- Email: [email protected]
PM111 Effect Of Mineralocorticoid Receptor Antagonists on Pulmonary Arterial Hypertension in Heart Failure Patients
POSTER ABSTRACTS
months. Patients were divided into 2 groups: gr. I (59 men; 77%), gr. II (18 women; 23%). Plasma levels of Nt-proBNP, interleukin (IL)-1b, IL-6, IL-10, tumor necrosis factor-alpha (TNF-a), C-reactive protein, galectin-3 (Gal-3), metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinase 1 and 4 (TIMP-1 and TIMP-4) and ratio MMP-9/TIMP-1, MMP-9/TIMP-4 were measured. According to dynamics of left ventricular end-systolic volume (LVESV) patients were classified into: non-responders (LVESV decrease <15%), responders (LVESV decrease 15-29%), super-responders (LVESV decrease 30%). Results: At baseline women had more likely left bundle branch block (81.3 vs 47.5%, p¼0.016). During follow-up women showed significantly greater number of super-responders (66.7 vs 30.5%), smaller number of responders (18.8 vs 31.1%) and non-responders (18.8 vs 36.1%) (p¼0.022). Both groups showed decrease of IL-6 levels (p<0.05), TNF-a (p<0.001; p<0.05, respectively), NT-proBNP (p¼0.001; p<0.05), Gal3 (p <0.05). However, biomarkers dynamics was more significant in women: there was decrease of IL-6 levels at 44.4 vs 23.5% in men (p ¼ 0.029), TNF-a at 41.4 vs 30.9%, respectively, NT-proBNP at 73.3 vs 46% (p¼0.002), Gal-3 at 82.3 vs 64.9%% (p<0.05). Gr.I also showed significant decrease of IL-10 levels at 34.2% (p<0.05). Group dynamics of TIMP-1 levels was opposite: gr.I showed tendency to reduction of TIMP-1 (p¼0.054), gr.II showed significant increase of TIMP-1 (p<0.05). Besides, women showed decrease of MMP-9 levels (p <0.05) and ratio MMP-9/TIMP-4 (p<0.05). Conclusion: Super-response to CRT is associated with gender. Women benefit of CRT may be because of greater decrease of neurohormonal activation and systemic inflammation, diminishing of the myocardial fibrosis, decrease of imbalance in the matrix metalloproteinases system. Disclosure of Interest: None Declared PM108 The Abnormal Status of Uncarboxylated Matrix Gla Protein Species Represents an Additional Mortality Risk in Heart Failure Patients With Vascular Disease O. Mayer*1, J. Seidlerová1, J. Vanek1, P. Karnosová1, J. Bruthans1, J. Filipovský1 1 2nd Dept. of Internal Medicine, Charles University, Medical Faculty, Plzen, Czech Republic Introduction: Matrix Gla protein (MGP) is a natural inhibitor of tissue calcification. In a previous study we observed the positive association between abnormal concentrations of uncarboxylated MGP species and increased mortality risk in stable vascular patients. Objectives: We explore whether co-incidence of abnormal status of uncarboxylated MPG and heart failure (HF) affects the mortality risk. Methods: We examined 799 patients (mean age 65.1 years) with stable vascular disease and followed them in a prospective study. Both, desphospho-uncarboxylated and total uncarboxylated MGP (dp-ucMGP or t-ucMGP) were quantified by pre-commercial ELISA assays (VitaK, Maastricht, The Netherlands). Results: Elevated (>100 ng/L) circulating brain natriuretic peptide (BNP) and abnormal status of plasma uncarboxylated MGP species (i.e: dp-ucMGP 977 pmol/L or t-ucMGP 2825 nmol/L) were all identified as robust predictors of all-cause 5-year mortality. However, their co-incidence represented a substantial additional risk. We observed the highest mortality risk in patients with elevated BNP plus high dp-ucMGP compared to those with normal BNP plus low dp-ucMGP; fully adjusted HRR’s were 4.86 (3.15-7.49). Likewise, the risk was increased when compared with patients with elevated BNP plus low dp-ucMGP; HRR 2.57 (1.60-4.10). Similar result we observed when co-incidence of elevated BNP and low t-ucMGP was analyzed [corresponding HRR’s were 4.16 (2.62-6.61) and 1.96 (1.243.12)]. Conclusion: The concomitant abnormality of uncarboxylated MGP and mild elevation of BNP leads in chronic patients with vascular disease to about two-fold increase of the relative mortality risk. We hypothesize that abnormal homeostasis of MGP is involved in the pathophysiology of HF. Disclosure of Interest: None Declared PM109 Clinical-Laboratory and Immunological Characteristics of Patients With Chronic Heart Failure of Various Etiologies G. Nagaeva*1, S. Nagaev2, N. Yuldashev3 1 Prevention of cardiovascular disease, The Republic Specialized Center of Cardiology, 2Human Genomics Laboratory, Scientific Research Institute of Immunology, 3endovascular surgery, Republican Specialized Center of Cardiology, Tashkent, Uzbekistan Introduction: In the development of heart failure plays an important role causative factor Objectives: Comparison of patients with CHF on a background of DCM and ischemic cardiomyopathy (ICM). Methods: The study involved 42 patients with CHF, mean age ¼ 54,914,1 years. In the whole group the mean functional class was CHF 3,30,6 (for NYHA). Depending on the etiology of the patients were divided into 2 groups: 1g. - 22 patients with DCM and 2gr. 20 patients with ICM. Conducted: scale evaluation of the clinical status - SECS (2000); biochemical with the calculation of glomerular filtration rate (GFR) by Cockcroft-Gault and MDRD; ECG; echocardiography; 6-minute walk test (SWT) and immune status (IS). Results: PPts. 1gr. differed young age and the short period of the disease (all p<0,05). Number of points on a scale SECS did not reach significant difference, however, indicators of both systolic and diastolic BP, unreliable prevailed in 2gr. In 2gr. liver enzyme levels, indicators of urea and creatinine were higher than in the 1gr. (all p<0.05). This was also reflected in the calculation of GFR, was 21.3% (by Cockcroft-Gault) lower than in 1gr. (p<0.05). By MDRD is also indicative of a renal dysfunction in 2gr. During the SWT, pts.of
