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ACUTE EFFECTS OF GANGLIONIC ELECTRICAL STIMULATION ON FLOW-MEDIATED VASODILATION IN HEALTHY MEN
Abstracts
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p¼0.79) and patients separated/divorced/widowed (14.0%; adjusted OR 0.75, [95% CI, 0.45-1.27]; p¼0.28). Similarly, the risk of individual endpoints, including mortality, was similar across the three groups. CONCLUSION: Among MI survivors following in-hospital PCI, we found no association between marital status and living arrangement with 15-month outcomes. Table 2: Rates of Cardiovascular Outcomes of Patients during 15 Month Follow-up Period by Marital Status and Living Arrangement Outcome
Event Rate
OR (95% CI)
(1) Married/Common Law and Living Together (n=1519)
(3) Adjusted (2) Separated, OR Never divorced/ P (2) vs. Married widowed (1) (n=223) (n=358)
Death
32 (2.1%)
6 (2.7%) 14 (3.9%)
1.09 (0.303.91)
0.64 0.90 (0.241.68)
0.36
MACE (4 events)
194 (12.8%)
1.09 30 50 (14.0%) (0.59(13.5%) 2.00)
0.75 0.79 (0.451.27)
0.28
MACE (7 events)
250 (16.5%)
1.31 44 63 (17.6%) (0.79(19.7%) 2.16)
0.77 0.29 (0.501.23)
0.29
MI
126 (8.3%)
20 (9.0%)
1.51 (0.683.38)
1.02 0.31 (0.492.16)
0.95
Stroke
12 (0.8%)
4 (1.8%) 2 (0.6%)
4.06 (0.9118.14)
0.60 0.07 (0.103.49)
0.57
UCR
117 (7.7%)
15 (6.7%)
27 (7.5%)
0.67 (0.271.64)
0.69 0.38 (0.351.38)
0.29
HF/Shock
79 (5.2%)
18 (8.1%)
22 (6.1%)
1.90 (0.943.86)
0.89 0.08 (0.451.73)
0.72
31 (8.7%)
Adjusted OR P (3) vs. (1)
Stent 30 (2.0%) Thrombosis
3 (1.3%) 3 (0.8%)
0.37 (0.052.94)
0.52 0.34 (0.141.95)
0.33
Major Bleeding
3 (1.3%) 4 (1.1%)
2.11 (0.558.10)
1.54 0.28 (0.445.40)
0.50
15 (1.0%)
Note: MACE 4 – Major adverse Cardiovascular Events which included death, MI, UCR and stroke; other 2 events (MACE 7) included HF/shock, and stent thrombosis, HF – heart failure, MI – myocardial infarction, UCR - urgent coronary revascularization
Women’s College Research Institute
270 CHARACTERIZING VASCULAR HEALTH IN FEMALE NURSES IN THE CHAMPLAIN REGION OF ONTARIO L Cotie, T Coutinho, S Prince, A Pipe, R Reid, J Reed Ottawa, Ontario BACKGROUND:
The number one killer of females over the age of 35 is cardiovascular disease (CVD). Nurses are a predominately female population, with many self-reporting as diabetic, dyslipidemic, hypertensive and overweight/obese; all known risk factors for CVD. Arterial stiffness, specifically aortic pulse wave velocity (aPWV), is an independent predictor of future CVD events. No studies to date have thoroughly characterized the vascular health of female nurses. Therefore, the purpose of the study was to measure and describe the vascular health of female nurses from 11 rural and urban hospitals in the Champlain region of Ontario.
METHODS:
Questionnaires were administered to determine chronic disease status and the participants wore an ActiGraph accelerometer (Pensacola, Florida) to objectively measure their physical activity levels. Their body mass index (BMI) was calculated and waist circumference (WC) was measured. Vascular health was measured using aPWV (Mobil-O-Graph, Stolberg, Germany) and compared to published normative values for aPWV according to age. RESULTS: One hundred and sixty females (meanSD ¼ age: 43.712.4 years; BMI: 27.45.4kg/m2; WC: 80.811.7cm) were included in this study. Two percent of the nurses reported taking medications for diabetes, 3% for dyslipidemia and 8% for hypertension. Nine percent were smokers, 54% were overweight/obese and 74% were not meeting the current Canadian Physical Activity Guidelines (CPAG) (150 minutes of moderate-to-vigorous intensity physical activity/week in bouts 10 minutes). Six percent (n¼10) of the nurses presented with poor vascular health (30-39 years: normative value ¼ 6.5m/s, 2 nurses above 6.5m/s; 40-49 years: normative value ¼ 7.2m/s, 5 nurses above 7.2m/s; and, 50-59 years: normative value ¼ 8.3m/s, 3 nurses above 8.3m/s). Among the nurses with poor vascular health, 10% reported taking medications for dyslipidemia and 40% for hypertension. Ten percent were smokers and 88% were not meeting the current CPAG. They also had significantly higher BMI (32.75.9 kg/m2 vs. 27.05.29 kg/m2, p¼0.013) and waist circumference (95.011.4 cm vs. 79.911.2 cm, p¼0.002) when compared with those who presented with normal vascular health. CONCLUSION: Despite reporting taking medications for chronic conditions known to be risk factors for CVD, smoking and failing to meet CPAG, few (6%) female nurses in the Champlain region of Ontario appear to present with poor vascular health. These women did, however, have greater BMI and waist circumference than those with normal vascular health. This study provides valuable data regarding the vascular health of female nurses and may inform future interventions targeting CVD risk in this population. Ottawa Region for Advanced Cardiovascular Research Excellence Innovation Cluster Pilot Project Fund 271 ACUTE EFFECTS OF GANGLIONIC ELECTRICAL STIMULATION ON FLOW-MEDIATED VASODILATION IN HEALTHY MEN CH Nakata, FA Teixeira, SH Ramalho, AG de Lima, G Cipriano, Jr. Brasília, Brazil BACKGROUND:
The endothelium is the key regulator of vascular homeostasis and its function is linked to cardiovascular risk factors and has been provide prognostic information. Vascular tone is determined by many different vasoconstrictor and vasodilator influences, considering intrinsic (myogenic mechanisms, endothelial factors, local hormones/chemical and metabolic products) and extrinsic factors (neurohumoral and
S222
circulating factors). The tone response can be evaluated noninvasively by measurement of high-frequency ultrasonographic imaging of the brachial artery to assess endothelium-dependent flow-mediated vasodilation (FMD). Several studies have shown that the transcutaneous electrical stimulation (TENS) can promote effects in cardiovascular system and when applied on the ganglionic chain it represents a possible therapeutic intervention. PURPOSE: To analyse acute effects of TENS on the vascular function by the evaluation of FMD. We hypothesize that electrical stimulation over the ganglionic region may increase peripheral vasodilation. DESIGN: Crossover randomized experimental study. METHODS: Ten healthy men (482.29years; Weight: 86.449.6kg; Height: 176.758.38cm; VO2: 24.837.91ml.O2.Kg; VE/VO2Slope: 24.872.62; OUES 2462609) received, in supine position, an application of TENS (100Hz) and Sham in cervico-thoracic region (C7, T4) during 30 minutes. Before and after these intervention, they had their forearm occluded for 5 minutes, and FMD was evaluated for 5 minutes after cuff released. Sample size of 10 individuals have a power of 85% to detect a 20% difference between means of FMD with a ¼ 0.05. Normality data were verified by the Shapiro-Wilk test. Descriptive data are presented as mean SD. The effects of the intervention were compared using General Linear Model, and post-hoc analysis was Tukey test or Bonferroni’s test. p <0.05. RESULTS: The ultrasonographic imaging showed that application of Ganglionic TENS (100Hz) increased FMD to 10.74 2.52% (basal dilation ¼ 4.94 0.33mm, maximal dilation ¼ 5.54 0.46mm, difference ¼ 0.602 0.17) from 6.32 2.39% (basal dilation ¼ 4.87 0.41mm, maximal dilation ¼ 5.2 0.42mm, difference ¼ 0.33 0.12). The Sham did not promote a significance variation on FMD (6,32 2.56% to 6.48 2.68%). CONCLUSION: After 30 minutes of TENS application, FMD of brachial artery demonstrated that ganglionic electrical stimulation is capable to improve peripheral vascular endothelial function by increasing by almost 70% to peripheral vasodilatation in healthy men.
