Secondary prevention of stroke in Czech patients in the EUROASPIRE III Study - Stroke Specific Module
J Bruthans1, O Mayer2, J Simon2, M Galovcova1, J Hrbkova2, J Belohoubek1, R Cifkova1, H Rosolova2
1Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 2Charles University School of Medicine, Pilsen, Czech Republic
Topic: Stroke
Aims of study: To assess the prevalence of major risk factors for ischemic stroke, to determine implementation of the secondary prevention of stroke in clinical practice.
Methods: A total of 507 consecutive patients aged < 80 years and hospitalized for their first ischemic stroke in the respective district hospital (Praha 4 and Plzen-mesto) were selected retrospectively. Data were obtained from patients hospital medical records and subsequent patients history including the completion of structured questionnaires. Outpatient examination including fasting blood sampling was performed at 636 months post-stroke. the survey was carried out as part of a European study using the protocol of the EUROASPIRE III study Stroke Specific Module.
Results: A total of 341 men and women were examined. Of these, at the time of examination, 6–36 months post stroke, 14.9% were current smokers, 38.8% were obese, 81% had blood pressure levels > 130/80 mmHg, 71.1% had increased LDL-cholesterol (> 2.5 mmol/L), 32.3% had overt diabetes (fasting blood glucose > 7 mmol/L or treatment with oral hypoglycemic agents or insulin), with only 5.5% of patients with diabetes showing satisfactory diabetes control (fasting blood glucose < 6.1 mmol/L). At the time of this examination, 78.9% of patients were receiving antiplatelet drugs or anticoagulants, 52.2% statins, 85.9% antihypertensive medication (43.1% beta-blockers, 68.9% ACE inhibitors or angiotensin II receptor blockers, 39.9% diuretics, and 32.6% calcium-channel blockers). Only a small proportion of patients were compliant with non-pharmacologic measures of secondary prevention (exercise and diet in particular). While signs of depression were possibly or likely present in 33.3% of patients, 21% of patients showed likely or probable anxiety.
Conclusion: Secondary preventive lifestyle measures are inadequately implemented, with only a small proportion of patients achieving goal values of risk factors despite widely used drug therapy. the role of post-stroke rehabilitation and psychotherapy is largely underestimated.
P476
Predicting risk of stroke following a Myocardial Infarction
S N C Barra, R Providencia, P Gomes, J Silva, L Seca, A L Marques
Hospital Center of Coimbra, Coimbra, Portugal
Topic: Stroke
Purpose: Patients with coronary artery disease (CAD) are at increased risk of stroke. the aim of this study was to analyze the prognostic power of selected clinical variables in predicting the risk of stroke following discharge for a Myocardial Infarction (MI).
Methods: 404 consecutive patients (68.1±13.7 years old; 63.4% males; 37.4% with Diabetes Mellitus) discharged after being admitted for a MI. Data collected: cardiovascular risk factors, admission glycemia (GlycAd), HbA1c, creatinine; maximum troponin levels (MaxTrop); glomerular filtration rate (GFR) by MDRD formula; maximum Killip Class (mKC); GRACE score; and CAD extension. Patients were followed for two years and each variable was tested as a possible predictor of stroke.
Results: Patients with Diabetes Mellitus, hypertension or dyslipidaemia had higher stroke risk, yet the differences were not statistically significant. the presence of previously known CAD or the type of MI (STEMI vs. NSTEMI) did not help predict the risk for stroke. the following variables were associated with higher stroke risk GFR<60ml/min/m2 (12.8% vs. 5.2%, p=0.029, OR 2.65); mKC > 1 (13.9% vs. 5.6%, p=0.025, OR 2.71); GRACE > 180 (17.4% vs. 4.9%, p=0.001, OR 4.09); GlicAd > 7.7 mmol/L (14.5% vs. 2.9%, p=0.001, OR 5.74); MaxTrop > 42 ng/mL (14.3% vs. 5.9%, p=0.032, OR 2.64). CAD extension was not associated with increased stroke risk. Logistic regression obtained a model with the predictors GRACE > 180 and GlicAd > 7.7 mmol/L that adjusted well to data (Hosmer-Lemeshow: p=0.969). GRACE > 180 had an OR of 2.73 and GlicAd > 7.7 mmol/L an OR of 4.18.
Conclusions: In patients with a MI, variables known as predictors of intra-hospital mortality, e.g., admission glycaemia and renal function, the occurrence of acute heart failure, and GRACE score, were found to be useful predictors of stroke during a 2 year follow up. Whilst both GRACE > 180 and GlicAd > 7.7 mmol/L were independent predictors of stroke, CV risk factors, the presence of previously known CAD, and the extension of CAD assessed by coronariography did not improve prediction of stroke risk. this study reinforces the need for an even more aggressive secondary prevention in patients most at risk.
P477
Bone marrow-derived progenitor cells in ischemic stroke patients: relationship between infarct size, neurological impairment and discharge outcome
F Cesari1, AM Gori1, R Marcucci1, G Pracucci2, P Nencini2, D Inzitari3, GF Gensini1, R Abbate1
1Department of Medical and Surgical Critical Care, thrombosis Centre, University of Florence, Florence, Italy, 2Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy, 3Stroke Unit, Azienda Ospedaliero-Universitaria Careggi, Florence., Italy
Topic: Stroke
Introduction: Some data suggested that the number of bone marrow circulating progenitor cells, both endothelial progenitor (EPCs) and circulating progenitor cells (CPCs), negatively correlated with the number of cerebral infarctions as well as with the outcome of ischemic stroke patients.
Aim: Aim of this study was to contemporary analyze the number of CPCs and EPCs in ischemic stroke patients during the acute phase of the disease and to establish a relationship with the infarct size, neurological impairment and discharge outcome.
Methods: In 67 (40M; 27F) ischemic stroke patients with a median age of 73 (21–91) years, the number of EPCs and CPCs was measured by flow cytometry within 72 hours from the event. EPCs cells were considered as CD34+/KDR+; CD133+/KDR+ and CD34+/CD133+/KDR+. CPCs were defined as cells CD45dim and positive for CD34+, CD133+ and CD34+/CD133+.
Results: According to the Oxford Stroke classification, patients with partial anterior circulation syndrome (PACS) showed a higher CPCs number with respect to patients with the total anterior circulation syndrome (TACS) [CD34+:224(70–482) vs. 85(49–267) cells/106 events p=0.006; CD133+: 217(60–489) vs. 82(45–240) cells/106 events p=0.007; CD34+/CD133+: 207(50–482) vs. 80(40–240) cells/106 events, p=0.005]. Moreover, a negative relationship between NIHSS score at the admission and CPCs levels was observed [CD34+ and NIHSS r=-0.36 p=0.003; CD133+ and NIHSS r=-0.36 p=0.002; CD133+/CD34+ and NIHSS r=-0.37 p=0.002]. When the outcome was considered (group A patients sent at home and group B patients sent in a neurological rehabilitation unit) a higher number of CPCs was present in group A with respect to group B [CD34+: 229 (63–482) cells/106 events vs. 119 (46–891) cells/106 events; CD133+: 219 (63–489) cells/106 events vs. 119 (45–885) cells/106 events; CD34+/133+: 215 (63–482) cells/106 events vs. 119 (40–885) cells/106 events, p=0.002]. In a multivariate analyses, after adjustment for age, sex, hypertension, smoking habit, diabetes, hypercholesterolemia, ESR, fibrinogen levels and leukocyte number, CPCs number remained significantly associated with the outcome [OR 95% (IC): CD34+ 0.108 (0.014–0.843) p=0.034; CD133+ 0.117 (0.015–0.909) p=0.040; CD34+/CD133+ 0.116 (0.015–0.880) p=0.037].
Conclusions: We observed a relationship between the number of circulating progenitor cells, infarct size, NIHSS score and the outcome at discharge.
Our data indicate that diminished number of CPCs can provide a marker for cerebrovascular function in the setting of ischemic conditions.
P478
Patent foramen ovale detection in cryptogenic stroke: Transesophageal echocardiogram not good enough?
LF Seca, J Silva, R Providencia, P Gomes, M Costa, AM Leitao Marques
Hospital Center of Coimbra, Coimbra, Portugal
Topic: Stroke
Purpose: To retrospectively assess the incidence of patent foramen ovale (PFO) in a group of patients with stroke of unknown cause (cryptogenic) referenced for transesophageal echocardiography (TEE). Patients were then followed to evaluate recurrence of cerebrovascular events and death.
Methods: We retrospectively reviewed the total number of patients with cryptogenic stroke submitted to transesophageal echocardiogram in our facility from January 2004 to December 2008. PFO detection was done using color Doppler and agitated saline contrast with Valsalva Maneuver by experienced cardiologists. Some of these patients were then submitted to percutaneous closure with Amplatzer device while the remaining where treated medically. All PFO patients completed a minimum of 6 months of follow up, with a mean follow-up time of 28±17,2 months.
Results: A total of 1898 TEE were performed in our centre, 309 of which in patients with cryptogenic stroke. A PFO was detected in 18 patients (6%), 10 of these presenting with anatomical higher risk characteristics (atrial septal aneurysm, spontaneous shunt or Eustachian valve). A total of 12 patients were submitted to percutaneous closure. One case of recurrent stroke and one death was documented, both of which occurred in medically treated group.
Conclusions: this small study highlights the low incidence of PFO detected by TEE in cryptogenic stroke patients when comparing to the high overall prevalence in autopsy studies (27%), questioning the sensitivity of TEE in diagnosing this anatomical variant as well as the actual role of PFO in the so called cryptogenic stroke.
