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APSC2015-1148 Are Minor Echocardiographic Changes Associated With an Increased Risk of Acute Rheumatic Fever or Progression to Rheumatic Heart Disease?
POSTER ABSTRACTS
Results: 442 individuals were enrolled. Forty-two (9.5%) exhibited deterioration of valvular lesions and 17 (40%) of these progressed to Definite RHD. Three common factors were independently associated with both outcome measures: Borderline RHD of the MV (Borderline RHD A or B), NSVA, and receiving secondary antibiotic prophylaxis. Borderline RHD of the aortic valve (Borderline RHD C) also conferred a significant increase in the chance of development of Definite RHD but this was less than that seen with Borderline RHD of the MV. Cases with MR were not at a significantly increased risk of deterioration of valvular lesions (RR 1.2, 95% CI 0.6 - 2.5) or progression to Definite RHD (RR 1.5, 95% CI 0.5 – 4.1) compared to Cases without MR. Conclusion: A combination of functional and/or morphologic features of the MV is important in detecting those at greatest chance of deterioration of valvular lesions and progression to Definite RHD. However, aortic valve changes cannot be ignored. Disclosure of Interest: None Declared Keywords: Diagnosis, Echocardiography, Rheumatic Heart Disease APSC2015-1148 Are Minor Echocardiographic Changes Associated With an Increased Risk of Acute Rheumatic Fever or Progression to Rheumatic Heart Disease? Marc Remond*1, David Atkinson2, Andrew White3, Alex Brown4, Jonathan Carapetis5, Bo Remenyi6, Kathryn Roberts6, Graeme Maguire7 1 James Cook University, Cairns, 2The University of Western Australia, Broome, 3James Cook University, Townsville, 4South Australian Health and Medical Research Institute, Adelaide, 5 Telethon Kids Institute, The University of Western Australia, Perth, 6Menzies School of Health Research, Darwin, 7Baker IDI Heart and Diabetes Institute, Melbourne, Australia Background: In 2012, the World Heart Federation published criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) in the absence of a previous diagnosis of acute rheumatic fever (ARF). These criteria include a category of “Borderline” RHD, recognizing potential minor heart valve abnormalities of uncertain significance on echocardiography that may be the earliest sign of RHD. Whether minor heart valve abnormalities influence the risk of future ARF or development of RHD remains unclear but is important when considering follow-up and secondary antibiotic prophylaxis. Methods: A prospective cohort study of Indigenous Australian children aged 8-18 years. Cases were children with Borderline RHD or other minor non-specific valvular abnormalities (NSVAs) detected on prior screening echocardiography. Controls were children with a prior normal screening echocardiogram. Participants underwent a follow-up echocardiogram to assess for progression and development of Definite RHD. Interval diagnoses of ARF were also ascertained. Results: 343 individuals were included in the analysis. Borderline RHD Cases were at significantly greater risk of ARF (incidence rate ratio 8.8, 95% CI 1.4 – 53.8) and any echocardiographic progression of valve lesions (relative risk 8.2, 95% CI 2.4 – 27.5) than their matched Controls. Borderline RHD Cases were at increased risk of progression to Definite RHD (1 in 6 progressed) as were, to a lesser extent, NSVA Cases (1 in 10 progressed). Conclusion: Children with Borderline RHD had an increased risk of ARF, progression of valvular lesions, and development of Definite RHD while children with NSVAs were at a lesser increased risk of progression to Definite RHD. These findings provide support for considering secondary antibiotic prophylaxis or ongoing surveillance echocardiography in high-risk children with Borderline RHD or NSVAs. Further work is needed to identify which children with Borderline RHD or NSVAs are at greatest risk. Disclosure of Interest: None Declared Keywords: Diagnosis, Echocardiography, Rheumatic heart disease
GHEART Vol 10/2S/2015
j
June, 2015
j
