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P-252: Transcatheter aortic valve implantation registry with comprehensive geriatric assessment (CGA-TAVI)
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
in random double-blinded order. Subjects were fed a standardized meal and then continuously monitored for 90 minutes. Results: 14 out of 15 Type 2 diabetes subjects in our study demonstrated PPH during the placebo session. Subjects demonstrated 0.7 fewer PHEs (p = 0.042, 0.1 to 1.2, 95 percent confidence interval) during the acarbose session (0.8±0.2 PHEs) as compared to the placebo session (1.5±0.3 PHEs). Systolic blood pressure (SBP; main effect of session, p = 0.030) and mean arterial pressure (MAP; p = 0.035) were higher during the acarbose session by 2-way mixed design analysis of variance with repeated measures. Conclusions: This is the first study to demonstrate acarbose reduced PHEs and raises postprandial blood pressure in older adults with Type 2 diabetes complicated by PPH. P-252 Transcatheter aortic valve implantation registry with comprehensive geriatric assessment (CGA-TAVI) G. Mannarino1 , G. Santoro2 , M. Stolcova2 , L. Piccioli3 , N. Marchionni4 , A. Schoenenberger5 , P. Bramlage6 , J. Kurucova7 , J.-P. Michel8 , M. Thoenes7 , A. Ungar9 1 AOU Careggi Universit` a Degli Studi Firenze, Florence, Italy; 2 AOU Careggi, Florence, Italy; 3 Universit` a di Firenze, Florence, Italy; 4 Geriatric Cardiology and Medicine, Florence, Italy; 5 Switzerland; 6 IPPMed, Mahlow, Germany; 7 Edwards, Geneve, Switzerland; 8 EUGMS, Geneve, Switzerland; 9 Azienda Ospedaliero Universitaria Careggi, Florence, Italy Objectives: Many elderly patients are never considered for surgery as treatment of severe degenerative aortic stenosis, resulting in a curtailed survival rate at 32%, 60% after one, 5 years. The transcatheter aortic valve implantation (TAVI) has shown an absolute reduction in all-cause mortality of 20% compared to medical therapy. The aim of the registry is to identify patient characteristics and indicators related to complications and clinical benefit in the elderly. Methods: CGA-TAVI commenced in February 2014. The coprimary objectives are to establish predictive value of CGA (with Multidimensional-Prognostic-Index (MPI), short-physicalperformance-battery (SPPB), and SilverCode) for mortality and hospitalization and to demonstrate CGA changes after TAVI. Results: As of April 2015 44 patients had been enrolled. Patients had a mean age of 85.4±2.7 years. The majority of patients had NYHA class III/IV (82.4%). At baseline mean MPI was 0.34±0.11, SPPB 6.4±3.3 and SilverCode 21.2±8.4, compared to 0.33±0.14, 7.6±2.8, and 23.4±6.9 three months after TAVI. One patient had NYHA III, none NYHA IV. A total of 6 patients reached the combined endpoint of death or stroke within 3 months after TAVI which had a higher MPI (0.42±0.14) and SilverCode (23.3±4.4) at baseline compared to those without (0.34±0.10; 20.9±8.3). Conclusions: These preliminary results show improvement of NYHA functional class at 3 months follow-up. Although of the limited number of patients the registry hint to identify patients who would benefit by TAVI. P-253 Acute respiratory distress in geriatrics: the saving call to the medical intensivist A. Martin-Kleisch1 , A.-A. Zulfiqar1 , J.-L. Novella2 1 CHU Reims, Reims, France; 2 France Objectives: The vital distress in geriatric populations is common, however, the appeal of a medical intensivist is not systematic as it could allow a saving care. Methods: We illustrate this problem by a clinical case. Results: A patient of 80 years is hospitalized in our department for blood transfusion for anemia. She is followed for mixed chronic respiratory failure treated by oxygen therapy 1 Litre per minute.
