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PM080 Diastolic Stiffness As Assessed By Diastolic Wall Strain In Patients With Chronic Kidney Disease
POSTER ABSTRACTS
ventricle were collected and placed immediately into a solution of “RNA later” (Qiagen, Hilden, Germany) and stored until RNA isolation. All the subjects agreed to participate in the study after being informed of its nature and purpose. Patient’s confirmed consent and the protocol of the study were approved by the Institutional Local Ethics Committee.The level of expression was measured using TagMan method. Results: The results show that the average expression of PPARg is almost identical in the aorta and left ventricle. Figure 1. Relative quantification of PPARg expression in aorta and left ventricle (Wilcoxon Rank Sum Test p ¼ 0,235). Conclusion: PPARg receptor expression in aortic and left ventricular tissue samples of patients with ischemic heart disease is similar. Disclosure of Interest: None Declared PM078 Is the correlation between TNF-308 ( rs 1800629) peroxisome proliferator-activated receptor gamma(rs1801282) polymorphisms and development of heart failure in patients with ischemic heart disease after coronary bypass grafting ? Preeliminary data Izabela Wojtkowska*1, Janusz A. Siedlecki2, Janina Janas3, Zbigniew Juraszynski4, Andrzej Tysarowski2, Janina Stepinska1 1 ICCU, National Institute of Cardiology, 2Department of Molecular Biology, Institute of Oncology, 3Department of Clinical Biochemistry, 4Departament of Cardiosurgery, National Institute of Cardiology, Warsaw, Poland Introduction: It is commonly knows that both TNF alpha and peroxisome proliferatoractivated receptor g (PPARg) affects the myocardium through inhibition of inflammatory cytokines and metabolic modulation but their effect in the progression of heart failure is unclear. The aim of the study was to assess the influence of the TNF-308 (rs1800629) and PPARg (rs1801282) of polymorphisms in patients with ischemic heart disease after coronary bypass grafting on the risk development of heart failure. Methods: 57 patients were recruited and followed-up. All patients who underwent CABG had multi-vessel ischemic heart disease. Mean age of patients was 63 8.8 years, 85% were men. Patients with diabetes mellitus, prior heart failure and valvular disease were excluded. TNF-308 (rs1800629) and PPARg (rs1801282) of polymorphisms were assayed using TaqMan method. The samples of follow-up were taken before CABG and 1-month, 12months and 24- month after. During CABG all patients had left ventricle and aortic wall specimen collected for the assessment of PPAR g expression. HF was defined as ejection fraction <40% or NT-proBNP >400pg/ml, or six-minute walk test <400m.We divided all patients into two groups: with heart failure (HF) and without heart failure (NHF). Results: None of the patients had HF before CABG. Preeliminary data of 57 pts shows presents of polymorphism Pro 12 Ala in PPARg in 26 pts (45%) and polymorphism G308 A in the promoter of the TNF-alpha in 16 (28%) pts. Only six pts had both polimorphic changes. Conclusion: So far we did not find correlation between TNF-308 ( rs 1800629)peroxisome proliferator-activated receptor gamma(rs1801282) polymorphisms and development of heart failure in patients with ischemic heart disease after coronary bypass grafting. Disclosure of Interest: None Declared PM079 Prognostic significance of Tissue Doppler and deformation parameters in asymptomatic typ 2 diabetic patients Angelina Stevanovic*1, Milica Dekleva2, Radosava Cvjetan3, Snezana Trajic4, Nevena Paunovic1, Vesna Andric1, Goran Podnar1 1 Cardiology department, Railway Health Care Institute, 2Cardiology department, University Clinical Center Zvezdara, 3Cardiology department, Zemun Medical Centre, 4Cardiology department, Dedinje Cardiovascular Institute, Belgrade, Serbia Introduction: Subclinical left ventricular (LV) systolic and diastolic dysfunction has been reported to be prevalent in diabetic subjects. This patients are at risk of future cardiac events. Objectives: The aim of this study was to explored the prognostic role of Tissue Doppler and