- Email: [email protected]
PT225 Knowledge, attitudes and behaviors related to sodium intake of Cardiac Care Unit Lebanese adult patients
POSTER ABSTRACTS
PT217 Catheterization-Related Cerebral Infarction Evaluated At Diffusion-Weighted Magnetic Resonance Imaging In High-Risk Patients Takao Kato*1, Yusuke Morita1, Moriaki Inoko1 Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Osaka, Japan 1
Introduction: Stroke related with catheterization was devastating complications after procedures. The rates of stroke range from 0.1-0.4% according to previous studies. Stroke was taken only as new neurological complications, therefore clinically unapparent cerebral embolisms were not taken into account. Diffusion weighted magnetic resonance imaging (DW-MRI) is very high sensitive tools for detecting acute cerebral ischemic lesions. Due to improvements of catheter design and approach, catheterization-related cerebral infarctions are expected to decrease, whereas this may be counterbalanced by increased risk profile of patients who undergo catheterization. Objectives: We aimed to examine the current prevalence and risk factors of symptomatic and asymptomatic catheterization-related cerebral infarctions by DW-MRI. Methods: We retrospectively analyzed 84 patients who underwent 1237 diagnostic and interventional catheterization procedures through the aortic arch conducted within 2010 and 2011 in our hospital and who obtained the MRI within 14 days a catheterization. Results: Ten patients who developed symptoms and 3 patients were finally diagnosed as stroke, which was defined as any neurological deficits lasting over 24 hours. The remaining 74 patients were asymptomatic and underwent MRI for various other reasons, including the assessment before coronary artery bypass graft (35%), valvular surgery (18%) or aortic repair (6.8%). The MRI revealed a fresh cerebral infarction in 22 of 74 asymptomatic patients (29.7%). Patients with cerebral infarction underwent longer procedures (mean SEM, 17.1 1.7 minutes vs. 22.7 2.4 minutes, p<0.05), used higher number of catheters and were more likely to be old (mean SEM, 74.1 1.67 vs. 70.4 1.1 years old), to have dyslipidemia, and to undergo in urgent settings and for interventional purposes. In DW-MRI findings, more patients with new infarction had multiple or bilateral lesions. More lesions were seen in the anterior and anterior plus posterior territories. Conclusion: Stroke after catheterization occurred 3 of 1237 (0.16%) patients, and this rate was almost equivalent to those seen in previous studies. However, the rate of small asymptomatic catheterization-related cerebral infarctions detected using diffusion-weighted MRI remains high in high-risk patients or candidates for cardiac surgery. Disclosure of Interest: None Declared PT221 Nocturnal hypertension is associated with preclinical organ damage in untreated hypertension Emmanuel Androulakis1, Dimitris Tousoulis*1, Evaggelos Chatzistamatiou1, Nikolaos Papageorgiou1, George Hatzis1, Ioannis Kallikazaros1, Christodoulos Stefanadis1 1 1st Cardiology Department, Hippocration Hospital, Athens, Greece Introduction: Although nocturnal hypertension has been associated with increased cardiovascular morbidity and mortality, its clinical significance in relation to subclinical target organ damage remains controversial. Objectives: The purpose of this study was to assess whether nocturnal hypertension is associated with preclinical vascular damage, cardiac hypertrophy and renal function, as indices of subclinical target organ damage in untreated hypertension. Methods: The study population consisted of 302 untreated essential hypertensives. Based on the presence of NH (>120/70 mmHg), the population was divided into two groups: nocturnal normotensive (n¼150) and nocturnal hypertensive subjects (n¼152), who did not differ in classical risk factors. Carotid-femoral pulse wave velocity (cf-PWV), flow mediated dilation (FMD), intima-media thickness of carotid arteries (C-IMT), augmentation index, ankle-brachial index were assessed in all participants. Also, left ventricular mass index (LVMI) and E/A (the mean ratio of early and late diastolic tissue velocities) were assessed by echocardiography. Serum cystatin-C levels were measured by ELISA kit and glomerular filtration rate (GFR) was assessed by the Cockcroft-Gault formula. Results: Patients with NH were characterized by increased arterial cf-PWV (911.7 vs 8.41.5 m/sec, p¼0.0001) and marginally decreased FMD values (5.13.4 vs 4.12.6, p¼0.066). In addition, this group showed increased C-IMT (0.770.18 vs 0,690,15 mm, p¼0.016) compared to normotensive subjects, whereas no other significant differences were observed, regarding other vascular indices (p¼NS for both). Notably, they also exhibited impaired values of LVMI (88.122.9 vs 82.816.6 gr/m2, p¼0.043) and E/A (0.900.26 vs 0.880.43, p¼0.030), respectively. However, the two groups did not differ with respect to renal function, based on the values both of GFR (p¼0.689) and cystatin-C (p¼0.283). Conclusion: In the present study we found that nocturnal hypertension is accompanied by subclinical atherosclerosis, as well as structural and functional cardiac abnormalities, without significant association with renal function in this untreated hypertensive population. Disclosure of Interest: None Declared PT223 Impact of chronic pressure and volume overload on left atrial shape and function Angelina Stevanovic*1, Milica Dekleva2, Radosava Cvjetan3, Snezana Trajic4, Nevena Paunovic1, Vesna Andric1, Goran Podnar1 1 Cardiology department, Railway Health Care Institute, 2Cardiology department, University Clinical Center Zvezdara, 3Cardiology department, Zemun Medical Centre, 4Cardiology department, Dedinje Cardiovascular Institute, Belgrade, Serbia
e210
Introduction: Chronic pressure and volume overload may cause dfferent type of left atrial (LA) remodeling. Two different patterns of LA remodeling can be discriminate bay left atrial eccentricity index (LAEI). Objectives: To assess the left atrial shape and function in chronic presure and voloume overload. Methods: The study included 103 hypertensive patients with diastolic dysfunction and with or without mitral regurgitation (MR): 39 patients without MR, 30 patients with mild MR, and 34 patients with moderate/moderate to severe MR. Peak LA strain and strain rate during ventricular systole (S-LAs and SR-LAs), peak early diastolic LA strain and strain rate (S-LAe and SR-LAe), and peak LA strain and strain rate during atrial systole (SLAa and SR-LAa) were measured as LA function parameters. Left atrial volume (LAV) was measured at three time points (maximal LAV, pre-atrial contraction volume and minimal LAV) and the following LA emptying volumes were then derived: LA stroke volume (LASV) and fraction (LASVFr), LA passive emptying volume (LAPEV) and fraction (LAPEVFr), LA conduit volume (LACV) and LA active emptying volume (LAAEV) and fraction (LAAEV). All LA volumes were indexed to body surface area. Results: There were significant correlations between of LAEI and RV (r¼-0,405; p¼0,003) and significant decrease in LAEI (1,490,17 vs 1,310,15 vs 1,210,15, p¼0,0003), SLAs (29,610,4 vs 26,35,87 vs 23,98,85, p¼0,022), SR-LAs (1,540,53 vs 1,330,38 vs 1,220,42, p¼0.012), S-LAe (19,69,26 vs 16,35,97 vs 15,45,71, p¼0,041), SRLAe (-1,600,45 vs -1,380,41 vs -1,220,67, p¼0.011) and SR-Laa -2,170,68 vs -1,940,54 vs -1,690,53, p¼0.004) with increasing severety of MR. LAEI also significantly correlated with left atrial deformation parameters and with LAVI (r¼-0.382; p¼0.0007), LASVFr (r¼0.519; p¼0.0002), LAPEVFr (r¼0.386; p¼0.0005) and LAAEVFr (r¼0.401; p¼0.0003). Conclusion: Left atrium was more spherical and with inferior mechanical function in all three phases (reservoir, conduit and active contractile functions) in a simultaneous chronic pressure and volume overload and with increasing severity of MR. Usefulness of LAEI in identification of patients associated with a higher rate of AF with a higher cardiovascular risk need to be verified. Disclosure of Interest: None Declared PT224 Genome-wide association study identifies eight novel loci associated with blood pressure responses to interventions in Han Chinese Jiang He*1, Tanika N. Kelly1, Qi Zhao1, Hongfan Li2, Dabeeru C. Rao3, James E. Hixson4, Dongfeng Gu2, GenSalt Investigators 1 Department of Epidemiology, Tulane University, New Orleans, United States, 2Department of Epidemiology and Population Genetics, Fuwai Hospital, Beijing, China, 3Division of Biostatistics, Washington University, St. Louis, 4Human Genetics Center, University of Texas, Houston, United States Introduction: Blood pressure (BP) responses to dietary sodium and potassium intervention and cold pressor test (CPT) vary considerably among individuals. Objectives: We aimed to identify novel genetic variants influencing individuals’ BP responses to dietary intervention and CPT. Methods: We conducted a genome-wide association study of BP responses in 1,881 Han Chinese and de novo genotyped top findings in 698 Han Chinese. Diet-feeding study included a 7-day low-sodium (51.3 mmol/day), a 7-day high-sodium (307.8 mmol/day), and a 7-day high-sodium plus potassium-supplementation (60 mmol/day). Nine BP measurements were obtained during baseline observation and each intervention period. Results: The meta-analyses identified eight novel loci for BP phenotypes, which physically mapped in or near PRMT6 (P¼7.2910-9), CDCA7 (P¼3.5710-8), PIBF1 (P¼1.7810-9), ARL4C (P¼1.8610-8), IRAK1BP1 (P¼1.4410-10), SALL1 (P¼7.0110-13), TRPM8 (P¼2.6810-8), and FBXL13 (P¼3.7410-9). There was a strong dose-response relationship between the number of risk alleles of these independent SNPs and the risk of developing hypertension over 4-years follow-up in the study participants. Compared to those in the lowest quartile of risk alleles, odds ratios (95% confidence intervals) for those in the second, third and fourth quartiles were 1.24 (0.82, 1.87), 1.55 (1.01, 2.39), and 1.92 (1.28, 2.89), respectively (p¼0.0008 for trend). Conclusion: Our study identified 8 novel loci for BP responses to dietary sodium and potassium intervention and CPT. The effect size of these novel loci on BP phenotypes are much larger than those reported by the previously published studies. Furthermore, these variants predict the risk of developing hypertension among individuals with normal BP at baseline. Disclosure of Interest: None Declared PT225 Knowledge, attitudes and behaviors related to sodium intake of Cardiac Care Unit Lebanese adult patients Jihan Fathallah1, Mohamad Almedawar*1, Torkom Garabedian1, Sabine Keyrouz1, Laila Al-Shaar2, Lara Nasreddine3, Samir Alam1, Hussain Isma’eel1, Vascular Medicine Program 1 Cardiology, 2Vascular Medicine Program, 3Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon Introduction: High dietary salt intake has been directly correlated with hypertension, the leading preventable risk factor for death in the world. Assessing knowledge, attitudes, and behaviors of high cardiovascular (CV) risk patients and comparing them to community based results would direct future focused interventions to reduce intake of salt. Objectives: To assess the knowledge, attitudes, and behaviors of high risk patients in the Cardiac Care Unit (CCU) regarding salt intake to guide future interventions, and to
