- Email: [email protected]
PT115 Impaired Right Ventricular Function in Long-term Survivors of Submassive Pulmonary Embolism
greater impaired RV longitudinal function (TAPSE 2.20.3 vs. 1.90.3cm, p<0.001), higher PASP (30.75.9 vs. 39.08.2mmHg, p<0.001) and PVR (1.60.3 vs. 2.20.4 Wood units, p<0.001), higher pro-BNP levels (34.28.7 vs. 84.230.5 pmol/L, p¼0.03) despite similar LV systolic and diastolic function, when compared to those with normal 6MWT. Conclusion: Functional impairment is evident in apparently well long-term survivors of submassive PE and is associated with RV dysfunction and raised PASP and PVR. Disclosure of Interest: None Declared
PT114
PT117
Prognostic factors for in-hospital death of Rheumatic Heart Disease Patients after valvular heart disease surgery in Brazil
Pulmonary Hypertension and Valvular Heart Disease: Does assessment of reversibility help?
Vitor M. P. Azevedo1, Wilma F. Golebiovski2, Guilherme D. T. Amorim2, Amanda Bonfim2, Regina E. Müller*1, Fabio Tagliari2, Marcela Cedenila2, Regina Maria Aquino Xavier1, Clara Weksler2 1 Research, 2Cardiology, NATIONAL INSTITUTE OF CARDIOLOGY, Rio de Janeiro, Brazil Introduction: In development countries, rheumatic heart disease (RHD) still brings concern. It remains doubtful which prognostic factors are involved in these patients after valvular heart disease surgery. Objectives: To study prognostic factors for valvular heart disease surgery in a Brazilian tertiary referral center. Methods: Retrospective review of 466 adults RHD patients that were submitted to valvular heart disease surgery in Brazil from 2004 and 2012. It was studied in-hospital mortality by any cause. Statistical analyses were accomplished by chi-square, Student t test, and Cox regression model. Significance was achieved by p<0.05, and all tests were two-tailed. Results: Mean age 44.8 (13.7) years, height 1.61m (0.1), BSA 1.66 m2 (0.21), creatinine 1.01 (0.31), creatinine clearance 78.9 (29.7), LVEF 61.4% (12.0), LA 5.26cm (1.10), SPAP 54.1mmHg (21.1), perfusion time 126.4min (49.0), ischemic time 103.9min (40.9), female 67.8%, Afro-Brazilian 46.6%, diabetes 5.9%, renal failure 1.51%, infective endocarditis 12.03%, COPD 3.43%, heart failure 64.4% being NYHA III or IV 64.5%, previous valvular surgery 27.6%, moderate/severe valvular lesions: aortic stenosis 21.9%, mitral stenosis 65.0%, aortic regurgitation 28.7%, mitral regurgitation 55.1%, tricuspid regurgitation 31.3%, CABG associated 4.72%. Mortality rate was 13.7% (64). In univariate analysis for death, they were factors: age (deceased 52.113.8 vs survivor 43.613.3, p<0.001), height 1.590.09 vs 1.620.1(p¼0.016), BSA 1.600.22 vs 1.670.21(p¼0.022), creatinine 1.160.54 vs 0.990.25 (p<0.001), creatinine clearance 62.225.0 vs 81.629.5 (p<0.001), LVEF 62.012.8 vs 61.211.9 (p¼0.627 - NS), LA 5.31.14 vs 5.21.1 (p¼0.668 - NS), perfusion time 158.3 72.3 vs 121.442.3 (p<0.001), ischemic time 119.055.4 vs 101.537.7 (p¼0.001), previous valvular surgery 21.9% vs 10.7% (p¼0.002), NYHA III or IV 17.6% vs 8.5% (p¼0.031), moderate/severe tricuspid regurgitation 21.2% vs 10.3% (p¼0.001), and CABG associated 31.8% vs 12.8% (p¼0.012). In multivariate analysis were prognosis factors: creatinine clearance (each 5 points) (HR¼0.802, 95CI¼0.701-0.917) (p¼0.001), and perfusion time (each 10 min) (HR¼1.129, 95CI¼1.083- 1.177) (p<0.001). Age was close to significance (HR¼1.021, 95CI¼0.997- 1.045) (p¼0.083). Conclusion: They were prognosis factors for in-hospital death in multivariate analysis: creatinine clearance, and perfusion time. Disclosure of Interest: None Declared PT115
Kashif Khokhar*1 Cardiology, Waikato Hospital, Hamilton, Hamilton, New Zealand
