysia
Introduction: Aspirin is the most common antiplatelet agent used for the treatment of
stable coronary artery disease (CAD). Despite its wide usage, there is concern regarding
aspirin resistance (AspR).
Objectives: The objective of this study was to determine the prevalence of high on-
treatment platelet reactivity (HOTPR), reflecting AspR, defined by aspirin reaction unit
(ARU) > 550 after aspirin treatment in stable coronary artery disease patients.
Methods: Retrospective data collection was done from 15 July to 14 August 2013 at
the outpatient cardiac clinic. Medical records of patients with stable coronary artery
disease who receive daily UniAspirinÒ 75mg (Acetylsalicylic Acid) or GlypirinÒ 100mg
(Acetylsalicylic Acid with Glycine) were screened. Patients who were on aspirin treat-
ment for at least a month, compliant to their medications with 8-item Modified
Morisky Scale of 6 to 8 and platelet reactivity measured by VerifyNow were included in
the study.
Results: Out of 164 patient medical records screened, 60 were included in the study.
All patients were male with a mean age of 54.3 (11.2) years and mean BMI of 26.5
(4.2) kg/m2. 46.7% of the patients were Malay, 33.3% Chinese, and 20.0% non-
Malay Bumiputera. Prevalence of established cardiovascular risk factors was high:
hypertension (63.3%), dyslipidemia (40.0%), diabetes mellitus (33.3%) and 13.3% are
current smokers. 66.7% had a history of percutaneous coronary intervention (PCI)
and 33.3% implanted with at least one drug eluting stent (DES).The mean platelet
reactivity was 430.8 (63.9) ARU. 6.7% was found to be AspR. Mean ARU was found
to be higher in diabetic patients [455.0 (75.4)] than non-diabetic patients [423.6
(57.1)], p¼0.225. There is no significant difference between the mean ARU of
UniAspirinÒ group [n¼30, 439.0 (80.8)] and GlypirinÒ group [n¼30, 422.5 (40.6)],
(p¼0.321).
Conclusion: The prevalence of HOTPR in stable CAD treated with aspirin is low. The
mean ARU of approximately 430 is slightly lower than most reported literature for stable
CAD patients. However, given the prevalence and clinical presentation of CAD in Malaysia,
a larger study of HOTPR to aspirin is warranted.
Disclosure of Interest: None Declared
e108
PM224
Thrombospondin-1 exerts bidirectional effects on prostacyclin signalling in human
platelets: implications regarding clopidogrel resistance
Vivek B. Nooney*1,2, Hurst Nicola3, Jeffrey Isenberg4, Yuliy Chirkov2,3, John Horowitz5
1
University of South Australia, 2Basil Hetzel Institute, 3University of Adelaide, Adelaide,
Australia, 4University of Pittsburgh, Pittsburgh, United States, 5Cardiology and Clinical
Pharmacology, The Queen Elizabeth Hospital, Adelaide, Australia
Introduction: We have recently demonstrated that impaired platelet responsiveness to
PGE1/ PGI2 is a strong and independent predictor of clopidogrel resistance. Hence factors
which modulate PGE1/ PGI2 signalling may exert substantial effects on clopidogrel
responsiveness.
Objectives: We therefore sought to determine the extent of change in responsiveness to
PGE1 in human platelets by varying concentrations of thrombospondin-1 (TSP-1), a
matricellular protein released into plasma primarily from platelet alpha granules.
Methods: TSP-1/PGE1 interaction was investigated in platelet-rich plasma from normal
subjects (N¼8) utilizing TSP-1 concentrations of 10-13 to 10-8M and 15 minutes pre-
incubation before the induction of aggregation. Extent of inhibition of ADP induced ag-
gregation with PGE1 was quantitated as % change in maximal aggregation. Furthermore,
effects of TSP-1 on superoxide generation were determined in whole blood via lucigenin
derived chemiluminiscence.
Results: TSP-1 induced biphasic effects on PGE1 response: there was initial inhibition of
response (max inhibition 24
7 [SEM] % at 8.8 x 10-11 M). At higher concentrations there
was restoration of PGE1 responsiveness, with mean response at 1.3 x 10-10M being 94.5

14 % of baseline. In whole blood, TSP-1 consistently increased O2- release with peak in-
creases of 172
75 % at 10-12M (p ¼0.03, Wilcoxon matched pairs signed rank test)
compared to baseline.
Conclusion: TSP-1 potentially impairs platelet responsiveness to PGE1/PGI2, presumably
via inhibition of associated adenylate cyclase and also increases whole blood oxidative stress
measured by O2- release. Both of these effects may contribute to clopidogrel resistance as
the integrity of adenylate cyclase signalling is a key determinant of clopidogrel response.
Disclosure of Interest: None Declared
PM225
Utility of High-Sensitivity Troponin To Diagnose Myocardial Infarction After Isolated
Aortic Valve Replacement
Tom Kai Ming Wang*1, Ralph Stewart1,2, Tharumenthiran Ramanathan1, David H.-M. Choi1,
Greg Gamble2, Peter Ruygrok1,2, Harvey White1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: The Universal Definition for type 5 myocardial infarction (MI) applies to
coronary artery bypass grafting (CABG), while perioperative MIs for other cardiac surgeries
are rarely studied and not specifically defined.
Objectives: We assessed whether high-sensitivity troponin (hs-TnT), with or without
concurrent ischaemic changes on electrocardiogram or echocardiogram, predicted mor-
tality and morbidity after aortic valve replacement (AVR) as definition for MI.
Methods: Isolated AVR performed during July 2010-December 2012 were identified (n¼219),
and hs-TnT routinely measured 12-24 hours post-operatively were collected. We pre-specified
140ng/L (10 times 99th percentile upper reference limit (URL)), 500ng/L (10 times coefficient of
variation of 10% for 4th generation troponin T applied to hs-TnT) and the optimal hs-TnT
cutpoints from receiver-operative characteristics curves as thresholds for analyses.
Results: There were 216 (98.6%) of patients with hs-TnT>140ng/L and 31.1% (68)
>500ng/L. The optimal cutpoints to detect operative mortality for isolated troponin rise
was 619ng/L (18.7%¼41/219), and for dual criteria was hs-TnT>448ng/Land ECG and/or
echocardiographic changes (4.6%¼10/219). The latter was the only criteria to indepen-
dently predict operative mortality odds ratio (OR) 10.6, 95% confidence interval (95%CI)
1.09-103, P¼0.041 and mortality during follow-up hazards ratio 5.54, 95%CI 1.35-22.8,
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
P¼0.018. Independent predictors for this criteria include angina class, congestive heart
failure, hypertension and pulmonary hypertension. Hs-TnT>619ng/L was the best pre-
dictor of composite morbidity OR 2.86, 95%CI 1.18-6.91, P¼0.020.
Conclusion: A cut-point around 32 times 99th percentile URL for hs-TnT together with
ECG and/or echocardiographic criteria is the best predictor for mortality after AVR. Our
findings suggest different thresholds to CABG for defining MI after AVR.
Disclosure of Interest: None Declared
PM226
Male Patients Had More Vulnerable Plaque Than In Female, Specifically In Patients
With Stable Angina And Young Age Group
1 1 1 1
Seung Hwan Han* , Jong Goo Seo , Pyung Chun Oh , Kyounghoon Lee , Woong Chul Kang , 1 Prescribed antiplatelet therapy on discharge
Soon Youn Suh1, Kwang Kon Koh1, Tae Hoon Ahn1, Eak Kyun Shin1
1
Cardiology, Gachon University Gil Hospital, Incheon, Korea, Republic Of
Introduction: Although males are thought to have a higher total burden of atherosclerotic
plaque, little is known about gender differences in plaque morphology and composition.
Objectives: Accordingly, the aim of this study was to evaluate tissue characteristics of
culprit coronary lesions by clinical presentation and age between genders.
Methods: VH-IVUS on culprit lesions before PCI prospectively underwent by operator’s
discretion. Consecutive data for tissue characteristics and plaque morphology were
analyzed by clinical presentations (acute coronary syndrome (ACS) or stable angina) and 2
age groups (65< or 65 years old) between genders. All analysis was based on volumetric
analysis in the entire length of culprit lesions.
Results: Total 187 patients (men 134, female 53, 194 culprit lesions) were enrolled. Males
were younger (59.3
11.6 vs 67.5
8.4 years, p<0.001), more likely to smoke (39.6 vs
11.3%, p<0.001), had greater fasting glucose (118.7
45.0 vs 100.6
26.0 mg/dL,
p¼0.001), hemoglobin (13.3
1.7 vs. 11.6
1.2 mg/dL, p<0.001) and less LDL cholesterol
(95.0
31.5 vs 105.8
35.3 mg/dL, p¼0.044), HDL cholesterol (41.2
10.4 vs 44.5
9.0
mg/dL, p¼0.042) compared with females. In all patients, percentage necrotic core (NC%)
was greater in males than in females (22.01
8.20 vs 19.22
6.97 %, p¼0.028), although
percent plaque volume did not differ significantly. Males had greater NC% compared with
females in patients with stable angina (21.20
9.33 vs 17.19
5.99 %, p¼0.047) and young
age group (22.31
8.29 vs 15.68
6.78 %, p¼0.004), but not in patients with ACS patients
and old age group. Of interest, thin-cap fibroatheroma (TCFA) were more prevalent in
males with stable angina (14/39 (35.9%) vs 2/21 (9.5%), p¼0.034) compared with females,
but not in patients with ACS (35/98 (35.7%) vs 12/34 (35.9%), p¼0.965).
Table. Prevalence of TCFA between genders
Males Females p inhibitor. However, there was limited data regarding its use in valvular heart disease.
All culprit lesions 49/137, 35.8% 14/55, 25.5% 0.169
ACS 35/98, 35.7% 12/34, 35.3% 0.965
Stable angina 14/39, 35.9% 2/21, 9.5% 0.028
old 18/47, 38.3% 12/40, 30% 0.417
young 31/90, 34.4% 2/15, 13.3% <0.001
However, gender itself was not independent predictor of TCFA, instead diabetes and
triglyceride level were independent predictors of TCFA (odd ratio 5.013 [1.914-13.127],
p¼0.001, 1.007 [1.002-1.012], p¼0.006, respectively) by multivariate regression analysis.
Conclusion: Male patients had more vulnerable plaque than in female, specifically in
patients with stable angina and young patients. These results may be attributed to different
prevalence of risk factors between genders.
Disclosure of Interest: None Declared
PM230
Thromboprophylaxis prescription in hospitalised patients with heart failure and
concomitant atrial fibrillation: Preliminary findings from the Atrial Fibrillation And
Stroke Thromboprophylaxis in hEart failuRe (AFASTER) cohort study
Caleb Ferguson*1, Sally C. Inglis1, Phillip J. Newton1, Sandy Middleton2, Peter S. Macdonald3,
Patricia M. Davidson4
1
Centre for Cardiovascular & Chronic Care, University of Technology, Sydney, 2National Centre
for Clinical Outcomes Research (NaCCOR), Australian Catholic University & St Vincents
Hospital, 3Victor Chang Research Institute, St Vincents Hospital & UNSW, 4Centre for
Cardiovascular & Chronic Care, University of Technology, Sydney & St Vincents Hospital,
Sydney, Australia
Introduction: Atrial Fibrillation (AF) is common in the setting of Chronic Heart Failure
(CHF) increasing the risk of stroke 3 - 5 fold. Thromboprophylaxis in AF prevents strokes
yet; its use is known to be suboptimal.
Objectives: The AFASTER study aims to elucidate factors that influence the judicious
application of thromboprophylaxis to assist in improving therapy allocation. The aim of
this paper is to describe patterns of thromboprophylaxis use and medication prescription in
patients with CHF and concomitant AF.
Methods: Prospective, consecutive participants admitted to a medical cardiology ward
were enrolled in the cohort study over 6 months between April – September 2013. Par-
ticipants were included with CHF with concomitant AF of any type and any aetiology
confirmed by a cardiologist and consistent with international guidelines (minimum
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
CHA2DS2VASc ¼1). Exclusion criteria included age <18 years or AF due to reversible
POSTER ABSTRACTS
causes. The rate and type of thromboprophylaxis were obtained at patient discharge via
electronic discharge summary.
Results: The analysis included the first 97 participants enrolled over 6 month between
April – September 2013. Mean age was 73 years (SD 15), mostly male (67%), primarily
NYHA class II - III (54%), Mean LVEF 43% (SD 20). Most were identified as having
permanent AF. Mean CHA2DS2VASc Score ¼ 3.25 (SD 1.94). Mean HASBLED Score ¼
2.95 (SD 1.55), Mean Charlson Comorbidity Score ¼ 3.07 (SD 1.84), Mean no of medi-
cations on discharge ¼ 11 (SD 4). 32% lived alone.
Table 1. Thromboprophylaxis prescription at discharge.
40%
Prescribed combined antiplatelet and anticoagulant on discharge 19%
Prescribed anticoagulant therapy on discharge 63%
Prescribed warfarin on discharge 56%
Prescribed novel oral anticoagulant on discharge 5%
Discussion: In this moderate to high risk group approximately two thirds of patients were
prescribed anticoagulation therapy at discharge. These data are similar to recently pub-
lished Australian and international studies. There were a number of reasons why anti-
coagulation therapy was not prescribed. The appropriateness of these clinical decisions is
harder to assess highlighting the complexity of assessing risk of stroke versus risk of
bleeding, likely adherence with therapy and ability to monitor these risks.
Conclusion: This study shows that approximately two thirds of participants were pre-
scribed anticoagulation at time of discharge. There is scope for improvement of throm-
boprophylaxis for stroke prevention.
Disclosure of Interest: None Declared
PM231
Factor Xa Levels In Atrial Fibrillation Secondary To Mitral Stenosis
Pipin Ardhianto*1, Yan Herry1, Susi Herminingsih1
1
Cardiology and Vascular Medicine, Medical Faculty of Diponegoro University/dr.Kariadi
General Hospital, Semarang, Indonesia, Semarang, Indonesia
Introduction: Systemic thromboembolism is a serious major complication in patients with
atrial fibrillation secondary to mitral stenosis. Novel oral anticoagulants have been devel-
oped to prevent this complication in non-valvular heart disease, including direct factor Xa
Activated factor X (Factor Xa) is traditionally known as an important player in the coag-
ulation cascade responsible for thrombin generation. There have never been reports of
Factor Xa in atrial fibrillation secondary to mitral stenosis.
Objectives: This study investigate Factor Xa levels in peripheral blood of patients with
atrial fibrillation secondary to mitral stenosis compared with normal subjects.
Methods: We determined the plasma levels of factor Xa in specimens of blood obtained
from peripheral vein of 18 patients (5 male) with atrial fibrillation secondary to mitral
stenosis, none of whom received oral anticoagulant for last 3 days.
Results: Peripheral blood plasma levels of Factor Xa were significantily higher in patients
than in age and sex matched control group of normal subjects without mitral stenosis
(0,728 ng/mL
0,252 VS 0,109 ng/mL
0,092, respectively, p<0,05).
Conclusion: This study showed increased levels of FXa in patients with atrial fibrillation
secondary to mitral stenosis, which may contribute to the pathogenesis of tromboembolism.
Disclosure of Interest: None Declared
PM233
Can Allen’S And Inverse Allen’s With Pulse Oximetry Test Be Used To Prefer Which
Artery Is Better For Vascular Access
Alice Supit*1, Bambang Budiono2, Agnes L. Panda1, Reggy Lefrandt1, Janry Pangemanan1
1
Cardiology and Vascular Medicine, Sam Ratulangi University, Manado, 2Cardiology and
Vascular Medicine, Awal Bros Hospital, Makassar, Indonesia
Introduction: Trans-radial acces has been widely used world wide in the last few years.
However, the use of Allen’s and inverse Allen’s tes to determine suitable artery for vascular
access remain controversial.
Objectives: to investigate whether Allen’s and inverse Allen’s with pulse oximetry test
correlate with the diameter of ulnar and radial artery.
Methods: This study was conducted from January to March 2013. All patients underwent
the Allen’s, inverse Allen’s, and pulse oximetry test before the procedure by 1 investigator,
amd operator was blinded. Both radial and ulnar artery inner luminal diameter were
measured using quantitative angiographic analysis software. Pearson correlation test was
used to analyze the correlation between Allen’s and inverse Allen’s test and diameter of
radial and ulnar artery. P < 0.05 was considered as statistically significant. Statistical
analysis was performed with SPSS v.19.
Results: There were 122 patients (99 males and 23 females, mean age: 57.5
11.9 years)
Using quantitative coronary analysis software, the mean diameter of radial and ulnar artery
was 2.14
0.34 mm and 1.95
0.45 mm, respectively. Pearson correlation test showed
significant correlations between Allen’s test and diameter of ulnar artery (p¼0.000;
r¼-0.526), inverse Allen’s test and diameter of radial artery (p¼0.018;r¼-0.213), oxygen
saturation (SpO2) when radial artery compressed and diameter of ulnar artery (p¼0.001;
e109
 r¼0.288), and SpO2 when ulnar artery compressed and diameter of radial artery with the endothelium-dependent vasodilation of brachial artery in patient with coronary
artery calcification (r ¼ - 0,426, p ¼ 0,048).
POSTER ABSTRACTS

(p¼0.033;r¼0.194).
Conclusion: Allen’s, inverse Allen’s test and pulse oximetry test could predict the larger artery
diameter. Normal Allen’s test and oxygen saturation when radial artery compressed indicates
ulnar artery may be used as an alternative access site when radial approach failed or even as
initial access if inverse Allen’s test was abnormal or Allen’s test is shorter than inverse Allen’s,
especially for intervention procedure which need larger artery as access site. We recommend
the use of both Allen’s and pulse oximetry test before diagnostic or interventional procedure.
Future research with larger series of patients will be necessary to confirm our results.
Disclosure of Interest: None Declared
Conclusion: Our data support the hypothesis of systemic endothelial dysfunction in pa-
tient with coronary atherosclerosis at micro- and at large vessels.
Disclosure of Interest: None Declared
PM236
Lyubertsy study on mortality rate in patients after cerebral stroke or transient
ischemic attack (LIS-2). Design and medical treatment estimation before admission

PM234 Sergey Y. Martsevich1, Natalia P. Kutishenko1, Liubov Y. Drozdova*1, Moisey L. Ginzburg1,2,

Alexander Y. Suvorov1, Anna V. Akimova1, Natalia Y. Zhuravskaya1, Anna V. Fokina1,2,
Carotid ultrasound: possible contribution to non-invasive diagnostic algorithms of Elena V. Daniels1,2
coronary artery disease 1
Department of Preventive Pharmacotherapy, National Research Center for Preventive Medicine,
Dariusz Slawek1, Jan Z. Peruga1, Lukasz Chrzanowski1, Radoslaw Krecki1, Anna Binkowska1, Moscow, 2Lyubertsy District Hospital N2, Lyubertsy, Russian Federation
Jaroslaw D. Kasprzak*1
1 Introduction: LIS-2 (study of mortality among patients (pts) survived stroke in Lyubertsy
Bieganski Hospital, Medical University Lodz, Lodz, Poland dIStrict) is a local registry, held in a typical Russian small town Lyubertsy near Moscow.
Introduction: Ultrasound can reveal carotid artery abnormalities correlated with coronary The registry included all the patients with stroke, intracranial hemorrhage (IH) and tran-
atherosclerosis. sient ischemic attack (TIA), admitted to the Lyubertsy district hospital ¼ 2.
Objectives: Evaluation of ultrasound measurements of intima – media thickness of carotid Objectives: Estimation of social, demographic and anamnestic characteristics of pts with
artery (CIMT) and plaque detection as markers correlated with the presence of coronary cerebral stroke (CS) as well as the medical treatment received by the pts before the
artery disease (CAD), defined as 50% reduction in diameter of at least one large coronary reference CS in the hospital.
artery segment. Methods: All the pts, regardless of age, sex, etc. admitted to the Lyubertsy regional
Methods: 71 patients (pts) were evaluated for suspected stable CAD (23,9% women, age hospital ¼ 2 due to CS from 01.01.2009 to 31.12.2011 were included into the registry.
61.5
7.5). Standard clinical protocol including Bruce treadmill exercise test was expanded Analysis of social, demographic, anamnestic characteristics, assessment of cardiovascular
with carotid ultrasound examination to detect plaques and measure averaged CIMT. therapy before the reference CS was performed.
Coronary angiography was performed in all pts., with the semiquantification (QCA) of Results: Among all included (N¼983), 37.0% (n¼364) were men, 63.0% (n¼619) – women.
stenotic lesions and calculation of Gensini Score (GS). Mean age was 71.0
9.9 years old (min age was 18, max 99 years old). The rate of ischemic stroke
Results: CAD was present in 43 (60.5%) patients. CIMT was thicker in patients with CAD made up 90.2% (n¼887), 6.0% (n¼59) pts had TIA, while in 3.7% (n¼37) IH was diagnosed.
1.01
0.11 mm vs 0.88
0.14 mm (p¼0.0001), and plaques were more prevalent 76.7% vs Common cardiovascular risk factors were analyzed for all pts: 87.1% (n¼856) of pts had
42.9%, p¼0.008. Averaged CIMT was correlated with GS values including total (r¼0.36 p history of hypertension earlier, 26.8% (n¼264) had atrial fibrillation (AF). Diabetes mel-
¼0.0017), proximal (r¼0.32 p¼0.0056) and distal (r¼0.33, p¼0.0052) coronary score. litus (DM) rate was 20.8% (n¼204). Among all the pts 12.7% (n¼125) were smokers and
Total and distal GS was significantly higher among patients with carotid atherosclerotic 10.9% (n¼107) suffered from alcohol abuse. Hyperlipidemia was revealed in 51.6% of pts
plaques (p¼0.0035, p¼0.0011). Male sex (OR:15,4 p¼0,0013), increased CIMT (>0.98 (n¼507), 12.7% (n¼125) survived previous myocardial infarction (MI), 22.3% (n¼219)
mm) - (OR:7.9; p¼0,009), and ST segment depression during the exercise test (>0.8 mm) had previous CS, 2.6% (n¼26) had previous TIA.
were independent diagnostic predictors of CAD (OR:6.9; p¼0,0026). IMT values iim- In-hospital mortality was 21.5% (n¼212). Among the mortality group 33.5% (n¼71)
proved sensitivity and negative prognostic value of noninvasive CAD prediction. were men, 66.5% (n¼141) - women, mean age 73.0
9.7 years old. Typical cardiovascular
risk factors were estimated in the mortality group: 82.1% (n¼174) had hypertension in the
anamnesis, 41.5% (n¼88) had AF, 22.6% (n¼48) had DM, 25.9% (n¼55) survived CS
Sensitivity Specificity Accuracy Positive Negative earlier, 10.9% (n¼23) had previous history of MI.
Diagnostic test (%) (%) (%) PV(%) PV(%) Before the admission 6.1% (n¼60) of all pts received antiplatelet agents, 26.9% (n¼755)
– ACE inhibitors, angiotensin receptor blockers received 1.6% (n¼16), calcium channel
Positive treadmill exercise 76,7 57,1 69 73,3 61 blockers – 7.6% (n¼75), 8.3% (n¼82) received diuretics, 9.8% (n¼97) - b-blockers, 3.6%
test (TET) (n¼36) - antiarrhythmics. Statins and warfarin were recommended to 6 pts (0.6%).
Mean CIMT [>0,98 mm] 74,4 78,6 76 84,2 66,7 Conclusion: High prevalence of common cardiovascular risk factors in pts with CS was
revealed. Low frequency of administration medical therapy with proven influence on life-
Positive TET+ Mean CIMT 90,6 50 74,6 73,5 77,7
prognosis before the reference CS was observed.
[>0,98 mm] Disclosure of Interest: S. Martsevich Grant/research support from: Pfizer, Speakers bu-
Positive TET + plaque 95,3 39,3 73,2 70,7 84,6 reau: Pfizer, Bayer, Egis, PRO.MED.CS Praha a.s., N. Kutishenko Grant/research support
Positive TET + [plaque v 97,6 35,7 73,2 70,0 90,9
from: Pfizer, Speakers bureau: Pfizer,Egis,PRO.MED.CS Praha a.s., L. Drozdova Grant/
research support from: Pfizer, Speakers bureau: Pfizer, MSD,PRO.MED.CS Praha a.s., M.
CIMT]
Ginzburg: None Declared, A. Suvorov: None Declared, A. Akimova: None Declared, N.
Zhuravskaya: None Declared, A. Fokina: None Declared, E. Daniels: None Declared
Conclusion: Thicker IMT and the incidence of atherosclerotic plaques in the carotid ar-
teries are prevalent in CAD pts. Abnormal carotid images can complement classic diag-
PM241
nostic pathway of stable angina to improve diagnostic accuracy of non-invasive algorithm
due to improved sensitivity and begative predictive value. Left ventricle/right ventricle interaction in patients with arterial hypertension
Disclosure of Interest: None Declared
Krasimira Hristova*1, Luidmila Vladimirova_kitova2, Fedya Nikolov2, Tzvetana Katova1
1
Noninvasive Functional Diagnostic and Imaging, National Heart Hospital, Sofia, 2Medical
PM235
University, Plovdiv, Bulgaria
Association of endothelium-dependent vasodilation of the brachial artery with
microcirculatory vascular reactivity patients with coronary artery calcification Introduction: Speckle tracking echocardiography in patients with hypertension is sensitive
method for noninvasive assessment of early changes on left ventricular remodeling.
1 1 2
Konstantin Y. Nikolaev* , Mikhail Voevoda , Alla Ovsyannikova , Galina Lifshitz , 1
Objectives: The relationship between carotid pathology and exercise stress – test in patients with
Alevtina Nikolaeva2 new onset symptoms for cardiovascular disease (CVD) as predictor for cardiovascular events.
1
Novosibirsk State University, 2Institute of Internal Medicine, Novosibirsk, Russian Federation Methods: We compared echocardiographic measures in 66 patients with arterial hyper-
tension and left ventricular hypertrophy (LVH group) with 20 healthy control subjects. Of
Introduction: It is known that before the clinical manifestations of coronary atheroscle- note, none of the hypertensive patients had symptomatic heart failure. Apical four-, three
rosis, the endothelial dysfunction (ED) is detected at the level of the large vessels, as well as and two- chamber images and parasternal short axis on the three levels were acquired
at the level of microcirculation. However, examinations of associations between signs of ED (frame rate 74
6 frames/s) and analyzed offline in order to extract the strain (rate) curves.
in micro- and large vessels in patients with coronary atherosclerosis, are rare. From these, the maximal systolic strain (PSS) and peak strain rate (PSR) on right and left
Objectives: The purpose of this study was to examine associations of endothelium- ventricle were derived, using STE software.
dependent vasodilation of the brachial artery with microcirculatory vascular reactivity to Results: Body surface area, blood pressure, and heart rate were comparable between the LVH
acetylcholine and histamine in patient with coronary artery calcification. and control groups. Relative to controls, the LVH group had greater average wall thickness
Methods: The study involved 23 patients with calcification of the coronary arteries (mean (13.49
1.67 mm vs.9.2
0.55mm, p <0.01), LV mass (238
15.3g vs. 173
11.3g, p
age 59,39
1,51 years). Coronary atherosclerosis determined by electron-beam computed <0.01) and left ventricle diameter (51.05
5.13.cm vs. 46.03
.2.01cm, p ¼ 0.64 ). The E/A
tomography. Microcirculatory vascular reactivity to vasoactive substances (histamine and ratio on mitral inflow tract was lower in the LVH group (0. 75
0. 41 vs. 1. 87
0.48; P <
acetylcholine) was measured by laser Doppler flowmetry. Assessment of endothelial 0.001). Global strain measures for the LV were not significantly different between groups
function of brachial artery was performed using the method of reactive hyperemia. (PSSLV -16.4
3.14 vs. - 19.69
1.82, p¼ 0, 56) whereas RV strain was diminished in the
Results: We found that the endothelium-dependent vasodilation of brachial artery directly LVH group (PSS RV -10.03
4, 5 vs. -15, 5
2, 3, p< 0.01). Similarly, greater differences were
associated with microcirculatory vascular reactivity to histamine (r ¼ 0,439, p ¼ 0,041). seen for strain rate in the RV (PSR 0.45 vs.1.75 1/s, p < 0.01 for LVH vs. control). For regional
The low level of microcirculatory vascular reactivity to acetylcholine inversely associated RV function, PSS was lower in the LVH group than the control group in the mid (- 11, 24
3.2 %

e110 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

vs. -17.23
2.23 %, p ¼ <0.01) and apical (- 7, 87
2.34 % vs. - 12.3
2.56 %; P < 0.05). RV
free wall, whilst basal PSS was similar (- 12, 31
3, 87% vs. -14.03
3.78 %, p ¼0.65).
Conclusion: The present study demonstrates that measures of RV deformation are reduced in
patients with LVH secondary to hypertension. Thus, this data suggests that LVH may cause early
sub-clinical RV dysfunction even in the absence of overt diastolic dysfunction and heart failure
Disclosure of Interest: None Declared
PM242
Pulse Wave Velocity Changes In Controlled Versus Uncontrolled Hypertensive
Patients-An East Coast Malaysian Study
Seng Loong Ng*1, Reena Sharma Fokeer1, Aida Hanum Ghulam Rasool1, Zurkurnai Yusof1
1
Department of Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, Malaysia
Introduction: Arterial stiffness is an important predictor of increased cardiovascular events.
It has been shown to be strongly positively correlated with systolic blood pressure. The
pulse wave velocity (PWV) is a non invasive measure of arterial stiffness and can reliably
predict the degree of arterial stiffness in hypertensive patients who are asymptomatic of
cardiovascular disease but who are at risk of developing ischemic heart disease.
Objectives: The objective of this study was to determine changes in the pulse wave velocity
PWV between controlled and uncontrolled systolic blood pressure (SBP) in hypertensive
subjects at Hospital Universiti Sains Malaysia (HUSM).
Methods: This is a cross sectional study with convenient sampling and powered at 80 %
using 2 means formula. Eighty four hypertensive patients were recruited. They were equally
divided into 2 groups (controlled and uncontrolled SBP) based upon the SBP readings
observed over the previous 6 months. The PWV was determined using the Sphygmocor Ò
machine, which is an automated tonometer. The right carotid and right femoral pulse
waves were the sites used in this study to determine the PWV.
Results: Fourty nine patients (58.3%) had a controlled systolic blood pressure of less than
140 mmHg, and 35 patients (41.7%) had an uncontrolled systolic blood pressure of 140
mmHg or higher. Seventy one percent (71.4%) of the study patients were of Malay race.
The mean PWV was 9.96 m/s (SD 1.33) in the controlled hypertension and 12.9m/s
(SD2.03) in the later group. The PWV difference in between the 2 groups was statistically
significant, even after adjusting for age and gender using analysis of covariates (ANCOVA)
with p<0.001.
Conclusion: This study has shown that there was a statistically lower PWV in the
controlled SBP group reflecting reduction in the arterial stiffness.
Disclosure of Interest: None Declared
PM244
L-arginine Transporters: A New Treatment Target in Obesity Induced Hypertension?
Niwanthi Rajapakse*1, Steven Fernandez1, Florian Karim1, Geoffery Head1, David Kaye1
1 acteristics were obtained from the subjects using a structured questionnaire. Anthropo-
Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Introduction: Obesity induced hypertension is associated with over activation of the
sympathetic nervous system (SNS). Nitric oxide (NO) can buffer the pro-hypertensive effects
of the SNS. L-arginine is the substrate for NO formation and cationic amino acid transporter-
1 (CAT-1) is the predominant L-arginine transporter expressed in endothelial cells.
Objectives: To determine the effects of increasing endothelial L-arginine transport and NO
in the pathogenesis of obesity induced hypertension.
Methods: With the use of telemetry, baseline mean arterial pressure (MAP) and responses
of MAP to the ganglionic blocker, pentolinium (5 mg/kg) were measured in conscious wild
type mice (WT; n ¼ 10) and mice over expressing endothelial CAT1 (CAT+; n¼15) fed a
normal or a high fat diet for 20 weeks. Plasma nitrate/nitrite levels in all treatment groups
were assessed by a commercially available kit from Cayman Chemical.
Results: Both genotypes of mice developed obesity when placed on a high fat diet (Pdiet within
genotype  0.007). MAP was greater by 12
2 mmHg in WT mice fed a high fat diet, compared
to those fed a normal fat diet (Pdiet within genotype < 0.001). In contrast, MAP was not significantly
different in CAT+ mice fed a normal or a high fat diet (Pdiet within genotype ¼ 0.1; Pdiet*genotype¼
0.002). Plasma nitrate/nitrite levels were 42% less in WT fed a high fat diet compared to WT fed
a normal diet (Pdiet within genotype ¼0.05). Consistent with the blunting of the hypertensive
response to fat feeding in CAT+ mice, plasma nitrate/nitrite levels were indistinguishable in
CAT+ mice fed a high fat diet, compared to those fed a normal fat diet (Pdiet within genotype ¼
0.44). Reduction in MAP to pentolinium was greater in WT mice fed a high fat diet (-27
2
mmHg), compared to WT mice fed a normal fat diet (-16
2 mmHg; Pdiet within genotype ¼
0.004) suggesting that the obesity induced hypertension is due to increased activity of the
sympathetic nervous system. In CAT+ mice, MAP responses to pentolinium were similar in
mice fed a normal or a high fat diet (Pdiet within genotype ¼ 0.7; Pdiet*genotype¼0.01).
Conclusion: These data suggest that endothelial CAT1 over expression can separate
obesity from hypertension by buffering the activity of the sympathetic nervous system.
Disclosure of Interest: None Declared
PM245
Effect of Obstructive Sleep Apnea Hypopnea Syndrome on Blood Pressure And
C-Reactive Protein In Male Hypertension Patients
Li Fan*1
1
International Medical Center, the PLA General Hospital, Beijing, China
Introduction: Hypertensive patients often appear blood pressure rhythm changes. We
found that patients suffered with obstructive sleep apnea hypopnea syndrome would
appeared elevated nighttime blood pressure, but the reason is not very clear.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: To investigate the effect of obstructive sleep apnea hypopnea syndrome
POSTER ABSTRACTS
(OSAHS) on blood pressure and C-reactive protein in male hypertension patients.
Methods: A total of 188 newly diagnosed male hypertension patients received sleeping
apnea monitor and divided to 4 groups according the hypopnea index (AHI), control group
(AHI5, n¼35), mild OSAHS group (5<AHI15, n¼28), moderate OSAHS group
(15<AHI30, n¼57), and severe OSAHS group (AHI>30, n¼68). All the patients
received ambulatory blood pressure monitor the next day. The blood sample were of the
patients were taken to test fasting blood glucose (FBG), triglyceride (TG), low density li-
poprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), high-sensi-
tive C-reactive protein (hs-CRP).
Results: Compared with control group, the serum TG and hs-CRP level were significantly
higher in moderate and severe OSAHS group patients (P<0.01, P<0.05). At same time,
compared with control group, patients in moderate and severe OSAHS groups had
increased mean systolic blood pressure (nSBP) and mean diastolic blood pressure at night
(nDBP) (P<0.01, P<0.05), as well as the nocturnal blood pressure reduction percentage
decreased significantly (P<0.01). The AHI and hs-CRP were both independently and
positively correlated with the nSBP (adjust R2¼0.46) and nDBP (adjust R2¼0.38). At the
same time, they were both independently and negatively correlated with the nocturnal
blood pressure reduction percentage (adjust R2¼0.48).
Conclusion: Server OSAHS can increase patient’s blood pressure at night, while increase
the serum CRP level and further damaging the circadian rhythm of blood pressure.
Disclosure of Interest: None Declared
PM247
Pre hypertension Among Apparently Normal Healthcare Providers: An opportunity
for Workplace Health Promotion Program
Abiodun M. Adeoye*1, Adewole Adebiyi1, Ayodele Falase1
1
Department of Medicine, Universityof Ibadan/Unversity College Hospital, Ibadan, Nigeria
Introduction: Hypertension has been described as the single greatest preventable cause of
death. Recent studies have documented an increase in the risk of cardiovascular disease and
a high rate of progression to hypertension in persons with prehypertension. Pre-
hypertension therefore provide a window period for prevention of hypertension associated
cardiovascular morbidity and mortality. Most of the reported literature to date is based on
studies conducted among persons of European descent with dearth of data among the
workforce in Nigeria. In this study, we report the prevalence of prehypertension among
apparently normal healthcare providers in a Nigerian Tertiary Hospital.
Objectives: To assess the prevalence of prehypertension among apparently normal
healthcare providers.
Methods: A total of 352 core hospital workers comprising 127(36.1%) males and
224(63.6%) females were recruited. Subjects comprised of physician (46.3%), nurses
(40.6%), pharmacist (5.1%), and others (7.9%). Baseline clinical and demographic char-
metric measurements including height, weight, waist, and hip circumferences were
obtained. Blood pressure measurements were measured according to standard guidelines
with a mercury sphygmomanometer (Accoson, London). Using JNC VII, subjects were
classified as normal, prehypertension, stage I hypertension and stage II hypertension.
Results: The mean age of the participants was 42.03(9.4) years. Females were older with
higher weight and hip circumference while males were taller with higher waist-hip ratio.
Systolic and diastolic blood pressure, mean arterial pressure (MAP) and fasting plasma
glucose were higher in males compared with females. Total cholesterol, triglyceride, high
density lipoprotein (HDL) were comparable across the gender with females having higher
low Density lipoprotein (LDL). The prevalence of prehypertension was 32.5% and normal,
treated hypertension, Grade I hypertension and Grade II hypertension were 32.5%, 19%,
32.5%, 13.8%, 2.1% respectively. 36.2%of physicians had prehypertension against 27.4%
nurses though did not reach statistical significance.
Conclusion: The study showed a high prevalence of prehypertension and hypertension
among the study group which is representative of high socioeconomic class. Lifestyle
modification and implementation of workplace health promotion programs recommended.
A longitudinal study to assess the efficacy of such health intervention programme is
advocated.
Disclosure of Interest: None Declared
PM248
Association of Left Ventricular Wall Thickness and Retinopathy Among Patients with
Essential Hypertension
Abiodun M. Adeoye*1, Tunji S. Oluleye2, Bolutife Olusanya2
1
Department of Medicine, 2Department of Opthalmology, Universityof Ibadan/Unversity College
Hospital, Ibadan, Nigeria
Introduction: In a nested case–control analysis of the Beaver Dam Eye Study, individuals
with hypertensive retinopathy were twice as likely to die from cardiovascular events as
those without these signs. Earlier study from Asia showed no significant relationship be-
tween LVH severity and retinopathy. There is dearth of data among subjects of African
descent. We report the association between left ventricular relative wall thickness and
hypertensive retinopathy.
Objectives: To assess the association between left ventricular relative wall thickness and
hypertensive retinopathy.
Methods: 156 consecutive newly presenting hypertensives (73 males and 83females) with
informed consent were recruited for the study. All participants underwent full clinical
evaluation and echocardiographic examination was performed according to the ASE
e111
 recommendation. The degree of retinopathy on ophthalmological examination was defined
POSTER ABSTRACTS
according to the Keith-Wagener classification. Left ventricular hypertrophy was considered
present if the left ventricular mass index is greater or equal 51g/m2.7. Relative wall thickness
RWT was calculated as 2PWTd/LVIDd. Increased wall thickness was present when RWT
>0.45. Left ventricular geometry was stratified using left ventricular mass index and
relative wall thickness.
Results: The mean age of the hypertensive subjects was 59.5 (
12.3) years. Ocular ex-
amination revealed normal 35(20.9%), grade 1 retinopathy 68(45.1%), grade 11retinop-
athy 51(32.0%), and grade III retinopathy 2 (1.3%). There is a positive correlation between
LV relative wall thickness and severity of retinopathy in both eyes in this study. There was
no correlation between LV geometric pattern and retinopathy.
Conclusion: The study showed a strong positive relation between LV relative wall thick-
ness and grades of retinopathy. It may suggest simultaneous target organ damage associated
with hypertension. Prompt management of hypertension in the study population may
prevent untoward cardiovascular events.
Disclosure of Interest: None Declared
PM249
Cardiovascular Risk Estimates Among Newly Presenting African Hypertensives
Abiodun M. Adeoye*1, Mirabel Nwosu2, Adewole Adebiyi1, Olulola Oladapo1, Ayodele Falase1
1 predictor of HRR. Likewise, it was noted that HRR incidence varies depending on the
Department of Medicine, University of Ibadan/Unversity College Hospital, 2Department Of
Medicine, University College Hospital, Ibadan, Nigeria
Introduction: Cardiovascular morbidity and mortality is a global concern. Primary pre-
vention through risk estimates is pivotal to achieving global focus of 25 % reduction of
cardiovascular events in 2025. While different risk stratification algorithms have been
tested in several population studies, such data is rare in Nigeria. We report risk estimates
among newly presenting hypertensives in our centre.
Objectives: To determine the 10 year risk of cardiovascular events among newly pre-
senting hypertensives using QRISK2-2011 models.
Methods: 160 consecutive newly presenting hypertensives comprising 87 (54.4%) males
and 73(45.6%) females with informed consent were recruited. Baseline clinical and de-
mographic characteristics were obtained from the subjects using a structured questionnaire.
Anthropometric measurements including height, weight, waist, and hip circumferences
were obtained. Blood pressure measurements were measured according to standard
guidelines with a mercury sphygmomanometer (Accoson, London). All patients had resting
electrocardiogram and blood samples taken for fasting lipids, electrolytes and urea. Using
QRISK2-2011 models, subjects were grouped as low risk (<5%), moderate risk (6-20%),
and high risk (>20%).
Results: The mean age of the hypertensive subjects was 54.5% (14.84%) years. Blood
pressure parameters, age and body weight were comparable across the gender. Female had
higher body mass index, waist circumference, total cholesterol and LDLc when compared
with males. The overall risks among the subjects were low risk (38%), moderate risk (50%),
and High risk (12%). Compared with females, male counterparts had higher prevalence of
moderate risk (60% vs 38.6%,p¼0.0001) and high risk(16% vs 7.1%, p¼0.0001).
Conclusion: The study show high prevalence of CV risk among the subjects studied and
significant gender differences in the risk estimates with male preponderance. The study
provides an opportunity for early intervention in the natural history of cardiovascular
events. There is the need for longitudinal study to adapt the risk algorithms that best suits
our population.
Disclosure of Interest: None Declared
PM250
Synthesis and characterization of Atenolol nanoformulation for effective delivery and
increased bioavailability in in vitro model of myocardial infarction
Ajay Ashok*1, Rupinder K. Kanwar1, Jagat R. Kanwar1, Uma K. Maheswari2
1
School of Medicine, Deakin University, Geelong, Australia, 2School of Chemical &
Biotechnology, SASTRA University, Thanjavur, India
Introduction: Beta blockers have long been established as a potent and widely used
antihypertensive drug. But like any other drug, it suffers from the disadvantage of poor
bioavailability, undesirable pharmacokinetics and side effects. Hence there is an urgent
need of therapeutics that can trounce all these undesirable effects. Nanoformulations of
various drugs are being widely prepared and tested as a key for the management of con-
ditions competently and efficiently. Atenolol is a well-known and established beta blocker
utilized to attenuate the hypertensive activity of the heart. This study discusses the suc-
cessful synthesis and characterization of Atenolol nanoformulation (NF) and its effective-
ness in delivering the drug payload (proof of concept – prostate cancer cells DU145).
Objectives: To successfully synthesize and characterize Atenolol nanoformulation and
analyse its cell internalization efficiency.
Methods: The Atenolol encapsulated polycaprolactone (PCL-FDA approved) NF was
synthesized using the water/oil/water (w/o/w) double emulsion technique for maximum
encapsulation efficiency. The Atenolol NF was characterized using scanning electron mi-
croscopy (SEM), FTIR (Fourier transform infrared) spectroscopy and particle size analyser
(PSA). The thermal stability of the nanoformulation was analysed using the differential
scanning calorimeter (DSC). The serum and storage stability of the NF was analysed using
the PSA. NF internalisation studies were done in DU145 as a proof of concept. Studies are
being conducted in the lab to check the effect of these NF on primary human
cardiomyocytes.
Results: It was observed that the NF size ranged from 200-250nm and had a uniform size
distribution. The DSC, serum and storage stability analysis validated the thermal, storage
and physiological stability of the NF. FTIR spectroscopy confirmed the successful
e112
encapsulation of the drug in the NF and the NF exhibited a sustained release of the drug
over a period of 90 hours. The in-vitro results showed that the Atenolol NF internalised
efficiently into the DU145 within 4 hours of treatment.
Conclusion: It was observed that, Atenolol NF was very efficient in delivering the drug
payload into the cells .This NF can be used as an effective treatment option for the
management of hypertension during cardiovascular diseases (CVDs). The experiments to
study its efficacy in in vitro myocardial infarction model are in progress and the results will
be presented during the conference.
Disclosure of Interest: None Declared
PM251
Non-alcoholic steatohepatitis and blood pressure hyper-reactivity during exercise
Antonio G. Laurinavicius*1, Raquel D. D. O. Conceicao1, José Antonio M. Carvalho1,
Raul D. Santos1
1
Unidade de Medicina Preventiva, Hospital Israelita Albert Einstein, São Paulo, Brazil
Introduction: Blood pressure hyper-reactive response (HRR) during the exercise test is
associated with an increased risk of developing hypertension and with increased cardio-
vascular risk. It was previously demonstrated that hepatic steatosis (HS) is an independent
degree of HS, being significantly higher in the presence of severe steatosis. Yet, whether
HRR incidence varies depending on the presence of non-alcoholic steatohepatitis (NASH) is
still to be determined.
Objectives: We intended to evaluate the impact of transaminases elevation on HRR inci-
dence among HS patients.
Methods: We evaluated 5,081 consecutive HS carriers (mean age: 44.1 years, 6.9% fe-
male), presenting AUDIT score <8, who underwent symptom limited exercise stress test,
abdominal ultrasonography and an extensive clinical and laboratory evaluation as part of a
check-up protocol between 2006 and 2012. We assessed the association between HRR
during exercise and the presence of NASH. HRR was defined by a systolic blood pressure
higher than 220 mmHg and/or elevation of 15 mmHg or more in diastolic blood pressure.
NASH was defined by the identification of HS at abdominal ultrasonography associated
with alanine aminotransferase (AST) and/or aspartate aminotransferase (ALT) levels above
the reference values. The association between NASH and HRR was tested by multiple lo-
gistic regression.
Results: HRR incidence among HS individuals was 7.7%. NASH was associated with a
higher incidence of HRR (8.6% versus 7.1%, OR 1.23 CI 1.00 to 1.52, p¼0.048). Raised
gamma-glutamyl transferase (GGT) levels, not included in NASH definition, also showed a
strong association with HRR (OR 1.55, CI 1.26 to 1.91, p<0.001). Mean levels of AST,
ALT and GGT significantly increased according to the degree of steatosis (p<0.001).
Nevertheless, after multiple logistic regression and adjustment by HS degree, raised
transaminases levels remained an independent predictor of HRR.
Conclusion: Among patients with HS, NASH is associated with additional risk of blood
pressure hyper-reactivity during exercise.
Disclosure of Interest: None Declared
PM252
Interaction between hypertension and fibrinogen genetic variability in patients
admitted for stable angina pectoris symptoms: effects on inflammation and
coagulation
Nikolaos Papageorgiou1, Dimitris Tousoulis*1, George Hatzis1, Alexandros Briasoulis1,
Antigoni Miliou1, Maria Kozanitou1, Emmanuel Androulakis1, Marietta Charakida1,
Costas Tentolouris1, Costas Tsioufis1, Zoi Pallantza1, Christodoulos Stefanadis1
1
1st Cardiology Department, Hippocration Hospital, Athens, Greece
Introduction: Evidence suggests that hypertension (HTN) is associated with increased
inflammation and altered coagulation process.
Objectives: In the present study, we aimed to investigate whether rs180070 and
rs2070011 fibrinogen gene variants are associated with increased risk of coronary artery
disease (CAD) in hypertensive patients via their effects on the aforementioned processes.
Methods: Our study population consisted of 744 consecutive patients admitted for
coronary angiography due to symptoms of stable angina pectoris, of which 332 were
hypertensives. The two polymorphisms were determined by polymerase chain reaction-
restriction fragment length polymorphism (PCR-RFLP) technique. Plasma fibrinogen,
interleukin-6 (IL-6) and D-dimer levels, as well as factors V, X activity were also assessed
with appropriate methods.
Results: The presence of A allele of rs180070 was associated with significantly high levels
of fibrinogen (433.36
10.9 vs 405.7
8.8, p¼0.05) in the HTN group. According to
multivariable analysis, AA homozygosity (b(SE): 0.257 (18.6), p<0.001) was independent
predictor of fibrinogen levels, and in turn, increased fibrinogen levels >443 mg/dl [OR:
3.5, 95% CI (1.14-10.9, p¼0.029) were independent predictor of CAD. Notably, in the
group of AA homozygotes (rs180070) IL-6 levels were higher compared to G-allele carriers
(4.96
0.69 vs 3.7
0.2, p¼0.046) while, this genotype was the only adjusted independent
predictor of IL-6 levels [b(SE): 0.151 (0.642), P ¼ 0.032]. Furthermore, it was associated
with higher D-dimer levels in HTN compared to the G allele carriers (623.3
79.6 vs
388.6
23.5, p¼0.048). However, both rs180070 and rs2070011 polymorphisms were not
associated with altered activity of factors V, X (p¼NS for all).
Conclusion: Our results suggest that the AA genotype (rs180070) is a strong predictor of
both prothrombotic and inflammatory profile in this cohort. Importantly, fibrinogen levels
remain the only independent predictor of CAD in this hypertensive cohort.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM253
Awareness, Medication Use and Control of Hypertension in United Arab Emirates 1
Layla Al-Marzouqi, 1Syed M Shah, 2Jawad Hashim, 3Satish Chandra-Nair, 1Tom
Loney, 1Iain Blair, 1Tar-Ching Aw
Layla M. Al Marzouqi*1, syed shah1, Jawad Hashim2, Satish Chandra-Nair3, Tom Loney1,
Iain Blair1, Tar-Ching Aw1
1 Objectives: The ACTION study documents the proportion of patients achieving BP goal
Institute of public health, College of Medicine and Health Science, 2Department of Family
Medicine, College of Medicine & Health Science, United arab emirates univeristy, 3Tawam
hospital, al ain, United Arab Emirates
Introduction: WHO estimates that the mortality associate with non-communicable dis-
eases will increase more rapidly in developing countries but the morbidity is projected to
increase in Middle East is increasing due to good healthcare system in this part of the
world. In a rapidly develop society such as the UAE, the rapid changes in lifestyles,
increased levels of unhealthy diet and sedentary behaviors have increased the risk of non-
communicable diseases including hyertension. In 2008 WHO estimated the prevalence of
hypertension in the UAE to be 27.5% . studies in the UAE revealed that hypertension is
underdiagnosed and undertreated.
Objectives: With unacceptably high rates of obesity and diabetes, hypertension is becoming
a major public health problem the United Arab Emirates (UAE). This study was conducted to
determine the prevalence, awareness and control of hypertension in adults in Al Ain, UAE.
Methods: This was a cross-sectional study. Study participants (n¼622) were recruited as part of a
global health project to identify risk factors for non-communicable diseases. Trained nurses
measured blood pressure (BP), height, weight, waist and hip circumference and collected a fasted
venous blood sample. Inadequate BP control was defined as greater than or equal to 140/90 mmHg.
Results: The mean age of the study subjects was 43 years (54% females). Ethnic
composition included native Emirati (52%), other Arabs (46%), and others (2%). The
overall prevalence of hypertension was 18% (95%CI, 15.3-21.6) which varied by ethnicity,
14% (Emirati), 22% (other Arab) and 38% (others). Of those with hypertension, 34.8%
were not aware of their hypertension status. The lack of awareness was 41% in Emirati,
30% in other Arabs and 40% in others. Over half of hypertensive study participants (54%)
reported that they had not used anti-hypertension medicine in the last two days. Of those
who reported using medicine during the previous month, 49% had inadequate BP control.
Conclusion: A high proportion of adults in the UAE with hypertension had inadequate control
of blood pressure. There was ethnic disparity in hypertension prevalence and awareness in the
study subjects. Future public health awareness programs should focus on educating at-risk
populations about the health risks associated with inadequate BP control and offer screening
services coupled with lifestyle modification counseling and self-monitoring of BP training.
Disclosure of Interest: None Declared
PM254
Trend and predictors of arterial compliance in a group of normotensive and untreated
hypertensive cameroonian subjects in yaounde
Walinjom N. Joshua*1
1 Introduction: Catheter-based radiofrequency renal denervation (RDN) has been
Intenal Medicine, Yaounde Teaching Hospital, Yaounde, Cameroon
Introduction: The focus in the prevention and therapy of cardiovascular disease (CVD) in
the new millennium is the blood vessel wall. It has become increasingly apparent over the
past decade that when we are trying to prevent myocardial ischemia, acute myocardial
infarction, and other cardiovascular (CV) events, the disease we are actually treating is that of
the arterial wall. Arterial compliance is an important prognosticator of cardiovascular events.
Objectives: Arterial compliance, an important independent predictor of cardiovascular
events decreases with age and this decrease is accelerated by hypertension. The main ob-
jectives 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 PulsePenÒ device was
used to determine; carotid-femoral or aortic PWV and central augmentation index % (AIx).
Left ventricular hypertrophy (LVH) was investigated using a 12 leads CardiaxÒ ECG
machine. Other measurements obtained were blood pressure (BP), body mass index (BMI),
fasting glycaemia, lipid profile and serum creatinine.
Results: 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 cfPWV.
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.
Disclosure of Interest: None Declared
PM255
Achievement of Target Blood Pressure In Patients on Antihypertensive Therapy In
Pakistan: Results of Action Registry
Bashir Hanif*1, Aziz U. Rehman2, Nadeem H. Mallick3, Saleem Ullah4, Fayaz H. Shah5
1
Cardiology, Tabba Heart Institute, Karachi, 2Services Hospital, Lahore, 3Punjab Institute of Cardiology,
4
Abbasi Shaheed Hospital, Karachi, 5Cardiology, Benazir Bhutto Shaheed Hospital, Rawalpindi, Pakistan
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: The National Health Survey of Pakistan (1998) reports that only 3%
POSTER ABSTRACTS
hypertensive patients in Pakistan are at blood pressure (BP) goal despite availability of
antihypertensive drugs and treatment recommendations. During the last decade, new
therapies have been introduced and international and local practice guidelines have
been revised to set improved BP goals for patients. It is hypothesized that a greater
proportion of hypertensive patients are likely to have achieved BP goal as a result of
this change.
on existing antihypertensive therapy and reasons for not achieving BP goals in out-patient
setting.
Methods: This study was an observational, cross-sectional, multi-center epidemiological
disease registry of patients (>15 years of age) with known hypertension on medications for
4 weeks. Data was collected on patients’ demographic and disease characteristics, BP
control status, and treatment practices to help attain BP goal.
Results: The mean age of patients (N¼1130) on antihypertensive medication was
52.6
11.9 years. Of them 49% were females. The mean duration of HTN was 6.1
(
6.2) years. There were 23.8% patients at BP goal (defined as <140/90 for non-
diabetics and <130/80 for patients with diabetes and/or Chronic Kidney Disease).
Risk factors identified in patients not at BP goal were: history of sedentary lifestyle
(60.3%), diabetes (42.9%), and dyslipidemia (40.3%). Co-morbid conditions iden-
tified included coronary artery disease (21.2%), myocardial infarction (8.1%) and
congestive heart failure (8.0%). Lack of patient understanding of the importance of
treatment (47.0%) and non-adherence to medication (34.5%) were the most
important reasons for not achieving BP goal as identified by the physician. Lifestyle
modification (37.7%), addition of another drug (37.7%), and increase in the dose of
drug (21.4%) were recommended to patients not at BP goal. Angiotensin-converting
enzyme inhibitors (36.1%), beta blockers (34.6%), calcium channel blockers (31.6%)
and angiotensin-receptor blockers (27.9%) were used as monotherapy in patients at
BP goal.
Conclusion: In Pakistan, only one in four patients taking antihypertensive medication and
presenting to physicians in the outpatients setting achieves BP goals according to the local
and international guidelines.
Disclosure of Interest: B. Hanif Grant/research support from: Sanofi Aventis Pakistan, A.
Rehman: None Declared, N. Mallick: None Declared, S. Ullah: None Declared, F. Shah:
None Declared
PM256
Effects of Catheter-based Renal Sympathetic Denervation on Blood Pressure
Variability and Morning Surge of BP in Resistant Hypertensive Patients
Yusuke Sata*1, Geoffrey A. Head2, Dagmara Hering1, Petra Marusic1, Danielle McCartney1,
Murray D. Esler1, Markus P. Schlaich1
1
Hypertension and Kidney Disease, 2Neuropharmacology Laboratory, Baker IDI Heart and
Diabetes Institute, Melbourne, Australia
demonstrated to be effective in reducing office blood pressure (BP) in patients with
resistant hypertension over the long term. The recent inclusion of ambulatory BP
monitoring (ABPM) in these patients has enabled to evaluate short term BP variability
(BPV) and morning surge of BP which has been shown to contribute to end organ
damage in hypertensive patients. Although the reduction in both office and ambulatory
BP has been reported, the effects of RDN on BPV and morning surge of BP remain
unknown.
Objectives: The present study was disigned to elucidate the effects of RDN on BPV and
morning surge of BP in patients with resistant hypertension.
Methods: A total of 90 patients were diagnosed true resistant hypertension, defined as
office systolic BP140mmHg and mean ambulatory 24-hour systolic BP130mmHg
despite more than three antihypertensive drugs at optimal dose, and underwent bilateral
RDN. Office and ambulatory BP, short-term BPV (standard deviation of ambulatory BP, SD)
and morning surge in systolic BP were measured from ABPM before RDN and at 3, 6, 12,
and 24 months after the procedure.
Results: The RDN cohort had a mean age of 63
10 years, and body mass index was
30
6 kg/m2. Average number of antihypertensive drugs were 4.9
0.8, including
angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers or dual
blockade, b-blockers, calcium channel blockers, diuretics, aldosterone antagonists, and a-
blockers.
RDN significantly reduced office systolic BP (169
20, 159
26, 161
25, 149
28,
and 139
14 mmHg), diastolic BP (85
17, 82
19, 82
19, 76
15, and 65
18,
mmHg), ambulatory systolic BP (154
16, 152
19, 149
21, 148
20, and 142
17
mmHg), 24-hour SD (16
5, 15
4, 14
5, 14
5, 13
5 mmHg), daytime SD
(13
5, 11
4, 10
5, 10
4, and 10
5 mmHg), night time SD (15
5, 13
5, 13
5,
14
6, and 12
5 mmHg), and morning surge in systolic BP (55
16, 53
15,
50
18, 52
18, and 46
17 mmHg), whereas unchanged in heart rate (65
12,
65
13, 64
12, 64
14, and 57
6 bpm) at baseline, 3, 6, 12, and 24 months,
respectively.
Conclusion: We conclude that RDN not only reduced office and ambulatory BP but also
improved BPV and morning surge of BP in patients with true resistant hypertension. The
improvement in BPV may be of long term benefits in reducing end organ damage in
resistant hypertensive patients.
Disclosure of Interest: Y. Sata Grant/research support from: Japan Heart Foundation/
Bayer Yakuhin Research Grant Abroad, G. Head: None Declared, D. Hering: None
Declared, P. Marusic: None Declared, D. McCartney: None Declared, M. Esler: None
Declared, M. Schlaich: None Declared
e113
 PM257
POSTER ABSTRACTS
Failure of Hypertension Drugs in Tanzania
Dr Harun E. Nyagori*1
1
General Cardiology, Ministry of Health and Social welfare/Afya Medicare specialized clinic,
Morogoro Region, Tanzania, United Republic of
Introduction: Experience with patients shows that, prescribed drugs for treating hyper-
tension disease fail to work effectively, causing high mortality rates in Tanzania. This sit-
uation has resulted into query as to why the situation exists.
Objectives: The study was conducted to investigate factors affecting failure of hypertension
drugs among patients suffering from the disease. Particularly, the study aimed at examining
cultural, individual and financial factors affecting drug failure among Tanzania patients.
Methods: The sample consisted of 300 respondents from Afya Medicare Specialized clinic and
Morogoro Referral Hospital in Tanzania. Questionnaires were distributed and interviews were
conducted to patients and their care takers, doctors and nurses in both health centers.
Results: The study revealed that, the drugs fail to provide relief to the patients because of
the negative attitude towards the consumption of the drugs, in the belief that the disease
affects only rich people and developed countries. Moreover, it was found out that, some of
the respondents associate the disease with witchcraft, hence, seek alternative drugs, and
that, early and frequent usage of the drugs only worsens their condition. In addition to that,
it was discovered that, in some cases, the drugs do not work effectively due to financial
difficulty and failure to follow instructions as directed by their doctors.
Conclusion: From the findings it was concluded that, education should be provided to the
patients as well as their caretakers on the fact that the disease can affect anyone and
emphasize on preventive measures. Along with this, heavy investment is needed to create
awareness to cardiovascular diseases among the population, by individuals, organizations
and the government of Tanzania so as to seek solution to the problem. Investment should
also aim at supporting patients who cannot afford to buy the drugs in order to reduce high
death rates resulting from inability of the patients to afford the drugs.
Disclosure of Interest: None Declared
PM258
The effects of compound 21 on L-NAME-induced hypertension in rats
Ludovit Paulis*1,2, Sophie T. Becker3, Patrick Schmerler3, Svetlana Slavic4, Elena Kaschina3,
Bjoern Dahloef5, Johannes Baulmann6, Thomas Unger7, Muscha Steckelings8
1
Institute of Pathophysiology, Comenius University, Faculty of Medicine, 2Institute of Normal and
Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia, 3Charite-University
Medicine, Center for Cardiovascular Research, Berlin, Germany, 4Institute of Pathophysiology,
Veterinaermedizinische Universitaet Wien, Wien, Austria, 5Sahlgrenska University Hospital,
Gothenburg, Sweden, 6Clinic of Medicine, University of Luebeck, Luebeck, Germany, 7CARIM - School
for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands, 8IMM - Department of
Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
Introduction: There is a continuing interest for novel ways to prevent target organ damage, such
as vascular remodeling aimed to achieve further cardiovascular risk reduction in hypertensive
patients. Increased pulse wave velocity (PWV) represents an independent cardiovascular risk
factor and serves as a direct marker of arterial stiffness. Previously, the AT2 receptor (AT2R)
stimulation elicited anti-inflammatory, cardioprotective and renoprotective effects.
Objectives: To investigate, whether an AT2R agonist, compound 21, alone or combined
with AT1 receptor blockade prevented aortic stiffening in L-NAME-induced hypertension.
Methods: Male adult Wistar rats (n¼65) were randomized into 6 groups: control, L-
NAME, L-NAME + compound 21, L-NAME + olmesartan and L-NAME + compound 21 +
olmesartan. Blood pressure (BP) was measured each week. After 6-week treatment, aortic
hydroxyproline content, PWV, wall thickness (WT) and inner diameter were determined
and aortic stiffness (elasticity modulus) was estimated.
Results: L-NAME administration was associated with augmented BP, PWV, WT, aortic stiffness
and hydroxyproline concentration. Olmesartan completely prevented BP, PWV, WT and stiffness
increase and partly prevented hydroxyproline accumulation. Compound 21 partly prevented all
these alterations, yet without concomitant prevention of BP rise. Although the combination
therapy with olmesartan and compound 21 led to BP levels, PWV and WT comparable to
olmesartan alone-treated rats, only in the combination group complete prevention of increased
hydroxyproline deposition was achieved, resulting in even more pronounced stiffness reduction.
Conclusion: In rats with inhibited NO-synthase, the BP-independent effect on aortic
stiffening and collagen accumulation by AT2R stimulation was additive to AT1 receptor
blockade. (Partly supported by APVV-0205-11)
Disclosure of Interest: L. Paulis Grant/research support from: APVV 0205-11, S. Becker:
None Declared, P. Schmerler: None Declared, S. Slavic: None Declared, E. Kaschina: None
Declared, B. Dahloef: None Declared, J. Baulmann: None Declared, T. Unger: None
Declared, M. Steckelings: None Declared
PM259
Potential impact of structured care and percutaneous transluminal renal denervation
to provide greater blood pressure control in those with persistent/resistant
hypertension
Matias Yudi*1, Yih-Kai Chan2, Simon Stewart2, Melinda Carrington2
1
Baker IDI Heart and Diabetes Institute, Melbourne, Australia, 2Preventative Health, Baker IDI
Heart and Diabetes Institute, Melbourne, Australia
Introduction: Hypertension continues to be a major driver of highly preventable cardiovascular
events with up to one in two treated patients in primary care above blood pressure (BP) targets.
e114
Objectives: We sought to describe (from a real-world perspective) how many individuals
being treated for hypertension in primary care would firstly respond to a program of
intensive, structured hypertension management (IHSM) comprising combination/triple
anti-hypertensive therapy) or require consideration for percutaneous transluminal renal
denervation (PTRD).
Methods: Data from a national cohort of 733 family physicians and 532,050 patients
were used to identify a cohort of 15,079 patients with persistent hypertension
despite treatment. The potential impact of proven IHSM - the Valsartan Intensified
Primary carE Reduction of Blood Pressure program - was then modelled according
to clinical profile and likely BP response. A further analysis was then undertaken to
identify those patients with likely resistant hypertension (based on a systolic BP of
 160mmHg for non-diabetics and  150mmHg for diabetics) who may benefit
from PTRD.
Results: A total of 7,235 men (66
13 years, BP 155
13/86
11 mmHg) and 7,844
women (71
13 years, BP 156
14/84
12 mmHg) with persistent hypertension despite
a minimum of 12 months anti-hypertensive treatment (48% of potentially eligible cases).
The “pre and post” histogram shows the overall modelled impact of ISHM over 6-12
months on systolic BP. In men this strategy was projected to achieve a BP of <140/
90mmHg in 3,930 (54% - mean BP 139
6/80
9 mmHg). In women the equivalent
figures were 4,476 (57% - mean BP 141
7/77
9 mmHg). This would still leave a
residual portion of 109 men (1.5%, mean BP 167
12/85
7 mmHg) and 142 women
(1.8%, mean BP 167
10/82
9 mmHg) with probable resistant hypertension who
would likely respond to PTRD.
web 3C=FPO
Conclusion: In the “real-world” primary care setting there is potential to selectively apply
IHSM in around 50% of hypertensive cases to better control persistent hypertension. Of
these, a small minority would then benefit from consideration of PTRD to treat resistant
hypertension.
Disclosure of Interest: None Declared
PM260
Combination Therapy With Pravastatin And Valsartan Has Additive Effects To
Improve Vascular Phenotypes Over Monotherapy In Patients With
Hypercholesterolemia
Kwang Koh*1, Pyung Oh2
1
Cardiology, 2GIL HOSPITAL, Incheon, Korea, Republic Of
Introduction: Statin and angiotensin II type 1 receptor blocker therapy improve endo-
thelial dysfunction using distinct mechanisms.
Objectives: We evaluated simultaneous vascular and metabolic responses to pra-
vastatin and valsartan therapy, alone or in combination, in hypercholesterolemic
patients.
Methods: Forty-eight hypercholesterolemic patients (23 had metabolic syndrome) were
given pravastatin 40 mg and placebo, pravastatin 40 mg and valsartan 160 mg, or valsartan
160 mg and placebo daily during each 2 month treatment period in a randomized, single-
blind, placebo-controlled cross-over trial with three treatment arms and two washout
periods (each 2 months).
Results: All three treatment arms significantly improved flow-mediated dilator
response to hyperemia (FMD) relative to baseline measurements. However, FMD were
changed to a greater extent with combined therapy when compared with pravastatin or
valsartan alone (P<0.001 by repeated measures ANOVA). Relative to baseline mea-
surements, valsartan alone, pravastatin alone or combined therapy reduced hs-CRP
levels (P¼0.158, P¼0.001, and P<0.001 by Wilcoxon Signed Rank test, respectively).
Interestingly, when compared with valsartan or pravastatin alone, combined therapy
significantly reduced hs-CRP levels to a greater extent (P¼0.019 by repeated measures
ANOVA on Ranks). All three treatment arms significantly increased plasma adiponectin
levels relative to baseline measurements. However, combined therapy significantly
increased plasma adiponectin levels to a greater extent than monotherapy (P¼0.003 by
repeated measures ANOVA on Ranks). Overall, we observed similar results in 23
patients with metabolic syndrome.
Conclusion: Pravastatin combined with valsartan improved endothelial function with
improving inflammatory biomarkers to a greater extent than monotherapy with either drug
in patients with hypercholesterolemia or metabolic syndrome.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM265
The epidemiological profile of first-ever hospitalisations for atrial fibrillation in
Aboriginal and non-Aboriginal Western Australians, 2000-2009
Judith M. Katzenellenbogen*1, Tiew-Hwa Katherine Teng1, Derrick Lopez1, Frank Sanfilippo2,
Matthew Knuiman2, Michael Hobbs2, Joseph Hung3, Sandra C. Thompson1
1
Combined Universities Centre for Rural Health, 2School of Population Health, 3Sir Charles
Gairdner Hospital Unit, The University of Western Australia, Perth, Australia
Introduction: The epidemiology of atrial fibrillation (AF) is poorly described for
Aboriginal Australians, despite AF being a major determinant of heart failure and
stroke.
Objectives: To compare the epidemiological profile of first-ever hospitalised AF between
Aboriginal and non-Aboriginal Western Australians aged 20-84 years (2000-09) with
respect to incidence, demography, co-morbidity, 28-day and 1-year mortality.
Methods: Incident public and private hospital AF admissions (AF hospital admission-free
for 15 years) were identified from all diagnosis fields, and subsequent mortality deter-
mined using person-based linked hospital and mortality data. Comorbidity histories of
specific chronic conditions were ascertained using a 10-year look-back from index AF
admission. Age-standardised incidence rates were estimated using the WHO standard and
the adjusted risk of 28-day and 1-year mortality calculated using logistic and Cox
regression.
Results: Aboriginal patients comprised 923 (2.5%) of the 37,097 incident AFs. Compared
with non-Aboriginal patients, Aboriginal patients had lower proportions of AF diagnoses in
the primary diagnosis field (24% vs 33%) but higher emergency presentations (85% vs
65%); lower mean age (54.8 vs 69.3 years); more females (45.9% vs 40.8%) and rural
admissions (50% vs 14%); higher comorbidity prevalence of heart failure, diabetes and
CKD (all p<¼0.001). Age-specific AF incidence rates were higher in Aboriginals than non-
Aboriginal in all age groups <70 years. The Aboriginal to non-Aboriginal age-standardised
AF incidence rate ratios for men and women 20-54 years were 3.6 and 6.4 respectively and
1.3 and 1.8 respectively for 55-84 years.
Crude and adjusted 28-day mortality was similar in both groups. Crude 1-year mortality
in 28-day survivors with a primary AF diagnosis was significantly higher in Aboriginal
patients (7.5% vs 3.5%), while fully adjusted mortality was significantly higher in
Aboriginal women (HR¼1.7: CI 1.23-2.34) but not men (HR¼1.28: CI 0.93-1.76). The
adjusted HR for 1-year mortality in Aboriginal patients with a secondary AF diagnosis was
1.30 (CI 1.02-1.65).
Conclusion: The incidence of hospitalised AF is significantly higher in Aboriginal people,
particularly at younger ages. The high proportion being admitted with AF as a secondary
diagnosis and as an emergency suggests that AF is under-diagnosed and undertreated in
this population. The higher 1-year mortality implies the need for better post-discharge
management.
Disclosure of Interest: None Declared
PM266
Predicting 30-years cardiovascular disease in riverside communities in the Brazilian
Amazon
Raitany C. Almeida*1, Otavio R. Coelho2, Diego J. Dias1, Carlos H. Spesia1, Karime Deguchi1,
Victor H. Motta JR1, Vinicius R. Grillo3, Manoel G. Souza Neto1, Marcella S. Martello1
1 graphic angiography (CCTA) enables a minimally invasive assessment of coronary artery
Universidade Federal Rondonia, Porto Velho, 2UNICAMP, Campinas, 3LIGA Rondoniense de
Cardiologia, Porto Velho, Brazil
Introduction: Cardiovascular diseases (CVD) remain the leading cause of mortality in
Brazil and worldwide. Estimate CVD risk in the next 30 years tends to improve the primary
prevention.
Objectives: To determine the risk of developing CVD in the next 30 years in riverside
communities in the Brazilian Amazon and to evaluate the percentage of the population
above normal risk comparing gender and age.
Methods: Between April and July 2013, household visits was conducted in four riverside
the communities at Madeira River – Amazon. The study was cross-sectional, descriptive,
quantitative and qualitative. Standardized questionnaires were used, measured blood
pressure (BP), weight, height, waist circumference. The 30-years CVD risk was observed in
patients aged 20 to 59 years and assessed the following predictors: gender, age, systolic
blood pressure, smoking, use of antihypertensive drugs, body mass index and diabetes. The
risk of developing CVD in 30 years was calculated based on the Framingham risk score and
all the data analyzed in the statistical program Epiinfo.
Results: Included 637 subjects, 44.58% were male (M). The median age was 37.62 years
(SD: + / -13.38). Of female (F) subjects between 20-29 years, 45.53% were above normal
risk for 30 years -CVD, while 65.21% male (p <0,05). Between 30 to 39 years had
56.55%(F) vs. 73.61%(M)( p <0.05). Between 40-49 years had 85.33%(F) vs. 81.81% (M)
(p> 0.05); and 50-59 years had 90.90%(F) vs. 92.42%(M) (p> 0.05) were higher than
normal risk for 30-years CVD. About the age, in female, by comparing the average risk
CVD found and average risk CVD expected in the group: 20-29 years (4%vs.3%) (p>
0.05); 30-39 years (12%vs.9%) (p> 0.05); 40-49 years (27%vs.15%)(p <0.05); 50-59
years (46%vs.24%) (p <0.05). About the age, in male, by comparing the average risk CVD
found and average risk CVD expected in the group: 20-29 years (9%vs.6%) (p <0.05); 30-
39 years (20%vs.13%) (p <0.05); 40-49 years (37%vs.24%) (p <0.05); 50-59 years (56%
vs.36%) (p <0.05).
Conclusion: In the age group 20 to 40 years male had higher 30-years CVD risk than
female. The average found for 30-years CVD risk was higher than the average expected in
all age male groups and female groups over 40 years.. Therefore, it is necessary to improve
preventive care in riverside communities.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM267
POSTER ABSTRACTS
Effects Of Listening To Joyful Music On Endothelial Function In Rehabilitation Of
Patients After Myocardial Infarction
Marina Deljanin Ilic*1, Stevan Ilic1, Gordana Kocic2, Radmila Pavlovic2, Viktor Stoickov1,
Dejan Simonovic1
1
Cardiology, Institute of Cardiology, Medical Faculty University of NIS, 2Institute of
Biochemistry, Medical Faculty University of NIS, NIS, Serbia
Introduction: In the setting of cardiovascular disease the endothelium loses its normal
function. Exercise training has been shown to improve endothelial function, however little
is known about the role of music in cardiovascular rehabilitation or the effects of listening
to favourite music on endothelial function.
Objectives: To evaluate the effects of listening to joyful music on the endothelial function, assess
through changes of circulating blood markers of endothelial function: the stable end products of
nitric oxide (NOx), S – nitrosothiols (RSNO – reservoir for bioavailable nitric oxide), and
asymmetric dimethylarginine (ADMA) in patients (pts) after myocardial infarction (MI).
Methods: 50pts after MI were studied. At baseline and 3 weeks later, in all pts values of NOx,
RSNO and ADMA were evaluated and exercise test was performed. After the initial study, patients
were randomized to music (M,n¼20) and control (C,n¼30) group. Patients in both groups
underwent a supervised 3 weeks aerobic exercise training at residential center. Additionaly to
exercise training patients in M group were listening their favorite music for half an hour every day.
Results: Baseline values of NOx, RSNO and ADMA were similar in M and C group. After 3
weeks value of NOx increased significantly in M group (from 32.7
9.0 to 49.0
10.5
mmol/l, P<0.001), as well as in C group (from 32.5
12.0 to 42.0
11.0 mmol/l, P<0.005),
however increase in NOx was higher in M than in C group (49%vs 30%) compared to
baseline values. In both groups, value of RSNO increased after 3 weeks: in M group RSNO
increased from 3.2
1.3 to 5.3
1.3 mmol/l (P<0.001) and in C group from 3.1
1.6 to
4.5
1.4 mmol/l (P<0.001). After 3 weeks increase in RSNO was higher in M than in C group
(65% vs 45%), compared to baseline values. Value of ADMA decreased in both groups (ns)
after 3 weeks, and this reduction was greater in M than in C group (13.7% vs 8.2%).
Conclusion: Listening to joyful music in combination with regular exercise training pro-
gram leads to more pronounced benefit and improvement of endothelial function than
exercise training alone. Therefore, listening to joyful music may be an adjunct method in
the rehabilitation of patients after myocardial infarction.
Disclosure of Interest: None Declared
PM271
Plasma lipidomic analysis predicts soft coronary artery plaque in asymptomatic
patients at intermediate risk of coronary artery disease
Andris H. Ellims*1, Gerard Wong2, Jacquelyn M. Weir2, Philip Lew3, Peter J. Meikle2,
Andrew J. Taylor1
1
Heart Centre, Alfred Hospital and Baker IDI Heart & Diabetes Institute, 2Baker IDI Heart &
Diabetes Institute, 3Department of Radiology, Alfred Hospital, Melbourne, Australia
Introduction: The optimal management of asymptomatic subjects at intermediate risk of
coronary artery disease (CAD) is often uncertain. Re-stratification to a high or low risk
category may enable optimization of preventative strategies. Coronary computed tomo-
plaque quantity and composition. Soft plaque by CCTA is lipid-rich and more vulnerable
to rupture and resultant acute coronary syndromes.
Objectives: To determine whether novel approaches to CAD risk stratification, such as
plasma lipid profiling, may predict soft plaque burden in intermediate risk subjects.
Methods: CCTA and several markers of CAD (including plasma lipid profiling, carotid
intima-media thickness, aortic pulse wave velocity, and C-reactive protein) were pro-
spectively performed in 100 asymptomatic patients at intermediate CAD risk according to
the Framingham risk score. Segment stenosis scores (SSS) were calculated to evaluate the
burden of total, calcified, and soft coronary artery plaque.
Results: Soft plaque was observed in 66 subjects and 158 of 1425 (11%) coronary artery
segments. 18 lipid species demonstrated significant associations with soft plaque burden,
but not with total plaque or calcified plaque burden. No other marker of CAD was found to
predict coronary artery plaque burden.
Conclusion: Plasma lipidomic analysis can predict the burden of soft coronary artery
plaque in asymptomatic subjects at intermediate risk of CAD. Given that soft plaque is
linked to an increased risk of future acute coronary events, plasma lipid profiling may allow
re-stratification of these patients to a higher or lower risk category and, thereby, enable
more appropriate and effective primary prevention management strategies.
Disclosure of Interest: None Declared
PM272
Could Routine Laboratory Parameters Predict The Severity Of Coronary Artery
Lesions? Preliminary Study
Benny M. Setiadi*1, Hariman Kristian1, Bambang Budiono2, Agnes L. Panda1,
Janry Pangemanan1, Reggy Lefrandt1
1
Cardiology and Vascular Medicine, Sam Ratulangi University, Manado, 2Cardiology and
Vascular Medicine, Awal Bros Hospital, Makassar, Indonesia
Introduction: Several studies have reported the association between several laboratory
parameters to severity of coronary artery lesions; however each of those parameters were
analyzed in different population.
e115
 Objectives: To investigate the correlation between routine laboratory parameters with
POSTER ABSTRACTS
severity of coronary artery lesions.
Methods: Patients who underwent coronary angiography between January to August 2013
were included. The indication for coronary angiography was positive non invasive test or
symptoms indicating coronary artery disease (CAD). The exclusion criteria include
incomplete data, infection, anemia, chronic statin treatment and previous coronary inter-
vention. Routine laboratory examinations (including hemoglobin, red cell distribution
width, white blood cell count, platelet, fasting blood glucose [FBG], lipid profile and
creatinine) were analyzed to identify their relation to the severity of coronary artery lesion
based on modified gensini score. Statistical analyses were done using SPSS 17.0 software. P
value <0.05 was considered statistically significant.
Results: A total 101 patients were included in this study. From these, 86 patients (85.15%)
were male. Hypertension, diabetes and dyslipidemia were found in 60 patients (59.41%),
31 patients (30.69%), and 85 patients (84.16%) respectively. There is significant correla-
tion between total cholesterol (r¼0.316; P value¼ 0.001), LDL (r¼0.246; P value¼0.013),
HDL (r¼-0.222; P value¼0.025), FBG (r¼0.295; P value¼ 0.003), LDL/HDL ratio
(r¼0.290; P value¼0.003), and total cholesterol/HDL (TC/HDL) ratio (r¼0.336; P value¼
0.001) with the severity of coronary artery lesion. In multivariate analysis, TC/HDL ratio is
the only independent predictor of CAD (OR¼ 1.79, P value¼ 0.024) and the strongest
independent predictor of moderate to severe lesion (modified gensini score >7) (OR¼
2.59, P value <0.001). From the Receiver Operating Curve (ROC) analysis, the most
effective cutoff values for TC/HDL ratio to predict CAD (Area Under the Curve [AUC]¼
0.76; P value¼0.008) and moderate to severe lesion (AUC¼ 0.73; P value <0.001) are 3.91
(sensitivity 82.4% and specificity 70%) and 5.22 (sensitivity 70.6% and specificity 72%)
respectively.
Conclusion: TC/HDL ratio demonstrates strongest correlation with the severity of coronary
artery lesions. TC/HDL ratio independently predicts patients with CAD and predicts more
severe lesion.
Disclosure of Interest: None Declared
PM273
Lipid Profile of Adult Population in Bangladesh
Md. Abdul K. Akanda*1, Kamrun N. Choudhury2, Md Z. Ali1, Lima A. Saymi1, Reza M. Huda1
1 study tested the feasibility of regional electronic patient database for obtaining information
Cardiology, National Institute of Cardiovascular Diseases, 2Epidemiology, National Centre for
Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh
Introduction: Lipid disorder is a major risk factor for the progression of atherosclerosis,
coronary artery disease and stroke. The causal association between plasma lipid level and
risk of coronary artery disease is established. With increasing urbanization and socioeco-
nomic improvement, changing population dynamics is expected to influence disease
pattern with rising trends of Non communicable diseases (NCDs).Thus there is a need to
screen healthy adults for their lipid pattern with high population dynamics in Bangladesh.
Objectives: Present study was aimed to find out the prevalence and distribution of lipid
profile in adult population of Bangladesh.
Methods: A cross-sectional study was carried out among adults age over 18 years residing
in an urban and a rural community. Multistage simple random method was used for data
collection. A total of seven hundred sixty eight (768) participants were screened after
obtaining informed consent. Data included socioeconomic information, behavioral risk
factors, anthropometric measurement and biochemical measurement using a pretested
questionnaire.
Results: Between the urban and rural participants, the mean total cholesterol (TC) levels
were 175.2
37.5 vs. 149.6
23.8 (mg/dl), mean triglyceride (TG) were 132.5
35.3
vs.154.7
34 (mg/dl) and mean low density lipoprotein (LDL) were 104.0
34.6
vs.79.7
25.5 (mg/dl), respectively, with a P- value <0.05, which was significantly asso-
ciated. Mean high density lipoprotein (HDL) were 37.0
8.9 mg/dl and 37.3
4.9 mg/dl
and similar between urban and rural adults. There was an increase in total cholesterol with
increasing age OR¼4.53 (95% C I¼ 3.55-9.52) and with p-value less than (p<0.05) be-
tween the areas in logistic model. Total Cholesterol level increased with economic status
between the areas and significantly associated (p<0.05), OR¼ 1.88 (95% CI¼ 0.89-2.37).
Total cholesterol was found to be high among urban participants and triglyceride level was
found to be high among rural population (p<0.05). Factors significantly associated with
dyslipidemia were blood pressure, fasting blood sugar and food habits (p<0.05). Partici-
pants with above 200mg/dl constituted 23.8% in case of total cholesterol and 25.6% in case
of triglyceride.
Conclusion: The result will be used for lifestyle intervention program to maintain the
normal level of lipid profile and to achieve primary prevention of coronary artery disease
and associated NCDs in the entire population.
Disclosure of Interest: None Declared
PM274
Evidence- NOT epidemiological-based guidelines are needed in diabetic patients
David Colquhoun*1, Antonio Ferreira-Jardim2
1
Cardiology, Wesley Hospital, 2University of Queensland, Brisbane, Australia
Introduction: Currently, risk factor guidelines for diabetic patients are based on arbitrary
cut-points derived from epidemiological studies. There is a general presumption that
aggressive treatment to the following levels will lower CHD risk: HbA1c <6.5%, Systolic BP
<130 mmHG (and <120 if proteinuric) and LDL-C <2.5 mmol/L.
Objectives: To evaluate recent intervention trials in diabetics assessing whether guideline
targets have been validated and if not, to suggest evidence-based targets.
Methods: A systematic review of completed randomised controlled trials via PubMed
involving risk factors in diabetics over the last 30 years. Trials needed to have more than
e116
1000 patients and followed up for more than one year. Risk factors evaluated were systolic
BP, HbA1c and LDL-C.
Results: More than 20,000 diabetic patients have been assessed in each category. The
lowest CV event rates were seen in patients with an HbA1c of between 7-8%. Aggressive
lowering of HbA1c beyond these limits is neverthless being assessed in more than 10
ongoing intervention trials. The ideal systolic BP was determined to be between 130-140
mmHg (<120 mmHg was associated with increased mortality). LDL-C benefit RRR in
diabetics was the same as non-diabetics with incremental benefit in those with an LDL-C
<1.5 mmol/L.
Conclusion: CHD risk factor guidelines in diabetes should be modified to reflect evidence
from intervention trials. Patients could thus be spared unnecessary drugs or insulin
therapy.
Disclosure of Interest: None Declared
PM275
Evidence-treatment gap in type 2 diabetes care
Tiina Laatikainen*1,2,3, Maija Sikiö4, Hilkka Tirkkonen5, Päivi Kekäläinen3, James Dunbar6,
Markku Tykkyläinen4
1
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio,
2
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki,
3
Hospital District of North Karelia, 4Department of Geographical and Historical Studies,
University of Eastern Finland, Joensuu, 5Health Centre of Outokumpu, Outokumpu, Finland,
6
Greater Green Triangle Department of Rural Health, Deakin and Flinders Universities,
Warrnambool, Australia
Introduction: T2DM generates a large burden of work and economic cost for primary
health care. Only limited information is available about the quality of care of non-
communicable diseases in different countries. In North Karelia, Finland, a recently estab-
lished region-wide electronic patient database has provided the possibility to assess the
evidence-treatment gap among patients with T2DM.
Objectives: The aim of the study was to assess the quality of care of T2DM in primary
health care comparing guideline recommendations with clinical performance. Besides, the
for assessing the areal variation of quality of T2DM care.
Methods: Data were obtained from the joint patient database of the North Karelian 13
municipalities. Both primary and secondary health care records were investigated to find all
T2DM patients (ICD-10 E11) in the region. Altogether 10,204 patients were identified
corresponding to 6.2% prevalence in the population. Four quality indicators from the
Finnish guidelines where used: laboratory tests for HbA1c and LDL cholesterol,
HbA1c<7.0 % and LDL<2.5mmol/L. All laboratory analyses and their results from years
2011-2012 were retrieved from the database.
Results: The follow-up of T2DM patients showed reasonable levels of follow-up as judged
by measured HbA1c and LDL cholesterol levels. During 2011-2012, HbA1c had been
measured on 83% of patients and LDL among 75%. Of those whose HbA1c was measured,
72% reached the optimal treatment level <7.0 %. The LDL results were not so good; about
55% reached the recommended level <2.5 mmol/L. There was quite marked variation in
both the prevalence of T2DM and the outcomes of treatment between the municipalities
reflecting different processes in screening and management of T2DM patients.
Conclusion: The regional electronic patient database gave important information on
quality of care. The management of T2DM in North Karelia is reasonably good but the
results indicate that there is still room for improvements in both screening and manage-
ment. In brief, the regional patient database can provide efficient statistics to improve
disease management and benchmarking in municipalities.
Disclosure of Interest: None Declared
PM276
Biodiesel Exhaust Exposure Causes Vascular Dysfunction In Healthy Subjects
Jon Unosson*1, Anders Blomberg1, Thomas Sandström1, Mikael Kabele1, Christoffer Boman2,
Andrew J. Lucking3, Nicholas L. Mills3, David E. Newby3, Jeremy P. Langrish3, Jenny A. Bosson1
1
Public Health and Clinical Medicine, 2Department of Applied Physics and Electronics, Umeå
Universitet, Umeå, Sweden, 3University/BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, United Kingdom
Introduction: Traffic-derived air pollution is associated with cardiorespiratory disease and
mortality, as well as being a major contributor to greenhouse gases. Biodiesel represents
one of the most established biofuels on the global marketplace and whilst replacing pet-
rodiesel with biodiesel may have beneficial ecological impacts, the resulting health effects
are unknown.
Objectives: Controlled exposures to petrodiesel exhaust have consistently resulted in
vascular dysfunction in human subjects. The purpose of this study was to compare the
cardiovascular effects of biodiesel exhaust exposure from a 30% rape seed methyl ester
biodiesel blend (RME30) and 100% rape seed methyl ester biodiesel (RME100) to the well-
known adverse effects of petrodiesel exhaust.
Methods: In two separate studies non-smoking healthy volunteers were exposed to
petrodiesel exhaust or biodiesel exhaust (RME30 and RME100) in a randomised,
controlled, double-blind crossover fashion. In study one, sixteen subjects were exposed to
petrodiesel exhaust (PM10 313.7 mg/m3) and RME30 exhaust (PM10 309.1 mg/m3)
standardized for particle mass. In study two, nineteen subjects were exposed to petro-
diesel exhaust (PM10 309.8 mg/m3) and RME100 exhaust (PM10 165.0 mg/m3) stan-
dardized for emission factor. Exposures lasted one hour during which the subjects
performed intermittent exercise.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 Vascular endothelial dysfunction was assessed four to six hours post exposure using
forearm venous occlusion plethysmography, with unilateral intraarterial infusion of the
vasodilators acetylcholine, bradykinin, sodium nitroprusside and verapamil.
Results: Infusion of all vasodilators caused a dose-dependent increase in forearm blood
flow that was similar following exposures to RME30 and RME100 as well as petrodiesel
exhaust (P>0.05 for all).
Conclusion: Diesel exhaust exposure has consistently been shown to impair vascular
endothelial function. The present study demonstrates that replacing 100% petrodiesel with
RME30 or RME100 results in similar adverse cardiovascular effects. We suggest that these
detrimental health effects should be taken into consideration alongside environmental
concerns when assessing future alternative fuels.
Disclosure of Interest: None Declared
PM277
Quality assurance in point of care INR monitoring
Siang Y. Soh*1,2, Dennis T. Wong2,3, Leanne Morgan2, Jan Hosking2, Simone Young2,
Alan Soward2
1
Alfred Health, Melbourne, 2Mildura Cardiology, Mildura, 3MonashHeart, Melbourne, Australia
Introduction: Anticoagulation with warfarin is commonly used for stroke prevention in
atrial fibrillation. Point of care (POC) INR (International Normalized Ratio) testing has
become widely used in the clinic setting to manage anticoagulation. POC INR analysers are
inexpensive and simple to use. Given the importance of accurate INR measurement,
validation of these analyzers in the clinic setting is required.
Objectives: We sought to assess the accuracy of POC INR testing in a private cardiology
practice.
Methods: Patients taking warfarin and attending for INR monitoring at a private car-
diology practice were recruited. All patients were taking warfarin at night, and INR’s
were measured using the CoaguChekXS handheld coagulation analyzer. Patients were
then sent immediately to a local pathology service for a laboratory full blood INR using
reagent Thromborel S and a Sysmex CA-540 coagulation analyzer. Using target ther-
apeutic ranges of 2.0-3.0 for atrial fibrillation and 2.5-3.5 for mechanical cardiac
valves, hypothetical dosing decisions (either change or no change) were made based on
both POC INR’s and laboratory INR’s. Statistical analyses were performed utilizing
paired t-test and Pearson’s correlation with 2 sided p value <0.05 accepted as statis-
tically significant.
Results: Eighty-six patients (age 74
10 years, 54% males) were recruited. Ninety-five
percent were taking warfarin for atrial fibrillation stroke prevention. The mean INR using
the POC analyzer was 2.50
0.59 and 2.79
0.57 using the laboratory analyzer (P <
0.001). The POC analyzer underestimated INR compared to the laboratory analyzer with a
mean difference of 0.29
0.23 (P <0.001). Based on the above INR targets, 71 (83%) of
the results were concordant (P <0.001). 15 (17%) results were discordant and could have
resulted in different dosing advice.
Conclusion: This study showed INR testing using the POC analyzer mildly underestimated
INR compared with the laboratory analyzer. Clinics using POC INR testing should consider
validating their results against laboratory standards.
Disclosure of Interest: None Declared
PM278
The Global Burden of Ischemic Heart Disease in 1990 and 2010: The Global Burden
of Disease 2010 Study
Andrew E. Moran*1, Mohammad H. Forouzanfar2, Gregory Roth3, Majid Ezzati4,
George Mensah5, Abraham Flaxman2, Christopher J. Murray2, Mohsen Naghavi2
1
Medicine, Columbia University Medical Center, New York, 2Institute for Health Metrics and
Evaluation, 3Medicine, University of Washington, Seattle, United States, 4Schoo of Public Health,
Imperial College London, London, United Kingdom, 5National Heart, Lung and Blood Institute,
United States National Institutes of Health, Bethesda, United States
Introduction: Ischemic heart disease (IHD) burden consists of years of life lost from IHD
deaths and years of disability lived with three non-fatal IHD sequelae: nonfatal acute
myocardial infarction (AMI), angina pectoris, and ischemic heart failure. Our aim was to
estimate global and regional burden of IHD in 1990 and 2010.
Objectives: To measure and compare the burden of IHD in 21 world regions in 1990 and
2010.
Methods: Years of life lost due to IHD were estimated from country-level mortality data
using ensemble cause-of-death models. Years lived with disability from IHD were esimated
from regional estimates of AMI incidence and angina and heart failure prevalence by age,
sex, and world region in 1990 and 2010 based on data from a systematic review and
nonlinear mixed effects meta-regression methods. Non-fatal IHD disability was weighted
using disability penalties estimated in a population-based survey on disease-related quality
of life.
Results: Eastern Europe, Central Asia, North Africa/Middle East, and South Asia had the
highest age-standardized DALYs per 100,000 in the world in 2010 (Figure). The global
burden of IHD increased by 29 million disability-adjusted life years (DALYs; 29% in-
crease) between 1990 and 2010. About 32.4% of the growth in global IHD DALYs be-
tween 1990 and 2010 was due to aging of the world population, 22.1% due to
population growth, and total DALYs were attenuated by a 25.3% decrease in per capita
IHD burden (decreased rate). The number of people living with non-fatal IHD increased
more than the number of IHD deaths since 1990, but >90% of IHD DALYs in 2010 were
due to IHD deaths.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
POSTER ABSTRACTS
Conclusion: Globally, age-standardized IHD mortality declined in most regions since
1990, but increased in Eastern Europe, Central Asia, South Asia, and East Asia. Despite
decreased age-standardized fatal and non-fatal IHD in most regions since 1990, population
growth and aging led to a higher global burden of IHD in 2010.
Disclosure of Interest: None Declared
PM280
Knowledge, Attitude, and Behaviour Regarding Hypertension Among Indonesian
Primary Health Care Providers and Hypertensive Patients in Remote Area: Internship
Study
Felix Chikita Fredy*1, Devi Felicia1, Sarah Febiana Rahayu2, Alexandra Gabriella3,
Nurnajmia Curie Proklamartina4, Joshua Patrick Mulyadi5, Ratna Andriyati6,
Bhayu Hanggadhi Nugroho7, Gracia Lilihata6, Vincent Kane8, Dexanda Pravian6
1
Internship Doctor, Sangatta General Hospital, Sangatta, 2Internship Doctor, Mukomuko
General Hospital, Mukomuko, 3Internship Doctor, Robert Wolter Mongisidi General Hospital,
Manado, 4Internship Doctor, Kanujoso Dhatiwibowo General Hospital, Balikpapan, 5Internship
Doctor, Singaraja General Hospital, Singaraja, 6Internship Doctor, Tanjung General Hospital,
Tanjung, 7Internship Doctor, Kupang General Hospital, Kupang, 8Internship Doctor, Leuwiliang
General Hospital, Bogor, Indonesia
Introduction: In Indonesia approximately 41.0% of adults had been diagnosed with
hypertension. It is responsible for at least 45% of deaths due to heart disease. The
numbers increase because of lack of knowledge, attitude, and behaviour (KAB)
regarding hypertension among patients and the health care providers. Hypertension
itself needs continuous and comprehensive management which is also largely affected
by KAB.
Objectives: To assess the status of KAB of health care providers and the patients in
primary health care (PHC) at rural and remote area in Indonesia regarding
hypertension.
Methods: The present cross-sectional study was carried out in 8 PHC spread in 7
provinces in Indonesia. The data were collected from subjects using comprehensive
questionnaire guided by interviewers. All available health care providers and pa-
tients in PHC centres were approached to determine their KAB regarding hyper-
tension. Questionnaires were validated and pilot tested. Each section of the
questionnaire was scored and the total scores were calculated. KAB status of health
care providers and patients based on the same items in questionnaires was
compared.
Results: A total of 185 health care providers (42.7% males; median age 28),
consisted of 68 general practitioners, 107 nurses, and 10 specialists, and 184
hypertensive patients (41.8% males; median age 56) were enrolled in the study.
Most of patients showed poor knowledge (70.7%), average attitude (53.8%), and
neutral behaviour (51.6%), while most of health care providers also showed the
same status: average knowledge (54.6%), average attitude (65.4%), and neutral
behaviour (56.8%). Median score of knowledge, attitude, behaviour were 20.0 (0.0-
90.0), 45.5 (0.0-91.0), 42.9 (14.0-86.0) for patients and 33.3 (8.0-92.0), 60.9
(30.0-100.0), 50.0 (13.0-100.0) for health care providers. For the same questions,
health care providers showed better knowledge (50.8
23.0 vs 28.4
19.0;
p<0.001) and behaviour score (60.1
18.5 vs 44.0
23.2; p<0.001) than the
patients’, but no significant difference found in attitude score (38.9
30.1 vs
33.0
25.8; p¼0.08).
Conclusion: The study revealed that KAB of patients in PHC in rural and remote area was
low. It was worse that the health care providers were also lacked KAB in this area of their
work. Hypertension education must be strengthened for both health care providers and
patients. An increased KAB is crucial the successful management of hypertension in
Indonesia.
Disclosure of Interest: None Declared
e117
 1
PM281 School of Nursing, 2Public health, University of North Florida, Jacksonville, 3College of Public Health,
POSTER ABSTRACTS

University of South Florida, Tampa, 4College of Public Health, University of North Florida,
Primary Health Practitioners’ State of Knowledge, Attitude, and Practice Concerning
Management of Hypertension in Low-Income Country Indonesia: Internship Study Jacksonville, 5Outcomes and Clinical Research, Palo Alto Medical Foundation, Palo Alto, United States

Felix Chikita Fredy1, Devi Felicia1, Alexandra Gabriella*2, Gracia Lilihata3, Vincent Kane4, Introduction: Because metabolic syndrome is not an absolute risk indicator and does not
Sarah Febiana Rahayu5, Nurnajmia Curie Proklamartina6, Joshua Patrick Mulyadi7, address many distinguishing factors such as age, sex, smoking, and low-density lipoprotein
cholesterol levels, it further complicates the ability to outline specific criteria that would
Ratna Andriyati3, Bhayu Hanggadhi Nugroho8, Dexanda Pravian3
1 encompass all individuals and accurately describe the prevalence of metabolic syndrome
Internship Doctor, Sangatta General Hospital, Sangatta, 2Internship Doctor, Robert Wolter across various ethnic groups. Improving the diagnostic criteria in addition to recognizing
Mongisidi General Hospital, Manado, 3Internship Doctor, Tanjung General Hospital, Tanjung, specific markers for minority groups will improve screening requirements and aid in early
4
Internship Doctor, Leuwiliang General Hospital, Bogor, 5Internship Doctor, Mukomuko General recognition of future adverse health events.
Hospital, Mukomuko, 6Internship Doctor, Kanujoso Dhatiwibowo General Hospital, Balikpapan, Objectives: The study aimed to investigate the discrepancy among the multiple guidelines and
7
Internship Doctor, Singaraja General Hospital, Singaraja, 8Internship Doctor, Kupang General the actual clinical presentation in minority groups, specifically Filipino-American women.
Hospital, Kupang, Indonesia Methods: A cross-sectional community based study conducted across four US cities. FAW
(n¼384) were recruited and enrolled after fasting for a minimum of 12 hours. Waist
Introduction: Nowadays approximately 41.0% of Indonesian adults suffer from hyper- circumference, blood pressure, lipid levels and fasting glucose levels were obtained. Fre-
tension. It disproportionately affects populations in low-income countries where health quencies and chi square analyses were obtained to determine significant differences among
systems are weak. General practitioners (GPs), especially those are at primary health care MetS variables relative to the three definitions of MetS namely, the International Diabetes
(PHC) and tertiary hospitals, have role as gate keepers: letting the condition worse or Federation (IDF), Harmonizing and National Cholesterol Education Program’s Adult
keeping control and improving it. Treatment Panel III (NCEP/ATP III).
Objectives: To assess the knowledge, attitude, and practice of PHC and tertiary hospitals Results: Mean waist circumference was 37
4 inches, with 96% having a waist over 31
GPs toward the management of hypertension. inches and 76% have a waist >35 inches; 68% were hypertensive(SBP 120 mmHg, DBP
Methods: The present cross-sectional study was foot of Internship Study. Subjects were GPs  80 mmHg), 42% were treated for hypertension, 37% had elevated glucose levels (100
worked in 8 PHC and 8 tertiary hospitals in 7 provinces in Indonesia. All available GPs were mg/dL), 24% had reduced HDL levels (50 mg/dL), and 21% had elevated triglyceride
subjected to a prevalidated interview questionnaire. Questionnaire was validated and pilot levels. Identifying MetS according to the Harmonized definition showed a significantly
tested. Each section of the questionnaire was scored and the total scores were calculated. higher overall prevalence (n¼211, 55%) compared to the prevalence using NCEP/ATP III
Bivariate analysis was done to find any factors influencing the level of knowledge of GPs. (n¼207, 54%) and IDF definition (n¼179, 46%) p < 0.001. All three definitions showed a
Results: A total of 68 GPs (45.6% males; median age 27.5), were enrolled in the study. prevalence of MetS at a BMI category of 25-29.9 kg/m2 and a waist >35 inches.
Hypertension was considered as a big health problem in almost all subjects, yet only 23.5%
and 36.8% were correct in defining hypertension and its stages. They prescribed antihy-
pertensive drugs for 13.4 (4-30) days. However, there were still 54.4% and 45.6% confused
in choosing antihypertensive drugs and its dose. About 13.2% were failed calling at least 3
antihypertensive drugs and 47.1% failed in defining the target therapy of hypertension.
Overall level of knowledge, attitude, and practice of GPs was average (68.5%), average
(69.1%), neutral (69.1%), respectively. Experience of attending any hypertension confer-
ences/seminar (p¼0.05) and the origin of province (p¼0.009) were two factors significantly
associated with GPs’ level of knowledge.
Conclusion: Primary healthcare practitioners have unsatisfactory knowledge, attitude, and
practice on hypertension. There is a need of more continuing medical education since GPs
are the first liner on this on-going threat of hypertension.
Disclosure of Interest: None Declared

PM282
Understanding adherence to a cardiovascular polypill strategy- a process evaluation
of a pragmatic clinical trial
Hueiming Liu*1, Luciana Massi1, Tracey Laba1, Stephen Jan1, on behalf of PEAK team
1
The George Institute for Global Health, Sydney, Australia

Introduction: Kanyini GAP (KGAP) was a pragmatic randomized, controlled trial (RCT) in
the Australian primary health care setting exploring whether a polypill-based strategy
would improve patient self-reported medication use to indicated treatments for primary
and secondary prevention of cardiovascular disease (CVD). This paper describes the
findings from a process evaluation of this RCT.
Objectives: A process evaluation of a clinical trial to understand the strengths and limi-
tations of a polypill based strategy.
Methods: Qualitative in-depth, semi-structured interviews were conducted with 47
healthcare providers and 47 patients from participating private general practices (GP) and
Aboriginal Medical Services (AMS) and were analysed thematically and interpretively.
Results: Patients in the polypill arm commented frequently on the cost savings, ease and
convenience of a daily dosing pill. Most providers considered a polypill strategy to be a useful
facilitator for improved medication use for their patients. AMS providers and Indigenous
patients felt the strategy was acceptable to and beneficial for Indigenous patients given the
high disease burden in this population and challenges in ensuring adherence. Providers in
both GP and AMS settings found the fixed dose regimen inflexible to prescribe at times, with
the dosages at times being inappropriate for patients with existing CVD and complex
management considerations. Many of the providers described that the polypill strategy in its
current formulation was more suitable for the primary prevention group.
Conclusion: The polypill strategy was generally acceptable to most patients and providers
for improving use of indicated medication. The process evaluation exposed limitations to
provider acceptability of this particular polypill formulation and a perception that it was
more suitable for primary prevention patients. This strategy could in particular be a useful
approach to maintaining patients on treatment and lowering the high CVD burden in
Australian Indigenous populations.
Disclosure of Interest: None Declared

PM283
International Diabetes Federation (IDF), Harmonizing and National Cholesterol
Education Program’s Adult Treatment Panel III (NCEP/ATP III) Definition for
Metabolic Syndrome: Which of These Criteria Best Captures the Prevalence of
Metabolic Syndrome Among Filipino Women?
Irma B. Ancheta*1, Teresa Tuason2, Jenna Levenson1, Christine V. Ancheta3, Cynthia Battie4, Conclusion: MetS is prevalent among Filipino American women independent of criteria
Latha Palaniappan5 used to define metabolic syndrome. Higher values for prevalence of MetS are obtained

e118 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

using the harmonizing definition of MetS, and therefore best captures more CVD risk and
may be a more appropriate criteria used to define MetS in this population.
Disclosure of Interest: None Declared
PM284
RHD Prevention and Control Programme in Tuvalu
Liz Kennedy*1, Maliesi Latasi2, Stephen Homasi3, Samantha Colquhoun1,4,5,
Jonathan Carapetis6, Ben Reeves7, Lafou Laupula8
1
Global Health, Menzies School of Health Research, Darwin, Australia, 2Paediatrics, 3Public
Health, Ministry of Health, Funafuti, Tuvalu, 4Centre for International Child Health, University
of Melbourne, 5Murdoch Childrens Research Institute, Melbourne, 6Telethon Institute for Child
Health Research, Perth, 7Paediatrics, Cairns Base Hospital, Cairns, Australia, 8Medical services,
Ministry of Health, Funafuti, Tuvalu
Introduction: The high burden of RHD disease has serious social and economic impli-
cations in Tuvalu due to the remote geographically isolated population base and limited
health resources.
Objectives: To implement a comprehensive RHD Prevention and Control Programme
utilising diagonal integration model, that has been facilitated in a number of Pacific Island
countries to increase team local capacity and autonomy.
Methods: The programme is based on WHO recommendations for prevention and control
of RHD and supported by the World Heart Federation to strengthen patient management
practices, improve Benzathine penicillin G (BPG) adherence and enhance disease surveil-
lance by supporting locally delivered training with external technical support.
Results: Tuvalu has developed an RHD National Strategic Plan and established a national
RHD register and advisory committee. In 2012 25% of the 5-15 yr old population was
screened for RHD, prevalence is estimated at 31.5 per 1000 population as categorised by
the WHF RHD echocardiography criteria. Transport to the remote islands is unreliable
leaving many island populations with limited access to medical care beyond the primary
care level. A local team visited two outer islands in 2012 to conduct education about ARF
and RHD, introduce recording and reporting systems to health clinics and screen children
as part of a strategy to early detect RHD. Monthly outpatient clinics combined with health
worker training has increased the awareness of RHD and the importance of secondary
prophylaxis. Higher compliance rates are evident among newly diagnosed patients. There is
no dedicated RHD coordinator in place, however recently a local doctor was allocated time
for RHD and other staff have taken on specific programme responsibilities. It is anticipated
that these changes will greatly enhance the capacity of the programme.
Conclusion: The prevalence of RHD in the school aged population in Tuvalu is higher than
neighbouring countries. Despite clear successes, geographical remoteness, lack of reliable
transportation both to and within Tuvalu combined with a dependence on overseas surgery
for RHD patients continues to provide unique and costly challenges to RHD programming.
The long- term sustainability of this programme would be more assured if a dedicated
coordinator was in place and an increased level of integration with the NCD strategy in
Tuvalu was achieved.
Disclosure of Interest: None Declared
PM285
Low olive oil supplementation reduces triglycerides and oxidative characteristic
associated with low-density lipoprotein in individuals with intermediate and high
cardiovascular risk
Adriane Marangoni1, Nágila R. T. Damasceno*1
1
Nutrition, University of São Paulo, São Paulo, Brazil
Introduction: Cardiovascular disease is the leading cause of premature morbidity and
mortality worldwide, and accounts for a large part of the costs applied to public policy
programs. In this context, diet represents an important tool in managing and reducing the
risk of cardiovascular disease. Regarding that numerous studies show that consumption of
omega 9 or food source changes positively several classical cardiovascular risk factors, it
becomes important to evaluate its effect on physicochemical properties of LDL and HDL,
cardiometabolic and oxidative markers in Brazilian individuals with different levels of
cardiovascular risk.
Objectives: This study aimed to evaluate the effect of olive oil intake on classical and new
cardiometabolic properties in individuals with different levels of cardiovascular risk.
Methods: From clinical, prospective, randomized, placebo controlled, double blind trial
based on nutritional intervention, individuals of both sexes were randomized into groups
olive oil (OO) and placebo (PL) groups. During 8 weeks individuals received 3 g/d of olive
oil or placebo. The cardiovascular risk levels were classified following the criteria estab-
lished by the Framingham Risk Score (FRS). At baseline time and T¼8 w, clinical profile,
the family history of diseases, blood pressure, food consumption and physical activity level
were evaluated. From plasma or serum obtained after 12 h of fasting lipid profile, apoli-
poproteins, LDL and HDL size, LDL(-) and NEFAS levels, and activity of paraoxonase were
determined. Adherence to intervention was monitored by direct means (biochemical
markers) and indirect (capsules intake).
Results: The OO group showed significant reduction of triglycerides in individuals at high
cardiovascular risk (p¼0.049) and LDL-C (p¼0.045). LDL(-) level showed significant
reduction (-34%) in individuals with high cardiovascular risk. However, changes in other
parameters were not detected when comparing the intervention group and the placebo
group.
Conclusion: Low olive oil intake promotes reduction of triglycerides, LDL-C and LDL(-).
Therefore, the consumption of olive oil, even in low doses, could be recommended.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM286
POSTER ABSTRACTS
Using Lipid-based And Body Mass Index-based Framingham Risk Score to Compare
the General Cardiovascular Disease Risk for a Malaysia Rural Population
Nazar Mohd Zabadi Mohd Azahar*1, Ambigga Devi S. Krishnapillai2, Ng K. Keat3, Khalid Yusoff1
1
Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, 2Faculty of Medicine & Defence
Health, National Defence University of Malaysia, Sungai Besi, 3Faculty of Medicine, Universiti
Teknologi MARA, Selayang, Malaysia
Introduction: Predicting the risk of developing cardiovascular diseases (CVD) prospec-
tively is an important step to identify the target individuals who need intervention for the
disease prevention.
Objectives: This study compares the differences in predicting the 10-year general CVD risk
by using the lipid-based and BMI-based Framingham Heart Study (FHS) Risk Calculators
for a rural population.
Methods: This community-based study was conducted in a rural population in Raub,
Malaysia. Respondents were recruited based on pragmatic sampling. For each of the re-
spondents, seven major CVD risk factors were obtained for the general CVD risk prediction
analysis, namely age, smoking status, diabetic status, BMI, blood pressure, total cholesterol
and HDL-cholesterol.
Results: A total of 600 respondents were screened. However, only 436 were eligible for this
study. There were 58.3% females. Mean age of respondents was 58.4 years (SD
10 years).
There were 81.4% of respondents had at least two risk factors while 15.2% of respondents
had one risk factor. According to the lipid-based FHS risk calculator prediction, the
prevalence of low, moderate and high 10-year CVD risk for the studied population was
29.4%, 28.2% and 42.2% respectively; meanwhile the same prevalence was 29.5%, 28.7%
and 41.8% respectively if BMI-based FHS risk calculator was used.
Conclusion: Both risk calculators provide a consistent estimate of the 10-year general CVD
risk. Henceforth, this study suggests that risk prediction based on BMI can be utilized in
rural community when there is a constraint to laboratory assessment and health resources.
Disclosure of Interest: None Declared
PM287
Low social economic status is associated with higher cardiovascular mortality in a
country of the African region
Pascal Bovet*1,2, Silvia Stringhini1, Bharathi Viswanathan2, Valentin Rousson3, Jude Gedeon4,
Fred Paccaud1
1
Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland,
2
NCD section, Ministry of Health, Victoria, 3Institute of Social and Preventive Medicine, Ministry
of Health, Lausanne, 4Ministry of Health, Victoria, Seychelles
Introduction: Low socioeconomic status (SES) is associated with higher cardiovascular
(CVD) mortality in high income countries. Few studies have assessed this association in low
and middle income countries, largely because of lack of reliable mortality data.
Objectives: We assessed SES differences in CVD mortality in the Seychelles, a rapidly
developing small island state east in the Indian Ocean, east to Kenya.
Methods: Causes of deaths were available in all deaths through vital statistics and the age
distribution of the population was known through national censuses and yearly updates by
administrative authorities between 1989 and 2012. SES and other health risk factors were
assessed with standard questions in a total of 3246 participants from three independent
population-based surveys in 1989, 1994 and 2004. Vital status of survey participants was
ascertained by linkage with vital statistics.
Results: During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died
(overall mortality rate 10.8 per 1000 person-years). CVD accounted for 219 deaths. Low vs
high SES was associated with higher all-cause (HR¼1.80; 95% CI: 1.24-2.62) and CVD
(HR¼1.95; 1.04-3.65) mortality. Major lifestyle-related risk factors (smoking, heavy
drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained 25% and 11%
of the associations between all-cause and CVD mortality, respectively.
Conclusion: In this first population-based study to assess social inequalities in mortality in
the African region, low SES was strongly associated with all-cause and CVD mortality. Our
findings support the view that the burden of non-communicable diseases may dis-
proportionally affect the poor in low and middle income countries.
Disclosure of Interest: None Declared
PM288
Childhood determinants of adult left ventricular mass
Quan L. Huynh*1, Christopher L. Blizzard1, Costan G. Magnussen1, James E. Sharman1,
Terry Dwyer2, Alison J. Venn1, Thomas H. Marwick1
1
Menzies Research Institute Tasmania, University of Tasmania, Hobart, 2Murdoch Childrens
Research Institute, Melbourne, Australia
Introduction: Cardiovascular disease is reported to have origins in childhood. Left ven-
tricular mass (LVM) is an important component of cardiovascular health and can inde-
pendently predict cardiovascular mortality.
Objectives: This study aimed to investigate the childhood determinants of hypertrophic
left ventricle in adulthood.
Methods: Subjects were 148 participants aged 7–15 years at baseline in 1985 with 20-year
follow-up. Anthropometry, blood pressure, blood biochemistry and cardiorespiratory
fitness were measured both at baseline and follow-up. These measures were converted to
age- and sex-specific z-scores for use in analysis. LVM was measured at follow-up using
echocardiography. Left ventricular mass index (LVMI) was calculated as LVM/height2.7
e119
 (g/m2.7) and as LVM divided by body surface area (g/m2). Hypertrophic left ventricle was
POSTER ABSTRACTS
defined as LVMI>48 g/m2.7 for men or LVMI>44 g/m2.7 for women.
Results: Among the childhood measures, childhood body mass index (BMI r¼0.36
p<0.001) and systolic blood pressure (SBP r¼0.21 p¼0.009) were most strongly associated
with adult LVMI. Low BMI and SBP in childhood were defined as respective z-score0. High
BMI and SBP in childhood were defined as respective z-score>0. Compared with partici-
pants with low BMI and low SBP in childhood (LVMI¼30.3
5.5 g/m2.7) and those with high
BMI or high SBP in childhood (LVMI¼34.7
6.5 g/m2.7), those with high BMI and high SBP
in childhood had the greatest mean value of adult LVMI (38.5
7.2 g/m2.7, p<0.001), and
2.3-fold (95% CI: 1.1–4.9) higher risk of abnormal left ventricular geometry (see table) and
3.5-fold (95% CI: 1.1–11.3) higher risk of hypertrophic left ventricle in adulthood. These
results were independent of potential confounders in adulthood.
Conclusion: Children with higher BMI and SBP compared to their counterparts have
greater risk of hypertrophic left ventricle in adulthood.
Disclosure of Interest: None Declared
PM289
Real World Practice of Community-based Cardiovascular Disease Preventive Care
and Practice Characteristics in Beijing
Xiaohui Yang*1, Changsheng Ma2, Xin Du2
1
Beijing Municipal Office for CVD prevention & Control, 2Dept. of Cardiology, Beijing Anzhen
Hospital, Capital University of Medical Science & Beijing Institute of Blood Vessel, Lung and
Heart Disease, Beijing, China
Introduction: In order to observe the real world practice of community-based cardiovascular
disease preventive care and practice characteristics in Beijing and to realize self-confidence
and barriers for delivering CVD preventive interventions recommended by guidelines among
general practitioners(GPs). cross-sectional survey in both patients and GPs were conducted by
trained investigators by using unified special questionnaires from July to September, 2011.
Results showed thatThe majority of patients visiting CHSCs were not receiving standardized
preventive interventions for CVD and its risk factors recommended by guidelines. The control
rate of CVD risk factors were at low levels. GPs in Beijing were lack of self-confidence in
delivering CVD preventive care and incorporating CVD prevention guidelines into practice.
Objectives: To observe the real world practice of community-based cardiovascular disease
preventive care and practice characteristics in Beijing and to realize self-confidence and
barriers for delivering CVD preventive interventions recommended by guidelines among
general practitioners(GPs).
Methods: 2 districts and 3 counties were chosen from 4 districts in Beijing by multi-stage cluster
random sampling methods. cross-sectional survey in both patients and GPs were conducted by
trained investigators by using unified special questionnaires from July to September, 2011.
Results: In patients with documented coronary heart disease, the medicine taking rate
according to medication recommendations of aspirin, ACEI/ARB, b-blockers, lipid-
lowering statins was 45%, 19.4%, 13%, 13.1% respectively. The control rates of CVD risk
factors for achieving the recommended level were low.Key barriers to implementation of
guidelines by GPs were seen as prescribing cost or non-reimbursement (39.7%), poor
patient incompliance (38.6%).
Conclusion: 1. The majority of patients visiting CHSCs were not receiving standardized
preventive interventions for CVD and its risk factors recommended by guidelines. The
control rate of CVD risk factors were at low levels. 2. GPs in Beijing were lack of self-
confidence in delivering CVD preventive care. Efforts should be directed toward the
establishment of sustainable system to effectively disseminate CVD prevention guidelines
and improve quality of CVD preventive care at the community-based level, and in the end
enhance the effectiveness of CVD prevention and control.
Disclosure of Interest: None Declared
PM290
Right ventricular fatigue developing during endurance exercise: a real-time exercise
cardiac magnetic resonance imaging study
Guido Claessen*1, Piet Claus2, Stefan Ghysels3, Pieter Vermeersch4, Steven Dymarkowski3,
Andre La Gerche1,5, Hein Heidbuchel1
1
Cardiology, University Hospitals Leuven, 2Cardiovascular Imaging and Dynamics, University of
Leuven, 3Radiology, 4Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium, 5St
Vincent’s Hospital Department of Medicine, University of Melbourne, Melbourne, Australia
e120
Introduction: Prolonged intense exercise has often been associated with impairment of
right ventricular (RV) function after activity, whilst this is rare for the left ventricle (LV).
The impact of prolonged exercise on the heart has not been adequately measured during
exercise itself.
Objectives: To evaluate biventricular volumes in endurance athletes, before and imme-
diately after an endurance race, using a novel exercise cardiac magnetic resonance imaging
(CMR) technique.
Methods: We performed real-time CMR imaging at rest and during incremental exercise in
14 male endurance athletes 1-3 weeks before (baseline) and immediately after a 150 km
cycling event (post-race) to measure LV and RV end-diastolic and end-systolic volumes
(EDV and ESV), ejection fraction (EF) and ventricular-arterial coupling (SV/ESV).
Results: Post-race RVEDV was unchanged from baseline at rest, but was significantly
increased during maximal exercise (235
18 vs. 217
24 ml; P<0.0001). Resting RVESV
was higher post-race (100
16 vs. 93
15 ml; P¼0.009), which became more appreciable
during maximal exercise (75
15 vs. 60
14 ml; P<0.0001). RVEF, whilst unchanged at
rest, was significantly decreased during maximal exercise (68
5 vs. 73
4 %; P¼0.001).
LV volume measures were similar at baseline and post-race. Therefore, the impact of
endurance activity on the RV and LV was significantly different (P<0.0001). Cardiac
output increased to similar values at maximal exertion before and after the race (See
Figure). However, whereas LV SV/ESV was unchanged, RV SV/ESV was attenuated post-
race (P¼0.02 for interaction with race setting).
web 3C=FPO
Conclusion: Intense endurance exercise does not impact LV volume or function, but re-
sults in RV dilatation and reduced RVEF which becomes even more significant during
exercise. Alterations in RV ventricular-arterial coupling suggest that this may be an
expression of exercise-induced RV contractile impairment rather than changes in auto-
nomic or loading conditions.
Disclosure of Interest: None Declared
PM291
Risk Factors for Telomere Shortening in Early Childhood
Michael Skilton*1, Shirley Nakhla2, Guy Marks3, David Celermajer4
1
Boden Institute, University of Sydney, 2Heart Research Institute, 3Woolcock Institute of Medical
Research, 4Sydney Medical School, University of Sydney, Sydney, Australia
Introduction: Leukocyte telomere length is a biological marker of aging that is associated
with cardiovascular morbidity and mortality in adults. Risk factors for telomere shortening
include age and male sex. There is also evidence that plasma omega-3 levels in adults and
obesity during childhood could influence telomere length.
Objectives: We sought to determine the parental and early life predictors of telomere
length in young children.
Methods: Participants were 331 children (49% boys), aged 18 months – 5 years
(mean 3.6 years [SD 1.0]), who were studied from birth as part of an ongoing
longitudinal study (CAPS). Leukocyte telomere length was assessed by quantitative
real-time PCR, and expressed as the telomere-to-single-copy gene ratio. Putative
parental and early life risk factors were age, sex, weight to length z-score at birth,
childhood body mass index z-score, childhood plasma omega-3 fatty acids, breastfed
status for at least 6 months, maternal smoking during pregnancy, maternal and
paternal age, gestational duration, and primigravida status. Maternal and paternal body
mass index were also assessed at a later date, when the child was 8 years old, in a
subset of participants (n¼255 and 247, respectively). Associations were determined by
Pearson’s correlation, and multivariable regression modeling adjusted for age, sex and
parental education.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: Age (r ¼ -0.128, P ¼ 0.02), female sex (r ¼ 0.106, P ¼ 0.05), weight to length

POSTER ABSTRACTS
z-score at birth (r ¼ 0.085, P ¼ 0.12), primigravida status (r ¼ -0.084, P ¼ 0.13) and
maternal body mass index (r ¼ -0.106, P ¼ 0.09) were most strongly associated with
telomere length in univariate analysis (P > 0.25 for all other comparisons). In multivariable
modeling, significant independent predictors of longer telomere length in early childhood
were younger age (-0.117 units per year [95% CI -0.210, -0.024], P ¼ 0.01), female sex
(0.199 units [95% CI 0.016, 0.382], P ¼ 0.03), and lesser maternal BMI (-0.013 units per
kg/m2 [95% CI -0.025, -0.000], P ¼ 0.05).
Conclusion: Age, male sex and maternal adiposity are independently associated with
telomere shortening in early childhood.
Disclosure of Interest: None Declared

PM292
Genetic Characterization of Familial Hypercholesterolemia in Indian Population
Nitika Setia*1, Renu Saxena1, Jps Sawhney2, Ratna Puri1, Ishwar C. Verma1, Anjali Arora2
1
Center of Medical Genetics, 2Cardiology, Sir Ganga Ram Hospital, New Delhi, New Delhi, India
Introduction: Familial Hypercholesterolemia (FH) is an inherited disorder of lipid meta-
bolism characterized by very high levels of Total and LDL cholesterol since birth. These
patients are at a very high risk of Premature Coronary Heart Disease. Prevalence of FH is 1
in 500 in most countries with data unavailable in the Indian population. It is inherited in an
autosomal dominant fashion. Three genes are currently known as a cause of FH: Low Conclusion: The HHA program of work has the potential to improve cardiovascular health
density lipoprotein receptor (LDLR), ApoB 100, PCSK9. outcomes for all Australians through articulation of barriers and enablers, the identification of
Objectives: India has high number of deaths occurring due to premature heart disease appropriate strategies to address these, and supporting change through a suite of resources. The
resulting from major risk factors like deranged lipids. In our study, we would like to captured data will potentially be aggregated at a national level to guide the development of
differentiate between mutational underlying factor and lifestyle issues. Confirmation of upstream policy, patient/population registers, and provide an evidence implementation metric.
possible FH cases would help in additional case finding by “Cascade screening”. Early death Disclosure of Interest: None Declared
can be prevented if the cause is detected.
Methods: We enrolled 35 patients with 33 Possible and 2 Definite FH cases. DNA was
extracted from EDTA blood and then screened for LDLR, ApoB and PCSK9 genes using
PCR- SSCP technique followed by Sanger sequencing. Dosage analysis for large rear- PM296
rangements in LDLR gene was performed by MLPA technique.
Prehypertension Its Relation With Cardiovascular Morbidity And Mortality
Results: Out of 35 cases, sequencing analysis is complete for 11 cases and disease causing
mutations were found in 7 cases in LDLR gene. Out of 7, 4 missense, 1 splice site, 1 Nurys B. Armas Rojas*1, Alfredo F. Dueñas Herrera1, Reinaldo de la Noval García1,
nonsense and 1 large deletion have been detected. For 2 cases a variation was observed in Mayda Diaz González2
PCSK9 gene, which has been confirmed as a mutation with the help of familial segregation 1
Cardiology Preventive, Institute of Cardiology and cardiac surgery. Havana. Cuba, La Habana,
of variation with diseased state in one case. No mutation has been observed in ApoB gene. 2
Chronic Diseases, Colon Hygyene and Epidemiology Municipality Center, Colon Matanzas,
Analysis is in process for rest of the cases.
Conclusion: Molecular diagnosis helps in equivocal diagnosis of FH. With early detection Cuba
of FH in patients, family members can be screened for that particular mutation and lives Introduction: Persons with a systolic blood pressure of 130-139 mm/Hg and/or diastolic
can be saved from developing premature heart disease. With new lipid lowering drugs blood pressure of 80-89 mm/hg must be considered as prehypertensive. Persons with
(Mipomersan and PCSK9 inhibitors) in advanced stages of clinical trials, many FH patients prehypertension have a higher risk of becoming hypertensive. Prehypertension doubles the
will be benefitted to reach their LDL goal. risk of becoming hypertensive. Normotensive: No history of hypertension and blood
Disclosure of Interest: None Declared pressure of < 120-80 mm/Hg. Prehypertensive: No history of hypertension and blood
pressure of 120-139 / 80 – 89 mm/Hg. Hypertensive: History of hypertension, antihy-
pertensive treatment or blood pressure  140/90 Hg.
Objectives: To determine if the status of prehypertension increase the morbidity and
PM294 mortality risk by cardiovascular diseases.
The Heart Health Approach: Achieving Systematic Quality Care For All Methods: In 1999 – 2000 were examined 28 724 persons 35 years and more, both
sexes. They were searching for cardiovascular diseases and coronary risk factors.Blood
Rebecca Lee1, on behalf of National Model of Care for Heart Disease working group, pressure was measured twice; the mean was used as the blood pressure of the individual.
Robert Grenfell2, on behalf of National Model of Care for Heart Disease working group, This cohort was followed for 8 years. In 2008 were re-examined 21 821 persons from
Karen Page*3, on behalf of National Model of Care for Heart Disease working group and this cohort and 1630 individuals died at the interval. Cause of death was certified by
National Model of Care for Heart Disease working group death certificate. Morbidity by cardiac events and ictus were registered in the second
1 examination. The risk factors relative risk was determine by multiple logistic regression
Heart Care - Secondary Prevention, 2National Director, Cardiovascular Health, 3National
analysis.
Manager, Health Equity and Secondary Prevention, NATIONAL HEART FOUNDATION OF Results: More than one third of this population have PreHT (43,5%). PreHT was
AUSTRALIA, Melbourne, Australia more prevalent in female 50.3% vs 38,0% in male. From the normotensive group
at the beginning 24.6% became hypertensive and from the PreHT group 22.6%, the
Introduction: Globally, cardiovascular disease (CVD) is the leading cause of death and
prevalence of smoking and diabetes was almost the same for both groups.
disease burden. Despite robust evidence underpinning a wide range of lifestyle and
Morbidity by CHD, stroke and renal failure in the 8 years interval was similar for
biomedical interventions and treatments, patients who present with heart disease are
both groups. Mortality by Cardiovascular diseases and IHD was higher for PreHT
frequently managed sub-optimally. As a consequence, repeat events often occur. As a
group.
leader in the provision of heart health guidance in Australia, the National Heart
Foundation of Australia is committed to improving access for all Australians to quality
care.
Objectives: To reduce the burden of heart disease by developing a systematic approach to
the timely implementation of best-practice care – The Heart Health Approach (HHA) to
develop relevant care improvement strategies and increased adherence to clinical practice
guidelines.
Methods: The HHA project has applied a quality framework and a system analysis across
the care continuum to identify barriers and enablers to evidence-based care delivery,
including the identification of appropriate data collection tools and outcome measures for
primary and secondary care. Leading experts in the fields of cardiology, primary care
practice and systems redesign have collaborated in these processes.
Results: The barriers and enablers have been identified and articulated utilising a fishbone
diagram (see attached image).
For both primary and secondary care, outcome measures and data have been articulated,
with work commencing on supporting resources. One of these resources is an electronic
tool integrated with existing clinical operating systems, which provides easy access to
clinical practice guidelines, enables data capture facilitating health professionals to deliver
best practice care in a timely manner.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e121

 contraction quality and myocardial deformation capacity in specific subjects and
POSTER ABSTRACTS

groups.
Methods: The study population consisted of 643 male subjects and 335 female sub-
jects, each divided in three age groups: 40-59 years, 60-79 years and 80-99 years. All
subjects, self-supporting and ambulatory consulting because of thoracic pain, underwent
AFI for determination of GLPSS and also for assessment of the average strain of the 5
myocardial segments with the lowest strain values(Avg5LSS). We measured also E/E’
and the sum of the maximal left atrial diameter plus the maximal left ventricle diameter
(LALV).
Results: In all age groups GLPSSavg is in females statistically (p¼0,000) higher than in
males. Also the Avg5LSS is in all age groups statistically higher (p¼0,000) in females.
Although usually without statistically significant differences, there is a tendency to a pro-
gressive decrease of GLPSSavg and Avg5LSS with aging both in females as in males. The
LALV is in all age groups statistically larger (p¼0,000) in males compared with females.
Progressive increase of LALV with aging both in females and in males. Progressive increase
in the E/E’ ratio with aging both in females and in males but no significant differences
between females and males.

Conclusion: Prehypertension increase mortality risk by CVD mainly in persons with other
risk factors. No differences were found in cardiovascular morbidity and mortality by stroke
on renal failure.
Disclosure of Interest: None Declared

PM298
Impact Of Gender On Treatment And Clinical Outcomes In Patients With Acute
Myocardial Infarction In Durres Population
Eliverta Zera*1, Elizana Zaimi Petrela2
1
Cardiology, Regional Hospital, Durres, 2Head of Statistic Service, Faculty of Medicine University
Hospital Center "Mother TERESA", Tirane, Albania

Introduction: CHD is the leading cause of mortality and morbidity in men as well as in
women. Men and women share the same coronary risk factors but ischemic heart
disease appears later in women than in men although this diference reduces and dis-
appears in older age group. Whereas, the cardiovascular death rates are declining in
men,they remain constant in women. However, it remains unclear whether this higher

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mortality is explained by the higher age of females or presence of other risk factors,
notably diabetes.
Objectives: To assess any gender differences on treatment and clinical outcomes in patients
with AMI in Durres population.
Methods: 362 patients consecutive with acute myocardial infarction (AMI) who presented
in the Cardiology Department, Regional Hospital of Durres, Albania between January 2011
to January 2013 were included in the study. The patient characteristics, treatment, and
hospital outcome were collected and validated. In-hospital management and outcomes
were compared between men and women.
Results: Of 362 pts, 129(35.63%) were women and 233 (64.37%) were men. Mean age
in men was 61.08
1.41 and mean age in women was 69.97+8.59.(8 years older than
men) p< 0,001. Women had a higher incidence of diabetes and hypertension(52.7.%
vs.43.7%,p < 0.001 and 64.3% vs.47.7%, p <0.001) and were more obese (59.1%
vs38.8% p < 0.001). Smoking and family risk factor were found in men more than in
women (61.5% vs. 21.1%, p < 0.001 and 33.8% vs.26.4%,p < 0.001). Cardiac dis-
pnea and shock were more frequently in women than men (47.3% vs40.6%). There
was no difference in the treatment with Bblocker, statine, ACEI, and ARB aspirin,
clopidrogel, enoxaparine. No gender diferences in coronary angiografy e PCI (70.6% vs
70.8%) p 0.963. Unadjusted inhospital mortality was significantly higher in women
than in men (22.4% vs.12.7%).
Conclusion: Women with AMI were older and had a higher incidence of hypertension,
obesity and diabetes than men. Women had a higher risk for in-hospital morbidity and
mortality than men. No association was observed between the gender of patients with AMI
and the application of diagnostic or therapeutic procedures.
Disclosure of Interest: None Declared
web 3C=FPO

PM299
Influence Of Aging And Gender In Cardiac Function And Structure By Using Speckle-
Tracking Echocardiography
Jan E. Claessens*1, Philip Claessens2, Christophe Claessens3, Marc Claessens4, Maria Claessens1
1
Cardiology, Cardiological Centre "Kloppend Hart" Schilde-Essen-Antwerpen, Antwerp,
2
Cardiology, AZ Sint Jozef, Malle, 3Internal Medicine, AZ Turnhout, Turnhout, 4Surgery, AZ
Klina, Brasschaat, Belgium

Introduction: In middle age ischemic heart disease is mostly a male problem. Genetic,
hormonal and environmental factors are decisive but intrinsic properties of the myocar-
dium could also be important. There is an increasing need for noninvasive diagnostic
modalities able to objectively quantify myocardial function.
Objectives: Strain measurements gives a correct idea about the contractile reserve
of the myocardium. Automated Function Imaging (AFI) is a novel algorithm based
on speckle-tracking imaging that can be used for assessment of global longitudinal
strain of left ventricle(GLPSSavg) and for differentiation of the intrinsic myocardial
Conclusion: The contractile reserve and the deformation capacities of the left ventricular
myocardial wall measured by GLPSSavg and Avg4LSS are for all age groups higher in fe-
males compared with males, resulting in smaller diameters of left atrium and left ventricle
in the female population. These findings could be an explanatory factor for the lower
incidence of life-threatening arrhythmias and other important cardiac problems in middle-
aged females.
Disclosure of Interest: None Declared

e122 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

PM300
Type of Coronary Artery lesions and The incidence of Total Occlusion in Metabolic
Syndrome Patients
Andhi Purabaya*1, Reggy Lefrandt1, Bambang Budiono2, Agnes L. Panda1, Janry Pangemanan1
1
Cardiovascular dept, Sam ratulangi univ, Manado, 2Cardiovascular dept, Awal bros hospital,
Makasar, Indonesia
Introduction: The Constellation of metabolic abnormalities including centrally distributed
obesity, decreased high-density lipoprotein, elevated triglycerides, elevated blood pressure,
and hyperglycaemia are known as the metabolic syndrome. Metabolic syndrome amplifies
and accelerates the risk of atherosclerosis. Coronary lesions were divided into type A,B,C,
based on AHA Classification. This classification is useful to predict successful rate of
coronary intervention as well as risk stratification for procedural complication and in-
hospital cardiovascular event. Other studies showed that severity of coronary lesions
associated with long-term outcome.
Objectives: To investigate type of coronary lesions and incidence of total occlusion in
patients with metabolic syndrome.
Methods: A Total 129 consecutive patients with or without metabolic syndrome who
underwent coronary angiography were enrolled at January until September 2013. Patients
categorized as having metabolic syndrome when they met the NCEP ATPIII definition for
Asian Population.
Results: From 129 patients, 81 (62%) met the criteria of metabolic syndrome. In patients
with metabolic syndrome, it was found that coronary lesions type A, B, and C were 9,9%,
30,8%, and 59,2% respectively. 34,5% of patients with Type C lesions were total occlusion.
In non-metabolic syndrome patients, It was found that non significant coronary lession,
Type A, B, and C, were 18,7%, 43,7%, 33,3%, and 4,2%, respectively. No total oclussion
lesion was found in non metabolic syndrome patients. It was a significant difference in
coronary lesions severity and incidence of total occlusion between two groups (p <0.001).
Conclusion: Metabolic syndrome was associated with the worse coronary lesions type and
increased incidence of total occlusion.
Disclosure of Interest: None Declared
PM301
Metabolic Syndrome And Psychological Distress
Hamidreza Roohafza1, Masoumeh Sadeghi2, Abdullah Ahmadi1, Nizal Sarrafzadegan*1
1
Isfahan Cardiovascular Research Center, 2Cardiac Rehabilitation Research Center, Isfahan
Cardiovascular Research Institute, Iafahan, Iran, Islamic Republic Of
Introduction: Metabolic syndrome and psychological distress are hypothesized to have a
bidirectional relationship.Thus,appraisal of this theory would be of great clinical and
research interest.
Objectives: This study aimed to associate the relation between MetS and its components
with psychological distress level.
Methods: A total of 9553 men and women aged
19 years were selected from‘‘Isfahan
Healthy Heart Program’’. Measurements consisted of serologic tests, anthropometrics, and
self-reported 12-item general health questionnaire. Logistic regression analysis was used to
find the association between MetS, MetS components, and distress level.
Results: The mean age of participants was 38.7115.8 years. After adjusting for de-
mographic factors, MetS(OR¼1.25,95% CI:1.01-1.37), central obesity(OR¼1.40,95%
CI:1.15-1.49), and hypertension(OR¼1.55,95% CI:1.42-1.70) were associated with high
distress level. After adding smoking status and low-density lipoprotein cholesterol to the
adjustment factors, hypertension(OR¼1.79,95% CI:1.53-1.98) and central
obesity(OR¼1.41,95% CI:1.17-1.55), but not the MetS, remained significantly associated
with distress level.
Conclusion: The results signify the importance of integrating psychological assessment and
intervention in the standard management of MetS patients.
Disclosure of Interest: None Declared
PM302
Age- and Gender- specific Risk Factors of the Left Ventricular Myocardial Relaxation:
Data Obtained thorough Physical Examinations in Healthy Subjects
Haruki Sekiguchi*, Ken Shimamoto, Yufuko Takahashi, Tatsumi Fujio, Eri Watanabe,
Masatoshi Kawana
Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Japan
Introduction: The risks of left ventricular myocardial relaxation have not been reported
across the age and gender spectrum in adults without cardiovascular disease. Previous
studies indicate that adults with metabolic syndrome (MetS) are at higher risk of left
ventricular (LV) diastolic dysfunction. However, little is known about which MetS factors
contribute to the development of LV dysfunction for given ages and gender.
Objectives: To investigate the most significant age- and gender-specific attributable factors
of Mets, cardiovascular disease and major organ dysfunction to LV myocardial relaxation
based on thorough medical examinations in healthy subjects.
Methods: A total of 1055 adults (mean age 6313, 58.8% men) without diabetes mellitus,
systolic dysfunction or other heart disease underwent a thorough physical examination
including tissue Doppler echocardiography. We designated peak early mitral annular ve-
locity (e’) of less than 5.0 to indicate abnormal LV myocardial relaxation (LVMR). We
performed single and multiple logistic regression analyses of e’ and cardiovascular risk
factors, including MetS factors and indicators of major organ dysfunction and evaluated
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
results with regard to three age groups: young (49y), middle-aged (50-69y) and elderly
POSTER ABSTRACTS
(
70y) for both men and women.
Results: Abnormal LVMR (e’<5) was observed in 18.8% of subjects (198/1055).
In men, 21.5% (133/620) of subjects showed abnormal LVMR, and e’ correlated with
abnormal WC (
85 cm) in the age
50, high FPG (
110 mg/dl) in the age < 50, and
renal dysfunction (Ccr<60 ml/min) in the age
70.
In women, 14.9% (65/435) of subjects showed abnormal LVMR, and e’ correlated with
high DBP (
85 mmHg) in the age
50.
Multiple logistic regression analysis indicated that abnormal WC correlated with
abnormal LVMR in both middle-aged and elderly men (odds ratio [OR]; 2.5, 3.7,
respectively, P<0.05). Correlation was also observed between abnormal LVMR and renal
dysfunction in elderly men (OR 3.6, p<0.05). In women, only high DBP in the middle-
aged and elderly groups showed a significant correlation with abnormal LVMR (OR 5.6,
4.3, respectively, P<0.05).
Moreover, 12 (1.1%) subjects were hospitalized for heart failure in follow up; 75% (9/12)
of these had abnormal LV myocardial relaxation.
Conclusion: Risk factors for abnormal LV myocardial relaxation are different in the gen-
eration and gender. These findings from physical examination and routine laboratory ex-
amination are useful for prediction of diastolic heart failure in the medical checkup.
Disclosure of Interest: None Declared
PM303
Gender Differences In Left Ventricular Hypertrophy In Response To Increased Body
Weight
Richmond Jeremy*, Elizabeth Robertson
Medicine, Unversity of Sydney, Sydney, Australia
Introduction: Obesity is associated with left ventricular (LV) hypertrophy. In the
Australian population, mean BMI has increased by nearly 2 kg.m-2 in last 20 years, but the
impact of this weight gain on left ventricular geometry in normal men and women is
undefined.
Objectives: To compare changes in LV mass between males and females, according to
change in BMI over 20 years.
Methods: Parallel cross-sectional studies of patients with normal hearts in 1988-90 (410 M,
519 F) and 2008-1010 (864 M, 1036 F), with echocardiographic measurement of LV wall
thickness and mass.
Results: Mean BMI increased by 2.1 kg.m-2 in males and 1.9 kg.m-2 in females between
1988-90 and 2008-10 and LV mass increased a mean of 22 g in males but only 8 g in
females (p<0.05). Both genders exhibited concentric remodeling: in 1988-90 only 12% M
and 14 % F had a relative wall thickness (RWT) > 0.42 but by 2008-2010, 38% M and
40% F had RWT > 0.42 (p<0.001).
Change from 1998-90 to 2008-10
Males Females
BMI 8.2  3.5 % 7.8  4.7 %
Septum 10.1  2.4% 6.9  2.6 % *
LVPW 9.0  2.8 % 5.4  2.7 % *
LVED -2.4  2.1 % -3.4  1.7 %
LV Mass 8.0  4.9 % 2.2  3.8 % *
LVPW ¼ left ventricular posterior wall; LVED ¼ left ventricular end-diastolic diameter;
* p<0.05 vs males
Conclusion: The general mild to moderate increase in population body weight is associ-
ated with adverse ventricular remodeling in patients with apparently normal hearts and this
remodeling is proportionally greater in males.
Disclosure of Interest: None Declared
PM304
Drinkable Preparation of TheracurminÒ Has a High Absorption Potency in Human -A
Double Blind, Randomized, 4-Way Crossover Study-
Sae Hirano*1,2, Yoichi Sunagawa1,3, Yasufumi Katanasaka1, Osamu Doi4, Tsunehiko Yokoji4,
Hiromichi Wada3, Atsushi Imaizumi5, Tadashi Hashimoto5, Akira Shimatsu6, Hideaki Kakeya7,
Koji Hasegawa3, Tatsuya Morimoto1
1
Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka,
2
Department of Pharmacy, Shizuoka Saiseikai General Hospital, Shizuoka, 3Division of
Translational Research, Clinical Research Institute, Kyoto Medical Center, Kyoto, 4Shizuoka
General Hospital, Shizuoka, 5Proteomics Research Center, Theravalues Corporation, Tokyo,
6
Clinical Research Institute, Kyoto Medical Center, 7Department of System Chemotherapy and
Molecular Sciences, Kyoto University Graduate School of Pharmaceutical Sciences, Kyoto, Japan
Introduction: Curcumin, a major component of Curcuma Longa, has various biological
activities such as anti-cancer, anti-oxidant, and anti-inflammatory, and is expected as a
beneficial agent for lifecycle and circulatory diseases. In our previous study, we also
demonstrated that curcumin improved the development of heart failure in two different
heart failure model rats, hypertension and myocardial infarction. However, its therapeutic
efficiency is limited due to its poor bioavailability. To overcome this problem, we have
e123
 generated curcumin dispersed with colloidal nano-particle, TheracurminÒ which increases
POSTER ABSTRACTS
its oral bioavailability 30-fold higher that curcumin powder in both rats and humans.
However, the comparative study to measure plasma curcumin levels taking TheracurminÒ
and other commercially available curcumin beverages has not been reported.
Objectives: In this study, to evaluate the absorption efficiency of this type of curcumin, we
performed a double-blind, single-dose, randomized, 4-way crossover study.
Methods: Twenty-four volunteers (male/female¼13/11, age 23-32) were divided into four
groups and administrated TheracurminÒ beverage (30 mg) and other 3 drinkable types of
curcumin (Drink A: 30 mg, B: 40 mg, and C: 30 mg) at interval of 1 week. Blood specimens
were obtained immediately at 0.5, 1, 2, 4, and 8 hours after taking them.
Results: At all point, plasma levels of curcumin were higher in TheracurminÒ than Drink
A, B, and C. Plasma maximum concentration values (Cmax) of TheracurminÒ (25.512.2
ng/ml) were higher than those of Drink A (14.95.4 ng/ml), Drink B (8.64.9 ng/ml), and
Drink C (6.73.0 ng/ml), respectively. The calculated AUC at 0-8 hours was significantly
higher in TheracurminÒ (121.265.6 ng/ml) than Drink A (79.531.4 ng/ml), Drink B
(40.924.9 ng/ml), and Drink C (30.114.4 ng/ml). Individual differences in pharma-
cokinetics of curcumin are shared by all 4 types of curcumin beverages.
Conclusion: These findings indicate that our newly prepared TheracurminÒ beverage
exhibits the highest bioavailability among currently available preparations of curcumin.
Thus, TheracurminÒ may be useful to exert its benefits for cardiovascular diseases in
humans at low dosage.
Disclosure of Interest: S. Hirano: None Declared, Y. Sunagawa: None Declared, Y.
Katanasaka: None Declared, O. Doi: None Declared, T. Yokoji: None Declared, H. Wada:
None Declared, A. Imaizumi Employee from: Theravalues Corporation, T. Hashimoto
Employee from: Theravalues Corporation, A. Shimatsu: None Declared, H. Kakeya: None
Declared, K. Hasegawa: None Declared, T. Morimoto: None Declared
PM305
Atherosclerosis, Target Organ Damage in Patients with Metabolic Syndrome and
Hypertension
Sang-Hyun Kim*1, Hyang-Lim Lee2, Yeon Lee2, Young-Joon Seong1, Hack-Lyoung Kim1,
Jae-Bin Seo1, Woo-Young Chung1, Joo-Hee Zo1, Myung-A. Kim1
1
Cardiology, Internal Medicine, Seoul Boramae Hospital, Seoul National University College of
Medicine, 2Internal Medicine, Seoul Bukbu Hospital, Seoul, Korea, Republic Of
Introduction: Metabolic syndrome is the constellation of risk factors of cardiovascular
disease.
Objectives: The metabolic syndrome consists of abdominal obesity, insulin resistance,
glucose intolerance, hypertension, and dyslipidemia. The prevalence of metabolic syn-
drome (MS) in Korea is continuously increasing. Hypertension is a component of metabolic
syndrome and has intimate relations with pathophysiology and clinical importance. The
aim of this study is to evaluate clinical and chemical characters in hypertensive patients
with MS.
Methods: We reviewed medical records of patients with hypertension in BORAMAE
Medical center. Only the patients with metabolic syndrome were included. Anti-hyper-
tension medications were classified according to their action mechanism. The prevalence of
target-organ damage was evaluated, including left ventricular hypertrophy, heart failure,
coronary artery disease, albuminuria, renal failure, carotid atheroma, arterial stiffness, ce-
rebrovascular disease.
Results: Of 155 patients with MS, 66% was obese, 46% had high triglyceride, 61% had
low HDL-cholsterol, 62% was glucose intolerance. ACE inhibitor and angiotension II re-
ceptors blocker (ARB) were used in 86 patients, beta blocker in 34 patients, calcium
channel blocker in 86 patients, diuretics in 25 patients. The prevalence of disease related
with target-organ was 31, 28, 15, 16 events respectively for heart, kidney, peripheral
vessels, brain. 5% of total patients showed left ventricular hypertrophy, 7% showed heart
failure, 10% showed coronary artery disease. 9% of total patients showed micro-
albuminuria, 14% showed decrease of glomerular filtation rate.
web 3C=FPO
e124
Conclusion: The hypertensive patients with MS showed multiple target-organ damage and
need proper management on hypertension, diabetes, dyslipidemia, obesity.
Disclosure of Interest: None Declared
PM306
A User-Centred Design Process Informs The Development of A Web-Based
Cardiovascular Prevention Program
Lis Neubeck*1,2, David Peiris1,3, Genevieve Coorey1, Fred Hersch4, Bindu Patel1,
Marilyn Lyford1, Jax Wechsler5, Lauren Tan5, Julie Redfern1,3
1
Cardiovascular, The George Institute for Global Health, 2Sydney Nursing School, 3Sydney
Medical School, The University of Sydney, Sydney, Australia, 4Essential Healthcare, The George
Institute for Global Health, Oxford, United Kingdom, 5Sticky Design Studio, Sydney, Australia
Introduction: Cardiovascular disease (CVD) is the leading killer globally and secondary
prevention substantially reduces risk. However access to preventive programs is low,
leading to development of alternative models of care.
Objectives: To inform the development of a web-based preventive program integrated with
general practitioner (GP) record systems, we undertook a collaborative user-centred design
process to understand the needs of patients with prior CVD event and those at high risk of CVD.
Methods: A five stage iterative process was utilised involving seven multidisciplinary cli-
nicians and academics (GP, public health nurses and allied health professionals), two
strategic design consultants and nine proposed end-users. The two-month process
included (i) literature search and competitor review; (ii) face-to-face interviews, (iii) end-
user diary studies, (iv) user experience strategy workshops and (v) co-design and prototype
validation activities with prospective users. This work enabled deep understanding of user
contexts, specifying the user and organisational requirements, and producing increasingly
detailed designs and prototypes.
Results: We reviewed ten related apps/websites and 15 observational and interventional
studies in a half-day workshop and derived a set of core components and ideal features for
the system. These included the need for interactivity, visual appeal, credible information,
virtual rewards and need for emotional and physical support. Four ‘personas’ and two
customer journey frameworks were consequently developed. These personas were used as
a starting point and were then iteratively refined based on user research. The following
three features were identified as essential: (i) both mobile and web-enabled ‘apps’, (ii) an
emphasis on medication management, and (iii) strong psychosocial support component.
Subsequent workshops (n¼6; 2 x 1.5 hours) informed the development of functionality
and lo-fidelity sketches of interfaces for the tool. These ideas were next tested in focus
groups with patients (n¼9; 3 x 1.5 hours). Finally, prototypes of increasing fidelity were
developed emphasising workflow of the application, including language, navigation and
labels, and specifics features e.g. tracking bio-metric data.
Conclusion: End-users of web-based CVD preventive programs have complex needs
including physical and psychosocial support. A user-centred design process aided the
integration of these needs into the development and refinement of our web-based appli-
cation for prevention of CVD.
Disclosure of Interest: None Declared
PM307
Higher Adherence to a Western Type of Diet is Associated With Higher Probability of
Severe Coronary Artery Disease
Eleni Kokkou1, Dimitris Tousoulis*2, Gerasimos Siasos2, Evangelos Oikonomou1,
Stamatios Kioufis1, Marina Zaromitidou1, Konstantinos Maniatis1, Savvas Mazaris1,
Nikolaos Gouliopoulos1, Theodosia Konsola1, Konstantinos Zisimos1, Panagiotis Tourikis1,
Vasiliki Genimata3, Christodoulos Stefanadis1
1
1st Cardiology Department, University of Athens Medical School, “Hippokration” Hospital,
2
1st Cardiology Department, University of Athens Medical School, “Hippokration” Hospital,
Athens, Greece, 3University of Athens Medical School, “Hippokration” Hospital, Athens,
Greece
Introduction: The association of dietary pattern with cardiovascular disease is well
established.
Objectives: In this study we examined the association between different dietary patterns
and the severity of coronary artery disease (CAD).
Methods: The study population consisted of 188 consecutive symptomatic CAD patients
recruited from the outpatient clinic of our Hospital. All patients underwent coronary
angiography and they were categorized in subjects with one, two or three vessel disease
(1VD, 2VD, 3VD respectively) and in subjects with LM disease. Accordingly, patients with
LM disease (stenosis
50%), 3VD, or 2VD marked by stenosis of the proximal left anterior
descending artery
70% were characterized as having angiographically severe CAD.
Among several other demographics and clinical characteristics all subjects were tested with
a validated semi quantitative food frequency questionnaire. Univariate and multivariate
(principal components analysis) analyses were used in order to evaluate the relationship
between dietary habits and the severity of CAD, adjusting for potential confounders.
Results: There was no statistically significant difference in the presence of diabetes mellitus,
hypertension, hyperlipidemia, family history of CAD and smoking habits between patients
with severe and non-severe CAD. Body mass index did not differ between patients with
severe and non-severe CAD (29.113.52 vs. 27.694.50, p¼0.11). After adjusting for all
traditional risk factors, an increase in red meat consumption lead to a 47% increase in the
probability of having severe CAD (p<0.01). Moreover, dietary pattern consisting of high
consumption of red meat, sweets, pasta, potatoes and low consumption of fruits and
vegetables was associated with higher probability of having severe CAD (p<0.01). This
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
association between "Western type" diet and severe CAD was also evident even after
adjustment for several cardiovascular risk factors (OR¼1.9, p¼0.022).
Conclusion: Dietary patterns affect the progression and severity of CAD. Western type diet
is associated with the extent of CAD independently from traditional cardiovascular risk
factors. Further studies are needed to elucidate the impact of different dietary patterns on
cardiovascular health.
Disclosure of Interest: E. Kokkou Grant/research support from: Onassis Foundation, D.
Tousoulis: None Declared, G. Siasos: None Declared, E. Oikonomou: None Declared, S.
Kioufis: None Declared, M. Zaromitidou: None Declared, K. Maniatis: None Declared, S.
Mazaris: None Declared, N. Gouliopoulos: None Declared, T. Konsola: None Declared, K.
Zisimos: None Declared, P. Tourikis: None Declared, V. Genimata: None Declared, C.
Stefanadis: None Declared
PM308
Effects Of Coq10 Supplementation On Serum Lipoprotein, Il-6, Icam-1 And Plasma
Fibrinogen In Hyperlipidemic Patients With Myocard Infarctionqqaa`
Farzad Shidfar*, Mona Mohseni, Mohammadreza Vafa, Seyedjavad Hajmiresmail
nutrition, Iran University of Medical Sciences, Tehran, Iran, Islamic Republic Of
Introduction: Dyslipidemia,inflammation and hypercoagulation are the major risk factors
for cardiovascular diseases.
Objectives: The Effects of CoQ10 supplementation on serum lipoprotein, Il-6, ICAM-1
and plasma fibrinogen in hyperlipidemic patients with myocard infarction.
Methods: In a double blind placebo controled clinical trial,52 hyperlipidemic patients with
myocard infarction and age range of 35-70 years were randomly allocated to receive daily
200 mg CoQ10 or placebo for 3 months.Fasting blood, Physical activity and daily dietary
intake were obtained at beginning and end of 3 months.SPSS version 18 were used for
statistical analysis.
Results: At the end of study in CoQ10 group,There were significant decrease in total
cholesterol(TC),Triglyceride(TG),LDL-c, LDL-c/HDL-c and TC/HDL-c(p<0.05), IL-
6(p<0.001) and ICAM-1(p<0.001) and significant increase in HDL-c(p<0.05) compare to
beginning of study.At the end of study there were significant decrease in LDL-c/HDL-c (
p<0.05), TC/HDL-c ( p<0.05),IL-6 (p<0.001), ICAM-1 (P<0.001) and significant in-
crease in HDL-c(p<0.05) compare to placebo group.
Conclusion: 200 mg daily CoQ10 for 3 months may have favorite effects on serum li-
poproteins and inflammation indicators but no effect on fibrinogen and may be benefical in
myocard infarction patients.
Disclosure of Interest: None Declared
PM309
Urinary Na & K Excretion Among Egyptians (Salt Survey; Pilot study)
Ghada Youssef*, Dalia El Remaisy, Ghada Reda, Wafaa El Aroussy, Mohsen Ibrahim
Cardiology, Cairo University, Cairo, Egypt
Introduction: It is known that moderate salt intake is associated with the lowest risk of
cardiovascular events. There is a general agreement that Na reduction is appropriate for
persons with hypertension. There is no clear recommendation regarding salt reduction
and primary prevention of cardiovascular diseases. No recent available data about salt
intake among sample of Egyptians. No available data about source of salt intake in
Egyptian food. Urinary Na excretion may be a practical method to estimate the dietary
salt intake.
Objectives: Study the pattern of Urinary Na & K excretion in a drug naïve sample of
Egyptians and to correlate Urinary Na & K levels with demography.
Methods: Normal, drug-naïve Egyptians were included in the study. Height, weight and
waist circumference were measured and body mass index (BMI) was calculated. Blood
pressure and heart rate were measured using Omron 6 machine; three readings were taken
and averaged. Subjects were asked about the pattern of their usual diet by a specific
questionnaire. A morning drop up urine sample is used to evaluate 24 hours urinary Na
(24HUNa) and K (24HUK) excretion.
Results: A total of 379 subjects were included, 171 (45.1%) were males. The mean age
was 40.110.2 years. The mean BMI was 30.07.1 Kg/m2 and the mean waist
circumference was 99.713.7 cm. The mean systolic (SBP) and diastolic (DBP) blood
pressures were 119.016.0 mmHg and 81.511.0 mmHg, respectively. The mean
24HUNa excretion was 327.865.9 mmol and the mean 24HUK excretion was
99.524.2 mmol. A 24HUNa excretion showed a weak negative correlation with age
(r¼0.25, p<0.001), SBP (r¼0.05, p¼0.4) and DBP (r¼0.03, p¼0.7) and weak positive
correlation with BMI (r¼0.33, p<0.001) and waist circumference (r¼0.33, p<0.001). A
24HUNa excretion was higher in males (p¼0.006), workers (p<0.001) and university
grade subjects (p<0.001). A 24HUK excretion showed a weak negative correlation with
age (r¼0.06, p¼0.2), SBP (r¼0.04, p¼0.5) and DBP (r¼0.02, p¼0.7) and weak positive
correlation with BMI (r¼0.25, p<0.001) and waist circumference (r¼0.29, p<0.001). A
24HUK excretion was higher in urban inhabitants (p¼0.013) and university grade
subjects (p¼0.028).
Conclusion: The 24HUNa and 24HUK excretions were high among sample of Egyptians.
Males, workers, urban residents and well educated subjects showed higher 24HUNa and K
excretion.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM310
POSTER ABSTRACTS
The efficiacy and safety of a chest pain protocol for short stay unit patients- a one year
follow-up
Geraldine Lee*1, Biswadev mitra2
1
School of Nursing & Midwifery, King’s College London, London, United Kingdom, 2Emergency
Department, Alfred Hospital, Melbourne, Australia
Introduction: The Alfred Emergency Short Stay Unit (ESSU) initiated a chest pain protocol
for patients with acute chest pain stratifying them as low-to-intermediate risk for Acute
Coronary Syndrome (ACS). These low-to-moderate risk patients underwent stress testing
prior to discharge. A thirty-day follow-up of 300 patients demonstrated no deaths or ACS.
The protocol was efficacious and safe in the short term (i.e. one month follow-up).
Objectives: A one year follow-up was undertaken to evaluate the long-term efficacy of the
chest pain protocol.
Methods: Patients were contacted by telephone to document adverse cardiac and non-
cardiac events in the previous 12 months.
Results: A total of 224 patients (75%) were contacted 12 month following discharge. There
was one death from a stroke (0.4%) and another from an unknown cause and five patients
had been diagnosed with atrial fibrillation (2.2%). Three patients had an acute myocardial
infarction (1.3%) and four more were diagnosed with angina (1.8%). Nearly half (n¼101)
had returned to the emergency department (ED) for various conditions and of these, 42
patients experienced further chest pain and returned to ED for treatment. A total of 96 had
specialist referrals: thirty four had cardiology referrals (15%) and twenty five patients had
gastroenterology referrals. Cardiac investigations undertaken included angiograms (n¼10),
24-hour tapes (n¼17), 24-hour blood pressure monitoring (n¼4) and thallium scans
(n¼5).
Conclusion: The study demonstrated that the risk stratification of patients deemed at low-
to-intermediate risk of ACS had a low risk of adverse events 12 months after discharge but
significant healthcare utilization was observed for chest pain.
Disclosure of Interest: None Declared
PM311
Reported Alcohol Intake, Control Of Risk Factors And Mortality In Patients With
Stable Manifest Vascular Disease
Otto Mayer*1, Katarina Timoracka1, Jan Bruthans1
1
2nd Dept. of Internal Medicine, Charles University, Medical Faculty, Plzen, Czech Republic
Introduction: Mild alcohol intake were in several epidemiological studies associated with
modest mortality benefit. However, we have limited data in this context from secondary
prevention of cardiovascular disease.
Objectives: We aimed to prove the association between reported weekly alcohol intake
and control of risk factors, quality of life and all-cause mortality in subject with clinical
coronary of cerebrovascular disease.
Methods: 820 patients after myocardial infarction, coronary revascularization or first
ischemic stroke were examined in 2006-2007 as Czech sample of EUROASPIRE III a
EUROASPIRE- stroke surveys. Alcohol intake was established using one week recall,
vital status and cause of death up to May 31, 2012 using Czech Registry of
Inhabitants.
Results: In total sample, 43.9% were abstainers, 39.5% reported mild alcohol intake (ie. up
to 308g of ethanol) and 16.6% moderate (or even heavy) intake. Among these categories,
the prevalence of obesity and increased waist circumference significantly decreased [42.8
vs. 35.2 and 32.6 resp, and 62.3 vs. 49.8 and 52.2% resp.]. Mild drinkers showed better
control of hypercholesterolemia, than abstainers (53.7% of LDL>2.5 vs. 62.9%], while
blood pressure and glucose metabolism remained uninfluenced. Significantly lower were in
mild drinkers also the prevalence of raised BNP, subclinical depression and impaired
quality of life by SF score. 5-year all-cause mortality decreased among alcohol intake
categories [23.6 vs 19.8 and 14.7%], but after adjustment to age, gender and primary
diagnosis these differences lost the statistical significance. After complex adjustment in
multiple logistic step-wise regression following parameters were signicantly associated with
mild alcohol intake: male gender (odds ratio 1.82), BMI>30 (OR 0.61), depression (OR
0.55) and BNP>150 (0.54).
Conclusion: Mild alcohol intake showed rather neutral effect on conventional risk profile
of cardiovascular patients, even from point-of view of mortality. However, it was associated
with better quality of life and surprisingly with lower prevalence of heart failure.
Disclosure of Interest: None Declared
PM312
Epicardial Adipose Tissue In Children Is Associated With An Unfavorable
Cardiometabolic Risk Profile, But Is Not A Stronger Indicator Than Bmi
Ingrid Schusterova*1, Frans Leenen2, Jana Saligova1, Mialn Kuchta1, Ludmila Potocnakova1
1
II. department of pediatric and adolescent’s medicine, Medical Faculty, P.J. Safarik University
and Children Faculty Hospital, Kosice, Slovakia, 2Hypertension, University of Ottawa Heart
Institute, Ottawa, Canada
Introduction: Epicardial adipose tissue (EAT) is the visceral fat deposit around the heart
and is commonly increased in obese subjects. EAT is related to cardiometabolic risk factors
and non-alcoholic fatty liver disease (NAFLD) in adults, but this relationship is not well
known in children.
e125
 Objectives: The aim of our study was to assess by echocardiography the EAT in overweight
POSTER ABSTRACTS
and obese children and its relationship to cardiometabolic risk factors, insuline resitance,
NAFLD markers and hyperuricemia.
Methods: In 25 (mean age 13.0  2.3) overweight and obese subjects and 24 lean controls,
blood pressure (BP), WC, fasting plasma glucose and insulin, lipids, uric acid and hepatic
enzymes were estalished and EAT thickness measured by transthoracic echocardiography.
Results: In overweight and obese subjects, EAT was significantly higher compared to
normal weight children. Overweight and obese children had significantly higher body mass
index (BMI), WC, BP, triglycerides (TAG), low-density lipoprotein and total cholesterol,
hepatic enzymes alanine aminotransferase (ALT) and g-glutamyl transferase, and lower
high-density lipoprotein cholesterol (HDL-C). EAT correlated significantly with BP, TAG,
uric acid, HDL-C, apoprotein B and ALT. Correlation coefficients were similar or better
than for WC, but similar or lower than for BMI.
Conclusion: EAT thickness in children is associated with an unfavorable cardiometabolic
risk profile including biochemical signs of NAFLD and hyperuricaemia, but is not a
stronger indicator than BMI.
Disclosure of Interest: None Declared
PM313
From the Couch to the Cuff: The Relationship between Physical Activity levels
and Blood Pressure in Older Australians
Alan Pierce*, Walter P. Abhayaratna
Academic Unit of Internal Medicine, Canberra Hospital, Canberra, Australia
Introduction: National Physical Activity Guidelines recommend that older Australians
undertake 30 minutes of moderate intensity physical activity (PA) on most days of the
week. However, the evidence to support these guidelines is lacking. In particular, there is
little evidence to support the claim adherence to these guidelines results in better control of
CVD risk factors such as systemic hypertension in the long-term.
Objectives: We sought to identify the relationship between PA levels amongst older
Australians and changes in blood pressure (BP) over time. Specifically, we evaluate whether
recommended PA levels suggested in the National guidelines have an effect upon future BP.
It is hypothesised that achieving adequate levels of PA recommended by the Australian
National Guidelines will be protective against the changes in BP associated with ageing.
Methods: In a population-based prospective cohort study, PA levels were assessed using
the Active Australia Survey. Brachial blood pressure was measured in accordance with
National Heart Foundation guidelines. The effects of PA on systolic BP (SBP), diastolic BP
(DBP) and pulse pressure (PP) after a median follow-up period of 7 years were assessed.
Results: Of the 1302 participants (69 9 years; 53% women), 609 (46.8%) had hyper-
tension at baseline. At follow-up assessment, SBP, DBP and PP increased by 16.9  21.5
mmHg, 3.4  11.6 mmHg and 13.5  18.2, respectively. In bivariate analysis, baseline PA
(p<0.05) and change in PA time from baseline to follow-up had an inverse relationship
with SBP and PP at follow-up and positive relationship with DBP. After adjustment for age
and gender, the association between baseline PA time and SBP (p¼0.63), DBP (p¼0.63),
and PP (p¼0.30) was attenuated. While not significant statistically, those who engaged in
“insufficient” and sufficient” PA levels at baseline had an attenuated increase in SBP
(p¼0.49) and PP (p¼0.14), and an attenuated decrease in DBP (p¼0.12) with ageing.
Conclusion: In this population-based sample of older Australians, the positive effects of
baseline PA and change in PA over time on future SBP, DBP and PP were attenuated by the
effects age and gender. There was no evidence that adherence to current National Physical
Activity Guidelines was associated with lower levels of BP in the future.
Disclosure of Interest: None Declared
PM314
Association of muscle strength with markers of cardiovascular risk in young adults
Robinson Ramírez-Vélez*1, Hector R. Triana-Reina2
1 earlier age than people of Caucasian (Cau) origin.
Facultad de Cultura Física, Deporte y Recreacion, Universidad Santo Tomas, Bogota,
2
Departamento de Educación Física y Deporte, Universidad del Valle, Meléndez, Cali, Colombia
Introduction: Physical fitness is one of the strongest predictors of individual future health
status. Together with cardiorespiratory fitness (CRF), muscular strength has been
increasingly recognized in the pathogenesis and prevention of cardiovascular disease.
Objectives: To assess the association between muscle strength and early cardiovascular risk
(CVR) markers in young adults.
Methods: Cross-sectional study including 176 university students, 18-30 years old, from
Cali, Colombia. Body mass index and fat percentage were calculated, and waist circum-
ference, grip strength by dynamometry, systolic blood pressure, diastolic blood pressure,
mean arterial pressure, and CRF by VO2max were measured as CVR markers. A multivariate
logistic regression analysis was used to assess associations between muscle strength and
CVR markers.
Results: Inverse correlations were found between muscle strength and adiposity (r¼-.317;
P¼.001), waist circumference (r¼-.309; P¼.001), systolic blood pressure (r¼-.401;
P¼.001), and mean arterial pressure (r¼-.256; P¼.001). Subjects with lower levels of
muscle strength had a 5.79-fold (95% CI 1.57 to 9.34; P¼.008) risk of having higher
adiposity levels (
25%) and a 9.67-fold (95% CI¼3.86 to 19.22; P<.001) risk of having
lower CRF values for VO2max (31.5mL$kg$min-1).
Conclusion: In young adults, muscle strength is associated to early manifestations of CVR.
It is suggested that muscle strength testing is added to routine measurement of VO2max and
traditional risk factors for prevention and treatment of cardiovascular risk.
Disclosure of Interest: None Declared
e126
PM316
Depression, Chronic Stress, Or Both, And Cardiovascular Risk Factors: A Cross
Sectional Study Among Urban Subjects In India
Rajeev Gupta*1, Sonia Suchday2, Krishnakumar Sharma3, Balkishan Gupta4, Vijay Achari5,
Jitendra Singh6, Anil Bhansali7, Arthur Asirvatham8, Rajababu Panwar9, Prakash Deedwania10
1
Medicine, Fortis Escorts Hospital, Jaipur, India, 2Ferkauf Graduate School of Psychology, Albert
Einstein College of Medicine, New York, United States, 3Fortis Escorts Hospital, Jaipur, 4SP
Medical College, Bikaner, 5Patna Medical College, Patna, 6Government Medical College, Jammu,
7
Postgraduate Institute of Medical Education and Research, Chandigarh, 8Madurai Medical
College, Madurai, 9Rajasthan University of Health Sciences, Jaipur, India, 10University of
California San Francisco, Fresno, United States
Introduction: Association of psychological factors with cardiovascular risk has not been
well reported from low and lower-middle income countries such as India.
Objectives: To determine association of depression, chronic stress, or both with cardio-
vascular risk factors we performed a population-based study in India.
Methods: Study was performed at eleven cities in India using population-based cluster
sampling. Overall 6198 subjects were recruited, details of psychological factors were
available in 5234 (84.4%, men 2891, women 2343). Subjects were evaluated for socio-
demographic, lifestyle, anthropometric and biochemical factors. Prevalence of depression
or stress (work, home or financial for
12 months) was determined using validated criteria.
Cardiovascular risk factors were defined according to standard guidelines. Associations
were determined using X2 test and logistic regression. Odds ratios (OR) and 95% confi-
dence intervals (CI) were calculated.
Results: Age-adjusted prevalence (%, 95% CI) in men and women, respectively, was
depression 23.5 (21.9-25.0) and 24.7 (23.1-26.3), home-related stress 56.0 (54.2-57.8)
and 60.5 (58.5-62.5), work-related stress 46.3 (44.5-48.1) and 36.5 (34.5-38.4), financial
stress 54.4 (52.6-56.2) and 55.5 (34.5-38.4), all three in 30.7 (29.0-32.4)and 23.8 (22.1-
25.5), and all three with depression in 11.3 (10.1-12.4) and 7.8 (6.7-8.9). In subjects
with depression vs without, prevalence was significantly greater for physical inactivity
(men 46.6 vs 36.4, women 51.9 vs 45.5), high waist-hip ratio (men 80.2 vs 67.2,
women 88.5 vs 83.4), low HDL cholesterol (men 37.7 vs 32.3, women 58.1 vs 52.0),
and diabetes (men 17.5 vs 15.5, women 14.5 vs 12.4) (p<0.05). There was no signif-
icant difference in smoking, overweight/obesity, hypertension, high total cholesterol or
high triglycerides. Subjects with various forms of stress had greater prevalence of physical
inactivity, truncal obesity, low HDL cholesterol, diabetes and metabolic syndrome (ORs
1.22-2.19, p<0.05). Subjects with all three stressors with depression had greater prev-
alence of physical inactivity, low HDL cholesterol and metabolic syndrome (ORs 1.36-
2.27, p<0.05).
Conclusion: Depression, chronic stress, or both are associated with decreased physical
activity and greater truncal obesity, low HDL cholesterol and diabetes. This association can
explain greater cardiovascular risk in these subjects.
Disclosure of Interest: None Declared
PM317
Lipoprotein(a) and CETP in South Asians and Caucasians at risk for cardiovascular
disease
Reyhana Yahya1, Henk Roeters Van Lennep*1, Sjaam Jainandunsing1, Rajiv Biharie1,
Jeanette Touw1, Marieke Boon2, Patrick Rensen2, Felix de Rooy1, Eric Sijbrands1,
Adrie Verhoeven1, Jeanine Roeters van Lennep1, Monique Mulder1
1
vascular medicine, Erasmus Medical Centre, Rotterdam, 2endocrinology, Leiden University
Medical Center, Leiden, Netherlands
Introduction: People of South Asian (SA) origin develop obesity, metabolic syndrome,
Type 2 Diabetes Mellitus (T2D) and as a consequence cardiovascular disease (CVD) at an
SA display more severe dyslipidaemia than Cau with higher levels of Lipoprotein(a)
(Lp(a)). Lp(a) is an independent risk factor for CVD, but the underlying mechanisms
remain unclear. Plasma Lp(a) levels are mostly genetically determined, but can also be
affected by specific environmental factors and some drugs. SA have higher levels of Lp(a)
than other ethnicities. SA are also more prone to develop obesity, metabolic syndrome,
T2D, more severe dyslipidaemia and CVD than Cau. Once the have developed T2D, they
have a higher morbidity and mortality than other ethnicities.
Objectives: to assess whether Lp (a) is related to CVD risk in SA and Cau at risk for (T2D)
Methods: We recruited in total 31 SA and 42 Cau T2D patients and their normoglycemic
and pre-diabetic relatives, based on an Oral Glucose Tolerance Test. Lipoprotein profile
including Lp(a) and Cholesteryl Ester Transfer Protein (CETP) levels were determined in
fasting plasma.
Results: Lp(a) (after log transformation) strongly correlated with age in both SA
(r¼0.459;p¼0.009) and Cau (r¼0.315;p¼0.042) even after correction for fasting glucose
levels. CETP correlated negatively with age (r¼-0.394;p¼0.001) in Cau but not in SA.
Lp(a) inversely correlated with CETP (r¼0.241;p¼0.04), in the total population but no
longer after correction for age.
Conclusion: Although Lp(a) levels are assumed to be stable over life-time, we found that
Lp(a) significantly increased with age and fasting glucose. Lp(a) inversely correlated with
CETP, which disappeared when corrected for age. Our data are suggestive of an interaction
between Lp(a) and CETP which is in line with the observation that CETP-inhibitors reduce
Lp(a) levels.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM318
Variation in care between English speaking and culturally and linguistically diverse
patients in SNAPSHOT ACS
Karice Hyun*1,2,3, Julie Redfern1,2,3, Bernadette Aliprandi-Costa4, John French5, Greg Gamble6,
Karen Lintern7, Tegwen Howell8, Robyn Clark9, Kannikar Wechkunanukul9, David Brieger3,4,
SNAPSHOT ACS Investigators
1
The George Institute for Global Health, 2Sydney Medical School, 3The University of Sydney,
4
Department of Cardiology, Concord Hospital, 5Department of Cardiology, Liverpool Hospital,
Sydney, Australia, 6Department of Medicine, University of Auckland, Auckland, New Zealand,
7
Agency for Clinical Innovation, Sydney, 8Qld Snapshot Co-ordinator, Brisbane, 9Flinders
University, Adelaide, Australia
Introduction: The provision of equitable acute coronary syndrome (ACS) care in Australia
and New Zealand requires an understanding of the sources of variation in the provision of
this care. Previous studies have suggested that there are differences in treatment and
outcomes of culturally and linguistically diverse (CALD) patients, possibly due to their
proficiency in English.
Objectives: To compare the variation in care between English speaking and CALD ACS
patients admitted to Australian and New Zealand hospitals.
Methods: Demographics and medical data from 4398 suspected or confirmed ACS patients
from 478 hospitals were collected bi-nationally from 14-27 May 2012. We compared
hospital care and outcomes according to primary language spoken at home (English v not
(CALD)) using c2 tests, odds ratios (ORs) and the corresponding 95% confidence intervals
(95% CI).
Results: The 294 CALD patients were older (7113 years v 6615, p<.001), had higher
prevalence of hypertension (71% v 63%, p¼0.004), hyperlipidaemia (62% v 54%,
p¼0.010), diabetes (40% v 24%, p<0.001) renal impairment (16% v 11%, p¼0.006) and
lower smoking prevalence (14% v 18%, p¼0.001) compared to the 4104 English speaking
patients. Both groups had similar median of symptom onset to hospital presentation time
(4.2 v 2.8 hours, p¼0.889). Once in hospital, there were no differences in time to
reperfusion for patients with STEMI or receipt of coronary angiography (53% v 57%,
p¼0.293), percutaneous coronary intervention (30% v 32%, p¼0.699) or coronary artery
bypass graft surgery (6% v 7%, p¼0.539) among all patients with ACS. CALD patients
received less aspirin at discharge (66% v 72%, p¼0.042), and there were no differences in
prescription of other evidence based discharge medications. Median length of stay was
longer for CALD patients (74 v 59 hours, p¼0.019), and they were less likely to be referred
to outpatient cardiac rehabilitation (24% v 30%, p¼0.038). Following adjustment by
GRACE risk score CALD patients had higher in-hospital death (OR:2.1, 95% CI:1.1-4.2;
p¼0.025), in hospital cardiac arrest (OR:2.5, 95% CI:1.3-4.5; p¼0.004) and acute renal
failure (OR:1.8, 95% CI:1.1-3.0; p¼0.031).
Conclusion: CALD patients tend to present later to hospital than English speaking pa-
tients. Although process measures of care are similar, in hospital outcomes are worse. These
findings highlight an important area of public health that require greater scrutiny.
Disclosure of Interest: None Declared
PM319
Assessment of left ventricular mechanics using speckle tracking imaging
echocardiography in young women with abdominal obesity
Bianca L. Share*1, Geraldine Naughton1, Philippe Obert2, Edward Crendal1, Justin Kemp1
1
School of Exercise Science, Australian Catholic University, Melbourne, Australia, 2Laboratory of
Cardiovascular Pharmacology, University of Avignon, Avignon, France
Introduction: Cardiovascular abnormalities are often described in obese adults but less so
in young women. Speckle tracking imaging echocardiography (STE) has been shown to
detect subtle changes of subclinical myocardial dysfunction and may be more sensitive to
cardiac dysfunction in young women than conventional and tissue Doppler imaging (TDI)
echocardiography.
Objectives: To demonstrate differences in left ventricular (LV) myocardial mechanics using
two-dimensional STE in a cross-section of young women; with and without abdominal
obesity (AO).
Methods: Thirty-nine young women (18-30 years) with AO (waist circumference (WC)

80 cm), and 33 controls (WC < 80cm) underwent conventional and TDI echocardiog-
raphy. STE measures included LV longitudinal and circumferential strain and strain rate
(SR), and rotational mechanics. Cardiometabolic risk factors included anthropometry,
blood pressure, carotid artery intima-media thickness, blood biochemistry and fitness.
Independent t-tests compared means between groups.
Results: Compared with controls women with AO had a 20 cm greater WC, 26 kg heavier
body mass, and a 10 kg.m2 great body mass index (P < 0.05). Women with AO also
demonstrated 27% lower fitness and 62% less weekly physical activity (P < 0.05). Blood
biochemistry differences showed women with AO had higher fasting insulin, HOMA-IR
and high sensitivity C-reactive protein (P < 0.05). Using conventional echocardiography,
women with AO revealed a dilated left atrium (P ¼ 0.022) and impaired LV diastolic
parameters [decreased E, Em, and increased E/Em, IVRT and DT (P <0.05)] compared with
controls. Although these values do not fall within a clinically significant range, statistical
significance was supported by moderate effect sizes. LV ejection fraction was similar be-
tween groups (P ¼ 0.074), but systolic tissue velocity was impaired in AO (P < 0.05).
From STE, only longitudinal strain and diastolic SR were lower in women with AO than
controls (P < 0.05).
Conclusion: Findings from conventional and TDI echocardiography are consistent with
previous research showing decreased LV diastolic function but preserved systolic function
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
in individuals with obesity. The use of STE revealed more subtle changes in LV function.
POSTER ABSTRACTS
Young women with AO showed impaired LV longitudinal myocardial function but pre-
served circumferential deformation indexes and rotational mechanics.
Disclosure of Interest: None Declared
PM320
Multiorgan versus single organ atherosclerotic disease as a risk factor for
cardiovascular events in patients with end-stage renal disease
Luis Henrique Wolff Gowdak*1, Flavio J. de Paula2, Luiz Antonio M. Cesar1,
Luiz Aparecido Bortolotto1, Jose Jayme G. de Lima1
1
Heart Institute (InCor), University of Sao Paulo Medical School, 2Renal Transplant Unit,
Hospital das Clinicas, Sao Paulo, Brazil
Introduction: Patients(pt) with end-stage renal disease (ESRD) have an increased risk of
major adverse cardiovascular events (MACE) mainly due to atherosclerotic disease. It is
unknown whether the risk of MACE is dependent on the presence of, or the extension of
atherosclerotic vascular disease (AVD) in this high-risk population.
Objectives: To determine the long-term risk of MACE in pt with ESRD according to the
number of AVDs present at baseline.
Methods: 1,016 pt with ESRD on dialysis (5311 years-old, 60% men, 34% with diabetes)
were prospectively enrolled. At baseline, a detailed medical history and a careful physical
examination were recorded for each pt in order to identify any AVD such as previous
myocardial infarction, stroke, or peripheral artery disease. Based on the number of clinically
identifiable AVDs, pt were classified as low- (no AVD; n ¼704), intermediate- (one AVD;
n¼246) or high-risk (at least 2 AVDs; n¼66). Kaplan-Meier curves were constructed for
the probability of survival free of fatal/non-fatal MACE during a median follow-up of 30
months (range¼1 to 107).
Results: There were 210 (20.7%) fatal/non-fatal MACE; low-risk pt had the lowest inci-
dence of MACE (15.3%) compared to intermediate- (30.9%) and high-risk (39.4%) pt (P <
0.0001). There was no difference in the probability of being event-free between pt at in-
termediate- and high-risk groups (P¼ 0.19). The presence of a single AVD carried a 2.4-
fold (CI95% 1.7-3.4; P < 0.0001) increase in the risk of MACE compared to pt with no
disease. Figure 1 shows the cumulative survival probability in each group during follow-up.
web 3C=FPO
Conclusion: In this large cohort of pt with ESRD, it was the presence of, and not the
extension of clinically manifest atherosclerotic disease, that imposed a worse long-term
prognosis compared to pt with no disease.
Disclosure of Interest: None Declared
PM322
Clinical value and application of endothelial function assessment in metabolic
syndrome patients without coronary heart disease: results of the 2-year prospective
study
Olga Polikina*, Igor P. Bobrovnitsky
Russian Scientific Centre for Medical Rehabilitation and Balneology, Moscow, Russian
Federation
Introduction: Patients both with different risk factors for coronary heart disease (CHD)
and metabolic syndrome are known to have increased carotid artery (CA) intima-media
complex thickness (IMT) index, comparing to healthy subjects. Recently, the significant
correlation between IMT, changes in flow-mediated dilatation (FMD) of the brachial artery
(BA), different CHD risk factors and such important components of metabolic syndrome
(MS), as insulin resistance and hyperglycaemia was shown. Nevertheless, the relationship
between IMT and FMD and their role in atherogenesis are still ill defined.
Objectives: Our aim was to investigate the dynamics of IMT and number of newly found
CA atherosclerotic plaques (ASP), as well as the number of cardiovascular (CV) events in
patients with normal and lowered FMD.
Methods: Study group comprised of 107 men and women with lowered FMD (less then
5%) and 181 subjects (92 men and 89 women) with normal FMD (more, then 5%), 31–52
years of age. At baseline all the participants have undergone clinical examination according
to standardized protocol, including physical examination, blood samples for lipid profile
e127
 and glucose levels. Using high definition ultrasound IMT was measured and CA ultrasound
POSTER ABSTRACTS
scan was performed. All patients were followed up for two years.
Results: At two-years visit in patients with initially lowered FMD the IMT increase was
significantly higher, then in those with normal FMD at baseline (delta S 5.39% vs 1.12%,
p 0.0001, respectively). In the group with initially lowered FMD number of newly found
ASP was 37 (34.6%), whereas in group with initially normal FMD there were only 23 new
cases (12.2%). No fatal CV events were observed in either groups, although there were
non-fatal ones in the group with initially lowered FMD.
Conclusion: There is a positive correlation between initially impaired (lowered) FMD and
increased IMT and higher number of new ASPs in the CA after two years follow-up. We
recommentd endothelial function assessment as an easily performed, non-expensive and
very informative screening test for subjects with metabolic syndrome.
Disclosure of Interest: None Declared
PM323
Prediction of cardiovascular and all-cause mortality at 10 years in the hypertensive
aged
Quan Huynh*1, Enayet K. Chowdhury2, Molla M. Huq2, Baki Billah2, Christopher M. Reid2,
Mark R. Nelson1
1
Menzies Research Institute Tasmania, University of Tasmania, Hobart, 2Monash University,
Melbourne, Australia
Introduction: Most of the scores for predicting mortality in people without prior cardio-
vascular events are based on middle-aged populations. Given the increasing number of
elderly people, many of whom have hypertension, a risk score relevant to them is needed.
Objectives: We have previously developed a score for predicting cardiovascular events in
this population. In this study, we aimed to extend this work by developing a risk score to
predict 10-year cardiovascular and all-cause mortality in the hypertensive aged and
examine its internal validity.
Methods: This study used 10-year follow-up data of 5378 hypertensive participants in
the Second Australian National Blood Pressure study who were aged 65-84 years at
baseline (1995-2001) and free from prior cardiovascular events. Our risk score model
was developed by Cox regression on 1000 bootstrapped samples from the database
and selecting the model that provides variables with the lowest AIC and BIC, and
highest C-Statistics. Internal validation was also undertaken using bootstrap sampling
methods.
Results: The final model of all-cause mortality included age, sex, alcohol consumption,
smoking, socio-economic status, body mass index, statin use, and blood glucose (C-Sta-
tistic was 0.6829). The final model of cardiovascular mortality included age, sex, alcohol
consumption, smoking, waist-hip ratio, socio-economic status, diabetes and being physi-
cally active (C-Statistic was 0.712). The C-Statistic for bootstrap validation was 0.678 (all-
cause mortality) and 0.707 (cardiovascular mortality).
Conclusion: This prediction score provides a direct estimation of cardiovascular and all-
cause mortality for hypertensive aged individuals. It remains to be compared to existing
models and externally validated.
Disclosure of Interest: None Declared
PM325
Cardivascular risk factors in young adult university students in Nairobi, Kenya
Elijah N. Ogola*1, Boniface W. Machira1, Mark D. Joshi1, Eraustus Njeru2
1
Clinical medicine and therapeutics, 2School of public health, University of Nairobi, Nairobi,
Kenya
Introduction: Cardiovascular diseases (CVD) are rapidly increasing in Africa due to
epidemiologic transition. Many risk factors are acquired in chidhood and early adult-
hood. University students are exposed to multiple lifestyle influences. Understanding
the dynamics of risk factors in this population provides a platform for early
intervention.
Objectives: To determine the prevalence of CVD risk factors in Universty of Nairobi
students.
Methods: A cross sectional survey was done using the WHO STEPs questionnaire. BP;
weight and height for BMI and non fasting sugar were measured. Fasting lipid profile was
done in a subsample. Descriptive statistics such as means, proportions and frequecy dis-
tributions were used. Associtions were analyzed using student’s t test or chi square as
appropriate.
Results: 768 students were studied. Median age was 22 years (IQR 20-23), 64% were
male. Prevalence of hypertension was 13.7% (CI 11.2-16.6), all but 3 were newly diag-
nosed. Overweight was 12.55% (CI 10.1-15.4) and obsity 1.9% (CI 1.05-3.2).Females
were more likely to be overweight: 28.6% vs. 6.8% (OR 5.5, CI 3.5-8.6).Current smokers
were 8.2% (CI 6.3-10.5), all were male.There were 3 diabetics, 2 previously diagnosed.
Alcohol use was 51.2% (CI 46.2-56.5).There was a higher male prvalence: 56.4% (CI 50-
63.4) vs. 41.8% (CI 34.5-50.2). Twenty (17 males, 3 females) engaged iin hazardous
drinking (2.6% -CI 1.6-4.0).A subsample of 91 had fasting lipid profile. By ATP III criteria
48.4% and 42.9% had elevated total and LDL cholesterol respectively. Confidence in-
tervals were at 95%.
Conclusion: We demonstrate a high prevalence of CVD risk factors in a young population.
This implies high lifetime risk exposure.University students are exposed to various lifestyle
choices in the setting of newly found autonomy.They are also seen by their peers as role
e128
models. These data suggest need for concerted efforts at risk factor intervention in this
group of young adults.
Disclosure of Interest: None Declared
PM326
Stent technology is a strong driver of coronary artery revascularisation procedure
rates in Western Australia: trends 1981-2011
Frank Sanfilippo*1, Jamie Rankin2, Matthew Knuiman1, Michael Nguyen3, Tom Briffa1,
Mark Newman4, Elizabeth Geelhoed1, Don Cutlip5,6, Michael Hobbs1
1
School of Population Health, University of Western Australia, 2Cardiology, Royal Perth Hospital,
3
Cardiology, Fremantle Hospital, 4Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth,
Australia, 5Harvard Clinical Research Institute, 6Beth Israel Deaconess Medical Centre, Harvard
Medical School, Boston, United States
Introduction: Coronary artery revascularisation procedures (CARP) are the main inter-
ventional treatment for coronary artery disease and have evolved with time. Trends in rates
of CARP at the population level, particularly after the introduction of drug eluting stents
(DES), are largely undocumented in Australia.
Objectives: To investigate the changing trends in CARPs from 1981 to 2011 in Western
Australia.
Methods: We used records of hospital admissions from the Western Australian Data
Linkage System to identify all admissions for CARPs in people aged 35 years or over
during 1981 to 2011. Age-standardised rates of admission for CARPs were calculated in
males and females separately by the direct method using the Western Australian resi-
dent population at 30 June 2006 as the standard. The proportion of DES use was
calculated from cardiology registers and medical notes in hospitals in which CARPs are
performed.
Results: Age-standardised rates of CARP have more than doubled since 1981 from 195
per 100,000 person-years in males and 37 per 100,000 person-years in females to 557
and 165 per 100,000 person-years, respectively, in 2011. Coronary artery bypass graft
(CABG) rates peaked in 1993 at 305 and 82 per 100,000 person-years in males and
females, respectively, but then steadily declined to 100 and 25 per 100,000 person-
years, respectively, in 2011. Rates of percutaneous coronary intervention (PCI) increased
rapidly following the introduction of bare metal stents (BMS) in 1992 and surpassed
those for CABG in 1995. A second period of accelerated growth in PCI rates occurred
following the introduction of DES in 2002. DES comprised 26% of total stent use in
2002, increasing rapidly to 96% by 2005 then falling to 88% in 2006, 68% in 2009
and increasing again to 83% by 2011. Decreasing use of DES in 2006-2009 followed
publication of registry data suggesting an increased risk of stent thrombosis. More
recent increases in DES rates followed publication of trials for the current generation of
DES, with one year risk of stent thrombosis of <1% and very low risk of late stent
thrombosis.
Conclusion: Age-standardised rates of CARP have steadily increased in Western Australia
since 1981. The introduction of BMS in 1992 and of DES in 2002 were associated with
periods of accelerated growth in total CARPs. Adverse publicity for DES contributed to a
transient decline in use of DES between 2006-2009, but DES remains the primary inter-
ventional technology for coronary revascularisation.
Disclosure of Interest: None Declared
PM327
Attributable Risk of Coronary and Cerebrovascular Disease Risk Factors: 5 year
follow-up of 9,700 subjects in Chile (FONIS SA09I222)
MTeresa Lira*1,2, Sonia Kunstmann2,3, Gloria Icaza4, Loreto Nuñez5, MCristina Escobar6,
Daniela Gainza7, JAndrés de Grazia8
1
Clinical Research Unit, Hospital Fuerza Aérea de Chile, 2Cardiology Department, Clínica Las
Condes, 3Medicine Faculty, Universidad de los Andes, Santiago, 4Public Heath Department,
5
Public Heatlh Department, Universidad de Talca, Talca, 6Cardiovascular Health Program,
Ministry of Health, 7Universidad de los Andes, 8Universidad de Chile, Santiago, Chile
Introduction: Understanding the contribution of risk factors (RF) for coronary and cere-
brovascular events may aid to tailor individual and population preventive strategies more
efficiently. Determining the attributable risk of classic RF in different populations is key to
identify susceptible individuals more accurately.
Objectives: To estimate attributable risk and population attributable risk of classic risk
factors for Coronary Heart Disease (CHD) and Ischemic Cerebrovascular Disease (ICD).
Methods: A population of 9790 subjects (35-74y) free from CHD and ICD was
screened for cardiovascular RF in 2002 using standard methods. A total of 8224
(84%) were successfully contacted to evaluate the incidence of coronary or ce-
rebrovascular events in a 5 year period. From them, 147 suffered coronary events
and 73 ischemic cerebrovascular events. Attributable Risk (AR) and Population
Attributable Risk (PAR) were estimated. P value of comparison of survival free of
events between exposed and non exposed to the RF was calculated (Log Rank
Test).
Results: A total of 3975 men (48.3%) and 4249 women (51.7%) mean age 50.3 
10.1 were follow-up for 5y. (Mean 4.7y. 37,470 y/person) Abnormal Waist Circum-
ference (M>95, W>82) evidenced an AR of 37.1% and a PAR of 26.9% for CHD (p¼
0.008), but was not significant for ICD (p¼ 0.93). Kaplan-Meier curves for survival free
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

of events showed that for Diabetes and Hypertension curves between exposed and non
exposed separate early, in Abnormal Waist Circumference and excess weight the rate of
events are similar in early stages and the curves start to separate later. Smoking curves
stay together and showed no significant differences in the events rate in the period
observed.
Conclusion: In this population, Hypertension and Diabetes add significant risk of suffering
a CHD or ICD event in short term follow-up. At a population level Hypertension accounts
for 1 out of 4 coronary events and at least 1 in 3 isquemic cerebrovascular events.
Abnormal Waist Circumference constitutes a significant RF for CHD. Compared with the
AR and PAR of other risk factors, Smoking appears not to be a significant RF in short term.
More analysis is required in long term follow up.
Disclosure of Interest: None Declared
PM328
AMI Performance Measures in Primary PCI in South Australia
Rosanna Tavella*1,2, Chris Zeitz1, Margaret Arstall1,3, Derek Chew4,5, Stephen Worthley1,6,
Matthew Worthley1,6, John Beltrame1,2
1
Discipline of Medicine, The University of Adelaide, 2Department of Cardiology, The Queen
Elizabeth Hospital, 3Department of Cardiology, Lyell McEwin Hospital, 4School of Medicine,
Flinders University, 5Department of Cardiovascular Medicine, Flinders Medical Centre,
6 Conclusion: In Chest Pain in Korean Women’s Registry, conventional predictors of CAD
Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
Introduction: The American College of Cardiology and American Heart Association (ACC/
AHA) have established clinical performance measures for patients admitted with an acute
myocardial infarction (AMI) but these have not been formally assessed in an Australian
population. Within an evolving culture from Australian health authorities to quantify the
delivery of ‘quality care’ within the universal public health system, registry data provides
opportunities to assess these measures.
Objectives: To evaluate the ACC/AHA AMI performance markers in a population of AMI
patients undergoing primary percutaneous coronary intervention (PCI) in South Australian
major public hospitals.
Methods: The Coronary Angiogram Database of South Australia (CADOSA) is a
comprehensive registry of all public cardiac catheterization procedures performed in South
Australia (SA). Data for 2012 ST-elevation AMI (STEMI) patients undergoing primary PCI
was used to evaluate the application of best treatments and strategies.
Results: In 2012, there were 355 STEMI patients who underwent primary PCI at an SA
tertiary hospital. Of these, 22% were female and mean age was 6212 years. Aspirin on
arrival to hospital was observed in only 29% of patients, however at discharge, 91% of
patients were prescribed aspirin, and 88% received other anti-platelet therapy including
clopidgorel, prasugrel or ticagrelor. Dual antiplatelet management was observed in 86% of
patients. Additional performance measures are described below in table.
Primary PCI Patients (n[355) Performance Measures in SA Hospitals
Beta Blocker at Discharge 58%
Statin at Discharge 87%
LV Systolic Function Evaluation 30%
ACE-I or ARB Discharge 82%
Cardiac Rehab Referral 72%
Bleeding Event 4%
Conclusion: Many of the international, evidenced-based performance measures were
achieved in more than half of the STEMI patients presenting to South Australian public
hospitals. However, further improvement could be achieved to ensure optimal quality care
in these patients.
Disclosure of Interest: None Declared
PM329
Clinical usefulness of treadmill test in Korean women with chest pain: Chest Pain in
Korean Women’s Registry
1 2 2 3 4 1
Yong-Hyun Kim , Wan-Joo Shim* , Seong-Mi Park , Yong J. Kim , Kyoung I. Cho ,
Myung A. Kim5, Hyun J. Yoon6, Gil J. Shin7, Yun K. Cho8, Sung E. Kim9, Kyung S. Hong10,
Jin-Oh Na11, Mi-Seung Shin12, on behalf of Chest Pain in Korean Women’s registry
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
1
Cardiovascular division, Korea university Ansan hospital, Ansan, 2Cardiovascular division,
POSTER ABSTRACTS
Korea University Anam Hospital, 3Cardiovascular center, Seoul national unversity hospital,
Seoul, 4Cardiovascular center, Koshin university Gospel hospital, Bu-san, 5Cardiovascular center,
Seoul national university Boramae hospital, Seoul, 6Cardiovascular center, Chonnam university
hospital, Gwang-ju, 7Cardiovascular center, Ewha university Mokdong hospital, 8Cardiovascular
center, Gangnam Cha hospital, 9Cardiovascular center, Kangdong Sacred Heart hospital, Seoul,
10
Cardiovascular center, Chuncheon Sacred Heart hospital, Chuncheon, 11Cardiovascular center,
Korea university Guro hospital, Seoul, 12Cardiovascular center, Gachon university Gil hospital,
Incheon, Korea, Republic Of
Introduction: Chest pain in women seems to have different features from that in man.
Objectives: Chest Pain in Korean Women’s Registry was established in 2011 to elucidate
unique features of chest pain in women. We evaluated clinical usefulness of treadmill test
(TMT) with the registry data.
Methods: 758 subjects were registered by July, 2013. We reviewed demographic charac-
teristics including obstetric history as well as echocardiographic/angiographic data in 457
patients with available TMT results and evaluated clinical usefulness of TMT in this
population.
Results: Mean age of the patients was 58.010.8. Sixty five patients (14.2%) had diabetes
mellitus (DM) and 183 patients (40.0%) had hypertension. Between patients with positive
(n¼160) and negative TMT results (n¼297), there was no difference in age, blood pressure
at rest, prevalence of DM/hypertension and obstetric history. However, patients with
positive TMT had more exertion-related pain (p¼0.000) and dyspnea (p¼0.040), took
more aspirin (p¼0.023) and clopidogrel (p¼0.001), but less gastrointestinal drugs
(p¼0.040), took exercise more regularly (p¼0.007), and had higher systolic blood pressure
during TMT (p¼0.015). 430 patients underwent coronary angiography and 45 (10.4%), 43
(10.0%) and 42 patients (9.8%) showed mild, moderate and severe coronary artery ste-
nosis, respectively. Significant coronary artery disease (CAD) was defined, when they had
moderate to severe coronary artery stenosis and there were 241 patients with negative TMT
and no CAD, 104 with positive TMT and no CAD, 32 with negative TMT and significant
CAD, 53 with positive TMT and significant CAD. Treadmill test had 62.4% of sensitivity
and 69.9% of specificity in detecting significant CAD (AUC in ROC curve was 0.661).
such as age, DM, hypertension were not different between patients with positive and
negative TMT. TMT showed moderately strong sensitivity and specificity in detecting
significant CAD in this population.
Disclosure of Interest: None Declared
PM331
Influence of post-smoking cessation weight gain on atherogenic a1-antitrypsin-low
density-lipoprotein
Maki Komiyama*1,2, Syuichi Ura1, Hiromichi Wada1, Hajime Yamakage Yamakage1,
Noriko Asahara1, Sayaka Shimada1, Akira Shimatsu1, Hiroshi Koyama1, Koichi Kono2,
Yuko Takahashi3, Koji Hasegawa1
1
Kyoto Medical Center, National Hospital Organization, Kyoto, 2Department of Hygiene and
Public Health, Osaka Medical College, Osaka, 3Nara Women’s University, Nara, Japan
Introduction: The cardiovascular risk decreases after quitting smoking, while, in many
cases, the body weight increases in the early period after smoking cessation. We previously
reported that such weight gain were significantly correlated with triglyceride, HDL-C, daily
cigarette consumption and the Fagerström Test for Nicotine Dependence (FTND) score,
and that a high FTND score was the most relevant factor. We also reported that the serum
level of a1-antitrypsin low-density-lipoprotein (AT-LDL) complexdoxidatively modified
LDL that accelerates atherosclerosisdis high in current smokers, and that the level rapidly
decreases after smoking cessation. However, the effects of post-smoking cessation body-
weight gain on this cardiovascular marker are unknown.
Objectives: We investigated the effects of post-smoking cessation body-weight gain on AT-
LDL.
Methods: In 91 outpatients (64 males, 27 females) who successfully quit smoking, serum
AT-LDL was measured using the enzyme-linked immunosorbent assay.
Results: For all persons who successfully quit smoking, serum AT-LDL significantly
decreased 3 months after the first examination (post-smoking cessation period) (P<0.01).
The mean BMI increased 1.5% on average (p<0.01) in the post-smoking cessation period.
Looking at post-smoking cessation period changes in serum AT-LDL values by separate
body mass index (BMI) increases, in the group with a BMI increase of more than the
average, no significant changes were found, but a significant decrease (P<0.01) was found
in the group with a BMI increase of less than the average. A significant positive correlation
was noted between DBMI and DAT-LDL (r¼0.258, p¼0.013).
Conclusion: The findings of the present study suggest that a decrease in serum AT-LDL
after quitting smoking is inhibited by a post-smoking cessation BMI increase.
Disclosure of Interest: None Declared
PM332
Nicotine impairs cardiac function in healthy rats: Comparison between low and
moderate doses
Satirah Zainalabidin*1, Anand Ramalingam1, Siti Balkis Budin1, Norsyahida M. Fauzi2
Program of Biomedical Science, School of Diagnostic and Applied Health Sciences, Faculty of
Health Sciences, 2Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur,
Malaysia
e129
 Introduction: Nicotine is a key player in progression of smoking-related cardiovascular
POSTER ABSTRACTS
diseases. Studies have well-established its vascular effects, which predominantly
involved in development of vascular endothelial dysfunction, atherosclerosis and hy-
pertension. However, its cardiac effects are still less studied. There is insufficient data to
describe role of nicotine in smoking-induced ventricular remodeling. It is also impor-
tant to note that no studies have been done to evaluate effects of low-to-moderate dose
of nicotine exposure on cardiac function in absence of any underlying cardiovascular
symptoms.
Objectives: To compare the chronic effects of nicotine, under conditions mimicking
circulating levels of nicotine in light and moderate smokers on rat cardiac function.
Methods: Healthy male Sprague-Dawley rats were divided into three groups (n ¼ 8
per group). Rats are given either saline as control, 0.6 mg/kg nicotine (low-dose) or
1.2 mg/kg nicotine (moderate dose) via intraperitoneal injection for 28 days. Upon
sacrifice, hearts were excised and perfused retrogradely using Langendorff technique
for assessment of contractile function. Hearts were then kept frozen for biochemical
analysis.
Results: Isovolumetrically-beating isolated hearts from nicotine groups were present with
markedly smaller index of left ventricle developed pressure (Low ¼ 53.86  6.68; Mod-
erate ¼ 51.42  9.46 mmHg) than control (61.64  3.87 mmHg). Similar pattern was
seen for its derivatives, dP/dt. However, rate-pressure product (RPP), indicative of
myocardial workload was higher in nicotine groups (Low ¼ 23.97  2.36; Moderate ¼
25.30  3.12 x1000 mmHg.beats/min) as compared to control (21.94  4.26 x1000
mmHg.beats/min). Lipid peroxidation was high in both nicotine groups at mitochondrial
and cytosolic fractions. Yet, activity of antioxidant enzymes, superoxide dismutase (SOD)
and glutathione peroxidase (GPx) were significantly altered in mitochondrial fractions only.
The left ventricle mass was significantly increased in both nicotine groups compared to
control.
Conclusion: Taken together, nicotine exposure at both low-to-moderate doses promotes
pathological ventricular remodeling with contractile dysfunction, even in absence of any
underlying cardiomyopathy. Future studies are recommended to characterize nicotine-
induced damage to cardiac mitochondria, as a potential target for drug discovery.
Disclosure of Interest: None Declared
PM333
Tobacco Control Challenges In Eritrea With a Focus in Schools
Zemuy G. Abraha*
Pharmacy, Boots apotek Norge, Hamar, Norway
Introduction: The prevalence of non-communicable disease is increasing globally. Eritrea
is not different from the rest of the world in this regard. Tobacco use is a recognized risk
factor for the most of these diseases, especially cardiovascular disease. Tobacco use is
reducing among the developed countries as compared to the rise in the developing
countries.
Objectives: The purpose of the study was to assess the impact of tobacco control proc-
lamation 143/2004 with regard to smoking ban in schools. No assessement was made on
the proclamation implementation before.
Methods: A systematic review was carried out to evaluate the change in prevalence over a
period of 2005 til 2009. The time period was limited to 2009 because no further studies
were carried out with regard to tobacco use from 2009 til now.
Results: The prevalence of tobacco use study 2004 among the general population was
8.1%. The global youth tobacco survey (GYTS) 2005 among students aged 13-15 showed
6.6%. Studies carried out in 2009 among students also showed that 6% of them use
tobacco.On the contrary the high prevalence of tobacco use 12% among school personnel
based on study made in 2009 can negatively affect the effort of tobacco control on the
schools.And another study made i 2009, tobacco use among health professionals also
showed that it was 7%. The trend of tobacco use among the various population groups was
at its steady state. Especially the studies of tobacco use among students in the 2005 and
2009 seemed to be on a steady state.When compared the tobacco use in Eritrea among
students and general population is not quite different although the studies were carried out
at different time periods. This attributes to the poor implementation and systematic
approach towards tobacco control among the schools in the country.
Conclusion: This study showed that there is still a challenge in the implementation of the
tobacco control proclamation issued in 2004. Efforts must be made to benefit the use of the
existing proclamation. On the other hand the lack of ratification of Framework Convention
on Tobacco Control is still a challenge for the effective implementation of the tobacco
control program in Eritrea. Therefore a sensitisation of the policy decision makers to ratify
FCTC would play an important role in reducing the use of tobacco control in the general
population and particularly among the school aged groups. The implementation of school
based tobacco control implementation could have a paramount impact on reducing to-
bacco use in Eritrea.
Disclosure of Interest: None Declared
PM337
Relationship of age and underweight with systolic and diastolic blood pressure, pulse
pressure and heart rate among blacks schoolchildren in Central Africa Country
Bertrand F. Ellenga Mbolla*1, Thierry R. Gombet2, Annie R. Okoko2,
Christian M. Koula Landa3, suzy-Gisèle Kimbally-Kaky2, Benjamin Longo-Mbenza4
1
Medecine, Faculty of Health Sciences, Marien Ngouabi University, 2Marien Ngouabi University,
Faculty of Health Science, 3Cardiology, University hospital of Brazzaville, Brazzaville, Congo,
4
Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
e130
Introduction: Underweight is a public health problem in sub-Saharan Africa. It has an
impact on the change in blood pressure and heart rate (HR).
Objectives: To determine the prevalence of underweight and his relationship between age
and systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) and
HR among schoolchildren in Brazzaville
Methods: This is a case-control study, conducted from March to May 2011 in Brazzaville.
We had radomn the children in five representative schools. 603 children divided to 325
girls (54%) and 278 boys (46%) were included. The mean age was 11.8  3.6 years (range
5-18 years).The students were divided in two groups, the underweight and others. The
underweight was define by BMI < 2SD curves for age.
Results: 62 cases of underweight (10.3%, 95% CI: 8 to 13.1) including 29 girls (8.9%) and
33 males (11.9%) (p> 0.05) were noted. The mean age of underweight was 11.6  3.3
years vs 11.8  3.7 years (p> 0.05). The average of SBP, DBP and PP in underweight
children was lower (p> 0.05) than others. The averages of the different parameters were
significantly different according to age groups (p <0.001). SBP, DBP and PP in children
with underweight as for others, evolved increasing with age (figure), while the average HR
was higher in underweight children (p> 0.05), and waned in gradually with age (figure). In
multivariate analysis by logistic regression, any variables were independant to underweight:
SBP (b coeff¼0.152 ;p¼0.172), DBP (b coeff¼0.147 ;p¼0.192), PP (b coeff¼0.133
;p¼0.229), HR (b coeff¼0.011 ;p¼0.309).
web 3C=FPO
Conclusion: blood pressure levels are lower among students with underweight in Braz-
zaville, while their FC is higher. These parameters change with age for all students.
Although the variables studied are lower (SBP, DBP, PP) or higher (HR) in children with
underweight, they do not have a strong relationship with underweight.
Keywords: underweight, blacks children, school, blood pressure, heart rate, Congo
graph I: evolution of mean of SBP (a), DBP (b), PP (c) et HR (d) by age
A: < 8 years
B: 8-11,9 years
C: 12-15,9 years
D: > 16 years
Green: underweight
Blue: others
Disclosure of Interest: None Declared
PM339
Kilojoule labelling in Australia: a public health outcome of advocacy, policy,
legislation and collaboration
Barbara Eden*1, Lisa Szabo2, Samantha Torres2, Ian Caterson3, Jo Mitchell4
1
Cardiovascular Health, Heart Foundation, 2NSW Food Authority, 3The Boden Institute of
Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, 4Centre for Population
Health, NSW Ministry of Health, Sydney, Australia
Introduction: Chronic disease, including cardiovascular disease (CVD), is a leading cause
of premature death and disability in Australia with 62.8% of adults being either overweight
or obese. The 2012 National Health Measures Survey indicates that being overweight or
obese increases the likelihood of abnormal CVD risk biomedical results. Research indicates
that people significantly underestimate the energy/kilojoules (kJ) in food and that eating
fast food is associated with weight gain.
Objectives: Our advocacy aimed to establish healthy public policy and legislation for
nutrition labelling in fast food chains. Being informed about the nutrient content of foods
enables consumers to make informed decisions about what they purchase from fast or
snack food outlets.
Methods: Through a number of advocacy strategies during 2009, including meetings with
key advocates, the NSW Government held a Food Forum in 2010. This meeting initiated
the collaborative and consultative processes which engaged key sectors, including gov-
ernment, food industry, academic institutions, and public health and consumer organi-
sations in the development of the legislation and regulations, as well as the implementation
and evaluation phases of the kJ labelling initiative in NSW. A consumer education
campaign with social media was developed and implemented during 2012 and an evalu-
ation strategy was developed for the whole initiative. This included measuring awareness
and influence of kJ labelling and supporting educational tools via online and store intercept
surveys.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: The introduction of legislation was very rapid – first drafted in August 2010;
enacted in November 2010; became law in February 2011; kJ appeared on menu
boards in about 2800 NSW fast and snack food outlets by February 2012; and in
supermarkets by February 2013. In all 39 food chains implemented kJ labelling with
only one significant non-compliance issue. Consumers increasingly noticed the new
information, reported an increased influence of kJ on food choice and almost 100,000
downloaded the 8700 app. Kilojoule labelling has extended beyond NSW state borders
to all Australia.
Conclusion: While kJ labelling alone is not the silver bullet in obesity prevention, out-
comes show that policy and legislation can be part of a suite of initiatives implemented
centrally for public health benefit. The multi-sector collaboration, consumer campaign and
evaluation are central to the ongoing success of this initiative in Australia.
Disclosure of Interest: None Declared
PM340
Point-of-care testing for the screening of dyslipidaemia: Final results of a three-year
independent evaluation protocol
1 1 2 1
Elena Matteucci* , Luca Della Bartola , Luca Rossi , Ottavio Giampietro
1
Clinical and Experimental Medicine, Pisa University, 2Clinical Pathology, AOUP, Pisa, Italy
Introduction: Hyperlipidaemia is a major modifiable risk factor for coronary artery disease.
Point-of-care testing (PoCT) for the analysis of lipid panels may improve risk stratification
in primary prevention. Quality control is required to ensure that PoCT laboratory testing is
high quality and cost effective.
Objectives: The aim of this study was to evaluate the accuracy and precision of PoCT
devises for lipid screening compared with laboratory lipid test results in healthy subjects
and patients with dyslipidaemia.
Methods: In three years, several CardioChek PA Analysers (CCPA; PTS, Indianapolis,
USA), which employ light reflectance to measure total cholesterol, HDL cholesterol and
triglycerides in whole blood, were evaluated. PTS, for its part, was engaged to improve
instrument performance characteristics. At the final evaluation, fasting venous samples
from 783 subjects were analysed on both CCPA and the routine clinical laboratory assay
(COBAS 6000, Roche Diagnostics, Milano, Italy). Fasting finger-stick samples of 152
volunteers were also analysed. Precision was calculated by performing 10runs of fresh
venous blood samples from different subjects on the same instrument; different levels of
cholesterol and triglycerides were studied.
Results: Initial CCPA evaluation showed poor estimated agreement for repeated mea-
surement data with a wide dispersion across the zero-difference line. At the final eval-
uation, there was no significant difference between portable measurements of lipids vs.
clinical laboratory results. Capillary values of total cholesterol, HDL cholesterol, and
triglycerides well correlated with laboratory results on venous blood (r 0.95-1.0,
p<0.001). Within-run variation coefficient (CV) of total cholesterol (range 114-276 mg/
dl) was 1.70.6%, CV of HDL cholesterol (27-90) was 4.31.7%, CV of triglyderides
(65-209) was 3.11.5%. The values of lipids on different CCPA devices as well as
different strip lot numbers were consistent among themselves and with the laboratory
results.
Conclusion: Our data show that current CCPA devices provide sufficiently high-quality
results to be used as in programmes aimed at the early identification of dyslipidaemia
through population-wide, targeted, or opportunistic screenings.
Disclosure of Interest: None Declared
PM341
Knowledge and Attitude of Hypertension and Its Therapy Among Hypertensive
Patients in Rural Community in Low-Income Country, Indonesia: Internship Study
Felix Chikita Fredy*1, Devi Felicia1, Alexandra Gabriella2, Bhayu Hanggadhi Nugroho3,
Dexanda Pravian4, Gracia Lilihata4, Joshua Patrick Mulyadi5,
Nurnajmia Curie Proklamartina6, Ratna Andriyati4, Sarah Febiana Rahayu7, Vincent Kane8
1
Internship Doctor, Sangatta General Hospital, Sangatta, 2Internship Doctor, Robert Wolter
Mongisidi General Hospital, Manado, 3Internship Doctor, Kupang General Hospital, Kupang,
4
Internship Doctor, Tanjung General Hospital, Tanjung, 5Internship Doctor, Singaraja General
Hospital, Singaraja, 6Internship Doctor, Kanujoso Dhatiwibowo General Hospital, Balikpapan,
7
Internship Doctor, Mukomuko General Hospital, Mukomuko, 8Internship Doctor, Leuwiliang
General Hospital, Bogor, Indonesia
Introduction: Worldwide approximately 2 of 5 adults had been diagnosed with hyper-
tension. The prevalence’s found higher in low-income countries because of the higher
numbers of undiagnosed, untreated, and uncontrolled cases and the weak health system.
Whatsoever control strategy is being taken, the patients’ participation itself is of utmost
importance, which will depend largely on their level of knowledge and attitude.
Objectives: To assess the knowledge and attitude of hypertensive patients in rural com-
munity in low-income country, Indonesia, towards hypertension and its therapy.
Methods: Subjects were people with hypertension from the Internship Study carried out in
8 primary health care and 8 tertiary hospitals in 7 provinces in Indonesia. The data were
collected from subjects using comprehensive questionnaire guided by interviewers.
Bivariate analysis was conducted to find any factors significantly influencing the level of
knowledge and attitude of the subjects.
Results: The present study included 184 people with hypertension (41.8% males; median
age 56). Median systolic and diastolic were 150 (100-250) and 90 (70-180) mmHg. Almost
all subjects considered taking drugs as most important thing in keep their blood pressure
controlled. However, correct rate answers for when and how long drugs should be taken
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
were 60.9% and 20.7%. There was only 4.3% who answered correctly what the target of
POSTER ABSTRACTS
blood pressure must be achieved. Only 37.0% could remember the name of their anti-
hypertensive drug. About 67.9% agreed that hypertension can be cured totally. Health care
providers was the common source of such knowledge being reported by 113 (61.4%)
subjects, yet ironically only 12 (6.5%) subjects admitted ever got adequate information
from health care providers. Overall level of knowledge and attitude were poor (70.7%) and
average (53.8%). The knowledge score was influenced by the presence of family history of
hypertension (p¼0.002), previous information from health care providers (p¼0.002), and
educational background (0<0.001) and the attitude score was influenced by sex (p¼0.03),
previous hypertension information from health care providers (p¼0.04), and educational
background (p¼0.001).
Conclusion: Level of knowledge and attitude of hypertension and its therapy are poor and
average. More efforts are needed to improve patients’ knowledge and attitude of hyper-
tension and its therapy.
Disclosure of Interest: None Declared
PM342
The SMART choice: There is an inverse relationship between low socioeconomic
statues and SMART phone usage
Kim Lamont*1, Kerstin Klipstein2, Karin Sliwa3
1
Internal Medicine, Soweto Cardiovascular Research Unit, Wits University, 2Public Health, Wits
University, Johannesburg, 3Medicine, Hatter Institute of Cardiovascular Research, UCT, Cape
Town, South Africa
Introduction: Mobile health (mHealth) is evolving as a valuable tool to advance healthcare
access in areas of limited access to health services. Limited access is associated with poor
antenatal care, and maternal and perinatal mortality. Evidence provided show that SMS
services facilitate access and wide dissemination of health information as proposed by
programs implemented in Zanzibar, Tanzania (Wired Mothers), the United States
(Text4Baby), in which gestational period specific sms’s messages are sent to subscribed
women to provide educational material.
Objectives: To determine availability, affordability and accessibility of cell phone usage in
pregnant women in Soweto, South Africa for cell phone based ANC support. Soweto
consists of 1.1 million blacks and represents the largest black community in this sub-
Saharan nation. There have been changes in both the socioeconomic and demographic
environment which has led to epidemiological transition.
Methods: A questionnaire on cell phone availability, affordability and use was developed
and piloted in pregnant women residing in Soweto. Subsequently the questionnaire was
applied in 50 women to investigate cell phone use in relation to socio-economic status.The
study is on-going and will be tested on 100 women.
Results: As evaluated by the questionnaire administered 59.86.5% of the pregnant
women that visit the clinic are unemployed. The age group of interest are between 257.3
years and have been pregnant before 31.2 times. Most women visit the clinic for the first
time at 28 8.2 weeks into their pregnancy. 725.3% of pregnant women would like to
receive health information via sms, 52% of the pregnant women would like this infor-
mation to be consolidated on the Health Education Africa site (http://www.hedu-africa.org/)
in the form of videos. Interestingly, we established that 70% of the women possessed SMART
phones (price range of R1000-3000), even though the average income ranges between
R2000-R5000 per month.
Conclusion: There is an inverse association between socio-economic statues and the use of
SMART cell phones as demonstrated by average income versus average cost of the SMART
phones utilised. All pregnant women that visited the clinic have a cell phone. These women
would be interested in receiving SMS’s with educational information regarding pregnancy
and health. Many pregnant women in the Soweto population would benefit from such a
mHealth program.
Disclosure of Interest: None Declared
PM343
Physical inactivity and arterial stiffness did not change after a lifestyle educational
and counselling intervention
Lucimere Bohn*, Helena Leal, Ana Ramoa, Norton Oliveira, Gustavo Silva, Jose Oliveira
Faculty of Sports, Oporto University, Porto, Portugal
Introduction: Physical inactivity and arterial stiffness have been identified as cardiovascular
risk factors. Primary prevention should identify the individuals at risk and promote healthy
behaviors.
Objectives: The aim of the study was to assess the impact of a lifestyle educational and
counseling intervention in primary health care setting on physical activity (PA) patterns and
arterial stiffness.
Methods: One hundred and seventeen participants classified as being at moderate to high
cardiovascular risk were allocated into two groups; a control group (mean age 54,8  7,8)
who received usual medical follow up and an intervention group (mean age 57,0  6,2)
that participated in an educational and counseling program in 3 consecutive weeks for the
management of cardiovascular risk factors and modification of PA behavior. Additionally,
during the 4 months study period, the participants in the intervention group received a
weekly text message on personal mobile phone encouraging PA practice. At baseline and
after 4 months PA was assessed by accelerometry and arterial stiffness by applanation
tonometry [pulse wave velocity (PWV) and augmentation index].
Results: At baseline the two groups were not different regarding age, sex, anthropometrics
and body composition, cardiovascular risk factors, medication and arterial stiffness indexes.
Moreover, control group presented lower time spent in sedentary activities (p¼0.00) and
higher time in light PA (p¼0.000). There was no significant group x time interaction for
e131
 PWV (p¼ 0.228; h2¼ 0.017) neither for augmentation index (p¼ 0,945; h2¼ 0,00).
POSTER ABSTRACTS
Group x time interaction was not significant for time spent in sedentary activities (p¼ 0.31;
h2¼ 0.011), light PA (p¼0.47; h2¼ 0.005) and moderate to vigorous PA (p¼ 0.201; h2¼
0.017) (Table).
Conclusion: Education and counseling for healthy lifestyles seems not to be enough to
promote changes in PA levels and arterial stiffness indexes.
Disclosure of Interest: None Declared
PM344
Cardiovascular risk factors among men living in an internally displaced persons camp
in Kenya
Varun Bhoopathy, Robyn L. Richmond*, Kamal Singh, Heather Worth, Holly Seale
School of Public Health and Community Medicine, University of New South Wales, Sydney,
Australia
Introduction: Around 200,000 people were displaced from the post-election violence that
occurred in Kenya in 2007 and 2008.
Objectives: To assess the cardiovascular risk factors of men living in an internally displaced
persons camp in Kenya.
Methods: Cross sectional survey of 267 men who live in the Shalom Internally Displaced
Persons Camp in the Rift Valley in Kenya. Respondent driving sampling technique was
used to recruit the men. Data on cardiovascular risk factors was collected using a ques-
tionnaire (WHO STEPwise instrument) that asked about tobacco use, alcohol consump-
tion, history of raised blood sugar. Biometric measures were taken of blood pressure,
weight and height for BMI and waist hip circumference.
Results: Demographic characteristics were: mean age 37 years, 84.5% were of Kikuyu
ethnicity, 36% had no schooling or had not completed primary school, over half were
married and the average household size was 7 people. Half were employed (predominantly
in agriculture) and median monthly household income was 2500 Kenyan Shillings ($AUD
31.86). Results for cardiovascular risk factors were: 36% daily smoking, 31% consumed
alcohol in past 30 days, 10% had BP
140/90 and a quarter were underweight (< 18.5
BMI).
Conclusion: The overcrowded living conditions in the small mud houses in the camp are
very basic with inadequate sanitation and access to fresh water. These difficult living
conditions which accompany the range of cardiovascular risk factors identified among the
men will lead to poor health outcomes unless the health, living conditions and access to
health facilities improve.
Disclosure of Interest: None Declared
PM345
Low Risk Surgery In Women Over Aged 50 Years: Is There Need For Preoperative
Tests?
Lafayete Ramos*1, Flávia Carneiro2, Maria Silva2, Maria Guiotti2, Eliane Elly1,
Edilberto Castilho1, Bárbara Cristina1, Mônica Wolf1, Marlelo Calil1, João Goes1
1
Brazilian Institute for Cancer Control, 2Universitary Center São Camilo, São Paulo, Brazil
Introduction: Cardiologists are frequently requested to perform the preoperative clinical
evaluation to non-cardiac surgery. Several preoperative tests are ordered for the majority of
these patients.
Objectives: The aim of this study was to determine whether women over aged 50 years
have any benefit from preoperative tests results to submit to low-risk surgery.
Methods: Was evaluated a historical cohort of 999 women (63.099.09 years) with
cancer that to submitted to surgical procedures under general anesthesia considered to low-
risk. All patients are submitted to preoperative clinical evaluation and they performed the
follow tests: Electrocardiogram, chest X-ray and blood tests(cell counts, glucose, urea,
creatinine, and coagulation). The patients were divided in group A (no comorbidities), B
(with one), C (with two) and D (with three or more). Each group was subdivided according
to presence or not of abnormalities in at least one test in A1 (normal tests) and A2 (at least
one abnormal tests), B1 and B2, C1 and C2, and D1 and D2. The in-hospital outcomes
were observed. Variables as age, time of anesthesia, prior chemotherapy, prior radiotherapy
and surgical risk (ASA) were analyzed. Adverse outcome was considered any complication
that increased the in-hospital length of stay or death.
Results: From 999 patients, 477 (47.7%) presented all normal tests. The mean operative
time was 2.62  1.01 hours. Group A1¼ 165 patients, A2¼66, B1¼216, B2¼220,
C1¼66, C2¼154, D1¼20 and D2¼92. In regard to adverse postoperative outcomes, we
can observe: A1 x A2 (2.3% x 5.8%; OR¼2.63 CI 0.64-10.83, p¼0.227), B1 x B2 (1.9% x
2.7%; OR¼1.49 CI 0.41-5.34, p¼0.751), C1 x C2 (6.1% x 3.2%; OR¼0.52 CI 0.14-2.00,
p¼0.457) e D1 x D2 (0% x 12.7%, p¼0.206). Among the variables analyzed only the time
of anesthesia (p¼0.028) and surgical risk (p<0.001) were associated with postoperative
outcome. The multivariate logistic regression shown that the number of comorbidities
overlap the number of abnormalities in the tests, being that the chance of adverse outcome
e132
increase to each comorbidity independently to have or not abnormalities in the preoper-
ative tests (OR¼1.59 CI 1.13-3.22; p¼0.02).
Conclusion: These results suggest that patients over aged 50 years submitted to low risk
surgery do not get any benefit with preoperative tests results in regard to postoperative
outcome.
Disclosure of Interest: None Declared
PM346
Asymptomatic Patients Without Comorbidities: What Is The Role Of Preoperative
Testing?
Lafayete Ramos*1, Mariana Alves2, Talita Maciel2, Eliane Elly1, Edilberto Castilho1,
Bárbara Cristina1, Mônica Wolf1, Isabelle Caroline3, Marlelo Calil1, João Goes1
1
Brazilian Institute for Cancer Control, 2São Camilo Medical School, São Paulo, 3Campos dos
Goytacazes Medical School, Campos - RJ, Brazil
Introduction: Cardiologists are frequently asked to perform preoperative clinical evalua-
tions prior to noncardiac surgery. On average, half of these patients are asymptomatic and
do not have comorbidities. Results of a few small studies suggest that a clinical history and
physical examination may be sufficient evaluation. However, routine preoperative tests are
required for the majority these patients. The increased expense is particularly burdensome
for low-income countries.
Objectives: The aim of this study was determine whether the results of preoperative tests
are associated with in-hospital postoperative outcome.
Methods: A total of 1,706 asymptomatic patients (45.0  12.8 years; 1,541 females)
without comorbidities who required surgical treatment under general anesthesia were
evaluated. All patients underwent complete preoperative evaluation before surgery, which
consisted of electrocardiogram, chest X-ray, and blood tests (cell counts, glucose, urea,
creatinine, and coagulation). All patients were followed along their in-hospital evolution.
The patients were divided into 2 groups: normal (A) and abnormal (B) preoperative test
results. The hospital outcome of both patient groups were compared. The contributions of
each of the following variables on the probability of abnormal test results and/or outcome
was evaluated: age, surgical risk (ASA), prior chemotherapy (QT), prior radiotherapy
(RXT), and duration of surgery. An adverse outcome was considered to be death or any
complication that increased the length of stay (LOS) in the hospital.
Results: The mean operative time was 158.4  97.3 minutes. Of the 1,706 patients, 1,467
(86%; group A) had normal and 239 (group B) had some abnormal preoperative test re-
sults. Among group A patients, 47 had adverse outcomes vs 10 group B patients (3.2%, CI
2.3-4.1 vs 4.2%; CI 1.6-6.7, respectively; p¼0.434). Age (p<0.001), prior QT (p<0.001),
and prior RXT (p<0.001) were associated with the probability of abnormal test results.
Only duration of surgery (155.2 vs 251.9 minutes, p<0.001) was associated with adverse
outcomes according to multivariate logistic regression.
Conclusion: Our results indicate that abnormal preoperative test results in asymptomatic
patients without comorbidities did not have significant impact on postoperative outcomes,
suggesting that these tests are not useful for this patient cohort.
Disclosure of Interest: None Declared
PM347
An Evaluation Of Global Non-Communicable Disease In Public Health Curricula
Henry Greenberg*1, Stephen R. Leeder1, Stephanie Shiau1
1
Mailman School of Public Health, Columbia University, New York, United States
Introduction: The burden of non-communicable diseases (NCDs) is a major public health
challenge for emerging economies. The World Health Organization projects global deaths
from NCDs, including cardiovascular disease (CVD), cancer, chronic respiratory disease,
and diabetes, will increase to 55 million by 2030. Addressing these will require a larger,
better informed workforce with focused, relevant academic preparation. However, Master
of Public Health (MPH) curricula in the United States do not provide interested students
germane coursework and experience. Though MPH students are aware of and interested in
global health, the emphasis, historically, has been on infectious and acute childhood
diseases.
Objectives: We wanted to assess the availability of global NCD courses in MPH curricula.
Methods: We searched the online websites of the 50 schools accredited by the Council on
Education for Public Health (CEPH) in the Association of Schools and Programs of Public
Health as of July 1, 2013. A questionnaire was developed to query the websites. Variables
recorded included: availability of a global or international health department or track as
well as requirements, availability of a chronic disease or NCD track, and whether or not the
school offered courses on NCDs, NCD risk factors, CVD, or global NCDs as well as global
health infrastructure.
Results: All 50 CEPH-accredited schools had coursework available for viewing online.
Thirty one (62%) schools offered a global/international health track or certificate; 38 (76%)
offered a chronic disease course, domestic or global, and 25 (50%) offered a cardiovascular
disease course. Only 3 (6%) schools offered a global NCD or CVD course. Of the 31
schools with a global health track or certificate, none required a course on NCDs but all
schools offered courses on global health economics or infrastructure.
Conclusion: Although more than half of CEPH-accredited schools offer a global health
focus for MPH students, very few have a global NCD course available. For public health
education to be aligned with global public health realities, curricular initiatives that
highlight the chronic disease epidemic and their complex cultural and societal risk factors
will need to be emphasized.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM348
Heart Education Assessment And Rehabilitation Toolkit: Heart Online. A Web
Resource For Clinicians
Julie Adsett*1, Karen Page2, Rachelle Foreman3, Robert Mullins4, Annabel Hickey5
1
Heart Failure Service, Royal Brisbane and Women’s Hospital, Brisbane, 2Heart Foundation,
Melbourne, 3Heart Foundation, 4Queensland University of Technology, 5The Prince Charles
Hospital, Brisbane, Australia
Introduction: Access to the right information at the right time is a challenge facing health
professionals across the globe. HEART Online (www.heartonline.org.au) is a website
designed to support the delivery of evidence based care for the prevention and rehabili-
tation of heart disease. It was developed by the Queensland Government and the National
Heart Foundation of Australia and launched May 2013.
Objectives: HEART Online’s mission is to be a leading web resource that links best evi-
dence with practical clinical tools promoting delivery of multi-disciplinary care.
Methods: HEART Online was developed through a consensus approach. Content Leads
wrote content for the following seven areas: i) risk factors and symptoms, ii) medications,
iii) psycho-social issues, iv) exercise, v) patient education, vi) behaviour change and,
vii) program evaluation. Content Leads were supported by contributions from over 40
clinicians and academics. Content was independently reviewed by six experts, with re-
visions made based upon their feedback.
Ongoing evaluation of the site has consisted of user surveys, google analytics including
‘bounce rates’ (where a person visits only one page) and feedback via the ‘contact us’ page
on the site. As the first content to be completed was relevant to exercise professionals,
initial user evaluation invited physiotherapists and exercise physiologists to review the site
and to complete a survey.
Results: Surveys were completed by 31 exercises professionals with mean age 36 yrs and
11yrs post graduate clinical experience. Responses ranged from 3.45 to 4.61 across all
questions on the Likert scales (5 being a positive strongly agree). Google analytics report for
May to September 2013 identified that there had been 9451 visitors with 65% being
unique visitors. Bounce rates were 38% suggesting that the majority of visitors are
exploring the content.
Conclusion: Initial evaluation suggests that HEART Online is reaching a large audience
which is engaged by the content. The content is considered trustworthy, useful to clinical
practice, specifically with regards to clarity and accuracy of content. It is proving to be a
useful clinical tool in clinical and has the potential to improve standards of practice.
Disclosure of Interest: None Declared
PM350
New directions to address heart disease in Australian women
Julie Anne Mitchell*1, Roberta Donovan2, Bill Straveski3
1
Cardiovascular Health Programs, Heart Foundation of Australia, Sydney, 2Marketing and
Communications, 3Data and Evaluation, Heart Foundation of Australia, Melbourne, Australia
Introduction: Heart disease amongst women is often described in the literature as
“under-recognized, under treated and under researched”. In 2007 the Heart Foundation
of Australia committed resources to investigate whether this was also true of Australian
women. It was agreed that our first five year strategy would focus on building the
evidence base around the treatment and management of heart disease in Australian
women as well as explore their knowledge, attitudes and behaviors. This would then
place us in a position to determine what priorities we should pursue in improving the
heart health journey of Australian women either identified at risk or living with heart
disease.
Objectives: To collate available data and increase recognition of heart disease in women as
an important health issue for women, clinicians, researchers and policy officers.
Methods: Actions included commissioning a national report on the treatment and man-
agement of heart disease in Australian women; market research into women’s attitudes and
beliefs, hosting a national policy and research forum to identify priorities, conducting bi-
annual population survey’s to track women’s awareness, trialing community engagement
initiatives to raise awareness and implementation of an annual Go Red for Women
campaign.
Results: Implementation of this strategy resulted in
- a significant increase in women’s awareness of heart disease as the leading cause of
death
- creation of an evidence base on women and heart disease in Australia that includes
both quantitative and qualitative measures
- Recognition of heart disease as an issue in national and state women’s health policies
- Corporate support of over $2 million dollars plus leverage of an additional $2
million in ‘in kind’ support
- Strong stakeholder engagement and support amongst high profile individuals and
female politicians ’and
- Recognition that the workplace is an important setting to promote heart health
messages to women,
Conclusion: As we embark on our next 5 year national strategy, our focus will change from
awareness raising, to how we can more directly support women diagnosed or at risk of
disease. This will include a heightened focused on women’s clinical risk factors of heart
disease; the atypical symptoms often associated with heart attack; the importance of cardiac
rehabilitation and the necessity of sex specific data collection to enable better gender
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
analysis of service provision and usage. This presentation will highlight how we intend to
POSTER ABSTRACTS
progress this agenda.
Disclosure of Interest: None Declared
PM352
Responding to the unequal burden of cardiovascular disease in Australia: The role of
a leading Non Government Organisation (NGO) in tackling health inequities
Karen Page*1, Greg Ford1, Gillian Mangan2, Jane Potter1, Vicki Wade3, Robert Grenfell1
1
National Heart Foundation of Australia, Melbourne, 2National Heart Foundation of Australia,
Hobart, 3National Heart Foundation of Australia, Sydney, Australia
Introduction: Despite declining rates of cardiovascular disease mortality in Australia,
people from lower socioeconomic groups continue to experience a disproportionate
burden of cardiovascular disease. The most disadvantaged Australians are almost twice
as likely to die from cardiovascular disease as those from the least disadvantaged
groups. This inequity is not randomly assigned, it is shaped by deeper social struc-
tures – the systems and policies that govern opportunities for health and wellbeing. As
a result, it can be difficult to identify a clear role and appropriate actions for health-
focused organisations. The NHFA has developed a strategic imperative to focus on
health equity.
Objectives: The National Heart Foundation of Australia (NHFA) is aiming to “level up”
heart disease death rates; striving for the best cardiovascular health outcomes for all
Australians.
Methods: The organisation has been building its internal capacity, embedding equity into
its systems, developing new partnerships, investing in better data monitoring/capture and
growing research alliances. Changing culture is a large-scale undertaking, and all of the
organisational tools for changing minds are needed. In general, the most fruitful success
strategy is to begin with leadership tools, including a vision for the future, cement the
change in place with management tools, such as role definitions, measurement and control
systems.
Results: Leadership tools have included a scoping paper to describe the vision and
future directions for the NHFA. The identification of equity principles and concepts
to support planning of appropriate policy and programs. Management tools have
included an equity impact assessment to ensure interventions consider their role in
contributing to health equity. Accessible and user friendly education and training
tools have been developed to support an organisational collective understanding of
health equity.
Conclusion: Health-focused NGOs play a key role in responding to the WHO’s Call to
Action to Close the Gap in a Generation. For the NHFA this has meant embedding
social justice principles into the organisational culture and building staff commitment to
the social determinants of health. This will enable the NHFA to remain relevant to
future needs of all people and engender an organisational vision where equity is at the
core.
Disclosure of Interest: None Declared
PM353
Impact of Noise Exposure on Hypertension
Won Ju Hwang*1, Oisaeng Hong2
1
College of Nursing Science, Kyung Hee University, Seoul, Korea, Republic Of, 2College of
Nursing, University of California San Francisco, San Francisco, United States
Introduction: Cardiovascular disease is the most reported cause of mortality in Korean
workers. Escalating healthcare costs for CVD and stroke doubled in Asian pacific countries.
Chronic noise exposure in the environment and industry may be a risk factor for car-
diovascular disease. There is need to investigate occupational noise exposure is a risk factor
for hypertension in working population.
Objectives: This population based study aimed to investigate the effects of occupational
noise exposure on cardiovascular disease (CVD) risk in Korean workforce.
Methods: A secondary data analysis was conducted with 2008 Korean National Health
and Nutrition Examination Survey (KNHANES)-IV data. KNHANES-IV consists of in-
terviews and health examination data collected from the representative samples of
general population in Korea to assess the health and nutritional status. Multiple logistic
regression analysis using SPSS 17 was performed to examine work-related factors on
hypertension.
Results: A total of 2,037 (1,109 men and 928 women) aged 20 to 64 years were
included in the analysis. The overall age-adjusted prevalence of hypertension was 17.2
%. Men and women showed a significant difference in prevalence of hypertension
(20.7% in men vs. 13.0% in women). After adjustment for work-related factors (shift
work, chemical exposure, job demand, and job control) and all of known CVD risk
factors (age, smoking, physical activity, stress, lipid level, and obesity), the significant
factors for men workforces were noise exposure, age, high Triglyceride, high Choles-
terol, and obesity, and for women workers, age, education, high Triglyceride, and
obesity.
Conclusion: This study revealed occupational noise exposure is a risk factor for hyper-
tension in Korean men workforce. There is a need to develop and support intensive CVD
risk management programs nationally giving consideration to hypertension associated with
noise exposure for men workers.
Disclosure of Interest: None Declared
e133
 PM355
POSTER ABSTRACTS
The Policy Depot: Harnessing The Power Of Social Networking To Implement Ncd
Policies
Benn Grover*, John Clymer
National Forum for Heart Disease and Stroke Prevention, Washington, DC, United States
Introduction: Although NCD policy priority areas have been identified and prioritized,
limited access to the human and financial resources needed to implement these policies
limits traction. The Institute of Medicine emphasizes that a majority of stakeholders trying
to develop and implement these policies – particularly in developing countries – do not
have the tools needed to reconcile the complex set of health, cultural, economic, and
political factors that influence NCDs.
Recognizing the need to increase the capacity of policy stakeholders worldwide, the
National Forum for Heart Disease and Stroke Prevention launched the Policy Depot
on World Heart Day 2012. The Policy Depot is a dynamic, digital platform that
connects decision-makers, practitioners, and researchers to policies, resources, and
other professionals that can address the unique factors within their policy
environments.
Harnessing the power of social networking, the Policy Depot enables users to
explore powerful, innovative ways of developing contextually specific NCD policy
solutions. Rather than providing static content (such as reports, research, or position
papers), the Policy Depot emphasizes the unique role of the individual policy
stakeholder and the dynamic, ever-changing environment in which he/she does policy
work. This tailored, multi-dimensional approach creates opportunities for individuals
to develop meaningful cross-sector and geographically diverse collaborations. In doing
so, The Policy Depot will build a community of practitioners that harnesses the
unique knowledge, skills, and attitudes needed to implement evidence-based preven-
tive NCD policies.
By connecting policy stakeholders in immediate, personal, and profound ways, the
Policy Depot sits alone in its potential impact on NCD policy development throughout the
world. This unique approach – using social media to address desperately needed public
health prevention strategies – will change the way individuals identify and share relevant,
evidence-based knowledge while collaboratively working towards reversing the global NCD
epidemic.
Please visit www.policydepot.org for more information.
Objectives: N/A
Methods: N/A
Results: N/A
Conclusion: N/A
Disclosure of Interest: None Declared
PM357
Omega-3 fatty acid changes size and concentration of lipoproteins of Brazilian
subjects included in Cardionutri study
Marlene N. Aldin, Nagila R. T. Damasceno*, on behalf of Cardionutri: Patricia A. Lima,
Antonio Augusto F. Carioca, Flávia D. C. Cartolano, Cardionutri
Human Nutrition, Health School/USP, São Paulo, Brazil
Introduction: Cardiovascular diseases (CVD) remain the main cause of mortality in the
world despite of the reduced death observed in development countries. In this context, diet
represents a principal focus of healthy public programs and the impact of omega-3 in
physical properties of lipoproteins is sparkly described.
Objectives: To evaluate the effect of supplementation of omega-3 acid (n-3) on changes
biochemical and lipoproteins profile in subjects.
Methods: The design of study was based on nutritional intervention, prospective,
randomized and double blind clinical trial. Adult and elderly subjects (n¼146) were
randomized in omega-3 group (n¼77) and placebo group (n¼69). Cardiovascular risk
was estimated by Framingham risk score, followed by the ATP III classification and the
groups were divided into risk score low, intermediate and high. All subjects underwent
an electrocardiogram as a screening measure to assess the presence of previous CAD.
After 12h of fasting blood samples were collected at baseline and after 4 and 8 weeks
of intervention (3 g/d n-3 or placebo). From plasma, lipid profile (total cholesterol,
LDL, HDL and TAG, NEFAS, APO AI, APO B) were analyzed by standard methods.
The LDL and HDL size and concentration were analyzed by LipoprintÒ System
(Quantimetrix Corporation). Adherence to the intervention was monitored by counting
capsules and plasma fatty acids (GC). Statistical analysis was tested in the Statistical
Package for the Social Sciences Ò (SPSS), version 16.0 and the significance level was p
<0.05.
Results: N-3 promotes decrease in TAG (p¼0.021, OR 1.30, CI 1.06 to 1.60) and
total cholesterol (p¼0.048, OR 1.44, CI 1.05 -1.98). (showed an incorporation of
EPA and DHA significant n-3 group (mean 4%). After 8 w of n-3 intervention,
Intermediate HDL particles (p ¼ 0.036) increased and small HDL showed significant
reduction (p¼0.001). Univariate logistic regression analyzes demonstrated that in-
crease of one unit of EPA-DHA sum was inversely associated to reduced TAG
(p¼0.001, CI -0.011 to -0.003), systolic blood pressure (p¼0.040, CI -0.693 to
-0.017), diastolic blood pressure (p¼0.020, CI -0.408 to -0.035) and large HDL
particles (p¼0.017, CI 0.043 to 0.436). Changes in size and concentration of LDL
were not significant.
e134
Conclusion: Supplementation with n-3 promotes changes in lipid profile, and HDL size
that contribute to a less cardiovascular risk. Financial support: FAPESP (2011/12523-2;
2011/15026-0), INCT-FCx, NAP-FCx, CNPq.
Disclosure of Interest: None Declared
PM358
The Eco-society or Eco-socialÓ environment and heart disease. A General Systems
Approach
John B. Myers*
Internal Medicine, Lorne Street Therapy, Lalor, Australia
Introduction: Myers (1) has proposed two assumptions of Biological response (Laws) as
part of General Systems Theory (1), which explains evolution, aging and disease, in
particular, hypertension(1,2). These assumptions are:
A. Innermost membranes maintain the fluids external to that membrane
within an optimal range. This occurs at all other outer levels of biological
organisation.
B. A persistent disturbance of the external fluid at any biological level of organisation
will result in a change in the inner fluids.
Objectives: To define “Eco-society or Eco-social environment” as the optimum space-time
dimension for healthy reproduction, growth and wellbeing and that application of this
understanding is a key to understanding means of preventing stress related conditions
including depression and heart disease.
Methods: The two assumptions (viewed as Laws of Biological response) though theoretical
are based on experimental evidence (1) and understanding that the basic functional unit
consists of a pair.
Results: An analysis of any environment e.g. city vs urban, or factors e.g. plasma
factors as risk for heart disease or emotional response will show that external
factors create an inner system change that may be appropriate and adequate or
none of these. Understanding environment from this perspective will lead one to
identify that where there are trees there is less stress on the individual, and the
more diverse the environment greater is the wellbeing of the creatures, including
man, living with it. Consequently, diverse diets, ability to exercise, sunlight and
nightlight, periods of work, including hunting and harvesting, and of rest made use
of and other such functional pairs promote wellbeing, whereas the opposite of
more noise, lest rest, less exercise, more confinement, more stress, bureaucratic
predominance and mono-diets whether as refined carbohydrate or saturated fats or
excessive salt, and less plant and fewer animal/invertebrate species are typical of
low diversity and disease.
Conclusion: Two Laws of Biological Response and the definition of the optimum Eco-
social environment provide a robust as well as intricate model of social order necessary to
promote reproduction, diversity, growth and wellbeing, with particular relevance to car-
diovascular risk and disease.
1. Myers JB. Biochemical response to change in the environment and the nature of
“essential” hypertension. Medical Hypotheses 1982: 9: 241-57.
2. Myers JB. “Sodium-sensitivity” in Man. Medical Hypotheses 1987: 23: 265-276.
Disclosure of Interest: None Declared
PM362
Bnp Metabolism In Patients With Metabolic Syndrome – Mechanistic Study
Dariusz Korczyk*
Cardiology, PAH, Brisbane, Australia
Introduction: Obesity and insulin resistance, integral components of the metabolic syn-
drome, predispose to lower circulating natriuretic peptide levels. The imbalance between
synthesis (lower production) and elimination (higher degradation) of the peptides could be
the cause. BNP is metabolised utilising two main mechanisms: tissue specific elimination
via Natriuretic Peptide Receptor C (NPR-C) and systemic degradation by extracellular
proteases including neprilysin (NEP). Both a raised NEP activity and an elevated NPR-C
gene expression (in the adipose tissue) have been described in obese individuals with
insulin resistance and lower circulating levels of natriuretic peptide. However the pre-
vailing mechanism of the higher peptide clearance (NEP vs. NPR-C pathways) remains
unknown.
Objectives: In this mechanistic study we assessed the correlation between markers of
peptide production and pulmonary clearance with indices of insulin resistance and elevated
body weight.
Methods: Twenty one individuals admitted for EP study were consented. The blood was
drawn for fasting glucose, insulin, lipid profile, baseline BNP level and HOMA-IR, a marker
of insulin resistance. Swann Ganz and steerable EP catheter were inserted to pulmonary
artery and coronary sinus respectively. Simultaneous sampling of serum BNP level was
performed from femoral artery and vein, coronary sinus and femoral artery and pulmonary
artery and from pulmonary wedge position. The ability of an individual organ to remove or
secrete molecule from/to the circulation was calculated using the extraction ratio (ER). The
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 cardiac, peripheral and pulmonary ER has been quantified to assess BNP synthesis and
clearance. We assumed that the pulmonary ER would represent NEP depending clearance
pathway.
Results: The mean serum BNP level was 37ng/L. The mean cardiac ER was 1.20,
pulmonary and peripheral ER was 0.13. There was a tendency for lower cardiac
and pulmonary ER in males. Pulmonary ER correlated with age (r¼0.495,
p¼0.023) and systolic BP (r¼0.58, p¼0.006) only. However there was no cor-
relation between cardiac and pulmonary ER with BMI, waist circumference and
HOMA-IR.
web 3C=FPO
web 3C=FPO
Conclusion: We found no correlation between the markers of BNP production and pul-
monary clearance with body size (BMI and waist circumference) and insulin resistance
(HOMA-IR). The adipose tissue specific NPR-C pathway (rather than NEP clearance or
BNP production) is more likely the cause of the lower level of BNP in patients with obesity
and insulin resistance.
Disclosure of Interest: None Declared
PM365
Effects of Androgen Replacement on Age-Related Impairment in Ischaemia-Mediated
Neovascularisation
Laura Lecce1,2, Yuen Ting Lam*1, David J. Handelsman2,3, Richard Karas4, Martin K. Ng1,2
1
The Heart Research Institute, 2The University of Sydney, 3The ANZAC Research Institute,
Sydney, Australia, 4Tufts University School of Medicine, Boston, United States
Introduction: Ageing is a significant risk factor for cardiovascular disease that is charac-
terised by impairment of vascular repair mechanisms such as angiogenesis and vasculo-
genesis. In men ageing is associated with progressive decline in androgen levels and
increasing evidence indicates that androgens regulate angiogenesis.
Objectives: We sought to investigate the role of androgen replacement in modulating age-
related impairment in ischaemia-mediated neovascularisation.
Methods: Young (2month) and old (24month) castrated male C57Bl/6J mice underwent
hindlimb ischaemia (HLI) and insertion of dihydrotestosterone (DHT) or placebo (P) im-
plants. Laser Doppler Perfusion Imaging (LDPI) assessed blood flow recovery. Sca1+/
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
CXCR4+ endothelial progenitor cells (EPCs) were quantified by flow cytometry. Muscle
POSTER ABSTRACTS
protein and mRNA were analysed by western blotting and RT-qPCR.
Results: Ageing was associated with marked impairment in ischaemic recovery after HLI.
Androgen replacement augmented blood flow recovery in young mice and significantly
attenuated age-related impairment of ischaemic recovery in old mice after HLI (young;
DHT vs. P, 0.920.18 vs. 0.720.21, p<0.05. Old; DHT vs. P, 0.340.05 vs. 0.160.05,
p<0.01). In old mice, androgen replacement augmented EPC proliferation and restored
age-related impairment in EPC mobilisation to levels not different to young mice (Young
DHT vs. Old DHT, 26.393.02 vs. 23.652.51). Interestingly, androgen replacement in
young mice increased muscle androgen receptors by 2-fold (p<0.01) however androgen
receptors in old mice were unresponsive to DHT treatment. Consistent with these findings,
striking age-related differences were observed in androgen regulation of key angiogenesis
related genes in ischaemic muscle with enhancement of hypoxia inducible factor-1a (HIF-
1a) (DHT vs. P, 3.840.77 vs. 1.980.18, p<0.05) and stromal derived factor-1 (DHT vs.
P, 2.880.74 vs. 1.640.22, p<0.05) expression in young mice, but no response to
androgen replacement in old mice.
web 3C=FPO
Conclusion: Androgen replacement attenuates age-related impairment of ischaemia-
mediated neovascularisation with reversal of age-related decline in ischaemia-induced EPC
mobilisation. However, by comparison to young animals, ageing is associated with loss of
androgen augmentation of key angiogenesis mechanisms in ischaemic muscle. These
findings have implications for the role of androgen replacement in elderly men with car-
diovascular disease.
Disclosure of Interest: None Declared
PM366
Hyperglycemia induced abnormal mitochondrial function causes endothelial
dysfunction: protective effects of resveratrol treatment
Mandar S. Joshi*1, David Williams1, Duncan Horlock1, Karen Andrews2, Ann-maree Jefferis2,
Jaye Chin-Dusting2, David M. Kaye1
1
Heart Failure Research Group, 2Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Introduction: Oxidative stress and endothelial dysfunction are major contributors to the
development of coronary microvascular complications in diabetes. Mitochondrial
dysfunction increases oxidative stress and may lead to reduced vascular tone in diabetes,
but the exact role is not studied.
Objectives: Here we tested the hypothesis that mitochondrial dysfunction leads to
endothelial dysfunction as well as abnormal angiogenesis; and treatment with resveratrol
demonstrates protective effects.
Methods: Bovine aortic endothelial cells (BAECs) were exposed to normal (5.5mM; NG) or
high (20mM; HG) glucose, with or without resveratrol (RESV). Mitochondrial function was
measured using Seahorse XF24 analyser. Endothelium dependent responses were
measured in isolated mouse aortic rings incubated with rotenone (ROT) or with rotenone +
resveratrol (ROT+RESV). Matrigel tubule formation was studied in the presence of ROT
and ROT+RESV. One-way ANOVA was used to test multiple groups and non-parametric t-
test to compare two groups.
Results: Mitochondrial oxygen consumption rate (OCR) measured after serial addition of
inhibitors/uncouplers, was significantly reduced in HG group (OCR – pmol/min: NG;
HG - 956.5729.09; 810.4030.78: p<0.05). Spare respiratory capacity in HG was
significantly lower than NG and RESV treatment preserved mitochondrial function. In
isolated aortic rings, inhibition of mitochondria by ROT significantly impaired the
endothelium dependent vascular tone; RESV treatment protected the aortic rings against
impaired responses (EC50 -log10 [ACh] (M): VEH; ROT; ROT+RESV - -7.400.13;
-7.010.07; -8.180.12: p<0.05). Inhibition of mitochondrial function causes impaired
angiogenesis as evaluated in the matrigel assay and resveratrol treatment is protective in
this setting (No. of tubules - % of control: ROT; ROT+RESV – 61.315.01; 77.573.78:
p<0.05).
Conclusion: Thus, mitochondrial dysfunction induced by hyperglycemia causes endo-
thelial dysfunction and may be an important mediator of coronary microvascular com-
plications of diabetes. RESV treatment protects the endothelial cells and endothelial
mitochondria, suggesting that resveratrol maybe a viable treatment option for microvas-
cular complications of diabetes.
Disclosure of Interest: None Declared
e135
 PM367
POSTER ABSTRACTS
Stable Angina Pectoris And Diabetes Mellitus Of Type 2: The Role Of The
Atherogenic Lipid Profile And Inflammatory Markers
Ludmila Gapon, Tatiana Petelina, Natalia Musikhina, Natalia Dementjeva,
Vadim Kuznetsov*
Tyumen Cardiology Center, Tyumen, Russian Federation
Introduction: Cardiovascular disease in patients with type 2 diabetes mellitus (DM) as a
cause of death is a leader in virtually all countries of the world. The risk of coronary artery
disease (CAD) in patients with type 2 DM is 2-4 times higher and the risk of acute
myocardial infarction is 6-10 times higher than in the general population of patients. The
condition of lipid profile and vascular inflammatory reaction is of great importance when
shaping coronary atherosclerotic stenosis in patients with stable angina pectoris (SAP) and
DM of type 2.
Objectives: Comparable evaluation of lipid profile and inflammatory markers in patients
with SAP and patients with SAP and DM of type 2.
Methods: A total of 97 patients with CAD (mean age 60.39.8 years) with nonsignifi-
cant coronary stenosis (<75%) were examined. Group I included 33 patients with SAP
and DM of type 2, group II consisted of 64 patients with SAP without DM. All patients
received statins, ACE inhibitors, beta blockers, dual antiplatelet therapy. In group I all
patients received antihyperglycemic therapy. Lipid profile parameters (total cholesterol,
triglycerides, LDL cholesterol, VLDL cholesterol, lipoprotein (a), Apo-A, Apo-B), in-
flammatory markers (hs-CRP, TNF-alpha, homocysteine, interleukine 1 b, 6, 8, sCD40 L,
MMP-9, TIMP-1), endothelial dysfunction markers (endothelin-1, nitrites) were
measured.
Results: There were high levels of hs-CRP, TNF-alpha, lipoprotein (a), MMP-9, tri-
glycerides, and endothelin-1 in both groups. The level of TIMP-1 was significantly
reduced in both groups. Patients in group 1 had significantly elevated levels of total
cholesterol, LDL cholesterol, homocysteine, Apo-B, Apo-B/Apo A-1 ratio, IL -1 b . In
group 1 the following positive correlations were found: between glycohemoglobin and
Apo-B, Apo-B/Apo A-1 ratio, homocysteine, IL -1 b, sCD40 L; IL-6 and hs-CRP; ho-
mocysteine and LDL cholesterol, MMP-9, duration of CAD; endothelin-1 and sCD40L,
TNF-alpha. It was shown that with an increase of 1 mmol/L in homocysteine level and of
1 mg/l in hs–CRP level, the risk of DM in patients with SAP increased by 1.1 and 3.8
times, respectively.
Conclusion: In patients with type 2 DM there was a significant increase in the levels of
atherogenic lipid fractions as well as homocysteine, hs-CRP and IL-1 b which may
indicate a higher risk of coronary events even in the absence of significant coronary
stenosis.
Disclosure of Interest: None Declared
PM368
A novel mechanism of hyperhomocysteinemia-promoted leukocyte-endothelium
interaction
Juan Feng*1, Yuhong Luo1, Haiping Zhao1, Wengong Wang2, Xian Wang1
1 with arterial stiffness and significant markers of cardiovascular disease.
Dept. of Physiology and Pathophysiology, 2Dept. of Biochemistry and Molecular Biology, Peking
University Health Science Center, Beijing, China
Introduction: Atherosclerosis is an inflammatory disease with immunoinflammatory re-
sponses contributing to disease initiation and progression. The interaction between the
endothelium and activated immune cells is an early event in hyperhomocysteinemia
(HHcy)-induced vascular injury and atherosclerosis. But the mechanism is still unknown.
Objectives: To investigate the effects and possible mechanisms of acute HHcy-induced
leukocyte rolling and adhesion in mouse cerebral venules. Furthermore, we will explore the
role of tRNA methyltransferase NSun2 in Hcy-promoted interaction between the endo-
thelium and leukocytes.
Methods: Male C57 BL⁄6J mice were injected with D.L-Hcy (50 mg⁄kg). The effect of HHcy
on the leukocyte rolling and adhesion in cerebral vessels was assessed using intravital
microscopy. Plasma cytokines and chemokines were evaluated by cytometric bead array.
ROS production in human umbilical vein endothelial cells (HUVECs) was determined by
flow cytometry. NSun2 and adhesion molecule expression were investigated by immu-
nohistochemistry or western blot. CD18 phosphorylation and the Src⁄PI3K⁄Akt pathway in
leukocytes were determined by confocal microscopy and western blot. In co-culture sys-
tem, the role of NSun2 in the interaction between leukocytes and HUVECs was also
investigated.
Results: HHcy promoted leukocyte rolling and adhesion, ROS production in HUVECs.
Plasma KC, MIP-2, and MCP-1 levels were increased significantly by HHcy. E-selectin and
ICAM-1 expression on cerebrovascular endothelium and CD11b⁄CD18 expression on leu-
kocytes were upregulated by HHcy. And Src⁄PI3K⁄Akt pathway mediated the CD18 phos-
phorylation in leukocytes. Results of the in vitro experiments have indicated that Hcy increased
the expression of NSun2 and ICAM-1 in HUVECs. NSun2 could bind to and methylate ICAM-
1 3’-UTR, thus increased the ICAM-1 expression by enhancing its translation. Knockdown of
NSun2 decreased endothelial ICAM-1 expression and the number of adhered cells.
Conclusion: HHcy provoked leukocyte rolling and adhesion in cerebral venules, adhesion
molecule expression and activation, which is related to the Src⁄PI3K⁄Akt pathway in leu-
kocytes. NSun2 mediated the upregulated ICAM-1 expression and HUVEC-leukocyte
interaction induced by Hcy. It will provide a new mechanism for Hcy-related inflammation
from the angle of RNA methylation.
Disclosure of Interest: None Declared
e136
PM370
Non-Invasive Molecular Ultrasound Imaging For Monitoring And Efficacy Testing Of
Targeted Anti-Thrombotic Agents Using Platelet-Targeted Microbubbles
Xiaowei Wang1, Jan David Hohmann1, Ephraem Leitner1, Ingo Ahrens2, Christoph Hagemeyer1,
Karlheinz Peter*1
1
Thrombosis, BakerIDI Heart and Diabetes Institute, Melbourne, Australia, 2Cardiology,
Univerisity of Freiburg, Freiburg, Germany
Introduction: Molecular ultrasound imaging offers a non-invasive technology widely
available for rapid clinical diagnosis. We tested whether microbubbles (MBs), which are
selectively targeted to activated platelets, provide a high-resolution, real-time imaging of
thrombosis and monitoring of thrombolysis.
Objectives: We used this approach to evaluate a platelet targeted urokinase plasminogen
activator (targ-scuPA) that is hypothesized to offer anti-thrombolytic potency without
bleeding complications.
Methods: MBs were conjugated to a single-chain antibody specific for an epitope called
Ligand Induced Binding Site on activated GPIIb/IIIa (LIBS-MB).
Results: LIBS-MBs strongly adhered to immobilized activated platelets and micro-thrombi
under flow. Carotid artery thrombi in mice, induced by ferric chloride, were assessed with ul-
trasound before and after MB injection. Analysis of the thrombus area demonstrated a significant
increase in decibel after LIBS-MB but not after MB injection (p<0.01). After thrombolysis with
500U/g BW of commercial urokinase (commUPA), LIBS-MB ultrasound imaging allows
monitoring of the reduction in thrombus size (p<0.001). Similar results were obtained when
comparing the size to grayscale intensity reduction. In addition, 75U/g BW of targ-scuPA is
sufficient for thrombolysis, whereas 75U/g BW of commUPA or non-targ-scuPA are not
(p<0.01). 500U/g BW of commUPA, the concentration required to match the effectiveness of
75U/g BW of targ-scuPA, resulted in prolonged tail bleeding time, whereas no increase in
bleeding was observed when the equally effective but lower dose of 75U/g BW scuPA (p<0.001).
Conclusion: We are able to demonstrate that our targeted MB specifically bind to activated
platelets enabling real-time molecular ultrasound imaging of thrombosis and monitoring of
success or failure of thrombolysis in vivo. In an exemplary application a highly promising
clot-targeted thrombolytic drug was shown to provide effective thrombolytic potential
without compromising haemostasis.
Disclosure of Interest: None Declared
PM371
Prediction of Angiographic Severity of Coronary Artery Disease by Simple Biomarker
A Preliminary Study
Hariman Kristian*1, Benny Setiadi1, Bambang Budiono2, Janry Pangemanan1, Agnes L. Panda1,
Reggy Lefrandt1
1
cardiology and vascular medicine, sam ratulangi university, manado, 2cardiology and vascular
medicine, rs awal bros, makassar, Indonesia
Introduction: Consistent relationship between various inflammatory markers and car-
diovascular diseases has been established. Neutrophil to lymphocyte ratio (NLR) is an
inexpensive, easy to obtain, widely available marker of inflammation, which was associated
Objectives: To analyze the relatonship between NLR and the severity of CAD.
Methods: This is a cross sectional study, which include CAD patients who underwent
coronary angiography between January to August 2013. The exclusion criteria include
active infection,malignancy, and previous coronary intervention. Routine blood test
was done in all patients. NLR and traditional risk factors, including hypertension,
type 2 diabetes mellitus, and dyslipidemia were analyzed to identify their relation to
the severity of coronary artery stenosis based on modified gensini score. Statistical
analyses were done using SPSS 17.0 with P < 0.05 is considered statistically
significant.
Results: A total 88 patients were included in this study (mean age 579 years, mean
NLR 2.672.05). From these, 72 patients (81.8%) were male. Hypertension, type 2
diabetes mellitus and dyslipidemia were found in 64 patients (72.73%), 48 patients
(47.73%), and 42 patients (47.73%) respectively. There is a significant relationship be-
tween NLR with the modified gensini score (r¼ 0.44, P value <0.001). From multi-
variate analysis, NLR is an independent predictor of severe lesion (modified gensini score
>13) with OR1.55, P value 0.001. From the Receiver operating curve (ROC) analysis,
the most effective cutoff value for NLR to predict severe lesion was 2.87 (sensitivity 75%,
specificity 77.6%).
Conclusion: There is significant relationship between NLR with the severity of coronary
artery stenosis. NLR is an independent predictor of severe lesion. The most effective cutoff
value for NLR to predict severe lesion is 2.87. NLR is simple biomarkers which can predict
severity of coronary artery disease.
Disclosure of Interest: None Declared
PM372
Cardiomyocytes derived from human embryonic stem cells have a distinctive micro-
RNA signature
Deevina Arasaratnam*1, David Elliott1, Anthony White2
1
Cell Biology, Murdoch Childrens Research Institute, 2Medicine, Nursing and Health Sciences,
Monash University, Melbourne, Australia
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: MicroRNAs (miRs) are small non-coding RNA molecules, which modulate
gene expression. A given miR can cause large scale of switching of gene expression pro-
grammes, hence may have a role in directing cell fate decisions.
Objectives: To identify differentially expressed miRs in human embryonic stem cell (hESC)
derived cardiomyocytes.
Methods: We had previously generated a reporter cardiac cell line NKX2-5GFP/w in which
green fluorescent protein (GFP) expression is under control of the cardiac-specific
transcription factor NKX2.5 promoter. This facilitates the separation and comparison of
hESC derived cardiomyocytes. NKX2-5GFP/w hESCs were differentiated for 7 days, then
separated into GFP+ and GFP- fractions by flow cytometry. The differential micro-RNA
expression profile of GFP+ and GFP- fraction was examined by micro-array (Affymetrix)
and changes confirmed using RT-PCR Taqman microRNA assays (Applied Biosystems).
Finally, functional analysis was performed using miR knock-down experiments in
embryoid bodies.
Results: A number of miRs, previously associated with pluripotency exhibited lower
levels in the GFP positive fraction including miRs -200c,-302a, -302c*,-302d, 371-5p,-
372, and-373. Similarly, there were a number of miRs with higher expression in the
GFP+ fraction, most notably known muscle markers miR-1 and -133a. Preliminary
experiments demonstrated a decrease in GFP expression upon knocking down miR-
133a via inhibitors.
Conclusion: Cardiomyocytes derived from human embryonic stem cells have a distinctive
miRNA profile. Lentiviral-based overexpression and knock-down experiments are currenly
being undertaken to determine if the differentially expressed miRs are involved in the
mechanism of cardiac differentiation.
Disclosure of Interest: None Declared
PM373
In Vivo Assessment of Biodistribution and Efficacy of Bone Marrow Mononuclear
Cells for Ischaemia-mediated Neovascularisation
Sui Ching G. Yuen*1,2, Zoe Clayton1,2, Ashanti Dantanarayana1, Laura Lecce1,2, Louise Dunn3,
Martin Ng1,2,4
1
Translational Research Group, Heart Research Institute, Newtown, 2Sydney Medical School,
University of Sydney, Sydney, 3Vascular Biology Division, Victor Chang Cardiac Research
Institute, Darlinghurst, 4Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
Australia
Introduction: Bone marrow-derived mononuclear cells (BMMNCs) are a viable
and popular cell candidate in clinical trials for ischaemic conditions but have
thus far yielded inconsistent results. This may be due to substantial inter-trial
differences in cell therapy protocols including cell number and delivery
method.
Objectives: Aim to optimise BMMNC transplantation procedures by longitudinally eval-
uating the efficacy of cell number, survival, homing and engraftment of BMMNCs using
bioluminescent imaging (BLI) and two delivery methods in a murine hindlimb ischaemia
(HLI) model.
Methods: BMMNCs (2x105/1x106) were extracted from the bone marrow of trans-
genic L2G mice (ubiquitously expressing Fluc and GFP reporter genes) and intra-
venously (IV) or intramuscularly (IM) injected into syngeneic mice after HLI to
assess the role of BMMNCs in ischaemia-mediated neovascularisation. BLI was used
to monitor the in vivo kinetics of the BMMNCs, while recovery was assessed
concurrently using Laser Doppler Perfusion Imaging. Histology was performed to
determine engraftment.
Results: Biodistribution data from BLI showed both low and high dose IV treatments
homing to the site of injury between days 2-4, with peak BLI signal between weeks
1-2. Both delivery methods displayed similar cell survival of between 1-3 weeks, with
high dose BMMNCs (1x106) showing BLI signal consistent with engraftment
(BMMNCvsControl BLI, p
0.2). Histology complemented the BLI data, confirming
engraftment of high dose BMMNCs. Despite all IV transplantations homing to
ischaemic sites, only the high dose IV was able to augment perfusion recovery
compared to controls on Day 7 (0.740.09vs0.54 0.09, p<0.01). Mice that received
high dose IM BMMNCs showed the greatest increase in perfusion recovery compared
to controls on Days 4 (0.560.06vs0.250.04, p<0.001), 7 (0.880.07vs0.570.13,
p<0.001), 10 (0.870.04vs0.630.07, p<0.01) and 14 (0.970.05vs0.760.03,
p<0.05).
Conclusion: Delivery method and cell number used for BMMNC therapies can lead to
striking differences in efficacy of treatment. In this model, homing and engraftment of
BMMNCs does not necessarily equate to increased ischaemia-mediated neovascularisation.
It was found that a threshold number of BMMNCs is required for the enhancement of
angiogenesis. Regardless of delivery method, there is limited cell survival and engraftment
for single dose BMMNC therapy.
Disclosure of Interest: None Declared
PM374
Abstract Withdrawn
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM375
POSTER ABSTRACTS
Endothelin-1 Differentially Activates Protein Kinase C and Rho Kinase in Large and
Small Arteries
Kanchani Rajopadhyaya1,2, Jessica Maddern3, John Beltrame1,2,4, David Wilson2,3,
Amenah Jaghoori*1
1
Medicine, The University of Adelaide, 2Vascular Diseases and Therapeutics Reserach Group,
The Basil Hetzel Institute For Medical Research, 3Physiology, The University of Adelaide,
4
Cardiology, The Queen Elizabeth Hospital, Adelaide, Australia
Introduction: The clinical management of vasospastic disorders is focused on the
blockade of extracellular Ca2+ entry and or specific G-protein coupled receptors.
However these therapies neglect numerous additional modes of Ca2+ entry and often do
not resolve small vessel dysfunction. This warrants investigating whether there are
fundamental differences in the ways that large and small arteries constrict to a given
agonist.
Objectives: This study aimed to identify whether protein kinase C (PKC) and Rho kinase
(ROK)-mediated Ca2+ sensitisation is differentially regulated in large vs small vessels in an
acute endothelin-1 (ET-1) model.
Methods: Using wire myography, the vascular response to ET-1 was determined acutely in
rat caudal arteries following incubation with pharmacological inhibitors.
Results: In large caudal arteries (500mm), PKC inhibition prior to ET-1 attenuated
the sustained phase of ET-1-mediated vasoconstriction (p<0.05). In contrast ROK
and combined PKC/ROK inhibition prior to stimulation attenuated the initiation and
maintenance of ET-1-mediated vasoconstriction (p<0.05). In small mesenteric arteries
(300mm), only combined PKC/ROK inhibition prior to stimulation significantly
attenuated the initiation of contraction (p<0.05). In contrast inhibition of PKC, ROK
and combined PKC/ROK prior to stimulation inhibited sustained ET-1-mediated
vasoconstriction (p<0.05). During sustained ET-1-mediated vasoconstriction, inhibi-
tion of PKC and ROK did not significantly attenuate vasoconstriction in small
mesenteric arteries (p>0.05) but did attenuate constriction in the large caudal artery
(p<0.05).
Conclusion: Differential regulation of PKC and ROK in small and large arteries emphasises
the value in considering independent management of large and small vascular disorders.
These data indicate that prophylactic ROK inhibition may be an effective treatment strategy
for large vessel hyper-reactivity while combined PKC/ROK inhibition, but not ROK inhi-
bition alone may be useful in the treatment of small vessel vasoconstriction.
Disclosure of Interest: None Declared
PM376
Direct phosphorylation of the human cardiac L-type calcium channel alpha subunit
by cAMP-dependent protein kinase alters function
Henrietta Cserne Szappanos*1, David Longman1, Tanzila Mahzabin1,
Padmapriya Muralidharan1, Evan Ingley2, Livia Hool1
1
School of Anatomy, Physiology and Human Biology, University of Western Australia, Crawley,
2
Cell Signalling Research, Western Australian Institute for Medical Research, Perth, Australia
Introduction: The L-type calcium channel plays a critical role in excitation-contraction
coupling by mediating calcium influx into cardiomyocytes. In vivo, beta-adrenergic re-
ceptor stimulation is proposed to increase the activity of the channel via cAMP-dependent
protein kinase A (PKA) phosphorylation. It is not clear whether direct phosphorylation of
the channel protein is sufficient to alter function. In addition, while several consensus
phosphorylation sites exist, the site/s responsible for increased channel activity remains
unknown.
Objectives: The aim of our project was to determine the effect of PKA phosphorylation on
the function of the human L-type calcium channel pore forming alpha subunit (Cav1.2) in
the absence of modification by other subunits of the channel or other cell regulatory
proteins.
Methods: We reconstituted the human long N terminal isoform and the short N terminal
isoform of Cav1.2 in proteoliposomes and performed functional assessment of the single
channel activity using patch-clamp technique. Immunoblot technique was used to deter-
mine the possible PKA phosphorylation site(s) of purified Cav1.2 channel with phospho-
(Ser/Thr) PKA substrate primary antibody.
Results: Application of PKA increased open probability (Po) of the long NT isoform
3.11.5 fold (n¼9; p<0.05). Similarly PKA increased Po of short NT isoform
2.10.2 fold (n¼5; p<0.05) suggesting that the N terminus does not contain the
critical site/s. Truncation of the C terminus at amino acid 1504 did not alter the
effect of PKA (4.30.7 fold increase in Po, n¼18, p<0.05) nor did mutation of
Ser1928 to alanine (2.40.5 fold increase in Po, n¼7, p<0.05). In addition, spe-
cifically blocking the association of the regulatory subunit of PKA and AKAP with
AKAP inhibitor peptide St-Ht31 (10 mM) did not affect the response of the channels
to PKA (2.90.1 fold increase in Po, n¼13). Pretreatment of the proteoliposomes
with 5 mM PKA inhibitor peptide PKI for 30 min attenuated the effect of PKA
(n¼5).
Conclusion: We conclude that direct phosphorylation of Cav1.2 subunit is sufficient for
PKA-dependent increase in channel activity. However the critical sites for phosphorylation
by PKA are not within the N terminal or C terminal regions.
Disclosure of Interest: None Declared
e137
 PM377
POSTER ABSTRACTS
Leucine Supplementation Improves Electrocardiogram And Cardiac Biomarkers In
Cachectic Tumor-Bearing Rats
Aline Toneto, Luiz Alberto F. Ramos*, Emiliane Salomão, Miguel A. Areas,
Maria Cristina C. Gomes-Marcondes
Biology Structural and Physiology, State University of Campinas - Unicamp,
Campinas, Brazil
Introduction: Cancer-cachexia state promotes intense involuntary weight loss, wasting
skeletal muscle protein due to higher proteolysis and/or decreased protein synthesis. This
process can be improved by branched-chain amino acids, as leucine, which provides en-
ergy source by skeletal muscle and acts as a cell signaling.
Objectives: This work aim to evaluate whether the leucine-rich diet (3%>leu) can
modulate theelectrocardiogram (ECG) and cardiac biomarkers in the cachectic tumor-
bearing rats.
Methods: Adult rats were distributed into 4 groups: C–control rats; W- Walker-256 tumor
tumor-bearing rats; L–leucine supplemented diet (leu-3%) and LW-leucine supplemented
diet tumor-bearing rats (5 animals per group). The electrocardiogram was evaluated after
anesthesia (ketamine 100mg/Kg. plus xelazine 7mg/Kg intramuscular) during pre-agonic
state assayed by LabChart software. Cardiac biomarkers (MPO, TIMP, PAI-total) were
evaluated in heart muscle homogenate assayed by multiplex assay (Millipore-Luminex).
Difference among groups used one-way ANOVA analyses followed by Bonferroni’s test
(P<0.05).
Results: ECG parameters: the heart rate reduced in both tumor-bearing groups; QT-c
tended to increase in W group, but was recovered in LW rats; T wave amplitude tended to
increase in W group and was similar in LW group when compared to control rats. Cardiac
biomarkers: MPO, TIMP and PAI increased only in W group, despite having tumor the LW
group had similar values as the control rats.
Conclusion: Tumor evolution caused damage on cardiac function, decreasing the ven-
tricular function and increases the sudden death risk in these animals. Here, the result
e138
clearly show the beneficial effects of leucine-rich diet in tumor-bearing animals, by
restoring the ventricular electrical conduction and reduces the risk of ischemia and
thrombrogenesis process, as the cardiac biomarkers are maintained by this nutritional
supplementation.
References:1. SALOMÃO et al, Nutrition and Cancer, 2010, 62(8), 1095.
Disclosure of Interest: None Declared
PM378
Connexin45 Over-Expression Causes Arrhythmia in Rat Hearts
Peter Fahmy*1,2,3,4, Renuka Rao1, Ajita Kanthan4, Ian Alexander5, Eddy Kizana1,2
1
Cardiology, Westmead Hospital/Westmead Millennium Institute, Westmead, 2Medical School,
University of Sydney, 3Medical School, University of Western Sydney, Sydney, 4Cardiology,
Blacktown Hospital, Blacktown, 5Children Medical Research Institute, Westmead, Australia
Introduction: Gap junction remodelling occurs in heart disease and likely contributes to
the pathophysiology of cardiac arrhythmias. The most abundant cardiac gap junction
proteins are connexin (Cx) 43, 40 and 45. Cx45 expression in cardiac physiology is the
least studied.
Objectives: Our aim was to phenotype the rat heart following over-expression of Cx45 by
somatic gene transfer.
Methods: Adult Sprague-Dawley rats were tail-vein injected with 1X1012 vector genomes
of recombinant adeno-associated virus encoding eGFP (n¼12), Cx43 (n¼12) or Cx45
cDNA (n¼22). Surface and transoesophageal ECGs were performed on anaesthetised rats at
Day 0 and 28 following injection.
Results: Immunoflourescence revealed a transduction efficiency of >90%. Surface ECG in
Cx45 treated rats revealed PR interval (45.86.0 vs 59.014.0ms) and QRS duration
(14.81.9 vs 16.21.8ms) prolongation over the 28 day period (P<0.05). The eGFP and
Cx43 groups had no ECG changes from baseline. Heart block was seen in 5 of 22 Cx45
treated rats but not in the Cx43 or eGFP groups. Importantly 13 of 22 Cx45 treated rats
had inducible ventricular tachyarrhythmia compared with 1 of 12 Cx43 and none of the
eGFP treated rats (P<0.01). Heart to body weight ratio, ANP and beta-MHC gene acti-
vation, and cardiac fibrosis staining was similar between groups.
Conclusion: Cardiac over-expression of Cx45 slowed conduction as evidenced by pro-
longed ECG intervals and AV block. Cx45 over-expression modified ventricular myocar-
dium increasing the propensity for inducible ventricular tachyarrhythmia. These effects of
Cx45 were independent of cardiac failure or fibrosis.
Disclosure of Interest: None Declared
PM380
Fibrinogen and its genetic variants modify the risk for coronary artery disease in
subjects suspected for stable angina by altering the coagulation cascade
Nikolaos Papageorgiou, Dimitris Tousoulis*, Alexandros Briasoulis, Antigoni Miliou,
Maria Kozanitou, George Hatzis, Emmanuel Androulakis, Gerasimos Siasos, Costas Tentolouris,
Zoi Pallantza, Christodoulos Stefanadis
1st Cardiology Department, Hippocration Hospital, Athens, Greece
Introduction: It is well known that coronary artery disease (CAD) is characterized by
altered coagulation process, while plasma fibrinogen levels are associated with increased
risk of CAD.
Objectives: We aimed to assess the effects of rs180070 and rs2070011 polymorphisms on
coagulation cascade and the risk for CAD in subjects suspected for CAD.
Methods: The study population consisted of 744 subjects who were admitted for coronary
angiography due to symptoms of stable angina pectoris. The two polymorphisms were
determined by PCR-RFLP technique. Plasma fibrinogen, CD40L and D-dimer levels were
assessed with appropriate methods. Participants were also divided in 3 sub-categories ac-
cording to fibrinogen levels (<347; 347–443; >443 mg/dl).
Results: We found that CAD was present in 448 out of 744 subjects. Multivariate logistic
regression analysis after adjustment for classical risk factors revealed that increased
fibrinogen levels (>443 mg/dl category) were associated with higher risk for CAD [OR: 3.9,
95% CI (1.7-9.4), p¼0.002)] compared to levels <347 mg/dl, whereas the intermediate
fibrinogen levels subcategory had no significant effect on the risk of CAD [(adjusted OR:
1.02, 95% CI (0.46-2.24) p¼0.97)]. Of note, AA homozygosity (rs1800700) was signifi-
cantly associated with increased risk of CAD [OR: 3.2, 95% CI (1.01-10.1, p¼0.049)],
while this group had significantly higher fibrinogen levels compared to the G allele carriers
(503.418.8 vs 402.65.14, p<0.001). Moreover, in the total study population, AA
homozygotes (rs180070) exhibited significantly higher levels of CD40L (2.550.35 vs
2.130.19, p¼0.019) and D-dimer (555.343 vs 469.119.6, p¼0.033), compared to G-
allele carriers. The presence of the A allele (rs180070 and rs2070011) was neither asso-
ciated with the angiographic severity [(OR: 1.36, 95%CI (0.63–2.95) p¼0.434 and
OR:0.99, 95%CI (0.56-1.78,) p¼0.995 respectively) nor with the occurrence of acute
myocardial infarction [OR:1.87, 95%CI (0.37–8.9), p¼0.46] and [OR: 0.75, 95%CI (0.39-
1.43), p¼0.378] respectively.
Conclusion: The present study suggests that the rs180070 fibrinogen gene variant may be
associated with altered coagulation, as well as the risk of CAD. Furthermore, the increased
fibrinogen levels which are also affected by the aforementioned variant may be indepen-
dently associated with higher risk for CAD.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