S99
On the seventh day, she presented an episode of desaturation and significant bronchial congestion. The blood pressure of the patient was of 135/85 mmHg, the heart rate was 75 beats per minute, the saturation in 1 liter of ambient O2 was 75% and a temperature at 38.6°C. Clinical examination showed only confusion, a draw sternal and intercostal and the emergence of left basal crackling. The gasses blood showed a pH 7.21, a 35 mmHg pO2, pCO2 at 108 mmHg, the HCO3–37 mmol / L. Biology showed the appearance of a CRP increased to 280 mg / L. The chest radiograph showed atelectasis in the left lung base. Given this acute carbonarcosis associated with a probable bronchopulmonary infection, we contacted the intensivists who have accepted the patient in intensive care. However, the evolution has proved fatal after 48 hours non-invasive ventilation. Conclusions: It is essential to have a constructive dialogue with intensivists. Geriatricians must be convinced of the usefulness of a transfer in the ICU, which also determines the approval of the medical intensivist. P-254 Aseptic osteonecrosis of the femoral neck: a diagnosis not to ignore in the elderly A. Martin-Kleisch1 , A.-A. Zulfiqar1 , J.-L. Novella2 1 CHU Reims, Reims, France; 2 France Objectives: Aseptic osteonecrosis of the femoral neck is a diagnosis not to ignore in the elderly. Methods: We illustrate this problem by this case. Results: A patient of 92 years was referred to our department for minor drop repeatedly for several months. She was diagnosed with type 2 non-insulin dependent diabetes treated with biguanide. She would have fallen with his walker and wouldn’t have been able to stand up. The patient had spontaneous pain at the right hip flexion without flessum, but had a limited mobility of the lower limb in external rotation to 20°, internal rotation to about 10°, adduction and abduction to about 20° flexion to 70° bent knee and extension at 5°. Otherwise, the physical examination was normal. The pelvis radiograph showed osteoarthritis of the hip, but also possible signs of osteonecrosis with a focus of sclerosis of the femoral neck may correspond to a stage IV of Ficat’s classification. This was complemented by a CT report confirming this osteonecrosis stage 4. The etiological balance of this osteonecrosis did not find any inflammatory, neoplastic particular abnormality Given the absence of chronic alcoholism and cancer, often the traumatological cause associated with an ancient type 2 diabetes could be retained in the diagnosis of osteonecrosis of the femoral head. Surgical management was decided. Conclusions: In front of all repeated fall, radiological examination must be performed and the only fracture is not the only orthopedic diagnosis to look in the elderly. P-255 Age and gender differences in the haemodynamic response of patients with neurally mediated syncope N. Obiechina1 , A. Michael2 , D. Bezzina1 , M. Oldfield1 , L. Jones1 , L. Barber1 , N. Naseer1 , C. Jackson1 , C. Jayakumar1 1 Queen’s Hospital, Burton on Trent, United Kingdom; 2 Russells Hall Hospital, Dudley, United Kingdom Introduction: Neurally mediated (reflex) syncope is the most common cause of syncope. The incidence of syncope shows a sharp rise after the age of 70 years. We studied the age and gender differences in the haemodynamic response in patients with positive Tilt Table Tests (TTT). Methods: Audit of all patients, referred as part of syncope and falls work up, who had a TTT in a 62 months period in a UK district general hospital. The modified Westminster protocol was used.
in random double-blinded order. Subjects were fed a standardized meal and then continuously monitored for 90 minutes. Results: 14 out of 15 Type 2 diabetes subjects in our study demonstrated PPH during the placebo session. Subjects demonstrated 0.7 fewer PHEs (p = 0.042, 0.1 to 1.2, 95 percent confidence interval) during the acarbose session (0.8±0.2 PHEs) as compared to the placebo session (1.5±0.3 PHEs). Systolic blood pressure (SBP; main effect of session, p = 0.030) and mean arterial pressure (MAP; p = 0.035) were higher during the acarbose session by 2-way mixed design analysis of variance with repeated measures. Conclusions: This is the first study to demonstrate acarbose reduced PHEs and raises postprandial blood pressure in older adults with Type 2 diabetes complicated by PPH. P-252 Transcatheter aortic valve implantation registry with comprehensive geriatric assessment (CGA-TAVI) G. Mannarino1 , G. Santoro2 , M. Stolcova2 , L. Piccioli3 , N. Marchionni4 , A. Schoenenberger5 , P. Bramlage6 , J. Kurucova7 , J.-P. Michel8 , M. Thoenes7 , A. Ungar9 1 AOU Careggi Universit` a Degli Studi Firenze, Florence, Italy; 2 AOU Careggi, Florence, Italy; 3 Universit` a di Firenze, Florence, Italy; 4 Geriatric Cardiology and Medicine, Florence, Italy; 5 Switzerland; 6 IPPMed, Mahlow, Germany; 7 Edwards, Geneve, Switzerland; 8 EUGMS, Geneve, Switzerland; 9 Azienda Ospedaliero Universitaria Careggi, Florence, Italy Objectives: Many elderly patients are never considered for surgery as treatment of severe degenerative aortic stenosis, resulting in a curtailed survival rate at 32%, 60% after one, 5 years. The transcatheter aortic valve implantation (TAVI) has shown an absolute reduction in all-cause mortality of 20% compared to medical therapy. The aim of the registry is to identify patient characteristics and indicators related to complications and clinical benefit in the elderly. Methods: CGA-TAVI commenced in February 2014. The coprimary objectives are to establish predictive value of CGA (with Multidimensional-Prognostic-Index (MPI), short-physicalperformance-battery (SPPB), and SilverCode) for mortality and hospitalization and to demonstrate CGA changes after TAVI. Results: As of April 2015 44 patients had been enrolled. Patients had a mean age of 85.4±2.7 years. The majority of patients had NYHA class III/IV (82.4%). At baseline mean MPI was 0.34±0.11, SPPB 6.4±3.3 and SilverCode 21.2±8.4, compared to 0.33±0.14, 7.6±2.8, and 23.4±6.9 three months after TAVI. One patient had NYHA III, none NYHA IV. A total of 6 patients reached the combined endpoint of death or stroke within 3 months after TAVI which had a higher MPI (0.42±0.14) and SilverCode (23.3±4.4) at baseline compared to those without (0.34±0.10; 20.9±8.3). Conclusions: These preliminary results show improvement of NYHA functional class at 3 months follow-up. Although of the limited number of patients the registry hint to identify patients who would benefit by TAVI. P-253 Acute respiratory distress in geriatrics: the saving call to the medical intensivist A. Martin-Kleisch1 , A.-A. Zulfiqar1 , J.-L. Novella2 1 CHU Reims, Reims, France; 2 France Objectives: The vital distress in geriatric populations is common, however, the appeal of a medical intensivist is not systematic as it could allow a saving care. Methods: We illustrate this problem by a clinical case. Results: A patient of 80 years is hospitalized in our department for blood transfusion for anemia. She is followed for mixed chronic respiratory failure treated by oxygen therapy 1 Litre per minute.
