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Insight into Retardation of Aortic Stenosis: A Therapeutic Role for ACE Inhibitors?
S208
Abstracts
Heart, Lung and Circulation 2011;20S:S156–S251
ABSTRACTS
507
508
Insight into Retardation of Aortic Stenosis: A Therapeutic Role for ACE Inhibitors?
Limited Utility of Exercise Stress Test in the Evaluation of Suspected Acute Coronary Syndrome in Patients Aged Less Than 40 Years with Intermediate Risk Features
A. Sverdlov, D. Ngo, Y. Chirkov, J. Horowitz ∗ The Queen Elizabeth Hospital, University of Adelaide, Australia Background: Aortic valve stenosis (AS) and its precursor, aortic sclerosis (ASc) occur frequently in Western populations. Investigations to retard progression of AS using statins have been unsuccessful. Recently, we have shown that (1) development of ASc in humans is associated with increased aortic valve backscatter (AVBS), and (2) in an animal model, ramipril retarded AVBS progression and AS development. We now sought to identify factors associated with progression of ASc in humans. Methods and results: At baseline and after four years, 204 randomly selected, ageing subjects (age 63 ± 6 years at study entry) underwent echocardiography with determination of AVBS values, measurements of platelet nitric oxide responsiveness, plasma asymmetric dimethylarginine concentrations, lipid profile, hs-CRP, routine biochemistry, and 25-hydroxyvitamin D levels. Subsequently 68% of subjects had detectable AVBS progression and 17.2% developed new ASc. On multiple linear regression analysis, the only predictor of lack of disease progression in the overall cohort was the use of ACE inhibitors/angiotensin II receptor blockers (ACEI/AIIRB) (β = 0.651; p < 0.001). In subjects without ASc at baseline (n = 160), independent predictors of no progression of disease were use of ACEI/AIIRB (β = 1.3; p = 0.001) and higher vitamin D levels (β = 0.18; p = 0.035). No conventional coronary risk factors were associated with disease progression. Conclusion: This study of early aortic valve disease detected ASc progression in the majority of the normal ageing population over a four year period; reinforces clinical data dissociating progression of ASc from coronary risk factors; and provides additional data linking ACEI/AIIRBs use with retardation of ASc. doi:10.1016/j.hlc.2011.05.511
A. Lamanna 1,∗ , A. Scott 1,5 , J. Bilesky 1,2 , J. Greenslade 2,4 , L. Cullen 2,4,5 , C. Denaro 3,4 , A. Brown 2,4 , W. Parsonage 1 1 Department of Cardiology, Royal Brisbane and Women’s Hos-
pital, Brisbane, QLD, Australia of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia 3 Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia 4 School of Medicine, University of Queensland, Brisbane, QLD, Australia 5 School of Public Health, Queensland University of Technology, Brisbane, QLD, Australia 2 Department
Introduction: National Heart Foundation guidelines for the management of acute coronary syndrome (ACS) recommend provocative testing to risk stratify intermediate risk patients presenting with symptoms of ACS. This approach is applied to young adults under the age of 40 years despite their lower pre-test probability of coronary artery disease. The utility of EST in young adults with suspected intermediate risk ACS who have negative serial cardiac biomarkers and non-diagnostic ECG was evaluated. Methods: An analysis of exercise stress tests (EST) performed in the RBWH Cardiology Department on patients aged less than 40 years referred through the Emergency Department chest pain pathway between November 2005 and January 2011 was undertaken. Results: There were 3987 patients with intermediate risk ACS who underwent an EST. 1027 (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of the 1027 patients had positive tests. Of these, three patients had subsequent non-invasive investigation that yielded negative result, i.e. were false positive. One patient did not undergo further investigation and was assumed to be a true positive. Thus only one of 1027 patients (0.097%) had a positive EST. Conclusion: One quarter of patients presenting with symptoms of suspected intermediate risk ACS were aged less than 40 years. EST has limited value in the risk stratification of adults under the age of 40 years with intermediate risk ACS who have negative cardiac biomarkers and non-diagnostic ECGs. The current recommendation for provocative testing in all patients with intermediate risk features appears unnecessary. doi:10.1016/j.hlc.2011.05.512
Abstracts
Heart, Lung and Circulation 2011;20S:S156–S251
ABSTRACTS
507
508
Insight into Retardation of Aortic Stenosis: A Therapeutic Role for ACE Inhibitors?
