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Impact of stage III and IV diabetic nephropathy on cardiovascular disease
The aim of the present study was evaluation of the mass, size and LV function in athletes and hypertensive patients. Methods: We studied 52 soccer players (I group), 30 hypertensive patients (II group) and 15 healthy volunteers (III group). LV mass and function was evaluated by Doppler echocardiography. Results: In all groups LV-mass, End systolic–diastolic diameters, septum and posterior wall thickness, ejection fraction, LV diastolic filling velocities: VE, VA was measured. Pulmonary vein flow was assessed. LV mass index was 188 ± 14.5 g/m2 (95% CI 165–121) in I group, 168 ± 6.5 g/m2 (95% CI 138–182) in II group and 106 ± 5.3 g/m2 (95% CI 96.4–115.6) in III group. VE/VA in I group 1.1 ± 0.9 (95% CI 0.5–2.58), 0.85 ± 0.33 (95% CI 0.43–1.161) and 1.12 ± 0.3 (95% CI 0.72–1.52) in II and III groups. Comparison showed, that group of athletes is more heterogeneous depending on standard deviation and wide variation of 95% CI of study parameters. From me group 15 subjects were separated. In all of them variation of indices significantly exceeded the variations in control group. This 15 athletes formed group IA After separation I group became more homogeneous (group IB). In IA group LV mass index was 188 ± 3.2 g/m2 (95% CI 182–193.6) and 172 ± 4.1 g/m2 (95% CI 163.9–180) in IB group. VE/VA in IA group was 1.0 ± 0.25 (95% CI 0.56–1.44) and 2.2 ± 0.28 (95% CI 1.1–2.7). In IB group LV mass growth was associated with heart function enhancement, while in IA group large LV mass and signs of impaired diastolic function was found, like in patient’s group. Conclusions: We suggested that LV hypertrophy in athletes is not always pure physiologic adaptation and individuals with impaired LV function may be at higher risk of cardiovascular events, than athletes with preserved heart function. doi:10.1016/j.hlc.2007.11.104 How can we grade impaired relaxation pattern with elevated E/E as grade 1 diastolic dysfunction by echocardiography? Joon-Han Shin ∗ , Un-Jung Choi, Hong-Seok Lim, SooJin Kang, Jung-Won Hwang, Byoung-Joo Choi, So-Yeon Choi, Myeong-Ho Yoon, Gyo-Seung Hwang, Seung-Jea Tahk Ajou University School of Medicine, Republic of Korea Purpose: Impaired relaxation pattern (grade 1 diastolic dysfunction) by Doppler echocardiography is known to reflect preserved left ventricular filling pressure (LVFP), while increased ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E ) indicated elevated LVFP. We evaluated the characteristics of impaired relaxation pattern with elevated E/E’ ratio. Methods: Eighty-eight patients (mean age 63 ± 11, 59 males) who had coronary artery disease with impaired relaxation pattern (E/A < 1) were enrolled. Echocardiography including tissue Doppler imaging (TDI) was performed. All patients underwent cardiac catheterization to investigate LV pre-A pressure (LVPpre-A) within 6 h after
Poster Presentations
S41
Table 1. Parameters
E/E < 10 (n = 71) E/E ≥ 10 (n = 17) p-Value
LVPpre-A (mmHg) 13 ± 5 EF (%) 49 ± 9 LA volume (ml) 52 ± 19 E/A 0.69 ± 0.16 DT (ms) 230 ± 52 IVRT (ms) 144 ± 34 PVs/PVd 1.58 ± 0.38
20 40 63 0.69 230 145 1.62
± ± ± ± ± ± ±
5 6 18 0.12 53 23 0.40
<0.001 <0.001 0.039 0.994 0.995 0.932 0.726
echocardiographic measurement. Patients were divided into subjects with E/E’ < 10 (n = 71) and E/E ≥ 10 (n = 17). Results: LVPpre-A was well correlated with echocardiographic Doppler and hemodynamic parameters (E/E , r = 0.536, p < 0.001; LA volume, r = 0.295, p = 0.008; EF, r = −0.234, p = 0.028). Forty (45% of total) patients had high LVFP, defined as LVPpre-A ≥ 15 mmHg. Patients with E/E’ ≥ 10 had a significantly higher incidence of high LVFP, when compared to patients with E/E’ < 10 (88% vs. 35%, p < 0.001). LA volume and LVPpre-A were significantly increased and EF was decreased in patients with E/E ≥ 10 (Table 1). However, there were no significant differences of parameters derived from transmitral inflow and transpulmonary venous flow between two groups. Conclusions: In patients with impaired relaxation pattern, elevated E/E has related to elevation of LVFP, regardless of transmitral inflow and transpulmonary indices. Therefore, impaired relaxation pattern with elevated ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E ) may have been considered as another grade of diastolic dysfunction. doi:10.1016/j.hlc.2007.11.105 Impact of stage III and IV diabetic nephropathy on cardiovascular disease ˜ Neves Ana Paula Silva ∗ , Alexandre Baptista, Pedro Leao Hospital Distrital Faro Background and aims: Cardiovascular disease (CVD) is common in the general population, affecting the majority of adults past the age of 60 years. Patients with diabetes mellitus (DM) have a significantly higher risk and a higher mortality from cardiovascular disease. The diabetic patient has a 2–4-fold increase in the risk for development CVD. The aim of our study was to evaluate the impact of stage III and IV the diabetic nephropathy (DN) on cardiovascular and cerebrovascular (CV) disease. Methods: The retrospective study, comparative from January 2000 to September 2007. We analysed patients with nephropathy diabetic and divided in two groups: A (stage III DN) and group B (Stage IV DN). We have studied the distribution by age, laboratorial parameters, cardiovascular (manifested by myocardial infarction, angina pectoris, heart failure) and cerebrovascular (manifested by stroke and transient ischemic attack) disease.
POSTER PRESENTATIONS
Heart, Lung and Circulation 2008;17S:S4–S53
S42 POSTER PRESENTATIONS
Heart, Lung and Circulation 2008;17S:S4–S53
Poster Presentations
Statistical analysis was performed with Student’s t-test, χ2 test. Results: Group B, had lower haemoglobin level (12.6 g/dl vs. 13.6 g/dl, p = 0.006), lower creatinine clearance (50 ml/min vs. 80 ml/min, p = 0.0001) and elderly patients (60.5 years vs. 49.7 years, p = 0.006). There was also the incidence of CVD (p = 0.001) and CV (p = 0.002) was significantly higher. Conclusion: In our study the stage IV of diabetic nephropathy were greater the high rates of cardiovascular and cerebrovascular disease. doi:10.1016/j.hlc.2007.11.106 Inflammatory markers and progression of end-stage renal and cardiovascular disease in patients with diabetic nephropathy ˜ Neves Ana Paula Silva ∗ , Alexandre Baptista, Pedro Leao Hospital Distrital de Faro Introduction and aims: Chronic inflammation is increasingly recognized as an important issue due to its role in various pathological states. Diabetes is a risk factor for atherosclerosis and low-degree inflammation may play a central role in both diseases. Various reports have indicated a significant association between increase serum of inflammatory biomarkers, such as interleukin-6 (IL-6) and high sensitivity C reactive protein (hs CRP) and cardiovascular disease (CVD), mortality, morbidity and progression of end-stage renal disease (ESRD) in diabetic patients group. The aim of the present study was to assess the association between inflammatory biomarkers and fast progression of ESRD and cardiovascular disease in patients with diabetic nephropathy stage IV. Methods: We included 30 patients, type 2, and stage IV DN, mean age 68.2 years, followed in outpatient clinic for more than 24 months. The presence of inflammation parameters obtained from blood sample collected monthly since the first day of consultation. The CVD is manifested by myocardial infarction, angina pectoris, heart failure. The patients were divided in two groups: group A = 12 patients develop ESRD and beginning dialysis and group B = 18 patients not develop ESRD. The two groups were compared relation of IL-6, hs CPR and fast progression of ESRD and the cardiovascular disease. Results: The patients group A showed elevated IL-6 and hs CRP levels (6.7 vs. 4.0, p = 0.08) and (1.3 vs. 0.46, p = 0.015) and develop ESRD 20 months later and increase the cardiovascular disease. Conclusions: The present study elevated levels of IL-6 and hs CPR contribute to the development and the fast progression of ESRD and cardiovascular disease in patients with DN stage IV. doi:10.1016/j.hlc.2007.11.107
Interleukin-6 (IL-6): Is a marker for cardiovascular disease in patients with diabetic nephropathy Ana Paula Silva ∗ , Alexandre Baptista, Ana Cabrita, Pedro ˜ Neves Leao Hospital Distrital de Faro Interleukin-6 (IL-6) is synthesized in response to diverse inflammatory stimuli and causes cellular damage and promotes atherosclerotic process. Elevated concentrations of IL-6 are associated with the development and severity of coronary heart and renal disease. The aim of the present study was to assess the relationship between increased plasma IL-6 levels and outcome in patients with diabetic nephropathy (DN). We included 30 patients, mean age 80 years, followed in on low clearance outpatient clinic for more than 12 months. The presence of inflammation parameters obtained from blood samples collected monthly since the first day of consultation and the criterion of hospitalization (cardiovascular disease) is defined by medical history and clinical symptoms. The patients were divided in two groups: Group A = 12 patients beginning dialysis and Group B = 18 patients that not evolution of ESRF. The two groups were compared in relation of IL-6 and outcome (number and day of hospitalization from cardiovascular disease) in patients with DN. The IL-6 is measured by means IMMULITE 2000 analyser. The presence of clinical cardiovascular disease (CVD) was defined by medical history and clinical symptoms. For comparisons between groups, Student’s t-test and the χ2 test were used. The patients in the A group showed elevated IL-6 levels (6.7 vs. 4.0, p = 0.08) and the number and the duration of hospitalization in this group is significantly higher (1.42 vs. 0.1, p = 0.002 and 12 vs. 0.6 day, p = 0.004. The present study the elevated IL-6 plasma level has a major effect on cardiovascular disease in patients with diabetic nephropathy doi:10.1016/j.hlc.2007.11.108 Donor heart procurement experience in Singapore David Kheng Leng Sim ∗ , R.N. Ka Lee Kerk, R.N. Chia Lee Neo, Chong-Hee Lim, C. Sivathasan, Teing Ee Tan, Bernard Wing Kuin Kwok National Heart Centre, Singapore Background: Heart transplantation began in Singapore at our centre in 1990. Although the incidence of heart failure is increasing, the number of heart transplant being done remains low, mainly due to low organ donation rate and limited population. To alleviate the demand for more organ donors, Human Organ Transplant Act (HOTA) was amended in 2004 to allow removal of organ upon death unless the individual registered an objection. We review our organ procurement experience before after HOTA amendment.
Poster Presentations
S41
Table 1. Parameters
E/E < 10 (n = 71) E/E ≥ 10 (n = 17) p-Value
LVPpre-A (mmHg) 13 ± 5 EF (%) 49 ± 9 LA volume (ml) 52 ± 19 E/A 0.69 ± 0.16 DT (ms) 230 ± 52 IVRT (ms) 144 ± 34 PVs/PVd 1.58 ± 0.38
20 40 63 0.69 230 145 1.62
± ± ± ± ± ± ±
5 6 18 0.12 53 23 0.40
<0.001 <0.001 0.039 0.994 0.995 0.932 0.726
echocardiographic measurement. Patients were divided into subjects with E/E’ < 10 (n = 71) and E/E ≥ 10 (n = 17). Results: LVPpre-A was well correlated with echocardiographic Doppler and hemodynamic parameters (E/E , r = 0.536, p < 0.001; LA volume, r = 0.295, p = 0.008; EF, r = −0.234, p = 0.028). Forty (45% of total) patients had high LVFP, defined as LVPpre-A ≥ 15 mmHg. Patients with E/E’ ≥ 10 had a significantly higher incidence of high LVFP, when compared to patients with E/E’ < 10 (88% vs. 35%, p < 0.001). LA volume and LVPpre-A were significantly increased and EF was decreased in patients with E/E ≥ 10 (Table 1). However, there were no significant differences of parameters derived from transmitral inflow and transpulmonary venous flow between two groups. Conclusions: In patients with impaired relaxation pattern, elevated E/E has related to elevation of LVFP, regardless of transmitral inflow and transpulmonary indices. Therefore, impaired relaxation pattern with elevated ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E ) may have been considered as another grade of diastolic dysfunction. doi:10.1016/j.hlc.2007.11.105 Impact of stage III and IV diabetic nephropathy on cardiovascular disease ˜ Neves Ana Paula Silva ∗ , Alexandre Baptista, Pedro Leao Hospital Distrital Faro Background and aims: Cardiovascular disease (CVD) is common in the general population, affecting the majority of adults past the age of 60 years. Patients with diabetes mellitus (DM) have a significantly higher risk and a higher mortality from cardiovascular disease. The diabetic patient has a 2–4-fold increase in the risk for development CVD. The aim of our study was to evaluate the impact of stage III and IV the diabetic nephropathy (DN) on cardiovascular and cerebrovascular (CV) disease. Methods: The retrospective study, comparative from January 2000 to September 2007. We analysed patients with nephropathy diabetic and divided in two groups: A (stage III DN) and group B (Stage IV DN). We have studied the distribution by age, laboratorial parameters, cardiovascular (manifested by myocardial infarction, angina pectoris, heart failure) and cerebrovascular (manifested by stroke and transient ischemic attack) disease.
POSTER PRESENTATIONS
Heart, Lung and Circulation 2008;17S:S4–S53
S42 POSTER PRESENTATIONS
Heart, Lung and Circulation 2008;17S:S4–S53
Poster Presentations
Statistical analysis was performed with Student’s t-test, χ2 test. Results: Group B, had lower haemoglobin level (12.6 g/dl vs. 13.6 g/dl, p = 0.006), lower creatinine clearance (50 ml/min vs. 80 ml/min, p = 0.0001) and elderly patients (60.5 years vs. 49.7 years, p = 0.006). There was also the incidence of CVD (p = 0.001) and CV (p = 0.002) was significantly higher. Conclusion: In our study the stage IV of diabetic nephropathy were greater the high rates of cardiovascular and cerebrovascular disease. doi:10.1016/j.hlc.2007.11.106 Inflammatory markers and progression of end-stage renal and cardiovascular disease in patients with diabetic nephropathy ˜ Neves Ana Paula Silva ∗ , Alexandre Baptista, Pedro Leao Hospital Distrital de Faro Introduction and aims: Chronic inflammation is increasingly recognized as an important issue due to its role in various pathological states. Diabetes is a risk factor for atherosclerosis and low-degree inflammation may play a central role in both diseases. Various reports have indicated a significant association between increase serum of inflammatory biomarkers, such as interleukin-6 (IL-6) and high sensitivity C reactive protein (hs CRP) and cardiovascular disease (CVD), mortality, morbidity and progression of end-stage renal disease (ESRD) in diabetic patients group. The aim of the present study was to assess the association between inflammatory biomarkers and fast progression of ESRD and cardiovascular disease in patients with diabetic nephropathy stage IV. Methods: We included 30 patients, type 2, and stage IV DN, mean age 68.2 years, followed in outpatient clinic for more than 24 months. The presence of inflammation parameters obtained from blood sample collected monthly since the first day of consultation. The CVD is manifested by myocardial infarction, angina pectoris, heart failure. The patients were divided in two groups: group A = 12 patients develop ESRD and beginning dialysis and group B = 18 patients not develop ESRD. The two groups were compared relation of IL-6, hs CPR and fast progression of ESRD and the cardiovascular disease. Results: The patients group A showed elevated IL-6 and hs CRP levels (6.7 vs. 4.0, p = 0.08) and (1.3 vs. 0.46, p = 0.015) and develop ESRD 20 months later and increase the cardiovascular disease. Conclusions: The present study elevated levels of IL-6 and hs CPR contribute to the development and the fast progression of ESRD and cardiovascular disease in patients with DN stage IV. doi:10.1016/j.hlc.2007.11.107
Interleukin-6 (IL-6): Is a marker for cardiovascular disease in patients with diabetic nephropathy Ana Paula Silva ∗ , Alexandre Baptista, Ana Cabrita, Pedro ˜ Neves Leao Hospital Distrital de Faro Interleukin-6 (IL-6) is synthesized in response to diverse inflammatory stimuli and causes cellular damage and promotes atherosclerotic process. Elevated concentrations of IL-6 are associated with the development and severity of coronary heart and renal disease. The aim of the present study was to assess the relationship between increased plasma IL-6 levels and outcome in patients with diabetic nephropathy (DN). We included 30 patients, mean age 80 years, followed in on low clearance outpatient clinic for more than 12 months. The presence of inflammation parameters obtained from blood samples collected monthly since the first day of consultation and the criterion of hospitalization (cardiovascular disease) is defined by medical history and clinical symptoms. The patients were divided in two groups: Group A = 12 patients beginning dialysis and Group B = 18 patients that not evolution of ESRF. The two groups were compared in relation of IL-6 and outcome (number and day of hospitalization from cardiovascular disease) in patients with DN. The IL-6 is measured by means IMMULITE 2000 analyser. The presence of clinical cardiovascular disease (CVD) was defined by medical history and clinical symptoms. For comparisons between groups, Student’s t-test and the χ2 test were used. The patients in the A group showed elevated IL-6 levels (6.7 vs. 4.0, p = 0.08) and the number and the duration of hospitalization in this group is significantly higher (1.42 vs. 0.1, p = 0.002 and 12 vs. 0.6 day, p = 0.004. The present study the elevated IL-6 plasma level has a major effect on cardiovascular disease in patients with diabetic nephropathy doi:10.1016/j.hlc.2007.11.108 Donor heart procurement experience in Singapore David Kheng Leng Sim ∗ , R.N. Ka Lee Kerk, R.N. Chia Lee Neo, Chong-Hee Lim, C. Sivathasan, Teing Ee Tan, Bernard Wing Kuin Kwok National Heart Centre, Singapore Background: Heart transplantation began in Singapore at our centre in 1990. Although the incidence of heart failure is increasing, the number of heart transplant being done remains low, mainly due to low organ donation rate and limited population. To alleviate the demand for more organ donors, Human Organ Transplant Act (HOTA) was amended in 2004 to allow removal of organ upon death unless the individual registered an objection. We review our organ procurement experience before after HOTA amendment.