- Email: [email protected]
Cardiac involvement in systemic sclerosis: Multicentric study in Tunisia
13 — Others
155
Background Cardiovascular disease is the most prevalent cause of morbidity and mortality in diabetic populations. Safe beverages of medicinal plants contribute as a strategy for the prevention and management of these complications. We investigated the effects of a drink mixture of Hibiscus sabdariffa and Stevia rebaudiana extracts on diastolic function in a group of type 2 diabetes patients. Methods We carried out a non-randomized open-label, onearm clinical trial. Patients with type 2 diabetes and glycated hemoglobin < 8% were included. Each participant consumed 425 mL of a standardized drink every morning after breakfast over a period of 8 weeks. The effects on the E/A ratio (Mitral peak velocity of early filling E/Mitral peak velocity of last filling A) and lipid profile were determined. Results We included 20 patients (13 women and 7 men) with a median age of 59 years [56—63.5] and type 2 diabetes of a duration of 8 years [3.25—11.5]. Transthoracic ultrasound at baseline showed 12 patients with diastolic dysfunction. After the 8 weeks intervention, lipid profile parameters improved significantly: triglycerides decreased by 45.58% (P = 0.008), LDLcholesterol by 21% (P = 0.018) and HDL-cholesterol increased by 29.26% (P < 0.001). Generally, there was an insignificant increase in E/A ratio after intervention, from 0.68 [0.55—1.00] to 0.80 [0.70—0.97], P = 0.937. However, patients with diastolic dysfunction at baseline showed a significant increase in the E/A ratio from 0.60 [0.50—0.69] to 0.70 [0.60—0.95] corresponding to a variation of 16.7% (P = 0.016). We did not find any significant side effects and the drink was judged to be quite palatable in 18/20 patients. Conclusion A drink associating Hibiscus sabdariffa with Stevia rebaudiana has beneficial effects on the diastolic function of type 2 diabetes patients and also on their lipid profile. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.343
https://doi.org/10.1016/j.acvdsp.2018.10.344
326
Cardiac radiation exposure associated with breast cancer radiotherapy: Dose distribution to the heart substructures and coronary arteries (BACCARAT study) Walker 1,∗ ,
irradiation of healthy tissue. However, the heart often remains partially exposed. Detailed individual heart dosimetry information is required to better understand radiation-induced cardiac damage. Purpose To analyze the distribution of individually-determined radiation dose to the heart and its substructures, in particular coronary arteries, after RT in breast cancer patients from the BACCARAT study. Methods BACCARAT is a monocentric prospective cohort study that included unilateral breast cancer patients treated with RT between 2015 and 2017 and followed for 2 years with repeated cardiac imaging examinations, including coronary computed tomography angiography. Using the 3D dose matrix generated during RT treatment planning and the added coronary contours, dose distributions were generated for the following cardiac structures: whole heart, left ventricle (LV), left main coronary artery (LM), left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). A descriptive analysis of the physical doses in Gray (Gy) was performed. Results Dose distributions were generated for 59 patients (50 left-sided breast cancer, 9 right-sided) who all received a treatment of 50 Gy to the breast. The mean heart dose was 2.98 Gy for left sided patients and 0.42 Gy for right sided and mean LV doses were respectively 6.23 Gy and 0.09 Gy. For left-sided patients, mean dose to LM (D LM) = 1.29 Gy, D LAD = 16.32 Gy, D LCX = 1.59 Gy and D RCA = 0.67 Gy, whereas corresponding doses for right-sided patients were D LM = 0.35 Gy, D LAD = 0.11 Gy, D LCX = 0.14 Gy and D RCA = 1.10 Gy. For left sided patients, the most exposed part of the LAD could receive doses > 45 Gy. Conclusion Our study illustrates the wide range of doses experienced by the heart substructures and thus the poor significance of the mean heart dose as a radiation damage indicator. Disclosure of interest The authors declare that they have no competing interest.
Broggio 2 ,
Derreumaux 3 ,
Camilleri 4 ,
V. D. S. J. E. Bruguière 5 , M. Lapeyre 5 , O. Fondard 6 , O. Lairez 7 , M.O. Bernier 1 , D. Laurier 8 , C. Chevelle 4 , G. Jimenez 4 , J. Ferrières 7,9 , S. Jacob 1 1 Laboratoire d’épidémiologie, Institut de radioprotection et de sureté nucléaire (IRSN), Fontenay-aux-Roses, France 2 Laboratoire d’évaluation de la dose interne, Institut de radioprotection et de sureté Nucléaire (IRSN), Fontenay-Aux-Roses, France 3 Unité d’expertise en radioprotection médicale, Institut de radioprotection et de sureté nucléaire (IRSN), Fontenay-Aux-Roses, France 4 Radiothérapie (Oncorad), Clinique Pasteur, Toulouse, France 5 Radiologie, Clinique Pasteur, Toulouse, France 6 Cardiologie générale et interventionnelle, Clinique Pasteur, Toulouse, France 7 Cardiologie, CHU Rangueil, Toulouse, France 8 Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Institut de radioprotection et de sureté nucléaire (IRSN), Fontenay-Aux-Roses, France 9 UMR1027, Inserm, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (V. Walker) Background Radiotherapy (RT) is a major component of breast cancer treatment and advanced RT techniques allowed reducing
140
Cardiac involvement in systemic sclerosis: Multicentric study in Tunisia S. Hammami 1,2,∗ , S. Bouomrani 1,2 , F. Chalbi 1,2 , A. Barhoumi 1,2 1 Biochemistry Laboratory, LR12ES05 LR-NAFS ‘‘Nutrition Functional Food & Vascular Health’’, Faculty of Medicine University of Monastir (Tunisia), Monastir 2 Medecine Interne, CHU F Bourguiba, Faculty of Medicine, University of Monastir, Tunisie, Tunisia ∗ Corresponding author. E-mail address: [email protected] (S. Hammami) Background Systemic sclerosis (SSc) is a systemic autoimmune disease that is characterised by endothelial dysfunction resulting in a small-vessel vasculopathy, fibroblast dysfunction, and immunological abnormalities. Cardiac manifestations of SSc can affect all structures of the heart; the incidence of cardiac disease is estimated to be about 7% in localized lcSSc and 21% in diffuse cutaneous sclerosis (dcSSc) patients. Purpose We investigated the prevalence and incidence (at time of diagnosis and during follow-up) of various cardiovascular diseases in a large multicenter study cohort in Tunisian patients with SSc throughout 8 Departments of Internal Medicine. Methods One hundred and eight cases of SSc were recorded according to American College of Rheumatology criteria, during a 15-years period. Prevalence of cardiovascular diseases at the time of the SSc diagnosis and incidences during follow-up was assessed using Echocardiography and Electrocardiography. Results They were 93 women and 15 men with an average age at SSc onset of approximately 46.9 years. Only 18 patients had limited
156 cutaneous SSc. Cardiac manifestations were observed in 29 patients (27%) pericardial effusion in 9 patients (8.3%),myocardial infarction n = 4 (3.7%), pulmonary arterial hypertension n = 15 (13.8%),valvulopathy n = 7 (6.4%), cardiac conduction diseases n = 6 (5.5%), arrhythmias n = 3 (2.7%), cardiomyopathy n = 9 (8.3%). Patients with limited SSc had similar cardiac abnormalities to patients with diffuse SSc. Conclusion The prevalence of cardiac involvement in SSc is variable and difficult to determine because of the diversity of cardiac manifestations and the type of diagnostic tools applied. In our study, we confirm the increased risk of several SSc cardiac complications. Screening for subclinical cardiac involvement with modern, sensitive tools provides an opportunity for earlier detection and treatment. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.345
013
Cognitive impairment, adverse events and mortality among elderly patients treated with long-term oral anticoagulation: A monocentric prospective study C. Nguyen Dac , P. Massoure ∗ , O. Camus , L. Fourcade Cardiologie, HIA Laveran, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (P. Massoure) Background Oral anticoagulants (AC) represent the leading cause of iatrogenic morbimortality in France. AC are widely prescribed among the elderly. The assessment of the cognitive impairment (CI) is not included within the common thrombotic and bleeding risk scores. Purpose The objective of this study was to examine an association between CI and adverse events in patients receiving long term oral AC. Methods A prospective monocentric cohort study was conducted in patients (> 60 years-old) on oral AC. Death, hemorrhages, falls, hospital readmission and thromboembolic events were collected over 6 months follow-up. Patients were included during an hospitalization for any medical or surgical condition and divided into three groups, according to their Mini Mental State Examination (MMSE): Group 1 (absence of CI) MMSE > 26, Group 2 (mild CI) 23 < MMSE < 27, Group 3 (significant CI) MMSE < 24. Results Regardless of the kind of oral AC, among 120 patients (mean age: 82,2 ± 8,8 years), the all-causes mortality (n = 25) was significantly higher in the Group 3 (n = 17, P = 0,006); this also applies to the incidence of falls (n = 34, P = 0,009) or major hemorrhages (n = 10, P = 0,023). There was no thromboembolic event. Minor hemorrhages and hospital readmissions were not different in the 3 groups. Conclusion After 6 months of follow up, the cognitive impairment was associated with mortality, major hemorrhages and falls among the elderly receiving oral AC. A systematic assessment of cognitive functions of these patients seems to be essential to analyze the global risk and the risks related to the AC treatment. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.346
Abstracts 121
Correlations between echocardiographic findings and heart rate recovery after exercise stress test in patients with autonomic nervous system dysfunction E. Enciu 1,∗ , S. Stanciu 2 , G. Rouls 3 Hôpitaux Civils de Colmar, Colmar, France 2 Hôpital Militaire Central, Bucuresti, Romania 3 Nouvel Hôpital Civil, Strasbourg, France ∗ Corresponding author. E-mail address: [email protected] (E. Enciu)
1
Introduction The importance of an integer autonomic nervous system function is well known since Loewi demonstrated in the 20th century the moderating cardiac effect of the vagal nerve and unfortunately autonomic impairment is a reality of everyday clinical practice. Its role it was already been demonstrated in the major cardiovascular risk factors such as diabetes and hypertension. Purpose This study is based upon the typical patients which asociate numerous cardiovascular risk factors but without a cardiovascular event and it is meant to increase the awareness for the importance of primary prevention as they may also associate an autonomic nervous system impairment. Materials and method We performed a retrospective 3 years study on 81 patients (mean age 66.6 years) who underwent noninvasive cardiovascular investigations: echocardiography, exercise stress test and ECG Holter. The study group presented 4 major cardiovascular risk factors: smoking 33%, hypertension (74%), diabetes (31%) and obesity (47%). A total of 13 patients had an ejection fraction (EF) 50—40% and 4 less than 40%. All of the patients included had an abnormal heart rate recovery starting from the 3rd minute of recovery (with a cut-off of 13 beats per minute of recovery). Results We found a positive correlation between the heart rate in the second minute of recovery and diastolic type I dysfunction(P = 0.05) and also with the presence of a minor aortic (P = 0.001) or mitral insufficiency (P = 0.049). The ejection fraction demonstrated to have a negative correlation with the heart rate in the third minute of recovery (R2 = −0.137) (Fig. 1). Conclusion We propose a new approach when considering the traditional cardiovascular risk assessment and perhaps the presence of autonomic dysfunction should be consider among the risk factors for a more thorough primary prevention for this category of patients.
