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PO19-543 THE IMPORTANCE OF TRIGLYCERIDE ON SUBJECTIVE CARDIAC SYMPTOMS OF MIDDLE-AGED POPULATION
150
Poster Sessions PO19 Novel and classical CV risk factors and markers
associated with a prolonged isovolumetric relaxation time as a measure of LV diastolic dysfunction (r=0.16, p=0.037). The same results were found when LDL replaced total cholesterol. In a multivariate linear regression model, LV mass index (beta=-0.27, p<0.001) and serum cholesterol (beta=-0.23, p=0.001) were both independent predictors of a low midwall fractional shortening. Conclusion: In young patients with uncomplicated essential hypertension, a high serum cholesterol is associated with early, asymptomatic systolic and diastolic left ventricular dysfunction. This relation is in part independent from the effect of several confounders, including age, sex, blood pressure, and left ventricular mass. PO19-540
HIGH LIPOPROTEIN(A) LEVEL AND LOW-MOLECULAR WEIGHT APO(A) PHENOTYPES PREDISPOSE TO CORONARY OCCLUSIONS
M.V. Ezhov, A.A. Lyakishev, O.I. Afanasieva, M.I. Afanasieva, V.V. Kukharchuk, S.N. Pokrovsky. Cardiology Research Center, Moscow, Russia The aim of the study was to assess frequency of elevated lipoprotein(a) level and apo(a) phenotypes in coronary heart disease (CHD) patients with occluded coronary arteries. Methods: We have examined 224 CHD patients (198 men, mean age 52.4±8.1 years). The presence of significant coronary lesions was confirmed by coronary angiography; classic risk factors, serum lipids as well as Lp(a) level and apo(a) phenotypes were analysed in all patients. Results: According to number of coronary occlusions we divided patients into 3 groups: no occlusions (n=81), 1 occlusion (n=99), >2 occlusions (n=44). Lp(a) level was significantly higher in patients with the presence of 1 and 2 occlusions: 43±46 and 43±38 mg/dl (p<0.05 for both) compared to 26±31 mg/dl in those without occlusions. The frequency of low-molecular weight apo(a) phenotypes was 35% in CHD patients with non-occluded coronaries and it was significantly higher and steadily increased with number of occluded arteries: 53% for 1 occlusion (p<0.05) and 66% for 2 and more occlusions (p<0.01). There were no differences in classic risk factors and serum lipids concentration between the groups. Conclusion: Elevated lipoprotein(a) level and higher frequency of low-molecular weight apo(a) phenotypes are associated with occlusions of coronary arteries independent of other atherosclerosis risk factors. This association could be due to thrombogenic properties of lipoprotein(a) particle. PO19-541
INCREASED PRESENCE OF MACROPHAGES SECRETING RESISTIN IN EPICARDIAL FAT OF PATIENTS WITH ACUTE CORONARY SYNDROME
S. Langheim 1 , L. Dreas 2 , L. Veschini 3 , F. Maisano 1 , C. Foglieni 1 , B. Zingone 2 , O. Alfieri 1 , E. Ferrero 3 , A. Maseri 1 , G. Ruotolo 1 . 1 Cardiovascular Department, Scientific Institute San Raffaele, Milano, Italy; 2 Cardiovascular Department, Ospedali Riuniti, Trieste, Italy; 3 Oncology Department, Scientific Institute San Raffaele, Milano, Italy Aim of the present study was to evaluate the expression of several adipocytokines in epicardial fat of patients undergoing CABG surgery for acute coronary syndrome (ACS, n=23) as compared to that of age- and BMI-matched patients with chronic stable angina (CSA, n=26). Patients undergoing cardiac surgery for valvular defects, but with angiographically normal coronary arteries served as reference group (n=20). The local expression and protein secretion (24h culture medium) of adipocytokines from epicardial fat biopsies was evaluated by Real-Time PCR (adiponectin, leptin, resistin, visfatin, IL-6, IL-8, IL-10, CRP, MCP-1, PAI-1, MIF), and multiplexed fluorescent immunoassay (adiponectin, resistin, leptin, IL-6, PAI-1, MCP-1), respectively. Immunohistochemical stainings of epicardial fat slides were also performed to show presence of inflammatory cells (T-lymphocytes, macrophages, mast cells). The 24h medium from epicardial adipose tissue culture was also tested in experiments of endothelial cell (HUVEC) permeability and proliferation in vitro. A significantly higher expression of resistin, CD68, and MCP-1 genes was observed in epicardial fat biopsies of ACS as compared to CSA patients. ACS patients also showed significantly increased levels of resistin in 24h culture medium of epicardial adipose tissue. In addition, these changes were paralleled by a significantly increased presence of CD68+ cells in epicardial fat depots of ACS patients. Finally, a significantly increased
permeability of endothelial cells was also observed after incubation with culture medium from epicardial fat of ACS patients. In conclusion, an increased presence of macrophages is associated with higher expression and secretion of resistin in epicardial adipose tissue of patients with ACS. PO19-542
THE EVALUATION OF ISCHEMIA MODIFIED ALBUMIN AS A MARKER OF MYOCARDIAL ISCHAEMIA IN END STAGE RENAL DISEASE
R. Sharma 1 , D. Gaze 2 , P.O. Collinson 2 , D. Pellerin 3 , H. Gregson 2 , C.H. Streather 2 , S.J.D. Brecker 2 . 1 Ealing Hospital, London, UK; 2 St Georges Hospital, London, UK; 3 The Heart Hospital, London, UK Background and Aims: The early diagnosis of myocardial ischaemia is problematic in patients with end stage renal disease (ESRD). The study aim was to determine whether Ischemia Modified Albumin (IMA) detects myocardial ischaemia in these patients. Methods: 114 renal transplant candidates were prospectively studied. All received dobutamine stress echocardiography (DSE). Serum IMA was measured by the albumin cobalt binding (ACB) test. IMA levels were taken at baseline and 1 hour after cessation of DSE. Results: 35 patients (31%) had a positive DSE result for ischaemia. The rise in IMA was significantly higher in the DSE positive group compared to those with no ischaemic response (26.5 ± 19.1 KU/L vs 8.2 ± 9.6 KU/L, p 0.007). From ROC analysis, the optimal IMA rise to predict an ischaemic response was 20 KU/L, with sensitivity 81% and specificity 72% (AUC = 0.80, 95%; CI 0.44, 0.94; p = 0.03). There were 18 deaths, 10 cardiac over a follow up period of 2.25 ± 0.71 years. An IMA rise > 20 KU/L (seen in 32% patients) was associated with significantly worse survival (p = 0.02). Conclusions: IMA is a promising marker of myocardial ischaemia in ESRD. An IMA rise > 20 KU/L during DSE had high sensitivity and moderate specificity for ischaemia diagnosis and was associated with significantly worse survival. PO19-543
THE IMPORTANCE OF TRIGLYCERIDE ON SUBJECTIVE CARDIAC SYMPTOMS OF MIDDLE-AGED POPULATION
W.T. Li, C.H. Hsu, C.H. Lee, Y.W. Liu, W.C. Tsai, J.Y. Chen, L.M. Tsai, L.J. Lin, J.H. Chen. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Background and Aims: Many physicians focus on treating cholesterol and sugar more than triglyceride. They even omit mild hypertriglycemia. We designed this study to review the importance of triglyceride on middle-aged population with subjective cardiac symptoms. Methods: Total 595 consecutive patients (mean age = 41.7± 9.1 y/o, 359 females) who having subjective cardiac symptoms and receiving treadmill exercise test were enrolled into study. Subjective cardiac symptoms were one of the followings: chest discomfort or chest pain, dyspnea, palpitation, or syncope. The age limitation was defined less than forty-five years old in male and less than fifty-five years old in female. We also check other serum biochemistry and arrange echocardiography for complete cardiac evaluation. Results: 130 patients (21.8%) was hypertensive and 38 patients (6.4%) had diabetes. There were 402 patients (67.6%) with chest discomfort, 176 patients (29.6%) with dyspnea, 137 patients (23%) with palpitation, and 16 patients (2.7%) with syncope. Positive treadmill exercise test was recorded in 68 patients (11.4%). Average cholesterol is 195±43 mg/dL and triglyceride is 133±77 mg/dL. However, triglyceride had more closely correlation with inflammatory marker and metabolic factor such as BMI (r = 0.459, p< 0.001), white blood cell count (r = 0.334, p< 0.001), uric acid (r = 0.261, p= 0.002), and fasting glucose (r = 0.263, p< 0.001) than cholesterol (p= 0.012, p= 0.08, p= 0.01, p= 0.001). Conclusions: In evaluating lipid profile with cardiovascular consideration, triglyceride is as important as total cholesterol.
