POSTER SESSION 5puma.isti.cnr.it/rmydownload.php?filename=cnr.ifc/... · 95%:1,84-6,59); p , 0,001; C3 vs. C1: HR ¼ 3,18 (IC 95%:1,62-6,21); p ¼ 0,001. Conclusions: In patients

POSTER SESSION 5

Tuesday 24 May 2011, 08:30–12:30

Location: Poster Area

ACUTE HEART FAILURE (DIAGNOSIS, PATHOPHYSIOLOGY,OTHER)

P1157The frequency and serial changes of cardiac troponin release in patients withacute heart failure syndrome who were treated with levosimendan ordobutamine

Y. Cavusoglu; E. Gencer; F. Mutlu; M. Tek; A. Nadiradze; A. Birdane; B. Gorenek;A. Unalir; N. AtaEskisehir Osmangazi University, Eskisehir, Turkey

Purpose: Increasing evidence suggests that episodes of acute heart failure syndrome(AHFS) are associated with transient increases in markers of myocyte injury, such ascardiac troponin (cTn). However, less is known about serial changes in cTn duringtherapy. In contrast to dobutamine (DOB), levosimendan (LEVO) doesn’t increase intra-cellular calcium levels and myocardial oxygen demand and therefore is thought to havecardio protective properties. So, we evaluated 1-) the frequency and serial changes ofabnormal cTn release and 2-) the effects of LEVO and DOB treatments on cTn releasein patients presenting with AHFS.Methods: This study enrolled 122 patients with NYHA class IV AHFS and LVEF ,35%in whom an acute coronary syndrome was not suspected. Forty patients were treatedwith optimal pharmacologic therapy with oxygen, diuretics and intravenous vasodila-tors (control group), 40 patients were treated with a 24-h infusion of LEVO (LEVOgroup) and 42 patients received DOB with a continuous infusion for 24 hours(DOB group) in addition to optimal pharmacologic therapy. Blood samples for cTnImeasurements were obtained from all patients at baseline and 24 h after the initiationof HF therapy. The detectable level of cTnI for the assay used in this study was ≥0.01ng/ml and the 99th percentile of normal healthy individuals was 0.07 ng/ml and cTnIwas considered to abnormal if cTnI was detected above this level.Results: At baseline, 103 patients (84.4%) had a detectable level of cTnI (≥0.01 ng/ml);32 (82%) in control group, 34 (85%) in LEVO group and 37 (88%) in DOB group (p ¼0.263), and 39 patients (32%) had an abnormal level of cTnI (0.07 ng/ml); 17 (43%) incontrol group, 11 (27%) in LEVO group and 11 (26%) in DOB group (p ¼ 0.181). cTnIlevels increased in 44 patients (36%) during HF therapy. In patients treated with LEVOor DOB in addition to optimal pharmacologic therapy, 13 (32.5%) in LEVO group and17 (40.5%) in DOB group developed an increase in cTnI from baseline levels. 14 (35%)patients in control group had an increase in cTnI levels from baseline. No significantdifference was found among three groups in the percentage of patients who have anincrease cTnI during therapy (p ¼ 0.687)Conclusions: This study suggests that majority of patients with AHFS have detectableor abnormal levels of cTnI at admission and one-third of patients develop cTnI increaseduring the treatment period. The changes in cTnI with LEVO and DOB treatments donot differ from controls and both inotropic regimens have a similar effect on cTnIrelease.

P1158The prognosis of patient hospitalised with acute heart failure on departmentswith 24 hour cath lab service - Acute HEArt Database (AHEAD) main registry

J. Spinar1; J. Parenica1; J. Vitovec1; L. Spinarova1; R. Miklik1; P. Widimsky2; A. Linhart2;J. Jarkovsky1; L. Dusek1

1University hospital, Brno, Czech Republic; 2University Hospital, Prague, CzechRepublic