1
Introduction: Background: Valvular heart disease (VHD) may result in pulmonary hypertension (PHT) which is an important predictor of right ventricular failure and mortality following surgical intervention. Objectives: Assessment of reversibility of pulmonary artery pressures (PAP) and pulmonary vasculature resistance index (PVRI) may be useful in identifying high risk patients resulting in better procedural outcomes. Methods: We have done a retrospective study of 100 consecutive patients of VHD with moderate to severe PHT (systolic PAP of 50mmHg, mean PAP >30mmHg and mean pulmonary capillary wedge pressure >15mmHg), from June 2010 until June 2013. Assessment of pulmonary vascular reversibility was performed by using nebulised illoprost (20microgram/ml for 10minutes). Results: The median patient age was 77 years (range 27 to 84), 60% male. Seventy two (72%) had severe mitral valve and 28(28%) had severe aortic valve disease. Twenty one patients (30%) with severe mitral valve disease had dual valve pathology. Reversibility was assessed in 30 patients (30%). Seventeen (53%) had a 20% or greater decrease in PVRI and was more likely to occur in patients with higher PVRI. Response was less likely to occur in patients with high wedge pressure and left ventricular dilatation.
Age
Responders (N[17)
Non-Responders (N[13)
Median 71yrs (Range 37-83)
Median 66yrs (Range 51-79)
0.376 *0.030
p-value
Mean PCWP (Right heart study)
22mmHg
29mmHg
Pulmonary Artery Systolic Pressure (Right heart study)
60 mmHg
59 mmHg
0.5498
Pulmonary Vascular Resistance Index (PVRI)
11WU/m2
7.3WU/m2
*0.00758
Change in PVRI post Reversibility test with Iloprost
3.3WU/m2
0.03WU/m2
*0.000144
Cardiac Index Litres/min/metre2
2.55L/min/m2
2.04L/min/m2
*0.001249
Left Ventricle diastolic dimension on transthoracic echo. Pre-study
53 millimetre
60 millimetre
*0.0257
*p-value of less than 0.05 is statistically significant
Impaired Right Ventricular Function in Long-term Survivors of Submassive Pulmonary Embolism Vincent Chow*1, Austin C. C. Ng1, Leigh Seccombe2, Tommy Chung1, Liza Thomas3, David Celermajer4, Matthew Peters2, Leonard Kritharides1 1 Cardiology, Concord Hospital & The University of Sydney, NSW, Australia, 2Thoracic Medicine, Concord Hospital, 3Cardiology, Liverpool Hospital and University of New South Wales, 4 Cardiology, Royal Prince Alfred Hospital and The University of Sydney, Sydney, Australia
Conclusion: Assessment of reversibility of PHT is infrequently performed in patients with VHD. When performed reduction in pulmonary vascular resistance is demonstrated in over 50% and may aid in identifying patients more likely to have a better peri-procedural outcome. Disclosure of Interest: None Declared
Introduction: It is unknown if submassive pulmonary embolism (PE) carries long-term right ventricular (RV) functional impairment. In particular, RV function and functional capacity of long-term survivors of submassive PE are unreported. Objectives: We sought to assess RV function and its relationship to functional impairment, as assessed by six-minute walk test (6MWT), in apparently well long-term survivors of PE. Methods: From a previously published population of 1023 patients hospitalized for an acute PE event, long-term survivors from this cohort were prospectively invited to undergo 6MWT, clinical and biochemical evaluation with cardiac biomarkers. RV chamber size and the tricuspid annular plane systolic excursion (TAPSE) were assessed by transthoracic echocardiography (TTE) to determine RV longitudinal function. The pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) were