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Impact of sleep disordered breathing severity on the hemodynamics, functional status and autonomic function of chronic heart failure patients
S34 POSTER PRESENTATIONS
Heart, Lung and Circulation 2008;17S:S4–S53
Poster Presentations
control of heart failure has an important role in diabetic patients. doi:10.1016/j.hlc.2007.11.084 Effect of atorvastatin on paraoxonase (pon) gene family and oxidative stress in a hypercholesterolemiac Thai population Amar Nagila ∗ , Surerrut Porntadavity The School of Pharmaceutical and Biomedical Sciences, Department of Clinical Chemistry, Faculty of Medical Technology, Mahidol University, Thailand The paraoxonase (PON) gene family consists of three members, PON1, PON2 and PON3. PON reduces oxidative stress in plasma and tissues, thus protecting against cardiovascular diseases. The aim of this study is to investigate the effect of atorvastatin on PON levels and the influence of PON polymorphisms on the therapeutic response of atorvastatin in hypercholesterolemia Thai population. Atorvastatin significantly reduced TC (24.5%, P < 0.001), LDL (22.4%, P < 0.001), TG (24.4, P < 0.05), CD (4.4%, P < 0.05), MDA (15.2%, P < 0.01) and total peroxide (13.0%, P < 0.01) levels whereas, TAS level was significantly increased (27.3%, P < 0.001). Interestingly, there were significant increases in serum PON1 activity towards paraoxon (13.4%, P < 0.05) and PON3 activity towards P-NO2 butyrate (13.2%, P < 0.05), but PON2 activity in monocytes were not significantly changed after atorvastatin treatment. There were no significant differences of basal PON1 and PON2 activity according to PON1 and PON2 polymorphisms were observed. However, PON1T107C polymorphisms affected the therapeutic response of PON1 levels to atorvastatin therapy (P = 0.03). Taken together, atorvastatin treatment not only reduces atherogenic lipids but also reduced lipid oxidation and only PON1T-107C influence therapeutic response which may be via an increasing PON1 and PON3 enzyme activity. doi:10.1016/j.hlc.2007.11.085 Inflammatory markers (TNF-alpha, IL-6, CRP), BNP and spiroergometric stress test parameters in patients with heart failure and atrial fibrillation Bohdan Nessler a,∗ , Jadwiga Nessler a , Mariusz b , Andrzej Gackowski a , Wies3 awa Piwowarska a ˜ Kitlinski a Institute of Cardiology, Jagiellonian School of Medicine, Poland b Department of Cardiology, University Hospital, Malmoe, Sweden
Background: Heart failure frequently coexists with atrial fibrillation. There are only a few reports on concentrations of inflammatory markers (TNF-alpha, IL-6, CRP), BNP and exercise capacity evaluated by cardiopulmonary testing (CPX) in this group of patients. Aim: to compare concentrations of TNF-alpha, IL-6, CRP, BNP and CPX parameters in heart failure patients with atrial fibrillation and sinus rhythm.
Material and methods: 106 patients with heart failure in NYHA class II and III (AF group – 26 patients with atrial fibrillation and SR group – 80 patients with sinus rhythm). We analyzed functional capacity according to NYHA, concentrations of TNF-alpha, IL-6 and CRP, BNP, echocardiographic parameters (LVDd, LVEDV, EF) and CPX and gas exchange (tmax, HRs, HRmax, VO2peak % N, VO2peak). Results: LVEF was comparable between groups. In AF group as compared with SR group we found significantly higher CRP (21.13 ± 20.06 mg/dl vs. 13.2 ± 11.28 mg/dl; p = 0.04) and IL-6 (13.55 ± 10.94 pg/ml vs. 8.6 ± 7.33 pg/ml; p = 0.05), BNP (582.75 ± 179.35 pg/ml vs. 442.94 ± 213.75 pg/ml; p = 0.03). In AF patients there was a negative correlation between IL-6 and test duration (r = −0.24, p = 0.5) and MET (r = −0.24, p = 0.05). Conclusions: Patients with heart failure and atrial fibrillation have higher IL-6 and CRP, BNP indicating increased inflammatory reaction in this group. Atrial fibrillation significantly reduces exercise tolerance and peak oxygen consumption in patients with heart failure. doi:10.1016/j.hlc.2007.11.086 Impact of sleep disordered breathing severity on the hemodynamics, functional status and autonomic function of chronic heart failure patients Chin Chwan Austin Ng a,∗ , Chin Moi Chow b , Helen Wong a , Andrew Sindone a , Glen Davis b , Saul Freedman a a Cardiology
