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PW047 Echocardiography Underestimates Maximum Interventricular Septum Thickness in Hypertrophic Cardiomyopathy
POSTER ABSTRACTS
PW046 In-hospital and medium term prognosis of takotsubo cardiomyopathy –A multicenter study 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 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, but the prognosis of TC is not yet fully established. Objectives: To evaluate in-hospital and medium term prognosis of patients 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 71patients with TC, predominantly females (91.5%). Mean age was 67 11 years. Chest pain was the most common clinical presentation (93%). Emotional or physical stress was identified as a possible triggering factor in 60.6% of patients. The admission ECG showed ST-segment elevation (56.3%) or depression (32.4%) in most patients. There was elevation of troponin I on admission in 83.1% of cases (peak value of 4.2 4.3ng/mL). Echocardiogram revealed akinesia of apical and medium LV segments in 97.2% of cases. The coronary angiography revealed no coronary disease(85.9%).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%). Complete reversal of LV dysfunction occurred in 38% during hospitalization and in 43.7% up to 15 days after admission. Over a follow-up of 31 29 months, there were: TC recurrence (4.2%), stroke / TIA (4.2%) and death (1.4%). Conclusion: In the acute phase, TC has a high prevalence of complications, particularly heart failure and cardiogenic shock, and severe complications such as stroke and death may also occur. At the medium term follow-up, the prognosis is good with a low prevalence of stroke / TIA, a low mortality and a low recurrence rate. Disclosure of Interest: None Declared PW047 Echocardiography Underestimates Maximum Interventricular Septum Thickness in Hypertrophic Cardiomyopathy Shane Nanayakkara*1, Andrew Taylor1, Andris Ellims1 1 Cardiology, The Alfred, Melbourne, Australia Introduction: Echocardiography is routinely used in the evaluation of patients with hypertrophic cardiomyopathy (HCM) however assessment of left ventricular (LV) wall thickness using this modality may be inaccurate, particularly if image quality is reduced. Cardiac magnetic resonance (CMR) imaging, the gold-standard modality for LV morphologic analysis, is increasingly utilised in HCM. Objectives: To determine the accuracy of echocardiographic measures of ventricular wall thickness compared to CMR in HCM. Methods: Consecutive patients with a clinical diagnosis of HCM referred for CMR at the Alfred Hospital were included. Volumetric analysis of a short-axis cine stack (extending from the mitral annulus to the LV apex) was performed in all patients to determine maximum thicknesses of the interventricular septum and LV lateral wall. Measures of these walls from each patient’s most recent echocardiographic study were also obtained. Results: CMR was completed in 138 patients (51 14 years, 66% male). Maximum interventricular septum thickness was significantly greater using CMR compared to echocardiography (19.6 4.5 mm vs. 17.7 3.9 mm, p ¼ 0.001). Conversely, maximum LV lateral wall thickness was significantly less using CMR compared to echocardiography (8.8 2.2 mm vs. 11.1 3.4 mm, p < 0.001. Echocardiography correlated significantly with CMR for interventricular septum thickness (r ¼ 0.67, p < 0.001) and for lateral wall thickness (r ¼ 0.49, p < 0.001).