obtained noninvasively by Doppler analysis on TTE using the following equation: PVR ¼ TRV/TVIRVOT x 10 ¼ 0.16 Wood units. (TRV ¼ peak tricuspid regurgiation velocity m/sec & TVIRVOT ¼ time-velocity integral of the RV outflow tract), with PVR>2 Wood units considered abnormal. Results: A total of 120 long-term survivors (52 males; mean age [SD], 6514years) were recruited in this study. Mean follow-up post index PE event was 7.71.4years. The 6MWT distance (6MWD) was significantly lower than predicted, adjusted for patient’s age, sex, and height (observed 448114m vs. predicted 47589m, p¼0.005). TTE showed RV dilatation (Ratio of end diastolic RV to Left Ventricular [LV] Area>0.67), impaired TAPSE (<1.8cm), raised PASP (>36mmHg) and PVR (>2 Wood units) in 7%, 13%, 29% and 21% of patients respectively. Patients with 6MWD <85% of predicted had significantly
PT118
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
A study on Quality of life index in patients with prosthetic valve Meenakshi Kadiyala*1, R. Bathrinarayanan1, Sundar Chidambaram1, V. E. Dhandapani1, M. S. Ravi1, D. Muthukumar1, N. Swaminathan1, G. Ravishankar1, N. Premanand1 1 Cardiology, Madras medical college, Chennai, India Introduction: The use of Prosthetic heart valves for heart valve disease has been rampened since the invention of heart World’s first prosthetic valve replacement done in 1960. Outcomes of surgery have been improved recently along with prosthetic heart valves providing improved hemodynamics, antithrombogenecity, and durability. However further improvement in QOL (quality of life index) of patient with Prosthetic valve would be desirable in regards to social, psychological, family and health care. The QOL of patients with prosthetic valve replacement has been evaluated in very few studies. We conducted the study to evaluate the effects of prosthetic valve in Quality of Life Index in patients with prosthetic valve. Objectives: The QOL of patients with prosthetic valve replacement has been evaluated in very few studies. We conducted the study to evaluate the effects of prosthetic valve in Quality of Life Index in patients with prosthetic valve. Methods: 200 patients who had undergone Prosthetic valve replacement in our institution from Jan 2010 to March 2010 were included in this study. All of them agreed to participate in the study and provided us with written informed consent. There was no significant
e189
POSTER ABSTRACTS
68.2% vs 15.9% (p<0.001), and heart failure 18.6% vs 14.2% (p¼0.06) was close to significance. In multivariate analysis were prognosis factors: age (HR¼1.020, 95CI¼1.0071.035), creatinine clearance (each 5 points) (HR¼0.868, 95CI¼0.798-0.945), LVEF (each 5%) (HR¼0.940, 95CI¼0.890-0.992), and perfusion time (each 10 min) (HR¼1.135, 95CI¼1.111- 1.160). Conclusion: They were prognosis factors for in-hospital death in multivariate analysis: age, creatinine clearance, LVEF, and perfusion time. Disclosure of Interest: None Declared
PT114
PT117
Prognostic factors for in-hospital death of Rheumatic Heart Disease Patients after valvular heart disease surgery in Brazil
Pulmonary Hypertension and Valvular Heart Disease: Does assessment of reversibility help?