e90
2gr. overcame a smaller. In analyzing the parameters of the IS of the blood in all pts. been detected deficiency of immune cells: marked reduction of the pool of T-helper cells (CD3+ & CD4+) and activation of T-suppressors (CD8+) as compared to the standard data. The increase in the CD8+ level was more pronounced in pts. with DCM. In addition there was a significant increase in T-killer cells. Analysis of the humoral IS showed that the free and bound antigens of myocardium were detected in pts. with HF, regardless of its causes. Conclusion: CHF in CHD develops over a long time & at an older age. Multiple organ failure prevailed in patients with ICM. In the blood of patients with CHF, regardless of cause, determined by high titers of antibodies to the myocardial, however, high concentrations of circulating immune complexes were significantly more common in DCM. Disclosure of Interest: None Declared PM110 Quality of Life Measured With Euroqol-5d Questionnaire Predicts Outcome and Echocardiographic Response in Cardiac Resynchronisation Therapy Patients V. K. Nagy*1, G. Szeplaki1, A. M. Boros1, P. Perge1, L. Molnar1, S. Szilagyi1, J. Karady1, A. Apor1, L. Geller1, B. Merkely1 1 Heart and Vascular Center, Semmelweis University, Budapest, Hungary Introduction: Previous studies revealed the prognostic significance of quality of life (QoL) in CRT-implanted patients measured with complex heart failure questionnaires (Minnesota Living With Heart Failure, Kansas City Cardiomyopathy). However, there is no data available in this patient population with the EuroQol-5 dimensions (EQ-5D) health questionnaire, which provides a simple descriptive profile for health status. Objectives: We aimed to assess the predictive role of baseline QoL and QoL change measured at 6 months after CRT implantation with EQ-5D on two years mortality and response to therapy. Methods: Consecutive HF patients (n¼130) with CRT indication were enrolled prospectively. All patients underwent clinical evaluation and echocardiography before and 6 months after CRT and followed up for 24 months. Subjects filled out the EQ-5D questionnaire prior to and 6 months after CRT, which comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. It also includes a visual analogue scale (VAS) indicating the overall health state of the patient. The primary end-point was two years all-cause mortality. CRT-response was defined at 6 months as 15% reduction in LV end-systolic volume. Results: Total of 27 patients (20.7%) died during the 24 months follow up and 63 (48.5%) patients were considered responders to CRT. There were significant improvement in usual activities in 93 (71.5%, p¼0.037), pain/discomfort in 92 (70.7%, p¼0.029) patients and health status based on VAS scale [50.0% (35.0-65.0) vs. 60.0% (50.0-75.0), p<0.001] also improved at 6 months. Patients with self-care problems at baseline had significantly lower survival (log-rank, p¼0.003) and lower echocardiographic response [OR¼0.11 (0.010.97), p¼0.047]. At 6 months those patients with improved mobility and less pain/ discomfort had significantly better survival during the 2 years follow-up (p¼0,009 and p¼0.014, respectively). Conclusion: The EQ-5D health questionnaire is an easy method to assess QoL in patients undergoing CRT. Problems with self-care before CRT-implantation and lack of improvement in mobility and pain/discomfort predicts poor outcome. Moreover, self-care problems at baseline are associated with lower response. It may be therefore considered to include this simple measurement in patient selection and follow-up care. Disclosure of Interest: None Declared PM111 Effect Of Mineralocorticoid Receptor Antagonists on Pulmonary Arterial Hypertension in Heart Failure Patients C. Cintora-Martínez*1, D. González-Islas1, A. Orea-Tejeda1, B. Santellano-Suárez1, R. Sánchez-Santillán1, J. Pineda-Juárez1, V. Peláez-Hernández1, R. Pablo-Santiago1, E. Pérez-Cabañas1, E. W. Contreras-Ramírez1 1 Heart Failure and Respiratory Clinic, Instituto Nacional de Enfermedades Respiratorias”Ismael Cosío Villegas”, Mexico, Mexico Introduction: Mineralocorticoid Receptor Antagonists (MRAs) in pulmonary arterial hypertension (PAH) have been described experimentally. These have shown to attenuate vascular resistance and diminish pulmonary vascular remodeling. In clinical trials, it has been demonstrated that pulmonary arterial pressure (PAP) is lowered when administered conjunctly with other treatment for pulmonary arterial hypertension and heart failure (HF) patients. However, the effect of MRAs on PAP in patients with HF remains unknown. Objectives: To evaluate the effect of MRA on pulmonary arterial hypertension (PAH) secondary to HF. Methods: A cross-sectional study was carried out in stable HP patients. Inclusion criteria: age of 18 years or older, with a diagnostic of HF corroborated by echocardiogram. A multiple linear regression performed with the objective of evaluating the effect of MRA on PAH. Results: Data from 615 patients was evaluated, of which 55.12% were men, age 62.82 16.17 years, the most frequent comorbidities were systemic hypertension 72.68 %, dyslipidemias 50.89%, diabetes mellitus 45.37 %, Ischemic heart disease 34.13% pulmonary arterial hypertension was found in 90.13%. the MRAs decrease 0.91 mm Hg per gram of MRA administered (spironolactone 25 mg per week on average) was observed, adjusted by sex, age, angiotensin converting ezyme inhibitors dosage, beta blockers dosage, right
