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Effect of Treatment on Lipid Profile and Body Fat Composition in the Patients of Coronary Artery Diseases (CAD)
S38
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
increased by 9.1% from 8.78 (3.11) mm2 to 9.5 (3.36) mm2 , p = 0.0111. Conclusion: All proximal reference luminal dimensions increased significantly post PCI probably reflecting flowmediated vasodilation. This may have implications when measuring luminal dimensions with angiography or OCT to guide stent sizing and the adequacy of postdilation to avoid malapposition of stents. http://dx.doi.org/10.1016/j.hlc.2012.05.100 91 Effect of Combining Flavonol and Remote Ischaemic Preconditioning on Myocardial Post-ischaemia Reperfusion Salvage C. Thomas 1 , U. Varma 2,∗ , D. Ng 3 , L. Delbridge 4 , C. May 2 1 La
Trobe University, Australia Neuroscience Institutes, Parkville, Australia 3 Department of Biochemistry and Molecular Biology, Bio21 Institute, University of Melbourne, Victoria, Australia 4 Department of Physiology, University of Melbourne, Australia 2 Florey
The present study examined the molecular mechanisms of myocardial protection afforded by remote-ischaemic preconditioning (RIPC) in the hind limb of sheep, and whether the combination of a novel cardioprotectant flavonol NP202 with RIPC produced additional cardioprotection above that afforded by individual treatments alone. Anaesthetised sheep were randomly allocated to four groups: sham conditioning ± NP202 or RIPC ± NP202 (each n = 4). RIPC consisted of 3× 5 min occlusions of the iliac artery. Subsequently, animals underwent coronary artery occlusion for 1 h then, 5 min before reperfusion animals, were treated with vehicle or NP202 (6.6 mg/kg, IV). At the end of 3 h reperfusion size was measured, and noninfarcted area-at-risk (AAR) myocardium (the area that can be rescued by treatment) was collected to assess activation of protein kinases. Separately, RIPC and NP202 significantly reduced infarct size compared to control (by 45 ± 10% and 51 ± 16%, respectively, P < 0.05). No synergistic effect of combined RIPC and NP202 treatment on infarct size reduction was observed (infarct size was reduced by a comparable 42 ± 10%). Myocardial I/R also induced pro-survival (ERK1/2, AKT) and pro-injury (p38, JNK) kinase phosphorylation, however no significant modulatory effect of RIPC and NP202 on kinase phosphorylation could be demonstrated. The present study indicates that RIPC and NP202 are effective individual treatment strategies to reduce myocardial I/R injury. However, combining both therapies did not offer greater cardioprotection than either treatment alone. http://dx.doi.org/10.1016/j.hlc.2012.05.101
92 Effect of Revascularisation Procedure on Cardiac Rehabilitation Outcome H. Jelinek 1,∗ , Z. Huang 2 , D. Chang 3 , H. Kiat 1 1 Macquarie
University, Sydney, Australia Third Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China 3 University of Western Sydney, Sydney, Australia 2 The
Background: Coronary artery disease (CAD) represents the third leading cause of death and disability in developed countries. Currently percutaneous coronary angioplasty (PCA) and coronary artery bypass grafting (CABG) are effective and established treatments for reducing the symptoms and mortality for coronary disease. Cardiac rehabilitation (CR) has as its overall aim to improve in function, relieve symptoms and enhance the patients’ quality of life. The effect of surgery on cardiac rehabilitation has not been investigated using 6-min walk test (6MWT) and heart rate variability (HRV). Methods and results: Thirty-eight patients were included in this study. Patients were divided into two groups: PCI (n = 22) and CABG (n = 16). A 25 min lead II ECG was recorded for each patient before and after a 6-week CR program. Pre and post 6MWT measures were also obtained to determine the impact of CR on exercise capacity. No significant changes in HRV indices following CR were observed in the PCI group. However, a significant increase/improvement was seen for SDNN (37.9 ± 22.7 vs. 55.6 ± 27.3 ms, p = 0.006), LF (348.4 ± 695.7 vs. 1071.8 ± 1241.7 ms2 , p = 0.003) and HF (428.3 ± 1034.0 vs. 944.7 ± 1713.0 ms2 , p = 0.015) in CABG group. Conclusions: Our results suggest that a 6-week CR program increased parasympathetic modulation of cardiac function in subjects who had undergone successful CABG but not in PCI patients. Therefore CR duration and prescribed exercises may need to be re-evaluated and adjusted with respect to the type of revascularisation procedure to maximise the cardiac benefit in patients attending CR. http://dx.doi.org/10.1016/j.hlc.2012.05.102 93 Effect of Treatment on Lipid Profile and Body Fat Composition in the Patients of Coronary Artery Diseases (CAD) A. Puri, V. Singh, S. Pandey ∗ , R. Srivastav CSM Medical University, India Introduction: CAD patients are aggressively treated for lipid lowering. However, CAD risk people remain untreated. We aim to compare lipids and body fat composition of these two groups and study the effect of lipid lowering treatment. Methods: 477 subjects divided in three groups: documented CAD (n = 153), CAD risk (n = 174) and control (n = 150). CAD patients: documented CAD with prior high dose lipid lowering treatment for minimum six weeks. CAD risk: those with metabolic syndrome (based on
CSANZ 2012 Abstracts
NCEP-ATPIII) or with Framingham 10 year risk > 10%. We measured body fat percentage (BF%), visceral fat rating (VFR) by bioelectrical impedance using InnerScanV (TANITA Inc, Tokyo) & lipid profile; trigylcerides (TG), total cholesterol (TC), low and high density lipoprotein (LDL, HDL). Groups were compared by one way ANOVA and Tukey’s test. Results: TG, TC, and LDL were raised and HDL reduced in risk group while lipid profile was similar in CAD patients and control apart from HDL which was lower in CAD patients. BF% was higher in risk group and not different between CAD patients and control. VFR of CAD patients was higher from risk and control. Variables
Control (n = 153)
TG (mg/dl) TC (mg/dl) HDL (mg/dl) LDL (mg/dl) BF% VFR
136.76 158.21 39.48 91.38 23.92 7.77
± ± ± ± ± ±
5.37 3.42 0.97 3.08 0.75 0.26
CAD Risk (n = 174) 204.09 194.19 31.28 122.58 30.72 10.03
± ± ± ± ± ±
a
p < 0.05 as compared to control group.
b
p < 0.05 as compared to risk group.
6.63a 3.84a 0.87a 3.78a 0.64a 0.23a
CAD Patients (n = 150) 140.63 160.83 35.65 97.06 25.44 11.30
± ± ± ± ± ±
4.65b 3.22b 0.64a , b 2.83b 0.76b 0.38a , b
Conclusion: As a result of aggressive lipid lowering treatment, TG, TC, LDL and BF% were significantly lower in CAD patients; similar to control. Minimal effect of treatment was seen on HDL and VFR. There is need of more aggressive treatment in CAD risk population. http://dx.doi.org/10.1016/j.hlc.2012.05.103 94 Examining Efficacy of Nanoparticles as a Mode of Delivery of a Peptide Derived Against the Alpha-interacting Domain of the L-Type Ca2+ Channel in Ischaemiareperfusion Injury in Guinea-pig Heart L. Hool ∗ , H. Viola, T. Clemons, K. Swaminatha-Iyer The University of Western Australia, Australia Increased calcium influx through the L-type Ca2+ channel or over-expression of the alpha subunit of the channel induces cardiac hypertrophy. Decreasing the movement of the auxiliary beta subunit with a peptide derived against the alpha-interacting domain (AID) of the channel, attenuates ischaemia-reperfusion injury without altering intracellular calcium or contractility. We compared the efficacy of delivering the AID peptide through the inclusion of a TAT sequence with nanosphere-assisted delivery of the peptide. Guinea-pigs of either sex were anaesthetised with pentobarbitone sodium (160 mg/kg) by intraperitoneal injection. Hearts were perfused retrogradely on a Langendorff apparatus with Ca2+ -containing Krebs (30 min), followed by no-flow ischaemia (30 min), then reperfusion for 30 min in the presence of 1 M AID-TAT peptide or polymer-based nanospheres and 1 M AID peptide (minus TAT). Damage was assessed as release of creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate. We have found that 1 M AID-tethered nanospheres (AID-NP) were more effective than 1 M AID-TAT at decreasing muscle damage assessed as release of CK (11.3 ± 2.6 U/I AID-NP, n = 5 vs
S39
21.2 ± 4.5 U/I AID-TAT, n = 8). LDH release after administration of AID-tethered nanospheres (4.1 ± 2.2 U/I, n = 4) and AID-TAT peptide was similar and significantly less than in hearts administered AID(S)-TAT (n = 8). In addition, the nanospheres were more efficiently taken up into the myocytes with maximal uptake occurring at 15 min (n = 19) vs 35 min for AID-TAT (n = 14). These data suggest that delivery of the peptide with nanospheres may be more effective at reducing ischaemia-reperfusion injury than AID-TAT. http://dx.doi.org/10.1016/j.hlc.2012.05.104 95 Factors that Impact Left Ventricular Systolic Function After Acute Coronary Syndromes A. Incani 1,∗ , K. Poon 1 , M. Savage 1 , M. Dahl 1 , J. Fu 1 , H. Muller 2 , D. Colburn 2 , K. Renkin 2 , D. Callow 1 , C. Hammett 2 , D. Walters 1 1 The 2 The
Prince Charles Hospital, Australia Royal Brisbane and Women’s Hospital, Australia
Background: Left ventricular ejection fraction (LVEF) is an important predictor of prognosis after an acute coronary syndrome (ACS). We sought to analyse the clinical factors that may predict reduced LVEF post ACS. Methods: Patient data was retrieved between 20/12/2006 and 21/8/2011 from a novel web-based ACS referral service operating in Queensland that links two metropolitan with 10 non-metropolitan hospitals. Only patients with documented LV systolic function were included. Normal LVEF was defined as ≥55% and abnormal LVEF <55%. Data on age, gender, body mass index (BMI), type of ACS presentation [ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation (NSTEMI) or unstable angina (UA)] and traditional cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, smoking history, past history and family history) were collected and analysed for correlation with normal LVEF (NLVEF) or abnormal LVEF. Results: 879 patients were included. Average age was 62.9 ± 12.4 years with 571 (65%) being male. Mean BMI was 28.7 ± 0.2 kg/m2 . Univariate analysis demonstrated that the proportion of patients with abnormal LVEF increased with age, especially those > 60 years (p < 0.05). Abnormal LVEF was also demonstrated to be more likely with increasing severity of ACS presentation [(STEMI > NSTEM > UA, p < 0.05)]. Multivariate analysis failed to demonstrate any correlation between abnormal LVEF and gender, BMI, hypertension, diabetes, dyslipidaemia, smoking, past history or family history of cardiovascular disease (all p > 0.05). Conclusion: Increasing age, particularly > 60 years, and type of ACS presentation (particularly STEMI) were the most important factors that predicted reduced LVEF post ACS. http://dx.doi.org/10.1016/j.hlc.2012.05.105
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
increased by 9.1% from 8.78 (3.11) mm2 to 9.5 (3.36) mm2 , p = 0.0111. Conclusion: All proximal reference luminal dimensions increased significantly post PCI probably reflecting flowmediated vasodilation. This may have implications when measuring luminal dimensions with angiography or OCT to guide stent sizing and the adequacy of postdilation to avoid malapposition of stents. http://dx.doi.org/10.1016/j.hlc.2012.05.100 91 Effect of Combining Flavonol and Remote Ischaemic Preconditioning on Myocardial Post-ischaemia Reperfusion Salvage C. Thomas 1 , U. Varma 2,∗ , D. Ng 3 , L. Delbridge 4 , C. May 2 1 La
Trobe University, Australia Neuroscience Institutes, Parkville, Australia 3 Department of Biochemistry and Molecular Biology, Bio21 Institute, University of Melbourne, Victoria, Australia 4 Department of Physiology, University of Melbourne, Australia 2 Florey
The present study examined the molecular mechanisms of myocardial protection afforded by remote-ischaemic preconditioning (RIPC) in the hind limb of sheep, and whether the combination of a novel cardioprotectant flavonol NP202 with RIPC produced additional cardioprotection above that afforded by individual treatments alone. Anaesthetised sheep were randomly allocated to four groups: sham conditioning ± NP202 or RIPC ± NP202 (each n = 4). RIPC consisted of 3× 5 min occlusions of the iliac artery. Subsequently, animals underwent coronary artery occlusion for 1 h then, 5 min before reperfusion animals, were treated with vehicle or NP202 (6.6 mg/kg, IV). At the end of 3 h reperfusion size was measured, and noninfarcted area-at-risk (AAR) myocardium (the area that can be rescued by treatment) was collected to assess activation of protein kinases. Separately, RIPC and NP202 significantly reduced infarct size compared to control (by 45 ± 10% and 51 ± 16%, respectively, P < 0.05). No synergistic effect of combined RIPC and NP202 treatment on infarct size reduction was observed (infarct size was reduced by a comparable 42 ± 10%). Myocardial I/R also induced pro-survival (ERK1/2, AKT) and pro-injury (p38, JNK) kinase phosphorylation, however no significant modulatory effect of RIPC and NP202 on kinase phosphorylation could be demonstrated. The present study indicates that RIPC and NP202 are effective individual treatment strategies to reduce myocardial I/R injury. However, combining both therapies did not offer greater cardioprotection than either treatment alone. http://dx.doi.org/10.1016/j.hlc.2012.05.101
92 Effect of Revascularisation Procedure on Cardiac Rehabilitation Outcome H. Jelinek 1,∗ , Z. Huang 2 , D. Chang 3 , H. Kiat 1 1 Macquarie
University, Sydney, Australia Third Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China 3 University of Western Sydney, Sydney, Australia 2 The
Background: Coronary artery disease (CAD) represents the third leading cause of death and disability in developed countries. Currently percutaneous coronary angioplasty (PCA) and coronary artery bypass grafting (CABG) are effective and established treatments for reducing the symptoms and mortality for coronary disease. Cardiac rehabilitation (CR) has as its overall aim to improve in function, relieve symptoms and enhance the patients’ quality of life. The effect of surgery on cardiac rehabilitation has not been investigated using 6-min walk test (6MWT) and heart rate variability (HRV). Methods and results: Thirty-eight patients were included in this study. Patients were divided into two groups: PCI (n = 22) and CABG (n = 16). A 25 min lead II ECG was recorded for each patient before and after a 6-week CR program. Pre and post 6MWT measures were also obtained to determine the impact of CR on exercise capacity. No significant changes in HRV indices following CR were observed in the PCI group. However, a significant increase/improvement was seen for SDNN (37.9 ± 22.7 vs. 55.6 ± 27.3 ms, p = 0.006), LF (348.4 ± 695.7 vs. 1071.8 ± 1241.7 ms2 , p = 0.003) and HF (428.3 ± 1034.0 vs. 944.7 ± 1713.0 ms2 , p = 0.015) in CABG group. Conclusions: Our results suggest that a 6-week CR program increased parasympathetic modulation of cardiac function in subjects who had undergone successful CABG but not in PCI patients. Therefore CR duration and prescribed exercises may need to be re-evaluated and adjusted with respect to the type of revascularisation procedure to maximise the cardiac benefit in patients attending CR. http://dx.doi.org/10.1016/j.hlc.2012.05.102 93 Effect of Treatment on Lipid Profile and Body Fat Composition in the Patients of Coronary Artery Diseases (CAD) A. Puri, V. Singh, S. Pandey ∗ , R. Srivastav CSM Medical University, India Introduction: CAD patients are aggressively treated for lipid lowering. However, CAD risk people remain untreated. We aim to compare lipids and body fat composition of these two groups and study the effect of lipid lowering treatment. Methods: 477 subjects divided in three groups: documented CAD (n = 153), CAD risk (n = 174) and control (n = 150). CAD patients: documented CAD with prior high dose lipid lowering treatment for minimum six weeks. CAD risk: those with metabolic syndrome (based on
CSANZ 2012 Abstracts
NCEP-ATPIII) or with Framingham 10 year risk > 10%. We measured body fat percentage (BF%), visceral fat rating (VFR) by bioelectrical impedance using InnerScanV (TANITA Inc, Tokyo) & lipid profile; trigylcerides (TG), total cholesterol (TC), low and high density lipoprotein (LDL, HDL). Groups were compared by one way ANOVA and Tukey’s test. Results: TG, TC, and LDL were raised and HDL reduced in risk group while lipid profile was similar in CAD patients and control apart from HDL which was lower in CAD patients. BF% was higher in risk group and not different between CAD patients and control. VFR of CAD patients was higher from risk and control. Variables
Control (n = 153)
TG (mg/dl) TC (mg/dl) HDL (mg/dl) LDL (mg/dl) BF% VFR
136.76 158.21 39.48 91.38 23.92 7.77
± ± ± ± ± ±
5.37 3.42 0.97 3.08 0.75 0.26
CAD Risk (n = 174) 204.09 194.19 31.28 122.58 30.72 10.03
± ± ± ± ± ±
a
p < 0.05 as compared to control group.
b
p < 0.05 as compared to risk group.
6.63a 3.84a 0.87a 3.78a 0.64a 0.23a
CAD Patients (n = 150) 140.63 160.83 35.65 97.06 25.44 11.30
± ± ± ± ± ±
4.65b 3.22b 0.64a , b 2.83b 0.76b 0.38a , b
Conclusion: As a result of aggressive lipid lowering treatment, TG, TC, LDL and BF% were significantly lower in CAD patients; similar to control. Minimal effect of treatment was seen on HDL and VFR. There is need of more aggressive treatment in CAD risk population. http://dx.doi.org/10.1016/j.hlc.2012.05.103 94 Examining Efficacy of Nanoparticles as a Mode of Delivery of a Peptide Derived Against the Alpha-interacting Domain of the L-Type Ca2+ Channel in Ischaemiareperfusion Injury in Guinea-pig Heart L. Hool ∗ , H. Viola, T. Clemons, K. Swaminatha-Iyer The University of Western Australia, Australia Increased calcium influx through the L-type Ca2+ channel or over-expression of the alpha subunit of the channel induces cardiac hypertrophy. Decreasing the movement of the auxiliary beta subunit with a peptide derived against the alpha-interacting domain (AID) of the channel, attenuates ischaemia-reperfusion injury without altering intracellular calcium or contractility. We compared the efficacy of delivering the AID peptide through the inclusion of a TAT sequence with nanosphere-assisted delivery of the peptide. Guinea-pigs of either sex were anaesthetised with pentobarbitone sodium (160 mg/kg) by intraperitoneal injection. Hearts were perfused retrogradely on a Langendorff apparatus with Ca2+ -containing Krebs (30 min), followed by no-flow ischaemia (30 min), then reperfusion for 30 min in the presence of 1 M AID-TAT peptide or polymer-based nanospheres and 1 M AID peptide (minus TAT). Damage was assessed as release of creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate. We have found that 1 M AID-tethered nanospheres (AID-NP) were more effective than 1 M AID-TAT at decreasing muscle damage assessed as release of CK (11.3 ± 2.6 U/I AID-NP, n = 5 vs
S39
21.2 ± 4.5 U/I AID-TAT, n = 8). LDH release after administration of AID-tethered nanospheres (4.1 ± 2.2 U/I, n = 4) and AID-TAT peptide was similar and significantly less than in hearts administered AID(S)-TAT (n = 8). In addition, the nanospheres were more efficiently taken up into the myocytes with maximal uptake occurring at 15 min (n = 19) vs 35 min for AID-TAT (n = 14). These data suggest that delivery of the peptide with nanospheres may be more effective at reducing ischaemia-reperfusion injury than AID-TAT. http://dx.doi.org/10.1016/j.hlc.2012.05.104 95 Factors that Impact Left Ventricular Systolic Function After Acute Coronary Syndromes A. Incani 1,∗ , K. Poon 1 , M. Savage 1 , M. Dahl 1 , J. Fu 1 , H. Muller 2 , D. Colburn 2 , K. Renkin 2 , D. Callow 1 , C. Hammett 2 , D. Walters 1 1 The 2 The
Prince Charles Hospital, Australia Royal Brisbane and Women’s Hospital, Australia
Background: Left ventricular ejection fraction (LVEF) is an important predictor of prognosis after an acute coronary syndrome (ACS). We sought to analyse the clinical factors that may predict reduced LVEF post ACS. Methods: Patient data was retrieved between 20/12/2006 and 21/8/2011 from a novel web-based ACS referral service operating in Queensland that links two metropolitan with 10 non-metropolitan hospitals. Only patients with documented LV systolic function were included. Normal LVEF was defined as ≥55% and abnormal LVEF <55%. Data on age, gender, body mass index (BMI), type of ACS presentation [ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation (NSTEMI) or unstable angina (UA)] and traditional cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, smoking history, past history and family history) were collected and analysed for correlation with normal LVEF (NLVEF) or abnormal LVEF. Results: 879 patients were included. Average age was 62.9 ± 12.4 years with 571 (65%) being male. Mean BMI was 28.7 ± 0.2 kg/m2 . Univariate analysis demonstrated that the proportion of patients with abnormal LVEF increased with age, especially those > 60 years (p < 0.05). Abnormal LVEF was also demonstrated to be more likely with increasing severity of ACS presentation [(STEMI > NSTEM > UA, p < 0.05)]. Multivariate analysis failed to demonstrate any correlation between abnormal LVEF and gender, BMI, hypertension, diabetes, dyslipidaemia, smoking, past history or family history of cardiovascular disease (all p > 0.05). Conclusion: Increasing age, particularly > 60 years, and type of ACS presentation (particularly STEMI) were the most important factors that predicted reduced LVEF post ACS. http://dx.doi.org/10.1016/j.hlc.2012.05.105
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142