Figure 1 Correlations between heart rate in the second minute of recovery, dystolic dysfunction (E.A < 0.5), Aortic insufficiency (Iao11), mitral insufficiency (IM11) and maximal systolic blood pressure (TASmax). Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.347
155
Background Cardiovascular disease is the most prevalent cause of morbidity and mortality in diabetic populations. Safe beverages of medicinal plants contribute as a strategy for the prevention and management of these complications. We investigated the effects of a drink mixture of Hibiscus sabdariffa and Stevia rebaudiana extracts on diastolic function in a group of type 2 diabetes patients. Methods We carried out a non-randomized open-label, onearm clinical trial. Patients with type 2 diabetes and glycated hemoglobin < 8% were included. Each participant consumed 425 mL of a standardized drink every morning after breakfast over a period of 8 weeks. The effects on the E/A ratio (Mitral peak velocity of early filling E/Mitral peak velocity of last filling A) and lipid profile were determined. Results We included 20 patients (13 women and 7 men) with a median age of 59 years [56—63.5] and type 2 diabetes of a duration of 8 years [3.25—11.5]. Transthoracic ultrasound at baseline showed 12 patients with diastolic dysfunction. After the 8 weeks intervention, lipid profile parameters improved significantly: triglycerides decreased by 45.58% (P = 0.008), LDLcholesterol by 21% (P = 0.018) and HDL-cholesterol increased by 29.26% (P < 0.001). Generally, there was an insignificant increase in E/A ratio after intervention, from 0.68 [0.55—1.00] to 0.80 [0.70—0.97], P = 0.937. However, patients with diastolic dysfunction at baseline showed a significant increase in the E/A ratio from 0.60 [0.50—0.69] to 0.70 [0.60—0.95] corresponding to a variation of 16.7% (P = 0.016). We did not find any significant side effects and the drink was judged to be quite palatable in 18/20 patients. Conclusion A drink associating Hibiscus sabdariffa with Stevia rebaudiana has beneficial effects on the diastolic function of type 2 diabetes patients and also on their lipid profile. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.343
https://doi.org/10.1016/j.acvdsp.2018.10.344
326
Cardiac radiation exposure associated with breast cancer radiotherapy: Dose distribution to the heart substructures and coronary arteries (BACCARAT study) Walker 1,∗ ,
irradiation of healthy tissue. However, the heart often remains partially exposed. Detailed individual heart dosimetry information is required to better understand radiation-induced cardiac damage. Purpose To analyze the distribution of individually-determined radiation dose to the heart and its substructures, in particular coronary arteries, after RT in breast cancer patients from the BACCARAT study. Methods BACCARAT is a monocentric prospective cohort study that included unilateral breast cancer patients treated with RT between 2015 and 2017 and followed for 2 years with repeated cardiac imaging examinations, including coronary computed tomography angiography. Using the 3D dose matrix generated during RT treatment planning and the added coronary contours, dose distributions were generated for the following cardiac structures: whole heart, left ventricle (LV), left main coronary artery (LM), left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). A descriptive analysis of the physical doses in Gray (Gy) was performed. Results Dose distributions were generated for 59 patients (50 left-sided breast cancer, 9 right-sided) who all received a treatment of 50 Gy to the breast. The mean heart dose was 2.98 Gy for left sided patients and 0.42 Gy for right sided and mean LV doses were respectively 6.23 Gy and 0.09 Gy. For left-sided patients, mean dose to LM (D LM) = 1.29 Gy, D LAD = 16.32 Gy, D LCX = 1.59 Gy and D RCA = 0.67 Gy, whereas corresponding doses for right-sided patients were D LM = 0.35 Gy, D LAD = 0.11 Gy, D LCX = 0.14 Gy and D RCA = 1.10 Gy. For left sided patients, the most exposed part of the LAD could receive doses > 45 Gy. Conclusion Our study illustrates the wide range of doses experienced by the heart substructures and thus the poor significance of the mean heart dose as a radiation damage indicator. Disclosure of interest The authors declare that they have no competing interest.
