- Email: [email protected]
O134 GAS emm-types probably involved in acute rheumatic fever
O133
Gerasimos Siasos1, Dimitris Tousoulis*1, Eleni Kokkou2, Stamatios Kioufis2, Evangelos Oikonomou2, Marina Zaromitidou2, Konstantinos Maniatis2, Nikolaos Gouliopoulos2, Panagiotis Tourikis2, Konstantinos Zisimos2, Savvas Mazaris2, Theodosia Konsola2, Vasiliki Genimata3, Christodoulos Stefanadis2 1 1st Cardiology Department, University of Athens Medical School, “Hippokration” Hospital, Athens, Greece, 21st Cardiology Department, 3University of Athens Medical School, “Hippokration” Hospital, Athens, Greece Introduction: The clinical benefit of clopidogrel and prasugrel has been attributed to their antiplatelet effects. Though, clopidogrel treatment has also pleiotropic vasoprotective effects, such as modulation of vascular tone, improvement of endothelial function, as well as inhibition of inflammation and oxidative stress. Objectives: We examined the impact of clopidogrel and prasugrel treatment on endothelial function and platelet reactivity in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). Methods: We consecutively enrolled 12 patients with stable CAD receiving prasugrel regimen (10mg/d) and 12 aged and sex matched CAD patients receiving clopidogrel regimen (75mg/d), one month after PCI. Flow mediated dilation (FMD) was used as a measured of endothelial function. High on treatment platelet reactivity was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU) and the diagnostic cut-off value is 230 PRU. Results: There was no difference between CAD patients on clopidogrel and prasugrel treatment in age (5610 years vs. 5610 years, p¼0.88), smoking habits (20% vs. 33%, p¼0.11), in the presence of diabetes mellitus (42% vs. 11%, p¼0.12), arterial hypertension (87% vs. 82%, p¼0.89),hyperlipidemia (90% vs. 85%, p¼0.25) and in the presence of multivessel CAD (40% vs. 30%, p¼0.24). Subjects on prasugrel treatment compared to subjects on clopidogrel treatment had significantly lower PRU (11180 vs. 23480, p¼0.001). The presence of patients with high on treatment platelet reactivity was significantly lower in prasugrel group, compared to clopidogrel group (8% vs. 50%, p¼0.03). Interestingly, subjects on prasugrel group had significantly improved endothelial function compared to subjects on clopidogrel group (9.823.63% vs. 6.721.39%, p¼0.01). Conclusion: Prasugrel, compared to clopidogrel treatment, showed a greater effect on endothelial function and inhibition of platelet activation in CAD patients after PCI. Further studies are needed to elucidate the impact of prasugrel and clopidogrel treatment on vascular function and atherosclerosis progression. Disclosure of Interest: G. Siasos: None Declared, D. Tousoulis: None Declared, E. Kokkou Grant/research support from: State Scholarship Foundation, S. Kioufis: None Declared, E. Oikonomou: None Declared, M. Zaromitidou: None Declared, K. Maniatis: None Declared, N. Gouliopoulos: None Declared, P. Tourikis: None Declared, K. Zisimos: None Declared, S. Mazaris: None Declared, T. Konsola: None Declared, V. Genimata: None Declared, C. Stefanadis: None Declared