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thrombotic events in those patients with spironolactone treatment continuously vs those who did not. Disclosure of Interest: None Declared
PM112
An Evidence-Based Practice Team Approach to Health Failure Patient Education
Association of Cardiac Cachexia and Heart Failure Types: Right and Left (With Reduced or Preserved Ejection Fraction)
S. Robinson*1, C. May2, A. Young1, C. Wied1, G. Assam1, B. Shah1, S. Almond3, B. Sebastian3, P. Ghimire3, on behalf of Enhanced Heart Failure Patient Education 1 Cardiac Telemetry Unit North, 2Advanced Heart Failure, Inova Heart and Vascular, Falls Church, 3Nursing, George Mason University, Fairfax, United States
R. Sánchez-Santillán1, A. Orea-Tejeda1, E. Arámbula-Garza1, D. González-Islas1, B. Santellano-Suárez*1, C. Cintora-Martínez1, J. Pineda-Juárez1, V. Peláez-Hernández1, R. Pablo-Santiago1, E. Contreras-Ramírez1 1 Heart Failure and Respiratory Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico, Mexico Introduction: Cardiac cachexia is a frequent complication in advanced heart failure (HF). Is complicated to diagnosis specially the right heart failure (RHF). The mixed heart failure (left and right) lead to visceral congestion and intestinal malabsorption, it has an increased complication as cardiac cachexia (CC), the range estimates is about 8-42% of cases and is characterized by weight loss, muscle weakness, and edema, and it’s a marker of poor prognosis. Bioelectrical impedance with vectorial analysis BIVA) allows to now the cellular mass and the body composition, without to assume the hydration status, which by definition in this population is unstable. Objectives: To establish the association between type of heart failure with the development of CC assessed with Bioelectrical impedance by vectorial analysis (BIVA). Methods: We assessed a case control studies in patients with stable chronic heart failure demonstrated with echocardiography and radionuclide ventriculography, also body composition analysis. They were identified the cases of cardiac cachexia and left HF was considered with reduced ejection fraction (EFrLV, < 40%) or preserved (EFpLV 40), and <35% for right ventricle in repose and stress respectively. Results: From a total of 757 patients, 359 (47.4%) of them developed cardiac cachexia, (52.9% were man, medium age was 65 years old [55-74] although the patients with cachexia was older 72 years [61-67] than those with not cardiac cachexia,with 62 years [5270, p<0.01]). Regarding the type of heart failure, 53.5% with LVpEF, 7.1% LVrEF and 39% with isolated right heart failure compared with control cases (p¼0.05). A higher proportion of right heart failure was observed, in cases with atrial fibrillation (FA) (21.95% vs 7.33% p¼0.007), as well as a higher diameter in the left atrum (49.83 +8.55 vs 42.25 + 7.45, p<0.001), and the diastolic diameter of right ventricle (41.82 + 9.80 vs 37.23 + 9.52, p¼0.028). Conclusion: The CC demonstrated with BIVA is more frequent in right HF and LV LVpEF, this allows us to speculate that in its pathogenesis the gastrointestinal congestion has a predominant roll. Disclosure of Interest: None Declared PM113 Effects of Spironolactone on Mortality and Thrombotic Events in Patients With Decompensated Heart Failure B. Santellano-Suárez1, A. Orea-Tejeda1, D. González-Islas1, J. Pineda-Juárez1, V. Peláez-Hernández1, C. Cintora-Martínez*1, R. Sánchez-Santillán1, R. Pablo-Santiago1, O. Lozano-Cruz1 1 Heart Failure and Respiratory Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico, Mexico Introduction: Aldosterone plays an essential roll in the pathophysiology of heart failure (HF) promoting sodium retention, loss of magnesium and potassium, sympathetic activation, parasympathetic inhibition, vascular and myocardial fibrosis, alteration in baroreceptor function and vascular damage. Nevertheless, there are few studies that describe the effects of spironolactone on mortality and thrombotic events in patients with decompensated HF. Objectives: Evaluate the effect of spironolactone on decompensated heart failure patients mortality and thrombotic events. Methods: Observational retrospective study from a cohort of hospitalized patients during 2009-2013 at on acute or chronic decompensated HF. The difference between mortality and thrombotic events (cerebral, CVE, venous, DVT and pulmonary, PTE) was evaluated amongst patients on spironolactone administration continuously and those patients who did not. Results: Were included 96 HF patients of which: 42 (43.8%) were male, 81 (84.37%) did not receive continuous treatment with spironolactone, and 15 (15.62%) received spironolactone before and after hospitalization. None off the 15 patients who received spironolactone continuously died, however 21 patients (25.9%) with not continuous spironolactone treatment died (p¼0.036). Respect to the thrombotic events, of the 81 patients without continuous spironolactone treatment, 9 (11.1%) had an event, and of the 15 patients with continuous spironolactone treatment, 5 (33.3%) had a thrombotic event (p¼0.04). Conclusion: An increase in mortality due to any cause with a significant statistical difference was observed in HF patients who did not used spironolactone continuously in comparison to those who did used it continuously. There were also a greater number of