of LV hypertrophy in patients with HCM, CMR should be considered in all patients to improve diagnostic accuracy. Disclosure of Interest: None Declared PW048 Features of chronic heart failture at women Elena Klester*1 1 Department of hospital and outpatients therapeutics with occupational diseases and endocrinology courses, Altai State Medical University, Barnaul, Russian Federation Introduction: Gender component in an etiology of chronic heart failure lead to clinical features of a current of chronic heart failure at women that it is necessary to consider in development of individual treatment-and-prophylactic strategy. Objectives: Optimization of diagnostics, treatment, current prediction and prevention of CHF on the basis of complex estimation of clinic-functional features of cardiovascular system and the psychosomatic state of women. Methods: Clinic-statistical analysis of CHF was conducted during a year in therapeutics department. The diagnosis of CHF was established according to National recommendations of All-Russian scientific cardiologist society criteria on diagnostics and CHF treatment (the third revision, 2009) at 489 patients. There are 270 (55,2%) men, 219 (44,8%) women who includes in research on entry. Middle age is 65,213,4 [min 41, max 94] years, men 60,911,2; women - 67,610,4 (p<0,05). Results: The average value on risk scale of cardiovascular diseases was 3,61.11: in men’s group - 3,51,04; in women’s group - 3,81,12 (p<0.05). BWI was 27,6 [18,3 min, 39,1 max], men – 26,23,5; women – 28,74,8 (p¼0.000). Between age and BWI there is weak, but statistically significant correlation ([¼0.25. p¼0.001). More often etiological factor at men was IHD, generating 74,8% cases CHF. Thus at men with IHD at 149 (73,8%) patients CHF appeared after MI. AH frequency was 11,5%, dilated myocardiopathy (DMP) - 10,7%, other – 1,1%. The main reason of CHF at women were AH - 44,7%; IHD - 26,5%. Another reasons were diabetes mellitus (15,1%), valvular disease (7,8%), DMP (5,0%). Among hospitalized patients with CHF, the IV FC (NYHA) statistically significantly met at men (a mean grades of the clinical condition scale (CCS) – 5,81,14; at women – 4,21,07, p<0,05). In the analysis of gender distinctions of remodeling it is established that at women with CHF the diastolic dysfunction prevailed, mainly the I type LVDD, of ejection fraction (EF) LV on the average on group – 62,15,18%. Quality of life of the women is characterized by high level of anxiety in comparison with the men group. Conclusion: The most significant reason of formation of CHF at women is the AH, at men – IHD (often after MI). Women had the II FC on CCS on the average, men – the III FC. CHF is accompanied of depression and decreasing quality of life at women that is the basis for formation of gender distinctions in approaches to treatment correction at CHF. Disclosure of Interest: None Declared PW049 The enantiomers of the myocardial metabolic agent perhexiline display divergent effects on hepatic energy metabolism and peripheral neural function in rats Giovanni Licari*1, Benedetta C. Sallustio1, Andrew A. Somogyi1, Robert W. Milne2 1 Pharmacology, Adelaide University, 2Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia Introduction: Perhexiline, a chiral drug, is a potent anti-ischaemic agent whose clinical utility is limited by hepatic and neural toxicity. Perhexiline inhibits mitochondrial carnitine palmitoyltransferase-1, however, excessive inhibition is associated with tissue steatosis. Objectives: This study tested the hypothesis that the toxicity of perhexiline is enantioselective. Methods: Dark Agouti rats were administered vehicle or 200 mg/kg/day of racemic, (+)- or (-)-perhexiline orally for 8 weeks. Plasma liver function tests and von Frey assessments of peripheral neural function were performed. Hepatic and neuronal histology, including lipid and glycogen contents, were assessed using electron microscopy, and concentrations of the perhexiline enantiomers and metabolites were measured in plasma, liver and heart. Results: Racemic perhexiline did not affect hepatic lipid or glycogen content. However, (-)perhexiline induced a concentration-dependent increase in glycogen content, while (+)- perhexiline induced concentration-dependent increases in lipid and decreases in glycogen content. Racemic (p<0.001) and (+)-perhexiline (p<0.05) induced peripheral nerve dysfunction, while (-)-perhexiline induced no change. Mean (s.e.m.) plasma perhexiline concentrations in rats treated with racemate, (+)- or (-)-enantiomer were 0.84 (0.40), 0.67 (0.07) and 0.29 (0.04) mg/L, respectively, corresponding to the mid-upper clinical therapeutic range. Oral clearance was greater for (-)-compared to (+)-perhexiline. The distribution of (+)-perhexiline into liver and heart was greater when administered as pure enantiomer compared to racemate. Conclusion: Perhexiline’s enantiomers exert substantially different effects on hepatic lipid and glycogen accumulation, and on neuronal function. Our data suggest that the hepatoand neuro-toxicity of racemic perhexiline resides predominately in the (+)-enantiomer, consistent with inhibition of carnitine palmitoyltransferase-1, whilst (-)-perhexiline may offer greater potential long-term safety. Disclosure of Interest: None Declared PW051
Conclusion: In HCM, echocardiography underestimates maximum interventricular septum thickness and overestimates LV lateral wall thickness. Because accurate assessments of LV wall thickness are required both for risk stratification and monitoring of progression
e272
The effect of methoxy poiyethilenglicol -epoietin beta in patiens chronic heart failure with anemic syndrome Kamala Zahidova*1, Faig Guliyev1 1 Cardiology, Azerbaijan State Training, Baku, Azerbaijan
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PW046 In-hospital and medium term prognosis of takotsubo cardiomyopathy –A multicenter study 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 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, but the prognosis of TC is not yet fully established. Objectives: To evaluate in-hospital and medium term prognosis of patients 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 71patients with TC, predominantly females (91.5%). Mean age was 67 11 years. Chest pain was the most common clinical presentation (93%). Emotional or physical stress was identified as a possible triggering factor in 60.6% of patients. The admission ECG showed ST-segment elevation (56.3%) or depression (32.4%) in most patients. There was elevation of troponin I on admission in 83.1% of cases (peak value of 4.2 4.3ng/mL). Echocardiogram revealed akinesia of apical and medium LV segments in 97.2% of cases. The coronary angiography revealed no coronary disease(85.9%).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%). Complete reversal of LV dysfunction occurred in 38% during hospitalization and in 43.7% up to 15 days after admission. Over a follow-up of 31 29 months, there were: TC recurrence (4.2%), stroke / TIA (4.2%) and death (1.4%). Conclusion: In the acute phase, TC has a high prevalence of complications, particularly heart failure and cardiogenic shock, and severe complications such as stroke and death may also occur. At the medium term follow-up, the prognosis is good with a low prevalence of stroke / TIA, a low mortality and a low recurrence rate. Disclosure of Interest: None Declared PW047 Echocardiography Underestimates Maximum Interventricular Septum Thickness in Hypertrophic Cardiomyopathy Shane Nanayakkara*1, Andrew Taylor1, Andris Ellims1 1 Cardiology, The Alfred, Melbourne, Australia Introduction: Echocardiography is routinely used in the evaluation of patients with hypertrophic cardiomyopathy (HCM) however assessment of left ventricular (LV) wall thickness using this modality may be inaccurate, particularly if image quality is reduced. Cardiac magnetic resonance (CMR) imaging, the gold-standard modality for LV morphologic analysis, is increasingly utilised in HCM. Objectives: To determine the accuracy of echocardiographic measures of ventricular wall thickness compared to CMR in HCM. Methods: Consecutive patients with a clinical diagnosis of HCM referred for CMR at the Alfred Hospital were included. Volumetric analysis of a short-axis cine stack (extending from the mitral annulus to the LV apex) was performed in all patients to determine maximum thicknesses of the interventricular septum and LV lateral wall. Measures of these walls from each patient’s most recent echocardiographic study were also obtained. Results: CMR was completed in 138 patients (51 14 years, 66% male). Maximum interventricular septum thickness was significantly greater using CMR compared to echocardiography (19.6 4.5 mm vs. 17.7 3.9 mm, p ¼ 0.001). Conversely, maximum LV lateral wall thickness was significantly less using CMR compared to echocardiography (8.8 2.2 mm vs. 11.1 3.4 mm, p < 0.001. Echocardiography correlated significantly with CMR for interventricular septum thickness (r ¼ 0.67, p < 0.001) and for lateral wall thickness (r ¼ 0.49, p < 0.001).
of LV hypertrophy in patients with HCM, CMR should be considered in all patients to improve diagnostic accuracy. Disclosure of Interest: None Declared PW048 Features of chronic heart failture at women Elena Klester*1 1 Department of hospital and outpatients therapeutics with occupational diseases and endocrinology courses, Altai State Medical University, Barnaul, Russian Federation Introduction: Gender component in an etiology of chronic heart failure lead to clinical features of a current of chronic heart failure at women that it is necessary to consider in development of individual treatment-and-prophylactic strategy. Objectives: Optimization of diagnostics, treatment, current prediction and prevention of CHF on the basis of complex estimation of clinic-functional features of cardiovascular system and the psychosomatic state of women. Methods: Clinic-statistical analysis of CHF was conducted during a year in therapeutics department. The diagnosis of CHF was established according to National recommendations of All-Russian scientific cardiologist society criteria on diagnostics and CHF treatment (the third revision, 2009) at 489 patients. There are 270 (55,2%) men, 219 (44,8%) women who includes in research on entry. Middle age is 65,213,4 [min 41, max 94] years, men 60,911,2; women - 67,610,4 (p<0,05). Results: The average value on risk scale of cardiovascular diseases was 3,61.11: in men’s group - 3,51,04; in women’s group - 3,81,12 (p<0.05). BWI was 27,6 [18,3 min, 39,1 max], men – 26,23,5; women – 28,74,8 (p¼0.000). Between age and BWI there is weak, but statistically significant correlation ([¼0.25. p¼0.001). More often etiological factor at men was IHD, generating 74,8% cases CHF. Thus at men with IHD at 149 (73,8%) patients CHF appeared after MI. AH frequency was 11,5%, dilated myocardiopathy (DMP) - 10,7%, other – 1,1%. The main reason of CHF at women were AH - 44,7%; IHD - 26,5%. Another reasons were diabetes mellitus (15,1%), valvular disease (7,8%), DMP (5,0%). Among hospitalized patients with CHF, the IV FC (NYHA) statistically significantly met at men (a mean grades of the clinical condition scale (CCS) – 5,81,14; at women – 4,21,07, p<0,05). In the analysis of gender distinctions of remodeling it is established that at women with CHF the diastolic dysfunction prevailed, mainly the I type LVDD, of ejection fraction (EF) LV on the average on group – 62,15,18%. Quality of life of the women is characterized by high level of anxiety in comparison with the men group. Conclusion: The most significant reason of formation of CHF at women is the AH, at men – IHD (often after MI). Women had the II FC on CCS on the average, men – the III FC. CHF is accompanied of depression and decreasing quality of life at women that is the basis for formation of gender distinctions in approaches to treatment correction at CHF. Disclosure of Interest: None Declared PW049 The enantiomers of the myocardial metabolic agent perhexiline display divergent effects on hepatic energy metabolism and peripheral neural function in rats Giovanni Licari*1, Benedetta C. Sallustio1, Andrew A. Somogyi1, Robert W. Milne2 1 Pharmacology, Adelaide University, 2Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia Introduction: Perhexiline, a chiral drug, is a potent anti-ischaemic agent whose clinical utility is limited by hepatic and neural toxicity. Perhexiline inhibits mitochondrial carnitine palmitoyltransferase-1, however, excessive inhibition is associated with tissue steatosis. Objectives: This study tested the hypothesis that the toxicity of perhexiline is enantioselective. Methods: Dark Agouti rats were administered vehicle or 200 mg/kg/day of racemic, (+)- or (-)-perhexiline orally for 8 weeks. Plasma liver function tests and von Frey assessments of peripheral neural function were performed. Hepatic and neuronal histology, including lipid and glycogen contents, were assessed using electron microscopy, and concentrations of the perhexiline enantiomers and metabolites were measured in plasma, liver and heart. Results: Racemic perhexiline did not affect hepatic lipid or glycogen content. However, (-)perhexiline induced a concentration-dependent increase in glycogen content, while (+)- perhexiline induced concentration-dependent increases in lipid and decreases in glycogen content. Racemic (p<0.001) and (+)-perhexiline (p<0.05) induced peripheral nerve dysfunction, while (-)-perhexiline induced no change. Mean (s.e.m.) plasma perhexiline concentrations in rats treated with racemate, (+)- or (-)-enantiomer were 0.84 (0.40), 0.67 (0.07) and 0.29 (0.04) mg/L, respectively, corresponding to the mid-upper clinical therapeutic range. Oral clearance was greater for (-)-compared to (+)-perhexiline. The distribution of (+)-perhexiline into liver and heart was greater when administered as pure enantiomer compared to racemate. Conclusion: Perhexiline’s enantiomers exert substantially different effects on hepatic lipid and glycogen accumulation, and on neuronal function. Our data suggest that the hepatoand neuro-toxicity of racemic perhexiline resides predominately in the (+)-enantiomer, consistent with inhibition of carnitine palmitoyltransferase-1, whilst (-)-perhexiline may offer greater potential long-term safety. Disclosure of Interest: None Declared PW051
Conclusion: In HCM, echocardiography underestimates maximum interventricular septum thickness and overestimates LV lateral wall thickness. Because accurate assessments of LV wall thickness are required both for risk stratification and monitoring of progression
e272
The effect of methoxy poiyethilenglicol -epoietin beta in patiens chronic heart failure with anemic syndrome Kamala Zahidova*1, Faig Guliyev1 1 Cardiology, Azerbaijan State Training, Baku, Azerbaijan
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters