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P033 The Effect of Physical Training on Systemic Pro-inflammatory Cytokine Expression in Heart Failure Patients: A Systematic Review
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Poster Sessions / International Journal of Cardiology 147S1 (2011) S9–S32
in 15% of patients. Other common complications noted were: glomerulonephritis (4.2%), arrhythmia (4.2%), and gastrointestinal bleed (4.2%). In hospital mortality was 42% and 52% of patients were discharged, 6% went home against medical advice. Prosthetic valve endocarditis (PVE) in particular had a mortality rate of 87%. Burkholderia pseudomallei was isolated in 57.1% of these cases. Most common causes of death were sepsis, congestive heart failure, and arrhythmia. Conclusion: This large and most recent review demonstrated the evolving microbiologic and clinical profile of IE in the adult Filipino. Despite recent advances in antibiotic therapy and surgical technique, mortality remains high in IE particularly in PVE. P032 Evaluation of Myocardial Function using the Tei Index in Patients with Beta-Thalassaemia Major A. Rohani1 , V. Akbari2 , M. Moradipoor2 . 1 Yasuy University of Medical Sciences, Iran; 2 Sajjad Hospital, Yasuy, Iran Objective: The aim of this study was to evaluate myocardial function and two year follow up of Beta (b)-thalassaemia major patients using the myocardial performance index, also known as the Tei index. Methods: Out of a total of 170 patients suffering from b-thalassemia major seen during the study period, 72 (42%) were referred for cardiac evaluation due to abnormal physical examination. Cardiovascular investigations included echocardiogram. The Tei index was assessed. Patients were followed for two years. Results: 59 (81%) patients were found to have cardiac disease of which diastolic dysfunction was the most common manifestation. 11 (15%) had significant pulmonary arterial hypertension and all these group of patients had abnormal Tei index. The Tei index was significantly higher (P < 0.001) in subjects with symptoms than in asymptomatic subjects. Treatment was altered in all patients diagnosed with a cardiac disease. All 7 patients in functional class II at initial presentation, except for one of them are still alive and in a stable clinical condition after a mean follow-up of 18±7 months. 3 patients became newly symptomatic and 2 of them had significantly high index at the start of study. Conclusion: The Tei-Index is easily obtained and highly reproducible. Our data suggest that the index is a sensitive indicator of overall cardiac dysfunction and has good correlation with diastolic and systolic dysfunction and presence of symptoms. It may be used in the follow-up. P033 The Effect of Physical Training on Systemic Pro-inflammatory Cytokine Expression in Heart Failure Patients: A Systematic Review N.A. Smart, M. Steele. Faculty of Health Science and Medicine, Bond University, QLD., Australia Objective: Systemic inflammation is associated with cardiovascular disease, especially the end stages of heart failure. We sought to determine by, systematic review and appropriate data pooling, whether physical therapy reduces serum levels of pro-inflammatory cytokines in heart failure patients. Methods: Potential studies were identified from a systematic search of Medline (Ovid) (1950-October 2010), Embase.com (1974current), Cochrane Central Register of Controlled Trials, CINAHL (1981-current) and Web of Science (2000-current). The search strategy included a mix of MeSH and free text terms for the key concepts. Results: Data from four included studies was available on 224 patients. Meta-analysis of available tumor necrosis factoralpha data in 114 patients following physical therapy showed a 25% reduction, mean difference −1.11 pg/L (95% CI −1.36 to −0.85, p < 0.00001). Meta-analysis of available interleukin-6 data in 68 patients following physical therapy showed a 16% reduction,
mean difference −1.25 pg/L (95% CI −1.86 to −0.63, p < 0.0001), while a concurrent 17.8±4% increase in peak VO2 , in those undertaking exercise therapy was observed. Conclusion: Published studies show an unequivocal reduction in serum levels of pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-alpha following physical therapy in heart failure patients. The data currently available does not provide a guide to the optimum physical therapy regime to retard or reverse the adverse effects of systemic inflammation. P034 Evaluating the Diagnostic Accuracy of 2D and 3D Echocardiography in Ebstein’s Anomaly in Comparison with Intraoperative Findings L. Wang1 , J. Cui1 , Q. Wu1 , G. Pan1 . 