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PM116
Introduction: According to a statement from the American Heart Association, providing structured and individually reinforced education in a culturally and linguistically sensitive manner during clinical encounters is vital for the promotion self-care. The purpose of this project is to achieve improvement in HCAHPS scores and reduce 30-day readmissions for the heart failure patient population. An interdisciplinary EBP project team was developed to enhanced heart failure patient education. Objectives: 1. Reduce 30 day readmissions 2. Develop standardized heart failure education process 3. Achieve an improvement in patient satisfaction Methods: EBP interventions for heart failure patient education implemented, building on the current education processes. The EBP team utilized available tools including the on demand video system, and teach back questions to tailor education. Results: Patient satisfaction compared 4 question categories between second quarter 2015 before intervention and third quarter after intervention. Comparison analysis of readmission for heart failure DRGs from patients admitted discharged and readmitted to CTUN. Comparison analysis of heart failure readmission complication and heart failure with multiple complications and comorbidities. Improvement in 4 categories of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) metric, as well as improvement in days between admissions. Conclusion: This EBP project allowed collaboration of team members and focus on the needs of individual patients. At the same time hardwired the use of a standard process. This project demonstrated improvement in a reduction in readmissions for the heart failure patient population. Recommendations include the necessity to have a robust dedicated multidisciplinary team. Disclosure of Interest: None Declared PM117 ECG Predictors of Long Term Mortality in Patients With Heart Failure and Impaired Ejection Fraction T. Shen*1, J. Yap2, W. Ong1, D. Sim2, C. P. Lim2, S. Y. Chia2, L. L. Sim2, C. K. Ching2 1 Yong Loo Lin School of Medicine, National University of Singapore, 2Cardiology, National Heart Center, Singapore, Singapore Introduction: Heart failure with impaired ejection fraction (EF) portends a great mortality and morbidity. Identifying the at-risk patient can help the clinician in the management of these patients. The electrocardiogram (ECG) is a simple and readily available screening tool. Objectives: We aim to analyse the ECG predictors of mortality in Asian patients with reduced EF. Methods: Consecutive patients admitted to our institution for heart failure from 1 Jan 2008 to 31 Dec 2009 with EF <50% on transthoracic echocardiogram were included. ECG variables studied included heart rate, PR interval, QRS duration, left bundle branch block (BBB), right BBB, left ventricular hypertrophy and right ventricular hypertrophy (RVH). Other clinical variables studied included comorbid diseases, blood pressure, laboratory results and discharge medications. All patients were followed-up for 5 years. Outcomes included all-cause and cardiovascular mortality obtained from national registries. Results: Our study included a total of 1032 patients (mean age 66.3 12.4 years old, 666 males, 67.8% Chinese, 18.3% Malay, 11.8% Indian). The 5-year all-cause mortality was 65.2% (673/1032) and 5-year cardiovascular mortality was 43.0% (444/1032). Significant univariate ECG predictors of all-cause mortality included heart rate and QRS duration. Significant univariate ECG predictors of cardiovascular mortality included heart rate, QRS duration and RVH. On multivariate analysis, QRS duration was a significant predictor of both all-cause (HR 1.005 (95% CI 1.001-1.008), p¼0.004) and cardiovascular mortality (HR 1.006 (95% CI 1.002-1.010), p¼0.003). The rest of the ECG variables were not significant. Conclusion: In Asian patients with impaired EF, QRS duration is a significant predictor of both long-term all-cause and cardiovascular mortality. Disclosure of Interest: None Declared PM120 Electrical Myostimulation Improves Quality of Life, Left Ventricular Function and Peak Oxygen Consumption in Patients With Chronic Heart Failure - Results From the EMS Study Comparing Different Stimulation Strategies F. Van Buuren*1, A. Fründ2, N. Bogunovic1, D. Horstkotte1, K.-P. Mellwig1 1 Clinic for Cardiology, 2Dept. of Physiotherapy, Herz- und Diabeteszentrum NRW, RuhrUniversität Bochum, Bad Oeynhausen, Germany
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POSTER ABSTRACTS
ventricle ejection fraction, phase angle (measured by bioelectrical impedance with vectorial analysis). Conclusion: In patients with heart failure and pulmonary arterial hypertension, MRAs lower PAP considerably. Disclosure of Interest: None Declared
