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DETERMINANTS OF PLATELET ACTIVATION IN HEART FAILURE
S52
Oral Communications / European Journal of Internal Medicine 19S (2008), S1–S59
end lowering the absorption [ezetimibe (E)]. Moreover, the fixed associative therapy improves the therapy compliance because patient get just a pill daily. Actually, the only available fixed associative therapy is formed by simvastatin (S) ed E (Inegy® , Vytorin® ). In our office, we evaluated the achieving of therapeutic goal (LDL <100 mg/dl) in moderate-high risk hyperlipidaemic patients using S+E 40+10 mg fixed therapy once a day. Moreover, we evaluated the difference of the principal lipidic parameters after the beginning of the therapy. Forty moderate-high risk hyperlipidaemic patients were enrolled (18 male; 22 female). The medium age was 53.4±11.1 years. All the data are available for 38 of the 40 patients. After three months the beginning of the fixed therapy, 32 patients (78.9%) have reached the given therapeutic goal. The levels of cholesterol decreased of 45.09% (from 275±41.1 to 151±32.2 mg/dl). The levels of HDL raised of 4% (from 49±8.65 to 50±8.9 mg/dl). The levels of trglycerides decreased of 30.5% (from 199±91.8 to 139±82 mg/dl). Overall, the levels of LDL decreased of 59.72% (from 185.995±41.66 to 74.91±31.01 mg/dl). The fixed hypolipidaemic therapy with S+E is useful to achieve the therapeutic goal in moderate-high risk patients
SA-20 DETERMINANTS OF PLATELET ACTIVATION IN HEART FAILURE Francesca Santilli 1 , Stefania Basili 2 , Stefano Lattanzio 1 , Adele Cavoni 1 , Giuseppe Guizzardi 1 , Lucrezia De Feudis 1 , Giancarlo Traisci 1 , Giovanni Ciabattoni 1 , Giovanni Davì 1 , Carlo Patrono 3 . 1 University of Chieti “G. D’Annunzio”; 2 University of Rome “La Sapienza”; 3 Catholic University, Rome, Italy Introduction: Thromboembolism is a critical and relatively common complication of chronic heart failure (HF). Methods: We performed a cross-sectional study in 84 HF patients [33 M; 81±8 yr; 49 in I-II, 35 in III-IV New York Heart Association (NYHA) class] and 42 controls, using urinary (U) 8-iso-prostaglandin (PG) F2alpha and 11-dehydro-thromboxane (TX) B2 as non-invasive indexes of oxidative stress and platelet activation, respectively, B-type natriuretic peptide (BNP) as a biomarker of cardiac function, plasma asymmetric dimethylarginine (ADMA) as an index of endothelial dysfunction, C-reactive protein (CRP) and sCD40 ligand (sCD40L) as markers of inflammation. Results: Forty-two HF patients not on aspirin treatment had significantly higher U-11-dehydro-TXB2 excretion [Median (IQR): 1488 (824-2130) vs 440 (313-611) pg/mg cr], 8-iso-PGF2alpha [528 (430-702) vs. 304 (228-364) pg/mg cr], BNP [363 (196-659) vs 78 (56-98) pg/mL], ADMA (1.6±0.5 vs 0.5±0.2 micromol/L), CRP [1.74 (0.98-2.7) vs 0.5 (0.4-0.7) mg/L] and sCD40L levels [1342 (653-2320) vs 432 (322-840) pg/mL] (all p<0.0001) than controls. Forty-two HF patients on low-dose aspirin showed significantly lower 11-dehydro-TXB2 [343 (227-455) pg/mg cr, p<0.007] and sCD40L levels [820 (535-1160) pg/mL, p<0.02] than HF patients not on aspirin. Patients in NYHA classes III-IV showed higher U-11-dehydro-TXB2 excretion than patients in I-II classes, independently of aspirin treatment (p<0.05). In the 42 HF patients not on aspirin, U-11-dehydro-TXB2 was correlated with BNP (Rs=0.59), 8-iso-PGF2alpha (Rho=0.58), and CD40L (Rs=0.61) (all p<0.0001). Multiple regression analysis revealed that higher BNP levels (Beta Coefficient = 0.74), no aspirin therapy (-0.41), and higher sCD40L levels (0.32) (all p<0.0001), independently predicted the excretion rate of 11-dehydro-TXB2 in the 84 pts. Conclusions: Persistent platelet activation characterizes patients with heart failure.This phenomenon is related to disease severity and is largely suppressable by low-dose aspirin
SA-21 PREVALENCE OF CORONARY ARTERY DISEASE AND PLAQUE MORPHOLOGY ASSESSED BY MULTI-SLICE COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN ASYMPTOMATIC PATIENTS WITH VERY HIGH CARDIOVASCULAR RISK R. Nasti 1 , M.L. Mangoni 2 , R.R. Auriemma 2 , S. Esposito 2 , L. Picardi 3 , O. Carbonara 1 , A. Ascione 1 , F. Zibella 1 , R. D’Urso 1 , R. Torella 1 , F.C. Sasso 1 . 1 Dip. di Medicina Sperimentale, SUN; 2 Dip. di Radiologia, ASL-NA4; 3 Dip. di Cardiologia, ASL-NA4 Cardiovascular complications, including coronary artery disease (CAD), are