Department, Concord Hospital, The University of Sydney, Australia b Discipline of Exercise and Sport Science, The University of Sydney, Australia Background: Despite advances in medical therapy, sleep disordered breathing (SDB) remains highly prevalent in patients with chronic heart failure (CHF). We explored whether severity of the SDB impacts on the clinical profile of a contemporary cohort of heart failure patients. Methods: A cohort of 13 (12 males) consecutive ambulatory patients with stable CHF and SDB, confirmed on polysomnograph, were prospectively enrolled from a tertiary referral heart failure clinic. Patients underwent standard hemodynamic and functional assessments, treadmill cardiopulmonary testing, with gas exchange and heart rate variability (HRV) analyses. Results: Mean age was 66 ± 10 years; left ventricular ejection fraction 37 ± 9%; New York Heart Association functional class 2.1 ± 0.3. Majority were on chronic betablocker, angiotensin-converting enzyme inhibitor and/or angiotensin-II-receptor blocker. All had evidence of SDB: mean apnoea-hypopnoea index (AHI) 32 ± 19, with predominantly hypopnoea rather than apnoea events. Anthropomorphic measurements correlated positively with increasing AHI severity (P < 0.05). There was an inverse relationship between apnoea-hypopnoea duration (shorter) and mean SaO2 desaturation (greater) with
worsening SDB. Although SDB severity did not impact on VE/VCO2-slope and VE/VCO2, patients in the highest AHI tertile (AHI > 35) demonstrated significantly greater respiratory effort (VE, VO2 and VCO2) during and postexercise. Similarly, these patients had significantly higher mean resting heart rate and depressed heart rate variability compared to patients with milder SDB, which may be related to parasympathetic depression rather than increased sympathetic activity. Conclusions: Despite on contemporary heart failure medical therapy, evidence of sleep disordered breathing was found in all these patients with chronic stable heart failure, with adverse consequences that was related to the severity of the sleep disordered breathing. doi:10.1016/j.hlc.2007.11.087 Ten years experience with transposition of the great arteries associated with ventricular septal defect and left ventricular outflow tract obstruction (LVOTO) Mohammad Nobakht ∗ , Mohammad Yousef Aarabi, Akbar Shahmohammadi, Paridokhtnokhostin Davari, Seid Mahmood Meraji, Avisa Tabib, Hojjat Mortazaeiyan Heart Center, Pediatric Heart Department Rajaee Hospital, Tehran, Iran Objective: Our purpose was to describe the outcome of the corrent management of paediatric patients with D transposition of the great arteries associated with VSD & left ventricular outflow tract obstruction (LVOTO) in our centre that is the largest referral centre. Conclusions: At present the rastelli repair is the best procedure for management of DTGA-VSD) -(LVOTO) patient in our facility due to relative low mortality, but we should not ignore importance of intracardiac mixing mechanisms that dictate more than a simple palliative shunt in preparation for total corrective operation in future. Substantial late morbidity and mortality are associated with conduit obstruction, left ventricular outflow tract obstruction, residual VSD and rhythm disturbances especially complete heart block. Lack of Pulmonary arterial pressure measurement has been an important ignorance that resulted in long term morbidity and important cause of unsuccessful total cavopulmonary connection in Iran for congenital heart disease. doi:10.1016/j.hlc.2007.11.088 Intravenous amiodarone is superior to DC Cardioversion for maintaining sinus rhythm in new onset atrial fibrillation Brian Noronha ∗ , Gopala Rao, Leslie Innasimuthu, Gaurav Mathur University Hospital Aintree, Liverpool, UK Introduction: Only a few randomised trials on amiodarone treatment in acute AF are available and the results of these are inconsistent. We tested the hypothesis that
Poster Presentations
S35
chemical cardioversion with amiodarone is superior to DC Cardioversion in maintaining sinus rhythm in new onset atrial fibrillation (<48 h duration). Methods: Three hundred patients (males 56%, females 44%) with a mean age of 71 ± 0.5 years were prospectively randomised to receive either amiodarone (300 mg IV infusion over 30 min followed by 900 mg in 1 L of 5% dextrose over the next 20 h) or rate control medication followed by DC Cardioversion at 4 weeks. Patients were maintained on oral amiodarone (100–200 mg) following discharge. In the DC Cardioverted group rate control was initially achieved with beta blockers (45%), Digoxin (22%), Diltiazem (20%), amiodarone (8%) and others (5%). Serial follow ups were arranged at 3, 6 and 12 months in both groups. Data was analysed by unpaired students t test and a p value of <0.05 considered significant. Results: Sinus rhythm was restored immediately following cardioversion in 66.9% of patients (n = 101). In the amiodarone group, majority of patients (84.2%, n = 126) reverted