P13
The CUORE Project Risk Observatory: the experience of blood donors
L Palmieri1, L De Matte'2, M Longo3, C Lo Noce1, F Dima1, C Donfrancesco1, S Giampaoli1
1
Istituto Superiore di Sanita, Rome, Italy, 2CINECA Consorzio Interuniversitario, Bologna, Italy, 3IRCCS Osp. Maggiore Policlinico Mangiagalli e Regina Elena, Milano, Italy
Topic: CVD surveillance
Purpose: Blood donation represents an opportunity for cardiovascular (CVD) risk assessment and healthy lifestyle counselling. As part of the CUORE Project, blood donor organizations were encouraged to assess CVD risk.
Methods: The cuore.exe software was the framework for data collection. The observatory of cardiovascular disease risk (OCR) aims to provide the National Institute of Health with a database to evaluate experience with risk assessment and risk factors, and to compare results at regional and national level in order to aid health policy makers in their decision process.
Results: By September 2009, 21,027 CVD risk assessments were performed in 12,420 blood donors; 6,358 blood donors were assessed twice in one year; 72% of the sample were men and 28% women; mean age was 45 years (men) and 46 years (women). Mean level of CR (average estimated percentage of persons who will experience a major CVD event in 10 years) was 1% for women and 3% for men; 67% of men and 95% of women were at lower risk (CR >3%); 0.3% of men were at very high risk (CR =20%). Among those with at least two risk assessments one year apart, 2% shifted to lower risk. Mean level of systolic blood pressure decreased by about 0.8 mmHg in men and 2.6 mmHg in women and diastolic blood pressure decreased by about 0.7 mmHg in men and 1.8 mmHg in women; total cholesterol by 7 mg/dl in men and 4 mg/dl in women, HDL-cholesterol increased by 0.6 mg/dl in men and 2.5 mg/dl in women; prevalence of smokers did not change.
Conclusions: Blood donors are not representative of the general population: they are a lower risk group due to younger age. Blood donation represents an opportunity to involve younger adults in CVD risk assessment and foster healthy lifestyles. The National Health System encourages use of blood donation to provide free examination of risk factors and CVD risk assessment, as an aid to CVD prevention. Routine application of CVD risk assessment for blood donors is strongly recommended.
P32
Clinical diagnosis versus genetic diagnosis in familial hypercholesterolaemia
M Bourbon1, AM Medeiros1, AC Alves1, V Francisco1, IM Gaspar2, Q Rato3, A Gaspar4, A Guerra5
1
Instituto Nacional de Saude Dr Ricardo Jorge, Lisbon, Portugal, 2Hospital Egas Moniz, Lisbon, Portugal, 3Hospital S Bernardo, CHS, Setubal, Portugal, 4Hospital Sta Maria, Lisboa, Portugal, 5Hospital S. Joao, Porto, Portugal
Topic: Early detection of asymptomatic disease the investigators of the Portuguese FH Study
Purpose: Familial hypercholesterolaemia (FH) is an inherited disorder of cholesterol metabolism. Due to the increased lipid accumulation in peripheral tissues these patients develop premature coronary heart disease (CHD) and atherosclerosis. Since FH is a silent disorder with severe manifestations later in life, early identification of affected individuals is very important, allowing counselling and early administration of adequate lipid lowering treatment that leads to an increase in life expectancy and quality. The Portuguese FH Study has been successfully established and already has genetically identified 368 individuals (154 index patients and 214 relatives). The main aims of this study are: 1) to determine if the clinical characterization is sufficient to identify these individuals at high risk of developing CHD and 2) to determine the clinical applicability of the genetic diagnosis for FH.
Methods: Clinical and molecular data, of FH patients and relatives, are register in a data base. The total cholesterol values of these patients with and without mutations in the LDLR, APOB and PCSK9 genes, were used to evaluate if the clinical characterization is enough to correctly identify FH patients. The molecular results obtained from the 457 index cases studied were used to determine if the genetic diagnosis is needed to correctly identify FH patients. The mean cholesterol values of patients with clinical diagnosis of FH, before and after treatment, was analysed to determine if FH patients were treated according to their condition. For statistical analysis SPSS version 12 was used.
Results and Conclusions: The analysis of individuals with and without mutations in the LDLR gene revealed that there are several values overlapped in these two groups making it difficult to identify FH patients based only in biochemical values. Only 50% of the patients with clinical criteria for FH had a mutation in one of the 3 genes associated with FH. Hypercholesterolemia, family history of hypercholesterolaemia and/or premature CHD are enough for the clinician to prescribe lipid lowering treatment but are not enough to establish the actual cause of FH or the severity of the phenotype. The genetic diagnosis is important to distinguish between patients with higher risk of developing premature CHD and allows the establishment of the appropriated therapeutic measures to decrease the increased cardiovascular risk of these patients. Also allows the early identification of relatives at risk that otherwise could be identified later in life, mostly likely after a CHD event had already occurred.
P33
Volunteer blood donation as an opportunity for early detection of asymptomatic cardiovascular disease risk
M H Sayers1, S Eason2
1
University of Texas, Southwestern Medical Center, Dallas, United States of America, 2Carter BloodCare, Bedford, United States of America
Topic: Early detection of asymptomatic disease
Purpose: Ostensibly healthy individuals are routinely tested serologically for infectious disease markers when their candidacy for blood donation is being decided. Bearing in mind that heart disease has reached epidemic proportions, we decided to find out if this donor screening opportunity could be supplemented with additional testing to identify individuals who might, unknowingly, be at risk for cardiovascular disease.
Methods: During 2008, adult volunteers who were acceptable as blood donors by virtue of their health history and serological results were also screened by total non-fasting cholesterol. A web site was designed which allowed individuals to retrieve their individual results. We analysed the results by age group and gender, with particular attention to donors between 16 and 19 years of age. A cholesterol result of 5.2 mmol/L or less was regarded as desirable (Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, NIH Publication 02–5215, 2002)
Results: Total non-fasting cholesterol determinations were made on 188,793 donors. 94,282 were female and 94,511 were male. These donors were between 16 and 70 years of age. Overall, 32.1% of the female and 30.6% of the male donors had total non-fasting cholesterol levels greater than 5.2mmol/L. Among teenage blood donors in the 16 to 19 age range, 9.0% of 17,582 females and 6.3% of 18,126 males had total non-fasting cholesterol levels greater than 5.2mmol/L. For females at all ages, the highest prevalence of cholesterol greater 5.2mmol/L was reached at 54.5% in the 60 to 64 year old group. For men, the highest prevalence, namely 43.9%, was seen in the 40 to 44 year old group.