76th Congress of the European Atherosclerosis Society, June 10–13, 2007, Helsinki, Finland
Poster Sessions PO19 Novel and classical CV risk factors and markers
associated with a prolonged isovolumetric relaxation time as a measure of LV diastolic dysfunction (r=0.16, p=0.037). The same results were found when LDL replaced total cholesterol. In a multivariate linear regression model, LV mass index (beta=-0.27, p<0.001) and serum cholesterol (beta=-0.23, p=0.001) were both independent predictors of a low midwall fractional shortening. Conclusion: In young patients with uncomplicated essential hypertension, a high serum cholesterol is associated with early, asymptomatic systolic and diastolic left ventricular dysfunction. This relation is in part independent from the effect of several confounders, including age, sex, blood pressure, and left ventricular mass. PO19-540
HIGH LIPOPROTEIN(A) LEVEL AND LOW-MOLECULAR WEIGHT APO(A) PHENOTYPES PREDISPOSE TO CORONARY OCCLUSIONS
M.V. Ezhov, A.A. Lyakishev, O.I. Afanasieva, M.I. Afanasieva, V.V. Kukharchuk, S.N. Pokrovsky. Cardiology Research Center, Moscow, Russia The aim of the study was to assess frequency of elevated lipoprotein(a) level and apo(a) phenotypes in coronary heart disease (CHD) patients with occluded coronary arteries. Methods: We have examined 224 CHD patients (198 men, mean age 52.4±8.1 years). The presence of significant coronary lesions was confirmed by coronary angiography; classic risk factors, serum lipids as well as Lp(a) level and apo(a) phenotypes were analysed in all patients. Results: According to number of coronary occlusions we divided patients into 3 groups: no occlusions (n=81), 1 occlusion (n=99), >2 occlusions (n=44). Lp(a) level was significantly higher in patients with the presence of 1 and 2 occlusions: 43±46 and 43±38 mg/dl (p<0.05 for both) compared to 26±31 mg/dl in those without occlusions. The frequency of low-molecular weight apo(a) phenotypes was 35% in CHD patients with non-occluded coronaries and it was significantly higher and steadily increased with number of occluded arteries: 53% for 1 occlusion (p<0.05) and 66% for 2 and more occlusions (p<0.01). There were no differences in classic risk factors and serum lipids concentration between the groups. Conclusion: Elevated lipoprotein(a) level and higher frequency of low-molecular weight apo(a) phenotypes are associated with occlusions of coronary arteries independent of other atherosclerosis risk factors. This association could be due to thrombogenic properties of lipoprotein(a) particle. PO19-541
INCREASED PRESENCE OF MACROPHAGES SECRETING RESISTIN IN EPICARDIAL FAT OF PATIENTS WITH ACUTE CORONARY SYNDROME
S. Langheim 1 , L. Dreas 2 , L. Veschini 3 , F. Maisano 1 , C. Foglieni 1 , B. Zingone 2 , O. Alfieri 1 , E. Ferrero 3 , A. Maseri 1 , G. Ruotolo 1 . 1 Cardiovascular Department, Scientific Institute San Raffaele, Milano, Italy; 2 Cardiovascular Department, Ospedali Riuniti, Trieste, Italy; 3 Oncology Department, Scientific Institute San Raffaele, Milano, Italy Aim of the present study was to evaluate the expression of several adipocytokines in epicardial fat of patients undergoing CABG surgery for acute coronary syndrome (ACS, n=23) as compared to that of age- and BMI-matched patients with chronic stable angina (CSA, n=26). Patients undergoing cardiac surgery for valvular defects, but with angiographically normal coronary arteries served as reference group (n=20). The local expression and protein secretion (24h culture medium) of adipocytokines from epicardial fat biopsies was evaluated by Real-Time PCR (adiponectin, leptin, resistin, visfatin, IL-6, IL-8, IL-10, CRP, MCP-1, PAI-1, MIF), and multiplexed fluorescent immunoassay (adiponectin, resistin, leptin, IL-6, PAI-1, MCP-1), respectively. Immunohistochemical stainings of epicardial fat slides were also performed to show presence of inflammatory cells (T-lymphocytes, macrophages, mast cells). The 24h medium from epicardial adipose tissue culture was also tested in experiments of endothelial cell (HUVEC) permeability and proliferation in vitro. A significantly higher expression of resistin, CD68, and MCP-1 genes was observed in epicardial fat biopsies of ACS as compared to CSA patients. ACS patients also showed significantly increased levels of resistin in 24h culture medium of epicardial adipose tissue. In addition, these changes were paralleled by a significantly increased presence of CD68+ cells in epicardial fat depots of ACS patients. Finally, a significantly increased
permeability of endothelial cells was also observed after incubation with culture medium from epicardial fat of ACS patients. In conclusion, an increased presence of macrophages is associated with higher expression and secretion of resistin in epicardial adipose tissue of patients with ACS. PO19-542
THE EVALUATION OF ISCHEMIA MODIFIED ALBUMIN AS A MARKER OF MYOCARDIAL ISCHAEMIA IN END STAGE RENAL DISEASE
R. Sharma 1 , D. Gaze 2 , P.O. Collinson 2 , D. Pellerin 3 , H. Gregson 2 , C.H. Streather 2 , S.J.D. Brecker 2 . 1 Ealing Hospital, London, UK; 2 St Georges Hospital, London, UK; 3 The Heart Hospital, London, UK Background and Aims: The early diagnosis of myocardial ischaemia is problematic in patients with end stage renal disease (ESRD). The study aim was to determine whether Ischemia Modified Albumin (IMA) detects myocardial ischaemia in these patients. Methods: 114 renal transplant candidates were prospectively studied. All received dobutamine stress echocardiography (DSE). Serum IMA was measured by the albumin cobalt binding (ACB) test. IMA levels were taken at baseline and 1 hour after cessation of DSE. Results: 35 patients (31%) had a positive DSE result for ischaemia. The rise in IMA was significantly higher in the DSE positive group compared to those with no ischaemic response (26.5 ± 19.1 KU/L vs 8.2 ± 9.6 KU/L, p 0.007). From ROC analysis, the optimal IMA rise to predict an ischaemic response was 20 KU/L, with sensitivity 81% and specificity 72% (AUC = 0.80, 95%; CI 0.44, 0.94; p = 0.03). There were 18 deaths, 10 cardiac over a follow up period of 2.25 ± 0.71 years. An IMA rise > 20 KU/L (seen in 32% patients) was associated with significantly worse survival (p = 0.02). Conclusions: IMA is a promising marker of myocardial ischaemia in ESRD. An IMA rise > 20 KU/L during DSE had high sensitivity and moderate specificity for ischaemia diagnosis and was associated with significantly worse survival. PO19-543
THE IMPORTANCE OF TRIGLYCERIDE ON SUBJECTIVE CARDIAC SYMPTOMS OF MIDDLE-AGED POPULATION
W.T. Li, C.H. Hsu, C.H. Lee, Y.W. Liu, W.C. Tsai, J.Y. Chen, L.M. Tsai, L.J. Lin, J.H. Chen. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Background and Aims: Many physicians focus on treating cholesterol and sugar more than triglyceride. They even omit mild hypertriglycemia. We designed this study to review the importance of triglyceride on middle-aged population with subjective cardiac symptoms. Methods: Total 595 consecutive patients (mean age = 41.7± 9.1 y/o, 359 females) who having subjective cardiac symptoms and receiving treadmill exercise test were enrolled into study. Subjective cardiac symptoms were one of the followings: chest discomfort or chest pain, dyspnea, palpitation, or syncope. The age limitation was defined less than forty-five years old in male and less than fifty-five years old in female. We also check other serum biochemistry and arrange echocardiography for complete cardiac evaluation. Results: 130 patients (21.8%) was hypertensive and 38 patients (6.4%) had diabetes. There were 402 patients (67.6%) with chest discomfort, 176 patients (29.6%) with dyspnea, 137 patients (23%) with palpitation, and 16 patients (2.7%) with syncope. Positive treadmill exercise test was recorded in 68 patients (11.4%). Average cholesterol is 195±43 mg/dL and triglyceride is 133±77 mg/dL. However, triglyceride had more closely correlation with inflammatory marker and metabolic factor such as BMI (r = 0.459, p< 0.001), white blood cell count (r = 0.334, p< 0.001), uric acid (r = 0.261, p= 0.002), and fasting glucose (r = 0.263, p< 0.001) than cholesterol (p= 0.012, p= 0.08, p= 0.01, p= 0.001). Conclusions: In evaluating lipid profile with cardiovascular consideration, triglyceride is as important as total cholesterol.
76th Congress of the European Atherosclerosis Society, June 10–13, 2007, Helsinki, Finland