to sinus rhythm before discharge. The results of cardioversion however were disappointing in the short and long term compared to amiodarone (3 months; 38.5% vs. 85.5%, p < 0.001; 6 months: 36.1% vs. 81.5%, p < 0.001; 12 months: 25.2% vs. 78.9%; p < 0.001). Only amiodarone (n = 20) and sotalol (n = 17) helped to maintain patients in sinus rhythm post-cardioversion at 1 year. Conclusions: Our study demonstrates that DC Cardioversion compared to amiodarone fails to maintain patients in sinus rhythm in the long term. Treatment with amiodarone or sotalol following DC shock may help in achieving this goal. doi:10.1016/j.hlc.2007.11.089 Some pathogenetic differences in heart failure caused by ischemic disease versus idiopathic dilated cardiomyopathy may be due to increased responsiveness to endothelin-1 in ischaemia Norayr Nranyan The study aims to investigate the differences in patients with ischemic cardiomyopathy (IC) vs. idiopathic dilated cardiomyopathy (IDC) as assessed by exercise test and neurohormones. A treadmill test was carried out in 15 patients with IDC and 19 patients with IC. Maximal oxygen consumption (MVO2), the ventilatory equivalent for carbon dioxide (VE/VCO2), anaerobic threshold (AT), exercise time (E) and HR were determined. BNP and endothelin-1 plasma levels were measured by radioimmunoassay before and at peak exercise. IC patients had the least efficient breathing (VE/VCO2 41.9 + 9.1 vs. 34.9 + 8.8, p < 0.01), lowest MVO2 (13.9 + 3.1 ml/min kg vs. 21.1 + 8.4, p < 0.001) and AT (8.0 + 2.5 ml/min kg vs. 11.7 + 3.6, p < 0.003), shortest E (245 + 110 s vs. 440 + 226, p < 0.005) compared to IDC patients. BNP increased significantly from 87.9 + 137.3 pg/ml to 125.7 + 161.6 in IDC and from 122.7 + 158.8 to 189.1 + 208.0 in IC (p < 0.0005). ET1 increased significantly from 5.8 + 2.3 pg/ml to 8.7 + 3.5 in IDC and from 5.1 + 3.3 to 8.2 + 4.4 in IC (p < 0.0001). A posi-
POSTER PRESENTATIONS
Heart, Lung and Circulation 2008;17S:S4–S53
Heart, Lung and Circulation 2008;17S:S4–S53
Poster Presentations
control of heart failure has an important role in diabetic patients. doi:10.1016/j.hlc.2007.11.084 Effect of atorvastatin on paraoxonase (pon) gene family and oxidative stress in a hypercholesterolemiac Thai population Amar Nagila ∗ , Surerrut Porntadavity The School of Pharmaceutical and Biomedical Sciences, Department of Clinical Chemistry, Faculty of Medical Technology, Mahidol University, Thailand The paraoxonase (PON) gene family consists of three members, PON1, PON2 and PON3. PON reduces oxidative stress in plasma and tissues, thus protecting against cardiovascular diseases. The aim of this study is to investigate the effect of atorvastatin on PON levels and the influence of PON polymorphisms on the therapeutic response of atorvastatin in hypercholesterolemia Thai population. Atorvastatin significantly reduced TC (24.5%, P < 0.001), LDL (22.4%, P < 0.001), TG (24.4, P < 0.05), CD (4.4%, P < 0.05), MDA (15.2%, P < 0.01) and total peroxide (13.0%, P < 0.01) levels whereas, TAS level was significantly increased (27.3%, P < 0.001). Interestingly, there were significant increases in serum PON1 activity towards paraoxon (13.4%, P < 0.05) and PON3 activity towards P-NO2 butyrate (13.2%, P < 0.05), but PON2 activity in monocytes were not significantly changed after atorvastatin treatment. There were no significant differences of basal PON1 and PON2 activity according to PON1 and PON2 polymorphisms were observed. However, PON1T107C polymorphisms affected the therapeutic response of PON1 levels to atorvastatin therapy (P = 0.03). Taken together, atorvastatin treatment not only reduces atherogenic lipids but also reduced lipid oxidation and only PON1T-107C influence therapeutic response which may be via an increasing PON1 and PON3 enzyme activity. doi:10.1016/j.hlc.2007.11.085 Inflammatory markers (TNF-alpha, IL-6, CRP), BNP and spiroergometric stress test parameters in patients with heart failure and atrial fibrillation Bohdan Nessler a,∗ , Jadwiga Nessler a , Mariusz b , Andrzej Gackowski a , Wies3 awa Piwowarska a ˜ Kitlinski a Institute of Cardiology, Jagiellonian School of Medicine, Poland b Department of Cardiology, University Hospital, Malmoe, Sweden
Background: Heart failure frequently coexists with atrial fibrillation. There are only a few reports on concentrations of inflammatory markers (TNF-alpha, IL-6, CRP), BNP and exercise capacity evaluated by cardiopulmonary testing (CPX) in this group of patients. Aim: to compare concentrations of TNF-alpha, IL-6, CRP, BNP and CPX parameters in heart failure patients with atrial fibrillation and sinus rhythm.