Limited Utility of Exercise Stress Test in the Evaluation of Suspected Acute Coronary Syndrome in Patients Aged Less Than 40 Years with Intermediate Risk Features
A. Sverdlov, D. Ngo, Y. Chirkov, J. Horowitz ∗ The Queen Elizabeth Hospital, University of Adelaide, Australia Background: Aortic valve stenosis (AS) and its precursor, aortic sclerosis (ASc) occur frequently in Western populations. Investigations to retard progression of AS using statins have been unsuccessful. Recently, we have shown that (1) development of ASc in humans is associated with increased aortic valve backscatter (AVBS), and (2) in an animal model, ramipril retarded AVBS progression and AS development. We now sought to identify factors associated with progression of ASc in humans. Methods and results: At baseline and after four years, 204 randomly selected, ageing subjects (age 63 ± 6 years at study entry) underwent echocardiography with determination of AVBS values, measurements of platelet nitric oxide responsiveness, plasma asymmetric dimethylarginine concentrations, lipid profile, hs-CRP, routine biochemistry, and 25-hydroxyvitamin D levels. Subsequently 68% of subjects had detectable AVBS progression and 17.2% developed new ASc. On multiple linear regression analysis, the only predictor of lack of disease progression in the overall cohort was the use of ACE inhibitors/angiotensin II receptor blockers (ACEI/AIIRB) (β = 0.651; p < 0.001). In subjects without ASc at baseline (n = 160), independent predictors of no progression of disease were use of ACEI/AIIRB (β = 1.3; p = 0.001) and higher vitamin D levels (β = 0.18; p = 0.035). No conventional coronary risk factors were associated with disease progression. Conclusion: This study of early aortic valve disease detected ASc progression in the majority of the normal ageing population over a four year period; reinforces clinical data dissociating progression of ASc from coronary risk factors; and provides additional data linking ACEI/AIIRBs use with retardation of ASc. doi:10.1016/j.hlc.2011.05.511
A. Lamanna 1,∗ , A. Scott 1,5 , J. Bilesky 1,2 , J. Greenslade 2,4 , L. Cullen 2,4,5 , C. Denaro 3,4 , A. Brown 2,4 , W. Parsonage 1 1 Department of Cardiology, Royal Brisbane and Women’s Hos-
pital, Brisbane, QLD, Australia of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia 3 Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia 4 School of Medicine, University of Queensland, Brisbane, QLD, Australia 5 School of Public Health, Queensland University of Technology, Brisbane, QLD, Australia 2 Department
Introduction: National Heart Foundation guidelines for the management of acute coronary syndrome (ACS) recommend provocative testing to risk stratify intermediate risk patients presenting with symptoms of ACS. This approach is applied to young adults under the age of 40 years despite their lower pre-test probability of coronary artery disease. The utility of EST in young adults with suspected intermediate risk ACS who have negative serial cardiac biomarkers and non-diagnostic ECG was evaluated. Methods: An analysis of exercise stress tests (EST) performed in the RBWH Cardiology Department on patients aged less than 40 years referred through the Emergency Department chest pain pathway between November 2005 and January 2011 was undertaken. Results: There were 3987 patients with intermediate risk ACS who underwent an EST. 1027 (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of the 1027 patients had positive tests. Of these, three patients had subsequent non-invasive investigation that yielded negative result, i.e. were false positive. One patient did not undergo further investigation and was assumed to be a true positive. Thus only one of 1027 patients (0.097%) had a positive EST. Conclusion: One quarter of patients presenting with symptoms of suspected intermediate risk ACS were aged less than 40 years. EST has limited value in the risk stratification of adults under the age of 40 years with intermediate risk ACS who have negative cardiac biomarkers and non-diagnostic ECGs. The current recommendation for provocative testing in all patients with intermediate risk features appears unnecessary. doi:10.1016/j.hlc.2011.05.512