the leading causes of morbidity and mortality in individuals with type 2 diabetes mellitus. The 10-year mortality in patients with known CAD and diabetes exceeds 70%. Diabetic nephropathy allows us to identify a group of patients at very high cardio-renal risk. Recently, multi-slice computed tomography (MSCT) has been proposed as an alternative imaging technique for the evaluation of patients with known or suspected CAD. MSCT allows anatomic, non-invasive imaging of the coronary arteries, including detection of coronary atherosclerosis by assessing the coronary artery calcium burden (calcium scoring) and performing non-invasive angiography. This technique has the capacity to detect CAD at an early stage. The recent 64-slice MSCT showed high sensitivity and specificity for the detection of significant (≥50% luminal narrowing) stenosis, and this technique has been validated. We have enrolled 18 patients (mean age 61+8) following these inclusion criteria: type 2 diabetes, microalbuminuria (AER >30 <300 mg/24h), macroalbuminuria (AER>300 mg/24h), severe diabetic retinopathy, stress and rest single photon emission computer tomography test negative for inducible myocardial ischemia, age >40 years. Patients were studied with 64 slice TC. Cardio-MSCT showed following results: nine patients (50%) show obstructive plaques, 5 patients (27,7%) had calcified and mixed non obstructive plaques (<50%), three patients (16,6%) did not show any coronary plaques. Nine patients with obstructive plaques performed an invasive coronary angiography. MSCT detected a high prevalence of CAD in asymptomatic patients with type 2 diabetes with diabetic nephropathy, without history of coronary heart disease, and negative for inducible ischemia to traditional screening. In conclusion MSCT results useful for early diagnosis of coronary heart disease in patient with type 2 diabetes and diabetic nephropathy
Saturday, 10 May 2008, 11.45–13.00
Room C
Emergency Medicine SA-22 CLINICAL CHARACTERISATION AND CORRELATES OF ANEMIA IN A COHORT OF ELDERLY PATIENTS WITH ACUTE CARDIOGENIC PULMONARY OEDEMA Giovanna Graziadei, Christian Folli, Valeria Savojardo, Annamaria Brambilla, Ciro Canetta, Roberto Cosentini, Angelo Rovellini, Valter Monzani. IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy Aims: The clinical characteristics of anemia are poorly known in acute cardiogenic pulmonary oedema (ACPE). Moreover, the cut-off points of hemoglobin (Hb) concentration for diagnosis of anemia are frequently discordant. We aimed to characterise anemia in patients with ACPE by using the World Health Organization (WHO) criteria for diagnosis of anemia and to compare anemia status, as diagnosed according to the WHO criteria, to anemia status as diagnosed by restrictive criteria (Hb concentrations <12 gramms in men and <11 gramms in females). Methods and Results: We evaluated 200 patients with ACPE. 37% had anemia according to the WHO criteria. Anemic patients were older, had higher serum creatinine, I-Troponin and C-reactive protein, and lower total and LDL-cholesterol, blood iron, plasma albumin, arterial pCO2, and diastolic blood pressure than non-anemic patients. Anemic females had higher LVEF than males. On multivariate analysis, higher serum creatinine and lower serum total cholesterol were independent predictors of anemia in females, and higher serum creatinine, lower serum iron and LVEF in males. Patients with more severe anemia received CPAP- and nitrate treatment less frequently than non-anemic patients. In males, anemia was prevalently normocytic, while 20% of anemic females had microcytic iron-deficiency anemia. By diagnostic restrictive criteria for anemia, the prevalence of anemia decreased from 36 to 19.5%. In females microcytic forms increased from 20 to 33%, while in males anemia remained predominantly normocytic. The susceptibility to CPAP treatment decreased from 72.2 to 61.5% of cases. Conclusion: Renal failure is a powerful predictor of anemia, but the cause of anemia in ACPE is multifactorial, including inflammation status and malnutrition. Important clinical differences among gender are present in the anemic pattern, suggesting that sex-specific targets should be applied. Finally, the cut-off values of Hb concentration influence the clinical features of the anemic population.
Oral Communications / European Journal of Internal Medicine 19S (2008), S1–S59
end lowering the absorption [ezetimibe (E)]. Moreover, the fixed associative therapy improves the therapy compliance because patient get just a pill daily. Actually, the only available fixed associative therapy is formed by simvastatin (S) ed E (Inegy® , Vytorin® ). In our office, we evaluated the achieving of therapeutic goal (LDL <100 mg/dl) in moderate-high risk hyperlipidaemic patients using S+E 40+10 mg fixed therapy once a day. Moreover, we evaluated the difference of the principal lipidic parameters after the beginning of the therapy. Forty moderate-high risk hyperlipidaemic patients were enrolled (18 male; 22 female). The medium age was 53.4±11.1 years. All the data are available for 38 of the 40 patients. After three months the beginning of the fixed therapy, 32 patients (78.9%) have reached the given therapeutic goal. The levels of cholesterol decreased of 45.09% (from 275±41.1 to 151±32.2 mg/dl). The levels of HDL raised of 4% (from 49±8.65 to 50±8.9 mg/dl). The levels of trglycerides decreased of 30.5% (from 199±91.8 to 139±82 mg/dl). Overall, the levels of LDL decreased of 59.72% (from 185.995±41.66 to 74.91±31.01 mg/dl). The fixed hypolipidaemic therapy with S+E is useful to achieve the therapeutic goal in moderate-high risk patients
SA-20 DETERMINANTS OF PLATELET ACTIVATION IN HEART FAILURE Francesca Santilli 1 , Stefania Basili 2 , Stefano Lattanzio 1 , Adele Cavoni 1 , Giuseppe Guizzardi 1 , Lucrezia De Feudis 1 , Giancarlo Traisci 1 , Giovanni Ciabattoni 1 , Giovanni Davì 1 , Carlo Patrono 3 . 1 University of Chieti “G. D’Annunzio”; 2 University of Rome “La Sapienza”; 3 Catholic University, Rome, Italy Introduction: Thromboembolism is a critical and relatively common complication of chronic heart failure (HF). Methods: We performed a cross-sectional study in 84 HF patients [33 M; 81±8 yr; 49 in I-II, 35 in III-IV New York Heart Association (NYHA) class] and 42 controls, using urinary (U) 8-iso-prostaglandin (PG) F2alpha and 11-dehydro-thromboxane (TX) B2 as non-invasive indexes of oxidative stress and platelet activation, respectively, B-type natriuretic peptide (BNP) as a biomarker of cardiac function, plasma asymmetric dimethylarginine (ADMA) as an index of endothelial dysfunction, C-reactive protein (CRP) and sCD40 ligand (sCD40L) as markers of inflammation. Results: Forty-two HF patients not on aspirin treatment had significantly higher U-11-dehydro-TXB2 excretion [Median (IQR): 1488 (824-2130) vs 440 (313-611) pg/mg cr], 8-iso-PGF2alpha [528 (430-702) vs. 304 (228-364) pg/mg cr], BNP [363 (196-659) vs 78 (56-98) pg/mL], ADMA (1.6±0.5 vs 0.5±0.2 micromol/L), CRP [1.74 (0.98-2.7) vs 0.5 (0.4-0.7) mg/L] and sCD40L levels [1342 (653-2320) vs 432 (322-840) pg/mL] (all p<0.0001) than controls. Forty-two HF patients on low-dose aspirin showed significantly lower 11-dehydro-TXB2 [343 (227-455) pg/mg cr, p<0.007] and sCD40L levels [820 (535-1160) pg/mL, p<0.02] than HF patients not on aspirin. Patients in NYHA classes III-IV showed higher U-11-dehydro-TXB2 excretion than patients in I-II classes, independently of aspirin treatment (p<0.05). In the 42 HF patients not on aspirin, U-11-dehydro-TXB2 was correlated with BNP (Rs=0.59), 8-iso-PGF2alpha (Rho=0.58), and CD40L (Rs=0.61) (all p<0.0001). Multiple regression analysis revealed that higher BNP levels (Beta Coefficient = 0.74), no aspirin therapy (-0.41), and higher sCD40L levels (0.32) (all p<0.0001), independently predicted the excretion rate of 11-dehydro-TXB2 in the 84 pts. Conclusions: Persistent platelet activation characterizes patients with heart failure.This phenomenon is related to disease severity and is largely suppressable by low-dose aspirin
SA-21 PREVALENCE OF CORONARY ARTERY DISEASE AND PLAQUE MORPHOLOGY ASSESSED BY MULTI-SLICE COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN ASYMPTOMATIC PATIENTS WITH VERY HIGH CARDIOVASCULAR RISK R. Nasti 1 , M.L. Mangoni 2 , R.R. Auriemma 2 , S. Esposito 2 , L. Picardi 3 , O. Carbonara 1 , A. Ascione 1 , F. Zibella 1 , R. D’Urso 1 , R. Torella 1 , F.C. Sasso 1 . 1 Dip. di Medicina Sperimentale, SUN; 2 Dip. di Radiologia, ASL-NA4; 3 Dip. di Cardiologia, ASL-NA4 Cardiovascular complications, including coronary artery disease (CAD), are