1 Heart Center, First Hosp. of Tsinghua University, Beijing, China Objective: To evaluate the diagnostic accuracy of Ebstein’s anomaly by comparing the intraoperative findings with 2D and 3D echocardiography. Methods: 155 patients diagnosed as Ebstein’s anomaly were reviewed. Among them, 93 received surgical repair. Intraoperative findings were compared with echocardiography reports. In 10 patients, 3D echocardiography was also performed. Results: The diagnosis of Ebstein’s anomaly was confirmed in all patients. Tricuspid regurgitation was severe in 73, moderate in 19, mild in 1. Downward displacement of tricuspid leaflet were: septal in 73, posterior in 68, anterior in 18; leaflet absence was identified as septal in 6, posterior in 7; remarkable leaflet hypoplasty was reported as septal in 8, posterior in 5 and anterior in 3. The accuracy of leaflet involvement by echo was 100% in septal and posterior, while only 35% in anterior; the accuracy of leaflet absence by echo was 60% and 63.6% in septal and posterior respectively. Leaflet hypoplasty was reported in 16 cases by echo, accounting for only 17.2% of those observed during operation, compatible with the severely hypoplastic leaflets. With 3D echo study, the abnormal downward displacement and hypoplasty of leaflets were well viewed in short axis of the RV. Hypoplasty of the tricuspid valve was much easier to be identified. Also postoperative 3D echo can clearly show the bicuspidized tricuspid valve in good function also the anatomical changes underlying remarkable tricuspid regurgitation, which is beyond 2D echo. Conclusion: 2D echo is good in identifying septal and posterior leaflet displacement, but it is easy to miss partial anterior downward diaplacement. The anotomical changes of the leaflet are often underevaluated by 2D echo. 3D echo can offer better information pre- and postoperatively. P035 A Study on One-Year Outcome of Patients with Heart Failure with Type 2 Diabetes Mellitus versus Non-Diabetics S.C. Chai, K.T. Leong, P.P. Goh. Department of Cardiology, Changi General Hospital Objective: To compare the clinical features and one-year prognosis of patients with heart failure and type 2 diabetes mellitus against patients with heart failure but without type 2 diabetes mellitus (T2DM). Methods: This is an observational prospective study on patients admitted to Changi General Hospital between November 2003 and April 2004 fulfilling the modified Framingham Criteria for clinical heart failure (HF) and whose serum creatinine <267 umol/L, serum albumin >28 g/L. Results: 173 patients with heart failure were enrolled into the study. There were 87 patients with T2DM (50.3%) compared to 86 patients without T2DM (49.7%). The prevalence of hypertension was significantly higher in the T2DM HF cohort (72.8% vs 57.0%, p = 0.003). The incidence of acute myocardial infarct in the
Poster Sessions / International Journal of Cardiology 147S1 (2011) S9–S32
in 15% of patients. Other common complications noted were: glomerulonephritis (4.2%), arrhythmia (4.2%), and gastrointestinal bleed (4.2%). In hospital mortality was 42% and 52% of patients were discharged, 6% went home against medical advice. Prosthetic valve endocarditis (PVE) in particular had a mortality rate of 87%. Burkholderia pseudomallei was isolated in 57.1% of these cases. Most common causes of death were sepsis, congestive heart failure, and arrhythmia. Conclusion: This large and most recent review demonstrated the evolving microbiologic and clinical profile of IE in the adult Filipino. Despite recent advances in antibiotic therapy and surgical technique, mortality remains high in IE particularly in PVE. P032 Evaluation of Myocardial Function using the Tei Index in Patients with Beta-Thalassaemia Major A. Rohani1 , V. Akbari2 , M. Moradipoor2 . 1 Yasuy University of Medical Sciences, Iran; 2 Sajjad Hospital, Yasuy, Iran Objective: The aim of this study was to evaluate myocardial function and two year follow up of Beta (b)-thalassaemia major patients using the myocardial performance index, also known as the Tei index. Methods: Out of a total of 170 patients suffering from b-thalassemia major seen during the study period, 72 (42%) were referred for cardiac evaluation due to abnormal physical examination. Cardiovascular investigations included echocardiogram. The Tei index was assessed. Patients were followed for two years. Results: 59 (81%) patients were found to have cardiac disease of which diastolic dysfunction was the most common manifestation. 11 (15%) had significant pulmonary arterial hypertension and all these group of patients had abnormal Tei index. The Tei index was significantly higher (P < 0.001) in subjects with symptoms than in asymptomatic subjects. Treatment was altered in all patients diagnosed with a cardiac disease. All 7 patients in functional class II at initial presentation, except for one of them are still alive and in a stable clinical condition after a mean follow-up of 18±7 months. 