derived deformation parameters for the primary cardiac events in asymptomatic patients with type 2 diabetes mellitus. Methods: The study included 50 asymptomatic typ 2 diabetic patients and 35 age and sex matched healthy subjects. Left atrial dimension, left atrial volume index and parameters of left ventricular geometry, including left ventricular mass index, were estimated by echocardiography. Maximal velocity of early and late diastolic LV filling (E, A, E/A), deceleration E time (DTE) and isovolumic relaxation time (IVRT) were measured from transmitral Doppler. Tissue Doppler velocities were measured from medial and lateral annulus (e, a, e/a, s) including isovolumic contraction velocity (IVCv) and acceleration during isovolumic contraction (IVA), E/e and Doppler tissue myocardial performance index. Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking. All patients were followed up for three years. The end point was cardiac event (myocardial infarction, coronary revascularization procedures, stabile or nonstabile newonset angina and heart failure). Results: There was close correlations between values of GLS and E/e (r¼0.488, p¼0.0002), and IVCv (r ¼ -0.429, p¼0.0004) with significantly lower values of GLS (-17.82.8 vs -26,92.9; p¼0.0007) and IVCv (0.070.023m/s vs 0.090.025m/s; p¼0.005) and significantly higher value of E/e (9.112.24 vs 7.121.52; p¼0.0006) in group of diabetic patients. Diabetic patients with E/e 12 (Long Rank 6.11, p¼0.013) and
e78
with IVCv 0.06 (Long Rank 4.25, p¼0.039) were at most at risk of cardiac event in the following three years. Conclusion: Diabetes mellitus is asociated with subclinical LV diastolic and systolic dysfunction. Isovolumic contraction velocity and E/e represents a simple, effective tools for assessing cardiac risk in asymptomatic typ 2 diabetic patients, but prognostic value of GLS may need to be verified through prospective study in a larger group of patients. Disclosure of Interest: None Declared PM080 Diastolic Stiffness As Assessed By Diastolic Wall Strain In Patients With Chronic Kidney Disease Feiqiong Huang*1, Thu Thao Le1, Nadira Hamid1, Ru San Tan1 1 Cardiology, National Heart Centre Singapore, Singapore, Singapore Introduction: Increased left ventricular (LV) diastolic stiffness plays a key role in heart failure. The diastolic wall strain (DWS) index is based on the linear elastic theory, which predicts that impaired diastolic wall thinning reflects resistance to deformation in diastole and thus, increased diastolic myocardial stiffness Objectives: We aim to examine LV diastolic stiffness in patients with chronic kidney disease (CKD) without cardiovascular disease. Methods: 34 patients (age: 45.538.75y) with asymptomatic non-diabetic stage III CKD (creatinine clearance was 39-50ml/min) without cardiovascular disease and 30 age matched controls (age:46.5110.46y) were included in our study. Transthoracic echocardiography was performed and left ventricular systolic and diastolic functions were analyzed. DWS was calculated as (LV posterior wall thickness at the end of systole - LV posterior wall thickness at the end of diastole)/ LV posterior wall thickness at the end of systole. Results: DWS index was significantly decreased (0.320.10 vs 0.440.10; p<0.0001), whereas LV mass and deceleration time of mitral flow E increased (167.6461.01 vs 115.2539.54, p<0.0001 and 225.0349.60 vs 170.6639.55, p<0.0001, respectively) in patients with stage III CKD compared with normal controls. Table 1. Echocardiography parameters in 2 groups CKD (n[34)
Normal (n[30)
LVEF (%)
62.539.16
65.265.26
LV mass (g)
167.6461.01*
115.2539.54
E/E’
7.391.88
6.812.23
E/A
1.310.37
1.240.48
DT (ms)
225.0349.60*
170.6639.55
LA volume index (ml/m2)
20.396.21
21.565.48
DWS
0.320.10*
0.440.11
* p<0.001 compared with normal controls