P479
Prevalence and prognostic value of Arterial Hypertension in patients with stroke
H Ribeiro, R Margato, S Carvalho, C Ferreira, P Mateus, A Ferreira, I Moreira
Centro Hospitalar de Trás-os-Montes e Alto Douro, Cardiology Department, Vila Real, Portugal
Topic: Stroke
Purpose: Arterial hypertension (AH) is an important risk factor for cerebrovascular disease that is the leading cause of death and disability in our country. Our aim was to assess the prevalence, clinical characteristics and prognosis associated with AH in patients admitted for stroke.
Methods: Retrospective analysis of patients consecutively admitted to a cerebrovascular disease unit with stroke or transient ischemic attack (TIA) over a period of 5 years. Isquemic stroke patients were classified according to Bamford Topographic Classification in total/partial anterior circulation infartion- TACI/PACI, posterior circulation infarction POCI and lacunar circulation infarction LACI. the population was divided into 2 groups: Group A - with AH and Group B - without AH. the prevalence of AH was determined and the two groups were evaluated and compared concerning demographic and clinical features, scales of functional capacity (SFC) (Rankin, NIH) and mortality. In statistical analysis, X and Student s t test were used; logistic regression was performed for multivariate analysis.
Results: We studied 3508 dts, predominantly (52.3%) males, mean age of 73.2 ± 11.5 years. the prevalence of AH was 55.2%. Group A patients were older (73.5±12.6 vs 72.9±10.5, p=0.04), had superior proportion of females (49.2 vs 45.8%, p=0.04), LACI(17.6 vs 12.1, p<0.001) and POCI(18.5 vs 15.3, p<0.001), higher coexistence of vascular risk factors (diabetes-24.8 vs 11.8%, p<0.001; dyslipidemia 19.3 vs 7.5%, p<0.001; obesity − 7.3 vs 2.5%, p<0.001) as well as comorbidities (cardiac disease-24.5 vs 19.1%, p<0.001; cerebrovascular disease-5.9 vs 4.1%, p=0.016; chronic renal failure-4.3 vs 2.2%, p=0.006) and SFC less favourable at admission but similar at discharge (Table 1). the mortality rate was higher in AH patients (17,4 vs 12,9%, p<0,001), and after adjustement for age, risk factors, comorbidities, type of stroke and functional scales, remained superior (OR=1,3, 95% CI 1,1 a 1,6, p=0,004).
Conclusions: this study showed a high prevalence of AH (55.2%) and identified AH as an independent risk factor for mortality in stroke.
Scales of funcional capacity
Group A
Group B
p
Rankin admission//discharge
3,4±1,5//2,3±1,6
3,2±1,6//2,4±1,7
0,027/NS
NIH admission//discharge
9,8±9,1//5,7±7,1
8,5±8,1//5,4±-6,8
<0,001/NS
P480
Heightened systemic oxidative stress critically accelerates worsening carotid atherosclerosis in patients with ischemic stroke
1the University of Hong Kong, Hong Kong, People's Republic of China, 2Queen Mary Hospital, Department of Medicine, Hong Kong, Hong Kong SAR, People's Republic of China, 3Tung Wah Hospital, Hong Kong, People's Republic of China
Topic: Stroke
Background: Both increased oxidative and inflammatory stresses are implicated in atherogenesis. However, little is known about their role in atherosclerotic progression in patients already at the advanced cardiovascular continuum.
Objective: To investigate the impact of oxidative and inflammatory stress on the progression of carotid atherosclerosis in patients with established ischemic stroke.
Methods: A total of 43 consecutive patients (mean age 65.7 ± 8.8 years; male 70%) with primary or recurrent ischemic stroke (>6 months) were recruited from our medical outpatient clinics. High resolution ultrasound (Agilent Sonos 5500, Philips, USA) was used to assess burden of carotid atherosclerosis in terms of maximum intima-media thickness (mIMT). Serum malodialdehyde (MDA) and high-sensitivity C-reactive protein (hsCRP) were respectively measured as markers of systemic oxidative and inflammatory stress.
Results: these patients showed a mean mIMT of 2.25 ± 0.98 mm. Serum MDA (Pearson r=0.32, P=0.035) and hsCRP (Pearson r=0.41, P=0.007) were both positively associated with mIMT. Adjusting for potential confounders by multivariate model (age, gender, hypertension, diabetes mellitus, hyperlipidemia, smoking history, use of aspirin/statins/antihypertensives and body-mass index), each 1 çM increase in serum MDA independently predicted increase in mIMT by 0.79 mm (95% CI [0.23 1.36], P=0.008). Furthermore, each 1 mg/L increase of hsCRP was independently predictive of increase in mIMT by 0.06 mm (95% CI [0.01 0.12], P=0.017). Hyperlipidemia and diabetes accounted for IMT increase by 0.56 mm (95% CI [0.04 − 1.08], P=0.037) and 0.53 mm (95% CI [0.01-1.05], P=0.046) respectively.
Conclusions: this study demonstrated that systemic oxidative stress strongly accelerates secondary progression of carotid atherosclerosis in patients with established ischemic stroke, independent of and above all conventional risk factors including systemic inflammation. this suggests that effective reduction of oxidative stress should be a major therapeutic target in patients at the advanced cardiovascular continuum.
P481
the incidence of stroke in the United Kingdom, 1985 to 2008: a systematic review
P Bhatnagar1, P Scarborough1, N Smeeton2, S Allender1
1University of Oxford, Oxford, United Kingdom, 2King's College London, London, United Kingdom
Topic: Stroke
Purpose: Stroke mortality varies substantially around the United Kingdom and is one of the largest health burdens. To date, it is unclear how much of this variation is due to incidence or case-fatality. this systematic review reports on high-quality, population-based studies documenting the incidence of any stroke and stroke subtypes, between 1985 and 2008 in the United Kingdom. We aimed to study geographic trends and compare these with equivalent mortality trends.
Methods: MEDLINE and EMBASE were searched using MeSH terms, reference lists were inspected and authors of included papers contacted. Inclusion criteria were designed to only identify high quality studies. Incidence rates were directly standardised to the European Standard Population for those over 45 years and those between 45 and 74 years. Geographic trends in incidence rates were compared to equivalent mortality rates.
Results: Five papers were included in this review, with Scotland, the South, the South West and North West of England represented (see table). For all stroke, men aged over 45, incidence rates per 100,000 ranged from 143 in South London, to 184 in Scotland. For all stroke, men aged 45–74, incidence rates per 100,000 ranged from 79 in the North West of England, to 112 in Scotland. Incidence rates for all stroke largely reflected mortality rates for the same populations. Stroke subtype data around the country was more limited, but suggested no substantial variation in incidence rates by subtype.
Conclusion: Predominantly, incidence rates echo mortality rates in the areas included in this review, suggesting that variations in stroke mortality are likely to be due to variations in incidence, rather than case-fatality. Geographic inequalities should therefore be tackled through policies aimed at reducing risk factor prevalence. More high-quality studies in the UK are required to confirm this, especially in Wales, Northern Ireland and some areas of England.
Details of included studies
Setting
Study years
Number of strokes
Population
Study design
ICD codes
East Lancashire
1994–1995
642
405,272
Prospective; hot pursuit, death certificates, rehabilitation services
ICD-9 430–438
Oxfordshire
2002–2005
439
91,106
Prospective; hot pursuit, death certificates, imaging or autopsy
ICD-10 I60–69
South London
1995–2004
2,874
271,817
Prospective; hot pursuit, death certificates, imaging, cerbrospinal fluid analysis
ICD-9 430–434 & 436 ICD-10 I60–69
Scottish Borders
1998–2000
596
106,352
Prospective; hot pursuit, death certificates, CT scans
ICD-9 430–438
Devon & Cornwall
1992–1996
800
1,504,847
Retrospective; hospital records, death certificates, cerebral angiography database, surgery database, GP records, CT scans, necropsy
Recurrent risks after transient ischemic attack or mild ischemic stroke in Japan
Y Kono1, S Yamada2, K Kamisaka3, A Araki4, Y Fujioka1, K Yasui4, Y Hasegawa4, Y Koike2
1Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Nagoya University School of Health Science, Nagoya, Japan, 3Kitano Hospital, Osaka, Japan, 4Nagoya Daini Red Cross Hospital, Nagoya, Japan
Topic: Stroke
Purpose: Japanese people have high rates of morbidity and mortality from stroke. Among stroke survivors, recurrence is common, resulting in cumulative disability and cognitive dysfunction. Despite of that almost 70% of stroke has mild to moderate paresis, previous reports that referred stroke recurrence included mild to severe paresis and the data of recurrence in mild to moderate stroke remained unknown. therefore, this study aimed to identify the recurrence rate and risk factors or clinical variables predictive for vascular events after TIA and mild ischemic stroke (IS).
Methods: From December 2005 to September 2006, patients with acute TIA or IS who met criteria of modified Rankin Scale 0∼2, no communication disability and emergent admission to a sophisticated acute hospital in Nagoya city district were consecutively enrolled in this study. Patients with age over 80 years old, cardiogenic stroke, severe dementia, psychiatry disorder and extracorporenal dialysis were excluded. During hospitalization, we assessed sex, family history, age, height, weight, stroke subtype, blood pressure, lipid profile, fasting glucose, HbA1c, smoking, alcohol consumption, exercise habits, waist circumference, and ankle-brachial pressure index (ABI). Primary outcome was stroke recurrence or other vascular events such as myocardial infarction, angina pectoris, and peripheral artery disease. Survival curves were calculated by Kaplan Meier survival analysis and significance was determined using the log rank test. Hazard ratios (HR) for recurrence were determined by univariate and multivariate Cox proportional hazards regression model.