O135 Newer insights on prognosis of reversible peripartum cardiomyopathy Cecily Mary Majella Jayaraj*, venkatesan sangareddi, gnanavelu ganesan, v. e. dhandapani, m. s. ravi, k. m. meenakshi, d. m muthukumar, n swaminathan, g. ravisankar, g. prathapkumar Cardiology, Madras Medical College and Research Institute, Chennai, India Introduction: Peripartum cardiomyopathy (PPCM) which was first described in the 1800s, yet its etiology is still unclear. Its diagnosis is often delayed because its symptoms closely resemble those within the normal spectrum of pregnancy and the postpartum period.Earlier diagnosis favours a better outcome. Objectives: To evaluate the clinical profile and prognosis of peripartum cardiomyopathy . Methods: Patients in the last month of pregnancy and 5 months postpartum referred for cardiac evaluation from september 1, 2011, to august 31,2012 were included in this study.Clinical and serial echocardiographic evaluation were done and followed up at 1, 3, and 6 months on these patients. Results: Among 5475 patients 14 patients[0.25%] were diagnosed as peripartum cardiomyopathy.Mean age:253years,time of presentation [last month of conception-4 [28%],first month of postpartum -10[72%],preceding h/o of viral fever- 2[14%]pregnancy induced hypertension [PIH]on betablockers-4[28%] ,mean ejectionfraction at presentation 308%,mean fractional shortening 224%,mean end-diastolic dimension [5.91.8cm] biventricular thrombi -2[14%]pulmonary embolism -3[21%][1-saddle type ,2- proximal left pulmonary artery]. Mortality-3/14[21%].Mortality was high among patients with massive pulmonary embolism and those with preceding viral fever.Follow up echo was done at discharge and after 1,3 and 6 months .Echocardiographic features at diagnosis were unable to predict individually who would eventually recover, although a statistically significant difference occurred at diagnosis between the recovered group and nonrecovered group for mean ejection fraction (28% vs 23%; P<.001) and fractional shortening (18% vs 14%; P¼.004).of leftventricle,whereas mean end-diastolic dimension (6.1 vs 5.7 cm; P¼.08)was not statistically significant,Patients with pregnancy induced hypertension[428%] had earlier [3months vs 6months ] and complete recovery of ejection fraction [58.6vs 36.8 p¼0.02]. Conclusion: We conclude PPCM when associated with PIH shows relatively a better outcome .The reason could be earlier exposure to betablockers may moderate the disease progression and make it more likely,that full recovery will occur.Gestational hypertension brings patients for medical and cardiac evaluation earlier resulting in earlier and better prognosis. Disclosure of Interest: None Declared
O134 O136
GAS emm-types probably involved in acute rheumatic fever 1
1
2,3
3,4
Noémie Baroux , Eric D’Ortenzio , Pierre Smeesters , Andrew Steer* 1 Epidemiology of infectious diseases, Institut Pasteur de Nouvelle-Calédonie, Noumea, New Caledonia, 2Laboratoire de Génétique et Physiologie Bactérienne, Institut de Biologie et de Médecine Moléculaires, Faculté des Sciences, Université Libre de Bruxelles, Gosselies, Belgium, 3 Group A Streptococcus, Murdoch Childrens Research Institute, 4Centre for International Child Health, University of Melbourne, Melbourne, Australia Introduction: Group A streptococcal (GAS) is responsible for the chain leading to acute rheumatic fever (ARF) and rheumatic heart disease (RHD). That certain GAS strains may be more rheumatogenic than others is a concept widely believed. However, there has only been a single review of predominant serotypes involved in streptococcal outbreaks associated with ARF between 1939 and 1971. This review of US studies found the following emm-types to be associated with ARF: 1, 3, 5, 6, 14, 18, 19, 24, 27 and 29. However, a review of GAS emm-types associated with ARF in developing countries, where ARF is endemic, has never been undertaken. Objectives: The aim of this systematic review was to provide the most comprehensive list of emm-types associated with ARF cases. Methods: We searched, for