months. Patients were divided into 2 groups: gr. I (59 men; 77%), gr. II (18 women; 23%). Plasma levels of Nt-proBNP, interleukin (IL)-1b, IL-6, IL-10, tumor necrosis factor-alpha (TNF-a), C-reactive protein, galectin-3 (Gal-3), metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinase 1 and 4 (TIMP-1 and TIMP-4) and ratio MMP-9/TIMP-1, MMP-9/TIMP-4 were measured. According to dynamics of left ventricular end-systolic volume (LVESV) patients were classified into: non-responders (LVESV decrease <15%), responders (LVESV decrease 15-29%), super-responders (LVESV decrease 30%). Results: At baseline women had more likely left bundle branch block (81.3 vs 47.5%, p¼0.016). During follow-up women showed significantly greater number of super-responders (66.7 vs 30.5%), smaller number of responders (18.8 vs 31.1%) and non-responders (18.8 vs 36.1%) (p¼0.022). Both groups showed decrease of IL-6 levels (p<0.05), TNF-a (p<0.001; p<0.05, respectively), NT-proBNP (p¼0.001; p<0.05), Gal3 (p <0.05). However, biomarkers dynamics was more significant in women: there was decrease of IL-6 levels at 44.4 vs 23.5% in men (p ¼ 0.029), TNF-a at 41.4 vs 30.9%, respectively, NT-proBNP at 73.3 vs 46% (p¼0.002), Gal-3 at 82.3 vs 64.9%% (p<0.05). Gr.I also showed significant decrease of IL-10 levels at 34.2% (p<0.05). Group dynamics of TIMP-1 levels was opposite: gr.I showed tendency to reduction of TIMP-1 (p¼0.054), gr.II showed significant increase of TIMP-1 (p<0.05). Besides, women showed decrease of MMP-9 levels (p <0.05) and ratio MMP-9/TIMP-4 (p<0.05). Conclusion: Super-response to CRT is associated with gender. Women benefit of CRT may be because of greater decrease of neurohormonal activation and systemic inflammation, diminishing of the myocardial fibrosis, decrease of imbalance in the matrix metalloproteinases system. Disclosure of Interest: None Declared PM108 The Abnormal Status of Uncarboxylated Matrix Gla Protein Species Represents an Additional Mortality Risk in Heart Failure Patients With Vascular Disease O. Mayer*1, J. Seidlerová1, J. Vanek1, P. Karnosová1, J. Bruthans1, J. Filipovský1 1 2nd Dept. of Internal Medicine, Charles University, Medical Faculty, Plzen, Czech Republic Introduction: Matrix Gla protein (MGP) is a natural inhibitor of tissue calcification. In a previous study we observed the positive association between abnormal concentrations of uncarboxylated MGP species and increased mortality risk in stable vascular patients. Objectives: We explore whether co-incidence of abnormal status of uncarboxylated MPG and heart failure (HF) affects the mortality risk. Methods: We examined 799 patients (mean age 65.1 years) with stable vascular disease and followed them in a prospective study. Both, desphospho-uncarboxylated and total uncarboxylated MGP (dp-ucMGP or t-ucMGP) were quantified by pre-commercial ELISA assays (VitaK, Maastricht, The Netherlands). Results: Elevated (>100 ng/L) circulating brain natriuretic peptide (BNP) and abnormal status of plasma uncarboxylated MGP species (i.e: dp-ucMGP 977 pmol/L or t-ucMGP 2825 nmol/L) were all identified as robust predictors of all-cause 5-year mortality. However, their co-incidence represented a substantial additional risk. We observed the highest mortality risk in patients with elevated BNP plus high dp-ucMGP compared to those with normal BNP plus low dp-ucMGP; fully adjusted HRR’s were 4.86 (3.15-7.49). Likewise, the risk was increased when compared with patients with elevated BNP plus low dp-ucMGP; HRR 2.57 (1.60-4.10). Similar result we observed when co-incidence of elevated BNP and low t-ucMGP was analyzed [corresponding HRR’s were 4.16 (2.62-6.61) and 1.96 (1.243.12)]. Conclusion: The concomitant abnormality of uncarboxylated MGP and mild elevation of BNP leads in chronic patients with vascular disease to about two-fold increase of the relative mortality risk. We hypothesize that abnormal homeostasis of MGP is involved in the pathophysiology of HF. Disclosure of Interest: None Declared PM109 Clinical-Laboratory and Immunological Characteristics of Patients With Chronic Heart Failure of Various Etiologies G. Nagaeva*1, S. Nagaev2, N. Yuldashev3 1 Prevention of cardiovascular disease, The Republic Specialized Center of Cardiology, 2Human Genomics Laboratory, Scientific Research Institute of Immunology, 3endovascular surgery, Republican Specialized Center of Cardiology, Tashkent, Uzbekistan Introduction: In the development of heart failure plays an important role causative factor Objectives: Comparison of patients with CHF on a background of DCM and ischemic cardiomyopathy (ICM). Methods: The study involved 42 patients with CHF, mean age ¼ 54,914,1 years. In the whole group the mean functional class was CHF 3,30,6 (for NYHA). Depending on the etiology of the patients were divided into 2 groups: 1g. - 22 patients with DCM and 2gr. 20 patients with ICM. Conducted: scale evaluation of the clinical status - SECS (2000); biochemical with the calculation of glomerular filtration rate (GFR) by Cockcroft-Gault and MDRD; ECG; echocardiography; 6-minute walk test (SWT) and immune status (IS). Results: PPts. 1gr. differed young age and the short period of the disease (all p<0,05). Number of points on a scale SECS did not reach significant difference, however, indicators of both systolic and diastolic BP, unreliable prevailed in 2gr. In 2gr. liver enzyme levels, indicators of urea and creatinine were higher than in the 1gr. (all p<0.05). This was also reflected in the calculation of GFR, was 21.3% (by Cockcroft-Gault) lower than in 1gr. (p<0.05). By MDRD is also indicative of a renal dysfunction in 2gr. During the SWT, pts.of
e90
2gr. overcame a smaller. In analyzing the parameters of the IS of the blood in all pts. been detected deficiency of immune cells: marked reduction of the pool of T-helper cells (CD3+ & CD4+) and activation of T-suppressors (CD8+) as compared to the standard data. The increase in the CD8+ level was more pronounced in pts. with DCM. In addition there was a significant increase in T-killer cells. Analysis of the humoral IS showed that the free and bound antigens of myocardium were detected in pts. with HF, regardless of its causes. Conclusion: CHF in CHD develops over a long time & at an older age. Multiple organ failure prevailed in patients with ICM. In the blood of patients with CHF, regardless of cause, determined by high titers of antibodies to the myocardial, however, high concentrations of circulating immune complexes were significantly more common in DCM. Disclosure of Interest: None Declared PM110 Quality of Life Measured With Euroqol-5d Questionnaire Predicts Outcome and Echocardiographic Response in Cardiac Resynchronisation Therapy Patients V. K. Nagy*1, G. Szeplaki1, A. M. Boros1, P. Perge1, L. Molnar1, S. Szilagyi1, J. Karady1, A. Apor1, L. Geller1, B. Merkely1 1 Heart and Vascular Center, Semmelweis University, Budapest, Hungary Introduction: Previous studies revealed the prognostic significance of quality of life (QoL) in CRT-implanted patients measured with complex heart failure questionnaires (Minnesota Living With Heart Failure, Kansas City Cardiomyopathy). However, there is no data available in this patient population with the EuroQol-5 dimensions (EQ-5D) health questionnaire, which provides a simple descriptive profile for health status. Objectives: We aimed to assess the predictive role of baseline QoL and QoL change measured at 6 months after CRT implantation with EQ-5D on two years mortality and response to therapy. Methods: Consecutive HF patients (n¼130) with CRT indication were enrolled prospectively. All patients underwent clinical evaluation and echocardiography before and 6 months after CRT and followed up for 24 months. Subjects filled out the EQ-5D questionnaire prior to and 6 months after CRT, which comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. It also includes a visual analogue scale (VAS) indicating the overall health state of the patient. The primary end-point was two years all-cause mortality. CRT-response was defined at 6 months as 15% reduction in LV end-systolic volume. Results: Total of 27 patients (20.7%) died during the 24 months follow up and 63 (48.5%) patients were considered responders to CRT. There were significant improvement in usual activities in 93 (71.5%, p¼0.037), pain/discomfort in 92 (70.7%, p¼0.029) patients and health status based on VAS scale [50.0% (35.0-65.0) vs. 60.0% (50.0-75.0), p<0.001] also improved at 6 months. Patients with self-care problems at baseline had significantly lower survival (log-rank, p¼0.003) and lower echocardiographic response [OR¼0.11 (0.010.97), p¼0.047]. At 6 months those patients with improved mobility and less pain/ discomfort had significantly better survival during the 2 years follow-up (p¼0,009 and p¼0.014, respectively). Conclusion: The EQ-5D health questionnaire is an easy method to assess QoL in patients undergoing CRT. Problems with self-care before CRT-implantation and lack of improvement in mobility and pain/discomfort predicts poor outcome. Moreover, self-care problems at baseline are associated with lower response. It may be therefore considered to include this simple measurement in patient selection and follow-up care. Disclosure of Interest: None Declared PM111 Effect Of Mineralocorticoid Receptor Antagonists on Pulmonary Arterial Hypertension in Heart Failure Patients C. Cintora-Martínez*1, D. González-Islas1, A. Orea-Tejeda1, B. Santellano-Suárez1, R. Sánchez-Santillán1, J. Pineda-Juárez1, V. Peláez-Hernández1, R. Pablo-Santiago1, E. Pérez-Cabañas1, E. W. Contreras-Ramírez1 1 Heart Failure and Respiratory Clinic, Instituto Nacional de Enfermedades Respiratorias”Ismael Cosío Villegas”, Mexico, Mexico Introduction: Mineralocorticoid Receptor Antagonists (MRAs) in pulmonary arterial hypertension (PAH) have been described experimentally. These have shown to attenuate vascular resistance and diminish pulmonary vascular remodeling. In clinical trials, it has been demonstrated that pulmonary arterial pressure (PAP) is lowered when administered conjunctly with other treatment for pulmonary arterial hypertension and heart failure (HF) patients. However, the effect of MRAs on PAP in patients with HF remains unknown. Objectives: To evaluate the effect of MRA on pulmonary arterial hypertension (PAH) secondary to HF. Methods: A cross-sectional study was carried out in stable HP patients. Inclusion criteria: age of 18 years or older, with a diagnostic of HF corroborated by echocardiogram. A multiple linear regression performed with the objective of evaluating the effect of MRA on PAH. Results: Data from 615 patients was evaluated, of which 55.12% were men, age 62.82 16.17 years, the most frequent comorbidities were systemic hypertension 72.68 %, dyslipidemias 50.89%, diabetes mellitus 45.37 %, Ischemic heart disease 34.13% pulmonary arterial hypertension was found in 90.13%. the MRAs decrease 0.91 mm Hg per gram of MRA administered (spironolactone 25 mg per week on average) was observed, adjusted by sex, age, angiotensin converting ezyme inhibitors dosage, beta blockers dosage, right