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Table 1. Characteristics of the CCU sample (n¼115) 60.6315.39
Age,Mean±SD BMI,Mean±SD
29.37±5.41
SBP,Mean±SD
125.61±22.14
smoking,N(%)
43(37.70)
Family Hx-CAD,N(%)
30(26.30)
Medical Hx-HTN,N(%)
85(74.60)
Medical Hx–Coronary PCI,N(%)
44(38.60)
Coronary PCI during Current visit,N(%)
35(30.70)
PT227 Large artery stiffness and carotid intima-media thickness in relation to markers of bone mineral metabolism in postmenopausal African women: The PURE-study Aletta Schutte*1, Lebo Gafane1, Iolanthe Kruger2, Rudolph Schutte1 1 Hypertension in Africa Research Team (HART), 2Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa Introduction: Increased vascular calcification, cardiovascular morbidity and mortality have been associated with altered bone metabolism and associated calciotropic hormones. Objectives: Due to the lack of information on the contribution of altered bone metabolism and calciotropic hormones on cardiovascular disease in Africans, this study aimed to explore the relationships of carotid intima-media thickness (cIMT) and central pulse pressure (cPP) with the parathyroid hormone-to-vitamin D ratio (PTH:25-OH-D) and Ctelopeptide of type I collagen (CTX) in postmenopausal African women. Methods: A study population of 434 African women, aged 47 years, was divided into lean and overweight/obese groups. We assessed cPP and cIMT, and determined PTH, 25OH-D and CTX concentrations. Results: In the overweight/obese group we found elevated PTH and PTH:25-OH-D compared to the lean group (p<0.001), while the lean group had higher CTX concentrations (p<0.001). Single, partial and multiple regression analyses confirmed that only in lean women, cIMT was independently associated with PTH:25-OH-D (R2¼0.22; b¼0.26; p¼0.003); whereas in obese women, cPP associated with both PTH:25-OH-D (R2¼0.20; b¼0.17; p¼0.017) and CTX (R2¼0.20; b¼0.17; p¼0.025). Conclusion: In postmenopausal African women with increased adiposity, cPP, as indicator of central arterial stiffness, was positively associated with alterations in bone metabolism and calciotropic hormones, whereas cIMT of lean women was positively associated with PTH:25-OH-D. Our results suggest that alterations in bone metabolism may contribute to arterial calcification. Disclosure of Interest: None Declared PT229
Conclusion: Our study shows a lack of knowledge regarding salt major contributors in the Lebanese diet and allowed maximum intake levels relative to the community based sample. *Nasreddine et al. “Knowledge, Attitudes and Behaviors Related to Sodium Intake of Lebanese Consumers aged 19-60” (Unpublished data). Disclosure of Interest: None Declared PT226 Erectile dysfunction risk factors in patients with severe obstructive sleep apnea syndrome and identifying CPAP response predictors Haruki Sekiguchi*1,2, Ken Shimamoto1, Koji Narui3, Yuji Inoue4, Yufuko Takahashi1, Tatsumi Fujio1, Yasunobu Hashimoto5, Yoshiko Maeda5, Eri Watanabe1, Masatoshi Kawana1, Fujio Tatsumi1, Mayumi Suzuki6, Ken Shimamoto1, Kazuhiro Yamaguchi6, Masatoshi Kawana1 1 Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Japan, 2Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Jersey, 3Respiratory Medicine, Toranomon Hospital, 4Aoyama Hospital Tokyo Women’s Medical University, 5Urology, 6Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Japan Introduction: Erectile dysfunction (ED) is one of the important complications in patients with sleep apnea syndrome (SAS). ED is known as a risk factor and risk indicator for future cardiovascular diseases. However, risk factors related to ED as well as the efficacy of continuous positive airway pressure (CPAP) therapy on improving ED have not been established in Japanese subjects with obstructive SAS. Objectives: This study investigates risk factors of ED and factors predicting the efficacy of CPAP for the treatment of ED in Japanese SAS patients. Methods: We conducted a retrospective population-based study of Japanese subjects linking questionnaire data with characteristics of patients hospitalized (170 males, age: 4912.3 years) due to SAS diagnosis by polysomnography. SAS was diagnosed as AHI > 5 and ED diagnosed by an International Index of Erectile Function (IIEF)-5 score < 22. Thirty patients answered IIEF5 twice before CPAP treatment and at 6 months after CPAP treatment. We analyzed the correlation between ED and potential explanatory variables including age, body mass index (BMI), apnea/hypopnea index (AHI), micro-arousals, hypertension (HTN), diabetes mellitus (DM), dementia, ischemic heart disease, dyslipidemia, and benign prostatic hyperplasia. We also investigated predictors judging the efficacy of CPAP on improvement of ED. Results: In this study population, baseline BMI and AHI were, 27.34.0 kg/m2 and 43.127.8 /hr, respectively. ED was observed in 59.4% (101/170) of the patients. DM and HTN were found to be risk factors for ED (odds ratio: 2.89, [95% CI 1.46-5.68], P<0.001, OR: 3.47, [95% CI 1.77-6.85], P<0.01, respectively). Multivariate analysis revealed that DM (OR: 4.4, [95% CI 1.92-9.97], P<0.001) was a unique, independent risk factor for ED. After 6 months of CPAP treatment, IIEF5 scores significantly decreased in 53.3% (16/30) of ED patients (3.42.3, P<0.001). Baseline AHI for SAS diagnosed patients was significantly higher in CPAP responders compared to non-responders (53.922.9 vs. 37.019.8, P<0.05, respectively). However, in patients over 65 years of age (N¼5), CPAP therapy was not effective for treating ED (DIIEF 5 ¼ –5.48.0) in 80% of cases. Conclusion: DM is an important risk factor inducing ED in SAS patients. Furthermore, CPAP treatment should be considered for patients suffering from severe SAS complicated with ED. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Assessment of quality of life and its correlates among Hypertensive patients in a West African Cardiology practice Amam C. Mbakwem*1, Francis Aina1, Casmir E. Amadi2, Abiola Akinbode2, Joy Mokwunyei3 1 Medicine, 2Psychiatry, University of Lagos, 3Medicine, Lagos University Teaching Hospital, Lagos, Nigeria Introduction: Hypertension (HTN) is majorly asymptomatic except when complicated and may not be expected to impact on the quality of life (QoL) of patients. Poor QoL may affect health seeking behaviour, adherence to treatment and disease outcome. The aspect of quality of life has not been given much prominence in the management of patients with hypertension. We therefore evaluated the QoL of hypertensive patients attending the cardiology clinic of our hospital using a generic instrument, the WHOQOL-BREF. Objectives: To determine the quality of life of hypertensive patients and its correlates in a cardiology practice in west Africa. Methods: Hypertensive patients without co-morbidities who were attending the cardiology clinic were recruited. Relevant clinical data were retrieved from their notes and subjects self completed the WHOQOL-BREF. The single item scores were computed and analysed. The domain scores in the WHOQOL-BREF were computed, transformed and analysed. These were correlated with the single item scores and clinical parameters. Results: There were 74 males and 110 females with mean age 56.4712.02yrs. About 40% had post high-school education, 72% had poor finances and most, 80% were married. About 16% felt their QoL was poor to average while 49% were dissatisfied with their health status. Transformed scores for the main domains, physical health, psychological, social relationships and environment were 67.3726.35, 68.7613.58, 67.9215.93 and 67.1413.86 respectively. Also 14.9%, 9.1%, 8.5% and 8.8% had scores less than 50% for physical health, psychological, social relationships and environment domains respectively. More females (18.2% vs. 12.2%, p ¼ 0.05) felt their quality of life was below average. There was positive correlation between age and domains of social relationships and the environment, r¼.214, p¼0.006 and r ¼.183, p¼0.02 respectively. Positive correlation was observed between perception of poor quality of life and health status and the four domains evaluated, p <0.0001. Conclusion: The QoL of hypertensive patients must be given consideration in their management as this may contribute to poor adherence and affect outcomes. Particular attention should be paid to female hypertensives who appear to have worse QoL scores. Disclosure of Interest: None Declared PT230 Role of Brain Natriuretic Peptide In Predicting The Short Term Cardiovascular Outcomes In Preeclampsia And Eclampsia Patients Ghada Youssef*1, Nader Haroon1, Reda Diab1, Essam Baligh1 1 Cardiology, Cairo University, Cairo, Egypt Introduction: Brain natriuretic peptide (BNP) concentrations were found to be higher in preeclampsia and other hypertensive disorders of pregnancy than in normal pregnancy. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia. Objectives: To evaluate the possible role of elevated BNP level in predicting the short-term maternal cardiovascular outcome in patients presented with preeclampsia/eclampsia disease. Methods: Fifty patients who presented with preeclampsia or eclampsia were included. They were followed up clinically and by echocardiography till delivery and at 1, 3 and 6
e211
POSTER ABSTRACTS
compare the awareness level of our study sample to healthy individuals in the community (HIC) from a previous study*. Methods: Based on unpublished data*, it is estimated that around 82.2% of Lebanese adults know that salt/sodium worsens human’s health. With a confidence interval of 7% and a type 1 error of 5%, we sampled 115 out of the annual 1500 Lebanese high CV risk patients admitted to the Cardiac Care Unit (CCU). They were administered a questionnaire developed to assess awareness of salt intake recommended level, content in food, and associated CV risk. Statistical analysis was conducted using SPSS 20 for Windows. Results: In terms of knowledge, 36.5% of CCU patients knew that the main source of salt in the diet is processed foods such as breads, cured meats, and canned food compared to 21.5% of HIC, while 47% thought it was salt added at the table compared to 42.1% of HIC. Moreover, 19.1% of CCU and 28.9% of HIC knew the maximum daily amount of salt recommended. In terms of attitudes and behaviors, 58.53% admitted they never look at the salt or sodium content on food labels compared to 66.5% of HIC. When asked about the main motive to reduce Salt intake, 65.8% of CCU and 51.7% of HIC admitted that it would be a dramatic change in health status.
PT217 Catheterization-Related Cerebral Infarction Evaluated At Diffusion-Weighted Magnetic Resonance Imaging In High-Risk Patients Takao Kato*1, Yusuke Morita1, Moriaki Inoko1 Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Osaka, Japan 1
Introduction: Stroke related with catheterization was devastating complications after procedures. The rates of stroke range from 0.1-0.4% according to previous studies. Stroke was taken only as new neurological complications, therefore clinically unapparent cerebral embolisms were not taken into account. Diffusion weighted magnetic resonance imaging (DW-MRI) is very high sensitive tools for detecting acute cerebral ischemic lesions. Due to improvements of catheter design and approach, catheterization-related cerebral infarctions are expected to decrease, whereas this may be counterbalanced by increased risk profile of patients who undergo catheterization. Objectives: We aimed to examine the current prevalence and risk factors of symptomatic and asymptomatic catheterization-related cerebral infarctions by DW-MRI. Methods: We retrospectively analyzed 84 patients who underwent 1237 diagnostic and interventional catheterization procedures through the aortic arch conducted within 2010 and 2011 in our hospital and who obtained the MRI within 14 days a catheterization. Results: Ten patients who developed symptoms and 3 patients were finally diagnosed as stroke, which was defined as any neurological deficits lasting over 24 hours. The remaining 74 patients were asymptomatic and underwent MRI for various other reasons, including the assessment before coronary artery bypass graft (35%), valvular surgery (18%) or aortic repair (6.8%). The MRI revealed a fresh cerebral infarction in 22 of 74 asymptomatic patients (29.7%). Patients with cerebral infarction underwent longer procedures (mean SEM, 17.1 1.7 minutes vs. 22.7 2.4 minutes, p<0.05), used higher number of catheters and were more likely to be old (mean SEM, 74.1 1.67 vs. 70.4 1.1 years old), to have dyslipidemia, and to undergo in urgent settings and for interventional purposes. In DW-MRI findings, more patients with new infarction had multiple or bilateral lesions. More lesions were seen in the anterior and anterior plus posterior territories. Conclusion: Stroke after catheterization occurred 3 of 1237 (0.16%) patients, and this rate was almost equivalent to those seen in previous studies. However, the rate of small asymptomatic catheterization-related cerebral infarctions detected using diffusion-weighted MRI remains high in high-risk patients or candidates for cardiac surgery. Disclosure of Interest: None Declared PT221 Nocturnal hypertension is associated with preclinical organ damage in untreated hypertension Emmanuel Androulakis1, Dimitris Tousoulis*1, Evaggelos Chatzistamatiou1, Nikolaos Papageorgiou1, George Hatzis1, Ioannis Kallikazaros1, Christodoulos Stefanadis1 1 1st Cardiology Department, Hippocration Hospital, Athens, Greece Introduction: Although nocturnal hypertension has been associated with increased cardiovascular morbidity and mortality, its clinical significance in relation to subclinical target organ damage remains controversial. Objectives: The purpose of this study was to assess whether nocturnal hypertension is associated with preclinical vascular damage, cardiac hypertrophy and renal function, as indices of subclinical target organ damage in untreated hypertension. Methods: The study population consisted of 302 untreated essential hypertensives. Based on the presence of NH (>120/70 mmHg), the population was divided into two groups: nocturnal normotensive (n¼150) and nocturnal hypertensive subjects (n¼152), who did not differ in classical risk factors. Carotid-femoral pulse wave velocity (cf-PWV), flow mediated dilation (FMD), intima-media thickness of carotid arteries (C-IMT), augmentation index, ankle-brachial index were assessed in all participants. Also, left ventricular mass index (LVMI) and E/A (the mean ratio of early and late diastolic tissue velocities) were assessed by echocardiography. Serum cystatin-C levels were measured by ELISA kit and glomerular filtration rate (GFR) was assessed by the Cockcroft-Gault formula. Results: Patients with NH were characterized by increased arterial cf-PWV (911.7 vs 8.41.5 m/sec, p¼0.0001) and marginally decreased FMD values (5.13.4 vs 4.12.6, p¼0.066). In addition, this group showed increased C-IMT (0.770.18 vs 0,690,15 mm, p¼0.016) compared to normotensive subjects, whereas no other significant differences were observed, regarding other vascular indices (p¼NS for both). Notably, they also exhibited impaired values of LVMI (88.122.9 vs 82.816.6 gr/m2, p¼0.043) and E/A (0.900.26 vs 0.880.43, p¼0.030), respectively. However, the two groups did not differ with respect to renal function, based on the values both of GFR (p¼0.689) and cystatin-C (p¼0.283). Conclusion: In the present study we found that nocturnal hypertension is accompanied by subclinical atherosclerosis, as well as structural and functional cardiac abnormalities, without significant association with renal function in this untreated hypertensive population. Disclosure of Interest: None Declared PT223 Impact of chronic pressure and volume overload on left atrial shape and function Angelina Stevanovic*1, Milica Dekleva2, Radosava Cvjetan3, Snezana Trajic4, Nevena Paunovic1, Vesna Andric1, Goran Podnar1 1 Cardiology department, Railway Health Care Institute, 2Cardiology department, University Clinical Center Zvezdara, 3Cardiology department, Zemun Medical Centre, 4Cardiology department, Dedinje Cardiovascular Institute, Belgrade, Serbia
e210
Introduction: Chronic pressure and volume overload may cause dfferent type of left atrial (LA) remodeling. Two different patterns of LA remodeling can be discriminate bay left atrial eccentricity index (LAEI). Objectives: To assess the left atrial shape and function in chronic presure and voloume overload. Methods: The study included 103 hypertensive patients with diastolic dysfunction and with or without mitral regurgitation (MR): 39 patients without MR, 30 patients with mild MR, and 34 patients with moderate/moderate to severe MR. Peak LA strain and strain rate during ventricular systole (S-LAs and SR-LAs), peak early diastolic LA strain and strain rate (S-LAe and SR-LAe), and peak LA strain and strain rate during atrial systole (SLAa and SR-LAa) were measured as LA function parameters. Left atrial volume (LAV) was measured at three time points (maximal LAV, pre-atrial contraction volume and minimal LAV) and the following LA emptying volumes were then derived: LA stroke volume (LASV) and fraction (LASVFr), LA passive emptying volume (LAPEV) and fraction (LAPEVFr), LA conduit volume (LACV) and LA active emptying volume (LAAEV) and fraction (LAAEV). All LA volumes were indexed to body surface area. Results: There were significant correlations between of LAEI and RV (r¼-0,405; p¼0,003) and significant decrease in LAEI (1,490,17 vs 1,310,15 vs 1,210,15, p¼0,0003), SLAs (29,610,4 vs 26,35,87 vs 23,98,85, p¼0,022), SR-LAs (1,540,53 vs 1,330,38 vs 1,220,42, p¼0.012), S-LAe (19,69,26 vs 16,35,97 vs 15,45,71, p¼0,041), SRLAe (-1,600,45 vs -1,380,41 vs -1,220,67, p¼0.011) and SR-Laa -2,170,68 vs -1,940,54 vs -1,690,53, p¼0.004) with increasing severety of MR. LAEI also significantly correlated with left atrial deformation parameters and with LAVI (r¼-0.382; p¼0.0007), LASVFr (r¼0.519; p¼0.0002), LAPEVFr (r¼0.386; p¼0.0005) and LAAEVFr (r¼0.401; p¼0.0003). Conclusion: Left atrium was more spherical and with inferior mechanical function in all three phases (reservoir, conduit and active contractile functions) in a simultaneous chronic pressure and volume overload and with increasing severity of MR. Usefulness of LAEI in identification of patients associated with a higher rate of AF with a higher cardiovascular risk need to be verified. Disclosure of Interest: None Declared PT224 Genome-wide association study identifies eight novel loci associated with blood pressure responses to interventions in Han Chinese Jiang He*1, Tanika N. Kelly1, Qi Zhao1, Hongfan Li2, Dabeeru C. Rao3, James E. Hixson4, Dongfeng Gu2, GenSalt Investigators 1 Department of Epidemiology, Tulane University, New Orleans, United States, 2Department of Epidemiology and Population Genetics, Fuwai Hospital, Beijing, China, 3Division of Biostatistics, Washington University, St. Louis, 4Human Genetics Center, University of Texas, Houston, United States Introduction: Blood pressure (BP) responses to dietary sodium and potassium intervention and cold pressor test (CPT) vary considerably among individuals. Objectives: We aimed to identify novel genetic variants influencing individuals’ BP responses to dietary intervention and CPT. Methods: We conducted a genome-wide association study of BP responses in 1,881 Han Chinese and de novo genotyped top findings in 698 Han Chinese. Diet-feeding study included a 7-day low-sodium (51.3 mmol/day), a 7-day high-sodium (307.8 mmol/day), and a 7-day high-sodium plus potassium-supplementation (60 mmol/day). Nine BP measurements were obtained during baseline observation and each intervention period. Results: The meta-analyses identified eight novel loci for BP phenotypes, which physically mapped in or near PRMT6 (P¼7.2910-9), CDCA7 (P¼3.5710-8), PIBF1 (P¼1.7810-9), ARL4C (P¼1.8610-8), IRAK1BP1 (P¼1.4410-10), SALL1 (P¼7.0110-13), TRPM8 (P¼2.6810-8), and FBXL13 (P¼3.7410-9). There was a strong dose-response relationship between the number of risk alleles of these independent SNPs and the risk of developing hypertension over 4-years follow-up in the study participants. Compared to those in the lowest quartile of risk alleles, odds ratios (95% confidence intervals) for those in the second, third and fourth quartiles were 1.24 (0.82, 1.87), 1.55 (1.01, 2.39), and 1.92 (1.28, 2.89), respectively (p¼0.0008 for trend). Conclusion: Our study identified 8 novel loci for BP responses to dietary sodium and potassium intervention and CPT. The effect size of these novel loci on BP phenotypes are much larger than those reported by the previously published studies. Furthermore, these variants predict the risk of developing hypertension among individuals with normal BP at baseline. Disclosure of Interest: None Declared PT225 Knowledge, attitudes and behaviors related to sodium intake of Cardiac Care Unit Lebanese adult patients Jihan Fathallah1, Mohamad Almedawar*1, Torkom Garabedian1, Sabine Keyrouz1, Laila Al-Shaar2, Lara Nasreddine3, Samir Alam1, Hussain Isma’eel1, Vascular Medicine Program 1 Cardiology, 2Vascular Medicine Program, 3Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon Introduction: High dietary salt intake has been directly correlated with hypertension, the leading preventable risk factor for death in the world. Assessing knowledge, attitudes, and behaviors of high cardiovascular (CV) risk patients and comparing them to community based results would direct future focused interventions to reduce intake of salt. Objectives: To assess the knowledge, attitudes, and behaviors of high risk patients in the Cardiac Care Unit (CCU) regarding salt intake to guide future interventions, and to
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Table 1. Characteristics of the CCU sample (n¼115) 60.6315.39
Age,Mean±SD BMI,Mean±SD
29.37±5.41
SBP,Mean±SD
125.61±22.14
smoking,N(%)
43(37.70)
Family Hx-CAD,N(%)
30(26.30)
Medical Hx-HTN,N(%)
85(74.60)
Medical Hx–Coronary PCI,N(%)
44(38.60)
Coronary PCI during Current visit,N(%)
35(30.70)
PT227 Large artery stiffness and carotid intima-media thickness in relation to markers of bone mineral metabolism in postmenopausal African women: The PURE-study Aletta Schutte*1, Lebo Gafane1, Iolanthe Kruger2, Rudolph Schutte1 1 Hypertension in Africa Research Team (HART), 2Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa Introduction: Increased vascular calcification, cardiovascular morbidity and mortality have been associated with altered bone metabolism and associated calciotropic hormones. Objectives: Due to the lack of information on the contribution of altered bone metabolism and calciotropic hormones on cardiovascular disease in Africans, this study aimed to explore the relationships of carotid intima-media thickness (cIMT) and central pulse pressure (cPP) with the parathyroid hormone-to-vitamin D ratio (PTH:25-OH-D) and Ctelopeptide of type I collagen (CTX) in postmenopausal African women. Methods: A study population of 434 African women, aged 47 years, was divided into lean and overweight/obese groups. We assessed cPP and cIMT, and determined PTH, 25OH-D and CTX concentrations. Results: In the overweight/obese group we found elevated PTH and PTH:25-OH-D compared to the lean group (p<0.001), while the lean group had higher CTX concentrations (p<0.001). Single, partial and multiple regression analyses confirmed that only in lean women, cIMT was independently associated with PTH:25-OH-D (R2¼0.22; b¼0.26; p¼0.003); whereas in obese women, cPP associated with both PTH:25-OH-D (R2¼0.20; b¼0.17; p¼0.017) and CTX (R2¼0.20; b¼0.17; p¼0.025). Conclusion: In postmenopausal African women with increased adiposity, cPP, as indicator of central arterial stiffness, was positively associated with alterations in bone metabolism and calciotropic hormones, whereas cIMT of lean women was positively associated with PTH:25-OH-D. Our results suggest that alterations in bone metabolism may contribute to arterial calcification. Disclosure of Interest: None Declared PT229
Conclusion: Our study shows a lack of knowledge regarding salt major contributors in the Lebanese diet and allowed maximum intake levels relative to the community based sample. *Nasreddine et al. “Knowledge, Attitudes and Behaviors Related to Sodium Intake of Lebanese Consumers aged 19-60” (Unpublished data). Disclosure of Interest: None Declared PT226 Erectile dysfunction risk factors in patients with severe obstructive sleep apnea syndrome and identifying CPAP response predictors Haruki Sekiguchi*1,2, Ken Shimamoto1, Koji Narui3, Yuji Inoue4, Yufuko Takahashi1, Tatsumi Fujio1, Yasunobu Hashimoto5, Yoshiko Maeda5, Eri Watanabe1, Masatoshi Kawana1, Fujio Tatsumi1, Mayumi Suzuki6, Ken Shimamoto1, Kazuhiro Yamaguchi6, Masatoshi Kawana1 1 Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Japan, 2Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Jersey, 3Respiratory Medicine, Toranomon Hospital, 4Aoyama Hospital Tokyo Women’s Medical University, 5Urology, 6Aoyama Hospital, Tokyo Women’s Medical University, Tokyo, Japan Introduction: Erectile dysfunction (ED) is one of the important complications in patients with sleep apnea syndrome (SAS). ED is known as a risk factor and risk indicator for future cardiovascular diseases. However, risk factors related to ED as well as the efficacy of continuous positive airway pressure (CPAP) therapy on improving ED have not been established in Japanese subjects with obstructive SAS. Objectives: This study investigates risk factors of ED and factors predicting the efficacy of CPAP for the treatment of ED in Japanese SAS patients. Methods: We conducted a retrospective population-based study of Japanese subjects linking questionnaire data with characteristics of patients hospitalized (170 males, age: 4912.3 years) due to SAS diagnosis by polysomnography. SAS was diagnosed as AHI > 5 and ED diagnosed by an International Index of Erectile Function (IIEF)-5 score < 22. Thirty patients answered IIEF5 twice before CPAP treatment and at 6 months after CPAP treatment. We analyzed the correlation between ED and potential explanatory variables including age, body mass index (BMI), apnea/hypopnea index (AHI), micro-arousals, hypertension (HTN), diabetes mellitus (DM), dementia, ischemic heart disease, dyslipidemia, and benign prostatic hyperplasia. We also investigated predictors judging the efficacy of CPAP on improvement of ED. Results: In this study population, baseline BMI and AHI were, 27.34.0 kg/m2 and 43.127.8 /hr, respectively. ED was observed in 59.4% (101/170) of the patients. DM and HTN were found to be risk factors for ED (odds ratio: 2.89, [95% CI 1.46-5.68], P<0.001, OR: 3.47, [95% CI 1.77-6.85], P<0.01, respectively). Multivariate analysis revealed that DM (OR: 4.4, [95% CI 1.92-9.97], P<0.001) was a unique, independent risk factor for ED. After 6 months of CPAP treatment, IIEF5 scores significantly decreased in 53.3% (16/30) of ED patients (3.42.3, P<0.001). Baseline AHI for SAS diagnosed patients was significantly higher in CPAP responders compared to non-responders (53.922.9 vs. 37.019.8, P<0.05, respectively). However, in patients over 65 years of age (N¼5), CPAP therapy was not effective for treating ED (DIIEF 5 ¼ –5.48.0) in 80% of cases. Conclusion: DM is an important risk factor inducing ED in SAS patients. Furthermore, CPAP treatment should be considered for patients suffering from severe SAS complicated with ED. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Assessment of quality of life and its correlates among Hypertensive patients in a West African Cardiology practice Amam C. Mbakwem*1, Francis Aina1, Casmir E. Amadi2, Abiola Akinbode2, Joy Mokwunyei3 1 Medicine, 2Psychiatry, University of Lagos, 3Medicine, Lagos University Teaching Hospital, Lagos, Nigeria Introduction: Hypertension (HTN) is majorly asymptomatic except when complicated and may not be expected to impact on the quality of life (QoL) of patients. Poor QoL may affect health seeking behaviour, adherence to treatment and disease outcome. The aspect of quality of life has not been given much prominence in the management of patients with hypertension. We therefore evaluated the QoL of hypertensive patients attending the cardiology clinic of our hospital using a generic instrument, the WHOQOL-BREF. Objectives: To determine the quality of life of hypertensive patients and its correlates in a cardiology practice in west Africa. Methods: Hypertensive patients without co-morbidities who were attending the cardiology clinic were recruited. Relevant clinical data were retrieved from their notes and subjects self completed the WHOQOL-BREF. The single item scores were computed and analysed. The domain scores in the WHOQOL-BREF were computed, transformed and analysed. These were correlated with the single item scores and clinical parameters. Results: There were 74 males and 110 females with mean age 56.4712.02yrs. About 40% had post high-school education, 72% had poor finances and most, 80% were married. About 16% felt their QoL was poor to average while 49% were dissatisfied with their health status. Transformed scores for the main domains, physical health, psychological, social relationships and environment were 67.3726.35, 68.7613.58, 67.9215.93 and 67.1413.86 respectively. Also 14.9%, 9.1%, 8.5% and 8.8% had scores less than 50% for physical health, psychological, social relationships and environment domains respectively. More females (18.2% vs. 12.2%, p ¼ 0.05) felt their quality of life was below average. There was positive correlation between age and domains of social relationships and the environment, r¼.214, p¼0.006 and r ¼.183, p¼0.02 respectively. Positive correlation was observed between perception of poor quality of life and health status and the four domains evaluated, p <0.0001. Conclusion: The QoL of hypertensive patients must be given consideration in their management as this may contribute to poor adherence and affect outcomes. Particular attention should be paid to female hypertensives who appear to have worse QoL scores. Disclosure of Interest: None Declared PT230 Role of Brain Natriuretic Peptide In Predicting The Short Term Cardiovascular Outcomes In Preeclampsia And Eclampsia Patients Ghada Youssef*1, Nader Haroon1, Reda Diab1, Essam Baligh1 1 Cardiology, Cairo University, Cairo, Egypt Introduction: Brain natriuretic peptide (BNP) concentrations were found to be higher in preeclampsia and other hypertensive disorders of pregnancy than in normal pregnancy. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia. Objectives: To evaluate the possible role of elevated BNP level in predicting the short-term maternal cardiovascular outcome in patients presented with preeclampsia/eclampsia disease. Methods: Fifty patients who presented with preeclampsia or eclampsia were included. They were followed up clinically and by echocardiography till delivery and at 1, 3 and 6
e211
POSTER ABSTRACTS
compare the awareness level of our study sample to healthy individuals in the community (HIC) from a previous study*. Methods: Based on unpublished data*, it is estimated that around 82.2% of Lebanese adults know that salt/sodium worsens human’s health. With a confidence interval of 7% and a type 1 error of 5%, we sampled 115 out of the annual 1500 Lebanese high CV risk patients admitted to the Cardiac Care Unit (CCU). They were administered a questionnaire developed to assess awareness of salt intake recommended level, content in food, and associated CV risk. Statistical analysis was conducted using SPSS 20 for Windows. Results: In terms of knowledge, 36.5% of CCU patients knew that the main source of salt in the diet is processed foods such as breads, cured meats, and canned food compared to 21.5% of HIC, while 47% thought it was salt added at the table compared to 42.1% of HIC. Moreover, 19.1% of CCU and 28.9% of HIC knew the maximum daily amount of salt recommended. In terms of attitudes and behaviors, 58.53% admitted they never look at the salt or sodium content on food labels compared to 66.5% of HIC. When asked about the main motive to reduce Salt intake, 65.8% of CCU and 51.7% of HIC admitted that it would be a dramatic change in health status.