Broggio 2 ,
Derreumaux 3 ,
Camilleri 4 ,
V. D. S. J. E. Bruguière 5 , M. Lapeyre 5 , O. Fondard 6 , O. Lairez 7 , M.O. Bernier 1 , D. Laurier 8 , C. Chevelle 4 , G. Jimenez 4 , J. Ferrières 7,9 , S. Jacob 1 1 Laboratoire d’épidémiologie, Institut de radioprotection et de sureté nucléaire (IRSN), Fontenay-aux-Roses, France 2 Laboratoire d’évaluation de la dose interne, Institut de radioprotection et de sureté Nucléaire (IRSN), Fontenay-Aux-Roses, France 3 Unité d’expertise en radioprotection médicale, Institut de radioprotection et de sureté nucléaire (IRSN), Fontenay-Aux-Roses, France 4 Radiothérapie (Oncorad), Clinique Pasteur, Toulouse, France 5 Radiologie, Clinique Pasteur, Toulouse, France 6 Cardiologie générale et interventionnelle, Clinique Pasteur, Toulouse, France 7 Cardiologie, CHU Rangueil, Toulouse, France 8 Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Institut de radioprotection et de sureté nucléaire (IRSN), Fontenay-Aux-Roses, France 9 UMR1027, Inserm, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (V. Walker) Background Radiotherapy (RT) is a major component of breast cancer treatment and advanced RT techniques allowed reducing
140
Cardiac involvement in systemic sclerosis: Multicentric study in Tunisia S. Hammami 1,2,∗ , S. Bouomrani 1,2 , F. Chalbi 1,2 , A. Barhoumi 1,2 1 Biochemistry Laboratory, LR12ES05 LR-NAFS ‘‘Nutrition Functional Food & Vascular Health’’, Faculty of Medicine University of Monastir (Tunisia), Monastir 2 Medecine Interne, CHU F Bourguiba, Faculty of Medicine, University of Monastir, Tunisie, Tunisia ∗ Corresponding author. E-mail address: [email protected] (S. Hammami) Background Systemic sclerosis (SSc) is a systemic autoimmune disease that is characterised by endothelial dysfunction resulting in a small-vessel vasculopathy, fibroblast dysfunction, and immunological abnormalities. Cardiac manifestations of SSc can affect all structures of the heart; the incidence of cardiac disease is estimated to be about 7% in localized lcSSc and 21% in diffuse cutaneous sclerosis (dcSSc) patients. Purpose We investigated the prevalence and incidence (at time of diagnosis and during follow-up) of various cardiovascular diseases in a large multicenter study cohort in Tunisian patients with SSc throughout 8 Departments of Internal Medicine. Methods One hundred and eight cases of SSc were recorded according to American College of Rheumatology criteria, during a 15-years period. Prevalence of cardiovascular diseases at the time of the SSc diagnosis and incidences during follow-up was assessed using Echocardiography and Electrocardiography. Results They were 93 women and 15 men with an average age at SSc onset of approximately 46.9 years. Only 18 patients had limited
156 cutaneous SSc. Cardiac manifestations were observed in 29 patients (27%) pericardial effusion in 9 patients (8.3%),myocardial infarction n = 4 (3.7%), pulmonary arterial hypertension n = 15 (13.8%),valvulopathy n = 7 (6.4%), cardiac conduction diseases n = 6 (5.5%), arrhythmias n = 3 (2.7%), cardiomyopathy n = 9 (8.3%). Patients with limited SSc had similar cardiac abnormalities to patients with diffuse SSc. Conclusion The prevalence of cardiac involvement in SSc is variable and difficult to determine because of the diversity of cardiac manifestations and the type of diagnostic tools applied. In our study, we confirm the increased risk of several SSc cardiac complications. Screening for subclinical cardiac involvement with modern, sensitive tools provides an opportunity for earlier detection and treatment. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.345
013
Cognitive impairment, adverse events and mortality among elderly patients treated with long-term oral anticoagulation: A monocentric prospective study C. Nguyen Dac , P. Massoure ∗ , O. Camus , L. Fourcade Cardiologie, HIA Laveran, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (P. Massoure) Background Oral anticoagulants (AC) represent the leading cause of iatrogenic morbimortality in France. AC are widely prescribed among the elderly. The assessment of the cognitive impairment (CI) is not included within the common thrombotic and bleeding risk scores. Purpose The objective of this study was to examine an association between CI and adverse events in patients receiving long term oral AC. Methods A prospective monocentric cohort study was conducted in patients (> 60 years-old) on oral AC. Death, hemorrhages, falls, hospital readmission and thromboembolic events were collected over 6 months follow-up. Patients were included during an hospitalization for any medical or surgical condition and divided into three groups, according to their Mini Mental State Examination (MMSE): Group 1 (absence of CI) MMSE > 26, Group 2 (mild CI) 23 < MMSE < 27, Group 3 (significant CI) MMSE < 24. Results Regardless of the kind of oral AC, among 120 patients (mean age: 82,2 ± 8,8 years), the all-causes mortality (n = 25) was significantly higher in the Group 3 (n = 17, P = 0,006); this also applies to the incidence of falls (n = 34, P = 0,009) or major hemorrhages (n = 10, P = 0,023). There was no thromboembolic event. Minor hemorrhages and hospital readmissions were not different in the 3 groups. Conclusion After 6 months of follow up, the cognitive impairment was associated with mortality, major hemorrhages and falls among the elderly receiving oral AC. A systematic assessment of cognitive functions of these patients seems to be essential to analyze the global risk and the risks related to the AC treatment. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.346
Abstracts 121
Correlations between echocardiographic findings and heart rate recovery after exercise stress test in patients with autonomic nervous system dysfunction E. Enciu 1,∗ , S. Stanciu 2 , G. Rouls 3 Hôpitaux Civils de Colmar, Colmar, France 2 Hôpital Militaire Central, Bucuresti, Romania 3 Nouvel Hôpital Civil, Strasbourg, France ∗ Corresponding author. E-mail address: [email protected] (E. Enciu)
1
Introduction The importance of an integer autonomic nervous system function is well known since Loewi demonstrated in the 20th century the moderating cardiac effect of the vagal nerve and unfortunately autonomic impairment is a reality of everyday clinical practice. Its role it was already been demonstrated in the major cardiovascular risk factors such as diabetes and hypertension. Purpose This study is based upon the typical patients which asociate numerous cardiovascular risk factors but without a cardiovascular event and it is meant to increase the awareness for the importance of primary prevention as they may also associate an autonomic nervous system impairment. Materials and method We performed a retrospective 3 years study on 81 patients (mean age 66.6 years) who underwent noninvasive cardiovascular investigations: echocardiography, exercise stress test and ECG Holter. The study group presented 4 major cardiovascular risk factors: smoking 33%, hypertension (74%), diabetes (31%) and obesity (47%). A total of 13 patients had an ejection fraction (EF) 50—40% and 4 less than 40%. All of the patients included had an abnormal heart rate recovery starting from the 3rd minute of recovery (with a cut-off of 13 beats per minute of recovery). Results We found a positive correlation between the heart rate in the second minute of recovery and diastolic type I dysfunction(P = 0.05) and also with the presence of a minor aortic (P = 0.001) or mitral insufficiency (P = 0.049). The ejection fraction demonstrated to have a negative correlation with the heart rate in the third minute of recovery (R2 = −0.137) (Fig. 1). Conclusion We propose a new approach when considering the traditional cardiovascular risk assessment and perhaps the presence of autonomic dysfunction should be consider among the risk factors for a more thorough primary prevention for this category of patients.
Figure 1 Correlations between heart rate in the second minute of recovery, dystolic dysfunction (E.A < 0.5), Aortic insufficiency (Iao11), mitral insufficiency (IM11) and maximal systolic blood pressure (TASmax). Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.347