Material and methods: 106 patients with heart failure in NYHA class II and III (AF group – 26 patients with atrial fibrillation and SR group – 80 patients with sinus rhythm). We analyzed functional capacity according to NYHA, concentrations of TNF-alpha, IL-6 and CRP, BNP, echocardiographic parameters (LVDd, LVEDV, EF) and CPX and gas exchange (tmax, HRs, HRmax, VO2peak % N, VO2peak). Results: LVEF was comparable between groups. In AF group as compared with SR group we found significantly higher CRP (21.13 ± 20.06 mg/dl vs. 13.2 ± 11.28 mg/dl; p = 0.04) and IL-6 (13.55 ± 10.94 pg/ml vs. 8.6 ± 7.33 pg/ml; p = 0.05), BNP (582.75 ± 179.35 pg/ml vs. 442.94 ± 213.75 pg/ml; p = 0.03). In AF patients there was a negative correlation between IL-6 and test duration (r = −0.24, p = 0.5) and MET (r = −0.24, p = 0.05). Conclusions: Patients with heart failure and atrial fibrillation have higher IL-6 and CRP, BNP indicating increased inflammatory reaction in this group. Atrial fibrillation significantly reduces exercise tolerance and peak oxygen consumption in patients with heart failure. doi:10.1016/j.hlc.2007.11.086 Impact of sleep disordered breathing severity on the hemodynamics, functional status and autonomic function of chronic heart failure patients Chin Chwan Austin Ng a,∗ , Chin Moi Chow b , Helen Wong a , Andrew Sindone a , Glen Davis b , Saul Freedman a a Cardiology
Department, Concord Hospital, The University of Sydney, Australia b Discipline of Exercise and Sport Science, The University of Sydney, Australia Background: Despite advances in medical therapy, sleep disordered breathing (SDB) remains highly prevalent in patients with chronic heart failure (CHF). We explored whether severity of the SDB impacts on the clinical profile of a contemporary cohort of heart failure patients. Methods: A cohort of 13 (12 males) consecutive ambulatory patients with stable CHF and SDB, confirmed on polysomnograph, were prospectively enrolled from a tertiary referral heart failure clinic. Patients underwent standard hemodynamic and functional assessments, treadmill cardiopulmonary testing, with gas exchange and heart rate variability (HRV) analyses. Results: Mean age was 66 ± 10 years; left ventricular ejection fraction 37 ± 9%; New York Heart Association functional class 2.1 ± 0.3. Majority were on chronic betablocker, angiotensin-converting enzyme inhibitor and/or angiotensin-II-receptor blocker. All had evidence of SDB: mean apnoea-hypopnoea index (AHI) 32 ± 19, with predominantly hypopnoea rather than apnoea events. Anthropomorphic measurements correlated positively with increasing AHI severity (P < 0.05). There was an inverse relationship between apnoea-hypopnoea duration (shorter) and mean SaO2 desaturation (greater) with
worsening SDB. Although SDB severity did not impact on VE/VCO2-slope and VE/VCO2, patients in the highest AHI tertile (AHI > 35) demonstrated significantly greater respiratory effort (VE, VO2 and VCO2) during and postexercise. Similarly, these patients had significantly higher mean resting heart rate and depressed heart rate variability compared to patients with milder SDB, which may be related to parasympathetic depression rather than increased sympathetic activity. Conclusions: Despite on contemporary heart failure medical therapy, evidence of sleep disordered breathing was found in all these patients with chronic stable heart failure, with adverse consequences that was related to the severity of the sleep disordered breathing. doi:10.1016/j.hlc.2007.11.087 Ten years experience with transposition of the great arteries associated with ventricular septal defect and left ventricular outflow tract obstruction (LVOTO) Mohammad Nobakht ∗ , Mohammad Yousef Aarabi, Akbar Shahmohammadi, Paridokhtnokhostin Davari, Seid Mahmood Meraji, Avisa Tabib, Hojjat Mortazaeiyan Heart Center, Pediatric Heart Department Rajaee Hospital, Tehran, Iran Objective: Our purpose was to describe the outcome of the corrent management of paediatric patients with D transposition of the great arteries associated with VSD & left ventricular outflow tract obstruction (LVOTO) in our centre that is the largest referral centre. Conclusions: At