Conclusion: DWS decreased which reflect increased LV diastolic stiffness in patients with stage III CKD although the cardiac function is normal. DWS maybe a simple and useful tool in assessing diastolic stiffness in patients with stage III CKD. Disclosure of Interest: None Declared PM082 A High Index of Suspicion of Tuberculous Pericarditis Erwin Jannino O. Ybanez*1, Antonio S. Sibulo1 1 Heart Institute, St. Luke’s Medical Center, Quezon City, Philippines Introduction: Tuberculous pericarditis is life threatening and elusive, which necessitates a high index of suspicion and prompt management. Objectives: To present a case of acute tuberculous pericarditis due to high index of clinical suspicion. Methods: This is a case of a 46 year old male, Filipino, hypertensive, who came in due to persistent high grade fever for 2 weeks associated with body malaise and weight loss. He denies cough, difficulty of breathing and chest pain. He had history of recurrent shingles for 2 years and denies any sexual history. He came in awake, febrile, normotensive and tachycardic. Pertinent physical examination revealed anicteric sclera, no cervical lymphadenopathy, left axillary lymphadenopathy, clear breath sounds, muffled heart sounds, pericardial friction rub, no organomegaly on abdominal palpation and had bilateral inguinal lymphadenopathies. Results: The following diagnostic examinations were done. Complete blood count showed hemoglobin of 10.2 g/dl, haematocrit 30.6%, wbc 4580 mm3, neutrophil 32%, lymphocyte of 55% and platelet count of 185,000. Test for Dengue Fever and Typhoid Fever were negative. Chest X-ray revealed cardiomegaly with no active infiltrates. ECG showed sinus tachycardia. 2D echocardiogram showed moderate pericardial effusion with no tamponade physiology. Thyroid function tests were normal. ESR 119 mm/hr and C-reactive protein were elevated. ANA showed speckled pattern, and normal anti-ds DNA, negative for AntiSmith, anti-ribonucleoprotein and anti-cardiolipin antibody IgM and positive for anticardiolipin antibody IgG. Lupus anticoagulant was weakly present (LAC (DRVVT) 1.3). Peripheral blood smear shows normochromic and normocytic anemia. Chest computer tomography scan showed subcentimeter non-calcified nodules in both upper and right upper lobes, subcarinal lymphadenopathy and minimal pericardial effusion. Abdominal computer tomography scan showed bilateral external iliac lymphadenopathies. Left axillary
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
ventricle were collected and placed immediately into a solution of “RNA later” (Qiagen, Hilden, Germany) and stored until RNA isolation. All the subjects agreed to participate in the study after being informed of its nature and purpose. Patient’s confirmed consent and the protocol of the study were approved by the Institutional Local Ethics Committee.The level of expression was measured using TagMan method. Results: The results show that the average expression of PPARg is almost identical in the aorta and left ventricle. Figure 1. Relative quantification of PPARg expression in aorta and left ventricle (Wilcoxon Rank Sum Test p ¼ 0,235). Conclusion: PPARg receptor expression in aortic and left ventricular tissue samples of patients with ischemic heart disease is similar. Disclosure of Interest: None Declared PM078 Is the correlation between TNF-308 ( rs 1800629) peroxisome proliferator-activated receptor gamma(rs1801282) polymorphisms and development of heart failure in patients with ischemic heart disease after coronary bypass grafting ? Preeliminary data Izabela Wojtkowska*1, Janusz A. Siedlecki2, Janina Janas3, Zbigniew Juraszynski4, Andrzej Tysarowski2, Janina Stepinska1 1 ICCU, National Institute of Cardiology, 2Department of Molecular Biology, Institute of Oncology, 3Department of Clinical Biochemistry, 4Departament of Cardiosurgery, National Institute of Cardiology, Warsaw, Poland Introduction: It is commonly knows that both TNF alpha and peroxisome proliferatoractivated receptor g (PPARg) affects the myocardium through inhibition of inflammatory cytokines and metabolic modulation but their effect in the progression of heart failure is unclear. The aim of the study was to assess the influence of the TNF-308 (rs1800629) and PPARg (rs1801282) of polymorphisms in patients with ischemic heart disease after coronary bypass grafting on the risk development of heart failure. Methods: 57 patients were recruited and followed-up. All patients who underwent CABG had