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PW045 Is prognosis of takotsubo cardiomyopathy related with the speed of recovery of left ventricular function?
PW042 Predictors of Mortality in Patients With Hypertrophic Cardiomyopathy - A Hospital Admissions Study: 2000-2013 Niece K. Khouw1, Mohammed Wasim1, Hardeep Uppal2, Suresh Chandran3, Rahul Potluri*4 1 General Medicine, Pennine Acute Hospital NHS Trust, Manchester, 2Coventry and Warwickshire Partnership NHS Trust, Coventry, 3Acute Medicine, Pennine Acute Hospital NHS Trust, Manchester, 4ACALM Study Unit in collaboration with School of Medical Sciences, Aston University, Birmingham, United Kingdom Introduction: Hypertrophic Cardiomyopathy (HCM) is a rare condition that can be assoociated with sudden cardiac death. The predictors of mortality in patients with HCM has not been well studied. Objectives: The aim of this study is to investigate the predictors of mortality in patients with HCM from a large sample of hospital admissions. Methods: Anonymous information on patients with Hypertrophic Cardiomyopathy, comorbidities and procedures attending large multi-ethnic general hospitals in Manchester, United Kingdom in the period 2000-2012 was obtained from the local health authority computerised hospital activity analysis register using ICD-10 and OPCS coding systems. Statistical analysis was performed using SPSS version 20. Results: Out of 1,221,216 patients admitted, there were 253 patients with HCM. The mean age of 55.8years18.8(S.D) with 63.2% male patients VS 36.8% female patients. The main co-morbidities were Hypertension (86;34.0%), Atrial Fibrillation (69;27.3%), Heart Failure (27;10.7%), Type 2 Diabetes Mellitus (24;9.5%), Ventricular Tachycardia (16;6.3%), Defibrillator Implant (16;6.3%). A multi-nominal logistic regression model accounting for variations in age, sex and ethnic group showed that only Atrial Fibrillation (RR3.8;C.I1.7-8.1) and Heart Failure (RR5.0;C.I1.9-13.5) are significant predictors of mortality (p <0.05). Conclusion: We have shown that Atrial Fibrillation and Heart Failure are significant predictors of mortality in patients with HCM from a large hospital based sample in the UK. This reflects the known complications of HCM affecting mortality. However, it is surprising that Defibrillator implantation does not confer improved mortality. Our improved understanding of these predictors will guide clinicians to focus on these high risk groups to improve clinical practice and outcomes in patients with HCM. Disclosure of Interest: None Declared PW043 Predictors of outcome in takotsubo cardiomyopathy – a multicenter study Nuno S. Marques*1, Olga Azevedo2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado1, Vitor Pereira2, Ana Rita Almeida3, SUNSHINE 1 Cardiology, Faro Hospital, Faro, 2Cardiology, CHAA, Guimarães, 3Cardiology, H. Garcia Orta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo, Portugal Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ventricular (LV) dysfunction in the absence of significant coronary artery disease. The predictors of prognosis of TC are not yet fully established. Objectives: To identify predictors of outcome in patients (P) diagnosed with TC. Methods: Multicenter studyinvolving 5 hospital centers that included all patients diagnosed with TC in the last 10 years. We assessed demographic data, precipitating factors and clinical presentation, trying to establish the predictors of after discharge outcomes. Results: We included 71 P diagnosed with TC. During hospitalization (6.1 4.6 days) occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation (9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke / TIA (2.8%), LV thrombus (1.4%) and death (1.4%).