Conclusions: The volunteer blood donor experience can be expanded to include random cholesterol testing performed routinely at each donation. In this approach, individuals, who regard themselves as healthy enough to donate blood, will be identified who are nonetheless potentially at greater risk of cardiovascular disease. The individuals who are identified include teenagers, for whom early detection of asymptomatic risk might be of particular value once successful notification, education and intervention strategies are developed.
P34
Speckle tracking and tissue doppler imaging for detection of preclinical cardiovascular involvement in Rheumatoid Arthritis
S Sitia1, L Tomasoni1, L Gianturco1, F Atzeni2, P Sarzi-Puttini2, M Turiel1
1
IRCCS Galeazzi Orthopedic Institute, Department of Health Technologies, Cardiology Unit, Milan, Italy, 2Luigi Sacco Hospital, Department of Rheumatology, Milan, Italy
Topic: Early detection of asymptomatic disease
Purpose: It is mandatory to recognize preclinical cardiovascular impairment in patients with rheumatoid arthritis (RA). The aim of our study was to assess if speckle tracking echocardiography (STE) could be more reliable than Tissue Doppler Imaging (TDI) to detect preclinical myocardial strain (e) impairment in RA patients.
Methods: We enrolled 18 RA patients (8 M, 10 F, aged 50 ± 11 yrs) with negative dypiridamole echostress by wall motion criteria and without clinical evidence of coronary artery disease (CAD) and 18 healthy controls matched for age and sex. LV end-systolic longitudinal and radial e were assessed by speckle tracking echocardiography from apical 4-chamber view, and LV end-systolic radial displacement was studied from short axis view. LV longitudinal function has been also assessed by TDI.
Results: LV end-systolic radial e by STE of basal-lateral, basal- and mid-septal, mid-lateral and apical segments in RA patients were reduced compared to controls (3.88 ± 1.83 vs 9.72 ±4.82, P < 0.001; 1.22 ± 1.01 vs 9.66 ± 7.81, P < 0.001; 6.47 ± 5.84 vs 15.19 ± 7.63, P < 0.001; 10.37 ± 7.40 vs 17.96 ± 11.69, P < 0.05; 5.48 ± 4.59 vs 12.0 ± 9.66, P < 0.05; respectively) as well as LV end-systolic longitudinal e of basal-lateral, basal- and mid-septal, mid-lateral and apical segments (–13.34 ± 5.25 vs –21.06 ± 9.50, P < 0.01; –8.52 ± 4.14 vs –12.13 ± 6.12, P < 0.05; –14.83 ± 4.88 vs –18.20 ± 4.83, P < 0.05; –10.08 ± 4.26 vs –12.67 ± 3.06, P < 0.05; –17.63 ± 5.05 vs –20.92 ± 3.82, P < 0.05; respectively). At the same time, also radial displacement of anterior, anterior-lateral, anterior-septal and inferior-lateral segments were impaired in RA patients in comparison to healthy controls (0.48 ± 0.14 vs 0.76 ± 0.19, P < 0.001; 0.51 ± 0.13 vs 0.85 ± 0.28, P < 0.001; 0.32 ± 0.16 vs 0.54 ± 0.32, P < 0.05; 0.52 ± 0.23 vs 0.73 ± 0.32, P < 0.05; respectively). In RA patients, we also observed a significant reduction of S, E and E/A ratio obtained from the basal septum and lateral mitral annulus in comparison with controls. A values from lateral annulus and E/E ratio from basal septum and lateral annulus were increased.
Conclusions: Our data indicate that STE is a more reliable tool than TDI to detect subclinical cardiac involvement in RA patients, because it allow to investigate both longitudinal and radial myocardial function. On the contrary, TDI could be only used to assessed longitudinal LV function. Non invasive evaluation of LV function by STE appears to be useful to detect subclinical cardiac involvement representing a promising new modality to follow-up RA patients.
P35
C-reactive protein, metabolic syndrome and subclinical carotid atherosclerosis in apparently healthy men
A Jovelic1, N Cemerlic1, K Pavlovic1, P Mesaros1, M Maletin1, S Bugarski1, T Popov1, M Kovacevic
1
Clinic of Cardiology, Institute of Cardiovascular diseases, Vojvodina Sremska Kamenica, Serbia
Topic: Early detection of asymptomatic disease
Background: Atherosclerosis and metabolic syndrome (MS) are inflammatory diseases. The relationships between MS, C-reactive protein (CRP) and subclinical atherosclerosis are not fully elucidated.
Aim: To assess the cross-sectional relationship between CRP, traditional and metabolic risk factors with common carotid artery intima-media thickness (CCAIMT) in healthy men.
Methods: We studied 161 men (age 38+/–6 years) free of cardiovascular disease and diabetes. MS was defined according to International Diabetes Federation. Plasma high sensitive CRP was measured by immunonephelometry. CCAIMT was measured by ultrasonography.
Results: The mean CRP concentrations in subjects grouped according to the absence, and presence of 3, 4, and 5 features of the MS were 1.11, 1.89, 1.72 and 2.22 mg/L, respectively (p=0.023), with significant difference between those with and without MS (p=0.01). In multiple regression analysis waist circumference (β=0.411, p=0.000) and triglycerides to high density lipoprotein cholesterol ratio (β=0.774, p=0.000) were independent predictors of C-reactive protein. 66.5% subjects had CCAIMT >0.9mm (p>0.01). The means of CCAIMT in subjects grouped according to the absence and presence of 3, 4, and 5 features of the MS were 0.98, 1.05, 1.14, and 1.18 mm, respectively, (p>0.001), with a statistically significant differences between those with and without MS. The mean C-reactive protein plasma concentrations in subjects with CCAIMT >0.9mm was 1.94+/–2.1mg/L and 1.04+/–1.14mg/L in those with CCAIMT =0.9mm, respectively (p=0.004). In a simple regression analyses age adjusted CRP was associated with common carotid artery intima-media thickness (β=0,285, p>0.01), and only high density lipoprotein cholesterol was not associated with common carotid artery intima-media thickness. Controlling for glucose, triglycerides to high density lipoprotein cholesterol ratio, and total cholesterol to high density lipoprotein cholesterol ratio resulted in some reduction in the strength of the association between CRP and CCAIMT, but including waist circumference in the regression made the relationship no longer significant (p=0.119). Body mass index (β=0.352; p>0.01), total cholesterol to high density lipoprotein cholesterol ratio (β=0.334; p>0.01) and age (β=0.190; p=0.036) were the independent predictors of common carotid artery intima-media thickness.