present the rastelli repair is the best procedure for management of DTGA-VSD) -(LVOTO) patient in our facility due to relative low mortality, but we should not ignore importance of intracardiac mixing mechanisms that dictate more than a simple palliative shunt in preparation for total corrective operation in future. Substantial late morbidity and mortality are associated with conduit obstruction, left ventricular outflow tract obstruction, residual VSD and rhythm disturbances especially complete heart block. Lack of Pulmonary arterial pressure measurement has been an important ignorance that resulted in long term morbidity and important cause of unsuccessful total cavopulmonary connection in Iran for congenital heart disease. doi:10.1016/j.hlc.2007.11.088 Intravenous amiodarone is superior to DC Cardioversion for maintaining sinus rhythm in new onset atrial fibrillation Brian Noronha ∗ , Gopala Rao, Leslie Innasimuthu, Gaurav Mathur University Hospital Aintree, Liverpool, UK Introduction: Only a few randomised trials on amiodarone treatment in acute AF are available and the results of these are inconsistent. We tested the hypothesis that
Poster Presentations
S35
chemical cardioversion with amiodarone is superior to DC Cardioversion in maintaining sinus rhythm in new onset atrial fibrillation (<48 h duration). Methods: Three hundred patients (males 56%, females 44%) with a mean age of 71 ± 0.5 years were prospectively randomised to receive either amiodarone (300 mg IV infusion over 30 min followed by 900 mg in 1 L of 5% dextrose over the next 20 h) or rate control medication followed by DC Cardioversion at 4 weeks. Patients were maintained on oral amiodarone (100–200 mg) following discharge. In the DC Cardioverted group rate control was initially achieved with beta blockers (45%), Digoxin (22%), Diltiazem (20%), amiodarone (8%) and others (5%). Serial follow ups were arranged at 3, 6 and 12 months in both groups. Data was analysed by unpaired students t test and a p value of <0.05 considered significant. Results: Sinus rhythm was restored immediately following cardioversion in 66.9% of patients (n = 101). In the amiodarone group, majority of patients (84.2%, n = 126) reverted to sinus rhythm before discharge. The results of cardioversion however were disappointing in the short and long term compared to amiodarone (3 months; 38.5% vs. 85.5%, p < 0.001; 6 months: 36.1% vs. 81.5%, p < 0.001; 12 months: 25.2% vs. 78.9%; p < 0.001). Only amiodarone (n = 20) and sotalol (n = 17) helped to maintain patients in sinus rhythm post-cardioversion at 1 year. Conclusions: Our study demonstrates that DC Cardioversion compared to amiodarone fails to maintain patients in sinus rhythm in the long term. Treatment with amiodarone or sotalol following DC shock may help in achieving this goal. doi:10.1016/j.hlc.2007.11.089 Some pathogenetic differences in heart failure caused by ischemic disease versus idiopathic dilated cardiomyopathy may be due to increased responsiveness to endothelin-1 in ischaemia Norayr Nranyan The study aims to investigate the differences in patients with ischemic cardiomyopathy (IC) vs. idiopathic dilated cardiomyopathy (IDC) as assessed by exercise test and neurohormones. A treadmill test was carried out in 15 patients with IDC and 19 patients with IC. Maximal oxygen consumption (MVO2), the ventilatory equivalent for carbon dioxide (VE/VCO2), anaerobic threshold (AT), exercise time (E) and HR were determined. BNP and endothelin-1 plasma levels were measured by radioimmunoassay before and at peak exercise. IC patients had the least efficient breathing (VE/VCO2 41.9 + 9.1 vs. 34.9 + 8.8, p < 0.01), lowest MVO2 (13.9 + 3.1 ml/min kg vs. 21.1 + 8.4, p < 0.001) and AT (8.0 + 2.5 ml/min kg vs. 11.7 + 3.6, p < 0.003), shortest E (245 + 110 s vs. 440 + 226, p < 0.005) compared to IDC patients. BNP increased significantly from 87.9 + 137.3 pg/ml to 125.7 + 161.6 in IDC and from 122.7 + 158.8 to 189.1 + 208.0 in IC (p < 0.0005). ET1 increased significantly from 5.8 + 2.3 pg/ml to 8.7 + 3.5 in IDC and from 5.1 + 3.3 to 8.2 + 4.4 in IC (p < 0.0001). A posi-
POSTER PRESENTATIONS
Heart, Lung and Circulation 2008;17S:S4–S53