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thrombotic events in those patients with spironolactone treatment continuously vs those who did not. Disclosure of Interest: None Declared
PM112
An Evidence-Based Practice Team Approach to Health Failure Patient Education
Association of Cardiac Cachexia and Heart Failure Types: Right and Left (With Reduced or Preserved Ejection Fraction)
S. Robinson*1, C. May2, A. Young1, C. Wied1, G. Assam1, B. Shah1, S. Almond3, B. Sebastian3, P. Ghimire3, on behalf of Enhanced Heart Failure Patient Education 1 Cardiac Telemetry Unit North, 2Advanced Heart Failure, Inova Heart and Vascular, Falls Church, 3Nursing, George Mason University, Fairfax, United States
R. Sánchez-Santillán1, A. Orea-Tejeda1, E. Arámbula-Garza1, D. González-Islas1, B. Santellano-Suárez*1, C. Cintora-Martínez1, J. Pineda-Juárez1, V. Peláez-Hernández1, R. Pablo-Santiago1, E. Contreras-Ramírez1 1 Heart Failure and Respiratory Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico, Mexico Introduction: Cardiac cachexia is a frequent complication in advanced heart failure (HF). Is complicated to diagnosis specially the right heart failure (RHF). The mixed heart failure (left and right) lead to visceral congestion and intestinal malabsorption, it has an increased complication as cardiac cachexia (CC), the range estimates is about 8-42% of cases and is characterized by weight loss, muscle weakness, and edema, and it’s a marker of poor prognosis. Bioelectrical impedance with vectorial analysis BIVA) allows to now the cellular mass and the body composition, without to assume the hydration status, which by definition in this population is unstable. Objectives: To establish the association between type of heart failure with the development of CC assessed with Bioelectrical impedance by vectorial analysis (BIVA). Methods: We assessed a case control studies in patients with stable chronic heart failure demonstrated with echocardiography and radionuclide ventriculography, also body composition analysis. They were identified the cases of cardiac cachexia and left HF was considered with reduced ejection fraction (EFrLV, < 40%) or preserved (EFpLV 40), and <35% for right ventricle in repose and stress respectively. Results: From a total of 757 patients, 359 (47.4%) of them developed cardiac cachexia, (52.9% were man, medium age was 65 years old [55-74] although the patients with cachexia was older 72 years [61-67] than those with not cardiac cachexia,with 62 years [5270, p<0.01]). Regarding the type of heart failure, 53.5% with LVpEF, 7.1% LVrEF and 39% with isolated right heart failure compared with control cases (p¼0.05). A higher proportion of right heart failure was observed, in cases with atrial fibrillation (FA) (21.95% vs 7.33% p¼0.007), as well as a higher diameter in the left atrum (49.83 +8.55 vs 42.25 + 7.45, p<0.001), and the diastolic diameter of right ventricle (41.82 + 9.80 vs 37.23 + 9.52, p¼0.028). Conclusion: The CC demonstrated with BIVA is more frequent in right HF and LV LVpEF, this allows us to speculate that in its pathogenesis the gastrointestinal congestion has a predominant roll. Disclosure of Interest: None Declared PM113 Effects of Spironolactone on Mortality and Thrombotic Events in Patients With Decompensated Heart Failure B. Santellano-Suárez1, A. Orea-Tejeda1, D. González-Islas1, J. Pineda-Juárez1, V. Peláez-Hernández1, C. Cintora-Martínez*1, R. Sánchez-Santillán1, R. Pablo-Santiago1, O. Lozano-Cruz1 1 Heart Failure and Respiratory Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico, Mexico Introduction: Aldosterone plays an essential roll in the pathophysiology of heart failure (HF) promoting sodium retention, loss of magnesium and potassium, sympathetic activation, parasympathetic inhibition, vascular and myocardial fibrosis, alteration in baroreceptor function and vascular damage. Nevertheless, there are few studies that describe the effects of spironolactone on mortality and thrombotic events in patients with decompensated HF. Objectives: Evaluate the effect of spironolactone on decompensated heart failure patients mortality and thrombotic events. Methods: Observational retrospective study from a cohort of hospitalized patients during 2009-2013 at on acute or chronic decompensated HF. The difference between mortality and thrombotic events (cerebral, CVE, venous, DVT and pulmonary, PTE) was evaluated amongst patients on spironolactone administration continuously and those patients who did not. Results: Were included 96 HF patients of which: 42 (43.8%) were male, 81 (84.37%) did not receive continuous treatment with spironolactone, and 15 (15.62%) received spironolactone before and after hospitalization. None off the 15 patients who received spironolactone continuously died, however 21 patients (25.9%) with not continuous spironolactone treatment died (p¼0.036). Respect to the thrombotic events, of the 81 patients without continuous spironolactone treatment, 9 (11.1%) had an event, and of the 15 patients with continuous spironolactone treatment, 5 (33.3%) had a thrombotic event (p¼0.04). Conclusion: An increase in mortality due to any cause with a significant statistical difference was observed in HF patients who did not used spironolactone continuously in comparison to those who did used it continuously. There were also a greater number of