Conclusions: In studied group of healthy men C-reactive protein per se was not an independent predictor of early arteriosclerosis, and may mediate the effect of certain metabolic risk factors on promoting atherosclerosis.
P36
Patients with metabolic syndrome who have normal coronary anatomy and myocardial perfusion abnormalities have higher C-reactive protein levels compared to those with normal myocardial perfusion
Y Cavusoglu, A Parspour, E Entok, A Birdane, I Uslu, C Demirustu, B Gorenek, N Ata
Eskisehir Osmangazi University, Eskisehir, Turkey
Topic: Early detection of asymptomatic disease
Purpose: Chronic inflammation, represented by C-reactive protein (CRP), predicts the presence of endothelial dysfunction and is associated with certain components of the metabolic syndrome (MS). Also insulin resistant state in MS plays an important role in the pathogenesis of endothelial dysfunction. Myocardial perfusiondefects on SPECT scan in the presence of normal coronary anatomy are referred to be a sing of myocardial microcirculatory dysfunction. The aim of this study was to evaluate CRP levels in MS patients with normal epicardial coronary anatomy and myocardial perfusion abnormalities.
Methods: The study consisted of 143 patients with MS. MS was defined by NCEP ATP III criteria. All patients underwent exercise stress Tc-99m sestamibi SPECT and patients who have myocardial perfusion defects underwent coronary angiography. Patients with coronary artery disease were excluded from the study. Blood samples were obtained at study entry for the assessment of CRP levels.
Results: In the study population 55 patients had myocardial perfusion defects and 88 patients showed no perfusion abnormality on sestamibi SPECT. There were no significant difference between patients with perfusion defects and those with no perfusion abnormality in terms of waist circumference, total cholesterol, triglyceride, HDL-C, LDL-C and fasting glucose levels. CRP levels were found to be significantly higher in patients with perfusion defects compared to those with normal myocardial perfusion (Table).
Conclusion: This study suggests that patients with MS who have normal epicardial coronary anatomy and myocardial perfusion abnormalities, possibly due to microvascular dysfunction, have higher CRP levels, which may indicate the role of inflammatory process in the pathogenesis of endothelial dysfunction in patients with MS.
P37
Contribution to early diagnosis of Marfan syndrome in children
A Jurko, A Jurko, N Misovicova
Jessenius Medical Faculty, Martin, Slovak Republic
Topic: Early detection of asymptomatic disease
The aim of study: To examine evolution of the physical and echocardiographic characteristics of Marfançs syndrome throughout childhood.
Methods: The authors have studied 15 cases suffering from Marfançs syndrome in childhood. They described the main features of the disease and point out the difficulty of accurate diagnosis in children with minor involvement. Musculoskeletal features predominated and evolved throughout childhood. Evolution of the clinical characteristics was determined by repeat evaluation in all children with Marfan syndrome. DNA marker studies was used to facilitate diagnose in one case with the familial condition. All children with Marfançs syndrome were investigated by echocardiography and results were compared with control groups.
Results: Cardiac abnormalities were present in all children with Marfançs syndrome. Mitral regurgitation and mitral valve prolapse occureed in all 15 children. Serial echocardiographic aortic root measurement in all 15 children with Marfanç s syndrome were available for evaluation of aortic root growth. Based on individual growth of the aortic root a discrimination was looking to distinquish Marfançs patients from control subjects. Patients who have the Marfan syndrome should have serial echocardiograms to measure. In children with Marfan syndrome, aortic root diameter, sinuses of Valsalva and subsequent levels differs significantly from subjects in control groupp (p =0,01, p = 0.001 and p= 0.05). The following ascending aortic elastic parameters showed statistically significant differences between the Marfan group and the control group. Parameters of aortic distensibility and stiffness index were statistic significantly lower in children with Marfançs syndrome. Parameters of left venticle have been not different from parameters of a healthy children.
Conclusions: These observations may aid the clinical diagnosis of Marfançs syndrome in childhood, especially in those with the sporadic condition. Gene cracking has a role in the early diagnosis of familial Marfançs syndrome, allowing appropriate follow up and preventive care.
P38
Predictors of carotid intima-media thinkness in adolescents
E Silva, L Chacin, JJ Villasmil, G Bermudez, A Gonzalez, M Bracho, C Esis
Instituto RegionalDe Investigacion YEstudios De Enfermedades Cardiovasculares, Universidad Del Zul, Maracaibo, Venezuela
Topic: Early detection of asymptomatic disease
Purpose: To investigate the predictors of carotid intima-media thickness (c-IMT) in adolescents.
Methods: Participants were 163 adolescents, aged 12 to 18 years, of Maracaibo city, Venezuela, 71 males and 92 females. Anthropometric (weight, height and waist circumference), demographic (age, gender) and clinical data [systolic and diastolic blood pressure (BP)] were collected in all adolescents. Body mass index (BMI) was calculated. Serum glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were determined. Intima-media thickness was measured at carotid common artery near the bifurcation at far wall by B-mode ultrasound. Statistical analysis: Partial correlation coefficient (R) was used to estimate the association between c-IMT and the independent variables (weight, waist circumference, BMI, serum glucose, total cholesterol, LDL-cholesterol, HDL-Cholesterol, triglycerides, systolic and diastolic BP). Gender, age and height were utilized as controlling variables. The stepwise regression procedure was applied to build predictive models whit the different predictive factors.
Results: The mean and the standard deviation of the c-IMT were 0.438 ± 0.7 mm in all adolescents; 0.463 ± 0.06 for males and 0.419±0.07 for females (p>0.0001). The partial correlation, controlling by gender, age and height, showed significant association between c-IMT with triglycerides (R=0.34; p>0.0001), systolic BP (R=0.18; p>0.03), LDL-cholesterol (R= –0.17; p>0.03) and waist circumference (R=0.16; p>0.04). These factors were included in the stepwise regression analysis using the c-IMT as dependent variable, and the predictor factors founded by this procedure were triglycerides, systolic BP and LDL-cholesterol. The estimated model to predict c-IMT was: Yi = 0.299 + 0.00038 [Triglycerides] + 0.002 [Systolic BP] 0.001 [LDL-cholesterol], R2 = 0.20.
Conclusions: In the adolescence, it is possible to predict the c-IMT. The triglycerides levels and systolic BP values are positively associated with the c-IMT, being the triglycerides the most important predictive factor. These findings suggest that it is necessary to control these factors during the adolescence to decrease the possibility of the atherosclerosis progression.
P39
Anklebrachial index in type 2 diabetes patients and cardiovascular risk
B Nussbaumerova, H Rosolova, J Simon
Charles University Prague, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
Topic: Early detection of asymptomatic disease
Purpose: The ankle brachial index (ABI) i.e. the ratio of systolic blood pressure (SBP) measured on the ankle and on the arm is considered the diagnostic parameter for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. We measured ABI in patients with type 2 diabetes (DM2) and evaluated its impact on CV risk.
Method: A sample of 253 DM2 (135 males, 118 females, aged 66±9y) was examined. The supine ankle SBP was measured by a Doppler ultrasonography sond after 5 minutes rest, with 2 mmHg accuracy, SBP on the identical arm the same way and accuracy by a mercury sphygmomanometer. The ABI=0,9 suggests arterial occlusion, ABI =1,2 is nondiagnostic and suggestsmediocalcinosis. The CV risk was evaluated according to up-to-date guidelines; as the high risk patients were considered the patients with manifested CV disease (information from the patients’ documentation), with elevated coronary calcium score (CAC) evaluated by Agatston's score (101–400 high risk, =401 very high risk) or according to the global CV Risk Score = 5%. Statistical Method Wilcoxon's unpaired test, X2 test, Spearman's correlation, multiple logistic regression.
Results: The ABI=0,9 was found unilateral in 20 DM2 (8%), bilateral in 27 (11%), thusABI was decreased in 47 (19%) DM2. Other 168 DM2 (66%) showed normal ABI and 38 (15%) nondiagnostic ABI. There was no significant difference in the characteristics of DM2 with normal and nondiagnostic ABI. The DM2 with ABI=0,9 compared to the restwere older males with elevated total cholesterol (chol), total homocystein (Hcy) and CAC and with the history of CV diseases. Many CV and metabolic risk factors correlated significantly positively with ABI=0,9: age, glycaemia, Hcy, CAC (p>0,05) and LDL-chol (p>0,01), by contrast SBP correlated negatively (p>0,01). The ABI=0,9 was significantly and independently associated with age (p>0,001), smoking (p>0,01), LDL-chol, Hcy and CAC (p>0,05). Decreased ABI was a strong significant predictor of ischemic stroke and symptomatic carotid stenosis for the next 3 years (p>0,001). The ABI=0,9 correlated significantly neither with ultrasensitive C-reactive protein nor with presence of metabolic syndrome in DM2.
Conclusion: Decreased ABI =0,9 was found in 19% of DM2 patients. It was in a significant and independent association with age, smoking, LDL-chol, Hcy and CAC. We evaluated ABI =0,9 as a strong predictor of ischemic stroke and symptomatic carotid artery stenosis. That is why these patients need a complex intensive intervention. Nondiagnostic ABI was found in 15% of the sample; a high prevalence of mediocalcinosis in DM2is suspected.
P40
Early detection of left ventricular diastolic dysfunction with the use of tissue doppler imaging echocardiography in patients with diabetes mellitus type1
K Yiangou1, CH Azina2, TH Christodoulides1, M Ioannides1, M Pikolos3, I Markou2, E Nicolaides1
1
Nicosia General Hospital, Department of Cardiology, Nicosia, Cyprus, 2Nicosia General Hospital, Department of Internal Medicine, Diabetes Clinic, Nicosia, Cyprus, 3Diabetes Clinic, Private Sector, Nicosia, Cyprus
Topic: Early detection of asymptomatic disease
Purpose: Diabetes Mellitus type 1 (DM1) as a classic risk factor for coronary artery disease (CAD), may be linked with the development of Left Ventricle Diastolic Dysfunction (DD) before the presence of symptoms or signs of cardiac disease.
Tissue Doppler Imaging (TDI) is a relatively modern echocardiographic technique with established contribution to the detection of DD. Our aim was to detect early DD in asymptomatic patients with DM1 with the aid of TDI indices.
Method: A group of DM 1 patients and a group of healthy individuals underwent a complete conventional echocardiographic study, as well as the application of TDI indices at the level of lateral mitral annulus and posterior interventricular septum at the four-chamber apical view. The early (E) and late (A) waves of transmitral flow were measured, as well as the ratio E/A, the early (E) and late (A) waves of TDI, the ratios E/A and E/E. All individuals did not have any other risk factors for CAD nor microalbuminurea.
Results: 44 persons were divided into two groups of 22. Group A contained asymptomatic patients with DM1 and group B was the control group. The two groups were age and gender matched and the aforementioned measurements were compared among the groups. A statistically significant difference in ratio E/E between the two groups was observed (group A 7,87 +/– 2,78 group B 5,29 +/– 0,92 p=0.02) as well as a statistically significant difference in the absolute value of E (group A 12,1 +/– 2,63 cm/sec group B 14,3 +/– 3,78 cm/sec). 7 patients (32%) from from the DM1 group had E/E’ value grater than 8, in contrast with none (0%) from the healthy individuals grooup. For the conventional indices, a non statistically significant reduction in wave E value in group A was observed.
Conclusion: Asymptomatic patients with DM1 have early indices of DD which can reliably be detected with the use of TDI echocardiography. This finding can stratify these patients in low/high risk groups for early target organ damage. The modification of their medical therapy which consists of more premature and more offensive intervention may improve their long term prognosis.
P41
Can we detect early signs of cardiotoxicity in patients undergoing chemotherapy?
M Giuditta1, L Zingale1, V Filippazzi2, A Gambaro2, E Piazza2, L Dalla Vecchia1
1
Salvatore Maugeri Foundation, IRCCS - Center of Milan, Milan, Italy, 2Luigi Sacco Hospital, Milan, Italy
Topic: Early detection of asymptomatic disease
Background: In clinical practice cardiotoxicity due to chemotherapy is a well known problem. Brain Natriuretic Peptide (BNP) is commonly used to help in diagnosis and treatment of patients with congestive heart failure; recently BNP or its fragment NT-pro-BNP has been proposed as an index of myocardial damage in patients undergoing chemotherapy.
Aim of our study is to test whether an increase in NT-pro-BNP is accompanied by modifications of cardiac function.
Methods: We studied 29 patients (14M, 15F, age 59±3 years) undergoing chemotherapy for cancer. NT-pro-BNP fragment (ElettroChemiLuminescenceImmunoAssay-ECLIA) was quantified before (B), at a middle time (M) and at the end of the treatment (E). A complete echocardiographic and color Doppler evaluation was performed at time B and E. The following parameters of systolic and diastolic function were considered: left ventricular ejection fraction (EF), transmitral PW deceleration time (DT), isovolumetric relaxation time (IVRT), tissue Doppler velocity at the lateral mitral annulus (E').
Results: Echocardiographic parameters (mean±SD) of systolic function were not significantly different at time B and E (EF 57±11 vs 54±9 %; p=0.1), while the indeces of diastolic function changed as follows: DT from 176±46 to 140±43 ms (p=0.003); IVRT from 90±10 to 82±13 ms (p=0.000); E’ from 7.9±3.3 to 7.2±3.7 cm/s (p=0.1); E/E’ from 9.7±3.1 to 10.5±3.9 (p=0.1). NT-proBNP (pg/ml) was considered normal if >88 and >277 for M, age < or >50 years respectively, and if >153 and >334 for F, age < o >50 years respectively. Coehn coefficient of agreement between NT-proBNP at time M and diastolic indeces at time E is shown in table.
Conclusions: NT-proBNP can be considered an index of early diastolic dysfunction in patients undergoing chemotherapy, therefore it can be used as a simple test to identify patients with increased risk for cardiotoxic complications.
P42
Microalbuminuria and subclinical atherosclerosis in diabetic patients
E E Babes, VV Babes, M Rus, MI Popescu, A Ardelean
Faculty of Medicine, Oradea, Romania
Topic: Early detection of asymptomatic disease
Background: In diabetic subjects microalbuminuria (MA) is associated with an increased cardiovascular risk, independent of known risk determinants. It has been suggested that in type 2 diabetic populations MA is an early indicator of atherosclerosis but how exactly MA is linked to cardiovascular risk is unclear. The association between MA and cardiovascular disease is probably explained by a common pathophysiologic process such as endothelial dysfunction (ED).
The aim of the study was to investigate the relationship between MA and two indicators of subclinical atherosclerosis: ED an early event of atherosclerosis evaluated non-invasively by determining brachial flow mediated dilation (FMD) and carotid intim-media thickening (CIMT) a marker of structural atherosclerosis.
Methods: Study was performed on 118 patients with type 2 diabetes mellitus (DM)(mean age 57,11y ±5,2; 57 men) and no history or symptoms of atherosclerotic disease. The following parameters were recorded: age, sex, duration and treatment of diabetes, smoking status, body mass index, blood pressure (BP) measurement and ambulatory BP monitoring, blood testing for: glycated Hb, creatinine, lipids and MA testing. Were excluded patients with macroalbuminuria or target organ damage. CIMT and FMD were determined in all patients.
Results: MA was present in 40 patients (33,9%). According to the presence of MA subjects were divided into two groups. There were no significant differences between groups regarding: sex, age, BMI, diabetes treatment, smoking habit, use of statins or ACE inhibitors.
Patients with MA had higher prevalence of hypertension (p>0.0001); higher systolic BP (p>0,001); higher triglyceride levels (p>0,01); a longer duration of diabetes (p=0,03) and higher glycated Hb levels (p=0,02). CIMT was significantly greater in patients with MA –0,895 ±0,02 mm vs. 0,86 ±0,01mm,(p>0,0001). FMD was significantly lower in patients with MA –3,26 ±1,0% vs. 4,24 ± 1,3%, (p=0,0001). In multiple regression analysis after adjustment for confounding factors the only independent predictor for CIMT was MA (r=0,78, p>0,0001) and for FMD independent predictors remained glycated Hb (r= − 0,54, p=0,04) and MA (r= − 0,52, p=0,014).
Conclusions: MA is strongly related to subclinical atherosclerosis assessed as IMT in type 2 DM patients. In type 2 DM patients MA is also strongly correlated with ED, which may lead to the initiation and the progression of atherosclerosis. MA is useful in improving cardiovascular risk stratification. In type 2 DM patients with MA specific interventions to improve ED may be of benefit.
P43
Isovolumic myocardial acceleration, new index of right ventricular function after percutaneous mitral valvuloplasty
E A Enas AliKhalifa1
1
Dar Al-Fouad Hospital, Giza, Egypt
Topic: Early detection of asymptomatic disease
Objectives: In mitral stenosis, Right ventricular (RV) function may be affected either by rheumatic process or due to pulmonary vascular alterations. The aim of this study was to determin if isovolumic myocardial acceleration (IVA) measured by tissue Doppler imaging (DTI) of tricuspid annulus could be used in detection of RV function immediately after percutaneous mitral valvuloplasty (PMV).
Patients and methods: The current study enrolled 80 patients with chronic rheumatic mitral stenosis in sinus rhythm. Conventional echocardiographic parameters, mitral valve area (MVA), transmitral diastolic gradient, pulmonary artery pressure (PAP), RV fractional shortening (RVFS%), tricuspid annular plane systolic excursion (TAPSE). TDI-derived systolic velocities of tricuspid annulus, isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sm) and RV Tei index were calculated to all patients be for and after (one day) PMV.
Results: TAPSE, RVFS% and Sm were relatively higher following PMV but did not attain statistical significance. TDI-derived IVA, IVV index were found to be significantly increased after PMV from 1.71+0.54 m/s2 to 3.27+0.22 m/s2, and from 0.11+0.04 cm/s to 0.14+0.06 cm/s respectivly with (P >0.001) for all. RV Tei index significantlly deceased from 0.49+0.025 to 0.31+0.21 (P < 0.01). Significant negative correlation could be established between IVA and PAP (before and after PMV) (r = –0.61, r= –0.58 respectively), Tei index (r = –0.72) and mean transmitral diastolic gradient (r = –0.74), whereas significant positive correlation was established between IVA and MVA (r = 0.68) with p>0.0001 for all correlations.
Conclusion: TDI- derived IVA can be used as reliable, non invasive parameter to detect early improvement of RV function following PMV.
P44
Improvement of endothelial function and coronary flow reserve after kindey transplantation
S Sitia1, L Tomasoni1, L Gianturco1, V De Gennaro Colonna2, M Turiel1
1
IRCCS Galeazzi Orthopedic Institute, Department of Health Technologies, Cardiology Unit, Milan, Italy, 2University of Milan, Department of Pharmacology, Milan, Italy
Topic: Early detection of asymptomatic disease
Purpose: The diagnosis of subclinical cardiovascular involvement is important for adequate long-term management of young renal transplant recipients (RTR). Chronic kidney disease is a well recognized cardiovascular risk factor. End-stage renal disease and dialysis are associated with chronic inflammation and endothelial dysfunction which promote enhanced atherosclerosis. Renal transplantation partially improves renal function but, on the other hand, immunosuppressive therapy represents an additional cardiovascular risk factor. The aim of this study is to investigate endothelial function and coronary microcirculation in young RTR.
Methods: 15 RTR (7 M and 8 F; mean age 25±5 yrs) in absence of clinical history and any sign or symptoms of cardiac disease underwent high dose dypiridamole echostress with coronary flow reserve (CFR) evaluation and determination of plasma asymmetric dymethilarginine (ADMA) levels at baseline and after 18 months of follow up.
Results: At the end of follow up, we observed improvement of CFR (2.72±0.42 vs 3.18±0.62; P< 0.01) and decreased plasma ADMA levels (3.76±1.3 vs 0.7±0.14; P< 0.001) compared to baseline. Moreover, plasma ADMA levels negatively correlate with CFR (P>0.05; r=–0.51).
Conclusions: Our data demonstrated that endothelial function improved after renal transplantation and positively influences coronary microcirculation. This suggests that drugs positively affecting endothelial function could preserve coronary function in RTR.
P45
Psoriatic arthritis coul be considered an independent cardiovascular risk factor?
S Sitia1, L Tomasoni1, L Gianturco1, V De Gennaro Colonna2, F Atzeni3, P Sarzi-Puttini3, M Turiel1
1
IRCCS Galeazzi Orthopedic Institute, Department of Health Technologies, Cardiology Unit, Milan, Italy, 2University of Milan, Department of Pharmacology, Milan, Italy, 3Luigi Sacco Hospital, Department of Rheumatology, Milan, Italy
Topic: Early detection of asymptomatic disease
Purpose: Psoriatic arthritis (PsA) is defined as an inflammatory arthritis associated with psoriasis. Increased common carotid intima-media thickness (IMT) has been previously demonstrated in PsA as a marker of subclinical atherosclerosis. Moreover, PsA duration has been found positively association with the development of enhanced atherosclerosis. However, few information about cardiovascular (CV) involvement in PsA are known. The aim of this study was to investigate coronary microcirculation and endothelial function in PsA at the onset of the disease.
Methods: Sixteen patients with new diagnosis of PsA without clinical evidence of coronary artery diseases and 20 healthy controls underwent high dose dipyridamole echostress with coronary flow reserve (CFR) evaluation, plasma asymmetric dymethilarginine (ADMA) levels determination by high performance liquid chromatography (HPLC) and ultrasound evaluation of common carotid IMT.
Results: Despite normal standard echocardiographic examinations, PsA patients had reduced CFR (2.86±0.65 vs 3.5±0.8; P>0.001) and increased plasma ADMA levels (0.70±0.08 vs 0.52±0.2; P>0.001) compared to healthy controls. We found a negative correlation between CFR and plasma ADMA levels (P>0.03; r=–0.81: r2=0.65). Common carotid IMT did not differ between the 2 groups.
Conclusion: PsA is early associated with preclinical endothelial dysfunction and impaired coronary microcirculation despite normal common carotid IMT in absence of signs and symptoms of CV involvement and traditional CV risk factors. Can we consider PsA as an independent CV risk factor?
P46
Predictors for the paroxysmal atrial fibrillation after the cardiac surgery in the short-term observation
A Wilczek-Banc1, T Roleder2, K Widenka3
1
Medical Univesity of Rzeszœw, Rzeszow, Poland, 2Slaski Uniwersytet Medyczny w Katowicach, Katowice, Poland, 3The Cardiac Surgery Unit, Rzeszow, Poland
Topic: Early detection of asymptomatic disease
Background: The paroxysmal atrial fibrillation (PAF) arises frequently between 48th and 96th hour after the surgery. The aim of the study was to asses predictors of the PAF after the cardiac surgery.
Methods: The study group consisted of 95 patients (62 female) after the cardiac surgery: the coronary artery bypass grafting (64%), the mitral valve repair (MVR; 8%) or replacement (2%) and the aortic valve replacement (AVR; 39%). Patients were observed in the first 35 days after the surgery. 47 patients of the study group had an episode of PAF after the surgery, but only one of them suffered for PAF before. There were analyzed the following parameters as potential PAF risk factors: age, sex, BMI, a presence or an absence of the diabetes, a type of the surgery, a presence of the arterial hypertension, sodium, potassium, hemoglobin and creatinine level in the blood. The echocardiography were performed to obtain the end diastolic-, systolic volume index, the ejection fraction and to diagnose the pericardial effusion (PE) or the hydrothorax. The diagnosed acute bronchitis or the pneumonia and the infection of surgical wounds were also taken into account. Uni- and multivariable Cox regression analysis were performed.
Conclusion: Predictors of PAF during the post cardiac surgery period were MVR or AVR, PE and the absence of the diabetes.
HR-Hazard Ratio, CI- Confidential Intervals.
P47
Fetal echocardiographic diagnosis of rhabdomyoma
A Jurko, M Holan
Jessenius Medical Faculty, Martin, Slovak Republic
Topic: Early detection of asymptomatic disease
Summary Background: Cardiac rhabdomyoma is the most common primary heart tumors in infants. Spontaneous regression of such tumor is common, particularly with smaller lesions, followed by resolution of symptoms. Although the rhabdomyoma is histologically benign, it can be life- threating secondary to mass obstruction.
Objective: The aim of this study is to facilitate basic orientations when abnormal echoes during fetal echocardiography are detected.
Methods: The diagnosis of rhabdomyoma was made by two-dimensional echocardiography and tuberous sclerosis by magnetic resonance imaging.
Results: Over 5 years period 3 children with rhabdomyomas were diagnose at department of pediatric cardiology in Martin. In two cases tumor was diagnosed in fetus by ultrasound investigations and in third case after birth by ultrasound investigation of the heart. The localization of tumors were in the left ventricle especially interventricular septum. In two cases rhabdomyoma was associated with tuberous sclerosis. The diagnosis of concomitant tuberous sclerosis in one child was confirmed after seizure. In one case was confirmed association rhabdomyoma tuberous sclerosis and Wolff-Parkinson-White syndrome. In one case we confirmed moderate hemodynamic gradient across the right ventricular outflow tract, the mean gradient was 38 mmHg. The gradient was established primarily by echocardiography. Follow-up cross-sectional echocardiography in our cases showed that almost all intracardiac tumors showed spontaneous regression.
Conclusion: The diagnosis of rhabdomyoma is made by two-dimensional echocardiography and magnetic resonance imaging. Echocardiography should be systematic in all children with rhabdomyoma and tuberous sclerosis and is also recommended for members of their families, even those apparently unaffected, in order not to miss paucisymptomatic forms of tuberous sclerosis. The approach for prenatal diagnosis of fetal rhabdomyoma should be based on free set of ultrasound signs: general signs, organ-specific signs and tumor specific signs. Histologic proof of the diagnosis of rhabdomyoma is not necesssary in the presence of characteristic echocardiographic findings. Once a fetal tumor has been detected, close surveillance by a multidisciplinary team of doctors was mandatory, with anticipation and early recognition of problems during pregnancy, labor and immediate postnatal life. Clinical observation is still the mainstay of management because the natural history of these tumor is one of gradual resolution.
P48
Profile of young athletes: a Brazilian experience in adolescents sports medicine clinic
S Vertematti, MSS Vittale, AC Sato, ME Poli, GLM Ferrari, FF Naves
Federal University of Sao Paulo, Sao Paulo, Brazil
Topic: Early detection of asymptomatic disease
Purpose: The goal of a Sports Medicine Ambulatory in assisting adolescents involved in sports program is to identify health problems and inadequate development as consequence of an inadequate sport practice. Therefore the purpose of this work is to analyze the profile of young athletes assisted in a sports medicine ambulatory for adolescents.
Methods: This retrospective study reviewed 48 medical records of patients seen from November 2008 to November 2009 at the Centro de Atendimento e Apoio ao Adolescente (Adolescent Medicine Clinic) of the Pediatrics Department of the Federal University of Sao Paulo. The target age was 10 to 19 years. Out of total, 37 (81.40%) were males. The analysis was done with simple frequency, simple mean and standard deviation. All of them were undergoing physical examination including Tanner's pubertal stage for breasts and genital development (M for breasts and G for genital on female and male respectively); clinical history (with emphasis on clinical symptoms and family history) and derivation of 12 lead electrocardiograms (ECG).
Results: The sport modalities analyzed in the research were Basketball (53.5%); Soccer (9.3%); Swimming (9.3%); Judo (9.3%) and others as Volleyball, Synchronized Swimming and Athletics (18.6) totalizing a medium of 1058.3± 1202.6 hours training. The Female Tanner's stage results were M2=17%, M4=33% and M5=50% and the Male Tanner's stage results were G1–29%, G2=25%, G3=7%, G4=29% and G5=18%. The participants chronological age was 13.61 ± 2.29 and clinically 65.1% were asymptomatic. The others clinical situations and symptoms were: back and knee pain; overweight; 31.2% of ECG shows alterations such as bradycardia, early repolarization, and right bundle branch block. Three important conditions were found related to adolescents unable to perform sports: sickle cell anemia, right risk Marfan syndrome's cardiovascular manifestation and right ventricular arrhythmogenic dysplasia.
Conclusions: From the Public Health perspective, regular exercise can play the major role in preventing several leading degenerative diseases in industrialized societies. The results indicate the necessity of a Pre-participation clinical evaluation for young athletes that includes physical exam with Tanner development; attention to clinical symptoms and a detailed and careful analyze of the ECG alterations and its correlation with clinical finds. All these procedures are essential to refer them to specialized medical evaluation (when necessary) in order to take care of their sport's eligibility and clinical health.
P49
Left atrial dimension and compliance in metabolic syndrome
L Dalla Vecchia1, P Barbier2, D Lucini3, M Pagani3
1
Salvatore Maugeri Foundation, IRCCS - Center of Milan, Milan, Italy, 2Centro Cardiologico Monzino, IRCCS, Milan, Italy, 3University of Milan, Milan, Italy
Topic: Early detection of asymptomatic disease
Purpose: The metabolic syndrome (MS) is known to represent a risk factor for cardovascular disease (CVD);the left atrial (LA) dilatation has also been associated withCVD. Although this relationship can be explained by hemodynamic mechanisms, there is recent evidence that LA mightplay an indipendent role. Aim of the present study was to investigate relations between MS and LA anatomic and functional remodeling in a healthy population.
Methods: We studied 134 subjetcs (age 20–86 ys, M/F 83/52) without history of CVD. The following parameters were obtained: arterial blood pressure (ABP), waist circumference, carotid intima-media thickness (IMT) and metabolic indices (blood glucose, lipid profile, insulin resistance, C-reactive protein). The MS was diagnosed according to the NCEP-ATP III criteria. Echocardiographic evaluation included M-mode left ventricular (LV) mass index and end-systolic stress, 2D LV end-diastolic volume, and 4-chamber LA maximum and minimum areas, indexed by BSA, and calculated filling fraction as an index of LA compliance.
Results: Prevalence of MS was high (26%). Mean LA indexed area was normal (< 15 cm/m2), but LA compliance was reduced (>50%) in 26% of subjects. Subjects with alteredLA compliance were characterized by older age (52±19 vs 42±15 years, p<.01), higher systolic blood pressure (137±22 vs 127±17 mmHg, p=.009), higher prevalence of MS (47% vs 21, p<.01), higher total cholesterol (219±42 vs 197±37 mg/dl, p=.008) and LDL (157±39 vs 138±34 mg/dl, p=.01), larger LA (10±2 vs 8.8±2 cm/m2, p=.002), longer E wave deceleration time (184±53 vs 164±35 ms, p=.02), and higher IMT (.61±.01 vs. 56±.01, p=.02). In subjects with MS, indexed LA maximum area was larger than in subjects without MS, although still within normal limits; in contrast, LA compliance (LA reservoir filling) was significantly reduced. Specifically, LA compliance was normal (> 50%) in 82% of the subjects without MS and was abnormal in 58% of the subjects with MS (X2, p= .007).
Conclusions: In a homogeneous and healthy population we found a high prevalence of MS and decreased LA chamber compliance. Both LA dimensions and compliance were associated to MS and dyslipidemia. Our study suggests a direct effect of lipid profile on LA remodelling and providessome evidence of significant LA diastolic dysfunction secondary to metabolic factors; this might explain the role of the left atrium as a prognostic factor in CVD.
P50
Matrix GLA protein is correlated with carotid stenosis
D-T Zdrenghea, D Pop, A-V Sitar-Taut
Department of Cardiology, Clinical Rehabilitation Hospital, University of Medicine and Pharmacy, Cluj-Napoca, Romania
Topic: Early detection of asymptomatic disease
Serum matrix GLA protein was correlated with vascular calcification and with risk factors for atherosclerosis, but the relationship with carotid stenosis was not studied until now.
Objectives: To study the relationship between matrix GLA protein and carotid stenosis and its degree.
Methods: There were studied 60 patients, 23 males and 37 females aged 67.25 ± 9.42 years. Each patient was submitted to an Eco Doppler carotid examination, carotid stenosis being classified as unsignificant >20%, moderate 20–50%, severe >50%. In each patient, matrix GLA protein was determined using ELISA method (normal values >7 nmol/L).
Results: There were significant differences of matrix GLA protein serum level between subjects with (>20%) and without carotid stenosis (22.85 ± 2.92 nmol/L vs 19.70 ± 3.06 nmol/L, p>0.0001). The values were also correlated with the degree of the stenosis (>50% 21.48 ± 3.19 nmol/L vs >50% 23.46 ± 3.83 nmol/L) and it was possible to establish a cut off value for the severe stenosis (cut off value 21.5 nmol/L, AUROC 0.637, sensibility 75%, specificity 55.8%). In turn, the matrix GLA protein level concentration did not correlate with cardiovascular risk factors, no significant differences being registered in relationship with sex (22.10 ± 3.33 nmol/L in females vs 21.18 ± 3.29 nmol/L in males), hypertension (21.85 ± 3.45 nmol/L vs 21.1 ± 2.36 nmol/L), diabetes mellitus (21.77 ± 3.49 vs 21.74 ± 3.29 nmol/L), obesity (21.44 ± 3.82 vs 21.87 ± 3.09 nmol/L) or smoking habit (20.91 ± 3.71 vs 21.86 ± 3.29 nmol/L).
Conclusion: Serum matrix GLA protein can be used not only as an index of arterial calcification, but also of carotid atherosclerosis and its severity independently of cardiovascular risk factors.
P51
A-priori and a-posterior techniques to assess the repeatability of derived dietary patterns in relation to cardiovascular disease risk using a semi-quantified food frequency questionnaire
V Bountziouka, E Bathrellou, E Polychronopoulos, DB Panagiotakos
1
Harokopio University, Athens, Greece
Topic: Methodology and statistics
Purpose: To examine the reproducibility of dietary patterns derived by α-priori and α-posterior techniques, through a semi-quantified food frequency questionnaire (FFQ).
Methods: From February 2008 until February 2009, 189 men (38±15 years) and 311 women (36±15 years) were enrolled to the Repeatability study, and were asked to fill-in a 76-food item FFQ twice, within a 15 days interval. The MedDietScorè was used as an α-priori approach, while principal components (PCA) and cluster analysis were the α-posterior techniques.
Results: Although 9 out of the 11 components of the MedDietScorè were found repeatable (p>0.1), the overall MedDietScorè was found repeatable (i.e. mean score for the 1st recording 28±3.7 vs. 28±3.8 for the 2nd recording, p=0.07). Regarding data-driven techniques, although PCA revealed 13 components (PC) in both records (eigenvalues > 1.0) explaining 60% of total variance, only 5 of them were considered as major components. These components, derived through the 1st recording were characterized by high fruit consumption (1st PC-11% of explained variance), vegetable consumption (2nd PC-9.0% of explained variance), white meat (i.e. poultry, pork) and delicatessens (3rd PC-5.4% of explained variance), red meat and potato consumption (4th PC-4.9% of explained variance) and eggs and pasta consumption (5th PC-4.2% of explained variance). Regarding to the 5 components obtained through the 2nd recording, the 1st PC was heavily loaded of vegetables (11.4% of explained variance), the 2nd PC from fruit (10.7% of explained variance), the 3rd PC was characterized by high meat consumption (4.9% of explained variance), high scores of fish and seafood are presented in the 4th PC (4.4% of explained variance), while the 5th PC is mainly characterized from delicatessens (4.2% of explained variance). Moreover, according to cluster analysis three clusters (i.e. Traditional Greek Diet, Western and Unspecified patterns) were better reflecting the sample's dietary patterns and were revealed from both records, despite the low correct classification rate (39%).
Conclusions: Dietary patterns were found to be related with clinical and biological markers of chronic diseases such as cardiovascular disease. However, a major concern in nutritional epidemiology is whether these results can be reproduced using the same data set. Our study revealed that, a-priori method had a better repeatability as compared to a-posterior methods. In conclusion, the use of these methods to obtain dietary patterns and, thus, assess nutritional strategies should be done with cautious.