all reports of original research in the PubMed database (http:// www.ncbi.nlm.nih.gov/pubmed/) from the 1st January 1944 (first publication of Jones criteria) to the 31rd December 2012 using combinations of the following terms STREPTOCOCCUS PYOGENES, GROUP A STREPTOCOCCI, RHEUMATOGENIC, EMM, M, OUTBREAK and ACUTE RHEUMATIC FEVER. Grey literature was also reviewed. All articles reporting emm-type of GAS isolated or antibodies against emm-type from children or adults with ARF were selected. A probable rheumatogenic GAS was defined as a GAS isolate typed from the throat of an ARF case with Jones criteria reported, while a possible rheumatogenic GAS one in which the ARF case was defined without Jones criteria. Results: The PubMed search yielded 357 potentially relevant articles. Finally, we selected 28 relevant studies. In total, 57 different GAS emm-types or anti-M antibodies were classified as a probable or a possible GAS emm-type: 45.1% of these emm-types were known as classical rheumatogenic GAS. In 11 studies, 52 GAS isolates were reported as probable rheumatogenic strains corresponding to 18 different emm-types. Among them, 30.1% were
GHEART Vol 9/1S/2014
j
March, 2014
j
ORAL/2014 WCC Orals
Diffuse Atrial and Ventricular Fibrosis Measured by T1 Mapping on Cardiac MRI Predicts Success of Atrial Fibrillation Ablation Alex J. Mclellan*1,2, Liang-Han Ling2, Andris H. Ellims2, Leah M. Iles2, Sonia Azzopardi2, Joseph B. Morton1, Jonathan M. Kalman1, Andrew J. Taylor2, Peter M. Kistler2 1 Royal Melbourne Hospital, 2The Alfred Hospital/ BakerIDI, Melbourne, Australia Introduction: Atrial fibrillation may be associated with atrial and ventricular fibrosis. Contrast enhanced T1 mapping using Cardiac Magnetic Resonance imaging (CMR) provides a method to quantitate diffuse atrial and ventricular fibrosis. Objectives: The aim of the present study was to investigate the relationship between post contrast atrial and ventricular T1 relaxation times and freedom from AF following pulmonary vein isolation(PVI). Methods: 121 patients with atrial fibrillation (63% paroxysmal AF; age 57.510.4 years; LA area 26.96.5cm2; LVEF 58.78.2%) underwent CMR with a 1.5T scanner prior to PVI and post contrast atrial and ventricular T1 relaxation times were determined at the inter-atrial septum and mid short axis left ventricle respectively. Freedom from AF post ablation was documented by clinical review and 7 Day Holter monitoring at 6 monthly intervals. Results: At a mean follow up of 167 months, 91 of 121 (75%) patients were in sinus rhythm off antiarrhythmic medication. Recurrent AF was associated with a significant shortening of both the atrial T1 time (21733ms vs. 24342ms in no AF recurrence; p¼0.003) and the ventricular T1 time (36673ms vs. 42890ms in no AF recurrence; p¼0.002). Univariate predictors of AF recurrence included post contrast atrial T1 time (p¼0.002), post contrast ventricular T1 time (p¼0.005), AF group (paroxysmal vs. persistent, p¼0.019), AF duration (p¼0.029), left atrial ejection fraction (p¼0.012), and intraprocedural DCR (p¼0.005). Following multivariate analysis post contrast atrial T1 time was the only independent predictor of AF recurrence (p¼0.023). On receiver operating characteristic curve analysis, an atrial T1 time of 235ms (Area Under Curve (AUC) 0.64; p¼0.02), a ventricular T1 time of 380ms (AUC 0.67; p¼0.009) and the combination of both an atrial T1 time of 235ms and a ventricular T1 time of 500ms (AUC 0.71; p¼0.002) were the best performing cut-offs (Kaplan Meier analysis using these cut-offs are presented in the figure below).