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PM116
Introduction: According to a statement from the American Heart Association, providing structured and individually reinforced education in a culturally and linguistically sensitive manner during clinical encounters is vital for the promotion self-care. The purpose of this project is to achieve improvement in HCAHPS scores and reduce 30-day readmissions for the heart failure patient population. An interdisciplinary EBP project team was developed to enhanced heart failure patient education. Objectives: 1. Reduce 30 day readmissions 2. Develop standardized heart failure education process 3. Achieve an improvement in patient satisfaction Methods: EBP interventions for heart failure patient education implemented, building on the current education processes. The EBP team utilized available tools including the on demand video system, and teach back questions to tailor education. Results: Patient satisfaction compared 4 question categories between second quarter 2015 before intervention and third quarter after intervention. Comparison analysis of readmission for heart failure DRGs from patients admitted discharged and readmitted to CTUN. Comparison analysis of heart failure readmission complication and heart failure with multiple complications and comorbidities. Improvement in 4 categories of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) metric, as well as improvement in days between admissions. Conclusion: This EBP project allowed collaboration of team members and focus on the needs of individual patients. At the same time hardwired the use of a standard process. This project demonstrated improvement in a reduction in readmissions for the heart failure patient population. Recommendations include the necessity to have a robust dedicated multidisciplinary team. Disclosure of Interest: None Declared PM117 ECG Predictors of Long Term Mortality in Patients With Heart Failure and Impaired Ejection Fraction T. Shen*1, J. Yap2, W. Ong1, D. Sim2, C. P. Lim2, S. Y. Chia2, L. L. Sim2, C. K. Ching2 1 Yong Loo Lin School of Medicine, National University of Singapore, 2Cardiology, National Heart Center, Singapore, Singapore Introduction: Heart failure with impaired ejection fraction (EF) portends a great mortality and morbidity. Identifying the at-risk patient can help the clinician in the management of these patients. The electrocardiogram (ECG) is a simple and readily available screening tool. Objectives: We aim to analyse the ECG predictors of mortality in Asian patients with reduced EF. Methods: Consecutive patients admitted to our institution for heart failure from 1 Jan 2008 to 31 Dec 2009 with EF <50% on transthoracic echocardiogram were included. ECG variables studied included heart rate, PR interval, QRS duration, left bundle branch block (BBB), right BBB, left ventricular hypertrophy and right ventricular hypertrophy (RVH). Other clinical variables studied included comorbid diseases, blood pressure, laboratory results and discharge medications. All patients were followed-up for 5 years. Outcomes included all-cause and cardiovascular mortality obtained from national registries. Results: Our study included a total of 1032 patients (mean age 66.3 12.4 years old, 666 males, 67.8% Chinese, 18.3% Malay, 11.8% Indian). The 5-year all-cause mortality was 65.2% (673/1032) and 5-year cardiovascular mortality was 43.0% (444/1032). Significant univariate ECG predictors of all-cause mortality included heart rate and QRS duration. Significant univariate ECG predictors of cardiovascular mortality included heart rate, QRS duration and RVH. On multivariate analysis, QRS duration was a significant predictor of both all-cause (HR 1.005 (95% CI 1.001-1.008), p¼0.004) and cardiovascular mortality (HR 1.006 (95% CI 1.002-1.010), p¼0.003). The rest of the ECG variables were not significant. Conclusion: In Asian patients with impaired EF, QRS duration is a significant predictor of both long-term all-cause and cardiovascular mortality. Disclosure of Interest: None Declared PM120 Electrical Myostimulation Improves Quality of Life, Left Ventricular Function and Peak Oxygen Consumption in Patients With Chronic Heart Failure - Results From the EMS Study Comparing Different Stimulation Strategies F. Van Buuren*1, A. Fründ2, N. Bogunovic1, D. Horstkotte1, K.-P. Mellwig1 1 Clinic for Cardiology, 2Dept. of Physiotherapy, Herz- und Diabeteszentrum NRW, RuhrUniversität Bochum, Bad Oeynhausen, Germany
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ventricle ejection fraction, phase angle (measured by bioelectrical impedance with vectorial analysis). Conclusion: In patients with heart failure and pulmonary arterial hypertension, MRAs lower PAP considerably. Disclosure of Interest: None Declared