- Email: [email protected]
PT050 Reversible Dilated Cardiomyopathy in tobacco with betel nut users
PT047 Effects of short-term exercise training on the plasma lipids, lipid transfer to HDL and cytokine levels in patients with heart failure Daiana C. Bündchen1, Raul C. Maranhão2, Anderson Z. Ulbrich1, Lourenço S. Mara1, Sabrina W. Sties1, Vitor G. Angarten1, Almir Schmitt Neto1, Tales de Carvalho*1 1 Cardiology and Exercise Medicine Center, Santa Catarina State University, Florianópolis, 2 Heart Institute (InCor) of the Medical School Hospital and Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil Introduction: In the heart failure, the effects of exercise on the metabolic pathways, especially lipid metabolism intravascular, are unknown and deserve investigation. Objectives: To analyze in heart failure patients the effects of short-term exercise training on the plasma lipids, lipid transfer to HDL and cytokine levels. Methods: Before and after 12 weeks of exercise were evaluated men with chronic heart failure, functional class II or III (NYHA), statin (n ¼ 9) and without statin (n¼10). The exercise was performed three times a week, during 40 minutes, in a zone delimited by the heart rate corresponding to the first and second ventilatory threshold, determined by the cardiopulmonary test. Were evaluated the transfers of four lipids from a radioactively labeled lipid donor nanoemulsion to HDL. Were determined the cytokine levels (TNF-a). Results: Was observed decreased of LDL (-16%; p¼0.03) in the group with statin and increased of HDL (+24%; p¼0.05) in the group without statin. In statin group occurred a significant increase of the transfer of triglycerides from the donor nanoemulsion to HDL (p¼0.03), while the transfer of the three other lipids (unesterified and esterified cholesterol and phospolipids) were unchanged. In the the group without statin the transfer of all four lipids not changed. In the group without statin the TNF-a decreased (p<0.01), while in the statin group not changed significantly (p¼0.07). In both groups no was observed correlation between HDL and TNF-a. Conclusion: In patients with heart failure, short-term training reduced LDL-C in patients treated with statins, increased HDL-C in the non-statin group, reduced the levels of cytokines in non-statin group; not changed the transfer of lipids to HDL in the non-statin group, and significantly increased the transfer of triglycerides to HDL in the statin group. Disclosure of Interest: None Declared PT048 A Potential Linkage Between Mitochondrial Function Of The Heart And Leg Muscle In Heart Failure Patients Takao Kato*1, Moriaki Inoko2 Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, 2 Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Osaka, Japan
1
Introduction: Mitochondria play pivotal roles in heart failure in terms of energy production and cell signaling. Because of the lipophilic cationic nature of Technetium-99m sestamibi (99mTc-MIBI) which is one of tracers used for the diagnosis of myocardial ischemia, it has been reported to be distributed across biological membranes and to show slow clearance in proportion to mitochondrial membrane potential in cultured cardiomyocytes. We also reported that the washout rate of 99mTc-MIBI was correlated with the mitochondrial function in vivo and ex vivo. Objectives: We hypothesized that an increase of 99mTc-MIBI washout would occur in patients with chronic heart failure associated with its severity or oxygen consumption. Methods: We enrolled 45 patients with chronic heart failure after the treatment of acute exacerbation. Chronic heart failure was diagnosed according to the Framingham criteria. The exclusion criteria consisted of Killip class IV heart failure and no consent. After administration of 99mTc-MIBI, they were examined by collecting signals from the heart and bilateral legs in early (20 minutes after the injection) and delayed phases (3 hours), in which washout rates were calculated. We tested the correlation between the washout rate and ejection fraction (EF) on echocardiography, brain natriuretic peptides (BNP), and other clinical values along with the parameters of an exercise tolerance test and muscle power of the thighs. Results: Patients characteristics were as follows: 62.2% were male; 37% had dilated cardiomyopathy; 55% had hypertension and 24% had diabetes; the age was 6815.2 years (meanSD); the mean ejection fraction was 4114%; and the mean washout rate was 46.89.1%. The 99mTc-MIBI washout rate of the heart was positively correlated with BNP levels (r¼0.61, p<0.005) and the 99mTc-MIBI washout rate of the leg (r¼0.427, p<0.005), but was not correlated with EF. Peak oxygen consumption was negatively correlated with the 99mTc-MIBI washout rate of the legs (r¼0.66, p¼0.018) and mildly correlated with the length of the circumflex of the thigh (r¼0.44, p¼0.05), indicating that mitochondrial function of leg muscle, along with the muscle volume, may limit the exercise capacity in patients with chronic heart failure. Conclusion: The 99mTc-MIBI washout rate of the heart is thought to be one of the markers of myocardial damage or dysfunction. There was an association between mitochondrial function of the heart and peripheral muscle in heart failure patients. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PT049 Underperfomance of family screening in hypertrophic cardiomyopathy (HCM) can be improved by a specialised HCM clinic Alexander Olaussen*1,2, Ivan Macciocca1,3, Andris Ellims1 1 HCM clinic @ The Alfred, The Alfred Hospital, 2Faculty of Medicine, Nursing and Health Sciences, Monash University, 3Murdoch Childrens research Institute, Victorian Clinical Genetics Services, Melbourne, Australia Introduction: Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease that can cause significant morbidity and sudden death. 50% of first-degree relatives (FDRs) of affected patients are at risk of also developing HCM. Current guidelines strongly recommend clinical screening, including echocardiography, for all FDRs of patients with HCM. Objectives: We sought to: i) establish the degree of adherence to these guidelines at a patient’s initial assessment in our newly-established specialised HCM clinic, and ii) determine to what extent attendance at our clinic improves the rate of family screening. Methods: Detailed family pedigrees were obtained from all patients with HCM referred to the HCM Clinic @ The Alfred during its first year. For each patient, the number of living FDRs, and whether they had previously been screened with echocardiography, was determined. A co-ordinated family screening approach, including patient/family education, written correspondence and facilitated screening opportunities, was instituted for all patients. Follow-up twelve months after a patient’s initial clinic assessment was performed to record the number of additional FDRs who had been screened. Results: Of the 61 patients with HCM who attended our specialised clinic, 302 living FDRs were identified. Of these, only 80 (26%) had previously been screened with echocardiography, yielding 13 (16%) cases of subclinical HCM. Twelve months after a co-ordinated screening approach initiated by our clinic, 49 additional FDR screenings had been performed (representing a 61% improvement in the screening rate) and an additional 8 cases of HCM had been identified. Conclusion: Family screening for HCM is underperformed. A co-ordinated approach facilitated by a specialised HCM clinic significantly improves adherence to current guidelines and identifies new cases of HCM. As recognition of subclinical HCM enables preventative strategies to reduce morbidity and mortality, referral to a specialised HCM clinic should be considered for all patients with HCM and their families. Disclosure of Interest: None Declared PT050 Reversible Dilated Cardiomyopathy in tobacco with betel nut users Meenakshi Kadiyala*1, R. Rameshwar1 Cardiology, Madras medical college, Chennai, India
1
Introduction: The carcinogenic effects of the addicting mouth freshner containing tobacco with betel nut have been well established. This study was undertaken following the observation of number of patients who presented with dilated cardiomyopathy which got reversed following cessation of mouth freshner with tobacco and betel nut. Objectives: This study was undertaken following the observation of number of patients who presented with dilated cardiomyopathy which got reversed following cessation of mouth freshner with tobacco and betel nut. Methods: Thirty two person (age ranging from 33 – 81 yrs), all males, mouth freshner containing tobacco with betel nut users(consuming 6- 10 gms / day) for a time ranging from six to eight and a half years with symptoms of breathlessness (NYHA CLASS III- IV), extreme fatigue & PND were diagnosed to have dilated cardiomyopathy by echocardiography (EF 30% - 34%).Patients were managed medically with diuretics, digoxin and ACE inhibitors. Simultaneously counselling was done to encourage abstinence from mouth freshner containing tobacco with betel nut. Results: Initially 29 persons abstained completly from mouth freshner containing tobacco with betel nut and the LV function by ECHO 12 weeks later showed a normal LV function in 27 of the 29 patients (EF 59% - 72%). In the 2 remaining patients both of whom were Diabetics, the EF improved to 47% & 50% resp). Three patients who did not stop mouth freshner containing tobacco with betel nut completely but who were now consuming 2- 3gms/day also showed a marginal improvement in LV function (EF 39% -41%). All patients underwent a TMT 9 months after the initial visit, of which 3 patients showed a positive test and all 3 patients had triple vessel disease in the coronary angio. Patients who had a negative TMT did not undergo CAG. Eleven of the 29 initial abstainers started to reconsume mouth freshner containing tobacco with betel nut months – 12 months after initial cessation. In 4 of them, the EF fell after the initial rise to <48%, in 1 to 51% and the remaining 6 continued to have normal LV function. Continuous mouth freshner containing tobacco with betel nut abstainers continued to have normal LV Function. Conclusion: From this it is reasonable to conclude that the active ingredients in mouth freshner containing tobacco with betel nut were possibly responsible for the reversible dose & time related reduction in the LV function in persons without CAD and no risk factors. Disclosure of Interest: None Declared PT051 Subclinical Cardiomyopathy, Global Hypercoagulability and Inflammation in Patients with Schizophrenia Receiving Long-Term Clozapine Vincent Chow*1, Thomas Yeoh2, Austin C. C. Ng2, Tundra Pasqualon3, Elizabeth Scott4, Tommy Chung2, Liza Thomas5, Jennifer Curnow6, David Celermajer7, Leonard Kritharides1 1 Cardiology, Concord Hospital, The University of Sydney & Anzac Research Institute, 2 Cardiology, Concord Hospital & The University of Sydney, 3Psychiatry, Croydon Health Centre, 4 Psychiatry, Headspace: National Youth Mental Health Foundation and the University of Sydney, 5 Cardiology, Liverpool Hospital and University of New South Wales, 6Haematology, Concord
e175
POSTER ABSTRACTS
Conclusion: Compared with the blood BNP levels in decompensated CHF due to CAD, the levels in RHD, COPD and non-Ischemic cardiomypathies were not significantly different. BNP levels significantly correlate with the ventricular size and function on echocardiography but not with the left atrial size in decompensated heart failure patients. Disclosure of Interest: None Declared
1
Introduction: Mitochondria play pivotal roles in heart failure in terms of energy production and cell signaling. Because of the lipophilic cationic nature of Technetium-99m sestamibi (99mTc-MIBI) which is one of tracers used for the diagnosis of myocardial ischemia, it has been reported to be distributed across biological membranes and to show slow clearance in proportion to mitochondrial membrane potential in cultured cardiomyocytes. We also reported that the washout rate of 99mTc-MIBI was correlated with the mitochondrial function in vivo and ex vivo. Objectives: We hypothesized that an increase of 99mTc-MIBI washout would occur in patients with chronic heart failure associated with its severity or oxygen consumption. Methods: We enrolled 45 patients with chronic heart failure after the treatment of acute exacerbation. Chronic heart failure was diagnosed according to the Framingham criteria. The exclusion criteria consisted of Killip class IV heart failure and no consent. After administration of 99mTc-MIBI, they were examined by collecting signals from the heart and bilateral legs in early (20 minutes after the injection) and delayed phases (3 hours), in which washout rates were calculated. We tested the correlation between the washout rate and ejection fraction (EF) on echocardiography, brain natriuretic peptides (BNP), and other clinical values along with the parameters of an exercise tolerance test and muscle power of the thighs. Results: Patients characteristics were as follows: 62.2% were male; 37% had dilated cardiomyopathy; 55% had hypertension and 24% had diabetes; the age was 6815.2 years (meanSD); the mean ejection fraction was 4114%; and the mean washout rate was 46.89.1%. The 99mTc-MIBI washout rate of the heart was positively correlated with BNP levels (r¼0.61, p<0.005) and the 99mTc-MIBI washout rate of the leg (r¼0.427, p<0.005), but was not correlated with EF. Peak oxygen consumption was negatively correlated with the 99mTc-MIBI washout rate of the legs (r¼0.66, p¼0.018) and mildly correlated with the length of the circumflex of the thigh (r¼0.44, p¼0.05), indicating that mitochondrial function of leg muscle, along with the muscle volume, may limit the exercise capacity in patients with chronic heart failure. Conclusion: The 99mTc-MIBI washout rate of the heart is thought to be one of the markers of myocardial damage or dysfunction. There was an association between mitochondrial function of the heart and peripheral muscle in heart failure patients. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PT049 Underperfomance of family screening in hypertrophic cardiomyopathy (HCM) can be improved by a specialised HCM clinic Alexander Olaussen*1,2, Ivan Macciocca1,3, Andris Ellims1 1 HCM clinic @ The Alfred, The Alfred Hospital, 2Faculty of Medicine, Nursing and Health Sciences, Monash University, 3Murdoch Childrens research Institute, Victorian Clinical Genetics Services, Melbourne, Australia Introduction: Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease that can cause significant morbidity and sudden death. 50% of first-degree relatives (FDRs) of affected patients are at risk of also developing HCM. Current guidelines strongly recommend clinical screening, including echocardiography, for all FDRs of patients with HCM. Objectives: We sought to: i) establish the degree of adherence to these guidelines at a patient’s initial assessment in our newly-established specialised HCM clinic, and ii) determine to what extent attendance at our clinic improves the rate of family screening. Methods: Detailed family pedigrees were obtained from all patients with HCM referred to the HCM Clinic @ The Alfred during its first year. For each patient, the number of living FDRs, and whether they had previously been screened with echocardiography, was determined. A co-ordinated family screening approach, including patient/family education, written correspondence and facilitated screening opportunities, was instituted for all patients. Follow-up twelve months after a patient’s initial clinic assessment was performed to record the number of additional FDRs who had been screened. Results: Of the 61 patients with HCM who attended our specialised clinic, 302 living FDRs were identified. Of these, only 80 (26%) had previously been screened with echocardiography, yielding 13 (16%) cases of subclinical HCM. Twelve months after a co-ordinated screening approach initiated by our clinic, 49 additional FDR screenings had been performed (representing a 61% improvement in the screening rate) and an additional 8 cases of HCM had been identified. Conclusion: Family screening for HCM is underperformed. A co-ordinated approach facilitated by a specialised HCM clinic significantly improves adherence to current guidelines and identifies new cases of HCM. As recognition of subclinical HCM enables preventative strategies to reduce morbidity and mortality, referral to a specialised HCM clinic should be considered for all patients with HCM and their families. Disclosure of Interest: None Declared PT050 Reversible Dilated Cardiomyopathy in tobacco with betel nut users Meenakshi Kadiyala*1, R. Rameshwar1 Cardiology, Madras medical college, Chennai, India
1
Introduction: The carcinogenic effects of the addicting mouth freshner containing tobacco with betel nut have been well established. This study was undertaken following the observation of number of patients who presented with dilated cardiomyopathy which got reversed following cessation of mouth freshner with tobacco and betel nut. Objectives: This study was undertaken following the observation of number of patients who presented with dilated cardiomyopathy which got reversed following cessation of mouth freshner with tobacco and betel nut. Methods: Thirty two person (age ranging from 33 – 81 yrs), all males, mouth freshner containing tobacco with betel nut users(consuming 6- 10 gms / day) for a time ranging from six to eight and a half years with symptoms of breathlessness (NYHA CLASS III- IV), extreme fatigue & PND were diagnosed to have dilated cardiomyopathy by echocardiography (EF 30% - 34%).Patients were managed medically with diuretics, digoxin and ACE inhibitors. Simultaneously counselling was done to encourage abstinence from mouth freshner containing tobacco with betel nut. Results: Initially 29 persons abstained completly from mouth freshner containing tobacco with betel nut and the LV function by ECHO 12 weeks later showed a normal LV function in 27 of the 29 patients (EF 59% - 72%). In the 2 remaining patients both of whom were Diabetics, the EF improved to 47% & 50% resp). Three patients who did not stop mouth freshner containing tobacco with betel nut completely but who were now consuming 2- 3gms/day also showed a marginal improvement in LV function (EF 39% -41%). All patients underwent a TMT 9 months after the initial visit, of which 3 patients showed a positive test and all 3 patients had triple vessel disease in the coronary angio. Patients who had a negative TMT did not undergo CAG. Eleven of the 29 initial abstainers started to reconsume mouth freshner containing tobacco with betel nut months – 12 months after initial cessation. In 4 of them, the EF fell after the initial rise to <48%, in 1 to 51% and the remaining 6 continued to have normal LV function. Continuous mouth freshner containing tobacco with betel nut abstainers continued to have normal LV Function. Conclusion: From this it is reasonable to conclude that the active ingredients in mouth freshner containing tobacco with betel nut were possibly responsible for the reversible dose & time related reduction in the LV function in persons without CAD and no risk factors. Disclosure of Interest: None Declared PT051 Subclinical Cardiomyopathy, Global Hypercoagulability and Inflammation in Patients with Schizophrenia Receiving Long-Term Clozapine Vincent Chow*1, Thomas Yeoh2, Austin C. C. Ng2, Tundra Pasqualon3, Elizabeth Scott4, Tommy Chung2, Liza Thomas5, Jennifer Curnow6, David Celermajer7, Leonard Kritharides1 1 Cardiology, Concord Hospital, The University of Sydney & Anzac Research Institute, 2 Cardiology, Concord Hospital & The University of Sydney, 3Psychiatry, Croydon Health Centre, 4 Psychiatry, Headspace: National Youth Mental Health Foundation and the University of Sydney, 5 Cardiology, Liverpool Hospital and University of New South Wales, 6Haematology, Concord
e175
POSTER ABSTRACTS
Conclusion: Compared with the blood BNP levels in decompensated CHF due to CAD, the levels in RHD, COPD and non-Ischemic cardiomypathies were not significantly different. BNP levels significantly correlate with the ventricular size and function on echocardiography but not with the left atrial size in decompensated heart failure patients. Disclosure of Interest: None Declared