e37
ORAL ABSTRACTS
Endothelial Function And Platelet Reactivity In Patients After Percutaneous Coronary Intervention: Clopidogrel Vs Prasugrel
already identified as classical rheumatogenic strains and the 5 most prevalent GAS were M12 (n¼10), M18 (n¼10), M75 (n¼5), M1 (n¼5), M29 (n¼3). Conclusion: Our study revealed a large number of GAS emm-types associated with ARF, greater than the number of classical rheumatogenic strains previously described. Thereby, the concept of ”rheumatogenicity” should be extended to strains other than those classically described in the USA. In the context of the development of a GAS vaccine, this study reframes the GAS emm-types involved in the occurrence of ARF. Disclosure of Interest: None Declared
Gerasimos Siasos1, Dimitris Tousoulis*1, Eleni Kokkou2, Stamatios Kioufis2, Evangelos Oikonomou2, Marina Zaromitidou2, Konstantinos Maniatis2, Nikolaos Gouliopoulos2, Panagiotis Tourikis2, Konstantinos Zisimos2, Savvas Mazaris2, Theodosia Konsola2, Vasiliki Genimata3, Christodoulos Stefanadis2 1 1st Cardiology Department, University of Athens Medical School, “Hippokration” Hospital, Athens, Greece, 21st Cardiology Department, 3University of Athens Medical School, “Hippokration” Hospital, Athens, Greece Introduction: The clinical benefit of clopidogrel and prasugrel has been attributed to their antiplatelet effects. Though, clopidogrel treatment has also pleiotropic vasoprotective effects, such as modulation of vascular tone, improvement of endothelial function, as well as inhibition of inflammation and oxidative stress. Objectives: We examined the impact of clopidogrel and prasugrel treatment on endothelial function and platelet reactivity in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). Methods: We consecutively enrolled 12 patients with stable CAD receiving prasugrel regimen (10mg/d) and 12 aged and sex matched CAD patients receiving clopidogrel regimen (75mg/d), one month after PCI. Flow mediated dilation (FMD) was used as a measured of endothelial function. High on treatment platelet reactivity was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU) and the diagnostic cut-off value is 230 PRU. Results: There was no difference between CAD patients on clopidogrel and prasugrel treatment in age (5610 years vs. 5610 years, p¼0.88), smoking habits (20% vs. 33%, p¼0.11), in the presence of diabetes mellitus (42% vs. 11%, p¼0.12), arterial hypertension (87% vs. 82%, p¼0.89),hyperlipidemia (90% vs. 85%, p¼0.25) and in the presence of multivessel CAD (40% vs. 30%, p¼0.24). Subjects on prasugrel treatment compared to subjects on clopidogrel treatment had significantly lower PRU (11180 vs. 23480, p¼0.001). The presence of patients with high on treatment platelet reactivity was significantly lower in prasugrel group, compared to clopidogrel group (8% vs. 50%, p¼0.03). Interestingly, subjects on prasugrel group had significantly improved endothelial function compared to subjects on clopidogrel group (9.823.63% vs. 6.721.39%, p¼0.01). Conclusion: Prasugrel, compared to clopidogrel treatment, showed a greater effect on endothelial function and inhibition of platelet activation in CAD patients after PCI. Further studies are needed to elucidate the impact of prasugrel and clopidogrel treatment on vascular function and atherosclerosis progression. Disclosure of Interest: G. Siasos: None Declared, D. Tousoulis: None Declared, E. Kokkou Grant/research support from: State Scholarship Foundation, S. Kioufis: None Declared, E. Oikonomou: None Declared, M. Zaromitidou: None Declared, K. Maniatis: None Declared, N. Gouliopoulos: None Declared, P. Tourikis: None Declared, K. Zisimos: None Declared, S. Mazaris: None Declared, T. Konsola: None Declared, V. Genimata: None Declared, C. Stefanadis: None Declared
O135 Newer insights on prognosis of reversible peripartum cardiomyopathy Cecily Mary Majella Jayaraj*, venkatesan sangareddi, gnanavelu ganesan, v. e. dhandapani, m. s. ravi, k. m. meenakshi, d. m muthukumar, n swaminathan, g. ravisankar, g. prathapkumar Cardiology, Madras Medical College and Research Institute, Chennai, India Introduction: Peripartum cardiomyopathy (PPCM) which was first described in the 1800s, yet its etiology is still unclear. Its diagnosis is often delayed because its symptoms closely resemble those within the normal spectrum of pregnancy and the postpartum period.Earlier diagnosis favours a better outcome. Objectives: To evaluate the clinical profile and prognosis of peripartum cardiomyopathy . Methods: Patients in the last month of pregnancy and 5 months postpartum referred for cardiac evaluation from september 1, 2011, to august 31,2012 were included in this study.Clinical and serial echocardiographic evaluation were done and followed up at 1, 3, and 6 months on these patients. Results: Among 5475 patients 14 patients[0.25%] were diagnosed as peripartum cardiomyopathy.Mean age:253years,time of presentation [last month of conception-4 [28%],first month of postpartum -10[72%],preceding h/o of viral fever- 2[14%]pregnancy induced hypertension [PIH]on betablockers-4[28%] ,mean ejectionfraction at presentation 308%,mean fractional shortening 224%,mean end-diastolic dimension [5.91.8cm] biventricular thrombi -2[14%]pulmonary embolism -3[21%][1-saddle type ,2- proximal left pulmonary artery]. Mortality-3/14[21%].Mortality was high among patients with massive pulmonary embolism and those with preceding viral fever.Follow up echo was done at discharge and after 1,3 and 6 months .Echocardiographic features at diagnosis were unable to predict individually who would eventually recover, although a statistically significant difference occurred at diagnosis between the recovered group and nonrecovered group for mean ejection fraction (28% vs 23%; P<.001) and fractional shortening (18% vs 14%; P¼.004).of leftventricle,whereas mean end-diastolic dimension (6.1 vs 5.7 cm; P¼.08)was not statistically significant,Patients with pregnancy induced hypertension[428%] had earlier [3months vs 6months ] and complete recovery of ejection fraction [58.6vs 36.8 p¼0.02]. Conclusion: We conclude PPCM when associated with PIH shows relatively a better outcome .The reason could be earlier exposure to betablockers may moderate the disease progression and make it more likely,that full recovery will occur.Gestational hypertension brings patients for medical and cardiac evaluation earlier resulting in earlier and better prognosis. Disclosure of Interest: None Declared
O134 O136
GAS emm-types probably involved in acute rheumatic fever 1
1
2,3
3,4
Noémie Baroux , Eric D’Ortenzio , Pierre Smeesters , Andrew Steer* 1 Epidemiology of infectious diseases, Institut Pasteur de Nouvelle-Calédonie, Noumea, New Caledonia, 2Laboratoire de Génétique et Physiologie Bactérienne, Institut de Biologie et de Médecine Moléculaires, Faculté des Sciences, Université Libre de Bruxelles, Gosselies, Belgium, 3 Group A Streptococcus, Murdoch Childrens Research Institute, 4Centre for International Child Health, University of Melbourne, Melbourne, Australia Introduction: Group A streptococcal (GAS) is responsible for the chain leading to acute rheumatic fever (ARF) and rheumatic heart disease (RHD). That certain GAS strains may be more rheumatogenic than others is a concept widely believed. However, there has only been a single review of predominant serotypes involved in streptococcal outbreaks associated with ARF between 1939 and 1971. This review of US studies found the following emm-types to be associated with ARF: 1, 3, 5, 6, 14, 18, 19, 24, 27 and 29. However, a review of GAS emm-types associated with ARF in developing countries, where ARF is endemic, has never been undertaken. Objectives: The aim of this systematic review was to provide the most comprehensive list of emm-types associated with ARF cases. Methods: We searched, for all reports of original research in the PubMed database (http:// www.ncbi.nlm.nih.gov/pubmed/) from the 1st January 1944 (first publication of Jones criteria) to the 31rd December 2012 using combinations of the following terms STREPTOCOCCUS PYOGENES, GROUP A STREPTOCOCCI, RHEUMATOGENIC, EMM, M, OUTBREAK and ACUTE RHEUMATIC FEVER. Grey literature was also reviewed. All articles reporting emm-type of GAS isolated or antibodies against emm-type from children or adults with ARF were selected. A probable rheumatogenic GAS was defined as a GAS isolate typed from the throat of an ARF case with Jones criteria reported, while a possible rheumatogenic GAS one in which the ARF case was defined without Jones criteria. Results: The PubMed search yielded 357 potentially relevant articles. Finally, we selected 28 relevant studies. In total, 57 different GAS emm-types or anti-M antibodies were classified as a probable or a possible GAS emm-type: 45.1% of these emm-types were known as classical rheumatogenic GAS. In 11 studies, 52 GAS isolates were reported as probable rheumatogenic strains corresponding to 18 different emm-types. Among them, 30.1% were
GHEART Vol 9/1S/2014
j
March, 2014
j
ORAL/2014 WCC Orals
Diffuse Atrial and Ventricular Fibrosis Measured by T1 Mapping on Cardiac MRI Predicts Success of Atrial Fibrillation Ablation Alex J. Mclellan*1,2, Liang-Han Ling2, Andris H. Ellims2, Leah M. Iles2, Sonia Azzopardi2, Joseph B. Morton1, Jonathan M. Kalman1, Andrew J. Taylor2, Peter M. Kistler2 1 Royal Melbourne Hospital, 2The Alfred Hospital/ BakerIDI, Melbourne, Australia Introduction: Atrial fibrillation may be associated with atrial and ventricular fibrosis. Contrast enhanced T1 mapping using Cardiac Magnetic Resonance imaging (CMR) provides a method to quantitate diffuse atrial and ventricular fibrosis. Objectives: The aim of the present study was to investigate the relationship between post contrast atrial and ventricular T1 relaxation times and freedom from AF following pulmonary vein isolation(PVI). Methods: 121 patients with atrial fibrillation (63% paroxysmal AF; age 57.510.4 years; LA area 26.96.5cm2; LVEF 58.78.2%) underwent CMR with a 1.5T scanner prior to PVI and post contrast atrial and ventricular T1 relaxation times were determined at the inter-atrial septum and mid short axis left ventricle respectively. Freedom from AF post ablation was documented by clinical review and 7 Day Holter monitoring at 6 monthly intervals. Results: At a mean follow up of 167 months, 91 of 121 (75%) patients were in sinus rhythm off antiarrhythmic medication. Recurrent AF was associated with a significant shortening of both the atrial T1 time (21733ms vs. 24342ms in no AF recurrence; p¼0.003) and the ventricular T1 time (36673ms vs. 42890ms in no AF recurrence; p¼0.002). Univariate predictors of AF recurrence included post contrast atrial T1 time (p¼0.002), post contrast ventricular T1 time (p¼0.005), AF group (paroxysmal vs. persistent, p¼0.019), AF duration (p¼0.029), left atrial ejection fraction (p¼0.012), and intraprocedural DCR (p¼0.005). Following multivariate analysis post contrast atrial T1 time was the only independent predictor of AF recurrence (p¼0.023). On receiver operating characteristic curve analysis, an atrial T1 time of 235ms (Area Under Curve (AUC) 0.64; p¼0.02), a ventricular T1 time of 380ms (AUC 0.67; p¼0.009) and the combination of both an atrial T1 time of 235ms and a ventricular T1 time of 500ms (AUC 0.71; p¼0.002) were the best performing cut-offs (Kaplan Meier analysis using these cut-offs are presented in the figure below).
e37
ORAL ABSTRACTS
Endothelial Function And Platelet Reactivity In Patients After Percutaneous Coronary Intervention: Clopidogrel Vs Prasugrel
already identified as classical rheumatogenic strains and the 5 most prevalent GAS were M12 (n¼10), M18 (n¼10), M75 (n¼5), M1 (n¼5), M29 (n¼3). Conclusion: Our study revealed a large number of GAS emm-types associated with ARF, greater than the number of classical rheumatogenic strains previously described. Thereby, the concept of ”rheumatogenicity” should be extended to strains other than those classically described in the USA. In the context of the development of a GAS vaccine, this study reframes the GAS emm-types involved in the occurrence of ARF. Disclosure of Interest: None Declared