APSC2015-1082 The Early Repolarization Normal Variant Electrocardiogram in Healthy Japanese Haruki Sekiguchi*1,2, Ken Shimamoto1, Makiko Kimura1, Fujio Tatsumi1, Eri Watanabe1, Masatoshi Kawana1 1 Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, 2Cardiology, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan Purpose: Early repolarization (ER) is sometimes observed in healthy subjects. Recently, J wave and ST-segment elevation in inferior/lateral leads suggested the risk of arrhythmic death. However, there are a few reports regarding the detail of ER pattern (ERP) in the healthy adults in Japanese. Methods: We assessed the prevalence of ERP within the Total Health Care (THC) members at the annual medical check-up using 12-lead electrocardiography from 2007 to 2014. ER was stratified by two independent cardiologist according to the J wave (notching or slurring) with/without J-point elevation (ST amplitude 0.1mV) in the lateral leads (I,aVL), inferior leads (II,III,aVF), and left precordial leads (V4-6). ERP was characterized 6 different definitions according to Macfarlane’s criteria; type1/2 is notching with/without J-point elevation, type 3/4 is slurring with/without J-point elevation, type 5 is only J-point elevation without J wave, and type 6 is unclassifiable. Result: Total 625 subjects were enrolled in this study. Forty-seven subjects were excluded from the initial sample because subjects present with atrial fibrillation (n ¼ 12), compete right bundle branch block (n ¼ 30), left bundle branch block (n ¼ 2), or Brugada type electrocardiogram (n ¼ 3). There were 578 healthy subjects (mean age 63 12 years, male: 337, 58%) in the analysis. ERP was present in 220 subjects (38.1%, male: 143, 65%); Type 1: 6 subjects (1.0%), Type 2: 31 subjects (5.4%), Type 3: 10 subjects (1.7%), Type 4: 125 subjects (21.6%), Type 5: 29 subjects (5.0%), and type 6: 18 subjects (3.1%). In the malignancy type (Type1 or 3 in inferior, n ¼ 11), All of them were male. Conclusion: This is the first report to investigate the detail prevalence of J wave patterns in healthy Japanese. The prevalence of J wave patterns semms to be similar to the findings of previous population-based studies. Disclosure of Interest: None Declared Keywords: Early Repolarization Variant, Electrocardiography, J Wave APSC2015-1311 Comparing GFR Estimating Equations Using Cystatin C And Creatinine in Elderly Japanese With Chronic Heart Failure Haruki Sekiguchi*1,2, Makiko Kimura1, Fujio Tatsumi1, Eri Watanabe1, Ken Shimamoto1, Masatoshi Kawana1 1 Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, 2Cardiology, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan Aim: Nowadays as the population ages, so the average age of patients get older. Most of them have impaired renal function, however it is not enough to assess the function in
POSTER/20th Asian Pacific Society Cardiology Congress Posters
e19
Results: 442 individuals were enrolled. Forty-two (9.5%) exhibited deterioration of valvular lesions and 17 (40%) of these progressed to Definite RHD. Three common factors were independently associated with both outcome measures: Borderline RHD of the MV (Borderline RHD A or B), NSVA, and receiving secondary antibiotic prophylaxis. Borderline RHD of the aortic valve (Borderline RHD C) also conferred a significant increase in the chance of development of Definite RHD but this was less than that seen with Borderline RHD of the MV. Cases with MR were not at a significantly increased risk of deterioration of valvular lesions (RR 1.2, 95% CI 0.6 - 2.5) or progression to Definite RHD (RR 1.5, 95% CI 0.5 – 4.1) compared to Cases without MR. Conclusion: A combination of functional and/or morphologic features of the MV is important in detecting those at greatest chance of deterioration of valvular lesions and progression to Definite RHD. However, aortic valve changes cannot be ignored. Disclosure of Interest: None Declared Keywords: Diagnosis, Echocardiography, Rheumatic Heart Disease APSC2015-1148 Are Minor Echocardiographic Changes Associated With an Increased Risk of Acute Rheumatic Fever or Progression to Rheumatic Heart Disease? Marc Remond*1, David Atkinson2, Andrew White3, Alex Brown4, Jonathan Carapetis5, Bo Remenyi6, Kathryn Roberts6, Graeme Maguire7 1 James Cook University, Cairns, 2The University of Western Australia, Broome, 3James Cook University, Townsville, 4South Australian Health and Medical Research Institute, Adelaide, 5 Telethon Kids Institute, The University of Western Australia, Perth, 6Menzies School of Health Research, Darwin, 7Baker IDI Heart and Diabetes Institute, Melbourne, Australia Background: In 2012, the World Heart Federation published criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) in the absence of a previous diagnosis of acute rheumatic fever (ARF). These criteria include a category of “Borderline” RHD, recognizing potential minor heart valve abnormalities of uncertain significance on echocardiography that may be the earliest sign of RHD. Whether minor heart valve abnormalities influence the risk of future