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Cigarette Smoking and Triglyceride Levels are Independently Associated with Dynamic Retinal Microcirculatory Function
Abstracts CSANZ 2012 Abstracts
S245
590
591
Biphasic Cardioversions of Atrial Tachyarrhythmias: The Role of High-Energy Defibrillators in a Local Hospital Setting
Cigarette Smoking and Triglyceride Levels are Independently Associated with Dynamic Retinal Microcirculatory Function
M. Wittwer 1,2,∗ , J. Kealley 2 , M. Arstall 1,2
A. Al-Fiadh 1,∗ , N. Uddin 2 , R. Kawasaki 3 , S. Patel 4 , E. Glatz 3 , A. Wilson 4 , L. Burrell 1 , T. Wong 3 , O. Farouque 1
1 Lyell
McEwin Hospital, Elizabeth Vale, SA, Australia of Adelaide, Adelaide, South Australia, Australia
2 University
Background: Restoration of sinus rhythm by biphasic direct current cardioversion is an important rhythm control strategy for patients in atrial tachyarrhythmias. This study aimed to investigate the real-life practice of in-patient cardioversions with a focus on high-energy cardioversions and the application of international guidelines. Methods: A semi-prospective analysis of all cardioversions of atrial tachyarrhythmias was conducted within a local hospital setting from January 2009 to June 2011. Patient demographics, relevant medical history and cardioversion data for each admission was collected. Results: 198 cardioversions from 158 patients were included in the final analysis. Maximal energy exceeding 200 J was applied during 31 (16%) cardioversions, of which 18 (58%) were successful. Heavier weight was the strongest predictor of requiring a high-energy cardioversion (P < 0.05). Patient weight was also the most influential variable for first-shock energy selection (P < 0.05). There was no correlation observed between high-energy use, or limited energy escalation (≤200 J), and success (P > 0.05). Conculsions: High-energy cardioversion is necessary for a small but significant group of patients with atrial tachyarrhythmias. Patient weight was found to be the most influential variable for a high-energy requirement and first-shock energy selection. The ability to escalate to high energy levels was not found to be significantly associated with cardioversion efficacy within this study. However, it is worth considering the potential for an increased efficacy if high-energy defibrillators are made available for all cardioversions. Overall, the significant variation in cardioversion practice observed in this study highlighted the need for the development of an internal cardioversion protocol. http://dx.doi.org/10.1016/j.hlc.2012.05.601
1 Austin
Health/University of Melbourne, Australia Health, Australia 3 University of Melbourne/Centre for Eye Research Australia, Australia 4 University of Melbourne, Australia 2 Austin
Introduction: Atherosclerosis risk factors result in vascular injury and endothelial dysfunction. We sought to determine the effect of cigarette smoking and triglyceride level on the structure and function of retinal and peripheral microcirculation, and plasma vascular biomarkers. Methods: Patients with atherosclerosis risk factors were recruited (n = 197). Structural and functional retinal changes were assessed using retinal photography and the Dynamic Vessel Analyzer (DVA). Augmentation Index (AI) was measured by endothelial peripheral arterial tonometry (endoPAT). Plasma high sensitivity C-reactive protein (CRP), endothelin (ET-1) and adrenomedullin (ADM) were measured. Linear and logistic regression analyses were used to determine the relationships between risk factors and markers of vascular function. Results: Mean age was 58 ± 12 years with 66% male, 77% hypertensive, 81% with dyslipidaemia, 40% with diabetes and 24% were smokers. Mean BMI was 33 ± 7 kg/m2 and 40% had coronary artery disease. Adjustments were made for age, gender, blood pressure, BMI, waist–hip ratio, hypertension, dyslipidaemia, renal function, LDL, HDL, and cardiac medication. Cigarette smoking was associated with increased AI (β = 7.96%; 95%CI 2.69, 13.23; p < 0.01), increased odds of retinal arteriovenous nicking (OR 5.69; 95%CI 1.31, 24.73; p = 0.02), decreased flicker-light induced retinal arteriolar dilatation (FI-RAD) (β = −1.16%; 95%CI −2.01, −0.30; p = 0.01) and increased serum ET-1 level (β = 0.24; 95%CI 0.07, 0.42; p = 0.01). Elevation of triglyceride level by 1 mmol/L was associated with increased CRP (β = 3.49 mg/L; 95%CI 0.71, 6.26; p = 0.01), decreased ADM (β = −0.95 pmol/L; 95%CI −1.74, −0.17; p = 0.02) and decreased FI-RAD (β = −0.58%; 95%CI −1.06, −0.09; p = 0.02). Conclusion: Cigarette smoking and elevated triglycerides are independently associated with biomarkers of vascular structure and function, including retinal microvascular endothelial function. http://dx.doi.org/10.1016/j.hlc.2012.05.602
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316
S245
590
591
Biphasic Cardioversions of Atrial Tachyarrhythmias: The Role of High-Energy Defibrillators in a Local Hospital Setting
Cigarette Smoking and Triglyceride Levels are Independently Associated with Dynamic Retinal Microcirculatory Function
M. Wittwer 1,2,∗ , J. Kealley 2 , M. Arstall 1,2
A. Al-Fiadh 1,∗ , N. Uddin 2 , R. Kawasaki 3 , S. Patel 4 , E. Glatz 3 , A. Wilson 4 , L. Burrell 1 , T. Wong 3 , O. Farouque 1
1 Lyell
McEwin Hospital, Elizabeth Vale, SA, Australia of Adelaide, Adelaide, South Australia, Australia
2 University
Background: Restoration of sinus rhythm by biphasic direct current cardioversion is an important rhythm control strategy for patients in atrial tachyarrhythmias. This study aimed to investigate the real-life practice of in-patient cardioversions with a focus on high-energy cardioversions and the application of international guidelines. Methods: A semi-prospective analysis of all cardioversions of atrial tachyarrhythmias was conducted within a local hospital setting from January 2009 to June 2011. Patient demographics, relevant medical history and cardioversion data for each admission was collected. Results: 198 cardioversions from 158 patients were included in the final analysis. Maximal energy exceeding 200 J was applied during 31 (16%) cardioversions, of which 18 (58%) were successful. Heavier weight was the strongest predictor of requiring a high-energy cardioversion (P < 0.05). Patient weight was also the most influential variable for first-shock energy selection (P < 0.05). There was no correlation observed between high-energy use, or limited energy escalation (≤200 J), and success (P > 0.05). Conculsions: High-energy cardioversion is necessary for a small but significant group of patients with atrial tachyarrhythmias. Patient weight was found to be the most influential variable for a high-energy requirement and first-shock energy selection. The ability to escalate to high energy levels was not found to be significantly associated with cardioversion efficacy within this study. However, it is worth considering the potential for an increased efficacy if high-energy defibrillators are made available for all cardioversions. Overall, the significant variation in cardioversion practice observed in this study highlighted the need for the development of an internal cardioversion protocol. http://dx.doi.org/10.1016/j.hlc.2012.05.601
1 Austin
Health/University of Melbourne, Australia Health, Australia 3 University of Melbourne/Centre for Eye Research Australia, Australia 4 University of Melbourne, Australia 2 Austin
Introduction: Atherosclerosis risk factors result in vascular injury and endothelial dysfunction. We sought to determine the effect of cigarette smoking and triglyceride level on the structure and function of retinal and peripheral microcirculation, and plasma vascular biomarkers. Methods: Patients with atherosclerosis risk factors were recruited (n = 197). Structural and functional retinal changes were assessed using retinal photography and the Dynamic Vessel Analyzer (DVA). Augmentation Index (AI) was measured by endothelial peripheral arterial tonometry (endoPAT). Plasma high sensitivity C-reactive protein (CRP), endothelin (ET-1) and adrenomedullin (ADM) were measured. Linear and logistic regression analyses were used to determine the relationships between risk factors and markers of vascular function. Results: Mean age was 58 ± 12 years with 66% male, 77% hypertensive, 81% with dyslipidaemia, 40% with diabetes and 24% were smokers. Mean BMI was 33 ± 7 kg/m2 and 40% had coronary artery disease. Adjustments were made for age, gender, blood pressure, BMI, waist–hip ratio, hypertension, dyslipidaemia, renal function, LDL, HDL, and cardiac medication. Cigarette smoking was associated with increased AI (β = 7.96%; 95%CI 2.69, 13.23; p < 0.01), increased odds of retinal arteriovenous nicking (OR 5.69; 95%CI 1.31, 24.73; p = 0.02), decreased flicker-light induced retinal arteriolar dilatation (FI-RAD) (β = −1.16%; 95%CI −2.01, −0.30; p = 0.01) and increased serum ET-1 level (β = 0.24; 95%CI 0.07, 0.42; p = 0.01). Elevation of triglyceride level by 1 mmol/L was associated with increased CRP (β = 3.49 mg/L; 95%CI 0.71, 6.26; p = 0.01), decreased ADM (β = −0.95 pmol/L; 95%CI −1.74, −0.17; p = 0.02) and decreased FI-RAD (β = −0.58%; 95%CI −1.06, −0.09; p = 0.02). Conclusion: Cigarette smoking and elevated triglycerides are independently associated with biomarkers of vascular structure and function, including retinal microvascular endothelial function. http://dx.doi.org/10.1016/j.hlc.2012.05.602
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316