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PM095 Atrial Fibrillation Independently Predicts Short And Long-Term Mortality After Aortic Valve Replacement
POSTER ABSTRACTS
PM089
PM091
A novel, simplified diastolic scoring system better classifies subjects into diastolic grades with increasing cardiovascular risk than EAE/ASE recommendations
Is restrictive filling post ST elevation myocardial infarction (STEMI) treated by primary percutaneous intervention a predictor for development of heart failure?
Jennifer M. Coller*1,2, Duncan J. Campbell2, Henry Krum3, Michele McGrady4, Louise Shiel3, Chris Reid3, Umberto Boffa5, Rory Wolfe4, Simon Stewart6, David L. Prior7 1 Department of Medicine, St Vincent’s Hospital, 2St Vincent’s Institute, 3Centre for Cardiovascular Research and Education in Therapeutics, 4Monash University, Melbourne, 5 University of Adelaide, Adelaide, 6Baker IDI, 7St Vincent’s Hospital, Melbourne, Australia
Leia Hee*1, Kim Munk2, Niels H. Andersen2, Chrisian J. Terkelsen2, Hans E. Botker2, Sandy Prasad3, Pramesh Kovoor4, Liza Thomas1, Steen H. Poulsen2 1 Cardiology, Liverpool Hospital/ UNSW, Sydney, Australia, 2Cardiology, Aarhus University Hospital, Aarhus C, Denmark, 3Cardiology, Royal Brisbane Hospital, Brisbane, 4Cardiology, Westmead Hospital/University of Sydney, Sydney, Australia
Introduction: EAE/ASE recommendations for diastolic evaluation are complex and may not offer optimal cardiovascular (CV) risk stratification. There exists a need to develop a simpler approach to diastolic grading which identifies subjects at increased mortality risk. Objectives: To compare the ability of the EAE/ASE recommendations and a novel, simplified diastolic score to identify subjects at increased CV risk, reflected by elevated serum NT-proBNP levels. Methods: Detailed evaluation of diastolic function was undertaken in 3046 asymptomatic subjects >60 years with 1 risk factors for heart failure. Algorithms were constructed to grade subjects according to EAE/ASE recommendations and a novel scoring system (three grades: normal (E/A ratio>0.75 with 1 feature of abnormal diastolic function), mild dysfunction (E/A ratio<0.75) and moderate-severe dysfunction (E/A ratio>0.75 with 3 abnormal features)). Abnormal diastolic features included left atrial enlargement (LAVI>34mL/min), average E’<8cm/s, average E/E’>13, or S/D reversal. Serum NT-proBNP levels are reported as median (25th,75th centile). NT-proBNP levels in each grade were compared with levels in the Normal group using analysis of variance. Results: Diastolic function could be assessed in most subjects (EAE/ASE: 2870, 94%; novel scoring system: 2806, 92%). The EAE/ASE recommendations definitively classified only 40% of subjects, fewer than the novel scoring system (73%). Using the EAE/ASE schema, serum NT-proBNP levels were significantly higher in Athlete’s Heart, Grade I and II-III categories than in the Normal category, but NT-proBNP levels decreased from Grade I to Grades II-III. Using the novel scoring system for grading, NT-proBNP levels increased progressively with worsening diastolic grade.
Introduction: Restrictive filling after STEMI treated by thrombolysis is a known predictor of future heart failure (HF). However, primary percutaneous intervention (PCI) results in early revascularization of myocardium and improved recovery. Objectives: We hypothesized that restrictive filling post STEMI treated by PCI, may not result in development of HF. Methods: 680 patients STEMI patients treated by PCI from3 high volume centres (Aarhus hospital, Denmark; Liverpool and Westmead Hospitals, Australia) who underwent an echocardiogram within 1 week of STEMI. Restrictive filling was defined as E/A ratio 2 and/or deceleration time <140ms (as per MERGE analysis). All patients were prospectively followed for the development of HF (in patient or outpatient). Results: 105/680 patients (15%) had restrictive filling on ECHO. At 32 ( 24) months follow up, a significantly greater number of patients in the restrictive filling group developed HF (10.5% vs 5.7%; p<0.05). We examined determinants of restrictive filling at baseline. Neither age, gender, hypertension, diabetes or previous ischemic heart disease, were determinants of restrictive filling. Symptom to reperfusion time was similar in both groups; although a greater proportion of patients were observed the LAD as the culprit artery in the restrictive filling group (60% vs 43%; p¼0.01). Of the echocardiographic parameters, only baseline left ventricular ejection fraction (LVEF) was significantly lower (44 11 vs 50 10 %; p<0.001) in the restrictive filling group. Conclusion: Despite early and improved revascularization by PCI, the presence of restrictive filling post STEMI increases the incidence of HF. A reduced LVEF post STEMI was the only determinant of restrictive filling. Disclosure of Interest: None Declared PM092
EAE/ASE recommendations Diastolic grade(n)
Normal (489)
Athlete’s Heart(201)
Grade I (177)
Grades II-III (281)
Indeterminate (1617)
Serum NT-proBNP
8(4,16)
12 (6,21)
14 (8,24)
12 (7,24)
11 (6,20)
p<0.001
p<0.001
p<0.001
p<0.001
(pmol/L)
Novel scoring system Diastolic grade(n)
Normal (1169)
NA
Mild (714)
Mod-Severe (173)
Indeterminate (749)
Serum NT-proBNP
9 (5,17)
NA
11 (6,20)
16 (8,32)
12 (6,21)
NA
p<0.001
p<0.001
p<0.001
(pmol/L)
Conclusion: The novel diastolic scoring system allocated more subjects to definitive diastolic grades than EAE/ASE recommendations. Progressively increasing NT-proBNP levels with worsening grade by this system suggests it also more effectively differentiates between groups at differing CV risk than EAE/ASE recommendations. Disclosure of Interest: None Declared PM090 Is there any correlation between Brain Natriuretic and the left ventricular diastolic dysfunction in patients with acute coronary syndrome Leila Abid Trigui*1, Salma Charfeddine1, Mona Turki2, Fatma Ayedi2, Samir Kammoun1 1 Cardiology Departement, Hedi Chaker Hospital, Sfax (Tunisia), Medecine University Sfax, 2 Biochemistry Departement, Habib Bourguiba Hospital, Sfax, Tunisia Introduction: The utility of Brain Natriuretic Peptide (BNP) for detecting leftventricular (LV) diastolic dysfunction in patients presenting an acute coronary syndrome without heart failure symptoms is unclear Objectives: we investigated the relation between BNP plasma levels and LV diastolic dysfunction in patients with postmyocardial infarction with preserved systolic function Methods: We studied 81 patients admitted for STMI ou NSTMI. Patients with heart failure symptoms or abnormal systolic function were excluded. Patients were divided in three groups according to E/E’ ratios < 10 (groupI), E/E’ ratios between 10 and 15 (group II) and E/E’ ratios > 15 (group III) Results: The BNP blood levels were positively correlated significantly with E/E’ ratio (p < 0.02). Patients with elevated LV end diastolic pressure (LVEDP), defined as E/E’ > 15 (n ¼ 27) had highest BNP (302 68 pg/ml) levels. E/E’ 10 to 15 group (n ¼ 24) had a mean BNP level of 136.4 +/- 27 pg/ml, and those with E/E’ < 10 (n ¼ 29) had 82 +/- 20 pg/ml. A BNP value of 107.8 pg/ml had a sensitivity of 89%, a specificity of 61% for predicting E/E’ > 15. The area under the ROC curve for BNP to detect any diastolic dysfunction was 0.757. A BNP value of 72.7 pg/ml had a sensitivity of 82.2% and a specificity of 66.7% for detecting a diastolic dysfunction Conclusion: A rapid assay for BNP can detect the presence of diastolic abnormalities on echocardiography in patients with preserved systolic function post myocardial infarction Disclosure of Interest: None Declared
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Left and right ventricular systolic and diastolic dysfunction assessed by cardiac magnetic resonance imaging during cytostatic therapy Marianna Gyongyosi*1, Christian Geier1, Gerald Maurer1, Jutta Bergler-Klein1 1 Cardiology, Medical University of Vienna, Vienna, Austria Introduction: Current chemotherapy using anthracycline and its derivates, such as doxorubicin (DOX) or the liposome–encapsulated doxorubicin–citrate complex Myocet (MYO) have significantly improved survival in cancer patients. However, besides myelosuppression, cardiotoxicity in terms of clinical or subclinical left ventricular dysfunction is the primary clinical concern when anthracycline is used, leading to increased cardiovascular morbidity and mortality in cancer survival patients. Objectives: The main objective of the present study is to recognize of early signs of cardiac abnormalities using late gadolinium enhancement (LE) cardiac magnetic resonance imaging (cMRI) during cytostatic treatment under experimental conditions. Methods: Fifteen pigs received either DOX (n¼6) or MYO (n¼9) in 3 cycles of cytostatic treatment of human dose, with 3 weeks between the treatments. cMRI with LE were performed before treatment start and at 3 weeks after the last dose application. The left (LV) and right (RV) ventricular systolic (ejection fraction, EF), and diastolic (peak filling rate, PFR) function were automatically calculated. Myocardial fibrosis was assessed as hyperintensity in LE diastolic phase images. Routine blood parameter such as number of leukocytes, red blood cells and thrombocytes were counted and liver, kidney parameter and electrolytes were measured before each treatment cycle and at the final follow-up. Left and right myocardial segments were stained with Picrosirius red to quantify cardiac fibrosis via histology. Results: Five of 6 of DOX and 6 of 9 MYO animals completed the study. The baseline cMRI and laboratory parameter were similar in the groups. LV EF (56.45.6% vs 41.913.5%, p¼0.039) and RV EF (42.12.8% vs 28.98.9%, p¼0.009) were significantly higher in animals receiving MYO as compared with DOX, with trend towards better LV diastolic function in MYO group (PFR: 10.7 +/- 4.8 vs 7.9+/-2.5 ml/s). Myocardial fibrosis was found in 33% vs 60% of the animals in MYO vs DOX groups. Histology confirmed the presence of myocardial fibrosis in the myocardium (LV: 5.84.1% vs 6.62.9% of the entire LV; and RV: 6.21.9% vs 8.63.9% of the entire RV). Conclusion: The liposomal-encapsulated doxorubicin-citrat (MYO) proved to be less cardiotoxic as compared with DOX, resulting in higher LV systolic and better diastolic function with trend towards less LV and RV myocardial fibrosis in an experimental model of cardiotoxic therapy. Disclosure of Interest: None Declared PM095 Atrial Fibrillation Independently Predicts Short And Long-Term Mortality After Aortic Valve Replacement Tom Kai Ming Wang*1, David H.-M. Choi1, Tharumenthiran Ramanathan1, Peter Ruygrok1,2 Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine, University of Auckland, Auckland, New Zealand 1
Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia, becoming increasing prevalent as the population ages, and an important risk factor for stroke. There is
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POSTER/2014 WCC Posters
PM096 Warfarin and Post-Discharge Survival After Acute Pulmonary Embolism in Octogenarians John P. Moutzouris*1, Austin C. C. Ng1, Vincent Chow1, Tommy Chung1, Vasikaran Naganathan2, Leonard Kritharides1 1 Cardiology, 2Geriatric Medicine, Concord Hospital, Sydney, Australia Introduction: The clinical characteristics of octogenarians or older (age 80-years) with acute PE remain poorly defined and predictors of short-term mortality in these patients are unknown. Objectives: Examine the outcomes of octogenarians following an acute PE event. Methods: Clinical details of all patients admitted to a tertiary institution from 2000–2007 with acute PE were retrieved retrospectively. Outcomes were tracked from a statewide death registry and analyses performed using binary regression modelling. Results: Of the 1023 patients included in this study, 273 (26.7%) were aged 80-years. Patients 80-years were more likely to be females (66% vs. 51%), had higher rates of ischaemic heart disease (34% vs. 16%), heart failure (24% vs. 9%), atrial fibrillation (26% vs. 12%) and neurodegenerative disease (15% vs. 3%), and were less likely to present with chest pain (48% vs. 64%), compared to patients <80-years (all P0.01). Table 1 shows the cohort’s outcomes.
Age<80 (n¼750)
Age80 (n¼273)
In-hospital mortality
31 (3.0,2.1-4.3)
20 (2.7,1.7-4.1)
11 (4.0,2.3-7.1)
30-day mortality
41 (4.0,3.0-5.4)
27 (3.6,2.5-5.2)
14 (5.1,3.1-8.4)
3-month mortality
85 (8.3,6.8-10.2)
57 (7.6,5.9-9.7)
28 (10.3,7.2-14.4)
Survival did not differ significantly between patients 80-years and <80-years. Amongst patients 80-years, univariate predictors of all-cause mortality at 3-months included a history of hypertension (hazard ratio [HR] 0.22), malignancy (HR 4.42), presenting with chest pain (HR 0.20), oxygen saturation <90% (HR 4.18), and not being discharged on warfarin (HR 6.36) (all P0.05). Multivariate analysis showed patients 80-years who survived to discharge, but were not discharged on warfarin, had an 11.8-fold increased risk of all-cause mortality at 3-months (Table 2). Table 2. Multivariate analysis (only univariate predictors with P<0.10 were included) P-value
Variables
Adjusted HR
95% CI
Not discharged on warfarin
11.76
1.75-78.84
0.01
Chest Pain
0.19
0.03-1.07
0.06
Hypertension
0.15
0.01-1.31
0.09
Malignancy
2.56
0.54-12.53
0.23
Oxygen saturation <90%
1.81
0.33-9.94
0.50
Conclusion: Elderly patients with PE have a greater burden of cardiovascular and neurodegenerative diseases and more commonly present without chest pain. Absence of anti-coagulant treatment at discharge was independently associated with a significantly increased short-term mortality in this population. Disclosure of Interest: None Declared
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Development of A Novel, Fenestrated Aortic Arch Stent Graft With A Preloaded Catheter For Protecting Branch Arteries: An Experimental Study In Swine Han Cheol Lee*1, Jae Hoon Choi2, Jin-Sup Park1 Cardiology, Pusan National University Hospital, 2Cardiology, Busan Medical Center, Busan, Korea, Republic Of
1
Introduction: TEVAR shows limitations in cases where the aortic pathology involves the aortic arch and only a short proximal landing zone is thereby available for the stent graft. Objectives: In this study, we developed a fenestrated aortic arch stent graft (FASG) with a two preloaded catheter for protecting branch arteries and performed a preclinical study with this device in swine. Methods: The FASG is a self-expandable nitinol-PTEF stent graft with round shape fenestration and preloading catheter that is designed to access carotid and subclavian artery safely. We design a round shape fenestration and preloading catheter placed inside the stent graft to save blood flow to the carotid and subclavian artery. After FASG is partially deployed, 0.035 inch guidewire is placed into the carotid artery, assembling round shape fenestration into carotid artery, and then stent graft is fully deployed. Following seperate stent grafts for carotid arteries are deployed. Six FASGs with 1 preloaded catheter and 1 side branch stent graft (1-branch FASG) and 5 FASGs with 2 preloaded catheters and 2 side branch stent grafts (2-branch FASG) were advanced through the iliac artery in 11 swines weighing 70–80 kg. The presence of endoleaks and the patency and deformity of the grafts were examined with computed tomography (CT) at 4 weeks postoperatively. A postmortem examination was performed at 8 weeks to evaluate the gross morphology, patency, and deformity of the 1branch and 2-branch FASGs. Results: The mean procedure time for the 1-branch and 2-branch FASG groups was 31.0 5.0 and 45.8 9.6 minutes, respectively. Meanwhile, the mean time for the selection of the carotid artery was 4.8 0.7 minutes and 6.8 2.5 minutes, respectively. There was a major adverse event in the 11 pigs. One pig died at 4 weeks after the CT examination, likely because of the effects of the high dose of ketamine used for the CT examination, while the remaining 10 pigs survived the 8-week observational period. For both the 1-branch and 2branch FASG groups, no endoleaks, no disconnection of the stent grafts, and no occlusion of the stent grafts for the carotid arteries were observed in the CT findings at 4 weeks. Moreover, no disconnection or tearing of the stent grafts, no fractures in the stent grafts, and no occlusion of the stent graft for carotid arteries were found in the postmortem gross findings. Conclusion: The FASG with the preloaded catheter developed here was found to be safe and convenient to use in this preclinical study with swine. Disclosure of Interest: None Declared