ARF or development of RHD remains unclear but is important when considering follow-up and secondary antibiotic prophylaxis. Methods: A prospective cohort study of Indigenous Australian children aged 8-18 years. Cases were children with Borderline RHD or other minor non-specific valvular abnormalities (NSVAs) detected on prior screening echocardiography. Controls were children with a prior normal screening echocardiogram. Participants underwent a follow-up echocardiogram to assess for progression and development of Definite RHD. Interval diagnoses of ARF were also ascertained. Results: 343 individuals were included in the analysis. Borderline RHD Cases were at significantly greater risk of ARF (incidence rate ratio 8.8, 95% CI 1.4 – 53.8) and any echocardiographic progression of valve lesions (relative risk 8.2, 95% CI 2.4 – 27.5) than their matched Controls. Borderline RHD Cases were at increased risk of progression to Definite RHD (1 in 6 progressed) as were, to a lesser extent, NSVA Cases (1 in 10 progressed). Conclusion: Children with Borderline RHD had an increased risk of ARF, progression of valvular lesions, and development of Definite RHD while children with NSVAs were at a lesser increased risk of progression to Definite RHD. These findings provide support for considering secondary antibiotic prophylaxis or ongoing surveillance echocardiography in high-risk children with Borderline RHD or NSVAs. Further work is needed to identify which children with Borderline RHD or NSVAs are at greatest risk. Disclosure of Interest: None Declared Keywords: Diagnosis, Echocardiography, Rheumatic heart disease
GHEART Vol 10/2S/2015
j
June, 2015
j
APSC2015-1082 The Early Repolarization Normal Variant Electrocardiogram in Healthy Japanese Haruki Sekiguchi*1,2, Ken Shimamoto1, Makiko Kimura1, Fujio Tatsumi1, Eri Watanabe1, Masatoshi Kawana1 1 Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, 2Cardiology, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan Purpose: Early repolarization (ER) is sometimes observed in healthy subjects. Recently, J wave and ST-segment elevation in inferior/lateral leads suggested the risk of arrhythmic death. However, there are a few reports regarding the detail of ER pattern (ERP) in the healthy adults in Japanese. Methods: We assessed the prevalence of ERP within the Total Health Care (THC) members at the annual medical check-up using 12-lead electrocardiography from 2007 to 2014. ER was stratified by two independent cardiologist according to the J wave (notching or slurring) with/without J-point elevation (ST amplitude 0.1mV) in the lateral leads (I,aVL), inferior leads (II,III,aVF), and left precordial leads (V4-6). ERP was characterized 6 different definitions according to Macfarlane’s criteria; type1/2 is notching with/without J-point elevation, type 3/4 is slurring with/without J-point elevation, type 5 is only J-point elevation without J wave, and type 6 is unclassifiable. Result: Total 625 subjects were enrolled in this study. Forty-seven subjects were excluded from the initial sample because subjects present with atrial fibrillation (n ¼ 12), compete right bundle branch block (n ¼ 30), left bundle branch block (n ¼ 2), or Brugada type electrocardiogram (n ¼ 3). There were 578 healthy subjects (mean age 63 12 years, male: 337, 58%) in the analysis. ERP was present in 220 subjects (38.1%, male: 143, 65%); Type 1: 6 subjects (1.0%), Type 2: 31 subjects (5.4%), Type 3: 10 subjects (1.7%), Type 4: 125 subjects (21.6%), Type 5: 29 subjects (5.0%), and type 6: 18 subjects (3.1%). In the malignancy type (Type1 or 3 in inferior, n ¼ 11), All of them were male. Conclusion: This is the first report to investigate the detail prevalence of J wave patterns in healthy Japanese. The prevalence of J wave patterns semms to be similar to the findings of previous population-based studies. Disclosure of Interest: None Declared Keywords: Early Repolarization Variant, Electrocardiography, J Wave APSC2015-1311 Comparing GFR Estimating Equations Using Cystatin C And Creatinine in Elderly Japanese With Chronic Heart Failure Haruki Sekiguchi*1,2, Makiko Kimura1, Fujio Tatsumi1, Eri Watanabe1, Ken Shimamoto1, Masatoshi Kawana1 1 Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, 2Cardiology, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan Aim: Nowadays as the population ages, so the average age of patients get older. Most of them have impaired renal function, however it is not enough to assess the function in
POSTER/20th Asian Pacific Society Cardiology Congress Posters
e19