Results: the total of 102 patients (78 men and 24 women, mean age 64 years) was successfully conducted 2 years follow-up review. In 102 patients, twenty-two out of 102 (21.5%) had stroke recurrence, 3 (2.9%) had coronary event, and 2 (1.9%) died due to cancer. Among a set of variables, abnormal ABI (HR: 4.18, P= 0.002), metabolic syndrome (HR: 3.03, P= 0.010), stroke subtypes (HR: 2.63, P= 0.050) were selected as significant independent predictors for stroke recurrence or cardiovascular events.
Conclusion: the results in this study suggest that abnormal ABI, metabolic syndrome and stroke subtype will aid to identify high risk patients for stroke recurrence or other cardiovascular events in TIA or mild IS patients within first two years.
P483
Barriers to the prevention of Stroke in patients with AF: a primary care study
KE Griffith, A Graham
West Yorkshire Cardiac Network, York, United Kingdom
Topic: Stroke
Purpose: Atrial Fibrillation (AF) is the commonest preventable cause of stroke, and the strokes associate dwith aF have a worse prognosis. It is increasing in prevalence with the increasing age of the population and it is important to identify those at high risk of stoke and offer them appropriate preventive therapy.
Methods: General practitioners in the UK are rewarded throught the Quality and Outcomes Framework to identify those registered patients with AF and offer then warfarin or an antiplatelet agent. ther is no incentive to assess stroke risk and treat high risk patients with warfarin. the authors have been involved in the development of a tool (GRASP-AF) which uses the CHADS” scoring system to assess stroke risk for AF patients on a GP data base. the tool was used in 24 practices in one English city with a total population of 233,000. Primary care physicians were asked to review high risk patients and consider warfarin if appropriate.
Results: the study demonstrates the age related prevalence of AF and use of antithrombotic therapy. Of patients with a CHADS2 score of 2 or more only 53% were taking warfarin, and increasing risk was not reflected by increasing use of warfarin. the increase in warfarin prescription after review was much less than expected and the reasons for this were identified and will be discussed.
Conclusion: It is important to combine risk scoring with intensive education and clinical support to increase the use of anticoagulation and prevent the fatal and disabling strokes associated with AF.
P484
Left atrial appendage: assessment of thrombosis using tissue Doppler Imaging in patients with persistent nonvalvular atrial fibrillation
C Mornos, A Ionac, D Gaita, A Mornos
Institute of Cardiovascular Diseases, Timisoara, Romania
Topic: Stroke
the incidence of thromboembolism remains high in patients with atrial fibrillation (AF). the left atrial appendage (LAA) is a potential site for development of thrombus and LAA dysfunction is an independent predictor of thromboembolism. the magnitude of LAA flow velocities are dependent on acute changes in loading conditions. Myocardial velocities obtained by tissue doppler imaging are less dependent on preload and may help in more accurate risk prediction.
Background: this study was planned to assess whether LAA longitudinal strain (LAAS) calculated with Tissue Doppler Imaging is a useful method for prediction of the LAA thrombosis in patients with nonvalvular persistent AF.
Material and Methods: We studied 55 patients (mean age 60±12 years) with nonvalvular persistent AF referred for clinically indicated echocardiographic study. Patients undergoing anticoagulant therapy were excluded. Left atrial diameter (LAD), surface (LAS) and volume (LAV) were measured by using transthoracic echocardiography. LAA emptying (LAAEV) and filling (LAAFV) velocities were measured by transesophageal Doppler echocardiography. Realtime 2-dimensional color Doppler myocardial imaging data were recorded from the LAA at a high frame rate. LAAS was performed with Tissue Doppler offline analysis from midsegment of lateral wall of LAA. LAAEV, LAAFV and LAAS were averaged for six consecutive cardiac cycles.
Results: Transesophageal echocardiography demonstrated LAA thrombus in 23 of 55 patients; in all of these patients the spontaneous echo contrast was detected. the area under the receiver-operating characteristic curve (ROC) for predicting the patients with LAA thrombus was greatest for LAAS (AUC=0.91, p<0.001), followed by LAAEV (AUC=0.85, p<0.001), LAAFV (AUC=0.83, p<0.001), LAV (AUC=0.69, p<0.001), LAS (AUC=0.70, p<0.001) and LAD (AUC=0.67, p<0.001). A statistical comparison of the ROC curves demonstrates significant differences between LAAS and LAAEV (p=0.02), and LAAS and LAAFV (p=0.007), respectively. the optimal LAAS cut-off for predicting the patients with LAA thrombus was –3.35 % (sensitivity of 88% and specificity of 83%). For LAAEV the optimal cut-off was 32.3 cm/s (sensitivity of 81% and specificity of 74%).
Conclusions: LAAS appears to be a clinically applicable and reliable imaging technique and might serve as a predictor of LAA thrombus formation in nonvalvular persistent AF.
P485
Implications for secondary prevention of atherothrombotic events. What happens with pattern of recurrence in diabetic patients?
R C Rafael CarlosVidal Perez, F Otero-Ravina, J Alvear Garcia, C Caneda Villar, J Torres Colomer, L Grigorian Shamagian, P Mazon Ramos, JR Gonzalez Juanatey
University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
Topic: Stroke
the Barbanza Diabetes Study Group
Purpose: the recurrence pattern of atherothrombotic events in diabetics with cardiovascular disease is not well known, although there are data that suggest that the recurrence as acute coronary syndrome is common in patients with a previous stroke. the aim of our study is to analyze in a prospective manner the recurrence pattern in diabetics with prior cardiovascular disease.
Methods: Multicenter prospective cohort study involved 1423 consecutive patients with diabetes mellitus who were recruited by 31 primary care physicians. the patients characteristics were recorded and they were followed up for 45±10 months.
Results: the mean age of the patients (50% male) was 66 years, 64% had hypertension, 70% had dyslipidemia, and 26% had had a previous cardiovascular event. By the end of follow-up, 81 (6.2%) had died, 40 (3%) of whom due to cardiovascular causes, and 393 (30%) had been hospitalized, 179 (14%) of whom for cardiovascular disease. Multivariate analysis identified the following factors as independent predictors of mortality: age (hazard ratio [HR] =1.08; 95% confidence interval [CI], 1.05–1.11), previous cardiovascular disease (HR=2.15; 95% CI, 1.12–4.14) and diuretic treatment (HR=3.40; 95% CI, 1.76–6.56), while the prescription of an angiotensin converting enzyme inhibitor or an angiotensin-receptor antagonist had a protective effect (HR=0.48; 95% CI, 0.25–0.93). Compared with diabetics without a previous cardiovascular event, the risk of a cardiovascular event during follow-up was greater in those with a history of either ischemic heart disease (HR=2.48; 95% CI, 1.51–4.07), cerebrovascular disease (HR=2.51; 95% CI, 1.28–4.92), or peripheral vascular disease (HR=1.46; 95% CI, 0.81–2.60).
Conclusions: the diabetic patients with chronic ischaemic heart disease or cerebrovascular disease have a pattern of recurrence that shows preference over the same vascular bed. these results have implications for the secondary prevention strategy in diabetic patients with prior cardiovascular disease.
P486
One year stroke registry of a community hospital: incidence, risk factors, delays in seeking medical care, outcome, and predictors of severity
T Christodoulides1, P Georgiou1, P Anastasiou1, K Yiangou1, A Stylianou2, E Nicolaides1, L Petsas2
1Nicosia General Hospital, Nicosia, Cyprus, 2Larnaca General Hospital, Larnaca, Cyprus
Topic: Stroke
Purpose: the aim of our study was to calculate the incidence of stroke in our area, describe the profile of our patients, and investigate their outcome. Another aim of the study was to identify which risk factors were associated with an increased stroke severity.
Methods: All patients presenting with stroke for a period of a year, at a community hospital without the ability of fibrinolysis, were enrolled in the study. Time between symptom onset and seeking medical care was recorded as well as the demographic and risk factor profile of the patients. the severity of their presenting symptoms was evaluated by using National Institute of Health's Stroke Scale (NIHSS). their complications during hospitalization as well as their outcome were also recorded (mortality, disability according to modified Rankin scale). Finally, factors which were associated with stroke severity were identified through regression analysis.
Results: 98 patients were enrolled. the incidence of stroke among the population of the area was 1,15/1000 (1,31/1000 for men and 1,03/1000 for women). their mean age was 74,7 years (95% CI: 63,1–86,3). 49% were males. the most common risk factor was hypertension (71,4%). Mean time from the onset of symptoms until the arrival to the hospital was 499,9 minutes, which was much longer than the 120 minutes margin for treatment with fibrinolysis. this delay was independent of the patients age, stroke severity, sex, and educational level. Stroke severity according to NIHSS was higher in patients with history of atrial fibrillation. Regression analysis revealed that the previous use of ACE-inhibitors was independently related with decreased stroke severity. the most common complication during hospitalization was unirary tract infection. Mean Rankin score at discharge was 2,92. In-hospital mortality was 10,2%.
Conclusion: Stroke occurs in 1,15/1000 persons in the studied district. Time from symptom onset until seeking medical care was very long in comparison with similar measurements from other studies. Consequently, even if treatment with fibrinolysis was applied by the hospital, the patients wouldn't be able to benefit from it. therefore, the population of the district must be educated in order to recognize symptoms of stroke before the establishment of a system for fibrinolytic treatment of stroke. Also, the effect of ACE-inhibitors on stroke severity should be further studied in prospective studies.
P488
the influence of luminal coronary artery stenosis on myocardial deformation at rest analysed using 2-dimensional strain echocardiography
C Mornos, I Zacharopoulou, D Gaita, SI Dragulescu
Institute of Cardiovascular Diseases, Timisoara, Romania
Topic: Stable angina pectoris
Background: Left ventricular (LV) fibers are mainly directed longitudinally and helically. LV torsion (LV tor) and longitudinal strain are essential components of global LV performance. Significant coronary artery disease may lead to alteration of normal myocardial deformation.
Aim: We investigated the influence of = 70% luminal coronary artery stenosis on myocardial deformation at rest analysed using 2-dimensional strain echocardiography in consecutive patients, clinically referred for invasive coronarography.
Methods: Standard echocardiogram was performed in 115 consecutive patients, in sinus rhythm, clinically referred for invasive coronarography. We excluded the patients with inadequate echocardiographic images, acute coronary syndrome, prior myocardial infarction or prior coronary revascularization. the remaining 61 patients formed our study group. the parasternal apical and basal short-axis planes were recorded. LV twist (LV tw, the net difference between rotation angles at base and apex) and LV tor (LV tw normalized for LV diastolic longitudinal length) were measured by 2D-strain. Longitudinal peak sistolic strain was determined from the apical planes using 2D strain in a 16 LV segments model. Value of global longitudinal strain (LV e) was obtained by averaging all 16 LV-segments. Patients were divided into two groups acording to the coronarography: group 1, at least 70% stenosis in at least one major coronary artery, n=28, and group 2, without =70% coronary stenosis, n=33.
Results: LV e was significantly different in group 1 (—14.63±3.19%) compared with group 2 (—18.08±2.27%), p<0.05. LV tor and LV tw were not different between group 1 and 2 (2.68±1.57/cm vs 3.06±1.76/cm, and 16.38±2.77 vs 18.86±2.89 respectively, each p>0.05). the area under the receiver-operating characteristic curve for prediction of =70% coronary stenosis using LV e was 0.75 (p<0.001); the optimal cut-off for LV e was –16.6% (70% sensitivity and 73% specificity).
Conclusions: LV e is an effective parameter for detection with reasonable accuracy of patients with =70% stenosis in at least one major coronary artery (without acute coronary syndrome, prior myocardial infarction or prior coronary revascularization).
P489
Prevalence of increased heart rate in stable coronary artery disease patients
P Meurin1, M Guenoun2, F Paganelli2, JY Tabet1, MC Malergue3, D Guedj4
1Les Grands Pres, Villeneuve Saint Denis, France, 2AP-HM - Hospital Nord, Marseille, France, 3Institute Hospital Jacques Cartier, Massy, France, 4Cabinet medical, Paris, France
Topic: Stable angina pectoris
College National des Cardiologues Franoais
Background: In stable coronary artery disease (CAD) patients, resting heart rate (RHR) is an independent predictor of cardiovascular major events. the aim of this study is to describe RHR distribution in a large population of stable CAD patients.
Methods: the INDYCE study was conducted in clinical practice by 343 cardiologists who accepted to include 10 consecutive stable CAD outpatients. In this analysis focusing on RHR, only patients with sinusal rythm were analyzed.
Results: 3119 patients were enrolled (male: 80 %, 68 ± 11 years old, diabetes: 24.3 %, hypertension: 61.6 %). Medical therapy was in keeping with Guidelines (antiplatelet agents: 88.4 %; statins: 85.9 %; ACE-I/ARBs: 78.8 %, beta-blockers (BB): 74.6 %).19.2 % of the patients had clinical angina pectoris.
2750 of them had a sinusal rythm and were therefore studied. Mean RHR was of 64.06 ± 10.1 bpm, (62.7 ± 9.3 in beta-blocked patients: vs 67.7 ± 10.5 in non beta-blocked patients: p< 0.001). 30.1 % of the patients had a RHR = 70 bpm (beta-blocked patients: 23.5% vs non beta-blocked patients: 42.2%, p< 0.001).
Among the 601 patients who did not receive a BB, 80 % did not receive a rate limiting calcium antagonist (RLCaI: verapamil, diltiazem), although (1) they had as many angina crisis as patients receiving a BB or a RLCaI, and (2) their mean HR was clearly higher than BB or RLCaI treated patients (68.1 ± 11.1 vs 63.5 ± 9.9, p< 0.001). 15 patients were on ivabradine which had just been introduced on the French market at the time of the study.
Conclusions: In spite of the use of beta blockers in the vast majority of stable CAD patients, 30 % of them had a RHR =70 bpm in this study. Moreover, About 20% of the patients did not receive any heart rate limiting agent.
P490
Risk factors, subclinical carotid and coronary atherosclerosis in patients with stable angina
K Pavlovic, N Cemerlic-Adjic, A Jovelic, P Mesaros, M Lukic, M Stefanovic
Clinic of Cardiology, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
Topic: Stable angina pectoris
Background: Common carotid artery intima-media thickness (CCAIMT) is independent predictor of cardiovascular events and diabetes mellitus. Relationship between CCAIMT and significant coronary artery disease (CAD) is not fully elucidated, and therefore our aim was to assess the cross-sectional relationship between CCAIMT, cardiovascular risk factors and coronary atherosclerosis.
Methods: Using our hospital informational system database, we evaluated 711 patients (63% males, age 61.1+/–9.1 years) with stable CAD who underwent coronary angiography during 2008. Age, total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), triglycerides (Tg), fasting glucose, blood pressure, smoking habit, body mass index (BMI), serum creatinine, fibrinogen, C-reactive protein (CRP) and uric acid were determined in every subject. the CCAIMT was measured by high-resolution B-mode ultrasonography in the posterior wall of the distal 1 cm of both common carotid arteries. Patients with renal insufficiency and prior myocardial infarction were excluded.
Results: 68.6% of all subjects had CCAIMT=0.7mm (p<0.001), and 62.3 % had significant CAD (p<0.001). the CCAIMT was increased in patients with significant CAD (0.94±0.32 vs. 1.04±0.27; p<0.001), and positively correlated with a number of significant coronary artery stenosis (r=0.2; p<0.001). In a simple regression analyses age (β=0.197 p<0.01), systolic (β=0.112, p=0.011) and diastolic (β= 0.093, p=0.034) blood pressure were associated with CCAIMT, while age (β=0.198 p<0.01) was the only independent predictor of CCAIMT. In a simple logistic regression analyses gender, age, HDL-c/Tg, glucose, uric acid and CCAIMT, were associated with significant CAD, while blood pressure, TC, LDL-c, CRP, fibrinogen, and creatinine were not. In a multiple logistic regression analysis, CCAIMT (Odds Ratio (OR 3.64 (95% confidence interval (CI) 1.84–7.19); p<0.001) and HDL-c/Tg ratio (OR 1.94; 95% CI 1.07–2.77) were the only independent predictors of significant CAD.
Conclusions: In studied group of patients with stable coronary artery disease CCAIMT increased with age, while parameters of metabolic syndrome, HDL-c/Tg ratio and CCAIMT were the only independent predictors of haemodynamically significant coronary artery disease.
P491
Ethnic variations in the incidence and mortality of stroke in Scotland: retrospective cohort study linking census, mortality and morbidity data
R Bhopal1, N Bansal1, C Fischbacher2, G Mueller3, H Brown1, S Capewell4
1University of Edinburgh, Edinburgh, United Kingdom, 2NHS National Services Scotland, Edinburgh, United Kingdom, 3General Register Office for Scotland, Edinburgh, United Kingdom, 4University of Liverpool, Liverpool, United Kingdom
Topic: Public health
the Retrocoding Project Team
Background: Ethnicity is a contested concept in stroke epidemiology. Nonetheless, there is increasing evidence of large differences in disease incidence, mortality and other outcomes by self-reported ethnic group or other proxy indicators of ethnicity such as country of birth or name analysis. In the UK, large variations in stroke mortality rate by country of birth are poorly understood. Ethnic variations in stroke are important, and require deeper study now that better linked datasets are becoming available for analysis, as in Scotland.
Method: Using computerised matching of names, addresses, dates of birth and sex, we linked ethnicity data from respondents to the national 2001 Census for Scotland to subsequent hospital discharge and deaths data.
Analysing this cohort of 4.6 million people, we calculated age and sex-specific stroke rates, directly standardised rates, ratios of directly standardised rates (expressed as a percentage of the standard population), and 95% confidence intervals. We adjusted these summary figures for a well validated area based measure of socio-economic position (Scottish Index of Multiple Deprivation, SIMD). the White Scottish group was used as the standard comparison population.
Results: Compared to the reference White Scottish population, age-standardised incidence rates for stroke were slightly higher in South Asian and Black populations. However, these differences were much reduced after adjusting for deprivation. Stroke rates were significantly lower in the Other White group (predominantly English and Welsh), and in Chinese populations. this advantage persisted even after adjustment for deprivation.
Conclusions: these linkage methods offer potentially valuable opportunities to examine ethnic variations in stroke incidence in Scotland. the ethnic variations were smaller than previously suggested by routine UK mortality data. Importantly, the relatively high rates in Black and Pakistani men shrank after adjusting for an area based measure of socio-economic deprivation. this important finding deserves further study. Important variations within the ethnic subgroups of the White population were also observed. these have been ignored in many previous studies. Specific groups enjoyed comparatively low stroke rates: a better understanding of the underlying protective factors may help to inform future prevention strategies.
P492
Correlation between pre-treatment whith statins and infarct size
S Ribeiro, A Gaspar, S Rocha, S Nabais, P Azevedo, MA Pereira, A Correia
Hospital de Braga, Braga, Portugal
Topic: Pharmacoepidemiology
Purpose: Some studies have shown that patients (P) under lipid-lowering therapy have less extensive myocardial infarcts. this appears to be independent of serum lipid level reduction and could be explained by acceleration of endogenous fibrinolysis and their effect on endothelial dysfunction. the purpose of our study was to compare infarct size in P previously medicated or not with statins.
Methods: Retrospective study of 1288 P consecutively admitted from January 2004 to August 2007 to our coronary care unit, with acute myocardial infarction (AMI). Among those, we selected 746 P, excluding who died in-hospital and who had presented more than 12h between symptoms initiation and hospital admission. Among those with ST-elevation acute myocardial infarction (STEMI) who did reperfusion therapy we admitted only P who did fibrinolysis. the primary end-point in our study was infarct size, using peak creatine kinase MB [CK-MB] to quantify it. We defined intervals of CK-MB values according to the upper limit of normal (ULN) (< ULN, 1–3 times ULN, 3–5 ULN, 5–10 ULN and > 10 ULN) and analysed the association between pre-treatment with statins and those intervals. We further compared the median CK-MB ULN between the 2 groups under and not under statins therapy. We defined the infarct size as being less or more extensive using peak CK-MB >5 vs = 5 times the ULN.
Results: Among 746 P, 75.5% were men, the mean age was 63.3 years old (± 12.8); 57.6% P were admitted with STEMI (fibrinolysis was given to 67.95% P); 25.9% P were previously medicated with statins; 51.6% had peak CK-MB> 5 times ULN. P under statins had less extensive myocardial infarction (median peak CK-MB 2.8 vs 5.28 times ULN; p<0.001). It was observed a correlation between pre-treatment with statins and lower intervals of CK-MB ULN (p trend < 0.001). In a multivariable model, the association between pre-treatment with statins and smaller infarct size persisted (odds ratio [OR] for CK-MB >5 times the ULN 0.49, 95% confidence interval [CI] 0.32–0.76, p=0.001). In a subgroup analysis of P admitted with STEMI, this correlation was confirmed after a multivariable model, regardless of fibrinolysis treatment (OR 0.49, CI 0.28–0.83, p=0.008).
Conclusions: P admitted with AMI pre-treated with statins had less extensive myocardial infarction, making them an important therapeutic approach in the early phase of acute coronary syndrome. It is particularly important to emphasize the underuse of statins among patients with established atherosclerotic vascular disease.
P493
the physical examination is accurate for the detection of peripheral arterial disease
B Parfrey, D Armstrong, A thakrar, M Nault, D Brouillard, M Matangi
Kingston Heart Clinic, Kingston, Canada
Topic: Peripheral vascular disease
Purpose: Peripheral arterial disease (PAD) is a major risk factor for adverse cardiovascular events. there has been a definite push for wider use of the ankle-brachial index (ABI) as a simple screening tool for PAD. this has occurredperhaps to the detriment of a good physical examination? the purpose of our study was to assess the accuracy of the physical examination to detect clinically significant PAD when compared to the ABI.
Methods: PAD file, the peripheral arterial disease module of CARDIO file, our cardiology database was searched for all patients who had peripheral arterial testing. Patients lower limbs were divided into two groups, those with a normal ABI between 0.91 − 1.30 and those with an abnormal ABI of <0.91. Peripheral pulses were graded as either absent or present. Absent was graded as (0/3), present but reduced (1/3), normal (2/3) or bounding (3/3). Femoral bruits were graded as either present (1) or absent (0). Using the ABI as the gold standard, the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and overall accuracy were calculated for the, dorsalis pedis pulse (DP), the posterior tibial pulse (PT), both pedal pulses, for the presence or absence of a femoral bruit and finally for a combination of both pedal pulses and the presence or absence of a femoral bruit.
Conclusions: the clinical examination of the peripheral arterial foot pulses and the auscultation for a femoral bruit has a high degree of accuracy (94.1%) for the detection or exclusion of PAD when compared to the ABI. If both peripheral foot pulses are present in both lower limbs and there are no femoral bruits, the specificity and negative predictive values of 98.6% and 95.0% respectively makes the measurement of the ABI seem redundant. the emphasis in PAD detection should be directed towards a good physical examination.
Quality of life and functional capacity following peripheral arterial disease exercise programme
MM Guidon1, H Mc Gee1, C Kelly2
1Royal College of Surgeons in Ireland, Dublin, Ireland, 2Beaumont Hospital, Dublin, Ireland
Topic: Peripheral vascular disease
Purpose: Peripheral arterial disease (PAD) is a chronic, progressive disease with a significant impact on functional capacity and quality of life (QOL). the main aim of treatment is maintenance or improvement in quality of life by eliminating ischaemic symptoms and preventing progression to vascular occlusion. the purpose of this study was to determine the effects of participation in a supervised exercise programme on functional capacity and quality of life in patients with intermittent claudication (IC).
Methods: Forty-two claudicants (ABI < 0.9) were randomly allocated to a control (n=16) or exercise group (n=26). thirteen subjects withdrew resulting in 31 subjects available for assessment at 12 weeks (control n=14; exercise n=17). the control group received usual care. the exercise group participated in a twice-weekly supervised exercise programme for 12 weeks. Subjects completed functional capacity (Walking Impairment Questionnaire WIQ) and disease-specific quality of life (Intermittent Claudication Questionnaire ICQ) questionnaires at baseline and at 12 weeks. the WIQ has been validated to detect changes in community-based walking ability and to monitor the effectiveness of therapeutic interventions. the ICQ has been validated to identify small but important changes in quality of life with a lower score indicating a better quality of life.
Results: the mean age of participants was 67 (+/— 8.12 years) and 70.5% were male. Functional Capacity:
Exercise Group
Increases were observed in all WIQ scores with a statistically significant increase in the WIQ Distance score (t=–2.71, p < .016). Mean increase was 15.18 (95% CI. 27.13 to 3.2).
Control Group
Scores for the WIQ Stair-Climbing and Distance categories decreased with a marginal increase in the WIQ Speed score. None of the changes were significant.
Quality of life:
Exercise group
there was a statistically significant decrease in ICQ scores from baseline (M= 34.11, SD 19.81) to 12 week follow- up (M= 24.37, SD 17.94), t=3.46, p<.003). Mean decrease was 9.74(95% C.I 3.77 to 15.72).
Control group
No significant difference was demonstrated in the control group.
Conclusion: Health-related QOL scores provide a useful and valid outcome measure in the evaluation of therapeutic effectiveness and factors that affect patients directly e.g. social and physical functioning. In this study a significant improvement in quality of life was demonstrated following participation in a 12-week supervised exercise programme. Improvements were also noted in walking speed, distance and stair-climbing ability.
P495
the features of lower extremity arterial disease in women: is it different from that in men?
V Aursulesei, A Cozma, R Popa, MD Datcu
University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
Topic: Peripheral vascular disease
Purpose: To highlight the differences in the presentation, diagnosis and treatment of peripheral (lower extremity) arterial disease (PAD) based on gender.
Material and Methods: We analysed 1574 consecutive patients (920 clinical symptoms of PAD, 654 other atherosclerotic cardiovascular disease). Patients with PAD were evaluated by contrast angiography and followed up for 2.3 ± 0.4 years after revascularization/lower limb amputation. the cardiovascular risk profile and subclinical organ damage, ankle-brachial index (ABI) were evaluated in the entire cohort. All parameters were compared between females (group 1) and males (group 2) for characterization of PAD.
Results: the overall prevalence according to gender was 21.7% in symptomatic PAD and 29.3% in asymptomatic PAD for females (73.7% and 41.5% in males). Females were significantly older than males (mean 5.7 years older, p<0.03) and composed a higher proportion of patients over 70 years old (58.6% vs 51.2%) in symptomatic PAD. Diabetes and dyslipidemia were similar in prevalence between the groups, but smoking had a higher prevalence in males (89.2% vs 54.7%, p<0.001), irrespective the clinical stage of PAD. Arterial hypertension and abdominal obesity were more prevalent in females with asymptomatic PAD (43% vs 26.3% and 31.75 vs 11.02%, p<0.05). Among females, 23.5% had a history of coronary heart disease (37.2% in males, p<0.02), 31.6% IMT >0.9 mm (56.1% in males, p<0.02), without significant differences between LVMI and microalbuminuria prevalence. the distribution according to clinical presentation was 81% for stages III and IV Leriche in group 1 compared with 73% in group 2 (p<0.001), with a higher incidence of successful revascularization in males (19% vs 12.7%). ABI was significant lower in females compared with males only for stage IV Leriche (—0.18±0.002, p<0.05). In group 2 there were more prevalent extended arterial lesions (32.7% vs 15.6%, p<0.001) and iliac arteries thrombosis (11% vs 3.7%, p<0.02). At the end of follow-up period, 62% of females were taking antiplatelet agents (vs 78% males) and 34.6% IECA (vs 18.8% males), without significant difference for using statins.
Conclusions: In our study the higher prevalence of PAD in females is not confirmed, except the subgroup over 70 years old. there is a later diagnosis for PAD compared with males, related with decreased ABI, advanced clinical status and poor prognosis. PAD is often a “systemic disease” in females, so improved active detection, aggressive risk factor modification and adequate therapy are strongly necessary for controlling the incidence and evolution of PAD.
P496
After Acute Coronary Syndrome, diabetic patients with Peripheral Vascular Disease remain at high risk of cardiovascular events despite secondary prevention measures
M Lafitte1, L Barandon1, YP Pucheu1, X Pillois2, H Gin3, J Bonnet3, T Couffinhal3
1University Hospital of Bordeaux - Hospital Haut Leveque, Department of Cardiology, Pessac, France, 2University Bordeaux 2, Inserm U828, Pessac, France, 3Hopital Haut Leveque and Bordeaux, Victor Segalen University, Pessac, France
Topic: Peripheral vascular disease
Background: Peripheral vascular disease (PVD) is associated with a high risk of cardiovascular events after an acute coronary syndrome (ACS). the responsibility of insufficient control of risk factors and drug prescription has not been established in explaining the increased morbid-mortality rate in patients with PVD in post ACS.
Methods and results: 851 patients with an ACS benefited from an intensified intervention focusing on evaluating risk factors and atherosclerosis lesions, and on optimizing treatment and education. We compared its impact on long-term risk factors, medication observance and cardiovascular (CV) outcomes in two groups (1) with Coronary Artery Disease (CAD) alone (n=715, 84.0%), (2) with CAD and PVD (n=136; 16.0%). At a median follow-up of 18.6 months, the two groups reached recommended secondary prevention goals and showed no significant difference in drug prescription. PVD was not associated with minor CV events (HR 1.32; 95% CI 0.57–3.02) but remained independently associated with major CV events (HR 2.15; 95% CI 1.12–4.13) and total CV events (HR 1.76; 95% CI 1.05–2.93) (p<0.05). this risk was significantly higher in CAD patients carrying both PVD and diabetes (HR2, 87; 95% CI 1.52–5.43; p=0.0012), but not in PVD patients without DM (HR 1.35; 95% CI 0.71–2.56; p=0.35), nor in diabetic patients with out PVD (HR 1.11; 95% CI 0.68–1.81; p=0.68) compared to patients with CAD alone.
Conclusion: Despite optimization of risk factor control and drug prescription after ACS, patients with both PVD and diabetes carry a 2.9 fold risk excess of CV events at 18 months follow-up compared to CAD alone, still this risk excess is not significant in PVD patients without diabetes or in diabetic patients without PVD.
P497
Direct renin inhibition in complex therapy of decompensated congestive heart failure
A L Anna L Volkova1, GP Arutyunov2, NA Bylova2, II Dayter1
1City Clinical Hospital 4, CCU, Moscow, Russian Federation, 2Russian State Medical University, Department of Internal Diseases, Moscow, Russian Federation
Topic: Heart disease
Chronic heart failure (CHF) usually associated with decrease of blood pressure that leads to decreasing of perfusion pressure in kidney glomerule. High doses of diuretics lead to decrease of glomerule filtration. We suggest that aliskiren may be helpful in complex therapy of CHF.
Methods: 69 patients with CHF, who were hospitalized due to decompensation of CHF of ischemic genesis. All of these patients receive standard therapy: diuretics (i/v), ACE inhibitors (ACEi), cardiac glycosides (i/v), β-blockers. All patients were randomized in two groups: first group (n=34) receive aliskiren (150 mg a day) in addition to standard therapy, second group (n=33) placebo. At day 1, 8, 14, 28 pulse, blood pressure, level of NT-pro-BNP, urine volume, weight, glomerular filtration rate (GFR) (by MDRD), Na in urine were evaluated. At day 1 and 28 ejection fraction, level of Na in urine, activity of renin in plasma were evaluated. Study was approved by local ethical committee.
Results: at baseline urine volume was 1454±107 ml/24 h, in I group at day 2 urine volume increase to 2364± 174 ml/24 h, in II group only at day 4 urine volume increase to 2069± 101 ml/24 h. At baseline GFR was 73, 1±8,5 ml/min/SA. In I group statistically significant increase of GFR at day 3 − 119,5±10,4 ml/min/SA (p<0.05), in II group at day 8 GFR was 87,3±9,6 ml/min/SA At baseline NT-pro-BNP was 3226,7±267,2 pg/ml, at day 8 in I group this index decreased to 1886,8±95,9pg/ml, at II group-2613,7± 134,5 pg/ml. Baseline Na in urine was 122,5±9,8 mmol/24 h, at day 8 this value in I group was 235±17,5 mmol/24 h, in II group 159,7±13,4 mmol/24 h. Activity of renin in plasma: at baseline 9,4±1,5 ng/ml/h, at day 8 in I group 7,1±1,6 ng/ml/h, in II group 9,6±2,1 ng/ml/h. Also use of aliskiren associated with decrease of duration of hospitalization.
Conclusions: in patients with III-IV FC CHF use of aliskiren in complex therapy leads to faster compensation and low duration of hospitalization.
P498
Left ventricular remodeling is related to oxidative stress in patients after first myocardial infarction
MN Dekleva1, J Suzic Lazic1, S Mazic2
1Clinical Hospital Center Dr D Misovic, University Clinic for Internal Medicine, Belgrade, Serbia, 2Institute of Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Topic: Heart disease
there is growing evidence for a role of oxidative stress in the processes underlying cardiac remodeling after acute myocardial infarction (AMI). Exercise is well-recognized model of oxidative stress.
Aim: We investigated the role of oxidative stress in late cardiac remodeling after first MI.
Methods: Left ventricular (LV) and left atria (LA) diameters was measured by M mode echocardiography, LA volume, LV volumes normalized by body surface area (EDV/bsa, ESV/bsa), ejection fraction (LVEF) with a modified Simpson s rule. Mitral inflow velocities (E and A), E/A, and mitral regurgitation (MR) were assessed by Doppler. All examination obtained during first week and six months after AMI.
All patients underwent incremental bicycle exercise testing with modified Bruce protocol whereas respiratory exchange ratio > 1 was taken to indicate maximal effort. Superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity in blood were evaluated before and after exercise with commercially available kits (Randox).
thirty one patients aged 53±5 enrolled in the study in first week and 6 months after first MI with mild to moderate LV remodeling and preserved systolic function.
Results: Antioxidative defense was attenuated in patients after first AMI according to decrease in SOD from 1051,77 to 1005.82U/gHb, p = 0.007 increase of Gpx (from 40.87 to 44.80 U/gHb, p = 0.078). there were negative correlation between changes in LV volumes during six months (?EDV/bsa and ?ESV/bsa) and antioxidative response of SOD (r= —0.420, p = 0.009; r= –0.554, p = 0.001). Enlarged LA was related with lower response of GPx (r = –0.530, p = 0.001). Severity of MR closely correlated with attenuated response of SOD (r = –0.450, p = 0.011)
Conclusion: Even mild to moderate LV remodeling in patients after first MI with preserved systolic function and coronary reserve is related to increased level of oxidative stress.
P499
Can the QRS duration predict the mid term outcome of patients with right ventricular pacing for acquired atrioventricular block?
E Belu1, R Musetescu1, C Bataiosu1, M Popescu1, D -D Ionescu1, M Cosulschi2, V Mechirova3, N Florescu1
1Cardiology Center, Craiova, Romania, 2University Craiova, Romania, 3University of Medicine, Kosice, Slovak Republic
Topic: Heart disease
Background: Chronic right ventricular apical pacing is known to be associated with cardiac dyssynchrony and impaired left ventricular (LV) function. Our study aimed to assess the prevalence and clinical predictors for the development of LV systolic dysfunction after long-term RV apical pacing in patients with acquired atrioventricular (AV) block who require permanent pacing.
Methods: We studied the clinical outcomes after mid-term (>90% ventricular pacing) RV apical pacing in 44 patients with high degree acquired atrioventricular (AV) block implanted in our hospital with VVI pacemakers. Patients were divided into 2 subgroups: the first one without a LV systolic dysfunction (mean ejection fraction EF>50%) and the second subgroup with an EF <50%. We compared age, sex, hypertension, coronary artery disease, paced QRS duration and different echocardiographic measurements (including conventional Doppler parameters and tissue Doppler imaging TDI) between the 2 subgroups. the follow up period lasted for 12 ± 2 months.
Results: RV apical pacing was associated with LV systolic dysfunction in 33 % of patients with high degree AV block from the subgroup with normal EF. In a multivariate regression, after adjusting for the cardiovascular risk factors mentioned before, a paced QRS duration might independently predict LV systolic dysfunction. A paced QRS duration more than 165 msec seemed to be the cutoff value in order to differentiate the LV systolic dysfunction from normal LV function.
Conclusions: A paced QRS duration more than 165 msec is associated with LV systolic dysfunction after permanent RV apical pacing in patients with high degree AV block. the echocardiographic parameters of the ventricular function can help us to identify patients with baseline abnormal LVEF who develop a worse clinical outcome after permanent right ventricular apical pacing.
P500
CRT response predicts occurrence of atrial fibrillation in non-ischemic dilated cardiomyopathy: new insights from a prospective study
V Marino1, S D'ascia1, C D'ascia1, C Arturo2, V Liguori2, G Persiano2, M Chiariello1, G Santulli1
1University of Naples Federico II, Department of Internal Medicine - Cardiology, Naples, Italy, 2University of Naples Federico II, Department of Clinical and Experimental Medicine, Naples, Italy
Topic: Heart disease
Purpose: Albeit several studies examined the association between cardiac resynchronization therapy (CRT) and atrial fibrillation (AF) in heart failure (HF), results are still unclear and quite conflicting. So, we designed a single-center prospective study to determine whether CRT has a favorable effect on the incidence of new-onset AF in a homogeneous population of patients with non-ischemic idiopathic dilated cardiomyopathy and severe HF.
Methods: We enrolled 58 patients, AF naÿve when received CRT. After 1 year of follow-up our population was subdivided into responders (72.4%) and non (27.6%), so to compare the incidence of AF after 1, 2 and 3 years of follow-up in these two groups.
Results: there was a favorable improvement of clinical status in the group of CRT responders, evidenced already at 1 year follow-up, and corroborated after 2 and 3 years. Specifically, we evidenced the positive effects of CRT in NYHA functional class, LVEF, reduction of mitral regurgitation, 6-min walk test, Minnesota Living With HF Quality of Life score, oxygen uptake at peak exercise and at anaerobic threshold.
Already after 1 year, there is a significant (p<0.05) difference in new-onset AF in non-responder patients respect to responders (18.2% vs 3.3%). these data are confirmed at 2 year (33.3% vs 12.2%) and 3 year (50.0% vs 15.0%) follow-up.
In particular, at 3 year follow-up, non-responders have an increased risk to develop new-onset AF (OR=5.67, 95% confidence interval = 1.36–23.59, p=0.019). Furthermore, Kaplan-Meier curves showed a significant difference in developing new-onset AF between the two groups (p<0.05).
Moreover, we identified two echocardiographic pre-implantation parameters useful to select responder patients: the left ventricular end-diastolic diameter and the degree of mitral regurgitation.
Conclusions: this is the first study that analyzes long-term effects of CRT in a homogeneous population of patients with non-ischemic dilated cardiomyopathy. the present work suggests a possible favorable role of this non-pharmacological therapy, on the prevention of AF. Now we are studying bioptic cardiac samples from our patients to explain the immost molecular mechanisms of atrial reverse remodeling.
P501
Response to the cardiac resynchronization therapy: the muscular metabolic pathway?
J Jauussaud, PB Blanc, P Bordachar, R Roudaut, H Douard
University Hospital of Bordeaux - Hospital Haut Leveque, Department of Cardiology, Pessac, France
Topic: Heart disease
Histological, metabolism and functional changes in peripheral muscle in heart failure leads to a shift from aerobic to early anaerobic metabolism during exercise, high production in carbon dioxide and in peak respiratory exchange ratio (V02/VC02). Muscular impairement could increase sympathetic tone by ergoreceptor overactivation leading to exaggerated hyperventilation. this study was designed to investigate exercise cardio-pulmonary parameters before and 6 months after cardiac resynchronization (CRT) parameters and in particular ventilatory data and peak respiratory exchange ratio.
40 patients (32 males, 59 ± 12 years) performed cardio-pulmonary exercise test with gaz exchange measurement and echocardiographic evaluation before and 6 months after CRT. the peak respiratoty exchange ratio was significantly reduced from 1,16 ± 0,14 to 1,11 ± 0,07 (p=0,02) suggesting the possibility of increased efficiency of energy production in skeletal muscle with less anaerobic metabolism by a shift from a glycolytic to an oxidative metabolism. Peak V02, VE/VC02, exercise duration, peak workload, peak circulatory power and NYHA were improved after CRT (13 ± 4 to 16 ± 5 ml/kg/min (p=0,02), 45 ± 16 to 39 ± 13 (p=0,003), 406 ± 175 to 469 ± 164 seconds (p=0,01), 78 ± 18 to 86 ± 26 watts (p=0,02), 1805 ± 844 to 2225 ±1171 mmHg.ml/kg/min (p=0,009) and 3 ± 0,35 to 1,88 ± 0,4 (p=0,01)). In addition, left ventricular ejection fraction and end-systolic volumes were improved from 24 ± 8 to 29 ± 7 % (p=0,005) and from 157 ± 69 to 122 ± 55 ml (p=0,002).
In conclusion, we suggest that CRT leads to an increase in peripheral blood flow by improvement in haemodynamic condition. this leads to an increase in oxidative metabolism, in oxygen consumption with ATP production by the beta oxydation pathway and in a reduction in the carbon dioxyd production resulting in a decrease in peak respiratory exchange ratio. these changes could reduce sympathoexcitation and the exaggerated hyperventilation during exercise.
P502
Myocardial performance index in children with dilated cardiomyopathy
A Jurko, A Jurko
Jessenius Medical Faculty, Martin, Slovak Republic
Topic: Heart disease
Background: Dilated cardiomyopathy is related to contraction and relaxation abnormalities of the ventricle. Isolated analysis of other mechanism may not be reflective of overall cardiac dysfunction. A combined myocardial performance index (isovolumic contraction time plus isovolumic relaxation time divided by ejection time (Tei-index) has been described which may be more effective for analysis of global cardiac dysfunction than systolic or diastolic measures alone.
Objective: the aim of this study was to investigation to evaluate the Tei-index in clinical maniferstations of dilated cardiomyopathy, documented by ECG, X-ray and echocardiohraphic signs.
Methods: 15 children had dilated cardiomyopathy defined by clinical symptoms and with pathological criteria evaluated by ECG examinations, on x- ray picture and by echocardiographic analysis. Using conventional echo-Doppler methods parameters assessed were: heart rate (HR), systolic blood pressure (BPs), diastolic blood pressure (BPd), body mass index (BMI), end-systolic volume (ESV), end-diastolic-volume (EDV), systolic volume (SV), ejection fraction (EF%), peak velocities of early (E) and late (A) diastolic filling, fractional shortening (FS). the Tei-index was obtained by subtracting ejection time from the interval between cessation and onset of the mitral flow and divided by ejection time.
Results: Mean age, height, HR, BPs, BPd, BMI, SV were similar in children with dilation forms of cardiomyopathy and in control group. Compared to the participants in control group, children with dilated cardiomyopathy had increased ESV, EDV, EF, LVM, FS, the mitral E velocity, mitral A velocity and left ventricular myocardial performance index. the LVMPI in healthy children were 0,32 +−0.03 and in 2nd group with dilation forms of cardiomyopahy 0,70 +—0,16. LVMPI measurements were statistically significant different between both groups (p = 0.0001).
Conclusion: the control group and children with dilation forms of cardiomyopathy did differ with respect to many hemodynamic parameters by two dimensional echocardiography. the ejection fraction was reduced in children with dilation form of cardiomyopasthy (61 ± 10 v.s 43 ± 11%, p = 0.001). the Tei-index was easily and reproducibly measured in all subjects. the mean value of the Tei-index was significantly different between the control group and children with cardiomyopathy. No correlation was observed between the Tei-index and heart rate, systolic blood pressure or diastolic blood pressure.
P503
Left atrial dimension predicted stroke risk for Chinese adults without atrial fibrillation – a report from the Chin-Shan Community Cardiovascular Cohort study
1Far Eastern Memorial Hospital, Taipei, Taiwan, 2National Taiwan University, Taipei, Taiwan, 3National Taiwan University Hospital, Taipei, Taiwan, 4China Medical University, Taichung, Taiwan
Topic: Cardiovascular epidemiology the Chin-Shan Community Cardiovascular Cohort study
Background: Evidence on left atrial dimension for predicting cardiovascular events is inconclusive. We explored the prediction power of left atrial dimension for stroke and all-cause death in a Chinese population.
Methods: We recruited 2638 subjects having echocardiography without prior atrial fibrillation/stroke in the Chin-Shan Community Cardiovascular Cohort (CCCC) study. Left atrial dimension was indexed by body surface area to obtain left atrial dimension index (LADI). the end-points were stroke and all-cause death over a median follow-up of 16.2 years. Multivariate Cox regression analysis was used to estimate the relative risks between participants stratified by quartiles of LADI.
Results: the simple relative risk for stroke for participants in the highest quartile of LADI compared with those in the lowest quartile of LADI was 1.93 (95% CI, 1.28 to 2.29, p for trend=0.001) and the risk reduced slightly after multivariate adjustment (relative risk 1.58, 95% CI, 1.00 to 2.50, p for trend=0.046). In subgroup analysis, a significant association between quartiles of LADI and risk of stroke in adults < 65 years of age was found.(p for trend=0.0003) the adjusted relative risk of stroke was 3.09 (95% CI, 1.68 to 5.67) in participants in the highest quartile of LADI compared with those in the lowest quartile. In adults >= 65 years, LADI was not associated with stroke.(p for trend=0.57) LADI was not associated with the risk of all-cause death. Participants with LADI >= 24.0 mm/m2 carried significantly higher risk of stroke (adjusted relative risk: 1.78, 95% CI, 1.24 to 2.56, p = 0.002) compared with participants with LADI < 24.0 mm/m2.
Conclusions: Our data indicated an association between LADI and stroke in a Chinese cohort without atrial fibrillation, especially in adults aged < 65 years.
Cumulative percentage
P504
Left ventricular mass and risk of cardiovascular events and all-cause death among ethnic Chinese - the Chin-Shan Community Cardiovascular Cohort study
1Far Eastern Memorial Hospital, Taipei, Taiwan, 2National Taiwan University, Taipei, Taiwan, 3National Taiwan University Hospital, Taipei, Taiwan, 4China Medical University, Taichung, Taiwan
Topic: Cardiovascular epidemiology the Chin-Shan Community Cardiovascular Cohort study
Background: We conducted this cohort study involving ethnic Chinese population to explore the association between left ventricular mass and cardiovascular events and all-cause death, and to define the cut-off value of left ventricular mass for risk stratification.
Methods: We evaluated 2604 participants aged >= 35 years in the Chin-Shan Community Cardiovascular Cohort (CCCC) study who had received echocardiography without previous cardiovascular events. Left ventricular mass was divided by body surface area to obtain left ventricular mass index (LVMI). the end-points were all-cause death and incident cardiovascular events including coronary heart disease and stroke over a median follow-up of 14.4 years.
Results: By multivariate Cox regression analyses, a linear relationship between LVMI and cardiovascular events was found (adjusted hazard ratio 2.01, 95% CI, 1.11 to 3.63, for the highest quintile of LVMI compared with the lowest quintile, p for trend=0.001). A J-shape relationship between LVMI and all-cause death was observed, with the test for a linear relationship being rejected (p=0.003). the adjusted hazard ratios of all-cause death were significantly lower in the second quintile (0.58, 95% CI, 0.40 to 0.84) and in the third quintile (0.68, 95% CI, 0.47 to 0.96) of LVMI compared with the lowest quintile. the proposed cut-off value of LVMI was 105 g/m2 for prediction of cardiovascular events.
Conclusion: A linear relationship between LVMI and cardiovascular events, and a J-shape relationship between LVMI and all-cause death were found. the cut-off value derived from our Chinese population was lower than the frequently applied value derived from Caucasian population.6674520091119024105.jpg
P505
Significance of borderline and high ankle brachial index in the assessment of atherosclerosis
R Bedair, H Rizk, H Yehya, S El Tobgi
Cairo University, Faculty of Medicine, Cairo, Egypt
Topic: Cardiovascular epidemiology
Background: A low (<0.9) ABI (ankle brachial index) is a marker of advanced atherosclerosis. the literature on the association between a borderline (0.9–0.99) or high ABI (>1.3) and atheroslcerosis is sparse and conflicting.
Aim: To assess the association between different categories of ABI and atherosclerosis in the coronary, carotid and proximal femoral beds.
Methods: We included 247 consecutive patients aged >55 years undergoing coronary angiography. the carotid & femoral bifurcations were scanned for plaques and combined plaque intima media thickness measurement (CPIMT= maximum IMT or in the presence of plaque, the maximum plaque thickness). Coronary angiograms were reviewed for the number of vessels with >50% stenosis. Patients were categorised into 4 groups according to their ABI.
Results: the highest rates of single & multiple plaques were seen in the Low and High ABI groups with 40% patients in these two groups showing plaque in the 3 beds. the Borderline ABI group showed higher rates of atherosclerosis in the femoral bed when compared to the normal ABI group. the CPIMT was significantly lower in the Normal ABI group when compared to all other ABI groups.
Conclusion: A U-shaped association between atherosclerosis and ABI exists, with high rates observed at both extremes. A borderline ABI signifies local atherosclerosis in the femoral bed, while a high ABI is associated with significant and widespread atheroslcerosis. Any deviation from a ‘normal’ ABI is a marker of atherosclerosis.
Low ABI
Borderline ABI
Normal ABI
High ABI
p for
(<0.9) n=64
(0.9–0.99) n=35
(1.0–1.3) n=136
(>1.3) n=12
trend
Age (years)
63±6
64±6
62±5
62±6
NS
Diabetes Mellitus
28 (44%)
22 (63%)
79 (58%)
8 (67%)
NS
Coronary artery disease
60 (94%)
32 (91%)
107 (79%)
11 (92%)
0.02
Multivessel CAD
49 (77%)
13 (37%)
80 (59%)
8 (67%)
0.002
Carotid plaque
48 (7.5%)
18 (51%)
74 (54%)
11 (92%)
0.003
Multiple carotid plaque
30 (47%)
10 (29%)
44 32
7(58%
NS
Femoral plaque
37(58%)
22 (63%)
48 (35%)
6 (50%)
0.003
Multiple femoral plaque
19 (30%)
10 (29%)
16 (12%)
3 (25%)
0.009
Plaque in 3 beds
26 (41%)
10 (29%)
22 (16%)
5 (42%)
0.001
Carotid CPIMT mm mean±SD (95% CI)
2,4±1.4 (2.0–2.7)
2.2±1.5(1.7–2.8)
1.8±1.0 (1.6–2.0)
3.0±2.1 (1.7–4.4)
0.001
Femoral CPIMT mm mean±SD (95% CI)
2,1±1.0(1.9–2.4)
2.0±0.9(1.7–2.3)
1.6±0.8 (1.4–1.7)
1.9±1.1 (1.1–2.6)
<0.001
P506
N-terminal pro B-type natriuretic peptide, C - reactive protein and gamma glutamyl-transferase are independent risk markers in patients with stable coronary heart disease
E Bode, T Wuppinger, T Bode, H Alber, H Ulmer, O Pachinger, J Mair
Innsbruck Medical University, Innsbruck, Austria
Topic: Biomarkers
Biomarkers are gaining interest for risk stratification in patients with stable coronary artery disease (CAD).the aim of the present study was to determine the importance of novel recently proposed markers in the context of multimaker testing and classical risk factors.
Methods: We enrolled 525 consecutive patients with stable CAD from March 2004 until end of February 2005 in whom CAD was verified by coronary angiography (CAG). N-terminal pro B-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hs-CRP), and gamma-glutamyltransferase (?GT) were measured as part of the routine laboratory testing before CAG. the severity of CAD was assessed by angiographic criteria and ventricular function was quantified by ventriculography or echocardiography. Mortality and the combined endpoint (mortality, need for coronary revascularization, myocardial infarction, rehospitalization for cardiac causes, or stroke) were evaluated with the help of death registry data, chart review, or telephone interviews. From these 525 patients 394 had a complete follow-up, the remaining patients could not be reachedor declined an interview. the T-test, Mann Whitney U test and the Chi square test were used for group comparisons. the prognostic value of each variable was assessed univariately by means of Kaplan Meyer survival rate analysis and by the multivariate Cox regression analysis. P-values <0.05 were considered as statistically significant.
Results: Demographic, clinical, CAG and laboratory findings did not differ significantly between the initial and final study population. the average follow-up period was 1177 days. the univariate analysis showed that the standard risk factors apart from diabetes mellitus and impaired renal function at the time of CAG were of no prognostic relevance for prediction of outcome defined as mortality or combined endpoint. the severity of CAD and a status post coronary bypass surgery or coronary intervention and the ventricular function were of prognostic relevance. NT-proBNP, hs-CRP and ?GT were significant predicators of mortality, however only NT-proBNP was a significant predictor of the combined endpoint. In an age- and gender adjusted multivariate analysis, NT-proBNP was the strongest independent predictor of the combined endpoint (odds ratio 2.92). All three laboratory parameters remained independent risk markers for mortality in the multivariate analysis. NT-proBNP, however, revealed the highest odds ratio.
Conclusion: In comparison with other tested novel biomarkers and classical risk factors, NT-proBNP was the most predicitve prognostic marker in patients with stable CAD.
P507
Tei index obtained from tissue Doppler imaging: correlation with NTproBNP levels in patients with left ventricular dysfunction
C Mornos, I Zacharopoulou, SI Dragulescu
Institute of Cardiovascular Diseases, Timisoara, Romania
Topic: Biomarkers
the myocardial performance index (Tei index) determined by the pulsed Doppler method is a simple and noninvasive measurement for assessing global left ventricular (LV) function. this index can also be obtained by tissue Doppler imaging (Tei-TDI). N-terminal pro-brain natriuretic peptide (NTproBNP) is recognized as a reliable marker of systolic and diastolic LV function.
Aim: To assess the relationship between Tei-TDI and NTproBNP levels in patients with left ventricular dysfunction, in sinus rhythm.
Methods: Conventional echocardiography and Tissue Doppler Imaging (TDI) were performed simultaneously with NTproBNP determination in 135 consecutive patients with left ventricular dysfunction, in sinus rhythm, referred for echocardiography. Patients with inadequate echocardiographic image, paced rhythm, mitral stenosis, significant primary or organic mitral regurgitation, mitral prosthesis, acute coronary syndrome, coronary artery by-pass within 72 hours or renal failure were excluded. the remaining 113 patients (age 62 ±13 years) formed our study group. Peak early diastolic transmitral velocity (E, using pulsed Doppler) / peak early mitral annular diastolic velocity (Ea, using TDI) ratio and the peak systolic velocity during ejection in TDI of the mitral annulus (Sa) were determined; the average of the velocities from the septal and lateral site of the mitral annulus was used. From TDI recordings, the time interval during diastole (a') and the duration of the systole Sa-wave (b') were measured. the modified Tei index obtained by TDI was calculated as (a’ - b')/b'. Tei-TDI was measured at the septal and lateral sites of the mitral annulus, and the average was utilized.
Results: Simple regression analysis demonstrated a significant linear correlation between Tei-TDI and NTproBNP (r=0.70, p<0.001). Significant but weaker correlations were found between NTproBNP and E/Ea (r=0.56, p<0.001), pulmonary artery systolic pressure (r=0,51, p<0,001), Sa (r= –0.45, p<0.001), E wave (r=0.33, p=0.001), LVEF (r= –0.32, p=0.003), mitral E deceleration time (r= –0.29, p=0.002) and Ea (r=—0.25, p=0.008). We couldn t demonstrate significant relationships between NTproBNP and left atrial diameter, left atrial surface or left atrial volume. the optimal Tei-TDI cut-off for prediction of NTproBNP levels >1200 pg/ml was 0.51 (sensitivity of 87% and specificity of 74%) with 88% accuracy.
Conclusions: Tei-TDI had a good correlation with plasma NTproBNP levels and can be used to predict high levels of serum NTproBNP in patients with left ventricular dysfunction, in sinus rhythm.