PM099 Clinical presentation and prognosis of patients with acute aortic intramural hematoma
Table 1. All-cause mortality – no.(%, 95% confidence interval [CI]) Study cohort (n¼1023)
PM098
POSTER/2014 WCC Posters
Jovan P. Perunicic*1, Bosiljka Vujisic Tesic2, Ratko Lasica1, Nebojsa Radovanovic1, Igor Mrdovic2, Marko Milanov1, Mladen Kocica3, Igor Koncar4, Lazar Davidovic4, Petar Djukic3 1 Emergency center, 2Clinical of cardiology, 3Cardiosurgery clinic, 4Clinic of vascularsurgery, Clinical center of Serbia, Belgrade, Serbia Introduction: Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection. Objectives: To evaluate clinical presentation, early and late prognosis of patients with acute aortic IMH. Methods: 297 consecutive patients with acute aortic syndrome diagnosed in our hospital from 1988-1999 were evaluated. Of these patients, 25 (8.4%) had IMH ( 7 type A [28%], 18 type B [72%]). Results: Patients with IMH were older (67,3613,51 years vs 54,7 11,9 years; p<0.001). Clinical characteristics of patients with IMH did not differ significantly from AD except the absence of neurological symptoms at initial presentation. Initially five patients with IMH type A and only one with type B IMH were managed surgically and all of them survive. Two patients with IMH type B were managed with endovascular stent-grafting because of aortic rupture and pseudoaneurysm. Early progression of IMH in AD (2 patients), persistent pain with coronary malperfusion (2 patients) and aneurysmatic dilatation of aorta were indications for early surgical intervention in type A IMH. Intrahospital survival of patients with IMH is better than in AD irrespective of type (85.7% vs 45.8% in type A and 94.5% vs 78.5% in type B). In long-term follow-up (mean 39 months), complete resolution or regression occurs in about half of patients with IMH (47.6%) while the progression of aortic diameter and aortic dissection were noted in 52.4% patients. Late complications of IMH – further dilatation of aorta, progression to aortic dissection or aortic rupture were present only in patients with aortic diameter at presentation > 50mm and IMH thickness >11mm. Conclusion: Acute IMH has similar presentation to classic AD. In opposite of classic AD, IMH type B is more prevalent than type A. Intrahospital survival of patients with IMH, irrespective of type, is better than in classic AD. Older age, larger diameter of diseased aortic segment and thicker IMH are predictors of unfavorable long-term prognosis. Disclosure of Interest: None Declared
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POSTER ABSTRACTS
conflicting results around whether AF is associated with adverse outcomes after aortic valve replacement (AVR) amongst the few studies that have investigated this. Objectives: We compared the characteristics and outcomes of patients undergoing AVR by history of AF. Methods: Isolated AVR patients at Auckland City Hospital 2005-2012 were divided into those with and without pre-operative AF for comparative analyses. Results: Amongst 620 patients, 19.2% (119) had permanent or paroxysmal AF preoperatively. Patients with AF were significantly older (70.5 vs 63.4 years, p<0.001), had higher proportion of New Zealand European (82.4% vs 68.1%, p¼0.004), urgent or emergency operation (62.1% vs 48.3%, p¼0.016), NYHA class III-IV (55.4% vs 37.4%,p¼0.004), history of stroke (10.9% vs 5.0%, p¼0.031), pulmonary hypertension (27.8% vs 16.2%, p¼0.002), lower creatinine clearance (73 vs 82, p¼0.001) and higher EuroSCORE II (5.2% vs 3.4%, p<0.001). Operative mortality (6.7% vs 2.0%, p¼0.012) and composite morbidity (27.7% vs 16.5%, p¼0.006) were also higher in AF. After adjusting for significant variables, pre-operative AF remained an independent predictor of operative mortality odds ratio 3.38 (95% confidence interval 1.18-9.69), mortality during follow-up 2.36 (1.44-3.87) and prolonged ventilation>24 hours 2.48 (1.32-4.69). Conclusion: AF was associated with a number of cardiovascular and cardiac surgery risk factors, but remained independently associated with short and long-term mortality. AF should be incorporated into cardiac surgery risk models and AF ablation be considered when AVR is performed. Disclosure of Interest: None Declared
PM089
PM091
A novel, simplified diastolic scoring system better classifies subjects into diastolic grades with increasing cardiovascular risk than EAE/ASE recommendations
Is restrictive filling post ST elevation myocardial infarction (STEMI) treated by primary percutaneous intervention a predictor for development of heart failure?
Jennifer M. Coller*1,2, Duncan J. Campbell2, Henry Krum3, Michele McGrady4, Louise Shiel3, Chris Reid3, Umberto Boffa5, Rory Wolfe4, Simon Stewart6, David L. Prior7 1 Department of Medicine, St Vincent’s Hospital, 2St Vincent’s Institute, 3Centre for Cardiovascular Research and Education in Therapeutics, 4Monash University, Melbourne, 5 University of Adelaide, Adelaide, 6Baker IDI, 7St Vincent’s Hospital, Melbourne, Australia
Leia Hee*1, Kim Munk2, Niels H. Andersen2, Chrisian J. Terkelsen2, Hans E. Botker2, Sandy Prasad3, Pramesh Kovoor4, Liza Thomas1, Steen H. Poulsen2 1 Cardiology, Liverpool Hospital/ UNSW, Sydney, Australia, 2Cardiology, Aarhus University Hospital, Aarhus C, Denmark, 3Cardiology, Royal Brisbane Hospital, Brisbane, 4Cardiology, Westmead Hospital/University of Sydney, Sydney, Australia
Introduction: EAE/ASE recommendations for diastolic evaluation are complex and may not offer optimal cardiovascular (CV) risk stratification. There exists a need to develop a simpler approach to diastolic grading which identifies subjects at increased mortality risk. Objectives: To compare the ability of the EAE/ASE recommendations and a novel, simplified diastolic score to identify subjects at increased CV risk, reflected by elevated serum NT-proBNP levels. Methods: Detailed evaluation of diastolic function was undertaken in 3046 asymptomatic subjects >60 years with 1 risk factors for heart failure. Algorithms were constructed to grade subjects according to EAE/ASE recommendations and a novel scoring system (three grades: normal (E/A ratio>0.75 with 1 feature of abnormal diastolic function), mild dysfunction (E/A ratio<0.75) and moderate-severe dysfunction (E/A ratio>0.75 with 3 abnormal features)). Abnormal diastolic features included left atrial enlargement (LAVI>34mL/min), average E’<8cm/s, average E/E’>13, or S/D reversal. Serum NT-proBNP levels are reported as median (25th,75th centile). NT-proBNP levels in each grade were compared with levels in the Normal group using analysis of variance. Results: Diastolic function could be assessed in most subjects (EAE/ASE: 2870, 94%; novel scoring system: 2806, 92%). The EAE/ASE recommendations definitively classified only 40% of subjects, fewer than the novel scoring system (73%). Using the EAE/ASE schema, serum NT-proBNP levels were significantly higher in Athlete’s Heart, Grade I and II-III categories than in the Normal category, but NT-proBNP levels decreased from Grade I to Grades II-III. Using the novel scoring system for grading, NT-proBNP levels increased progressively with worsening diastolic grade.
Introduction: Restrictive filling after STEMI treated by thrombolysis is a known predictor of future heart failure (HF). However, primary percutaneous intervention (PCI) results in early revascularization of myocardium and improved recovery. Objectives: We hypothesized that restrictive filling post STEMI treated by PCI, may not result in development of HF. Methods: 680 patients STEMI patients treated by PCI from3 high volume centres (Aarhus hospital, Denmark; Liverpool and Westmead Hospitals, Australia) who underwent an echocardiogram within 1 week of STEMI. Restrictive filling was defined as E/A ratio 2 and/or deceleration time <140ms (as per MERGE analysis). All patients were prospectively followed for the development of HF (in patient or outpatient). Results: 105/680 patients (15%) had restrictive filling on ECHO. At 32 ( 24) months follow up, a significantly greater number of patients in the restrictive filling group developed HF (10.5% vs 5.7%; p<0.05). We examined determinants of restrictive filling at baseline. Neither age, gender, hypertension, diabetes or previous ischemic heart disease, were determinants of restrictive filling. Symptom to reperfusion time was similar in both groups; although a greater proportion of patients were observed the LAD as the culprit artery in the restrictive filling group (60% vs 43%; p¼0.01). Of the echocardiographic parameters, only baseline left ventricular ejection fraction (LVEF) was significantly lower (44 11 vs 50 10 %; p<0.001) in the restrictive filling group. Conclusion: Despite early and improved revascularization by PCI, the presence of restrictive filling post STEMI increases the incidence of HF. A reduced LVEF post STEMI was the only determinant of restrictive filling. Disclosure of Interest: None Declared PM092
EAE/ASE recommendations Diastolic grade(n)
Normal (489)
Athlete’s Heart(201)
Grade I (177)
Grades II-III (281)
Indeterminate (1617)
Serum NT-proBNP
8(4,16)
12 (6,21)
14 (8,24)
12 (7,24)
11 (6,20)
p<0.001
p<0.001
p<0.001
p<0.001
(pmol/L)
Novel scoring system Diastolic grade(n)
Normal (1169)
NA
Mild (714)
Mod-Severe (173)
Indeterminate (749)
Serum NT-proBNP
9 (5,17)
NA
11 (6,20)
16 (8,32)
12 (6,21)
NA
p<0.001
p<0.001
p<0.001
(pmol/L)
Conclusion: The novel diastolic scoring system allocated more subjects to definitive diastolic grades than EAE/ASE recommendations. Progressively increasing NT-proBNP levels with worsening grade by this system suggests it also more effectively differentiates between groups at differing CV risk than EAE/ASE recommendations. Disclosure of Interest: None Declared PM090 Is there any correlation between Brain Natriuretic and the left ventricular diastolic dysfunction in patients with acute coronary syndrome Leila Abid Trigui*1, Salma Charfeddine1, Mona Turki2, Fatma Ayedi2, Samir Kammoun1 1 Cardiology Departement, Hedi Chaker Hospital, Sfax (Tunisia), Medecine University Sfax, 2 Biochemistry Departement, Habib Bourguiba Hospital, Sfax, Tunisia Introduction: The utility of Brain Natriuretic Peptide (BNP) for detecting leftventricular (LV) diastolic dysfunction in patients presenting an acute coronary syndrome without heart failure symptoms is unclear Objectives: we investigated the relation between BNP plasma levels and LV diastolic dysfunction in patients with postmyocardial infarction with preserved systolic function Methods: We studied 81 patients admitted for STMI ou NSTMI. Patients with heart failure symptoms or abnormal systolic function were excluded. Patients were divided in three groups according to E/E’ ratios < 10 (groupI), E/E’ ratios between 10 and 15 (group II) and E/E’ ratios > 15 (group III) Results: The BNP blood levels were positively correlated significantly with E/E’ ratio (p < 0.02). Patients with elevated LV end diastolic pressure (LVEDP), defined as E/E’ > 15 (n ¼ 27) had highest BNP (302 68 pg/ml) levels. E/E’ 10 to 15 group (n ¼ 24) had a mean BNP level of 136.4 +/- 27 pg/ml, and those with E/E’ < 10 (n ¼ 29) had 82 +/- 20 pg/ml. A BNP value of 107.8 pg/ml had a sensitivity of 89%, a specificity of 61% for predicting E/E’ > 15. The area under the ROC curve for BNP to detect any diastolic dysfunction was 0.757. A BNP value of 72.7 pg/ml had a sensitivity of 82.2% and a specificity of 66.7% for detecting a diastolic dysfunction Conclusion: A rapid assay for BNP can detect the presence of diastolic abnormalities on echocardiography in patients with preserved systolic function post myocardial infarction Disclosure of Interest: None Declared
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Left and right ventricular systolic and diastolic dysfunction assessed by cardiac magnetic resonance imaging during cytostatic therapy Marianna Gyongyosi*1, Christian Geier1, Gerald Maurer1, Jutta Bergler-Klein1 1 Cardiology, Medical University of Vienna, Vienna, Austria Introduction: Current chemotherapy using anthracycline and its derivates, such as doxorubicin (DOX) or the liposome–encapsulated doxorubicin–citrate complex Myocet (MYO) have significantly improved survival in cancer patients. However, besides myelosuppression, cardiotoxicity in terms of clinical or subclinical left ventricular dysfunction is the primary clinical concern when anthracycline is used, leading to increased cardiovascular morbidity and mortality in cancer survival patients. Objectives: The main objective of the present study is to recognize of early signs of cardiac abnormalities using late gadolinium enhancement (LE) cardiac magnetic resonance imaging (cMRI) during cytostatic treatment under experimental conditions. Methods: Fifteen pigs received either DOX (n¼6) or MYO (n¼9) in 3 cycles of cytostatic treatment of human dose, with 3 weeks between the treatments. cMRI with LE were performed before treatment start and at 3 weeks after the last dose application. The left (LV) and right (RV) ventricular systolic (ejection fraction, EF), and diastolic (peak filling rate, PFR) function were automatically calculated. Myocardial fibrosis was assessed as hyperintensity in LE diastolic phase images. Routine blood parameter such as number of leukocytes, red blood cells and thrombocytes were counted and liver, kidney parameter and electrolytes were measured before each treatment cycle and at the final follow-up. Left and right myocardial segments were stained with Picrosirius red to quantify cardiac fibrosis via histology. Results: Five of 6 of DOX and 6 of 9 MYO animals completed the study. The baseline cMRI and laboratory parameter were similar in the groups. LV EF (56.45.6% vs 41.913.5%, p¼0.039) and RV EF (42.12.8% vs 28.98.9%, p¼0.009) were significantly higher in animals receiving MYO as compared with DOX, with trend towards better LV diastolic function in MYO group (PFR: 10.7 +/- 4.8 vs 7.9+/-2.5 ml/s). Myocardial fibrosis was found in 33% vs 60% of the animals in MYO vs DOX groups. Histology confirmed the presence of myocardial fibrosis in the myocardium (LV: 5.84.1% vs 6.62.9% of the entire LV; and RV: 6.21.9% vs 8.63.9% of the entire RV). Conclusion: The liposomal-encapsulated doxorubicin-citrat (MYO) proved to be less cardiotoxic as compared with DOX, resulting in higher LV systolic and better diastolic function with trend towards less LV and RV myocardial fibrosis in an experimental model of cardiotoxic therapy. Disclosure of Interest: None Declared PM095 Atrial Fibrillation Independently Predicts Short And Long-Term Mortality After Aortic Valve Replacement Tom Kai Ming Wang*1, David H.-M. Choi1, Tharumenthiran Ramanathan1, Peter Ruygrok1,2 Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine, University of Auckland, Auckland, New Zealand 1
Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia, becoming increasing prevalent as the population ages, and an important risk factor for stroke. There is
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PM096 Warfarin and Post-Discharge Survival After Acute Pulmonary Embolism in Octogenarians John P. Moutzouris*1, Austin C. C. Ng1, Vincent Chow1, Tommy Chung1, Vasikaran Naganathan2, Leonard Kritharides1 1 Cardiology, 2Geriatric Medicine, Concord Hospital, Sydney, Australia Introduction: The clinical characteristics of octogenarians or older (age 80-years) with acute PE remain poorly defined and predictors of short-term mortality in these patients are unknown. Objectives: Examine the outcomes of octogenarians following an acute PE event. Methods: Clinical details of all patients admitted to a tertiary institution from 2000–2007 with acute PE were retrieved retrospectively. Outcomes were tracked from a statewide death registry and analyses performed using binary regression modelling. Results: Of the 1023 patients included in this study, 273 (26.7%) were aged 80-years. Patients 80-years were more likely to be females (66% vs. 51%), had higher rates of ischaemic heart disease (34% vs. 16%), heart failure (24% vs. 9%), atrial fibrillation (26% vs. 12%) and neurodegenerative disease (15% vs. 3%), and were less likely to present with chest pain (48% vs. 64%), compared to patients <80-years (all P0.01). Table 1 shows the cohort’s outcomes.
Age<80 (n¼750)
Age80 (n¼273)
In-hospital mortality
31 (3.0,2.1-4.3)
20 (2.7,1.7-4.1)
11 (4.0,2.3-7.1)
30-day mortality
41 (4.0,3.0-5.4)
27 (3.6,2.5-5.2)
14 (5.1,3.1-8.4)
3-month mortality
85 (8.3,6.8-10.2)
57 (7.6,5.9-9.7)
28 (10.3,7.2-14.4)
Survival did not differ significantly between patients 80-years and <80-years. Amongst patients 80-years, univariate predictors of all-cause mortality at 3-months included a history of hypertension (hazard ratio [HR] 0.22), malignancy (HR 4.42), presenting with chest pain (HR 0.20), oxygen saturation <90% (HR 4.18), and not being discharged on warfarin (HR 6.36) (all P0.05). Multivariate analysis showed patients 80-years who survived to discharge, but were not discharged on warfarin, had an 11.8-fold increased risk of all-cause mortality at 3-months (Table 2). Table 2. Multivariate analysis (only univariate predictors with P<0.10 were included) P-value
Variables
Adjusted HR
95% CI
Not discharged on warfarin
11.76
1.75-78.84
0.01
Chest Pain
0.19
0.03-1.07
0.06
Hypertension
0.15
0.01-1.31
0.09
Malignancy
2.56
0.54-12.53
0.23
Oxygen saturation <90%
1.81
0.33-9.94
0.50
Conclusion: Elderly patients with PE have a greater burden of cardiovascular and neurodegenerative diseases and more commonly present without chest pain. Absence of anti-coagulant treatment at discharge was independently associated with a significantly increased short-term mortality in this population. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
Development of A Novel, Fenestrated Aortic Arch Stent Graft With A Preloaded Catheter For Protecting Branch Arteries: An Experimental Study In Swine Han Cheol Lee*1, Jae Hoon Choi2, Jin-Sup Park1 Cardiology, Pusan National University Hospital, 2Cardiology, Busan Medical Center, Busan, Korea, Republic Of
1
Introduction: TEVAR shows limitations in cases where the aortic pathology involves the aortic arch and only a short proximal landing zone is thereby available for the stent graft. Objectives: In this study, we developed a fenestrated aortic arch stent graft (FASG) with a two preloaded catheter for protecting branch arteries and performed a preclinical study with this device in swine. Methods: The FASG is a self-expandable nitinol-PTEF stent graft with round shape fenestration and preloading catheter that is designed to access carotid and subclavian artery safely. We design a round shape fenestration and preloading catheter placed inside the stent graft to save blood flow to the carotid and subclavian artery. After FASG is partially deployed, 0.035 inch guidewire is placed into the carotid artery, assembling round shape fenestration into carotid artery, and then stent graft is fully deployed. Following seperate stent grafts for carotid arteries are deployed. Six FASGs with 1 preloaded catheter and 1 side branch stent graft (1-branch FASG) and 5 FASGs with 2 preloaded catheters and 2 side branch stent grafts (2-branch FASG) were advanced through the iliac artery in 11 swines weighing 70–80 kg. The presence of endoleaks and the patency and deformity of the grafts were examined with computed tomography (CT) at 4 weeks postoperatively. A postmortem examination was performed at 8 weeks to evaluate the gross morphology, patency, and deformity of the 1branch and 2-branch FASGs. Results: The mean procedure time for the 1-branch and 2-branch FASG groups was 31.0 5.0 and 45.8 9.6 minutes, respectively. Meanwhile, the mean time for the selection of the carotid artery was 4.8 0.7 minutes and 6.8 2.5 minutes, respectively. There was a major adverse event in the 11 pigs. One pig died at 4 weeks after the CT examination, likely because of the effects of the high dose of ketamine used for the CT examination, while the remaining 10 pigs survived the 8-week observational period. For both the 1-branch and 2branch FASG groups, no endoleaks, no disconnection of the stent grafts, and no occlusion of the stent grafts for the carotid arteries were observed in the CT findings at 4 weeks. Moreover, no disconnection or tearing of the stent grafts, no fractures in the stent grafts, and no occlusion of the stent graft for carotid arteries were found in the postmortem gross findings. Conclusion: The FASG with the preloaded catheter developed here was found to be safe and convenient to use in this preclinical study with swine. Disclosure of Interest: None Declared
PM099 Clinical presentation and prognosis of patients with acute aortic intramural hematoma
Table 1. All-cause mortality – no.(%, 95% confidence interval [CI]) Study cohort (n¼1023)
PM098
POSTER/2014 WCC Posters
Jovan P. Perunicic*1, Bosiljka Vujisic Tesic2, Ratko Lasica1, Nebojsa Radovanovic1, Igor Mrdovic2, Marko Milanov1, Mladen Kocica3, Igor Koncar4, Lazar Davidovic4, Petar Djukic3 1 Emergency center, 2Clinical of cardiology, 3Cardiosurgery clinic, 4Clinic of vascularsurgery, Clinical center of Serbia, Belgrade, Serbia Introduction: Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection. Objectives: To evaluate clinical presentation, early and late prognosis of patients with acute aortic IMH. Methods: 297 consecutive patients with acute aortic syndrome diagnosed in our hospital from 1988-1999 were evaluated. Of these patients, 25 (8.4%) had IMH ( 7 type A [28%], 18 type B [72%]). Results: Patients with IMH were older (67,3613,51 years vs 54,7 11,9 years; p<0.001). Clinical characteristics of patients with IMH did not differ significantly from AD except the absence of neurological symptoms at initial presentation. Initially five patients with IMH type A and only one with type B IMH were managed surgically and all of them survive. Two patients with IMH type B were managed with endovascular stent-grafting because of aortic rupture and pseudoaneurysm. Early progression of IMH in AD (2 patients), persistent pain with coronary malperfusion (2 patients) and aneurysmatic dilatation of aorta were indications for early surgical intervention in type A IMH. Intrahospital survival of patients with IMH is better than in AD irrespective of type (85.7% vs 45.8% in type A and 94.5% vs 78.5% in type B). In long-term follow-up (mean 39 months), complete resolution or regression occurs in about half of patients with IMH (47.6%) while the progression of aortic diameter and aortic dissection were noted in 52.4% patients. Late complications of IMH – further dilatation of aorta, progression to aortic dissection or aortic rupture were present only in patients with aortic diameter at presentation > 50mm and IMH thickness >11mm. Conclusion: Acute IMH has similar presentation to classic AD. In opposite of classic AD, IMH type B is more prevalent than type A. Intrahospital survival of patients with IMH, irrespective of type, is better than in classic AD. Older age, larger diameter of diseased aortic segment and thicker IMH are predictors of unfavorable long-term prognosis. Disclosure of Interest: None Declared
e81
POSTER ABSTRACTS
conflicting results around whether AF is associated with adverse outcomes after aortic valve replacement (AVR) amongst the few studies that have investigated this. Objectives: We compared the characteristics and outcomes of patients undergoing AVR by history of AF. Methods: Isolated AVR patients at Auckland City Hospital 2005-2012 were divided into those with and without pre-operative AF for comparative analyses. Results: Amongst 620 patients, 19.2% (119) had permanent or paroxysmal AF preoperatively. Patients with AF were significantly older (70.5 vs 63.4 years, p<0.001), had higher proportion of New Zealand European (82.4% vs 68.1%, p¼0.004), urgent or emergency operation (62.1% vs 48.3%, p¼0.016), NYHA class III-IV (55.4% vs 37.4%,p¼0.004), history of stroke (10.9% vs 5.0%, p¼0.031), pulmonary hypertension (27.8% vs 16.2%, p¼0.002), lower creatinine clearance (73 vs 82, p¼0.001) and higher EuroSCORE II (5.2% vs 3.4%, p<0.001). Operative mortality (6.7% vs 2.0%, p¼0.012) and composite morbidity (27.7% vs 16.5%, p¼0.006) were also higher in AF. After adjusting for significant variables, pre-operative AF remained an independent predictor of operative mortality odds ratio 3.38 (95% confidence interval 1.18-9.69), mortality during follow-up 2.36 (1.44-3.87) and prolonged ventilation>24 hours 2.48 (1.32-4.69). Conclusion: AF was associated with a number of cardiovascular and cardiac surgery risk factors, but remained independently associated with short and long-term mortality. AF should be incorporated into cardiac surgery risk models and AF ablation be considered when AVR is performed. Disclosure of Interest: None Declared