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Smoking and Body Mass Index are Risk Factors for Thromboembolism in Mitral Stenosis Independently of Left Atrial Spontaneous Echo Contrast
S72
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
179 Smoking and Body Mass Index are Risk Factors for Thromboembolism in Mitral Stenosis Independently of Left Atrial Spontaneous Echo Contrast
180 Electrocardiographic Left Ventricular ‘Strain’ Predicts Early Left Ventricular Dysfunction in Asymptomatic Aortic Stenosis
R. Peverill ∗ , J. Gelman, R. Harper, J. Smolich
R. Stewart 1,∗ , A. Kerr 2 , B. Cowan 3 , G. Whalley 1 , C. Occleshaw 1 , A. Young 3 , M. Richards 4 , C. Edwards 5 , D. Freidlander 6 , M. Williams 7 , H. White 1 ,
MonashHeart, Southern Health & Monash University, Clayton, Victoria, Australia
for ZEST investigators Left atrial spontaneous echo contrast (LASEC) reflects left atrial stasis and is the most important disease-related risk factor for thromboembolism (TE) in mitral stenosis (MS). However, not all patients with MS and LASEC develop TE, raising the possibility that there may be non MS-related factors which may also influence TE risk. We have investigated whether smoking, body mass index (BMI) and hypertension influenced TE risk in a cohort of patients with symptomatic MS who underwent transoesophageal echocardiography and cardiac catheterization. Methods: TE was defined as a current or past history of left atrial thrombus, non-haemorrhagic stroke or peripheral embolism. LASEC was rated on a validated scale from 0 to 4. Smoking was categorized based on smoking status at the time of the TE event. Hypertension categorization was based on history alone. Results: Of the 170 patients in the study group, 30 were men, 82 were in atrial fibrillation (AF) and 35 had TE. The mean age was 54 (range 22–80) years. On logistic regression analysis, LASEC, smoking and hypertension were significant predictors of TE (p < 0.05 for all) and BMI was a borderline significant predictor (p = 0.05). On multivariate analysis, LASEC, smoking and BMI were independent predictors of TE (p < 0.05 for all), whereas hypertension was borderline significant (p = 0.065). LASEC, smoking and BMI remained independent predictors of TE after adjusting for age, sex and cardiac rhythm (p < 0.05 for all) and even after excluding patients of age over 55 years with stroke of uncertain origin (p < 0.05 for all). Conclusion: Smoking and BMI contribute independently of LASEC to TE risk in MS. doi:10.1016/j.hlc.2007.06.184
1 Green
Lane Cardiovascular Service, Auckland, New Zealand; Hospital, Auckland, New Zealand; 3 Centre for Advanced Magnetic Resonance Imaging, University of Auckland, New Zealand; 4 Department of Medicine, Christchurch Hospital, New Zealand; 5 Cardiology Department, North Shore Hospital, Auckland, New Zealand; 6 Cardiology Department, Waikato Hospital, Waikato, New Zealand; 7 Cardiology Department, Hawke’s Bay Hospital, Hawke’s Bay, all in New Zealand, New Zealand 2 Middlemore
The aim of this study was to determine whether ECG LV ‘strain’ is associated with LV dysfunction as well as LV hypertrophy in asymptomatic patients (pts) with moderate to severe aortic stenosis. Methods: LV hypertrophy and function assessed by cardiac magnetic resonance imaging (CMR), echocardiography and N-terminal pro-B-type natriuretic peptide (N-BNP) were compared for 7 patients with and 57 without LV ‘strain’ defined as ≥1 mm ST depression and T wave inversion in leads V5/6. Results: Age (mean 67 ± SD10) and aortic valve area (0.9 ± 0.3 cm2 ) were similar for pts with and without LV ‘strain’. In pts with LV ‘strain’ LV mass index (131 ± 30 versus 100 ± 21 g/m2.7 , p = 0.009) and LV end systolic volume index (37 ± 11 versus 26 ± 10 mls/m2.7 , p = 0.02) were higher and ejection fraction was lower (57 ± 11 versus 66 ± 7.5%, p < 0.0001). Differences in systolic (5.7 ± 1.4 versus 7.1 ± 2.4 cm/s, p = 0.21), and diastolic (5.8 ± 2.8 versus 6.9 ± 2.2 cm/s, p = 0.26) peak mitral annular velocities were not statistically significant. The plasma level of N-BNP was ∼3 times higher in patients with LV strain (105 ± 44 versus 34 ± 26 pmol/l, p < 0.0001). Associations between LV strain and N-BNP (p < 0.0001) and ejection fraction (p = 0.03) remained after adjusting for LV mass, age and height2.7 . Conclusion: In asymptomatic pts with aortic stenosis ECG LV ‘strain’ predicts early LV dysfunction after adjusting for LV mass. doi:10.1016/j.hlc.2007.06.185
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
179 Smoking and Body Mass Index are Risk Factors for Thromboembolism in Mitral Stenosis Independently of Left Atrial Spontaneous Echo Contrast
180 Electrocardiographic Left Ventricular ‘Strain’ Predicts Early Left Ventricular Dysfunction in Asymptomatic Aortic Stenosis
R. Peverill ∗ , J. Gelman, R. Harper, J. Smolich
R. Stewart 1,∗ , A. Kerr 2 , B. Cowan 3 , G. Whalley 1 , C. Occleshaw 1 , A. Young 3 , M. Richards 4 , C. Edwards 5 , D. Freidlander 6 , M. Williams 7 , H. White 1 ,
MonashHeart, Southern Health & Monash University, Clayton, Victoria, Australia
for ZEST investigators Left atrial spontaneous echo contrast (LASEC) reflects left atrial stasis and is the most important disease-related risk factor for thromboembolism (TE) in mitral stenosis (MS). However, not all patients with MS and LASEC develop TE, raising the possibility that there may be non MS-related factors which may also influence TE risk. We have investigated whether smoking, body mass index (BMI) and hypertension influenced TE risk in a cohort of patients with symptomatic MS who underwent transoesophageal echocardiography and cardiac catheterization. Methods: TE was defined as a current or past history of left atrial thrombus, non-haemorrhagic stroke or peripheral embolism. LASEC was rated on a validated scale from 0 to 4. Smoking was categorized based on smoking status at the time of the TE event. Hypertension categorization was based on history alone. Results: Of the 170 patients in the study group, 30 were men, 82 were in atrial fibrillation (AF) and 35 had TE. The mean age was 54 (range 22–80) years. On logistic regression analysis, LASEC, smoking and hypertension were significant predictors of TE (p < 0.05 for all) and BMI was a borderline significant predictor (p = 0.05). On multivariate analysis, LASEC, smoking and BMI were independent predictors of TE (p < 0.05 for all), whereas hypertension was borderline significant (p = 0.065). LASEC, smoking and BMI remained independent predictors of TE after adjusting for age, sex and cardiac rhythm (p < 0.05 for all) and even after excluding patients of age over 55 years with stroke of uncertain origin (p < 0.05 for all). Conclusion: Smoking and BMI contribute independently of LASEC to TE risk in MS. doi:10.1016/j.hlc.2007.06.184
1 Green
Lane Cardiovascular Service, Auckland, New Zealand; Hospital, Auckland, New Zealand; 3 Centre for Advanced Magnetic Resonance Imaging, University of Auckland, New Zealand; 4 Department of Medicine, Christchurch Hospital, New Zealand; 5 Cardiology Department, North Shore Hospital, Auckland, New Zealand; 6 Cardiology Department, Waikato Hospital, Waikato, New Zealand; 7 Cardiology Department, Hawke’s Bay Hospital, Hawke’s Bay, all in New Zealand, New Zealand 2 Middlemore
The aim of this study was to determine whether ECG LV ‘strain’ is associated with LV dysfunction as well as LV hypertrophy in asymptomatic patients (pts) with moderate to severe aortic stenosis. Methods: LV hypertrophy and function assessed by cardiac magnetic resonance imaging (CMR), echocardiography and N-terminal pro-B-type natriuretic peptide (N-BNP) were compared for 7 patients with and 57 without LV ‘strain’ defined as ≥1 mm ST depression and T wave inversion in leads V5/6. Results: Age (mean 67 ± SD10) and aortic valve area (0.9 ± 0.3 cm2 ) were similar for pts with and without LV ‘strain’. In pts with LV ‘strain’ LV mass index (131 ± 30 versus 100 ± 21 g/m2.7 , p = 0.009) and LV end systolic volume index (37 ± 11 versus 26 ± 10 mls/m2.7 , p = 0.02) were higher and ejection fraction was lower (57 ± 11 versus 66 ± 7.5%, p < 0.0001). Differences in systolic (5.7 ± 1.4 versus 7.1 ± 2.4 cm/s, p = 0.21), and diastolic (5.8 ± 2.8 versus 6.9 ± 2.2 cm/s, p = 0.26) peak mitral annular velocities were not statistically significant. The plasma level of N-BNP was ∼3 times higher in patients with LV strain (105 ± 44 versus 34 ± 26 pmol/l, p < 0.0001). Associations between LV strain and N-BNP (p < 0.0001) and ejection fraction (p = 0.03) remained after adjusting for LV mass, age and height2.7 . Conclusion: In asymptomatic pts with aortic stenosis ECG LV ‘strain’ predicts early LV dysfunction after adjusting for LV mass. doi:10.1016/j.hlc.2007.06.185