multi-vessel ischemic heart disease. Mean age of patients was 63 8.8 years, 85% were men. Patients with diabetes mellitus, prior heart failure and valvular disease were excluded. TNF-308 (rs1800629) and PPARg (rs1801282) of polymorphisms were assayed using TaqMan method. The samples of follow-up were taken before CABG and 1-month, 12months and 24- month after. During CABG all patients had left ventricle and aortic wall specimen collected for the assessment of PPAR g expression. HF was defined as ejection fraction <40% or NT-proBNP >400pg/ml, or six-minute walk test <400m.We divided all patients into two groups: with heart failure (HF) and without heart failure (NHF). Results: None of the patients had HF before CABG. Preeliminary data of 57 pts shows presents of polymorphism Pro 12 Ala in PPARg in 26 pts (45%) and polymorphism G308 A in the promoter of the TNF-alpha in 16 (28%) pts. Only six pts had both polimorphic changes. Conclusion: So far we did not find correlation between TNF-308 ( rs 1800629)peroxisome proliferator-activated receptor gamma(rs1801282) polymorphisms and development of heart failure in patients with ischemic heart disease after coronary bypass grafting. Disclosure of Interest: None Declared PM079 Prognostic significance of Tissue Doppler and deformation parameters in asymptomatic typ 2 diabetic patients Angelina Stevanovic*1, Milica Dekleva2, Radosava Cvjetan3, Snezana Trajic4, Nevena Paunovic1, Vesna Andric1, Goran Podnar1 1 Cardiology department, Railway Health Care Institute, 2Cardiology department, University Clinical Center Zvezdara, 3Cardiology department, Zemun Medical Centre, 4Cardiology department, Dedinje Cardiovascular Institute, Belgrade, Serbia Introduction: Subclinical left ventricular (LV) systolic and diastolic dysfunction has been reported to be prevalent in diabetic subjects. This patients are at risk of future cardiac events. Objectives: The aim of this study was to explored the prognostic role of Tissue Doppler and derived deformation parameters for the primary cardiac events in asymptomatic patients with type 2 diabetes mellitus. Methods: The study included 50 asymptomatic typ 2 diabetic patients and 35 age and sex matched healthy subjects. Left atrial dimension, left atrial volume index and parameters of left ventricular geometry, including left ventricular mass index, were estimated by echocardiography. Maximal velocity of early and late diastolic LV filling (E, A, E/A), deceleration E time (DTE) and isovolumic relaxation time (IVRT) were measured from transmitral Doppler. Tissue Doppler velocities were measured from medial and lateral annulus (e, a, e/a, s) including isovolumic contraction velocity (IVCv) and acceleration during isovolumic contraction (IVA), E/e and Doppler tissue myocardial performance index. Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking. All patients were followed up for three years. The end point was cardiac event (myocardial infarction, coronary revascularization procedures, stabile or nonstabile newonset angina and heart failure). Results: There was close correlations between values of GLS and E/e (r¼0.488, p¼0.0002), and IVCv (r ¼ -0.429, p¼0.0004) with significantly lower values of GLS (-17.82.8 vs -26,92.9; p¼0.0007) and IVCv (0.070.023m/s vs 0.090.025m/s; p¼0.005) and significantly higher value of E/e (9.112.24 vs 7.121.52; p¼0.0006) in group of diabetic patients. Diabetic patients with E/e 12 (Long Rank 6.11, p¼0.013) and
e78
with IVCv 0.06 (Long Rank 4.25, p¼0.039) were at most at risk of cardiac event in the following three years. Conclusion: Diabetes mellitus is asociated with subclinical LV diastolic and systolic dysfunction. Isovolumic contraction velocity and E/e represents a simple, effective tools for assessing cardiac risk in asymptomatic typ 2 diabetic patients, but prognostic value of GLS may need to be verified through prospective study in a larger group of patients. Disclosure of Interest: None Declared PM080 Diastolic Stiffness As Assessed By Diastolic Wall Strain In Patients With Chronic Kidney Disease Feiqiong Huang*1, Thu Thao Le1, Nadira Hamid1, Ru San Tan1 1 Cardiology, National