PM381
The role of lipocalin-2 gene in cell death in a heritable polygenic model of cardiac
hypertrophy
Francine Z. Marques1, Indrajeet Rana1, Joanna Skommer1, Vivek Jayaswal2, Claire Curl3,
Jean Y. Yang2, Paul A. Lewandowski4, Lea Delbridge3, Stephen Harrap3, Fadi J. Charchar*1
1
School of Health Sciences, University of Ballarat, Ballarat, 2School of Mathematics and Statistics,
University of Sydney, Sydney, 3Department of Physiology, University of Melbourne, Melbourne,
4
School of Medicine, Deakin University, Geelong, Australia
Introduction: The Hypertrophic Heart Rat (HHR) is a normotensive model of human
polygenic cardiac hypertrophy. It has a reduced complement of cardiomyocytes from birth,
which leads to compensatory hypertrophy, and causes cardiac failure and premature death
in adulthood.
Objectives: Our aim was to investigate the regulatory mechanisms at the genome-level that
may govern these processes, in particular the role of genes in cell death.
Methods: Genome-wide transcriptome expression was measured by Affymetrix Rat Gene
ST Arrays using RNA from the left ventricle of neonatal HHR and control rat, the Normal
Heart Rat (NHR) (n¼16). Real-time PCR (qPCR) was used to validate gene expression. We
also over-expressed lipocalin-2 (Lcn2) in a cardiac cell line in vitro, and measured the
number of cells and caspase-3/7 activity (3 independent experiments).
Results: Statistical analysis identified 109 differentially expressed genes in cardiac ventricle
of male HHR (FDR<0.05 and fold change>1.5). Gene ontology analysis highlighted an
over-representation of genes related to cell death, cell differentiation and DNA replication.
The gene for Lcn2 was the most significantly differentially expressed gene, with 12-fold
higher expression in the HHR. This was further validated by qPCR (P¼ 0.0001). This gene
is located in a quantitative trait locus in the rat previously identified by several independent
studies to be associated with cardiac mass independent of blood pressure. Lcn2 has been
recently described as a critical regulator of cell proliferation, autophagy and mitochondrial
function. The over-expression of Lcn2 in a cardiomyocytes in vitro confirmed the ability of
this gene to decrease the number of cells (P¼0.001) and increase the activity of executioner
caspase-3/7 (P¼0.006), supporting a role of this gene in the reduced complement of
cardiomyocytes in the HHR.
Conclusion: Together these findings suggest that dysregulation of the gene for Lcn2 during
the neonatal period may be an important regulatory mechanism governing cardiomyocyte
differentiation in the HHR.
Disclosure of Interest: None Declared
PM382
Evaluation of associations of lipoprotein (a) with coronary atherosclerosis and with
polymorphic markers of the apolipoprotein (a) gene in men in Sibiria
Konstantin Y. Nikolaev*1, Vladimir Maksimov2, Mikhail Voevoda1, Ekaterina Mazdorova2,
Yulia Ragino2
1
Novosibirsk State University, 2Institute of Internal Medicine, Novosibirsk, Russian Federation
Introduction: It is well known that lipoprotein(a) contributes to the formation to
atherosclerosis, promotes inflammation and stimulates prothrombotic processes.
Objectives: The aim of study was to assess the association of lipoprotein (a) (LP (a)) with
coronary heart disease (CHD) and associations with polymorphic markers of the apoli-
poprotein (a) gene in Caucasian men with coronary atherosclerosis.
Methods: The sample consisted of 166 men (81 men with coronary atherosclerosis which
was verified at coronary angiography in comparison with 85 men without coronary heart
disease), aged 42-77 years, inhabitants of Novosibirsk. PCR-based genotyping was applied
for LPA gene (rs 3798220, rs10455872). LP (a) were determined by enzyme-linked
immunosorbent assay (ELISA). Considered an indicator of elevated lipoprotein (a)
30
mg/dL.
Results: The mean age of all men included in study was 57.56 years  0,52 (M  SE). LP
(a) level was superior by 1.5 times in men with coronary atherosclerosis in comparison
with men without coronary artery disease (p <0.001). In the group of men with coronary
heart disease the high lipoprotein (a) level
30 mg / dl was detected in 25 men (30.9%) in
comparison with men without CHD (p <0.001). The odds ratio of CHD were 9.04
(95% CI: 2.98-27.41, p <0.001) among men with increased lipoprotein (a) levels
compared to men with normal lp(a) levels. Genotype frequencies were 77.8% /22.2% /0%
vs 90.6% /9.4% /0%, p¼0.072, n¼123. But when adjusting for age was used we found
significant association of G allele carriers LPA gene with increased atherogenic lipid markers
of lipoprotein (a) among men with increased lipoprotein (a) levels, OR 3.43 (95% CI: 1.04-
11.31), p¼0.043.
Conclusion: We found the strong association between increased lipoprotein (a) levels and
coronary heart disease in men. There is a significant association of G allele carriers of LPA
gene (rs10455872) with elevation of atherogenic lipid markers of lipoprotein (a) among
men with increased lipoprotein (a) levels.
Disclosure of Interest: None Declared
PM385
Safety, Tolerability, And Efficacy Of Long-Term Administration Of Monthly AMG
145 In Subjects With Heterozygous Familial Hypercholesterolemia
Frederick Raal1, Patric Nelson2, Gisle Langslet3, Dick C. G. Basart4, Fernando Civeira5,
Jose Lopez-Miranda6, Dirk Blom7, Luis Masana8, Mats Eriksson9, Brian Tomlinson*10
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
1
University of the Witwatersrand Medical School, Johannesburg, South Africa, 2Amgen Inc.,
POSTER ABSTRACTS
Thousand Oaks, United States, 3Lipid Clinic, Oslo University Hospital, Oslo, Norway,
4
Cardiology, Westfries Gasthuis, Hoorn, Hoorn, Netherlands, 5Hospital Universitario Miguel
Servet, Zaragoza, 6Hospital Universitario Reina Sofia, Cordoba, Spain, 7Univeristy of Cape
Town, Cape Town, South Africa, 8Unitat Recerca Lipids & Arteriosclerosi, Reus, Spain,
9
Karolinska University Hospital, Stockholm, Sweden, 10Prince of Wales Hospital The Chinese
University of Hong Kong, Hong Kong, China
Introduction: The RUTHERFORD study showed that 12 weeks of treatment with AMG
145, a fully human monoclonal antibody against PCSK9, was well tolerated and signifi-
cantly reduced LDL-C by 44 – 56% compared to placebo in over 160 subjects with het-
erozygous familial hypercholesterolemia (HeFH). However, to date, the long-term safety
and efficacy of AMG 145 or PCSK9 inhibition therapy in HeFH subjects has been
undefined.
Objectives: The primary objective was to evaluate the safety and tolerability of AMG 145
on a background of standard of care (SOC). Secondary objectives were effects on lipid
parameters compared to study baseline.
Methods: Subjects with HeFH diagnosed by Simon Broome criteria with LDL-C > 100mg/
dL despite statin therapy with or without ezetimibe and who completed the 12-week
RUTHERFORD study were invited to participate in an open-label extension (OLE) study.
Subjects were randomized to receive AMG 145 420 mg monthly with SOC or SOC alone
for 1 year.
Results: A total of 147 subjects (mean [SD] age 49 [13] years, 54% male) enrolled in
the OLE study. As of January 24, 2013, the median duration of AMG 145 study
exposure was 14 months (Min – Max: 10.9 – 17.8). LDL-C levels in subjects who
crossed over to SOC returned to pre–AMG 145 treatment levels in 12 weeks, whereas
those randomized to AMG 145 had similar reductions in LDL-C to subjects who
received AMG 145 in RUTHERFORD. Subjects who received AMG 145 in RUTH-
ERFORD and continued it in OLE experienced stable and sustained reductions in LDL-C
(Figure). The overall incidence of treatment-emergent adverse events (TEAEs) was 88.7%
in the SOC group and 91.5% in the AMG 145 + SOC group. The incidence of serious
TEAEs was higher in the SOC group (11.3%) than in the AMG 145 + SOC group
(6.4%). There were no serious study drug-related TEAEs, TEAEs leading to study drug
discontinuation, or deaths.
web 3C=FPO
Conclusion: Monthly AMG 145 dosing demonstrates encouraging safety, tolerability and
sustained efficacy during prolonged treatment of hyperlipidemia in HeFH subjects.
Disclosure of Interest: F. Raal Grant/research support from: Reimbursement for con-
ducting clinical trials with novel lipid-lowering therapies - Amgen, Sanofi, Consultancy for:
AstraZeneca, Pfizer, Merck, Honorarium from: AstraZeneca, Pfizer, Merck, Amgen, Sanofi,
Speakers bureau: AstraZeneca, Pfizer, Merck, Amgen, P. Nelson Shareholder of: Amgen
Inc., Employee from: Amgen Inc., G. Langslet Consultancy for: Janssen Pharmaceutical, D.
Basart: None Declared, F. Civeira Consultancy for: modest support, J. Lopez-Miranda
Shareholder of: modest support, Grant/research support from: modest support, Consul-
tancy for: modest support, Employee from: significant support, Honorarium from: modest
support, Speakers bureau: modest support, D. Blom Consultancy for: MSD, Sanoti Aventis,
Aegerion, Honorarium from: Amgen, Sanofi Aventis, MSD, PharmaDynamics, AstraZeneca,
Aegerion, L. Masana Consultancy for: Amgen, Novartis, Esteve, Danone, Speakers bureau:
MSD, Kowa, Esteve, M. Eriksson Consultancy for: modest support, Honorarium from:
modest support, B. Tomlinson Grant/research support from: AstraZeneca, Bristol-Myers
Squibb, GlaxoSmithKline, Merck Serono, Merck Sharp and Dohme, Novartis, Roche,
Takeda, Consultancy for: Amgen, Genzyme, Janssen, Merck Serono, Speakers bureau:
Boehringer, Ingelheim, Merck Serono, Merck Sharp and Dohme
PM387
GPR119 mediates metabolic and hypertrophic signalling pathways in cardiac
myoblasts in vitro
Lauren Cornall*1, Michael Mathai1, Deanne Hryciw2, Andrew McAinch1
1
College of Health and Biomedicine, Victoria University, 2Department of Physiology, The
University of Melbourne, Melbourne, Australia
Introduction: Obesity and type 2 diabetes (T2D) are 2 of the major causes of cardiovas-
cular disease (CVD). The prevalence of these conditions continues to rise in concert with
e139
 each other. Agonists for the G-protein coupled receptor, GPR119, are currently being
POSTER ABSTRACTS
developed as anti-diabetic agents, with initial studies showing hypoglycaemic and anorectic
effects. However the effects of GPR119 agonists on the heart are unknown.
Objectives: Given the relationship between obesity, T2D and impaired cardiac health, we
examined the direct effects of activating GPR119 on markers of nutrient metabolism and
hypertrophy in cardiomyoblasts.
Methods: H9c2 myoblasts were cultured in the presence or absence of a high fat envi-
ronment (HFE; 5 mM Palmitate) for 16 hrs. Cells were then exposed to the GPR119 specific
agonist, PSN632408 (PSN; 5 mM) with/without continued palmitate treatment for a further
15 mins (protein analysis) or 6 hrs (mRNA, metabolic activity, hypertrophy analysis). n ¼
6-10/group, significance was accepted at p  0.05.
Results: In H9c2 myoblasts untreated with palmitate (basal), PSN significantly decreased the
mRNA abundance of key markers of glucose and fatty acid metabolism, AMPKa, NFATc3 and
PPARa, and inflammatory/hypertrophic markers, CTGF, SOCS3 and TGFb1. The HFE
largely abrogated the effects of GPR119 agonism with only SOCS3 mRNAs being up-regu-
lated compared to palmitate treated cells. Reversion to basal fatty acid conditions after
exposure to the HFE led to PSN-induced increase in TGFb1 and decrease in CTGF mRNAs.
Western blotting also revealed differential regulation of ERK1/2 and JNK MAPK proteins
following treatment with PSN and/or palmitate where basal conditions down-regulated
pERK1/2 while the HFE induced pJNK expression. AMPKa protein was unaffected by PSN in
all conditions. Importantly PSN reduced metabolic activity in the H9c2 cells both in basal and
the HFE. However PSN did not induce hypertrophy in either condition.
Conclusion: These results imply that direct activation of GPR119 in heart cells is unlikely
to have a beneficial effect on overall cardiac function in the presence of impaired metabolic
health. Given that the therapeutic application of GPR119 agonists is in their ability to
attenuate pre-existing metabolic disease we suggest caution is required if this class of drugs
is to be further developed for the treatment of obesity and T2D.
LMC was supported by a scholarship (PB 10M 5472) from the National Heart Foun-
dation of Australia.
Disclosure of Interest: None Declared
PM389
Protein Arginine Methyltransferase 5/Methylosome Protein 50 Complex Regulates
Hypertrophic Responses by Suppressing p300/GATA4 Pathway in Cardiomyocytes
Yusuke Miyazaki*1, Yasufumi Katanasaka1, Yukiko Nakagawa1, Yoichi Sunagawa1,
Junya Nakada1, Hidetoshi Suzuki1, Hiromichi Wada2, Koji Hasegawa2, Tatsuya Morimoto1
1
Division of Molecular Medicine, University of Shizuoka, Shizuoka, 2Division of Translational
Research, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
Introduction: A zinc finger protein, GATA4, is one of the transcription factors that mediate
changes in gene expression during myocardial-cell hypertrophy and forms a functional
complex with an intrinsic histone acetyltransferase (HAT), p300. HAT activity of p300 is
required for acetylation and the transcriptional activation of GATA4 as well as for cardiac
hypertrophy and the development of heart failure in vivo. By tandem affinity purification
and mass spectrometric analysis, we identified arginine methyltransferase 5 (PRMT5) and
methylosome protein 50 (MEP50) are novel components of the p300/GATA4 complex.
However, precise functional regulation by PRMT5/MEP50during hypertrophic responses is
still unclear.
Objectives: We assessed the hypothesis that PRMT5/MEP50 complex suppressed cardiac
hypertrophic responses by regulating post-transcriptional modification of p300/GATA4 in
cardiomyocytes.
Methods: The binding of PRMT5 and MEP50 with GATA4 and p300 was examined by
glutathione S transferase (GST) pull-down assay and immunoprecipitation followed by
Western-blot analysis (IP-WB) in HEK293 cells. Acetylated form of GATA4 and methylated
form of p300 were determined by IP-WB in HEK293 cells. HEK293 cells and primary car-
diomyocytes from neonatal rats in culture were transfected with reporter plasmids encoding
atrial natriuretic factor (ANF) and endothelin-1(ET-1) promoters. These cells were harvested
for luciferase assays. Cardiomyocytes overexpressed with PRMT5 and MEP50 were stained
with b-myosin heavy chain (b-MHC) antibody and measured the myocardial cell surface area.
Results: GST pull-down assay and IP-WB demonstrated that PRMT5 and MEP50 bind not
only GATA4 but also p300, respectively. Overexpression of MEP50 increased the binding
between PRMT5 and p300. PRMT5 increased the methylation of p300 and repressed p300-
induced acetylation of GATA4 in HEK293T cells. Overexpression of PRMT5 or MEP50
inhibited p300/GATA4-induced ANF and ET-1 promoter activities in HEK293T cells. In
cardiomyocytes, overexpression of PRMT5 or MEP50 significantly inhibited phenyleph-
rine-induced hypertrophic responses such as myofibrillar organization, an increase in the
cell size, and the activation of ANF and ET-1 promoters.
Conclusion: PRMT5 and MEP50 form a repressor complex with p300/GATA4. MEP50
recruits PRTM5 on p300, increases the methylation of p300, and inhibits p300/GATA4-
dependent transcription and hypertrophic responses in cardiomyocytes.
Disclosure of Interest: None Declared
PM390
Recovery Of Vascular And Ventricular Dysfunction By A New N-Acylhydrazone
Derivative In Experimental Pulmonary Hypertension
Gisele Zapata-Sudo*1, Allan K. Alencar1, Sharlene L. Pereira1, Roberta Tesch1, Flavia E. Silva1,
Valeria N. Cunha2, Eliezer J. Barreiro1, Jose H. Nascimento1, Carlos A. Fraga1, Roberto T. Sudo1
1
universidade Federal Do Rio De Janeiro, Rio de Janeiro, Brazil, 2Pharmacology, Universidade
Federal Do Rio De Janeiro, Rio de Janeiro, Brazil
e140
Introduction: Pulmonary arterial hypertension (PAH) is a disease that results in right
ventricular (RV) dysfunction which is major determinant of its prognosis.
Objectives: This work investigated the effects of (E)-N’-(3,4-dimethoxybenzylidene)-4-
methoxybenzohydrazide (LASSBio-1386), a N-acylhydrazone derivative, on relaxation of
lung vasculature and on RV dysfunction induced by experimental PAH.
Methods: Protocols were approved by Animal Care and Use Committee at Universidade
Federal do Rio de Janeiro. Male Wistar rats received a single intraperitoneal injection of
monocrotaline (MCT) (60 mg/kg) for PAH induction. Animals were randomly divided in
the following groups: 1. saline, 2. MCT + vehicle (PAH), 3. MCT + LASSBio-1386 (50
mg/kg p.o.). After 14 days of treatment, some parameters were evaluated: 1. exercise
capacity (EC) performed in a graded treadmill; 2.pulmonary acceleration time (PAT)
measured using transthoracic echocardiography; 3. right ventricular systolic pressure
(RVSP); 4. vascular reactivity to acetylcholine in pulmonary artery; 5. expression of the
endothelial nitric oxide synthase (eNOS), adenosine A2A receptor (A2AR), SERCA2a and
phospholamban through the western blot; 6. docking study in the A2A receptor crystal
structure.
Results: PAH reduced the EC from 1544.0  109.1m.kg to 760.9  34.7 m.kg and
oral treatment with LASSBio-1386 recovered to 1357.0  87.8 m.kg. Increased RVSP
(mmHg) in PAH (49.5  5.0) was recovered to 23.0  1.0 after treatment with
LASSBio-1386. RV/BW (mg/g) in PAH (1.63  0.16) was reduced to 0.65  0.41 in
MCT + LASSBio-1386 group. RV wall thickness (cm) increased from 0.10  0.02
(control) to 0.15  0.09 (PAH) and recovered to 0.10  0.01 in rats treated with
LASSBio-1386. Pulmonary artery diameter (cm) was enhanced from 0.29  0.01
(control) to 0.41  0.01 (PAH) and reduced to 0.29  0.03 after treatment. PAT (ms)
was reduced from 44.2  0.7 (control) to 25.5  1.3 (PAH) and restored to 41.9 
1.2 with LASSBio-1386 treatment. Acetylcholine-induced maximum relaxation of pul-
monary artery (%) was reduced from 62.7  1.5 to 43.6  1.2 and restored to 68.4 
3.5 after LASSBio-1386. The docking study in the A2A crystal structure demonstrated
possible interaction of LASSBio-1386. A2AR, SERCA2a and phospholamban expression
in lung and RV tissue was changed by PAH and normalized after treatment with
LASSBio-1386.
Conclusion: LASSBio-1386 effectively reversed RV hypertrophy and pulmonary vascular
remodeling in rats with MCT-induced PAH.
Disclosure of Interest: None Declared
PM391
Improvement Of Vascular And Cardiac Remodeling By Benzoylhydrazone Derivative
In Rats With Monocrotaline-Induced Pulmonary Hypertension
Gisele Zapata-Sudo*, Carla M. Leal, Daniella M. Leal, Sharlene L. Pereira,
Emanuelle B. Ferraz, Carlos A. Fraga, Jose H. Nascimento, Eliezer J. Barreiro,
Roberto T. Sudo
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Introduction: Right ventricular hypertrophy, increased right ventricular pressure associ-
ated with pulmonary vascular remodeling are changes observed in pulmonary arterial
hypertension (PAH).
Objectives: The present work investigated the effects of 2-thienyl-3,4-methylenediox-
ybenzoylhydrazone (LASSBio-1027), a novel A2A adenosine receptor agonist in rats with
monocrotaline (MCT)-induced PAH.
Methods: Male Wistar rats received a single intraperitoneal injection of MCT (60 mg/kg)
for PAH induction. Studied groups were: control, MCT + vehicle (DMSO), MCT +
LASSBio-1027 (20 mg/kg i.p. or 50 mg/kg p.o.). The rats were treated with vehicle or
LASSBio-1027 for 14 days after the onset of disease (n ¼ 6 per group). The following
parameters were analyzed: right ventricular systolic pressure (RVSP), right ventricle weight
(RV), relation between right ventricle weight to body weight (RV/BW). In addition,
endothelial dysfunction of pulmonary artery was evaluated by the observation of acetyl-
choline-induced relaxation. Transthoracic echocardiography was performed to determine
pulmonary acceleration time (PAT) and RV wall thickness. Protocols were approved by
Animal Care and Use Committee at Universidade Federal do Rio de Janeiro.
Results: The results observed in the expeimental groups are presented in the following
table.
Maximum acetylcholine-induced relaxation (%) was reduced from 65.3  4.3 (control)
to 35.4  3.3 in pulmonary artery from MCT rats (P < 0.05). Treatment with 20 mg/kg
and 50 mg/kg of LASSBio-1027 recovered to 62.9  5.4% (P < 0.05) and 59.8  6.4%
(P < 0.05).
Conclusion: LASSBio-1027 reduced cardiac hypertrophy, ventricular and endothelial
dysfunction in MCT-injected rats suggesting a new perspective for the treatment of PAH.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PM392

POSTER ABSTRACTS
Characterising Mkk3 And Mkk6 Signaling In Isolated Cardiomyocytes
Andrei Alexa*
Health Science and Medicine, Bond University, Gold Coast, Australia
Introduction: MKK3 and MKK6 are the primary upstream signalling proteins of the
p38-MAPK pathway involved in modulating ischaemic stress. Previous studies
involving MKK3 and MKK6 in isolated cardiomyocyte and transgenic animal models
have both been used to determine that MKK3 preferentially activates p38a while
MKK6 activates both p38a and p38b, however, a comprehensive characterisation of
the transcriptional response prior to and following ischaemic stress has yet to be
carried out.
Objectives: The objective of this study is to examine the effects of ischaemic stress in
isolated cardiomyocytes following transient knockdown of MKK3, MKK6 and dual MKK3/
MKK6.
Methods: Cell stress, as determined by LDH release, will be quantified in normoxic and
ischaemically stressed MKK3, MKK6 and dual MKK3 and MKK6 miRNA transfected
cardiomyocytes referenced to LacZ GFP transfection controls, after which transcriptional
changes will be examined using RT-qPCR. Ischaemia will be simulated using a buffer
exchange of ischaemia mimetic media in an oxygen poor environment in a hypoxic
chamber for 2 hours followed by cell recovery in KH media at physiological oxygen

levels for 6 hours, all at 37 degrees. Protein and activated protein will also be quan-
tified and compared across all samples to characterise the post-transcriptional response
concurrently.
Results: Preliminary results obtained in previous gene knockdown studies of MAPK14
(p38a) and MAPK11 (p38b) determined that LDH release was reduced and MKK6
transcription was significantly increased when the p38 –MAPK pathway was partially
silenced. To be more specific in MAPK14 (p38a) silenced cells MKK3 transcription
levels remained unchanged compared to normoxic LacZ transfection control. In
MAPK11 (p38b) knockdown cells however the transcription of MKK3 was impaired
and LDH release was reduced to normoxic levels compared to normoxic LacZ trans-
fection control.
Conclusion: In Conclusion these preliminary results lend credence to previous find-
ings that determined MKK6 transcription to be cardioprotective while MKK3 tran-
scription reduced tolerance to ischaemic stress. What is yet to be determined is how
loss of either MKK3 or MKK6 transcription will affect cell tolerance to ischaemic
stress and what are the associated post-translational and transcriptional changes at the
cell surface, the various intracellular signalling pathways, the nucleus and the
mitochondria.
Disclosure of Interest: None Declared
PM393
Microrna-22 Protects Against Ischemia/Reperfusion-Induced Myocardial Injury Via
Anti-Apoptosis Through Its Target Gene Cbp
Jian Yang*1, Jun Yang1, Jia W. Ding1, Li H. Chen1, Song Li1, Xin X. Li1
1
Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges
University, Yichang, China
Introduction: MicroRNAs (miRs) participate in various cardiac pathophysiological pro-
cesses, including ischemia/reperfusion (I/R)-induced myocardial injury. Recently, we and
other researchers have found microRNA 22 (miR-22) is acutely downregulated in rat
hearts after I/R. However, the specific function of miR-22 in myocardial I/R injury is
uncertain.
Objectives: In the present study, we will determine the role of miR-22 on myocardial I/R
injury and investigate the underlying mechanism of miR-22 mediated myocardial
protection.
Methods: Fifty-six rats were randomly divided into four groups: an I/R model group
with Ad-Scramble (Ad-Scramble group), an I/R model group with Ad-miR-22 (Ad-
miR-22 group), an I/R control group with saline (I/R group) and a sham-surgery
group (Sham group). All the animals were euthanized at the end of 12 hours
reperfusion after 30-min ischemia via left anterior descending coronary artery occlu-
sion. Serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels were
determined with commercial kits. Myocardial infarct size was evaluated by Evans Blue/
Triphenyltetrazolium chloride (TTC) staining. We also used terminal deoxynucleotide
transferase dUTP nick end labeling (TUNEL) to detect cardiomyocytes apoptosis.
Meanwhile, protein and mRNA expression of CREB binding protein (CBP), p53 and
pro-apoptotic related genes were examined by Western blot and real-time PCR
respectively.
Results: It was shown that adenovirus-mediated miR-22 overexpression markedly
reduced the release of CK and LDH (P both <0.05). Moreover, Ad-miR-22 signif-
icantly reduced myocardial infarct size and cardiomyocytes apoptosis compared with
that in the I/R and Ad-Scramble groups (P both <0.05). Then we went further to
study the mechanism. We observed that CBP as a potential miR-22 target by bio-
informatics was significantly inhibited after miR-22 transfection (Figure 1, P <0.05).
We also found that p53 acetylation activity, pro-apoptotic related genes Bax and p21
levels were all decreased associated with the down-regulation of CBP (Figure 1, P all
<0.05).
web 3C=FPO
Conclusion: Our study provides the first evidence that miR-22 could attenuate I/R injury
and offer myocardial protection against I/R induced cardiomyocytes apoptosis by directly
targeting CBP. These data suggest that enhancing miR-22 expression might be a desirable
therapeutic approach for the treatment of myocardial I/R injury.
Disclosure of Interest: None Declared
PM395
Differential post-translational modification of CaMKII splice variants may be
critical to determining post-ischemic arrhythmia vulnerability in male and
female hearts
James Bell*1, Antonia Raaijmakers1, Melissa Reichelt1, Claire Curl1, Lea Delbridge1
1
Department of Physiology, University of Melbourne, Melbourne, Australia
Introduction: Lethal arrhythmias are a major cause of death in ischemic heart disease,
with incidence generally greater in men (vs women). Ca2+/calmodulin-dependent kinase
II (CaMKII) is a key regulator of myocardial Ca2+-handling proteins, which mediates
Ca2+-related pathologies including reperfusion arrhythmias. Expressed as two splice
variants (dB & dC) with postulated, but not well-defined selective targets, CaMKII
activity can also be maintained through autophosphorylation or oxidation (P-CaMKII &
ox-CaMKII). Little is known about whether these splice variants are differentially
susceptible to autophosphorylation/oxidation, and how this may influence
arrhythmogenesis.
Objectives: The aim of this study was to assess the role of CaMKII in reperfusion ar-
rhythmias in male/female hearts, and identify the post-translational molecular processes
involved.
Methods: Male/female isolated rat hearts (n¼7-8) were subjected to 20mins ischemia plus
either 10mins reperfusion (assessment of arrhythmias) or 2mins reperfusion (maximal
CaMKII activity). Ventricular homogenates were subsequently prepared for Western blot
analysis.
Results: Ventricular tachycardia/fibrillation in early reperfusion was significantly lower in
female hearts (vs males; 51784 vs 5918 secs, p<0.05), despite an augmented upre-
gulation of P-CaMKII (1.50.1 vs 2.70.3 arb units, p<0.05) and phosphorylation of its
downstream substrates, phospholamban (PLB-Thr17) and ryanodine receptor (Ser2814).
This contrasts with the current literature (male) linking CaMKII activation with reperfusion
arrhythmias. An inverse relationship between PLB-Thr17 and ox-CaMKII in individual
hearts was observed, with low ox-CaMKII levels associated with high PLB-Thr17. P-
CaMKII and PLB-Thr17 levels were modulated in parallel. Analysis of sub-fractionated
homogenates showed CaMKIIdB predominantly localized in the nuclear/myofilament
fraction, whilst CaMKIIdC was enriched in the membrane fraction. Interestingly, P-CaMKII
and ox-CaMKII closely co-localised with CaMKIIdB and CaMKIIdC respectively, suggesting
a differential susceptibility of splice variants to autophosphorylation/oxidative
modifications.
Conclusion: These data challenge the canonical view of CaMKII as a pro-arrhythmic
mediator, and suggest its arrhythmogenic actions may be dependent on the specific car-
diomyocyte subcellular localisation. In females, arrhythmic vulnerability may be

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e141

 suppressed due to augmented generation of ‘cardioprotective’ P-CaMKIIdB possibly
POSTER ABSTRACTS
limiting deleterious actions associated with ox-CaMKIIdC.
Disclosure of Interest: None Declared
PM396
Impact of Fetal Growth and Preterm Birth on the Microvasculature in Mid Adulthood
Monira Hussain*1,2, Mika Kähönen3, Olli Raitakari4, Michael Skilton5, Nicholas Witt6,
Nishi Chaturvedi6, Alun Hughes6, Simon McG Thom6, Andrew Metha1, Robyn Tapp1
1
Department of Optometry and Vision Sciences, The University of Melbourne,
2
Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia,
3
Department of Clinical Physiology, Tampere University Hospital and the University of Tampere,
Tampere, 4Research Centre of Applied and Preventive Cardiovascular Medicine and Department
of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital,
Turku, Finland, 5Boden Institute of Obesity Nutrition Exercise and Eating Disorders, University
of Sydney, New South Walse, Australia, 6International Centre for Circulatory Health, St Mary’s
Hospital and Imperial College, London, United Kingdom
Introduction: Microvascular dysfunction may be critical to our understanding of the
mechanisms linking early life events with the later development of cardiovascular
disease.
Objectives: We hypothesised that preterm birth and being born small for gestational
age would be associated with changes in retinal microvascular architecture and that
these changes would be more marked among those born preterm. We predicted that
these changes would correlate with early markers of cardiovascular disease in mid-
adulthood.
Methods: The Cardiovascular Risk in Young Finns Study included randomly selected
children from 5 Finnish University cities. Retinal microvascular architecture of par-
ticipants born preterm (<37 weeks gestation, n¼122), born at term and small for
gestational age (n¼122) and a control group born at term and appropriate for
gestational age (n¼495) were compared. Retinal microvascular measures were eval-
uated, including tortuosity, retinal diameters, bifurcation angles and length/diameter
ratios.
Results: The mean age of the participants was 40 years (range 34 – 49 years) at the time
of retinal photography. In participants born preterm, simple arteriolar tortuosity was
higher (means (standard error), 0.06 (0.01) versus 0.04 (0.01), p¼0.001), arteriolar
length increased (644.9 (35.9) versus 591.7 (33.5), p¼0.007) and arteriolar diameters
narrowed (19.9 (0.4) versus 20.3 (0.3), p¼0.034) compared to participants born
appropriate for gestational age. All the analysis were adjusted for age, sex, marital status,
employment status and smoking. In participants born small for gestational age, only
simple arteriolar tortuosity was higher (0.05 (0.01) versus 0.04 (0.01), p¼0.074)
compared to participants born appropriate for gestational age. A difference in birth
weight of 500g independently influenced arteriolar tortuosity by the same amount as
23mmHg systolic blood pressure, 0.3mm intima media thickness and had three times the
effect of daily smoking.
Conclusion: This study demonstrated that being born small for gestational age and in
particular preterm birth are associated with changes in retinal microvascular architecture
and may be related to early markers of cardiovascular disease. The immediate postnatal
environment may provide vital information on the mechanisms of early vascular changes.
Disclosure of Interest: None Declared
PM397
Nerve Growth Factor promotes mammalian cardiomyocytes to proliferate
Nicholas T. Lam1, David M. Kaye*1
1
Heart Failure Research Group, Baker IDI Heart & Diabetes Institute, Melbourne, Australia
Introduction: Significant cardiomyocyte loss and insufficient endogenous cardiac
regeneration in adult mammals lead to heart failure. In contrast, fetal and neonatal
hearts are capable of compensatory proliferation of cardiomyocytes following cardiac
injury.
We have previously shown that Nerve growth factor (NGF) is decreased in failing hearts
and recently it was demonstrated in zebrafish that NGF enhanced cardiac regeneration by
increasing cardiomyocyte proliferation in vivo. It is not yet known whether NGF can also
increase cardiomyocyte proliferation in mammals.
Objectives: We aim to validate the effect of NGF on cardiomyocyte proliferation in
a mammalian system by studying the effect of NGF on mouse embryonic heart organ
culture.
Methods: E13.5 mouse hearts were cultured for 2 and 24 hours in vitro and the effect of
NGF was tested. Confocal micrographs generated from transverse sections of E13.5 heart
immunohistochemistry were manually counted for cTnT+ and pH3+ cells.
Results: Of the total cTnT+ cells in random transverse sections from E13.5 mouse hearts
cultured in DMEM and DMEM supplemented with NGF for 24 hours, approximately
2.20.2% and 5.10.1% of cardiomyocytes respectively were also positive for pH3. E13.5
mouse hearts exposed to NGF for 24 hours induced a 2.30.2 fold increase in pH3+ cTnT+
cells (p<0.001, n¼3) compared to DMEM controls. Taken together, these data would
suggest that NGF increased mitosis of cardiomyocytes in E13.5 mouse heart explant
cultures.
E13.5 mouse hearts cultured in DMEM supplemented with NGF for 2 hours increased
Nrg1 and ErbB4 mRNA transcript levels by 2.260.48 fold (p<0.05, n¼3) and 3.270.76
fold (p<0.05, n¼3) respectively compared to hearts cultured in DMEM controls. This
e142
suggests that NGF mediates this effect through the NRG1/ErbB4 cardiomyocyte prolifer-
ation pathway.
Conclusion: In summary, this study validated that NGF promotes cardiomyocyte prolif-
eration in mammals, which may be mediated through the Neuregulin1/ErbB4 pathway.
Further studies are required to determine if NGF can increase adult mammalian car-
diomyocytes to proliferate.
Disclosure of Interest: None Declared
PM398
Mechanisms Underlying High Temperature-Induced Arrhythmogenesis In An
Experimental Model Of Brugada Syndrome
Rocio Picon*1, Jose Di Diego2, Charles Antzelevitch3
1
Cardiology, Hospital Universitario Virgen De Valme, Seville, Spain, 2Experimental Cardiology,
3
Director of Research, Masonic Medical Research Laboratory, Utica, United States
Introduction: It well known that in some cases of Brugada syndrome (BrS) a febrile
state can unmask or exacerbate the electrocardiographic and arrhythmic manifestations
of BrS
Objectives: In this study, we examine the effect of high temperature in a coronary-perfused
right ventricular wedge preparations treated with and sodium channel current (INa)
blocker and transient outward current (Ito) agonist to pharmacologically model BrS.
Methods: Canine right ventricular wedge preparations (2x1x1 cm; n¼ 18) were coronary
perfused with Tyrode’s solution and bubbled with O2/CO2 (95%/5%) at 370.5oC.
Ajmaline (5-10 mM), an INa blocker and the Ito activator NS5806 (5-10 mM) were used
to pharmacologically model BrS-related SCN5A and KCND3 mutations. Pacing was
applied to the endocardial surface at basic cycle lengths of 500 and 2000 ms. Floating
glass microelectrodes were used to simultaneously record intracellular action potentials
from subendocardium and subepicardium (Epi) together with a transmural ECG recor-
ded across the bath. Coronary perfusate temperature was varied over a range of 37 to
40 C.
Results: Elevating temperature to 40 C resulted in abbreviation of repolarization and
reduction of the Epi AP notch, under control conditions as well as under conditions that
mimic the ECG phenotype of BrS, suggesting reduced arrhythmic risk at 40 C.
Conclusion: Our results suggest that reduction of peak INa and augmentation of peak Ito
alone are not sufficient to recapitulate the response to high temperatures in the setting of
BrS. Our data support the notion that other factors including temperature-mediated effects
on already defective ion channel gating (e.g., accelerated inactivation of INa), further
reduction of already impaired trafficking, and possibly release of endogenous cytokines,
may underlie the higher arrhythmia risk of BrS patients during fever.
Disclosure of Interest: None Declared
PM399
Chronic High Salt Intake Induces Myocardial Autophagic Vacuolization and
Accelerates Left Ventricular Dysfunction in Spontaneously Hypertensive Rats
Ying Bi1, Xin Zhou1, Wen-Jie Ji1, Shan Zeng1, Guo-Hong Yang1, Tie-Min Jiang1, Yu-Ming Li1,
Zhao-Zeng Guo*1
1
Institute of Cardiovascular Disease and Heart Center, Tianjin Key Laboratory of Cardiovascular
Remodeling and Target Organ Injury, Pingjin Hospital, Logistics University of Cpapf, Tianjin,
China
Introduction: Chronic high salt (HS) intake is associated with left ventricular (LV)
hypertrophy and progression to systolic and diastolic dysfunction. Autophagy is an
essential, life-sustaining renewal process that involves the degradation of cell constituents,
when subjected to cellular stress or during certain stages of development. The involvement
of autophagy in HS intake-accelerated LV remodeling progression remains unclear.
Objectives: To investigate the dynamic of autophagic activation and its association
with the functional and structural transition from compensated left ventricular (LV) hy-
pertrophy to decompensation during chronic HS challenge in spontaneously hypertensive
rats (SHR)
Methods: SHR and Wistar Kyoto (WKY) rats were fed low-salt (LS, 0.5% NaCl) and HS
(8.0% NaCl) diets and were subject to invasive LV hemodynamic analysis after 8, 12 and 16
weeks of dietary intervention.
Results: A global activation of autophagy-associated key components, as well as increased
cardiomyocyte autophagic vacuolization by transmission electron microscopy, was
observed after 12 weeks of HS challenge, along with a transition from compensated to
decompensated LV hypertrophy during this period, as shown by a progressive impairment
of the SHR LV function. Myocardial tonicity-responsive enhancer binding protein, a
transcription factor induced by osmotic stress, was significantly upregulated in HS fed rats,
thus providing evidence that supports myocardial interstitial hypertonicity by chronic HS
intake. The global activation of autophagy and overt deterioration of LV function were not
observed in LS-fed SHR and HS-fed WKY rats. An in vitro study using rat H9c2 car-
diomyocytes demonstrated a cytosolic [Na+] elevation-mediated, reactive oxygen species
(ROS)-dependent enhancement of the autophagic response when exposed to an increased
extracellular [Na+].
Conclusion: This work depicts the kinetics of myocardial autophagy during the transition
from compensated LV hypertrophy to decompensated heart failure after HS challenge in
SHR and reveals a novel mechanism by which interstitial hypertonicity-induced cytosolic
[Na+] elevation triggers an ROS-dependent autophagy activation.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 PM400 volumes. LVEDV did not change (11622ml vs. 11824ml, P¼0.68), however there was a

Utility of calcium channel autoantibodies in predicting sudden cardiac death and all-
cause death in chronic heart failure patients caused by DCM and ICM
Haiyun Yu*1, Juanhui Pei1, Xiaoyan Liu1, Jingzhou Chen1, Xian Li1, Yinhui Zhang1, Ning Li1,
Zengwu Wang1, Ping Zhang2, Kejiang Cao3, Jielin Pu1
1 volumes. However, hyperdynamic LV systolic function results in an increased LV ejection
State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory,
Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical
Sciences and Peking Union Medical College, 2People’s Hospital, Peking University, Beijing, 3First
People’s Hospital of Jiangsu Province, Nanjing, China
Introduction: Recent studies indicated that calcium channel autoantibody (CC-AAbs)
plays an important role in the autoimmune pathogenesis of dilated cardiomyopathy
(DCM). It is unclear, yet, whether CC-AAbs effect in patients of chronic heart failure (CHF)
caused by DCM and ischemic cardiomyopathy (ICM).
Objectives: The purpose of this study was to evaluate whether CC-AAbs might predict the
prognosis in a larger scale of patients with CHF.
Methods: A total of 2096 patients with CHF (732 DCM patients, 1099 ICM patients) and
834 control subjects were recruited. CC-AAbs was detected by enzyme-linked immuno-
sorbent assay (ELISA) and the relationship between CC-AAbs and the prognosis of patients
was analyzed.
Results: During a median follow-up of 52 months (0.40w92months), 578 cases died,
consist of 248 DCM and 330 ICM patients. Of these, sudden cardiac death (SCD) occurred
in 102 cases of DCM and in 121 cases of ICM. The positive rate of CC-AAbs in DCM and
ICM patients were both significant higher than that in controls (5.87% and 4.64% vs.
1.20%, both p<0.001). Multivariate analysis revealed that the positive CC-AAbs were
associated with a higher mortality in CHF patients and that it predicted SCD (HR 3.191,
95% CI 1.598-6.369 for DCM; HR 2.805, 95% CI 1.488-5.288 for ICM) and all-cause
death (HR 1.733, 95% CI 1.042-2.883 for DCM; HR 2.219, 95% CI 1.461-3.371 for ICM).
The significant association between CC-AAbs and non-SCD (NSCD) was only found in
ICM patients (HR¼1.887, 95% CI 1.081-3.293).
Conclusion: Our results demonstrated that the positive rate of CC-AAbs was higher in
CHF patients than that in controls, and there was a high incidence of all-cause death as well
as SCD in CC-AAbs positive patients with CHF. Positive CC-AAbs might serve as an in-
dependent predictor for SCD and all-cause death in these patients.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
trend towards decreased LVESV (3815ml vs. 3318ml, P¼0.09) and increased LV stroke
volume (7814ml vs. 8512ml, P¼0.12) with a significantly increased LV ejection fraction
(688% vs. 7411%, P¼0.009). Net aortic stroke volume by PCI did not change following
feeding (6714ml vs. 6811ml, P¼0.74). RV volumes did not change significantly.
Conclusion: HH volume increases significantly following feeding and this decreases LA
fraction and net aortic stroke volume is preserved under resting conditions.
Disclosure of Interest: None Declared
PM406
Quantitation Of Pulmonary Regurgitation In Repaired Tetralogy Of Fallot By Cardiac
Magnetic Resonance – It Matters Where You Measure!
Effarezan Abdul Rahman*1,2, Marymol Koshy1,2, Johanne Neill1, Wendy Strugnell1,
Dorothy J. Radford1, Dr Richard E. Slaughter1, Christian Hamilton-Craig1,3
1
Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital,
Brisbane, Australia, 2Faculty Of Medicine, Universiti Teknologi Mara (UiTM), Shah Alam,
Malaysia, 3School of Medicine, University of Queensland, Brisbane, Australia
Introduction: Pulmonary regurgitation (PR) is a common complication in repaired Tera-
tology of Fallot (TOF), causing right ventricular (RV) dilation and dysfunction. Cardiac
magnetic resonance (CMR) is the reference standard for quantitation of PR regurgitant
volume (RVol) and fraction (RF%). Measurements of RVol and RF% are used to guide
clinical decisions for surgical or percutaneous valvular interventions. However, differences
in measured flow may occur when acquired at different phase-contrast slice positions
within the pulmonary artery.
Objectives: To quantitate the difference in measured flow at two sites within the pul-
monary artery, and the effects on calculated RF%.
Methods: 101 adult patients with repaired TOF undergoing CMR at 1.5T for clinical
evaluation were analyzed. Patients with concomitant pulmonary stenosis or Melody valves
were excluded. RV diastolic, systolic volumes and ejection fraction were calculated from
cine images using the modified RV-short axis method. Phase-contrast flow imaging was
performed at the level of the pulmonary valve tips (PV) and at the main pulmonary artery
prior to the bifurcation (MPA) (figure 1). Forward flow, backward flow, RVol and RF%

PM404
Post-prandial left atrial volumes are acutely decreased in patients with hiatal hernia: a
cardiac MRI study
Christopher Naoum*1, Raj Puranik2, Gregory L. Falk3, John Yiannikas1, Leonard Kritharides1
1
Cardiology, Concord Hospital, 2Cardiology, Royal Prince Alfred Hospital, 3Upper GI Surgery,
Concord Hospital, Sydney, Australia

Introduction: Left atrial (LA) compression is common among patients with large hiatal
hernia (HH). The relationship between LA compression and exertional dyspnoea, which is
highly prevalent in this cohort, is incompletely understood. Moreover, the acute haemo-
dynamic effect of post-prandial HH distension has not been systematically studied.
Objectives: To assess the effect of acute HH distension on resting cardiac volumes.
Methods: Patients with clinically significant HH were prospectively selected for inclusion.
CMR was performed using a 1.5T System (Philips) before and after oral feeding with a
commercially available rice-mixture and 5-10ml/kg of mannitol. Survey axial thoracic
images were obtained for calculation of HH volume. Steady-state free precession cine MR
images were acquired in the short-axis view for calculation of left ventricular (LV) and right
ventricular (RV) volumes at end-systole (ESV) and end-diastole (EDV). Short-axis LA im-
aging was similarly acquired for calculation of multiphasic LA volumes. Through-plane
phase-contrast imaging (PCI) data was acquired in the ascending aorta for calculation of
aortic stroke volume.
Results: Between April 2012 and August 2013, 10 patients completed the CMR protocol
before and after feeding (mean  SD age, 668 yrs; 6/10 female). After feeding, mean HH
volume increased significantly (473546ml vs. 576621ml, P¼0.004) and multiphasic LA
volumes decreased throughout the cardiac cycle (Figure) with significant reductions in
maximal (8117 vs. 7115ml, P¼0.005) and minimal (409 vs. 358ml, P¼0.03) LA
web 3C=FPO

web 3C=FPO

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e143

 were measured using Circle CVi42 software by expert observers. Metrics (SD) were
POSTER ABSTRACTS
compared with the student T-test using MedCalc.
Results: Mean age 2812 years, RVEDV 23959 ml, RVESV 13444 ml, RVEF 44 6%,
LVEF 516%. Mean distance between PV and MPA flow acquisition planes was 15.3mm.
Statistically significant differences in flow metrics occurred between PV and MPA measure-
ments: Forward flow 95.7  21m vs. 90.513ml (P¼0.0001), Backward flow 23.919ml vs.
21.217ml (P<0.0001), regurgitant fraction 2519 % vs. 2317% (P¼0.0002, figure 2). In
25% of cases the difference in RF% was greater than 5%. MPA and PV stroke volumes had good
correlation with RV stroke volume from cine imaging (r¼0.70, r¼0.71 respectively). Inter-
observer reproducibility of RVol and RF% was excellent, Pearson’s correlation r¼0.99.
Conclusion: MRI flow measurements acquired at the PV level are more sensitive to both
forward flow and backward flow, and these measurements are highly reproducible. There is
a statistically and clinically significant reduction in RVol and RF% when measured at the
MPA level. For accurate quantitation of pulmonary RF% in TOF patients, MRI flow ac-
quisitions should be close to the PV valve plane. This is important to accurately inform
decision-making in the management of repaired TOF.
Disclosure of Interest: None Declared
PM407
Use of Cardiac Magnetic Resonance Imaging in predicting risk of Idiopathic
Ventricular Fibrillation
Michael Wong*1,2,3, Joseph Morton1, Alex McLellan1,2,3,4, Alex Voskoboinik2,
Liang-Han Ling1,2,3,4, Peter Kistler2,3,4, Jonathan M. Kalman1,3, Andrew Taylor2,4
1
Department of Cardiology, Royal Melbourne Hospital, 2Department of Cardiology, The Alfred
Hospital, 3Department of Medicine, University of Melbourne, Parkville, 4Clinical Cardiovascular
Research Group, The Baker IDI Heart & Diabetes Research Institute, Melbourne, Australia
Introduction: The majority of patients with non-ischaemic cardiomyopathy (NICM) do
not have macroscopic scarring at autopsy. Presence of CMR identified delayed gadolinium
enhancement (DGE) can predict sustained monomorphic VT (SMVT) during ICD
follow-up.
Objectives: We sought to characterise the CMR finding of ventricular DGE in NICM
patients with VF but not SMVT.
Methods: CMR cases performed with a 1.5-T system between September 2007 &
December 2012 post VF cardiac arrest (CA) were reviewed. VF was defined if resuscitated
CA with VF. Cases were excluded if SMVT, hypertrophic cardiomyopathy, cardiac amyloid/
sarcoid, ARVC, channelopathy (Long QT, Brugada, CPVT), prior MI/coronary artery dis-
ease were diagnosed. Pre-existing ICD was a contraindication to CMR according to insti-
tutional guidelines.
Results: 57 patients with unexplained VF underwent CMR. 15/57 had DGE and 42/57 no
DGE. 24/57 had normal LV/RV function while NICM was diagnosed in 33/57 if low LVEF/
RVEF or abnormal ventricular dilatation was evident. 13/33 (39%) NICM cases had CMR
identified DGE - 9/13 with septal midwall enhancement (3 with additional transmural/
subepicardial anteroseptal/lateral changes); 4/13 with basal inferolateral wall changes (2
with changes in keeping with previous myocarditis related injury).
Conclusion: In this selected cohort, cases with DGE on CMR could predominantly be
labelled as having NICM; however overall, 61% of cases with VF and NICM had no DGE
on CMR. DGE does not appear to be a requirement for the occurrence of VF. Further
studies are required to define if there is a role for CMR identified DGE in selecting NICM
patients at risk of VF.
Disclosure of Interest: None Declared
PM408
Comprehensive Right Heart Systolic Function Assessment Using Cardiac Magnetic
Resonance Imaging (CMR) After Inferior St Elevation Myocardial Infarction - CMR
characteristics and short term clinical outcomes
Nor Hanim Mohd. Amin*1, Seng Keong Chua1, Asri Said2, Yee Ling Cham1, Kuan Leong Yew1,
Ning Zan Khiew1, Sian Kong Tan1, Chi Yen Voon1, Fazalena Johari1, Alan Y. Y. Fong1, Tiong Kiam Ong1
1
Cardiology Department, Sarawak General Hospital Heart Centre, 2Medical Department, University
Malaysia Sarawak, Kota Samarahan, Malaysia
e144
Introduction: Acute inferior ST elevation myocardial infarction (Ac-Inf-STEMI) and its
associated posterior and right ventricular (RV) infarction has been extensively studied with
electrophysiology and echocardiography. A recent CMR study showed that poor RV
function was associated with poor long term survival post myocardial infarction. However,
limited CMR data exists especially on short term clinical outcomes in Ac-Inf-STEMI.
Objectives: Determining the RVEF, right atrial ejection fraction (RAEF), and other CMR
characteristics in Ac-Inf-STEMI and association with immediate and early clinical
outcomes.
Methods: 39 patients presenting with Ac-Inf-STEMI by ECG suitable for CMR were
recruited from August 2012 till July 2013. Most had thrombolysis followed by early routine
invasive strategy while 2 had primary coronary angioplasty. CMR was done during
admission and at Week 2.
Results: Mean age was 52 years, 90% males and 74% smokers. 64% had multivessel
disease, 34 had culprit right coronary artery while 5 had circumflex artery culprit. . Mean
admission SBP was 9229 mmHg, DBP 5720 mmHg and HR 5217 bpm. 6 required
atropine and 2 temporary pacing.
CMR detected 36 and 24 patients with inferobasal and RV infarcts while electrocar-
diogram (ECG) diagnosed 22 and 10 patients respectively with corresponding posterior
and RV infarcts.
Admission RAEF was correlated with RVEF (p ¼ 0.002, r¼0.477) and RVEF with LVEF
(0.002, r¼0.478). Left ventricular infarct size correlated with ejection fraction (LVEF)
(p<0.0001, r¼0.618). RVEF improved at second week (Week 0 RVEF¼55.5%, Week 2
RVEF¼61.1%, p¼0.022), but LVEF (p¼0.43) and RAEF (0.72) did not. In patients
without RV infarction by CMR or ECG criteria, none showed improvement (p¼0.552). The
2 observed mortalities had triple vessel disease, poor LVEF and RVEF <40% and extensive
microvascular obstruction while none who survived had all of the above adverse
prognosticators.
Conclusion: Our study demonstrated the interdependance between the right atrial and
biventricular systolic functions post Ac-Inf-STEMI and some degree of RV systolic function
recovery 2 weeks after a CMR or ECG confirmed RV infarction. The clinical and CMR
characteristics in the only 2 observed mortalities showed that CMR evaluation in these
patients may have additional short term prognostic value. Larger studies are needed but
this study suggests that a comprehensive right heart systolic function assessment with CMR
may not be unreasonable in patients presenting with Ac-Inf-STEMI patients.
Disclosure of Interest: None Declared
PM409
Positive Correlation between ECG Dispersion Mapping (HeartVueÔ) with
Prediabetes
Acil Aryadi*1,2, Sidhi L. Purwowiyoto1,2, Bima Suryaatmadja1,2, Bambang B. Siswanto1,2,
Djoko Wibisono3, Budhi Purwowiyoto1,2
1
Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, 2National
Cardiovascular Center Harapan Kita, 3Internal Medicine, Gatot Subroto Central Army Hospital,
Jakarta, Indonesia
Introduction: The cardiovascular risk is increased before diabetes is diagnosed, when
impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) develop. Electro-
cardiogram dispersion mapping (ECG-DM), HeartVueÔ 6S System, is recently developed
technology that may provide non-invasive assessment of myocardial ischemia by analyzing
low amplitude oscillation of ECG micro fluctuation signal.
Objectives: To determine if prediabetes is associated with abnormal result of ECG-DM.
Methods: Eighty patients who came to the outpatient clinic were divided into two groups:
prediabetic and normal group; each n ¼ 40. Baseline characteristics and ECG-DM were
compared among the groups.
Results: Body Mass Index (24.6  2.9 vs 22.2  0.9, p¼<0.01), blood glucose level [2
hours post prandial (143.9  20.6 vs 118.6  10.9, p¼<0.01) and fasting blood glucose
level (105.8  9.2 vs 87.1  8.3, p¼<0.01)], total cholesterol level (199.8  34.7 vs 175.9
 20.0, p¼<0.01) and LDL-cholesterol level (147.7  28.2 vs 130.9  21.2, p¼<0.01)
are higher in prediabetic group than in normal group. Abnormal result of ECG-DM is
higher in prediabetic group than in normal group (25.0% vs 5.0%, p¼0.01), test using
Lambda contingency showed weak positive correlation (r ¼ 0.28, p ¼0.01). Bivariate
analysis showed only two hours post prandial have significant association with abnormal
result of ECG-DM (r¼0.42, p<0.01).
Conclusion: There is a positive correlation between abnormal result of ECG-DM (Heart-
VueÔ) with prediabetes.
Disclosure of Interest: None Declared
PM410
Poor tissue Doppler sample volume placement leads to errors in estimates of left
ventricular filling pressures
Jennifer M. Coller*1,2, Duncan J. Campbell2, Henry Krum3, Michele McGrady4, Louise Shiel3,
Chris Reid3, Umberto Boffa5, Rory Wolfe4, Simon Stewart6, David L. Prior7
1
Department of Medicine, St Vincent’s Hospital, 2St Vincent’s Institute, 3Centre for
Cardiovascular Research and Education in Therapeutics, 4Monash University, Melbourne,
5
University of Adelaide, Adelaide, 6Baker IDI, 7St Vincent’s Hospital, Melbourne, Australia
Introduction: Tissue Doppler imaging (TDI) is useful in assessing left ventricular (LV)
relaxation and estimating LV filling pressures. Suboptimal sample volume placement may
lead to errors in diastolic categorization due to under- or over-estimation of TDI
parameters.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: To determine whether sample volume placement impacts upon TDI
LV strain and strain rate

POSTER ABSTRACTS
measurements.
Methods: 105 consecutive subjects presenting for imaging in a hospital-based echocardi- CKD control
ography laboratory were recruited prospectively. Subjects with previous valve replacement, Parameters N[45 N[45 p value
significant mitral annular calcification or poor TDI traces were excluded. The 5mm sample
LV Global strain (%) 15.833.9 16.673.4 0.27
volume was placed at 4 standardised positions surrounding the mitral annulus (basal
ventricle, systolic and diastolic limits of annular motion and annular mid-point). Peak early LV S-SR (s-1) 0.850.21 0.810.15 0.36
diastolic relaxation velocity (E’) was collected at the septal and lateral annulus and the E/E’ LV E-SR (s-1) 0.770.27 0.870.28 0.08
ratio calculated from the ratio of peak early mitral inflow velocity (E) to E’ velocity. Images
were collected by one sonographer and measurements performed by a single observer. LV A-SR (s-1) 0.810.26* 0.940.24 0.02
Differences in means between different sample volume positions and annular mid-point *p<0.05 compared to control.
measurements were compared using paired samples t-tests, with Bonferroni correction for
multiple comparisons (significance level p<0.017).
Results: Sample volume placement in the basal ventricle led to significant overestimation LAVI was increased in group 1. LA dysfunction was demonstrated by the reduction in
of peak E’ velocities and underestimation of the E/E’ ratio. Placement at the systolic limit of global LA systolic strain as well as LV A-SR in the CKD group. LV systolic strain, LA
annular motion resulted in overestimation of E’ velocities and underestimation of the reservoir (S-SR), conduit (E-SR) and contractile function (A-SR) were comparable in both
septal/average (but not lateral) E/E’ ratios. Placement at the diastolic limit of annular motion groups.
led to underestimation of the lateral/average E’ velocities and overestimation of E/E’ ratios. Conclusion: Despite similar LV 2D strain values in both groups, LA enlargement and
dysfunction (reduced global strain are reduced) in the CKD group demonstrating the
additive effect of CKD over associated hypertension and diabetes. Hence measuring LA
Annular Annular systolic Annular diastolic parameters may be more useful for the early detection of cardiovascular involvement in
Parameter midpoint Basal ventricle limit limit CKD. Its prognostic value needs to be determined in future studies.
Disclosure of Interest: None Declared
Septal E’ 7.32.5 8.12.8 p<0.001 8.43.1 p<0.001 7.33.2 p¼0.8
velocity PM412
(cm/s)
Diagnostic Value Of Segmental Longitudinal Strain By Automated Function Imaging
Septal 10.44.0 9.33.3 p<0.001 9.23.5 p<0.001 10.94.5 p¼0.04
(Afi) In Patients With Acute Coronary Syndrome
E/E’ ratio
Lateral E’ 10.13.6 10.63.9 p<0.001 10.33.8 p¼0.013 9.6 3.7 p<0.001 Li Li Cheung*, Lam Chun Wai, Chan Kin Wing, Cheung Man Ying, Joseph Yet Sun Chan
velocity Medicine and Therapeutics department, Division of Cardiology, Prince of Wales Hospital, Hong
(cm/s) Kong, Hong Kong, Hong Kong

Lateral E/E’ 8.14.1 7.33.1 p¼0.001 7.63.1 p¼0.07 8.44.1 p¼0.08 Introduction: Speckle-tracking echocardiography by automated function imaging (AFI) is
ratio a novel method for assessment of left ventricular (LV) function and ischemic changes. The
aim of this study was to assess the diagnostic value of two-dimensional longitudinal strain
Average E’ 8.73.0 9.33.1 p<0.001 9.43.3 p<0.001 8.4 3.3 p¼0.006
in identification of significant coronary artery stenosis in patients with acute coronary
velocity syndrome.
(cm/s) Objectives: The aim of this study was to assess the diagnostic value of two-dimensional
Average 9.23.8 8.43.0 p<0.001 8.43.3 p<0.001 9.74.1 p¼0.001 longitudinal strain in identification of significant coronary artery stenosis in patients with
E/E’ ratio acute coronary syndrome.
Methods: Speckle tracking derived strain analysis was performed in patients admitted for
acute coronary syndrome. The global and segmental longitudinal strains were analyzed in
Conclusion: Correct sample volume positioning is imperative when collecting TDI pa- 78 patients with acute coronary syndrome and 16 normal control subjects.
rameters, in order to avoid errors in LV filling pressure estimates which could lead to Results: Sixty-seven patients had significant coronary artery stenosis on coronary angi-
significant changes in diastolic grading. ography. Significant differences were observed in all strain parameters between patients
Disclosure of Interest: None Declared with and without coronary artery stenosis. The global longitudinal peak systolic strain
(GLPSS) was significantly lower in patients with severe CAD such as left main or triple
vessel coronary stenosis. The area under the receiver operating characteristic curve for
PM411 GLPSS was 0.78 and territorial peak systolic strain was 0.76, 0.74 and 0.76 at left anterior
Left atrial and ventricular changes in Chronic Kidney Disease descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA)
respectively. By defining the cut off value of 18%, the sensitivity and specificity of GLPSS
Krishna K. Kadappu*1, Walter Abayaratna2, katrina Abayaratna2, John K. French3, for detecting a significant coronary artery stenosis was 80% and 67% respectively. How-
Liza Thomas3 ever, the study failed to demonstrate the predictive power of GLPSS on all cause mortality.
1
Cardiology, Campbelltown and Liverpool hospital, Liverpool, 2Cardiology, Canberra Hospital, Conclusion: Patients with severe coronary stenosis had significantly lower GLPSS. In
Canberra, 3Cardiology, Liverpool Hospital, Liverpool, Australia patients with non-ST segment elevation acute coronary syndrome, those with severe cor-
onary artery stenosis had significantly lower longitudinal strain values than those without.
Introduction: Left ventricular (LV) changes in chronic kidney disease (CKD) are well Detection of contractile abnormalities by 2D derived myocardial strain is a powerful and
recognised; however, little is known about associated changes in the left atrium (LA). convenient tool to select patients with high-risk coronary anatomy.
Objectives: To evaluate the independent effect of mild CKD (stage 3 - eGFR 30-59ml/min/ Disclosure of Interest: None Declared
1.73m2) on LA size and function and to determine which parameter is able to detect the
early involvement of cardiovascular system in CKD.
Methods: 45 CKD (eGFR 30-59ml/min/1.73m2) patients (Group 1) were compared with PM414
45 age, gender and risk factor (ie hypertension and diabetes mellitus) matched control
subjects (Group 2). Biplane LA volume was measured and indexed to body surface area Ranolazine prevents trastuzumab-cardiotoxicity in experimental models
(LAVI). LA and LV global and segmental function was measured by 2d speckle tracking. Nicola Maurea*1, Carmela Coppola1, Giovanna Piscopo1, Clemente Cipresso1, Domenica Rea2,
Groups were compared using independent sample t test. Sabato A. Boccia1, Claudio Arra2
Results: 1
Cardiology, 2Animal Facility, National Cancer Institute Pascale Foundation, Naples, Italy
Introduction: ErbB2 is overexpressed in about 25% of breast cancers. It modulates
myocardial development and function in the heart. Trastuzumab (T), an anti-ErbB2 in-
hibitor, has improved the prognosis of patients with breast cancer, but is related to an
LA strain and strain rate and LA Volume increased risk of asymptomatic left ventricular (LV) dysfunction (3-34%) and heart failure
CKD control
(2-4%). The mechanisms of T cardiotoxicity are not entirely known and can include
changes in Ca2+ regulation related to blockade of ErbB2.
Parameters N[45 N[45 p value
Objectives: Here, we aim at assessing whether RAN, diminishing intracellular Ca2+
LAVI 38.410.2* 29.87.5 <0.0001 through its inhibition of late INa, blunts T cardiotoxicity in vivo.
LA Global strain (%) 21.035.98* 25.967.46 0.001 Methods: To evaluate cardiac function in vivo, fractional shortening (FS) and ejection
fraction (EF) were measured by echocardiography M-Mode in C57BL6 mice, 2-4 mo old,
LA S-SR (s-1) 1.160.32 1.220.27 0.34 pretreated with RAN (750mg/kg/day, a dose comparable to the one used in humans) per os
LA E-SR (s-1) 1.020.4 0.980.3 0.52 for 3 days. RAN was then administered for additional 7 days, alone and together with T
(2.25 mg/kg/day ip), according to our well established protocol.
LA A-SR (s-1) 1.550.4 1.630.48 0.4
Results: In our in vivo studies, after 7 days with T, FS decreased to 491.5%, p<0.01 vs
*p<0.05 compared to control. 600.5% (sham), and EF to 812%, p<0.01 vs 911% (sham). RAN alone did not
change FS (592%) nor EF 891%. Interestingly, in mice treated with RAN and T, the

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e145

 reduction in cardiac function was milder: FS was 581%, EF was 901%, p¼0.01 and Methods: ECG-gated retinal fundus photographs were taken of the left eye at 10 seconds
POSTER ABSTRACTS

p<0.01 respectively, vs T alone. intervals in 30 diabetic and non-diabetic subjects: 1 minute of pre-flicker, 2 minutes with
Conclusion: In our mouse model, T produces LV dysfunction and RAN blunts T car- flicker, and 1 minute of post-flicker. A semi-automated software analysis program, developed
diotoxic effects. We plan to test RAN as a cardioprotective agent with other antineoplastic in-house, was used to generate ECG-gated photographs, and measure retinal vessel calibre.
cardiotoxic drugs in our experimental models and to define the mechanisms of Reactive hyperaemic index (RHI) was also examined (EndoPAT 2000). Subjects with severe
cardioprotection. proliferative diabetic retinopathy, arrhythmias, cataracts and cardiovascular complications
Disclosure of Interest: None Declared were excluded. The independent t-test was used to assess statistical significance of data.
Results: Mean arterial vasodilation in response to flicker was significantly impaired in
subjects with T2DM compared with controls (1.76  0.70 vs. 3.16  1.31%, p<0.001).
RHI was also significantly reduced in diabetes compared with controls (1.68 0.64 vs. 1.98
PM415  0.53, p¼0.002).
Cardiac chamber dimensions in chronic obstructive pulmonary disease
Yogesh Varma1, Swapnil S. Garde*1, Virendra K. Sharma1, lokendra dave2,
Raghvendra S. Meena3, Amit S. Barpha1, Gurmeet Singh3, Chaitanya S. kulkarni1,
Somesh S. Garde4
1
Medicine, 2Tb And Chest, 3Cardiology, Gandhi Medical College, Bhopal, 4Undergraduate
Student, Government Medical College, Aurangabad, India
Introduction: Chronic obstructive pulmonary disease (COPD) is defined as a disease
characterized by airflow limitation that is not fully reversible. COPD includes emphysema
an anatomically defined condition characterized by destruction and enlargement of the
lung alveoli; chronic bronchitis, a clinically defined condition with chronic cough and
phlegm; and small airway disease, a condition in which small bronchioles are narrowed.
This study is designed to assess Cardiac Chamber dimensions in relation to COPD.
Objectives: To evaluate the relation of COPD(GOLD STAGES 1-4) with cardiac chambers
dimension.
Methods: In the ongoing study, Patients between 40-70 years(male-16,females-4)
attending out-patient clinic and admitted in the medical unit of Department of Medicine
and Pulmonology, were included in the study. The following patients were excluded:$
Asthma$ Other Chronic respiratory disorder$ Malignancy$ Active Pulmonary Tuber-
culosis$ Ischemic heart disease/ Hypertension/ Diabetes mellitus type 2. Pulmonary func-
tion test, ECG, Chest X ray PA view and Cardiac Echo Doppler were performed in all the
cases. Cardiac chamber sizes: Left atrium, Left Ventricle, Left Ventricle Ejection frac-
tion(LVEF), Right atrium, and Right Ventricle dimension were recorded by a trained Echo-
cardiographer. Prospective-observational cross sectional analytical study on 20 COPD
patients was conducted.
Results:
1. COPD(n¼20) by GOLD criteria revealed following results: In the patients having
FEV1/FVC(Post Bronchodilator) <70% had average LA size 2.728 cm.
2.
FEV1/FVC AVERAGE LA SIZE(cm) LVEF
60-70% 3.0cm 60.25%
50-60% 2.6cm 61.33%
40-50% 2.8cm 54.0%

3. Out of 20 patients dilated right atrium was found in 12(60%) and average RV
diameter was 2.19cm.
Conclusion: In the ongoing study the severity of COPD based on FEV1/FVC had no direct
relationship with LA size and LVEF. However, the RA and RV were dilated. Thus, it can be
concluded that in patients with COPD, left heart failure may not be associated, unless there
are superimposed risk factors or associated coronary artery disease.
Disclosure of Interest: None Declared

PM417
Conclusion: The ECG-gated fundoscopy system demonstrated an impairment of retinal
Assessing endothelial function in type-2-diabetes mellitus using ECG-gated retinal artery calibre during flicker provocation in T2DM. Therefore this system may represent a
artery flicker provocation and digital reactive hyperaemia (EndopatÒ) useful, non-invasive method for the assessment of endothelial function in patients at risk of
cardiovascular disease.
Anchal Lal*1,2, Aravinda Thiagalingam1, Paul Mitchell2, Oliver Gibbs1, Tony Barry3, Disclosure of Interest: None Declared
Pramesh Kovoor1
1
Cardiology, 2Ophthalmology, University of Sydney, 3Cardiology, Westmead Hospital, Sydney, PM418
Australia
Cumulative Radiation Exposure and Peak Skin Dose Quantification using a real time
Introduction: Endothelial dysfunction is highly associated in type-2 diabetes mellitus dose tracking system in coronary procedures
(T2DM) and cardiovascular disease. Brachial ischaemic-induced hyperaemia has tradi-
tionally been used to examine endothelial function, however, it requires abstaining from Sharon Wilson*1, Amy Virdi1, Glenn Ison1, Ananth Prasan1, James Weaver1
1
vasoactive substances for a reliable assessment. The retinal arteries are isolated from Cardiology, St George Hospital, Sydney, Australia
autonomic innervation and therefore are useful in endothelial function examination. Flicker
Introduction: Coronary angiography and intervention involves exposure to ionising ra-
provocation in the retina induces an autoregulation response of endothelial-mediated
diation. Radiation minimisation remains an important safety issue. New technologies have
vasodilation. The flickering light causes an increase in rod and cone turn over, which leads
been developed to provide real time measurement of patient radiation exposure, such as
to an increase in retinal oxygen demand. This demand is met by the release of vasodilator
the dose tracking system (DTS). This is a computer-based method which prospectively
mediators such as nitric oxide that cause an increase in retinal artery calibre and subse-
calculates the peak skin dose (PSD) from a combination of imaging parameters and is
quently, blood flow augmentation. Since retinal artery calibre is an independent risk
displayed in real time.
marker for endothelial dysfunction and cardiovascular disease, we have developed an ECG-
Objectives: This study sought to correlate the peak skin dose (PSD) with clinical, pro-
gated fundoscopy system for the assessment of retinal vessel calibre during flicker
cedural and widely accepted radiation parameters.
provocation.
Methods: Consecutive patients undergoing coronary procedures had clinical, procedural
Objectives: The purpose of this study was to compare the ECG-gated retinal artery flicker
and radiation variables recorded. These variables were compared to the PSD derived from
provocation with digital reactive hyperaemia (EndopatÒ) for the assessment of endothelial
the DTS. High risk dose thresholds were defined as: fluoroscopy time (FT) > 30 minutes,
function in patients with and without T2DM.
dose air kerma (Kar) > 3 Gy and PSD > 2 Gy.

e146 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Results: Over a period of 8 weeks, 173 cases were included of which 111 were coronary

POSTER ABSTRACTS
angiography (64%) and the remainder PCI. There was a good correlation between PSD and
FT r¼ 0.80, dose area product (DAP) r¼0.87 and Kar r¼0.92. 8 % of patients were
regarded as high risk on PSD, 5% on Kar 4% on FT all of whom underwent PCI. 5 cases
(3%) were only at risk on PSD.
Patients undergoing angiography who were obese, had higher PSD (p ¼ 0.001), DAP
(p¼ 0.001) and Kar (p ¼0.003). Radial access (n ¼ 57) compared with femoral conferred
no difference in FT (6.7 vs 4.9 p ¼0.194,) Kar (0.696 vs 0.691 p ¼ 0.943) or PSD (0.322 vs
0.344 p ¼ 0.891).
Conclusion: Peak skin dose as defined on DTS correlates well with Kar and fluoroscopy
time. Whilst obesity is related to increased PSD, radial access site results in no increase. Real
time PSD monitoring may allow greater risk stratification for patient safety in coronary
procedures.
Disclosure of Interest: None Declared

PM420
Does The Presence of Diabetes Influence Referral for Coronary Revascularization
after Myocardial Perfusion Imaging?
Shigeru Fukuzawa*1, Shinnichi Okino1, Atsushi Ikeda1
1
Division of Cardiology, Funabashi Municipal Medical Center, Chiba, Japan
Introduction: Previous data suggest diabetic patients are at greater risk for future cardiac
events than non-diabetics. However, data regarding the referral pattern for cardiac cathe-
terization or coronary revascularization after myocardial perfusion imaging (MPI) are
limited.
Objectives: The purpose of this study was to evaluate the incremental role of stress single-
photon emission computed tomography imaging in diabetic patients in the prediction of
cardiac catheterization or coronary revascularization.
Methods: 2452 patients without any prior coronary artery disease (CAD) referred for MPI
during 2001 - 2010 were identified. All MPI studies were interpreted using 4-point system
with 17- segment model and summed stress score (SSS) were categorized as: normal (SSS
< or ¼ 3), mild (SSS 4-8), and severe (SSS > or ¼ 9) defects. Significant CAD by cardiac
catheterization was defined as > 70% stenosis of any vessel or > 50% left main stenosis.
Results: In 2452 patients, 909 (37.0 %: Diabetes 449, Non-diabetes 460) underwent
cardiac catheterization within 90 days of study and 673 (27.4%: Diabetes 363, Non-
diabetes 310) patients required revascularization therapy. The referral trends for cathe-
terization were similar between diabetic and non-diabetic patients across all perfusion
categories (Normal/Mild/Severe: 4.2%/73.4%/99.4% in Diabetes, 3.4%/67.3%/99.7% in
Non-Diabetes), whereas the referral for revascularization of diabetic patients was higher
than non-diabetic patients in relation to imaging results (Normal/Mild/Severe: 0.8%/38.5%/
92.6% in Diabetes, 0.2%/26.9%/78.9% in Non-Diabetes). Conclusion: In patients with CAD history, baseline clinical factors (PAD, current smoking
Conclusion: Referral for cardiac catheterization in diabetic patients with suspected CAD and CKD), and SDS of stress MPI results are significant predictors of cardiovascular events.
was no different from non-diabetic patients. On the other hand, diabetes is an independent Stress MPI may have a relatively limited role in predicting cardiovascular events.
predictor of revascularization based on severity of perfusion abnormalities on MPI. Disclosure of Interest: None Declared
Disclosure of Interest: None Declared
PM422
Can Myocardial Blushing Grade Predicts Myocardial Viability?
PM421
Ismail Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,
The Usefulness Of Stress Myocardial Perfusion Imaging As A Predictor of
Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli1
Cardiovascular Events In Patients With Prior Coronary Artery Disease 1
Cardiology, UiTM, Sungai Buloh, Malaysia
Tatsuhiko Furuhashi*1, Masao Moroi1, Toru Awaya1, Megumi Minakawa1, Hirofumi Masai1,
Taeko Kunimasa1, Hiroshi Fukuda1, Kaoru Sugi1 Introduction: Reperfusion strategy with thrombolysis is still widely practised. Despite
1 timely reperfusion, occluded infarct related vessels are seen during angiography in the
Division of cardiovascular medicine, Toho University Ohashi Medical Center, Tokyo, Japan
absence of ischemic symptoms. Revascularisation is an option if sufficient ischaemic
Introduction: Stress myocardial perfusion imaging (MPI) is well established for coronary burden demonstrated. Little is known on assessing myocardial viability using myocardial
artery disease (CAD) diagnosis and prognosis. blush grade and confirmation with dobutamine stress echo in these patients.
Objectives: However, the fixed and/or reversible defect of stress MPI results varies Objectives: Myocardial viability assessment using myocardial blush grade and association
considerably among patients with CAD history. We compared the usefulness of stress MPI with dobutamine stress echocardiogram.
results and baseline clinical factors as independent predictors of cardiovascular events in Methods: Stable patients post acute coronary syndrome that undergo coronary angiog-
patients with CAD history. raphy from year 2011 to 2012 were recruited. A total of 135 arteries were analyzed. During
Methods: Summed stress score (SSS), summed rest score (SRS), and summed difference coronary angiogram the Myocardial Blush Grade (MBG) was scored. Dobutamine echo-
score (SDS) were calculated for 354 patients with CAD history (n ¼ 354, 281 males; mean cardiography was done for viability assessment of the related artery and read independent
age, 71 years; mean CAD duration before stress MPI, 7.1 years; mean observation period, of the angiography result.
32 months; myocardial infarction history, n ¼ 179 patients) who underwent stress MPI. Results: Majority of the study samples were men (66.7%) with mean age of 61.8  7.8
Cardiovascular events were defined as cardiac death, non-fatal myocardial infarction and years. MBG 0 was present in 22 (16.3%) arteries, grade 1 in 53 (39.3%) arteries, grade 2 in
Braunwald III unstable angina requiring hospitalization. 44 (32.6%) arteries, and grade 3 in 16 (11.9%) arteries. Among the 22 arteries with MBG
Results: Cardiovascular events were observed in 45 patients (13%). Univariate Cox score 0, 17 (77.3%) were still viable when assessed with dobutamine stress echocardio-
regression analysis identified the following as significant predictors of events; peripheral gram. There was no association MBG score and myocardial viability found, x2 (3, N ¼ 135)
artery disease (PAD), diabetes, chronic kidney disease (CKD), current smoking, left ¼ 7.53, p ¼ 0.06.
ventricular ejection fraction (LVEF) and SDS of stress MPI result. Multivariate Cox Conclusion: In stable patients post ACS, using MBG alone may not be sufficient to fully
regression analysis revealed that PAD (hazard ratio ¼ 5.41; P ¼ 0.002), current smoking demonstrate viability, as those with MBG 0 the myocardium may still be viable.
(hazard ratio ¼ 6.80; P < 0.001), CKD (hazard ratio ¼ 2.97; P < 0.001) and SDS of Disclosure of Interest: None Declared
stress MPI (hazard ratio ¼ 1.21; P ¼ 0.002) were independent and significant risk factors
of cardiovascular events. Kaplan-Meier survival curves shown in Figure 1 revealed that PM423
the prognosis of cardiovascular events was significantly better in patients with no
reversible defect abnormality (SDS <2) than in patients with reversible defect abnor- Exercise Left Ventricular Diastolic Filling Pressure: Relationship To Ischemia
mality (SDS 2). In addition, as shown in Figure 2, we compared patients with 0-1
Marina Deljanin Ilic*1, Stevan Ilic1, Viktor Stoickov1, Dimitra Kalimanovska Osric2,
coexisting risk factors (PAD, current smoking, and CKD) and patients with 2-3 risk
factors. In patients with and without reversible defect abnormality, the prognosis of Vladimir Ilic1
1
cardiovascular events was significantly better in patients with 0-1 factors compared with Cardiology, Institute of Cardiology, Medical Faculty University of Nis, Nis, 2Cardiology, Clinic
those with 2-3 factors. of Cardiology-Kcs, Belgrade, Serbia

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e147

 Introduction: Changes in ratio of E/E` during exercise echocardiography may identify pulmonary hypertension as being significant cardiac causes of syncope.All patients had a
POSTER ABSTRACTS

diastolic dysfunction in patients (pts) who complain of exertional dyspnea.
However, the role of exercise E/E`, for the detection of myocardial ischemia, is still an
open question.
Objectives: To assess if there is an association between Doppler parameters of left ven-
tricular diastolic filling pressure and ischemic wall motion abnormalities (WMA) during
exercise stress echocardiography (ESE).
Methods: We studied 75 pts (58 men; mean age 56 years) referred for clinically indicated
ESE. In all pts left ventricular filling pressure (E/E`) was estimated from pulsed-wave
Doppler measurements of mitral inflow and annular tissue velocities at rest and after bicycle
exercise (25W, 3-min increments). ESE identified ischemia by the occurrence of WMA with
stress. Before and after ESE, wall motion score index (WMSI) was calculated. Patients were
classified as having sress induced myocardial ischemia (MI, n¼ 42) or no ischemia (NMI,
n¼ 33) on the basis of the development of new WMA during ESE.
Results: In NMI group E/E` ratio did not increase during exercise, while in MI group E/E`
was significantly higher after ESE compared to baseline values (9,00,80 vs 5,20,70,
P<0.0001). Out of 42 pts with ESE induced myocardial ischemia, in 25 pts (60%) WMSI
increased from the value of 1 at rest up to or equal 1,5 after ESE. In this subgroup of pts E/
E` ratio increased from 4,90,72 at reast to 8,30,82 after ESE, P<0.0001. In 17 pts
(40%) WMSI increased from the value of 1 at rest to the value greater than 1,5 after ESE,
and the value of E/E` ratio increased from 5,60,67 at reast to 10,10,77 after ESE,
P<0.0001. After ESE, ratio E/E` was higher in the subgroup of pts with WMSI value greater
than 1,5 than in the subgroup of pts with WMSI value equal or less than 1,5 (P<0.0001).
Conclusion: Myocardial ischemia during ESE is associated with an increase in left ven-
tricular diastolic filling pressure. Grater increase in E/E` ratio is associated with the presence
of more severe ESE induced myocardial ischemia.
Disclosure of Interest: None Declared
PM424
Assessment of Left Ventricular Mechanical Dyssynchrony in Patients with Severe
Mitral Regurgitation of Rheumatic Etiology
Azza A. M. Farrag*1, Wafaa A. El Aroussy1, Soliman Ghareeb1, Raafat Hasan1
1 (CS) in short-axis view at the level of papillary muscle, and the relevant strain rate (SR),
Cardiovascular Department, Cairo University, Cairo, Egypt
Introduction: Intraventricular systolic dyssynchrony refers to differences in the timing of
contraction between the different myocardial segments. It is a common phenomenon in
patients with left ventricular systolic dyssynchrony with or without secondary mitral
regurgitation (MR). Very few studies reported mechanical dyssynchrony in patients with
primary mitral regurgitation, but no study was interested in assessing this phenomenon in
patients with severe MR due to rheumatic etiology.
Objectives: The aim of this study was to evaluate the phenomenon of mechanical systolic
dyssynchrony in patients with primary MR due to rheumatic etiology.
Methods: Thirty one female patients (mean age 30.4  8 years) with severe MR of
rheumatic etiology, and 15 normal female subjects (mean age 29.7  6 years) served as a
control group were studied by detailed transthoracic echocardiographic examination.
Tissue Doppler imaging (TDI) was performed to determine left ventricular systolic dys-
synchrony by measuring Ts-SD (SD of time to peak myocardial systolic velocity during the
ejection period) using the six-basal / six-mid segmental model. In addition, real time 3D
echocardiography (RT3DE) was performed to assess global left ventricular ejection fraction
(LVEF) and the systolic dyssynchrony index (SDI).
Results: There was no difference between patients and control group as regards LVEF
(60.4  13.2 vs. 62.8  7.7, p ¼ 0.379). Patients had prolonged Ts-SD (43.2  10.9 ms)
compared to the control group (22.4  10.4 ms); p <0.000. By RT3DE, SDI differed
significantly between patients and controls (2.25  2.35 vs. 1.19  0.64, p ¼ 0.021).
Pearson correlation coefficients showed significant negative correlation between SDI and
LVEF (r ¼ -0.532, p ¼ 0.002), and significant positive correlation with left ventricular
systolic volume index (r ¼ 0.553, p ¼ 0.001) in rheumatic patients.
Conclusion: This is the first study to document mechanical systolic dyssynchrony in
patients with severe MR due to rheumatic etiology.
Disclosure of Interest: None Declared
two-dimensional and Doppler TTE.
Results: We concluded the mean age of the patient cohort was 82 with ages ranging from
34 – 98. There were 89 females and 61 males. 1/150 (0.7%) patient had severe AS and 6/
150 (4%) patients had severe left ventricular dysfunction (LVD). None of the patients had
other significant echocardiographic abnormality that may result in a fall/ syncope.
Conclusion: The population assessed was primarily octogenarian presenting with syncope/
fall. TTE is shown to be most feasible when there is proven indication as described by
the European Society of Cardiology or there is high clinical suspicion. We recommend the
use of hand held focused echocardiography in this group of patients rather than a full
formal echocardiography which imposes a burden on the services and increases inpatient
stay.
Disclosure of Interest: None Declared
PM426
Experimental Validation of Left Ventricular Transmural Strain Gradient with
Echocardiographic Velocity Vector Imaging
Chao Yu1, Tiang Gang Zhu*2, Ling Yun Kong1
1
Heart center, Peking University People’ Hospital, Beijing, 2Heart center, Peking University
People’ Hospital, Beijng, China
Introduction: The myofiber can be divided into three layers，include endomyocardium,
mid-wall, and epimyocardium. All three myocardial layers have different mechanical
contraction, electrophysiologic characteristics and cell types. The latest velocity vector
Iimaging(VVI) echocardiography can measure the parameters of three layer respectively.
Objectives: To validate transmural strain gradient of endo-, mid-wall, and epimyocardium
measured by velocity vector imaging (VVI) between healthy subjects and hypertrophic
cardiomyopathy (HCM) patients.
Methods: 38 healthy subjects and 12 HCM patients were enrolled in this study. By using
VVI automatic analysis software, we calculated radial strain (RS) and all three layers’ lon-
gitudinal strain (LS) in apical 4-chamber view, RS and three layers’ circumferential strain
strain gradient.
Results: The LS and CS of endo-, mid-wall, and epimyocardium (LSendo, LSmyo, LSepi;
CSendo, CSmyo, CSepi) decreased gradually in both healthy subjects and HCM patients
(all p<0.001), longitudinal and circumferential SR also have this characteristic (all
p<0.01). The strain gradient among the three layers of two set of subjects have no statistics
significance (all p>0.05). The LS of endo-, mid-wall, epimyocardium and their mean value
(LSmean) in healthy subjects are higher than those in HCM patients (all p<0.001). The
ejection fraction (EF) of healthy subjects has a significant linear correlation with the RS,
LSendo, LSmyo in apical 4-chamber view and RS, CSmyo in short-axis view at the level of
papillary muscle (p<0.05 or p<0.01).

PM425
A retrospective analysis investigating the yield of Transthoracic Echocardiogram in
patients presenting with falls to a regional tertiary referral center in Australia
Daniel Devenney*1, Ankur Srivastava1, Pathap Hegde1
1
Cardiology, The Wollongong Hospital, Wollongong, Australia
Introduction: In light of our aging population there is an increasing number of patients
presenting to hospital for investigation of syncope/fall. There are indeed well known
structural cardiac abnormalities that can be confirmed using transthoracic echocardiogra-
phy (TTE) that may result in a fall. The European Society of Cardiology recommend, TTE
only when there is previous known heart disease or data suggestive of structural heart
disease or syncope secondary to cardiovascular cause. It appears that it is quite common to
perform a TTE as a routine work up for patients presenting with a fall in many instituitions.
The evidence is somewhat controversial for using TTE in assessing for the etiology of falls
in the elderly population.
Objectives: To assess the the yield of transthoracic echocardiography the this category. Conclusion: There is a certain rule in LS and CS gradient, which is inner strain>mid-
Methods: We retrospectively reviewed all TTEs performed over a six month period from wall>outer strain, and there is no apparent difference between healthy subjects and HCM
1st January 2013 to 30th June 2013. One thousand one hundred TTEs were performed of patients. This study demonstrates that LS at three layers and LSmean in healthy subjects
which, 150 had the indication documented as falls for investigation. We assessed for the were significantly higher than those in HCM patients. The EF was linearly associated with
following cardiac abnormalities: Severe valvular lesions like AS, AR, MS, MR and HOCM RS, LSendo, LSmyo and CSmyo, which is something the HCM patients do not have.
causing LVOT obstruction, severe left ventricular systolic dysfunction and severe Disclosure of Interest: None Declared

e148 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

 PM427 of Queensland, 3Cardiology Department, Prince Charles Hospital, Brisbane, Queensland,

POSTER ABSTRACTS
Australia
Non-Invasive Contribution To The Diagnosis Of Ischemic Heart Disease Using
Speckle-Tracking Echocardiography Of The Left Ventricle Introduction: Three-dimensional echocardiography is recommended by the ASE for
Jan E. Claessens*1, Philip Claessens2, Christophe Claessens3, Marc Claessens4, Maria Claessens1 ventricular volume and ejection fraction measurement. We and others have shown that 3D
1 Left Ventricular Ejection Fraction (3DLVEF) quantification using semi-automated, border-
Cardiology, Cardiological Centre "Kloppend Hart" Schilde-Essen-Antwerpen, Antwerp,
2 detection algorithms with retrospective manual-adjustment (3DLVEF-MA) has comparable
Cardiology, AZ Sint Jozef, Malle, 3Internal Medicine, AZ Turnhout, Turnhout, 4Surgery, AZ accuracy to cardiac magnetic resonance imaging. The GE Healthcare EchoPAC LVQ soft-
Klina, Brasschaat, Belgium ware also contains a novel function for 3DLVEF assessment with no input required from
the operator once the image has been acquired (3DLVEF-Auto).
Introduction: Ischemic heart disease is the most important cause of cardiac morbidity and
Objectives: We sought to determine the comparative accuracy and reproducibility of the
death. Early detection of cardiac deterioration is imperative. To reach a large population
3DLVEF-Auto and 3DLVEF-MA in 100 selected and unselected studies acquired by
safe, easy accessible and reliable non-invasive investigation methods are required.
experienced sonographers.
Objectives: Speckle-tracking echocardiography is a new technique founded on pure 2D
Methods: 50 optimal image quality studies and 50 unselected, consecutive outpatients
gray scale ultrasound acquisition and provides non-doppler, angle-independent and
attending the echocardiography laboratory were used. The fully automated 3DLVEF
objective quantification of myocardial deformation and of left ventricular systolic and
(3DLVEF-Auto) was compared to the manually optimised 3DLVEF obtained by an expe-
diastolic dynamics. Left ventricular dysfunction is a sensitive predictor of cardiovascular
rienced sonographer (3DLVEF-MA). Comparative accuracy was assessed using Pearson’s
atherosclerotic diseases.
correlation, weighted Cohen’s kappa (k) for agreement, and Bland Altman for mean dif-
Methods: We investigated 969 male, self-supporting and ambulant patients, divided in 495
ferences and limits of agreement (LOA).
healthy subjects (HS) with documented normal coronary arteries and in 474 coronary
Results: Of the total 100 cases, there was an overall Pearson’s correlation of R¼0.83
patients (CP), treated with multiple stent implantation or bypass surgery. Both groups were
(P<0.0001) between the 3DLVEF-Auto and 3DLVEF-MA. Good weighted agreement
divided in three age groups: 40-59y, 60-79y and 80-99y. We measured by speckle-tracking
(k¼0.73) was also found with a mean difference of -0.7% and reasonable LOA (+11.9-
echocardiography the “global longitudinal peak systolic strain average” (GLPSSavg) of the
13.3%). For the optimal image quality cases, there was a Pearson’s correlation of R¼0.93
left ventricle, divided in 24 segments, and also the “average peak longitudinal strain of the 5
(P<0.0001) with good weighted agreement (k¼0.76), a mean difference of 0.1% and good
myocardial segments with the lowest strain values” (Avg5LSS). The more negative the strain
LOA (+9-9.1%). For the consecutive unselected cases there was a Pearson’s correlation of
value, the better the myocardial contractile reserve. Measurement of sum maximal diameter
R¼0.63 (P<0.0001) with moderate to good weighted agreement (k¼0.66), a mean dif-
left atrium plus maximal diameter left ventricle in cm (LALV).
ference of -1.4% and resonable LOA (+14.1-16.9%).
Results: For all age groups significant decrease (p¼0,000) of GLPSSavg in CP compared
Conclusion: Utilization of the GE Healthcare Auto LVQ software in performing completely
with HS but quasi unchanged results with aging. Also statistically significant decrease
automated 3DLVEF has potential applications. Further technical analysis is required to
(p¼0,000) of Avg5LSS for all age groups in CP compared with HS but with a tendency to a
conclusively assess the use of the completely automated 3D LVEF assessment using the GE
progressive decrease of Avg5LSS with aging. LALV is in all age groups statistically signif-
EchoPAC LVQ algorithm, especially when image quality is poor, or assessment is
icantly larger (p¼0,000) in CP compared with HS. Progressive increase of LALV with aging.
complicated by relevant pathology.
(Table 1)
Disclosure of Interest: None Declared

PM429
Early LV Dysfunction in Stage 3 Chronic Kidney Disease (CKD) Assessed by Stress
Based Ventricular Contractility Index
Nadira Hamid*1, Thu Thao Le1, Feiqiong Huang1, Qifeng Chen1, Fei Gao1,
Sufi Muhammad Suhail2, Ru San Tan1
1
Cardiology, National Heart Centre Singapore, 2Renal Medicine, Singapore General Hospital,
Singapore, Singapore

Introduction: Renal dysfunction confers adverse cardiovascular outcomes. Early left ven-
tricular (LV) dysfunction may be present in early chronic kidney disease (CKD). Maximal
rate-of-change of pressure-normalized wall stress (ds*/dtmax), has been reported to be
sensitive for detecting early LV contractile abnormality in heart failure with preserved
ejection fraction.
Objectives: In this study, we aimed to assess ds*/dtmax, as well as other echo systolic and
diastolic parameters, in asymptomatic stage 3 non-diabetic CKD subjects with preserved
ejection fraction.
Methods: Single-centre prospective cohort study. 35 asymptomatic non-diabetic CKD
subjects with median MDRD GFR 38.8 (range 33-43.7) ml/min/1.73m2 and 26 healthy
controls underwent echo. LV ejection fraction (EF) and mass were determined from M-
mode using standard methods; mitral deceleration time (DT), mitral E and A velocities
from Doppler echo; and septal myocardial velocities, from tissue Doppler. ds*/dtmax was
calculated as 1.5x maximal LV outflow rate/ LV myocardial volume. Statistical significance
was defined as p <0.05 on Mann-Whitney U tests.
Results: CKD patients have significantly reduced contractility, as assessed by ds*/dtmax,
web 3C=FPO

and slower relaxation (DT) than controls (table), despite significantly lower ages. Subgroup
analysis in CKD patients with (n¼12) versus without hypertension (n¼23) showed similar
results.

Parameters CKD (n [ 35) Normal (n [ 26) p value

Age (years) 45 (39-55) 49 (44-59) 0.007
Gender (M:F) 26: 9 8: 18 <0.001
Conclusion: Speckle-tracking echocardiography is an opportunity for early detection of LVEF (%) 65.1 (57.9-68.5) 71.7 (66.1-76.9) <0.001
left ventricular dysfunction before other non-invasive investigation methods could detect
cardiac deterioration. Notwithstanding all patients were ambulant we documented a sta- E/A 1.23 (0.99-1.44) 0.98 (0.8-1.59) ns
tistically significant difference between HS and CP in the deformation capacity of the left E/E’ 7.04 (5.94-8.24) 6.71 (5.87-7.90) ns
ventricular myocardial wall, resulting in dilated left heart cavities in CP with a higher risk
DT (ms) 228 (188-265) 174 (144-192) <0.001
for heart failure, arrhythmias and thrombo-embolic events.
Disclosure of Interest: None Declared ds*/dtmax (s-1) 2.78 (2.17-3.61) 4.60 (3.73-5.48) <0.001

PM428
Table. Demographics and echo parameters comparison between CKD and normal
Accuracy and reproducibility of completely automated 3-dimensional left ventricular subjects. Values are expressed as median (interquartile range).
ejection fraction quantification Conclusion: We found subclinical evidence of decreased LV relaxation, LV EF and
contractility as assessed by ds*/dtmax in non-diabetic stage 3 CKD patients. This suggests
Kym Smith1, Kristyan B. Guppy-Coles*1,2, Samuel Hillier3, Ada Lo1, Joanne Sippel1, that moderate renal dysfunction can induce abnormal myocardial fibre contraction and
Sandhir B. Prasad1, John J. Atherton1,2 relaxation.
1
Cardiology Department, Royal Brisbane and Women’s Hospital, 2School of Medicine, University Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e149

 PM430
POSTER ABSTRACTS
Right ventricular assessment by echocardiography in patients with schistosomotic
pulmonary artery hypertension
Oscar S. Osella*1, Jose M. Del-Castillo2, Angela P. Bandeira2, Eugenio S. D. Albuquerque2,
Carlos M. Silveira2
1 Results: 122 patients underwent CT CA (n ¼ 92 < 100, n ¼ 30  100; male 37 % vs
Health Sciense, University of Brasilia, Brasilia, 2Procape, University of Pernambuco, Recife,
Brazil
Introduction: In the right ventricle (RV), unlike the left ventricle (LV), there is a pre-
dominance of longitudinal fibers that are necessary to empty systolic volume against the
low pulmonary resistance. The normal longitudinal strain of the RV is -30 to -35% and
transversal (radial) strain 20 to 25%. As pulmonary artery hypertension (PAH) develops RV
dysfunction, systolic tricuspid regurgitation may be inadequate to estimate the pulmonary
pressure.The pulmonary flow acceleration time, TAPSE and tissue Doppler of the tricuspid
annulus may infer, but not quantify RV function.
Objectives: The aim of this work is to assess with speckle tracking RV strain in patients
with PAH and compare the results with data obtained in normal subjects.
Methods: Assess RV function parameters (fractional areas, TAPSE and tricuspid regurgi-
tation gradient). Determine longitudinal and transverse strain from the apical view in
septum and free wall in patients with PAH and in healthy subjects. Material: 30 PAH
patients, mean age 56+/-11 years, 21 male.
Results: Among PAH patients and normal subjects, fractional areas were 22% and 46%
and TAPSE 1.6 and 2.5 cm. Tricuspid regurgitation gradient was 57 and 19 mmHg.
Longitudinal strain -14% and -29% and transverse strain 37% and 22% respectively.
Conclusion: Patients with PAH modify the pattern of myocardial strain, with high
transversal deformation, probably due to the RV adaptation to the high pressur-
e.Conventional parameters to assess RV function may be masked by the systolic
dysfunction of this camera.
Disclosure of Interest: None Declared
PM431
CT coronary angiography can effectively rule out significant coronary artery disease
in patients undergoing isolated valve or ascending aorta surgery
A. Fyfe*1, A. J. Pope1, H. Winch2, C. Ellis2, S. A. Barnard3, P. A. Weeks3, F. Wu3, R. S. Gabriel1,
J. L. Looi1, N. C. van Pelt1
1
Cardiology, Middlemore hospital, 2Auckland Heart Group, 3Radiology, Middlemore hospital,
Auckland, New Zealand
Introduction: Many patients being evaluated for isolated valve and ascending aorta surgery
undergo invasive coronary angiography (ICA) to exclude significant coronary artery disease
(CAD). CT coronary angiography (CTCA) may be an effective and safe alternative.
Objectives: To determine whether CTCA can be an effective and safe alternative to ICA to
exclude significant coronary artery disease prior to isolated valve or aortic surgery.
Methods: All patients without prior CAD or atrial fibrillation, who were referred for CTCA
prior to cardiac surgery between May 2008 to May 2013 were evaluated. The CTCA scans
were performed on a GE Lightspeed 64 slice (n¼46) or a Siemens Somatom Definition
Flash dual source (n¼10) scanner. Patients were graded as having no CAD, mild CAD or
significant CAD (defined as at least 1 major coronary vessel with 50% diameter loss).
Patients with no significant CAD proceeded directly to cardiac surgery without invasive
coronary angiography. Patients identified as having significant CAD underwent invasive
coronary angiography (ICA) to confirm the findings. Clinical parameters evaluated
included the Duke score (likelihood of significant CAD). Patients were assessed for peri
operative complications including myocardial infarction (MI).
Results: Fifty six patients mean age 51  11.1 yrs were evaluated. The median Duke score
was 15 (Interquartile range 14.3). Fifty (89%) patients underwent valve surgery and 6
(11%) ascending aorta surgery.
CTCA demonstrated no CAD in 34 patients (61%), mild CAD in 12 (21%) and sig-
nificant CAD in 9 patients (17%). In the 9 patients with significant CAD on CTCA who
underwent ICA there were 3 false positives. One patient with an uninterpretable CTCA
result also underwent ICA. This showed no significant disease. Patients with significant
CAD had a higher median Duke score 49(10.5) vs 15(14) (p ¼ 0.2) and were older 63 
12.8 yrs vs 53  11.5 yrs (p ¼ 0.1) compared with patients with no or mild CAD. Eight
patients (14%) had significant non-cardiac findings detected by CTCA of whom 4 required
further investigations. No patients who underwent CTCA that excluded significant CAD
before cardiac surgery had a peri operative MI.
Conclusion: CTCA can safely and effectively rule out significant CAD prior to isolated
valve and ascending aorta surgery in selected patients.
Disclosure of Interest: None Declared
PM432
CT CA effectively rules out coronary artery disease in patients over 100 kg with low
radiation dose
1 1 1 1 2 2
A. J. Pope* , A. Fyfe , R. S. Gabriel , J. L. Looi , S. A. Barnard , S. Y. Tang , P. A. Weeks ,
F. Wu2, N. C. van Pelt1
1
Cardiology, 2Radiology, Middlemore Hospital, Auckland, New Zealand
Introduction: Computed tomography coronary angiography (CT CA) is an appropriate
first line investigation for the investigation of chest pain syndrome (CPS) patients. The
investigation of overweight patients with CPS is often challenging due to inadequate stress
testing and suboptimal cardiac imaging.
e150
Objectives: We sought to determine the effectiveness of low dose CT CA for the inves-
tigation of CPS in patients  100 kg using a Siemens Somatom Definition Flash dual source
scanner.
Methods: Consecutive patients referred for outpatient CT CA for CPS between August 2012
and May 2013 were included. Patients that weighed  100 kg were compared with patients
< 100 kg. Image quality, effective radiation dose and diagnostic accuracy were reviewed.
53 %). The average ages (mean  std) were 56.5  12.3 yr (< 100) vs 54.7  10.7 yr (
100) (p ¼ 0.49) and weights were 75.5  14.1 kg (< 100) vs 115.1  13.8 kg ( 100).
Only six patients were > 130 kg.
CT scan modes were prospective acquisition in 67 % of patients < 100 vs 77 % ( 100),
flash high pitch spiral acquisition in 33 % vs 10 % and retrospective imaging in 0 % vs 13
%. Image quality was judged good in 80 % (< 100) vs 50 % ( 100), fair in 17 % vs 37 %
and poor in 3 % (n ¼ 3) vs 13 % (n ¼ 4) respectively with no significant difference in the
distribution of image qualities between the two groups.
The estimated effective dose of radiation was 1.9  1.7 mSv compared with 5.0  3.3
mSv ( 100) (p < 0.01). Significant CAD was identified in one or more vessels in 13 % vs
27 % ( 100) of patients of which 5 of 12 (< 100) and 7 of 8 ( 100) patients proceeded
to invasive coronary angiography (ICA). In the < 100 kg group, all 5 ICA confirmed the
finding of significant CAD and of those  100 kg 5 out of 7 patients had significant CAD
while 2 were false positives.
Conclusion: CT CA was an appropriate investigation in CPS patients that weighed  100
kg and significant CAD was excluded in the majority of cases. However, the likelihood of a
scan with poor image quality scan was increased and the estimated effective radiation was
twice that for patients < 100 kg.
Disclosure of Interest: None Declared
PM433
A novel CT coronary angiographic index (STELLA score) for diagnosis of functionally
significant coronary stenoses in lesions with intermediate stenosis severity
Brian Ko*1, Dennis Wong1, Darryl Leong2, James Cameron1, Ian Meredith1, Sujith Seneviratne1
1
MonashHEART, Monash Medical Centre, Melbourne, 2Discipline of Medicine, University of
Adelaide, Adelaide, Australia
Introduction: Computed tomography (CT) angiographic evaluation of diameter stenosis
has only modest predictive value for functionally significant coronary-artery-stenoses as
assessed by fractional-flow-reserve (FFR) in lesions of intermediate stenosis severity.
Combined use of CT derived information including lesion length and myocardium at risk
(APPROACH score) may improve prediction of significantly reduced (FFR0.8).
Objectives: Our aim was to 1) identify CT indices which are independently associated with
FFR0.8, 2) derive a score which combines CT indices most predictive of FFR0.8 and 3)
to evaluate the diagnostic accuracy of the score (STELLA) in prediction of FFR0.8.
Methods: We prospectively assessed patients who underwent CCTA and FFR assessment,
with 1 discrete lesion with intermediate (30% to 70%) stenosis on CT. Quantitative
CCTA measurements were performed using dedicated software (Sure Plaque, Vital Images
USA). Multivariate analyses was performed on CT indices including plaque burden,
minimal luminal area and diameter, diameter stenosis, area stenosis (AS), lesion length
(LL), remodelling index, plaque morphology, calcifications severity and APPROACH score
to identify independent predictors of FFR0.8. The modified Akaike’s information crite-
rion (AIC) was used to ensure the most parsimonious model to derive the score.
Results: Our cohort consisted of 69 patients (124 lesions). Using multivariate analysis,
plaque burden, AS, LL and APPROACH score were the strongest predictors for FFR0.8.
STELLA score was derived using these indices, excluding plaque burden which did not add
incremental value in accordance to AIC (p¼0.24). Using an optimal threshold score of 7,
STELLA score predicted FFR0.8 with 76% sensitivity, 77% specificity and 77% overall
accuracy. The optimism-adjusted Harrell’s c-statistic for STELLA score was 0.82 compared
to 0.74 for AS, 0.75 for LL and 0.71 for APPROACH score.
Conclusion: Combined assessment using the STELLA score taking into account CT
derived area stenosis, lesion length and APPROACH score may have incremental predictive
value beyond the individual indices alone for diagnosis of functionally significant coronary
stenoses in lesions with intermediate stenosis severity.
Disclosure of Interest: None Declared
PM434
Coronary CT angiography is useful in the acute workup of higher risk troponin
positive patients
Peter R. Barr1, Andrew C. To*1, Marzia Rigolli1, Hamish Hart1, David Cranefield2,
Colin Edwards1, Jo Wickham1
1
Cardiovascular Division, 2Department of Radiology, North Shore Hospital, Auckland, New
Zealand
Introduction: Coronary CT angiography (CCTA) is now routinely performed in low-in-
termediate risk troponin-negative patients. However, due to concern regarding inaccuracy,
2
its role in higher risk groups with an elevated troponin has not yet been defined.
Objectives: We set out to assess the accuracy of CCTA in patients within two patient
populations; Those referred with chest pain and a modestly elevated troponin I, suspected
acute coronary syndrome (ACS), and those with suspected Type 2 myocardial infarction
(T2MI).
Methods: We prospectively investigated consecutive troponin-positive patients undergoing
CCTA in our institution (320-slice Aquillon ONE, Toshiba Medical Systems; mean radi-
ation dose 2.92.5mSv) from August 2011 to June 2013. Two groups of patients were
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 identified: those referred with suspected ACS, and those referred with suspected T2MI.
Baseline demographics, serial troponins, and outcome data were collected.
Results: Of the 76 troponin positive patients who had CCTA (age 5513 years, female
gender 46%, BMI 276, median peak troponin I, 118 ng/L, IQR 61,352), 34 had sus-
pected ACS and 42 had suspected T2MI. The prevalence of obstructive coronary disease as
identified by CCTA in these groups was 24% and 14%, respectively. Overall, 17% un-
derwent invasive angiography, and 5% required percutaneous intervention. No patient in
the T2MI ultimately required revascularization. False positives were recorded in 23%. Age,
gender, and peak troponin were not found to be predictors of obstructive coronary disease
in the overall cohort. Age was a predictor only in the T2MI subgroup.
After a median follow up of 8.4 months, only one patient was readmitted with ACS, having
refused invasive angiography during the index admission. No patient died during follow up.
Conclusion: CCTA is accurate with reasonable specificity in the initial assessment of
carefully selected troponin-positive patients referred with either suspected ACS or T2MI.
Using CCTA avoided the need for invassive coronary angiography in 83% of patients. This
may have significant cost and resource impilications.
Disclosure of Interest: None Declared
PM435
Fat volume measurements as predictor of image noise in coronary computed
tomography angiography
Rami M. Abazid*1
1 None, Consultancy for: none, Employee from: none, Honorarium from: none, Speakers
noninvasive cardiology, prince sultan cardiac center Qassim, Burydah, Saudi Arabia
Introduction: image noise can negatively affects the overall quality of coronary computed
tomography angiography (CCTA); it can be reduced using higher tube voltage (120kv) but
with increases radiation exposure.
Objectives: The purpose of this study is to evaluate the relationship between image noise
and fat volumes of the chest wall, then compare it with other patient-specific predictor of
image noise, like body weight (BW) and body mass index (BMI) trying to identify suitable
patients for lower tube voltage (100 kv).
Methods: A prospective study was done at Prince Sultan Cardiac Centre Qassim. A total of
132 patients underwent CCTA (dual source 256 scanner, Siemens Flash Definition, rota-
tion time 280 millisecond). The Tube voltage 100 KV were used for patient with less than
85 kg body weight, and 120 kV if BW 85kg. patient’s height, BW,BMI, hip, waist cir-
cumferences, and waist -hip ratio (WHR) was measured.The image noise in the aortic root,
the area of the thoracic solid tissue (AREA), single slice fat volume (SFV) and subcutaneous
fat volume (SCFV) at the level of left mean coronary artery (LM) were analysed.
Results: A total of 132 consecutive patients were enrolled with a mean age SD of 5111
years. 64% were males. Mean image noise was 30.511 HU. Patient cohort was divided
into 4 groups according to BW and image noise. If BW <85 kg [group A (39patients) had
noise 31HU and group B (39patients) had noise >31HU], in patients with body weight
85 kg [group C (27patients) noise 26 HU and group D (27patients) noise >26HU]. T-
test analysis of group A and B (BW<85kg) showed fat volumes (SFV and SCFV) and AREA
can predict image noise better than BW (p ¼0.002 for SFV and SCFV vs. P¼0.003 for
AREA and p¼0.27 for BW), the comparison between group C and D (BW85kg) showed
fat volumes superior to other parameter in predicting noise (p<0.0001 for SFV and SCFV
vs. P¼0.012 for AREA and p¼0.01 for BW). In Linear regression analysis including all
patients, the image noise correlation with SCFV (R ¼ 0.417; p < 0.0001), SFV (R ¼ 0.399;
p < 0.0001), and ARAE (R ¼ 0.292; p < 0.0001), BMI(R ¼ 0.154; p < 0.039), but no
significant correlation with BW (R¼ -0.102; p¼0.12).
web 3C=FPO
Conclusion: fat volume measurements of the chest wall (at the level of left mean coronary
artery) can predict CCTA image noise better than other patient-specific predictors, like
body weight and body mass index. It may add valuable information to choose suitable tube
voltage (KV) and maintain a low image noise with lowest radiation exposure.
Disclosure of Interest: None Declared
PM436
Low Radiation CT Coronary Angiography for Ruling Out Coronary Artery Disease in
Patient with low to intermediate risk of CAD and Newly diagnosed LV dysfunction- A
real world experience
Shashi Ranjan*1, Prasad Challa1, Bruno Jesuthasan1, Mark Horder2, Sheila Ryan2,
Arun Dahiya1
1
Cardiology, 2Radiology, Logan hospital, Brisbane, Brisbane, Australia
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: Heart failure is a progressive disorder and underlying ischemic heart disease is
POSTER ABSTRACTS
leading cause in western world. Coronary angiogram has been the gold standard invasive test
to rule out underlying coronary artery disease (CAD) in these groups of patients. CT coronary
angiography (CTCA) has emerged as attractive alternative however heart rate control and low
blood pressure during scanning remains a limiting factor in these group of patients for CTCA
to be as informative as conventional coronary angiogram. Furthermore ability of low dose
radiation CTCA in ruling out CAD in these complex patients remains unknown.
Objectives: We sought to assess the ability of low radiation CTCA to rule out significant
CAD in consecutive patient with new diagnosis of LV systolic dysfunction.
Methods: We recruited 22 consecutive patients with new diagnoses left ventricular
dysfunction on transthoracic echocardiography (men 15, Female 7 with mean age 5918,
BSA 1.90.5, F <50% ( average 38%10). We evaluated the ability of low radiation step
and shoot (Axial sequential imaging) CTCA technique (256 slice Phillips scanner) to rule out
CAD in these patient. Patient received premedications for the scan as per SCCT guidelines.
Results: Patients were scanned with Philips iCT 256 slice scanner using step and shoot
technique (13 diastolic and 9 systolic gating). Average heart rate during the scan was
6814 beats per minute (18 sinus rhythm and 4 AF) during the scan. Average radiation
dose was low with a dose length produce of 19293 mG*cm (Effective dose of 2.71.3
mSev). Significant coronary artery disease was ruled out in 21 of the 22 patients with 1
patient requiring invasive coronary angiogram for further evaluation.
Conclusion: Low radiation CTCA can rule out significant CAD in 95% of patients with low
to intermediate risk of CAD with LV systolic dysfunction
Disclosure of Interest: S. Ranjan Shareholder of: None, Grant/research support from:
bureau: none, P. Challa: None Declared, B. Jesuthasan: None Declared, M. Horder: None
Declared, S. Ryan: None Declared, A. Dahiya: None Declared
PM439
Correlates of CMR-detectable inflammation in Systemic Lupus Erythematosus
Martin Seneviratne*1, Stuart Grieve1, Gemma Figtree2, David Celermajer3, Roger Garsia4,
Stephen Adelstein4, Rajesh Puranik3
1
University of Sydney, 2Department of Cardiology, Royal North Shore Hospital, 3Department of
Cardiology, 4Department of Immunology, Royal Prince Alfred Hospital, Sydney, Australia
Introduction: Cardiac magnetic resonance (CMR) studies using late gadolinium
enhancement (LGE) have demonstrated high rates of myocardial inflammation in patients
with systemic lupus erythematosus (SLE). It is not well understood how this CMR-
detectable inflammation relates to either SLE severity or cardiac function.
Objectives: To investigate the relationships between the extent of myocardial inflammation
and (i) immunological markers of SLE severity, (ii) systolic and diastolic function, and (iii)
exercise tolerance.
Methods: Cardiac magnetic resonance (1.5T) with gadolinium contrast was performed on 40
consecutively recruited patients with SLE (mean age 39.9  12.5 years; 80% female). SLE
severity was quantified with a SLEDAI assessment by an experienced immunologist (mean
SLEDAI 3.8  3.5, normal range??), and exercise tolerance was assessed with formal treadmill
exercise testing with the Bruce Protocol (mean exercise capacity 97.524.5% predicted METS).
Results: Of the 40 patients, CMR revealed mid-wall LGE in 14 (35%), in which the
percentage of LV myocardium affected varied from 1-25%. LGE was most commonly
visualised in the anteroseptal region extending from base to apex. Percent LGE correlated
negatively with the LV E:A ratio (p¼0.02). No correlation was found with SLEDAI score or
any serum immunological markers (anti-dsDNA, anti-Sm, C3, C4). There was no corre-
lation between percent LGE and exercise capacity.
Conclusion: Immunological metrics for SLE severity do not predict subclinical inflammatory
changes detectable on CMR. Myocardial inflammation is associated with reduced LV E:A
ratio, suggestive of diastolic dysfunction despite no manifest reduction in exercise tolerance.
Disclosure of Interest: None Declared
PM443
Ebstein’s Anomaly in Adults – favourable outcomes from a single specialist centre
experience
Queenie Luu*1, Preeti Choudhary1,2, Dan Jackson1, Mark McGuire1, Richard Chard3,
David S. Celermajer1,2
1
Cardiology, Royal Prince Alfred Hospital, 2Central Clinical School, University of Sydney,
3
Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
Introduction: Ebstein’s anomaly (EA) is rare, occurring in about 1–5 per 200 000 live
births, thus accounting for less than 1% of all congenital heart disease (CHD). Long term
follow up data of adults with EA are scarce due to the relatively low frequency of the disease
and the remarkable variation of its anatomic and haemodynamic profile. Since 1995, in our
adult CHD centre, we have practised an uniform approach to their management of
“watchful waiting” with operation reserved for either those with refractory arrhythmia
(failed medical and/or catheter-based treatment) or worsening symptoms of breathlessness,
with a lower threshold for surgery in cases with tricuspid valves judged likely reparable
(compared with requiring replacement) and in those with what was judged to be an
adequate LV and functional RV.
Objectives: To evaluate the long term outcomes of our EA patients.
Methods: All patients with EA and normal cardiac connections from our database of 2853
patients aged over 16 years were selected for the study. Records were reviewed for outcomes.
Results: Fifty-three EA patients (16 males, mean age at diagnosis 18.3  19.9 years, mean
age first seen at our service 31.9  14.3 years) were followed for a mean time of 21.4 years
(range 0–54). Of these, 18 patients (34%) had documented supraventricular arrhythmia,
e151
 with typical Wolff-Parkinson-White syndrome occurring in 5 patients (9%). Eleven pa-
POSTER ABSTRACTS
tients (21%) underwent catheter-based ablation therapy (with long term relief from
arrhythmia in 8) and 4 patients (8%) required pacemaker implantation. Fifteen patients
(28%) underwent tricuspid valve (TV) surgery (10 repair and 5 valve replacement). Seven
patients had anti-arrhythmia surgery at the time of TV surgery. Four patients required redo
TV surgery. Small LV, defined as end–diastolic diameter less than 40 mm in adulthood, was
present in 21 cases (40%). One patient died of cardiogenic shock during follow up.
Conclusion: EA in adulthood often has severe morphological abnormalities but is
compatible with good medium-term survival, with a conservative approach to the in-
dications for interventions.
Disclosure of Interest: None Declared
PM444
Increased Cardiac Output During Exercise and Reduced Pulmonary Regurgitation in
Adults with Repaired Tetralogy of Fallot
Shamus O’Meagher*1, Phillip A. Munoz2, Nathan Malitz3, David J. Tanous4,
David S. Celermajer5, Rajesh Puranik5
1
Medicine, University of Sydney, 2Respiratory and Sleep Medicine, Royal Prince Alfred Hospital,
3
Specialist MRI, 4Cardiology, Westmead Hospital, 5Cardiology, Royal Prince Alfred Hospital,
Sydney, Australia
Introduction: Changes in ventricular function and cardiac flows during exercise in adults
with repaired tetralogy of Fallot (TOF) and severe pulmonary regurgitation (PR) are poorly
characterised.
Objectives: To quantify ventricular function and cardiac flows during exercise in order to
investigate the effects of right ventricular dilatation late after TOF repair.
Methods: 16 repaired TOF patients (257 years of age) and 8 age and sex matched
controls (254 years of age) underwent cardiopulmonary exercise testing (CPET) and then
real-time cardiac MRI (1.5T) at rest and whilst exercising within the scanner, aiming for
30% heart rate reserve (HRR) (Level 1) and 60% HRR (Level 2), using a custom built MRI
compatible foot pedal device.
Results: At rest, TOF patients had severely dilated RVs (indexed RV end-diastolic volume
[RVEDVi]: 14937mL/m2), moderate-severe PR fraction (3412%), lower normal RV
ejection fraction (RVEF: 527%) and lower normal exercise capacity on exercise testing
(8315% of predicted maximal work rate).
Table 1. Exercise MRI results for all tetralogy of Fallot patients.
PR fraction decreased from rest to Level 2 in patients with an RVEDVi <140 mL/m2
(3318 vs 2717%, p¼0.002) but not in those >140 mL/m2 (4111 vs 369%,
p¼0.141). PA net forward flow was maintained at level 2 (7015 vs 698, p¼0.893) via a
significant change in RVEF (0.84 vs 1412%, p¼0.012).
Conclusion: During exercise in repaired TOF subjects with free PR at rest, increased RV
cardiac output was facilitated by an increase in HR, an increase in RVEF and a decrease in
PR fraction. Reduced diastolic filling time as HR increases is a possible explanation for this
observation.
Disclosure of Interest: None Declared
PM445
Dextrocardia in Adults with Congenital Heart Disease (CHD)
Sophie Offen*1,2, Dan Jackson1, Preeti Choudhary1,2, David Celermajer1,2
1
Department of Cardiology, Royal Prince Alfred Hospital, 2The Sydney Medical School,
University of Sydney, Sydney, Australia
Introduction: Dextrocardia is a very rare finding in the general population, occurring in
approximately 1/10,000 live births, and is often associated with significant additional
cardiac malformations. However, the prevalence and associated defects in adults with
dextrocardia has not previously been documented.
Objectives: We sought to identify the range of additional cardiac malformations and
previous surgical interventions in an adult population with dextrocardia.
Methods: We interrogated the database for our large tertiary referral Adult CHD service. Of
2853 adults (>16yrs, seen at least once since 1999), 22 had dextrocardia and 5 dextro-
position. 27 patients were included in the study, a comprehensive search of their medical
records was conducted and the data subsequently analyzed.
Results: There were 15 men and 12 women, aged 16yrs to 76yrs at last follow-up. Situs
was solitus in 16 (59.2%), inversus in 8 (29.6%) and ambiguous in 2 (7.4%). No infor-
mation regarding situs was available in 1 patient (3.7%).
22/27 patients (81.4%) had 1 additional cardiac malformation, with a mean of 3 per
patient (range 0-7). Ventricular septal defect (40.7%), Fontan circulation (37%), atrial
septal defect (33.3%) and pulmonary atresia (25.9%) were most frequently identified.
There was a relatively even distribution of defects in accordance with frequency of situs;
62.9% of the total defects were identified with situs solitus, 24.6% situs inversus and 8.6%
situs ambiguus. 2/2 patients with situs ambiguous (100%) had a diagnosed heterotaxy
e152
syndrome; one Ivemarks asplenia syndrome and one CHARGE syndrome. 1/8 patients with
situs inversus (12.5%) had Kartageners Syndrome.
18/27 patients (66.6%) required some form of surgical intervention. Palliative shunt
procedures were performed in 14/27 patients (52%), 12 of which were followed by a
Fontan procedure between age 3 and 41. 1/27 patients underwent diversion of an
anomalous left SVC, 1/27 had repair of an aortic coarctation and 2/27 had an isolated repair
of a septal defect. Further surgical revisions were required in 9/17 patients (52.9%), two of
which involved valvular repairs. 5/27 patients (18%) had electrophysiology ablation pro-
cedures and one patient had an insertion of a biventricular pacemaker.
Conclusion: Dextrocardia is much commoner in adults with CHD than in the general
population, often associated with abnormal situs and usually associated with complex le-
sions requiring multiple surgical interventions.
Disclosure of Interest: None Declared
PM446
High fat diet for refratary epilepsy promotes lipid and phenotype disorders in
lipoproteins of brazilian children and adolescents
Patricia A. Lima1, Mariana B. Prudêncio2, Daniela Murakami3, Leticia P. D. B. Sampaio4,
Nágila R. T. Damasceno*2
1
Nutrition, Applied Human Nutrition - Farmacy Science University USP, 2Nutrition, School
Health Public, 3Nutrition, 4Neurology, Children’s Institute USP, Sao Paulo, Brazil
Introduction: The ketogenic diet (KD) is a nonpharmacological treatment used worldwide
for children and adolescents with intractable epilepsy. This diet provides adequate protein,
low carbohydrates and high fat. High fat proportion favors production of ketone bodies
related to mechanism anticonvulsant this diet. Despite these benefits, this high fat can lead
to changes of lipid profile and to increase cardiometabolic risk in children and adolescents.
Objectives: Assess the impact of the ketogenic diet in lipid disorders in children and
adolescents with refractory epilepsy.
Methods: Children and adolescents undergoing treatment with KD were monitored at
times: T0-before the introduction of KD and T1-after 3 months of treatment with KD. The
lipid disorders were classified according to the cutoff points propose by American Academy
of Pediatrics (2011). The cutoff point to atherogenic phenotype A or B was based in LDL
size according proposed by Lipoprint System QuantrimetrixÒ. Statistical analyzes were
performed with the Software SPSS 16.0 using McNemar test
Results: Seventeen patients (12 children and 5 adolescents) with an average age of 6.7 years
(1.4 to 15 years) were included. At T0 time, all children and adolescents showed pattern A,
but at T1 time, 23.5% of patients migrated to pattern intermediate and 5.9% migrated to
pattern B. Table 1 shows the increased frequency of lipid disorders after 3 months of KD.
Conclusion: The results show significant increase in the frequency of children and ado-
lescents with elevated LDL, non-HDL and APOB. In addition, the KD has negative effect on
the LDL phenotype demonstrating that KD used for the treatment of intractable epilepsy is
linked to pro-atherogenic profile.
Disclosure of Interest: None Declared
PM447
Abnormalities of ventricular morphology and compaction are prevalent in adults with
coarctation of the aorta – a two-centre cardiac magnetic resonance imaging (CMR)
study
Preeti Choudhary*1,2, Christian Hamilton-Craig3,4, Wendy Strugnell4, Peter Robinson5,
Lynne Pressley5, David Tanous6, David S. Celermajer1,2, Rajesh Puranik1
1
Cardiology, Royal Prince Alfred Hospital, 2Central Clinical School, University of Sydney, Sydney,
3
The University of Queensland, 4Cardiology, The Prince Charles Hospital, Brisbane, 5Sydney Heart
Centre, Royal Prince Alfred Hospital, 6Cardiology, Westmead Hospital, Sydney, Australia
Introduction: Coarctation of the aorta (CoA) is associated with valvular and aortic disease
but the abnormalities in ventricular morphology are less well understood. Echocardio-
graphic case series suggest a high prevalence of left ventricular non-compaction (LVNC)
compared to normal controls but this has not been clarified by the superior LVNC
detection technique of cardiac magnetic resonance imaging (CMR).
Objectives: We thus sought to assess the prevalence of non-compaction and abnormal
ventricular morphology in patients with CoA.
Methods: CMR images of CoA adults were collated from two state-wide tertiary referral
centres in Australia. LVNC was defined as ratio of non-compacted to compacted myocardium
of greater than 2.3 and abnormal compaction (LVAC) was defined by a ratio of 1.5-2.3 in
end-diastole. Clinical information, volumetric data and mass calculations were obtained.
Results: CMR scans of 293 CoA patients were analysed (Mean age 30+/-13 years; 50%
male). 140 patients (48%) had bicuspid aortic valve disease and 14 had unrepaired CoA.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
LVAC was evident in 78 (%) patients and LVNC in 15 (%). The most prevalent abnormality

POSTER ABSTRACTS
was mid-ventricular septal trabeculation in 40 patients.. Patients with LVNC had signifi-
cantly higher indexed end-diastolic (97+/-24 mL/m2 vs. 119+/-29 mL/m2; p¼0.006) and
end-systolic volumes (58+/-19 mL/m2 vs. 47+/-16 mL/m2; p ¼ 0.03) compared to normally
compacted ventricles. Ejection fraction did not significantly differ between the LVAC and
normally compacted patients. (EF 60+/-6% vs. abnormally compacted EF 52+/-1; p ¼
0.30). Age, gender or presence of bicuspid aortic valves did not correlate with presence of
NC. In a subset of 148 cases, detailed short axis LV cine stacks were performed, revealing
abnormalities of the mitral valve leaflets in 10, papillary muscles in 17 and myocardial clefts
in 28 patients.
Conclusion: Abnormal ventricular morphology is prevalent in CoA and should be
considered in addition to the known valvular and vascular complications. Ventricular non-
compaction correlates with increased end-diastolic volumes and may impact on ventricular
function over time.
Disclosure of Interest: None Declared

PM448
Ventricular non-compaction is prevalent in patients with single ventricle physiology
but does not alter ventricular function
Preeti Choudhary*1,2, Christian Hamilton-Craig3,4, Wendy Strugnell3, Peter Robinson5,
Lynne Pressley5, David Tanous6, Rajesh Puranik1, David S. Celermajer1,2
1
Cardiology, Royal Prince Alfred Hospital, 2Central Clinical School, University of Sydney,
Sydney, 3Cardiology, The Prince Charles Hospital, 4University of Queensland, Brisbane, 5Sydney
Heart Centre, Royal Prince Alfred Hospital, 6Cardiology, Westmead Hospital, Sydney, Australia

Introduction: Single ventricle heart disease (SVHD) is a unique haemodynamic state due to
various congenital heart lesions resulting in a volume loaded sub-aortic ventricle. Ven-
tricular non-compaction (NC) is thought to occur due to early embryonic arrest in the
compaction process.
Objectives: We hypothesised that haemodynamic loading conditions such as excess vol-
ume load may also influence NC occurrence.
Methods: We analysed clinical features and cardiac MRI scans of 87 patients (mean age
25+/-9 years; 52% male) with congenital univentricular physiology from two state-wide
tertiary referral centres in Australia. NC was defined as a ratio of non-compacted to
compacted myocardium greater than 2.3. Abnormal compaction was defined as a ratio
between 1.5-2.3 for the ventricle in end-diastole.
Results: The systemic ventricle was a morphologic left ventricle (LV) in 60 patients
(69%) with no significant differences in ejection fraction compared to single right
ventricles (45+/-11% vs. 44+/-15%; p¼0.6). Abnormal compaction was present in 27
(%) patients with morphologic LV, and criteria for LVNC were met in 23 (38%). There
were no significant differences in indexed end diastolic volumes (141+/-62 vs. 111+/-
46; p¼0.065), end systolic volumes (78+/-36 vs. 61+/-32; p¼0.085) or ejection frac- Conclusion: This retrospective assessment of use of 320-detector-row CT imaging in a
tion (44+/-12 vs. 47+/-8; p¼0.35) in patients with LVNC compared to those with paediatric population found that the most common indication for scanning was congenital
normal compaction. The distribution of LVNC in patients with morphologic LV was heart disease. The majority of CT scans demonstrated an abnormality and as expected due
localized to the apex in 19 and involved the mid-ventricular segments in 6 patients. 8 of to scanning protocols older patients (with greater weight) received a higher radiation dose.
these had double inlet left ventricle and 14 had tricuspid atresia as their primary lesion. Disclosure of Interest: None Declared
10 patients (37%) with a morphologic right ventricle as systemic ventricle had sig-
nificant NC. There were no significant differences in ventricular function comparing
trabeculated to non-trabeculated morphological right ventricles (41+/-18% vs. 46+/- PM450
4%; p¼0.5). A serial ultrasound evaluation of cardiac structure and function from two days to six
Conclusion: Non-compaction occurs with a high prevalence in patients with uni- months of age in preterm lambs
ventricular physiology (LV or RV morphology) despite a variety of primary lesions, sug-
gesting a common haemodynamic influence in NC pathogenesis. In our cohort, the Paul Lombardo*1, Michal Schneider1, Robert De Matteo2, Richard Harding2, Vivian Nguyen2,
presence of LVNC did not correlate with adverse ventricular function. Graeme Polglase3, M. Jane Black2
1
Disclosure of Interest: None Declared Medical Imaging and Radiations Science, 2Department of Anatomy & Developmental Biology,
Monash University, 3The Ritchie Centre, Monash Institute of Medical Research, Clayton,
PM449 Australia

Use of 320-detector-row CT in paediatric cardiac imaging in a single tertiary hospital
Sarah Hosking*1, Sarah Hope1,2,3, James Cameron1,2,3
1
Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of
Medicine (MMC), Monash University, 2MonashHeart, Monash Health, 3Southern Clinical School,
Monash University, Melbourne, Australia
Introduction: Radiation dose associated with medical imaging is particularly important in a
paediatric population. Cardiac CT imaging is growing in use with effective radiation dose
decreasing with improvements in technology. Imaging using 320-detector-row cardiac CT
has shown applicability in children, with shorter image acquisition times (0.175s) and
reduced radiation compared to the older helical scanners.
Objectives: We aimed to investigate the usage (indication and outcome) and associated
effective radiation dose for 320-multislice cardiac CT imaging in a paediatric cardiology
unit at a single large university hospital following its inception in 2008.
Methods: The institutional database was retrospectively searched for patients between 0-18
years of age who had undergone 320-multislice CT scan between 2008 and 2013. Data
collected included patient age, CT dose length product (DLP), findings and study quality.
Results: 58 patients (age range four months and 18 years, 29 male) were identified. DLP
was available in 51 patients. The most common indication for CT scanning was
congenital heart disease (28, 48%), followed by collapse (9, 16%), Kawasaki disease and
aortic coarctation (both 6, 10%). 71% of scans identified or confirmed an abnormality.
Radiation dose was strongly age related (P<0.001) but not associated with indication
(P<0.2), (See Figures). 69% of studies were rated as “good” or “excellent” by scan
reporter.
Introduction: Cardiac adaptations in response to preterm birth are not well understood
and may contribute to the development of long-term cardiovascular disease.
Objectives: To compare heart structure and function in preterm and term lambs from two
days after birth to six months of age using ultrasound imaging.
Methods: Preterm birth was induced at 0.9 of term (via maternal Epostane) in Border
Leicester x Merino ewes, with a clinical course of antenatal corticosteroids (Celestone
Chronodose) administered prior to delivery. Ten female and thirteen male preterm lambs
were born vaginally at 1321 days gestational age (dGA). A control group of six female
and eleven male lambs were born at term (1471 dGA). Ultrasound imaging was con-
ducted on all lambs at two days, two weeks, three months and six months postnatal age.
The thickness of the left ventricular wall, interventricular septum and the short axis in-
ternal diameter of the left ventricular chamber at the level of papillary muscles were
recorded at end systole and end diastole. All measurements were adjusted to body weight.
Percent fractional shortening of the left ventricle was calculated. Data were analysed using
a two-way ANOVA and Tukey post-hoc analysis with preterm/term and postnatal age as
factors.
Results: Growth of the heart in preterm lambs was altered in the early postnatal
period, with relative thickness of the anterior and posterior wall of the left ventricle,
relative thickness of the interventricular septum and the diameter of the left ventricular
chamber all significantly increased in preterm lambs compared to term lambs at 2 days
and 2 weeks after birth. However, cardiac contractility was not affected, with no dif-
ference in the fractional shortening of the left ventricle in the preterm and term lambs.
The structural differences in the preterm lambs normalised by three months of age and
fractional shortening remained normal. There were no significant sex differences at any
age.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e153

 Conclusion: It appears that growth of the heart in the initial postnatal period is altered as RPA (distal to the SVC) was increased and decreased by inspiration and expiration
POSTER ABSTRACTS

an adaptive response to preterm birth. However, this adaptation does not appear to respectively (Figure 2).
adversely affect cardiac function as measured by percentage fractional shortening of the left
ventricle.
Disclosure of Interest: None Declared

PM451
Cardiac Dysfunction Among HIV Infected Children on Combination Anti Retroviral
therapy Attending Joint Clinical Research Centre, Kampala Uganda
Judith Namuyonga*1, Peter Lwabi2, Sulaiman Lubega2, Victor Musiime3, Irene Lubega1
1
Paediatrics, Makerere University College of Health Sciences, 2Paediatrics, Uganda Heart
Institute, Kampala, Uganda, 3Paediatrics, Joint Clinical Research Centre, Kampala, Uganda,
Kampala, Uganda
Introduction: Cardiac abnormalities are quite common among antiretroviral therapy (ART)
naïve HIV-infected children. Despite effective ART, HIV still persists in reservoir sites like
the cardiac muscle. The impact this would have on cardiac function among children in
Uganda in the ART era has not been described.
Objectives: To determine the magnitude of cardiac dysfunction and to describe the
cardiac abnormalities among HIV infected Ugandan children on combination ART
(cART).
Methods: We enrolled 285 children aged 1 to 18 years who were on combination ART for
at least 6 months at Joint Clinical Research Centre, Kampala, Uganda.
Institutional, Informed consent and assent were obtained. Electrocardiogram and
echocardiogram were performed by two paediatric cardiologists at Uganda Heart
Institute in Mulago National Referral and teaching hospital. Blood for CD4 counts,
viral load and complete blood count were obtained. Data was analyzed using STATA
version 12.
Results: Of the 285 children, 54% were females, median age was 9years (IQR 6, 13); 72%

web 3C=FPO
were on first line cART. Mean CD4 count was 1092 cells/mm3, median viral load: 20
copies/ml (IQR 20,76). 94% had adherence to cART of more than 95%.
Cardiac abnormalities were detected in 82 (28.7%) children. The most common ECG
abnormalities were left ventricular hypertrophy 14 (4.9%), sinus tachycardia 13 (4.6%),
and non specific T wave changes 13 (4.6%). Abnormalities by echocardiogram were;
pericardial disease 8 (2.8%), left ventricular systolic dysfunction 7 (2.5%), congenital heart
disease 8 (2.8%), rheumatic heart disease 2 (0.7%), and dilated cardiomyopathy 1 (0.4 %).
The children with pericardial effusions were symptomatic and had all failed on com-
bination ART. CD4 counts greater than 750cells/mm3 were protective against cardiac
dysfunction (p¼ 0.02, OR¼ 0.26, 95% CI 0.08 - 0.86).
Cardiac dysfunction was not associated with age, duration from diagnosis of
HIV, ART regimen, duration of cART, and history of treatment for tuberculosis or
cancer.
Conclusion: The magnitude of cardiac dysfunction among HIV-infected children on cART
is high: conversely it decreased with CD4 count above 750cells/mm3. Dilated cardiomy-
opathy is rare in this population contrary to earlier observations in ART naïve children.

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Echocardiography is recommended in children failing on combination anti retroviral
therapy.
Disclosure of Interest: None Declared

PM452
Bidirectional Flow In The Superior Vena Cava After The 1.5 Ventricle Repair:
Mathematical Modelling And Wave Intensity Analysis Conclusion: Bidirectional flow in the SVC after 1.5VR is caused by transmission of RV
1 1 2
contraction and relaxation waves. Although the early systolic compression wave increases
Jonathan P. Mynard* , Joseph J. Smolich , Daniel J. Penny MPA flow, it also leads to retrograde SVC flow. Respiration has a substantial effect on both
1
Heart Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia, 2Pediatric pulmonary blood flow and the degree of retrograde SVC flow.
Cardiology, Texas Children’s Hospital, Houston, TX, United States Disclosure of Interest: None Declared

Introduction: In children with a hypoplastic and marginally functional right ventricle, the
1.5 ventricle repair (1.5VR) may be chosen to avoid Fontan physiology or a two-ventricle
repair. The 1.5VR involves shunting superior vena caval (SVC) blood flow directly into the
pulmonary arteries, while inferior vena caval flow forms the entire right ventricular (RV)
output. Although this procedure was proposed almost 25 years ago, little is known about
the underlying physiology of resulting cavopulmonary haemodynamics. For instance,
bidirectional flow may be evident in the SVC after a 1.5VR, the origin of which is unclear.
Objectives: To develop a mathematical model of 1.5VR physiology and evaluate the
mechanisms underlying bidirectional SVC flow.
Methods: A one-dimensional model of the entire cardiovascular system of a normal 6-year-
old child was modified to represent 1.5VR by connecting the SVC to the right pulmonary
artery (RPA) and reducing RV size by 60%. The haemodynamic influence of normal
respiration was modelled by applying a time-varying negative intrathoracic pressure (ITP)
to the heart and thoracic blood vessels along with an accompanying positive external
pressure to intraabdominal vessels. Wave intensity analysis was used to determine the
mechanisms underlying bidirectional flow in the SVC.
Results: Simulated flow waveforms and wave intensity profiles in the main pulmonary
artery (MPA) and SVC are shown in Figure 1. RV contraction and relaxation produced a
flow-increasing forward compression wave (FCW) and a flow-decreasing forward expan-
sion wave (FEW) respectively in the MPA. Retrograde SVC flow during RV systole was
caused by transmission of the FCW into the SVC as a flow-decreasing backward
compression wave (BCW). Antegrade flow was reinstated by transmission of the FEW into
the SVC as a flow-increasing backward expansion wave (BEW). Retrograde SVC flow was
ameliorated by inspiration and enhanced by expiration (Figure 2). In addition, flow in the
PM453
A mathematical model of the entire cardiovascular system of a six-year-old child
Jonathan P. Mynard*1
1
Heart Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
Introduction: Cardiovascular system modelling enables detailed investigation of complex
ventriculo-vascular interactions under normal and pathological conditions in a general or
patient-specific manner. Past models have focused on the adult circulation and to our
knowledge no comprehensive circulatory models of children have been described.
Objectives: The aim of the present study was to design and test a model of the entire
cardiovascular system of a normal six year old child (body weight 20 kg, body surface area
0.8 m2) for use as a reference point when studying congenital heart disease, including
repairs or palliations often performed around this age.
Methods: The model was structurally identical to a recently-described adult circulation
model (Mynard JP, PhD thesis, University of Melbourne, 2011). The major systemic,
pulmonary and coronary arteries and veins were represented with one-dimensional
vascular networks (Figure 1). Each of the four heart chambers consisted of a time-varying
elastance and source resistance. A heart valve model enabled prediction of valve dynamics
based on transvalvar pressure differences and optional degrees of stenosis and/or regur-
gitation. Lumped parameter compartments were used for microvascular beds. Dimensions
of the vascular networks were estimated via allometric scaling of values in the adult model
(body weight 75 kg, scaling power 0.35). Cardiac parameters and vascular resistances and

e154 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

 compliances were also scaled, with scaling powers (and initial pressures) estimated to Conclusion: A model of the entire cardiovascular system of a six-year-old child was

approximately achieve the following target metrics: cardiac output 3.2 L/min (cardiac index
4 L/min/m2), ascending aortic pressure 95/65 mmHg, pulmonary arterial pressure 23/13
mmHg.
Results: Simulated pressure waveforms in the femoral, radial and carotid arteries were
similar to tonometry-derived group-averaged waveforms from children in the first decade
of life (Kelly et al, Circulation 80:1652-1659, 1989); note that the tonometry waveforms
were scaled to match the maximum and minimum of the simulated results (Figure 2).
Predicted augmentation index (AI) in the ascending aorta was 0.35, in agreement with
findings of Avolio (J Hypertens 10:S83-S86, 1992) that AI is higher in children than young
adults.
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POSTER ABSTRACTS
developed and its physiological relevance established by comparison with published data.
The model will be useful for studying normal and pathology-related cardiovascular dy-
namics in childhood.
Disclosure of Interest: None Declared
PM454
Clinical outcomes of mitral valve replacement with 16-mm ATS-advanced
performance valve in neonates and infants
Moon Chiyong*1, Kagisaki Koji1, Hoashi Takaya1, Kurosaki Kenichi2, Shiraisi Isao2,
Ichikawa Hajime1
1
Pediatric cardiovascular surgery and cardiology, 2Pediatric cardiology, National Cerebral and
Cardiovascular Center, Suita, Japan
Introduction: Whereas mitral valve (MV) repair is the preferred approach for mitral
regurgitation (MR) in pediatric populations, MV replacement (MVR) is the only
treatment option in some cases. For neonates and infants, however, MVR is challenging
due to the small size of native valve annulus and difficulty of subsequent anti-
coagulation therapy.
Objectives: This study aimed to review our surgical experiences of MVR with commercially
available smallest sized mechanical valves for neonates and infants.
Methods: From 1999 to 2013, 18 patients less than 1 year old underwent MVR with
16-mm ATS-Advanced Performance (AP) valve. The mean age and body weight at
operation were 4.0  1.9 months old (range, 4 days-7 months) and 5.2  1.6 kg (3.3 -
8.3). Primary diagnosis was acute MR due to ruptured chordae tendineae in 9 patients,
post repair of atrioventricular septal defect in 5, MR concomitant with ventricular

septal defect in 2, congenital MR in 1, and anomalous left coronary artery from pul-
monary artery in 1. Prosthetic valve was implanted onto supra-annular position in all
patients except 1
Results: Follow-up was completed on all patients and the mean follow-up period
was 2.7 years (2 months - 8.6 years). Overall survival rate at 7 years was 87.5%.
Freedom from redo MVR rates at 1, 3, and 5 years were 94.1%, 85.7%, and 51.3%,
respectively. Three cases had redo MVR. Two of them are for pulmonary hyper-
tension associated with patient-prosthesis mismatch (PPM), which developed at 2
and 4 years after first MVR, and the other is for hemolysis. The estimated effective
orifice area index (effective orifice area / body surface area) had clear inverse cor-
relation with peak trans-mitral pressure gradient through the entire follow-up period
(r¼ -0.784, p< 0.01). Rate of freedom from permanent pacemaker implantation
(PMI) at 7 years was 66.8%. Three of 5 PMI were required for sick sinus syndrome.
Freedom from hemorrhagic or thromboembolic complications at 7 years was 78.4%.
Although neurological sequelae did not remain, intracranial hemorrhage was
encountered in 3 patients within 1,4 and 12 months after the operation,
respectively.
Conclusion: Most of the implanted 16-mm ATS-AP valves functioned well until PPM
was encountered, without excessive pannus or unexpected clot formation. MVR on
supra-annular position would be a risk for PMI due to injury of sinus node artery.
The anticoagulation alternative to coumadin is expected to reduce hemorrhagic
complications.
Disclosure of Interest: None Declared

PM455
Anomalous Origin of Coronary Arteries from Right Pulmonary Artery
nawal alabdulkarim*1
1
Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

Introduction: Anomalous origin of coronary arteries from right pulmonary artery ACARPA
is a rare variant of anomalous left coronary artery from the pulmonary artery ALCAPA. It is
essential to recognize this anomaly since it causes higher morbidity/mortality of the asso-
ciated congenital cardiac lesions.
Objectives: Assess the incidence and patterns of ACARPA in tertiary care setting.
Methods: Retrospective description of findings in the cases of ACARPA that were diag-
nosed at a referral cardiac center during 1990-2012.
Results: 46 patients had ALCAPA, 4 patients (8.6%) were diagnosed with ACARPA as
described in Table. All underwent surgical reimplantation of ACARPA

Age Assoiated Congenital Diagnosis Angios Anomlous

Patients Months Sex Cardiac defects delay Echo Presentation Confirmation Coronary

1 2 Male ASD Yes DCM/MR/ALCAPA? Yes RCA/LCA

2 27 Male Coarctation VSD Yes DCM/MR/ALCAPA? Yes LCA

3 7 Male VSD Yes DCM/MR/ALCAPA? Yes LCA

4 16 Male Coarctation Mitral Yes DCM/MR/ALCAPA? Yes LCA

stenosis

DCM: dilated cardiomyopathy MR: mitral regurgitation LCA: left coronary artery RCA:
right coronary artery.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e155


POSTER ABSTRACTS
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Conclusion: ACARPA is a rare subset of ALCAPA suspected by atypical findings of
ALCAPA, Confirmation requires angiography. It is usually associated with other congenital
heart disease which causes delayed diagnosis and adverse effect on outcome.
Disclosure of Interest: None Declared
PM457
Aortic Valve Balloon Dilatation in neonates and young infants – Immediate results
and mid-term follow up
1 1 1 1
Anita Saxena* , Mithun Varghese , Sivasubramanian Ramakrishnan , Saurabh K. Gupta ,
Rajnish Juneja1, Shyam S. Kothari1
1
Cardiology, All India Institute of Medical Sciences, New Delhi, India
Introduction: Neonatal critical aortic stenosis (AS), although uncommon, is a potentially
life threatening condition with a high morbidity and significant mortality. Despite two
decades of experience with aortic valve balloon dilatation (AVBD), the predictors of success
remain ill defined.
Objectives: To define outcome following AVBD in neonates and young infants with critical
AS.
Methods: This study is a retrospective analysis of all AVBD performed in neonates and
infants  6 months of age done over the last six years at a tertiary care center. Procedural
success was defined as >50% reduction in initial gradient or a significant improvement in
left ventricular function in the absence of > 1+ increase in aortic regurgitation (AR).
Results: Of the 55 patients who were included in the analysis, there were 47 males and 8
females. Their age varied from one to 180 days with a median age of 30 days. Pre procedure
prostaglandin infusion, inotropic support and ventilatory support was required in 13
(23.64%), 15 (27.27%) and 10 (18.18%) patients respectively. The median aortic annulus Z
score was -0.93 (-2.79 to +1.28). The procedure was done through retrograde approach in all
patients through femoral route. Median balloon annulus ratio was 1 (0.76 – 1.2) with the
median number of dilatations being 2 (1 -5). The procedural success was obtained in 36
(65.45%) patients. Post procedure severe aortic regurgitation (AR) occurred in 10 (18.18%)
patients. There were four deaths (7.27%) and all the patients who died were neonates. None
of the mortality was directly related to procedure. Most common complication encountered
was femoral access related, with 18 patients developing femoral artery thrombus requiring
either heparin or streptokinase (in 6 patients). The predictors of ‘mortality or severe AR’
included age <14 days [OR-4.63; 95% CI- 1.-07 – 19.84; p¼0.04], balloon annulus ratio >
1.0 [OR-4.63; 95% CI1.10 – 19.50; p¼0.04], requirement of inotropic support [OR-10.79;
95% CI- 2.28 – 51.02; p<0.01] and ventilator requirement [OR-8; 95% CI- 1.70 – 37.67;
p<0.01]. Of the 37 patients with follow-up (median – 20 months range), only two patients
underwent repeat AVBD for restenosis and one patient required open surgical correction.
Conclusion: AVBD is a life saving procedure in the treatment of critical congenital AS in
neonates and infants with acceptable complication profile. Age < 14 days, balloon annulus
ratio > 1.0 and inotropic or ventilator requirement were the predictors of ‘mortality or
severe AR’ in these patients.
Disclosure of Interest: None Declared
PM461
Higher Pre-Catheterisation High-Sensitivity Troponin Levels In Maori And Pacific
Patients With St-Elevation Myocardial Infarction In New Zealand: Implications For
Reducing Ethnic Disparities In Cardiovascular Outcomes
Tom Kai Ming Wang*1, Tim Snow1, Tim Watson1, Peter Ruygrok1,2, Harvey White1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: Maori and Pacific ethnicities are associated with higher prevalence of car-
diovascular risk factors, disease and age-standardised deaths in New Zealand. Urgent
primary percutaneous coronary intervention is recommended for treating ST-elevation
myocardial infarction (STEMI), so biomarkers play minimal roles, despite recently devel-
oped high-sensitivity troponin (hs-Tn) assays having increased sensitivity for myocardial
necrosis and enable more rapid diagnosis for MI.
e156
Objectives: We compared pre-catheterisation hs-TnT levels and major adverse cardio-
vascular events (MACE) in STEMI between ethnic groups.
Methods: Patients undergoing acute coronary catheterisation for presumed STEMI at
Auckland City Hospital between October 2010 and September 2010 were divided into
Maori or Pacific and other ethnicities. Admission hs-TnT measurements pre-catheterisation
and MACE (death, myocardial infarction or revascularisation) rates at 30 days and 1 year
were analysed.
Results: In our cohort, 13.3% (23) patients were of Maori or Pacific ethnicity. They were
significantly younger (median 64 vs 58 years, P¼0.016) and had higher prevalence of
smoking (56.5% vs 24.0%, P¼0.002) and chronic respiratory disease (17.4% vs 3.3%,
P¼0.019) than other ethnicities. They also had a trend towards a longer time between
symptoms onset and hs-TnT measurement (3.8 vs 2.5 hours, P¼0.080), and significantly
higher pre-catheterisation hs-TnT measurement (median 275 vs 51ng/L, P¼0.007). MACE
rates at 30 days (8.7% vs 10.0%, P¼1.00) and 1 year (13.0% vs 18.7%, P¼0.770) were
similar, although length of hospital stay was longer (median 4.4 vs 3.2, P¼0.016). In
multivariate analysis Maori or Pacific ethnicity independently predicted admission hs-
TnT>225ng/L (odds ratio 6.01, 95% confidence interval 1.84-19.6, P¼0.003) which is
previously found to be the hs-TnT cutpoint most prognostic of MACE), while admission
log(hs-TnT) predicted both MACE at 30 days with odds ratio 7.61, 95%CI (2.33-24.8) and
1 year with hazards ratio 2.88, 95%CI (1.79-4.63).
Conclusion: Maori and Pacific patients with STEMI were independently associated with
higher admission hs-TnT levels suggesting both longer periods of suboptimal and time to
reach hospital for intervention. Strategies tailored towards these disparities are required to
reduce inequalities in cardiovascular outcomes.
Disclosure of Interest: None Declared
PM462
Prevalence of Group A b-hemolytic Streptococcus and Clinical-Functional
Peculiarities Assessment of Rheumatic Fever in the Kyrgyz Republic
Nazgul Omurzakova*1, Toshihiro Nakajima2
1
Rheumatology, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan,
2
Rheumatology, Tokyo Medical University, Tokyo, Japan
Introduction: Rheumatic fever (RF) well known as frequent complications of a Group A
Streptococcal (GAS)-tonsillopharyngitis noticeably grew especially among young genera-
tion for the last 15 years in Kyrgyzstan.
Objectives: Screening of 665 inhabitants has been carried out by rapid antigen detection
test, including 320 children (80 of which with ARF/RRF) from 3 to 17 years of age (average
age 12,94,0) in the I Group, and 345 adults (15 with ARF/ RRF) at the ages of 18-60
years (41,010,0) in the II Group. Total of 200 patients with Acute Rheumatic Fever (27
patients) and with reoccurring (173 patients) Rheumatic Fever have been studied in the age
group of 15-45 (average age 25,68 years).
Methods: The following studied were conducted: complex clinic diagnosis, rapid antigen
detection test of GAS, smear from throats, ECG registration, Doppler EchoCG, Holter ECG-
monitoring.
Results: The using of rapid tests of GAS and bacterial seeds of smears from throats
demonstrated that there is high prevalence of GAS among patients with tonsillopharyngitis,
RF and among relatively healthy people. Specification of express-methods of diagnosis
reached out 85%, sensibility – 67.5%, which contributed to rapid diagnosis (within 5-10
minues) of etiology of tonsillopharyngitis and development of treatment methodology.
Clinical evidence of RF in the Kyrgyz Republic is characterized by latent beginning, pre-
dominance of minimal and moderate activity, frequent formation after first episode of ARF
postphologistic prolapse mitral valve (PMV), vavular failuge of primary aortal valves at
people of male sex and high possibility of formation of combined valvular defect at female
sex. Demonstrated that tonsillopharyngitis or epipharyngeal infections, sex (female), syn-
drome of dysplasia of heart connective tissues influence on prevalence of ARF.
Conclusion: The prevalence of GAS was studied in the Kyrgyz Republic using high
technology method, such as rapid antigen test of GAS, as well as using evaluation of RF
with studying clinical and functional characteristics of the disease course under current
conditions. Different population age groups were screened, which enabled to identify
the frequency of GAS currence, and define the importance of certain risk factors in the
onset of RF.
Disclosure of Interest: None Declared
PM463
Scoping the barriers and facilitators to quality care for Aboriginal and Torres Strait
Islander peoples with Acute Coronary Syndromes (ACS)
Robert Grenfell*1, Kelley O’Donohue2, Andrew McAuliffe3, Vicki Wade4
1
Cardiovascular Health, The National Heart Foundation, Melbourne, 2National Aboriginal
Health Unit, The National Heart Foundation, Brisbane, 3Policy & Networks, Australian
Healthcare & Hospitals Association, Canberra, 4National Aboriginal Health Unit, The National
Heart Foundation, Sydney, Australia
Introduction: In 2012 the National Heart Foundation and the Australian Healthcare and
Hospitals Association received funding from the Australian Government Department of
Health and Ageing to scope a national, innovative hospital focused project to improve the
care of Aboriginal and Torres Strait Islander peoples experiencing Acute Coronary Syn-
drome (ACS) by sharing the knowledge, skills and experience developed by exemplary
‘lighthouse’ hospitals.
Objectives: The aim was to explore the barriers and facilitators to the delivery of evidence
based care for Aboriginal and Torres Strait Islander peoples experiencing ACS.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: This was a descriptive quality study using survey and face-to face interview. A
letter was published in the Medical Journal of Australia (MJA) and circulated through a
number of clinical, professional and health management networks inviting participation
from healthcare professionals and institutions that had implemented an initiative to
improve the management of Aboriginal and Torres Strait Islander patients with ACS.
Participants were also sourced through informal networking opportunities and word-of-
mouth. Those identified through this process were invited to complete a questionnaire
describing their project and the key elements that contributed to, or hampered its success.
If agreed to by participants, face-to-face interviews were then scheduled.
Results: Completed questionnaires were received from 10 participants and face-to-face
discussions were held with nine. The ‘initiatives’ explored were grouped into one or more
of four domains: cultural safety, clinical quality improvement, workforce and governance
and accountability. Almost without exception, successful initiatives involved consideration
of most or all of these at various and numerous points throughout the patient journey.
Conclusion: This work highlighted that for effective ACS care Aboriginal Liaison Officers,
Aboriginal Health Workers, and equivalent roles need to be optimised. Healthcare settings
should encourage effective processes for the identification of Aboriginal patients; build
effective partnerships and community consultation channels; foster and support clinical
champions and utilise newer technologies. Importantly, quality matrixes should inform
care pathways. Whilst this project originally referred to better hospital care, it was clear that
improving the journey involved a broader range (and, in some cases, innovative use) of
other settings.
Disclosure of Interest: None Declared
PM464
The effect of a 12 week exercise and lifestyle change programme on cardiac risk
reduction: A Pilot using a kaupapa Maori philosophy
Anna Rolleston*1, Robert Doughty1
1
Medicine, University of Auckland, Auckland, New Zealand
Introduction: Cardiovascular disease (CVD) remains the leading cause of premature death
and disability for all New Zealander’s. Maori are the indigenous people of New Zealand and
are disproportionately affected by CVD. The New Zealand Maori Health Policy recognises
that “health and wellbeing are influenced and affected by the ‘collective’ as well as the
individual, and the importance of working with people in their social contexts, not just
with their physical symptoms.” In a Maori worldview, a holistic approach to health and
wellbeing is innate and it is difficult to separate overlapping and interconnected elements.
Objectives: The overall purpose of the project was to trial a kaupapa Maori approach
within the existing structure of a 12 week clinical exercise and lifestyle change programme.
The specific aims of the project were to determine the effectiveness of a kaupapa Maori 12
week exercise and lifestyle change programme on parameters of cardiac risk and quality of
life.
Methods: 12 participants were recruited from a Kaupapa Maori healthcare service. Par-
ticipants attended, three times per week, over a 12 week period for monitored, supervised
and individualised exercise. Participants performed a progressive aerobic only (AO) pro-
gramme for the first 6 weeks and then commenced a combined aerobic and resistance
training (AR) programme from week 7 through 12. Education was administered in an ad
hoc manner throughout the programme.
Results: There was a statistically significant improvement in waist circumference (-3.7cm;
p ¼ 0.05), hip circumference (-4.6cml p ¼ 0.03), systolic blood pressure (-22mmHg; p ¼
0.01) and HDL cholesterol (0.22; p ¼ 0.01) in response to the 12 week programme. There
were no medication changes and no correlation between type of medication and change in
cardiac parameters. In addition, overall quality of life improved (p ¼ 0.03).
Conclusion: A kaupapa Maori approach within a structured lifestyle change programme
modifies cardiac risk parameters in a small cohesive group of Maori.
Disclosure of Interest: None Declared
PM465
Thirty-day outcomes in Indigenous Australians following coronary revascularisation
Jessica O’Brien*1, Christopher Reid2, Lavinia Tran2, Robert Baker3, Andrew Newcomb4,
Julian Smith5, Molla Huq2, Stephen Duffy1
1
Cardiology, The Alfred Hospital, 2Centre for Cardiovascular Research & Education (CCRE) in
Therapeutics, Monash University, Melbourne, 3Cardiac & Thoracic Surgical Unit, Flinders
Medical Centre, Adelaide, 4Cardiothoracic Surgery, St Vincent’s Hospital, 5Cardiothoracic
Surgery, Monash Medical Centre, Melbourne, Australia
Introduction: It is well established that Indigenous Australians (IA) have higher rates of
cardiovascular disease and contributing co-morbidities compared to their non-Indigenous
Australian (NIA) counterparts. Whether this translates into worse outcomes following
coronary revascularization is unclear.
Objectives: We sought to evaluate whether Indigenous status per se portends a poorer
short-term (30-day) prognosis following isolated coronary artery bypass grafting (CABG).
Methods: The outcomes of 778 Indigenous Australians (5510 years; 32% female)
enrolled in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) registry were compared to 36,124 non-Indigenous Australians (6610 years;
21% female) following isolated CABG. In a secondary analysis, patients were propensity-
matched (1:1) by age, gender, renal function, diabetes, and left ventricular ejection fraction
(778 individuals in each group).
Results: IA were younger and more likely to be female, current smokers, to have diabetes,
hypertension, renal impairment, peripheral and cerebrovascular disease, heart failure,
and previous CABG (all p<0.04). Although both groups had similar rates of double- and
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
triple-vessel coronary disease (p¼0.68), IA had lower rates of left main disease, less distal
POSTER ABSTRACTS
arterial anastomoses with arterial conduits (including less internal mammary artery use),
and a higher number of distal vein anastomoses (p<0.001 for the latter four comparisons).
IA had shorter cross-clamp and cardiopulmonary bypass times (p<0.001). IA had lower
rates of post-operative complications such as myocardial infarction, inotrope use,
arrhythmia and new renal impairment (all p<0.04), though bleeding rates were higher
(p¼0.001). However, in-hospital and 30-day mortality, and rates of 30-day readmission
were similar between the IA and NIA groups. With propensity-matching, rates of post-
operative complications become similar amongst the two groups, with the exception of
bleeding, which remained higher in IA (p¼0.03). Mortality and readmission rates remained
comparable among the two groups.
Conclusion: Despite procedural differences and higher rates of baseline co-morbidities, IA
do not have worse short-term outcomes following isolated CABG. Given the higher rates of
baseline co-morbidities and lower rates of arterial conduit use, it will be essential to
determine long-term outcomes.
Disclosure of Interest: None Declared
PM466
RHD Prevention and Control Programme in the Republic of Kiribati
Samantha Colquhoun*1,2,3, Akineti Nikuata4, Joseph H. Kado5, Kautu Bakatu4, Teatao Tiira4,
Patrick Timeon4, Liz Kennedy2, Gavin Wheaton6, Jonathan Carapetis7
1
Dept of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne,
2
Global Health Division, Menzies School of Health Research, Darwin, 3Murdoch Childrens
Research Institute, Melbourne, Australia, 4Kiribati Ministry of Health, Tarawa, Kiribati, 5Fiji
GrASP, Ministry of Health, Suva, Fiji, 6Cardiology, Adelaide Women’s and Children’s Hospital,
Adelaide, 7Telethon Institute for Child Health Research, University of Western Australia, Perth,
Australia, Perth, Australia
Introduction: Kiribati is a country of 19 remote island atolls in the Pacific with a popu-
lation density of 2,258 people per km2 on the main island. The under 5yr mortality rate is
49/1000, GDP per capita is US$1688.
Objectives: The Ministry of Health (MoH) and Medical Services in Kiribati commenced a
RHD prevention programme in December 2011 with support from an Australian based
technical team.
Methods: Activities based on WHO recommendations, include the establishment of a
national RHD database, case finding, an assessment of barriers to Benzathine penicillin G
(BPG) delivery, health worker training and community awareness sessions. A local RHD
nurse has been employed to coordinate the programme. RHD screening of school children
using portable echocardiography to define the RHD prevalence using the WHF RHD
echocardiography criteria has been undertaken.
Results: The RHD prevalence in school aged children in Kiribati is 20.6 per 1000. National
protocols based on the diagnosis and management of ARF/RHD have been introduced and
212 cases of ARF and RHD have been registered since 2012. In 2013 12 RHD patients were
sent to India for urgent cardiac surgery and following this a new pre and post surgery
assessment plan for patients was introduced. ARF and RHD were recently added to the
national monthly reporting form which is completed by all health clinics. The RHD
coordinator accesses these data to update the national database with newly diagnosed and
known patient information from across the country. The MoH has identified and addressed
some barriers affecting adherence including removing the requirement for a new pre-
scription each month for BPG. Reminder cards have been created, and monthly supply of
penicillin from pharmacy to health centres has been increased as injections can now be
given at local clinics. The delivery of BPG remains an ongoing challenge as is communi-
cation between the outer islands and the capital. Patient education and support sessions
have been facilitated and 200 health workers received RHD training.
Conclusion: Having a dedicated coordinator has assisted in focusing and accelerating RHD
activities; however, due to the remoteness of many of the outer islands populations,
absence of national or regional surgical facilities, competing disease priorities and need for
integration with new NCD strategies, ongoing commitment and support will be required
towards developing a sustainable RHD programme.
Disclosure of Interest: None Declared
PM467
Review of a Western Australian Hospital in the Home (HiTH) program for bicillin
secondary prophylaxis in paediatric patients at risk of recurrent acute rheumatic
fever
Jennifer Melvin*1, James Ramsay2, Julie Vine3
1
The University of Notre Dame Australia, Fremantle, 2Children’s Cardiac Centre, 3Ambulatory
Care Services, Princess Margaret Hospital for Children, Perth, Australia
Introduction: Research suggests that secondary prevention with antibiotic prophylaxis is
the most cost-effective Rheumatic Heart Disease (RHD) control strategy. However, data
from Australian RHD registers have shown only 30-40% receive the recommended
benchmark of 80% of scheduled bicillin doses.
Objectives: The aim of this study was to audit compliance with secondary antibiotic pro-
phylaxis and clinical reviews of paediatric patients diagnosed with Acute Rheumatic Fever
(ARF)/RHD living in Perth Western Australia (WA). These children are referred to a nurse-
led Hospital in the Home (HiTH) program, which delivers bicillin injections to patients at
their home. The audit was matched against the standards recommended in the Australian
guideline for prevention, diagnosis and management of ARF and RHD (2nd edition).
Methods: The audit operated under the standard that 100% of patients requiring sec-
ondary prophylaxis received 80% of scheduled injections between 01/01/2012 and
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 30/06/2013. Additionally it was expected that patients attended 100% of required clinical
POSTER ABSTRACTS
reviews. All patients (3 to 18 years) living in Perth diagnosed with ARF/RHD having bicillin
prophylaxis provided by the HiTH service were included. Medical records including bicillin
compliance data were reviewed and analysed using simple statistics.
Results: 25 patients met the inclusion criteria, 17 male (68%) and 8 female (32%). Age
range ten to 17 (mean 14 years). 19 patients were Indigenous, four Pacific Islanders and
two Maori. Ten patients were diagnosed during the audit period. Four patients (16%)
classified as Priority 1 (severe RHD), two (8%) Priority 2 (moderate RHD) and 19 (76%)
Priority 3 (mild or no RHD). 21 patients (84%) met the standard receiving 80%
scheduled injections. 14 (56%) had 100% compliance. All six patients requiring specialist
review during the audit attended their appointments. Only 1 patient did not achieve the
standard for echocardiography.
Conclusion:
- The HiTH program has a higher success rate of compliance with secondary antibiotic
prophylaxis than has been documented before in Australian RHD Control Programs.
- 84% of patients achieved the benchmark of 80% compliance.
- This strategy may be applied as a model in other regions of WA and Australia.
- High compliance for routine reviews has been achieved.
Disclosure of Interest: None Declared
PM468
Rheumatic Rescue: Public health component 2013 program
Lori B. Allen*1, Marvin Allen2, John S. Kauwe3, Farah Marumatakimanu4, Troy Nelson5,
Adonica Kauwe5, Tawny Larsen5, Annika Slater5, Danielle Bate5
1
Public and Community Health, Utah Valley University, 2Cardiology, Central Utah Clinic,
Orem, 3Biology, Brigham Young University, Provo, United States, 4Pediatrics, Nation Health
Service, Apia, Samoa, 5Nursing, Utah Valley University, Orem, United States
Introduction: In an effort to combat the ongoing problem of rheumatic heart disease
(RHD), Rheumatic Rescue (RR) has adopted a three-component approach. The focus of this
report is the public health component of the Rheumatic Rescue (RR) program. Information
in this report was a continuation of previously published research done by the RR team.
The goal is to educate children age 5-15 years and their caregivers. The RR program
incorporated the first three levels of the ecological model in conjunction with the four
elements of the social change model.
Objectives: The purpose of the RR health education program was to broaden the reach and
definition of primary prevention through a public health campaign that enlisted the target
population and associated caregivers. This includes not only making these populations
aware of the symptoms and potential outcomes of a sore throat, but to also encourage
action through understanding and dissemination of appropriate clinical contacts.
Methods: Using the ecological and social change behavioral theoretical models, Samoan
National Health Services staff and RR team members offered presentations prepared for
children and adults. A puppet show, and RHD-related lyrics set to familiar tunes, was
prepared for the children. Each child received a coloring book that followed the puppet
show, with parent information on the last page. A leave-behind poster illustrating critical
RHD aspects was prepared for local doctors to guide the adult discussions. All materials,
scripts, and songs were prepared in the Samoan language.
Results: During the 2013 program, a total of 25 schools were visited, with over 4,000
children receiving the education information. On average, attendance at the caregiver
meeting was 10-12 adults. Program feedback from participants was consistently positive
and offered secondary benefits of the program, such as strengthened relations between a
government agency and its citizens.
Conclusion: Implementation of a public health campaign as a method of sharing the re-
sponsibility with the target population is an essential element to, and compliment of, RHD
prevention programs. This can be accomplished through a collaborative effort between
trained professionals and indigenous health sector personnel.
Disclosure of Interest: None Declared
PM470
Audit of rheumatic heart disease outpatient service
Houng Bang Liew*1
1
Cardiology, Queen Elizabeth Hospital II, Kota Kinabalu, Malaysia
Introduction: Two important elements of Rheumatic Heart Disease (RHD) management
include presription of secondary prohylaxis and family planning for women of child-bearing
age. Monthly intramuscular penicillin is more effective than oral penicillin. An evidence-
based review in Australia highlighted five maternal risk factors associated with RHD during
pregnancy including heart failure and pulmonary hypertension. Our previous review of local
RHD registry revealed that 66.8% of our RHD patients were female, out of whom, only
29.6% received secondary antibiotic prophylaxis: 8.7% were on IM Benzathine Penicillin.
Objectives: To evaluate the family planning referral and trend of prescription of antibiotic
for secondary prophylaxis amongst RHD patients.
Methods: Retrospective audit of case-notes amongst RHD patients at Cardiology Depart-
ment, Sabah, Malaysia. RHD outpatients’ attendances between May 2013 to June 2013
were reviewed. A checklist was used to assess the family planning referral and secondary
prophylaxis presribed to patients.
Results: Forty-seven RHD patients’ case-notes were audited. More than two-thirds were female
(35, 74.5%). Mean age was 37 year-old. The commonest valve involvement was mitral
regurgitation (74.5%) Sixty-two percent received secondary antibiotic prophylaxis: 44.7%
presribed IM Benzathine Penicillin (IM Ben Pen) while 17.0% presribed oral Penicillin V.
Amongst those who was not on prohylaxis (38.3%), 29.8% was patients aged more than 40
e158
year-old, whom were considered less vulnerable to recurrent carditis. 27 our of 35 female
patients (77.1%) was in the reproductive age group (15-45 years old): 55.6% was given edu-
cation on family planning, however only 25.9% had formal referral to family planning services.
Conclusion: The usage of IM Penicillin has increased amongst RHD patients since our last
audit. Majority of those not prescribed were more than 40-year-old. Family planning re-
ferrals still need to be improved even though education was given to half of the women
with RHD. Awareness and advocacy is needed amongst both healthcare workers & patients
to improve standards of RHD outpatient care.
Disclosure of Interest: None Declared
PM471
Mortality amongst patients with rheumatic heart disease in Fiji: a national historic
data-linkage cohort study
Tom Parks*1,2, Joseph Kado3, Anne E. Miller4, Brenton Ward5, Rachel C. Heenan6,
Samantha M. Colquhoun5,6,7, Isimeli Tukana3, Andrew C. Steer4,5,6
1
Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, 2Faculty
of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London,
United Kingdom, 3Fiji Ministry of Health, Suva, Fiji, 4Royal Children’s Hospital, 5Murdoch
Children’s Research Institute, 6Centre for International Child Health, University of Melbourne,
Melbourne, 7Menzies School of Health Research, Charles Darwin University, Darwin, Australia
Introduction: Rheumatic heart disease (RHD) is considered a major public health problem
in developing countries but the risk of death associated with the condition in these settings
is poorly understood. Instead, current estimates of disease burden rely on studies dating
from before the decline of RHD in industrialised nations.
Objectives: We aimed to determine the risk of death amongst patients who have had at
least one contact with health services from nationwide sources of routine clinical and
administrative data in Fiji, where RHD is endemic.
Methods: We linked data for the period 2008-2012 from a patient information system, a
database of death certificates, the national disease control programme’s (NDCP) register,
and information collected from echocardiography clinic registers. We included patients if
they were known to the NDCP, had been discharged from hospital with a diagnosis of
RHD, or had echocardiographic evidence of the disease. We calculated standardised
mortality ratios (SMR) and used multivariate Poisson regression to determine the rate ratios
(RRs) for key risk factors for all-cause death within the cohort.
Results: In total, 4,934 records were linked to identify 2,060 RHD patients observed for
6178.9 person-years. 353 patients died at a median age of 44 years (IQR 28.7-56.9). The
crude death rate was 5.7% per year (95% CI 5.1-6.3). Standardised by age, gender and ethnic
group, patients with RHD were at eight-fold increased risk of death (SMR 8.8, 95% CI 7.9-9.8)
compared to the general population. Patients of iTaukei (Indigenous Fijian) ethnicity were at
greater risk than patients of Indian descent (SMR 12.4 vs SMR 5.0) and young iTaukei men
were at greatest risk (SMR 50.0). During follow-up 399 patients were admitted to hospital for
heart failure, which was strongly associated with risk of death, an effect most pronounced in
the young (RR 51.5 for patients aged 4-19 years vs RR 11.9 40 years, both p < 0.001).
Conclusion: Patients with RHD are at significantly increased risk of death compared to the
general population. The risk is greatest for young adults and the iTaukei population, and
increases considerably following hospitalisation for heart failure highlighting the impor-
tance of early detection and effective secondary prevention. With computerised patient
administration systems increasingly used in developing countries, linkage of routine data
provides an inexpensive and efficient means to conduct epidemiologic studies. Similar
methods might be employed in other areas where RHD is endemic.
Disclosure of Interest: None Declared
PM472
Echocardiographic screening for Rheumatic Valvular Heart Disease among Egyptian
School Children
Azza A. M. Farrag*1, Wafaa A. El Aroussy1, Nashwa El Hagracy2, Hossam Fawzy2,
Nasser Taha3
1
Cardiovascular Department, Cairo University, 2Cardiovascular Department, 6th October
University, 3Cardiovascular Department, Menia University, Cairo, Egypt
Introduction: Exact prevalence data for rheumatic valvular heart disease (RVHD) in school
children are still lacking in Egypt. It is highly desirable to facilitate health care planning
programs.
Objectives: This study was conducted to determine the prevalence of RVHD among
Egyptian school children using transthoracic echocardiographic study (TTE) and Doppler
examination for confirmation.
Methods: A total of 48930 school children were examined clinically after detailed history
taking. TTE and Doppler examination was performed to assess for the presence of RVHD.
Definite RVHD is defined by the presence of mitral (MV) and/or aortic valve (AV) regur-
gitation seen in two planes by Doppler echocardiography, accompanied by at least two of
the following three morphologic abnormalities of the regurgitant valve: restricted leaflet
mobility, focal or generalized valvular thickening. Possible RVHD is defined as isolated
valvular thickening or leaflet restriction of more than mild regurgitation.
Results: Age ranged between 6 and 18 years, 49.1% were males. An abnormal cardiac
examination or history suggestive of RVHD was reported in 2712 students. Only 1603 had
an adequately imaged TTE. Definite RVHD was documented in 35 (2.2%), and possible
affection in 107. The prevalence rate of RVHD is 0.07%. Abnormal combination of MV
affection was the dominant feature in 174 (65.9%, n¼264); 34 had thickening of leaflets,
21 had subvalvular thickening, 16 had mitral stenosis. AV was reported abnormal in 43
(16.3%), bicuspid in 6 (0.2%), and regurgitant of grade II severity in 8 (0.3%).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: These data suggested low prevalence rate of RVHD in Egyptian school chil-
dren. It had potentially important implications for case finding, early detection and delivery
of effective primary and secondary prevention.
Disclosure of Interest: None Declared
PM473
Prevalence and pattern of Rheumatic Heart Disease in School children from Eastern
part of underdeveloped, poor country Nepal, A cross-sectional, observational study
Samir Gautam*1
1
Cardiology, College of Medical Sciences, Kathmandu University, Bharatpur, Chitwan, Nepal
Introduction: RHD which is more prevalent in underdeveloped countries, is one of the
common cause of morbidity and mortality among school age children, in Nepal.
Objectives: To evaluate the prevalence and pattern of Rheumatic heart disease in School
going children aged 5-15 years from eastern Nepal.
Methods: It was a cross-sectional observational study conducted in 2006-2007.School
children aged 5-15 years were screened using stethoscope as a tool for presence of valvular
heart disease. Clinically suspected cases were evaluated with echocardiography to confirm
the presence of RHD.
Results: A total of 2043 children aged 5-15 years were screened. 23(1.12%) were clinically
suspected to have RHD. Out of them 5(21.74%) found to have RHD, one congenital heart
disease. Commonest valve involved was mitral valve (100%) and commonest lesion found
was Mitral stenosis. Pure mitral stenosis found in 40% cases, Pure Mitral regurgitation in
20%. Mixed involvement of valves seen in 40% cases, MS with MR (20%) and MS with AR
(20%) cases. Commonest and only congenital heart disease was ASD.
Conclusion: In eastern part of Nepal prevalence of RHD was found to be 2.5/1000 school-
children with predominant valve involved as mitral valve and predominant lesion Mitral stenosis.
Disclosure of Interest: None Declared
PM474
Tuberculous Pericarditis in an 87 year old male presenting with difficulty of
breathing
Eduardo O. Yambao Jr.*1, Erlyn Demerre1, Adelaida Yanga-Gaddi2
1
Heart Institute, 2Institute of Pulmonary Medicine, St. Lukes Medical Center, Quezon City,
Philippines
Introduction: Tuberculous pericarditis is the most common cause of pericarditis in Africa
and other countries in which tuberculosis remains a major public health problem. The
Philippines is one of the countries with a high prevalence of tuberculosis. Tuberculous
pericarditis is the leading cause of pericarditis in the world.This also applies in the Phil-
ippine setting. In the review made by Nadura et al, 25.1% percent of the cases of pericardial
effusion from 1985-1999 at the Philippine Heart Center was attributed to tuberculosis.
Pericarditis is a rare manifestation of tuberculous disease. There is no well defined
diagnostic work-up and management guidelines.
Objectives: We report a case of an 87 year old male who presented with difficulty of
breathing and chest discomfort.
Methods: This is a case report of the account of the patient’s clinical status during his
admission at our institution. He was initially managed as a case of chronic obstructive
pulmonary disease (COPD). Persistence of symptoms prompted further work ups.
Results: Echocardiogram showed large pericardial effusion without tamponade physi-
ology. Right heart catheterization and attempted pericardiostomy was done, which resulted
in a bloody tap. In the setting of a bloody tap, the interventional cardiology service sug-
gested a pericardial window insertion and biopsy. Hence, referral to thoracic and cardio-
vascular surgery (TCVS) service was made.
Patient underwent pericardiostomy under general anesthesia on the fifth hospital day.
Pericardial biopsy was done which showed some mesothelial cells admixed with numerous
neutrophils and lymphocytes and set in a fibrinous background.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
POSTER ABSTRACTS
Conclusion: Patient was treated as a case of tuberculous pericarditis. High index of sus-
picion for tuberculous (TB) pericarditis is highlighted in this report as well as the need for a
systematic diagnostic and treatment approach.
Disclosure of Interest: None Declared
PM475
Getting to the Heart of the Matter – The role of RHDAustralia
Catherine Boardman*1, C. Halkon1, C. Milne1, R. Harbridge1
1
Menzies School of Health Research, RHDAustralia, Darwin, Australia
Introduction: Acute Rheumatic Fever (ARF) is an autoimmune sequelae of group A
streptococcal (GAS) infection mostly affecting children 6-14 years of age. Recurrent epi-
sodes of ARF lead to cumulative heart valve damage and the development of rheumatic
heart disease (RHD). RHD is a chronic, sometimes fatal disease that often requires heart
valve surgery. It is estimated that RHD affects 15.6 to 19.6 million people worldwide and
causes 233,000 to 492,000 deaths each year. ARF and RHD are particularly prevalent in
remote Aboriginal communities.
Objectives: RHDA was established to support RHD control programs in the Northern
Territory, Queensland, South Australia and Western Australia by providing technical
assistance, advocacy and policy development. RHDA has established a data collection and
reporting system to measure the quality of local health service delivery and to provide
epidemiological data across participating jurisdictions.
Methods: In partnership with the National Heart Foundation and the Australian Cardiac
Society the evidence based Australian Guideline for Prevention, Diagnosis and Management
of ARF/RHD was developed and disseminated and, translated into an iPhone and Android
app platform for use in clinical and remote settings. RHDA also works to increase com-
munity awareness and prevention of ARF/RHD with a particular focus on primordial
prevention through the development of resources that have been designed specifically for
use in Aboriginal & Torres Strait Islander (ATSI) communities following a process of
community engagement.
Results: ARF & RHD remain a major health problem in indigenous people in the top end
with rates remaining the highest in the world. The Australian Northern Territory has the
highest rate of ARF in the world with RHD affecting approximately 25 Aboriginal people in
every 1,000 of which 45% require heart valve surgery in Australia, most of whom are less
than 25 years old.
Conclusion: Timely diagnosis of an initial ARF episode and subsequent use of antibiotic
prophylaxis is the best method of preventing RHD. This paper summarises current stra-
tegies to improve health outcomes for ATSI drawing on international and Australian
experience.
Disclosure of Interest: None Declared
PM478
Significance of the elements in the CADILLAC and TIMI risk prediction tools in a
cohort of women presenting with STEMI
Elizabeth A. Scruth*1,2, Aziz Rahman1,3, Noel Bairey Merz4, Eugene Cheng5,
Linda Worrall-Carter1,3
1
St Vincent’s Centre for Nursing Research, Faculty of Health Sciences, Australian Catholic
University, Melbourne, Australia, 2Quality and Regulatory, Kaiser Permanente NCAL, Oakland,
United States, 3Cardiovascular Research Centre, Faculty of Health Sciences, Australian Catholic
University, Melbourne, Australia, 4Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart
Institute, Los Angeles, 5Critical Care/Anesthesia, Kaiser San Jose Medical Centre, San Jose,
United States
Introduction: Studies exploring the use of risk assessment tools following an ACS among
women are very limited. The elements in the assessment tools have not been individually
analysed in women to determine which hold the greatest risk for major cardiac events
(MCE) or non major cardiac events (NMCE) following an ACS. Two risk assessment tools:
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 Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications
POSTER ABSTRACTS
(CADILLAC) and the Thrombolysis in Myocardial Infarction (TIMI) have elements that
predict death, a MCE or a NMCE after a ST Elevation myocardial infarction (STEMI). The
TIMI and the CADILLAC use eight and seven variables, respectively.
Objectives: This study aimed to explore the variables within the CADILLAC and TIMI
tools to determine the strongest predictors of risk for MCEs in hospital and at one year in
women presenting with STEMI and treated with percutaneous coronary intervention (PCI).
Methods: This retrospective study used data from women aged 18 years and above
diagnosed with STEMI in emergency departments of 21 Northern California hospitals from
January 2007 to December 2008 who were treated with PCI. The TIMI and CADILLAC
scores were calculated. Women presenting with cardiogenic shock were excluded. De-
mographic, clinical, angiographic data, in-hospital complications, and follow-up for one
year post PCI for STEMI were collected and recorded in an electronic database.
Results: The variables in the TIMI risk tool which were most predictive (p 0.001) of a MCE and
or death in hospital and at one year were systolic blood pressure less than 100 mmHg (OR:
5.02; CI: 1.83-13.75); and Killip class II-IV (p 0.005) (OR: 2.74; CI: 1.13-6.62). Killip class II-
IV (p 0.001) (OR: 5.12; CI: 2.26-11.58) was also a strong predictor of MCE and or death in
hospital for the CADILLAC risk tool. However triple vessel disease (TVD) (p 0.019) (OR: 2.55;
CI: 1.17-5.57) also predicted in hospital MCE and death in the CADILLAC risk tool analysis.
Conclusion: The results of our analyses of the variables in the TIMI and CADILLAC scores
demonstrate the strongest predictors of adverse events after STEMI and PCI in women were
systolic blood pressure less than 100 mmHg, Killip class II-IV, and triple vessel disease.
This knowledge can be used to deploy strategies to prevent MCE and death after STEMI
treated with PCI in women. Larger studies with varying ethnic groups of women are
needed to generalize and validate these results.
Disclosure of Interest: None Declared
PM479
Groin Dressing Post Cardiac Catheterization: Traditional Pressure Vs Transparent
Film
Rokaia Alshualah*1
1 recently been cited as determinants of weight loss. Such behaviours may guide develop-
Education & Training Department, Royal Commission Hospital, Jubail, Saudi Arabia
Introduction: Post cardiac catheterization puncture site care is usually done with a tight
pressure dressing in many institutions and cardiac centers due to the belief that it should
prevent the bleeding. This practice is uncomfortable to the patients. Nurses have also
described difficulty in assessing the sheath insertion site in the groin when pressure
dressing is in place . A new way of dressing using transparent film dressing (TFD) has
approved and rated better with regard to: comfort, less pain, decrease hematoma formation
and facilitates nurses assessment of puncture wound site after femoral sheath removal.
Objectives: To determine the efficacy of using a small transparent non pressure dressing
compared with the traditional controlled pressure dressing applied to the femoral artery
puncture wound site to maintain haemostasis following cardiac catheterization procedures.
Methods: Design: An experimental design, randomized controlled trial.
Setting: King Fahd University Hospital in Khober, Saudi Arabia.
Patients: 80 post cardiac catheterization patients were randomized to have their groins
dressed either with pressure dressing (N ¼ 40) or Transparent Film Dressing (N ¼ 40).
Patients ambulated 8 hours after the procedures. Outcome variables were hematoma for-
mation or bleeding, patient discomfort, and nurse-reported ease of observation of the groin
puncture site after the procedure. Five instruments were used for data collection: 1) De-
mographic and medical data sheet, 2) Hematoma Formation and Bleeding Scale, 3) Skin
Integrity Scale, 4) Patient Discomfort and Pain Scale & 5) Nurses Ease of Assessment Scale.
Results: Results of the study show that 100% in TFD group vs 55% in pressure dressing group
reported feeling very comfortable ( p value of 0.003). Hematoma formation was equal in the
two dressing groups with no incidence of bleeding complications. Nurses rated the ease of
assessing the groin significantly higher for TFD than for pressure dressings ( p value of 0.000).
Conclusion: Dressing of the puncture site after cardiac catheterization with TFD was more
comfortable than the conventional pressure dressing without any difference in hematoma or
bleeding complications. So TFD can be used safely and comfortably after achieving hemostasis.
Disclosure of Interest: None Declared
PM480
Functional independence following subacute inpatient rehabilitation was not affected
by age among older patients recovering from cardiac-related hospital admissions
Steven M. McPhail*1, Suzanne Kuys2, Paul Varghese3
1
School of Public Health and Centre for Functioning and Health Research, Queensland University
of Technology and Metro South Health, 2Allied Health Research Collaborative, The Prince
Charles Hospital and Griffith University, 3Geriatric Assessment and Rehabilitation Unit, Princess
Alexandra Hospital and The University of Queensland, Brisbane, Australia
Introduction: Older people recovering from cardiac events requiring an acute hospital
admission may experience a decline in physical function limiting their ability to return
home to their previous accommodation. Subacute inpatient rehabilitation therapies have
potential to assist recovery of physical functioning. However, it is unknown whether age
influences the length of stay or physical functioning at discharge from subacute inpatient
rehabilitation for this population.
Objectives: This study examined the outcomes of a cohort of older patients recovering
from a cardiac event requiring hospitalisation to investigate the association between age and
physical function at discharge, as well as age and length of rehabilitation stay.
Methods: Participants included 145 consecutive inpatient admissions to a subacute geri-
atric assessment and rehabilitation unit with a cardiac condition as their primary reason for
e160
hospital admission. Participants were required to complete a multi-disciplinary physical
functioning assessment within 72 hours of admission to the unit, and again within 72
hours prior to discharge from the unit. The primary outcome measure was the Functional
Independence Measure motor score. Demographic and clinical information, including
length of stay and discharge destination, were also recorded.
Results: A total n¼126 (87%) participants, with a mean (standard deviation) age of 79 (10)
years, had both assessments completed and were included in analyses. Participants who
had passed away (n¼4, 3%), or did not have both assessments completed per protocol
were excluded from analyses. Discharge destinations included home (n¼101, 80%), resi-
dential aged care (n¼17, 13%) and another hospital (n¼8, 6%). The (median, interquartile
range) Functional Independence Measure motor score was higher at discharge (79, 71 to
84) than admission (61, 48 to 71); z¼7.75 p<0.001. Age was not associated with Func-
tional Independence Measure motor score at discharge (t¼ -0.18, p¼0.86), or length of
stay in the rehabilitation unit (t¼ -0.52, 0.60).
Conclusion: Any perception that age may be associated with longer lengths of stay and
reduced physical function outcomes among patients with cardiac conditions admitted for
subacute inpatient rehabilitation for older adults is not supported data from this investi-
gation. Older age should not be considered a disincentive when considering the suitability
of patients with cardiac diagnoses for this type of inpatient rehabilitation or their potential
physical functioning outcome.
Disclosure of Interest: None Declared
PM481
Eating behaviours and predicting weight loss in cardiac rehabilitation patients
Frances Wise*1,2, Darren Harris3, Robyn Sheppard2, Jennifer Patrick2
1
Epworth Monash Rehabilitation Medicine Unit, Epworth Hospital, 2Cardiac Rehabilitation Unit,
Caulfield Hospital, 3Aspex Consulting, Melbourne, Australia
Introduction: The prevalence of overweight and obesity is increasing globally and is an
acknowledged risk factor for coronary artery disease. Eating behaviours such as emotional
eating and cognitive restraint (the self-initiated intent to limit food intake) have more
ment of successful weight loss strategies but their predictive value in cardiac rehabilitation
patients is unknown.
Objectives: To evaluate potential predictors of fat loss (including eating behaviours) in
cardiac rehabilitation patients.
Methods: A sample of 56 consecutively admitted cardiac rehabilitation outpatients (Mean
age: 60.4yrs SD 12.9; 21% female) were recruited to this study. They completed the Three-
Factor Eating Questionnaire, Hospital Anxiety and Depression Questionnaire and 6 Minute
Walk Test, and were weighed using Body Composition scales. All measures were
completed on admission to and discharge from a 6 week outpatient cardiac rehabilitation
program.
Results: Thirty-three subjects (59% of the sample) lost body fat from admission to
discharge, with a mean loss of 1.5kg fat (SD 1.0). Both reduction in fat mass, and per-
centage fat loss, from admission to discharge, correlated significantly with levels of
cognitively restrained eating. Subjects who lost fat had significantly higher cognitive re-
straint scores compared with those who lost no fat (p ¼ .004). Fat loss was not associated
with overeating or emotional eating behaviours, nor with exercise capacity, improvement in
exercise capacity, sex, age, anxiety, depression or initial fat mass or BMI.
Conclusion: Cognitive restraint was the only significant predictor of fat mass loss and
percentage fat loss in cardiac rehabilitation patients. Weight loss strategies that increase
overweight cardiac patients’ ability to employ cognitive restraint may result in greater
weight loss and prevent weight gain in this group.
Disclosure of Interest: None Declared
PM482
Safety profile of long-term myocardial metabolic agent perhexiline
Helen Phuong*1, Bo Choi2, Betty Raman3, Cher-Rin Chong1,2,3, John D. Horowitz2,3
1
Dept of Pharmacy, Queen Elizabeth Hospital, 2Univ of Adelaide, 3Dept of Clin Pharmacology
and Cardiology, Basil Hetzel Institute, Adelaide, Australia
Introduction: The safe use of medication aims at promoting therapeutic efficacy while
minimizing adverse events. In the case of cardioprotective agent perhexiline which exhibits
complex pharmacokinetics, regular therapeutic monitoring at 3-monthly interval is rec-
ommended. This is not only to maintain plasma concentration within therapeutic range of
0.15-0.6mg/L; but also to reduce its long-term adverse events which are usually associated
with high concentrations, namely neuro- and hepato-toxicity. However, it is unknown if
these adverse events are minimized under current recommendations.
Objectives: (1) To determine the incidence of hepato- and neuro-toxicity during long-term
(>12 months) perhexiline treatment.
(2) To evaluate the relationship between monitoring of plasma perhexiline concentra-
tions and development of adverse effects.
Methods: A retrospective audit was performed to collect data from patients (n¼95) over
1997-2003 receiving perhexiline therapy for >12 months. Hepatotoxicity is defined as
elevation of hepatic enzymes above three times the upper limit of normal; and neurotox-
icity is defined as new peripheral function impairment verified by physical examination 
nerve conduction studies. All identified cases of adverse events were assessed by two
medical officers.
Results: This is the largest analysis of long-term safety of perhexiline. Baseline clinical
characteristics are summarised in Table 1. Median duration of treatment was 53 months
(IQR: 27-96). Each patient had 62  21.96% (SD) of all their perhexiline assays within the
therapeutic range, 28  22.29% (SD) of levels were subtherapeutic, and only 10  14.28%
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
(SD) were supratherapeutic. However, only 32% of patients had 3-monthly monitoring.
51% of patients had 3-6 monthly monitoring, and 17% had less than 6-monthly moni-
toring. 29 (30%) of patients developed transient or prolonged hepatic function abnor-
malities during treatment, none of which was attributed to perhexiline as a probable cause.
In two (2%) cases new onset of peripheral neuropathy was noted. Perhexiline was sus-
pected to be a probable cause and details of the cases are summarized in Table 2.
Conclusion:
 The incidence of long-term toxicity with perhexiline in this cohort is low
(approximately 0.4 cases per 100 patient-years).
 Toxicity in these cases was relatively mild.
 Relatively few patients had elevation of plasma perhexiline levels beyond the
therapeutic range.
Disclosure of Interest: None Declared
PM483
Sensitivity And Specificity Of A Five Minute Cognitive Screen In Heart Failure
Patients
1 2 3 1 4
Jan Cameron* , Robyn Gallagher , Susan J. Pressler , Chantal F. Ski , Anne Sullivan ,
Rhonda Burke4, Susan Hales4, Geoffrey Tofler4, David R. Thompson1
1
Cardiovascular Research Centre, Australian Catholic University, Melbourne, 2Faculty of
Nursing, Midwifery and Health, University of Technology, Sydney, Australia, 3School of Nursing,
Ann Arbor, University of Michigan, Michigan, United States, 4Royal North Shore MACARF
program, Sydney, Australia
Introduction: Cognitive dysfunction is exhibited in 24% to 70% of heart failure (HF)
patients. A five minute protocol has been recommended by the National Institute of
Neurological Disorders and Stroke and the Canadian Stroke Network to screen for vascular
cognitive impairment, but this has not been evaluated in HF populations.
Objectives: To examine whether the three recommended items from the Montreal
Cognitive Assessment (MoCA) had adequate sensitivity (>85%) and specificity (70%) to
be recommend as a five minute screen in detecting possible cognitive dysfunction and need
for further evaluation in HF patients.
Methods: Data analysis of MoCA administered to HF patients enrolled in two disease
management programs. Scores <26 on the MoCA characterised cognitive dysfunction. The
recommended five minute screen uses three MoCA items (verbal fluency, delayed recall
and orientation) with possible scores of 1 to 12 (lower scores indicate poorer cognitive
function). Receiver operator characteristics (ROC) were constructed with MoCA <26 as the
positive test, to determine the sensitivity and specificity and appropriate cut-score of the
five minute cognitive screen.
Results: The sample (n¼221) had a mean age of 76 (SD 12.3) years with 98 (44%) females
and 110 (48%) NYHA class III. The mean MoCA was 24.2 (SD 3.5) and 134 (61%) patients
were identified as having possible cognitive dysfunction. Actual scores on the five minute
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
screen ranged from 3 to 11 (x̅ 8.56, SD 1.8) and as expected were strongly correlated with
POSTER ABSTRACTS
overall MoCA score (r¼0.72, p<0.001) and MoCA cut-off score <26 (r¼0.63, p<0.01). A
cut-off score 9 on the 5-minute cognitive screen provided 89% sensitivity and 70%
specificity, and the area under the ROC curve was good (0.88, p<0.01, 95% CI 0.83 to
0.92).
Conclusion: Using a cut-off score 9, the three recommended items from the MoCA
(verbal fluency, delayed recall and orientation) had adequate sensitivity and specificity to be
used as a five minute screen to detect possible cognitive dysfunction in HF patients.
Disclosure of Interest: None Declared
PM484
Incidence of delirium in octogenarian patients undergoing surgical aortic valve
replacement or transcatether aortic valve replacement
Leslie S. P. Eide*1, Anette H. Ranhoff1,2, Bengt Fridlund3, Rune Haaverstad4,5,
Karl O. Hufthammer6, Karel Kuiper4, Jan E. Nordrehaug1,4, Tone M. Norekvål1,4
1
Department of Clinical Science, University of Bergen, 2Kavli Research Center for Ageing and
Dementia, Bergen, Norway, 3School for Health Sciences, Jönköping University, Jönköping,
Sweden, 4Department of Heart Disease, Haukeland University Hospital, 5Department of Surgical
Sciences, University of Bergen, 6Centre for Clinical Research, Haukeland University Hospital,
Bergen, Norway
Introduction: Transcatether aortic valve intervention (TAVI) is an option to high-risk
patients unsuitable for conventional surgical aortic valve replacement (SAVR). Older pa-
tients are prone to develop delirium while being treated in hospital settings. Delirium, an
acute confusional state characterized by inattention, disorganized thinking and altered
consciousness, is associated with short- and long-term adverse outcomes. Studies on oc-
togenarians are scarce, and delirium has not previously been studied among TAVI patients.
Objectives: The aim of this study was to determine the incidence of postoperative delirium
(PD) among patients 80+ undergoing SAVR or TAVI.
Methods: Patients were included in “Octogenarians undergoing cardiac surgery or
intervention- CARDELIR”. The CARDELIR study is a prospective cohort study of
patients undergoing elective TAVI or SAVR in an 1100-bed university hospital in
western Norway. Inclusion criteria: severe aortic stenosis, accepted for TAVI or SAVR
and age 80+. Exclusion criteria: inability to speak Norwegian and denied consent to
join the study. The presence of PD was assessed daily, from the first to the fifth
postoperative day, using the Confusion Assessment Method (CAM), a valid and reli-
able instrument based on criteria from the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV).
Results: Between 2011 and 2013, 144 consecutive patients were included of which 44%
underwent TAVI. TAVI patients were older (85 years [SD 2.8] vs. 83 years [SD 2.1];
p<0.001); more often female (63% vs. 50%; p ¼ 0.12); had more comorbidities (3.3 [SD
2.5] vs. 2.1. [SD 1.8]; p ¼ 0.003); and a preoperative maximal aortic pressure gradient of
73.8 mm Hg (SD 21.6) vs. 84 mm Hg (SD 25); p ¼ 0.024.
PD was present at least once in 60% of the total sample. In the TAVI group, 49% of
patients developed delirium compared to 68% of those treated with SAVR (p¼0.04). The
average number of days with PD was 1.25 for TAVI patients vs. 1.49 for SAVR.
Conclusion: A high incidence of delirium was present among octogenarians undergoing
TAVI and SAVR but it was lower among those treated with TAVI. Further research is
needed to establish risk factors that might affect PD, and to suggest preventive strategies.
Disclosure of Interest: None Declared
PM485
Training effect on the recovery of the kinetics of oxygen, in patients with low ejection
fraction
Hermes L. Ilarraza*1, Garcia S. Marianna1, Castaneda L. Javier1, Bueno Leopoldo1,
Jorge V. Lara1, Rafael D. Chavez2, Carlos-Felipe R. Barrera3, Maria Dolores S. Rius1,
Maria Esther O. Franco1
1
Cardiac Rehabilitation, 2Epidemiology, National Institute of Cardiology Ignacio Chavez, Mexico
City, 3Cardiology, Hospital La Concepcion, Saltillo, Mexico
Introduction: Heart failure (HF) is the final common pathway of most heart disease and a
major cause of death and disability for humans. Physical training (PT) has been shown to
increase exercise tolerance and survival in these patients. On the other hand, patient’s
exercise behavior, during the recovery period of cardiopulmonary exercise testing (CPX),
has a prognostic value in the medium and long term.
Objectives: The study objective was to evaluate the effect of a PT program on the recovery
of oxygen kinetics.
Methods: We evaluated a cohort of patients with chronic HF admitted to an outpatient
cardiac rehabilitation program. All patients met a PT program during 4 weeks, which
included 30 minutes of moderate-intensity resistance exercise using a cycle ergometer, five
days a week, supplemented by a program of kinesiotherapy and control of cardiovascular
risk factors. All patients underwent a symptom-limited CPX before and after the PT pro-
gram. Results are shown as mean (SD) and frequency (%). Differences were assessed using
the Chi2 test, Student’s t test and Wilcoxon rank-test, as needed. All p value <0.05 were
considered stochastically significant.
Results: We evaluated 213 patients, 84% were men, mean age 5412 years and a LVEF
of 339%. The most prevalent underlying diseases were coronary artery disease (73%),
dilated cardiomyopathy (17%) and valvular heart disease (7%). After 4 weeks of PT,
treadmill exercise-time increased from 5.81.6 to 6.71.6 minutes (p<0.001) and peak
oxygen consumption rose from 19.76 to 21.77 mlO2/kg/min, (p<0.001). Recovery
time of the oxygen kinetics decreased from 265102 to 24077 seconds (p<0.05).
e161
 Conclusion: Patients with chronic heart failure improve after an PT program, both in peak
POSTER ABSTRACTS
oxygen consumption as in the recovery time of the kinetics of oxygen.
Disclosure of Interest: None Declared
PM486
Socio-demographic correlates of disease-related knowledge in cardiac rehabilitation
participants in Toronto, Canada
Raquel Britto*1, Gabriela L. M. Ghisi2, Nickan Motamedi3, Sherry Grace3
1
Physical therapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil,
2
Faculty of Kinesiology and Physical Education, University of Toronto, 3School of Kinesiology and
Health Science, York University, Toronto, Canada
Introduction: Patient education is a core component of cardiac rehabilitation (CR). The
goal of patient education is to promote patient understanding of their disease and man-
agement. Research shows that knowledge is necessary for patients to engage in risk-
reduction behaviors, and hence prolong their life. However, patient education in CR is only
scantly investigated.
Objectives: (1) to assess cardiac patients’disease-related knowledge pre- and post-CR; and,
(2) to investigate socio-demographic correlates of this knowledge.
Methods: As part of an ongoing program evaluation at 3 CR programs, new patients
completed an online survey consisted of socio-demographic items and the Coronary Artery
Disease Education Questionnaire (CADE-Q). Patients are emailed a similar survey 6
months later. The CADE-Q is a psychometrically-validated scale composed of 19 multiple-
choice items, which assess cardiac patients’ knowledge in 4 areas.The maximum score is
57, with higher scores indicating greater knowledge. Education was offered by each pro-
gram, in individual and group format, either at the beginning and end of the program, or
on a weekly basis. Spearman’s correlation, Mann-Whitney U, Wilcoxon and ANOVA tests
were computed, as applicable.
Results: CADE-Q was completed by 144 patients (n¼43,39% female;mean
age¼66.39.7; n¼86,60% with college degree or higher). Pre-CR mean total knowl-
edge scores were similar among those who completed (41.36.9) and did not
completed CR (38.77.6; p>.05). However, post-CR scores were significantly higher
among those who completed CR (41.15.8 vs 35.78.8; p¼.004). There was no
change in patients’ knowledge in any area over time (p>.05). Greater pre- and post-CR
knowledge was significantly associated with greater education and English-language
proficiency, being married, and lower age. Knowledge was unrelated to sex, ethnicity,
and work status.
Conclusion: Patients initiating CR had high knowledge regarding their disease. This may
be due to inpatient education pre-CR, as well as early CR education (i.e. during intake).
These findings suggest that patients are receiving high-quality education that results in a
high degree of knowledge which is sustained over the course of the 6 month program, or
that patients who gain access to CR are more educated. Those who did not completed CR
had similar scores to a middle-income country sample, as reported previously. Better
design of educational programming should be considered for patients who have less formal
education and limited English-language proficiency.
Disclosure of Interest: None Declared
PM487
Impact of Motivational Posters on Improving Attitudes to Stair Climbing Among
Students
1 1 1 1,2
Charmie Vora , Abraham S. Babu* , Sundar K. Veluswamy , Arun G. Maiya
1
Department of Physiotherapy, 2Dr. TMA Pai Endowment Chair in Exercise Science and Health
Promotion, School of Allied Health Sciences, Manipal University, Manipal, India
Introduction: Physical inactivity is an established non-communicable disease risk factor.
Stair climbing is a vigorous-intensity physical activity (PA) which is commonly used as part
of PA promotion strategies. Nevertheless, stair climbing as PA is grossly under-utilized and
the impact of methods to promote it among students has been under-reported.
Objectives: To understand the effects of motivational posters on improving attitudes to-
wards stair climbing.
Methods: Using a repeat cross-sectional design, 62 randomly chosen students from an
Allied Health Sciences college in South India participated in baseline evaluations of atti-
tudes towards stair climbing and awareness of its benefits. The college building has four
floors, connected through an elevator and a staircase with 96 steps around it. All the 618
students, of the college were divided according to the floor their department was situated
and a minimum of 10% of each floor’s student strength were recruited for this preliminary
study. Motivational posters sporting the “Ms. Fitness Freak” mascot, were placed in stra-
tegic locations for a period of six months. Following this, a randomly chosen group of
students (n¼58) were assessed to determine if the posters had an impact on their attitudes
and awareness regarding benefits of stair climbing. A sub-group of 30 participants
answered questions related to their views on the posters.
Results: From the initial assessment, 35.5% of the 62 students (mean age 202.1yrs)
preferred using the elevator to ascend while 24.2% preferred using the stairs. After six
months, it was seen that among 58 students, 34.4% preferred using the stairs for health
benefits. Students reported benefits of stair climbing in terms of improved fitness (51/58,
87.9%) and reduction in weight (25/58, 43.1%) which was much higher than the benefits
reported prior to the display of the posters (35/68, 51.4% and 20/68, 29.4% respectively).
A semi-structured interview of 30 random participants revealed that the posters provided
new information (24/30) and were motivating (26/30).
Conclusion: The use of motivational posters improved students’ attitudes toward stair
climbing in a positive manner while also improving awareness on the benefits of stair
e162
climbing. However, more research is required in various settings to understand how
motivational posters will directly influence objective measurement of PA.
Disclosure of Interest: None Declared
PM488
Challenges and opportunities in applying a “traffic light” approach to risk profiling in
secondary prevention: The Green Amber Red Delineation of rIsk And Need
(GARDIAN) in action
Simon Stewart*1, Melinda Carrington1, Yih-Kai Chan1, on behalf of the Young @ Heart Study
Investigators
1
Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Introduction: With a sustained burden of chronic heart disease in our ageing populations
there is urgent need to optimise secondary prevention of heart disease.
Objectives: To determine the potential benefits of applying an innovative traffic light
system, the Green Amber Red Delineation of rIsk And Need (GARDIAN), to guide the
management of hospitalised patients with heart disease.
Methods: Multicentre, randomised trial involving privately insured, hospitalised cardiac
patients (n¼602; aged 45 years). A total of 293 subjects randomised into the study
intervention received a post-discharge home visit (7-14 days post discharge) by a cardiac
nurse and were classified according to GARDIAN criteria that assesses 3 key criteria
(clinical stability, gold-standard management and holistic profile). Secondary prevention
and follow-up was then titrated accordingly. We examined subsequent event-free survival
from all-cause mortality and hospital readmission during 31.5  7.5 months follow-up
according to GARDIAN status.
Results: Mean age was 7010 years, 70% were male and the most (59%) had coronary
artery disease (39% underwent coronary revascularisation). Overall, 49 (16.7%), 204
(69.6%) and 40 (13.7%) patients were designated as low (green), medium (amber) and
high (red – due to clinical instability) risk of a secondary event or disease progression.
Intensity of post-discharge management was applied accordingly. The figure below shows
that the prospectively applied GARDIAN system successfully predicted different disease
trajectories on an adjusted basis.
web 3C=FPO
Conclusion: GARDIAN appears to accurately predict outcomes in recently hospitalised
patients with heart disease. Given mixed outcomes (relative to usual care) in men and
women in this trial the challenge will be cost-effectively utilising GARDIAN profiling.
Disclosure of Interest: None Declared
PM489
Non-physician led exercise stress testing is a feasible and effective practice in low to
intermediate risk patients with chest pain
Joel A. Archbald*1, Harley T. Cross1, Kate Sanford1, Alice McDonald1, Katie Williams1,
Scott Hughes1, William A. Parsonage1,2, Adam C. Scott1,3
1
Cardiology, Royal Brisbane and Women’s Hospital, 2School of Medicine, University of
Queensland, 3Faculty of Health, Queensland University of Technology, Brisbane, Australia
Introduction: Exercise stress testing (EST) is a non-invasive procedure that provides
diagnostic and prognostic information for the evaluation of several pathologies,
including arrhythmia provocation, assessment of exercise capacity and coronary heart
disease. Historically, ESTs were directly supervised by physicians; however, cost-
containment issues and time constraints on physicians have encouraged the use of
health professionals with specific training and experience to supervise selected exercise
stress tests. Evidence suggests that non-physician led exercise stress testing is a safe
and effective practice with similar morbidity and mortality rates as those performed or
supervised by a physician.
Objectives: Demonstrate that appropriately trained Cardiac Scientists can perform and
supervise exercise stress testing, following CSANZ guidelines, without a physician directly
present in the testing room.
Methods: An evidence based training manual was developed and implemented whereby
competently trained Cardiac Scientists performed non-physician led ESTs. Low/interme-
diate risk patients who were deemed as appropriate from a Chest Pain Management
pathway were referred for same day EST. All tests were reported by a Cardiology Advanced
Trainee Registrar who was in the immediate vicinity and available for any emergencies that
arose.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: Over a 2 month period, 102 patients (63 Males: age: 48.69.9 years; 39 participants 58 years vs. 64 years, p¼0.005), poor aerobic capacity (mean 6MWT

Females: age: 52.79.9 years) performed a single non-physician led EST. Overall; 5 of
the patients were deemed positive (4.91%), 89 negative (87.25%) and 8 equivocal
(7.84%). Patients with a positive or equivocal test result were followed up with further
testing using either coronary angiography, computed tomography coronary angiogram
or stress echocardiogram. All 5 positives tests were false positives and the equivocal
tests were all deemed negative after further testing or were as a result of a sub-maximal
test (poor exercise tolerance). All patients were able to be returned to the Emergency
Department, as per the Chest Pain Pathway, for further management in regards to their
outcome.
Conclusion: The study provides supporting evidence to the existing literature that in-
dicates non-physician led EST is a feasible practice when performed by properly trained
health professionals.
Disclosure of Interest: None Declared
PM491
Identifying those at risk of depression: Development of the Depression Risk
Assessment Questionnaire
1 2 3 4
Jo N. Crittenden* , Gavin Leslie , Patricia M. Davidson , Sean D. Hood , Peter L. Thompson
1 Centre for Chronic Disease Control, 2CoE-CARRS, Public Health Foundation of India, New
Cardiovascular Medicine, Sir Charles Gairdner Hospital, 2School of Nursing, Curtin University,
Perth, WA, Australia, 3School of Nursing, Johns Hopkins University, Balitmore, United States,
4 Tropical Medicine, London, United Kingdom, 4Endocrinology & Metabolism, All India Institute of
Dept of Psychiatry, 5Heart Research Insititute, Sir Charles Gairdner Hospital, Perth, WA,
Australia
Introduction: Depression is an important comorbid diagnosis in Acute Coronary Syn-
drome (ACS) that confers an increased risk of mortality, disability and a reduced health
related quality of life. Early detection of depression risk maybe helpful in ameliorating the
development of depression in ACS patients.
Objectives: This research project aimed to develop a brief depression risk assessment
instrument for use by nurses in the acute clinical setting.
Methods: The Depression Risk Assessment Questionnaire (DRAQ) was developed using a
four step approach. 1. Literature were searched for studies identifying risk factors for
depression in ACS samples then graded for quality of evidence using the Oxford Centre
for Evidence-based Medicine approach. The evidence review provided the basis for the
draft DRAQ. 2. Comprehensiveness and content validity of the DRAQ was assessed by a
panel of eight experts and items retained or removed using a Content Validity Index
score. 3. The refined DRAQ was tested for internal consistency, reliability and temporal
stability in a sample of 220 ACS patients admitted to a coronary care unit. 4. Qualitative
acceptability of the DRAQ as a clinical assessment was established in a small survey of
study participants.
Results: Thirteen risk factors were initially identified as highly relevant to developing
depression from the literature. The structure, layout and choice of question type were
influenced by the need for a high level of clinical utility. Following assessment of the
comprehensiveness and content validity, nine questions were retained. The internal con-
sistency of the DRAQ was calculated using the Cronbach’s coefficient alpha based on raw
(0.71) and standardized (0.68) variables. Temporal stability was assessed using the kappa
statistic with results indicating ‘fair agreement’ (0.47) to ‘excellent agreement’ (1.00). Eleven
patient participants reviewed the acceptability of the DRAQ and reported questions were
clear, relevant and appropriate.
Conclusion: This project has developed a preliminary tool with acceptable psychometric
properties which could be used by nurses to help screen for the potential development of
depression amongst ACS patients and then refer to post discharge services. This creates
opportunities to explore preventive therapies rather than observing for the onset of
depression and then treating the disease.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
338m vs. 380m, p¼0.016), and greater functional impairment (59% of depressed
participants NYHA class III/IV vs. 23% non-depressed, p¼0.001). Of those depressed
at baseline, only 11/74 (14.9%) received antidepressant medication. Higher ejection
fraction (mean ejection fraction of patients prescribed antidepressant medication 42.3
 17.5 vs. 29.2  13.4, p¼0.006) and recent falls (5/11 medically treated patients vs.
9/63, p¼0.03) were associated with increased likelihood of receiving antidepressant
treatment.
Conclusion: This data suggests that the prevalence of depression remains high in HF
patients, and is still under-treated. Better identification of patients at risk and improved
strategies for early treatment are needed.
Disclosure of Interest: None Declared
PM493
Development of a smartphone-based decision support system (DSS) to facilitate
evidence based hypertension management at primary health care facilities in India:
The mPower Heart DSS
Ajay S. Vamadevan*1,2,3, Devraj Jindal1, Nikhil Tandon4, Sanjay Kinra3,
5 Dorairaj Prabhakaran1,2
1
Delhi, India, 3Dept. of Non-communicable Disease Epidemiology, London School of Hygiene &
Medical Sciences, New Delhi, India
Introduction: Hypertension affects more than 140 million adults in India. However,
inadequate use of evidence based guidelines for opportunistic screening and management
of hypertension is a barrier at primary care setting that result in high burden of undiag-
nosed and undertreated hypertension in India.
Objectives:
1. To develop a smartphone based decision support system (DSS) for the use of
healthcare team at primary care setting for the management of hypertension in
India.
2. To assess the feasibility the smartphone-based DSS for hypertension management
at primary care setting in India.
Methods: The design and feasibility assessment of the DSS was carried out in five
Community Health Centers (CHCs) in the Indian state of Himachal Pradesh using mixed
methods in four iterative steps: 1) literature review and expert consultation; 2) needs
assessment; 3) adapting the clinical management guideline to local context; and 4)
piloting the DSS to assess its feasibility. In-depth interviews with the healthcare team
members and non-participant observation was adopted to assess the feasibility of the
innovation.
Results: Based on the inputs from literature review, and needs assessment carried out at
five CHCs, an adapted version of the hypertension management guideline recommended
by the Government of India was converted into a DSS having four features: 1) computation
of personalized management plan based on patient parameters; 2) capability to synchronize
with a central database; 3) search capability to find details of previous visits of patient
records during follow-up visits; and 4) security features to prevent unauthorized access to
patient data. The accuracy of the treatment plan generated by the prototype DSS, which
had 37 elements, was tested by two researchers using all clinical scenarios possible. The full
version DSS was then piloted for its feasibility, which due to high number of data elements
was found to be chocking the patient flow. Subsequently, through expert consultation and
user-testing feedback, DSS version 2 with 23 data elements was deployed which underwent
seven more minor iterations to suit the local context with high acceptance from the
healthcare team (Image).

PM492
Are We Still Under Treating Depression In Heart Failure?
Todd Moller*1, Jessica M. Suna2, Alison M. Mudge2,3, Jeff S. Coombes1, Adam C. Scott3,4,5
1
School of Human Movement Studies, University of Queensland, 2Internal Medicine Research
Unit, Royal Brisbane and Women’s Hospital, 3School of Public Health, Queensland University of
Technology, 4Cardiology, Royal Brisbane and Women’s Hospital, 5White Cloud Foundation,
Brisbane, Australia

Introduction: The prevalence of co-morbid depression in the heart failure (HF) population
is high, and its presence leads to poorer health outcomes. Recent evidence supports the
web 3C=FPO

safety and efficacy of antidepressant drugs, but previous studies have shown gaps in
recognition and treatment of depression in HF.
Objectives: This study aimed to assess the prevalence and treatment of depression in a HF
sample, and describe patient characteristics of those with depression and those being
medically treated for it.
Methods: This investigation represented a sub-study of consecutive participants enrolled in
a clinical trial of exercise training for recently hospitalised HF patients. Depression was
defined as Geriatric Depression Scale >6. Antidepressant drugs, demographic and clinical
data were obtained from the clinical chart, patient interview and clinical assessments within
6 weeks of hospital discharge. Conclusion: A smartphone based DSS for hypertension is feasible for use at primary care
Results: Prevalence of depression was 74/207 (35.7%). Patient characteristics signifi- facilities in India.
cantly associated with depression included younger age (mean age in depressed Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e163

 PT001 p< 0.01) and time to peak systolic blood pressure (BL 369 [350-404]ms, RVA 408 [391-
POSTER ABSTRACTS

443]ms, RVOT 433 [395-455]ms p <0.001). Compared to baseline, RVA pacing demon-
Incidence Of Subclavian Vein Obstruction Following Device Implantation strated significant increases in arterial BNP (32.6 [18.8-69.7] vs 39.6 [20.2-74.1]ng/L,
p¼<0.001), venous NT pro-BNP (76.9 [46.2-126.9] vs 80.3 [50.2-127.7]ng/L, p¼0.048)
Rocio Picon*1, Manuel Gonzalez2, Juan Leal del Ojo2, Dolores Garcia2, Ana Garcia2, and arterial hs-TnT (see Fig 1). RVOT pacing compared to baseline demonstrated significant
Alicia Asian2, Ma Jose Romero2, Maria Mera2, Carlos Arias1, Raquel Guerola2, Luis Pastor1 increases in arterial BNP (37 [18.4-56.4] vs 40.5 [21.2-75.8]ng/L, p¼<0.001) and NT pro-
1
Cardiology, 2Hospital Universitario Virgen De Valme, Seville, Spain BNP (73.4 [41.7-129.6] vs 76.5 [49.3-140.8]ng/L, p¼<0.001) and venous, arterial and
coronary sinus hs-TnT (refer to Fig 2). There was no significant difference between RVA and
Introduction: The data about the incidence of subclavian venous (SCV) obstruction or RVOT pacing in hemodynamic, hormonal and biochemical responses.
thrombosis after transvenous device implantation is limited and it is rare following im-
mediate period after the implantation. However, when it is neccesary to substitute defected
leads or improve the funcional status by making a device upgrade, the presence of
obstruction or severe stenosis can make the intervention difficult, forcing to use the
opposite side to implant the new device.
Objectives: We aimed to assess the incidence of venous obstruction or severe stenosis and its
tortuosity after a pacemaker or ICD implantation in our population. We obtained an iodinated
contrast venography study just before the elective device
s replacement due to battery discharge.
Methods: A contrast venography was performed in 26 patients who were candidates to
elective generator change due to battery discharge. 16 p (64%) were men, the main age was
77
11 years; 13p (50%) had Chronic Heart Failure and in 18p (72%) Ischemic cardiomy-
opathy was diagnosed. The mean period between the first implant and device
s replacement
was 9,3
3,4 years. 17p (68%) had Diabetes Mellitus, 15p (60%) were Hypercholesterolemic,
9p (36%) were smokers and 11p (44%) were had systemic arterial hypertension.
Results: The initial indication to implantation the device was AuriculoVentricular block in
11p (42%), sinus node dysfunction in 8p (32%), resynchronization therapy with or without
ICD in 5p (20%), and prevention of sudden death without resynchronization therapy in
1p(4%). The generator was DDD in 11p (44%), VDD in 2p (8%), VVI in 6p (24%)%, CRT in
4p (16%), and CRT-ICD in 2p (8%). The Right Ventricular lead was implanted in the outflow
tract in 14p (56%) and in 11p(44%) the site was the right ventricular apex. In 100% of the
patients the leads were implanted through the Left Subclavian Vein. Venous severe stenosis
or obstruction was observed with venographic study in 4p (16%) and tortuosity in 2p(8%).
We didn
t find any predictor of severe stenosis or obstruction of the access veins.
Conclusion: Severe stenosis, obstruction or tortuosity of the access veins after a pacemaker Conclusion: Right ventricular based pacing strategies demonstrated increases in filling
or ICD implantation make difficult futures upgrades and leads change. The process can be pressures and elevated serum levels of BNP, NT pro-BNP and hs-TnT above baseline with
facilitated by means of doing a previous venography. In our population it is unusual in an very short durations of pacing (10 minutes). There was no difference in response between
intermediate-long term period RVOT and RVA sites. These findings imply very short periods of asynchronous right
Disclosure of Interest: None Declared ventricular pacing are potentially deleterious.
Disclosure of Interest: None Declared
PT002
Comparison of invasive haemodynamics, Brain Natriuretic Peptide and high PT003
sensitivity Troponin T levels with right ventricular apical and right ventricular
outflow tract pacing in normal hearts Pulmonary vein isolation: the impact of pulmonary venous anatomy on long term
outcome of catheter ablation for paroxysmal atrial fibrillation
1,2 2 1,2 2 2
Paul Gould , Kevin Ng , Yohan Chacko* , Sanja Doneva , Andrew Claughton ,
Korczyk Dariusz2, Goce Dimeski1,3 Alex J. Mclellan*1,2, Liang-han Ling1, Michael C. Wong2,3, Tomos E. Walters2,3, Ashley Nisbet2,
1
University of Queensland, 2Cardiology, 3Biochemistry, Princess Alexandra Hospital, Brisbane, Anoop K. Shetty2, Andrew J. Taylor1, Joseph B. Morton2, Jonathan M. Kalman2, Peter M. Kistler1
Australia 1
The Alfred Hospital/ Baker IDI, 2Royal Melbourne Hospital, 3The Alfred Hospital, Melbourne,
Introduction: Right ventricular apical (RVA) based pacing is the main stay of ventricular Australia
pacing, however it has been associated with deleterious effects on the ventricle and increased
morbidity and possibly mortality. The mechanism and duration required is unknown. Introduction: Circumferential pulmonary vein isolation is the cornerstone of catheter
Alternative pacing strategies including right ventricular outflow tract (RVOT) pacing are ablation for atrial fibrillation (AF) however pulmonary vein (PV) reconnection remains
being investigated with some supportive clinical data that it has benefits over RVA pacing. problematic.
Objectives: To determine the acute haemodynamic, biochemical and horomonal response Objectives: We assessed the impact of PV anatomy on the outcome of catheter ablation for
to right ventricular pacing; comparing RVOT and RVA pacing in structurally normal hearts. paroxysmal AF.
Methods: In 21 patients with structurally normal hearts and renal function undergoing Methods: 102 patients with paroxysmal AF underwent CMR (60%) or CT (40%) prior to
electrophysiology studies +/- ablation for supraventricular tachycardia, the acute invasive pulmonary vein isolation. PV anatomy was classified according to: presence of common
cardiac hemodynamic response, levels of Brain Natriuretic Peptide (BNP), N-Terminal PVs; accessory PVs; PV branching pattern; and the dimensions of the PV ostia, intervenous
Brain Natriuretic Peptide (NT-proBNP) and high sensitivity Troponin T (hs-TnT) to 10 ridges (IVR) and the left atrial appendage (LAA)-left PV ridge.
minutes of either RVOT or RVA asynchronous pacing was assessed in a randomised Results: Four discrete PVs were present in 47% of patients, a left common PV in 37%, a
crossover fashion and compared to baseline and each other. right common PV in 2% and an accessory right PV in 20% and left PV in 4%. At 12
4
Results: Compared to baseline (BL), both pacing sites showed a significant rise in pulmonary months follow-up 75 of 102 (74%) patients were free of recurrent AF. The presence of a left
capillary wedge pressure (BL 9 +/-3mmHg, RVA 13 +/-5mmHg, RVOT 12 +/-4mmHg, p < common PV was associated with an increase in freedom from AF (87% vs. 66% for 4 PV
0.001), increase in QRS width (BL 90 +/-19ms, RVA 149+/-16ms, RVOT 146+/-15ms, anatomy; p¼0.03). Greater left IVR length (16.9
3.5mm vs. 14.0
3.0mm; p¼<0.001)
and width (1.4
0.6mm vs. 1.1
0.6mm; p¼0.02) were associated with increased AF
recurrence. On multivariate analysis abnormal anatomy (left common PV or accessory PV)
and left IVR length were the only independent predictors of freedom from AF.
Conclusion: Four discrete pulmonary veins are present in the minority of patients with
paroxysmal AF undergoing PVI. The presence of a left common PV is associated with an
increased freedom from AF following catheter ablation. Pulmonary vein anatomy may in part
explain the variable long term outcome to electrical isolation in patients with paroxysmal AF.
Disclosure of Interest: None Declared

PT004
Initial Clinical Experience and Follow-up of Patients Undergoing Shannon Entropy
(ShEn) Ablation as a Guide to Localisation of Rotors in Atrial Fibrillation
Anand Ganesan*1, Pawel Kuklik1, Lauren Wilson1, Rajiv Mahajan1, Darragh Twomey1,
Dennis Lau1, Prashanthan Sanders1
1
Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
Introduction: Localised rotors are postulated as the drivers of atrial fibrillation (AF).
Targeted ablation of rotors mapped with basket catheters has been suggested as a strategy
with improved clinical outcomes compared to pulmonary vein isolation. In recent

e164 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

theoretical and experimental studies, our group has shown that high bipolar electrogram
Shannon entropy (ShEn) distinguishes the pivot and periphery of rotors. We hypothesised
that ablation directed towards regions of high ShEn could slow or terminate AF.
Objectives: The aim was to determine if directed ablation of regions of high ShEn would
slow or terminate human persistent AF.
Methods: The study enrolled 9 patients undergoing persistent AF ablation. (Left atrial
diameter 45
6mm, LV ejection fraction 52
5%). Patients in spontaneous or induced AF
were mapped with a 20-pole PentaRay catheter and NavX system. 8-second recordings of
each mapped point were acquired, with endocardial contact verified by fluosocopy at each
site. After mapping, mapped point electrophysiologic data and location data were exported
to a PC where Shannon entropy (ShEn) was calculated for each mapped point. Points were
ranked by entropy value, and colour-coded ShEn maps constructed. The top 10% of ShEn
points were annotated on to the NavX map, and used to guide selection of regions for
ablation. Ablation of pre-identified ShEn regions was performed after pulmonary vein
antral isolation without CFAE or linear ablation. The study endpoints were: (i) AF cycle
length change; and (ii) AF termination.
Results: Mapping was able to be performed in all cases, with 621
26 points/pt acquired.
AF termination occurred in 6/9 cases, with 3/9 cases requiring cardioversion. 5/9 cases
showed AF termination co-localised with pre-specified regions of ShEn. In 3 of these cases,
termination occurred at pre-specified regions of ShEn encountered during pulmonary vein
antral isolation. In 2 cases,termination occurred at ShEn sites outside the pulmonary vein
antra. Mean AFCL change post PV isolation was 11.8
13ms (p¼0.07), and AFCL change
post-ShEn ablation was 29.1
26ms (p¼0.02). 6/9 cases remained in sinus rhythm at
median follow-up 274
148 days . Sites of ShEn region termination included the base of LA
appendage, right anterior wall, roof, posterior wall, and left superior PV ridge.
Conclusion: The study demonstrates the feasibility of ablation of high ShEn regions,
associated with termination of AF and/or AF cycle length slowing in selected AF patients,
and requires further investigation in AF ablation.
Disclosure of Interest: None Declared
PT005
Presence of thrombus in left atrium in patients with atrium fibrillation anticoagulated
with coumarin anticoagulants versus dabigatran
Claudio Dizeo*1, Daniel Chirino Navarta1, Rolando Palacios1, Ariel Monteros1, Graciela Trejo1
1
cardiología, Unidad Asistencial Por Mas Salud Dr. César Milstein, Buenos Aires, Argentina
Introduction: Patients with atrial fibrillation (AF) and embolic risk benefit from anti-
coagulation. The presence of left atrium thrombus (LAT) is an important predictor of
stroke. Coumarin are the standard treatment. The dabigatram is a novel anticoagulant that
has proven useful in these patients.
Objectives: The aim of the study was to evaluate in elder patients with AF of resent
diagnosis in witch electrical cardioversion (ECV) was indicated, the presence of LAT after
anticoagulation with acenocumarol or dabigatran.
Methods: The study included patients older than 65 years with recent diagnosed of AF
with indication of scheduled ECV with CHADvasc score 2. Anticoagulant treatment was
initiated at least four weeks before ECV, and transesophageal echocardiogram (TEE) was
perform before ECV in all the patients. Anticoagulant treatment was assigned in a no-
randomized way, acenocumarol for a INR>2 or dabigatran 150 mg each 12 hours in
younger than 75 years and 110 mg each 12 hours in patients older to 75 years. Primary end
point was the presence of LAT on the TEE. Continuous variables were expressed as media

standard deviation, and the categorical ones as percentage. CHI2 and Test T student
were used to compare both groups. A p<0.05 was considered significant.
Results: Total of 69 patients older than 75
6 years were included, 42% were women, 40
treated with dabigatram and 29 with acenocumarol. No differences at age (74
5 vs 75
6),
hypertension (85% vs 67%), diabetes (17% vs 25%), heart failure (20% vs 18%), stroke
(0% vs 7%) and CHADSvasc score 4 (40% vs 50%). No difference at TEE of left atrial area
(27,2
5cm2 vs 27,5
4 cm2), left ventricular diastolic diameter (11,1
1,5mm vs
11,7
1,7mm), the patients included in dabigatran group show left appendix atrium speed
higher than acenocumarol group (0,41
0,16m/s vs 0,31
0,14 m/s; p¼0,008).
LAT was present at 7,5% (3 patients) of the dabigatran group and at 28,5% (8 patients)
of the coumarin anticoagulants group, Relative Risk ¼0, 26 (Confidence Interval 95% 0,07-
0,9; p¼0,02), Relative Risk Reduction of 73,7% (confidence interval 95% 9,6-92,3;
p¼0,02).
Conclusion: In elder patients with AF of resent diagnosis, treatment with dabigatran for at
least four weeks had a reduction of the risk of a LAT compare with coumarin anti-
coagulation treatment.
Disclosure of Interest: None Declared
PT006
Occurrence of poor sleep quality in atrial fibrillation patients according to EHRA
score
Filip M. Szymanski*1, Krzysztof J. Filipiak1, Anna E. Platek1, Grzegorz Karpinski1,
Anna Szymanska2, Grzegorz Opolski1
1
Cardiology Department, 2Department of Cardiology, Hypertension and Internal Diseases, The
Medical University of Warsaw, Warsaw, Poland
Introduction: Poor sleep is a factor negatively influencing not only performance during the
day, but also general quality of life, and health condition. Disturbances in sleep duration are
known to be associated with higher risk of cardiovascular disease.
Objectives: The aim of the study was to assess the prevalence of sleep quality disorders in
patients qualified for ablation for atrial fibrillation.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: We enrolled consecutive patients admitted to the cardiology department for
POSTER ABSTRACTS
ablation for atrial fibrillation. On the day prior to procedure all patients were asked to fill in
Pittsburg Sleep Quality Index (PSQI) questionnaire assessing sleep quality. Data concerning
anthropometrical features, comorbidities, cardiovascular risk factors, and symptoms
associated with atrial fibrillation were also collected. Basing on the PSQI score patients’
sleep quality was described as good or poor. All patients were followed to assess sleep
quality influence on short-term ablation efficacy, defined as sinus rhythm on discharge.
Results: Study population consisted of 177 patients (63.8% males, aged 55.9
10.3
years). Mean body mass index (BMI) was 29.7
4.7 kg/m2 and 8.5% of patients had
history of stroke. Poor sleep quality was present in 49.7% of patients. Patients with poor
sleep quality were less often male (53.4% vs. 74.2%; p¼0.007), were older (57.9
10.1 vs.
53.9
10.0 years; p¼0.005), and had higher systolic blood pressure (134.4
16.4 vs.
129.8
17.8 mmHg; p¼0.03) comparing to poor sleep quality patients. There were no
further differences between the groups, concerning baseline characteristics including his-
tory of hypertension, diabetes, or prior cardiovascular disease (p>0.05). When we divided
patients into subgroups according to severity of atrial fibrillation symptoms according to
the European Heart Rhythm Association (EHRA) score, we saw that poor sleep quality was
present in 33.3% EHRA I; 43.9% EHRA II, 58.1% EHRA III, and 61.5% EHRA IV patients
(p value for trend 0.01).
Conclusion: Sleep quality disturbances are highly present in patients qualified for ablation
for atrial fibrillation. Prevalence of poor sleep quality rises stepwise with the severity of atrial
fibrillation symptoms, and is the lowest in EHRA I patients, and the highest in EHRA IV.
Disclosure of Interest: None Declared
PT007
Screening Education And Recognition By Primary Care Physician Of Atrial
Fibrillation To Prevent Stroke (Search-Af Ii Stroke Prevention Study) And The Role of
General Practice Receptionists
Jessica Orchard*1,2, Saul Ben Freedman3,4,5, Nicole Lowres3,4,5, Lis Neubeck1,6
1
Cardiovascular, The George Institute for Global Health, 2School of Public Health, University of
Sydney, 3Cardiology Department, Concord Repatriation General Hospital, University of Sydney,
4
Anzac Research Institute, 5Sydney Medical School, 6Sydney Nursing School, University of
Sydney, Sydney, Australia
Introduction: Atrial fibrillation (AF) is often asymptomatic in people aged 65 years and
may remain undetected until the occurrence of stroke. Use of a previously validated single-
lead iPhone ECG (iECG) to detect unknown AF could make general practice-based
screening, conducted by receptionists, feasible for stroke prevention.
Objectives: This pilot study aims to determine the feasibility and acceptability of a primary care
screening program to identify people with undiagnosed AF in general practices. The secondary
aims of the study are (i) to assess the satisfaction of general practitioners (GPs), receptionists and
patients with the screening process; (ii) to raise AF awareness in the general public; and (iii) to
inform the design and refinement of a future large-scale implementation study.
Methods: Cross-sectional screening pilot study in three general practices. Receptionists
screened patients aged 65 years, using iECG (transmitted to secure website). GP review
was provided during the patient’s consultation together with a validated automated
interpretation. Semi-structured interviews were conducted with one doctor, one recep-
tionist and 2-3 patients from each practice. Interviews included open-ended questions
about barriers, enablers, practicalities and possible improvements to processes. Interviews
were transcribed verbatim and analysed using grounded theory.
Results: 73 participants were screened (51% male). Preliminary results from completed
interviews show that the iECG was well accepted and screening by receptionists in general
practice was feasible. Major enablers for screening were the ease of use of the iECG, a positive
feeling that the device represented cutting edge technology and GP engagement. Barriers to
screening were primarily the need to complete the written consent form, receptionist
workload / attitude and IT issues (e.g. workplace blocking access to website, flash player not
working), particularly in the corporate practice. Receptionists liked the device, the engage-
ment with patients and could see the benefits of screening in terms of enhanced GP care.
web 3C=FPO
Conclusion: This study demonstrates that it is feasible for general practice receptionists to
perform an iECG screen for AF that is subsequently reviewed by the GP. It has important im-
plications for how to successfully design and implement a larger scale future study, particularly
the need to streamline the screening process and reduce study paperwork if possible.
Disclosure of Interest: J. Orchard: None Declared, S. B. Freedman Grant/research support
from: Bayer, Boehringer Ingelheim, BMS/Pfizer, Honorarium from: Bayer, BMS/Pfizer,
Servier, Astra-Zeneca, N. Lowres: None Declared, L. Neubeck Grant/research support from:
Pfizer/BMS, Boehringer Ingelheim, Bayer
e165
 PT008
POSTER ABSTRACTS
The Role of an Integrated Nurse Led Service in the Management of Acute
Symptomatic Atrial Fibrillation
John D. Hung1, Muhammad Rashid*1, Hossam Elsayed1, Paula Dawson1, Paul Nugent1,
Paula McCarten-Twiss1, Homeyra Douglas1
1
Cardiology, Aintree University Hospital, Liverpool, United Kingdom
Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia managed by
emergency and acute physicians, with a wide variation in management practices.1,2 Early
specialist input in the management of AF improves patient outcomes.3
Objectives: The AF service was set up with 3 arrhythmia specialist nurses (ASNs) in 2011.
The aim of the service was to improve quality of care by standardising treatment,
streamlining patient care, and reducing hospital admissions for acute symptomatic AF.
Decisions regarding rate vs rhythm control and anticoagulation are undertaken on dis-
cussion with a cardiologist, and subsequent treatment regimes are as per the standardised
AF management pathways. All patients are reviewed by the ASNs within 48 hours of being
discharged from hospital, who oversee the entire patient journey.
Methods: Data was recorded for all patients referred to the AF service from 2011 to 2013.
Patients were followed up until the point of discharge.
Results: A total of 1020 patients aged 28 – 92 years old were referred to the service be-
tween 2011 and 2013. Thirty three percent of patients were seen and discharged on the
same day (n¼343). Of those who required admission (n¼677), 36% were discharged
within the first 48 hours (n¼246). The majority of patients were considered for a rate
control strategy and one third of patients were referred for direct current cardioversion
(DCCV). (See figure 1) The DCCV was performed by the same nurses.
There were no reported deaths or major adverse cardiac events (MACE). There were a
total of 12 patients (1%) readmitted within 2 weeks of discharge with unsettled, symp-
tomatic AF.
web 3C=FPO
Conclusion: An integrated nurse led service expedites early specialist input and streamlines
patient care by standardising treatment in acute symptomatic atrial fibrillation.
Disclosure of Interest: None Declared
PT009
Effect of preaortic fat pad removal on atrial fibrillation post off-pump coronary artery
bypass grafting (CABG): A randomized controlled trial
Neda Fotoohi1, Masoud Mirzaei*1, Mehdi Haddadzadeh2
1
Yazd Cardiovascular Research Centre, 2Department of Cardiac Surgery, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic Of
Introduction: An anterior periaortic fat pad (AFP) in human containing parasympathetic
ganglia has been described in the aorto-pulmonary window. Changes in the autonomic
nervous system (ANS) tone can lead to postoperative atrial fibrillation (POAF). The AFP is
usually removed during coronary bypass grafting (CABG) to fully expose the aortic root.
Objectives: The purpose of this study was to evaluate the effect of AFP removal during
CABG on the ANS tone, incidence of POAF, length of hospital stay in-hospital morbidity
and mortality.
Methods: In this double blind randomized controlled trial, a total of 184 patients who
were nominated for off pump CABG were randomized in to either removal (n ¼90) or
maintenance (n ¼94) of the AFP arms during their first CABG. All patients underwent
continuous telemetry monitoring after surgery. POAF was defined as fibrillation for more
than five minutes or fibrillation causing hemodynamic instability.
Results: The mean of participants was 60 years, and 69.6% were male. There was no
difference in the incidence of POAF between the retained and removed AFP arms (12.2%
Vs. 5.3% respectively; P ¼0.12). Length of -hospital stay, and postoperative morbidity and
mortality were similar in both arms, except for the bleeding incidence which was higher in
the retained AFP arm (P¼0.014).
Conclusions: Removal of AFP during CABG has no significant effect on the incidence of
POAF, other arrhythmia, and postoperative morbidity or mortality.
Disclosure of Interest: None Declared
e166
PT010
Predictors of asymptomatic atrial fibrillation in pacemaker patients
Nikola Bulj1, Vjekoslav Radelji
c1, Bogdan Radakovi
c1, Vedran Bursic*1
1
University Hospital Sisters of Mercy, Zagreb, Croatia
Introduction: The intention of this study was to investigate predictors of asymptomatic
atrial fibrillation occurrence in homogenous patients group with complete atrioventricular
block treated with pacemaker.
Objectives: We hypothesized that new risk factors for asymptomatic atrial fibrillation can
be identified analyzing atrial electrogram and that patients with lower atrial electrogram
amplitude and wider atrial signal are prone to develop asymptomatic atrial fibrillation. We
also hypothesized that patients prone to develop asymptomatic atrial fibrillation would
show higher level of natriuretic peptides at time of the pacemaker implantation.
Methods: In the enrollment period 194 patients with complete heart block and indication
for pacemaker implantation were hospitalized. All patients with known risk factors for
atrial fibrillation such as heart failure, heart cavity dilatation, structural heart disease, hy-
perthyroidisms were excluded. Dual chamber pacemaker was implanted in 141 cases while
single chamber pacemaker was implanted in 53 other. From 141 patients with dual
chamber pacemaker, 51 were excluded due exclusion criteria while 90 other were followed.
According to defined criteria in third month after pacemaker implantation 65 patients meat
asymptomatic atrial fibrillation criteria (cumulative AF time of more than 1 %). Same
criteria in 24th month after implantation meat 60 % of enrolled patients.
Results: History of hypertension was steady risk factor for asymptomatic atrial fibrillation in
third month after implantation (P¼0,036) and 24 month after implantation as well (P¼0,02).
Group of patients with asymptomatic atrial fibrillation had higher occurrence of atrial signal
width of more than 50 ms, but statistically insignificantly. On the other side patients with later
developed asymptomatic atrial fibrillation had higher occurrence of P wave width of more
than >100 ms (P<0,001). In this way standard electrocardiogram superiority over intacardial
recordings was shown. Patients with later developed asymptomatic atrial fibrillation had
significantly higher level of BNP at the time of implantation (P¼0,031). After the follow-up
period difference in mortality neither major cardiovascular events was not shown.
Conclusion: P wave width >100 ms in standard electrocardiogram and elevated levels of
BNP at the time of pacemaker implantation could identify pacemaker patients with
increased risk of developing asymptomatic atrial fibrillation
Disclosure of Interest: None Declared
PT011
NOX4 as a new biomaker of non-valvular atrial fibrillation
Tong Liu*1, Qingmiao Shao1, Panagiotis Korantzopoulos2, Hongmei Liu1, Enzhao Liu1,
Gang Xu1, Guangping Li1
1
Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China,
2
Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
Introduction: Recent evidence indicates that NADPH oxidases (NOX)-derived reactive
oxygen species (ROS) play a pivotal role in the development of atrial fibrillation (AF).
Objectives: We sought to investigate the potential association between serum levels of
NOX4, as well as inflammatory biomarkers, and AF.
Methods: We enrolled 108 patients with AF (71 with paroxysmal AF and 37 with persistent/
permanent AF) and 68 patients without AF as controls. Demographic, clinical, laboratory,
electrocardiographic and echocardiographic characteristics were carefully recorded.
Results: Serum levels of myeloperoxidase (MPO), hs-CRP and NOX4 were assessed. Left atrial
diameter (LAD), left ventricular end diastolic diameter (LVEDD) and P wave dispersion (PWD)
were significantly increased in patients with paroxysmal AF and persistent/permanent AF
compared with controls while NOX4 levels were significantly higher in patients with parox-
ysmal AF and persistent/permanent AF compared to controls (155.57
90, 155.88
64.79 vs
126.72
23.51pg/mL, respectively, P<0.05). A significant correlation between serum NOX4
levels and hs-CRP, and between NOX4 levels and MPO was also evident (r¼0.170; r¼0.227,
p<0.05, respectively). Multivariate analysis demonstrated that baseline serum NOX4 level was
independently associated with paroxysmal AF (OR: 1.014, 95% CI: 1.001-1.027, p<0.05) and
with persistent/permanent AF (OR: 1.022, 95% CI: 1.000-1.044, p<0.05).
Conclusion: There seems to be an association between increased NOX4 levels and AF, sug-
gesting NOX4 involvement in the pathophysiology of human AF. Further studies are needed to
elucidate its role in atrial remodeling and to examine its potential prognostic impact.
Disclosure of Interest: None Declared
PT012
ICD insertion confers reduced mortality and improved survival in patients with
Dilated Cardiomyopathy: Real-life data from Manchester, UK, 2000-2013
Rahul Potluri*1, Amir Aziz2, Haren E. Wijesinghe3, Nicholas Gollop4, Noman Ali2,
Hardeep Uppal5, Suresh Chandran6, Michael Coupe7
1
Acalm Study Unit in collaboration with School of Medical Sciences, Aston University,
Birmingham, 2Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds,
3
The Medical School, University of Birmingham, Birmingham, 4The Norfolk and Norwich
University Hospital, Norwich, 5Department of Psychiatry of Learning Disability, Brooklands
Hospital, Birmingham, 6Training Programme Director in Acute Medicine, North Western
Deanery, 7Department of Cardiology, Pennine Acute Hospitals NHS Foundation Trust,
Manchester, United Kingdom
Introduction: Dilated cardiomyopathy(DCM) is associated with adverse mortality. A high
percentage of deaths from DCM are sudden, mostly due to ventricular arrhythmias. RCTs
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 have shown that insertion of implantable cardioverter defibrillators(ICD) reduce mortality

POSTER ABSTRACTS
in these patients. However, the insertion of these devices in the UK is still directed by
national guidelines and cost. Real-life data showing the mortality benefit of ICD insertions
in patients with DCM in UK is lacking.
Objectives: We evaluated long-term mortality and survival in patients with DCM from a
large sample from Manchester,UK.
Methods: Anonymous information on patients with DCM, co-morbidities and
procedures attending seven-hospitals in Manchester, UK in the period 2000-2013
was obtained from the local-health-authority-computerised hospital-activity-analysis-
register using ICD-10 and OPCS coding-systems. Logistic-regression-analysis was
used for predictors of mortality and survival was determined by Kaplan-Meier-
curves.
Results: Over the time period, there were 725patients with DCM; mean age

web 3C=FPO
53.9years
15.5(S.D); Male(530,73.1%), Female(195,26.0%). Of these 198 patients
died(27.3%). The main co-morbidities were HeartFailure(400;55.2%), AtrialFi-
brillation(249;34.3%), Hypertension(248;34.2%), IschaemicHeartDisease(144;19.9%),
Type2DiabetesMellitus(126;17.4%), ChronicKidneyDisease(70;9.7%). 43pa-
tients(5.9%) had ventricular tachyarrhythmias and 47patients(6.5%) had ICD
inserted. A logistic-regression-model showed only increasing age(RR1.02;
C.I1.01-1.03), IschaemicHeartDisease (RR1.97;C.I 1.21-3.21) and ChronicK-
idneyDisease (RR4.73;C.I2.51-8.91) to be significant predictors of worsened mor-
tality in this population. Insertion of ICD(RR0.16;C.I0.06-0.48) and Hypertension
(RR0.61;C.I0.39-0.96) were found to be significant predictors of improved mortality
(Figure1).

web 3C=FPO
web 3C=FPO

Conclusion: In a large real-life patient dataset covering a 13year-period, we have
shown that ICD-insertion improves long-term-survival and mortality in DCM patients.
Presence of Hypertension also confers benefit possibly reflecting the mortality benefit
of anti-hypertensive medications such as beta-blockers and angiotensin-converting-
enzyme-inhibitors. We acknowledge the limitations of these data, such as lack of pa-
tient-specific information including ejection-fraction, symptoms and functional-status.
Nevertheless, the presence of an ICD in these patients appears to confer real-life-
mortality benefits which should be taken into consideration whilst deliberating about
ICD-insertion.
Disclosure of Interest: None Declared
PT013
Insights into basics of radiofrequency ablation with visual ablation catheter in the
ovine model
Abhishek Bhaskaran*1, William chik1, Christine Midekin1, Doan Trang Nguyen2,
Jim Pouliopoulos1, Tony Barry1, Pramesh Kovoor1, Aravinda Thiagalingam1
1
Cardiology, Westmead Hospital, Sydney, 2Engineering, University of Sydney, Sydney, Australia
Introduction: Balancing safety and efficacy in cardiac ablation had been a difficult
challenge.
Using an endoscopic visual ablation catheter(Iris, Voyager) as an experimental tool we
attempt to revisit the fundamentals of RF ablation.
Objectives: To define the temporal characteristics of lesion growth.
To evaluate the use of local electrogram amplitude and impedance drop as a marker for
effective lesion formation.
Methods: Direct Endocardial Visualization (DEV) catheter delivers RF energy via a distal
hood aperture utilizing saline irrigation as a virtual electrode.
88 ablations(n¼88)were analysed in this invivo study. Power 12 -20 W and duration 20-
40s. Local electrogram amplitude and the impedance was measured.
Results: The mean lesion surface area plateaued after 20s, 8+/-4mm2 .fig 1
Mean drop of catheter electrogram amplitude(>50%) p value-0.03,and impedance(25%)
p value .04 was maximum in the first 10 seconds and correlated well with lesion growth.
Fig 2
No incidence of complications.
Conclusion: Lesion growth, local electrogram amplitude and impedance drop occurs very
early during ablation. The observation that ablation lesion area is less dependent on
duration is an important finding which will help optimize lesion size and reduce
complications.
Disclosure of Interest: A. Bhaskaran: None Declared, W. chik: None Declared, C. Mid-
ekin: None Declared, D. T. Nguyen: None Declared, J. Pouliopoulos: None Declared, T.
Barry Consultancy for: Voyage Medical, P. Kovoor: None Declared, A. Thiagalingam
Consultancy for: Scientific advisory board member of Voyage medical
PT014
A novel microwave catheter with a toroidal radiation pattern can form circular lesions
on endocardial ablation
Pierre Qian1, Michael A. Barry1, Doan Trang Nguyen1,2, Alistair McEwan1,2,
Sujitha Thavapalachandran*1, Aravinda Thiagalingam1,3
1
Cardiology Department, Westmead Hospital, 2School of Electrical and Information Engineering,
3
Sydney Medical School, University of Sydney, Sydney, Australia
Introduction: Antral segmental pulmonary vein isolation is an effective treatment for
recurrent atrial fibrillation refractory to medical treatment. Point to point radiofrequency
ablation to achieve pulmonary vein isolation is technically demanding and time consuming
leading to the development of endovascular balloon based therapies such as cryoballoon,
laser balloon and hot balloon ablations. These technologies, however, depend on the
exclusion of the blood pool and maintainence of circumferential catheter contact throughout
ablation. This is difficult at the pulmonary vein antrum level, predisposing to gaps in ablation
rings that compromise efficacy as well as necessitating further ablations that may lead to
longer procedures and higher complication rates. Furthermore, endothelial injury during
contact based ablation results in significant microembolisation and not an insignificant risk
of clinical stroke. Microwave ablation does not require catheter contact and avoids surface
overheating making it an attractive energy source for pulmonary vein isolation.
Objectives: To confirm that a novel microwave catheter produces a toroid radiation
pattern and is capable of forming a circular lesion on endomyocardial ablation of cardiac
muscle.
Methods: A microwave myocardial phantom with a conical depression composed of a gel
matrix was imbedded with a thermochromic liquid crystal (TLC) sheet that changes colour
with temperature between 50  C to 78  C. Ablations with the microwave catheter was
performed and repeated with a 45 rotation of the catheter to demonstrate the axial
symmetry of the radiation pattern. Sheep right ventricular free wall was then fashioned into
a funnel shaped structure and bathed with flowing 0.9% saline. Endocardial ablation was

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e167

 then performed and the tissue was sectioned and stained with nitro-blue tetrazolium (NBT)
POSTER ABSTRACTS
to demonstrate non-viable tissue.
Results: The microwave catheter demonstrated an axially symmetrical sideward heating
pattern in the phantom model consistent with a toroidal radiation pattern. Ablation at
100W for 3min in tubular cardiac muscle yielded a circular lesion with a maximal lesion
depth of 10mm.
web 3C=FPO
web 3C=FPO
Conclusion: This study provides proof of principle that a novel microwave catheter with a
toroidal radiation pattern is capable of produce deep circular lesions on myocardium. This
may have future applications in endocardial catheter ablation for pulmonary vein isolation.
Disclosure of Interest: None Declared
PT015
Association of Ethnicity, Age and Body Size with Electrocardiographic Values in the
Community
Eugene S. Tan*1, Chang Fen Xu1, Liang Feng1, Rajalakshmi Santhanakrishnan1,
Michelle M.-Y. Chan1, Swee Chong Seow1, Chi Keong Ching2, Arthur M. Richards1, Tze Pin Ng1,
Carolyn S. P. Lam1
1
National University Health Service, 2National Heart Centre Singapore, Singapore, Singapore
Introduction: Existing reference values for electrocardiography (ECG) were derived in
middle-aged Caucasian adults. The impact of ethnicity, age and body size on normal ECG
values is ill-defined.
Objectives: We studied the association of ethnicity, age and body size with ECG mea-
surements in a multi-ethnic community-based cohort of Asian adults.
Methods: Randomly sampled healthy community-based adults without cardiovascular
disease (hypertension, diabetes, coronary disease or heart failure) or bundle branch block
e168
were identified from the prospective Singapore Longitudinal Aging Study. All participants
had 12-lead resting ECG and anthropometric measurements. Standardized ECG mea-
surements were made by blinded trained staff.
Results: Among 1939 healthy Asians (63% women; age 62
8 years old), there were
ethnic differences in ECG values (Table). Malay women had longer QTc intervals when
compared with Chinese women, whereas Indian women had larger R in aVL and smaller S
in V3 than other ethnicities. Similar ethnic trends in R in aVL and S in V3 were also seen in
men. In both men and women, advancing age was associated with prolongation of the PR
interval and increasing depth of S in V3; while increasing weight and BMI correlated to
widening of the QRS duration, increasing R voltage in aVL and leftward QRS axis shift (all P
 0.02). Adjusting for age, height and weight, ethnic differences in PR and QTc intervals
persisted among women (P < 0.01), but not men.
Conclusion: Among healthy Asian adults in the community, ethnicity, age and body size
affect ECG values and may need to be taken into consideration when defining normal
reference limits. These data highlight the potential limitation of commonly used ECG
criteria for the diagnosis of left ventricular hypertrophy (E.g. Cornell criteria based on R in
aVL and S in V3) in Asian populations.
Disclosure of Interest: None Declared
PT016
How Long Does A Normal Preoperative Electrocardiogram Remain Valid For Another
Surgical Intervention?
Lafayete Ramos*1, Ivan Dias2, Rodrigo Oliveira2, Eliane Elly1, Edilberto Castilho1,
Bárbara Cristina1, Mônica Wolf1, Isabelle Caroline3, Marcelo Calil1, João Goes1
1
Brazilian Institute for Cancer Control, 2São Camilo Medical School, São Paulo, 3Campos dos
Goytacazes Medical School, Campos, Brazil
Introduction: The volume of noncardiac surgery has progressively increased over the past
two decades to levels exceeding prior predictions. Cardiac complications are the major
cause of postoperative morbidity and mortality. In many times preoperative electrocar-
diogram (ECG) is ordered routinely.The increased expense is particularly burdensome for
low-income coutries. Since the paucity of data exists that delimits the validity period of this
test, it is repeated in a matter of months if a second surgery is scheduled.
Objectives: The aim of this study was to determine the temporal probability for change in a
normal preoperative ECG and its relation to in-hospital evolution.
Methods: A total of 1,034 patients (946 female; 49.7
12.3 years) with a neoplasm, who
required surgical reintervention were evaluated. All the patients were submitted to pre-
operative ECG on both interventions. All patients had normal ECG at the first intervention.
The ECGs for the first intervention were compared with those of the second. The possible
contribution of the following factors was analyzed as test modification determinants: age;
surgical risk (ASA); prior chemotherapy (QT) or radiotherapy (RXT); and presence of co-
morbidities. In-hospital evolution was followed.
Results: The mean interval between procedures was 41.2
32.7 months (range: 6-191
months). The probability of change was 0.3% (CI: 0.0 – 0.7), 1.7% (CI: 0.7 – 2.7), 3.0%
(CI: 1.5 – 4.4), 4.9% (CI: 3.1 – 6.7) and 6.4% (CI: 4.2 – 8.6) for 12, 24, 36, 48 and 60
months respectively. Among the variable analyzed, presence of co-morbidities (p<0.001),
prior RXT (p¼0.007) and surgical risk (p¼0.003) correlated with the probability of test
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
change. No correlation was found between in-hospital outcomes and the presence of ECG
change (p¼0.709).
Conclusion: Our results demonstrate that the probability preoperative ECG changes
during the initial years are rare; furthermore, when they occur, they do not have any
significant impact on the postoperative outcome.
Disclosure of Interest: None Declared
PT019
Chest pain in primary care: a study by a telecardiology service
1,2 3 2,3
Milena Marcolino* , Tati G. P. Assis , Daniel M. F. Palhares , Maria Beatriz M. Alkmim ,
Antonio L. Ribeiro1,2
1 Objectives: The study included 26 patients (62,83
1,49; 8,92 years old) with CCHD and
Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais,
2
Telehealth Network of Minas Gerais, 3Medical School, Universidade Federal de Minas Gerais,
Belo Horizonte, Brazil
Introduction: Chest pain is a common presentation in primary care. Although coronary
artery disease is an infrequent etiology in this setting, it should be ruled out. In this context,
the electrocardiogram (ECG) is very useful to assess patients with chest pain.
Objectives: To assess the prevalence of ECG abnormalities in primary care patients with
chest pain.
Methods: This is an observational retrospective study. All ECGs performed by the Tele-
health Network of Minas Gerais, a Brazilian public telehealth service, from January to
December 2011, were analyzed. This service attends 660 cities in the state of Minas Gerais.
The prevalence of ECG abnormalities was assessed.
Results: During the study period, 197,101 ECGs were performed in patients with chest
pain (mean age 50
19 years, 59.4% women). Hypertension was the most frequent co-
morbidity (26.8%). Family history of coronary artery disease was reported in 13.1%,
smoking in 6.3% and diabetes in 4.6%. Regarding the ECGs, 61.7% had no abnormalities.
The prevalence of abnormalities suggestive of ischemia was 4.4%: 2.5% poor R wave
progression, 1.5% abnormalities suggestive of acute ischemia; 0.4% pathological Q waves.
First degree atrioventricular block as observed in 1.8%, left bundle branch block in 1.6%,
right bundle branch block in 2.8%, atrial fibrillation 1.7%, left ventricular or atrial hy-
pertrophy in 6.5%, premature beats in 4.2% and nonspecific repolarization abnormalities
in 17.4%.
Although the percentage of patients with abnormalities suggestive of acute ischemia is
low, primary care physicians should have in mind that a normal ECG does not rule out
coronary artery disease, and a careful clinical assessment should be performed in all
patients.
Conclusion: In this study in a large sample of primary care patients with chest pain, the
prevalence of exams with no abnormalities is higher than 50%, and a minority of patients
has abnormalities suggestive of myocardial ischemia.
Disclosure of Interest: None Declared
PT021
The effects of Cilostazol on the ion Channels in rat right ventricular myocyte
Guangping Li*1, Rong He1
1
Department of Cardiology, The Second Hospital of Tianjn Medical University, Tianjin Institute
of Cardiology, Tianjin, China
Introduction: It is important for Brugada syndrom contributing sudden cardiac death, to
study the influence on ion chennel, especially Ito associated with Burgada wave.
Objectives: This study aims to observe the effects of Cilostazol on the transient outward
potassium current and L-Type calcium channels in rat right ventricular myocyte.
Methods: Single myocytes were isolated from right ventricular of adult rat with
collagenase II. Ito and ICa,L in cell of right ventricular were recoreded by whole-
cell patch clamp technique. This experiment were divided into two parts, (1) acute
pharmacological expriment means the perfusion expriment, there are four groups,
Cilostazole 1, 2, 5, 50mmol/L groups. The differentce about current density of Ito
was recoreded between before and after drug perfusion in each group, and the
differentce about change of current density of Ito also was observed among four
groups. (2) chronic pharmacological expriment means oral medication expriment
invided two groups: control group(CON group) and exprimental group(CILO
group), The differentce about current density of ICa,L was recoreded between the
two groups.
Results: 1. The result of perfusion expriment (1) In Cilostazole 1, 2, 5, 50mmol/L each
group, current density of Ito after cilostazol perfusion is lower than before, and here
were significant statistical differences when the self-command voltage +60 mV ( all
P<0.05), the current density of Ito in ecah group were: (20.82
7.42) vs(7.48
2.56)
pA/pF; (18.64
7.89) vs (7.63
1.78) pA/pF; (18.87
5.05) vs(7.19
1.79);
(21.45
2.54) vs(6.96
2.31) pA/pF; (2) in each command voltage, this study
compared the reduction rate of current density of Ito among four different concen-
trations of cilostazol perfusate, and found there was no significant changes among four
groups without statistical significance(P>0.05), in addition, reduction rate of current
density of Ito are all about 60% among four groups in +60 mV. 2. The result of oral
medication expriment : the current density of ICa,L in CON group is sightly higer than
CILO group in +60 mV without statistical significance, (-6.24
2.65) pA/pF vs
(5.17
1.61) pA/pF (P>0.05).
Conclusion: Ito was significantly inhited by Cilostazole directly acting on the rat right
ventricular cells.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT022
POSTER ABSTRACTS
Fractal and antifractal analysis of triggers and resonators in electrical instability in
the patients with coronary heart disease and sinus node dysfunction
Sergii K. Kulishov*1, Kostyantyn Y. Vakulenko1, Olexander M. Iakovenko2
1
internal medicine No 1, Higher state educational institution of Ukraine (HSEIU) “Ukrainian
Medical Stomatological Academy”, Poltava, 2V.P. Komissarenko Institute of Endocrinology and
Metabolism AMS Ukraine, Kyiv, Ukraine
Introduction: It is known that fractal myocardial electrical unstability are more better
diagnosis as investigation of PQRST-PQRST rotation bodies (Kulishov S.K. et al., 2004).
2
The purpose of the study was determination triggers and resonators of electrical instability
in the patients with chronic CHD (CCHD) and SND.
SSNS, including 22 with stable angina pectoris (SAP), II-III functional class and 4 -
arrhythmic CHD. Essential hypertension was presented at 18 (69,2%) patients from 26. 10
(38,5%) patients from 26 had postinfarction cardiosclerosis.
Methods: Holter electrocardiography monitoring and daily blood pressure monitoring was
used. Fractal and anti-fractal analysis were used. Statistical analysis included parametric and
nonparametric methods (program SPSS for Windows Release 13.00, SPSS Inc., (1989-
2004).
Results: In the patients with CCHD and SND, EH III stage, postinfarction cardiosclerosis
average daily value of low power component of heart rate variability (439,25

126,77 ms2; 253,54; P ¼ 0.019) was higher activity of the sympathetic autonomic nervous
system compared to surveys with concomitant EH II stage. In the patients with CCHD and
SSNS occur iterative function systems - geometric transformation of the type of rotation
and reflection depolarization-repolarization processes, including the appearance of ven-
tricular and supraventricular arrhythmias; changes of ST segment and T wave by the di-
rection, amplitude and duration (p <0,01 according to criterion of sign). Atrial fibrillation,
which was registered in 19.5% of patients with CCHD and SSNS refers to the iterative
function systems, characterized by replacement of P waves by smaller f-wave. Iteration
formula in 42.3% of patients with CCHD and SSNS characterized by tachycardia-brady-
cardia periods. The combination of the main types of iterations, the presence of fractal
formula and substitution mechanisms, and functional systems, observed in 19.2% of pa-
tients with CCHD and SSNS.
Conclusion: Fractal and anti-fractal analysis of myocardial electrical instability in the pa-
tients with CCHD and SSNS allowed to determine mechanisms of arrhythmogenesis,
correction treatment.
Disclosure of Interest: None Declared
PT023
Pecularities of cardiac remodeling, cytokines change, electric myocardial instability
in patients with chronic ischemic heart disease and arterial hypertension as
predispose to making treatment decision
Sergii K. Kulishov*1, Kostyantyn Y. Vakulenko2, Olexandr M. Iakovenko3
1
internal medicine No 1, Higher state educational institution of Ukraine (HSEIU) “Ukrainian
Medical Stomatological Academy”, 2Poltava Regional Clinical Cardiological Dispensary, Poltava,
3
V.P. Komissarenko Institute of Endocrinology and Metabolism AMS Ukraine, Kyiv, Ukraine
Introduction: It is known that coronary heart disease (CHD) causes changes of cytokine
activity, morphological and electrical heart remodeling. The purpose of the study was to
determine the influence of cardiac remodeling, ischemic, pressor factors, changes of
cytokine system on the electric myocardial instability in patients with chronic ischemic
heart disease (CCHD) and arterial hypertension (AH) as a precondition for making treat-
ment decision by genetic algorithm.
Objectives: The study included 36 patients (62,83
1,49; 8,92 years old - M
SEM,SD;
men – 27, women - 9 ) with CCHD and AH, including 24 with stable angina pectoris
(SAP), II-III functional class, 12 - with diffuse cardiosclerosis and heart failure, arrhythmias.
36 healthy subjects (59,3
0,85; 11,22 years old; men – 24, women 12) were consisted
control group.
Methods: We measured the interleukins – 1 beta (IL 1b), 6, 8, 10 (IL 6; 8; 10), C-reactive
protein, factor of tumor necrosis alpha by ELISA. Holter electrocardiography monitoring
and daily blood pressure monitoring, echocardiography were used. Statistical analysis
included parametric and nonparametric methods (program SPSS for Windows Release
13.00, SPSS Inc., (1989-2004).
Results: Indicators of echocardiographic morphometry, daily monitoring of blood pres-
sure, electrocardiography by Holter, cytokine status were depended from the severity of
supraventricular and ventricular arrhythmias at patients with CCHD in combination with
AH, including prevalence of pair supraventricular extrasystolia, atrial fibrillation or prev-
alence of ventricular arrhythmia classes IV-V by Lown-Wolf. The relationship between
levels of interleukins (IL 1b and IL 10 by Spearman correlation – R¼0,512, PR¼0,002);
dynamics of arterial pressure and IL 1b in patients with CCHD and AH (average daytime
systolic blood pressure and IL 1b – R¼0,46, PR¼0,036).determine peculiarities of course
of diseases. Application of evolutionary algorithms contributed to determine structural
component syndromes in patients with coronary artery disease, diagnostic and therapeutic
making decisions.
Conclusion: Data of heart remodeling, ischemic, pressor factors, changes of cytokine
system, electric myocardial instability in patients with CCHD and AH, arrhythmias were
main factors for making treatment decision by genetic algorithm.
Disclosure of Interest: None Declared
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 PT024
POSTER ABSTRACTS
Comparative study between 24 hour time RR plot and RR-Lorenz plot in the
diagnosis of atrial flutter with 2:1 to 4:1 AV block
Jihong Shen1, zhongjian Li1, shifeng Li1, Xiangdong Niu*2
1
Electrocardiogrom Lab, The Second Affiliated Hospital of Zhengzhou University,
2
Electrocardiogram Department, the Fifth Affiliated Hospital of Zzu, Zhengzhou, China
Introduction: Atrial flutter is a cardiac arrhythmia characterized by atrial rates of 240-400
beats/min and some degree of atrioventricular (AV) node conduction block.As a new kind
of noninvasive nonlinear analysis method in 24-hour ambulatory electrocardiogram, scatter
plot is becoming more and more popular to reflect all kinds of arrhythmias was better in
reflecting the relationship between time and rhythm due to its characteristic changes.
Objectives: To compare the advantages and disadvantages of 24-hour time RR plot and
RR-Lorenz plot in the diagnosis of atrial flutter with 2:1 to 4:1 AV nodal block by analyzing
the characteristics of 24-hour AECG.
Methods: Analyze and compare the characteristics of the 24-hour AECG of 10 patients
with atrial flutter with 2:1 to 4:1 AV nodal block by the same software made by Beneware
in Hangzhou of China,which can provide two scatter plot functions, that is 24-hour time
RR plot and RR-Lorenz plot.
Results: 1. The 24-hour time RR plot was calculated by time as X-axis and RR interval as Y-
axis,while the RR-Lorenz plot was calculated by two adjacent RR intervals as X-axis and Y-
axis separately,so the former can reflect the time of each plot,thus clear up the relationship
between time and rhythm. 2. The 24-hour time RR plot showed a stripe parallel to the x-
axis,with distinct border, basically unvaried in width, and didn’t fluctuated with an obvious
day and night variation when AV block was 2:1; The 24-hour time RR plot showed a two-
layer discontinuous stripe when AV block varied between 2:1 and 4:1.The upper layer
indicated 4:1 AV block, and the lower layer indicated 2:1AV block. 3. The RR-Lorenz plot
showed as particular four-graphic distribution, the two different AV block ratios formed
two RR intervals,and further four point sets(A,B,C and D).Point sets A and B lied along
45 line,and point sets C and D lied along the line perpendicular to 45 line.
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Conclusion: Both 24-hour time RR plot and RR-Lorenz plot have advantages in the
diagnosis of atrial flutter with 2:1 to 4:1 AV nodal block according to their characteristic
changes,the former was better in reflecting the relationship between time and rhythm.
Disclosure of Interest: None Declared
e170
PT026
Importance of atrial kick in cardiac resynchronization
Juraj Melichercik*1, Bruno Ismer2
1
Department of cardiology, Mediclin Heart Center Lahr/baden, Lahr, 2Peter Osypka Institute for
Pacing and Ablation, Offenburg University of Applied Sciences, Offenburg, Germany
Introduction: Non-responder rate in cardiac resynchronization therapy (CRT) could be
partly decreased by individualized parameter optimization excluding adverse hemody-
namic timing. In heart failure patients with sinus rhythm, an atrial kick enables the
completion of atrial contraction and may significantly enhance the ventricular filling.
Compared to that, exclusion of atrial kick is a sign of suboptimal atrioventricular timing.
However, the recognition of atrial kick by echocardiography will be negatively affected in
patients requiring a very short or long AV delays.
Objectives: To improve the detection of adverse hemodynamic timing in CRT patients
atrial kick hampering.
Methods: Suboptimal AV delay (AVD) programming excluding atrial kick was considered
if the onset of the atrial deflection in the esophageal left atrial electrogram (LAE) appears
after ventricular stimulation. Optimal AV delay was defined by the onset of the ventricular
stimulation appearing immediately after complete duration of left atrial activity. All mea-
surements were performed perorally applying a TOslim electrode (Osypka AG, Germany)
in position of maximal left atrial deflection in 20 guideline CRT-D patients (5 f, 15 m, aged
69
10 yrs.) with AVD in factory settings. The esophageal left atrial electrogram was
recorded using the esophageal electrogram option of the Biotronik ICS 3000 standard
programmer (Biotronik, Germany). The Intervals LA-Vp between left atrial deflection (LA)
and ventricular stimulus (Vp) were measured in VDD and DDD operation.
Results: During factory AVD settings we found LA-Vp of 53
38ms ranging between
-28ms and 95ms in VDD and 26
28ms ranging between -40ms and 62ms in DDD
operation. In 3 of the 20 patients (15%) in factory AVD, onsets of atrial deflection appeared
after ventricular stimulation characterizing exclusion of atrial kick and defining hemody-
namic adverse timing. AV delay individualization by LAE allowing completion of left atrial
activity resulted in LA-Vp of 51
3ms in both, VDD and DDD pacing.
Conclusion: The esophageal left atrial electrogram can be used to detect hemodynamic
adverse timing in CRT patients and to optimize AV delay resulting in LA-Vp of about 50ms.
Disclosure of Interest: None Declared
PT028
Cardiovascular Emergencies Simulation in dental practice
Lilia Timerman*1, Ana Carolina P. D. Andrade1, Gabriella A. M. D. C. D. Angelis1,
Valeria C. L. D. Souza1, Viviane U. S. D. Souza1, Karen Abrão2, Sergio Timerman2,
Francisco Gutierrez3
1
Dentistry departament, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil, 2Laureate
International Universities, 3Medicine and Health Science, Laureate International Universities,
Baltimore, United States
Introduction: Many dentists do not feel competent managing cardiovascular emergencies;
a problem requiring improved undergraduate training. Simulation provides a range of
educational tools that have increasingly been incorporated into dental pratice curricula.
Standardized patients and some partial task trainers have been used for decades. More
recently, a growing number of computer-screen simulations, high-fidelity mannequins, and
virtual-reality simulators have expanded the number of procedures and conditions, which
can be effectively simulated.
Objectives: This study developed a comprehensive simulation based training programme
for dental surgeons and assessed attitudes towards training.
Methods: Dental doctors (DD n ¼ 29) from general and cardiology hospitals were required to
complete simulation training incorporating an interactive tutorial and realistic, simulated
emergency scenarios conducted in the real clinical environment. DD evaluated each session
with a questionnaire that measured agreement with statements about the scenario, using a 5-
point Likert scale(1 ¼ strongly disagree, 5 ¼ strongly agree) assessed attitudes. An additional
questionnaire addressed skill (self assessed) and was given to all DD before and after the course.
Results: Dentist responses supported simulation training, evidenced by the following
selected questionnaire responses: achieved greater confidence in managing emergencies
5.15
0.48 (n ¼ 29); prefer lecture to simulation 1.38
0.74 (n ¼ 14); simulation
training is important in clinical pratice 4.92
0.35 (n ¼ 15)
Conclusion: Clinical simulation in management of cardiovascular emergencies for dental
practice is expensive and further objective assessment learning of clinical skills. We found a
significant increase in the confidence of DD in their emergency skills. Given the importance of
this subject, this mode of training would benefit dentist if incorporated into dental courses.
Disclosure of Interest: None Declared
PT029
Outcomes Of Rapid Defibrillation By Lay Rescuers After Cardiac Arrest In Sao Paulo
Subway
Renan Gianotto-Oliveira*1, Maria Margarita Gonzalez1, Eduardo P. Amui2, Thiago Liguori1,
Gustavo Gianotto-Oliveira2, Caio B. Vianna1, Maurício M. Alves1, Sergio Timerman1,
Roberto Kalil Filho1
1
Simulation Laboratory, Heart Institute (InCor), 2Medicine School, Anhembi Morumbi
University, Sao Paulo, Brazil
Introduction: Sao Paulo’s Subway carries about 4.5 million people per day. Since 2006, the
employees (lays rescuers) from Sao Paulo’s Subway facilities conduct continuous training
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
(at least every two years) in cardiopulmonary resuscitation (CPR) and handling of the
automatic external defibrillator (AED). This program also includes the installation of AEDs
in every subway station.
Objectives: Calculate the rate of hospital survival in patients that suffered from cardiac
arrest (CA) at Sao Paulo Subway after employees had received training and the imple-
mentation of defibrillators at the subway stations had been done.
Methods: We studied a prospective series of cases of sudden cardiac arrest in Sao Paulo’s
Subways from September 2006 to November 2012. Subway security officials were
instructed to perform CPR and to use AEDs. The outcome of each patient was followed
through medical records of the hospitals to which patients were referred. Reading the DEA
registration of each patient was performed. The primary outcome was survival after 1 year
without neurologic impairment.
Results: Automated external defibrillators were used in 62 patients whose initial cardiac
rhythm was ventricular fibrillation. The average age of victims was 59.9
14.1 years and 77%
were male. The percentage of patients who achieved sustained return of spontaneous circulation
was 74%; 54% patients arrived alive at the hospital, but only 35% were survived to discharge
from the hospital without neurologic impairment. Comparing the periods Sept/2006 to Apr/
2009 versus May/2009 to Nov/2012, respectively, the survival rate without neurologic
impairment was 22% vs. 50% after one month, and 20% vs. 43% after one year of the event.
Conclusion: We conclude that the implementation of the program of public access to
defibrillation greatly increased the survival rate of victims who suffered CA in Sao Paulo’s
Subways. This is the highest rate of survival of CA registered in public place from Latin
America so far.
Disclosure of Interest: None Declared
PT030
What Is The Optimal Left Ventricular Ejection Fraction Cut-Off For Risk
Stratification For Primary Prevention Of Sudden Cardiac Death Early After
Myocardial Infarction?
Sarah Zaman*1, Arun Narayan1, Gopal Sivagangabalan1, Aravinda Thiagalingam1,
Stuart Thomas1, David L. Ross1, Pramesh Kovoor1
1
Cardiology, Westmead Hospital, sydney, Australia
Introduction: Optimal left ventricular ejection fraction (LVEF) to select patients early post
myocardial infarction (MI) for risk stratification for prevention of sudden cardiac death
(SCD) in the era of primary percutaneous coronary intervention (PPCI) is unknown.
Objectives: We aimed to determine the optimal LVEF dichotomy limit to select patients
early after PPCI for ST-elevation MI (STEMI) to undergo further risk stratification with EPS,
for primary prevention of SCD. The secondary aim was to determine the long term inci-
dence of spontaneous tachyarrhythmia or death based on an early LVEF post-STEMI.
Methods: Consecutive patients treated with PPCI for ST-elevation MI underwent early
LVEF assessment. Electrophysiology study (EPS) was performed if LVEF40% and a
prophylactic implantable-cardioverter defibrillator (ICD) implanted for a positive [induc-
ible monomorphic ventricular tachycardia (VT)], but not a negative, result. Patients were
followed according to early LVEF with a primary endpoint of inducible VT at EPS and a
secondary combined endpoint of death or arrhythmia (SCD, resuscitated cardiac arrest or
ECG-documented VT/ventricular fibrillation).
Results: A total of 1,722 STEMI patients underwent early (median 4 days) LVEF assessment.
The proportion of patients with early LVEF>40%, 36-40%, 31-35% and 30% was 75%
(n¼1,286), 7% (n¼128), 8% (n¼136) and 10% (n¼172), respectively. Inducible VT
occurred in 22%, 25% and 40% of patients with LVEF 36-40%, 31-35% and 30%,
respectively (p¼0.014). At 3 years death or arrhythmia occurred in 6.6
0.8%, 8.1
2.6%,
18.0
3.4% and 37.4
3.9% of patients with LVEF>40%, 36-40%, 31-35% and 30%,
respectively (overall P<0.001; LVEF 36-40% versus LVEF>40% P¼0.265, Figure I). In EPS-
positive patients with LVEF 36-40%, 31-35% and 30%, the number of patients receiving
an ICD to treat one arrhythmic event was 18.3
1.2, 11.5
1.5 and 4.2
3.0, respectively.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: A cut-off LVEF40% selects patients with a high incidence of inducible VT
POSTER ABSTRACTS
post-PPCI. Patients with LVEF35% and inducible VT appear to derive a greater benefit
from prophylactic ICD implantation due to their higher risk of death or arrhythmia.
Disclosure of Interest: None Declared
PT031
Assessment of autonomic function after long term follow-up in young adults with
vasovagal syncope, who underwent Senning atrial switch correction of d-
transposition of great arteries
Beata Pietrucha*1, Artur Z. Pietrucha2, Irena B. Bzukala2, Danuta Mroczek-Czernecka2,
Ewa Konduracka2, Wieslawa Piwowarska3, Andrzej Rudzinski1, Jadwiga Nessler2
1
Department of Children Cardiology, Children University Hospital, Medical College of
Jagiellonian University, 2Department of Coronary Disease, Medical College of Jagiellonian
University, John Paul II Hospital, 3Department of Coronary Disease, Medical College of
Jagiellonian University, Cracow, Poland
Introduction: We try to evaluate a baroreceptors sensitivity (BRS) in relation to presence of
reflex syncope in young adults with benign forms of sinus node dysfunction (SND) in near-
asymptomatic young adults after reparation of d-transposition of great arteries d-TGA by
Senning atrial switch (SAS)
Objectives: We observed 21 pts (14 men) aged 18-21 yrs with d-TGA, with ECG-signs of
SND and history of presyncope and 21 sex and age matched healthy volunteers.
Methods: All pts underwent head-up tilt test (HUTT) and transoesophageal atrial stimu-
lation for evaluation of corrected sinus node recovery times (CNRT) before and after
pharmacological blockade (PHB). CNRT>525 ms was assumed as abnormal. Non-invasive
evaluation of BRS during HUTT was evaluated in dTGA patients and healthy control group
using NEXFIN analyser.
Results: HUTT was positive in 6 pts (28,6%). Mean CNRT value was 698,2ms, and shorten
significantely after PHB (362,8ms). Reduction of BRS was observed in dTGA pts. in comparison
to healthy controls. Depletion of BRS was observed in pts. with negative HUTT in relation to
non-fainter, both in dTGA(SBP: 11,4 vs 16,9 ms/mmHg; DBP 18,4 vs 21,1 mmHg;p<0,03) and
control groups (SBP: 12,6 vs 19,4 ms/mmHg; DBP 13,3 vs 16,6 mmHg;p<0,02).
Conclusion:
1. Reflex vasovagal syncope frequently occurs after physiological correction of d-TGA.
2. Reduction of baroreceptor sensitivity was observed after dTGA correction by atrial
switch both in pts. with positive and negative HUTT.
3. Electrocardiographic signs of sinus node dysfunction rather then abnormal elec-
trophysiological parameters were noticed in near-asymptomatic young adults after
reparation of d-TGA by Senning atrial switch
Disclosure of Interest: None Declared
PT032
Epicardial fat may have a role in predicting VT
Sujitha Thavapalachandran*1, Jim Pouliopoulos1,2, Dushan Bandara1, Neeru Agarwal1,
Angela McPhee1, Pramesh Kovoor1,2, Aravinda Thiagalingam1,2
1
Cardiology, Westmead Hospital, 2Sydney University, Sydney, Australia
Introduction: Intramyocardial adiposity of left ventricular scar borders post infarction is a
significant factor for increased propensity of ventricular tachycardia (VT) post myocardial
infarction. Previous studies have shown a significant correlation between echocardio-
graphic epicardial fat and intramyocardial fat content. Epicardial fat using TTE is an easy,
reliable and non-invasive imaging method for assessing epicardial fat.
Objectives: To determine whether there is a correlation between epicardial fat thickness
and VT inducibility using TTE.
Methods: Epicardial fat thickness was measured in 50 patients (22 women, 28 men, mean
age 62.5 +/- 14.2 years, median BSA 1.92m2) who underwent a TTE and electrophysiology
study (EPS) for clinical indications within a 6 month period.
Results: Among 50 patients, 40% had VT inducibility on EPS. These subjects showed
median values of epicardial fat thickness of 3.0 +/- 0.9 mm, significantly lower than those in
subjects without VT inducibility (epicardial fat thickness 4.3+/- 1.1 mm). Non-parametric
testing using the Mann-Whitney test showed a statistical significance between these two
groups (P<0.05). With further adjustment of other factors such as BSA, post-myocardial
infarction and LV dysfunction, VT inducibility was still associated with a lower epicardial
fat than the non-VT inducibility group.
Conclusion: Epicardial fat thickness was significantly lower in patients with inducible VT
in this pilot study; however, the significance of this correlation is uncertain. Further in-
vestigations are required to confirm or refute a physiologic mechanism or explanation for
this relationship.
Disclosure of Interest: None Declared
PT036
Gender differences in acute decompensated heart failure patients: Insights from the
Heart function Assessment Registry Trial in Saudi Arabia (HEARTS)
Hussam AlFaleh*1, khalid AlHabib1, Abdelfatah Elasfar2, Tarek Kashour1, Ahmed Hersi1,
Hanan AlBackr1, Fayez Alshaer1, Gamal Hussein3, Layth Mimish4, Ali Almasood5,
Waleed AlHabib1, Saleh AlGhamdi6, Abdullah Ghabashi7, Asif Malik8, Ahmed Abuosa9
1
Cardiac Sciences, King Saud University, King Khalid university Hospital, 2Cardiology
Department, Prince Salman Heart Center, King Fahd Medical City, Riyadh, 3Cardiology
e171
 department, North West Armed Forces Hospital, Tabuk, 4Medicine, King Abdulaziz University
POSTER ABSTRACTS
Hospital, Jeddah, 5Cardiology, Prince Sultan Cardiac Center, Riyadh, 6Cardiology, Madina
Cardiac Center, AlMadina AlMonaoarah, 7Cardiology, Prince Sultan Cardiac Center, Hafouf,
8
Cardiology, King Fahad General Hospital, 9National Guard Hospital, Jeddah, Saudi Arabia
Introduction: Acute decompensated heart failure (ADHF) is a major cause for morbidity
and mortality worldwide. The HEARTS registry is the first Saudi acute heart failure national
registry describing the clinical features, management, short and long-term outcomes in
patients admitted with (ADHF)
Objectives: To explore if there are any gender specific differences in clinical features,
management, and outcomes of ADHF patients.
Methods: HEARTS is a prospective registry in 18 hospitals in Saudi Arabia conducted
between October 2009 and December 2010. Clinical features, management, in-hospital,
short, and intermediate-term outcomes for men and woman are described.
Results: 2609 consecutive patients were enrolled in HEARTS registry. Of those, 65.8% were
men, and 34.2% were woman. Women were older, and more likely to be Saudi nationals.
Men were more likely to have traditional risk factors for coronary artery disease, and to have
past vascular disease. On the other hand, women were more likely to have rheumatic heart
disease, and valve disease in general. Acute coronary syndrome was the primary cause for
ADHF in men (60.5% vs. 46.6%, p< 0.001), while hypertensive heart disease and primary
valve disease was higher in women (17.8% vs. 8.6%, and 12.8% vs. 5.1%, p< 0.001,
respectively). Compared to woman, Men were more likely to have moderate or severe Left
ventricular systolic dysfunction. On discharge, a significantly higher use of Angiotensin
converting enzyme inhibitors, b blockers, and aldosterone inhibitors were seen in men
compared to woman (p<0.001 for all comparisons). Atrial fibrillation occurred more often in
women during hospitalization (8.4% vs. 4.7%, p¼0.029), while men had higher rates of
ventricular arrhythmia (4.8% vs. 3%, p<0.001). There was no difference in hospital, 30
days, and one year mortality between men and woman.
Conclusion: Among patients with ADHF, significant gender differences in clinical char-
acteristics, precipitating causes, and management were noted. This however did not result
in differences in Hospital, short, and intermediate-term mortality.
Disclosure of Interest: None Declared
PT037
Effect of pump speed changes with exercise in patients with continuous flow
ventricular assist devices
1,2 1 1 1 1
Jacqueline Lai* , Kavitha Muthiah , Ros Prichard , Robyn Walker , Desiree Robson ,
Peter Macdonald1, Paul Jansz1, Christopher Hayward1,2
1
St Vincent’s Hospital, 2University of New South Wales, Sydney, Australia
Introduction: The spontaneous increase in pump flow accompanying exercise in contin-
uous flow left ventricular assist device (cfLVAD) patients is slight in comparison to the
physiological response, limiting exercise capacity. Given the strong linear relationship
between pump speed and flow, augmentation of pump flow with activity through pump
speed modulation is an intuitive line of investigation.
Objectives: We investigated whether operating a cfLVAD at a higher pump speed improves
central haemodynamics at rest and with graded exercise as compared to operation at
baseline speed.
Methods: Eight patients (median age 56 years, range 41-70) implanted with a HeartWare
HVAD underwent right heart catheterisation and were monitored using a continuous cardiac
output monitor, echocardiography and the HeartWare Clinical Data Acquisition System
(CDAS). At rest, pump speed was gradually increased to determine a safe working maximum.
Patients then performed incremental supine exercise on a bicycle ergometer until exhaustion
both at baseline and maximum pump speed. Haemodynamic, echocardiographic and LVAD
parameters were measured at each stage of speed titration and exercise.
Results: Pump speed was safely increased to 320rpm above baseline in all patients. Significantly
greater pump flows were achieved with maximum pump speed compared to baseline during
light exercise (6.8
0.9 L/min vs. 5.8
0.9 L/min, p ¼ 0.01) and peak exercise (7.7
0.7 L/min
vs. 7.0
0.7 L/min, p ¼ 0.028). However, continuous cardiac output was significantly greater at
baseline speed during peak exercise (6.6
0.5 L/min vs. 5.6
0.5 L/min, p ¼ 0.001). Pulmonary
e172
capillary wedge pressure was significantly reduced during peak exercise at maximum speed
compared to exercise at baseline speed (27
8 mmHg vs. 30
9 mmHg, p ¼ 0.017). Heart rate,
mean arterial pressure, right atrial pressure, mean pulmonary arterial pressure and mixed venous
oxygen saturation were unaffected by changes in pump speed.
Conclusion: This study provides support for the adjustment of pump speed with activity.
Increasing pump speed augments flow while blunting the increase in pulmonary capillary
wedge pressure that accompanies exercise.
Disclosure of Interest: None Declared
PT038
Left Ventricular Assist Device (LVAD) Driveline Infections in a South East Asian
Single Centre Experience
Laura Lihua Chan*1, Teing Ee Tan2, Ban Hock Tan3, Thuan Tong Tan3, Chong Hee Lim2,
C. Sivathasan2, Ka Lee Kerk2, Joycelyn L. L. Tan2, David Sim1
1
Cardiology, 2Cardiothoracic Surgery, National Heart Centre Singapore, 3Infectious Disease,
Singapore General Hospital, Singapore, Singapore
Introduction: LVAD implantation has revolutionized the treatment of end-stage heart
failure. The management of its complications; especially infection of driveline and pump
pocket; remains a challenge.
Objectives: We seek to describe our experience with driveline infections after LVAD
implantation.
Methods: A retrospective review from May 2009 to September 2013 was performed on 40
patients who underwent LVAD implantation in our centre.
Results: 11 patients had 29 episodes of driveline infections. The mean age was 41 years old
(range 16 to 58). 81% of them were overweight with body mass index more than 23.5. 2
were diabetic.
The most common presenting symptom was pain and/or discharge, seen in 26 (89.7%) of
the episodes. Fever alone was seen in 1 (3.4%). Both symptoms were present in the rest. In 5
patients there was a history of trauma. 3 admitted to improper dressing techniques. It was
related to mediastinitis in 1. In 2 patients, no antecedent precipitating factor could be elicited.
3 out of 4 who had recurrent infections had the same species with an identical anti-
biogram isolated repeatedly. The most common organism was Methicillin-sensitive
Staphylococcus aureus (27.6%), followed by coagulase-negative Staphylococcus (CNS)
(20.7%). Patients with CNS swab-cultured all had discharge and pain from exit site. 3.4%
had negative swab-cultures while no swab was done in 13.8% as the site was dry.
8 patients required further imaging, such as computed tomography, tagged white blood
cell scans or ultrasound. 5 patients required hospitalization for intravenous antibiotics.
Deeper infection was detected in 3 as evidenced by positive blood culture; pus seen during
bridge to transplant and pump exchange due to lead fracture respectively.
All were successfully treated without surgical intervention. Antibiotic usage was guided
by infectious disease consult. The average duration of antibiotics required was 18.6 days
(range 0 to 105). The average duration of hospitalization was 15 days (range 5 to 23).
Conclusion: Driveline infections vary greatly in severity. Prompt medical attention likely
contributed to the good outcomes. Lifelong antibiotics do not appear to be necessary with
driveline infections.
Disclosure of Interest: None Declared
PT040
Abnormal troponin I results after blunt chest trauma
Danielle Harrop*1, Mathivathana Indrajith2, Lisa Gillinder1, Shi Yi Goo1, Jenny Tian2,
Michael Fryer1, Stuart Butterly1, Bevan Lowe3, Arnold C. T. Ng2, William Y. S. Wang2
1
Cardiology, Princess Alexandra Hospital, 2University of Queensland, 3Emergency Medicine,
Princess Alexandra Hospital, Brisbane, Australia
Introduction: The troponin I assay (TnI) is often used as a screening tool for cardiac
contusion in blunt chest trauma. However, there are other potential causes of TnI elevation
in this situation and it is unclear if TnI elevation is a predictor of adverse cardiac events or
overall prognosis.
Objectives: We aimed to determine which characteristics of a patient and their injury were
associated with TnI elevation in the setting of blunt chest trauma and to determine if TnI
elevation was a predictor of cardiac events or prognosis.
Methods: We conducted a retrospective analysis of all patients presenting with blunt chest
trauma during 2009 to a tertiary trauma centre. Data was collected on injuries sustained,
physiological parameters at the time of first medical contact, TnI results, electrocardiogram
(ECG) abnormalities, documented arrhythmias and in-hospital mortality. We compared
patient characteristics, trauma characteristics and incidence of clinical events between the
TnI positive (defined as 0.04mg/L) and TnI negative groups.
Results: In 2009, 337 patients presented with blunt chest trauma and 111 of these had a TnI
result recorded. Forty-nine were excluded because the test was not performed within 24
hours of their injury and two were excluded because they suffered out of hospital cardiac
arrest. Sixty-one patients were included in the final analysis including 18 with a positive TnI
result and 42 with a negative result. Patients with positive TnI results were more likely to be
haemodynamically unstable at the time of their injury, as reflected by a mean arterial pressure
(MAP) less than 60mmHg (17% vs 0%, p < 0.01) and a heart rate greater than 100bpm (33%
vs 12%, p ¼ 0.05). However, the severity of trauma was not significantly different between
the two groups, based on average Abbreviated Injury Score for thoracic trauma (2.83 vs 2.67,
p ¼ 0.46). Patients with a positive TnI had a significantly higher in-hospital mortality (12%
vs 0%, p ¼ 0.03). There was no significant difference between the two groups in documented
arrhythmia (11% vs 10%, p ¼ 0.85) but there was a trend towards more ST segment changes
on the ECG in the TnI positive group (28% vs 10%, p ¼ 0.07).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: Our results suggest that TnI elevation in blunt chest trauma may occur more PT043

often in those patients who are haemodynamically unstable but may not be related to the
severity of chest trauma. Troponin I elevation may also be a predictor of worse prognosis
but not necessarily of arrhythmia or other cardiac events.
Disclosure of Interest: None Declared
PT041
Applicability of BNP as a Biomarker of Prognosis in Long-Term Mortality in a Cohort
of Elderly Patients in South Brazil
Eduardo Pitthan1, Vânia Hirakata2, Juarez N. Barbisan*1
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, Porto Alegre, Brazil
Introduction: The BNP is used as a biomarker of prognosis, in the short term, in patients
with heart failure (HF). The prognostic role of the long-term mortality is not enough
studied.
Objectives: To validate the BNP test as a biomarker of long-term prognosis in patients with
suspected HF.
Methods: Three hundred eighteen patients, who presented at the emergency room, from
March 2003 through September 2009, with suspected HF, took part of this study. The
accuracy of BNP to identify patients with heart failure and the search from the association
with the level of BNP (POCT Biosite) and with the long-term prognosis were evaluated. The
cause of death was identified through the search of death certificates in registries, informed
by the Brazilian Information Service of Mortality.
Results: Most of the patients were white (93.1%), female (63.8%), and aged 77.3
8.6
years. HF was diagnosed based in a new gold standard that considered the Framingham and
Boston criteria plus echocardiography and ECG. HF was present in 170 pt (53.5%). Most of
these 108 pt (63.5%) had HF with Preserved Ejection Fraction (HFPEF). The functional class
III and IV NYHA was present in 87%. The BNP presented AUC 0.93 (CI 95%, 0.88 to 0.97).
The best cutoff of BNP was 180 pg/ml with S 0.83 (CI 95%, 66.7 to 80.4) and Sp 0.90 (CI
95%, 76.7 to 95.4). LR + 6.7 (95 %, 3.1 to 14.3), accuracy of 77.7. In the bivariate analysis
BNP> 180pg/ml was associated with a higher risk of mortality. In multivariate analysis HR
BNP> 180pg/ml remained associated with increased risk of mortality HR 3.4 (HF 1.2 to 9.6
p <0.02). Survival analysis in 30 days, 180 days and at the end of the study (six years and six
months) was performed by Kaplan-Meier curve. Systolic HF group the median BNP was 595
pg/ml, The Mean Survival Time (MST) was 27 months and mortality of 47%. The group
HFPEF the median BNP was 369 pg/ml, MST was 52 months, and mortality 38%. Group
Not-HF BNP was 38 pg/ml, MST was >50% and mortality of 26%. The comparison HFS
group and NHF showed RRR 0,21 (CI 95% 0,05 – 0,38) p<0,001. Betwin HFPEF group
and N-HF group RRR 0,12 (CI 95% -0,02 - 0,27). HFS and HFPEF the RRR 0,089 (CI 95%
-0,67 – 0,24). Ninety nine 99 deaths were recorded in the total group.
Conclusion: The level of the BNP showed association with mortality index. The BNP is an
independent prognostic biomarker of long-term mortality in patients with HF.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
Diagnostic and prognostic value of the B-type natriuretic peptide in elderly patients,
in south Brazil, with suspected heart failure in the emergency room
Eduardo Pitthan1, Juarez N. Barbisan*1, Patrícia S. Sant’Anna2, Bruna H. Suzigan2,
Isabella D. A. Dossin2, Vitor B. Pedrozo2
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, Porto Alegre, Brazil
Introduction: Few studies have been performed concerning the B-type natriuretic peptide
(BNP) in the elderly population, but it is used as a diagnostic and prognostic factor of heart
failure (HF).
Objectives: This study seeks to evaluate its value and accuracy as a biomarker in elderly
patients with suspected HF, in south Brazil.
Methods: Retrospective Cohort Study. From March 2003 to November 2008, 318 patients
with suspected HF were evaluated. The overall number of patients evaluated included 224
who met the inclusion criteria at the age of 60 years or over. A BNP dosage was performed
using the POCT Biosite method, and the Framingham score was used as gold standard for the
diagnosis of heart failure. For all patients, one and two-dimensional Doppler echocardiog-
raphy and chest X-ray were performed. Clinical data from the patients were obtained from
the records. In order to adjust accuracy in subgroups with specific clinical characteristics and
to analyze the risk of mortality, a multivariate analysis was done with logistic regression.
Results: BNP presented an AUC (0.93) (CI 0.88 to 0.97), Sensitivity (S) (74) and Specifity (E)
(88.9), Positive Predictive Value (PPV) (95.5), Negative Predictive Value (NPV) (52.2). The
stratified analyses of the BMI>30 subgroup presented S (54.1), NPV (46.9) and median BNP
of 217; in the subgroup Endogenous Creatinine Clearance (ECC) < 30: E (0.75), NPV (75)
and median of BNP, 944; subgroup > 80 years, Area Under the Curve (AUC) (0.94), S (83.1),
E (90.5) and median BNP of 453. Mean time of survival (30, 180 and more than 180 days): 27
months for the systolic heart failure (SHF) group, 52 months for the Heart Failure with
Preserved Ejection Fraction (HFPEF) group; at the end of the study over 50% of the group –
non HF (NHF) had survived. Median BNP (gold standard): 595 pg/mL for the SHF group, 369
pg/mL for the HFPEF group and 38 pg/mL for NHF. Once the study was ended, 70 deaths
were recorded in the group above the age of 60 years and 99 from the initial sample.

PT042
Impact of the extracardiac variables on BNP cut-offs within a cohort of patients with
suspected heart failure in a tertiary referral hospital

web 3C=FPO
Eduardo Pitthan1, Vânia N. Hirakata2, Patrícia S. Sant’Anna2, Juarez N. Barbisan*1
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, Porto Alegre, Brazil

Introduction: Considering that the cardiac and extracardiac variables, such as gender, age,
body mass index (BMI) and endogenous creatinine clearance (ECC) impact on the plasmatic
levels of the natriuretic peptides BNP e NT-proBNP, we have carried out a cohort study of
older adults with suspected heart failure (HF) in the emergency room of a tertiary hospital.
Objectives: Evaluate and compare alternative cut-offs for BNP test through stratified
sampling in the subgroups age, BMI, ECC and gender.
Methods: We studied 318 patients, including 224 patients with suspected HF, to whom
we applied the Gold-Standard (Framingham Risk Score, Boston Score and Echocardio-
gram), performed the BNP dosage and calculated the BMI, ECC (Crockcroft-Gaut). The
sample was then divided into 3 groups: Systolic HF (SHF), HF with Preserved Ejection
Fraction (HFPEF) and Non-Heart Failure (NHF). Stratified analyses were performed in the
subgroups of gender, BMI30kg/m2 and <30kg/m2, ECC 30ml/min and <30ml/min
and age80 compared to <80, comparing the plasmatic levels of BNP to evaluate the
association of patients with HF, relating the cut-off value of BNP and comparing with cut-
web 3C/FPO

offs from the literature and the general sample.

Results: The average age was 77,3
8,6, female 63,8% and caucasian 93,1%. Heart Failure
was detected in 170 (74,5%), SHF in 59 (26,3%), HFPEF in 108 (48,2%) and NHF in 54.
The functional classes III and IV NYHA were present in 87%. BNP showed AUC 0,93 (HF
95%, 0,88 to 0,97), Sensitivity (S) 74,0 (HF 95%, 66,7 to 80,4) and Specificity (E) 88,9
(HF 95%, 76,7 to 95,4). BNP best cut-off was 180 pg/ml with S 0,83 and E 0,90. The
stratified analyses of BMI30 Kg/m2 subgroup showed S 54,1 (HF 95%, 37,1 to 70,2),
NPV 46,9 (HF 95% 29,5 to 65,0) and BNP median was 217 pg/mL; and of BMI<30 was
462 pg/ml, p0.028. In the ECC < 30 ml/min: E 0,75 (HF of 95%, 21,9 to 98,7), VPN 75
(HF 95%, 21,9 to 98,7) and BNP median of 944 pg/ml and <30, 361pg/ml; the subgroup
age 80, AUC 0,94 (HF 95%, 0,89 to 0,99), S 83,1 (HF 95%, 71,9 to 90,6), E 90,5 (HF
95%, 68,2 to 98,3) and BNP median 453 pg/ml, compared to the subgroup age <80 anos,
BNP median 335 pg/ml.
Conclusion: Plasmatic levels of BNP identified elderly patients with HF and NHF. BNP persists
as independent biomarker in the groups: BMI> 30, impaired renal function and age>80.
Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e173

 Conclusion: BNP presented significant accuracy for the diagnosis of HF in patients 60
POSTER ABSTRACTS
years or older, in the emergency room, and remained an independent predictor of mortality
when fitted according to individual parameters.
Disclosure of Interest: None Declared
PT044
Validation and Comparison of Alternative Cut-Offs For BNP Test in Subgroups With
Altered Response in Heart Failure
Eduardo Pitthan1, Vânia Hirakata2, Juarez N. Barbisan*1
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, Porto Alegre, Brazil
Introduction:
Objectives: Validate and compare alternative cut-offs for BNP test in subgroups with
altered response with suspected Heart Failure.
Methods: This study will be developed using data collected from patients with suspected
Heart Failure assisted in the Emergency Room of Mãe de Deus Hospital from March 2003
to March 2013. The study consisted of two samples. The first sample, named Test Sample,
included 318 patients from March, 2003 to November, 2008; and the second, Validation
Sample, included 391 patients from December, 2008 to March, 2013. BNP dosage was
performed using the POCT Biosite method, and the Framingham score was used as gold
standard. For all patients, one and two-dimensional Doppler echocardiography and chest
X-ray were performed. Clinical data on the patients were obtained from the records. In
order to adjust accuracy in subgroups with specific clinical characteristics, a multivariate
analysis was done with logistic regression. The patients with gold standard Heart Fail-
ure(HF) or Not Heart Failure (NHF) in the Test Sample will be analyzed relating the BNP
cut-off value to the age, gender, BMI and ECC (renal function was assessed via the
Cockroft-Gault formula) and comparing to the cut-off values in the literature. BNP
correction formula will be calculated by multiple logistic regression and the probability of
having Heart Failure or not will be calculated as well. The calculated formula will be
applied to the Validation Sample and the probability of having Heart Failure or not will be
estimated. Moreover, AUC, BNP cut-offs will be compared to sensibility values, specificity,
positive predictive value, negative predictive value, RV+, RV-, and BNP cut-offs.
Results: Below, the results of the stratified analysis of BNP and AUC medians in subgroups
BMI>30kg/m2, ECC<30ml/min, age > 80 and gender of the Test Sample. The results showed
significant difference in BNP and AUC medians in the studied subgroups, compared to the cut-
offs of the General Sample. The observed differences suggest the calculation by multiple logistic
regression of a correction factor (Beta) to calculate a new BNP cut-off in subgroups with altered
response to improve the biomarker accuracy for diagnosis and prognosis of Heart failure.
web 3C=FPO
web 3C/FPO
e174
Conclusion: Validation of new BNP cut-offs in subgroups showing BMI over 30 kg/m2,
80+ years old or ECC under 30 mL/min, with altered response in Heart Failure are ex-
pected from this study.
Disclosure of Interest: None Declared
PT045
Epidemiological profile of patients with suspected Heart Failure, subjected to BNP
test, assisted in the Emergency Room of a Tertiary Hospital in south Brazil
Eduardo Pitthan1, Juarez N. Barbisan*1, Vânia Hirakata2, Patrícia S. Sant’Anna2
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, Porto Alegre, Brazil
Introduction: Heart faiure is one of the major issues of public health, and it is the most
commom cause of hospitalization among people over the age of 65. This cross-sectional
study shows the epidemiological profile and related comorbities in patients assisted in the
Emergency Room of Mãe de Deus Hospital, placed in the diagnostic uncertainty zone.
Objectives: Evaluate and describe the epidemiological profile of patients with suspected
Heart Failure.
Methods: 449 patients were assisted consecutively in the Emergency Room of Mãe de Deus
Hospital, without a definite diagnosis of Heart Failure, form March 2003 to November
2011. They were submitted to the BNP test, according to institutional procedure.
Results: Out of the total, 178 men (39,6 %) and 271 women (60,4%), average age of 77,3 (

8,6), among which 171 over the age of 80 (38,1%), caucasian 90,2%. The most prevalent
comorbities: COPD 191 patients (56,2%), pneumonia 154 (35,3%), pulmonary embolism 32
patients (7,3%), diabetes 216 patients (48,1%), anemia 186 patients (41,4%), systemic arterial
hypertension 278 patients (62%), history of previous heart attack 90 patients (19,9%),
BMI>30kg/m2, kidney failure ECC<30ml/min (Cockcroft-Gault equation) 62 patients
(14,1%). The chest X-ray analysis has shown cardiomegaly in 317 patients (72,7%), pulmonary
edema 258 patients (59,2%), right-sided pleural effusion 157 patients (36%), left-sided pleural
effusion 21 patients (4,8%) and pleural effusion in both lungs 47 patients (10,8%), EF 58,6%
(
14,8%). For diagnostic accuracy of Heart Failure, a new Gold-Standard was constituted
(Framingham Risk Score, Boston Score and Doppler One/Two-dimensional Echocardiogra-
phy). According to the Gold-Standard, the sample has been split into 3 subgroups: was then
divided into 3 groups: Systolic HF (SHF), HF with Preserved Ejection Fraction (HFPEF) and
NonHeart Failure (NHF). The group SHF with 117 patients (26,3%), BNP median of 596pg/ml
and EF 39,7 (
11,3), HFPEF 202 patients (45,4%), with BNP median of 370pg/ml, EF 64,7
(
7,6) and NHF 126 patients (28,3%) with BNP median of 44pg/ml EF 66,8 (
7,8). Analysis
of the variables EF and BNP in the groups SHF, HFPEF and NHF showed p<0,001.
Conclusion: The results obtained are superimposable with data from the literature. The
prevalence of 50% of HFPEF in elderly people, with predominance of female and highly
related to comorbities. BNP has shown a significant difference among the 3 studied groups
SHF, HFPEF and NHF, revealing to be a good diagnostic tool in Emergency Rooms.
Disclosure of Interest: None Declared
PT046
Comparison Of Blood Bnp Levels In Patients With Decompensated Congestive Heart
Failure Due To Different Etiology And Its Correlation With Echocardiographic
Parameters
Muhammad Irfan1, Muhammad A. Rauf*1, jabar ali1, Mohammad Hafizullah1, Adnan M. Gul1,
cardiology departement lady reading hospital peshawar
1
Cardiology, Lady reading hospital, pesahwar, Pakistan
Introduction: The high levels of brain natriuretic peptide (BNP) in patients with non Q MI,
rheumatic heart disease, restrictive cardiomyopathy and lone atrial fibrillation indicate that
mechanisms beyond stretch and dilatation of the heart may be operational in the secretion
of BNP from the myocardium.
Objectives:
1) To compare the blood BNP levels in patients with decompensated CHF due to
rheumatic heart disease (RHD), chronic obstructive pulmonary disease (COPD) or
non-Ischemic cardiomyopathies with the BNP levels in patients with decompensated
CHF due to coronary artery disease (CAD).
2) To find the correlation of blood BNP level with echocardiographic parameters in
patient with decompensated CHF.
Methods: Patients admitted as decompensated CHF in NYHA class III or IV dyspnea,
sorted into four groups based on the cause of CHF i.e. coronary artery disease, rheumatic
heart disease, chronic obstructive pulmonary disease or cardiomyopathies. Blood samples
for BNP assay were taken and echocardiographic examination done. Data analysis was done
using student’s t-test, coefficient of simple correlation and ANOVA was used. p value of less
than 0.05 taken as significant using SPSS-10.
Results: Out of 91 CCF patients (54 male), 51 had CAD, 17 RHD, 05 COPD and 18 had
non ischemic cardiomyopathy. Compared to blood BNP levels in CAD (2081
1434 pg/ml)
there was no significant difference in the blood BNP levels in RHD (1811
1137pg/ml,
p¼0.484), COPD (2355
1595 pg/ml, p¼0.688) and non ischemic cardiomypathies
(1951
1322 pg/ml, p¼0.737). There was significant difference in the BNP levels in the
NYHA III and IV (884
685pg/ml vs. 2666
1207pg/ml, p¼0.000). There was significant
correlation between blood BNP levels and left ventricular end systolic diameter (r¼0.208,
p¼0.048), left ventricular fractional shortening (r¼-0.327, p¼0.002), left ventricular end
systolic volume (r¼0.225, p¼0.032), left ventricular ejection fraction (r¼-0.321, p¼0.002)
and right ventricular end diastolic diameter(r¼0.221, p¼0.036). There was no significant
correlation between BNP levels and left ventricular end diastolic diameter (r¼0.086,
p¼0.420), left atrial size (r¼0.023, p¼0.831).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: Compared with the blood BNP levels in decompensated CHF due to CAD,
the levels in RHD, COPD and non-Ischemic cardiomypathies were not significantly
different. BNP levels significantly correlate with the ventricular size and function on
echocardiography but not with the left atrial size in decompensated heart failure
patients.
Disclosure of Interest: None Declared
PT047
Effects of short-term exercise training on the plasma lipids, lipid transfer to HDL and
cytokine levels in patients with heart failure
Daiana C. Bündchen1, Raul C. Maranhão2, Anderson Z. Ulbrich1, Lourenço S. Mara1,
Sabrina W. Sties1, Vitor G. Angarten1, Almir Schmitt Neto1, Tales de Carvalho*1
1
Cardiology and Exercise Medicine Center, Santa Catarina State University, Florianópolis,
2
Heart Institute (InCor) of the Medical School Hospital and Faculty of Pharmaceutical Sciences,
University of São Paulo, São Paulo, Brazil
Introduction: In the heart failure, the effects of exercise on the metabolic pathways,
especially lipid metabolism intravascular, are unknown and deserve investigation.
Objectives: To analyze in heart failure patients the effects of short-term exercise training on
the plasma lipids, lipid transfer to HDL and cytokine levels.
Methods: Before and after 12 weeks of exercise were evaluated men with chronic heart
failure, functional class II or III (NYHA), statin (n ¼ 9) and without statin (n¼10). The
exercise was performed three times a week, during 40 minutes, in a zone delimited by
the heart rate corresponding to the first and second ventilatory threshold, determined
by the cardiopulmonary test. Were evaluated the transfers of four lipids from a
radioactively labeled lipid donor nanoemulsion to HDL. Were determined the cytokine
levels (TNF-a).
Results: Was observed decreased of LDL (-16%; p¼0.03) in the group with statin and
increased of HDL (+24%; p¼0.05) in the group without statin. In statin group occurred a
significant increase of the transfer of triglycerides from the donor nanoemulsion to HDL
(p¼0.03), while the transfer of the three other lipids (unesterified and esterified cholesterol
and phospolipids) were unchanged. In the the group without statin the transfer of all four
lipids not changed. In the group without statin the TNF-a decreased (p<0.01), while in the
statin group not changed significantly (p¼0.07). In both groups no was observed corre-
lation between HDL and TNF-a.
Conclusion: In patients with heart failure, short-term training reduced LDL-C in patients
treated with statins, increased HDL-C in the non-statin group, reduced the levels of cy-
tokines in non-statin group; not changed the transfer of lipids to HDL in the non-statin
group, and significantly increased the transfer of triglycerides to HDL in the statin group.
Disclosure of Interest: None Declared
PT048
A Potential Linkage Between Mitochondrial Function Of The Heart And Leg Muscle
In Heart Failure Patients
Takao Kato*1, Moriaki Inoko2
1
Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute,
2
Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Osaka,
Japan
Introduction: Mitochondria play pivotal roles in heart failure in terms of energy pro-
duction and cell signaling. Because of the lipophilic cationic nature of Technetium-99m
sestamibi (99mTc-MIBI) which is one of tracers used for the diagnosis of myocardial
ischemia, it has been reported to be distributed across biological membranes and to show
slow clearance in proportion to mitochondrial membrane potential in cultured car-
diomyocytes. We also reported that the washout rate of 99mTc-MIBI was correlated with the
mitochondrial function in vivo and ex vivo.
Objectives: We hypothesized that an increase of 99mTc-MIBI washout would occur in
patients with chronic heart failure associated with its severity or oxygen consumption.
Methods: We enrolled 45 patients with chronic heart failure after the treatment of acute
exacerbation. Chronic heart failure was diagnosed according to the Framingham criteria.
The exclusion criteria consisted of Killip class IV heart failure and no consent. After
administration of 99mTc-MIBI, they were examined by collecting signals from the heart and
bilateral legs in early (20 minutes after the injection) and delayed phases (3 hours), in
which washout rates were calculated. We tested the correlation between the washout rate
and ejection fraction (EF) on echocardiography, brain natriuretic peptides (BNP), and other
clinical values along with the parameters of an exercise tolerance test and muscle power of
the thighs.
Results: Patients characteristics were as follows: 62.2% were male; 37% had dilated car-
diomyopathy; 55% had hypertension and 24% had diabetes; the age was 68
15.2 years
(mean
SD); the mean ejection fraction was 41
14%; and the mean washout rate was
46.8
9.1%. The 99mTc-MIBI washout rate of the heart was positively correlated with BNP
levels (r¼0.61, p<0.005) and the 99mTc-MIBI washout rate of the leg (r¼0.427, p<0.005),
but was not correlated with EF. Peak oxygen consumption was negatively correlated with
the 99mTc-MIBI washout rate of the legs (r¼0.66, p¼0.018) and mildly correlated with the
length of the circumflex of the thigh (r¼0.44, p¼0.05), indicating that mitochondrial
function of leg muscle, along with the muscle volume, may limit the exercise capacity in
patients with chronic heart failure.
Conclusion: The 99mTc-MIBI washout rate of the heart is thought to be one of the markers
of myocardial damage or dysfunction. There was an association between mitochondrial
function of the heart and peripheral muscle in heart failure patients.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT049
POSTER ABSTRACTS
Underperfomance of family screening in hypertrophic cardiomyopathy (HCM) can be
improved by a specialised HCM clinic
Alexander Olaussen*1,2, Ivan Macciocca1,3, Andris Ellims1
1
HCM clinic @ The Alfred, The Alfred Hospital, 2Faculty of Medicine, Nursing and Health
Sciences, Monash University, 3Murdoch Childrens research Institute, Victorian Clinical Genetics
Services, Melbourne, Australia
Introduction: Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease that
can cause significant morbidity and sudden death. 50% of first-degree relatives (FDRs) of
affected patients are at risk of also developing HCM. Current guidelines strongly recom-
mend clinical screening, including echocardiography, for all FDRs of patients with HCM.
Objectives: We sought to: i) establish the degree of adherence to these guidelines at a
patient’s initial assessment in our newly-established specialised HCM clinic, and ii)
determine to what extent attendance at our clinic improves the rate of family screening.
Methods: Detailed family pedigrees were obtained from all patients with HCM referred to
the HCM Clinic @ The Alfred during its first year. For each patient, the number of living
FDRs, and whether they had previously been screened with echocardiography, was
determined. A co-ordinated family screening approach, including patient/family education,
written correspondence and facilitated screening opportunities, was instituted for all pa-
tients. Follow-up twelve months after a patient’s initial clinic assessment was performed to
record the number of additional FDRs who had been screened.
Results: Of the 61 patients with HCM who attended our specialised clinic, 302 living FDRs were
identified. Of these, only 80 (26%) had previously been screened with echocardiography,
yielding 13 (16%) cases of subclinical HCM. Twelve months after a co-ordinated screening
approach initiated by our clinic, 49 additional FDR screenings had been performed (representing
a 61% improvement in the screening rate) and an additional 8 cases of HCM had been identified.
Conclusion: Family screening for HCM is underperformed. A co-ordinated approach
facilitated by a specialised HCM clinic significantly improves adherence to current guide-
lines and identifies new cases of HCM. As recognition of subclinical HCM enables pre-
ventative strategies to reduce morbidity and mortality, referral to a specialised HCM clinic
should be considered for all patients with HCM and their families.
Disclosure of Interest: None Declared
PT050
Reversible Dilated Cardiomyopathy in tobacco with betel nut users
Meenakshi Kadiyala*1, R. Rameshwar1
1
Cardiology, Madras medical college, Chennai, India
Introduction: The carcinogenic effects of the addicting mouth freshner containing tobacco
with betel nut have been well established. This study was undertaken following the
observation of number of patients who presented with dilated cardiomyopathy which got
reversed following cessation of mouth freshner with tobacco and betel nut.
Objectives: This study was undertaken following the observation of number of patients
who presented with dilated cardiomyopathy which got reversed following cessation of
mouth freshner with tobacco and betel nut.
Methods: Thirty two person (age ranging from 33 – 81 yrs), all males, mouth freshner
containing tobacco with betel nut users(consuming 6- 10 gms / day) for a time ranging
from six to eight and a half years with symptoms of breathlessness (NYHA CLASS III- IV),
extreme fatigue & PND were diagnosed to have dilated cardiomyopathy by echocardiog-
raphy (EF 30% - 34%).Patients were managed medically with diuretics, digoxin and ACE
inhibitors. Simultaneously counselling was done to encourage abstinence from mouth
freshner containing tobacco with betel nut.
Results: Initially 29 persons abstained completly from mouth freshner containing tobacco
with betel nut and the LV function by ECHO 12 weeks later showed a normal LV function
in 27 of the 29 patients (EF 59% - 72%). In the 2 remaining patients both of whom were
Diabetics, the EF improved to 47% & 50% resp). Three patients who did not stop mouth
freshner containing tobacco with betel nut completely but who were now consuming
2- 3gms/day also showed a marginal improvement in LV function (EF 39% -41%). All
patients underwent a TMT 9 months after the initial visit, of which 3 patients showed a
positive test and all 3 patients had triple vessel disease in the coronary angio. Patients who
had a negative TMT did not undergo CAG. Eleven of the 29 initial abstainers started to
reconsume mouth freshner containing tobacco with betel nut months – 12 months after
initial cessation. In 4 of them, the EF fell after the initial rise to <48%, in 1 to 51% and the
remaining 6 continued to have normal LV function. Continuous mouth freshner containing
tobacco with betel nut abstainers continued to have normal LV Function.
Conclusion: From this it is reasonable to conclude that the active ingredients in mouth
freshner containing tobacco with betel nut were possibly responsible for the reversible
dose & time related reduction in the LV function in persons without CAD and no risk factors.
Disclosure of Interest: None Declared
PT051
Subclinical Cardiomyopathy, Global Hypercoagulability and Inflammation in
Patients with Schizophrenia Receiving Long-Term Clozapine
Vincent Chow*1, Thomas Yeoh2, Austin C. C. Ng2, Tundra Pasqualon3, Elizabeth Scott4,
Tommy Chung2, Liza Thomas5, Jennifer Curnow6, David Celermajer7, Leonard Kritharides1
1
Cardiology, Concord Hospital, The University of Sydney & Anzac Research Institute,
2
Cardiology, Concord Hospital & The University of Sydney, 3Psychiatry, Croydon Health Centre,
4
Psychiatry, Headspace: National Youth Mental Health Foundation and the University of Sydney,
5
Cardiology, Liverpool Hospital and University of New South Wales, 6Haematology, Concord
e175
 Hospital, The University of Sydney and Anzac Research Institute, 7Cardiology, Royal Prince
POSTER ABSTRACTS
Alfred Hospital and The University of Sydney, Sydney, Australia
Introduction: Patients with schizophrenia are at risk of acute myocarditis and dilated car-
diomyopathy from clozapine use, and venous thromboembolism. Although guidelines advo-
cate regular cardiac surveillance, the prevalence of subclinical cardiac dysfunction is unknown.
Objectives: To assess the prevalence and predictors of subclinical cardiomyopathy after
long-term clozapine use and investigate hypercoagulable state in schizophrenia and assess if
this is associated with clozapine use.
Methods: Consecutive patients with no cardiac history, with history of schizophrenia treated
with either clozapine (group-1,n¼100) or non-clozapine antipsychotics (group-2,n¼21) for
>1year, and age and sex-matched controls without schizophrenia (group-3,n¼20), underwent
clinical, transthoracic echocardiography (TTE), biochemical (NT-proBNP & Hs Trop T) and
coagulation testing. TTE assessment included biplane left ventricular ejection fraction (LVEF) and
LV 2D-speckle-tracking global longitudinal strain (LS). Hypercoagulability assessment included a
novel Overall Hemostatic Potential assay to assess integrated coagulation and fibrinolysis.
Results: Patients with schizophrenia received clozapine or non-clozapine antipsychotics for
(mean
SD) 6.8
5.3 and 9.7
6.1years, respectively. Those on clozapine demonstrated
impaired LVEF (58.3
5.3% group-1 vs 62.2
5.3% group-2 vs 64.8
5.8% group-
3,p<0.001), and LS (-16.7
2.1% group-1 vs -18.6
1.6% group-2 vs -20.2
2.3% group-
3,p<0.001). Nine (9%) clozapine patients and no healthy controls or non-clozapine patients,
had LVEF <50%. In the clozapine group, multivariate analysis showed elevated neutrophil
count and low HDL-cholesterol as the only independent associations with impaired LS. Platelet
count, D-dimer and fibrinogen levels did not differ between controls and patients with
schizophrenia. In contrast, the overall coagulation potential (54.0
12.6 vs 45.9
9.1,p¼0.002),
overall haemostatic potential (12.6
5.8 vs 7.2
3.7,p<0.001), and overall fibrinolytic potential
(76.6
9.8% vs 84.9
6.4%,p<0.001) were all significantly different in patients with schizo-
phrenia compared to controls and were unaffected by clozapine use.
Conclusion: Asymptomatic LV impairment is common in patients with schizophrenia
receiving long-term clozapine, and is associated with neutrophilia and low plasma HDL
suggesting an inflammatory link. There is also a hypercoagulable and hypofibrinolytic state
in patients with schizophrenia unrelated to specific clozapine use.
Disclosure of Interest: V. Chow: None Declared, T. Yeoh: None Declared, A. C. C. Ng:
None Declared, T. Pasqualon: None Declared, E. Scott: None Declared, T. Chung: None
Declared, L. Thomas: None Declared, J. Curnow Consultancy for: Haematology consul-
tative services to Novartis for the clozaril patient monitoring service, D. Celermajer: None
Declared, L. Kritharides: None Declared
PT052
“Idiopathic” dilated cardiomyopathy: biopsy proved markers of disease sub-entities
Virginija Grabauskiene1, Vyt_e Maneikiene*2, Jelena Celutkiene2, Kestutis Rucinskas2
1
Pathology, Forensic Medicine and Pharmacology, 2Cardiovascular Diseases, Vilnius university,
Medical faculty, Vilnius, Lithuania
Objectives: To identify biopsy proved etiopathogenetic markers of “idiopathic” dilated
cardiomyopathy (DCM) for diagnosis of distinct disease sub-entities and for possible eti-
ology-directed treatment strategies
Methods: 36 patients (28 men, 41.9
11.6 years) with dilated cardiomyopathy (average left
ventricle diastolic diameter 6.64
0.18 cm, EF 24.9
1.39%, mean PCWP-17.75
2.18)
have undergone endomyocardial biopsy (EMB) examination including histology, immu-
nohistochemistry (IHC) and viral genome detection by polymerase chain reaction (PCR).
Results: On histological analysis the Dallas criteria was positive in 33 subjects (91.6 %),
indicating borderline myocarditis. IHC staining revealed significant inflammatory cellular
infiltrates (14 leucocytes/mm2 including up to 4 monocytes/mm2 with the presence of CD 3
positive T-lymphocytes 7 cells/mm2 ) in 26 subjects (72.2%). Viral genome by PCR was
detected in the myocardium of 15 subjects (41.7%), 3 of whom (8.3%) had double infections
and 1 (2.8 %) – triple. The following virus species were detected: parvovirus B19 (n¼12,
33.3%), human herpes virus type 6 (n¼4, 11.1%), enterovirus species, hepatitis C virus,
varicella zoster virus, Epstein-Barr virus (n¼1, 2.8%) respectively. On the basis of the presence
or absence of viral genome in myocardium the patients was defined as virus-positive – 15
(41.7%) and virus negative – 21 (58.3%). Based on viral genome in combination with IHC
characterization of inflammation we discriminated four specific sub-groups of patients for
possible etiology-directed treatment strategies:1) Virus positive chronic myocarditis (virus+/
IHC+) 12 (34.3%) – agent-specific antiviral therapy;2) Autoreactive myocardial disease (virus-/
IHC+) 14 (40.0%) – immunosuppressive or immunomodulatory therapy;3) Virus positive
myocardial disease (virus+/IHC-) 2 (5.7 %) – agent-specific antiviral therapy;4) No inflam-
matory heart disease (virus-/IHC-) 7 (20.0 %) – conventional HF and arrhythmias treatment.
Conclusion: Our approach of using immunohistochemical characterisation of inflamma-
tion and virus-positive PCR as etiopathogenetic markers of inflammatory DCM should help
identify specific subgroups of patients for etiology-directed treatment strategies and for
recruitment in future studies.
Disclosure of Interest: None Declared
PT053
Insights Into Clinical Impact Of Sarcomeric Mutations In Hypertrophic
Cardiomyopathy: Mutation Spectrum In A Large Cohort Of Unrelated Chinese
Patients
Wenling Liu*1, Wen Liu1, Dayi Hu1
1
cardiology, Peking Univ. People’s Hosp., Beijing, China
Introduction: Hypertrophic cardiomyopathy (HCM) is a hereditary heterogeneous car-
diovascular disorder. But the clinical impact of its genetics has remained poorly elucidated.
e176
Objectives: We aimed to determine if the clinical characteristics correlate with different
genotypes in a large cohort of Chinese patients.
Methods: Direct sequencing of b-myosin heavy chain (MYH7), myosin binding protein-C
(MYBPC3) and cardiac troponin T (TNNT2) genes was performed in 136 unrelated HAN
Chinese HCM patients (27 familial and 109 sporadic cases) and their family members.
Clinical evaluation and genotype-phenotype relationship analysis were performed for all
probands blinded to patient genotype.
Results: In total, 32 mutations were identified in 36 patients (27%), including 10 novel
ones. Distribution of genes was 56.3% (MYBPC3), 31.3% (MYH7) and 12.5% (TNNT2).
The occurrence of HCM-associated sarcomeric mutations were associated with an earlier
age of onset, increased left ventricular hypertrophy, a higher incidence of syncope and
sudden cardiac death and a family history. Patients with double mutations had an earlier
age of onset, increased left ventricle thickness and more adverse events than those with a
single mutation. In contrast, no statistical difference was identified in the three underlying
genes regarding the clinical characteristics and prognosis for any variable.
Conclusion: MYBPC3 is the most predominant gene. A worse clinical phenotype and
increased adverse events were found in genotyped patients, especially in those with double
mutations. There was an association between the presence of two mutational defects and
clinical expression and prognosis. However, target gene and mutation screening failed to
provide risk stratification among the individuals.
Disclosure of Interest: None Declared
PT054
The safety and efficacy of prednisolone in preventing re-accumulation of ascites
among EMF patients at Mulago Hospital: A randomised clinical trial(pilot)
Yvonne B. Nabunnya*1, James kayima1
1
Medicine, Makerere College of Health Sciences, Kampala, Uganda
Introduction: Endomyocardial fibrosis is the commonest restrictive cardiomyopathy
worldwide and is of unknown origin. Continuous inflammation and fibrosis in the heart
and other parts of the body like the peritoneum may explain the exudative ascites. Ascites
causes acute discomfort and pain in these patients yet medical treatment is disappointing.
Objectives: This pilot study, set out to determine the efficacy and safety of prednisolone in
preventing re-accumul ation of ascites from grade 2 to grade 3 among patients attending
Mulago hospital cardiology service.
Methods: This was a randomised placebo controlled trial with a 1:1 parallel design. Over a
period of ten months, screening, recruitment and randomization to receive 1mg/Kg of
either prednisolone or placebo if they met the eligibility criteria was done. Every four weeks
for a period of up to two months follow up was done. The primary outcome variables were;
the proportion of patients receiving prednisolone prevented from re- accumulating ascites
from grade 2 to grade 3 at the end of treatment and, time to re-accumulation of ascites from
grade 2 to grade 3. The safety of prednisolone was assessed using a questionnaire
addressing particular side effects as well as physical examination.
Results: Sixteen patients were randomised to and received prednisolone, while nineteen
were randomised to and received placebo. Six patients were lost to follow up (1-pred-
nisolone arm, 5-placebo). There were no statistically significant differences in the baseline
demographic, clinical and laboratory characteristics in the two arms of the study. The
efficacy of prednisolone was found to be 0.7 (95% confidence interval 0.439-1.114) and
P-value 0.121. On survival analysis, the probability of progression to grade 3 ascites was
found to be the same in both arms of the study. Prednisolone was found to be relatively safe
when used on these patients with no statistically significant difference in the occurrence of
the different side effects monitored.
Conclusion: Prednisolone was found to be relatively safe and can be used in this patient
population even if there was no statistically significant evidence of efficacy. We recommend
further studies to test the relevance of autoimmunity in the aetiology and progression of
this disease.
Disclosure of Interest: None Declared
PT055
The relationship between admission time and baseline characteristics in patients with
acute heart failure syndrome
Atsushi Mizuno*1, Koichiro Niwa2
1
Cardiology, 2St.Luke’s International hospital, Tokyo, Japan
Introduction: Although there is significant relationship between in-hospital mortality/
quality of care, treatment options, and regular hours admission in patients with acute
myocardial infarction, in patients with acute heart failure syndrome (AFHS) these effects are
questionable. Furthermore, we choose treatment options according to patients’ baseline
characteristics in in AFHS patients.
Objectives: To invetigate the relationship between patients’ baseline characteristics and
time of day of admission in AFHS.
Methods: Total 2131 patients (Age;75.1
14.1, male n¼1176) with AFHS from July 2003
to August 2011 were analyzed. We classified patient hospital arrival time, and retrospec-
tively compared in-hospital mortality and vital signs between daytime (7a.m.-5p.m) and
nighttime (5p.m.-7a.m.) as well as between regular hours (weekdays, 7a.m.-5p.m.) and off-
hours (weekdays 5p.m.-7a.m. and weekends).
Results: There is no significant differences between regular hours and off-hours. But there
are significant differences in vital signs between daytime and nighttime. In both mortality
comparisons, there are no significant differences between two groups, but nighttime
seemed relatively worse. Furthermore, the rate of AHFS without volumeoverload is follows;
daytime28.6% vs nighttime34.0% (p<0.001), regular hours31.4% vs off-hours30.3%
(p¼0.723).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: This is the first study about time of day impact on AHFS treatment. Vital signs
are significant different between daytime and nighttime, which made us think about the
treatment options. Therefore, it is clinically important to know about the nighttime is high
prevalence of AHFS patients in whom we should consider vasodilator therapy.
Disclosure of Interest: None Declared
PT056
Pharmacological Restoration of Mood In Heart Failure (Pro-Heart): Rationale And
Design
David L. Hare*1, Deidre Toia1, Andrea Driscoll2, Henry Krum3, Bruce Jackson4,
William Van Gaal5, Samia R. Toukhsati1
1
Cardiology, Austin Health, 2School of Nursing and Midwifery, Deakin University, 3Department
of Epidemiology & Preventive Medicine, Monash University, 4Department of Vascular Medicine
and Sciences, Southern Health, 5Cardiology, Northern Hospital, Melbourne, Australia
Introduction: More than 20% of chronic heart failure (CHF) patients are depressed and
have an increased mortality risk, poor medication adherence and poor quality of life. There
is currently no evidence that depressed CHF patients respond to anti-depressant medica-
tions. The Pharmacological Restoration of mOod in HEART failure (PRO-HEART) trial
(www.anzctr.org.au/ACTRN12610000223033.aspx) is an investigator initiated, double-
blind, randomized, placebo-controlled, parallel group, multi-centre study run by Austin
Health with collaborative funding from the Heart Foundation of Australia and beyondblue.
Objectives: The primary aim of PRO-HEART is to assess the efficacy of the selective se-
rotonin reuptake inhibitor, escitalopram, to reduce depression symptoms in CHF patients
using the Hamilton Depression Rating Scale (HAM-D) and the Cardiac Depression Scale
(CDS). Secondary aims are to examine the association between change in depression scores
and autonomic function, psychosocial functioning, and gene polymorphisms.
Methods: Systolic CHF patients receiving optimal heart failure pharmacotherapy, with
documented LVEF < 0.40 and screening positive for depression confirmed by psychiatric
interview are eligible for enrolment. Power calculations on the primary end-point require
randomisation of 124 patients, stratified according to investigational site and depression
severity. Escitalopram or matching placebo will be up-titrated from 5mg to 10mg after 1
week, followed by depression-severity guided up-titration to 20mg at 2 months. Patients
will receive allocated, blinded treatment for 6 months, followed by a 6 month open label
phase for the active treatment group.
Results: Treatment efficacy will be evaluated from baseline to 6 months on the CDS and
17-item HAM-D scores for combined Major and Minor Depression using Analysis of
Covariance (ANCOVA), with the effects of escitalopram on depression, autonomic and
psychosocial functioning adjusted for age, gender and baseline psychological functioning.
Hierarchical multiple regression will be used to examine the association between change in
depression and change in intermediate cardiac end points, such as autonomic functioning,
and social support.
Conclusion: PRO-HEART should inform and contribute to international management
guidelines for depression in CHF patients.
Disclosure of Interest: None Declared
PT058
Clinical Presentation, Predictors, And Outcomes of Aldosterone Therapy-Eligible
Acute Heart Failure Patients: A Sub-Study of The Heart Function Assessment
Registry Trial In Saudi Arabia (Hearts)
Khalid F. AlHabib*1, Hussam Alfaleh1, Ahmad Hersi1, Tarek Kashour1, Abdulfattah Elasfar2,
Waleed AlHabeeb1, Ali AlMasood3, Abdullah Ghabashi4, Layth Mimish5
1
Cardiac Sciences, King Fahad Cardiac Center, King Saud University, 2Prince Salman Heart
Center, King Fahd Medical City, 3Prince Sultan Cardiac Center, Riyadh, 4Prince Sultan Cardiac
Center, Hafouf, 5King Abdulaziz University Hospital, Jeddah, Saudi Arabia
Introduction: Aldosterone antagonist (AA) therapy is indicated in patients admitted with
acute heart failure (AHF) post-acute myocardial infarction with ejection fraction  40%,
and in the absence of contraindications.
Objectives: We sought to compare the clinical presentation, independent predictors, and
outcomes of the AA-treated group versus not in the AA-eligible AHF patients.
Methods: We conducted a prospective registry of AHF patients in 15 hospitals (mostly
tertiary care) in Saudi Arabia between October 2009 and December 2010, and followed
mortality rates till January 2013 in both groups.
Results: The study enrolled an overall 2,610 AHF patients, of which 413 (15.8%) were AA-
eligible and among them 164 (39.7%) were prescribed AA therapy. Compared with pa-
tients who did not receive AA therapy at discharge, those who did were significantly more
likely to present with NSTEMI (71 vs 59%), acute on chronic HF (53 vs 40%), have history
of HF (58 vs 40%), ischemic heart disease (74 vs 56%), stroke (12.2 vs 6.4%), QRS 120
msec on ECG (16.6 vs 7.7%), severe left ventricular systolic dysfunction (59 vs 45%), in-
hospital recurrent congestive heart failure (51 vs 31%) but had similar age, gender, and risk
factors. They were more likely to be treated with oral furosemide (90 vs 79%), digoxin (22
vs 11%), but had similar rates of ACE-I/ARB (82.5 vs 82.7%). Independent predictors for
AA therapy included history of HF (OR 2.0, 95%CI 1.3 – 3.1) but less use at University
hospitals (OR 0.3, 95%CI 0.2 -0.5). There was no significant difference in the 3-year crude
and adjusted mortality rates among the two groups (HR 0.9, 95% 0.5-1.7).
Conclusion: Among eligible AHF patients, AA use in our country was relatively higher
than real-life data from the developed countries. Lack of long-term survival benefit raises
concerns about system-problems, such as proper follow-up and management after hospital
discharge, which requires further investigations.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT059
POSTER ABSTRACTS
Renal L-arginine transport: a new treatment target in renal damage in HF?
Steven Fernandez1, Niwanthi Rajapakse1, David Kaye*1
1
Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Introduction: Heart failure (HF) is a highly prevalent cardiovascular disorder, which is
associated with significant morbidity and mortality. Patho-physiologically, reduced nitric
oxide (NO) bioavailability and impaired renal function are well established as contributors
as well as prognostic features in this disease condition. L-arginine is the substrate for NO
formation. Cationic amino acid transporter-1 (CAT-1) is the predominant L-arginine
transporter expressed in the kidney. Of note, reduced CAT-1 expression in the kidney can
reduce renal NO bioavailability leading to renal damage.
Objectives: In this study, we aimed to determine whether renal L-Arg transport is impaired
in a transgenic mouse model of HF (MST-1 mice).
Methods: Quantitative real time PCR was used to measure renal CAT1 levels in MST-1
transgenic mice with HF 1 and wild type mice (n¼2-3 per group). Histological renal
damage in MST-1 and WT mice was also assessed (n¼4-5 per group).
Results: Our data indicate that percentage increase in mesangial area in the kidney was 3
fold greater in MST-1 mice compared to control (P < 0.001). Glomerular injury score was
also greater in MST-1 mice (3.42
0.13) compared to control (1.26
0.32; P < 0.001).
CAT1 mRNA expression in the kidney was 37% less in MST-1 mice compared to WT,
suggesting reduced CAT1 expression in the MST-1 kidney. Consistent with this, 3H L-
arginine uptake was 95.7
3.5% less in primary renal cells prepared from MST-1 mice
compared to 3H L-arginine uptake in primary renal cells prepared from WT mice.
Conclusion: Collectively, our data suggest that impairments in renal L-arginine transport
may contribute to renal damage in HF. As such, renal L-arginine transport may be a po-
tential new treatment target in renal injury in HF.
Disclosure of Interest: None Declared
PT060
Effects of levosimendan-cathecolamine combined treatment on haemodynamics and
ventricular arrythmias in canine heart failure model
Vivien Klaudia Nagy*1, Annamaria Kosztin1, Endre Zima1, Eszter Vegh1, Balazs Sax1,
Violetta Kekesi1, Bela Merkely1
1
Heart and Vascular Center, Semmelweis University, Budapest, Hungary
Introduction: Calcium sensitiser levosimendan has become the first-line treatment in acute
heart failure (AHF) besides early applied catecholamines (CA), the latter of which is limited
by the increase of oxygen demand and arrhythmogenic effects.
Objectives: The present study aims to evaluate haemodynamics and arrythmogenic effects
of levosimendan (LEVO) administered together with catecholamines, as dobutamine
(DOB), dopamine (DA) and arterenol (ART) in a tachypacing induced canine heart failure
model.
Methods: Heart failure (n¼7) induced by rapid right ventricular pacing (240/min) occured
22
4 days after pacemaker implantation. Development of heart failure was monitored with
echocardiography and dedicated heart failure biomarkers. Pacing was continued until acute
cardiac decompensation. Effects of LEVO and CAs were investigated on anesthetized animals
by applying constant infusion (0.1 mg/kg/min) of LEVO alone, and increasing dosages of 3 of
one agents, as DOB, DA and ART for 10 minutes each. On-line monitoring of mean blood
pressure (MBP), left ventricular end-diastolic pressure (LVEDP), contractility (dP/dtmax),
relaxation (dP/dtmin) and ECG were performed. Incidence of single ventricular premature
beats (VES), coupled VESia (bigeminy, trigeminy) and ventricular tachyacardias (nsVT, VT)
were analysed at baseline, during Levo infusion and at different dosages of catecholamines.
Results: Under Levo infusion MBP (112
27 vs 121
18Hgmm p¼0,074) and LVEDP
(26,8
7,5 vs 20,7
9,1Hgmm, p¼0,178) did not change significantly compared to base-
line values. dP/dtmax (2391
987 vs 2979
946Hgmm/s, p¼0,006) and dP/dtmin
(-2306
830 vs -3062
1012 Hgmm/s, p¼0,002) were significantly increased. In the
course of combination of LEVO and single CAs, both dP/dtmax and dP/dtmin were
increased, greatest elevation was observed with DA (2391
987vs 4283
1248 Hgmm/s,
p<0,0001; and -2306
830 vs -3551
1206 p<0,0001, respectively). MBP was just
slightly increased by catecholamines. We could observe significant decrease in LVEDP
(26,8
7,5 vs 16,4
7,7 Hgmm, p¼0,029) with co-admission of LEVO and DOB. Harmful
ventricular arrhythmias, or significant increase in VES occurrence could not be observed,
even at high doses and combined application of LEVO and CAs.
Conclusion: Levosimendan-catecholamine combined treatment had beneficial effect on
haemodynamics and did not lead to malignant arrythmias or increase in arrythmogenic
activity in our canine heart failure model.
Disclosure of Interest: None Declared
PT061
Prognostic features of rhythm disturbance at a combination of CHF and diabetes
mellitus of 2 type
Elena Klester*1, Valerii Vuchev1, Lubov Plunokosova1, Karolina Klester1
1
Department of hospital and outpatients therapeutics with occupational diseases and
endocrinology courses, Altai State Medical University, Barnaul, Russian Federation
Introduction: Diabetes mellitus may provoke cardiac defeat and development of the CHF and
the CHF itself contributes to the development of insulin resistance and in this clinical script
occurs relationship between CHF and diabetes. Association of CHF and diabetes generates a
higher rate of complications, including rhythm disturbanes, which needs further study.
e177
 Objectives: Acertain occurrence frequency of lifethreaten rhythm disturbances at a com-
POSTER ABSTRACTS
bination CHF and diabetes mellitus of 2 type.
Methods: Advanced clinical observations with analysis of ECG, EchoCG, 6-minute walking
test, Holter monitoring were made at 74 p-ts was defined CHF (I group), 80 patients had a
combination of CHF and diabetes (II group), predominantly II FC by NYHA, 43 p-ts -
diabetes (III group) (criterion American Diabetes Association (2011). Groups are commen-
surable on sex, age, degree of severity and complications presence. Age of patients was
62,1
2,43 years. At the majority of patients with diabetes the HbA1c level > 7,5%. CHF was
established to National All-Russian recommendations (2009).
Results: At patients of the I group often diagnosed IHD - for 55 patients (74,3%). Ven-
tricular premature beats were at 16,8% p-ts of the I group: rare–6, frequent–10, group–9,
multifocus-at 5. Overventricular rhythm disturbances were diagnosed at 24,4% of p-ts: rare
- 2, frequent - 5, group - 4, multifocus - 2. In the II group IHD and AH rivaled, thus more
than at a half (67,5%) patients was defined their combination. In the presence of CHF and
diabetes combination compensatory abilities of the main pacemaker are limited therefore
the combined rhythm disturbances (41,2%) were registered more often (rI-II <0,01). It is
established that in process of increase of severity of coronary deficiency, especially at pa-
tients with the HbA1c level > 7,5%, increased quantity of ventricular arrhythmias. Ven-
tricular rhythm disturbances of various gradation (by B.Lown and V.Wolf) were registered:
the 1st gradation – at 31,3%, the 2nd – at 37,5%, the 3rd – at 12,5%, 4thA – at 4,2%, 4thB –
at 4,2% and the 5th– at 3,8% of the examined p-ts. Overventricular rhythm disturbances
were registered mostly at p-ts with diabetes – at 22 (44%) p-ts.
Conclusion: High frequency hemodynamic and prognostic pejorative arrhythmias were
diagnosed predominantly at patients with combination CHF and diabetes of 2 type, which
determine as aggravation of myocardial insufficiency as associate with diabetes pathogenetic
factors (dysglycemia, cardiac neuropathy, diabetic neuropathy).
Disclosure of Interest: None Declared
PT066
Training nurses to acquire images and measure left ventricular ejection fraction using
semi-automated 3-dimensional echocardiography
Kristyan B. Guppy-Coles*1,2, Samuel Hillier3, Kym Smith1, Ada Lo1, Sandhir B. Prasad1,
John J. Atherton1,2
1
Cardiology Department, Royal Brisbane and Women’s Hospital, 2School of Medicine, University
of Queensland, 3Cardiology Department, Prince Charles Hospital, Brisbane, Queensland,
Australia
Introduction: Assessment of left ventricular ejection fraction (LVEF) by nurses is an
attractive concept with many potential clinical applications. We have previously shown that
nurses can accurately measure LVEF using semi-automated, real-time, 3-dimensional
software on images acquired by experienced sonographers.
Objectives: We sought to determine feasibility of training echocardiography-naïve cardiac
nurses to perform bedside scanning and 3DLVEF quantification. We developed a 2-stage
training protocol including workstation-based training and bedside scanning with 3DLVEF
quantification.
Methods: Stage I: 50 cases were selected from a pre-existing library. All cases had 3DLVEF
quantified by 2 experienced sonographers, with averages between sonographers used as the
comparator for the nurses. Nurses received 2 brief lectures about cardiac anatomy and
physiology (30 minutes) and 3DLVEF assessment (30 minutes), before having a hands-on
demonstration in 20 cases. Nurses then independently assessed 3DLVEF on 50 test cases
using the Auto LVQ package with semi-automated, border detection (GE, Horton, Norway).
Stage II: 3 nurses who demonstrated proficiency in Stage I and were available for further
training, participated in bedside training which involved focussed apical scanning and
calculation of 3DLVEF in real-world patients undergoing outpatient echocardiography. The
3DLVEF values obtained by the nurses were compared with sonographer comparator values.
Results: Stage I: The 50 test cases had a 3DLVEF range of 23-85%. All nurses showed
excellent agreement with expert sonographers for 3DLVEF (Pearson’s correlation range
R¼0.90-0.97, all p<0.05; Bland Altman mean difference range -1.3 to 3.0%). Minimal
intra-observer variability was noted on both short-term retest and long-term retest (cor-
relation range R¼0.93-0.97, all p<0.05). Stage II: The 3 nurses scanned a median of 22
cases each. The 3DLVEF calculated by each nurse showed excellent correlation with the
experienced sonographer (correlation values at R¼0.80, 0.80 and 0.88 respectively, all
p<0.05), good agreement (weighted Cohen’s Kappa values at 0.83, 0.71 and 0.79
respectively) and Bland Altman mean differences and range (%) being -2.5 (+10.7-15.7),
1.3 (+11.6-9.1) and 2 (+12.7-8.7) respectively.
Conclusion: It is feasible to train echocardiography naïve nurses to perform focussed
imaging with 3DLVEF quantification in real-world patients. Clinical applications could
include cost-effective screening and monitoring of LV dysfunction in high-risk cohorts.
Disclosure of Interest: None Declared
PT067
Differential cardiotoxic effect of Doxorubicin, Epirubicin and Myocet: an
experimental study
Jutta Bergler-Klein*1, Christian Geier1, Gerald Maurer1, Mariann Gyongyosi1
1
Cardiology, Med. Univ. of Vienna, Vienna, Austria
Introduction: Anthracycline chemotherapy allows effective treatment of malignancies such
as breast cancer. Unfortunately, cardiotoxic adverse effects of anthracyclines such as
doxorubicin might be severe, causing clinical manifest heart failure. Encapsulation of drugs
with liposomes limits the cytostatic delivery to healthy tissues and is a recognized method
to reduce drug toxicities.
e178
Objectives: The aim of this pre-clinical experimental study was to investigate and compare
the cardiotoxic effects of three chemotherapeutics doxorubicin (DOX), Epirubicin (EPI)
and the liposome–encapsulated doxorubicin–citrate complex (MyocetÒ MYO).
Methods: Twenty-four pigs were divided in three groups; each group received human
dose-equivalent of either conventional DOX, or EPI, or MYO in 3 cycles. Transthoracic
echocardiography was performed before treatment and 3 weeks after the last chemotherapy
cycle and the left and right ventricular and atrial diameter, left ventricular (LV) systolic
function with fractional shortening (FS) and ejection fraction (EF) and diastolic function in
term of mitral E/A and tissue Doppler E/E` ratio were measured. Blood levels of NT-proBNP
were determined by using porcine-specific ELISA at baseline and at final follow-up.
Results: Due to high mortality, the study was terminated after 3 cycles of chemotherapy. Due to
low number of survivals (5/6 DOX, 6/9 MYO and 2/9 EPI), the EPI group was excluded from the
final analysis. The baseline echocardiographic and laboratory parameter did not show differ-
ences between the groups. The final LV and RV end-diastolic, and left and right atrial diameter
were similar in all groups. Trend towards smaller LV end-systolic diameter was measured in the
MYO group. Animals in the MYO group had significantly better LV systolic function (FS:
43.8
5.7% vs 36.2
4.5%, p¼0.039; EF: 74.3
6.3% vs 66.0
5.7%, p¼0.048). The E/A ratio
was nonsignificantly lower in MYO group as compared with DOX group (1.3
0.3 vs 1.6
0.3).
However, the diastolic parameter average E/E` ratio was significantly lower in MYO group
(6.1
1.3 vs 8.6
1.6, p¼0.02) as compared with DOX group, indicating better diastolic
function in animals receiving MYO. A trend towards lower level of NT-proBNP was measured in
MYO group as compared to DOX group (184
96 vs 342
299 ng/mL).
Conclusion: The encapsulation of doxorubicin in liposome resulted in less cardiotoxic
effect in terms of better LV systolic and diastolic function in an experimental model of
cardiotoxicity.
Disclosure of Interest: None Declared
PT069
The Effective And Safety Of Autologous Intracoronary Bone Marrow Mononuclear
Cells Transplantation In Cardiomyopathy
Yue-Xi Wang*1, Bao-jun Ren1
1
Cardiology, Affiliated Hospital, Huhhot, China
Introduction: Invest the effective and safety transplantation of autologous bone marrow–
derived mononuclear cells (BMMNCs) in dilated cardiomyopathy.
Objectives: To invest the effective and safety transplantation of autologous bone marrow–
derived mononuclear cells (BMMNCs) in dilated cardiomyopathy. We report the results of
the randomized trial of BMMNC therapy in 20 patients with dilated cardiomyopathy.
Methods: Patients 18 to 67 years of age with dilated cardiomyopathy, New York Heart
Association class III to IV heart failure, left ventricular ejection fraction (LVEF) <35%, were
randomized to intracoronary injection of autologous BMMNCs or ordinary drugs treat-
ment. The primary end point was the difference in LVEF from baseline to 6 months after
treatment between groups.
Results: Between Jun 2008 and jun 2012, 20 patients were enrolled. The 20 patients, 12 in the
control group and 8 in the BMMNCs group. Median number of injected BMMNCs was2.90109
(range, 1.80w5.90109). Change in LVEF differ significantly between treatment groups: at 6
months mean change in LVEF, 45.4
5.2% for BMMNCs group and 39.2%
6.3% for control
group (P<0.05); change in LVEDd, 50.3
4.2 for BMMNCs group and 55.4
3.7 for placebo
group (P<0.05). and 6-minute walking test also differ between the two groups (P<0.05).
Conclusion: Intracoronary injection of autologous BMMNCs improve left ventricular func-
tion or quality of life in patients with cardiomyopathy. The Intracoronary injection of autol-
ogous BMMNCs was effective and safety at 6 months after treatment. But the longer effective
and safety of the Intracoronary injection of autologous BMMNCs is under investigation.
Disclosure of Interest: Y.-X. Wang Consultancy for: No, B.-J. Ren: None Declared
PT070
Eosinophilic Myocarditis: Characteristics, Diagnostics And Outcomes
Tom Kai Ming Wang*1, Tim Watson1,2, Boris Lowe1, James Pemberton1, Nicky Kingston3,
Chris Ellis1, Peter Ruygrok1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, 3Department of Pathology (Histology), Auckland City Hospital,
Auckland, New Zealand
Introduction: Eosinophilic myocarditis (EM) is a rare and potentially fatal entity charac-
terised by inflammation with infiltrating eosinophils. Limited published data are available
documenting presentation, management and prognosis.
Objectives: We report these parameters in a series of patients with EM treated at Auckland
City Hospital.
Methods: All patients diagnosed with EM at our institution during January 2010-August
2013 were identified from the electronic laboratory histolopathology and haematology
databases, and clinical characteristics and outcomes reviewed.
Results: Seven patients, four male and median age 41 (range 1.5-62) years were identified.
Median follow-up was 18 (range 0.2-33) months. Abnormal repolarization on electrocar-
diogram was present in 3 patients, and echocardiography found moderate and severe
impairment of left ventricular (LV) systolic function in 3 and 2 respectively, right ventricular
impairment in 3 and apical thrombus in 2. The peripheral eosinophil count was abnormal in
ˇ
5 and median peak levels were 2.1 (0.22-17.7) x10 9/L. Troponin T was elevated in 6 cases.
Cardiac biopsy was diagnostic of EM in 5 of 6 cases performed, while eosinophilia of bone
marrow was found in 3 of 4 performed. Inotropic support for cardiogenic shock was
required in 3 cases. Corticosteroids were commenced in 5 patients, and in 3 cases this was
initially given intravenously. Corticosteroids achieved normalisation of eosinophil count in 4
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 patients, and in 2 of 3 patients this led to improvement in LV function to normal, while the
remaining patient died in hospital. Two patients developed ventricular arrhythmia also
leading to one in-hospital death, and one death at 2 years after initial diagnosis.
Conclusion: Our findings suggest endomyocardial biopsy has good diagnostic yield for
EM, corticosteroid is an effective first line treatment, and ventricular arrhythmia is an
important cause of mortality. Multi-centre collaboration to obtain a larger data set for this
rare condition is warranted.
Disclosure of Interest: None Declared
PT071
Malignancy Presenting As A Cardiac Tamponade: A Case Presentation And Literature
Review
Ronny Cohen*1, Michael J. Gale2, Brooks Mirrer1, Pablo Loarte3, Angela Yeh2
1
Cardiology, Woodhull Medical Center / NYU School of Medicine, 2Medicine, Woodhull Medical
Center, 3Medicine, Brookdale Hospital, Brooklyn, NYC, United States
Introduction: Malignant pericardial effusion presents as a clinical spectrum that ranges
from the totally asymptomatic state to acute cardiac tamponade. Primary malignancies with
a propensity for cardiac involvement include lung cancer, breast cancer, and lymphomas1.
Objectives: Advanced malignant disease frequently involves the heart and pericardium,
and pericardial effusion is a common postmortem finding in such patients. Identification of
pericardial effusions in life is uncommon, except when symptomatic.
We illustrate via an unusual case study, the discovery of advanced underlying malig-
nancy after presentation with cardiac tamponade.
Methods: Case study. A 60 year old female presented in respiratory distress (RR: 36/min).
relatively hypotensive (BP 101/59), and tachycardic (HR: 124 bpm). On physical exami-
nation, prominent jugular venous distension to the angle of the jaw was noted, with distant
heart sounds and pulsus paradoxus of 12mmHg, with diminished breath sounds over both
lung fields. Clinical impression of cardiac tamponade was supported by CT scan of thorax
and echocardiogram (see below, Results). An emergency pericaridiocentesis was per-
formed, with subsequent pericardial window, followed by video assisted thoracoscopy with
talc pleurodesis.
Results: Noninvasive Testing
EKG showed sinus tachycardia with low voltage QRS and electrical alternans in anterior
chest leads.
Computed tomographic scan of thorax (Image I) showed large pericardial effusion and
right pleural effusion. Echocardiogram (Image 2) showed a large pericardial effusion with
diastolic collapse of the right ventricle and prolonged right atrial collapse, with Doppler
respirophasic variation of mitral inflow consistent with tamponade physiology.
web 3C=FPO
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: On review of the literature, we have found that cardiac tamponade occurring
POSTER ABSTRACTS
as the first presentation of malignancy is uncommon. Tamponade can result from invasion
by the primary tumor or metastases. In our patient, pericardial biopsy demonstrated
metastatic adenocarcinoma. Our paper highlights the importance of awareness of the un-
derlying etiologies of cardiac tamponade. We discuss diagnostic tests and current best
management.
1. Med Klin (Munich). Berg M, Heisel A, Ukena D, Schäfers HJ, Schieffer H
Disclosure of Interest: None Declared
PT072
Heart failure and sudden death in infarcted patients with prior revascularization;
13-year experience
Predrag Mitrovic*1, Branislav Stefanovic1, Mina Radovanovic1, Nebojsa Radovanovic1,
Gordana Matic1, Dubravka Rajic1, Tanja Jozic1, Ana Novakovic1, Ida Subotic1,
Zorana Vasiljevic1
1
Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade,
Belgrade, Serbia
Introduction: Patients (pts) who have clinical evidence of congestive heart failure (CHF)
after acute myocardial infarction (AMI) and previous coronary artery bypass grafting
(CABG) have a poor prognosis.
Objectives: To elucidate the clinical predictors of death, 748 patients (pts) (males 82.8%,
mean age 59.4
6.9 yrs) with acute myocardial infarction (AMI) after prior coronary artery
bypass surgery (CABS) have been selected from the pts consecutively submitted from April
1990 to April 2013.
Methods: The pts with early perioperative AMI were excluded from the study. The average
time interval from CABS to AMI was 92.4
10 months. The average number of grafts was
3.3 grafts/pts. All pts were divided in 3 groups: pts died from sudden cardiac death, pts
died from cardiac causes of death and pts died from non-cardiac causes of death. The mean
interval of survival was 12.4
6.2 months.
Results: In 120-months follow-up period 135 (18%) pts died after AMI and previous
CABS. Eighty-five pts (63%) died in first two years after AMI and the more often cause of
death in these pts was sudden cardiac death (81/85 pts, 95.3%). Forty-six total of 135 pts
(34%) died from cardiac causes of death. The most frequent cause of death in this group of
pts was congestive heart failure (38/46 pts, 82.6%). Eight pts (17.4%) died from rein-
farctus. In eight pts (5.9%) the cause of death was non-cardiac. Eighty-one patient (60%)
died from sudden cardiac death. Analyze of events which might be causes of death in pts
died from sudden cardiac death shown that: angina pectoris was present in all 81 pts, atrial
fibrillation was present in 39/81 (48.1%) pts and congestive heart failure in 64/81 (79%)
pts.
Conclusion: The most frequent cause of death in 135 patients died after AMI and previous
CABS was sudden cardiac death; congestive heart failure is one of very important predictor
of sudden cardiac death in this patients.
Disclosure of Interest: None Declared
PT076
Quantitative assessment of cardiac mechanical dyssynchrony before and after
Cardiac Resynchronization therapy in patients with non-ischemic dilated
cardiomyopathy using Equilibrium radionuclide angiography
Anirban Mukherjee*1, Chetan D. Patel1, Harmandeep Singh1, Punit Sharma1, Nitish Naik2,
Gautam Sharma2, Ambuj Roy2, Arun Malhotra1
1
Nuclear Medicine, 2Cardiology, All India Institute of Medical Sciences, New
Delhi, India
Introduction: Cardiac Resynchronisation Therapy (CRT) is an effective treatment for se-
vere heart failure refractory to medical management. Still, 20% patients do not respond to
this expensive treatment. Response to CRT depends on presence of cardiac mechanical
dyssynchrony (CMD) before treatment and resynchronisation after device implantation.
Equilibrium radionuclide angiography (ERNA) phase analysis has been proven to be an
accurate and reproducible tool for assessing cardiac mechanical dyssynchrony.
Objectives: Quantitative assessment of CMD before and after CRT in patients with non-
ischemic dilated cardiomyopathy (DCM) using ERNA.
Methods: Ten patients selected for CRT implantation using conventional criteria were
prospectively included in this single centre study, from November 2012 to June 2013.
Patients with history of ischemic heart disease and any structural heart disease were
excluded. Institute ethical committee approval was taken. ERNA and clinical evaluation
was performed before and 3 months after CRT device implantation. Standard deviation
of LV mean phase angle (SD LVmPA) and difference between LV and right ventricle
mPA (LV-RVmPA) expressed in degrees were used to quantify left intraventricular
synchrony and interventricular synchrony respectively. Established cut-off values of
ERNA were used to detect the presence of dyssynchrony. LV ejection fraction (LVEF)
was evaluated.
Results: The patient characteristics before CRT were as follows: age (54.1
9.96 years),
7 males, NYHA class [III (n¼7), IV (n¼3)], QRS duration (141
14.49 ms) and LVEF
(24.8
11.09%). Three months after CRT, 9 patients were identified as responders with
an improvement of NYHA class (3.2
0.34 before CRT vs. 2.1
0.56 after CRT;
p 0.003). As compared to baseline, significant improvement in LVEF (24.8
11.09 vs.
32.7
13.75, p 0.002) and CMD parameters [SD LVmPA (49.1
21.30 vs. 33.5
19.94,
p 0.003) and LV-RVmPA (34.7
21.46 vs. 22.7
12.40, p 0.037)] were noted 3 months
after CRT.
e179
POSTER ABSTRACTS

Conclusion: While MPP from a single CS branch effectively improves EF in CRT patients,
it may have a particularly strong benefit in patients with lower BASELINE EF.
Disclosure of Interest: C. Pappone: None Declared, Z. Calovic: None Declared, A. Cuko:
None Declared, L. Mcspadden Shareholder of: St. Jude Medical, Employee from: St. Jude
Medical, K. Ryu Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, E.
Romano Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, M. Baldi: None
Declared, A. Pappone: None Declared, G. Vicedomini: None Declared, V. Santinelli: None
Declared

PT079
Importance Of Evaluation And Quantification Of Left Atrial Function Using Strain
Imaging
Jan E. Claessens*1, Philip Claessens2, Christophe Claessens3, Marc Claessens4, Maria Claessens1
web 3C=FPO

1
Cardiology, Cardiological Centre "Kloppend Hart" Schilde-Essen-Antwerpen, Antwerp,
2
Cardiology, AZ Sint Jozef, Malle, 3Internal Medicine, AZ Turnhout, Turnhout, 4Surgery, AZ
Klina, Brasschaat, Belgium

Introduction: In the contraction-relaxation cycle of the myocardium the left atrium play an
important but often forgotten and neglected role. The atria contribute up to 30% of left
ventricular filling and cardiac output and are particularly important in the setting of
impaired left ventricular function.
Objectives: Ischemic heart disease may lead to an increase in fibrosis, causing remodeling
Conclusion: ERNA can be used for response evaluation of patients undergoing cardiac
of the myocardium, resulting in a deterioration of myocardial function. For an adequate
resynchronisation therapy in routine cardiac practice. ERNA phase analysis has potential
cardiac pump function, the contractile function of left atrium is of crucial importance. Left
for detecting CMD and selection of patients for CRT.
atrial function can be evaluated by strain measurements of the left atrial wall.
Disclosure of Interest: None Declared
Methods: The study group consisted of 681 ambulant and asymptomatic male patients
with a normal systolic left ventricular ejection fraction, divided in six groups: 3 groups
healthy subjects (HS): 40-59years; 60-79y; 80-99y and 3 groups coronary patients (CP)
PT077
treated with stent implantation or surgical revascularization:40-59years; 60-79y; 80-99y.
Multipoint left ventricular pacing gives greater benefit in patients with lower baseline For the contractile function of the left atrium we assessed by strain measurements the
ejection fraction reservoir function(RF) and the conduit function(CF). The more positive the strain value the
better the elasticity and elongation capacity of the left atrium.
Carlo Pappone1, Zarko Calovic1, Amarild Cuko1, Luke C. Mcspadden2, Kyungmoo Ryu*2, Results: Statistically significant decrease of left atrium RF in CP compared with
Enrico Romano3, Mario Baldi1, Alessia Pappone1, Gabriele Vicedomini1, Vincenzo Santinelli1 HS(p¼0,000). Also subdivided in age groups left atrium RF decreases significantly with age
1
Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), as well in HS as in CP(p¼0,000). The same findings for left atrium CF; statistically
Italy, 2St. Jude Medical, Sylmar, CA, United States, 3St. Jude Medical, Milan, Italy important decrease of left atrium CF in CP compared with HS(p¼0,000) and when sub-
divided in age groups progressive decrease with age (Table 1).
Introduction: Cardiac resynchronization therapy (CRT) with multipoint left ventricular
(LV) pacing (MultiPointÔ Pacing [MPP], St. Jude Medical) in a single coronary sinus (CS)
branch has been shown to improve acute LV hemodynamic function and CRT response
rate at 3-month follow-up.
Objectives: The aim of this study was to determine if baseline ejection fraction (EF)
delineated response to CRT with MPP or conventional CRT (CONV) at 3-month
follow-up.
Methods: Consecutive patients receiving a quadripolar CRT implant (Unify Quadra MPÔ
or Quadra Assura MPÔ CRT-D and QuartetÔ LV lead, St. Jude Medical) were randomized
to receive biventricular pacing with either conventional LV pacing (CONV arm) or MPP
(MPP arm). For each patient, an optimal pacing configuration for the assigned pacing mode
was programmed based on intraoperative pressure-volume loop measurements. A clinical
web 3C/FPO

evaluation and transthoracic echocardiography exam were performed prior to implant

(BASELINE) and 3 months post-implant and analyzed by a blinded observer. A cutoff in
baseline EF of 25% was used to divide the patients in each arm into two groups. CRT
response was evaluated by the percentage point improvement in EF from BASELINE to 3
months.
Results: Forty-four patients (80% male, NYHA 3.0
0.0, end-systolic volume 180
77 mL,
EF 27
6%, QRS duration 152
17 ms) were enrolled and randomized to either CONV
arm (N¼22) or MPP arm (N¼22). Patient characteristics at BASELINE were not signifi-
cantly different between the two arms. One patient in the MPP arm was lost to follow-up
and excluded from further analysis. After 3 months, patients in the CONV arm improved
similar magnitudes regardless of BASELINE EF (<25%: PP change of 7.0
4.5%, N¼7 vs.
25%: PP change of 4.9
1.8%, N¼15, p¼0.12, see Fig). However, in the MPP arm,
patients with lower BASELINE EF improved significantly more than patients with higher
BASELINE EF (<25%: PP change of 17.8
4.5%, N¼9 vs. 25%: PP change of
10.6
5.4%, N¼12, p¼0.004).

e180 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: Strain imaging permits us to quantify the contractile function of left

POSTER ABSTRACTS
atrium, resulting in early detection of left atrium dysfunction and in a significantly
reduced elasticity and elongation capacity of left atrium in coronary patients. Age and
ischemic heart disease are both independent factors in the development of atrial
dysfunction. Atrial strain measurements expressed earlier than left ventricular function
the myocardial contractile reserve and provided a first warning for arrhythmias and
thrombo-embolic events.
Disclosure of Interest: None Declared

PT080
Quality of life and exercise tolerance in subjects with ischemic cardiovascular disease
and diastolic dysfunction
Maria Leonarda De Rosa*1, Carlo Melissa1, Arianna Esposito1
1
Medical Science, University Federico II of Naples, Italy, Naples, Italy
Introduction: Diastolic dysfunction may be exacerbated by increased systolic blood
pressure (SBP) during exercise. Ang II may contribute to this process.
Objectives: Late sodium current, in ischemic cardiovascular disease, may also contribute to
diastolic dysfunction, attributable to calcium oscillations in sodium–calcium overload
conditions.

web 3C=FPO
Methods: In our study we observed exercise tolerance, assessed using a modified Bruce
Protocol at baseline, wash-out period, and after four-week post ischemic treatment
period, and Quality of life (QOL), assessed using the Minnesota Living with Heart
Failure questionnaire, in our ambulatory ischemic cardiovascular population, for four
years.
Results: During exercise, Ang II levels increased from 27 +/- 16 to 32 +/- 19 pg/ml (P
< 0.05). SBP during exercise was 211 +/- 8 mm Hg at baseline and similarly reduced
by Ang II receptor blockade (196 +/- 17, P < 0.01) and b blockers(196 +/- 13, P <
0.01). With Ang II receptor blockade and inhibitor of late sodium current, exercise
time increased from 795 +/- 180 seconds to 847 +/- 162 seconds (P < 0.05), and QOL Conclusion: FID is present in the majority of Asian patients with HF regardless of EF. The
improved from 10 +/- 15 to 6 +/- 5 (P < 0.05). In contrast, b blockers did not functional and prognostic impact of FID suggests that it is an important therapeutic target
significantly improve exercise time or QOL. While inhibitor of late sodium current in in Asian patients with HF.
addition to b blockers improved QOL from 9 to
12 to 5
4( p<0.5). In patients with Disclosure of Interest: None Declared
mild diastolic dysfunction at rest and a hypertensive response to exercise, both Ang II
receptor blockade and b blockers blunted the hypertensive response to exercise, only
inhibitor of late sodium current in addition to Ang II blockade increased exercise PT082
tolerance 687
148 seconds to 819
149 seconds (p<0.01)and improved QOL from
10
8to7
4 (p<0.5). Ventricular Mechanical Efficiency Is Impaired In Patients With Hfpef
Conclusion: Reduction of late sodium current would therefore be expected to have
therapeutic benefits, particularly in disease states such as ischemia in which sodium–cal- Vanessa Van Empel*1, Justin Mariani2, David Kaye2
1
cium overload is a major feature. Cardiology, Maastricht University Medical Center, Maastricht, Netherlands, 2Cardiovascular
Disclosure of Interest: None Declared Medicine, Alfred Hospital, Melbourne, Australia

Introduction: Impaired diastolic reserve is fundamental to the abnormal exercise physi-

PT081
Functional iron deficiency in heart failure with preserved versus reduced ejection
fraction
Tee Joo Yeo1, Poh Shuan Daniel Yeo2, David Sim3, Gerard Kui Toh Leong4, Hean Yee Ong5,
Fazlur Jaufeerally*6, Kim Yee Lee1, Lieng H. Ling1, A. Mark Richards1,7,
Carolyn S. P. Lam1
1 mmHg) compared to healthy (16
2 mmHg, p<0.001) and hypertensive controls (17
1
National University Heart Centre Singapore, 2Tan Tock Seng Hospital, 3National Heart
Centre Singapore, 4Changi General Hospital, 5Khoo Teck Puat Hospital, 6Singapore General
Hospital, 7Cardiovascular Research Institute, Singapore, Singapore
Introduction: Iron deficiency is highlighted as an important therapeutic target in recent
heart failure (HF) guidelines. However, prior studies were limited to mainly Caucasian
populations and HF with reduced ejection fraction (HFrEF).
Objectives: We aimed to study the functional significance and prognostic impact of
functional iron deficiency (FID) in a large cohort of Asian patients with HFrEF and HF with
preserved ejection fraction (HFpEF).
Methods: Transferrin saturation (Tsat) was measured in 740 patients enrolled in a pro-
spective nationwide longitudinal HF study. FID was defined as Tsat<20%. Anemia was
defined as hemoglobin <12g/dL (women) or <13g/dL (men). HF groups were HFpEF
(EF50%; N¼148) and HFrEF (N¼592).
Results: FID was present in 472 (63.8%) of patients with HF (64.7% in HFrEF,
60.1% in HFpEF; p¼0.302). There was no association between the presence of FID
and the presence of anemia, with 215 patients having FID without anemia, and 84
patients having anemia without FID. At baseline, patients with FID had worse
functional status as measured by New York Heart Association Class (p<0.001 for
HFrEF; p¼0.16 for HFpEF) and higher Minnesota Living With Heart Failure Scores
(p < 0.05 for both HFrEF and HFpEF) than those without FID (Figure 1). Over a
median follow up of 307 days, there were 196 events (HF hospitalization or death).
Low Tsat was associated with greater risk of events (p¼0.019) even after adjusting
for age, sex and comorbidities. There was no interaction between FID and HF
group. Patients with both FID and anemia (N¼224) had the poorest prognosis
(Figure 2).
ology that characterises heart failure with preserved ejection fraction (HFPEF). Although
the presence of excess extracellular matrix has been presumed to be the fundamental
mechanism, the potential contribution of other mechanisms affecting active and passive
components of diastolic function have not been comprehensively assessed.
Objectives: In this study we investigated the role of altered myocardial energetics in the
pathophysiology of HFPEF.
Methods: Patients with HFPEF, hypertension and healthy controls underwent simulta-
neous right-heart catheterisation, echocardiography and multi-site (arterial, pulmonary
artery and coronary sinus) blood gas sampling at rest and during supine-cycle ergometry.
Results: At peak exercise pulmonary capillary wedge pressure was higher in HFPEF (33
3
mmHg, p<0.001). Left ventricular work (LVW) was similar in all groups at baseline,
however peak exercise LVW was significantly lower in HFPEF compared to controls and
hypertensives (9.7
1.2 vs 19.1
1.4 and 19.5
2.2 kg-m/min respectively, both p<0.05).
The transcardiac oxygen content gradient was measured at rest and during exercise, revealing
that ventricular mechanical efficiency during activity is substantially lower in HFPEF
compared to control and hypertensive groups (both p<0.05). The myocardial respiratory
quotient and uptake gradients for glucose and lactate did not differ between groups.
Conclusion: Patients with HFPEF exhibit impaired ventricular mechanical efficiency
suggesting the presence of fundamental changes in energetics, possibly reflecting excess
energy utilization for active relaxation. Elucidation of the underlying mechanism may
identify further therapeutic targets.
Disclosure of Interest: None Declared
PT083
Prevalence, clinical presentation, diagnostic and prognostic features of HFPEF in a
prospective single-centre Asian cohort
Wen Ruan*1, Swee Han Lim2, Zee Pin Ding1, Kurugulasigamoney Gunasegaran1,
David Kheng Leng Sim1, Bernard Wing Kuin Kwok1, Ru San Tan1
1
Cardiology, National Heart Centre Singapore, 2Emergency, Singapore General Hospital,
Singapore, Singapore
Introduction: Data on heart failure with preserved ejection fraction (HFPEF) prevalence
and presentation are lacking in Asian patients.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e181

 Objectives: We compared the clinical characteristics of HFPEF vs. heart failure with and endothelin-1 (ET-1) (10-11 to 10-8 M). The effect of L (10-8M to 3 x 10-5M) was
POSTER ABSTRACTS

reduced ejection fraction (HFREF) in Singapore patients presenting with acute heart failure studied in pre-contracted arterial rings (3 x 10-9M endothelin, 3 x 10-8M thromboxane A2
to the emergency room. mimetic U46619 and 3 x10-7M serotonin). Potency (pD2) and maximal response (Emax)
Methods: Prospective single-center cohort study of patients presenting with acute values were calculated from the concentration-response curves. Emax is the maximal
dyspnea to the emergency room. Acute myocardial infarction presentations were relaxant response and pD2 corresponds to the negative logarithmic concentration pro-
excluded. Non-cardiac dyspnea cases were ruled out if N-terminal prohormone of ducing 50% of the Emax. Data are expressed as mean
SEM. We used unpaired t-test
brain natriuretic peptide were <300 pg/ml. Framingham Criteria for Congestive Heart with a P<0.05.
Failure were employed to identify acute heart failure cases, who all then underwent Results: Mean PAP increased (13
2 vs 26
3 mmHg) and AoP decreased (96
12 vs
echocardiography and were stratified into HFPEF and HFREF with LVEF50% and 43
11 mmHg) during PE (P<0.05). PE did not affect the response of PA rings either to
<50%, respectively. Acetylcholine or to ET-1. L relaxed both CPA and RPA rings in a concentration-dependent
Results: 148 patients presenting with acute dyspnea were enrolled between December manner in both groups. pD2 was significantly higher in RPA with respect to CPA and did
2003 and November 2004. 98 (66%) were diagnosed with HF. Univariate analyses revealed not change in PE group.
that compared with HFREF, HFPEF were more likely to have used dihydropyridine cal-
cium channel blockers (38% vs. 10%, P<0.01), had lower levels of NT-ProBNP and he-
moglobin (see table). Regarding clinical presentation, HFREF patients were more
tachycardic (97
24 vs. 85
21 bpm, P<0.01) with higher diastolic blood pressure (85
18
vs. 73
15mmHg, P<0.01) compared with HFPEF, but there was no significant difference Sham(n[8) PE (n[8)
in other presenting features. At 30 days and 6 months, mortality rates in HFPEF and RPA CPA RPA CPA
HFREF were not statistically significantly different.
Emax,% 70
8 60
4 71
9 65
6
pD2 6.8
0.12 5.9
0.15* 6.7
0.10 6.1
0.10*
*P<0.05 vs RPA
HFPEF(n[48) HFREF(n[50) P
Age (yr) 72(9) 71(11) 0.38
Female 27(56%) 19(38%) 0.24
Dihydropyridine 18(38%) 5(10%) 0.01
Conclusion: During PE, L is a more potent vasodilator of resistance PA. We could affirm
that the lower vasodilator effect on conduit PA by L may reduce dynamic pulmonary
Betablocker 14(29%) 17(34%) 0.59 afterload improving right ventriculo-arterial coupling during PE.
ACEI/ARB 19(40%) 30(60%) 0.12 Disclosure of Interest: None Declared
Diuretics 23(48%) 33(66%) 0.18
Digoxin 10(21%) 10(20%) 1.00

PT088
Comparison of Patients undergoing Endovascular aneurysm repair in Australia,
Canada and the UK
HFPEF(n[48) HFREF(n[50) P Clare Mackillop1, Robert Fitridge1, Margaret Boult1, Prue Cowled*1, Mary Barnes2,
SBP (mmHg) 142(29) 150(27) 0.17 Tania De Loryn1
1
Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide,
NT-proBNP (pg/ml) 6331(11008) 13565(15322) 0.01 2
Computational Informatics, CSIRO, Adelaide, Australia
Creatinine (umol/L) 145(102) 130(81) 0.44
Introduction: A large dataset was amassed using data from patients who had undergone
Cretinine Kinase (U/L) 116(82) 175(194) 0.05
elective treatment of endovascular aneurysm repair (EVAR) data in Australia, UK and
Hemoglobin (g/L) 11(2) 13(2) <0.01 Canada.
Death at 30 day 2(4%) 3(6%) 0.66 Objectives: EVAR data was compiled with the purpose of reviewing whether there were
any discernible differences in patients between countries and / or centres.
Death at 6 month 4(8%) 7(14%) 0.37 Methods: EVAR data for 4192 patients was obtained from the following sources (n, years
of procedure):

- Australia (512, 2009 – 2012)

Conclusion: Similar to global data, HFPEF is found in about half of acute heart failure
presentations. HFPEF patients have lower NT-pro BNP levels. More anemia was found in
HFPEF, and there is also an association between calcium channel blocker dihydropyridine
use and HFPEF presentation.
Disclosure of Interest: None Declared
PT087
Preferential Vasodilator Effects of Levosimendan in Resistance Pulmonary Arteries in
a Rat Pulmonary Embolism Model
Camila Bedó1, Bianca Barreira2, Francisco Pérez-Vizcaíno2, Juan C. Grignola*1
1 ones in the UK. Neck length and neck diameter was noticeably longer and wider in the
Pathophysiology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay,
2
Pharmacology, Universidad Complutense, Madrid, Spain
Introduction: Levosimendan (L) is a new type of inodilator drug that was introduced for
clinical use more than a decade ago. The relaxant properties of L were studied mainly in
systemic vessels. We have demonstrated that L significantly decreased pulmonary dynamic
afterload during an ovine embolism model, suggesting a predominant vasodilation effect on
resistance pulmonary arteries (PAs).
Objectives: We analyzed the vasoactive effects of L on isolated proximal (conductance,
CPA) and distal (resistance, RPA) PA in a rat pulmonary embolism model.
Methods: Pulmonary arterial (PAP) and aortic pressures (AoP) were measured in anes-
thetized Wistar rats. The animals were divided in a sham and pulmonary embolism group
(PE). Venous embolization with fresh autologous blood-clot was carried out progressively
over 60 minutes until arterial systemic hypotension was produced. After removing the
heart and lungs, conduit (2nd order) and resistance (5th order) branches of PA arteries
were carefully dissected from surrounding tissue and cut into rings of 2mm of length.
Each ring was mounted in a myograph for isometric tension recording in a 5-ml organ
bath filled with Krebs solution at 37 C and aerated with 95% O2-5% CO2. Vascular
function was studied by concentration-response curves of acetylcholine (10-9 to 10-5 M)
- Australia (959, 1999 – 2001)
- London UK (292, 2001 – 2007)
- London UK (272, 2007 – 2010)
- Leicester UK (533, 1999 – 2010)
- Cambridge UK (523, 2006 – 2010)
- Ontario Canada (1102, 1999 – 2010)
Comparable information on a number of preoperative variables and death was
available. Statistical comparisons were undertaken using the following items: date of
birth, date of death, date of procedure, gender, ASA, creatinine, maximum aneurysm
size, infrarenal neck length, infrarenal neck diameter, aortic neck angle, tortuosity and
calcification.
Results: Patients operated on in London were significantly older than their counter-
parts elsewhere (p<0.001). Smaller aneurysms were treated in Australia and larger
recent London patients. Patient fitness, as measured by ASA was worse in Canada
(p<0.001). Renal fitness was lower in the more recent datasets (London and Australia).
With some exceptions, twelve-month survival appears to be slightly improved in pa-
tients operated on after 2006, regardless of country. No significant differences were
found in tortuosity rankings however London patients appeared to have more calci-
fication of the iliac arteries than Australian patients. A small difference seems to exist
between the number of female patients operated on in Australia and Canada compared
with the UK.
Conclusion: There may some differences in the way certain anatomical measurements are
made at different centres which may explain the differences in neck length and diameter.
Calcification and tortuosity can also be subjective, as can ASA.
However, given the large number of patients in this combined study, some
conclusions can be made. Generally Australian surgeons operate on smaller aneu-
rysms and slightly fitter patients than those in the UK and Canada. London patients
are typically older and have the largest aneurysms. Despite these differences, survival
does not seem to vary between centres so much as over time and appears to be
improving.
Disclosure of Interest: None Declared

e182 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

PT089 Methods: We retrospectively examined the files for all patients presenting to a teaching

Preoperative Factors Associated with 12 Month Survical after EVAR
Robert Fitridge1, Margaret Boult1, Prue Cowled*1, Mary Barnes2, Tania De Loryn1,
Domenic Robinson1
1 chest pain presentations. Sudden onset nature of the pain was the most predictive factor,
Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide,
2 occurring in 62.8% of cases and appeared to be the best discriminating factor from
Computational Informatics, CSIRO, Adelaide, Australia
Introduction: Survival after endovascular aneurysm repair (EVAR) is an important
consideration for patients considering elective surgery. For some patients, risk of rupture
per year with no treatment may be similar to the risk of dying of unrelated causes within 12
months of having EVAR. Identifying preoperative factors that most strongly influence 12
month survival will help clinicians & patients decide whether an intervention may be
unnecessary and medical surveillance preferable.
Objectives: The aim of the study was to identify preoperative clinical and anatomical
factors, which would significantly predict the likelihood of a patient surviving 12 months
after EVAR.
Methods: Data were derived from two Australian audits of EVAR; procedures performed
between 1999 to 2001 (n¼961) and 2009 to 2011 (n¼383). Death data were obtained
POSTER ABSTRACTS
hospital over an 11 and a half year period, from 2001 to 2012, who were coded to have
aortic dissection on discharge.
Results: Of the 160 patients identified at coding, 43 were deemed to have acute aortic
dissection (Stanford type A or B). This equated to approximately one episode in every 800
ischaemic heart disease. The chest pain was almost three times more likely to be described
as heavy, dull or ‘typical of ischaemic chest pain’ than it was sharp of tearing. Widened
mediastinum on Chest X-Ray was rarely useful. CT aortogram was the most likely mode of
diagnosis. Of the 43 patients, 24 went for surgery. Hospital mortality was 18.6%. In pa-
tients with acute type A dissection where time to diagnosis could be accurately determined,
the average time to diagnosis was 483 minutes. Using our retrospectively created flow
chart, 100% of patients with type A dissection in this cohort would have been identified
immediately for prompt investigation.

web 3C=FPO
from the National Death Index. The study type was a retrospective analysis of prospectively
collected data. Preoperative variables included routine demographic data, clinical health
assessments and CT-derived anatomical data of the AAA and associated vasculature. One
predictor at a time binomial/logistic regressions were performed to determine which var-
iables significantly predicted one year survival after EVAR. Statistical significance was
determined at P  0.05.
Results: The mean all-cause mortality at 12 months in the combined two cohorts was
6.7%. Eleven of the predictive variables tested were independently correlated with mor-
tality (Tables). The most significant were aneurysm diameter, serum creatinine levels and
ASA score based on p-values and ROC. Conclusion: Acute aortic dissection is a rare condition which may present in a wide variety
of ways, leading to significant delays in diagnosis. A high index of clinical suspicion is
required as the presentation is infrequently the ‘classical’ tearing chest pain. Mortality re-
mains high despite current best medical practice. From our results we created a simple flow
Number Number of cases
chart which can be used to help quickly identify those patients who require prompt
investigation.
Preoperative anatomical factor p ROC of Deaths with data available
Disclosure of Interest: None Declared
Maximum Diameter of Aneurysm 0.00001 0.65 87 1304
Neck Angle greater than 600 0.01700 0.57 36 585 PT092
Infrarenal Neck Diameter 0.02600 0.57 80 1233 Doppler Timing Intervals For Discriminating “True” Severe Stenosis From “Pseudo-
Infrarenal Neck Length 0.04100 0.56 80 1225 severe” Stenosis In Low-flow Low-gradient Aortic Stenosis By Transthoracic
Echocardiography
Highest Calcification Rating 0.04900 0.56 87 1246
Adrian Chong*1,2, Howard Leong-Poi2, Alicia Bartlett1, Sudhir Wahi1
1
Cardiology, Princess Alexandra Hospital, Brisbane, Australia, 2Cardiology, St Michael’s
Hospital, Toronto, Canada

Introduction: Low-flow low-gradient aortic stenosis (LFLG AS) is defined echocardio-

Number Number of cases graphically by AVA<1.0cm2, LVEF<40% and mean gradient (MG)<30-40mmHg. Un-
Preoperative clinical factor p ROC of Deaths with data available differentiated LFLG AS patients have a poor prognosis and high surgical mortality. Aortic
ASA 0.00000 0.62 89 1296 valve replacement (AVR) is beneficial in “true” severe (TS) but not “pseudo-severe” (PS) AS.
Low-dose Dobutamine stress echocardiography (LDSE) is the only current discriminator.
Creatinine 0.00240 0.63 86 1279
Objectives: We aimed to determine if Doppler-derived acceleration (AT) and ejection
Age 0.02300 0.56 91 1344 times (ET) are able to distinguish TS from PS.
Respiratory Assessment 0.02300 0.55 87 1291 Methods: A retrospective analysis of all LDSE for LFLG AS was conducted. TS was defined
by a peak AVA <1.0cm2and/or MG>40mmHg (with AVA<1.0cm2) with/without con-
Cardiac Assessment 0.02700 0.58 87 1294 tractile reserve (stroke volume (SV) increase >20%). Standard hemodynamic variables of
Cancer (non-skin) 0.004 71 961 MG, AVA and SVi were used as reference. Stroke work loss (SWL), valve resistance (VR)
and projected AVA (pAVA) were calculated for comparison. Timing intervals (AT, ET, AT/
ET ratio) were measured for correlation.
Results: 23 TS and 13 PS patients by DSE-criteria were included (77
8yrs; 33% fe-
male). There were significant differences in resting MG (TS 26.3
5.7 vs PS
Conclusion: Univariate analysis has identified eleven factors that are significantly 19.4
5.0mmHg, P<0.001), AVA (TS 0.72
0.13 vs PS 0.82
0.14cm2, P¼0.04), DSI
associated with 12-month all-cause mortality. We aim to develop a risk stratification (TS 0.20
0.03 vs PS 0.23
0.03, P¼0.006), SWL (TS 18.6
4.6 vs PS 13.9
4.8%,
model for 12-month survival of individual patients using these preoperative variables. P¼0.006), and VR (TS 200
45 vs PS 149
30dynes-s-cm-5, P<0.001) but not with
This will help surgeons & patients decide whether there is likely to be significant SVi or LVEF. Significant differences were observed in baseline AT (TS 119.1
11.6 vs
benefit from surgery. PS 90.7
10.3ms, P<0.001) and AT/ET (TS 0.41
0.02 vs PS 0.31
0.03, P<0.001)
Disclosure of Interest: None Declared and remained discriminatory at peak dose (TS vs PS: AT 96.3
15.4 vs 70.0
13.5ms,
P<0.001; AT/ET 0.38
0.03 vs 0.29
0.03, P<0.001). The AT/ET ratio paralleled
PT091 expected findings in peak-DSE MG (TS 40.0
7.5 vs PS 26.3
9.2mmHg, P<0.001),
AVA (TS 0.83
0.11 vs PS 1.25
0.21cm2, P<0.001) and pAVA (TS 0.83
0.09 vs PS
Mode of Presentation and Diagnosis of Acute Aortic Dissection: A Difficult Diagnosis 1.14
0.20cm2, P<0.001). In a model including DSI, pAVA and AT/ET, the AT/ET had
That Doesn’t Read the Textbooks!
the highest AUC on ROC analysis (P<0.001) at rest and remained unchanged at peak
Roland Hilling-Smith1, Vishesh Turaga*1, Josh Laing1, Shalini Balachandran1, Elizabeth Potter2, dose highlighting its relative flow-independence.
Geoff toogood1 Conclusion: AT/ET is able to discriminate between TS and PS on baseline echocardiog-
1 raphy and appears relatively flow-independent. AT/ET may be a useful resting discrimi-
Cardiology, Frankston Hospital, 2General Medicine, Monash, Melbourne, Australia
natory parameter in the assessment of LFLG AS without the need for LDSE.
Introduction: Acute aortic dissection is a relatively rare condition with variable presen- Disclosure of Interest: None Declared
tation which carries a significant mortality rate, however survival is improved with early
diagnosis and management. The last update from the International Registry of Acute Aortic PT093
Dissection was in 2000, since this time diagnostic and therapeutic techniques have
advanced significantly. Balloon Aortic Valvuloplasty (BAV) for the management of Severe Aortic Stenosis in
Objectives: To obtain a real world snapshot of mode of presentation and initial the era of Transcatheter aortic valve implantation (TAVI)
investigation of acute aortic dissection in a teaching hospital in the modern era. We Karthigesh (Kat) Sree Raman*1, Rajesh Nair1, Gerard Devlin1, Sanjeevan Pasupati1
created a simple flow chart to improve emergency department assessment and diag- 1
Cardiology, Waikato Hospital, Hamilton, New Zealand
nostic yield.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e183

 Introduction: The advent of TAVI has seen resurgence in BAV for both bridging and
POSTER ABSTRACTS
palliation of patients with symptomatic severe aortic stenosis (AS).
Objectives: We report our experience with BAV over a five year period at Waikato Hos-
pital, Hamilton, New Zealand.
Methods: Retrospective study of all patients undergoing BAV from December 2007
to December 2012 was included. Bridging time to surgical aortic valve replacement
(sAVR) or TAVI was by 3 months and those who were not bridged; if they were
still alive at subsequent follow-ups were reassessed for suitability for a definitive
therapy.
Results: A total of 164 procedures were performed in 159 patients with 1 patient
undergoing 2 redo BAV. No patients were lost to follow up with a median follow up of
399 days (range 1–1848 days). Mean age was 81
10, 102 patients (64%) were men.
Mean logistic EUROSCORE was 24%
18%. 18% had a concomitant coronary inter-
vention. Post BAV aortic mean gradient and valve area improved from 48
16 to
30
11mmHg (p<0.0001) and 0.7
0.2 to 1.0
0.3cm2 (p<0.0001). According to
VARC definition, major vascular complications occurred in 1%, major and minor
stroke in 1% and 0.6% respectively and major bleeding in 1%. There was no proce-
dural mortality. Median NYHA class improved from 3 to 1 (p<0.0001). Patients
(n¼71) with reduced ejection fraction (EF) (EF <50%); 37(52%) patients showed an
improvement in EF, 29(41%) had no change and in 5(7%) the EF had worsened. In
patients with significant mitral regurgitation (n¼64), 29(45%) patients improved
sufficiently post BAV to avoid mitral valve replacement (p<0.0001). Compared to 6
months pre and post BAV mean admission with AS symptoms dropped from 1
1 to
0
1 (p<0.0001). 61 patients were bridged (11(18%) patients sAVR; 50(82%) patients
TAVI) of which 29(48%) patients were bridged by 3 months; median bridging time
was 125 days (range 8-925 days). Overall 30 days, 1 and 2 year all cause and car-
diovascular survival are:
All patients (n[164) Bridged (n[61) Non-Bridged (n[103)
30 days
All cause 92% 98% 88%
Cardiovascular survival 94% 98% 92%
1 year
All cause 64% 92% 52%
Cardiovascular survival 82% 98% 72%
2 year
All cause 50% 87% 22%
Cardiovascular survival 72% 95% 47%
Conclusion: In a high-risk cohort BAV can be performed safely to bridge to definitive
therapy. It is useful to assess cardiac reserve and improvement in MR and functional status
to decide on sAVR or TAVI. As a palliative procedure it reduces hospital admissions and
improves quality of life.
Disclosure of Interest: None Declared
PT094
Echocardiographic characteristics of very elderly patients submitted to valve
replacement due to severe aortic stenosis
Nuno S. Marques*1, Daniel S. Caldeira2, Olga Azevedo3, Rui Lima4, Emanuel Correia5,
Miguel Alves6, Bruno Piçarra7, Catarina Sousa8, Ana Rita Almeida2, Sunshine
1
Cardiology, Faro Hospital, Faro, 2Cardiology, Hospital Garcia Horta, Almada, 3Cardiology,
Chaa, Guimarães, 4Cardiology, H. Viana Castelo, Viana do Castelo, 5Cardiology, H. São
Teotónio, Faro, 6Cardiology, H. Santarém, Santarém, 7Cardiology, H. Évora, Évora,
8 PT097
Cardiology, H. Barreiro, Barreiro, Portugal
Introduction: The aging of population led to an increase of the number of patients with
severe aortic stenosis with indication for valve replacement. Echocardiogram is very
important in the selection of candidates to surgery among the very elderly patients with
severe aortic stenosis
Objectives: Echocardiographic evaluation of thevery elderly patients with severe aortic
stenosis submitted to valve replacement.
Methods: Multicenter retrospective systematic study including all patients submitted to
valve replacement due to severe aortic stenosis at the age of 80 years or older, from Jan/
2007 to Dec/2011. Transthoracic echocardiogram (TTE) was performed and the following
parameters were evaluated: left ventricular (LV) systolic function, concomitant valve dis-
ease, maximum and mean pressure gradient and maximum flow velocity across the aortic
valve and aortic valve area. LV systolic function was evaluated by echocardiogram in the
follow-up. Statistical analysis using SPSS 20.0.
Results: The study included 41 patients (53.7% males). The indication for surgery was
predominantly the presence of symptoms (97.6%). Coronary heart disease was present in
43.9% of patients and other comorbidities in 85.4% of patients. ECG showed sinus rhythm
in 78% of patients and LV hypertrophy in 46.3%.
Pre-operative echocardiogram showed preserved LV function in 85.4% of patients,
mild LV dysfunction (LVEF 40-50%) in 7.3% of patients, moderate LV dysfunction
e184
(LVEF 30-40%) in 4.9% of patients and severe LV dysfunction (LVEF <30%) in 2.4%
of patients. Mean LV ejection fraction (LVEF) was 64
13. Concomitant valve disease
was present in 51.2% of patients (mitral regurgitation in 36.6% of cases). Mean and
maximum pressure gradient was 44
11 mmHg and 83
20 mmHg, respectively. Mean
aortic valve area was 0.7
0.2cm2. Three patients had low flow low gradient aortic
stenosis.
In the follow-up, the echocardiogram was performed at 60
14 months after surgery in
30 of the 32 patients that were still alive. LV systolic function was preserved in 81.6% of
patients, mildly decreased in 7.9%, moderately decreased in 5.3% and severely decreased in
5.3% of patients.
Conclusion: In this series, the majority of the very elderly patients with severe aortic
stenosis submitted to valve replacement had preserved LV function and high pressure
gradients and flow velocities in the pre-operative echocardiogram. In the medium term
follow-up, LV function remained preserved in most patients.
Disclosure of Interest: None Declared
PT096
Therapeutic Approaches And Survival Patterns In Adults With Pah And Chd –
Insights From The Anz Registry
Michelle Rose*1,2, Geoff Strange3, Leeanne Grigg4, Fiona Kermeen5, Clare O’Donnell6,
Ingrid King7, David Celermajer8, Robert Weintraub2
1
Cardiology, The Murdoch Children’s Research Institute, 2Cardiology, The Royal Children’s
Hospital, Melbourne, 3Phsanz, Sydney, 4Cardiology, The Royal Melbourne Hospital, Melbourne,
5
Thoracic, The Prince Charles Hospital, Brisbane, Australia, 6The Starship Children’s Hospital,
Auckland, New Zealand, 7The Murdoch Children’s Research Institute, Melbourne, 8Cardiology,
Prince Charles Hospital, Sydney, Australia
Introduction: Improving care of congenital heart disease patients has resulted in a new
population of adult congenital heart disease (CHD) survivors who are at risk of
complications including heart failure, arrhythmias and pulmonary arterial hypertension
(PAH).
Objectives: To better understand management patterns and long-term outcomes of these
patients.
Methods: A bi-national ANZ web-based registry for adult CHD patients with asso-
ciated PAH was established. The inclusion criteria were patients aged >16 yrs, seen
at least once in an adult CHD centre after 1/1/2000, with a confirmed diagnosis of
PAH.
Results: Of the 360 adults enrolled, 66% were classified as having simple CHD lesions
and 68% had Eisenmenger Syndrome (ES). At the time of first ACHD visit, 56% of
cases were Functional Class (FC) III and 34% FC II. PAH targeted therapies were
widely utilized with endothelin receptor antagonists (ERA’s) prescribed to 73% of
patients, compared to 40% on PDE5 inhibitors. Anticoagulants were prescribed in 44%
of cases and diuretics in 39%.
Freedom from decline in NYHA FC was 80% at 5yrs, 65% at 10yrs and 55% at 15 years
during adult CHD follow-up. Freedom from a 20% decline in 6 minute walk-distance was
65% at 10 years. Freedom from hospitalizations for any cause was 68% at 10 years and
48% at 20 years, with heart failure and arrhythmias the most likely reasons for hospital
admission. Transplant-free survival was 85% at 5 years, 78% at 10 years and 65% at 20
years. Lower baseline 6MWD (<375m) was related to worse survival (p¼.03) as was the
presence of congestive heart failure (p¼.02) and earlier era of first adult CHD attendance
(p¼.03).
Conclusion: New options for management of this emerging population pose challenges
for adult CHD centres. Requirement for medical therapy and utilization of health re-
sources are high. Specialist multidisciplinary PAH services incorporating CHD care and
targeted PAH therapies both should optimize long-term management of this chal-
lenging group.
Disclosure of Interest: None Declared
Staphylococcus aureus endocarditis in an Australian tertiary hospital: a 10-year
review
Andrew Lin*1, Edward Buratto2, Myles Wright2, Paul Conaglen2, Jonathan Darby3,
Andrew Newcomb2, Phillip Davis2, Andrew Wilson1, Melbourne Endocarditis Study Group
1
Department of Cardiology, 2Department of Cardiothoracic Surgery, 3Department of Infectious
Diseases, St. Vincent’s Hospital, Melbourne, Australia
Introduction: Staphylococcus aureus is the leading cause of infective endocarditis (IE) and
its mortality has remained high despite advances in diagnostic and treatment strategies over
time.
Objectives: To describe the characteristics, management and outcomes of patients with
S.aureus IE in an Australian tertiary hospital and identify trends in this cohort over 10
years.
Methods: Retrospective analysis of S.aureus IE patients treated at St. Vincent’s Hospital
Melbourne between 2001 and 2011.
Results: During the study period there were 81 patients with definite S.aureus IE. The
median age was 45 years. Patients were classified into two groups: 1) right-sided IE (33
patients) and 2) left-sided IE (48 patients). Patients with right-sided IE were younger,
had fewer comorbidities, and were more likely to be intravenous drug users (66.7% vs.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
22.9%, p<0.01) than were patients with left-sided IE. Among the cases of left-sided IE, Objectives: To evaluate the significance of initial presenting symptoms in predicting the

the aortic valve was more commonly involved than the mitral valve (72.9% vs. 27.1%).
Overall, 68.2% of patients with left-sided IE developed one or more cardiac or extra-
cardiac complication, whilst 75.8% of patients with right-sided IE developed com-
plications, predominantly pulmonary emboli. Prosthetic valve IE occurred in 16.0% of
patients, resulted in a shorter duration of symptoms until diagnosis (9.1 vs. 16.4 days,
p<0.05), and required more frequent and more urgent surgery compared to patients
with native valve IE.
The in-hospital mortality rate was significantly higher for patients with left-sided IE
compared to those with right-sided IE (hazard ratio [HR], 6.1; 95% confidence interval
[CI], 2.8–21.2). Risk factors for in-hospital mortality for all patients included age over 60
(HR, 2.2; 95% CI, 1.2–6.0), renal failure (HR 3.1, 95% CI, 1.5–7.8), and prosthetic valve
IE (HR, 3.2; 95% CI, 1.3–9.2).
Surgical treatment was undertaken in 29 patients (35.8%), and was associated with a
trend towards reduced in-hospital mortality in patients with left-sided IE (HR, 0.3; 95% CI,
0.1–1.0). During the study period there was an increase in presentations to non-tertiary
hospitals and rates of methicillin-resistant S.aureus (MRSA) infection. There was no clear
improvement in survival over the 10 years.
Conclusion: S.aureus endocarditis is an aggressive, often fatal, infection, especially in
patients with left-sided and prosthetic valve involvement. Surgery may be associated with
improved outcomes in patients with left-sided infection.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
severity of CIED infections in those patients undergoing device extraction.
Methods: A retrospective analysis was performed of consecutive patients who underwent
CIED extraction at the Royal Melbourne Hospital between January 2012 and February
2013. Patients and device related data was reviewed from the clinical notes and pathology
server for analysis.
Results: 53 patients underwent CIED extraction for infection over the period. Overall,
75% presented with predominately localised symptoms (pocket collection, cellulitis
and/or device erosion), and 25% presented with predominately systemic symptoms
(fevers, rigors and/or septic shock). The former were more likely to be culture negative
(35% vs 0%, p¼0.012). Despite having significantly lower rates of pocket infection
(15% vs 83%, p¼<0.001) and device erosion (0% vs 56%, p<0.001), patients pre-
senting with systemic symptoms had a higher presenting WCC (11.0
4.2 vs
6.9
4.3), more frequent positive blood cultures (92.3% vs 5.0%, p<0.001), lead
endocarditis (100% vs 10%, p<0.001) and Staphylococcus Aureus related infections
(38.5% vs 12.5%, p¼0.038) (Figure 1). There were no major differences in de-
mographic characteristics, or major co-morbidities between the two populations
(Figure 2).

PT098
Early Transesophageal echocardiography and empirical antibiotic therapy may
prevent higher mortality and morbidity in medically treated patients of infective
endocarditis
Farook Ahmad*1, Christabel David Mojiun2, Muhammad Athar Sadiq2
1
School Of Medicine, University Of Queensland, Brisbane, Australia, 2School Of Medicine,
Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia

web 3C=FPO
Introduction: Infective endocarditis (IE) carries a high risk of in hospital mortality (9.6%
to 26%). Current data show that up to 50% of patients with IE undergo surgery during
hospitalization. Early surgery has been shown to reduce mortality in some sub-groups,
especially those with Staphylococcus aureus–IE
Objectives: This study assessed the role of early transoesophageal echocardiography (TEE)
in patients with clinically-suspected IE. The effect on 6-week in-hospital morbidity/mor-
tality in patients receiving immediate antibiotic therapy but not undergoing early valve
replacement was determined.
Methods: The course and clinical outcome of 50 patients, from 2008 to 2012 at
University Malaya Medical Centre, with native valve IE was retrospectively reviewed.
All patients with clinical suspicion of IE and positive blood cultures were promptly
evaluated by TEE. Intra-cardiac evidence of endocarditis was confirmed in each case.
All patients were treated medically as cardiac surgery was not readily available due to
institutional practice
Results: Isolated mitral valve endocarditis was the most common form of involvement
(n¼27, 54.0%), followed by aortic (n¼11, 22.0%) and tricuspid valve (n¼4, 8.0%). Six
patients (12.0%) developed combined mitral and aortic valve endocarditis. S. aureus was
the most common cause of IE (n¼29, 58.0%). Other isolated organisms included Strep-
tococcus viridans (n¼6), Enterococcus (n¼5), HACEK and fungal (n¼2) and non-aureus
Staphylococci. All patients received AHA guideline recommended antibiotic therapy fine-
tuned with microbiological data. Frequent complications were severe heart failure (NYHA
Class III-IV; n¼12, 24.0%); persistently positive blood cultures (n¼8, 14.5%,); new
conduction system abnormalities (n¼5, 9.1%); systemic embolization (n¼7, 4.5%); and
intra-cardiac abscess (n¼2, 3.6%). The overall mortality was 10 % (n¼5), all related to S.
aureus. In these patients the TEE showed severe, destructive valvular disease with abscess
formation and perforation. All surviving patients were discharged without clinical evidence
of ongoing IE.
Conclusion: Confirming the diagnosis of IE by early TEE with immediate empiric anti-
biotic therapy appeared to at least prevent higher morbidity/mortality in a center where
cardiac surgery was not an available option during the course of medical therapy. Patients web 3C=FPO
with S. aureus who present with heart failure and persistently positive blood cultures may
do poorly with medical treatment.
Disclosure of Interest: None Declared

PT099
Predicting the severity of cardiac device-related infections – Can the urgency for
device extraction be risk stratified based on initial presentation?
Sandeep Prabhu*1, Nigel Lewis1, Nisha S. Rao1, Matias B. Yudi1, Neil F. Strathmore1
1
Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Introduction: The epidemiology of patients with cardiac implantable electronic devices
(CIED) infections undergoing extraction is poorly characterized. In particular, the
correlation between initial presenting symptoms and infection severity has not been
previously characterised in the extraction population. Such correlation may help risk
stratify patients for extraction, given the limited availability of device extraction
resources.
Conclusion: Despite being a less common mode of presentation, patients with CEID
related infections with systemic symptoms displayed multiple features of increased
infection severity – namely increased rates of bacteraemia, leukocytosis, endocarditis
and an aggressive culprit organism. Such patients may warrant expedited extraction
over those presenting with localized symptoms only. Thus, mode of presentation may
be a factor used to stratify the urgency of device extraction and prioritize access to a
limited resource.
Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e185

 PT100
POSTER ABSTRACTS
Comparative Risk Of Recurrent Adverse Events In Marfan And Non-Marfan
Aortopathy
Richmond Jeremy*1, Elizabeth Robertson1
1
Medicine, University of Sydney, Sydney, Australia
Introduction: The adverse impact of genetic aortopathies of the non-Marfan spectrum is
increasingly recognized. Surgical intervention with aortic root replacement is advocated to
prevent fatal dissection, but residual risk remains for dissection of other aortic segments.
Objectives: To characterize the risk of recurrent adverse aortic events after initial surgical
intervention in patients with Marfan and non-Marfan aortopathy.
Methods: Prospective enrolment of all patients with genetic aortopathy in dedicated clinic
registry from 1990 – 2012, with documentation of all adverse events, including surgery,
dissection and death.
Results: There were 273 Marfan and 365 non-Marfan patients enrolled with mean follow-
up of 12.2 years and 5.9 years respectively. There were 139 first events in the Marfan group
(26 fatal) followed by 53 second events (19 fatal) at 6.9
6.2 years after first event and 21
third events (9 fatal) at 5.1
4.4 years after second event. In the non-Marfan group there
were 269 first events (85 fatal) with 48 second events (24 fatal) at 6.0
6.7 years after first
event and 11 third events (5 fatal) at 4.5
4.8 years after second event.
Marfan Non Marfan
N (% risk) Age (years) N (% risk) Age
1 - Dissection 43 (15.8%) 35.5
14.3 137 (37.5%) 50.1
13.8 *
1 - Surgery 96 (35.2%) 132 (36.2%)
2 - Dissection 15 (6.1%) 40.3
11.3 12 (4.3%) 52.7
14.7 *
2 - Surgery 38 (15.4%) 36 (12.9%)
3 - Dissection 9 (3.9%) 44.9
12.9 7 (2.6%) 53.7
16.5
3 - Surgery 12 (5.3%) 4 (1.5%)
* p<0.001 vs Marfan
Conclusion: Both Marfan and non-Marfan aortopathy have high adverse event rates,
although first events occur later in non-Marfan aortopathy. Both groups have significant
number of recurrent events relatively soon after the first event.
Disclosure of Interest: None Declared
PT102
Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous
Mitral Commissurotomy In Patients With Rheumatic Mitral Stenosis With Impaired
Left Ventricular Systolic Function
Md. Toufiqur Rahman*1,2, Md. Afzalur Rahman1, Md. Murshidur Rahman Khan1
1
Cardiology, National Institute of Cardiovascular Diseases, Dhaka, 2Cardiology, Al-Helal Heart
Institute, Mirpur, Dhaka, Bangladesh
Introduction: Rheumatic fever and rheumatic heart disease continue to be the major
health problem in all developing countries including Bangladesh. Left ventricular
dysfunction is known in patients with mitral stenosis, but the incidence and cause
remain unclear. Many factors such as extension of subvalvular disease, progression of
mitral annular calcification, and tachycardiomyopathy have been postulated as putative
causes.
Objectives: The purpose was to see the effect of left ventricular diastolic dysfunction on the
immediate clinical and echocardiographic outcome of patients undergoing PTMC.
Methods: The immediate procedural and in-hospital clinical outcome after PTMC of 264
patients with left ventricular dysfunction were prospectively collected and compared with
those of 288 patients with normal left ventricular function with mitral stenosis admitted in
National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur,
Dhaka during the period of August 2003 to May 2013
Patients with left ventricular diastolic dysfunction were included as mild LV systolic
dysfunction if ejection fraction was < 50% and moderate LV systolic dysfunction if ejection
fraction between 30% and 50% and as severely depressed LVEF if below 30%. So, patients
were divided into four groups. Group-1 includes patients with normal ejection fraction;
Group-2 has 200 patients with mild LV systolic function, Group-3 has 70 patients with
moderate LV systolic dysfunction, Group-4 has 18 patients with severe LV systolic
dysfunction.
Results: Mean age of the study population was 28.31
11.21 years .Most of the popu-
lation are female (81%). Before PTMC Mitral Valve Area (MVA) in Group-1 was 0.82

0.11 cm2, in Group-2 was 0.81
0.18 cm2, in Group-3 was 0.80
0.52 cm2 and in
Group-4 was 0.81
0.91 cm2. After PTMC Mitral Valve Area (MVA) in Group-1 was 1.63

0.57 cm2, in Group-2 was 1.64
0.38 cm2, in Group-3 was 1.62
0.57 cm2 and in
Group-4 was 1.62
0.39 cm2 . Before PTMC, Left Atrial Pressure was 32
08 mm Hg in
Group-1, 33
07 mm Hg in Group-2, 32
09 mm Hg in Group-3 and 33
05 mm Hg in
Group-4 . After PTMC Left Atrial Pressure was 32
08 mm Hg in Group-1, 33
07 mm
Hg in Group-2, 32
09 mm Hg in Group-3 and 33
05 mm Hg in Group-4. Compli-
cations during and after the procedure was very few.
Conclusion: PTMC is a safe and effective procedure even in patients of mitral stenosis with
severe LV systolic dysfunction.
Disclosure of Interest: None Declared
e186
PT103
A Novel Approach for Measuring Aortic Regurgitation post Transcatheter Aortic
Valve Implantation using Time Density Changes in Contrast
Abdul Rahman Ihdayhid*1, Sandeep Chopra1, Gerald Yong1, Carl Schultz1,2
1
Cardiology Department, Royal Perth Hospital, 2School of Medicine and Pharmacology,
University of Western Australia, Perth, Australia
Introduction: Aortic regurgitation (AR) post Transcatheter Aortic Valve Implantation
(TAVI) is associated with increased mortality. Conventional assessment of aortic regurgi-
tation using echocardiography is problematic due to multiple jets, eccentric jets, inadequate
Doppler beam alignment and artefact from the prosthesis.
Objectives: We aim to evaluate a new software for quantifying aortic regurgitation by using
time density changes during contrast aortography (CAAS qRA, Pie Medical Imaging,
Maastricht, Netherlands) in comparison to a subjective visual assessment (Seller’s).
Methods: 152 Aortograms post TAVI from 2009 to 2013 were retrospectively assessed for
suitable image quality for inclusion in the study. Imaging criteria were a C-arm projection
showing ascending aorta, aortic valve and left ventricle (LV) without over-projection,
adequate contrast injection, cine of at least 30 frames/s, absence of motion artefact from
echocardiography probe and breathing.
Two independent assessors visually assessed post TAVI AR using Seller’s technique in
addition to quantifying AR with qRA software which compares contrast density changes in
the aortic root and left ventricle (Fig. 1). Relative area under the time-density curve (RAUC)
was measured by dividing the LV AUC by the aortic root AUC. qRA index was calculated
by weighting RAUC by several factors. An interrater reliability analysis using Kappa statistic
was performed to determine consistency in Seller’s assessment. Spearman’s correlation was
used to assess reproducibility of AUC and qRA index.
Results: 14 aortograms from 12 patients were included in study. The majority of patients
were excluded due to projection of descending aorta over the LV and motion artefact. The
median grade of AR using Seller’s was 2+. The inter-observer reproducibility of Seller’s
assessment was moderate (Kappa ¼0.57, p<0.001). The inter-observer correlations for
RAUC and qRA index were respectively 0.89 and 0.78, both p<0.001. Seller’s assessment
was highly correlated with RAUC (0.80, p<0.001) and moderately with qRA-index (0.66,
p<0.01).
web 3C=FPO
Conclusion: Assessment of AR post TAVI using qRA-software to analyse time-density
curves from aortograms shows promise as being reproducible and accurate. Attention to
image acquisition should substantially improve quality. Prospective data will be presented.
Disclosure of Interest: None Declared
PT104
Ruptures of the device landing zone in patients undergoing Transcatheter Aortic
Valve Implantation – an analysis of TAVIK patients using computed tomography and
the HeartNavigator
Gerhard Schymik*1, Martin Heimeshoff2, Peter Bramlage3, Rainer Wondraschek1,
Tim Süselbeck4, Jan Gerhardus2, Armin Luik1, Herbert Posival2, Claus Schmitt1, Holger Schröfel2
1
Cardiology, STÄDT. KLINIKUM KARLSRUHE, 2cardiac surgery, Clinic for Cardiac Surgery,
Karlsruhe, 3ippmed, Mahlow, 4Cardiology, Medical Clinic I - Department of Cardiology,
Mannheim University, Germany, Mannheim, Germany
Introduction: Ruptures of the device landing zone are rare complications of transcatheter
aortic valve implantation (TAVI) potentially leading to cardiac tamponade and hemody-
namic collapse. Though relatively infrequent with rates reported between 0.5 to 1.1%,
mortality is approximately 50%. Compared to standard surgical procedures, the compli-
cation is very difficult to control.
Objectives: Examine ruptures of the annular device landing zone in transcatheter aortic
valve implantation (TAVI). The HeartNavigator helps plan the optimal location and angle
for device implantation and choosing the appropriate valve size.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 Methods: We used the HeartNavigator for planning 1,000 TAVIs between April 2008 and
April 2012 (TAVIK).
Results: We observed a total of 6 ruptures of the device landing zone (0.60%) with no dif-
ference between balloon expandable (Edwards SAPIEN 5/801; 0.62%) versus self-expandable
valves (Medtronic-CoreValve/Symetis-ACURATE 1/199; 0.50%; p¼n.s.). We found that 1)
the relative size of the valve compared to the aortic annulus and its geometric form (potentially
ellipsoid), 2) the need for post dilation of the new valve in situ because of paravalvular leakage,
and 3) the degree and location of calcifications are determinants of ruptures of the device
landing zone. Caution is warranted if the following anatomic/morphologic conditions exist:
1) flat sinuses of Valsalva and severe calcifications on the body or the free edge of the aortic
cusps (supraannular rupture), 2) an ellipsoid annulus and bulky calcifications on the base of
the cusps or the rim of the annulus (annular rupture) and 3) a narrow left ventricular outflow
tract (LVOT) and bulky calcification in the LVOT (subannular rupture).
web 3C=FPO
Conclusion: Mortality in patients with ruptures of the device landing zone is high. The
combination of computed tomography with the HeartNavigator as a planning tool might be
useful in further reducing this devastating TAVI complication.
Disclosure of Interest: G. Schymik Consultancy for: Edwards Lifesciences, Honorarium
from: Edwards Lifesciences, Medtronic, M. Heimeshoff Grant/research support from:
Edwards Lifesciences, Consultancy for: Edwards Lifesciences, P. Bramlage: None Declared,
R. Wondraschek: None Declared, T. Süselbeck Honorarium from: Medtronic, J. Gerhardus:
None Declared, A. Luik: None Declared, H. Posival: None Declared, C. Schmitt: None
Declared, H. Schröfel Honorarium from: Edwards Lifesciences, Philips, Symetis
PT105
Redo percutaneous mitral commissurotomy for mitral restenosis: A fifteen-year
experience
Leila Abid Trigui*1, ahmed tounsi1, salma charfeddine1, samir kammoun1
1 Conclusion: PMBC is a safe and effective procedure for selected pregnant women with
cardiology departement, Hedi Chaker Hospital, Sfax (Tunisia), MEDECINE UNIVERSITY
SFAX, sfax, Tunisia
Introduction: Very few reports have looked at redo percutaneous mitral commissurotomy
in patients with mitral restenosis
Objectives: To prove that redo PMC is as safe and efficient as a first procedure
Methods: Our study was a retrospective. Between 1998 and 2012, 480 patients underwent
a PMC. Among them 107 required a new PMC during follow-up. Echocardiographic
assessment of the mitral valve was performed in all patients. PMC was performed by using
Inoue technique. Procedural success was defined as a 50% or more increase in mitral valve
area, with a final mitral valve area  1.5 cm2, without major complications
Results: Both groups were similar in terms of age (33.96+/- 12.87 for de novo group versus
29.57 +/-11.04 for redo group) and female percentage 78 % vs 79% (p¼0, 84). There was
no difference between groups in term of pre procedural mitral valve area: (0.99 +/- 0.24 for
the 480 patients and 1.01 +/- 0.30 for the 107 others), valve morphology quantified using
the Wilkins score and pulmonary systolic pressures. The procedure was successful for
85.4% of patients of the de novo group and only 79.4 % for the redo group
(p ¼0.28).There was no exceed in major immediate complications such as hemopericar-
dium, acute severe mitral regurgitation or death. During follow up 24 cases or restenosis
were noticed among the 107patients group within a mean period of 79+/-51months versus
118 cases in the other group. But the difference wasn’t statistically significant
Conclusion: Repeat PMC results in good immediate and long term outcomes with no
exceed of complications especially in patients with favorable anatomic forms
Disclosure of Interest: None Declared
PT106
Impact of atrial fibrillation on immediate and long-term results of percutaneous
mitral balloon commissurotomy: Our experience
Leila Abid Trigui*1, ahmed tounsi1, salma charfeddine1, samir kammoun1
1 observed in 27% of patients. Neither moderate thrombocytopenia, nor a decrease in
cardiology departement, Hedi Chaker Hospital, Sfax (Tunisia), MEDECINE UNIVERSITY
SFAX, sfax, Tunisia
Introduction: There is controversy as to whether the presence of atrial fibrillation (AF)
has a direct negative effect on the outcome after percutaneous mitral balloon commis-
surotomy (PMC)
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: to examine the effect of AF on the immediate and long-term outcome of
POSTER ABSTRACTS
patients undergoing (PMC)
Methods: The immediate procedural and the long-term clinical outcome after PMC of 130
patients with AF (group 1) were retrospectively collected and compared with those of 350
patients in normal sinus rhythm (group 2)
Results: Group 1 patients were older (45 +/- 13 versus 29.9 +/- 10 years; p <0.001), had a
larger left atrial diameter and presented more frequently with echocardiographic score >8
(36.9% vs. 22.8%; p < 0.001). The two groups were similar in terms of the final mitral
valve area, the gain of mitral valve area, the mean pressure gradient across the mitral valve,
and the complication rate (NS for all). The procedural success was 87.7% in group 1 and
92.8% in group 2 (p ¼ NS). In group 1, 44 cases of restenosis were noticed within a mean
period of 79+/-51months of follow up versus 95 cases in the other group.(p¼0.01). AF was
an independent predictor of combined events (death, redo PMC or mitral valve surgery; OR
¼ 1.86; p ¼0.01), and was a univariate predictor of restenosis (p ¼ 0.038)
Conclusion: Patients with AF have good immediate results, but poorer long-term outcome
after PMC. AF a marker of worse prognosis in patients with mitral stenosis as it is in the
general population
Disclosure of Interest: None Declared
PT107
Treatment of severe mitral stenosis with percutaneous balloon commissurotomy in
pregnant patients in a tertiary Tunisian center of cardiology
Leila Abid Trigui*1,1, salma charfeddine1, ahmed tounsi1, ahmed siala1, dorra abid1,
samir kammoun1
1
cardiology departement, Hedi Chaker Hospital, Sfax (Tunisia), MEDECINE UNIVERSITY
SFAX, Sfax, Tunisia
Introduction: Pregnancy can cause life-threatening complications in women with mitral
stenosis. Frequently, there is an urgent need to increase the mitral valve area. In selected
cases, percutaneous mitral balloon commissurotomy (PMBC) has emerged as a safe and
effective alternative to surgical commissurotomy
Objectives: To present our experience of PMBC by the Inoue technique in sixteen preg-
nant patients with severe symptomatic mitral stenosis
Methods: During 15 years, 379 PMBC were successfully performed in women, 16 of them
were pregnant.The patients were in NYHA functional class III or IV at the time of procedure
and did not respond positively to drug treatment
Results: PMBC was performed in 16 pregnant females aged 33
5 years (range 23-38) with
severe mitral stenosis at around 24 weeks of gestation. After the procedure, all patients
showed marked immediate clinical and hemodynamic improvement, NYHA functional class
I- II. After dilatation, the mean left atrial pressure decreased from 28
6.53 to 13
4.85
mmHg (p ¼ 0.037), the mitral gradient decreased from 21
5.88 to 7.5
5.34 mmHg (p ¼
0.015) and the calculated mitral valve area increased from 1
0.18 to 2
0.37 cm2. During
the procedure, there were no maternal or fetal complications. All patients had uneventful
term deliveries of normal babies. During follow up, one patient who had moderate mitral
regurgitation after valvuloplasty developed severe mitral regurgitation, requiring surgical
correction after 4 years and another patient developed restenosis requiring a second PMBC
severe mitral stenosis who are refractory to medical treatment. The possible harmful effects
to the fetus from its exposure to radiation are unknown
Disclosure of Interest: None Declared
PT108
Thrombocytopenia Post Transcatheter Aortic Valve Implantation – Incidence and
Impact on Clinical Outcomes
Matias Yudi*1, Khoa Phan1, Caitlin Cheshire1, James Wong1, Subodh Joshi1, Roderic Warren1,
Vanessa Ogden1, Marco Larobina1, John Goldblatt1, Ronen Gurvitch1
1
Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Recently, anecdotal reports of alterations in platelet counts following
Transcatheter Aortic Valve Implantation (TAVI) have emerged. There is currently a paucity
of data regarding its incidence and potential impact on clinical outcomes.
Objectives: We aim to describe the incidence of post-TAVI platelet count reduction and
occurrence of moderate thrombocytopenia (platelet count <100X109/L), and assess its
impact on in-hospital outcomes.
Methods: The first fifty patients undergoing successful TAVI with the Edwards Sapien-XT
valves at Royal Melbourne Hospital were analysed. One patient was excluded because
platelet transfusion was required pre-procedure. Clinical characteristics, pre-procedural
and daily post-procedural platelet counts were analyzed. In-hospital outcomes including
VARC (Valve Academic Research Consortium) major bleeding, blood transfusion, vascular
complications and prolonged hospitalizations were evaluated.
Results: Patients were 83.9
5.6 years old, had a mean STS score of 7.8%
3.7%, and
63% underwent trans-femoral TAVI. The mean pre-procedural platelet count was
208
54X109/L and the mean lowest post-procedural platelet count was 127
43X109/L. A
25% decrease in platelet count was observed in 88% of patients and a 50% decrease in
platelet count was observed in 14% of patients. At least moderate thrombocytopenia was
platelet count by more than 50% was significantly associated with VARC major bleeding
(p¼0.17), blood transfusions (p¼0.80), vascular complications (p¼0.26) or prolonged
hospitalization (p¼0.32). No patients required post procedural platelet transfusions.
Conclusion: A vast majority of patients experience at least a 25% reduction in platelet
count post-TAVI, without any apparent significant increases in adverse clinical endpoints
e187
 including VARC bleeding, vascular complications, prolonged hospitalization or need for
POSTER ABSTRACTS
blood transfusion. The mechanism of this complication and impact on long-term outcomes
requires further evaluation.
Disclosure of Interest: None Declared
PT109
Short term clinical outcomes after percutaneous mitral commissurotomy for mitral
stenosis
1 1 1
Muhammad A. Rauf* , Nida M. Rauf , Wahaj Aman , Mohammad Hafizullah , cardiology1
departement lady reading hospital peshawar
1
Cardiology, Lady reading hospital, peshawar, Pakistan
Introduction: Percutaneous Transvenous Mitral Commissurotomy (PTMC) is the treat-
ment of choice for mitral stenosis. Patients with valvular calcification, thickened fibrotic
leaflets and subvalvular fusion have adverse short terms outcomes of PTMC.
Objectives: To determine the frequency of short term clinical outcomes of percutaneous
transvenous mitral commissurotomy for mitral stenosis among patients having wilkin score
of  12.
Methods: STUDY DESIGN: Descriptive cross sectional study.
Setting: Cardiology Unit Govt. Lady Reading Hospital Peshawar.
Duration: Nine months and twenty days (July 01, 2012- June 20, 2013).
Subjects: One hundred and seventy five patients of mitral stenosis.
Methods: Mitral stenosis patients with or without pre existing mild mitral regurgitation
admitted in Cardiology Unit, Lady Reading Hospital Peshawar were included in the study.
After performing PTMC according to standard protocol, data regarding improvement in
mitral valve area, pulmonary artery pressure and severity of mitral regurgitation was recorded.
Results: Out of total 175 patients 56 (32%) were males. The mean age of the patients was 22.69

7.93 years. Mean BMI of patients was 21.07
3.95. Mean Wilkin’s score was 6.69
1.99
ranging from 3-11. Improvement in mitral valve area, pulmonary artery pressure, mitral valve
gradient and left atrial volume were found in 148 (84.6%), 170 (97.1%), 175(100%) and
170(97.1%) respectively. While worsening in mitral regurgitation was 47(26.9%).
Conclusion: PTMC is a safe and effective procedure with good short term outcomes like
improvement in mitral valve area, pulmonary artery pressure, mitral valve gradient and left
atrial volume and not worsening mitral regurgitations in patients of mitral stenosis having
Wilkin’s score  12
Disclosure of Interest: None Declared
PT110
Melatonin Reduces The Pulmonary Vasoconstriction In Rats With Pulmonary
Hypertension Induced By Monocrotaline
Luiz Alberto F. Ramos*1, Fernanda P. Henrique-Cabrini1, Dora M. Grassi-Kassisse1,
Miguel A. Areas1
1
Biology Structural and Physiology, STATE UNIVERSITY OF CAMPINAS - UNICAMP,
Campinas, Brazil
Introduction: Pulmonary Arterial Hypertension (PAH) is characterized by thickening of
vascular smooth muscle cells, increased pulmonary arterial pressure and right ventricular
hypertrophy and impairs alveolar gas exchange and cardiac function. Monocrotaline (MCT)
is an alkaloid and an animal model of PAH in rats by cardiovascular alterations. Melatonin
(MEL) is a hormone produced by pineal gland, can reduce the smooth muscle vascular
tone, and also modulate the hemodynamic parameters.
Objectives: Evaluate the effect of melatonin on the contractile response of pulmonary
artery in monocrotaline-induced rats.
Methods: Male Wistar rats (250g.) were divided into four groups: CO (control), MCT
(monocrotaline), MEL (melatonin), five animals per group (n¼5). MCT was administered
as a single dose intraperitoneal (ip) (60mg/Kg ip) to induce PAH. Melatonin was admin-
istered (10mg/Kg ip) during 28 days of experimental period, after this phase, the animals
were anesthetized (ketamin 100mg/Kg. plus xilazine 7mg/Kg intramuscular) to obtain
vascular rings in vitro. Statistical procedure: Analysis of Variance (ANOVA) followed by
Tukey test for comparison between groups (p<0.05).
Results: Melatonin significantly reduced the contractile response of pulmonary artery and
control rats with PAH for maximum response of vascular reactivity.
e188
Conclusion: - Melatonin treatment was able to reduce the changes in pulmonary artery in
rats with PAH.
References: Anita Umesh et all; - Alteration of Pulmonary Artery Integrin Levels in
Chronic Hypoxia and Monocrotaline-Induced Pulmonary Hypertension J Vasc Res
2011;48:525–537
Disclosure of Interest: None Declared
PT111
Dobutamine improves left ventricular diastolic function in pulmonary arterial
hypertension
Nithin R. Iyer*1, Edmund M. Lau1,2, Preeti Choudhary1, Christina W. Chan1,
David S. Celermajer1
1
Department of Cardiology, 2Department of Respiratory and Sleep Medicine, Royal Prince Alfred
Hospital, Camperdown, Australia
Introduction: In pulmonary arterial hypertension (PAH), left ventricular (LV) diastolic
dysfunction occurs at rest, due to interventricular interaction. Although dobutamine is
clinically used in decompensated right ventricular (RV) failure, the positive chronotropic
effect of dobutamine may worsen LV diastolic abnormalities by shortening diastolic filling
time, thus limiting any rise in cardiac output from improved RV systolic performance. The
effect of dobutamine on LV diastolic function has not previously been characterised.
Objectives: To determine the effect of dobutamine on LV diastolic function in PAH
patients.
Methods: 11 PAH subjects (age 57
18) and 18 healthy controls (age 49
16; P¼0.27 vs
PAH subjects) were studied with Doppler echocardiography at baseline and during
dobutamine infusion (pre-specified infusion end point was 20 mcg/kg/min or HR>120
bpm). LV diastolic function was assessed by ratio of early transmitral velocity to tissue
Doppler mitral annular early diastolic velocity (E/e
). LV systolic function was assessed by
systolic medial mitral annular velocity (s’) and stroke volume (SV), estimated from left
ventricular outflow time velocity integral. RV systolic function was assessed by tricuspid
annular plane systolic excursion (TAPSE) and systolic tricuspid annular velocity (s’).
Results: At baseline, systolic pulmonary artery pressure was 82
23mmHg in PAH subjects
and 21
5mmHg in controls (P<0.001). Baseline E/e
was elevated in PAH subjects
compared to controls (12.8
4.9 vs 8.9
3.3cm/s, P¼0.02), consistent with restricted
diastolic filling. Peak dobutamine dose reached was similar between PAH subjects (20mcg/
kg/min; n¼9) and controls (20mcg/kg/min; n¼17; P¼0.6 vs PAH subjects). LV systolic
function improved significantly with dobutamine infusion in both PAH (LV medial s’:
7.1
0.7cm/s to 11.9
2.9cm/s; P<0.01) and control subjects (7.4
0.9cm/s to
13.8
2.8cm/s; P<0.001). Dobutamine infusion increased stroke volume in PAH subjects
from 57
12mL to 71
15mL, accompanied by an increase in RV s’ from 10.8
3.0cm/s to
18.0
7.4cm/s (P<0.01) and TAPSE from 1.7
0.4cm to 1.9
0.4cm (P¼0.045). Dobut-
amine decreased E/e
in PAH subjects (9.4
3.1; P¼0.04 vs baseline) but remained un-
changed in healthy controls (8.8
2.7; P>0.9 vs baseline).
Conclusion: Dobutamine, a commonly used inotropic agent for the treatment of RV
failure, improves LV diastolic dysfunction in subjects with PAH. The improvement in
cardiac output seen during dobutamine therapy may, in part, be mediated through
improved LV diastolic filling.
Disclosure of Interest: None Declared
PT113
Prognostic factors for in-hospital death after valvular heart disease surgery in Brazil
Vitor M. P. Azevedo1, Wilma F. Golebiovski2, Guilherme D. T. Amorim2, Amanda Bonfim2,
Regina E. Müller*1, Fabio Tagliari2, Marcela Cedenila2, Regina Maria Aquino Xavier1,
Clara Weksler2
1
Research, 2Cardiology, NATIONAL INSTITUTE OF CARDIOLOGY, Rio de Janeiro, Brazil
Introduction: In developed counties, valvular heart disease is most related to degenerative
etiology and prognostic linked to age and comorbidities. It remains doubtful whether in
development countries the prognostic factors are similar, considering that rheumatic heart
disease (RHD) still brings concern.
Objectives: To study prognostic factors for valvular heart disease surgery in a Brazilian
tertiary referral center.
Methods: Retrospective review of 1012 adults patients that were submitted to valvular
heart disease surgery in Brazil from 2004 and 2012. It was studied in-hospital mortality by
any cause. Statistical analyses were accomplished by chi-square, Student t test, and Cox
regression model. Significance was achieved by p<0.05, and all tests were two-tailed.
Results: Mean age 52.2 (15.2) years, BMI 24.7 (4.7), creatinine 1.07 (0.47), creatinine
clearance 74.3 (29.3), LVEF 60.7% (13.7), LA 4.88cm (1.13), SPAP 51.7mmHg (20.5),
perfusion time 127.0min (52.2), ischemic time 105.5min (43.1), RHD 46.0%, female
53.6%, Afro-Brazilian 40.1%, diabetes 10.6%, renal failure 2.18%, infective endocarditis
9.89%, COPD 4.96%, heart failure 60.2% being NYHA III or IV 63.7%, previous valvular
surgery 18.0%, moderate/severe valvular lesions: aortic stenosis 32.8%, mitral stenosis
36.2%, aortic regurgitation 29.8%, mitral regurgitation 45.3%, tricuspid regurgitation
21.7%, CABG associated 15.6%. Mortality rate was 17.0% (172). In univariate analysis for
death, they were factors: age (deceased 59.8
13.9 vs survivor 50.7
15.8, p<0.001),
creatinine 1.24
0.8 vs 1.03
0.34 (p<0.001), creatinine clearance 60.8
23.5vs
77.1
29.5 (p<0.001), LVEF 57.9
15.0 vs 61.2
13.3 (p¼0.004), perfusion time 169.4

75.4 vs 118.5
41.1 (p<0.001), ischemic time 134.2
58.9 vs 99.6
36.3 (p<0.001); non
RHD etiology 19.8% vs 13.8% (p¼0.011), diabetes 25.7% vs 16.0% (p¼0.012), renal
failure 47.6% vs 16.5% (p<0.001), previous valvular surgery 27.0% vs 14.8% (p<0.001),
moderate/severe tricuspid regurgitation 21.8% vs 15.7% (p¼0.033), CABG associated
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
68.2% vs 15.9% (p<0.001), and heart failure 18.6% vs 14.2% (p¼0.06) was close to greater impaired RV longitudinal function (TAPSE 2.2
0.3 vs. 1.9
0.3cm, p<0.001),

significance. In multivariate analysis were prognosis factors: age (HR¼1.020, 95CI¼1.007-
1.035), creatinine clearance (each 5 points) (HR¼0.868, 95CI¼0.798-0.945), LVEF (each
5%) (HR¼0.940, 95CI¼0.890-0.992), and perfusion time (each 10 min) (HR¼1.135,
95CI¼1.111- 1.160).
Conclusion: They were prognosis factors for in-hospital death in multivariate analysis: age,
creatinine clearance, LVEF, and perfusion time.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
higher PASP (30.7
5.9 vs. 39.0
8.2mmHg, p<0.001) and PVR (1.6
0.3 vs. 2.2
0.4
Wood units, p<0.001), higher pro-BNP levels (34.2
8.7 vs. 84.2
30.5 pmol/L, p¼0.03)
despite similar LV systolic and diastolic function, when compared to those with normal
6MWT.
Conclusion: Functional impairment is evident in apparently well long-term survivors of
submassive PE and is associated with RV dysfunction and raised PASP and PVR.
Disclosure of Interest: None Declared

PT114 PT117

Prognostic factors for in-hospital death of Rheumatic Heart Disease Patients after Pulmonary Hypertension and Valvular Heart Disease: Does assessment of
valvular heart disease surgery in Brazil reversibility help?

Vitor M. P. Azevedo1, Wilma F. Golebiovski2, Guilherme D. T. Amorim2, Amanda Bonfim2, Kashif Khokhar*1
1
Regina E. Müller*1, Fabio Tagliari2, Marcela Cedenila2, Regina Maria Aquino Xavier1, Cardiology, Waikato Hospital, Hamilton, Hamilton, New Zealand
Clara Weksler2 Introduction: Background: Valvular heart disease (VHD) may result in pulmonary hy-
1
Research, 2Cardiology, NATIONAL INSTITUTE OF CARDIOLOGY, Rio de Janeiro, Brazil pertension (PHT) which is an important predictor of right ventricular failure and mortality
following surgical intervention.
Introduction: In development countries, rheumatic heart disease (RHD) still brings Objectives: Assessment of reversibility of pulmonary artery pressures (PAP) and pulmo-
concern. It remains doubtful which prognostic factors are involved in these patients after nary vasculature resistance index (PVRI) may be useful in identifying high risk patients
valvular heart disease surgery. resulting in better procedural outcomes.
Objectives: To study prognostic factors for valvular heart disease surgery in a Brazilian Methods: We have done a retrospective study of 100 consecutive patients of VHD with
tertiary referral center. moderate to severe PHT (systolic PAP of 50mmHg, mean PAP >30mmHg and mean
Methods: Retrospective review of 466 adults RHD patients that were submitted to valvular pulmonary capillary wedge pressure >15mmHg), from June 2010 until June 2013.
heart disease surgery in Brazil from 2004 and 2012. It was studied in-hospital mortality by Assessment of pulmonary vascular reversibility was performed by using nebulised illoprost
any cause. Statistical analyses were accomplished by chi-square, Student t test, and Cox (20microgram/ml for 10minutes).
regression model. Significance was achieved by p<0.05, and all tests were two-tailed. Results: The median patient age was 77 years (range 27 to 84), 60% male. Seventy two
Results: Mean age 44.8 (13.7) years, height 1.61m (0.1), BSA 1.66 m2 (0.21), creatinine (72%) had severe mitral valve and 28(28%) had severe aortic valve disease. Twenty one
1.01 (0.31), creatinine clearance 78.9 (29.7), LVEF 61.4% (12.0), LA 5.26cm (1.10), SPAP patients (30%) with severe mitral valve disease had dual valve pathology. Reversibility was
54.1mmHg (21.1), perfusion time 126.4min (49.0), ischemic time 103.9min (40.9), female assessed in 30 patients (30%). Seventeen (53%) had a 20% or greater decrease in PVRI and
67.8%, Afro-Brazilian 46.6%, diabetes 5.9%, renal failure 1.51%, infective endocarditis was more likely to occur in patients with higher PVRI. Response was less likely to occur in
12.03%, COPD 3.43%, heart failure 64.4% being NYHA III or IV 64.5%, previous valvular patients with high wedge pressure and left ventricular dilatation.
surgery 27.6%, moderate/severe valvular lesions: aortic stenosis 21.9%, mitral stenosis
65.0%, aortic regurgitation 28.7%, mitral regurgitation 55.1%, tricuspid regurgitation
31.3%, CABG associated 4.72%. Mortality rate was 13.7% (64). In univariate analysis for Responders Non-Responders
death, they were factors: age (deceased 52.1
13.8 vs survivor 43.6
13.3, p<0.001),
(N[17) (N[13) p-value
height 1.59
0.09 vs 1.62
0.1(p¼0.016), BSA 1.60
0.22 vs 1.67
0.21(p¼0.022),
creatinine 1.16
0.54 vs 0.99
0.25 (p<0.001), creatinine clearance 62.2
25.0 vs Age Median 71yrs Median 66yrs 0.376
81.6
29.5 (p<0.001), LVEF 62.0
12.8 vs 61.2
11.9 (p¼0.627 - NS), LA 5.3
1.14 vs (Range 37-83) (Range 51-79)
5.2
1.1 (p¼0.668 - NS), perfusion time 158.3
72.3 vs 121.4
42.3 (p<0.001), ischemic Mean PCWP (Right heart study) 22mmHg 29mmHg *0.030
time 119.0
55.4 vs 101.5
37.7 (p¼0.001), previous valvular surgery 21.9% vs 10.7%
(p¼0.002), NYHA III or IV 17.6% vs 8.5% (p¼0.031), moderate/severe tricuspid regur- Pulmonary Artery Systolic Pressure 60 mmHg 59 mmHg 0.5498
gitation 21.2% vs 10.3% (p¼0.001), and CABG associated 31.8% vs 12.8% (p¼0.012). In (Right heart study)
multivariate analysis were prognosis factors: creatinine clearance (each 5 points) Pulmonary Vascular 11WU/m2 7.3WU/m2 *0.00758
(HR¼0.802, 95CI¼0.701-0.917) (p¼0.001), and perfusion time (each 10 min) Resistance Index (PVRI)
(HR¼1.129, 95CI¼1.083- 1.177) (p<0.001). Age was close to significance (HR¼1.021,
95CI¼0.997- 1.045) (p¼0.083). Change in PVRI post Reversibility 3.3WU/m2 0.03WU/m2 *0.000144
Conclusion: They were prognosis factors for in-hospital death in multivariate analysis: test with Iloprost
creatinine clearance, and perfusion time. Cardiac Index Litres/min/metre2 2.55L/min/m2 2.04L/min/m2 *0.001249
Disclosure of Interest: None Declared
Left Ventricle diastolic dimension on 53 millimetre 60 millimetre *0.0257
transthoracic echo. Pre-study
PT115
*p-value of less than 0.05 is statistically significant
Impaired Right Ventricular Function in Long-term Survivors of Submassive
Pulmonary Embolism
Vincent Chow*1, Austin C. C. Ng1, Leigh Seccombe2, Tommy Chung1, Liza Thomas3, Conclusion: Assessment of reversibility of PHT is infrequently performed in patients with
VHD. When performed reduction in pulmonary vascular resistance is demonstrated in over
David Celermajer4, Matthew Peters2, Leonard Kritharides1
1 50% and may aid in identifying patients more likely to have a better peri-procedural
Cardiology, Concord Hospital & The University of Sydney, NSW, Australia, 2Thoracic outcome.
Medicine, Concord Hospital, 3Cardiology, Liverpool Hospital and University of New South Wales, Disclosure of Interest: None Declared
4
Cardiology, Royal Prince Alfred Hospital and The University of Sydney, Sydney, Australia
Introduction: It is unknown if submassive pulmonary embolism (PE) carries long-term PT118
right ventricular (RV) functional impairment. In particular, RV function and functional A study on Quality of life index in patients with prosthetic valve
capacity of long-term survivors of submassive PE are unreported.
Objectives: We sought to assess RV function and its relationship to functional impairment, Meenakshi Kadiyala*1, R. Bathrinarayanan1, Sundar Chidambaram1, V. E. Dhandapani1,
as assessed by six-minute walk test (6MWT), in apparently well long-term survivors of PE. M. S. Ravi1, D. Muthukumar1, N. Swaminathan1, G. Ravishankar1, N. Premanand1
Methods: From a previously published population of 1023 patients hospitalized for an 1
Cardiology, Madras medical college, Chennai, India
acute PE event, long-term survivors from this cohort were prospectively invited to undergo
6MWT, clinical and biochemical evaluation with cardiac biomarkers. RV chamber size and Introduction: The use of Prosthetic heart valves for heart valve disease has been rampened
the tricuspid annular plane systolic excursion (TAPSE) were assessed by transthoracic since the invention of heart World’s first prosthetic valve replacement done in 1960.
echocardiography (TTE) to determine RV longitudinal function. The pulmonary artery Outcomes of surgery have been improved recently along with prosthetic heart valves
systolic pressure (PASP) and pulmonary vascular resistance (PVR) were obtained non- providing improved hemodynamics, antithrombogenecity, and durability. However further
invasively by Doppler analysis on TTE using the following equation: improvement in QOL (quality of life index) of patient with Prosthetic valve would be
PVR ¼ TRV/TVIRVOT x 10 ¼ 0.16 Wood units. desirable in regards to social, psychological, family and health care. The QOL of patients
(TRV ¼ peak tricuspid regurgiation velocity m/sec & TVIRVOT ¼ time-velocity integral of with prosthetic valve replacement has been evaluated in very few studies. We conducted
the RV outflow tract), with PVR>2 Wood units considered abnormal. the study to evaluate the effects of prosthetic valve in Quality of Life Index in patients with
Results: A total of 120 long-term survivors (52 males; mean age [
SD], 65
14years) were prosthetic valve.
recruited in this study. Mean follow-up post index PE event was 7.7
1.4years. The 6MWT Objectives: The QOL of patients with prosthetic valve replacement has been evaluated in
distance (6MWD) was significantly lower than predicted, adjusted for patient’s age, sex, very few studies. We conducted the study to evaluate the effects of prosthetic valve in
and height (observed 448
114m vs. predicted 475
89m, p¼0.005). TTE showed RV Quality of Life Index in patients with prosthetic valve.
dilatation (Ratio of end diastolic RV to Left Ventricular [LV] Area>0.67), impaired TAPSE Methods: 200 patients who had undergone Prosthetic valve replacement in our institution
(<1.8cm), raised PASP (>36mmHg) and PVR (>2 Wood units) in 7%, 13%, 29% and from Jan 2010 to March 2010 were included in this study. All of them agreed to participate
21% of patients respectively. Patients with 6MWD <85% of predicted had significantly in the study and provided us with written informed consent. There was no significant

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e189

 difference in the participant’s valve types. We used a Ferrans and power questionnaire for
POSTER ABSTRACTS
evaluating patient before and after surgical valve replacement to measure health-related
QOL. Excluded from the analysis were patients who failed to respond to all questions
Results: With respect to the quality of life, prosthetic valve improves a lot after surgery.
Quality of Life Index was improved in patients after prosthetic valve surgery in terms of
Health and Functioning subscale (p<.000), Psychological and spiritual subscale (p<0.003)
and Family subscale (p<.001). Social and Economic subscale was not improved before and
after surgery (p<.485).
Conclusion: The present study suggested that Prosthetic valve improves the quality of life
in patients. For more comprehensive accurate evaluation, large scale studies are needed.
Disclosure of Interest: None Declared
PT119
Evaluation of p53 polymorphism in patients with pannus-derived prosthetic
dysfunction
Süleyman Karakoyun1, Mustafa O. Gürsoy1, Ali Emrah Oguz1, Macit Kalçık1, Mahmut Yesin1,
Sabahattin Gündüz1, Mehmet Ali Astarcıoglu1, Tayyar Gökdeniz1, Mehmet Özkan*1
1
Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, I_stanbul, Turkey
Introduction: Prosthetic valve dysfunction (PVD) due to pannus formation is an infrequent
but serious complication. It is considered to be a bioreaction to prosthetic material. Pannus
usually originates from the neointimal hyperplasia of periannular tissue. The p53 gene
plays a critical role in apoptosis, cell proliferation, and DNA repair.
Objectives: We aimed to evaluate the association between pannus-derived PVD and p53
G72C (Arg72Pro) polymorphism.
Methods: This monocentric, prospective study included 25 patients (group 1) who un-
derwent redo valve surgery due to PVD and age-sex matched 49 control groups (group 2)
with normofunctional prosthesis implanted more than 5 years ago. Prosthesis were
examined with 2 and 3 dimensional transthoracic and transesophageal echocardiography.
Analysis of P53 G72C (Arg72Pro) polymorphism was performed using Roche LightCyler
2.0 Real-time PCR. Genomic DNA was isolated from the peripheral venous blood (leu-
kocytes) using QIAMP DNA Blood Mini Kit (QIAGEN). Minisequencing method was
utilized to analyze mutations.
Results: The mean age of the study population and the control group was 45.6
12.5 (80%
female) and 47.3
12.2 (85.7% female), respectively. The mean elapsed time from first
valve replacement was 119.6
58.4 (range 28-276 ) months and 155.7
68.8 (range 62-
365) months, respectively. There was no significant difference between the groups in terms
of gender, hypertension, diabetes and hyperlipidemia. The incidence of atrial fibrillation
was higher in group 1 than group 2 (58.5% vs. 33.3%, respectively, p¼0.031). In group 1
normal alleles were observed in 48% of the patients, whereas 4% showed homozygous
mutation and 48 % showed heterozygous mutation. In group 2, 42.9% of the patients had
normal alleles, whereas 8.2 % had homozygous mutation and 49% had heterozygous
mutation. No significant difference was observed between the groups with regard to p53
Arg72Pro polymorphism (p¼0.769).
Conclusion: This is the first study that evaluates the genetical basis of pannus overgrowth
after prosthetic valve replacement. According to these preliminary results, the underlying
mechanism behind the pannus formation is unrelated with P53 Arg72Pro polymorphism in
patients with prosthetic valves. Further researches are needed to highlight the etiopatho-
genesis of pannus-derived PVD.
Disclosure of Interest: None Declared
PT123
The Triage Rule-Out Using Sensitive Troponin Study (TRUST). An observational
study of early risk-stratification of patients with suspected cardiac chest pain and
initiation of presentation high-sensitivity troponin testing in low risk Emergency
Department patients
Edward Carlton*1,2, Martin Than3, Ahmed Khattab1, John Beavis1, Kim Greaves4
1
School of Health and Social Care, Bournemouth University, Bournemouth, 2Emergency
Department, Poole Hospital NHS Foundation Trust, Poole, United Kingdom, 3Emergency
Department, Christchurch Hospital, Canterbury District Health Board, Christchurch,
New Zealand, 4Cardiology, Sunshine Coast Health Hospital, Nambour, Australia
Introduction: Following the introduction of high-sensitivity troponin (hsTn) assays, there
is a lack of consensus regarding the optimum rapid rule-out strategy for Emergency
Department (ED) patients presenting with suspected cardiac chest pain. A single hsTn
result below the 99th centile value at presentation has a sensitivity for Acute MI of <94%,
too low for early rule-out of AMI. We tested a rule-out strategy using a combination of risk-
scoring and a single hsTnT at presentation. This is the first truly pragmatic real-world study
of its kind involving over 1000 ED patients.
Objectives: To establish the safety of combining a modified Goldman risk score with an
hsTnT level of <14ng/l within 1-hour of presentation to identify patients at low-risk of
Major Adverse Cardiac Events (MACE) within 30 days.
Methods: This prospective observational study was carried out from July 2012 to August
2013 in a UK District ED. Recruitment was undertaken 24/7 and included patients aged
18-79 who presented with suspected cardiac chest pain and a non-ischaemic ECG un-
dergoing inpatient evaluation. Patients who scored 0 or 1 using the Goldman risk score,
assessed by the treating physician, and had a blinded presentation hsTnT level <14ng/l
were considered low-risk. Follow-up for MACE was undertaken from the hospital elec-
tronic patient record or GP records.
Results: 1020 patients were recruited. Mean age 59 (
12 years SD), and median time to
presentation after chest pain onset was 135 minutes (Interquartile Range 35-235 mins). In
e190
an interim analysis of 400 patients with an overall prevalence of MACE of 13%, there
were 165 patients (43%) that were identified as low-risk. One low-risk patient (0.26%)
had a MACE at 30-days. The Sensitivity, specificity and negative predictive values for
MACE were 98.1% (95% CI 88.4-99.9%), 49.5% (44-55.1%) and 99.4% (96.2-100%)
respectively.
Conclusion: An early discharge strategy of combining a modified Goldman risk score of
0 or 1 with a negative single hsTnT result at presentation may identify 40% of patients
suitable for early discharge. Full results will be presented at the conference.
Disclosure of Interest: E. Carlton Grant/research support from: UK Colleg of Emergency
Medicine, M. Than Grant/research support from: Health Research Council New Zealand
and New Zealand National Heart Foundation, Speakers bureau: Chair of the Emergency
Care Foundation, A. Khattab: None Declared, J. Beavis: None Declared, K. Greaves Hon-
orarium from: AstraZeneca UK
PT125
Contributors to delay to angiography in acute coronary syndrome patients presenting
to secondary centres
Margaret Couper*1, Scott Harding1, Peter Larsen1
1
Wellington Regional Heart and Lung Unit, Wellingon Regional Hospital, Wellington,
New Zealand
Introduction: Aim: Previous studies have shown patients with Acute Coronary Syndrome
(ACS) experience delays if they are referred to a tertiary hospital for angiography from an
outlying hospital.
Objectives: This study examined factors contributing to delays in time to angiography.
Methods: We prospectively examined all ACS patients referred for angiography over a four
week period, and recorded admission time, referral time, time to transfer, time to angio-
gram and catergorised the cause of any delay from referral to transfer and from referral to
angiography.
Results: During the study period 105 patients were referred for angiography, 29 (28%) of
whom were admitted directly to our tertiary hospital with the remaining 76 being referred
from outlying hospitals. Overall the median (interquartlie range) time from admission to
referral was 1 day (0-1), from admission to transfer 3 days (1-5), from admission to
angiogram 3 days (2-5), from referral to transfer 1 day (0-3) and from referral to angiogram
2 days (1-3). Twenty-two patients waited 4 or more days from referral to angiogram. Only
30% of patients from outlying hospitals were transferred on the day of referral, with 46%
waiting more than 2 days for transfer. Median times from admission to referral (p¼0.02),
admission to angiogram (p<0.001) and from referral to angiogram (p<0.001) were all
significantly greater for those not admitted directly to the tertiary hospital. Transfer delays
were due to lack of available bed in the tertiary hospital in 35%, catheterisation laboratory
list time being unavilable 53%, no suitable transportation available in 11%. The weekend
accounted for the majority of time when the catheterisation laboratory was unavailable. A
further delay to angiography occurred in 12% due to intercurrent medical illness or
anticoagulation.
Conclusion: ACS pateints admitted to a secondary hospital had delays to angiography
caused by slower referral and transfer delays. Transfer delays mostly occurred on weekends
when the catheterisation laboratory was unavailable, or because of a shortage of beds.
Operating angiography on the weekends and increasing bed numbers would be likely to
reduce transfer delays for these patients.
Disclosure of Interest: None Declared
PT127
Characteristics and clinical course of STEMI patients who received no reperfusion in
the ANZ SNAPSHOT ACS Registry
Ahmad Farshid*1, David Brieger2, Derek Chew3, Karice Hyun4, Chris Ellis5,
Christopher Hammett6, Gerry Devlin7, Tom Briffa8, Jeff Lefkovits9, John French10, SNAPSHOT
ACS Investigators
1
Cardiology Unit, The Canberra Hospital, Canberra, 2Cardiology Unit, Concord Hospital,
Sydney, 3Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide,
4
Statistician, The George Institute for Global Health, Sydney, Australia, 5Cardiology Unit,
Auckland City Hospital, Auckland, New Zealand, 6Cardiology Unit, Royal Brisbane and
Women’s Hospital, Brisbane, Australia, 7Cardiology Unit, Waikato Hospital, Hamilton, New
Zealand, 8School of Population Health, University of Western Australia, Perth, 9Cardiology Unit,
Royal Melbourne Hospital, Melbourne, 10Cardiology Unit, Liverpool Hospital, Sydney, Australia
Introduction: Community studies of STEMI patients have indicated that over 30% receive
no reperfusion (NR) which is associated with a worse outcome. Reasons for this and
barriers to greater use of reperfusion in STEMI patients have not been well studied.
Objectives: To study the characteristics and clinical outcome of STEMI patients with NR in
Australia and New Zealand as part of the SNAPSHOT ACS Registry.
Methods: The Registry collected standardised data on consecutive ACS patients in 478
hospitals in Australia and New Zealand during 14-27 May 2012.
Results: Of 4398 patients enrolled, 421 had STEMI. Primary PCI (PPCI) was performed
in 160 (38%), fibrinolysis in 106 (25.2%), and 155 (36.8%) had NR. Patients with NR
had a mean age (SD) of 70.2 (15.0) years compared with 63.0 (13.4) in the reperfusion
group (p<0.0001). There were more females in the NR group (37.4% v 22.9%
p¼0.0016) and they were significantly more likely to have a history of hypertension,
atrial fibrillation, MI, CABG, stroke, vascular and renal disease, and to be nursing home
residents (all p<0.05). Presentation to a non-PPCI hospital was a significant predictor of
NR (48% v 32%, p¼0.0012). Only 69% of the NR group underwent angiography
compared with 94% of the reperfusion group (p<0.0001). Proportion of patients
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
receiving 4-5 guideline-recommended medications in the NR group was 68% versus 93%

POSTER ABSTRACTS
in others (p<0.0001). Patients with NR had a significantly higher mortality in hospital
(11.6% v 4.9%, p¼0.013) and a trend towards a higher risk of re-MI (7.7% v 3.8%,
p¼0.08). Of all STEMI patients, 358/421 presented within 12 hours and only 251 of
these reperfusion-eligible patients (70%) received reperfusion. In NR patients presenting
<12 hours, relative contraindications to fibrinolysis including severe hypertension, car-
diac arrest, anticoagulant therapy, history of stroke, dementia and bleeding were present
in only 8 patients. An additional 9 patients had coronary angiography within 12 hours
and underwent non-urgent CABG.
Conclusion: Of consecutive STEMI patients in Australia and New Zealand, 36.8%
did not receive any reperfusion and they had a higher risk of death in hospital.
These patients were older with a higher proportion of females and comorbidities
and often presented late. National strategies to encourage earlier medical contact and
greater use of reperfusion in eligible patients may lead to better outcomes in STEMI
patients.
Disclosure of Interest: None Declared

PT128
Predictors and outcome of slow flow during primary PCI for STEMI in consecutive
patients
Ahmad Farshid*1, Chris Allada1, Darryl McGill1, Simon O’Connor1, Moyazur Rahman1, Conclusion: This study concluded that NLCR has a moderate positive correlation with
Ren Tan1, Paul Marley1, Jaya Chandrasekhar2 MMP-9 in AMI patients.
1
Cardiology Unit, The Canberra Hospital, Canberra, Australia, 2Ottawa Heart Institute, Ottawa, Disclosure of Interest: None Declared
Canada
PT130
Introduction: Slow flow (TIMI <3) during Primary PCI (PPCI) for STEMI occurs in 5-23%
of cases, indicates poor myocardial tissue perfusion, and is associated with a worse Ambulance activation of Code MI substantially reduces door to balloon time
outcome. Christopher Zeitz*1, Bernadette Hoffmann2, Betty Raman1, Kuljit Singh1, Wai Chan1,
Objectives: To determine predictors of slow flow during PPCI and 12 month outcome of
Rachel Dreyer1, Abdul Sheikh1, David DiFiori1, Margaret Arstall2
patients who experienced this complication. 1
Methods: We analysed the PCI database of The Canberra Hospital to identify 774 Cardiology, CENTRAL ADELAIDE LHN, 2Cardiology, Lyell McEwin Hospital, Adelaide,
consecutive patients who underwent PPCI during 2008-2012. Follow up at 12 months was Australia
with letter, phone call and review of hospital records.
Introduction: Outcomes for patients with acute ST elevation myocardial infarction
Results: Slow flow was observed in 49 patients (6.3%) at the end of the procedure. Patients
(STEMI) are highly dependent on timely reperfusion of the infarct-related artery.
with slow flow were older than others (63.8 years v 61.9, p¼ns). Patients older than 60
Objectives: Delivering a rapidly responsive service is not only dependent on an efficient
years had a higher risk of slow flow compared with younger patients (8.1% v 4.6%,
cardiac team but is also dependent on early recognition of patients and activation of a Code
p¼0.046). Slow flow occurred in 7% of males and 4% of females (p¼ns). The risk of slow
MI system.
flow increased if more than one vessel was treated (12.7% v 5.9%, p¼0.048), or if more
Methods: We have operated a Code MI paging system since early 2006. In 2009, we
than one stent was implanted (9.0% v 4.7%, p¼0.035). Type C lesions were associated
established the ability for selected ambulance crews to activate the Code MI system from
with a higher risk of slow flow (9.9% v 4.6%, p¼0.005) as were lesions longer than 30 mm
the field, without any advance consultation or transmission of electrocardiograph. We have
(10.7% v 4.5%, p¼0.006), whereas there was a trend away from slow flow if the artery had
compared treatment times for patients self-presenting to the emergency department with
initial TIMI 3 flow (3.5% v 7.2%, p¼0.067). There was a trend towards slow flow with
those arriving via ambulance and those with Code MI activated in the field.
pain to balloon time more than 6 hours (9.7% v 5.7%, p¼0.098). Diabetes, smoking and
Results: Between 2009 and 2012, there were 673 STEMI cases that underwent primary
other risk factors were not significant predictors of slow flow in our patients. During 12
percutaneous coronary intervention. Performance measures are recorded in the table.
months follow up, slow flow was associated with a higher incidence of death (14.3% v
5.2%, p¼0.023) and MACE (composite of death, MI, CVA, re-PCI, CABG) (26.5% v
12.8%, p¼0.014). Median (minutes) n Code MI to Balloon Door to Balloon
Conclusion: Slow flow occurred in 6.3% of PPCI patients and was more likely with age
> 60, type C lesions, long lesions, multi-vessel PCI and multiple stent deployment. Slow Self-presentation 228 57 74
flow was associated with a higher risk of death and adverse events during follow up. Arrive by ambulance 367 57 77
Strategies to minimise the risk of slow flow may improve outcomes in PPCI. Field ambulance activation 88 60 44
Disclosure of Interest: None Declared
*p<0.001 vs arrive by ambulance

PT129
The associations of neutrophil-lymphocyte count ratio and matrix metalloproteinase-9
in acute myocard infarct patients
Badai B. Tiksnadi*1, Muhammad R. Akbar1, Achmad F. Yahya1, Syarief Hidayat1,
Toni M. Aprami1
1
Cardiology and Vascular Medicine, Hasan Sadikin Hospital, Bandung, Indonesia
Introduction: Matrix metalloproteinase (MMP)-9 is one of extracellular matrix degrading
proteases which has a role in myocardial remodeling process after acute myocardial infarct
(AMI). There is a new parameter routinely examined for a patient at admission, neutrophyl-
lymphocyte count ratio (NLCR), which also increases in AMI patients and is also assumed
can predict ventricular remodeling.
Objectives: The aim of this study was to find a positive correlation between NLCR and
MMP-9 in patients with AMI.
Methods: This was a cross-sectional study which recruited patients who came to emer-
gency department with ischemic chest pain initiated less than 24 hours. Blood sample of
serum MMP-9 was drawn together with routine blood examination on admission.
Results: There were 37 patients who were eligible in this study. The mean age was
55.8 years and 78% of them were male. Seventy-six percent of the subject had ST-
Elevation Myocard Infarct (STEMI) and the median of onset was six hours. The mean
of NLCR was 5.24 (2.4) ng/ml, and the median of MMP-9 was 370 ng/ml with first and
third quartile (240 – 530) ng/ml. One-sided Pearson correlation showed positive
correlation between two variables with r¼0.44 and p¼0.003. Multivariable analysis of;
infarct type; ACE-inhibitor usage; and statin usage variables, which was conducted
using linear regression test showed that NLCR was an independent variable to predict
MMP-9. This equation then was made: MMP-9 ¼ 40.87 (NLCR) + 211.3 which
afforded linear regression rules.
Conclusion: A simple measure that permits ambulance staff to activate a Code MI from the
field substantially reduces door to balloon times for patients with STEMI. Implementation
of this strategy across all ambulance crews is currently occurring. Additional work is being
done to ensure that Code MI activation from the field occurs at the earliest possible time in
order to facilitate maximum efficiency in assembling the cath lab team.
Disclosure of Interest: None Declared
PT131
Effect of Nicorandil on Clinical Outcomes In Patient With St-Segment Elevation And
Non St-Segment Elevation Myocardial Infarction: Based on The Korea Acute
Myocardial Infarction Registry(Kamir)
Han Cheol Lee*1, Jae Hoon Choi2, Jin-Sup Park1
1
Cardiology, Pusan National University Hospital, 2Cardiology, Busan Medical Center, Busan,
Korea, Republic Of
Introduction: Nicorandil has cardiac protective effect in the ischemic myocardium. The
effect is related to ischemic preconditioning, prevent vasospasm, reduce myocardial
inflammation, reduce myocardial necrosis, and improve coronary artery perfusion.
Objectives: However, there are rare large studies whether or not nicorandil is effective in
patient with ST segment elevation myocardial infarction(STEMI)and non ST segment
elevation myocardial infarction(NSTEMI).
Methods: 6370 patients with STEMI in Korean Acute Myocardial Infarction Registry
(KAMIR) were divided to two groups: a group with nicorandil(STEMI-N group, n¼1,313)
and a group without nicorandil(STEMI-C group, n¼ 5,057,). 4184 patients with NSTEMI
in KAMIR was divided to two groups: a group with nicorandil(NSTEMI-N group, n¼874)
and a group without nicorandil (NSTEMI-C group, n¼ 3,306). We analyzed for death and
myocardial infarction and composite of major adverse cardiac events(MACE) at 1, 6 month.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e191

 Results: In the STEMI, STEMI-N group is significant low incidence of MACE, MI
POSTER ABSTRACTS
compared to STEMI-C group on 1 month[Composite MACE: 2.2% vs. 4.1%, p¼0.001,
Cardiac death: 1.1% vs. 1.8%, p¼0.068, MI: 0.1% vs. 0.5%, p¼0.019), On 6 month,
STEMI-N group is also significant low incidence of MACEs, MI compared to STEMI-C
group. (Composite MACE: 8.1% vs. 10.1%, p¼0.047, Cardiac death: 1.7% vs. 2.7%,
p¼0.054, MI: 0.1% vs. 0.9% p¼0.002). Patients with NSTEMI do not show differences of
clinical outcomes at 1, 6 months between NSTEMI-N group and NSTEMI-C group.
Table. Clinical outcomes in patients with STEMI on months
Nicorandil Control
(STEMI-N group) (STEMI-C group)
(n[1.313) (n[5.057) P-value
6-month composite MACE(%) 90 (8.1) 445 (10.1) 0.047
All-cause death 26 (2.3) 162 (3.7) 0.026
Cardiac death 19 (1.7) 120 (2.7) 0.054
Myocardial infarction 1 (0.1) 38 (0.9) 0.002
Conclusion: Nicorandil in patients with STEMI reduced incidence of MACE and MI on 1,
6 months. But, there was no beneficial effect of nicorandil in patients with NSTEMI.
Disclosure of Interest: None Declared
PT132
Study on in-hospital mortality for female patients with ST-segment Elevation
Myocardial Infarction
Hao Fu1, Q. I. Hua2, Yusheng Zhao*3
1
Emergency Center, Capital University of Medical Sciences affiliated Beijing Anzhen Hospital,, Bei jing,
2
Cardiology, Capital University of Medical Sciences affiliated Beijing Xuanwu Holspital, 3Gerontic
Cardiovascular Disease Institution, Chinese People Liberation Army Hospital, Beijing, China
Introduction: There are conflicting reports in the literature regarding the role of sex on the
in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI)
Objectives: To analyze in-hospital mortality for female patients with ST-segment elevation
myocardial infarction .
Methods: 1189 patients were enrolled. At first, 320 female patients were compared with
869 male patients about baseline(i.e. age,comorbidity,etc)and clinical factors (i.e. typical
angina pectoris, in-hospital mortality, etc).Then analyze gender defferences of in-hospital
mortality in a multivariate model.
Results: Compared with male patients, female patients were older(68.51 years VS 60.76 years,
P<0.001), the morbidities of type 2 diabetes mellitus and hypertension were significant higher in
female patients than in male patients (24.4% VS 14.6%, P<0.001; 61.3% VS 42.2%, P<0.001,
respectively), the rates of mental labors, smokers, drinkers were significant lower in female pa-
tients than in male patients (3.4% VS 23.7%, P<0.001; 27.2% VS 68.1%, P<0.001; 2.2% VS
27.0%, P<0.001; respectively); Female patients were presented with less triggering factors and
typical symptoms but more complications than male patients(27.5% VS 35.9%, P¼0.008;
50.9% VS 68.2%, P<0.001; 41.9% VS 32.2%, P¼0.002, respectively), fewer female patients
accepted actue reperfusion therapy than male patients(67.2% VS 77.7%, P<0.001). In-hospital
mortality in female patients were significant higher than in male patients(17.5% VS 7.9%,
P<0.001), multivariate analysis revealed that female gender was not an independent predictor of
in-hospital mortality(P¼0.109),while age, hypertension and acute reperfusion therapy were
independent predictors of in-hospital mortality(P<0.001, P¼0.022, P<0.001, respectively).
Conclusion: In-hospital mortality in female patients with STEMI were significant higher
than in male patients. This is because of the gender difference of age, hypertension and
acute reperfusion therapy, female gender was not an independent predictor of in-hospital
mortality in patients with STEMI.
Disclosure of Interest: None Declared
PT133
Ischaemic times and adverse outcomes in STEMI stratified by glomerular filtration
rate
Jaya Chandrasekhar*1, Michel LeMay1
1 pg/mL indicated patients with the highest risk of death (36.7% vs 16.2% and 22.4% in
Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
Introduction: Creatinine clearance during STEMI admissions reflect a combination of pre
existing disease, haemodynamic stressors and contrast use for angiography and stenting.
Objectives: We sought to evaluate ischaemic times, and mortality and bleeding outcomes
in our STEMI patients grouped by glomerular filtration rate (GFR).
Methods: Retrospective registry analysis of 2540 STEMI patients at University of Ottawa
Heart Institute between June 1, 2004 and June 30, 2011. We stratified our STEMI patients
undergoing primary PCI as per GFR by Cockroft Gault formula using first available
admission creatinine in to 4 groups: 1- GFR <30, 2- GFR 30-60, 3- GFR 60-90, 4- GFR >90.
Results: Patients with impaired renal function in both groups 1 and 2 had significantly poorer
outcomes compared with group 4. They were older (group 1- 81.25 yrs, group 2- 74.4 yrs,
group 3- 62.7 yrs, group 4- 53.1 yrs), female (group 1- 68.7%, group 2-48.4%, group
3- 25.9%, group 4-14.3%) and of lower body weight (BMI group 1-23.5, group 2- 24.99,
group 3- 26.7, group 4- 30.09). Their ischaemic times were longer (pain to balloon time
for group 1- 218min, group 2- 215min vs group 3- 200 min, group 4- 205min) including
onset to 911 and local anaesthetic to balloon time. Their presentation blood pressure
was lower (systolic blood pressure group 1- 128.6mmHg, group 2- 130.6mmHg, group
e192
3- 135.7mmHg, group 4- 140.2mmHg), incidence of Killp 4 failure and IABP use higher, rate
of final TIMI3 flow lower (group 1- 91.3%, group 2- 91.8%, group 3- 93.9%, group 4- 97.0%)
with worse mortality rates in hospital (group 1- 21.43%, group 2-11.84% vs group 3- 2.27%,
group 4- 1.05%) and at 180 days (group 1- 29.1%, group 2-16.55% vs group 3- 3.62%, group
4- 2.05%). The incidence of TIMI major bleeding was highest in group 1 and lowest in group 4
(group 1- 15.24%, group 2- 8.36%, group 3- 4.08%, group 4- 1.38%).
Conclusion: Compared with the group with GFR >90, the group with GFR <30 had 20
fold higher mortality and a 15 fold risk of a major bleeding outcome in hospital while the
group with GFR 30-60 had a 10 fold higher mortality and 8 fold higher risk of a major bleed.
Disclosure of Interest: None Declared
PT134
Target-vessel versus multivessel revascularization in ST-elevation myocardial
infarction A meta-analysis of randomized trials
Kiran Sarathy*1, Vinayak Nagaraja1, Jwalant Raval2, Guy D. Eslick3, A. Robert Denniss2
1
Prince of Wales Hospital, University of Sydney, 2Cardiology, Blacktown Hospital,
3
The University of Sydney, Sydney, Australia
Introduction: In acute ST-segment elevation myocardial infarction (STEMI), coronary
reperfusion with percutaneous coronary intervention (PCI) to treat the culprit lesion
responsible for infarction improves clinical outcomes in nearly all patients. In patients with
acute STEMI who undergo primary PCI,a strategy of treatment of significant non-infarct
stenoses (preventive PCI) in addition to the culprit lesion responsible for infarction results
in improved cardiovascular outcomes and reduced overall mortality.
Objectives: To compare target-vessel and multivessel revascularization in ST-elevation
myocardial infarction
Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Cur-
rent Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of
Science. Original data were abstracted from each study and used to calculate a pooled odd
ratio (OR) and 95% confidence interval (95% CI).
Results: Only four randomised trials comprising of 775 patients met full criteria for
analysis. The incidence of nonfatal MI (OR: 0.376, 95% CI: 0.192-0.763), refractory angina
(OR: 0.400, 95% CI: 0.241-0.741) and repeat revascularisation (OR: 0.336, 95% CI:
0.202-0.661) was lower in multivessel revascularization cohort. Death from cardiac causes
or non fatal MI(OR: 0.336, 95% CI: 0.223-0.505) and from non cardiac outcomes (OR:
0.420, 95% CI: 0.245-0.722) were significantly lower in the multivessel revascularization
cohort. The Median Contrast Volume and Procedure Length were similar in both cohorts.
Conclusion: In patients with acute STEMI who undergo primary PCI,a strategy of treatment
of significant non-infarct stenoses (preventive PCI) in addition to the culprit lesion responsible
for infarction results in improved cardiovascular outcomes and reduced overall mortality.
Disclosure of Interest: None Declared
PT135
Admission B-type natriuretic peptide and Cystatin C levels predict mid-term survival
in patients with acute myocardial infarction
Leila Abid Trigui*1, salma charfeddine1, mona turki2, ayedi fatma2, samir kammoun1
1
cardiology departement, Hedi Chaker Hospital, Sfax (Tunisia), MEDECINE UNIVERSITY
SFAX, 2biochemistry laboratery, habib bourguiba hospital, sfax, Tunisia
Introduction: In patients with acute myocardial infarction (AMI), B-type natriuretic pep-
tide (BNP) and cystatine C (Cyc C) are predictors of short- and medium-term mortality
Objectives: To evaluate the mid-term prognostic value of a single measurement of plasma
BNP and Cys C in patients with first ST-elevation myocardial infarction (STEMI) or non
ST-elevation myocardial infarction (NSTMI)
Methods: Plasma BNP and cysC concentrations were analyzed on admission in 127 pa-
tients, median age 58
11.65 years, admitted with first STEMI or NSTEMI and treated
with percutaneous coronary intervention (PCI). Left ventricular ejection fraction (LVEF)
was assessed by echocardiography during the first 72 hours. Patients were followed for a
median 11 (9.4 - 13.6) months.
Results: The median BNP level was 138 (10-2090) pg/mL and the median CysC level was
0.98 (0.55-2.43) mg/L. During the follow-up period, 87.3% of patients survived. Logistic
regression analysis indicated that among the assessed clinical, biochemical, angiographic
and echocardiographic parameters, the best predictors of mortality were LVEF, renal
dysfunction, Cys C and BNP measurements, (p < 0.05). Admission BNP level > 350
patients with BNP level < 100 pg/mL and 100-400 pg/mL, respectively; p < 0.05)
Conclusion: A single measurement of BNP and Cys C on admission can improve long-
term risk stratification in first STEMI patients
Disclosure of Interest: None Declared
PT136
Review of thrombolysis outcomes for acute ST elevation Myocardial Infarction
(STEMI) in rural versus greater metropolitan Brisbane area
Mathivathana Indrajith1,2, Stuart Butterley1,2, Lisa Gillinder1,2, Shi Yi Goo1,2, Danielle Harrop1,
Josh Tsai1, Stephen Rashford3, Paul Garrahy1, Arnold C. Ng1,2, William Y. Wang*1,2
1
Cardiology, Princess Alexandra Hospital, 2School of Medicine, University of Queensland,
3
Director, Queensland Ambulance Service, Brisbane, Australia
Introduction: Early reperfusion is critical in the determining the short-term and long-term
outcomes of STEMIs. Thrombolysis is still utilized in areas without ready access to
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
percutaneous coronary intervention (PCI), as thrombolysis can be administered within few Table 2. Outcomes (# exclude 3 pre-hospital thrombolysis cases)

POSTER ABSTRACTS
minutes of STEMI diagnosis. Metropolitan hospitals are equipped with more staff, access to
physician/cardiology and sufficient resources for further treatment compared to rural Thrombolysis PCI p value
centres. It is unclear how these expertise and choices may impact on either expediting or Symptom onset to STEMI diagnosis times 39
15 32
15 NS
delaying decision making in revascularization strategies.
Symptom onset to thrombolysis / device times 75
22 202
73 0.001 *
Objectives: Compare efficiency of thrombolysis in rural versus greater Brisbane metro-
politan areas in those patients with acute STEMI. Diagnostic ECG to thrombolysis / device times 37
16 164
69 0.001 *
Methods: Acute STEMI patients who were directly or eventually referred to a tertiary centre DTD/DTN times # 32
13 95
49 0.014 *
in Brisbane (Princess Alexandra Hospital) over a 4 months period were identified. The
onset to needle time (OTN), first diagnostic ECG to needle times and Door to needle (DTN) Mean Peak CK 2039
2367 2298
2407 NS
times were estimated in patients presenting with acute STEMI within 6 hours. Maximum Median Peak CK 904 965 NS
creatine kinase (CK) rise used as the assessment of the extent of myocardial infarction. EF 49
12 45
16 NS
Results: A total of 195 (average age 61yrs, 78% male) acute STEMI patients were pro-
spectively reviewed over the past 4 months. The Table 1 and 2 below shows the results in
detail.
Conclusion: In patients who received medical contact within 60 minutes from onset of
symptoms, thrombolysis and primary PCI had similar early outcomes.
Table 1. Basic Characteristics Disclosure of Interest: None Declared
Metropolitan Rural p value
PT138
n 19 14
% female 11 36 NS The implementation of the myocardial infarction system of care in a large city in
Brazil
Age (mean
SD) 56
12 62
11 NS
Milena Marcolino*1, Luisa C. C. Brant2, de Araujo J. Guimarães3, Bruno R. Nascimento1,
Luiz Ricardo A. Castro4, Paula Martins3, Lucas Lodi-Junqueira4, Antonio L. Ribeiro1
1
Table 2. Outcomes Internal Medicine Department, Medical School, Universidade Federal de Minas Gerais,
2
Cardiology Service, Univerity Hospital, Universidade Federal de Minas Gerais, 3Municipal
Metropolitan Rural p value Health Department of Belo Horizonte, 4Cardiology Service, University Hospital, Universidade
Symptom onset to thrombolysis 110
64 169
82 NS Federal de Minas Gerais, Belo Horizonte, Brazil
Diagnostic ECG to thrombolysis 35
21 37
29 NS Introduction: Although there was a significant reduction in mortality from cardiovascular
DTN times 34
16 47
29 0.013 diseases in recent decades worldwide, they still remain the leading cause of mortality in
Brazil. The implementation of system of care for Acute Myocardial Infarction (AMI) is
Mean Peak CK 1294
1363 2427
2320 NS
designed to optimize timeliness of therapy and improve patient care.
Median Peak CK 813 1990 NS Objectives: Tto evaluate the implementation of the system of care for AMI in Belo Hori-
EF 47
12 50
13 NS zonte, Brazil, a large urban city with 2.4 million inhabitants, and its impact on AMI hospital
mortality rate.
% Failed thrombolysis 11 21 Methods: The system of care for AMI was established in Belo Horizonte in 2010-2011 in
order to increase the access of patients of the public healthcare to treatment recommended
Conclusion: The greater Brisbane metropolitan hospital patients had significantly lower by current guidelines, including early reperfusion and treatment in intensive care. There
door to needle time and a propensity towards better early outcomes as shown by a trend was an increase in the number of intensive care unit beds, teams of emergency units were
towards lower peak CK. When considering rural centres results, higher peak CK could also trained and tele-electrocardiography was implemented in those units, to enable the early
be reflective of delay or lack of rescue PCI access. These results have implications for rural activation of the catheterization laboratory. The primary endpoints of this retrospective
hospital practice in management of acute STEMI. observational study were the number of hospitalizations and hospital mortality from AMI
Disclosure of Interest: None Declared in the years 2009 (baseline) to 2011.
Results: During the study period, 294 professionals were trained and 563 ECGs were
transmitted from the emergency care units to the coronary care units. There was a sig-
PT137 nificant decrease in hospital mortality rate (12.3% in 2009 vs. 7.1% in 2011, p <0.001),
Evaluation of thrombolysis versus primary percutaneous coronary intervention (PCI) while the number of admissions for AMI remained stable. There was an increase in the
outcomes for patients with early presentation (within 60 minutes) of acute ST average cost of hospitalization (average US$ 1189.56 vs. US$ 1679.30, p <0.001),
elevation myocardial infarction (STEMI) increasing the proportion of admissions which included admission in intensive care unit
(32.4% in 2009 vs. 66.1% in 2011, p <0.001) and admission in high complexity hospitals
Mathivathana Indrajith1,2, Stuart Butterley1,2, Danielle Harrop1, Lisa Gillinder1,2, Shi Yi Goo1,2, (47.0% vs. 69.6%, p <0.001).
Josh Tsai1, Stephen Rashford3, Paul Garrahy1, Arnold C. Ng1,2, William Y. Wang*1,2 The establishment of the system of care for AMI led to the reorganization of the care of
1
Cardiology, Princess Alexandra Hospital, 2School of Medicine, University of Queensland, patients with suspected acute coronary syndrome in the city of Belo Horizonte, Brazil,
3
Director, Queensland Ambulance Service, Brisbane, Australia which included training and motivation of emergency care teams, in addition to integration
between the services, facilitating the access to hemodynamic laboratories, intensive care
Introduction: Early reperfusion is essential in the determination of outcomes of STEMI. beds and high-complexity hospitals in cardiology. There was a significant reduction in
Australia Registry data demonstrates that timely provision of PCI in STEMI patients is hospital mortality from AMI after the establishment of this system of care.
difficult to achieve, with median hospital door to angioplasty device/balloon (DTD) times of Conclusion: The implementation of the system of care for AMI in Belo Horizonte allowed
102 minutes and only 36.5% of cases achieving DTD times of <90 minutes. Thrombolysis easier access to appropriate treatment and, consequently, reduction in AMI hospital
is still used where there is no ready access to PCI centres. However, given the ability to mortality rate.
rapidly deliver thrombolysis out of tertiary centres, it may be of greater value in very early Disclosure of Interest: None Declared
STEMIs.
Objectives: Comparison of thrombolysis with primary PCI in patients presenting with PT140
acute STEMI within 60 minutes of onset of symptoms to first medical contact (FMC).
Methods: Acute STEMI patients who were directly or eventually referred to a tertiary centre Complete Myocardial Revascularization In The Same Session In Patients With Acute
in Brisbane (Princess Alexandra Hospital) over a 4 months period were identified. The Myocardial Infarct And Cardiac Failure
DTD/ Door to needle (DTN times) and FMC to device/thrombolysis times were assessed
Ricardo A. Costantini*1, Cristian S. García1, Juan M. Telayna1
with maximum CK rise used as the assessment of the extent of myocardial infarction. 1
Results: A total of 195 (average age 61yrs, 78% male) with STEMI were identified. Out of Interventional Cardiology, Austral University Hospital, Pilar, Argentina
these 14 (21% female) PCI patients and 15 (0%) thrombolysis (including 3 pre-hospital Introduction: In STEMI with cardiogenic shock (CS), prompt primary PCI of the infarct-
thrombolysis) patients had FMC within 60 minutes. No intra-hospital mortality in both related artery improves survival; however, mortality remains unacceptably high. The ma-
groups. The Table 1 and 2 below shows the results in detail. jority of STEMI and CS has multivessel coronary disease (MVD). This is more likely to
induce widespread myocardial ischemia and progressive ventricular dysfunction, and has
been associated with increased mortality. However, there is little evidence to support the
Table 1. Baseline Characteristics strategy multivessel, which could conversely worsen outcomes by increasing the risk of
non-IRA distal embolization, stent thrombosis, and contrast nephropathy.
Thrombolysis PCI p value Objectives: To determine the results of the primary PCI with complete revascularization in
STEMI and cardiac failure with presence of MVD.
n 15 14
Methods: From 7/2000 to 2/2013, was realized 342 procedures of primary PCI, of which
% female 0% 21% NS 89(26%), presented signs of cardiac failure to the admission. These were analyzed ac-
Age (mean
SD) 58
10 56
11 NS cording to the presence of MVD (n¼54) and the PCI only of the culprit vessel (Group A¼
33) vs complete revascularization coronary in the same session (Group B¼ 21).

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e193

 Basal characteristics, group A and B, respectively n (%): age 61,6
11,2 vs 59
14,5;
POSTER ABSTRACTS
masculine sex 28(85) vs 18(86); diabetes 9(27) vs 7(33); prior infarct 7(21) vs 5(24); prior
revascularization 5(15) vs 3(14); LVEF 39,6
16 vs 46,5
21; anterior infarct 10(30) vs
9(43); anterior descending artery affected 18(54) vs 19(90); presence of collateral circu-
lation 10(30) vs 3(14); use of IABP 11(33) vs 3(14); use of GP IIbIIIa 10(30) vs 2(9); use of
tromboaspiration 3(9) vs 2(9); millimeters of stent implanted 46
32 vs 71,5
32; implant
of drug eluting stents 5(15) vs 8(38); dye material 263,1
121 vs 305,2
93 ml; time of
fluoroscopy 25,3
21,5 vs 23,7
16,4 minutes.
Results: Group A and B n (%), respectively: mortality intrahospitalary 7(21) vs 2(9); rein-
farct 0 vs 2 (9); early occlusion coronary 1(3) vs 2(9); renal insufficiency pos PCI 0 vs 1(5).
In the average follow-up to 20 months of the 96% population there demonstrated, group
A and B n (%), respectively: total mortality to 6 months 10(30) vs 4(19); cardiac mortality
to 6 months 10(30) vs 2(9) p¼0,05; reinfarct 1(4) vs 0; need of coronary revascularization
7(27) vs 1(5) and events combined of cardiac death, reinfarct and new revascularization
18(54) vs 5(21) p¼0,02.
Conclusion: The complete coronary revascularization in the same session in STEMI and
cardiac failure and MVD, demonstrated to be more favorable in terms of total mortality and
adverse major combined events that the PCI only of the culprit vessel.
Disclosure of Interest: None Declared
PT143
Outcomes of oral Anticoagulation management post Anterior STEMI in the Primary
PCI era
Damon K. Jackson*1, Louise Roberts1, Andrew Teh1, David J. Clark2, Philippa Loane3,
Chin Hiew4, Hariharan Sugumar1, David Eccleston5, Gishel New1, Melanie Freeman1
1 and was compared to SM to see which is more accurate to detect AP. All procedures were
Cardiology, Eastern Health, Box Hill, 2Cardiology, Austin Hospital, Heidelberg, 3Cardiology,
CCRET - Monash University, Melbourne, 4Cardiology, Barwon Health, Geelong, 5Cardiology,
Royal Melbourne Hospital, Parkville, Australia
Introduction: Left ventricular (LV) thrombus is a well known complication of anterior
STEMI occurring in up to 18% of patients and is more common in those with reduced
ejection fraction <40%. Anticoagulation is used to prevent thromboembolic complications
in Anterior STEMI, however little data exist in the primary PCI era.
Objectives: To evaluate the use of warfarin therapy in preventing thromboembolic com-
plications following primary PCI for anterior STEMI, utilizing a large Australian registry.
Methods: We analysed 365 patients who underwent primary PCI for Anterior STEMI due
to proximal LAD occlusion between 2005 and 2011. Baseline characteristics, procedural
data and clinical outcomes were compared between those patients on warfarin (n¼98) and
those not on warfarin at 30 days following PCI (n¼267).Patients with atrial fibrillation,
previous valvular surgery, or previous revascularisation were excluded. Patients who died
<30 days were also excluded.
Results: Patients treated with warfarin were younger (59
13 vs 63
12years p¼0.005)
and had lower mean LV ejection fraction (41
10% vs 49
12% p<0.001). There were no
significant differences in gender, diabetes, BMI or past history of cerebrovascular disease.
Cardiogenic shock (14% vs 8% p¼0.07) or out of hospital cardiac arrest (10% vs 8% p ¼
0.4) did not differ between the two groups, however the warfarin group were more likely to
require IABP insertion (18% vs 9% p ¼ 0.01). There were no differences in glycoprotein
IIbIIIa and dual antiplatelet therapy use between the two groups. Drug eluting stent use
was similar between the two groups (26% vs 36% p¼0.2) and there were no differences in
dual antiplatelet therapy between the 2 groups. Those on warfarin were more likely to have
developed in-hospital bleeding complications (10% vs 4% p¼0.02). There were no sig-
nificant differences in in-hospital stroke (1% vs 0% p¼0.1) or 12-month death (0% vs
0.4% p¼0.5), stroke (1% vs 0.4% p¼0.5) and MACE (8% vs 6% p¼0.6). Ejection fraction
less than 40% was not a predictor of 12-month MACE (OR 1.5 95% CI 0.66-3.8).
Conclusion: In this small sample of patients who underwent primary PCI for Anterior
STEMI, treatment with warfarin did not appear to reduce 12-month stroke or major
adverse cardiac events, however those treated with warfarin were more likely to have in-
hospital bleeding complications. The benefit of anticoagulation in this subset requires
further investigation.
Disclosure of Interest: None Declared
PT145
Primary Utilization of EECP In Chronic Stable Angina Patients With Left Ventricular
Dysfunction and Long Time Follow Up
Pratiksha Gandhi*1, Ramasamy Subramanian2, Monica Mittal1
1
Cardiology, IPC Heart Care Centre, Mumbai, 2Cardiology, CHENNAI HEART FAILURE
CLINIC, Chennai, India
Introduction: Enhanced external counter pulsation (EECP) is shown to be effective in
Chronic stable angina patients refractory to medical therapy and revascularization. The
treatment work similar to intra aortic balloon pump except it increases the venous return,
as the cuffs in the lower limb compress both arterial and venous compartment.
Objectives: We examined the effect of EECP therapy in chronic stable angina patient with
left ventricular dysfunction and follow them up to 3.5 years.
Methods: We Investigated 637 patients enrolled, who have chronic stable angina treated
by EECP therapy during 2005-2009. All the patients were subjected to exercise tolerance
test with modified Bruce protocol and Echocardiography assessment of LVEF by M-Mode
method pre and post EECP. The patients were followed up by telephone consultations
Results: The patients with a mean age of 60.65
8.69, 82% of them are male with baseline
LV ejection fraction (LVEF) 54.43
.08. 93% are candidate for either PTCA or CABG but
taken EECP treatment as alternative due to their personal preference. Demography includes
e194
39% had prior MI, 71% HT, 47% DM, 20% chronic smokers, 56% had family history, 56%
had TVD, 23% had DVD,52 % at least have one vessel proximal lession,7% had prior
CABG and 11% had prior PTCA. 92% of the patient had at least one class decrease in
Canadian Cardiovascular society (CCS) functional class. The exercise treadmill time
increased from baseline 6.68
3.36 minutes pre-EECP to 9.63
3.37 minutes post-EECP
(p<0.0001). The mean LVEF increased from 53.95
8.0% at baseline to 58.01
6.94 %
post-EECP (p<0.0001). The patients are followed up for a mean period 3.5 yrs. There were
21.66% patients lost during follow up, 66.4% of the patients retained their EECP treatment
benefit, 4.23% underwent CABG, 1.88% underwent PTCA and 5.18% expired. The sur-
vival rate is 95%.
Conclusion: EECP is effective and safe in enhancing the exercise capacity, ejection fraction
and functional class in angina patients with moderate to normal LVEF and these benefits
sustained up to a mean of 3.5 years
Disclosure of Interest: None Declared
PT146
Myocardial Contrast Echocardiography Map - A New Noninvasive Gate Way To
Detect Coronary Artery Disease
Ri-Ichiro Kakihara*1, Chinatsu Naruse1, Yoshiko Moutai1
1
Department of Cardiology, Private Kakihara Clinic, Toyohashi, Japan
Introduction: Peak systolic strain map (SM) is used to detect angina pectoris (AP) by
segmental left ventricular wall (SLVW) dysfunction. SLVW dysfunction is not always
caused by myocardial ischemia. It could be more accurate and direct to observe whether
SLVW is ischemic.Therefore myocardial contrast echocardiography map (CM) was created
performed in accordance with Declaration of Helsinki of the World Medical Association.
Objectives: 198 coronary arteries (CAs) of 66 patients with coronary angiography within
the last three months were enrolled; informed consents were obtained. Among the 198
CAs, 111 CAs were <50% stenosis; 36 were 50%; 32 were 75% and 20 were 90%.
Methods: The left ventricular wall of the figures of APLAX, AP2ch and AP4ch was divided
into 17 segments (seg.s) in both CM and SM. Among them the middle-anterior seg.7 was
regarded as LAD, the middle-posterior seg.11 was regarded as LCX and the middle-inferior
seg.10 was regarded as RCA. SonazoidÒ was employed as a contrast agent for CM. In the
CM, differences of intensity value between the mid-point of the left ventricular cavity and of
each seg. were shown, while in the SM strain values of the mid-point of each seg. were
illustrated. In both maps, sensitivity (SC), specificity (SP), diagnostic accuracy (DA) of each
CA stenosis were investigated by ROC. From the data, which map more accurately detected
CAD and its severity was concluded.
Results: CM group: average intensity difference values <50% -8.9
2.9db, 50%
-15.4
1.1db, 75% -18.8
1.9db, 90% -21.7
2.2db. Cutoff values were 50% :-14.0db,
75%:-16.0db and 90%:-19.0. SC were 50% 1.000, 75% 1.000, 90% 1.000. SP 50%
0.902, 75% 0.984, 90% 1.000. DA 50% 0.939, 75% 0.989, 90% 1.000. There
were significant differences between <50% and 50%, 50% and 75%, 75% and
90% (p<0.0001). SM group: average strain values <50% -20.7
3.9%, 50%-18.4
4.6%,
75%-17.5
4.6%, 90%-12.1
4.0%. Cutoff values were 50% -18.0%, 75% -17.0% and
90%-16.0%. SC were 50% 0.631, 75% 0.630, 90%0.857. SP were 50% 0.689, 75%
0.787, 90% 0.869. DA were50% 0.667, 75% 0.739, 90% 0.866. There was significant
difference between 75% and 90% stenosis only (p <0.0002). There were significant
differences between CM and SM in all 4 CA stenosis pairs (p<0.0001).
Conclusion: Based on the results, CM accurately and directly detected myocardial ischemic
extent and its severity at the same time, which SM suggested only.
Disclosure of Interest: None Declared
PT147
Measuring Serum Vitamin D level as a part of evaluating patients presenting with
Atypical Chest Pain
Syed Raza*1
1
Cardiology, Awali hospital, Manama, Bahrain
Introduction: Chest pain is a leading cause of ambulatory visits to any hospital. After
serious cardiopulmonary conditions are excluded, musculoskeletal causes of chest pain,
including costochondritis, are commonly attributed to the final diagnosis .Although there
are a few reports of osteomalacia and vitamin D deficiency associated with chest pain, we
are unaware of any literature where measurement of Vitamin D level forms a part of
evaluation in patients presenting with chest pain.
Objectives: We conducted this study to explore the association of Vitamin D as a possible
cause of chest pain in patients who presented with atypical symptoms.
Methods: We, over a period of one year prospectively studied 324 patients who presented
with atypical chest pain and in whom more serious cardio-respiratory causes were excluded
after initial investigation. . A provisional diagnosis of musculo-skeletal pain was made in
patients in whom either chest pain was reproduced on twisting upper torso or chest wall
and sternal tenderness were appreciated on palpation. Vitamin D level was checked in all
these patients. If deemed appropriate Vitamin D was prescribed in appropriate doses and
patients were followed up after one week and two months.
Results: .A provisional diagnosis of musculo-skeletal cause of chest pain was made in 194
(60.4%) patients. Serum Vitamin D level was requested in all patients as per standard
protocol. 45(23.1%) patients had optimal serum Vitamin D level. 96 (49.4%) patients had
insufficient while 53(27.3%) patients had deficient levels of serum Vitamin D level. 131
patients attended the first follow up while only 94 patients came for the second .On the
first follow up 54 (41.2%) patients reported improvement in symptoms or complete res-
olution of chest pain. A similar trend was seen in 81 (86.1%) patients on second follow up.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: Vitamin D deficiency is very common but not a well recognized cause of chest
pain in patients with costochondritis, or bony sternal pain. Physicians should consider
vitamin D deficiency as a part of evaluation when faced with patients with non cardiac or
atypical chest pain.
Disclosure of Interest: None Declared
PT148
Value of A “Negative” Coronary Angiogram During Investigation of Suspected
Angina Pectoris
Tom Kai Ming Wang*1, Timothy Oh1, Chinthaka Samaranayake1, Timothy Watson1,2,
James Stewart1, Mark Webster1,2, Peter Ruygrok1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: Coronary angiography is the standard technique for assessment of coronary
artery disease (CAD). In many patients investigated with angiography, no or minimal CAD
(<50% stenosis) is detected. It is uncertain how this “negative” result influences subsequent
management and outcomes.
Objectives: We reviewed characteristics and outcomes in a contemporary cohort of pa-
tients with suspected angina pectoris and subsequently “negative” coronary angiography.
Methods: Records for all patients undergoing coronary angiography at Auckland City
Hospital during July 2010-October 2011 were reviewed (n¼2,983) and 15.6% (466) had
“negative” results. Those referred on the basis of suspected angina pectoris (troponin
negative) were studied (n¼369) and followed-up for 2.3+/-0.6 years.
Results: Mean age was 60.0+/-12.3 years and 56.1% (207) were female. The ECG was
abnormal in 55.0% (203) and left ventricular systolic function impaired in 21.6% (47/218
performed). Stress testing was considered abnormal in 57.3% (86/150 performed). After
angiography, 43.2% (158) had no changes to cardiac medications, while aspirin, statin, beta-
blocker or ACE inhibitor was started in 14.2-22.1% of patients and only stopped in 4.1-8.2%.
No final diagnosis was formulated in 53.4% (197), whilst a non-cardiac diagnosis suggested in
27.9% (103). Rates of major adverse cardiovascular events and re-admissions with chest pain
were 0.3% (1) and 1.9% (7) respectively at 30 days, and 1.9% (7) and 6.0%(22) at 1 year.
Conclusion: In this real-world cohort coronary angiography was “negative” in 15.6% of
patients. Despite this finding, cardiac medications were more likely to be added than sub-
tracted. Only a minority represented to hospital within the first year with further chest pain.
Disclosure of Interest: None Declared
PT149
Antiplatelet agentS in STEMI: a Comparison of TicagrelOr, Prasugrel aNd
ClopiDogrel (SECOND)
1 1 1 1 1
Dinesh K. Natarajan* , Anis Taeed , Nadim Shah , Rifly Rafiudeen , Soe K. Ko ,
Anne Oppermann1, Peter Y. Chan1, Nicholas Cox1, Kean Soon1
1
Department of Cardiology, Western Health, Melbourne, Australia
Introduction: Prasugrel reduced the combined rate of death from cardiovascular causes,
nonfatal myocardial infarction, or nonfatal stroke but this was offset by increased rates of
serious bleeding (TRITON-TIMI 38). Ticagrelor had better mortality rates than Clopidogrel
in patients with acute coronary syndrome but had greater rates of non-lethal bleeding and
major bleeding not related to CABG (PLATO).
Objectives: There is no clinical data comparing Prasugrel and Ticagrelor. Our objective
was to determine 30-day MACE outcomes and bleeding complications associated with
different antiplatelet agents (Clopidogrel, Prasugrel, Ticagrelor) in combination with
Aspirin in the setting of STEMI.
Methods: From 1 August 2012 till 23 July 2013, all STEMI cases that presented to our
hospital were included in this study. Patient demographics, procedural characteristics, use
of antiplatelet agents, 30-day MACE composite endpoints (death, recurrent MI, TVR,
stroke), major (HORIZON) bleeding and minor bleeding were prospectively collected. Chi-
Square and Kruskal-Wallis tests were used for statistical analyses.
Results: 177 patients (139 males, 38 females, mean age¼61years) were treated with pri-
mary PCI (Clopidogrel 43¼, Prasugrel¼66, Ticagrelor¼62). The median ages were
Clopidogrel¼71 years, Prasugrel¼56 years, Ticagrelor¼61.5 years (p<0.005). 86% (Clo-
pidogrel), 98% (Prasugrel) and 87% (Ticagrelor) achieved 30-day MACE free outcome
(p¼0.044). 4.7% (Clopidogrel), 0% (Prasugrel) and 3.2% (Ticagrelor) were complicated by
major bleeding fulfilling the HORIZON criteria (p¼0.398). 4.7% (Clopidogrel), 7.5%
(Prasugrel) and 4.8% (Ticagrelor) had minor bleeding complications (p¼0.839).
Conclusion: Prasugrel is associated with reduced 30-day MACE rates in comparison with
Clopidogrel or Ticagrelor post PCI in the setting of STEMI. However, there was no sta-
tistically significant difference in bleeding complication rates among these three different
antiplatelet agents.
Disclosure of Interest: None Declared
PT150
Resumption of Platelet Function By Verify Now Assay After Ceasing Ticagelor In
Patients on Dual Anti-Platelet Therapy Awaiting Surgery . The Ressurect Pilot Study
Marcus H. Lee*1, Vijay Pera1, Kat Raman1, Adam El Gamel2, Gerrard P. Devlin1
1
Dept of Cardiology, 2Dept of Cardiothoracic Surgery, Waikato DHB, Hamilton, New Zealand
Introduction: Current guidelines recommend discontinuation of ticagrelor 5 days prior to
surgery. A half-life of 14 hours and a twice-daily dosing regime suggests this may be longer
than necessary for restoration of platelet function. We report the time course of platelet
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
function following cessation of ticagrelor in patients presenting with an acute coronary
POSTER ABSTRACTS
syndrome (ACS) referred for surgical revascularisation.
Objectives: To determine the ideal waiting time to proceed to surgery post cessation of
Ticagrelor.
Methods: A prospective pilot study of ACS patients at Waikato Hospital who were
commenced on ticagrelor and then referred for coronary artery bypass surgery post angi-
ography. Ticagrelor was discontinued immediately post angiography. Platelet function was
assessed at this timepoint and daily with the VERIFY-NOW assay. Percentage (%) platelet
inhibition was assessed and the time to return to normal (<20%) was plotted.
Results: 10 patients were recruited. All patients received aspirin and ticagrelor.The mean
patient age was 60 years (50-64) with 70% male. 60% of patients were diabetic. The
indication for angiography was Non ST-elevation MI in 80% and Unstable angina in 20%.
Indication for surgical revascularisation was 3 vessel disease in 90% and extensive LAD
disease in 10%.The time course of platelet function is shown for all 10 patients. The
majority had high platelet inhibition prior to discontinuation of ticagrelor with platelet
function normalising by day 2 (p<0.0001). 90% of patients had less than 20% residual
platelet inhibition at 48 hours with no significant rebound noted at 5 days.
Conclusion: This pilot study demonstrates that discontinuation of ticagrelor results in
recovery of platelet function within 2 days. If confirmed in larger series these findings may
result in shorter waiting times for cardiac surgery in ACS patients.
Disclosure of Interest: None Declared
PT151
Ticagrelor versus Prasugrel in Patient with Acute Coronary Syndromes treated with
Percutaneous Coronary Intervention
Matias Yudi*1, Christopher Reid2, Matthew Brooks3, David J. Clark4, Melanie Freeman4,
Julian Yeoh1, Chin Hiew5, Sandeep Prabhu1, Caitlin Cheshire1, Andrew Ajani1
1
Cardiology Department, Royal Melbourne Hospital, 2Monash University, 3Royal Melbourne
Hospital, 4Cardiology Department, Austin Hospital, 5Geelong Hospital, Melbourne, Australia
Introduction: International guidelines recommend ticagrelor or prasugrel over clopidogrel
in the management of patient with acute coronary syndromes (ACS) undergoing percu-
taneous coronary intervention (PCI). This is based on the results of the PLATO and
TRITON-TIMI 38 trials where the newer antiplatelet agents were shown to be more effi-
cacious than clopidogrel at the expense of higher bleeding. There have been no randomized
control trials comparing the two newer agents against each other in ACS, and this is un-
likely to occur in the future. Furthermore, no such comparison has been documented from
an Australian registry.
Objectives: The aim of this study is to compare the safety and efficacy of ticagrelor and
prasugrel in patients with ACS undergoing PCI from a real-life Australian cohort.
Methods: The Melbourne Interventional Group registry was analysed from August 2009,
the time prasugrel gained a Pharmaceutical Benefit Scheme listing, until July 2013. Clinical
characteristics and outcomes of patients with ACS that underwent PCI and were treated
with ticagrelor or prasugrel were obtained. The primary efficacy end points were 30-day
mortality, myocardial infarction (MI), target vessel revascularization (TVR) and major
adverse cardiovascular events (MACE). The primary safety endpoint was in-hospital
bleeding complications.
Results: 395 patients with ACS who underwent PCI were treated with either ticagrelor
(50%) or prasugrel (50%). When compared to prasugrel, ticagrelor was used significantly
more in NSTEACS (47% vs 35%, p¼ 0.02), older patients (62yrs vs 56yrs, p<0.01),
females (23% vs 13%, p<0.001), patients with an eGFR<60 (22% vs 12%, p<0.012), and
patients receiving a drug eluting stent (67% vs 48%, p<0.01). With regards to outcomes,
there was no statistical difference between ticagrelor and prasugrel in 30 day mortality (4%
vs 1%, p¼0.09), MI (1% vs 0%, p¼0.15, TVR (2% vs 2%, p¼0.69) and MACE rates (5% vs
3%, p¼0.18). There was also no difference in bleeding complications (4% vs 3%, p¼0.57).
Conclusion: Early experience in an Australian PCI cohort reveals no difference in safety or
efficacy in patients with ACS undergoing PCI who were treated with either ticagrelor or
prasugrel.
Disclosure of Interest: None Declared
e195
 PT153
POSTER ABSTRACTS
Management of ACS in Hospital with limited resources. A single non PCI capable
District General Hospital experience
Ahmed Hailan1, Zia Ul-Haq*1, Aled Jones1, Stephen Hutchison1
1
Cardiology, Nevill Hall Hospital, Abergavenny, United Kingdom
Introduction: ACS requires emergency treatment in hospital. The type of treatment de-
pends on many factors, including pt history, investigations and hospital resources
Objectives: We studied diagnoses and outcomes of pts presenting with chest pain at
Nevill Hall Hospital a non PCI capable centre in Wales in order to gain a better
insight into the patient with chest pain’s route through the health service in South
Wales.
Methods: We instituted a policy of undertaking early triaging cardiac sounding CP Patients
presented at NHH ED to Cardiology ward. The record of 198 pts admitted between June-
August 2012 were studied retrospectively and post discharge data was obtained through
the cardiac rehabilitation service, patient Demographics, troponins & Grace Scores(all
positive trop pts) were checked. We analysed 1 & 6 months mortality, and treatment on
discharge including revascularisation therapy.
Results: 198 pts mean age 67, 58%male with chest pain were included. 27 (14%)
diagnosed with STEMI, 30 (15%) NSTEMI, 13(7%) Angina,128(65%) non cardiac
chest pain. Of the STEMI group 9 patients (33%) were admitted directly to tertiary
centre for PPCI and 18(66%) admitted to NHH where 22% were transferred for PPCI
from ED, 33% received thrombolytic therapy followed by referral for early revascu-
larization (83% PCI & 17% CABG), 2(11%) had late presentation and the rest 33%
octogenarians treated medically.The 30 (15%) NSTEMI, 12(40%) underwent inpatient
PCI, 2(7%) CABG and 15(50%) treated medically & revascularization strategy reserved
for those with persisting anginal symptoms or positive ischemia. The overall 1 & 6
month mortality in our study group was 2% & 1% respectively, 83% of one month
mortality was octogenarians and medically treated. 1 & 6 month mortality in STEMI
pts 7%, 4%, NSTEMI 7% & 0% & 0.8%, 0% in non cardiac chest pain (Only 1 died of
pneumonia). It is noteworthy that Trop levels were statistically higher for STEMI than
NSTEMI (p¼0.25). In addition Pts who died following an MI during the 1-6month
period had higher GRACE % scores than those who didn’t (22 vs. 13 for NSTEMI and
80 vs. 23 for STEMI).
Conclusion: This study shows that a strategy of early triaging to Cardiology Ward
following good history taking, risk stratifications of patients presenting with chest pains can
lead to high rate of success and safe treatment in hospital with limited resources and non
PCI capable centre. Age, high Troponin, and high Grace Score remain a strong predictive of
mortality in patients presenting with chest pains.
Disclosure of Interest: None Declared
PT154
Comparison Between In Hospital Outcomes Of Patients Admitted For Acute
Coronary Syndromes With Diabetes Mellitus & Without Diabetes Mellitus
1,2 3 2
Biplob Bhattacharjee* , Sandipan Das , Probir Das
1
Cardiology, Chevron, 2Cardiology, Chittagong Medical College, 3Cardiology, Cmch, Chittagong,
Bangladesh
Introduction: Acute coronary syndromes are a major cause of morbidity & mortality in the
western world & also in Bangladesh. Diabetes mellitus is also a devastating health problem
in our country. Several prior studies have shown that patients with diabetes have same fatal
complications as acute coronary syndrome.
Objectives: To compare thein hospital outcomes of acute coronary syndrome, in patients
with Diabetes Mellitus & without Diabetes Mellitus.
Methods: this prospective observational study was conducted in Chittagong Medical
college hospital during July 2009 – June 2010. The sample size was 200, selected by
convenient type of non probability sampling method among the admitted patient in
coronary care unit of Chittagong Medical College Hospital. Hypothesis was established
as patients with acute coronary syndrome who suffer from diabetes mellitus are at
higher risk of in hospital mortality and other adverse outcomes than non diabetic CAD
patients.
Results: Total 200 patients, among which 100 patients were diabetic and 100 patients
were non diabeti were enrlled. Risk score was done by Grace Risk Score. 28% of
diabetic & 43% of non diabetic patients were in low risk group. 40% of diabetic &
32% of non diabetic were in intermediate risk group. 32% of diabetic & 25% of non
diabetic patients were in high risk group. Cardiogenic shock developed in 10% of
diabetic group & 4% of non diabetic group. Heart failure & arrhythmia were higher in
diabetic CAD patients compared to that of nondiabetic group, (16% vs 9%), (20% vs
12%). (p¼0.027 vs p¼o.123 respectively.) Recurrent angina occurred in 6% of diabetic
& none of the non diabetics. 4% of diabetic group & 0% patients in non diabetic
group died during hospital stay ( p¼0.048). Cardiogenic shock developed in 18.7% of
high GRACE risk score group & 10% of intermediate risk score group. Heart failure
developed in 0% of patients of low risk groups. 05% patients of intermediate risk
groups & 34.4% of high risk groups. Death also occurred in 9.4% of patients of only
high risk group.
Conclusion: This study showed diabetic patients with acute coronary syndrome were
mostly in intermediate and high risk category. This encountered in hospital mor-
tality and other adverse outcomes at a greater extent than those of non diabetic
patients.
Disclosure of Interest: None Declared
e196
PT155
The National Heart Foundation of Australia Consensus Statement on Psychosocial
Risk Factors for Coronary Heart Disease
Nick Glozier1, Geoffrey H. Tofler2, David M. Colquhoun3, Stephen J. Bunker4, David M. Clarke5,
David L. Hare6, Ian B. Hickie1, James Tatoulis7, David R. Thompson*8, Maree Branagan9,
The National Heart Foundation of Australia Psychosocial Risk Factors and Coronary Heart
Disease expert committee
1
Brain and Mind Research Institute, University of Sydney, 2Royal North Shore Hospital,
University of Sydney, Sydney, 3University of Queensland, Brisbane, 4Greater Green Triangle
University Department of Rural Health, Flinders University and Deakin University,
Warrnambool, Vic, 5Monash University, 6University of Melbourne, 7National Heart Foundation
of Australia, 8Cardiovascular Research Centre, Australian Catholic University, 9Clinical
Programs, The National Heart Foundation of Australia, Melbourne, Australia
Introduction: New evidence has emerged regarding psychosocial risk factors for coronary
heart disease (CHD).
Objectives: To present a National Heart Foundation of Australia (NHFA) review of current
evidence around psychosocial risk factors and CHD to guide health professionals [1].
Methods: An expert working group performed literature searches with key search phrases
including “cardiovascular diseases”, “myocardial infarction”, “angina “work conditions”,
“long working hours”, “social isolation”, ”triggers”, “emotion”, “stress”, “takotsubo”, “anger”,
“anxiety”, “life events”, and “bereavement”. Psychosocial stressors included acute individual
stressors, acute population stressors, and chronic stressors (in particular work stress).
Depression is discussed in a separate paper. The Cardiac Society of Australia and New
Zealand and Royal Australian and New Zealand College of Psychiatrists have endorsed the
content.
Results: An acute emotional stress may trigger myocardial infarction (MI) and Takotsubo
(“stress”) cardiomyopathy, although the absolute increase in transient risk due to an in-
dividual stressor is low.
- Perceived chronic job stress and shift work have been associated with a small
increased risk of developing CHD. Although notable, this effect is far weaker than
that from standard CHD risk factors such as smoking, hypertension, abnormal lipid
levels and depression.
- Social isolation after MI is associated with an adverse prognosis. Although measures
to reduce isolation are likely to produce positive psychological effects, it is unclear
whether this would also improve CHD outcomes.
- The Heart Foundation evaluates adoption of clinical guidance, and data will be
presented around this.
Evidence statement [1] Grade of evidence
1. Social isolation increases the risk of a poor CHD prognosis B
2. MI can be precipitated by negative emotional states B
3. CHD events can be precipitated by bereavement B
Recommendation [1] Grade of evidence
1. Wider public access to defibrillators should be available B
where large groups of people gather, such as sporting
venues, airports, and as part of the response to disasters.
Conclusion: Psychosocial stressors have an impact on CHD however clinical significance
requires further study. Awareness of the potential for cardiovascular risk associated with
certain psychosocial risk factors may assist health professionals caring for CHD patients.
[1] Nick Glozier, et al. Med J Aust 2013; 199 (3): 179-180
Disclosure of Interest: None Declared
PT156
National Heart Foundation of Australia Review of Evidence Around Depression In
Patients With Coronary Heart Disease
David M. Colquhoun1, Stephen J. Bunker2, David M. Clarke3, Nick Glozier4, David L. Hare5,
Ian B. Hickie4, James Tatoulis6, David R. Thompson*7, Geoffrey H. Tofler8,
Maree G. Branagan9, National Heart Foundation Psychosocial Risk Factors and CHD expert
committee
1
University of Queensland, Brisbane, 2Greater Green Triangle University Department of Rural
Health, Flinders University and Deakin University, Warrnambool, Vic, 3Monash University,
Melbourne, 4Brain and Mind Research Institute, University of Sydney, Sydney, 5University of
Melbourne, 6National Heart Foundation of Australia, 7Cardiovascular Research Centre,
Australian Catholic University, Melbourne, 8Royal North Shore Hospital, University of Sydney,
Sydney, 9Clinical Programs, The National Heart Foundation of Australia, Melbourne, Australia
Introduction: Depression is an important independent risk factor for first and recurrent
coronary heart disease (CHD) events. The prevalence of depression is higher in patients
with CHD than in the general population.
Objectives: To review current evidence around depression in CHD patients to guide health
professionals.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: An expert working group reviewed new evidence in this area. Literature searches
used key search phrases, including stress, depression, anxiety, acute coronary syndromes,
adherence, treatment and screening. Recommendations were made for screening, referral and
treatment based on this evidence [1]. The Cardiac Society of Australia and New Zealand and
the Royal Australian and New Zealand College of Psychiatrists have endorsed the content.
Results: The prevalence of depression is high in patients with CHD and it has a significant
negative impact on the patient’s quality of life and prognosis.
- Comorbid depression in CHD patients is associated with decreased adherence to
therapy, and reduces the chances of successful modification of other risk factors and
participation in cardiac rehabilitation.
- It is important to recognise depression in patients with CHD. A simple tool for initial
screening, such as the Patient Health Questionnaire-2 (PHQ-2), or the Short-Form
Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with
minimal interference, and may increase uptake of screening. If screening is followed
by comprehensive co-ordinated care, depression outcomes are likely to be improved.
Grade of
Recommendation [1] recommendation
1. For patients with CHD, it is reasonable to screen for depression. Grade A
2. Treatment of depression in CHD patients changes behavioural Grade B
risk factors/ adherence
3. Exercise is an effective treatment of depression in patients with CHD Grade A
4. Exercise improves CHD outcomes in patients with CHD Grade B
5. Psychological interventions improve depression in patients with CHD Grade B
6. SSRIs improve depression in patients with CHD Grade A
7. Collaborative care approach improves depression in patients with CHD Grade B
Conclusion: The benefits of screening for and treating depression in CHD patients include
improved quality of life, improved adherence to other therapies and potentially improved
CHD outcomes.
[1] Colquhoun DM, et al. Med J Aust 2013; 198 (9): 483-484.
Disclosure of Interest: None Declared
PT158
Clinical characteristics, etiology and occurrence of type 2 acute myocardial infarction
Filip M. Szymanski*1, Krzysztof J. Filipiak1, Anna E. Platek1, Anna Szymanska2,
Grzegorz Karpinski1, Grzegorz Opolski1
1
Cardiology Department, 2Department of Cardiology, Hypertension and Internal Diseases,
The Medical University of Warsaw, Warsaw, Poland
Introduction: Type 2 myocardial infarction is secondary to ischaemia due to either
increased demand or decreased supply of oxygen, e.g. coronary artery spasm, anaemia,
arrhythmia, coronary embolism, hypertension, or hypotension.
Objectives: The aim of the study was to assess the occurrence and etiology of type 2 acute
myocardial infarction (AMI), and to describe the clinical characteristics of study patients.
Methods: Retrospectively, the medical records for patients hospitalized in Cardiology
Department with AMI between 2009-2012 were reviewed. All patients underwent coronary
angiography. Patients were categorized according to the etiology of the type 2 of AMI.
Results: Among 2882 patients, we selected 58 (2%) [mean age 67.3
13; 60.3% female]
with discharge diagnosis AMI type 2. 23 (39.6%) patients experiencing coronary artery
spasm, 15 (25.9%) arrhythmias, 11 (19%) severe anaemia and 9 (15.5%) patients hyper-
tension without significant coronary artery disease. 42 (72.4%) study patients were diag-
nosed as non-ST-segment elevation myocardial infarction, 14 (24.1%) as ST-segment
elevation myocardial infarction and 2 (3.5%) patients as acute myocardial infarction in the
presence of ventricular paced rhythm. 42 (72.4%) study patients had history of hyper-
tension, 14 (24.1%) history of diabetes mellitus, 23 (39.7%) history of dyslipidemia, 24
(41.4%) family history of heart disease and 16 (27.6%) history of smoking. 34 (58.6%)
patients suffered from chest pain of various intensity, 17 (29.3%) had palpitations, and 9
(15.5%) had dyspnea. Fainting was a manifestation of AMI in 8 patients (13.8%). The all-
cause mortality rate at 30 days was 5.2%, and at 6 months 6.9%.
Conclusion: Type 2 AMI patients were more often female and diagnosed as non-ST-
segment elevation myocardial infarction. The prevalence of classical cardiovascular risk
factors in this subgroup of patients was very high. Leading cause of AMI was coronary
artery spasm. The outcome was similar to patients with AMI type 1.
Disclosure of Interest: None Declared
PT159
Impact of Assessment and Treatment of Coronary Artery Disease on Prognosis of
Patients on the Renal Transplantation Waiting List
Jose De Lima*1, Luis Henrique W. Gowdak1, Flavio J. de Paula2, Luiz A. Bortolotto1
1
Cardiology, Heart Institute (InCor) Hospital das Clinicas University of São Paulo Medical
School, 2Urology, Renal Transplant Unit Hospital das Clinicas University of São Paulo Medical
School, São Paulo, Brazil
Introduction: The value of systematic assess of coronary artery disease (CAD) on the
waiting list for renal transplantation is controversial.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: To assess the impact of diagnosis and treatment of CAD on the incidence of CV
POSTER ABSTRACTS
events (myocardial infarction, unstable angina, cardiac arrest, major arrhythmia, heart
failure, acute peripheral vascular syndrome) and death in patients on the transplant waiting
list.
Methods: Unicentric cohort study in 1429 chronic kidney disease patients (54
11 yo,
62% males, 69% Caucasians, 82% hypertensive, 41% diabetic, 39% with associated CVD,
median follow-up 42 months) prospectively evaluated for CAD and treated according with
AHA/ACCA guidelines between 1997 and 2013. All individuals underwent myocardial
scan. Coronary angiography was restricted to patients with angina, altered scan and those
with at least two of the following: age  50 yo, diabetes or CVD.
Results: The incidence of events was 13%, 20%, and 33% for low-risk patients that did not
undergo CA (G 1, n¼ 424), those with nonsignificant stenosis (G 2, n¼ 544) and those
with  70% stenosis (G 3, n¼ 461), respectively, p< 0.0001; G 1v G 2 HR 2.17 %CI 1.58-
3.08; G 2 v G 3 HR 1.72 %CI 1.35-2.22. The incidence of death also differed among
groups (p< 0.0001). Among 448 patients with  70% stenosis, 349 received medical
treatment, 41 were selected for PCI and 58 for CABG (intention to treat). The incidence of
events were 34%, 24% and 41%, respectively, p¼ 0.39. The incidence of death also did not
differ (p¼ 0.09). However, the difference between patients that actually underwent
intervention (n¼ 59) with those who did not (n¼ 40), was significant for events
(p¼ 0.004) and death (p¼ 0.0001). Four hundred-twelve patients underwent trans-
plantation and the results for CAD assessment and treatment were similar.
Conclusion: Clinical assess for CAD is a useful risk-stratification method for patients on
the waiting list. Medical treatment is not inferior compared to intervention when properly
selected. However, non-intervention when indicated according with current guidelines may
have serious consequences.
Disclosure of Interest: None Declared
PT160
A greater decline in 30-day case fatality following incident myocardial infarction in
diabetics than non-diabetics between 1998 and 2010
Lee Nedkoff*1, Matthew Knuiman1, Joe Hung1,2, Tom Briffa1
1
School of Population Health, 2School of Medicine and Pharmacology, The University of Western
Australia, Perth, Australia
Introduction: Early mortality following myocardial infarction (MI) is worse in diabetics
than non-diabetics. Whether more aggressive risk factor management of diabetics as well as
better treatment after MI onset have reduced this differential is unknown.
Objectives: To measure population trends in 30-day case fatality following incident MI in
patients with and without diabetes.
Methods: All incident MIs in 35-84 year olds from 1998-2010 were identified from the
WA Data Linkage System, using a 13-year hospitalisation history to identify incident MI
and classify patients as diabetic. 30-day case-fatality was defined as all-cause death within
30-days of MI admission. Case-fatality was age-standardised by 5-year agegroup and trends
analysed with age-adjusted logistic regression models by period (1998-2001, 2002-04,
2005-07, 2008-10). Variables associated with 30-day deaths from logistic regression
(p<0.05) were entered into a multivariate model to test for differences in trends between
diabetics and non-diabetics.
Results: There were 26,610 incident MIs during the 13-year study period, with 1691
deaths occurring within 30 days (29.3% diabetics, 58.9% men). Unadjusted 30-day case-
fatality was highest in women in the first period (14.1% in diabetics and 12.4% in non-
diabetics). Age-standardised case fatality fell from 9.0% to 2.6% in diabetic women and
from 5.6% to 2.7% in non-diabetic women, and from 7.1% to 1.5% in diabetic men and
from 3.6% to 2.1% in non-diabetic men. The strongest univariate predictors of 30-day
deaths were increasing age, heart failure, prior stroke and chronic kidney disease, with PCI
during the incident admission protective of 30-day deaths. After multivariate adjustment,
the annual rate of decline in 30-day deaths was significantly greater in diabetic than non-
diabetic men (-7%/year vs -1%/year, p<0.01), and was also greater, although not signifi-
cantly so, in diabetic than non-diabetic women (-8%/year vs -4%/year, p¼0.16).
Conclusion: Early case-fatality following incident MI has improved significantly over the
past decade in diabetics and non-diabetics, with greater absolute declines seen in diabetic
men and women. These findings are consistent with improved acute MI care and possibly
better control of cardiovascular risk profile in diabetics.
Disclosure of Interest: None Declared
PT161
Long-term mortality in diabetics and non-diabetics after incident myocardial
infarction
Lee Nedkoff*1, Matthew Knuiman1, Joe Hung1,2, Tom Briffa1
1
School of Population Health, 2School of Medicine and Pharmacology, The University of Western
Australia, Perth, Australia
Introduction: Post-myocardial infarction (MI) survival is worse in diabetics than non-di-
abetics, however it is unclear if this differential in mortality has reduced over time.
Objectives: To measure population trends in 5-year mortality after incident MI in patients
with and without diabetes, and determine whether the gap in mortality has changed over
time.
Methods: The Western Australian Data Linkage System was used to identify incident MIs
in 35-84 year olds from 1998-2005. Cases were stratified by diabetes status based on
13-year hospitalisation history. All-cause and cardiovascular disease (CVD) deaths within
5-years in patients surviving 30-days were identified. Men and women were analysed
separately. Unadjusted mortality for incident MIs were estimated from Kaplan-Meier
curves. Hazard ratios (HR) for 5-year mortality in diabetics compared with non-diabetics
e197
 were calculated separately for incident MIs occurring in 1998-2001 and 2002-2005, and
POSTER ABSTRACTS
obtained from multivariable Cox regression models that adjusted for age, indigenous status,
comorbidities, prior revascularisation, and revascularisation within 30 days of MI. Changes
in the hazard ratio between the two periods were tested using a period x diabetic status
interaction term.
Results: There were 13,874 30-day survivors post incident MI from 1998-2005 (23.9%
diabetics), with 2,657 deaths within 5 years (38.2% diabetics), of which 50.9% were CVD
deaths (36.9% diabetics). Unadjusted 5-year all-cause mortality was higher in diabetics
than non-diabetics in women (36.0% vs 20.0%) and men (27.7% vs 13.9%) overall. When
restricted to CVD deaths only, unadjusted 5-year mortality was also higher in diabetics
(women 19.8% vs 10.6%; men 14.5% vs 7.5%). The adjusted hazard ratio comparing all-
cause mortality in diabetics with non-diabetics was greater in 2002-2005 in men (HR 1.5,
95% CI 1.3, 1.8) compared with 1998-2001 (HR 1.3, 95% CI 1.1, 1.5) and similarly in
women (HR 1.6, 95% CI 1.3, 1.9 versus HR 1.3, 95% CI 1.1, 1.6), although differences
between the periods were not significant (interaction p-value men 0.11, women 0.55).
There was no significant difference in the hazard ratios for 5-year CVD mortality between
the two periods.
Conclusion: The excess mortality in diabetics compared with non-diabetics following MI
did not diminish during the study period. This indicates a need for more aggressive sec-
ondary prevention for diabetic patients who survive a first MI.
Disclosure of Interest: None Declared
PT162
Prediction of Major Adverse Cardiac Events of Patients With Acute Coronary
Syndrome In Hospital Using Timi Risk Score And Timi Risk Index
Mohammad A. Ehsan1, Manzoor Mahmood*2, Md A. Salim2, Jahanara Arzu2, M. M. Rahman2
1
Cardiology, Sylhet MAG Osmani Medical College, Sylhet, 2Cardiology, Bangabandhu Sheikh
Mujib Medical University, Dhaka, Bangladesh
Introduction: Patient with acute coronary syndrome (ACS) has considerable variability
in outcome and mortality risk.The Thrombolysis in Myocardial Infarction (TIMI) risk
score and TIMI risk index (TRI) for unstable angina (UA)/non STelevation myocardial
infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) were a conve-
nient bedside clinical risk score for predicting 30 days mortality at presentation
with ACS.
Objectives: This study was done to predict and validate major adverse cardiac events
(MACE) in patients of ACS thus it will help us to quantify risk, observe the prognostic value
and to guide appropriate therapy by using TIMI risk score and TRI.
Methods: This prospective study was carried out in the department of cardiology,
Bangabandhu Sheikh Mujib Medical University, Dhaka from April 2011 to March
2012. Data were collected from 279 patients attending cardiac emergency department
with the presentation of ACS. History, physical examination, ECG and cardiac markers
were done. TIMI risk score and TRI were calculated in each patient. The MACE
(recurrent myocardial infarction, urgent revascularization and all-cause mortality) were
measured for next 30 days in hospital and out-patient department by follow up. After
follow up Cox univariate and multivariate regression analysis were used to evaluate the
influence of potential risk factors on duration of event free survival, and likelihood
ratio tests to assess the outcome.
Results: In patients with UA/NSTEMI, MACE were 0%, 4.2%, 6.9%, 12.5%, 13.6% and
33.3% with TIMI score 0,1, 2, 3, 4, 5, 6 and 7 respectively. In patients with STEMI
group, MACE were 0%, 0%, 0%, 0%, 7.1%, 9.5%, 10%, 17.6%, 19% and 38.5% with
TIMI score 0, 1, 2, 3, 4, 5, 6, 7, 8 and more than 8 respectively. Death from TRI group 1,
2, 3, 4 and 5 were 0%, 0%, 3.7%, 12.9% and 19.2% respectively in UA/NSTEMI group.
In STEMI group death of TRI group 1, 2, 3, 4 and 5 were 0%, 4.7%, 12.5%, 17.1%
and24.1% respectively.
Conclusion: Increasing TIMI risk score was associated with increased risk of MACE. These
score were a valid tool for risk assessment.
Disclosure of Interest: None Declared
PT163
Gender differences of coronary intervention for patients with acute coronary
syndrome admitted at a major metropolitan hospital in Melbourne, Australia
Linda Worrall-Carter1, Andrew I. MacIsaac2, Elizabeth Scruth3, Muhammad Aziz Rahman*1
1
St Vincent’s Centre for Nursing Research (SVCNR) & The Cardiovascular Research Centre
(CvRC), Faculty of Health Sciences, Australian Catholic University, 2Department of Cardiology,
St Vincent’s Hospital, Melbourne, Australia, 3Kaiser Permanente (NCAL) Regional Quality and
Regulatory Services, California, United States
Introduction: Literature suggests an ongoing gender disparity in the use of coronary
angiography and subsequent interventions among patients with acute coronary syndrome
(ACS). Many studies describe women with ACS as being older, with more co-morbidities
than men resulting in less coronary interventions.
Objectives: To investigate the factors underlying the gender differences for coronary
angiogram and revascularization for patients admitted with ACS at a major metropolitan
hospital in Melbourne during 2009-12.
Methods: Patients, having the primary diagnosis of ACS in the database and admitted for
the first time, were selected for analyses. ICD-10 was used for coding of ACS and co-
morbidities. ACS was classified as unstable angina (UA), ST-segment elevation myocardial
infarction (STEMI) and non-STEMI. For each category, gender differences were analysed
on demographics, coronary angiogram, angioplasty, coronary artery bypass grafting
(CABG), risk factors and co-morbidities.
e198
Results: A total of 2096 patients were included, 624 (30%) were women. Mean age
(SD) of the patients was 64.3(13.4) years. Half of them (51%) were diagnosed as
NSTEMI, 23% as STEMI and 25% as UA. Women diagnosed with NSTEMI were 24%
less likely to have an angiogram than men (60% vs. 67%, p<0.05, odds ratio 0.76,
95%CI 0.58-0.99). Compared to men, women were less likely to have angioplasty if
diagnosed with STEMI (57% vs. 72%, p<0.01, odds ratio 0.50, 95%CI 0.33-0.76) and
diagnosed with NSTEMI (32% vs. 39%, p<0.05, odds ratio 0.75, 95%CI 0.57-0.98).
Women were also less likely to have CABG than men if diagnosed with UA (10% vs.
21%, p<0.01, odds ratio 0.41, 95%CI 0.23-0.72) and diagnosed with NSTEMI (9% vs.
16%, p<0.01, odds ratio 0.51, 95%CI 0.33-0.78). Women of 35-59 years were less
likely to have coronary interventions, however, the likelihood of this increased if they
were above 70 years of age. There was no gender difference for severe co-morbidities.
Current smoking was the only significant risk factor for gender difference and men
were more likely to smoke than women.
web 3C=FPO
Conclusion: Younger women were less likely to receive coronary intervention in
terms of diagnosis and treatment compared to men. Future research investigating
symptom presentation of younger women as well as exploring perceptions of health
care workers including cardiologists for decisions on coronary intervention could
explain the reasons of gender disparity and subsequent gaps in treatment adherence
guideline.
Disclosure of Interest: None Declared
PT164
Alcohol consumption and acute myocardial infarction in patients with previous
revascularization
Predrag Mitrovic*1, Branislav Stefanovic1, Mina Radovanovic1, Nebojsa Radovanovic1,
Gordana Matic1, Dubravka Rajic1, Tanja Jozic1, Ana Novakovic1, Ida Subotic1,
Zorana Vasiljevic1
1
Cardiology Clinic, CLINICAL CENTER OF SERBIA, Faculty of Medicine, University of
Belgrade, Belgrade, Serbia
Introduction: It is well known that the risk of myocardial infarction is lower among light-
to-moderate alcohol consumers compared with abstainers.
Objectives: The prognosis of patients (pts) after coronary artery bypass surgery (CABS)
has been noted in many studies, but there were no studies which analyzed prognosis of
light-to-moderate alcohol consumers with acute myocardial infarction (AMI) after prior
CABS.
Methods: The effect of light-to-moderate alcohol consumption was assessed in 324
pts with AMI after prior CABS (post bypass group) and control group of 538 pts
with AMI and without prior CABS, who were followed from April 1988 to April
2013.
Results: At baseline post bypass group was slightly younger (p¼0.0402), with more men
(p¼0.445) and with more pts with previous angina (p¼0.0440) and previous AMI
(p¼0.0389). Control group of pts had more hypertensives (p¼0.0318) and hyperlipidemia
(p¼0.0205) . Other baselines characteristics were similar in both groups of patients. In-
dexes of infarct size were lower in post bypass group (p¼0.0104). In-hospital mortality was
similar (p¼0.4012). After adjustment for cardiovascular risk factors by logistic regression,
alcohol consumption displayed a protective effect against myocardial infarction in control
group of patients, but not in bypass group of pts.
Conclusion: The effect of light-to-moderate alcohol consumption is associated with
decreasing risk of myocardial infarction in pts with AMI and without prior CABS, but not
in pts with AMI and with prior CABS. This effect of light-to-moderate alcohol consumption
is probably because of decreasing of cholesterol, triglycerides and fibrinogen, as well as
increasing of diastolic and systolic blood pressure.
Disclosure of Interest: None Declared
PT165
Prediction of short and intermediate-term mortality in patients with acute coronary
syndrome: Validation of the lab index in patients from the Gulf-RACE-2 registry
Tarek Kashour*1, Khalid Alhabib1, Hussam Alfaleh1, Ahmed Hersi1, Anhar Ullah2,
Alawi Alsheikhali3, Jassim Al Suwaidi4, Haitham Amin5, Ahmed Al-motarreb6,
Ahmed Al-Motarreb6, Wael Almahmeed3
1
Cardiology, King Saud University, 2Security Forces Hospital, Riyadh, Saudi Arabia,
3
Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 4Cardiology,
Hamad Medical corporation, Doha, Qatar, 5Cardiology, Mohammed bin Khalifa Cardiac center,
Manama, Bahrain, 6Cardiology, Sana’s University, Sana’a, Yemen
Introduction: Lab index is a simple score that incorporates hemoglobin and creatinine
clearance, was developed and validated in two large STEMI trials (InTIME II- TIMI 17 and
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 ExTRACT-TIMI25) and was shown to be a powerful predictor of death in STEMI separately
and with TIMI risk score
Objectives: To test whether the lab index can predict short and intermediate-term
mortality in real world all ACS patients separately and in combination with GRACE
score.
Methods: The study population consisted of 7929 consecutive patients enrolled in the
Gulf-RACE 2 registry from 6 gulf countries in the Middle East. Lab index was calculated
for every patient according to the formula (15 - Hgb + [100- CrCl/8]). C-statistic was
used to test the predictive power of lab index for 30-day and 1-year mortality in the entire
ACS cohort, and in STEMI and non-STEMI groups, and was compared to GRACE score. We
also tested whether the addition of the lab index to GRACE score improves its predictive
power
Results: The predictive power of the lab index for the 30-day mortality was reasonably
good with C-statistic for all ACS patients 0.71 (95% CI 0.69-0.74), STEMI 0.75 (95%
CI 0.71-0.77) and non-STEMI 0.70 (95% CI 0.66-0.74). Similarly, the predictive
power for the1-year mortality was good; C-statistic for all ACS patients 0.72 (95% CI
0.70-0.74), STEMI 0.74 (95% CI 0.71-0.76) and non-STEMI 0.71 (95% CI 0.68-
0.71). Overall, the lab index was as good as GRACE score in predicting 30-day and
1-year mortality, however, it performed better than GRACE score for STEMI patients
with C-statistic of 0.75 vs. 0.71 at 30 days (P¼ 0.02) and 0.74 vs. 0.69 at 1 year (P¼
0.001).
The low and intermediate GRACE risk groups showed significant variation in the pre-
dicted risk of death when stratified by different levels of lab index.
web 3C=FPO
Conclusion: In non-selected ACS patients, lab index has reasonable predictive power for
the 30-day and 1-year mortality and performed better than GRACE score for STEMI pa-
tients at both time points.
Disclosure of Interest: None Declared
PT166
How Many Dialysis Patients Receive Transplantation After Achieving Eligibility By
Undergoing Coronary Artery Bypass Grafting?
Janarthanan Sathananthan*1, Helen Pilmore2, Janak De Zoysa3, Peter Ruygrok1
1
Cardiology, Greenlane Cardiovascular Service, 2Department of Renal Medicine, Auckland
District Health Board, 3Department of Renal Medicine, Waitemata District Health Board,
Auckland, New Zealand
Introduction: In some centres dialysis patients undergo coronary artery bypass grafting
(CABG) to achieve eligibility for potential future renal transplantation (RTX).
Objectives: We wished to determine mortality and rate of renal transplantation following
CABG in this patient population.
Methods: All dialysis patients were identified, both symptomatic and asymptomatic, who
underwent isolated CABG from January 2005 to December 2012, in Auckland City
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Hospital, prior to potential future renal transplant. Mortality and rate of subsequent RTX
POSTER ABSTRACTS
were assessed.
Results: Isolated CABG was performed in 90 dialysis patients, with 45 (50%)
considered potential future RTX candidates. Of these 20 (44%) were asymptomatic,
with 4 (20%) receiving subsequent RTX, 10 (50%) removed from the transplant list or
died, and 6 (30%) patients continued to await renal transplantation as at 1st July 2013.
In symptomatic dialysis patients eligible for RTX, 3 (12%) received RTX, 17 (68%)
were removed from the transplant list or died and 5 (20%) continue to await renal
transplantation. There was no difference between asymptomatic patients and symp-
tomatic patients for rate of transplantation(p<0.68) and rate of removal from trans-
plant list due to ineligibility or death(p<0.24). Median follow-up time for
asymptomatic and symptomatic patients was 1487 and 1711 days respectively. Mor-
tality at 30 days was 5% and 12% for asymptomatic and symptomatic patients
respectively (p<0.62).
Conclusion: In dialysis patients, both symptomatic and asymptomatic, only a small pro-
portion undergo subsequent renal transplantation following CABG, with more than half
becoming ineligible. Strict selection criteria is important to ensure the appropriate patients
undergo CABG prior to RTX.
Disclosure of Interest: None Declared
PT167
Health-Related Quality of Life Five Years After Coronary Artery Bypass Graft
Surgery
Josip Vincelj*1, Tihana Jendricko2, Lela Bitar3, Mario Udovicic1, Mladen Petrovecki4
1
Cardiology, University Hospital Dubrava, 2Pshychiatry, University Psychiatric Hospital Vrapce,
3
Internal medicine, University Hospital Center Zagreb, 4Laboratory Diagnostics, University
Hospital Dubrava, Zagreb, Croatia
Introduction: Coronary artery bypass graft (CABG) surgery is performed to reduce
cardiac mortality and to relieve patients’ symptoms of coronary artery disease and to
prolong lives. Health related quality of life (HRQL) is a sensitive tool to asses the
outcome of coronary artery bypass graft surgery in terms of patient’s postoperative
functionality.
Objectives: The aim of our study was to determine HRQL of our patients and to determine
variables that have an impact on impaired or unimpaired HRQL, based on the completion
of the short form health survey questionnaire (SF-36).
Methods: Eligible subjects were adults who underwent CABG surgery in University
Hospital Dubrava, Zagreb during 2007. HRQL was assessed by the Short-Form 36 ques-
tionnaire. Demographic data (age, gender, BMI, smoking status, family history), medical
characteristics (cholesterol, LDL and blood glucose level) and presence of co-morbidity
(myocardial infarction, cerebrovascular disease, arterial hypertension, hyperlipidemia and
diabetes mellitus) were collected.
Results: The study population included 140 patients with age range between 43-83 years,
mean 61. 9
9.27. The study population had a significant burden of morbidity, including
hyperlipidemia 82%, hypertension 74% and myocardial infarction 59%. Good or excellent
health was reported by 62% of subjects. Limited performance during vigorous activities
was reported by 62.9% of our subjects, while only 20% of them reporetd limited perfor-
mance during moderate activities. Also 60.7% of our subjects reported that they accom-
plished less than they would like. Physical health or emotional problems didn’t interfere
with their normal social activities in 73%. Based on SF-36 answers we identified two
groups of subjects, first with unimpaired HRQL and second with impaired HRQL after
CABG surgery. We have found that gender, age, co-morbidity and smoking status were no
significant predictors of group membership (p>0.1). However, some of the variables were
associated with specific HRQL outcomes. For example, myocardial infarction was a sig-
nificant predictor for decreased work ability and difficulties in performing everyday tasks
(p<0.1).
Conclusion: Overall HRQL is unimpaired for most of the patients. There were no sig-
nificant predictors for impaired or unimpaired HRQL. We identified variables that are
associated with specific HRQL outcomes, which could be used as preoperative assessment
and to improve patients’ outcomes.
Disclosure of Interest: None Declared
PT168
Predictors of Thromboischemic Events In Early Postoperative Period of Coronary
Artery Bypass Grafting
Sergey Altarev*1, Olga Barbarash2, Yulia Podaneva2
1
Pehabilitation Laboratory, 2Research Institute of Complex Issues of Cardiovascular Diseases,
Kemerovo, Russian Federation
Introduction: Although contemporary invasive cardiology and cardiac surgery have ach-
ieved great success, perioperative periods including after coronary artery bypass grafting
(CABG) are still complicated with cerebral and cardiac ischemic events.
Objectives: Determine predictors of thromboischemic events in the early postoperative
period after CABG.
Methods: We analyzed the data of the CABG Registry which had been carried out in the
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian
Federation, in 2009. The Registry contains the data of all the patients undergone CABG
in the Institute in 2009. Ischemic events included fatal and nonfatal myocardial in-
farctions and ischemic strokes. All the statistical calculations were performed using
e199
 SPSS for Windows, version 13.0 (SPSS Inc.). Binary data were presented as counts and
POSTER ABSTRACTS
frequencies. Binary logistic regression analysis with forward conditional inclusion data
method was used to determine predictors of thromboischemic events in the early
postoperative period after CABG. Odds ratios (OR) and 95% confidence intervals (CI)
were calculated for each separate factor. Factors were included in the model if they had
a tendency to be associated with prognosis (p<0.11). A p value <0.05 was considered
statistically significant.
Results: 825 patients were included in the Registry, of those 659 (79.9%) were
male, mean age 58.4
7.9 years. In the early postoperative period after CABG,
there were 27 (3.3%) cerebral and cardiac ischemic events. Binary logistic
regression analysis showed the following predictors of adverse postoperative
events: intra-aortic balloon counterpulsation (IABC) in the perioperative period,
OR 18.25 (95% CI 3.99-83.45), p<0.001, and early (more than 2 days before
CABG) direct anticoagulants withdrawal, OR 3.90 (CI 1.27-11.91), p¼0.02; male
patients and those with body mass index (BMI) 25,0 kg/m2 were less likely to
have a complicated postoperative period, OR 0.29 (CI 0.11-0.74), p¼0.01, and
OR 0.14 (CI 0.06-0.34), p<0.001, respectively. This model allowed to classify
correctly 96.5% of patients (R2 Nagelkerke¼0.26). After the adjustment for age,
ejection fraction, laboratory results, diabetes mellitus, renal diseases and preop-
erative treatment there were no additional findings, the model appears to be
steady.
Conclusion: Predictors of cerebral and cardiac ischemic events in the early postoperative
period of CABG are the perioperative IABC use, early direct anticoagulants withdrawal
before CABG, female gender and normal/low BMI.
Disclosure of Interest: None Declared
PT169
Safety, feasibility and diagnostic performance of dobutamine stress echocardiography
with early atropine injection in prospective study of 364 tests
Karina Wierzbowska-Drabik*1, Nikolina Roszczyk1, Maria Sobczak1, Marcin Ojrzanowski1,
Monika Mo_zd_zan1, Małgorzata Kurpesa1, Ewa Trzos1, Tomasz Rechci
nski1,
Paulina Wejner-Mik1, Jarosław D. Kasprzak1
1 97.2% vs. 93.7%, P¼0.02; beta-blocker: 79.6% vs. 57.6%, P<0.01; statins: 96.1%
Cardiology Department, Medical University of Lodz, Lodz, Poland
Introduction: Dobutamine-atropine stress echocardiography (DASE) is a widely used
method for diagnosis of coronary artery disease (CAD). Early atropine administration may
limit dobutamine dose and its harmful effects.
Objectives: We assessed the feasibility, safety and diagnostic utility of DASE with early
atropine injection.
Methods: DASE with atropine (to whole dose of 2 mg) administered after the completion
of 20 mg/kg/min dobutamine was performed in 364 consecutive patients (190 men, 30%
with history of infarction, 74% on betaadrenolytics) with clinically indicated myocardial
ischemia workup. The test was considered positive when 2 adjacent segments displayed
new or worsened contractility impairment. Stenosis 70% in coronary arteries was
considered significant.
Results: Early atropine DASE offered 91,8% feasibility defined as reaching  85%
maximal age adjusted heart rate or diagnosis of ischaemia. In 81% of tests dose of
1 mg atropine was administered, in 48% DASE was stopped during infusion of 30/
mg/kg/min, in remaining cases during 40/mg/kg/min. Angiography confirmed presence
or absence of significant stenosis in 127/111 subjects. Test sensitivity for detection of
CAD was 87%, specificity 75%, positive/negative predictive value 80%/83% with
overall accuracy 81%. Observed complications are shown in table, any adverse event
occurred in 32 cases (8,8%).
The most severe adverse reactions were AF with rapid ventricular rate (1 patient),
prolonged chest pain or symptomatic hypotonia (2 cases each) totaling in 1,4% of studies
with no cases of test-related deaths or severe arrythmias.
Complications Number
severe, prolonged pain 8 Introduction: Myocardial reperfusion is important to attenuate damage following
hypotonia 2 myocardial infarction (MI). However, this elicits additional ischaemia-reperfusion (I-R)
excessive hypertonia 3 Objectives: To determine whether annexin-A1 mimetics Ac2-26 or the small molecule non-
bradyarrhytmia 3 peptide Agonist 43 (Ag43) protect against inflammation, myocardial and potential remote
supraventricular tachyarhytmias 2 lung injury, after 48h myocardial I-R.
ventricular arrythmias 14
all 32
Conclusion: DASE with early atropine performed in elevated risk population reveals high
feasibility, good safety profile and diagnostic utility at least non-inferior to classic high-
dose dobutamine test.
Disclosure of Interest: K. Wierzbowska-Drabik Grant/research support from: The
State Committee for Scientific Research, number N N402 5002 40, N. Roszczyk
Grant/research support from: The State Committee for Scientific Research, number
e200
N N402 5002 40, M. Sobczak Grant/research support from: The State Committee
for Scientific Research, number N N402 5002 40, M. Ojrzanowski: None Declared,
M. Mo_zd_zan: None Declared, M. Kurpesa: None Declared, E. Trzos: None Declared,
T. Rechci
nski: None Declared, P. Wejner-Mik: None Declared, J. Kasprzak Grant/
research support from: The State Committee for Scientific Research, number N
N402 5002 40.
PT170
Passive Prescription of Secondary Prevention Medical Therapy During Index
Hospitalization For Acute Myocardial Infarction Is Prevalent And Associated With
Adverse Clinical Outcomes
Xu-Rui Huang1, Ming Lau1, John E. Sanderson1, Yat-Yin Lam1, Alex Lee1, Cheuk-Man Yu1,
Bryan P. Yan*1
1
Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
Introduction: Secondary prevention therapy including aspirin, beta-blockers, statins,
angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers
(ARB) reduce death and re-infarction after acute myocardial infarction (AMI) but are
under-utilized in clinical practice. Mechanisms for this therapeutic gap are not well
established.
Objectives: We aim to evaluate the impact of passive continuation compared to active
initiation of secondary prevention therapy for AMI during index hospitalization.
Methods: We analyzed 1083 consecutive patients presenting with AMI to a tertiary
referral hospital in Hong Kong from February 2006 to October 2011 and assessed
discharge prescription rates of secondary prevention therapies (aspirin, beta-blockers,
statins, ACEI/ARB). Multivariate analysis was used to identify independent predictors of
discharge medication and Kaplan-Meier survival curve was used to evaluate 12-month
survival.
Results: Overall prescription rates of aspirin, beta-blocker, statin, ACEI/ARB on
discharge was 94.8%, 64.5%, 83.5% and 61.4%, respectively. Patients who were
prescribed each therapy prior to admission compared to those who were treat-
ment naïve were more likely to be discharged on the same medication (aspirin:
vs. 79.3%, P<0.01; ACEI/ARB: 80.2% vs. 54.4%, P<0.01). Multivariate analysis
showed that prior use of each therapy was an independent predictor of pre-
scription of the same therapy on discharge: aspirin [Odds ratio (OR) ¼4.8, 95%
CI ¼1.9-12.3, P<0.01]; beta-blocker (OR¼2.5, 95%CI¼ 1.8-3.4, P<0.01); statin
(OR¼8.3, 95%CI¼0.4-15.7, P<0.01) and ACEI/ARB (OR¼2.9, 95%CI¼2.0-4.3,
P<0.01). Passive continuation of prior medication was associated with higher
1-year mortality rates than active initiation in treatment naïve patient [aspirin
(13.7% vs. 5.7%), beta-blockers (12.9% vs. 5.6%), statins (11.0% vs. 4.6%), all
p<0.01]
Conclusion: Overall use of secondary prevention medication for acute myocardial
infarction was suboptimal. Our findings suggested that the practice of passive continuation
of prior medication was prevalent and associated with adverse clinical outcomes compared
to active initiation of secondary preventive therapies for acute myocardial infarction during
index hospitalization.
Disclosure of Interest: None Declared
PT174
Ac2-26, an Annexin A1 mimetic, reduces inflammation against myocardial
reperfusion injury in mice in vivo
Chengxue Qin*1, Renming Li1,2, Xiaoming Gao3, Nga Cao1, Sarah Rosli1, Chantal Donovan2,
Meaghan FitzPatrick2, Jane E. Bourke2, Rebecca H. Ritchie1,2
1
Basic and Clinical Cardiology, Baker IDI Heart and Diabetes Institute, 2Department of
Pharmacology, University of Melbourne, 3Experimental Cardiology, Baker IDI Heart and
Diabetes Institute, Melbourne, Australia
injury, contributing to morbidity and mortality.
Methods: Male C57/bl6 mice (30
0.4g) were subjected to sham (n¼6) or 1h coronary
artery occlusion (n¼8/grp), under ketamine (100mg/kg)-xylazine (20mg/kg) i.p. anaes-
thesia, with 48h reperfusion. Ac2-26 (1mg/kg i.v.), Ag43 (50mg/kg i.p.) or vehicle were
administered daily on reperfusion. Systemic inflammation was assessed by total and dif-
ferential white blood cell counts. Myocardial damage was assessed by enumeration of
macrophage infiltration (CD68+ fluorescence) and qualitative assessment of morphology
(H&E score). Lung injury was assessed by tracheal hyperresponsiveness (myograph) and
pulmonary oedema (wet:dry lung weight).
Results: Myocardial I-R induced systemic and cardiac inflammation after 48h, but
no lung injury was evident. Ac2–26 and Ag43 both decreased cardiac injury. Ac2-26
also attenuated the increased serum neutrophils and macrophage infiltration
(Table, *P<0.05 vs sham; #P<0.05 vs vehicle I-R, unpaired t-test; ND, not
determined).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 Women Men

POSTER ABSTRACTS
In Hospital Outcome, n (%) n[4024 n[12200 p-value
CVA 16 (0.4%) 22 (0.2%) 0.013
Arrhythmia 294 (7.3%) 778 (6.4%) 0.039
Tamponade 10 (0.2%) 8 (0.1%) 0.002
Conclusion: These results support further investigation of Ac2-26 to improve systemic and
Bleeding complication 149 (3.7%) 238 (2.0%) 0.000
cardiac outcomes after MI.
Disclosure of Interest: None Declared Death 105 (2.6%) 216 (1.8%) 0.001

PT175
Role of novel noninvasive herbal procedure Sampurna Hriday Shudhikaran (SHS) in
reducing angina & improving effort tolerance in Ischemic Heart Disease
Rohit M. Sane1, Milind S. Hanchate*2
1
Cardiology, 2Research, Madhavbaug Cardiac Center, Thane, India
Introduction: India is experiencing an alarming increase in ischemic heart disease.
The clinical and economic importance of IHD is widely recognized. By 2020 India
will have more than 2.58 million deaths due to ischemic heart disease. Herbal
treatments may provide promising, beneficial effect in reducing angina and
improving effort tolerance in IHD patients. But unfortunately there are no promising
report that shows herbal treatment is effective treatment. In that context we planned
present study.
Objectives: To study the effect of novel noninvasive herbal procedure Sampurna Hriday
Shudhikaran (SHS) intervention model in reducing angina and improving the effort
tolerance in IHD patients.
Methods: 280 IHD patients (205 males & 75 Females ) were selected for study. A pro-
spective observational study was conducted with SHS as a six days residential therapy in
Madhavbaug Cardiac Center, Mumbai, India. SHS consist of the 4 pronged interventions of
Snehan, Swedan, Hrid Dhara and Basti was used in each patient who received twice daily
sessions of 90 minutes each for 6 consecutive days. Symptomatic IHD patients (age 25–75
years) with heart failure (grade 1–3 of New York Heart Association classification) of either
sex with ejection fraction more than 25% and who provided written informed consent were
included in study. Preintervention & postintervention stress test was done to measure ST
segment depressions for angina and metabolic equivalents (METs) for effort tolerance to
assess improvement.
Results: The mean improvement of angina in IHD patients with multiple risk factors was
1
0.1mm of ST segment depression on stress test in males(p<0.000)) & 0.56
0.1mm
of ST segment depression in females(p<0.01) was found to be highly significant. The mean
improvement in effort tolerance was found to be 1.53
0.09 METs in males (p<0.000)and
1.16
0.09 METs in females (p<0.000). Mean triglycerides were reduced significantly
25
4 mg/dl in both males & females (p<0.000) .No significant adverse events were seen
in any patient.
Conclusion: Herbal procedure SHS results in reducing angina and improving effort
tolerance in both male & female patients having IHD. SHS therapy may be helpful as an
adjunctive non-pharmacological treatment for symptomatic IHD patients.
Key Words: Ischemic Heart Disease, Sampurna Hriday Shudhikaran, ST segment
depression, Angina, Effort Tolerance
Disclosure of Interest: None Declared
At 30 days, unadjusted mortality (3.2 vs. 2.1%, p<0.001) and MACE (6.5 vs. 5.4%,
p<0.01) remained higher in women. However, at 12 months gender was not an inde-
pendent predictor of death (OR 0.99, 95% CI 0.79 – 1.25, p¼0.944) or MACE (OR 1.06,
95% CI 0.93 – 1.19, p¼0.389).
Conclusion: Our registry data showed that women had a higher rate of in hospital
complications but their outcome at 12 months was comparable to men. Cardiologists need
to be aware of the potential risk of procedural complications in women but this should not
affect the decision to offer PCI.
Disclosure of Interest: None Declared
PT177
Predictors and outcomes of early coronary angiography in patients with prior
coronary artery bypass surgery presenting with non-ST elevation myocardial
infarction
Muhammad Asrar Ul Haq*1, Tamara Mogilevski1, Mueed Mian1, Anastasia Castles1,
Vivek Mutha1, Nima Rudd1, William Van Gaal1
1
Cardiology, The Northern Hospital, Melbourne, Australia
Introduction: Current guidelines support an early invasive strategy for high risk NSTEMI.
The best strategy in subgroup of patients with prior CABG who present with NSTEMI
remains less well defined.
Objectives: To compare the characteristics, therapeutic interventions, and outcomes of
patients with prior CABG presenting with NSTEMI.
Methods: All patients who presented to Northern Health during 2007-2012 with available
electronic records were analysed retrospectively. Outcomes were compared between pa-
tients who underwent coronary angiography or percutaneous coronary intervention (PCI)
versus those who were treated medically.
Results: A total of 117 patients were analysed. 79 patients were managed medically while
38 underwent angiography, out of which only 11 (9.5%) received PCI during the index
admission. Patients treated medically were older (74
10 vs.70
8;p¼0.05). New ECG
changes were the only independent predictor for early angiography (OR 0.4, 95%CI 0.15-
0.99;p¼0.05) while recurrent chest pain (OR 0.2, 95%CI 0.05-0.97;p¼0.05) predicted PCI
on multivariate analysis. PCI group had higher GRACE score (176
29 vs.
150
31;p¼0.01). No significant difference was found in readmission rates, morbidity
(unstable angina, NSTEMI, STEMI, or combination) or mortality at 12 months between the
groups who underwent angiography, PCI, or treated medically on univariate and multi-
variate analysis.

PT176
Women are at risk of procedural complications following percutaneous coronary
intervention but have comparable 12 month outcomes
Hui-Chen Han*1, Peter Scott1, Nick Andrianopoulos2, Angela Brennan2, Melanie Freeman3,
Omar Farouque1, Ali Al-Fiadh1, Stephen Duffy4, Andrew Ajani5, David Clark1
1
Cardiology, Austin Hospital, 2Monash University, 3Cardiology, Box Hill Hospital, 4Cardiology,
Alfred Hospital, 5Cardiology, Royal Melbourne Hospital, Melbourne, Australia

Introduction: It has been well described that females undergoing percutaneous coronary
intervention (PCI) are older and have greater co-morbidities than males. Previous registry
data has also described gender to be associated with MACE and morbidity. However, there
is still debate whether risk factors entirely account for their higher mortality or whether
females are specifically pre-disposed to a higher risk of procedural complications based on
gender alone.
Objectives: The aim of this study was to compare the incidence of procedural compli-
cations, 30 day, and 12 month outcomes in women undergoing PCI when compared to
men.
Methods: We compared clinical characteristics, in-hospital complications, 30-day and
1-year outcomes in 4024 (24.8%) women with 12200 (75.2%) men undergoing PCI from
2005 to 2011 from the multicentre Melbourne Interventional Group (MIG) registry.
Multivariate analysis accounting for clinical and procedural variables was used to determine
predictors of 12 month mortality and major adverse cardiac events (MACE).
Results: Women were more likely to be older, have a history of hypertension, diabetes,
stroke, atrial fibrillation, renal dysfunction, and have non-ST elevation myocardial infarc-
tion and/or cardiogenic shock. Conversely, men were more likely to be smokers, have a left
ventricular ejection fraction 45%, and present with ST elevation myocardial infarction
and/or out of hospital cardiac arrest. In-hospital complications, including death were
higher among women (see table).

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e201

 Conclusion: The opportunity to intervene in prior CABG patients presenting with
POSTER ABSTRACTS
NSTEMI is often low. Medical management may be a reasonable option in carefully selected
patients particularly in the absence of ongoing symptoms, new ECG changes, or very high
GRACE scores. Further studies are required to evaluate the safety of initial noninvasive
strategies in managing this population.
Disclosure of Interest: None Declared
PT178
The impact of moderate chronic kidney disease on 1 year outcomes after
Percutaneous Coronary Intervention
Nicolas Grandjean-Thomsen*1, Paul Marley2, Ahmad Farshid2
1
The Australian National University, 2Cardiology, The Canberra Hospital, Canberra,
Australia
Introduction: Patients with end-stage Chronic Kidney Disease (CKD) have worse out-
comes after Percutaneous Coronary Intervention (PCI). However, outcomes after PCI in
patients with moderate CKD have not been well studied.
Objectives: Determine the incidence of adverse cardiac events in patients with and without
CKD undergoing PCI.
Methods: The PCI database of Canberra Hospital was analysed to determine demographic,
procedural and outcome variables for consecutive patients (Oct 2009- Nov 2010). Patients
were followed up at 12 months via letter, phone call and review of medical records. CKD
was defined as GFR < 60.
Results: Of 764 patients treated there were 141 (18.5%) with CKD. CKD patients
were older (mean age (SD) 72.4 (10.5) v 62.4(11.2) p <0.0001), and more often
female (39.7% v. 20.7% p < 0.0001). CKD patients were more likely to have
diabetes (35.5% v 20.7% p¼0.0018), hypertension (66.7% v 48.6% p < 0.0001),
three vessel disease (27.0% v 14.6% p¼0.0023) and complex (type C) lesions (35%
v 23.8% p¼0.0079). Amongst the groups (CKD vs Non-CKD), procedural success
was the same (97.9% v 98.6% p¼ns), as was the usage of drug eluting stents
(36.9% v 38.8% p¼ns). During the follow up period, there was a higher incidence
of death (10.6% v 2.6% p¼0.0001) and adverse cardiac events (22.0% v 8.7%
p<0.0001) in the CKD group. There were no significant differences observed for
stent thrombosis (2.1% v 0.8%), myocardial infarction (5.0% v 3.2%), repeat PCI
(5.0% v 5.0%) or subsequent bypass surgery (3.5% v 1.3%)(p¼ns for all). Patients
with stage 3 CKD (GFR 30-59) had a significantly higher risk of death (10.6% v
2.6%, p¼0.0016) and adverse events (19.5% v 8.5% p¼0.0011) compared with
patients with GFR >59.
Conclusion: CKD patients undergoing PCI are older, more likely to be female, with a
higher prevalence of diabetes and hypertension than non-CKD patients. Patients with even
moderate CKD have a significantly increased risk of death and major adverse cardiac
events. Intensive treatment of vascular and renal disease in these patients is warranted in an
effort to reduce their risk of adverse events.
Disclosure of Interest: None Declared
PT179
Increasing risk profile amongst patients undergoing PCI in Australia
Ryan J. Spencer*1, Nick Andrianopoulos2, Peter Scott1, Omar Farouque1, Stephen Duffy3,
Andrew Ajani4, Jay Ramchand1, Thomas Yip5, Angela Brennan2, David Clark1
1
Cardiology, Austin Health, Heidelberg, 2CCRET, Monash University, 3Cardiology, Alfred
Health, Melbourne, 4Cardiology, Austin Health, Parkville, 5Cardiology, Barwon Health, Geelong,
Australia
Introduction: Changes in the clinical and procedural characteristics of patients undergoing
percutaneous coronary intervention (PCI) have implications for health resource utilization
and proposed public reporting of outcomes.
Objectives: To determine trends in demographics, risk factors, clinical presentation and
procedural device/drug use in patients undergoing PCI in Australia.
Methods: We analysed the change in clinical characteristics between 2005 and 2012 in
19068 consecutive patients undergoing PCI from the large, Australian, multi-centre Mel-
bourne Interventional Group registry.
Results: While the mean age of patients remained unchanged at 65 years the percentage of
octogenarians rose over the 8 years from 11% to 13% (p¼0.04) The proportion of current
smokers (22% to 27%) and hypertensive patients (62% to 67%) increased (both p<0.001),
but the mean BMI (28 kg/m2) and percentage of diabetics (25%) did not significantly
change. The number of patients with eGFR 30-59 mL/min/1.73m2 decreased from 25% to
19%, p<0.001 while the number of patients with eGFR < 30 mL/min/1.73m2 was un-
changed (3%).
There was an increase in the proportion of patients undergoing PCI with acute coronary
syndrome (ACS) from 61% in 2005 to 71% in 2012 (p<0.001) and in the subset with ST
elevation myocardial infarction (STEMI) from 20% to 34% (p<0.001). There was a cor-
responding decrease in elective PCI from 39% to 29%. Over this period there was also a
significant (all p<0.001) increase in the number of patients presenting with cardiogenic
shock (2.0% to 3.7%), current heart failure (4.1% to 5.9%) and out of hospital cardiac
arrest (0.7% to 3.7%).
Drug eluting stent use decreased from 51% in 2005 to 34% in 2007 and then increased
yearly back to 52% in 2012. Utilisation of GP IIb/IIIa inhibitors increased from 25% to
30% (p<0.001).
Conclusion: Patients presenting for PCI in Australia now are more likely to be
unstable with ACS, STEMI, and hemodynamic instability with a resultant higher
e202
risk of short term mortality. There is increasing procedural use of drug eluting
stents and GP IIb/IIIa inhibitors. This data is crucial to ensure optimal resource
allocation and accurate reporting of outcomes by using contemporary risk adjust-
ment models.
Disclosure of Interest: None Declared
PT180
Gender Differences of methods of hospital presentation, time to presentation and
door to balloon times in an Australian ST-Elevation Myocardial Infarction population
undergoing primary Percutaneous Intervention
Vinesh Appadurai*1,2, Rohan Poulter1,2, Peter Larsen1,2, Darren Colburn1, Corina Preda2,
Alexander Willson1,2
1
Cardiology, Nambour General Hospital, 2School of Medicine, University of Queensland,
Nambour, Australia
Introduction: ST-Elevation myocardial infarction (STEMI) is associated with significant
mortality with primary percutaneous intervention (PCI) being the standard of care. Shorter
door to balloon times is associated with reduced mortality. Additionally, delay in hospital
presentation from the time of onset of chest pain and self presenting to hospital rather than
contacting ambulance services may also increase risk.
Objectives: To determine whether gender influences presentation times or method
of presentation to hospital, in patients presenting withSTEMIs in an Australian
setting.
Methods: A retrospective cohort analysis was undertaken of consecutive patients suffering
from STEMIs whom had undergone primary PCI. Statistical analysis of chest pain to first
medical contact times, chest pain to door times, chest pain to balloon times and door to
balloon times were performed.
Results: 106 patients were analysed of which, 81 were male (76.4%) and 25 were female
(23.6%). 84% (21/25) of females vs. 70.4% (57/81) of males arrived to hospital via
ambulance (p¼0.177). There was no difference between males and females for the
following times: median chest pain onset to ambulance arrival time [43 (IQR: 19, 89) vs.
46.5 (IQR: 23.5, 77) min, p¼0.249], chest pain to door time [114 (IQR: 69.5, 194) vs.
134 (IQR: 84.5, 230.5) min, p¼0.861], chest pain to balloon time [188 (IQR: 142.5, 258)
vs. 193 (IQR: 149.5, 313.5) min, p¼0.861] and door to balloon time [81 (IQR: 35,
129.5) vs. 42 (IQR: 27.5, 72) min, p¼0.258] were not significantly different in females vs.
males.
Conclusion: Gender was not associated with a significant difference in method of hospital
presentation, time to hospital presentation or door to balloon times in patients suffering a
STEMI and undergoing primary PCI.
Disclosure of Interest: None Declared
PT181
Treatment delays in Primary Angioplasty. The influence of the Diabetic Trend on
Long Term Mortality
Chris Nunn*1, Anne Silverstone1, Gerry Devlin1
1
Cardiology, Waikato Hospital, Hamilton, New Zealand
Introduction: Treatment delays have long been recognised in randomised trials to influ-
ence patient outcome. The impact on long term mortality in real world practise is less well
known. Waikato Hospital has been performing Primary Angioplasty (PAMI) since 1994
initially just on high risk infarcts.
Objectives: We investigated the longitudinal relationship between door to balloon
(D-t-B) times and 1 year mortality for patients undergoing PAMI from 1995 to 2010.
We sought to compare this relationship to changes in the incidence of Diabetes in our
population.
Methods: A prospective database has been maintained from the outset with all patients
having a 1 year follow up by phone contact. The analysis was confined to Anterior MI’s
presenting to Waikato Hospital and proceeding to PAMI. Rescue angioplasties and patients
transferred from other hospitals were excluded. Patients already in hospital at the time of
infarct were also excluded.
Results: Follow up was achieved in 98.3%. Over the 15 year period there were a total of
623 patients (63% male). Mean age was 61.2yrs and 17% were in Killip class 2-4 heart
web 3C=FPO
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 failure with 9% in cardiogenic shock. 1 yr mortality was 6.9%. Median door to balloon Introduction: High frequency of percutaneous coronary intervention (PCI) in Iran ne-

(D-t-B) time reduced over this period however 1 yr mortality trended in the opposite
direction (Fig 1). This may reflect the increasing proportion of diabetes mellitus in our
study population (Fig 2). The non-diabetic patient experienced reduced mortality with
shorter delays, 4.5% 1Yr mortality with D-t-B <80mins vs 12.3% with D-t-B
>120mins(p<0.05).
web 3C=FPO
POSTER ABSTRACTS
cessitates the implementation of measures to prevent the incidence of major adverse cardiac
events (MACE) after the procedure.
Objectives: The present study assessed the significance of troponin and myeloperoxidase
levels in prediction of MACE during the first month after PCI.
Methods: This prospective, longitudinal study included 100 patients with acute
coronary syndrome who underwent PCI. Convenience sampling was performed
until the desired sample size was reached. The participants’ characteristics were
recorded in a questionnaire. Blood samples were obtained before and 24 hours after
PCI and troponin and myeloperoxidase levels were measured. During the one

month after PCI, death, myocardial reinfarction, and revascularization during

admission were investigated through weekly phone calls. The value of troponin and
myeloperoxidase levels before and after PCI in predicting MACE was evaluated
using Cox regression.
Results: Considering the obtained methods and the short duration of the study, 99% o
the patients completed the study. One death and four cases of myocardial infarction
and revascularization were reported. Cox regression did not show significant relations
between the incidence of MACE and myeloperoxidase levels before (beta:1.0; 95%
confidence interval: 0.672-1.48)and after PCI (beta: 0.852; 95% confidence interval:
Conclusion: Despite a reduction in D-t-B time no reduction in mortality was noted for 0.606-1.194) or troponin levels before (beta:0.394; 95% confidence interval: 0.060-
PAMI patients over a 15 year period. The incidence of diabetes mellitus increased over this 2.59). and after PCI (beta: 0.963; 95% confidence interval: 0.791-1.17). aluated using
period and may be factorial in these unexpected findings. Cox regression.
Disclosure of Interest: None Declared Conclusion: It seems that the few cases of MACE due to the small sample size and
short duration of follow-up had been insufficient for determining the predictive value
of troponin and myeloperoxidase levels before and after PCI. Therefore, further studies
with larger sample size and longer follow-up are recommended. fidence interval:
PT182 0.606-1.194) or troponin levels before (beta:0.394; 95% confidence interval: 0.060-
Length of Stay for Acute Coronary Syndromes Following Introduction of Coronary 2.59). and after PCI (beta: 0.963; 95% confidence interval: 0.791-1.17). aluated using
Angiography and PCI in a Rural Health District Cox regression.
Disclosure of Interest: None Declared
David Amos*1, Sophie Martin1, Ruth Arnold1, Andrew French1, Imre Hunyor1,2, Mark Adams2
1
Cardiology, Orange Health Service, Orange, 2Cardiology, Royal Prince Alfred Hospital, Sydney,
Australia

Introduction: One of the many benefits of having Cardiac Catheterisation Units in rural
sites is the potential to reduce length of stay for patients with acute coronary syndromes PT184
(ACS). Previous studies have shown that patients admitted to sites without intervention
have delays to investigation and treatment. 1,2 Trends and survival for unprotected left main PCI in Western Australia
Objectives: To compare length of stay at the three major regional hospitals during four 2000-2005
time periods associated with introduction of a cardiac catheterisation service in Orange in
2005: - before coronary angiography was available(2004-2005), after introduction of Sandeep Chopra*1, Carl Schultz1,2, Jamie Rankin1, Matthew Knuiman3, Don Cutlip4,5,
diagnostic angiography only(2005-2007), after beginning interventional cases one day per Michael Nguyen6, Mark Newman7, Michael Hobbs3, Tom Briffa3, Frank Sanfilippo3
1
week as a visiting service(2007-2011), and after a full time interventionist moved to the Cardiology, Royal Perth Hospital, 2School of Medicine and Pharmacology, 3School of Population
area(2011-2013). Health, University of Western Australia, Perth, Australia, 4Harvard Clinical Research Institute,
Methods: Length of stay data for STEMI and Non-STEMI was compared at the three main 5
Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, United States,
base hospitals using coding information from medical records. Information was not 6
Cardiology, Fremantle Hospital, 7Cardiothoracic Surgery, Sir Charles Gairdner Hospital,
available if the patient was transferred out of the area as to further length of stay in a Perth, Australia
metropolitan hospital.
Results: Results are shown in the table below. Length of stay for each hospital is shown for Introduction: The introduction of drug-eluting stents and advances in catheter techniques
both STEMI and non-STEMI. Number of separations is shown in brackets. may have led to increasing acceptance of percutaneous coronary intervention (PCI) as a
viable alternative to coronary artery bypass graft (CABG) for unprotected left main (LM)
disease.
Bathurst Base Hospital Dubbo Base Hospital Orange Base Hospital
Objectives: To investigate 5-year trends and outcomes in a population cohort of
non- STEMI STEMI non- STEMI STEMI non- STEMI STEMI unprotected LM disease treated with bare metal (BMS) or drug-eluting stents
Pre Angiograhy 4.7 (61) 4.6 (48) 5.3 (118) 4.5 (59) 6.1 (102) 3.4 (55)
(DES).
Methods: Clinical data from all hospitals offering PCI in Western Australia between
Diagnostic Angiograhy only 5.0 (165) 3.6 (57) 4.6 (293) 2.6 (76) 5.9 (327) 3.9 (72) 2000 and 2005 and linked administrative health data (hospital admissions and death)
Visiting Interventional Service 4.4 (256) 3.0 (112) 4.7 (590) 2.1 (242) 4.7 (396) 3.5 (164) from the Western Australian Data Linkage System were merged for all patients who
had LM coronary artery PCI. Previous treatment with CABG prior to the index LM PCI
Permanent Interventional Service 3.8 (163) 2.3 (73) 4.4 (422) 3.0 (123) 3.4 (263) 2.2 (56)
was identified by lookback to 1980. Five-year outcomes were death (all-cause) and the
composite of death/myocardial infarction (MI) admission/subsequent coronary artery
revascularisation (MACE). The risk of 5-year outcomes were calculated using the
Conclusion: There was a general trend to reduction in bed stay over the nine year period, Kaplan-Meier method and compared using log-rank tests and adjusted Cox propor-
which has resulted in significant cost savings for the health district. Variable reduction in tional hazards regression.
length of stay may be accounted for by a proportion of patients who still are referred to Results: In our cohort of 237 patients, unprotected LM PCI increased over time
Sydney. Whilst there may be other factors involved, the utilisation of local services appears (n¼4 unprotected of 18 LM PCIs in 2000 to n¼59 of 78 in 2005), whereas
to have had a positive outcome for earlier treatment and discharge. protected LM PCI remained stable (n¼14 vs n¼19 respectively). We excluded 97
References: patients with a history of CABG leaving 140 patients with unprotected LM PCI
1. N Z Med J. 2010 Jul 30;123(1319):44-60. (mean age 73 years (range 38-91), 73% males). BMS and DES were implanted in
2. Heart. 2012 Sep;98(17):1285-9. 13.6% and 86.4% patients, respectively. The 5-year all-cause mortality was 36%
(52.6% for BMS and 33.1% for DES, p¼0.06). MI within 5 years of the LM PCI
Disclosure of Interest: None Declared was seen in 9.3% overall, and in 5.3% vs 9.9% for BMS and DES respectively
(p¼0.53). Repeat revascularisation within 5 years of the LM PCI was seen in 30.7%
PT183 overall, and 26.3% vs 31.4% respectively for BMS vs DES (p¼0.82). MACE
occurred in 60.7% overall and 68.4% BMS vs 59.5% DES (p¼0.19). There was a
Can Myeloperoxidase Levels Predict Short-Term Clinical Outcome of Percutaneous lower risk of 5-year death for DES compared with BMS (adjusted hazard ratio (HR)
Coronary Intervention In Patients With Acute Coronary Syndrome? 0.42, 95% CI 0.20-0.90) and an apparent lower risk for 5-year MACE (HR 0.55,
95% CI 0.29-1.03).
Masoumeh Sadeghi1,1, Abedin Bazgir2, Mohammad Garakyaraghi2, Hamidreza Roohafza2,
Conclusion: In Western Australia, unprotected LM PCI increased substantially, predom-
Nizal Sarrafzadegan*2 inantly due to increased use of DES rather than BMS. DES use was associated with lower
1
Cardiac Rehabilitation Research Center, 2Isfahan Cardiovascular Research Center, Isfahan all-cause death after 5 years. Further analyses are needed to evaluate the separate effects of
Cardiovascular Research Institute, Isfahan University of MedicalScieces, Isfahan, Iran, Islamic comorbidities.
Republic Of Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e203

 PT186
POSTER ABSTRACTS
Different efficacy of thrombectomy aspiration catheters on epicardial blood flow –
stratified metaanalysis of randomized controlled trials of adjunctive manual
thrombectomy in treatment of ST elevation myocardial infarction
Andrzej Tomasik*1, Agnieszka Stroba1, Angelika Copija1, Wojciech Jachec1,
Ewa Nowalany-Kozielska1
1
II Dept. of Cardiology in Zabrze, Medical University of Silesia, Zabrze, Poland
Introduction: There is convincing evidence on the usefulness of manual thrombectomy in
management of ST-elevation myocardial infarction. Experimental data obtained in vitro
disclosed important differences in physicomechanical parameters required for effective
thrombus aspiration with distinct aspiration catheters (AC). Direct in vitro comparison of
several commercially available AC showed substantial differences in their trackability,
pushability, and most of all, different volume of standardized saline solution or thrombus
aspirated within a prespecified time unit.
Objectives: The aim of the study was to assess the impact of different manual AC
on immediate angioplasty results. For this purpose we have performed a stratified
metaanalysis of randomized trials and reviewed the articles under several efficacy
categories.
Methods: From Medline and Cochrane Library we have idenified 11 randomized
controlled trials with six different manual AC: Diver CE, Export, Eliminate, Pronto, Rescue,
and Thrombuster.
Results: Macroscopic thrombus was removed in 98.5% of cases in Eliminate group;
91% of cases in Diver CE group, 89% of cases in Pronto and Rescue groups, and
75.9% of patients in Export group. The use of thromboaspiration is better in achieving
final TIMI III flow in comparison to PCI alone (OR 1.59 with 95% CI 1.16 – 2.19,
p ¼0.004), however none of the aspiration catheter proved to be better than the
others. The use of thromboaspiration is better in achieving final myocardial blush
grade 3 in comparison to PCI alone (OR 1.94 with 95% CI 1.57 – 2.39, p ¼0.000)
with best performance of Pronto (OR 9.48, p¼0,000), Diver (OR 2.57, p¼0.0058),
Thrombuster (OR 2.33, p¼0.04), and Export (OR 1.77, p ¼0.000). The only aspi-
ration catheter to prevent distal embolization is Pronto (OR 0.24, 95% CI 0.08 – 0.78,
p¼0.0178). Thromboaspiration is better in achieving complete resolution of ST
elevation in comparison to PCI alone (OR 1.42 with 95% CI 1.06 – 1.9, p ¼0.0179)
and the only catheter to impact the complete ST resolution is Pronto (OR 2.08 with
95% CI 1.07-4.06, p¼0.031).
Conclusion: This stratified metaanalysis shows Pronto aspiration catheter as most effica-
cious in restoring epicardial blood flow and myocardial perfusion in culprit vessel. How-
ever we must be cautious in interpreting this data as they are based on a single trial with
Pronto aspiration catheter. The results of this metaanalysis are meant to be helpful in
choosing the best aspiration catheter for everyday practice in STEMI patients.
Disclosure of Interest: None Declared
PT187
Bioresorbable scaffolds in the treatment of chronic total occlusions (CTO)
1 1 1 1 1
Austin N. May* , Alastair Carlyle , Mark Pitney , Sze Yuan Ooi , Nigel Jepson
1
Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
Introduction: Despite the rising use of the AbsorbTM bioresorbable scaffold (ABS), there is
no short- or long-term data on its use in the percutaneous revascularisation of chronic total
occlusion (CTO) lesions.
Objectives: To establish a single centre experience for clinical and safety outcomes asso-
ciated with ABS implantation for CTO lesions.
Methods: This was retrospective review of consecutive patients undergoing ABS implan-
tation in CTO lesions with Thrombolysis in Myocardial Infarction (TIMI) Grade 0 between
Oct 2012–Sept 2013 at a single major referral centre.
Results: Ten patients underwent ABS implantation for CTO in the study period. Mean
age was 64
13 years. Nine patients were male and one was female. One patient had a
history of diabetes. Indication for PCI was stable angina in seven patients (70%); staged
procedure after recent STEMI in two patients (20%); and non-STEMI in one patient
(10%). The culprit CTO vessel was the RCA in seven cases (70%), Cx artery in two
cases (20%) and LAD artery in one case (10%). Mean CTO lesion length was 25
17
mm. Six procedures were performed via anterograde approach (60%) and four via
retrograde approach (40%). Mean screening time was 52
30 mins and mean contrast
volume 256
97 mL. Pre-inflation was performed in all cases with adjunctive rotational
atherectomy in one case (10%). Mean of 1.8 (range 1–3) ABS devices were implanted
per target lesion. In total, 18 ABS devices were deployed– 14 devices (78%) 28 mm in
length and four devices (22%) 18 mm. High pressure post-dilation was performed in
16 devices (89%). Three cases involved staged multi-vessel revascularisation (30%) and
three procedures entailed concomitant implantation of a metallic drug eluting stent in
the target vessel (30%). All 10 CTOs were successfully treated (Procedure success
100%) and there was no case of failure to advance an ABS (Device success 100%).
There were no procedural adverse events. There were no major adverse cardiac events
(death, MI or target lesion revascularization) in-hospital, at 30 days, and at mean
follow up of 144
116 days. There have been no scaffold thromboses. One patient
underwent target vessel PCI (non-target lesion revascularisation) at 2.3 months for
distal branch disease.
Conclusion: Our early experience confirms that CTO lesions are not a contraindication to
ABS implantation. With appropriate vessel preparation, ABS is a very safe and efficacious
device for the acute treatment of CTOs.
Disclosure of Interest: None Declared
e204
PT188
Equilibrium radionuclide angiography for evaluating the effect of early percutaneous
coronary intervention follow thrombolysis on ventricular remodeling in patients with
acute myocardial infarction
Liu Jun*1, gao lei1, wang zhen1, fu xianghua2
1
Cardiology, The First Hospital of Hebei Medical University, 2Cardiology, The Second Hospital of
Hebei Medical University, shijiazhuang, China
Introduction: It is unclear whether the early percutaneous coronary intervention (PCI)
follow thrombolysis via transradial approach therapy is prior to the primary PCI with
improved of ventricular remodeling in Chinese patients.
Objectives: To evaluate the influence on ventricular remodeling using primary percuta-
neous coronary intervention (PCI) and early PCI follow thrombolysis via transradial
approach therapy in older patients with acute anterior myocardial infarction (AMI) by
equilibrium radionuclide angiography (ERNA).
Methods: A total of 172 patients (age>60 years) with primary anterior AMI were enrolled
in this study. 116 patients to primary PCI group (P-PCI) and 56 patients to early PCI follow
thrombolysis group (E-PCI). At 1 and 28 weeks after AMI onset, the parameters of left
ventricular systolic function and paradox volume index (PVI) were measured by ERNA.
Major adverse cardiac events (MACE) such as post-AMI angina, recurrence MI or mortality
were recorded.
Results:
1. There were no significant difference between the two groups in clinical
characteristics.
2. The coronary angiography showed that the TIMI-3 grade of infarction-related
artery(IRA) in E-PCI group was markedly higher than that in LVAP group
(30.36% vs 8.62%,c2¼11.09, P<0.01). The TIMI-3 grade rate of IRA post-PCI in
E-PCI group was higher than that in P-PCI group(98.21% vs 88.79%,c2¼4.35;
P<0.05).
3. At 28 weeks post-AMI, the parameters of LVEF and peak ejection rate(PER) in the
E-PCI group were increased(t¼2.08,2.13,P<0.05,respectively), while time to peak
ejection rate(TPER), PVI were decreased as compared with those in P-PCI
group(t¼2.10,2.49,P<0.05, respectively).
4. There were no significant differences between the E-PCI group and P-PCI group in
complication and MACE rates.
Conclusion: The early PCI follow thrombolysis via transradial approach therapy might
significantly inhibit left ventricular remodeling and improve the left ventricular function by
the complete, persistent repatency of IRA, which was superiority to the primary PCI
therapy.
Disclosure of Interest: None Declared
PT189
Short Term Outcome of Bioresorbable Vascular Scaffold Use in Patients with ST
Elevation Myocardial Infarction – The Auckland Regional Experience
Patricia Y. J. Ding*1, William Harrison1, Patrick Kay1, Douglas S. Scott1, John A. Ormiston2,
Jonathon White2, Ali Khan3
1
Cardiology, Middlemore Hospital, Auckland, 2Cardiology, Auckland City Hospital, 3Cardiology,
North Shore Hospital, Auckland, New Zealand
Introduction: Bioresorbable vascular scaffold (BVS) has been shown to be safe in non-acute
coronary syndrome patients and has the benefit of restoring vasomotion and compliance of
coronary arteries. There is little data on the outcome of patients who present with ST
elevation myocardial infarction (STEMI) and treated with BVS, a cohort at increased risk of
stent thrombosis.
Objectives: To observe the short term outcome of patients who presented with STEMI and
treated with BVS.
Methods: A retrospective study of consecutive patients in Auckland region who pre-
sented with STEMI and received everolimus-eluting BVS (ABSORB, Abbott Vascular,
Santa Clara, CA) from April 2013 to September 2013. All patients’ medical records and
coronary angiograms were reviewed. Calibrated measurements of final proximal stent
diameter and proximal reference vessel diameter were compared to see relative dif-
ference angiographically. Thirty day and up to six month clinical outcome such as
cardiovascular mortality, major adverse cardiovascular events (MACE) including early
stent thrombosis, myocardial infarction not clearly attributable to a nontarget vessel,
target lesion revascularization, ischaemic stroke and vascular complications were
reviewed.
Results: A total of eight patients with median age of 49 years presented with STEMI
received BVS from April to September 2013 in Auckland region. Median follow-up was 77
days. All procedures were performed using radial access and six French guide catheters.
Left anterior descending artery (LAD) was the culprit vessel in 87.5% patients and of which
86% were in either mid or distal segment of LAD. Diameter of BVS used ranged from
2.5mm to 3.5mm. Final angiographic results showed median of 2.5% relative increase in
proximal stent diameter compared with proximal reference vessel diameter on calibrated
measurements. None of the patients had cardiovascular mortality, early stent thrombosis or
other MACE events during the follow-up period.
Conclusion: The use of ABSORB BVS in patients with STEMI can achieve good angio-
graphic and short term clinical outcome. It may be a safe and feasible option in patients
with STEMI.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT191
Chest Compressions Using Mechanical Devices Are More Effective Than Manual
Compressions Concomitant With Emergency Percutaneous Coronary Interventions
Luis Dallan*1, Tulio Vargas1, Bruno Janella1, Jamil Cade1, Andre Spadaro1, Sergio Timerman2,
Marco Perin1
1
Hemodynamics, Hospital Santa Marcelina, 2Emergency Simulation, InCor, Sao Paulo,
Brazil
Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as
manual chest compressions prevents the continuity of coronary angiography and coronary
angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation
(CPR) quickly and accurately. AutoPulseÒ is a mechanical CPR device that consists of
mechanical pneumatic band attached to a board that involves the patient’s chest and allows
effective and continuous pneumatic compressions, allowing mechanical CPR simulta-
neously to coronary angiography and angioplasty.
Objectives: We assessed the hypothesis that mechanical CPR may be feasible during
percutaneous coronary interventions and more effective than manual CPR by the analysis of
intra-coronary pressure curves.
Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular
fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab,
allowing continuity of percutaneous coronary intervention concomitant with CPR. Intra-
coronary curves were measured initially during manual chest compressions (manual CPR)
and later, after the correct installation of AutoPulseÒ during mechanical compressions with
this device (mechanical CPR).
Results: It was possible to complete coronary angiography with the device attached to the
patient in all cases, and it was also possible to complete coronary angioplasty during
mechanical CPR. In all cases, mechanical CPR provided uninterrupted chest compressions
more effectively and always stable in stead of manual compressions. Although a mean
blood pressure of 40mmHg in both methods, mechanical CPR was able to maintain this
pressure for a long time, but manual CPR had an important reduction in mean blood
pressure after two minutes of CPR in all cases. All patients progressed to death in spite of
interventions.
Conclusion: In conclusion, percutaneous coronary interventions are feasible concurrent
with mechanical CPR using AutoPulseÒ in patients suffering cardiac arrest in the Cath Lab.
The device provided uninterrupted chest compressions more effective than manual com-
pressions, as well as allowed the freedom of the physicians to attempt other functions,
different from CPR, during the procedures.
Disclosure of Interest: None Declared
PT192
Chronic Stress Stimulation Aggravated Early-Stage Ventricular Remodeling After
Acute Myocardial Infarction
jian-gang Liu*1, Dawu Zhang1, xin Jin2, da-zhuo Shi1
1
Department of Cardiovascular disease, XIYUAN HOSPITAL, CHINA ACADEMY OF CHINESE
MEDICAL SCIENCES, Beijing, 2Inner Mongolia College of Traditional Chinese Medicine,
Hohhot, China
Introduction: The early-stage excessive ventricular remodeling is an important factor
to aggravate cardiac function, it remains unknown whether chronic unpredictable
mild stress (CUMS) have an impact on the aggravation of early-stage ventricular
remodeling.
Objectives: To observe the impact of CUMS on the early-stage ventricular remodeling in
rat after acute myocardial infarction (AMI).
Methods: Wistar rats were established into AMI models, 24 hours later, survival rats
were randomly divided into sham group(suture around left anterior descending cor-
onary artery was not tied), AMI model group(AMI group), chronic stress model
group(CUMS group) and AMI + chronic stress model group(AMI+CUMS group).
CUMS group and AMI+CUMS group were stimulated about 28 days [these stimula-
tions were random, including swimming in 4 C icy water for 5 minutes; 45 C heat
stimulation for 5 minutes; fasting for 24 hours; water deprivation for 24 hours;
clamping tail for 1 minute; reversed day and night during 24 hours; high level of
shaking(1 times/s) for 5 minutes; frequent flash exposure (120times/min)], each
stimulation cannot be more than 3 times, the animal can not predict the stimulation of
next day. 28 days later, the rats were intraperitoneally anesthetized, the changes of
cardic structure and function were measured by ultrasonic diagnostic apparatus, and
then arterial blood samples were extracted, serum contents of high sensitive C-reactive
protein (hs-CRP) and interleukin-6 (IL-6) were examined.
Results: Compared with sham group, left ventricle end-diastolic and end-systolic
dimension increased significantly in AMI group and AMI+CUMS group (P<0.05), the
end-diastolic and end-systolic thickness of interventricular septum also decreased
significantly (P<0.05). the left ventricular ejection fraction in AMI+CUMS group is
lower than that of AMI group (34.4% and 48.8%, P<0.05). Compared with sham
group, the serum contents of hs-CRP increased significantly in AMI group and
AMI+CUMS group (P<0.01), the serum content of hs-CRP in AMI+CUMS group is
higer than that of AMI (P<0.01).
Conclusion: Chronic stress stimulation could increase pathological ventriclular remodeling
and inflammatory factors infiltrating in rat after AMI, which lead to increased left ventricle
dimension and decreased cardiac function.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT194
POSTER ABSTRACTS
Gender Differences In Chronic Mitral Regurgitation In Postmyocardial Infarction
Patients
Vadim Kuznetsov*1, Elena Yaroslavskaya1, Georgiy Pushkarev1, Dmitriy Krinochkin1,
Grigoriy Kolunin1, Luiza Maryinskikh1
1
TYUMEN CARDIOLOGY CENTER, Tyumen, Russian Federation
Introduction: There are two mechanisms of mitral regurgitation (MR) formation in
postmyocardial infarction patients: local myocardial remodeling with changing of
mitral chord tethering, and global myocardial remodeling with dilatation of mitral ring.
There are no data about gender differences in MR formation in postmyocardial
infarction patients.
Objectives: To compare the relationship between chronic MR and clinical, echo-
cardiographic and angiographic parameters in postmyocardial infarction men and
women.
Methods: From 15.283 patients who underwent coronary angiography in 1991-2012
we selected patients with previous Q-wave myocardial infarction and echocardio-
graphic signs of postinfarction left ventricular (LV) remodeling without acute
myocardial infarction, congenital heart disease or acquired valvular disease. There were
139 men of 49.7
3.1 years old and 53 women of 57.6
8.5 years old with moderate or
severe MR.
Results: According to the results of multivariate analysis, MR in men was indepen-
dently associated with stenosis of right coronary artery (OR¼2.14; 95% CI 1.18-3.87;
p¼0.012), dilatation of left atrium (OR¼1.87; 95% CI 1.57-2.23; p<0.001), reduced
LV systolic function (OR¼0.93; 95% CI 0.90-0.97; p<0.001), lower level of plasma
total cholesterol (OR¼0.69; 95% CI 0.54-0.89; p¼0.003) and index of LV posterior
wall thickness (OR¼0.51; 95% CI 0.32-0.81; p¼0.004). MR in women was inde-
pendently associated with worse NYHA class of congestive heart failure (OR 4.26; 95%
CI 1.40-12.88; p¼0.010) and increased index of LV dimension (OR 1.64; 95% CI
1.24-2.17; p¼0.001).
Conclusion: In postmyocardial infarction men MR was predominately associated with
lesions of right coronary artery and related local myocardial damage. In postmyocardial
infarction women MR was mostly associated with global LV remodeling.
Disclosure of Interest: None Declared
PT195
Impact of gender on in-hospital outcomes of patients with acute myocardial
infarction: A Beijing Study
Yusheng Zhao*1, Wei Gao1, Jiayue Li1, Xingli Wu1, Qiao Xue1
1
Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
Introduction: Women with acute myocardial infarction (AMI) have a higher hospital
mortality rate than men. This difference has been ascribed to their older age, more frequent
comorbidities, and less frequent use of revascularization.
Objectives: The aim of this study is to assess these factors in relation to excess mortality in
women.
Methods: All hospital admissions with a discharge diagnosis of acute myocardial infarction
were extracted from the Chinese PLA General Hospital Patients Information System
Database. Cox’s regression on mortality was performed for sex, age, comorbidities, and
coronary interventions.
Results: Data were analyzed from 6 675 patients hospitalized with acute myocardial
infarction from January 1, 1993 to June 30, 2011, 20.9 % of whom were women. Women
were older (67 versus 62 years of age, P<0.001) and had a higher rate of hospital mortality
(12.6% versus 7.6%, P<0.001) more comorbidities, such as histories of diabetes, atrial
fibrillation, prior stroke, and more complications included cardiogenic shock, heart failure,
ventricular tachycardia or fibrillation, pneumonia, and gastrointestinal bleeding than men.
Percutaneous coronary interventions were more frequent in men (47.3% versus 34.7%
with stent, P<0.001). Mortality adjusted for age and comorbidities was higher in women
(odds ratio 1.42, 95% CI 1.18 to 1.70, P<0.001).
Conclusion: The difference in mortality rate between men and women with acute
myocardial infarction is due largely to the different age structure of these populations.
However, age-adjusted hospital mortality was higher for women and was associated with
higher comorbidities and a lower rate of percutaneous coronary intervention.
Disclosure of Interest: None Declared
PT196
Predominance of STEMI and severity of coronary artery disease in a cohort of
admitted patients with Acute Coronary Syndrome: Insight from Faculdade de
Medicina do ABC, Sao Paulo, Brazil
Marcelo Rodrigues Bacci1, Antonio C. P. Chagas*2, Janaina A. B. Santos2,
Leonardo F. F. Nogueira2, Otavio Berwanger2, Neif Murad2, Felipe R. Bruniera1,
Felipe Ferreira1, Natalia P. C. Zing1, Danielle M. Barros1
1
General Practice, 2Cardiology, Faculdade de Medicina do ABC, Santo André, Brazil
e205
 Introduction: Acute coronary syndromes represent a prevalent disease in Brazil and
POSTER ABSTRACTS
worldwide with high mortality. The severity of coronary artery disease is not known in
patients attended in a Sao Paulo’s suburb region.
Objectives: To study the profile of the coronary disease in admitted patients with ACS who
underwent coronary angiography in Hospital e Pronto Socorro Central between 2012 and
2013
Methods: This is an observational study which included consecutive patients with acute
coronary syndromes admitted to the emergency room of the hospital. Data collection was
done by medical records with the following variables: sex, age, risk factors for cardiovas-
cular disease, diagnoses and coronary lesions on coronary angiography. Continuous vari-
ables were expressed as average and standard deviation whereas categorical variables as
percentages. The alpha error was set at 5%.
Results: The sample in this period was 131 patients, 64.8% men. The most prevalent
diagnosis was STEMI (57.2%) followed by NSTEMI (22.1%) and UA (20.6%). There were
no significant differences in the epidemiology and risk factors between the diagnoses,
except for the presence of heart failure was more prevalent in patients with UA (Tab.1).
Table 2 showed differences between the groups according to the number of involved
coronary arteries (p¼0.006).
Table 2: Severity of number of affected coronary lesions according to diagnoses.
Number of arteries with Unstable p Fisher’s
important and moderate occlusion Angina STEMI NSTEMI Exact Test
One (%) 15.38 41.33 24.14 0.006
Multiple (%) 50.00 50.67 65.52 0.006
None (%) 34.62 8.00 10.34 0.006
Conclusion: STEMI shows similar multi and single vessel lesions; NSTEMI, more multi-
vessel lesions, and UA, more multivessel lesions or free lesion arteries. There were no
differences between which coronaries were affected. Despite the multivessel lesions were
more prevalent in all groups, STEMI shows a significant high number of single vessel le-
sions compared with the other acute coronary syndromes. The study proves a predomi-
nance of STEMI in the studied population, which differs from the usual results in acute
coronary syndromes
Disclosure of Interest: None Declared
PT197
Outcomes of PCI in Hospital with and without On-site Cardiac Surgery. An
Australian experience
David Tong*1, Nick Andrianopoulos2, Angela Brennan2, Stephen J. Duffy3, Andrew Teh1,
Andrew E. Ajani4, Damon K. Jackson1, Louise Roberts1, Melanie Freeman1, Gishel New1
1
Cardiology, Eastern Health, Box Hill, 2Cardiology, CCRET - Monash University, 3Cardiology,
Alfred Hospital, 4Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Increasing evidence suggests that both primary and non-emergent PCI
performed in centres without on-site cardiac surgery is safe with comparable outcomes to
those with on-site cardiac surgery; however this remains a class IIb recommendation within
the ACC/AHA/SCAI Guidelines.
Objectives: To evaluate the safety and efficacy of PCI performed in hospitals with and
without on-site cardiac surgery utilising a large multicentre Australian registry.
Methods: We compared 30-day and 12-month outcomes in 2,779 patients undergoing
PCI in hospitals without on-site cardiac surgery with 12,399 patients undergoing PCI in
hospitals with on-site cardiac surgery, prospectively enrolled in the Melbourne Interven-
tional Group registry between 2005 and 2011.
Results: Age and female gender were similar between the two groups. Those patients
who underwent PCI in hospitals with on-site cardiac surgery had more comorbid-
ities including diabetes (26.0% vs 18.3%), renal failure (24.3% vs 19.6%), and
congestive cardiac failure (4.4% vs 1.2%), and were more likely to have previous MI
(30.1% vs 20.6%), PCI (26.3% vs 19.9%) and CABG (9.8% vs 4.6%, all p<0.001).
They were also more likely to have multivessel disease (60.1% vs 56.0%, p<0.001)
with reduced ejection fraction <40% (11.5% vs 5.2%, p<0.001). Patients under-
going PCI in hospitals without on-site cardiac surgery presented more frequently
with STEMI (38.1% vs 27.0%) and NSTEMI (28.5% vs 25.6% (both p<0.001)), had
cardiogenic shock (3.7% vs 2.9%, p¼0.048) and required intra-aortic balloon pump
insertion (3.7% vs 2.3%, p<0.001). Procedural success rates were similar in both
groups. There was no significant difference in mortality (2.7% vs 2.4%) or MACE
(5.9% vs 5.4%) at 30-day. 12-month mortality rates were similar between the two
groups (4.0% vs 4.5%, p¼0.18). However, MI (5.0% vs 2.9%), TVR (7.7% vs
5.5%), and overall MACE (14.3% vs 10.1%) rates were higher within the on-site
cardiac surgery group (all p<0.001).
Conclusion: Despite a higher proportion of unstable patients with acute coronary syn-
dromes, mortality did not differ between those with or without on-site cardiac surgery
suggesting that PCI can be safely performed in hospitals without on-site cardiac surgery.
e206
Increased major adverse cardiac events within hospitals with on-site cardiac surgery likely
reflect more co-morbid conditions.
Disclosure of Interest: None Declared
PT198
Effects of SSRI antidepressants on bleeding rates post PCI
Garth Birdsey*1, Chin Hiew2, Zoe Rule1, Kate Flentji3
1
Pharmacy Services, 2Cardiac Services, Barwon Health The Geelong Hospital, 3Medical Student,
Deakin University, Geelong, Australia
Introduction: It is known that SSRI antidepressants increase bleeding rates post non-
cardiac surgery and acute coronary syndrome, but what about patients post PCI where the
patient is exposed to extra anticoagulation
Objectives: To investigate the impact of SSRI antidepressants on post proceddural bleeding
rates in patients taking SSRI antidepressants who need to have a PCI. To also investigate the
impact of co-administration of GpIIb/IIIa antagonists, P2Y12 inhibitors and unfractionated
heparin on the bleeding rates
Methods: A retrospective audit of 5 years of PCI in a single centre was undertaken. Data
collected was admission medications, peri-procedural therapies and bleeding complications
after the procedure. Bleeding was defined as haematoma and re-bleed at the puncture site.
The catheter laboratory data base, the hospitals electronic medical record and pharmacy
dispensing records were all used to find the data required
Results: 1854 PCI’s were surveyed. 238(12.8%) had bleeding complications. 119 of
the total cohort were taking SSRI antidepressants, of these 31 (26.05% had bleeding
complications. All patients recieved unfractionated heaprin and a P2Y12 inhibitor.
275 patients recieved GpIIb/IIIa antagonists, 29(10.5%) of these recorded a bleeding
complication. Of the 275 patients 15 were taking a SSRI and only 1 had a bleeding
complication. None of the bleeding complications lead to an increased length of
stay.
Conclusion: Patients who are taking a SSRI antidepressant who undergo a PCI have
double the rate of puncture site bleeding complications compared to those who are
not on SSRi’s. This effect is independant of co-administration of anti-platelet
therapies. Importantly this effect did not impact on the patients length of stay in
hospital
Disclosure of Interest: None Declared
PT199
Immediate And In-Hospital Complications of Percutaneous Coronary Intervention
Md. Toufiqur Rahman*1, Md. Afzalur Rahman1, Abdullah Al Shafi Majumder1
1
Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Dhaka, Bangladesh
Introduction: Ischemic Heart Disease (IHD) is a major and increasing health care issue
in Bangladesh. Since the first human percutaneous transluminal coronary angioplasty
(PTCA) procedure was performed in 1977, the use of this procedure has increased
dramatically, becoming one of the most common medical interventions performed.
The technique, originally developed in Switzerland by Andreas Gruentzig, has trans-
formed the practice of revascularization for coronary artery disease (CAD). Initially
used in the treatment of patients with stable angina and discrete lesions in a single
coronary artery, coronary angioplasty has multiple indications today, including un-
stable angina, acute myocardial infarction (MI), and multivessel CAD. With the
combination of sophisticated equipment, experienced operators, and modern drug
therapy, coronary angioplasty has evolved into an effective nonsurgical modality for
treating patients with CAD.
Objectives: We aimed to see the immediate and in-hospital complications of percutaneous
coronary interventons.
Methods: A prospective study was conducted in National Institute of Cardiovascular
Diseases (NICVD) Dhaka; Al-Helal Heart Institute and Hospital, Mirpur Dhaka; Urobangla
Heart Hospital, Lalmatia, Dhaka, Lab-Aid Cardiac Hospital, Dhaka and Metropolitan
Hospital, Mohakhali, Dhaka from August 2003 to May 2013. A total of 600 patients un-
derwent coronary angioplasty and stenting. Angioplasty was done as elective & adhoc
basis.
Results: Most of the cases are of middle age group. 88% are male. 58% are smokers, 40%
hypertensives, 33% have diabetes and 28% are dyslipidemic. 54% had STEMI, 20% had
unstable angina, 14% had chronic stable angina. 75% had single vessel disease, 20% had
double vessel diseases, 5% had triple vessel diseases. 80 patients had total occlusion. 47 %
had lesion in LAD, 33% had lesion in RCA, 12% had lesion in LCX. In most of the
indicated cases PCI was done efficiently with very minimum rate of failure & complica-
tions. In hospital mortality was only 1.6% with 0.8% periprocedure MI - due to sub acute
stent thrombosis.
Conclusion: In the field of management of coronary artery disease percutaneous cor-
onary intervention (PCI) is the internationally recognized standard treatment world-
wide for more than last 3 decades. Our result of PCI correlates well with the other
studies worldwide, though the study population is not big enough & there are many
lacks of logistics in our country. Complications during and in-hospital period are very
few.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT200
Effect of Short-Time Compression with Kaolin-Filled Pad on Radial Artery Occlusion
After Transradial Acess Catheterization
Ming-Ting Chou*1, Chun-Yuen Chiang1
1
Cardiology, Chi-Mei Medical Center, Tainan, Taiwan, Province of China
Introduction: Despite the increasing use of transradial technique for cardiac percutaneous
procedure, the occurrence radial artery occlusion (RAO) remained high about 2-18% of patients.
It was reported shorter duration of hemostatic compression can effectively reduce the rate of RAO.
Objectives: To evaluate the effect of early sheath removal and short time compression with
QuikClotÒ pad(Z-Medica Corporation, Wallingford, CT,USA) on acute and chronic
occurrence rate of RAO.
Methods: One hundred patients who received first time transradial catheterization (diag-
nostic or interventional) were enrolled. Patients were randomized to 2 different strategies of
radial closure: a short compression with QuikClotÒ (15 minutes, group 1) and a conventional
prolonged compression (2 hours, group 2). Color Doppler Vascular ultrasound was used to
evaluate the radial access site in the early (< 24 hour) and later (1-2 month) days.
Results: Demographic as well as procedural variables were similar between group 1 and group
2. Early RAO occurred in none of patients in group 1 and 5 (10%) in group 2, the difference was
statistically significant(P ¼ 0.035). Late RAO occurred still none of patients in group 1 and 3
(6%) in group 2, the difference was statistically significant (P ¼0.05). Duration of occlusive
compression was the only independent predictor of RAO (Odds ratio ¼ 12.7, P ¼ 0.001).
None of patient in both groups developed hematoma or other local vascular complication.
Conclusion: Early sheet removal and short time compression with QuikClotÒ pad can
reduce the rate of RAO after transradial diagnostic or interventional procedures. It was
postulated that the effect may be more significant in patients who had received repeated
transradial procedure before.
Disclosure of Interest: None Declared
PT201
Complication Rates of Percutaneous Coronary Intervention from a Regional Hospital
without On-Site Surgical Back-Up
Sophie Martin*1, Ruth Arnold1, Andrew French1, Mark Adams2, David Amos1
1
Cardiology, Orange Health Service, Orange, 2Cardiology, RPAH, Sydney, Australia
Introduction: Performance of percutaneous coronary intervention (PCI) at facilities
without on-site cardiothoracic surgical back-up has been controversial. The Cardiac Society
of Australia and New Zealand guidelines indicate that these procedures are preferably
performed with on-site surgical support but recognise that PCI can be performed safely
when adhering to specific conditions [1]. Orange Health Service (OHS) began interven-
tional procedures in 2007 following 18 months of diagnostic procedures only.
Objectives: To evaluate the complication rates of PCI procedures at OHS in the initial 5
years of operation, and compare these with the standards from tertiary centres.
Methods: A retrospective audit of all PCI cases at OHS from April 2007 until April 2012 was
conducted. Records were obtained from electronic medical records, angiography reports,
morbidity and mortality review meetings and the cardiac catheter laboratory database.
Results: A total of 1050 patients underwent PCI at OHS within the 5yr period. Of these 17
were primary cases. Of the 1033 patients who underwent elective PCI, there were 44
(4.3%) with significant complications. Of these, 13 (1.3%) were access-related complica-
tions; 5 (0.5%) were coronary artery dissection; 8 (0.8%) re-stenoses; 2 (0.2%) contrast
reactions; 6 (0.6%) were failed attempts; 2 (0.2%) infection-related; 1 (0.1%) post-pro-
cedural DVT; 2 (0.2%) with cardiogenic shock and 4 (0.4%) with a significant arrhythmia
or arrest. 3 (0.3%) peri-procedural deaths were recorded. No patient died during or
immediately after a procedure or required transfer for urgent CABG. The 3 patients who
died within 30 days were all non-elective procedures.
Conclusion: The complication rates from OHS are comparable to standard rates as quoted in
the literature. Overall in-hospital mortality rates with elective PCI are quoted as 0.65%[2],
versus 0.3% 30-day mortality at OHS. Vascular complication rates vary from 2- 6%[2], which
is also comparable to 1.3% as above. This data demonstrates that PCI can be performed safely
in regional centres following the implementation of an appropriate and safe program.
References:
1. CSANZ (2011). Guidelines on Support Facilities for Coronary Angiography and
Percutaneous Coronary Intervention (PCI) including Guidelines on the Perfor-
mance of Procedures in Rural Sites.
2. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. (2099).
JACC. 58 (24).
Disclosure of Interest: None Declared
PT202
Predictors of the coronary in-stent restenosis
Mihail Popovici*1, Ciobanu Lucia1, Sava Costin1, Ion Popovici1, Valeriu Cobet1
1
Interventional Cardiology, Institute of Cardiology of Moldova, Chisinau, Moldova, Republic of
Introduction: The coronary in-stent restenosis predictors evaluation is an important step
for following after angioplasty negative coronary remodeling understanding and prognosis,
as well as therapeutic targets underling.
Objectives: Evaluation of the collagen I and III synthesis/degradation markers as well as of
micro-ARN-143/145 expression in the tissue pattern of the in-stent restenosis (ISR).
Methods: Applying techniques of in situ hybridization, immunofluorescent and confocal
microscopy of multiple immulabeling using antobodies against PICP, CITP and SM-actin have
been determined following indices in the tissue pattern taken postmortem from 19 patients:
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PINP, CITP, collagen III/I ratio, MMP-2 and TIMMP-2 quantity, expression and quantity of
POSTER ABSTRACTS
micro-RNA-143/145. Obtained data were compared with indices of normal coronary segment.
Results: In media and in integral wall a multiply increase of CITP/PICP ratio was detected
among ISR progression especially in coronary media. In adventice a significant CITP rise was
found in severe ISR. PICP values were significantly lower in ISR lesions. Importantly, diminished
PINP levels were more profound in the media and ISR and correlated well with the severity of the
ISR lesions. PICP was found to be decreased by 30% in the tunica adventitia and by 70% and 82%
in the media and ISR zones, respectively. In comparison with minimal lesions, the moderate and
severe forms of ISR were characterized by reduced PICP levels from 75% to 85%, respectively.
Collagen III degradation is less leading to collagen III/I ratio increase almost 13-fold in
the integral artery wall and more than 25 times in coronary media in moderate and severe
degree of restenosis compared to normal pattern. MMP-2 quantity was established as
double raised in moderate ISR and more than 5-fold in severe ISR, while TIMMP-2,
contrarily, reduced by same rations. The micro-RNA-143/145 decreases as ISR is pro-
gressing: from 28% in moderate ISR till 78% in severe degree.
Conclusion: 1. ISR evolution is associated with extracellular matrix reorganization due to
collagen type I degradation, preserved collagen III degradation and collagen III/I ratio rise.
2. MMP-2 quantity is elevated while TIMMP-2 is found reduced that led to MMP-2/
TIMMP-2 ratio rise. 3. Micro-RNA-143/145 expression and quantity is reducing correla-
tively to ISR progression and neointimal secretory-smooth cell accumulation.
Disclosure of Interest: None Declared
PT203
Thrombus Aspiration in ST-Elevation myocardial inFarction – is it fUtiLe?
(TASTEFUL?)
Dinesh K. Natarajan*1, Soe K. Ko1, Rifly Rafiudeen1, Peter Y. Chan1, Anis Taeed1,
Nadim Shah1, Salvatore Rametta1, Nicholas Cox1, Kean Soon1
1
Department of Cardiology, Western Health, Melbourne, Australia
Introduction: The Thrombus Aspiration in ST-Elevation myocardial infarction in Scan-
dinavia (TASTE) trial demonstrated that routine thrombus aspiration before PCI in STEMI
patients did not reduce 30-day mortality as compared with PCI alone.
Objectives: Our objective was to determine if thrombus aspiration before PCI in STEMI
reduced 30-day MACE outcomes.
Methods: From 1 August 2012 till 23 July 2013, all STEMI cases that presented to our
hospital were included in this study. Patient demographics, procedural characteristics, use
of thrombus aspiration (Export catheter), TIMI flow pre and post intervention and 30-day
MACE composite endpoints (death, recurrent MI, TVR, stroke) were prospectively
collected. Chi-Square and Kruskal-Wallis tests were used for statistical analyses.
Results: 177 patients (139 males, 38 females, mean age¼61years) were treated with pri-
mary PCI (Thrombus Aspiration¼93, Non-Thrombus Aspiration¼84). 98% in the
Thrombus Aspiration cohort vs. 97% in the Non-Thrombus Aspiration cohort achieved
TIMI III flow at the end of the procedure(p¼1). 95% (Thrombus Aspiration) vs. 87%
(Non-Thrombus Aspiration) achieved 30-day MACE free outcome (p¼0.113).
Conclusion: There was no significant difference in achieving TIMI III flow when
comparing the Thrombus Aspiration and Non-Thrombus Aspiration groups. However,
there was a trend towards less 30-day MACE in the group that had Thrombus Aspiration
(this was not statistically significant).
Disclosure of Interest: None Declared
PT204
Incidence of Clopidogrel Resistence in South Asians and the Impact of Balloon
Inflation on Platelet Inhibition in Blood Samples obtained from Guide Cathters:
Comparison of Clopidogrel with Prasugrel in a South Asian Population presenting
with Acute Coronary Syndrome
Chowdhury H. Ahsan1, M. A. Rashid2, Saidur R. Khan2, Rezaul M. Karim2,
M. Maksumul Haq*2, University Medical Center Las Vegas and Cardiovascular Research Group,
ICHRI, Dhaka, Bangladesh
1
Cardiology, University Medical Center, Las Vegas, United States, 2Cardiology, Ibrahim Cardiac
Hospital and Research Institute, Dhaka, Bangladesh
Introduction: Dual antiplatelet therapy with aspirin and thienopyridine is currently recom-
mended for prevention of thrombotic events in patients undergoing coronary stenting. Clopi-
dogrel (C) is a prodrug and is subjected to variable metabolism by Cytochrome P450-IIC19 and
therefore bioavailability of the active metabolites can be unpredictable in patients with reduced
enzyme expression and be related to decreased platelet inhibition. Significantly decreased platelet
inhibition can be related to ischemic events following coronary intervention. Newer thieno-
pyridine drug, Prasugrel is not subjected to metabolism by Cytochrome P450-IIC19.
Objectives: South Asians are reported to have higher incidence of Cytochrome P450-IIC19
polymorphism and this study aimed at investigating the extent of variability of platelet
inhibition following clopidogrel administration and compared this that followinging pra-
sugrel dosage. We investigated the impact of balloon inflation on platelet activation by
collecting samples from guide catheters and see the influence of clopidogrel or prasugrel on
platelet activation following balloon inflation. The results may have implications on the use
of adjunct pharmacotherapy during coronary intervention.
Methods: 120 SA pts. in Dhaka, Bangladesh with ACS and high TIMI score between ages
18 to 75 years were alternatively given 60 mg P or 600mg C as LD irrespective of pts taking
C or not. PCI was done between 6 to 24 h after LD. Both P and C groups had equal number
of DM and non-DM pts. 5 samples of blood were collected: before LD, just before PCI,
from the guide catheters after BI, 24 h after PCI and 2 weeks after for P2Y12 receptor
binding activity by VerifyNow. PRU values were compared between groups.
e207
 Results: 65% on C had PRU above 200 compared to those on P. More % of SA had higher
POSTER ABSTRACTS
PRU (over 220) than reported in Caucasians. After BI, 85% in P group had PRU less than
160 whereas 80% in C group still had PRU more than 160. No significant difference in PRU
noted in DM and Non DM groups. BI had no different influence in DM pts.
Conclusion: More South Asians were C non-responders. BI significantly increased PRU.
Significantly higher number of pts on P had PRU still less than 160 after BI. The results may
have implications on the use of adjunct pharmacotherapy during PCI. This also raises
question about which sample for PRU value after oral administration of a thienopyridine to
be used for defining drug resistance for p.
Disclosure of Interest: None Declared
PT206
Main Platelet volume in patients older than 65 years with acute coronary syndrome.
A case-control study
Claudio Dizeo*1, Daniel Chirino Navarta1, Alicia Murua2, Florencia Baglioni2, Ariel Monteros1,
Graciela Trejo1
1
Cardiología, 2Hematologia, Unidad Asistencial Por Mas Salud Dr. César Milstein, Buenos Aires,
Argentina
Introduction: Main Platelet volume (MPV) has been associated to myocardial infraction
(MI) and is a predictor of cardiovascular events in these patients. Many studies published
have an average age lower to 65 years old. The target of this study is to evaluate if MPV is
associated to MI and cardiovascular events in patients older than 65 year.
Objectives: The target of this study is to evaluate if MPV is associated to MI and cardio-
vascular events in patients older than 65 year.
Methods: Case- control study. There were included patients with supra ST elevation
myocardial infraction (STEMI), without ST elevation (NSTEMI) and control cases
(admitted for a different cause than acute coronary syndrome, ACS). There were divided
into three groups: patients with MI (according to the last universal definition of MI), pa-
tients with unstable angina (UA), and group control. MPV was analyzed at admission in the
three groups. Hospital evolution in patients with MI and UA was analyzated. The primary
end point was the combinated of mortality, recurrent angina, heart failure and myocardial
infraction during the hospital station.
Results: There were included 48 patients with MI, 53 with UA, and 68 controls. Patients
with MI and UA were younger than control ( 73,8 8 vs 72,4  7 vs 78,5  9 years,
respectably; p¼0,001), had history of dyslipidemia ( 67 % vs 88% vs 32%; p¼0,001) and
there was no difference of hypertension (81% vs 88% vs 76 %), diabetes (31% vs 30% vs
27%) and smoking (12% vs 15% vs 8%) in the three groups. MPV had no difference
between the three groups at admission (10,6 1fl vs 10,40,9 fl vs 10,5 1 fl).
Furthermore, there was not association between MVP and severe coronary artery disease,
meaning left main coronary artery and/ or three vessels disease (10,4 0,9 fl vs 10,8  1 fl;
p¼0,4). MPV had no correlation with age (r¼0,14; p¼0,07). Primary end point was
present in 22% of patients with MI and UA, and was associated with lower MPV (10,21
vs 10,80,9; p¼0,02). In multivariable analysis, MPV was associated independently to
combinated end point (OR 0,92 IC: 95% 0,86-0,99; p¼0,02).
Conclusion: In patients older than 65 years, MPV was not associated to MI or severe
coronary artery disease. However, a lower MPV was associated with more hospital events.
Disclosure of Interest: None Declared
PT207
Association of Red Cell Distribution Width (RDW) in Diabetic Patients With
Coronary Artery Disease
Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,
Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli1
1
Cardiology, UiTM, Sungai Buloh, Malaysia
Introduction: Red cell distribution width (RDW) is a measurement of the variation of red
blood cell (RBC) size. Recent study has showed the RBC in diabetes patient has ultra-
structure changed that could impair its function. Further more, diabetes is also known to
cause erythrocyte membrane architecture abnormality and compromise the function at
molecular level that lead to coronary thrombosis. A few study have been done before to
assess the association and impact of RDW in coronary artery disease patients. However little
is known about RDW association in diabetic patients with coronary artery disease.
Objectives: To assess association of RDW with coronary artery disease among diabetic patients.
Methods: This was a single-centre, observational study of 472 patients who were admitted
for coronary angiogram for various indicated reasons from Jan 2012 to Dec 2012. Baseline
blood analysis was done on admission using automated complete blood count machine.
Significant coronary artery disease is defined as any coronary artery obstruction of more
than 50%. Cut off point of RDW is taken as 14.8% base on the normal lab value.
Results: The mean patient age was 56.9  9.4 years and 77.3% of the patients were male.
54.4% of the patients were diabetic. Mean RDW was 14.4%  0.5. Among diabetic patients
54.5% (79) had increase RDW of more than 14.8% and 59.3% (213) had significant
coronary artery stenosis. In diabetic patients with CAD the mean RDW was slightly higher
at 14.4  1.4 compared to non-CAD patients 14.2  1.3. However there was no significant
difference of RDW between this two group, p ¼ 0.62. When 14.8% taken as cut-off value
for RDW, 84.8% (67) diabetic patients with CAD had higher RDW level as compared to
15.2% (12) in non-CAD patients. There was no association between RDW level in diabetic
patients with CAD and non-CAD patients, p ¼ 0.30.
Conclusion: Our results show that there is no association of RDW level in diabetic patients
with coronary artery disease.
Disclosure of Interest: None Declared
e208
PT208
Bivalirudin versus Heparin alone in Primary PCI for ST-segment Elevation
Myocardial Infarction
Nadim Shah*1, Dinesh K. Natarajan1, Rifly Rafiudeen1, Soe K. Ko1, Anis Taeed1, Kean Soon1,
Nicholas Cox1, Western Health Cardiovascular Research Group
1
Department of Cardiology, Western Health, Melbourne, Australia
Introduction: The use of Bivalirudin, a direct thrombin inhibitor, in the setting of primary
percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction
(STEMI) is associated with reduced major bleeding and major adverse cardiovascular events
(MACE) when compared with the combination of heparin and glycoprotein IIb/IIIa inhibition.
Recent data however suggests removal of the glycoprotein IIb/IIIa inhibitor from this com-
bination for acute coronary syndromes managed with PCI may result in contrasting outcomes.
Objectives: We investigated the rate of major bleeding and MACE with the use of Biva-
lirudin versus heparin alone for patients proceeding to primary PCI for STEMI.
Methods: Consecutive patients undergoing primary PCI for STEMI between August 2012
and July 2013 were included. Patients receiving a glycoprotein IIb/IIIa inhibitor were
excluded. Cardiogenic shock and intra-aortic balloon pump use did not preclude inclusion.
Definitions of major bleeding and MACE were derived from the HORIZONS-AMI trial.
Results: 69 patients met inclusion criteria with 50 (72.5%) patients receiving heparin alone
and 19 (27.5%) Bivalirudin. Mean patient age was 62.712.8 and 58.312.9 years with
66.0% and 78.9% (p¼0.17) males in the Heparin and Bivalirudin groups respectively. There
were no statistically significant differences in the rate of femoral access or achievement of
TIMI 3 flow between the groups. 30-day MACE rates were 8.0% and 5.3% in the Heparin
and Bivalirudin groups respectively (p¼0.7) with no statistical difference in the acute or
subacute stent thrombosis rates. There were no major bleeds in the Heparin group whereas
5.3% of patients in the Bivalirudin group suffered a major bleeding complication (p¼0.2).
Conclusion: In comparison with heparin alone, without the administration of a glyco-
protein IIb/IIIa inhibitor, use of Bivalirudin in primary PCI for STEMI is associated with a
trend towards higher major bleeding rate with no additional benefit in MACE outcomes.
Disclosure of Interest: None Declared
PT209
“High On-treatment” Platelet Reactivity, But Not Pre-treatment Hyperaggregability,
Predicts Clopidogrel Response
Vivek B. Nooney*1,2, Yuliy Chirkov3,4, John Horowitz5
1
School of Pharmacy and Medical Sciences, University of South Australia, 2Cardiology, Basil
Hetzel Institute, 3University of Adelaide, 4Basil Hetzel Institute, 5Cardiology and Clinical
Pharmacology, The Queen Elizabeth Hospital, Adelaide, Australia
Introduction: Although responsiveness to antiaggregatory agents require blood sampling before
and after initiation of treatment, most studies have used on-treatment measures of agonist (ADP)
induced aggregation as an index of clopidogrel response. The contribution of thrombin and
thromboxane A2 to platelet aggregation and their relevance to on-treatment aggregability is not
well understood. We have previously shown that PGE1 response predicts clopidogrel response.
Objectives: To investigate relationships between PGE1 response, as an indirect measure of
clopidogrel response with ADP, TRAP (thrombin receptor activating peptide) and U46619
(analogue of thromboxaneA2) induced platelet aggregation.
Methods: Baseline and post-clopidogrel 600mg (4hrs) blood samples were taken from
patients (n¼31) with coronary artery disease, scheduled for non-emergent stent insertion.
Whole blood impedance aggregomtery was performed. Platelet PGE1 (30nmol/L) responses
were determined at baseline based on inhibition of ADP (2.5mmol/L) induced aggregation.
Aggregation induced with TRAP (3mmol/L) and U46619 (1mmol/L) was also recorded for
baseline and 4hr blood samples. Clopidogrel response (DADP) was measured as % change
in platelet aggregation post clopidogrel.
Results: PGE1 response was inversely associated with baseline ADP(r ¼ -0.68, p ¼ 0.001),
TRAP(r ¼ -0.59, p ¼ 0.0005) and U46619 (rs ¼ -0.53, p ¼ 0.002) induced aggregation.
Despite the pre-existing hyper-aggregability, baseline responses to ADP, TRAP and U46619
were not significantly associated with the impairment of clopidogrel response. However
there was a significant relationship between on-treatment hyperaggregability to ADP, TRAP,
U46619 and hypo responsiveness to clopidogrel ([ADP, p < 0.001], [TRAP, p ¼ 0.024],
[U46619, p ¼ 0.003]: using Fisher’s exact test).
Conclusion: “High on-treatment” platelet reactivity to ADP is indeed a valid index of
impaired clopidogrel response in most cases. Furthermore, persistent hyperaggregability to
other pro-aggregants (TRAP, U46619) has similar predictive value, emphasising the effect
of P2Y12 antagonists of limiting aggregation induced by agonists other than ADP.
Disclosure of Interest: None Declared
PT210
Clinical outcome in dialysis patients who underwent percutaneous coronary
intervention
jiangming fam*1, chunyuan khoo1, jonanthan yap1, khung keong yeo1, james xinzhe cai1,
yeehow lau2, lingling sim2, soo teik lim1, terrance siang jin chua1, tian hai koh1
1
Cardiology, National Heart Centre Singapore, 2Singapore Cardiac Data Bank, Singapore, Singapore
Introduction: Percutaneous coronary intervention (PCI) in patients with renal failure on
dialysis have been shown to be associated with high periprocedural mortality and poor
clinical outcome. However, there are limited data in Asian patients.
Objectives: The aim of this study is to study the angiographic characteristics and clinical
outcomes of dialysis dependent patients treated with PCI in an Asian society.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: A retrospective analysis of 319 dialysis patients who underwent PCI between
2007 to 2012 in a single tertiary care institution was performed. Demographics, clinical and
angiographic characteristics of the study subjects were analyzed. The primary outcome
measure studied was 6 month all-cause mortality. The secondary outcome measure was
readmission for revascularisation at 6 months.
Results: Of the 319 patients, 63.9% were males (n¼ 204), median age was 62 years old.
There were 71.5% Chinese (n¼ 221), 19.1% Malay (n¼61), 7.2% Indian (n¼23) and 2.2%
of other races (n¼ 7). The prevalence of diabetes mellitus, hypertension and hyper-
lipidaemia are 65.8% (n¼ 210), 94% (n¼ 300) and 80.3% (n¼ 256) respectively. 10%
(n ¼ 32) of patients underwent PCI for STEMI. 44.2% (n¼ 141) and 3.1% (n¼10) have
LAD and left main disease/ equivalent as dominant vessel involvement respectively. 40.1%
(n¼ 128) had  1 DES implanted and 50.8%% (n¼ 162) had only BMS implanted. 9.1%
(n¼ 29) underwent balloon angioplasty. Procedural angiographic success rate was
96.6%.The in-hospital mortality and all- cause mortality rate at 6 months were 5.6%
(n¼ 18) and 10.7% (n¼ 34) respectively. Readmission for unplanned revascularisation at
6 months was 15.7% (n¼ 50). Predictors of 6 month mortality by multivariate analysis are
age (OR 1.064, 95% CI 1.017- 1.113, p¼ 0.007), Indian race (OR 4.478, 95% CI 1.293-
15.515, p¼ 0.018) and presence of angiographic left main disease (OR 4.417, 95%
CI 1.310 -14.895, p ¼ 0.017).
Conclusion: PCI can be performed in selected renal dialysis patients with an acceptable in-
hospital mortality rate; however, 6 month mortality remains high in dialysis patients after
coronary revascularization.
Disclosure of Interest: None Declared
PT214
Real-World’ Study on The Role And Impact of Novel Anticoagulants on
Contemporary Cardiovascular Care
Hui-shan Ong*1, J. S. Hon2, Jessie Zhang3, J. M. Fam1, Laura Chan1, C. K. Ching1, R. S. Tan1,
Angela S. Koh1
1
Cardiology, 2Pharmacy, 3Finance, National Heart Centre Singapore, Singapore, Singapore
Introduction: The new class of novel anticoagulants is changing the paradigm of
contemporary cardiovascular disease treatment.
Objectives: This study was designed to collect real world data on patient profiles and
outcome events following novel anticoagulant (NOAC) use with dabigatran or rivaroxaban,
compared to traditional warfarin use.
Methods: Patients who received clinically indicated oral anticoagulants either warfarin or
NOAC (dabigatran or rivaroxaban) between January 2012 and November 2012 were
included in the study. Baseline clinical information was obtained retrospectively from
medical and pharmacy records while clinical outcome events up to one year including
stroke, major bleeding, myocardial infarction and death were obtained additionally from
administrative and disease registry data.
Results: We analysed a total of 94 patients (mean age 669 years; 39% females). During
the study period, we observed a linear downward trend for warfarin prescriptions and a
gradual switch from warfarin to NOAC prescription (Figure 1). Male patients (warfarin
63%; dabigatran 53%, rivaroxaban 21%, p¼0.009), patients who had prior systemic
thromboembolism (warfarin 17%; dabigatran 0%, rivaroxaban 5%, p¼0.026) or liver
disease (warfarin 53%; dabigatran 30%, rivaroxaban 13%, p¼0.017) and patients who
received concomitant aspirin therapy (warfarin 37%, dabigatran 9%, rivaroxaban 16%,
p¼0.012) were more likely to receive warfarin over the NOACs. However, there was a
trend towards NOAC use over warfarin in patients with history of previous bleeding (19%
vs 5%, p¼0.058). CHADS2 and HAS-BLED scores did not differ between the groups.
Composite event rate of 6.4% occurred over one year; there were no significant differences
between the warfarin versus NOAC group (ischemic stroke 2.4% vs 1.9%; major bleeding
2.4% vs 5.7%) respectively. No deaths or myocardial infarction were observed.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: There was a gradual change in prescription patterns between the traditional
POSTER ABSTRACTS
and novel oral anticoagulants. Further study is required to analyse the impact of differences
in baseline patient characteristics between the groups on long term clinical outcome.
Disclosure of Interest: None Declared
PT215
Long Term Clinical Outcomes of Chinese Patients with Borderline Ankle Brachial
Index
Bryan P. Yan*1, Toria Lee1, Nikki Lee2, Kim Au1, James Y. Lau1
1
The Chinese University of Hong Kong, Hong Kong, Hong Kong, 2Sheffield University, Sheffield,
United Kingdom
Introduction: An ankle brachial index (ABI) <0.9 is conventionally used to define pe-
ripheral arterial disease (PAD) and those at increased risk for myocardial infarction, stroke
and death. Recent evidence suggested that borderline ABI (0.90-0.99) is also associated
with raised cardiovascular risk.
Objectives: To evaluate long-term clinical significance of borderline ankle-brachial index
(ABI) in Chinese patients.
Methods: We retrospectively analyzed 685 consecutive patients with ABI measured at the
Prince of Wales Hospital from 2004 to 2009. Patients were categorized as severe (ABI
<0.50), moderate (ABI 0.50 to 0.69), mild PAD (ABI 0.70 to 0.89), borderline (0.90 to
0.99) and normal ABI (1.00 to 1.30). Baseline characteristics and clinical outcomes were
compared between groups. Event-free survival was assessed using Kaplan-Meier methods.
Results: Indication for ABI was claudication in 54.6% and critical limb ischemia in 28.8% of
patients. Prevalence of severe, moderate, mild PAD, borderline and normal ABI were 28.2%,
25.7%, 16.9%, 9.1% and 13.3%, respectively. Mean age of patients with borderline ABI
(72.411) were older than patients with normal ABI (64.812) but younger than patient
with PAD (74.710, p<0.01). Cardio-protective therapies such as antiplatelet and statin
therapies were underutilized among patients with PAD (55.1% and 20.2%) and borderline
ABI (38.4% and 23.9%). Mean follow-up was 4.32.8 years. Mortality rates of patients with
borderline ABI (56.5%) was significantly higher than patients with normal ABI (31.9%,
p<0.01), similar to patients with mild (46.6%) and moderate PAD (55.1%) but lower than
patients with severe PAD (60.1%, p<0.01). Amputation rates progressively increased from
normal and borderline ABI, mild, moderate and severe PAD (1.4%, 6.5%, 10.3%, 9.7% and
17.6%, respectively, p<0.01). Mean event-free survival for patients with borderline ABI was
5.3 mths compared to 7.3, 5.7, 5.3 and 5.3 months for patients with normal ABI, mild,
moderate and severe PAD, respectively (p<0.01). Cumulative survival differed significantly
between patients with borderline and normal ABI but similar to patients with PAD.
Conclusion: Patients with borderline ABI is associated with worse long-term outcomes
compared to patients with normal ABI but similar to patients with PAD. Patients with PAD
and borderline ABI were under-treated in terms of cardio-protective therapies. Better
adherence to therapeutic guideline recommendations may improve their outcomes.
Disclosure of Interest: None Declared
PT216
Capillaries are involved in the systolic and the diastolic blood pressure response to
changes in sodium chloride intake in normotensive subjects
John B. Myers*1
1
Internal Medicine, Lorne Street Therapies, Melbourne, Australia
Introduction: Volume (V) and capacitance (C) factors determine blood pressure response to
changes in sodium intake in normotensive subjects (1,2). Apart from renal function, the variables
that determine systolic (SBP) and diastolic blood pressure (DBP) response differ, yet correlation
between these responses remains. DBP response is determined by microcirculatory responses.
Objectives: The question posed is whether capillaries are also involved in the SBP response
to changes in sodium intake?
Methods: Sodium intake was altered in 172 subjects aged 6-77y. In 117 subjects creatinine
clearance and haematocrit (microhaematocrit method) were measured after two weeks on a
reduced sodium diet plus sodium chloride tablets or placebo, in a randomly assigned cross
over design, following two weeks run-in on their usual diet.
Results: All subjects gained weight on the sodium added diet. In 43 haematocrit rose on
the high sodium diet and diastolic blood pressure increased. Age and diastolic blood
pressure response were not related. SBP response was related to age, to initial systolic blood
pressure in place of age but not to haematocrit. SBP and DBP responses correlated and were
both inversely related to creatinine clearance on the reduced sodium diet.
Conclusion: On the basis of these findings a microcirculation hypothesis of “essential”
hypertension has been proposed (3) as increased weight and increased haematocrit indi-
cated fluid shifted, i.e. capillary permeability increased and fluid distribution altered which
was associated with the rise in arteriolar resistance (DBP).
Stefanidis et al (4) showed that aortic stiffness is determined by adventitial perfusion, i.e.
microcirculation.
Thus, notwithstanding higher systolic blood pressures result from aortic dysfunction in
terms of compliance by the increased arteriolar resistance, the aortic microcirculation may
also be involved. Reducing adventitial fluid formation and therefore aortic compliance
depends on the functional integrity and anatomy of adventitial capillaries, which are
affected with age, whereas DBP response was not age related. Fluid retention resulting from
glomerular loss or dysfunction and or tubular mechanisms, whether primary or secondary
to microcirculatory determinants, contributed to the volume factors that determine the SBP
and DBP response to increasing sodium intake. In addition to affecting DBP response,
capillary involvement affects (V) (stroke volume) as well as (C) (aortic compliance), which
determine the SBP response to changes in sodium intake.
Disclosure of Interest: None Declared
e209
 PT217
POSTER ABSTRACTS
Catheterization-Related Cerebral Infarction Evaluated At Diffusion-Weighted
Magnetic Resonance Imaging In High-Risk Patients
Takao Kato*1, Yusuke Morita1, Moriaki Inoko1
1
Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Osaka,
Japan
Introduction: Stroke related with catheterization was devastating complications after
procedures. The rates of stroke range from 0.1-0.4% according to previous studies. Stroke
was taken only as new neurological complications, therefore clinically unapparent cerebral
embolisms were not taken into account. Diffusion weighted magnetic resonance imaging
(DW-MRI) is very high sensitive tools for detecting acute cerebral ischemic lesions. Due to
improvements of catheter design and approach, catheterization-related cerebral infarctions
are expected to decrease, whereas this may be counterbalanced by increased risk profile of
patients who undergo catheterization.
Objectives: We aimed to examine the current prevalence and risk factors of symptomatic
and asymptomatic catheterization-related cerebral infarctions by DW-MRI.
Methods: We retrospectively analyzed 84 patients who underwent 1237 diagnostic and
interventional catheterization procedures through the aortic arch conducted within 2010
and 2011 in our hospital and who obtained the MRI within 14 days a catheterization.
Results: Ten patients who developed symptoms and 3 patients were finally diagnosed as
stroke, which was defined as any neurological deficits lasting over 24 hours. The remaining
74 patients were asymptomatic and underwent MRI for various other reasons, including
the assessment before coronary artery bypass graft (35%), valvular surgery (18%) or aortic
repair (6.8%). The MRI revealed a fresh cerebral infarction in 22 of 74 asymptomatic
patients (29.7%). Patients with cerebral infarction underwent longer procedures (mean 
SEM, 17.1  1.7 minutes vs. 22.7  2.4 minutes, p<0.05), used higher number of
catheters and were more likely to be old (mean  SEM, 74.1  1.67 vs. 70.4  1.1 years
old), to have dyslipidemia, and to undergo in urgent settings and for interventional pur-
poses. In DW-MRI findings, more patients with new infarction had multiple or bilateral
lesions. More lesions were seen in the anterior and anterior plus posterior territories.
Conclusion: Stroke after catheterization occurred 3 of 1237 (0.16%) patients, and this rate
was almost equivalent to those seen in previous studies. However, the rate of small
asymptomatic catheterization-related cerebral infarctions detected using diffusion-weighted
MRI remains high in high-risk patients or candidates for cardiac surgery.
Disclosure of Interest: None Declared
PT221
Nocturnal hypertension is associated with preclinical organ damage in untreated
hypertension
Emmanuel Androulakis1, Dimitris Tousoulis*1, Evaggelos Chatzistamatiou1,
Nikolaos Papageorgiou1, George Hatzis1, Ioannis Kallikazaros1, Christodoulos Stefanadis1
1
1st Cardiology Department, Hippocration Hospital, Athens, Greece
Introduction: Although nocturnal hypertension has been associated with increased car-
diovascular morbidity and mortality, its clinical significance in relation to subclinical target
organ damage remains controversial.
Objectives: The purpose of this study was to assess whether nocturnal hypertension is
associated with preclinical vascular damage, cardiac hypertrophy and renal function, as
indices of subclinical target organ damage in untreated hypertension.
Methods: The study population consisted of 302 untreated essential hypertensives. Based
on the presence of NH (>120/70 mmHg), the population was divided into two groups:
nocturnal normotensive (n¼150) and nocturnal hypertensive subjects (n¼152), who did
not differ in classical risk factors. Carotid-femoral pulse wave velocity (cf-PWV), flow
mediated dilation (FMD), intima-media thickness of carotid arteries (C-IMT), augmentation
index, ankle-brachial index were assessed in all participants. Also, left ventricular mass
index (LVMI) and E/A (the mean ratio of early and late diastolic tissue velocities) were
assessed by echocardiography. Serum cystatin-C levels were measured by ELISA kit and
glomerular filtration rate (GFR) was assessed by the Cockcroft-Gault formula.
Results: Patients with NH were characterized by increased arterial cf-PWV (911.7 vs
8.41.5 m/sec, p¼0.0001) and marginally decreased FMD values (5.13.4 vs 4.12.6,
p¼0.066). In addition, this group showed increased C-IMT (0.770.18 vs 0,690,15 mm,
p¼0.016) compared to normotensive subjects, whereas no other significant differences
were observed, regarding other vascular indices (p¼NS for both). Notably, they also
exhibited impaired values of LVMI (88.122.9 vs 82.816.6 gr/m2, p¼0.043) and E/A
(0.900.26 vs 0.880.43, p¼0.030), respectively. However, the two groups did not differ
with respect to renal function, based on the values both of GFR (p¼0.689) and cystatin-C
(p¼0.283).
Conclusion: In the present study we found that nocturnal hypertension is accompanied by
subclinical atherosclerosis, as well as structural and functional cardiac abnormalities, without
significant association with renal function in this untreated hypertensive population.
Disclosure of Interest: None Declared
PT223
Impact of chronic pressure and volume overload on left atrial shape and function
Angelina Stevanovic*1, Milica Dekleva2, Radosava Cvjetan3, Snezana Trajic4,
Nevena Paunovic1, Vesna Andric1, Goran Podnar1
1
Cardiology department, Railway Health Care Institute, 2Cardiology department, University
Clinical Center Zvezdara, 3Cardiology department, Zemun Medical Centre, 4Cardiology
department, Dedinje Cardiovascular Institute, Belgrade, Serbia
e210
Introduction: Chronic pressure and volume overload may cause dfferent type of left atrial
(LA) remodeling. Two different patterns of LA remodeling can be discriminate bay left atrial
eccentricity index (LAEI).
Objectives: To assess the left atrial shape and function in chronic presure and voloume
overload.
Methods: The study included 103 hypertensive patients with diastolic dysfunction and
with or without mitral regurgitation (MR): 39 patients without MR, 30 patients with mild
MR, and 34 patients with moderate/moderate to severe MR.
Peak LA strain and strain rate during ventricular systole (S-LAs and SR-LAs), peak early
diastolic LA strain and strain rate (S-LAe and SR-LAe), and peak LA strain and strain rate
during atrial systole (SLAa and SR-LAa) were measured as LA function parameters.
Left atrial volume (LAV) was measured at three time points (maximal LAV, pre-atrial
contraction volume and minimal LAV) and the following LA emptying volumes were then
derived: LA stroke volume (LASV) and fraction (LASVFr), LA passive emptying volume
(LAPEV) and fraction (LAPEVFr), LA conduit volume (LACV) and LA active emptying
volume (LAAEV) and fraction (LAAEV). All LA volumes were indexed to body surface area.
Results: There were significant correlations between of LAEI and RV (r¼-0,405; p¼0,003)
and significant decrease in LAEI (1,490,17 vs 1,310,15 vs 1,210,15, p¼0,0003), S-
LAs (29,610,4 vs 26,35,87 vs 23,98,85, p¼0,022), SR-LAs (1,540,53 vs 1,330,38
vs 1,220,42, p¼0.012), S-LAe (19,69,26 vs 16,35,97 vs 15,45,71, p¼0,041), SR-
LAe (-1,600,45 vs -1,380,41 vs -1,220,67, p¼0.011) and SR-Laa -2,170,68 vs
-1,940,54 vs -1,690,53, p¼0.004) with increasing severety of MR. LAEI also signifi-
cantly correlated with left atrial deformation parameters and with LAVI (r¼-0.382;
p¼0.0007), LASVFr (r¼0.519; p¼0.0002), LAPEVFr (r¼0.386; p¼0.0005) and LAAEVFr
(r¼0.401; p¼0.0003).
Conclusion: Left atrium was more spherical and with inferior mechanical function in all
three phases (reservoir, conduit and active contractile functions) in a simultaneous chronic
pressure and volume overload and with increasing severity of MR. Usefulness of LAEI in
identification of patients associated with a higher rate of AF with a higher cardiovascular
risk need to be verified.
Disclosure of Interest: None Declared
PT224
Genome-wide association study identifies eight novel loci associated with blood
pressure responses to interventions in Han Chinese
Jiang He*1, Tanika N. Kelly1, Qi Zhao1, Hongfan Li2, Dabeeru C. Rao3, James E. Hixson4,
Dongfeng Gu2, GenSalt Investigators
1
Department of Epidemiology, Tulane University, New Orleans, United States, 2Department of
Epidemiology and Population Genetics, Fuwai Hospital, Beijing, China, 3Division of Biostatistics,
Washington University, St. Louis, 4Human Genetics Center, University of Texas, Houston, United
States
Introduction: Blood pressure (BP) responses to dietary sodium and potassium intervention
and cold pressor test (CPT) vary considerably among individuals.
Objectives: We aimed to identify novel genetic variants influencing individuals’ BP re-
sponses to dietary intervention and CPT.
Methods: We conducted a genome-wide association study of BP responses in 1,881 Han
Chinese and de novo genotyped top findings in 698 Han Chinese. Diet-feeding study
included a 7-day low-sodium (51.3 mmol/day), a 7-day high-sodium (307.8 mmol/day),
and a 7-day high-sodium plus potassium-supplementation (60 mmol/day). Nine BP
measurements were obtained during baseline observation and each intervention period.
Results: The meta-analyses identified eight novel loci for BP phenotypes, which physically
mapped in or near PRMT6 (P¼7.2910-9), CDCA7 (P¼3.5710-8), PIBF1 (P¼1.7810-9),
ARL4C (P¼1.8610-8), IRAK1BP1 (P¼1.4410-10), SALL1 (P¼7.0110-13), TRPM8
(P¼2.6810-8), and FBXL13 (P¼3.7410-9). There was a strong dose-response relation-
ship between the number of risk alleles of these independent SNPs and the risk of
developing hypertension over 4-years follow-up in the study participants. Compared to
those in the lowest quartile of risk alleles, odds ratios (95% confidence intervals) for those
in the second, third and fourth quartiles were 1.24 (0.82, 1.87), 1.55 (1.01, 2.39), and 1.92
(1.28, 2.89), respectively (p¼0.0008 for trend).
Conclusion: Our study identified 8 novel loci for BP responses to dietary sodium and po-
tassium intervention and CPT. The effect size of these novel loci on BP phenotypes are much
larger than those reported by the previously published studies. Furthermore, these variants
predict the risk of developing hypertension among individuals with normal BP at baseline.
Disclosure of Interest: None Declared
PT225
Knowledge, attitudes and behaviors related to sodium intake of Cardiac Care Unit
Lebanese adult patients
Jihan Fathallah1, Mohamad Almedawar*1, Torkom Garabedian1, Sabine Keyrouz1,
Laila Al-Shaar2, Lara Nasreddine3, Samir Alam1, Hussain Isma’eel1, Vascular Medicine
Program
1
Cardiology, 2Vascular Medicine Program, 3Nutrition and Food Sciences, American University of
Beirut, Beirut, Lebanon
Introduction: High dietary salt intake has been directly correlated with hypertension, the
leading preventable risk factor for death in the world. Assessing knowledge, attitudes, and
behaviors of high cardiovascular (CV) risk patients and comparing them to community
based results would direct future focused interventions to reduce intake of salt.
Objectives: To assess the knowledge, attitudes, and behaviors of high risk patients in the
Cardiac Care Unit (CCU) regarding salt intake to guide future interventions, and to
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
compare the awareness level of our study sample to healthy individuals in the community
(HIC) from a previous study*.
Methods: Based on unpublished data*, it is estimated that around 82.2% of Lebanese
adults know that salt/sodium worsens human’s health. With a confidence interval of
7% and a type 1 error of 5%, we sampled 115 out of the annual 1500 Lebanese high
CV risk patients admitted to the Cardiac Care Unit (CCU). They were administered a
questionnaire developed to assess awareness of salt intake recommended level, content
in food, and associated CV risk. Statistical analysis was conducted using SPSS 20 for
Windows.
Results: In terms of knowledge, 36.5% of CCU patients knew that the main source of salt
in the diet is processed foods such as breads, cured meats, and canned food compared to
21.5% of HIC, while 47% thought it was salt added at the table compared to 42.1% of HIC.
Moreover, 19.1% of CCU and 28.9% of HIC knew the maximum daily amount of salt
recommended. In terms of attitudes and behaviors, 58.53% admitted they never look at the
salt or sodium content on food labels compared to 66.5% of HIC. When asked about the
main motive to reduce Salt intake, 65.8% of CCU and 51.7% of HIC admitted that it would
be a dramatic change in health status.
Table 1. Characteristics of the CCU sample (n¼115)
Age,Mean±SD 60.6315.39
BMI,Mean±SD 29.37±5.41
SBP,Mean±SD 125.61±22.14
smoking,N(%) 43(37.70)
Family Hx-CAD,N(%) 30(26.30)
Medical Hx-HTN,N(%) 85(74.60)
Medical Hx–Coronary PCI,N(%) 44(38.60)
Coronary PCI during Current visit,N(%) 35(30.70)
Conclusion: Our study shows a lack of knowledge regarding salt major contributors in
the Lebanese diet and allowed maximum intake levels relative to the community based
sample.
*Nasreddine et al. “Knowledge, Attitudes and Behaviors Related to Sodium Intake of
Lebanese Consumers aged 19-60” (Unpublished data).
Disclosure of Interest: None Declared
PT226
Erectile dysfunction risk factors in patients with severe obstructive sleep apnea
syndrome and identifying CPAP response predictors
Haruki Sekiguchi*1,2, Ken Shimamoto1, Koji Narui3, Yuji Inoue4, Yufuko Takahashi1,
Tatsumi Fujio1, Yasunobu Hashimoto5, Yoshiko Maeda5, Eri Watanabe1, Masatoshi Kawana1,
Fujio Tatsumi1, Mayumi Suzuki6, Ken Shimamoto1, Kazuhiro Yamaguchi6, Masatoshi Kawana1
1
Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Japan, 2Cardiology,
Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Jersey, 3Respiratory Medicine,
Toranomon Hospital, 4Aoyama Hospital Tokyo Women’s Medical University, 5Urology, 6Aoyama
Hospital, Tokyo Women’s Medical University, Tokyo, Japan
Introduction: Erectile dysfunction (ED) is one of the important complications in patients
with sleep apnea syndrome (SAS). ED is known as a risk factor and risk indicator for future
cardiovascular diseases. However, risk factors related to ED as well as the efficacy of
continuous positive airway pressure (CPAP) therapy on improving ED have not been
established in Japanese subjects with obstructive SAS.
Objectives: This study investigates risk factors of ED and factors predicting the efficacy of
CPAP for the treatment of ED in Japanese SAS patients.
Methods: We conducted a retrospective population-based study of Japanese subjects
linking questionnaire data with characteristics of patients hospitalized (170 males, age:
4912.3 years) due to SAS diagnosis by polysomnography. SAS was diagnosed as AHI > 5
and ED diagnosed by an International Index of Erectile Function (IIEF)-5 score < 22.
Thirty patients answered IIEF5 twice before CPAP treatment and at 6 months after CPAP
treatment. We analyzed the correlation between ED and potential explanatory variables
including age, body mass index (BMI), apnea/hypopnea index (AHI), micro-arousals, hy-
pertension (HTN), diabetes mellitus (DM), dementia, ischemic heart disease, dyslipidemia,
and benign prostatic hyperplasia. We also investigated predictors judging the efficacy of
CPAP on improvement of ED.
Results: In this study population, baseline BMI and AHI were, 27.34.0 kg/m2 and
43.127.8 /hr, respectively. ED was observed in 59.4% (101/170) of the patients. DM
and HTN were found to be risk factors for ED (odds ratio: 2.89, [95% CI 1.46-5.68],
P<0.001, OR: 3.47, [95% CI 1.77-6.85], P<0.01, respectively). Multivariate analysis
revealed that DM (OR: 4.4, [95% CI 1.92-9.97], P<0.001) was a unique, independent
risk factor for ED. After 6 months of CPAP treatment, IIEF5 scores significantly decreased
in 53.3% (16/30) of ED patients (3.42.3, P<0.001). Baseline AHI for SAS diagnosed
patients was significantly higher in CPAP responders compared to non-responders
(53.922.9 vs. 37.019.8, P<0.05, respectively). However, in patients over 65 years of
age (N¼5), CPAP therapy was not effective for treating ED (DIIEF 5 ¼ –5.48.0) in 80%
of cases.
Conclusion: DM is an important risk factor inducing ED in SAS patients. Furthermore,
CPAP treatment should be considered for patients suffering from severe SAS complicated
with ED.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT227
POSTER ABSTRACTS
Large artery stiffness and carotid intima-media thickness in relation to markers of
bone mineral metabolism in postmenopausal African women: The PURE-study
Aletta Schutte*1, Lebo Gafane1, Iolanthe Kruger2, Rudolph Schutte1
1
Hypertension in Africa Research Team (HART), 2Africa Unit for Transdisciplinary Health
Research, North-West University, Potchefstroom, South Africa
Introduction: Increased vascular calcification, cardiovascular morbidity and mortality have
been associated with altered bone metabolism and associated calciotropic hormones.
Objectives: Due to the lack of information on the contribution of altered bone metabolism
and calciotropic hormones on cardiovascular disease in Africans, this study aimed to
explore the relationships of carotid intima-media thickness (cIMT) and central pulse
pressure (cPP) with the parathyroid hormone-to-vitamin D ratio (PTH:25-OH-D) and C-
telopeptide of type I collagen (CTX) in postmenopausal African women.
Methods: A study population of 434 African women, aged 47 years, was divided into
lean and overweight/obese groups. We assessed cPP and cIMT, and determined PTH, 25-
OH-D and CTX concentrations.
Results: In the overweight/obese group we found elevated PTH and PTH:25-OH-D
compared to the lean group (p<0.001), while the lean group had higher CTX concen-
trations (p<0.001). Single, partial and multiple regression analyses confirmed that only in
lean women, cIMT was independently associated with PTH:25-OH-D (R2¼0.22; b¼0.26;
p¼0.003); whereas in obese women, cPP associated with both PTH:25-OH-D (R2¼0.20;
b¼0.17; p¼0.017) and CTX (R2¼0.20; b¼0.17; p¼0.025).
Conclusion: In postmenopausal African women with increased adiposity, cPP, as indicator
of central arterial stiffness, was positively associated with alterations in bone metabolism
and calciotropic hormones, whereas cIMT of lean women was positively associated with
PTH:25-OH-D. Our results suggest that alterations in bone metabolism may contribute to
arterial calcification.
Disclosure of Interest: None Declared
PT229
Assessment of quality of life and its correlates among Hypertensive patients in a West
African Cardiology practice
Amam C. Mbakwem*1, Francis Aina1, Casmir E. Amadi2, Abiola Akinbode2, Joy Mokwunyei3
1
Medicine, 2Psychiatry, University of Lagos, 3Medicine, Lagos University Teaching Hospital,
Lagos, Nigeria
Introduction: Hypertension (HTN) is majorly asymptomatic except when complicated and
may not be expected to impact on the quality of life (QoL) of patients. Poor QoL may affect
health seeking behaviour, adherence to treatment and disease outcome. The aspect of
quality of life has not been given much prominence in the management of patients with
hypertension. We therefore evaluated the QoL of hypertensive patients attending the
cardiology clinic of our hospital using a generic instrument, the WHOQOL-BREF.
Objectives: To determine the quality of life of hypertensive patients and its correlates in a
cardiology practice in west Africa.
Methods: Hypertensive patients without co-morbidities who were attending the cardiology
clinic were recruited. Relevant clinical data were retrieved from their notes and subjects self
completed the WHOQOL-BREF. The single item scores were computed and analysed. The
domain scores in the WHOQOL-BREF were computed, transformed and analysed. These
were correlated with the single item scores and clinical parameters.
Results: There were 74 males and 110 females with mean age 56.4712.02yrs. About 40%
had post high-school education, 72% had poor finances and most, 80% were married. About
16% felt their QoL was poor to average while 49% were dissatisfied with their health status.
Transformed scores for the main domains, physical health, psychological, social relationships
and environment were 67.3726.35, 68.7613.58, 67.9215.93 and 67.1413.86
respectively. Also 14.9%, 9.1%, 8.5% and 8.8% had scores less than 50% for physical health,
psychological, social relationships and environment domains respectively. More females
(18.2% vs. 12.2%, p ¼ 0.05) felt their quality of life was below average. There was positive
correlation between age and domains of social relationships and the environment, r¼.214,
p¼0.006 and r ¼.183, p¼0.02 respectively. Positive correlation was observed between
perception of poor quality of life and health status and the four domains evaluated, p <0.0001.
Conclusion: The QoL of hypertensive patients must be given consideration in their
management as this may contribute to poor adherence and affect outcomes. Particular
attention should be paid to female hypertensives who appear to have worse QoL scores.
Disclosure of Interest: None Declared
PT230
Role of Brain Natriuretic Peptide In Predicting The Short Term Cardiovascular
Outcomes In Preeclampsia And Eclampsia Patients
Ghada Youssef*1, Nader Haroon1, Reda Diab1, Essam Baligh1
1
Cardiology, Cairo University, Cairo, Egypt
Introduction: Brain natriuretic peptide (BNP) concentrations were found to be higher in
preeclampsia and other hypertensive disorders of pregnancy than in normal pregnancy.
This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with
preeclampsia.
Objectives: To evaluate the possible role of elevated BNP level in predicting the short-term
maternal cardiovascular outcome in patients presented with preeclampsia/eclampsia disease.
Methods: Fifty patients who presented with preeclampsia or eclampsia were included.
They were followed up clinically and by echocardiography till delivery and at 1, 3 and 6
e211
 months after delivery. BNP level was measured by a point-of-care test at time of presen- Conclusion: This meta-analysis suggests that non-invasive cBP estimation is device /
POSTER ABSTRACTS

tation, before delivery. Maternal cardiovascular outcomes were reported. technique dependent. Consequently, caution is advisable in applying different devices and
Results: The median BNP level was 92.6 ng/L (range: 22.6 to 1170.0). Twenty one mothers techniques in clinical studies.
(42%) delivered with complications and 2 (4%) died before delivery. The most common Disclosure of Interest: None Declared
complication was renal impairment. No reported cardiovascular complications. Occurrence
of maternal complications were significantly related to the level of systolic and diastolic
PT232
blood pressure during pregnancy (p value¼ 0.005 and <0.001 respectively). No significant
relation between maternal complications and BNP plasma level (p value is 0.8). There were Functional Cardiac Paraganglioma -Case report
no reported maternal cardiovascular complications in the post-delivery follow up period.
Conclusion: Elevated BNP plasma level, in patients with preeclampsia/eclampsia disease, Waleed Aty*1,2, Bruce French1
1
could not be related to maternal outcome. Maternal complications occurred more in Cardiothoracic Unit, Liverpool Hospital, Sydney, Australia, 2Cardiothoracic unit, Suez Canal
women with higher blood pressure level. No reported cardiovascular complications either University Teaching Hospital, Ismailia, Egypt
in the pre- or post-delivery period.
Disclosure of Interest: None Declared Introduction: Cardiac paraganglioma is very rare tumor. The first case of surgically
resected cardiac paraganglioma was described in 1974(1). Up to date, less than 50 cases of
cardiac pheochromocytomas were reported in surgical literatures.
PT231
Objectives: Diagnosis, preoperative preparation and surgical resection of cardiac para-
Impact of device and measurement technique on central systolic blood pressure ganglioma using cardiopulmonary bypass machine.
estimation - A meta-analysis of Methods: We present a 55 years old male patient with 10 years history of refractory hy-
pertension resulting from a functional cardiac paraganglioma. After appropriate preoper-
Om Narayan*1, Joshua Casan1, Martin Szarski1, Anthony Dart2, James Cameron1 ative medically control of hypertension, he underwent surgical resection of the tumor that
1
Monash Cardiovascular Research Centre, MonashHeart, 2Department of Cardiology, Alfred invading Right inferior pulmonary vein and posterior surface of left atrium using cardio-
Hospital, Melbourne, Australia pulmonary bypass through right thoracotomy.
Results: comple surgical resection required to do right side lower lobectomy and resection
Introduction: Central aortic blood pressure (cBP) is considered to be superior to con- of the roof of left atrium and patched with bovine pericardium. Patient had smooth
ventional brachial blood pressure as a predictor of future cardiovascular events. Several postoperative care and follow for one year with normal 24- hour urinary norepinephrine,
devices and techniques, each purporting to measure cBP have entered commercial use. The plasma normetanephrine levels and chest CT scan.
interchangeability of cBP measurements and the influence of disease states on central to
brachial pulse pressure amplification remain unclear. The measurement of cBP in clinical
trials is dependent on clarification of these issues.
Objectives: We sought to clarify the influence of device and technique on the brachial to
estimated central systolic blood pressure difference across cohorts of patients with varying
disease states. We hypothesised that this difference would be principally influenced by the
device / technique used, rather than underlying disease or demographic states.
Methods: We performed a systematic meta-analysis of studies reporting cBP between 2000
and December 2012. Studies were included if central and brachial systolic blood pressures
(cSBP and bSBP) were reported. Studies were categorized by device and according to the
prevalent disease state. The mean difference between bSBP and cSBP was calculated. A
random effects model (inverse variance weighted approach) was used to estimate a com-
bined mean difference for each device.
Results: Of 162 included studies, the SphygmoCorÔ device was most commonly reported

web 3C=FPO
(110 studies) with direct carotid applanation second most utilized (31 studies). In 24
included invasive studies, the measured cSBP estimate did not differ significantly from the
oscillometric bSBP estimate (mean difference 4.19mmHg, 95%CI -4.13-12.51) whereas
mean differences of 12.77mmHg and 8.83mmHg were obtained with the SphygmoCorÔ
and carotid applanation techniques respectively (both P<0.05). Conversely the mean cSBP
to bSBP differences measured across various disease states with the SphygmoCorÔ tech-
nique did not differ significantly.

web 3C=FPO

Conclusion: Surgical resection of cardiac paragangliomas is an effective treatment with

most cases being curative. Appropriate perioperative control of hypertension one of the
corner stone in management of this type of tumor.
Disclosure of Interest: None Declared

PT234
Controlled clinic blood pressure lowers the risk of left ventricular hypertrophy: A
study among hypertensive Indonesians in rural areas
Gracia Lilihata1, Ratna Andriyati*1, Cindya K. Simanjuntak1, Chris T. Handjaya1,
Ardeno Kristanto2, Felix C. Fredy3, Dexanda Pravian1, William J. Iskandar1
1
Internship Doctor, Tanjung General Hospital, Lombok Utara, Indonesia, Tanjung, 2Internship
Doctor, Wolter Monginsidi Military Hospital, Manado, 3Internship Doctor, Sangatta General
Hospital, Sangatta, Indonesia

e212 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Introduction: Left ventricular hypertrophy (LVH) is a well-known strong predictor for
morbidity and mortality of hypertensive patients. Studies have showed that LVH is greatly
affected by blood pressure control, and it is best reflected by ambulatory blood pressure
monitoring (ABPM). However, ABPM and echocardiography as standard measurement are
difficult to be performed in rural areas in Indonesia due to the lack of health facilities.
Although clinic blood pressure (CBP) and electrocardiography (ECG) are inferior to ABPM
and echocardiography, but they can be used as good alternatives.
Objectives: We sought to evaluate whether an individual CBP correlates with risk of LVH.
Methods: Cross-sectional study was conducted in three primary hospitals in rural areas in
Indonesia, from April to September 2013. Hypertensive patients admitted to emergency
room or outpatient clinic were classified into controlled CBP and uncontrolled CBP.
Diagnosis of LVH was based on ECG using combination of five voltage-based and point
score criteria (Sokolow-Lyon, Cornell voltage, Lewis index, Minnesota code, and Romhilt-
Estes point-score) to increase sensitivity. Bivariate analysis were performed to evaluate
significance between CBP and electrocardiographic LVH, continued with multivariate
analysis to investigate CBP’s significance after adjusted with other relevant factors.
Results: Of 145 hypertensive patients included (46.2% male; mean age 56 years), only 35
patients (24.1%) had controlled CBP. Prevalence of electrocardiographic LVH was 40%.
LVH was significantly higher in patients with uncontrolled CBP (48.2% vs 14.3% p¼
0.001) than controlled CBP (Odds Ratio 5.5; 95%CI 2.016-15.440). Multivariate analysis
showed that CBP remained significant as predictor for electrocardiographic LVH (OR 3.9,
95% CI 1.228-12.163) after adjusted to duration of known hypertension, smoking, dia-
betes, dyslipidemia, and body-mass index.
Conclusion: Individual CBP correlates with risk of LVH. Controlled CBP predicts lower
risk of electrocardiographic LVH. This study showed that CBP can be used as an alternative
when ABPM is difficult to be performed in rural areas.
Disclosure of Interest: None Declared
PT243
Finding enablers and knowing barriers - facilitating primary health care nurses to
implement an absolute CVD risk approach in general practice
Tracey M. Bucki*1, Harry Patsamanis1, Bianca Crosling1, Jinty Wilson1
1
National Heart Foundation of Australia, Melbourne, Australia
Introduction: Absolute cardiovascular disease (CVD) risk is the numerical probability of a
cardiovascular event occurring within a five-year period. Recognising primary health care
nurses (PHCNs) integral role in the general practice team, the Heart Foundation Victoria in
partnership with the Australian Primary Health Care Nurses Association developed an online
learning module (OLM). The module is based on the National Vascular Disease Prevention
Alliance’s Guidelines for the management of absolute CVD risk and is a mechanism to translate a
new evidence based guideline into practice. The OLM is designed to improve PHCN con-
fidence to systematically assess and manage patients at risk of CVD in general practice.
Objectives: To evaluate outcomes of the OLM through a one year post evaluation among
PHCNs who have completed the module. In particular, to determine the enablers and
barriers to implementing an absolute CVD risk approach in general practice.
Methods: Almost 700 PHCNs who had completed the module were approached by email
to participate in an online feedback survey. Participants were asked if they had imple-
mented any improvements relating to the practice team, data systems or patient manage-
ment since completing the module. Participants were also asked to report any challenges
they had experienced.
Results: In total, 151 completed surveys were received (22% response rate).
The most common improvements implemented by participants since completing the
OLM included:
- explaining absolute CVD risk to another staff member
- downloading the web based risk calculator onto the practice desktop
- routinely recording and updating risk factors
- using electronic recall and reminder system to target eligible patients
- providing lifestyle counselling/action plans to patients.
The most common barriers reported in relation to implementing absolute risk included
‘lack of time’ and ‘getting the practice team on board’.
Case studies detailing PHCNs experiences in implementing an absolute CVD risk
approach within their practice will also be presented.
Conclusion: The evaluation has demonstrated that the OLM is a mechanism to translate a
new evidence based guideline into practice. Insight into enablers and barriers in imple-
menting absolute CVD risk has empowered the Heart Foundation to refine their multi-
faceted strategy in engaging and influencing Australian general practice to adopt an
absolute CVD risk approach.
Disclosure of Interest: None Declared
PT244
Assessment of musculoskeletal pain in participants of cardiac rehabilitation
Daiane P. Lima1, Daiana C. Bündchen1, Sabrina W. Sties1, Priscilla G. Wittkopf1,
Ana I. Gonzáles1, Almir Schmitt Neto1, Pablo A. B. de Araujo1, Vitor G. Angarten1,
Tales de Carvalho*1
1
Cardiology and Exercise Medicine Center, Santa Catarina State University, Florianópolis, Brazil
Introduction: In patients with cardiovascular disease, musculoskeletal disorders may limit
treatment and adherence to cardiac rehabilitation (CR), mainly due to the pain.
Objectives: To verify the prevalence of musculoskeletal pain at rest and if it is influenced
by physical activity.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: We prospectively studied 37 patients with cardiovascular diseases, 60.73  10.2
POSTER ABSTRACTS
years old, both gender, at entry in CR and after three months they underwent evaluation of
pain at rest and if it is worsened by physical activity, through an adaptation of the
musculoskeletal system assessment inventory (MSSAI). The data were analyzed using
descriptive statistics, and the Wilcoxon test was used to assess differences between paired
scores, with significance level of 5%.
Results: Knee pain (24.1%) and low back pain (19.3%) were the problems most reported.
At baseline, 57% of participants reported the presence of pain at rest, that after three
months dropped to 52% (p¼0.223). The presence of pain aggravated by exercise was
reduced from 27% to 16% (p ¼ 0.038). There were no significant changes in the intensity
of pain at rest and that worsened by physical activity.
Conclusion: There was a decrease in the prevalence of musculoskeletal pain aggravated by
physical activity and no changes were verify in pain at rest, suggesting possible involvement
of patients with musculoskeletal pain in cardiac rehabilitation.
Disclosure of Interest: None Declared
PT245
The Impacts of Cardiac Rehabilitation Program on Functional Status and Quality of
Life of Coronary Artery Disease Patients With Left Ventricular Dysfunction
Masoumeh Sadeghi1, Mahboobeh Taghavi2, Mohammad Garakyaraghi2, Hamidreza Roohafza2,
Nizal Sarrafzadegan*2
1
Cardiac Rehabilitation Research Center, 2Isfahan Cardiovascular Research Center, Isfahan
Cardiovascular Research Institute, Isfahan University of MedicalScieces, Isfahan, Iran, Islamic
Republic Of
Introduction: Cardiac rehabilitation is defined as the “coordinated sum of interventions
required to ensure the best physical, psychological and social conditions so that patients
with chronic or post-acute cardiovascular disease may, by their own efforts, preserve or
resume optimal functioning in society and, through improved health behaviors, slow or
reverse progression of disease.
Objectives: We determined the impacts of cardiac rehabilitation on functional status and
quality of life in CAD patients.
Methods: Coronary artery disease patients with mild to moderate left ventricular
dysfunction participated in an exercise-based rehabilitation program for eight consecutive
weeks. Subjects underwent exercise test before and eight weeks after rehabilitation. Quality
of life was assessed with Short-Form Health Survey questionnaire.
Results: Seventy patients (mean age ¼ 57.5  10.2 years, 77.1% male) were studied. After
rehabilitation, peak exercise capacity measured in metabolic equivalents increased from
8.002.56 to 10.083.00 (P < 0.001) and exercise duration increased from 14.175.27
to 17.215.85 min (P < 0.001). Also, the patients’ quality of life improved in several
physical and psychological dimensions (p < 0.05).
Conclusion: Cardiac rehabilitation results in a significant improvement in health related
quality of life, functional status, and exercise capacity of CAD patients with mild to
moderate left ventricular dysfunction.
Disclosure of Interest: None Declared
PT246
Effect of Recommended Physical Activity Dose on Maternal Metabolic Outcomes in
Pregnant Latina Women
Robinson Ramírez-Vélez*1, Grupo de investigación en ciencias aplicadas al ejercicio físico, el
deporte y la salud (GICAEDS), Facultad de Cultura Física, Deporte y Recreación, Universidad
Santo Tomás, Bogotá, D.C., Colombia
1
Facultad de Cultura Física, Deporte y Recreacion, Universidad Santo Tomas, Bogota, Colombia
Introduction: Despite recommendations for pregnant women to be active, the majority of Latin
American women are not meeting guidelines. Physical activity may reduce risk of maternal
disorders of pregnancy, but few data exists on physical activity in pregnant Latina women.
Objectives: To evaluate the influence of recommended physical activity dose on maternal
metabolic outcomes in in pregnant latina women.
Methods: This is a secondary analysis of data from a controlled randomized trial designed
to determine the influence of physical exercise on endothelial function in pregnant women.
The study included Sixty-seven nulliparous in gestational week 16–20, attending for
prenatal care at three tertiary hospitals in Colombia who were randomly assigned into one
of two groups: 1) The experimental group took part in aerobic exercise at an intensity of
55–75% of their maximum heart rate for 60 min, three times a week for 12 weeks, 2) The
control group undertook their usual physical activity. The primary outcomes were changes
in immediately after the 12 weeks intervention on blood lipids, insulin sensitivity(HOMA-IR)
and body composition.
Results: At the end of the 12-week program, there was no difference in the change in bio-
markers total cholesterol -6 mg/dL (95%CI -21 to 33), low-density lipoprotein -8 mg/dL (95%
CI -3 to 29), glucose 0.3 mg/dL (95%CI -6 to 6), fasting insulin -2 mU/L (95%CI -2 to 4) or
HOMA-IR -0.9 (-0.1 to 1.9). Triglycerides and very-low density lipoprotein were significantly
lower in the experimental group by -28 mg/mL (95%CI 1 to 55) and -6 mg/dL (95%CI 1 to
11), respectively. There were no significant differences between the groups regarding
maternal weight gain or fatness during pregnancy. The experimental group showed lower
values fat-free mass, body fat and skinfold thicknesses (biceps, triceps, subscapular, and
suprailiac regions) than did the control group, but these differentials were non-significant.
Conclusion: The potential public health benefits of exercise are too great and this study
supports existing guidelines indicating that latina women may begin or maintain an ex-
ercise program during pregnancy.
Disclosure of Interest: None Declared
e213
 PT247 Objectives: Aim of the study was to evaluate possible seasonal variantion in men and
POSTER ABSTRACTS

women hospitalization and case-fatality rates of acute myocardial infarction in Vilnius

High Density Lipoprotein Cholesterol Level and Severity of Coronary Artery Disease University Hospital Santariskes Clinics, Cardiac and Intensive Care unit during the 2000 –
in Asian People 2010 years period.
Sang-Hyun Kim*1, Young-Joon Seong1, Hyang Lim Lee2, Hack-Lyoung Kim1, Jae Bin Seo1, Methods: We analysed 15333 hospitalized due to acute myocardial infarction patients
Woo-Young Chung1, Joo-Hee Zo1, Myung-A. Kim1 cases. Median age was 72  1,5 years. 931 patients deaths were caused by the acute
1 myocardial infarction during the exploring period. There were estimated hospitalization
Cardiology, Internal Medicine, Seoul Boramae Hospital, Seoul National University College of
and deaths from acute myocardial infarction rates through the four seasons.
Medicine, 2Internal Medicine, Seoul Bukbu Hospital, Seoul, Korea, Republic Of Results: There were observed 7 % - 10% more men died from acute myocardial infarction
Introduction: Blood level of low density lipoprotein cholesterol (LDL cholesterol) is the in spring and 8% - 11% more in autumn, rather than number of the deaths in winter or
major risk factor of coronary artery disease (CAD). Low high density lipoprotein cholesterol summer. In the women group 10% – 11% more died in spring and 12% – 13% in autumn,
(HDL cholesterol) level is one of risk factors of CAD in western countries. Mean HDL compare with other seasons.
cholesterol level of Korean people is much lower than those of western or other Asian Conclusion: Study demonstrated the significant seasonal variation in the hospitalizations
countries. But the prevalence of CAD is lower than those of western or other Asian countries. rates and deaths from acute myocardial infarction, with more common morbidity in March –
Objectives: The aim of this study was to investigate impact of HDL cholesterol level on April – May and higher mortality rate in March - April and in September – October –
prevalence and severity of CAD diagnosed in Korean People whose prevalence of CAD was Noverber months. Patients older than 55 years have approximately 3,5 – 4,5 times higher
much lower than those of western or other Asian countries. mortality due to acute myocardial infarction risk, compare with younger patients.
Methods: The subjects were 1884 Korean patients received the coronary angiography. The Disclosure of Interest: None Declared
severity of CAD was determined by the number of involved vessels and Friesinger Score on
angiography. The effects HDL cholesterol level on the development and severity of CAD PT252
were analyzed according to stratified subgroup and mean HDL cholesterol level.
Independent Association of Severe Vitamin D Deficiency As a Risk of Acute
Results: As HDL cholesterol level decreased, the odds ratio of CAD prevalence increased
Myocardial Infarction in Indians
proportionally. The patients with HDL cholesterol < 30mg/dL had 3.4 times higher risk
than patients with HDL cholesterol  60mg/dL. The mean HDL cholesterol level was Ambuj Roy*1, D. Prabhakaran2, R. Lakshmy3, N. Tandon4, Tariq Rana3, V. K. Bahl1,
43.5mg/dL, 41.0mg/dL, 38.5mg/dL, 37.5mg/dL respectively in the control group (without K. S. Reddy5
CAD), 1-vessel disease (VD), 2VD, 3VD. Even the subgroup analysis among patients with 1
Cardiology, All India Institute of Medical Sciences, 2Centre for Chronic Disease Control,
LDL cholesterol < 100mg/dL showed the significant correlation between HDL cholesterol 3
Cardiac Biochemistry, 4Endocrinology, All India Institute of Medical Sciences, 5Public health
level and the severity of coronary artery disease. The HDL cholesterol level was found to
have significant negative association with Friesinger score (r¼-0.201, P<0.001). Foundation of India, New Delhi, India
Conclusion: HDL cholesterol level was significantly associated with the prevalence and Introduction: Vitamin D deficiency has been associated with coronary heart disease
severity of CAD on coronary angiography in Korean people whose prevalence of CAD was (CHD). Emerging data from India has shown high prevalence of vitamin D deficiency
much lower than those of western or other Asian countries. despite abundant sunshine in large parts of India.Thus it would be useful to determine the
Disclosure of Interest: None Declared role of this novel and potentially reversible risk factor of CHD in Indians.
Objectives: To study the association of vitamin D with acute myocardial infarction (MI) in
PT250 Indians by analyzing 25 hydroxy vitamin D (25(OH) D) levels in cases of MI and age and
gender matched healthy controls.
Impact of Insulin Treatment vs Oral Anti Diabetic Drugs on Coronary Lesions Methods: Consecutive cases of first incident MI (n¼120) and controls (n¼120) were recruited
Morphology and Severity A Preliminary Study in the study at All India Institute of Medical Sciences, New Delhi. The clinical and biochemical
Vekky Sariowan*1, Bambang Budiono2, Reggy Lefrandt1, Agnes L. Panda1, Janry Pangemanan1, risk factors were assessed for both cases and controls. 25 (OH) D assay was measured from stored
samples for cases and controls using standard gold procedure radioimmunoassay.
Benny Setiadi1, Steven R. Utomo1, Hariman Kristian1
1 Results: The mean age of cases and controls was 51.9 11.4 and 52.1 11.0 years
Departement Cardiology and Vascular Medicine, Sam Ratulangi University, Manado, respectively. 25(OH) D deficiency (< 30ng/ml) was extremely common in cases and
2
Departement Cardiology and Vascular Medicine, Awal Bros Hospital, Makassar, Indonesia controls (98.3% and 95.8% respectively) with median levels significantly lower in cases
(Table 1). The cases were more frequently diabetic, hypertensive, tobacco and alcohol
Introduction: It had been known that diabetic patients tend to have more severe and difuse
consumers. They had higher mean waist hip ratio (WHR), total and LDL cholesterol (Table
pattern of CAD as compared to non diabetic patients, but no previous study has been done
1).Severe vitamin D deficiency (<10ng/ml) was strongly associated with a risk of MI with
to investigate the relation between type of diabetic treatment to the morphology and
an odds ratio of 4.6 (95% CI 2.3-9.4), even after adjusting for known confounders like
severity of coronary artery lesion.
hypertension, diabetes, cholesterol, smoking, alcohol use and WHR.
Objectives: The aim of this study is to investigate the association of diabetes treatment
(insulin vs oral anti diabetic drugs) to the morphology and severity of coronary artery
lesions in type 2 diabetes mellitus patients. Table 1. The characteristics of the cases and controls.
Methods: This is a cross sectional study which include type 2 diabetic patients who un-
derwent coronary angiography between October 2012 to August 2013. Patients were Cases Controls p value
divided into two groups, which include oral anti diabetic drugs (OAD) group and insulin Hypertensive 34.2% 12.5% <0.00
group. The association between diabetes treatment to the morphology of coronary artery Diabetics 40.0% 20.0% <0.00
lesion assessed by Society of Coronary Angiography and Intervention (SCAI) lesion class
and the number of vessel disease were analyzed. Statistical analysis was done using SPSS Waist Hip Ratio 0.950.06 0.920.07 <0.00
16.0 software. P value <0.05 was considered statistically significant. Total Chol (mean) (mg/dl) 194.1 62.8 177.538.1 0.01
Results: A total 49 patients were included in this study, in which 25 patients (51%) belong to
HDL Chol (mean) (mg/dl) 39.19.9 40.310.4 0.3
the OAD group and 24 patients (49%) belong to the insulin group. The only difference found
between the two group was the value of fasting blood glucose in the OAD group and insulin LDL Chol (mean) (mg/dl) 123.756.3 108.338.5 0.01
group (194.5 56 vs 163.2  42.7, P ¼ 0.021, respectively). Diabetic patients with insulin 25 (OH)VitD levels (ng/ml) (median) 6.0(3.9-9.0) 11.1(6.5-18.3) <0.00
therapy significantly have a higher risk to develop SCAI class IV lesion classification (OR 4.2,
P ¼ 0.045) and three vessel disease (OR 4.43, P ¼ 0.035). From the multivariate analysis, * in mg/dl; Chol¼Cholesterol
insulin treatment is an independent predictor of class IV SCAI lesion classification (OR 7.73,
P ¼ 0.028). However, insulin therapy is not an independent predictor of three vessel disease.
Conclusion: Diabetic patients with insulin therapy have a significant risk to develop class Conclusion: This study shows that vitamin D deficiency is very common among patients
IV SCAI lesion classification and three vessel disease. Insulin therapy is an independent of acute MI and healthy controls, with levels of 25 (OH) D being significantly lower among
predictor to develop class IV SCAI lesion. This finding may explain why diabetic patients cases. It for the first time reveals that severe vitamin D deficiency is associated with a strong
who undergo PCI and treated with insulin has the worst outcomes. risk of acute MI in Indians. This association needs to be tested in larger cross-sectional and
Disclosure of Interest: None Declared cohort studies. Population awareness of vitamin D deficiency must be created and its
skeletal and possible cardiovascular harm should be mitigated by encouraging sun expo-
sure and food fortification.
PT251
Disclosure of Interest: None Declared
Does Seasonal Variation Impacts on Acute Myocardial Infarction Induced
Hospitalization and Deaths Rates in Lithuania? PT253
Pranas Serpytis*1,2, Jonas Misiura1,2, Egidijus Berukstis1,2, Simona Pelanyte2, Rokas Serpytis1, Understanding the impact of a multifaceted quality improvement intervention to
Robertas Katliorius1 improve cardiovascular disease risk management in Australian Primary Health Care:
1 The TORPEDO study process evaluation
Clinic of Cardiac and Vascular Diseases, Vilnius University Hospital Santariskiu Klinikos,
2
Faculty of Medicine, Vilnius University, Vilnius, Lithuania Bindu Patel*1,2, Tim Usherwood3, Mark Harris4, Katie Panaretto5, Julie Redfern1, Jesse Jansen2,
Introduction: The first data on enviromental and seasonal effect on human health was Shannon McKinn2, Marilyn Lyford1, Anushka Patel2,6,7, David Peiris2,8
1
published in 1926. Though the data on the seasonal variation effect on cardiac health is Cardiovascular Division, The George Institute for Global Health, 2School of Medicine, University
very scarce. of Sydney, Camperdown, 3Department of General Practice, Sydney Medical School-Westmead,

e214 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

University of Sydney, Camerdown, 4School of Public Health and Community Medicine,
University of New South Wales, Randwick, 5Queensland Aboriginal and Islander Health Council,
Brisbane, 6Office of the Chief Scientist, The George Institute for Global Health, 7Cardiology, Royal
Prince Alfred Hospital, 8Primary Health Care Research, The George Institute for Global Health,
Camperdown, Australia
Introduction: Multiple barriers to uptake of guidelines into practice exist. TORPEDO was a
cluster-RCT of an Australian primary healthcare quality improvement (QI) intervention
seeking to address barriers to improved cardiovascular disease risk management. The
intervention comprised of computerised decision support, audit and feedback tools, and
clinical workforce training.
Objectives: We conducted a process evaluation to understand the factors that promoted
and hindered impact of the intervention.
Methods: Study design was initially guided by Realist Evaluation and Behaviour Change
Wheel framework. Informed by case study methodology, we purposively sampled a total
of nine cases from intervention and control arms (six General Practices and three
Aboriginal Community Controlled Health Services) that included high, medium and low
performing services in relation to trial outcomes. Data collection and analysis were mixed
method, initially intra-case and then across cases. Data sources included: (1) site-specific
trial data; (2) health provider surveys using the Team Climate Inventory and Warr-Cook
Wall Job Satisfaction; (3) semi-structured interviews with clinical staff and patients at case
study sites; and (4) video-ethnography of GP-patient consultations at case study sites.
Framework analysis of the qualitative data identified recurring themes and patterns, and
multi-level modelling was conducted to determine health service correlates with the trial
outcomes.
Results: Key drivers to successful implementation of the intervention were: (1) a ‘critical
mass’ of staff members committed to fostering a culture of quality improvement in the
service; (2) local clinical champions who understood the clinical rationale for the inter-
vention and advocated for its use; (3) healthcare providers who effectively incorporated
point-of-care computerised information into shared decision making with patients; and (4)
sufficient support which included face-to-face training in use of the tools, technical support
with software implementation, and participation in training webinars. The dominant
barrier to uptake was inadequate information technology infrastructure at several health
services to support installation of the electronic tools. This led to slowing of clinical sys-
tems, limited exposure to the decision support component of the intervention and lack of
engagement on the part of care providers.
Conclusion: These findings identify the critical factors needed to maximise the impact of a
multifaceted QI intervention.
Disclosure of Interest: None Declared
PT254
The Aspirin in Reducing Events in the Elderly Trial (ASPREE): Progress Report
John McNeil1, Richard Grimm2, Mark Nelson3, Anne Murray4, Brenda Kirpach2, Rory Wolfe1,
Robyn Woods5, Christopher Reid*1, the ASPREE Study Group
1
Dept. of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia, 2The
Berman Centre for Clinical Research, Minneapolis, United States, 3Menzies Research Institute,
University of Tasmania, Hobart, Australia, 4Hennepin County Medical Centre, Minneapolis,
United States, 5ASPREE Co-ordinating Centre, Monash University, Melbourne, Australia
Introduction: The beneficial effect of low dose aspirin for the primary prevention of
cardiovascular disease remains controversial despite the conduct of 6 randomised trials
addressing the question. Equipoise remains as to whether reductions in myocardial
infarction, ischaemic stroke, cancer and cognitive decline outweigh the risks of haemor-
rhagic stroke and gastro-intestinal bleeding. The elderly, in particularly, are most likely to
be the group in where benefit and risk balance is critical.
Objectives: The ASPREE (ASPirin in Reducing Events of in the Elderly) Study is a pri-
mary prevention trial of low dose aspirin versus placebo in 19,000 persons 70 years
(65 for US minorities), being conducted in Australia and the United States. The primary
composite endpoint includes death from any cause, dementia and persistent physical
disability. Secondary events include cardiovascular events and clinically significant
bleeding.
Methods: Subjects free of known previous cardiovascular disease, dementia and
disability, no life threating illness and with no contraindication to aspirin are rando-
mised (1:1) to 100 mg enteric coated aspirin or matching placebo. Community dwelling
participants are recruited through general practices in Australia and clinical trial centres
in the US where the focus is on minority groups. The study commenced recruiting in
March 2010.
Results: At September 2013, 1741 Australian GPs have participated and 56073 phone
screenings undertaken to yield 17624 eligibility visits. 12,361 participants had been
recruited (81% of eligibility visits). In the US, 1,865 participants have been recruited from
44 clinical sites with 52% minority recruitment. Of all 14,226 participants, 57% are women
and the mean age is 75.4 years. Following a median of 2.4 years of follow-up, <1% of
participants have withdrawn from the study and 89% of patients remain either on medi-
cation or have temporarily ceased randomised therapy. 381 events (including cardiovas-
cular events and clinically significant bleeding) have been adjudicated.
Conclusion: With 75% of recruitment achieved, high levels of retention and follow-up,
and accumulating end-points, ASPREE will be sufficiently powered to detect 10% differ-
ence in the primary endpoint following 5 years of follow-up. With an increased interest in
the potential for aspirin to provide protection against the major diseases of ageing, ASPREE
is a unique study in the elderly and will contribute to resolving the equipoise in regards to
risks versus benefits in primary prevention.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT255
POSTER ABSTRACTS
Is Low Hdl A Risk Factor For Cardiovascular Disease?
Mahfouz El Shahawy MD*1, Miglena Entcheva1, Antonella Sabatini1
1
Cardiovascular Center of Sarasota, Cardiovascular Center of Sarasota, Sarasota, United States
Introduction: Low HDL has been implicated in the Framingham Heart Study as a risk
factor for CVD. Recent publications casted doubt about the therapeutic value of raising
HDL for improving cardiovascular risk.
Objectives: The purpose of this study is to examine whether low HDL by itself without the
presence of any other well-known CV risk factors is associated with early CV structural and
functional abnormalities versus control subjects with normal HDL and subjects with
normal HDL and associated risk factors.
Methods: We screened 2234 asymptomatic subjects, age 23-80, for CVD risk using Early
CVD Risk Score (ECVDRS). ECVDRS consists of 10 tests: large (C1) and small (C2) artery
stiffness, BP at rest and PME, Carotid Intima Media Thickness (CIMT), abdominal aorta
and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro-BNP.
Hypertension (HTN) was defined according to the JNC VII criteria. HDL was defined
according to NCEP/ATP III (F HDL < 50, M HDL < 40).
Results: Based on the presence or absence of comorbidities and the level of HDL the 2234
subjects screened (1046 male and 1188 female) were divided in 4 groups: Untreated with
no comorbidities with normal or low HDL respectively, and untreated with comorbidities
with normal or low HDL respectively. The structural and functional abnormalities found
are shown on Table1:
Conclusion: Based on our data, (1) low HDL without comorbidities has no significant early
alterations on functional and structural CV abnormalities as compared to the control group
or the group with normal HDL without comorbidities. (2). Comorbidities superimposed on
low HDL result in significant alterations in CV structural and functional abnormalities.
Based on our data low HDL without other comorbidities appears not to be associated with
significant early CVD structural and functional abnormalities. Therefore, we do not see the
need for aggressive treatment in subjects exhibiting only low HDL without other comor-
bidities. May be it is time to reassess the value of including HDL in the FRS calculation.
Disclosure of Interest: None Declared
PT256
Electrocardiographic abnormalities in elderly patients in primary care
Milena Marcolino*1,2, Ana M. Ribeiro3, Tati G. P. Assis3, Maria Beatriz M. Alkmim2,
Antonio L. Ribeiro1,2
1
Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais,
2
Telehealth Network of Minas Gerais, 3Medical School, Universidade Federal de Minas Gerais,
Belo Horizonte, Brazil
Introduction: The proportion of elderly people continues to grow worldwide, especially in
the developing countries. This poses a challenge to health policy makers, as disease patterns
have been changing. Cardiovascular diseases are the leading cause of disability and mor-
tality worldwide. The electrocardiogram (ECG) is a useful tool to assess the impact of
cardiovascular disease in the population context and to guide preventive actions.
Objectives: To analyze the prevalence of electrocardiographic abnormalities in elderly
patients in primary care.
Methods: In this observational and retrospective study, all 12-lead standard digital ECGs
analyzed by cardiologists of the Telehealth Network of Minas Gerais, a public telemedicine
service in Brazil, from January to December 2011, were assessed. This service attends
primary care of 660 cities in the state of Minas Gerais. ECGs were sent by remote healthcare
professionals through internet to be analyzed by cardiologists who are trained and expe-
rienced in the analysis and interpretation of ECG. The prevalence of ECG abnormalities in
elderly patients was assessed.
Results: During the study period, 264,324 exams were performed; 33.2% (87,804) of
them in elderly patients (median age of 69.9 years, interquartile range 64.6-76.4; 57%
women). Hypertension was observed in 48.7% of cases, diabetes in 9.1%, smoking in
6.4%, and Chagas disease in 3.5%. Only 41.6% of the exams had no abnormalities, and
this proportion was significantly lower in octogenarians (27.7%, p<0.01). The mean
number of abnormalities was 1.131.29. Atrial fibrillation or flutter was observed in 4.2%
of the ECGs; 8.4% in octogenarians. Supraventricular premature beats were observed in
e215
 3.8% and ventricular in 4.7%; left bundle branch block in 3.6% and right bundle branch
POSTER ABSTRACTS
block in 5.5%; left anterior fascicular block in 11.7%, left ventricular hypertrophy in 6.2%;
and non-specific repolarization abnormalities in 30.4%. The reason for performing the
exam was investigation of chest pain in 63,322 patients (73.2%). Of these, 8.9% had
abnormalities related to that ischemia, 3.0% of acute ischemia.
Conclusion: This study in a large sample of elderly patients in primary care revealed that
electrocardiographic abnormalities are common in this population. The prevalence of atrial
fibrillation, which is important to guide the implementation of anticoagulation strategies, is
noteworthy.
Disclosure of Interest: None Declared
PT257
Positive Serology tendency for chagas disease in public hospital of Buenos Aires
suburbs, in an 18 year period
Monica Graciela Galli1, Eduardo E. Alvarez*1, Marcelo V. Boscaro1, Juan Seresi2,
Gustavo Marquez1, Juan Fernandez Arias3
1
Cardiología, 2Hematología, Hospital Petrona V. de Cordero San Fernando /Sociedad Argentina
de Cardiología, 3Cardiología, Hospital Petrona V. de Cordero San Fernando, San Fernando,
Argentina
Introduction: Chagas disease is endemic in much of the Republic Argentina, and its
endemicity corresponds to the area of dispersion of the vector Trypanosoma Infestans.
Why it is relevant to the monitoring of the prevalence of the disease, in a non-endemic,
urbanized area of suburbs of the north of the province of Buenos Aires, since in this way
may reflects the growth of the same.
Objectives: To determinate the tendency of positive serology for chagas, in Buenos Aires
suburbs (non endemic zone) in a period of 18 years, starting in 1995. Using the lab of Htal.
P.V de Cordero for all the serology determination.
Methods: All patients that underwent Chagas determinations in character of blood donors
for a period of 18 years between 1995-2012 (n¼29459), were taken into account. Samples
were analyzed in the lab of this hospital, performing HAI, IFI, and ELISA, considering as
reactive the concordance of 2 of the 3 reactions. For a better analysis, population was
divided in 3 periods 1) 1995-2000, n¼10705, 2) 2001-2006 n¼8797, and 3) 2006-2012
n¼9957. Proportional test was used for statistical analysis.
Results:
P P
Donors Reactive Prevalence period 1 period 2
1 Period 10705 269 2.76%
1995-2000
2 Period 8797 205 2.33% P1 vs P2:0.00025
2001-2006 P1 vs P3:0.00001
3 Period 9957 141 1.41% P2 vs P3 :0.00001
2007-2012
Conclusion: The analysis of the 3 períods,showed a clear reduction of the positive reactive
since 2001, with a P significative (0.00001).
Disclosure of Interest: None Declared
PT258
Hypertension in Adults of Himalayan Mountain Villages: Prevalence, Awareness, and
Control
Mubarak Shah*1, Ali Khan2, Mahtab Jan2, Neelum Jahan2, Asma Ahmed3, Syed M. Shah4
1
District Headquarter Hospital, Government Health Department Gilgit Baltistan, 2Aga Khan
Health Center, Aga Khan Health Service Pakistan, Gilgit, 3Medicine, Aga Khan University,
Karachi, Pakistan, 4Institute of Public Health, College of Medicine and Health Sciences, United
Arab Emirates University, Al Ain, United Arab Emirates
Introduction: Little data is available on hypertension in high mountain population living
amid the mountain ranges of Himalayas, the Hindu Kush and the Karakoram, also known
as ‘Roof of the World’.
Objectives: We aimed to identify the prevalence, associated risk factors and control of
hypertension among adults in Gilgit Baltistan, Pakistan.
Methods: A total of 1789 adults aged 18 years and older were enrolled between March and
July 2013, as part of type 2 diabetes screening program. The baseline characteristics and blood
pressure (BP) data were collected. Hypertension was defined as systolic BP  140 mmHg and /
or diastolic BP  90 mmHg and/or current use of antihypertensive drug treatment.
Results: The mean age of study participants was 40.0 years. The study population reported
use of salted tea, on average, three cups daily. A high proportion (81.7%) never had their
blood cholesterol measured.
Of those aware (54.3%), a high proportion (66.7%) was taking antihypertensive drugs
and 33.3% had controlled blood pressure.
The overall prevalence of hypertension was 33.1% (95% confidence interval [CI] 30.9 to
35.4). Of the study participants 485 (27.1%) were overweight and 223 (12.5%) were
obese. After multivariable adjustment, prevalence of hypertension was positively correlated
with overweight (adjusted odds ratio [aOR] 1.60, 95% CI 1.23 to 2.08), obesity (aOR 2.71,
95% CI 1.91 to 3.86), abdominal obesity (aOR 1.89, 95% CI 1.43 to 2.48), male gender
(aOR 2.32, 95% CI 1.74 to 3.09) less likely to walk 30 minutes daily (aOR 1.72, 95% CI
e216
1.36 to 2.17), resident of Hunza Nagar district (aOR 1.58, 95% CI 1.17 to 2.13) or Gilgit
district (aOR 1.45, 95% CI 1.11 to 1.91) as compared to being resident of Ghizar district.
Hypertension was negatively correlated with having up to 10 grade (aOR 0.28, 95% CI
0.21 to 0.37) and more than 10 grade education (aOR 0.16, 95% CI 0.11 to 0.24).
Conclusion: While the prevalence of hypertension high, the awareness, treatment, and
control of hypertension is low. Urgent strategies are needed to improve prevention,
detection and treatment of hypertension in this vulnerable population.
Disclosure of Interest: M. Shah Grant/research support from: This project is supported by
BRIDGES. BRIDGES is an International Diabetes Federation program supported by an
educational grant from Lilly Diabetes, A. Khan: None Declared, M. Jan: None Declared, N.
Jahan: None Declared, A. Ahmed: None Declared, S. Shah: None Declared
PT259
The burden and secular trends of cardiovascular disease amongst patients with
rheumatoid arthritis
Paul Carter*1, Gurjit Rai1, Haren E. Wijesinghe1, Nicholas Gollop2, Jake Mann3,
Sudhir Rayasamudra4, Mudassar Baig5, Suresh Chandran6, Hardeep Uppal7, Rahul Potluri8
1
The Medical School, University of Birmingham, Birmingham, 2The Norfolk and Norwich
University Hospital, Norwich, 3Department of Medicine and Health, University of Leeds, Leeds,
4
Acute Medicine, Chesterfield Hospital, Chesterfield, 5Department of Cardiology, Blackpool
Teaching Hospitals, Blackpool, 6Training Programme Director in Acute Medicine, North Western
Deanery, Manchester, 7Department of Psychiatry of Learning Disability, Brooklands Hospital,
8
ACALM Study Unit in collaboration with School of Medical Sciences, Aston University,
Birmingham, United Kingdom
Introduction: Rheumatoid arthritis (RA) is associated with increased cardiovascular
morbidity and mortality. This has been largely attributed to systemic inflammation driving
atherosclerotic diseases. However, other non-inflammatory factors such as traditional
cardiovascular disease (CVD) risk factors also contribute, and, other non-atherosclerotic
cardiovascular processes could be increased in RA patients.
Objectives: Our aim for this study was to characterise the prevalence of cardiovascular risk
factors and diseases, and the secular trends of these cardiovascular co-morbidities amongst
patients with RA over a 14-year period between 2000-2013 in Manchester, UK.
Methods: Anonymous information was obtained from the local health authority hospital
activity register from 7 hospitals in the Manchester area during 2000-2013. Of the 929465
patients, 7556 patients had RA. Cardiovascular co-morbidities were coded according to the
ICD-10 criteria and their prevalence was analysed over the entire 14-year study period and
in four time periods to investigate trends.
Results: The prevalence of cardiovascular diagnoses amongst the 7556 RA-patients, over
the study period, were: Hypertension (34.5%), IschaemicHeartDisease (17.9%), Type2-
DiabetesMellitus (12.4%), HeartFailure (8.7%), Hyperlipidaemia (8.3%), ChronicK-
idneyDisease (4.7%), MyocardialInfarction(4.7), IschaemicStroke (3.2%) and Peripheral
Vascular Disease(2.4%). Overall, there were a total of 7820cardiovascular co-morbidities
found during the whole study period, but remarkably when analysed in shorter periods,
the proportion of RA patients with a cardiovascular co-morbidity showed a biphasic pattern
with an initial increase and then a steady decline. The total number of cardiovascular di-
agnoses found between 2001-2003, 2004-2006, 2007-2009, 2010-2012 were 396,984,549
and 329 respectively. This trend was demonstrated in some of the most prevalent condi-
tions listed, including IHD,T2DM and AF. Hypertension and hyperlipidaemia showed a
steady increase in prevalence throughout the study period.
Conclusion: We have shown that CVD, particularly atherosclerotic disease, is an important
health problem amongst RA patients, although we also found a large decline in recent
years. This could in part be due to increased management of CVD risk factors in RA pa-
tients, which is in line with the recently published EULAR clinicalguidelines. However,
worryingly, important CVD risk factors, such as hypertension and hyperlipidaemia are
highly prevalent, and steadily increasing.
Disclosure of Interest: None Declared
PT260
Follow up of patients undergoing cardiovascular surgery. Impact of education on
secondary prevention objectives
Soraya Kerbage1, Arnaldo Angelino1, Ernesto Duronto*1, Hernan Delmonte1, Sebastian Burgos1,
Lidia Diaz1, Luis Castañeda1, Carlos Lirio1, Cristina Barrios1, Cecilia Comes1
1
Cardiac and Pulmonar Rehabilitation, Favaloro Foundation, Caba, Argentina
Introduction: Patients who participate in education programs are more compliant with
cardiovascular rehabilitation, and are able to better control coronary disease risk factors.
Objectives: To describe the general characteristics of the population.To assess adherence to
the different cardiovascular rehabilitation phases, and to evaluate the impact on secondary
prevention objectives at 1 year follow up.
Methods: All the patients were included in the Cardiovascular Rehabilitation program, and
completed Phase I (education during hospital stay).Compliance to Phase II (2 months after
surgery), and to Phase III (one year after surgery) were assessed, and the baseline and one-
year variables were compared.Follow up phone calls were made.For the statistical analysis,
the mean  standard deviation or median descriptive analysis was used (interquartile
range) depending on the variable distribution. Categorical variables were reported as
percentages.For the comparison of quantitative variables, the matched-pairs t- test and the
Wilcoxon signed rank test were used; for the categorical variables, the Mc Nemmar test was
used. A cut off point of 0.05 p was accepted for the statistical significance.
Results: The study included 4327 patients, mean age 62.5  12.2, 74% were males.The
baseline characteristics were: hypertension 72.91%, diabetes I 0.67%, diabetes type II
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
18.79%, dyslipidemia 54.89 %; cigarette smoking 17.36%, sedentarism 97.34%, post-
menopause 10.08%. 34% went to Phase II; 23.41% to Phase III;34.27% were in a su-
pervised program; 65.73% in a home-based program.At 1 year total adherence was
10.36%, partial adherence was 68.57%, and the dropout rate was 21.07%.Compliance with
statin was 61.82%, to aspirin 71.16%; the return to work rate was 45.5%.The events were:
chest pain, 0.12%, congestive heart failure (CHF) 0.12%, Reoperations 0.07%, angioplasty,
0.09%, cerebrovascular accidents (CVA) 0.09%.
Baseline 12 months P (n¼17). All patients were genotyped regarding the ApoE locus and were followed-
BMI median interquartile range 27 (24.6-29.75) 25.1 (23.6-27.5) 0.0000
Mean weight SD 77.95 14.9 72.69 10.3 0.0000
Mean cholesterol level SD 192.54 33 181.53 28.5 0.0000
Mean glycemia SD 102.8 96.2 0.0000
Sedentarism 97.34 % 11.26% 0.0000
Cigarette smoking 17.36 % 1.30 0.0000
Conclusion: Adherence to rehabilitation programs is reasonably acceptable among patients
included in education programs. These patients exhibit a significant weight loss, and a sig-
nificant reduction in body mass index, glycemia, cholesterol levels, smoking and sedentarism.
Disclosure of Interest: S. Kerbage Employee from: Favaloro Foundation, A. Angelino
Employee from: Favaloro Foundation, E. Duronto Employee from: Favaloro Foundation,
H. Delmonte Consultancy for: Favaloro Foundation, S. Burgos Employee from: Favaloro
Foundation, L. Diaz Employee from: Favaloro Foundation, L. Castañeda Employee from:
Favaloro Foundation, C. Lirio Employee from: Favaloro Foundation, C. Barrios Employee
from: Favaloro Foundation, C. Comes Employee from: Favaloro Foundation
PT261
Hypertension Prevalence, Awareness, Treatment, and Control, in South Asian
Immigrants in United Arab Emirates
Syed M. Shah*1, Tom Loney2, Sheek-Hussein Mohamud2, Mohammd El Sadig2,
Salma Al Dhaheri3, Layla Al-Marzouqi4, Tar-Ching Aw5, Rhagib Ali1
1 A common NOS1AP genetic polymorphism rs12567209 G>A is associated with
Institute of Public Health, Al Ain, United Arab Emirates, United Arab Emirates University,
College of Medicine and Health Sciences, 2Institute of Public Health, College of Medicine and
Health Sciences, United Arab Emirates University, 3Ambulatory Health Services, SEHA, Al Ain,
4
Dubai Health Authority, Dubai Health Authority, Dubai, 5College of Medicine and Health
Sciences, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain,
United Arab Emirates
Introduction: Hypertension is the leading risk factor for cardiovascular diseases. Few data
is available on the prevalence of hypertension among South Asian immigrants in the United
Arab Emirates (UAE).
Objectives: We aimed to identify the prevalence, associated risk factors, awreness and control
of hypertension among male immigrants from India, Pakistan and Bangladesh in the UAE.
Methods: We selected a representative sample (n¼1375) of male South Asian immigrants,
aged 18 years in UAE. Data on blood pressure (BP), height, weight, waist and hip
circumference were obtained using standard protocols. Information related to socio-de-
mographics, lifestyle factors, history of diagnosis and treatment of hypertension was
collected through a pilot-tested questionnaire. Hypertension was defined as systolic BP 
140 mmHg and /or diastolic BP  90 mmHg and/or current use of antihypertensive drug
treatment.
Results: Out of 1800 eligible participants 1375 (76.4%) participated. The overall preva-
lence of hypertension was 30.5% (95% CI 28.0, 32.8). Of those with hypertension, 61.6%
reported that they had never had their blood pressure measured. Of those aware (24.0%),
only 8.3% had controlled BP. People with hypertension were more likely to be overweight
(adjusted odds ratio (AOR)¼ 1.43;95%CI 1.01, 2.01); obese (AOR¼2.49; 95%CI: 1.51,
4.10); to have central obesity (AOR¼2.01; 95%CI 1.37, 2.92); were less likely to walk 30
minutes daily (AOR¼1.79; 95%CI 1.24, 2.60) and more likely to have a family history of
hypertension (AOR¼1.51; 95%CI 1.05, 2.17). People aware of their hypertension were
more likely to live in the UAE for 6 to 10 years (AOR¼5.65; 95%CI 1.64, 19.47); or more
than 10 years (AOR¼6.01; 95%CI 1.71, 21.16); to have diabetes (AOR¼7.56; 95%CI 2.67,
21.38) or a family history of hypertension (AOR¼5.67; 95%CI 2.33, 13.79).
Conclusion: While the prevalence of hypertension in South Asian immigrants is relatively
high, awareness, treatment, and control of hypertension is very low. Urgent strategies are
needed to improve prevention, detection and treatment of hypertension in this vulnerable
population.
Disclosure of Interest: None Declared
PT264
Effect of apolipoprotein E genotypes on long-term major cardiovascular events in a
moderate-cardiovascular risk population: a hospital-based study
Manuel O. Santos*1, Rui Baptista2, Marta Rebelo3, Diana Oliveira3, Francisco Parente3,
Patricia Dias3, Rui Martins1, José P. Moura3, Lèlita Santos3, Mariano Pego1
1
Cardiology, 2Coimbra Hospital, Coimbra, Portugal, 3Medicine, Coimbra Hospital, Coimbra,
Portugal
Introduction: The apolipoprotein E (ApoE) locus and its three common alleles, E4, E3 and
E2, determine six genotypes that have been shown to influence low-density lipoprotein–
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
cholesterol levels. Previous studies showed increased cardiovascular risk (CV) in carriers of
POSTER ABSTRACTS
the E4 allele and a favourable effect of the E2 allele, in comparison to E3/E3 patients. There
is a paucity of data regarding the interaction of the ApoE genotype and CV disease in lower-
risk Mediterranean countries.
Objectives: We investigated whether ApoE4 genotype preserved its negative impact
on CV outcomes in a southern European cohort of patients with global moderate
CV risk.
Methods: We prospectively included 463 patients followed at the Lipidology Clinic
of our Hospital. Patients with CV events prior to the first visit were excluded
up for ten years after the first visit. Our endpoint was a composite of all-cause
mortality, acute myocardial infarction and stroke. Kaplan Mayer survival analysis
and Cox Regression models were used for comparisons between the following
groups: ApoE4 carriers (E4/E4 and E4/E3), ApoE2 carriers (E3/E2 and E2/E2) and
ApoE3 homozygotes (E3/E3); patients with E4/E2 genotype were excluded. Age,
total cholesterol and sex were included in the regression model to adjust for
confounding.
Results: The most prevalent allele was ApoE3, with 284 homozygotes, followed by
ApoE4 (103 carriers) and ApoE2 (51 carriers). Demographic data was similar between the
three groups (sex, total cholesterol, smoking, blood pressure) except for age: carriers of
ApoE4 (44.114.7 years) were significantly younger than ApoE2 carriers (53.013.3
years) and ApoE3 homozygotes (50.114.0 years). The overall 10-year CV mortality rate
was 1.4%, yielding a low-to-intermediate CV risk cohort. The relative risk for the com-
posite endpoint was 1.32 (95% CI 0.54-3.21, p¼0.54) for ApoE4 carriers and 1.45 (95%
CI 0.54-3.90, p¼0.47) for ApoE2 carriers, compared to ApoE3 homozygotes. Consid-
ering individual endpoints, the relative risks for ApoE4 and ApoE2 carriers were,
respectively, 0.76 and 1.80 for all-cause mortality, 1.55 and 0.65 for acute myocardial
infarction and 1.47 and 1.52 for stroke, all with p>0.05.
Conclusion: In a large, prospective, southern European cohort of patients with low-to-
moderate global CV risk, treated with aggressive lipid-lowering therapy, there was no
interaction of ApoE genotype on various CV outcomes.
Disclosure of Interest: None Declared
PT265
sudden cardiac death in patients with chronic heart failure in Chinese Han
population
Xiaoyan Liu*1, Juanhui Pei1, Cuihong Hou1, Na Liu1, Jianmin Chu1, Jielin Pu1, Shu Zhang1
1
Arrhythmia Diagnosis and Treatment Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
Introduction: Variants in NOS1AP were associated with cardiac repolarization and sudden
cardiac deaths (SCD) in several independent populations and patients with coronary
arterial disease have been reported.
Objectives: To investigated the association between genetic variations of NOS1AP and
prognosis of patients with chronic heart failure (CHF) in a case-control cohort in Chinese Han
population, and further, to evaluate the relationship between suspected SNP and QTc interval.
Methods: A total of 1428 patients with CHF and 480 control subjects were genotyped for
SNPs of NOS1AP and the genetic associations with mortality as well as QTc interval were
analyzed. Six SNPs of NOS1AP previously reported to be associated with SCD were
selected for analysis. Multiple linear models and Cox proportional hazards regression
models were used.
Results: During a median follow-up period of 52 months, 467 (32.70%) patients died, of
whom 169 (36.19%) were SCD. Genotyping demonstrated that rs12567209 significantly
associated with mortality and QTc interval, which had a minor allelic (A) frequency of
12.11%, and was in HWE (P¼0.052). The A allele of rs12567209 was associated with
greater risk of all-cause death and SCD (HR 1.381, 95 % CI 1.124-1.698, P ¼0.002 and HR
1.645, 95 % CI 1.184-2.287, P ¼ 0.003, Figure 1). After adjusting for other risk factors,
significances remained (HR 1.309, 95% CI 1.054-1.624, P¼0.015 and HR 1.601, 95% CI
1.129-2.271, P¼0.008). The A allele was also associated with a prolonged of QTc interval
by 4.04 ms in the entire population (P¼0.026).
Conclusion: The A allele of rs12567209 in NOS1AP might serve as an independent
predictor of all-cause death and SCD in patients with CHF in Chinese Han population, and
also associate with prolonged QTc interval in Chinese Han population.
Disclosure of Interest: None Declared
e217
 PT266
POSTER ABSTRACTS

The Incremental Value of Ambulatory Blood Pressure For The Primary Prevention of
Cardiovascular Disease In Older Men
Katy J. L. Bell*1, Elaine Beller1, Johan Sundström2, Kevin McGeechan3, Andrew Hayen4,
Les Irwig3, Bruce Neal5, Paul Glasziou1
1
Center for Research in Evidence Based Practice, Bond University, Gold Coast, Australia,
2
Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden, 3Screening and
Diagnostic Test Evaluation Program, University of Sydney, 4School of Public Health and
Community Medicine, University of New South Wales, 5George Institute for International Health,
Royal Prince Alfred Hospital, Sydney, Australia

web 3C=FPO
Introduction: Ambulatory Blood Pressure (BP) is increasingly recommended in the pri-
mary care setting to determine when BP lowering treatment should be started. However the
value of measuring ambulatory BP in the context of the absolute risk of a cardiovascular
event is unknown.
Objectives: To determine the incremental value of ambulatory BP in predicting cardio-
vascular risk when clinic BP is known.
Methods: We undertook a secondary analysis of data from the Uppsala Longitudinal Study
of Adult Men. We included 872 men, all aged approximately 70 years at baseline, who had
data available on Ambulatory BP and traditional cardiovascular risk factors including clinic Conclusion: In the context of an absolute risk based approach to primary prevention of
BP. We first screened different ambulatory BP variables by adding them to a model with cardiovascular disease in older men, Ambulatory BP has limited incremental value that is of
traditional risk factors not including clinic BP. We then assessed the incremental value of questionable clinical importance.
adding the best ambulatory BP variables to a model with traditional risk factors including Disclosure of Interest: None Declared
clinic BP. We calculated hazard ratios and measures of discrimination, calibration and re-
classification (using estimated 5 year risk of cardiovascular disease). PT268
Results: The Ambulatory BP variable with the highest likelihood ratio and change in c-
statistic was mean daytime systolic BP, adding other variables to this did not lead to further Do women differ when it comes to the care of their hearts?
improvements. Ambulatory systolic BP was an independent risk factor for cardiovascular Caroline A. Volgman*1, Neelum Aggarwal2, Gina Lundberg3, Lynne T. Braun4, Rami Doukky4,
disease, but much of its predictiveness was achieved through lowering that of clinic systolic
Annabelle S. Volgman4
BP, (especially for men on treatment, see Table 1). The overall prediction of cardiovascular 1
disease was only minimally improved, with small improvements in the overall model fit, Latin School of Chicago, 2Neurology, Rush University Medical Center, Chicago, 3Cardiology,
discrimination and calibration (see Table 2). There were also very small improvements in Emory University, Georgia, 4Cardiology, Rush University Medical Center, Chicago,
reclassification: most men were not reclassified downwards or upwards across the treat- United States
ment threshold (see Figures).
Introduction: Since 1984 more women died from cardiovascular disease (CVD) than men in
the US. In 2000 a study showed that most women did not perceive CVD as a major health
concern. Since 2000 dramatic decline was seen in the numbers of women dying from CVD.
Table 1. Hazard Ratios Hormone replacement therapy to prevent CVD was discouraged and guidelines for CVD in
Type of SBP HR Clinic HR Clinic women were published in 2007. Awareness campaigns and the media educated the public about
this issue. Across the country heart centers for women (HCW) opened to improve their care.
included in SBP*: On SBP*: Not HR Ambulatory SBP*: HR Ambulatory SBP*:
Objectives: To determine whether there are differences in women who seek their CVD care
model treatment on treatment On treatment Not on treatment
from a general cardiology office (GC) or HCW.
Clinic SBP 1.46 1.43 - - Methods: Female patients (pts) who received care at a GC or HCW were surveyed
Clinic SBP + 1.04 1.27 1.64 1.31 regarding gender preferences in doctors (MD), influence of media, perception of their heart
health, and genetic testing to assess risk. This was a cross-sectional survey of 365 women;
Ambulatory
GC (n¼214) and HCW (n¼151) pts seen for new and return visits in June & July 2013.
SBP We compared proportions of responses between the 2 groups.
Results: The women were 21 to 95 years old (mean 6115); 54% Caucasians, 32% Af-
rican-American, 9% Latina, 5% other. Although not all women preferred female MDs, 67%
of the total group, felt it was important the MD specialize in heart disease in women. Tables
1&2 show the comparison results.
Table 2. Overall risk prediction
Type of SBP Overall model Discrimination Calibration Reclassification Table 1
included in model fit (-2LL) (c-statistic) (p value) (NRI)
Question HCW GC p value1
Clinic SBP 5111.0 0.6233 0.009 -
(6df) Preferred female MD 45% 12% <0.001

Clinic SBP + 5100.425 (8df) 0.6315 0.68 1.8% Media influence of gender preference (scale 1 - 5) 2.0  3.2 1.1  2.5 <0.0012
Ambulatory SBP Wanted to know her genetic risk of CVD 54% 37% <0.001
Has family history and wanted to know if she 27% 18% 0.02
inherited genes that increased their risk

Table 2
Reason for Visit HCW GC p value1
Symptoms of CVD 38% 26% <0.01
Self referred 21% 9% <0.001
Encouraged by family/friend for CVD evaluation 10% 4% 0.03
Heard an MD speak 6% 1% 0.02
Received a promotional letter from the HCW 7% 3% <0.05
1 2
p value obtained using Chi square test except p value obtained using Mann-Whitney U test

Conclusion: These findings suggest important distinctions between women who chose
to obtain care from HCW compared to women who obtained care from GC. Follow up
studies with a larger and more ethnically diverse sample of women, and more fully
validated measures will be necessary to confirm these findings. Health research

e218 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

suggests that a gender specific approach to clinical care is not only highly effective but
also efficient in promoting gender responsiveness to health and wellness, and could
shape response to disease burden, assessment and diagnosis, and available health care
options.
Disclosure of Interest: None Declared
PT270
Excess metabolic and cardiovascukar risks among females health workers compared
with males
Abiodun M. Adeoye*1, Adewole Adebiyi1, Ayodele Falase1
1
Department of Medicine, University of Ibadan/Unversity College Hospital,
Ibadan, Nigeria
Introduction: Metabolic syndrome (MS) is a major health concern in the world because it
is associated with significant cardiovascular morbidity and mortality. Studies have sug-
gested that there may be differences in the prevalence of metabolic syndrome by occupation
type and gender. Few data exist on the prevalence of metabolic syndrome and gender
disparities among hospital personnel in Nigeria.
Objectives: This study aimed to investigate the prevalence of metabolic syndrome among
Nigerian health workers and determine whether the prevalence differed according to
occupation and gender.
Methods: A total of 256 core hospital workers, including nurses and physicians,
comprising 84 (32.8%) males and 172 (67.2%) females were recruited. Baseline clinical and
demographic characteristics were obtained from the subjects using a structured ques-
tionnaire. Metabolic syndrome (MS) was defined according to the International Diabetic
Federation (IDF) criteria, by the presence of waist circumference 94 cm in men and 80
cm in women and any two of the following characteristics: triglycerides  150 mg/dl; HDL
cholesterol <40 mg/dl in men and <50 mg/dl in women; blood pressure  130/85 mm
Hg; and fasting glucose  100 mg/dl. Proportions were compared using the chi square test
or Fisher’s exact test.
Results: The mean age of the participants was 42.03 (9.4) years. The overall
prevalence of metabolic syndrome was 24.2%. Participants with metabolic syn-
drome were older and heavier with higher mean systolic blood pressure and fasting
plasma glucose when compared with subjects without MS. Compared with males,
females had a higher frequency of metabolic syndrome (34.9% vs 2.4%,
p<0.0001). Total cholesterol was higher among the physicians compared with
nurses (182.7(19.71) vs 171.4(15.63) p<0.001) Blood pressure measurements
were comparable across the occupational groups. Nurses were found to have
greater frequency of metabolic syndrome when compared with physicians (40.2%
vs 4.8%, p<0.0001).
Conclusion: This study has revealed excess female gender influence on the proportional
distribution of metabolic syndrome. The high prevalence of MS among core health workers
who should serve as models of health is of concern. Lifestyle modification changes through
workplace health promotion programs addressing risk factors for metabolic syndrome are
needed.
Disclosure of Interest: None Declared
PT271
Prevalence of Metabolic Syndrome in Patients with HIV in the Era of Highly Active
Antiretroviral Therapy
Bernardo Lombo*1, Irma Fotjadhi1, Sreedhar Ravi1, Marjorie Golden2, Michael Virata2,
Martha Lievano3, Jose Diez4, Andre Ghantous1, Thomas Donohue1
1
Cardiology, 2Infectious Diseases, Yale New Haven Hospital, Yale University, New Haven, United
States, 3Nutrition, Universidad Javeriana, Bogota, Colombia, 4Cardiology, Baylor College of
Medicine, Houston, United States
Introduction: Since the introduction of Highly Active Antiretroviral Therapy (HAART) as
the standard of care for HIV disease, there has been a precipitous decline in the death rate
due to HIV/AIDS. HAART can induce significant metabolic complications including dys-
lipidemia and insulin resistance.
Objectives: The purpose of this study was to report the prevalence of Metabolic
Syndrome in HIV infected patients in the Era of Highly Active Antiretroviral
Therapy.
Methods: A retrospective cross-sectional observational study of 259 patients with HIV
infection from an urban community hospital was performed. Metabolic Syndrome preva-
lence was defined using the International Diabetes Federation (IDF) and U.S. National
Cholesterol Education Program Adult Treatment Panel III (ATPIII) criteria. Study patients
were between the ages 18 and 81 and were included irrespective of race, duration of
diagnosis, or duration of HAART. Patients who had been hospitalized within the previous
month were excluded from the study.
Results: Mean patient age was 49.6  9.7 and mean Body Mass Index was 28.6 10
kg/m2. The prevalence of Metabolic Syndrome was 27% using IDF criteria and 26%
using ATP-III criteria. In patients with Metabolic syndrome by IDF, 54% were
women, with a mean duration of HIV infection of 12.6  6 yrs, and mean duration
of HAART of 9  5 yrs. Hypertension was present in 55.6 %, coronary artery disease
in 5.6%, and obesity in 66.7% of patients. In patients with Metabolic syndrome by
ATP-III, 43% were women, mean duration of HIV infection was 11.8  6.2 yrs, and
mean duration of HAART was 8.9  5.7 yrs. Hypertension was present in 57.4%,
coronary artery disease in 5.9%, and obesity in 51.5 % of patients. Logistic regression
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
analysis found an association between treatment with the protease inhibitor, dar-
POSTER ABSTRACTS
unavir and Metabolic Syndrome. (OR 3.32 with 95% confidence interval between
1.54 and 7.15).
Conclusion: We found a high prevalence of Metabolic syndrome and obesity in HIV
patients. Metabolic Syndrome was associated with the use of the protease inhibitor dar-
unavir. Hypertension was the most common co-morbidity found while symptomatic
coronary artery disease was relatively uncommon in this cohort.
Disclosure of Interest: None Declared
PT274
Brazilian adults with Metabolic Syndrome Show Higher Atherogenic Risk Linked to
Particle Size of Lipoproteins
Flavia De Conti Cartolano1, Patricia A. de Lima1, Caroline Pappiani1,
Antonio Augusto F. Carioca1, Nagila Raquel T. Damasceno*1
1
School of Public Health, University of Sao Paulo, São Paulo, Brazil
Introduction: Despite of reduced mortality for cardiovascular diseases (CVD) observed in
United States in the last years, these remain the major cause of morbi-mortality in the
world. The high prevalence of CVD is related increased incidence of Metabolic Syndrome
(MetS). MetS is accepted with constellation of classical cardiovascular risk factors (waist
circumference, insulin resistance, imbalance of lipid and hypertension), however, the
impact of physical changes of lipoprotein (size and concentration) are not includes in this
criteria.
Objectives: Evaluate the possible association between MetS and size and concentration of
LDL and HDL in individual adults in Brazil.
Methods: From a subsample (n¼287) of the CARDIONUTRI study, a cross-sectional
sample including patients of both genders and ages between 30-74 years was selected.
Complete clinical, socio-demographic and familial history disease data were performed by
validated methods. Blood samples were collected after 12h of fasting and from the plasma
lipid profile (total cholesterol, LDL, HDL and TG, APO AI, APO B) and lipoprotein sub-
classes (size and concentration) were monitored. The particle size of LDL and HDL were
analyzed by Lipoprint SystemÒ (Quantimetrix Corporation). The classification of the
metabolic syndrome was performed as proposed by IDF. Statistical analysis was performed
by Statistical Package for the Social Sciences Ò (SPSS) version 17.0, at significant level of
p<0.05.
Results: The results indicated a predominance of females in the sample (63.4%), but
equally distributed between groups with and without MetS. The MetS group had
higher TG level (p<0.001) and lower levels of LDL (p<0.05), HDL (p<0.001) and
Apo AI (p<0.001), with no difference in the amount of Apo B. In addition, the MetS
group showed a higher proportion of small (p<0.001) and intermediate (p<0.001)
HDL, smaller particle size LDL (p<0.001) and higher proportion of small LDL
(p<0.001). No difference was found in the proportion of large LDL between the two
groups.
Conclusion: Individuals with MetS showed increased atherogenic risk linked to worse
lipid profile, with more small particles of LDL and small HDL.
Financial support: FAPESP (2011/15026-0 / 2011/12523-2, 2011/14556-5, 2011/
15590-2, 2012/03775-0), INCT-FCx, NAP-FCx e CNPq.
Disclosure of Interest: None Declared
PT275
Prevalence of metabolic syndrome according to three Criteria in hypertensive
population in a rural hospital setting
Umar G. Adamu*1, Okon I. Ibok1, Ikenna Umenze1, O. M. Olaniyi1
1
Department of medicine, Federal Medical Centre, Bida, Nigeria
Introduction: : Metabolic syndrome is the occurrence of several cardiovascular risk
factors in individuals. Several criteria have been proposed to determine its
prevalence.
e219
 Objectives: To determine and compare the prevalence of metabolic syndrome according
POSTER ABSTRACTS
to National Cholesterol Education Program Adult treatment Panel III (NCEP ATP III),
American Heart Association-National Heart Lung and Blood institute (AHA-NHLB)and
the Joint Interim Statement (JIS) criteria in hypertensives attending a rural cardiology
clinic.
Methods: This cross-sectional study used the National Cholesterol Education
Program Adult treatment Panel III, American Heart Association-National Heart
Lung and Blood institute (AHA-NHLBI) and the joint interim statement criteria to
assess metabolic syndrome in 204 patients with arterial hypertension attending
cardiology clinic of Federal medical centre (Bida,Nigeria)from February 2010 to
April 2013.
Results: Two hundred and four hypertensives were enrolled made up of 47.1% males
and 52.9% females. The mean age was 53.43  11.78 years. Using the NCEP ATP III,
Eighty three (40.7%) hypertensives had metabolic syndrome (33 males: 16.2%, 50
females: 24.5%) while the application of AHA-NHLBI criteria, resulted in metabolic
syndrome in 96 (47.1%) of hypertensives (42 males: 20.6%, 54 females: 26.5% fe-
males) and in 108 (52.9%) hypertensive (46 males: 22.5%, 62 females: 33.9% females).
The prevalence of metabolic syndrome were significantly higher in both males and
females using the JIS compared with the NCEP ATP III, but only in males using the
AHA-NHLBI criteria . In both male and female hypertensives with metabolic syndrome,
low high density lipoprotein cholesterol (HDL-C) and abdominal obesity were the
most common components (87.9% versus 78%, 78.1% versus 76% and 85% versus
79.6%) respectively.
Conclusion: There is a high prevalence of metabolic syndrome in hypertensives in rural
Nigeria and varies with criteria used. The need for public health promotion, screening and
management of hypertensives for other components of metabolic syndrome is hereby
stressed.
Disclosure of Interest: None Declared
PT276
Relaxation of arterial graft induced by epicatechin
Aleksandra Novakovic*1, Aleksandra Vranic1, Goran Jankovic1, Ivan Stojanovic2,3,
Predrag Milojevic2,3, Nenad Ugresic1, Vladimir Kanjuh4, Qin Yang5, Guo-Wei He6
1
Deparmtent of Pharmacology, Faculty of Pharmacy, University of Belgrade, 2Deparmtent of
Surgery, Faculty of Medicine, University of Belgrade, 3Institute for Cardiovascular Diseases
“Dedinje”, 4Academy of Sciences and Arts, Belgrade, Serbia, 5Department of Surgery, Chinese
University of Hong Kong, Hong Kong, 6TEDA International Cardiovascular Hospital, Medical
College, Nankai University, Tianjin, China
Introduction: Flavanols such as epicatechin and catechin, are commonly present in
higher plants, and their high content in certain food plants, such as Vitis vinifera
(grape wine), Camellia sinensis (tea), and Theobroma cacao (cocoa) are especially
noteworthy in the context of human nutrition. Epidemiological studies suggest that
a high dietary intake of flavanols, is associated with reduced risk of cardiovascular
disease.The mechanism of cardiovascular benefits probably includes vasorelaxation.
The mechanisms by which flavanol compound epicatechin cause vasodilation are
uncertain.
Objectives: The aim of this study was to investigate the effects of epicatechin on the
isolated human internal mammary artery (HIMA) and to define the contribution of
different K+ channel subtypes in epicatechin action on this blood vessel.
Methods: The HIMA segments were collected from male patients suffering from coronary
artery disease who were undergoing coronary artery bypass surgery and studied in organ
bath. HIMA rings were pre-contracted with phenylephrine (10 mM). Endothelium was
removed mechanically.
Results: Epicatechin induced a concentration-dependent relaxation of rings with
endothelium and without endothelium. Glibenclamide (10 mM), a highly selective
blocker of ATP-sensitive K+ (KATP) channels, did not inhibit relaxation of HIMA
induced by epicatechin. In contrast, iberiotoxin (100 nM), a most selective blocker of
large-conductance KCa (BKCa) channels, antagonized relaxation of HIMA. A non-
selective blocker of voltage-gated K+ (KV) channels, 4-aminopyridine (4-AP, 0.5 mM),
partly antagonized relaxation of HIMA, while margatoxin (10 nM), a potent inhibitor
of KV1.3 channels, did not significantly modify the epicatechin-induced relaxation of
HIMA.
Conclusion: Our results showed that epicatechin induced strong endothelium-indepen-
dent relaxation of HIMA. It seems that BKCa and 4-AP-sensitive K+ channels channels
located in the smooth muscle of HIMA mediated relaxation induced by epicatechin.
Disclosure of Interest: None Declared
PT277
U-3 Fatty Acids And Prostate Cancer: A Review of Recent Literature
Crishan Haran1, David Colquhoun*1, Antonio Ferreira-Jardim2
1
University of Queensland, 2Core Research Group, Brisbane, Australia
Introduction: Recent claims that high u-3 fatty acid intake increases the risk of prostate
cancer have been made.
Objectives: We evaluated these claims to determine their scientific basis.
Methods: We reviewed published studies on u-3 intake and cancer risk from PubMed and
Google. Additionally, we reviewed international data regarding fish intake and literature
regarding prostate cancer prevalence in genetically similar individuals in different
geographic locations.
e220
Results: Migrant studies from Japan and the US demonstrated a clear increase of prostate
cancer risk in Japanese living in the US, a country with a high prostate cancer prevalence.
This correlated with data from Iceland which showed seafaring residents with high fish
consumption during the first 20 years of life had a lower risk of prostate cancer than those
who did not consume fish.
A meta-analysis of cohort and case-control studies that included 19,729 prostate cancer
cases showed no relationship between high fish consumption and prostate cancer. Analysis
of the case control studies showed that high fish consumption was associated with a 25%
reduction (p¼0.05) of prostate cancer, a 44% reduction of metastatic disease and a 63%
reduction (p¼0.005) of prostate cancer specific mortality.
The cohort study which reported ‘high fish intake’ increased prostate cancer risk, the
SELECT trial, included 834 prostate cancer cases. This trial was found to be underpowered
and inadequately designed. To quantify u-3 levels, plasma PL levels were measured; a
method which reflects intake of u-3 over the preceding few days. The difference in u-3
levels between the “high grade cancer group” and “no cancer group” was only 0.23%
(approximately 1.75g/day of fish or 1% of an average serve) a number too small to be
biologically plausible.
Mice models demonstrated that u-3 supplementation decreases tumour cell prolifera-
tion, increases induction of apoptosis and down-regulates carcinogenic signal mediators.
Conclusion: Recent claims that u-3 fatty acid intake is linked to an increased risk of
prostate cancer are not substantiated in the literature, nor are they biologically plausible.
High intake of u-3 fatty acids may decrease the risk of prostate cancer, the risk of pro-
gression of prostate cancer and probably prostate specific related mortality.
Disclosure of Interest: None Declared
PT278
Vitamin D Serum Levels Are Associated With Cardiovascular Outcome In Coronary
Artery Disease
Gerasimos Siasos1, Dimitris Tousoulis*1, Evangelos Oikonomou1, Konstantinos Maniatis1,
Stamatios Kioufis1, Marina Zaromitidou1, Eleni Kokkou1, Savvas Mazaris1, Theodosia Konsola1,
Manolis Vavuranakis1, Konstantinos Zisimos1, Antigoni Miliou1, Vasiliki Genimata2,
Christodoulos Stefanadis1
1
1st Cardiology Department, 2University of Athens Medical School, “Hippokration” Hospital,
Athens, Greece
Introduction: The role of vitamin D in coronary artery disease is under question recently.
Objectives: We study the diagnostic and prognostic significance of vitamin D status in
coronary artery disease (CAD) patients.
Methods: In this cohort study we included 252 patients (mean aged 6211 years) with
stable CAD, one month after percutaneous coronary intervention, followed-up for 3 to 36
(median 15) months. The extent of CAD (1 vessel disease (1VD), 2VD and 3VD) was
determined by coronary angiography and severity of CAD was evaluated by Gensini score.
Measures for vitamin D were performed using Liquid Chromatography Mass Spectrometry
technology. Subjects with vitamin D levels above and below 30ng/ml were characterized as
having sufficiency and deficiency respectively. The primary end point was the composite of
death from cardiovascular causes, cardiovascular events and hospitalization for cardio-
vascular causes.
Results: From the study population, 222 (88%) were categorized as having vitamin
D deficiency and 30 subjects as having vitamin D sufficiency (12%). There was no
difference between subjects with deficiency and sufficiency in baseline characteris-
tics. There was no association of Vitamin D levels with Gensini score (rho¼0.06,
p¼0.36) and with the extent of CAD [17.75 (11.37-23.53) vs. 18.40 (13.65-23.53)
vs. 16.90 (12.97-26.50) ng/ml, p¼0.96, for 1VD, 2VD and 3VD respectively].
During the follow up period the primary end point occurred in 24% of the subjects
with vitamin D deficiency and in 7% of the subjects with vitamin D sufficiency.
Cox-regression analysis after adjustment for multiple confounders such as age,
gender, creatinine clearance, gensini score, the presence of dyslipidemia, arterial
hypertension, diabetes mellitus, smoking habits and obesity revealed that subjects
with vitamin D deficiency have seven times increased hazard (HR¼7.24, p¼0.05)
for the occurrence of primary end point compared to subjects with vitamin D
sufficiency.
Conclusion: Vitamin D deficiency is highly prevalent in CAD patients. Though, the
severity of CAD was independent of vitamin D status. Importantly, vitamin D deficiency is
associated with adverse cardiovascular outcome in this high risk population a finding that
must be further evaluated by interventional studies.
Disclosure of Interest: G. Siasos: None Declared, D. Tousoulis: None Declared, E.
Oikonomou: None Declared, K. Maniatis: None Declared, S. Kioufis: None Declared, M.
Zaromitidou: None Declared, E. Kokkou Grant/research support from: State Scholarship
Foundation, S. Mazaris: None Declared, T. Konsola: None Declared, M. Vavuranakis: None
Declared, K. Zisimos: None Declared, A. Miliou: None Declared, V. Genimata: None
Declared, C. Stefanadis: None Declared
PT281
Predictors of Recurrent Chest Pain at 12 months in Patients with Normal Coronary
Angiography
Rosanna Tavella*1,2, Abdul R. Sheikh1,2, David DiFiore1,2, Chris Zeitz1,2, John Beltrame1,2
1
Discipline of Medicine, The University of Adelaide, 2Department of Cardiology, The Queen
Elizabeth Hospital, Adelaide, Australia
Introduction: About 20% patients presenting with chest pain have normal/near-normal
coronary arteries on angiography (NoCAD). Although these patients are at low risk of
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
cardiac events compared to those with established coronary artery disease (CAD), many that provides an estimation and accurate stratification of CVD risk for the Filipino

continue to experience chest pain.
Objectives: The objective of this study is to identify the clinical determinants of recurrent
chest pain at 12 months in patients with chest pain and NoCAD at the original diagnostic
angiogram.
Methods: Angiographic, clinical and health status (determined from the Seattle
Angina Questionnaire, SAQ) details were obtained from patients undergoing diag-
nostic coronary angiography for evaluation of chest pain at two participating Adelaide
public hospitals, between 2003-2007. NoCAD was defined as no stenosis  50% and
the absence of left ventricular dysfunction, or valvular heart disease. The Throm-
bolysis in Myocardial Infarction (TIMI) flow grade and the corrected TIMI frame
count (CTFC) were also determined from the index diagnostic angiogram. Clinical
and health status details were prospectively re-assessed at 12 months following index
angiography.
Results: Of the 1,146 patients undergoing angiography, 320 (28%) had NoCAD.
Compared with patients who had CAD, the NoCAD patients were younger (6211
vs 5712 years, p <0.01) and more often female (26% vs 57%, p<0.01). At 12-
month follow-up, ongoing chest pain was similar between CAD (59%) and NoCAD
(53%, p¼0.10) patients. Multivariable logistic regression assessment of ongoing
chest pain identified only younger age (OR¼0.97; 95%CI:0.95-0.99, p¼0.011) and
female gender (OR¼2.34; 95%CI:1.35-4.08, p¼0.003) as signficant independent
predictors.
Conclusion: Over half of NoCAD patients continue to experience chest pain 12 months
following index angiography; especially if they are younger and female, whereas the
presence of conventional risk factors and angiographic findings were not important
predictors.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
population.
Objectives: To investigate the relationship between waist circumference (WC) and CVD
physiological risk markers.
Methods: Women (n ¼ 375; 53.5  0.4 years of age; 62.2  0.5 kg) were classified into
three categories based on their WC (mean WC ¼ 37.2  0.21 in.). Categories were low
(< 31 in.; n ¼ 9), middle (31 – 34.9 in.; n ¼ 75), and higher (n ¼  35 in.; n ¼ 291).
Analysis of the influence of stratified WC on physiological makers analyzed with a one-
way ANOVA using the GLM procedure was performed. Correlation analyses and PROC
FREQ procedures of SAS were also used to compare the percentage of individuals within
stratification categories that were classified as diabetic, hypertensive, and processed risk
associated with cardiovascular disease. Results are presented as least squares means 
standard error.
Results: WC was found to be associated (P < 0.001) with concentrations of glucose
(r ¼ .19), hs- crp (r ¼ 24), hemoglobin A1C (r ¼ .20), triglycerides (r ¼ 0.20), and
systolic (r ¼ 0.32) and diastolic (r ¼ 0.32) blood pressure and negatively correlated
with HDL (r ¼ -0.25; P < 0.001). Both systolic and diastolic blood pressure (P <
0.001), triglycerides and high-sensitivity c reactive protein (hs-crp) (P < 0.05) was
influenced by a high WC classification. High-density lipoprotein cholesterol was
influenced by a middle WC classification. The prevalence of hypertension and risk of
CVD inflammation as measured by hs-crp was significantly greater in FAW having a
WC>35 inches.

PT283
Prevalence of Obesity and Other Cardiovascular Risk Factors in Young Egyptian
Adults
Azza A. M. Farrag*1, Abdel Moniem Ibrahim2, Mohsen Ibrahim1
1
Cardiovascular Department, 2Physiology, Cairo University, Cairo, Egypt

Introduction: Most cardiovascular disease events nowadays are taking place in low and
middle income countries with about 80% of the burden occurring in these countries. In
Egypt, since 1990, the cardiovascular related mortality was increased over three folds; to be
responsible for over 40% of deaths compared with 12% reported two decades earlier. Very
little is known about the prevalence and trends of cardiovascular risk factors among ad-
olescents and young adults in Egypt.
Objectives: The aim of this study was to evaluate the prevalence of obesity and other
cardiovascular risk factors in a group of young Egyptian adults.
Methods: Data from these analyses were drawn from 10 public universities in 10 Egyptian
governorates that represent different geographic areas in Egypt. A total of 2895 (mean age
of 20.2  1.8 years) students were recruited for self-administered questionnaire, anthro-
pometric (Body weight, height and waist circumference) and blood pressure measure-
ments. The student questionnaire consisted of precoded answers about demographic
characteristics including, age and gender, use of tobacco, physical activity and dietary
habits. Participants were asked to report the number of days per week they perform
different types of exercise. Periods of exercise were expressed as  30 minutes or < 30
minutes.
Results: The majority of students (93%) were non smokers, but the minority (15%)
performed regular physical exercise (> 4 days per week for  30 minutes). Eleven percent
of students were shown to be hypertensives (BP > 140/90 mmHg) and 21% were pre-
hypertensives (BP  140 /90 -  130 / 85 mmHg). Obesity (body mass index > 30) was
encountered in 13% of participants mostly from Delta and South Upper Egypt, while Conclusion: WC was an excellent predictor of elevated CVD risk factors in this population
truncal obesity (waist to height ratio > 0.5) was shown in 47% of students mainly in Cairo and the prevalence of most of these factors increased at WC 31-34.9 inches suggesting a
and also South Upper Egypt. Truncal obesity was shown in 38.8% of male students and in need to investigate risk factors and CVD outcomes as a function of waist in larger studies of
51.7% of female students. Filipino-American women.
Conclusion: This is one of the few reports exploring the prevalence of cardiovascular risk Disclosure of Interest: None Declared
factors among young adults in Egypt. Hypertension and pre-hypertension were prevalent in
our study population. Obesity, particularly, the truncal type was very prevalent especially
in females.
Disclosure of Interest: None Declared PT285
Determinants of Physical Activity Levels in Older Australians

PT284 Annie Y.-C. Su*1, Walter P. Abhayaratna1

The Influence of Waist Circumference on Cardiovascular Risk Factors Among
Filipino-American Women
Irma B. Ancheta*1, Christine V. Ancheta2, Cynthia Battie3, Rene Flores4
1
School of Nursing, University of North Florida, Jacksonville, 2College of Public Health,
University of South Florida, Tampa, 3College of Public Health, University of North Florida,
Jacksonville, 4Animal Welfare Committee j Research Compliance, Integrity and Education,
University of Texas Health Science Center at Houston, Houston, United States
Introduction: Obesity and metabolic syndrome are risk factors that lead to the
development of cardiovascular disease (CVD). Central adiposity is measured using
established waist circumference (WC) cut-off levels that vary as a function of ethnicity
and residency. Since Filipino-American women have a high prevalence of hyperten-
sion, diabetes and metabolic syndrome, it is crucial to determine a waist cut-off level
1
Academic Unit of Internal Medicine, Canberra Hospital, Canberra, Australia
Introduction: While the National Physical Activity (PA) Guidelines for adults and
older Australians are similar, a large proportion of people who frequently reported
little to no exercise levels had been those from the older population. However,
the extent to which factors influence PA levels has not been documented in
Australia.
Objectives: We sought to identify the determinants of PA levels in older adults over
time.
Methods: In this population-based prospective cohort study, PA levels were assessed using
the Active Australia Survey and categorised as ‘sedentary’, ‘insufficiently active’ or ‘suffi-
ciently active’. Data on demographics, education level, self-perceived health status and
clinical status were collected through questionnaires, physical examination or by review of
subject’s medical records. Regression analysis was used to identify the predictors of PA
levels at baseline and at median follow-up period of 7 years.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e221

 Results: Of the 928 participants (68.46.0 years; 53% women), 137 (15%) were
POSTER ABSTRACTS
‘sedentary’ at baseline; 342 (37%) were ‘insufficiently active’; and 449 (48%) were ‘suffi-
ciently active’. Independent predictors of higher PA levels at baseline included younger age,
increased body mass index, tertiary education, higher alcohol consumption, increased
pulse pressure and lower perceived health status (all p<0.05). Even after adjustment for
these factors, women were less likely to be ‘sufficiently active’. Comorbidity with chronic
obstructive pulmonary and current employment status predicted lower physical levels
(p<0.0005). During follow-up, the only predictor of future PA levels was an increase in
body mass(p¼0.03).
Conclusion: The level of PA in older adults is influenced by gender differences, body mass
index, self-perceived health and educational status. Future public health efforts with in-
terventions directed at these factors are required to increase PA levels at the population-
level.
Disclosure of Interest: None Declared
PT286
The Effect of Physical Activity on Cholesterol Levels in Older Australians
Joan E. Flores*1, Walter P. Abhayaratna1
1
Academic Unit of Internal Medicine, Canberra Hospital, Canberra, Australia
Introduction: Although physical activity (PA) has been shown to ameliorate lipid levels,
there is limited information regarding its impact in older individuals, in whom cardio-
vascular events are high.
Objectives: To determine the effect of PA on serum cholesterol levels in older
Australians.
Methods: In this prospective population-based cohort study, fasting lipid levels (total
cholesterol [TC], low density lipoprotein [LDL-C], high density lipoprotein [HDL-C] and
triglycerides [TG]) were measured on serum blood samples obtained at baseline and after a
median follow up of 7 years. PA level was categorized as sedentary, insufficient or sufficient
using the Active Australia Survey. Multivariable linear and ordinal regression analyses were
used to determine predictors of lipid levels and the need for initiation of lipid-lowering
therapy during the follow-up period, respectively.
Results: Of 1302 subjects (69  6.5 years; 53% women), 510 (39.2%) reported a history
of hyperlipidaemia at baseline. Independent predictors of hyperlipidaemic status included
diabetes mellitus, systemic hypertension, coronary artery disease, history of myocardial
infarction; and heart failure (all p<0.05). During follow-up, sufficient PA levels were
predictive of lower levels of TG (p¼0.028) and HDL-C (p¼0.003). Furthermore, sufficient
(p¼0.014) or even insufficient PA (p¼0.06) were less likely to commence statins during
follow-up than sedentary individuals.
Conclusion: In older Australians, PA was associated with increased HDL-C levels,
decreased TG levels and a lower rate of initiation of statin therapy over time. Whether these
observations are associated with a reduction of adverse clinical outcomes requires further
investigation.
Disclosure of Interest: None Declared
PT287
Family stress and risk of acute cardiovascular diseases in female population aged
25-64 years in Russia (based on WHO epidemiological program
“MONICA-psychosocial”)
Valery Gafarov1, Dmitriy Panov*1, Elena Gromova1, Igor Gagulin1, Almira Gafarova1
1 Tousoulis: None Declared, G. Siasos: None Declared, E. Oikonomou: None Declared, S.
Collaborative laboratory of cardiovascular diseases epidemiology SB RAMS, FSBI Institute of
Internal Medicine SB RAMS, Novosibirsk, Russian Federation
Introduction: It is known a little about the role of family stress in prediction risk of acute
cardiovascular diseases in Russian female population.
e222
Objectives: To explore the influence of family stress on relative risk of myocardial
infarction (MI) and stroke in female population aged of 25-64 years in Russia over 16 years
of follow-up.
Methods: Under the third screening of the WHO "MONICA-psychosocial" program
random representative sample of women aged 25-64 years (n¼870) were surveyed in
Novosibirsk. Questionnaire “Awareness and attitude towards the health” was used to es-
timate levels of family stress. From 1995 to 2010 women were followed for the incidence of
stroke and MI with using “Myocardial Infarction Registry” data. Cox regression model was
used for relative risk assessment (HR) of MI, stroke.
Results: The prevalence of high family stress level in women aged 25-64 years was 20.9%.
There were tendencies of growth rates of family stress in the youngest (25-34 years) –
27.6% and middle age group (45-54 years) – 30.5%.
HR of MI over 16 years of follow-up in women with high family stress was 5.59-
fold higher (95.0%CI:1.99-15.70, p¼0.001) compared to those with lower levels of
family stress. HR of stroke in women with high family stress was 3.53-fold higher
(95.0%CI:1.82-6.84, p<0.001). There were tendencies of increasing MI and stroke
rates in married women experienced stress in family compared to divorced and
widowed with the same stress level. As the tendency a stroke more likely developed in
women with high and elementary school education having family stress. With regard
to occupational class the tendency of higher stroke rates was found for “physical
workers” with family stress compared to those without it (c2¼3.69 df¼1 p¼0.055)
and MI rates were tend to be higher in “managers” and “engineers” experienced stress
in family.
Conclusion: The prevalence of high stress in family in female population aged 25-
64 years is more than 20% in Russia. Women with high family stress had
significantly higher relative risk of MI and stroke over 16-th years of follow-up.
Rates of MI and stroke development were more likely in married women with low
educational level and high family stress in professional class “managers” and
“physical laborers”.
Disclosure of Interest: None Declared
PT288
Association Between Symptoms of Anxiety and Depression and Severity of Coronary
Artery Disease
Eleni Kokkou1, Dimitris Tousoulis*2, Gerasimos Siasos2, Evangelos Oikonomou1,
Stamatios Kioufis1, Marina Zaromitidou1, Konstantinos Maniatis1, Savvas Mazaris1,
Nikolaos Gouliopoulos1, Theodosia Konsola1, Konstantinos Zisimos1, Panagiotis Tourikis1,
Vasiliki Genimata3, Christodoulos Stefanadis1
1
1st Cardiology Department, University of Athens Medical School, “Hippokration” Hospital,
2
1st Cardiology Department, University of Athens Medical School, “Hippokration” Hospital,
Athens, Greece, 3University of Athens Medical School, “Hippokration” Hospital, Athens,
Greece
Introduction: A high incidence of depression and anxiety has been reported in patients
with coronary artery disease (CAD), specifically in those who have experienced myocardial
infarction and angina.
Objectives: In this study we evaluated the association between symptoms of anxiety and
depression and the severity of CAD.
Methods: In this cohort study we involved 164 (82% men; mean age6511 years)
consecutive patients with symptomatic CAD undergoing elective coronary angi-
ography. All patients underwent coronary angiography and they were categorized
in subjects with one, two or three vessel disease (1VD, 2VD, 3VD respectively)
and in subjects with LM disease. According, to coronary angiographies patients
with left main coronary artery disease (stenosis50%), 3 vessel disease, or 2
vessel disease marked by stenosis of the proximal left anterior descending artery
70% were characterized as having angiographically severe CAD. Among several
other demographic and clinical characteristics all subjects completed the Hospital
Anxiety and Depression Scale (HADS). A cut-off value above 11 in the depression
and anxiety scale was used for the diagnosis of depression and anxiety
respectively.
Results: Among traditional risk factors only male sex was associated with severe CAD
(p¼0.005). Women compared to men exhibited significantly higher depression (30% vs.
13%, p¼0.02) and anxiety scores (52% vs. 22%, p<0.001), even though they had severe
CAD less frequently. Interestingly, in women there was no statistically significant difference
in the prevalence of anxiety (50% vs. 50%, p¼0.99) and depression (23% vs. 25%,
p¼0.89) scores between subjects with non-severe and severe CAD. In men, subjects with
non-severe CAD compared to subjects with severe CAD, had higher anxiety prevalence
(29% vs. 13%, p¼0.03) while, there was no difference in the prevalence of depression
(14% vs. 12%, p¼0.78).
Conclusion: Several psychological characteristics, and most notably anxiety and
depressive symptoms are significantly associated with female sex in symptomatic
CAD patients while in male subjects anxiety is associated with angiographically
severe CAD.
Disclosure of Interest: E. Kokkou Grant/research support from: Onassis Foundation, D.
Kioufis: None Declared, M. Zaromitidou: None Declared, K. Maniatis: None Declared, S.
Mazaris: None Declared, N. Gouliopoulos: None Declared, T. Konsola: None Declared, K.
Zisimos: None Declared, P. Tourikis: None Declared, V. Genimata: None Declared, C.
Stefanadis: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT289
Erectile dysfunction in patients who recived pacemakers
Ivana Burazor*1, Zoran Perisic2, Predrag Cvetkovic2, Milica Lazovic3
1
Cardiology department, Institute for rehabilitation Belgrade, Belgrade, 2Clinic for cardiovascular
diseases, Clinical Center, Nis, 3Institute for rehabilitation Belgrade, Belgrade, Serbia
Introduction: The current concept of quality of life acknowledges that patients put their
actual situation in relation to their personal expectation. The latter can vary over time, and
react to length and severity of illness.
Objectives: We aimed to investigate quality of life in patients who were implanted pace-
makers and the presence of erectile dysfunction.
Methods: Out of 550 patients sheduled for pacemaker follow up till 31st December
2012, the total of 101 males entered in the study. Patients were asked about the quality
of life and to fill in the International Index of Erectile Function -5 (IIEF-5) ques-
tionnaires for identifying erectile dysfunction. Total score was calculated. Risk factors
were noted.
Results: All included patients were married or in a relationship, from 30 to 69 years of age.
Average follow up from pacemaker implantation was 4.672.8 years.The total of 14% had
ICD, 4% CRT-D and the 82% had single or dual chamber anti bradicardial devises. After
the pacemaker has been implanted, the patient reported to feel better and have more
energy. There were some restrictions observed: 55% of patients still had fear to move the
hand on the part were device was implanted, drive a car (24%) or use the cell phone (15%).
The majority of patients were sexualy active (82%). The overall IIEF-5 score was higher
than 21. The total of 5% of patients had IIEF-5 score between 8 and 11; 2% of patients had
lower then 7.
Conclusion: Pacemakers as lifesavers greatly improve the quality of life in patients with
sexual activity highly present in our examined group.
Disclosure of Interest: None Declared
PT290
Health-Related Quality of Life in Adolescents with Congenital Heart Disease
Juliana Bertoletti1, Giovana C. Marx2, Sérgio P. Hattge JR2, Taiana S. Carvalho2,
Lucia C. Pellanda*1,3
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, 3Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Brazil
Introduction: Advances in heart surgery techniques have increased the life expectancy of
children and adolescents with congenital heart disease.
Objectives: This study aims to evaluate the health-related quality of life (HRQL) of ado-
lescents with congenital heart disease (CHD), describing HRQL according to the diagnosis
and severity of CHD.
Methods: A cross-sectional study was conducted with 203 adolescents with CHD attended
at the pediatric ambulatory of a reference cardiology hospital in Brazil. The Brazilian version
of the questionnaire KIDSCREEN-27 was used for the assessment of HRQL. Information
related to the CHD diagnosis and clinical variables were collected from the medical records
of the patients.
Results: Adolescents that referred a good general health presented significantly better
results in all dimensions of HRQL, except for Autonomy and Parent Relation, than those
who presented clinical symptoms (p<0.05). there was no statistically significant differ-
ence between acyanotic and cyanotic groups, as well as for different diagnosis of CHD. A
trend for better HRQL in the dimension of Psychological Well-being (p¼0,054) was
found among adolescents who have been submitted to surgical intervention and used
medication.
Conclusion: Type of CHD and initial diagnosis did not seem to affect the perception of
HRQL, corroborating findings of several studies. Surgical interventions and use of medi-
cation can improve previous clinical status, leading to benefits in terms of psychological
well-being. Presence of clinical symptoms was the variable that caused the largest impact on
the perception of HRQL, possibly due to the impairment they bring to the daily lives of
these patients.
Disclosure of Interest: None Declared
PT291
Psychosocial risk factors of coronary artery disease in open male population aged
25-64 years: single epidemiological study
Ekaterina Akimova1, Vadim Kuznetsov*1, Valery Gafarov2, Marina Kayumova1
1
Tyumen Cardiology Center, Tyumen, 2Interdepartmental Laboratory of Cardiovascular
Diseases Epidemiology in Siberia, Novosibirsk, Russian Federation
Introduction: Psychosocial health and its influence on risk factors of coronary artery
disease (CAD) are considered as one of the most important issues concerning the main
aspects of life, working conditions and lifestyle of the population.
Objectives: To study the prevalence of psychosocial risk factors of CAD in open male
population aged 25-64 years.
Methods: A representative sample of 1000 men (250 in each age group: 25-34, 35-44, 45-
54, 55-64 years) was recruited from the voting lists of one of the administrative districts of
Tyumen. The analysis of such psychosocial risk factors as trait anxiety (TA), depression (D),
hostility (H) and vital exhaustion (VE) was carried out within the cardiac screening using
standard self-administered WHO MONICA questionnaire. The response rate to cardiac
screening was 85.0% (n¼850).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: The prevalence of high levels of psychosocial risk factors of CAD in males
POSTER ABSTRACTS
aged 25-64 years was (age-adjusted rates): D – 4.6%, VE – 15.9%, TA – 36.6% and
H – 46.4%. High level of TA increased with age and reached its significant maximum
in the group of patients aged 55-64 years compared to the young patients in 25-34 age
group (28.8% – 50.0%, p <0.001) and 35-44 age group (33.8% – 50.0%, p <0.01).
Major depression was maximal in the group of patients aged 55-64 years compared to
patients of other age groups and population based index 25-54 years (4.6% – 14.6%,
p<0.001). Level of hostility in 25-34 and 55-64 age groups was almost twice higher
the medium and in 35-44, 45-54 age groups was almost three times higher. High level
of vital exhaustion was maximal in the group of patients aged 55-64 years compared to
patients of other age groups and population based index 25-54 years (15.9% – 31.3%,
p <0.001).
Conclusion: Thus, in Tyumen male population levels of trait anxiety, depression, hostility
and vital exhaustion increased with age and reached its maximum in the group of patients
aged 55-64 years.
Disclosure of Interest: None Declared
PT292
Risk of developing hypertension and its prevalence in riverside communities of Porto
Velho Rondonia ( Brazil Amazon)
Raitany Almeida*1, Otavio R. Coelho2, Diego J. Dias1, Carlos H. Spesia1, Karime Deguchi1,
Vanessa B. Nunes1, Alana A. Campione1, Laise R. Lopes1, Ana E. Castilho1
1
UNIVERSIDADE FEDERAL RONDONIA, Porto Velho, 2UNICAMP, Campinas, Brazil
Introduction: Hypertension is one the most prevalent risk factors worldwide and its has
become an important public health challenge. There are no epidemiological data about
hypertension in river dwellers in the Amazon region. The risk of developing high blood
pressure (BP) in the short term is unknown.
Objectives: To assess the prevalence of arterial hypertension in a sample Amazon popu-
lation from the riverside communities and estimate the risk of developing hypertension
over the next four years.
Methods: Quantitative study, cross-sectional, descriptive, whose sample consisted of
individuals living in the catchment area of four riverside communities in Madeira
River. The demographic data were recorded and two measurements of BP were ob-
tained by trained observers. The sample was random and used a standard question-
naire, which addressed risk factors as diabetes mellitus, hypertension, medication use
and parental hypertension. Measures have been verified as BP, weight, height and waist
circumference. After this first phase that occurred through household visits between
May and August 2013 followed by the compilation of data in EpiInfo statistical pro-
gram and performed Hypertension Risk Score - incidence of hypertension in four
years, based on the Framingham Heart Study.
Results: Included 762 individuals, 351 (46.06%) males. The median age was 43.7
years, range 20 to 92 years (SD: +/-15.58). From the sample, 178 (23,35%) re-
ported having a previous diagnosis of hypertension, 522 (68,5%) denied having
hypertension while 62 (8.13%) did not know. Of the 584 people who had not or
could not say, 114 (19.52%) had BP levels above recommended ( > 140 mmHg for
systolic BP and/or > 90mmHg for diastolic BP). Of these 470 participants who had
blood pressure levels considered normal, 433 had inclusion criteria to calculate the
risk of developing hypertension over the next four years found that belong to low
risk (<5% chance ) 201 individuals (46.42%), 95 individuals (21.93%) to medium
risk (5 - 10% chance) and 137 (31.63%) had high risk (> 10% chance to develop
hypertension).
Conclusion: The prevalence of hypertension in this population was high (42.87%). Most
individuals had normal BP presented low or medium risk for developing hypertension in
four years. In this survey, was high percentage of hypertensive subjects who did not
know.Therefore it is necessary, effective action to control and optimize primary prevention
in riverside communities in Brazilian Amazon.
Disclosure of Interest: None Declared
PT295
Correlation of Ankle Brachial Index and The Severity of Coronary Artery Lesions, A
Preliminary Study
Hariman Kristian*1, Benny Setiadi1, Bambang Budiono2, Lucia A. Panda1, Reggy Lefrandt1,
Janry Pangemanan1
1
Cardiology And Vascular Medicine, Sam Ratulangi University, Manado, 2Cardiology And
Vascular Medicine, Awal Bros Hospital, Makassar, Indonesia
Introduction: Atherosclerosis is a diffuse disease process, being present in one vascular
bed predicts its presence in the others. Ankle –brachial pressure index (ABI) is a non
invasive test proved to be sensitive and specific in detecting and assessing the severity
of peripheral artery disease and can predict coexistent of coronary artery disease
(CAD).
Objectives: The aim of this study is to investigate the correlation between decreased ABI
with the severity of coronary artery lesions.
Methods: This is a cross sectional study, which include CAD patients who underwent
coronary angiography between July 2013 to August 2013. The patient divided into three
groups based on the ABI, which include control (ABI  0.9), low (ABI 0.81-0.89) and very
low (ABI 0.8), The clinical and risk factors of cardiovascular disease, including hyper-
tension, type 2 diabetes mellitus, dyslipidemia, and smoking were analyzed to identify their
relation to the severity coronary stenosis by modified gensini score. Statistical analyses were
done using SPSS 17.0
e223
 Results: A total 34 patients was included in this study, in which 17 patients (50%), 13 risk factors and echocardiograph were obtained. LA volume was calculated by the area-
POSTER ABSTRACTS

patients (38%) and 4 patients (11%) belongs to the control group, low ABI group and very length method in the apical 2-chamber and apical 4-chamber view and indexed to body
low ABI group respectively. The overall mean ABI is 0.93 with minimum and maximum surface area (BSA). Descriptive, univariate and multivariate analysis were performed using
ABI value is 0.71 and 1.31 respectively. There is significant difference in the mean modified SPSS version 16.
gensini score between the three groups (5.244.35 vs 13.623.31 vs 169.83 in control, Results: A total of 1932 subjects with echocardiogram were analyzed. Mean age was 54.6
low ABI and very low ABI respectively, P value <0.001). From Pearson correlation test,  11.6. Majority of the subjects were male 98.3% (1899). Mean systolic ejection fraction
there is significant corelation between ABI and modified gensini score ( r ¼ -0.612 and (EF) was 64.5%  7.0. Majority was Malay ethnic 81.9% (1582), 13.8% (266) were di-
p value < 0.001). ABI <0.9 significantly have higher odds of having severe coronary artery abetics and 9.6% (185) had impaired fasting glocose (IFG). 60.6% (1170) had high LDL
stenosis (modified gensini score >13), with odd ratio (OR) 9.07, P value 0.003. Low ABI level of more than 3.4mmol/L. 26.1% (505) were hypertensive and 59.1% (142) were
(OR 8.67 P value 0.03) and very low ABI (OR 5.15 P value 0.023), both have a higher odds obese. Mean left atrial volume index was 28.0  9.1 ml/m2. Total of 40.3% (778) had LAVI
of having severe coronary artery stenosis compared to control. On multivariate logistic > 28 ml/m2. For those with LAVI > 28 ml/m2, 12.6% (98) were in the healthy subjects
regression analysis, ABI remained an independent predictor of CAD severity after correcting while the remaining 87.4% (680) had at least 1 risk factor (diabetes, hypertension, dysli-
for other conventional risk factors for CAD. pidemia or obesity). Table below summarized the prevalence of LAVI > 28 ml/m2 in
Conclusion: ABI <0.9 have a higher risk to have severe coronary artery stenosis. Decreased normal and disease subjects. For subjects with LAVI 28 ml/m2, hypertension, and live in
ABI value associated with the increased of severity coronary artery stenosis. ABI is a simple urban area remained the strong predictors for LAVI > 28 ml/m2 after univariate and
and noninvasive method that can predict severity of coronary artery stenosis patient with multivariate analysis with age adjusted.
coronary artery disease. This association is independent of other conventional cardiovas-
cular risk factors.
Disclosure of Interest: None Declared % LAVI > 28 ml/m2
Risk factors N[778 p value OR CI
PT296 No risk 12.6 0.30 - -
Patterns of cardiovascular risk factors in asymptomatic diabetics and pre-diabetics 1 risk or more 87.4
from South East Asia Diabetes mellitus 0.27 - -
Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1, Yes 12.9
Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli1 No 87.1
1
Cardiology, UiTM, Sungai Buloh, Malaysia
Hypertension < 0.001 0.7 0.57-0.88
Introduction: Diabetes mellitus increases the risk of heart failure independent of coronary Yes 32.0
heart disease and hypertension. It is also associated with diabetic cardiomyopathy of which
the epidemiology is not well defined. We sought to study the pattern of cardiovascular risk No 68.0
factors in an asymptomatic diabetic population from Malaysia. Dyslipidemia 0.50 - -
Objectives: To assess cardiovascular risk factors in diabetic and pre-diabetic patients.
Yes 60.2
Methods: Subjects were recruited as part of a community study on cardiovascular diseases
between the years 2007 to 2011. Demographic details, cardiovascular risk factors along No 39.8
with echocardiogram were obtained. Obese 0.85 - -
Results: A total of 1932 subjects with echocardiogram were analyzed. Mean age was 54.6
Yes 59.4
 11.6. Majority of the subjects were male 98.3% (1899). Mean systolic ejection fraction
(EF) was 64.5%  7.0. Prevalenve of diastolic dysfunction was 52.8% (1021). Of all the No 40.6
subjects with diastolic dysfunction, 29.9% (578) had impaired relaxation, 21.0% (406) Area < 0.001 1.6 1.28-1.89
pseudonormal and 1.9% (37) restrictive defect. Among subjects with diastolic dysfunction,
13.8% (266) were diabetic and 9.6% (185) were pre-diabetic (impaired fasting glucose). Urban 35.3
Table below summarize the cardiovascular risk factors among the subjects with diabetes Rural 64.7
and pre-diabetes. In univariate analysis only age and hypertension found to be significant
predictor for diastolic dysfunction among diabetes mellitus subjects. However in multi-
variate analysis, age was the only the strong predictor for a diabetic patients to have dia-
stolic dysfunction with OR 0.57 (CI:1.01-1.10). Conclusion: Our findings supported previous study that LAVI measurement is a potential
tool to be used in assessment of asymptomatic patients with cardiovascular risk factors as
these subclinical patients might benefit from aggresive risk factor control to prevent further
Impaired fasting glucose (%) Diabetes (%) complication.
CV risk factors N[185 N[266 Disclosure of Interest: None Declared
Diastolic dysfunction 61.6 58.6
PT298
Hypertension 35.1 37.2
Dyslipidemia 55.7 57.1 Combination Therapy With Pravastatin And Valsartan Has Additive Effects To
Improve Vascular And Metabolic Phenotypes Over Monotherapy In
Obesity 73.0 77.4 Hypercholesterolemic Patients
Kwang Koh*1, Pyung Oh2
1
Cardiology, 2Gil Hospital, Incheon, Korea, Republic Of
Conclusion: The prevalence of diastolic dysfunction in diabetic and impaired glucose
Introduction: Statin and angiotensin II type 1 receptor blocker therapy improve endo-
tolerance subjects in our population was suprisingly higher than reported. Age and hy-
thelial dysfunction using distinct mechanisms.
pertension remain a significant risk factor associated with risk of developing diastolic
Objectives: We evaluated simultaneous vascular and metabolic responses to pravastatin
dysfunction in patients with diabetes mellitus, however after adjusted only age is the strong
and valsartan therapy, alone or in combination, in hypercholesterolemic patients.
predictor.
Methods: Forty-eight hypercholesterolemic patients (23 had metabolic syndrome) were
Disclosure of Interest: None Declared
given pravastatin 40 mg and placebo, pravastatin 40 mg and valsartan 160 mg, or valsartan
160 mg and placebo daily during each 2 month treatment period in a randomized, single-
PT297 blind, placebo-controlled cross-over trial with three treatment arms and two washout
Echocardiographic left atrial volume index (LAVI) in a heterogenous Asian periods (each 2 months).
population Results: Of note, brachial artery flow-mediated dilation improved to a greater extent with
combined therapy vs. either monotherapy (P<0.001 by ANOVA). Interestingly, when
Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1, compared with monotherapy, combined therapy significantly reduced hs-CRP levels to a
Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli1 greater extent (P¼0.019 by ANOVA on Ranks). We also observed simultaneous improvement
1
Cardiology, UiTM, Sungai Buloh, Malaysia in metabolic phenotypes with all three treatments causing increased plasma adiponectin
levels, reduced fasting plasma insulin levels, and increased insulin sensitivity (determined by
Introduction: The left atrium (LA) is a complex structure and is frequently involved in QUICKI) relative to baseline measurements. For the first time in a statin combination trial,
disease affecting the left ventricle. LA dilation is related to an increased filling pressure and pravastatin combined with valsartan therapy increased plasma adiponectin, lowered fasting
is a strong predictor of heart failure, stroke and death. Assessment of LAVI in asymptomatic insulin, and improved insulin sensitivity in an additive manner when compared with either
patients may help in aggressive risk factors control and prevent further complication as it is monotherapy alone (P¼0.003, P¼0.049, and P¼0.049 by ANOVA on Ranks, respectively).
an inexpensive and readily available tool. Overall, we observed similar results in 23 patients with metabolic syndrome.
Objectives: To describe LAVI in normal and diseased states in an asymptomatic Asian Conclusion: Pravastatin combined with valsartan improved endothelial function and
population. metabolic phenotypes in an additive fashion in patients with hypercholesterolemia or
Methods: Between 2007 and 2011, subjects participating in a longitudinal population metabolic syndrome.
study looking at cardiovascular diseases were enrolled. Demographic data, cardiovascular Disclosure of Interest: None Declared

e224 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

PT300
Depression Among Cardiovascular Patients Living In A Middle Eastern Country- A
Preliminary Report
Tam Truong Donnelly*1, Jassim M. Al Suwaidi2, Awad Al-Qahtani2, Nidal Asaad2,
Najlaa Abdul Qader2, Rajvir Singh2, Tak Fung3, Irem Mueed1, Noha El Banna1,
Shima Sharara1, Sarah Hussein Omar1
1 Objectives: The main objectives of the study were to examine the acute effects of snus on
Research, University of Calgary-Qatar, 2Medicine, Hamad Medical Corporation, Doha, Qatar,
3
Math, University of Calgary, Calgary, Canada
Introduction: Cardiovascular diseases (CVD) are the leading cause of death globally.
Similar to other countries, cardiovascular diseases are rising rapidly in Qatar. Depression is
associated with an increased morbidity and mortality rate among cardiovascular (CV)
patients. Early detection of, and intervention for, depression among CV patients can reduce
morbidity and mortality, and save health care costs. However, information on the presence
of depression and mental health care needs among cardiovascular patients in the Middle
East is limited.
Objectives: Funded by the Qatar National Research Fund, the goals of this study are to
find ways to effectively manage depression and to evaluate incidence and prevalence of
depression in Arab CV patients in Qatar.
Methods: A quantitative population-based survey was conducted with 604 Arab CV pa-
tients (98% response rate), who are 20 years and over, have confirmed diagnosis of CVD
and were admitted to the Heart Hospital in Qatar for treatment between January and
August, 2013. Face-to-face interviews were conducted using structured survey question-
naires which include an Arabic demographic questionnaire (to assess demographic factors
such as income, age, marital status, etc.) and the self report Arabic version of the Beck
Depression Inventory 2nd Edition (BDI-II) (to assess depressive symptoms).
Results: 60% of the patients rated their health as excellent or good, 13% rated as poor,
14% admitted to experience symptoms of depression and 7% said that they had a
confirmed history of depression. Evaluation by the BDI-II indicated that 76% of the pa-
tients had no depressive symptoms, 18% suffered low levels of depression and 6% with
significant levels of depression. Twice as many females than males were assessed having
depression. Of the patients with a history of depression, 31% were receiving medication.
While 71% and 37% of the patients agreed to share their mental health information with
family and friends respectively, less than 1% agreed to share it with a mental health
clinician on a weekly basis.
Conclusion: It is imperative that systematic assessment for depression amongst cardio-
vascular patients is routinely performed and treatment implemented. To improve quality of
life and survival of cardiovascular patients, increase awareness, early recognition of and
treatment for depression are necessary in Qatar.
Disclosure of Interest: None Declared
PT304
Levels of secondhand smoke exposure and biomarkers of cardiovascular diseases: a
Scotland-wide study
Liya Lu*1
1
Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
Introduction: Both active smoking and secondhand smoke (SHS) exposure are associated
with cardiovascular disease, but sidestream smoke contains higher levels of small particles
and toxic gases than mainstream smoke.
Objectives: We examined the relationship between cotinine concentration and a number
of cardiovascular biomarkers in non smokers and active smokers.
Methods: We undertook a cross-sectional study using Scottish Health Surveys conducted
between 1998 and 2010. Inclusion was restricted to participants aged
16 years who had
provided blood and saliva samples. Univariate and multivariate regression models were
used to examine the relationships between cotinine concentration and C reactive protein
(CRP), high-density lipoprotein (HDL) cholesterol, and fibrinogen concentrations, as well
as HDL:total cholesterol ratios.
Results: Of the 10,018 eligible participants, 7,345 (73.3%) were confirmed non-smokers
(cotinine <15.0 ng/mL) and 2,673 were confirmed current smokers (cotinine
15.0 ng/
mL). CRP and HDL:total cholesterol increased, and HDL cholesterol decreased with
increasing cotinine concentration across non-smokers and smokers (all p<0.001). How-
ever, there were step changes at the interface, whereby non-smokers with high exposure to
SHS had lower concentrations of cotinine than light active smokers but comparable con-
centrations of CRP (p¼0.709), HDL cholesterol (p¼0.931) and HDL:total cholesterol
(p¼0.417). Fibrinogen concentrations were significantly raised in moderate and heavy
active smokers only.
Conclusion: These findings add to existing evidence that exposure to SHS is associated
with a disproportionately high cardiovascular risk compared with active smoking. Pro-
tection from exposure to SHS should be a public health priority.
Disclosure of Interest: None Declared
PT305
Acute effects of Swedish oral moist snuff (snus) on arterial stiffness in young habitual
users
Lukasz Antoniewicz*1, Mirza Novo2, Magnus Lundbäck1, Fariborz Mobarrez1, Jeanette Kuhl1,
Jenny Bosson2
1 2
Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Stockholm,
2
Department of Medicine, Umeå University Hospital, Umeå, Sweden
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: Oral moist snuff, also known as Swedish “snus” is often considered as a
POSTER ABSTRACTS
healthier alternative to cigarettes, but recent studies indicate a higher risk of heart failure,
development of type II diabetes, fatal ischemic stroke and preterm birth. Atherosclerotic
diseases are associated with increased arterial stiffness (AS), measured by pulse wave
analysis (PWA) and pulse wave velocity (PWV). Only limited data exists on the effects of
snus on AS, in the younger population especially in younger women, where the use of snus
has noticeably increased.
arterial elasticity and hemodynamics in young males and females.
Methods: In a randomized, double blinded crossover study, 23 healthy subjects (mean age
31 5 yrs, females n¼11) with regular snus consumption were exposed for oral moist
snuff (8 mg of nicotine per pouch) or tobacco-free placebo. Blood pressure and pulse was
measured as well as PWA and PWV (Vicorder/Sphygmocor software). Augmentation Index
was calculated and corrected for heart rate at 75 bpm (AIx75). Measurements were per-
formed for 40 minutes during the exposure and 25 minutes following exposure.
Results: Results showed an increase in systolic blood pressure (SBP) as well as an increase
in heart rate (HR) while exposed to snus (SBP increase: snus: +8.1 mmHg 11 vs. placebo:
+1.7 mmHg 11, p¼0.002 and for HR +9.3 bpm 13 vs. +2.3 bpm 12, p<0.001).
Following exposure SBP and HR decreased slightly, but remained significantly elevated as
compared to placebo. There was a trend towards an elevation in diastolic blood pressure
(DBP increase: snus +6.2 mmHg 11 vs. placebo +2.7 mmHg 9, p¼0.075). Arterial
stiffness measurements (PWV, arterial pressure (AP) and AIx75) remained unaffected by
exposure to snus.
Conclusion: These results confirm that acute exposure to Swedish snus leads to a rapid
increase in SBP and HR, which does not return to baseline levels during the post-snus
period. Previous studies showed similar results on hemodynamics and a sudden elevation
in epinephrine suggesting nicotine as a strong sympathetic stimulus. However, we could
not show any effects on arterial elasticity measured by PWA and PWV. As age and duration
of snus-use may play a crucial role, additional studies are required in order to further
investigate possible cardiovascular effects due to chronic use.
Disclosure of Interest: None Declared
PT306
Does use of ‘gul’ (smokeless tobacco) increase the risk of coronary heart disease in
Bangladesh?
Muhammad Aziz Rahman*1, Nicola Spurrier2, Mohammad Afzal Mahmood2,
Mahmudur Rahman3, Sohel Reza Choudhury4, Stephen Leeder5
1
St Vincent’s Centre for Nursing Research (SVCNR) and The Cardiovascular Research Centre
(CvRC), Faculty of Health Sciences, Australian Catholic University, Melbourne, 2Discipline of
Public Health, The University of Adelaide, Adelaide, Australia, 3Institute of Epidemiology,
Disease Control and Research (IEDCR), 4Department of Epidemiology and Research, National
Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh, 5Menzies Centre for Health
Policy and School of Public Health, The University of Sydney, Sydney, Australia
Introduction: ‘Gul’ is the powder form of commercially available smokeless tobacco (SLT)
product, kept between cheek and gums, is commonly used in Bangladesh and cheaper than
other available SLT products. Studies exploring the association between coronary heart
disease (CHD) and South Asian SLT products are very scarce.
Objectives: To explore the association between CHD and ‘gul’ use among non-smoking
adults in Bangladesh.
Methods: Non-smoking Bangladeshi adults, aged 18-75 years were included in this
matched case-control study in 2010. CHD cases, diagnosed by cardiologists within last one
year, were selected from two large cardiac hospitals. Neighbourhood residents of the CHD
cases, not known to have any cardiac disease, were selected as community controls.
Hospital controls were selected from outpatients of the same hospitals. Each case was
matched with four community controls and one hospital control. Cases and controls were
reclassified using the Rose Angina Questionnaire (RAQ).
Results: Participants included 302 CHD cases, 1208 community controls and 302 hospital
controls. Current use of ‘gul’ was slightly more common among cases (5%) compared to
either group of controls (2%). However, current use of ‘gul’ and ‘jarda’ together was more
common among community controls (5%) compared to cases (3%) or hospital controls
(2%). Among 48 exclusive ‘gul’ users, 45 (94%) of them were heavy users (at least once a
day) and 58% were users for long duration (>10 years). There was a strong association
between current use of ‘gul’ and CHD when both control groups were combined (adjusted
odds ratio 2.9, 95%CI 1.3-6.7). However, when never smokers were considered only, there
was no association between ‘gul’ use and CHD (adjusted odds ratio 1.4, 95%CI 0.4-5.2).
Frequency and duration of ‘gul’ use was also not associated with an increased risk of CHD
among never smokers. Re-classification with the RAQ also did not change the results.
Conclusion: The study was limited by small number of ‘gul’ users and the association with
CHD was not significant statistically in this study. Further research in other parts of the
country, specifically utilising rural population, is warranted to confirm the findings of this
study.
Disclosure of Interest: None Declared
PT307
Cuban Prospective Study of Tobacco, Alcohol And Mortality
Nurys B. Armas Rojas*1, Alfredo F. Dueñas Herrera1, Mayda Diaz González2
1
Preventive Cardiology, Institute of Cardiology and cardiac surgery. Havana. Cuba, La Habana,
Colon Chronic Disease, Colon Hygiene and Epidemiology Municipality Center,
Colon Matanzas, Cuba
e225
 Introduction: In Cuba, 26% of men and 18% of women die between ages 35-69 years,
POSTER ABSTRACTS
mainly from vascular, cancer and respiratory causes. Studies are need of the main causes of
chronic diseases in middle age and their risk factors.
Objectives: To determine mortality related to tobacco and alcohol in Cuba. 1999- 2011.
Methods: 140,000 adults recruited 1997-2000 from 4 provinces in Cuba; 50, 000 men and
60,000 women with no reported cancer or CVD at entry. Mean age 53 years. Mean follow-
up for mortality 11 years. Specific causes of death were obtained from mortality statistics of
the Ministry of Health Data matched by name and ID number. Variables: Name, ID
number, sex, age, education, occupation, marital status, tobacco smoking, alcohol con-
sumption, medical history, height, weight, blood pressure. Statistic analysis: Cox
regression models, adjusted for age and alcohol.
Results: In both men and women, tobacco smoking was more prevalent at younger ages
and there was a strong positive association between all-cause mortality and the number of
cigarettes smoked. Mortality was strongly and inversely associated with age started
smoking, so that male smokers who smoked 20 cigs/day and started before 15 years of age
were at 50% higher risk than never smokers, and female smokers who smoked 20 cigs/day
who started at 10 years of age were at twice the risk of never smokers, stopping young
works. For those men who had given up before 45 years old there was no excess risk. After
5 years the risks approach those of never smokers. Current smoking was associated with
web 3C/FPO
e226
4-fold risk of lung cancer, upper aero-digestive cancer and chronic obstructive pulmonary
disease (COPD) 50% increased risk of IHD and stroke. There was a strong positive and
continuous association among men so that the risk of death increased with increasing
alcohol consumption.
Conclusion: Smoking RRs are lower in Cuba than in US/UK studies for COPD, lung
cancer, upper aero-digestive cancer and vascular disease. Starting young causes bigger risk,
diminishes >5 years after stopping smoking and giving up before age 45 avoids most of the
risk. Alcohol has minimal total mortality in light drinkers.
Disclosure of Interest: None Declared
PT308
Networking and coalition buildings, challenges and opportunities: a case study
Wael Abd El Meguid*1,2
1
Technical lead, Coalition For Tobacco Control, Cairo, Egypt, 2Technical lead, Coalition for
Tobacco Control Egypt, Beiruth, Lebanon
Introduction: Coalition building plays an important role in supporting the TC programms.
Lessons learned from a case study from the Middle East region point out the role of an
International organization in supporting the establishment of the two Coalitions in Egypt
and Lebanon by variety of NGOs in collaboration with The MOHP-Egypt and TC, program
in Lebanon.
Objectives: Coalitions and Networks in Tobacco control, what works and what are the
opportunities and challenges, how to overcome the challenges?
Methods: Analysis of Strengths, weaknesses, Opportunities and Threats of the National
Tobacco Control Program in Egypt and Lebanon was conducted which identified the scarce
financial recourses as well as the extreme lack of manpower within the MOH in both
countries to effectively implement and monitor tobacco control policies in Egypt. Then the
potential members of the proposed coalition came together and agree on working together
in a unified strategic plan. Netowrking and meetings was conducted for coalitions and
partners to exchange experiences and increase the outcome of the work.
Results: Two coalitions developed and acting in different areas of TC to support the
ministries in their respective countries in fulfilling with TC requirements. The two co-
alitions included new members with diverse spheres and geographical distribution to in-
crease the outreach and outcome of the work. The coalitions are working on monitoring
the Tobacco Industry as well as identifying new areas of work TC as exploring and
advocating for NCDs.
web 3C=FPO
Conclusion: Recognizing the important role the coalition can play in adding a momentum
to the national tobacco control efforts, The Union Middle East office in collaboration with
The Tobacco Control Department Ministry of Health and Population in Egypt and Tobacco
control program in Lebanon have facilitated networking and planning by NGOs to
establish and build National Tobacco Control Coalitions. The NGOs members of the co-
alitions are collaborating with the MOHP in both countries for implementation of tobacco
control polices as they have the needed human resources, wide geographical outreach as
well as the experience to work at the grass root levels.
Disclosure of Interest: None Declared
PT312
Healthy Habits Education for Overweight Children Impacts Both Children and
Caregivers: a Randomized Clinical Trial
Vanessa Minossi1, Fátima H. Cecchetto1, Lucia C. Pellanda*1,2
1
Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia / Fundação
Universitária de Cardiologia, 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Brazil
Introduction: Childhood obesity is consistently increasing. It is believed that good results
can be achieved with the adoption of early strategies directed towards the promotion of
health through nutritional guidance and increased physical activity, in conjunction with
healthy lifestyle habits.
Objectives: To access the effectivity of a program for healthy habits education for over-
weight children in improving LDL-cholesterol and blood pressure both in children and
their caregivers.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: Randomized clinical Trial with 93 children from 7 to 11 years. Intervention
group (IG) received 10 weekly group encounters with children and parents or caregivers,
including orientation and ludic activities about food, healthy family habits, physical activity
and attitudes. In all activities resources were elaborated to address specific objectives and to
use simple and low cost resources. Control group (CG) received usual individual outpatient
management with a multidisciplinary team. Outcomes included blood pressure and lipid
profile after intervention. Statistical analysis included ANOVA, repeated measures ANOVA
and Mc Nemar test.
Results: Mean age was 9.13  1.43 years, 52.7% were girls. LDL-cholesterol was abnormal
in 17 (35.4%) of children in IG at baseline, reducing to 5 (10.4%) after intervention, while
in CG there was an increase of children with abnormal LDL(p < 0.002). The LDL levels
were abnormal in 8 (16.7%) of caregivers in IG and 7 (15.16%) of CG. After interventions,
none of the caregivers of IG showed alterations, while in CG this number rose to 11
(24.4%). Mean systolic blood pressure was significantly lower in children of IG compared
to CG after intervention.
Conclusion: An education program based in simple and low cost resources may be
effective to reduce LDL-cholesterol both in children and their caregivers, showing that
intervention with children may have extended benefits to their families. The intervention
was also effective in reducing systolic blood pressure in children.
Disclosure of Interest: None Declared
PT313
Knowledge About Healthy Habits and Risk Factors for Cardiovascular Disease: a
Randomized Clinical Trial With Schoolchildren
Fátima H. Cecchetto1, Daniela B. Peña2, Vanessa Minossi1, Lucia C. Pellanda*1,3
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, 3Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Brazil
Introduction: In recent decades, childhood obesity has been considered as a global
epidemic, present among all socioeconomic classes and ethnic groups. In this context, there
is an urgent need to focus on early prevention. Although genetic factors can influence
susceptibility to weight gain, the consensus is that a sedentary lifestyle, changes in dietary
practices and changes in family structures are factors that contribute to this epidemic. New
forms of interventions should be developed and improved.
Objectives: To ascertain the impact of ludic workshops on children’s knowledge and
self-care.
Methods: This was a randomized, clinical trial with 79 students aged 7-11. Anthropo-
metric measurements were collected and two questionnaires were applied at baseline, and
again after three months, just after eight ludic workshops were implemented. The two
questionnaires were: the typical day of physical activity (TDPA) and a questionnaire about
knowledge, healthy habits and risk factors for cardiovascular disease (QKHHRFCD), both
validated to portuguese.
Results: The intervention group contained 40 students, while the control group contained
39. The average age (10.03  1.1) was the same in both groups. The scores concerning
knowledge and practice of physical activity were similar at the baseline evaluation. After
two months, the intervention group showed significant improvement (p<0.005) in the
scores for knowledge and increased physical activity. There was a reduction in the BMI
percentile of the intervention group, but there was no significant statistical difference be-
tween the two groups.
Conclusion: The data suggests that knowledge may be improved by . education and health
strategies using ludical techniques. In the long term, these can be beneficial in helping to
control childhood weight and improve self-care when performed in conjunction with other
strategies.
Disclosure of Interest: None Declared
PT314
Motivating Indian youth to embrace walking – the Ground Miles Challenge
Radhika Shrivastav*1, Manjusha Chatterjee2, Nikunj Sharma1, Ima Chopra1,
Prerna Bharadwaj1, Monika Arora2
1
Hriday, 2PHFI, New Delhi, India
Introduction: Globally, more people die from CVDs than from any other cause. In 2008,
CVDs claimed 17.3 million lives and, by 2030, it is expected that number will increase to
over 23 million. Physical inactivity is the fourth leading risk factor for global mortality (after
high blood pressure, tobacco use and high blood glucose), and is a key risk factor for
CVDs. In India, annual CVD-related deaths are projected to rise from 2.7 million to 4
million in 2030. Effective health promotion strategies targeted at youth are much needed to
encourage healthy lifestyles, including adequate physical activity. Campaigns that effec-
tively engage youth have a strong potential to get amplified to reach families, schools and
communities at large. HRIDAY is partnering with the Public Health Foundation of India
(PHFI), WHF, Bupa and Max Bupa for an innovative walking campaign – GROUND MILES
(GM), supported by a robust smartphone App which enables walkers to track the distance
walked and meet their walking goals.
Objectives: Motivating youth to actively embrace walking as a sustainable medium for
maintaining adequate levels of physical activity, tracking the distance they walk and
advocating for walking-friendly environment and policies.
Methods: Nearly 5000 youth from three Indian cities (Delhi, Mumbai and Vishakha-
patnam) will be mobilized to join the global GM challenge and participate in walking events
organized by Indian partners. Engagement with schools has already commenced and there
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
is an enthusiastic response to the campaign, as well as the App. To ‘warm up’ the young
POSTER ABSTRACTS
advocates for the walking events scheduled in October-November 2013, interactive ses-
sions, including intra-and inter-school poster making competitions on the theme of
walking. These precursor activities will commence around World Heart Day 2013.
Results: The GM Challenge will be evaluated through participation in walking events,
download and usage of the App. Social media activities, digital engagement and media
coverage will also be important measures of success for the overall campaign, coupled with
key advocacy initiatives to promote walking-friendly policies.
Conclusion: The campaign which will run from October-December 2013, has the po-
tential to pitch walking as a ‘youthful’ and fun activity and boost youngsters to adopt
regular walking – which will potentially have significant impact on their heart health as
adults.
Disclosure of Interest: None Declared
PT315
Oil usage practices among small and medium sized vendors in South Delhi, India
Archna Singh*1, Aarti Srivastava2, Richa Bisht3, Anita Singh1
1
Biochemistry, All India Institute of Medical Sciences, New Delhi, 2Indian Institute of Public
Health, Gurgaon, 3UNICEF-ECHO, Shivpuri, India
Introduction: Policy and advocacy efforts are ongoing to minimize trans fatty acid con-
sumption in India, in the context of the increasing chronic disease burden driven by un-
healthy nutrition practices and choices. Trans fat consumption in India is considered to be
chiefly through hydrogenated oils i.e. vanaspati. In addition, the fatty acid composition of
oils also affects its quality for consumption due to susceptibility to degradative processes
like peroxidation etc.
Objectives: This study aimed to assess oil usage practices among small and medium sized
vendors in an area of Delhi, India. Such vendors are a substantial source of freshly prepared
ready-to-eat snacks in India.
Methods: The study sites were selected from the census enumeration block list, mapped
for vendor numbers and location; participants were selected by a random number gen-
eration . The survey was conducted amongst 50 vendors using a pretested questionnaire in
2011-2012 after obtaining informed consent.
Results: 19/26 (73.1%) of vendors had daily earnings of <2000INR. The mean number of
employees in the establishments (n¼47; 3 had
20 employees) was 4. Soy bean oil (86%)
was the most frequently reported frying medium (43/50). 60% of vendors (n¼30) were
using vanaspati for cooking (shortening as well as deep frying). Availability (34%) was the
commonest reason cited for choice of oils followed by taste and health factors (20% each).
11 types of freshly prepared deep fried snacks were reported being sold; common ones
being bread pakora (n¼32) (bread savoury), samosa (potato filled flaky pastry; n¼30) and
aloo tikki (potato cakes; n¼21). Cast iron utensils (Karahis) were most commonly used by
vendors for deep frying. 42/50 (84%) vendors reported intermittent heating and re-heating
of oils during the workday; 20 vendors were reusing the leftover oil/fat on the following
day. None of the vendors were using any scientific method to check the temperature of the
frying medium. Only 5 /50 (10%) vendors surveyed were aware of the term “trans fatty
acid” and its possible health impacts.
Conclusion: Regular and frequent use of hydrogenated oils for preparing snacks was re-
ported by food vendors with minimal knowledge about hydrogenated oils . Approaches to
minimize unhealthy oil consumption should include targeted awareness campaigns among
vendors and promotion of optimal cooking/food preparation practices. Policy makers
would benefit from such evidence to formulate policies to facilitate the implementation of
these strategies.
Disclosure of Interest: None Declared
PT316
Bringing data to life – an interactive online mapping tool for clinicians and health
planners
Harry Patsamanis*1, Greg Ford1, Steve Vander Horn2, Karen Page3, Hella Parker4
1
Victorian Division, National Heart Foundation of Australia, 2University of Melbourne, 3National
Heart Foundation of Australia, 4Victorian Department of Health, Melbourne, Australia
Introduction: The National Heart Foundation (HF) in collaboration with The University of
Melbourne and The Victorian Health Department developed an interactive online mapping
tool that visually presents the rate of hospital separations for acute coronary syndrome
(ACS) and heart failure at the local level. The tool takes hospital level data and presents it in
a format that is engaging for both clinicians and health planners. Data on risk factors and
socio-economic status was included to assist with population health planning and chronic
disease prevention.
Objectives: To take data that is already collected by government departments and make it
meaningful at a local level for agencies and health workers who deliver prevention and
treatment programs.
Methods: Five years of hospital data and key risk factor and socio- demographic data was
analysed to enable comparisons to be made between local populations, identifying trends
and patterns of presentation and risk. A software mapping program StatPlanet was used to
visually represent the data and allow for interactive search and discovery.
Results: In total, 79 local government areas were mapped allowing for meaningful com-
parisons at the local and regional level.
The maps identified major differences in the distribution of heart disease across the state
of Victoria; these were most evident between metropolitan and regional areas and those
living in areas of greater social disadvantage; for example regional areas had a 37% higher
admission rate for ST elevation myocardial infarction than metropolitan areas.
e227
 The maps have attracted significant interest from media, service providers, and gov-
POSTER ABSTRACTS
ernment agencies. Since the maps were launched in May 2013 there have been:
- $ 3,236 unique page views on the HF website (May-Sept)
- $ More than 150 stories in metropolitan and regional media within the first month
- $ Engagement with key agencies through workshops, newsletters, and presentations
Conclusion: This has proved to be an effective way to take existing data and present it in a
way that is accessible and meaningful. This tool could be adopted by other jurisdictions to
increase the profile of the burden of heart disease and the need for a better and more
coordinated service response; ensuring that services are planned for areas of greatest need.
Disclosure of Interest: None Declared
PT317
Modelling a pragmatic approach to the nigerian cardiovascular disease challenge: The
H.E.L.P model
Iseko I. Iseko*1, Abiodun M. Adeoye1
1 to their own technology
Medicine, University College Hospital, Ibadan, Nigeria
Introduction: World Health Organization report revealed that 80% of deaths from car-
diovascular diseases and 87% of related disability currently occur in low and middle in-
come countries and further emphasized that cardiovascular diseases have become the
leading cause of death in many developing countries.
Objectives: The development of a program for a pragmatic and sustainable approach to the
cardiovascular disease challenge in low and middle-income countries that is multi-faceted
but primarily two-pronged: (i) preventing and reduction of cardiovascular risk and (ii)
timely and appropriate intervention cardiovascular diseases.
Methods: H.E.L.P Model
The Health Education, Leadership and Primary cardiovascular care (H.E.L.P) model
seeks to emphasize attention to basic problems at the foundation level, education, lead-
ership and primary care, adapted to fit communities in a manner that is socially and
culturally acceptable, employing essential scientifically proven techniques for the
improvement of cardiovascular disease statistics amongst Nigerian communities and
possibly across Sub-Saharan Africa.
a) Education should be employed on two levels: (i) Community health education to
improve awareness of the largely asymptomatic cardiovascular risk and enlightenment to
foster lifestyle changes and patient participatory care; (ii) Medical education of doctors,
nurses, community health workers would have to place emphasis on cardiovascular dis-
eases in addition to the currently emphasized communicable diseases. This would form the
bedrock of early diagnosis, consultation and adherence to treatment.
b) Leadership represents a composite of political will and impactful scientific community
position on policy.
c) Primary cardiovascular care that is tailored essential health care based on available
evidence from Nigerian literature.
This model should form the bedrock of policy and community health advocacy to ensure
sustainability.
Results:
web 3C=FPO
Conclusion: If widely adopted and practiced, it is hoped that the estimated marked
reduction in morbidity and mortality from cardiovascular diseases would be significant to
at least equal the advantage of high end technology, infrastructure and personnel available
in economically advantaged countries.
Disclosure of Interest: None Declared
PT318
Health Navigator Project: Utlising a mobile website for smart phones and tablets to
actively reduce chronic disease risk factors in the Metro North Brisbane Medicare
Local catchment area
Joanna Jarden*1, Megan Collier2
1
Metro North Brisbane Medicare Local, 2Heart Foundation, Brisbane, Australia
Introduction: In an innovative approach to health promotion, this project utilises a mobile
website for smart phones and tablets to actively reduce chronic disease risk factors in the
Metro North Brisbane Medicare Local (MNBML) catchment area with an emphasis on the
socially disadvantaged, Indigenous, and culturally and linguistically diverse population.
The 2011 Medicare Local needs assessment found supporting primary care and attention to
early detection and disease prevention were key areas of need. There are underutilised
e228
health and wellbeing programs in the MNBML catchment area and nationally the usage of
technology for communication is increasing.
Objectives: To increase knowledge and awareness of risk factors among the target group
for chronic disease through innovation/technology To increase access for the target group
to GPs and Lifestyle Modification Programs (LMP’s) and other services in the local area, and
To increase the number of general practices undertaking risk assessments for cardiovas-
cular, diabetes and kidney disease
Methods: Development of a mobile website for smart phones and tablets with the
following functions:
- an easy to use consumer risk assessment tool
- advice and information
- links to a directory for GP access/ electronic self refer option into local programs
Form partnerships with neighbourhood centres, CALD and Indigenous organisations in
target communities to deliver onsite LMP’s to the disadvantaged community and address
cultural, transport and client trust barriers
Provide neighbourhood centre staff with tablets for use by clients who do not have access
Subsidise out of pocket fees to increase involvement in existing LMPs
Support general practice to integrate Absolute Risk for cardiovascular disease
Results: Preliminary information on the learnings to date of the development of the mobile
website will be provided. Strong partnerships have been built with organisations sharing
common goals including The George Institute for Global Health, the National Vascular
Disease Prevention Alliance, the Heart Foundation and local councils.
Conclusion: The meshing of specialist knowledge through key partnerships in the tech-
nology, clinical, and community sector both locally and nationally has been a unique and
critical enabler to the early success in this innovative project.
Disclosure of Interest: None Declared
PT319
Engaging the Community in a Mass Cardiopulmonary Resuscitation (CPR) training
session of the new Hands only guidelines
Orla Merrigan*1, julie sprakel2
1
Nursing, 2community Engagement office, Royal college of surgeons Ireland Medical university
Bahrain, Manama, Bahrain
Introduction: RCSI Bahrain has incorporated Community engagement as part of one of the
pillars of the Strategic Plan. Community Engagement as a concept refers to strategic
intervention on the part of the university to enhancing the wellbeing of the wider com-
munity. Under the auspices of Community Engagement it was decided to plan and run the
fist Free Mass Cardiopulmonary Resuscitation course (using the Family & Friends CPR kit)
for members of the lay public. A Mass CPR Learn to Save a life for free training session was
conducted for 300 members of the lay public in a large shopping Mall in Bahrain.
Objectives: The aim was to provide the first Mass CPR in Bahrain, therefore increasing the
number of lay public trained in the new life saving techniques. Additional aims of this pilot
project were to raise awareness of the lay public on the new Hands Only CPR guidelines as
per American Heart Association (2010)
Methods: An anonymous quantitative questionnaire was utilized, which assessed knowl-
edge of the New Hands only CPR, & usage of Social media in disseminating health care
information, here in the Gulf region.
Results: 52% (n¼145) were unable to identify when someone was in cardiac arrest, and
27% (n¼75) had witnessed a person in cardiac arrest. Only 51% (n¼142) were aware of
the new Hands Only guidelines 51% (n¼142). Evaluation of the session indicated that 98%
(n¼269) felt competent to perform hands only CPR in an Emergency. 98% (n¼268) were
interested in repeating this training session on a regular basis and 99% (n¼273) indicated
that they would use the DVD to show other members of their family and friends.
Conclusion: This is the first time that a Mass CPR campaign was run in the GCC. This
study has indicated that the public is eager for information, knowledge and training on
what to do in an emergency situation. The public also have advocated that they would like
to see policy or legislation on CPR and AED use in education and training.
Disclosure of Interest: None Declared
PT320
Sale of non-prescription medicines to cardiac patients in community pharmacies in
Saudi Arabia: A simulated client based study
Tarek Kashour*1, Abdulaziz Joury2, Mahmoud Althagafi2, Abdullah Al-Otaibi3, Ahmed Hersi1
1
Cardiology, 2King Saud University, Riyadh, 3King Abdulaziz University, Jeddah, Saudi Arabia
Introduction: Self-medication is well recognized as one of the reasons behind delayed
presentation of patients with ACS and AHF. Easy access to community pharmacies and the
purchase of cardiac medicines without a prescription can play an important role in this
phenomenon. The magnitude of this problem is unknown in Saudi Arabia.
Objectives: To determine the proportion of pharmacies selling medicines to cardiac pa-
tients without prescription in Saudi Arabia using simulate client method.
Methods: A random sample of community pharmacies in the two largest cities in Saudi
Arabia (Riyadh and Jeddah) were randomly selected and stratified by the region, time of the
day and week. Two investigators visited each pharmacy and simulated having a parent with
symptoms suggestive of either acute coronary syndrome or acute heart failure.
Results: Total of 600 pharmacies representative of all 5 regions of each city were visited at
different times of the day and week. 382 pharmacies dispensed medications without
prescription and 218 did not (63.7% vs. 36.3%; p<0.001). Of the 382 pharmacies
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
dispensing medications, 255 did so without demand, 67 with level-one demand and 60
with level-two demand (66.8%, 17.5% and 15.7%; p<0.001). Scenario type, time of the
day and week and number of clients present in the pharmacy didn’t affect pharmacist
decision. Bronchodilators and Pain killers were the highest dispensed medications for the
AHF scenario (57%% and 7%) and (26% and 24%) for the ACS scenario. Seventy percent
of the pharmacies presented with ACS and 56% with AHF scenarios advised clients to seek
medical opinion. Sixty two percent of the pharmacists instructed clients how often to take
the medications and 28.7% explained for how long to take them. Among the 218 (36.3% of
total pharmacists) who did not dispense medications, 210 (96.3%) did so for medical
reasons and only 3.7% for administrative reasons.
Conclusion: Our study shows that the patients presenting with symptoms of ACS and
AHF to community pharmacies can obtain medications without prescription. This repre-
sents a challenging public health problem in Saudi Arabia.
Disclosure of Interest: None Declared
PT321
Economic consequences of cardiovascular disease in South African households: an
analysis of the WHO Study on Global Aging (SAGE)
David Watkins*1,2, Elizabeth Brouwer3, Rachel Nugent3
1
Department of Medicine, University of Cape Town, Cape Town, South Africa, 2Department of
Medicine, 3Department of Global Health, University of Washington, Seattle, United States
Introduction: The burden of cardiovascular diseases (CVDs) and their risk factors is
increasing in South Africa at a time when the health system is simultaneously dealing with
the colliding epidemics of HIV/AIDS and injuries. Recently, surveys have demonstrated a
high economic burden of medical illness on households; however, little is known about the
particular economic impact of CVD.
Objectives: The objective of this study is to profile the economic impact of CVD care on
South African individuals and their households.
Methods: We use data from the World Health Organization Study on Global Ageing
(SAGE), South Africa, wave 1 to profile a nationally-representative sample of individuals
aged 50 or greater and their households. We define a subset of individuals and households
with stroke, angina, or CVD generally, based on self-report. We produce descriptive sta-
tistics for relevant health economic indicators at the individual and household level.
Results: Overall, 4895 individual respondents and 4227 households participated in the survey,
including 124 individuals with history of stroke, 209 individuals with angina, and 20 in-
dividuals with both conditions (total of 355 individuals with CVD). CVD patients were evenly
distributed across income quintiles; however, 81% had no private insurance, and 64% used
public facilities. Average out-of-pocket expenditures (OOP) for inpatient care were much higher
than the general inpatient population (ZAR 7173 vs. ZAR 883), with stroke and angina patients
paying an average of ZAR 1475 and ZAR 11,670 respectively. Outpatient OOP expenditures
averaged about ZAR 122, regardless of condition. Standard deviations for all measures were
large. The prevalence of hardship financing, defined as use of savings, sale of assets, or
borrowing to pay for care, was similar in CVD vs. non-CVD households (approximately 12%),
though slightly higher among angina patients than stroke patients (13.8% vs. 9.5%). Our study
was limited by self-reported diagnoses, recall bias, and variable response rates.
Conclusion: Older South Africans and their households spend more on inpatient care in
the presence of CVD, particularly angina. CVD does not appear to influence outpatient
OOP expenditures or rates of hardship financing. These results highlight the importance of
preventing acute CVD to protect households from financial shocks. Detailed prospective
studies are needed to understand the drivers of high OOP expenditure and the risk pre-
dictors of high household economic burden.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT322
POSTER ABSTRACTS
Potential disability-adjusted life years gained from a comprehensive salt reduction
policy in South Africa
David Watkins*1,2, Melanie Bertram3
1
Department of Medicine, University of Washington, Seattle, United States, 2Department of
Medicine, University of Cape Town, Cape Town, South Africa, 3Department of Health Systems
Financing, World Health Organization, Geneva, Switzerland
Introduction: The World Health Organization (WHO) has called salt reduction a “best
buy” in reducing the burden of non-communicable diseases globally. In 2011, the South
African government established targets for population salt reduction and recently passed
mandatory limits on salt in processed foods. A preliminary analysis estimated large re-
ductions in ischemic heart disease (IHD) and stroke, but the potential impact of the policy
has not modeled in a dynamic population over time.
Objectives: The objective of this study is to quantify the range of disability-adjusted life
years (DALYs) that could be averted by achieving from South Africa’s salt consumption
target 5 grams per person daily within the next 10 years.
Methods: We model the expected reduction in cardiovascular disease and death due to the
policy using nutritional surveys and a nationally-representative survey containing blood
pressure and socio-demographic data. We use regression coefficients and hazard ratios
from published meta-analyses of salt reduction and blood pressure reduction, respectively,
to estimate the average policy effect by age and sex. We use IHD and stroke mortality rates
and prevalence data from the WHO global burden of disease database. We input all pa-
rameters into PopMod, a dynamic state-transition model developed for cost-effectiveness
analysis. Effects are modeled over a 100-year period, assuming immediate reduction in risk
to the target with reversion of risk to present levels for the subsequent 90 years. Estimations
of favorable cost-effectiveness ratios are calculated using standard GDP thresholds rec-
ommended by WHO.
Results: We estimate that 148,089 DALYs will be averted by implementing the policy, with
79,706 DALYs among females and 68,383 DALYs among males. Any program costing less
than US$ 3.33 billion (2012 USD) over 10 years would be considered cost-effective, and
any program costing less than US$ 1.11 billion over 10 years would be considered very
cost-effective.
Conclusion: Population salt reduction in South Africa is likely to result in large reductions
in the burden of IHD and stroke, with slightly more health gains among women. At modest
levels of program cost, such a policy is likely to be very cost-effective. A full cost-effec-
tiveness analysis of this policy is ongoing and will incorporate the resource needs, unit
costs, and feasibility of achieving the proposed salt targets, as well quantify the uncertainty
around model inputs.
Disclosure of Interest: D. Watkins: None Declared, M. Bertram Employee from: Melanie
Bertram is a staff member of the World Health Organization. The author alone is
responsible for the views expressed in this publication, and they do not necessarily
represent the decisions, policy, or views of the World Health Organization.
PT323
Quality of Warfarin Management Determines the Ultimate Cost-Effectiveness for
Payer, Professional and Patient In Oral Anticoagulation
Gary B. Liska1, Thomas I. Koshy2, Richard C. San George3, Victoria Pigott1, Mark Volling*4
1
Clinical Development & Education, Alere, Inc., San Diego, CA, 2Scientific Affairs, Alere, Inc.,
Chicago, IL, 3Clinical Affairs, Alere, Inc., San Diego, CA, United States, 4Market Development,
Alere, Inc., Melbourne, Australia
Introduction: The anticoagulation market continues to expand with the approval of two
new classes of oral agents and additional drugs in development. Claims of non-inferiority
or superiority, in select subgroups, have been made under sub-optimal warfarin control.
New oral anticoagulants’ (NOAC) use has been limited by the same feature that drives their
convenience – lack of routine monitoring and therefore, no means of measuring patient
adherence. Additional barriers for use include high cost, no reversal agent and use in those
with renal impairment. All new agents have been compared to usual warfarin care. When
warfarin is well controlled, it can become the preferred agent, due in part to the ability to
monitor patient adherence.
Three independent studies have established NOACs to be equal to warfarin when the
time in therapeutic range was as low as 65.5%. Despite their relative brief time on the
market – NOACs have exceeded warfarin in total number of reported adverse events in the
U.S. FDA database. The balance between quality and cost containment is a global challenge
for clinicians and payers.
Objectives: Compare highly controlled NOAC studies to a real-world high quality warfarin
study and evaluate the impact on patient safety and reimbursement issues.
Methods: The following clinical trials of NOAC trials were evaluated: RE-LY (dabigatran),
ARISTOTLE (apixaban), ROCKET-AF (rivaroxaban), Hokusai-VTE (edoxaban). STABLE
was chosen as the high quality warfarin comparator study.
Results: The warfarin TTR results in the NOAC studies ranged from: 55%> 64%, STABLE
achieved a high TTR of 74%.
Conclusion: The quality of warfarin control significantly impacts whether to select and in
whom to prescribe a NOAC. Small improvements in warfarin control result in dramatically
improved outcomes. A global standard of care of weekly warfarin self-testing would
contribute to uniform improvement of warfarin quality irrespective of a patient care setting
and save governments significant drug costs while assuring drug adherence through
electronic INR data reporting.
Disclosure of Interest: G. Liska Employee from: Alere Inc., T. Koshy Employee from:
Alere Inc., R. San George Employee from: Alere Inc., V. Pigott Employee from: Alere Inc.,
M. Volling Employee from: Alere Inc.
e229
 PT324
POSTER ABSTRACTS
Free Pacemakers As Peace Makers - Saving Lives One Heart At A Time
Vijaya Bharat*1
1
Cardiology, Tata Steel, Jamshedpur, India
Introduction: In developing countries poverty poses challenges in healthcare delivery. In
the context of treatment involving pacemakers, most of the hospitals turn away poor pa-
tients who could not afford the expensive device. A large hospital in Eastern India took up
the challenge.
Objectives: To share the experience of developing a system for providing free pacemakers
to poor patients
Methods: Cardiologist of the hospital searched several options and zeroed on Heart Beat
International (HBI) in the USA. HBI coordinates with pacemaker manufacturers who
donate new devices for needy patients anywhere in the world. It distributes pacemakers
through banks governed by Rotary Clubs. In the year 2005, in association with a local
Rotary Club, a Pacemaker Bank was established. The steel industry to which the hospital is
attached waived off the procedure charge in poor patients. The fee of US $ 5000 to HBI was
donated every year by a partnering Rotary club from another city. Batches of new pace-
makers were sent from USA and Germany as per requirement.
Results: From March 2005 till Sep 11th 2013, 147 devices were implanted in 142 poor
patients. One of the beneficiaries was a poor man from distant Kabul in Afghanistan, who
got information about our work. There were 105 males and 37 females in the age range of
20 to 86 years. Medtronic, Biotronic, St Jude, Vitatron and Guidant pacemakers were
received. We implanted 90 dual chamber pacemakers, 50 single chamber pacemakers, 6
AICDs and one CRT device. While on regular follow up, ‘end of life’ warning was noted in
five dual chamber devices and one AICD. They were replaced with new devices. The
pacemaker bank experiences were shared in the HBI workshops held along with the
Annual Conferences of the American College of Cardiology at Chicago, New Orleans and
Atlanta. Interactions with experts led to RVOT pacing and a paper on the work was
published in a Canadian journal. Sakuji Tanaka, the President of Rotary International
awarded the cardiologist for humanitarian service.
Conclusion: After establishing the Pacemaker Bank no patient who could live normally
with a pacemaker is turned away from the hospital.
Disclosure of Interest: None Declared
PT326
The Evaluation of a Public Service Advertisement "Being healthy, Being away from
chronic diseases" in Chongqing, China
ping hu1, yuan ning2, chenbin wu3, haoxiang wang4, yaojie xie5, yong zhao1, Wentao Li*6
1
School of Public Health & Management, Chongqing Medical University, 2Community Health
Center, shiqiaopu Street, Yuzhong District Chongqing, 3Institute of health education, Chongqing,
Chongqing, China, 4General Practice and Primary Care, University of Glasgow, Glasgow, United
Kingdom, 5School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong,
Pokfulam, Hong Kong, 6School of nursing, Dalian university, Liaoning, China
Introduction: Chronic disease has become a global public health problem, affecting now
more than 260 million people in China. Public interest advertising acts as a high level
advertising form and an important approach in health education and health promotion.
Objectives: 1) to evaluate the effect of public service advertising on Chongqing citizens’
cognitive situation after broadcasting; 2) to explore how the audiences promote, memorise,
and understand information; 3) to assess the impact of publicity information on citizens’
attitudes and future behaviour changes.
Methods: The theme of public service advertisement on “being healthy, being away from
chronic diseases” was launched by Chongqing municipal Health Bureau of education
broadcasts via Chongqing television and mobile car from February to April, 2013. After
broadcasting, four communities were selected in Chongqing urban area. A self-designed
questionnaire was used by outdoor intercept survey to collect information on citizens
regarding the effect of cognitive situation after the public service ads.
Results: There were a total of 1000 people in total survey with 997 valid questionnaires
and 99.7% percent of completeness. The masses have a higher cognitive accuracy on
the types of chronic disease (58.43%w83.63%), the incentives (83.43%w89.56%), and
the prevention of health life style (86.14%w 93.78%) .There are 57.52%, 57.36%,
57.52% people agreed to "advertising for me and my life is a relationship", "the AD
makes me stop and thinks about my life", "advertising provides new information to
me", after watching it. 77.44% people tried to remind others to prevent chronic dis-
eases, 78.20% people tried to persuade others to change their bad life style, and a
proportion of 73.68% people mentioned that it increased the possibility of change their
own lifestyle.
Conclusion: The public service ads achieved a better knowledge propaganda effect. An
increase in the application range of public service advertisement was also observed. At the
same time, enhancing the advertising of the chronic diseases information (such as cancer
and harmfulness of smoking) that are less known to public in an intensive way would bring
about more comprehens
Disclosure of Interest: None Declared
PT327
Healthy Hearts through Healthy Spaces and Places
Kate White1, Jen Thompson1, Robert Grenfell*1
1
Healthy Hearts, Heart Foundation, Melbourne, Australia
e230
Introduction: Healthy Spaces & Places provides is the first-ever national guide in Australia
on how to make our cities and towns places that encourage walking, cycling, running and
catching public transport, in order that individually and as a society can have improved
lifelong health and wellbeing.
Healthy Spaces and Places outlines the design principles to consider when designing and
planning for health and wellbeing benefits.
Objectives: Key principles in designing the built environment can contribute to an in-
dividual’s propensity to be physically active and result in improved health outcomes. When
these design principles are integrated and applied correctly they can create an environment
that supports greater levels of physical activity, reduces the incidence of obesity and im-
proves mental health outcomes. There are ten key principles, for information on each click
on the principle below:
Active Transport
Aesthetics
Connectivity
Environments for All People
Mixed Density
Mixed Land Use
Parks and Open Space
Safety and Surveillance
Social Inclusion
Supporting Infrastructure
Methods: Healthy Spaces & Places is a resource designed in consultation with and for:
Planning & Design Professionals; Health Professionals; Governments; Property Devel-
opment Industry; and Community.
The unique tri-party partnership between non-traditional partners was a key to the
success of this unique resource. Since its inception in 2009, the partnership remains strong
and is between the Heart Foundation, the Planning Institute of Australia and the Australian
Local Government Association.
Results: Case studies: showing by example key principles and processes of implementing
Healthy Spaces and Places
The case studies are a small snapshot of policies, programs and projects being
undertaken around Australia that encourage physical activity through changes to the
built environment and have resulted in, or aim to improve mental and physical
health.
Conclusion: Healthy planning calls for multiple tools and cross-sectoral approaches.
It cannot be stated enough: everyday decisions make a difference. Small changes can
count as much as big or strategic ones.
Disclosure of Interest: None Declared
PT328
Variation in population health related quality of life (HRQoL) as measured by EQ5D
and impact of chronic conditions on QoL: Results from CARRS Study in India and
Pakistan
Kavita Singh*1,2, Roopa Shivashankar2,3, Mohammed K. Ali4, Rajendra Pradeepa5,
Mehmood K. Hassan6, Viswanathan Mohan5, Muhammad M. Kadir7, Nikhil Tandon1,
K. M. Venkat Narayan4, Dorairaj Prabhakaran2,3
1
Endocrinology and Metabolism, All India Institute of Medical Sciences, 2Centre for Chronic
Disease Control, 3Public Health Foundation of India, Delhi, India, 4Rollins School of Public
Health, Emory University, Atlanta, Georgia, United States, 5Madras Diabetes Research
Foundation, Chennai, India, 6Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ)
GmbH, Peshawar, 7Aga Khan University, Karachi, Pakistan
Introduction: HRQoL is a patient-oriented outcome of health care and is useful to guide
policy. The EQ5D (European Quality of Life 5 dimension) instrument is a generic HRQoL
measure of five dimensions of health status (mobility, self-care, usual-care, pain/discomfort
and anxiety/depression) within three severity levels. As data on HRQoL from developing
countries are scarce, there is interest in applying the EQ5D instrument to South Asian
populations.
Objectives: To measure and analyse EQ5D Visual Analogue Scale (EQ5D-VAS) data
collected from a representative sample of non-pregnant adults aged
20 years from three
metropolitan cities in India and Pakistan, and to determine the impact of major chronic
conditions (self-reported hypertension, diabetes, heart diseases, stroke and chronic kidney
disease) on HRQoL.
Methods: CARRS (Centre for Cardiometabolic Risk Reduction in South Asia) is a multi-
stage cluster random sampling cross-sectional survey of cardiometabolic risk-factors and
cardiovascular diseases in South-Asia. The EQ5D instrument was used in the CARRS
baseline survey (2010-11) to measure HRQoL. All descriptive analyses i.e. percentage of
respondents reporting moderate or severe health problems in each of the five EQ5D di-
mensions reported were stratified by study sites, and gender. Odds-ratios of moderate or
severe health problems in people with chronic conditions vs. without chronic conditions
were estimated.
Results: EQ5D-VAS was available in 16,284 participants; 52.4% women, and mean ages
43.5 and 41.3 years, for men and women, respectively. Seventy-four percent rated a health
profile of 11111 (perfect health), and only nine respondents rated 33333 (worst health).
Mean VAS was 74 (95%CI 73.7-74.2). Health status declined with advancing age, and
women reported more problems than men in the dimensions of mobility, pain/discomfort
and anxiety/depression (Table 1), similar to findings of EQ5D population health studies in
other countries. Persons with chronic conditions had worse HRQoL than those without
chronic illness (Table 2) - maximum odds ratio of 4.7 (95%CI 2.4-9.5) reported by men in
Delhi for self-care.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

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Conclusion: We found gender differences in HRQoL and confirm the negative impact of
chronic conditions on HRQoL. Our data in a large urban sample from India and Pakistan
are consistent with results from EQ5D population studies in other countries.
Disclosure of Interest: None Declared
PT330
Monitoring and Evaluation Mechanism of one of the PAN India NCDs program with
specific focus on Gestational Diabetes Mellitus Management
Manoj Joshi*1, Sandeep Bhalla1, Kolli S. Reddy2, Viswanathan Mohan3, Ranjit Unnikrishnan4,
Pratibha Karnad5, Dorairaj Prabhakaran6
1 Initiative for Primary Care Physicians in Non-Communicable Diseases- Evidence
Training, 2President, Public Health Foundation of India (PHFI), New Delhi, 3Dr. Mohan’s
Diabetes Specialities Centre, 4Dr. Mohan’s Diabetes Specialities Centre, Chennai, 5Johnson &
Johnson Medical India, Mumbai, 6Centre for Chronic Disease Control- CCDC, Public Health
Foundation of India (PHFI), New Delhi, India
Introduction: Given the current scenario of high incidence (15% of pregnant women)
of Gestational Diabetes Mellitus (GDM) worldwide and an estimated 4 million women
affected in India; there is a huge shortage of trained cadre of Obstetricians and
Gynaecologists (OG specialists), Primary Care Physicians (PCPs) to combat this
burden. To address this need, a comprehensive Certificate Course in GDM (CCGDM)
was launched on 25th August, 2013 to train 1460 OG specialists and PCPs in 55
Regional Centers covering 16 States, 1 Union Territory and 39 cities across India. The
training would be provided by 110 Regional Faculty under the guidance of 15 Na-
tional Experts.
Objectives: To ensure quality and standardized delivery of training program, a robust and
innovative Monitoring and Evaluation (M & E) mechanism has been devised which
comprises of onsite and offsite monitoring.
Methods: CCGDM aims to follow a vigorous Monitoring Mechanism during the entire
tenure of program as it will synthesize evidence regarding the challenges faced by stake-
holders, help in collation of feedback on course modalities and timely solutions for chal-
lenges which are crucial to maintain interest and reduce attrition of participants. A cadre of
25 Observers who are eminent Public Health Professionals and Hospital Administrators are
the backbone of M & E Mechanism. A detailed onsite and offsite Monitoring Plan has been
developed on the basis of standardized indicators and parameters to provide clear and
uniform format where data would be collected and stored for greater efficiency, trans-
parency and ease of access for all stakeholders.
M & E for this program comprises of indicators that measure inputs, process, outputs,
and outcomes. For effective M and E of CCGDM a list of indicators/ parameters have been
finalized. These include baseline survey to assess Knowledge, Attitude and Practices (KAP)
of GDM among participants, Short Message services (SMS) Real Time E- Monitoring
System and an End Line Evaluation. Routine data collection and compilation will be done
and compiled into a meaningful process document so that appropriate programmatic in-
terventions can be identified.
Results: The preliminary results will be presented at the meeting.
Conclusion: The launch of this program to tackle the shortage of trained manpower in
GDM management in India is just the beginning but the final success of program will
depend on how effectively we monitor and evaluate it.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT331
POSTER ABSTRACTS
Evaluation of certificate course in evidence based diabetes management: A pan India
capacity building program for primary care physicians
Rakesh Mehra*1, Shivangi Vats1
1
Training, Public Health Foundation of India, New Delhi, India
Introduction: Diabetes is considered as one of the major contributors to global burden of
disease. In India, health system is constraint in term of trained manpower and limited
institutional capacities for diabetes management. So keeping this fact in mind, Public health
foundation of India in collaboration with Dr Mohan Diabetes Education Academy devel-
oped an evidence based diabetes management course in 2010 for primary care physicians
to build their capacity and improve their skill in diabetes management.
Objectives: The aim of this study is to evaluate the short term impact of PAN India
Certificate Course in Evidence Based Diabetes Management (CCEBDM).
Methods: We used mixed method design for data collection incorporation on site pre and
post evaluation of all the primary care physicians and off site follow ups from n ¼ 225
participants who attended the course from 2010 to 2012. Impact of on site pre and post
evaluation was assessed used the significance level and off site evaluation was assessed by
using 5-point Likert Scale and observational technique was used to evaluate the impact of
course on their clinical practices and infrastructure.
Results: 2776 primary care physicians were assessed for knowledge improvement and it
was found that there is significant improvement (P value < 0.001) in knowledge
regarding basics of diabetes, pharmacological treatment, acute and chronic complica-
tions with management. Off site evaluation showed that frequency of treating diabetic
patient/physician/month increased (38% 501 to 1,500 patients per month and 44%
stated that they treated about 101 to 500 patients per month), confidence level of
physician increased. 90% were confident about managing patients on insulin
independently.
Assessment of clinic structure showed that 66% physicians had provision for laboratory
facilities routine blood screenings, 53% had on-site dieticians to help diabetic patients, 35%
had counsellors to guide patients, 49% were using DBMS, 79% had full time nurses on
duty, 76% used various forms of Patient Education Resources to elicit awareness about
diabetes.
Conclusion: CCEBDM found to be effective in knowledge improvement of physicians and
ultimately improving clinical practice in diabetes management. Also by building capacity of
primary care physicians in diabetes management, there seems to be a solution to control the
increasing burden of diabetes and to improve productivity of people who are living with
diabetes.
Disclosure of Interest: None Declared
PT332
An Integrated Potential Monitoring System for the Pan-India Capacity Building
Based Diabetes Management
Rakesh Mehra1, Shivangi Vats1, Shreyas Sharma*2
1
Training, Public Health Foundation of India, New Delhi, 2Training, Public Health Foundation of
India, Gurgaon, India
Introduction: Non-Communicable diseases are embracing India like a plague and the
huge burden is faced from Diabetes. Medical and Health fraternity is alarmed due to early
onset of Type-2 diabetes among young Indians as compared to their western counter-
parts. There is a contiguous need of building a national capacity of primary care physicians
through evidence based knowledge on diabetes management. Primary care physicians are
the first person to diagnose the disease in the initial stage. Based on this, a year-long once-
in-a- month Pan-India certificate course is launched to train physicians in the field of
evidence based diabetes management. 2776 doctors are already benefitted from the course
in past 2 years and 2306 are currently getting trained. With 134 centers and 164 trainers
spread across India, an unparalleled and rigorous monitoring plan needed to be formu-
lated with a practical and robust approach to ensure quality and effectiveness of the
program.
Objectives: Monitoring component was designed and executed to ensure quality and
effectiveness of the sessions conducted as per the standardised protocols of the program, to
determine the difficulties faced by trainers and participants in smooth session conduction
and take remedial actions to resolve the concerned issues to facilitate smooth conduction of
the program.
Methods: Monitoring component was divided into two sections, first in On-site moni-
toring component and second in Off-site monitoring component. For On-site monitoring
observers from all across India were identified and trained for monitoring visits. Tools were
developed for On-site and Off-site monitoring. Every month 13% of total centers were
monitored on-site and 10% of remaining centers were monitored off-site by collecting
feedback from the enrolled doctors.
Results: Regular and consecrated monitoring continuously for 3 years throughout the
program cycles, show 93% average satisfaction level among Observers in conduction of
sessions and adherence to protocols. Trainers average satisfaction level with the quality
management of the program is 78%. Participants reflect 84% average satisfaction level
pertaining to program management and quality of the course delivery.
Conclusion: Program specific designing and implementation of a well planned, stringent
and veritable monitoring model is important to ensure quality conduction of such Pan-
India programs to achieve satisfaction levels of the stakeholders.
Disclosure of Interest: None Declared
e231
 PT333 PT338
POSTER ABSTRACTS

The Relationship between Smoking and Cardiovascular Related Disease
Masanari Kuwabara*1,2,3, Koichiro Niwa2, Yutaro Nishi2, Ichiro Hisatome3
1
Cardiology, Toranomon Hospital, 2Cardiology, St. Luke’s Intrernational Hospital, Tokyo,
3
Regenerative Medicine and Therapeutics, Graduate School of Medical Science, Tottori
University, Yonago, Japan
Introduction: There were many reports that smoking influenced cardiovascular events, but
there were a few reports about the relationship between smoking and cardiovascular related
diseases in general people by using medical check-up (Ningen-doc) data.
Objectives: The purpose of this study is to clarify the relationship between smoking and
cardiovascular related diseases by using mass medical check-up data.
Methods: We collected data from the medical records of 90,143 Japanese (45,906 fe-
male(50.9%)) who had annual medical check-up from January 2004 to June 2010 in St.
Luke’s International Hospital, Tokyo, Japan. We compared the following data between
smoking and non-smoking people.
Results: Smokers was 36633(40.6%); male 27353(61.8%), female 9280(20.2%). The
data indicated smoker’s character in comparison with non-smoker. The rate of male(75%
vs 32%, p<0.001) was significantly higher. Age (47.111.8 vs 45.812.1 years,
p<0.001) was older. The prevalence of hypertension(18.4% vs 13.5%, p<0.001), dia-
betes(6.14% vs 2.85%, p<0.001), dyslipidemia(43.3% vs 30.3%, p<0.001), gout and/or
hyperuricemia(4.79% vs 1.54%, p<0.001), atrial fibrillation(0.50% vs 0.21%, p<0.001)
were higher. Though, these data had gender bias, we analyzed to divide in male and
female. In male, age (48.311.9 vs 44.812.1 years, p<0.001) was older. The preva-
lence of hypertension(22.2% vs 18.5%, p<0.001), diabetes(7.70% vs 4.43%, p<0.001),
dyslipidemia(50.7% vs 41.8%, p<0.001), gout and/or hyperuricemia(6.37% vs 4.63%,
p<0.001), atrial fibrillation(0.65% vs 0.42%, p¼0.001) were higher. In female, age
(43.710.8 vs 46.212.2 years, p<0.001) was younger. The prevalence of hyperten-
sion(7.3% vs 11.2%, p<0.001), diabetes(1.54% vs 2.13%, p<0.001), dyslipide-
mia(21.8% vs 25.0%, p<0.001) were lower. The prevalence of gout and/or
hyperuricemia(1.40% vs 1.12%, p¼0.16), atrial fibrillation(0.066% vs 0.096%, p¼0.08)
didin’t have significant difference.
Conclusion: Smoking may have strong influence of hypertension, diabetes, dyslipidemia,
gout and/or hyperuricemia, and atrial fibrillation in male, but in female smoking may have
less influence of cardiovascular related diseases than male.
Disclosure of Interest: None Declared
The new and the old – Digital reconstruction and analysis of mid-cross sections of
stained explanted hearts; evaluation and potential scope
Huw H. Llewellyn1, Leah M. Iles2, Andris H. Ellims2, David M. Kaye2, Andrew J. Taylor2,
Catriona A. McLean*1
1
Dept Anatomical Pathology, 2Department of Cardiology, The Alfred Hospital, Melbourne,
Australia
Introduction: Myocardial pathology from a range of disease processes;myocardial infarc-
tion, hypertension, cardiomyopathy and inherited disorders is typically heterogeneous.
Heterogeneity is increased by multi-focal and/or dual pathology. Standard pathological
analysis from single myocardial sections may not allow for complete understanding of
pathogenesis of human cardiac disease. Full mid-sections of explanted hearts, recon-
structed and digitally imaged for quantitation have advantages for pathologic diagnosis and
analyses of a larger 2-D format are useful for comparison with clinical diagnoses and
evolving imaging technologies.
Objectives: We aimed to develop and evaluate the accuracy of a technique for recon-
struction and analysis of full mid-sections of explanted hearts using routine pathology
techniques combined with widely available digital technologies.
Methods: 11 explanted hearts (dilated n¼8, ischaemic n¼1, restrictive cardiomyopathies
n¼1, congenital heart disease n¼1) were cut mid-way between the atrioventricular groove
and the apex. Both ventricles were sectioned and stained with masson-trichrome (M-T) and
sirius red stains. Slides were scanned on a lit-back scanner as .tiff images with M-T images
uploaded to Adobe Photoshop CS6 Extended (PS6). Several PS6 actions were run to allow
for complete reconstruction of hearts (see Fig.1) with quantitative pixel counts performed
to accurately quantitate myocardium and fibrosis into two layers and establish % fibrosis
per tissue section. For validation, a Pearson’s correlation coefficient was determined using a
sub-group of Sirius red stained single sections photographed at multiple x 200 magnifi-
cations using standard Image-J technology for fibrosis quantitation
Results: The correlation of our novel methodology for fibrosis quantification with con-
ventional analysis was excellent (R¼0.95, p<0.0001) (see Fig.2). Reconstructed whole
heart cross sections also allowed for comparison with the primary clinical diagnosis
(agreement in 11/11 cases) and accurate pathologic evaluation of the distribution, pattern
and viability of myocardial and interstitial changes including inflammation, early reparative
changes and collagen production across the entire left and right ventricles at the mid-short
axis level.

PT334
Supporting smoking cessation in Australian primary care: Results of the Quit in
General Practice study
Nicholas Zwar1, Robyn L. Richmond*1, Elizabeth Halcomb2, John Furler3, Julie Smith4,
Oshana Hermiz5, Irene Blackberry6, Ron Borland7
1
School of Public Health and Community Medicine, University of New South Wales, Sydney,

web 3C=FPO
2
School of Nursing, Midwifery & Indigenous Health, University of Wollongong, Wollongong,
3
Department of General Practice, University of Melbourne, Melbourne, 4College of Medicine,
Biology and Environment, Australian National University, Canberra, 5Centre for Primary Health
Care and Equity, University of New South Wales, Sydney, 6University of Melbourne, 7Cancer
Council Victoria, Melbourne, Australia

Introduction: Worldwide tobacco use remains one of the major preventable causes of
death and illness. Primary care interventions to support smoking cessation can be effective
but are often underutilized. New models are needed of enhanced cessation support in
primary care.
Objectives: To determine if personalized smoking cessation support provided primarily by
the practice nurse (PN) is more effective than Quitline referral or normal care.
Methods: Three arm cluster randomized controlled trial with blinded outcome assessment
conducted in family practices in Sydney and Melbourne. Participants were patients 18 and
over presenting to see their general practitioner (GP) who were current smokers and able to
give informed consent. The intervention consisted of quit support primarily provided by
the PN compared to Quitline referral and usual FP care. Patients in all three groups were
offered free nicotine patches. PNs in the study undertook six hours of education and were
then supported by mentoring phone calls. Sustained abstinence and point prevalence
abstinence was measured at 3 month and 12 month follow-up collected by telephone
interviewers blind to group allocation.
Results: Follow-up at 12 months was 82%. Assuming all those lost to follow-up relapsed,
web 3C=FPO

the sustained and point prevalence abstinence rates respectively at three months by group
were: PN intervention 13.1% and 16.3%; Quitline referral 10.8% and 14.2%; Usual GP
care 11.4% and 15.0%. At 12 months the rates were: PN intervention 5.4% and 17.1%;
Quitline referral 4.4% and 18.8%; Usual GP care 2.9% and 16.4%. Only 43% of partici-
pants in the PN intervention group attended to see the nurse. Multilevel regression analysis
showed no effect of intervention group overall but participants who received partial or
complete PN support were more likely to report sustained abstinence (partial support OR
2.27; complete support OR 5.34).
Conclusion: The results show no difference by intervention group on intention to treat
analysis. A dose-response effect was found where those patients who received more Conclusion: This novel but inexpensive methodology using old histologic and new digital
intensive nurse intervention were more likely to quit. This suggests that PN led cessation technologies provides accurate quantitation of various pathologies of entire cardiac mid-
support can be effective if patients are engaged and attend for follow-up. sections, with multiple potential diagnostic, clinical and research applications.
Disclosure of Interest: None Declared Disclosure of Interest: None Declared

e232 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

PT339
The Ang 1-7 mediated vascular and coronary reactivity in diabetic endothelial
dysfunction
Mihail Popovici*1, Popovici Lucia1, Valeriu Cobet1, Mihail Todiras1, Ion Moraru1
1 1
Interventional Cardiology, Institute of Cardiology of Moldova, Chisinau, Moldova, Republic of
Introduction: Ang 1-7 appeares as an intrigant peptide regulating AT1 receptor activity
and effects.
Objectives: The in vitro evaluation of rat aorta and coronary system response on action of
the different neuroendocrine factors, inclusively Ang 1-7, in diabetes induced endothelial
dysfunction.
Methods: Diabetes induced endothelial dysfunction (DED) was reproduced by strepto-
zotocin administration in rats. Using the models of isolated aorta ring and isovolumic heart
perfusion the vascular response (relaxant or constricting) and coronary flux were deter-
mined on action of acetylcholine (Ach), bradykinin, Ang 1-7, Ang II (inclusively in con-
dition of mas receptor blockade by A779), hydrogen peroxide, norepinephrine and
endothelin-1.
Results: The Ach action up on phenylephrine induced aorta ring contraction manifested
in DED by significant vasorelaxation reduction by up to 36% vs control pattern.
Remarkably, Ang 1-7 (10-7-10-5 M) has induced an aortic ring relaxation similarly to
control level, achieving a range of 11,4-26,5%. The Ang II induced constrictor plateau
is significantly elevated in DED by 51,9%. However, it decreases by 32,8% when a
premedication by Ang 1-7 is performed, and, contrarily, raises by 36,4% when mas
receptors are blocked by A779. Norepinephrine and endothelin-1 have induced in DED
an aorta contraction increasing by 34-42%. The analogous events were fixed in heart.
Thus, functional coronary reserve is reduced in DED on Ach and bradykinin action by
38 and 31%, respectively. Nevertheless, coronary reserve is not affected during Ang 1-7
action compared to control index: 8,84 vs 9,86% (p>0,05). Coronary flux on Ang II
action is decreased more pronounced by 46%, but the decline is limited by almost 50%
in condition of Ang 1-7 administration. The mas receptor blocking led to Ang II
induced coronary flow diminution more by 52%. Interestingly, the hyperpolarization
induced coronary dilation level related to hydrogen peroxide action is not impaired in
DED.
Conclusion: 1. Vasorelaxation and coronary dilation effects of Ang 1-7 are not impaired in
diabetes induced endothelial dysfunction, event that may be emphasized as compensator
pattern considering the fact of affected cholinergic vascular response. 2. Ang 1-7 signifi-
cantly reduces Ang II induced vaso- and coronary constricting effects, but mas receptor
blocking, contrarily, leads to their augmentation.
Disclosure of Interest: None Declared
PT340
Age-related impairment in androgen stimulation of vascular endothelial growth
factor-mediated angiogenesis
Yuen Ting Lam*1,2, Laura Lecce1,2, Laura Lindsay2, Gloria Yuen1,2, David J. Handelsman3,
Martin K. Ng1,2,4
1
Translational Research Group, The Heart Research Institute, 2The University of Sydney,
3
ANZAC Research Institute, 4Royal Prince Alfred Hospital, Sydney, Australia
Introduction: Vascular repair mechanisms such as angiogenesis are impaired with
increasing age. In men, ageing is also associated with a gradual decline in serum androgen
levels. Recent evidence has implicated androgens in the regulation of angiogenesis in vitro
and in vivo.
Objectives: We hypothesised that there may be an age-related impairment in androgen-
mediated angiogenesis.
Methods: Human dermal fibroblasts were isolated from young (<30yrs) and older
(>65yrs) men. Cells were incubated for 48h with 40nM dihydrotestosterone (DHT), with/
without hydroxyflutamide (HF), or phosphoinositide 3-kinase (PI3-kinase) inhibitor. Fi-
broblasts and fibroblast-conditioned media (FCmedia) were analysed by western blotting
and ELISA. FCmedia were used to assess angiogenic functions such as migration and tubule
formation in human umbilical vein endothelial cells (HUVECs). Nuclear fractionation and
fluorescence microscopy were used to study androgen receptor (AR) localisation following
treatment with 40nM DHT.
Results: FCmedia from DHT-treated young fibroblasts produced a 3-fold increase in
HUVEC tubulogenesis (p<0.05) and 2-fold increase in migration through increased VEGF
mRNA expression (p<0.05) and secretion (p<0.05). By contrast, fibroblasts from older
men were unresponsive to DHT treatment in that FCmedia from old cells lacked both
androgen-induced VEGF production and failed to enhance HUVEC angiogenic functions.
DHT-induced stimulation of VEGF secretion from young fibroblasts was AR-dependent
and corresponded with increased nuclear AR translocation (p<0.01) as well as increased
AKT expression (p<0.05) and phosphorylation (p<0.01), which were abrogated by PI3-
kinase inhibition. Fibroblasts from older men treated with DHT displayed reduced AR
nuclear translocation and absent AR-mediated VEGF production, despite a comparable
baseline level of AR protein.
Conclusion: Androgens stimulate paracrine modulation of angiogenesis via androgen re-
ceptor and PI3-kinase-dependent enhancement of VEGF production. Despite comparable
AR expression, old fibroblasts lack androgen-mediated VEGF production and subsequent
androgen stimulation of paracrine angiogenic processes. The absence of androgen-
enhanced stimulation of angiogenesis by fibroblasts from old men is likely due to defective
nuclear translocation of the androgen receptor.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT342
POSTER ABSTRACTS
A novel hemodynamics based mouse model as a tool for discovery of genes and
micro-rna that are associated with atherosclerotic plaque instability/rupture
Yung-Chih Chen1, Karlheinz Peter*1
Atherthrombosis, BakerIDI Heart and Diabetes Institute, Melbourne, Australia
Introduction: The high morbidity/mortality of atherosclerosis is typically precipitated by
plaque rupture and consequent thrombosis. However, research on underlying mechanisms
and therapeutic approaches is significantly hampered by the lack of animal models that
reproduce plaque instability observed in humans.
Objectives: An animal model of atherosclerotic plaque rupture is highly sought after for
new drug testing and new biomarker discovery.
Methods: Typical haemo dynamic conditions that contribute to the development of
vulnerable, unstable atherosclerotic plaques are low shear stress and high tensile stress.
Based on computational fluid dynamics modelling, we developed a mouse model that
imitates these haemodynamic conditions by a tandem stenosis.
Results: At 7 weeks postoperatively, we observed intraplaque hemorrhage (Figure 1) in
w50% of mice, as well as disruption of fibrous caps, intra-luminal thrombosis, neo-
vascularization and further characteristics typically seen in human unstable plaques.
Rupture vessel segment contain more abundance of CD3/CD31/CD45/MOMA-2 and
relatively large necrotic core and thinner fibrous cap. Administration of atorvastatin was
associated with plaque stabilisation and down regulation of MCP-1 and ubiquitin.
Microarray profiling of mRNA and microRNA and in particular its combined analysis
demonstrated major differences in the hierarchical clustering of genes and microRNAs
between non-atherosclerotic arteries, stable and unstable plaques and allows the identifi-
cation of distinct genes/microRNAs, potentially representing novel therapeutic targets for
plaque stabilisation. The feasibility of the described animal model as a discovery tool was
established in a pilot approach, identifying ADAMTS4 and miR-322 as potential pathogenic
factors of plaque instability in mice and the involvement in plaque instability was validated
in human atherosclerotic plaques.
web 3C=FPO
Conclusion: The newly described mouse model reflects human atherosclerotic plaque
instability/rupture and represents a unique discovery tool that allows the identification of
distinctly expressed genes and microRNAs that are linked to plaque instability. It also holds
promise towards the development and testing of therapeutic strategies aimed at preventing
plaque rupture.
Disclosure of Interest: None Declared
PT343
Higher plasma thrombospondin-1 level is associated with cardiovascular disease and
predicts mortality in hemodialysis patients
Chi-Lun Huang*1, Wei-Shiung Yang2, Yuh-Shiun Jong1
1
Internal Medicine, Taoyuan General Hospital, Taoyuan City, 2Internal Medicine, National
Taiwan University Hospital, Taipei, Taiwan, Province of China
Introduction: Thrombospondin-1 (TSP-1), an extracellular matrix glycoprotein first
discovered in activated platelets, is currently known to be involved in angiogenesis,
inflammation, and cancer. It binds to protein components of the extracellular matrix and is
a major activator of transforming growth factor beta 1. Recent studies found that TSP-1
regulates cardiovascular function via CD47. Clinical investigations also confirmed its roles
in peripheral artery disease, coronary artery disease, and pulmonary hypertension.
Objectives: The aim of our study was to evaluate the association of plasma TSP-1 levels
with cardiovascular disease (CVD) in patients undergoing maintenance hemodialysis.
Moreover, we examined the clinical importance of the biomarker with regard to outcome
prediction in hemodialysis patients.
Methods: A total of 140 Taiwanese hemodialysis outpatients (age 61.0  12.4 years) were
prospectively followed up for 34  7 months. Two-dimensional echocardiography, ankle-
brachial index (ABI), and Tl-201 dipyridamole single-photon emission computed tomog-
raphy were performed for cardiovascular evaluation. Levels of TSP-1 and other biomarkers
were analyzed from pre-hemodialysis fasting blood samples.
e233
 Results: Plasma TSP-1 levels were higher in subjects with preexisting CVD than those
POSTER ABSTRACTS
without CVD (5.41 vs. 3.35 ng/mL, P < 0.0001). In the univariate correlation ana-
lyses, TSP-1 level was negatively correlated with ABI, LV ejection fraction and posi-
tively correlated with myocardial scar burden. Stepwise logistic regression analysis
demonstrated that TSP-1 level was independently associated with the presence of
CVD, with an odds ratio of 1.33 (95% CI, 1.05–1.67, P ¼ 0.017). In the survival
analyses, 31 patients (22%) died during the follow-up, of whom 16 (52%) died of
cardiovascular causes. The Cox hazards analysis after adjustment for the conventional
risk factors revealed that TSP-1 level in the highest tertile was a determinant of total
mortality (HR 4.62; 95% CI, 1.50–14.32; P ¼ 0.008) and cardiovascular mortality
(HR 5.34; 95% CI, 1.04–27.32; P ¼ 0.044) when compared with the TSP-1 level in
the lowest tertile.
Conclusion: Plasma TSP-1 concentration was higher in hemodialysis patients who have
CVD than in those without CVD and was also an independent predictor of all-cause and
cardiovascular mortality during the 3-year follow-up period. The associations of TSP-1
concentration with CVD and mortality prediction suggest its potential roles in risk strati-
fication among hemodialysis patients.
Disclosure of Interest: None Declared
PT345
In Vivo Assessment And Comparison of The Pro-Angiogenic Properties of Ipsc-Ecs
Generated By Retroviral Transduction and Modified Mrna Transfection
Zoe E. Clayton*1, Sheena Abraham2, Bob Bao3, Gloria Yuen1, Martin Ng1,4, John Cooke2,5,
Sanjay Patel1,4
1
Heart Research Institute, University of Sydney, Sydney, Australia, 2Stanford University,
Stanford, United States, 3Department of Pathology, University of Sydney, 4Department of
Cardiology, Royal Prince Alfred Hospital, Sydney, Australia, 5Cardiovascular Sciences, The
Houston Methodist Research Institute, Houston, United States
Introduction: Autologous stem cell therapies have shown potential in promoting
vascular regeneration in patients with cardiovascular disease. Induced pluripotent stem
cells (iPSCs) are a novel cell type generated by reprogramming somatic cells to a
pluripotent state via overexpression of key transcription factors. iPSCs can then be re-
differentiated into other cell types, including endothelial cells (iPSC-ECs). iPSC-ECs
generated by viral transduction have been previously shown to promote angiogenesis in
a murine model of peripheral arterial disease, however such cells may not be suitable for
human studies.
Objectives: Therefore, we aimed to assess the in vivo angiogenic potential of iPSC-ECs
generated using modified mRNA and to compare these cells to virally transduced
iPSC-ECs.
Methods: Male NOD-SCID mice were randomly assigned to receive either iPSC-ECs
generated by viral transduction, iPSC-ECs generated by modified mRNA transfection
or control media. Unilateral femoral artery ligation was performed and cells were
delivered via intramuscular injection at the time of surgery. Recovery of the ischaemic
limb was tracked using Laser Doppler perfusion imaging on days 0, 1, 2, 4, 7, 10
and 14 and cell survival was tracked using bioluminescence imaging. At day 14,
gastrocnemius and adductor muscle samples were taken for histological and molecular
analysis.
Results: Blood perfusion recovery in the ischaemic limb was enhanced in mice that
received iPSC-ECs. At Day 14, recovery was significantly enhanced in mice that received
mRNA transfected iPSC-ECs, compared to controls (0.610.08 vs 0.400.05, p<0.01).
There was no significant difference between virally transduced iPSC-ECs and modified
mRNA-transfected iPSC-ECs or between viral iPSC-ECs and controls. Immunohisto-
chemical analysis of ischaemic gastrocnemius muscle sections found that capillary density
tended to be higher in mice that received mRNA transfected iPSC-ECs (1.080.03 vs
0.980.02). The difference between the two groups was not significant, although there was
a significant overall treatment effect (p<0.05).
web 3C=FPO
Conclusion: iPSC-ECs generated using modified mRNA augmented perfusion recovery in
this hindlimb ischaemia model. These findings support the notion that iPSC-ECs are a
promising regenerative strategy for patients with cardiovascular diseases.
Disclosure of Interest: None Declared
e234
PT347
Chronic Simvastatin treatment reduces heart function and causes myocardial fibrosis
in healthy mice
Margareta Scharin Täng*1, Martin Dalin2, Jan Borén1, Martin Bergö2
1
Department of Molecular and Clinical Medicine/Cardiology, 2Department of Molecular and
Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
Introduction: Statins (HMG-CoA reductase inhibitors) have lipid-lowering and anti-
atherosclerotic effects and decrease mortality in patients with hypercholesterolemia. Statins
have also been shown to have some cholesterol-independent positive effects on the
myocardium, suggesting a possible use in patients with normal lipid levels as well. How-
ever, the effect of long term statin treatment on heart function of patients with normal
cholesterol levels has not been investigated, and no previously published mouse models
have assessed this issue.
Objectives: The aim of our study was to investigate the effect of heart function after long-
term Simvastatin treatment in mice.
Methods: Wildtype mice were given normal chow (controls) or normal chow with Sim-
vastatin (40mg/kg/day) added from 3 weeks of age. The echocardiographic examination
was performed with isofluorane anesthesia (w1,0%) using a VEVO 770 system and linear
transducer RMV 704 (Visualsonics Inc., Toronto, Canada)
Results: Echocardiographic examination at 12 months of age showed reduced heart
function in the Simvastatin-treated group (Table 1). Simvastatin-treated mice also had a 3-
fold increase in myocardial fibrosis and a 20% increase in relative heart weight compared to
control mice at 12 months of age. There was no difference between the groups regarding
lipid levels or liver weight.
Table 1. Echocardiographic analysis.
Control (n[8)f Simva (n[8) p
HR, bpm 45946 37967 <0.05
EF, % 588 4710 <0.05
CI, ml/min/g 0.520.14 0.380.10 <0.05
LVEDV, ml 57.417.3 66.218.4 ns.
LVESV, ml 24.912.0 36.015.2 ns.
HR, heart rate; bpm, beats per minute; EF, ejection fraction; CI, cardiac index; LVEDV, left ventricular
end-diastolic volume; LVESV, left ventricular end-systolic volume;. Values are meanSD. P values are
from Student’s t test (unpaired, 2-tailed).
Conclusion: Chronic oral treatment with Simvastatin leads to reduced heart function,
heart hypertrophy and myocardial fibrosis in mice with normal lipid levels. These results
suggest some caution in terms of Simvastatin treatment in patients with normal cholesterol
levels.
Disclosure of Interest: None Declared
PT348
Left Ventricular Filling Pressure (Estimated By E/Ea) Predicts Cardiovascular Events
In Fabry Disease: Assessment of Long-Term Outcomes In an Australian Fabry Cohort
Andrew Talbot*1, Nigel Lewis2, Kathy Nicholls1
1
Nephrology, 2Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Fabry Disease (FD) is an X-linked lysosomal storage disease caused by
deficiency in the enzyme a-galactosidase resulting in intracellular storage of globo-
triaosylceramide. Cardiac involvement is associated with left ventricular hypertrophy,
conduction defects and diastolic dysfunction that can improve with enzyme replacement
therapy (ERT).
Objectives: We assessed the long-term progression of cardiomyopathy in a single centre
Australian cohort of Fabry patients on ERT. The impact of initial disease status, dia-
stolic dysfunction, renal function and hypertension on cardiovascular outcomes was
determined.
Methods: A retrospective analysis of 30 patients from the single Victorian Fabry Centre
cohort was undertaken. Cardiovascular outcomes were prospectively monitored 6 monthly
by clinical review and ECG with echocardiography at 12 monthly intervals. Concurrent 6-
monthly monitoring of renal parameters was performed. Data was analysed at baseline,
then 1, 2, 5, 7 and 10 years after commencement of ERT.
Results: Over 10 years of treatment, left ventricular mass index (LVMI) increased by 38.9
g/m2 (138.0  47.6 versus 176.9  88.0, p¼0.0284), interventricular wall thickness
(IVSd) increased by 3.2mm (12.33  2.89 versus 15.54  6.57, p¼0.0085) and posterior
wall thickness (PWd) by 1.3mm (11.92  2.73 versus 13.15  4.08, p¼0.0296). Patients
with end-stage renal disease (CKD5) (N¼10) had worse baseline measurements and
increased cardiovascular events over time (Figure 1). Increases in LVMI, IVSd and PWd
correlated with markers of diastolic dysfunction. E/Ea was higher in patients having car-
diovascular events (13.83  4.78 versus 27.9  9.7, p<0.0001). Renal function was stable
in non CKD5 patients (baseline 84  18.1 ml/min/m2 versus 10 years of ERT 84.4  27.7
ml/min/m2, p¼0.59).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: Early treatment of FD with ERT stabilizes cardiac morphology and renal
function. If abnormal cardiac parameters have not improved by 2 years on ERT, they are
unlikely to respond later. Elevated left ventricular filling pressure, defined by E/Ea >15,
identified patients at increased risk of cardiac events. Patients with severe renal disease
continue to decline despite ERT and renal transplantation.
Disclosure of Interest: A. Talbot Grant/research support from: Shire Corporation, Sanofi
Corporation, Amicus Therapeutics, Protalix Biotherapeutics, Honorarium from: Shire
Corporation, Sanofi Corporation, N. Lewis: None Declared, K. Nicholls Grant/research
support from: Shire Corporation, Sanofi Corporation, Amicus Therapeutics, Protalix Bio-
therapeutics, Honorarium from: Shire Corporation, Sanofi Corporation, Amicus Thera-
peutics, Protalix Biotherapeutics
PT349
Droplet digital PCR measurement of copy number variation in genome-wide
association regions for blood pressure reveal association with essential hypertension
Francine Marques1, Priscilla R. Prestes1, Leonardo B. Pinheiro2, Katrina Scurrah3,
Kerry R. Emslie2, Maciej Tomaszewski4, Stephen B. Harrap3, Fadi J. Charchar*1
1
School of Health Sciences, University of Ballarat, Ballarat, 2National Measurement Institute,
Sydney, 3Department of Physiology, University of Melbourne, Melbourne, Australia,
4
Department of Cardiovascular Science, University of Leicester, Leicester, United Kingdom
Introduction: The role of copy number variation (CNV) has been poorly explored in
essential hypertension in part due to technical difficulties in accurately assessing absolute
numbers of DNA copies. Droplet digital PCR (ddPCR) provides a powerful new approach
to CNV quantitation.
Objectives: Aim of our study was to investigate whether CNVs located in regions previ-
ously associated with blood pressure (BP) variation in genome-wide association studies
were associated with essential hypertension by the use of ddPCR.
Methods: Using a “power of extreme” approach, we quantified nucleic acids using
ddPCR in white subjects from the Victorian Family Heart Study with extremely high
(n ¼ 96) and low (n ¼ 92) SBP, providing power equivalent to 1714 subjects selected
at random.
Results: A deletion of the CNVs 3306 and 64617 on chromosome 1p13.2 was significantly
more prevalent in extreme high BP subjects after adjustment for age, body mass index and
sex (12.6% vs. 2.2%; P¼0.013). Subjects with 3 copies of the CNV 4094 on chromosome
20p12.2 had 5.5 mmHg lower diastolic BP in the extreme high BP group than those with 2
copies in the same group (P¼0.024).
Conclusion: These data suggest that CNVs within regions identified in previous GWAS
may play a role in human essential hypertension.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT350
POSTER ABSTRACTS
A novel zebrafish model of dilated cardiomyopathy
Inken Martin*1, Arie Jacoby1, Kelly Smith2, Joachim Berger3, Gunjan Trivedi1, Diane Fatkin1
1
Molecular Cardiology, Victor Chang Cardiac Research Institute, Sydney, 2Institute for Molecular
Bioscience, University of Queensland, Brisbane, 3Department of Zebrafish Muscle Development
and Evolution, Australian Regenerative Medicine Institute, Melbourne, Australia
Introduction: Dilated cardiomyopathy (DCM) is a myocardial disorder characterised by
ventricular enlargement and contractile dysfunction and is a major cause of heart failure.
Genetic factors play a significant role in the pathogenesis of DCM, however these are poorly
understood. In recent years, the zebrafish has emerged as an important model of genetic
heart disease and here we present a novel zebrafish mutant, torn heart (toh), isolated from a
chemical mutagenesis screen and displaying the features of dilated cardiomyopathy.
Objectives: The objectives of this study were to characterise the phenotype of the toh
zebrafish mutant and identify the causative mutation in order to understand the cellular,
molecular and genetic basis for the cardiomyopathy in this strain.
Methods: Development of the heart and the decline in contractile function was docu-
mented by microscopic observation of live embryos. Immunohistochemistry was carried
out to assess heart development in the mutant. A combination of next-generation
sequencing and linkage analysis was used to localise the underlying mutation in toh.
Results: The toh mutant has a robust, embryonic heart failure phenotype with a recessive
inheritance pattern. The hearts of mutant embryos were found to develop normally and
contract vigorously but shortly after chamber formation, ventricular contractility of toh
embryos began to decrease. From 40 hours post fertilization (hpf), the ejection fraction of
the toh ventricular chamber progressively declined from the normal 37% to 10% at 72 hpf,
and by 96 hpf the ventricle was completely silent. This was accompanied by failure of
circulation, bradycardia and increasing pericardial edema, with the heart chambers
becoming thin and elongated. In the majority of toh embryos, by 72 hpf the atrial chamber
partially detached from the venous inlet, to which it remained attached only by a thread of
myocardium. Conventionally, chemically-induced mutations have been identified by po-
sitional cloning using microsatellite markers. However, the recent completion of the
zebrafish genome has enabled the application of next-generation sequencing to this type of
study. Our novel approach employs whole genome sequencing of the mutant to identify
the causative genetic variant. The results of this approach will be presented.
Conclusion: Identification of the genetic basis of the toh mutant may reveal a previously
unknown candidate gene for human DCM.
Disclosure of Interest: None Declared
PT351
Influence of ABCB1 and CYP2C19 Polymorphisms on ADP-Induced Platelet
Aggregation and Clinical Outcomes in Clopidogrel-Treated Multiethnic Asian
Patients Planned for Percutaneous Coronary Intervention (PCI)
Jia Ni Chua1, Alan Y. Y. Fong2, Siaw San Hwang1, Wen Ni Tiong3, Lana Y. H. Lai4,
Mejin Melissa4, Lee Len Tiong*4, Tiong Kiam Ong2
1
Faculty of Engineering, Computing and Science, Swinburne University of Technology Sarawak
Campus, Kuching, 2Department of Cardiology, Sarawak General Hospital Heart Centre, Kota
Samarahan, 3Clinical Research Centre, Sarawak General Hospital, Kuching, 4Department of
Pharmacy, Sarawak General Hospital Heart Centre, Kota Samarahan, Malaysia
Introduction: Clopidogrel plays a crucial role in preventing thrombotic events in patients
undergoing PCI. ABCB1 and CYP2C19 polymorphisms involved in drug absorption and
metabolism can influence the antiplatelet efficacy of clopidogrel.
Objectives: We aimed to determine the frequencies of ABCB1 C3435T, CYP2C19*2, *3
and *17 variant alleles and their association with ADP-induced platelet aggregation (ADP-
PA) in clopidogrel-treated multiethnic Asian patients before possible PCI and 1-month-
follow-up of clinical outcomes in those who had PCI.
Methods: A total of 237 consecutive patients, who were electively admitted for possible
PCI, were recruited from a Malaysian tertiary cardiology referral centre. These patients
underwent either dual antiplatelet therapy, DAPT (clopidogrel plus aspirin) or aspirin
monotherapy. ABCB1 C3435T, CYP2C19*2, *3 and *17 genotypes were determined by
PCR-RFLP assay and high resolution melt analysis. ADP-PA was assessed by Multiplate
analyzer.
Results: The allelic frequencies of CYP2C19*2, *3, *17 and ABCB1 3435 T alleles were
18.1%, 1.9%, 0.4% and 19.0% for Chinese, 5.9%, 1.5%, 0.2% and 7.4% for Malay, 3.2%,
1.9%, 0.2% and 6.5% for native Iban, and 2.1%, 0.8%, 0.8% and 4.0% for other races,
respectively. Of the 104 patients who underwent the most common DAPT pretreatment
regime (Aspirin 75mg OD
2 days and Clopidogrel 75mg OD
4 days), 82.7% (n¼86) of
patients were CYP2C19 or ABCB1 loss-of-function (LoF) allele carriers showed higher
ADP-PA levels than non-LoF carriers (306.7149.2 vs 265.6144.9 AU*min, p¼0.29).
From the 104 patients, only 41.3% (n¼43) had PCI with
1 stent. Among these 43 pa-
tients, 81.4% (n¼35) were CYP2C19 or ABCB1 LoF allele carriers. Again, ADP-PA levels
were higher in LoF allele carriers compared to non-LoF carriers (311.3158.0 vs
233.3120.6 AU*min, p¼0.20). None of the 43 patients had major adverse cardiovascular
events (MACE) or major bleeding events up to 1 month post-PCI.
Conclusion: ABCB1 3435C>T and CYP2C19*2 carriers, but not CYP2C19*3 and *17, are
highly prevalent in Malaysians especially in the Chinese subjects. ABCB1 and CYP2C19
genotypes were not significantly associated with ADP-PA level, and 1 month-MACE in
those undergoing PCI, in the Malaysian population.
Disclosure of Interest: None Declared
e235
 PT352 Introduction: Ageing is a significant risk factor for cardiovascular disease that is charac-
POSTER ABSTRACTS

terised by progressive impairment of vascular repair mechanisms such as vasculogenesis

Insulin-Like Growth Factor Binding Protein 4 Enhances Cardiomyocyte Induction In
Mouse Induced Pluripotent Stem Cells
Hui Gong*1, Yuanyuan Xue1, Yuan Yan1, Peipei Yin1, Zhiwen Ding1, Guoping Zhang1,
Chunjie Yang1, Yunzeng Zou1
1 Methods: Young (2month) and old (24month) male C57Bl/6J mice underwent hindlimb
Zhongshan hospital, Fudan University, Shanghai, China
Introduction: The establishment of induced pluripotent stem cells (iPSCs) potentially
provides a unique resource for generating patient specific cardiomyocytes to for cardiac
repair. However, the poor efficiency and yield of cardiomyocytes currently limits the
application of this technology. Insulin-like growth factor binding protein 4 (IGFBP4) has
been reported to play critical role in cardiomyocytes differentiation of embryonic stem cells
(ESCs). But whether it promotes iPSCs into cardiomyocytes is unclear.
Objectives: In the present study, we aim to explore the role of IGFBP4 in the cardiogenesis
of mouse iPSCs.
Methods: For differentiation, iPSCs were trypsinized and EBs were generated by the three-
dimensional hanging-drop method. EBs were grown in hanging drops for three days (day
0 to day 3), each drop initially consisted of 1000 cells in 30 mL of differentiation medium
(growth medium without LIF). IGFBP4 (Sino Biological Inc.) was added at day 3-8,day 3-6
and day 6-8 period under 1 mg/ mL to determine the effective time-window.
Results: We observed that IGFBP4 treatment at late-stage during differentiation process of
mouse iPSCs greatly enhanced the beating frequency of embryoid bodies (EBs). The ex-
pressions of Nkx2.5 (cardiac specific transcription factor), a-MHC, a-actinin and Troponin
I (cardiac specific protein) were significantly enhanced by IGFBP4 treatment. Immuno-
staining analysis showed that a-MHC, TNNT2 and connex43, typical cardiac markers,
were obviously expressed in isolated cardiomyocytes from iPSCs with or without IGFBP4
treatment. Further study revealed that IGFBP4 had little effect on the apoptosis of EBs. But
it significantly promoted the proliferation of cardiomycytes from iPSCs chracterized by
higher ratio BrdU positive cells in differentiated cardiomyocytes. We next observed that
IGFBP4 inhibted b-catenin expression in cytosol of EBs at late-stage during differentiation
of iPSCs. Knockdown of b-catenin using a siRNA technique promoted the proliferation of
differentiated cardiomyocytes and enhancing cardiomyocytes induction of iPSCs, sug-
gesting that the effect of IGFBP4 on cardiomyocyte differentiation of iPSCs has relationship
with b-catenin signaling pathway.
Conclusion: In conclusion, IGFBP4 promotes cardiogenesis of iPSCs by enhancing the
proliferation of differentiated cardiomyocytes through b-catenin signaling.
Disclosure of Interest: None Declared
PT353
and angiogenesis. However, to date, the impact of ageing on the mechanisms underlying
ischaemia-mediated neovascularisation are incompletely understood.
Objectives: To investigate the mechanisms which underlie the age-related decline in
ischaemia-mediated vasculogenesis and angiogenesis.
ischaemia (HLI) surgery and subsequent monitoring of blood flow recovery via laser
doppler perfusion imaging. Sca1+/CXCR4+ endothelial progenitor cells (EPCs) were
quantified by flow cytometry. To assess the effect of ageing on EPC function in vivo, bone
marrow transplantation and intramuscular injection of isolated bone marrow mononuclear
cells (MNCs) were performed in conjunction with hindlimb ischaemia
Results: Young mice achieved full recovery of blood flow post-HLI within 14 days, whereas
blood flow recovery was absent in old mice (p<0.001). Ageing was associated with impaired
EPC mobilisation into circulating blood on day 7 post-HLI (young vs. old, 27.21%3.162 vs.
17.13%1.089, p<0.05) despite adequate EPC numbers in bone marrow on day 3 post-HLI
(young vs. old, 1.97%0.366 vs. 3.97%0.616, p<0.01). Young recipients transplanted
with old bone marrow also demonstrated impaired EPC mobilisation into the blood on day 7
compared with recipients which received young marrow (young vs. old, 30.791.986 vs.
8.9220.849, p<0.001). The failure of old EPC mobilisation in young recipients suggested a
defective EPC response to adequate ischaemia-mediated tissue signalling. To assess old EPC
function in vivo, isolated MNCs from old mice were manually mobilized by intramuscular
injection. Old mice injected with MNCs showed an improvement in blood flow recovery post-
HLI (MNC vs. PBS, 0.7930.092 vs. 0.4800.075, p<0.01).
Conclusion: The age-related impairment in revascularisation observed in old mice cor-
responds with a lack of progenitor cell mobilisation. Defective EPC mobilisation from old
marrow cannot be rescued by transplantation into a young environment. However, EPCs
from old mice retain adequate function in promoting revascularisation of ischaemic tissue
once mobilised.
Disclosure of Interest: None Declared
PT356
VCP746, a novel A1/A2 adenosine receptor agonist, reduces hypertrophy in cardiac
myocytes and collagen synthesis in cardiac fibroblasts and renal mesangial cells
Chung Hui Chuo*1, Lauren May1, Longxing Cao1, Peter Scammells1, Henry Krum1,
Bing Hui Wang1, Paul White1
1
Monash University, Melbourne, Australia

Identification of miRNA networks in pathological cardiac remodelling-New Introduction: Following myocardial infarction (MI), a localised inflammatory response
therapeutic targets occurs as a result of the migration of inflammatory immune cells such as macrophages and
neutrophils to the myocardium. Post-MI patients have elevated plasma levels of cytokines
Jenny Y. Y. Ooi*1, Bianca C. Bernardo1, Esther J. H. Boey1, Ruby C. Y. Lin2, Julie R. McMullen1 such as IL-1b and TGF-b1 which contribute to adverse cardiac remodelling and the
1
Cardiac Hypertrophy, Baker IDI Heart and Diabetes Institute, Melbourne, 2Ramaciotti Centre subsequent development of heart failure and chronic kidney disease (hence leading to the
for Gene Function Analysis, University of New South Wales, Randwick, Australia development of cardio-renal syndrome).
Objectives: The aim of this study was to determine the effects of the novel A1/A2 adenosine
Introduction: MicroRNAs (miRNAs) have emerged as novel and promising therapeutic receptor agonist, VCP746, on hypertrophy in cardiomyocytes and fibrosis in both cardiac
targets for cardiovascular diseases. We recently reported that therapeutic inhibition of miR- fibroblasts and renal mesangial cells, which are important processes involved in cardiac and
34a (with a 15 mer antimiR) was not as effective as the inhibition of the entire miR-34 renal remodelling.
family (with an 8 mer antimiR) in attenuation of pathological cardiac remodelling (PNAS Methods: Neonatal rat cardiac myocytes (NCMs) and fibroblasts (NCFs) were isolated
2012; 109(43):17615-20). We hypothesized that the reduced efficacy with antimiR-34a from day 1 to 2 pups using enzymatic digestion. NCM, NCF and rat renal mesangial cells
may be due to the compensation of other miRNAs. (RMCs) were pre-treated with VCP746 before stimulation with IL-1b and TNF-a; AngII
Objectives: To identify miRNAs regulated by miR-34 and understand miRNA networks
involved in miR-34/34a inhibition therapy for pathological cardiac hypertrophy.
Methods: Next generation sequencing (NGS) was performed on total RNA from hearts of
mice (n¼3-4) subcutaneously administered a locked nucleic acid-antimiR-34a/34 for 6
weeks.
Results: The expression of miR-34 family members (miR-34a, miR-34b, miR-34c) are
increased in the hearts of mice subjected to transverse aortic constriction (TAC) compared to
sham controls (p<0.05). Inhibition of the miR-34 family, but not miR-34a, significantly
attenuated the increase in heart size typically seen with pressure overload. To uncover the
underlying miRNA interactions, we carried out NGS to identify other miRNAs that might be
dysregulated in response to antimiR-34/34a-based therapy. The expression of miR-24-1-5p, a
miRNA that is upregulated in a setting of stress, was elevated in mice administered with
antimiR-34a (1.75-fold, n¼3, p<0.05), but not in mice with antimiR-34 treatment. The in-
crease in miR-24-1-5p expression could explain why antimiR-34a was less effective compared
to antimiR-34 in attenuation of pathological cardiac remodelling. The data also suggests that
modulation of multiple targets rather than a single target is likely to be key in efficient treatment
of complex diseases like heart failure. In support of our hypotheses, inhibition of miR-24-1-5p
in the cardiomyoblast H9c2 cell line protected cells from H2O2-induced cell death (n¼3).
Conclusion: The identification of miR-24-1-5p and other regulated miRNAs in response to
antimiR-34 treatment may improve our understanding of miRNA networks for optimisa-
tion of better therapeutic strategies.
Disclosure of Interest: None Declared

PT355
Characterisation of the effects of ageing on ischaemia-mediated neovascularisation
Yuen Ting Lam*1,2, Laura Lecce1,2, Richard Karas3, Martin K. Ng2,4,5
1
Translational Research Group, The Heart Research Institute, 2The University of Sydney, Sydney,
Australia, 3Tufts Medical Center, Boston, United States, 4The Heart Research Institute,
5
Royal Prince Alfred Hospital, Sydney, Australia

e236 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

 POSTER ABSTRACTS
and TGF-b1; and TGF-b1, respectively, for 48 hours before harvesting. Cardiac myocyte
hypertrophy, fibroblast and RMC collagen synthesis were determined by [3H]-leucine and
[3H]-proline incorporation, respectively.
Results: VCP746 reduced IL-1b- and TNF-a-stimulated NCM hypertrophy (85.1  4.3%
and 91.7  3.1% of unstimulated control, respectively; VCP746 10-7 M; P < 0.0001 vs. IL-
1b and TNF-a alone) in a concentration-dependent manner. VCP746 also concentration-
dependently reduced AngII- and TGF-b1-mediated NCF collagen synthesis (104.8  5.1%
and 142.8  4.8% of unstimulated control, respectively; VCP746 10-6 M; P < 0.05 vs.
AngII alone, P < 0.0001 vs. TGF-b1 alone). TGF-b1-stimulated RMC collagen synthesis
was also inhibited in a concentration-dependent manner by VCP746 (105.9  4.5% of
unstimulated control; VCP746 10-6 M; P < 0.0001 vs. TGF-b1 alone). MTT assay showed
that VCP746 had no effects on cell viability.
Conclusion: This study has demonstrated that the A1/A2 adenosine receptor agonist,
VCP746, can reduce cardiac hypertrophy and fibrosis, as well as renal fibrosis. Targeting
adenosine receptors may represent a novel therapeutic approach to the management of
heart failure and associated renal fibrosis.
Disclosure of Interest: None Declared

PT357
Angiotensin-receptor neprilysin-inhibition (ARNi) attenuates ischemic cardiac failure
in vivo and angiotensin-II-induced cellular cardiac hypertrophy and fibrosis
Thomas G. Von Lueder*1,2, Bing Wang1, Andrew Kompa1, Randy Webb3, Pierre Jordaan4,
Henry Krum1
1
Centre of Cardiovascular Research and Education in Therapeutics, Monash University,
Melbourne, Australia, 2Department of Cardiology, Oslo University Hospital Ullevål, Oslo,
Norway, 3Institutes for BioMedical Research, Novartis, East Hanover, United States, 4Institutes
for BioMedical Research, Novartis, Basel, Switzerland

Introduction: Despite current pharmacotherapies including blockers of the renin-angio-

tensin-aldosterone system (RAAS), hypertension and heart failure (HF) remain major
causes of death and morbidity worldwide. The natriuretic peptides (NP), part of the most
powerful endogenous blood pressure-lowering system, are broken down by neprilysin
(NEP). Novel dual-acting angiotensin-receptor neprilysin (NEP) inhibitors (ARNi) combine
NEP inhibitor-mediated NP augmentation with RAAS blockade. Early clinical data is
encouraging, but mechanisms of ARNi on cardiac cells are unclear.
Objectives: We tested effects of ARNi on cardiac remodelling and function after experi-
mental myocardial infarction (MI). To elucidate potential mechanisms, we investigated
ARNi in a model of angiotensin-II (AngII) mediated cardiac hypertrophy and fibrosis.
Methods: Adult male rats were subjected to experimental myocardial infarction (MI) and
randomized to 4 weeks treatment with vehicle (VHC-MI, n¼6) or the ARNi LCZ696 (68
mg/kg body weight orally; ARNi-MI, n¼11). The intervention commenced one week post-
MI. Echocardiography, invasive hemodynamics and organ weights served to assess cardiac
structure and function at 5 weeks after MI. We studied direct effects of ARNi on neonatal
rat cardiac cells. AngII-stimulated (100nM) 3[H]leucine-incorporation in cardiomyocytes
(CM) over 60 h and 3[H]proline-incorporation in cardiac fibroblasts (CF) over 48 h (CF)
served as measures of cardiac hypertrophy and collagen accumulation, respectively. Cell
cultures were pre-incubated with valsartan (VAL), NEP inhibitor LBQ657 (LBQ; 10mM), or
both VAL and LBQ (i.e., ARNi).
Results: ARNi-treated MI rats had lower heart, atrial, and left ventricular weights VHC-MI
rats. Moreover, LV dimensions and function were significantly better-preserved (see Fig. 1).
In cell studies, VAL dose-dependently inhibited cardiac hypertrophy and fibrosis. In Conclusion: We demonstrate that ARNi attenuates cardiac remodelling and dysfunction
contrast, LBQ had only weak effects in CM and CF. ARNi (i.e. addition of LBQ) augmented after MI, possibly through direct anti-fibrotic and anti-hypertrophic effects which are su-
the inhibitory effects of VAL alone. Only combined VAL+LBQ (ARNi) at the highest dose perior to VAL alone.
completely inhibited AngII-stimulated cardiac hypertrophy and fibrosis. Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e237

 PT358
POSTER ABSTRACTS
Newly Identified Binding Molecules of Nobiletin, a Citrus Flavonoid, Is Therapeutic
Targets for Cardiac Hypertrophy
Kehima Hieda*1, Yoichi Sunagawa1,2, Yoshimi Ikai1, Yasufumi Katanasaka1,2, Hidetoshi Suzuki1,
Tomohiro Asakawa3, Akira Murakami4, Hiromichi Wada2, Tadashi Hashimoto5,
Akira Shimatsu6, Toshiyuki Kan3, Koji Hasegawa2, Tatsuya Morimoto1
1 compound with higher solubility such as resveratrol may be more efficacious.
Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka,
Shizuoka, 2Division of Translational Research, Clinical Research Institute, Kyoto Medical Center,
Kyoto, 3Synthetic Organic & Medicinal Chemistry, School of Pharmaceutical Sciences, University
of Shizuoka, Shizuoka, 4Division of Food Science and Biotechnology, Kyoto University Graduate
School of Agriculture, Kyoto, 5Proteomics Research Center, Theravalues Corporation, Tokyo,
6
Clinical Research Institute, Kyoto Medical Center, Kyoto, Japan
Introduction: Maladaptive hypertrophy is being recognized as a critical event during the
development of heart failure. We screened some natural compounds purified from a citrus
fruits library and found that nobiletin, contained in natural fruits, represses phenylephrine-
induced hypertrophic responses in cardiomyocytes. Nobiletin has various useful effects
such as anti-cancer, anti-inflammation, and anti-oxidant and may be applicable to phar-
macological therapy for heart failure. In previous study, we demonstrated that oral
administration of nobiletin prevented systolic functional deterioration and LV pathological
hypertrophy after MI in vivo. Thus, nobiletin is expected as an effective agent for cardiac
hypertrophy and heart failure. However, the target molecule of nobiletin in cardiomyocytes
is still unclear.
Objectives: To identify the target molecule of nobiletin against anti-hypertrophic effect, we
investigate nobiletin-binding proteins in rat hearts by a proteomics approach.
Methods: First, we investigated localization of nobiletin within cardiomyocytes by
generating nobiletin conjugated with Tokyo-green, a fluorescein analogue (TG-nobiletin).
Next, to identify nobiletin-binding proteins, we have newly synthesized biotin-conjugated
nobiletin (Bio-nobiletin). Protein extracts form rat hearts were incubated with Bio-nobiletin
or Biotin alone and binding proteins were precipitated with streptavidin beads and ana-
lyized by LC-LC/MS-MS.
Results: We confirmed that TG-nobiletin retains its ability to inhibit cardiomyocyte hy-
pertrophy in a manner similar with natural nobiletin, and found localization of TG-nobi-
letin in a cytoplasm of cardiomyocytes. By LC-LC/MS-MS analysis, we identified 162 novel
nobiletin-binding proteins in the heart. These include some kinase of signal pathways,
histone de-acetylase family, and hypertrophy-responsive transcription factors. In addition,
Bio-nobiletin pull-down assay showed that recombinant Protein X, which related to cellular
metabolic processes, can interact with Bio-nobiletin. In cardiomyocyte, knockdown of
Protein X failed to the inhibitory action of nobiletin against phenylephrine-induced car-
diomyocyte hypertrophy. Conversely, overexpression of Protein X inhibited phenyleph-
rine-induced hypertrophy.
Conclusion: Proteomics analysis on molecular targets of nobiletin is useful to delineate
signaling pathways that mediate hypertrophic responses in cardiomyocytes. Protein X may
be a target of Nolitetin, a potent therapeutic agent for cardiac hypertrophy.
Disclosure of Interest: K. Hieda: None Declared, Y. Sunagawa: None Declared, Y. Ikai:
None Declared, Y. Katanasaka: None Declared, H. Suzuki: None Declared, T. Asakawa:
None Declared, A. Murakami: None Declared, H. Wada: None Declared, T. Hashimoto
Employee from: Theravalues Corporation, A. Shimatsu: None Declared, T. Kan: None
Declared, K. Hasegawa: None Declared, T. Morimoto: None Declared
PT359
Comparing efficacy of delivery of the antioxidant curcumin with a peptide derived
against the AID region of the L-type calcium channel in reduction of ischemia
reperfusion injury using nanoparticle technology
Naviin Hardy*1, Helena Viola2, Tristan Clemons2, Swaminathan Iyer3, Livia Hool2
1
Physics, 2Anatomy, Physiology and Human Biology, 3Chemistry and Biochemistry, The
University of Western Australia, Perth, Australia
Introduction: The L-type Ca2+ channel is the main route for calcium influx into cardiac
myocytes. There is good evidence that increases in intracellular calcium and oxidative stress
contribute to the pathophysiology of cardiac hypertrophy. Increased calcium influx
through the L-type Ca2+ channel or over-expression of the alpha subunit of the channel
induces cardiac hypertrophy. We have previously demonstrated that nanoparticle (NP)-
assisted delivery of a peptide derived against the alpha-interacting domain (AID) of the
channel to decrease the movement of the beta subunit of the L-type Ca2+ channel (AID-
tethered NP), decreases myocardial damage associated with reperfusion after ischemia in
guinea-pig hearts ex vivo.
Objectives: We investigated the effect of AID-tethered NP loaded with 7.4mM of the
antioxidant curcumin (AID-NP-curcumin) on myocardial damage and oxidative stress
associated with reperfusion after ischemia ex vivo.
Methods: We isolated hearts from 8wk old male Wistar rats and perfused the hearts
retrogradely on a Langendorff apparatus. Hearts were perfused with Ca2+-containing Krebs
solution for 30min, followed by no-flow ischemia for 30min, then reperfusion for 60min in
the presence of either 1mM AID-NP-curcumin or empty-NP and compared with 1mM AID-
NP. Damage was assessed as release of creatine kinase (CK) and lactate dehydrogenase
(LDH) in the perfusate. Oxidative stress was assessed as the ratio of reduced to oxidised
glutathione (GSH/GSSG).
Results: Perfusion of 7 hearts with1mM AID-NP-curcumin resulted in a significant decrease
in CK (13.13.7 vs 58.618.1 units/L; p<0.05 ANOVA) and apparently less LDH release
(11.95.0 vs 20.86.7 units/L; p¼NS) compared with 4 hearts treated with empty-NP
and was no more effective than 1mM AID-NP (11.93.1 units/L CK; n¼7, p<0.05 vs
e238
empty-NP; 6.62.3 units/L LDH; n¼7, p<0.05 vs empty-NP). GSH/GSSG ratio did not
improve in hearts treated with 1mM AID-NP-curcumin (4.70.9 vs 6.10.4 nmol/g tissue
empty-NP; n¼7; p¼NS).
Conclusion: We conclude that AID-tethered nanoparticles loaded with antioxidant cur-
cumin are no more effective at decreasing myocardial damage than AID-tethered nano-
particles alone and did not improve oxidative stress. Since curcumin has low solubility we
propose this is due to poor release of curcumin from the nanoparticles and suggest that a
Disclosure of Interest: None Declared
PT360
Difference in timing but not magnitude of aortic reservoir pressure calculated by four
different methods
Joe Smolich*1,2, Michael Cheung1,2,3, Jonathan Mynard1
1
Heart Research, Murdoch Childrens Research Institute, Melbourne, 2Paediatrics, University of
Melbourne, Parkville, 3Cardiology, Royal Children’s Hospital, Melbourne, Australia
Introduction: The arterial circulation demonstrates an important reservoir or ‘windkessel’
function, whereby a portion of left ventricular output is transiently stored in the aorta and
other large elastic arteries during systole, and then discharged into more distal arteries
during diastole. As filling and discharge of a reservoir is accompanied by rises and falls in
reservoir pressure (Pres), mathematical approaches have recently been developed to
calculate this variable, with clinical data suggesting that Pres is an independent predictor of
adverse cardiovascular events. However, although four main approaches for calculating Pres
have been described to date, these various methods have never been directly compared
experimentally using high-fidelity signals in the setting of altered aortic reservoir function.
Objectives: To compare different methods of calculating Pres, under baseline conditions
and after decreased aortic compliance produced by stepwise aortic constriction.
Methods: Anaesthetized open-chest wethers (n¼8) were instrumented with an ascending
aortic (AoT) transit-time flow probe and a micromanometer to measure high-fidelity blood
pressure. Haemodynamics were recorded at baseline and after incremental increases in
mean AoT blood pressure by w10 and w20 mmHg with mechanical constriction of the
descending aorta. Pres was calculated using blood pressure and flow data (Pres-PQ) or blood
pressure data only (Pres-P) to iteratively fit the 2-element windkessel equation to the dia-
stolic pressure profile, from a 3-element windkessel model (Pres-3Wk), and as 2Pbk, where
Pbk is the reflected component of pressure from wave separation analysis (Pres-RW).
Results: At baseline, neither minimum, maximum nor pulse Pres-PQ, Pres-P, Pres-3Wk or Pres-
RW were significantly different. Furthermore, minimum, maximum and pulse Pres rose with
each level of constriction (P<0.001), with no significant interaction between the four
methods of calculating Pres (P>0.7). However, minimum Pres-PQ and Pres-P preceded
minimum Pres-3Wk by w20 and w10 ms, and minimum Pres-RW by w40 and w25 ms at
baseline and after aortic constriction respectively (P<0.005). On the other hand, maximum
Pres-PQ and Pres-P preceded Pres-3Wk and Pres-RW by w20 ms at baseline (P<0.005), but no
difference in timing was apparent after aortic constriction.
Conclusion: Four different current methods of calculating Pres are equivalent, but differ-
ences occur in the timing of Pres profiles, particularly minimum Pres.
Disclosure of Interest: None Declared
PT361
The Relationship of Thrombin And Factor Xa With The Time In Therapeutic Range
In Patients on Long Term Warfarin Therapy
Melissa S. H. Lim*1,2, Lawrence Anchah2, Wen Ni Tiong1, Felicia Y. Y. Chin1, Melissa Mejin1,2,
Lee Len Tiong1,2, Khai Liy Kong1, Siaw San Hwang3, Tiong Kiam Ong4, Alan Y. Y. Fong1,4,5
1
Clinical Research Center, Sarawak General Hospital, Kuching, 2Department of Pharmacy,
Sarawak General Hospital Heart Center, Kota Samarahan, 3Faculty of Engineering, Computing
and Science, Swinburne University of Technology Sarawak Campus, Kuching, 4Department of
Cardiology, Sarawak General Hospital Heart Center, Kota Samarahan, 5Faculty of Medicine and
Health Sciences, Universiti Malaysia Sarawak, Kuching, Malaysia
Introduction: Thrombin and Factor Xa play vital roles in the clotting cascade and is
affected by warfarin anticoagulant therapy. Time in therapeutic range (TTR) reflects the
INR control over time in patients on warfarin anticoagulant therapy. The association be-
tween plasma thrombin and factor Xa levels with TTR has not been previously studied in
our population. Plasma levels of thrombin and factor Xa have been considered candidate
markers for anticoagulation control in patients on warfarin anticoagulation.
Objectives: To characterize the association of thrombin and factor Xa with TTR in long
term warfarin treated patients with atrial fibrillation.
Methods: 190 patients with AF on warfarin therapy for
1 year were enrolled. Patients
with poor TTR (less than 66%) were categorized into group I while those with TTR more
than 66% in group II. Plasma levels of Thrombin and FXa were determined by enzyme
linked immunosorbent assay (ELISA).
Results: There were 105 (55.3%) patients in Group I. The age, ethnicity, weekly warfarin
dose and clinical risk factors in both groups were equally distributed. Proportions of pa-
tients with INR in the sub-therapeutic, therapeutic and above therapeutic range were
29.5%, 65.7%, 4.8% in Group I, and 27.1%, 68.2%, 4.8% in Group II. Mean type of
concomitant medications was 4.6 (1.9) and 4.4(1.9) for Group I and II, respectively.
Plasma thrombin levels were significantly higher in Group I [median (IQR); 544.9(940.9)
ug/ml vs. 368.3(429.2)ug/ml, p<0.001]. There were significant correlations between
plasma thrombin levels with TTR (r¼-0.19, p¼0.009) and weekly warfarin dose (r¼-0.21,
p¼0.003). Female gender was associated with higher levels of thrombin (p<0.001). Lower
plasma thrombin levels were found in patients with diabetes [median (IQR); 253.3(429.2)
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
ug/ml vs. 505.1(780.5)ug/ml p<0.001] and hypertension [median (IQR); 402.2(427.5)ug/ Results: Compared to the control, HPC increased Klotho levels in plasma and myocar-

POSTER ABSTRACTS
ml vs. 656.5(950.5)ug/ml p<0.001]. There were no significant correlations between Factor dium. HPC prevented IR-induced decrease in myocardial Klotho level (Figure 1). The HPC
Xa with TTR, weekly warfarin dose and gender; and no significant differences of Factor Xa heart suffered IR had a better postischemic LVDP recovery as compared to IR hearts. HPC
levels in diabetic and hypertensive patients. significantly decreased LDH release and limited infarction caused by IR. Blockade of b-
Conclusion: Thrombin, but not Factor Xa levels, are associated with TTR status, with glucuronidase activity abolished the contractile recovery, and LDH and myocardial
higher levels found in those with poor TTR, female gender and lower warfarin dose, infarction mitigated by HPC (Table 1).
suggesting that thrombin may be a candidate marker in predicting anticoagulation control. Conclusion: Our results demonstrate that exposure of rats to moderate hypoxia leads to an
As alternative to TTR, compared to Factor Xa, thrombin may be a better marker to reflect increase in Klotho expression in the heart. This effect reduces heart susceptibly to IR injury.
anticoagulant control in our population. The underlying mechanism is possibly related to b-glucuronidase activity of Klotho and
Disclosure of Interest: None Declared subsequent activation of cardioprotectant TRPV1.
Disclosure of Interest: None Declared
PT362
Hypoxic Preconditioning Protects Rat Hearts Against Ischemia-Reperfusion Injury:
Role of Klotho PT363
Ming-Chieh Ma*1, Yih-Sharng Chen2 A Novel Cytokine, Interleukin-27, Protects Rat Cardiomyocytes Against Ischemia-
1
School of Medicine, Fu-Jen Catholic University, New Taipei City, 2Department of Surgery, Reperfusion Injury
National Taiwan University Hospital, Taipei, Taiwan, Province of China Ming-Chieh Ma*1, Yu-Tzu Huang1
1
Introduction: Hypoxic preconditioning (HPC) protects hearts against ischemia-reperfusion School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Province of China
(IR) injury, but it is unclear that the effect of HPC is dependent on Klotho, an anti-aging Introduction: Pro-inflammatory cytokine interleukin (IL) is thought to act as a damaged
hormone. Klotho deficiency plays a role in the development of age-related cardiovascular molecule for left ventricular contractile dysfunction following ischemia-reperfusion (IR)
disorders. Moreover, we previously showed that acute treatment of Klotho in rat hearts injury. However, cytokine has been shown to be cardioprotective with recent evidences
against IR is relied on its b-glucuronidase activity in transient receptor potential vanilloid supporting a role for triggering pro-survival signal pathways. IL-27 is a cytokine belonging
channel 1 (TRPV1) activation. to the novel entity of the IL-6 family that is composed of two subunits, Epstein-Barr viral
Objectives: The present study investigated whether HPC enhances the level of Klotho and gene 3 (EBI3) and IL27-p28.
thus protects hearts against IR. Objectives: The present study investigated changes in myocardial IL-27 levels after IR
Methods: The heart from rats kept in room air or in air preconditioned with 10% O2 for 4 insult and the cellular mechanism of IL-27-induced cardioprotection.
weeks were isolated and mounted on the Langendorff apparatus to avoid non-cardiac ef- Methods: The in vivo rat model of IR injury was induced by left coronary ligation and
fects of Klotho from circulation. To study the role of Klotho, another HPC+IR group was release for 21 days. The H9c2 cardiomyoblasts and cardiomyocytes isolated from neonatal
received D-saccharic acid 1,4-lactone (DSL) for b-glucuronidase activity inhibition via a rat hearts were applied to examine the direct effect of IL-27 in in vitro. Rat hearts were
subcutaneous mini-osmotic pump during HPC induction. Acute IR injury was induced by isolated and perfused ex vivo on the Langendorff apparatus to avoid non-cardiac effects of
a 30-min stop of perfusion and 4-h reflow. Myocardial protection was assessed by interleukin from circulating cells. Myocardial protection was assessed by measuring left
measuring left ventricular developed pressure (LVDP), lactate dehydrogenase (LDH) ventricular developed pressure (LVDP), creatine kinase-MB (CK-MB) release, and coronary
release, and infarct size (IS). Klotho levels in plasma and myocardial tissue were examined. flow (CF). Cell viability was assessed by lactate dehydrogenase release and crystal violet
staining. Protein and mRNA expression that associated with protective signalling were
Groups/Parameters Control HPC IR HPC+IR HPC+IR+DSL evaluated.
Results: IL-27 expression was upregulated in rat hearts following reperfusion (Figure 1),
LVDP (mmHg) 928 967 465* 706*# 423y
indicating IL-27 play a role in myocardial repairing. Interestingly, IL-27 subunits WSX-1
LDH (U/L) 165 204 699* 346*# 536y and glycoprotein (gp) 130 were present in rat hearts and H9c2 cells. Exogenous IL-27
IS (%) 04 13 668* 397*# 523y supplement significantly attenuated hypoxia-induced lethality in H9c2 cells and primary
cardiomyocytes. Incubating these cells with IL-27 resulted in a time-dependent activation
N ¼ 8 for each group. Values are expressed as mean  SEM. *P<0.05 compared to the control (C) of signal transducers and activators of transcription 3 (STAT3), and cell protection
group. #P<0.05 compared to the IR group. yP<0.05 compared to the HPC+IR group. conferred by IL-27 was blocked by a STAT3 inhibitor or a neutralizing antibody to gp130.
Finally, the heart treated with IL-27 had a better postischemic contractile recovery
following IR insult by significantly reduction of CK-MB release and improvement of cor-
onary perfusion (Figure 2).

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e239


POSTER ABSTRACTS
Conclusion: Our findings demonstrate that IL-27 upregulation in response to ischemia is
beneficial to tissue recovery during reperfusion and the gp130/STAT3 pathway down-
stream of IL-27 may serve as a venue for potential therapeutic interventions in ischemic
heart disease.
Disclosure of Interest: None Declared
PT364
Characterizing phenotypes of fibrotic cardiomyopathy and spontaneous
arrhythmogenesis in a transgenic mouse model
My-Nhan Nguyen*1, Helen Kiriazis1, Yidan Su1, Xiao-Jun Du1
1
Experimental Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Introduction: Cardiac arrhythmias remain poorly controlled constituting a major clinical
problem. Research using animal models of arrhythmias is critical for mechanistic and
therapeutic testing. However, arrhythmias in a majority of models are induced by pro-
grammed electrical stimulation in vivo (large species) or in vitro (rodents). Ideal animal
models would have spontaneous onset of arrhythmias and pro-arrhythmic substrates seen
in human patients such as cardiac fibrosis.
Objectives: 1) to characterize the fibrotic cardiomyopathy and arrhythmic phenotypes in a
transgenic (TG) mouse model; 2) to assess the effects of anti-fibrotic agent relaxin.
Methods: We used a TG strain with cardiac-restricted overexpression of b2-adrenoceptors
(b2-TG). Mice were on C57Bl/6 background and male b2-TG and non-transgenic (NTG)
littermates aged 3-12 months were studied. Under isoflurane anaesthesia and maintained
body temperature, body surface electrocardiogram (ECG) was recorded for a period of 10-
e240
minutes. Onset of ventricular ectopic beats (VEBs) were analysed and scored (0-9). Ven-
tricular tachycardia (VT) was defined as over 4 consecutive VEBs. Hydroxyproline assay of
left ventricular tissues was performed to quantify fibrosis. To test the efficacy of the anti-
fibrotic agent relaxin, b2-TG and NTG mice were treated for 14 days with relaxin (0.15 and
0.5 mg/kg/day, via osmotic minipump).
Results: Incidence of VEB was 94% for b2-TG (n¼77) and 7% for NTG mice (n¼45). By
dividing animals into 6 age-groups (b2-TG: n¼10-19; NTG: n¼4-16), an age-dependent
increase in arrhythmia score was evident (p<0.001; Figure A). Incidence of VT was limited
to b2-TG mice (20% vs. 0%, p<0.001), and increased with ageing (2.5% in 3-5 month
groups, 27-40% in 5-9 month groups). Collagen content was also higher in 6-month-old
b2-TG mice and increased with ageing (p<0.001; Figure B). Treatment with relaxin
reduced myocardial collagen content (-40% and -23% at 0.5 and 0.15 mg/kg/day, both
p<0.01 vs. untreated b2-TG), but showed no effect on collagen content in various organs
of NTG mice.
Conclusion: The b2-TG model demonstrated an age-dependent increase in the onset of
ventricular tachyarrhythmias and cardiac fibrosis. Relaxin exhibits anti-fibrotic action in
this model. Whether relaxin is anti-arrhythmic via fibrosis reversal in this model requires
further research using telemetry ECG monitoring.
Disclosure of Interest: None Declared
PT365
Is there a biochemical basis for differential thromboembolic risk in atrial fibrillation?
Studies with platelet nitric oxide signalling
Nathan E. K. Procter*1, Jocasta Ball2, Doan Ngo1, Yuliy Y. Chirkov1, Jeffrey S. Isenberg3,
Elaine M. Hylek4, Simon Stewart2, John D. Horowitz1
1
Cardiology, Basil Hetzel Institute, The University of Adelaide, Adelaide, 2Baker IDI Heart and
Diabetes Institute, Melbourne, Australia, 3Medicine, Vascular Medicine Institute, University of
Pittsburgh, Pittsburgh, 4Medicine, Boston University, School of Medicine, Boston, United States
Introduction: Atrial fibrillation (AF) is engendered by inflammatory activation, endothelial
dysfunction and atrial distension. While thromboembolic risk in AF can be predicted on
the basis of clinical characteristics (i.e. CHADS2 and CHA2DS2VASc scores), the
biochemical determinants of this risk remain unclear, particularly in the case of incremental
risk associated with new onset AF. The nitric oxide (NO) signalling pathway contributes to
regulation of the cardiovascular system, with ‘NO resistance’ being implicated in the
development of cardiovascular disease. Furthermore, it has recently been recognised that
inflammatory activation (i.e. myeloperoxidase [MPO], thrombospondin-1 [TSP-1] and
thioredoxin-interacting protein [Txnip]) may impair NO signalling, thus increasing
thrombogenic risk.
Objectives: We sought to evaluate these parameters in a cohort of AF patients.
Methods: Patients (n¼106) were evaluated upon hospital admission. Platelet function was
assessed by whole blood impedance aggregometry using ADP (2.5mM) and the NO donor
sodium nitroprusside (10mM). Plasma concentrations of asymmetric dimethylarginine
(ADMA), MPO, TSP-1 and platelet Txnip content were determined.
Results:
1. Determinants of platelet aggregation. Females were hyperaggregable in response to
ADP compared to men (9.7 [7.5, 11.6]U vs. 7.8 [5.4, 10.1]U respectively,
p<0.05). Platelet aggregation was directly correlated with plasma TSP-1 (r¼0.254,
p<0.01) and inversely correlated with plasma creatinine (r¼-0.301, p<0.01) and
plasma ADMA (r¼-0.225, p<0.05).
2. Determinants of platelet NO response. Platelet Txnip content (r¼-0.211, p<0.05)
and ADP-induced aggregation (r¼-0.422, p<0.001) were inverse correlates of
platelet NO response. Neither CHADS2 nor CHA2DS2VASc scores correlated with
platelet NO response. New onset AF was associated with significantly diminished
platelet NO response compared to chronic AF patients (Figure, p<0.01).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: Impairment in NO signalling was not associated with either CHADS2 or
CHA2DS2VASc scores, however, impaired platelet NO response (correlated with elevated
Txnip content) was closely associated with new onset AF. Consistent with previous reports,
female sex was associated with platelet hyperaggregability, as was plasma TSP-1. Taken
together, these findings constitute a theoretical basis for the observed gender- and acuity-
based thromboembolic risk observed in AF.
Disclosure of Interest: None Declared
PT366
Anti-aggregatory effects of nitrite are augmented in venous, relative to arterial blood
Rustem F. Dautov*1, Saifei Liu1, Yuliy Y. Chirkov1, John D. Horowitz1
1 Magnetic resonance characteristics and follow-up of patients with myocarditis
Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital, Adelaide, Australia
Introduction: Nitrite (NO2-), once considered inert, is now recognized to be reduced to
nitric oxide (NO) in vivo, particularly under hypoxic conditions. While NO2- - mediated
vasodilatation has been extensively evaluated, less information is available concerning its
effects in inhibiting human platelet aggregation.
Objectives: In the current study, we hypothesized that because of lower oxygenation, NO2-
anti-aggregatory effects would be enhanced in venous (VB) as compared with arterial blood (AB).
Methods: Initial studies were performed utilizing exposure of blood to hypoxia in vitro and
evaluating effects on NO2- inhibition of ADP-induced platelet aggregation. Next, in 16
subjects undergoing cardiac catheterization, paired sampling of AB and VB was utilized for
comparison of NO2- effect. Whole blood reactive oxygen species (ROS) content was
determined via EPR and the contribution of NO release to NO2- effects was evaluated with
the NO scavenger CPTIO.
Results: In vitro hypoxia potentiated anti-aggregatory response to NO2- (1mM) from
83(SEM)% to 4913% (p¼0.02). Similarly, anti-aggregatory effects of NO2- were
consistently greater in VB than AB (Figure). CPTIO (200mM) reduced venous NO2-
response by approximately 75%. Furthermore, CPTIO potentiated ADP-induced aggre-
gation, with a trend towards differential augmentation in venous blood (p¼0.13). There
was no significant difference in ROS content between AB and VB.
Conclusion: (1) NO2- exerts potentially clinically important anti-aggregatory effects,
especially in VB.
(2) These effects are largely mediated via NO release.
(3) It is possible that nitrite functions as a “tonic” anti-aggregant in VB.
Disclosure of Interest: None Declared
PT367
Chronic nicotine administration impairs aortic function in Sprague-Dawley rat
Yi Cheng Lim*1, Satirah Zainalabidin1, Anand Ramalingam1, Siti Balkis Budin1
1
Programme of Biomedical Science, School of Diagnostic and Applied Health Sciences, Faculty of
Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: Nicotine has been traditionally known as the causative agent in the devel-
POSTER ABSTRACTS
opment of atherosclerosis and hypertension. In spite of the abundant studies on nicotine,
there is no clear evidence on the effect of nicotine to the reactivity of main pulsatile arteries.
Objectives: The aim of this study was to determine the effect of chronic low dose nicotine
on aortic reactivity, oxidative stress markers and histomorphological changes in the aorta.
Methods: Twelve male Sprague-Dawley rats (250-300 g) were randomly divided into two
groups and given normal saline as control or 0.6 mg/kg nicotine for 28 days (i.p., n¼6 per
group). After 28 days of treatment, the rats were sacrificed and the thoracic aorta was
dissected for further studies. Alpha-adrenergic vasoconstrictor, phenylephrine (PE,
10-9w10-4 M), and endothelium-dependent relaxant, acetylcholine (ACh, 10-9w10-4 M),
was used to test the vascular reactivity.
Results: The tail-cuff study showed that the mean arterial pressure (MAP) and pulse
pressure (PP) of nicotine-treated vs. control were significantly increased (p<0.05). There
were no significant changes in potassium chloride (KCl)-induced contraction. The PE-
induced contraction and ACh-induced relaxation in the nicotine group was found to be
significantly different than control group (p<0.05), indicating a loss of primary vascular
function. Biochemical findings found that malondialdehyde (MDA) was significantly higher
in nicotine group, whereas superoxide dismutase (SOD) enzymatic activity, glutathione
(GSH) and total protein content were all reduced in nicotine group (p<0.05) vs. control.
These biochemical findings suggested that chronic low dose nicotine could lead to
oxidative imbalance. The histomorphometric study showed significant increase in the
tunica media, and decrease in lumen diameter of nicotine-treated group, suggesting a
vascular remodeling which could cause hypertension.
Conclusion: In conclusion, chronic nicotine administration impaired the aortic reactivity,
probably via redox imbalance and vascular remodeling mechanism.
Disclosure of Interest: None Declared
PT371
mimicking ST-elevation myocardial infarction
Hajnalka Vago*1, Attila Toth1, Ferenc Suhai1, David Becker1, Tamas Simor2, Bela Merkely1
1
Heart Center, Semmelweis University, Budapest, 2Heart Institute, University of Pecs Faculty of
Medicine, Pecs, Hungary
Introduction: Making diagnosis can be difficult in patients with clinical signs of ST-
elevation myocardial infarction (STEMI) but without culprit lesion on coronary
angiography.
Objectives: The aim of our study was to investigate the magnetic resonance (MR) char-
acteristics of the different diseases and follow-up patients with myocarditis mimicking
STEMI.
Methods: Our prospective study was performed in 54 consecutive pts (mean age:3515
years) with clinical signs of STEMI but without culprit lesion on coronary angiography.
They underwent acute cardiac MR examination in the first 1-7 days. In pts with myocarditis
control MR examination was performed after at least 2 months, and clinical follow-up six
monthly. ECG synchronized cine movie, T2-weighted SPIR, delayed contrast enhancement
(DE) images were taken. Left (LV) and right ventricular (RV) volumes, ejection fractions
(EF), masses, myocardial necrosis/scar (core and gray zone) were evaluated.
Results: In 91% of cases cardiac MRI could clarify the diagnosis, STEMI was proven in 6
cases, apical ballooning syndrome in 6 female pts, myocardial contusion in one patient. In
36 patients (30 male, mean age:299 year) characteristics of myocarditis were found.
There was no difference in laboratory (troponin-T, CK-MB, CRP) and MR parameters in pts
with myocarditis and STEMI. In pts with apical ballooning syndrome LV EF was lower
compared to pts with myocarditis or infarction (myocarditis:5611%, infarction:527%,
Tako-Tsubo:416%, p<0.05). In pts with myocarditis there was a positive correlation
between the maximal level of CK-MB and troponin-T and the mass of gray zone (p¼0.007),
and negative correlation between the value of maximal CK-MB and LV EF (p¼0.043).
There was also negative correlation between gray zone mass% and LV EF (p¼0.001).
Control MRI showed higher LV EF (56% vs. 62%,p¼0.002), lower LV mass compared to
acute data (136g vs.115g, 70g/m2 vs. 58g/m2, p<0.001), the size of necrotic/fibrotic region
was shrinking (core+gray zone median:10.2g vs 6.4g,p¼0.025), however remaining DE
could be detected in 69% of pts. During the 3.3-year mean follow-up no hospitalisation did
occur due to heart failure or arrhythmia, or clinical symptoms suggesting these disorders.
Conclusion: In cases with clinical signs of STEMI and normal coronary angiography
cardiac MRI can differentiate, providing exact morphological and functional information.
In our study myocarditis mimicking STEMI affected mainly young male patients, showing
good prognosis during the 3.3-year follow-up period.
Disclosure of Interest: None Declared
PT372
Quantification of Intramyocardial Triglyceride by 1H-Magnetic Resonance
Spectroscopy Using Fewer Number of Signal Averages Has High Feasibility, Excellent
Agreement, and Significant Time Savings Compared to the “Gold Standard”
Spectrum with 128 Signal Averages
Lisa Gillinder*1, Shi Y. Goo1, Gary Cowin2, Mark Strudwick2, Josh Tsai1, Jenny Tian1,
Danielle Harrop1, Mathivathana Indrajith1, William Y. Wang1, Arnold C. Ng1
1
Cardiology, Princess Alexandra Hospital, 2University of Queensland, Brisbane, Australia
Introduction: Cardiac 1H magnetic resonance spectroscopy (1H-MRS) can quantify
intramyocardial triglyceride (TG), creatine (Cr) and choline (Cho) levels (Figure). However,
acquisitions of spectra using “gold standard” 128 signal averages are time consuming.
e241
 Objectives: Determine the feasibilities, accuracies and scan durations of water-suppressed Introduction: Current “gold standard” quantification of intramyocardial triglyceride (TG)
POSTER ABSTRACTS

1H-MRS spectra with fewer number of signals compared to “gold standard” spectrum with by cardiac 1H magnetic resonance spectroscopy (1H-MRS) is time consuming and tech-
128 signals. nically challenging due to main field (B0) inhomogeneities. “VARPRO” is a multi-echo
Methods: A total of 32 patients were prospectively recruited. 1H-MRS was performed method for fat and water separation based on the difference in resonance frequencies
using 1.5T Siemens Magnetom Sonata (Erlangen, Germany) system with the volume of between fat and water. It incorporates B0-field inhomogeniety and can rapidly derive fat-
interest placed in the interventricular septum. Spectroscopic data acquisitions were double- and water-only images from a single breath-hold (Figure).
triggered with ECG triggering and respiratory navigator. Water suppressed spectra were Objectives: Validate intramyocardial TG quantification by VARPRO against “gold stan-
acquired to measure intramyocardial TG, Cr and Cho contents, and spectra without water dard” 1H-MRS.
suppression were acquired and used as an internal standard. Intramyocardial TG or Cr or Methods: A total of 36 patients were prospectively recruited. VARPRO was performed
Cho contents relative to water were calculated and expressed as a percentage based on: using 1.5T Siemens Magnetom Sonata (Erlangen, Germany), and epicardial/endocardial
(signal amplitude of TG or Cr or Cho)/ (signal amplitude of water) x 100. Agreements contours were outlined on the basal left ventricular (LV) short axis. Intramyocardial TG
between spectra with less number of signals versus “gold standard” spectrum with 128 quantification by VARPRO was calculated and expressed as a percentage based on: {1 –
signals were determined by intraclass correlations (ICC). [(water-only signal intensity – fat-only signal intensity)/water-only signal intensity]} x 100.
Results: The table outlines the feasibility, intraclass correlations and mean scan durations “Gold standard” 1H-MRS spectroscopic data were double-triggered with ECG triggering
for 1H-MRS. and respiratory navigator. Water suppressed spectra were acquired to measure intra-
myocardial TG, and spectra without water suppression were used as an internal standard.
Intramyocardial TG by 1H-MRS was calculated and expressed as a percentage based on:
(signal amplitude of TG)/ (signal amplitude of water) x 100.
Results: The mean LV end-diastolic volume, end-systolic volume, ejection fraction and
Number of Scan duration Triglyceride (% Creatine (% Choline (% mass were 174  35mL, 79  17mL, 55  3% and 84  19g respectively. There was
excellent correlation between intramyocardial TG quantification by VARPRO versus 1H-
signals (minutes) feasibility/ICC) feasibility/ICC) feasibility/ICC)
MRS (Figure).
8 averages 0.6  0.3 81%/0.974 88%/0.897 82%/0.792
16 averages 1.1  0.5 88%/0.987 94%/0.875 84%/0.934
32 averages 2.6  0.9 88%/0.989 91%/0.906 91%/0.912
64 averages 5.9  2.0 97%/0.997 94%/0.906 91%/0.928
128 averages 13.2  4.5 100%/- 97%/- 100%/
(“gold
standard”)

web 3C=FPO
ICC ¼ Intraclass correlation

Conclusion: Quantification of intramyocardial TG by VARPRO has excellent correlation

with “gold standard” 1H-MRS and can be rapidly performed using a single breath-hold.
Disclosure of Interest: None Declared

PT374
Extensive thrombus burden, microvascular obstruction and underlying
thrombophilic propensity in cocaine-related myocardial infarction
Rebecca Kozor*1, James Cockburn1, Stuart M. Grieve2, Ravinay Bhindi1, Gemma A. Figtree1
1
Cardiology, Royal North Shore Hospital, 2Sydney University, Sydney, Australia

Introduction: Cocaine causes myocardial injury via multiple mechanisms, including

increasing the risk of thrombosis.
Objectives: To examine the degree and characteristics of coronary artery thrombosis using
coronary angiography and cardiovascular magnetic resonance imaging (CMR) in cocaine-
induced ST-elevation myocardial infarctions (c-STEMI).
Methods: We retrospectively examined cases of c-STEMI and compared them to all other
STEMI cases at our institution during 2009-2013.
Results: Five (out of a total of 1688) STEMIs presenting to our hospital were attributed to
web 3C=FPO

Conclusion: Quantification of intramyocardial TG using 1H-MRS with only 64 signal
averages is highly feasible, shows excellent agreement with the “gold standard” of 128
averages, and has significantly shorter scan duration. In contrast, quantification of smaller
metabolites such as Cr and Cho with fewer number of signal averages has lower feasibility
and agreement with “gold standard”.
Disclosure of Interest: None Declared
PT373
cocaine use during this time period. All c-STEMIs were male with a mean age 374 years
(compared to 6414 years for the remaining STEMI cohort). A high degree of thrombus
burden was noted in all 5 c-STEMI cases, with a mean Thrombolysis In Myocardial
Infarction (TIMI) thrombus grade of 4. Although post-procedural TIMI 3 flow was ach-
ieved in 100% (mean culprit vessel size 4.41.1mm), myocardial blush grade was only 1
or 2 (20% and 80% respectively). No culprit plaque was identified in 3 of 5 cases, sug-
gesting a possible primary thrombotic mechanism. CMR performed on average 3 days post
event demonstrated extensive transmural infarction in all c-STEMI cases, with a large
quantity of myocardial late gadolinium enhancement (LGE) (average 26% of left ventricular
mass (LVM), range 19-40%) and microvascular obstruction (MVO) (average 3.8% of LVM,
range 1.9-5.9%). The 2 patients with the highest proportion of MVO had a positive
thrombophilia screen (1 with homozygous Factor V Leiden deficiency, 1 with Protein C
deficiency and lupus anticoagulant).
Conclusion: STEMIs attributable to cocaine use were associated with extensive thrombus
burden and microvascular obstruction, consistent with cocaine’s known thrombophilic
effects. The high incidence of detectable prothrombotic conditions suggests an important
interaction that warrents further study.
Disclosure of Interest: None Declared

Multi-Echo Fat and Water Separation by Magnetic Resonance Imaging “VARPRO” PT375
Sequence has Excellent Correlation with “Gold Standard” Spectroscopy for
Quantification of Intramyocardial Triglyceride Content Myocardial Oxygenation is Reduced in End-Stage Renal Failure: A Novel Blood
Oxygen Level Dependant (BOLD)-Cardiac MRI Study
Lisa Gillinder*1, Shi Y. Goo1, Gary Cowin2, Mark Strudwick2, Jenny Tian1, Josh Tsai1,
Danielle Harrop1, Mathivathana Indrajith1, William Y. Wang1, Arnold Ng1 Susie F. C. Parnham*1, Suchi Grover1, Carmine De Pasquale1, Darryl Leong2,
1
Cardiology, Princess Alexandra Hospital, 2University of Queensland, brisbane, Australia Jonathan Gleadle3, Joseph Selvanayagam4

e242 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

 1
Cardiology, 2Flinders University/Flinders Medical Centre, South Australia, Australia, 3Renal
Medicine, 4Cardiology and Cardiovascular Magnetic Resonance Research, Flinders University/
Flinders Medical Centre, South Australia, Australia
Introduction: Cardiovascular disease is the leading cause of mortality and morbidity in
end-stage renal failure (ESRF) population, mostly from coronary artery disease (CAD).
Majority of CAD in ESRF patients is asymptomatic and current cardiac stress imaging
modalities are sub-optimal as risk predictors. Advances in cardiovascular magnetic reso-
nance (CMR) with the novel blood oxygen level-dependent (BOLD) technique provides
unprecedented capability to assess regional myocardial deoxygenation.
Objectives: We hypothesized that myocardial oxygenation would be reduced in ESRF
patients and may form a novel strategy to assess myocardial ischemia.
Methods: Sixteen chronic renal failure (CRF) patients (7 on dialysis, 9 pre-dialysis) with no
known history of CAD underwent CMR scanning at 3.0 T. Given known reductions in
BOLD signals in hypertrophied myocardium, we also assessed a controlled group of hy-
pertensive patients (HT) with no history of CAD (n¼6).Myocardial function, rest and stress
BOLD was performed. To measure oxygenation, using a T2-prepared BOLD sequence,
myocardial Signal Intensity (SI) was measured at adenosine stress (140 mg/kg/min) and at
rest (corrected to RR interval). Comparison of myocardial SI analyses were performed using
multivariate linear regression.
Results: Baseline clinical characteristics were similar in both CRF case and HT control
groups, except higher body mass index in HT group (p¼0.02). Left and right ventricular
dimensions and functions were similar. Interventricular septal thickness and LV mass were
similar in both RF case and HT control groups (LV septum: 1.2  0.1 cm RF vs 1.2  0.1
cm HT, p>NS; LV mass index 78  6 g/m2 RF vs 63  4 g/m2, p>NS). Rate Pressure
Product (RPP) was similar in both groups. Global myocardial BOLD SI change was
significantly lower in RF case group compared to HT control group (-1.79  9.13 vs 17.36
 9.19, p¼0.0004) (Figure 1). BOLD SI Change globally and in the LAD and RCA cor-
onary artery territory level were significantly lower in patients with renal failure (Table 1),
although did not reach statistical significance in the left circumflex territory.
web 3C=FPO
web 3C=FPO
Conclusion: Chronic renal failure patients have global reductions in myocardial oxygen-
ation even controlling for the degree of LVH. BOLD CMR is a promising tool to detect
myocardial ischemia in the renal failure population, and may form a novel risk predictor of
cardiovascular prognosis.
Disclosure of Interest: None Declared
PT376
Evaluation of Dietary Salt Intake Variation Induced Subcutaneous Adipose Tissue
and Visceral Adipose Tissue Blood Oxygen Level Changes by Blood Oxygen Level-
Dependent Magnetic Resonance Imaging
Zhao-Zeng Guo1, Xin Zhou1, Fei Yuan1, Wen-Jie Ji1, Ling Zhang1, Tie-Min Jiang1, Yu-Ming Li1,
Zhao-Zeng Guo*1
1
Institute of Cardiovascular Disease and Heart Center, Tianjin Key Laboratory of Cardiovascular
Remodeling and Target Organ Injury, Pingjin Hospital, Logistics University of CPAPF, Tianjin,
China
Introduction: Adipose tissue hypoxia (ATH) is a key pathophysiological process associated
with obesity and insulin resistance. Current, limited methods available to evaluate ATH
non-invasively. Blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI)
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
offers a non-invasive and reliable tool for assessing organ/tissue hypoxia under different
POSTER ABSTRACTS
disease conditions. Changes in dietary salt intake can lead to alterations in lipid and glucose
metabolism and insulin resistance
Objectives: To determine the feasibility of BOLD-MRI in evaluating changes of adipose
tissue oxygenation in subcutaneous adipose tissue and visceral adipose tissue induced by
dietary salt loading/depletion in human by BOLD-MRI.
Methods: A total of 14 healthy volunteers participated in a 17-day dietary salt intervention
study. For the first 3 days, we provided with usual diet (baseline) and then start with high-
salt diet (15g NaCl per day) for 7 days (high-salt stage) and low-salt diet (5g NaCl per day)
for another 7 days (low-salt stage). BOLD-MRI evaluation of the abdominal subcutaneous
adipose tissue (SAT) and abdominal visceral adipose tissue (VAT) was performed using a
3.0T MR imager at baseline, end of high-salt, and end of low-salt stage.
Results: The R2* value (a BOLD-MRI-derived parameter that is positively correlated with
oxygenation) of SAT were significantly higher than VAT (P<0.001) at all three measure-
ments. Compared with baseline, the R2* values of SAT and VAT were significantly
increased after 7 days of high salt feeding (P<0.001). At the end of low-salt dietary
intervention, the R2* values of SAT and VAT were all regressed to baseline levels.
Compared with high-salt stage, the R2* values of SAT and VAT were all significantly
decreased after 7 days of low-salt dietary intervention (P<0.001).
Conclusion: Variation in dietary salt intake could lead to corresponding changes in
oxygenation of SAT and VAT. The basal and high-salt intake induced oxygenation level of
SAT is lower in comparison to VAT. This work provides the proof-of-principle evidence
that BOLD-MRI offers a non-invasive tool for assessment of ATH.
Disclosure of Interest: None Declared
PT377
Positive correlation between ECG dispersion mapping (heartvueÔ) with T2DM
patients
Sidhi Laksono Purwowiyoto*1, Acil Aryadi1, Bima Suryaatmadja1, Djunaidi Ruray2,
Budhi Setianto Purwowiyoto1, Bambang Budi Siswanto1
1
Department Cardiology and Vascular Medicine, FMUI-NCCHK, 2Department of Internal
Medicine, Gatot Subroto Army Hospital, Jakarta, Indonesia
Introduction: Type 2 Diabetes Mellitus (T2DM) is a metabolic disease with greatest prevalence
in the world and associated with coronary heart disease (CHD). Asymptomatic CHD is more
common cardiovascular problem in patients with T2DM. HeartVueÔ 6S System is recently
developed technology that may provide non-invasive assessment of myocardial ischemia by
analyzing low amplitude oscillation of ECG micro fluctuation signal. Meanwhile, the corre-
lation between ECG-DM with T2DM patients is not yet clear, so this study is undertaken.
Objectives: To know the correlation between abnormal result of ECG-DM with T2DM
Methods: Correlative study with cross sectional design that uses 114 consecutive sampling
patients (divided in two groups; T2DM and control group; each n ¼ 57) who came for
treatment at the outpatient clinic of the metabolic endocrine and diabetes, Department of
Internal Medicine of Gatot Subroto Army Hospital, Indonesia.
Results: Blood sugar level is greater in T2DM group compared with the non T2DM [2 hours
after meal blood glucose level (229.56  94.98 vs 122.79  12:10) and fasting blood glucose
level (156.88  58.45 vs 100.19  8:18)]. T2DM patients have more deviation on ECG-DM
with moderate and specific form than the non T2DM. In T2DM group is more common with
red color on a three-dimensional view of the heart in ECG-DM compared with the non T2DM
group (70.2% vs 19.3%). In addition, the percentage of the index myocardium in T2DM group
is higher than non T2DM (19:25  9:45 vs. 1:40  14.68). Correlation test is then performed
using a Lambda contingency and showed moderate strength and positive (r ¼ 0.57, p <0.001).
Conclusion: There is a positive correlation between ECG-DM (HeartVue Ô) with T2DM
patients.
Disclosure of Interest: None Declared
PT378
Evaluation of Myocardial Function in Patients Undergoing Chemotherapy- 3D Left
Ventricle Ejection Fraction has Superior Correlation with the Myocardial
Contractility
Arun Dahiya*1, Ada Lo1, Kim Smith1, John Younger1, Sandhir Prasad1, Charles Chao1,
William Parsonage1, Cleonie Jayasuria1, Julie Ch’ng1, John Atherton1
1
Cardiology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
Introduction: Several methods have been proposed for early detection of chemotherapy-
induced cardiomyopathy. Global longitudinal strain is considered as the reference measure
of myocardial contractility. We sought to evaluate the correlation of 2 dimensional (2D)
and 3 dimensional (3D) left ventricle ejection fraction against the reference standard of
Global longitudinal strain (GLS).
Objectives: We sought to evaluate the correlation of 2 dimensional (2D) and 3 dimen-
sional (3D) left ventricle ejection fraction against the reference standard of Global longi-
tudinal strain. Our hypothesis was that 3D LVEF will have superior correlation with
myocardial contractility.
Methods: We studied 80 consecutive patients undergoing comprehensive chemotherapy
myocardial imaging protocol using echocardiography inclusive 2D LVEF, 3D LVEF and
GLS. 2D LVEF was derived using biplane Simpson’s methods and 3D LVEF was measured
using multi beat 3 dimensional Imaging. GLS was derived using 2D speckle tracking.
Results: Patients mean age was 54+/- 18 years. Mean 2D LVEF, 3D LVEF and GLS was
575%, 596% and -193% respectively. Compared to 2D LVEF 57, 3D LVEF had
superior correlation with GLS (2D versus GLS R¼ 0.5, P<0.001, 3D versus GLS R¼ 0.6,
P<0.001).
e243

POSTER ABSTRACTS
web 3C/FPO
Conclusion: Compared to 2D, 3D LVEF has superior correlation with myocardial
contractility and should be routinely performed in patients undergoing chemotherapy as it
may facilitate early and precise detection of chemotherapy induced myocardial toxicity.
Disclosure of Interest: None Declared
PT379
“Strategic Scheduling” Felicitates Feasibility of a Comprehensive Myocardial Imaging
Protocol for Chemotherapy Patients in a Busy Echo Lab
Arun Dahiya*1, Ada Lo1, Kim Smith1, John Younger1, Sandhir Prasad1, Charles Chao1,
William Parsonage1, Cleonie Jayasuria1, Julie Ch’ng1, John Atherton1
1
Cardiology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
Introduction: Increased use of chemotherapy, overall increased survival, and development
of newer agents have led to the emergence of chemotherapy-induced cardiotoxicity as a
major public health issue. Therefore it is crucial to accurately monitor heart function during
chemotherapy so that cardiac dysfunction can be detected. Several sophisticated methods
have been proposed for detection of chemotherapy-induced cardiotoxicity, however their
feasibility in a busy echolab with limited resources is unknown.
Objectives: To evaluate the feasibility of incorporating a comprehensive myocardial im-
aging protocol for chemotherapy patients in a busy Echo Lab.
Methods: We developed a comprehensive myocardial imaging protocol to screen
chemotherapy patients for cardiotoxicity. The protocol was inclusive of 2D Left Ventricle
Ejection Fraction (LVEF) with or without contrast, 3D LVEF and 2 dimensional speckle
tracking derived myocardial strain. Special scheduling arrangements were made to ensure
availability of equipment and trained personelle required to perform the comprehensive
imaging protocol (“Strategic Scheduling”) without affecting the workflow.
Results: 80 chemotherapy patients were referred to our lab during the stipulated period
(Dec 2012-April2013). 76% of patients underwent all components of the imaging protocol
inclusive of 2D LVEF, 3D LVEF and 2D speckle tracking (Fig). There was no significant
impact on the workflow of the Echo lab during the studied time.
web 3C=FPO
Conclusion: “Strategic scheduling” increases the feasibility of implementing a compre-
hensive myocardial imaging protocol in chemotherapy patients without impacting work-
flow in a busy Echolab. This strategy will facilitate early and precise detection of
chemotherapy-induced myocardial toxicity.
Disclosure of Interest: None Declared
PT380
An Echocardiographic Method of Estimating Pulmonary Venous Flow using a
combination of Pulsed Doppler and Pulmonary Vein Diameter with M Mode Echo
Charlotte Poposki1, Laurent Quiqueree1, Bruce Bastian*1
1
Dept Cardiovascular Medicine, JohnHunter Hospital, Hunter New Enland Local Health District,
Newcastle, Australia
e244
Introduction: Doppler evaluation of the pulmonary veins is routine in the evaluation of
Diastolic function of the Heart. However the recorded flow velocity does not record true
flow. Phasic changes in Pulmonary vein diameter have been confirmed with MRI and CT
studies, but these techniques are difficult, and not appropriate for serial studies of patients
Objectives: We wished to define whether Cardiac echo could define phasic changes in the
pulmonary veins, and identify potential uses for this technique
Methods: Echoes were recorded from patients presenting as in or out patients, with pulmonary
vein velocity recorded in the Apical 4 chamber view, and Mmode recording of the left upper
pulmonary vein in a modified 4 chamber view. The images were planimetered and matched for
identical cycle lengths, and flow calculated throughout the cardiac cycle. Patients were classed
as Normal if they did not have overt pathology. Comparisons were made based on age. Patients
judged to have heart failure were reviewed and compared with normals for their age.
Results: On mmode the diameter of the left upper pulmonary vein changed through the
cardiac cycle, with maximum diameter in late ventricular systole, reducing in size rapidly in
early diastole, relatively constant in diastasis, and contracting in atrial systole. This repli-
cated CT and MRI study findings. The increase in pulmonary vein size during systole was
less with increasing age. The velocity of flow in young patients was low, but absolute flow
greater in systole. In patients with elevated LVEDP, the phasic changes were much less, but
changed as the LA pressure dropped.
Conclusion: Mmode images of the pulmonary veins are feasible and may play a significant
role in the the evaluation of diastolic function, by enabling an estimation of pulmonary vein
flow rather than velocity alone.
Disclosure of Interest: None Declared
PT382
Differences in Global Strain between current versions of Strain software are
analogous to variations of EF and less than LV volumes
Hong Yang*1, Nobuaki Fukuda2, James D. Thomas3, Thomas H. Marwick1, Kazuaki Negishi1
1
Cardiovascular Imaging, Menzies Research Institute, Hobart, Australia, 2Takasaki General
Medical Centre, Takasaki, Japan, 3Heart Vascular Institute, Cleveland Clinic, Cleveland, United
States
Introduction: Measurement of strain using 2-dimensional speckle tracking echocardiogram
(STE) provides an objective test of myocardial performance in various clinical settings.
Following previous work showing variations in measurement between different vendors, the
strain uniformity project proposed a variety of standard features. We examined the variability
of global longitudinal strain (GLS) and biplane 2-dimensional volume assessment using two
current vendor systems with versions of software reflecting the project.
Objectives: To test the hypothesis that the extent of variability of GLS with different ul-
trasound system is similar to that of LV volume assessment and LV ejection fraction (EF).
Methods: 76 subjects (age: 5220, 54% males) were prospectively included in the study.
All subjects underwent two transthoracic echocardiograms within the same day using
two ultrasound systems (S5-1, iE33 vs. M5S-D, Vivid E9). For each system, GLS was
calculated using proprietary software (EchoPAC PC v11.0.0 and QLAB version 9). LV
volume was measured using biplane method of disks. The mean, standard deviation
(SD), coefficient of variation (CV), bias, limits of agreement (LOA) and percentage error
(¼LOA/mean) of each variable were calculated and analyzed using Bland-Altman plot for
comparison. The difference corrected by its mean value (cDiff) was also calculated. CV
and cDiff of different systems among four parameters (LV end-diastolic volume (LVEDV),
end-systolic volume (LVESV), LVEF and GLS) were compared by mixed model for the
significance.
Results: Figure 1a and 1b show the Bland-Altman plot of vendor specific analysis of LVEF
(bias -0.2%; LOA 9.7%) and GLS (bias -0.19%; LOA 4.0%). The percentage errors were
web 3C/FPO
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
LVEDV (0.31), LVESV (0.40), LVEF (0.16) and GLS (0.22). The CV and cDiff of LVEDV Objectives: We sought to identify the most reliable markers of haemodynamic improve-

and LVESV using two different vendor systems were significantly larger than those of LVEF
and GLS (figure 2a and 2b). There were no significant differences in the CV and cDiff
between LVEF and GLS (p¼0.99 after Bonferroni correction)
Conclusion: Current GLS measurement variability between different vendor systems is
analogous with that of LVEF and significantly smaller than those of LV volumes. The
removal of concerns about measurement variability should allow wider use of GLS.
Disclosure of Interest: None Declared
PT383
Concordance in the assessment of left atrial size between M-mode diameter, left atrial
area, and left atrial volume cut-offs recommended by contemporary guidelines
Lauren White1, Kristyan B. Guppy-Coles*1,2, Ada Lo1, John J. Atherton1,2, Sandhir B. Prasad1
1
Cardiology Department, Royal Brisbane and Women’s Hospital, 2School of Medicine, University
of Queensland, Brisbane, Queensland, Australia
Introduction: Assessment of left atrial (LA) size with echocardiography is complicated by
the frequent finding of discrepancies between M-mode diameter, LA area and LA volume.
The current American Society of Echocardiography (ASE) guidelines provide normal ranges
for all 3 measurements, but there are limited data on concordance between these
parameters.
Objectives: We sought to determine concordance and misclassification between the
grading of LA size by M-mode diameter, LA area and LA volume by echocardiography, as
well as determine misclassification by any two techniques.
Methods: A total of 150 consecutive echocardiograms were assessed for LA size using the 3
standard methods in accordance with ASE guidelines. LA size was graded as normal, mildly
enlarged, moderately enlarged and severely enlarged. Weighted Cohen’s Kappa (k) was
used to assess agreement between the 3 methods. Minor misclassification was standardized
as disparity not exceeding one degree of ASE classification, with major misclassification
standardized as a minimum of two degrees disparity.
Results: Within the study cohort, LA volume ranged from 21.7-310ml by LA volume. M-
mode diameter was found to have a poor agreement (k¼0.38) and a 51% concordance
when compared to LA area (38% minor and 11% major misclassification). When
comparing M-mode diameter to LA volume, moderate agreement (k¼0.5) and a 56%
concordance was found (31% minor and 13% major misclassification). Moderate agree-
ment (k¼0.51) was also found when comparing LA area to LA volume with a 55%
concordance (35% minor and 10% major misclassification). Concordance by all compar-
ative methods was found in 33% of cases (n¼50); with minor misclassification by any two
methods in 33% of cases (n¼49); and major misclassification by any two methods in 34%
(n¼51).
Conclusion: Multiparametric assessment of LA size can result in significant misclassifica-
tion. A single parameter, preferably LA volume on the basis of previously published data,
should be used to consistently grade LA size.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
ment after drainage and how best to combine them together or in a hierarchy
Methods: We developed an algorithm to predict response to pericardial drainage in
moderate or greater pericardial effusion in 226 patients; 184 consecutive patients (age
5916, 82 drained) definition group and 42 patients in a validation group (27 required
drainage). Response was defined by reduction in heart rate. A Classification and
Regression Tree (CART) algorithm was used to combine parameters for prediction of
response. We evaluated selection by; 1) combination of these variables and 2) appli-
cation of a decision tree.
Results: In the definition group, hemodynamic improvement (occurring in 61 of 82
patients who required drainage) was associated with IVC diameter
2.5cm, systolic
blood pressure (sBP) <120mmHg, mitral inflow respiratory variation >28%, lateral
effusion
1.6cm and anterior effusion
1.1cm. In the entire population, the presence
of any of these parameters showed very high sensitivity (96%) and negative predictive
value (85%) but low specificity (17%). The use of a decision tree (Figure) yielded
AUC 0.92 and improved accuracy (sensitivity 61%, specificity 75%, PPV67% and
NPV 71%). Application of the decision tree in the validation group yielded an
accuracy of 64%.
Conclusion: Current decision-making regarding pericardial drainage is arbitrary and in-
volves balancing a variety of often contradictory variables. The development and validation
of this algorithm suggests that a more balanced approach is possible but clinical application
will require further work on calibration.
Disclosure of Interest: None Declared
PT385
Compliance with ACCF/ASE Appropriateness Criteria for Transoesophageal
Echocardiography at a regional hospital in Queensland, Australia
Mohammad Paymard*1, Rajesh Garg1
1
Cardiology, Rockhampton Hospital, Rockhampton, Australia
Introduction: ACCF/ASE Appropriateness Criteria for Transoesophageal echocardiography
(TOE) classified the indications as appropriate (A), uncertain (U), or inappropriate (I).

PT384
Validation of a Decision Algorithm for Pericardial Drainage
Mehdi Eskandari*1, Kazuaki Negishi2, Nael Aldweib3, Tomoko Negishi2, Zoran B. Popovic3,
Allan L. Klein3, Thomas H. Marwick2
1
Royal Hobart Hospital, 2Menzies Research Institute Tasmania, Hobart, Australia, 3Cleveland
Clinic, Cleveland, United States

web 3C/FPO
Introduction: Echocardiography has a major role in decision-making for pericardial
drainage. The individual accuracy of echocardiographic parameters is variable and their
additive value is unknown.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e245

 Objectives: This study examined the appropriate utilization of TOE using ACCF/ASE 2007
POSTER ABSTRACTS
and 2011 Guidelines.
Methods: We retrospectively reviewed total number of TOEs performed at our Centre
between January 2010 and January 2013. The clinical indication for TOE was obtained
from pre-procedural clinical documentation.
Results: The mean age of the 161 patients who underwent TOE was 56.6 16.9 years
.Out of 161 TOEs, 83.85% were Appropriate (A), 4.97% were Uncertain (U) and 11.18%
were Inappropriate (I).The most common Appropriate indication of TOE was to exclude
left atrial appendage thrombus before direct current cardioversion for atrial fibrillation or
flutter. All TOEs with Uncertain indications, were used to exclude patent foramen ovale in
patients with stroke who either had no transthoracic echocardiography (TTE) prior or had
normal findings on TTE in the absence of atrial fibrillation. All Inappropriate TOEs were
performed to rule out infective endocarditis (IE) in patients with no evidence of bacteremia
or new murmurs.
The following graphs display the age distribution of males and females and the pro-
portions of TOE appropriateness categories in this study.
Conclusion: The most TOEs performed at our Institute were Appropriate. However, pa-
tients who need TOE to exclude IE should be chosen more carefully to avoid inappropriate
referrals.
Disclosure of Interest: None Declared
PT386
Prevalence of Infective Endocarditis Diagnosed by Transthoracic and
Transoesophageal Echocardiography in Patients with Bacteraemia
Samuel D. Hillier*1, Darryl Burstow1, David Platts1, John Sedgwick1
1
Cardiology, The Prince Charles Hospital, Brisbane, Australia
Introduction: Screening with echocardiography is a cornerstone in the diagnosis of sus-
pected infective endocarditis (IE). Positive blood cultures in the appropriate clinical setting
are the usual reason for an imaging referral.
Objectives: To determine the prevalence of diagnostic echocardiographic findings of IE
according to the Modified Duke Criteria, in patients with bacteraemia referred for
echocardiography.
Methods: All patients with positive blood cultures who had an echocardiogram to assess
for the presence of IE during the last two consecutive years were identified from a database.
The organism type isolated from blood cultures was documented, and echocardiographic
findings reviewed.
Results: 420 studies (228 Transthoracic echocardiograms (TTE), 192 transoesophageal
echocardiograms (TOE)) were performed on 314 patients with positive blood cultures (234
Staph sp, 75 Strep sp, 36 Enterococcus, 19 Fungal, 7 HACEK group, and 61 other). TTE was
the initial study modality in 202 patients, with TOE in 112 patients.
Duke Echocardiographic Criteria identified
Vegetation Abscess Valvular Dehiscence Minor Criteria
TTE 45/228 (20%) 4/228 (2%) 0/228 (0%) 14/228 (6%)
TOE 84/192 (44%) 20/192 (10%) 2/192 (1%) 22/192 (11%)
In 54 patients with an initial TTE followed by TOE, 5/54 had possible endocarditis
excluded following TOE, whilst 12/54 had new findings consistent with IE (31% increase
in diagnostic yield). In total, echocardiographic evidence of infective endocarditis occurred
in 31% of patients with positive blood cultures.
Conclusion: As expected, TOE is superior for the detection of IE in blood culture positive
referrals, particularly for perivalvular complications, such as abscess. Explanations for this
include the higher diagnostic sensitivity of TOE, and patient selection bias, with cases of
higher clinical suspicion more likely to be referred initially or serially for TOE. However,
the majority of patients referred for echocardiography with bacteraemia did not have
diagnostic imaging criteria for IE. Both these findings highlight the importance of careful
clinical screening, and determination of pretest probability prior to echocardiographic
referral.
Disclosure of Interest: None Declared
PT387
The Prevalence of Positive Duke Echocardiographic Criteria in Culture Negative
Patients Referred for Screening to Exclude Infective Endocarditis
Samuel D. Hillier*1, Darryl Burstow1, David Platts1, John Sedgwick1
1
Cardiology, The Prince Charles Hospital, Brisbane, Australia
Introduction: Bacteraemia is not compulsory to diagnose infective endocarditis (IE), when
positive echocardiographic findings are combined with sufficient systemic signs of infec-
tion, fulfilling minor Duke Criteria.
Objectives: To determine the prevalence of major and minor Duke Echocardiographic
Criteria (DEC) in patients referred with a clinical suspicion of IE, despite negative blood
cultures.
Methods: Patient data and echocardiographic findings from our database were retrospec-
tively analysed from January 2011 until February 2013, and microbiology results reviewed.
Results: Baseline characteristics included age 5520 years (65% males). 264 studies were
preformed in 237 patients with a clinical suspicion of IE despite negative blood cultures.
Index imaging included 181 transthoracic (TTE) and 83 transoesophageal (TOE)
e246
echocardiograms. The most common clinical features prompting referral included a) pros-
thetic valves (24%) b) culture negative extra-cardiac infection (24%) c) fever (21%) d)
intravenous drug-use (12%) e) immunocompromised (9%) f) new murmur (7%) g)
congenital heart disease (5%). Further imaging (6 TTE, 9 TOE) was performed in 15 patients
(6%), following an initial negative TTE. Only 1 patient (7%) had a new positive DEC finding.
Overall, 23% of culture negative referrals had echocardiographic features of IE, detailed
below.
Total DEC identified by imaging modality
Newly Diagnosed Combined Minor
Vegetation Abscess Dehiscence DEC
TTE 30/181 1/ 1/181 (0.5%) 3/181 (1.7%)
(16.6%) 181(0.5%)
TOE 21/83 (25.3%) 2/83 (2.5%) 1/83 (1.2%) 5/83 (6.0%)
Conclusion: The presence of positive DEC (primarily vegetations) is a common finding in
patients referred with a clinical suspicion of IE despite negative blood cultures, occurring
in nearly 1 in 4 in our group. This can create a difficult diagnostic and management
dilemma. Whilst a positive diagnosis of IE can be made if sufficient supporting Minor
Duke Criteria are met, careful clinical correlation is required to avoid a false positive
diagnosis due to echocardiographic ‘mimickers’ on imaging e.g. degenerative valvular
change.
Disclosure of Interest: None Declared
PT388
Impact of introduction of CT coronary angiography into the Australian Medicare
Benefits Schedule on use of other non-invasive cardiac diagnostic imaging techniques
Anastasia Vlachadis Castles*1,2, William van Gaal1,2,3
1
Cardiology Department, 2Radiology Department, The Northern Hospital, Epping, Victoria,
3
University of Melbourne, Melbourne, Victoria, Australia
Introduction: In July 2011, CT coronary angiography (CTCA) was introduced into the
Australian Medicare Benefits Schedule, allowing this imaging technique to be more widely
used. Mohasseb et al found that this did not have a significant impact on rates of invasive
coronary angiography or stress echocardiography, however, it is unclear whether or not the
availability of CTCA has influenced rates of other non-invasive diagnostic imaging
techniques.
Objectives: This study aims to demonstrate trends in use of non-invasive cardiac
diagnostic imaging techniques over the past five years. In particular, the impact of the
introduction of CT coronary angiography into the Australian Medicare Benefits
Schedule on use of other non-invasive cardiac diagnostic imaging techniques is
examined.
Methods: Publicly available Medicare Australia statistics from January 2008 to
December 2012 inclusive were accessed and analysed to determine the number of
patients undergoing CTCA, rest/stress echocardiography, rest thansthoracic echocardi-
ography, single phase nuclear medicine myocardial perfusion scanning (NM MPS),
combined rest/stress NM MPS and myocardial infarct avid studies. From this infor-
mation, we were able to determine the number of each of these studies performed as
well as the relative proportion of each study. Use of Medicare data means that studies
not funded by Medicare (patients not covered by Medicare, non-rebateable indications,
non-Medicare-endorsed imaging practices or reporting physicians) are not included in
this study.
Results: Figures 1 and 2, below, demonstrate the number and relative proportion of non-
invasive cardiac diagnostic imaging studies performed over the period of January 2008 to
December 2012.
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web 3C=FPO
Conclusion: Trends in use of non-invasive cardiac diagnostic imaging modalities in
Australia have not been affected by the introduction of CTCA in the Medicare Benefits
Schedule. While there has been moderate uptake of the new technology, increasing rates of
echocardiography have continued over the last five years and there has been little change in
the rates of NM MPS studies.
Reference: Mohasseb I, Gericke C, Atherton J, Dahiya A, Chao C and Younger J. Reim-
bursement for CT Coronary Angiography Did Not Lead to a Decrease in Invasive Coronary
Angiography or Stress Echocardiography in Australia. Heart, Lung and Circulation
2013;22:S194-195
Disclosure of Interest: None Declared
PT389
Relationship of coronary stenosis with degree of myocardial perfusion assessed by
integrated PET/CT imaging in patients with suspected ischemic heart disease
Erick Alexanderson-Rosas*1, Bruno Strada2, Sergio Maury1, Antonio Jordán-Rios1,
Monserrat Martínez-Aguilar1, Elisa Magaña-Bailón1, Luis Juárez1, Juan C. De La Fuente1,
Aloha Meave1
1
National Heart Institute "Ignacio Chavez", Mexico, Mexico City, Mexico, 2Sanatorio San
Geronimo, Santa Fe, Argentina
Introduction: The value of CTA for predicting myocardial ischemia is unclear, so inte-
grated PET/CCTA imaging could be used nonivasively to assess functionality of detected
coronary lesions allowing better guidance for subsequent therapy.
Objectives: We aimed to evaluate the relationship between coronary stenosis and its
functional impact with ammonia PET in patients with suspected CAD.
Methods: We studied 348 consecutive patients (median age, 62 +-11.3 years; 68.1% male,
31.9% female) with suspected CAD with rest/adenosine stress 13N-Ammonia PET imaging
for myocardial perfusion and CTA for coronary stenosis evaluation in the same setting.
Results: Of the 348 patients studied,254 (73%)patients had ischemia and/or necrosis
detected for PET and 192 (55.2%) had coronary stenosis by CCTA; 162 (84%) of the 192
patients with lesions detected by CCTA had ischemia detected by PET, and 95 (92%)of the
103 patients had significant lesions had ischemia. 156 patients had normal coronary ar-
teries, and 92(59%) of them had ischemia detected by PET. The relationship between the
degree of stenosis on CCTA and PET ischemia was significant (p¼0.001), and the rela-
tionship between PET ischemia and CT stenosis was also significant (p¼0.001).The rela-
tionship between the degree of ischemia (moderate or severe) and the presence of coronary
significant stenosis was also significant (p¼0.001). PET sensitivity for detecting CCTA
significant lesions was 92%, and specificity was 35%, Positive Predictive Value (PPV) was
37%, Negative Predictive Value (NPV) was 91%.
Conclusion: PET/CT allows simultaneous evaluation of the perfusion and coronary
anatomy, providing complementary information regarding the functional significance of
the coronary lesions. We found a good correlation between significant and non significant
coronary stenosis identified by coronary CCTA with moderate and severe perfusion defects
obtained by 13-N-Ammonia PET. However, cases with no stenosis with ischemic defects by
PET were patients with mild ischemia that may be related to vascular dysfunction caused
by risk factors such as DM, dyslipidemia, hypertension, smoking, as well as other vascular
anomalies.
Disclosure of Interest: None Declared
PT390
Left ventricle ejection fraction assessment through three imaging methods: A study in
oncologic women
Erick Alexanderson-Rosas*1,2, Lucely Cetina-Perez3, Roberto Jiménez-Lima3,
Antonio Jordan-Rios1, Luis Eduardo Juárez-Orozco4, Myriam Monserrat Martínez-Aguilar1,
Sergio Maury-Ordaz1, Elisa Magaña-Bailon1, Aloha Meave-González5,
Cynthia Romero-Aragones5
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
1
Nuclear Cardiology, National Heart Institute "Ignacio Chavez", Mexico, 2PET/CT Cyclotron
POSTER ABSTRACTS
Unit, National University of Mexico, 3Oncology, National Institute of Oncology, Mexico city,
Mexico, 4Universitair Medisch Centrum Groningen, Groningen, Netherlands, 5Cardiovascular
Magnetic Resonance, National Heart Institute "Ignacio Chavez", Mexico, Mexico city, Mexico
Introduction: It is well known that chemotherapy conveys a degree of risk for car-
diotoxicity in oncologic patients. Therefore choosing the most appropriate imaging
method in their follow-up is crucial for evaluation before and after each chemotherapy
administration. Nowadays, cardiac magnetic resonance (CMR) is considered the gold
standard for left ventricle ejection fraction (LVEF) evaluation. Nevertheless, this is an
expensive method and is not available in every medical center, especially in developing
countries. At the same time there are other widely spread and accessible non-invasive
imaging methods such as echocardiography (ECHO) and radionuclide
ventriculography (RV).
Objectives: The aim of this work is to determine whether there are differences in the
assessment of LVEF between these imaging methods as well as to determine which one may
be the most suitable for oncologic patients in developing countries.
Methods: We analyzed an established cohort of Mexican women. 52 patients were
included, with ages in the range of 18-70 years old with diagnosis of cervical cancer stage
IV-B and no previous cardiovascular history. We performed RV, ECHO and CMR in one a
one or 2 day session, one week before chemotherapy administration. We applied a t-test for
paired groups to assess for the difference of means, a value of p<0.05 was considered
statistically significant.
Results: The mean LVEF using RV was 62.1%7.21, the mean LVEF using ECHO was
64%8.82 and the mean LVEF using CMR was 61.5%6.49. When comparing RV vs
CMR the result was p¼0.46, meanwhile when comparing ECHO vs CMR the result was
p¼0.03.
Descriptive Statistics (Mean +/- standard deviation) n[52
Imaging method LVEF (mean) p
CMR 61.5% 6.49 Gold Standard
ECHO 64% 8.82 0.03
RV 62.1% 7.21 0.46
Conclusion: As expected there was no statistically significant difference between RV and
CMR Interestingly, there was statistically significant difference between ECHO and CMR.
This can be attributed to the fact that ECHO is an operator dependent study which in turn
conveys a wider variability. Since there was no difference between RV and CMR we
consider appropriate to utilize RV when CMR is not available since it offers adequate
measurements and it is less prone to inter-observer variability. Nevertheless, the decision
about which method to use should be based on availability, radiation exposure, economic
burden and patient comorbidities.
Disclosure of Interest: None Declared
PT391
Building a monitoring system for clinician-led governance and quality Improvement:
beginning with the end in mind
Ian Smith1,3, John Rivers*1,2, James Cameron1,2, Kelley Foster1, Russell Brighouse1
1
St Andrew’s Medical Institute, 2Queensland Cardiovascular Group, 3St Andrew’s War Memorial
Hospital, Brisbane, Australia
Introduction: Collection of new data into a clinical registry is often proposed as the initial
step in establishing a monitoring program for service-level clinical governance and clini-
cian-led quality improvement. However without an agreed step-by-step pathway of action
for subsequent analysis and findings, this activity risks becoming an end unto itself - rather
the means to that end.
Objectives: To outline a theory-based framework for clinician-led design and imple-
mentation of an integrated outcomes monitoring and quality improvement program.
Methods: Program design begins with the clinicians identifying a minimum set of in-
dicators which summarise from the clinician’s perspective, performance of the speciality’s
clinical processes and outcomes. Potential indicators are prioritised according to the extent
that when longitudinally tracked, significant differences from a risk-adjusted target rate
could be investigated – and whether variation of the indicator requires meaningful action.
Composite indicators are often chosen as meeting these requirements where single low
frequency indicators may not provide adequate signals. The framework describes a
collaborative process for the systematic optimisation of clinical outcomes at individual and
craft group levels.
Results: Starting comprehensive data collection can give a sense of progress towards
generic improvement goals. However, commencing collection of whatever data is available
may be at the expense of data that is most relevant and useful to the program’s real pur-
pose. We advocate a framework that begins by developing an agreed step-by-step pathway
to help ensure authentic findings from the monitoring program are properly actioned.
Clinician-led application of the framework is intended to develop and generate agreement
on protocols on:
- Response to authentic outlier performance or patterns
- Investigation of outlier performance or patterns
e247
 - Feedback to clinician groups of clinically meaningful comparisons
POSTER ABSTRACTS
- Risk-adjusted sequential control charting and monitoring
- Ensuring quality of collected data remains fit-for-purpose
- And lastly, optimising data collected
web 3C=FPO
Conclusion: The framework’s purpose is to engage clinicians in designing a system for
timely review of authentic differences in comparative performance of carefully chosen
clinical indicators. Use of the framework is recommended when establishing a monitoring
program for service-level clinical governance and clinician-led quality improvement.
Disclosure of Interest: None Declared
PT392
Use of a standardised output ratio to compare cardiac imaging systems
Ian Smith1, Anthony Wallace2, Luke Wilkinson3, John Rivers*1, Russell Brighouse1
1 structured clinical governance monitoring processes we demonstrate the effectiveness of
St Andrew’s Medical Institute, Brisbane, 2Arpansa, 3St Vincent’s Hospital, Melbourne, Australia
Introduction: Monitoring and improvement of clinical service delivery has been enhanced
through the application of risk adjustment (RA) to account for common sources of
variation.
Objectives: This project describes the development and application of RA techniques to
account for patient and clinician technique differences in the monitoring and comparison
of cardiac imaging system performance. Extension of this technique to the evaluation of
between clinician technique differences will also be explored.
Methods: Data for this project was obtained from imaging systems participating in the
pilot national diagnostic reference level interventional survey for coronary angiography
(CA). In total, data relating to 327 CA procedures performed at 9 practices using 14
cardiac imaging systems across 3 states (Victoria, Queensland and WA) were analysed. The
basis for the RA is a generalized multiple linear regression model that explains variation in
dose area product (DAP) attributable to measured factors such as patient weight, fluo-
roscopy time and digital acquisition time. Construction of the generalized model used the
pooled data set to establish model parameter coefficients. A standardized output ratio
e248
(SOR), defined as the geometric mean of the observed on expected DAP values for each
imaging system, was then derived. Optimum performance would minimise both DAP and
SOR without compromising image quality. This methodology was further applied to data
from a single imaging system to explore systematic technique difference between indi-
vidual cardiologists.
Results: Although a plot of DAP against the corresponding SOR for each imaging system
demonstrates a strong correlation, careful evaluation of these two measures in tandem can
identify instances of where modification of system configuration (dose and/or frame rates)
or clinical technique could bring about reduction in patient/staff radiation risk. Application
of this technique to a single lab can be shown to offer insight into differences in clinician
and radiographer technique that may contribute to improved efficiency in clinical
performance.
Conclusion: Whilst analysis of individual radiation related metrics may provide similar
insight into variances in imaging system configuration and use, this technique delivers a
valuable summary metric that can be used in quality assurance programs to ensure per-
formance optimisation and security.
Disclosure of Interest: None Declared
PT393
Use of statistical process control charting techniques for prospective monitoring of
outcomes of changes in clinical practice
Ian Smith1, John Rivers*1, Russell Brighouse1
1
St Andrew’s Medical Institute, Brisbane, Australia
Introduction: Traditional use of Statistical Process Control (SPC) charting techniques in
healthcare has focused on their ability to efficiently detect instances of deteriorating per-
formance in applications where the goal is to maintain a set standard.
Objectives: We will explore and illustrate the broader power of these tools to prospectively
detect variance in an environment of intended change.
Methods: Since 2006, St Andrew’s Medical Institute has been using SPC methods to
monitor but also as an active component of processes driving improvement in
cardiac service outcomes at St Andrew’s War Memorial Hospital. We review the
varied application of these tools and describe instances where they have been used
to drive quality improvement and prospectively confirm the impact of interventions
when change was intended or changes in service structure or resources were
introduced.
Results: In addition to confirming the effectiveness of SPC charting as a key component of
these tools in a range of applications where change in clinical practice, environment, re-
sources or technology have been introduced. Examples include change management ap-
plications dealing with the impact of education and feedback on radiation use, the efficacy
of equipment upgrades such as reduced radiation use from equipment modification and
process of care changes such as the introduction of intraoperative transoesophageal echo in
bypass surgery.
Conclusion: SPC charts, which are risk adjusted and based on research grade data, should
be an integral component of all aspects of clinical governance processes.
Disclosure of Interest: None Declared
PT394
Statistical process control supported clinical governance
James Cameron1,2, John Rivers*1,2, Ian Smith2,3, Russell Brighouse2, Kelley Foster2
1
Queensland Cardiovascular Group, 2St Andrew’s Medical Institute, 3St Andrew’s War Memorial
Hospital, Brisbane, Australia
Introduction: Thoughtfully implemented statistical quality control methods have been
shown to markedly improve identification of variations in clinical outcomes in a range of
health care settings. We describe the implementation of these techniques to a systematic
process for ensuring the delivery of high quality comprehensive cardiac care at a hospital
level.
Objectives: To develop a clinical governance system, supported by statistical process
control (SPC) tools, to monitor and drive improvement in institutional and individual
clinician performance in the delivery of cardiac services.
Methods: Clinician stakeholders were engaged in working groups to identify suitable
clinical outcome indicators (COIs) to describe the quality of service delivered by each of the
specialties of the hospital’s cardiac service. Dedicated clinical registries and data quality
monitoring processes were then developed to support the capture of outcomes data along
with data useful in developing suitable risk adjustment algorithms. Control chart based
monitoring, evaluation and performance feedback mechanisms employing internal and
external benchmarks were implemented to maintain, and if possible, drive performance
improvement.
Results: For diagnostic angiography (DCA), measures included the rate of normal/
minor disease cases while for angioplasty (PCI), electrophysiology (EP) and cardiac
implantable device (CID) procedures, procedural success and acute post procedural
complication rates were also monitored. Key adverse events following PCI (target
lesion revascularisation and major adverse cardiac events (MACE)) and EP/CID
(rehospitalisation, infection) were followed to 12 months. For all imaging procedures,
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

radiation use was also monitored and reported. In cardiac surgery, COIs included
MACE or deep sternal infections, bleeding related issues, prolonged length of stay or
readmission and bypass duration. Regular reporting of these metrics to clinicians has
been shown to influence performance as evidenced by a reduction in radiation use in
cardiac imaging and reduced reliance on blood products and antifibrinolytics in car-
diac surgery.
Conclusion: A comprehensive clinical outcomes monitoring program must include
measures across a wide temporal domain. SPC tools facilitate near “real-time”
performance monitoring allowing early detection and intervention in altered
performance. Careful interpretation of charts for group and individual clinicians
have proven helpful in detecting and differentiating systemic versus individual
variation.
Disclosure of Interest: None Declared
PT395
Worldwide variation in use of radiation dose best practices for nuclear
cardiology: results from the 66 country INCAPS (IAEA Nuclear Cardiology
Protocols) Study
Andrew J. Einstein*1, Thomas N. B. Pascual2, Joao Vitola3, John J. Mahmarian4,
Ganesan Karthikeyan5, Vincent P. Magboo6, Erin R. Kulick1, Joseph B. Meeks2, Ravi Kashyap2,
Diana Paez2, Maurizio Dondi2, on behalf of INCAPS Investigators Group
1
Columbia University Medical Center, New York, United States, 2International Atomic
Energy Agency, Vienna, Austria, 3Quanta Diagnostico & Terapia, Curitiba, Brazil, 4Houston
Methodist DeBakey Heart & Vascular Center, Houston, United States, 5All India Institute
of Medical Sciences, New Delhi, India, 6University of the Philippines Manila,
Manila, Philippines
Introduction: Nuclear stress testing is a widely used test worldwide to effectively diagnose
coronary artery disease, stratify risk, predict outcomes, and guide patient management.
Nevertheless, significant concerns have been raised regarding its high radiation dose, the
low utilization of strategies to minimize radiation, and the variability in how such practices
are applied worldwide.
Objectives: To characterize variability in application of nuclear cardiology best practices
between world regions.
Methods: INCAPS collected data on protocols used for all nuclear cardiology pro-
cedures performed in 307 laboratories in 66 countries for a single week selected by
each laboratory in March or April 2013. Best practices considered included avoidance of
dual isotope and thallium stress testing in nonelderly patients, use of appropriate
administered activities as per guidelines, weight-based dosing, use of stress-only imaging
in some patients, and use of camera-based dose-reduction approaches. A Quality Index
(QI) between 0 and 8 was determined for each laboratory as the number of best-
practices used, and compared between groups using Kruskal-Wallis and Fisher’s exact
tests.
Results: 7955 nuclear cardiology studies were performed during the selected week. QI
scores observed ranged from 2 to 8. Mean QI worldwide was 5.6. There was a significant
difference in QI between world regions (p¼0.0001), with the greatest use of best practices
in Europe (mean QI 6.0, 101 sites) and the few African sites (mean QI 5.9, 12 sites), and
the lowest use in Asia (mean QI 5.1, 69 sites). There was no significant difference in QI
between World Bank economic regions. Africa and Europe had the highest rate of sites
employing stress-only protocols in some patients (66.7% and 49.5%, respectively),
whereas in Asia thallium was frequently used in nonelderly patients (23.2% of
laboratories).
Conclusion: Variability in utilization of nuclear cardiology best practices offers numerous
opportunities to reduce radiation doses and improve quality of care globally.
Disclosure of Interest: A. Einstein Grant/research support from: This study was funded
by grants from the Margaret Q. Landenberger Research Foundation and the Louis V.
Gerstner Scholars Program. Dr. Einstein has received grant support for other re-
search from GE Healthcare, Philips Healthcare, and Spectrum Dynamics., T. Pascual:
None Declared, J. Vitola: None Declared, J. Mahmarian: None Declared, G. Karthikeyan:
None Declared, V. Magboo: None Declared, E. Kulick: None Declared, J. Meeks: None
Declared, R. Kashyap: None Declared, D. Paez: None Declared, M. Dondi: None
Declared
PT396
Radiation dosimetry and radiation best practice use for nuclear cardiology in
Australia and New Zealand: results from the 66 country INCAPS (IAEA Nuclear
Cardiology Protocols) Study
Andrew J. Einstein*1, Thomas N. B. Pascual2, Nathan Better3, Joao Vitola4, John J. Mahmarian5,
Ganesan Karthikeyan6, Vincent P. Magboo7, Erin R. Kulick1, Joseph B. Meeks2, Ravi Kashyap2,
Diana Paez2, Maurizio Dondi2, on behalf of INCAPS Investigators Group
1
Columbia University Medical Center, New York, United States, 2International Atomic
Energy Agency, Vienna, Austria, 3Royal Melbourne Hospital, Melbourne, Australia,
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
4
Quanta Diagnostico & Terapia, Curitiba, Brazil, 5Houston Methodist DeBakey Heart &
POSTER ABSTRACTS
Vascular Center, Houston, United States, 6All India Institute of Medical Sciences, New Delhi,
India, 7University of the Philippines Manila, Manila, Philippines
Introduction: Numerous factors affect radiation doses received by patients from nu-
clear stress testing. While nuclear stress testing provides numerous clinical benefits in
terms of coronary artery disease diagnosis and prognostication, optimizing its benefit-
to-risk ratio requires careful attention to protocol technique including use of best
practices.
Objectives: To characterize effective dose of radiation and use of best practices for opti-
mizing radiation dose in nuclear cardiology in Australia and New Zealand (ANZ), and
compare ANZ practice to that in the rest of the world.
Methods: INCAPS collected data on protocols used for all nuclear cardiology procedures
performed in 307 laboratories in 66 countries worldwide for a single week selected by
each laboratory in March or April 2013, including 34 labs in ANZ. Effective radiation
dose was estimated using dose coefficients from ICRP 120. Best practices considered
included avoidance of dual isotope and thallium stress testing in nonelderly patients, use
of appropriate administered activities as per guidelines, weight-based dosing, use of
stress-only imaging in some patients, and use of camera-based dose-reduction ap-
proaches. A Quality Index (QI) between 0 and 8 was determined for each laboratory as
the number of best-practices used, and compared between groups using t- and Fisher’s
exact tests.
Results: 430 nuclear cardiology studies were performed in ANZ during the selected
week, and 7525 studies were performed in non-ANZ laboratories. The lower mean
effective dose from nuclear cardiology procedures observed in ANZ (9.86 mSv vs.
10.89 mSv) was not statistically significant. QI scores observed ranged from 2 to 8
worldwide (mean 5.6) and from 3 to 7 in ANZ (mean 5.7; p¼0.21 for ANZ vs. rest
of the world). No dual isotope testing was reported in ANZ. Compared to other
regions, a lower percentage of nuclear cardiology laboratories in ANZ used stress-only
imaging in some patients (20.6% vs. 38.1%, p¼0.03), however a higher percentage of
ANZ labs utilized camera-based dose-reduction approaches such as attenuation
correction, prone imaging, or advanced reconstruction software (88.2% vs. 63.4%,
p¼0.002).
Conclusion: Radiation dosimetry from nuclear cardiology procedures is comparable in
ANZ to the rest of the world. ANZ is a global leader in the use of camera-based dose-
reduction methods in nuclear cardiology, however its use of stress-only imaging lags
behind the rest of the world.
Disclosure of Interest: A. Einstein Grant/research support from: This study was funded by
grants from the Margaret Q. Landenberger Research Foundation and the Louis V. Gerstner
Scholars Program. Dr. Einstein has received grant support for other research from GE
Healthcare, Philips Healthcare, and Spectrum Dynamics., T. Pascual: None Declared, N.
Better: None Declared, J. Vitola: None Declared, J. Mahmarian: None Declared, G. Kar-
thikeyan: None Declared, V. Magboo: None Declared, E. Kulick: None Declared, J. Meeks:
None Declared, R. Kashyap: None Declared, D. Paez: None Declared, M. Dondi: None
Declared
PT397
Correlation of cardiac mechanical dyssynchrony parameters assessed by Tc-99m
MIBI myocardial perfusion SPECT and Equilibrium Radionuclide Angiography in
patients with non-ischemic dilated cardiomyopathy
Chetan D. Patel*1, Anirban Mukherjee1, Harmandeep Singh1, Punit Sharma1, Nitish Naik2,
Gautam Sharma2, Ambuj Roy2, Arun Malhotra1
1
Nuclear Medicine, 2Cardiology, All India Institute of Medical Sciences, New Delhi, India
Introduction: Myocardial perfusion SPECT (MPS) and Equilibrium Radionuclide Angi-
ography (ERNA) are potential modalities for non invasive assessment of cardiac mechanical
dyssynchrony (CMD). Studies have shown that objective assessment of CMD is important
for prediction of response to cardiac resynchronization therapy (CRT) in patient with non-
ischemic dilated cardiomyopathy. Till now, no data is available showing correlation be-
tween CMD parameters assessed by MPS and ERNA.
Objectives: Correlation of CMD parameters assessed by Tc-99m MIBI MPS and ERNA in
patients with non-ischemic dilated cardiomyopathy
Methods: Seventeen patients having dilated cardiomyopathy (DCM) being planned for
CRT were prospectively included. Patients with history of ischemic heart disease and
structural heart disease were excluded. This single centre study was performed be-
tween November 2012 and June 2013. Institute ethical committee approval was taken.
Both 99m-MPS and ERNA were performed within a week of each other and patients
were clinically evaluated. Standard deviation of LV mean phase angle (SD LVmPA)
expressed in degrees derived from phase images of ERNA was used to quantify left
intraventricular synchrony, and LV-RVmPA was used to quantify interventricular
synchrony. In MPS, phase standard deviation (PSD) and phase histogram bandwidth
(PHB) were used for assessment of CMD. Established cut-off values of both ERNA
and MPS were used to detect the presence of dyssynchrony. LVEF was evaluated by
both modalities.
Results: The patient characteristics were as follows: age (56.18.63 years), 12 males,
NYHA class III (n¼12) or IV (n¼5), LVEF (24.611.51%). The CMD parameters
e249
 obtained from ERNA were SD LVmPA (49.620.54) and LV-RVmPA (26.619.9); and
POSTER ABSTRACTS
from MPS were PSD (54.922.1) and PHB (182.683.1). All 17 patients found to
have dyssynchrony in both ERNA and MPS using established cut off values. Good
correlation was been found between intraventricular synchrony parameters: SD LVmPA
(ERNA) and Phase SD (MPS) (r 0.645, p 0.005). Also, significant correlation was found
LVEF and SD LVmPA (Both ERNA) (r -0.813, p 0.0001) and LVEF and PSD (Both
MPS) (r -0.574, p 0.01).
web 3C=FPO
Conclusion: MPS and ERNA offer a simple, non invasive and objective tool for CMD
assessment and results of both the imaging are comparable and correlate with each other.
They may play complementary role in contribution to the prediction and evaluation of
response to the CRT.
Disclosure of Interest: None Declared
PT398
Detection of Viable Myocardium By Adenosine Stress Spect-Mpi
Syed M. E. Al Baker*1, Md. M. Rahman1, Lutfen Nessa1, K. M. H. S. S. Haque1, Faria Nasreen1
1
Department of Cardiology, Government, Dhaka, Bangladesh
Introduction: Adenosine is a coronary vasodilator but its role as a pharmacological stress
agent for detection of viable myocardium MPI in Bangladesh has not yet been tried.
Objectives: To see the evaluation of viable myocardium of coronary artery disease patients
Methods: Crosses sectional study was done on 82 randomly selected patients with CAD
for evaluation of viable myocardium. There were 68 male &14 female. Age range was
30 to79 years. After 2 week of Adenosine stress MPI, Coronary angiogram was
performed.
Results: Among 82 study subjects, 33(40.2%)had OMI, 24(29.3%)had stable angina,
9(11%)had atypical chest pain, 6(7.3%) had CABG, 6(7.3%) patients had complains of
SOB & 4(4.9%)had PTCA.By echocardiography 56.1% had regional wall motion abnor-
mality and their mean percent of EF was 41.610.6 .BY SPECT post stress mean percent
of ejection fraction was 67.04.4 among the patients with normal scan and 46.316.6
among the patients with abnormal scan and the mean difference was statistically significant
(p<0.001). MPI was normal 21(25.6%) & those patients with abnormal MPI, 26(31.7%)
had fixed defects consistent with previous MI,11(13.4%) had reversible defects consistent
with myocardial ischemia, 24(29.3%)patients had mixed defect. Coronary angiography
revealed normal coronary arteries in 24(29.3%) patients, significant single vessel disease
was detected in 20(24.4%), double vessel disease in 15(18.3 %), triple vessel disease in
23(28%) patients. Comparative analysis of MPI findings with CAG showed sensitivity
e250
96.7%, specificity 63.9%& predictive accuracy 87.8%for the detection of coronary artery
disease. Adenosine infusion did not cause any major heart rate and BP changes. ECG
changes occurred in 36 (43.9%) patients compatible with myocardial ischemia. Side effects
were, flushing(59.8%), bronchospasm(30.5%), chest pain(15.9%), palpitation(17.1%),
headache(25.6%).
Conclusion: From this study Adenosine stress MPI is fairly sensitive method for evaluation
of patients with CAD for detection of viable myocardium.
Disclosure of Interest: None Declared
PT399
Diagnostic Accuracy of Dobutamine Stress Echocardiography in Korean Women with
Chest Pain: Chest Pain in Korean Women’s Registry
Seong-Mi Park*1, Wan-Joo Shim1, Yong-Hyun Kim2, Mi-Seung Shin3, Sung-Hee Shin4,
Mina Kim1, Sua Kim1, Korean women’s heart disease research working group
1
Cardiology, Korea University College of Medicine, Seoul, 2Cardiology, Korea University College
of Medicine, Ansan, 3Cardiology, Gil hospital, 4Cardiology, Inha university, Incheon, Korea,
Republic Of
Introduction: There was little study of the utility of dobutamine stress echocardiography
(DSE) in Korean women who visited in clinic for chest pain.
Objectives: The aim of this project was to assess the diagnostic accuracy of DSE for
evaluation of Korean women with suspected ischemic heart disease and to compare with
that of treadmill test (TMT).
Methods: Of 880 women patients from chest pain in Korean women’s registry (which was
a multicenter registry for Korean women who visited in cardiology clinic for chest pain),
122 patients (mean age, 5710 years) who underwent both DSE and TMT were included.
Patient who had left ventricular (LV) regional wall motion abnormality or LV ejection
fraction <50% at baseline were excluded. Coronary angiography was done in all patients
and the presence of CAD and severe CAD were defined as any epicardial coronary artery
stenosis
50% and
70%, respectively.
Results: 45 of 122 women (36.9%) had no significant major risk for CAD, and 26
(21.3%) had
2 risk factors. Fifteen of 122 women (12.2%) had wall motion abnor-
malities during DSE. Thirty of 122 patients (24.6%) had CAD and 16 of 30 patients
(53.3%) had severe CAD. 13 of 30 (43.3%) patients had multivessel CAD. DSE was
abnormal in 12 of these 30 women, yielding overall sensitivity of 40%, 56.3% and
53.8% for severe and multivessel CAD. DSE was normal in 107 of the 122 women
with CAD, specificity 87.7%. The specificity of DSE for severe CAD was 94.3%. Fifty-
two of 122 women (51.0%) had significant ST segment depression for positive result in
TMT. Positive-TMT was in 19 of 30 women with CAD, yielding overall sensitivity of
63.3%, 62.5% and 69.25% for severe and multivessel CAD. Negative-TMT was in 92 of
the 122 women with CAD, specificity 64.1%. The specificity of TMT for severe CAD
was 60.4%. The diagnostic accuracy for the presence of CAD was similar between two
methods (p¼0.44) and for severe CAD, was slightly better with DSE than with TMT
(p¼0.08).
web 3C=FPO
Conclusion: Women in this study were in relatively low to intermediate pretest
probability and the sensitivity was low in both TMT and DSE. TMT appears to be of
limited diagnostic value in women with suspected myocardial ischemia in these patients.
In contrary, DSE can be a screening tool for the exclusion of severe CAD in Korean
women with low to intermediate pretest probability to avoid unnecessary coronary
angiography.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT403
Early changes in left ventricular function post STEMI predicts adverse diastolic
function
Jarred Hogan*1, Tuan Nguyen1,2, Justin Phan1,2, Daniel Moses1,3, Hany Dimitri1,2,
Rohan Rajaratnam1,2,4, Craig Juergens1,2, John French1,2, David Richards1,2, Liza Thomas1,2
1
University of New South Wales, 2Department of Cardiology, 3Department of Radiology,
Liverpool Hospital, 4University of Western Sydney, Sydney, Australia
Introduction: Left ventricular (LV) ejection fraction (EF), LV end systolic volume (LVESV)
and scar size are well described predictors of adverse cardiovascular events post myocardial
infarction (MI).
Objectives: The purpose of this study was to evaluate the relationship between early
reduction in LVEF, scar size and altered diastolic function.
Methods: Acute STEMI patients (n¼101), treated with percutaneous coronary interven-
tion, were prospectively enrolled (May 2012 to February 2013). Transthoracic echocar-
diograms (TTE) were performed at 53 days (baseline) and 6014 days (follow up) post
STEMI. LVESV, LVEF, and LV diastolic parameters: (diastolic function grade: 0¼normal;
1¼impaired relaxation; 2¼pseudonormal; and 3¼restrictive filling, E/E’ ratio, E/A ratio,
and deceleration time) were measured from TTE. CMRI with delayed gadolinium
enhancement images was used to assess scar size at follow-up.
Results: 101 consecutive patients (mean age 5610 years; 90% males) were recruited.
15.8% had diabetes mellitus; 85% were first presentation of MI. Mean LVEF was
45.39.1% (baseline) and 49.210.8% (follow up). Twenty-one patients underwent
negative remodelling (had a reduction in LVEF from baseline: Group 1). This group
had significantly lower E’ (p¼0.014), larger E/E’ ratio (p¼0.010) and LVESV (p¼0.012)
at follow-up compared with the group in whom LVEF remained unchanged or
improved (Group 2). Negative remodelling was also associated with worse diastolic
function grade, and a higher percentage with restrictive filling {Group 1 9/21 (42.8%)
vs. Group 2 6/79 (7.5%)} at follow-up. Furthermore, change in LVEF correlated with
CMRI scar percentage (R¼ -0.264, P¼0.008) and scar volume (R¼ -0.219, P¼0.028) at
follow-up, such that reduction in LVEF from baseline was present in those with greater
scar size.
Conclusion: Early LV remodelling changes post STEMI, demonstrated by a reduction in
LVEF from baseline, is a predictor for worsening diastolic dysfunction, and is associated
with larger scar size. Early LV remodelling changes may contribute useful clinical infor-
mation to help identify patients at higher risk post-MI. Longer term outcome data will help
to further elucidate its prognostic value.
Disclosure of Interest: None Declared
PT404
Clinical Application of Speckle Tracking Echocardiography for Assessing of Infarct
Size Early After Reperfusion in Patients with Acute Myocardial Infarction
Krasimira Hristova*1, Dobrin Vasilev1, Tzvetana Katova1
1 oblique measurement of the maximum sinus-commisure diameter or measurement of AP
National Heart Hospital, Sofia, Bulgaria
Introduction: STE enables quantification of regional myocardial function in patients with
acute and chronic myocardial infaction.
Objectives: The aim of our study was to investigate the ability of speckle tracking
echocardiography (STE) (using vector velocity imaging technique (VVI) to determinate
the infarct size 24 hours after early primary percutaneous coronary angioplasty in pa-
tients with acute myocardial infarction (AMI). The results were compared with intra-
coronary electrocardiography records (i.c. ECG), as a sensitive method for ischemia
detection.
Methods: 20 normal volunteers (mean age 31y5) and 30 patients (mean age 6313)
with AMI in the first 24 hours after PCI, were enrolled in this study. Standard
echocardiography was performed and B- mode gray scale (frame rate- 657 frames/s)
were acquired in the apical 4-chamber, 2 chamber and 3- chamber long axis view and
in the parasternal short axis view at basal, middle and apical levels and strain (ε) was
analyzing, using a commercial speckle tracking tool in infarct, perinfarct and remote
regions. The strain curves (εLL, εCC, εRR) were extracted and derived using VVI soft-
ware in 18 segments left ventricle model. The i.c. ECG was performed during PCI
procedure, placing the coronary guidewire tip in all branches >1.5mm, making a
“map” of residual ischemic region expressed in same 18 segment model. ST-segment
resolution less than 70% on ic ECG was accepted as a marker of necrosis in a given
segment.
Results: After infarct, adverse remodeling (progressive increase in LV size, mass and
reduced EF) was found. The radial and circumferential strain decreased in the infarct,
perinfarct and remote regions acutely (Tabl.1) comparable with normals. The reduction
was numerically lower for all types of strain (radial, circumferential and longitudinal).
The longitudinal strain only was significantly decreased in infarct regions. There was a
significant correlation between the infarct size (31,1  3,4 %) and longitudinal strain (r¼
-0.49, p<0.01), radial strain (r ¼-0.37, p<0,01) and circumferential strain (r¼-0.39,
p<0.05).
Conclusion: STE enables quantification of regional myocardial function in patients
with AMI. The longitudinal strain measured early after mechanical reperfusion may
predict infarct size and LV remodeling. Thus, this data suggests that radial and
circumferential strain in perinfarct and remote regions demonstrate early after AMI
may cause to adverse left ventricular remodeling and progression to ischemic
cardiomyopathy.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT405
POSTER ABSTRACTS
Measurements of the aortic root from 320 slice cardiac CT studies in patients with
aortopathy: Which parameter is most consistent with echocardiography?
Ian Agahari*1, John Troupis1,2, Sujith Seneviratne1, Siobhan Lockwood1, Laura Dobson1,
Philip Mottram1, Stuart Moir1
1
MonashHeart, 2Radiology, Monash Health, Clayton, Australia
Introduction: Reference values for measurements of the aortic root have been obtained by
Transthoracic echocardiography (TTE), and TTE is used for the detection, follow-up and
surgical decision making in aortic disease because of the outcome data that have been
published with this approach. Contemporary gated CT studies provide a 3 dimensional
data set offering the potential for more precise measurement of the aorta, although it is
unclear which measurement is most interchangeable with TTE.
Objectives: We aim to compare various CT based measurements of the aortic root
with those from echocardiograms to determine which is most consistent with
echocardiography.
Methods: 40 patients with dilatation of the aortic root on echocardiography who also
underwent prospective gated cardiac CT scan less than 4 months apart were evaluated. TTE
images were evaluated by a blinded reader measuring the max antero-posterior (AP)
diameter of the trans-sinus region with calipers from the PLAX view,utilising inner edge to
inner edge method. CT images were evaluated by a separate reader who manipulated data
using the “double oblique” technique to create an on-axis en face view of the aortic root.
Measurements included the distance from each aortic sinus to their opposing commissure
(S-C) and also the trans-sinus dimensions (S-S). Additionally CT images were manipulated
to create a long axis view similar to the view obtained from echocardiography (CTLAX)
where the maximum AP diameter was obtained.
Results: All CT related measurements demonstrated good correlation with echocardio-
graphic measurements. CT sinus to sinus distance measurements were consistently larger
than echo, while the average S-C was significantly smaller. The measurements showing no
significant difference with TTE were the maximal S-C and CTLAX aortic root measurement,
although the S-C had a slightly better correlation.
cm p Vs TTE r Vs TTE
TTE 4.39
CT Max S-C 4.43 0.305 0.89
CT average S-C 4.26 0.001 0.89
CT max S-S 5.57 <0.001 0.84
CT average S-S 5.12 <0.001 0.85
CTLAX 4.43 0.312 0.81
Conclusion: In patients with aortic dilatation undergoing gated CT scanning, double
diameter from the CTLAX provide similar results to TTE.
Disclosure of Interest: None Declared
PT406
Incidental findings are common in CT scans performed prior to atrial fibrillation
ablation
Kimberley Chan*1, Michael D. Flannery2, David O’Donnell2
1
University of Melbourne, 2Cardiology, Austin Health, Melbourne, Australia
Introduction: Cardiac CTs are routinely performed prior to atrial fibrillation (AF) ablation
procedures. Cardiac CTs are most commonly performed to define the coronary anatomy in
patients with intermediate risk of coronary disease. Incidental findings are common in
cardiac CTs and are associated with morbidity related to further investigation of these
incidental findings. The incidence of incidental findings may be different in these two
populations.
Objectives: We sought to define the incidence of incidental findings in patients under-
going Cardiac CTs prior to AF ablation and to determine if the incidence was different in
patients undergoing CT coronary angiograms (CTCA).
Methods: The final reports of all CTs at our institution performed prior to AF ablation
from 1/1/2013 through 23/8/2013 were reviewed. All incidental findings were recorded
and categorized as non-cardiac and cardiac. Incidental findings were judged to be signif-
icant if further action would be clinically indicated based on the report. All CTCA reports
over the same period were reviewed and the same data was recorded.
Results: 109 CT scans were performed prior to AF ablation during the study period.
73.4% of the patients were male with an average age of 58  9.0. Thirty-one (28.4%) had
incidental non-cardiac findings, 15 (13.8%) of which were clinically significant. Forty
(36.7%) had incidental cardiac findings. Coronary artery calcification was noted in 19
(17.4%) patients. Fifteen (13.8%) had clinically significant cardiac findings excluding
coronary calcification. In total 28 (25.7%) had clinically significant incidental findings.
Only one procedure was abandoned due to incidental findings. During the study period
224 CTCAs were performed. In total, 48 (21.4%) had clinically significant incidental
findings. There was not a significant difference in the rate of clinically significant inci-
dental findings between the patients undergoing CT prior to AF ablation and those
undergoing CTCA.
e251
 1
MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 2Department of
AF Ablation Coronary Angiogram
POSTER ABSTRACTS

Radiology and Oncotherapy, SEMMELWEIS UNIVERSITY, Budapest, Hungary, 3Medis Medical

n[109 n[224
Imaging Systems B.V., Leiden, Netherlands, 43rd Department of Internal Medicine, Bajcsy
Age 58.4  9.0 54.1  9.7 p<0.05 Zsilinszky Hospital, Budapest, Hungary
% Male 73.4 55.8 p<0.05
Introduction: Twin studies provide a unique method for assessing the phenotypic impacts
Coronary Calcification 19 (17.4%) 69 (30.8%) p<0.05 of environmental and genetic factors through the comparison of monozygotic (MZ) and
Any Incidental Finding* 54 (49.5%) 128 (57.1%) p¼ns dizygotic (DZ) twins. The heritability of coronary anatomy, which may influence plaque
Significant Incidental Finding* 28 (25.7%) 48 (21.4%) p¼ns formation through local hemodynamic effects, and the heritability of plaque morphology
were not yet studied. Here we report our initial experience.
Pulmonary Nodule 14 (12.8%) 17 (7.6%) p¼ns Objectives: To determine the heritability of coronary anatomy, plaque burden and plaque
*excluding coronary calcification morphology.
Methods: In this classical twin study we plan to enroll 100 asymptomatic, adult twin pairs
with no history of coronary artery disease. The %plaque burden, plaque volume and non-
Conclusion: Clinically significant incidental findings are common in CT scans performed calcified plaque volume were assessed by coronary CT angiography (Philips 256-slice iCT,
prior to AF ablation. The rate of incidental findings is similar to that seen in CTCAs. Best, The Netherlands). Plaque analysis was perfomed with a dedicated software (QAngio
Disclosure of Interest: K. Chan: None Declared, M. Flannery Grant/research support CT Research Edition, Medis B.V., Leiden, The Netherlands).
from: Fellowship Support from Medtronic, D. O’Donnell Grant/research support from: Results: At this point 30 twins (mean age 579 years, 22% male), 6 MZ and 9 DZ pairs,
Research support from St Jude Medical and Medtronic, Consultancy for: Consultancy fees were enrolled. Dyslipidemia was present in 57%, hypertension in 27%, diabetes in 10% of
from St Jude Medical and Medtronic. the twins and 33% of the twins were smokers. Coronary artery disease was present in 12
subjects and 56 plaques were detected. We observed a median total plaque burden of 40.3
PT407 (IQR: 34.7-45.9)%; plaque volume of 39.6 (IQR: 24.9-82.9) mm3 and a non-calcified
plaque volume of 15.4 (IQR: 8.6-30.2) mm3. Figure: The volume rendered CT images
Impact of Heart Rate on Diagnostic Accuracy of Second Generation 320-Detector show subtle differences between the hearts of monozygotic twins.
Computed Tomography Coronary Angiography (CTCA)
Nitesh Nerlekar*1, Arthur Nasis2, Brian Ko2, Michael Leung1, Dennis Wong2,
James D. Cameron2, Siang Y. Soh1, Ian T. Meredith1, John Troupis2, Sujith K. Seneviratne2
1
MonashHeart, 2MonashHealth, Melbourne, Australia

Introduction: Second generation 320-detector CTCA (AquilionOne Vision, Toshiba) has

improved temporal resolution (135ms).
Objectives: We hypothesised that patients imaged on this system at higher heart rates will
require less beta-blocker therapy with shorter length of stay (LOS) in the department,
whilst maintaining acceptable image quality and diagnostic accuracy, as patients with lower

web 3C=FPO
heart rates.
Methods: Consecutive patients with suspected coronary artery disease and no previous
CTCA who were referred for invasive angiography (ICA) were prospectively enrolled
to undergo CTCA. Patients with presentation heart rate >80bpm received additional
beta-blocker otherwise scans were acquired at the native hear rate (HR). CTCA and
ICA were visually interpreted by two independent cardiologists blinded to results of
ICA and CTCA respectively. Significant disease was defined as 50% diameter ste-
nosis on ICA. Image quality was graded using a five-point Likert scale (1-poor to 5-
excellent).
Results: 41 patients (529 coronary segments) were studied (HR range 37-80bpm). Patients
were subdivided into two cohorts according to acquisition HR (cohort 1 HR<60bpm,
cohort 2 HR>60bpm). There was no difference in Age or BMI between groups (Table 1). Conclusion: Our first impression is that CCTA of twins provides valuable tool to assess
The cumulative beta-blocker dose was higher in the low heart rate group (P<0.01). LOS heritability of coronary geometry and coronary plaque morphology. To perform statistically
was significantly shorter in the high heart rate group (P<0.01). Per segment sensitivity, robust analysis the enrollment of 100 twin pairs is warranted. The target completion date of
specificity, positive and negative predictive values for cohort 1 (n¼259) vs. cohort the study is May 2014.
2 (n¼270) was 96%, 97%, 82%, 99% vs. 94%, 97%, 85%, 99%. There was no difference in Disclosure of Interest: P. Maurovich-Horvat Grant/research support from: TÁMOP 4.2.4.
image quality or effective radiation dose between cohorts (Table 2). A/-11-1-2012-0001 ‘National Excellence Program’, A. Jermendy: None Declared, T.
Horvath: None Declared, A. Tarnoki: None Declared, D. Tarnoki: None Declared, A.
Panajotu: None Declared, M. Karolyi Grant/research support from: TÁMOP 4.2.4. A/-11-
Cohort 1 (HR<60) Cohort 2 (HR>60) 1-2012-0001 ‘National Excellence Program’, P. Kitslaar: None Declared, G. Jermendy
(n[21) (n[20) P-value Grant/research support from: EFSD New Horizons research grant, B. Merkely: None
Age (y) 64  9 65  9 0.68
Declared

BMI 29  4 29  6 0.93
Acquisition HR (bpm) 52  5 69  6 <0.01 PT409
Median radiation dose (mSV) 2.7  1 3.7  2 0.16 The Absence of Coronary Calcium Compares Favourably to a Negative Myocardial
Median Image Quality 3.8 3.5 0.54 Perfusion Scan in Detecting Severe Stenosis on Cardiac CT Angiography
Disease prevalence 11% 12% 0.62 Swee Yaw Tan*1, Terrance Chua1, John Allen2
1
Number requiring rate control (n) 7 5 0.56 National Heart Centre Singapore, 2Duke NUS GMS, Singapore, Singapore
Time in department (mins) 62  56 35  26 <0.01 Introduction: Myocardial perfusion imaging (MPI) has been used extensively to determine
Cumulative oral metoprolol dose (mg) 275 137.5 <0.01 the presence of coronary ischaemia. Although it has high specificity and sensitivity in
detecting significant coronary stenosis the test is, expensive, imparts high radiation to
patients and is time consuming.
Coronary calcium score (CACS) is an excellent tool in the detection of atherosclerosis in
Conclusion: Second generation 320-CCTA provides acceptably high diagnostic perfor- the coronary vascularture and is widely used prognostication for cardiac events. The test is
mance, image quality and low radiation exposure in patients with HR up to 80bpm. In fast, relatively cheap and exposes the patient to low levels of radiation. A CACS of zero in
addition less beta-blocker therapy is required resulting in shorter departmental length of asymptomatic individuals confers a very high negative predictive value of excluding sig-
stay and increased throughput. nificant coronary atherosclerosis.
Disclosure of Interest: None Declared Objectives: To show that a CACS of zero in patients with atypical chest pain, performs just
as well as, a negative MPI in excluding significant coronary stenosis on a cardiac CT
angtiogram (CTA).
PT408
Methods: 193 patients with atypical chest pain, prospectively underwent both a MPI and a
A classical twin study of coronary anatomy and plaque morphology: Initial CTA. Scans were performed within 2 months of each other and patients had no intervening
experience procedures or cardiac events. The MPI scan consisted of a physiologic "stress and rest",
technetium-99m MIBI myocardial imaging protocol. The CTA was perfomed on a 320 slice
Pal Maurovich-Horvat*1, Adam Jermendy1, Tamas Horvath1, Adam D. Tarnoki2, multi-detector CT scanner which included a calcium score. A negative MPI was defined as a
David L. Tarnoki2, Alexisz Panajotu1, Mihaly Karolyi1, Pieter Kitslaar3, Gyorgy Jermendy4, myocardial perfusion scan with no perfusion defect detected. ROC curves were used
Bela Merkely1 to compare the ability of a negative MPI, stress ECG and CACS of zero in excluding

e252 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

significant stenosis on CTA. A significant stenosis on CTA was defined as any stenosis
greater than 70%.
Results: In the ROC curve analysis for the exclusion of significant stenosis on CTA, a
negative stress ECG had a AUC of 0.63. A negative MPI had a AUC of 0.77 whilst a calcium
score of zero had a AUC of 0.85. Interestingly the combination of a calcium score of zero
and a negative MPI conferred the highest AUC of 0.89.
Conclusion: The absence of coronary calcification, in patients with atypical chest pain,
compares favourably to a negative MPI scan, in their ability to exclude severe coronary
stenosis on cardiac CT Angiography. The use of CACS, rather than MPI in excluding severe
coronary stenosis can potentially save cost, time and improve patient safety in this sub-
group of patients.
Disclosure of Interest: None Declared
PT414
Improved Survival for Adults with Coarctation of the Aorta in the Current Era
Carla Canniffe*1, Preeti Choudhary2,3, Dan Jackson2, David Tanous4, Kevin Walsh1,
David S. Celermajer2,3
1
Cardiology, Mater Misericordiae Hospital, Dublin, Ireland, 2Cardiology, Royal Prince Alfred
Hospital, 3Central Clinical School, University of Sydney, 4Cardiology, Westmead Hospital,
Sydney, Australia
Introduction: Previous studies from the 1970s and 1980s have reported a median age at
death of 38 years in patients with repaired coarctation of the aorta (CoA) predominantly
related to valvular and vascular complications.
Objectives: We hypothesized that this outlook has improved, in the contemporary era.
Methods: We evaluated outcomes in adult patients (seen at least once when aged >16
years) with simple coarctation, from two tertiary referral centres for Adult Congenital
heart Disease, in Australia and Ireland. Patients with co-existing bicuspid aortic valves,
ductus arteriosus or ventricular septal defect not requiring surgical repair were
included.
Results: 301 patients (55% male) and age 32+/-14 years had had coarctation surgery at age
10+/-13 years with end-to-end repair in 80, subclavian flap in 66 and patch aortoplasty in
31 patients. 39 had endovascular repair, 23 were unrepaired and repair type was not
known in 52. Follow-up period was 32+/- 13 years. 189 (63%) had bicuspid aortic valves.
Five deaths occurred; 2 with ascending aortic dissection (a 31 year old with Turner’s
syndrome and a male with un-repaired CoA), one with subarachnoid hemorrhage (24 year
old), and two with sudden cardiac death (a 56 yo male with coronary disease and a 62 y.o.
lady, cause unknown). Actuarial survival was 99% at 40 years, 98% at 50 and 92% at 60
years of age. Recoarctation occurred in 23%, with 15% requiring surgical re-repair. Aortic
aneurysms (ascending and descending) occurred in 10%, requiring surgical repair in 7%.
Patch aortoplasty was significantly associated with a higher risk of local aneurysm for-
mation (p<0.001).
In this series, surgical repair strategy did not influence mortality or the incidence of re-
coarctation.
Conclusion: In the contemporary era, long-term survival for adults with repaired aortic
coarctation is very good, up to age 60 years. Long-term morbidity is common, however,
related largely to aortic complications.
Disclosure of Interest: None Declared
PT415
Right ventricular abnormalities in young adults operated for ventricular septal defect
as toddlers: a long-term follow-up
Johan Heiberg*1, Steffen Ringgaard2, Vibeke Elisabeth Hjortdal1
1
Dept. of Cardiothoracic & Vascular Surgery, 2The MR Research Center, Aarhus University
Hospital, Aarhus N, Denmark
Introduction: Right ventricular function and morphology are expected to restore to normal
after surgical closure of ventricular septal defects in early childhood.
Objectives: Long-term abnormalities may, however, exist and were the subject of this study.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: Patients (n¼26), median age at surgery of 2.6 years (1.5-4.1 years) and 21.1
POSTER ABSTRACTS
years (19.8-23.2 years) at the time of examination, and age-matched control subjects
(n¼28) underwent Cardiac Magnetic Resonans scanning using a Philips Intera, 1.5T MR
scanner. We acquired 4-chamber view, right ventricular 2-chamber view, and 12 contig-
uous short-axis slices. Quantitative flow measurements were made using phase-contrast
gradient imaging at level of the pulmonary valve. Blinded and semiautomative time-to-peak
analyses were performed using TomTec 2D Cardiac Performance Analysis Software. The
endocardiel border was outlined in end-diastole as well as end-systole. Strain and strain
rate were calculated in the longitudinal and radial direction. Flow measurements and
myocardial mass calculations were performed using Medviso Segment software in mid-
papillary short-axis view.
Results: In comparison with controls, VSD-patients had a significantly higher right
myocardial mass index; 7.3 1.4 g m-2 vs. 6.2 1.3 g m-2, p<0.01. Peak ejection velocity
was 88.124.2 ml/sec in the VSD-group vs. 90.316.5 ml/sec in the control group,
p¼0.71. In terms of right ventricular function radial strain was higher in the VSD-group
compared with controls; 30.210.4% vs. 22.47.7%, p<0.01. No dissimilarity was found
in longitudinal strain; -20.13.8% among VSD-patients vs. -21.54.7% among controls,
p¼0.28. Lastly, a significantly lower longitudinal strain rate was demonstrated in the pa-
tient group; 1.320.42 s-1 vs. 1.560.35 s-1 in the control group, p<0.05. Radial strain
rate was not different between the groups; 1.510.51 s-1 in the VSD-group vs. 1.48 0.37
s-1 in the control group, p¼0.49. Right ventricular ejection fraction was not different
between the groups.
Conclusion: Twenty years after surgically closed VSD, we demonstrated a larger right
ventricular mass index in comparison with healthy controls. Furthermore, we found dis-
similarities in right ventricular function that heavily indicate permanent damage in either
right ventricular myocardium or the pulmonary vascular system. The consequence for
long-term outcome is unknown and will need further studies.
Disclosure of Interest: None Declared
PT416
Clinical and Echocardiographic Determinants for the Severity of Pulmonary
Hypertension in Uncorrected Adult with Atrial Septal Defect: lessons from
Indonesian patients
Lucia Krisdinarti*1, Dyah W. Anggrahini1, Budi Y. Setianto1, Nahar Taufiq1,
Hariadi Hariawan1
1
Cardiology and Vascular Medicine, Gadjah Mada University/Sardjito Hospital, Yogyakarta,
Indonesia
Introduction: Congenital heart defect in the adult remains big problem in particular an
uncorrected Atrial Septal Defect (ASD) often leads to deadly PH. Our previous hospital
records showed that during mid-2011 to mid-2012, there were 112 newly diagnosed Atrial
Septal Defect (ASD) adult patients with various degree of pulmonary hypertension.
However, the causes and factors that determine the severity of pulmonary hypertension
(PH) in ASD remain unevaluated.
Objectives: Our study aims to evaluate the clinical and echocardiographic determinants for
the severity of PH in uncorrected adult with ASD for the characterizations among Indo-
nesian patients.
Methods: We conducted a single centre-hospital based registry from July 2012. Newly
diagnosed patients who were referred to our cardiac centre in Sardjito Hospital Jogjakarta,
Indonesia were systematically recorded for clinical, echocardiographic and hemodynamic
database.
Results: During the last one year, there were 120 newly diagnosed adult patients with ASD,
with the mean age were 35.3 years-old (18-79). The majority of the cases was secundum
type ASD (94.2%) followed by ASD primum and SVD (3.3% and 2.5%; respectively).
Among those who were performed RHC (n¼40), there were no differences in age, gender
and defect size between those without PH, mild PH, moderate PH and severe PH. The
echocardiographic features for RA and RV diameter, the tricuspid valve gradient, and
TAPSE were significantly different for among those groups. More importantly there is
significant correlation between mPAP with RA diameter, RV diameter, TVG and RV
function (r¼0.43; r¼0.5; r¼0.9, r¼-0.3 p<0.05;respectively). We also evaluated the LV
eccentricity index and there is significant correlation between EI and the meanPAP. In
addition, the hemodynamic status showed that mean PVRI were also significantly different
between each groups (1.70.2 vs. 3.20.8 vs. 53.1 vs. 60.7 Wood Unit; p<0.05;
respectively). However pulmonary to systemic flow ratio (Qp/Qs) were not different and
were not correlated to meanPAP.
Conclusion: Our study showed that age, gender, defect size and Qp/Qs did not determine
the severity of PH in our patients. The echocardiographic characters of the different degree
of PH revealed more on the consequences of high meanPAP. Biomarkers and genetic de-
terminants were needed to evaluate the cause of different PH severity in our population.
Disclosure of Interest: None Declared
PT417
Right ventricle evaluation in Eisenmenger syndrome – MRI or echo?
Monika Kaldararova1, Iveta Simkova*2, Zuzana Berecova3, Vladimir Neuschl4
1
Childrens Cardiac Center, National Institute of cardiovascular Diseases, 2Department of
Cardiology and Angiology, Slovak Medical University and National Institute of Cardiovascular
Disesases, Bratislava, 3Institute of Imaging Diagnosis, 4Institute of Imaging Diagnosis, Trnava,
Slovakia
Introduction: Right ventricle (RV) plays a crucial role in pulmonary hypertension (PH). RV in
Eisenmenger syndrome (ES) (severe PH associated with congenital heart defects) shows some
e253
 specific features; which notably influences survival and clinical performance of ES patients
POSTER ABSTRACTS
compared to other PH types. Long-term follow-up with serial RV evaluation is therefore
mandatory. Echocardiography (ECHO) is widely available but RV assessment is often
regarded unfeasible; magnetic resonance imaging (MRI) is mostly considered golden standard.
Objectives: To evaluate RV in ES, comparing MRI and ECHO; focused on detailed eval-
uation of RV dilatation, hypertrophy, and function.
Methods: Analyzed were 22 patients (16F/6M), median age 41.5 years. All had ECHO
and MRI performed within 24hours. Measured were by MRI: 1. RV volume (VOL, ml/m2),
2. RV mass (MASS, g/m2), 3. RV ejection fraction (EF, %); and by ECHO: 1. RV diastolic
diameters (according to guidelines) and RV VOL (ml/m2) (by Simpson method; and by
simple mathematical model (MODEL): RV width*length*outflow tract diameter); 2. RV
free-wall diastolic diameter, RV mass (g/m2) (using Simpsons method); 3. RV function (by
fractional area change (FAC, %) and TAPSE (mm)).
Results: 1. RV dilatation: good correlation of MRI VOL vs all ECHO measured di-
ameters (best: RV diameter in long-axis-view P<0.0001, R square 0.73); as well as
ECHO VOL (best: MODEL P<0.0001, R square 0.73). 2. RV hypertrophy: MRI MASS
vs ECHO MASS (P¼0.05, R square 0.54); but no correlation with RV free-wall
diameter. 3. RV function: MRI EF vs ECHO FAC (P¼0.006) but not with TAPSE;
best correlation in marked RV dysfunction (MRI EF<30% vs ECHO FAC<30%,
P¼0.0066).
Conclusion: ECHO RV estimation is fully sufficient, especially in patients with RV sym-
metric dilatation/hypertrophy and global systolic impairment, like it is in ES (or in PH
generally). Presence of RV dilatation can be estimated by any ECHO parameter; best global
assessment is taking into consideration RV width*length*outflow tract diameter, as pre-
sented in our study. In RV hypertrophy a simple wall-diameter measurement is not
sufficient; ECHO estimation of RV mass though is comparable with MRI. RV function is
best assessed by FAC, especially in patients with marked RV dysfunction and is comparable
to MRI. Serial RV assessment is therefore feasible to evaluate progressive RV deterioration.
Together with clinical performance RV evaluation strongly influences further patient
management.
Disclosure of Interest: None Declared
PT418
Overweight and associated factors in children with congenital heart disease:
incremental risks?
Sandra M. Barbiero1, Daniela Schuch2, Daniela B. Peña2, Camila W. Schaan2,
Claudia C. Cesa1, Aline Dalmazo2, Ana W. Tech2, Lucia C. Pellanda*1,3
1
Post-Graduation Program in Health Sciences: Cardiology, 2Instituto de Cardiologia / Fundação
Universitária de Cardiologia, 3Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Brazil
Introduction: Children with unhealthy lifestyles are predisposed to the development of
hypertension, dyslipidemia, and obesity in adult life. This may be an added burden to
children with congenital heart disease (CHD).
Objectives: To estimate the prevalence of obesity and describe dietary habits, family his-
tory and systemic arterial pressure in children with CHD.
Methods: Cross-sectional study with 316 children and adolescents with congenital heart
disease seen in the Pediatric Cardiology Clinic of a reference hospital, including inves-
tigation of family history of chronic diseases, anthropometry, dietary habits and labora-
tory tests.
Results: Prevalence of overweight was 26.9%. Family f risk factors included 44.3%
overweight, 53.8% dyslipidemia, 49.7% diabetes, 83.2% hypertension and 52.2%
ischaemic heart disease. Analysis of dietary habits showed that patients consumed un-
healthy foods, such as: sweets (54.7%), sausages (47.7%), fried food (33.2%) and soft
drinks (32.8%). In addition, altered levels of cholesterol were observed in 46.9% of the
patients, of HDL in 32.7% and of LDL in 23.6% of the patients, as well as high triglycerides
levels in 20.0%. A higher frequency of family history of obesity (42.6%; p¼0.001), dys-
lipidemia (48.1%; p¼ <0.001), diabetes (47.4%; p¼0.002), hypertension (39.2%;
p¼0.006) and ischemic disease (43.7%; p¼0.023), as well as significantly higher values of
triglycerides (p¼0.017), glycemia (p¼0.004) and C-reactive protein (p¼0.002) were
observed among overweight patients.
Conclusion: Children with CHD present high frequency of unhealthy habits and risks
factors, adding to the risks associated to their heart lesions.
Disclosure of Interest: None Declared
PT419
Cardiovascular Risk Factors in a Pediatric Preventive Cardiology Outpatient Clinic:
Baseline Results of a Clinical Cohort Study
Cláudia C. Cesa1, Sandra M. Barbiero1, Rosemary D. O. Petkowicz1, Natássia B. Machado2,
Mateus A. D. Reis2, Lucia C. Pellanda*1,2
1
Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia / Fundação
Universitária de Cardiologia, 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto
Alegre, Brazil
Introduction: Despite the recognized importance of primordial and primary preven-
tion on atherosclerosis risk factors, very few clinical findings from a pediatric popu-
lation with cardiovascular risk factors treated in a preventive outpatient clinic are
available.
Objectives: To describe the cardiovascular risk factors of patients in a pediatric preventive
cardiology outpatient clinic.
e254
Methods: Baseline cross-sectional analysis nested within a clinical cohort with 216 children
and adolescents from a pediatric preventive cardiology outpatient. The main outcome
measures were health indicators and prevalence rates of positive family history, blood
pressure, blood work (lipid panel and fasting glucose test), body mass index z-score (z-
BMI), waist circumference (WC), and screen time.
Results: Most children were overweight or obese (76.4%), but all other risk factors were
also highly prevalent (positive familiar history, 93.3%; WC > 90th, 52.8%; obesity, 73.4%;
hypertension, 31.5%; total cholesterol, 53%; low high-density lipoprotein, 30.4%; tri-
glycerides, 64%; and metabolic syndrome, 40.9%). A cluster of at least three risk factors
was prevalent in 90.3% of the sample, and the prevalence of metabolic syndrome was
40.9%.
Conclusion: High prevalence rates of overweight, obesity, cluster of risk factors, and
metabolic syndrome were found in a preventive pediatric cardiology outpatient clinic.
These data are important for the effective planning of primary prevention interventions to
address atherosclerosis risk factors.
Disclosure of Interest: None Declared
PT420
Toxic metals and metalloids in heart and other intraoperative and autopsy tissues of
children with congenital heart diseases
Oleksandra Koval*1, Natalia Nagorna1, Mokryk Igor2, Ganna Dubova3
1
Pediatric of educational institute of postgraduate education, Donetsk National medical university
n.a. M. Gorkiy, 2Children’s cardiac surgery, cardiology and rehabilitation, Government
Institution “Institute of Urgent and Recovery Surgery named after V.K. Gusak National Academy
of Medical Science of Ukraine”, Ukraine, 3Pediatric of educational institute of postgraduate
education, Donetsk National Medical University n.a. M.Gorkiy, Donetsk, Ukraine
Introduction: There are about 30 metals and metalloids that are potentially toxic to
humans. Some of them, according to the experimental data, able to penetrate the placental
barrier and violent cardiogenesis.
Objectives: investigate the levels of different toxic metals and metalloids in the biopsies of
the various tissues of children with CHD.
Methods: 34 children (22 boys and 12 girls), aged from 14 days to 17 years old (median:
26 month  2 month) with different CHD underwent content analysis of following toxic
metals and matalloids: Al, Cd, Pb, Hg, Be, Ba, Tl, Bi, As, Ni, Sb, Sn, Sr, Ti, W, Zr, Ag, Li,
B, Co, Si, V in intraoperative (n¼28) and autopsy (n¼6) biopsy tissue samples of
endocardium (n¼22), myocardium (n¼26), pericardium (n¼7), aorta (n¼10), skin
(n¼8), subcutaneous fat (n¼8), intercostal muscles (n¼24), fascia (n¼2), kidneys (n¼5),
brain (n¼2) and hair (n¼9) by methods of the atomic emission spectrometry in the
inductively coupled plasma and atomic absorption spectrometry with electrothermal
atomization.
Results: We revealed the presence of toxic metals in 79,46,9% of the patients. They
are: barium, aluminum, lithium, nickel, strontium, arsenic, zirconium. The results
demonstrated that the higher of mentioned metals concentration was in heart tissue in
comparison to its concentration in other body tissues. Investigation of their frequency of
occurrence in children with cardiovascular malformations revealed that the most
frequent was barium that was discovered in 64,7% of the patients in comparison with
other elements. These toxic substances occurred as one chemical element in 76,7% of
patients, and in combination of two or more in 33,3%. The most common is the
combination of barium and aluminum. Excess degree of mentioned substances reached
150 times in comparison with the permissible concentration and depended on biopsy
topography: in the locus of aortic coarctation, valve atresia, septum in septal defect it
concentration was significantly (p <0.05) higher than in normal area of the heart or great
vessel.
Conclusion: Our results indicate that, children with CHD have a special elevated set of
specific toxic metals at the site of malformation. The above mentioned suggests a possible
role of barium, aluminum, lithium, nickel, strontium, arsenic in formation of cardiovas-
cular malformations, that needs further evaluation. Future development of this methods
may possible serve as addition diagnostic tool in detection of CHD in fetus and kids.
Disclosure of Interest: None Declared
PT422
Comparison of peak oxygen consumption in children with congenital heart disease,
at a moderately high altitude
Hermes L. Ilarraza*1, Irma C. Miranda2, Alfonso G. Martinez2, Javier L. Castaneda1,
Maria Dolores S. Rius1, Jessica C. Rojano1, Alejandro G. Hernandez1, Alfonso H. Buendia2,
Juan C. Calderon2
1
Cardiac Rehabilitation, 2Cardiology Pediatrics, National Institute of Cardiology Ignacio Chavez,
Mexico City, Mexico
Introduction: Congenital malformations are one of the most prevalent causes of heart
disease, and these children can reach adulthood. One of the most widely used screening
studies in adults is exercise testing, however its use among pediatric population is limited.
Moreover, cardiopulmonary behavior of human beings varies with altitude, particularly due
to a decrease in the availability of oxygen in the atmosphere.
Objectives: The aim of this study was to evaluate the cardiopulmonary performance at a
moderately high altitude, in a group of children with congenital heart disease (CHD).
Methods: In a cardiological center placed at 2240 meters above sea level, we studied a
cohort of patients with different types of CHD. All children underwent cardiopulmonary
exercise testing (CPX), using a Schiller PowerCube device and a treadmill. Results were
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
compared with a group of children without heart disease. Variables are presented as mean (1 not diagnosed until 8 month), 1 pulmonary atresia with VSD, 1 severe aortic stenosis

POSTER ABSTRACTS
 SD, frequencies and percentages. Comparison among groups was performed using and 1 Ebstein’s anomaly. No babies were identified by the WA Forensics Dept as having
analysis of Chi2, ANOVA or Wilcoxon test as needed. All values of p<0.05 were considered died due to CCHD over the study period. A significant number of babies diagnosed after
stochastically significant. discharge from hospital were haemodynamically compromised on admission. The mor-
Results: We evaluated 664 children (63% male, 37% female), with a mean age of 114 tality of the whole cohort of CCHD was 12.5% (12/96).
years (3 to 17 y). Studied groups were: acyanotic-CHD 36%, cyanotic-CHD 10%, Conclusion:
cardiomyopathy 8% (CM), other heart disease 17% (OTHER) and apparently healthy 1. This study has demonstrated that currently 48% of babies with CCHD in WA are
children 29% (CTRL). The lowest peak oxygen consumption (VO2peak), was observed being diagnosed antenatally and 52% post-natally.
in the cyanotic-CHD group (2810 mlO2/kg/min), followed by CM (3010 mlO2/kg/ 2. 20% of babies with CCHD were discharged from hospital prior to diagnosis.
min), acyanotic-CHD (329 mlO2/kg/min), OTHER (3310 mlO2/kg/min) and finally 3. Routine pulse oximetry screening prior to discharge should detect a significant pro-
the CTRL group (379 mlO2/kg/min). Stochastically differences were observed among portion of these babies and potentially prevent major haemodynamic consequences.
CTRL group and the other types of CHD (p<0.001). However, among pathologies, only Our study would be supportive of introducing such screening in Western Australia.
statistically differences were found between cyanotic-CHD and acyanotic-CHD
(p<0.05). Disclosure of Interest: None Declared
Conclusion: At a moderately high altitude, patients with CHD have a lower VO2peak than
those apparently healthy children. This difference is particularly evident between children
with cyanotic and acyanotic CHD. PT425
Disclosure of Interest: None Declared Parental Consanguinity Is A Risk Factor For Congenital Heart Disease In A South
Indian Population
PT423 Srinivas Ramaka*1, Bhaskar Rao Beesetty2, Ravikumar Chodavarapu3
1
Cardiology, Srinivasa Heart Centre, 2Paediatrics, Mahatma Gandhi Memorial Hospital,
Screening for Critical Congenital Heart Disease in Western Australia with Pulse
Oximetry – A One Year Pilot Study Warangal, 3Paediatrics, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research
Foundation, Vijayawada, India
Gitanjali P. Mansukhani1, Sofia Lindberg-Bilock1, James Ramsay*1,
Abhijeet Rakshasbhuvankar2, Emma Harris2, Joanne Colvin3, Corrado Minutillo4, Scott Stokes5 Introduction: With an estimated incidence rate of 8/1000 live births, each year in India
1
Dept of Paediatric Cardiology, Princess Margaret Hospital for Children, 2Dept of Neonatology, 180,000 children are born with CHD.The prevalence of congenital heart disease is
increasing in India.Parental consanguinity is common in Indian population. Preventing
King Edward Memorial Hospital for Women, 3Dept of Neonatology, St John of God Subiaco
CHD is more cost-effective in India than treating.
Hospital, 4Kaleeya Hospital and Attadale Private Hospital, Perth, 5Broome Public Hospital, Objectives:
Broome, Australia  Is parental consanguinity a risk factor for congenital heart disease in the child?
 Are other demographic factors risk factors for CHD?.
Introduction: Many states in the USA and a number of European countries have started
Methods: A Hospital- based case control study of children attending Mahatma Gandhi
screening newborn babies routinely with pulse oximetry (POx) to detect babies with
Memorial Hospital and Srinivasa Heart Centre, Warangal, Andhra Pradesh, India. Study
critical congenital heart disease (CCHD) prior to discharge. Australia does not have a
subjects: Cases (277) are children aged 1 day to 12 years with CHD and without other
specific state based collaboration between neonatal and tertiary paediatric cardiac ser-
congenital anomalies. Controls (329) are children aged 1 day to 12 years without CHD and
vices to introduce an oximetry screening program. A pilot study was commenced on 1st
other congenital anomalies.
Sept 2012 to begin such a service in a number of maternity hospitals in Western
Variables Measured: Presence or absence of CHD and the type of lesion as assessed by ECG,
Australia (WA).
X-ray chest and 2D ECHO; Age of mother and father at the time of child birth; Age of the
Objectives: To analyze the utility of routine pulse oximetry prior to discharge as a
child at the time of study and at the time of diagnosis of CHD; sex of the child; religion of
screening tool to diagnose CCHD in five maternity units in WA over a one year
parents; presence or absence of parental consanguinity and the degree of consanguinity
period.
(relationship of mother and father before marriage); Domicile area (urban or rural) of
Methods: From 1st Sept 2012-31st Aug 2013, oximetry screening was commenced in
mother during pregnancy.
eligible babies born in 5 maternity units in WA. Oxygen saturations were checked in
Statistical Analysis: Statistical analysis is done using EpiInfo, 3.5.3 of C.D.C, U.S.A &
either lower limb and a cut off value of below 95% was taken as abnormal. Timing of
Medcalc 12.6.1.0.
screening was dependent on the time of discharge and not specifically fixed to >24 hours
Appropriate statistical tests for the data are done. Logistic regression to identify significant
of age.
risk factors for congenital heart disease is done. A P-value below 0.05 is taken significant.
Results: Of 9502 eligible babies, 7719 babies were screened (81%). No true positives cases
Results: Table 1: Proportion of acyanotic and cyanotic CHD are increasing with
were identified. There were only two false positives cases, one baby had an abnormal low
consanguinity.
oxygen affinity hemoglobin (Hemoglobin Titusville) and the other baby had Trisomy 21
with pulmonary hypertension. There were 2 false negative cases, one baby with total
anomalous pulmonary venous return and the other a term baby with coarctation of aorta,
both of whom passed the oximetry screen at discharge. There were significant logistical
problems with the program including who should perform screening, documentation
details and how to include those babies who were discharged early.
Conclusion: This initial pilot program has confirmed a low false positive rate for oximetry
screening indicating no significant increase in workload for tertiary paediatric cardiology
centres or neonatal units/postnatal wards. There are plans to expand screening to more
maternity units in Western Australia and address the specific problems of this initial
experience including more extensive education of midwives and medical staff.
Disclosure of Interest: None Declared

PT424
Diagnosis and outcomes of critical congenital heart disease in Western Australia
Gitanjali P. Mansukhani1, Sofia Lindberg-Bilock1, James Ramsay*1
1
Dept of Paediatric Cardiology, Princess Margaret Hospital for Children, Perth, Australia

Introduction: Congenital heart disease (CHD) is the leading cause of infant death in
many developed nations. 2-3 /1000 babies are born with critical congenital heart disease
(CCHD).
Objectives: To determine mode of presentation, diagnosis and outcome of CCHD in
newborns born in Western Australia (WA) from 01/01/2011-15/09/2013.
Methods: Neonates and infants diagnosed with CCHD in WA from 01/01/2011-15/09/
2013 were reviewed. This study was initially retrospective and then prospective from 01/
09/2012, when an oximetry pilot study began in WA. Information was collated from the
Cardiothoracic Surgical Database, Cardiobase, Synapse (echo database), patient medical
records and the WA forensic database. Table 2:
Results: A total of 96 neonates with CCHD were born between 01/01/2011 and 15/09/
2013. Antenatal diagnosis was made in 48% (46/96). Postnatal diagnosis before hospital  Parental consanguinity increases risk of CHD by 3.76 times.
discharge occurred in 31% (30/96). 20% (19/96) of babies with CCHD were discharged  Male children compared to female are 0.7 times less likely to have CHD.
home before diagnosis and one baby was a homebirth. Diagnoses of patients discharged  Domicile area of mother during pregnancy, religion and age of parents at child birth
included: 7 with coarctation of aorta, 4 with TGA complex, 3 TAPVR, 3 tetralogy of Fallot are not associated with CHD in child.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e255


POSTER ABSTRACTS
Conclusion:
 Parental consanguinity is a preventable risk factor for CHD.
 Health education to avoid consanguineous marriages is needed to reduce the
burden of CHD.
Disclosure of Interest: None Declared
PT430
Involvement of Th17 cytokines in acute rheumatic fever
William J. Martin*1, Gabriela Minigo2, Joanne Keeble1, Peta Tipping2, Melita McKinnon2,
Ruijie Liu3, Gordon Smyth3, Jonathan Carapetis2,4, Ian Wicks5,6
1 Babak Moini*1, Jan E. Hanson2, Allison Webel3, Haddy Nalubwama4, Robert Salata5,
Inflammation Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, 2Menzies
School of Health Research, Darwin, 3Bioinformatics Division, Walter & Eliza Hall Institute of
Medical Research, Melbourne, 4Telethon Institute for Child Health Research, Perth,
5 Bolton School of Nursing, Case Western University, Cleveland, United States, 4School of Public
Inflammation Division, Walter & Eliza Hall Institute, 6Rheumatology Unit, Royal Melbourne
Hospital, Melbourne, Australia
Introduction: The immune mechanisms that begin with group A streptococcal (GAS)
infection and result in acute rheumatic fever (ARF) and rheumatic heart disease (RHD)
remain poorly understood. It is widely believed that the Th1 response is involved in the
development of ARF and RHD. This is largely due to the detection of the Th1 cytokine,
IFNg, in ARF patient sera and in surgically removed rheumatic heart valves. However,
IFNg also features in Th17 responses, and Th17 responses have been identified as being
pathogenic in a number of autoimmune diseases. We sought to determine whether there
was any evidence of Th17 responses resulting from GAS stimulation of immune cells and in
ARF patients undergoing an acute episode.
Objectives: To determine whether Th17 responses are involved in responses to GAS and
the development of ARF.
Methods: Peripheral blood mononuclear cells (PBMC) were isolated by ficoll gradient.
Transcriptional profiling was performed using Illumina HT-12 Bead Chips and genes
were analysed using rotation gene set testing, ROAST.
Flow cytometry was used to detect intracellular cytokines produced by CD4+ T-cells in
culture.
Cytokines in patient plasma and culture supernatants were measured using Milliplex
MAP human Th17 bead kit and ELISA.
Results: Microarray of PBMC stimulated with GAS in vitro revealed that genes related
to the Th17 as well as the Th1 response were upregulated simultaneously following
exposure to GAS. CD4+ T-cells cultured with autologous, monocyte-derived dendritic
cells loaded with GAS produced IFNg and IL-17A and IL-17F, with an increased
proportion of CD4+ T cells co-producing IFNg and IL-17A/F. A cohort of 18
Aboriginal and Torres Strait Islanders undergoing an active episode of ARF exhibited
elevated levels of five Th17 cytokines at an average of 18.7 days following the onset of
symptoms with levels of Th17 cytokines returning to those of healthy controls
following treatment.
Conclusion: These data indicate that the involvement of the Th1 response as the primary
pathological response in ARF and RHD, as evidenced by the presence of IFNg, may be a
red herring. Instead, ARF may be the result of an underlying Th17 response. This provides
new avenues for investigation of ARF immunopathogenesis.
Disclosure of Interest: None Declared
PT431
Role of care co-ordination and case conferencing in managing pre and post operative
challenges in the NT remote indigenous patients with severe rheumatic heart disease
Nadarajah Kangaharan*1, Marcus Ilton1, Pupalan Iyngkaran1, Colin Farquharson1
1
Cardiology, Royal Darwin Hospital, Darwin, Australia
Introduction: Northern Territory has a high proportion of indigenous patients living
remotely with high burden of rheumatic heart disease (RHD). There are significant man-
agement challenges faced by the local cardiac service in providing optimum and evidence
e256
based therapy. Some of these challenges include both patient factors (young age, preg-
nancy, non-adherence to therapy, psycho-social factors) and system issues (lack of co-
ordination, infrastructure and staffing issues).
Objectives: We aim to discuss some of these recent challenging cases of RHD and discuss
our co-ordinated and collaborative approach to improve patient care and the outcome.
Methods: Royal Darwin Hospital is the only major hospital with onsite cardiac services in
the Northern Territory. RDH has most cardiac diagnostic capabilities but does not have any
onsite interventional or cardiac surgical facilities. RDH cardiology unit has established a
long standing relationship with Flinders Medical Centre (Cardiology and Cardio-thoracic
units). FMC provides the vast majority of the cardiac surgical support to patients from the
Top End. In the past, many complex patients have been managed in an ad-hoc manner and
some have been lost to follow up resulting in poor outcome.
Results: Over the last two years, there have been improvement with establishment of
indigenous cardiac nurse co-ordinator (ICNC) positions and weekly complex case
conferencing (“Triple C”) with FMC. A weekly case conferencing session is dedicated be-
tween these two units to discuss complex patients with rheumatic heart disease. There is an
open and transparent discussion among a variety of clinicians (both interventional cardi-
ologists and cardiac surgeons). Discussions and consensus recommendations are docu-
mented and communicated through the “chair” to all the clinicians involved.
Recommendations are followed through by the ICNC based at RDH. ICNC is involved in
the communication with patients, primary care team, local cardiologists and FMC staff and
ensure the patients are not lost in the system. There will also be an establishment of a NT
Cardiovascular Information System (CVIS) which is a partnership between NT Cardiac Pty
Ltd, NT Government and the Commonwealth).
Conclusion: Despite the significant challenges faced by the NT remote indigenous patients
with RHD, there is an opportunity to improve clinical outcome by a co-ordinated and
collaborative approach by all the service providers and the health systems involved.
Disclosure of Interest: None Declared
PT432
Promoting primary prevention of rheumatic heart disease in Uganda: a qualitative
study of group A streptococcal pharyngitis awareness in urban and rural communities
Chris Longenecker6
1
Internal Medicine, University Hospitals Of Cleveland, 2Graduate School of Public Health,
3
Health, Makerere University, Kampala, Uganda, 5Infectious Diseases, 6Cardiology, University
Hospitals Of Cleveland, Cleveland, United States
Introduction: Rheumatic heart disease (RHD) is the most common cause of cardiovascular
morbidity and mortality among children and young adults in Uganda with an estimated
prevalence of 1.4% among school aged children. Increased community awareness of the
causes of RHD and the appropriate treatment of Group A streptococcus (GAS) pharyngitis
may decrease the prevalence of RHD in Uganda.
Objectives: The objective of this study was twofold. In the first phase of the study, we
aimed to investigate the knowledge of Ugandan children and their caregivers regarding the
potential complications of GAS pharyngitis and its management. Using this data, the
second phase of the study aimed to increase community awareness of appropriate phar-
yngitis treatment.
Methods: We conducted focus group discussions with conveniently selected caregivers
(N¼28). Separately, we conducted focus groups with adolescents 10 to 17 years of age
(N¼24). The subjects were recruited from rural and peri-urban locations in Wakiso District
in south-central Uganda. We used these qualitative data to inform the design of posters and
radio advertisements which were used in a 4-week community-education intervention in
the same geographical areas. Door-to-door post intervention surveys were conducted to
measure the efficacy of the intervention.
Results: Overall, most children had experienced symptoms of pharyngitis (78%), but
less frequently reported symptoms to caregivers (38%). Many caregivers reported using
home remedies to treat sore throat (71%). Very few caregivers understood that phar-
yngitis may lead to heart disease (19%), and only one subject reported any knowledge
of RHD. The post intervention survey findings are summarized in the Table. Twenty-
five adults were randomly selected and interviewed. Overall, substantially more people
heard the radio advertisement than saw the posters (16 vs 8). Significantly more people
who were exposed to the interventions reported that they would change their practice
to seek appropriate treatment of pharyngitis compared to those who were not exposed
(82% vs 0%).
Conclusion: There was a significant lack of knowledge among residents of Wakiso District,
Uganda regarding causes and treatment of pharyngitis and the potential risk of rheumatic
heart disease. A simple, cost-effective, community-awareness intervention appears to
effectively increase residents’ intentions to seek medical treatment for future episodes of
pharyngitis.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PT433 Methods: The study was conducted on the basis of rheumatic department. The study

Rheumatic Rescue: Genetic basis for elevated rheumatic heart disease susceptibility
in Samoa
John K. Kauwe1, Lori B. Allen2, Marvin Allen3, David Gage1, John B. Allen*4, Tyler Weenig1,
Adonica I. Kauwe2
1 Age of initiate PsA - 34,410.5. Most of patients (61.1%) had polyarthritic variant of
Biology, Brigham Young University, Provo, 2Public and Community Health, Utah Valley
University, Orem, 3Cardiology, Central Utah Clinic, 4Biology, Brigham Young Univeristy, Provo,
United States
Introduction: Pathogenesis of Rheumatic Heart Disease (RHD) is complex. Environmental
and genetic factors are contributing factors. Estimated heritability from a metaanalysis of
twin studies was 60%. Rates of RHD are elevated in Samoa, and ecent data suggests that
within Samoa there are geographic regions with significantly higher rates of RHD than
others.
Objectives: We analyzed prevalence data from screening efforts by the Rheumatic Rescue
organization to determine statistically significant regional variation in rates of RHD.
Families in Samoa with multiple affected individuals and patterns of inheritance indicative
of elevated genetic risk for disease were identified. Exome sequencing was performed to
search for the variant(s) responsible for this elevated risk.
Methods: We compared the number of unaffected and affected individuals in each school
to coresponding numbers in all other schools screened using Fisher’s Exact test. P-values
were adjusted for multiple tests using a Bonferroni correction. For pedigree identification
we contacted the parents of individuals who screened positive to assess the number and
relatedness of other known RHD cases. When multiple affected individuals were identified
we obtained consent, conducted a full RHD screening, and collected DNA via saliva
samples from all available family members.
Results: We identified a significantly higher rate of RHD at two schools (P¼0.0046,
P¼0.0013). Two other schools showed an excess in RHD rates but were smaller in size;
therefore, the differences were not statistically significant.
We characterized one family with multiple affected individuals (fig 1). Thirteen in-
dividuals were available for screening and DNA collection. Four of the nine offspring,
ranging in age from 7 years to 27 years, screened positive for RHD. DNA from all 13 in-
dividuals in this pedigree has been extracted and is being sequenced. We plan to report the
results of this analysis at the conference.
Conclusion: The prevalence of RHD in Samoa is known to be elevated. Our findings show
that even within Samoa, there are small geographic regions (school boundaries), which
have further elevated rates of RHD. We have identified a large pedigree that likely harbors
RHD risk variants. While environmental factors clearly contribute to elevated rates of RHD
in Samoa, our data suggest that is also a genetic contribution to RHD risk. We anticipate
that our exome sequencing efforts will lead to the identification of genetic variants in this
pedigree that alter risk for RHD.
Disclosure of Interest: None Declared
PT434
Establishing Rheumatic Heart Disease Control Program in Sudan: achievements and
challenges
Sulafa Ali*1
1
Pediatric Cardiology, Sudan Heart Istitute, Khartoum, Sudan
Introduction: Rheumatic heart disease (RHD) has a significant burden on the health of
young people in Sudan with a prevalence of 10 per 1000. There has been no control
program for RHD in Sudan for the last 15 years.
Objectives: To describe an RHD control program initiated in May 2012.
Methods: The authors, inspired by the experience of the Pan African Society of Cardiology
(PASCAR) and the RHD Group of the World Heart Federation last meeting in Dubai May
2012 initiated a RHD control program initiative based on the Awareness, Surveillance,
Advocacy and Prevention (ASAP) initiative of the PASCAR. The program is supported by
the Sudan Heart Society and the Sudanese Association of Pediatricians.
Results: Primary prevention protocol based on research that validated a clinical algo-
rithm for diagnosis of bacterial pharyngitis is described. Secondary prevention is rein-
forced. The program included protocols for primary and secondary care physicians as
well as health assistants, nurses and school teachers. Training workshops were con-
ducted for these categories in collaboration with the Ministry of Health, School Health
and Noncommunicable Disease Departments. Initiation of awareness programs for
physicians, medical students, school staff and the public and initiation of a local registry
was initiated
Conclusion: The paper throws light on the achievements and difficulties of this program.
Disclosure of Interest: None Declared
POSTER ABSTRACTS
included 36 patients with definite diagnosis of PsA. Diagnosis of PsA based on avail-
ability of diagnostic criteria CASPAR (2006), the comparison group (CG) amounted 20
healthy individuals comparable by gender, age and body mass index (BMI) (p>0.05).
The average age of patients was 45,89.7 years. For the evaluation of coronary risk the
European scale SCORE was used. Age of initiate of psoriasis was 24.1of 6.3 years.
PsA. Activity evaluation by DAS4 was 3,5 (2,2; 3,9). The average score on the criteria
CASPAS - 5,3 (3,7; 7,1).
Results: The average Smoking index at patients with PSA ¼ 179,419,8. Anamnesis of
Smoking ¼ 21,711,3 packs/years. Arterial hypertension was diagnosed at 23 (63,9%)
patients with PSA, in the CG - 7 (35,0%; p<0.05). Patients with PSA statistically
significantly more often diagnosed BMI >to 34.9 kg/m2 (7 p-ts), which corresponds to
obesity of the II and III stage. At 18 of 36 surveyed PSA observed the changes in blood
lipid spectrum, in the CG changes was at 3 of 20 p-ts. Total cholesterol at PSA patients
was 5.25 mmol/l (4,39; 6,19), at healthy people- 4,92 mmol/l (4,28; 5,11; p¼0.06).
Family anamnesis of CVD had 22 (61,1%) PSA patients and 3 (15%) p-ts of CG
(p<0.05). Low total cardiovascular risk was diagnosed at 8 (22,2%) p-ts, average - at 10
(27,8%), high – at 12 (33,3%), very high risk by SCORE - at 6 (16,7%) PSA patients. In
the comparison group at 14 (70,0%) p-ts was registered the lowest and at 6 (30,0%) -
average risk by SCORE.
Conclusion: A half (50,0%) of PSA patients noted the high and very high risk of devel-
oping CVD. Traditional cardiovascular risk factors correlate with the activity of chronic
immune inflammation, which is the basis of PSA. It is nessesary to consider the severity of
systemic inflammation and endothelial dysfunction, contributing to the development of
early atherosclerosis and its complications in determining cardiovascular risk, in spite of
traditional factors.
Disclosure of Interest: None Declared
PT436
Review of Australian hospital birth admissions of women with rheumatic heart
disease (RHD)
Geraldine A. Vaughan*1, on behalf of Rheumatic heart disease in pregnancy: an AMOSS study:
Elizabeth Sullivan2, on behalf of Rheumatic heart disease in pregnancy: an AMOSS study and
Rheumatic heart disease in pregnancy: an AMOSS study
1
Australasian Maternity Outcomes Surveillance System (AMOSS), National Perinatal
Epidemiology and Statistics Unit, 2National Perinatal Epidemiology Statistics Unit (NPESU),
University of New South Wales, Randwick, Australia
Introduction: RHD is a disease of paradox in Australia. Whilst overall rare, Aboriginal and
Torres Strait Islander peoples have among the highest rates of RHD in the world. This
preventable disease can have serious impact in pregnancy, where increased cardiac de-
mands often unmask undiagnosed RHD.
Objectives: Review hospital births of women with RHD (RHD-P) in selected Australian
jurisdictions from 2004/05 to 2009/10, and determine trends over time.
Methods: Records of hospital births for women aged 15-44 with a diagnosis of RHD
during 2004/05 to 2009/10 in selected Australian jurisdictions. Hospital separations with
ICD10-AM code ‘Z37’ were counted as hospital births. Rheumatic heart disease was defined
as ICD10-AM code ‘I05’-‘I09’.
Results: The report demonstrates the disproportionate number of Aboriginal and/or
Torres Strait Islander women with RHD, particularly in Northern Territory (NT) where
94% of women with RHD-P are Indigenous. It is highly likely that Indigenous status is
under-reported. Whilst rare (overall estimated rate of 4.5 per 10,000 births), RDH-P
rates varied markedly from 1.3 per 10,000 births (Victoria) to 99 per 10,000 births in
NT. Rates of RHD-P among Indigenous women in NT were 54 times that of the overall
rate in Australia (figure 1). Numbers reported declined from 2004/05 (n¼151) to 2009/
10 (n¼90), an overall decrease of 34%, with 40% decrease in NT (figure 2). However, a
recent review of acute rheumatic fever (ARF)/RHD in the NT showed evidence of a
reduction in recurrence rate of ARF by 9%/year since 1997, but no decrease in incidence
of RHD(1).
(1) Lawrence, J.G., et al., Acute Rheumatic Fever and Rheumatic Heart Disease: Incidence
and Progression in the Northern Territory of Australia, 1997 to 2010. Circulation, 2013.
128(0009-7322): p. 492-501.

PT435
Features factors of cardiovascular risk in patients with psoriatic arthritis
Elena Klester*1, Ekaterina Loktionova1, Karolina Klester1
1
web 3C=FPO

Department of hospital and outpatients therapeutics with occupational diseases and

endocrinology courses, Altai State Medical University, Barnaul, Russian Federation
Introduction: Frequency of the PsA in population reaches 1%, and prevalence of arthritis
at patients with a psoriasis from 13,5% to 47,5%. The main reason for death at patients of
the PsA are cardiovascular diseases.
Objectives: To assess the features of cardiovascular risk factors in patients with psoriatic
arthritis.

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POSTER ABSTRACTS
web 3C/FPO
Conclusion: It is inconclusive whether the reported downward trend in RHD-P represents
a true decline, or is an artefact due to overall small numbers and probable under-reporting.
The results reinforce the importance of an ANZ study of RHD-P, with nearly 300 sites
reporting data on history, clinical pathway and outcomes for women with RHD-P. The
surveillance and research uses the Australasian Maternity Outcomes Surveillance System
(AMOSS), a surveillance and research system that monitors rare, serious conditions in
pregnancy. This prospective observational study forms the largest population-based
research of women with RHD-P ever studied, and will examine the true incidence, dis-
tribution, epidemiology and impact of the disease in pregnancy.
Disclosure of Interest: None Declared
PT437
Working with health services: the AMOSS rheumatic heart disease (RHD) in
pregnancy study
Geraldine A. Vaughan*1,2, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS
study: Kylie Tune3, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Faith Mahony4, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Lisa Jackson Pulver5, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Jonathan Carapetis6, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Warren Walsh7, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Michael J. Peek8, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Claire McLintock4, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Sue Kruske9, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Juanita Sherwood10, Elizabeth Sullivan11, on behalf of Rheumatic Heart Disease in Pregnancy:
an AMOSS study, Rheumatic Heart Disease in Pregnancy: an AMOSS study
1
Australasian Maternity Outcomes Surveillance System (AMOSS), National Perinatal
Epidemiology and Statistics Unit, University of New South Wales, Sydney, 2Australasian
Maternity Outcomes Surveillance System (AMOSS), National Perinatal Epidemiology and
Statistics Unit, University of New South Wales, Randwick, 3NT project coördinator, Menzies
School of Health Research, Darwin, Australia, 4National Women’s Health, Auckland City
Hospital, Auckland, New Zealand, 5Muru Marri Indigenous Health Unit, University of New
South Wales, Sydney, 6Telethon Institute of Child Health Research, Perth, 7Eastern Heart Clinic,
Prince of Wales Hospital and UNSW, Randwick, 8Sydney Medical School Nepean, University
of Sydney, Penrith, 9Queensland Centre for Mothers & Babies, The University of Queensland,
Brisbane, 10Faculty of Arts and Social Sciences, University of Technology, 11National Perinatal
Epidemiology and Statistics Unit, University of New South Wales, Sydney, Australia
Introduction: Whilst overall rare in Australia and New Zealand (ANZ), RHD is
disproportionate amongst Aboriginal and Torres Strait Islander, and Maori and Pacific
Islander peoples and immigrants (particularly refugees) from Africa and Asia. This
disease of inequity carries increased risk in pregnancy, with an exacerbated burden of
late diagnosis.
The Australasian Maternity Outcomes Surveillance System (AMOSS), a UNSW-based
surveillance and research system that monitors rare and serious conditions in pregnancy,
has received funding for a mixed-method study of RHD in pregnancy (RHD-P) over four
years. Participating sites across ANZ collect data on history, clinical pathway and outcomes
for women with RHD-P.
Objectives: Establish effective mechanisms for optimal awareness among health services of
the impact of RHD in pregnancy and the AMOSS RHD-P study, particularly in high-risk
populations across ANZ.
Methods: In NZ, mandated data collection through the Perinatal and Maternal Mor-
tality Review Committee (PMMRC) is managed by the NZ coordinator across 24 sites.
The majority of women live in the North Island of NZ. In Australia, volunteer data
e258
collectors across nearly 300 AMOSS sites participate in the RHD-P study. Challenges
to optimal reporting include a) multiple health information systems and incompatible
technologies; b) high numbers of women with RHD-P in Australia living in remote
regions, with attendant issues related to maternity care; and c) varying degrees
of awareness among health professionals, particularly in regions of low overall
prevalence.
The consultative process that commenced prior to the RHD-P study has been extended
considerably to support an enhanced surveillance system, particularly in regions with
known increased risk of RHD.
Results: Consultative methods have varied across and between countries. Collaborative
processes have been established with nearly 200 other key stakeholders and groups (Figure
1) to support the RHD-P study.
web 3C=FPO
Conclusion: Effective mechanisms to increase awareness of RHD-P span remote, cardiac
and Aboriginal and Maori health professionals and groups, as well as the usual AMOSS
model of notification within maternity care. In additional to perinatal data, information
systems including cardiac and remote health data have been queried to enhance
notification.
The enhanced surveillance and educative processes are serving to improve notification
and awareness of this disease, which can have such a deleterious impact during pregnancy.
Disclosure of Interest: None Declared
PT438
Profile Of Rheumatic Heart Disease At A Cardiac Center In Bandung City, Indonesia:
An Echocardiography Study
Leonardo P. Suciadi*1, Giky Karwiky1, Syarief Hidayat1
1
Cardiology & Vascular Medicine Department, Faculty of Medicine of Padjadjaran University/
Hasan Sadikin General Hospital, Bandung, Indonesia
Introduction: Rheumatic heart disease (RHD) remains a major public health problem in
developing countries, including Indonesia. RHD is the leading cause of congestive heart
failure and thromboembolic events in young adult population in our country.
Objectives: We evaluated data of transthoracic echocardiography (TTE) at our center to
report the pattern of valve involvement of RHD.
Methods: In this retrospective study, data were collected over a period of 13 months
(March 2012 to March 2013) from our echocardiography laboratory at a central general
hospital in Bandung, West Java, Indonesia. Patients with diagnosis of RHD based on TTE
examination within the 13-month period were included.
Results: A total of 4682 echocardiographic examinations were performed during the 13-
month period. Echo findings of RHD were found in 108 patients (2.3%), predominantly
by 84 female patients (78%). The range of ages were from 17 to 75 (mean 44.01) years
old, with 6 patients found under 25 years old. Combination of mitral and aortic valves
involvement was the commonest echo findings in our patients, present in 61 patients
(56.48%). Mixed mitral valve disease was found in 28 patients (25.92%), whereas sole
mitral stenosis was found in 19 patients (17.6%). Clinical diagnosis of RHD had been
suspected as the reason for asking echocardiographic examination in 83 patients
(76.85%). Complications of RHD observed in our patients were atrial fibrillation in 93
patients (86.11%), spontaneous echocardiographic contrast (SEC) in 37 patients
(34.26%), left atrial thrombus in 12 patients (11.11%) including 1 case of large
thrombus, embolic stroke in 4 patients (3.7%), reduced LVEF in 10 patients (9%),
pericardial effusion in 28 patients (25.92%) including 3 cases of massive pericardial
effusion. Functional tricuspid regurgitation was detected in 95 patients (87.9%), but
significant pulmonary hypertension was only detected in 54 patients (50%). Infective
endocarditis was not detected in all patients.
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web 3C=FPO
Conclusion: RHD is still important cardiovascular disease in our center, leading to many
serious complications and high morbidity.
Disclosure of Interest: None Declared
PT439
Is rheumatic fever already controlled in Brazilian children and adolescents? An
overview about the last 21 years epidemiological data
Vitor M. P. Azevedo1, Regina E. Müller*1, Renato Kaufman2, Marco Aurelio Santos1,
Rogerio B. M. Chaves1, Arn Migowski1, Márcia Cristina C. M. Pinheiro1,
Regina Maria Aquino Xavier1
1
Research, National Institute of Cardiology, 2Cardiology, State Institute of Cardiology Aloisio de
Castro, Rio de Janeiro, Brazil
Introduction: Acute rheumatic fever (ARF) is considered controlled in developed coun-
tries. Brazil has a middle high Human Development Index (HDI). It remains doubtful how
controlled ARF is in Brazilian population. This phenomenon perhaps reflects similarities
with other countries which are at the same stratum by HDI.
Objectives: Analyse the evolution of epidemiologic data about acute rheumatic fever and
rheumatic heart disease, having all causes of hospital admissions as a benchmark.
Methods: It was performed a search in Brazilian Ministry of Health databases. It was
analysed total hospital admissions number, average length of stay, mortality rate, and cost
of hospitalization from 1992 to 2012. Patients’ age was limited from 5 to 19 years old. It
was considered three groups: all causes of hospital admissions combined (all causes), ARF
and rheumatic heart disease (RHD).
Results: In the studied period for all causes, total hospital admissions number dropped
from 2,223,478 to 1,443,952 (-35%) that corresponds to a drop from 4.50% to 2.89%
(-35.8%) if the relation between total hospital admissions/number of children in the
studied age range was considerate; the average length of stay fell from 4.2 to 3.6 days
(-14.3%); mortality rate were stable (0.48% to 0.49%), and cost increased from
U$198.11 to U$351.35 (+77.3%). In ARF group, total hospital admissions number
dropped from 11,188 to 962 (-91.4%); the average length of stay fell from 7.4 to 6.8
days (-8.1%); mortality rate were stable (0.63% to 0.60%) until 2011 and had an
increase to 0.94 in 2012, and cost increased from U$146.61 to U$187.70 (+28.0%). In
RHD group, total hospital admissions number dropped from 1,896 to 555 (-70.7%);
the average length of stay fell from 15.2 to 11.0 days (-27.6%); mortality rate decreased
from 4.96% to 2.70% (-45.6), and cost increased from U$3630.19 to U$3785.77
(+4.3%).
Conclusion: There was an impressive decrease in the number of hospital admissions for all
causes as well as for rheumatic fever (ARF and RHD). Nevertheless, the number of hos-
pitalizations remains significant and the fact that we still have new cases brings concern.
Average length of stay may reflect Brazilian payment politics for health care. There is also
concern about access for treatment for adolescents. The good work needs to be continued.
Disclosure of Interest: None Declared
PT440
Is rheumatic fever in Brazilian young adults an already controlled disease? An
overview about the last 21 years epidemiological data
Vitor M. P. Azevedo1, Regina E. Müller*1, Renato Kaufman2, Marco Aurelio Santos1,
Rogerio B. M. Chaves1, Arn Migowski1, Márcia Cristina C. M. Pinheiro1,
Regina Maria Aquino Xavier1
1
Research, National Institute of Cardiology, 2Cardiology, State Institute of Cardiology Aloisio de
Castro, Rio de Janeiro, Brazil
Introduction: Acute rheumatic fever is considered controlled in developed countries. Brazil
has a middle high Human Development Index (HDI). It remains doubtful how controlled
acute rheumatic fever is in Brazilian population. This phenomenon perhaps reflect simi-
larities with others countries which are at the same stratum by HDI.
Objectives: Analyse the evolution of epidemiologic data about acute rheumatic fever and
rheumatic heart disease, having all causes of hospital admissions as a benchmark.
Methods: It was performed a search in Brazilian Ministry of Health databases. It was
analysed total hospital admissions number, average length of stay, mortality rate, and cost
of hospitalization from 1992 to 2012. Patients’ age was limited from 20 to 39 years old. It
was considered three groups: all causes of hospital admissions combined (all causes), acute
rheumatic fever (ARF) and rheumatic heart disease (RHD).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: In the studied period for all causes, total hospital admissions number dropped from
POSTER ABSTRACTS
5,315,116 to 3,561,490 (-33%) that correspond to a drop from 11.19% to 5.47% (-51,1%) if
it was considerate the relation total hospital admissions/number of young adults in the
studied age range; the average length of stay were stable (4.5 to 4.6 days); mortality rate
increased from 0.71% to 0.93% (31.0%), and cost increased from U$215.21 to U$402.79
(+87.2%). In ARF group, total hospital admissions number dropped from 4,400 to 872
(-80.2%); the average length of stay were stable (6.6 to 6.5) days; mortality rate increased
from 0.75% to 1.38% (+84.0%), and cost increased from U$164.78 to U$201.87 (+22.5%).
In RHD group, total hospital admissions number dropped from 3,922 to 2,004 (-51.1%);
the average length of stay fell from 14.0 to 11.3 days (-19.3%); mortality rate increased from
5.10% to 5.54% (-8.6), and cost increased from U$4562.28 to U$5462.88 (+19.7%).
Conclusion: There was an impressive decrease in the number of hospital admissions for all
causes as well as for rheumatic fever (ARF and RHD). Nevertheless, the number of hos-
pitalizations remains significant and the fact that we still have acute cases with higher
mortality rate brings concern. We suspect that there is a delay in ARF diagnosis and lack of
hospital beds for this group of patients. Educational actions among practitioners and
cardiologists must continue.
Disclosure of Interest: None Declared
PT441
The Global Burden of Rheumatic Heart Disease: The Tip of The Iceberg
Samantha Colquhoun*1,2,3, Ganesan Karthikeyan4, John Condon5, Bongani Mayosi6,
Andrew Steer1, Tom Parks7,8, George Mensah9, Mohammad Forouzanfar10, Majid Ezzati11,
Jonathan Carapetis12, GBD RHD writing group
1
Dept of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne,
2
Global Health Division, Menzies School of Health Research, Darwin, 3Murdoch Childrens
Research Institute, Melbourne, Australia, 4All India Institute of Medical Sciences, New Delhi,
India, 5Menzies School of Health Research, Darwin, Australia, 6University of Cape Town, Cape
Town, South Africa, 7Centre for Clinical Vaccinology and Tropical Medicine, University of
Oxford, Oxford, 8Faculty of Infectious and Tropical Diseases, London School of Hygiene and
Tropical Medicine, London, United Kingdom, 9National Institutes of Health, Bethesda, 10Institute
of Health Metrics and Evaluation, University of Washington, Seattle, United States, 11Imperial
College London, London, United Kingdom, 12Telethon Institute for Child Health Research,
University of Western Australia, Perth, Australia
Introduction: In 1990 the Global Burden of Disease (GBD) study published global pop-
ulation based data showing estimates of Rheumatic Heart Disease (RHD) prevalence,
incidence and mortality. Recent prevalence studies have used echocardiographic confir-
mation of identified cases resulting in more accurate estimates of disease burden than
previously published. Yet many gaps in understanding the burden of RHD remain as few
studies are available to show incidence and mortality from RHD. The GBD 2010 study was
undertaken to provide an updated estimate of global epidemiology.
Objectives: To update the estimates of RHD burden of disease using vital statistics data in
187 countries and 21 regions of the world for the period 1990 to 2010.
Methods: A systematic review of RHD published and grey literature was undertaken. In-
clusion criteria were population based studies published from 1990-2009. Data on RHD
incidence, prevalence and mortality were included. Studies were reviewed by two expert
reviewers and data abstraction was done in duplicate. The final data set was sent to the GBD
core team at the University of Washington. Incidence, prevalence, number of deaths and
Disability Adjusted Life Years (DALYs), were calculated using epidemiological modelling tools.
Results: Of 473 articles retrieved by our search strategy, a total of 76 articles and reports
fulfilled inclusion criteria. Data were identified for 18 of the 21 regions. Five studies
describing RHD incidence and four sources of population based mortality data were
identified globally. Modelling was undertaken using data from the review and vital statistics
data for each region and country. In 1990 there were 29,172,383 prevalent cases of RHD
estimated globally, increasing to 34,232,795 in 2010; the highest prevalences were Oceania
and Eastern Europe (both 9.8 per 1,000). The global number of incident RHD cases for
1990 and 2005 were 2,146,273 and 1,542,454 cases respectively. Deaths totalled
8,593,116 deaths globally for the period 1990-2010, with the highest rates in developing
countries.
Conclusion: The estimates suggest a higher burden of RHD than previously reported.
However these calculations were based on modelling influenced by few real data from the
highest risk regions. Further work is ongoing to test the modelling assumptions utilising
the best available population data from Australia, New Zealand and Fiji. Final estimations
will be available in the coming months.
Disclosure of Interest: None Declared
PT442
Disparity in Mortality Rates from Rheumatic Heart Disease in the Australian
Indigenous and Non-Indigenous Populations
Samantha Colquhoun*1,2,3, John Condon4, Shu Qin Li5, Steve Guthridge6, Jonathan Carapetis7
1
Global Health Division, Menzies School of Health Research, Darwin, 2Centre for International
Child Health, University of Melbourne, 3Murdoch Childrens Research Institute, Melbourne,
4
Menzies School of Health Research, 5Health Gains Planning Unit, Department of Health and
Families, 6Health Gains Planning Unit, Department of Health and Families, Darwin, 7Telethon
Institute for Child Health Research, University of Western Australia, Perth, Australia
Introduction: Over the past 60 years there have been dramatic declines in the prevalence
of rheumatic heart disease (RHD) throughout the industrialised world. These
e259
 improvements are yet to be seen in many developing countries and in Indigenous pop-
POSTER ABSTRACTS
ulations defined by ethnicity or geographical location. Recent estimates of the global
burden of RHD have highlighted the paucity of reliable data documenting mortality from
RHD from places where RHD prevalence is high.
Objectives: To investigate rheumatic heart disease (RHD) mortality rates and trends for
Indigenous compared with non-Indigenous Australians in the Northern Territory (NT) for
the period 1977-2005 and semi-nationally from 1997-2005.
Methods: Indigenous identification in death registrations has been of high quality in the NT
since 1977 and in four other states since 1997. Using national cause of death and population
data, we investigated RHD mortality for the NT for 1977- 2005 and five jurisdictions com-
bined, for 1997-2005 examining RHD as the underlying cause of death. These jurisdictions
include 84% of Indigenous Australians. We examined the number of deaths, age-specific
and age-adjusted death rates; and for the NT only, regression analysis of time trends over a 29-
year period. All analysis was by undertaken by Indigenous status, gender, age at death.
Results: In the NT for the period 1977-2005 there were 280 deaths from RHD; 90% were in
Indigenous people and 59% in females. For non-Indigenous people death rates were low for
all age-groups except 65+ age-group. Indigenous death rates increased with age and were
higher for females than males in all age-groups. Death rates decreased between 1997 and
2005 for both Indigenous and non-Indigenous people in the NT, but the decrease was
greater for non-Indigenous people. RHD death rates were lower for Indigenous people in
other parts of Australia than in the NT, but were still much higher than non-Indigenous rates.
Conclusion: Indigenous people are much more likely to die from RHD than other Aus-
tralians. Rates of death from RHD among Indigenous people in the NT exceed other states
in Australia and those reported in many industrialised countries over a century ago. The
majority of deaths among non-Indigenous Australians occur in people aged over 65 years
and reflect a time in the mid-last century when rheumatic fever and RHD were more
common in the overall Australian population.
Disclosure of Interest: None Declared
PT443
Burden of Rheumatic Heart Disease in the Solomon Islands
Liz Kennedy*1, Titus Nasi2, Bardley Ludawane3, Divi Ogaoga6, Samantha Colquhoun1,4,5,
Jonathan Carapetis7, Geoffrey Kenilorea8, Gavin Wheaton9
1
Global Health, Menzies School of Health Research, Darwin, Australia, 2Paediatrics, Ministry of
Health, 3Paediatrics, Ministry of Health, Solomon Islands, Honiara, Solomon Islands, 4Centre for
International Child Health, University of Melbourne, 5Murdoch Childrens Research Institute,
Melbourne, Australia, 6Maternal and Reproductive Health, Ministry of Health, Honiara, Solomon
Islands, 7Telethon Institute for Child Health Research, Perth, Australia, 8Non communicable
diseases, Ministry of Health, Honiara, Solomon Islands, 9Paediatrics, Womens and Childrens
Hospital, Adelaide, Australia
Introduction: The Solomon Islands, ranked 143 on the human development index, is one
of the poorest countries in the Pacific region. Recent data confirms the country has a high
burden of rheumatic heart disease (RHD). These data are being used to advocate for and
inform better management practices for RHD patients in the Solomon Islands.
Objectives: To collect baseline data on rheumatic heart disease in the Solomon Islands.
Methods: Medical discharge data on RHD was collected from hospitals in three provinces
in the Solomon Islands and school screening conducted in two schools in the second most
populated province of Guadalcanal. With support from an Australian based technical team
data will be used to inform the establishment of a prevention and control programme
including the establishment of a national RHD register.
Results: A local doctor collected RHD patient data from the main provincial hospitals in
Gizo and Kilu’ufi and the main hospital in the capital of Honiara. A total of 88 cases were
identified and documented in the newly established national RHD register which is being
managed jointly by the Reproductive and Child Health Unit and NCD Unit.
In 2012 school screening for RHD, was undertaken in Honiara; 700 children in the 5-15
age group from two schools were screened using the WHF RHD Echocardiography
diagnostic criteria. Seventeen new cases of RHD were detected giving a prevalence of 24
cases per 1000 population in children aged 5-16 yrs.
There are no cardiac surgical facilities in the Pacific region and the Ministry of Health rely
on overseas donations and support for priority paediatric surgery cases. Priority paediatric
surgery cases may be sent overseas or every two –three years an Australian based cardiac
surgical team will visit the Solomon Islands.
The Ministry of Health are in the early stages of establishing a register based prevention
and control programme to provide nationwide RHD training of health workers, develop-
ment of national protocols for the diagnosis and management of acute rheumatic fever and
overall system strengthening and integration.
Conclusion: Early detection and effective management of patients will significantly
improve health outcomes for those affected by RHD in the Solomon Islands. Further
support will help to build capacity within the local team, assist integration with child health
and NCD services and ensure sustainability of the programme activities.
Disclosure of Interest: None Declared
PT444
Rheumatic Rescue: Age-related prevalence of rheumatic heart disease related to
World Heart Federation criteria
Marvin Allen*1, Lori B. Allen2,2, John W. Allen1, Farah Marumatakimanu3, Andrew Jo1,
Kyle Dawson1, Adonica I. Kauwe2
1
Cardiology, Central Utah Clinic, Provo, 2Public and Community Health, Utah Valley
University, Orem, United States, 3Pediatrics, National Health Services, Apia, Samoa
e260
Introduction: Based on previous studies, echo based prevalence of RHD Disease in school
aged children have been found to be age dependent.
Objectives: The objective of this report is to examine the pattern between age and prev-
alence of patients in each of three WHF categories for RHD.
Methods: In order to investigate this phenomenon, we have compiled data comparing
the prevalence of three RHD diagnosis categories set by the World Heart Federation to
the ages of the patients by screening a sample of 3869 school age children from 24
schools in Samoa. We then separated the children into four age groups, minimizing the
differences in number of subjects among each age group. The WHF criteria for echo-
cardiographic diagnosis of RHD was used to classify patients into Definite RHD,
Borderline RHD, and Normal Regurgitation categories. These classifications were based
upon the diagnosis of pathologic regurgitation which requires the following: a complete
continuous wave (pan systolic and/or pan diastolic) Doppler envelope, color Doppler
visualization in at least 2 planes, a jet velocity of 3 m/s in at least one plane for one
complete envelope, and a jet length of 1 cm or greater for aortic regurgitation or 2 cm or
more for mitral regurgitation. Morphologic criteria were determined based on valve
leaflet thickness and mobility. At least 2 morphologic abnormalities were required for a
positive morphologic diagnosis. The Definite category is defined as a patient having both
pathologic regurgitation and a positive morphologic diagnosis. The Borderline category
will have only one or the other for each patient. Normal Regurgitation patients will have
neither pathologic regurgitation nor positive morphologic diagnosis and have a jet length
greater than 1 cm.
Results: The results are given in the Figure 1:
Conclusion: Comparing the three categories, only the Definite category had a consistent
increase in prevalence with age, supporting its diagnosis of RHD.
Disclosure of Interest: None Declared
PT445
Prevalence of rheumatic heart disease among primary school children in Samoa
detected by echocardiographic screening
Viali Satupaitea*1
1
Cardiology, National Hospital Samoa, Apia, Samoa
Introduction: Rheumatic Heart Disease (RHD) remains a major cause of morbidity and
premature death in Samoa. RHD imposes a significant burden on our limited health care
system budget. Many of our patients present with significant RHD without rheumatic fever
symptoms. Screening with Echocardiography is effective in diagnosing RHD. Early
detection of RHD is vitally important to minimize the risk of advanced valvular heart
disease requiring surgery.
Objectives: As part of our National RHD screening program, we screened as many children
as possible to identify undiagnosed RHD. The RHD screening program in Samoa utilized
portable echocardiography examinations.
Methods: We screened 8,457 school children in primary school aged 3 to 16 years from
2008 to 2012. Those who had any abnormalities suggestive of RHD in the first examination
were brought back for a second confirmatory echocardiography. The pathologies on the
second echocardiography were categorized according to the 2012 World Heart Federation
RHD criteria and were reported as Definite or Borderline RHD, and Normal. All with
Definite RHD were started on penicillin prophylaxis.
Results: The first screening echocardiogram detected abnormalities that may be related
to RHD in 367 (4.34%) of 8,457 children. The second confirmatory echocardiogram
detected 118 (32.15%) definite RHD. The age-standardized prevalence rate for Definite
RHD from 5-13 years old was 1.43% (95% CI, 1.17 – 1.69). The age-standardized
Borderline RHD prevalence rate was 0.51% (95% CI, 0.35 – 0.67). The age groups that
had the highest prevalence of RHD were 12 years (4.02%) and 13 years (3.21%) old.
The RHD prevalence was slightly higher in the rural regions, and in the public schools in
the urban regions. Majority (96%) of RHD were previously undiagnosed. The most
common lesion was mitral regurgitation (90% of RHD). Most of the RHD were mild
(50%) and moderate (39%) in severity, and only 11% were severe. Six kids required
surgery.
Conclusion: The prevalence of RHD in Samoa is high amongst the Primary school chil-
dren. Identifying these RHD early, gave us the chance to administer secondary penicillin
prophylaxis. The National RHD Screening program will screen every child in Samoa at age
12 and 13 years old.
Disclosure of Interest: None Declared
PT449
Patients who self-present with ST elevation in myocardial infarction (stemi): Are they
forgotten in systems to improve door to balloon time (DTBT)?
Lorelle Martin*1, Carolyn Naismith1, David Clark1, Omar Farouque1
1
Cardiology, Austin Health, Melbourne, Australia
Introduction: Timely treatment for ST-segment elevation myocardial infarction (STEMI) is
critical to patient outcomes. The past few years have seen the implementation of systems to
reduce door to balloon time (DTBT), in particular pre-hospital notification systems to
hospitals. However not all STEMI patients arrive to hospital via this system with a sig-
nificant percentage self-presenting to the emergency department.
Objectives: We sought to determine the characteristics and outcomes of STEMI patients
who self-presented compared to those who presented via ambulance with pre-hospital
notification.
Methods: A five-year review was undertaken of consecutive patients who either self-pre-
sented to hospital or arrived to hospital with pre-hospital notification. Comparisons were
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
made of baseline demographics, clinical characteristics, DTBT and in-hospital, short-term Results: Significant differences were seen as for strength and flexibility before and after

POSTER ABSTRACTS
and longer term mortality. Chi-square and Student’s t tests were undertaken to identify training, (P<0.001 Table 1) with a non significant trend (P<0.10 Table 2) as for the return
differences between the groups. Data were expressed as percentage or mean+/-SD. to work variable in patients who exhibited a larger difference in strength.
Results: A total of 176 STEMI patients were examined; 96 patients self-presented to
hospital and 80 patients arrived to hospital by ambulance with pre-hospital notification.
There were no differences in gender; 87% vs 85% male (p¼0.83); presentation in Mean SD
working hours; 47% vs 40% (p¼0.45); first cardiac admission 90% vs 94% (p¼0.60);
Strength 1st time 20.2 0.4
diabetes 21% vs 14% (p¼0.24); Thrombolysis in Myocardial Infarction (TIMI) risk score
greater than five 22% vs 27% (p¼0.48) and anterior infarction 41% vs 41% (p¼0.74), in Flexibility 1st time 9.6 0.6
patients who self-presented compared to those with pre-hospital notification respectively. Strength 2nd time 23.5 0.5
Those who self-presented were younger (60+/-12 years vs 64+/-14 years; p¼0.05), and
less frequently achieved a DTBT< 90 minutes (45% vs 95%; p<0.0001). The median Flexibility 2nd time 14.6 0.6
DTBT for self-presenters was 103+/-45 mins vs 52+/-25.1 mins (p<0.001). Although the Strength difference * 3.28 .32
number of deaths were small, mortality for self-presenters was numerically higher in-
Flexibility difference* 4.99 .35
hospital (3.1% vs 1.3%; p¼0.62), at 30 days (3.1% vs 1.3%; p¼0.62) and at 12 months
(4.2% vs 1.3%; p¼0.38).
Conclusion: Self-presenters to hospital have longer DTBT. Whilst this did not translate to
poorer mortality outcomes in this study, patients who self-present remain a challenge to
systems of care designed to improve DTBT. Further examination is required to pinpoint the Strength difference Flexibility difference
exact cause for delay in this group of STEMI patients to improve access to timely treatment. median [ 2.5 median [ 4.37
Disclosure of Interest: None Declared Return to work lower higher lower higher
no 46.4% 35.0% 35.5% 46.0%
PT450 yes 53.6% 65.0% 64.5% 54.0%
Electrophysiology Procedure Sedation And Analgesia Patient Risk Assessment - A
Patient Safety Focused Retrospective Review Conclusion: A strength and flexibility exercise program improves fitness and self efficiency
1 1 1
in daily life and favors return to work.
Wai-Ching Ma , Raelene Porter* , Annika Fingland Disclosure of Interest: S. Kerbage Employee from: Favaloro Foundation, L. Brandani
1
Cardiology Catheter Laboratory, Westmead Hospital, Sydney, Australia Employee from: Favaloro Foundation, A. Angelino Employee from: Favaloro Foundation,
M. Santos Employee from: Favaloro Foundation, R. Bianco Employee from: Favaloro
Introduction: Procedural sedation and analgesia (PSA) is routinely administered for Foundation, D. Motta Employee from: Favaloro Foundation, J. Gatta Castel Employee
electrophysiology (EP) studies by registered nurses under non-anaesthetist medical su- from: Favaloro Foundation, C. Lirio Employee from: Favaloro Foundation, C. Barrios
pervision in the cardiac catheter laboratory (CCL). With the prevalence of patient co- Employee from: Favaloro Foundation, C. Rodriguez Correa Employee from: Favaloro
morbidities and introduction of advanced mapping technologies, procedural complexity Foundation, E. Duronto: None Declared
and length ( 6 hours) has impacted on total PSA dosage and patient recovery. Safe patient
management pre, peri and post PSA administration was consequently identified as an issue
by the CCL nursing team. Based on nursing concerns patients’ unsuitable for PSA or where PT452
PSA is considered ineffective must be referred for general anaesthesia (GA).
Objectives: This study is a quality improvement review evaluating patient safety outcomes Barriers and Facilitators to Nurse Management of Hypertension in Rural Western
and impact of pre-procedure patient risk assessment. Kenya: A Qualitative Analysis
Methods: Retrospective data retrieval of patients undergoing EP study with PSA or GA
from 2007 to 2012 (n¼3080) identifying patient numbers and PSA related incidents re- Rajesh Vedanthan*1, Nelly Tuikong2, Claire Hutchinson1, Evan Blank1, Jemima H. Kamano3,
ported in the Australian Incident Management System (IIMS). Sylvester Kimaiyo4, Thomas S. Inui5, Carol R. Horowitz6, Valentin Fuster7
1
Results: Cardiology, Icahn School of Medicine at Mount Sinai, New York City, United States, 2Academic
1. Procedure composition changed between 2007 and 2012; Diagnostic EP decreased Model Providing Access to Healthcare, 3Academic Model Providing Access to Healthcare; Moi
(62%>51%) and Supraventricular Tachycardia (SVT) ablation increased (13%> Teaching and Referral Hospital, 4Academic Model Providing Access to Healthcare; Moi
23%). The other proportions remained constant p<0.001. University College of Health Sciences, School of Medicine, Department of Medicine, Eldoret,
2. Logistic regression analysis detected a statistically significant interaction between Kenya, 5Indiana University School of Medicine, Indianapolis, 6Icahn School of Medicine at Mount
procedure type and the effect of time on the odds of GA (p¼0.036).
Sinai, 7Icahn School of Medicine at Mount Sinai; Centro Nacional de Investigaciones
3. There was no significant trend over time in the odds of GA for Defibrillator Check,
Diagnostic EP, His Bundle ablation. There were significant increases in the odds of Cardiovasculares, New York City, United States
GA over time for Atrial Flutter ablation (OR-1.31/yr, p¼0.015), Pulmonary Veins Introduction: Hypertension is the leading global risk for mortality and its prevalence is
Isolation (OR-1.45/yr, p<0.001), SVT ablation (OR¼1.24/yr, p<0.001), Ventric- increasing in sub-Saharan Africa (SSA). Unless adequately controlled, hypertension will
ular Tachycardia ablation (OR¼1.60/yr, p<0.001). impose large health and economic burdens. Poor treatment and control of hypertension in
4. The incidence of PSA associated complications fell from 1.1% (5/465 2007) to 0% SSA is due to several reasons, including insufficient human resources. Nurse management
(0/363 2012) however the trend over time failed to reach statistically significance of hypertension is a novel approach to address the human resource challenge. However,
p¼0.98. specific barriers and facilitators to this strategy in SSA are not known.
Conclusion: Data review identified a correlation between patient selection and the Objectives: To evaluate barriers and facilitators to nurse management of hypertensive
exclusion of high risk patients and/or procedures from PSA administration with an overall patients in rural western Kenya, using a qualitative research approach.
reduction in significant clinical incidents. This manoeuvrer added value and purpose to Methods: Six key informant interviews (5 men, 1 woman) and seven focus group dis-
PSA administration by providing comfort and reduced anxiety in patients undergoing EP cussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses,
studies. support staff, patients, and community leaders. Content analysis was performed using
Disclosure of Interest: None Declared Atlas.ti 7.0, using deductive and inductive codes which were then grouped into themes
representing distinct barriers and facilitators. Ranking of barriers and facilitators was per-
formed using triangulation of density of participant responses, investigator assessments
PT451 using the Delphi technique, and published literature.
Flexibility And Strength Measurement, And Return To Work In Phase II Results: Frustration with the current system of care delivery was commonly expressed. At
Rehabilitation the same time, participants frequently expressed hope that care integration across the
public health care system in Kenya would result in improved health outcomes. The salient
Soraya Kerbage1, Laura Brandani1, Arnaldo Angelino1, Maximo Santos1, Raul Bianco1, barriers and facilitators to nurse management are summarized in the Table.
Domingo Motta1, Juan Gatta Castel1, Carlos Lirio1, Cristina Barrios1, Carlos Rodriguez Correa1,
Ernesto Duronto*1
1 Table. Barriers and facilitators to nurse management of hypertension
Cardiac and Pulmonar Rehabilitation, Favaloro Foundation, Caba, Argentina
Category Barrier Facilitator
Introduction: Strength and muscular flexibility exercises in a cardiovascular rehabilitation
program are beneficial for both fitness and quality of life. Health Systems - Access to Drugs - Integration of health system
Objectives: To measure the level of strength and muscular flexibility and the correlation - Insufficient Human Resources
with return to work at 12 months. Nurse-specific - Inadequate training - Confidence
Methods: 344 patients recruited for a lower limb exercise protocol were prospectively
assessed. To evaluate strength the Epley test was used (maximum repetition using a pre- Patient factors - Preference for physicians - Trust of nurses
established load). For flexibility, the sit and reach test was used for trunk flexion and - Lack of hypertension knowledge
hamstrings stretch. As for return to work, follow up phone calls were made. For data Emotional - Stigma of HIV services at same site - Importance of community
analysis, the Students t test and the c2 test for matched samples were used. The data are - Fear of displeasing clinicians - Fear of death
expressed a mean  mean standard deviation (SD).

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e261

 Conclusion: Nurse management of hypertension is a potentially feasible strategy to address
POSTER ABSTRACTS
the human resource challenge of hypertension control, and there are several factors that
may facilitate implementation. However, successful execution will be contingent upon
satisfactorily addressing potential barriers at the health systems, health personnel, cognitive,
and emotional levels.
Disclosure of Interest: None Declared
PT453
Disease Management Interventions For Improving Self-Management In Lower-Limb
Peripheral Arterial Disease: A Cochrane Review
Sally C. Inglis*1, HuiYun Du2, Phillip J. Newton1, Michelle DiGiacomo1, Abdullah Omari3,
Patricia M. Davidson4
1
University of Technology, Sydney, Sydney, 2Latrobe University, Shepparton, 3St Vincent’s
Hospital, Darlinghurst, Australia, 4Johns Hopkins University, Baltimore, United States
Introduction: Peripheral arterial disease (PAD) contributes to psychological burden, poor
quality of life and an increased risk of cardiovascular events. Disease management strategies
supporting behavioural change and long-term adherence may improve outcomes for
people with PAD. However, to our knowledge the evidence relating to self-management
interventions for people with PAD has not yet been systematically reviewed or meta-
analysed.
Objectives: To systematically review, synthesise and quantify the effects of non-pharma-
cological and non-surgical chronic disease management interventions targeted at improving
self-management for people with PAD.
Methods: Following approval and publication of the protocol for this systematic review by
the Cochrane Collaboration, an extensive search was performed of databases, including
MEDLINE, EMBASE, CINAHL, AMED, Psych Info, theses databases as well as hand-
searching relevant conference abstracts to identify randomised controlled trials (RCTs) of
disease management interventions to address self-management in people with PAD. Three
reviewers assessed all identified studies according to a detailed inclusion and exclusion
criterion.
Results: To date seven RCTs meet the inclusion criteria (n¼783 participants with PAD).
Studies are multifaceted and address more than one aspect of PAD management including:
smoking cessation; exercise participation and adherence; healthy diet; lipid management
and medication adherence. Primary outcomes examined are functional status and health-
related quality of life using PAD-specific measures and questionnaires. Secondary outcomes
include all-cause mortality, revascularisation or amputation, myocardial infarction and
modifiable risk factors (smoking, blood pressure, lipids) along with patient adherence,
acceptance and satisfaction with the intervention.
Conclusion: This systematic review identifies and summarises the currently available ev-
idence to support the use of disease management interventions supporting self-manage-
ment for people with PAD. The burden of disease with PAD underscores the importance of
evidence-based strategies to promote self-management and treatment adherence in this
patient population.
Disclosure of Interest: None Declared
PT455
A systematic review of patient education in cardiac patients: do they increase
knowledge and promote health behavior change?
Gabriela L. M. Ghisi*1,2, Flavia Abdallah3, Sherry Grace2,4, Scott Thomas1, Paul Oh2
1
Faculty of Kinesiology and Physical Education, University of Toronto, 2Cardiac Rehabilitation
and Prevention Program, Toronto Rehabilitation Institute, 3University Health Network, 4School of
Kinesiology and Health Science, York University, Toronto, Canada
Introduction: Coronary artery disease (CAD) requires a careful medical management
with multiple recommendations for patients to achieve optimal secondary prevention.
As a consequence, patient education is a necessary first step to promote understanding
of the recommended therapies and behavior changes, as well as to follow them. Pa-
tient education is consider a core component of cardiac rehabilitation; yet, has been
only scantly investigated. To our knowledge, reviews published in this area included a
small number of trials and focus on outcomes, failing to describe interventions in
depth.
Objectives: (1) to investigate the impact of education on patients’ knowledge; (2) to
determine if educational interventions are related to health behavior change in CAD pa-
tients; and (3) to describe the nature of educational interventions offered.
Methods: A literature search of several electronic databases was conducted for published
articles from database inception to August 2012. Eligible articles included cardiac patients,
and described delivery of educational interventions by a healthcare provider. Outcomes
were knowledge, smoking, physical activity, dietary habits, response to symptoms, and
medication adherence, as well as psychosocial well-being. Articles were considered for
inclusion by 2 authors independently.
Results: Overall, 42 articles were included, of which 23 (55%) were randomized
controlled trials, and 16 (38%) were considered “good” quality. Eleven studies (26%)
assessed knowledge, and the majority (n¼10) showed a significant increase with edu-
cation. With regard to outcomes, educational interventions were significantly and posi-
tively related to physical activity in 20 (77% of the studies assessing this behavior), dietary
habits in 21 (84%) studies, and smoking cessation in 13 (65%) studies, response to
symptoms in 1 (50%), medication adherence in 1 (25%), and psychosocial well-being in
e262
3 (43%) studies. The nature of interventions were poorly described and most frequently
delivered by a nurse, post-discharge, and in groups. The average number of educational
sessions delivered was 6 and an average of 3.3 topics per intervention was delivered, with
the most common ones being nutrition, exercise, and risk factors. Few studies described
education duration.
Conclusion: Findings support the benefits of educational interventions in CAD, though
increase in patients’ knowledge and behavior change. Future reporting of education in-
terventions should be more explicitly characterized, in order to be reproducible and
assessed.
Disclosure of Interest: None Declared
PT456
A prospective study of the utility of egan’s model in phase one cardiac rehabilitation
delivery
Chezhan Hall*1,2, Maria Murphy1,2, Andrew Scanlon1, Lorelle Martin2, Omar Farouque2
1
Department of Nursing & Midwifery, LaTrobe University, 2Cardiac Services, Austin Health,
Melbourne, Australia
Introduction: Phase one cardiac rehabilitation (CR) is an education and counseling
program that delivers preventative and rehabilitative services to hospitalized patients.
Understanding and implementing appropriate methods to deliver such information is
vital. Egan’s Skilled Helping Model (ESHM) is a recognized model. This model in-
corporates three stages; problem clarification, setting goals and facilitating action (Egan,
2009). Phase one CR is comprised of three sessions. Each session can align with a stage
in Egan’s model; clarifying diagnosis, setting goals for risk factor management and
facilitating a chest pain action program. Program delivery of Phase one CR is rarely
evaluated.
Objectives: To raise awareness of CR as part of a patient centred approach to care; increase
staff participation in the delivery of Phase one CR by implementing the ESHM framework
and, increase phase two CR referral.
Methods: A retrospective, comparative, single site study was conducted. Four weeks of
staff in-services modeling phase one CR program delivery were conducted. An electronic
file review with a purpose designed audit tool was performed 12 weeks pre and 12 weeks
post implementation of the in-services. Audit inclusion criteria: discharge diagnosis of ICD-
10 code I20 (AMI) and subsets of this as reported in the International Statistical Classifi-
cation Of Diseases And Related Problems (ICD-10-AM, 2010) and age > 18 years. Data
analysis: SPSS V21.
Results: Cardiology and Cardiac surgery file review of all 124 inpatient files pre and
164 inpatient files post intervention was undertaken. Comparisons were made between
cohorts to assess differences by age t ¼ -0.60(df) ¼247, p¼0.55, gender (x2¼0.11,
df¼1, N¼288, p¼0.79), English speaking (x2¼2.19, df¼2, N¼287, p¼0.33) and
comorbidities (x2¼5.05, df¼7, N¼288, p¼0.65). There were no statistically significant
differences between groups in delivery of phase one CR (14% vs. 19%) (x2¼0.01,
df¼1, N¼288, p¼0.98) or referral to phase two (19% vs. 31%) (x2¼4.23, df¼2,
N¼288, p¼0.12).
Conclusion: The patient population is a stable profile. While ESHM is a valid model, other
strategies need to be considered to identify the barriers to delivery of phase one and referral
to phase two CR. There is little published international data to compare these results.
Ongoing evaluations are necessary.
Disclosure of Interest: None Declared
PT457
Staff perceptions of Phase one cardiac rehabilitation in a tertiary setting
Chezhan Hall*1,2, Maria Murphy1,2, Andrew Scanlon1, Omar Farouque2
1
Department of Nursing & Midwifery, LaTrobe University, 2Cardiac Services, Austin Health,
Melbourne, Australia
Introduction: Globally, coronary heart disease (CHD) is a leading cause of mortality and
morbidity. Improved treatments have led to increased survival. The frequency of repeat
coronary events and hospital readmissions is increasing. Cardiac rehabilitation (CR) can
help patients to modify coronary risk factors and decrease repeat coronary events. There are
three phases of CR. Phase one CR is an inpatient program focusing on confirmation of the
diagnosis, counseling on risk factor management, resumption of activities, medications and
a chest pain management action plan.
Objectives: To measure the staff perceptions in a multi-disciplinary cardiac health care
team of the preparation, utility, documentation and barriers for Phase one CR in a tertiary
setting.
Methods: A purpose designed mixed methods survey in a tertiary center. Face validity of
the tool was achieved. Staff in-services outlined the study. Surveys were distributed to
nursing, medical and allied health professionals’ involved in the acute care of inpatients
with an acute CHD. Consent was implied by return of the questionnaire. Data analysis:
SPSS V21 or free form analysis as appropriate.
Results: 126 surveys distributed, 75 (60%) returned. Staff reported working as a registered
health professional Median (IQR1-3) 7.5(3-20) years. 100% reported their role involved
phase one CR. 63% reported formal education in phase one CR. 99% reported program
utility. Regularly documenting program delivery was reported by 53%. Patient centered
program delivery was reported by 77%, associated with years working in their discipline
rs(72)¼.39, p¼.001. Family involvement was reported by 85%. Referral to a phase two CR
program was associated with years working in their health discipline rs(72)¼.28, p¼0.02.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Freeform text reported barriers included organizational, patient, professional, program and
the environment. No correlation between number of years working and barriers nominated
rs(72)¼ .034, p¼0.78.
Conclusion: The number of years working as a health professional correlates to the report
of the importance of patient centered phase one and referral to phase two CR but not
barriers. There was a mismatch between report of program utility and reported delivery.
Every effort needs to be made to optimize program delivery to increase survival and
decrease repeat coronary events.
Disclosure of Interest: None Declared
PT458
What is the Quality of Life of Australian patients 1 year post PCI? Results from a
national multi-centre registry
Karen J. Patching*1, Catherine Oliver1, Lesley Bryant2, Lara Waltham3, Stephanie Nagel4,
Ann-Maree Mitchell5, Estelle Beevors6, David Eccleston7
1
Research, Heart Care Victoria, Melbourne, Victoria, 2Research, Heart Care Partners, Brisbane,
Queensland, 3Adelaide Cardiology, Adelaide, South Australia, 4Heart Care Cardiology Western
Australia, Perth, Australia, 5Research, Adelaide Cardiology, Adelaide, South Australia, 6Heart
Care Partners, Brisbane, Queensland, 7Interventional Cardiology, Heart Care Victoria,
Melbourne, Victoria, Australia
Introduction: Several large multi-centre registries have evaluated outcomes after
percutaneous coronary intervention (PCI) in the USA. However, few data exist
regarding Quality of life (QOL) after PCI in Australia. The aim of this study was to
report long-term QOL from the multicentre national Genesis Heart Care Group PCI
Registry, This will allow comparison of clinical and PCI outcomes with international
standards, and improve patient management by facilitating the appropriate application
of clinical guideline.
Objectives: To evaluate the long-term QOL of patients after PCI, utilizing a large Australian
registry.
Methods: We prospectively enrolled 5002 consecutive patients undergoing PCI to 6837
lesions at 8 Australian private hospitals from November 2008 - August 2013. Baseline
patient/procedural data, in-hospital, and 1 year outcomes and QOL (using the EQ-5D
scale) were recorded and stored electronically in the Department of Epidemiology at
Monash University.
Results: The mean age was 67  12 years. Females comprised 25.1 %, diabetics 23.3%,
35.3% were obese (BMI>30) and 37.2% had acute coronary syndromes. At least one DES
was used in 64.9% of PCI. Procedural success rates were 97%. In patients not taking
Warfarin, 99.0% were taking aspirin and 97.7% clopidogrel at discharge. Obese patients
were more likely to be readmitted by 12 months (p¼0.002) At baseline, 18.71% of patients
reported moderate or severe anxiety or depression; this was not significantly different
(19.86%) at 12 month.
Conclusion: In Australian patients undergoing PCI, nearly one fifth describe moderate
or severe levels of anxiety or depression prior to their procedure. Despite good
adherence to guideline therapies these psychosocial issues remain a significant concern
at 1 year.
Disclosure of Interest: None Declared
PT459
Living with pain: does quality of life relate to angina functional class in patients with
refractory angina?
Luis Henrique Wolff Gowdak*1, Ananda R. Musselli2, Antonio Marcos M. dos Santos2,
Nilson T. Poppi1, Luciana O. C. Dourado1, Eduardo L. Adam1, Thiago N. P. Leite1,
Luiz Antonio M. Cesar1
1
Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, 2Nursing School,
Pontificia Universidade Catolica de Campinas, Campinas, Brazil
Introduction: Patients (pt) with refractory angina (RA) due to advanced coronary artery
disease (CAD) usually present great impairment in their quality of life. The occurrence of
disabling symptoms unresponsive to optimal medical therapy and the impossibility of
myocardial revascularization procedures may lead to mood disturbances, including
depression and anxiety, which, in turn, could be underestimated by the widely used Ca-
nadian Cardiovascular Society (CCS) classification of angina functional class.
Objectives: To determine the relationship between health-related quality of life and CCS
functional class in a highly selected cohort of pt with RA.
Methods: 19 pt with RA (16 men) with a mean age of 6110 years old were included.
All pt were on optimal medical therapy and deemed to be not candidates for
myocardial revascularization. The impact of angina pain on quality of life was deter-
mined by the Roland Morris Disability Questionnaire (RMDQ) and the Short-Form Six-
Dimensions (SF-6D) utility index according to CCS functional class. The mean scores
for each instrument were compared using the students t test. Statistical significance was
set at a P value < 0.05.
Results: 11 pt were on CCS class II and 8 pt on CCS class III. Table 1 shows
that the mean scores for both indices were not statistically different for pt in CCS II or
CCS III.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Table 1
POSTER ABSTRACTS
Instrument CCS II CCS III P value
RMDQ 12.64.5 15.16.4 0.33
SF-6D 11.47.2 15.54.8 0.18
Conclusion: In this small cohort of pt with RA, health-related quality of life was not related
to angina functional class. We believe that for pt with advanced CAD, specific tools for
assessing quality of life should be employed. Relying only on the Canadian Cardiovascular
Society functional class may lead to an underestimation to the true impairment of quality of
life for those living with pain.
Disclosure of Interest: None Declared
PT460
Perception of benefits and psychological growth following a cardiac event:
relationship with anxiety and depression
Susan J. Crebbin*1,2, Barbara Murphy2,3, Lisa Phillips1, Alun Jackson2,3
1
Psychology, University of Melbourne, 2Heart Research Centre, 3University of Melbourne,
Melbourne, Australia
Introduction: Responses to life-threatening health events are varied. Research indicates
that some individuals report elevated levels of anxiety and depression up to 12 months
after acute coronary syndrome (ACS) and coronary artery bypass graft surgery
(CABGS). Moderate levels of depression have been associated with posttraumatic
growth (PTG) in survivors of non-medical life-threatening events. Positive gains such
as benefit-finding (BF) and psychological growth have been reported in patients
confronting life-threatening illnesses, including cardiac patients. However, there are
very few longitudinal studies investigating PTG and none have been conducted in an
Australian setting.
Objectives: The current study investigated the temporal nature of the relationships be-
tween anxiety and depression, perception of benefits and psychological growth in cardiac
patients 12 and 24 months post-event.
Methods: Participants (ACS n ¼ 210, and CABGS n ¼ 216) were consecutively recruited
from three metropolitan hospitals (Melbourne, Australia). Quantitative and qualitative data
was collected in hospital, at 12 months (n ¼ 360) by telephone and at 24 months (n ¼ 201)
by postal questionnaire.
Results: Modest PTG was reported (M ¼ 42.19, SD ¼ 24.56). However, 25% of partici-
pants reported growth in response range moderate to a very great degree (PTG >63).
Moderate level of depression in hospital was associated with PTG 24 months post-event,
F(2, 178) ¼ 5.66, p ¼ .004. Elevated anxiety at 12 months was associated with growth at
24 months, F(1, 164) ¼ 7.02, p ¼ .009. Anxiety and depression were significantly and
highly correlated at all assessments. Participants with elevated anxiety and moderate
depression at 12 months showed a trend for reporting higher PTG scores (M ¼ 58.15, SD
¼ 23.99) than other groupings, F(2, 160) ¼ 2.53, p ¼ .083 (Fig 1). Additionally, benefits
related to Health were reported by 56% of the sample. Other benefit themes to emerge
related to increased appreciation of life and others, new possibilities/path in life and
spiritual/religious change.
Fig 1. Total Posttraumatic Growth Inventory (PTGI) mean scores for Hospital Anxiety
and Depression Scale anxiety and depression categories. Anx ¼ Anxiety, Dep ¼
Depression
web 3C=FPO
Conclusion: Psychological adjustment following a cardiac event is complex. Findings
underscore the importance of psychological support in cardiac rehabilitation programs.
The results raise the issue of information relating to emotional well-being, over the longer
term, being addressed with patients.
Disclosure of Interest: None Declared
e263
 PW001
POSTER ABSTRACTS
Cardiac electronic device implantation infection - A comparison of patients with
infections in newly implanted devices compared with those post generator change
or device upgrade
Sandeep Prabhu*1,1, Nigel T. Lewis1, Nisha S. Rao1, Matias B. Yudi1, Neil F. Strathmore1
1
Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Introduction: Previous studies have demonstrated higher rates of cardiac electronic
implantable device (CEID) related infections following a generator change or device up-
grade compared to new device implantation. However the extent to which the procedure
itself is the source of infection is poorly understood.
Objectives: To evaluate the temporal and epidemiological relationship of CEID-related
infections in newly-implanted devices versus those having had a generator change or device
upgrade, in patients undergoing device extraction.
Methods: A retrospective analysis was performed of consecutive patients who underwent
CIED extraction at the Royal Melbourne Hospital between January 2012 and February
2013. Patients and device related data was reviewed from the clinical notes and pathology
server for analysis. Patients were divided into two groups – those having had a generator
change or device upgrade since implantation (group 1), and those with the original
implanted CEID (group 2).
Results: 53 patients underwent device extraction for infection over the period with
significantly more patients in group 1 compared to group 2 (66% vs 34%, p¼0.003). The
former had a significantly shorter time period from procedure to infective symptom onset
(20.7 vs 42.2 months, p¼0.005) and a significantly higher likelihood of pocket rather than
lead infective focus (group 1: 68% vs 27%, p<0.001, OR¼5.8, 95%CI: 2.0-16.6; group 2:
50% vs 44%, p¼0.74). A significantly higher proportion of infections in group 2 were
related to Staphylococcus Aureus (44% vs 6%, p<0.001), whereas other non-Staph Aureus
skin-related organisms (including other staph species, pseudomonas and fungal species)
were more commonly isolated from group 1 (59% vs 22%, p¼0.024). There were no
significant differences in demographic characteristics, device type and major co-morbidities
between the two populations.
web 3C=FPO
web 3C=FPO
Conclusion: Compared to new CEID implants, infections following a generator change or
device upgrade present earlier, manifest as indolent pocket infection, and are more
commonly due to a range of skin-related flora rather than a virulent organism such as
Staphylococcus Aureus. These findings may suggest a procedural source of infection in
patients in such patients rather than haematological spread from a distant site.
Disclosure of Interest: None Declared
PW002
Electrical Performance In Right Ventricular Outflow Tract Versus Right Ventricular
Apical Pacing Site- An East Coast Malaysia Study
Seng Loong Ng*1, Siti Mariam Abdul Rahim2, Suhairi Ibrahim1, Meng Hun Tee1,
Mohd Sapawi Mohamed1, Zurkurnai Yusof1
1
Department of Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, 2Department of
Internal Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
Introduction: Since the introduction of the transvenous cardiac pacing almost five decades
ago, the right ventricular apical (RVA) has been the preferred site for ventricular lead
attachment. This is due to the ease of placement, stability and reliability. However, it was
associated with progressive left ventricular dysfunction. This led to an interest in alternative
RV pacing sites particularly the right ventricular outflow tract (RVOT).
e264
Objectives: The study aims to compare the long term electrical performance (i.e.
impedance, threshold and sensing) of RVOT pacing versus RVA pacing in patients with
permanent pacemakers in Hospital Universiti Sains Malaysia (HUSM), a leading tertiary
referral centre in East Peninsular Malaysia.
Methods: This is a retrospective study involving all patients who underwent permanent
pacemaker implantation at HUSM from January 2002 until June 2008. The patients were
divided into two groups based on the pacing site. Patients’ demographics, symptoms at
presentation and indications for pacing, data on stimulation threshold, R wave sensing and
lead impedance at time of pacemaker implantation and two years post implantation were
collected and analyzed.
Results: A total of 96 patients were enrolled, however only 66 patients had complete data
for interpretation. Ventricle pacing thresholds, impedance values, and R wave amplitudes
measured at implantation were not statistically significant. However, at 2 years post-
implantation there was significant difference for the ventricle lead impedance and threshold
between the two groups. The impedance of the RVOT lead was significantly higher than
RVA site. The threshold of the RVOT lead was significantly better than RVA. However
values for both parameters were within the accepted range.
Conclusion: The ventricular lead performance of right ventricular outflow tract (RVOT)
pacing site is safe and better compared with the right ventricular apical (RVA) group.
The pacing parameters are comparable with conventional RVA pacing in the long term
follow-up.
Disclosure of Interest: None Declared
PW003
Frailty and thromboprophylaxis prescription in heart failure and atrial fibrillation:
Preliminary findings from the Atrial Fibrillation And Stroke Thromboprophylaxis in
hEart failuRe (AFASTER) cohort study
Caleb Ferguson*1, Sally C. Inglis1, Phillip J. Newton1, Sandy Middleton2, Peter S. Macdonald3,
Patricia M. Davidson4
1
Centre for Cardiovascular & Chronic Care, University of Technology, Sydney, 2National Centre
for Clinical Outcomes Research (NaCCOR), Australian Catholic University & St Vincents
Hospital, 3Victor Chang Research Institute, St Vincents Hospital & UNSW, 4Centre for
Cardiovascular & Chronic Care, University of Technology, Sydney & St Vincents Hospital,
Sydney, Australia
Introduction: Frailty is a common occurrence in atrial fibrillation (AF). Previous studies
have demonstrated that frail patients are less likely to receive thromboprophylaxis in AF.
Objectives:
1) To investigate the prevalence of frailty in patients with chronic heart failure and
concomitant atrial fibrillation in an inpatient setting.
2) To examine if frailty was associated with non-prescription of anticoagulation at
discharge.
Methods: Prospective, consecutive participants admitted to a medical cardiology ward
were enrolled in the cohort study between April – September 2013. Participants were
included with CHF with concomitant AF of any type and any aetiology confirmed by a
cardiologist and consistent with international guidelines (minimum CHA2DS2VASc ¼1).
Exclusion criteria included age <18 years or AF due to reversible causes. Frailty was
measured using the SHARE Frailty Instrument as close to discharge as clinically possible.
Results: The analysis included the first 97 participants enrolled between April – September
2013. Mean age was 73 years (SD 15), mostly male (67%), primarily NYHA class II - III
(54%), Mean LVEF 43% (SD 20). Most were identified as having permanent AF. Mean
CHA2DS2VASc Score ¼ 3.25 (SD 1.94). Mean HASBLED Score ¼ 2.95 (SD 1.55), Mean
Charlson Comorbidity Score ¼ 3.07 (SD 1.84), Mean no of medications on discharge ¼ 11
(SD 4). 32% lived alone.
The majority of patients were classified as frail ¼ 61% (Non-frail ¼ 17%, Pre-frail 22%)
The below analysis is a subset including 74 participants.
Table 1. Frailty category and rate of anticoagulation from anticoagulation perspective
Frailty Not prescribed anticoagulation on Prescribed anticoagulation on
category discharge (n [ 20) discharge (n [ 54)
Non Frail 0% (n¼ 0) 24% (n¼13)
Pre Frail 20% (n ¼ 4) 24% (n ¼ 13)
Frail 80% (n ¼ 16) 52% (n ¼ 28)
Table 2. Frailty category and rate of anticoagulation from frailty perspective
Frailty Not prescribed anticoagulation on Prescribed anticoagulation on
category discharge (n [ 20) discharge (n [ 54)
Non Frail 0% (n¼ 0) 100% (n¼13)
Pre Frail 23% (n¼ 4) 77% (n ¼ 13)
Frail 36% (n ¼ 16) 64% (n ¼ 28)
Conclusion: The majority of patients in this cohort were identified as being frail. Inpatient
assessment of frailty using the SHARE Frailty Instrument demonstrated that frailty is not
associated with suboptimal prescription of anticoagulation in patients with chronic heart
failure and concomitant atrial fibrillation. This is in contrast to previous research.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PW005
Safety and efficacy of dabigatran compared to warfarin for periprocedural
anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation
Nitin Kansal1, Natalia Pinilla1, Sam Schulman2, Carlos Morillo*1
1
Cardiology- Arrhythmia Service, 2Medicine- thrombosis service, Mcmaster University,
Hamilton, On, Canada, hamilton, Canada
Introduction: Adequate periprocedural anticoagulation is required in patients undergoing
ablation for atrial fibrillation (AF). Dabigatran, a newer oral anticoagulant, may be good
alternative to warfarin in this context. However, Dabigatran efficacy and safety for peri-
procedural anticoagulation for AF ablation is not well established.
Objectives: Retrospective cohort study to review safety and efficacy of Dabigatran
compared to warfarin for periprocedural anticoagulation, in patients undergoing radio-
frequency ablation for AF.
Methods: Retrospective chart review of 249 consecutive patients who underwent radio-
frequency ablation for AF or left atrial flutter, between January 2011 to July 2013. Peri-
procedural anticoagulation with dabigatran (n¼112) was compared with warfarin
(n¼137). Dabigatran was stopped a median of 24 hours prior to ablation and restarted
between 6-18 hours after the procedure. Warfarin was stopped 5 days prior to surgery and
restarted after 6 hours at double dose. Warfarin patients were bridged with enoxaparin 3
days pre to 3 days post procedure. Primary outcome was a composite of complications
including major and minor bleeding, stroke and systemic embolism.
Results: Mean age was 58.6  10.6 in the warfarin group compared to 56.9  10.7 in the
dabigatran group. Mean CHADS2 score was 0.8  0.9 in the warfarin group compared to
0.7  0.9 in the dabigatran group. Mean CHA2DS2VASc score was 1.4  1.2 in the
warfarin group vs 1.3  1.2 in the dabigatran group. Major bleeding occurred in 5 (3.6%)
patients in the warfarin group compared to none in the dabigatran group (p¼ 0.066).
Groin hematoma was reported in 5 (3.6%) patients in warfarin group and 2 (1.8%) in the
dabigatran group (p¼0.463). No patient had stroke and 1 (0.7%) patient in the warfarin
group developed TIA (p¼0.365). Pericardial effusion not requiring drainage was observed
in 3 (2.7%) patients in the dabigatran group compared to 1 (0.7%) patient in the warfarin
group (p¼0.329). The combined end point occurred in 12 patients in the warfarin group
compared to 6 in the dabigatran group (p¼0.209).
Conclusion: Periprocedural complications with oral anticoagulants post AF ablation are
rare. Dabigatran appears to be a safe and effective alternative to warfarin in patients at low
risk of stroke and bleeding undergoing radiofrequency ablation for AF.
Disclosure of Interest: None Declared
PW006
Aging and atrial fibrillation substrate in patients with non-paroxysmal atrial
fibrillation
Ri-Bo Tang*1, Chang-Sheng Ma1, Jian-Zeng Dong1, Rong-Hui Yu1, De-Yong Long1
1
Beijing An Zhen Hospital, Beijing, China
Introduction: Atrial fibrillation (AF) is the most common arrhythmias in the elderly.
Objectives: This study sought to investigate the impact of ageing on complex fractionated
atiral electrograms (CFAEs) in patients with non-valvular non-paroxysmal AF.
Methods: In this prospective study, 116 patients with non-paroxysmal AF were enrolled.
Left atrial geometry (LA) was reconstructed with a 3.5 mm tip ablation catheter with fill-in
threshold 10 in CARTO system. The mapping catheter was stabled at each endocardial
location for at least 3 seconds for recording 2.5-second with infilter highpass 30Hz and
lowpass 400Hz. The 2.5-second bipolar electrogram recordings at each endocardial loca-
tion were analyzed with a custom software embedded in the CARTO mapping system.
Interval confidence level (ICL) was used to characterize CFAEs. As the default setting of the
software, ICL more than or equal to 7 was considered sites with a highly repetitive CFAEs
complex. CFAEs index was defined as the fraction of area of ICL more than or equal to 7 to
the left atrial surface. The spatial distribution of CFAEs evaluated in six LA region: anterior
wall, posterior wall, roof, inferior wall, lateral wall and septum. The elderly was defined as
age  60 years old.
Results: In all the 116 patients, 48 (41.4%) were in the elderly group and 68 (58.6%)
were in the young group. The elderly group had higher prevalence of male (72.9%VS.
88.2%, P¼0.035), hypertension (64.4% VS. 39.7%, P¼0.002) and stroke(18.8% VS.
5.9%, P¼0.030). ICL max (16.72.0 VS. 15.72.2, P¼0.014)and CFAEs index (60.4%
22.9% VS. 48.6%22.3%, P¼0.007)in the elderly group was significantly higher than that
in the young group. The regional distribution of CFAEs was frequently found in LA
anterior wall and LA septum in the elderly. Age had positive relation with CFAEs(r¼0.234,
P¼0.012).
Conclusion: The elderly had extensive substrate for non-paroxysmal AF, which hinted that
electrophysiological remodeling had a important role in non-paroxysmal AF in the elderly.
Disclosure of Interest: None Declared
PW008
The Comparison Between Manual Radial Pulse Palpation And Mean 24 Hour Holter
Ventricular Rate Based On The Rate Controlled Strategy Of Atrial Fibrillation
(£80 Bpm) Among 140 Patients Attending Inr Clinic
W. Yus Haniff W. Isa*1, Seng Loong Ng1, Zurkurnai Yusof1, Nyi Nyi Naing2
1
Cardiology Unit, Department of Internal Medicine, Hospital USM, 2Unit of Biostatistics
and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia (USM),
Kota Bharu, Malaysia
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: The accuracy of manual radial pulse palpation for rate controlled strategy in
POSTER ABSTRACTS
AF was never been studied.
Objectives: The purpose of this study was to determine the difference and agreement
between manual radial pulse palpation of heart rate(MHR) for chronic AF patients
attending outpatient clinic with the mean 24 hour ventricular rate (HVR) from the Holter
monitor.
Methods: A cross sectional study was done on AF patients attending INR clinic in a tertiary
centre. Patients were selected before consultation and date for 24 hour Holter monitor
fixation given. The MHR was palpated by the clinic doctors. Controlled rate was taken as 
80 bpm. Statistical methods used were paired t-test for mean difference and intraclass
correlation coefficient (ICC) together with Bland-Altman plot for the agreement test.
Results: The mean MHR was 78 (11) bpm and HVR was 76 (13) bpm with P ¼ 0.257.
There were 55 patients (39.3%) with MHR which was opposite to HVR. A total of 85
patients (60.7%) had their MHR in the same range of HVR with 68 patients (48.6%)
controlled and 17 patients (12.1%) uncontrolled. There was fair agreement between the 2
methods with ICC of 0.314 (95% CI 0.157, 0.456, p < 0.001) while Bland-Altman plot
revealed no consistent bias pattern with several outliers. A total of 3 (2.1%) patients had
significant pause due to sinus node dysfunction.
Conclusion: The difference between the mean MHR and the mean HVR was not signifi-
cant. There were 60.7% cases where MHR was tallied by HVR when the controlled rate was
taken at  80 bpm. We concluded that manual radial pulse palpation at rest was adequate
for monitoring asymptomatic chronic AF patients in the clinic when the palpation was
done by trained medical personnel. The fair agreement obtained using ICC and Bland-
Altman plot between the 2 methods, explained the large variability of heart rate in AF. This
study emphasized the role of Holter in selected cases of AF especially in symptomatic
patients and when dangerous arrhythmias are suspected.
Disclosure of Interest: None Declared
PW009
Expression of Kv1.5 Channel in Right Atria of Patients with Rheumatic Heart Disease
and Atrial Fibrillation
Xianhong Ou*1
1
Department of Electrophysiology, Institute of Cardiovascular Research, Luzhou Medical College,
Luzhou, China
Introduction: Atrial fibrillation (AF) is currently the most common sustained arrhythmia
in humans. The incidence of AF in rheumatic heart diseases is very high and increases with
age. Ocurrence and development of AF are very complicated process accompanied by
many mechanisms in them. Ion-channel remodeling, including Kv1.5 Channel, plays an
important role in the pathophysiology of AF. Kv1.5 channels carry ultra-rapid delayed
rectified potassium current (IKur) which is much more abundant in atria than in ventricles.
It has been shown that reduction of IKur prolongs 90% action potential duration (APD90) in
remodeled atrial cells. However, the changes of Kv1.5 channel proteins in patients with
rheumatic heart disease and AF remain poorly understood.
Objectives: To study the changes of Kv1.5 protein expressions in patients with rheumatic
heart disease with AF and its relationship to age and sex, discuss the role of the expression
changes of Kv1.5 in the happening and persistence of atrial fibrillation.
Methods: Right atrial appendages were obtained from 20 patients with normal cardiac
functions who had undergone surgery, and 26 patients with AF. Subjects were picked from
four groups: adult patients (n¼14, mean age 12.1.23.0 ), and aged patients (n ¼6, mean
age 56.23.5 ) in normal sinus rhythm (SR) and adult patients (n ¼8, mean age
41.64.2), aged patients (n ¼18, mean age 54.84.2 ) with AF. Meanwhile, patients were
indivied into non-RHD and RHD group or men and women group in normal SR and AF,
respectively. The expression of Kv1.5 protein was measured by Western-blot method.
Results: In SR groups, Kv1.5 protein expression in adult and aged groups were 0.730.33
and 1.350.44, respectively. The difference between these two groups was statistically
significant. In AF groups, the expression of Kv1.5 protein also increased significantly with
aging, with the relative amount of 0.510.29, and 0.920.45 in adult and aged groups.
Moreover, it is also showed that Kv1.5 protein expression in AF groups was lower than that
in SR groups in the same age range. However, there were not only significant difference in
non-RHD and RHD group but also in men and women group of normal SR and AF.
Conclusion: The expression of Kv1.5 channel protein remains unchanged in patient with
RHD and is unrelated to sex. But it is increased in atria with aging in both SR and AF
groups. In the same age range, Kv1.5 expression is lower in AF groups than in SR groups,
which may contribute to the initiation of AF in the aged population.
Disclosure of Interest: None Declared
PW010
Plasma Galectin-3 Elevated in Patients With Paroxysmal and Persistent Atrial
Fibrillation
Xiao Yan Wu*1, Rong Bai1, Nian Liu1, Song Nan Li1, Song Nan Wen1, Xin Du1,
Jian Zeng Dong1, Chang Sheng Ma1
1
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Introduction: Atrial fibrosis involves in the pathological process of AF. Galectin-3 (Gal-3)
is an important mediator of cardiac fibrosis. Whether Gal-3 elevates in the development of
AF is unknown.
Objectives: We investigated whether the plasma Galectin-3 (Gal-3) differed in various
forms of atrial fibrillation (AF) and in sinus rhythm (SR) in humans.
Methods: Plasma Gal-3 were measured in 73 patients with lone AF and 38 healthy control
subjects in SR.
e265
 Results: Gal-3 was significantly higher in lone AF patients than in control subjects technique of wide antral isolation (WAI). However, it is not known whether these tech-
POSTER ABSTRACTS

(6.213.61 ng/ml vs. 3.510.88 ng/ml, p ¼ .000 ). Compared with control subjects, niques have different effects on LA size and function.
patients with persistent and paroxysmal AF had higher levels of Gal-3 (3.50.88 ng/ml vs. Objectives: To compare LA size and function in patients who have had AF ablation by
7.254.51 ng/ml, p ¼ .000 and 3.50.88 ng/ml vs. 5.252.15, p ¼ 0.009, respectively). means of SRI versus WAI.
Gal-3 was also higher in persistent AF patients than in paroxysmal AF patients (p¼0.004). Methods: 220 patients with drug refractory AF were block randomised (1:1) to either SRI
Conclusion: Plasma Gal-3 differed significantly between patients with lone AF and SR. or WRI. 211 patients (mean age 58yrs; 82% males) underwent pre-procedural trans-
Furthermore, Gal-3 also differed significantly between paroxysmal and persistent AF pa- thoracic echocardiograms (TTE) and 187 of these had follow up TTE at 3 and 6 months.
tients, suggesting that Gal-3 may be related to the burden or type of AF. AF was paroxysmal in 61% and persistent in 39% of the cohort. LA biplane maximum and
Disclosure of Interest: None Declared minimum volume and expansion index and ejection fraction were measured. Differences in
LA parameters at baseline, 3 and 6 months post-procedure were assessed using a linear
PW011 mixed model analysis, adjusting for variables including type and duration of AF, hyper-
tension and diabetes. Bonferroni adjustment was used to account for multiple comparisons
Plasma Myeloperoxidase Elevation in Patients With Lone Atrial Fibrillation over time (p ¼ 0.017 for significance).
Results: At baseline there were no differences in parameters of LA size or function between
Xiao Yan Wu*1, Rong Bai1, Nian Liu1, Song Nan Wen1, Song Nan Li1, Xin Du1,
the two groups. At 3 and 6 months post-ablation, there were no significant differences in
Jian Zeng Dong1, Chang Sheng Ma1 LA maximum or minimum volumes. There was a trend towards lower values for LA
1
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China expansion index and LA ejection fraction in patients who underwent SRI at 3 and 6 months
post-ablation compared to those who underwent WAI. However, these differences were
Introduction: Myeloperoxidase (MPO) has been implicated as a mediator of atrial fibrosis
small and neither clinically nor statistically significant (Table 1). Left atrial size decreased
and atrial arrhythmogeneity. We hypothesized that MPO is elevated in patients with lone
over the 6 months following ablation in both groups, however this trend did not differ
atrial fibrillation (AF).
between the two groups. p < 0.017 for significance after Bonferroni adjustment
Objectives: We are to test the level of plasma MPO in patients with lone atrial fibrillation.
Methods: Using a case-control study design, plasma MPO in 73 patients with lone AF was
compared with MPO in 38 control subjects. Table 1. LA size and function parameters at baseline, 3 months and 6 months post
Results: MPO was significantly higher in lone AF than in control subjects (30.3417.5 ng/ ablation
ml vs. 16.269.19 ng/ml, p¼ .000). Patients with both paroxysmal AF and persistent AF
Baseline (SRI vs WAI) 3 months (SRI vs WAI) 6 months (SRI vs WAI)
had higher MPO than controls (30.0319.54 ng/ml vs. 30.6215.71 ng/ml vs.
16.269.19 ng/ml, respectively, p0.001). MPO in patients with persistent AF was not LA max vol 71.7 vs 72.8 mL (p ¼ 62.5 vs 66.6 mL (p ¼ 62.7 vs 61.3 mL (p ¼
different than in patients with paroxysmal AF (p¼0.9). (mean) 0.89) 0.32) 0.44)
Conclusion: Plasma MPO is elevated in lone AF patients. Although the cause of elevated LA min vol 42.9 vs 44.3 mL (p ¼ 38.7 vs 40.6 mL (p ¼ 38.4 vs 37.0 mL (p ¼
MPO levels in lone AF patients remains unknown, elevated MPO may reflect inflammation
(mean) 0.65) 0.81) 0.14)
and oxidative stress that promotes lone AF. Further study is warranted to investigate the
mechanism under wihich plasma MPO is related to AF. LA expansion 79.4 vs 76.9% (p ¼ 67.4 vs 70.2% (p ¼ 68.8 vs 70.6% (p ¼
Disclosure of Interest: None Declared index 0.45) 0.08) 0.07)
LAEF 41.8 vs 40.9% (p ¼ 39.0 vs 39.9% (p ¼ 39.6 vs 40.4% (p ¼
PW013 0.42) 0.07) 0.05)
Early implantation of primary prevention implantable cardioverter defibrillators for
newly diagnosed non-ischaemic cardiomyopathy: single center experience
Alex Voskoboinik*1, Andrew J. Taylor1, Justin A. Mariani1
1
Cardiology, Alfred Hospital, Melbourne, Australia Conclusion: Despite patients undergoing SRI having fewer AF recurrences compared to
those undergoing WAI, there were no significant deleterious procedural effects on LA size
Introduction: Primary prevention implantable cardioverter defibrillators (ICD) reduce or function.
mortality in selected patients with severe left ventricular systolic dysfunction. Current Disclosure of Interest: None Declared
guidelines suggest a waiting period of 3 - 6 months from diagnosis prior to consideration of
ICD insertion.
PW015
Objectives: To determine the long-term outcomes of patients with newly diagnosed non-
ischaemic cardiomyopathy who have undergone ICD implantation early after diagnosis. Radiofrequency ablation of posteroseptal accessory pathways. When the standad
Specifically, whether they continue to meet criteria for ICD implantation according to endocardial approach is not enough
current guidelines, rate of appropriate ICD therapy, and change in ejection fraction.
Methods: We retrospectively studied consecutive patients with non-ischaemic cardiomy- Rafael Rabinovich*1, Andres Bochoeyer1, Natalia Schnetzer1, Raúl Ferreyra1
1
opathy who underwent ICD implantation within 6 months of diagnosis from 2008 through Cardiology, Sanatorio Trinidad Mitre, Buenos Aires, Argentina
2013. The primary endpoint was qualification for ICD at 12 months post implant, and the
secondary endpoint was rate of appropriate ICD therapy. Introduction: Successful radiofrequency ablation (RF) for the treatment of accessory
Results: A total of 25 patients were identified with mean age 4715 years and baseline pathways (AP) in the posteroseptal location (PS) may be affected by the complex anatomy
ejection fraction (EF) 20.211.4%. Median time from diagnosis to ICD implantation was of the region addressed. AP of epicardial location is common in the posteroseptal region of
32 days. Prior to ICD implantation, 63% had evidence of regional fibrosis on MRI and 52% the heart. In this stage, the epicardial approach via the coronary sinus (CS) or sub-xiphoid
had non-sustained ventricular tachycardia. Only 8% and 32% were at target doses of ACE punition could be an effective strategy in order to reach the AP.
inhibitors and beta-blockers, respectively, at implant. After a median follow-up of 586 days, Objectives: We propose to describe and analyze the results obtained by our group in this
only 1 patient received appropriate ICD therapy. This patient had evidence of regional particular setting.
fibrosis on MRI. At 12 months post ICD implantation, 64% of patients no longer met ICD Methods: From January 2005 to August 2013, we performed 72 RF sessions of PS AP. We
appropriateness criteria. This was due to either improvement in EF above 35% (50% of used a stepwise endocardial-epicardial mapping protocol: initially with standard endo-
patients), implantation of a ventricular assist device or heart transplantation (14% of pa- cardial tricuspid annulus, following the mitral valve. If AP was not located, we ended up
tients). The median improvement in EF after 12 months of medical therapy was 20%, with with epicardial approach via the coronary sinus or sub-xiphoid punition. Was defined as a
a relative mean improvement of 118% from baseline. criterion for successful RF to the absence of AP conduction by the end of the procedure.
Conclusion: The rate of appropriate ICD therapy is particularly low for patients who have Results: The average age of patients (Pts) was 26 years old (range 6-67). Males: 53%.In
ICDs implanted within 6 months of diagnosis. Moreover, the majority of these patients 32/72 pts the epicardial mapping was required (30 CS ’approach and 2 sub xiphoid).
would not qualify for an ICD at 1 year post-diagnosis. In the absence of an evidence-based Primary Success of RF: 29/32 pts (90.6%).
risk score to predict those at highest risk of sudden cardiac death, there may be a role for Conclusion: When the PS AP cannot be addressed from the standard endocardium
wearable cardioverter defibrillators as a bridge to ICD decision. approach, epicardial-mapping strategies allowed us to achieve a successful outcome in a
Disclosure of Interest: None Declared high percentage of pts. Also, the epicardial approach of the PS AP proved to be a safe and
effective strategy.
Disclosure of Interest: None Declared
PW014
Single Ring Posterior Left Atrial (Box) Isolation versus Wide Antral Pulmonary Vein PW016
Isolation; Effects on Left Atrial Size and Function St Elevation Morphology And Site Of Early Repolarization Pattern In Patients With
Adam Lee*1, See Valerie1, Toon W. Lim2, Choon H. Koay3, William Chik3, Joseph Descellar4, False Tendons
David Ross3, Stuart Thomas5, Liza Thomas1 Ahmed M. Ragab*1, Amir AbdelWahab1, Yasser Yazeed1, Wael El Naggar1
1
Cardiology, Liverpool Hospital, Sydney, Australia, 2Cardiology, National University Heart 1
Cardiology, Cairo university, Cairo, Egypt
Centre, Singapore, Singapore, 3Cardiology, Westmead Hospital, 4The Ingham Institute, Sydney,
5
Cardiology, Westmead Hospital, Singapore, Australia Introduction: Although early repolarization pattern (ERP) have been considered for long
time to be a normal electrocardiographic finding, it was proved in recent studies to cause
Introduction: We have previously demonstrated that the technique of single ring isolation sudden cardiac death. Exact mechanism underling this electrocardiogaphic phenomenon is
(SRI) results in fewer recurrences of atrial fibrillation (AF) compared to the more common not well established. False tendons are (FT) fibromuscular bands that transverse the left

e266 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

ventricular cavity and often contain conduction tissue which proved in some case reports to
cause ventricular tachycardia.
Objectives: To investigate the electrocardiographic characteristics of patients with false
tendons.
Methods: We studied 60 non cardiac patients with FTs and 60 non cardiac patients with
ERP. Patients were classified according to presence of ERP and FTs to: ERP+FT (group 1,
n¼52 ) and ERP or FT (group 2, n¼68 ). ERP was defined as J point elevation manifested
either as QRS slurring (transition from the QRS segment to the ST segment) or notching
(positive deflection on terminal S wave), upper concavity ST segment elevation for more
than 0.1mV and prominent T waves in at least 2 contiguous leads. False tendons were
defined ( by 2D TTE) as bands stretching across the left ventricle (LV) from the ventricular
septum to the papillary muscle or LV free wall but not connecting, like the chordae ten-
dinae, to the mitral leaflet. PRd, QRSd, QT, QTc, JT and JTc were calculated, site,
morphology of ST elevation were identified and amplitude of ERP and number of leads
with ST elevation were calculated. Site and number of FTs were identified and length&
thickness & volume of FT were measured. FTs were classified according to their points of
attachment as type 1 (longitudinal), type 2 (diagonal), type 3 (transverse) and type 4
(weblike).
Results: ERP was present in 29 patients (48.3%) of patients with FTs and FTs were present
in 23 patients (38.3%) of patients with false tendons .Horizontal ST segment elevation was
found in (61.4%) patients of those with ER and FT which is much more common than
patients with ER alone (27.8%) and this was statistically significant (P¼ 0.007). We found
that 80% of patients with ER pattern in the inferior leads have oblique FTs (P ¼ 0.043).
and 72% of patients with ER pattern in the infrolateral leads have transverse FTs (P ¼
0.05).
Conclusion: Our results suggest that FTs may play a role in genesis and determination of
site and morphology of ERP.
Disclosure of Interest: None Declared
PW019
Cardiac Arrhythmias During Pregnancy; managment
Pascal Lefebvre*1, Stéphanie Blondel2
1
Cardiology, 2Obstetrics and gynaecology, CHU Charleroi, Charleroi, Belgium
Introduction: Pregnancy can precipitate cardiac arrhythmias not previously present in
seemingly well individuals. Risk of arrhythmias is relatively higher during labor and de-
livery. The exact mechanism of increased arrhythmia burden during pregnancy is unclear,
but has been attributed to hemodynamic, hormonal, and autonomic changes related to
pregnancy.
Objectives: Paroxysmal supraventricular and ventricular tachycardia may cause hemody-
namic compromise with consequences to the fetus. Management of arrhythmias in preg-
nant women is similar to that in non-pregnant but a special consideration must be given to
avoid adverse fetal effects. However, due to the theoretical or known adverse effects of
antiarrhythmic drugs on the fetus, antiarrhythmic drugs are generally reserved for the
treatment of arrhythmias associated with significant symptoms or hemodynamic
compromise.
Methods: Treatment strategies during pregnancy are hampered by the lack of randomized
trials in this cohort of women. Choice of therapy, for the most part, is based on limited data
from animal studies, case reports, observational studies, and clinical experience. Adenosine
or a cardioselective beta-blocker could be used if vagal maneuvers are ineffective. Alter-
natively, verapamil or diltiazem may be given. In pregnant women with atrial fibrillation,
the goal of treatment is conversion to sinus rhythm or to control ventricular rate by a
cardioselective beta-adrenergic blocker drug or digoxin. Ventricular arrhythmias may occur
in the pregnant women with cardiomyopathy, congenital heart disease, valvular heart
disease, or mitral valve prolapse. Termination of ventricular arrhythmias can usually be
achieved by intravenous lidocaine or procainamide or by electrical cardioversion.
Results: Direct current cardioversion to terminate maternal arrhythmias is well tolerated
and effective, and should not be delayed if indicated. The use of an implantable car-
dioverter-defibrillator should be considered for women of childbearing potential with life-
threatening ventricular arrhythmias.
Conclusion: During pregnancy, significant changes occur in the hormonal and hemody-
namic state of women that make arrhythmias more likely to occur. Palpitations are
frequently reported, but are usually found to be associated with sinus tachycardia. Acute
treatment of arrhythmias for pregnant women is much the same as that for non-pregnant
patients. Chronic drug therapy during pregnancy should be reserved only for the frequent,
hemodynamically significant arrhythmias.
Disclosure of Interest: None Declared
PW020
Long-Term Arrhythmia-Free Survival In Patients With Severe Left Ventricular
Dysfunction And No Inducible Ventricular Tachycardia Post Myocardial Infarction
Sarah Zaman*1, Arun Narayan1, Aravinda Thiagalingam1, Gopal Sivagangabalan1,
Stuart Thomas1, David L. Ross1, Pramesh Kovoor1
1
Cardiology, Westmead Hospital, Sydney, Australia
Introduction: Patients with impaired left ventricular ejection fraction (LVEF) late after
myocardial infarct (MI) derive a mortality benefit from prophylactic implantable-
cardioverter defibrillator (ICD) therapy. As this mortality benefit was not seen early post-
MI, guidelines limit ICDs to patients who are >40 days with LVEF30%, or LVEF35%
in the presence of New York Heart Association (NYHA) class II/III heart failure (HF).
However, LVEF alone as a risk stratification tool for prevention of sudden death is limited
by its poor specificity for arrhythmic versus non-arrhythmic cardiac death.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: We aimed to demonstrate that a negative electrophysiology study (EPS) can be
POSTER ABSTRACTS
used to delineate a sub-group of early post-MI patients with severely impaired LVEF who
are safe long-term without an ICD.
Methods: Consecutive patients treated with primary percutaneous coronary intervention
for ST-elevation MI (STEMI) underwent early LVEF assessment. Patients with LVEF40%
underwent EPS. A prophylactic ICD was implanted for a positive [inducible monomorphic
ventricular tachycardia (VT)] but not for a negative (no inducible VT or inducible ven-
tricular fibrillation (VF)/flutter) EPS result. Patients who would have become eligible for a
late primary prevention ICD with LVEF30% or 35% with NYHA class II/III heart failure
(HF) were included and analysed according to EPS result. Patients with LVEF>40% who
were not eligible for EPS were followed as controls. The primary endpoint was survival free
of death or arrhythmia (resuscitated cardiac arrest or sustained VT/VF).
Results: A total 1,722 STEMI patients underwent early (median 4 days) LVEF assessment.
Patients with LVEF>40% made up 75% (n¼1,286). EPS was performed in 128 patients
with LVEF30%/35% & HF, with a negative EPS in 63% (n¼80) and a positive EPS in
37% (n¼48). ICDs were implanted in <0.1%, 4% and 90% of control, EPS negative and
EPS positive patients, respectively. At 3 years 93.41.0% of EPS negative patients with
LVEF30%/35% & HF and 91.83.2% of control patients (LVEF>40%) were free of
death or arrhythmia (P¼0.953, Figure I), compared to 62.77.5% of EPS positive patients
with LVEF30%/35% & HF (P<0.001).
Conclusion: Re-vascularised STEMI patients with severely impaired LV function but no
inducible VT have favourable long term prognosis without the protection of an ICD.
Disclosure of Interest: None Declared
PW021
The relationship between the coupling interval of premature beat and hemodynamics
Zhongjian Li*1, jihong Shen1, yuan Cheng1, shuaibing Li1, yan Jing1
1
Electrocardiogrom Lab, The Second Affiliated Hospital of Zhengzhou University,
Zhengzhou, China
Introduction: Premature beat is one of the most frequent cardiac arrhythmia in clinical
cardiovascular diseases. Many previous research of premature beat were about the causes,
mechanism, whether accompanying with organic heart disease or not and whether will
cause sudden death risk or not etc. Few studies have examined about hemodynamic
changes cased by shortening coupling interval of premature beat. Therefore, in order to
explore various kinds of premature coupling interval change impact on cardiac function
and hemodynamics, 70 cases of premature beat observed and analyzed.
Objectives: To study the relationship between the coupling interval of premature beat(PB)
and pulsography, and explore the effect of PB on the hemodynamics.
Methods: 48 patients with artrial premature beat(APB,18 cases of premature beat originate
from left atrial,30cases of premature beat originate from right atrial) and 51 patients with
ventricular premature beat(VPB,21 cases of premature beat originate from left ventricu-
lar,30 cases of premature beat originate from right ventricular) were detected by 12 lead
surface electrocardiograms. They were divided according to the advanced ratios. Cardiac
function was investigated through cardiac function check apparatus. The pulsographic
areas were measured by signal processing technique.
Results: 1. The pulsographic areas of PB were smallest when advanced ratios were
>40%,which were middle when the ratios were between 20%>40%, and largest when the
ratios were <20% (P<0.05). 2. When advanced ratios were same, there was a negative
correlation between left and right artrial of pulsographic areas (P<0.05); and a positive
correlation between left and right ventricular (P<0.05).
Table 1. Comparison of pulsography integral area between atrial and ventricular
premature beat
Atrial premature beat Ventricular premature beat
advanced ratios(%) n Pulsography integral area n pulsography integral area
>40 17 390.5920.80 20 248.3577.33
Conclusion: The hemodynamics changes of were influenced by the coupling interval of
premature beat and the original sites when they were ventricular premature beat.
Disclosure of Interest: None Declared
PW022
Prognostic value of troponin I and NTproBNP concentration in patients after
in-hospital cardiac arrest
Filip M. Szymanski*1, Krzysztof J. Filipiak1, Anna E. Platek1, Anna Szymanska2,
Grzegorz Karpinski1, Grzegorz Opolski1
1
Cardiology Department, 2Department of Cardiology, Hypertension and Internal Diseases, The
Medical University of Warsaw, Warsaw, Poland
Introduction: Cardiovascular diseases are the leading cause of mortality and morbidity
worldwide. Unfortunately, the cardiac arrest (CA) is often the first presentation of cardiac
disease in many patients.
Objectives: The aim of the study was: /1/ to describe clinical characteristics of patients with
in-hospital cardiac arrest (IHCA), and /2/ to assess if troponin I and (NTproBNP) con-
centration are predictive of mortality.
Methods: We enrolled in the study 106 consecutive patients of intensive cardiac care unit
experiencing cardiac arrest within first 12 hours after admission. Baseline characteristics,
e267
 information about CA circumstances, cardiopulmonary resuscitation (CPR), and initial PW027
POSTER ABSTRACTS

biochemical parameters were retrospectively collected.

Results: 106 patients (61 males, aged 71.412.6 years) were enrolled. 34 (32.1%) patients Coronary Sinus Cannulation Using a Steerable Catheter with Electrogram Guidance
had history of myocardial infarction, and 13 (12.3%) history of stroke. Total 30-day during Biventricular Device Implantation
mortality was 60.4%. Deceased patients were older (73.711.9 vs. 67.813.0 years; Lingwei Wang*1
p¼0.01), had lower systolic (89.437.0 vs. 115.024.0 mmHg ;p¼0.0001) and diastolic 1
Cardiology, Lund University Hospital, Lund, Sweden
(53.624.8 vs. 66.115.0 mmHg; p¼0.008) blood pressure on admission. Shockable
initial rhythm was more often noted in survivor group (54.8% vs. 28.1%; p¼0.01). Introduction: During cardiac resynchronization therapy (CRT) implantations, gaining
Deceased patients had also lower eGFR (36.915.4 vs. 47.915.7 ml/min/1.73; p¼0.001), access to the coronary sinus (CS) can be challenging and time consuming. Valves, ridges,
and higher NTproBNP level (20088.821 724.2 vs. 9938.321 273.7 pg/ml; p¼0.02). and unexpected anatomical changes due to natural or surgical causes can increase the time
There were no differences in first two measurements of troponin I, with higher value in required to access the CS, and there is a 5-15% failure rate according to clinical reports. CS
third measurement in non-survivors (108.371.3 vs. 27.225.1 ng/ml; p¼0.009). cannulation using electrode catheter and electrogram guidance is widely used in electro-
Conclusion: 30-day survival rate of patients after in-hospital cardiac arrest is poor. Factors physiological laboratories, but not yet in CRT implantation. To our knowledge, there has
such as older age, lower systolic and diastolic blood pressure are more often present in not been any publication before concerning the use of a steerable catheter and electrogram
deceased patients. Deceased patients have higher NTproBNP and lower eGFR levels on guidance during CRT implantation. Recently, a steerable catheter with electrogram guid-
admission, along with higher troponin I concentration at third measurement. ance (CS-assist catheter) was developed to help gain access to the CS during CRT
Disclosure of Interest: None Declared implantation.
Objectives: In current study, we aimed to determine whether a steerable catheter with
electrogram guidance could facilitate access to the CS during CRT implantation.
PW023 Methods: Consecutive patients who underwent CRT implantation were recruited prospec-
The dynamic electrocardiogram changes after anti-copper treatment in 28 patients tively to use the steerable catheter technique with real-time electrogram guidance (CS-assist
with Wilson’s disease group, n¼81) and compared with those using conventional techniques with Terumo wire,
direct lead, or guide wire without electrogram guidance (conventional group, n¼101).
Guizhi Liu*1, Yan Zhang2, xiuqin Chen3 Results: There were 5 CS cannulation failures (4.95%) in the conventional group and no
1 failures in the CS-assist group. Thus, the CS cannulation success rate was clearly greater in
Electrocardiogram Room, First Affiliated hospital, Zhengzhou University, Zhengzhou,
2
Electrocardiographic room, first affiliated hospital, zhengzhou university, Zhengzhou City, the CS-assist group (100%) than in the conventional group (95.05%, p<0.05), with
3
Health Bureau, Yucheng county, yucheng, China significantly shorter mean procedure time (52.620.6 min vs. 73.240.9 min, p<0.0001)
and fluoroscopy time (3.63.2 min vs. 14.220.4 min, p<0.0001). In the 5 CS cannu-
Introduction: Wilson’s disease is a severe genetic multisystem disorder associated with lation failure cases, mean procedure time (144.037.0 min) and fluoroscopic time
intracellular copper storage. Wilson’s disease is characterized by an inadequate excretion of (57.824.8 min) were significantly longer than in the other patients (61.232.3 and
absorbed dietary copper via bile resulting in the accumulation of toxic amounts of copper 8.213.6 min respectively, n¼177, both p<0.0001). There were 2 patients in the CS-assist
in the liver and other organs. However, electrocardiographic abnormalities have not group in whom CS cannulation had failed in a previous procedure. In case 1, CS venog-
received much attention. raphy showed that the CS sheath was located exactly at the CS ostium and a Thebesian
Objectives: To evaluate the 24 hour dynamic electrocardiogram (DCG) changes and the valve covered almost the entire CS ostium (Figure 1), which could have been the reason for
relationship between clinical therapeutic effect and DCG changes after anti-copper treat- the difficulties in performing the procedure.
ment in 28 patients with Wilson’s disease (WD).
Methods: standard 12-lead electrocardiogram (ECG) and DCG were recorded in 28 WD
patients (16 male, 12 female; mean age 18.5 +/- 7.5 years) in three days after admission and
after anti-copper treatment for eight weeks respectively. The clinical therapeutic effect was
evaluated by the same observer, according to the Unified Wilson’s Disease Rating Scale
(UWDRS).
Results: Before anti-copper treatment, ten patients (35.7%) had at least one abnormality in
the ECG, that mainly included arrhythmia, left ventricular high voltage, ST depression and T
wave abnormalities, eighteen patients (64.3%) had at least one abnormality in the DCG, that
mainly included arrhythmia, ST depression and T wave abnormalities, and time-dependent
measures of heart rate variability (HRV), SDNN and RMSSD values were 135.786  57.304
and 57.357  34.193 respectively. After anti-copper treatment for 8 weeks, improvement of
the clinical symptoms was significant(t ¼ 3.138, p ¼ 0.004), but improvement of ECG, DCG
and the measures of HRV (SDNN, RMSSD) were not significant(p > 0.05).
Conclusion: The clinical symptoms of WD patients might be improved after anti-copper
treatment. The improvement of ECG and DCG might be not in accordance with the clinical
therapeutic effect.
Disclosure of Interest: None Declared

PW024
Life-threatening complications in the cardiac stress test laboratory
Jovo Stevanovic*1
1
The Specialist Centre Parovic, Teslic, Bosnia and Herzegovina
Introduction: Cardiac stress testing has been in widespread clinical use since the last century
and generally regarded as a safe medical procedure. However, both serious complications such
as myocardial infarction and death have been reported at a rate of up to one per two and half
thousand stress tests, and hence can be expected to occur in association with these noninvasive
modalities used to assess patients with suspected or proven cardiovascular disease.
Objectives: The reduction of life-threatening complications and the avoidance of un-
wanted outcomes associated with cardiac stress testing.
Methods: Between May 1988 and November 2012, twenty thousand and eighty eight
cardiac stress tests were carried out under supervision of the author in laboratories for
stress electrocardiography, stress echocardiography and stress radionuclide cardiac imaging
at former Special Hospital for Cardiovascular and Rheumatic Diseases and Rehabilitation,
Teslic, Bosnia and Herzegovina - former Yugoslavia; Monash Medical Centre, Clayton,
Victoria - Australia; and the Specialist Centre Parovic, Teslic, Republic of Serbska - Bosnia
and Herzegovina. Procedures were carried out in the non-selected population including
both males and females between four and ninety-two years of age. As a stress modality,
exercise on the treadmill was employed in the majority of subjects.
Results: The procedure was complicated by ventricular tachyarrhythmia associated with he-
modynamic compromise successfully resuscitated in two patients, without fatalities. There were
no other major complications associated with the procedure in the rest of this population.
Conclusion: Serious complications do occur during cardiac stress testing requiring sound
clinical judgment in the cardiac stress test laboratory. Life-threatening complications can be
reduced and unwanted outcomes avoided if the procedure is carried out by an expert
cardiologist.
Disclosure of Interest: None Declared
Conclusion: Using the steerable catheter with real-time electrogram guidance, location of
and access to the CS is more rapid and successful, which may improve the success of CRT
implantation and give significant time savings.
Disclosure of Interest: None Declared
PW028
“Out of hospital cardiac arrest is pre-hospital disease, Surveillance in Dubai”
DR.Tanveer Yadgir1, Omer Al Sakaf1, Arwa Hamid2, Ghulam Naroo*3, Bina Nasim3
1
Accreditation & Research, 2Training, Dubai Corporation for Ambulance Services, 3Accident &
Emeregency, Rashid Hospital, Dubai, United Arab Emirates
Introduction: Out-of-Hospital Cardiac Arrest (OHCA) being leading causes of death
worldwide. Each year numbers of persons receive attempted resuscitation from cardiac
arrest by Emergency Medical Services (EMS). The prognosis for the majority of these arrests
remains poor. As the study shows Ventricular fibrillation, a disturbance in heart rhythm
resulting in uncoordinated contraction of ventricular cardiac muscles, is the most common
cause of sudden cardiac arrest. Early defibrillation with shock by a defibrillator is the most
effective means of resuscitation from cardiac arrest and the only definitive treatment for
ventricular fibrillation.

e268 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Objectives: The hypothesis of research study is to monitor and asses the OHCA outcome to
improve the quality of care of pre-hospital and hospital to improve the survival rate from OHCA.
Methods: The surveillance data has been collected by Dubai Corporation for Ambulance
Services (DCAS) encoded in PAROS (Pan Asian Resuscitation Outcome Study) Registry for
OHCA.
Sample Size: The surveillance data collected during 1st April 2011 to 31st August 2013
from DCAS encoded in PAROS (Pan Asian Resuscitation Outcome Study) Registry.
Results: The total n¼750 cases register by DCAS in PAROS Registry by using Utstein Survival
Report the non cardiac etiology and missing data not included (n¼320), while n¼430 OHCA
cases with cardiac etiology were analyzed. The most OHCA occurred at home n¼239
(55.6%), mean age was 51.2 years, 82% (n¼353) who experience OHCA were male and 18%
(n¼77) were female. 48.8% (n¼210) were witnessed arrest by bystander. Survival rate to
hospital admission was 7.9%, and overall survival rate to hospital discharge was 4%. The
patient of OHCA who found shockable rhythm survival to discharge was 15.1%.Most of the
patient survival to discharge showed 1or 2 CPC (Cerebral performance category) scale.
Conclusion: Though there are improvements in resuscitation outcome but still Out of
Hospital Cardiac Arrest remains a challenge for public health. Efforts to improve resusci-
tation focus on the links to chain of survival. Despite the several years of research around
the world for the OHCA still survival to hospital discharge remains poor. Only valuable
data can help us for further research to improve the survival rate. Participation in OHCA
registry enables the healthcare providers to compare OHCA cases and opportunities to
improve quality of care for making a difference between life and death.
Disclosure of Interest: None Declared
PW029
Sudden cardiac death and its determinants in an isolated population
Masoud Mirzaei*1, Fatemeh Mirzadeh1, Abbas Andishmand2
1
Yazd Cardiovascular Research Centre, 2Department of Cardiology, Shahid Sadoughi University
of Medical Sciences, Yazd, Iran, Islamic Republic Of
Introduction: When onset of death is sudden, probability of sudden cardiac death (SCD)
is more than 95%. Understanding the predisposing factors of sudden cardiac death
(SCD) in high-risk groups is important. Most of these factors can lead to an increased risk
of SCD in asymptomatic persons. Few studies investigated these factors in developing
countries.
Objectives: This study aims to assess SCD in an isolated population in central Iran.
Methods: In a population based study, all death certificates issued in Yazd city with 600000
inhabitants during 2011 were investigated. Victims who had criteria of sudden cardiac death,
according to the international classification of disease (ICD) 10th revision, were identified.
Verbal autopsies using a questionnaire were done by calling or visiting families and reviewing
the hospital records by two general practitioners under supervision of a cardiologist.
Results: All cause mortality rate was 575/105(n¼3350), 1048 cases (180/105) of cardiac
arrest were observed and 317 cases (54/105) of SCD were recognized according to the
criteria. Incidence of SCD was higher in males compared to females. In males the incidence
reached to its peak in age 64 and in females at age 84. Most victims (75.4%) had at least
one major risk factor of coronary heart disease with hypertension existed in 38.8%, dia-
betes in 32.8%, hyperlipidemia in 30% and tobacco smoking in 24.9% (Table 1). Fifty
three percent of males and 56% of females presented with typical cardiac chest pain and
49% of females and 42% of males presented with atypical chest pain. Majority of SCD
(80%) happened out of hospital and only 2.8% happened in ED.
Only in 68% of cases ambulance services was requested by the witnesses of SCD and
41% of victims did not receive resuscitation from ambulance staff.
Table 1. Determinants of suden cardiac death in Yazd population 2011
Males (n) Females (n) Total (n)
Risk factors of CAD>1 57.7%(138) 42.3%(101) 75.4%(239)
Hypertension 43.1%(53) 56.9%(70) 38.8%(123)
Diabetes Mellitus 53.8%(56) 46.2%(48) 32.8%(104)
Hyperlipidemia 53.7%(51) 46.3%(44) 30%(95)
Tobacco smoking 92.4%(73) 7.6%(6) 24.9%(79)
Conclusion: More public education is needed for public and families. High risk persons
and their families should be trained to know early symptoms and resuscitation techniques.
Calling ambulance for SCD victims by witnesses should be encouraged. Early and adequate
resuscitate of SCD victims by ambulance staff even in the absences of vital signs need to be
promoted.
Disclosure of Interest: None Declared
PW030
Evaluation of the influence of tilt training on baroreceptors function in patients with
vasovagal syncope
Artur Z. Pietrucha*1, Irena B. Bzukala1, Danuta Mroczek-Czernecka1, Mateusz Wnuk1,
Joanna Jedrzejczyk-Spaho1, Jadwiga Nessler1
1
Department of Coronary Disease, Medical College of Jagiellonian University, John Paul II
Hospital, Cracow, Poland
Introduction: The aim of study was an analysis of baroreceptor sensitivity Changes of
baroreceptor sensitivity during the treatment of with vasovagal syncope with tilt training.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: Study population: we observed 75 pts. (23 men, 1162 women) aged 18-42 yrs
POSTER ABSTRACTS
(median of age: 21 yrs) with vasovagal syncope (VVS) confirmed by head-up tilt test
(HUTT) and referred to non-pharmacological treatment by tilt training.
Methods: All pts underwent HUTT performed according Italian protocol. After positive
HUTT result patient were referred to classical tilt training proposed by Ector – repeated
tilting until achieving two consecutive negative responses. Continuous non-invasive
monitoring of heart rate (HR) and blood pressure (beat-to beat) was performed using
NEXFIN analyser. Based on registered HR and blood pressure values the baroreceptor
sensitivity index (iBRS) was calculated separately for supine and for tilting during the
following training sessions.
Results: Significant reduction of iBRS during tilt across the training cycle was observed in
all patients (2,5 vs. 9,8 ms/mmHg p<0,01), whereas there was no changes regarding su-
pine values of iBRS through the training.
web 3C=FPO
Conclusion:
1. Modification of baroreceptor sensitivity during the tilting seems to be important
mechanism responsible for antysyncopal effect of tilt training.
2. The monitoring of tilt related baroreceptor sensitivity may be marker of effec-
tiveness of treatment of vasovagal syncope by tilt training.
Disclosure of Interest: None Declared
PW031
Assessment of baroreceptors function during head-up tilt test in patients with
vasovagal syncope
Artur Z. Pietrucha*1, Irena B. Bzukala1, Joanna Jedrzejczyk-Spaho1,
Danuta Mroczek-Czernecka1, Mateusz Wnuk1, Jadwiga Nessler1
1
Department of Coronary Disease, Medical College of Jagiellonian University, John Paul II
Hospital, Cracow, Poland
Introduction: The aim of study was an analysis of baroreceptor sensitivity during head-up
tilt test (HUTT) in patients with vaso-vagal syncope.
Objectives: Study population: we observed 240 pts. (78 men, 162 women) aged 18-56 yrs
(median of age: 23 yrs) with vaso-vagal syncope (VVS) referred to head-up tilt test (HUTT).
Cardio- and neurogenic reasons of syncope were previously excluded in all pts.
Methods: All pts underwent HUTT performed according standard Westminster protocol.
Continuous non-invasive monitoring of heart rate (HR) and blood pressure (beat-to beat) was
performed using NEXFIN analyser. Based on registered HR and blood pressure values the
baroreceptor sensitivity index was calculated both for systolic (BRS-S) and diastolic (BRS-D)
blood pressure. We analyse values of baroreceptor sensitivity indexes between pts. with and
without HUTT-induced syncope as well as between different types of vasovagal response.
Results: Significant reduction of baroreceptor sensitivity index for systolic blood pressure
was observed I patients with positive HUTT in relation to non-fainters (8,6 vs. 21,4 ms/
mmHg; p<0,015) whereas there was no significant differences regarding baroreceptor
sensitivity index for diastolic blood pressure (15,3 vs. 15,6 ms/mmHg, p¼0,85). There were
no significant trend thru higher values of BRS-S in patients with cardiodepressive VVS.
Conclusion: 1. Impairment of baroreceptor sensitivity seems to play an important role in
the patomechanism of vasovagal syncope.
Disclosure of Interest: None Declared
PW032
Evaluation of menstrual cycle influence on the results of head-up tilt test in women
with suspected vasovagal syncope
Artur Z. Pietrucha*1, Joanna Jedrzejczyk-Spaho1, Irena B. Bzukala1,
Danuta Mroczek-Czernecka1, Mateusz Wnuk1, Ewa Konduracka1, Marta Wegrzynowska1,
Olga Kruszelnicka1, Wieslawa Piwowarska2, Jadwiga Nessler1
1
Department of Coronary Disease, Medical College of Jagiellonian University, John Paul II
Hospital, 2Department of Coronary Disease, Medical College of Jagiellonian University, Cracow,
Poland
Introduction: The aim of study: evaluation of influence of menstruation on frequency and
type of vasovagal response to orthostatic stress during head-up tilt test (HUTT) in patients
with vasovagal syncope (VVS).
e269
 Objectives: Study population: among 850 consecutive patients with suspected VVS we Methods: We did a retrospective comparison of 399 hospital admissions for heart failure
POSTER ABSTRACTS

observed a cohort of 500 women at age 13-79 yrs (median of age 37,5), referred to HUTT between 1st January 2012 and 31st December 2012 admitted under Cardiology or General
according to the ESC 2009 guidelines, was recruited. Medical teams. We analysed the patients’ histories relating to these admissions looking into
Methods: Phase of menses period was described as phase II if covered last 14 days of different aspects of heart failure management, including; inpatient investigations, medical
menstruation cycle or phase I – when covered the period before phase II. therapy, device therapy, coronary intervention, consideration of transplantation as well as
According to results of HUTT the type of VVS, the duration of total HUTT and both follow up plan for these patients
passive and active phase were evaluated in relation to presence of menstruation and the Results: Analysis of 399 patient admissions (307 admissions under cardiology unit and 92
phase of menses period. under general medical unit) demonstrated a significantly higher number of appropriate pa-
Results: mong all studied women 315 pts were still menstruated (median of age 25 yrs; tients treated with Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin Receptor
IQR 16-57): 170 (34.0%) in follicular, and 145 (29.0%) in luteal phase of the menstrual Blocker (ARB) therapy (P<0.001), Beta blocker therapy (P<0.001), spironolactone or
cycle whereas 185 (37.0%) underwent menopause (median of age 65 yrs; IQR 42-82); eplerenone therapy (P¼0.002). There was also a significant increase in referrals to Outpatient
Mean age of first syncope was significantly lower in menstruated female in relation to Heart Failure Rehabilitation programs (P<0.001). Patients admitted under the Cardiology
those after menopause (median of age: 30 [IQR 14-56] vs 15 [IQR 10-21] yrs, p<0,0001). unit were also much more likely to have certain inpatient investigations including Trans-
There was no difference between menstruating women in whom HUTT was performed thoracic Echocardiogram (TTE) and Coronary Angiogram (P<0.001 for both investigations).
at 1st and 2nd phase of menstruation cycle, regarding age of first syncope, number of
syncope/presyncope episodes and CSSS results.
Vasodepressive VVS response was more frequently observed in women after menopause
(29,9 vs 9,7%, p<0,0001), whereas cardioinhibitory (24,1 vs 9,0 %, p<0,0001) and mixed
(45,7 vs 36,3%, p<0,001) responses were more frequent in menstruated ones.
Younger woman (age < median of age in whole group – 37,5 yrs) have similar distri-
bution of type of VVS response during HUTT to menstruated ones, whereas type of
response distribution in women after menopause was parallel to older ones (> 37,5 ys)
Conclusion:
1. Higher incidence of vasodepressive reaction in postmenopausal women in com-
parison to premenopausal women was noticed. Differences of type of vasovagal
response during HUTT seems to be more relative to the age of women than the

web 3C=FPO
presence of menstruation.
2. Age of first syncope presentation was significantly lower in menstruating women in
relation to females after menopause – it may suggest different patomechanism of
vasovagal syncope in these group of women (classical VVS or vasovagal disease).

Disclosure of Interest: None Declared

PW033
Management of Cardiovascular Emergencies in the Dental Office
1 1
Lilia Timerman* , Ana Carolina P. D. Andrade , Gabriella A. M. D. C. D. Angelis ,
Valeria C. L. D. Souza1, Viviane U. S. D. Souza1, Karen Abrão2, Sergio Timerman3
1
Dentistry departament, Dante Pazzanese Institute of Cardiology, 2Medical department,
Anhembi Morumbi University, 3Medical department, Laureate International Universities, Sao
Paulo, Brazil
Conclusion: Based on data from this retrospective study, there are many aspects of
1
investigation and management that may explain why outcomes of patients admitted with
heart failure under cardiology teams have improved outcomes in other studies. This study
highlights some areas that may be able to be improved by general medical teams to
optimise outcomes in patients admitted with heart failure.
Disclosure of Interest: None Declared

Introduction: Dentists must be prepared to manage medical emergencies which may arise
in practice.
Objectives: In Sao Paulo, Brazil, a study was conducted between 2011 and 2012 by Dante
Pazzanese Institute of Cardiology Dental Depatment.
Methods: The data was collected via self administered questionnaires prepared. The
questionnaires were distributed among specialist dentists. Statistical analysis used:
Descriptive statistics and analysis of variance were carried out, and a value of p, 0.05 was
considered to be significant.
Results: The results from this study showed that anywhere from 21% to 42% of dentists
had a patient with a cardiovascular emergency in any one year. Most of these complica-
tions, approximately 80%, were mild, but 3% were considered to be serious. It was found
that 35% of the patients were known to have some underlying disease. Cardiovascular
disease was found in 73% of those patients.Medical emergencies were most likely to occur
during and after local anesthesia, primarily during tooth extraction and endodontics. Over
60% of the emergencies were syncope, with hyperventilation the next most frequent at 7%.
In addition to syncope, other emergencies reported to have occurred include allergic re-
actions, angina pectoris/myocardial infarction, cardiac arrest, postural hypotension, sei-
zures, bronchospasm and diabetic emergencies.
Conclusion: The extent of treatment by the dentist requires preparation, prevention and
then management, as necessary. Prevention is accomplished by conducting a thorough
medical history with appropriate alterations to dental treatment as required. The most
important aspect of nearly all medical emergencies in the dental office is to prevent, or
correct, insufficient oxygenation of the brain and heart. Therefore, the management of all
medical emergencies should include ensuring that oxygenated blood is being delivered to
these critical organs. This is consistent with basic cardiopulmonary resuscitation, with
which the dentist must be competent.
Disclosure of Interest: None Declared
PW037
Management of heart failure patients admitted under cardiologists or general
physicians
Ian G. Matthews*1, Daniel D’Souza1, David Prior2, John Santamaria3, Belinda Smith1
1
General Medicine, 2Cardiology, 3Intensive Care, St Vincent’s Hospital, Melbourne, Australia
Introduction: Previous studies have suggested that patients treated in hospital for heart failure
have improved outcomes if treated by Cardiologists rather than other Physicians. A few studies
have also suggested that Cardiologists are more likely to follow evidence-based practice in terms
of heart failure management, but no studies have been conducted in Australia.
Objectives: The objective of this study was to show a statistical significant difference in the
management of patients looked after by the cardiology unit, with respect to evidence based
management of heart failure, when compared to the general medicine teams.
PW038
How Active Are Heart Transplant Recipients After Their Transplant?
Scott C. Mckenzie*1,2, Rebecca Francis3, Martin R. Brown2, David G. Platts1,2, Jared Brunning4,
Helen Seale4, James Walsh3
1
Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, 2School of
Medicine, University of Queensland, 3Physiotherapy, 4The Prince Charles Hospital, Brisbane,
Australia
Introduction: Weight gain and obesity are common after heart transplantation. Obesity
after heart transplant is associated with worse prognosis. No studies have directly assessed
the effect of physical activity levels on weight gain after heart transplant.
Objectives: This study was to quantify physical activity levels of heart transplant recipients.
Methods: Transplant recipients > 6 months post heart transplant were invited to partic-
ipate at the time of their attendance at outpatient clinic. Recipients were excluded if they
had a rejection episode within 2 months, reduced left ventricular systolic function or a
recent injury or illness that could reasonably be expected to reduce their mobility. Subjects
wore a Sensewear Pro 3 Armband (“Sensewear”) for 7 days. This well validated device
provides information on energy expenditure, time spent above different METS levels, time
lying down, sleeping duration and steps per day. Average daily physical activity level (PAL)
can be expressed as an index, comparing activity whilst sleeping (1.0 METS) with activity
for the day as a whole. A PAL of 1.69 is considered physically active according to World
Health Organisation (WHO). The Sensewear data was analysed.
Results: Thirty two patients were recruited. Mean age 60 years, 16% female. Mean BMI
27.9. Mean daily PAL 1.65 (SD: 0.46). Only 25% of patients achieve a mean PAL > 1.67.
Mean daily total energy expenditure 1.42 METs (SD: 0.42). Mean daily steps 7518 (SD:
3654). Mean daily hours lying down: 8.7 (SD: 2.0). Mean sedentary hours 20.7 (as defined
by MET < 3.0). Mean hours engaged in moderate activity: 1.7 (SD: 1.8). Mean hours
engaged in more than moderate activity: 0.35 (SD: 0.79).
Conclusion: Despite having no disability precluding physical activity, most heart trans-
plant recipients in good physical health do not achieve WHO recommended levels of
physical activity.
Disclosure of Interest: None Declared
PW041
Influence of high intensity training on erectile function of patients with heart failure
Sabrina W. Sties1, Anderson Z. Ulbrich1, Lourenço S. de Mara1, Ana I. Gonzáles1,
Almir Schmitt Netto1, Gabriela D. de Carvalho1, Helena D. O. Braga1, Daiana C. Bundchen1,
Daiane P. Lima1, Tales de Carvalho*1
1
Cardiology and Exercise Medicine Center, Santa Catarina State University, Florianópolis, Brazil

e270 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Introduction: It has been shown that high intensity training is more effective in treating
patients with heart failure (HF) however studies haven
t been evaluated sexual function.
Objectives: To compare moderate versus high intensity exercise with regard to sexual and
cardiorespiratory function.
Methods: Twenty patients with stable HF (aged 53.25  8.87 years), left ventricle ejection
fraction  45%, were randomized to moderate continuous training (MCT) or high-in-
tensity interval training (HIT). The subjects underwent 12 weeks of exercise training, three
times per week, in MCT target zone of heart rate (HR) corresponding to anaerobic
threshold (first ventilatory threshold) and in HIT the HR corresponding to respiratory
compensation point (second ventilatory threshold) alternating with HR corresponding to
anaerobic threshold (recovery period). Patients underwent assessment of sexual function by
the International Index of Erectile Function (IIEF), determination of VO2 peak by car-
diopulmonary exercise testing (CPET), determination of distance walk by the six-minute
walk test (6MWT) and assessment of endothelial function by Doppler echocardiography. In
statistical analysis was used Shapiro-Wilk test, Chi-square (x2), Fisher exact test, t test,
Mann-Whitney U and paired t test, with significance level of 5%.
Results: Only in HIT was observed increase in erectile function (11  10.46 to 19.55 
9.07, p ¼ 0.030), desire (from 4.77  2.04 to 6.88  2.08, p ¼ 0.034), sexual satisfaction
(from 4.00  4.63 to 8.33  5.36, p ¼ 0.017) and VO2 peak (from 21.07  4.30 to 23.79
 5.26, p ¼ 0.021) while in MCT was no significant changes in these outcomes. Distance
walked in 6MWT increased after MCT (462.63  63.10 to 603.45  67.50, p ¼ 0.003)
and HIT(456.44  38.51 to 589.66  59, 69, p ¼ 0.008). No significant changes occurred
in endothelial function (HIT: +43.6%, p ¼ 0.666; MCT:+193%, p ¼ 0.214).
Conclusion: High-intensity training was superior than MCT for increase sexual and
cardiorespiratory function in patients with heart failure.
Disclosure of Interest: None Declared
PW042
Predictors of Mortality in Patients With Hypertrophic Cardiomyopathy - A Hospital
Admissions Study: 2000-2013
Niece K. Khouw1, Mohammed Wasim1, Hardeep Uppal2, Suresh Chandran3, Rahul Potluri*4
1
General Medicine, Pennine Acute Hospital NHS Trust, Manchester, 2Coventry and
Warwickshire Partnership NHS Trust, Coventry, 3Acute Medicine, Pennine Acute Hospital NHS
Trust, Manchester, 4ACALM Study Unit in collaboration with School of Medical Sciences, Aston
University, Birmingham, United Kingdom
Introduction: Hypertrophic Cardiomyopathy (HCM) is a rare condition that can be
assoociated with sudden cardiac death. The predictors of mortality in patients with HCM
has not been well studied.
Objectives: The aim of this study is to investigate the predictors of mortality in patients
with HCM from a large sample of hospital admissions.
Methods: Anonymous information on patients with Hypertrophic Cardiomyopathy, co-
morbidities and procedures attending large multi-ethnic general hospitals in Manchester,
United Kingdom in the period 2000-2012 was obtained from the local health authority
computerised hospital activity analysis register using ICD-10 and OPCS coding systems.
Statistical analysis was performed using SPSS version 20.
Results: Out of 1,221,216 patients admitted, there were 253 patients with HCM. The
mean age of 55.8years18.8(S.D) with 63.2% male patients VS 36.8% female patients. The
main co-morbidities were Hypertension (86;34.0%), Atrial Fibrillation (69;27.3%), Heart
Failure (27;10.7%), Type 2 Diabetes Mellitus (24;9.5%), Ventricular Tachycardia
(16;6.3%), Defibrillator Implant (16;6.3%). A multi-nominal logistic regression model
accounting for variations in age, sex and ethnic group showed that only Atrial Fibrillation
(RR3.8;C.I1.7-8.1) and Heart Failure (RR5.0;C.I1.9-13.5) are significant predictors of
mortality (p <0.05).
Conclusion: We have shown that Atrial Fibrillation and Heart Failure are significant
predictors of mortality in patients with HCM from a large hospital based sample in the UK.
This reflects the known complications of HCM affecting mortality. However, it is surprising
that Defibrillator implantation does not confer improved mortality. Our improved un-
derstanding of these predictors will guide clinicians to focus on these high risk groups to
improve clinical practice and outcomes in patients with HCM.
Disclosure of Interest: None Declared
PW043
Predictors of outcome in takotsubo cardiomyopathy – a multicenter study
Nuno S. Marques*1, Olga Azevedo2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado1,
Vitor Pereira2, Ana Rita Almeida3, SUNSHINE
1
Cardiology, Faro Hospital, Faro, 2Cardiology, CHAA, Guimarães, 3Cardiology, H. Garcia Orta,
Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo,
Portugal
Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ven-
tricular (LV) dysfunction in the absence of significant coronary artery disease. The pre-
dictors of prognosis of TC are not yet fully established.
Objectives: To identify predictors of outcome in patients (P) diagnosed with TC.
Methods: Multicenter studyinvolving 5 hospital centers that included all patients diag-
nosed with TC in the last 10 years. We assessed demographic data, precipitating factors and
clinical presentation, trying to establish the predictors of after discharge outcomes.
Results: We included 71 P diagnosed with TC. During hospitalization (6.1  4.6 days)
occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation
(9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke /
TIA (2.8%), LV thrombus (1.4%) and death (1.4%).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Over a follow-up of 31  29 months, there were: TC recurrence (4.2%), stroke / TIA
POSTER ABSTRACTS
(4.2%) and death (1.4%).
The following variables were identified as predictors of complications at follow-up: (i) ST
segment depression on admission EKG was a predictor of TC recurrence (p¼0,016); (ii)
Chronic renal failure was a predictor of stroke/TIA (p¼0.023) and death (p¼0,027).
Conclusion: TC has a low rate of complications in the follow-up. Chronic renal failure is a
predictor of death and also of stroke in the follow-up. The admission EKG may have a
prognostic role and ST segment depression was the only identified predictor of TC
recurrence. Our results need confirmation in larger studies.
Disclosure of Interest: None Declared
PW044
Predictors of in-hospital outcome in takotsubo cardiomyopathy – A multicenter study
Nuno S. Marques*1, Olga Azevedo2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado1,
Vitor Pereira2, Ana Rita Almeida3, SUNSHINE
1
Cardiology, Faro Hospital, Faro, 2Cardiology, CHAA, Guimarães, 3Cardiology, H. Garcia de
Orta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do
Castelo, Portugal
Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ven-
tricular (LV) dysfunction in the absence of significant coronary artery disease. The pre-
dictors of prognosis of TC are not yet fully established.
Objectives: To identify predictors of outcome in patients (P) diagnosed with TC.
Methods: Multicenter study involving 5 hospital centers that included all patients diag-
nosed with TC in the last 10 years.
Results: We included 71 P diagnosed with TC. During hospitalization (6.1  4.6 days)
occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation
(9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke /
TIA (2.8%), LV thrombus (1.4%) and death (1.4%).
In the multivariate analysis, the following variables were identified as independent
predictors of in-hospital complications: (i) Predictors of complete atrioventricular block
were angina pectoris (p¼0,028), syncope at presentation (p¼0,012), ST segment elevation
on the admission EKG (p¼0,010) and T wave inversion (p¼0,043); (ii) ST segment
depression on the admission EKG was identified as a predictor of acute pulmonary edema
(p¼0,029); (iii) LV dysfunction was an independent predictor of heart failure (p¼0,003),
acute pulmonary edema (p¼0,015), stroke/TIA (p¼0,035) and death (p¼0,049); (iv) Male
gender was an independent predictor of stroke/TIA (p¼0,013) and death (p<0,001); (v)
Other predictors of death were diabetes mellitus (p¼0,007), chronic renal failure
(p¼0,048), syncope at presentation (p¼0,036).
Conclusion: TC has a high rate of complications in the acute phase. TC, a disease of mainly
females, has worse in-hospital prognosis in males. Male gender is a predictor of in-hospital
stroke/TIA and death. Diabetes, chronic renal failure, syncope at presentation and LV
dysfunction were also predictors of in-hospital death.
Disclosure of Interest: None Declared
PW045
Is prognosis of takotsubo cardiomyopathy related with the speed of recovery of left
ventricular function?
Olga Azevedo*1, Nuno S. Marques2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado2,
Vitor Pereira1, Ana Rita Almeida3, SUNSHINE
1
Cardiology, CHAA, Guimarães, 2Cardiology, Faro Hospital, Faro, 3Cardiology, H. Garcia de
Orta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do
Castelo, Portugal
Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ven-
tricular (LV) dysfunction. The recovery rate of LV function is variable. There is lack of data
with respect to the impact of the rate of recovery of LV function in the prognosis of TC.
Objectives: To determine if the patients diagnosed with TC that present a faster recovery of
LV function have better medium term prognosis.
Methods: Multicenter study involving 5 hospitals that included all patients diagnosed with
TC in the last 10 years. We assessed patients with echocardiography at admission,
discharge and at follow-up. Full recovery was defined as complete normalization of LV
global function and segmental motility. We established the discharge time and 15 days after
admission as cut-offs for recovery of LV function. We determine if the patients with faster
recovery of LV function had better medium term prognosis.
Results: We included 71 patients with TC. Total recovery of LV function was observed at
hospital discharge in 27 patients (38,0%) and at 15 days after admission in 31 patients
(43,7%).
The recovery of LV function during the hospital stay was not associated with death (0%
vs 2,7%, p¼0,437), stroke/TIA (5,4% vs 4,5%, p¼0,884) or TC recurrence (0% vs 8,1%,
p¼0,170) in the follow-up. In the multivariate analysis, the faster recovery of LV function
was not an independent predictor of events.
The recovery of LV function at 15 days after admission was not associated with death
(0% vs 2,8%, p¼0,410), stroke/TIA (4,2% vs 5,6%, p¼0,809) or TC recurrence (0% vs
8,3%, p¼0,147) in the follow-up. In the multivariate analysis, the faster recovery of LV
function was not an independent predictor of events.
Conclusion: In this multicenter study, the patients with TC that present a faster recovery of
LV function do not have a better medium term prognosis. However, the low rate of
complications in the follow-up may have limited the study results. Our results need further
confirmation in larger studies.
Disclosure of Interest: None Declared
e271
 PW046
POSTER ABSTRACTS
In-hospital and medium term prognosis of takotsubo cardiomyopathy –A multicenter
study
Olga Azevedo*1, Nuno S. Marques2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado2,
Vitor Pereira1, Ana Rita Almeida3, SUNSHINE
1 Features of chronic heart failture at women
Cardiology, CHAA, Guimarães, 2Cardiology, Faro Hospital, Faro, 3Cardiology, H. Garcia Orta,
Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo,
Portugal
Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ven-
tricular (LV) dysfunction, but the prognosis of TC is not yet fully established.
Objectives: To evaluate in-hospital and medium term prognosis of patients diagnosed with TC.
Methods: Multicenter study involving 5 hospital centers that included all patients diag-
nosed with TC in the last 10 years.
Results: We included 71patients with TC, predominantly females (91.5%). Mean age was
67 11 years. Chest pain was the most common clinical presentation (93%). Emotional or
physical stress was identified as a possible triggering factor in 60.6% of patients. The
admission ECG showed ST-segment elevation (56.3%) or depression (32.4%) in most
patients. There was elevation of troponin I on admission in 83.1% of cases (peak value of
4.2  4.3ng/mL). Echocardiogram revealed akinesia of apical and medium LV segments in
97.2% of cases. The coronary angiography revealed no coronary disease(85.9%).During
hospitalization (6.1  4.6 days) occurred complications: heart failure (31%), cardiogenic
shock (15.5%), atrial fibrillation (9.9%), complete atrioventricular block (4.2 %), acute
pulmonary edema (4.2%), stroke / TIA (2.8%), LV thrombus (1.4%) and death (1.4%).
Complete reversal of LV dysfunction occurred in 38% during hospitalization and in 43.7%
up to 15 days after admission. Over a follow-up of 31  29 months, there were: TC
recurrence (4.2%), stroke / TIA (4.2%) and death (1.4%).
Conclusion: In the acute phase, TC has a high prevalence of complications, particularly
heart failure and cardiogenic shock, and severe complications such as stroke and death may
also occur. At the medium term follow-up, the prognosis is good with a low prevalence of
stroke / TIA, a low mortality and a low recurrence rate.
Disclosure of Interest: None Declared
PW047
Echocardiography Underestimates Maximum Interventricular Septum Thickness in
Hypertrophic Cardiomyopathy
Shane Nanayakkara*1, Andrew Taylor1, Andris Ellims1
1 CHF is accompanied of depression and decreasing quality of life at women that is the
Cardiology, The Alfred, Melbourne, Australia
Introduction: Echocardiography is routinely used in the evaluation of patients with hy-
pertrophic cardiomyopathy (HCM) however assessment of left ventricular (LV) wall
thickness using this modality may be inaccurate, particularly if image quality is reduced.
Cardiac magnetic resonance (CMR) imaging, the gold-standard modality for LV morpho-
logic analysis, is increasingly utilised in HCM.
Objectives: To determine the accuracy of echocardiographic measures of ventricular wall
thickness compared to CMR in HCM.
Methods: Consecutive patients with a clinical diagnosis of HCM referred for CMR at the
Alfred Hospital were included. Volumetric analysis of a short-axis cine stack (extending
from the mitral annulus to the LV apex) was performed in all patients to determine
maximum thicknesses of the interventricular septum and LV lateral wall. Measures of these
walls from each patient’s most recent echocardiographic study were also obtained.
Results: CMR was completed in 138 patients (51  14 years, 66% male). Maximum inter-
ventricular septum thickness was significantly greater using CMR compared to echocardiography
(19.6  4.5 mm vs. 17.7  3.9 mm, p ¼ 0.001). Conversely, maximum LV lateral wall thickness
was significantly less using CMR compared to echocardiography (8.8  2.2 mm vs. 11.1  3.4
mm, p < 0.001. Echocardiography correlated significantly with CMR for interventricular septum
thickness (r ¼ 0.67, p < 0.001) and for lateral wall thickness (r ¼ 0.49, p < 0.001).
Conclusion: In HCM, echocardiography underestimates maximum interventricular
septum thickness and overestimates LV lateral wall thickness. Because accurate assessments
of LV wall thickness are required both for risk stratification and monitoring of progression
e272
of LV hypertrophy in patients with HCM, CMR should be considered in all patients to
improve diagnostic accuracy.
Disclosure of Interest: None Declared
PW048
Elena Klester*1
1
Department of hospital and outpatients therapeutics with occupational diseases and
endocrinology courses, Altai State Medical University, Barnaul, Russian Federation
Introduction: Gender component in an etiology of chronic heart failure lead to clinical
features of a current of chronic heart failure at women that it is necessary to consider in
development of individual treatment-and-prophylactic strategy.
Objectives: Optimization of diagnostics, treatment, current prediction and prevention of
CHF on the basis of complex estimation of clinic-functional features of cardiovascular
system and the psychosomatic state of women.
Methods: Clinic-statistical analysis of CHF was conducted during a year in therapeutics
department. The diagnosis of CHF was established according to National recommendations
of All-Russian scientific cardiologist society criteria on diagnostics and CHF treatment (the
third revision, 2009) at 489 patients. There are 270 (55,2%) men, 219 (44,8%) women
who includes in research on entry. Middle age is 65,213,4 [min 41, max 94] years, men -
60,911,2; women - 67,610,4 (p<0,05).
Results: The average value on risk scale of cardiovascular diseases was 3,61.11: in men’s
group - 3,51,04; in women’s group - 3,81,12 (p<0.05). BWI was 27,6 [18,3 min, 39,1
max], men – 26,23,5; women – 28,74,8 (p¼0.000). Between age and BWI there is weak,
but statistically significant correlation ([¼0.25. p¼0.001). More often etiological factor at
men was IHD, generating 74,8% cases CHF. Thus at men with IHD at 149 (73,8%) patients
CHF appeared after MI. AH frequency was 11,5%, dilated myocardiopathy (DMP) - 10,7%,
other – 1,1%. The main reason of CHF at women were AH - 44,7%; IHD - 26,5%. Another
reasons were diabetes mellitus (15,1%), valvular disease (7,8%), DMP (5,0%).
Among hospitalized patients with CHF, the IV FC (NYHA) statistically significantly met
at men (a mean grades of the clinical condition scale (CCS) – 5,81,14; at women –
4,21,07, p<0,05). In the analysis of gender distinctions of remodeling it is established
that at women with CHF the diastolic dysfunction prevailed, mainly the I type LVDD, of
ejection fraction (EF) LV on the average on group – 62,15,18%. Quality of life of the
women is characterized by high level of anxiety in comparison with the men group.
Conclusion: The most significant reason of formation of CHF at women is the AH, at men –
IHD (often after MI). Women had the II FC on CCS on the average, men – the III FC.
basis for formation of gender distinctions in approaches to treatment correction at CHF.
Disclosure of Interest: None Declared
PW049
The enantiomers of the myocardial metabolic agent perhexiline display divergent
effects on hepatic energy metabolism and peripheral neural function in rats
Giovanni Licari*1, Benedetta C. Sallustio1, Andrew A. Somogyi1, Robert W. Milne2
1
Pharmacology, Adelaide University, 2Pharmacy and Medical Sciences, University of South
Australia, Adelaide, Australia
Introduction: Perhexiline, a chiral drug, is a potent anti-ischaemic agent whose clinical
utility is limited by hepatic and neural toxicity. Perhexiline inhibits mitochondrial carnitine
palmitoyltransferase-1, however, excessive inhibition is associated with tissue steatosis.
Objectives: This study tested the hypothesis that the toxicity of perhexiline is
enantioselective.
Methods: Dark Agouti rats were administered vehicle or 200 mg/kg/day of racemic, (+)- or
(-)-perhexiline orally for 8 weeks. Plasma liver function tests and von Frey assessments of
peripheral neural function were performed. Hepatic and neuronal histology, including lipid
and glycogen contents, were assessed using electron microscopy, and concentrations of the
perhexiline enantiomers and metabolites were measured in plasma, liver and heart.
Results: Racemic perhexiline did not affect hepatic lipid or glycogen content. However, (-)-
perhexiline induced a concentration-dependent increase in glycogen content, while (+)- per-
hexiline induced concentration-dependent increases in lipid and decreases in glycogen content.
Racemic (p<0.001) and (+)-perhexiline (p<0.05) induced peripheral nerve dysfunction, while
(-)-perhexiline induced no change. Mean (s.e.m.) plasma perhexiline concentrations in rats
treated with racemate, (+)- or (-)-enantiomer were 0.84 (0.40), 0.67 (0.07) and 0.29
(0.04) mg/L, respectively, corresponding to the mid-upper clinical therapeutic range. Oral
clearance was greater for (-)-compared to (+)-perhexiline. The distribution of (+)-perhexiline
into liver and heart was greater when administered as pure enantiomer compared to racemate.
Conclusion: Perhexiline’s enantiomers exert substantially different effects on hepatic lipid
and glycogen accumulation, and on neuronal function. Our data suggest that the hepato-
and neuro-toxicity of racemic perhexiline resides predominately in the (+)-enantiomer,
consistent with inhibition of carnitine palmitoyltransferase-1, whilst (-)-perhexiline may
offer greater potential long-term safety.
Disclosure of Interest: None Declared
PW051
The effect of methoxy poiyethilenglicol -epoietin beta in patiens chronic heart failure
with anemic syndrome
Kamala Zahidova*1, Faig Guliyev1
1
Cardiology, Azerbaijan State Training, Baku, Azerbaijan
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: Anaemia although common in chronic heart failure (CHF) patients,reduces
functional status quality of life and is an independent risk factor for hospital admission and
mortality.Erythropoiesis stimulating agents (ESA) are frequently used for its treatment.-
Therefore,our aim was to perform the study to determine the effect of continuous eryth-
ropoietin reseptor activator C.E.R.A.-methoxy polyethyleneglycol-epoietin-b (MEB)
treatment on mortality, hospitalization and adverse events in patients with CHF.
Objectives: The purpose of investigation to study erythropoietinic effect and security of
MEB its impact on the level hemoglobin,erythropoietin,serum ferritin,transfferin saturation,
NT pro BNP,cytocine and on regress of symptoms CHF.
Methods: 84 patients with chronic heart failure of New York Heart Association
(NYHA) functional class __-_V a left ventricular ejection fraction of 40% or less with
anaemia were included in investigation. Mean age of patients 59,71,6 years (54 males, 34
females). A hemoglobin level of less 120 g/l by males and less110g/l by females. 44 patients
were treated basis treatment of CHF (_ group) and 40 patients were treated with MEB (__
group).
Percutaneus MEB in dose 50 IU in day in one months patients without iron deficiency to
receive in follow-up on 6 months.Echocardiografic indices of LV systolic and diastolic
function,plasma NT pro BNP,cytocine,erythropoietin,ferritin and 6 minute walked distance
were assessed at baseline and posttreatment.
Results: MEB treatment had a significantly increase LVEF on 23,3 % (p<0,02) as
compared with of patients receiving _ group.A greater 6-minute distance walked on ex-
ercise testing from 23110 to 33023meters(p
Conclusion: Percutaneus MEB in dose 50 IU in day in one month in follow-up 6 months
has emerged as well tolerated and effective therapy to improve symptoms and quality of life
in anaemic CHF patients with erythropoietin failure.
Disclosure of Interest: None Declared
PW054
Acquired Arteriovenous Fistula of the Right Common Iliac Artery and Left Common
Iliac Vein and Bilateral Lower Extremity Deep Venous Thrombosis in a Woman
Presenting as High Output Failure
Jaime M. Aherrera1, Edgar Timbol1, Antonio Faltado*2, Agnes Mejia2, Mark Vicente1
1
Cardiology, 2Medicine, Philippine General Hospital, Manila, Philippines
Introduction: Acquired intra-abdominal arteriovenous fistulas (AVFs) are a rare disorder
where the communication most commonly occurs between abdominal aorta and inferior
vena cava. Ilioiliac AVF has been reported previously, but is exceedingly rare.
Objectives: We present a case of acquired arteriovienous fistula of the right common iliac
artery and left common iliac vein with extensive collateralization in a 36 year-old who
presented with symptoms of high output congestive heart failure eighteen years after
sustaining an abdominal gunshot wound.
Methods: N/A
Results: A 36-year old female presented with complaints of dyspnea and abdominal
enlargement. Eighteen years prior to consult, she sustained a gunshot wound through the
abdomen for which she underwent surgical exploration with an uneventful recovery. Over
the past years, she had been experiencing progressive dyspnea, orthopnea, paroxysmal
nocturnal dyspnea associated with abdominal enlargement and intermittent bilateral lower
extremity edema. No consult was done and no medications were taken during this time.
CT aortogram revealed an arteriovienous fistula of the right common iliac artery and left
common iliac vein with extensive collateralization. There was also aneurysmal dilatation of
the right common iliac artery and severe fusiform ectasia of the left common iliac vein.
Lower extremity venous duplex scan showed right lower extremity deep venous
thrombosis (DVT) of common and superficial femoral vein, acute partially occluding, with
deep venous insufficiency and perforator incompetence; and left lower extremity DVT of
the Iliac vein. The final diagnosis was congestive heart failure functional class III from high
output heart failure secondary to ilioiliac fistula (right common iliac artery and left com-
mon iliac vein), right common iliac artery aneurysm and bilateral DVT.
Conclusion: Surgical repair was strongly advised however the patient refused surgery. The
case described here is an example of progressively deteriorating hyperdynamic heart failure
due to the chronic, sustained volume overload caused by a traumatic AVF - specifically
connecting right common iliac artery and left common iliac vein seen by helical CT im-
aging. A thorough history and a physical examination are still indispensible tools that aid
the physician in diagnosing such an uncommon condition.
Disclosure of Interest: None Declared
PW055
Title: What education is provided to the heart failure patient in the rural setting: A
Joanne Leonard*1, Lis Neubeck2
1
Wagga Wagga base Hospital/Murrumbidgee local health district, Wagga Wagga, 2St George
Institue, Sydney, Australia
Introduction: Heart failure is a major global problem. Readmissions rates are increasing
and the economic and societal costs are rising. However, up to two thirds of hospitaliza-
tions may be preventable. Education programs have been shown to reduce readmission
rates, improve quality of life and to decrease mortality. Rural patients are particularly
isolated and have a greater burden of disease than those living in metropolitan areas.
Objectives: To determine what education is available to heart failure patients in rural and
remote setting to detail components of these programs which may improve quality of life.
Methods: A standard systematic review process was followed. We searched electronic
database, including Medline, Cinahl, Joanna Briggs, Cochrane and the rural database.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Search terms included “Heart failure; education; rural; remote.” We also undertook word
POSTER ABSTRACTS
searching of the World Wide Web and reviewed the reference lists of eligible papers.
Quality of papers was determined through the use of CASP tool.
Results: Only four papers fulfilled the inclusion criteria, including 1086 participants with
heart failure. Three studies were randomized controlled trials and one was descriptive
correlational study. Two studies tested heart failure educationalinterventions. One study
showed a reduction in hospitalizations in the intervention group (n-405), the other study
demonstrated improved knowledge (n- 86) . The interventions used were telephone
support, resources,individualized education, and counseling session. The other two studies
utilized surveys completed by the participants, to determine their heart failurehealth lit-
eracy. These studies indicated that self-care behavior and symptom relief knowledge was
lower in participants with heart failure and particularly those who lived alone or who were
older. The majority of participants had mild cognitive impairment.
Conclusion: There was a lack of research about the education for heart failure patients in a
rural setting. Improving access to education for patients in rural and remote settings could
potentially reduce the burden on the health system and prevent avoidable readmissions.
Disclosure of Interest: None Declared
PW056
Melatonin Protects Against Cardiovascular Alterations In Rats With Pulmonary
Arterial Hypertension (Pah) Induced By Monocrotaline
Luiz Alberto F. Ramos*1, Thiago M. Batista1, Rafael L. Camargo1, Renato C. Branco1,
Felix G. R. Reyes1, Dora M. Grassi-Kassisse1, Miguel A. Areas1
1
Biology Structural and Physiology, State University of Campinas - Unicamp, Campinas, Brazil
Introduction: Pulmonary Arterial Hypertension (PAH) is characterized by thickening of
vascular smooth muscle cells, affecting the cardio respiratory system. Monocrotaline (MCT)
is an alkaloid and an animal model of PAH in rats by cardiovascular alterations. Melatonin
(MEL) is a hormone produced by pineal gland, can modulate the heart rate through cardiac
pacemaker cells by decreasing the cyclic Adenosine Monophosphate (cAMP) levels by
Protein Kinase dependent of cyclic Adenosine Monophosphate (PKA) and also modulate
the Heart Rate Variability by ratio Low frequency/High frequency LF/HF.
Objectives: To evaluate the effect of melatonin in the treatment of monocrotaline-induced
PAH.
Methods: Male Wistar rats (250g.) were divided into four groups: CO (control), MCT
(monocrotaline, MEL (melatonin), five animals per group (n¼5). MCT was administered as a
single dose intraperitoneal (ip) (60mg/Kg ip) to induce PAH. Melatonin was administered
(10mg/Kg ip) during 28 days of experimental period, after this phase, the animals were
anesthetized (ketamin 100mg/Kg. plus xilazine 7mg/Kg intramuscular) to obtain the elec-
trocardiographic parameters and molecular analysis of the heart. Statistical procedure: Anal-
ysis of Variance (ANOVA) followed by Tukey test for comparison between groups (p<0.05).
Results: Reduced electrocardigraphic alterations in rats with PAH;
- Decreased of the heart rate;
- Decreased of LF/HF ratio;
- Decreased of the cAMP levels by PKA in the western blotting analysis.
Conclusions: Melatonin modulates of autonomic system and reduces the cardiovascular
alterations in PAH induced rats.
Reference: David S. Park and Glenn I. Fishman. The Cardiac Conduction System. Cir-
culation 2011, 123:904-915
- Jacqueline Aliga, Laurine Margerb, Pietro Mesircab, Heimo Ehmkec, Matteo E.
Mangonib, and Dirk Isbrandta. Control of heart rate by cAMP sensitivity of HCN
channels. PNAS, July 21, 2009 _ vol. 106 _ no. 29.
- Florian Hofmann, Larissa Fabritz, Juliane Stieber, Joachim Schmitt, Paulus Kirchhof,
Andreas Ludwig, and Stefan Herrmann. Cardiovascular Research (2012) 95, 317–326.
Disclosure of Interest: None Declared
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 PW057
POSTER ABSTRACTS
Epidemiology of Heart Failure in a Multicultural and Low Socio-economic
Population –an Audit of Logan Hospital Heart Failure Service
Maureen Barnes*1, Prasad Challa1, Arun Dahiya1, Jeffrey Franco1, Bruno Jesuthesan1,
Erin Bortic1
1 MINOCA patients (n¼12,465) available in the literature. The mean age of MINOCA
Cardiology, Logan Hospital, Brisbane, Australia
Introduction: Heart failure is the most common cause of hospitalisation and readmission
due to cardiovascular disease in people over the age of 65 years throughout the world. Post
discharge programs reduce mortality risk, morbidity and subsequent burden on hospital
and health services. However resource utilisation needs to be catered towards the needs of
the local population.
Demographic and aetiology of heart failure in a low socio economic area like Logan may
have unique features that may not resemble the nationwide spectrum. Impact of dedicated
heart failure services on the clinical outcomes in this specific population remains unknown.
Objectives: To conduct an audit on patients admitted to hospital with heart failure to
understand local patient demographics, aetiologies of heart failure and evaluate outcomes.
Methods: Data collected over 24 months from 342 patients hospitalised with heart failure.
100 patients died, had another prevailing condition (eg cancer), or were lost to follow up.
Remaining data were analysed to determine patient characteristics, clinical and functional
improvement, and mortality and readmission rates.
Results: The aetiology of heart failure reflected the adverse health issues of a diverse and
disadvantaged socio- economic community. A large multinational population group was
identified (46% of patients born outside Australia). 60% were unemployed or receiving
benefits. Patients were younger than those in published trials and other Queensland Health
service districts (61% under 70 years of age). Unlike international study results, ischaemic heart
disease was under represented as a cause -39% of patients, compared to 45% non-ischaemic
and 16 % HFPEF (Heart Failure Preserved Ejection Fraction). Mortality rate was comparable to
national benchmarks. However, a data snapshot showed reduced rate of readmission for heart
failure and all causes at 30 days and 6 months compared to other Queensland Health services.
Conclusion: There is a high degree of unemployment, co-morbidities and high prevalence
of non ischaemic cardiomyopathy in the low socio economic heart failure population.
However, despite these adversities, dedicated heart failure services can improve clinical
outcomes and reduce health care burden by decreasing readmissions.
Disclosure of Interest: None Declared
PW058
Computer System To Aid In Diagnosing Acute Coronary Syndromes
Manoel G. Freitas Junior*1, Denys Emilio C. Nicolosi1
1
Coordenação De Pós-Graduação, Instituto Dante Pazzanese De Cardiologia/Universidade De
São Paulo, Sao Paulo, Brazil
Introduction: Acute coronary syndromes are responsible for a high mortality rate in Brazil
and worldwide. Diagnosti failures, especially when the patient is treated in emergency
services by general practitioners certainly contribute to this condition, although tele-
medicine cardiology systems are possible responsible for the reduction of that mortality
rate. However, many emergency services do not have access to these systems and also have
a limited diagnostic capacity for diagnosing cases of acute coronary diseases.
Objectives: The objective of this system is to reduce the global mortality rate due to acute
coronary syndromes, using a personal computer to assist a general practitioner in the
diagnostic of these diseases, without making use of tele-medicine or laboratory tests.
Methods: This system uses a Excel personal computer program in a configuration of artificial
intelligence adopting fuzzy logic and also an interpretive electrocardiograph that can overcome
the general practitioner’s deficiencies in the analysis of the electrocardiogram. The pysician,
starting from the important elements of the clinical hystory, the physical examination and the
electrocardiogram automatic report from the electrocardiograph, enter these data into the
Excel program so that provides a suggestion of diagnostic and terapeutic management.
Results: The developed system is low cost and has a grat performance. The tests shown an
accuracy of 93.5%. and the area under the ROC curve equal to 0.94.
Conclusion: The developed computer system is a viable solution to the problem of early
diagnostic of acute coronary syndromes in primary emergency units and can contribute to
reduce the mortality rate due to these diseases worldwide.
Disclosure of Interest: None Declared
PW059
Myocardial Infarction with Non Obstructive Coronary Arteries (MINOCA): A
Systematic Review and Meta analysis
Sivabaskari Pasupathy*1, Rosanna Tavella1, Rachel Dreyer2, John Betrame1
1
Medicine, The University of Adelaide, Adelaide, Australia, 2Medicine, The Yale-New Haven
Hospital Center, New Haven, United States
Introduction: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is
an enigma that is being increasingly recognized with the more common use of angiography
during acute Myocardial Infarction (AMI). Many previous reviews have implicated high
prevalence of women and multiple pathogenetic mechanisms in patients with MINOCA.
Despite this, clinical and prognostic features remain illusive.
Objectives: The objective of this study is to examine the clinical features and pathological
mechanisms of MINOCA by undertaking a structured systematic review of the published data.
Methods: A literature search for original data was conducted using PubMed and Embase for
the search terms ‘Myocardial Infarction’, ‘non-obstructive coronaries’ and ‘coronary
e274
angiography’. Inclusion criteria for data were (i) large cohort (n 100 patients), (ii)
consecutive patient recruitment and (iii) evidence of AMI. Prevalence and clinical charac-
teristics were pooled across studies using random effects meta-analysis models or overall
percentages.
Results: In the 27 published prevalence studies included in this analysis, 7% of the
177,497 AMI patients fulfilled the MINOCA criteria representing the largest cohort of
patients were 54 years with only 40% being women. Cardiovascular risk factors in the
MINOCA cohort included hypertension (44%), smoking (42%), hypercholesterolaemia
(33%) and diabetes (13%). In-hospital death was reported as 1% of patients while one-year
follow up studies revealed cardiac death in 5% (range 0-6%) of MINOCA patients. In
20 published mechanistic studies, coronary spasm was identified in 27%, and hyper-
coagulable disorders in 14%. In 28 published Cardiac Magnetic Resonance Imaging
studies, non-diagnostic features were revealed in 25% of patients with other diagnoses
including AMI (23%), myocarditis (33%), Takotsubo cardiomyopathy (18%) and other
forms of cardiomyopathy (6%).
Conclusion: In the largest cohort of MINOCA patients, this systematic review reveals a
prevalence of 7% amongst AMI patients, with males more often being affected and a
spectrum of disorders potentially being responsible for the presentation.
Disclosure of Interest: None Declared
PW061
Effects of Carvedilol Treatment on Cardiac Camp Response Element Binding Protein
Expression and Phosphorylation in Acute Coxsackievirus B3-Induced Myocarditis
Ge Li-Sha1, Chen Yi-He2, Li Yue-Chun*2
1
Pediatric, 2Cardiology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
Introduction: The role of b-adrenergic stimulation on viral myocarditis has been investi-
gated in animal models of viral myocarditis. Excess stimulation of b-adrenergic receptors by
catecholamines causes phosphorylation/activation of cAMP response element binding
protein (CREB) by the cAMP signaling pathway. CREB as an important regulator of gene
expression mediates the cardiovascular remodeling process and promotes anti-inflamma-
tory immune responses. However, the CREB expression and phosphorylation have not
been studied, and the effects of carvedilol (a nonselective b-adrenoceptor antagonist) on the
CREB has not been investigated in the setting of acute viral myocarditis.
Objectives: This study was therefore designed to examine the effects of carvedilol on the
transcriptional factor CREB in a murine model of acute viral myocarditis.
Methods: In a coxsackievirus B3 murine myocarditis model (Balb/c), effects of carvedilol
on plasma noradrenaline, heart rate and blood pressure, myocardial histopathological
changes and fibrosis, cardiomyocyte apoptosis, cardiac CREB and phosphorylated CREB,
cytokine levels, and viral RNA were studied.
Results: The expression and phosphorylation of CREB were decreased with concomitant
increase of IL-6 and TNF-a in murine coxsackievirus-induced acute viral myocarditis. The
levels of IL-6 and TNF-a were correlated with the expression of CREB or phosphorylated
CREB. Carvedilol increased the cardiac CREB expression and phosphorylation and
decreased the plasma catecholamine levels and the production of IL-6 and TNF-a with
amelioration of acute viral myocarditis.
Conclusion: These results show that CREB may be involved in the pathophysiology of viral
myocarditis and carvedilol exerts some of its beneficial effects by increasing the CREB
expression and phosphorylation.
Disclosure of Interest: None Declared
PW062
Cardiac Resynchronization Therapy Optimization Using Trans Esophageal Doppler
In Patients With Dilated Cardiomyopathy
Abdallah Youssif*1, Ahmed Abdelaziz2, hamdy Saber1, Mohamed Afify1
1
Critical Care Department, Cairo University, Faculty of Medicine, 2Critical Care Depatment,
Cairo Uneversity, Faculty of Medicine, Cairo, Egypt
Introduction: Congestive heart failure (CHF) continues to be among the most serious
health problems in the world, In the effort to develop novel therapies for CHF, cardiac
resynchronization therapy (CRT) has proved to be particularly successful. Application of
CRT remains a challenge, both from the technical aspect and optimization.
Transesophageal Doppler is a simple Hemodynamic monitoring technique, and most
users acknowledge that it is fairly easy to achieve adequate probe positioning and obtain
reproducible results.
Objectives: We investigated the utility trans esophageal Doppler to optimize cardiac
resynchronization therapy (CRT) parameters at implant and prospectively evaluated the
clinical and echocardiographic results.
Methods: thirty patients with ischaemic or non-ischaemic dilated cardiomyopathy, sinus
rhythm, Class II to III congestive heart failure, and QRS >150 ms underwent baseline 2D
echocardiogram (echo), 6 min walk distance, and quality of life (QOL) questionnaire
within 1 week of implant. Following implant, 15 patients (group A) had their CRT, CRTD
device A-V delay and V-V delay optimized using trans esophageal Doppler(Deltex cardio Q
system). After the probe positioning the patients Atrioventricular (AV) delay was adjusted
to (90, 100, 110,120,130,140 ms, Biventricular simaltaneous pacing) then V-V delay was
adjusted to ( -40 to 40 ms in 10 ms increments) were varied every 60 s.the probe was used
to monitor SV on a beat-to-beat basis. Optimal parameters were programmed. 15 patients
were left with fixed AV delay 120 ms and fixed VV delay 0 ms (group B). Echo, 6 min
walk, and QOL were repeated at 3-6 months post-implant.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: All parameters significantly improved at follow up when compared to baseline
for all patients, comparing the 2 groups to each other group A showed statistically
significant improvement at follow up in LVES & EF% only (5.150.9 & 38.5 9 for
group A versus 5.90.9 & 31.48.8 for group B, P value 0.03 & 0.04 respectively for
LVES & EF%). But did not show a statistically significant improvement in LVED
(6.620.86 for group A VS 6.960.7 for group B), QOL (41.621.46 VS
50.6720.19) or in six minute walk test (358.67131.4 VS 265.87126.2) but there
was a trend for improvement in these parameters which opens the way for more
research with more number of patients.
Conclusion: Esophageal Doppler can be used to optimize CRT at the time of implant.
Optimization only improves some of the Echo parameters.
Disclosure of Interest: None Declared
PW067
Diastolic dysfunction in Malaysian population and the association with
cardiovascular risk factors
Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,
Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli1
1 reduce mortality, but 33% of patients (pts) reject invasive treatment. No medical treatment
Cardiology, UiTM, Sungai Buloh, Malaysia
Introduction: Current data shows that heart failure with preserved ejection fraction (HF-
PEF) is found in approximately half all patients with congestive heart failure (CHF).
Moderate to severe diastolic dysfunction in isolation from left ventricular systolic
dysfunction is associated with mortality. The prevalence of diastolic dysfunction and its
associated risk factors is presented.
Objectives: To determine the prevalence of diastolic dysfunction and the association with
cardiovascular risk factors in an asymptomatic community.
Methods: 1932 subjects were recruited between the years 2007-2011. All subjects had
echocardiographic assessment of systolic and diastolic function. Mitral E/A, IVRT, dece-
laration times along with LA volumes were recorded. Demographic data were collected
along with cardiovascular risk profiles.
Results: In this cross-sectional sample, diastolic dysfunction was found in 835 (43.2%) of
screened subjects.
Of these, 383 (45.9%) had impaired relaxation, 133 (16.0%) had pseudonormal filling,
and 318 (38.1 %) had restrictive filling patterns.
In subjects with diastolic dysfunction, 15.1%, 34.8%, 31.1%, 19.0% had 0, 1, 2, or
3 modifiable risk factors respectively.
Multiple regression analysis showed that diabetes mellitus, hypertension, hyperlipidemia
and obesity are strong predictors for severe restrictive diastolic dysfunction, but not in mild
and moderate diastolic dysfunction. There was no association of the diastolic dysfunction
to age, gender or urban versus rural subjects.
Conclusion: In this community of Malaysian subjects, diastolic dysfunction is a common
finding. The presence of diastolic dysfunction is associated with the presence of other
modifiable risk factors, and the presence of diabetes, hypertension, hyperlipidemia and
obesity are strong predictors for severe restrictive diastolic dysfunction.
Disclosure of Interest: None Declared
PW073
Is it better ivabradine than beta blockers in symptomatic severe aortic stenosis with
coronary artery disease?
Gustavo A. Cortez Quiroga*1, Carmen Rus Mansilla1, Maria D. C. Duran Torralba1,
Jorge Curotto Grasiosi2, Bruno Peressotti2, Luciano Lucas3, María G. Lopez Moyano1,
Esther M. Ruiz de Temiño de Andres4, Ana I. Sanchez Floro4, Manuela Delgado Moreno1
1
Cardiologia, Hospital Alto Guadalquivir, Andújar, Spain, 2Cardiologia, Hospital Militar Central
601, 3Cardiologia, Hospital Italiano, Buenos Aires, Argentina, 4Cardiologia, Hospital Alta
Resolución Sierra de Segura, Puente de Genave, Spain
Introduction: Aortic stenosis (AS) is the most common valvular disease in Europe. Aortic
valve surgery and transcatheter aortic valve replacement are the unique treatments that
reduce mortality, but 33% of patients (pts) reject invasive treatment. No medical treatment
has proved benefits in morbidity and mortality in severe AS. 35% of pts have angina and
50% of pts over 75 years old have coronary artery disease. This is the reason why a high
percentage of pts are using beta blockers (BB) in severe AS, a controversial drug in this
disease. Ivabradine features, negative chronotropic without negative inotropic effect, and
his utility in stable coronary artery disease (SCAD), led us to change BB by ivabradine in pts
with severe AS with angina or SCAD who dismissed intervention.
Objectives: Compare the hemodinamyc and clinical effects between BB treatment and the
substitution by ivabradine in this type of patients.
Methods: Prospective interventional case control study. We select pts with symptomatic
severe AS who dismissed invasive treatment. All of them have angina or known SCAD,
were in sinus rhytm and ejection fraction (LVEF) greater than 55%. They must be under BB
treatment. We made a baseline echocardiogram, electrocardiogram, six minutes walk test
(6MWT) and laboratory. Afterwards, the BB were withdarwn and pts began ivabradine 2,5
mg bid. increasing the dose on day 15 th to 5 mg bid. One month after beginning ivab-
radine the same studies were repeated.
Results: The analysis were completed in 10 patients. There were not significant changes in
heart rate (62,5 bpm vs 61 bpm, p:0.26), and left ventricle end-diastolic diameter (4,93 cm
vs 4,78 cm, p:0,87), but improve significantly LVEF (69% vs 73,45% p:0.028), systolic
volume (87,39 ml vs 95,82 ml, p:0,007), cardiac output (5,17 l/m vs 5,69 l/m, p: 0.047)
and 6MWT distance (251 mts vs 333 mts p: 0,049).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: Ivabradine had shown to be safe and a more appropriate treatment than beta
POSTER ABSTRACTS
blockers in this study population. Ivabradine increases systolic volume, cardiac output and
the 6MWT distance at same preload conditions.
Disclosure of Interest: None Declared
PW074
Clinical and hemodynamic effect of heart rate control in patients with severe aortic
stenosis
Gustavo A. Cortez Quiroga*1, María D. C. Duran Torralba1, Carmen Rus Mansilla1,
Luciano Lucas2, Bruno Peressotti3, Jorge Curotto Grasiosi3, Maria G. Lopez Moyano1,
Ana I. Sánchez Floro4, Esther M. Ruiz de Temiño de Andres4, Manuela Delgado Moreno1
1
Cardiologia, Hospital Alto Guadalquivir, Andujar, Spain, 2Cardiologia, Hospital Italiano,
3
Cardiologia, Hospital Militar 601, Buenos Aires, Argentina, 4Cardiologia, Hospital Alta
Resolución Sierra de Segura, Puente Genave, Spain
Introduction: Aortic stenosis (AS) is the most common valvular disease in Europe. Aortic
valve surgery and transcatheter aortic valve replacement are the unique treatments that
has shown benefits in morbidity and mortality.
Adaptive changes reduced sistolic volume, contractility and increase oxygen consump-
tion, generating symptoms and increase the risk of sudden death. As in other cardiac
pathologies, we believe that the reduction in heart rate in severe aortic stenosis with pre-
served ejection fraction could be beneficial, increasing the preload can generate an increase
in the ejection fraction (LVEF) that would generate an improve in stroke volume.
To reduce heart rate we use ivabradine, safe drug without negative inotropic effect.
Objectives: Assess the possible hemodynamic and clinical benefits after reduce heart rate
with ivabradine in this type of patients.
Methods: Prospective interventional case control study. We select pts with symptomatic
AS who dismissed invasive treatment, all of them were in sinus rhythm and preserve
eyection fraction. No patient had beta blockers in home treatment. We made a baseline
echocardiogram, electrocardiogram, laboratory and six minute walk test (6MWT). After-
wards pts began with ivabradine 2.5 mg bid, increasing the dose on day 15 th to 5 mg bid.
One month after beginning ivabradine the same studies were repeated.
Results: The analysis was completed in 18 pts, six pts didn
t perform the 6MWT by motor
problems. Ivabradine reduces significantly heart rate (78 bpm vs 62 bpm, p:0.001), in-
creases significantly left ventricular end-diastolic diameter (4,68 cm vs 4,91 cm, p:0.004),
improves significantly LVEF (69,1% vs 75,15% p:0,01), systolic volume (78,05 ml vs
100,74 ml, p:<0.001), Aortic VTI (100,5 cm vs 119,5 cm, p:<0.001) and LV outflow tract
VTI (29,9 cm vs 35,8 cm, p:<0.001). The walk distance was improved significantly (383
mt vs 424 mt p:<0,004). There was not significant benefit in the cardiac output (6,25 l/m
vs 5,88 l/m, p:0,39).
Conclusion: Ivabradine was shown to be a safe drug in pts with severe symptomatic AS
who dismissed invasive treatment. The reduction in heart rate increase left ventricular
filling time, left ventricular end-diastolic diameter, LVEF, and by these reasons improved
the systolic volume and 6MWT distance.
Disclosure of Interest: None Declared
PW076
Impaired Long-term Functional Capacity of Survivors of Submassive Pulmonary
Embolism Utilizing the Six-minute Walk Test
Vincent Chow*1, Austin C. C. Ng1, Leigh Seccombe2, Tommy Chung1, Liza Thomas3,
David Celermajer4, Matthew Peters2, Leonard Kritharides1
1
Cardiology, Concord Hospital & The University of Sydney, 2Thoracic Medicine, Concord
Hospital, 3Cardiology, Liverpool Hospital and University of New South Wales, 4Cardiology, Royal
Prince Alfred Hospital and The University of Sydney, Sydney, Australia
Introduction: The functional capacity of long-term survivors of submassive pulmonary
embolism (PE) is unreported. A six-minute walk distance (6MWD) <350m and heart rate
recovery (HRR) <16 beats per minute (bpm) indicate adverse prognosis in various chronic
diseases.
Objectives: We sought to assess whether long-term impairment of functional capacity exist
in apparently well survivors of PE during long-term follow-up.
Methods: Long-term survivors of acute PE were prospectively invited to undergo six-
minute walk test (6MWT), transthoracic echocardiogram, clinical and biochemical evalu-
ation with cardiac biomarkers. The predicted six-minute walk distance (6MWD) was
calculated utilising Enright’s well-validated formula:
Predicted 6MWD (males) ¼ (7.57 x heightcm) - (5.02 x age) - (1.76 x weightkg) - 309
metres &
Predicted 6MWD (females) ¼ (2.11 x heightcm) - (5.78 x age) - (2.29 x weightkg) + 667
metres. HRR was calculated as the difference between heart rate at 6-minutes and at 1-
minute post 6MWT.
Results: One-hundred and twenty patients (52 males, age-6514years) were identified to
have had a prior confirmed PE. Mean (SD) follow-up was 7.71.4years. The 6MWD was
significantly lower than predicted after adjustment for age, sex, and height (448114m vs.
47589m, p¼0.005, Figure 1). Importantly, 55% (57/104) demonstrated 85% below
expected 6MWD, 16% (17/104) had 6MWD<350m and 31% (32/104) had HRR<16bpm.
Among patients with no baseline comorbidities at follow-up (defined as Charlson
comorbidity index of 0), 8% (4/52) had 6MWD<350m and 25% (13/52) had
HRR<16bpm.
e275

POSTER ABSTRACTS
Conclusion: Amongst apparently well long-term survivors of submassive PE, 55%
demonstrated below than expected 6MWT, and 16% had 6MWT distance <350m
implying significantly impaired exercise capacity in this population.
Disclosure of Interest: None Declared
PW077
Are higher levels of C reactive protein predictive of positive echocardiographic
findings of infective endocarditis ?
Abhishek Sengupta*1, Samuel Hillier1, Emma Ivens1, David Platts1, John Sedgwick1
1
Cardiology, The Prince Charles Hospital, Brisbane, Australia
Introduction: Serum C-reactive protein (CRP) is an acute phase reactant protein present in
inflammatory conditions and infections including endocarditis. Its relationship to type of
bacteraemia, and presence of positive echocardiographic findings is not well defined.
Objectives: To determine how initial CRP levels correlate with blood cultures and echo-
cardiographic findings.
Methods: Patients from the last two years referred for echocardiography at our institution to
exclude infective endocarditis were included, and imaging findings were reviewed. We
analysed initial blood cultures, CRP at or near time of presentation and epidemiological data.
Results: 139 patients were selected from our echocardiography database for referral of
possible endocarditis over the last two years (males 68%), average age 58 years (range 22-
94). The major echocardigraphic findings of infective endocarditis included: vegetation
(53), abscess (16), and leaflet perforation (16). Mean CRP in these groups was 147, 119
and 120 respectively. 39/139 (28%) patients had positive blood cultures and echocar-
diographic findings suggestive of infective endocarditis; 38/139 (27%) had bacteraemia and
no echocardiographic criteria of infective endocarditis; and 7/139 (5%) patients had pos-
itive echocardigraphic findings despite negative blood cultures. Mean CRP in this group
was 141, 134, 49 and 72 respectively (see table below). There were 40 cases of native valve
endocarditis, 20 cases of prosthetic valve endocarditis, and 4 cases of pacing lead infection.
In these sub- groups, mean CRP was 153, 142, and 125.
Echo
Positive Negative
Blood Culture Positive 141 134.4 p¼NS
Negative 72 49.5 p¼NS
p¼0.07 p¼0.002
Conclusion: The main predictor of serum CRP levels in this study was the presence of
bacteraemia, rather than the actual echocardigraphic changes. Although positive echocar-
diographic findings were predictive of higher CRP values in all subgroups, the difference
was small. Hence, using CRP to monitor response to antimicrobial therapy is less likely to
correlate with improvement in echocardigraphic changes.
Disclosure of Interest: None Declared
PW078
Imaging for Complications of Infective Endocarditis: a 10 year review
Edward Buratto*1, Andrew Lin2, Myles Wright1, Andrew Newcomb1, Philip Davis1,
Jonathan Darby3, Andrew Wilson4, Melbourne Endocarditis Study Group (MESG)
1
Department of Cardiac Surgery, 2Department of Cardiology, 3Department of Infectious Disease,
4
Cardiology, St Vincent’s Hospital, Melbourne, Australia
Introduction: Infective endocarditis (IE) is associated with a myriad of complications due
to septic, embolic and vascular phenomena. As a result, IE patients are subjected to a large
number of investigations, yet the diagnostic yield of such investigations is unknown.
e276
Objectives: The present study was designed to review the investigations performed for
IE complications over a 10 year period and determine their rate of positive findings.
Methods: Imaging requests and reports recorded from January 2003 to January 2013 were
searched for the terms “mycotic aneurysm”, “septic embolus” and “endocarditis”. For each
investigation the report was reviewed to determine relevance and the presence and nature
of IE related sequelae. For each patient discharge summaries and echocardiography reports
were reviewed to confirm the presence of endocarditis.
Results: A total of 224 patients underwent 971 investigations for complications of IE during
the study period. Staphylococcus aureus was the most common infective agent (81 cases),
followed by viridans Streptococci (34 cases) and Enterococcus spp. (13 cases). Cerebral imaging
was most frequent (329 studies), followed by abdominal imaging (300 studies), thoracic (131
studies), spinal (78 studies) and nuclear medicine imaging (70 studies). 415 of these in-
vestigations (43%) identified at least 1 complication of IE. The complications identified
included 166 infarcts, 63 septic emboli, 63 mycotic aneurysms, 61 bone and joint infections,
54 abscesses and 40 haemorrhages. For cerebral imaging, MRI had a significantly higher pick
up rate than CT (66.2% v 40.2%, p<0.001). Likewise for spinal imaging, MRI identified
significantly more complications than CT (58.5% v 23.1%, p¼0.02) For abdominal imaging
CT had a greater pick up rate than ultrasound (40.0% v 19.5%, p¼0.01). There was no
increase in imaging rates or complication pick-up rates over the study period.
Conclusion: Imaging performed to investigate complications of IE over a 10-year period at
the study institution had a high rate of identifying complications. Many of the complica-
tions are important causes of morbidity and mortality, and significantly impact on patient
management, risk stratification and prognostication. MRI has a superior rate of identifying
cerebral and spinal complications than CT. For abdominal imaging, CT identifies com-
plications more frequently than CT. Further analyses will identify the cost effectiveness of
the various imaging modalities studied.
Disclosure of Interest: None Declared
PW079
Timing, Characteristics And Outcomes Of Surgery For Infective Endocarditis: Seven-
Year Contemporary Study
Tom Kai Ming Wang*1, Timothy Oh1, Jamie Voss1, Nicholas Kang1, James Pemberton1
1
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
Introduction: Infective endocarditis remains a heterogeneous disease with high mortality,
and surgery is required in approximately half for resultant heart failure, uncontrolled
infection or embolism prevention. Several recent studies advocate operating early to have
superior outcomes.
Objectives: We reviewed the characteristics, timing and outcomes of cardiac operations
performed for infective endocarditis at Auckland City Hospital.
Methods: All patients undergoing surgery for infective endocarditis during 2005-2012
were analysed, focusing on outcomes and predictors, and comparing early (within 7 days of
diagnosis) and late surgery.
Results: 146 patients were studied with mean age 48.8+/-16.0 years and 70.5% (103) were
male. Pre-operatively, 47.3% (69) had congestive heart failure and 40.4% (59) had new
embolic event. Structures involved were predominantly aortic valve 64.4% (94) and mitral
valve 42.5% (62), with 33.6% (49) having prosthetic valve involvement and 27.4% (40) had
intracardiac abscess. Blood culture grew Staphylococcus aureus in 29.5% (43). Early surgery
was performed in 42.5% (62). Operative mortality and composite morbidity were 6.8% (10)
and 33.6% (49) respectively. One and five year survivals were 92.5% and 89.0%, freedoms
from recurrent endocarditis 96.6% and 92.8%, and freedoms from re-operation 96.4% and
86.8%. All outcomes were similar between early and late surgery (operative mortality 8.1%
(5) vs 6.0% (5), P¼0.744 respectively). Critical pre-operative state, previous coronary surgery
and dialysis were independent predictors of operative and follow-up mortality.
Conclusion: Our outcomes compare favourably to other studies internationally, and
important predictors for adverse outcomes were identified. Delaying surgery for medical
stabilisation was not associated with survival benefit.
Disclosure of Interest: None Declared
PW080
Ascending aorta aneurysm complicating bicuspid aortic valve stenosis
Majdi Gueldich1, Ellouze Tarak2, ahmed tounsi3, abid dorra3, faten triki3, leila abid*3,
samir kammoun3, imed frikha4
1
cardiovascular and thoracic surgery, Habib Bourguiba hospital, 2Habib Bourguiba hospital. Sfax.
Tunisia, 3cardiology, hedi chaker hospital, 4cardiovascular and thoracic surgery, Habib
Bourguiba hospital. Sfax. Tunisia, sfax, Tunisia
Introduction: The bicuspid aortic valve (BAV) is the most common congenital abnormality
of the human heart. It is estimated that a bicuspid morphology will lead to structural aortic
valve problems (stenosis or regurgitation) in all patients who live long enough to manifest
them. The BAV disease accounts for more morbidity and mortality than all other congenital
heart diseases combined. The dimensions of the proximal aorta (especially the tubular
ascending aorta) are significantly larger than those in persons with tricuspid aortic valve,
even in the absence of significant valvular hemodynamic disturbance.
Objectives: We report a case of bicuspid aortic valve stenosis complicated by an aneurysm
of the ascending aorta.
Methods: 40 year old patient, admitted for chest pain with exertional dyspnea NYHA class
III. Chest radiograph showed a mediastinal enlargement. ECG and troponines levels
weren’t in favor of an acute coronary syndrome.
Results: Echocardiography showed a bicuspid aortic valve stenosis. Left ventricle – aorta
gradient was 60 mmHg. Left ventricle parameters were normal: telesystolic diameter:
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
28mm; telediastolic diameter: 45mm: inter ventricular septum: 11mm. Left ventricle vol-
ume ejection was estimated to be 65%. Moreover, an aneurysm of the ascending aorta
measuring 50 mm was detected. Aortic angiography confirmed the ultrasound data by
objectifying a significant ectasia of the ascending aorta measuring 52 * 63 mm. In addition,
the aortic walls were thin and regular. Thus, patient was addressed to department of
surgery for Bentall operation. Intra operative exploration found, addition to calcified
bicuspid aortic valve, an important dilatation of the ascending aorta (tubular segment). A
double replacement of the aortic valve and the ascending aorta was achieved without
necessity to coronary arteries’re implantation. Postoperative course was marked by onset of
third degrees auriculo-ventricular bloc well evolved with a decline of 6 months.
Conclusion: BAV is a common congenital anomaly which involves not only vavular
damages but also structural aortic wall abnormalities. Hemodynamic and genetic hy-
pothesis have well explained the possible occurrence of aortic aneurysm or dissection.
Currently, diagnosis is based on ultrasonographic data and results of computed tomog-
raphy. Other risk factors such as hypertension and dyslipidemia must be researched and
treated. Genetic hypothesis should encourage familial screening.
Disclosure of Interest: M. Gueldich Shareholder of: none, Grant/research support from:
none, Consultancy for: none, Employee from: none, Honorarium from: NONE, Speakers
bureau: NONE, E. Tarak: None Declared, A. tounsi: None Declared, A. dorra: None
Declared, F. triki: None Declared, L. abid: None Declared, S. kammoun: None Declared, I.
frikha: None Declared
PW081
The Profile of Mitral Valve Prolapse in Hasan Sadikin General Hospital, Bandung,
Indonesia
Robin H. Wibowo*1, Syarief Hidayat1, Erwan Martanto1, Wuri Setyaningrum1,
Triwedya I. Dewi1
1
Cardiology and Vascular Medicine, Padjadjaran University, Bandung, Indonesia
Introduction: Mitral valve prolapse (MVP) is a variable clinical syndrome that results from
diverse pathogenic mechanism. Recent observational studies demonstrated that MVP has a
prevalence of 2.4% in adults. with twice as frequent in females than in males. The majority
of patients with MVP are asymptomatic. Echocardiography plays an essential role in the
diagnosis of MVP and has been delineation of this syndrome.
Objectives: To establish the MVP profile data in Indonesian population.
Methods: This descriptive study evaluated 14687 echocardiographic records from August
2008 to June 2013. MVP was defined as superior displacement of the mitral leaflets of more
than 2 mm during systole. Echocardiographic examinations were performed using Vivid 7.
The mitral valve apparatus and mitral regurgitation was examined with long axis images,
short axis images and apical four chamber images.
Results: There were 257 patients with 128(49,8%) males and 129(50,2%) females, the
mean age was 50,2 years old with the youngest is 7 years old and the oldest is 87 years old.
The proportion of MVP was 1,75% in our population with age group younger than 35
years and older than 36 years were 60(23,3%) and 197(76,7%) respectively. Prolapse of
anterior and posterior mitral leaflet was found in 181(70,4%), 66(25,7%), and both
10(3,9%) respectively. Mitral regurgitation was found in 247(96,1%) patients and the
grading was trivial in 27(10,5%), mild in 86(33,5%), moderate in 73(28,4%) and severe in
61(23,7%) patients. The ejection fraction below 50% was found in 35(13,6%) patients.
Conclusion: Mitral valve prolapse is on low proportion in our population with similar
frequency in male and female. The findings was predominantly older patients and anterior
mitral valve prolapse involvement. The presentation of MVP was more frequent with
moderate to severe mitral regurgitation.
Disclosure of Interest: None Declared
PW082
Mitral Valve Replacement For Surgical Correction of Post Rheumatic Heart Disease In
Children In A Tertiary Sub-Saharan Centre
Tantchou Tchoumi Jacques Cabral*1, Gianfranco Butera2
1 Results: Since 2009, 160 BAV were performed on 148 patients (mean age 83 years). 11
Cardiac centre, St. Elizabeth Catholic General Hospital, Shisong, Kumbo, Cameroon, 2Pediatric
Cardiology, Cardiac Surgery and GUCH unit, Policlinico San Donato IRCC, San Donato, Milan,
Italy
Introduction: Rheumatic heart disease is the most important sequelae of acute rheumatic
fever, which is caused by group A streptococci and usually presents in childhood, affecting
5 to 14 years old although it can strike people up to the age of 30.
Objectives: To study the outcome and early follow-up in children with mitral valve
replacement for post rheumatic valvulopathy correction.
Methods: This retrospective analysis included 29 patients who underwent mitral valve
replacement from April 2003 through June 2009. Data from patients’ records, operative
intervention, and preoperative and postoperative parameters were reviewed. The duration
of the follow-up was from 6 months to 91 months.
Results: 29 patients (14 males and 15 females) aged between 9,5 and 17 years with a mean
age of 10,5  6,5 years old underwent mitral valve replacement with a mechanical pros-
thesis. Mitral valve regurgitation was the commonest diagnosis present in 51,7% patients,
35% had pure mitral stenosis. Patients were extubated from 5-10 hours after surgery, the
mean stay in intensive care unit was 1,5  0,5 days. The mean cardiopulmonary by-pass
time was 104  20 min. The drains were removed at the 3rd  1,5 post surgical day in the
ward. In the early post surgical period, the ejection fraction (EF) changed from 45,3  1,5
% to 56,1  1,4% (p<0,005) in 3 months and stayed almost the same after six
months 57,2  2,7% (p>0,05); at nine months it was 55,1  1,8% (p>0,05), at
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
12 months - 58,4 1,7% (p>0,05), at the latest patient’s check up, the EF was 56,2 
POSTER ABSTRACTS
1,3% (p>0,05); however the basal part of the interventricular septum was hypokinetic.
Conclusion: The study showed very good early results in the post surgical follow-up of
patients with valve replacement for the correction of post rheumatic valvulopathies. Due to
financial limitation poverty and illiteracy of parents, the post surgical follow up of patients
is challenging.
Disclosure of Interest: None Declared
PW083
Long term outcomes after percutaneous mitral commissurotomy in the real world
Carlos Uribe1,2, Carlos Tenorio1,2, Carlos Eusse1,2, Carlos Rubio1,2, Julian Ochoa3,
Roland Njoh4, Bernardo Lombo*4, John Forrest4
1
Cardiology, Clinica CardioVID, 2Universidad Pontificia Bolivariana, Medellin, 3Cardiology,
Fundacion Valle de Lili, Cali, Colombia, 4Cardiology, Yale New Haven Hospital, Yale University,
New Haven, United States
Introduction: In 1993, Colombia, South America began a National Mitral Balloon Val-
vuloplasty Registry. This multicenter database was designed to establish the long term
safety and efficacy of percutaneous mitral commissurotomy, as well as rate of restenosis.
Objectives: To evaluate the long term clinical results of percutaneous mitral balloon val-
vuloplasty in patients with rheumatic mitral stenosis.
Methods: Between January 1993 and December 2011, 182 patients >18 years old were
treated for rheumatic mitral stenosis with percutaneous valvuloplasty in two centers in
Colombia, South America. Clinical, echocardiographic and hemodynamic data were stored
in an electronic database. The Inoue Balloon technique was used in 99% of patients. The
longest follow up period was 15 years.
Results: 182 patients were included; women (89%), hypertension (19%), dyslipidemia
(1.6%), smoking (8.8%), diabetes (5.5%) and renal failure (1%). Forty-six patients (25.7%)
were NYHA functional class III-IV. Procedure related mortality was 1.09% (2 patients).
Fourteen patients (7.69%) had significant post procedure mitral insufficiency (grades III-IV); 4
patients (2.19%) had cardiac tamponade and 6 patients (3.3%) had vascular site related
complications. The survival rate at 12 months was 96%. At 50 months, 60.7% of patients were
alive and free of mitral surgery and repeated mitral valvuloplasty. The percentage of severe
restenosis of mitral valve was 4.8%; 19.2%; 15.2% at one, five and 10 years of follow up.
Conclusion: Percutaneous mitral valvuloplasty using the Inoue balloon technique im-
proves the hemodynamic profile of severe mitral stenosis. Long term follow up suggest that
it is a safe alternative to mitral valve surgery in well selected patients.
Disclosure of Interest: None Declared
PW084
Contemporary indications and outcomes of balloon aortic valvuloplasty in the era of
transcatheter aortic valve replacement
James Marangou*1, Sandeep Chopra1, Jamie Rankin1, Robert Larbalestier1, Gerald Yong1
1
Cardiology, Royal Perth Hospital, Perth, Australia
Introduction: Transcatheter aortic valve replacement (TAVR) has emerged as a viable
option to surgical aortic valve replacement (SAVR) for high risk patients with symptomatic
severe aortic stenosis (AS). This has led to an increased incidence of balloon aortic val-
vuloplasty (BAV) as an important percutaneous treatment modality.
Objectives: To describe the contemporary indications as well as immediate and medium
term outcomes of patients who underwent BAV in a setting whereby TAVR is available.
Methods: Retrospective analysis was undertaken on all BAV performed at a single state
TAVR centre since initiation of the program in 2009. The indications for BAV were clas-
sified as 1. Emergency (patients with shock or admission with heart failure recalcitrant to
aggressive therapy therefore preventing discharge from hospital); 2. Bridge (aimed at
improving certain cardiac physiology or clinical features with a view to definitive valve
replacement in the future); 3. Palliative (symptomatic relief in patients deemed unsuitable
for SAVR or TAVR). The in-patient and medium term outcomes were reported.
patients had repeat procedures, including one who underwent three valvuloplasties. In-
dications included: Emergency (n¼17); Bridge (n¼61); Palliative (n¼82). Procedural death
occurred in two cases (1.3%). In-hospital and one year mortality and subsequent definitive
treatment with AVR are described in the following table:
Emergency Bridge Palliative Total
In-hospital mortality 7 (41.2%) 3 (4.9%) 2 (2.4%) 12 (7.5%)
1 year mortality 59.7% 25.6% 37.1% 35.1%
Subsequent AVR 5 (29.4%) 33 (55.9%) 2 (2.8%) 40 (27.0%)
- SAVR 2 (11.8%) 6 (10.2%) 1 (1.4%) 9 (6.1%)
- TAVR 3 (17.6%) 27 (45.8%) 1 (1.4%) 31 (20.9%)
The patients who underwent AVR following BAV had a significantly lower 1 year
mortality compared to those who did not undergo subsequent AVR (12.6% vs 54.7%,
p¼0.001).
Conclusion: BAV in this contemporary era is a relatively safe procedure in high risk pa-
tients with severe aortic stenosis not immediately suited for AVR and forms an important
treatment option in TAVR programs. Except in patients with BAV performed for Palliative
e277
 indications, it allows 30% - 55% of patients to undergo a successful subsequent AVR (even
POSTER ABSTRACTS
if BAV is performed as an emergency). The medium and long term outcomes of stand-alone
BAV remain poor if not treated with definitive AVR.
Disclosure of Interest: None Declared
PW085
Impact of pulmonary artery hypertension on immediate and long-term results of
percutaneous mitral balloon commissurotomy: Our experience
Leila Abid Trigui*1, Ahmed Tounsi1, Salma Charfeddine1, Samir Kammoun1
1 were compared using a Fisher’s exact test.
Cardiology Departement, Hedi Chaker Hospital, Sfax (Tunisia), Medecine University Sfax, sfax,
Tunisia
Introduction: Patients with mitral stenosis with severe pulmonary artery hypertension
(PAH) constitute a high-risk subset for surgical commissurotomy or valve replacement.
Objectives: to examine the effect of PAH on immediate and long term results of the
percutaneous mitral commissurotomy (PMC) in 480 patients.
Methods: The immediate procedural and the long-term clinical outcome after first-time
PMC of 225 patients with systolic pulmonary artery pressure >¼45 mmhg (group 1) were
retrospectively collected and compared with those of 255 patients with systolic pulmonary
artery pressure <45 mmhg (group 2) (between 1998 and 2012).
Results: Group 1 patients were older (38.1 +/- 11.8 versus 31.6 +/- 10.8 years; p
¼0.02),more symptomatic and had more severe mitral stenosis, echocardiographic score
>8, and atrial fibrillation. The two groups were similar in terms of the final mitral valve area,
the gain of mitral valve area, the mean pressure gradient across the mitral valve, and the
complication rate (NS for all). The procedural success was similar (p ¼ NS). The residual
systolic pulmonary artery pressure was higher in group 1 (42.9+/-14mmhg VS 31.8+/-12
mmhg, p<0.01). During a mean follow-up of 79+/-51months, there was no difference in the
overall survival rate, but restenosis rate and cardiac events was higher in group 1 (p<0.05).
Conclusion: PMC is safe and effective, has a low morbidity and mortality rate, but has
poorer long-term outcome in patients with PAH.
Disclosure of Interest: None Declared
PW087
Feasibility and outcomes of transcatheter aortic valve implantation in high-risk
patients with stenotic bicuspid aortic valves
_ Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, istanbul, Turkey
Radoslaw Parma1, Piotr Pysz2, Ewa Gaszewska-Zurek 1
, Zofia Parma3, Wojciech Wojakowski1,
Grzegorz Smolka1, Andrzej Ochała*1
1
3rd Department of Cardiology, 22nd Department of Cardiology, 31st Department of Cardiology,
Medical University of Silesia, Katowice, Poland
Introduction: Bicuspid aortic valve (BAV) is the most common congenital heart disease
and may lead to aortic valve stenosis. Although Transcatheter Aortic Valve Implantation
(TAVI) emerged as an alternative therapy in high-risk patients with tricuspid aortic valve
stenosis, presence of a stenotic BAV is often considered a contraindication, due to its
unique anatomy and increased risk of periprocedural complications.
Objectives: We aimed to assess the feasibility and outcomes of TAVI in high-risk patients
with bicuspid aortic valve stenosis.
Methods: Of 109 high-risk patients with severe aortic stenosis who underwent TAVI from
January 2009 to September 2013 in our centre, 10 (9%) had documented BAV. They were
treated using a transfemoral approach using both Medtronic CoreValve (6 patients) and
Edwards Sapien XT systems.
Results: Patients were aged 768 years (range 66-90), with mean EuroScore I of 328%,
all in New York Heart Association functional class III. The mean aortic valve area was
0.70.1 cm2, the mean gradient was 4712 mmHg and mean LVEF was 4713%. The
procedure was successful in 8 patients. Major adverse events according to the second
Valvular Academic Research Consortium definitions were present in 2 patients: 1 peri-
procedural death, 1 periprocedural stroke; all related to prosthesis dislocation from the
bicuspid aortic valve annulus. Postprocedural mean gradient was 81 mmHg and AVA
1.40.3 cm2. After a mean follow-up of 1412 months no further adverse events
occurred. All survivors remained in NYHA class I or II.
Conclusion: Our experience suggests that transfemoral TAVI using Medtronic CoreValve
and Edwards Sapien XT in high-risk patients with stenotic bicuspid aortic valve is feasible,
leading to good short-term hemodynamic and clinical improvement. However, prosthesis
dislocation during implantation carries ominous prognosis warranting further multicentre
studies on BAV anatomy and prosthesis matching for this specific group of patients.
Disclosure of Interest: None Declared
PW089
Usefulness of Anti-Streptococcal Antibody Profiling for Confirmation of Latent
Rheumatic Heart Disease in Asymptomatic Ugandan Schoolchildren Diagnosed by
Echocardiography
Andrea Beaton*1, Bill Kabat2, Jason Rippe2, Jessica Davies2, Aaruni Khanolkar2, Emmy Okello3,
Twalib Aliku3, Sulaiman Lubega3, Peter Lwabi3, Craig Sable1, Stanford Shulman2
1
Children’s National Medical Center, Washington, 2Ann & Robert H. Lurie Children’s Hospital of
Chicago, Chicago, United States, 3The Uganda Heart Institute, Kampala, Uganda
Introduction: Absent a clear history of acute rheumatic fever (ARF), there is no confir-
matory test for latent rheumatic heart disease (RHD): RHD diagnosed by echocardiogram in
an asymptomatic individual. In the 1970’s, Ayoub and Shulman reported that children
with RHD demonstrated persistently elevated anti-group A carbohydrate (A-Antibody)
e278
levels after anti-streptolysin O (ASO) and anti-desoxyribonuclease B (anti-DNAse B) titers
had normalized. Measurement of A-Antibody levels is not commercially available and has
not been studied in endemic populations.
Objectives: Explore the usefulness of streptococcal antibody tests – ASO, anti-DNAse B, and
A-antibody – in differentiating those with latent RHD from normal in the developing world.
Methods: Asymptomatic Ugandan schoolchildren aged 5-15 were examined for evidence
of RHD using echocardiography. Diagnosis of latent RHD was made according to the 2012
World Heart Federation criteria. Abnormal antibody titers were defined by the level that
was exceeded by 15% of a control population (Ugandan schoolchildren with normal
echocardiograms): ASO  200, AntiDNAse B  555, and A-Antibody  3300. Groups
Results: Antibody titers were determined for 84 normal controls, and 32 children with
latent RHD: 6 with definite RHD and 26 with borderline RHD. Five of six children with
definite RHD had normal ASO and anti-DNAse B; one had an elevated anti-DNAse B. Of
these five, three had an elevated A-Antibody level (60%). 23 of 26 children with borderline
RHD had normal ASO and anti-DNAse B; three had an elevated ASO. Of these 23, two had
an elevated A-Antibody level (9%). In this small sample, the proportion of children with a
pattern reflecting chronic RHD – an elevated A-Antibody level in the context of normal
ASO and normal Anti-DNAse B levels – was significantly higher in those with definite RHD
compared to those with borderline RHD (p¼0.027).
Conclusion: Streptococcal antibody profiling which includes the A-antibody may have the
potential to provide a confirmatory test for latent RHD. Among control children, the titers
for antiDNAse B and A-Antibody in Uganda were substantially higher than those reported
in North American populations (likely reflecting high rates of group A streptococcal skin
infection in tropical areas) which complicates the definition of elevated antibody titers.
More research, including prospective antibody profiling in ARF patients, is needed to fully
investigate the potential of these antibody profiles.
Disclosure of Interest: None Declared
PW090
The Effect of Hemolysis on Serum Lipid Levels in Patients Suffering from Mitral and/
or Aortic Prosthetic Paravalvular Leakage
Macit Kalcik1, M. Ozan Gursoy1, Lutfi Ocal1, Mahmut Yesin1, Suleyman Karakoyun1,
Zubeyde Bayram1, Beytullah Cakal1, Mehmet A. Astarcioglu1, Sabahattin Gunduz1,
Mehmet Ozkan*1
1
Introduction: Paravalvular leak (PVL) is a relatively rare complication related to the sur-
gical replacement of mitral and aortic valves. One of the most common problems with PVLs
is intravascular hemolysis which can be diagnosed based on reduced hemoglobin levels,
elevated lactate dehydrogenase activity (LDH), changed reticulocyte counts and bilirubin
levels, as well as reduced haptoglobin concentrations. Since haptoglobin plays an important
role in the regulation of reverse cholesterol transport to liver, diminished haptoglobin levels
during hemolysis in PVL patients may effect serum lipid levels daramatically.
Objectives: We aimed to evaluate whether there is an association between serum lipid
levels and severity of the PVL and/or hemolysis in patients with prosthetic heart valves.
Methods: Blood samples for hemoglobin, LDH, Low-Density Lipoprotein (LDL), High-
Density Lipoprotein (HDL), Triglyserides and Total Cholesterol were obtained from patients
with diagnosis of mild, moderate and severe mitral or aortic PVLs and a control group of
patients with normal prosthetic valves. The relationship between serum lipid levels and he-
molytic parameters with PVL severities were analyzed. The severity of hemolysis was defined
according to LDH levels: 500-1000¼ mild, 1000-1500¼moderate and > 1500¼ severe.
Results: The study included 214 PVL patients (male:118 (55%), female:96 (45%),
mitral:152 (71%), aortic: 62 (29%), 28 (13%) mild, 63 (29%)moderate, 123(58%) se-
vere) and 90 control patients (male: 52 (57%), female 38(43%), mitral:57 (63%), aortic:
33 (37%) ). There was a strong positive correlation between PVL severity and hemolysis
(r¼0.851, p<0.001). The PVL group had significantly lower HDL, LDL and total
cholesterol levels when compared with control group (p<0.001 for each), whereas there
was no significant difference between the groups in terms of TG (p¼0.35) . There was
mild negative correlation between the severity of PVL and LDL with total cholesterol
levels (r¼-3.36, p<0.001 and r¼-3,54, p<0.001 respectively ). Furthermore, there was
modest negative correlation between severity of PVL and HDL levels (r¼-5.95,
p<0.001). HDL, LDL and total cholesterol levels were also negatively correlated with
severity of hemolysis (r¼-5.89,p<0.001, r¼-3.35, p<0.001 and r¼-3.51, p<0.001
respectively).
Conclusion: In this study, we have shown that serum HDL, LDL and total cholesterol
levels were negatively correlated with the severity of PVL and degree of hemolysis in pa-
tients with prosthetic heart valves.
Disclosure of Interest: None Declared
PW094
Variation in measured quality of discharge prescribing for acute coronary syndrome
using common indicators
Eva Hoff1, Kevin Mc Namara*2,3, Rochelle Gellatly2, Rohan Elliott2, Harin Karunajeewa4,
Karen Sanders5, Danny Lay6, Melanie Welsh6, Susan Poole2, Edward Janus3,4
1
Masters in Pharmacy candidate, University of Utrecht, Utrecht, Netherlands, 2Centre for
Medicine Use and Safety, Monash University, Parkville, 3Greater Green Triangle University
Dept of Rural Health, Flinders University and Deakin University, Warrnambool, 4Department of
General Medicine, Western Health, Footscray, 5Department of Cardiology, Austin Hospital,
Heidelberg, 6Undergraduate pharmacy student, Monash University, Parkville, Australia
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: Rates of prescribing of statins, aspirin, beta blockers and renin-angiotensin
system (RAS) agents on discharge from hospital following an admission for acute coronary
syndrome (ACS) are key quality of care indicators internationally. As Australia proposes to
change prescribing indicator criteria, understanding the impact of these changes is
necessary to understand real prescribing trends.
Objectives: To compare observed quality of prescribing at discharge post-ACS using
current and proposed Australian indicators, and the dominant research definition of pre-
scribing quality.
Methods: A retrospective medical chart audit of patients discharged following ACS was
undertaken in three Victorian tertiary referral centres and a regional hospital. Random
samples were selected over twelve months, stratified 50:50 between cardiology and non-
cardiology patients in hospitals with cardiology units. Prescribing quality for the four key
medicines were assessed as follows:
1. 2007 criteria (current, crude prescribing rate): number prescribed x 100 O
number of ACS discharges.
2. 2013 criteria (proposed, rate of appropriate care): number prescribed therapy or
with a contraindication x 100 O number of ACS discharges.
Dominant research method (rate of appropriate prescribing): number prescribed x
100 O number of ACS discharges without contraindication.
Results: In total, 553 discharges were examined. Cardiology patient characteristics differed
significantly from non-cardiology. Criteria compliance for all four therapies occurred among
63%, 69% and 69% of cardiology discharge patients using methods 1-3 above respectively;
the equivalent data for non-cardiology discharges were 34%, 53% and 40%. When
2007 and 2013 criteria were compared for individual agents, quality indicators for anti-
platelets, beta blockers and statins were relatively unchanged. RAS agents’ performance
increased from 79% to 83% for cardiology, and 59% to 84% for non-cardiology with 2013
criteria.
Conclusion: Moving from 2007 to 2013 criteria will produce large increases in overall
compliance rates, particularly outside cardiology units. All three measures are valid, but
represent different perspectives of prescribing quality.
Disclosure of Interest: None Declared
PW095
Quality Assessment Of Patient Care With St Elevation Myocardial Infarction
Péter Ofner*1, on behalf of Hungarian Myocardial Infarction Registry: András Jánosi1, on behalf
of Hungarian Myocardial Infarction Registry
1 Disclosure of Interest: None Declared
Cardiology, "Gottsegen" National Institute of Cardiology, Budapest, Hungary
Introduction: Primary PCI (p-PCI) is the optimal care for patients (pts) with ST elevation
myocardial infarction (STEMI) if it is performed early. Primary PCI is practically the only
reperfusion strategy in Hungary, but we have limited country-level data on care of pts with
STEMI.
Objectives: The aim is to study the frequency of p-PCI in STEMI pts, time of intervention,
door-to-balloon time, short- and long-term prognosis, and the connection between long-
term survival and intervention time.
Methods: A prospective, on-line, voluntary myocardial infarction registry was launched in
Hungary on 1 January 2010. From that date and until 31 December 2011, 4,981 pts with
STEMI were registered at 32 hospitals at different locations throughout the country.
Participating hospitals treating pts with acute myocardial infarction (AMI) ranged from
regional hospitals to secondary and tertiary centres.
Results: Of the 4,981 STEMI pts, 4,538 pts (91.1%) were treated in hospitals with
on-site heart catheterisation facilities (Cs). Half of these patients (50.9%) were trans-
ferred with primary transport. Primary PCI was performed in 82% of pts treated
in Cs. The median time from symptom onset to needle was 234 minutes. The in-
hospital transfer (“door to needle”) was 45 minutes (median time). The in-hospital,
30-day, and 1-year mortality rates were 3.7%, 9.5%, and 16.5% respectively. Table 1
shows the 1-year mortality rate according to the intervention time (onset of symptoms
to the needle).
( ) ¼ number of pts who died within 1 year; *p¼0.03; **p<0.0001
Patients treated with p-PCI more than 12 hours after onset of symptoms had poorer
prognoses with highly significant differences statistically. A high number of enrolled pts
received preventive medications at discharge: b blockers (91% of pts), ACE/ARB (92%),
statin (94%), aspirin and clopidogrel (95.5%), aspirin only (3.9%).
£2h £4h->2h £2h->4h >12h
Number of pts 84(8) 1,420(152) 1,805(212) 1,058(198)
Mortality (%) 9.5%* 10.7%** 11.7%** 18.7%
Conclusion:
1. Regional networks should be organised to increase the primary transport of STEMI
pts to PCI hospitals.
2. Primary PCI is an adequate revascularisation strategy if it is prformed less than 12
hours after onset of symtoms.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PW098
POSTER ABSTRACTS
Early versus Delayed Percutaneous Coronary Intervention in Patients with Non-ST
Elevation Acute Coronary Syndromes
Matias Yudi*1, Christopher Reid2, Bryan P. Yan3, Ernesto Oqueil4, Matthew Brooks5,
Khoa Phan1, Eliza Teo1, Melanie Freeman6, Andrew Ajani1, David Eccleston1
1
Cardiology Department, Royal Melbourne Hospital, 2Monash University, Melbourne, Australia,
3
Chinese University of Hong Kong, Hong Kong, Hong Kong, 4Cardiology Department, Ballarat
Hospital, Ballarat, 5Royal Melbourne Hospital, 6Cardiology Department, Austin Hospital,
Melbourne, Australia
Introduction: International guidelines advocate early angiography and percutaneous cor-
onary intervention (PCI) for high-risk patients presenting with non-ST elevation acute
coronary syndromes (NSTEACS). Scoring systems, particularly the GRACE and TIMI
scores, have been used in clinical trials to identify high-risk patients. In real-world practice,
the use of these scoring systems to guide timing of intervention appears to be limited. Thus
it is unclear which patients are more likely to receive early PCI and how this impacts on
short and long term clinical outcomes.
Objectives: The aim of this study is to compare the clinical characteristics and outcomes,
both 30-day and 12 month, of patients with NSTEACS depending on the timing of their
PCI from initial presentation.
Methods: The Melbourne Interventional Group Registry was analysed from 1st January 2005
until December 31st 2011. Patients were divided into two cohorts: those who underwent PCI
within a calendar day of presentation (early PCI group) and those who received PCI group
after one calendar day, but within the index admission (delayed PCI group). Patients trans-
ferred from a non-PCI capable hospital were excluded. Clinical characteristics and outcomes
were obtained. The primary efficacy end points were 30-day and 12-month mortality,
myocardial infarction (MI), target vessel revascularization (TVR) and major adverse cardio-
vascular events (MACE). The primary safety endpoint was in-hospital bleeding complications.
Results: 4307 patients with NSTEACS were included in the analysis with 51% undergoing
PCI within a calendar day of admission. Patients undergoing delayed PCI were more likely
to be older (67yrs vs 64yrs, p<0.01), have troponin elevation (70% vs 66%, p<0.01), have
diabetes (32% vs 25%, p<0.01), have had a previous MI (33% vs 26%, p<0.01) and
previous CAGS (14% vs 8%, p<0.01). Delayed PCI was associated with higher 12-month
mortality (5% vs 3%, p¼0.03), MI (8% vs 5%, p<0.01) and MACE (15% vs 12%,
p<0.01). On multivariate analysis, delayed PCI was not an independent predictor of
mortality at 12-months with an odds ratio of 0.95 (95% confidence interval, 0.68-1.31).
Conclusion: In an Australian PCI cohort, patients with NSTEACS and high risk features
were more likely to undergo delayed PCI. Delayed PCI was not an independent predictor of
mortality at 12-months.
PW099
A comparison of standard and high sensitivity troponin assays and the rates of
reclassification to a potential myocardial infarction
Peter S. Dias*1, Samuel D. Vasikaran2, John Blennerhassett2, Carl Schultz1,3, James Rankin1,
Damon A. Bell2,4,5
1
Cardiology, Royal Perth Hospital, 2Department of Clinical Biochemistry, PathWest Laboratory
Medicine, Royal Perth Hospital, 3School of Medicine and Pharmacology, 4Schools of Medicine &
Pharmacology and Pathology & Laboratory Medicine, University of Western Australia, 5Lipid
Disorders Clinic, Department of Internal Medicine, Royal Perth Hospital, Perth, Australia
Introduction: Newer troponin assays that are capable of accurately and precisely
measuring troponin at the 99th percentile of an illness free (normal) population have the
potential to improve patient care by rapidly identifying patients with myocardial infarction
(MI). The Abbott high sensitivity troponin I (hsTnI) assay is able to precisely determine the
normal troponin distribution, however the 99th percentile was different for men and
women. There has been a consensus among Australian laboratories using hsTnI to adopt
these gender specific reference intervals: males <26 ng/L and females < 16ng/L.
Objectives: To evaluate in a real world clinical setting, the impact of adopting the gender
specific hsTnI cutpoints in terms of identifying the proportion of negative troponin I (TnI)
results that would be reclassified as a potential MI based on a hsTnI assay.
Methods: Abbott hsTnI was retrospectively analysed on 600 consecutive plasma specimens
over a 17 day period where TnI was clinically requested. The 99th percentile based
threshold for the current Architect STAT TnI assay was 0.04 mg/L regardless of gender.
The 99th percentile based threshold for the hsTnI assay was >26 ng/L for males and >16
ng/L for females. Results are shown as a mean +/- standard deviation.
Results: There were results for 343 males and 257 females. Mean age was 65.718.4 years.
Mean age for males 63.117.3 years was lower than for females 69.119.3 years (p<0.0001).
Forty eight patients (8%) were reclassified with potential MI based on a hsTnI result above
the 99th percentile: 16 (4.7% of) males and 32 (12.4% of) females (p<0.001). Of the
reclassified patients, 12 males and 12 females had TnI of 0.03 mg/L and 18 females had TnI of
0.02 mg/L.
There were 5 (0.83%) patients with hsTnI results less than the 99th percentile who had
TnI results greater than the 99th percentile: 3 males and 2 females (p¼1.0). All of these
patients had a TnI of 0.04 or 0.05 mg/L. None of these 5 patients had angiography or
admission to hospital with MI in the subsequent 14 months.
Conclusion: During this 17 day period, the hsTnI identified an additional 48 (8%) patients as
having a potential MI based on troponin I >99th percentile. Females were significantly more
likely to be reclassified than males. The small percentage of patients (0.83%) with a TnI above
the 99th percentile but a hsTnI below the 99th percentile may have a good prognosis.
Disclosure of Interest: None Declared
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 PW100
POSTER ABSTRACTS
A Comparison Of Door To Balloon Times Between Different Age Groups At The
Prince Charles Hospital – A 5 Year Experience
Ali Safaa*1,2, Alexander Incani1, Christopher Raffel1, Michael Savage1, Jinlin Fu3, Brendan Bell1,
Karl Poon1, Darren Walters1,2
1
Cardiology Department, The Prince Charles Hospital, 2The University of Queensland, 3Mater
Medical Research Institute, Brisbane, Australia
Introduction: Achieving rapid reperfusion of the infarct related artery by shortening the
door to balloon time (D2B) to < 90 minutes in ST-Elevation Myocardial Infarction (STEMI)
patients correlates well with improved outcomes. Some international studies have sug-
gested longer D2B times in elderly patients.
Objectives: This study aimed to determine D2B times in elderly patients versus their
younger counterparts with STEMI re-vascularised by primary percutaneous coronary
intervention (PPCI).
Methods: A cohort of 516 consecutive STEMI patients was studied for D2B times after
PPCI at TPCH. Patients were divided into three groups: those >70 years (elderly), 50-70
years (middle aged) and those < 50 years (young).
Results: The overall average and individual groups D2B times were well within the
recommended 90 minutes, yet the elderly group of patients had a statistically signif-
icant longer D2B time compared to the younger population (by 9.95 minutes p ¼
0.019).
< 50 years 50-70 years > 70 years Total
Number of patients 98 (18.9%) 294 (56.9%) 124 (24%) 516
Average D2B (min) 57.30 +/- 29.4 60.21 +/- 37.7 67.25 +/- 34.5 61.40+/- 35.58
Conclusion: Despite applying the same PPCI contemporary STEMI protocol to
different age groups at the Prince Charles Hospital, the elderly population seem to have
significantly longer door to balloon times compared to younger patients. The reasons
behind this need to be addressed if we are to improve STEMI outcomes in our ageing
population.
Disclosure of Interest: None Declared
PW102
Beyond the general cardiologist: Sub-specialization in ACS care impacts mortality
Dylan Jones*1, Derek Chew1, Sam Lehman1, Carmine G. De Pasquale1,
Andrew D. McGavigan1, Julian Vaile1, Cameron Bridgman1, Ajay Sinhal1, William Heddle1,
Robert Minson1
1
Cardiology, Flinders Medical Centre, Adelaide, Australia
Introduction: Despite formal acute coronary syndromes (ACS) guidelines, clinical
discretion still plays a large role in patient management decisions. Greatest variation is seen
in the decision to provide percutaneous coronary intervention (PCI) versus conservative
management. It is unclear whether the cardiologist subspecialty impacts the provision of
care and mortality.
Objectives: This analysis aims to determine the relationship between treating cardiologist
subspecialty on provision of invasive management and long-term mortality in patients with
an ACS.
Methods: All ACS patients (STEMI, NSTEMI and Unstable Angina) admitted to a
tertiary teaching hospital from 2003 to 2012 were stratified by admitting cardiol-
ogist subspecialty (Interventionalist (INT) vs Non-Interventionalist (NON-INT)).
Cardiologists were rostered to clinical service on a weekly basis without consider-
ation of their subspecialty interests. Patients were assessed for baseline comorbidities
and a logistic regression model for predicted 12-month mortality risk was used to
stratify patients (predicted mortality: 0-4.9%, 5-9.9%, 10-14.9% or >15%). Rates of
in-hospital angiography, PCI and CABG were assessed, as well as mortality by 12
months.
Results: In total, 8,193 consecutive ACS patients were identified. When grouped by
cardiologist subspecialty, patients admitted under non-interventionalists were slightly
older (mean age: INT 65.6 years vs NON-INT 67.7 years, p¼0.0001), more
frequently had a past history of heart failure (INT 8.6% vs NON-INT 10.3%,
p¼0.009) but had no difference in baseline renal function or the need for ICU
admission. Angiography and PCI were significantly more frequent among INT-
managed patients (INT 57.6% vs NON-INT 52.0%, INT 34.9% vs NON-INT 27.4%,
respectively, p<0.001 each). When adjusting for age and comorbidities, 12-month
mortality was higher among NON-INT patients (hazard ratio of 1.16, [95% CI 1.05-
1.28], p¼0.004). The greatest mortality differences were observed among the highest
risk patients.
Conclusion: Treatment directed by an interventional cardiologist is associated with a
significant increase in the use of angiography and PCI, and a lower rate of late
mortality, most evident among patients at increased risk. As subspecialization in
cardiology continues to emerge, these data suggest that the development of stream-
lined cardiac services that aligns clinical expertise with the management of ACS pa-
tients, even at the highest levels of clinical training, may lead to further improvements
in outcome.
Disclosure of Interest: None Declared
e280
PW103
Risk assessment for STEMI management: which score fits best the Tunisian context?
Ghassen Cheniti1, Majed Hassine1, Marwen Mahjoub1, Nidhal Bouchehda1, Ibtihel Mechri1,
Mejdi Ben Messoud1, Zohra Dridi1, Fethi Betbout1, Habib Gamra*1
1
Cardiology A department, Fattouma Bourguiba Hospital, Monastir, monastir, Tunisia
Introduction: Risk assessment after ACS is essential. Risk scores have been mainly used in
Non-STEMI patients; nevertheless, patients with STEMI should also be screened according
to their risk. Scores have been validated in European and American populations but have
not been tested in African populations such as the Tunisian-one.
Objectives: to compare the short term prognosis according to the GRACE and TIMI scores
for STEMI.
Methods: GRACE and TIMI scores for STEMI were calculated for patients who were
admitted for STEMI to the Cardiology A department of Monastir between January 2000
and June 2012. All variables included in each score were tested by univariate analysis then
included in multivariate model. ROC curve was assessed for each score.
Results: 1162 patients were included in our analysis. 132 deaths occurred during the study
period. All variables included in both scores were tested by univariate analysis and were
significantly correlated to intra-hospital mortality except time delay to reperfusion >
4hours (p¼0.38). By multivariate analysis, the model provided 88.6% power to predict
mortality and explained 35.1% of the outcome. Mean GRACE and TIMI scores were
significantly higher in the mortality Group (respectively: 198 vs 149 and 7.46 vs 5.88;
p<0.001).
ROC curve was then drawn for each score; GRACE score provided a better accuracy in
predicting the outcomes (AUC: 0.862, CI 95% [0.788-0.863]) than TIMI score (AUC:
0.715, CI 95% [0.668, 0.762]).
web 3C=FPO
Conclusion: In Tunisia, GRACE score seems to be more powerful in predicting intra-
hospital mortality after STEMI and therefore it should be assessed in every patient.
Disclosure of Interest: None Declared
PW104
Right ventricular infarction in the setting of inferior myocardial infarction: when does
it occur and affect prognosis?
Ghassen Cheniti1, Majed Hassine1, Marwen Mahjoub1, Nidhal Boucheda1, Mehdi Khlif1,
Mejdi Ben Messoud1, Zohra Dridi1, Fethi Betbout1, Habib Gamra*1
1
Cardiology A department, Fattouma Bourguiba Hospital, Monastir, monastir, Tunisia
Introduction: Right ventricular (RV) infarction complicates up to 50% of inferior
myocardial infarctions (MI). Although RV shows good long term recovery, in the short
term, RV involvement portends a worse prognosis to uncomplicated inferior MI. Data for
predictive factors for the RV infarction in inferior MI and for mortality after RV involvement
remain scarce.
Objectives: to study predictive factors for the occurrence of right ventricular infarction in
the setting of inferior MI and assess intrahospital mortality for symptomatic and/or elec-
trocardiographic RV infarction.
Methods: Data was collected from the MIRAMI registry which is a monocenter registry
including all patients with MI seen in cardiology A department in Monastir between
January 1995 and March 2013. All the variables were tested by univariate analysis then
included in multivariate model.
Results: 1483 patients were enrolled in our registry, 661 patients had an inferior MI among
whom 160 (24.2%) patients had a RV infarction. 37 (23.1%) patients presented with RV
heart failure while the remaining patients presented with isolated features of RV involve-
ment attested by ST elevation in right leads.
Predictive factors for the occurrence of RV involvement in inferior MI were the age (OR:
1.024, 95% CI [1.01; 1.04], p:0.02) and a history of coronary artery disease (OR: 1.97,
95% CI [1.01; 3.89], p:0.048). When complicated RV infarction, inferior MI is associated
with worse outcomes and higher mortality (5.8% vs 12.5%, p: 0.005).
Patients with RV infarction benefited from was Thrombolysis in 48 cases (30%), an-
gioplasty in 62 cases (38.8%), a combined treatment in 10 cases (6.3%) and medical
treatment in 40 cases (25%). No strategy was associated with higher mortality (p: 0.556).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 Factors found to predict intrahospital mortality for patients with RV infarction were: renal PW106

POSTER ABSTRACTS
impairment defined as creatinine levels >130umol/l (OR: 8.22; 95% CI [1.33-50.9]; p:
0.023), 3 vessel disease (OR: 7.09; 95% CI [1.738-28.93]; p: 0.006) and the association of Systems of Repurfusion for STEMI in Hunter New England NSW
signs of left ventricular failure with KILLIP >1 (OR: 4.09; 95% CI [1.58-10.58]; p:0.004). Lindsay Savage*1, Trent Williams1, Peter Fletcher1, Paul Stewart2, Dawn McIvor1,
Helen Orvad1
1
Cardiology Stream, Hunter New England Health, Newcastle, 2New South Wales Ambulance
web 3C/FPO

Service, Ambulance, Sydney, Australia

Conclusion: RV infarction complicates inferior MIs mainly in elderly and in patients with a
history of coronary artery disease. In this setting, prognosis is dramatically affected par-
ticulary in patients with renal impairment, 3 vessel disease and KILLIP> 1.
Disclosure of Interest: None Declared
PW105
Coronary artery disease in The Young In India – A gender based comparison
Harikrishnan Sivadasanpillai*1, Jaganmohan Tharakan1, N. Jayakumari2, Reema George2,
Jeemon Panniyammakal3, Manas Chacko1, Krishna Sankar1, Vivek Narayanan1, Suresh Babu1,
C. P. Vineeth1
1
Cardiology, 2Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences and Technology,
Trivandrum, India, Trivandrum, 3Center for Chronic Disease Control, New Delhi, India
Introduction: Coronary artery disease(CAD) affects Indians at a younger age. There is
paucity of data on young patients with CAD from India.
Objectives: To compare the risk factor profile and mode of presentation of young females
(less than 55 years) versus males in the same age group.
Methods: Retrospective analysis of the data of consecutive patients admitted to SCTIMST,
a tertiary care center in South India from 2001-2010 (10 years). The data regarding CAD
risk factors and mode of presentation were analyzed.
Results: During the 10 year period, 18537 patients presented to the hospital with CAD.
Out of them 4933 (26.6%) were below 55 years. Out of the 4933 patients, 4333 were males
(87.8%) and 600 were females (12.2%).
Females were slightly older compared to males. Hypertension and diabetes mellitus were
Introduction: The importance of reducing time to reperfusion in the treatment of STEMI is
well known. The greatest benefits are gained when treatment is achieved closest to
symptom onset and first medical contact. An integrated system of clinicians using tech-
nology to support point of care STEMI diagnosis is utilised within Ambulance, remote rural
health facilities and tertiary hospitals to maximise the potential benefit to the patient with
STEMI. Hunter New England (HNE) Local Health District in NSW covers 130,000 square
kilometres or an area comparable to England.
Objectives: The objective for reperfusion services in HNE is to provide early accurate
identification and treatment of STEMI. Remote rural sites and teaching hospitals need
to offer treatment that does not disadvantage the community through isolation or
distance while relationships within health are used to best advantage to achieve that
objective.
Methods: HNE provides three distinct but integrated solutions to the treatment of
STEMI. Access to primary angioplasty is provided for patients where pre-hospital or
inter-hospital STEMI identification and transport to the CCL is within 60 minutes from
first medical contact. Patients who cannot achieve that benchmark are assessed and
where appropriate provided lysis by paramedics, nurses or doctors as soon as possible.
Identification of STEMI is supported in all hospitals (n¼36) and ambulance by the
utilisation of the Glasgow algorithm and the ability to electronically send ECG for
expert review.
Results: HNE has 14,500 patients’ present with cardiac symptoms to its facilities. Uti-
lisation of the Glasgow algorithm in the management of STEMI has been implemented with
varying success. Local epidemiological data has shown a trend in failure to appropriately
treat STEMI. Current instances of inadequate treatment of STEMI have been linked to the
non - use of the algorithm and transmission of the ECG to gain expert support.
Pre–Hospital Thrombolysis and Nurse Administered Thrombolysis have both achieved
timely reperfusion in a rural environment.
Conclusion: An integrated system of reperfusion management utilising appropriate clini-
cian skills supported by a point of care electronic ECG interpretation and transmission
system is possible over a large geographical area. Resistance to change in the management
of STEMI poses occasional implementation difficulty.
Disclosure of Interest: None Declared
PW107

GENDER The value of electrocardiographic changes in predicting culprit coronary artery in

patients with Acute Myocardial Infarction and Combined ST-segment Elevation in
Female Male Anterior and Inferior Leads
AGE GROUP <35 8 (1.33%) 131 (3.02%)
Mir Milad Pourmousavi Khoshknab*1, samad ghafari2
36-45 140 (23.33%) 1240 (28.62%) 1
Medical student, Member of scientific Association of medical university, Tabriz branch, Islamic
46-55 452 (75.33%) 2962 (68.36%) Azad University, Tabriz, Iran, Member of scientific Association of medical university, Tabriz
PRESENTATION Non-ACS 271 (45.18%) 945 (21.85%) branch, Islamic Azad University, Tabriz, Iran, 2Madani heart hospital of Tabriz, Iran, Tabriz
medical university, Tabriz, Iran, Islamic Republic Of
ACS 329 (54.82%) 3387 (78.15)
Introduction: Simultaneous elevation of ST-segment in precordial and inferior leads of
patients with acute myocardial infarction is a rare finding. Acute occlusion of left
anterior descending (LAD) coronary artery often results in ST-segment Elevation in
V1-V6 leads and depression in inferior leads. Also occlusion of the right coronary
Variables Men (n[4333) Women (n[600) P value
artery (RCA) is a rare cause of combined ST-segment elevation in anterior and inferior
Age (mean, SD) 47.62 (5.88) 49.03 (5.27) <0.001 leads.
Family history (n, %) 1297 (29.93) 223 (37.35) <0.001 Objectives: The clinical and Angiographic importance of combined ST-segment elevation
in anterior and inferior leads is not yet established, so the aim of this study is determine the
Hypertension (n, %) 1848 (46.25) 389 (64.83) <0.001 value of this pattern.
Diabetes (n, %) 1530 (35.31) 317 (52.83) <0.001 Methods: In a cross-sectional–analysis study on 3650 patients, 60 out of 3650 patients
Dyslipidemia (n, %) 2191 (50.57) 286 (47.67) 0.183
with acute myocardial infarction (1.6%) had combined ST-segment elevation in anterior
and inferior leads. These patients were studied during a period of 6 years at the Madani
Tobacco use (n, %) 2839 (65.52) 8 (1.3) <0.001 heart hospital of Tabriz, Iran. Angiographic and electrocardiographic findings of patients
were gathered for comparison. Vessel diameter stenosis  50% was considered Significant.
Results: Based on angiographic findings of study population, in 34 (57%) patients LAD
significantly more prevalent among females. Smoking was negligible among females artery was the Culprit vessel and in most of them [30 cases (88%)] it had a wrap around
(1.3%), but 65% of the males gave a history of smoking. A positive family history of appearance. In the remaining 26 (43%) patients RCA was responsible for the infarction. In
premature coronary artery disease was significantly more among females(30 vs 37%). The the LAD Group, 31 patients had patent RCA which was completely normal or had a lesion
lipid profile (all in mg/dl, SD in parentheses) was significantly different, males Vs females. with diameter stenosis of <50%. In the RCA Group, 22 patients had patent LAD and only 4
Total cholesterol (TC), LDL cholesterol (LDLC) and HDL cholesterol (HDLC) were patients showed significant stenosis of LAD. The two groups were matched for age, sex,
significantly higher (p<0.001) among females [ TC - 188.40 (53.41 Vs 172.37 (49.19), medical history and risk factors for atherosclerosis, electrocardiographic pattern and me-
LDL - 121.53 (50.24) Vs 106.06 (43.18), HDLC – 39.09 (10.38) Vs 34.51 (8.86) ]. chanical complications of acute myocardial infarction, the mean left ventricular ejection
Triglyceride levels were higher among males 158.34 (72.83) Vs 137.29 (67.90). Males fraction, rate of thrombolytic therapy, and six-month mortality rates were similar. The ST-
presented more commonly with ACS (78%) while almost half of females (45%) had a non- segment elevation in leads V2  V3 had a sensitivity of 77.2% and specificity of 78.4% in
ACS mode of presentation.(p<0.001). predicting the LAD as culprit vessel. Also ST elevation in lead III  II had a sensitivity of
Conclusion: This data shows that females have higher prevalence of risk factors which 54.4% and specificity of 72.6% in predicting the role of RCA as culprit vessel.
predisposes them to the development of CAD in this younger age. Smoking is a very Conclusion: Most cases of acute myocardial infarction with simultaneous ST-segment
important risk factor among males. Programs for early detection and control of risk factors elevation in the anterior and inferior leads are the result of a single coronary artery blockage
will do a great extent in preventing the development of CAD in the young population in and electrocardiographic findings can be helpful in determining the involved coronary
Kerala, India. artery.
Disclosure of Interest: None Declared Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e281

 PW108 PW112
POSTER ABSTRACTS

A retrospective review of the impact of concurrently implementing Pre-hospital Use of Intensive Lipid-lowering Therapy in Patients Hospitalized with Acute
Ambulance activation of Primary Angioplasty and opening a second coronary Coronary Syndrome in Dubai, United Arab Emirates
catherisation laboratory on door to balloon times for ST elevation myocardial
infarctions Sahar Hussain1, Syed M. Shah*2, Sadeq I. Tabatabai3, Fathimunnissa Hussain4, Kosar Hussain5,
Ahmad F. Alhimairi3, Nooshin M. Bazarghani3, Arif A. A. AlMulla3, AfzalHussein Yusufali6
Sarah Fitzsimons*1, Mark Sader1, Sharon Wilson1 1
Clinical Pharmacy, Dubai Pharmacy College, Dubai, 2Institute of Public Health, College of
1
Cardiology, St George Hospital, Sydney, Australia Medicine and Health Sciences, United Arab Emirates University, Al Ain, 3Cardiology, 4Dubai
Introduction: Improved door to balloon times (DBT) correlate with better outcomes for Heart Centre, Dubai Hospital, 5Internal Medicine, Rashid Hospital, Dubai Health Authority,
6
patients with ST Elevation Myocardial Infarctions (STEMIs). In order to improve the DBT Cardiology, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
at St George Hospital, a tertiary referral centre providing 24-hour primary coronary an-
Introduction: Early and intensive lipid-lowering therapy (LLT) in patients with acute
gioplasty, a Pre-hospital Ambulance activation of Primary Angioplasty (PAPA) commenced
coronary syndrome (ACS) reduces cardiovascular morbidity and mortality. Few data is
in June 2011. This coincided with re-installation of the second catheter laboratory, which
available about the utilization and predictors of LLT among hospitalized ACS patients in
had been non-functional for 6 months.
United Arab Emirate (UAE).
Objectives: We sought to assess the impact on DBT of, firstly, the implementation of the
Objectives: This study aimed to analyze the use of intensive LLT at discharge in patients
PAPA system and secondly the availability of a second laboratory for presentations that
hospitalized with ACS in a tertiary care hospital in Dubai, UAE.
occur ‘in hours’ (08:00 – 17:00).
Methods: The study is based on the data collected for ACS-related admissions in Dubai
Methods: Data is routinely collected using a standardized form and securely stored for
Hospital in UAE between 2006 and 2010. The use of intensive LLT, defined as dose of
every STEMI. Retrospective analysis was conducted for each STEMI patient who presented
statin or combination therapy likely to produce >50% reduction in low-density lipoprotein
in the 15 months before and after PAPA implementation. ‘In hours’ data was reviewed for
(LDL) and less intensive LLT at discharge was assessed. We compared the baseline char-
the six months pre and post the second laboratory re-installation. ‘Door to balloon time’
acteristics and temporal trends in these two groups.
(DBT) was defined as ‘time of emergency triage’ to ‘time of balloon inflation’ for all pre-
Results: Out of 1,899 (95.4%) patients discharged on LLT, only 676 (35.6%) were
sentations except PAPA cases where DBT was defined as the ‘time of ambulance arrival’ to
treated with an intensive LLT regimen. Among those with LDL >130 mg/dl, only
‘time of balloon inflation’.
39.4% or less received intensive LLT. We did not find statistically significant variation
Results: Populations were similar with an average age pre and post PAPA of 64 years.
in intensive LLT by male (35.8%) and female (35.2%) gender, and by nationality,
Male patients accounted for 74% of the population pre PAPA and 78% in the post PAPA
South Asian (35.2%), Arabs (33.0%), native Emirati (39.9%) and others (38.3%). Mean
period.
total cholesterol, LDL-cholesterol and triglycerides were significantly (p<0.05) higher
There were 75 STEMIs with an average DBT of 93minutes in the 15 months prior to
in the intensive LLT group. Predictors of intensive LLT at discharge included history of
PAPA implementation and 96 STEMIs (68 non-PAPA and 28 PAPA cases) with an average
hypercholesterolemia, diabetes, and use of beta-blockers prior to the admission to
DBT of 67 minutes (78 and 41 minutes respectively) in the 15 months post. DBT improved
hospital. We noted an increase in use of intensive LLT from 25.5% in 2007 to 71.4%
on average by 26 minutes (15 minutes for non PAPA cases and 52 minutes for PAPA cases).
in 2010.
For PAPA cases DBT decreased by 56% (p<0.05).
Conclusion: In our study sample of patients with ACS, a high proportion of eligible pa-
In the 6 months prior to PAPA 14 of the 33 STEMIs occurred ‘in hours’ with an average
tients were not discharged on intensive LLT. The increase in use of intensive LLT over
DBT of 78minutes. In the 6 months post PAPA 18 of 33 STEMIs occurred ‘in hours’ with a
study years is encouraging.
DBT of 65 minutes. For in hour presentations there was an average 13 minute reduction of
Disclosure of Interest: None Declared
DBT after the re-installation of the second catheter laboratory-an improvement of 18%
(p<0.05).
Conclusion: Implementation of Pre-hospital Ambulance activation of Primary Angioplasty PW114
significantly decreased door to balloon time for primary coronary angioplasty in ST Clinical significance of carotid plaque score in the prediction of coronary artery
Elevation Myocardial Infarctions. The availability of a second catheterization laboratory ‘in complexity in patients with suspected angina pectoris
hours’ added to improved door to balloon times.
Disclosure of Interest: None Declared Haruhiko Higashi*1, Makoto Saito2, Shinji Inaba1, Hiroe Morioka1, Jun Aono1, Toyofumi Yoshii1,
Go Hiasa1, Takumi Sumimoto1, Jitsuo Higaki3, Akiyoshi Ogimoto3
1
PW109 Kitaishikai Hospital, Ozu, Japan, 2Menzies Research Institute Tasmania, Hobart, Australia,
3
Ehime University Graduate School of Medicine, Toon, Japan
Ratio Of Proinflammatory And Antiinflammatory Factors For Acute Coronary Heart
Disease Course Introduction: The SYNTAX score is strongly associated with the complexity of coronary
1 1
artery disease (CAD). Recently, several non-invasive testing for the severity of atheroscle-
Sergii K. Kulishov* , Nataly P. Prihodko rosis has been shown to predict CAD.
1
internal medicine No 1, Higher state educational institution of Ukraine (HSEIU) “Ukrainian Objectives: We set up this study to examine which non-invasive test has the strongest
Medical Stomatological Academy”, Poltava, Ukraine relation with SYNTAX score and its incremental value over clinical parameters.
Methods: 266 consecutive patients (7011 yrs, 64% males) with suspected angina pectoris
Introduction: The aim of the study was differential diagnosis of the inflammation syn- who had coronary angiography and non-invasive tests during the index admission were
drome at the patients with ACHD. studied. We measured three parameters (plaque score (PS), mean intima-media thickness
Objectives: The study included 27 patients (64,521,82; 9,08 years old – y.o.) with ST (IMT), and max IMT) using carotid ultrasonography and 2 parameters (ankle-brachial
segment elevation acute myocardial infarction (STEMI) and 25 (64,151,58; 8,23 y.o.) - index (ABI) and brachial-ankle pulse wave velocity) using plethysmography. We also
with unstable angina pectoris (UAP). 10 healthy subjects 22-58 y.o. consisted control calculated Framingham risk score for CAD.
group. Results: The prevalences of patients with low (0-22), intermediate (23-32), and high
Methods: Research included investigation of cardiac biomarkers, interleukin-10 (IL- ( 33) Syntax score were 88.3, 6.0, and 5.7%, respectively. SYNTAX score  23 was
10), high sensitive C-reactive protein (hsCRP), auto-antibodies to chaperone 60 (anti-
Hsp 60); Statistical analysis included t-Student’s t test, ANOVA, tests Kruskal-Wallis
(KW), Mann-Whitney (MW) (SPSS for Windows Release 13.00, SPSS Inc., 1989–
2004). Calculated value of M - mean, SEM - standard error; SD-standard deviation,
95% Cl-95% confidence intervals for the mean, Med - median; Q - lower and upper
quartiles.
Results: Ratio on division of the level anti-Hsp 60 and hsCRP (anti-Hsp 60 / hsCRP) at
patients with STEMI was significantly lower {15,914,43; 23,04 conventional units (c.u.);
(6,80-25,03); 5,73; (2,73-21,64), Pmw¼0,0001} than in healthy 348,02107,55; 340,12;
(104,71-591,32); 275,33; (58,34-583,00). Index ratio of hsCRP to IL-10 {(hsCRP / IL-10)
1,50  0,35; 1,83 c.u.; (0,78-2,22); 0,35; (0,07-2, 43) Pmw¼0,001}; index of dividing the
product of anti-Hsp 60 and hsCRP on IL-10 (anti-Hsp 60 * hsCRP) / IL 10} at patients with
STEMI was significantly higher 109,80  31,48; 163,57 c.u.; (45,10-174,51); 32,17; (2,85-
209,42), Pmw¼0,001 compared with the control group. In patients with UAP were
dominant index ratio of IL-10 to the absolute phagocyte count (IL10/ absolute phagocyte
count) (MSEM; SD; 95%CI: 2,820,27; 1,37; 2,26-3,39 c.u..), moderate this ratio at
patients with uncomplicated STEMI (1,940,38; 1,08; 1,04-2,84 c.u.) and reduced - in
complicated STEMI (1,590,26; 1,11; 1,05-2,13; PANOVA 1-2-3¼0,006) (table 2). A similar
trend was typical for index ratio of hsCRP to the absolute phagocyte count (hsCRP / ab-
solute phagocyte count).
Conclusion: Severe inflammatory and anti-inflammatory activities is characteristic
feature for the patients with UAP. Moderate inflammatory and autoimmune inflam-
matory activity with reduced anti-inflammatory potential was typical for patients with
complicated AMI.
Disclosure of Interest: None Declared

e282 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

 significantly associated with higher Framingham risk score, mean IMT, max IMT, and
PS. In a multivariable regression, PS was an independent predictor of SYNTAX score
 23. In sequential models for the prediction of SYNTAX score  23, a model based
on Framingham risk score, ABI and max IMT was significantly improved by PS
(Figure).
Conclusion: PS has a strong association with complexity of CAD and provides incremental
value over clinical and basic atherosclerotic parameters for the prediction of complexity of
CAD.
Disclosure of Interest: None Declared
PW115
Opportunities In An Ambulatory Setting For A Non-Invasive Diagnosis Of Angina
Pectoris, When Anamnesis And Electrocardiography Fail To Conclude
Jan E. Claessens*1, Philip Claessens2, Christophe Claessens3, Marc Claessens4, Maria Claessens1
1
Cardiology, Cardiological Centre "Kloppend Hart" Schilde-Essen-Antwerpen, Antwerp,
2
Cardiology, AZ Sint Jozef, Malle, 3Internal Medicine, AZ Turnhout, Turnhout, 4Surgery, AZ
Klina, Brasschaat, Belgium
Introduction: Prevention and treatment of ischemic heart disease undoubtedly will
affect the life expectancy of our population. The most obvious and non-invasive
methods in the detection of coronary atherosclerosis remain anamnesis and
electrocardiography.
Objectives: There is need for diagnostic modalities, able to objectively quantify myocardial
function. To reach and to screen the widest possible population, we are obliged to use non-
invasive investigation techniques.
Methods: Study population of 975 male ambulant and self-supporting patients, com-
plaining of thoracic pain, divided in 495 healthy subjects(HS) and in 480 coronary pa-
tients (CP). Both groups subdivided in three age groups: 40-59y; 60-79y; 80-99y.
Measurement by speckle-tracking echocardiography “global longitudinal peak systolic
strain average (GLPSSavg) of left ventricle, divided in 24 segments, and “average peak
longitudinal strain of 5 myocardial segments with the lowest strain values” (Avg5LSS).
Maximal exercise tests on the bicycle to calculate the percentage maximal exercise ca-
pacity expressed in percentage of the performed load compared with the calculated
maximal expected load (PL/EL). Heart rate variation: maximal heart rate at end-exercise
minus heart rate at rest (HR). Sum maximal diameter left atrium plus maximal diameter
left ventricle (LVLA). E/E’ completed our investigation. For statistical analysis we used the
Levene’s Test for Equality of Variances, the t-test for Equality of Means and the 95%
confidence interval.
Results: Significant decrease of GLPSSavg (p¼0,000) for total group and for all age
groups in CP. Similar findings for Avg5LSS. Progressive decrease of PL/EL% with age
as well in HS as in CP. For all groups significant decrease (p¼0,000) of PL/EL% in CP.
HR during exercise statistically significant lower (p¼0.000) in CP. LVLA significantly
higher (p¼0.000) in CP. E/E’ for all groups significantly higher (p¼0,000) in CP
(Table 1). In a graphic representation with GLPSSavg or Avg5LSS on y-axis and PL/EL
%, HR, LVLA or E/E’ on x-axis, we observed two separated and independent clusters
between HS and CP. These findings could be confirmed by 95% confidence interval
(Table 2).
web 3C=FPO
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
POSTER ABSTRACTS
web 3C=FPO
Conclusion: When in an ambulatory setting after anamnesis and electrocardiography the
diagnosis of coronary atherosclerosis remains unresolved, we dispose of non-invasive pa-
rameters to predict underlying ischemic heart disease. Measurement of these parameters,
GLPSS, Avg5LSS, PL/EL%, HR, LVLA and E/E’, can be a guideline for further invasive
cardiac exploration.
Disclosure of Interest: None Declared
PW116
Chest pain in women patients with normal coronary arteriograms; Chest Pain in
Korean Women’s Registry
Kyung-Hee Kim*1, Myung-A. Kim2, Seong-Mi Park3, Wan Joo Shim4, Mi Seung Shin5,
Kyung-Sun Hong6, Sin Gil Ja7
1
Division of cardiology, Sejong general hospital, 2Division of cardiology, SMG-SNU Boramae
Medical Center, 3Division of cardiology, Korea University Medical Center, 4Division of
cardiology, Korea University Medical Center, Seoul, 5Division of cardiology, Gacheon College of
Medicine, Incheon, 6Division of cardiology, Hallym University College of Medicine, Chuncheon,
7
Division of cardiology, Ewha Womens University Hospita, Seoul, Korea, Republic Of
Introduction: Accurate diagnosis of IHD in women is a major challenge to physicians due
to lack of data in Asian population.
Objectives: The aim of study was to improve understanding of women’s non- ischemic
symptom and evaluate risk factors in Korean population.
Methods: Chest Pain in Korean Women’s Registry is a large, multicenter registry data
including demographic and clinical data, symptom and psychosocial variables, coronary
angiographic, echocardiographic data and a variety of blood meaurement.
Results: As part of the core data, 687 women referred for clinically indicated coronary
angiography and 227 patients (33%) were diagnosed with IHD, 240 patients (34%) other
cardiac disease including arrhythmia, microvascular angina, and vasospastic angina and
220 patients (32%) were other problems like GI origin or psychologic disorders. Korean
women with non-IHD has typical chest pain (37%), atypical chest pain like heart burn
(22%), inability to expression (39%) with mainly located at substernal area (40%). Women
with non-IHD are younger (58 vs 63, p¼0.04), have loser prevalence of DM (29% vs 46%,
p < 0.01), family history (22% vs 30%, p¼0.04). Other social history like marital status or
occupations are comparable to IHD patients.
Conclusion: In Korean women with chest pain without fixed coronary lesion are diag-
nosed mostly with microvascular angina or vasospastic angina. They have typical chest pain
and younger age compared with IHD patients.
Disclosure of Interest: None Declared
PW117
Anti-platelet agent sensitivity measured prospectively by Verify Now in patients with
acute coronary syndrome (ACS) predicts transfusion after coronary artery bypass
grafting (CABG)
Sophie Chatterton*1, Rebecca Dignan1, Queenie Luu1, Waleed Aty1, John French1
1
Cardiothoracic, Liverpool Hospital, Liverpool, Australia
Introduction: For patients with ACS, initial therapy includes dual anti-platelet medication
including aspirin. Responses to aspirin are heterogeneous and can be evaluated using point-
of-care platelet function tests. Despite availability of such tests, a concise definition of
aspirin response remains arbitrary, though utilising the near patient VerifyNow Aspirin
assay is clinically appealing.
Objectives: Given the finite supply and complications of blood transfusions, identifying
predictors of bleeding in CABG surgery patients is important. We postulated that patients
who hyper-respond to aspirin, as identified by VerifyNow Aspirin assay, are at increased
risk of transfusion. Current recommendations identify a haemoglobin less than 7g/dL post
CABG as a ‘transfusion trigger’. Therefore, we also proposed that VerifyNow can identify
patients that will have a greater median adjusted drop in haemoglobin, a surrogate marker
of bleeding.
Methods: This prospective cohort study examined response to aspirin, as assessed by
VerifyNow aspirin assay, in patients undergoing CABG surgery (n¼61) at Liverpool Hospital
from 2009 to 2013. VerifyNow aspirin hyper-responders were identified as patients with
aspirin reaction units (ARU) values in the lower 50th percentile. The proportion of patients
e283
 transfused in the CABG group and the median adjusted indexed drop in haemoglobin was
POSTER ABSTRACTS
compared between the two groups. The median adjusted indexed drop in haemoglobin was
calculated by dividing the fall in haemoglobin by the patient’s BSA. Logistic regression was
performed to determine factors associated with increased risk of transfusion.
Results: Seventy percent (21/30) of surgical patients identified as aspirin hyper-responders
by VerifyNow Aspirin, were transfused compared with 38.7% (12/31) of surgical patients
who did not hyper-respond, (OR 3.694, 95% CI 1.275-10.706, p¼ 0.014). Multivariate
analysis also showed VerifyNow Aspirin hyper-response (OR 3.694, 95% CI 1.275-10.706,
p¼0.016) being associated with an increased risk of transfusion. Additionally, VerifyNow
Aspirin hyper-responders had a greater median adjusted indexed drop in haemoglobin
compared to non-hyper-responders (34.1g/L versus 26.6g/L respectively, p¼0.032).
Conclusion: VerifyNow Aspirin is able to pre-operatively identify aspirin hyper-responders
at an increased risk of bleeding and subsequent transfusion in the context of CABG surgery.
A larger study to evaluate the clinical utility of VerifyNow Aspirin in assessing pre-CABG
aspirin therapy is recommended.
Disclosure of Interest: None Declared
PW118
Does Stable Angina Really Confer Long-term Stability?
Alex L.-I. Huang*1, Angela Brennan2, Philippa Loane2, Antony Walton1, Ernesto Oqueli3,
Jessica O’Brien1, Andrew Ajani4, Kerrie Charter5, Anthony Dart1, Stephen J. Duffy1, on behalf of
The Melbourne Intervention Group
1
Cardiology, The Alfred Hospital, 2Centre of Cardiovascular Research & Education (CCRE) in
Therapeutics, Monash University, Melbourne, 3Cardiology, Ballarat Health Services, Ballarat,
4
Cardiology, Royal Melbourne Hospital, 5Cardiology, The Austin, Melbourne, Australia
Introduction: Clinical manifestations of atherosclerosis are often dichotomised into stable
angina resulting from gradual atheroma progression versus acute coronary syndrome (ACS)
triggered by abrupt plaque rupture and thrombosis. While ACS undoubtedly carries a
worse short-term prognosis, data on long-term prognosis between these two presentations
are limited.
Objectives: To determine if stable angina, often perceived as a more benign form of
atherosclerosis, actually carries a better prognosis.
Methods: We compared the demographic and clinical features between patients who under-
went percutaneous coronary intervention (PCI) for stable angina (n¼2,091) and those for ACS
(7,119) in the Melbourne Interventional Group Registry, a collaborative venture of 7 hospitals in
the state of Victoria in which patient clinical and outcome data (up to 12 months) were collected.
Patients with previous ACS or coronary revascularization were excluded from the analysis.
Given the worse short-term prognosis in patients with ACS, a landmark analysis was performed
and events that occurred within 6 months of the index procedure were excluded.
Results: Patients who received PCI for stable angina were older (6511 vs. 6312 years,
P<0.0001) and had a higher prevalence of most traditional risk factors, including increased
body-mass index, diabetes, hypertension, dyslipidaemia, cerebrovascular and peripheral
vascular disease (all P0.003). Stable patients were more likely to receive a drug-eluting stent
(P¼0.0001). ACS patients were more likely to be current smokers, have multivessel disease,
lower left ventricular ejection fraction, have complex lesions, and be treated with bare-metal
stents and a glycoprotein IIb/IIIa inhibitor (all P0.0001). At 12 months, the two groups had
similar rates of major adverse cardiac events (MACE; death, myocardial infarction [MI] and
target vessel revascularization). However, the ACS group had a higher rate of the composite
of death and MI, but lower rates of target vessel revascularization (see table).
Stable Angina (%) ACS (%)
12-Month Event (n[2091) (n[7119) P Value
MACE 10.1 9.1 0.16
Death 0.6 0.9 0.16
MI 2.9 3.6 0.09
Death + MI 3.4 4.4 0.04
Target Vessel Revascularization 8.2 6.5 0.005
Conclusion: Patients with stable angina and ACS have similar overall prognosis in the
medium-term following PCI. However, patients with ACS at the index procedure are still
more likely to have ischaemic events out to 12 months.
Disclosure of Interest: None Declared
PW120
Does obesity increase risk in the patient with an ACS?
Jennifer Barraclough*1, Karice Hyun2, Anushka Patel2, Derek Chew3, Pratap Shetty4,
Antonio Tiberio4, Sanjay Patel1, Steven Coverdale5, David Amos6, David Brieger7, The
Concordance Investigators
1
Department of Cardiology, The Royal Prince Alfred Hospital, 2The Cardiovascular Division, The
George Institute for International Health, Sydney, 3Department of Cardiology, Flinders Medical
Center, Adelaide, 4Department of Cardiology, Wollongong Hospital, Wollongong, 5Department of
Medicine, Nambour Hospital, Nambour, 6Department of Cardiology, Orange Base Hospital,
Orange, 7Department of Cardiology, Concord Hospital, Sydney, Australia
Introduction: Obesity is an established risk factor for coronary artery disease, however,
there are conflicting data on the associations between obesity and outcomes among patients
presenting with an Acute Coronary Syndrome (ACS).
e284
Objectives: To compare the clinical features, in hospital management and outcomes be-
tween obese and non-obese ACS patients in Australia.
Methods: An analysis of ACS presentations in 23 Australian hospitals between 2009-2013
from the CONCORDANCE database. Under and normal weight patients (BMI<25), were
compared to overweight and obese (BMI  25) using Chi-squared tests, odds ratios (OR)
and corresponding 95% confidence intervals (CI).
Results: 2248 patients had a recorded BMI, of whom 1649, (73.3%) were overweight or
obese. The overweight and obese population were younger (62.6 v 66.4 yrs, p<0.0001)
more likely to have coronary risk factors including diabetes (27.7% vs 17.4 %, p <
0.0001), hypertension (63.3% vs 54.4%, p ¼ 0.0001) and dyslipidaemia (58.1% vs 50.3%,
p ¼ 0.0009). There were no differences between groups in receipt of coronary angiography
(83.9% vs 82.9%, p ¼ 0.59), PCI (45.6% vs 43%, p ¼0.28) or CABG 11.1% vs 9.6%, (p ¼
0.32). The use of antiplatelet agents and beta-blockers did not differ between groups,
however, there was more aggressive use of statins in the overweight and obese group (p ¼
0.007). There was a paradoxical reduction in in-hospital mortality (1.9% vs 4.1%, p ¼
0.003) and (re)AMI (2.7% vs 4.2%,p ¼ 0.007) in patients with a BMI 25, but no dif-
ference in stroke and bleeding events. Following adjustment for Grace Risk Score the
difference in (re)AMI persisted (OR 0.31, 95%CI 0.13-0.74).
Conclusion: Elevated BMI is associated with a greater prevalence of risk factors and no
difference in in-hospital revascularization. There is a reduction in reMI in hospital sug-
gesting obesity is not associated with increased risk in established ACS.
Disclosure of Interest: None Declared
PW121
Adverse outcomes of patients with chest pain and primary diagnosis of non-cardiac
pain: A 30 days prospective study
Md. Hossein Soltani1, Masoud Mirzaei*2, Reza Aryanpoor1
1
Department of Cardiology, 2Yazd Cardiovascular Research Centre, Shahid Sadoughi University
of Medical Sciences, Yazd, Iran, Islamic Republic Of
Introduction: Chest pain is a common symptom for referring to emergency department (ED).
Among those referred, some are admitted to hospital with a definite or suspicious diagnosis of
acute coronary syndrome and some discharged with primary diagnosis of non-cardiac pain.
Objectives: This study aims to investigate 30 days adverse outcomes of patients discharged
from emergency department of a major heart center located in Yazd- central Iran during 2011.
Methods: Out of 1638 chest pain admissions, 962 patients (mean age ¼ 50.915.9) who
were admitted with chest pain as their main chief complaint to the Afshar Heart Centre’s
ED and discharged with primary diagnosis of non-cardiac chest pain, were followed 30
days for any cardiac events. The end points were; unstable angina, non ST elevated
myocardial infarction (MI) and ST elevated MI, coronary revascularization, percutaneous
angioplasty, CABG and death.
Results: Cardiac events including acute coronary syndrome (ACS), revascularization and
death were observed in 3.1% of patients, acute MI 5 (%.5), sudden cardiac death in 1
(%.1), coronary revascularization in 8 (%.8) and hospitalization due to unstable angina/
NSTEMI in 16 (%1.7). All-causes mortality was 0.41%. Cardiac events were seen more
frequently in patients with history of hypertension, dyslipidemia and previous coronary
artery disease. The odds ratio for hypertension, dyslipidemia, diabetes mellitus and history
of previous coronary artery disease were 9.3, 3.5, 2.4 and 3.8 respectively.
Conclusion: The extent of cardiac events in patients with a primary diagnosis of non-
cardiac chest pain within 30 days of discharge is significant, mandating nation-wide reg-
istries to provide better care for these patients.
Disclosure of Interest: None Declared
PW122
Presentation, treatment and in-hospital outcome of Acute coronary syndrome in
Young patients in South east Asian population
Md. Abu Salim*1, Sajal Banerjee1, Syed A. Ahsan1, Mohammad Safiuddin1,
Mokhlesur Rahman1, Manzoor Mahmood1, Md A. Siddique1, Jahanara Arzu1
1
Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Introduction: For last few decades Acute coronary syndrome (ACS) has been increasingly
reported in relatively young population. In Bangladesh ACS in patients aged 35 years and
below not studied well yet.
Objectives: The objective of this study is to evaluate the incidence and outcome of these
young group of patients in our population.
Methods: This prospective observational study was conducted in Bangabandhu Sheikh
Mujib Medical University (BSMMU), Dhaka, Bangladesh from march 2011 to june 2013,
total 1238 patients were enrolled. We included ST segment elevation myocardial infarction
(STEMI), non ST segment elevation myocardial infarction (NSTEMI) and Unstable angina
(UA). The standardized questionnaire form for each patient was filled. Information relating
to previous medical history, clinical presentation on admission, in-hospital management
and prognosis was recorded. Data was analyzed into 2 groups as 35 years and 35 years.
The SPSS software was used for all statistical analysis.
Results: Among the patients 24 patients (1.93%) were 35 years or younger. Compared
with other patients chest pain were more likely the presenting symptom (95.2% vs 79.7%;
P<0.005). In other presenting symptoms acute pulmonary oedema was also the presenting
symptom (Killip class III-IV in 4.2 % 20.7%: P<0.05). Among the cardiovascular risk
factors dyslipidemia and family history of Coronary artery disease were more common in
young patients (Prevalance 69% and 53%). Young patients received early and more in-
terventions and had relatively good in-hospital outcome with fewer MACE (major adverse
cardiac events).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: Young patients more commonly presented with chest pain and in the form of
acute STEMI, they received more early intervention and had favorable in-hospital
outcomes.
Disclosure of Interest: None Declared
PW123
Long-term outcomes following coronary artery revascularization procedures in
diabetics and non-diabetics
Michael Nguyen*1, Jamie Rankin2, Matthew Knuiman3, Lee Nedkoff3, Tom Briffa3,
Mark Newman4, Don Cutlip5,6, Elizabeth Geelhoed3, Michael Hobbs3, Frank Sanfilippo3
1
Cardiology, Fremantle Hospital, 2Cardiology, Royal Perth Hospital, 3School of Population
Health, University of Western Australia, 4Cardiothoracic Surgery, Sir Charles Gairdner Hospital,
Perth, Australia, 5Harvard Clinical Research Institute, 6Beth Israel Deaconess Medical Centre,
Harvard Medical School, Boston, United States
Introduction: Patients with diabetes are at greater risk of developing coronary artery
disease and have been shown to have increased adverse outcomes following coronary artery
revascularization procedures (CARPs). Long-term population-based data are needed to
determine the real-world effectiveness of CARPs in patients with diabetes.
Objectives: Comparison of 4-year outcomes in patients with and without diabetes who
had CARPs in Western Australia during 2000-2004.
Methods: Clinical data and linked administrative data (hospital admissions and death) from
the Western Australian Data Linkage System were merged for all patients who had their first
CARP with stents (PCI) or coronary artery bypass graft (CABG) in Western Australia between
2000-2004. A history of diabetes was identified from the linked data using a 10-year
lookback period. Clinical data were collected from all hospitals in Western Australia where
CARP procedures are performed. We calculated the unadjusted (Kaplan-Meier) and adjusted
(Cox) risks for 4-year death (all-cause), admission for myocardial infarction (MI), and the
composite outcome of death/MI admission/subsequent CARP (MACE).
Results: There were 14,118 patients who had CARPs, with 3427 (24%) diabetic patients
(72% males, mean age 64.5, mean Charlson comorbidity score 2.9) and 10,691 (76%) non-
diabetics (78% males, mean age 63.8, mean Charlson score 1.1). In non-diabetics, 9.1% died
within 4 years of the index procedure, compared with 13.7% of diabetics (log-rank
p<0.0001); 4.8% of non-diabetics had an admission for MI compared with 7.4% of diabetics
(p<0.0001); and 13.7% of non-diabetics had a subsequent CARP vs 15.5% of diabetics
(p¼0.008). For MACE, 23.4% of non-diabetics vs 29.7% of diabetics experienced an event
within 4 years of the index procedure (p<0.0001). After adjusting for age, gender, comor-
bidities and other covariates, diabetics had a lower risk of 4-year mortality than non-diabetics
(HR 0.85, 95% CI 0.75–0.96; HR 1.53 95% CI 1.37-1.71 with no comorbidity adjustment).
The risk of MACE at 4 years was equivalent (HR 0.96, 95% CI 0.89-1.04), whilst repeat
revascularization was higher in the diabetic cohort (HR 1.31, 95% CI 1.17-1.46).
Conclusion: In a real world population, patients with diabetes have significantly worse
long-term outcomes (death, MI, repeat CARP) following CARPs than non-diabetics.
However, after adjustment for comorbidities, only repeat revascularization was increased in
the diabetic group.
Disclosure of Interest: None Declared
PW125
Management Of Ischemic Heart Disease In Sub-Saharan Africa: The Experience Of
The Shisong Cardiac Centre
Tantchou Tchoumi Jacques Cabral*1
1
Cardiac centre, St. Elizabeth Catholic General Hospital, Shisong, Kumbo, Cameroon
Introduction: Developing Countries are now undergoing an epidemiological transition as a
result of progressive urbanization and westernization of lifestyle. These changes are leading
to a new epidemiological situation in the world where there is a decline in infectious
diseases and an emergence of cardiovascular diseases in general and ischemic heart disease
(IHD) in particular.
Objectives: The aim of the study was to determine the prevalence, as well as the spectrum
of IHD and its management in Cameroon.
Methods: Between January 2006 and June 2010, 32 patients were evaluated for ischemic
heart disease. Clinical examinations were carried out followed by an electrocardiographic
evaluation and a comprehensive transthoracic Doppler-echocardiogram.
Results: The age range of the patients was between 56 and 82 years (mean: 61.3  5.6). There
were 60% male and 40% female. The mean BMI was 27.8  2.7 kg/m2; the mean blood pressure
was 145  10mmHg systolic and 88  12 mmHg diastolic. According to the instrumental and
clinical criteria of ischemic heart diseases, patients were divided into two groups:
In 26 patients (group I) that represented 4.6% of the studied population, clinical and
electrocardiographic criteria of ischemic heart disease were undertaken. All patients in this
group were hypertensive and overweighed; average blood pressure values were respectively
162  4 mmHg systolic and 92  5.2 mmHg diastolic; BMI was 28.2  2.4 kg/m2; 10%
were smokers, and sedentarity was observe in 2.5%. Three patients were diabetic (11.5%).
Stable angina was present in 11.4% cases; unstable angina was not diagnosed in the
population; acute myocardial infarction in 14.3%, while patients with ischemic cardio-
myopathy with an old myocardial infarction scar were 74.3%.
In 6 patients (group II) representing 1%, only the clinical criterion of ischemic heart
disease was considered. In this group, 25% patients were hypertensive; the mean blood
pressure was 135 37 mmHg –systolic and 85  28 – diastolic. The mean BMI was 27.5 
3 kg/m2. Diabetic patients represented 8%.
Conclusion: The rate of ischemic heart disease in the Cardiac Centre is very low, but the
management of the disease is challenging in our financially constrained area. Therefore
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Government efforts towards improving access to effective and affordable medical care and
POSTER ABSTRACTS
procedures are highly recommended.
Disclosure of Interest: None Declared
PW127
Prognostic Utility Of High-Sensitivity Troponin T Pre-Catheterisation In Patients
Without Significant Coronary Artery Disease
Tom Kai Ming Wang*1, Timothy Oh1, Chinthaka Samaranayake1, Timothy Watson1,2,
James Stewart1, Mark Webster1,2, Peter Ruygrok1,2, Harvey White1,2
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: Myocardial infarction (MI) in patients subsequently shown to have no
obvious, or trivial coronary artery disease (<50% stenosis) at angirography is seldom
studied, but may be attributable to either a primary coronary event or, less commonly, type 2
MI. Recently developed, high-sensitivity troponin T (hs-TnT) assays have increased sensi-
tivity for detection of minor degrees of myocardial necrosis, improving MI detection rate.
Objectives: We assessed the prognostic utility of pre-catheterisation hs-TnT in patients
without angiographically significant coronary narrowing.
Methods: Patients without significant coronary artery disease (CAD) on coronary angi-
ography during July 2010-October 2011 were reviewed (n¼466), and those with pre-
catheterisation hs-TnT measurements studied (n¼256) for Major Adverse Cardiovascular
Events (MACE: death, MI or revascularisation).
Results: Median pre-catheterisation hs-TnT level was 26ng/L (interquartile range 9-88ng/
L). Incidences of MACE at 30 days and during follow-up of 2.3+/-0.6 years were 1.6%
(n¼4) and 5.9% (n¼15) respectively. C-statistics (95% Confidence Interval, CI) of hs-TnT
were 0.888 (0.775-1.000) and 0.684 (0.503-0.865) respectively for predicting MACE at 30
days and during follow-up, with optimal cutpoint being hs-TnT98ng/L. The only in-
dependent predictor of hs-TnT98ng/L threshold was ST elevation; odds ratio 6.60 (95%
CI 2.73-16.0, P<0.001). Log (hs-TnT) was independently associated with MACE at 30
days; odds ratio 9.93 (1.51-65.3, P¼0.017) and MACE during follow-up hazards ratio 2.00
(1.27-3.15, P<0.001). The other predictor of MACE at 30 days was dialysis (P¼0.005),
while chronic respiratory disease (P¼0.015) and ST elevation (P¼0.025) predicted MACE
during long term follow-up.
Conclusion: In patients without significant CAD at angiography, pre-catheterisation hs-
TnT level predicts MACE at 30 days and 1 year. Hs-TnT could therefore be important for
risk stratification and targeted treatment in these patients.
Disclosure of Interest: None Declared
PW128
Leukocytosis and adverse in-hospital outcomes of patients after acute myocardial
infarction in Beijing
Yusheng Zhao*1, Wei Gao1, Zongbin Li1, Jiayue Li1, Qiao Xue1, Xingli Wu1
1
Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
Introduction: An elevated white blood cell (WBC) count at the time of hospital presen-
tation is associated with increased mortality after acute myocardial infarction (AMI). The
association between WBC count and the development of clinically significant complications
of AMI and death during hospitalization for AMI is not well known.
Objectives: The objectives of this observational study were to examine the association
between baseline WBC count, the development of cardiogenic shock, ventricular tachy-
cardia or fibrillation, pneumonia, and death during hospitalization for AMI.
Methods: The study sample consisted of the patients hospitalized with confirmed AMI at age of
15 to 101 at the Chinese PLA General Hospital. The study population consisted of 3,474 men and
921 women hospitalized with validated AMI, in 12 annual periods between 1998 and 2009,
aggregated into quartiles based on WBC count obtained at the time of hospital admission.
Results: In multivariable-adjusted regression analyses controlling for age, gender,
comorbidities, complications, and percutaneous coronary interventions, patients in the
uppermost quartiles of WBC count were at increased risk for cardiogenic shock (odds ratio
[OR] 3.02, 95% confidence interval [CI] 2.21 to 4.12), ventricular tachycardia or fibril-
lation (OR 1.74, 95% CI 1.14 to 2.66), pneumonia (OR 2.54, 95% CI 2.03 to 3.17), and
hospital death (OR 2.66, 95% CI 2.06 to 3.43).
Conclusion: The results of our observational study suggest that the peripheral total
leukocyte count is strongly associated with the development of cardiogenic shock, ven-
tricular tachycardia or fibrillation, pneumonia, and death during hospitalization for AMI.
These findings suggest that the WBC count should be considered an important prognostic
factor associated with adverse hospital outcomes in patients with AMI.
Disclosure of Interest: None Declared
PW129
Right Heart Ventriculography from Left Internal mammarian artery
Imran Onur*1, ekrem B. karaayvaz1, nail G. serbest1, fehmi mercanoglu1, ali elitok1,
kamil adalet1
1
cardiology department, istanbul medical faculty, istanbul, Turkey
Introduction: Acquired aorto-coronary fistulae (ACF) due to inadvertent anastomosis of a
saphenous vein graft or of an arterial conduit to a cardiac vein is a rare complication of
coronary artery bypass greft (CABG) surgery. Surgical repair has been generally recom-
mended for consequential ischemic symptoms regardless of shunt ratio, but percutaneous
catheter-based techniques have also been described.
e285
 Objectives: A 67 years old men had admitted with anterior myocardial infarction and had
POSTER ABSTRACTS
been administered streptokinase successfully six years ago. His control angiography
showed three vessel disease and underwent coronary artery bypass surgery (CABGx3:
LI_MA-LAD, AO-PD, AO-D) same year. His echocardiography had left ventricular wall
motion abnormality, mild left ventricular systolic dysfunction (EF: %49), left atrial
enlargement (4.6 cm), degeneration in aort and mitral valves at that time. He has started
having chest pain about 2 months with pain progression in last week. He has interned with
diagnosis of unstable angina pectoris. In his echocardiography EF was %30.
His coronary angiography showed narrowed diffuse lesions in LAD and Cx arteries. His
RCA was patent as well as his Ao-PD safen greft. During aortography no other greft was
seen. His Ao-PD venosus greft had collaterals feeding LAD territory. Selectively LI_MA was
shown. LI_MA was widened and contrast was going directly right atrium through the great
cardiac vein and coronary sinus. The cardiac veins was dilated as well. The Qp / Qs from
catheterization was 1.1.
Methods: this is a case report.
Results: Although the patient was stable, we decided to treat LIMA to GCV anastomosis
because most ACF patients experience symptoms between 6 weeks and 4 years after CABG
surgery. But in our patient it was more than 6 years and the symptoms of the patient has
started recently, the patient sent to redo CABG.
e286
Conclusion: Iatrogenic ACF is an unusual complication of coronary artery by pass surgery.
With the use of cardioplegia during coronary artery bypass surgery, asclerotic GCV in an
area of epicardial fat or adjacent to an intramyocardial portion of the LAD coronary artery
can easily be confused for the target vessel. In previously reported cases, some of the
patients treated by percutanous coronary interventions and the other including our cases
treated by surgery.
(1-3)
Disclosure of Interest: None Declared
PW131
Perioperative subcinical changes in serum creatinine are predictive biomarker of
increased 30-Day mortality and morbidity after cardiac surgery
Waleed Aty*1,2, rebecca Verchin1, rebecca dignan1
1
cardiothoracic unit, liverpool hospital, sydney, Australia, 2cardiothoracic unit, suez canal
university teaching hospital, ismailia, Egypt
Introduction: Preoperative renal impairment is associated with increase hospital mortality
and morbidity after cardiac surgery.
Objectives: To evaluate wheather subclinical increases in serum creatinine that do not
meet the current defintions of actue renal failure can be used as biomarker predictive of
postoperative mortality and morbidities after cardiac surgery.
Methods: We analyzed the data of retrospective cohort of 1219 consecutive patients
undergoing cardiac surgery in 2008 to 2011. Patients with perioperative serum
creatinine greater than 200 mg/dl, preoperative dialysis or renal transplant were
excluded. Patients were stratified into 5 groups by percent increase in postoperative
creatinine from baseline: <25%, 25% to 49%, 50% to 75%, 76% to 99% and >100%.
Postoperative mortalities and morbidities end point were analysed with multivariate
logistic regression analysis and adjusted odds ratios (OR) and 95% confidence intervals
(95% CI) for all five creatinine groups were reported using the 0-25% creatinine
change group as the reference group.
Results: Patient’s groups with the largest perioperative serum creatinine increase (76 to
99% or >100%) had significantly higher postoperative mortality compared with pa-
tients with a smaller increase (<75%; P<0.001) (OR: 5.37, 95% CI: 2.47-11.67). The
76 to 99 and >100% increase in serum creatinine groups were associated with longer
hours (>24hours) of mechanical ventilationand ICU stay and increase in low cardiac
output syndrome compared to the other groups. Group >100% rise of serum creat-
inine were associated with significant increase in stroke, multiorgan failure . Increase
of perioperative serum creatinine above 50% increased the risk of postoperative renal
failure by 9 times (OR 8.98, 95% CI 3.96-20.37) and in > 100% group increased the
risk by 35 times compared to reference group (OR 35.32, 95% CI16.79-74.31).
Analysis of Serum creatinine change showed that a 47% increase was the best pre-
dictor of renal failure after cardiac surgery, with 86.76% specificity and 64.89%
sensitivity.
Conclusion: Subclinical changes in perioperative serum creatinine in cardiac surgery can
be used as biomarker predictive of postoperative mortality and increased risk of many
major morbidity outcomes. Identification of patients with subclinical worsening renal
function and efforts to preserve renal function before and during cardiac surgery may yield
benefits for patient’s outcomes.
Disclosure of Interest: None Declared
PW133
Impact of transradial angiography on total arterial revascularisation at subsequent
coronary artery bypass surgery
Jason E. Bloom*1, Victoria M. Newgreen1, Nicholas Cox1
1
Department of Cardiology, Western Health, Melbourne, Australia
Introduction: Radial artery access in coronary angiography (RA) has been demonstrated to
reduce bleeding, access site complications and length of hospital stay compared with
femoral access angiography (FA) and so is becoming the preferred route of access for many
cardiologists. Total arterial revascularisation (TAR) is defined as use of all arterial conduits
at the time of coronary artery bypass graft (CABG) surgery. TAR may benefit long-term
graft patency. As TAR frequently requires use of both radial arteries as bypass conduits,
surgeons express concern that the radial artery, if previously cannulated for angiography,
may be unsuitable for use as a conduit at subsequent bypass operation.
Objectives: To determine if RA results in reduced TAR, in patients receiving CABG, when
compared with FA.
Methods: Retrospective cohort study of all patients undergoing angiography at
Western Health in 2011, who were referred for CABG, excluding those with con-
current valvular surgery or previous CABG. The primary end point was use of TAR
at CABG.
Results: 2365 patients underwent coronary angiography, 212 were referred for CABG
and 109 were eligible for study inclusion. Complete data was available for 89 patients
who underwent CABG. Twenty-three patients had RA and 66 FA. TAR was performed
in 60.7% (54) of all patients; 52.2% (12) of RA patients; 63.6% (42) of FA patients
(Graph 1). The 11.4% difference between RA and FA rates was not statistically sig-
nificant (p¼0.332). Radial grafts were utilised in 75 patients, of which 53 were FA and
22 RA. Of the patients who had a radial grafts utilised in their surgery, bilateral radial
artery conduits were used in 18.2% (4) RA group compared with 39.6% (21) FA group
(p¼0.073).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: There was an 11.4% trend towards reduced TAR and 21.4% reduction in
bilateral radial artery use in patients who underwent radial access angiography. This study
was limited by its sample size and ongoing dataset expansion will provide more robust
statistical analysis. Given TAR is proposed as having greater long-term graft patency then
there may be a need to review current practice. Further studies on graft patency outcomes
in patients who have had radial artery grafting after RA will provide important clinical
information.
Disclosure of Interest: None Declared
PW134
Nicotine exacerbates myocardial ischemia-reperfusion injury by aggravating
oxidative stress and neutrophil activation
Anand Ramalingam*1, Satirah Zainalabidin1, Siti Balkis Budin1, Norsyahida M. Fauzi2
1 standing of the steps to follow in case of symptoms. 7-Absence of an adult at home. 8-
Program of Biomedical Science, School of Diagnostic and Applied Health Sciences, Faculty of
Health Sciences, 2Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur,
Malaysia
Introduction: Long term exposure to cigarette smoke, either active or passive increases the
risk of coronary heart disease. Cigarette smoke exposure to animal models increased
sensitivity of heart to ischemia-reperfusion (I/R) injury, with indication of free radical
mechanisms. However, the direct effects of nicotine, a potent free-radical generator in
tobacco, have not been studied against myocardial tolerance to I/R injury except that
prenatal exposure to nicotine exacerbates I/R injury.
Objectives: To investigate tolerance to experimental I/R injury in isolated heart of chronic-
nicotine administered rats.
Methods: Healthy male Sprague-Dawley rats were divided into three groups (n ¼ 8 per
group). Rats were given either saline as control, 0.6 mg/kg nicotine as low-dose or 1.2 mg/
kg nicotine as moderate dose (28 days, i.p.). Upon sacrifice, hearts were excised and
perfused retrogradely using Langendorff technique. Upon stabilisation, hearts were sub-
jected to 20 minutes ischemia and 60 minutes reperfusion. Coronary effluent and portion
of heart tissues were kept frozen for biochemical analysis.
Results: Post-ischemic recovery of rate-pressure product, indicator for myocardial work-
load was significantly (p<0.05) lower in nicotine-administered rats (Low ¼ 48.2  3.4;
Moderate ¼ 45.5  8.2%) than control group (62.4  5.1%). Similarly, recovery of left
ventricle developed pressure, its derivatives (dP/dt) and heart rate were reduced in
nicotine groups. Lactate dehydrogenase (LDH) leakage in coronary effluent, used as index
for cell death was markedly elevated onset of reperfusion in nicotine groups (Low ¼ 36.5;
Moderate ¼ 41.34 U/ml) compared to control (28.4 U/ml). Lipid peroxidation index was
higher in nicotine groups, indicative of high degree of oxidative stress. Moreover, elevated
myeloperoxidase (MPO) activity was seen, indicating aggravated neutrophil activation
during I/R injury.
Conclusion: Chronic nicotine exposure increases myocardial sensitivity to I/R injury by
aggravating oxidative stress and neutrophil-mediated cell injury.
Disclosure of Interest: None Declared
PW135
A dedicated program for PCI to Chronic Total Occlusions improves outcomes
Jeremy Knott*1, George Touma1, David Ramsay1, James Weaver1
1
Cardiology, St George Hospital, Sydney, Australia
Introduction: Successful percutaneous coronary intervention (PCI) of chronic total oc-
clusion (CTO) results in improved clinical outcomes. Yet, PCI is attempted in a minority
and success rates remain low using conventional methods. In February 2011, an institu-
tional CTO-PCI strategy incorporating dedicated dual operators, retrograde PCI, pre-
planning cases and specialised equipment was established after a visiting international
mentorship.
Objectives: To determine the rates of intervention, procedural success, radiation exposure
and outcomes of PCI in patients with CTOs, before and after a dedicated CTO-PCI strategy.
Methods: A retrospective database search was performed for CTOs and chronicity
confirmed by clinical and angiographic variables. Patients with a patent coronary bypass
graft (CABG) were excluded. Detailed clinical and procedural data was collected for each
case. Follow-up for major adverse cardiac events (death, myocardial infarction, target vessel
revascularisation and CABG) was obtained by phone interview. Outcomes were analysed
based upon inclusion in the CTO dual operator program.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: Between January 2008 and July 2013, 889 CTOs were identified on 7363 an-
POSTER ABSTRACTS
giograms. PCI was recommended in 20% and CABG in 38%. Institution of a dedicated
CTO-PCI program increased PCI rates from 17.2% (88/511) to 23.3% (88/378) at the
expense of CABG (40.5% to 34.9%) (p¼0.016). Institutional PCI success rates improved
from 58.8% to 73.3% (p¼0.045) after mentorship. This was due to higher success rates
with dual operators performing anterograde and retrograde PCI (n¼31) compared to single
operators (90% vs 58.5%, p<0.001). These improvements were associated with the
retrograde approach (p¼0.034), dual arterial access (p<0.001), microcatheter use
(p<0.001), intravascular ultrasound (p¼0.035) and planned cases (p<0.001). The
complication rate with dual operators (3%) was lower than single operators (17%).
Contrast use was no different but radiation exposure was increased; Dose Area Product
51043 vs 29831cGycm2 (p<0.001) and fluoroscopy time 59 vs 32min (p<0.001). At a
median follow-up of 2.47 years, those with successful compared with failed PCI had a
greater improvement in angina (p¼0.002), less CABG (p¼0.026) and a trend towards
lower MACE (8.9% vs 30%, p¼0.054).
Conclusion: Chronic total occlusions are common and a dedicated CTO-PCI program
improves referral rates, procedural success and outcomes. This is associated with increased
radiation exposure. Methods of radiation minimisation are being explored.
Disclosure of Interest: None Declared
PW136
Criteria To The Beginning A Program Of Ambulatory Coronary Angioplasty
Ricardo A. Costantini*1, Juan M. Telayna1, Cristian S. García1
1
Interventional Cardiology, Austral University Hospital, Pilar, Argentina
Introduction: The main reasons in elective PTCA that made necessary patients (pt) control
during first night in hospital have been controlled and diminished.
Objectives: To evaluate the safety of the selected criteria to do Ambulatory PTCA, with
same day procedure discharge.
Methods: Two groups: GROUP B: PRE PTCA: 1-Allen negative. 2-PTCA urgent. 3-
Impossibility to sign consent. 4-PTCA post 2pm. 5-LVEF minor 50%. 6-Non under-
Access to hospital post PTCA in more than 40 minutes. INTRA PTCA: 9-PTCA of the only
permeable vessel. 10-LM not protected. 11-Cardiopulmonary resurge. 12-Persistent
changes in EKG. 13-Hemodynamic collapse during balloon inflation. POST PTCA: 14-
Any degree of coronary dissection. 15-Suboptimal result. 16-Intracoronary thrombs. 17-
Branch occlusion. 18-PTCA without stent. 19-Persistent angina post PTCA. 20-Vascular
access: pain, edema, hematome or bleeding. GROUP A: pts not included in group B and
discharged after 4-6 hours of observation.
Final Primary Point: cardiovascular events and related to vascular access within 24 hs
post PTCA (death, urgent CABG, myocardial infarction, rePTCA, pseudoaneurism, major
bleeding, AV fistule, and radial artery occlusion).
POPULATION: 958 PTCA were done since sep 2009, 685 excluded for clinical reasons
or related to vascular access, 273 pts were chosen. 98 pts fulfilled criteria of selection for
group A, 15 refused to participate and 2 pts had post PTCA symptoms. The PTCA will be
made only by radial access. Pts signed an informed consent previously approved by the
Hospitals Ethics Committee.
Baselines: group A and B n(%), respectively: age 609 vs 609; diabetes 34(35) vs
55(31); prior infarction 18(18) vs 46(26); test of effort 95(97) vs 150(86); silent ischemia
57(58) vs 86(49); stable chronicle angina 11(11) vs 19(11); low risk unstable angina 31(31)
vs 70(40); mean vessel diameter 3,41,2 vs 3,40,8; total mms of implanted stents 4731
vs 4225; TIMI flow III final 98(100) vs 172(98).
Results: Groups A and B n(%) respectively: cardiovascular events and related to vascular
access within 24 hours 0 vs 8(4,5) p¼0,05; acute coronary occlusion 0 vs 0; infarction post
PTCA 0 vs 6(3); intrahospital cardiac death 0 vs 1 (0,5); intrahospital non cardiac death
0 vs 1 (0,5).
Conclusion: The selected criteria to beginning a program of Ambulatory Angioplasty
proved to be correct and safe. These parameters will allow a change in the paradigm of care
of the PTCA in 36% of the procedures.
Disclosure of Interest: None Declared
PW137
The Relationship Between Hba1c Level And Coronary Artery Stenosis Severity In
Diabetic Patients With Coronary Artery Disease-An East Coast Malaysia Study
Seng Loong Ng*1, Nik Fathanah Nik Ali2, Wan Mohamad Wan Mohd Izani1, Zurkurnai Yusof1
1
Department of Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, 2Department of
Internal Medicine, Hospital Sultanah Ampuan Afzan, Kuantan, Malaysia
Introduction: The prevalence of Type 2 diabetes mellitus (DM) continues to rise around the
world and much of the global burden of this disease is expected to come from the Western-
Pacific as well as the South-East Asia regions. Coronary artery disease is significantly asso-
ciated with DM. Glycosylated haemoglobin (HbA1c) is used for monitoring diabetic control
and reduction in levels has been associated with reduction in coronary events.
Objectives: This study was done to evaluate the association between HbA1c level and the
degree of coronary artery stenosis. Other objectives include identifying modifiable risk
factors that can be associated with the severity of coronary artery stenosis lesions.
Methods: This was a retrospective study where 124 adult patients with DM who under-
went coronary angiogram between 1st January 2009 and 30th October 2011 in Hospital
Universiti Sains Malaysia (HUSM) were enrolled. This study was powered at 80% using 2
proportion formula.
Results: Fifty six point five percent (56.5%) of the study population had severe coronary
artery stenosis and 81.0% of them had HbA1c more than 7%. Univariate analysis
e287
 comparing mean HbA1c in normal group with other levels of coronary artery disease showed
POSTER ABSTRACTS
a significant association with the severity of coronary stenosis. Multivariate analysis identified
male gender ( OR ¼ 3.71, 95 % CI 1.75, 5.67, p < 0.001 ), DM of more than 10 years ( OR ¼
3.78, 95% CI 1.63, 5.92, p ¼ 0.001 ), smoking ( OR ¼ 4.47, 95 % CI 2.47, 6.47, p < 0.001 )
and patient with HbA1c more than 7% ( OR ¼ 6.82, 95% CI 4.65, 9.05, p < 0.001 ) were
associated with higher risk for severe coronary artery stenosis. Majority (88.7%) were of
Malay race, reflecting the local demographic while 64.5 % were male. The mean age was 56.8
(SD 10.2) years, while the mean HbA1C was 7.7 (SD 1.9) %. 41.1% were overweight patients
and 43.5% were obese patients. For other risk factors, 37.1 % had DM of more than 10 years,
53.2% were smokers, 70.2% had hyperlipidaemia and 87.1% had hypertension.
Among the study population, there was no significant increase in severity of coronary
stenosis based on body mass index (BMI) or LDL-C level.
Conclusion: There is a significant relationship between HbA1c level with the severity of
coronary artery stenosis. Other significant risks include male gender, smoking and the
duration of DM. Majority of coronary artery disease patients in HUSM are male, overweight
with obesity, hypertensive and hyperlipidaemic.
Disclosure of Interest: None Declared
PW138
Outcomes in diabetic patients with ST elevation Myocardial Infarction after PCI
Sonya Burgess*1, Leia Hee1, Ibrahim Shugman1, Sidney Lo1, Phong Nguyen1, David Taylor1,
Rohan Rajaratnam1, Christian Mussap1, Liza Thomas1, Dominic Leung1, Andrew Hopkins1,
Craig Juergens1, John French1
1
Cardiology, Liverpool Hospital, Sydney, NSW, Sydney, Australia
Introduction: The FREEDOM (Future REvascularization Evaluation in patients with
Diabetes mellitus: optimal management of Multivessel disease) trial reported better out-
comes with surgical revascularisation when compared with percutaneous coronary inter-
vention (PCI), among patients with multivessel disease (MVD) and diabetes (DM) though
only w1/3 of patients had a recent acute coronary syndrome (ACS), and those post ST-
segment elevation myocardial infarction (STEMI) had to be stable, no recent PCI and with
normal CKMB levels. Thus the preferred management such DM patients with STEMI is
unclear. We retrospectively reviewed outcomes of these patients in our institution.
Objectives: To evaluate the outcomes of patients with diabetes presenting with ST
elevation Myocardial infarction.
Methods: We examined clinical outcomes among 1702 patients with STEMI who un-
derwent PCI during their initial hospitalization in the 9 years after October 2003 at Liv-
erpool Hospital (Sydney, NSW). Data was collected using medical records, state death
registry, and follow up was made at 30 days and 1 year by clinical staff contacting patients,
next of kin and primary physicians.
Results: Patients were aged 5912 years, 85% were male, 15% had diabetes mellitus.
MVD was present in 39% of non-diabetic patients and 51% of patients with diabetes
(p¼0.002). Rates of reMI (4.3%) were similar, irrespective of diabetic status and single
vessel disease (SVD) or MVD. Overall rates of further revascularisation were similar with no
significant difference between SVD and MVD in patients with diabetes (5.3% vs 7.1%;
p¼0.59). In diabetic patients who received further revascularization, surgical revascular-
isation was used in 29% of patients with MVD and 20% of patients with SVD (p¼0.74).
There was no significant difference in revascularisation rates between diabetic and non-
diabetic patients with MVD (7.1% vs 6.1%; p¼0.71). The presence of MVD predicted death
in patients with diabetes (5.3% vs 18.4%; p¼0.005).
Conclusion: STEMI patients with diabetes and MVD had high late mortality. Outcomes in
diabetic patients with MVD and STEMI should be evaluated in a randomized clinical trial,
to assess the optimal method of revascularization.
Disclosure of Interest: None Declared
PW142
Percutaneous coronary intervention (PCI) in a geographically isolated non-surgical
centre provides not only high quality but timely intervention. The first Australasian
medium term report of 1000 PCI outcomes
Muhammad T. Mowjood*1, Samuel Wilson1, Sarah Lake2, Nicholas G. Fisher1, Tammy Pegg1
1
Cardiology, 2Corporate Support, Nelson Marlborough District Health Board, Nelson, New
Zealand
Introduction: Increasing international experience supporting the safety of PCI in non-
surgical centres has seen a surge in PCI in such settings, but with little follow-up data on
longer term safety and impact on health care. Nelson Hospital is a geographically isolated
secondary care service in New Zealand which established its PCI service in 2007. The first
1000 unselected consecutive cases are described.
Objectives: To assess the safety and efficacy of our PCI service in terms of complication
rates, 30 day major adverse cardiovascular events (MACE- composite of death, myocardial
infarction, stroke and revascularisation other than staged PCI) and time to acute inter-
vention. Secondarily, we assessed the use of evidence based pharmacotherapy; and thirdly
rates of late readmission with acute coronary syndrome (ACS) and heart failure.
Methods: Data was prospectively entered on all PCI patients into an integrated cardiac
software package. Results and clinical records of the first 1000 consecutive PCI patients
were retrospectively analysed. Patient records were interrogated for 30 day MACE and
readmissions with ACS or heart failure over the entire period of follow-up. Discharge
medications were recorded. Total mortality was checked against a unique identifier for each
patient and includes non-same hospital mortality.
Results: Between 2007 and 2013, 887 patients underwent a total of 1000 PCI. 74% of
cases were performed on males; 68% were in the context of an unplanned admission for
e288
ACS; and 13% were either primary or rescue PCI. The mean time from admission to acute
PCI was 2.0 days, including weekends. No patients were transferred to a cardiosurgical
centre due to PCI complications. There were 13 deaths (1.3%) during the index admission,
4 (0.4%) possibly related to PCI and 1 (0.1%) probably related to PCI. The 30-day MACE
rate was 3.9%. 94% of patients were discharged on 4 or more evidence-based drugs for
coronary disease. Rates of readmission with definite ACS and heart failure were 51 and 18
per 1000 person-years respectively. Total all-cause mortality at 12 months post procedure
was 3.2%.
Conclusion: The provision of an unselected PCI service in a geographically isolated centre
without on site-cardiac surgery affords high quality, timely and safe care leading to
excellent medium term outcomes and low readmission rates with complications of cardiac
disease.
Disclosure of Interest: None Declared
PW143
Patient Perspectives Of Using A Web Based Intervention Program For Patients With
Type 2 Diabetes And Acute Coronary Syndrome
Chiung-Jung (Jo) Wu*1, John Atherton2, Anne Chang1, Mary Courtney3, Alex Clark4,
Steven McPhail5, Esben Strodl6, Mary-Anne Ramis1, Michael Kuhn7
1
School of Nursing, Queensland University of Technology, 2Department of Cardiology, Royal
Brisbane and Women’s Hospital, 3School of Nursing, Midwifery and Paramedicine, Australian
Catholic University, Brisbane, Australia, 4Faculty of Nursing, University of Alberta, Edmonton,
Canada, 5Centre for Functioning and Health Research, Metro South Health and School of Public
Health and Social Work, Queensland University of Technology, 6School of Psychology and
Counselling, Queensland University of Technology, 7Marketing, Communications Department,
Queensland University of Technology, Brisbane, Australia
Introduction: Research highlights patients with dual diagnoses of type 2 diabetes and acute
coronary syndrome (ACS) have higher readmission rates and poorer health outcomes than
patients with singular chronic conditions. Despite this, there is a lack of education pro-
grams targeted for this dual diagnosis population to improve self-management and decrease
negative health outcomes. There is evidence to suggest that internet based interventions
may improve health outcomes for patients with singular chronic conditions, however there
is a need to develop an evidence base for ACS patients with comorbid diabetes. There is a
growing awareness of the importance of a participatory model in developing effective
online interventions. That is, internet interventions are more effective if end users’ per-
ceptions of the intervention are incorporated in their final development prior to testing in
large scale trials.
Objectives: This study investigated patients’ perspectives of the web-based intervention
designed to promote self-management of the dual conditions in order to refine the inter-
vention prior to clinical trial evaluation.
Methods: An interpretive approach with thematic analysis was used to obtain deeper
understanding regarding participants’ experience when using web-application interventions
for patients with ACS and type 2 diabetes. Semi-structured interviews were undertaken on
a purposive sample of 30 patients meeting strict inclusion and exclusion criteria to obtain
their perspectives on the program.
Results: Preliminary results indicate patients with dual diagnoses express more complex
needs than those with a singular condition. Participants express a positive experience with
the proposed internet intervention and emerging themes include that the web page is seen
as easy to use and comforting as a support, in that patients know they are not alone.
Further results will be reported as they become available.
Conclusion: The results indicate potential for patient acceptability of the newly developed
internet intervention for patients with ACS and comorbid diabetes. Incorporation of patient
perspectives into the final development of the intervention is likely to maximise successful
outcomes of any future trials that utilise this intervention. Future quantitative evaluation of
the effectiveness of the intervention is being planned.
Acknowledgements: This study is supported by RBWH Foundation.
Disclosure of Interest: None Declared
PW145
Life-Style Factors Related To Psychiatric Disorders After Acute Coronary Syndrome
Tihana Jendricko1, Josip Vincelj*2, Lovorka Derek3, Goranka Oremovic2
1
Department of Social Psychiatry, University Psychiatric Hospital Vrapce, 2Department of
Internal Medicine, Institute of Cardiovascular Diseases, 3Clinical Department for Laboratory
Diagnostics, University Hospital Dubrava, Zagreb, Croatia
Introduction: Acute coronary syndrome (ACS) has numerous consequences, including
physical and psychical disturbances. According to literature data, most common psychiatric
disorders among patients with ACS are depressive, anxiety or posttraumatic stress disorder
(PTSD).
Objectives: The aim of our study was to explore the relationship between life-style factors
(body mass index (BMI), lipid levels, physical activity, cigarette smoking and alcohol
consumption) and development of psychiatric disorders one month and six months after
ACS.
Methods: This follow-up study consists of 3 phases: a) first phase (stable somatic status
after ACS), b) second phase (one month after ACS), and c) third phase (6 months after
ACS). Age and sex adjusted subjects with ACS were screened by a cardiologist. Psychiatrist
excluded existence of previous or actual mental disorders in the first phase. Subjects were
contacted and retested after one month and after six months. Instruments: Mini Interna-
tional Neuropsychiatric Interview, Questionnaire of general socio demographic data and
life-style factors, Acute Stress Disorder Interview, and Clinician-administered PTSD Scale.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: First phase comprised 120 subjects, second phase 80 and third phase 56 subjects.
BVS

POSTER ABSTRACTS
Mean age was 53 (45-61) years. Mean BMI was 28.353.59 kg/m2. After one month 22
(27.5%) of the subjects had acute stress disorder (ASD) and 13.8% had major depressive pre dilation Scaffold vessel thrombosis
disorder (MDD). After six months 15 (37.5%) subjects had PTSD and 12 (27.3%) had No % stenosis Balloon size ATM second thrombosis duration
MDD. Alcohol consumption showed to be predictive for development of MDD in the 1 LAD 90% 3.5 x12 3.5 18 14 8 2 days
second phase (P¼0.002, OR¼2.48), while physical inactivity showed to be predictive for OM 90% 3.5x12
the development of comorbidity of MDD and ASD in the second phase (P¼0.036,
OR¼100.00). RCA 90% 3x18 3x18 14 12 RCA
Conclusion: Our results showed that cardiovascular disorders can cause anxious and 2 LAD 99% 3x 20 3 x 18 16 60 LAD 5 months
depressive disorders among frequent alcohol consumers and physically inactive in- 3x28
dividuals. So, depression, anxiety, physical inactivity, and alcohol consumption cannot
Lcx 90% 2.5 x12 3.5x12 16 60
only be considered as risk factors for cardiovascular disorders, but should also be regarded
as a consequence of cardiovascular disorders. 3 RCA 70% 2.5x12 3 x18 14 12 RCA 5 months
Disclosure of Interest: None Declared 4 LAD100% 2.5 x12 3 x18 16 20 LAD 2 days
Lcx 99% 2.5x12 3 x 18 16 20
PW146
Out-of-hours Primary Percutaneous Coronary Intervention for ST-elevation Conclusion: Such a high incidence of BVS thrombosis seen in our patients is not previ-
Myocardial Infarction Does Not Portend Worse Outcomes ously reported. This occurrence may be due to technical issues, inherent issues with the
Angela L. Brennan*1, Nick Andrianopoulos1, Chris Reid1, Andrew E. Ajani2, Melanie Freeman3, BVS, aspirin or clopidogrel non compliance or resistance. IVUS or OCT would have been
helpful in knowing the etiology.
Jess O’Brien4, Martin Sebastian5, Bryan P. Yan6, Antony Walton4, Stephen J. Duffy4 Disclosure of Interest: None Declared
1
School of Public Health & Preventive Medicine, Monash University, 2Cardiology, Royal
Melbourne Hospital, 3Cardiology, Box Hill Hospital, 4Cardiology, Alfred Hospital, Melbourne,
5
Cardiology, Geelong Hospital, Geelong, Australia, 6Department of Medicine and Therapeutics, PW148
Chinese University of Hong Kong, Shatin, NT, Hong Kong
Modified Pot technique (Proximal Optimization Technique) to avoid complex
Introduction: Logistically, it is faster to mobilise catheterization laboratory staff during bifurcation stenting
normal working hours, generally leading to shorter door-to-balloon times (DTBT’s) for Leong Weng San*1, Tieh Siaw Cheng2, Kong Poi Keong2
patients with ST-elevation myocardial infarction (STEMI) treated with primary percuta- 1
Cardiology, Hospital Raja Permaisuri Bainun, Ipoh, 2Cardiology, Penang Hospital, Goergetown,
neous coronary intervention (PPCI). Prior studies have suggested that the outcomes of
patients undergoing PPCI out-of-hours are worse than those treated in-hours, however Malaysia
more recent studies have contradicted this finding. Introduction: Benefit of bifurcation stenting has been controversial. Single stent of main
Objectives: To examine the effect of timing of hospital presentation (in-hours [IH] versus vessel strategy alone may be preferred to dual stents for both the main and the side branch.
out-of-hours [OH]) on the outcomes of patients undergoing PPCI for STEMI in a However, there is risk of side branch closure following main branch stenting and high
contemporary setting. pressure post dilatation. Pot technique has been used to facilitate side branch rewiring and
Methods: We analysed data from 2,193 patients presenting with STEMI undergoing PPCI stent placement.
from the Melbourne Interventional Group (MIG) registry. Transfer and rescue PCI’s were Objectives: We postulate that a modified method of Pot technique to open up the side
excluded.. IH refers to the usual operating hours of cardiac catheter laboratories; i.e. branch carina would help reduce side branch closure during predilatation, stent deploy-
8 a.m. – 6 p.m. Monday to Friday, with OH referring to 6 p.m. – 8 a.m. Monday to Friday, ment and postdilatation of the main branch.
all weekends and public holidays. Methods: We performed prospective study on 5 patients with LAD bifurcation lesions.
Results: Apart from IH patients being older (6413 vs. 6213 years, p<0.001), OH Side branches (diagonal arteries) of all patients were considered need to be protected if
patients having increased BMI (27.24.7 vs. 27.85.0 kg/m2, p¼0.009) and being more vessel diameter was more than 2.0mm. Both LAD/ Diagonal were wired with 0.014” PCI
likely to be current smokers (31% vs. 38%, p¼0.03), the baseline demographics were wires. Point A (proximal to side branch) was predilated at higher pressure as compared to
similar. The OH patients presented to hospital quicker with median symptom-to-door Point B (at level of side branch) and Point C (distal to side branch). Main vessel lesion was
time of 97 (IQR 65-150) vs. 90 minutes (IQR 62-138), p¼0.04. The IH group had a stented, followed by guidewire exchange. Point A was postdilated to bigger diameter as
shorter DTBT (68 [IQR 48-94] vs. 93 [IQR 73-119] minutes, p<0.0001), and achieved a compared to point B and point C. Primary end point was side branch closure, worsening
DTBT of 90 minutes in 71% of cases compared to 45% in the OH group, p<0.001. TIMI flow, narrowing of ostial side branch diameter and need for kissing balloon or side
DES use was higher in the OH group (30%) compared to IH (26%), p¼0.02. Mortality branch stenting.
and major adverse cardiac events (MACE; death, recurrent MI or target lesion revascu- Results: Our 5 patients had mid LAD bifurcation lesions with different variations of
larization) were similar at 30 days and 12 months. However, the OH group had a higher Madina classes. All 5 patients were admitted for acute coronary syndromes. Predicted
12-month stroke rate (0.6% vs. 1.7%, p¼0.03), despite having similar baseline incidence main vessel diameters for all 5 patients were 2.75mm. LAD was predilated with
of hypertension, cerebrovascular disease and atrial fibrillation. Multivariable analysis compliant balloon diameter 2.0-2.5mm. All patients have successful LAD stenting and
showed OH presentation was associated with a trend towards improved survival at 12 postdilatation of LAD stents. There was no observed side branch closure, dissection,
months (OR 0.63; 95% CI: 0.41-0.99, p<0.045) and lower MACE (0.78; 0.59-1.04, narrowing of ostial side branch or poorer TIMI flow. All patient has final TIMI 3 flow
p¼0.088). in their respective side branch. There is no need for kissing balloon or side branch
Conclusion: In contrast to some earlier studies, out-of-hours presentation to hospital with stenting.
STEMI is not associated with worse outcomes in patients undergoing PPCI, despite longer
DTBTs. There remains room for improvement in achieving better DTBTs in this group.
Disclosure of Interest: None Declared

PW147
Bioabsorb Vascular Scaffold (BVS) thrombosis
Gohar Jamil*1, Abbas Ahmed1, Mujgan Jamil2, Mohammad Nour1, Husam Ouda1
1
Cardiology, 2medicine, Tawam Hospital, Al Ain, United Arab Emirates
Introduction: Bioabsorabable vascular scaffold (BSV) has emerged with the idea of less
permanence and possibly less short and long term complications. Worldwide there is very
web 3C=FPO

limited clinical experience of the BVS.

Objectives: To look at the incidence of scaffold thrombosis.
Methods: Retrospective analysis of patient’s outcome from tertiary care facility, in which
BSV was used. Over 10 month period 29 BVS were deployed in 20 patients. In two patients
the scaffold could not be delivered or deployed to the target site. These patients were
excluded from our analysis.
Results: A total of x BVS were deployed in the LAD, x in the LCx and x in the RCA.
Indications for BVS deployment were STEMI in 5, NSTEMI in 10 and angina in 5 patients.
The average deployment pressure was 14 ATMs and average duration of BVS inflation was
14 seconds. TIMI 3 flow was noted in all arteries after scaffold deployment. The size of BVS Conclusion: Though Pot technique was earlier described to facilitate bifurcation stenting,
ranged from 2.5 to 4.0 mm diameter. our step by step modified method of Pot technique may be used to open up the carina of
BVS thrombosis was seen in 4 patients, 2 in the LAD and 2 in the RCA. Thrombosis was the side branch, and thus avoid complicated bifurcation stenting with good immediate
noted within 2 days in two patients, after 5 months in two patients who were non result. Further study would be needed to recruit more patients and other non-LAD cor-
compliant with dual antiplatelet therapy. In all these four patients, TIMI 3 flow was suc- onary arteries.
cessfully restored with DES deployed inside the scaffold. Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e289

 PW149
POSTER ABSTRACTS
The Characteristics and Trends of Poba in Current Des Era
Manabu Moriya*1, Sugao Ishiwata1, Ohno Minoru1
1
Cardsiology, Toranomon Hospital, Tokyo, Japan
Introduction: Although drug eluting stents (DES) are known to minimize the risk of
restenosis, some of the cases are still selecting plain old balloon angioplasty (POBA) for
some reasons.
Objectives: The aim of this study is to clarify the characteristics and trends of POBA in
current DES era.
Methods: We examined the cases of POBA performed in our institute during years of 2008
to 2012 retrospectively. For control, bare metal stents (BMS) and DES implantation done in
2011 were analyzed.
Results: During the period, 85 POBA, 63 BMS, 132 DES cases were identified. POBA cases
were significantly older than BMS (69.5+/-10.7, 64.0+/-10.1, 67.6+/-9.5 year-old, POBA,
BMS, DES, respectively, p<0.05). The device used were significantly smaller diameter in
POBA than others (2.69+/-0.55, 3.07+/-0.49, 2.94+/-0.41 mm, POBA, BMS, DES,
respectively, p<0.01). Within 218 cases (POBA 63, BMS 47, DES 108) completed follow
up angiography, the rate of restenosis was significantly higher in POBA than BMS and DES
(39.7%, 14.9%, 3.7%, POBA, BMS, DES, respectively, p<0.001). Unlike other strategies,
restenosis cases in POBA used significantly larger devices than the other (2.90+/-0.64 vs.
2.61+/-0.49 mm, restenosis or not, p<0.05). After extracting the cases unable to classify,
we create 3 categories for the reason of selecting POBA. 1; stent delivery failure or expected
difficulty for stent delivery due to calcification etc. (n¼14), 2; intervention for in-stent
restenosis or stent thrombosis (n¼34), 3; successful POBA for small vessels without
complication (n¼14). According to it, category 1 showed significantly high probability for
restenosis than others (1; 10/14, 71.4%, 2; 12/34, 35.3%, 3; 2/14, 14.3%, p<0.05) while
category 3 showed nearly as good as BMS.
Conclusion: POBA was done for older cases with smaller devices and showed significantly
high probability for restenosis. We can interpret the categories of reason for POBA as
follows; category 1 for negative selection, 3 for positive selection. Cases forced to select
POBA had still unfavorable results whereas cases intentionally avoid stent implantation had
tolerable outcome in current DES era.
Disclosure of Interest: None Declared
PW150
Predictive Factors of Long-Term Cardiovascular Death After A First Myocardial
Infarction: A 9.6-Year Follow-Up Study
Kais Ouerghi*1, Salem Abdessalem1, Amani Kallel1, Riadh Jemaa1, Rachid Mechmeche1
1
Cardiology, La Rabta Hospital, Tunis, Tunisia
Introduction: Few studies have studied predictive factors of mortality in long term in
patients who presented an acute coronary syndrome with ST segment elevation (STEMI)
treated with fibrinolysis or percutaneous angioplasty.
Objectives: We sought to assess the predicting factors of mortality, 9.6 years after first
myocardial infarction.
Methods: This is a prospective single-center longitudinal trial held between August 1997
and September 2011.
Between August 1997 and august 2004, were randomly included 146 patients who had
had a first nonfatal myocardial infarction during the first 30 days. After a mean follow up of
9.6 years, we recorded the event cardiovascular death.
Results: The total number of cardiovascular death at 9.6 years is 18 with a mortality of
12.3%. The average time of death is 5.2 + / -4.8 years, ranging from 127 days to 13.4 years.
Factors significantly predictive of cardiovascular death at 9.6 years in univariate analysis
were age (p ¼ 0.002), diabetes (p ¼ 0.01) and multivessel coronary disease (p ¼ 0.05).
There is a tendency to correlation of cardiovascular death at 9.6 years with history of
hypertension (p ¼ 0.06).
In multivariate analysis independent factors predictors of cardiovascular death are: age>
55 years (OR ¼ 8.53, 95% CI: 1.97, 36.96, p ¼ 0.004), diabetes (OR ¼ 4.3, 95% CI: 1.31,
14.15, p ¼ 0016) and the anterior territory of myocardial infarction (OR ¼ 5.5, 95% CI:
1.02, 29.66, p ¼ 0.047).
There was no difference in mortality at 9.6 years between patients treated with fibri-
nolysis or coronary angioplasty.
Conclusion: In our population predictors of cardiovascular mortality at 9.6 years after a
first non-fatal myocardial infarction, in the multivariate analysis, are age, the anterior ter-
ritory of the infarct and diabetes. Particular care in those patients should be held to reduce
the long-term mortality.
Disclosure of Interest: None Declared
PW152
Initial Experience With The Pre-Hospital Assessment For Primary Angiogram (PAPA)
Program For ST Elevation Myocardial Infarction Based On The Glasgow Algorithm At
A Regional New South Wales Hospital Without Onsite Cardiac Surgery
1 1 1 1 1
Giuseppe Femia* , Daniel Devenney , Antonio Tiberio , Prathap Hegde , Nguyen Dang ,
William McKenzie1, Dwain Owensby1, Pratap Shetty1, Aaron Yeung1, Astin Lee1
1
The Wollongong Hospital Cardiology Department, Wollongong, Australia
Introduction: The Wollongong Hospital Cardiology Department provides primary
percutaneous coronary intervention (PPCI) service to a high-risk population of approxi-
mately 350 000 residents. To enable ST elevation myocardial infarcts (STEMIs) access to
timely cardiology care and improve first medical contact to lab/balloon (FMCL/B) times and
e290
cardiovascular outcomes, the Glasgow algorithm was implemented and termed pre hospital
assessment for primary angiogram (PAPA). In this program, pre-hospital ECGs are pre-
formed for patents with chest pain and those that satisfy the ST elevation algorithm are
reviewed by the on call interventionist. Patients deemed appropriate are brought directly to
the catheterization lab without attending the emergency department.
Objectives: Evaluate the effectiveness of the Glasgow algorithm as a method to improve
intervention times and cardiovascular outcomes.
Methods: This study was conducted at a center where PPCI is routinely performed for all
STEMIs. All ECGs that satisfied the Glasgow algorithm between March 31st and August 1st
2013 were retrospectively evaluated for FMCL/B times and primary and secondary out-
comes. Hospital transfers and out of hospital cardiac arrests were excluded. Primary out-
comes included in hospital death, cardiogenic shock and recurrent MI at 30 days.
Secondary outcomes included acute kidney injury and bleeding.
Results: 35 pre-hospital ECGs satisfied the algorithm but only 22 (62.8%) were deemed
appropriate by the on call interventionist. Of the 22 patients, 19 (54.3%) underwent
PPCI, 1 (2.9%) was medically unstable and not suitable for investigation and 2 (5.7%)
had no identifiable culprit lesion and were treated medically. On review of the 13 rejected
ECGs, zero had ST elevation but 3 had troponin rises and required coronary intervention.
Median FMCL/B times were 45 (19-52) and 78 (55-116) minutes respectively. FMCB was
within 90 minutes for 17 (89%) and within 120 minutes for 19 (100%) of the patients.
The positive predictive value (PPV) for the algorithm was 66% for STEMIs and 54% for
intervention. Clinical follow-up at 30 days was available for 34 patients; there were 4
(18.1%) primary outcomes with 1 (4.5%) in hospital death and 2 (9.1%) secondary
outcomes.
Conclusion: Initial data indicates that within the PAPA program, haemodynamically stable
patients with suspected STEMIs can be safely and effectively identified with the Glasgow
algorithm and transported directly for PPCI.
Disclosure of Interest: None Declared
PW153
The Safety of Remote PCI in 1,543 Patients in Rural New South Wales without
Cardiac Surgery Onsite
Colin-John Perrins*1, Arnagretta Hunter1,2, Craig McLachlan1, Hassan Assareh1,3,
Peter Ruchin1,2, Michael McCready1,2, Joseph Suttie1,2, Paul Roy4, Gerard Carroll1,2
1
Faculty of Medicine, Rural Clinical School, UNSW, 2Riverina Cardiology, Wagga Wagga,
3
Simpson Centre for Health Services Research, Australian Institute of Health Innovation, Faculty
of Medicine, UNSW, 4St Vincent’s Clinic, Sydney, Australia
Introduction: Historically there are concerns about PCI at centres without onsite cardiac
surgery. This policy effectively rules out the gold standard of care for patients with STEMI
and ACS in regional and remote areas. While this policy remains controversial, a growing
international body of research indicates the safety and efficacy of PCI without cardiac
surgery onsite. Wagga Wagga, NSW offers regional PCI for urgent and elective cases and is
the furthest from cardiac surgical backup that has been published to date internationally.
Objectives: To describe demographics and cardiac risk factors of patients undergoing PCI
in Wagga Wagga. To model procedural factors associated with adverse outcomes while
adjusting for baseline risk factors. To audit major adverse cardiac events in-hospital and at
30 days. The 30-day MACE outcome combines mortality, myocardial infarction, cere-
brovascular accident and target lesion revascularisation (TLR).
Methods: A retrospective audit was undertaken from June 2004 to June 2013 of patients
receiving PCI in Wagga Wagga, NSW. A cohort of 1,543 consecutive patients was included
in the study with no exclusion criteria. Multivariate logistic models were used to investigate
the association between procedural factors 30-day PCI outcomes.
Results: Patients received emergency PCI for STEMI (18.3%), Non-ST-Elevation Acute
Coronary Syndrome (26.4%) or symptomatic relief in Stable Coronary Disease (55.3%).
Angiographic success for all patients was 97%. 5 patients died in hospital over 9 years
(0.3%): three of these patients presented late with severe anterior STEMI (one having failed
thrombolysis), one re-infarcted after PCI, one suffered respiratory arrest. The rate of 30-day
MACE was low for all patients (3.2%) and 7.6% for the STEMI group. The difference was
additional repeat TLR procedures post PCI for STEMI (3.5%). The patients with stents
inserted were less likely to have a 30-day MACE (OR¼0.127, p¼0.001). The significant
decrease in 30-day MACE over time (OR¼0.739, p¼0.001) was seen alongside the increase
in DES usage (OR¼1.077, p¼0.043).
Conclusion: The cohort of patients who have undergone PCI without surgical backup in
Wagga Wagga represent a range of indications and baseline risk reflective of the higher
rates of cardiovascular disease in rural Australia. The rate of angiographic success has been
high and the rates of adverse effects have been very low compared to international stan-
dards. This audit adds support for regional models of care for ACS without cardiac surgery
on site.
Disclosure of Interest: None Declared
PW154
Predictors of Stent Thrombosis After Percutaneous Coronary Intervention in Acute
Coronary Syndrome: KICS registry
Masahide Nagano*1, Seiji Hokimoto2, Koichi Nakao3, Hisao Ogawa4, Saiseikai Kumamoto
Hospital
1
Division of Cardiology, Saiseikai Kumamoto Hospital, 2Division of Cardiology, Kumamoto
University, 3Saiseikai Kumamoto Hospital, 4Kumamoto University, Kumamoto, Japan
Introduction: Stent thrombosis (ST) has emerged as a severe complication of percutaneous
coronary interventions (PCI) in acute coronary syndrome (ACS). The occurrence of ST is
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
lower in Japan than Western countries, so there are few data to predict ST after PCI in ACS, transradial and transfemoral access groups. Patient characteristics, procedural details and

POSTER ABSTRACTS
including a factor of prescription. radiation exposure in both groups were compared and data are presented as mean +/-
Objectives: We used data from the Kumamoto Intervention Conference Study (KICS) standard deviation.
registry. KICS is a multi-center registry enrolling consecutive procedures undergoing PCI in Results:
16 centers in Japan. Consecutive 6,286 patients were enrolled from June 2008 to March
2011.
Methods: Among them, we analyzed 2,978 patients who underwent PCI in ACS.
Transradial (n[92) Transfemoral (n[113) p
Results: The incidence of definite/probable ST throughout a median 365-day follow-up
period was 1.11% (33 patients). There were 18 patients with early ST (EST, within 30 Age (years) 68 (+/-11.3) 72 (+/-11.5) 0.03
days), 14 patients with late ST (LST, between 31-365 days), and 1 patient with very late ST Male 70 (76%) 60 (53%) <0.01
(VLST, over 1 year). The occurrences of ST were similar between Bare-Metal Stent and
Drug-Eluting Stent (1.2%, 1.0%, respectively). We obtained data of CYP2C19 poly- Weight (kg) 102 (+/-18.4) 78 (+/-16.7) <0.01
morphism about 6 ST patients and there were 4 carriers with CYP2C19 loss-of-function Body Mass Index (kg/m2) 31 (+/-5.3) 28 (+/-4.9) <0.01
allele. ST patients, especially in case of EST, tended to be administered less CCB compared
with non-ST patients (11.1%, 35.3%, respectively, p¼0.023). The occurrence of ST was
lower in patients with CCB than without CCB (0.7%, 1.3%, p¼0.062). By multiple
regression analysis, complex target lesion (type B2 or C) (p¼0.049), insufficient dilatation
(p¼0.044), and longer stent length (p¼0.041) were independent predictors for ST inci- Transradial (n[92) Transfemoral (n[113) p
dence. In case of EST, only insufficient dilatation (p¼0.013) was an independent predictor. Procedure time (min) 35 (+/-9.8) 29 (+/-9.8) <0.01
In both cases (all ST and EST), lack of CCB showed a tendency of an increased risk of ST
(p¼0.069, 0.057, respectively). Contrast use (ml) 73 (+/-23.9) 70 (+/-28.8) 0.43
Conclusion: These results suggest that prescription of CCB may be associated with a Cardiac acquisitions 9 (+/-1.6) 8 (+/-1.5) 0.04
decreased risk of ST after PCI in ACS in Japanese patients. Number of patients with 13 (14%) 9 (8%) 0.25
Disclosure of Interest: None Declared
non-cardiac acquisitions

PW155 Dose area product (DAP, Gy.cm2) 54 (+/-28) 38 (+/-27) <0.01

One month outcomes after elective percutaneous coronary intervention in Afshar
hospital: insights from a heart centre in a developing country
Hasan Tabatabaei1, Masoud Mirzaei*2, Mahmoud Emami1, Hossein Nough1
1
Cardiology, 2Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic Of
Introduction: Little is known about outcome of percutaneous coronary intervention (PCI)
in developing countries. Afshar Heart Center (AHC) is the main referral cardiac center
located in Yazd province in central Iran with 1 million population. Around 100 PCIs
performs in this centre monthly.
Objectives: This study aims to determine angiographic, procedural and clinical success of
elective percutaneous coronary interventions (PCI) in the main referral heart centre of yazd
province.
Methods: Those referred to the catheter laboratory of AHC for PCI over four months were
the subjects of this study, primary PCI cases were excluded. Information on past medical
history, IHD risk factors including diabetes mellitus, hypertension, tobacco smoking, hy-
percholesterolemia and overweight were collected. Coronary angiography and echocardi-
ography of target vessels were performed. Drug eluting stent (DES) were deployed in
diabetic patients, chronic total occlusion (CTO) and ostial coronary stenosis patients and
bare metal stents were deployed for the rest. The patients were followed up for one month.
Major adverse cardiac events were defined as myocardial infarction, sudden cardiac death
and need for emergency revascularization. MACE and relief of pain were also recorded.
Results: Elective (planned) PCIs were performed for all the patients (n¼ 182) with the
mean age of 58.510.4 years. Male gender was predominant (62%).
Occlusion in the left anterior descending (LAD) was the most common lesion observed
in 68.1% (n¼124), occlusion of the left circumflex artery (LCX) observed in 11% (22) and
occlusion of the right coronary artery (RCA) in 14.3% (n¼29). Twelve patients received
two stents.
Type A lesion was prevalent among patient group 51.6% type B 38.8% and Type C
9.9%.
PCI was performed for single vessel disease in 45%, for two vessels in 41% and for three
vessels in 14%. Angiographic success was recorded in 98.9%, procedural success in 93.4%
and clinical success in 87% of the patients. Ten patients (5.5%) experienced myocardial
infarction and two patients received revascularization. No mortality from IHD or stroke was
recorded.
Conclusion: PCI relieves patients’ symptoms and preserves the left ventricle function. This
study indicates that in a developing setting the short outcome is relatively acceptable. PCI
can be an alternative procedure in selected patients who refuse to go through cardiac
surgery in this setting.
Disclosure of Interest: None Declared
PW156
Comparison of Patient Selection and Radiation Exposure in Transradial and
Transfemoral Cardiac Catheterisation
Matthew Scott1, Robert Chan*2, Omar Farouque3, Mark Horrigan2, Matthew Chan2
1
Cardiology, Ramsay Health, 2Cardiology, Heart Care, 3Cardiology, Austen Health, Heidelberg,
Australia
Introduction: In Australia, transradial cardiac catheterisation is becoming increasingly
popular despite previous studies showing this technique to be associated with higher ra-
diation exposure to the patient and the operator. Studies on patient selection algorithm for
transradial over transfemoral access have been limited.
Objectives: Transradial and transfemoral cardiac catheterisation by experienced operators
who practise both techniques in similar frequency were examined.
Methods: Diagnostic coronary angiograms performed by two cardiologists with standard
radiation protection in one hospital (n¼205) were studied with patients being divided into
Fluoroscopy time (min) 3.7 (+/-2.0) 2.4 (+/-1.6) <0.01
Patients in the transradial access group were younger, more often male, and obese.
Although transradial procedures took longer, contrast use was similar to transfemoral cases.
Cardiac and non-cardiac acquisitions were also comparable in both groups. Significantly
higher DAP in transradial cases confirmed higher patient radiation exposure. This could be
related to significantly longer fluoroscopy time during transradial procedures, which
suggests potential increased radiation exposure to the operator and other laboratory
personnel.
Conclusion: Comparing transradial and transfemoral coronary angiography, operators
appeared to favour transradial access for younger and male patients, presumably because of
larger radial arteries, as well as obese patients to avoid groin complications. Transradial
cases may take longer with higher radiation dose being related to increased patient weight
and more prolonged fluoroscopy. Knowledge of these findings may prompt cardiologists to
adapt catheterisation techniques and collaborate with radiographers to mitigate such
differences.
Disclosure of Interest: None Declared
PW158
Comparison of Platelet Aggregation Before & After Loading Dose of Prasugrel And
Clopidogrel in Percutaneous Coronary Intervention in adult Pakistani CAD Patients
Ahmed Shahbaz*1, Ahmad Nouman1, Khawar Mehdi2, Muhammad Azhar1
1
Cardiology, PIC, Lahore, 2Research & Medical Affairs, Getz Pharma, karachi, Pakistan
Introduction: The use of dual antiplatelet therapy with aspirin and a thienopyridine
is an essential aspect of the supportive pharmacologic regimen administered to
CAD patients who are undergoing primary percutaneous coronary intervention
(PCI).
Objectives: This study was carried out to compare the inhibition of platelet aggregation
(IPA) between prasugrel and clopidogrel in adult Pakistani patients undergoing primary
PCI.
Methods: A total of hundred subjects were randomly assigned to two groups A & B.
Group A (n¼50) received prasugrel (PRISAÒ) 60 mg loading dose pre PCI and 10 mg
QD maintenance dose, whereas group B (n¼50) received clopidogrel 600 mg loading
and 75 mg BID maintenance dose respectively. Adenosine diphospahte (ADP) was used
as agonist before loading dose and post-PCI at 3-4 hours since it is the most commonly
used agonist, particularly in systems that measure only platelet aggregation in whole
blood.
Results: Male and female ratio was 4:1 in both groups. Mean age was insignificant
between group A and group B (50.3  9.6 vs. 50.3  10.9; range: 29-68 and 23-71
years respectively). In Group A (Prasugrel) n¼50; the respective occurrence of CAD
was: LAD n¼25 (50%), RCA n¼14 (28%), Cx Distal n¼5 (10%), MVD n¼3 (6%),
Non-stent 1 (2%) & others n¼2 (4%). In Group B (Clopidogrel) n¼50; the respective
occurrence of CAD was: LAD n¼23 (46%), RCA n¼11 (22%), MVD n¼8 (16%) & Cx
Distal n¼7 (14%) & others n¼1 (2%). None of the patient experienced minor or major
adverse cardiac events after taking loading dose in both groups. The before and after
loading dose mean platelet aggregation (MPA) responses were statistically significant
within the two treatment groups (Group A: 6.08  2.12 vs 1.56  2.11; p<0.001 and
Group B: 4.27  2.06 vs 0.68  1.38; p<0.001). The mean reduction in platelet
aggregation by Group A (Prasugrel) was 74.4% and by Group B (Clopidogrel) was
51.8%.
Conclusion: Prasugrel 60 mg loading dose (PRISA) achieves significantly greater IPA as
compared to clopidogrel 600 mg LD. Both drugs were well-tolerated and adverse drug
reactions were comparable.
Disclosure of Interest: A. Shahbaz: None Declared, A. Nouman: None Declared, K. Mehdi
Employee from: Director Medical Affairs & Research, M. Azhar: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e291

 PW159
POSTER ABSTRACTS
Response of loading dose & follow-up of Prasugrel (PRISAÒ) on Platelet Aggregation
in CAD Patients Undergoing Percutaneous Coronary Intervention
Ahmed Shahbaz*1, Ahmad Nouman1, Khawar Mehdi2, Muhammad Azhar1
1
Cardiology, PIC, Lahore, 2Research & Medical Affairs, Getz Pharma, karachi, Pakistan
Introduction: The use of dual antiplatelet therapy with aspirin and a thienopyridine in
CAD is an essential aspect of a supportive pharmacologic regimen administered to patients
undergoing percutaneous coronary intervention (PCI). Prasugrel, a thienopyridine reduces
platelet aggregation and has been demonstrated to improve outcomes in patients presenting
with acute coronary syndrome.
Objectives: This study was carried out to determine the effect of loading dose of prasugrel
(PRISAÒ) on platelet aggregation in CAD patients undergoing PCI.
Methods: A total of 50 out of 120 CAD patients were screened as per inclusion criteria (Both
genders b/w the ages of 18 - 65 undergoing PCI) and participated in the study. During PCI
the Platelet aggregation inhibition tests were performed just before and immediately after (3-
4 hours) the loading dose of 60 mg Prasugrel with Chronolog Whole Blood Aggregometer
Model 591A/592A using ADP (Adenosine diphospahte) reagent. Upon discharge the patients
were maintained on 10 mg Prasugrel daily for 14 days. Platelet aggregation inhibition test was
performed again at Day 14 and clinical outcomes like minor & major bleeding, shortness of
breath and death were observed. SPSS version 17 was used to analyze the data.
Results: Male and female ratio was 4:1, mean age 50.3  9.6 (range: 29 - 68 years). The Risk
factor history comprised of 60% hypertensive, 38% with family history of CAD, 32% diabetic,
8% hyperlipidemic and 18% with MI history. Out of 40 males; 10% were smokers, 48% ex-
smokers and 42% non smokers. The occurrence of CAD was: LAD 25 (50%), RCA 14 (28%),
Cx Distal 5 (10%), MVD 3 (6%), Non Stent 1 (2%) and others 2 (4%). The mean platelet
aggregation (MPA) values before loading dose, after loading dose and at 14 days follow-up
were 6.08  2.12 SD, 1.56  2.11 SD and 0.53  1.37 SD respectively with statistically
significant (p<0.001) difference showing good response to Prasugrel (PRISA). None of the
patient suffered side effect after the loading dose of prasugrel during PCI at 2 weeks follow-up.
Conclusion: Prasugrel (PRISAÒ) was seen to be clinically effective, well tolerated & safe with
significant MPA reduction after loading dose of prasugrel during PCI and at 14 days follow-up.
Disclosure of Interest: A. Shahbaz: None Declared, A. Nouman: None Declared, K. Mehdi
Employee from: Director Medical Affairs & Research, M. Azhar: None Declared
PW160
The effect of clopidogrel in patients with acute coronary syndromes
Pranas Serpytis*1,2, Austeja Vaiciulyte2, Rokas Serptytis1, Rokas Navickas1, Dalius Vitkus3
1 U. Cieslik: None Declared, M. Kurpesa: None Declared, J. Kasprzak Grant/research support
Clinic of Cardiac and Vascular Diseases, Vilnius University Hospital Santariskiu Klinikos,
2
Faculty of Medicine, Vilnius University, 3Centre of Laboratory Medicine, Vilnius University
Hospital Santariskiu Klinikos, Vilnius, Lithuania
Introduction: The adverse cardiovascular events usually occur despite recommended dual
antiplatelet therapy and this has been attributed in part to variable efficacy of clopidogrel.
Objectives: To asses the effect of Clopidogrel on platelet reactivity and its relation with
stent thrombosis in patients with acute coronary syndromes.
Methods: A retrospective analysis was made of patients with acute coronary syndromes
treated in Vilnius University Hospital Santariskiu Klinikos from 2012-03-16 to 2013-01-
31.The effect of clopidogrel on platelet reactivity was assessed with ADP test, performed
with Multiplate analyzer. 663 patients were included to the study, 27,85% (n¼184) female.
Average patient age- 65,28 years (SD  11,971). The loading dose of clopidogrel was
300mg or 600mg, following with 75mg daily. ADP testing was performed 12 to 24 hours
after the onset of treatment. Patients were divided into groups according to ADP value:
group 1. non-resistant to clopidogrel, group 2. patients at risk, group 3. resistant to clo-
pidogrel). The effect of clopidogrel was assessed by ADP value and it’s relation with stent
thrombosis. Thrombosis was evaluated during the period of hospitalization (3 to 10 days).
Results: Group 1. had 210 (31,7%) patients, group 2. - 107 (16,1%) patients, group 3.- 346
(52,2%) patients. Among resistant to clopidogrel patients, 28,6% (n¼ 99) were female. Out of
patients at risk 21.5% (n¼ 23) were females and among non-resistant patients 29,5% (n¼62)
were female, p¼0,280. After stenting, stent thrombosis was observed in 1,6% (n¼ 10) pa-
tients. Among females stent thrombosis was 0,6% (n¼1) and among males - 1,9% (n¼9), p¼
0,303. Whereas in group 3. stent thrombosis was observed in 2,7% (n¼ 9) patients and in
non-resistant 0,5% (n¼1). In group 1. there was no stent thrombosis, p¼ 0,046.
Conclusion: 1. Treatment with clopidogrel is not effective for more than half of patients. 2.
Among the females and males the rate of resistance to clopidogrel or stent thrombosis does
not differ with statistical significance. 3. For patients with resistance to clopidogrel the risk
of stent thrombosis is higher. 4. In order to asses the effect of clopidogrel ADP testing can
help to avoid stent thrombosis.
Disclosure of Interest: None Declared
PW165
Circumferential strain of carotid arteries as a new quantitative measurement of
atherosclerosis advancement - the assessment in the patients with three-vessel
coronary artery disease and in the control group
Karina Wierzbowska-Drabik*1, Kamila Cygulska1, Urszula Cieslik1, Małgorzata Kurpesa1,
Jarosław D. Kasprzak1
1
Cardiology Department, Medical University of Lodz, Lodz, Poland
Introduction: Speckle tracking echocardiography is widely used as a tool for the objective
analysis of myocardial function. Recently, circumferential deformation of carotid arteries
wall was postulated as promising indicator of vascular function.
e292
Objectives: We compared circumferential strain (CS) of both common carotid arteries
(CCA) in the 23 patients with three-vessel coronary artery disease (3VD) qualified to by-
pass surgery and in 14 age-matched control subjects (C). Additionally in randomly selected
11 patients we estimated pulse wave velocity (PWV) as a standard measure of vascular
function and assessed the correlation between PWV and CS.
Methods: The assessment of CS of CCA was performed on the Echopak workstation with
2D speckle-tracking echocardiography by two independent observers. Short-axis images
of arteries were acquired and digitally stored on Vivid 7 echocardiograph (General
Electric, Horten Norway) with linear probe with the optimized frame rate for strain
analysis. PWV was recorded by a non-invasive device (Complior, Artech Medical, Pantin,
France) with the pressure sensitive transducers. Mean age in the 3VD group was
69.78.9 years, 16 male and in the C group 67.46.5 years, 7 male (p¼0.407 for age
and p¼0.399 for gender).
Results: The intraobserver variability for the CS measurements (coefficient of variance)
were 4.9 and 5.4% for left and right CCA and interobserver variability were 11.7% and
12.5% respectively. The mean CS for left and right CCA did not differ compared groups
neither did not reveal significant asymmetry between left and right CCA. We did not find
significant correlation between CS strain and PWV (r¼-0.22, for the left CCA and r¼0.007
for the right CCA, p¼ns). The only significant difference was related to thicker intima-
media complex in patients with 3VD. The data are displayed in the Table.
Parameters 3VD C p
Diameter left CCA [mm] 6.620.95 6.410.68 0.476
Diameter right CCA [mm] 6.841.09 6.570.92 0.445
IMT left CCA [mm] 0.130.17 0.090.02 0.149
IMT right CCA [mm] 0.12±0.05 0.09±0.01 0.03
CS left CCA [%] 3.231.83 3.021.59 0.725
CS right CCA [%] 2.591.27 2.431.19 0.706
Conclusion: The global circumferential strain of CCA did not allow to differ between
subjects with 3VD and without significant changes in the coronary arteries. Despite good
feasibility and concordance of CS measurements its clinical significance remain to be
established.
Disclosure of Interest: K. Wierzbowska-Drabik Grant/research support from: The State
Committee for Scientific Research, number N N402 5002 40, K. Cygulska: None Declared,
from: The State Committee for Scientific Research, number N N402 5002 40
PW170
Clinical Validation Of The Smartphone
Francesco Lamonaca1, Domenico Grimaldi1, Alfonso Noto2, Vitaliano Spagnuolo*2
1
Department of Computer Science, Modeling, Electronic and System (DIMES), University of
Calabria, Rende (CS), 2Internal Medicine, AO di Cosenza, Cosenza, Italy
Introduction: The technology available in the smartphone is proposed to evaluate the
Pulse Rate (PR) and the Blood Pressure (BP) anywhere and anytime. The tasks performed
by smartphone are (i) extraction of the PhotoPlethysmoGram (PPG) signal from frame
sequence acquired by the integrated camera, and (ii) processing it by statistical approach for
the evaluation of the PR, and by Artificial Neural Network for the evaluation of the BP.
Objectives: The PPG signal is evaluated by analyzing the volumetric blood variation of the
fingertip on the frame sequence. The change of the blood volume changes the quantity of
light that through the fingertip reach the camera. From each frame the red component is
extracted and the PPG sample value is the number of pixel brighter than a threshold
statically evaluated. The PPG signal is monitored to detect abrupt variation due to misuse of
the smartphone. Successively, parameters characterizing the pulses of the PPG signal are
sent to the Fit Forward Neural Network for the simultaneously evaluation of the systolic
and the diastolic BP (Fig.1).
Methods: The validation of the results of the PR and BP is performed by comparing them
with the ones obtained by the Ambulatory Blood Pressure monitor ABP Spacelabs 90207,
and by the sphygmomanometer. Preliminary experimental results show an accuracy of 3
pulses and 2 mmHg.
Results: The ongoing activity is devoted to give a statistical validation of the proposed
solution and check if it meets the Association for the Advancement of Medical Instru-
mentation criteria.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: To this aim the tests are performed by comparing the results of the smart-
phone with the ones obtained by clynical methods on the selected population constituted
by two set of patients: not affected by hypertension pathologies, and affected by known
hypertension pathologies.
Disclosure of Interest: None Declared
PW171
Central Systolic Blood Pressure Variation During the Respiratory Cycle - An
Observational Study
Ben Costello*1, James A. Black2, Martin Schultz3
1
Cardiology, Western Health, Melbourne, 2Cardiology, Royal Hobart Hospital, Tasmania,
3
Menzies Institute, Hobart, Australia
Introduction: Systolic blood pressure (SBP) variation using traditionally measured brachial
cuff SBP is well described. A SBP difference of up to 10mmHg through the respiratory cycle
is considered normal. Greater variation may be a marker of hypovolemia, cardiac or res-
piratory pathology, or due to mechanical ventilation. Unlike in right heart studies, there is
no pre-specified point of the respiratory cycle at which measurements of blood pressure or
end diastolic pressure are taken.
Objectives: To assess central SBP variation through the respiratory cycle at the time of
angiography, and to evaluate the impact of vasodilatation on these measurements.
Methods: 88 recordings of invasive ascending aortic SBP were recorded in 47 patients
(aged 6310.3 years, 66% male) undergoing coronary angiography using a pigtail
catheter in the ascending aorta. Each recording was taken over 10-15 seconds (two
respiratory cycles).Measures were recorded at baseline and following intravenous
glyceryl trinitrate (GTN; 100-200mcg). Measurements are reported as mean standard
deviation.
Results: There was a large variation in central SBP through the respiratory cycle. At
baseline the variation was 147 mmHg. The administration of GTN did not significantly
alter the central SBP variation, with a mean difference of 136 mmHg.
Table 4. Respiratory Variation in aortic systolic blood pressure
Mean SBP High Low Difference (High – Standard
(mmHg) (mmHg) (mmHg) Low, mmHg) Deviation
All measurements 127 113 13 6 1
Baseline 131 136 121 14 7
Post GTN 113 118 106 13 6 and is closely related with arterial stiffness (AS), which is an independent CVD risk factor.
Conclusion: Our study demonstrated a large variability in central SBP through the res-
piratory cycle. This suggests care should be taken when assessing central pressures to
ensure reliability and repeatability of measures.
Disclosure of Interest: None Declared
PW173
Erectile dysfunction in ST-segment elevation myocardial infarction patients at high
risk of obstructive sleep apnea
Filip M. Szymanski*1, Krzysztof J. Filipiak1, Anna Szymanska2, Grzegorz Karpinski1,
Grzegorz Opolski1
1
Cardiology Department, 2Department of Cardiology, Hypertension and Internal Diseases, The
Medical University of Warsaw, Warsaw, Poland
Introduction: Erectile dysfunction (ED) and lack of sexual activity are a risk factors for
cardiovascular diseases morbidity and mortality.
Objectives: The aim of this prospective study was to investigate the prevalence of ED in
ST-segment elevation myocardial infarction (STEMI) patients at high risk of OSA, and to
evaluate the leading factors that increase the risk of ED.
Methods: We prospectively studied 90 consecutive male STEMI patients. Erectile function
was assessed using the International Index of Erectile Function (IIEF).
Results: 32 (35.6%) patients were at high risk of OSA. Patients at high risk of OSA had
often history of hypertension (90.6% vs. 50%; p<0.0001), higher systolic blood
pressure (145.632.9 vs. 131.427.6 mmHg; p¼0.04), diastolic blood pressure
(88.219.3 vs. 78.212.4 mmHg; p¼0.009), mean ESS score (15.63.1 vs. 5.93.3;
p<0.0001), body mass index (324.5 vs. 27.33.5 kg/m2; p<0.0001), lower
glomerular filtration rate (78.122.1 vs. 90.420.9 ml/min/1.73 m2; p¼0.02), and
higher mean C-reactive protein level (21.828.8 vs. 11.420.3 mg/l; p¼0.13)
compared to the patients at low risk. Overall ED prevalence was 61.1%. The patients at
higher risk of OSA had higher incidence of ED compared with those at low risk (73.7%
vs. 40.6%; p¼0.0002). The mean IIEF score was significantly lower in patients at high
risk of OSA (16.25.4 vs. 20.56.4; p¼0.004). In the multiple logistic regression
analysis, patient’s age [odds ratio (OR) 1.80, 95% confidence interval (CI): 1.32-2.47;
p¼0.0002], patient’s BMI (OR 1.62, 95%CI: 1.06-2.47; p¼0.024) and high risk of
OSA using the BQ and ESS (OR 55.71, 95%CI 3.36-923.81; p¼0.005) were inde-
pendent risk factors of ED in STEMI patients.
Conclusion: ED was highly prevalent in STEMI patients at high risk of OSA. High risk of
OSA was strong, independent risk factor for developing ED.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PW174
POSTER ABSTRACTS
Lipocalin-2, A-Fabp And Inflammatory Markers In Patients With Essential
Hypertension
Chang G. Park*1
1
Cardiology, Korea University Guro Hospital, Seoul, Korea, Republic Of
Introduction: Lipocalin families including lipocalin-2 and adipocyte fatty acid binding
protein (A-FABP) were recently identified as novel adipokines to be associated with the
cardiovascular risk variables of the metabolic syndrome.
Objectives: To evaluate the correlation between lipocalin-2, A-FABP levels, inflammatory
markers including hsCRP and IL-10, and flow-mediated vasodilatation (FMD) in essential
hypertension (EHT).
Methods: We evaluated the lipocalin-2 and A-FABP levels in 62 patients with EHT and 16
age-, gender- and body mass index-matched normotensive healthy subjects (NT).
Furthermore, we evaluated the correlation between lipocalin-2, A-FABP levels, inflamma-
tory markers including hsCRP and IL-10, and flow-mediated vasodilatation (FMD).
Results: In EHT, circulating lipocalin-2 levels were significantly higher than in NT (85.0 
37.6 ng/ml vs. 43.8  13.1 ng/ml, P<0.001). However, Although A-FABP levels were not
different between patients with EHT and NT, but gender analysis showed significant
correlation between A-FABP and blood pressure in only male (r¼0.459, p¼0.005). Serum
lipocalin-2 levels were more strongly associated with SBP (r¼0.54, P<0.001) compared to
DBP (r¼0.34, P¼0.003), and positively associated with fasting glucose levels (r¼0.25,
P¼0.032), On the other hand, circulating A-FABP levels were significantly associated with
variables such as BMI, fasting insulin, insulin resistance index and hsCRP. Multiple linear
regression analysis showed that mean arterial pressure was associated with fasting glucose,
lipocalin-2 levels, age, BMI and hsCRP levels (R2 ¼ 0.456). However, circulating lipocalin-2
levels were not associated with FMD.
Conclusion: In conclusion, lipocalin-2 levels were significantly higher in patients with
EHT, and A-FABP showed significant correlation with blood pressure in only male.
Disclosure of Interest: None Declared
PW175
Effects of Chronic Smoking on Arterial Stiffness in Healthy People
Chang G. Park*1
Cardiology, Korea University Guro Hospital, Seoul, Korea, Republic Of
Introduction: Smoking is a modifiable cardiovascular disease (CVD) [ 1] risk factor
However, the chronic effects of smoking have been controversial[ 2], and data are
relatively lacking regarding its effects on AS in ex-smokers (ES), who face remnant risk
compared to never-smokers (NS).
[ 1] [ 1]Generally, “CVD” is the abbreviation for “cardiovascular disease.” I
have revised this term based on this meaning. However, if the intent was to refer only to
“cardiovascular” as in the cardiovascular system, I suggest spelling it out instead.
[ 2] [ 2]Perhaps it would be more accurate to state that the effects have “not
been described definitively,” as it is not very clear in this statement exactly what is
controversial about the chronic effects of smoking.
Objectives: To evaluate there would be differences in AS between NS and ES, which will
provide insight into the phenomenon of why ES are more vulnerable beyond the con-
ventional risk.
Methods: We recruited 678 relatively healthy men from 1722 subjects who underwent a
health examination from September 2009 to November 2010 in Korea. To assess AS, the
corrected augmentation index (AIx@HR75) and pulse pressure amplification (PPamp) were
measured and compared according to smoking status.
Results: The baseline characteristics were similar among groups except age and triglyceride
level. AS was significantly increased in current smokers (CS) compared to that in both the
ES and NS. Overall, AIx@HR75 and PPamp did not differ between the NS and ES.
Smoking duration was associated with AS in the ES, and subanalysis showed that long-term
ES (LTES, 20 years of smoking) had significantly increased AS compared to both short-
term ES (STES, <20 years) and NS. The LTES had AS comparable to the CS despite lower
CVD risk scores.
Conclusion: Long-term smoking can cause irreversible AS even after smoking cessation.
Premature AS can be used as a supplementary measure for better risk stratification in this
specific population, and further study is needed to determine its clinical implication.
Disclosure of Interest: None Declared
PW177
Literature Review Of The Cost And Cost Effectiveness Of Amlodipine In The
Treatment Of Hypertension
Danny Liew*1, Larry Liu2,3, Barrett W. Jeffers2, Joanne Foody4
1
University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia, 2Pfizer Inc,
3
Weill Medical College of Cornell University, New York, NY, 4Brigham and Women’s Hospital,
Boston, MA, United States
Introduction: The global health and economic burden of hypertension is significant and
increasing. Antihypertensive therapy aims to achieve blood pressure (BP) control and
reduce overall cardiovascular risk. Hence it is likely to be life-long, making long-term
effectiveness, tolerability, and costs important. The calcium channel blocker amlodipine has
been shown to be more effective than angiotensin II receptor blockers (ARBs) in terms of
e293
 BP-lowering and equal or superior to other agents in reducing stroke and myocardial
POSTER ABSTRACTS
infarction (MI).
Objectives: To review the cost and cost effectiveness of amlodipine for the treatment of
hypertension.
Methods: A literature review of English language articles published between 1996 and
2011 that reported economic data. The literature included health economic assessments as
well as prospective and retrospective observational studies. Overall, 39 articles were
reviewed and included in this study.
Results: In Europe and the US, amlodipine use resulted in improved clinical outcomes
(stroke and MI) at a slightly lower cost versus usual care (ARBs, angiotensin-converting
enzyme inhibitors, diuretics or beta-blockers), and patients on amlodipine needed
fewer hospitalizations and revascularizations at a small incremental cost. According to a
3-year Markov model of the Swiss healthcare system, an amlodipine regimen was cost-
saving versus an atenolol regimen. US patients switched from nifedipine GITS to
amlodipine (5 or 10 mg daily) achieved significantly better BP control at an annual cost
saving in favor of amlodipine of US $47,844. Total medication costs to achieve BP goal
were $0.87/day on amlodipine versus $1.79/day on felodipine (with 87 and 33%
achieving BP goal, respectively). Studies from other regions showed less need for
hospitalizations and coronary procedures with amlodipine versus placebo and
confirmed the cost-benefit of amlodipine, with the estimated costs of not using
amlodipine being $6,519 in Canada (US $4,405) and 64,292 kroner in Norway (US
$7,337) over a 4-month period.
Conclusion: Data from the literature suggest that amlodipine is cost-effective according to
the WHO-recommended threshold, and potentially cost-saving in certain settings in
various countries.
Disclosure of Interest: D. Liew Grant/research support from: Pfizer Inc., Consultancy for:
Pfizer Inc., Honorarium from: Pfizer Inc., L. Liu Employee from: Pfizer Inc., B. Jeffers
Employee from: Pfizer Inc., J. Foody Grant/research support from: Pfizer Inc., Consultancy
for: Pfizer Inc.
PW178
Hypertensive Women Over 50 Years Of Age: The Value Of Preoperative
Electrocardiogram
1 2 2 2 1
Lafayete Ramos* , Flávia Carneiro , Maria Guiotti , Maria Silva , Eliane Elly ,
Edilberto Castilho1, Bárbara Cristina1, Mônica Wolf1, Isabelle Caroline3, Marcelo Calil1,
João Goes1
1
Brazilian Institute for Cancer Control, 2São Camilo Medical School, São Paulo, 3Campos dos
Goytacazes Medical School, Campos, Brazil
Introduction: Cardiac complications are the major cause of postoperative morbidity
and mortality in non-cardiac surgery. Many guidelines recommend a preoperative
Electrocardiogram (ECG) for hypertensive patients who are over 50 years old. It is
ordered routinely, often before the medical history is obtained and the physical ex-
amination is performed. The increased expense is particularly burdensome for low-
income coutries.
Objectives: The aim of this study was to determine the importance of abnormalities on the
preoperative ECG and its impact on the in-hospital outcome in this subset of patients.
Methods: We evaluated a historical cohort of 527 female cancer patients (63.95  8.59
years) scheduled for elective surgical procedures under general anesthesia that were
considered to be low-risk. All patients had arterial hypertension as an isolated co-
morbidity and underwent preoperative ECG. The patients were divided into two groups:
without (group A) and with (group B) abnormalities on the preoperative ECG. Each
group was subdivided into two other groups according to postoperative outcome. Vari-
ables such as age, duration of anesthesia, prior chemotherapy, prior radiotherapy, and
surgical risk (ASA) were analyzed. Multivariate logistic regression was used to determine
the adjusted influence of the variables on the in-hospital outcome. An adverse outcome
was considered to be any complication that increased the in-hospital length of stay or
death.
Results: Among 527 patients, 381 (72.3%) were found to have normal (group A), and 146
(27.7%) had any type of abnormality on ECG (group B). Of these, 32 (21.9%) were
submitted to others cardiac tests, which did not result in any changes in the surgical
management. Among the patients from group A, 14 (3,7%) had adverse outcomes,
compared to 5 (3.4%) from group B (OR¼0.93 CI 0.33-2.63, p¼0.890). According to
multivariate logistic regression, the duration of anesthesia (p¼0.035) and surgical risk
(p¼0.015) were associated with postoperative morbi-mortality independently of abnor-
malities on preoperative ECG (p¼0.511).
Conclusion: These results suggest that hypertensive women over 50 years of age who are
scheduled for low risk surgery do not derive any significant benefit from preoperative
electrocardiogram results.
Disclosure of Interest: None Declared
PW179
Electrocardiographic abnormalities in a large sample of primary care patients with
hypertension
Milena Marcolino*1,2, Barbara C. A. Marino2, Maria Beatriz M. Alkmim2, Antonio L. Ribeiro1,2
1 Objectives: To study structural parameters of vessel wall, lipid and inflammatory
Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais,
2
Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
Introduction: The 12-lead electrocardiogram (ECG) is the most readily available nonin-
vasive test for the detection of cardiac disease in primary care. The detection of preclinical
cardiac abnormalities is a key clinical step in hypertension management, and several
e294
guidelines for hypertension recommend an ECG in hypertensive patients to improve risk
prediction.
Objectives: To assess the prevalence of ECG abnormalities in patients with hypertension
who were attended at primary care centers in Brazil.
Methods: In this observational and retrospective study, all 12-lead standard digital ECGs
analyzed by cardiologists of the Telehealth Network of Minas Gerais, a public telemedicine
service in Brazil, from January to December 2011, were assessed. This service attends
primary care of 660 cities in the state of Minas Gerais. ECGs were sent by remote healthcare
professionals through internet to be analyzed by cardiologists who are trained and expe-
rienced in the analysis and interpretation of ECG. The prevalence of ECG abnormalities in
patients with hypertension was assessed.
Results: During the study period, 82,125 primary care patients with hypertension
underwent ECG (mean age 60.8  13.5 years, 63.7% females). The most common
comorbidities besides hypertension were diabetes (14.2%), smoking (11.4%), hyper-
lipidemia (7.0%) and Chagas disease (5.6%). Regarding the ECG analysis, 48.3% of
them had no abnormalities, and the mean number of abnormalities per patient was
0.91.1 (range 0-9). Regarding the rhythm, 2.9% had atrial fibrillation or flutter, 3.2%
ventricular premature beats, 2.4% supraventricular premature beats and 0.6% were
pacemaker users. Left bundle branch block (LBBB) was observed in 2.4% of the ECGs,
incomplete LBBB in 1.8%, right bundle branch block (RBBB) in 4.6% and left anterior
hemiblock in 8.7%. First degree atrioventricular block was found in 2.5%, second and
third degree in less than 0.1% each. There was electrocardiographic evidence of left
ventricular and atrial hypertrophy in 5.2% and 3.2% of patients, respectively, and
pathological Q waves in 1.5%. Non-specific repolarization abnormalities were observed
in 29.4% of the patients.
Conclusion: In this large sample of primary care patients with hypertension, ECG ab-
normalities were observed in more than 50% of patients. The most common abnormalities
were non-specific repolarization abnormalities, RBBB, LBBB, left ventricular hypertrophy,
premature beats and atrial fibrillation.
Disclosure of Interest: None Declared
PW180
Expression and Function of Ryanodine Receptors in Mesenteric Artery Smooth
Muscle Cells from patients with hypertension
Pengyun Li1, liang mao1, jun cheng1, jing wen1, yan yang1, xiaorong zeng1, Ou Xianhong*1
1
Institute of Cardiovasology, Luzhou Medical College, luzhou, China
Introduction: Hypertension is a clinical syndrome characterized by increased peripheral
resistance, which is mainly attributable to structural and functional alterations of small
arteries and arterioles. However, the molecular mechanism underlying vascular dysfunction
during acquired hypertension remains unresolved.
Objectives: In this study, we aimed to investigate whether the expression and functional
activity of RyRs would be different in mesenteric artery from patients with hypertension.
Methods: RyR expression, [Ca2+]i was measured by real-time quantitative RT-PCR,
immunofluorescence staining and wide-field fluorescence microscopy, respectively.
Results: All three isoforms of RyRs (RyR1, RyR2 and RyR3) mRNA were detected in
human mesenteric artery smooth muscle cells (HMASMCs), but their distributions and
expression levels were different. Immunofluorescense showed that each RyR isoform
distributed differentially among subcellular compartment. RyR1 and RyR3 localize
mostly to the central sarcoplasmic reticulum (SR), while RyR2 distribute around the
plasma membrane, colocalizing with BKCa channels. Real-time PCR indicated that RyR2
was especially the predominant isoform, and all of the three isoforms expression level
significantly increased in patients with hypertension. It was found interesting that more
copies of RyR3 mRNA expressed in HMASMCs from the patients with hypertension.
Application of caffeine (10 mM) to activate RyRs or high K+ (60 mM) induced different
kinetics of intracellular Ca2+ release. Moreover, the increases and decreases in [Ca2+]i
induced by caffeine is faster in HMASMCs from patients without hypertension
compared to those with hypertension.
Conclusion: This study provides comprehensive evidence that RyRs are heterogeneous in
expression and functional activity in HMASMCs from patients with hypertension, which
may contribute to the diversity of excitation-contraction coupling and intimate commu-
nication between sarcoplasmic reticulum and sarcolemmal ion channel in different vascular
smooth muscle cells.
Disclosure of Interest: None Declared
PW181
Structural Parameters Of Arterial Wall And Inflammatory Biochemical Parameters In
Hypertensive Patients With Abdominal Obesity
Tatiana Petelina1, Ludmila Gapon1, Natalia Musikhina1, Ksenia Avdeeva1, Vadim Kuznetsov*1,
Natalia Tretyakova1
1
Tyumen Cardiology Center, Tyumen, Russian Federation
Introduction: A number of major studies has shown that increasing stiffness of the arteries
is an independent predictor of cardiovascular disease and mortality. The condition of
vascular inflammatory reaction is of great importance in the process of endothelial
dysfunction and vascular remodeling.
biochemical parameters in patients with arterial hypertension (AH) and abdominal obesity
(AO).
Methods: 115 patients were included in the study and randomized into 2 groups: I - 72
subjects (mean age 47.391.60 years) with AH degree I-III and AO, II - 43 subjects (mean
age 47.290.95 years) without metabolic disorders. The parameters of sphygmography
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
and 24-hour blood pressure monitoring; biochemical parameters (total cholesterol, low-
General Others physicians and

POSTER ABSTRACTS
density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, malonic
dialdehyde (MD) and inflammatory markers -homocysteine and hs-CRP) were estimated. practitioners (%) Clinicians (%) Cardiologists (%) non- physicians (%)
Results: In group I there was registered significant increase in sphygmography indices Diagnosis 50 20 22 8
(pulse wave velocity (PWV) – normal importance <12 m/s, cardio-ankle vascular index), in Follow-up 38 22 29 11
mean 24-hour and mean daytime systolic blood pressure (SBP), in time and square indices
and in day time SBP variability (p<0.001) and decrease in ancle-brachial index. In Treatment 39 25 30 2
biochemical parameters significant increase in total cholesterol (p¼0.000), low-density
lipoprotein cholesterol (p¼0.034), triglyceride level (p¼0.002), MD level (p<0.05) and in
inflammatory markers - homocysteine (p¼0.000) and hs-CRP level (p¼0.001); decrease in
high-density lipoprotein cholesterol (p¼0.001) was found compared to group II patients. 2) Use of guidelines
Besides in group I there was detected positive correlation between inflammatory and lipid Most used guidelines were JNC 7 (15), ESC guidelines (13), national guidelines (10)
markers with parameters of sphygmography and 24-hour blood pressure monitoring. It and/or Nice guidelines (3).
was shown that with an increase in total cholesterol level m>5.0 mmol/l, the risk of high 3) Medications
rate PWV>12 m/s in patients with AH and AO increased by 15 times. Besides we revealed Specific medications for treatment were endorsed by the government in 13 countries and
that high levels of endothelin-1 and homocysteine were observed more frequently in 9 countries had specific medications recommended. In 9 countries there were programs/
women than in men, with an increase at 1 fmol/l the risk of high rate PWV>12 m/s agreements among pharmaceutical companies/drug manufacturers/government to decrease
increased by 2.6 times and 35%, respectively. cost and/or increase availability of medications.
Conclusion: The relationship between the markers of inflammation, endothelial 4) Barriers for prescription/compliance
dysfunction, parameters of atherogenic lipids and vascular remodeling process factors in- Lack of patient understanding for long-term need for medication (100%), lack of
dicates a high risk of progression of hypertension and cardiovascular complications in effective tools for follow-up (89%), cost of medications (84%), lack of skill among pro-
patients with AH and AO. viders to motivate/support patient adherence (63%), lack of consistent availability of
Disclosure of Interest: None Declared prescribed medications (53%), and varying opinions about the recommended medication
(21%).
Conclusion: Diagnosis/follow-up/treatment of HT are performed in most cases by physi-
PW182 cians. There is widespread use of different guidelines. Despite specific medications for
Factors influencing on endothelial dysfunction in patients with arterial hypertension treatment of HT being endorsed by the government in most countries, and several of them
combined with coronary artery disease having programs and/or agreements to decrease cost and/or increase availability of medi-
cations, there are still powerful barriers for prescription and compliance.
Natalia Musikhina1, Tatiana Petelina1, Ludmila Gapon1, Elena Mahneva1, Vadim Kuznetsov*1 Disclosure of Interest: None Declared
1
Tyumen Cardiology Center, Tyumen, Russian Federation

Introduction: Arterial hypertension (AH) is one of the major risk factors for atheroscle-
rosis, especially for coronary artery disease (CAD), therefore, these diseases are frequently PW185
accompanied by each other. Endothelium becomes a target organ for these diseases.
Efficacy of LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI), in patients
Objectives: To define factors influencing on endothelial dysfunction in patients with AH
with systolic hypertension
combined with CAD.
Methods: 121 patients (mean age 54.490.78 years) were examined. I group included 18 Joseph L. Izzo*1, Dion H. Zappe2, Yan Jia2, Kudsia Hafeez2, Jack Zhang2
patients without AH and CAD, II group – 57 patients with AH, III group – 46 patients with 1
Clinical Pharmacology, State University of New York, Buffalo, NY, 2Novartis Pharmaceuticals
AH combined with CAD. Patients in all groups were matched for gender, body mass index Corporation, East Hanover, NJ, United States
(BMI), circadian index (CI) of BP (dippers with CI 10-20% and nondippers with CI
<10%), level of endothelium-dependent vasodilation (EDV) >10% and <10%. All patients Introduction: The progressive increase in arterial stiffness that occurs with aging makes
underwent 24-hour blood pressure monitoring and ECG with heart rate variability (HRV) systolic hypertension (SH) difficult to treat. The anti-hypertensive drug LCZ696 (Japanese
assessment. Pulse wave velocity was measured in elastic arteries (R\L-PWV). Adopted Name [JAN]: Sucabitril Valsartan Sodium Hydrate), a first-in-class ARNI, may
Results: The comparison of three groups revealed no significant difference in EDV level. have unique effects on arterial stiffness and SH.
Male patients showed a decrease in EDV in response to AH and CAD (males: I group – Objectives: To compare the efficacy of LCZ696 against valsartan (V) in patients with SH
9.591.23%, II – 6.420.91%, III – 8.211.23%; females: I – 10.511.40%, II – (mean sitting [ms] systolic blood pressure [SBP]150 mmHg) and isolated SH (ISH,
9.830.78%, III – 8.341.09%). In group with AH significant differences in EDV between msSBP150 mmHg and ms diastolic BP [DBP]<90 mmHg).
male and female patients were detected (6.420.91% vs 9.830.73%, p<0.05). Patients Methods: Subjects included in this analysis participated in an 8-week, multicenter, ran-
with AH and CAD with BMI >30 demonstrated lower EDV vs patients without obesity domized, double-blind, placebo- and active-controlled, parallel-arm study. Primary
(10.10.98% vs 7.570.80%, p<0.05). dependent variable was the change in SBP at 8 weeks; pulse pressure (PP) and mean
The lowest EDV was observed in patients of III group – nondippers (II group, dippers – ambulatory (ma) BP were also evaluated.
12.732.30%, nondippers – 7.360.72%, p<0.05; III, dippers – 11.411.59%, non- Results: Overall, 343 patients with SH (age 61 years, 48% 65 years, 68% Caucasian,
dippers – 6.321.40%, p<0.05). body weight 82.4 kg, body mass index 29.9 kg/m2, duration of hypertension 8.7 years)
Subjects with impaired EDV in group with AH and CAD showed increase in PWV were randomized to placebo (n¼58), V 320 mg (n¼143) or LCZ696 400 mg (n¼142).
compared with healthy subjects (I group, R-PWV – 11.230.22 m/s vs L-PWV – Baseline msSBP, msDBP, and msPP were 159.8, 90.2, and 69.6 mmHg, respectively. ISH
11.380.10 m/s; III – 14.200.62 m/s vs 11.230.22 m/s, p<0.05), and decrease in HRV was present in 159 patients (46.4%); baseline msSBP, msDBP, and msPP were 159.2,
– LF and VLF that indicates the tone of the sympathetic division of the sympathetic nervous 82.4, and 76.7 mmHg, respectively. After 8 weeks of treatment for SH, LCZ696 400 mg
system: LF (I group – 1447.80647.39 m/s2, III – 404.2560.61 m/s2, p<0.05) and VLF lowered msSBP more than V (5.7 mmHg, p<0.001), along with msPP (3.4 mmHg,
(1867.44234.31 m/s2 vs 1210.75117.09 m/s2, p<0.05). p<0.05) and 24-hour maSBP (-3.4 mmHg, p<0.001). Similar results were obtained for
Conclusion: Male sex, obesity, abnormal circadian index of BP influence on endothelial ISH (Table).
dysfunction in patients with AH combined with CAD during reduction in the sympathetic
nervous system tone that may cause impaired vessel wall elasticity.
Disclosure of Interest: None Declared
SH ISH
PW183 Mean LCZ696 Valsartan LCZ696 Valsartan
Latin American Survey 2013 on Hypertension (SD) Placebo 400 mg 320 mg Placebo 400 mg 320 mg
N 58 142 143 25 64 70
Daniel J. Piñeiro*1, Marcia M. Barbosa2, Wistremundo Dones3, Araceli Delgado4, On behalf the
Interamerican Society of Cardiology msSBP -6.515.4 -21.513.7 -15.714.8 -8.210.6 -21.712.9 -15.814.9
1
Hospital de Clínicas "José de San Martin", Universidad de Buenos Aires, Buenos Aires, msDBP -3.510.5 -9.69.6 -6.98.7 -1.08.9 -5.78.5 -5.38.5
Argentina, 2Hospital Socor, Belo Horizonte, Brazil, 3Ryder Memorial Hospital, Humacao, Puerto msPP -3.011.6 -11.910.9 -8.812.4 -7.210.3 -16.010.2 -10.513.6
Rico, 4Interamerican Society of Cardiology, Mexico City, Mexico
maSBP -0.89.1 -13.69.3 -9.911.9 -0.99.3 -11.910.1 -9.812.4
Introduction: High blood pressure is the leading risk factor for heart attack and stroke, and maDBP 0.15.2 -6.66.4 -5.18.1 +0.53.9 -4.46.4 -5.19.0
is responsible for over 7 million, largely preventable, deaths each year worldwide. Similar to
the global situation, in Latin America (LA), hypertension (HT) is common and poorly
controlled.
Objectives: This survey aimed to collect data on the clinical practices in the management of
adult patients with HT in LA. All treatments were safe and well tolerated: adverse events with LCZ696 (29.6%) and V
Methods: A survey was sent to the 20 Presidents of the LA national societies/associations of (26.6%) were similar to placebo (34.5%).
Cardiology, contacted between October 2011 and February 2012. Conclusion: LCZ696 is superior to valsartan in reducing clinic and 24-hour ambulatory
Results: Responses were received from 19 societies (95%). SBP in SH and ISH and is thus an attractive treatment strategy for SH. Proof of a direct
1) Diagnoses, follow-up, and treatment effect of ARNI on arterial stiffness requires additional study.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e295

 Disclosure of Interest: J. Izzo Grant/research support from: Abbott Laboratories; Amylin
POSTER ABSTRACTS
Pharmaceuticals, Inc.; Forest Laboratories, Inc.; Novartis Pharmaceuticals Corporation,
Honorarium from: Novartis for consulting and presentations at scientific symposia, D.
Zappe Employee from: Novartis Pharmaceuticals Corporation and is eligible for Novartis
stock and stock options, Y. Jia Employee from: Novartis Pharmaceuticals Corporation and
is eligible for Novartis stock and stock options, K. Hafeez Employee from: Novartis
Pharmaceuticals Corporation and is eligible for Novartis stock and stock options, J. Zhang
Employee from: Novartis Pharmaceuticals Corporation and is eligible for Novartis stock
and stock options
PW187
Antihypertensive drug utilization and conformity to current guidelines in Bahraini
hypertensive population
Syed Raza*1
1
Cardiology, Awali Hospital, Manama, Bahrain
Introduction: Despite availability and usage of wide array of antihypertensive drugs,
blood pressure has remained poorly controlled in most health care settings particularly in
the Middle Eastern countries. Patient’s knowledge and understanding of hypertension and
the need for its management as well as varied prescription writing of these drugs among
other factors strongly determine the control of blood pressure particularly in Bahraini
population
Objectives: The aim of this study was to describe the current utilization pattern of anti-
hypertensive drugs in local Bahraini population in accordance with the regional and in-
ternational guidelines for hypertension management.
Methods: This is a cross sectional study of 540 adult hypertensive patients who were on
treatment at the Medical Out-Patient Department of our hospital. Data were collated from
the patients’ records and evaluated to see if current guidelines on use of antihypertensive
medication were being followed.
Results: Mean age was 49.54 years with 332 (61.4%) males. Average duration before a
patient was commenced on antihypertensive medication despite blood pressure > 140/90
mmHg on previous visits was 91 days. Life style measures were advised and recorded in
54 (10%) patients. A combination of anti-hypertensive therapy was commenced only in
34% of patients with stage II hypertension. Beta-blocker and HCT were being used as first
line antihypertensive agent in 28.24% and 13.49% patients respectively. None of the
patients received Chlorthalidone. ACE Inhibitor (ACEI) and Angiotensin II receptor
blocker (ARB) were not being prescribed in 23.59% patients despite compelling in-
dications. A follow up kidney function test after commencing ACEI or ARB was requested
only in 42.14% patients. An attempt to investigate the target organ damage was made
only in 44.56 patients. Ambulatory and home blood pressure readings were utilized in
only 12.43% of patients. Blood pressure was controlled in 54% of patients on their third
follow up visit.
Conclusion: There is a significant deviation from the current guidelines as to how the
antihypertensive medication is initiated and utilized amongst a sample Bahraini hyper-
tensive population. Combination antihypertensive medication and ACEI /ARB are still
being less utilized.
Disclosure of Interest: None Declared
PW192
In What Patients Does The Cold Pressor Test Offer Useful Information As A
Predictor Of Cardiovascular Events? Our Experience In 10 Years
Enrique J. Pautasso*1, Marrtin Koretzky1, Leopoldo Macon2, Carlos Borrego2
1
Cardiologia, Centro De Cardiologia Nuclear, 2Cardiologia, Sanatorio San Lucas, Buenos Aires,
Argentina
Introduction: Endothelial dysfunction is the first alteration known that intervenes in the
development of coronary artery disease and it can be evaluated by a perfusion test with
SPECT and the cold pressor test (CPT).
Objectives: To identify with the CPT those patients (p) with low coronary risk who are
most likely to suffer from cardiovascular events (CE).
Methods: 1048 p were admitted in a nuclear medicine center, that had a normal perfusion
test with SPECT. None of these p had a history of myocardial revascularization or prior
myocardial infarction. The CPT was performed between the third and fifth day after the
normal perfusion SPECT. It was considered positive when there was a decreased uptake of
the radioisotope in a segment that did not appear in the previous study and negative when
no change in uptake between both studies existed.
The average follow-up was 5116 months having located 85% of the p. The events
analyzed were: cardiac mortality, non-fatal myocardial infarction and coronary revascu-
larization . The mean age was 5910 years with a male prevalence of 55%. The exercise test
was adequate in 75% of the p. We analyzed different variables in individuals whose exercise
test were adequate (reached the target heart rate) vs. inadequate (did not reach the target
heart rate), identifying male sex, obesity, hypertension and p treated with beta blockers, as
more likely to have an inadequate response.
Results: 37 % of the p had a positive CPT.
The event-free survival rate of the whole population was 91%, indicating a low risk
population for CE, since the 10 year risk was 8%. However, during follow up, those p with
an adequate test had an event-free survival rate of 96% and 94% with a negative or positive
CPT respectively P < 0.28. On the other hand, the event-free survival rate in the in-
dividuals with inadequate exercise test was 91% and 84% in the negative and positive CPT
respectively P < 0.02 which indicates an intermediate risk in the subgroup of p with
inadequate treadmill test and positive CPT.
e296
Conclusion: It is very useful to carry out the CPT, in a low risk population because
with this test we could identify a subgroup of p with a higher likelihood of suffering
from CE.
In patients with a normal SPECT but inadequate exercise test, we suggest completing the
study with the CPT in order to identify p with intermediate risk.
Disclosure of Interest: None Declared
PW193
The role of telemetry in in-hospital cardiac rehabilitation units. single center
experiance
Ivana Burazor*1, Milca Lazovic2, Stamenko Susak3, Slavica Stevovic1, Aleksandar Radovic1,
Bojan Milanovic1
1
Cardiology department, 2Institute for rehabilitation Belgrade, Belgrade, 3Institute for
Cardiovascular Diseases, Novi Sad, Serbia
Introduction: Cardiac remote telemetry is the transmission of cardiac signals from a patient
to a distant receiving location with a goal of rhythm monitoring to ST segment monitoring
and sophisticated arrhythmia detection (such as paroxysmal atrial fibrillation, ventricular
tachycardia, de novo bundle branch block left or right etc) and diagnosis under surveillance
of trained personal.
Objectives: We aimed to investigate the usefulness of cardiac telemetry in patients’
admitted after coronary artery by pass surgery (CABG), valve surgery, percutaneous cor-
onary intervention (PCI) in our in-hospital cardiac rehabilitation center.
Methods: Out of 2176 patients admitted for in-hospital cardiac rehabilitation, we studied
one hundred forty two patients with previous CABG (45%), valve surgery and PCI (44%),
66% males, aged 65.748.01 years). Risk factors were noted, blood was sampled for
analyses. Exercise test were performed on admission and after 21 days of in-hospital
rehabilitation. According to the first test results patients were selected for exercises pro-
gram: free walking, cycle and/or Nyllin steps. During the exercise patients were continu-
ously monitor by using wireless cardiac remote system of 3 channels. Signals were
transmitted to the central work station. The surveillance of the displayed signals was
continuously assessed in real time by a personal trained in arrhythmia recognition su-
pervised by a cardiologist.
Results: By using cardiac remote monitoring ST segment depression ranging from 0.5 to
1.5 mm was detected in 14% of pts of whom majority were without any symptoms - silent
ischemia. Trimetazidine was added in the therapy and all patients fulfill in hospital reha-
bilitation program without further need for angiography. Rhythm disorders were detected
in 30% of patients: paroxysmal atrial fibrillation, VES, SVES. VT was detected in 2% of
patients and was well tolerated. Amiodarone was added in the therapy and patients were
monitored till discharge.
Conclusion: Cardiac remote telemetry is useful tool not for safety reasons but as diagnostic
tool in cardiac rehabilitation program, especially in patients after surgery in whom
paroxysmal atrial fibrillation and silent ischemia are common disorders.
Disclosure of Interest: None Declared
PW194
Perceived causes and symptom recognition of acute myocardial infarction: systematic
misconceptions among 536 survivors and 511 carers
Tone Norekval*1, Yih-Kai Chan2, Melinda Carrington2, Simon Stewart2, David Thompson3
1
Institute of Medicine, University of Bergen, Bergen, Norway, 2Preventative Health, Baker IDI
Heart and Diabetes Institute, 3Cardiovascular Research Centre, Australian Catholic University,
Melbourne, Australia
Introduction: Understanding and recognising the causes and symptoms of an acute
myocardial infarction (AMI) are vital for those individuals who have already survived a first
event and are at high risk of a potentially fatal secondary event.
Objectives: To assess the perceived causes and knowledge of symptoms of AMI in those
who had experienced such an event as well as in carers of equivalent individuals.
Methods: Prospectively designed national online survey of 1,047 adult Australians (536
subjects with a past AMI, mean age 648 years, 72% male; and 511 carers of subjects
with a past AMI mean age 5514 years, 79% female). A 20-30 minute online peer-
validated questionnaire was completed by all respondents with outcome measures on
the survivors’ and carers’ knowledge of the causes, triggers and possible symptoms of
an AMI.
Results: The majority (71%) of subjects endured their first AMI >3 years ago, one in four
(23%) believed stress was the primary trigger for their AMI. Alternatively, one in five
carers (19%) thought that physical inactivity was the primary trigger for AMI in the
person they cared for. Another 20% and 18% of subjects and carers, respectively, cited
metabolic risks and poor diet as the other main causal factors of AMI. Alarmingly, just 2%
of subjects and carers recognised progressive ageing as a key risk factor for an AMI, whilst
over one in ten (13%) subjects continued to smoke post-event. Despite one third (35%)
of subjects reporting elevated total cholesterol levels for those at high risk of a secondary
CVD event (>4mmol/L), the majority (93%) felt it was under control; reflecting under-
estimation of dyslipidaemia. Similarly, 44% of subjects did not know if their BP was
elevated and a significant proportion (35%) remained above the recommenced treatment
targets (>130/80mmHg). Overall levels of knowledge (64%) and attitude (75%) con-
cerning secondary events were suboptimal, particularly in male subjects and carers, of
whom were less likely to recognise the warning signs and symptoms of a repeat AMI
(p<0.05).
Conclusion: Overall, the subjects’ and their carers’ have different perceptions concerning
the triggers and symptoms of AMI. Many long-term AMI subjects still smoke and maintain
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
higher than recommended lipid and BP levels leaving them at risk of a second event. Statistically differences in interventional group in amotivation and Intrinsic Regulation

POSTER ABSTRACTS
Moreover, their ability to recognise a secondary event appears to be deficient.
Disclosure of Interest: None Declared

PW195 Baseline vs 4 months Baseline vs 10 months

P values P values
Lipid profile and Carotid Intimal Medial thickness in different stages of Chronic
Kidney Disease Intervention Control Intervention Control
Motivation group group group group
Avinash K. Dubey1, Yogesh Varma*1, Sonika dubey2, Gurmeet Singh2, Abhishek K. Dubey1,
Virendra Sharma1, Swapnil Grade3 Amotivation 0,002 0,537 0,010 0,514
1
Department of medicine, 2Department of Cardiology, Gandhi Medical College Bhopal India, External Regulation 0,023 0,590 0,891 0,715
3
Hamidia Hospital Bhopal, Bhopal, India Introjected Regulation 0,011 0,404 0,113 0,057
Introduction: Cardiovascular disease has been recognised to be a major cause of morbidity Identified Regulation 0,065 0,281 0,043 0,027
and mortality in Chronic Kidney Disease (CKD). Lipid abnormalities were originally Intrinsic Regulation 0,0001 0,781 0,003 0,038
considered as complications of end stage renal disease; these changes can be present in
early stages of CKD and may actively participate in the pathogenesis of serious compli-
cations such as atherosclerotic vascular disease. The dyslipidaemia can be influenced by
several intrinsic (nephrotic range proteinuria, diabetes mellitus, hereditary disorders of
lipid metabolism) or exogenous (erythropoietin administration, steroids, calcineurin in- Conclusion: Data suggest that worksite approach in health promotion programs on CVR
hibitors, etc.) factors. factors can be implemented and can have positive impact in amotivation and intrinsic
Objectives: Study of Carotid Intimal Medial thickness(CIMT) in different stages of CKD motivation for PA.
and its relation with lipid profile and comparing with similar control group. Disclosure of Interest: None Declared
Methods: Inclusion criteria: Patients with CKD between the age group 18-85years,
Exclusion criteria: patients with acute kidney injury, ischemic heart disease disease,
stroke, on hypolipidaemic drugs. 70 cases of CKD were selected on basis of simple random
sampling technique. 30 age and sex matched healthy control were taken. CKD patients
PW199
were classified into different stages according to glomerular filtration rate.
Results: Study showed 18 (25.7%) of the patients belonged to 4th and 5th decade. There Waist to height ratio and cardiovascular risk factors in a large representative North
was male preponderance 39 (55.7%). Most common etiology of CKD was Diabetic Indian Population
Nephrology 21 (30%). 16 (22.9%) patients were found to have Hypercholesterolemia, 42
(60%) had Triglyceride level 150 mg/dl. 23 (32.9%) patients had serum HDL-C  30 Dorothy Lall*1, Pradeep A. Praveen2, Ritvik Amarchand2, Ruby Gupta3, Ambuj Roy2,
mg/dl. The mean CIMT in patients was 0.840.23mm and control was 0.460.19mm. Lakshmy Ramakrishnan2, K. Srinath Reddy3, Anand Krishnan2, Nikhil Tandon2,
There was statistically significant (p < 0.001) difference in CIMT between two groups. Dorairaj Prabhakaran1
1
There was significant Univariate positive co-relation between CIMT and age (r¼0.605, Centre for Chronic Disease Control, 2All India Institute of Medical Sciences, 3Public Health
p<0.001), BMI (r¼0.377, p¼0.001). Total cholesterol (r¼0.236, p<0.018) and serum Foundation of India, Delhi, India
Triglyceride (r¼0.387, p<0.001). Statistically significant correlation was found between
CIMT and eGFR, VLDL and HDL-C. Introduction: Cardiovascular Disease (CVD) has emerged as the leading cause of
Conclusion: CIMT is significantly higher in CKD patients and is very well co-related with death in the world. This burden is disproportionately higher in low and middle
traditional cardiovascular risk factors like age, BMI, total Cholesterol and Triglyceride. income countries like India. Obesity is associated not only with increased risk for
Assessment of CIMT in different stages of CKD may act as a marker for premature or CVD but is also an independent risk factor for other risk factors of CVD like
established atherosclerosis. diabetes and hypertension. Indices like BMI, Waist Circumference (WC), waist hip
Disclosure of Interest: None Declared ratio (WHR), Waist circumference to height ratio (WHtR) and Body Adiposity Index
(BAI) are used to estimate central obesity. This study aims to compare the
PW198 discriminatory power of these indices for diabetes, hypertension, dyslipidaemias and
for the clustering of 2 or more risk factors in a large representative population of
Physical Activity Motivation: Impact of educational program in Primary care northern India.
Objectives: To determine the discriminatory power (by ROC curve) of BMI, WC, WHR,
Ana Ramoa*1,2, Lucimere Bohn3, Helena Leal2,3, José Oliveira1
1 WHtR and BAI for cardiovascular risk factors (Hypertension, diabetes and dyslipidaemias)
Ciafel, University of Porto, 2Usf Espaço Saude, 3University of Porto, Porto, Portugal and their clustering in a representative North Indian population.
Introduction: Cardiovascular disease (CVD) is common in general population, affecting Methods: Multistage, cluster and simple random sampling methods were used to
the majority of adults past the age of 60 years. Many of important risk factors od CVD are select households in both urban and rural areas. All adults >30 years were invited
modifiable by specific preventive measures. and after informed consent, interviewed. Trained personnel, using calibrated and
Regular physical activity (PA) is related to a reduced risk of fatal and non-fatal validated instruments, took anthropometric measurements and fasting blood sam-
coronary events in healthy individuals, subjects with coronary risk factors and ples. Diabetes, hypertension and dyslipidemias were defined as in guidelines by
cardiac patients over a wide age range. A sedentary lifestyle is one of the major risk ADA, JNC 7 and ATP III respectively and clustering of risk factors as presence of
factors for CVD. Physical activity is therefore suggested by guidelines as a very 2 risk factors.
important non-pharmacological tool for primary and secondary cardiovascular Results: A total of 5851 persons, 46.3% male, 52.6% urban with average age of
prevention. 46.2 (13.45) years accepted to participate in this study. The area under curve
Lifestyle modification can reduce blood pressure and lower cardiovascular risk. Moti- (AUC) values for WHtR (0.617–0.744) was higher than those for BMI and other
vation is a critical factor in supporting sustained exercise. Studies support a positive indices for all outcomes in women and comparable to BMI and WC in men. Also,
relation between more autonomous forms of motivation and exercise, with a trend to- WHtR, BMI and WC had similar AUCs for dyslipidemia (Table 1). The AUCs for
wards identified regulation predicting initial/short-term adoption more strongly than WHtR were significantly the highest for diabetes, 0.695 (.649-.716) and 0.733
intrinsic motivation, and intrinsic motivation being more predictive of long-term exercise (.701-.764) among men and women respectively. Clustering of risk factors was best
adherence. predicted by BMI, AUC 0.724 (.683-.765) among men and by WHtR, AUC 0.740
Objectives: The aim of this study is to evaluate the effects of a lifestyle educational (.696-.784) in women.
intervention on motivation for physical activity
Methods: Case-control study with 127 patients with moderate and high cardiovascular
Risk (CVR). 61 patients were submitted to 3 educational sessions about healthy lifestyles
and cardiovascular risk plus weekly encouragement and reinforcement via SMS. 66 patients
web 3C=FPO

were control group. The patients were evaluated before intervention, 4 and 10 after. BREQ-
2 was applied in all evalluations.
Results: There is no differences between interventional and control group

Intervention Group Control Group

Sex (W:M) 37:29 32:29
Age 56,4  6,7 54,6  7,6
Conclusion: The findings suggest the utility of waist to height ratio as a good predictor of
CVR
cardiovascular risk and diabetes, significantly better or similar to other traditional measures
Moderate 26 31 of obesity. As a metric it is easier to apply in the field, requiring only tape measure and
High and very high 40 31 therefore is a useful measure.
Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e297

 PW201
POSTER ABSTRACTS
Patterns of diastolic dysfunction in diabetics from South East Asia
Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,
Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli1
1
Cardiology, UiTM, Sungai Buloh, Malaysia
Introduction: Diabetes mellitus increases the risk of heart failure independent of coronary
heart disease and hypertension. It is also associated with diabetic cardiomyopathy of which
the epidemiology is not well defined. We sought to study the pattern of diastolic
dysfunction in an asymptomatic diabetic population from Malaysia.
Objectives: To assess prevalence of diastolic dysfunction and the predicting factors.
Methods: Subjects were recruited as part of a community study on cardiovascular diseases
between the years 2007 to 2011. Demographic details, cardiovascular risk factors along
with echocardiogram were obtained. An exclusion criterion is abnormal left ventricular
ejection fraction less than 40%.
Results: A total of 1932 subjects with echocardiogram were analyzed. Mean age was 54.6

11.6. Majority of the subjects were male 98.3% (1899). Mean systolic ejection fraction
(EF) was 64.5%
7.0. Prevalenve of diastolic dysfunction was 52.8% (1021). Of all the
subjects with diastolic dysfunction, 29.9% (578) had impaired relaxation, 21.0% (406)
pseudonormal and 1.9% (37) restrictive defect. Among subjects with diastolic dysfunction,
13.8% (266) were diabetic and 9.6% (185) were pre-diabetic (impaired fasting glucose).
60.6% (1170) had dyslipidemia of LDL level more than 3.4 mmol/L. 26.1% (505) were
hypertensive and 59.1% (1142) were obese. Table below summarize the univariate analysis
of the cardiovascular risk factors among the subjects with diastolic dysfunction. In
multivariate analysis hypertension was the only predictor of diastolic dysfunction ß¼-0.65,
t(505)¼18.6, p < 0.001. OR of hypertensive subjects to get diastolic dysfunction is 0.52
(0.39-0.70).
Diastolic No diastolic
dysfunction (%) dysfunction (%)
CV risk factors N[1021 N[911 P value OR 95% CI
Diabetes 15.3 12.1 0.04 0.76 0.58-0.99
Hypertension 32.9 18.6 < 0.001 0.45 0.38-0.57
Dyslipidemia 61.5 59.5 0.37 - -
Obesity 64.0 57.3 < 0.001 0.66 0.55-0.79
Conclusion: The prevalanve of diastolic dysfunction in our findings is higher than re-
ported. Diabetes mellitus, hypertension and obesity remained significant risk factors
associated with risk of developing diastolic dysfunction. After adjusted, hypertension re-
mains a strong predictor for diastolic dysfunction.
Disclosure of Interest: None Declared
PW202
Predictors of exposure to guideline-recommended secondary prevention during a
hospital admission for acute coronary syndrome (ACS)
Julie Redfern*1, Karice Hyun1, Carolyn Astley2, Clara Chow1, Bernadette Aliprandi-costa3,
Tegwen Howell4, Fiona Turnbull5, Cate Ferry6, Derek Chew7,8, Tom Briffa9, Snapshot ACS
Investigators
1
Cardiovascular Division, The George Institute; University of Sydney, Sydney, 2Clinical Network,
SA Health, Adelaide, 3Cardiology, Concord Hospital, Sydney, 4Qld Snapshot Co-ordinator,
Brisbane, 5The George Institute; University of Sydney, 6NSW Heart Foundation, Sydney,
7 Sandra Mandic*1, Sophia Leon de la Barra2, Enrique Garcia Bengoechea3, Emily Stevens1,
Flinders University, 8Southern Adelaide Local Health Network, Adelaide, 9School of Population
Health, University of Western Australia, Perth, Australia
Introduction: Narrowing the well-documented treatment gap in guideline-recommended
secondary prevention after ACS will reduce the rate of fatal and non-fatal premature out-of-
cardiovascular events.
Objectives: To investigate the predictors of receipt of guideline-recommended (or optimal)
preventive care among ACS in-patients who survived to discharge in Australia and New
Zealand.
Methods: We conducted a prospective audit, across 517 participating hospitals bi-na-
tionally, of consecutive patients hospitalised with a confirmed discharge diagnosis of ACS
between 14-27 May 2012. Optimal care was defined as documented receipt in a patient’s
notes of lifestyle advice (exercise/diet/quit guidance for smokers), referral to cardiac
rehabilitation and prescription of 4/5 protective pharmacotherapies (lipid-lowering,
aspirin, ADP receptor blocker, beta-blocker, ACE inhibitor/angiotensin receptor agent).
Predictors of optimal care were determined using multivariable logistic regression analysis.
Results: The 2,299 ACS cases had a mean age of 69
13 years, 35% were female, 40% had
a vascular history and 30% had prior coronary revascularisation. Receipt of optimal care
was low (603/2299, 26%) with only 46% (1065/2299) referred to cardiac rehabilitation,
46% (1059/2299) receiving lifestyle advice and 65% (1490/2299) discharged on 4
protective medicines. Exposure to optimal care was predicted by a diagnosis of ST elevation
myocardial infarction (STEMI) (OR:3.76 [95% CI: 2.75-5.14]; p<0.0001) or non-STEMI
(OR:2.68 [95% CI: 2.07-3.46]; p<0.0001) with both more likely to receive optimal care
compared with a diagnosis of unstable angina. Other predictors of optimal care were
having a percutaneous coronary intervention (PCI) during hospitalisation (OR:4.74 [95%
CI: 3.78-5.93]; p<0.0001), a history of hypertension (OR:1.49 [95% CI: 1.18-1.88];
p¼0.0009) and younger age (OR:0.78 [95% CI: 0.72-0.85]; p<0.0001).
e298
Conclusion: Less than one-third of ACS in-patients surviving to discharge received
guideline-eligible secondary prevention. Discharge diagnosis of infarction, in-hospital
revascularisation, history of hypertension and younger age predicted greater exposure of
guideline-recommended therapies. Efforts to close this treatment gap are clearly required.
Disclosure of Interest: None Declared
PW203
Impact of pill burden on the effects of a polypill-based strategy on use of indicated
medications in people with or at high risk of cardiovascular disease
Michael Truelove*1,2, Ruth Webster1,2,3, Severine Bompoint3, Anushka Patel1,3, the Kanyini-GAP
Collaboration
1
University of Sydney, 2Sydney Medical School, 3The George Institute for Global Health, Sydney,
Australia
Introduction: Use of cardiovascular disease (CVD) preventive medications is poor
globally. Increasing pill burden is associated with lower levels of medication adherence.
Recent studies have shown that use of ‘polypills’ improves use of indicated combina-
tion treatment in individuals with or at high risk of CVD. The Kanyini Guidelines
Adherence with the Polypill trial was one such study, involving 623 participants in
Australia. Participants were randomised to a polypill-based strategy (fixed dose com-
bination of aspirin, lisinopril, simvastatin and either atenolol or hydrochlorothiazide)
or to usual care. Primary outcomes were self-reported use of indicated combination
treatment, systolic blood pressure (SBP) and total cholesterol (TC). Median follow-up
was 18 months.
Objectives: We aimed to investigate whether the polypill based strategy was effective in
reducing pill burden; and also whether the effectiveness of this strategy on the primary
outcomes was modified by baseline pill burden.
Methods: Test of medians were used to compare differences in pill burden at study end.
Relative risk of combination treatment use was calculated using log-binomial regression.
Analyses of change in SBP and TC were conducted using longitudinal models using
generalized estimating equations. Participants were stratified into low (<¼6) or high (>6)
total pill burden groups at baseline, and primary analyses were repeated with the addition
of this subgroup variable and its interaction with treatment. The same method was
applied with participants stratified as having low (<¼4) or high (>4) CVD pill burden at
baseline.
Results: Median total pill burden at baseline was 6.0 (95% CI: 5.0 to 9.0) and 4.0
(3.0, 5.0) for total and CVD pill burden respectively, and significantly lower in the
polypill group compared to usual care at study end (total pill burden: 5.0 vs. 7.0,
p<0.0001).
Those with baseline pill burden of  6 medications had greater improvement in com-
bination treatment use with the polypill, compared to those with >6 medications (RR 2.01,
[1.54 to 2.62] vs. RR 1.25, [1.08 to 1.46], interaction p¼0.002). No interactions were
observed for the outcomes of SBP or TC. Similar findings were observed for subgroups
defined by CVD pill burden at baseline.
Conclusion: A polypill based strategy results in significant reductions in total pill burden
and CVD pill burden. The improvement in adherence to indicated medications with a
polypill based strategy is significantly less among those with a high pill burden at baseline.
Disclosure of Interest: M. Truelove: None Declared, R. Webster Grant/research support
from: Dr Reddy’s Laboratories, S. Bompoint: None Declared, A. Patel Grant/research
support from: Dr Reddy’s Laboratories
PW205
Personal, social and environmental correlates of active transport to school among
adolescents in Otago, New Zealand
Antoni Moore4, Melanie Middlemiss5, Paula Skidmore6, Claire Hodge1, John Williams7,
Charlotte Flaherty8
1
School of Physical Education, Sport and Exercise Sciences, 2Preventive and Social Medicine,
University of Otago, Dunedin, New Zealand, 3Kinesiology and Physical Education, McGill
University, Montreal, Canada, 4School of Surveying, 5Information Science, 6Human Nutrition,
7
School of Business, University of Otago, 8Dunedin City Council, Dunedin, New Zealand
Introduction: With increasingly sedentary lifestyles becoming more common in adoles-
cents, opportunities for physical activity such as active transport to school (ATS) need to be
promoted. ATS is a convenient way to increase daily physical activity and adopt an
environmentally sustainable travel practice.
Objectives: This study examined personal (sociodemographics, behavioural patterns,
motivational factors and perceived barriers), social (peer support, family resources, school
characteristics) and environmental (urban/rural setting, distance to school, neighbourhood
safety perceptions) correlates of ATS among adolescents.
Methods: A total of 1,815 adolescents (age: 13 to 19 years; 52% boys) from 22 schools
across Otago (New Zealand) completed the online survey as a part of the Otago School
Students Lifestyle Survey in 2009 and 2011. Data collected included usual mode of
transport to school, sociodemographic and behavioural characteristics, social support for
ATS, and personal and family perceptions of safety of ATS. Multivariate binary logistic
regression models were used to compare characteristics of students using ATS to charac-
teristics of bus and car users (motorised transport).
Results: Overall, 37% of students used ATS, 24% bus, and 39% car. Students who
lived in a rural area were more likely to use ATS (48% rural vs. 33% urban; p<0.001)
and live closer to school (median distance 2.3 km in rural areas vs. 3.4 in urban areas);
p<0.001). In a logistic regression model, parental perceptions of safety (OR (95%CIs):
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
2.95 (1.72-5.05)), the ability to chat with friends (2.74 (1.91-3.92)), nice things to Table. Multivariable adjusted odds ratio for uncontrolled BP ( 140/90 mmHg) in 525

POSTER ABSTRACTS
look at on the journey (1.87 (1.32-2.65) and meeting screen time guidelines (1.89 hypertensive patients followed in the Cardiovascular Health Program.
(1.29-2.78)) were positively associated with ATS, while distance from school (0.02
(0.01-0.04)), perceived time constraints of ATS (0.45 (0.30-0.67)), older age (0.81
(0.73-0.89)), more cars (0.65 (0.49-0.87)) and screens (0.56 (0.37-0.87)) in the Odds Ratio
household, and attending a girls-only school (0.44 (0.32-0.61)) had a negative asso- BP ‡ 140/90 adjusted for age
ciation with ATS. mmHg % (n) and sex (CI 95%) p-value
Conclusion: After removing the effect of distance, the most influential factors for ATS
Low Education (<8 years of education) 59,4 (98) 1,46 (1,15 – 1,84) 0.002
transport choice among adolescents were time constraints, household resources, screen
time, parental perceptions of safety, scenery on the route to school and opportunity to No adherence to Rx 53,8 (179) 1,14 (0,92 – 1,41) 0.248
socialize with friends. These findings suggest that personal, social and built environment Inadequate patient –physician relation 51,5 (51) 1,44 (1,10 – 1,88) 0.007
factors influence transport to school choices among New Zealand adolescents.
Disclosure of Interest: None Declared High emotional stress-depression score 60,1 (86) 1,44 (1,14 – 1,81) 0.002
Alcohol consumption 64,4 (47) 1,65 (1,20 – 2,26) <0.001
PW206 Diabetes 56,9 (99) 1,61 (1,28 – 2,03) <0.001
Obesity (BMI  30 Kg/m2) 59,2 (181) 1,95 (1,58 – 2,40) <0.001
Comparison of sociodemographic, family and environmental factors as motivations
and barriers for walking to school among adolescents in Dunedin, New Zealand
Sandra Mandic*1, Claire Hodge1, Charlotte Flaherty2, Hayley Horwood1, Ashley Mountfort1,
Debbie Hopkins3, Emily Brook1, Tara Duncan4 Conclusion: Adherence showed no significant impact, underscoring the importance of
1 socioeconomic determinants, psychosocial factors and co-morbidities in BP control along
School of Physical Education, Sport and Exercise Sciences, University of Otago, 2Dunedin City
with a comprehensive hypertension management program providing lifestyle modification
Council, 3Center for Sustainability, 4Tourism, University of Otago, Dunedin, New Zealand counseling. Throughout the CHP, a remarkable improvement was achieved in BP control
Introduction: If the distance to school is reasonable, active transport to school is a since the last Chilean National Health Survey (2010, 16.45% for the hypertensive popu-
convenient way to increase physical activity in adolescents and adopt an environmentally lation at large).
sustainable travel practice. Disclosure of Interest: None Declared
Objectives: This study examined personal, family and environmental characteristics as
motivations for and barriers to walking to school among adolescents who live within a PW208
reasonable distance from school (4.8 km).
Prevalence of Rheumatic Valvular Heart Disease Among Egyptian School Children.
Methods: A total of 143 adolescents (age: 15.3
1.5; 49.5% males) from 4 secondary
Echocardiographic And Doppler Screening
schools in Dunedin (New Zealand) completed an online survey in 2013. Survey data
included sociodemographic characteristics, travel to school habits, and attitudes and Wafaa A. M. El Aroussy*1, Nashwa ElHagracy2, Hossam Fawzi3, S. Zaher4, Nasser Taha5,
opinions about walking to school. Distance from home to school was calculated using Salah Moustafa6
Google Maps. Students living within 4.8 km from school (n¼107) were classified as regular 1
Cardiovascular Medicine, Cairo University, 2Cardiovascular Medicine Deparment, MSA,
walkers (RW), occasional walkers (OW) and non-walkers (NW) to school. Data were 3
Cardiovascular Medicine Deparment, NHI Embaba, Cairo, 4Pediatric, Alexandria University,
analysed using ANOVA and Chi-square tests.
Results: RW lived closer to school than OW and NW (RW: 1.26
0.74; OW: 2.05
0.98; Alexandria, 5Cardiovascular Medicine, Menia University, Menia, 6Biostatics, Ain Shams
NW: 3.35
1.27 km; all comparisons p<0.001). NW tended to have more vehicles at University, Cairo, Egypt
home compared to RW (NW: 2.6
0.7 vs RW: 2.0
1.0; p¼0.077). Four main reasons
Introduction: Exact prevalence data of rheumatic valvular heart disease (RVHD) are still
for choosing walking to school in RW were short distance to school (92.6%), convenience
lacking,and are also highly desirable to facilitate health care planning.
(63.2%), good exercise/fresh air (58.8%) and most enjoyable transport option (32.4%).
Objectives: To determine the prevalence of RVHD among Egyptian school children using
Compared to OW, RW perceived less time constraints (RW: 2.3
1.1 vs OW: 3.3
1.1),
transthoracic echocardiographic(TTE) and Doppler examination.
less personal safety concerns (RW: 2.0
1.0 vs OW: 2.8
1.2), less parental safety con-
Methods: A sample of school children was examined clinically and by TTE and Doppler
cerns (RW: 1.3
0.7 vs. OW: 1.8
1.0), aa well as less physical (tiredness: RW: 2.3
1.1
examination for the presence of RVHD. Definite RVHD is defined by the presence of mitral
vs. OW: 3.0
1.1) and psychosocial (lack of motivation: RW: 2.2
1.1 vs. OW: 3.4
1.2)
(MV) and/or aortic valve (AV) regurgitation seen in two planes by Doppler echocardiog-
barriers associated with walking to school (all p<0.05). NW received significantly less
raphy, accompanied by at least two of the following three morphologic abnormalities of the
parental encouragement to walk to school compared to RW and OW (NW: 2.1
0.9;
regurgitant valve: restricted leaflet mobility, focal or generalized valvular thickening.
OW: 3.1
1.3; RW: 3.6
1.1 out of 5; p<0.05 NW vs OW and RW). OW and NW
Possible RVHD is defined as isolated valvular thickening or leaflet restriction of more than
perceived walking to school as being good for their health (4.6
0.5), cool (3.5
1.0) and
mild mitral regurge.
a great way to get some exercise (4.4
0.5; out of 5). OW and NW reported that they
Results: A total of 48930 school children, age between 6 and 18 years, 49.1% males, were
would walk to school more often if they lived closer to school (3.8
1.3), had fewer
examined. An abnormal cardiac examination or history suggestive of RVHD was reported
books (3.4
1.3) and less gear to carry (3.2
1.3) and if the weather was warmer and
in 2712 students. Only 1603 had an adequately imaged TTE. Definite RVHD was docu-
drier (3.6
1.3 out of 5).
mented in 35 (2.2%), and possible affection in 107. The prevalence rate of RVHD is 0.07%.
Conclusion: Future interventions for encouraging walking to school in adolescents should
Abnormal combination of MV affection was the dominant feature in 174 (65.9%, n¼264);
focus on providing parental encouragement and minimizing both personal and parental
34 had thickening of leaflets, 21 had subvalvular thickening, 16 had mitral stenosis, 86 had
safety concerns.
variable degree of MV prolapse. AV was reported abnormal in 43 (16.3%), bicuspid in 6
Disclosure of Interest: None Declared
(0.2%), and regurgitant of grade II severity in 8 (0.3%).
Conclusion: These data have potentially important implications for case finding and early
PW207 detection, delivery of effective primary and secondary prevention, and adequate planning of
health services.
Impact Of A Comprehensive Hypertension Management Program In Blood Pressure Disclosure of Interest: None Declared
Control. Experience From A Country In A Process Of Socioeconomic Transition
Daniela Sandoval*1, Javier Chacón1, Javiera Garrido1, Ivonne Ahlers1, Hernán Aguilera1, PW209
Tomás Romero2 Association of serum bilirubin levels and promoter variations of HMOX1 and
1
Department of Primary Care and Health Family, University of Chile, Santiago, Chile, 2School of UGT1A1 genes with fabry disease
Medicine, University of California, San Diego, California, United States
Alena Jiraskova1, Giulia Bortolussi1, Gabriela Dostalova1, Lenka Kadlckova1, Jan Belohlavek1,
Introduction: Uncontrolled blood pressure (BP 140/90 mmHg) in hypertensive patients Lubor Golan1, Ales Linhart1, Libor Vitek*1
is a universal problem, worse in developing countries. 1
Charles University in Prague, Prague, Czech Republic
Objectives: Assess the influence of socio-economic, clinical, psychosocial, lifestyle char-
acteristics in achieving BP control (<140/90 mm/Hg) in Chilean hypertensive patients Introduction: Bilirubin belongs to the major endogenous antioxidants and its serum
referred to a comprehensive program providing free drug therapy (Rx), medical follow-up concentrations are regulated by enzymes heme oxygenase (HMOX) and bilirubin UDP-
and life style modification counseling, the Cardiovascular Health Program (CHP). glucuronosyl transferase (UGT1A1). It has been proved that highly polymorphic promoters
Methods: A weighted randomized sample of 525 patients from a universe of 1,533 hy- of genes coding for these enzymes are associated with diseases mediated by increased
pertensive patients (1,079 women) followed in government subsidized primary care clinics oxidative stress, including atherosclerosis.
throughout the CHP were analyzed. Socioeconomic, clinical, lifestyle and psychosocial Objectives: The aim of our study was to assess possible relationship between these
characteristics were evaluated using validated questionnaires. Chi-square test for categorical polymorphic gene promoters, serum bilirubin levels and Fabry disease (FD) characterized
variables and Odds ratio (OR) adjusted for age and sex to assess the influence on BP control by disordered glycosphingolipid metabolism, and accompanied by premature
of all the factors were analyzed. atherosclerosis.
Results: Mean age was 55.4
7.7 years. BP control was achieved in 47.04% (246 of 525) Methods: The study was performed on 56 patients with FD (M:F ratio ¼ 0.54) and 185
patients. 97.71% (513 of 525) received antihypertensive drug therapy (Rx). Adherence to healthy individuals. Complete standard laboratory and clinical work-up was performed in
Rx was 36.6% (186 of 513). Factors related to uncontrolled BP with their OR are shown in all subjects, together with determination of total peroxyl radical scavenging capacity. The
Table. (GT)n and (TA)n dinucleotide variations in HMOX1 and UGT1A1 gene promoters,

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e299

 respectively, were determined by fragment analysis. Analyzed variables were assessed by
POSTER ABSTRACTS
respective statistical tests (Mann-Whithey test and logistic regression analysis).
Results: Compared to controls, patients with FD had substantially lower serum bilirubin
levels (12.0 vs. 8.85 umol/L, p¼0.003) and also total peroxyl radical scavenging capacity
(p<0.05), which was in a close positive relationship with serum bilirubin levels (p¼0.05)
and also with use of enzyme replacement therapy (p¼0.036). Presence of L allele in
HMOX1 gene promoter responsible for lower enzyme activity was not associated with
manifestation of FD (OR¼1.69; 95% CI¼0.54-5.24, p¼0.46). On the other hand, presence
of TA7 allele UGT1A1 gene promoter responsible for higher systemic bilirubin levels was
associated with two-fold lower risk of manifestation of FD (OR¼0.51, 95% CI¼0.27-0.97,
p¼0.038).
Conclusion: FD is associated with markedly lower serum bilirubin levels, most likely due
to bilirubin consumption during increased oxidative stress accompanying FD. However,
genetic factors affecting defense against increased oxidative stress (UGT1A1 promoter gene
polymorphism) seems to contribute to manifestation of FD as well.
Acknowledgement: This work was supported by grants SVV 266516/2013 and PRVOUK
4102280002 from the Czech Ministry of Education.
Disclosure of Interest: None Declared
PW211
Significance of Genetic Risk Factors Like Lipoprotein(A). Apolipoprotein B100 And
Angiotensin Converting Enzyme Gene Polymorphism In Coronary Artery Disease In
North Indians
Satyendra Tewari*1, P. K. Goel1, Sarita Agarwal2
1
Cardiology, 2Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow,
India
Introduction: Incidence of modifiable risk factors do not account for high risk of pre-
mature CAD in Asian Indians. We studied the role of Lipoprotein [Lp (a)], Apolipoprotein
B100 (Apo B100) levels and Angiotensin converting enzyme (ACE) gene polymorphism in
patients having CAD.
Objectives: The aim of the study was to assess the non conventional risk factors for
premature atherosclerotic coronary artery disease and analyse the modifiable risk factors in
the angiographically proven CAD patients.
Methods: A total of 1259 subjects (691 patients of angiographically proven CAD and
568 controls with either normal coronary angiogram or negative stress test) were
evaluated for Lp(a) and ApoB100 levels, with ACE deletion/insertion (DD,ID and II)
genotypes being ascertained by polymerase chain reaction besides conventional risk
factors in the cohort.
Results: Mean age (Standard deviation SD) was 48.27 (12.07) and 49.38 (12.27) years in
patients with CAD and controls respectively. Prevalence of diabetes (21.8% vs. 26.3%,
p¼NS), hypertension (35.9% vs. 34.5%, p¼NS), positive family history of premature
CAD (15.7% vs. 19.1%, p¼NS) and total cholesterol levels [180.4 (46.1) vs. 178.1
(48.1) mg/dl, p¼NS] were similar whereas smoking (45.7% vs. 37%, p20 mg/dl] and
ApoB100 [>114 mg/dl] were more prevalent in patients as compared to controls (83%
vs. 35.6% and 86% vs.43.1% respectively, p114 mg/dl) levels (83.5% vs. 16.5%,
p<0.01). ACEDD genotype was more common in patients with CAD as compared to
controls (64.1% vs. 23.7%, p<0.01) whereas II and ID were more common in control
group (43.5% vs. 16.5% and 32% vs.19.4% respectively, p<0.01). On multivariate
analysis, elevated Lp(a) (OR¼3.89, 95% C.I.¼2.42-6.27, p<0.01), Apo B100
(OR¼7.56, 95% C.I¼5.09-11.24, p<0.01), triglyceride (OR¼3.17, 95% CI¼2.17-4.63,
p<0.01), smoking (OR¼1.78, 95% CI¼1.02-2.14, p<0.01) and ACE DD genotype were
significant predictors of CAD.
Conclusion: Elevated Lp(a), ApoB100 levels and ACE-DD genotypes were significantly
associated with CAD. ApoB100 levels helps to further predict CAD in patients with normal
LDL levels. ACE-DD genotype were significantly more common in Indian CAD patients as
compared to control group. ACE DD genotype have the same potential of imparting
genetically predetermined risk for having CAD in future life and its identification may help
one to detect person at risk at an early age.
Disclosure of Interest: None Declared
PW212
Prevalence Of Genes In Indian Patients Of Coronary Artery Disease And Its
Relationship With Apolipoprotein B 100, Lipoprotein (A) And Ace Gene
Polymorphism, Mthfr And Apo E
1 1 2
Satyendra Tewari* , P. K. Goel , Sarita Agarwal
1
Cardiology, 2Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow,
India
Introduction: Presence of newer risk factors like, apolipoprotien B-100, Lipoprotein (a)
and angiotensin converting enzyme (ACE) gene polymorphism and various genes like
MTHFR and Apo E are genetically determined risk factor for premature CAD. We studied
the role of these newer genetically determined risk factors in proven coronary artery disease
(CAD) patients.
Objectives: Analyse the potential impact of Genetic risk factors like Apo E, Apo B Lipo-
protein (a) and MTHFR in relation with the occurrence of premature coronary artery
disease and assess the role of modifiable risk factors in relation with the severity of the
Coronary Artery Disease.
Methods: A total of 856 subjects (467 patients of angiographically proven CAD and 389
controls with normal coronary angiogram or negative stress test) were evaluated for Lp(a),
Apo B100, ACE deletion/insertion (DD,ID,II) genotypes, MTHFR and Apo E genotypes by
polymerase chain reaction.
e300
Results: Mean age (standard deviation SD) was 43.71 (11.06) and 45.29 (11.16) years
in patients with CAD and controls respectively. Prevalence of hypertension (38.7 Vs
35.5%, P¼NS), diabetes (23.4 Vs 28.3%, P¼NS), positive family history of premature
CAD (17.8% Vs 20.2%, P¼NS) and total Cholesterol levels 194.4 (43.1) Vs 179.1
(49.1) mg/dl, P¼NS were similler whereas smoking 43.9 Vs 35%, Lp(a) and ApoB 100
(>114mg/dl) were more prevalent in patients as compare to controls (81% Vs 37.2%).
ACE-DD genotype was more common in patients with CAD as compare to controls
(67.1 Vs 27.4% p<0.01) whereas as II and ID were more common in control group
(46.5% Vs 19.5% and 34% Vs 21.2% resectively, P< 0.01). On multivariate analysis
elevated Lp(a), Apo B 100, triglyceride, smoking and ACE DD genotype were signif-
icant predictors of CAD. A significant association was observed for D allele of ACE
gene polymorphism (p¼0.048, OR 1.27, 95% CI 0.99-1.62) and Tallele of MTHFR
gene polymorphism (p¼0.049, OR 1.45, 95% CI 0.98-2.13) with coronary artery
disease. However insignificant difference was observed when apo E2 (p¼0.15, OR
0.75, 05% CI 0.49-1.14) and apo E4 allele (p¼ 0.059 OR 1.58, 95% CI 0.96-2.61)
when it is compared with apo E3 allele.
Conclusion: In Our cohart hypertension, diabetes and total cholesterol have similer
prevalance but elevated Lp(a), Apo B 100 levels and ACE-DD genotypes were significantly
associated with CAD. T allele of MTHFR, D allele of ACE gene might play an important role
in predisposition of premature coronary artery disease.
Disclosure of Interest: None Declared
PW213
Influence of Central Artery Compliance On Carotid Artery Blood Flow Profile
Jun Sugawara*1, Tsubasa Tomoto2, Seiji Maeda2
1
Human Technology Research Institute, National Institute of Advanced Industrial Science and
Technology, 2Graduate School of Comprehensive Human Sciences, University of Tsukuba,
Tsukuba, Japan
Introduction: Central artery compliance has an important role of buffering pulsatile flow
from the left ventricle (LV). There is a gaining recognition that low central artery
compliance (arterial stiffening) is associated with end-organ damage (i.e., brain and kid-
ney). On the other hand, superior LV function seen in well-trained athletes may result in
larger mechanical stress to the brain. However, it is not clear the influence of central artery
compliance on carotid arterial blood flow profile.
Objectives: The aim of the present study was to determine whether central artery
compliance is associated with pulsatile component of carotid arterial blood flow.
Methods: A total of 82 healthy men with wide age range (18-64 years) and various physical
activity levels. As a surrogate measure of pulsatile stress toward the brain, peak blood flow
velocity of common carotid artery (carotid peak BFV) was measured by the Doppler
echography method. Central artery compliance was evaluated with the pulse wave velocity
from the heart to carotid artery (hcPWV).
Results: Carotid peak BFV correlated with age (r¼-0.46), peak oxygen uptake (via
graded cycling exercise test) (r¼0.44), mean arterial pressure (r¼-0.36), and hcPWV
(r¼-0.46). In order to seek physiological determinants of hemodynamic mechanical
stress toward the brain, we used forward stepwise multi-regression analysis. It revealed
that hcPWV (b¼-0.33) was the primary physiological determinant of carotid peak BFV.
Additionally, end-diastolic diameter of common carotid artery ( b¼-0.30) and peak
oxygen uptake (b¼0.24) were also significant physiological determinants of carotid
peak BFV.
Conclusion: These results suggest that central artery compliance might be accompanied
with the hemodynamic mechanical stress toward the brain.
Disclosure of Interest: None Declared
PW214
The diagnosis and management of hypertension in different ethnic groups
Paramjit Gill*1, Una Martin1, Sally Wood2, Sheila Greenfield1, Sayeed Haque1, Jonathan Mant3,
Mohammed Mohammed1, Richard McManus2, and on behalf of the BP-Eth Study group
1
University of Birmingham, Birmingham, 2University of Oxford, Oxford, 3University of
Cambridge, Cambridge, United Kingdom
Introduction: Hypertension is the leading risk factor for cardiovascular diseases (CVD),
accounting for approximately 45% of global CVD morbidity and mortality. There are
striking differences in blood pressure (BP) and hypertension prevalence between ethnic
groups. The diagnosis and management of blood pressure in the UK are informed by
guidelines largely based on research from white populations.
Objectives: To determine if the thresholds for diagnosis of hypertension, and treatment
targets in hypertension comparable for white British and minority ethnic populations using
different measurement modalities: office blood pressure, ambulatory BP monitoring and
home monitoring?
Methods: A validation study was performed to compare BP measurement by
ambulatory monitoring (daytime mean, at least 14 measurements) with office (clinic
mean of second and third readings on 3 separate occasions (clinic23) and first clinic
reading on the first day (clinic1)) and last practice reading in participants of three
different ethnicities, with and without hypertension. Mean ambulatory daytime BP
was used as the reference standard. Cross-sectional population study which took
place between June 2010 - December 2012 and 28 general practices were recruited
to participate.
Results: A total of 771 patients completed the validation study of whom 301 were white
British (WB), 229 were African Caribbean (AC) and 241 were South Asian (SA).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 More hypertensives than non hypertensives were recruited in each group. More
men than women were recruited in WB and SA groups but not the AC. The WB
group was older than the other two groups and were more likely to drink
alcohol. The SA had lower smoking rates but were more likely to have diabetes
mellitus.
In terms of diagnosis, no differences detected between the 3 ethnic groups and the mode
of diagnosis. For managing hypertension, no significant differences found between the
three ethnic groups and BP thresholds.
Conclusion: Current guidelines for BP thresholds for the diagnosis and management of
hypertension are applicable in all 3 ethnic groups.
Disclosure of Interest: None Declared
PW215
Higher frequency of coronary vasospasm and coronary atherosclerosis in depressed
women with chest pain: From the Chest pain in Korean women registry
Kyoung Im Cho*1, Wan-Joo Shim2, Seong-Mi Park2, Myung- A. Kim3, Kyoung-Soon Hong4
1
Division of cardiology, Kosin Medical University, Busan, 2Division of cardiology, Korea
University Anam Hospital, 3Division of cardiology, Seoul National University Boramae Hospital,
4 countries) are due to chronic non-communicable diseases (NCDs). Of these chronic NCDs,
Division of cardiology, Hanllym University Chuncheon Sacred Heart Hospital, Seoul, Korea,
Republic Of
Introduction: Depression is important prognostic factors in patients with coronary
artery disease (CAD). Little is known about the characteristics of depressed female CAD
patients.
Objectives: The aim of our study was to investigate the association between emotional
conditions and coronary artery spam in female patients with chest pain.
Methods: In a multicenter, prospective cross-sectional survey of Korean women with
chest pain, 83 patients with a Beck Depression Inventory (BDI) score indicating
depression (7) were compared 80 with patients without depressive symptoms (<7).
Depression was also evaluated using the Korean Depression Scale (KDS-30). Eighty female
patients with normal coronary angiography underwent ergonovine or acetylcholine
provocation test.
Results: No differences in risk factors were found between the two groups. Patients
in the depressive group showed significant higher prevalence of significant coronary
artery disease (65.1% vs. 36.3%, p<0.001) or positive provocation test (25.9% vs.
6.8%, p ¼ 0.006) compared with patients in the non-depressive group. In multi-
variate analysis, BDI scores (odds ratio [OR]: 2.534, < 95% confidence interval [CI]
1.161-2.028; p ¼ 0.003) was important risk factors for the presence of coronary
artery spasm.
Conclusion: This study demonstrated that depression is associated with CAD and
coronary artery spasm in female patients with chest pain, suggesting a possible mech-
anism by which depressive mood may link with coronary endothelial dysfunction and
atherosclerosis.
Disclosure of Interest: None Declared
PW216
Relationship between depression and QTc interval in female patients with suspected
coronary artery disease: From the Chest pain in Korean women registry
Kyoung Im Cho*1, Wan Joo Shim2, Seong-Mi Park2, Myung- A. Kim3, Kyoung-Soon Hong4
1
Department of Cardiology, Kosin University Gospel Hospital, Busan, 2Department of
Cardiology, Korea University Anam Hospital, 3Department of Cardiology, Seoul National
University Boramae Hospital, 4Department of Cardiology, Hanllym University Chuncheon
Sacred Heart Hospital, Seoul, Korea, Republic Of
Introduction: Negative emotional conditions contribute to the development of coronary
artery disease (CAD), and little is known about the characteristics of depressed female CAD
patients.
Objectives: The aim of our study was to investigate the association between emotional
conditions and QTc interval in CAD.
Methods: In a multicenter, prospective cross-sectional survey of Korean women
with chest pain, 83 patients with a Beck Depression Inventory (BDI) score indi-
cating depression (7) were compared with 110 patients without depressive
symptoms (<7). Depression was also evaluated using KDS scores. According to the
coronary angiography, patients were defined as normal coronary arteries and sig-
nificant CAD.
Results: The KDS and BDI scores were higher in the CAD (n¼96) compared to the
normal coronary arteries (n¼97, KDS: 52.1
19.0 vs. 39.6
11.4, p <0.001 and BDI:
11.9
6.0 vs 6.9
6.6, p<0.001). Depression group showed significantly prolonged
corrected QT (QTc) interval compared to the non-depressed group (433.1
31.5 vs.
417.5
25.8 ms, p¼0.011). QTc interval showed strong positive correlation with BDI
(r¼0.469, p<0.001) and KDS scores (r¼0.562, p<0.001). In multivariate analysis, BDI
scores (odds ratio [OR]: 1.139, < 95% confidence interval [CI] 1.020-1.273; p ¼ 0.021),
KDS scores (OR: 1.051, < 95% Cl 1.008-1.095; p¼0.020) were important risk factors for
the presence of CAD.
Conclusion: This study demonstrated that depression is associated with prolonged QTc
interval in female patients with suspected CAD. Consequently, the occurrence of increased
cardiac symptoms indicates the need to screen for depression, whether depressive symp-
toms are apparent or not.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PW217
POSTER ABSTRACTS
The epidemiology of dyslipidemia, obesity and other cardiovascular risk factors in
the general adult population in Senegal
Dominique Doupa1, Adama Kane2, Sidy M. Seck3, Charles A. Dia3, Fatou A. Diallo4,
Modou O. Kane5, Pape M. Gueye6, Maimouna N. Mbaye7, Lamine Gueye8, Modou Jobe*2
1
1Laboratoire de Biochimie-Biologie Moléculaire, Unités de formation et de recherche
(UFR), Santé Université Gaston Berger, Saint Louis, 2Cardiologie, CHU Aristide Le
Dantec, Dakar, 3Néphrologie, Unités de formation et de recherche (UFR), Santé
Université Gaston Berger, Saint Louis, 4Laboratoire de Biochimie-Biologie Moléculaire,
Faculté de Médecine, de Pharmacie et d’Odontologie de l’Université Cheikh Anta
Diop, 5Laboratoire de Physiologie, Faculté de Médecine, de Pharmacie et
d’Odontologie de l’Université Cheikh Anta Diop, 6Laboratoire de Biochimie
pharmaceutique, Faculté de Médecine, de Pharmacie et d’Odontologie de l’Université
Cheikh Anta Diop, 7Médecine Interne, Centre Hospitalier Abass Ndao, Dakar,
8
Laboratoire de Physiologie, Unités de formation et de recherche (UFR), Santé
Université Gaston Berger, Saint Louis, Senegal
Introduction: According to the WHO, 50% of deaths worldwide (40.1% in developing
cardiovascular diseases remain the leading cause of death and disability in developed
countries. The Framingham study has shown the importance of hypercholesterolemia as a
primary risk factor. In Senegal, the epidemiology of dyslipidemia and obesity are still
poorly understood due to the lack of comprehensive studies on their impact on the general
population.
Objectives: To study the epidemiologic and socio-demographic determinants of the risk
factors for cardiovascular disease.
Methods: It was a cross-sectional descriptive epidemiological survey which included
1037 individuals selected by cluster sampling. Data were collected using a question-
naire following the WHO STEPwise approach. Socio-demographic, health and
biomedical variables were collected. P value <0.05 was considered to be statistically
significant.
Results: The average age was 48 years with a female predominance (M:F of 0.6). The
literacy rate was 65.2% and 44.7% of participants were from rural areas. The prevalence of
hypercholesterolemia, hyperLDLemia, hypoHDLemia, hypertriglyceridemia and mixed
hyperlipidemia were 56%, 22.5%, 12.4%, 7.11% and 1.9% respectively. One in four was
obese (BMI> 30kg/m2) and 34.8% had abdominal obesity. The main factors significantly
associated with dyslipidemia were obesity, living in an urban environment, physical
inactivity and a family history of dyslipidemia.
Conclusion: The prevalence of dyslipidemia, obesity and other risk factors in the popu-
lation was high needing immediate care for those affected and implementation of pre-
vention strategies.
Disclosure of Interest: None Declared
PW218
Comparison of rosuvastatin and simvastatin treatment on HDL subfractions in
metabolic syndrome
Georgios Souretis1, Aggeliki Papapanagiotou1, Gerasimos Siasos1, Dimitris Tousoulis*2,
Athanasios G. Papavassiliou1
1
Department of Biological Chemistry, University of Athens Medical School, 2University of Athens
Medical School, “Hippokration” Hospital, Athens, Greece, Athens, Greece
Introduction: The ongoing debate about metabolic syndrome (MS) still exists. It is so far
unresolved whether it is a marker or a mechanism. Regarding its atherothrombotic burden,
dyslipidemia is commonly treated with statins. HDL2 represents a subfraction of HDL with
atheroprotective action. However little is known about the effect of different statins on
HDL2.
Objectives: In the present study we compared the effect of two commonly used statins on
HDL2 and HDL3 subfractions.
Methods: The study population consisted of 40 consecutive subjects with metabolic
syndrome (mean age 54
9 years). Anthropometric parameters, as well as classic lipid
profile, plasma glucose, high sensitivity C-reactive protein (hs-CRP), serum creatinine
levels were assessed at baseline and one month after statin therapy. Participants that
needed antilipidemic therapy were divided into two groups: group A (n¼20) treated
with 10mg rosuvastatin and group B (n¼20) treated with 40mg simvastatin. HDL2
and HDL3 subfractions were isolated by ultracentrifugation of plasma with density
adjusted with NaCl-NaBr, and they were assessed before and one month after statin
therapy.
Results: No different effect in the classic lipid profile markers was observed between
the two groups. Cholesterol was reduced by 25% in group A and by 23.4% in group B
(p¼NS), while triglycerides were decreased by 19% and 18.4% in group A and B,
respectively (p¼NS). Moreover, LDL was decreased by 39.4% in group A and by
38.8% in group B (p¼NS). There was also a rise in HDL levels by 2.4% and by 3.7%,
in group A and B respectively (p¼NS). Besides the classic lipid profile parameters, no
difference was observed between the two groups in HDL2 (raise by 4% in group A vs
11% in group B (p¼NS)) and HDL3 levels (raise by 0.9% in group A vs 7.3% in group
B (p¼NS)).
Conclusion: Our findings indicate that the use of rosuvastatin and simvastatin improve in
an equal manner both classic and newer lipid profile parameters.
Disclosure of Interest: None Declared
e301
 PW219
POSTER ABSTRACTS
Prevalence Of Metabolic Syndrome And Association With Lifestyle Factors In India:
A Nationwide Cross Sectional Study In Urban Subjects
Prakash Deedwania*1, Rajeev Gupta2, Krishnakumar Sharma2, Vijay Achari3, Anil Bhansali4,
Balkishan Gupta5, Anuj Maheshwari6, Tulika G. Mahanta7, Arvind Gupta8
1 lection for Metabolic syndrome which needs further evaluation.
University of California San Francisco, Fresno, United States, 2Fortis Escorts Hospital, Jaipur,
3
Patna Medical College, Patna, 4Postgraduate Institute of Medical Education and Research,
Chandigarh, 5SP Medical College, Bikaner, 6BBD College of Dental Sciences, Lucknow, 7Assam
Medical College, Dibrugarh, 8Jaipur Diabetes Research Centre, Jaipur, India
Introduction: Metabolic syndrome is common but its lifestyle risk factors are poorly
studied, especially in low and lower-middle income countries.
Objectives: To determine association of socioeconomic and lifestyle factors with metabolic
syndrome prevalence we performed a multisite cross-sectional study in India.
Methods: The study was performed at eleven cities in India using cluster sampling. 6198
Subjects (men 3426, women 2772, response 62%, age 48
10 years) were evaluated for socio-
demographic, lifestyle, anthropometric and biochemical factors using uniform methodology.
Prevalence of metabolic syndrome was determined using Asian-specific harmonized criteria.
Significant socioeconomic and lifestyle associations were determined using linear trend analysis.
Results: Age adjusted prevalence (%, 95% confidence intervals) of metabolic syndrome in
men and women was 33.3 (31.7-34.9) and 40.4 (38.6-42.2) (harmonized Asian specific
criteria), 23.9 (22.4-26.4) and 34.5 (32.0-36.1) (modified Adult Treatment Panel-3, ATP-3)
and 17.2 (15.3-19.1) and 22.8 (20.1-24.2) (ATP-3). In men and women, respectively, high
waist circumference was in 35.7 (34.1-37.3) and 57.5 (55.6-59.3), high blood pressure in
50.6 (48.9-52.3) and 46.3 (44.4-48.1), impaired fasting glucose or diabetes in 29.0 (27.5-
30.5) and 28.0 (26.3-29.7), low HDL cholesterol in 34.1 (32.5-35.7) and 52.8 (50.9-54.7)
and high triglycerides in 41.2 (39.5-42.8) and 31.5 (29.7-33.2) percent. Prevalence was
significantly greater in subjects with lowest vs highest educational status (45 vs 26%),
occupational status (46 vs 40%), dietary fat intake (52 vs 45%), sedentary lifestyle (47 vs
38%) and body mass index (66 vs 29%) categories (ptrend<0.05).
Conclusion: There is high prevalence of metabolic syndrome among urban populations in
India. Socioeconomic (high educational and socioeconomic status) and lifestyle (high fat
diet, low physical activity, overweight and obesity) are important risk factors.
Disclosure of Interest: None Declared
PW220
The Prevalence of Metabolic syndrome in Coronary artery Disease patients compared
to those without Coronary Artery Disease: Insights from South Indian population
Stigimon Joseph*1
1
Cardiology, Little Flower Hospital And Research Center, Angamaly, Angamaly, Ernakulam,
Kerala, India, India
Introduction: There are few studies addressing the prevalence of Metabolic Syndrome among
the South Indian population. There are limited data comparing the prevalence of Metabolic
syndrome among Coronary Artery Disease (CAD) patients compared to healthy population.
Objectives: To assess the prevalence of Metabolic Syndrome in Coronary Artery Disease
patients and to compare with those without Coronary Artery Disease.
Methods: Patients with CAD who were seen in the cardiology Out Patient Department
formed the study group . CAD was defined as documented Acute Coronary Syndrome or
positive TMT or disease documentation by Coronary Angiogram.
During the same time period two population surveys were conducted which formed data
for healthy general population. The two different population surveys were :
a) Mostly manual laborers of the Panchayat ward where the hospital is situated (195
individuals participated).
b) Sedentary population (office staff, teachers) (242 individuals participated).
Results: A total of 1003 individuals were evaluated. 761 were included in the study. 405
patients have CAD as defined and they formed Group: A and 356 are healthy (group: B).
Male to female ratio is almost equal (361 females and 400 males).
The prevalence of Metabolic Syndrome is high and among South Indian population.
Table 1. Prevalence of Metabolic Syndrome
Definitions Total(761) Females(361) Males(400)
IDF 298(39.1%) 169(46.8%) 129(33.8%)
ATP III 361(47.4%) 192(53.3%) 172(43.1%)
WHO 308(41.7%) 122(33.7%) 186(46.6%)
Prevalence is higher coronary artery disease patients.
Table 2. Prevalence of Metabolic Syndrome CAD x no CAD groups
Different Groups. IDF ATP III WHO
Group.A (With CAD) 170 (41.6%) p** 209 (51.8%) p** 202(50%) p**
Group.B(without CAD) 128(34.3%) 147(41.4%) 103(26.1%)
4.9% of Coronary artery disease patients and 8.1% of healthy individuals have BMI<18. It is
interesting to note that 25% of them have ¼> 2 risk factors for Metabolic syndrome though
they cannot be classified as having Metabolic syndrome with present diagnostic criteria. This
observation “ the clustering of metabolic risk factors in lean individuals” needs further evaluation.
e302
Conclusion:
1. The overall prevalence of Metabolic Syndrome in South Indian population is high
(39%).
2. Coronary Artery Disease patients have higher prevalence compared to healthy
population.
3. A significant proportion of our population have BMI <18, still they have predi-
Disclosure of Interest: None Declared
PW222
A pragmatic tool to guide the intensity of chronic heart failure management: Green
Amber Red Delineation of rIsk And Need in Chronic Heart Failure (GARDIAN-CHF)
Simon Stewart*1, Yih-Kai Chan1, James McVeigh2, Melinda Carrington1, and on behalf of the
WHICH? Study Investigators
1
Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, 2Prince of Wales
Hospital, Randwick, Sydney, Australia
Introduction: There is scope to improve the cost-effective application of chronic heart
failure (CHF) management programs.
Objectives: To examine the potential cost-benefits of applying an innovative traffic light
system, the Green Amber Red Delineation of rIsk And Need (GARDIAN), to guide the
intensity of post-discharge management of CHF.
Methods: We used outcome data from the multicentre, randomized controlled Which
Intervention is most cost-effective and Consumer friendly in reducing Hospital stay (WHICH?)
Trial comprising typically older patients hospitalised with CHF. Using the distribution
(quartiles) of days alive and out-of-hospital up to 18 months post index hospitalisation we: 1)
confirmed a gradient of event-free survival, 2) identified characteristics that predicted event-
free survival (p<0.05 for observed gradients) and 3) aggregated predictive variables into 3 key
GARDIAN domains (clinical stability, gold-standard management and holistic profile).
Results: Differential group event-free outcomes were – Group A (n¼56, 548+ days event-
free, mean 1.8 days hospital stay and 0% mortality), Group B (n¼83, 530-547 days, 7.7
days, 0%), Group C (n¼71, 393-529 days, 28.2 days, 11.3%) and Group D (n¼70, 0 –
392 days, 24.1 days, 87.2%). Clear gradients across the 4 groups were found according to
age, self-care ability, cognitive impairment, language status, prior CHF admission, acute
pulmonary oedema, index stay, stay in intensive care, eGFR, anaemia, treatment with an
ACEi or beta-blocker and early post-discharge clinical instability (mostly congestion).
Compared with statistical modelling, pragmatic aggregation of these variables according to
pre-specified GARDIAN coding (Green/low risk with only one domain deficit, Amber/
medium risk with two domain deficits and automatic Red/high risk red status if post-
discharge clinical instability present) was most accurate in aligning with the groups; further
enhanced when any intensive care stay indicated clinical instability (automatic Red status).
Applying GARDIAN coding, for every 100 CHF patients, 9%, 64% and 27%, respectively
would be designated Green, Amber and Red and follow-up titrated accordingly. Predicted
false negatives (requiring redesignation as Red on readmission) in Green would be 22% (2
patients) and false positives in Red would be 11%.
Conclusion: The GARDIAN-CHF tool represents a promising, pragmatic tool to guide the
intensity of CHF-MPs when limited resources restrict their application.
Disclosure of Interest: None Declared
PW224
Hard Aquifer Drinking Water Linked To High Ct Coronary Angiogram Calcium
Scores
John F. England*1, Marcin Roman2, Lloyd Davis3
1
Cardiology, Blue Mountains District Anzac Memorial Hospital, Katoomba NSW, 2Radiology,
PRP, DUBBO NSW, 3Cardiology, Westmead Hospital, WESTMEAD NSW, Australia
Introduction: In rural Australia (compared to seaboard coastal population) health de-
mographics reports of an increased incidence of coronary artery disease, ruptured calcific
coronary arteries at angioplasty (haemopericardium) and thyroid disease prompted public
health officials in the town of Mudgee (300km west of Sydney) to install a water softening
plant two years ago. Drinking water from the Burrundulla aquifer was associated with salt
corrosion of metal plumbing fittings and hot water heating tanks.
Objectives: 100 consecutive CT coronary angiograms (CTCA) in the postal code area of
Mudgee (hard water) were compared to 100 consecutive CTCAs in postal code area of the
NSW coastal town of Gosford (soft water) and matched for age distribution and sex - 75%
male, aged 70 years
Methods: CTCA data compared the upper quartiles of each area and contrasted with
CTCAs from 100 older consecutive patients in the city of Sydney from the same radio-
logical practice.
Results:
Hard water Mudgee Calcium Score ¼ 1120.8 (SD 992)
Soft rainwater Gosford Calcium Score ¼ 767.6 (SD 522)
Dam water Sydney (older reference group) Calcium Score ¼ 897.4 (SD 812)
The hydrated lime water softening unit reduced the calcium carbonate levels from
410mg/L to 115mg/L and pH from 8.4 to 7.8. Sydney and coastal NSW drinking waters are
soft and reach WHO Guidelines for total hardness less than 50mg/L. Representative cases
over a 2 year period, different operators in different hospitals:
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 1. 55 year old male with past CABG surgery had stenting left main and later
attempted angioplasty native left circumflex bleeding controlled with coils proxi-
mally and also to large collateral vessel. Developed thyrotoxicosis post procedure.
2. 67 year old male - attempted angioplasty marginal circumflex artery. Developed
acute haemopericardium and urgent single vessel CABG surgery with drainage.
3. 66 year old male - attempted angioplasty (LAD-D2). Perforation. Developed acute
haemopericardium status epilepticus coma and was on life support for two weeks.
Conclusion: Hard drinking water is linked to higher calcium CTCA scores. Meta analysis
studies have shown that calcium supplements increase (in non-uraemic patients) the risk of
myocardial infarction by 30% (Bollard et ali New Zealand - BMJ 2010) - after exclusion of
health care and indigenous population variables.
Disclosure of Interest: None Declared
PW225
Cardiovascular Risk Factors In Saudi Patients With Vitamin D Deficiency
Mona A. Elsaidy*1, Ali ELGendy2
1
Cardiology, 2Internal Medicine, Elite Medical Center, Riyadh, Saudi Arabia
Introduction: Vitamin D deficiency is highly prevalent among Saudi patients who often
suffer from cardiovascular risk factors and are at increased risk for cardiovascular events.
The relation between vitamin D deficiency and cardiovascular risk factors is still
controversial.
Objectives: determine if cardiovascular risk factors are more prevalent in patients with
vitamin D deficiency.
Methods: 1000 Saudi patients with vitamin D deficiency group 1 who attended both in-
ternal medicine and cardiology clinics in one year underwent cardiovascular assessment
and were compared to 600 patients group 2 who have normal vitamin D level and were age
and sex matched to group 1.
Results: vitamin D deficiency was significantly lower in group 1 as compared to group 2; 10

4 vs 55
10, p<0.05, 65% of patients in group 1 were females while they were 60 % in
group 2, age did not differ significantly between the two groups it was 38
13 vs 40
10,
p¼0.3. Cardiovascular risk factors did not differ significantly between the two groups; 51%of
patients in group 1 had abdominal obesity as compared to 49%, 67%of patients in group1
have high total cholesterol TC compared to 62%, 32% have high triglycerides TG compared to
29%, 13% have low HDL compared to 11%, 46% have high LDL compared to 49%, 35% have
systolic HTN compared to 37%, 10% have diastolic HTN compared to 13%, 70% have high
fasting blood sugar FBS compared to 68% and 25% have high uric acid UA compared to 29%
in group 2 respectively .Waist circumference wasn’t significantly different from the 2 groups
105
7 vs 103
9, p¼0.23 .lipid profile components did not differ significantly between the
two groups; total cholesterol 206
39 vs 201
34, p¼0.11, LDL 127
33 vs 123
35
p¼0.23, TG 206
39 vs 200
33 p¼0.22, HDL 43
12 vs 40
10, p¼0.06, other risk
factors did not differ significantly between the two groups ;systolic blood pressure SBP 124

20 vs 130
15 p¼0.07, diastolic blood pressure DBP 66
11 vs 70
12, p¼0.066, fasting
blood sugar FBS 134
66 vs 132
60, p¼0.06 and finally uric acid 5.3
1.7 vs 5
0.9
p¼0.08. Vitamin D level in group 1 correlated poorly with SHTN, DBP, LIPID profile and uric
acid however the best correlation was with waist circumference, R¼- 0.33 and FBS, R¼-0.39
Conclusion: risk factors were not more prevalent in patients with vitamin D deficiency as
compared to patients with normal vitamin D level.There may be association between
vitamin D deficiency and abdominal obesity and that calls for further research .
Disclosure of Interest: None Declared
PW226
Prehypertension is Associated with the Left Ventricular Hypertrophy in Male Central
Obese Young Adults
1 1 1 commonly used public health message in PA promotion. Despite this, most PA ques-
Frans Wantania* , Lucia Panda , Reggy Lefrandt
1
Cardiovascular, Sam Ratulangi University, Manado, Manado, Indonesia
Introduction: Hypertension may affect cardiac structure result in Left Ventricular Hy-
pertrophy (LVH), but our previous study showed the LVH in central obese without dia-
betes or hypertension. Recent studies shows the role of inflammatory procces in
prehypertension and obese subjects.
Objectives: Aim of this study is to investigate the association of prehypertension with the
LVH in male central obese young adults.
Methods: Seventy four central obese and non obese subjects included in this cross
sectional study. Samples were taken consecutively among students of internal medicine
with age < 30 years old and no history of diabetes and hypertension. Blood pressure
measurement was taken 3 times in the Prof Kandou Hospital. Left Ventricular Mass Index
(LVMI) was evaluated by M-Mode and two dimension echocardiogram and value above
115 g/m2 are indicative of LVH.
Results: Sistolic Blood Pressure is higher in central obese subjects as compare to non
central obese subjects (119,1
8,18 mmHg vs 111,7
6,37 mmHg; p<0,01). We also
found diastolic blood pressure is higher in central obese subjects as compare to non central
obese subjects (76,6
6,01 mmHg vs 72,9
5,09 mmHg; p<0,05). Central obese subjects
had higher LVMI – reflecting Left Ventricular Hypertrophy (131,55
41,6 g/m2 vs
90,18
16,61 g/m2; p<0,001) and correlates positively to both sistolic (Spearman Coeff
R¼0,69; p<0,001) and diastolic blood pressure (r¼0,57; p<0,001). We observed the
prehypertension in 80% of LVH subjects as compare to 25% in non LVH subjects. All
prehypertension subjects had the increased of proinflammatory cytokines level as compare
to 20% in normotension subjects.
Conclusion: Prehypertension is associated with the development of LVH in male young
adults. Inflammatory may plays a pivotal role in development of prehypertension in central
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
obese male young adults. Blood pressure examination regularly in central obese may
POSTER ABSTRACTS
helpful to detect LVH earlier in male young adults.
Disclosure of Interest: None Declared
PW227
Obesity and comorbid risk factors for cardiovascular disease among physically
inactive patients with musculoskeletal disorders: A targeted intervention for this
priority patient group is warranted
Steven Mcphail*1
1
School of Public Health and Centre for Functioning and Health Research, Queensland University
of Technology and Metro South Health, Brisbane, Australia
Introduction: The benefits of physical activity are established and numerous; not the least
of which is reduced risk of negative cardiovascular events. While sedentary lifestyles are
having negative impacts across populations, people with musculoskeletal disorders may
face additional challenges to becoming physically active. Unfortunately, interventions in
ambulatory hospital clinics for people with musculoskeletal disorders primarily focus on
their presenting musculoskeletal complaint with cursory attention given to lifestyle risk
factors; including physical inactivity. This missed opportunity is likely to have both per-
sonal costs for patients and economic costs for downstream healthcare funders.
Objectives: The objective of this study was to investigate the presence of obesity, diabetes,
diagnosed cardiac conditions, and previous stroke (CVA) among insufficiently physically
active patients accessing (non-surgical) ambulatory hospital clinics for musculoskeletal
disorders to indicate whether a targeted risk-reducing intervention is warranted.
Methods: A sub-group analysis of patients (n¼110) who self-reported undertaking
insufficient physical activity level to meet national (Australian) minimum recommended
guidelines was conducted. Responses to the Active Australia Survey were used to identify
insufficiently active patients from a larger cohort study being undertaken across three (non-
surgical) ambulatory hospital clinics for musculoskeletal disorders. Outcomes of interest
included body mass index, Type-II diabetes, diagnosed cardiac conditions, previous CVA
and patients’ current health-related quality of life (Euroqol-5D).
Results: The mean (standard deviation) age of inactive patients was 56 (14) years. Body
mass index values indicated that n¼80 (73%) were overweight n¼26 (24%), or obese
n¼45 (49%). In addition to their presenting condition, a substantial number of patients
reported comorbid diabetes n¼23 (21%), hypertension n¼25 (23%) or an existing heart
condition n¼14 (13%); 4 (3%) had previously experienced a CVA as well as other co-
morbid conditions. Health-related quality of life was also substantially impacted, with a
mean (standard deviation) multi-attribute utility score of 0.51 (0.32).
Conclusion: A range of health conditions and risk factors for further negative health events,
including cardiovascular complications, consistent with physically inactive lifestyles were
evident. A targeted risk-reducing intervention is warranted for this high risk clinical group.
Disclosure of Interest: None Declared
PW228
Should Physical Activity Questionnaires Include Information on Stair Climbing? – A
Mixed Methods Pilot Study
Sundar K. Veluswamy1, Arun G. Maiya1,2, Abraham S. Babu*1, Suma Nair3, Vasudev Guddattu4
1
Department of Physiotherapy, School of Allied Health Sciences, Manipal University, 2Dr TMA Pai
Endowment Chair in Exercise Science and Health Promotion, Manipal University, 3Department of
Community Medicine, Kasturba Medical College, Manipal University, 4Department of Statistics,
Manipal University, Manipal, India
Introduction: Stair climbing is a vigorous intensity physical activity (PA) that reduces
cardiovascular disease risk factors and mortality risk. Encouraging stair climbing is a
tionnaires used in epidemiological studies like global physical activity questionnaire
(GPAQ) do not assess stair climbing for the estimation of PA.
Objectives: Determine the effect of adding information on stair climbing to GPAQ on total PA.
Describe the views of subject experts on including stair climbing information to PA
questionnaires.
Methods: The study protocol was approved by institutional ethics committee and all
participants provided written informed consent. Twenty healthy volunteers (9 men and 11
women) climbed four floors (total 96 steps, each of 6 inches height) at self-paced
comfortable speed. Oxygen consumption (VO2) at rest and during stair climbing were
assessed using indirect calorimetry (K4b2, COSMED, Italy) and the information used to
calculate metabolic equivalents (MET) of stair climbing.
GPAQ was administered by a single interviewer to 24 randomly selected employees of an
educational institution. Three questions were added to GPAQ for obtaining information on
energy expenditure of stair climbing. Difference in total physical activity obtained from
GPAQ with and without stair climbing information was compared using Wilcoxon signed-
rank test. In addition, a qualitative study is being conducted using in-depth interview and
group discussion among various health professionals to understand their opinion on
including information on stair climbing in PA questionnaires.
Results: Metabolic equivalent of self-paced stair climbing was 6.62
0.95 METs.
Twenty three participants (12 males, 11 females; 31.2
5.2 years of age) completed the
questionnaire. Median PA obtained from standard and modified GPAQ was 900 (480,
1800) and 956 (628, 1887) MET.min.wk-1 respectively. The difference in PA between both
methods of estimation was significant (p<0.001). Addition of stair climbing PA to standard
GPAQ re-categorised 17.4 % (4/23) participants to a higher PA category.
The need, advantages and disadvantages of adding stair climbing information to PA
questionnaires by interviews and group discussions are described.
e303
 Conclusion: Adding stair climbing information to GPAQ significantly increased the PA of
POSTER ABSTRACTS
participants. Validation studies of PA questionnaires with stair climbing information are
needed in heterogeneous population.
Disclosure of Interest: None Declared
PW229
Civil status and cardiovascular disease risk factors in rural north central nigeria
Basil N. Okeahialam*1, Chika Ogbonna2, Evelyn K. Chuhwak1, Ikechukwu Isiguzoro3,
Hadiza A. Agbo2
1
Medicine, 2Community Medicine, University of Jos, 3Chemical Pathology, Jos University
Teaching Hospital, Jos, Nigeria
Introduction: Educational status has been shown in previous studies to impact on CVD
mortality and so has civil status. Hardly has such studies been reported locally. Since such
status will shed light on peculiar risk factors, it is possible to modify them to patients’
benefit; improving CVD morbimortality indices.
Objectives: To determine the influence of educational and civil status of major cardio-
vascular disease risk factors in a rural sub-Saharan African community.
Methods: Data from our CVD survey in rural north central Nigeria were secondarily
analysed with a view to determining how level of educational attainment or civil status
related with some major CVD risk factors. Where significant between group differences
emerged, multiple comparison was done to see what exactly predisposed such group.
Results: Educational status turned out not to significantly correlate with the major CVD risk
factors unlike the situation in the west. For civil status, there was significant across group
correlation with Systolic Blood Pressure (P¼0.000), and Diastolic Blood Pressure (P¼0.005).
On Multiple comparison, the most burdened group (widows) were significantly less active
physically in regular occupation (p¼0.000) and leisure activity (p¼0.000). Their BMI was
higher but attained significance when compared with the single population (p¼0.04).
Conclusion: Unlike in the west, educational status did not seem to affect CVD risk factor
burden. The pervasive unemployment may be responsible since higher attainment gave no
socioeconomic advantage. Therefore the risks inherent in life style related to such status were
absent. With civil status, the widows as expected were worse off. Apart from the stress
(widowhood effect), they were largely sedentary. They should therefore be encouraged to be
physically active to reduce tendency to obesity and gain physiological benefits of exercise.
Disclosure of Interest: None Declared
PW230
Validation Of The Resilience Scale For Patients With Cardiovascular Disease
Conceição M. T. M. D. Lemos1, Lucia C. Pellanda*1, Claudio Hutz2, Marisa C. Muller3
1
Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia / Fundação
Universitária de Cardiologia, 2Univerisade Federal do Rio Grande do Sul, 3Pontifícia
Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
Introduction: This study describes the cross-cultural adaptation to Portuguese and the
psychometric evaluation of the resilience scale developed by Wagnild & Young.
Objectives: The present study describes the procedures used for the cross-cultural adaptation
and psychometric evaluation of the resilience scale developed by Wagnild & Young, by Pesce
(2004). The comparison between the original and the Portuguese version aims at collaborating
with the validation of cross-cultural equivalence of the instrument for cardiovascular disease.
Methods: Case-control study of 133 individuals aged between 35 and 65 years, of both
genders. The sample included 67 cases, group ’hospital’ and 66 "control group out-
patients". The individuals were assessed by the Resilience Scale, Wagnild & Young (2005),
and the socio-demographic data sheet. Each group was divided into two subgroups:
resilient and not resilient. Internal consistency was assessed by Cronbach’s a test, with
analysis of the principal components with oblique rotation, testing the construction of the
scale factors. Data were computed using the SPSS for Windows software, version 15.0.
Results: The Cronbach’s a scores in this study (0.77) were similar to the Brazilian version
Pesce (0.85), as well as to results reported by Wagnild & Young (0.91) and Arion (0.87),
indicating good internal consistency. The analysis of the principal components showed
three factors related to the resolution of actions and values that give meaning to life, the
idea of independence/determination, self-confidence and ability to adapt to situations.
Conclusion: In patients with cardiovascular disease, the Resilience Assessment Scale
(Wagnild & Young, 2005) revealed three significant factors compared to two factors of the
original scale.
Disclosure of Interest: None Declared
PW231
The burden of cardiovascular disease amongst psychiatric patients in Manchester, UK
Paul Carter*1, Gurjit Rai1, Nicholas Gollop2, Amir Aziz3, Sudhir Rayasamudra4, Noman Ali3,
Suresh Chandran5, Hardeep Uppal6, Rahul Potluri7
1 group (3.0 days). The mean survival from first diagnosis to death in these patients was
The Medical School, University of Birmingham, Birmingham, 2The Norfolk and Norwich
University Hospital, Norwich, 3Division of Cardiovascular and Diabetes Research, University of
Leeds, Leeds, 4Acute Medicine, Chesterfield Hospital, Chesterfield, 5Training Programme
Director in Acute Medicine, North Western Deanery, Manchester, 6Department of Psychiatry of
Learning Disability, Brooklands Hospital, 7ACALM Study Unit in collaboration with School of
Medical Sciences, Aston University, Birmingham, United Kingdom
Introduction: Cardiovascular disease (CVD) can be prevented through targeting of tradi-
tional risk factors, but increasingly, other conditions such as psychiatric disease are being
e304
associated with CVD. Research is required into the cardiovascular comorbidities which are
common in psychiatric patients and trends over time.
Objectives: We have previously demonstrated an increasing trend of CVD comorbities
amongst psychiatric patients on a smaller dataset, in Birmingham between 2000-2007. Our
aim for this study was to characterise the prevalence of CVD risk factors and comorbidities
amongst patients with psychiatric disease over a 14 year period between 2000-2013 in
Manchester, UK.
Methods: Anonymous information was obtained from the local health authority compu-
terised hospital activity analysis register regarding a total population of 929465 patients,
from seven-hospitals in the Manchester area during 2000-2013. 80898 patients had a
psychiatric condition. Cardiovascular comorbidities were coded according to the ICD-10
criteria and their prevalence were analysed over the entire 14-year study period and in three
time periods to investigate the trends.
Results: The prevalence of cardiovascular diagnoses amongst the 80898 patients with
psychiatric conditions, over the study period were hypertension (25.1%), ischaemic heart
disease (10.7%), type 2 diabetes mellitus (9.3%), atrial fibrillation (7.1%), hyper-
lipidaemia (5.6%), heart failure (4.9%), ischaemic stroke (4.1%), chronic kidney disease
(3.5%), myocardial infarction (2.4%) and peripheral vascular disease (1.4%). Overall
there were 58421 cardiovascular diagnoses during the entire study period, but remark-
ably when analysed in shorter periods, the proportion of psychiatric patients with a
cardiovascular comorbidity showed a biphasic pattern. The number of diagnoses
increased from 9470 between 2001-2004 to a peak of 30430diagnoses between 2005-
2008, before decreasing to 14066 between 2009-2012. This trend was representative
amongst all of the most prevalent conditions listed above apart from hyperlipidaemia and
myocardial infarction.
Conclusion: CVD risk factors and comorbidities are significant amongst psychiatric
patients. Although, as we have shown before, this trend was increasing, over more
recent years there has been a reduction in cardiovascular comorbidities in this group.
This could represent an increase in the identification and management of these risk
factors due to better recognition of psychiatric conditions as risk factors for cardio-
vascular disease.
Disclosure of Interest: None Declared
PW232
Type 2 diabetes mellitus in young South Asian patients leads to increased
cardiovascular co-morbidity and decreased survival
Rahul Potluri*1, Sudhir Rayasamudra2, Anand Kumar Ravi3, Jaskaran S. Mavi4,
Hardeep Uppal5, Deepthi Lavu6, Suresh Chandran7
1
ACALM Study Unit in collaboration with School of Medical Sciences, Aston
University, Birmingham, 2Chesterfield Hospital, Chesterfield, United Kingdom, 3Wayne
State University, Michigan, United States, 4Department of Medicine, Royal
Wolverhampton Hospitals, Wolverhampton, 5Department of Psychiatry of Learning
Disability, Brooklands Hospital, Birmingham, 6Keele University, Stoke-On-Trent,
7
Training Programme Director in Acute Medicine, North Western Deanery,
Manchester, United Kingdom
Introduction: The prevalence of type 2 diabetes mellitus in South Asian populations is
increasing significantly. This increase is thought to be because of the complex interplay
between environmental and genetic factors in the wake of rapid westernisation in South-
East asia. These lifestyle factors are particularly in the younger age groups. There isn’t much
evidence regarding the prevalence of cardiovascular co-morbidites and their impact on
health in young South Asian patients with type 2 diabetes mellitus compared to Caucasian
populations.
Objectives: We aimed to evaluate the burden of type 2 diabetes mellitus in South Asian
and Caucasian patients aged between the ages of 20 and 60.
Methods: Anonymous information on patients with type 2 diabetes mellitus, co-
morbidities and survival attending seven hospitals in Manchester, United
Kingdom in the period 2000-2013 was obtained from the local health authority
computerised hospital activity analysis register using ICD-10 and OPCS coding
systems.
Results: Out of a total type 2 diabetes population of 68194 (5.6%), there were 19469
patients between the ages of 20 and 60 in the South Asian and Caucasian groups. Of
these, there were 4918 South Asian patients and 14551 Caucasian patients. Mean age in
the South Asian group (48.1 years) was lower than the Caucasian group (49.9 years;
p<0.05). Cardiovascular co-morbidities such as hyperlipidaemia (25.7% South Asian vs
20.8% Caucasian), hypertension(49.8% South Asian vs 48.3% Caucasian), ischaemic
heart disease (23.4% South Asian vs 21.0% Caucasian) and myocardial infarction (5.9%
South Asian vs 5.2% Caucasian) were higher in the South Asian groups. Heart failure
(3.6% South Asian vs 4.4% Caucasian) and atrial fibrillation (1.8% South Asian vs 4.3%
Caucasian) rates were higher in the Caucasian group. The average length of hospital stay
was significantly longer in the Caucasian group (4.1 days) compared to the South Asian
significantly lower in the South Asian group (2078 days) compared to the Caucasian
group (2102 days).
Conclusion: Type 2 diabetes mellitus in young South Asian patients leads to
increased cardiovascular co-morbidity and decreased survival compared to Caucasian
counterparts in the same age group who are actually slightly older. In the context of
increasing type 2 diabetes mellitus in patients of South Asian origin, this data
suggests that new strategies are required to prevent healthcare debacles in these
young patients.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PW233 PW235

POSTER ABSTRACTS
Which Patients Reliably Estimate Their Exercise Tolerance? Quantifying The Impact of Using Coronary Artery Calcium Score For Risk
Categorization Instead of Framingham Score or European Heart Score In Lipid
Abraham Salacata*1 Lowering Algorithms
1
Cardiology, Endeavor Medical Research, Alpena, United States
Hussain Isma’eel1, Mohamad Almedawar*1, Bernard Harbieh1, Wissam Alajaji1,
Introduction: In clinical practice, functional capacity (FC) is a strong predictor of Laila Al-Shaar2, Antoine Abchee1, Mukbil Hourani3, Fadi El-Merhi3, Samir Alam1, Vascular
perioperative risk during non-cardiac surgery and of prognosis in patients with CAD Medicine Program
and CHF. While standardized exercise tests (ET) provide an accurate measurement of 1
Cardiology, 2Vascular Medicine Program, 3Radiology, American University of Beirut, Beirut,
FC, it is impossible to do an ET on all patients due to time and cost constraints. in
practice, FC is estimated using a number of clinical activity scales. But because they Lebanon
rely on the patient’s self reported ability to perform various activities, they are subject Introduction: The use Coronary Artery Calcium Score (CACS) for risk categorization
to bias and inaccuracies. instead of Framingham Risk Score (FRS) or European Heart SCORE (EHS) to improve
Objectives: We performed this study to determine whether clinical variables can classification of individuals is well documented. However, the impact of reclassifying in-
identify patients prone to inaccurate self-reported functional capacity estimates (SRFC) dividuals using CACS on initiating lipid lowering is not.
is unclear. Objectives: We aim to determine the percentage of individuals not requiring lipid lowering
Methods: Patients referred for exercise stress testing were interviewed regarding their therapy as per the FRS and EHS models but are found to require it using CACS and vice
ability to perform common daily activities enumerated in the modified Duke Activity Status versa; and to determine the level of agreement between CACS, FRS and EHS based models.
Index (DASI). Their SRFC was then rated as 1 or poor (capable of  4 METS), 2 or Methods: Data was collected for 500 patients who have already undergone CACS, of which
moderate (2, 4-7 METS), 3 or good (7-10 METS) or 4 or excellent (>10 METS). The only 286 met the inclusion criteria and were included in the analysis. Comparisons were
patients then underwent maximal exercise testing using a Bruce protocol. The exercise done using independent t-test, Chi-square test and Fisher Exact Test. Agreement was
determined functional capacity (EFC) was then generated using commercially available calculated based on Cohen’s Kappa coefficients.
stress software. The patients were then divided into those whose SRFC reflect their EFC Results: 79.7% to 81.5% of high risk individuals as per the models were down-classified
(Grp 1) and those that did not (Grp 2). The effect of age, sex, hypertension (HTN), history by CACS, while 10.7% to 11.5% of individuals at intermediate risk as per the models were
of arrhythmias (AR), diabetes (DM), hyperlipidemia (HLP), history CAD, previous MI, PCI, up-classified to high risk as per CACS, with slight to moderate agreement. Moreover, CACS
CABG, nonischemic cardiomyopathy (CM) and pulmonary diseases (PULM) on accuracy of recommended treatment to 10% and 7.5% of subjects untreated according to European
the SRFC was analyzed by calculating their odds ratio (OR). and Canadian guidelines, respectively; whereas 72.8% to 80.4% of those treated as per the
Results: 89 patients had a high SRFC. 49 (55%) were men, with an average age of 64.8 guidelines would not be treated based on CACS.

11.5 years. There was significant disagreement between SRFC and EFC (p < 0.001), Table 4. Stratification of treatment indication of the total sample and across gender; A: as
with a large proportion of patients overestimating their EFC by up to 2 functional per the Canadian Cardiology Society (CCS) guidelines versus Coronary Artery Calcium
classes. Of the 87 patients, 52 were in Grp 1 and 37 in Grp 2. There was no significant Score (AU); B: as per the European Society of Cardiology (ESC) guidelines versus Coronary
difference in age between the 2 groups (63.5 +/- 9.5 vs. 64.9 +/- 13.6 years, p ¼ 0.5). Artery Calcium Score (AU)
Subjects in Grp 1 were more likely to be men and less likely to have HLP. There was
otherwise no significant difference in the incidence of the other conditions between the
groups. Indication to treat as per CCS guidelines
Table 4-A using CACS risk categorization Agreement Level
Indication to treat Total (n¼286) No Yes Kappa p-value
as per CCS guidelines No 149 (92.5%) 12 (7.5%) 0.212 <0.001
Yes 91 (72.8%) 34 (27.2%)

Indication to treat as per ESC guidelines

Table 4-B using CACS risk categorization Agreement Level
Conclusion: In a community setting, it may be difficult to identify patients who can
Indication to treat Total (n¼286) No Yes Kappa p-value
accurately estimate their FC. Formal evaluation by stress testing should thus be performed
as per ESC No 96 (89.7%) 11 (10.3%) 0.074 0.039
if clinicians have any doubt as to the patients reported functional capacity.
Disclosure of Interest: None Declared guidelines
Yes 144 (80.4%) 35 (19.6%)

PW234
Impact of HbA1c on Extent and Severity of Coronary Artery Disease in Non-Diabetic
Patients
Azza A. M. Farrag*1, Waleed Ammar1, Nour Eldeen H. Samhoun1, Alaa El Deen Abdel Hady1
1
Cardiovascular Department, Cairo University, Cairo, Egypt
Introduction: It has been recognized that hyperglycemia and increased HbA1c levels in
non-diabetic subjects are risk factors for cardiovascular events and subclinical atheroscle-
rosis. Lowering HbA1c was shown to be associated with reduction of microvascular,
neuropathic and possibly macrovascular complications in patients with diabetes mellitus.
However, in non-diabetic patients, very few reports have examined the relationship be-
tween HbA1c and extent of coronary artery disease.
Objectives: The aim of this study was to examine the relationship between HbA1c level
and severity of coronary artery disease (CAD) in non-diabetic patients scheduled for
elective coronary angiography.
Methods: We studied 408 consecutive non-diabetic patients (mean age 54.4
9.5 years)
with or without previous history of myocardial infarction, who were scheduled for elective
coronary angiography. All patients had no previous coronary revascularization (percuta-
neous coronary intervention or coronary artery bypass grafting). Severity of CAD was
assessed by Gensini score. Gensini score >30 was considered severe coronary athero-
sclerosis. Patients were divided into a high risk group (HbA1c 5.7 - 6.4%, n¼ 292) and a
low risk group (HbA1c <5.7%, n¼ 116).
Results: Patients in both groups had comparable prevalence of hypertension, smoking and
family history of CAD. No significant difference was noted as regards age, gender, body
mass index, waist circumference and lipid profile. Patients in the high risk group had
higher Gensini score (45.1
36.7 vs. 26.8
26, p <0.000). HbA1c showed positive
correlation with Gensini score (r¼ 0.243, p <0.000). Patients with Gensini score >30 had
higher values of HbA1c (6.0
0.48 vs. 5.75
0.54, p <0.000). HbA1c value of 5.85
showed a sensitivity of 70% and a specificity of 50% for prediction of severe coronary
atherosclerosis (Gensini >30) (95% CI, 0.582 – 0.690; p <0.000).
Conclusion: HbA1c is significantly associated with CAD severity in non-diabetic patients.
Disclosure of Interest: None Declared
Conclusion: Using CACS for risk categorization warrants lipid lowering treatment for 7-
10% and spare 70-80% from treatment compared to the guidelines, thus impacting CVD
prevention health policy planning, suggesting cost-savings with more accurate risk
assessment.
Disclosure of Interest: None Declared
PW236
Comparison of Cardiovascular Disease Risk Scores in Filipino-American Women:
Results from the Filipino Across the Nations Study (FANS)
Irma B. Ancheta*1, Annabelle Volgman2, Christine V. Ancheta3, Cynthia Battie4
1
School of Nursing, University of North Florida, Jacksonville, 2Rush College of Medicine, Rush
Heart Center for Women, Chicago, 3College of Public Health, University of South Florida,
Tampa, 4College of Public Health, University of North Florida, Jacksonville, United States
Introduction: Filipino-American women (FAW) have multiple cardiovascular disease
(CVD) risk factors and high rates of CVD. However, the applicability of CVD risk models,
validated for Caucasians, to this population has not been determined although the appli-
cation of such tools may not be valid in Asians or women.
Objectives: To determine the CVD risk scores using the guideline recommended 10-year
Framingham (FRS) and Reynolds Risk Score (RRS), 30-year FRS “ Hard” and “Full” lipid
and BMI.
Methods: A cross-sectional study enrolled FAW (n¼234), aged 40-65 from four cities. The
10-year FRS and RRS, and the 30-year FRS “Hard” and “Full” Lipid and BMI were
calculated. “Hard” CVD outcomes include coronary death, myocardial infarction, and fatal
and non-fatal stroke. “FULL” CVD outcomes include hard CVD plus coronary insufficiency
and angina pectoris, transient ischemic attack, intermittent claudication and congestive
heart failure. The RRS also includes family history and high-sensitive C- reactive protein.
The 30 year risk scores additionally include diabetes with and without body mass index.
Results: CVD risk factors were prevalent in this cohort: 64% hypertensive, 36% elevated
hemoglobin A1c (>6.5%), 61% LDL-C >100 mg/dL), 48% family history, 52% over-
weight/ obese, and 56% metabolic syndrome. The 10 year FRS and RRS indicated that

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e305

 participants’ risk scores were <10% for CHD in the next 10 years. The 30 year risk scores
POSTER ABSTRACTS
re-classified participants. The “Hard” Lipid FRS classified subjects as 30% low risk, 38%
intermediate risk and 32% high risk over 30 years. The addition of BMI (“Hard” BMI FRS)
to the risk score classified subjects as 22% low risk, 35% intermediate risk and 43% high
risk over 30 years. Similar differences were seen for the “FULL” FRS with and without BMI.
Without BMI, the 30 year “ Full” score indicated 5% with low risk, 24% with intermediate
risk and 71% with high risk. The addition of BMI to this score resulted in 2% low risk, 20%
intermediate risk and 78% high risk.
Conclusion: The 10 year FRS and RRS may not be useful for FAW women as these tools
did not stratify participants’ risk. The 30- year FRS tools provided a more discerning risk
assessment and should improve understanding of lifetime risk of CVD. However, studies of
outcomes as a function of risk scores are sorely needed in Asians as a function of residency
before risk score tools should be adopted.
Disclosure of Interest: None Declared
PW237
Does routine pre-renal transplant cardiac evaluation reduce the rates of perioperative
acute coronary syndrome?
Nitesh Nerlekar*1, Timothy Barton1, Jane Waugh2, Jennifer Soon3, Peter Psaltis4,
Hassan Rehmani5, Tony He5, Baey Yiwei5, Stuart Moir1, Phillip M. Mottram4
1 Disclosure of Interest: P. Mehta Grant/research support from: Gilead, S. Cruz: None
Cardiology, MonashHeart, 2Nephrology, 3Medicine, MonashHealth, 4MonashHeart,
5
MonashHealth, Melbourne, Australia
Introduction: Stress cardiac imaging testing for cardiovascular risk assessment is widely
performed prior to renal transplantation. The impact of such testing on perioperative
adverse cardiac events is not established.
Objectives: To evaluate the impact of cardiovascular risk assessment on perioperative
cardiac events in potential renal transplant recipients.
Methods: Medical records of consecutive patients undergoing renal transplantation at a
large tertiary hospital from 2008-2012 were reviewed. Patients were stratified according to
stress imaging modality, resultant changes in cardiac medications and pre transplant cor-
onary revascularization. Perioperative events were defined as all-cause mortality, cardiac
arrest, and acute coronary syndrome (ACS) occurring within the index admission.
Troponin elevation was also documented and the occurrence of ACS adjudicated by 2
independent cardiologists reviewing the medical record.
Results: Of 370 renal transplants performed, 202 patients underwent stress echocardi-
ography, 77 nuclear myocardial perfusion imaging, 91 had no non-invasive investigation
(Table). Based on the stress test results there was no significant change to pre-transplant
aspirin, beta-blocker or statin prescription (p¼0.9). 15 patients underwent pre-transplant
coronary revascularization: 3 were based directly on the results of the stress test (i.e. pa-
tients had asymptomatic coronary artery disease); the remaining 12 cases were performed
for clinically unstable presentations. There were 4 adverse perioperative events: 2 deaths (1
cardiac arrhythmia in the setting of known hypertrophic obstructive cardiomyopathy, 1
due to sepsis), 1 nonfatal cardiac arrest (electrolyte imbalance), 1 ACS. 6 patients had
troponin elevation associated with concomitant sepsis or haemoglobin of <8g/dL in the
setting of post-operative bleeding.
e306
Table 1
Nuclear test Stress echo No Ix
(n[77) (n[202) (n[91)
Age (y) 52
12 51
11 42
14
Known ischaemic heart disease 9 13 6
Abnormal / Inconclusive 15 38 -
Preoperative coronary angiography 8 16 5
Revascularization based on test result 1 2 0
(asymptomatic)
Revascularization based on clinical event 3 6 3
(symptomatic)
Conclusion: Renal transplantation is associated with a low risk of adverse perioperative
events. Pre-operative stress testing does not appear to significantly impact on medical
therapy or coronary revascularization rates prior to surgery. This suggests that pre-transplant
testing may be over-utilised in asymptomatic patients, and prospective studies are warranted.
Disclosure of Interest: None Declared
PW238
Heart Disease and Breast Cancer Survivorship: A Cardio-Oncology Quality
Improvement Initiative
Puja K. Mehta*1, Sherwin D. Cruz1, Catherine Dang2, Arash Asher2, Amin Mirhadi2,
William Audeh2, Marc Goodman2, Beth Karlan2, C. Noel Bairey Merz2
1
Heart Institute, 2Cedars-Sinai Medical Center, Los Angeles, United States
Introduction: Survival from breast cancer has improved significantly due to screening
mammography and advances in chemotherapy and radiation, however premature heart dis-
ease appears to be an increasing problem for cancer survivors. To address this, we proposed a
multidisciplinary cardio-oncology clinic including cardiologists, breast cancer surgeons,
medical and radiation oncologists, as well as colleagues from imaging and rehabilitation
medicine to assess and provide appropriate interventions for cancer patients at our center.
Objectives: We conducted a preliminary quality improvement (QI) project to optimize
resource allocation and to determine the personnel effort that would be needed for the
Cardio-Oncology Clinic.
Methods: Electronic retrospective chart review was conducted of patients seen in the
Women’s Heart Clinics in the Barbra Streisand Women’s Heart Center (BSWHC) from
January 2013 to July 2013. The BSWHC is located in a diverse, multi-ethnic, large metro-
politan city of Los Angeles, California. Women are typically referred by other physicians or
self-referred to our center, usually for advanced, specialized diagnosis and treatment perti-
nent to women, but also for preventive cardiac care. The electronic record was queried for
ICD codes related to diagnoses of breast cancer, heart disease, and cardiac risk factors.
Results: 892 patients were seen in the BSWHC over 7 months, and 12% had a diagnosis of
cancer. 48% of cancer related ICD codes were for breast cancer (n¼ 51). Those with breast cancer
had a mean age of 64
10 and mean BMI of 24.6
4. Cardiac risk factors were highly prevalent:
92% of breast cancer survivors had at least one cardiac risk factor. 55% had hypertension, 64%
hyperlipidemia, 14% diabetes, 18% coronary artery disease, and 23% ischemic heart disease.
Pericardial (5%), conduction system disorder (5%), and valvular disease (9%) were also present.
Conclusion: In our outpatient Women’s Heart Clinics located in a large city that serves a
diverse population of women, we find a high percentage of women with a concomitant
diagnosis of cancer and risk factors for heart disease. Given our data, we propose that
Cardio-Oncology Clinics are needed, to help implement lifestyle modification and pre-
ventive therapeutic interventions in cancer survivors.
Declared, C. Dang: None Declared, A. Asher: None Declared, A. Mirhadi: None Declared,
W. Audeh: None Declared, M. Goodman: None Declared, B. Karlan: None Declared, C. N.
Bairey Merz Grant/research support from: Gilead, Consultancy for: Amgen, Gilead, Duke,
Honorarium from: Mayo Foundation, Practice Point Communications, Pri-Med, Vox Me-
dia, BGB Communications, NIH-SEP, ACC-SAPSutter West Bay Hospital
PW240
The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Collaboration -
improving quality of cardiovascular care in the Asia Pacific Region
Bryan Yan*1,2, Wan Azman Wan Ahmad3,4, Liew Houng Bang4,5,6, Sim Kui Hian4,5,6,
Terrance Chua7, Mark Chan8, John Beltrame9,10, Angela Brennan11, Andrew Ajani12,13,
Christopher Reid11
1
Prince of Wales Hospital, Hong Kong, 2Dept. of Medicine & Therapeutics, The Chinese University
of Hong Kong, Shatin, Nt, Hong Kong, 3Dept. of Medicine, University of Malaysia, 4National
Cardiovascular Disease Database Registry of Malaysia, Kuala Lumpur, 5Dept. of Cardiology,
Sarawak General Hospital, 6Faculty of Medicine, University of Malaysia, Sarawak, Malaysia,
7
National Heart Centre, 8National University Heart Centre, Singapore, Singapore, 9Department of
Medicine, University of Adelaide, 10Coronary Angiography Registry Database of South Australia
(CARDOSA) Registries, Adelaide, 11CCRE Therapeutics, Monash University, 12Coronary Care
Unit, Royal Melbourne Hospital, 13Melbourne Interventional Group, Melbourne, Australia
Introduction: Globally, clinicians and other stakeholders recognise the need for
clinical registries to monitor data in order to improve the outcome and quality of
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
care in the delivery of medical interventions. Cardiovascular interventions including PW242

POSTER ABSTRACTS
Percutaneous Coronary Intervention (PCI) are high cost activities that have become
widely adopted across the region. Registries in individual institutions and countries 40-year changes in cardiovascular diseases risk factors in Finland
are valuable, however, the establishment of a collaboration across the Asia Pacific Erkki Vartiainen*1, Tiina Laatikainen1, Katja Borodulin1, Markku Peltonen1, Veikko Salomaa1
Region to inform on variations in patient and procedural characteristics and asso- 1
Division of Welfare and Health Promotion, National Institute for Health and Welfare (THL),
ciated clinical outcomes would enable regional benchmarking of quality
Helsinki, Finland
performance.
Objectives: An inaugural Asia Pacific Evaluation of Cardiovascular Therapies Introduction: Finland has experienced remarkable changes both in population levels of
(ASPECT) Collaboration meeting was held in Singapore in July 2012 with 27 hospital coronary heart disease (CHD) risk factors and mortality over the past decades. For the
representatives attending. The proposed aims of the collaboration included a) to national monitoring of risk factors in major non-communicable diseases (NCDs), National
identify the characteristics of patients undergoing PCI across the Asia Pacific region, b) FINRISK Studies have been implemented from 1972 to 2012.
to report on outcomes of patients undergoing PCI across the Asia Pacific Region, c) to Objectives: Describe the 40-year changes in cardiovascular diseases risk factors in Finland.
develop an appropriate ethnic specific risk adjustment model for patients undergoing Methods: Study population included participants aged 30 to 59 years in the series on
PCI across the Asia Pacific Region and d) to establish a registry framework for independent random population samples. Data were collected in five-year intervals in
research, education and training in the area of cardiovascular interventions across the 1972-2012. FINRISK studies so far comprised 53 589 men and women who participated in
Asia Pacific Region. a health examination, gave a venous blood sample, and filled in questionnaires. Serum total
Methods: Following agreement, common fields were identified from data sets of existing cholesterol, systolic and diastolic blood pressure, and body mass index were measured
local registries and an initial report on patient characteristics across the region was pro- using standardized protocol, and smoking status was recorded.
posed. Descriptive characteristics of patients undergoing PCI over a 12 month period were Results: Total serum cholesterol decreased remarkably until the year 2007, but after that
collated and reported. has turned to an increase. Systolic blood pressure has continued to decline over time since
Results: In every country, males predominated PCI activity. Subjects were older and had 1972, while decrease in diastolic blood pressure has leveled off during last ten years.
higher rates of family history of cardiovascular disease in Australia, while Asian subjects had Smoking prevalence has markedly decreased. Body mass index has increased in the pop-
higher rates of diabetes, dyslipidaemia and renal failure. STEMI presentation was higher in ulation, yet the significant changes occurred in the earlier survey years, not in past 10 years.
Australia than in Asia and Drug eluting stent use was higher in Asia. Procedural success Conclusion: After three decades of favorable development, the population risk factor levels
rates were similar across the region (>95%). showed some increase in total cholesterol and diastolic blood pressure. This emphasizes the
Conclusion: Resolution of cross border individual patient data transfer and collation of need for continued efforts towards national disease prevention and health promotion.
pooled data in a central registry is ongoing. Patient characteristics differ across countries in Disclosure of Interest: None Declared
Asia in terms of pre-procedural risk factors and clinical presentation, however procedural
success was similar. Impact on patient outcomes at 30 days and longer term outcomes are
PW243
being assessed.
Disclosure of Interest: None Declared Recent trends in age- and sex-specific heart disease mortality in Australia
Melanie Nichols*1, Steven Allender1
1
Deakin University, Geelong, Australia
PW241
Introduction: There is evidence from around the world that the very significant reductions
The Cost-Effectiveness of Guideline-Driven Use of Drug-Eluting Stents in Victorian in coronary heart disease (CHD) mortality rates in recent decades have more recently
Public Hospitals occurred predominantly within older age groups. Amid increasing rates of obesity, diabetes
Thathya Ariyaratne1, Zanfina Ademi1, Bryan Yan2, Molla Huq1, Baki Billah1, Alexander Black3, and other risk factors, it appears that rates in younger groups may be plateauing or even
increasing in some contexts.
Gishel New4, Nick Andrianopoulos1, Christopher Reid*1
1 Objectives: The aim of this study was to examine age and sex-specific trends in CHD
CCRE Therapeutics, Monash University, Melbourne, Australia, 2Dept. of Medicine & mortality between 1970 and 2011 in Australia, with particular focus on the most recent
Therapeutics, Chinese University of Hong Kong, Sha Tin, NT, Hong Kong, 3Geelong Hospital, decade.
Geelong, 4Box Hill Hospital, Melbourne, Australia Methods: Joinpoint analysis of sex-specific trends in mortality rates according to ten-year
age bands, compared with age-standardised rates for all ages combined. The number and
Introduction: Clinical decision making in regards to the use of drug-eluting or bare metal location of significant joinpoints for each age group by sex was determined using a log-
stents for percutaneous coronary interventions has been shaped by the identification of linear model, and the annual percentage change within each segment calculated.
criteria for appropriate use. However the cost-implications and effectiveness of adopting Results: Australia has demonstrated among the most remarkable declines in CHD mortality
these criteria are not clear. in the world over the last four decades. In the last ten years, however, preliminary results
Objectives: We aimed to compare the cost-effectiveness of guideline-driven use of DES suggest that these dramatic improvements are no longer universally consistent. Detailed
versus bare-metal stents (BMS), from the perspective of the healthcare provider, in the results of joinpoint analysis of age- and sex-specific recent trends will be presented.
setting of Victorian public hospitals. Conclusion: Despite enviable successes to date, observed increases in heart disease risk
Methods: Baseline information and resource utilisation- data were obtained from the factors may present a significant future burden of heart disease mortality in Australia. A
Melbourne Interventional Group (MIG) registry for the period of April 2004 to December strong continued focus on both primary prevention and quality clinical care remains
2011. Costs of hospitalisations and medication use were derived from published sources. crucial.
Costs and effectiveness data from the study were combined in a decision analytic Disclosure of Interest: None Declared
modelling framework to determine 12-month cost per repeat-revascularisation avoided, in
patients meeting 0, 1, 2, or 3 indications for a DES [diabetes mellitus; small vessels; long
lesions; bifurcation lesions; ostial lesions; in-stent restenosis; and/or chronic total occlusions]. PW244
Propensity-score-matching was used to account for patient baseline differences in each Coronary Heart Disease And Related Risk Factors Data Audit: Evaluating The
group. Probabilistic sensitivity analysis (PSA) was undertaken to determine the robustness Adequacy And Availability Of Data To Understand Heart Health In Australia
of results.
Results: Melanie Nichols*1, Bill Stavreski2, Michaela Shackley1, Laura Jones1, Steven Allender1
1
Deakin University, Geelong, 2National Heart Foundation of Australia, Melbourne, Australia
Introduction: Coronary heart disease remains a leading cause of death in Australia and
Table 1. Expected 12-month cost-effectiveness based on decision analysis (Cost-effec-
around the world. A range of efforts are underway in many countries to quantify and track
tiveness threshold: $50,000 AUD) over time the morbidity, mortality, treatment, and full range of contributing risk and
Propensity- protective factors. High quality, representative, and regularly or routinely collected data are
a crucial foundation for understanding and in turn addressing the burden of coronary heart
Original cohort score-matched
disease.
(N) cohort (N) Cost per repeat revascularisation avoided Objectives: The aim of this study was to conduct a national audit of existing data sources
Criteria BMS DES BMS DES (DES v BMS) relevant to coronary heart disease and related risk factors in Australia.
Methods: Data sources were identified and obtained through a detailed, multi-strategy
3 162 724 141 141 -$7,201
search, including a systematic literature review, and grey literature, online searches and
2 913 1,782 741 741 $22,956 contact with key stakeholders to identify datasets held by state and federal government
1 2,935 2,332 1,852 1,852 $32,168 agencies, non-government organisations and international organisations. Identified datasets
were assessed for content, quality, coverage, collection frequency and availability.
0 3,382 480 445 445 $43,072 Results: Data sources varied widely in their coverage and accessibility for research. Mor-
tality and morbidity (e.g. hospital separations) data have comparatively very high coverage,
quality and detail, and are accessible for epidemiological research. Rates of (non-fatal) heart
attack incidence and a lack of registries represent key gaps in knowledge. A major issue for
Conclusion: Guideline-driven use of DES in high-risk patients is cost-saving at 12-months. many other types of data, particularly for risk factors, was the reliance on self-reported data
The value for money attractiveness of DES compared to BMS increased substantially with from semi-regular or ad hoc surveys, rather than data that are routinely collected and
increasing risk profile (1, 2, or 3-or-more criteria). collated as part of regular practice. Further, many data sources are state-based and may not
Disclosure of Interest: None Declared be available or comparable nationally.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e307

 Conclusion: It remains difficult to form a clear picture of many aspects of the heart health follow-up at 6 and 12 months (Table). Sixty-five percent of patients reported that they
POSTER ABSTRACTS

of Australians. There is demonstrated need for better monitoring of heart disease risk
factors and improved access protocols and linkage programs to make the best possible use
of existing administrative data sources. The release of results from the Australian Health
Survey will answer many questions, but will do little to address the ad hoc nature and
limited comparability of existing data sources.
Disclosure of Interest: None Declared
successfully ceased smoking. Twenty-five of the 35 SNPS were able to be genotyped. In
univariate analysis, none of the previously identified SNPs associated with smoking cessation
were statistically associated with smoking cessation at either 6 or 12 months. When clinical
demographic and smoking cessation interventions were included into the model, only SNP
RS17657679 was significantly associated with smoking cessation at 12 months.

PW245
Australia’s First PCI Registry-Derived Logistic and Additive Risk Score Calculations
Predicting Post-Procedural Adverse Outcomes
Nick Andrianopoulos1, William Chan2, Chris Reid1, Angela L. Brennan1, Bryan Yan3,
Thomas Yip4, David J. Clark5, Gishel New6, Andrew E. Ajani7, Stephen J. Duffy*2
1
School of Public Health & Preventive Medicine, Monash University, 2Cardiology, Alfred
Hospital, Melbourne, Australia, 3Dept. Medicine & Therapeutics, The Chinese University of
Hong Kong, Shatin, NT, Hong Kong, Hong Kong, 4Cardiology, Geelong Hospital, Geelong,
5
Cardiology, Austin Hospital, 6Cardiology, Box Hill Hospital, 7Cardiology, Royal Melbourne
Hospital, Melbourne, Australia
Introduction: Pre-procedural risk models and scoring systems are useful in guiding cli-
nicians and informing patients regarding estimated risk of adverse outcomes following a
procedure.
Objectives: To develop relevant contemporary clinical risk models for percutaneous cor-
onary intervention (PCI).
Methods: We determined predictors (from 34 predefined baseline characteristic and
procedural factors) for 4 outcomes of interest following PCI. Data were from the multi-
centre Melbourne Interventional Group registry. Utilising bootstrapping techniques,
N¼14,170 procedures performed from 2005-10 were used for risk model development
and internal validation. For temporal validation, N¼4,289 from 2011-12 were used for 30-
day models, and N¼2,101 of these from 2011 for 12-month models. Logistic coefficient
and additive score models were developed. Area-under-the-receiver operating characteristic
curve (ROC) and the Hosmer-Lemeshow chi-square statistic (H-L) were used to assess
model goodness-of-fit.
Results: Observed outcome rates for 30-day mortality (mort-30), 30-day mortality/MI
(mort-mi-30), 12-month mortality (mort-12) and 12-month mortality/MI (mort-mi-12)
were 1.9%, 3.7%, 3.7% and 8.1% respectively in 2005-10. In 2011-12 mort-30 and mort-
mi-30 rates were 1.9% and 3.9% respectively, whilst mort-12 and mort-mi-12 rates were
4% and 7.9% respectively in 2011. Predictors of outcome in the minimal logistic models
(p<0.05 in >90% of bootstrapped replications) included cardiogenic shock, estimated
glomerular filtration rate and left ventricular ejection fraction (all 4 outcomes), as well as
acute coronary syndrome in mort-30, multivessel disease and no-reflow in mort-mi-30, age
in mort-12 and age and stent type in mort-mi-12. These models had generation ROC very
similar to internal validation ROC which were 88%, 75%, 82% and 73% respectively.
Temporal validation ROC were 87%, 77%, 81% and 72% respectively. Additive score
(possible score range; internal validation ROC; temporal validation ROC) for these models
were: mort-30 (0-12; 88%; 87%), mort-mi-30 (0-12; 75%; 77%), mort-12(0-15;81%;81%)
and mort-mi-12 (0-30; 72%; 71%). All H-L p-values were p>0.10.
Conclusion: We have developed both logistic and additive score risk models predicting
hard endpoints following PCI. All models suggest excellent calibration, while the mortality
models appear to have better discrimination than the composite mortality/MI models.
These models may be useful in estimating adverse outcomes following PCI.
Disclosure of Interest: None Declared

PW247
Validation of Genetic Variants Associated with Smoking Cessation in Patients With
Coronary Artery Disease
Bimal Shah*1, Svati Shah1, Wassim Shatila1, Sharif Halim1, Linda Shaw1,
Christopher Granger1, Eric D. Peterson1, Jed Rose1, Laura K. Newby1
1 cessation at 12-month follow-up without an association found with any other previously
Duke University, Durham, United States
Introduction: Smoking remains a major public health issue as a major contributor to CV
morbidity and mortality. Recent data suggest that 35 SNPs are associated with smoking
cessation.
Objectives: We examined if these SNPs are associated with smoking cessation in patients
with CAD.
Methods: We obtained blood samples from patients undergoing cardiac catheterization at
Duke University. Detailed clinical and angiographic data was available as well as structured
phone follow-up for all patients at 6-month and 12-months after index catheterization that
included patient self-report of smoking status. We examined the smoking status at the time
of catheterization for all patients with  1 epicardial coronary artery with > 50% stenosis. All
patients had genotyping of previously identified 35 SNPs associated with smoking cessation
on a Taqman platform. All SNPs were evaluated for deviation from Hardy-Weinberg equi-
librium and minor allele frequencies were calculated. Smoking cessation was defined as
cessation at 6 and 12 months post-procedure and a chart review to assess smoking cessation
counseling, nicotine replacement use and cessation pharmacotherapy at baseline, 6-months
and 12-months. Clinical and genetic variables were tested a univariable logistic regression
model to determine association with smoking cessation at 6 and 12 months, respectively.
Stepwise selection was used to identify significant associations of SNPs with smoking
cessation adjusting for the clinical predictors of smoking cessation in multivariable analysis.
Results: We identified 966 and 1043 patients between January 2001 and June 2007 who
reported smoking tobacco at the time of baseline cardiac catheterization with complete
Conclusion: In patients with documented CAD, only 1 SNP was associated with smoking
identified SNPs at 6 and 12 months. This weak clinical link suggests that in patients with
CAD, other factors may better predict smoking cessation.
Disclosure of Interest: None Declared
PW248
Smoking Even Without Comorbidities Is A Major Risk Factor For Early
Cardiovascular Structural And Functional Abnormalities
Mahfouz El Shahawy MD*1, Miglena Entcheva1, Antonella Sabatini1
1
Cardiovascular Center of Sarasota, Sarasota, United States
Introduction: Smoking has been implicated as a major risk factor for cardiovascular (CV)
disease in many risk scoring systems including the FRS.
Objectives: The purpose of this study was to assess whether smoking without other CV
risk factors is associated with early CV structural and functional abnormalities.
Methods: We screened 2234 asymptomatic subjects, age 23-80, for CVD risk using Early
CVD Risk Score (ECVDRS). ECVDRS consists of 10 tests: large (C1) and small (C2) artery
stiffness, blood pressure (BP) at rest and post mild exercise (PME), Carotid Intima Media
Thickness (CIMT), abdominal aorta and left ventricle ultrasound, retinal photography,
microalbuminuria, ECG, and pro-BNP. Hypertension was defined according to the JNC VII
criteria. HDL was defined according to NCEP/ATP III (Female HDL < 50, Male HDL < 40).

e308 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Results: Among the 2234 subjects 1301 were not taking any medications. Among them 56
(4%) were smokers with no other major CV risk factors and 395 were non-smokers
without any major CV risk factors and were used as a control. The presence of early CV
structural and functional abnormalities in smokers without comorbidities as compared
with the non-smokes control group are shown in Table1:
Untreated Untreated
No Major CV Risk Factors Smoking is the Only Mjor CV Risk Factor
30% (395 of 1301) 4% (56 of 1301)
Abn. BP Rise PME 16% (62of 395) 30% (17 of 56)p¼ o.oo69
Abn. CIMT 26% (103of 395) 30% (25 of 56)p¼ o.oo39
Abn. C2 15% (60of 395) 25% (14 of 56)p¼ o.o636
Conclusion: Based on our data, smoking even in the absence of other risk factors, is
associated with statistically significant early structural and functional CV abnormalities in
comparison to control group. Hence, we urge aggressive screening of all smokers to stratify
the risk of early CVD and initiate appropriate treatment.
Disclosure of Interest: None Declared
PW249
Assessment of blood fluidity in smoking patients
Sayaka Shimada*1, Koji Hasegawa1, Hiromichi Wada1, Sachiko Terashima2, Maki Komiyama1,
Noriko Asahara1, Masaharu Akao1, Akira Shimatsu1, Yuko Takahashi3
1 formulation, governments around the world have established programs, such as the
Clinical Research Institute, 2Health Screening Center, Kyoto Medical Center, National Hospital
Organization, Kyoto, 3Health Administration Center, Nara Women’s University, Nara, Japan
Introduction: Blood rheology or fluidity, which is expressed as “viscous” or “non-viscous”,
reflects the blood viscosity and the state of microthrombus formation. Reduced blood
fluidity (BF) has been suggested to lead to cardiovascular thrombotic events such as
myocardial and cerebral infarction. While cigarette smoking is an independent risk factor
for cardiovascular events, to date, a useful and convenient method of predicting such
events in smoking individuals has not been established.
Objectives: The present study investigated improvement of BF by smoking cessation (SC).
Methods: The Micro Channel Array Flow Analyzer (MC-FAN) is an instrument which
measures the BF by employing the micro-channel method using a capillary model. We
assessed BF in smoking patients by measuring the blood passage time (BPT) in aliquot
(100ul) of blood samples using the MC-FAN.
Results: BPT was significantly related with smoking variables such as daily consumption of
tobacco, Brinkman’s index, and Fagerstrom Test for Nicotine Dependence (FTND) score.
Overall, SC in our outpatient clinic significantly (p¼0.015) decreased BPT (implying
improvement of BF) from 57.7 sec to 52.3 sec at 3 months after the start of SC therapy.
However, as BPT increased (implying deterioration of BF) even after SC in some patients,
we divided patients into the group exhibiting improvement of BF (I), that showing dete-
rioration (D) and that showing no change (N). West circumference and body mass index
significantly increased after SC in N and D, but not in I. In contrast, serum HDL-cholesterol
levels significantly increased in I, but not in N and D. Notably, serum triglyceride levels
markedly increased after SC in D (p¼0.003), moderately increased in N (p¼0.012), but
not in I (p¼0.366). We further evaluated BPT at one year after the start of therapy in D.
BPT significantly (p¼0.003) decreased from 3 months to one year after SC.
Conclusion: While decreased BF in smoking patients improves by 3 months of SC,
obesity-associated hyperlipidemia after the cessation perturbs such improvement. As BF
improves at one year in D, SC may finally lead to the decrease in cardiovascular risk even if
obesity occurs after the cessation. However, management of hyperlipidemia associated with
SC would further augment the improvement of BF, and reduce the risk of cardiovascular
events.
Disclosure of Interest: None Declared
PW254
Spectrum of Pediatric Cardiac Disease in Malawi, Africa
Amy Sims*1
1
Pediatric Cardiology, Baylor College of Medicine, Houston, United States
Introduction: Pediatric cardiac disease, both congenital and acquired, has a large impact in
Malawi, Africa, and has not previously been documented by a pediatric cardiologist.
Objectives: We characterize the spectrum of cardiac disease found in the pediatric cardiac
clinic and hospital wards in Lilongwe, Malawi, over a ten month time period.
Methods: Data was collected by a pediatric cardiologist based at the central referral hospital
from September 2011 to June 2012. Many, but not all, patients with cardiac disease seen in
the wards and clinic during this time period were recorded.
Results: Both congenital and acquired heart disease is prevalent in this population (see
chart). 210 patients with cardiac diagnoses were recorded. 115 had congenital defects, and
95 had acquired defects.
Congenital Lesions* (n [ 115)
Condition VSD TOF PDA CAVC Other
number 41 14 10 8 48
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Acquired Lesions* (n[ 95)
POSTER ABSTRACTS
Condition RHD Cardiomyopathy Other
Number 73 21 6
* some children may have more than one lesion
Of the children with RHD, the majority had severe disease (62%). 43 children with RHD
had MR, 32 children had MS, 19 children had AR, and 12 children had AS. Many children
had more than one lesion.
Conclusion: Both congenital and rheumatic heart disease are prevalent in Malawi. Further
work needs to be done to augment primary and secondary rheumatic heart disease pre-
vention programs. In addition, the system for identifying and referring children for
correction of cardiac defects needs to be strengthened.
Disclosure of Interest: None Declared
PW256
Evaluation of national food reformulation initiatives: a proposed evaluation tool
Beth Thomas*1, Jane Potter1, Gary Sacks2, Jacqui Webster3
1
National Heart Foundation of Australia, 2Deakin University, Melbourne, 3The George Institute
for Global Health, Sydney, Australia
Introduction: The reformulation of commonly-consumed processed foods to reduce nu-
trients such as salt, saturated fat and sugar, has enormous potential to improve population
health. In recognition of the need for a multi-sectoral approach to improving product
Australian Government’s Food & Health Dialogue (FHD) and the United Kingdom’s Salt
Reduction Strategy (UKSRS), which bring together government, food industry, and health
groups. However, the programs typically differ in their focus areas, targets, and nature of
stakeholder involvement. In the absence of formal evaluations, it is important to consider the
characteristics likely to lead to successful outcomes from a population health perspective.
Objectives: This paper analysed the FHD and the UKSRS with the aim of identifying the key
characteristics likely to lead to both food supply and population health improvements. This
informed the development of a proposed evaluation tool for assessing current and future initiatives.
Methods: Using criteria adapted from the National Heart Foundation of Australia’s rapid
review: Effectiveness of reformulation as a strategy to improve population health, a five point
scale that ranked program characteristics was developed for each criterion – this formed the
basis of the proposed evaluation tool. A detailed review of the UKSRS and the FHD was
then undertaken, and each scheme scored against each of the criteria. Informal consultation
with key opinion leaders internationally assisted in refining the proposed evaluation tool
and identifying strengths and limitations of assigning scores to the schemes.
Results: The UKSRS scored higher overall in terms of likely effectiveness due to the co-
ordination and monitoring of the initiative. However, through the consultation process it
was not possible to reach agreement on the validity of the scoring system. Instead, the
feedback enabled defining the characteristics from which a framework of good practice
principles has been developed. The framework encompasses governance, scope of imple-
mentation, stakeholder engagement, monitoring and evaluation.
Conclusion: This framework, which emphasises the need for adequate resourcing for
stakeholder engagement, monitoring and evaluation provides guidance for current and
future initiatives to elicit population health outcomes. Further stakeholder engagement and
piloting in different contexts is needed to further refine the proposed evaluation tool.
Disclosure of Interest: B. Thomas Consultancy for: The National Heart Foundation of
Australia provides technical expertise to the Food & Health Dialogue, J. Potter Consultancy
for: The National Heart Foundation of Australia provides technical expertise to the Food &
Health Dialogue, G. Sacks: None Declared, J. Webster Employee from: Jacqui Webster was
employed by the U.K. Food Standards Agency between 2000 and 2007
PW257
Therapy manual program induced alterations in autonomic nervous system
modulation of students preparing to apply for the universities
Heloisa A. Ferreira*1, Gustavo C. Trevisan1, Fernanda H. Penereiro1, Fernanda V. Bortz1,
Bianca J. Alves1, Luiz A. Ramos1, Miguel A. Areas1, Dora Maria G. Kassisse1
1
Departamento de Biologia Estrutural e Funcional, Universidade Estadual de Campinas,
Campinas, Brazil
Introduction: The selective process to join Brazilian universities is hard and an agent that
induces stress reaction in young. We had already identified high levels of stress in
September and November, time that students choose their career and test day and that the
manual therapy (MT) treatment was efficient to reduced perceived stress levels (QEP).
Modulation of autonomic nervous system (ANS) after MT program was still not studied.
Objectives: Evaluate the effects of MT on ANS modulation of students.
Methods: Number of volunteers was 16 (T), 9 men (M) and 7 women (W). We evaluate QEP,
and the recorded variability of heart frequency. We used the records of short duration (SD1, as
parasympatic activity, ms) and of long duration (global variability, SD2, ms) of heart beats
(HB, btm). HB was recorded during 15 min with S810i - PolarÒ, in supine position. The data
was collected before and after sessions of MT (45 min, twice a week) during 9 weeks from
September (initial-i) and November (final-f), (Ethical Committee no388/2006). Records were
interpolated and expressed as mean
SEM of 5 min data collected. Statistical analysis (Prism
Software) taking “t Student” tests paired and unpaired and using p<0.05 as significant.
Results: QEP values were reduced after MT: Ti 146
8 vs Tf 109
5; Wi 140.8
13 vs Wf
108
7 e Wi 151
12 vs Wf 115
7. MT lowered the cardiac frequency of the total
e309
 population: Ti 80
4 vs Tf 71
2. After the first MT session, SD1 values raised on T and W
POSTER ABSTRACTS
(T1b: 31
4 vs T1a 39
4; W1b: 23
2 vs W1a: 34
4) and SD2 values on T (T1b: 63
7 vs
T1a 81
8). At the ninth week, SD1 values increased just on W population (W9b: 26
6 vs
W9a: 42
9), and SD2 rose on T and W population [(T9b: 67
6 vs T9a 81
6; W9b: 52
6
vs W9a: 79
10)]. We also compared values before first week and ninth, therefore W have
conclude that only SD2 levels have risen on T (T1b: 63
7 vs T9a 81
6) and W (W1b:
46
4 vs W9a 79
10). There were differences between M and W on SD2 values on first
and ninth week (W1b 46
4 vs M1b: 76
11 e W9b: 52
6 vs M9b: 79
9).
web 3C=FPO
Conclusion: MT program reduced QEP and cardiac frequency values, indicating efficiency
of this therapy on managing stress. These effects were attributed to enlargements of the
parasympathetic tonus (SD1) and the global activity (SD2) over the heart and also can
clearly visualized on the Poincare’s plots. We can point out that MT’s benefits are evident
over the population which had the parasympathetic tonus and the global activity lower at
the beginning of the treatment as the women population case.
Disclosure of Interest: None Declared
PW258
Cardiometabolic protection against cardiovascular disease and diabetes via nurse-
facilitated management in a regional location: The Protecting Healthy Hearts study
Melinda Carrington*1, Simon Stewart1
1
Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Introduction: We have previously shown higher levels of cardiovascular (CV) risk in
regional-dwelling adults.
Objectives: To assess the potential benefits of a nurse-led, self-management program to
optimise CV and metabolic risk profiles.
Methods: A pre/post observational study was conducted and change from baseline
measured after 6 months follow-up. A nurse-led, heart health clinic was established in a
e310
regional community and self-selected participants (recruited over 7 weeks) were subject to
standardised screening. Individual targets and multidisciplinary strategies (including referral
to community-based health programs) to reduce risk factors were individually tailored ac-
cording to the Green Amber Red Delineation of rIsk And Need (GARDIAN) system.
Results: Overall, 530 self-selected individuals participated. Mean age was 54
14 years
(62% female). At baseline, 74% of participants were physically inactive, 67% had
abdominal obesity, 42% hypertension and 37% elevated LDL cholesterol. Participants
required low (43%), moderate (34%) or high (23%) levels of surveillance and management
according to GARDIAN criteria. We observed clinically significant changes in 326 (76%)
participants overall, comprising reductions in BP (42%), total cholesterol (59%), weight
(10%) and absolute CV risk (45%). Average BP decreased by 4/1 mmHg, weight by almost
1 kg and BMI by 0.3 kg/m2. Lipid profiles improved via decreased (mean) total cholesterol
(from 4.75 to 4.13 mmol/L), LDL cholesterol (from 2.68 to 2.37 mmol/L) and triglyceride
(from 1.59 to 1.22 mmol/L) levels. Reaffirming these improvements, change in absolute
CVD risk scores of 0.4% (4% reduction from baseline) was observed. A total of 141 (32%)
participants had visited their GP resulting in initiation/modification of pharmacological
treatment for 24 (6%) individuals. In adjusted analyses, GP attendance was important for
improving BP outcomes (OR 1.67; 95% CI 1.08-2.58, p¼.022). GARDIAN status, age,
physical activity and nurse guidance (including diabetes educators) were also indepen-
dently found to positively influence cholesterol, absolute CVD risk and weight levels of
participants.
Conclusion: The feasibility and short-term benefits of a dedicated “heart health” service for
high risk individuals living in regional locations with limited health care resources was
shown.
Disclosure of Interest: None Declared
PW259
Symbolic Dynamics and Íts Correlation With Other Heart Rate Variability Indexes in
Healthy Subjects
Rosangela A. Hoshi1, on behalf of Transdisciplinary Nucleus of Studies on Complexity and Chaos
(NUTECC): Moacir F. Godoy*2, on behalf of Transdisciplinary Nucleus of Studies on Complexity
and Chaos (NUTECC): Carlos M. Pastre3, on behalf of Sports Physical Therapy Laboratory:
Luiz Carlos M. Vanderlei3, on behalf of Stress Physiology Laboratory
1
Cardiology, 2Cardiology and vascular surgery, São José do Rio Preto Medicine School, São José
do Rio Preto, São Paulo, 3Physical Therapy, Paulista State University, Presidente Prudente,
Brazil
Introduction: Studying Heart Rate Variability by linear indexes is considered limited to find
some hidden features in cardiac time series, which may be potentially relevant in clinical
environment. Therefore, nonlinear methods were developed to reduce this limitation and
symbolic dynamic analysis is one of them. Still little is known about this technique that
consists in symbolize instantaneous heart rate by different symbols, reflecting the closeness
of each interbeat interval to the total average and grouping them in symbols “words”.
Objectives: Analyze symbolic dynamic patterns to access autonomic behavior in healthy
and young population and verify if there is association among well-known HRV indexes
and such symbolic dynamics variables.
Methods: 40 healthy young male subjects underwent 30 minutes in supine position with
registering heart rate beat-to-beat using a Polar RS800CX and, after filtering, 300 R-R in-
tervals were analyzed by software Kubios HRV, providing the values of SDNN, RMSSD, LF,
HF, LF/HF, SD1 and SD2 indexes. Symbolic analysis was carried out by grouping the
patterns of variation into four families: 0V (no variation), 1V (one variation), 2 LV (two like
variations) and 2ULV (two unlike variations). The association among the variables was
verified by Pearsons linear correlation and P value < 0.05 was considered significant.
Results: The predominant symbolic patterns observed was 1V (45.32
6.19%) followed
by 2ULV (21.12
10.33%) (Fig 1.). 0V and 2ULV patterns presented the most expressive
correlations with RMSSD (r ¼ -0.56 and r ¼ 0.65), HF (r ¼ -0.44 and r ¼ 0.52), LF/HF (r
¼ 0.61 and r ¼ -0.54) and SD1 (r ¼ -0.56 and r ¼ 0.66). Also, 1V pattern demonstrated
weak but significant correlation with RMSSD (r ¼ -0.36), HF (r ¼ -0.33) and SD1 (r ¼
-0.36) (Table 1.).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: In healthy subjects was observed a predominance of 1V pattern, which re-
flects both sympathetic and parasympathetic modulation. The parasympathetic related
pattern of symbolic dynamics (2ULV) presented higher correlations with parasympathetic
related indexes of time, frequency and nonlinear domains.
Disclosure of Interest: None Declared
PW260
One Year Behavioral Intervention For Uncontrolled Hypertension: A Cross Sectional
Study In Bengkulu, Indonesia
Surya Marthias*1, Trevino A. Pakask2, Mazaya L. Palupi2, Amy C. Demeriyenes2,
noviyanti yanti2, Anna Y. Putri2
1
Public health, Faculty of Medicine Universitas Indonesia, 2Public Health, FMUI, Jakarta,
Indonesia
Introduction: Hypertension has become a significant problem with prevalence of 31.7%
among adult in Indonesia. Although effective drugs are available, management of hypertension
is still inadequate. In Bengkulu, hypertension accounted for higher of incidence rate and
estimated 85 to 90% are uncontrolled with low compliance to anti hypertensive medication.
Objectives: This study is carried out to identify factors contributing to uncontrolled hy-
pertension and analized effect of intervention on drug consumed, systolic blood pressure
(SBP) level, and 1-yearcoronary heart disease (CHD) risk.
Methods: A cross sectional study was conducted on 2012 to 2013 with total 102 patients
age 50-80 with sustained uncontrolled hypertension in Primary Health Care, Lebong
District, Bengkulu.Patient were recruited using consecutive sampling and given standard-
ized questionnaire before and after one year behavioral intervention. Questionnaire had
been validated with alpha-cronbach 0,74. Guided discussion had done monthly in Centre
of Geriatric as part of intervention for both groups,followed by evaluation of drug
consumed. We conduct analysis effect in SBP and 1-year CHD riskamong compliers and to
compare with an intention-to-treat analysis
Results: Of 102 respondents, 55% were compliers who had significant increased in
consuming drug regularly (74% vs 26%), increased in knowledge score (54% vs 46%), and
had lower baseline SBP (133 vs 155 mmHg) compared with noncompliers. The effect of
intervention significant for SBPamong compliers (p¼0,04) with reduction of SBP at least
1,2 mmHg in a mean, but not significantdifferent for 1-year CHD risk (p>0,05). Factor
absence of symptoms (70%) significantly contribute to uncontrolled hypertension
(p¼0,02). However, family support in this regional was also played significant role that
influenced patient to consumed drug regularly.
Conclusion: Patients with positive knowledge and attitude are more likely to comply with
treatment and could significantly reduce SBP in a year. Educational programs focusing
onmodificating preventable risk factors and compliance towards antihypertensive drugs
should be carried out to reduce the mortality and morbidity associated with the disease.
Disclosure of Interest: None Declared
PW261
Effects of the pulmonary hypertension manual (PulHMan) on awareness of exercise
among patients with pulmonary hypertension
Abraham S. Babu*1, Ramachandran Padmakumar2, Arun G. Maiya1,3
1
Physiotherapy, School of Allied Health Sciences, Manipal University, 2Cardiology, Kasturba
Medical College, 3Dr. TMA Pai Endowment Chair in Exercise Science and Health Promotion,
School of Allied Health Sciences, Manipal University, Manipal, India
Introduction: Pulmonary hypertension (PH) is a condition causing severe functional
limitations and poor quality of life. Exercise training is an important adjunct to manage-
ment of patients with PH. However, exercise as an intervention is underutilized by both
health care professionals and patients. In order to improve awareness about PH and
benefits of exercise in its management, the ‘Pulmonary Hypertension Manual (PulHMan)’
was developed through a structured methodology.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: To study the effects of the PulHMan on awareness of exercise among patients
POSTER ABSTRACTS
with PH.
Methods: A prospective pre-post study was conducted on 20 patients with PH attending
the out-patient department of Cardiology at a tertiary level, University hospital in South
India. A self-developed and validated questionnaire to assess awareness was used prior to
the intervention (i.e., providing education through the PulHMan) and after three months.
Patients were contacted telephonically every month to determine if they had any queries.
Institutional ethical clearance and written informed consent was obtained.
Results: Ten males and females each, with a mean age of 45.5
14.5 years diagnosed with PH
(WHO groups1-4; WHO-functional class I-IV, Right ventricular systolic pressure:
89.2
21.1mm Hg; six minute walk distance: 315.5
119 meters) completed the study. All
patients heard about PH from their physician and were aware of only medical therapies for PH.
None of the patients were sure as to how to monitor their symptoms, received a formal exercise
program or were aware of the benefits of exercise. After three months, 85%(17/20) knew the
importance of monitoring symptoms and 80%(16/20) were willing to exercise in order to
perform their activities. 50% were aware of the benefits of exercise in terms of reducing dys-
pnea, fatigue and improvement in daily activities and18/20 (90%) were willing to participate in
an exercise program with a greater preference for exercising at home (16/20;80%).
Conclusion: The PulHMan improved awareness of PH and role of exercise in its man-
agement among patients with PH. However, more studies are required to understand how
the PulHMan will alter exercise behavior among those with PH.
Disclosure of Interest: A. Babu Grant/research support from: Tom Lantos Innvoation in
Community Services award, Pulmonary Hypertension Association, R. Padmakumar: None
Declared, A. Maiya: None Declared
PW262
The positive effect of education on prevention and healing of patients with atrial
fibrillation
Tünde Bettenbuch*1, Marianna Srej1, Piroska Szekeres1, Gábor Széplaki1, László Gellér1,
Béla Merkely1
1
Heart Center, Semmelweis University, Budapest, Budapest, Hungary
Introduction: Atrial fibrillation is the most common cardiac arrhythmia, which is rarely
life-threatening, but has a significant role in morbidity. The main goal in the treatment is
the prevention of stroke, since its risk is highly increased up to 17.6 fold.
In 1977, WHO announced the program “ Health for All by 2000 ". In 1994 a long -term
National Health Program was initiated, which focused on the significance of coronary and
cerebrovascular diseases and aimed mortality reduction. The WHO 2002 report points out
that a small number of preventable risk factors can greatly affect the appearance of a disease
and early mortality. Thus it is of outmost important to clearly recognize their connections
with disease prevalence.
In May 2011, Semmelweis University Heart Center established a national patient orga-
nization for patients with cardiovascular disease. The Association currently has 700
members. We offer patient education training courses once weekly for patients with cor-
onary artery disease and once monthly for patients with atrial fibrillation.
Objectives: The aim of the Association is patient education, to improve the knowledge about
the disease, the possible complications, treatment options, possible lifestyle changes, pre-
vention, thus giving a greater chance of living with an increased quality of life. By education,
we aimed to reduce the number of unnecessary hospital care and outpatient visits.
Methods: We have done 1347 catheter ablations for atrial fibrillation in our Department in
the past 5 years, 695 of those in 2012-2013. 565 patients agreed to participate in the
program; 380 came back once, 64 patients twice and 32 multiple times. A survey was done
to investigate the frequency of turning to medical care.
Results: Based on our data, 92 of 380 patients participating in the program, while 186 of
315 patients not requiring patient education showed up for unscheduled visits at our
outpatient clinic (p<0.001). The most frequent causes were palpitations and need for
revising medications (anticoagulation, antiarrhythmics).
Conclusion: According to our results, patients participating in the organized patient ed-
ucation program had been able to live with a better quality in the first 6 months following
ablation. They were more prepared to assess the severity of symptoms after treatment and
understood the rationale of their medication better. Most of them did not require additional
visits, hospitalization and information.
Disclosure of Interest: None Declared
PW264
Two-year hospitalisation major causes and costs in patients with atherothrombotic
disease
Emily Atkins*1, Elizabeth Geelhoed1, Tom Briffa1
1
School of Population Health, University of Western Australia, Perth, Australia
Introduction: It is well understood that patients with established atherothrombotic disease
(ATD) are at greater risk of further ATD events; however there is limited information on how
comorbidities and other admissions contribute to total hospitalisations and costs in the 24
months following an ATD admission. This information is important in understanding how
those with ATD use health services, and the factors that may influence future ATD care.
Objectives: Describe the total cost burden and causes of readmissions in the 24 months
following an ATD admission.
Methods: The study sample is comprised of all WA residents aged 35-84 years admitted to
a Western Australian tertiary public hospital in 2007 with a primary diagnosis of ATD.
Linked hospital morbidity and mortality data provided a 15-year look-back for morbidity
and 2 years of follow-up. Published costs were linked to the hospital discharge Diagnostic
Related Group codes and converted to 2013 Australian dollars using health index deflators.
e311
 Results: Of 5998 patients who survived their index admission 66% were male, with index
POSTER ABSTRACTS
admissions being 75% coronary disease, 19% stroke, 6% vascular disease. There were
33349 all-cause readmissions. Twenty-two per cent of patients (n¼1343) did not experi-
ence any readmissions (for ATD or other cause) in the two years following an ATD
admission. Index admission and ATD related readmission costs together comprise 54% the
total hospital costs for this group (47-60%; Figure 1). Two per cent of patients (n¼141)
had chronic kidney disease and experienced 16668 dialysis admissions. A primary diag-
nosis of ATD accounted for 11% of readmissions at 24 months. There were 1352 (4%)
admissions for rehabilitation in 842 patients and 702 (2%) admissions with a primary
diagnosis of chest pain in 502 people. Twenty-seven per cent of patients (n¼1629) had a
history of diabetes at index, of these 336 had a diabetes-related readmission. Another 17
patients without history of diabetes at index had a readmission for diabetes.
Conclusion: Seventy-eight per cent of patients return to hospital within two years of an
ATD admission. Other admissions make up a significant proportion of the total hospital
costs. Men aged 55-69 years had the highest ATD-related and total costs in the two years
following an ATD admission. Rehabilitation and chest pain are the most frequent reasons
for re-hospitalisation in those without kidney disease.
Disclosure of Interest: None Declared
PW265
Two-year hospital costs for atherothrombotic disease and related readmissions by age
and sex
Emily Atkins*1, Elizabeth Geelhoed1, Matthew Knuiman1, Tom Briffa1
1
School of Population Health, University of Western Australia, Perth, Australia
Introduction: Hospitalisation for atherothrombotic disease (ATD) is associated with very
low in-hospital death but high risk of readmission. The cost to the health system both in
profile of readmissions and proximity to the index admission is poorly characterised.
Objectives: To investigate the cost to the health system for an index hospitalisation with
ATD and related readmissions at 90 days, 12, and 24 months by age and sex.
Methods: All men and women aged 35-84 years admitted to a Western Australian tertiary
public hospital in 2007 with a primary discharge diagnosis of ATD according to the In-
ternational Classification of Disease version-10 Australian Modification were identified.
Person-level linked hospital morbidity and mortality data over 2 years was obtained for
each ATD case. Costs for the index admission and re-admissions were taken from Diag-
nostic Related Group codes and converted to 2013 Australian dollars using national health
index deflators.
Results: The 2007 sample included 6172 ATD patients (65% male; 74% coronary
disease, 20% stroke, 6% peripheral vascular disease). A total of 783 (13%) died within
e312
two years (174 were in-hospital fatal index cases). By two years there were 4586 ATD-
related readmissions. Sixty per cent of patients experienced no ATD-related read-
missions, 23% experienced one, and 17% 2. Seventy-eight per cent of the 2-year
ATD-related admission costs occurred within 90 days (ranging from 76% to 82%
across the age span; Figure 1). Overall mean (SD) index admission cost was $9166
($10941). Mean ATD-related readmission costs were: index to 90 days $2862 ($7850),
90 days to 12 months $1907 ($6834), and 12 to 24 months $1449 ($5902). Mean 90
day ATD-related costs was significantly higher (p<0.05) in males aged 55-69 years and
males aged 70-84 years compared to males aged 35-54 years. Compared to women,
men have significantly higher mean ATD-related admission costs for each follow-up
time period (p<0.05).
Conclusion: In a cohort hospitalised with ATD the associated 2-year cost to the health
system, including index admission, was $95 million, with 40% of the study sample
contributing at least one related readmission. The costs of ATD-related rehospitalisation
within 90 days of the index admission are substantial, across age and sex categories. The
higher bundled ATD cost in middle-aged men requires further investigation.
Disclosure of Interest: None Declared
PW266
Mobile Phones: Hope or Hype? A Qualitative Study of Best Practices in m-Health
Development in a Low Income Country
Dhruv S. Kazi*1,2,3, Pronoy Saha4, Nimi Mastey5
1
Medicine/Cardiology, San Francisco General Hospital, 2Medicine, 3Epidemiology and
Biostatistics, University of California San Francisco, 4Health Technology Forum, San Francisco,
5
Stanford University School of Medicine, Stanford, United States
Introduction: m-health, or mobile phone-based technology in healthcare, is touted
as a cost-effective solution to expand access and improve outcomes in low-resource
settings. Despite the proliferation of software applications (“apps”), best practices in
app development, particularly in low- and middle-income countries, remain
uncertain.
Objectives: To define best practices in the design, development, and field-testing of
healthcare apps in a resource-scarce setting, in order to optimize usability and
uptake.
Methods: We conducted a qualitative study involving detailed interviews with stake-
holders in the healthcare ecosystem, including patients, nurses, physicians, adminis-
trators, information technology staff, engineers, and software developers in hospital-
and community-based settings in Mysore and Bangalore, India (n ¼ 130). We used
prototypes (mock-ups or partially functional software) to elicit user preferences and to
define development priorities. Inputs obtained from stakeholders were quickly incor-
porated into the next iteration of prototypes, and the process was repeated (“rapid
prototyping”).
Results: Stakeholders had a favorable view of mobile technology-based solutions for
healthcare, but less than half had used a healthcare app prior to the interview.
Despite higher marginal costs, patients strongly preferred voice-based solutions to
text-based solutions because of limited literacy and numeracy, and unavailability of
Indian-language phones. Providers preferred versatile apps that were accessible from
a variety of devices (e.g., desktops, tablets, and phones); responsive web-based
solutions that were platform-agnostic therefore outperformed native mobile solutions
(e.g., Android or iOS clients) except in settings with limited internet connectivity.
Drop-down fields produced significantly fewer errors and were faster than free-text
entry. In projects involving low-literacy users or international collaborators, clarifi-
cation of the syntax for error-prone fields significantly reduced user error and
improved efficiency, e.g., dates (MM/DD/YYYY vs. DD/MM/YYYY), phone numbers
(e.g., with or without preceding area code), and numerical inputs involving decimals
(e.g., lab results). Data encryption and role-based password authentication were
acceptable solutions for data security.
Conclusion: Agile development practices involving rapid, iterative prototyping, and early,
frequent engagement of patients and providers can yield valuable insights in the design and
uptake of scalable m-health solutions.
Disclosure of Interest: None Declared
PW267
Australian Secondary Prevention Alliance: Health advocacy through unity
Julie Redfern*1, Katherine Gall1, Clara Chow1,2, Secondary Prevention Alliance (Australia)
1
Cardiovascular Division, The George Institute; University of Sydney, 2Cardiology Department,
Westmead Hospital, Sydney, Australia
Introduction: Heart disease accounts for greater morbidity in Australia than any other
disease state and 20% of deaths. Without a paradigm shift in the delivery of preventive
services the number of individuals dying of repeat heart attacks is expected to double.
Objectives: To describe the process, formation and structure of an Australian Alliance
aimed at achieving advocacy and better delivery of secondary prevention services across
Australia. Ultimately, the purpose is to describe an Australian plan for improving
achievement of cardiovascular risk targets.
Methods: To determine goals and identify organisations, a National consensus meeting
of 40 participants representing Australian government and non-government agencies,
consumers, health professionals (cardiology, primary care, nursing, allied health) and
other key opinion leaders was convened. Feedback from discussions and surveys
highlighted the need for formation of a National Alliance. Through a process of further
surveys and stakeholder analysis an alliance was formed. An iterative and collaborative
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
process of literature review and consensus (May-Aug 2013) led to establishment of million women have GDM. However there is a huge shortage of trained physicians in

agreed goals and key messages. An Advisory Council for individual input was also
formed and the Australian Federal Government and policy-makers were successfully
engaged. Communication is via teleconference, face-to-face workshops and electronic
means.
Results: The Secondary Prevention Alliance (Australia) was established (May 2013) with
representatives from 19 national organisations. These include government and non-gov-
ernment stakeholders, professional organisations, consumers and the Heart Foundation.
The Advisory Council consists of 149 individuals and experts from Australia, New
Zealand, Europe and Canada with a variety of expertise in clinical roles (43%), education/
research (31%), health management (19%) and government (7%). The Alliance has
already facilitated increased awareness of secondary prevention and has engaged media
and government relations. The alliance also allows consensus on national models of care
and indicators.
Conclusion: The National Secondary Prevention Alliance has united stakeholders with the
common goal of raising the profile of the need for improved health care services in
Australia. The process provides an example of how national unity and common messages
facilitates advocacy.
Disclosure of Interest: J. Redfern Grant/research support from: AZ Educational Grant, K.
Gall Grant/research support from: AZ Educational Grant, C. Chow Grant/research support
from: AZ Educational Grant
PW269
Modifying the Morisky Medication Adherence Scale by Adapting Two Items from the
Brief Medication Questionnaire to Fit Assessing the Overall Adherence to
Polypharmacy Regimen of Cardiac Patients
Ali Y. Nori*1, Muhamad S. A. K. Ali2, Baharudin Ibrahim1, Rahmat Awang3, M. Azmi Hassali1
1
School of Pharmaceutical Sciences, Universiti Sains Malaysia, 2Department of Cardiology,
Hospital Pulau Penang, 3WHO Collaborative Center of Tobacco Control, Universiti Sains
Malaysia, Penang Island, Malaysia
POSTER ABSTRACTS
India.
Objectives: To address this need, a comprehensive high end training initiative in the
form of Certificate Course in Gestational Diabetes Mellitus (CCGDM) is required for
Physicians.
Methods: An innovative and strategic partnership was established between Public
Health Foundation of India (PHFI) and Dr. Mohan’s Diabetes Educational Academy
(DMDEA), to train primary care physician, Obstetricians and Gynecologist on GDM by
updated contents covering majority of salient aspects of GDM prevention, screening
and management.
Results: This uniquely designed program is aimed to train 1460 Primary Care Physicians,
Obstetricians and Gynecologists of India in 55 Regional Centers, across India covering 16
states, 1 Union Territory and 39 cities with the backbone of 15 National Experts, 110
Regional Faculty and 25 Observers.
The regional training centers serve as practice oriented skill enhancement centers
and professional networking hubs. Sessions on GDM is conducted only on Sunday
once a month for 4 consecutive months by regional faculty through use of stan-
dardized teaching material following standard operating procedures PAN India. Each
center consist of dual expert i.e. Diabetologist/Endocrinologist and Gyn/Obst, each
who act as Regional Faculty. National faculty empanelled across the country
appraised the regional faculty on course curriculum and other modalities of the
course. Educational material developed for program is latest, context specific, con-
tent and resource sensitive. Quality assurance of the educational program is ensured
by necessary documentation, peer-reviews and by establishing alignment between
module objectives, lectures material, case discussions, assignments & assessments.
The educational grant for the program has been provided by Johnson & Johnson
Medical India.

Introduction: Heart disease maintains being the leading cause of premature death in
Malaysia. Careful follow up for cardiac patients is crucial to consistently optimize treatment
and monitor the therapeutic plan. Although the term adherence is found in the Malaysian
medical records, there is no standard method used in measuring compliance with the
prescribed medications. However the Morisky Medication Adherence Scale (MMAS) is
widely used in governmental hospitals, it is not accurately implemented when dealing with

web 3C=FPO
polypharmacy regimens.
Objectives: This study aimed to evaluate the applicability and reliability of a modified
version of MMAS after replacing two items of “medication discontinuation” and “medica-
tion missing” with a similar items adapted from the Brief Medication Questionnaire to
establish a general measure of adherence to the multiple medications of cardiovascular
disease (CVD).
Methods: A pilot phase included 22 cardiac patients was run to demonstrate face validity
for the modified MMAS as well as to improve the translation to the Malaysian language.
Thereafter, 174 patients were surveyed where the original MMAS was administered before
the modified extra two items along with other questions about demographics and barriers
to adherence. The patients were categorized according to their diagnosis into: coronary
heart disease, arrhythmias, heart failure, congenital heart disease, and valvular heart disease
groups.
Results: The mean age of the sample was 55 years (
10.25), 80.6% were males, 46.9%
were ethnically Chinese, monthly median income was z 330$ (1050 RM) and 81.1%
were not current smokers. The mean number of daily CVD medications per patient was
5. Only 65.7% of the respondents had correctly taken the medications according to the
prescribed instructions, whereas 73.7% had failed to name all their medications. 25.1%
had a history of medication discontinue without doctor’s order. The internal consistency
(Cronbach’s alpha reliability) of the original and modified MMAS were 0.583 and 0.588 a
respectively. Significant Item-total correlation (P <0.01) and between both versions
(0.898; P <0.01) manifests concurrent validity for the newly modified MMAS in addition

web 3C=FPO
to the retaining of the dimensional structure of a single-factor scale confirmed by factor
analysis.
Conclusion: Although the psychometric properties of both scales are similar, it is advised
to use the modified MMAS to assess adherence to multiple drug therapy (polypharmacy)
and get a clear picture about medication discontinuation behaviour.
Disclosure of Interest: None Declared

PW271
Implementation of educational training program in Gestational Diabetes Mellitus
Management for obstetricians / gynecologist and primary care physicians in India
Sourabh K. Sinha*1, Sandeep Bhalla1, V. Mohan2, Ranjit Unnikrishnan3, Pratibha Karnad4,
K. S. Reddy5, D. Prabhakaran6
1
Training, Public Health Foundation of India, New Delhi, 2Chairman, 3Vice Chairman, Dr
Mohans Diabetes Education Academy, Chennai, 4Education, Johnson & Johnson Medical India,
Mumbai, 5Administration, Public health foundation of India, 6Executive Director, Centre for
Chronic Disease Control, New Delhi, India
Introduction: Given the global scenario around 366 million people suffering from dia-
betes in 2011, which is expected to rise to a total of 552 million by 2030. India alone has
62.4 million people with diabetes and 77.2 million people with pre-diabetes as of year
2011. GDM affects up to 15% of pregnant women worldwide and in India estimated 4
Conclusion: GDM program is an effort to build capacity among primary care physicians,
gynecologist & obstetricians in Gestational Diabetes Mellitus Management. This unique
and sustainable initiative hopefully serve as a trend setter in the field of diabetes education
and help improve maternal and child health indices in India.
Disclosure of Interest: None Declared
PW272
Role of nursing staffs as primary care givers in Management of Non Communicable
Diseases with focus in Diabetes Mellitus in Rural India
Utplakshi Kaushik*1, Sourabh K. Sinha2
1
Sneh, Family Health International, 2Training, Public Health Foundation of India, New Delhi,
India

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e313

 Introduction: Given the lack of trained medical practitioners & allied healthcare profes-
POSTER ABSTRACTS

sional in rural settings of India; nurses as a primary care giver play a larger role in managing
diabetes mellitus in rural India. With increasing burden of Non Communicable Diseases
especially Diabetes, India alone has 62.4 million with diabetes and 77.2 million with pre
diabetes as of year 2011.
Objectives: Aim of the study is to explore the role of nurse as a primary care giver for
management of diabetes mellitus in rural India and a replacement for trained medical
practioners for managing complexities related to diabetes. To help primary care physi-
cians in educating the patients regarding the regime including diet, exercise, weight
management etc.
Methods: This study has used both primary and secondary methods of data collection.
A survey was conducted at six rural settings having primary care centres. Both qual-
itative and quantitative tools were used to capture data related to management of
diabetes and treatment of complexities raised due to diabetes by nurses in rural
settings.
Results: Nurses plays an important role in the prevention and management of diabetes
mellitus in rural settings by spreading awareness regarding this disease. This is done
through regular home visits and buildings rapport with the people living in rural
areas.
Nurse is the primary care given who provides better care in lack of physicians for
management of diabetes mellitus. She can handle small emergencies and proved better in
managing complexities.
Conclusion: 67% of the diabetic patients feel that nurses play a vital role in management of
diabetes mellitus in rural settings in India from prevention till management. They have
more confidence and faith on nurses than doctors. They feel free to share their problems
with them and their trust on them has built because of their caring attitude. Nurses are not
just responsible for adjusting insulin, but also responsible for the full gamut of cardio-
vascular disease risk reduction, including blood pressure, lipids, weight managementand
exercise.
Disclosure of Interest: None Declared

PW273
Implementation of a Clinic-based Tobacco Cessation Program in India
Srinivas Ramaka*1, Induja Nagireddy2, Sravanthi Patha2, Venkateshwarlu Koneru2,
Ravikumar Chodavarapu3
1
Cardiology, Srinivasa Heart Centre, 2Pharmacy, St.Peter’s Institute of Pharmaceutical Sciences,
Warangal, 3Paediatrics, Dr.Pinnamaneni Siddhartha Institute of Medical Sciences and Research
Foundation, Vijayawada, India

Introduction: The WHO ’s MPOWER policy emphasises the role of health professionals in
effective tobacco prevention.
Counselling initiated by a clinician and followup intensive counselling along with NRT
are effective in tobacco cessation.
There is a lack of consistent and effective clinic-based tobacco cessation programs in
India.
Objectives: To initiate a clinic –based tobacco cessation program and observe the limi-
tations of existing tobacco interventions with respect to Indian population.
Methods: This is a cross-sectional study of tobacco users attending Srinivasa Heart Centre,
Warangal, Andhra Pradesh, India.
Data of all tobacco users attending the clinic was collected and entered in MS Excel
database.
Brief counselling(<10 minutes) was given by the Consultant Cardiologist and
subsequent counselling(more than ten minutes and intensive counselling) was
given by the support staffdthe pharmacy professionals in-person and telephon-
ically over 1 month-counselling 1, 2 monthsdcounselling 2 and after 3 months-
counselling 3.
Though Nicotine Replacement Therapy was offered to all those unable to quit,only 70
subjects used NRT.
Variables measured are as in table 1 and 2 including mainly the results of Counselling
and use of NRT.
Statistical analysis is done using EpiInfo, 3.5.3 of C.D.C, U.S.A & Medcalc 12.6.1.0.
Appropriate statistical tests for the data are done.
Results:
Table 1:
Among the tobacco users of age group19d86 years,males are predominant.
Significant proportion are illiterate.
Table 2:
* Smoking is the dominant type of use of tobacco. Cigarette smoking is the commonest
form of tobacco use and predominantly it is light smoking.
* Though significant number do not have I.H.D (62.09%, 95% CL 58.16 to
68.56) the proportion with I.H.D, (37.91%, 95% CL 34.14 to 41.84) is clinically
significant.
* Repeated counselling sessions (counselling 1 to 3) by telephone resulted in increasing
proportion of stopping of tobacco use.
* Nicotine replacement therapy though suggested to all tobacco users is not imple-
mented by most.
* So in a population not able to implement NRT, intensive counselling-both in person
during follow-up and telephonically is a cost-effective and simple method in tobacco
cessation.
Conclusion: Clinician supervised counselling along with participation of the support staff
particularly pharmacy professionals is cost-effective in tobacco cessation.Implementation of
clinic based tobacco cessation programs in diverse clinic settings consistently is required for
effective tobacco prevention in India.
Disclosure of Interest: None Declared
PW276
Fasting Blood Glucose Over-Diagnoses Diabetes After Acute Myocardial Infarction
Jenny Tian*1, Josh P. Tsai2, Shi Yi Goo1, Lisa Gillinder1, Danielle Harrop2, William Y. Wang2,
Arnold Ng2
1
Princess Alexandra Hospital, Brisbane, Australia, 2Cardiology, Princess Alexandra Hospital,
Brisbane, Australia
Introduction: Fasting blood glucose 7.0mmol/L is diagnostic of diabetes. However,
patients can develop stress hyperglycemia during critical illness. Recently, World Health
Organization recommended HbA1c 6.5% as alternative diagnostic criterion for diabetes.
This study compares new diagnosis of diabetes in patients with acute myocardial infarction
by HbA1c and fasting BSL.
Objectives: Compare new diagnosis of diabetes by HbA1c and fasting BSL in patients
presenting with acute myocardial infarction (AMI).
Methods: Consecutive 359 (60.4
11.8 years, 76.6% male) patients with ST-elevation
(STEMI, 61.3%) and non-STEMI (38.7%) were prospectively recruited. HbA1c and fasting
BSL were performed on admission.
Results: A total of 94 (26.2%) patients had previously diagnosed diabetes on admission.
Mean HbA1c and fasting BSL were 6.5
1.7% and 7.6
3.0mmol/L respectively. Admission
HbA1c6.5% and fasting BSL 7.0mmol/L were present in an additional 29 (8.1%) and
76 (21.2%) patients without previous history of diabetes respectively. In the 29 newly
diagnosed patients with elevated HbA1c, 65.5% had fasting BSL7.0mmol/L. In contrast,
in the 76 newly diagnosed patients with elevated fasting BSL, only 25.0% had
HbA1c6.5%. Only 19 out of 86 (22.1%) newly diagnosed patients had both elevated
HbA1c and fasting BSL on admission. The concordance between new diagnosis of diabetes
by HbA1c and fasting BSL was poor (kappa 0.277).
Conclusion: Significant proportion of patients with elevated fasting BSL on admission after
AMI had normal HbA1c suggestive of stress hyperglycemia.
Disclosure of Interest: None Declared

e314 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

PW277
Changes in the loading conditions induced by vagal stimulation modify the
myocardial infarct size through sympathetic-parasympathetic interactions
Bruno Buchholz1, Martin Donato1, Ana C. Rey Deutch1, Maria A. Goyeneche1, Christian Höcht2,
Julieta Del Mauro2, Carla Greco3, Federico Gullace3, Manuel Rodriguez1, Ricardo J. Gelpi*1
1
Pathology, Institute of Cardiovascular Pathophysiology, Faculty of Medicine, University of
Buenos Aires, 2Pharmacology, Faculty of Pharmacy and Biochemistry, University of Buenos Aires,
3
Animal facility, Faculty of Veterinary, University of Buenos Aires, Buenos Aires, Argentina
Introduction: The autonomic imbalance is deleterious for the myocardium. In this sense,
one of the strategies used to modify this imbalance is electrical vagal stimulation. However,
the mechanisms by which vagal stimulation produces its protective effects are not yet
entirely known. In a previous research we described that vagal stimulation, perfomed under
certain conditions, increases the infarct size by causing the co-activation of the sympathetic
nervous system (SNS).
Objectives: A first aim was to determine if hemodynamic modifications that accom-
pany vagal stimulation are responsible for the co-activation of the SNS, and as a
consequence, of the increase in the infarct size. A second goal was to study if vagal
stimulation, applied intermittently, avoids this co-activation and produces protective
effects on the infarct size.
Methods: We used rabbits subjected to the following protocols: a) myocardial ischemia
of 30 minutes and 3 hours of reperfusion (I/R; n¼10); b) continuous pre-ischemic
electrical stimulation of the right vagus nerve during 10 minutes (VNS; n¼7); c) the
protocol of the group VNS was repeated but with the right vagus nerve sectioned at a
cervical level (VNS/RS; n¼11); d) right vagal efferent stimulation prior bilateral va-
gotomy (VNS/BS; n¼7); e) the protocol of the group VNS/RS was repeated but at
constant heart rate (VNS/RS+PAC; n¼6); f) intermittent right vagal stimulation was
applied (10” ON/50” OFF) prior 30 min of ischemia (VNS Int; n¼13). In all protocols
plasmatic catecholamines were measured.
Results: Vagal stimulation increases infarct size in groups VNS (70.7
4.3%) and VNS/
RS (68.6
4.1%) compared with group I/R (52.0
3.7%) (p<0.05). Bilateral vagotomy
(VNS/BS) and paced (VNS/RS+PAC) abolished the deleterious effect, reaching an
infarct size of 43.3
5.1% and 43.5
2.1%, respectively. Intermittent stimulation
reduced infarct size to 29.8
3.0% (p<0.05). Vagal stimulation induced bradycardia
and increases the loading conditions and wall stretching as well as plasmatic
catecholamines.
Conclusion: The effects of vagal stimulation on the infarct size strongly depend on the
sympathetic-parasympathetic interaction. Continuous vagal stimulation co-activates the
SNS and increases the infarct size by changes in the cardiac chamber volumes. On the
contrary, vagal stimulation performed intermittently antagonizes the sympathetic system
and reduces the infarct size.
Disclosure of Interest: None Declared
PW278
High density lipoproteins rescue hyperglycaemia-impaired angiogenesis via the
scavenger receptor-B1 and suppression of thioredoxin-interacting protein
Hamish Prosser1,2, Louise Dunn3, Laura Vanags1, Phillipa Simpson4, Laura Lecce2,4,
Steven Monger1, Joanne Tan1,2, Christina Bursill*1,2, Martin Ng4,5
1
Immunobiology Research Group, Heart Research Institute, 2School of Medicine, University of
Sydney, 3Victor Chang Cardiac Research Institute, 4Translational Research Group, Heart
Research Institute, 5Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
Introduction: Diabetics have lower plasma high-density lipoproteins (HDL) and impaired
ischaemia-driven angiogenesis. Thioredoxin-interacting protein (TXNIP), an anti-angio-
genic protein, is also elevated in diabetic sufferers.
Objectives: We have identified that reconstituted HDL (rHDL) inhibits TXNIP in hyper-
glycaemia, and hypothesise that HDL rescues diabetes-impaired angiogenesis in vivo.
Methods: In vitro, the actions of reconstituted HDL (rHDL, apoA-I complexed with
phosphatidylcholine) on key angiogenic functions (proliferation by Click-IT assay,
migration in Boyden chambers and tubule formation on matrigel); and protein expression
(Western blot) were determined using human coronary endothelial cells (HCAEC) in
normoglycaemic (5mM) and hyperglycaemic conditions (25mM glucose). Lentiviral-
shRNA knockdown was also used to determine the role of the scavenger receptor-BI (SR-
BI). In vivo, Streptozotocin-induced diabetic C57B6J wild type or SR-BI-/- mice were used
in two models of angiogenesis: 1) hind limb ischemia (rHDL delivered intravenously) or 2)
wounding healing (rHDL applied topically). Angiogenesis was determined using laser
Doppler imaging and immunocytochemistry.
Results: In HCAECs, hyperglycaemia significantly elevated TXNIP expression (190%),
suppressed VEGF expression (28%), and reduced cell migration (62%), tubulogenesis
(38%) and proliferation (22%). Pre-incubation with rHDL strikingly inhibited glucose-
induced TXNIP expression (90%), rescued hyperglycaemic-impairment of VEGF
(157%), and restored HCAEC proliferation, migration and tubulogenesis (209%, 67%
and 86% vs. hyperglycaemic controls, respectively, P<0.01). In shRNA SR-BI trans-
duced cells, rHDL failed to rescue hyperglycaemia-impaired tubule formation and
VEGF. In vivo, rHDL rescued diabetes-impaired capillary formation (144% & 20%)
and blood perfusion (25% & 91%) in response to hind-limb ischemia and wounding,
respectively; resulting in increased hind-limb revascularisation and accelerated
wound-healing. Furthermore, TXNIP expression was suppressed in the hindlimbs of
diabetic mice receiving rHDL (36%). In SR-BI-/- mice, rHDL was unable to rescue
diabetes-impaired angiogenesis, indicating that it plays a key role in mediating these
effects.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: rHDL rescues diabetes-impaired angiogenesis. These actions appear to be
POSTER ABSTRACTS
mediated via SR-BI, suppression of TXNIP and restoration of VEGF. Our studies have
implications for the therapeutic modulation of ischaemic injury in diabetic patients in
which the angiogenic response is impaired.
Disclosure of Interest: None Declared
PW280
Early retinal microvascular endothelial dysfunction correlates with chronic kidney
disease independent of traditional cardiovascular risk factors
Ali H. Al-Fiadh*1, Frank Ierino2, David J. Clark1, Omar Farouque1
1
Cardiology, 2Renal, Austin Health / University of Melbourne, Heidelberg, Australia
Introduction: Endothelial dysfunction is common in patients with advanced kidney
disease.
Objectives: We sought to determine the association between kidney function and novel
measures of endothelial function including retinal microvascular assessment.
Methods: Patients with at least two atherosclerosis risk factors (n¼192) were recruited.
Flicker light induced retinal arteriolar dilatation (FI-RAD), a measure of microvascular
endothelial function, was assessed using the Dynamic Vessel Analyzer (DVA) and expressed
as % increase over baseline diameter. Brachial artery flow mediated dilatation (FMD) during
reactive hyperaemia was assessed utilising vascular ultrasound and expressed as % increase
over baseline diameter. Serum endothelin was measured by radioimmunoassay. Estimated
glomerular filtration rate (eGFR) was measured using the MDRD formula. Logistic and
linear regression was used to determine the relationship between eGFR and endothelial
function.
Results: Compared to patients with normal eGFR (90ml/min, n¼84), patients with
reduced eGFR (<90ml/min, n¼108) were older (62
9 vs 53
12 yrs; p<0.01), more
likely to have hypertension (87% vs 65%; p<0.01) and dyslipidaemia (88% vs 74%;
p¼0.02). FI-RAD and FMD were lower with reduced eGFR (1.78
1.65% vs 2.4
2.02%;
p¼0.02 and 3.3
1.4% vs 4.5
2.4%; p<0.01) respectively, while endothelin was higher
(2.66
0.78 vs 2.38
0.57 pmol/L; p¼0.01). Retinal vascular structural changes including
diabetic retinopathy, AV nicking, focal arteriolar narrowing and retinal vessel calibre were
not different between groups. Decreased FI-RAD and FMD, and increased endothelin were
associated with increased odds of eGFR < 90ml/min after adjustment for risk factors and
medication use (Table). For each 10 ml/min eGFR reduction, FI-RAD and FMD decreased
by absolute values of 0.13% (95%CI-0.23, -0.03; p¼0.01), and 0.24% (95% CI-0.35,
-0.13; p<0.01) respectively, and endothelin increased by 0.11pmol/L (95%CI 0.07, 0.15;
p<0.01) after adjustment for clinical variables.
OR 95%CI P
FI-RAD (1% decrease) 1.27 1.05, 1.54 0.01
FMD (1% decrease) 1.38 1.13, 1.68 <0.01
Endothelin (1pmol/L increase) 1.94 1.12, 3.38 0.02
Conclusion: Novel measures of endothelial function are independently associated with
kidney function. Impairment in retinal microvascular function begins before retinal
vascular structural changes are evident. Retinal microvascular assessment and biomarkers
of endothelial function may be future tools for early detection of vascular disease and guide
early intervention in chronic kidney disease.
Disclosure of Interest: None Declared
PW281
Human Pluripotent Stem Cell Derived Cardiomyocytes Regenerate Infarcted Hearts
Of Non-Human Primates
James Chong*1,2,3, Xiulan Yang4, Creighton Don5, Elina Minami4, Benjamin Van Biber4,
Charles Murry6,7
1
Cardiology, Westmead Hospital, 2School of Medicine, University of Sydney, 3Westmead
Millennium Institute, Sydney, Australia, 4University of Washington, Seattle, United States,
5
Cardiology, 6Pathology, 7Bioengineering, University of Washington, Seattle, United States
Introduction: Pluripotent stem cells may provide a potential solution to current epidemic
rates of heart failure by providing cardiomyocytes to support heart regeneration. Studies of
human embryonic stem cell- derived cardiomyocytes (hESC-CMs) in small animal models
have shown favorable effects of this treatment. However, it remains unknown whether
clinical scale hESC-CM transplantation is feasible, safe or can provide large-scale
myocardial regeneration.
Objectives: 1) To demonstrate that hESC-CMs can be produced at a clinical scale (>1
billion cells/batch) and cryopreserved with good viability. 2) To investigate the ability of
hESC-CM to engraft and electromechanically couple after transplantation into a clinically
relevant large animal model of ischemic cardiac dysfunction.
Methods: hESC genetically modified to express the GCaMP3 fluorescent calcium indicator
were constructed and differentiated to the cardiomyocyte lineage. A non-human primate
(NHP) model of myocardial ischemia-reperfusion (I-R) was used with immunosuppression
commenced 5 days prior to cell transplantation. 1 billion hESC-CMs were injected into the
infarct region and surrounding border zones of 5 macaques. 2 macaques were subjected to
myocardial I-R only as controls. Telemetric electrocardiographic transmitters were
implanted subcutaneously and 24 hour periods regularly assessed for evidence of
arrhythmia. Euthanasia at 14, 28 or 84 days after hESC-CM transplantation was followed
e315
 by ex-vivo fluorescent imaging of hESC-CM grafts using an ex-vivo modified langendorff
POSTER ABSTRACTS
model.
Results: Large-scale remuscularization of the infarct was observed in all hESC-CM treated
macaques. In contrast to small animal models, the hESC-CM grafts caused ventricular
arrhythmias in primate hearts that resolved after a few weeks. The grafts showed pro-
gressive but incomplete, maturation over a three-month period. Grafts were perfused by
host vasculature, and electromechanical junctions between graft and host myocytes were
present within 2 weeks of engraftment. Importantly, grafts showed regular calcium tran-
sients that were synchronized to the host electrocardiogram, indicating electromechanical
coupling.
Conclusion: hESC-CMs can remuscularize substantial amounts of the infarcted monkey
heart. These studies support the further use of human cardiomyocytes for heart regen-
eration and identify ventricular arrhythmias as a hurdle to overcome en route to clinical
trials.
Disclosure of Interest: None Declared
PW283
Identification and characterisation of a novel hypertrophic cardiomyopathy gene
Dean Phelan*1, Gabrielle Wilson1, Joe Sim1, Melanie Bahlo2, Peter Hickey2, Paul James3,
Desiree du Sart3, Martin Delatyki1, David Amor3, Paul Lockhart1
1
Bruce Lefroy Centre, Murdoch Childrens Research Institute, 2Walter and Eliza Hall Institute of
Medical Research, 3Victorian Clinical Genetic Service, Melbourne, Australia
Introduction: Hypertrophic cardiomyopathy (HCM) is a disease characterised by hyper-
trophy of the left ventricle of the heart. HCM has a prevalence of w1 in 500 individuals
and is the leading cause of sudden cardiac death among young individuals. Over 20 HCM
genes have been identified but at least 20% of cases remain of unknown aetiology.
Objectives: To identify and characterise novel HCM genes.
Methods: An extended family presented to the Victorian Clinical Genetics Service
with a syndromic form of HCM in which the affected first cousins also suffered
from multiple pterygia (webbing of joints). Both affected individuals were the
offspring of a consanguineous relationship therefore an autosomal recessive pattern
of inheritance was expected. Copy number analysis and linkage studies were per-
formed using data from high density SNP-array analysis. A single linkage region was
identified with a LOD score >1.2. This region of 15q has not previously been
associated with cardiomyopathy and achieved a LOD score of 2.9. The linkage
encompassed 11.4Mb and contained 169 known genes. No CNVs of interest were
identified.
Results: Whole Exome Sequencing identified 100 homozygous variants within the
linkage interval of which 99 were excluded by bioinformatic filtering based on minor
allele frequency and predicted functional consequence. The causative mutation was a
homozygous truncating variant in a poorly characterised protein that may function in
cardiomyocyte differentiation. To determine the potential contribution of the gene to
HCM, we sequenced the gene in a cohort of HCM patients (n¼55) previously
excluded for mutations in common HCM causing genes. We did not identify any
predicted pathogenic variants suggesting mutations in the gene are not a common
cause of HCM.
To investigate the function of the gene we have characterised the expression in human
and mouse tissues. The tissues showing the highest expression levels were the heart and
skeletal muscle, consistent with patient phenotype. In addition, we have characterised
complex patterns of tissue specific alternative splicing. Immunocytochemical studies of
human and mouse heart and skeletal muscle tissue demonstrated predominant localisation
to the extracellular matrix.
Conclusion: In conclusion we have identified a novel gene for HCM. Further characteri-
sation of this protein and it’s cellular function will lead to increased understanding of the
molecular basis of cardiomyopathy and result in improved clinical outcomes for affected
individuals and families.
Disclosure of Interest: None Declared
PW284
Improved Accuracy Of Anticoagulant Dose Prediction Using A Pharmacogenetic And
Artificial Neural Network Based Method
Hussain Isma’eel1, George Sakr2, Robert Habib1, Mohamad Almedawar*1, Nathalie Zgheib3,
Imad Elhajj2, Vascular Medicine Program
1
Cardiology, 2Electrical & Computer Engineering, 3Pharmacology and Toxicology, American
University of Beirut, Beirut, Lebanon
Introduction: The unpredictability of acenocoumarol dose needed to achieve target blood
thinning level remains a challenge. Dosing algorithms based on pharmacogenetics and the
Least-Squares Modeling (LSM) method shows inaccuracy.
Objectives: We aimed to apply and compare pharmacogenetic LSM and Artificial neural
network (ANN) pharmacogenetic based models for predictions of weekly acenocoumarol
dosing.
Methods: LSM and ANN models were used to analyze previously collected data on 174
Lebanese participants (mean age: 67.45 SD 13.49 years) on long-term acenocoumarol
maintenance therapy. The Models were based on demographics, lifestyle habits,
concomitant diseases, medication intake, target INR, and genotyping results for
CYP2C9 and VKORC1. LSM versus ANN performance comparisons were done by two
methods; by randomly splitting the data as 50% derivation and 50% validation cohort
followed by a 200 iterations bootstrap, and by a 10-fold leave one out cross validation
technique.
e316
Results: ANN based pharmacogenetic model provided higher accuracy for predicting
weekly acenocoumarol dosage and larger R value than all other LSM based models. The
accuracy percentage improvement ranged between 5% and 24% for the derivation cohort
and between 12% and 25% for the validation cohort. The increase in R value ranged be-
tween 6% and 31% for the derivation cohort and between 2% and 31% for the validation
cohort.
Conclusion: ANN based pharmacogenetic guidance of acenocoumarol dosing reduces
the error in dosing to achieve target INR. These results need to be ascertained in a
prospective study, and send a signal to ongoing researchers to explore use of ANN in
their studies.
Disclosure of Interest: None Declared
PW287
Identification of key microRNAs involved in regulation of ovine fetal heart
development
Ramona Krauss*1, Belinda Phipson2, Nikita Gupta1, Joseph Smolich1, Alicia Oshlack2,
Michael Cheung3, Salvatore Pepe1
1
Heart Research, 2Bioinformatics, Murdoch Childrens Research Institute, 3Cardiology, Royal
Children’s Hospital, Melbourne, Australia
Introduction: MicroRNAs (miRNAs) are small non-coding RNAs which regulate gene
expression at a post-transcriptional level. Previous small animal studies indicate that
distinct spatial and temporal miRNA expression profiles are critical for early organo-
genesis and normal fetal heart development, but little is known about these profiles in
large animals such as sheep. In particular, it is unknown if miRNA profiles change with
the rapid heart growth occurring between the late-fetal and early newborn periods, or
whether differences in the pattern of miRNA expression exist between the left (LV) and
right ventricle (RV).
Objectives: To identify and sequence the expression of miRNAs in the RV and LV from
ovine preterm fetus (128-129 days gestation; term¼147 days), nearterm fetal lambs
(139-141 days gestation) and neonatal lambs (age <7 days old), and then determine
whether miRNA expression changed with developmental age, or differed between the
LV and RV.
Methods: After extraction from LV and RV samples (each n¼3/tissue), miRNAs were
measured by Illumina HiSeq next-generation deep sequencing. Known sheep miRNAs and
miRNAs homologous with other species were quantified in each sample by mapping
adaptor-trimmed sequences to the sheep genome. After data normalization, age and tissue-
specific miRNA differences were identified by empirical Bayes t-statistics and results were
validated by quantitative Real Time-PCR assays.
Results: Although over 1000 miRNAs were identified per sample, the number of miRNAs
with significant (false discovery rate <5%) age-related changes in their expression were
relatively low.
Thus, in the LV, <1% of all detected miRNAs increased expression with developmental
age (miRNA-146a and -b, miRNA-223, miRNA-22-3p, miRNA-23b, miRNA-30d), while
only miRNA-208a expression increased in the RV. Furthermore, only miRNA-148a in the
LV, and no miRNA in the RV was decreased in expression between the late-fetal and
neonatal periods.
Conclusion: This study has identified a small set of potentially key miRNAs that alter their
expression within ventricular myocardium during perinatal development in a chamber-
specific manner. While some of these miRNAs are known to regulate cell proliferation,
differentiation and the switch from fetal to adult myoglobin in other cell types, further
studies are required to establish the specific functional role of identified miRNAs in the
developing heart.
Disclosure of Interest: None Declared
PW288
One Arm Of The Endoplasmic Reticulum Stress, Perk Signaling, Plays A Major Role
In Myocyte Apoptosis In Diabetic Cardiomyopathy
Jiaohong Xue1, Zhongwei Liu*2, Haitao Zhu3, Xiaolin Niu1
1
Department of Cardiology, 2nd Affiliated Hospital of Xi’an Jiaotong University, 2Department of
Cardiology, 2nd Affliated Hospital of Xi’an Jiaotong University, 3School of Medicine, Xi’an
Jiaotong University, Xi’an, China
Introduction: Endoplasmic reticulum (ER) stress is considered one of the mechanisms
contributing to reactive oxygen spices (ROS)- medicated cell apoptosis. In diabetic car-
diomyopathy (DCM), cell apoptosis is generally accepted as the etiological factor and
closely related to cardiac ROS generation. ER stress is proposed the link between ROS and
cell apoptosis; however, the signaling pathways and their roles in participating ER stress-
induced apoptosis in DCM is still unclear.
Objectives: This study is aimed to explore the roles of three ER stress arms, induced by
three sensors, referred as PERK (RNA- dependent protein kinase (PRK)- like ER kinase),
IRE1 (intositol- requiring enzyme-1) and ATF6 (activating transcription factor) in myocytes
apoptosis during diabetic cardiomyopahty.
Methods: Diabetic rat model was utilized in this study. Cardiac pump function, conduc-
tion function and myocytes apoptosis were assessed. Activation of PERK, IRE1 and ATF6
signaling were examined in cardiac tissue. siRNA interference was used to knock down
PERK, IRE1 and ATF6 in myocytes cultured by high- glucose incubation. Then apoptosis
was detected to illustrate the protective effect of knocking down against cell death. Then
subcellular fractionation was used to detect the expression of PERK, IRE1 and ATF6 on
mitochondria- associated ER medmranes (MAMs).
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Results: In this study, we demonstrated that ER stress sensors, PERK (IRE1 (intositol-
requiring enzyme-1) and ATF6, were activated in ROS- mediated ER stress- induced
cell apoptosis in rat model of DCM. We further showed that the deletion of PERK in
cardiac cells exhibited stronger protective effect against apoptosis induced by high-
glucose incubation than deletion of ATF6 or IRE1 in the same cell line. By subcellular
fractionation, rather than ATF6 and IRE1, in myocytes, PERK was found a component
of MAMs which was the functional and physical contact site between ER and
mitochondria.
Conclusion: Thus, double sourced ROS stimulation makes PERK signaling pathway
(PERK- eIF2a- ATF4- CHOP) take the major responsibility in ROS- mediated ER stress-
induced cell apoptosis in DCM.
Disclosure of Interest: None Declared
PW289
Anthocyanins Extracted From Lycium Ruthenicum Murray Alleciate Cardiac
Cardiomyopathy In Experimental Diabetic Rats
Jiahong Xue1, Zhongwei Liu*2, Haitao Zhu3, Xiaolin Niu1, Ning Jing3
1
Department of Cardiology, 2nd Affiliated Hospital of Xi’an Jiaotong University, 2Department of
Cardiology, 2nd Affliated Hospital of Xi’an Jiaotong University, 3School of Medicine, Xi’an
Jiaotong University, Xi’an, China
Introduction: Several epidemiological studies indicate that increased consumption of an-
thocyanins decrease incidence of cardiovascular morbidity and mortality. Diabetic car-
diomyopathy (DCM) is the presence of myocardial dysfunction and structural alterations in
the absence of coronary artery disease and hypertension. DCM is considered as a major
mortality risk for diabetes patients.
Objectives: This study was sought to investigate whether the anthocyanins extracted
from lycium ruthenicum murray had protective effect on DCM and the mechanisms
involved.
Methods: Diabetic rat model was induced by intraperitoneal injection of streptozotocin
(STZ) at 60mg/Kg in male Sprague-Dawley (SD) rats. Anthocyanin was orally administrated
at a dose of 50 or 150 mg$kg-1$d-1, respectively. Cardiac function was documented by
serial echocardiography. Myocyte apotosis, extent of fibrosis and myocardial ultrastructure
were assessed by histopathologic analysis. Myocardial enzymes, oxidative stress status were
detected by biochemical assays, and interconnected proteins were examined by western
blot.
Results: Rats with DCM showed lower body weight and higher heart-to-body weight
(HW/BW) ratio, decreased left ventricular systolic and diastolic dysfunction accom-
panied with cardiomyocyte hypertrophy and interstitial fibrosis; elevated markers of
oxidative stress including malonaldehyde, reactive oxygen species, and NADP+/NADPH
ratio; enhanced cardiomyocyte apoptosis as evidenced by TUNEL and increased
expression of Bax and caspase-3; and increased PKC alpha/beta II phosphorylation and
diminished Akt phosphorylation. Remarkably, anthocyanins attenuated cardiac
dysfunction, myocardial fibrosis, oxidative stress status, and cell apoptosis in the heart
tissues of diabetic rats. The inactivation of PKC and activation of Akt was also induced
by anthocyanins treatment.
Conclusion: These data suggest that anthocyanins extracted from lycium ruthenicum
murray may have a usefull therapeutic potential in the treatment of DCM by attenuating
myocardial fibrosis, oxidative stress, and cell death. Moreover, PKC and Akt signaling
pathway may be involved in mediating these effects, providing a molecular mechanism for
the cardioprotective effect of anthocyanins.
Disclosure of Interest: None Declared
PW290
Impact of in vitro culture and embryo transfer on cardiomyocyte endowment in
postnatal life
Monalisa Padhee1, Caroline McMillen1, Song Zhang1, Kimberley Botting1,
Severence M. MacLaughlin1, David O. Kleemann2, Simon K. Walker2, Jens R. Nyengaard3,
Janna L. Morrison*1
1
Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of
South Australia, 2Turretfield Research Centre, South Australian Research and Development
Institute, Adelaide, Australia, 3Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
Introduction: Studies have found an association between assisted reproductive technolo-
gies and cardiovascular dysfunction in postnatal life.
Objectives: This study aims to investigate whether in vitroculture and transfer of the
embryo, which are important steps in assisted reproductive technologies, alter car-
diomyocyte endowment in postnatal life because a lower cardiomyocyte endowment may
increase the risk of left ventricular hypertrophy.
Methods: Embryos were either transferred to an intermediate ewe (ET) or cultured in vitro
in the absence (IVC) or presence of human serum (IVCHS) and a methyl donor
(IVCHS+M) for 6d. Naturally mated (NM) ewes acted as controls. At 24wks, hearts were
collected and mRNA expression of receptors and markers of hypertrophy and apoptosis
were measured. The estimation of numerical density in the left ventricle was performed
using design-unbiased stereological techniques.
Results: There was no difference in cardiac gene expression of IGF1R or molecules in this
physiological hypertrophy signaling pathway, including PI3K (P110 a), mTOR and 4EBP1.
However, there was a decrease in cardiac gene expression of S6K in IVC and IVCHS in
females, but not males. There was no change in the gene expression of ANP and MHCb,
markers of pathological hypertrophy. Culture and transfer of the embryo did not alter the
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
cardiac gene expression of molecules involved in apoptosis such as BCL2, BAX and TGFb.
POSTER ABSTRACTS
Numerical density remained unchanged in all of the treatment groups when compared to
NM.
Conclusion: This study demonstrates that embryo transfer and in vitro embryo culture may
not change numerical density of cardiomyocytes and signalling molecules involved in
hypertrophy and apoptosis. However, the decrease in S6K in females suggests that it may
be regulated by another signalling pathway and its’ protein and phosphorylated protein
expression must be measured.
Disclosure of Interest: None Declared
PW291
Influence Of Cardioplegia Techniques On High-Sensitivity Troponin Release And
Adverse Outcomes After Aortic Valve Replacement
Tom Kai Ming Wang*1, David Choi1, Timothy Wilcox1, Harvey White1,2,
Tharumenthiran Ramanathan1
1
Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine,
University of Auckland, Auckland, New Zealand
Introduction: Dual anterograde and retrograde cardioplegia delivery, warm induction and
hotshot delivery had previously been shown to confer myocardial protection, but have not
been studied for over a decade. High-sensitivity troponins (hs-Tn) are now the recom-
mended biomarkers for assessing myocardial necrosis.
Objectives: We compared the degree of hs-TnT release and outcomes of aortic valve
replacement (AVR) by these cardioplegia techniques.
Methods: All patients undergoing isolated AVR during July 2010-December 2012 were
studied, categorised by cardioplegia techniques for analyses.
Results: Amongst 219 patients followed-up for 1.8+/-0.8 days, 14.7% (32), 63.3% (138)
and 22.0% (48) had anterograde, retrograde and dual cardioplegia delivery route
respectively; 88.1% (193) and 11.9% (26) had cool and warm induction, and 77.6%
(171) had hotshot delivered. Dual anterograde and retrograde cardioplegia was inde-
pendently associated with Maori or Pacific ethnicity (P¼0.006), while hotshot delivery
was independently associated with cardiopulmonary bypass time (P¼0.001). None of the
cardioplegia techniques was associated with greater hs-TnT release post-operatively. In
multivariate analyses of outcomes, hotshot delivery was independently associated lower
operative mortality odds ratio 0.070, 95% confidence interval (95%CI) 0.006-0.781,
P¼0.031, greater survival during follow-up hazards ratio 0.214, 95%CI 0.064-0.716,
P¼0.012, and a trend towards lower rate of perioperative myocardial infarction
(P¼0.096). Warm induction was associated with a trend towards higher rates of pro-
longed ventilation>24 hours (P¼0.091).
Conclusion: Hotshot delivery was independently associated with reduced operative,
follow-up mortality and a trend towards lower rates of perioperative myocardial infarction.
None of the cardioplegia techniques were associated with greater hs-TnT release or com-
posite morbidity.
Disclosure of Interest: None Declared
PW292
Tranilast reduces cardiac fibrosis and improves diastolic function in a model of
chronic kidney disease
Andrew Kompa*1, Masataka Watanabe1, Qiang Fu1, Suree Lekawanvijit2, Bing Wang1,
Henry Krum1
1
Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, 2Pathology,
Chiang Mai University, Chiang Mai, Thailand
Introduction: Chronic kidney disease (CKD) is known to have adverse effects on the
heart. Patients with CKD have 10 to 30 times greater risk of cardiac death compared with
general population. Furthermore despite current treatments, CKD patients are still more
likely to develop systolic dysfunction, concentric left ventricular (LV) hypertrophy and
fibrosis.
Objectives: Fibrosis is a key determinant in disease progression heart failure patients,
hence, this study sought to examine the cardiac effects of an anti-fibrotic agent, tranilast, in
a model of CKD, induced by 5/6 nephrectomy.
Methods: Five sixths (5/6) subtotal nephrectomy (STNx) was induced in Sprague
Dawley (SD) rats, and sham-operated animals served as controls. Animals were ran-
domized to receive either tranilast (400mg/kg twice daily, p.o.) or vehicle (1%
carboxymethylcellulose) for 12 weeks. Glomerular filtration Rate (GFR) was analyzed
by a single shot Tc99m-DTPA clearance. Echocardiography was performed to access
cardiac systolic and diastolic function prior to harvesting myocardial tissues for his-
tological analysis. Real time PCR was used to examine gene expression of fibrosis
related pathways and markers.
Results: GFR was reduced in STNx animal (P<0.05), tranilast (Tran) treatment
significantly increased GFR (Control: 11.0
1.1, STNx+Veh: 0.9
0.3, STNx+Tran:
2.7
1.7 ml/min/kg) in CKD animals and improved diastolic function (Deceleration
Time, E’, E’/e) compared to vehicle treated rats (P<0.05). Interstitial LV fibrosis and
collagen I deposition, increased in STNx (P<0.05) was reduced with tranilast treat-
ment compared to vehicle treated rats (Control: 1.5
0.2, STNx+Veh: 5.7
0.7,
STNx+Tran: 3.1
0.4; P<0.05). Tranilast also reduced collagen I, transforming growth
factor b1 (TGFb1) and connective tissue growth factor (cTGF) gene expression, as well
as tissue inhibitor of metalloprotease-1 (TIMP-1) and TIMP-2 gene expression
compared to vehicle treated animals (P<0.05; Graph) with no effect on (matrix met-
alloprotease-2) MMP-2 and MMP-9.
e317
 Conclusion: These results support further assessment of the impact of upregulated protein
POSTER ABSTRACTS

O-GlcNAcylation on LV function, particularly in the diabetic heart.

Disclosure of Interest: None Declared

PW295
Is the heart of the IUGR fetus hypoxic in early gestation?
Michelle Tie1, Kimberley J. Botting1, Zhang Song1, Caroline I. McMillen1,
Severence M. MacLaughlin1, Sheridan Gentili1, Janna L. Morrison*1
1
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Introduction: Intrauterine growth restriction (IUGR) and chronic hypoxemia cause a
decrease in cardiomyocyte endowment in late gestation but there is no change in the
expression of hypoxia inducible factors (HIF1a, 1b and 2a) or genes with hypoxia response
elements (HRE).
Objectives: We hypothesised that the decreased cardiomyocyte endowment is due to
either a decrease in proliferation or an increase in cardiomyocyte death early in gestation.
Methods: A sheep model of IUGR was induced by removing endometrial caruncles
(placental implantation sites). At 55d gestation, ewes were humanely killed and fetuses
were weighed. The heart was dissected, weighed and samples were frozen and fixed. Gene
expression was determined relative to the geometric mean of 3 housekeepers using real-
time PCR. The percent proliferating cells was determined with Ki67 staining. Protein
expression was determined relative to a loading control using Western blotting. Data was
analysed using a Students’ t test.
Results: The IUGR fetuses were smaller (control, 0.034
0.001kg (n¼17); IUGR,
0.027
0.001kg (n¼19)) but there was no difference in relative heart weight. There was no
change in cardiac gene expression of HIF1a, 1b and 2a or genes with HRE including VEGF,
IGF2, IGF2R and GLUT1. There was no change in the expression of CHEK1, CDC2A,
Cyclin D1, Cyclin D2 and Cyclin D9, genes involved in promoting cell cycle entry, and
there is no difference in the percent of Ki67 positive cardiomyocytes between the control
and IUGR fetuses. There was, however, a decrease in the protein expression of Bcl-xl, an
anti-apoptotic protein, and an increase in the protein expression of beclin-1, a marker of
autophagy.
Conclusion: These data suggest that although the heart of the IUGR fetus is not hypoxic
Conclusion: Tranilast reduced cardiac fibrosis and improved diastolic cardiac and there is no change in cardiomyocyte proliferation in early gestation, there may be an
dysfunction, improved renal function. Reduction in collagen I deposition may be to increase in apoptosis or autophagy. A small decrease in cardiomyocyte number early in
due increased collagen turnover by reducing TIMP expression. These findings gestation may thus result in reduced cardiomyocyte endowment in the IUGR fetus in late
support the use of direct anti-fibrotic strategies in CKD with improved cardiac gestation.
outcomes. Disclosure of Interest: None Declared
Disclosure of Interest: None Declared
PW296
Fenofibrate Rescues Diabetes-related Impairment of Ischaemia-mediated
PW293 Angiogenesis by PPARa Independent Modulation of Thioredoxin Interacting Protein
Impact of upregulated O-GlcNAcylation on left ventricular (LV) inotropic Jun Yuan*1, Kushwin Rajamani2, Christina Bursill2, Laura Lecce2, Alicia Jenkins3,
responsiveness in diabetic heart Anthony Keech3, Martin K. C. Ng2
1
Translational Research Group, 2The Heart Research Institute, Newtown, 3Nhmrc Clinical Trial
Chengxue Qin*1, Rochelle S. Sleaby1,2, Cynthia Donarelli2, Nga Cao1, Sarah Rosli1,
Centre, Camperdown, Australia
Lea M. Delbridge2, Rebecca H. Ritchie1,3
Introduction: Fenofibrate, a peroxisome proliferator activated receptor alpha (PPARa)
1
Basic and Clinical Cardiology, Baker IDI Heart and Diabetes Institute, 2Department of
Physiology, 3Department of Pharmacology, University of Melbourne, Melbourne, Australia agonist, reduced amputation events in the Fenofibrate Intervention and Event Lowering in
Diabetes study. However, the mechanisms for the vascular benefits of fenofibrate in dia-
Introduction: Increased hexosamine biosythesis and downstream upregulated protein O- betes mellitus (DM) are largely unknown.
GlcNAcylation has been linked to diabetic complications in many tissues; its impact on LV Objectives: To investigate the effects and mechanisms of fenofibrate on impaired
contractile responsiveness is not well understood. ischaemia-mediated angiogenesis in diabetes in vitro and in vivo.
Objectives: To determine the impact of acute and chronic upregulated O-GlcNAcylation Methods: Key angiogenic events (tubulogenesis/migration/apoptosis) were assessed in
on LV inotropic responsiveness. primary human endothelial cells (ECs) under normal (5mM) or high (25mM) glucose with/
Methods: Hearts isolated from anaesthetised adult male rats (ketamine:xylazine, without fenofibric acid (50mM). PPARa independent mechanisms of fenofibrate were
100:20mg/kg i.p.) were Langendorff-perfused (Krebs’ at constant flow, 10ml/min). investigated using a PPARa antagonist and PPARa KO murine endothelial cells. Hindlimb
Baseline and phenylephrine-stimulated (PE, 10mmol/L) LV function was determined ischemia (HLI) was induced in a murine model of DM in wildtype (WT) and PPARa
in response to acute (5mmol/L glucosamine, 30mins pretreatment) versus chronic knockout (KO) mice with/without fenofibrate. Ischaemic recovery was assessed by laser
upregulation of O-GlcNAcylation (8 weeks post-streptozotocin diabetes, 55mg/kg Doppler (LDPI) and capillary density analysis.
i.v.). Results were compared to untreated control or non-diabetic sham hearts, Results: Fenofibric acid (FA), the active component of fenofibrate, rescued high
respectively. glucose-induced impairment in EC migration (82.5
0.1% vs. 52.8
0.4% of control,
Results: Chronic diabetes inhibited PE-induced inotropic responsiveness (Table, *P<0.05 P<0.05) tubulogenesis (89.5
0.2% vs. 56.5
0.3% of control, P<0.5) and apoptosis
vs control; #P<0.05 vs non-diabetic sham; peak at 6 mins); preliminary results also sug- (12.5
0.2% vs. 28.6
0.8%, P<0.001) in a PPARa-independent manner. FA action
gested a trend for diabetes-upregulated LV O-GlcNAc content (not shown). In contrast, was associated with PPARa-independent reversal of high glucose-induced over-
acute O-GlcNAcylation with glucosamine did not fully reproduce the impaired PE expression of thioredoxin-interacting protein (TXNIP) (P<0.05), an exquisitely
inotropic response (Table), although baseline LV function was transiently reduced (not glucose-sensitive regulator of angiogenesis. Interestingly, overexpression of TXNIP
shown). abrogated the protective effects of FA on tubulogenesis under high glucose (p>0.05).
In vivo, fenofibrate rescued diabetes-related impairment in ischaemic blood flow re-
covery and angiogenesis in both WT (LDPI: P<0.05, Capillary density: p<0.001) and
PE-stimulated LV function Acute O-GlcNAc Non-diabetic Sustained O-GlcNAc PPARa KO mice (LDPI: p<0.01; Capillary density: p<0.001), consistent with a
(relative to baseline) Control (n[6) (Glucosamine, n[7) sham (n[7) (Diabetes, n[7) PPARa-independent effect. Fenofibrate also reversed diabetes-related overexpression of
LV Systolic Pressure (%) 159
22 165
51 198
24 124
18#
TXNIP in WT (P<0.01) and PPARa KO mice (P<0.01), a finding associated with
restoration of diabetes-related impairment in VEGF production to non-diabetic levels
LV Developed Pressure (%) 167
17 159
40 202
31 114
17#
(0.94
0.12% vs. 0.56
0.14% of control, p<0.05).
LV End-Diastolic Pressure (fold) -1.4
2.3 -4.3
5.3 0.9
3.1 6.4
3.8 Conclusion: Fenofibrate rescues diabetic impairment in ischemia-mediated angiogen-
LV +dP/dt (%) 162
13 134
27 175
21 119
19 (P¼0.07) esis, in large part, by PPARa-independent restoration of VEGF by normalisation of
LV –dP/dt (%) 140
5.6 96
8.5* 154
25 108
18 high-glucose induced overexpression of TXNIP. Improved neovasculatization may
Rate Pressure Product (%) 161
13 122
16 (P¼0.09) 192
34 132
24
therefore explain in part the reduced amputations seen with fenofibrate in type 2
diabetes.
Perfusion Pressure (%) 125
7.9 154
26 132
18 130
16
Disclosure of Interest: None Declared

e318 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

PW301
Dobutamine stress cardiac MRI reliably predicts significant coronary disease in renal
transplant candidates
Anthony D. Pisaniello*1, Benjamin Dundon2, Murilo Maia1, Karen S.-L. Teo1,
Stephen G. Worthley1, Kym Bannister3, Randall Faull3, Patrick T. Coates3, Graeme Russ3,
Matthew I. Worthley1
1
Cardiology Unit, Royal Adelaide Hospital, Adelaide, 2Cardiology Unit, Monash Medical Centre,
Melbourne, 3Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
Introduction: Coronary artery disease (CAD) accounts for half of all deaths in patients with
end stage kidney disease (ESKD) who have undergone renal transplantation. In patients
with ESKD, “angiographically” significant CAD may be asymptomatic. Identification of
these patients, with subsequent revascularisation, may reduce the prevalence of adverse
cardiovascular events in the peri-transplant and post-transplant period.
Objectives: We aimed to evaluate the effectiveness of diagnostic (>85% maximum age-
predicted heart rate) dobutamine stress cardiac magnetic resonance (DSCMR) imaging in
identifying “angiographically” significant CAD in asymptomatic patients.
Methods: Over a five year period, 62 high-risk patients were referred to this program by
the nephrology team. All of these subjects had an invasive coronary angiogram (ICA).
These subjects had ESKD and were being considered for renal transplantation. 42 (68%)
were male. All had at least one traditional cardiovascular risk factor. 58 (94%) were on
renal replacement therapy. Of the 62 enrolled patients, 43 (69%) had a diagnostic DSCMR
followed by an ICA. ICA reporters were blinded to results of DSCMR and vice-versa. 19
patients (31%) were excluded from the analysis due to non-diagnostic DSCMR scans. The
most common reasons for a non-diagnostic DSCMR included insufficient augmentation in
heart rate with dobutamine stress (in 8 patients) and claustrophobia (in 5 patients). Sig-
nificant CAD was defined on ICA as a coronary stenosis of
70%.
Results: Of the 43 included patients, 12 (28%) had significant CAD, and all of these
patients had evidence of inducible myocardial ischaemia on DSCMR. 3 (7.0%) patients had
false positive DSCMR scans. There were no false negative scans. Of the 19 patients with
non-diagnostic CMR scans, 7 subjects had significant angiographic CAD. In this cohort
studied with a diagnostic DSCMR: sensitivity ¼ 100%, specificity ¼ 90%, positive pre-
dictive value ¼ 80%, negative predictive value ¼ 100%. Over this period, 26 patients have
undergone a successful transplantation and 8 patients have died (none of which had un-
dergone a renal transplantation).
Conclusion: When feasible, a diagnostic DSCMR can reliably detect “angiographically”
significant CAD in patients with ESKD being considered for renal transplantation.
Disclosure of Interest: None Declared
PW303
Utility of Cardiac Magnetic Resonance Imaging (CMR) in the Diagnosis of Cardiac
Sarcoidosis
Kelly Stanton*1, Madhusudan Ganigara2, Tamera Corte3, Peter Corte3, Rajesh Puranik1,
Paul Torzillo3
1
Cardiology, Royal Prince Alfred Hospital, 2Cardiology, Westmead Hospital, 3Respiratory, Royal
Prince Alfred Hospital, Sydney, Australia
Introduction: The diagnosis of cardiac sarcoidosis (CS) remains controversial and often
clinically challenging. Cardiac Magnetic Resonance imaging (CMR) with contrast is an
emerging modality for the diagnosis of CS. We compared CMR with the current guidelines
for the diagnosis of CS.
Objectives: To determine the utility of CMR in the diagnosis of CS and to evaluate the
spectrum of CMR findings in those with CS.
Methods: We retrospectively studied patients with a definite diagnosis of pulmonary
sarcoidosis who were referred for CMR at 1.5T as part of evaluation for CS. We reviewed
electrocardiograms, 24-h holter studies, echocardiograms and where available, gallium and
PET scans in these patients. The diagnostic accuracy of CMR for CS was determined using
both the 1993 Japanese Ministry of Health and Welfare guidelines and the modified 2006
version as the reference standard.
Results: Thirty-eight patients (49 +/- 14 years; 53% Male) with pulmonary sarcoidosis
underwent CMR for assessment of CS. Nine of the 38 patients (24%) had CMR findings
consistent with CS. All of these patients had late gadolinium enhancement (LGE) which
predominantly involved the basal and lateral segments. Of the patients who had LGE on
CMR, 78% had positive findings on T2 weighted imaging. There was no significant dif-
ference in ventricular function in patients with and without LGE.
Only two of the nine patients that had LGE on CMR fulfilled the diagnostic criteria for
CS according to the 1993 guidelines, while only one fulfilled the criteria according to the
modified 2006 guidelines. Three of the nine patients with LGE on CMR had ventricular
tachycardia (33%) and two of these patients have an AICD.
Of the patients with a normal or non diagnostic CMR, only one met the diagnostic
criteria for CS based on the 1993 guidelines, while none met the diagnostic criteria for CS
based on the modified 2006 guidelines.
There was an association with pulmonary stage and LGE on CMR in that CS was less
common with stage I disease (11%) compared to stage III or IV disease (67%). However,
LGE on CMR was seen across all four pulmonary stages.
Conclusion: CMR has a higher sensitivity and may have more optimal specificity for the
diagnosis of CS compared to the current diagnostic criteria. Given cardiac involvement
accounts for the majority of deaths from sarcoidosis; in particular the risk of arrhythmia
and sudden cardiac death; we suggest a greater role for CMR in the diagnosis of CS. Further
larger and longitudinal studies are required.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PW305
POSTER ABSTRACTS
A Clinical Assessment of the Glasgow ECG algorithm
Lindsay Savage*1, Peter Fletcher1, Paul Stewart2, Bruce Bastian1, Ian Agahari1
1
Cardiology Stream, Hunter New England Health, Newcastle, 2New South Wales Ambulance
Service, Ambulance, Sydney, Australia
Introduction: Electronic algorithms for the interpretation of ECG have been available for
many years. Despite many laboratory tests there have been very few clinical trials in the
assessment of algorithm accuracy. The potential for the effective use of algorithms in rural
and settings where expert interpretation of the ECG is not available is considerable. Triage
of patients by ambulance and rural clinicians may lead to improved identification of STEMI
and more rapid reperfusion and safer discharge. We looked at the accuracy of the Glasgow
algorithm in the clinical setting.
Objectives: The research goal was to identify if the Glasgow algorithm could accurately
identify STEMI and “normal “on ECG in a clinical setting. The validity of the algorithm in
use in triage and reperfusion systems was assessed.
Methods: 1,500 ECG collected from either a Burdick 8500 or a Lifepack 15 both with the
Glasgow algorithm were assessed from multiple Emergency Departments and Ambulance
transmitted ECG. An integrated database of ECG from 36 hospitals was used to review
ECG interpretation of the Glasgow algorithm against a blinded Cardiologist interpretation.
Patient clinical details of the ECG collected included admission diagnosis, troponin rise,
angiography result and length of stay. The accuracy in the algorithms ability to predict
admission and treatment for STEMI was assessed. The accuracy in the algorithms ability to
predict discharge and GP follow up by “normal” ECG was assessed.
Results: The Glasgow algorithm was able to predict STEMI with the presence of frequent
confounders. Both right and left bundle branch block caused the Glasgow Algorithm to
“overcall” STEMI on a number of occasions. Atrial tachycardia also was observed to occasionally
trigger the algorithms “Meets STEMI Criteria” as did electrical interference and wandering base-
line. There was a strong association between the algorithms identification of STEMI and
troponin rise, positive angiography result for coronary artery disease and admission. The al-
gorithm has a high sensitivity and specificity to identify true STEMI and “normal” ECG.
Conclusion: The use of the Glasgow algorithm in rural and ambulance setting may be a
safe and effective way of providing initial triage of ECG where expert evaluation is difficult
or slow to achieve. Confounders of algorithm ECG interpretation need to be taken into
consideration and the gaining of a clear trace vital. Further development of algorithm
identification of STEMI into low, medium or high probability may be beneficial.
Disclosure of Interest: None Declared
PW306
By following recommended guidelines by American Society of Echocardiography,
diastolic dysfunction is observed in twelve percent of the patients with Ankylosing
Spondylitis
Bente Elisabeth Grüner Sveälv*1, Margareta Scharin Täng1, Eva Klingberg2,
Helena Forsblad d’Elia2, Odd Bech-Hanssen1, Lennart Bergfeldt1
1
Department of Molecular and Clinical Medicine, 2Rheumatology, Medicine, Gothenburg,
Sweden
Introduction: Diastolic dysfunction is frequently mentioned as common disorder in pa-
tients with chronic inflammatory rheumatic disease. The prevalence of diastolic dysfunc-
tion in patients with Ankylosing Spondylitis has shown to differ from 1.4% to 63.7%,
calculated as a mean of 26.3%. This demonstrates that adequate guidelines are needed in
order to differ between decreased diastolic function, and diastolic dysfunction.
Objectives: The aim of the study was to determine the prevalence of diastolic dysfunction
in patients with Ankylosing Spondylitis by following recommended guidelines by American
Society of Echocardiography.
Methods: The patients (n¼ 187, 105 men, 82 women, mean age 5112 years and mean
duration of disease 1511 years), were investigated with Pulsed-Wave Doppler in order to
determine the E/A ratio and deceleration time. From tissue Doppler Imaging the following
variables were measured; early diastolic annular velocity (e) and late diastolic (atrial) ve-
locity (a).
Results: According to normal values for Doppler-derived diastolic measurements, patients
outside range of 95% confidence interval were: E/A ratio 13.6%, deceleration time 12.9%,
septal é 11.5% and lateral é 31.3%. Further, corresponding to guidelines, we observed that
164 (88%) of the patients had normal diastolic function as septal e>8 cm/sec and/ or lateral
e>10 cm/sec. Thus, the remaining 23 (12%) of the patients, prove to have mild diastolic
dysfunction.
Conclusion: By following satisfactory guidelines we observed that 12% of patients with AS
demonstrate to have mild diastolic dysfunction without elevated filling pressure. Further
studies are required in order to follow the diastolic process in this population.
Disclosure of Interest: None Declared
PW307
HbA1c, not Fasting Blood Glucose, Predicts Left Ventricular Diastolic Function and
Filling Pressures After ST-Elevation Myocardial Infarction
Josh P. Tsai*1, Jenny Tian2, Lisa Gillinder2, Shi Yi Goo2, Mathivathana Indrajith1,
William Y. Wang1, Arnold C. Ng1
1
Cardiology, 2Princess Alexandra Hospital, Brisbane, Australia
Introduction: Patients can develop stress hyperglycemia during critical illness. Recently,
World Health Organization recommended HbA1c
6.5% as alternative diagnostic criterion
e319
 for diabetes. Its prognostic value compared to fasting blood glucose (BSL) in patients with
POSTER ABSTRACTS
ST-elevation myocardial infarction (STEMI) is unknown.
Objectives: Compare HbA1c and fasting BSL for left ventricular (LV) diastolic function and
filling pressures after STEMI.
Methods: A total of 142 (61.812.1 years, 74.6% male) first STEMI patients were pro-
spectively recruited. LV diastolic function was defined as the mean septal and lateral early
diastolic velocities (average e’) by pulsed wave tissue Doppler, and filling pressure was the
ratio of transmitral early diastolic velocity to average e’ (average E/e’).
Results: Mean HbA1c and fasting BSL were 6.51.6% and 7.72.8mmol/L respectively.
Between diabetics and non-diabetics, there were no differences in the rates of coronary
angioplasty (p¼0.50), bypass surgery (p¼0.39), LV end-diastolic volume (EDV, 11637
vs. 11843mL, p¼0.78), end-systolic volume (ESV, 6933 vs. 6835mL, p¼0.93),
ejection fraction (EF, 4212 vs. 4411%, p¼0.49). On multivariable analyses, average e’
was independently associated with age (b¼-0.283, r¼0.001), LVEF (b¼0.211, r¼0.013)
and HbA1c (b¼-0.173, p¼0.034), but not BSL (p¼0.83). Similarly, average E/e’ was
independently associated with age (b¼0.290, p<0.001), LVEF (b¼-0.201, p¼0.018) and
HbA1c (b¼0.240, p¼0.003), but not BSL (p¼0.07). ROC analysis showed that an optimal
HbA1c cut-off of 6.4% (AUC¼0.68, p¼0.002) was associated with an elevated LV filling
pressure (average E/e’
13).
Conclusion: HbA1c, not fasting BSL is independently associated with impaired LV dia-
stolic function and increased filling pressures after STEMI.
Disclosure of Interest: None Declared
PW308
Prediction of Recovery After Primary Coronary Intervention in Patients With Acute
ST-Elevation Myocardial Infarction – the Role of Deformation Imaging
Krasimira Hristova*1, Dobrin Vasilev1, Tzvetana Katova1, Iana Simova1, Velislava Kostova2
1
National Heart Hospital, Sofia, Bulgaria, 2Noninvasive Functional Diagnostic and Imaging,
National Heart Hospital, Sofia, Bulgaria
Introduction: Left ventricular functional recovery and remodeling after acute myocardial
infarction followed by reperfusion remains incompletely understood.
Objectives: The aim of the study was to describe the recovery of LV strain(LVS), rate(-
LVSR),twist(LVT),untwist rate(LVUR) after AMI using tissue tracking and compare these
parameter with 4mFU after PCI.
Methods: 20 normals(31y5) and 103 patients(6313)with AMI in the first 24 hours after
PCI, were enrolled.Standard echocardiography was performed in first 36 hours and 4mFU
and B-mode (-657frames/s)were aquired in the apical 2-,4 and 4C view and parasternal
short axis view.The strain curves and LVT/LVUR were extracted and derived in18 segments
left ventricle model. The infarct size(IS) was estimated based on MRI delayed enhancement
and expressed as a percentage of the total LV volume.
Results: After infarct, adverse remodeling was found.The radial and circumferential strain
decreased in the infarct (32.28.7;-11.32.1), perinfarct (39.68.2;13.12.3) and remote
(41.16.4;-13.92.0) regions comparable with normals(51.064.95;-20.91.76).The
longitudinal strain was only significantly decreased in infarct regions at baseline(-8.31.2;-
13.32.1;-13.92.2) and 4mFU(-11.32.0;-17.52.2;-18.781.8).Circumferential and
radial strain after 4mFU were reduced in the infarcted(-13.62.2;38.33.6)segments, but
in perinfarcted(-15.83.4;41.25.78) in the remote(-18.42.2;45.68.2) close to the
normals.There was a significant correlation between the infarct size(31,13,4 %) and
longitudinal strain(r¼-0.49,p<0.01). A fair correlation of LVT with EF(r¼0.64) and LVS
and LVSR(r¼0.56) with IS were found. LVT/ LVUR are with high sensitivity for impaired
global LV function (<6;<-35/s) in the acute phase and do not depend on the area of the
infarct. On the 4mFU were found a significant improvement,but values remain below
normals (<12 ;<-90 /s). LVUR in the range -50/s -60  /s of 4mFU is a sign of LV
remodeling.
Conclusion: All indices of myocardial function demonstrate reduced systolic deformation
in infarcted myocardium and deformation gradually reduces with increasing infarct size
and transmural distribution.The longitudinal strain early after reperfusion may predict
infarct size and LV remodeling;radial and circumferential strain in perinfarct and remote
regions-adverse left ventricular remodeling and progression to ischemic cardiomyopathy.
LVT/ LVUR are parameters that shown high sensitivity recovery in the global left ventricular
function in patients after myocardial infarction.
Disclosure of Interest: None Declared
PW309
Association between early changes in left atrial strain and global left ventricular
longitudinal strain in patients with acute myocardial infarction
Krasimira Hristova*1, Vera Bogdanova2, Veselina Ferferieva3, Ivy Shuie4
1
National Heart Hospital, Sofia, Bulgaria, 2Noninvasive Functional Diagnostic and Imaging,
Private Hospital Athis Mons, Paris, France, 3BIOMED Research Institute, Hasselt, Belgium,
4
School of the Built Environment, Heriot-Watt University, Edinburgh, United Kingdom
Introduction: Left atrial (LA) maximal volume and index (LAVI) had a prognostic value in
patients after acute myocardial infarction (AMI). Recently, LA mechanical function and LA
strain have been introduced as alternative methods to assess LA performance more
accurately.
Objectives: To evaluate the relation between early changes in LA function and strain
(PALS) and correlate the association with global left ventricular (LV) longitudinal strain
(GLS) in patients with AMI.
Methods: We evaluated 125 subjects: 22 normals (31y5), and 103 pts with AMI
(65y12), out of which 80 had an inferior AMI. Echocardiography was performed in all
e320
patients within 36h (baseline) after revascularization (PCI) and after 4 months (4mFU) and
analyzed offline in order to extract the global and segmental strain values of the LV and LA
and LA volume and LAVI.
Results: The two groups were comparable for most of clinical variables. LV volumes,
ejection fraction, stroke volume, and mitral valve effective regurgitant orifice were similar
between the two groups. Also LA diameter and maximal volume were similar between the
two groups. At 36h,GLS is significantly reduced in both AMI groups (Tabl.1). At 4mFU,
both AMI groups showed recovery in EF and GLS increased significantly, but remained
below normal levels. LV GLS is the main parameter for myocardial dysfunction, which
changed significantly in the infarcted zone (p<0,001) at 36h and 4mFU. At 36h, reduced
PALS was associated with impairment of all measures of LV systolic and diastolic function,
and the correlation between global longitudinal strain and PALS was highly significant
(p<0.001; r¼-0.71). At 4mFU, PALS was significantly associated with lower global
longitudinal strain in group with anterior AMI (p<0.001, r¼0.61 ), LAVI > 28 ml/m2
(p<0.01,r¼0.57).
Conclusion: PALS and GLS are significantly reduced in AMI patients early after reperfusion
and recovered incompletely upon follow-up. PALS provides additional prognostic value
beyond LA volume and LAVI. Severe LV myocardial dysfunction and reduced GLS in AMI
patients reflected in decreased PALS, even still normal LAVI.
Disclosure of Interest: None Declared
PW310
The feasibility and comparability of tricuspid annular plane systolic excursion by
M-mode and tissue Doppler in a busy echo lab
Laura Dobson1, John Gelman1, Shona Evans1, Philip Mottram1, Catherine Mylrea*1,
Roger Peverill1
1
Non-Invasive Imaging, MonashHeart, Melbourne, Australia
Introduction: M-mode (MM) tricuspid annular plane systolic excursion (MM TAPSE)
provides diagnostic information about right ventricular function and forms part of a
standard echocardiographic study. However, we have observed that obtaining diagnostic
quality MM imaging can be difficult and hypothesised that pulsed wave tissue Doppler
(PWTD) may provide equivalent information and be more readily obtained.
Objectives: We investigated the feasibility and comparability of the PWTD velocity time
integral (VTI) of the right ventricle and MM TAPSE in a consecutive series of patients in
sinus rhythm.
Methods: 348 echocardiograms were analysed by an experienced echocardiographer to
determine whether the right ventricular MM and PWTD were of adequate quality for
measurement. To assess comparability, 87 of these studies were of optimal quality for both
PWTD and MM, having been acquired appropriately according to a predetermined
protocol. Three consecutive beats of both MM and PWTD of the lateral margin of the
tricuspid annulus were obtained. Three different VTI measurements of annular systolic
excursion were performed off-line as demonstrated on image 1; tracing inside the outer
border of the spectral envelope of the systolic signal (VTI1), tracing the outer (VTI2) and
modal (VTI3) line of the systolic signal + the pre ejection signal. The mean measurement of
3 consecutive beats was calculated.
Results: Of the 348 ‘real world’ echocardiograms analysed, an MM of adequate diagnostic
quality was obtained in 192 (55%), whereas an adequate tricuspid annular PWTD was
obtained in 299 (86%). VTI1 demonstrated the lowest mean difference compared to TAPSE
(+5%), with VTI2 and VTI3 differing by +22% and -8.5%, respectively. All 3 VTI mea-
surements were moderately and similarly correlated with MM TAPSE on linear regression
analysis (Table 1).
Mean TDI Mean Mean difference in 95% Confidence R
(cm) TAPSE (cm) measurements (cm) interval of difference value
VTI1 2.430.50 2.32  0.44 0.11 0.05 to 0.18 0.78
VTI2 2.800.54 2.32  0.44 0.56 0.42 to 0.56 0.79
VTI3 2.09 0.44 2.32  0.44 -0.19 -0.13 to -0.26 0.80
web 3C=FPO
Conclusion: In a real world setting, diagnostic quality PWTD of the tricuspid annulus was
obtained much more frequently than M-Mode. VTI1 was closest in absolute numbers to
MM TAPSE but there was a moderate correlation of all the VTI s with MM TAPSE. Whether
the moderate degree of correlation between PWTD VTI and MM TAPSE might represent
variability in tricuspid annular excursion over time or imprecision of one or both methods
of measurement is unclear.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
PW311 PW315

POSTER ABSTRACTS
Clinical And Echocardiographic Profile of Cardiac Myxomas Myocardial blood flow reserve correlates with semiquantitative degree of ischemia in
PET/CT 13N-Ammonia scans: a strong correlation?
Md. Toufiqur Rahman*1
1
Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Dhaka, Bangladesh Erick Alexanderson-Rosas*1,2, Luis E. Juarez Orozco3, Riemer Slart3,
Myriam M. Martínez Aguilar2, Antonio Jordán Ríos2, Sergio Maury Ordaz2,
Introduction: Cardiac myxoma is a benign neoplasm that represents the most common Elisa Magaña Bailon2, Ana G. Ayala Germán2, Lourdes Walls2, Aloha Meave Gonzalez2
primary tumour of the heart. Although the left atrium is the most commonly involved site 1
PET CT Unity, Faculty of Medicine, UNAM, 2Nuclear Cardiology, National Heart Institute
of origin in 75% of cases, it can arise from any of the cardiac chambers.
Objectives: We aimed to see clinical and echocardiohgraphic profile of 72 cardiac “Ignacio Chavez”, Mexico, Mexico, Mexico, 3Nuclear Cardiology, University of Groningen,
myoxomas. Groningen, Netherlands
Methods: 72 cardiac myxomas patients who admitted in National Institute of Cardio-
Introduction: PET/CT scanning constitutes nowadays a novel and powerful technique for
vascular Diseases, Dhaka from August 2003 to December, 2012 were studied clinically and
myocardial perfusion assessment in CAD. Moreover, myocardial blood flow measurement
by echocardiogram.
in absolute terms constitutes one of the several added values that increase the diagnostic
Results: There were 18 males and 54 females, ages ranged from 17 to 76 years. The
yield for functional impact of the localized or diffuse disease. The semiquantitative and
commonest symptom was dyspnoea (85%), followed by constitutional symptoms (42.4%),
absolute quantitative evaluation add-in for the comprenhensive evaluation of myocardial
embolization (21.5%), palpitation (22.9%), syncope (13.2%), pedal oedema (18.6%) and
perfusion.
chest discomfort (67.4%). The mean duration of symptoms was 09.7 months. Only in
Objectives: In the present study we aimed to assess the correlation between myocardial
7.9% cases was the diagnosis of myxomas made clinically. 73.7% cases were initially
perfusion reserve and the presence of ischemia according to the summed differential score
diagnosed as having: mitral valve disease, tricuspid valve disease (09%), ischemic heart
(SDS).
disease (3.4%), cardiomyopathy (1.7%), and the remaining 4.3% were detected during
Methods: We included 203 patients who underwent an 13N-Ammonia PET/CT perfusion
family screening and follow-up.. The sites of myxomas were left atrium 67; right atrium, 4;
scan between 2011 and 2013 for evaluation of the presence of myocardial ischemia. Data
and, biatrium1. All myxomas except 5 were attached to the interatrial septum. The site,
was reconstructed from the dynamic acquisition and interpreted by and expert in the field.
size, shape, attachment, mobility, prolapse into ventricle, and surface characteristic of
We divided the population in ischemic and non-ischemic according to the SDS (
2) and
myxomas were accurately assessed by 2D-echocardiography .When the morphological
analyzed the mean for MPR, LVEF and classical risk factors, a linear regression model was
characteristic of myxomas were studied and correlated with clinical features large left atrial
applied to evaluate SDS and MPR. A value of p<0.05 was considerate as significant.
myxoma size was closely related with constitutional symptoms, congestive heart failure,
Results: There were 134 men and 69 women. Within the non-ischemic group the mean
with syncope and auscultatory findings suggestive of mitral valve disease, whereas smaller
age was 58.7  13.03 and 61.6  10.2 in the ischemic group. There was no significant
myxoma size and irregular surface were associated with embolization.
differences between the demographic characteristics between the groups, including classic
Conclusion: Majority of myxomas mimic many cardiovascular diseases and were detected in
risk factors. There was a significantly different MPR for the non-ischemic (2.951.15) and
symptomatic patients, so a high index of clinical suspicion is important for its early and correct
ischemic group (2.490.86) (p¼0.005). The linear model showed a significant inverse
diagnosis. The size and appearance of the myxomas correlated with the presenting symptoms.
relation between MPR and SDS (p¼0.001).
Disclosure of Interest: None Declared

PW312 Demographic values

Echocardiography In Patients With Reumatoid Arthritis And Subclinical Age (median, ED) 61.40 (+- 10.58)
Cardiological Engagement Hypertension 54%

Sara Berensztein*, Berensztein Sara, Ariel K. Saad, Cintora Federico, Chavín Carolina, Diabetes Mellitus 18%
Grosso Oscar, Vinicki Juan Pablo, Nasswetter Gustavo, Vazquez Blanco Manuel Dyslipidemia 47%
Cardiology, Hospital de Clinicas, Buenos Aires, Argentina Smoking 41%
Introduction: Patients with Reumatoid Arthritis (RA) have a greater cardiovascular mor-
tality due to an accelerated vascular atherosclerosis that exceeds the mere presence of
traditional risk factors. Early detection could favor a more aggressive treatment.
Objectives: It is our purpose to analize the echo Doppler of RA patients and compare them
to a normal group.
Methods: Seventy five RA patients (age 55  13 years, 95% female sex) and 16 control patients
(age 51  18 years, 88% female sex) were studied. Patients with atrial fibrillation, diabetes and
structural cardiac disease were excluded. A 2D, Doppler and tissue echo were done following
the recommendations of the American Society of Echocardiography. Statistical analysis
employed was: a X2 and a student T test. A p <0.05 was considered statistical significant.
Results: No significant differences were evident in age, sex, cardiovascular risk factors,
anthropometrics and arterial pressure between both groups. In Table 1 and 2, the most
outstanding echocardiographic findings are appointed.

Table 1
RA (n[75) Controls (n[16) p
Conclusion: The degree of ischemia as assessed by the SDS and the MPR have a significant
Left atrial diameter (mm) 34.4  4.4 31.8  3.1 0.03
correlation as the latter significantly differs between ischemic and non-ischemic patients.
Left atrial area (cm ) 2
17.3  2.9 15.7  1.2 0.001 13N-Ammonia PET/CT scanning can assess ischemia with a high diagnostic yield.
Right atrial area (cm2) 14.5  2.3 13.5  1.4 0.02 Nevertheless, variation of MPR results can be observed in both groups, therefore patients
with no ischemia and low MPR might have a different risk profile and prognosis as well as
Mitral annular plane systolic excursion (mm) 16  1.9 18.8  1.8 0.001 ischemic patients with preserved MPR.Miocardial blood flow measurement constitutes a
Tricuspid annular plane systolic excursion (mm) 22.4  3.7 25.8  4 0.001 powerful added value to the technique and could probably account for the suggested
prognostic yield for MPR which needs further investigation.
Disclosure of Interest: None Declared
Table 2
RA (n[75) Controls (n[16) p PW316
Mitral tissue S wave (cm/sec) 9.4  2.1 11.9  3.1 0.006 Feasibility and safety of nuclear stress testing in patients referred for dobutamine
Left ventricle E/e ratio 6.5  1.8 5.2  1.2 0.001 stress echocardiography
Right ventricle E/e ratio 3.4  1 2.8  0.6 0.003 Anastasia Vlachadis Castles*1,2, Vivek Mutha1,3, Muhammad Asrar ul Haq1,3, Nima Rudd3,4,
Pulmonary systolic pressure (mmHg) 26.6  4.6 20.9  2.9 0.0002 William van Gaal1,2,3
1
Cardiology Department, 2Radiology Department, The Northern Hospital, Epping, Victoria,
3
University of Melbourne, Melbourne, Victoria, 4The Northern Hospital, Epping, Victoria,
Conclusion: AR patients presented greater atrial dimensions and greater pulmonary sys- Australia
tolic pressures in comparison to controls. Although systolic and diastolic function pa-
rameters were normal in AR patients, a smaller mitral and tricuspid annular plane systolic Introduction: Dobutamine Stress Echocardiography (DSE) is a useful alternative in the
excursion, a smaller mitral tissue Doppler S wave and a greater right and left E/e ratio were investigation of myocardial ischaemia for patients who cannot exercise to the level required
obtained in AR patients. These findings could point out early changes in systolic and to obtain a diagnostic exercise stress echocardiogram. However, DSE is time consuming
diastolic function. and is associated with a small risk of inducing ventricular arrhythmias. Indeed, total
Disclosure of Interest: None Declared number of DSE has been declining in Australia, as per Medicare statistics.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e321

 Objectives: To determine the feasibility and safety of adenosine/stress sestamibi in unse-
POSTER ABSTRACTS
lected patients referred for investigation of myocardial ischaemia by dobutamine stress
echocardiography.
Methods: Due to resource and access issues, we implemented a departmental policy
whereby all patients referred for DSE to investigate myocardial ischaemia instead under-
went myocardial perfusion /stress scintigraphy.
Data was collected for 77 patients over a period of one year. Physicians supervising the
tests determined whether the patients should be stressed by exercise, adenosine or a
combination protocol, taking into consideration any absolute or relative contraindications.
Information was collected about protocol used, diagnostic quality of scans, results and any
complications or cancellations.
Results:
Total 77 patients referred for DSE
Type of stress 28 (36%) exercise stress sestamibi
23 (30%) adenosine sestamibi
25 (32%) combined low level exercise and adenosine
sestamibi
1 (1.3%) dobutamine sestamibi
Contraindication to adenosine (significant asthma)
Success of myocardial 76 (98.7%) results available
perfusion scintigraphy 1 (1.3%) failed
Severely dyspnoeic with exercise, adenosine contraindicated
(COPD with reversible component)
Seventy four of 77 patients (96 %) referred for DSE completed nuclear stress tests safely
without any additional intervention. Of the remaining three, one required premedication
with salbutamol (for severe asthma) prior to adenosine infusion, another encountered
bronchospasm requiring aminophylline and only one test was aborted secondary to sig-
nificant airways disease. Overall results were available for 76/77 tests (98.8%)
Conclusion: Stress/adenosine nuclear cardiac stress tests can be safely used to investigate
myocardial ischaemia in unselected patients referred for dobutamine stress echocardiog-
raphy. This strategy may be used as an alternative modality if timely access to dobutamine
stress echocardiography is not available.
Disclosure of Interest: None Declared
PW317
Use of echocardiography and nuclear medicine myocardial perfusion scintigraphy in
assessing rest and stress cardiac function across different patient demographics in
Australia
Anastasia Vlachadis Castles*1,2, William van Gaal1,2,3
1
Cardiology Department, 2Radiology Department, The Northern Hospital, Epping, Victoria,
3 nificant difference was seen in DPSD and DPHB between those with and without
University of Melbourne, Melbourne, Victoria, Australia
Introduction: Combined rest and stress (exercise or pharmacological) imaging studies
provide functional information and may be used in conjunction with structural imaging
methods to provide comprehensive assessment of patients with known or suspected
ischaemic heart disease.
The two major modalities for combined rest/stress imaging are echocardiography and
nuclear medicine myocardial perfusion scintigraphy (NM MPS). While NM MPS is slightly
more sensitive than echocardiography, it is less widely available and carries the risks
associated with radiation exposure. Younger patients and females of childbearing age are
more vulnerable to the effects of radiation and some literature suggests that clinicians may
prefer to use rest/stress echocardiography for investigation of these patients.
Objectives: This study aims to determine the relative proportion of rest/stress echocar-
diography and NM MPS performed across different patient demographics in Australia.
Methods: Publicly available Medicare Australia statistics from January to December of 2012
inclusive were accessed and analysed to determine the number of patients undergoing rest/stress
echocardiography and rest/stress NM MPS. Single phase rest or stress studies were not included.
From this information, the relative proportion of echocardiography and NM MPS studies by
e322
patient age range and gender was determined. Use of Medicare data means that studies not
funded by Medicare (patients not covered by Medicare, non-rebateable indications, non-
Medicare-endorsed imaging practices or reporting physicians) are not included in this study.
Results: Figure 1, below, demonstrates the relative proportion of NM MPS studies by
patient demographics, as a percentage of all rest/stress functional imaging studies (rest/
stress echocardiography and NM MPS).
Conclusion: This study demonstrates that, in adults, the relative proportion of rest/stress NM
MPS compared to echocardiography increases with age. Females under the age of 35 are less
likely to undergo NM MPS than males of the same age range. This may reflect that clinicians, as
well as considering the diagnostic value of functional imaging tests, are taking into consid-
eration the radiation risk of NM MPS for younger patients and women of childbearing age.
Disclosure of Interest: None Declared
PW318
Assessment of relationship between stress induced changes in cardiac mechanical
dyssynchrony and conventional poor prognostic markers on Thallium-201
Myocardial Perfusion SPECT in coronary artery disease
Harmandeep Singh*1, Chetan D. Patel1, Punit Sharma1, Anirban Mukherjee1, Nitish Naik2,
Arun Malhotra1
1
Nuclear Medicine, 2Cardiology, All India Institute of Medical Sciences, New Delhi, India
Introduction: Stress-induced changes in left ventricular (LV) function and wall motion on
myocardial perfusion SPECT (MPS) are known markers for coronary artery disease (CAD).
Addition of phase analysis to evaluate exercise-induced cardiac mechanical dyssynchrony
(CMD) to conventional perfusion analysis on Thallium-201 (Tl-201) MPS enables better
identification of patients with multivessel CAD. However, relation of stress induced
changes in CMD with conventional poor prognostic markers on MPS remains unclear.
Objectives: To assess the relationship of stress induced changes in CMD with conventional
poor prognostic markers on Tl-201 MPS.
Methods: Data of 150 patients with suspected or known CAD, who underwent exercise
stress-rest Tl-201 MPS between January 2011 and December 2012 was retrospectively
analyzed. Only patients who underwent coronary angiography within 3 months of MPS,
and had confirmed CAD were included. Patients with history of prior revascularisation,
pacemaker implantation, and known rhythm abnormality were excluded. The presence of
Transient ischemic dilatation (TID), increased lung radiotracer uptake, and myocardial
stunning were noted. In MPS, CMD parameters [phase standard deviation (PSD), phase
histogram bandwidth (PHB), DPSD (Post stress PSD - Rest PSD), DPHB (Post stress PHB -
Rest PHB)] were assessed. DPSD and DPHB denote stress induced changes in CMD, with a
positive change denoting worsening of dyssynchrony.
Results: Mean patient age was 55.59.45 years and 142 were male, 87 were hypertensive,
53 had diabetes mellitus, 26 were obese and 55 were smokers. Out of 150, 78 had history
of previous MI (scar on MPS) and 112 were detected to have ischemia on MPS. Fifty one
patients had TID, 39 had increased Lung uptake, 15 had myocardial stunning, 43 had
positive DPSD and 42 had positive DPHB. Patients with TID had significantly higher DPSD
(p 0.005) and DPHB (p 0.034) than those without TID. Patients with increased lung
radiotracer uptake had significantly higher DPSD (p 0.049) than those without. No sig-
myocardial stunning (p 0.152, p 0.506, respectively). Overall, patients with poor prog-
nostic markers on MPS had higher DPSD and DPHB, than those without them.
Conclusion: Stress induced changes in cardiac mechanical dyssynchrony are significantly
higher in patients with poor prognostic markers on Thallium-201 Myocardial Perfusion
SPECT, and can be a potential poor prognostic marker on MPS needing further evaluation.
Disclosure of Interest: None Declared
PW319
Comparison of Thallium-201 and 99mTc-Tetrofosmin myocardial perfusion SPECT
in patients with triple vessel disease
Harmandeep Singh*1, Punit Sharma1, Chetan D. Patel1, Nitish Naik2, Arun Malhotra1
1
Nuclear Medicine, 2Cardiology, All India Institute of Medical Sciences, New Delhi, India
Introduction: Myocardial perfusion SPECT (MPS) is an important modality for evaluation
of patients with suspected or known coronary artery disease (CAD). Accuracy of MPS in
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
detection of TVD can be limited. The aim of the study was to compare the diagnostic
efficacy of Thallium-201 (Tl-201) and 99mTc-Tetrofosmin MPS in patients with triple
vessel disease (TVD) confirmed by conventional angiography (CA).
Objectives: Comparison of 201-Thallium and 99mTc-Tetrofosmin myocardial perfusion
SPECT in patients with triple vessel disease.
Methods: Studies of 156 patients who underwent exercise/pharmacological MPS were
retrospectively analysed. Only patients who underwent CA within a period of  3 months
of MPS and showed presence of TVD were included. Stenosis of
70% on CA was
considered as significant CAD. One hundred patients underwent stress-rest redistribution
Tl-201 MPS and 56 patients underwent stress reinjection 99mTc-Tetrofosmin MPS using
standard protocol. MPS Studies were processed and evaluated by two nuclear medicine
physicians in consensus.
Results: There was no significant difference between the 2 groups with respect to age
(p 0.130), sex (p 0.300), prevalence of hypertension (p 0.350), diabetes mellitus (p 0.070),
obesity (p 0.70), smoking (p 1.00), dyslipidemia (p 0.560) and positive family history of
CAD (p 1.00). Tl-201 MPS showed one or more perfusion abnormality in 92/100 (92%)
patients and 99m-Tc-Tetrofosmin in 47/56 (84%) patients (p 0.074). Sensitivity, Speci-
ficity, PPV and NPV of Tl-201 SPECT-MPI for detection of significant CAD in total arteries
was 56%, 89.5%, 95.7% and 32.3%, while that for 99mTc-Tetrofosmin was 56%, 84.6%,
89% and 46.3% respectively. Transient ischemic dilatation was detected in 26/100 (26 %)
with Tl-201 and 17/56 (26.7 %) with 99m-Tc-Tetrofosmin.
Conclusion: In patients with TVD, 99mTc-Tetrofosmin MPS shows similar efficacy to that
of Thallium-201 MPS with lower cost and lesser radiation exposure.
Disclosure of Interest: None Declared
PW320
Association between heart rate and decrease of left ventricular ejection fraction after
stress in normal perfusion imaging
Paola E. P. Smanio*1, Lidiane Lima1, Paula Fillipi1, Marco Oliveira1
1 Introduction: Myocardial Perfusion Scintigraphy (MPS) has high sensitivity and specificity
Nuclear Medicine, Grupo Fleury, Sao paulo, Brazil
Introduction: It is known that myocardial perfusion scintigraphy (MPS) is an important
non-invasive method in the investigation of ischemia. With the advent of the gated-SPECT
technique functional information such as decrease of left ventricular ejection fraction
(LVEF) after stress phase compared to baseline were obtained adding diagnostic and
prognostic values. However, many patients (p) with normal perfusion have LVEF decrease
and the significance is not yet fully established.
Objectives: To determine the association between LVEF decrease after stress and changes
in heart rate during image acquisition after stress phase compared to baseline. Also evaluate
whether any cardiovascular risk factors have association with the decrease of LVEF after
stress in p with normal and abnormal perfusion study.
Methods: We analyzed prospectively 381 p, 30.2% female, mean age 59.8 years, 46.2%
hypertensive, 12% diabetic, 34.2% had hyperlipidemia. The MPS were performed by
standard protocol, 78%p underwent exercise stress testing and 22%p dipyridamole stress
test. It were considered normal MPS (89,2% p) in the absence of abnormal (fixed or
reversible) uptake of tracer.Considered decreased in LVEF after stress if  5% in com-
parison to the basal phase and different heart rate (HR) during acquisition the stress and
rest phases if the difference was at least 10 bpm. Statistical analysis waere performed by
Fisher exact test and Mann - Whitney being considered significant at p values  0.05 .
Results: In the group with normal perfusion (340p) there was a significant association
between the LVEF decrease after exercise stress test and difference in HR during acquisition
of images, p ¼0.001. The same was not observed for the group of normal dipyridamole
MPS, p ¼ 0.14. In the group with abnormal perfusion the association was also observed for
p who performed exercise, p ¼ 0.018. The average difference between HR during acqui-
sitions founded in was 12,9 bpm in the group with normal perfusion and 16,3 bpm in the
group with abnormal perfusion. When analyzing the risk factors possibly associated with
the decrease in LVEF after stress, hypertension was the only one associated in the group
with normal perfusion, p < 0.001 .
Conclusion: The obtained results may suggest that difference in HR during image ac-
quisitions after exercise stress test and rest phases can be associated with LVEF decrease
greater than 5% for both normal and abnormal perfusion patients. Hypertension was
associated with LVEF decrease in the group with normal perfusion.
Disclosure of Interest: None Declared
PW321
Value of myocardial perfusion scintigraphy in the assessment of patients without
cardiac symptoms
Joao V. Holtz1, Juliana H. Silva1, Carlindo Marques1, Leandro Ueda1, Marilia Abreu1,
Leonardo Machado1, Paola E. P. Smanio*1
1 1
Nuclear Medicine, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
Introduction: Cardiovascular disease is the leading cause of death worldwide. Strategies for
risk stratification are used to establish prevention. The use of non-invasive methods for
early assessment of coronary artery disease (CAD) are very important. It is already estab-
lished that symptomatic patients (p) should perform investigation but if asymptomatic or
with atypical symptoms of CAD p should investigate ischemia is not established.
Myocardial perfusion scintigraphy (MPS) is a valuable diagnostic test and outlines the
extent, severity and location of myocardial perfusion abnormalities.
Objectives: Evaluating the value of MPS in a group of p with a high risk for CAD
asymptomatic or with atypical symptoms in determining the outcome (death and
myocardial infarction). The secondary objective was to determine if there were any risk
factors associated with an increased likelihood of abnormal MPS.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Methods: It was retrospectively evaluated 871 p asymptomatic or with atypical symptoms
POSTER ABSTRACTS
who underwent MPS with Tc-99m-sestamibi by standard technique between 12/2005 and
06/2011. The risk of CAD was stratified by the Framingham score. They were followed
until 07/2013 for the presence of death and MI, and analysis of risk factors that increase the
likelihood of having abnormal MPS (reversible or fixed defects). Statistical analysis was
performed using Pearson x2, Fisher test and logistic regression, with significance level of p
 0.05.
Results: Of the total, 70% (p 611) were classified as at high cardiovascular risk. In 26.1%
(277p) that had fixed perfusion defects in MPS significantly higher mortality in evolution
was observed, p ¼ 0.043. Presence of chronic renal failure, ischemic stroke, known CAD
and LVEF <50% were associated with greater likelihood of fixed perfusion defects (p ¼
0.007, p ¼ 0.0001, p ¼ 0.0001 and p ¼ 0.0001, respectively). Of the total, 15.3% (133 p)
had reversible perfusion defects. Diabetes, known CAD, and abnormal stress test were
associated with reversible defects in the logistic regression (p ¼ 0.046, p ¼ 0.001 and p ¼
0.001, respectively).
Conclusion: The obtained results may suggest that, in a group at high risk for CAD, even if
patients are asymptomatic or have atypical symptoms may benefit from the realization of a
non-invasive test for the early detection of ischemia. Fixed perfusion defects were associ-
ated with worse outcome. Diabetes, known CAD and stress test suggestive of ischemia were
associated with reversible perfusion defects in this group of patients.
Disclosure of Interest: None Declared
PW322
Evaluation of the appropriateness criteria for myocardial perfusion scintigraphy in a
tertiary hospital of cardiology
Paola E. P. Smanio*1, Mariana Foltran2, Cristiane Costa2, Elry Medeiros2, Priscila Cestari2
1
Nuclear Medicine, Instituto Dante Pazzanese de Cardiologia and Grupo Fleury, 2Nuclear
Medicine, Instituto Dante Pazzanese de Cardiologia, sao paulo, Brazil
in the diagnosis of coronary artery disease, providing valuable information such as risk
stratification,prognostic evaluation of patients (p) with stable angina, after myocardial
infarction and after myocardial revascularization, among others. In order to regulate the
use, avoiding unnecessary use, radiation exposure and risks of the stress test, in 2009 the
American College of Cardiology ( ACC ) published a document determining criteria for the
use of MPS.
Objectives: To evaluate the indications of MPS in relation to the appropriatness criteria
previously established using the criteria of the ACC, in a tertiary cardiology hospital.
Methods: It were randomly selected 236 p who had performed MPS between January and
July 2013 at our institution . When necessary, information from medical records were used
for determination of appropriatness and for determination of Framingham risk score and
ATPIII criteria.
Results: From a total of 86p, 56p were male, 40.4 % were diabetic, 79.8 % had hyper-
tension, 70.8 % hyperlipidemia, 29.2 % were smokers and 14.6 % obese. Of the total 64 %
were symptomatic (by the presence of chest pain and/ or ischemic equivalent), 46.1 %
underwent myocardial revascularization (surgical or percutaneous ) and 75.2 % performed
pharmacological test. When classified according to ACC criteria, 62.7 % met the criteria of
appropriation, a quarter of exams were considered inappropriated, and 12% unclear .The
largest number of appropriations was observed in the group of symptomatic p after
revascularization.
Results: From a total of 86p, 56p were male, 40.4 % were diabetic, 79.8 % had hyper-
tension, 70.8 % hyperlipidemia, 29.2 % were smokers and 14.6 % obese. Of the total 64 %
were symptomatic ( by the presence of chest pain and / or ischemic equivalent ), 46.1 %
underwent myocardial revascularization ( surgical or percutaneous ) and 75.2 % performed
pharmacological test. When classified according to ACC criteria, 62.7 % met the criteria of
appropriation, a quarter of exams were considered inappropriated, and 12% unclear.The
largest number of appropriations was observed in the group of symptomatic p after
revascularization.
Conclusion: The obtained results may suggest that in a institution of tertiary cardiology,
about 63% % of the MPS are considered at appropriate indication criteria for the ACC,
mostly in the symptomatic patients after revascularization.
Disclosure of Interest: None Declared
PW323
Left Ventricular Outflow Track Flow Deceleration Time Corrected For Heart Rate Is
A Sensitive Surrogate Marker For Static And Dynamic Central Hemodynamics And
Arterial Compliance
In-Jeong Cho*1, Chi Young Shim1, Sanghoon Shin1, Geu-Ru Hong1, Namsik Chung1,
Jong-Won Ha1
Severance cardiovascular center, Seoul, Korea, Republic Of
Introduction: Left ventricular outflow tract (LVOT) flow is confronted with the systolic
afterload that left ventricle encounter, but the shape and duration of LVOT Doppler flow
has not been applied to assess the central blood pressure (BP) and arterial stiffness.
Objectives: The aim of this study was to evaluate whether the LVOT flow deceleration time
(DT) is related with central BP and parameters of arterial compliance.
Methods: We studied 179 consecutive subjects who underwent supine bicycle exercise
echocardiography and arterial tonometry simultaneously (68 males, age 62  12 years).
The patients who had left ventricular systolic dysfunction, significant arrhythmia, valvular
disease and coronary artery disease were excluded. LVOT flow DT and RR interval were
measured using Doppler echocardiography at rest and during peak exercise. DT corrected
for heart rate (DTc) was calculated. Peripheral and central hemodynamics including systolic
e323
 blood pressure (SBP), diastolic blood pressure, pulse pressure (PP), augmentation index
POSTER ABSTRACTS
(AIx), and PP amplification were assessed using radial artery tonometry at rest and im-
mediate after peak exercise.
Results: DTc at rest was significantly correlated with tonometry-derived central SBP,
central PP, AIx, and PP amplification at rest (all p<0.001). Similarly, DTc during exercise
was significantly correlated with tonometry-derived central SBP, AIx, and PP amplification
immediately after peak exercise (p¼0.016, p<0.001 and p<0.001, respectively), although
the correlation was weaker during exercise than those at rest. On multivariate regression
analysis, DTc at rest was independently associated with central SBP, AIx and PP amplifi-
cation at rest (p<0.001, p¼0.001, and p<0.001, respectively). DTc at peak exercise also
had an independent association with tonometry-derived AIx and PP amplification, which
were measured immediate after peak exercise (p¼0.017 and p¼0.030).
web 3C=FPO
Conclusion: LVOT flow DTc is a sensitive surrogate marker for static and dynamic central
hemodynamics, although the correlation was rather weaker during exercise. Prolonged
LVOT flow DTc might be useful to estimate raised central SBP, and reduced arterial
compliance at rest and a feasible marker to speculate central hemodynamics during
exercise.
Disclosure of Interest: None Declared
PW324
Total Afterload as a Determinant of LV Longitudinal Strain in Aortic Stenosis: Should
Valvulo-Arterial Impedance be Derived from Peripheral or Central Blood Pressure?
Mehdi Eskandari*1, Joshua J. Hawson1, Hilda Yang2, James E. Sharman2, Thomas H. Marwick2
1
Royal Hobart Hospital, 2Menzies Research Institute Tasmania, Hobart, Australia
Introduction: Valvulo-arterial impedance (Zva), a measure of global left ventricular load
(valvular and arterial) in aortic stenosis is a determinant of decline in global longitudinal
strain (GLS) and an independent predictor of mortality.
Objectives: We sought to assess if use of central systolic blood pressure (CSBP) instead of
peripheral systolic blood pressure (PSBP) in calculating Zva would improve the Zva cor-
relation with global longitudinal strain.
Methods: 38 unselected patients (age 7310 years, 76% men) with moderate to severe
aortic stenosis underwent standard 2D echocardiography. Central and peripheral blood
pressure (using Mobil-O-GraphÒ NG. 2) was measured at the time of acquiring highest
gradient across the aortic valve. LV longitudinal strain was measured offline by a single
operator using 2D speckle tracking.
Results: Average GLS was -153.7%; 27 patients (71%) had reduced GLS. GLS was strongly
correlated with Zva by both PSBP(r¼0.68, p<0.0001) and CSBP(r¼0.65, p<0.0001)
(Figure), but only modestly correlated with central systolic blood pressure (r¼-0.33,
p¼0.04), aortic valve area (r¼ -0.39, p¼0.02), effective elastance (r¼0.46, p¼0.003). An
abnormal Zva index was seen in six and five patients (15.8% vs. 13.1%,p¼NS ) using PSBP
and CSBP.Arterial hemodynamic parameters such as augmentation index, total vascular
resistance and pulse wave velocity did not correlate with either Zva or GLS.
Conclusion: Global longitudinal strain appears to relate linearly to afterload, irrespective of
whether central or peripheral blood pressure are used in calculation of Zva index.
e324
Disclosure of Interest: None Declared
PW325
Global Longitudinal Strain is not Equivalent to Tissue Doppler Imaging for
Identification of Subclinical Myocardial Dysfunction in Patients with Normal Left
Ventricular Ejection Fraction
Kevin Cheng*1, Giovanni Romanelli1, James D. Cameron1,2, Stuart Moir1, Roger E. Peverill1,
Philip M. Mottram1,2
1
Monash Cardiovascular Research Centre, MonashHEART, Monash Health, 2Department of
Medicine (MMC), Monash University, Melbourne, Australia
Introduction: Assessment of mitral annular velocities with tissue Doppler imaging (TDI)
offers an objective quantification of longitudinal left ventricular (LV) function. Two
dimensional strain imaging, a more recent technique utilising speckle tracking technology,
provides reproducible assessment of longitudinal myocardial deformation. A normal global
longitudinal strain (GLS) cut-off value of -15% has been suggested and this value predicts
adverse outcomes in various cardiac conditions. TDI and GLS are both used to detect
subclinical myocardial dysfunction in patients with preserved left ventricular ejection
fraction (LVEF), however comparison of the techniques is lacking.
Objectives: To determine GLS in a population preselected with reduced longitudinal LV
function defined by abnormal TDI velocities, but with normal LVEF (>50%).
Methods: From patients undergoing stress echocardiography for suspected coronary artery
disease, we identified 100 consecutive patients (65 female, age 668 years) with abnormal
septal and lateral early diastolic mitral annular velocities (e`6cm/s). Patients with abnormal
LVEF (<50%), arrhythmia, conduction abnormality, valvular dysfunction, or myocardial
ischemia were excluded. GLS was assessed with 2D speckle tracking (GE Vivid 7) in apical 2-, 3-,
and 4-chamber views. TDI parameters are expressed as the average of septal and lateral values.
Results: Mean BP was 13618/8010mmHg, mean LVEF 62%, 74% had hypertension,
23% smokers, and 33% diabetes. As mandated, average e` velocity was low (4.70.8cm/s)
however mean GLS was relatively preserved at -17.42.7%. Only 19% had GLS>-15%;
3% had GLS >-13% (Figure 1). There was no significant correlation between GLS and
either septal or lateral e’. GLS was moderately correlated to both s’ (r¼0.36, p<0.001) and
s’ integral (r¼0.34, p¼0.001).
web 3C=FPO
Conclusion: In a population with a high prevalence of cardiovascular risk factors and
markedly abnormal e` velocities but preserved LVEF, the vast majority (81%) had normal
global strain values and the two parameters were unrelated. GLS and e` are therefore not
equivalent methods for the identification of subclinical myocardial dysfunction, a result
that has important implications for the identification of early myocardial disease with
echocardiography.
Disclosure of Interest: None Declared
PW326
Nonlinear Afterload-dependence of RV strain: A Follow-up Study During Pulmonary
Vasodilator Therapy
Leah Wright*1, Makoto Saito2, Nathan Dwyer3, Thomas Marwick2
1
Cardiology, 2Cardiac Research, Menzies Research Institute, 3Cardiology, Royal Hobart Hospital,
Hobart, Australia
Introduction: RV function is difficult to quantify with conventional echocardiography and
RV free wall strain (RVGS) has been validated for this purpose. However, strain is afterload-
dependent, so understanding RV status in pulmonary hypertension is challenging.
Objectives: We studied the relationship between changes in right ventricular systolic
pressure (RVSP) and changes in RVGS.
Methods: Data was gathered prospectively in 150 patients (age 63 14; 75% women)
undergoing routine echo during pulmonary vasodilator therapy for pulmonary hyperten-
sion. LV and RV dimensions were assessed per guidelines. RVSP was estimated from
tricuspid regurgitation. RVGS was obtained in an apical RV view using speckle tracking
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 (Research-Arena, TomTec Imaging Systems, Germany). A subgroup underwent right heart
catheterization (N¼15) and 6 MW test (N¼113).
Results: Baseline PASP was 4468 mmHg, and changed in the course of therapy to 4157
mmHg (p¼.012). Similarly RV strain changed from -18.885.9% to -19.705.87%
(p¼.059). Bivariate correlations showed a significant nonlinear correlations with changes in
TR and changes in RV free wall strain (R¼0.30, P<.001), with FAC showing no rela-
tionship. However, there was a stronger relationship between changes in RVSP and changes
in RVGS using a quadratic relationship (Figure 1; R¼.37, P<.001). In a regression model,
the quadratic relationship added significantly to the linear association of change in RV
function for change in TR. Moreover, in a further analysis of the percentage change in RVSP
and RVGS (Figure 2) showed significance (R¼.26, P¼.006) with the quadratic model, but
lack of significance (R¼.13, P¼.13) using a linear model. Changes in invasive PASP
correlated highly significantly with changes in echo derived RVSP (R¼.78, P<.001).
Changes in 6MW data also showed highly significant correlations with changes in RVSP
(R¼-.42, P<.001).There were no significant associations with changes in FAC and RVSP.
web 3C=FPO
web 3C=FPO
Conclusion: Changes in RV free strain are associated in a non-linear fashion with changes
in RVSP in a pulmonary hypertension cohort. These features need to be kept in mind in the
evaluation of RV function using strain.
Disclosure of Interest: None Declared
PW327
Association of inefficient contraction with deterioration of left ventricular
longitudinal function after pacemaker implantation
Makoto Saito*1, Kazuaki Negishi1, Gerry Kaye2, Nick Linker3, Michael Gammage4,
Thomas H. Marwick1
1
Menzies Research Institute Tasmania, Hobart, 2Princess Alexandra Hospital, Brisbane,
Australia, 3James Cook University Hospital, Cleveland, 4University of Birmingham, Birmingham,
United Kingdom
Introduction: Long term right ventricular pacing may be deleterious to LV systolic func-
tion, because asynchronous electrical activation causes mechanical dyssynchrony. The
dyssynchronous ventricle requires more oxygen to generate the same amount of
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
mechanical work, resulting in low mechanical efficiency, which can be measured with
POSTER ABSTRACTS
strain imaging.
Objectives: We sought to investigate the effect of the inefficient LV contraction on the
deterioration of LV longitudinal function.
Methods: Measurement of global longitudinal strain (GLS) was feasible in 148 pts with
preserved LVEF and implanted pacemaker due to high grade atrioventricular block. We
also measured LV longitudinal discoordination index (defined as stretch/shortening during
ejection) in 18 segments as a marker of inefficient contraction. Strain imaging was per-
formed using speckle tracking imaging on raw data (EchoPAC PC BT11: GE Healthcare,
QLAB version 9.1: Philips Medical Systems) at baseline (post pacemaker implantation) and
at two years.
Results: GLS significantly decreased after two years from -16.14.3% to -14.74.4%
(p<0.001). The change in GLS for two years had weak correlation with LV longitudinal
discoordination index at baseline, but significant positive correlation with the index at two
years (r¼0.426, p<0.001; Figure) and the change in those indices for two years (r¼-0.587,
p<0.001).
Conclusion: These results suggest that the residual inefficient LV contraction and its
deterioration are associated with the impairment of LV longitudinal function.
Disclosure of Interest: M. Saito: None Declared, K. Negishi: None Declared, G. Kaye
Grant/research support from: Medtronic, N. Linker Grant/research support from: Med-
tronic, M. Gammage Grant/research support from: Medtronic, T. Marwick Grant/research
support from: Medtronic
PW329
Feasibility of low radiation dose computed tomography coronary angiography
combining a broad detector scanner and dose reduction techniques
John Younger1, Charles Chao*1, Helen Sadler1, Nghi Mai1
1
Cardiology, Qieensland Cardiovascular Group, St Andrews War Memorial Hospital, Brisbane,
Australia
Introduction: Computed tomography coronary angiography (CTCA) has become widely
available as an investigative tool for coronary artery disease. With the latest generation
scanners and new software (such as a prospective, step and shoot (S+S) protocol, iterative
reconstruction, narrow field of view, dose modulation and availability of 80 kV protocols),
low radiation dose scans are achievable without compromising diagnostic accuracy or
necessitating further testing.
Objectives: We hypothesized that the majority CTCA scans could be performed for less
than 2 mSv using a low dose protocol, while still maintaining a low rate of non-diagnostic
studies.
Methods: Consecutive single center CTCA performed from 05/12/12 to 07/06/13 were
included in the analysis. This included graft studies, left atrial (LA) mapping studies and
CTCA with aortograms. Both step and shoot and helical scan modes were included. Ra-
diation dose was recorded as dose length product (DLP) and converted to miliSieverts
(mSv) using a conversion factor of 0.014.
Results: 608 CTCAs were performed in this period. 519 CTCAs were of native coronaries
and of these 483 were scanned using S+S and 36 with a helical protocol. 48 graft studies,
28 LA mappings and 14 CTCA with aortograms were performed.
Radiation is reported as median (SD). The radiation dose for all scans was 1.7mSv
(2.7mSv). For native coronary arteries the dose was 1.3mSv (0.6mSv). The percentage
of all studies performed for less than 1mSv, 2mSv and 3mSv was 18.9%, 60.5% and 81.5%
respectively.
20 patients (3.3%) required repeat scans due to the initial study being non-diagnostic.
Severe calcification prevented exclusion of a stenosis in 50 patients (8.2% of cohort) and
additional testing (invasive cath, MPS and ESE ) was performed in 31 (5.1%) patients.
e325
 Conclusion: Low dose CTCA is readily achievable using newer generation scanner and Table 1
POSTER ABSTRACTS

available software with more than ninety percent of native coronaries imaged using a
S+S protocol and the majority of all scans obtained with a radiation dose less than 2 Demographics N (%)
mSv. Sex
Disclosure of Interest: None Declared
Male 162(52.3)

PW330 Female 148 (47.7)

Ethnicity
Predictors of calcium score in symptomatic Asian patients
Malay 168(54.2)
1 1 1 1
Kamal Arshad* , Johan Ismail , Zubin Ibrahim , Effarezan Abdul Rahman ,
Chinese 104(33.5)
Hafisyatul Zainal Abidin1, Chiao Wen Lim1, Natasha Arifin2, Sazzli Kasim1
1
Cardiology, 2Radiology, UiTM, Sungai Buloh, Malaysia Indian 38(12.3)
Diabetes 123(39.7)
Introduction: The presence of calcium artery calcification (CAC) on CT as depicted by the
calcium score is a marker for atherosclerotic disease and has prognostic significance. Hypertension 211(68.1
Traditional risk factors such as age, male, hypertension, diabetes and dyslipidaemia are Smoking 78 (25.2)
known to be associated with a higher calcium score. Data of CAC in an Asian population
are however lacking.
Objectives: To determine predictors of calcium score in a symptomatic Asian population. univariate tools revealed high calcium score (p¼0.002) and eGFR (<0.001) as predictors of
Methods: Patients with symptoms suggestive of underlying coronary artery disease be- cardiovascular outcomes.
tween 2011 and 2012 were identified and enrolled into the study. All patients underwent Out of the 184 patients with calcium scores of <100, 177 (96.2%) are well with no
coronary calcium scoring and CT coronary angiogram. Demographic data, biochemistry vascular events, 7 (3.8%) required revascularisation and there were no deaths.
and CT data were collected. 52 patients had a calcium score of >400. In this group, 43 (82.7%) remains well with no
Results: A total of 310 patients were enrolled. The mean age is 56.5 with a mean BMI of vascular events, 8 (15.4%) required revascularisation and 1 (1.9%) died due to a
28.7. Further dermographics are as in Table 1. myocardial infarction.
Conclusion: Predictors of outcomes in this study of a symptomatic heterogenous Asian
population are eGFR and a high calcium score of more than 400.
Table 1 Disclosure of Interest: None Declared
Demographics N (%)
PW332
Sex
Correlation of global systolic strain measured with automated function imaging (AFI)
Male 162(52.3)
during dobutamine stress echocardiography (DSE) and calcium score in coronary
Female 148 (47.7) arteries assessed with computed tomography (CT)
Ethnicity Karina Wierzbowska-Drabik*1, Konrad Szymczyk1, Nikolina Roszczyk1, Kamila Cygulska1,
Malay 168(54.2) Jarosław D. Kasprzak1
1
Chinese 104(33.5) Cardiology Department, Medical University of Lodz, Lodz, Poland
Indian 38(12.3) Introduction: AFI analysis gives in semi-automated way values of longitudinal strain of left
Diabetes 123(39.7) ventricle. Diminished strain at the peak of DSE may indicate stenosis of coronary artery.
Calcium score (CS) reflects the burden of atherosclerosis in coronary tree.
Hypertension 211(68.1
Objectives: We examined the relationship between AFI during rest, peak stress and re-
Smoking 78 (25.2) covery phase of DSE and CS calculated by CT .
Methods: In 28 patients (mean age 5910, female 17, mean EF 604%) CT after DSE was
performed with calculation of CS. Global peak longitudinal systolic strain by AFI was
calculated during rest (mean heart rate (HR) 6910), peak stress (HR 14211) and recovery
(HR 9313). Correlations in whole group and in subjects with CS>0 were analyzed.
In a univariate analysis, predictors of a high calcium score are older age (p<0.001), race Results: Peak systolic strain correlated significantly with CS at rest (r¼0,52, p¼0,005, see
(p¼0.002) and diabetes mellitus (p<0.001). In this study, smoking, hypertension, BMI, Figure). AFI measured at peak stress and during recovery lost significant relationship with
ethnicity and surprisingly eGFR are not predictors of calcium score. CS when assessed in the whole group. In patients with CS>0 strain maintained its
After a multivariate analysis, the predictors of a high calcium score are older age significant correlations in all examined stages - numbers of subjects (n), correlation co-
(p<0.001) and diabetes mellitus (p¼0.001). efficients (r) and p values are displayed in Table.
Conclusion: Predictors of a high calcium score in this symptomatic Asian population are
older age and diabetes mellitus
Disclosure of Interest: None Declared AFI start AFI peak AFI recovery
n (all CS) 28 28 25
r (all CS) 0.52 0.35 0.23
PW331 p (all CS) 0.005 0.067 0.277
Predictors of outcome in a symptomatic heterogenous asian population n (CS>0) 18 18 16
Kamal Arshad*1, Johan Ismail1, Zubin Ibrahim1, Effarezan Abdul Rahman1, r (CS>0) 0.62 0.61 0.50
Hafisyatul Zainal Abidin1, Chiao Wen Lim1, Natasha Arifin2, Sazzli Kasim1 p (CS>0) 0.006 0.007 0.047
1
Cardiology, 2Radiology, UiTM, Sungai Buloh, Malaysia

Introduction: Cardiovascular disease remains a major problem worldwide, with a growing

disease burden in developing countries.Coronary artery calcium (CAC) is a constituent of
coronary atherosclerosis and is detected exclusively in atherosclerotic vessels. Studies have
shown CAC to be of prognostic significance with a higher CAC score related to higher
cardiovascular event rates. Data relating to CAC in the symptomatic Asian population is
lacking.
Objectives: To determine predictors of outcomes in a symptomatic heterogenous Asian
population.
Methods: Consecutive patients with symptoms suggestive of underlying coronary artery
disease between 2011 and 2012 were identified and enrolled in this study. All patients
underwent coronary calcium scoring and CT coronary angiogram. Demographic data,
biochemistry and CT data were collected. All patients were followed via clinic reviews or
telephone interviews at 6 months interval. Acute coronary syndromes, revascularisation,
incidence of heart failures, stroke and death was recorded. Outcomes predictor at 6months
is reported.
Results: A total of 310 patients were included with a mean age of 56.5 and a BMI of 28.7.
Further demographics as per Table 1.
184 (59.4%) had a calcium score of <100, 74 (23.9%) had a calcium score between 100
and 400 and 52 (16.8%) had calcium scores of >400. Analysis of outcomes using

e326 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

 Figure. Relationship between CS and resting AFI. Table. Correlations between CS and Methods: 70 male (mean age 50.1 years) and 24 female (mean age 53.4 years) newly

POSTER ABSTRACTS
AFI during DSE. diagnosed OSA patients with no known CAD had a coronary artery calcium study using
Conclusion: In patients presenting with calcified lesions in coronary artery tree strain Multi-Detector Computed Tomography. CACS was calculated using the standard Agatston
measured by AFI correlated significantly with CS during all stages of DSE. Nevertheless the method with a Vitrea 2 workstation. We divided the study population into 2 groups: CACS
relationship lost its statistical significance at peak stage and during recovery of DSE when of 0-399 and severe coronary calcification (CACS
400)(Miranda et al). Receiver Operating
subjects with CS equal zero were included. Characteristics (ROC) analyses were used to assess the diagnostic accuracy of severity of
Disclosure of Interest: K. Wierzbowska-Drabik Grant/research support from: The State OSA for detecting CACS
400. The OSA severity and hypoxic indices used were Apnoea
Committee for Scientific Research, number N N402 5002 40, K. Szymczyk: None Declared, Hypopnoea Index, Oxygen Desaturation Index and percentage of cumulative nocturnal
N. Roszczyk Grant/research support from: The State Committee for Scientific Research, time spent with oxygen saturation below 95% (CT95), 90%(CT90), and 85%(CT85).
number N N402 5002 40, K. Cygulska: None Declared, J. Kasprzak Grant/research support Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals
from: The State Committee for Scientific Research, number N N402 5002 40. (CIs) for CACS at the different score levels.
Results: ROC analysis of Negative Predictive Value (NPV) and Negative Likelihood Ratio
PW333 (LR(-)) for presence of CACS of
400, as a function of CT95, indicated 60% as an approximate
optimal cutpoint. For CT95 of <60%, NPV was 1.0 and LR(-) was 0. No event of CACS
400
Coronary Artery Calcium in an Asian Obstructive Sleep Apnoea Population occurred at <60%. AUC (95% CI) at the 60% cutpoint was 0.817 (0.71, 0.93). There was no
significant correlation between CACS and other indices of OSA severity or hypoxia.
Lohendran Baskaran*1,1, Thun How Ong2, John C. Allen3, Song Tar Toh4, Max B. H. Wu5,
Swee Yaw Tan1
1
Cardiovascular Medicine, National Heart Centre Singapore, 2Respiratory Medicine,
Singapore General Hospital, 3Centre for Quantitative Medicine, Duke-NUS Singapore,
4
Otolaryngology, Singapore General Hospital, 5National Heart Centre Singapore,
Singapore, Singapore
Introduction: Obstructive Sleep Apnoea (OSA) is associated with increased Cardiovascular
(CV) events. Coronary Artery Calcium Score (CACS) can prognosticate asymptomatic
patients at risk of Coronary Artery Disease (CAD) and risk stratify for future CV events. We
analysed the prevalence and distribution of Coronary Artery Calcium (CAC) amongst Asian
newly-diagnosed OSA patients with no known CAD.
Objectives:
1. To assess if there is a significant increase in prevalence in CAC in OSA patients with
no known prior CAD compared to prior registries.
2. To assess if this difference varies across different CACS categories.
Methods: 70 male (mean age 50.1 years) and 24 female (mean age 53.4 years) newly
diagnosed OSA patients with no known CAD had a coronary artery calcium study using
Multi-Detector Computed Tomography. CACS was calculated using the standard Agatston
method with a Vitrea 2 workstation and categorised in the following manner: 0, 1-100,
101-400, >400. Results were compared against previous registries done amongst asymp-
tomatic patients with no known CV disease, namely the MESA, CONFIRM and Korean
registries. Statistical analysis used Fisher’s exact test.
Results: As shown in the table below, 50.0% (47), 33.0%(31), 10.6%(10) and 6.4%(6) of
the study population had CACS of 0, 1-100, 101-400 and >400 respectively. Compared to
previous registries using asymptomatic non-OSA patients with no known CV disease, there
was a statistically significant increase of patients with CACS>0 amongst our registry
compared to the Korean registry across all categories (33% vs 13%, 10.6% vs 3.8%, 6.4%
vs 1% for categories CACS 1-100, 101-400, >400 respectively). There was also a trend
(though not statistically significant) for over-representation in the CACS 1-100 group in
our registry compared to the other registries.

CACS OSA n(%) MESA n(%) CONFIRM n(%) KOREAN n(%)

0 47 (50.0) 2167(60.2) 1971(44.9) 801(82.2)
1-100 31 (33.0) 859(23.9) 1119(25.5) 127(13.0)
101-400 10(10.6) 373(10.4) 732(16.7) 37(3.8)
>400 6(6.4) 202(5.6) 568(12.9) 10(1.0)
Total 79 3601 4390 975

Conclusion: Nocturnal hypoxia as measured by CT95 is associated with heavy/severe

Conclusion: There is an increased prevalence of CACS of >0 amongst Asian newly
diagnosed OSA patients with no CV symptoms or previously known CAD compared to
another Asian registry of patients with no prior cardiac history . CACS is potentially useful
for identifying subclinical CAD in OSA patients.Larger studies need to be done with follow
up for future risk stratification.
Disclosure of Interest: None Declared
PW334
coronary artery calcification. OSA patients who have cumulative desaturation below 95% of
more than approximately 60% of the duration of their sleep study are strongly associated
with a high CACS of
400. In OSA patients with no prior known Coronary Artery Disease,
a sleep study showing cumulative time with saturations below 95% of more than 60%
duration should have CACS quantified to assess for CAD. In light of this correlation be-
tween CT95 duration and CACS, CT95 should be considered as one of the main indices to
assess severity of OSA.
Disclosure of Interest: None Declared

Obstructive Sleep Apnoea as a Predictor of Coronary Artery Calcium Score

Lohendran Baskaran*1, Thun How Ong2, John C. Allen3, Song Tar Toh4, Max B. H. Wu5,
Swee Yaw Tan1
1
Cardiovascular Medicine, National Heart Centre Singapore, 2Respiratory Medicine, Singapore
General Hospital, 3Centre for Quantitative Medicine, Duke-NUS Singapore, 4Otolaryngology,
Singapore General Hospital, 5National Heart Centre Singapore, Singapore, Singapore
Introduction: Obstructive Sleep Apnoea (OSA) is associated with increased CV events. We
analysed Coronary Artery Calcium Scores (CACS) from newly diagnosed Asian OSA pa-
tients with no known Coronary Artery Disease (CAD). OSA and hypoxia were quantified
through a number of indices to assess their correlation with CACS.
Objectives: To assess correlation between the severity of OSA or hypoxia and the presence
of subclinical coronary artery calcification in newly diagnosed OSA patients. To identify the
measure of hypoxia/OSA which correlates best with coronary artery calcification.
PW335
Computed Tomography Coronary Angiography is an appropriate modality to
investigate chest pain in patients with low to intermediate risk of coronary artery
disease
Mohammad Paymard*1, Chia Lee Hsu2, Magda Budzillo2, Joyce Antony2, Rajesh Garg1,
Deborah Garcia3
1
Cardiology, 2Medicine, Rockhampton Hospital, 3Cardiology, Mater Misericordiae Hospital
Rockhampton, Rockhampton, Australia
Introduction: Computed tomography coronary angiography (CTCA) is a sensitive mo-
dality used to exclude significant coronary artery disease (CAD) in those individuals with
low to intermediate risk profile. Total coronary calcium score (TCCS) measured by CTCA
is related to the severity of CAD.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e327

 Objectives: This study evaluated one year outcome of patients with low to intermediate
POSTER ABSTRACTS
risk of CAD, presenting with chest pain who were managed based on their TCCS. We also
assessed the relation of traditional risk factors and their outcome.
Methods: In this retrospective study, we analyzed 260 consecutive patients with low to
intermediate risk profile undergoing CTCA using a 64 Multi-Slice scanner at our Institute
between January 2010 to January 2012. The patients were grouped based on recommended
management plan according to their TCCS. Primary end point was re-admission with
ischemic chest pain.
Results: The mean age was 44 13 years and 48.5 % were females. TCCS were zero
in 65.7%(171), mild in 24.2%(63), moderate in 6.5%(17) and severe in 3.4%(9). Risk factors
included Diabetes Mellitus 8.8%(23), obesity 43%(112), current smoker 40.4%(105), Family
history of premature CAD 36%(93), Hypertension 27.7%(72) and Dyslipidemia 26%(68).
Based on their TCCS, 93%(242) of patients were advised to modify their risk factors vs
7%(18) who were referred for a diagnostic coronary angiography. Out of the latter group
73%(13) had minor disease and managed medically, 17%(3) received coronary stents, and
11%(2) had severe disease requiring coronary artery bypass surgery. The study revealed that
moderate to severe TCCS (95% CI, p<0.001,Odds ratio¼ 45.1), dyslipidemia (95% CI,
p¼0.002,Odds ratio ¼7.0) and current smoking (95% CI, p¼0.037,Odds ratio ¼ 3.9) were
associated with invasive management. None of subjects from the group who were advised to
modify their risk factors was re-admitted with ischemic chest pain.
web 3C=FPO
web 3C=FPO
Conclusion: In low –to- intermediate-risk Patients presenting with chest pain, CTCA
provides high accuracy for non-invasive detection of suspected obstructive coronary artery
disease and also predicts their short-term outcome. Moderate to severe TCCS, dyslipidemia
and current smoking were associated with invasive management.
Disclosure of Interest: None Declared
PW336
CT coronary angiography: Distribution of early, non-occlusive coronary artery
disease
Victoria Cheng*1, Odgerel Tumur1, Chiew Wong1, Kean H. Soon1
1
Department of Cardiology, Western Health, Footscray, Melbourne, Australia
e328
Introduction: Although early studies have shown the pervasiveness of left anterior
descending artery (LAD) disease in angiographic and autopsy studies, the distri-
bution of non-occlusive disease by means of non-invasive imaging has not been
delineated.
Objectives: Here we describe the prevalence and distribution of early, non-occlusive
coronary artery disease (CAD) as well as associated risk factors using 64-slice computed
tomography coronary angiography(CTCA).
Methods: Prospective data was collected for all patients undergoing CTCA over a 2-year
period. Patients with significant (>50%) luminal stenosis or more than 2 coronary seg-
ments uninterpretable were excluded. A total of 323 studies were included into the final
analysis. Statistical analysis was performed using the MinitabÒ programme.
Results: The study population consisted of 180 males and 143 females. Mean age was
48.413.6 years. The main indication was for investigation of chest pain. The majority
(84%) had at least one risk factor for CAD that included type 2 diabetes, tobacco use,
hypertension, hypercholesterolemia and family history of premature coronary artery dis-
ease. Coronary artery dominance was as follows: 90% right, 9% left and 1% balanced
coronary artery system. 73 patients had functional testing prior, with 16% being positive.
183 studies were completely normal, and 140 had at least one coronary segment involved.
Of these, 11.7% had left main disease, 92.4% LAD, 25.5% left circumflex artery and 51.4%
had right coronary artery involvement. Proximal disease dominated in all 3 major vessels
with 81 proximal LAD(pLAD) compared to 53 mid and distal LAD diseased segments
combined. The number of diseased segments correlated with the number of risk
factors(p<0.005). Similarly, the number of proximal segments with disease also correlated
with the number of risk factors (p<0.008). Smoking appeared to be the only independent
predictor for proximal segment disease (p<0.02).
Conclusion: Early non-occlusive disease occurs at a disproportionately higher rate in the
LAD territory and more commonly in the proximal segments. Interestingly, smoking ap-
pears to be an independent risk factor for proximal segment disease.
Disclosure of Interest: None Declared
PW337
Incremental prognostic value of combining single-photon emission computed
tomography and coronary computed tomography angiography in patients with
suspected coronary artery disease
Yong-Jin Kim*1, Hack-Lyoung Kim1
1
Internal Medicine, Seoul National University Hospital, Seoul, Korea, Republic Of
Introduction: Noninvasive imaging tests play a vital role for the diagnosis and risk strat-
ification in patients with suspected coronary artery disease.
Objectives: This study was conducted to investigate the incremental prognostic value of
combined use of single-photon emission computed tomography (SPECT) and coronary
computed tomography angiography (CCTA) in patients with suspected coronary artery
disease (CAD).
Methods: A total of 1,295 patients with suspected CAD who underwent both CCTA and
SPECT within 90 days was retrospectively reviewed in 3 cardiac centers. Cardiovascular
events including cardiac death, non-fatal myocardial infarction, unstable angina and late (>
90 days of imaging tests) revascularization were assessed.
Results: During the mean follow-up period of 795  566 days (median, 735 days), there
were 109 events (8.4%). Perfusion defect on SPECT and significant stenosis (
50%) on
CCTA were independent predictors for events. Combined use of both imaging tests
significantly improved prediction of the cardiovascular events. Incremental prognostic
value of combined SPECT was significant in patients with stenosis of < 90% but not in
patients with stenosis of
90% on CCTA. Similarly, incremental prognostic value of
combined CCTA was significant in patients with summed stress score < 3 but not in
patients with summed stress score
4 on SPECT.
Conclusion: Combined use of SPECT and CCTA showed incremental prognostic value in
patients with suspected CAD. However, additional benefits were not significant when
CCTA revealed stenosis of
90% or SPECT revealed SSS
4. These results suggest an
effective risk stratification strategy for combining both anatomical and functional infor-
mation and maximizing the benefits in these patients.
Disclosure of Interest: None Declared
PW341
Frequency and causes of death in adults with Pulmonary Hypertension and
Congenital Heart Disease
Imre Hunyor*1, Geoff Strange2, Michelle Rose3, Leanne Grigg4, Fiona Kermeen5,
Clare O’Donnell6, Ingrid King7, Robert Weintraub3,8, David Celermajer1,9, and the PAH-CHD
Registry of Australia and New Zealand
1
Royal Prince Alfred Hospital, 2PHSANZ, Sydney, 3Royal Children’s Hospital, 4Royal Melbourne
Hospital, Melbourne, 5Pulmonary Vascular Disease Unit, The Prince Charles Hospital, Brisbane,
Australia, 6Starship Children’s Hospital, Auckland, New Zealand, 7The Murdoch Children’s
Research Institute, 8University of Melbourne, Melbourne, 9University of Sydney, Sydney,
Australia
Introduction: Pulmonary hypertension (PAH) complicates the clinical course of 1-5% of
adults with Congenital Heart Disease (CHD), with a negative impact on survival and quality
of life.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Objectives: We sought to document the frequency and causes of death for those
with a diagnosis of PAH complicating CHD, which has so far not been well
described.
Methods: We have established a Bi-National Registry of PAH-CHD cases from
Australia and New Zealand, comprising 360 adults with a confirmed diagnosis of
PAH and CHD and who have been seen at least once since Jan 1, 2000, at age over
16 years.
Results: 70 patients are known to have died (31 males, age 37  13 years). The un-
derlying causes of PAH were ASD (21%), PDA (23%), VSD (30%) and AVSD (16%); the
others had more complex CHD lesions (12%). 73% had Eisenmenger Syndrome and 24%
had Down’s Syndrome. Compared to survivors, the decedents were more likely to have a
single ventricle (13% vs 4%; p<0.001) and were less likely to have Tetralogy of Fallot
(1% vs 10%; p<0.02). There was no significant difference in the proportion of males,
smokers or those with Eisenmenger Syndrome, Down’s, ASD, PDA, AVSD or associated
lung disease in survivors compared with decedents. A similar proportion of patients in
both groups (27%) had undergone an intervention for their congenital heart disease. The
causes of death were varied and predominantly include cardiac arrest, right heart failure,
renal failure and sepsis.
Conclusion: Death is common in adults with PAH-CHD, often at a young age. The
commonest causes are progressive heart failure and sudden cardiac deaths however sepsis
and other causes have been documented. The effect of therapy on the risk and causes of
death in this group requires further prospective study.
Disclosure of Interest: None Declared
PW342
New scoring system for risk evaluation in Eisenmenger syndrome
Iveta Simkova*1, Monika Kaldararova2, Tatiana Valkovicova1, Anna Remkova3
1 and more social problems in cyanotic patients, and more social problems in the whole
Department of Cardiology and Angiology, Slovak Medical University and National Institute of
Cardiovascular Diseasess, 2Childrens Cardiac Centre, National Institute of Cardiovascular
Diseases, 3Hemomedika, Centre of Hemostasis and Thrombosis, Bratislava, Slovakia
Introduction: Eisenmenger syndrome (ES) means irreversible pulmonary arterial hyper-
tension (PAH) due to congenital heart disease (CHD); with right-to-left shunt leading to
systemic desaturation. ES patients (pts) are beyond CHD+PAH suffering also from com-
plications due to cyanosis and secondary cyanosis-related multisystemic dysfunction. These
non-cardiac problems are very often the cause of significant clinical worsening or even
death.
Objectives: Based on risk factors analysis during prospective long-term follow-up to create
a scoring system predicting high-risk pts.
Methods: 40 ES pts (28F/12M; median age 41.5 years; simple/combined shunts/complex
CHD 57.5%/17.5%/25%) underwent detailed analysis of subjective complaints and non-
cardiac diseases, clinical, laboratory, ECG analysis, 24-hour ECG monitoring, 6MWD,
echocardiography.
Results: Risk factors were considered: age >40y. (55%), complex CHD (25%), Down
syndrome (15%), NYHA III.-IV. (27.5%), 6MWD <380m (27.5%), arrhythmias (40%),
syncope (5%), right ventricular dysfunction (10%), increased NTpro-BNP (>1000ng/l)
(35%), systemic desaturation <85% (42.5%), oxygen therapy (15%), erythrocytosis (60%),
hematocrite
0.65 (7.5%), hyperviscose syndrome (2.5%), hyposideremia (55%), vitamin
B12 or folic acid deficiency (20%), bleeding event (35%), hemoptysis (12.5%), clinical
signs of thromboembolism (17.5%), laboratory parameters indicating increased bleeding
risk (30%) and risk for thrombosis (57.5%). Multisystemic affection: respiratory disease
(35%), renal dysfunction (25%), hepatobiliar dysfunction (27.5%), hyperuricemia (57.5%),
hypoalbuminemia (0), presence of
2 non-cardiac organ affection (70%). Scoring was
performed as follows: for each factor present was added 1 point. High-risk pts were
considered
10 points (35%), medium risk 6-9 points (35%) and low-risk pts with <5
points (30%).
Conclusion: In ES management crucial is the understanding of secondary affections due
to cyanosis and multisystemic dysfunction. These are often even more important for
survival and maintenance of clinical stability than PAH/CHD itself. Many of these
problems were separately analyzed and identified to play an important role in ES; though
no systematic approach was created so far. A unique complex scoring system is now
presented that can significantly help to evaluate ES pts, especially to define the ones at
highest risk; and to help to prevent complications and improve further management and
treatment considerations.
Disclosure of Interest: None Declared
PW343
Psychosocial Morbidity in Adolescents and Young Adults with Congenital Heart
Disease: Psychosocial Adjustment, Psychiatric Morbidity, Quality of Life and School
Performance may be affected, but Social Support and traits of Personality play an
important role in resilience
Maria Emília G. Areias*1, Liliana Gomes1,2, Daniela Cerqueira1,2, Catarina Pinto1,2,
Patrícia Vieira1,2, Isabela Freitas1,2, Flávio Teixeira1,2, Rosália Coelho1,2, Cláudia Moura3,4,
Victor Viana5,6, José Carlos Areias3,4,7
1 Sarah Eaton*1, QiFeng Wang2, Samuel Menahem3
Department of Psychology, Instituto Superior de Ciências da Saúde (CESPU), 2UNIPSA/CICS
(CESPU), Gandra-Paredes, 3Pediatric Cardiology, Hospital S. João, 4Unidade de Investigação
Cardiovascular, Faculty of Medicine, University of Porto, 5Pediatrics, Hospital S. João, 6Faculty
of Nutrition, University of Porto, 7Pediatrics, Faculty of Medicine, University of Porto, Porto,
Portugal
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Introduction: Remarkable progresses in medical and surgical care in congenital heart
POSTER ABSTRACTS
disease (CHD) allow patients to survive until a later time in adulthood and they are facing
challenges for adjustment throughout their life cycle.
Objectives: To study Quality of Life (QOL), Psychiatric Morbidity (PM), Psychosocial
Adjustment (PSA), School Performance (SP), Physical Limitations (PL) of patients with
Congenital Heart Disease (CHD) and the role of Social Support (SS) and Personality (P) on
resilience.
Methods: 196 CHD patients, 111 male, 12-26 years (M¼16.973.30), 109 cyanotic.
Clinical and demographic history was collected. Participants were interviewed once on
topics as SS, family educational style, self-image and PL, were administered a standardized
psychiatric interview (SADS-L) and completed self-report questionnaires on P (NEO-PI-R),
QOL (WHOQOL-BREF) PSA (YSR,ASR). One of their relatives filled the observational
versions of the questionnaires (CBCL,ABCL).
Results: We found a 15.3% lifetime prevalence of psychopathology (12.6%:mal-
es;18.8%:females) and 54.9% retentions in school (M¼ 1.55 year  0.50). Comparing
our patients to the population as a whole, they have better QOL in environmental
(t¼7.946;p¼0.000), social relationships:t¼4.296;p¼0.000), and overall (t¼2.489;
p¼0.014). Cyanotic showed worse QOL (physical:t¼-4.407;p¼0.000; psychological:t¼-
2.805; p¼0.006; environmental:t¼-4.233;p¼0.000) and overall. Complex CHD report
worse QOL (physical: t¼-3.357; p¼0.001; environmental: t¼-2.796; p¼0.006) and more
somatic complaints (u¼1644.000; p¼0.033); female patients refer more somatic com-
plaints (u¼4400.000; p¼0.005), feelings of anxiety/depression (u¼3803.500; p¼0.020),
thought problems (u¼3489.000; p¼0.001) and internalization (u¼2655.500; p¼0.000);
Patients submitted to surgery report worse QOL (physical: t¼-3.268; p¼0.001; psy-
chological: t¼-2.934; p¼0.004; environmental: t¼-2.236; p¼0.027) and more attention
problems (u¼2979.000; p¼0.005). Patients with better SS have better QOL (phys-
ical:t¼2.128;p¼0.035; psychological:t¼2.161;p¼0.032;social relationships: t¼4.130;
p¼0.000; environmental:t¼2.618;p¼ 0.010; overall:u¼2001.000; p¼0.002), and less
withdrawn behaviour (u¼2102.500;p¼0.011). Neurotic traits correlate to worse QOL
group.
Conclusion: CHD patients seemed to be more prone to PM, worse PSA and SP, although
SS plays a crucial role in resilience. P seem to provide a key explanation for a better or
worse QOL and PSA.
Disclosure of Interest: None Declared
PW344
Associations between sense of coherence, self-perceived health and physical health
status in Australian adults with congenital heart disease
Sarah Eaton*1, QiFeng Wang2, Samuel Menahem3
1
Melbourne Medical School, University of Melbourne, 2Monash University, Melbourne,
3
Wheatbelt GP Network, Perth, Australia
Introduction: Continuous advances in treatment of congenital heart disease (CHD) have
resulted in an increasing number of infants and children progressing to adulthood. A strong
sense of coherence has been found to have a positive impact on the health and well-being of
adults with chronic health conditions.
Objectives: To determine how sense of coherence and self-perceived health relate to the
physical health status of adults with CHD.
Methods: As part of the APPROACH - International Study, adults with CHD were recruited
from a consultant practice. Self reported questionnaires were completed including a 12
item health status survey, EuroQOL 5D, Brief Illness Perception Questionnaire, Orientation
to Life Questionnaire and Hospital Anxiety and Depression Scale. Clinical information was
provided by the participants’ current cardiologist.
Results: To date, 40 participants have been recruited with complete data available on 34.
Ages range from 17-49, with a mean age of 27. Currently 97% of participants are in NYHA
class 1. More than three quarters have had surgery for their cardiac condition. A higher
sense of coherence was found to positively correlate with a better physical health status
(Pearson correlation r¼0.45, p<0.05), while negatively correlating with symptoms of
anxiety and depression (r¼-0.48, p<0.01) and impact on life (r¼-0.39, p<0.05). It was
found that a worse perception of illness positively correlated with greater impact on par-
ticipants lives (r¼0.46, p<0.05) and negatively correlated with their physical health status
(r¼-0.42, p<0.05).
Conclusion: Participants with a strong sense of coherence experienced less impact on their
life, less symptoms of anxiety and depression and better physical health. Participants who
perceived their illness as more threatening experienced a greater impact on their life and
worse physical health. These findings highlight the importance for clinicians of adults with
CHD to focus on the positive aspects of their health despite the impact of their congenital
anomaly.
Disclosure of Interest: None Declared
PW345
Satisfaction with life and quality of life in adults with congenital heart disease and
their correlation with anxiety and depression – An Australian sample
1
Melbourne Medical School, University of Melbourne, 2Monash University, Melbourne,
3
Wheatbelt GP Network, Perth, Australia
Introduction: Following medical and surgical advances almost 85% of children born with
congenital heart disease (CHD) reach adulthood. Many report a worse quality of life and
e329
 more frequent emotional problems than their healthy counterparts despite varying
POSTER ABSTRACTS
outcomes.
Objectives: This study aims to determine the relationship between patients’ satisfaction
with life, quality of life and the impact on anxiety and depression experienced by adults
with CHD.
Methods: As part of the APPROACH - International Study, adults with CHD were
recruited from a consultant practice which also provided the patients’ clinical data. Self
reported questionnaires were completed including the Satisfaction with Life Scale,
Linear Analogue Scale for Quality of Life and the Hospital Anxiety and Depression
Scale.
Results: To date, 40 patients have been recruited with complete data currently avail-
able on 34 patients, including17 female and 13 male patients with a mean age of 27
(range 17-49 years). Three quarters had previously undergone surgery and 97% are
currently in NYHA class 1. The Satisfaction with Life Scale showed two thirds of
participants were extremely satisfied or satisfied. The Hospital Anxiety and Depression
Scale showed 68% of participants had no symptoms of anxiety, the rest showing
possible or probable anxiety. Four percent were found to have probable depression.
Participants rated their perceived quality of life on a linear analogue scale between 66
and 100, with a mean of 86. There was a significantly positive correlation between the
patients self-reported satisfaction with life and their quality of life (Pearson Correlation,
r¼0.58, p<0.01), with also a significant negative correlation with anxiety and
depression (r¼-0.46, p<0.01).
Conclusion: Patients with a higher quality of life also experienced a higher level
of personal satisfaction which correlated with fewer symptoms of anxiety and
depression. There is a need to sensitise health professionals to be more cognizant
of the psychological well-being of adults with CHD to allow for appropriate
interventions.
Disclosure of Interest: None Declared
PW346
The Utility and Safety of Contrast Echocardiography in Adult Congenital Heart
disease
Kylie Burns*1, Abhishek Sengupta1, Mugur Nicolae1, David Platts1
1
Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia
Introduction: Improvement in the diagnosis and management of congenital heart disease
during infancy has resulted in an increase in its prevalence in the adult population.
Contrast echocardiography may offer an additional benefit above conventional two-
dimensional echocardiography for the assessment of congenital heart disease patients with
suboptimal image quality.
Objectives: The aim of this pilot study is to evaluate the utility and safety of contrast
echocardiography for assessment of patients with congenital heart disease.
Methods: A retrospective analysis was undertaken involving all congenital heart disease
patients who underwent contrast echocardiography at our institution. Ventricular
morphology and function, endomyocardial definition, and baffle patency were assessed as
clinically appropriate, in patients with non-diagnostic 2D echocardiographic images and
in patients in whom cardiac MRI was contraindicated. Contrast (Definity) was adminis-
tered intravenously following written informed consent. One ampoule of contrast was
diluted to 10mls with normal saline. Any adverse effects were noted and managed as
appropriate.
Results: Contrast echocardiography was performed in 15 patients with adult congenital
heart disease. The spectrum of congenital disorders included Transposition of the Great
Arteries (n¼7), Co-arctation of the aorta with endocardial fibroelastosis (n¼1), Tetralogy of
Fallot (n¼4), LV Non-compaction (n¼2), Endomyocardial fibrosis (n¼1) and Double
Chamber Right Ventricle with infundibular obstruction (n¼1). Contrast echocardiography
improved estimation of right ventricular (RV) function in all nine patients requiring
assessment. Baffle patency was well demonstrated in two patients where baffle patency
could not be clearly defined on routine echocardiography. Endocardial enhancement with
contrast provided an accurate assessment of LV noncompaction and Endomyocardial
fibrosis/fibroelastosis when compared to the 2D images. Three patients were known to have
an ICD and two had permanent pacemakers. There were no recorded adverse reactions to
contrast.
Conclusion: This pilot study demonstrated that contrast echocardiography is a safe
imaging technique in a unique cohort of patients, providing incremental information
over and above sub-optimal conventional unenhanced echocardiograms. In particular,
it may be useful for the evaluation of right ventricular function, an important deter-
minant of outcome in those patients in whom an implantable device precludes a
cardiac MRI.
Disclosure of Interest: None Declared
PW347
Safety of intra-coronary delivery of human placental cord blood mononuclear cells in
a lamb model of infant cardiopulmonary bypass
Christian P. Brizard1, Jeffrey Y. Looi*2, Joseph J. Smolich3, Julie Angerosa3, Stephen Horton4,
Yves D’Udekem4, Ngaire J. Elwood5, Salvatore Pepe3
1
Cardiac Surgery, & MCRI, 2MCRI, Heart Research, Cord Blood Research, 3MCRI, Heart
e330
Research, 4Cardiac Surgery, 5MCRI, Cord Blood Research, Royal Children’s Hospital, Melbourne,
Australia
Introduction: One potential approach for enhancing right ventricular (RV) function and
muscle mass in infants after a Norwood procedure for palliation of hypoplastic left heart
syndrome (HLHS) is stem cell therapy. We previously demonstrated that direct intra-
myocardial injection of human placental cord blood mononuclear cells (CBMNC) in a
neonatal lamb model of RV overload augmented RV function and muscle mass measured
one month later (Ann Thorac Surg 89:585-93, 2010). In the context of treating human
infants with HLHS, whether CBMNC are safe to administer into the coronary vasculature
during cardiopulmonary bypass (CPB) is unknown, as are the acute effects and fate of these
cells.
Objectives: To evaluate the acute safety, functional effects and fate of human CBMNC
delivered directly into the coronary vasculature in a lamb model of infant CPB.
Methods: Anaesthetized lambs aged 7-10 days were randomized in blinded fashion
to receive blood cardioplegia alone (n¼5) or blood cardioplegia containing CD45+-
rich CBMNC (8x106 cells/kg body weight, n¼7) during CPB with cardiac arrest.
Aortic cross-clamp time was 40 min, with cardioplegia (+/- CBMNC) delivered
every 10 min. After CPB, haemodynamics were permitted to stabilize for 60 min.
Arterial and venous blood was sampled throughout, while left ventricular (LV)
function was measured pre-CPB and after the 60 min post-CPB recovery period
with a combined micromanometer-conductance catheter and pressure-volume loop
analysis. Distribution of human CD45+ cells was assessed by flow cytometry and
immunohistochemistry.
Results: CBMNC-treated lambs were haemodynamically stable post-CPB, with a decline
in LV end-systolic elastance (P<0.03) that was similar to control lambs (P¼0.3). CD45+
cells were heterogeneously distributed in all regions, with highest levels in the right
atrium and both ventricles (up to 24 cells/100mM2). All examined vasculature was patent,
without evidence of cell aggregates or blood clots. In all myocardial layers, CD45+ cells
were localized beyond endothelial cell layers and between myocytes. CD45+ cells were
rarely detected in arterial or venous blood sampled up to 1 hr post-CPB (<0.1% of
infused cells), but occasionally detected in spleen, liver, lungs and kidneys (<3 cells/
100mM2).
Conclusion: Coronary delivery of human CBMNC during cardioplegic arrest in a lamb
model of CPB has no short-term adverse cardiovascular effects.
Disclosure of Interest: None Declared
PW349
Percutaneous Closure of Atrial Septal Defect When Surgery Is Not Advisable
Mohamed Jahangir Abdul Wahab*1, Muhamad Ali Sheikh Abdul Kader1, Omar Ismail1
1
Department of Cardiology, Penang Hospital, Pulau Pinang, Malaysia
Introduction: Women with atrial septal defect (ASD) often reach child-bearing age without
closure. Managing them during pregnancy depends on ASD size and related pre-existing
cardiac issues.
Objectives: To perform percutaneous ASD closure at 2nd trimester due to non-advis-
ability of surgery and expected increased pulmonary artery pressure as pregnancy
progressed.
Methods: A 32-year-old at G3P2 at 22 weeks of gestation with secundum ASD and severe
pulmonary hypertension had defaulted surgical closure 8 years ago.
Currently, she was in NYHA functional class II, no clinical stigmata of Eisenmenger
syndrome and an ejection systolic murmur with a loud S2.
Transthoracic echocardiography showed a large secundum ASD, with left to right shunt.
Good ejection fraction seen and right sided chambers were dilated. Moderate tricuspid
regurgitation with pulmonary artery pressure of 69mmHg was noted. As pregnancy
advanced, blood volume would increase. ASD closure would reduce blood volume in the
right sided chambers and, in time, reduce pressure in the pulmonary artery.
She needed surgical closure but ruled out due to pregnancy which she declined to
terminate. Percutaneous ASD closure was chosen.
Right cardiac catheterization was performed. It showed severe pulmonary hypertension
with pulmonary artery systolic pressure 73 mmHg and a large left to right shunt with a Qp/
Qs 4.71. Aortic systolic pressure was 140mmHg. Pulmonary vascular resistance was less
than 5 Woods.
Intravenous Cefuroxime and Heparin were given. Procedure was performed under
sedation and fluoroscopic with abdominal shielding and transoesophageal echocardiogram
(TOE) guidance. TOE was used for sizing and procedure monitoring. Largest measured
diameter was 37 mm.
Using a MPA2 6Fr catheter and Terumo Straight wire, entered the left atrium
and left upper pulmonary vein. An Amplatz Superstiff wire was advanced. A 40mm
sized Amplatzer Septal Occluder (ASO) device was locked into 12Fr Amplatz
sheath. ASO was released sequentially into left upper pulmonary vein, left atrium,
septum and right atrium. ASO was deployed and released across the defect. Before
final release of the device, Minnesota Wiggle was done. Final result showed no
residual shunt.
Results: Repeat TTE showed reduction in pulmonary artery pressure to 30mmHg and no
ASD shunt was seen. She was discharged well with Aspirin 150mg daily for 6 months and
subacute bacterial endocarditis prophylaxis later during labour.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

web 3C=FPO
web 3C=FPO
Conclusion: Percutaneous closure of ASD in pregnant women is a high worth option.
Disclosure of Interest: None Declared
PW353
The Fiji Acute Rheumatic Fever Prophylaxis Adherence Study
Brenton Ward*1,2, Bircan Erbas1, Rigamoto Taito3, Samantha Colquhoun2,4,5, Tom Parks6,7,
Sophie Lavincente4, Don Vicendese1, Joseph Kado8, Andrew Steer2,4,9
1
School of Public Health, La Trobe University, 2Murdoch Childrens Research Institute,
Melbourne, Australia, 3Fiji Ministry of Health, Lautoka, Fiji, 4Centre for International Child
Health, The University of Melbourne, Melbourne, 5Menzies School of Health Research, Charles
Darwin University, Darwin, Australia, 6Centre for Clinical Vaccinology and Tropical Medicine,
University of Oxford, Oxford, 7Faculty of Infectious and Tropical Diseases, London School of
Hygiene and Tropical Medicine, London, United Kingdom, 8Fiji Ministry of Health, Suva, Fiji,
9 1
The Royal Children’s Hospital, Melbourne, Australia
Introduction: Acute Rheumatic Fever (ARF) is an immune-mediated, inflammatory disease
preceded by Group A Streptococcal infection. A consequence of recurrent ARF is Rheu-
matic Heart Disease (RHD). ARF and RHD are significant causes of premature morbidity
and mortality in the Pacific Island nation of Fiji.
ARF secondary prevention strategies involve regular treatment with intramuscular
penicillin and are essential for people with a past history of ARF to prevent ARF recurrence
and subsequent RHD progression.
Objectives: To determine the level of adherence to secondary prevention strategies among
patients in Fiji with a past history of acute rheumatic fever (ARF) or a diagnosis of rheu-
matic heart disease (RHD) and investigate associations between demographic factors, dis-
ease severity and adherence.
Methods: The study was conducted within a defined geographic area in the Western
Division of Fiji. Patient adherence to secondary prevention was assessed over a 5 year
period (2008-2012) by retrospective review of benzathine penicillin G injection re-
cords at 5 health facilities. Additional data including date of birth, gender, ethnicity,
location of residence and disease severity were analyzed for associations with
adherence.
Results: Adherence and demographic data was collected on 244 patients, and disease
severity data were obtainable for a subset of the study population. Data are currently under
analysis and will be available for presentation at the meeting.
Conclusion: Patient adherence to ARF secondary prevention regimens is vital for avoiding
ARF recurrence and RHD progression. This study assessed prevalence of adherence and
associations between demographic factors, disease severity and adherence. Results may be
utilised by RHD control and prevention programs to identify patients at risk of poor
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
adherence and enable targeted approaches to improve adherence with ARF secondary
POSTER ABSTRACTS
prevention regimens.
Disclosure of Interest: None Declared
PW354
Improving Access To Secondary Prevention of Rheumatic Heart Disease: Mitigating
Fear of Anaphylactic Penicillin Allergy In Zambia
John Musuku*1, Aidan Long2, Somwe W. Somwe1, Gloria Habanyama1, Brigitta Tadmor3,
Jonathan M. Spector3
1
Lusaka University Teaching Hospital, Lusaka, Zambia, 2Massachusetts General Hospital,
Boston, 3Novartis Institutes for BioMedical Research, Cambridge, United States
Introduction: Identifying barriers to penicillin administration is vital to the success of
secondary prevention programs for rheumatic heart disease (RHD). In Zambia we
discovered that fear of anaphylactic penicillin allergy is a fundamental concern causing
health workers’ failed compliance with established guidelines. This came to light initially
through “confessions” by numerous staff over several years. To address this concern, we
designed and implemented a citywide penicillin allergy workshop. This is, to our knowl-
edge, the first report of such a workshop in Africa.
Objectives: We sought to characterize changes in knowledge and skills after imple-
mentation of a novel penicillin allergy training workshop in Lusaka, Zambia, and to
determine trainees’ perceptions of the utility of the course.
Methods: As part of a public-private partnership to combat RHD in Zambia, a 2-day
penicillin allergy workshop was conducted in Lusaka in July 2013. The curriculum was
drawn from evidence-based guidelines from the World Allergy Organization, and included
interactive didactic sessions, peer-to-peer learning, and a skills session focused on
anaphylaxis management. Trainees completed a 10-item multiple-choice questionnaire
before and after the course and were graded on a standardized 5-point scale during pre-
and post-training skills sessions. Mean test scores were compared using paired Wilcoxon
signed rank sum testing (SOFA software, version 1.3.4).
Results: Twenty-nine health workers (mostly nurses and doctors) from more than
20 health centers participated. Fear of giving penicillin was corroborated in a focus
group session at the start of the workshop; nearly all trainees had heard anecdotal
stories of penicillin-induced harm, but few knew details of the cases and only one
had previous training in drug allergy recognition and management. Knowledge
scores improved from 7.8/10 (SD 1.6) to 9.8/10 (SD 0.4; p<0.001), and skill scores
improved from 2.5/5 (SD 1.4) to 4.8/5 (SD 0.4; p<0.001). In anonymous post-
course evaluations, all participants reported that their clinical practice would change
as a result of the course.
Conclusion: Fear of drug allergy may be an important under-recognized barrier to
secondary prevention of RHD. In Zambia, health workers demonstrated improved
knowledge and skills after a penicillin allergy workshop. To safeguard essential
medical care for patients with RHD globally, stakeholders in similar contexts
should explore whether drug allergy fear hinders secondary prevention in their
programs.
Disclosure of Interest: J. Musuku Grant/research support from: Novartis Institutes for
BioMedical Research, A. Long: None Declared, S. Somwe: None Declared, G. Habanyama:
None Declared, B. Tadmor Employee from: Novartis Institutes for BioMedical Research,
J. Spector Employee from: Novartis Institutes for BioMedical Research
PW355
Insights from the Pacific Rheumatic Heart Disease Prevention and Control
Programme
Samantha Colquhoun*1,2,3, Titus Nasi4, Teatro Tira5, Gano Mwareow6, Maliesi Latasi7,
Stephen Homasi8, Geoff Kenilorea9, Joseph Kado10, Liz Kennedy2, Jonathan Carapetis11
Dept of Paediatrics, Centre for International Child Health, UNiversity of Melbourne, Melbourne,
2
GLobal Health Division, Menzies School of Health Research, Darwin, 3Murdoch Childrens
Research Institute, Melbourne, Australia, 4Paediatrics, National Referral Hospital, Ministry of
Health, Honiara, Solomon Islands, 5Ministry of Health, Tarawa, Kiribati, 6Nursing, Ministry of
Health, Yaren District, Nauru, 7Paediatrics, 8Director of Health, Ministry of Health, Funafuti,
Tuvalu, 9NCD, Ministry of Health, Honiara, Solomon Islands, 10Paediatrics, Ministry of Health,
Suva, Fiji, 11Telethon Institute for Child Health Research, University of Western Australia, Perth,
Australia, Perth, Australia
Introduction: The Pacific region has the highest documented Rheumatic Heart Disease
(RHD) prevalence globally yet it struggles to achieve the profile and attention it deserves
from governments and funding bodies. A project is underway to strengthen RHD control in
Nauru, Tuvalu, Kiribati and the Solomon Islands with emphasis on improving patient
management and increasing programme integration within existing non-communicable
disease (NCD) and child health programmes.
Objectives: To improve capacity among Pacific Island nations to deliver comprehensive
register based prevention and control programmes.
Methods: Implement a register-based RHD prevention and control programme based on
WHO recommendations. An Australian based technical team assists Ministries of Health to
expand capacity and strengthen existing management activities though establishment of a
national register and reporting system, health worker training and supporting enhanced
surveillance.
Results: National protocols for the diagnosis and management of Acute Rheumatic
Fever (ARF) have been finalised and RHD has been integrated into the National Health
Strategy in Kiribati. One country currently has a dedicated RHD coordinator, which
e331
 has enhanced capacity to progress the programme beyond establishment phase. Stra-
POSTER ABSTRACTS
tegies to improve patient management including, introducing patient injection/
reminder cards, operating monthly patient clinics and strengthening data collection
practices have been implemented. Three countries now have a data system in place
which assists monitoring and management of patients and measurement of programme
performance. Advocacy and education efforts are enhanced through the school
screening programme and one on one training. Baseline burden of disease data has
been collected and health worker training and community awareness campaigns have
been commenced. Challenges to integration exist within health systems including;
competing health priorities, poor Benzathine Penicillin G (BPG) delivery rates, limited
diagnostic capacity and no regional surgical facility.
Conclusion: The Pacific RHD programme has seen an increase in disease awareness and
notification among health staff and the community; however, improving BPG compliance
and patient management remain key challenges. Efforts to increase integration with NCD
strategies are fundamental to ensuring long term sustainability of the programme at a
country and regional level.
Disclosure of Interest: None Declared
PW356
Epidemiology of rheumatic heart disease (RHD) in pregnancy: Australia and New
Zealand
Elizabeth Sullivan1, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Geraldine A. Vaughan*2,3, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS
study: Kylie Tune4, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Faith Mahony5, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Lisa Jackson Pulver6, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Jonathan Carapetis7, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Warren Walsh8, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Michael J. Peek9, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Claire McLintock5, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study:
Sue Kruske10, on behalf of Rheumatic Heart Disease in Pregnancy: an AMOSS study and
Rheumatic Heart Disease in Pregnancy: an AMOSS study
1
National Perinatal Epidemiology and Statistics Unit, 2Australasian Maternity Outcomes
Surveillance System (AMOSS), National Perinatal Epidemiology and Statistics Unit,
University of New South Wales, Sydney, 3Australasian Maternity Outcomes Surveillance
System (AMOSS), National Perinatal Epidemiology and Statistics Unit, University of New
South Wales, Randwick, 4NT project coördinator, Menzies School of Health Research,
Darwin, Australia, 5National Women’s Health, Auckland City Hospital, Auckland, New
Zealand, 6Muru Marri Indigenous Health Unit, University of New South Wales, Sydney,
7 culturally safe way and that people understood what they were consenting to. Whilst
Telethon Institute of Child Health Research, Perth, 8Eastern Heart Clinic, Prince of Wales
Hospital and UNSW, Randwick, 9Sydney Medical School Nepean, University of Sydney,
Penrith, 10Queensland Centre for Mothers & Babies, The University of Queensland,
Brisbane, Australia
Introduction: Whilst overall a rare disease in Australia and New Zealand (ANZ),
RHD is disproportionate amongst Aboriginal and Torres Strait Islander, and Maori
and Pacific Islander peoples and immigrants (particularly refugees) from sub-Saharan
Africa and Asia. This disease of poverty and inequity has increased impact in
pregnancy.
Objectives: The Australasian Maternity Outcomes Surveillance System (AMOSS) - a
UNSW-based surveillance and research system that monitors rare and serious conditions in
pregnancy - is conducting a four-year mixed-methods study of RHD in pregnancy (RHD-
P). Nearly 300 participating sites across ANZ report monthly and complete web-based
surveys on history, clinical pathways and outcomes for women with RHD-P during Jan
2013-Dec 2014.
Our objectives are to examine preliminary data provided to the AMOSS RHD-P quan-
titative study during the first 16 months of the study.
Methods: 1) Examination of survey data; 2) Australian surveillance data compared to
hospital jurisdictional reporting of RHD-P.
Eligibility includes pregnant women with RHD during 2013-2014 across ANZ, with a
rigorous inclusion review using World Heart Federation criteria for echocardiographic
diagnosis of RHD and peer review confirmation by investigators.
Up to four echocardiogram reports are submitted to the investigators for review and
entry, and these provide critical information regarding inclusion and clinical pathways of
the women.
Results: Based on jurisdictional data 2004/05-2009/10, the expected number of
Australian cases ranges from 90-151 per annum. During the first eight months of the
study, 51 eligible cases (Australia) and 43 (NZ) were notified. No women have died. A 2-
3 month lag in notification occurs in over 33% of sites. Enhanced surveillance has been
implemented in Northern Territory of Australia (NT) across perinatal, remote health,
RHD Control register and hospital data systems. A sub-study in NT has been developed
to explore care pathways and health services for women excluded from the main
quantitative study.
Conclusion: This prospective observational study forms the largest population-based
research of women with RHD-P ever studied. It is examining the true incidence, distri-
bution, epidemiology and impact of RHD-P, which has a profoundly disproportionate
impact amongst Aboriginal and Torres Strait Islander, and Maori and Pacific Islander
women. Study findings will enable benchmarking to identify key attributes of successful,
culturally safe models of health care.
Disclosure of Interest: None Declared
e332
PW357
Rheumatic Heart Disease: Establishing governance and Community Engagement for a
genome wide association study in an Indigenous Australian population
Heather A. D’antoine*1, Ngiare Brown2, Dawn Bessarab3, Maui Hudson4, Steven Tong5,
Andrew Steer6, Joanne Garnjulkpuy7, Elaine Maypilama8, Lorna Murakami-Gold9,
Alex Brown10
1
Education and Research Support, Menzies School of Health Research, Darwin, 2University of
Wollongong, Wollongong, 3Curtin University, Perth, Australia, 4Te Kotahi Research Institute,
University of Waikato, Hamilton, New Zealand, 5Global and Tropical Health, Menzies School of
Health Research, Darwin, 6Royal Childrens Hospital, Melboune, 7Yalu Marnithinyaraw,
Galiwin’ku, 8Wellbeing and Preventative Chronic Diseases, Menzies School of Health Research,
Darwin, 9Australian Centre for Indigenous Knowledge and Education, Charles Darwin
University, Alice Springs, 10School of Population Health, University of South Australia, Adelaide,
Australia
Introduction: Aboriginal people in the Northern Territory (NT) have among the highest
incidence of acute rheumatic fever (ARF) and prevalence of rheumatic heart disease
(RHD). The immune pathways leading from infection with Group A Streptococcus (GAS)
to the development of ARF/RHD are poorly understood. Although there is near universal
exposure to GAS, only 3 - 6% of Aboriginal people develop ARF. We are conducting a
genome wide association study to determine if individuals have an underlying genetic
susceptibility to developing ARF/RHD. However, there has been a fraught history with
regards to genetic research among Indigenous populations – both in Australia and
elsewhere.
Objectives: To ensure that the study is conducted in a culturally safe way, and addresses
future use of the samples, the first stage of the study involves establishing Aboriginal
governance, relationship building and community engagement.
Methods: We included three Aboriginal people in the investigator team and established an
all Indigenous governing committee. We conducted ‘Yarning Circles’, using community
based participatory action research methodology, to investigate community understandings
of genetic research and to develop culturally appropriate informed consent materials.
Detailed discussions with local community elders and councils were conducted in each
individual community.
Results: Key issues identified by the Indigenous governing committee include how
samples and data should be stored. The informed consent form allows for opt-in
consent for samples and data to be used for other future research: to date 29% of
participants have consented to such future research. The Yarning Circles have found
that although Aboriginal people have a limited and diverse understanding of genetics
and RHD and they were keen to know more about the condition and if there is an
associated link.
Conclusion: Community were keen to ensure that the research was conducted in a
community members have little understanding about the long term storage of the data and
samples for genetic research, there is increasing recognition of the value of genetic resources
and importance of Indigenous involvement in the conduct of research and ongoing
governance of data and samples.
Disclosure of Interest: None Declared
PW358
Multicentric study to find burden of Rheumatic Fever and Rheumatic Heart Disease
and its prevention through secondary prophylaxis in India
Meenakshi Sharma1, Vinod J. Abraham2, Rakesh Bahl3, Anil Bharani4, P. K. Borah5,
K. Brahmadathan6, Anuradha Chakraborti7, D. S. Jamwal3, M. G. Karmarkar8,
R. Krishnakumar*9, Rajesh Kumar10, J. Mahanta5, Murli L. Mathur11, Prakash Negi12,
J. S. Thakur10
1
Division of NCD, Indian Council of Medical Research, New Delhi, 2Community
Medicine, CMC, Vellore, 3Community Medicine, Govt Medical College, Jammu,
4
Cardiology, MGM Medical College, Indore, 5RMRC, Dibrugarh, 6Microbiology, CMC,
Vellore, 7Experimental Medicine and Biotechnology, PGIMER, Chandigarh, 8Microbiology,
KEM Hospital, Mumbai, 9Paediatric Cardiology, AIMS, Kochi, 10School of Public Health,
PGIMER, Chandigarh, 11DMRC, Jodhpur, 12Cardiology, Indira Gandhi Medical College,
Shimla, India
Introduction: Rheumatic Fever (RF)/Rheumatic Heart Disease (RHD) continue to be a
neglected public health priority in India.
Objectives: ICMR conducted epidemiological studies for Group A streptococcal (GAS)
sore throat and impetigo, school-based surveys and established 10 RF-RHD registries
from 2000-2010 to understand the biology of streptococci, magnitude of RF/RHD and
feasibility of implementing RF/RHD control program through the existing health
infrastructure.
Methods: RF/RHD registries were established in about one million populations in each of
the ten centres located in western, southern, central and northern India. Health education
campaigns in community and training to medical and paramedical staff was undertaken.
Monthly benzathine penicillin injections for secondary prophylaxis and referral to a tertiary
care for medical or surgical treatment of RHD cases were done. Oral penicillin was used in
3 of the southern centers in accordance with local policies. Secondary prophylaxis
compliance data was collected by 5 centres.
Cross-sectional surveys were conducted among 10,000 to 25,000 school children in
5-14 year age group in each center. Cases identified by auscultation in field area were
referred to a tertiary care hospital for echocardiography based examination by
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
cardiologist. Throat/ skin swab GAS isolates from children were emm typed. School
survey data was used for estimation of RF/RHD burden using a correction factor
(number of RF/RHD cases in 15+year population to be 5 times that in 5-14 year-olds).
Results: Sore throat GAS prevalence ranged from 0.1% to 11.3%. GAS impetigo prevalence
was 2.7% in Chandigarh and 27.3% in Vellore. Typing of 148 GAS isolates revealed 49
different emm types.
Of the 5590 RF/RHD registered cases, 4936 were RHD and rest were RF cases.
Sixty-two percent of cases were females. Mitral valve involvement was most common.
A large proportion (38 to 95%) of RHD cases could not get interventions, mainly due
to poor financial status. High rates of compliance to secondary prophylaxis were
reported. RHD prevalence in 5-14-year-old students was 0.1 to 1.2/1000. Consider-
able amount of under-reporting was observed in registries. Median population prev-
alence estimates of RF/RHD from school survey using a correction factor was 1.4/
1000.
Conclusion: RF/RHD continues to be a public health problem in India. Registry-based
secondary prevention program within the existing health services is feasible for RF/RHD
prevention and control.
Disclosure of Interest: None Declared
PW359
Exploring the case for an Atlas of Rheumatic Heart Disease
Rosemary Wyber*1
1
RhEACH, Telethon Institute for Child Health Research, Perth, Australia
Introduction: A large number of ‘disease specific atlases’ (DSAs) have been developed over
the last two decades including diabetes, tobacco and malaria. Cited as opportunities to
advance research, policy making, advocacy and fundraising DSAs have emerged as a novel
genre to communicate country level burden of disease data. Rheumatic heart disease (RHD)
control is stymied by a critical shortage of reliable epidemiologic data. Development of an
Atlas of RHD may offer an opportunity to collate existing prevalence data and overlay
disease control efforts.
Objectives: To describe the characteristics of existing DSAs, explore models of data
collection and impact evaluation. To evaluate the potential relevance to RHD.
Methods: WHO archives and websites of international disease specific advocacy
groups were searched to identify DSAs which used geographic maps to present na-
tional level data for a specific disease, category of disease or risk factor for disease.
Atlases were interrogated for data sources, structure, publication format and features.
Commentaries and referencing articles were reviewed for evidence of impact
evaluation.
Results: Twenty four DSAs were identified, acknowledging use of a relatively arbi-
trary definition for this novel genre. The majority were downloadable PDF docu-
ments based on secondary data collated from WHO and overlayed with survey
responses provided by in-country experts. A minority – largely DSAs for infectious
diseases – had an online platform with capacity for researchers to upload and
download data. Although there was little formal impact evaluation there was strong
circumstantial evidence that publishing institutions found atlases valuable as advo-
cacy tools.
Conclusion: There is strong circumstantial evidence that of disease specific atlases are
valuable for advocacy and interactive features may facilitate research. Given the challenges
in collating and comparing burden of disease estimates an Atlas of RHD may provide a
much needed platform for this otherwise neglected disease.
Disclosure of Interest: None Declared
PW360
Correlation of Echocardiographic Assessment of Mitral Valve Area with the Gorlin
Formula in Patients with Mitral Stenosis undergoing Percutaneous Balloon Mitral
Valvuloplasty
Samuel D. Hillier*1, Arvin Lamanna1, Darren Walters1, David Platts1
1 PW362
Cardiology, The Prince Charles Hospital, Brisbane, Australia
Introduction: Numerous echocardiographic methods can estimate mitral valve area in
patients with mitral stenosis, with mitral valve planimetry having the best correlation with
anatomical data. The Gorlin formula can be used to calculate mitral valve area using data
acquired from invasive measurements acquired during percutaneous balloon mitral val-
vuloplasty (PBMV).
Objectives: To determine correlation of mitral valve area obtained from echocardiographic
measurements (pressure half time, planimetry and continuity equation) with that obtained
from the Gorlin formula before and after PBMV.
Methods: All patients undergoing PBMV procedures from 2006 until September 2013
were identified from a database. Data from transthoracic and transoesophageal echocar-
diograms before and the day following PBMV were recorded. We recorded mitral valve area
by planimetry, transmitral pressure half time, and the continuity equation (unless >1/4
mitral or aortic regurgitation) in all procedures performed over a 7 year period, and
compared the results to that obtained by the Gorlin formula pre-and post balloon
dilatation.
Results: 47 patients were indentified (85% female), mean age 5317yrs (range 17–85
yrs). Echocardiographic and haemodynamic mitral valve area obtained pre and post
PBMV are detailed below. Pearson’s correlation and Bland-Altman agreement with Gorlin
Formula are calculated on combined pre-and-post valvuloplasty data. The continuity
equation could not be used in 53% of cases due to greater than 1/4 mitral or aortic
regurgitation.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Pressure Half Continuity Gorlin
POSTER ABSTRACTS
Planimetry Time Equation Formula
MVA pre 1.020.27 1.250.46 0.930.28 1.210.25
PBMV
MVA post- 1.650.30 1.540.43 1.230.38 1.840.51
PBMV
Pearson’s 0.77 (0.63-0.87) 0.40 (0.14-0.62) 0.61 (0.26-0.82)
Correlation p<0.0001 p¼0.004 p¼0.003
Bland-Altman -0.19 (-0.83–0.45) -0.16 (-1.2–0.89) -0.49 (-1.38–0.41)
Conclusion: Mitral valve area by planimetry correlates well with the invasive assessment of
mitral valve area by Gorlin formula. Whilst the continuity equation had reasonable cor-
relation, its assessment of mitral valve area is limited in rheumatic mitral stenosis by the
presence of aortic regurgitation and mixed mitral valve disease. Mitral valve area assessment
by pressure half time was poor in our cohort.
Disclosure of Interest: None Declared
PW361
Rheumatic Rescue: Prospective application of the World Heart Federation echo
screening guidelines in Samoa
Marvin Allen1, Lori B. Allen2, Farah Marumatakimanu*3, John W. Allen1, Andrew Jo1,
Kyle Dawson1, Adonica I. Kauwe2
1
Cardiology, Central Utah Clinic, Provo, 2Public and Community Health, Utah Valley
University, Orem, United States, 3Pediatrics, National Health Services, Apia, Samoa
Introduction: The World Heart Federation (WHF) has proposed screening echo criteria to
identify children with no prior diagnosis of rheumatic heart disease (RHD). These criteria
have not been prospectively applied to a population with endemic RHD. Samoa has a
known increased prevalence of RHD.
Objectives: To prospectively utilize the WHF screening echo criteria in school aged
children in Samoa to determine the prevalence of definite and borderline RHD.
Methods: Samoan school children in grades 1-8 were studied. A brief screening echo was
performed (parasternal long axis view with and without color). If >trivial mitral regurgi-
tation (MR), or any aortic regurgitation (AI) were seen, the child received a comprehensive
echo with emphasis on the WHF criteria. Experienced cardiologists reviewed the studies
and categorized them into definite RHD, borderline RHD or normal MR according to the
WHF guidelines.
Results: 3869 children were screened. 3 children were excluded with known RHD and
7 excluded due to significant congenital heart disease. The ages ranged from 5-17 with
a mean age of 10.1(+/- 2.4) years. 52% were male. 119 (3%) were referred for
comprehensive echos. 48 (12/1000) qualified as definite, 21 (5/1000) borderline and
50 (13/1000) as normal MR. Of those classified as definite, the mean age was 10.4(+/-
2.0) years, with 46% male. 33/48 had isolated MR, 10/48 had both MR and AI, 4/48
had isolated AI, and a single patient had mitral stenosis. 18/48 (38%) had regurgitant
lesions graded as moderate or severe. The borderline group mean age was 9.8 (+/-2.0)
years, 33% male. 14/21 had pathologic MR, 7/21 had morphologic changes of the
mitral valve and 1/21 had pathologic AI, with 3/21cases of moderate or severe
regurgitation.
Conclusion: The prevalence of definite RHD was 12/1000 in school-aged children in
Samoa. The majority of definite RHD lesions were isolated MR, however, a significant
portion had AI and moderate or severe regurgitation. Further study, including follow up
studies on these patients, will be needed to determine if the WHF criteria accurately
identifies children that will benefit from prophylactic antibiotics.
Disclosure of Interest: None Declared
Rheumatic Rescue:The use of Z scores to evaluate the World Heart Federation
classification of echo screening of rheumatic heart disease
Marvin Allen*1, John W. Allen1, Lori B. Allen2, Andrew Jo1, Kyle Dawson1, John B. Allen1
1
Cardiology, Central Utah Clinic, Provo, 2Public and Community Health, Utah Valley
University, Orem, United States
Introduction: The Z score corrects dimensional measurements based upon the height
and weight, which has been accepted for evaluation of pediatric patients. The Z score is
reported by a standard deviation from a mean measurement with a value of 0; rather
than a measured value. A Z score of +1 would be one standard deviation away from the
mean of 0.
Objectives: This study compares the Z scores of the Definite Rheumatic Heart
Disease group to the control group in order to identify the differences in cardiac
structure.
Methods: We conducted our study on two Samoan Island whose schools have a high
prevalence of RHD. The students who were classified as Definite RHD have an abnormal
valve leaflet morphology and a complete Doppler recording of regurgitation. While the
control group was selected from those who were free of valvular disease. The study con-
sisted of 3,869 students from 24 schools who were screened by a portable echocardio-
graphic machine. Preference was given to grades 3 through 8 with a mean age of 10.2  2.0
and 48% of the samples were female.
e333
 Results: 48 students were classified as Definite RHD with a mean age of 10.4 and 52%
POSTER ABSTRACTS
were female. 38 students were from the Control group with a mean age of 10.7 and 61%
were female.
Conclusion: The students that were classified as Definite RHD have a significant dif-
ference in cardiac structure as determined by a Z score when compared to the Control
group. This difference supports the Definite RHD classification according to WHF
criteria.
Disclosure of Interest: None Declared
PW363
Echocardiographic Screening In A Resource Poor Setting: Borderline Rheumatic
Heart Disease Could Be A Normal Variant
Samantha Colquhoun*1,2,3, Joseph H. Kado4, Bo Remenyi5, Nigel J. Wilson6,
Jonathan R. Carapetis7, Andrew C. Steer1,8
1
Dept of Paediatrics, Centre for International Child Health, University of Melbourne,
Melbourne, 2Global Health Division, Menzies School of Health Research, Darwin,
3 femoral vascular access was used for emergent PCI and this changed to predominantly
Murdoch Childrens Research Institute, Melbourne, Australia, 4Fiji GrASP, Ministry of
Health, Suva, Fiji, 5Menzies School of Health Research, Darwin, Australia, 6Auckland
District Health Board, Auckland, New Zealand, 7Telethon Institute for Child Health
Research, Centre for Child Health Research, University of Western Australia, Perth,
8 emergent PCI were retrospectively examined using prospectively collected data from the
Group A Streptococcal Research Group, Murdoch Childrens Research Institute,
Melbourne, Australia
Introduction: Pacific Island countries have among the highest prevalence of rheumatic
heart disease (RHD) documented in the world. Since 2005 Fiji has had a RHD control
and prevention programme, structured according to World Health Organization
(WHO) recommendations. The WHO guidelines recommend screening for new cases
to identify RHD before it becomes symptomatic so that secondary prevention can be
commenced.
Objectives: This study was undertaken to estimate the echocardiography confirmed
prevalence of rheumatic heart disease in primary school aged school children in Fiji.
Methods: A cross-sectional observational study of children aged 5-14 years was con-
ducted. Each child enrolled had a screening echocardiogram for RHD as well as
auscultation performed by a paediatrician. The study was undertaken in rural and
urban primary schools. Echocardiographic criteria for RHD diagnosis were based on
those previously published by the National Institutes of Health (NIH) and WHO, data
was also analyzed using the newly published World Heart Federation criteria. All
echocardiograms were reviewed subsequently by a cardiologist not involved with the
initial screening. Prevalence figures were calculated with binomial 95% confidence
intervals.
Results: Using the NIH/WHO criteria a definite RHD prevalence of 7.2 cases per 1000
was estimated, and a prevalence of probable RHD of 28.2 cases per 1000. Definite RHD
was more common in females (OR 5.1, 95% CI 1.1-48.3) and in children who
attended a school in a rural location (OR 2.3, 95% CI 0.6-13.50). The WHF RHD
echocardiography criteria gave a prevalence of definite RHD of 8.4 cases per 1000
(95% CI 4.6-14.1) and a prevalence of borderline RHD of 10.8 cases per 1000 (95% CI
6.4-17.0) was estimated. The association of risk factors in the Probable and Borderline
group did not follow expected pattern seen in the definite cases. Comparison between
echocardiography and auscultation for pathological murmur showed a sensitivity of
30% and a specificity of 97.5%.
Conclusion: This study highlights the importance of the use of highly sensitive and
specific diagnostic criteria for echocardiography diagnosis of RHD. Echocardiography
as a diagnostic tool for diagnosis and screening for RHD, in conjunction with stan-
dardized guidelines for diagnosis that allow high sensitivity and specificity, appears to
have made auscultation obsolete, however uncertainty remains around the definitions
of true RHD for cases that don’t fit the definite criteria. There is a high burden of
undiagnosed RHD in Fiji.
Disclosure of Interest: None Declared
PW367
The effect of insulin therapy algorithms on blood glucose levels in post-operative
patients following cardiac surgery: A systematic review
Megan Higgs*1, Ritin Fernandez2
1
Centre for Research in Nursing and Health, St George Hospital, 2Centre for Research in Nursing
and Health, St George Hospital, University of Wollongong, Sydney, Australia
Introduction: Current literature suggests that hyperglycaemia occurs almost universally
after cardiac surgery, and glycaemic control to a mean blood glucose of 5.7mmol/L lowers
morbidity and mortality by up to 50%.
Objectives: The objective of the systematic review was to determine the effect of insulin therapy
algorithms on blood glucose levels in post-operative patients following cardiac surgery.
Methods: Clinical trials were identified by searching the electronic medical and nursing
databases, reference lists and grey literature. Trials were included if they were undertaken
on adult patients, aged 18 years and over, who were admitted to a critical care unit
following cardiac surgery and who received insulin therapy for glycaemic control during
the acute postoperative phase (5 days) of admission.
Results: Fourteen clinical trials were identified through the search. Blood glucose targets
ranged from 4.4 – 11.1 mmol/L. The majority of the studies used arterial or venous samples
to monitor blood glucose levels. Frequency of monitoring of blood glucose levels ranged
from one to four hours. In all trials insulin was administered via infusion with doses
ranging from 0.1-10 IU per hour. The mean blood glucose levels following the insulin
e334
therapy algorithms in the trials ranged from 4.4 – 9.7 mmol/L. The incidence of hypo-
glycaemia ranged from 0.2-7.1%
Conclusion: Insulin therapy algorithms in the post-operative period are effective in
maintaining optimal blood glucose levels in patients following cardiac surgery.
Disclosure of Interest: None Declared
PW368
Impact Of Change To Vascular Access Route On Patient Outcomes For Pci Following
Thrombolysis For Ami
Trent Williams*1, Lindsay Savage1, Kerry Inder2, Nicholas Collins1
1
Department of Cardiology John Hunter Hospital, Hunter New England Health, 2School of
Medicine and Public Health, University of Newcastle, Newcastle, Australia
Introduction: Patients who undergo emergent Percutaneous Coronary Intervention (PCI)
after thrombolysis therapy for Acute Myocardial Infarction (AMI) are at risk of significant
haemorrhagic complications which impact on patient outcomes. During 2007-2010
radial artery access in 2011 at our centre.
Objectives: This study aimed to determine the impact of the change in vascular access on
length of hospital stay, 28 day readmission, in-hospital mortality and procedural times.
Methods: Consecutive patients from 2007 to 2011 who received thrombolysis followed by
institutions acute PCI database linked to a health district heart disease register. Categorical
variables were examined using Pearson Chi square and Fishers exact test. Continuous
variables were analyzed by two tailed student t tests. Data is reported as means and
standard deviations (SD). Significance is set as a p value <0.05.
Results: The sample consisted of 74 patients who underwent PCI following thrombolytic
therapy for AMI (78% men) comprising 53% femoral access and 47% radial access.
Vascular access site selection was based on operator preference, in the context of a
departmental change in practice. The mean age of the overall group was 62 years, (SD 1.5);
60 years in the femoral access group and 69 years in the radial access group.The com-
parison of radial compared to femoral access groups demonstrated significant decreases in
length of hospital stay for the radial access group (3.4  0.95 days vs 4.8 3.8 days;
p¼0.041) There were no statistically significant differences between the radial group
compared to the femoral access group for fluoroscopy time (15:17 vs 14:12 mins), pro-
cedural time (57.26 vs 57.31 mins), thrombolysis to balloon times (243 vs 311 mins), in-
hospital mortality (0 vs 6) or 28-day readmission rate (0 vs 4).
Conclusion: Compared to femoral artery access using radial artery access in the post
thrombolysis PCI group following AMI resulted in improved patient outcomes in terms
of length of stay with minimal impact on procedural and fluoroscopy times. In-hospital
adverse events were reduced but this was not statistically significant in this small
sample.
Disclosure of Interest: None Declared
PW369
Application of a pragmatic tool to guide the intensity of chronic heart failure
management in a real-world cohort: Green Amber Red Delineation of rIsk And Need
in Chronic Heart Failure (GARDIAN-CHF)
James McVeigh*1, Yih-Kai Chan2, Simon Stewart2, Melinda Carrington2
1
Prince of Wales Hospital, RANDWICK, Sydney, 2Preventative Health, Baker IDI Heart and
Diabetes Institute, Melbourne, Australia
Introduction: There is scope to improve the cost-effective application of chronic heart
failure (CHF) management programs by applying more intensive management to those
patients at particular high risk for (preventable) morbidity and mortality.
Objectives: To determine the real-world utility of an innovative traffic light system, the
Green Amber Red Delineation of rIsk And Need (GARDIAN), to guide the intensity of post-
discharge management of typically old and fragile patients with CHF.
Methods: We applied the recently developed GARDIAN-CHF tool to determine the
short-to-medium term risk of rehospitalisation and death in 80 consecutive patients
with CHF being managed by a CHF service at a single institution following a recent
hospitalisation. Potential deficits in three 3 key domains comprising GARDIAN-CHF
were assessed – 1) Holistic profile, 2) Therapeutic Management and 3) Clinical
Stability.
Results: Mean age was 77.9 years (range 33 – 96 years), 54% were male and 52% had
HF with preserved ejection fraction. A high risk holistic profile was found in 65 cases
(81% - 56 [70%] aged >75 years, 36 [45%] non-English speaking background and 6
[7.5%] cognitive impairment). A high risk management profile was also found in 41 cases
(51% - 21 [195] not prescribed/intolerant to an ACEi or 15 [13%] a beta blocker and 19
[17%] with a self-care deficit). A high-risk clinical profile was found in 51 cases (64% -
28 [35%] past admission for acute HF, 8 [10%] acute pulmonary oedema, 10 [13%]
length of stay >7days, 19 [24%] anaemia, 19 [24%] moderate to severe renal impairment
and 2 [2.5% automatic red status] stay in an intensive care). On hospital discharge 23
cases (28.7%) were green/low-risk status with 0-1 domain deficit noted, 31 cases amber/
intermediate risk (38.8% - 2 domains) and 26 cases red/high risk status (32.5% - 3
domains). A further 6 cases (7.5%) had clinical instability immediately post-discharge
(automatic red status) – that resulted in a finalised GARDIAN assessment of 27.5% green,
37.5% amber and 35.0% red status to guide subsequent intensity of longer-term
management.
Conclusion: The GARDIAN-CHF tool represents a promising, pragmatic tool to guide
the intensity of CHF-MPs when limited resources restrict their application. Unlike
other tools it provides an integrated approach to both screening and management to
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
modulate the nature and intensity of subsequent management. Further research is
required to determine if then improves health outcomes.
Disclosure of Interest: None Declared
PW370
Development of Nurse led Heart Failure Program for Indigenous and Non Indigenous
clients in the Top End of the Northern Territory, Australia
Mark Haste*1, Marcus Ilton2, Hugh Auckram1, Pupalan Iyngkaran2, Nadarajah Kangaharan2
1 Yih-Kai Chan*1, Melinda Carrington1, David Thompson2, Tone Norekval3, Simon Stewart1
Royal Darwin Hospital, Chronic Disease Coordination Unit, 2Royal Darwin Hospital,
Cardiology Department, Darwin, Australia
Introduction: The numbers of individuals living with Heart Failure (HF) continue to
rise both in the Northern Territory (NT) and nationally and results in a significant
burden of disease. Nationally HF occurs in as many as 2% of the overall population,
rising to 10% in the above 65 years age group. This consistently accounts for 1-2% of
the total health care budget. In 2011 the Department of Health recognised the need to
direct resources to HF.
Objectives: To describe the development and establishment of a Heart Failure Program
(HFP) in the Top End.
Methods: The HFP was developed following examination of NT HF data, including
admission trends at the Royal Darwin Hospital. A comprehensive literature review of
existing program designs also occurred. The HFP structure was developed in consul-
tation with key stakeholders and consists of a multi-disciplinary team of Nurses,
Cardiologists and Allied Health Workers. The program encompasses the principles of
support, monitoring and treatment of clients whilst providing education that enables
empowerment, thereby improving outcomes. The inpatient component of the program
identifies at risk groups and provides client education, including how to monitor for
signs of worsening HF, fluid intake and weight monitoring. This assists clients to have
sound understanding of their HF. The HF Nurse in consultation with the client and
family develops a plan of action appropriate to each individual that encourages self-
management of their HF. Following discharge ongoing telephone support and advice is
provided to enable clients to identify early signs of HF and to instigate treatment to
prevent hospitalisation.
Results: HFP data currently reveals that 55% of Top End HF clients reside within 50km of
Darwin and are predominately male (63%) with Ischaemic Heart Disease (50%) being the
most common co-morbidity. 54% of clients entering the HFP are of Indigenous descent, of
which 77% reside in remote locations.
Conclusion: Nurse Led HFP’s have been shown to reduce hospitalisation both in fre-
quency and duration. Additionally they improve medication compliance, increase quality of
life and reduce health care costs. Due to the infancy of this program these results are not yet
measurable and further investigation is pending.
Disclosure of Interest: None Declared
PW371
The relationship of oxygen debt and cardiac output during exercise in patients with
coronary artery disease
Sergey V. Ivanov*1, Yuri Izachik1, Anastasia Pestova1, Sergey S. Ivanov1, Kirill Arzamasov1,
Lidia Arzamasova1
1 The Country Access to Cardiac Health (CATCH) Program: evaluation of a telephone
functional cardiovascular diagnostic, Central Clinical Hospital #1 of Russian Railways, Moscow,
Russian Federation
Introduction: Dynamics of oxygen debt in exercise has used to assess the pumping
function of the heart. At the same time, direct comparisons of oxygen debt dynamics and
the dynamics of cardiac output have not been spent yet.
Objectives: That was the purpose of the present study.
Methods: 36 patients were studied. 16 patients had suffered from myocardial infarction. 8
patients’ ejection fraction was below 50%, 8 patients had mitral valve insufficiency of the
second degree, 14 patients-pulmonary hypertension. Treadmill test with rest periods after
each stage was conducted. During the test ECG, gas parameters, blood pressure were
registered. After each stage echocardiography was performed. Cardiac output (CO) was
calculated. To assess the oxygen debt after each stage of the test the recovery rate of oxygen
(RRO2) was calculated as the ratio of oxygen consumption during the period of recovery
and load level.
Results: Were found 2 types of dynamics of RRO2: type 1 - without fracture, the 2 -
with fracture towards abrupt increase. The first pointed to the adequacy of the growth
of the O2 debt, the second- to a pathological increase in O2 debt after a certain load
level. On the dynamics of CO patients were divided into 3 groups. In 13 - a
continuous growth was experienced to load in 7,30,4 MET, 12- had a tendency to
stabilization occurred at a load of 5,50,3 MET, and 11- after the continuous growth
had a falling values of the indicator at 4,90,5 MET. Ejection fraction in the 1, 2 and 3
groups was, respectively, -617, 588 and 459%. In the 1 group of patients with
continuous CO growth, no patient with RRO2 fracture was observed. At the same time,
all patients with the fall of CO had fracture of RRO2 (the 3 group). In the second
group of patients characterized by a tendency to stabilization of the CO, the fracture of
RRO2 dynamics appeared in 5 out of 12 people (42,014,2%). RRO2 fractures
occurred in the same range of loads (4,90,41 MET) as the start of stabilization or fall
in CO (5,10,35 MET). The correlation coefficient levels loads on these points was
0,94.
Conclusion: Thus, the fracture of RRO2 in patients with CAD with a probability of 90-100
% pointed to the beginning of the stabilization or fall in CO, i.e. on the occurrence of a
failure of the pumping function of the heart. The level of load at the moment of fracture
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
reflected the beginning of the cessation of CO growth. The normal dynamics of the RRO2
POSTER ABSTRACTS
(without fracture) pointed to the normal pumping function with a probability of 6510%.
Disclosure of Interest: None Declared
PW372
Attendance to a cardiac rehabilitation program results in modest and differential
improvements in adherence to post-AMI management and lifestyle change from a
patient versus carer perspective
1
Preventative Health, Baker IDI Heart and Diabetes Institute, 2Cardiovascular Research Centre,
Australian Catholic University, Melbourne, 3Institute of Medicine, University of Bergen, Bergen,
Australia
Introduction: Acute myocardial infarction (AMI) is a major cause of death and disability
with high risk of secondary events. It is known cardiac rehabilitation programs improve the
overall health and well-being of individuals who survive an AMI but their specific impact
on long-term health behaviours and carers is less certain.
Objectives: To determine the impact of cardiac rehabilitation on individuals and carers of
individuals who survived an AMI.
Methods: This was a prospective designed, Australia-wide survey that applied specific
peer-validated tools to evaluate the experiences of subjects and the carers of individuals
with a past AMI in surviving and coping with the event. We compared the attendance to a
cardiac rehabilitation program and the consequential post-event management and phar-
macotherapy adherence, knowledge, awareness and attitudes towards living with a heart
condition.
Results: A total of 536 post AMI subjects (mean age 64  8 years, 72% male and 31
months since AMI) and 511 carers of person with a past AMI (mean age 55  14 years,
79% female) were studied. Overall, the uptake of cardiac rehabilitation programs was
sub-optimal (54% and 39% among male and female subjects, respectively). Compared
with non-attendees, those subjects who attended cardiac rehabilitation programs were
more likely to follow their doctor’s advice (63% vs. 57%), adhere to a healthy diet
(45% vs. 41%), and make the appropriate lifestyle modifications (80% vs.72%;
p<0.05). These modest effects were more profound according to the carers whereby
cardiac rehabilitation attendance was positively associated with increased management
and pharmacotherapy concordance (84% vs. 72%), a healthy diet (49% vs. 39%),
regular exercise (33% vs. 20%) and more positive attitudes and capacity to adopt
healthy lifestyle changes (57% vs. 48%; all p<0.05). AMI subjects who attended a
cardiac rehabilitation program did, however, self-report significantly better control of
their total cholesterol (<4mmol/L; OR 1.57; 95% CI 1.03-2.38) and BP (<130/
80mmHg; OR 1.42; 95% CI 0.95-2.12) levels.
Conclusion: With low uptake, cardiac rehabilitation attendance among post AMI
subjects results in modest improvements in post-event management adherence and
lifestyle modifications. Cardiac rehabilitation also appeared to ‘sensitise’ individuals
to the potential adverse consequences of an AMI, at the same time, enhancing
perceptions of the importance of treatment and education for both subjects and
their carers.
Disclosure of Interest: None Declared
PW373
phase 2 cardiac rehabilitation program using a standardised program framework and
evaluation procedures
Rosy Tirimacco1, Philip Tideman*1, Susan Jones1, Robyn A. Clark2
1
iCCnet, Country Health South Australia, 2Flinders University, Adelaide, Australia
Introduction: International research priorities for heart disease in rural and remote areas
recommend that different options for delivering cardiac rehab programs be developed to
increase participation. One method of overcoming geographic barriers is the use of tele-
health to supplement in-person contact between patients and health professionals. The
Integrated Cardiovascular Clinical Network Country Health South Australia has partnered
with Country South Medicare Local to improve uptake of phase 2 cardiac rehabilitation by
implementing Country Access to Cardiac Health Program (CATCH) which has imple-
mented telehealth cardiac rehab to supplement face to face programs in their catchment
region.
Objectives: To develop and implement a telephone phase 2 cardiac rehabilitation program
using a standardised program framework and evaluation procedures.
Methods: CATCH engaged the services of the Health Information Service (HIS) of the
Heart Foundation to provide the coaching services for the provision of telephone based
phase 2 cardiac rehabilitation in accordance with the SPAN (Secondary Prevention for All
in Need) guidelines. This involved seven standardised phone calls with first call duration of
approximately 30 minutes and subsequent calls lasting approximately 15 minutes. Eval-
uation of participants using a survey was carried out to determine their satisfaction with
telephone program.
Results: To date 53 patients have been enrolled in the telephone phase 2 cardiac
rehabilitation program developed by CATCH program. Thirty seven patients (69.8%)
have successfully completed the program, 5 (9.4%) have withdrawn and 11 (20.8%)
are still active. If these 11 patients complete program our completion rate could be as
high as 48 (90.6%). Participants of the telephone service reported general satisfaction
with the format of the telephone program with a majority indicating content could be
covered in 5 calls.
Conclusion: Introduction of a telephone based phase 2 cardiac rehabilitation program
has achieved high completion rates and provided access to phase 2 cardiac
e335
 rehabilitation in rural area where no face-to-face programs existed. As per SPAN rec-
POSTER ABSTRACTS
ommendations our team is intending to offer a web based phase 2 option in the next
stage of this project.
Disclosure of Interest: None Declared
PW374
The Country Access to Cardiac Health (CATCH) Program: Addressing the
confounders of referral, attendance and access for rural patients post myocardial
infarction
Rosy Tirimacco1, Philip Tideman*1, Susan Jones1, Robyn A. Clark1
1
iCCnet, Country Health South Australia, Adelaide, Australia
Introduction: There is Level 1 evidence to support cardiac rehabilitation (CR) and
secondary prevention programs. However, translation of this evidence into clinical
practice has been poor throughout the world with attendance rates between 10%>
40%. Common barriers identified, to ensuring that life saving secondary prevention
programs research eligible patients, have mostly been health service factors such as
referral, access, relevant modes of delivery (to match modern lifestyles) and linked data
to evaluate outcomes.
Objectives: There is Level 1 evidence to support cardiac rehabilitation (CR) and sec-
ondary prevention programs. However, translation of this evidence into clinical
practice has been poor throughout the world with attendance rates between 10%>
40%. Common barriers identified, to ensuring that life saving secondary prevention
programs research eligible patients, have mostly been health service factors such as
referral, access, relevant modes of delivery (to match modern lifestyles) and linked data
to evaluate outcomes.
Methods: Metropolitan and country hospitals were instructed to refer eligible patients to
the Country Access to Cardiac Health (CATCH) Program. Patients were contacted by
telephone to assist them to choose and enrol in the appropriate CR delivery mode. Out-
comes of the CATCH program include CR referral, attendance and completion rates,
cardiac rehospitalisation and mortality.
Results: To date 377 patients have been referred to the CATCH program; 192 (51%)
have completed and 140 (37%) declined to participate. These data include 37 (69.8%)
who have successfully completed the telephone program. Six and 12-month outcomes are
on going.
Conclusion: These preliminary data indicate encouraging improvements in referral, ac-
cess and completion of CR and secondary prevention programs in rural areas where no
CR services have existed previously. Further studies are planned to investigate the reasons
why patients declined to attend CR and how to improve documentation and data retrieval
for CR.
Disclosure of Interest: None Declared
PW375
Innovative model of care for cardiovascular patients across the continuum
1,2 2,3 3 3
Mary Boyde* , Robyn Peters , Vivian Bryce , Nicole New
1
Cardiology/Nursing Practice Development Unit, Princess Alexandra Hospital, 2School of
Nursing and Midwifery, The University of Queensland, 3Cardiology, Princess Alexandra
Hospital, Brisbane, Australia
Introduction: Traditionally management for patients with cardiovascular disease has
occurred according to their current diagnosis within distinct Cardiac Rehabilitation (CR)
and Heart Failure (HF) management programs. Contemporary management of cardio-
vascular disease over the last decade has moved towards an integrated service based on
chronic disease models.
Objectives: To amalgamate the CR and HF Management Services and provide evidence
based care for people across the continuum from acute care to the community.
Methods: In a tertiary hospital, the Heart Recovery Service (HRS), an amalgamated
multidisciplinary CR and HF management program, was established. A service profile
was developed by senior CR and HF staff in consultation with Nursing Executive,
Cardiologists and Allied Health Staff. Patients diagnosed with Acute Coronary Syn-
drome, post cardiac surgery, elective angioplasty, and HF were eligible for management
by the HRS. The HRS implemented case management teams of nurses to facilitate
patient centred care, peer teaching and development of advanced cardiac nursing skills.
Data collection methods were established to enable evaluation of key performance
indicators (referral for CR, commencement of CR education and exercise program, post
discharge follow-up for HF).
Results: From 1/03/2013 to 31/08/2013, 1431 in-patients were screened for eligibility for
the HRS, on average 11 patients/day. Of the CR patients screened, 963 were appropriate
for further CR post discharge management; 868 (90%) had a referral completed to a CR
program. Of the 898 patients, 130(14.5%) were suitable for management by our HRS;
118 received telephone follow-up and of the 130, 72(55%) commenced our outpatient
CR program. Mean time to follow-up was 12(5.40;range 2-44) days and mean time to
commencement of this program was 34(10.19;range 9-67)days. Of the HF patients
screened, 161 were referred to a HF management program: of these 98(61%) patients
were suitable for our HRS; 94 received follow-up with a phone call, home visit or clinic
visit. Mean time to contact post discharge was 9(2.40;range 1-32) days and 85% of
patients received follow-up within 14 days. Of the 161 patients with HF 31% had a new
diagnosis.
Conclusion: A new patent-centred service has been established with initial results indi-
cating the service model has resulted in achievement of key performance indicators.
Disclosure of Interest: None Declared
e336
PW376
A pilot study of a post-discharge nurse-led, educational intervention on cardiac self-
efficacy and anxiety in post-PCI patients
Katina Corones-Watkins*1, Karen Theobald2, Katherine White3, Robyn A. Clark4
1
RN, PhD Candidate, School of Nursing, 2PhD, Senior Lecturer and Study Area Coordinator,
Emergency Nursing, School of Nursing, 3PhD, Postgraduate Research Coordinator, School of
Psychology, Queensland University of Technology, Brisbane, 4PhD, Professor of Acute Care and
Cardiovascular Research, School of Nursing and Midwifery, Flinders University, Adelaide,
Australia
Introduction: Hospitalisation for percutaneous coronary intervention (PCI) is often short,
with limited nurse-teaching time and poor information absorption. Currently, patients are
discharged home only to wait up to 4-8 weeks to commence a secondary prevention
program and visit their cardiologist. This wait is an anxious time for patients and confi-
dence or self-efficacy (SE) to self-manage may be low.
Objectives: To determine the effects of a nurse-led, educational intervention on participant
SE and anxiety in the early post-discharge period.
Methods: A pilot study was undertaken as a randomised controlled clinical trial. Thirty-
three participants were recruited, with n¼13 randomised to the intervention group. A
face-to-face, nurse-led, educational intervention was undertaken within the first 5-7 days
post-discharge. Intervention group participants received standard post-discharge educa-
tion, physical assessment, with a strong focus on the emotional impact of cardiovascular
events and PCI. Early reiteration of post-discharge education was offered, along with health
professional support with the aim to increase patients’ SE and to effectively manage their
post-discharge health and well being, as well as anxieties. Self-efficacy to return to normal
activities was measured to gauge participants’ abilities to manage post-PCI after attending
the intervention using the cardiac self-efficacy (CSE) scale. State and trait anxiety was also
measured using the State-Trait Anxiety Inventory (STAI) to determine if an increase in SE
would influence participant anxiety.
Results: There were some increases in mean CSE scores in the intervention group par-
ticipants over time. Areas of increase included return to normal social activities and con-
fidence to change diet. Although reductions were observed in mean state and trait anxiety
scores in both groups, an overall larger reduction in intervention group participants was
observed over time.
Conclusion: It is essential that patients are given the education, support, and skills to self-
manage in the early post-discharge period so that they have greater SE and are less anxious.
This study provides some initial evidence that nurse-led support and education during this
period, particularly the first week following PCI, is beneficial and could be trialled using
alternate modes of communication to support remote and rural PCI patients and extend to
other cardiovascular patients.
Disclosure of Interest: None Declared
PW377
Differentials according to sex and socio-economic profile in treatment adherence and
life-style modification following an acute myocardial infarction: a national survey of
536 men and women
Tone Norekval*1, Yih-Kai Chan2, Melinda Carrington2, Simon Stewart2, David Thompson3
1
Institute of Medicine, University of Bergen, Bergen, Norway, 2Preventative Health, Baker IDI
Heart and Diabetes Institute, 3Cardiovascular Research Centre, Australian Catholic University,
Melbourne, Australia
Introduction: For those fortunate to survive an acute myocardial infarction (AMI),
following appropriate secondary prevention including prescribed pharmacotherapy and
subscribing to long-term lifestyle changes can significantly reduce their risk of experiencing
a potentially fatal secondary event.
Objectives: We evaluated adherence to secondary prevention in male and female subjects
of a past AMI using data from a national representative online survey.
Methods: A total of 390 male (mean age 64  8 years) and 146 female (mean age 62  9
years) subjects with a past AMI completed an 20-30 minutes online validated questionnaire
with outcome measures on their clinical management, pharmacotherapy concordance and
lifestyle modifications following an AMI.
Results: Despite being at a high risk for a secondary event, more than one third of male
subjects (38%) failed to follow their doctor’s instructions and 35% occasionally forgot to
take their prescribed therapy. Equivalent proportions in women were 45% and 30%,
respectively. Surprisingly, one in ten (10%) subjects thought they no longer required any
treatment. Side effects (18%) and cost (10%) of prescribed therapy were the two most
common underlying reasons for non-compliance; particularly in women (difference w6-
10% versus men; p<0.05). The majority of subjects expressed responsibility for (65%) and/
or had recognised the importance of a healthy lifestyle (79%) to concomitantly reduce their
risk for a secondary event. However, less than half were able to adhere to their nutrition
plan (43%) or were exercising regularly (32%). Overall, proportionately more women than
men (83% vs. 73%; p<0.05) found lifestyle changes challenging, especially for those
residing in a lower income area. For example, those living in a low income area were
significantly more likely to remain physically inactive compared to those living in a high
income area (66% vs. 53%; p<0.05).
Conclusion: In this survey, many AMI subjects reported therapeutic inertia. A significant
number were non-adherent to prescribed therapy. Moreover, adherence to a healthy life-
style post-event remained challenging (especially for women) despite high levels of
recognition of the importance of a healthy lifestyle plan. Lower socio-economic status was
negatively associated with attitudes/capacity to adopt a healthier lifestyle.
Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

A, Rong .....................PM203 Agarwal, Neeru ............PT032 Alabdulkarim, Nawal .....PM455

Abazid, Rami M. ..........PM435 Agarwal, Sarita .............PW211, Alajaji, Wissam ............PW235
Abchee, Antoine ...........PW235 PW212 Alam, Samir ................PT225, PW235
Abd El Fattah, Alia .......PM086 Agbo, Hadiza A. ...........PW229 Alasaad, Nidal .............PM162
Abd El Meguid, Wael ....O065, PT308 Aggarwal, Neelum ........PT268 AlBackr, Hanan ............PT036
Abdallah, Flavia ...........PT455 Agouba, RIhab B. .........PM058 AlBinAli, Hajar.............O202
Abdel Hady, Alaa El Aguilera, Hernán ..........PW207 Albrecht, Madlin ..........PM137
Deen ...................PW234 Aherrera, Jaime M. ........PW054 Albuquerque, Eugenio S.
Abdelaziz, Ahmed .........PW062 Ahlers, Ivonne .............O169, PW207 D. ......................PM430
AbdelWahab, Amir .......PW016 Ahmad, Farook ............PT098 Aldalati, Omar .............PM199
Abdessalem, Salem ........PW150 Ahmadi, Arman ...........PM200 Al-Daydamony,
Abdul Rahim, Siti Ahmadi, Abdullah.........PM301 Mohammad ...........PM159
Mariam ................PW002 Ahmed, Abbas .............PW147 Aldin, Marlene N. .........PM357
Abdul Rahman, Ahmed, Asif ................PM017 Aldweib, Nael ..............PT384
Effarezan ..............PM406, Ahmed, Asma ..............PT258 Alejandro, Botbol .........PM063
PW330, PW331 Ahmed, Emad .............O202 Alencar, Allan K. ..........PM390
Abdul Wahab, Mohamed Ahmed, Fozia ..............O151 Alencar, Maria Clara N. ..PM061
Jahangir ...............PW349 Ahmed, Jasimuddin .......O196 Alexa, Andrei ..............PM392
Abelson, David ............O155 Ahn, Tae Hoon ............PM226 Alexander, Ian .............PM378
Abhayaratna, Walter P. ...PM313, Ahrens, Ingo ...............PM137, Alexander, Sarah ..........O016
PM411, PT285, PT286 PM370 Alexanderson-Rosas,
Abhayaratna, katrina ......PM411 Ahsan, Chowdhury H. ...PT204 Erick ...................PT389,
Abid, Dorra ................PT107 Ahsan, Syed A. ............PM204, PT390, PW315
Abid Trigui, Leila .........PM090, PW122 Alfaleh, Hussam ...........PM162,
PM190, PM191, PT105, PT106, Aina, Francis ...............PT229 PT036, PT058, PT165
PT107, PT135, PW080, PW085 Ajani, Andrew E. ..........O008, Al-Farqani, Abdullah M. .PM025
Aboulhosn, Jamil ..........O101 PM147, PM169, PM182, PM183, Al-Fiadh, Ali H. ...........PM198,
Abraha, Zemuy G. ........PM333 PM185, PM197, PT151, PT176, PT176, PW280
Abraham, Sheena ..........PT345 PT179, PT197, PW098, PW118, AlGhamdi, Saleh ..........PT036
Abraham, Vinod J. ........PW358 PW146, PW240, PW245 AlHabeeb, Waleed ........PT058
Abramson, Michael J. ....O189 Ajay, Vamadevan S. .......O195 Alhabib, Khalid ............PM162,
Abrão, Karen ...............PT028, Ajiro, Yoichi ...............PM003, PT036, PT058, PT165
PW033 PM059, PM171 AlHabib, Waleed ..........PT036
Abreu, Marilia .............PW321 Akanda, Md. Abdul K. ...PM273 Alhammad, Nasser J. .....O110
Abuosa, Ahmed ...........PT036 Akao, Masaharu ...........PW249 Alhimairi, Ahmad F. ......PW112
Abu-Sulaiman, Riyadh Akasaka, Takashi ..........PM151 Ali, Jabar ...................PT046
M. ......................PM058 Akbar, Muhammad R. ....PT129 Ali, Md Z. ..................PM273
Acevedo, Ramiro ..........PM106 Akilli, Rabia ................PM141 Ali, Mohammed K. .......O195, PT328
Achari, Vijay ...............PM316, Akıllı, Rabia E..............PM031 Ali, Muhamad S. A. K. ...PW269
PW219 Akimova, Anna V. ........PM236 Ali, Noman .................PT012,
Adalet, Kamil ..............PW129 Akimova, Ekaterina .......PT291 PW231
Adam, Eduardo L. ........PT459 Akinbode, Abiola ..........PT229 Ali, Onn A. ................PM100
Adams, Mark ..............PT182, PT201 Akram, Muhammad ......O189 Ali, Rhagib .................PT261
Adamu, Umar G. ..........PT275 Aktas, Halil .................PM031 Ali, Sulafa ..................PM058,
Adebiyi, Adewole .........PM247, Al Baker, Syed M. E. .....PM209, PT434
PM249, PT270 PT398 Aliku, Twalib O. ..........PM111,
Adelstein, Stephen ........PM439 Al Dhaheri, Salma .........PT261 PW089
Ademi, Zanfina ............PW241 Al Kandari, Fawzia Aliprandi-costa,
Adeoye, Abiodun M. .....PM247, Yousef .................PM085 Bernadette .............PM195,
PM248, PM249, PT270, PT317 Al Marzouqi, Layla M.....PM253 PM318, PW202
Adsett, Julie ................PM348 Al Raisi, Sara ...............O019 Alkizim, Faraj O. ..........O029
Afify, Mohamed ...........PW062 Al Sakaf, Omer ............PW028 Alkmim,
Agahari, Ian ................PM109, Al Suwaidi, Jassim ........O202, PT165 Maria Beatriz M. .....PT019,
PT405, PW305 Al Suwaidi, Jassim M. ....PT300 PT256, PW179

GHEART Vol 9/1S/2014 | March, 2014 | WCC Author Index e337

 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Allada, Chris ...............PT128 Aman, Wahaj ..............PT109 Antonis, Paul ..............PM149

Allahwala, Usaid K. .......O100 Amarchand, Ritvik ........PW199 Antony, Joyce ..............PW335
Allan, Roger ................PM193 Ambu, Alessandro ........PM021 Antzelevitch, Charles .....PM398
Allen, John B. ..............PT433, Amin, Haitham ............PT165 Anvardeen, Kalilur ........O176
PW362 Amin, Haitham ............PM162 Aono, Jun ..................PW114
Allen, John C. .............PT409, Ammar, Waleed ...........PW234 Apor, Astrid ................O056, PM018
PW333, PW334 Amor, David ...............PW283 Appadurai, Vinesh ........PT180
Allen, John W. ............PT444, Amorim, Guilherme D. Appel, Lawrence J. ........O211
PW361, PW362 T. .......................PT113, PT114 Appelbe, Alan ..............PM108
Allen, Lori B. ..............PM468, Amos, David ...............PT182, Appleby, Jo ................O143
PT433, PT444, PW361, PW362 PT201, PW120 Aprami, Toni M. ..........PT129
Allen, Marvin ..............PM468, An, Libin ...................O141 Aquino, Celeste M. .......O046
PT433, PT444, PW361, PW362 Ana, Milanino .............PM063 Aquino Xavier, Regina
Allender, Steven ...........PW243, Anchah, Lawrence ........PM223, Maria ..................O194, PT113,
PW244 PT361 PT114, PT439, PT440
Almahmeed, Wael ........PM162, Ancheta, Christine V. .....PM283, Arasaratnam, Deevina ....PM372
PT165 PT284, PW236 Archbald, Joel A. ..........PM489
Al-Marzouqi, Layla ........PT261 Ancheta, Irma B. ..........PM283, Ardhianto, Pipin ...........PM231
Al-Maskaryi, Salim N. ....PM025 PT284, PW236 Areas, Miguel A. ...........PM023,
AlMasood, Ali..............PT036, PT058 Andersen, Niels H. ........PM091 PM104, PM377, PT110, PW056,
Almedawar, Mohamad ...PT225, Andersen, Thor E. ........O053 PW257
PW235, PW284 Anderson, Amanda .......O210 Areias, José Carlos ........O036, PW343
Almeida, Ana Rita .........PT094, Anderson, Craig ...........O079 Areias, Maria Emília G. ...O036, PW343
PW043, PW044, PW045, PW046 Anderson, Leigh ...........O090 Arias, Carlos ...............PT001
Almeida, RAITANY C. ....PM266, Andishmand, Abbas ......PW029 Arifin, Natasha.............PW330,
PT292 Andrade, Ana Carolina P. PW331
Al-motarreb, Ahmed ......PT165, PT165 D. ......................PT028, Arima, Hisatomi ...........O079
Al-Motarreb, Ahmed ......PM162 PW033 Ariyaratne, Thathya .......PW241
AlMulla, Arif A. A. ........PW112 Andrews, Karen ...........PM366 Armaro, Alessandro .......PM021
Al-Otaibi, Abdullah .......PT320 Andrianopoulos, Nick ....O001, O008, Armas Rojas, Nurys B. ...PM296,
Al-Qahtani, Awad .........PT300 O063, PM016, PM147, PM182, PT307
Alsaif, Shukri ..............PM162 PM183, PM185, PM197, PT176, Arnold, Ruth ...............PT182, PT201
Al-Senaidi, Khalfan S. ....PM025 PT179, PT197, PW146, PW241, Arora, Anjali ...............PM292
Al-Shaar, Laila .............PT225, PW245 Arora, Monika .............O064, O201,
PW235 Andric, Vesna ..............PM079, O203, O205, PT314
Alshaer, Fayez .............PT036 PT223 Arra, Claudio ..............PM414
Alshammari, Qurain ......O179 Andriyati, Ratna ...........PM280, Arrat, Hasan ...............O058
AlsheikhAli, Alawi ........PM162, PM281, PM341, PT234 Arshad, Kamal .............PW330,
PT165 Androulakis, PW331
Alshoaibi, Naeem .........O095 Emmanuel ............PM252, Arstall, Margaret ...........O074, O092,
Alshualah, Rokaia .........PM479 PM380, PT221 PM175, PM328, PT130
Al-Sinan, Ali ...............PM156 Ang, Su .....................O219 Aryadi, Acil ................PM409,
AlSuwaidi, Jassim .........PM162 Angarten, Vitor G. ........O075, PT047, PT377
Altarev, Sergey .............PT168 PT244 Aryanpoor, Reza ...........PW121
Althagafi, Mahmoud ......PT320 Angelino, Arnaldo .........PT260, PT451 Arzamasov, Kirill ..........PW371
Al-Thani, Hassan ..........PM161 Angelis, Gabriella A. M. Arzamasova, Lidia .........PW371
Alvarez, Eduardo E. ......PT257 D. C. D. ...............PT028, Arzu, Jahanara .............PM204,
Alvarez-Palacios, Paula ...PM158 PW033 PM213, PT162, PW122
Alves, Bianca J. ............PW257 Angerosa, Julie .............PW347 Asaad, Nidal ...............PT300
Alves, Mariana .............PM346 Anggrahini, Dyah W. .....PT416 Asahara, Noriko ...........PM331,
Alves, Miguel ..............PT094 Anggriyani, Novi ..........-.- .............. PW249
Amadi, Casmir E. .........PT229 PM215 Asakawa, Tomohiro.......PT358
Amado, José ...............PW043, Antoniewicz, Lukasz ......PT305 Asato, Tetsuya .............PM119
PW044, PW045, PW046 Antonijevic, Nebojsa M. ..PM206 Asher, Arash ...............PW238

e338 GHEART Vol 9/1S/2014 | March, 2014 | WCC Author Index

 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Ashok, Ajay ................PM250 Bacci, Marcelo Barnes, Maureen...........PW057

Asian, Alicia ................PT001 Rodrigues .............PT196 Barnett, Tracie A. .........O206
Asirvatham, Bachmann, Max ...........O164 Bärnighausen, Till .........O114
Arthur .................PM316 Back, Liam .................PM200 Baroux, Noémie ...........O134
Asok Chandra, Rao .......O204 Baglioni, Florencia ........PT206 Barpha, Amit S. ...........PM415
Asrar ul Haq, Bahl, Rakesh ...............PW358 Barr, Peter R. ..............PM434
Muhammad ...........PT177, Bahl, V K ...................PT252 Barraclough, Jennifer .....PW120
PW316 Bahlo, Melanie .............PW283 Barreira, Bianca ............PT087
Assareh, Hassan ...........PW153 Bahuleyan, CG .............PM148 Barreiro, Eliezer J. .........PM390, PM391
Assis, Tati G. P. ...........PT019, PT256 Bai, Rong ...................PW010, Barrera,
Astarcioglu, Mehmet A. ..PW090 PW011 Carlos-Felipe R. ......PM485
Astarcıoglu, Baig, Mudassar ............PM136, Barrios, Cristina ...........PT260, PT451
Mehmet Ali ...........PT119 PT259 Barros, Danielle M. .......PT196
Astarcıo
glu, Bairey Merz, C. Noel .....PM478, Barry, Michael A. T. ......O019, O021,
Mehmet Ali ...........PM110 PW238 O154, PM020, PM417, PT013,
Astley, Carolyn ............PW202 Bakatu, Kautu .............PM466 PT014
Athan, Eugene .............PM108 Baker, Robert ..............O175, PM465 Bartels, Dorothee ..........O215
Atherton, John J. ..........PM054, Bala, Harini ................PM182 Barter, Philip J. ............O040
PM055, PM428, PT066, PT378, Balabushevich, Bartlett, Alicia ..............PT092
PT383, PW143, PT379 Alexander .............O111 Bartold, Peter M. ..........O162
Atkins, Emily ..............PW264, Balachandran, Shalini .....PT091 Barton, Timothy ...........PW237
PW265 Balasubramanian, Basart, Dick C. G. .........PM385
Atkinson, David ...........O070 Krithika ...............PM067 Basile, Giuseppe ...........PM021
Attia, John ..................O168 Baldi, Mario ................PT077 Baskaran, Lohendran .....PW333,
Aty, Waleed ................PT232, Baligh, Essam ..............PT230 PW334
PW117, PW131 Ball, Jocasta ................O163, PT365 Bastian, Bruce ..............PT380,
Au, Kim ....................PT215 Ballantyne, Christie M. ...O040 PW305
Auckram, Hugh ...........PW370 Balli, Mehmet ..............PM031, Bate, Danielle ..............PM468
Audeh, William ...........PW238 PM141 Batista, Thiago M. .........PW056
Auer, Reto ..................O002 Bandara, Dushan ..........PT032 Battie, Cynthia .............PM283,
Avanzas, Pablo .............PM120, Bandeira, Angela P. .......PM430 PT284, PW236
PM121, PM122 Bandyopadhyay, Arun ....O098 Battista, Josephine .........O080
Avdeeva, Ksenia ...........PW181 Banerjee, Amitava .........O050 Baulmann, Johannes ......PM258
Aw, Tar-Ching .............PM253, Banerjee, Sajal K. ..........PM204, Bayram, Zubeyde ..........PW090
PT261 PW122 Bazarghani,
Awang, Rahmat ............PW269 Banerjee, Tanima ..........O098 Nooshin M. ...........PW112
Awaya, Toru ...............PM421 Banks, Emily ...............O168 Bazgir, Abedin .............PT183
Ayala Germán, Ana G. ...PW315 Bannister, Kym ............PW301 Beale, Anna ................PM056
Ayedi, Fatma ...............PM090 Bannon, Paul G. ...........PM172 Beaton, Andrea ............PW089
Azam, Golam ..............PM209 Bao, Bob ....................PT345 Beavis, John ................PT123
Azevedo, Olga .............PT094, Bao, Shisan .................O022 Beca, John ..................O083
PW043, PW044, PW045, Baptista, Rui ...............PT264 Bech-Hanssen, Odd .......PW306
PW046 Baradi, Arul ................O001, O063, Becker, Ágnes ..............PM142
Azevedo, Vitor M. P. .....O046, O194, PM135, PM180, PM185 Becker, Dávid ..............PM142, PT371
PT113, PT114, PT439, PT440 Barbarash, Olga ............PT168 Becker, Sophie T. .........PM258
Azhar, Muhammad .......PW158, Barbiero, Sandra M. ......PT418, PT419 Bedó, Camila...............PT087
PW159 Barbisan, Juarez N. .......PM041, Beer, Dominik A. ..........PM025
Aziz, Amir ..................PM017, PT041, PT042, PT043, PT044, Beesetty, Bhaskar Rao ....PT425
PM136, PT012, PW231 PT045 Beevors, Estelle ............PT458
Azoz, Ayman ...............O076 Barbosa, Marcia M. .......PW183 Bell, Brendan...............PW100
Azzopardi, Sonia ..........O136 Bárczi, György .............PM142 Bell, Damon A. ............PW099
Babu, Abraham S. .........PM487, Barnard, S A. ..............PM431, Bell, James..................PM395
PW228, PW261 PM432 Bell, Katy J. L. .............PT266
Babu, Suresh ...............PW105 Barnes, Mary ...............PT088, PT089 Beller, Elaine ...............PT266

GHEART Vol 9/1S/2014 | March, 2014 | WCC Author Index e339

 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Bello, Halima S. ...........O024 Bienvenu, Laura A. ........O128 Bortic, Erin .................PW057

Belohlavek, Jan ............PW209 Biharie, Rajiv ...............PM317 Bortolotto, Luiz
Beltrame, John .............O006, O074, Bilek, Marcela M. .........PM049 Aparecido .............PM320, PT159
O092, O106, O214, PM175, Billah, Baki .................PM323, Bortolussi, Giulia ..........PW209
PM328, PM375, PT281, PW240 PW241 Bortz, Fernanda V. ........PW257
Ben Kahla, Sahar ..........PM190, Bin, Xiaohong .............PM028 Bosa-Ojeda, Francisco ....PM146
PM191 Binkowska, Anna ..........PM234 Boscaro, Marcelo V........PT257
Ben Messoud, Mejdi ......PW103, Birdsey, Garth .............PT198 Bosio, Fernando ...........PM106
PW104 Bironaite, Daiva............PM050, Bosson, Jenny A. ..........PM276,
Benjamin, Longo- PM051 PT305
Mbenza ................O178 Bischoff, Claudia ..........O200 Botker, Hans E. ...........PM091
Bennetts, Jayme ...........O175 Bisht, Richa ................PT315 Bottaro, Gaetano ..........PM021
Berecova, Zuzana ..........PT417 Biswas, Monodeep ........O098 Botting, Kimberley ........PW290,
Berensztein, Sara ..........PW312 Bitar, Lela ..................PT167 PW295
Berger, Joachim ............PT350 Bittner, Ronald ............O200 Boucheda, Nidhal .........PW104
Bergfeldt, Lennart .........PW306 Black, Alexander ..........PW241 Bouchehda, Nidhal .......PW103
Bergin, Peter ...............PM064 Black, James A. ............PW171 Boult, Margaret ............PT088, PT089
Bergler-Klein, Jutta ........PM092, Black, Mary Jane ..........O052, PM450 Bourke, Jane E. ............PT174
PT067 Blackberry, Irene ..........PT334 Bovendorp, Ana Carolina
Bergö, Martin ..............PT347 Blair, Iain ...................PM253 C. ......................PM012
Bernard, Kianu Phanzu ...O178 Blank, Evan ................PT452 Bovet, Pascal ...............PM287
Bernard, Stephen ..........O153 Blennerhassett, John ......PW099 Boyde, Mary ...............PW375
Bernardo, Bianca C. .......O166, PT353 Blizzard, Christopher L. ..PM288 Bozdogan, Sevcan .........PM141
Berta, Klára .................O056 Blom, Dirk .................PM385 Bradbrook, Craig ..........O077, O175
Bertoletti, Juliana ..........PT290 Blomberg, Anders .........PM276 Braga, Helena D. O. ......PW041
Bertram, Melanie ..........PT322 Blondel, Stéphanie ........PW019 Brahmadathan, K ..........PW358
Berukstis, Egidijus ........PT251 Bloom, David E. ...........O114 Bramlage, Peter ............O012, O122,
Berwanger, Otavio ........PT196 Bloom, Jason E. ...........PW133 PT104
Bessarab, Dawn ............PW357 Boardman, Catherine .....PM475 Branagan, Maree G. .......PT155,
Bessonov, Ivan .............PM164 Bobrovnitsky, Igor P. .....PM322 PT156
Betbout, Fethi .............PW103, Boccia, Sabato A. ..........PM414 Branch, Kelley E. ..........O078
PW104 Bochoeyer, Andres ........PW015 Branco, Renato C. .........PW056
Betrame, John..............PW059 Bode, Christoph ...........PM137 Brandani, Laura ...........PT451
Bettenbuch, Tünde ........PW262 Boey, Esther J. H. .........O166, PT353 Brant, Luisa C. C. .........PT138
Better, Nathan .............PT396 Boffa, Umberto ............O034, Braun, Lynne T. ...........PT268
Bhalla, Sandeep ............PT330, PM089, PM410 Breakey, Suellen ...........PM126
PW271 Bogana Shanmugam, Breazna, Andrei............O212
Bhansali, Anil ..............PM316, Vimalraj ...............PM202 Brennan, Angela L. ........O001, O008,
PW219 Bogdanova, Vera ..........PW309 O063, O214, PM147, PM182,
Bharadwaj, Prerna .........PT314 Bogomolovas, Julius ......PM050, PM183, PM185, PT176, PT179,
Bharani, Anil ...............PW358 PM051 PT197, PW118, PW146, PW240,
Bharat, Vijaya ..............PT324 Bohn, Lucimere ...........PM343, PW245
Bhargava, Santosh K. .....PM173 PW198 Brew, Nadine ..............O052
Bhaskaran, Abhishek .....O154, Bolman, R. Morton .......PM126 Brewer, Bryan ..............O040
PM020, PT013 Boman, Christoffer ........PM276 Briasoulis, Alexandros ....PM252,
Bhattacharjee, Biplob .....PT154 Bompoint, Severine .......O062, PW203 PM380
Bhayani, Raj ................PM017 Bonfim, Amanda ..........PT113, PT114 Bridgman, Cameron ......PW102
Bhindi, Ravinay ............O100, PT374 Boon, Marieke .............PM317 Brieger, David .............O110, O165,
Bhoopathy, Varun .........PM344 Borah, P K. .................PW358 PM013, PM195, PM196, PM318,
Bhuiyan, Mahfuzur R. ....O196 Borén, Jan ..................PT347 PT127, PW120
Bi, Ying .....................PM399 Borland, Ron ...............PT334 Briffa, Tom .................O082, O110,
Biagio, Armaro.............PM021 Bornancini, Norberto .....PM106 O131, O165, O218, PM326,
Bialkowska, Beata .........PM001 Borodulin, Katja ...........PW242 PT127, PT160, PT161, PT184,
Bianco, Raul................PT451 Borrego, Carlos ............PW192 PW123, PW202, PW264, PW265

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Brighouse, Russell .........PT391, Butera, Gianfranco ........PW082 Carrington, Melinda ......O109, O163,
PT392, PT393, PT394 Butterley, Stuart ...........PT136, O181, PM259, PM488, PW194,
Britto, Raquel R. ...........PM061, PT137 PW222, PW258, PW369, PW372,
PM486 Butterly, Stuart ............PT040 PW377
Brizard, Christian P. ......PW347 Byrom, Michael J. .........PM172 Carroll, Gerard ............PW153
Broad, Neville..............O165 Bzukala, Irena B. ..........O217, Carson, Kristin ............O172
Brook, Emily ...............PW206 PW030, PW031, PW032 Carter, Paul ................PT259,
Brooks, Matthew ..........O008, Cabo Fustaret, Marcela C. .O103 PW231
PM116, PM147, PT151, PW098 Cade, Jamil .................PT191 Cartolano, Flávia D. C. ...PM357
Brouwer, Elizabeth ........PT321 Cagliyan, Caglar E. .......PM031, Carvalho,
Brown, Alex ................O005, O006, PM141 José Antonio M.......PM251
O070, O162, O168, PW357 Cai, James Xinzhe .........PT210 Carvalho, Taiana S. .......PT290
Brown, Benjamin D. ......O151 Cakal, Beytullah ...........PW090 Casan, Joshua ..............PT231
Brown, Katharine .........O005, O006 Caldeira, Daniel S. ........PT094 Casanova, Verónica .......O068
Brown, Martin R. ..........PW038 Calderon, Juan C. .........PT422 Cass, Alan ..................O105
Brown, Ngiare .............PW357 Calil, Marcelo ..............PM345, Castaneda, Javier L. .......PT422
Bruniera, Felipe R. ........PT196 PM346, PT016, PW178 Castañeda, Luis ............PT260
Brunning, Jared ............PW038 Calovic, Zarko .............O157, PT077 Castier, Marcia B. .........O194
Bruthans, Jan ..............PM311 Calvo, David ...............PM120, Castilho, Ana E. ...........PT292
Bryant, Christina ..........PM015 PM121, PM122 Castilho, Edilberto ........PM345,
Bryant, Lesley ..............PT458 Camacho, Benjamín ......PM120, PM346, PT016, PW178
Bryce, Vivian ...............PW375 PM121, PM122 Castles, Anastasia ..........PT177
Buchholz, Bruno ..........PW277 Camargo, Rafael L. ........PW056 Castro, Luiz Ricardo A. ..PT138
Bucki, Tracey M. ..........PT243 Cameron, James D. .......PM149, Catalano, Paula ............PM170
Budek-Sydor, Agnieszka .O073 PM433, PM449, PT231, PT391, Caterson, Ian ..............PM339
Budin, Siti Balkis ..........PM332, PT394, PT407, PW325 Cayli, Murat................PM141
PT367, PW134 Cameron, Jan ..............O160, PM483 Cecchetto, Fátima H. .....PT312, PT313
Budiono, Bambang ........PM233, Campbell, Duncan J. .....O034, Cedenila, Marcela .........PT113, PT114
PM272, PM300, PM371, PT250, PM089, PM410 Celermajer, David .........O022, O059,
PT295 Campione, Alana A. ......PT292 O140, O155, O162, PM291,
Budzillo, Magda ...........PW335 Canniffe, Carla .............PT414 PM439, PM443, PM444, PM445,
Buendia, Alfonso H. ......PT422 Canobbio, Mary ...........O101 PM447, PM448, PT051, PT096,
Bulj, Nikola ................PT010 Canonico, Giovanni .......PM021 PT111, PT115, PT414, PW076,
Bull, Fiona .................O143 Cao, Christopher ..........O219 PW341
Bullock, Andrew ..........O140 Cao, Kejiang ...............PM400 Celutkiene, Jelena .........PT052
Bundchen, Daiana C. .....PW041 Cao, Longxing .............PT356 Cerqueira, Daniela ........PW343
Bündchen, Daiana C. .....PT047, PT244 Cao, Nga ...................PT174, PW293 Cesa, Claudia C. ..........PT418, PT419
Bunker, Stephen J. ........PT155, PT156 Carapetis, Jonathan .......O070, O097, Cesar, Luiz Antonio M. ..PM320,
Buratto, Edward ...........PT097, PM284, PM466, PT430, PT437, PT459
PW078 PT441, PT442, PT443, PW355, Cestari, Priscila ............PW322
Burazor, Ivana .............PT289, PW356, PW363 Cetina-Perez, Lucely ......PT390
PW193 Carbone, Angelo ..........O061 Cetta, Frank ................O101
Burgess, David .............O113 Carioca, Antonio CG, Bahuleyan .............O204
Burgess, Sonya .............O213, PW138 Augusto F. ............PM357, Chacko, Manas ............PW105
Burgos, Sebastian ..........PT260 PT274 Chacko, Yohan ............PT002
Burke, Rhonda.............PM483 Carlton, Edward ...........PT123 Chacón, Javier .............O169,
Burns, Andrew ............O014 Carlyle, Alastair ............O199, PT187 PW207
Burns, Kylie ................PW346 Carneiro, Flávia ...........PM345, Chagas, Antonio C. P. ....PT196
Burrell, Louise M. .........PM045 PW178 Chakraborti, Anuradha ...PW358
Bursic, Vedran .............PT010 Caro, Milagros .............PM007 Challa, Prasad .............PM436,
Bursill, Christina ..........PW278, Caroline, Isabelle ..........PM346, PW057
PW296 PT016, PW178 Chalmers, John ............O079
Burstow, Darryl J. .........O057, O180, Carosella, Victorino .......PM170 Cham, Yee Ling ...........PM408
PT386, PT387 Carr, Bridie .................O165 Chan, Christina W. .......PT111

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Chan, Jonathan ............O057, O078, Chen, Li H. ................PM393 Cho, KaWing ..............O195

O180 Chen, Qifeng ..............PM429 Cho, Kyoung I. ............PM329,
Chan, Kim H. .............O022 Chen, Su-Hui ..............PM068 PW215, PW216
Chan, Kimberley ..........PT406 Chen, Ting .................O185 Cho, Yun K. ...............PM329
Chan, Kit ...................O118 Chen, Xiuqin ..............PW023 Chodavarapu,
Chan, Laura ................PT214 Chen, Yih-Sharng .........PT362 Ravikumar ............PT425,
Chan, Laura Lihua ........PT038 Chen, Yuefeng .............PM067 PW273
Chan, Mark ................PW240 Chen, Yung-Chih .........PT342 Choi, Bo ....................PM482
Chan, Matthew J. .........O062, Cheng, Eugene ............PM478 Choi, David H.-M. ........O121,
PM198, PW156 Cheng, Jun .................PW180 PM095, PM129, PM225, PW291
Chan, Michelle M.-Y. .....PT015 Cheng, Kevin ..............PW325 Choi, Jae Hoon ............O045,
Chan, Peter Y. .............PM181, Cheng, Lijun ...............O137 PM098, PT131
PT149, PT203 Cheng, Victoria ............PM065, Chong, Adrian .............PT092
Chan, Robert K. ...........PM198, PW336 Chong, Cher-rin ...........O066,
PW156 Cheng, Yuan ...............PW021 PM076, PM220, PM482
Chan, Wai ..................PT130 Cheniti, Ghassen ..........PW103, Chong, James ..............O019, PW281
Chan, William .............PW245 PW104 Chong, Nelson W. ........O067
Chan, Yih-Kai ..............O109, O181, Chen-Xu, Michael .........PM156 Choong, Jamie .............PM135
PM259, PM488, PW194, PW222, Cheshire, Caitlin ..........PM116, Chopra, Ima ...............PT314
PW369, PW372, PW377 PM197, PT108, PT151 Chopra, Sandeep ..........PT103,
Chan, Yuen ................O052 Cheung, Carol .............O124 PT184, PW084
Chandran, Suresh .........PM017, Cheung, Li Li ..............PM412 Chou, Ming-Ting ..........PT200
PM136, PT012, PT259, PW042, Cheung, Michael ..........O035, O129, Choudhary, Preeti .........PM443,
PW231, PW232 O158, PT360, PW287 PM445, PM447, PM448, PT111,
Chandra-Nair, Satish .....PM253 Chew, Derek P.............O092, O110, PT414
Chandrasehkar, Rajiv .....O089 O165, PM196, PM328, PT127, Choudhury, Kamrun N. .PM273
Chandrasekhar, Jaya ......PT128, PT133 PW102, PW120, PW202 Choudhury, Sohel R. .....O196, PT306
Chang, Anne ...............PW143 Chhetri, Shailaja ...........O144 Chow, Clara ...............O019, O043,
Chao, Charles ..............PT378, Chia, Ee-May ..............O021, O059 O062, O112, PW202, PW267
PT379, PW329 Chia, Karin K. M. .........O149 Chow, Vincent.............PM096,
Chapman, Matthew .......PM100 Chia, Paul ..................PM200 PT051, PT115, PW076
Charakida, Marietta .......PM252 Chia, Shaw Yang ..........O209 Chowdhury, Enayet K. ...PM323
Charchar, Fadi J. ..........PM381, Chiam, Jenn Rong ........PM144 Chrzanowski, Lukasz .....PM234
PT349 Chiang, Chun-Yuen .......PT200 Chu, Jianmin ..............O049,
Chard, Richard ............PM443 Chiao Wen, Lim ..........PM422, PT265
Charfeddine, Salma .......PM090, PT207, PT296, PT297, PW067, Chu, Po-Yin ................O171
PM190, PM191, PT105, PT106, PW201 Chua, Jia Ni ................PT351
PT107, PT135, PW085 Chidambaram, Sundar ...PT118 Chua, Kelvin ...............PM144
Charles, Lugero ............PM009 Chien, Li-Yu ...............PM068 Chua, Seng Keong ........PM408
Charter, Kerrie .............PM184, Chik, William..............O118, O154, Chua, Terrance S. J. ......PT210,
PM198, PW118 PM020, PT013, PW014 PT409, PW240
Chatterjee, Manjusha .....O064, PT314 Chin, Felicia Y. Y. .........PM222, Chuhwak, Evelyn K. ......PW229
Chatterjee, Shelly ..........O098 PT361 Chung, Namsik............PW323
Chatterton, Sophie ........PW117 Chin-Dusting, Jaye ........PM366 Chung, Tommy ...........PM096,
Chaturvedi, Nishi .........PM396 Ching, Chi Keong .........O209, PT015, PT051, PT115, PW076
Chatzistamatiou, PT214 Chung, Woo-Young ......PM305,
Evaggelos .............PT221 Chiolero, Arnaud ..........O206 PT247
Chaves, Rogerio B. M. ....PT439, PT440 Chirino Navarta, Daniel ..PT005, PT206 Chuo, Chung Hui .........PT356
Chavez, Rafael D. .........PM485 Chirkov, Yuliy Y. ..........PT365, PT366 Ciambrone, Graciana .....PM170
Chawantanpipat, Chirkov, Yuliy .............O066, Cicale, Eliana ..............O068
Chirapan ..............O022 PM100, PM220, PM224, PT209 Cieslik, Urszula ............PW165
Chen, Hao .................O195 Chiyong, Moon ............PM454 Ciocanea, Iuliana ..........O018
Chen, Jing ..................O211 Ch’ng, Julie ................PT378, PT379 Cipresso, Clemente .......PM414
Chen, Jingzhou ............PM400 Cho, In-Jeong ..............PW323 Civeira, Fernando .........PM385

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Claessen, Guido ...........PM128, Conaglen, Paul ............PT097 Cruz, Inês ..................PW043,

PM290 Conceicao, PW044, PW045, PW046
Claessens, Christophe ....PM299, Raquel D. D. O.......PM251 Cruz, Sherwin D. .........PW238
PM427, PT079, PW115 Conde, Diego ..............PM007, Cserne Szappanos,
Claessens, Jan E. ..........PM299, PM157 Henrietta ..............O127, PM376
PM427, PT079, PW115 Condon, John .............PT441, PT442 Cuko, Amarild .............O157, PT077
Claessens, Marc ...........PM299, Connell, Cia ...............PM064 Cunha, Valeria N. .........PM390
PM427, PT079, PW115 Connolly, Stuart ...........O095 Cura, Fernando............PM157
Claessens, Maria ...........PM299, Consuegra-Sanchez, Curl, Claire ................PM381,
PM427, PT079, PW115 Luciano ................PM158 PM395
Claessens, Philip ..........PM299, Cooke, John ...............PT345 Curnow, Jennifer ..........PT051
PM427, PT079, PW115 Coombes, Jeff S. ...........PM030, Curotto Grasiosi, Jorge ...PW073,
Clark, Alex .................PW143 PM492 PW074
Clark, David J. .............O008, O063, Coorey, Genevieve ........O142, PM306 Cutlip, Donald .............O131, O218,
O214, PM147, PM182, PM183, Copija, Angelika ...........PT186 PM326, PT184, PW123
PM184, PM198, PT143, PT151, Coppola, Carmela .........PM414 Cvetkovic, Predrag ........PT289
PT176, PT179, PT449, PW245, Cornall, Lauren ............PM387 Cvjetan, Radosava .........PM079,
PW280 Corones-Watkins, PT223
Clark, Robyn A. ...........PM318, Katina..................PW376 Cygulska, Kamila ..........O073,
PW373, PW374, PW376 Correia, Emanuel ..........PT094 PW165, PW332
Clarke, David M. ..........PT155, PT156 Corros, Cecilia .............PM120, Czuriga, Daniel ............O023
Claughton, Andrew .......PT002 PM121, PM122 D, Dalus ....................O204
Claus, Piet ..................PM128, PM290 Corte, Peter ................PW303 D, muthukumar ...........O135, PT118
Clayton, Zoe E. ............O022, Corte, Tamera .............PW303 D’Annunzio, Verónica ....O068
PM373, PT345 Cortez Quiroga, D’Udekem, Yves ...........PW347
Clemens, Andreas .........O215 Gustavo A. ............PW073, da Silva, Edson L. .........O075
Clemons, Tristan ..........PT359 PW074 da Silva, Lilian A. .........PM012
Clymer, John ..............PM355 Cosentino, Egidia .........PM021 Dahiya, Arun ..............PM054,
Coates, Patrick T. .........PW301 Costa, Cristiane ............PW322 PM055, PM436, PT378, PT379,
Coates, Penelope ..........O110 Costa, Marco ...............O086, O087 PW057
Cobet, Valeriu .............PT202, PT339 Costello, Ben ...............PW171 Dahloef, Bjoern ............PM258
Cockburn, James A. ......O100, PT374 Costin, Sava ................PT202 Dai, Zixuan ................O017
Coelho, Otavio R. .........PM266, Coupe, Michael ............PT012 Dalin, Martin ..............PT347
PT292 Couper, Margaret .........PT125 Dallan, Luis ................PT191
Coelho, Rosália ............PW343 Courtney, Mary............PW143 Dalmazo, Aline ............PT418
Cohen, Ronny .............PT071 Coverdale, Steven .........PW120 Damasceno,
Colagiuri, Stephen ........O105 Cowie, Kath ................PM065 Nágila R. T. ...........PM285,
Colberg, Christian.........PM137 Cowin, Gary ...............PT372, PT373 PM357, PM446, PT274
Colburn, Darren ...........PT180 Cowled, Prue ..............PT088, PT089 Dang, Catherine ...........PW238
Cole, Justin A. .............PM016 Cox, Nicholas..............PM181, Dang, Nguyen .............PM210,
Coller, Jennifer M. ........O034, PT149, PT203, PT208, PW133 PW152
PM089, PM410 CP, Vineeth ................PW105 Daniels, Elena V. ..........PM236
Collier, Megan .............PT318 Cranefield, David..........PM434 Dantanarayana, Ashanti ..O022, PM373
Collier, Tim ................O116 Crebbin, Susan J. .........PT460 D’antoine, Heather A. ....PW357
Collins, Nicholas ..........PW368 Crendal, Edward ..........PM319 Darby, Jonathan ...........PT097,
Colman, Jack ..............O101 Crengle, Sue ...............O047, O069 PW078
Colquhoun, David M. ....PM274, Cristina, Bárbara ...........PM345, Dariusz, Korczyk ..........PT002
PT155, PT156, PT277 PM346, PT016, PW178 Dart, Anthony .............O003,
Colquhoun, Samantha ....O071, Crittenden, Jo N. ..........PM491 PM016, PT231, PW118
PM284, PM466, PM471, PT441, Crook, Robina .............O143 Darvish, Reyhaneh ........O187
PT442, PT443, PW353, PW355, Crosling, Bianca ...........PT243 Das, Probir .................PT154
PW363 Cross, Harley T. ...........PM489 Das, Sandipan .............PT154
Colvin, Joanne .............PT423 Crouch, Gareth ............O175 Daunoravicius, Dainius ...PM050,
Comes, Cecilia .............PT260 Cruz, Fernanda A. ........O075 PM051

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Dautov, Rustem F. ........PT366 Delafontaine, Patrice ......O211 Diaz González, Mayda ....PM296,
Dave, lokendra ............PM415 Delatyki, Martin ...........PW283 PT307
David Mojiun, Delbridge, Lea M. .........O128, Diener, Hans-Christoph ..O215
Christabel .............PT098 PM381, PM395, PW293 Diez, Jose ...................PT271
Davidovic, Lazar ...........PM099 Del-Castillo, Jose M. ......PM430 DiFiore, David .............PT281
Davidson, Patricia M. .....PM230, Delcourt, Candice .........O079 DiFiori, David .............PT130
PM491, PT453, PW003 Delcroix, Marion ..........PM128 DiGiacomo, Michelle .....PT453
Davies, Jessica .............PW089 Deleojo, Bolade F. ........O024 Dignan, Rebecca ...........PW117,
Davis, Lloyd................PW224 Delgado, Araceli ...........PW183 PW131
Davis, Philip ...............PT097, Delgado Moreno, Dimeski, Goce .............PT002
PW078 Manuela ...............PW073, Dimitri, Hany ..............O015,
Dawson, Kyle ..............PT444, PW074 PM143, PT403
PW361, PW362 Delic-Brkljacic, Diana .....O146 Ding, Jia W.................PM154,
Dawson, Paula .............O184, PT008 Deljanin Ilic, Marina ......PM267, PM393
De Anchorena, Martin ....O103 PM423 Ding, Patricia Y. J. ........PT189
de Araujo, Pablo A. B. ....PT244 Della Bartola, Luca ........PM340 Ding, Zee Pin ..............PT083
De Backer, Guy ............O192 Delmonte, Hernan ........PT260 Ding, Zhiwen ..............O026, PT352
De Bacquer, Dirk ..........O192 DeLong, Elizabeth R. .....O195 Disney, Patrick ............O140
de Carvalho, Gabriela D. .PW041 Dementjeva, Natalia ......PM367 Divakaramenon,
de Carvalho, Tales ........O075, Demeriyenes, Syamkumar ...........O095
PM052, PT047, PT244, PW041 Amy C. ................PW260 Dixon, Robyn ..............O081
De Conti Cartolano, Demerre, Erlyn ............PM474 Dizeo, Claudio .............PT005, PT206
Flavia ..................PT274 DeMicco, David A. ........O212 Djukic, Petar ...............PM099
de Grazia, JAndrés ........PM327 Demir, Mesut ..............PM031 do Nascimento, Fabiana
De La Fuente, Juan C.....PT389 Demirtas, Mustafa .........PM141 F. .......................O046
de la Hera, Jesus ..........PM120, Deniz, Ali ...................PM031 Dobrzynski, Halina .......O020
PM121, PM122 Dennekamp, Martine .....O189 Dobson, Laura .............PM109,
de la Noval García, Denniss, A.Robert .........O113, PT405, PW310
Reinaldo ...............PM296 PM102, PT134 Doi, Osamu ................PM304
de Lima, Jose Jayme G. ..PM320, Depasquale, Carmine .....O175 Don, Creighton ............PW281
PT159 Derek, Lovorka ............PW145 Donarelli, Cynthia ........PW293
de Lima, Patricia A. .......PT274 Descellar, Joseph ..........PW014 Donato, Maria S. ..........PM170
De Loryn, Tania ...........PT088, PT089 Deveci, Onur S. ...........PM031 Donato, Martin ............PW277
de Mara, Lourenço S......O075, Devenney, Daniel .........PM210, Dondi, Maurizio ...........PT395, PT396
PM052, PW041 PM425, PW152 Dones, Wistremundo .....PW183
De Matteo, Robert ........PM450 Devereaux, P. J. ...........O062 Doneva, Sanja .............PT002
De Pasquale, Carmine Devlin, Gerrard P..........O032, O165, Dong, Jian Zeng ...........O096,
G. ......................PT375, O208, PM070, PT093, PT127, PW006, PW010, PW011
PW102 PT150, PT181 Donnelly, Tam Truong ...PT300
de Paula, Flavio J. .........PM320, Dewi, Triwedya I. .........PW081 Donohue, Thomas ........PT271
PT159 Dey Biswas, SK ............PM173 Donova, Temenuga .......O123
de Rooy, Felix .............PM317 Di Diego, Jose .............PM398 Donovan, Chantal .........PT174
De Rosa, Maria Di Fiore, David ............O074, Donovan, Roberta .........PM350
Leonarda ..............PT080 PM175 Dooris, Mark ...............PM054
De Zoysa, Janak ...........PT166 Dia, Charles A. ............PW217 Dorra, Abid ................PW080
Deedwania, Prakash C. ...O170, O212, Diab, Reda .................PT230 D’Ortenzio, Eric ...........O134
PM316, PW219 Diab, Sara ..................O057 dos Santos, Antonio
Deguchi, Karime ..........PM266, Diallo, Fatou A. ...........PW217 Marcos M. ............PT459
PT292 Dias, Diego J. ..............PM266, Dossin, Isabella D. A. .....PM041,
Dekleva, Milica ............PM079, PT292 PT043
PT223 Dias, Ivan ..................PT016 Dostalova, Gabriela .......PW209
Del Mauro, Julieta.........PW277 Dias, Patricia ...............PT264 Doughty, Robert...........O208,
del Valle, Raquel ..........PM120, Dias, Peter S................PW099 PM070, PM464
PM121, PM122 Diaz, Lidia ..................PT260 Douglas, Homeyra ........O184, PT008

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Doukky, Rami .............PT268 Edwards, Colin ............PM434 Escobar, M Cristina .......PM327

Doupa, Dominique .......PW217 Edwards, James ............O106 Escribano, Pilar ............PM103
Dourado, Luciana O. C. .PT459 Effarezan, Abd Rahman ..PM422, Esfandiarei, Mitra .........O090
Dowie, Jack ................PM013 PT207, PT296, PT297, PW067, Eskandari, Mehdi .........O054, PT384,
Dreyer, Rachel .............PT130, PW201 PW324
PW059 Egger, Joseph R. ...........O188 Esler, Murray D. ..........PM256
Dridi, Zohra ................PW103, Ehsan, Mohammad A. ....PT162 Eslick, Guy D. .............PT134
PW104 Eide, Leslie S. P. ..........PM484 Eslick, Guy D. .............O113,
Driscoll, Andrea ...........O084, PT056 Einstein, Andrew J. .......PT395, PT396 PM101, PM102
Drozdova, Liubov Y. ......PM236 El Aroussy, Wafaa A. M. .PM309, Espíndola, Vanessa
Drury, Nigel E. ............PM076 PM424, PM472, PW208 Beatriz P. ..............O046
D’Souza, Daniel ............PW037 El Banna, Noha ............PT300 Esposito, Arianna .........PT080
Du, HuiYun ................PT453 El Gamel, Adam ...........PT150 Essue, Beverley ............O112
Du, Xiao-Jun ...............O166, PT364 El Hagracy, Nashwa ......PM472 Estrela, Anabela ...........O036
Du, Xin .....................PM289, El Naggar, Wael ...........PW016 Eusse, Carlos...............PW083
PW010, PW011 El Remaisy, Dalia..........PM309 Evans, Michael F. .........O197
du Sart, Desiree ...........PW283 El Sadig, Mohammd ......PT261 Evans, Shona ..............PW310
Dubey, Abhishek K. ......PW195 El Shahawy, Md, Evren Ozcan, Emin .......O150
Dubey, Avinash K. ........PW195 Mahfouz ...............PT255, Ezzati, Majid ...............O193,
Dubey, Sonika .............PW195 PW248 PM278, PT441
Dubner, Sergio ............O215 Elasfar, Abdelfatah ........PT036, PT058 Faddy, Steven ..............PM211
Dubova, Ganna ............PT420 ELGendy, Ali ..............PW225 Fahmy, Peter ...............PM378
Dueñas Herrera, Alfredo F. .PM296, PT307 ElHagracy, Nashwa .......PW208 Falase, Ayodele ............PM247,
Duerschmied, Daniel .....PM137 Elhajj, Imad ................PW284 PM249, PT270
Duffy, Stephen J. ..........O008, O063, Elissamburu, Pablo .......PM007, Falk, Gregory L. ...........PM404
O214, PM016, PM182, PM183, PM157 Fall, Caroline ..............PM173
PM465, PT176, PT179, PT197, Elitok, Ali ..................PW129 Faltado, Antonio ..........PW054
PW118, PW146, PW245 Ellenga Mbolla, Bertrand Faludi, Mária...............O056
Dunbar, James .............PM275 F. .......................PM337 Fam, Jiangming............PT210, PT214
Dunbar, Sandra B. ........O107 Ellims, Andris H. ..........O037, O038, Fam, JM ....................
Duncan, Tara ..............PW206 O136, PM056, PM075, PM271, Fan, Li ......................PM245
Dundon, Benjamin ........PW301 PT049, PT338, PW047 Fan, Shuqin ................O141
Dunn, Louise ..............O022, Elliott, David ...............PM372 Fan, Yuxin .................PM025
PM373, PW278 Elliott, Rohan ..............PW094 Fang, Bo ....................O186
Dunster, Kimble ...........O057 Ellis, Chris .................O165, Farag, El Sayed ............PM159
Dunzhu, Danzeng .........O195 PM431, PT070, PT127 Farouque, Omar ...........PM184,
Duran Torralba, Ellis, James .................O167 PM198, PT176, PT179,
María D. C. ...........PW073, Elly, Eliane .................PM345, PT449, PT456, PT457, PW156,
PW074 PM346, PT016, PW178 PW280
Duronto, Ernesto ..........PT260, PT451 El-Menyar, Ayman ........O202, PM161 Farquharson, Colin .......PT431
Dutta, Santanu.............O098 El-Merhi, Fadi .............PW235 Farrag, Azza A. M. ........PM424,
Dwyer, Nathan ............O155, PW326 Elsaidy, Mona A. ..........PW225 PM472, PT283, PW234
Dwyer, Terry ...............PM288 Elsayed, Hossam ..........O184, PT008 Farshid, Ahmad ...........PT127,
Dymarkowski, Steven ....PM128, Elwood, Ngaire J. .........PW347 PT128, PT178
PM290 Emami, Mahmoud ........PW155 Fathallah, Jihan ............PT225
Eaton, Sarah ...............PW344, Emslie, Kerry R. ...........PT349 Fatkin, Diane ..............O020, PT350
PW345 Engel, Leif-Christopher ...O010 Fatma, Ayedi ...............PT135
Ebrahim, Iftikar ...........PM085 England, John F. ..........PW224 Fauchier, Laurent .........O050
Eccleston, David ...........PM169, Enina, Tatiana .............O156, PM037 Faull, Randall ..............PW301
PM186, PM187, PM188, PM189, Entcheva, Miglena.........PT255, Fauzi, Norsyahida M. .....PM332,
PT143, PT458, PW098 PW248 PW134
Eden, Barbara ..............PM339 Erbas, Bircan ...............PW353 Fawzi, Hossam ............PW208
Edes, Istvan ................O023 Eriksson, Mats .............PM385 Fawzy, Hossam ............PM472
Edwards, Andrew .........O052 Escobar, Ana M. ...........O103 Fearon, William F. ........O130

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Feldman, Harold ..........O210 Flores, Joan E. .............PT286 Fu, Jinlin ...................PW100

Felicia, Devi ................PM280, Flores, Rene ................PT284 Fu, Qiang ..................PW292
PM281, PM341 Fokeer, Reena Sharma ....PM242 Fujimoto, Manabu ........PM071
Felix-Redondo, Fokina, Anna V. ...........PM236 Fujio, Tatsumi .............PM302,
Francisco J. ...........PM158 Foltran, Mariana ...........PW322 PT226
Femia, Giuseppe ..........PM210, Fong, Alan Y. Y. ...........PM222, Fukuda, Hiroshi ...........PM421
PW152 PM223, PM408, PT351, PT361 Fukuda, Nobuaki .........PT382
Feng, Jia-Li .................O082 Foody, Joanne .............PW177 Fukuyama, Asako .........PM119
Feng, Juan ..................PM368 Ford, Greg .................PM352, Fukuzawa, Shigeru ........PM420
Feng, Liang ................PT015 PT316 Fung, Tak ..................PT300
Ferferieva, Veselina .......PW309 Foreman, Rachelle ........PM348 Furler, John ................PT334
Ferguson, Caleb ...........PM230, Forouzanfar, Mohammad Furuhashi, Tatsuhiko .....PM421
PW003 H. ......................O193, Fuster, Valentin ...........O182, PT452
Fernandez, Ritin ...........PW367 PM278, PT441 Fyfe, A ......................PM431, PM432
Fernandez, Steven .........PM244, Forrest, John ...............PW083 Fynn, Simon P. ............O119
PT059 Forsblad d’Elia, Helena ...PW306 G, Ravishankar ............PT118
Fernandez Arias, Juan ....PT257 Forshaw, Tony ............PM030 G., Prathapkumar .........O135
Fernandez-Berges, Foster, Kelley ..............PT391, PT394 G., Ravisankar .............O135
Daniel .................PM158 Foster, Simon ..............O054 Gabric, Ivo Darko .........O146
Ferraz, Emanuelle B. ......PM391 Fothergill, Daniel P. ......O067 Gabriel, R S. ...............PM431,
Ferreira, Felipe ............PT196 Fotjadhi, Irma .............PT271 PM432
Ferreira, Heloisa A. .......PW257 Fotoohi, Neda .............PT009 Gabriella, Alexandra ......PM280,
Ferreira-Jardim, Fraga, Carlos A. ...........PM390, PM281, PM341
Antonio ...............PM274, PM391 Gafane, Lebo ...............PT227
PT277 Frampton, Chris ...........O140 Gafarov, Valery ............O173, PT287,
Ferreyra, Raúl ..............PW015 Francis, Rebecca ...........PW038 PT291
Ferry, Cate .................PW202 Franco, Jeffrey .............PW057 Gafarova, Almira ..........O173, PT287
Fetahovic, Taufik ..........PM135 Franco, Maria Esther O. .PM485 Gage, David ................PT433
Fifoot, Allison .............O078 Franich-Ray, Candice .....O083 Gagulin, Igor ...............O173, PT287
Figtree, Gemma A. ........O100, Fraser, John F. .............O057 Gaikwad, Niranjan ........O180
PM439, PT374 Fredy, Felix C. ............PM280, Gainza, Daniela ............PM327
Figueiras, Lourdes ........PM120, PM281, PM341, PT234 Gajic, Milan ................PM206
PM121 Freedman, Saul Ben ......PT007 Gale, Michael J.............PT071
Filgueiras, Lourdes M. ....PM122 Freeman, Melanie .........O001, O063, Gall, Katherine.............PW267
Filipiak, Krzysztof J. ......PT006, PM016, PM135, PM180, PM183, Gallagher, Robyn ..........PM483
PT158, PW022, PW173 PM185, PM197, PT143, PT151, Galli, Monica Graciela ....PT257
Fillipi, Paula ...............PW320 PT176, PT197, PW098, PW146 Galloway, Graham J. ......O179
Fingland, Annika ..........PT450 Freitas, Isabela .............PW343 Gambarte, Gimena ........PM170
Fischer, Avi ................PM033 Freitas Junior, Manoel Gamble, Greg ..............O047, O121,
Fisher, Nicholas G. .......PW142 G. ......................PW058 O220, PM129, PM225, PM318
Fitridge, Robert ............PT088, French, Andrew ...........PT182, PT201 Gammage, Michael ........O055, PW327
PT089 French, Bruce ..............PT232 Gamra, Habib ..............PW103,
Fitzgerald, John L. ........O149 French, John ...............O015, O110, PW104
FitzPatrick, Meaghan .....PT174 O165, PM143, PM318, PM411, Ganapathy, Sanjay ........O204
Fitzsimons, Sarah .........PW108 PT127, PT403, PW117, PW138 Gandhi, Pratiksha .........PT145
Flaherty, Charlotte ........PW205, Frennaux, Michael ........PM076 Ganesan, Anand ...........PT004
PW206 Fridlund, Bengt ............PM484 Ganesan, gnanavelu .......O135
Flannery, Michael D. .....O031, Fridman, Osvaldo .........PM063 Ganigara, Madhusudan ...PW303
PM014, PM034, PM035, PM036, Friedman, Daniel ..........PM193 Gao, Fei ....................PM088,
PT406 Frikha, Imed ...............PW080 PM429
Flaxman, Abraham ........PM278 Frost, Lachlan .............O061 Gao, Wei ...................O188, PT195,
Flentji, Kate ................PT198 Fryer, Michael .............PT040 PW128
Fletcher, Peter .............PM211, Fu, Hao .....................PT132 Gao, Xiao-Ming............O166
PW106, PW305 Fu, Huaying ...............O137, O183 Gao, Yuanfeng .............PM024

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Gao, Xiaoming .............PT174 Gerunsin, Jerry ............PM222 Gonzáles, Ana I. ...........PM052,

Gapon, Ludmila ...........O039, Ghabashi, Abdullah .......PT036, PT058 PT244, PW041
PM367, PW181, PW182 Ghafari, Samad ............PW107 Gonzalez, Manuel .........PT001
Garabedian, Torkom ......PT225 Ghantous, Andre ..........PT271 Goo, Shi Yi .................PT040,
Garakyaraghi, Ghareeb, Soliman .........PM424 PT372, PT373, PW276, PW307
Mohammad ...........PT183, PT245 Ghisi, Goodman, Marc ...........PW238
Garcia, Ana .................PM120, Gabriela L. D. M. ....O197, Gooley, Robert ............PM109
PM121, PM122, PT001 PM486, PT455 Gorbatenko, Elena ........O156,
Garcia, Deborah ...........PW335 Ghosh, Sudip ..............O098 PM037, PM164
Garcia, Dolores ............PT001 Ghulam Rasool, Aida Gordon, Allan .............O040
Garcia Bengoechea, Hanum ................PM242 Gould, Paul ................PT002
Enrique ................PW205 Ghysels, Stefan ............PM290 Gouliopoulos, Nikolaos ..O133,
García-Gonzalez, Martín Giampietro, Ottavio.......PM340 PM307, PT288
J. .......................PM146 Gibbs, Oliver ..............PM417 Govindan,
Garde, Somesh S. .........PM415 Giles, Robert ...............PM193 Vijayaraghavan .......O204
Garde, Swapnil S. .........PM415 Gill, Paramjit ...............PW214 Gowdak, Luis
Gardner, Christian ........O131 Gillinder, Lisa ..............PT040, Henrique W. .........PT159
Garg, Rajesh ...............PT385, PT136, PT137, PT372, PT373, Goyeneche, Maria A. .....PW277
PW335 PW276, PW307 Grabauskiene, Virginija ...PM050,
Garmendia, Cristian ......O068 Ginzburg, Moisey L. ......PM236 PM051, PT052
Garnjulkpuy, Joanne......PW357 Giri, Rinky .................PM108 Grace, Sherry L. ...........O197,
Garovic, Vesna D. .........PM192 Gjerdalen, Gard F. ........O053 PM486, PT455
Garrahy, Paul ..............PT136, PT137 Glasziou, Paul .............PT266 Grade, Swapnil ............PW195
Garrido, Javiera ............O169, PW207 Gleadle, Jonathan .........PT375 Grandjean-Thomsen,
Garsia, Roger ..............PM439 Gleason, Brigette ..........O086 Nicolas ................PT178
_
Gaszewska-Zurek, Ewa ...PW087 Glozier, Nick...............PT155, PT156 Granger, Christopher .....PW247
Gatta Castel, Juan .........PT451 Godoy, Moacir F. .........PW259 Grassi-Kassisse, Dora M. .PM104,
Gautam, Mani P. ..........PM057 Goel, PK ....................PW211, PT110, PW056
Gautam, Samir.............PM057, PW212 Greaves, Kim ..............PT123
PM473 Goes, João ..................PM345, Greco, Carla ...............PW277
Gaydukova, I ..............O126 PM346, PT016, PW178 Greenberg, Henry .........PM347
Gbadamosi, Maruf S. .....O024 Gökdeniz, Tayyar .........PM110, Greenfield, Sheila .........PW214
Ge, Lan .....................PM167 PT119 Greenwood, Bonnie .......PM126
Gedeon, Jude ..............PM287 Golan, Lubor ..............PW209 Grenfell, Robert ...........PM069,
Geelhoed, Elizabeth .......O131, O207, Goldblatt, John ............O177, PM294, PM352, PM463, PT327
O218, PM326, PW123, PW264, PM117, PM118, PT108 Grieve, Stuart M. ..........PM439,
PW265 Golden, Marjorie ..........PT271 PT374
Gehani, AA .................O202 Goldsworthy, Michelle ...O083 Grigg, Leeanne ............O140, PT096,
Geier, Christian ............PM092, Golebiovski, Wilma F. ...PT113, PW341
PT067 PT114 Grignola, Juan C. .........PM103, PT087
Gellatly, Rochelle M. .....PM064, Gollop, Nicholas ..........PT012, Grilllo, Vinicius R. ........PM266
PW094 PT259, PW231 Grimaldi, Domenico ......PW170
Geller, Mauro ..............O194 Gombet, Thierry R. .......PM337 Grimm, Richard ...........PT254
Gellér, László ..............O150, O152, Gomes, Liliana .............PW343 Griskevicius, Antanas .....PM046
PM018, PM019, PW262 Gomes-Marcondes, Maria Gromova, Elena ...........O173, PT287
Gelman, John ..............PW310 Cristina C. ............PM023, Grover, Benn...............PM355
Gelpi, Ricardo J. ...........O068, PW277 PM377 Grover, Suchi ..............O077, PT375
Genimata, Vasiliki .........O133, Gómez, Anabella ..........O068 Grüner Sveälv,
PM307, PT278, PT288 Gómez Sánchez, Miguel Bente Elisabeth .......PW306
Gentili, Sheridan ..........PW295 Angel ..................PM103 Gu, Dongfeng ..............PT224
George, Reema ............PW105 Gong, Gui ..................O026 Guddattu, Vasudev .......PW228
Georgescu, Valentina .....O018 Gong, Hui ..................O186, PT352 Gueldich, Majdi ...........PW080
Gerdes, A M................PM067 Gong, Tao ..................O085 Guerola, Raquel ...........PT001
Gerhardus, Jan.............PT104 Gonska, Bernd-Dieter.....O012, O122 Gueye, Lamine.............PW217

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Gueye, Pape M. ...........PW217 Hafisyatul, Zainal Harikrishnan, S ............PM148

Guillou, Matt ..............O022 Abidin .................PM422, Haroon, Nader ............PT230
Guimarães, de Araujo J. ..PT138 PT207, PT296, PT297, PW067, Harper, Richard W. .......PM149
Guiotti, Maria ..............PM345, PW201 Harrap, Stephen B.........PM381,
PW178 Hafizullah, Mohammad ..PT046, PT109 PT349
Gul, Adnan M. ............PT046 Hagemeyer, Christoph ...PM370 Harris, Darren .............PM481
Guliyev, Faig ...............PW051 Haikerwal, Anjali ..........O189 Harris, Emma ..............PT423
Gullace, Federico ..........PW277 Hailan, Ahmed ............PM199, PT153 Harris, Mark ...............O105, PT253
Gunasegaran, Hajime, Ichikawa ..........PM454 Harrison, Timothy ........PM195
Kurugulasigamoney .PT083 Hajmiresmail, Harrison, William .........PT189
Gunduz, Sabahattin .......PW090 Seyedjavad ............PM308 Harrop, Danielle ...........PT040,
Gündüz, Sabahattin .......PM110, Halcomb, Elizabeth .......PT334 PT136, PT137, PT372, PT373,
PT119 Hales, Susan ...............PM483 PW276
Gunn, Julia .................O083 Halim, Sharif ...............PW247 Hart, Hamish ..............PM434
Guo, Zhao-Zeng ...........PM165, Halkon, C ..................PM475 Hasan, Raafat ..............PM424
PM166, PM167, PM168, PM399, Hall, Chezhan .............PT456, PT457 Hasegawa, Koji ............O027,
PT376, PT376 Halliwell, Richard .........O062 PM304, PM331, PM389, PT358,
Guo, Zongwen .............O017 Halloran, Karen ...........O104, PM015 PW249
Guppy-Coles, Kristyan Halperin, Jonathan ........O215 Hashim, Jawad ............PM253
B. .......................PM428, Hamid, Arwa ..............PW028 Hashimoto, Tadashi ......PM304,
PT066, PT383 Hamid, Nadira .............PM080, PT358
Gupta, Arvind .............PW219 PM429 Hashimoto, Yasunobu ....PT226
Gupta, Balkishan ..........O170, Hamilton-Craig, Hassali, M. Azmi ..........PW269
PM316, PW219 Christian ..............O078, O179, Hassan, Mehmood K. ....PT328
Gupta, Nikita ..............O129, O180, PM406, PM447, PM448 Hassine, Majed ............PW103,
PW287 Hamm, Lee .................O210 PW104
Gupta, Rajeev ..............O170, Hammett, Christopher ...PT127 Haste, Mark ................PW370
PM316, PW219 Han, Hui-Chen ............PT176 Hattge Jr, Sérgio P. .......PT290
Gupta, Ruby ...............PW199 Han, Seung Hwan ........PM226 Hatzis, George .............PM252,
Gupta, Saurabh K. ........PM457 Han, Xiaoyuan .............O090 PM380, PT221
Gupta, Vinay K. ...........O201, O203, Hanchate, Milind S. ......PT175 Hawson, Joshua ...........O054, PW324
O205 Handelsman, David J. ....PM365, Haydock, David ...........O121, PM129
Gursoy, M.Ozan ...........PW090 PT340 Hayen, Andrew ............PT266
Gürsoy, Mustafa O. .......PM110, Handjaya, Chris T. ........PT234 Hayman, Noel .............O105
PT119 Hanif, Bashir ...............PM255 Hayward, Christopher ....PT037
Gurvitch, Ronen ...........O008, O177, Hannah, Jane ..............O081 He, Guo-Wei ..............PT276
PM116, PM117, PM118, PM147, Hansen, Mark ..............O078 He, Jiang ...................O210, O211,
PT108 Hansen, Peter S. ...........O100 PT224
Gusbeth-Tatomir, Paul ...O018 Hanson, JanE ..............PT432 He, Jing .....................PM124
Guthridge, Steve ..........PT442 Haq, M. Maksumul .......PT204 He, Tony ...................PW237
Gutierrez, Francisco ......PT028 Haque, KMHS S. ..........PM209, He, Rong ...................PT021
Gutleben, Klaus-Jürgen ...PM033 PT398 Head, Geoffrey A. .........PM244,
Gutman, Sarah J. ..........PM149 Haque, Sayeed .............PW214 PM256
Gyberg, Viveca ............O192 Haran, Crishan ............PT277 Healey, Jeffrey .............O095
Gyongyosi, Marianna .....PM092, Harbieh, Bernard ..........PW235 Heck, Patrick M. ..........O119
PT067 Harbridge, R ...............PM475 Heddle, William ...........PW102
Ha, Jong-Won .............PW323 Harding, Richard ..........PM450 Hee, Leia ...................PM091,
Haaverstad, Rune .........PM484 Harding, Scott .............O213, PW138
Habanyama, Gloria .......PW354 PM156, PT125 Heeley, Emma .............O079
Habib, Robert ..............PW284 Hardy, Naviin .............PT359 Heenan, Rachel C. ........O071, O114,
Habota, Tina ...............O160 Hare, David L. .............PT056, PM471
Haddadzadeh, PT155, PT156 Hegde, Prathap ............PM210,
Mehdi .................PT009 Hare, James L. .............O037, O038 PM425, PW152
Hafeez, Kudsia .............PW185 Hariawan, Hariadi .........PT416 Heiberg, Johan .............PT415

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Heidbuchel, Hein .........PM128, Höcht, Christian...........PW277 Howell, Tegwen ...........PM318,

PM290 Hodge, Claire ..............PW205, PW202
Heimeshoff, Martin .......O012, O122, PW206 Hristova, Krasimira .......PM145,
PT104 Hodt, Anders ..............O053 PM241, PT404, PW308, PW309
Hejazin, Barnaba ..........O200 Hoff, Eva ...................PW094 Hryciw, Deanne ...........PM387
Heltai, Krisztina ...........PM142 Hoffmann, Bernadette ....PT130 Hsieh, Calvin H. C. .......O021, O059
Hendriks, Randall .........PM200 Hoffmann, Udo............O010 HSU, Chia Lee .............PW335
Henrique-Cabrini, Hogan, Jarred ..............O015, Hsu, Chi-Jen ...............O022
Fernanda P. ...........PT110 PM143, PT403 Hu, Dayi ....................PM024,
Heo, Seongkum ...........O107 Hohmann, Jan David .....PM370 PT053
Heresztyn, Tamila .........PM100 Hokimoto, Seiji ............PW154 Hu, Ping ....................PT326
Hering, Dagmara ..........PM256 Holley, Ana ................PM156 Hua, QI .....................PT132
Herminingsih, Susi ........PM231 Holme, Ingar ...............O212 Huang, Alex L.-I. ..........O063, PW118
Hermiz, Oshana ...........PT334 Holt, Geoff .................PM186, Huang, Chi-Lun ...........PT343
Hernandez, PM188, PM189 Huang, Congxin ...........O017
Alejandro G. ..........PT422 Holtz, Joao V. .............PW321 Huang, Feiqiong ..........PM080,
Herry, Yan .................PM231 Homasi, Stephen ..........PM284, PM429
Hersch, Fred ...............O142, PM306 PW355 Huang, Kaimin ............O021
Hersi, Ahmed ..............PM162, Hon, JS .....................PT214 Huang, Xu-Rui ............PT170
PT036, PT058, PT165, PT320 Hong, Geu-Ru .............PW323 Huang, Yu-Tzu ............PT363
Hia, Cindy .................O124 Hong, Kyung S. ...........PM329, Huda, Reza M..............PM273
Hian, Sim Kui .............PW240 PW116.PW215, PW216 Hudson, Maui .............PW357
Hiasa, Go ...................PW114 Hong, Oisaeng .............PM353 Huffman, Mark ............PM148,
Hickey, Annabel ...........PM348 Hood, Sean D. .............PM491 PM173
Hickey, Peter...............PW283 Hool, Livia .................O127, Hufthammer, Karl O. .....PM484
Hickie, Ian B. ..............PT155, PT156 PM376, PT359 Hughes, Alun ..............O080, PM396
Hickling, Siobhan .........O082 Hoong, Caroline W. S. ...PM088 Hughes, Scott ..............PM489
Hidalgo, Ana B. ...........PM158 Hooper, Paula .............O143 Huisman, Menno ..........O215
Hidayat, Syarief ............PT129, Hope, Sarah ................PM449 Hung, Joe ..................PT160, PT161
PT438, PW081 Hopkins, Andrew .........PW138 Hung, John D. .............O184, PT008
Hieda, Kehima .............PT358 Hopkins, Debbie ..........PW206 Hung, Joseph ..............O207,
Hiew, Chin .................PM183, Hopper, Ingrid ............O145 PM196, PM265
PM197, PT143, PT151, PT198 Horder, Mark ..............PM436 Hung, Juichien ............PM172
Higa, Claudio C. ..........PM170 Horlock, Duncan ..........PM366 Hunt, Jenny ................O105
Higaki, Jitsuo ..............PW114 Horowitz, Carol R. ........PT452 Hunt, Lauent ..............PM055
Higashi, Haruhiko ........PW114 Horowitz, John D. ........O066, O163, Hunter, Arnagretta ........PW153
Higgs, Megan ..............PW367 O172, PM076, PM100, PM220, Hunyor, Imre ..............PT182,
Hillier, Samuel D. .........PM428, PM224, PM482, PT209, PT365, PW341
PT066, PT386, PT387, PW077, PT366 Huq, Molla M. .............PM323,
PW360 Horrigan, Mark ............PM184, PM465, PW241
Hilling-Smith, Roland ....PT091 PM186, PM188, PM189, PW156 Hurst, Nicola ..............PM220
Hillis, Graham .............O062 Horsfall, Matthew .........O110 Hussain, Fathimunnissa ..PW112
Hirakata, Vânia ............PT041, Horton, Stephen...........PW347 Hussain, Hussian ..........PM199
PT042, PT044, PT045 Horvath, Tamas ...........PT408 Hussain, Kosar ............PW112
Hirakawa, Yoichiro .......O079 Horwood, Hayley .........PW206 Hussain, Monira ...........O080, PM396
Hirano, Sae .................PM304 Hoshi, Rosangela A. ......PW259 Hussain, Sahar .............PW112
Hirata, Kazuhito ...........PM119 Hosking, Jan ...............PM277 Hussein, Gamal ............PT036
Hirata, Kumiko ............PM151 Hosking, Sarah ............PM449 Hussein Omar, Sarah .....PT300
Hisatome, Ichiro ..........PT333 Hosseini, Sharieh ..........O187 Hutchinson, Claire ........PT452
Hixson, James E. ..........PT224 Hou, Cuihong .............O049, Hutchinson, Darren .......O035
Hjortdal, Vibeke E. .......O013, PT415 PT265 Hutchison, Adam W. .....PM149
Hobbs, Michael ............O131, O207, Houng Bang, Liew ........PW240 Hutchison, Stephen .......PT153
O218, PM265, PM326, PT184, Hourani, Mukbil ..........PW235 Hutri-Kähönen, Nina .....O080
PW123 Howard, Kirsten ...........O161 Hutz, Claudio..............PW230

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Huynh, Quan L............PM288, Inoue, Yuji .................PT226 Jainandunsing, Sjaam .....PM317

PM323 Inui, Thomas S. ...........PT452 Jakobczak, Rachel .........O106
Hwang, Siaw San .........PT351, PT361 Ionescu, Adrian............PM199 Jakubauskas, Arturas .....PM050,
Hwang, Won Ju ...........PM353 Iorga-Siman, Ion ..........PM062 PM051
Hylek, Elaine M. ..........PT365 Irfan, Muhammad .........PT046 Jalalonmuhali, Maisarah ..PW166
Hyun, Karice ...............PM195, Irwig, Les ...................PT266 James, Paul .................PW283
PM196, PM318, PT127, PW120, Isao, Shiraisi ...............PM454 Jamieson, Lisa M. .........O162
PW202 Isbister, Julia ...............PM193 Jamil, Gohar ...............PW147
Iakovenko, Ischenko, Matthew ........O180 Jamil, Mujgan ..............PW147
Olexander M. .........PT022, PT023 Iseko, Iseko I. .............PT317 Jamison, Dean .............O117
Iaocharoen, Banthita ......PM208 Isenberg, Jeffrey S. ........PT365, Jamwal, D S. ...............PW358
Ibarra, Rita .................PM085 PM224 Jan, Mahtab ................PT258
Ibok, Okon I ..............PT275 Ishiwata, Sugao ............PW149 Jan, Stephen ...............O112, O161,
Ibrahim, Abdel Moniem .PT283 Isiguzoro, Ikechukwu ....PW229 PM282
Ibrahim, Baharudin .......PW269 Iskandar, William J. ......PT234 Janas, Janina ...............PM078
Ibrahim, Mohsen ..........PM309, Isma’eel, Hussain ..........PT225, Janella, Bruno ..............PT191
PT283 PW235, PW284 Janette, Power .............O054
Ibrahim, Suhairi ...........PW002 Ismail, Johan ...............PW330, Janicijevic, Aleksandra ....PM205
Ibrahim, Zubin ............PW330, PW331 Jankovic, Goran ...........PT276
PW331 Ismail, Muhammad Jánosi, András .............PW095
Icaza, Gloria................PM327 Dzafir ..................PW166 Jansen, Jesse ...............PT253
Ierino, Frank ...............PW280 Ismail, Omar ...............PW349 Jansz, Paul..................PT037
Igor, Mokryk...............PT420 Ismer, Bruno ...............PT026 Janus, Edward .............PW094
Ihdayhid, Abdul Ison, Glenn ................PM418 Jarden, Joanna .............PT318
Rahman ...............PM105, Ivanov, Sergey S. ..........PW371 Jaswal, Aparna .............PM085
PT103 Ivanov, Sergey V. .........PW371 Jaufeerally, Fazlur .........O009, PT081
Ikai, Yoshimi ...............PT358 Ivens, Emma ...............PW077 Javier, Castaneda L. .......PM485
Ikeda, Atsushi .............PM420 Iwade, Kazunori ...........PM003, Jaworski, Catherine .......O037
Ikeda, Tatsunori ...........PM071 PM059, PM171 Jayaraj, Cecily Mary
Ilarraza, Hermes L. ........PM485, Iyer, Nithin R. .............PT111 Majella .................O135
PT422 Iyer, Swaminathan ........PT359 Jayasuria, Cleonie .........PT378, PT379
Iles, Leah M. ...............O037, O038, Iyngkaran, Pupalan .......PT431, Jayaswal, Vivek ............PM381
O136, PM075, PT338 PW370 Jazvic, Marijana ............O146
Ilic, Stevan .................PM267, Izachik, Yuri ...............PW371 Jean Bosco, KASIAM LASI
PM423 Izzo, Joseph L. .............PW185 ON’KIN ...............O178
Ilic, Vladimir ...............PM423 Ja, Sin Gil ..................PW116 Jedrzejczyk-Spaho,
Illia, Ricardo ...............O103 Jachec, Wojciech ..........PM001, Joanna .................PW030,
Ilton, Marcus ..............O070, PT431, PT186 PW031, PW032
PW370 Jackson, Alun ..............PT460 Jeemon,
Imaizumi, Atsushi .........PM304 Jackson, Bruce .............PT056 Panniyammakal ......PM148
Imanishi, Toshio ..........PM151 Jackson, Catherine ........O069 Jeewandara,
Inaba, Shinji ...............PW114 Jackson, Damon K. .......O001, Thamarasee ...........PM049
Incani, Alexander .........PW100 PM135, PM180, PM185, PT143, Jefferis, Ann-maree ........PM366
Inder, Kerry ................PW368 PT197 Jeffers, Barrett W. .........PW177
Indrajith, Mathivathana ..PT040, Jackson, Dan ...............PM443, Jemaa, Riadh ...............PW150
PT136, PT137, PT372, PT373, PM445, PT414 Jendricko, Tihana .........PT167, PW145
PW307 Jackson Pulver, Lisa ......PT437, Jenkins, Alicia .............PW296
Indraratna, Praveen .......O219 PW356 Jennings, Catriona ........O192
Ingles, Jodie ................O082 Jacoby, Arie ................O020, PT350 Jennings, Garry ............O005
Ingley, Evan ................O127, PM376 Jacques Cabral, Tantchou Jepson, Nigel...............O199,
Inglis, Sally C. .............PM230, Tchoumi ..............PW082, PM193, PM200, PT187
PT453, PW003 PW125 Jeremy, Richmond ........O088,
Ino, Yasushi ................PM151 Jaghoori, Amenah .........O106, PM375 PM303, PT100
Inoko, Moriaki ............PT048, PT217 Jahan, Neelum .............PT258 Jermendy, Adam ..........PT408

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Jermendy, Gyorgy .........PT408 Joshy, Grace ...............O168 Kane, Adama...............PW217

Jesuthasan, Bruno .........PM436 Joury, Abdulaziz ...........PT320 Kane, Modou O. ..........PW217
Jesuthesan, Bruno .........PW057 Jovanovic, Ljubica .........PM206 Kane, Vincent ..............PM280,
Ji, Wen-Jie..................PM165, Jozic, Tanja.................PT072, PT164 PM281, PM341
PM166, PM167, PM168, PM399, Juárez, Luis ................PT389 Kang, Nicholas ............PW079
PT376 Juarez Orozco, Luis E. ...PW315 Kang, Woong Chul .......PM226
Ji, Zhen-Guo ...............PM140 Juárez-Orozco, Luis Kangaharan, Nadarajah ...PT431,
Jia, Yan .....................PW185 Eduardo ...............PT390 PW370
Jiang, Rong .................PM124 Judkins, Chris .............PM212 Kanjuh, Vladimir ..........PT276
Jiang, Tie-Min .............PM165, Juergens, Craig ............O015, Kanna, Rajesh ..............PM200
PM166, PM167, PM168, PM399, PM143, PT403, PW138 Kansal, Nitin ...............PW005
PT376 Jun, Liu .....................PT188 Kanthan, Ajita .............PM378
Jiang, Xuejun ..............O017 Juneja, Rajnish .............PM457 Kanwar, Jagat R............PM250
Jiménez-Lima, Roberto ...PT390 Jung, In-Hyun .............PM066 Kanwar, Rupinder K. .....PM250
Jin, xin ......................PT192 Juraszynski, Zbigniew ....PM077 Kapellas, Kostas ...........O162
Jindal, Devraj ..............PM493 Juraszynski, Zbigniew ....PM078 karaayvaz, ekrem B. ......PW129
Jing, Ning ..................PW289 K.M., Meenakshi ..........O135 Karadzic, Ana ..............PM205
JING, yan ..................PW021 Kabat, Bill ..................PW089 Karakoyun, Süleyman ....PM110,
Jing, Zhicheng .............PM124 Kabele, Mikael .............PM276 PT119, PW090
Jiraskova, Alena ...........PW209 Kadappu, Krishna K. .....PM411 Karas, Richard .............PM365,
Jo, Andrew .................PT444, Kadir, Muhammad M. ....PT328 PT355
PW361, PW362 Kadiyala, Meenakshi ......PT050, PT118 Karim, Florian .............PM244
Jobe, Modou ...............PW217 Kadlckova, Lenka .........PW209 Karim, Rezaul M. .........PT204
Jody, Mbuilu Pukuta .....O178 Kado, Joseph H. ...........O071, O114, Karlan, Beth ................PW238
Johan, Ismail R. ...........PM422, PM466, PM471, PW353, PW355, Karmarkar, M G. ..........PW358
PT207, PT296, PT297, PW067, PW363 Karnad, Pratibha ..........PT330,
PW201 Kagame, Abel ..............PM126 PW271
Johansson, Jan .............O040 Kähönen, Mika ............O080, PM396 Karolyi, Mihaly ............PT408
Johari, Fazalena............PM408 Kakeya, Hideaki ...........PM304 Karpinski, Grzegorz .......PT006,
Johnston, Lisa .............PM156 Kakihara, Ri-Ichiro ........PT146 PT158, PW022, PW173
Johnston, Nina ............PM155 Kalarus, Zbigniew .........PM001 Karthikeyan, Ganesan ....PT395,
Jones, Aled .................PT153 Kalcik, Macit ...............PW090 PT396, PT441
Jones, Bryn .................O035 Kalçık, Macit ...............PM110, Karunajeewa, Harin .......PW094
Jones, Dylan ...............PW102 PT119 Karwiky, Giky .............PT438
Jones, Elizabeth ...........PM045 Kaldararova, Monika......PT417, Kaschina, Elena ............PM258
Jones, Laura ................PW244 PW342 Kashour, Tarek ............PM162,
Jones, Susan ...............PW373, Kalimanovska Osric, PT036, PT058, PT165, PT320
PW374 Dimitra ................PM423 Kashyap, Ravi ..............PT395, PT396
Jong, Yuh-Shiun ...........PT343 Kallel, Amani ..............PW150 Kasim, Sazzli ...............PW330,
Jordaan, Pierre .............PT357 Kallianos, Kimberly .......O010 PW331
Jordán Ríos, Antonio .....PW315 Kallikazaros, Ioannis ......PT221 Kasprzak, Jaroslaw D. ....PM234
Jordan-Rios, Antonio .....PT390 Kalman, Jonathan M. .....O104, O119, Kasprzak, Jarosław D. ....O073, PT169,
Jordán-Rios, Antonio .....PT389 O136, PM015, PM407, PT003 PW165, PW332
Joseph, Bidingija Mabika .O178 Kamal, Arshad .............PM422, Kassisse, Dora Maria G. ..PW257
Joseph, Majo ...............O175 PT207, PT296, PT297, PW067, Kastelein, John J. ..........O040
Joseph, Stephen ...........O104 PW201 Katabarwa, Alex ...........PM126
Joseph, Stigimon ..........PW220 Kamano, Jemima H. ......PT452 Katanasaka, Yasufumi ....O027,
Joshi, Mandar S. ...........O171, PM366 Kamel, Walid ..............PM086 PM304, PM389, PT358
Joshi, Manoj ...............PT330 Kammoun, Samir .........PM090, Kataoka, Yu ................O040, O061,
Joshi, Mark D. .............PM325 PM190, PM191, PT105, PT106, O099
Joshi, Rohina ..............O043, O112 PT107, PT135, PW080, PW085 Katibi, Ibrahim A. .........O024
Joshi, Subodh ..............O177, Kamya, Moses .............O087 Katliorius, Robertas .......PM046, PT251
PM116, PM117, PM118, PT108 Kan, Toshiyuki ............PT358 Kato, Kota ..................PM073
Joshua, Walinjom N. .....PM254 Kanadasi, Mehmet ........PM141 Kato, Takao ................PT048, PT217

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Katova, Tzvetana ..........PM241, Kharats, Vsevolod .........O156 Klipstein, Kerstin ..........PM342

PT404, PW308 Khattab, Ahmed ...........PT123 Knott, Jeremy ..............PW135
Katukuri, Neelima ........O058 Khedar, Raghuvir S. ......O170 Knuiman, Matthew .......O082, O131,
Katzenellenbogen, Judith Khiew, Ning Zan ..........PM408 O207, O218, PM265, PM326,
M. ......................O207, PM265 Khlif, Mehdi ...............PW104 PT160, PT161, PT184, PW123,
Kaufman, Renato ..........O194, PT439, Khokhar, Kashif ...........PT117 PW265
PT440 Khoo, Chunyuan ..........PT210 Ko, Brian ...................PM433,
Kaushik, Urvashi ..........O201 Khouri, Yazan .............O058 PT407
Kaushik, Utplakshi ........PW272 Khouw, Niece K. ..........PM136, Ko, Soe K. ..................PM181,
Kauwe, Adonica I. ........PM468, PW042 PT149, PT203, PT208
PT433, PT444, PW361 Kibochi, Edward ..........O028 Koay, Choon H. ...........PM026,
Kauwe, John K. ...........PM468, Kilian, Jens .................PM196 PM027, PW014
PT433 Kim, Hack-Lyoung ........O130, Kocic, Gordana ............PM267
Kawana, Masatoshi ........PM171, PM305, PT247, PW337 Kocica, Mladen ............PM099
PM302, PT226, PT226 Kim, JinShil ................O107 Koenig, Wolfgang .........O010
Kawecki, Damian..........PM001 Kim, Kyung-Hee ..........PM066, Koh, Angela S. .............PT214
Kay, Patrick ................PT189 PW116 Koh, Choong Hou ........PM144
Kaye, David M. ............O037, O038, Kim, Mina ..................O060, PT399 Koh, Kwang Kon ..........PM226,
O171, PM075, PM244, PM366, Kim, Myung- A ............PM305, PM260, PT298
PM397, PT059, PT082, PT338 PM329, PT247, PW116, PW215, Koh, Tian Hai .............PM144,
Kaye, Gerry ................O055, PW327 PW216 PT210
kayima, James .............PM009, Kim, Sang-Hyun ..........PM305, Koji, Kagisaki ..............PM454
PT054 PT247 Kokkou, Eleni .............O133,
Kayumova, Marina ........PT291 Kim, Sua ...................O060, PT399 PM307, PT278, PT288
Kazi, Dhruv S. .............O002, PW266 Kim, Sung E. ..............PM329 Kokubo, Manabu ..........PM177
Kearney, Leighton .........PM045 Kim, Yong J. ...............PM329, Kolo, Philip M. ............O024
Keat, Ng K. ................PM286 PW337 Kolunin, Grigoriy .........O156, PT194
Keeble, Joanne .............PT430 Kim, Yong-Hyun ..........O060, Komiyama, Maki ..........PM331,
Keech, Anthony ...........PW296 PM329, PT399 PW249
Keech, Wendy .............O006 Kimaiyo, Sylvester ........PT452 Kompa, Andrew ...........PT357, PW292
Kekäläinen, Päivi ..........PM275 Kimbally-Kaky, Koncar, Igor ...............PM099
Kekesi, Violetta ............PT060 suzy-Gisèle ............PM337 Konduracka, Ewa .........PW032
Kellar, Petrina ..............PM193 King, Ingrid ................PT096, Kondyurin, Alexey ........PM049
Kelly, Andrew .............O070 PW341 Koneru,
Kelly, Tanika N. ...........PT224 Kingston, Nicky ...........PT070 Venkateshwarlu ......PW273
Kemp, Justin ...............PM319 Kinney, Sharon ............O083 Koneru, Srikanth ..........O054
Kenichi, Kurosaki .........PM454 Kinra, Sanjay ...............PM493 Kong, Ling Yun ...........PM426
Kenilorea, Geoffrey .......PT443, Kioufis, Stamatios .........O133, Kong, Khai Liy ............PM222,
PW355 PM307, PT278, PT288 PT361
Kennedy, Liz ...............PM284, Kiriazis, Helen .............O166, PT364 Kono, Koichi ...............PM331
PM466, PT443, PW355 Kirpach, Brenda ...........PT254 Konsola, Theodosia .......O133,
Keogh, Anne ...............O140 Kistler, Peter M. ...........O119, O136, PM307, PT278, PT288
Kerbage, Soraya ...........PT260, PT451 PM407, PT003 Koo, Bon-Kwon ...........O130
Kerk, Ka Lee ...............PT038 Kitslaar, Pieter .............PT408 Korantzopoulos,
Kermeen, Fiona ...........O140, PT096, Kityo, Cissy ................O086, O087 Panagiotis .............PT011
PW341 Kizana, Eddy ...............O019, O118, Korczyk, Dariusz ..........PM362
Keyrouz, Sabine ...........PT225 PM378 Korda, Rosemary ..........O168
Khalil, Anita................PM173 Kleemann, David O. ......PW290 Koretzky, Marrtin .........PW192
Khan, Ali ...................PT189, PT258 Klein, Allan L. .............PT384 Koshy, Marymol ...........PM406
Khan, MD. Murshidur Kleine, Eva .................O215 Koshy, Thomas I. .........PT323
Rahman ...............PT102 Klester, Elena ..............PT061, Kostova, Velislava .........PW308
Khan, Saidur R. ...........PT204 PT435, PW048 Kosztin, Annamaria .......O152, PT060
Khandaker, RK ............O196 Klester, Karolina ...........PT061, PT435 Kothari, Shyam S. .........PM457
Khanolkar, Aaruni ........PW089 Klingberg, Eva .............PW306 Kotseva, Kornelia ..........O192

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Koula Landa, Kumar, Raman K. .........O070 Larobina, Marco ...........O177,

Christian M. ..........PM337 Kunimasa, Taeko ..........PM421 PM117, PM118, PT108
Kovács, Attila ..............O056 Kunstmann, Sonia ........PM327 LaRosa, John C. ...........O212
Koval, Oleksandra ........PT420 Kure, Christina E. .........O109 Larsen, Peter ...............PM156,
Kovoor, Pramesh ..........O019, O021, Kurpesa, Małgorzata ......PT169, PT125, PT180
O062, O118, O154, PM020, PW165 Larsen, Tawny .............PM468
PM091, PM417, PT013, PT030, kurt, ibrahim H. ..........PM031 Lasica, Ratko ...............PM099
PT032, PW020 Kuschnir, Maria Cristina Laskowitz, Daniel T. .....O188
Kowalski, Remi ............O158 C. ......................O046 Latasi, Maliesi ..............PM284
Kowey, Peter R. ...........PM025 Kusek, John ................O210, O211 Latasi, Maliesi ..............PW355
Koyama, Hiroshi ..........PM331 Kutishenko, Natalia P. ...PM236 Latchem, Donald ..........PM186,
Kozanitou, Maria ..........PM252, Kutyifa, Valentina .........O152 PM189
PM380 Kuwabara, Masanari ......PT333 Lau, Antony ................PM193
Kozor, Rebecca ............PT374 Kuys, Suzanne .............PM480 Lau, Dennis ................PT004
Krauss, Ramona ...........O129, PW287 Kuznetsov, Vadim .........O039, O156, Lau, Edmund M. ..........O059, O155,
Krecki, Radoslaw ..........PM234 PM037, PM085, PM164, PT111
Krinochkin, Dmitriy ......O156, PM367, PT194, PT291, Lau, James Y. ..............PT215
PM037, PT194 PW181, PW182 Lau, Kent Ter ..............PM223
Krisdinarti, Lucia ..........PT416 Kwasney, Janice ...........O095 Lau, Ming ..................PT170
Krishnakumar, R. .........PW358 Kwok, Bernard Wing Lau, Yeehow ...............PT210
Krishnan, Anand ..........PW199 Kuin ...................PT083 Laupula, Lafou.............PM284
Krishnan, Kousik ..........O016 La Gerche, Andre .........O014, Laurinavicius, Antonio
Krishnan, Suresh ..........O204 PM128, PM290 G. ......................PM251
Krishnapillai, Ambigga Laatikainen, Tiina .........PM275, Lavincente, Sophie ........PW353
Devi S..................PM286 PW242 Lavu, Deepthi ..............PM017,
Krishnasivam, Deepan ....O176 Laba, Tracey-Lea ..........O161, PM282 PW232
Kristanto, Ardeno .........PT234 Lacalzada-Almeida, Lawson, Tony..............O005
Kristian, Hariman .........PM272, Juan ....................PM146 Lay, Danny .................PW094
PM371, PT250, PT295 Lai, Jacqueline .............PT037 Lazovic, Milica .............PT289,
Kritharides, Leonard ......PM096, Lai, Lana Y. H. ............PT351 PW193
PM404, PT051, PT115, PW076 Laing, Josh .................PT091 Le, Thu Thao ..............PM080,
Krljanac, Gordana .........PM205 Lake, Sarah .................PW142 PM429
Kruger, Iolanthe ...........PT227 Lakshmy, Leal, Carla M. .............PM391
Krum, Henry ..............O034, O084, Ramakrishnan ........PM173, Leal, Daniella M. ..........PM391
O116, O145, PM089, PM410, PT252 Leal, Helena ................PM343,
PT056, PT356, PT357, PW292 Lal, Anchal .................PM417 PW198
Kruske, Sue ................PT437, Lall, Dorothy ...............PW199 Leal del Ojo, Juan .........PT001
PW356 Lalor, Nicolas ..............PM007, Lecce, Laura ................O022,
Kruszelnicka, Olga ........PW032 PM157 PM365, PM373, PT340,
Ku, Ming Ying .............PM223 Lam, Carolyn S. P. .......O009, PT015, PT355, PW278,
Kubiak, Grzegorz..........PM001 PT081 PW296
Kubo, Takashi .............PM151 Lam, Kaitlyn ...............O176 Leclercq, Christopher .....PM033
Kuchta, Mialn ..............PM312 Lam, Nicholas T. ..........PM397 Lee, Adam ..................PW014
Kuhl, Jeanette ..............PT305 Lam, Yat-Yin ...............PT170 Lee, Alex ...................PT170
Kuhn, Lisa .................PM138, Lam, Yuen Ting ...........PM365, Lee, Astin ...................PM210,
PM139 PT340, PT355 PW152
Kuhn, Michael .............PW143 Lamanna, Arvin ...........PW360 Lee, Chi H. ................PM216
Kuiper, Karel...............PM484 Lamonaca, Francesco .....PW170 Lee, Geraldine .............PM310
Kuklik, Pawel ..............PT004 Lamont, Kim ...............PM342 Lee, Han Cheol ............O045,
Kulick, Erin R. ............PT395, PT396 Lane, Stephen ..............PM108 PM098, PT131
Kulishov, Sergii K. ........PT022, Langrish, Jeremy P. .......PM276 Lee, Hyang-Lim ...........PM305,
PT023, PW109 Langslet, Gisle .............PM385 PT247
kulkarni, Chaitanya S. ...PM415 Lara, Jorge V. ..............PM485 Lee, Kim Yee ...............PT081
Kumar, Rajesh .............PW358 Larbalestier, Robert .......O176, PW084 Lee, Kyounghoon .........PM226

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Lee, Marcus H. ............PT150 Li, Guangping .............O115, O137, Lim, Swee Han ............PT083
Lee, Nikki ..................PT215 O183, PT011, PT021 Lim, Terence C W ........O124
Lee, Rebecca ...............PM069, Li, Hongfan ................PT224 Lim, Toon W. .............PW014
PM294 Li, Jian ......................O137 Lim, Yi Cheng .............PT367
Lee, Suk-Jin ................PM066 Li, Jiayue ...................PT195, Lima, Daiane P. ...........PT244,
Lee, Toria ..................PT215 PW128 PW041
Lee, Vincent ................O062 Li, Miaoling ................PM028 Lima, Lidiane ..............PW320
Lee, Yeon ...................PM305 Li, Ning .....................PM400 Lima, Patricia A. ...........PM357,
Leeder, Stephen R. ........PM347, Li, Pengyun ................PW180 PM446
PT306 Li, Renming ................PT174 Lima, Rui ...................PT094,
Leenen, Frans ..............PM312 Li, Ruilai ....................O195 PW043, PW044, PW045, PW046
Lefebvre, Pascal ............PW019 Li, Shifeng ..................PT024 Lin, Andrew................PT097,
Lefkovits, Jeffrey ...........O008, O165, Li, Shu Qin ................PT442 PW078
PM147, PT127 Li, Shuaibing ...............PW021 Lin, Ruby C. Y. ............O166, PT353
Lefkovits, Lisa .............PM182 Li, Song .....................PM154, Lin, Sophia .................O216
Lefrandt, Reggy ............PM233, PM393 Lin, Tina ....................PM034,
PM272, PM300, PM371, PT250, Li, Song Nan ...............PW010, PM035, PM036
PT295, PW226 PW011 Lindberg-Bilock, Sofia ....PT423, PT424
Lehman, Sam ..............PW102 Li, Wentao .................O085, O141, Lindley, Richard ...........O079
Lehtimäki, Terho ..........O080 PT326 Lindsay, Laura .............PT340
Lei, Gao ....................PT188 Li, Xian .....................PM400 Lineburge,
Leite, Thiago N. P. .......PT459 Li, Xin X. ...................PM154, Alexandra A. .........PM052
Leitner, Ephraem ..........PM370 PM393 Ling, Liang-Han ...........O119, O136,
Lekawanvijit, Suree .......PW292 Li, Ying .....................O188 PM075, PM407, PT003, PT081
LeMay, Michel .............PT133 Li, Yu-Ming ................PM165, Linhart, Ales ...............PW209
Lemos, Conceição M. T. PM166, PM167, PM168, PM399, Linker, Nick ...............O055, PW327
M. D. ..................PW230 PT376 Lintern, Karen .............PM318
Lennie, Terry A. ...........O107 Li, Zhongjian ..............PT024, Liou, Kevin .................PM193
Lennon, Diana .............O069 PW021 Lip, Gregory Y. H. ........O050, O215
Leo, Seo Wei ..............O124 li, zhoubin .................O185 Lira, MTeresa ..............PM327
Leon de la Barra, Sophia .PW205 Li, Zongbin ................PW128 Lirio, Carlos ................PT260, PT451
Leonard, Joanne ...........PW055 Liang, Michael .............O213 Li-Sha, Ge ..................PW061
Leong, Darryl P. ...........O077, Licari, Giovanni ...........PM076, Liska, Gary B. .............PT323
PM433, PT375 PM220, PW049 Liu, Changle ...............O137, O183
Leong, Gerard Kui Toh ..O009, PT081 Lievano, Martha ...........PT271 Liu, Enzhao ................PT011
Leong-Poi, Howard .......PT092 Liew, Danny ...............O084, PW177 Liu, Guizhi .................PW023
Leopoldo, Bueno ..........PM485 Liew, Houng Bang ........PM470 Liu, Hong-bin .............PM140
Leslie, Gavin ...............PM491 Liew, Jonathan .............O003 Liu, Hongmei ..............PT011
Leung, Dominic ...........O059, Lifshitz, Galina ............PM235 Liu, Hueiming .............PM282
PW138 Light, Melanie .............PM108 Liu, jian-gang ..............PM179,
Leung, Michael ............PT407 Lijovic, Marijana ...........O153 PT192
Levenson, Jenna ...........PM283 Lilihata, Gracia ............PM280, Liu, Larry ...................PW177
Lever, Nigel A. ............O119 PM281, PM341, PT234 Liu, Na .....................PT265
Levin, Ricardo .............PM063, Lim, Chiao Wen ..........PW330, Liu, Nian ...................PW010,
PM106 PW331 PW011
Lew, Philip .................PM271 Lim, Chong Hee ..........PT038 Liu, Qianqian ..............PM124
Lewandowski, Paul A. ....PM381 Lim, Choon Pin ...........PM088 Liu, Ruijie ..................PT430
Lewis, Nigel T. ............O177, Lim, Dal-Su ................PM066 Liu, Saifei ...................O066,
PM074, PM116, PM117, PM118, Lim, Hong Seok ...........O130 PM220, PT366
PT099, PT348, PW001 Lim, Melissa S. H. ........PM222, Liu, Tong ...................O115, O137,
Li, Tao ......................PM028 PT361 O183, PT011
Li, Acrane ..................O220 Lim, Ruth ..................PM045 Liu, Wen ...................PT053
Li, Cong ....................O195 lim, soo teik ...............PM144, Liu, Wenling ...............PM024,
Li, Cuilan ...................PM024 PT210 PT053

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Liu, Xiaoyan ...............O049, Lu, Rui-Yi ..................PM165, Magnussen, Costan G. ...PM288

PM400, PT265 PM167, PM168 Maguire, Graeme ..........O070
Liu, Zhi-Hong .............PM140 Lubega, Irene ..............PM451 Mahajan, Rajiv .............PT004
Liu, Zhong .................O195 Lubega, Sulaiman .........PM111, Mahanta, J. .................PW358
Liu, Zhongwei .............O091, PM451, PW089 Mahanta, Tulika G. .......PW219
PW288, PW289 Lucas, Luciano .............PW073, Maheshwari, Anuj .........PW219
Llamosas, Clara ............O068 PW074 Maheswari, Uma K. .......PM250
Llanos Mestra, Luis .......PM106 Lucia, Popovici ............PT339 Mahjoub, Marwen ........PW103,
Llewellyn, Huw H. ........O037, PT338 Lucia, Ciobanu ............PT202 PW104
Lo, Ada .....................PM054, Lucking, Andrew J. .......PM276 Mahmarian, John J. .......PT395,
PM055, PM428, PT066, PT378, Ludawane, Bardley ........PT443 PT396
PT379, PT383 Luik, Armin ................O012, PT104 Mahmood, Manzoor ......PM204,
Lo, Sidney ..................PW138 Luker, Heather ............PM196 PM213, PT162, PW122
Lo Giudice, Adriana ......PM021 Lund, Mayanna ............O208, PM070 Mahmood, Mohammad
Loane, Philippa ............O214, Lundbäck, Magnus ........PT305 Afzal ...................PT306
PM016, PM180, PT143, PW118 Lundberg, Gina ............PT268 Mahmood Zuhdi, Ahmad
Loarte, Pablo ...............PT071 Luo, Yuhong ...............PM368 Syadi ...................PW166
Lobenstein, Guillermo ....O103 Lüscher, Thomas F. ......O167 Mahneva, Elena............PW182
Lockhart, Paul .............PW283 Luu, Queenie ..............PM443, Mahony, Faith .............PT437,
Lockwood, Siobhan .......PT405 PW117 PW356
Lodi-Junqueira, Lucas ....PT138 Lwabi, Peter ................O087, Mahzabin, Tanzila .........PM376
Lohmann, Christine ......O167 PM111, PM451, PW089 Mai, Nghi ..................PW329
Loktionova, Ekaterina ....PT435 Lyford, Marilyn ............O142, Maia, Murilo ...............PW301
Lombardo, Paul ...........PM450 PM306, PT253 Maior, Aline S. ............O046
Lombo, Bernardo .........PT271, M. S. Ravi ..................O042, O135, Maiya, Arun G. ............PM487,
PW083 PT118 PW228, PW261
Loney, Tom ................PM253, Ma, Chang-Sheng .........O096, O215, Majumder, Abdullah Al
PT261 PM289, PW006, PW010, Shafi ...................PT199
Long, Aidan ................PW354 PW011 Maksimov, Vladimir ......PM382
Long, De-Yong ............O096, Ma, Ming-Chieh ...........PT362, PT363 Malaiapan, Yuvaraj ........PM149,
PW006 Ma, Wai-Ching ............PT450 PM202
Longenecker, Chris T. ....O086, O087, Macciocca, Ivan ...........PM056, PT049 Malcolm, John .............O069
PT432 Macdonald, Peter S. ......PM230, Malhotra, Arun ............PT076,
Longman, David ...........PM376 PT037, PW003 PT397, PW318, PW319
Longo-Mbenza, Machado, Leonardo .......PW321 Malik, Abdul ...............O196
Benjamin ..............PM337 Machado, Natássia B. .....PT419 Malik, Asif ..................PT036
Looi, J L. ...................PM431, Machira, Boniface W. .....PM325 Malitz, Nathan .............PM444
PM432 Maciel, Talita ..............PM346 Mallick, Nadeem H. ......PM255
Looi, Jeffrey Y. ............PW347 MacIsaac, Andrew .........O014, Mamun, Mohammad A. ..O196
Lopes, Laise R. ............PT292 PM138, PM139, PT163 Man, Mihai .................PM062
Lopez, Derrick .............O207, PM265 MacIssac, Andrew .........PM212 Mandic, Sandra ............PW205,
Lopez Moyano, María Mackillop, Clare ...........PT088 PW206
G. ......................PW073, MacLaughlin, Severence Maneikiene, Vyt_e ..........PT052
PW074 M. ......................PW290, Mangalpally, Kiran ........O058
Lopez-Miranda, Jose ......PM385 PW295 Mangan, Gillian ...........PM352
Lou, Pey Wen .............O110 Macon, Leopoldo..........PW192 Maniatis, Konstantinos ...O133,
Lowe, Bevan ...............PT040 Maddern, Jessica ..........PM375 PM307, PT278, PT288
Lowe, Boris ................PT070 Maeda, Seiji ................O174, PW213 Mann, Jake .................PT259
Lowenstein, Diego ........PM170 Maeda, Yoshiko ...........PT226 Manov, Emil ...............O123
Lowres, Nicole .............PT007 Maeder, Micha T. .........PM075 Mansukhani,
Lozano, Luis ...............PM158 Magaña Bailon, Elisa ......PW315 Gitanjali P. ............PT423, PT424
Lu, Juntang ................O021 Magaña-Bailon, Elisa ......PT390 Mant, Jonathan ............PW214
Lu, Ken J. ..................PM045 Magaña-Bailón, Elisa ......PT389 Mao, Liang .................PW180
Lu, Liya .....................O025, PT304 Magboo, Vincent P. .......PT395, PT396 Maple-Brown, Louise J. ..O162

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Mara, Lourenço S. ........PT047 Mathew, Naveen ..........O089 McGrinder, Helen .........O081

Marangoni, Adriane .......PM285 Mathieu, Marie-Eve .......O206 McGuire, Mark ............PM443
Marangou, James ..........PW084 Mathur, Murli L. ..........PW358 McIvor, Dawn .............PW106
Maranhão, Raul C. ........PT047 Matic, Gordana ............PM072, Mckenzie, Scott C. ........PW038
Marcolino, Milena .........PM012, PM205, PT072, PT164 McKenzie, William ........PM210,
PT019, PT138, PT256, PW179 Matic, Dragan M. .........PM206 PW152
Mariani, Justin A. .........PM016, Matos, Samantha ..........O036 McKinn, Shannon .........PT253
PM075, PT082, PW013 Matsis, Phillip ..............O213 McKinnon, Melita .........PT430
Marianna, Garcia S. .......PM485 Matsuo, Yoshiki ...........PM151 McLachlan, Craig..........PW153
Marino, Barbara C. A. ....PW179 Matter, Christian ..........O167 McLaughlin, Mary Ann ...O182
Marks, Guy ................PM291 Matteucci, Elena ...........PM340 McLean, Catriona A. ......O037, PT338
Marley, Paul................PT128, PT178 Matthews, Ian G. ..........PW037 McLean, Margot ...........O069
Marouène, Morched ......PM191 Maurea, Nicola ............PM414 McLellan, Alex J. ..........O119, O136,
Marques, Carlindo ........PW321 Maurer, Gerald ............PM092, PM407, PT003
Marques, Francine Z. .....PM381, PT067 McLennan, Skye N. .......O160
PT349 Maurovich-Horvat, Pál ...O010, McLintock, Claire .........PT437,
Marques, Naiara S. ........PM012 PM018, PM142, PT408 PW356
Marques, Nuno S. ........PT094, Maury-Ordaz, Sergio .....PT389, McManus, Richard ........PW214
PW043, PW044, PW045, PW046 PT390, PW315 McMillen, Caroline I. .....PW290,
Marquez, Gustavo .........PT257 Mavi, Jaskaran S. ..........PW232 PW295
Martanto, Erwan ..........PW081 Maximova, Katerina.......O206 McMinn, Jason S. .........PM136
Martello, Marcella S. ......PM266 May, Austin N. ............PT187 McMullen, Julie R. ........O166, PT353
Marthias, Surya ............PW260 May, Lauren ...............PT356 McMurray, John ...........O116
Martin, Inken ..............O020, PT350 Mayer, Otto ................PM311 McNeil, John ...............PT254
Martin, Lorelle .............PT449, PT456 Mayer, Roberto ............O103 McPhail, Steven M. .......PM480,
Martin, Paul T. ............O149 Mayosi, Bongani ...........PT441 PW143, PW227
Martin, Sophie .............PT182, PT201 Maypilama, Elaine ........PW357 McPhee, Angela ...........PT032
Martin, Una ................PW214 Mazaris, Savvas ............O133, Mcspadden, Luke C. .....O157, PT077
Martin, William J. .........PT430 PM307, PT278, PT288 McVeigh, James ...........PW222,
Martín, Maria ..............PM120, Mazdorova, Ekaterina ....PM382 PW369
PM121, PM122 Mazhar, Jawad .............O077, O100 Mearns, Megan ............PM015
Martinez, Alfonso G. .....PT422 Mbakwem, Amam C. .....PT229 Meave, Aloha ..............PT389
Martínez Aguilar, Myriam Mbaye, Maimouna N. ....PW217 Meave Gonzalez,
M. ......................PT389, Mc Namara, Kevin ........PW094 Aloha ..................PW315
PT390, PW315 McAinch, Andrew .........PM387 Meave-González,
Martins, Paula .............PT138 McAuliffe, Andrew ........PM463 Aloha ..................PT390
Martins, Rui ................PT264 McCarten-Twiss, Paula ...O184, PT008 Mechmeche, Rachid ......PW150
Martsevich, Sergey Y. .....PM236 McCartney, Danielle ......PM256 Mechri, Ibtihel .............PW103
Marumatakimanu, McCormack, Louise ......PM055 Medeiros, Elry .............PW322
Farah ..................PM468, McCready, Michael .......PW153 Meeks, Joseph B. ..........PT395, PT396
PT444, PW361 McDonald, Alice ...........PM489 Meena, Raghvendra S. ....PM415
Marusic, Petra .............PM256 McDonald, Charles .......O057 Mehdi, Khawar ............PW158,
Marwene, Morched .......PM190 McEvedy, Samantha ......PM138, PW159
Marwick, Thomas H. .....O054, O055, PM139 Mehra, Rakesh .............PT331, PT332
PM288, PT382, PT384, PW324, McEwan, Alistair ..........O154, Mehta, Devin ..............O016
PW326, PW327 PM020, PT014 Mehta, Puja K. ............PW238
Marx, Giovana C. .........PT290 McG Thom, Simon .......O080, PM396 Meikle, Peter J. ............PM271
Maryinskikh, Luiza .......PT194 McGaughran, Julie ........PM054 Mejia, Agnes ...............PW054
Masai, Hirofumi ...........PM421 McGaughran,, Julie .......PM055 Mejin, Melissa .............PM222,
Masana, Luis ...............PM385 McGavigan, Andrew D. ..PW102 PT361
Massi, Luciana .............PM282 McGeechan, Kevin ........PT266 Melichercik, Juraj .........PT026
Mastey, Nimi ..............PW266 McGill, Darryl .............PT128 Melissa, Carlo ..............PT080
Mathai, Michael ...........PM387 McGrady, Michele.........O034, Melissa, Mejin .............PT351
Matheka, Duncan M. .....O028, O029 PM089, PM410 Melsom, Chris .............O143

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Melvin, Jennifer ...........PM467 Mirzaei, Masoud ...........O216, Morillo, Carlos ............O095,

Menahem, Samuel ........O052, PT009, PW029, PW121, PW005
PW344, PW345 PW155 Morimoto, Tatsuya ........O027,
Mensah, George ...........O193, Misiura, Jonas .............PT251 PM304, PM389, PT358
PM278, PT441 Mitchell, Ann-Maree ......PT458 Morioka, Hiroe ............PW114
Mera, Maria ................PT001 Mitchell, Jo .................PM339 Morís, Cesar ...............PM120,
Mercanoglu, Fehmi .......PW129 Mitchell, Julie Anne .......PM350 PM121, PM122
Meredith, Ian T. ...........PM149, Mitchell, Paul ..............PM417 Morita, Yusuke ............PT217
PM202, PM433, PT407 Mitra, Biswadev ...........PM310 Moriya, Manabu ...........PW149
Merkely, Béla ..............O056, Mitrovic, Predrag ..........PM072, Moroi, Masao ..............PM421
O150, O152, PM018, PM019, PM205, PT072, PT164 Morris, Gwilym M. .......O151
PM142, PT060, PT371, PT408, Mitsui, Toko ...............PM177 Morrison, Janna L. ........PW290,
PW262 Mittal, Monica .............PT145 PW295
Merrigan, Orla .............PT319 Miyachi, Motohiko ........O174 Morton, Joseph B. ........O104, O119,
Metha, Andrew ............O080, PM396 Miyagi, Motohiro ..........PM177 O136, PM407, PT003
Meyer, Mick ...............O189 Miyazaki, Yusuke..........PM389 Moser, Debra K. ...........O107
Mian, Mueed ...............PT177 Mizuno, Atsushi ...........PT055 Moses, Daniel ..............O015,
Michira, Brian N. ..........O029 Mobarrez, Fariborz........PT305 PM143, PT403
Middlemiss, Melanie ......PW205 Mogilevski, Tamara .......PT177 Motamedi, Nickan ........PM486
Middleton, Sandy .........PM230, Mohamed, Mohd Mott, Kathy ................O005
PW003 Sapawi .................PW002 Motta, Domingo ...........PT451
Midekin, Christine ........O154, PT013 Mohammadi, Vida ........O187 Mott JR, Victor H. ........PM266
Migowski, Arn .............PT439, PT440 Mohammed, Mottram, Philip M. .......PM109,
Mihaila, Marius ............PM062 Mohammed ...........PW214 PT405, PW237, PW310, PW325
Milanov, Marko ...........PM099 Mohamud, Motz, Wolfgang ...........O200
Milanovic, Bojan ..........PW193 1Sheek-Hussein ......PT261 Mountfort, Ashley .........PW206
Milic, Natasa M. ...........PM192 Mohan, Viswanathan .....PT328, Moura, Cláudia ............PW343
Miliou, Antigoni ...........PM252, PT330, PW271 Moura, José P. .............PT264
PM380, PT278 Mohanan, PP ..............PM148 Moustafa, Salah ............PW208
Miller, Anne E. ............O071, PM471 Mohd Azahar, Nazar Moutai, Yoshiko ...........PT146
Miller, Victoria .............PM195 Mohd Zabadi .........PM286 Moutzouris, John P. ......PM096
Mills, Clair .................O069 Mohd. Amin, Nor Mowjood,
Mills, Katherine T. ........O211 Hanim .................PM408 Muhammad T. .......PW142
Mills, Nicholas L. .........PM276 Mohseni, Mona ............PM308 Moxon, Te Aro ............O069
Milne, C. ...................PM475 Moini, Babak ...............PT432 Mo_zd_zan, Monika .........PT169
Milne, Robert W. .........PW049 Moir, Stuart ................PM109, Mrdovic, Igor ..............PM099
Milojevic, Predrag .........PT276 PT405, PW237, PW325 Mroczek-Czernecka,
Milosevic, Aleksandra ....PM205 Mokwunyei, Joy ...........PT229 Danuta.................O217,
Mimish, Layth .............PT036, PT058 Moller, Todd ...............PM492 PW030, PW031, PW032
Minakawa, Megumi .......PM421 Molnar, Levente ...........O152 Mucumbitsi, Joseph .......PM126
Minami, Elina ..............PW281 Molnár, Levente ...........O150 Mudge, Alison M. .........PM492
Minigo, Gabriela...........PT430 Mond, Harry G. ...........PM002 Mueed, Irem ...............PT300
Minoru, Ohno .............PW149 Monger, Steven ............PW278 Mugyenyi, Peter ...........O086, O087
Minossi, Vanessa ..........PT312, PT313 Montemezzo, Dayane .....PM061 Mukherjee, Anirban.......PT076,
Minson, Robert ............PW102 Monteros, Ariel ............PT005, PT206 PT397, PW318
Minutillo, Corrado ........PT423 Mooney, John .............O062 Mukherjee, Somaditya ....O098
Miranda, Irma C. ..........PT422 Moore, Alice ...............O054 Mukhlesur Rahman,
Miranda, Isabel ............PM158 Moore, Antoni .............PW205 Md. ....................PM213
Miranda, Melroy X. .......O167 Moran, Andrew E. ........O193, PM278 Mulder, Monique .........PM317
Mirembe, Grace ...........O086, O087 Moraru, Ion ................PT339 Muller, Marisa C. .........PW230
Mirhadi, Amin .............PW238 Morcillo, Yolanda .........PM158 Müller, Regina E. .........O046,
Mirkovic, Marija ...........PM192 Moreira, Sara...............O036 O194, PT113, PT114, PT439,
Mirrer, Brooks .............PT071 Morgan, James .............O128 PT440
Mirzadeh, Fatemeh .......PW029 Morgan, Leanne ...........PM277 Mullins, Anna ..............PM030

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Mullins, Robert ............PM348 Nagy, Andrea ..............O056 Nedkoff, Lee ...............O082, O218,
Mulyadi, Nagy, Vivien Klaudia .....O152, PT060 PT160, PT161, PW123
Joshua Patrick ........PM280, Nahar, Shamimum ........PM213 Negi, Prakash ..............PW358
PM281, PM341 Naik, Nitish ................PT076, Negishi, Kazuaki ..........O054, O055,
Mundisugih, Juan .........PM100 PT397, PW318, PW319 PT382, PT384, PW327
Munk, Kim .................PM091 Naing, Nyi Nyi ............PW008 Negishi, Tomoko ..........PT384
Munoz, Phillip A. .........PM444 Nair, Rajesh ................O032, PT093 Nehme, Ziad ...............O153
Muñoz, Reinaldo ..........O169 Nair, Suma .................PW228 Neill, Johanne .............O078, PM406
Murad, Neif ................PT196 Nair, Tiny ..................O204, PM148 Nelson, Adam .............O061
Murakami, Akira ..........PT358 Naismith, Carolyn ........PT449 Nelson, Mark R. ...........PM323,
Murakami, Haruka ........O174 Nakada, Junya .............PM389 PT254
Murakami, Daniela ........PM446 Nakagawa, Yukiko ........PM389 Nelson, Patric ..............PM385
Murakami-Gold, Lorna ...PW357 Nakajima, Toshihiro ......PM462 Nelson, Troy ...............PM468
Muralidharan, Nakao, Koichi .............PW154 Neo, Andy .................O209
Padmapriya ...........O127, PM376 Nakazato, Jun ..............PM119 Neo, Chia Lee .............PM088
Murch, Stuart ..............O014 Nakhla, Shirley ............PM291 Nerlekar, Nitesh ...........PM149,
Murgor, Mellany ..........O028 Nalliah, Chrishan J. .......PM026, PT407, PW237
Murphy, Adrianna ........O193 PM027 Nessa, Lutfen ..............PT398
Murphy, Barbara ..........PT460 Nalubwama, Haddy .......PT432 Nessler, Jadwiga ...........O217,
Murphy, Maria ............PT456, PT457 Nam, Chang-Wook .......O130 PW030, PW031, PW032
Murray, Anne ..............PT254 Namuyonga, Judith .......O086, PM451 Nestorovic, Emilija M.....PM192
Murray, Christopher J. ...PM278 Nanayakkara, Shane ......PW047 Neubeck, Lis ...............O142,
Murry, Charles ............PW281 Nanda, Navin C. ..........O098 PM306, PT007, PW055
Murua, Alicia ..............PT206 Nanoue, Masolo Muze Neuschl, Vladimir .........PT417
Musiime, Victor ...........O086, PM451 Kianu ..................O178 New, Gishel ................O001, O063,
Musikhina, Natalia ........O039, Naoum, Christopher ......PM404 PM135, PM180, PM185, PT143,
PM367, PW181, PW182 Narayan, Arun .............PT030, PT197, PW241, PW245
Mussap, Christian .........PW138 PW020 New, Nicole ................PW375
Musselli, Ananda R. ......PT459 Narayan, K. M. Venkat ...PT328 Newby, David E. ..........PM276
Musuku, John .............PW354 Narayan, Om ..............PT231 Newby, Laura K. ..........PW247
Mutha, Vivek ..............PT177, Narayanan, Vivek .........PW105 Newcomb, Andrew .......PM465,
PW316 Naroo, Ghulam ............PW028 PT097, PW078
Muthiah, Kavitha ..........PT037 Narui, Koji .................PT226 Newgreen, Victoria M. ...PW133
Muthukumar, Lakshmi ...O058 Naruse, Chinatsu ..........PT146 Newland, John ............O032
Mwareow, Gano ...........PW355 Nascimento, Bruno R. ....PT138 Newman, Mark ............O131, O218,
Myers, John B. ............PM358, Nascimento, Jose H. ......PM390, PM326, PT184, PW123
PT216 PM391 Newton, Phillip J. .........PM230,
Myint, Phyo K. ............O164 Nasi, Titus .................PT443, PT453, PW003
Mylrea, Catherine .........PW310 PW355 Ng, AiVee ..................PM015
Mynard, Jonathan P. .....O158, Nasim, Bina ................PW028 Ng, Arnold C. T. ..........O179,
PM452, PM453, PT360 Nasis, Arthur ..............PT407 PM054, PM055, PM130, PT040,
N, Jayakumari .............PW105 Nasreddine, Lara ..........PT225 PT136, PT137, PT372, PT373,
N, Premanand .............PT118 Nasreen, Faria .............PT398 PW276, PW307
N, Swaminathan ...........O135, PT118 Natarajan, Dinesh K. .....PM181, Ng, Austin C. C. ..........PM096,
Na, Jin-Oh .................PM329 PT149, PT203, PT208 PT051, PT115, PW076
Nabunnya, Yvonne B. ....PT054 Nathan, Dwyer ............O054 Ng, Elaine S. L.............PM088
Naganathan, Vasikaran ...PM096 Nau, Gerardo ..............PM157 Ng, Kevin ..................PT002
Nagano, Masahide ........PW154 Naughton, Geraldine .....PM319 Ng, Martin K. C. ..........O022, O130,
Nagaraja, Vinayak .........O113, Navickas, Rokas ...........PW160 O155, PM049, PM172, PM365,
PM101, PM102, PT134 Nazir, Noreen ..............O016 PM373, PT340, PT345, PT355,
Nagel, Stephanie ..........PT458 Nderitu, Joseph............O028 PW278, PW296
Naghavi, Mohsen ..........O193, PM278 Neacsu, Claudiu ...........O018 Ng, Seng Loong ...........PM242,
Nagireddy, Induja .........PW273 Neal, Bruce .................PT266 PW002, PW008, PW137
Nagorna, Natalia ..........PT420 Nedeljkovic, Milan A. ....PM192 Ng, Tze Pin ................O009, PT015

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Ngu, Philip .................O003 Norekvål, Tone M. ........PM484 Oh, Byeongtaek ...........PM216

Nguyen, Doan Trang .....O066, Nori, Ali Y. .................PW269 Oh, Paul ....................O197, PT455
PM220, PT013, PT014, PT365 Noto, Alfonso ..............PW170 Oh, Pyung Chun ..........PM226,
Nguyen, Michael C. ......O131, O218, Nough, Hossein ...........PW155 PM260, PT298
PM200, PM326, PT184, PW123 Nouman, Ahmad ..........PW158, Oh, Timothy ...............PT148,
Nguyen, My-Nhan ........PT364 PW159 PW079, PW127
Nguyen, Phong ............PW138 Nour, Mohammad ........PW147 Ohno, Hideki ..............PM171
Nguyen, Sally S. ...........O166 Novakovic, Aleksandra ...PT276 Oikonomou, Evangelos ..O133,
Nguyen, Thanh H. ........PM100 Novakovic, Ana ...........PM072, PM307, PT278, PT288
Nguyen, Tuan L. ..........O015, PM205, PT072, PT164 Ojo, Akinlolu ..............O210, O211
PM143, PT403 Novo, Fernando F. .......O103, PM170 Ojrzanowski, Marcin .....PT169
Nguyen, Vivian ............PM450 Novo, Mirza................PT305 Okeahialam, Basil N. .....PW229
Nicholls, Kathy ............PT348 Nowalany-Kozielska, Okello, Emmy .............O086, O087,
Nicholls, Stephen J. .......O040, O061, Ewa ....................PM001, PM111, PW089
O099 PT186 Okino, Shinnichi ..........PM420
Nichols, Melanie ..........PW243, Nugent, Paul ...............O184, PT008 Okoko, Annie R. ..........PM337
PW244 Nugent, Rachel ............O117, PT321 Oladapo, Olulola ..........PM249
Nicola, Hurst ..............PM224 Nugroho, Bhayu Olaniyi, OM ...............PT275
Nicolae, Mugur ............PW346 Hanggadhi ............PM280, Olaussen, Alexander ......PM056,
Nicolosi, Denys Emilio PM281, PM341 PT049
C. ......................PW058 Nunes, Vanessa B. ........PT292 Olejnik, Patricia ...........O103
Nigel, Steve ................O028 Nuñez, Loreto .............PM327 Oliveira, Diana.............PT264
Nik Ali, Nik Fathanah ....PW137 Nunn, Chris ...............PT181 Oliveira, José ...............PM343,
Nikolaev, Konstantin Y. ..O111, NWOSU, MIRABEL ......PM249 PW198
PM235, PM382 Nyagori, Dr Harun E. ....PM125, Oliveira, Marco ............PW320
Nikolaeva, Alevtina .......PM235 PM257 Oliveira, Norton ...........PM343
Nikolov, Fedya ............PM241 Nyboe, Camilla ............O013 Oliveira, Rodrigo ..........PT016
Nikolova-Krstevski, Nyengaard, Jens R. ........PW290 Oliver, Catherine ..........PT458
Vesna ..................O020 O’Donnell, Clare ..........PW341 Olson, Zachary ............O117
Nikuata, Akineti ...........PM466 Obert, Philippe ............PM319 Olsson, Anders G. ........O212
Ning, Guang ...............O125 O’Brien, Jennifer ...........O114 Oluleye, Tunji S. ..........PM248
Ning, Yuan .................PT326 O’Brien, Jessica ............PM182, Olusanya, Bolutife.........PM248
Nisbet, Ashley .............PT003 PM183, PM465, PW118, PW146 Omari, Abdullah ..........PT453
Nishi, Yutaro ...............PT333 Ocal, Lutfi ..................PW090 O’Meagher, Shamus ......PM444
Nishihata, Yosuke .........PM073 Ochała, Andrzej ...........PW087 Omotoso, ayodele B. .....O024
Nissen, Steven E. ..........O040, O099 Ochoa, Julian ..............PW083 Omurzakova, Nazgul .....PM462
Nitsos, Ilias.................O052 O’Connor, Simon .........PT128 Ong, Andrew T. ...........PM101
Niu, Xiangdong ...........PT024 O’Dea, Kerin ...............O162 Ong, Hean Yee ............O009, PT081
Niu, Xiaolin ................O091, O’Donnell, Clare ..........O140, PT096 Ong, Hui-shan .............PT214
PW288, PW289 O’Donnell, David ..........O031, Ong, Thun How ..........PW333,
Niwa, Koichiro ............PT055, PM014, PM033, PM034, PM035, PW334
PT333 PM036, PT406 Ong, Tiong Kiam .........PM222,
Nixon, Andrew ............PM135 O’Donohue, Kelley ........PM463 PM223, PM408, PT351, PT361
Njeru, Eraustus ............PM325 Offen, Sophie ..............PM445 Onur, Imran ...............PW129
Njoh, Roland ..............PW083 Ofner, Péter ................PW095 Ooi, Jenny Y. Y. ...........PT353
Noges, Ignacio .............PM170 Ogaoga, Divi ...............PT443 Ooi, Sze-Yuan .............PM193,
Nogueira, Ogawa, Hisao ..............PW154 PM200, PT187
Leonardo F. F. .......PT196 Ogbonna, Chika ...........PW229 Oosterhuis, Jantine........O088
Nomoto, Kenichiro .......PM177 Ogden, Vanessa ...........O177, Opolski, Grzegorz .........PT006,
Nooney, Vivek B. .........PM220, PM116, PM117, PM118, PT108 PT158, PW022, PW173
PM224, PT209 Ogimoto, Akiyoshi ........PW114 Oppermann, Anne ........PT149
Nordrehaug, Jan E. .......PM484 Ogola, Elijah N. ...........PM325 Oqueil, Ernesto ............PW098
Norekval, Tone ............PW194, Ogunmodede, James A. ..O024 Oqueli, Ernesto ............PM016,
PW372, PW377 Oguz, Ali Emrah ..........PT119 PW118

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Oquiel, Ernesto ............O001 Pang, Benjamin J.-M. .....PM002 Patel, Chetan D. ...........PT076,
Orchard, Jessica ...........PT007 Pangemanan, Janry........PM233, PT397, PW318, PW319
Ord, Michelle ..............PM045 PM272, PM300, PM371, PT250, Patel, Sanjay ...............PT345,
Oremovic, Goranka .......PW145 PT295 PW120
Ormiston, John A. ........PT189 Panniyammakal, Jeemon .PW105 Patha, Sravanthi ...........PW273
Orvad, Helen ..............PW106 Panov, Dmitriy ............O173, PT287 Patrick, Jennifer ...........PM481
Osella, Oscar S. ...........PM430 Panwar, Rajababu .........PM316 Patsamanis, Harry .........PT243, PT316
O’Shea, Rebekah ..........O005 Papageorgiou, Nikolaos ..PM252, Pattari, Sanjib ..............O098
Oshlack, Alicia.............PW287 PM380, PT221 Paulis, Ludovit .............PM258
Osmond, Clive ............PM173 Papai, Gyorgy ..............O023 Paunovic, Nevena .........PM079,
Ostern, Ekaterina..........PM085 Papapanagiotou, PT223
Osztheimer, Istvan ........O150, PM018 Aggeliki................PW218 Pautasso, Enrique J. ......PW192
Ou, Xianhong .............PM028, Papavassiliou, Athanasios Pavlovic, Radmila .........PM267
PW009 G. ......................PW218 Paymard, Mohammad ....PT385,
Ouda, Husam ..............PW147 Pappiani, Caroline ........PT274 PW335
Ouerghi, Kais ..............PW150 Pappone, Alessia ..........PT077 Pedagogos, Eugenia .......O104
Ovsyannikova, Alla .......PM235 Pappone, Carlo ............O157, Pedersen, Terje R. .........O212
Owensby, Dwain ..........PM210, PM033, PT077 Pedrozo, Vitor B. ..........PM041,
PW152 Paradis, Gilles ..............O206 PT043
Oyarzún, Eleana ...........O169 Parente, Francisco .........PT264 Peek, Michael J. ...........PT437,
Ozcan, Emin E. ...........PM018 Parfrey, Shane .............PM135 PW356
Özcan, Emin E. ...........PM019 Park, Chang G. ............PW174, Pegg, Tammy ..............PW142
Ozkan, Mehmet ...........PM110, PW175 Pego, Mariano .............PT264
PW090 Park, Jin-Sik ...............PM066 Pei, Juanhui ................O049,
Özkan, Mehmet ...........PT119 Park, Jin-Sup...............O045, PM400, PT265
Paccaud, Fred ..............PM287 PM098, PT131 Peiris, David ...............O105, O142,
Pacheco, Juliano A. .......PM052 Park, Seong-Mi ............O060, PM306, PT253
Padhee, Monalisa ..........PW290 PM329, PT399, PW116, PW215, Peixoto, Bruno .............O036
Padmakumar, PW216 Pelanyte, Simona ..........PT251
Ramachandran .......PW261 Parker, Hella ...............PT316 Pellanda, Lucia C. .........PT290,
Paez, Diana .................PT395, Parks, Tom .................O071, O114, PT312, PT313, PT418, PT419,
PT396 PM471, PT441, PW353 PW230
Pagano, Domenico ........PM076 Parma, Radoslaw ..........PW087 Peltonen, Markku .........PW242
Page, Karen ................PM069, Parma, Zofia ...............PW087 Pemberton, James .........O081, PT070,
PM294, PM348, PM352, PT316 Parnham, Susie F. C. .....PT375 PW079
Paige, Ellie .................O168 Parreira, Veronica F. ......PM061 Peña, Daniela B. ...........PT313, PT418
Pakask, Trevino A. ........PW260 Parsaik, Ajay ...............O172 Penereiro,
Palacios, Rolando .........PT005 Parsonage, William A. ....PM054, Fernanda H. ..........PW257
Paladin, Aleksandra .......PM072 PM489, PT378, PT379 Peng, Xin ...................O141
Palaniappan, Latha ........PM283 Pascual, Isaac ..............PM120, Pennock, Vicki ............O069
Palhares, Daniel M. F. ....PT019 PM121, PM122 Penny, Daniel J. ...........PM025,
Pallantza, Zoi ..............PM252, Pascual, Thomas N. B. ...PT395, PM452
PM380 PT396 Pepe, Salvatore ............O129,
Palma-Dias, Ricardo ......O035 Paskalev, Emil .............O123 PW287, PW347
Palmer, Sonny .............PM212 Pasqualon, Tundra ........PT051 Pera, Vijay ..................PT150
Palupi, Mazaya L. .........PW260 Pastor, Luis.................PT001 Pereira, Danielle G. .......PM061
Pan, Changyu ..............O125 Pastre, Carlos M. ..........PW259 Pereira, Sharlene L. .......PM390,
Panajotu, Alexisz ..........PT408 Pasupathy, Sivabaskari ...PW059 PM391
Panaretto, Katie ............O105, PT253 Pasupati, Sanjeevan .......O032, PT093 Pereira, Vitor ...............PW043,
Panda, Agnes L. ...........PM233, Patching, Karen J. .........PT458 PW044, PW045, PW046
PM272, PM300, PM371, PT250 Patel, Anushka .............O105, PT253, Peressotti, Bruno ..........PW073,
Panda, Lucia A. ............PT295, PW120, PW203 PW074
PW226 Patel, Bindu ................O142, Perez, Diego ................PM120,
Pang, Audrey ..............O124 PM306, PT253 PM121, PM122

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Perez, Virginia .............O068 Pinheiro, Márcia Cristina Pouliopoulos, Jim .........O019, O021,
Perez Baztarrica, C. M. ..................O046, PT439, O118, O154, PT013, PT032
Gabriel.................PM063, PT440 Poulsen, Steen H. .........PM091
PM106 Pinilla, Natalia .............PW005 Poulter, Rohan .............PT180
Pérez-Vizcaíno, Pintaric, Hrvoje ............O146 Pourmousavi Khoshknab,
Francisco ..............PT087 Pinto, Catarina .............PW343 Mir Milad .............PW107
Perin, Marco ...............PT191 Pisaniello, Anthony D. ...PW301 Prabhakaran, Dorairaj ....O195,
Perisic, Zoran ..............PT289 Piscopo, Giovanna ........PM414 PM148, PM173, PM493, PT252,
Perrins, Colin-John .......PW153 Pitney, Mark ...............O199, PT328, PT330, PW199, PW271
Peruga, Jan Z. .............PM234 PM193, PM200, PT187 Prabhakaran, Poornima ..PM173
Perunicic, Jovan P. ........PM099, Pitt, Bertram ...............O116 Prabhu, Sandeep ..........PM074,
PM206 Pitthan, Eduardo ..........PT041, PM197, PT099, PT151, PW001
Pestova, Anastasia .........PW371 PT042, PT043, PT044, PT045 Pradeepa, Rajendra ........PT328
Petelina, Tatiana ...........O039, Piwowarska, Wieslawa ...O217, Prasad, Sandhir B. ........PM054,
PM367, PW181, PW182 PW032 PM055, PM091, PM428, PT066,
Peter, Karlheinz ...........PM137, Planinc, Danijel ............O146 PT378, PT379, PT383
PM370, PT342 Platek, Anna E. ............PT006, Prasan, Ananth ............PM418
Peters, Matthew ...........PT115, PT158, PW022 Praveen, Pradeep A. ......PW199
PW076 Platts, David ...............O057, O180, Pravian, Dexanda ..........PM280,
Peters, Robyn ..............PW375 PT386, PT387, PW038, PW077, PM281, PM341, PT234
Peterson, Eric D. ..........O195, PW346, PW360 Prcevski, Petar .............O058
PW247 Plunokosova, Lubov ......PT061 Preda, Corina ..............PT180
Petkowicz, Pocock, Stuart .............O116 Pressler, Susan J. ..........O107, PM483
Rosemary D. O. ......PT419 Podaneva, Yulia ...........PT168 Pressley, Lynne ............PM447,
Petrovecki, Mladen ........PT167 Podnar, Goran .............PM079, PM448
Peverill, Roger E. ..........PW310, PT223 Prestes, Priscilla R. ........PT349
PW325 Pogosova, Nana ...........O193 Prichard, Ros ..............PT037
Pham, Phuong .............O059 Poi Keong, Kong ..........PW148 Prihodko, Nataly P. .......PW109
Phan, Justin ................O015, Pol, Christiana J. ..........PM067 Prior, David L. .............O014, O034,
PM143, PT403 Polanski, Carísi A. ........PM012 PM089, PM410, PW037
Phan, Khoa .................O177, Polglase, Graeme ..........PM450 Procter, Nathan E. K. .....PT365
PM116, PM117, PM118, PT108, Polikina, Olga..............PM322 Proklamartina, Nurnajmia
PW098 Poole, Susan ...............PW094 Curie ...................PM280,
Phelan, Dean ...............PW283 Poon, Karl ..................PW100 PM281, PM341
Phillips, Lisa ...............PT460 Pope, A J. ..................PM431, Prosser, Hamish ...........PW278
Phipson, Belinda ..........PW287 PM432 Prudêncio, Mariana B. ....PM446
Phuong, Helen .............PM482 Poposki, Charlotte ........PT380 Psaltis, Peter ...............PM202,
Piçarra, Bruno .............PT094, Popovic, Zoran B. .........PT384 PW237
PW043, PW044, PW045, PW046 Popovici, Ion ..............PT202 Pu, Jielin ....................O049,
Piccininni, Rocio ..........PM170 Popovici, Mihail ...........PT202, PT339 PM400, PT265
Picon, Rocio ...............PM398, Poppi, Nilson T. ..........PT459 Purabaya, Andhi ...........PM300
PT001 Porcile, Rafael ..............PM063, Puranik, Rajesh ............PM404,
Pierce, Alan ................PM313 PM106 PM439, PM444, PM447, PM448,
Pietrucha, Artur Z. ........O217, Porter, Raelene ............PT450 PW303
PW030, PW031, PW032 Posival, Herbert ...........O012, O122, Puri, Ratna .................PM292
Pigott, Victoria .............PT323 PT104 Puri, Rishi ..................O040, O061,
Pilgrim, Thomas ...........O144 Poskitt, Neil ................O069 O099
Pilmore, Helen .............PT166 Potluri, Rahul ..............PM017, Purwowiyoto, Budhi
Pilz, Lothar .................O012, PM136, PT012, PT259, PW042, Setianto ................PM409,
O122 PW231, PW232 PT377
Pincus, Matthew ...........O078 Potocnakova, Ludmila ....PM312 Purwowiyoto, Sidhi L.....PM409,
Piñeiro, Daniel J. ..........PW183 Potter, Elizabeth ...........PT091 PT377
Pingitore, Alessandro .....PM067 Potter, Jane .................PM352, Pushkarev, Georgiy .......PT194
Pinheiro, Leonardo B. ....PT349 PW256 Putri, Anna Y. .............PW260

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Pysz, Piotr ..................PW087 Rajab, Asadolah ...........O187 Rankin, Jamie ..............O131, O218,
Qader, Najlaa Abdul ......PT300 Rajagopalan, PM196, PM326, PT184, PW084,
Qian, Pierre ................PT014 Viswanathan ..........PM067 PW099, PW123
Qin, Chengxue ............PT174, Rajamani, Kushwin .......PW296 Rao, Dabeeru C. ...........PT224
PW293 Rajapakse, Niwanthi ......PM244, Rao, Nisha S. ..............PM074,
Quek, Swee Chye .........O124 PT059 PT099, PW001
Quintas, Jorge .............O036 Rajaratnam, Rohan ........O015, Rao, Renuka ...............PM378
Quiqueree, Laurent .......PT380 PM143, PT403, PW138 Rashford, Stephen .........PT136, PT137
R, Bathrinarayanan ........PT118 Rajaratnum, Rohan .......PM196 Rashid, M A................PT204
R, Rameshwar .............PT050 Rajendran, Sharmalar .....PM175 Rashid, Muhammad ......O184, PT008
Raaijmakers, Antonia .....PM395 Rajic, Dubravka ...........PM072, Rauf, Muhammad A. .....PT046,
Raal, Frederick.............PM385 PT072, PT164 PT109
Rabinovich, Rafael ........PW015 Rajopadhyaya, Rauf, Nida M. .............PT109
Racz, Ildiko ................O023 Kanchani ..............PM375 Raval, Jwalant ..............O113,
Radakovic, Bogdan ........PT010 Raju, Krishnam ............O043, O112 PM101, PM102, PT134
Radanovic, Aco ............PM206 Rakshasbhuvankar, Ravi, Anand Kumar .......PW232
Radeljic, Vjekoslav ........PT010 Abhijeet ...............PT423 Ravi, Sreedhar .............PT271
Radford, Dorothy J. .......PM406 Ramaka, Srinivas ..........PM038, Rayasamudra, Sudhir .....PT259,
Radovanovic, Mina ........PM072, PT425, PW273 PW231, PW232
PM205, PT072, PT164 Ramakrishnan, Rayasinghe, Rohan ........PM195
Radovanovic, Nebojsa ....PM072, Lakshmy ..............PW199 Raza, Syed ..................PT147,
PM205, PM206, PT072, PT164 Ramakrishnan, PW187
Radovanovic, Nebojsa ....PM099 Sivasubramanian .....PM457 Razavi, Hedi ...............PM033
Radovic, Aleksandar ......PW193 Ramalingam, Anand ......PM332, Rea, Domenica .............PM414
Rae, Paula ..................PM014, PT367, PW134 Rebelo, Marta ..............PT264
PM036 Raman, Betty ...............PM482, Rebrov, A ...................O126
Raffel, Christopher ........PW100 PT130 Rechcinski, Tomasz .......PT169
Rafiudeen, Rifly ...........PM181, Raman, Kat .................PT150 Reda, Ghada ...............PM309
PT149, PT203, PT208 Ramanathan, Reddy, Kolli S. ............O064, PT330,
Rafter, Tony ................PM186, Tharumenthiran ......O047, O220, PT252, PW199, PW271
PM188, PM189 PM095, PM225, PW291 Reddy, Prasuna ............O168
Ragab, Ahmed M. .........PW016 Ramchand, Jay .............PM184, Redfern, Julie ..............O105, O142,
Ragino, Yulia ...............PM382 PT179 O165, PM306, PM318, PT253,
Ragupathi, Loheetha ......O182 Rametta, Salvatore ........PT203 PW202, PW267
Rahayu, Sarah Febiana ...PM280, Ramírez-Vélez, Reed, Peter .................O069
PM281, PM341 Robinson ..............PM314, Reeves, Ben ................PM284
Rahimian, Roshanak ......O090 PT246 Regmi, Prakash R. .........PM127
Rahman, Md. Toufiqur ...O138, PT102, Ramis, Mary-Anne ........PW143 Rehman, Aziz U. ..........PM255
PT199, PW311 Ramji, Siddharth ..........PM173 Rehmani, Hassan ..........PW237
Rahman, AKM F. .........PM204 Ramoa, Ana ................PM343, Reichelt, Melissa E. .......O128, PM395
Rahman, Fazlur............PM209 PW198 Reid, Christopher M. .....O008, O034,
Rahman, M M. ............PM204, Ramos, Lafayete ...........PM345, PM089, PM182, PM183, PM323,
PM209, PT162, PT398, PW122 PM346, PT016, PW178 PM410, PM465, PT151, PT254,
Rahman, Mahboob ........O210, O211 Ramos, Luiz A. ............PW257 PW098, PW146, PW240, PW241,
Rahman, Mahmudur......PT306 Ramos, Luiz Alberto F. ...PM023, PW245
Rahman, MD Afzalur .....PT102, PT199 PM104, PM377, PT110, Reis, Mateus A. D. ........PT419
Rahman, Moyazur .........PT128 PW056 Remenyi, Bo ...............O070, O097,
Rahman, Muhammad Ramsay, David .............PW135 PW363
Aziz ....................PM138, Ramsay, James .............PM467, Remkova, Anna............PW342
PM139, PM478, PT163, PT306 PT423, PT424 Ren, Bao-jun ...............PT069
Rai, Gurjit ..................PT259, Rana, Indrajeet ............PM381 Ren, Fuxiu .................O188
PW231 Rana, Tariq .................PT252 Rendell, Peter G. ..........O160
Raitakari, Olli ..............O080, PM396 Ranhoff, Anette H. ........PM484 Rensen, Patrick ............PM317
Raj, Dominic ...............O210 Ranjan, Shashi .............PM436 Rey Deutch, Ana C........PW277

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Reyes, Felix G. R. .........PM104, Romero, Ma Jose ..........PT001 Ryan, Mark .................PM195

PW056 Romero, Tomás ...........O169, PW207 Ryan, Sheila ................PM436
Ribeiro, Ana M. ...........PT256 Romero-Aragones, Ryden, Lars ................O192
Ribeiro, Antonio L. .......PM012, Cynthia ................PT390 Ryding, Alisdair ...........O164
PT019, PT138, PT256, PW179 Roohafza, Hamidreza .....PM301, Ryu, Kyungmoo ...........O157,
Ribeiro, Eduardo P. .......PM052 PT183, PT245 PM033, PT077
Richards, A. Mark .........O009, PT081 Rose, Jed ...................PW247 Sabatini, Antonella ........PT255,
Richards, Arthur M. ......PT015 Rose, John ..................O161 PW248
Richards, David ...........O015, Rose, Michelle .............O140, PT096, Saber, hamdy ..............PW062
PM143, PT403 PW341 Sable, Craig ................PW089
Richmond, Robyn L. .....PM344, Rose, Sarah .................PM136 Sachdev, Harshpal S. .....PM173
PT334 Rosli, Sarah ................PT174, Sacks, Gary.................PW256
Rifqi, Sodiqur ..............PM215 PW293 Sacre, Julian ................PM030
Rigolli, Marzia .............PM434 Ross, David L. .............O021, O118, Sadeghi, Masoumeh ......PM301,
Rinaldi, C. Aldo ...........PM033 O154, PT030, PW014, PW020 PT183, PT245
Ringgaard, Steffen .........PT415 Rossi, Luca .................PM340 Sader, Mark ................PW108
Rippe, Jason ...............PW089 Roszczyk, Nikolina........PT169, Sadiq, Muhammad
Ristic, MIljko R. ...........PM192 PW332 Athar ...................PT098
Ritchie, Rebecca H. .......PT174, Roth, Gregory .............O193, PM278 Sadler, Helen ..............PW329
PW293 Rothman, Kenneth ........O215 Safaa, Ali ...................PW100
Rius, Maria Dolores S. ....PM485, Rouf, Abdur ................O196 Safiuddin, Mohammad ...PW122
PT422 Rousson, Valentin .........PM287 Sage, Peter..................PM186,
Rivas, Carlos ...............O103 Roy, Ambuj ................PT076, PM188, PM189
Rivers, John ................PT391, PT252, PT397, PW199 Saha, Pronoy ...............PW266
PT392, PT393, PT394 Roy, Paul ...................PW153 Sahnoun, Mohamed ......PM190,
Rizzo, Natalia ..............PM170 Royse, Alistair..............PM169 PM191
Roberts, Kathryn ..........O070 Royse, Colin ...............PM169 Said, Asri ...................PM408
Roberts, Louise ............O001, O063, Ruan, Wen .................PT083 Saito, Makoto ..............O054, O055,
PM135, PM180, PM185, PT143, Rubin, Jose .................PM120, PW114, PW326, PW327
PT197 PM121, PM122 Sakr, George ...............PW284
Roberts, Tim ...............O014 Rubio, Carlos ..............PW083 Salacata, Abraham .........PW233
Robertson, Elizabeth ......PM303, Ruchin, Peter ..............PW153 Salata, Robert ..............O086, O087,
PT100 Rucinskas, Kestutis .......PM050, PT432
Robinson, Domenic .......PT089 PM051, PT052 Salces, Neil Wayne C. ....O190
Robinson, Owen ..........PM105 Rudd, Nima ................PT177, Saligova, Jana ..............PM312
Robinson, Peter............PM447, PW316 Salih, Zena .................O151
PM448 Rugwinzangoga, Egidia ...PM126 Salim, Md A. ...............PM204,
Robson, Desiree ...........PT037 Ruhamya, Nathan .........PM126 PM213, PT162, PW122
Rodrigues, Roseane S. ....PM061 Ruiz Cano, María José ....PM103 Salkeld, Glenn .............PM013
Rodriguez, Leandro .......PM007, Ruiz de Temiño de Sallustio, Benedetta C. ....PM076,
PM157 Andres, Esther M. ...PW073, PW049
Rodriguez, Manuel ........PW277 PW074 Salomaa, Veikko ...........PW242
Rodriguez Correa, Rule, Zoe ...................PT198 Salomão, Emiliane ........PM023,
Carlos ..................PT451 Runev, Nikolay ............O123 PM377
Roeters Van Lennep, Ruray, Djunaidi ...........PT377 Salvaggio, Flavio ..........PM106
Henk ...................PM317 Rus Mansilla, Carmen ....PW073, Samaranayake,
Roeters van Lennep, PW074 Chinthaka .............PT148,
Jeanine ................PM317 Rusingiza, Emmanuel .....PM126 PW127
Rojano, Jessica C. .........PT422 Rusli, Siti Nadiah .........PM223 Samhoun, Nour Eldeen
Roka, Attila ................O152 Russ, Graeme ..............PW301 H. ......................PW234
Rolleston, Anna ...........PM464 Ruygrok, Peter .............O121, Samora, Giane A. .........PM061
Roman, Marcin ............PW224 PM095, PM129, PM150, PM225, Samoylova, Elena .........PM164
Romanelli, Giovanni ......PW325 PM461, PT070, PT148, PT166, Sampaio, Leticia P. D. B...PM446
Romano, Enrico ...........O157, PT077 PW127 Samy, Wael ................PM086

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

San George, Richard C. ..PT323 Sazzli, Kasim ...............PM422, Sedgwick, John ............PT386,
Sanchez Floro, Ana I. ....PW073 PT207, PT296, PT297, PW067, PT387, PW077
Sánchez Floro, Ana I. ....PW074 PW201 Segovia, Isabel .............O169
Sanchez-Grande Flecha, Scalia, Gregory M. ........O180 Seica, Anca .................O018
Alejandro ..............PM146 Scammells, Peter ..........PT356 Sekiguchi, Haruki .........PM003,
Sanders, Karen.............PW094 Scanlon, Andrew ..........PT456, PT457 PM003, PM059, PM171, PM302,
Sanders, Prashanthan .....O119, PT004 Schaan, Camila W. .......PT418 PT226
Sanderson, John E. .......PT170 Scharin Täng, Margareta .PT347, Selnow, Gary ..............O028
Sandoval, Daniela .........O169, PW306 Selvanayagam, Joseph B. .O077, O175,
PW207 Schenck-Gustafsson, PT375
Sandström, Thomas ......PM276 Karin G. ...............PM155 Semsarian, Christopher ..O082
Sane, Rohit M. .............PT175 Schlaich, Markus P. .......PM256 Seneviratne, Martin .......PM439
Sanfilippo, Frank ..........O131, O207, Schlett, Christopher L. ...O010 Seneviratne, Sujith K. ....PM202,
O218, PM265, PM326, PT184, Schmerler, Patrick .........PM258 PM433, PT405, PT407
PW123 Schmitt, Claus .............O012, O122, Sengupta, Abhishek .......PW077,
Sanford, Kate ..............PM489 PT104 PW346
Sangareddi, Schmitt Neto, Almir ......PT047, PT244 Seo, Jae-Bin ................PM305,
Venkatesan ............O135 Schmitt Netto, Almir .....O075, PW041 PT247
Sani, Yanti N. ..............PM223 Schneider, Michal .........PM450 Seo, Jong Goo .............PM226
Sankar, Krishna ...........PW105 Schnetzer, Natalia .........PW015 Seong, Young-Joon .......PM305,
Santamaria, John ..........PW037 Schoonjans, Kristina ......O167 PT247
Sant’Anna, Patrícia S. .....PM041, Schranz, Dietmar ..........O052 Seow, Swee Chong .......PT015
PT042, PT043, PT045 Schroefel, Holger ..........O012, O122 Sepsi, Milan ................PM085
Santhanakrishnan, Schröfel, Holger ...........PT104 Serbest, Nail G. ............PW129
Rajalakshmi ...........PT015 Schuch, Daniela ...........PT418 Seresi, Juan .................PT257
Santinelli, Vincenzo .......O157, PT077 Schulman, Sam ............PW005 Serptytis, Rokas ...........PW160
Santos, Janaina A. B.......PT196 Schultz, Carl ...............PM105, Serpytis, Pranas ............PM046,
Santos, Lèlita ...............PT264 PT103, PT184, PW099 PT251, PW160
Santos, Manuel O. ........PT264 Schultz, Martin ............PW171 Serpytis, Rokas ............PT251
Santos, Marco Aurelio ....PT439, PT440 Schusterova, Ingrid .......PM312 Setia, Nitika ................PM292
Santos, Maximo ...........PT451 Schutte, Aletta .............PT227 Setiadi, Benny M. .........PM272,
Santos, Raul D. ............PM251 Schutte, Rudolph ..........PT227 PM371, PT250, PT295
Sarathy, Kiran .............PT134 Schymik, Gerhard .........O012, O122, Setianto, Budi Y. ..........PT416
Sariowan, Vekky ..........PT250 PT104 Setyaningrum, Wuri ......PW081
Sarmento, Sofia ............O036 Schymik, Jan S. ...........O012, O122 Shabani, Rabhat ...........O123
Sarrafzadegan, Nizal ......PM301, Scott, Adam C. ............PM489, Shackley, Michaela ........PW244
PT183, PT245 PM492 Shah, Syed M. .............PW112
Sasha, Stella ................O003 Scott, Douglas S. ..........PT189 Shah, Bimal ................PW247
Sata, Yusuke ...............PM256 Scott, Elizabeth ............PT051 Shah, Fayaz H. ............PM255
Sathananthan, Scott, Ian ...................O110 Shah, Mubarak ............PT258
Janarthanan ...........PT166 Scott, Matthew ............PW156 Shah, Nadim ...............PM181,
Satupaitea, Viali ...........PT445 Scott, Peter .................PM184, PT149, PT203, PT208
Saunders, Debra ...........PM067 PT176, PT179 Shah, Svati .................PW247
Savage, Lindsay ............PM211, Scruth, Elizabeth A........PM478, Shah, Syed M. .............PM253,
PW106, PW305, PW368 PT163 PT258, PT261
Savage, Michael ............PW100 Scurrah, Katrina ...........PT349 Shahbaz, Ahmed ..........PW158,
Saviano, Massimo .........O157 Seale, Helen ................PW038 PW159
Savoiu, Gheorghe .........PM062 Seale, Holly ................PM344 Shaik, Ibrahim .............O058
Sawhney, Jps ...............PM292 Sebastian, Martin ..........O008, Shao, Junghua .............PM068
Sax, Balazs .................PT060 PM147, PM182, PW146 Shao, Qingmiao ...........O115, PT011
Saxena, Anita ..............PM457 Seccombe, Leigh ..........PT115, Sharara, Shima.............PT300
Saxena, Renu ..............PM292 PW076 Share, Bianca L. ...........PM319
Saymi, Lima A. ............PM273 Seck, Sidy M. ..............PW217 Sharma, Gautam ..........PT076, PT397

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Sharma, Krishnakumar ...O170, Shimatsu, Akira ...........O027, Simor, Tamas ..............PT371

PM316, PW219 PM304, PM331, PT358, PW249 Simova, Iana ...............PW308
Sharma, Meenakshi .......PW358 Shimizu, Atsuya ...........PM177 Simpson, Philippa .........O022, PW278
Sharma, Nikunj ...........O064, PT314 Shin, Eak Kyun............PM226 Sims, Amy..................PW254
Sharma, Parag .............PM013 Shin, Gil J. .................PM329 Singh, Anita ................PT315
Sharma, Punit .............PT076, Shin, Mi-Seung ............O060, Singh, Ankur ..............O203, O205
PT397, PW318, PW319 PM329, PT399, PW116 Singh, Archna .............PT315
Sharma, Shreyas ...........PT332 Shin, Sanghoon............PW323 Singh, Balwinder ..........O172
Sharma, Virendra K. ......PM415, Shin, Sung-Hee ............O060, PT399 Singh, Gurmeet ............PM415,
PW195 Shirazi, Masoumeh G. ....PM130 PW195
Sharman, James E. ........PM288, Shivashankar, Roopa .....PT328 Singh, Harmandeep .......PT076,
PW324 Shlipak, Michael ...........O210 PT397, PW318, PW319
Shatila, Wassim ...........PW247 Shoaib, Muhammad ......PM105 Singh, Jitendra .............PM316
Shaw, Elizabeth ...........O100 Shrestha, Nikesh R. .......O144 Singh, Kamal...............PM344
Shaw, James A. ............O003, O038, Shrivastav, Radhika .......O064, PT314 Singh, Kavita ...............PT328
PM183 Shugman, Ibrahim ........PW138 Singh, Kuljit ...............O172, PT130
Shaw, Linda ................PW247 Shuie, Ivy ..................PW309 Singh, Rajvir ...............O202, PT300
Sheikh, Abdul R. ..........O074, Shulman, Stanford ........PW089 Sinha, Sourabh K. .........PW271,
PM175, PT130, PT281 Siala, Ahmed ...............PT107 PW272
Sheikh, Imran .............PM105 Siasos, Gerasimos .........O133, Sinhal, Ajay ................O175, PW102
Sheikh Abdul Kader, PM307, PM380, PT278, PT288, Sippel, Joanne .............PM428
Muhamad Ali .........PW349 PW218 Siswanto, Bambang B. ....PM409,
Shekar, Kiran ..............O057 Siaw Cheng, Tieh .........PW148 PT377
Shekerdemian, Lara .......O083 Sibulo, Antonio S. ........PM082 Sivadasanpillai,
Shen, Jihong ...............PT024, Sicari, Gabrielle ............PM105 Harikrishnan .........O204, PW105
PW021 Siddique, Md A. ...........PM204, Sivagangabalan, Gopal ....O019, O118,
Shepherd, James...........O212 PW122 O154, PT030, PW020
Sheppard, Robyn ..........PM481 Sidharta, Samuel L. .......O061 Sivathasan, C ..............PT038
Shepstone, Lee.............O164 Siedlecki, Janusz A. .......PM078 Ski, Chantal F. ............O109, O160,
Sherwood, Juanita.........PT437 Siedlecki,, Janusz A. ......PM077 PM483
Shetty, Anoop K. ..........PT003 Sijbrands, Eric .............PM317 Skiba, Marina ..............O145
Shetty, Pratap ..............PM210, Sikiö, Maija ................PM275 Skidmore, Paula ...........PW205
PW120, PW152 Silva, Flavia E. .............PM390 Skilton, Michael ...........PM291,
Shi, da-zhuo ...............PM179, Silva, Gustavo .............PM343 PM396
PT192 Silva, Juliana H. ...........PW321 Skilton, Michael R. ........O162
Shi, Hongling ..............O141 Silva, Maria ................PM345, Skommer, Joanna .........PM381
Shi, Ping ....................O188 PW178 Slade, Gary D. .............O162
Shi, Rui .....................PM165, Silveira, Carlos M. ........PM430 Slart, Riemer ...............PW315
PM166, PM168 Silversides, Candice .......O101 Slater, Annika ..............PM468
Shiau, Stephanie ...........PM347 Silverstone, Anne ..........PT181 Slaughter, Dr Richard E. .PM406
Shidfar, Farzad ............O187, Sim, Beatrice ...............O057 Slavic, Svetlana ............PM258
PM308 Sim, David K. L. ..........O009, O209, Slavin, Glenn S. ...........O038
Shiel, Louise ...............O034, PM088, PT038, PT081, PT083 Slawek, Dariusz ...........PM234
PM089, PM410 Sim, Joe.....................PW283 Sleaby, Rochelle S. ........PW293
Shiina, Kazuki .............PM073 Sim, Ling Ling .............O209, Sliwa, Karin ................PM342
Shilton, Trevor R. .........O143 PM144, PT210 Smanio, Paola E.P. ........PW320,
Shim, Chi Young ..........PW323 Sim, Malcolm R. ..........O189 PW321, PW322
Shim, Wan-Joo ............O060, Sim, Pui Pui ...............PM223 Smeesters, Pierre ..........O134
PM329, PT399, PW116, PW215, Simanjuntak, Cindya K. ..PT234 Smigelskaite, Akvile .......PM046
PW216 Simkova, Iveta .............PT417, Smith, A/Prof Karen ......O153
Shimada, Sayaka ..........PM331, PW342 Smith, Belinda .............PW037
PW249 Simmonds, Mark ..........O213 Smith, Gerard ..............PM045
Shimamoto, Ken ..........PM171, Simon, Daniel .............O087 Smith, Ian ..................PT391,
PM302, PT226, PT226 Simonovic, Dejan .........PM267 PT392, PT393, PT394

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Smith, Julian ...............PM465 Sree Raman, Karthigesh Strange, Geoff ..............O140, PT096,
Smith, Julie ................PT334 (Kat) ...................O208, PW341
Smith, Karen ...............O189 PM070, PT093 Strathmore, Neil F. .......PM074,
Smith, Kelly ................PT350 Sreedharan, Madhu .......O204 PT099, PW001
Smith, Kim .................PM428, Srej, Marianna .............PW262 Straveski, Bill ..............PM350
PT066, PT378, PT379 Srinivas, Kaipa T. .........O155 Stribling, Judy .............O182
Smolich, Joseph J. ........O129, O158, Srivastava, Aarti ...........PT315 Stringhini, Silvia ...........PM287
PM452, PT360, PW287, PW347 Srivastava, Ankur..........PM425 Stroba, Agnieszka .........PT186
Smolka, Grzegorz .........PW087 Srivastava, Piyush M. .....PM045 Strodl, Esben ..............PW143
Smyth, Gordon ............PT430 Staels, Bart .................O167 Strudwick, Mark W. ......O179, PT372,
Snir, Afik D. ...............PM195, Stanton, Kelly ..............PW303 PT373
PM196 Stapf, Christian ............O079 Strugnell,
Snow, Timothy ............PM150, Stavreski, Bill ..............PW244 Wendy E. .............O180,
PM461 Steckelings, Muscha ......PM258 PM406, PM447, PM448
Sobczak, Maria ............PT169 Steer, Andrew C. ..........O071, O114, Stub, Dion .................O038
Soh, Siang Y. ..............PM277, O134, PM471, PT441, PW353, Stuklis, Robert .............O106
PT407 PW357, PW363 Stuto, Alfio .................PM021
soker, gokhan..............PM031 Stefanadis, Su, Annie Y.-C. ............PT285
Solberg, Erik E.............O053 Christodoulos ........O133, Su, Yidan ...................PT364
eljko ..............O146
Soldic, Z PM252, PM307, PM380, PT221, Suarez, Alfonso ............PM120,
Soltani, Md. Hossein .....PW121 PT278, PT288 PM121, PM122
Somogyi, Andrew A.......PW049 Stefanovic, Branislav S. ...PM072, Suarez, Emma .............PM120,
Somwe, Somwe W. .......PW354 PM205, PT072, PT164 PM121, PM122
Song, Eun Kyeung ........O107 Steine, Kjetil ...............O053 Subbashish, Agarwal ......O058
Song, Zhang ...............PW295 Stepinska, Janina ..........PM077, PM078 Subotic, Ida ................PM072,
Soo Kun, Lim ..............PW166 Stevanovic, Angelina ......PM079, PT072, PT164
Soon, Jennifer..............PW237 PT223 Subramanian,
Soon, Kean .................PM065, Stevanovic, Jovo ...........PW024 Ramasamy ............PT145
PM181, PT149, PT203, PT208, Stevens, Emily .............PW205 Suchday, Sonia ............PM316
PW336 Stevenson, Irene H. .......PM002 Suciadi, Leonardo P. ......PT438
Soria Arcos, Federico .....PM158 Stevovic, Slavica ...........PW193 Sudo, Roberto T. ..........PM390,
Soszyn, Natalie ............O035 Stewart, James .............PM150, PM391
Souretis, Georgios .........PW218 PT148, PW127 Sugawara, Jun .............O174, PW213
Sousa, Catarina ............PT094 Stewart, Paul ...............PM211, Sugi, Kaoru ................PM421
Souza, Valeria C.L.D. .....PT028, PW106, PW305 Sugumar, Hariharan ......O031, PM034,
PW033 Stewart, Ralph .............O047, O121, PM035, PM036, PM180, PT143
Souza, Viviane U.S.D. ....PT028, O220, PM129, PM225 Suh, Soon Youn ...........PM226
PW033 Stewart, Simon ............O034, O066, Suhai, Ferenc ..............PT371
Souza Neto, O109, O163, O181, PM089, Suhail, Sufi Muhammad .PM429
Manoel G. .............PM266 PM259, PM410, PM488, PT365, Sulaiman, Kadhim ........PM162
Soward, Alan ..............PM277 PW194, PW222, PW258, PW369, Sullivan, Anne .............PM483
Spadaro, Andre ............PT191 PW372, PW377 Sullivan, Elizabeth ........PT436,
Spagnuolo, Vitaliano ......PW170 Sties, Sabrina W. ..........O075, PT437, PW356
Sparks, Paul ................O104 PM052, PT047, PT244, PW041 Sumimoto, Takumi .......PW114
Spears, James R. ...........O058 Stiles, Martin K. ...........O119 Sun, Hai-Ying ..............PM166
Spector, Jonathan M. .....PW354 Stirling, Sue ................O164 Suna, Jessica M. ...........PM492
Spencer, Ryan J. ...........PM198, Stoickov, Viktor ...........PM267, Sunagawa, Yoichi .........O027,
PT179 PM423 PM304, PM389, PT358
Speranza, Vicki ............O180 Stojanovic, Ivan ...........PT276 Sundström, Johan .........PT266
Spesia, Carlos H. ..........PM266, Stojanovic, Jecka ..........PM206 Supit, Alice .................PM233
PT292 Stokes, Michael ............PM184 Suresh, K ...................PM148
Sprakel, Julie ...............PT319 Stokes, Scott ...............PT423 Suryaatmadja, Bima .......PM409,
Spurrier, Nicola ...........PT306 Strada, Bruno ..............PT389 PT377

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Susak, Stamenko ..........PW193 Takaya, Hoashi ............PM454 Tekin, Kamuran ...........PM141

Süselbeck, Tim ............PT104 Talbot, Andrew ............PT348 Teng, Tiew-Hwa
Suttie, Joseph ..............PW153 Tamuno, Peace ............O032 Katherine ..............O207, PM265
Suvorov, Alexander Y. ....PM236 Tan, Ban Hock ............PT038 Tenorio, Carlos ............PW083
Suzigan, Bruna H. .........PM041, Tan, Eugene S. ............PT015 Tentolouris, Costas .......PM252,
PT043 Tan, Jack ...................PM144 PM380
Suzuki, Hidetoshi .........O027, Tan, Joanne ................PW278 Teo, Eliza ...................O177,
PM389, PT358 Tan, Joycelyn L.L. .........PT038 PM015, PM116, PW098
Suzuki, Mayumi ...........PT226 Tan, Lauren ................O142, PM306 Teo, Karen S.-L. ...........PW301
Swain, JaBaris ..............PM126 Tan, Ren ....................PT128 Teo, Lee Wah ..............PM088
Swale, Matthew ............PM014, Tan, RS .....................PT214 Teoh, Mark ................O052
PM034, PM035 Tan, Ru San ................PM080, Terashima, Sachiko .......PW249
Swan, Amy .................O175 PM429, PT083 Terkelsen, Chrisian J. .....PM091
Swedberg, Karl ............O116 Tan, Sian Kong ............PM408 Terzic, Branka .............PM206
Szabo, Gabor T. ...........O023 Tan, Swee Yaw ............PT409, Tesch, Roberta .............PM390
Szabo, Lisa .................PM339 PW333, PW334 Tetiu, Ovidiu ..............PM062
Szabó, György .............PM142 Tan, Teing Ee ..............PT038 Teutsch, Christine.........O215
Szarski, Martin ............PT231 Tan, Thuan Tong .........PT038 Tewari, Satyendra .........PW211,
Szekeres, Piroska ..........PW262 Tanaka, Atsushi ...........PM151 PW212
Szeplaki, Gabor ............O150, O152, Tanaka, Hrofumi ..........O174 Thakur, J S. ................PW358
PM018 Tanaka, Naohide ..........PM171 Tham, Yow Keat ..........O166
Széplaki, Gábor ............PM019, Tandon, Nikhil ............PM173, Than, Martin ...............PT123
PW262 PM493, PT252, PT328, PW199 Thangavel, Arul ...........O002
Szigat, Frank ...............O200 Tang, Ri-Bo ................O096, PW006 Tharakan, Jaganmohan ...PW105
Szigat, Peter ................O200 Tang, S Y. ..................PM432 Thavapalachandran,
Szilagyi, Szabolcs ..........O150, O152, Tanimoto, Takashi ........PM151 Sujitha .................PT014, PT032
PM018 Tanous, David J. ..........PM447, Theobald, Karen ...........PW376
Szymanska, Anna .........PT006, PM444, PM448, PT414 Thiagalingam, Aravinda ..O019, O062,
PT158, PW022, PW173 Tapolyai, Mihály ..........O056 O118, O154, PM020, PM417,
Szymanski, Filip M. ......PT006, Tapp, Robyn ...............O080, PM396 PT013, PT014, PT030, PT032,
PT158, PW022, PW173 Tarak, Ellouze .............PW080 PW020
Szymczyk, Konrad ........PW332 Tarnoki, Adam D. .........PT408 Thibault, Bernard .........PM033
Szymonifka, Jackie ........O010 Tarnoki, David L. .........PT408 Thomas, Beth ..............PW256
Tabatabaei, Hasan .........PW155 Tase, Adrian G. ............O018, PM062 Thomas, James D. .........PT382
Tabatabai, Sadeq I. ........PW112 Tase, Anca..................PM062 Thomas, Liza ..............O015, O059,
Tadmor, Brigitta ...........PW354 Tatoulis, James ............PT155, PT156 PM091, PM143, PM411, PT051,
Taeed, Anis ................PM181, Tatsumi, Fujio .............PM171, PT226 PT115, PT403, PW014, PW076,
PT149, PT203, PT208 Taufiq, Nahar ..............PT416 PW138
Taghavi, Mahboobeh .....PT245 Tavella, Rosanna ..........O006, O092, Thomas, Scott .............O197, PT455
Tagliari, Fabio .............PT113, PT114 O214, PM328, PT281, PW059 Thomas, Stuart ............O019, O021,
Taha, Nasser ...............PM472, Tayeh, Osama .............PM086 O118, O154, PM026, PM027,
PW208 Taylor, Andrew J. .........O037, O038, PT030, PW014, PW020
Tahin, Tamas ..............O150, PM018 O136, PM075, PM271, PM407, Thompson, David R. .....O109, O160,
Tahk, Seung-Jea ...........O130 PT003, PT338, PW013, PW047 O163, PM483, PT155, PT156,
Tailleux, Anne .............O167 Taylor, David ..............PW138 PW194, PW372, PW377
Taira, Ryosyu ..............PM119 Taylor, Richard ............O216 Thompson, Jen ............PT327
Taito, Rigamoto ...........PW353 Tech, Ana W. ..............PT418 Thompson, Peter L. .......PM189,
Takahashi, Takanori ......PM119 Tee, Meng Hun ............PW002 PM491
Takahashi, Yufuko ........PM302, Teh, Andrew ...............O001, O031, Thompson, Sandra C. ....O207, PM265
PT226 O063, PM034, PM035, PM036, Thörn, Clara ...............PM155
Takahashi, Yuko...........PM331, PM180, PM185, PT143, PT197 Tian, Jenny .................PT040,
PW249 Teixeira, Flávio ............PW343 PT372, PT373, PW276, PW307
Takata, Yoshifumi .........PM073 Tejero, Veronica ...........PM158 Tian, Maoyi ................O195

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 AUTHOR INDEX

Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Tiberio, Antonio ...........PM210, Tourikis, Panagiotis .......O133, Tykkyläinen, Markku .....PM275

PW120, PW152 PM307, PT288 Tysarowski, Andrzej ......PM077
Tideman, Philip ...........PW373, Tousoulis, Dimitris........O133, Tysarowski,, Andrzej .....PM078
PW374 PM252, PM307, PM380, PT221, Tzonev, Svetlin ............O123
Tie, Michelle ...............PW295 PT278, PT288, PW218 Udovicic, Mario ...........PT167
Tiira, Teatao ...............PM466 Toussaint, Nigel ...........O104 Ueda, Leandro .............PW321
Tikkanen, Matti J. .........O212 Touw, Jeanette .............PM317 Ugresic, Nenad ............PT276
Tiksnadi, Badai B. .........PT129 Towner, Rheal .............PM067 Ulbrich, Anderson Z. .....O075,
Timbol, Edgar .............PW054 Townsend, PM052, PT047, PW041
Timeon, Patrick ...........PM466 Raymond R. ..........O211 Ulhaq, Zia ..................PM199
Timerman, Lilia ...........PT028, Trajic, Snezana ............PM079, Ul-Haq, Zia ................PT153
PW033 PT223 Ullah, Anhar ...............PM162,
Timerman, Sergio .........PT028, Tran, Lavinia ...............PM465 PT165
PT191, PW033 Trbusic, Matias ............O146 Ullah, Saleem ..............PM255
Timoracka, Katarina ......PM311 Trejo, Graciela .............PT005, PT206 Umenze, Ikenna ...........PT275
Tiong, Lee Len ............PM222, Tretyakova, Natalia .......PW181 Undok, Abdul Wahab ....PW166
PM223, PT351, PT361 Trevisan, Gustavo C. .....PW257 Unger, Thomas ............PM258
Tiong, Wen Ni ............PT351, PT361 Triana-Reina, Hector R. ..PM314 Unnikrishnan, Ranjit .....PT330,
Tipping, Peta ..............PT430 Triki, Faten ................PW080 PW271
Tira, Teatro ................PW355 Trivedi, Gunjan ...........O020, PT350 Uno, Kiyoko ...............O099
Tirimacco, Rosy ...........PW373, Trivi, Marcelo ..............PM157 Unosson, Jon ..............PM276
PW374 Trohman, Richard.........O016 Uppal, Hardeep ...........PM017,
Tirkkonen, Hilkka ........PM275 Troughton, Richard .......O208, PM070 PM017, PM136, PT012, PT259,
To, Andrew C. ............PM434 Troupis, John ..............PT405, PT407 PW042, PW231, PW232
Todiras, Mihail ............PT339 Truelove, Michael .........PW203 Ura, Syuichi ................PM331
Tofler, Geoffrey H. ........PM483, Truong, Quynh A. ........O010 Uranga Imaz, Matias ......O103
PT155, PT156 Trzos, Ewa .................PT169 Uribe, Carlos ...............PW083
Toh, Song Tar .............PW333, Tsai, Josh P. ................PT136, Usal, Ayhan ................PM031
PW334 PT137, PT372, PT373, PW276, Usherwood, Tim ..........O105, PT253
Tohda, Tomoko ...........PM151 PW307 Usmani, Zafar ..............O172
Toia, Deidre ................PT056 Tsang, David ...............PM147, Usui, Yasuhiro .............PM073
Tolentino, Kim ............O124 PM197 Utesheva, Alena ...........O039
Tomandao, Tsioufis, Costas ............PM252 Utomo, Steven R. .........PT250
Kathy Lou.............O132 Tuason, Teresa ............PM283 V.E., Dhandapani .........PT118
Tomasik, Andrzej .........PM001, Tuikong, Nelly ............PT452 V.E., Dhandapani .........O135
PT186 Tukana, Isimeli ............O071, PM471 Vafa, Mohammadreza ....PM308
Tomassoni, Gery ..........PM033 Tumur, Odgerel ...........PW336 Vago, Hajnalka ............PM018,
Tomaszewski, Maciej .....PT349 Tunbridge, Matthew ......O057 PT371
Tomlinson, Brian ..........PM385 Tune, Kylie .................PT437, Vágó, Hajnalka ............PM142
Tomoto, Tsubasa ..........PW213 PW356 Vaiciulyte, Austeja ........PW160
Toneto, Aline ..............PM023, Tung, Matthew K. Y. .....PM108 Vaile, Julian ................PW102
PM377 Tungsubutra, Wiwun .....PM208 Vakulenko, Kostyantyn
Tong, David ................PM135, Turaga, Vishesh ...........PT091 Y. .......................PT022, PT023
PM180, PM185, PT197 Turgonyi, Eva ..............O116 Valente Filho, Jamil M. ...PM052
Tong, Steven ...............PW357 Turki, Mona ...............PM090, Valerie, See .................PW014
Tonkin, Andrew ...........O084 PT135 Valkovicova, Tatiana ......PW342
Toogood, Geoff ............PT091 Turkmen, Serdar ..........PM031, Vamadevan, Ajay S. .......PM493
Torres, Samantha..........PM339 PM141 Van Biber, Benjamin ......PW281
Torzillo, Paul ..............PW303 Turnbull, Fiona............PM196, Van Empel, Vanessa ......PT082
Toth, Attila .................PT371 PW202 Van Gaal, William ........PT056,
Toukhsati, Samia R. ......PT056 Turner, Elizabeth L. ......O188 PT177, PT388, PW316, PW317
Touma, George ............PW135 Turquia, Cintia P. B.......PM012 van Pelt, N C. .............PM431,
Tounsi, Ahmed ............PT105, Tuzcu, E.Murat ............O099 PM432
PT106, PT107, PW080, PW085 Twomey, Darragh .........PT004 van Rosendal, Simon .....PM030

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Van Tits, Lambertus ......O167 Vinter, Ozren ..............O146 Walters, Darren L. ........O078, O180,
van Veldhuisen, Dirk .....O116 Viola, Helena ..............PT359 PW100, PW360
Vanags, Laura ..............PW278 Virata, Michael.............PT271 Walters, Tomos E. ........PM015,
Vander Horn, Steve .......PT316 Virdi, Amy .................PM418 PT003
Vanderlei, Luiz Carlos Viswanathan, Bharathi ....PM287 Waltham, Lara .............PT458
M. ......................PW259 Viswanathan, Sunitha.....O204, PM148 Walton, Antony ...........PW118,
Vargas, Patricia ............O169 Vitale, Luana ...............PM021 PW146
Vargas, Tulio ...............PT191 Vitale, Raffaele .............O157 Wan Ahmad,
Vargas-Torres, Manuel J. .PM146 Vitek, Libor ................PW209 Wan Azman ..........PW166,
Varghese, Mithun .........PM457 Vitkus, Dalius ..............PM050, PW240
Varghese, Paul .............PM480 PM051, PW160 Wan Mohd Izani, Wan
Varma, Yogesh .............PM415, Vitola, Joao .................PT395, PT396 Mohamad .............PW137
PW195 Vlachadis Castles, Wang, Bing Hui ...........PT356,
Vartiainen, Erkki ..........PW242 Anastasia ..............PT388, PT357, PW292
Vasikaran, Samuel D. .....PW099 PW316, PW317 Wang, Chenglong .........PM179
Vasilev, Dobrin ............PT404, Vladimirova_kitova, Wang, Christopher S.
PW308 Luidmila...............PM241 W. ......................PM181
Vasiljevic, Zorana .........PM072, Voevoda, Mikhail .........O111, Wang, Guoliang ...........PM025
PT072, PT164 PM235, PM382 Wang, Haoxiang ..........PT326
Vats, Shivangi ..............PT331, PT332 Vohra, Jitendra ............O104 Wang, Harry HX ..........O085
Vaughan, Geraldine A. ...PT436, Volgman, Annabelle S. ...O016, PT268, Wang, Hua .................PM028
PT437, PW356 PW236 Wang, Lan .................PM124
Vavuranakis, Manolis .....PT278 Volgman, Caroline A. ....O016, PT268 Wang, Lingwei ............PW027
Vazdar, Ljubica ............O146 Volling, Mark ..............PT323 WANG, Luzhen ...........PM028
Vedanthan, Rajesh ........O182, PT452 Von Lueder, Thomas G. .O053, Wang, QiFeng .............PW344,
Vegh, Eszter ................PT060 PT357 PW345
Velala Elumalai, Voon, Chi Yen .............PM408 Wang, Stephanie ..........O016
Dhandapani ...........O042 Vora, Charmie .............PM487 Wang, Tom Kai Ming ....O047, O121,
Veldman, Alex .............O052 Voskoboinik, Alex ........PM407, O220, PM095, PM129, PM150,
Veluswamy, Sundar K. ...PM487, PW013 PM225, PM461, PT070, PT148,
PW228 Voss, Jamie .................PW079 PW079, PW127, PW291
Venalis, Algirdas ...........PM050, Vranic, Aleksandra ........PT276 Wang, Wengong ..........PM368
PM051 Vuchev, Valerii ............PT061 Wang, William Y. S. ......O179,
Venkatesan, Sangareddi ..O042 Vujisic Tesic, Bosiljka ....PM099 PM130, PT040, PT136, PT137,
Venn, Alison J. ............PM288 Vukosavljevic, Dragana ...PM206 PT372, PT373, PW276, PW307
Verchin, rebecca ...........PW131 W. Isa, W. Yus Haniff ....PW008 Wang, Xia ..................O079
Verguet, Stephane .........O117 Wada, Hiromichi ..........O027, PM304, Wang, Xian ................PM368
Verhoeven, Adrie ..........PM317 PM331, PM389, PT358, PW249 Wang, Xiaowei ............PM370
Verma, Ishwar C. .........PM292 Wade, Vicki ................PM352, Wang, Xiaozhan ...........O017
Vermeersch, Pieter ........PM290 PM463 Wang, Xinghua ............O137,
Viana, Victor ...............PW343 Wagstaff, Jackie............O118 O183
Vicedomini, Gabriele .....O157, PT077 Wahi, Sudhir ..............PT092 Wang, Xule ................O017
Vicendese, Don ............PW353 Waites, Johnathon ........PM195 Wang, Yue-Xi ..............PM203,
Vicente, Mark ..............PW054 Wake, Minoru .............PM119 PT069
Vidaic, Jane ................O059 Walker, A/Prof Tony .....O153 Wang, Zengwu ............PM400
Vieira, Patrícia .............PW343 Walker, Robyn ............PT037 Wantania, Frans ...........PW226
Vijayakumar, maniyal ....O089 Walker, Simon K. .........PW290 Ward, Brenton .............O071,
Vijayaraghavan, G .........PM148 Wallace, Anthony .........PT392 PM471, PW353
Villecco, Sebastian ........PM106 Walls, Angela ..............O077 Warnes, Carole ............O101
Vincelj, Josip ...............PT167, Walls, Lourdes.............PW315 Warren, Josephine ........O003
PW145 Walsh, James ..............PW038 Warren, Roderic ...........O177,
Vincent, John ..............O116 Walsh, Kevin ..............PT414 PM117, PM118, PT108
Vine, Julie ..................PM467 Walsh, Warren ............PT437, Wasim, Mohammed ......PM136,
Vinogradova, Tatiana .....O156, PM037 PW356 PW042

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Watanabe, Eri..............PM302, Wibowo, Robin H. ........PW081 Wong, Chiew ..............PM065,

PT226 Wick, Kate .................PM015 PW336
Watanabe, Masataka ......PW292 Wickham, Jo ...............PM434 Wong, Dennis T. L. ......PM149,
Watkins, David ............O117, PT321, Wicks, Ian ..................PT430 PM202, PM277, PM433, PT407
PT322 Wierzbowska-Drabik, Wong, Flora ...............O052
Watson, Timothy .........PM150, Karina .................O073, PT169, Wong, Gerard .............PM271
PM461, PT070, PT148, PW165, PW332 Wong, Inez B ..............O124
PW127 Wijesinghe, Haren E. .....PT012, Wong, James ...............O177,
Waugh, Jane ...............PW237 PT259 PM116, PM117, PM118, PT108
Weaver, James .............PM418, Wilcox, Timothy ..........PW291 Wong, Michael C..........O104,
PW135 Wilkinson, Luke ..........PT392 PM407, PT003
Webb, Ian ..................O213 Williams, David ...........PM366 Wong, Norman ............O040
Webb, Randy ..............PT357 Williams, John .............PW205 Wong, Raymond C. C. ...O009
Webel, Allison .............PT432 Williams, Katie ............PM489 Wong, Tien Yin ...........O124
Webster, Jacqui ............PW256 Williams, Paul .............PM212 Wood, David A. ...........O192
Webster, Mark .............PM150, Williams, Trent ............PM211, Wood, Sally ................PW214
PT148, PW127 PW106, PW368 Woods, John A. ...........O207
Webster, Ruth .............PW203 Willoughby, Scott .........O061 Woods, Robyn .............PT254
Wechkunanukul, Willson, Alexander ........PT180 Worrall-Carter, Linda .....PM138,
Kannikar ..............PM318 Wilson, Andrew ...........PM212, PM139, PM478, PT163
Wechsler, Jax ..............O142, PM306 PT097, PW078 Worth, Heather............PM344
Weeks, P A. ................PM431, Wilson, David .............O106, PM375 Worthington, Michael ....O106
PM432 Wilson, Gabrielle ..........PW283 Worthley, Matthew I......O061, O092,
Weenig, Tyler ..............PT433 Wilson, Jinty ...............PT243 O214, PM328, PW301
Wegrzynowska, Marta ....PW032 Wilson, Lauren ............PT004 Worthley, Stephen G. ....O061, O092,
Weintraub, Robert ........O140, PT096, Wilson, Nigel J. ...........O097, PM189, PM328, PW301
PW341 PW363 Wozniak, Katarzyna ......PM001
Weir, Jacquelyn M. .......PM271 Wilson, Samuel ............PW142 Wright, Jay .................O151
Weiss, Anthony S. ........PM049, Wilson, Sharon ............PM418, Wright, Leah ...............PW326
PM172 PW108 Wright, Myles .............PT097,
Wejner-Mik, Paulina ......PT169 Wilson-O’brien, Amy .....PM212 PW078
Weksler, Clara .............PT113, PT114 Winch, H ...................PM431 Wu, Chaoneng ............O026
Welsh, Melanie ............PW094 Wise, Frances ..............PM481 Wu, Chenbin ..............O085, PT326
Wen, jing ...................PW180 Wise, Steven G. ...........PM049, Wu, Chiung-Jung (Jo) ....PW143
Wen, Song Nan ...........PW010, PM172 Wu, F .......................PM431,
PW011 Witt, Nicholas .............PM396 PM432
Weng San, Leong .........PW148 Wittkopf, Priscilla G. .....PT244 Wu, Joseph ................O022
Wheaton, Gavin ...........O070, Wnuk, Mateusz ...........O217, Wu, Max B. H. ............PW333,
PM466, PT443 PW030, PW031, PW032 PW334
Whelan, Alan ..............PM186, Wojakowski, Wojciech ...PW087 Wu, Shiying ...............O145
PM188, PM189, PM200 Wojciechowska, Celina ...PM001 Wu, Xiao Yan ..............PW010,
Whitbourn, Robert ........PM212 Wojtkowska, Izabela ......PM077, PW011
White, Anthony ...........PM372 PM078 Wu, Xingli .................PT195,
White, Harvey .............O047, O220, Wolf, Mônica ..............PM345, PW128
PM150, PM225, PM461, PW127, PM346, PT016, PW178 Wu, Yangfeng..............O195, O188
PW291 Wolfe, Rory ................O034, Wu, Yutao..................O185
White, Jonathon ...........PT189 PM089, PM410, PT254 Wuerth, Alexander ........O122
White, Kate ................PT327 Wolff Gowdak, Luis Wulf, Natalia...............O068
White, Katherine ..........PW376 Henrique ..............PM320, Würth, Alexander .........O012
White, Lauren .............PT383 PT459 Wyber, Rosemary .........PW359
White, Paul ................PT356 Wolski, Kathy .............O040 Wynn, Gareth J. ...........O151
Whitford, Helen ...........O140 Wondraschek, Rainer .....O012, O122, Xavier, Regina Maria A. ..O046
Whittaker, Samuel ........O032 PT104 Xianghua, Fu ..............PT188
Wibisono, Djoko ..........PM409 Wong, Aaron ..............PM144 Xianhong, Ou .............PW180

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Xie, Gaoqiang ..............O188 Yanti, Noviyanti ...........PW260 Yudi, Matias B. ............O177,

Xie, Yao Jie .................O085 Yap, Jonathan ..............O209, PM074, PM116, PM117,
Xie, Yaojie ..................PT326 PM144, PT210 PM118, PM147, PM197, PM259,
Xu, Chang Fen ............PT015 Yarokhno, Natalia .........O111 PT099, PT108, PT151, PW001,
Xu, Gang ...................PT011 Yaroslavskaya, Elena ......PT194 PW098
Xu, XiangLong .............O085 Yazeed, Yasser .............PW016 Yue-Chun, Li ..............PW061
Xu, Xiao-Fang .............O176, PM105 Ybanez, Erwin Yuen, Gloria ...............PT340,
Xue, Jiahong ...............O091, PW289 Jannino O. ............PM082 PT345
Xue, Jiaohong ..............PW288 Ye, Yong ....................O026 Yuen, Sui Ching G. .......O022,
Xue, Qiao ..................PT195, Yeh, Angela ................PT071 PM373
PW128 Yeh, An-Yun ...............O107 yuregir, ozge ...............PM141
Xue, Yuanyuan ............O186, PT352 Yeo, Khung Keong ........PM144, Yusof, Zurkurnai ..........PM242,
Yaakoub, Melissa C. ......O046 PT210 PW002, PW008, PW137
Yadav, Amit ................O064 Yeo, Poh Shuan Daniel ...O009, PT081 Yusoff, Khalid ..............PM286
Yadgir, Dr.Tanveer ........PW028 Yeo, Tee Joo ...............O009, PT081 Yusufali, AfzalHussein ....PW112
Yagi, Nobuhito ............PM119 Yeoh, Julian ................PM197, Zadura, Mariusz ...........O200
Yahya, Achmad F. ........PT129 PT151 Zafrir, Nili ..................O102
Yahya, Reyhana ............PM317 Yeoh, Thomas .............PT051 Zaher, S.....................PW208
Yamaguchi, Kazuhiro .....PT226 Yesin, Mahmut ............PM110, Zahidova, Kamala .........PW051
Yamaguchi, Tomoyuki ...PM151 PT119, PW090 Zaidi, Amir .................O151
Yamakage, Hajime Yeung, Aaron ..............PM210, Zaimi Petrela, Elizana .....PM298
Yamakage .............PM331 PW152 Zainal Abidin,
Yamano, Takashi ..........PM151 Yew, Kuan Leong .........PM408 Hafisyatul .............PW330,
Yamashina, Akira ..........PM073 Yi Goo, Shi .................PT136, PW331
Yambao Jr., Eduardo O. .PM474 PT137 Zainalabidin, Satirah ......PM332,
Yamen, Eric ................PM195 Yiannikas, John ............PM404 PT367, PW134
Yan, Bryan P. ..............PM016, Yi-He, Chen ................PW061 Zaman, Mohammed
PM197, PT170, PT215, PW098, Yilmaz, Mahmut ...........PM141 Justin ..................O164
PW146, PW240, PW241, PW245 Yin, Peipei ..................O186, PT352 Zaman, Sarah ..............PT030,
Yan, Hui ....................O185 Yip, Thomas ...............O001, PW020
Yan, Lijing L. ..............O195 PM180, PT179, PW245 Zannad, Faiez ..............O116
Yan, Yuan ..................O186, PT352 Yiwei, Baey .................PW237 Zapata-Sudo, Gisele .......PM390,
Yanes-Bowden, Yokoji, Tsunehiko.........PM304 PM391
Geoffrey. ..............PM146 Yong, Andy ................O022, O130 Zappe, Dion H. ............PW185
Yang, Chunjie .............O186, PT352 Yong, Gerald ...............O176, PT103, Zaromitidou, Marina ......O133,
Yang, Guo-Hong ..........PM399 PW084 PM307, PT278, PT288
Yang, Hilda ................PW324 Yoon, Hyun J. .............PM329 Zasytyte, Ieva ..............PM050,
Yang, Hong ................PT382 Yoon, Myeong-Ho ........O130 PM051
Yang, Jean Y. ...............PM381 Yoshii, Toyofumi ..........PW114 Zeitz, Christopher .........O006, O074,
Yang, Jian ..................PM154, Young, Jemima ............PM030 O092, O214, PM175, PM328,
PM393 Young, Morag J. ...........O128 PT130, PT281
Yang, Jun ...................PM154, Young, Simone ............PM277 Zeng, Shan .................PM165,
PM393 Younger, John .............PM054, PM166, PM168, PM399
Yang, Liwei .................O141 PT378, PT379, PW329 Zeng, Xiaorong ............PM028,
Yang, Peter .................O211 Youssef, Ghada ............PM309, PW180
Yang, Qin ..................PT276 PT230 Zentner, Dominica ........PM015
Yang, Wei ..................O210 Youssif, Abdallah ..........PW062 Zera, Eliverta ...............PM298
Yang, Wei-Shiung .........PT343 Yu, Chao ...................PM426 Zgheib, Nathalie ...........PW284
Yang, Wenying ............O125 Yu, Cheuk-Man ...........PT170 Zhang, Dawu ..............PM179,
Yang, Xiaohui ..............PM289 Yu, Haiyun .................O049, PM400 PT192
Yang, Xiulan ...............PW281 Yu, Rong-Hui ..............O096, PW006 Zhang, Guoping ...........O186, PT352
yang, yan ...................PM028, Yuan, Fei ...................PT376 Zhang, Jack ................PW185
PW180 Yuan, Jie ....................O026 Zhang, Jessie ...............PT214
Yanga-Gaddi, Adelaida ...PM474 Yuan, Jun ...................PW296 zhang, lei ...................PM179

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Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number Author . . . . . . . . . . . . . . . . . . . . . . . Abstract Number

Zhang, Li ...................O185, Zhao, Xingshan ............O195 Zint, Kristina ...............O215

PM024, PM025 Zhao, Yong .................O085, Zirlik, Andreas .............PM137
Zhang, Ling ................PT376 PT326 Zisimos, Konstantinos ....O133,
Zhang, Ping ................PM400 Zhao, Yusheng .............PT132, PM307, PT278, PT288
Zhang, Rui .................O090 PT195, PW128 ivkovic, Ivana D. ........PM206
Z
Zhang, Shu .................O049, Zhen, Wang ................PT188 Zo, Joo-Hee ................PM305,
PT265 Zheng, Nan ................O141 PT247
Zhang, Song ...............PW290 Zhou, Julia .................O110 Zong, Wenyi ...............O125
Zhang, Xiaoyi ..............O026 Zhou, Xiaohua .............O141 Zou, Yunzeng ..............O026, O186,
Zhang, Yan .................PW023 Zhou, Xin ..................PM165, PT352
Zhang, Ying-Ying ..........PM165 PM166, PM167, PM168, PM399, Zubin, Ibrahim ............PM422,
Zhang, Yinhui .............PM400 PT376 PT207, PT296, PT297, PW067,
Zhang, Yong ...............O085 Zhu, Haitao ................PW288, PW201
Zhang, Youhua ............PM067 PW289 Zurauskas,
Zhao, Bolun ................O141 Zhu, Tiang Gang ..........PM426 Edvardas ..............PM050,
Zhao, Haiping .............PM368 Zhu, Jianhua ...............O185 PM051
Zhao, Liancheng ...........O188 Zhuravskaya, Natalia Y. ..PM236 Zwar,
Zhao, Qi ....................PT224 Zima, Endre ................O150, O152, Nicholas ...............O105,
Zhao, Qingyan .............O017 PM142, PT060 PT334
Zhao, Qinhua ..............PM124 Zing, Natalia P. C. ........PT196 Zyrianov, Igor .............PM164

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