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PS270 Platelet Abnormalities in Eisenmenger Syndrome
Series Report of Balloon Plasty for Native Aortic Coarctation R. Zenteno Fuentes1, B. Macuil CHAZARO*2, V. J. González Coronado3, A. Alcocer Chauvet3, J. M. Rivera Capello3 1 Fellow Interventional Cardiology, 2Paediatric Interventional Cardiology, 3Interventional Cardiology, Hospital Regional 1o Octubre Issste, Mexico City, Mexico Introduction: Balloon coarctoplasty is considered the treatment of choice for native Aortic Coarctation without hypoplasia. The aim of this study was to determine a single center experience regarding long-term morbility and mortality of balloon coarctoplasty in a series of consecutive patients with this congenital entity. Objectives: To determine the effectiveness and safety of balloon coartoplasty in the treatment of native aortic coarctation. Methods: Data on 32 patients with native aortic coarctation treated by balloon coarctoplasty were obtained by retrospective chart review. Information regarding demographic, echocardiographic, hemodynamic, procedural derived and also the mean 7 ( 6 ) years of clinical and echocardiographic follow-up data were analysed. Results: The average age was 12 ( 11 ) years, with an mean initial echocardiographic and hemodynamic trans-coarctation gradient of 45 ( 14 ) mmHg and 36 ( 18 ) mmHg respectevely. The final mean post-balloon coarctoplasty hemodinamic gradient was 6 ( 4 ) mmHg. We reported 1 case of self-limiting aneurysm of 3 mm and 1 case of recoarctation treated with a second balloon coarctoplasty without actual relapse. Procedurural mortality was 0. None of the patients currently requires of antihypertensive treatment. The current mean echocardiographic gradient is 12 ( 6 ) mmHg, none other single patient has required further intervention until now. Conclusion: Aortic balloon coarctoplasty is a treatment with proved efficacy and safety on native aortic coarctation resolution specially in cases without hypoplasia of the aortic arch or diseases associated with intrinsic abnormality of the aortic vascular wall. Our study add more information regarding the real roll of balloon coarctoplasty on improving this congenital pathology prognosis. Disclosure of Interest: None Declared
Introduction: Group A b-haemolytic Streptococcus (GAS), a gram-positive bacterium also known as Streptococcus pyogenes, causes pyoderma, pharyngitis and invasive disease. Repeated GAS infections may lead to autoimmune diseases such as acute post-streptococcal glomerulonephritis, acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Invasive GAS (iGAS) disease is an important cause of mortality and mobidity world-wide. The burden of GAS infections is unknown in Africa because of lack of surveillance systems. Objectives: 1. To collect demographic and clinical information from patients with non-iGAS and iGAS laboratory-confirmed infection 2. To determine the molecular epidemiology on non-invasive and iGAS infection 3. To assess strategies for treatment, control and prevention of GAS infection 4. To conduct studies that contribute to the development of appropriate intervention such as vaccine Methods: The African group A streptococcal infection registry (the AFROStrep Study) is a collaborative multi-centre study of clinical, microbiological, epidemiological and molecular characteristics for GAS infection in Africa. The AFROStrep registry comprises two components: (1) active surveillance of GAS pharyngitis cases from sentinel primary care centres (non-iGAS), and (2) passive surveillance of invasive GAS disease (iGAS) from microbiology laboratories. Isolates will be subjected to DNA isolation to allow for characterization by molecular methods and cryo-preservation for long-term storage. Results: The active and passive surveillance arms of AFROStrep will commence on Jan 1, 2016; initially, pilot sites in South Africa will partipate in the AFROStrep Registry, after which, enrolment will involve centers from the rest of Africa. All participating sites will enrol patients for a minimum of two years. The participating regions in Africa are shown in the figure.
PS270 Platelet Abnormalities in Eisenmenger Syndrome I. Simkova*1, A. Remkova2, T. Valkovicova1, M. Kaldararova3 Department of Cardiology and Angiology, Slovak Medical University and National Institute of Cardiovascular Disesases, 2Department of Internal Medicine, Slovak Medical University, 3 Children Cardiac Centre, National Institute of Cardiovascular Diseases, Bratislava, Slovakia 1
Introduction: Eisenmenger syndrome (ES), as the most severe form of irreversible pulmonary arterial hypertension due to congenital heart defects, may lead to to systemic desaturation and cyanosis, secondary erytrocytosis, hyperviscosity syndrome as well as to abnormal hemostasis, platelet abnormalities, coagulation factors deficit. As a result of these abnormalities patients often suffer from life-threatening thrombotic and bleeding complications. Objectives: The aim of this study was to compare selected platelet, endothelial and coagulation parameters in healthy subjects and patients with ES. Methods: In the prospective study patients with ES (n ¼ 41) were compared with healthy subjects (n ¼ 50). Platelet count, mean platelet volume (MPV), and platelet aggregation spontaneous and induced by various concentrations of five agonists were investigated. To provide a comprehensive view on hemostasis some other hemostatic parameters (fibrinogen, coagulation factor VIII and XII, von Willebrand factor [vWF] antigen and activity, plasminogen activator inhibitor type 1, antithrombin III, D-dimer, anticardiolipin and antiß2-glycoprotein antibodies) were also investigated. Results: Decreased platelet count [190 (147-225) versus 248 (205-295) 109 L-1, P< 0.0001], higher MPV [10.9 (10.1-12.0) versus 10.2 (9.4-10.4) fL, P< 0.0001] and significantly decreased platelet aggregation (induced by five agonists, in various concentrations) in ES patients compared to controls were found. These changes were accompanied by a significant increase of plasma vWF antigen [141.6 (108.9-179.1) versus 117.4 (9.2140.7) IU dL-1, P¼0.022] and serum anti-ß2-glycoprotein [2.07 (0.71-3.41) versus 0.47 (0.18-0.99) U/mL-1, P<0.0001]. Conclusion: In ES patients very often thrombotic or bleeding complications can cause significant clinical worsening or even death. Thrombocytopenia with increased platelet size detected in our study is probably due to a higher platelet turnover and/or platelet activation and impaired platelet aggregation can reflect a specific platelet behaviour in ES patients. These changes may be related to bleeding as well as to thrombotic events. A higher vWF antigen as an endothelial marker may be a consequence of endothelial damage in ES, but the cause for an increase of anti-ß2-glycoprotein is unknown. Though further research is needed for a better understanding of the possible pathophysiological background of these findings. Disclosure of Interest: None Declared PS271 The Afrostrep Study: The Rationale and Design of the African Group a Streptococcal Infection Registry D. Barth*1, M. Engel1, A. Whitelaw2, B. Mayosi1 Medicine, University of Cape Town, 2Microbiology, Stellenbosch University, Cape Town, South Africa 1
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Conclusion: The AFROStrep study represents the first attempt to collect contemporary and comprehensive data on laboratory-confirmed GAS disease in Africa. The AFROStrep study will help quantify the burden of GAS infection, document the prevalent strains presenting in the respective communities and, provide information that could inform the development of locally sensitive guidelines, future research programmes and policy development, all of which have the potential to improve the management of individuals with GAS infection and GAS related diseases. Disclosure of Interest: None Declared PS272 Epidemiology of Pharyngitis in School Children and Local Treatment Patterns in Zambia: A Nested, Cross-Sectional Survey of Children and their Parents J. Musuku*1, J. C. Lungu1, E. Machila1, S. Schwaninger2, P. Musonda3, M. Gutierrez4, B. Tadmor5, J. M. Spector6 1 Paediatrics, University Teaching Hospital, 2Global Health, Novartis Institutes for BioMedical Research, 3Public Health, University of Zambia, Lusaka, Zambia, 4Global Scientific Development, Novartis Institutes for BioMedical Research, Basel, Switzerland, 5Education, Diversity, and Inclusion, Novartis Institutes for BioMedical Research, Lusaka, Zambia, 6Global Health, Novartis Institutes for BioMedical Research, Cambridge, United States Introduction: Prompt and correct treatment of streptococcal pharyngitis with an antibiotic prevents acute rheumatic fever and rheumatic heart disease (RHD). In efforts to eliminate RHD, understanding public perceptions and behaviors related to sore throat is essential to inform the design of health programs that aim to promote appropriate care seeking by patients. Objectives: We sought to describe the epidemiology of pediatric pharyngitis and its treatment, as reported by children and their parents in Lusaka, Zambia.
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POSTER ABSTRACTS
PS267
Introduction: Group A b-haemolytic Streptococcus (GAS), a gram-positive bacterium also known as Streptococcus pyogenes, causes pyoderma, pharyngitis and invasive disease. Repeated GAS infections may lead to autoimmune diseases such as acute post-streptococcal glomerulonephritis, acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Invasive GAS (iGAS) disease is an important cause of mortality and mobidity world-wide. The burden of GAS infections is unknown in Africa because of lack of surveillance systems. Objectives: 1. To collect demographic and clinical information from patients with non-iGAS and iGAS laboratory-confirmed infection 2. To determine the molecular epidemiology on non-invasive and iGAS infection 3. To assess strategies for treatment, control and prevention of GAS infection 4. To conduct studies that contribute to the development of appropriate intervention such as vaccine Methods: The African group A streptococcal infection registry (the AFROStrep Study) is a collaborative multi-centre study of clinical, microbiological, epidemiological and molecular characteristics for GAS infection in Africa. The AFROStrep registry comprises two components: (1) active surveillance of GAS pharyngitis cases from sentinel primary care centres (non-iGAS), and (2) passive surveillance of invasive GAS disease (iGAS) from microbiology laboratories. Isolates will be subjected to DNA isolation to allow for characterization by molecular methods and cryo-preservation for long-term storage. Results: The active and passive surveillance arms of AFROStrep will commence on Jan 1, 2016; initially, pilot sites in South Africa will partipate in the AFROStrep Registry, after which, enrolment will involve centers from the rest of Africa. All participating sites will enrol patients for a minimum of two years. The participating regions in Africa are shown in the figure.
PS270 Platelet Abnormalities in Eisenmenger Syndrome I. Simkova*1, A. Remkova2, T. Valkovicova1, M. Kaldararova3 Department of Cardiology and Angiology, Slovak Medical University and National Institute of Cardiovascular Disesases, 2Department of Internal Medicine, Slovak Medical University, 3 Children Cardiac Centre, National Institute of Cardiovascular Diseases, Bratislava, Slovakia 1
Introduction: Eisenmenger syndrome (ES), as the most severe form of irreversible pulmonary arterial hypertension due to congenital heart defects, may lead to to systemic desaturation and cyanosis, secondary erytrocytosis, hyperviscosity syndrome as well as to abnormal hemostasis, platelet abnormalities, coagulation factors deficit. As a result of these abnormalities patients often suffer from life-threatening thrombotic and bleeding complications. Objectives: The aim of this study was to compare selected platelet, endothelial and coagulation parameters in healthy subjects and patients with ES. Methods: In the prospective study patients with ES (n ¼ 41) were compared with healthy subjects (n ¼ 50). Platelet count, mean platelet volume (MPV), and platelet aggregation spontaneous and induced by various concentrations of five agonists were investigated. To provide a comprehensive view on hemostasis some other hemostatic parameters (fibrinogen, coagulation factor VIII and XII, von Willebrand factor [vWF] antigen and activity, plasminogen activator inhibitor type 1, antithrombin III, D-dimer, anticardiolipin and antiß2-glycoprotein antibodies) were also investigated. Results: Decreased platelet count [190 (147-225) versus 248 (205-295) 109 L-1, P< 0.0001], higher MPV [10.9 (10.1-12.0) versus 10.2 (9.4-10.4) fL, P< 0.0001] and significantly decreased platelet aggregation (induced by five agonists, in various concentrations) in ES patients compared to controls were found. These changes were accompanied by a significant increase of plasma vWF antigen [141.6 (108.9-179.1) versus 117.4 (9.2140.7) IU dL-1, P¼0.022] and serum anti-ß2-glycoprotein [2.07 (0.71-3.41) versus 0.47 (0.18-0.99) U/mL-1, P<0.0001]. Conclusion: In ES patients very often thrombotic or bleeding complications can cause significant clinical worsening or even death. Thrombocytopenia with increased platelet size detected in our study is probably due to a higher platelet turnover and/or platelet activation and impaired platelet aggregation can reflect a specific platelet behaviour in ES patients. These changes may be related to bleeding as well as to thrombotic events. A higher vWF antigen as an endothelial marker may be a consequence of endothelial damage in ES, but the cause for an increase of anti-ß2-glycoprotein is unknown. Though further research is needed for a better understanding of the possible pathophysiological background of these findings. Disclosure of Interest: None Declared PS271 The Afrostrep Study: The Rationale and Design of the African Group a Streptococcal Infection Registry D. Barth*1, M. Engel1, A. Whitelaw2, B. Mayosi1 Medicine, University of Cape Town, 2Microbiology, Stellenbosch University, Cape Town, South Africa 1
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Conclusion: The AFROStrep study represents the first attempt to collect contemporary and comprehensive data on laboratory-confirmed GAS disease in Africa. The AFROStrep study will help quantify the burden of GAS infection, document the prevalent strains presenting in the respective communities and, provide information that could inform the development of locally sensitive guidelines, future research programmes and policy development, all of which have the potential to improve the management of individuals with GAS infection and GAS related diseases. Disclosure of Interest: None Declared PS272 Epidemiology of Pharyngitis in School Children and Local Treatment Patterns in Zambia: A Nested, Cross-Sectional Survey of Children and their Parents J. Musuku*1, J. C. Lungu1, E. Machila1, S. Schwaninger2, P. Musonda3, M. Gutierrez4, B. Tadmor5, J. M. Spector6 1 Paediatrics, University Teaching Hospital, 2Global Health, Novartis Institutes for BioMedical Research, 3Public Health, University of Zambia, Lusaka, Zambia, 4Global Scientific Development, Novartis Institutes for BioMedical Research, Basel, Switzerland, 5Education, Diversity, and Inclusion, Novartis Institutes for BioMedical Research, Lusaka, Zambia, 6Global Health, Novartis Institutes for BioMedical Research, Cambridge, United States Introduction: Prompt and correct treatment of streptococcal pharyngitis with an antibiotic prevents acute rheumatic fever and rheumatic heart disease (RHD). In efforts to eliminate RHD, understanding public perceptions and behaviors related to sore throat is essential to inform the design of health programs that aim to promote appropriate care seeking by patients. Objectives: We sought to describe the epidemiology of pediatric pharyngitis and its treatment, as reported by children and their parents in Lusaka, Zambia.
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POSTER ABSTRACTS
PS267