Heart Centre Singapore, Singapore, Singapore Introduction: Increased left ventricular (LV) diastolic stiffness plays a key role in heart failure. The diastolic wall strain (DWS) index is based on the linear elastic theory, which predicts that impaired diastolic wall thinning reflects resistance to deformation in diastole and thus, increased diastolic myocardial stiffness Objectives: We aim to examine LV diastolic stiffness in patients with chronic kidney disease (CKD) without cardiovascular disease. Methods: 34 patients (age: 45.538.75y) with asymptomatic non-diabetic stage III CKD (creatinine clearance was 39-50ml/min) without cardiovascular disease and 30 age matched controls (age:46.5110.46y) were included in our study. Transthoracic echocardiography was performed and left ventricular systolic and diastolic functions were analyzed. DWS was calculated as (LV posterior wall thickness at the end of systole - LV posterior wall thickness at the end of diastole)/ LV posterior wall thickness at the end of systole. Results: DWS index was significantly decreased (0.320.10 vs 0.440.10; p<0.0001), whereas LV mass and deceleration time of mitral flow E increased (167.6461.01 vs 115.2539.54, p<0.0001 and 225.0349.60 vs 170.6639.55, p<0.0001, respectively) in patients with stage III CKD compared with normal controls. Table 1. Echocardiography parameters in 2 groups CKD (n[34)
Normal (n[30)
LVEF (%)
62.539.16
65.265.26
LV mass (g)
167.6461.01*
115.2539.54
E/E’
7.391.88
6.812.23
E/A
1.310.37
1.240.48
DT (ms)
225.0349.60*
170.6639.55
LA volume index (ml/m2)
20.396.21
21.565.48
DWS
0.320.10*
0.440.11
* p<0.001 compared with normal controls
Conclusion: DWS decreased which reflect increased LV diastolic stiffness in patients with stage III CKD although the cardiac function is normal. DWS maybe a simple and useful tool in assessing diastolic stiffness in patients with stage III CKD. Disclosure of Interest: None Declared PM082 A High Index of Suspicion of Tuberculous Pericarditis Erwin Jannino O. Ybanez*1, Antonio S. Sibulo1 1 Heart Institute, St. Luke’s Medical Center, Quezon City, Philippines Introduction: Tuberculous pericarditis is life threatening and elusive, which necessitates a high index of suspicion and prompt management. Objectives: To present a case of acute tuberculous pericarditis due to high index of clinical suspicion. Methods: This is a case of a 46 year old male, Filipino, hypertensive, who came in due to persistent high grade fever for 2 weeks associated with body malaise and weight loss. He denies cough, difficulty of breathing and chest pain. He had history of recurrent shingles for 2 years and denies any sexual history. He came in awake, febrile, normotensive and tachycardic. Pertinent physical examination revealed anicteric sclera, no cervical lymphadenopathy, left axillary lymphadenopathy, clear breath sounds, muffled heart sounds, pericardial friction rub, no organomegaly on abdominal palpation and had bilateral inguinal lymphadenopathies. Results: The following diagnostic examinations were done. Complete blood count showed hemoglobin of 10.2 g/dl, haematocrit 30.6%, wbc 4580 mm3, neutrophil 32%, lymphocyte of 55% and platelet count of 185,000. Test for Dengue Fever and Typhoid Fever were negative. Chest X-ray revealed cardiomegaly with no active infiltrates. ECG showed sinus tachycardia. 2D echocardiogram showed moderate pericardial effusion with no tamponade physiology. Thyroid function tests were normal. ESR 119 mm/hr and C-reactive protein were elevated. ANA showed speckled pattern, and normal anti-ds DNA, negative for AntiSmith, anti-ribonucleoprotein and anti-cardiolipin antibody IgM and positive for anticardiolipin antibody IgG. Lupus anticoagulant was weakly present (LAC (DRVVT) 1.3). Peripheral blood smear shows normochromic and normocytic anemia. Chest computer tomography scan showed subcentimeter non-calcified nodules in both upper and right upper lobes, subcarinal lymphadenopathy and minimal pericardial effusion. Abdominal computer tomography scan showed bilateral external iliac lymphadenopathies. Left axillary
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters