- Email: [email protected]
Influence of metabolic syndrome on cardiac structure and function and arterial stiffness in healthy children
S254
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
In contrast, neither ICAM-1 nor TF were increased in AMI patients versus control or SA patients (ICAM-1 = 84 ± 6 vs 101 ± 7 and 124 ± 7 ng/ml; TF = 350 ± 52 vs 234 ± 29 and 366 ± 46 pg/ml). Selective Egr-1-dependent molecules are increased acutely in humans in AMI. Egr-1 targeting may therefore provide some therapeutic benefit in AMI. doi:10.1016/j.hlc.2009.05.625 580 TAKOTSUBO CARDIOMYOPATHY: AN AUSTRALIAN SINGLE CENTRE EXPERIENCE WITH MEDIUM TERM FOLLOW-UP H. Samardhi, O.C. Raffel, T. Sirisena, D. Walters Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia Background: Takotsubo or Stress Cardiomyopathy (TC) is being increasingly recognized in patients presenting with clinical and biochemical features of acute coronary syndrome (ACS). We present a single centre experience of TC with a review of baseline features and medium term follow-up. Methods: Thirty-eight consecutive patients presenting to The Prince Charles Hospital with a diagnosis of TC from December 2006 to March 2009 were included. Results: Thirty-six (94.7%) patients were female with a mean age of 65 years. A stressful event preceded presentation in 22 (58%) patients of which 68% were emotional stressors. Chest pain was the commonest symptom (84%). One patient had an out of hospital cardiac arrest. ST segment elevation (50%) and Global T wave inversion (39%) were the most frequent ECG changes. 95% had a raised troponin. A diagnosis of TC was suspected in 5 patients with all others treated as an ACS. Thirty-five had typical angiographic apical ballooning and 3 had the mid segment variant. Thirty-four (89%) patients had an echocardiogram. Mean ejection fraction (EF) was 49% (20–70). Three had systolic anterior motion of the mitral valve with at least mild regurgitation. Mural thrombus was identified in two patients. In hospital complications occurred in 21% and included acute pulmonary edema (n = 6); cardiogenic shock (n = 3), stroke (n = 1) and atrial fibrillation (n = 3). Thirty-three (87%) had follow-up at a mean interval of 43 (1–115) weeks. There were no significant complications or recurrences at follow-up. Echocardiography (n = 15) demonstrated a significant improvement of EF (42.3% to 58.8%, p < 0.0001). Conclusions: The clinical demographics of our cohort are similar to those described in other regions. While TC is a reversible condition with low rates of complications and recurrence at follow-up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients. doi:10.1016/j.hlc.2009.05.626
581 THE INCIDENCE OF UNDIAGNOSED CARDIAC SARCOIDOSIS IN EXPLANTED HEARTS FOLLOWING HEART TRANSPLANTATION D. Arumugam, M. Brown, A. Galbraith, G. Javorsky, D. Platts The Prince Charles Hospital Background: Sarcoidosis is a multi-system disorder of unknown aetiology resulting in non-caseating granulomas. The incidence in Australia has been estimated at 4–6 per 100,000 with cardiac involvement in 25% of cases. The aim of this study was to assess the incidence of sarcoidosis in our heart transplant population. Method: We performed a retrospective evaluation of all cardiac transplants done at our institution. Presence or absence of sarcoidosis pre-transplant or in the explanted heart was evaluated. The initial aetiology and diagnostic testing results were compiled. Results: 301 cardiac transplants have been performed at our institution since 1991. Six cases (2%) were found unexpectedly to have sarcoidosis in the explanted heart. Average age at cardiomyopathy diagnosis was 42.5 ± 9 years. 4 presented with heart failure, 2 with ventricular tachycardia. Pre-transplant diagnoses were idiopathic dilated cardiomyopathy (n = 5), ischaemic cardiomyopathy (n = 1). Pre-transplant investigations: MRI (n = 1) with no evidence of cardiac sarcoidosis, TTE (n = 6) with no evidence of cardiac involvement, ACE level (n = 1) normal. 5 patients were transplanted within 2 years of diagnosis of cardiomyopathy. One patient had pulmonary sarcoidosis (stage I-steroid treated) diagnosed post transplant. No cases have had recurrent sarcoidosis in the transplanted heart. 1 patient died two days post transplant (primary graft failure)—the remainder have survived to date. Conclusion: Cardiac sarcoidosis can present with heart failure or arrhythmias and can be difficult to diagnose. 2% of cardiac transplants had sarcoidosis diagnosed on explanted heart histology. There has been no recurrence in the transplanted hearts, with good long-term survival. doi:10.1016/j.hlc.2009.05.627 Paediatric Cardiology 582 INFLUENCE OF METABOLIC SYNDROME ON CARDIAC STRUCTURE AND FUNCTION AND ARTERIAL STIFFNESS IN HEALTHY CHILDREN Walter P. Abhayaratna 1,2, , Satoru Hayes 1 ,
Christine
1 Canberra
Brown 1 ,
Sakuragi 1 , Katrina
Richard D. Telford 2
Hospital, Canberra, Australia National University, Canberra, Australia
2 Australian
Background: The influence of the clustered effects of metabolic syndrome (MetS) on cardiovascular phenotype in young children has been incompletely evaluated. In
Abstracts
this community-based study of healthy children, we determined the association between MetS and cardiac structure and carotid-femoral pulse wave velocity (PWV), an index of central arterial stiffness. Methods: Four hundred and thirty-nine non-diabetic children (mean age 10.1 ± 0.3 years; 51% boys) underwent clinical examination, a fasting blood test, and assessment of cardiac structure and function by echocardiography. Cardiorespiratory fitness and physical activity levels were determined using a 20-m shuttle run and 7-day pedometer count, respectively. PWV was estimated by applanation tonometry. MetS status was based on previously published guidelines for children. Results: Of the 8 (1.8%) subjects with 3 or more MetS components, 7 were girls (Table). In multivariable analysis, MetS was positively associated with left atrial and ventricular volumes, left ventricular mass, pulse pressure and PWV (all p < 0.01), independent of gender and fitness. Conclusion: MetS is associated with altered cardiac structure and increased arterial stiffness in prepubescent children. Metabolic Syndrome Score 0 (n = 330) Cardiorespiratory fitness (Stage) Body mass index (kg/m2 ) Pulse wave velocity (m/s) Left ventricular mass (g/m2.7 )
1–2 (n = 101)
p-value
3+ (n = 8)
4.6
3.5
<0.001
17.2
20.8
25.9
<0.001
4.3
4.6
4.6
<0.001
34
37
resistance exercise training in heart failure patients that measured BNP and/or ProBNP. Primary outcome measures were change in BNP and NT-proBNP. Secondary outcomes were change in functional capacity, exercise energy expenditure and measures of study quality. Results: Seven randomized controlled studies measuring BNP or NT-pro BNP met our eligibility criteria, including 411 subjects (230 exercise participants and 181 controls). Participants were matched for age and mostly male (50–89%) and New York Heart Association (NYHA) class I–II. Exercise training had a favourable effect on NTproBNP −679 pg/ml 95% C.I. (−756 to −601) p = <0.00001. Moreover the trials that showed a significant change in NT-proBNP all had a weekly exercise energy expenditure of more than 400 kcal. Conclusion: Data from seven published studies, suggest exercise training has a favorable effect on NT-proBNP in heart failure patients. Moreover our data suggest that exercise intensity and weekly minimum exercise energy expenditure may determine the magnitude and rate of change in the N-terminal portion of BNP in heart failure patients. doi:10.1016/j.hlc.2009.05.629
5.3
32
S255
<0.001
doi:10.1016/j.hlc.2009.05.628 Rehabilitation, Exercise and Prevention 583 A SYSTEMATIC REVIEW OF THE EFFECT OF AEROBIC AND RESISTANCE EXERCISE TRAINING ON SYSTEMIC BRAIN NATRIURETIC PEPTIDE (BNP) AND N-TERMINAL BNP EXPRESSION IN HEART FAILURE PATIENTS N. Smart, M. Steele Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia Background: BNP and the N-terminal portion (NTproBNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure on acute presentation. The aim of this work was to systematically review the effect of exercise training on BNP and NT-proBNP levels in patients with left ventricular dysfunction. Methods: A systematic search was conducted of Medline (Ovid) (1950–July 2008), Embase.com (1974–current), Cochrane Central Register of Controlled Trials, CINAHL (1981–current) and Web of Science (2000–current) to identify randomized controlled trials of aerobic and/or
584 A WORKING MODEL OF HOW TAI CHI HAS BEEN INCORPORATED INTO A CARDIAC REHABILITATION PROGRAM K. McCleary St. Vincent’s Hospital, Sydney, Australia Aim: To provide details of the working-model of how St. Vincent’s Hospital implemented a Tai Chi component into the existing cardiac rehabilitation exercise structure. Background: In 2008 the Cardiac Rehabilitation exercise program was reviewed and restructured by the physiotherapy department. Traditional Cardiac Rehabilitation programs contain a stretching element, upper limb weight exercises and an aerobic component. There is an abundance of research to support the benefits of the aerobic exercise component for heart disease patients, but little recent supportive literature for the benefits of warm-up stretches and upper limb weight exercises in this patient group. Much of the current research suggests that stretches are ineffective in reducing injuries, preventing delayed-onset muscle soreness and increasing muscle flexibility. The weight-exercise program for the upper limbs has been shown to be detrimental to the patient’s recovery, leading to sternal instability in at-risk patient groups. Conclusively, it was determined that a Tai Chi Exercise program would be implemented in place of the general stretching and upper-limb weight exercise components due to its researched benefits. Tai Chi has been shown to reduce stress, improve balance and flexibility, and reduce the incidence of falls –
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
In contrast, neither ICAM-1 nor TF were increased in AMI patients versus control or SA patients (ICAM-1 = 84 ± 6 vs 101 ± 7 and 124 ± 7 ng/ml; TF = 350 ± 52 vs 234 ± 29 and 366 ± 46 pg/ml). Selective Egr-1-dependent molecules are increased acutely in humans in AMI. Egr-1 targeting may therefore provide some therapeutic benefit in AMI. doi:10.1016/j.hlc.2009.05.625 580 TAKOTSUBO CARDIOMYOPATHY: AN AUSTRALIAN SINGLE CENTRE EXPERIENCE WITH MEDIUM TERM FOLLOW-UP H. Samardhi, O.C. Raffel, T. Sirisena, D. Walters Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia Background: Takotsubo or Stress Cardiomyopathy (TC) is being increasingly recognized in patients presenting with clinical and biochemical features of acute coronary syndrome (ACS). We present a single centre experience of TC with a review of baseline features and medium term follow-up. Methods: Thirty-eight consecutive patients presenting to The Prince Charles Hospital with a diagnosis of TC from December 2006 to March 2009 were included. Results: Thirty-six (94.7%) patients were female with a mean age of 65 years. A stressful event preceded presentation in 22 (58%) patients of which 68% were emotional stressors. Chest pain was the commonest symptom (84%). One patient had an out of hospital cardiac arrest. ST segment elevation (50%) and Global T wave inversion (39%) were the most frequent ECG changes. 95% had a raised troponin. A diagnosis of TC was suspected in 5 patients with all others treated as an ACS. Thirty-five had typical angiographic apical ballooning and 3 had the mid segment variant. Thirty-four (89%) patients had an echocardiogram. Mean ejection fraction (EF) was 49% (20–70). Three had systolic anterior motion of the mitral valve with at least mild regurgitation. Mural thrombus was identified in two patients. In hospital complications occurred in 21% and included acute pulmonary edema (n = 6); cardiogenic shock (n = 3), stroke (n = 1) and atrial fibrillation (n = 3). Thirty-three (87%) had follow-up at a mean interval of 43 (1–115) weeks. There were no significant complications or recurrences at follow-up. Echocardiography (n = 15) demonstrated a significant improvement of EF (42.3% to 58.8%, p < 0.0001). Conclusions: The clinical demographics of our cohort are similar to those described in other regions. While TC is a reversible condition with low rates of complications and recurrence at follow-up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients. doi:10.1016/j.hlc.2009.05.626
581 THE INCIDENCE OF UNDIAGNOSED CARDIAC SARCOIDOSIS IN EXPLANTED HEARTS FOLLOWING HEART TRANSPLANTATION D. Arumugam, M. Brown, A. Galbraith, G. Javorsky, D. Platts The Prince Charles Hospital Background: Sarcoidosis is a multi-system disorder of unknown aetiology resulting in non-caseating granulomas. The incidence in Australia has been estimated at 4–6 per 100,000 with cardiac involvement in 25% of cases. The aim of this study was to assess the incidence of sarcoidosis in our heart transplant population. Method: We performed a retrospective evaluation of all cardiac transplants done at our institution. Presence or absence of sarcoidosis pre-transplant or in the explanted heart was evaluated. The initial aetiology and diagnostic testing results were compiled. Results: 301 cardiac transplants have been performed at our institution since 1991. Six cases (2%) were found unexpectedly to have sarcoidosis in the explanted heart. Average age at cardiomyopathy diagnosis was 42.5 ± 9 years. 4 presented with heart failure, 2 with ventricular tachycardia. Pre-transplant diagnoses were idiopathic dilated cardiomyopathy (n = 5), ischaemic cardiomyopathy (n = 1). Pre-transplant investigations: MRI (n = 1) with no evidence of cardiac sarcoidosis, TTE (n = 6) with no evidence of cardiac involvement, ACE level (n = 1) normal. 5 patients were transplanted within 2 years of diagnosis of cardiomyopathy. One patient had pulmonary sarcoidosis (stage I-steroid treated) diagnosed post transplant. No cases have had recurrent sarcoidosis in the transplanted heart. 1 patient died two days post transplant (primary graft failure)—the remainder have survived to date. Conclusion: Cardiac sarcoidosis can present with heart failure or arrhythmias and can be difficult to diagnose. 2% of cardiac transplants had sarcoidosis diagnosed on explanted heart histology. There has been no recurrence in the transplanted hearts, with good long-term survival. doi:10.1016/j.hlc.2009.05.627 Paediatric Cardiology 582 INFLUENCE OF METABOLIC SYNDROME ON CARDIAC STRUCTURE AND FUNCTION AND ARTERIAL STIFFNESS IN HEALTHY CHILDREN Walter P. Abhayaratna 1,2, , Satoru Hayes 1 ,
Christine
1 Canberra
Brown 1 ,
Sakuragi 1 , Katrina
Richard D. Telford 2
Hospital, Canberra, Australia National University, Canberra, Australia
2 Australian
Background: The influence of the clustered effects of metabolic syndrome (MetS) on cardiovascular phenotype in young children has been incompletely evaluated. In
Abstracts
this community-based study of healthy children, we determined the association between MetS and cardiac structure and carotid-femoral pulse wave velocity (PWV), an index of central arterial stiffness. Methods: Four hundred and thirty-nine non-diabetic children (mean age 10.1 ± 0.3 years; 51% boys) underwent clinical examination, a fasting blood test, and assessment of cardiac structure and function by echocardiography. Cardiorespiratory fitness and physical activity levels were determined using a 20-m shuttle run and 7-day pedometer count, respectively. PWV was estimated by applanation tonometry. MetS status was based on previously published guidelines for children. Results: Of the 8 (1.8%) subjects with 3 or more MetS components, 7 were girls (Table). In multivariable analysis, MetS was positively associated with left atrial and ventricular volumes, left ventricular mass, pulse pressure and PWV (all p < 0.01), independent of gender and fitness. Conclusion: MetS is associated with altered cardiac structure and increased arterial stiffness in prepubescent children. Metabolic Syndrome Score 0 (n = 330) Cardiorespiratory fitness (Stage) Body mass index (kg/m2 ) Pulse wave velocity (m/s) Left ventricular mass (g/m2.7 )
1–2 (n = 101)
p-value
3+ (n = 8)
4.6
3.5
<0.001
17.2
20.8
25.9
<0.001
4.3
4.6
4.6
<0.001
34
37
resistance exercise training in heart failure patients that measured BNP and/or ProBNP. Primary outcome measures were change in BNP and NT-proBNP. Secondary outcomes were change in functional capacity, exercise energy expenditure and measures of study quality. Results: Seven randomized controlled studies measuring BNP or NT-pro BNP met our eligibility criteria, including 411 subjects (230 exercise participants and 181 controls). Participants were matched for age and mostly male (50–89%) and New York Heart Association (NYHA) class I–II. Exercise training had a favourable effect on NTproBNP −679 pg/ml 95% C.I. (−756 to −601) p = <0.00001. Moreover the trials that showed a significant change in NT-proBNP all had a weekly exercise energy expenditure of more than 400 kcal. Conclusion: Data from seven published studies, suggest exercise training has a favorable effect on NT-proBNP in heart failure patients. Moreover our data suggest that exercise intensity and weekly minimum exercise energy expenditure may determine the magnitude and rate of change in the N-terminal portion of BNP in heart failure patients. doi:10.1016/j.hlc.2009.05.629
5.3
32
S255
<0.001
doi:10.1016/j.hlc.2009.05.628 Rehabilitation, Exercise and Prevention 583 A SYSTEMATIC REVIEW OF THE EFFECT OF AEROBIC AND RESISTANCE EXERCISE TRAINING ON SYSTEMIC BRAIN NATRIURETIC PEPTIDE (BNP) AND N-TERMINAL BNP EXPRESSION IN HEART FAILURE PATIENTS N. Smart, M. Steele Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia Background: BNP and the N-terminal portion (NTproBNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure on acute presentation. The aim of this work was to systematically review the effect of exercise training on BNP and NT-proBNP levels in patients with left ventricular dysfunction. Methods: A systematic search was conducted of Medline (Ovid) (1950–July 2008), Embase.com (1974–current), Cochrane Central Register of Controlled Trials, CINAHL (1981–current) and Web of Science (2000–current) to identify randomized controlled trials of aerobic and/or
584 A WORKING MODEL OF HOW TAI CHI HAS BEEN INCORPORATED INTO A CARDIAC REHABILITATION PROGRAM K. McCleary St. Vincent’s Hospital, Sydney, Australia Aim: To provide details of the working-model of how St. Vincent’s Hospital implemented a Tai Chi component into the existing cardiac rehabilitation exercise structure. Background: In 2008 the Cardiac Rehabilitation exercise program was reviewed and restructured by the physiotherapy department. Traditional Cardiac Rehabilitation programs contain a stretching element, upper limb weight exercises and an aerobic component. There is an abundance of research to support the benefits of the aerobic exercise component for heart disease patients, but little recent supportive literature for the benefits of warm-up stretches and upper limb weight exercises in this patient group. Much of the current research suggests that stretches are ineffective in reducing injuries, preventing delayed-onset muscle soreness and increasing muscle flexibility. The weight-exercise program for the upper limbs has been shown to be detrimental to the patient’s recovery, leading to sternal instability in at-risk patient groups. Conclusively, it was determined that a Tai Chi Exercise program would be implemented in place of the general stretching and upper-limb weight exercise components due to its researched benefits. Tai Chi has been shown to reduce stress, improve balance and flexibility, and reduce the incidence of falls –
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286