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Over a follow-up of 31 29 months, there were: TC recurrence (4.2%), stroke / TIA (4.2%) and death (1.4%). The following variables were identified as predictors of complications at follow-up: (i) ST segment depression on admission EKG was a predictor of TC recurrence (p¼0,016); (ii) Chronic renal failure was a predictor of stroke/TIA (p¼0.023) and death (p¼0,027). Conclusion: TC has a low rate of complications in the follow-up. Chronic renal failure is a predictor of death and also of stroke in the follow-up. The admission EKG may have a prognostic role and ST segment depression was the only identified predictor of TC recurrence. Our results need confirmation in larger studies. Disclosure of Interest: None Declared PW044 Predictors of in-hospital outcome in takotsubo cardiomyopathy – A multicenter study Nuno S. Marques*1, Olga Azevedo2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado1, Vitor Pereira2, Ana Rita Almeida3, SUNSHINE 1 Cardiology, Faro Hospital, Faro, 2Cardiology, CHAA, Guimarães, 3Cardiology, H. Garcia de Orta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo, Portugal Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ventricular (LV) dysfunction in the absence of significant coronary artery disease. The predictors of prognosis of TC are not yet fully established. Objectives: To identify predictors of outcome in patients (P) diagnosed with TC. Methods: Multicenter study involving 5 hospital centers that included all patients diagnosed with TC in the last 10 years. Results: We included 71 P diagnosed with TC. During hospitalization (6.1 4.6 days) occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation (9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke / TIA (2.8%), LV thrombus (1.4%) and death (1.4%). In the multivariate analysis, the following variables were identified as independent predictors of in-hospital complications: (i) Predictors of complete atrioventricular block were angina pectoris (p¼0,028), syncope at presentation (p¼0,012), ST segment elevation on the admission EKG (p¼0,010) and T wave inversion (p¼0,043); (ii) ST segment depression on the admission EKG was identified as a predictor of acute pulmonary edema (p¼0,029); (iii) LV dysfunction was an independent predictor of heart failure (p¼0,003), acute pulmonary edema (p¼0,015), stroke/TIA (p¼0,035) and death (p¼0,049); (iv) Male gender was an independent predictor of stroke/TIA (p¼0,013) and death (p<0,001); (v) Other predictors of death were diabetes mellitus (p¼0,007), chronic renal failure (p¼0,048), syncope at presentation (p¼0,036). Conclusion: TC has a high rate of complications in the acute phase. TC, a disease of mainly females, has worse in-hospital prognosis in males. Male gender is a predictor of in-hospital stroke/TIA and death. Diabetes, chronic renal failure, syncope at presentation and LV dysfunction were also predictors of in-hospital death. Disclosure of Interest: None Declared PW045 Is prognosis of takotsubo cardiomyopathy related with the speed of recovery of left ventricular function? Olga Azevedo*1, Nuno S. Marques2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado2, Vitor Pereira1, Ana Rita Almeida3, SUNSHINE 1 Cardiology, CHAA, Guimarães, 2Cardiology, Faro Hospital, Faro, 3Cardiology, H. Garcia de Orta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo, Portugal Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ventricular (LV) dysfunction. The recovery rate of LV function is variable. There is lack of data with respect to the impact of the rate of recovery of LV function in the prognosis of TC. Objectives: To determine if the patients diagnosed with TC that present a faster recovery of LV function have better medium term prognosis. Methods: Multicenter study involving 5 hospitals that included all patients diagnosed with TC in the last 10 years. We assessed patients with echocardiography at admission, discharge and at follow-up. Full recovery was defined as complete normalization of LV global function and segmental motility. We established the discharge time and 15 days after admission as cut-offs for recovery of LV function. We determine if the patients with faster recovery of LV function had better medium term prognosis. Results: We included 71 patients with TC. Total recovery of LV function was observed at hospital discharge in 27 patients (38,0%) and at 15 days after admission in 31 patients (43,7%). The recovery of LV function during the hospital stay was not associated with death (0% vs 2,7%, p¼0,437), stroke/TIA (5,4% vs 4,5%, p¼0,884) or TC recurrence (0% vs 8,1%, p¼0,170) in the follow-up. In the multivariate analysis, the faster recovery of LV function was not an independent predictor of events. The recovery of LV function at 15 days after admission was not associated with death (0% vs 2,8%, p¼0,410), stroke/TIA (4,2% vs 5,6%, p¼0,809) or TC recurrence (0% vs 8,3%, p¼0,147) in the follow-up. In the multivariate analysis, the faster recovery of LV function was not an independent predictor of events. Conclusion: In this multicenter study, the patients with TC that present a faster recovery of LV function do not have a better medium term prognosis. However, the low rate of complications in the follow-up may have limited the study results. Our results need further confirmation in larger studies. Disclosure of Interest: None Declared
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POSTER ABSTRACTS
Introduction: It has been shown that high intensity training is more effective in treating patients with heart failure (HF) however studies haven’t been evaluated sexual function. Objectives: To compare moderate versus high intensity exercise with regard to sexual and cardiorespiratory function. Methods: Twenty patients with stable HF (aged 53.25 8.87 years), left ventricle ejection fraction 45%, were randomized to moderate continuous training (MCT) or high-intensity interval training (HIT). The subjects underwent 12 weeks of exercise training, three times per week, in MCT target zone of heart rate (HR) corresponding to anaerobic threshold (first ventilatory threshold) and in HIT the HR corresponding to respiratory compensation point (second ventilatory threshold) alternating with HR corresponding to anaerobic threshold (recovery period). Patients underwent assessment of sexual function by the International Index of Erectile Function (IIEF), determination of VO2 peak by cardiopulmonary exercise testing (CPET), determination of distance walk by the six-minute walk test (6MWT) and assessment of endothelial function by Doppler echocardiography. In statistical analysis was used Shapiro-Wilk test, Chi-square (x2), Fisher exact test, t test, Mann-Whitney U and paired t test, with significance level of 5%. Results: Only in HIT was observed increase in erectile function (11 10.46 to 19.55 9.07, p ¼ 0.030), desire (from 4.77 2.04 to 6.88 2.08, p ¼ 0.034), sexual satisfaction (from 4.00 4.63 to 8.33 5.36, p ¼ 0.017) and VO2 peak (from 21.07 4.30 to 23.79 5.26, p ¼ 0.021) while in MCT was no significant changes in these outcomes. Distance walked in 6MWT increased after MCT (462.63 63.10 to 603.45 67.50, p ¼ 0.003) and HIT(456.44 38.51 to 589.66 59, 69, p ¼ 0.008). No significant changes occurred in endothelial function (HIT: +43.6%, p ¼ 0.666; MCT:+193%, p ¼ 0.214). Conclusion: High-intensity training was superior than MCT for increase sexual and cardiorespiratory function in patients with heart failure. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Over a follow-up of 31 29 months, there were: TC recurrence (4.2%), stroke / TIA (4.2%) and death (1.4%). The following variables were identified as predictors of complications at follow-up: (i) ST segment depression on admission EKG was a predictor of TC recurrence (p¼0,016); (ii) Chronic renal failure was a predictor of stroke/TIA (p¼0.023) and death (p¼0,027). Conclusion: TC has a low rate of complications in the follow-up. Chronic renal failure is a predictor of death and also of stroke in the follow-up. The admission EKG may have a prognostic role and ST segment depression was the only identified predictor of TC recurrence. Our results need confirmation in larger studies. Disclosure of Interest: None Declared PW044 Predictors of in-hospital outcome in takotsubo cardiomyopathy – A multicenter study Nuno S. Marques*1, Olga Azevedo2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado1, Vitor Pereira2, Ana Rita Almeida3, SUNSHINE 1 Cardiology, Faro Hospital, Faro, 2Cardiology, CHAA, Guimarães, 3Cardiology, H. Garcia de Orta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo, Portugal Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ventricular (LV) dysfunction in the absence of significant coronary artery disease. The predictors of prognosis of TC are not yet fully established. Objectives: To identify predictors of outcome in patients (P) diagnosed with TC. Methods: Multicenter study involving 5 hospital centers that included all patients diagnosed with TC in the last 10 years. Results: We included 71 P diagnosed with TC. During hospitalization (6.1 4.6 days) occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation (9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke / TIA (2.8%), LV thrombus (1.4%) and death (1.4%). In the multivariate analysis, the following variables were identified as independent predictors of in-hospital complications: (i) Predictors of complete atrioventricular block were angina pectoris (p¼0,028), syncope at presentation (p¼0,012), ST segment elevation on the admission EKG (p¼0,010) and T wave inversion (p¼0,043); (ii) ST segment depression on the admission EKG was identified as a predictor of acute pulmonary edema (p¼0,029); (iii) LV dysfunction was an independent predictor of heart failure (p¼0,003), acute pulmonary edema (p¼0,015), stroke/TIA (p¼0,035) and death (p¼0,049); (iv) Male gender was an independent predictor of stroke/TIA (p¼0,013) and death (p<0,001); (v) Other predictors of death were diabetes mellitus (p¼0,007), chronic renal failure (p¼0,048), syncope at presentation (p¼0,036). Conclusion: TC has a high rate of complications in the acute phase. TC, a disease of mainly females, has worse in-hospital prognosis in males. Male gender is a predictor of in-hospital stroke/TIA and death. Diabetes, chronic renal failure, syncope at presentation and LV dysfunction were also predictors of in-hospital death. Disclosure of Interest: None Declared PW045 Is prognosis of takotsubo cardiomyopathy related with the speed of recovery of left ventricular function? Olga Azevedo*1, Nuno S. Marques2, Inês Cruz3, Bruno Piçarra4, Rui Lima5, José Amado2, Vitor Pereira1, Ana Rita Almeida3, SUNSHINE 1 Cardiology, CHAA, Guimarães, 2Cardiology, Faro Hospital, Faro, 3Cardiology, H. Garcia de Orta, Almada, 4Cardiology, H. Évora, Évora, 5Cardiology, H. Viana do Castelo, Viana do Castelo, Portugal Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ventricular (LV) dysfunction. The recovery rate of LV function is variable. There is lack of data with respect to the impact of the rate of recovery of LV function in the prognosis of TC. Objectives: To determine if the patients diagnosed with TC that present a faster recovery of LV function have better medium term prognosis. Methods: Multicenter study involving 5 hospitals that included all patients diagnosed with TC in the last 10 years. We assessed patients with echocardiography at admission, discharge and at follow-up. Full recovery was defined as complete normalization of LV global function and segmental motility. We established the discharge time and 15 days after admission as cut-offs for recovery of LV function. We determine if the patients with faster recovery of LV function had better medium term prognosis. Results: We included 71 patients with TC. Total recovery of LV function was observed at hospital discharge in 27 patients (38,0%) and at 15 days after admission in 31 patients (43,7%). The recovery of LV function during the hospital stay was not associated with death (0% vs 2,7%, p¼0,437), stroke/TIA (5,4% vs 4,5%, p¼0,884) or TC recurrence (0% vs 8,1%, p¼0,170) in the follow-up. In the multivariate analysis, the faster recovery of LV function was not an independent predictor of events. The recovery of LV function at 15 days after admission was not associated with death (0% vs 2,8%, p¼0,410), stroke/TIA (4,2% vs 5,6%, p¼0,809) or TC recurrence (0% vs 8,3%, p¼0,147) in the follow-up. In the multivariate analysis, the faster recovery of LV function was not an independent predictor of events. Conclusion: In this multicenter study, the patients with TC that present a faster recovery of LV function do not have a better medium term prognosis. However, the low rate of complications in the follow-up may have limited the study results. Our results need further confirmation in larger studies. Disclosure of Interest: None Declared
e271
POSTER ABSTRACTS
Introduction: It has been shown that high intensity training is more effective in treating patients with heart failure (HF) however studies haven’t been evaluated sexual function. Objectives: To compare moderate versus high intensity exercise with regard to sexual and cardiorespiratory function. Methods: Twenty patients with stable HF (aged 53.25 8.87 years), left ventricle ejection fraction 45%, were randomized to moderate continuous training (MCT) or high-intensity interval training (HIT). The subjects underwent 12 weeks of exercise training, three times per week, in MCT target zone of heart rate (HR) corresponding to anaerobic threshold (first ventilatory threshold) and in HIT the HR corresponding to respiratory compensation point (second ventilatory threshold) alternating with HR corresponding to anaerobic threshold (recovery period). Patients underwent assessment of sexual function by the International Index of Erectile Function (IIEF), determination of VO2 peak by cardiopulmonary exercise testing (CPET), determination of distance walk by the six-minute walk test (6MWT) and assessment of endothelial function by Doppler echocardiography. In statistical analysis was used Shapiro-Wilk test, Chi-square (x2), Fisher exact test, t test, Mann-Whitney U and paired t test, with significance level of 5%. Results: Only in HIT was observed increase in erectile function (11 10.46 to 19.55 9.07, p ¼ 0.030), desire (from 4.77 2.04 to 6.88 2.08, p ¼ 0.034), sexual satisfaction (from 4.00 4.63 to 8.33 5.36, p ¼ 0.017) and VO2 peak (from 21.07 4.30 to 23.79 5.26, p ¼ 0.021) while in MCT was no significant changes in these outcomes. Distance walked in 6MWT increased after MCT (462.63 63.10 to 603.45 67.50, p ¼ 0.003) and HIT(456.44 38.51 to 589.66 59, 69, p ¼ 0.008). No significant changes occurred in endothelial function (HIT: +43.6%, p ¼ 0.666; MCT:+193%, p ¼ 0.214). Conclusion: High-intensity training was superior than MCT for increase sexual and cardiorespiratory function in patients with heart failure. Disclosure of Interest: None Declared