PM126 Functional Mitral Regurgitation in Postmyocardial Infarction Patients: Female vs Male

POSTER ABSTRACTS

Introduction: Regular physical activity is an accepted therapy in patients with chronic heart failure (CHF). Apart from endurance training electromyostimulation (EMS) of skeletal muscles can be of use in individuals that are not able to perform training due to comorbidities or the underlying cardiac disease. Objectives: Aim of this pilot study was to investigate the effects of different stimulation strategies on physical performance, left ventricular function (EF), and quality of life (QoL) in CHF patients using a newly developed stimulation suit that involves eight major muscle groups including trunk and arm muscles (extended electromyostimulation (exEMS)) in comparison to EMS therapy limited to gluteal and leg muscles (limEMS). Methods: 28 stable CHF patients (NYHA class II-III) received either exEMS (15 patients, 11 males, mean age 59.6
13.8 years) or limEMS (13 patients, 10 males, 63.6
9.4 years). Training was performed for 10 weeks twice weekly for 20 minutes, the level of daily activity remained unchanged. Effects on QoL (SF36 questionnaire), exercise capacity and EF were evaluated. Results: QoL improved in all domains. In the exEMS group there was a significant improvement in the domain physical functioning (54.31
29.8 to 75.26
15.7, p¼ 0.48) and emotional role (63.23
45.8 to 93.51
20.1 p¼ 0.048). LimEMS group showed significant improvement in the domain vitality (37.4
7.1 to 52.8
12.3, p¼ 0.02). There was a significant increase of oxygen uptake at aerobic threshold in all groups (exEMS: 14.4
3.8 to 18.5
5.3 ml/kg/min (+29.6%, p<0.001); limEMS 13.8
2.9 to 16.2
3.7 ml/kg/min (+17.5%, p<0.001)). EF increased from 36.94
8.6 to 42.36
9.1 % (+14.7%, p¼0.003) in the exEMS group (limEMS 37.7
3.6 to 40.3
5.9 % (+6.9%, p¼0.18)). Conclusion: EMS contributes to an improved quality of life and can improve oxygen uptake and EF in CHF. It may be an alternative therapy in CHF patients who are otherwise unable to undertake conventional forms of exercise training. Disclosure of Interest: None Declared

Conclusion: In patients with heart failure, treated with ventricular assist devices there is a long-term propensity to develop “de novo” aortic regurgitation, and this can lead to ineffective spending of the device as well as organic malperfusion. Due to multiple reoperations who has suffered this type of patients and their multiple comorbidities; conventional aortic valve replacement is too risky to take place. In these cases; the use of TAVI is a reproducible and able to save the patient’s life, improve hemodynamic conditions, the functional class and their quality of life. But nevertheless; it is needed to carry out monitoring and experience to evaluate the durability and effectiveness of both treatments combined. Disclosure of Interest: None Declared PM123

PM122

Association of Cardiac Cachexia and Atrial Fibrillation in Heart Failure Patients

Succesfull Management of Aortic Regurgitation With Tavi in a Patient With a HeartMate II Ventricular Assistance Device 1

1

1

1

L. R. Meza-Lopez* , J. A. Cigarroa-Lopez , D. A. Castan-Flores , S. Hernandez-Meneses , G. H. Mendoza-Zavala1, G. Garcia-Dominguez1, A. Carrillo-Muñoz1, V. M. Lozano-Torres1, M. C. Calderon-Abbo1 1 Heart Failure and Heart Transplantation, IMSS, Mexico City, Mexico Introduction: In patients with heart failure that have been treated with ventricular assist devices there is a long-term propensity to develop aortic regurgitation, leading to malfunction of the VADs. In these cases, TAVI is an option for treating the aortic regurgitation avoiding the risk of a reoperation. Objectives: We report a patient with terminal heart failure, treated by a HeartMate II ventricular assist device in 2012, and who was placed a TAVI because of diagnosis of severe aortic regurgitation. Methods: A 70 years old male with a history of hypertension and dyslipidemia, and myocardial revascularization 17 years ago, who persisted with stable angina and was treated by placement of autologous stem cells, subsequently presenting ischemic dilated cardiomyopathy, and who underwent a HeartMate II ventricular assist device 3 years ago. Patient complained of progressive dyspnea (history of 11 months). Echocardiogram diagnosed severe aortic regurgitation that required modification in the number of revolutions of the device and adjusting medical treatment; but there was no complete remission of symptoms achieved. Heart team determined him as a candidate for TAVI. Results: Performed in December 2013, a percutaneous transfemoral Core valve implant was taken without complications. Patient subsequently developed transient renal failure which was managed medically and then presenting sensory deficit and transient engine right lower limb. And being a discharged of ICU and improvement floor.2 years follow up revealed No complications and remission of symptomatology with no regurgitation of prosthesis on echocardiogram.

E. Arámbula-Garza1, D. González-Islas1, A. Orea-Tejeda1, B. Santellano-Suárez1, R. Sánchez-Santillán1, C. Cintora-Martínez*1, J. Pineda-Juárez1, V. Peláez-Hernández1, R. Pablo-Santiago1, R. Herrera-Saucedo1 1 Heart Failure and Respiratory Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico, Mexico Introduction: Cachexia is a common complication in patients with advanced Heart Failure (HF), characterized by a remarkable musculoskeletal wear and activation inflammatory pathways response. Atrial fibrillation (AF) is the most frequent (26%) arrhythmia in HF probably by mechanisms of cardiac remodeling and other factors that exacerbate the status of cardiac cachexia (CC Objectives: Evaluate the association of cardiac cachexia and atrial fibrillation in heart failure. Methods: In a case-control study, was identified the proportion of subjects with and with not CC diagnosed by electrical bioimpedance by vectorial analysis (BIVA). Subjects with congenital cardiopathies, cancer, HIV, drug use and those with CC due to etiology different to HF were excluded. Results: Were analyzed 359 subjects, 52.9% were men, median age 65 years [55-74]. Although patients with cachexia, were older 72 years [61-67] than those with not cardiac cachexia, 62 years old [52-70, p <0.01). During follow-up 47.4% of the patients developed cardiac cachexia and 17.27% Atrial fibrillation (AF), in patients with cachexia FA was significantly more frequent (23% Vs 12.11% OR: 2.17 95% CI 1.19-4.01; p ¼ 0.006). Comparing the differences in subjects with and without AF was observed the following; lower ejection fraction of the left ventricle (25.49
12.96 vs 32.01
15.02, p ¼ 0.08), lower posterior wall thickness (10.03
2.12 vs 11.00
2.47, p ¼ 0.007), larger diameter of the left atrium (49.87
9.84 vs 42.66
7.56, p <0.001), and higher proportion of cardiac cachexia (85.42% vs. 69.77%, p ¼ 0.028). 50.58% were in NYHA class I. Those in NYHA III, FA was 22.95%, compared to those with not FA 12.10% (p ¼ 0.027). The HF tyoes were:: 59.31% eft heart failure with preserved ejection fraction (LVpEF), 40.6% with reduced ejection fraction (LVrEF). The presence of cachexia was associated with higher frequency of edema 62.7% (p <0.01), lower cholesterol levels (p ¼ 0.021) and triglycerides (p ¼ 0.009), lower weight (p ¼ 0.018) and BMI (normal weight and obesity) (p ¼ 0.013). The presence of CC and FA increased the frequency of edema (p ¼ 0.027). Conclusion: The cardiac cachexia and FA are frequent complications of heart failure, when coexist are indicative of greater severity of HF, regardless the type of HF. Disclosure of Interest: None Declared PM126 Functional Mitral Regurgitation in Postmyocardial Infarction Patients: Female vs Male V. Kuznetsov*1, E. Yaroslavskaya1, D. Krinochkin1, G. Pushkarev1, G. Kolunin1, E. Gorbatenko1 1

Tyumen Cardiology Center, Tyumen, Russian Federation

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PM127 Scale CHA2DS2-VASc and Its Interrelation With Klinik & Functional Data at Patients With Coronary Heart Disease Complicated of Atrial Fibrillation G. Nagaeva*1 1 prevention of cardiovascular disease, The Republic Specialized Center of Cardiology, Tashkent, Uzbekistan Introduction: Atrial fibrillation is still threatening complication of coronary heart disease. In modern literature there are descriptions of using the scale CHA2DS2-VASc, that was the reason for our research. Objectives: To evaluate the clinical and functional parameters of patients with coronary heart disease (CHD) complicated by atrial fibrillation (AF), depending on the scale of values CHA2DS2-VASc. Methods: The study included 62 patients, mean age ¼ 61,2
8,8 (47 to 74) years. 35 (56.5%) had the acute form of CHD (15 - acute myocardial infarction and 20 - progressive angina) and 27 (42.9%) - chronic CHD (in 3 - angina (CH) functional class (FC) II; 18 angina FC III & 6 - angina FC IV). All studies were performed: physical examination, laboratory tests; ECG; echocardiography; rating scale CHA2DS2-VASc. Results: When assessing patients on a scale CHA2DS2-VASc average score was 3,0
1,6, while respondents with acute CHD, the figure was higher than in patients with chronic CHD (3,1
1,4 points vs 2,9
1,8 points, respectively, p>0.05). It has been found that between scores on CHA2DS2-VASc and duration of disease is a direct correlation but unreliable nature (p¼0,377; r¼0,203). Namely, the average score among patients with disease duration  5 years amounted to 2,6
1,5 vs those with a duration > 5 years with an average score was 3,2
1,6 (p>0.05). Also, all of the respondents were found to have the relationship with the level of total cholesterol (HS): With increasing levels of HS observed increase in scores on CHA2DS2-VASc (p¼0,002; r¼0,628). Conclusion: CHD score on a scale CHA2DS2-VASc has a direct correlation with disease duration (p>0,05) and the level of total blood cholesterol (p<0,05). The aggravation of CHD complicated by AF is characterized by an increased risk of stroke and venous thromboembolism, as evidenced by the increase in the number of points on the scale CHA2DS2-VASc. Disclosure of Interest: None Declared PM128 Intracardiac Hemodynamic Options in Relation to the Scale CHA2DS2-Vasc in Coronary Heart Disease Complicated With Atrial Fibrillation G. Nagaeva*1 1 prevention of cardiovascular disease, The Republic Specialized Center of Cardiology, Tashkent, Uzbekistan Introduction: Atrial fibrillation - as a complication of coronary heart disease is still one of the urgent problem of modern cardiology. Objectives: Scale CHA2DS2-VASc in conjunction with echocardiographic parameters in patients with coronary heart disease (CHD) complicated with atrial fibrillation (AF). Methods: The study included 62 patients, mean age ¼ 61,2
8,8 (47 to 74) years. 35 (56.5%) had the acute form of CHD (15 - acute myocardial infarction and 20 - progressive angina) and 27 (42.9%) - chronic CHD (in 3 - angina (CH) functional class (FC) II; 18 angina FC III & 6 - angina FC IV). All studies were performed: physical examination, laboratory tests; ECG; echocardiography; rating scale CHA2DS2-VASc.

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Results: The average number of points on the scale CHA2DS2-VASc was 3,0
1,6, while respondents with acute CHD, the figure was higher than in patients with chronic CHD (3,1
1,4 vs 2 points 2,9
1,8 points, respectively, p>0.05). According to the echocardiography was an inverse correlation between the number of points on the scale CHA2DS2-VASc and systolic function of the heart muscle (p<0,001; r ¼ -0,793). At the same time, the patients (46.8%) with dilation of the left atrium (LA40mm) were characterized by a significant decrease in ejection fraction (EF) of the left ventricle (LV): mean LVEF ¼ 48,1
8,1%, while the in individuals with intact sizes LA the LVEF ¼ 63,6
6,7% (p<0.001). Conclusion: Persons with acute CHD characterized by a large number of points on the scale CHA2DS2-VASc and therefore an increased risk of stroke and vascular thrombosis. In the myocardial contractility of LV and scale CHA2DS2-VASc has inverse correlation (p<0.001). Dilation LA is accompanied by a decrease of EFLV. Disclosure of Interest: None Declared PM130 Time Course of Vascular Healing and Potential Mechanisms for Guaiane-Type Sesquiterpenoids of Curcuma Zedoaria Eluting Stent in a Porcine Coronary Injury Model Y. Cui1, F. Zhao*1, J. Liu1, D. Shi1, K. Chen1, X. Wang1, J. Du1, M. Guo1 1 Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China Introduction: Increasing evidences have demonstrated that complications of stent thrombosis are linked to incompleted endothelial coverage of stents. Objectives: The purpose of our study was to assess the time course of vascular healing and the potential mechanisms of this phenomenon for guaiane type sesquiterpenoids of Curcuma zedoaria eluting stents (ZES) in a porcine coronary injury model. Methods: Guaiane type sesquiterpenoids (GS), extracted from Curcuma zedoaria, have shown antiproliferative feasibility with low toxicity to normal cells. Three principal compounds (GS3) were separated to investigate their impacts on human umbilical vein endothelial cells (HUVEC) by MTT assay and flow cytometry. Then, being applied into nanoporous platform surface of stainless steel, ZES were made, detected by scanning electron microscopy (SEM) and histomorphometry in porcine coronary injury models. Available polymer based sirolimus eluting stents (SES) and bare metal stents (BMS) were served as the controls. Results: In vitro, being preincubated with GS3 (10w1000ug/ml) for 72h, the viability rates of HUVEC were increased about 15w40% by MTT assay. Preincubation HUVCE with GS3 (600,800,1000ug/ml) for 24h showed significantly less cell number arresting in G0/G1 phase than those with sirolimus. In vivo, ZES demonstrated increased percentage of reendothelializatdion area (94.04
5.01%) than either SES (47.59
19.91%, P¼0.003) or BMS (59.58
19.61%, P¼0.024) at 7d. And at 14d and 28d, nearly complete reendothelialization rates were observed in ZES when compared with SES (96.37
1.86% vs. 69.22
16.44%, 98.51
1.86% vs. 86.18
8.16%; P¼0.012, P¼0.001, respectively) with no differences with BMS. Consistent with SEM results, morphometric findings showed similar results. Greater endothelial cell adhesion was inclined to ZES with less inflammatory responses (1.67
0.62) at 28 days, whereas stented circumambient inflammation preferred to SES (2.30
0.66,P<0.001) and BMS (2.18
0.67,P<0.001). Conclusion: Applying three compounds of Guaiane type sesquiterpenoids of Curcuma zedoaria to stent promote reendothelialization at 7d in a porcine coronary injury model. The underlying mechanisms may be related to the great endotheilal cell adhesion and less inflammatory response. Disclosure of Interest: None Declared PM132 Immediate & Short Term Outcome of Using Single Bolus Eptifibatide in Percutaneous Coronary Intervention (Pci) dA Randomized Control Study S. A. Ahsan1, J. Arzu1, M. N. Hasan*1, M. Mahmood1, M. A. Siddique1, S. M. Zaman1, K. S. Hoque1 1 Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Introduction: Eptifibatide is a molecule isolated from the snake venom. It selectively inhibits the platelet glycoprotein IIb/IIIa receptor. Because of its relatively short half-life, the action is rapid and short.The incidence of non-ST elevated myocardial infarction (NSTEMI) reduced significantly in both urgent & elective PCI. The recommended dose for eptifibatide is 180 mcg/kg intravenous bolus dose followed by 2mcg/kg/min continuous infusion for18-24 hours.Bleeding and cost limits the use of this drug for many patients in our country. Objectives: The purpose of this study was to assess whether single bolus dose of eptifibatide is also effective like recommended regimen (bolus plus continuous infusion) of eptifibatide in elective percutaneous coronary intervention (PCI). Methods: We enrolled 146 patients who underwent elective PCI from May, 2013 to May, 2014 in University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU). Among 146 patients, single bolus dose of eptifibatide was randomly assigned to 74 patients and they were selected as case. The other 72 patients, who did not receive the drug were selected as control. All patients of both the groups were treated with aspirin, clopidogrel before and after the procedure in similar fashion. The outcome measures were 24-hours and 30-day morbidity (complications or adverse events) and mortality.

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POSTER ABSTRACTS

Introduction: There are two mechanisms of mitral regurgitation (MR) formation in postmyocardial infarction patients: local myocardial remodeling with changing of mitral chord tethering, and global myocardial remodeling with dilatation of mitral ring. There are no data about gender differences in MR formation in postmyocardial infarction patients. Objectives: To reveal gender differences in clinical and functional parameters of postmyocardial infarction patients with functional MR. Methods: Among 15283 patients examined from 1991 to 2012 we selected and assessed clinical and functional parameters of 350 men (mean age 49.7
3.1 years) and 53 women (mean age 57.6
8.5 years) with a history of Q-wave myocardial infarction and echocardiographic signs of postinfarction left ventricular (LV) remodeling and moderate or severe MR without acute myocardial infarction, congenital heart disease or acquired valvular disease. Results: Women compared to men had lower hemoglobin level (135.5
11.3 vs 148.3
14.2 g/l, p<0.001) and rate of smokers (9.8 vs 62.6%, p<0.001). The prevalence of hypothyroidism (29.7 vs 9.6%, p¼0.001) and severe MR (17.0 vs 9.1%, p¼0.038) were higher in women. They also had higher indexes of left atrium dimension (25.1
2.9 vs 23.7
3.2 mm/m2, p¼0.008), LV posterior wall thickness (6.0
0.7 vs 5.2
0.8 mm/m2, p<0.001) and LV ejection fraction (47.3
8.2 vs 43.9
9.2%, p¼0.013), lower extent of LV wall motion abnormalities (28.7
14.7 vs 33.5
14.9 %, p¼0.036). The localization of myocardial scars and coronary stenoses did not differ between men and women. According to the results of multivariate analysis, the female gender was independently associated with greater index of LV posterior wall thickness (OR 3.215; CI 1.781-5.804; p<0.001), body mass index (OR 1.17; CI 1.042-1.317; p¼0,008), higher prevalence of hypothyroidism (OR 3.070; CI 0.994-9.483; p¼0.050), lower rate of smokers (OR 0.056; CI 0.013-0.244; p<0.001) and hemoglobin level (OR 0.927; CI 0.890-0.966; p<0.001). Conclusion: There are gender differences in clinical and functional parameters of postmyocardial infarction patients with functional MR. Disclosure of Interest: None Declared