Canadian Journal of Cardiology Volume 32 2016
272 IMPACT OF BARIATRIC SURGERY ON PLASMA LDL CHOLESTEROL AND PCSK9 LEVELS IN PATIENTS WITH SEVERE OBESITY M Boyer, A Auclair, P Mathieu, P Poirier, M Piché, B Arsenault Québec, Québec BACKGROUND:
Patients with severe obesity are at high risk of developing cardiovascular disease (CVD). Currently, bariatric surgery represents the best long term treatment for these patients in order to improve their cardiometabolic risk profile. Moreover, genetic studies have highlighted the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) in the regulation of LDL cholesterol concentrations and CVD risk. The effects of bariatric surgery on plasma PCSK9 levels, if any, are still unknown. To determine the short term (24-hr, 5 days) and long term (6 and 12 months) impact of bariatric surgery on plasma LDL cholesterol and PCSK9 levels in patients with severe obesity. METHODS: Plasma PCSK9 levels were measured in 72 men (n¼23) and women (n¼59) (aged >18 years) before and after undergoing biliopancreatic diversion with duodenal switch (BPD-DS). A fasting lipoprotein-lipid profile was obtained and PCSK9 levels were measured by ELISA, before surgery and at 24h, 5 days, 6 months, and 12 months after surgery. PCSK9 levels were also measured in a control group of severely obese people (n¼34) at baseline and at 6 and 12 months. RESULTS: PCSK9 were increased by 8.6% after 24h (249.366.3 ng/ml to 270.665.8 ng/ml, p¼0.02) and decreased by 12.7% at 12 months compared to baseline (217.643.0 ng/mL, p<0.0001). LDL cholesterol levels decreased by 36.8% after 24h (2.60.7 mmol/L to. 1.70.6 mmol/L, p<0.0001) and by 36% at 12 months compared to baseline (1.60.5 mmol/L, p<0.0001). Plasma PCSK9 and LDL cholesterol levels did not change in the control group during follow-up. CONCLUSION: Our resutls suggest that bariatric surgery might improve LDL cholesterol and PCSK9 levels in the long term in severely obese patients. The effects of bariatric surgery on PCSK9 levels are different in the acute vs. long-term followup after surgery. The mechanisms explaining the variations in PCSK9 levels following bariatric surgery are currently under investigation. 273 BETA-BLOCKER TYPE EFFECT ON SUBSTRATE OXIDATION DURING DIFFERENT HIGHINTENSITY INTERMITTENT EXERCISES IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION: PILOT DATA PA Ribeiro, E Normandin, P Meyer, M Juneau, A Nigam, M Gayda Montréal, Québec BACKGROUND:
Beta-blockers agents are highly used in heart failure patients and they showed to improve quality of live and
S221
p¼0.79) and patients separated/divorced/widowed (14.0%; adjusted OR 0.75, [95% CI, 0.45-1.27]; p¼0.28). Similarly, the risk of individual endpoints, including mortality, was similar across the three groups. CONCLUSION: Among MI survivors following in-hospital PCI, we found no association between marital status and living arrangement with 15-month outcomes. Table 2: Rates of Cardiovascular Outcomes of Patients during 15 Month Follow-up Period by Marital Status and Living Arrangement Outcome
Event Rate
OR (95% CI)
(1) Married/Common Law and Living Together (n=1519)
(3) Adjusted (2) Separated, OR Never divorced/ P (2) vs. Married widowed (1) (n=223) (n=358)
Death
32 (2.1%)
6 (2.7%) 14 (3.9%)
1.09 (0.303.91)
0.64 0.90 (0.241.68)
0.36
MACE (4 events)
194 (12.8%)
1.09 30 50 (14.0%) (0.59(13.5%) 2.00)
0.75 0.79 (0.451.27)
0.28
MACE (7 events)
250 (16.5%)
1.31 44 63 (17.6%) (0.79(19.7%) 2.16)
0.77 0.29 (0.501.23)
0.29
MI
126 (8.3%)
20 (9.0%)
1.51 (0.683.38)
1.02 0.31 (0.492.16)
0.95
Stroke
12 (0.8%)
4 (1.8%) 2 (0.6%)
4.06 (0.9118.14)
0.60 0.07 (0.103.49)
0.57
UCR
117 (7.7%)
15 (6.7%)
27 (7.5%)
0.67 (0.271.64)
0.69 0.38 (0.351.38)
0.29
HF/Shock
79 (5.2%)
18 (8.1%)
22 (6.1%)
1.90 (0.943.86)
0.89 0.08 (0.451.73)
0.72
31 (8.7%)
Adjusted OR P (3) vs. (1)
Stent 30 (2.0%) Thrombosis
3 (1.3%) 3 (0.8%)
0.37 (0.052.94)
0.52 0.34 (0.141.95)
0.33
Major Bleeding
3 (1.3%) 4 (1.1%)
2.11 (0.558.10)
1.54 0.28 (0.445.40)
0.50
15 (1.0%)
Note: MACE 4 – Major adverse Cardiovascular Events which included death, MI, UCR and stroke; other 2 events (MACE 7) included HF/shock, and stent thrombosis, HF – heart failure, MI – myocardial infarction, UCR - urgent coronary revascularization
Women’s College Research Institute
270 CHARACTERIZING VASCULAR HEALTH IN FEMALE NURSES IN THE CHAMPLAIN REGION OF ONTARIO L Cotie, T Coutinho, S Prince, A Pipe, R Reid, J Reed Ottawa, Ontario BACKGROUND:
The number one killer of females over the age of 35 is cardiovascular disease (CVD). Nurses are a predominately female population, with many self-reporting as diabetic, dyslipidemic, hypertensive and overweight/obese; all known risk factors for CVD. Arterial stiffness, specifically aortic pulse wave velocity (aPWV), is an independent predictor of future CVD events. No studies to date have thoroughly characterized the vascular health of female nurses. Therefore, the purpose of the study was to measure and describe the vascular health of female nurses from 11 rural and urban hospitals in the Champlain region of Ontario.
METHODS:
Questionnaires were administered to determine chronic disease status and the participants wore an ActiGraph accelerometer (Pensacola, Florida) to objectively measure their physical activity levels. Their body mass index (BMI) was calculated and waist circumference (WC) was measured. Vascular health was measured using aPWV (Mobil-O-Graph, Stolberg, Germany) and compared to published normative values for aPWV according to age. RESULTS: One hundred and sixty females (meanSD ¼ age: 43.712.4 years; BMI: 27.45.4kg/m2; WC: 80.811.7cm) were included in this study. Two percent of the nurses reported taking medications for diabetes, 3% for dyslipidemia and 8% for hypertension. Nine percent were smokers, 54% were overweight/obese and 74% were not meeting the current Canadian Physical Activity Guidelines (CPAG) (150 minutes of moderate-to-vigorous intensity physical activity/week in bouts 10 minutes). Six percent (n¼10) of the nurses presented with poor vascular health (30-39 years: normative value ¼ 6.5m/s, 2 nurses above 6.5m/s; 40-49 years: normative value ¼ 7.2m/s, 5 nurses above 7.2m/s; and, 50-59 years: normative value ¼ 8.3m/s, 3 nurses above 8.3m/s). Among the nurses with poor vascular health, 10% reported taking medications for dyslipidemia and 40% for hypertension. Ten percent were smokers and 88% were not meeting the current CPAG. They also had significantly higher BMI (32.75.9 kg/m2 vs. 27.05.29 kg/m2, p¼0.013) and waist circumference (95.011.4 cm vs. 79.911.2 cm, p¼0.002) when compared with those who presented with normal vascular health. CONCLUSION: Despite reporting taking medications for chronic conditions known to be risk factors for CVD, smoking and failing to meet CPAG, few (6%) female nurses in the Champlain region of Ontario appear to present with poor vascular health. These women did, however, have greater BMI and waist circumference than those with normal vascular health. This study provides valuable data regarding the vascular health of female nurses and may inform future interventions targeting CVD risk in this population. Ottawa Region for Advanced Cardiovascular Research Excellence Innovation Cluster Pilot Project Fund 271 ACUTE EFFECTS OF GANGLIONIC ELECTRICAL STIMULATION ON FLOW-MEDIATED VASODILATION IN HEALTHY MEN CH Nakata, FA Teixeira, SH Ramalho, AG de Lima, G Cipriano, Jr. Brasília, Brazil BACKGROUND:
The endothelium is the key regulator of vascular homeostasis and its function is linked to cardiovascular risk factors and has been provide prognostic information. Vascular tone is determined by many different vasoconstrictor and vasodilator influences, considering intrinsic (myogenic mechanisms, endothelial factors, local hormones/chemical and metabolic products) and extrinsic factors (neurohumoral and
S222
circulating factors). The tone response can be evaluated noninvasively by measurement of high-frequency ultrasonographic imaging of the brachial artery to assess endothelium-dependent flow-mediated vasodilation (FMD). Several studies have shown that the transcutaneous electrical stimulation (TENS) can promote effects in cardiovascular system and when applied on the ganglionic chain it represents a possible therapeutic intervention. PURPOSE: To analyse acute effects of TENS on the vascular function by the evaluation of FMD. We hypothesize that electrical stimulation over the ganglionic region may increase peripheral vasodilation. DESIGN: Crossover randomized experimental study. METHODS: Ten healthy men (482.29years; Weight: 86.449.6kg; Height: 176.758.38cm; VO2: 24.837.91ml.O2.Kg; VE/VO2Slope: 24.872.62; OUES 2462609) received, in supine position, an application of TENS (100Hz) and Sham in cervico-thoracic region (C7, T4) during 30 minutes. Before and after these intervention, they had their forearm occluded for 5 minutes, and FMD was evaluated for 5 minutes after cuff released. Sample size of 10 individuals have a power of 85% to detect a 20% difference between means of FMD with a ¼ 0.05. Normality data were verified by the Shapiro-Wilk test. Descriptive data are presented as mean SD. The effects of the intervention were compared using General Linear Model, and post-hoc analysis was Tukey test or Bonferroni’s test. p <0.05. RESULTS: The ultrasonographic imaging showed that application of Ganglionic TENS (100Hz) increased FMD to 10.74 2.52% (basal dilation ¼ 4.94 0.33mm, maximal dilation ¼ 5.54 0.46mm, difference ¼ 0.602 0.17) from 6.32 2.39% (basal dilation ¼ 4.87 0.41mm, maximal dilation ¼ 5.2 0.42mm, difference ¼ 0.33 0.12). The Sham did not promote a significance variation on FMD (6,32 2.56% to 6.48 2.68%). CONCLUSION: After 30 minutes of TENS application, FMD of brachial artery demonstrated that ganglionic electrical stimulation is capable to improve peripheral vascular endothelial function by increasing by almost 70% to peripheral vasodilatation in healthy men.
Canadian Journal of Cardiology Volume 32 2016
272 IMPACT OF BARIATRIC SURGERY ON PLASMA LDL CHOLESTEROL AND PCSK9 LEVELS IN PATIENTS WITH SEVERE OBESITY M Boyer, A Auclair, P Mathieu, P Poirier, M Piché, B Arsenault Québec, Québec BACKGROUND:
Patients with severe obesity are at high risk of developing cardiovascular disease (CVD). Currently, bariatric surgery represents the best long term treatment for these patients in order to improve their cardiometabolic risk profile. Moreover, genetic studies have highlighted the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) in the regulation of LDL cholesterol concentrations and CVD risk. The effects of bariatric surgery on plasma PCSK9 levels, if any, are still unknown. To determine the short term (24-hr, 5 days) and long term (6 and 12 months) impact of bariatric surgery on plasma LDL cholesterol and PCSK9 levels in patients with severe obesity. METHODS: Plasma PCSK9 levels were measured in 72 men (n¼23) and women (n¼59) (aged >18 years) before and after undergoing biliopancreatic diversion with duodenal switch (BPD-DS). A fasting lipoprotein-lipid profile was obtained and PCSK9 levels were measured by ELISA, before surgery and at 24h, 5 days, 6 months, and 12 months after surgery. PCSK9 levels were also measured in a control group of severely obese people (n¼34) at baseline and at 6 and 12 months. RESULTS: PCSK9 were increased by 8.6% after 24h (249.366.3 ng/ml to 270.665.8 ng/ml, p¼0.02) and decreased by 12.7% at 12 months compared to baseline (217.643.0 ng/mL, p<0.0001). LDL cholesterol levels decreased by 36.8% after 24h (2.60.7 mmol/L to. 1.70.6 mmol/L, p<0.0001) and by 36% at 12 months compared to baseline (1.60.5 mmol/L, p<0.0001). Plasma PCSK9 and LDL cholesterol levels did not change in the control group during follow-up. CONCLUSION: Our resutls suggest that bariatric surgery might improve LDL cholesterol and PCSK9 levels in the long term in severely obese patients. The effects of bariatric surgery on PCSK9 levels are different in the acute vs. long-term followup after surgery. The mechanisms explaining the variations in PCSK9 levels following bariatric surgery are currently under investigation. 273 BETA-BLOCKER TYPE EFFECT ON SUBSTRATE OXIDATION DURING DIFFERENT HIGHINTENSITY INTERMITTENT EXERCISES IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION: PILOT DATA PA Ribeiro, E Normandin, P Meyer, M Juneau, A Nigam, M Gayda Montréal, Québec BACKGROUND:
Beta-blockers agents are highly used in heart failure patients and they showed to improve quality of live and