S99
On the seventh day, she presented an episode of desaturation and significant bronchial congestion. The blood pressure of the patient was of 135/85 mmHg, the heart rate was 75 beats per minute, the saturation in 1 liter of ambient O2 was 75% and a temperature at 38.6°C. Clinical examination showed only confusion, a draw sternal and intercostal and the emergence of left basal crackling. The gasses blood showed a pH 7.21, a 35 mmHg pO2, pCO2 at 108 mmHg, the HCO3–37 mmol / L. Biology showed the appearance of a CRP increased to 280 mg / L. The chest radiograph showed atelectasis in the left lung base. Given this acute carbonarcosis associated with a probable bronchopulmonary infection, we contacted the intensivists who have accepted the patient in intensive care. However, the evolution has proved fatal after 48 hours non-invasive ventilation. Conclusions: It is essential to have a constructive dialogue with intensivists. Geriatricians must be convinced of the usefulness of a transfer in the ICU, which also determines the approval of the medical intensivist. P-254 Aseptic osteonecrosis of the femoral neck: a diagnosis not to ignore in the elderly A. Martin-Kleisch1 , A.-A. Zulfiqar1 , J.-L. Novella2 1 CHU Reims, Reims, France; 2 France Objectives: Aseptic osteonecrosis of the femoral neck is a diagnosis not to ignore in the elderly. Methods: We illustrate this problem by this case. Results: A patient of 92 years was referred to our department for minor drop repeatedly for several months. She was diagnosed with type 2 non-insulin dependent diabetes treated with biguanide. She would have fallen with his walker and wouldn’t have been able to stand up. The patient had spontaneous pain at the right hip flexion without flessum, but had a limited mobility of the lower limb in external rotation to 20°, internal rotation to about 10°, adduction and abduction to about 20° flexion to 70° bent knee and extension at 5°. Otherwise, the physical examination was normal. The pelvis radiograph showed osteoarthritis of the hip, but also possible signs of osteonecrosis with a focus of sclerosis of the femoral neck may correspond to a stage IV of Ficat’s classification. This was complemented by a CT report confirming this osteonecrosis stage 4. The etiological balance of this osteonecrosis did not find any inflammatory, neoplastic particular abnormality Given the absence of chronic alcoholism and cancer, often the traumatological cause associated with an ancient type 2 diabetes could be retained in the diagnosis of osteonecrosis of the femoral head. Surgical management was decided. Conclusions: In front of all repeated fall, radiological examination must be performed and the only fracture is not the only orthopedic diagnosis to look in the elderly. P-255 Age and gender differences in the haemodynamic response of patients with neurally mediated syncope N. Obiechina1 , A. Michael2 , D. Bezzina1 , M. Oldfield1 , L. Jones1 , L. Barber1 , N. Naseer1 , C. Jackson1 , C. Jayakumar1 1 Queen’s Hospital, Burton on Trent, United Kingdom; 2 Russells Hall Hospital, Dudley, United Kingdom Introduction: Neurally mediated (reflex) syncope is the most common cause of syncope. The incidence of syncope shows a sharp rise after the age of 70 years. We studied the age and gender differences in the haemodynamic response in patients with positive Tilt Table Tests (TTT). Methods: Audit of all patients, referred as part of syncope and falls work up, who had a TTT in a 62 months period in a UK district general hospital. The modified Westminster protocol was used.