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The CHA2DS2-VASc score and the risk of ischemic stroke in community-dwelling individuals with and without atrial fibrillation: The Atherosclerosis Risk In Communities (ARIC) study
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Methodology: Asymptomatic patients with type 2 diabetes were included in our study. We excluded patients with known CAD, previous revascularization, low ejection fraction or abnormal ECG from the study. All patients had undergone history taking and clinical examination, ECG, echocardiography with measuring of Tei index and Holter monitoring for detecting silent ischemia. Results: 200 patients were recruited. We divided our patients into two groups: Group I: 64 patients with SMI, Group II: 136 patients without SMI. There was no significant difference between the two groups regarding clinical and conventional echocardiographic data. Tei index was significantly higher in patients with silent ischemia (p < 0.00001). Sensitivity, specificity, positive, and negative predictive values of Tei index P0.6 in prediction of Holter detected silent ischemia were 85.9 %, 90 %, 78.6 %, and 88.6 % respectively. We found a significant positive correlation between Tei index and number of ischemic episodes (r = 0.366, p = 0.0029). Conclusion: Measuring Tei index is helpful in predicting the presence of silent ischemia in asymptomatic type 2 diabetic patients. http://dx.doi:10.1016/j.jsha.2017.06.010
SHA28 PROF. M. AL FAGIH RESEARCH AWARD FINALISTS
3
indicated nuclear myocardial perfusion imaging using PET between January and October 2016. The Canadian Study of Health and Ageing Clinical Frailty Scale was used to assess frailty. Patients were considered frail if they had a score of four or higher. Multivariate adjusted logistic regression model was used to determine the independent predictors of elderly frail patients. Results: In this cohort, the median age of the included patients was 61 years and the prevalence of the frailty was 40%. The frail patients were older, more frequently females and had a higher body mass index. Additionally, frailty was associated with higher prevalence of cardiovascular risk factors: hypertension, diabetes and dyslipidaemia (85%, 75%, and 46%, respectively). In fully adjusted logistic regression model, female gender, high body mass index (P30 kg/m2), hypertension and reduced coronary flow reserve were independent predictors of elderly frail patients. Conclusion: With the aging of the Saudi population, frailty prevalence is expected to increase. Elderly obese hypertensive females have the highest risk of developing frailty. Interventions to reduce frailty should be focused on this high-risk population. http://dx.doi:10.1016/j.jsha.2017.06.011
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Prevalence of the frailty among saudi patients referred for myocardial perfusion imaging: A cross sectional study
The cha2ds2-vasc score and the risk of ischemic stroke in community-dwelling individuals with and without atrial fibrillation: The atherosclerosis risk in communities (aric) study
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ABSTRACTS
J Saudi Heart Assoc 2017;xxx:xxx–xxx
Amjad M. Ahmed a, Mousa Alfaris a, Dalia a,b Ahmed , Abdelrahman Jamiel a,b, Amanda Holmes a, Misfer Aldosari a, Abdulbaset a,b Sulaiman , Ahmed Aljizeeri a,b, Ihab F. Sulaiman a,b, Sherif Sakr b,c, Mouaz H. AlMallah a,b,c a King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guard- Riyadh, Saudi Arabia ; b King Saud bin Abdulaziz University for Health Sciences- Riyadh, Saudi Arabia ; c King Abdullah International Medical Research CentreRiyadh, Saudi Arabia Abstract type: Clinical Research. Presentation type: Oral Presentation. Introduction: Frailty is a state of vulnerability and decreased physiological response to stressors. Saudi vision 2030 stated a goal to increase Saudi life expectancy by 5 years. As the population ages, the prevalence of frailty is expected to increase. Thus, identifying tools and resources that efficiently reduces frailty among elderly patients is important. We aim to describe the prevalence and predictors of frailty among Saudi patients referred for stress testing with nuclear imaging. Methodology: We included 876 patients (mean age 60.28 ± 11, females 48.29%) who underwent clinically
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M. Chadi Alraies a, Faye L. Norby c, Lin Y. Chen b a Heart and Vascular Institute, Georgetown University/ MedStar Washington Hospital Center, Washington D.C., USA ; b Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA ; c Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA Abstract type: Clinical Research. Presentation type: Oral Presentation. Introduction: Recent evidence from hospital-based cohorts suggests that the CHA2DS2-VASc score may be used to predict ischemic stroke in individuals without atrial fibrillation (AF). We aimed to evaluate the association of the CHA2DS2-VASc score for incident ischemic stroke, with and without AF, among communitydwelling individuals. Methodology: We included all participants from the Atherosclerosis Risk in Communities (ARIC) study who attended visit 4 (1996–98) and had no prior AF, stroke, and were not on warfarin. Incident AF was ascertained from study ECGs and hospital discharge diagnosis codes, and stroke was physician-adjudicated. AF cases were matched with non-AF controls based on CHA2DS2-
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JSHA 421
No. of Pages 4, Model
6 July 2017
4
ABSTRACTS
300 301 302 303 304 305 306 307 308 309 310 311 312
SHA28 PROF. M. AL FAGIH RESEARCH AWARD FINALISTS
VASc variables, and participants were censored if they began anticoagulants during the follow-up period. Time-to-event and competing risk analyses were used to calculate the incidence rates of ischemic stroke by CHA2DS2-VASc score, stratified by AF status. Results: This analysis included 4,039 participants (mean age, 74.6 ± 6.8 years; 50% women; 14% blacks) of whom 1,180 had incident AF. After a mean follow-up of 5.1 ± 4.2 years, 182 (4.5%) developed ischemic stroke. Higher CHA2DS2-VASc score was associated with higher incidence of ischemic stroke in participants with and without AF. In participants without AF, the absolute 1year risk remained low (0.6%) even in those with
J Saudi Heart Assoc 2017;xxx:xxx–xxx
CHA2DS2-VASc score of P6. In participants with AF, the absolute 1-year risk of ischemic stroke was 3.2% even in those with CHA2DS2-VASc score of 0–1). Conclusion: The risk of ischemic stroke is low across CHA2DS2-VASc score categories in community-dwelling individuals without AF. Individuals with AF are at high risk for ischemic stroke even with low CHA2DS2-VASc score, suggesting the need for stroke prevention in individuals with AF and one CHA2DS2-VASc stroke risk factor. http://dx.doi:10.1016/j.jsha.2017.06.012
313 314 315 316 317 318 319 320 321 322 323 325 324 326 327
No. of Pages 4, Model
6 July 2017
187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 212 211
Methodology: Asymptomatic patients with type 2 diabetes were included in our study. We excluded patients with known CAD, previous revascularization, low ejection fraction or abnormal ECG from the study. All patients had undergone history taking and clinical examination, ECG, echocardiography with measuring of Tei index and Holter monitoring for detecting silent ischemia. Results: 200 patients were recruited. We divided our patients into two groups: Group I: 64 patients with SMI, Group II: 136 patients without SMI. There was no significant difference between the two groups regarding clinical and conventional echocardiographic data. Tei index was significantly higher in patients with silent ischemia (p < 0.00001). Sensitivity, specificity, positive, and negative predictive values of Tei index P0.6 in prediction of Holter detected silent ischemia were 85.9 %, 90 %, 78.6 %, and 88.6 % respectively. We found a significant positive correlation between Tei index and number of ischemic episodes (r = 0.366, p = 0.0029). Conclusion: Measuring Tei index is helpful in predicting the presence of silent ischemia in asymptomatic type 2 diabetic patients. http://dx.doi:10.1016/j.jsha.2017.06.010
SHA28 PROF. M. AL FAGIH RESEARCH AWARD FINALISTS
3
indicated nuclear myocardial perfusion imaging using PET between January and October 2016. The Canadian Study of Health and Ageing Clinical Frailty Scale was used to assess frailty. Patients were considered frail if they had a score of four or higher. Multivariate adjusted logistic regression model was used to determine the independent predictors of elderly frail patients. Results: In this cohort, the median age of the included patients was 61 years and the prevalence of the frailty was 40%. The frail patients were older, more frequently females and had a higher body mass index. Additionally, frailty was associated with higher prevalence of cardiovascular risk factors: hypertension, diabetes and dyslipidaemia (85%, 75%, and 46%, respectively). In fully adjusted logistic regression model, female gender, high body mass index (P30 kg/m2), hypertension and reduced coronary flow reserve were independent predictors of elderly frail patients. Conclusion: With the aging of the Saudi population, frailty prevalence is expected to increase. Elderly obese hypertensive females have the highest risk of developing frailty. Interventions to reduce frailty should be focused on this high-risk population. http://dx.doi:10.1016/j.jsha.2017.06.011
215 216
Prevalence of the frailty among saudi patients referred for myocardial perfusion imaging: A cross sectional study
The cha2ds2-vasc score and the risk of ischemic stroke in community-dwelling individuals with and without atrial fibrillation: The atherosclerosis risk in communities (aric) study
217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242
243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265
266 268 267 269
213 214
ABSTRACTS
J Saudi Heart Assoc 2017;xxx:xxx–xxx
Amjad M. Ahmed a, Mousa Alfaris a, Dalia a,b Ahmed , Abdelrahman Jamiel a,b, Amanda Holmes a, Misfer Aldosari a, Abdulbaset a,b Sulaiman , Ahmed Aljizeeri a,b, Ihab F. Sulaiman a,b, Sherif Sakr b,c, Mouaz H. AlMallah a,b,c a King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guard- Riyadh, Saudi Arabia ; b King Saud bin Abdulaziz University for Health Sciences- Riyadh, Saudi Arabia ; c King Abdullah International Medical Research CentreRiyadh, Saudi Arabia Abstract type: Clinical Research. Presentation type: Oral Presentation. Introduction: Frailty is a state of vulnerability and decreased physiological response to stressors. Saudi vision 2030 stated a goal to increase Saudi life expectancy by 5 years. As the population ages, the prevalence of frailty is expected to increase. Thus, identifying tools and resources that efficiently reduces frailty among elderly patients is important. We aim to describe the prevalence and predictors of frailty among Saudi patients referred for stress testing with nuclear imaging. Methodology: We included 876 patients (mean age 60.28 ± 11, females 48.29%) who underwent clinically
270 271 272 273
274
M. Chadi Alraies a, Faye L. Norby c, Lin Y. Chen b a Heart and Vascular Institute, Georgetown University/ MedStar Washington Hospital Center, Washington D.C., USA ; b Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA ; c Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA Abstract type: Clinical Research. Presentation type: Oral Presentation. Introduction: Recent evidence from hospital-based cohorts suggests that the CHA2DS2-VASc score may be used to predict ischemic stroke in individuals without atrial fibrillation (AF). We aimed to evaluate the association of the CHA2DS2-VASc score for incident ischemic stroke, with and without AF, among communitydwelling individuals. Methodology: We included all participants from the Atherosclerosis Risk in Communities (ARIC) study who attended visit 4 (1996–98) and had no prior AF, stroke, and were not on warfarin. Incident AF was ascertained from study ECGs and hospital discharge diagnosis codes, and stroke was physician-adjudicated. AF cases were matched with non-AF controls based on CHA2DS2-
275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299
JSHA 421
No. of Pages 4, Model
6 July 2017
4
ABSTRACTS
300 301 302 303 304 305 306 307 308 309 310 311 312
SHA28 PROF. M. AL FAGIH RESEARCH AWARD FINALISTS
VASc variables, and participants were censored if they began anticoagulants during the follow-up period. Time-to-event and competing risk analyses were used to calculate the incidence rates of ischemic stroke by CHA2DS2-VASc score, stratified by AF status. Results: This analysis included 4,039 participants (mean age, 74.6 ± 6.8 years; 50% women; 14% blacks) of whom 1,180 had incident AF. After a mean follow-up of 5.1 ± 4.2 years, 182 (4.5%) developed ischemic stroke. Higher CHA2DS2-VASc score was associated with higher incidence of ischemic stroke in participants with and without AF. In participants without AF, the absolute 1year risk remained low (0.6%) even in those with
J Saudi Heart Assoc 2017;xxx:xxx–xxx
CHA2DS2-VASc score of P6. In participants with AF, the absolute 1-year risk of ischemic stroke was 3.2% even in those with CHA2DS2-VASc score of 0–1). Conclusion: The risk of ischemic stroke is low across CHA2DS2-VASc score categories in community-dwelling individuals without AF. Individuals with AF are at high risk for ischemic stroke even with low CHA2DS2-VASc score, suggesting the need for stroke prevention in individuals with AF and one CHA2DS2-VASc stroke risk factor. http://dx.doi:10.1016/j.jsha.2017.06.012
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