Vitor M. P. Azevedo1, Wilma F. Golebiovski2, Guilherme D. T. Amorim2, Amanda Bonfim2, Regina E. Müller*1, Fabio Tagliari2, Marcela Cedenila2, Regina Maria Aquino Xavier1, Clara Weksler2 1 Research, 2Cardiology, NATIONAL INSTITUTE OF CARDIOLOGY, Rio de Janeiro, Brazil Introduction: In development countries, rheumatic heart disease (RHD) still brings concern. It remains doubtful which prognostic factors are involved in these patients after valvular heart disease surgery. Objectives: To study prognostic factors for valvular heart disease surgery in a Brazilian tertiary referral center. Methods: Retrospective review of 466 adults RHD patients that were submitted to valvular heart disease surgery in Brazil from 2004 and 2012. It was studied in-hospital mortality by any cause. Statistical analyses were accomplished by chi-square, Student t test, and Cox regression model. Significance was achieved by p<0.05, and all tests were two-tailed. Results: Mean age 44.8 (13.7) years, height 1.61m (0.1), BSA 1.66 m2 (0.21), creatinine 1.01 (0.31), creatinine clearance 78.9 (29.7), LVEF 61.4% (12.0), LA 5.26cm (1.10), SPAP 54.1mmHg (21.1), perfusion time 126.4min (49.0), ischemic time 103.9min (40.9), female 67.8%, Afro-Brazilian 46.6%, diabetes 5.9%, renal failure 1.51%, infective endocarditis 12.03%, COPD 3.43%, heart failure 64.4% being NYHA III or IV 64.5%, previous valvular surgery 27.6%, moderate/severe valvular lesions: aortic stenosis 21.9%, mitral stenosis 65.0%, aortic regurgitation 28.7%, mitral regurgitation 55.1%, tricuspid regurgitation 31.3%, CABG associated 4.72%. Mortality rate was 13.7% (64). In univariate analysis for death, they were factors: age (deceased 52.113.8 vs survivor 43.613.3, p<0.001), height 1.590.09 vs 1.620.1(p¼0.016), BSA 1.600.22 vs 1.670.21(p¼0.022), creatinine 1.160.54 vs 0.990.25 (p<0.001), creatinine clearance 62.225.0 vs 81.629.5 (p<0.001), LVEF 62.012.8 vs 61.211.9 (p¼0.627 - NS), LA 5.31.14 vs 5.21.1 (p¼0.668 - NS), perfusion time 158.3 72.3 vs 121.442.3 (p<0.001), ischemic time 119.055.4 vs 101.537.7 (p¼0.001), previous valvular surgery 21.9% vs 10.7% (p¼0.002), NYHA III or IV 17.6% vs 8.5% (p¼0.031), moderate/severe tricuspid regurgitation 21.2% vs 10.3% (p¼0.001), and CABG associated 31.8% vs 12.8% (p¼0.012). In multivariate analysis were prognosis factors: creatinine clearance (each 5 points) (HR¼0.802, 95CI¼0.701-0.917) (p¼0.001), and perfusion time (each 10 min) (HR¼1.129, 95CI¼1.083- 1.177) (p<0.001). Age was close to significance (HR¼1.021, 95CI¼0.997- 1.045) (p¼0.083). Conclusion: They were prognosis factors for in-hospital death in multivariate analysis: creatinine clearance, and perfusion time. Disclosure of Interest: None Declared PT115
Kashif Khokhar*1 Cardiology, Waikato Hospital, Hamilton, Hamilton, New Zealand
1
Introduction: Background: Valvular heart disease (VHD) may result in pulmonary hypertension (PHT) which is an important predictor of right ventricular failure and mortality following surgical intervention. Objectives: Assessment of reversibility of pulmonary artery pressures (PAP) and pulmonary vasculature resistance index (PVRI) may be useful in identifying high risk patients resulting in better procedural outcomes. Methods: We have done a retrospective study of 100 consecutive patients of VHD with moderate to severe PHT (systolic PAP of 50mmHg, mean PAP >30mmHg and mean pulmonary capillary wedge pressure >15mmHg), from June 2010 until June 2013. Assessment of pulmonary vascular reversibility was performed by using nebulised illoprost (20microgram/ml for 10minutes). Results: The median patient age was 77 years (range 27 to 84), 60% male. Seventy two (72%) had severe mitral valve and 28(28%) had severe aortic valve disease. Twenty one patients (30%) with severe mitral valve disease had dual valve pathology. Reversibility was assessed in 30 patients (30%). Seventeen (53%) had a 20% or greater decrease in PVRI and was more likely to occur in patients with higher PVRI. Response was less likely to occur in patients with high wedge pressure and left ventricular dilatation.
Age
Responders (N[17)
Non-Responders (N[13)
Median 71yrs (Range 37-83)
Median 66yrs (Range 51-79)
0.376 *0.030
p-value
Mean PCWP (Right heart study)
22mmHg
29mmHg
Pulmonary Artery Systolic Pressure (Right heart study)
60 mmHg
59 mmHg
0.5498
Pulmonary Vascular Resistance Index (PVRI)
11WU/m2
7.3WU/m2
*0.00758
Change in PVRI post Reversibility test with Iloprost
3.3WU/m2
0.03WU/m2
*0.000144
Cardiac Index Litres/min/metre2
2.55L/min/m2
2.04L/min/m2
*0.001249
Left Ventricle diastolic dimension on transthoracic echo. Pre-study
53 millimetre
60 millimetre
*0.0257
*p-value of less than 0.05 is statistically significant
Impaired Right Ventricular Function in Long-term Survivors of Submassive Pulmonary Embolism Vincent Chow*1, Austin C. C. Ng1, Leigh Seccombe2, Tommy Chung1, Liza Thomas3, David Celermajer4, Matthew Peters2, Leonard Kritharides1 1 Cardiology, Concord Hospital & The University of Sydney, NSW, Australia, 2Thoracic Medicine, Concord Hospital, 3Cardiology, Liverpool Hospital and University of New South Wales, 4 Cardiology, Royal Prince Alfred Hospital and The University of Sydney, Sydney, Australia
Conclusion: Assessment of reversibility of PHT is infrequently performed in patients with VHD. When performed reduction in pulmonary vascular resistance is demonstrated in over 50% and may aid in identifying patients more likely to have a better peri-procedural outcome. Disclosure of Interest: None Declared
Introduction: It is unknown if submassive pulmonary embolism (PE) carries long-term right ventricular (RV) functional impairment. In particular, RV function and functional capacity of long-term survivors of submassive PE are unreported. Objectives: We sought to assess RV function and its relationship to functional impairment, as assessed by six-minute walk test (6MWT), in apparently well long-term survivors of PE. Methods: From a previously published population of 1023 patients hospitalized for an acute PE event, long-term survivors from this cohort were prospectively invited to undergo 6MWT, clinical and biochemical evaluation with cardiac biomarkers. RV chamber size and the tricuspid annular plane systolic excursion (TAPSE) were assessed by transthoracic echocardiography (TTE) to determine RV longitudinal function. The pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) were obtained noninvasively by Doppler analysis on TTE using the following equation: PVR ¼ TRV/TVIRVOT x 10 ¼ 0.16 Wood units. (TRV ¼ peak tricuspid regurgiation velocity m/sec & TVIRVOT ¼ time-velocity integral of the RV outflow tract), with PVR>2 Wood units considered abnormal. Results: A total of 120 long-term survivors (52 males; mean age [SD], 6514years) were recruited in this study. Mean follow-up post index PE event was 7.71.4years. The 6MWT distance (6MWD) was significantly lower than predicted, adjusted for patient’s age, sex, and height (observed 448114m vs. predicted 47589m, p¼0.005). TTE showed RV dilatation (Ratio of end diastolic RV to Left Ventricular [LV] Area>0.67), impaired TAPSE (<1.8cm), raised PASP (>36mmHg) and PVR (>2 Wood units) in 7%, 13%, 29% and 21% of patients respectively. Patients with 6MWD <85% of predicted had significantly
PT118
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
A study on Quality of life index in patients with prosthetic valve Meenakshi Kadiyala*1, R. Bathrinarayanan1, Sundar Chidambaram1, V. E. Dhandapani1, M. S. Ravi1, D. Muthukumar1, N. Swaminathan1, G. Ravishankar1, N. Premanand1 1 Cardiology, Madras medical college, Chennai, India Introduction: The use of Prosthetic heart valves for heart valve disease has been rampened since the invention of heart World’s first prosthetic valve replacement done in 1960. Outcomes of surgery have been improved recently along with prosthetic heart valves providing improved hemodynamics, antithrombogenecity, and durability. However further improvement in QOL (quality of life index) of patient with Prosthetic valve would be desirable in regards to social, psychological, family and health care. The QOL of patients with prosthetic valve replacement has been evaluated in very few studies. We conducted the study to evaluate the effects of prosthetic valve in Quality of Life Index in patients with prosthetic valve. Objectives: The QOL of patients with prosthetic valve replacement has been evaluated in very few studies. We conducted the study to evaluate the effects of prosthetic valve in Quality of Life Index in patients with prosthetic valve. Methods: 200 patients who had undergone Prosthetic valve replacement in our institution from Jan 2010 to March 2010 were included in this study. All of them agreed to participate in the study and provided us with written informed consent. There was no significant
e189
POSTER ABSTRACTS
68.2% vs 15.9% (p<0.001), and heart failure 18.6% vs 14.2% (p¼0.06) was close to significance. In multivariate analysis were prognosis factors: age (HR¼1.020, 95CI¼1.0071.035), creatinine clearance (each 5 points) (HR¼0.868, 95CI¼0.798-0.945), LVEF (each 5%) (HR¼0.940, 95CI¼0.890-0.992), and perfusion time (each 10 min) (HR¼1.135, 95CI¼1.111- 1.160). Conclusion: They were prognosis factors for in-hospital death in multivariate analysis: age, creatinine clearance, LVEF, and perfusion time. Disclosure of Interest: None Declared