3 patients became newly symptomatic and 2 of them had significantly high index at the start of study. Conclusion: The Tei-Index is easily obtained and highly reproducible. Our data suggest that the index is a sensitive indicator of overall cardiac dysfunction and has good correlation with diastolic and systolic dysfunction and presence of symptoms. It may be used in the follow-up. P033 The Effect of Physical Training on Systemic Pro-inflammatory Cytokine Expression in Heart Failure Patients: A Systematic Review N.A. Smart, M. Steele. Faculty of Health Science and Medicine, Bond University, QLD., Australia Objective: Systemic inflammation is associated with cardiovascular disease, especially the end stages of heart failure. We sought to determine by, systematic review and appropriate data pooling, whether physical therapy reduces serum levels of pro-inflammatory cytokines in heart failure patients. Methods: Potential studies were identified from a systematic search of Medline (Ovid) (1950-October 2010), Embase.com (1974current), Cochrane Central Register of Controlled Trials, CINAHL (1981-current) and Web of Science (2000-current). The search strategy included a mix of MeSH and free text terms for the key concepts. Results: Data from four included studies was available on 224 patients. Meta-analysis of available tumor necrosis factoralpha data in 114 patients following physical therapy showed a 25% reduction, mean difference −1.11 pg/L (95% CI −1.36 to −0.85, p < 0.00001). Meta-analysis of available interleukin-6 data in 68 patients following physical therapy showed a 16% reduction,
mean difference −1.25 pg/L (95% CI −1.86 to −0.63, p < 0.0001), while a concurrent 17.8±4% increase in peak VO2 , in those undertaking exercise therapy was observed. Conclusion: Published studies show an unequivocal reduction in serum levels of pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-alpha following physical therapy in heart failure patients. The data currently available does not provide a guide to the optimum physical therapy regime to retard or reverse the adverse effects of systemic inflammation. P034 Evaluating the Diagnostic Accuracy of 2D and 3D Echocardiography in Ebstein’s Anomaly in Comparison with Intraoperative Findings L. Wang1 , J. Cui1 , Q. Wu1 , G. Pan1 . 1 Heart Center, First Hosp. of Tsinghua University, Beijing, China Objective: To evaluate the diagnostic accuracy of Ebstein’s anomaly by comparing the intraoperative findings with 2D and 3D echocardiography. Methods: 155 patients diagnosed as Ebstein’s anomaly were reviewed. Among them, 93 received surgical repair. Intraoperative findings were compared with echocardiography reports. In 10 patients, 3D echocardiography was also performed. Results: The diagnosis of Ebstein’s anomaly was confirmed in all patients. Tricuspid regurgitation was severe in 73, moderate in 19, mild in 1. Downward displacement of tricuspid leaflet were: septal in 73, posterior in 68, anterior in 18; leaflet absence was identified as septal in 6, posterior in 7; remarkable leaflet hypoplasty was reported as septal in 8, posterior in 5 and anterior in 3. The accuracy of leaflet involvement by echo was 100% in septal and posterior, while only 35% in anterior; the accuracy of leaflet absence by echo was 60% and 63.6% in septal and posterior respectively. Leaflet hypoplasty was reported in 16 cases by echo, accounting for only 17.2% of those observed during operation, compatible with the severely hypoplastic leaflets. With 3D echo study, the abnormal downward displacement and hypoplasty of leaflets were well viewed in short axis of the RV. Hypoplasty of the tricuspid valve was much easier to be identified. Also postoperative 3D echo can clearly show the bicuspidized tricuspid valve in good function also the anatomical changes underlying remarkable tricuspid regurgitation, which is beyond 2D echo. Conclusion: 2D echo is good in identifying septal and posterior leaflet displacement, but it is easy to miss partial anterior downward diaplacement. The anotomical changes of the leaflet are often underevaluated by 2D echo. 3D echo can offer better information pre- and postoperatively. P035 A Study on One-Year Outcome of Patients with Heart Failure with Type 2 Diabetes Mellitus versus Non-Diabetics S.C. Chai, K.T. Leong, P.P. Goh. Department of Cardiology, Changi General Hospital Objective: To compare the clinical features and one-year prognosis of patients with heart failure and type 2 diabetes mellitus against patients with heart failure but without type 2 diabetes mellitus (T2DM). Methods: This is an observational prospective study on patients admitted to Changi General Hospital between November 2003 and April 2004 fulfilling the modified Framingham Criteria for clinical heart failure (HF) and whose serum creatinine <267 umol/L, serum albumin >28 g/L. Results: 173 patients with heart failure were enrolled into the study. There were 87 patients with T2DM (50.3%) compared to 86 patients without T2DM (49.7%). The prevalence of hypertension was significantly higher in the T2DM HF cohort (72.8% vs 57.0%, p = 0.003). The incidence of acute myocardial infarct in the