the leading causes of morbidity and mortality in individuals with type 2 diabetes mellitus. The 10-year mortality in patients with known CAD and diabetes exceeds 70%. Diabetic nephropathy allows us to identify a group of patients at very high cardio-renal risk. Recently, multi-slice computed tomography (MSCT) has been proposed as an alternative imaging technique for the evaluation of patients with known or suspected CAD. MSCT allows anatomic, non-invasive imaging of the coronary arteries, including detection of coronary atherosclerosis by assessing the coronary artery calcium burden (calcium scoring) and performing non-invasive angiography. This technique has the capacity to detect CAD at an early stage. The recent 64-slice MSCT showed high sensitivity and specificity for the detection of significant (≥50% luminal narrowing) stenosis, and this technique has been validated. We have enrolled 18 patients (mean age 61+8) following these inclusion criteria: type 2 diabetes, microalbuminuria (AER >30 <300 mg/24h), macroalbuminuria (AER>300 mg/24h), severe diabetic retinopathy, stress and rest single photon emission computer tomography test negative for inducible myocardial ischemia, age >40 years. Patients were studied with 64 slice TC. Cardio-MSCT showed following results: nine patients (50%) show obstructive plaques, 5 patients (27,7%) had calcified and mixed non obstructive plaques (<50%), three patients (16,6%) did not show any coronary plaques. Nine patients with obstructive plaques performed an invasive coronary angiography. MSCT detected a high prevalence of CAD in asymptomatic patients with type 2 diabetes with diabetic nephropathy, without history of coronary heart disease, and negative for inducible ischemia to traditional screening. In conclusion MSCT results useful for early diagnosis of coronary heart disease in patient with type 2 diabetes and diabetic nephropathy
Saturday, 10 May 2008, 11.45–13.00
Room C
Emergency Medicine SA-22 CLINICAL CHARACTERISATION AND CORRELATES OF ANEMIA IN A COHORT OF ELDERLY PATIENTS WITH ACUTE CARDIOGENIC PULMONARY OEDEMA Giovanna Graziadei, Christian Folli, Valeria Savojardo, Annamaria Brambilla, Ciro Canetta, Roberto Cosentini, Angelo Rovellini, Valter Monzani. IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy Aims: The clinical characteristics of anemia are poorly known in acute cardiogenic pulmonary oedema (ACPE). Moreover, the cut-off points of hemoglobin (Hb) concentration for diagnosis of anemia are frequently discordant. We aimed to characterise anemia in patients with ACPE by using the World Health Organization (WHO) criteria for diagnosis of anemia and to compare anemia status, as diagnosed according to the WHO criteria, to anemia status as diagnosed by restrictive criteria (Hb concentrations <12 gramms in men and <11 gramms in females). Methods and Results: We evaluated 200 patients with ACPE. 37% had anemia according to the WHO criteria. Anemic patients were older, had higher serum creatinine, I-Troponin and C-reactive protein, and lower total and LDL-cholesterol, blood iron, plasma albumin, arterial pCO2, and diastolic blood pressure than non-anemic patients. Anemic females had higher LVEF than males. On multivariate analysis, higher serum creatinine and lower serum total cholesterol were independent predictors of anemia in females, and higher serum creatinine, lower serum iron and LVEF in males. Patients with more severe anemia received CPAP- and nitrate treatment less frequently than non-anemic patients. In males, anemia was prevalently normocytic, while 20% of anemic females had microcytic iron-deficiency anemia. By diagnostic restrictive criteria for anemia, the prevalence of anemia decreased from 36 to 19.5%. In females microcytic forms increased from 20 to 33%, while in males anemia remained predominantly normocytic. The susceptibility to CPAP treatment decreased from 72.2 to 61.5% of cases. Conclusion: Renal failure is a powerful predictor of anemia, but the cause of anemia in ACPE is multifactorial, including inflammation status and malnutrition. Important clinical differences among gender are present in the anemic pattern, suggesting that sex-specific targets should be applied. Finally, the cut-off values of Hb concentration influence the clinical features of the anemic population.