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OP-116 THE PROGNOSTIC IMPORTANCE OF CYSTATIN C IN SEVERE SYSTOLIC DYSFUNCTION WITHOUT CHRONIC KIDNEY DISEASE
Oral Presentations / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
system (CARTO, Biosense Webster) and performed with a temperaturecontrolled, quadripolar, deflectable catheter with an 8-mm tip (Navistar, Biosense Webster) to encircle the left and right pulmonary veins 1 to 2 cm from their ostia. Additional lines in the posterior left atrium or roof and along the mitral isthmus were performed in patients with nonparoxysmal AF. Cavotricuspid isthmus ablation also was performed 12 patients. Procedures lasted 135±28 minutes, including 35±5 minutes for radiofrequency (RF) ablation. After the procedure, anti-arrhythmic drug therapy was continued at two months. Patients were seen in the clinic at 1, 2, 3 months, and then 3-month intervals. Holter monitorization was performed 24-48 hours at least 2 times before the procedure and 3 months after the procedure. Results: Patients were followed up 27±5 months. 45 patients (64%) were asymptomatic at the follow-up. 5 patients in asymptomatic group had two CPVA procedures (paroxysmal AF; 4, persistant AF; 1). 11 patients with paroxysmal AF had structural heart disease. Success rate was found similar between paroxysmal AF group with and without structural heart disease (70% versus 60%, in respectively, p=0.11). 13 patients with non-paroxysmal AF had structural heart disease. Among the non-paroxysmal AF group, success rate was significantly lower in the patients with structural heart disease (33% versus 50%, p=0.03). Conclusions: Although long-term success rate of the CPVA was significantly lower in non-paroxysmal AF patients with structural heart disease, this procedure is safe and effective in paroxysmal AF patients with or without structural heart disease.
April 17, 2010 / 08.30–10.00 Heart Failure: Diagnostic and Therapeutic Challenges
OP-114 CARDIAC RESYNCHRONIZATION THERAPY IMPROVES LEFT VENTRICULAR DIASTOLIC FUNCTION Hakan Aksoy, Sercan Okutucu, Onur Sinan Deveci, Erol Tulumen, Ugur Nadir Karakulak, Kudret Aytemir, Ergun Baris Kaya, Lale Tokgozoglu, Giray Kabakci, Nasih Nazli, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Cardiac resynchronization therapy (CRT) in patients with left ventricular systolic dysfunction and electrical dyssynchrony has been shown to improve left ventricular (LV) systolic performance and hemodynamics. Improvement in diastolic dysfunction may contribute to these results. Variable results have been reported about the effects of CRT on diastolic function. Tissue Doppler imaging (TDI) provides rapid assessment of ventricular function and adds incremental value to the standard Dopplerechocardiographic measurements. This study was performed to evaluate the effects of CRT on diastolic function by using tissue Doppler imaging. Methods: A total of 54 patients (mean age, 61.9±10.5; 43 men; mean LV ejection fraction 24.6±4.0%) with New York Heart Association functional class III or IV heart failure symptoms despite maximal medical therapy were included in the study. Conventional echocardiography and tissue Doppler imaging were performed during initial hospital admission and 6 months after CRT implantation. The mitral inflow (E/A ratio, mitral valve deceleration time=E dec) was assessed with pulsed wave Doppler echocardiography (PWD). Mitral inflow color propagation (Vp) velocity was evaluated with color M mode and early diastolic mitral annular velocity (e’) at the lateral and septal annulus were measured by TDI. Mitral E/e’ and E/Vp were calculated in order to estimate LV filling pressures. Results: Compared to baseline, the E/A ratio (1.52±1.02 vs 1.19±0.86, p=0.01) decreased significantly and E deceleration time (150.38±42.91 ms vs 152.38±53.50 ms, p=0.02) increased significantly at the 6th month. Septal E/e’ (19.19±12.67 vs 14.65±7.22, p=0.015), Lateral E/e’ (13.86±8.67 vs 12.87±5.90, p=0.001), Average E/e’ (15.16±7.55 vs 13.29±5.65, p=0.002) and E/Vp (2.44±1.01 vs 1.19±0.86, p= 0.042) ratio decreased significantly at 6th month after CRT. Conclusions: These results discloses the significant improvement of diastolic functions and LV filling pressures in patients who were treated with CRT devices.
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OP-115 IMPROVEMENTS IN RIGHT VENTRICULAR SYSTOLIC FUNCTION AFTER CARDIAC RESYNCHRONIZATION THERAPY ARE COUPLED TO RESPONSE IN LEFT VENTRICULAR SYSTOLIC PERFORMANCE Hakan Aksoy, Sercan Okutucu, Ergun Baris Kaya, Sefik Gorkem Fatihoglu, Onur Sinan Deveci, Erol Tulumen, Naresh Maharjan, Kudret Aytemir, Giray Kabakci, Lale Tokgozoglu, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: The impact of cardiac resynchronization therapy (CRT) on functional status, left ventricular (LV) remodelling and LV systolic dysfunction have been demonstrated in randomized trials. However, the effect of CRT on right ventricular (RV) function, an independent prognostic factor in CHF remains questionable. Aim of this study is to compare the acute effects of biventricular pacing on RV functions between echocardiographic responders and non-responders. Methods: A total of 54 patients (mean age, 61.9±10.5; 43 men; mean LV ejection fraction 24.6±4.0%) with New York Heart Association functional class III or IV heart failure symptoms despite maximal medical therapy were included in the study. Conventional echocardiography and tissue Doppler (TDI) imaging were performed during initial hospital admission and 6 months after CRT implantation. Specifically, tricuspid anular plane systolic excursion (TAPSE), RV diameters (RVD1, RVD2, RVD3), RV area fractional shortening, right atrial (RA) area, TDI derived systolic parameters of the tricuspid annulus (isovolumic acceleration-IVA, acceleration time-Acc, peak myocardial velocity during isovolumic contraction - IVV, peak systolic velocity during ejection period-Sa) were recorded. Results: After CRT implantation RVAFC (23.2% vs. 25.5%, p=0.001), RV IVV (14.44 vs. 17.58, p=0.001) and RV IVA (1.81 vs. 2.33, p=0.001) improved significantly. When patients were stratified into 2 groups according to their systolic response at 6th month after CRT, patients with ≥10% reduction of LV end-systolic volume (LVESV) (38 patients, 70.4%) showed statistically significant reduction in RVD1, RVD2, RVD3, RA area and RV Acc. Among responders; RVAFC, TAPSE, RV Sa, RVIVV and RVIVA significantly increased after CRT. However, 16 patients (29.6%) with LVESV reduction <10% (non-responders) had no significant change in all these parameters. Conclusions: After CRT, RV systolic functions improves significantly but this improvement was closely related with the left ventricular systolic response.
OP-116 THE PROGNOSTIC IMPORTANCE OF CYSTATIN C IN SEVERE SYSTOLIC DYSFUNCTION WITHOUT CHRONIC KIDNEY DISEASE Serkan Ordu, Ismail Erden, Recai Alemdar, Mesut Aydin, Onur Caglar, Hakan Ozhan, Mehmet Yazici Duzce University, Duzce Medicine, Faculty Department of Cardiology, Duzce, Turkey Objective: Chronic heart failure represents the major cause of death and hospitalization in general population. Our aim was to investigate the prognostic importance of cystatin C in stable heart failure patients without renal insufficiency. Methods: We included 75 patients (50 males and 25 females, aged 67.6±10.6 years) who had been followed up with NYHA class 1-3 symptoms and who had an ejection fraction of <35% on echocardiography. The variables of patients who died or had (major cardiac adverse events) MACE during a median of 13 months period were compared with the patients who were free of MACE. Results: Multivariable analysis performed as the dependent variables revealed that, only cystatin C levels was determined as an independent risk factor for MACE rate [hazard ratio (HR) = 32.56 (95% confidence interval (CI); 2.26-468.62), p=0.01)]. For mortality rate, the same analyses revealed an independent interaction with cystatin C, which could not reach significance [HR: 37.1 (95% CI; 0.94-1464), p=0.054)]. According to ROC analysis, cystatin C levels >1.55 ng/mL could predict mortality with 82% sensitivity and 73% specificity. Furthermore, cystatin C levels >1.45 ng/mL could predict MACE rate with 76% sensitivity and 83% specificity. Conclusions: Elevation of serum cystatin C is an independent prognostic marker for MACE rate in stable heart failure who had an ejection fraction of <35% and a GFR of >60 ml/min/1.73m2 . It may also predict mortality but this assumption needs further investigation with a larger cohort.
system (CARTO, Biosense Webster) and performed with a temperaturecontrolled, quadripolar, deflectable catheter with an 8-mm tip (Navistar, Biosense Webster) to encircle the left and right pulmonary veins 1 to 2 cm from their ostia. Additional lines in the posterior left atrium or roof and along the mitral isthmus were performed in patients with nonparoxysmal AF. Cavotricuspid isthmus ablation also was performed 12 patients. Procedures lasted 135±28 minutes, including 35±5 minutes for radiofrequency (RF) ablation. After the procedure, anti-arrhythmic drug therapy was continued at two months. Patients were seen in the clinic at 1, 2, 3 months, and then 3-month intervals. Holter monitorization was performed 24-48 hours at least 2 times before the procedure and 3 months after the procedure. Results: Patients were followed up 27±5 months. 45 patients (64%) were asymptomatic at the follow-up. 5 patients in asymptomatic group had two CPVA procedures (paroxysmal AF; 4, persistant AF; 1). 11 patients with paroxysmal AF had structural heart disease. Success rate was found similar between paroxysmal AF group with and without structural heart disease (70% versus 60%, in respectively, p=0.11). 13 patients with non-paroxysmal AF had structural heart disease. Among the non-paroxysmal AF group, success rate was significantly lower in the patients with structural heart disease (33% versus 50%, p=0.03). Conclusions: Although long-term success rate of the CPVA was significantly lower in non-paroxysmal AF patients with structural heart disease, this procedure is safe and effective in paroxysmal AF patients with or without structural heart disease.
April 17, 2010 / 08.30–10.00 Heart Failure: Diagnostic and Therapeutic Challenges
OP-114 CARDIAC RESYNCHRONIZATION THERAPY IMPROVES LEFT VENTRICULAR DIASTOLIC FUNCTION Hakan Aksoy, Sercan Okutucu, Onur Sinan Deveci, Erol Tulumen, Ugur Nadir Karakulak, Kudret Aytemir, Ergun Baris Kaya, Lale Tokgozoglu, Giray Kabakci, Nasih Nazli, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Cardiac resynchronization therapy (CRT) in patients with left ventricular systolic dysfunction and electrical dyssynchrony has been shown to improve left ventricular (LV) systolic performance and hemodynamics. Improvement in diastolic dysfunction may contribute to these results. Variable results have been reported about the effects of CRT on diastolic function. Tissue Doppler imaging (TDI) provides rapid assessment of ventricular function and adds incremental value to the standard Dopplerechocardiographic measurements. This study was performed to evaluate the effects of CRT on diastolic function by using tissue Doppler imaging. Methods: A total of 54 patients (mean age, 61.9±10.5; 43 men; mean LV ejection fraction 24.6±4.0%) with New York Heart Association functional class III or IV heart failure symptoms despite maximal medical therapy were included in the study. Conventional echocardiography and tissue Doppler imaging were performed during initial hospital admission and 6 months after CRT implantation. The mitral inflow (E/A ratio, mitral valve deceleration time=E dec) was assessed with pulsed wave Doppler echocardiography (PWD). Mitral inflow color propagation (Vp) velocity was evaluated with color M mode and early diastolic mitral annular velocity (e’) at the lateral and septal annulus were measured by TDI. Mitral E/e’ and E/Vp were calculated in order to estimate LV filling pressures. Results: Compared to baseline, the E/A ratio (1.52±1.02 vs 1.19±0.86, p=0.01) decreased significantly and E deceleration time (150.38±42.91 ms vs 152.38±53.50 ms, p=0.02) increased significantly at the 6th month. Septal E/e’ (19.19±12.67 vs 14.65±7.22, p=0.015), Lateral E/e’ (13.86±8.67 vs 12.87±5.90, p=0.001), Average E/e’ (15.16±7.55 vs 13.29±5.65, p=0.002) and E/Vp (2.44±1.01 vs 1.19±0.86, p= 0.042) ratio decreased significantly at 6th month after CRT. Conclusions: These results discloses the significant improvement of diastolic functions and LV filling pressures in patients who were treated with CRT devices.
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OP-115 IMPROVEMENTS IN RIGHT VENTRICULAR SYSTOLIC FUNCTION AFTER CARDIAC RESYNCHRONIZATION THERAPY ARE COUPLED TO RESPONSE IN LEFT VENTRICULAR SYSTOLIC PERFORMANCE Hakan Aksoy, Sercan Okutucu, Ergun Baris Kaya, Sefik Gorkem Fatihoglu, Onur Sinan Deveci, Erol Tulumen, Naresh Maharjan, Kudret Aytemir, Giray Kabakci, Lale Tokgozoglu, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: The impact of cardiac resynchronization therapy (CRT) on functional status, left ventricular (LV) remodelling and LV systolic dysfunction have been demonstrated in randomized trials. However, the effect of CRT on right ventricular (RV) function, an independent prognostic factor in CHF remains questionable. Aim of this study is to compare the acute effects of biventricular pacing on RV functions between echocardiographic responders and non-responders. Methods: A total of 54 patients (mean age, 61.9±10.5; 43 men; mean LV ejection fraction 24.6±4.0%) with New York Heart Association functional class III or IV heart failure symptoms despite maximal medical therapy were included in the study. Conventional echocardiography and tissue Doppler (TDI) imaging were performed during initial hospital admission and 6 months after CRT implantation. Specifically, tricuspid anular plane systolic excursion (TAPSE), RV diameters (RVD1, RVD2, RVD3), RV area fractional shortening, right atrial (RA) area, TDI derived systolic parameters of the tricuspid annulus (isovolumic acceleration-IVA, acceleration time-Acc, peak myocardial velocity during isovolumic contraction - IVV, peak systolic velocity during ejection period-Sa) were recorded. Results: After CRT implantation RVAFC (23.2% vs. 25.5%, p=0.001), RV IVV (14.44 vs. 17.58, p=0.001) and RV IVA (1.81 vs. 2.33, p=0.001) improved significantly. When patients were stratified into 2 groups according to their systolic response at 6th month after CRT, patients with ≥10% reduction of LV end-systolic volume (LVESV) (38 patients, 70.4%) showed statistically significant reduction in RVD1, RVD2, RVD3, RA area and RV Acc. Among responders; RVAFC, TAPSE, RV Sa, RVIVV and RVIVA significantly increased after CRT. However, 16 patients (29.6%) with LVESV reduction <10% (non-responders) had no significant change in all these parameters. Conclusions: After CRT, RV systolic functions improves significantly but this improvement was closely related with the left ventricular systolic response.
OP-116 THE PROGNOSTIC IMPORTANCE OF CYSTATIN C IN SEVERE SYSTOLIC DYSFUNCTION WITHOUT CHRONIC KIDNEY DISEASE Serkan Ordu, Ismail Erden, Recai Alemdar, Mesut Aydin, Onur Caglar, Hakan Ozhan, Mehmet Yazici Duzce University, Duzce Medicine, Faculty Department of Cardiology, Duzce, Turkey Objective: Chronic heart failure represents the major cause of death and hospitalization in general population. Our aim was to investigate the prognostic importance of cystatin C in stable heart failure patients without renal insufficiency. Methods: We included 75 patients (50 males and 25 females, aged 67.6±10.6 years) who had been followed up with NYHA class 1-3 symptoms and who had an ejection fraction of <35% on echocardiography. The variables of patients who died or had (major cardiac adverse events) MACE during a median of 13 months period were compared with the patients who were free of MACE. Results: Multivariable analysis performed as the dependent variables revealed that, only cystatin C levels was determined as an independent risk factor for MACE rate [hazard ratio (HR) = 32.56 (95% confidence interval (CI); 2.26-468.62), p=0.01)]. For mortality rate, the same analyses revealed an independent interaction with cystatin C, which could not reach significance [HR: 37.1 (95% CI; 0.94-1464), p=0.054)]. According to ROC analysis, cystatin C levels >1.55 ng/mL could predict mortality with 82% sensitivity and 73% specificity. Furthermore, cystatin C levels >1.45 ng/mL could predict MACE rate with 76% sensitivity and 83% specificity. Conclusions: Elevation of serum cystatin C is an independent prognostic marker for MACE rate in stable heart failure who had an ejection fraction of <35% and a GFR of >60 ml/min/1.73m2 . It may also predict mortality but this assumption needs further investigation with a larger cohort.