Aims: The objectives of the Acute HEArt Database main (AHEAD main) was to assesspatients characteristics, aetiology, treatment and outcome of acute heart failure (HF) in

districts with centralised care of patients with acute coronary syndroms. The registrywas performed in 7 centres with cath lab and with non stop 24 hour angiography ser-vices and centralised care of acute coronary syndromes patients in districts of about 3million inhabitants.Methods and results: From 4 153 included patients, 526 (12.66%) patients died duringhospi-talisation, 3 627 patients were discharged home. AHF patients were elderly,average age 71.5+12.4 years and males were younger (68.6+12.4 years), comparedwith females (75.5+11.5 years) p , 0.001. Females hospitalised with HF had highersystolic blood pressure (BPs) (140 mmHg vs 130 mmHg) and lower ejection fraction(EF) than males (42.7 vs 37,5%). The mean length of hospitalisation was 9.1 + 2.7days, median 7.1 days, 5.5 days for those patients who died and 9.7 days for thosewho were discharged home. The in hospital mortality for both sexes was similar12.7%, in patients without cardiogenic shock 4.2%, in patients with cardiogenicshock 62.7%.Decompensated heart failure was the most common clinical presentation, accountingfor about two third. Cardiogenic shock was seen in 14.7%.Low blood pressure, low ejection fraction, low cholesterol, hyponatremia, hypokalemiaand the use of any inotropic agents were predictive parameters for in hospital mortalityin patients without cardiogenic shock. Invasive ventilation, use of noradrenalin and agewere the most important predictive factors of mortality for patients with and without car-diogenic shock and for both sexes.Conclusion: Females hospitalised with HF are older, have higher BPs and lower EF.The prognosis of both sexes is similar, systolic dysfunction of left ventricle and lowBPs are strong predictors of mortality.

P1159Carbohydrate antigen 125 serial measurements after an admission for acuteheart failure and early readmission

G. Minana Escriva; J. Nunez; J. Sanchis; V. Bodi; P. Palau; M. Olivares; C. Bonanad;S. Ventura; FJ. Chorro; A. LlacerUniversity Hospital Clinic, Cardiology Department, Valencia, Spain

Purpose: Readmission following an hospitalization for acute heart failure (AHF) is a fre-quent problem and its prediction remains a challenge. Although the prognostic value ofcarbohydrate antigen 125 (CA125) on mortality in patients with AHF has beendescribed, the association between CA125 and short-term readmission following anAHF episode remains unknown.Aim: to assess the prognostic value of serial CA125 measurements on short-term read-mission for AHF.Methods: We analyzed 293 consecutive patients admitted with AHF in which CA125was assessed during the index hospitalization and in the first outpatient visit after dis-charge (median 31 days). We established three categories based on categoricalchanges in CA125: C1 ¼ decrease and normalization of CA125 (≤35 U/ml); C2 ¼decrease but no normalization; and C3 ¼ increase and high levels (.35 U/ml) in thefirst ambulatory visit. We assessed the relationship between these categories and therisk of readmission for AHF by Cox regression analysis adjusted for competing events.Results: At 6 months follow up, we identified 54 (18.4%) readmissions for AHF. Categ-orical changes in CA125 were associated with readmission for AHF, so that patients inwhich CA125 increased (C3) or in which decreased but not normalized (C2) had higherreadmission rates than those in which CA125 normalized (C1) (see figure). In multi-variate setting, adjusting for age, systolic blood pressure, heart rate below 60 bmpand the interaction of beta-blockers treatment and heart rate below 60 bmp at thefirst outpatient visit, congestive signs (radiological pleural effusion and/or peripheraledema) during hospital admission, bundle branch block, treatment with diuretics athigh doses (furosemide .120 mg or torasemide .30 mg per day) and mortality as

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competing event, the respective hazard ratios (HR) were: C2 vs. C1: HR ¼ 3,48 (IC95%:1,84-6,59); p , 0,001; C3 vs. C1: HR ¼ 3,18 (IC 95%:1,62-6,21); p ¼ 0,001.Conclusions: In patients discharged for AHF, CA125 changes over time during the firstweeks after an admission for AHF are related with early readmission for AHF.

P1160Profile of the acute decompensated heart failure in children and adolescents:opportunities to improve care of this critically ill population

Moreira1; Diamantino2; Diamantino2; A. Costa2; F. Araujo2; L. Costa3

1Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte,Brazil; 2Faculdade Estadual de Montes Claros, Montes Claros, Brazil; 3Faculdade deCiencias Medicas de Minas Gerais, Belo Horizonte, Brazil

Purpose: Heart failure (HF) is the major cause of hospitalization in our country.However, few studies have evaluated HF in children and adolescents.This study triesto establish the profile of HF patients (PTS) in the age range 0 to 19 years hospitalizedwith acute decompensated HF, describe its etiology, clinical characteristics, clinicalmanagement and estimating the re-hospitalizations and the survival curve.Methods: 4,757 patients in the age range 0 to 19 years, admitted in five hospitals fromApril 1, 2008 to March 31, 2009, were prospectively interviewed, trying to identify thosewith cardiopathy diagnostic. 131 patients were identified with cardiopathy; amongthese 75 showed some HF signals or symptoms or were already being treated forthis syndrome. The only exclusion criterion was when the PT or the family person didnot agree to take part in the study. The PTS were followed up by phone after their hos-pital discharge for endpoints evaluation.Results: Seventy-five patients were admitted with HF, 62.7% males, 68% in the agerange 0 to 6 years and 44% white. At the admission, 68.7% were congenital cardiopa-thy carriers, 73.6% were in the HF stage C or D, 50% in the functional class IV (NYHA/ROSS) and 37.5% in class III. The length of stay in the hospital was 13.3 days onaverage, with a re-admission rate of 22.7%. The hospital mortality was 6.7% and theoverall mortality 14.7% during the 19 months follow-up, with the survival curveshowing that 89% of the patients were alive after 131 days observation and 86%after 416 days, it also being evidenced by the Kaplan-Meier estimator that the presenceof HF diagnostic increased 6.3 times the risk of death in the cardiopathy group. Thepresence of cardiac murmur was detected on 78.7% of the PTS, followed by hepato-megaly (62.7%) and pulmonary rales (40.3%); third sound was not frequent. TheEco-Dopplercardiography was performed on 85.3% of the PTS and the left ventricularejection fraction (LVEF) was normal for 81.5% of these PTS. Furosemide was the mostused medication (72%), with digoxin, ACE inhibitors and spironolactone appearing inless than 40% of the prescriptions. Dobutamine was prescribed for 30% of the PTS,prostagladine for 10%, beta-blockers for 5.3%, sildenafil for 4% and indometacine for1.3%.Conclusions: The majority of the PTS with HF have congenital cardiopathy with pre-served LVEF and are admitted in the stages C or D and HF classes III or IV; cardiacmurmur is the most frequent signal, functioning as warning for requesting cardiologyevaluations and early treatment largely different from those used for adults.

P1161Clinical characteristics and the outcome of acute heart failure with severe LVsystolic dysfunction at the time of diagnosis: from KorHF Registry

Kim1; SW. Han1; MS. Shin2; DJ. Choi3; JJ. Kim4; ES. Jeon5; MS. Cho6; CC. Chae7;KH. Ryu1

1Konkuk University Hospital, Seoul, Korea, Republic of; 2Gachon University Gil MedicalCenter, Incheon, Korea, Republic of; 3Seoul National University Bun-dang Hospital,Seoul, Korea, Republic of; 4Asan Medical Center, Seoul, Korea, Republic of; 5SamsungMedical Center, Cardiovascular Center, Seoul, Korea, Republic of; 6Chungbuk NationalUniversity Hospital, Cheongju, Korea, Republic of; 7Kyungpook National UniversityHospital, Daegu, Korea, Republic of

Background: In Korea, acute decompensated heart failure (ADHF) becomes moreprevalent and require large amount of public health resources. But very littleinformation is available on the clinical characteristics and prognosis of patients withADHF, especially on the patients with severe LV dysfunction.Methods: KorHF Registry Database composed of 3,200 patients, which enrolled hos-pitalized patients with ADHF from 28 university hospitals from Nov, 2005 to Nov. 2009.According to LVEDD and EF on echocardiogram, patients are classified to pure Mild,Moderate and Severe LV dysfunction groups. Severe LV dysfunction is defined byLVEDD ≥ 63 and EF ≤ 27 which mean 25 percentile values in distribution curve.Results: The total of 388 patients show severe LV dysfunction and 220 patients mod-erate, 216 patients mild respectively. Mean age of severe LV dysfunction is 60.3+15years, which is lower than those of other groups (69.0, 67.1 yrs respectively, p ,

0.01), and Men is more frequent in severe group.(68.2% vs 43%, 58.6%, p , 0.01).Severe group have more frequent history of previous HF(42.9% vs 20.3%, 31% respect-ively, p , 0.01), less frequent history of hypertension, DM and ischemic heartdisease(p , 0.01) Severe group show lower systolic blood pressure(122mmHg vs133mmHg. P , 0.01) at admission. But there are no differences in DBP, HR, BNP,BUN/Cr, Na level at admission. Expected event free survival rate (death or readmission)of severe LV dysfunction group at 1, 2 and 3 year are 0.67, 0.55 and 0.46 respectively,which are not inferior to those of mild or moderate groups.Conclusion: Even on the patients who show severe LV dysfunction at admission,optimal medical therapy is needed and expected to bring non-inferior outcome com-pared to the patients with mild or moderate LV dysfunction.

P1162BNP levels, markers on inflammation and their interrelationship with aorticstenosis

I. Burazor1; M. Burazor1; V. Atanaskovic1; J. Glasnovic1; S. Stamenko2

1Clinical Center, Clinic for Cardiovascular Diseases, Nis, Serbia; 2Institute ofCardiovascular Diseases Vojvodina, Novi Sad, Serbia

Aortic stenosis is a progressive disease of aging with serious complications, amongwhich heart failure is most dramatic and address the bad prognosis. The gold standardfor diagnosis is echocardiogram. Recent retrospective studies have correlated riskfactors commonly associated with coronary and vascular atherosclerosis with an accel-erated rate of aortic valve stenosis.We aimed to investigate markers of inflammation (C-reactive protein, albumin, fibrino-gen and white blood cells count –WBC) in patients presented with aortic stenosis (AS),their interrelationship and interrelationship with echocardiographical findings and BNPlevels.Patients and results: The study included a total of 69 patients with both heart failureand aortic stenosis (65 + 4.3 years of age, 49% females) admitted to our Clinic due toprogressive heart failure. Aortic stenosis was graded by gradient as mild, moderateand severe. Most of the patients had moderated AS with hemodynamic gradientbetween 36 and 64 mmHg, and heart failure by using BNP levels.Both, markers of inflammation and BNP levels were elevated in AS: CRP range from 6.3to 35.5 mg/dl, fibrinogen 5.6 + 1.7 g/l, WBC 9.7 x108G/L; albumin decreased to 41.8mg/l, BNP pg/ml were above 300, and furtehr graded heart failure as mild, moderateand severe. There was no correlation between BNP levels and hemodynamic gradient,but there was a correlation with ejection fraction. Our results suggest the linear corre-lation between inflammatory markers and echocardiographically determined gradientof stenosis.Conclusions: Results of the study suggest that inflammatory pathways might beinvolved in pathogenesis of aortic stenosis, but progression to heart failre is notrelated to degreed of stenosis – detemined by using BNP levels and echo parametars.Further research is to be done to confirm if statins intake might slow the progression ofthe disease.

KorHF Registry (Abstract P1161 Figure)

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P1163Endothelial dysfunction in patients with chronic heart failure and myocardialinfarction

N. Bylova1; GP. Arutyunov1; IM. Plieva2; EA. Kokin3; II. Daiter21Russian State Medical University, Moscow, Russian Federation; 2City Clinical Hospitaln8 4, Moscow, Russian Federation; 3Bakoulev Center for Cardio-Vascular Surgery,Moscow, Russian Federation

Earlier in the study we perform estimation of augmentation index (AI), pulse wave vel-ocity (PWV) and central arterial pressure (CAP) of patients suffering from Acute Myocar-dial Infarction (AMI) in compare with control group of patients suffering from unstableangina but without AMI in anamnesis. The obtained results testified that values of AIand PWV of patients with AMI are significantly higher than in control group and wereconstantly high during all period of hospitalization. We assume that in group of patientswith increased values of AI and PWV frequency of undesired events would be higherthan in control group, compared by all indices, but without AMI and subgroup 2 withnormal values of AI and PWV.Aim: to estimate amount of undesired events for patients suffering from AMI duringhospitalization period in dependence of AI values at the moment of AMI debut.Materials and methods: our study includes patients (n ¼ 45) suffering from AMI withanamnesis of heart failure I-II FC NYHA, average age 63,1+4,2 years. Inclusion criteriaare: age above 20 years, established diagnosis of AMI, Killip II. Control group includedpatients (n ¼ 45) suffering from unstable angina without AMI in anamnesis. On thebasis of previous study all patients were divided into two subgroups: 1 – patientswith high values of AI and PWV, 2 – patients with normal values of AI and PWV. Obser-vation period – 21 days. Study was approved by local ethic committee Moscow CityHospital.Results: during observation period adverse events were registered of 11 patients (24%).6 of those patients (54,5%) were from 1st subgroup and 5 patients (45,5%) were from2nd subgroup. Serious undesired events like relapse of AMI which required patientstransfer from cardiology department to cardioreanimation department occurred with 3of 6 patients (50%) from 1st subgroup. Among other undesired events of 1st subgroupwere: 4 patients (66%) with heart discomfort complains, 3 patients (50%) with generalweakness, 2 patients (33%) with headache, 2 patients (33%) with nausea, 1 patient(16%) with vomiting and diarrhea (once), 1 patient (16%) with shortness of breathepisode connected with increase of physical activity by patient. 2nd subgroup undesiredevents were: 2 patients (40%) with heart pain complains which didn’t needed treatmentin cardioreanimation department, 2 patients (40%) with chest pain complains connectedwith spinal root syndrome, 1 patient (20%) with weakness.Conclusions: we assume that estimation of AI and PWV can be used as early and easyto use method of prognosis evaluation for patients with AMI.

P1164Prognosis of heart failure (series of 1500 patients)

F. Wadrahmane; N. Zoubir; A. BennisIbn Rochd University Hospital, Casablanca, Morocco

There are differences between heart failure (HF) of the woman and that of man in termsof epidemiology, pathophysiology, treatment response and same quality of care. Theprognosis seems to be better in women although the mechanism is not well under-stood. Clinical trials of HF include more men than women which limits our understand-ing of this disease in women.Our goal is to analyze the epidemiological profile of women followed by Heart FailureTherapy Unit (UTIC) in the center of cardiology see how they are optimized to the thera-peutic and prove especially that the female is an independent prognostic factor.Our study group is composed of all patients followed at the Heart Failure Therapy Unit.1500 patients, between January 2006 and December 2010.Of the 1500 patients 975 were men and 525 women. The average age for men was64+4 years versus 68+4 years for women. 21% of men had diabetes and 26% hyper-tensive versus 38% and 47% in women. 28% of men had at least one coronary lesionconfirmed versus 11% in women. Concerning the treatment 78% of the men was opti-mized (full dose of beta blocker-ACE inhibitor conversion- Aldosterone antagonists)versus only 45% among women. After 1 year of follow up there were 8% of men whodied (3.5% of cardiovascular causes) versus 4.2% among women (1.6% of cardiovas-cular causes) (p , 0.001).The results of our study are similar to those of the literature, show that women with heartfailure are treated worse than men and their prognosis is better than that of men.

P1165Effect of afterload alterations on left ventricular diastolic function andmechanical dyssynchrony during ischemia and reperfusion; experimental study

N. Diakos1; I. Pozios1; L. Katsaros1; E. Tseliou1; M. Bonios1; M. Tsamatsoulis2;A. Ntalianis1; A. Papalois3; J. Terrovitis1; J. Nanas1

1University of Athens, School of Medicine, 3rd Cardiology Dept., Athens, Greece;2Evangelismos General Hospital, 2nd Department of Cardiac Surgery, Athens, Greece;3University of Patras, Patras, Greece

Background: Afterload dependence of diastolic function has been identified in thenormal heart. We examined the effect of afterload alterations on left ventricular diastolicfunction and mechanical dyssynchrony during acute myocardial ischemia-reperfusion.Methods: In 12 anesthetized, open-chest pigs, instrumented with Millar pressure cath-eter and sonomicrometry crystals, middle LAD was ligated for 1 hour followed by 2

hours of reperfusion. Load alterations were induced by synchronizing the inflation ofthe balloon of an intraaortic balloon pump (IABP), placed at the descending aorta,with different phases of the cardiac cycle. Early inflation (EI) increased the load at alate point during heart ejection, late deflation (LD) increased the load during isovolumiccontraction. Load independent index of relaxation (tau) was examined acutely (5-10systoles) after each load increase, at four periods (baseline, ischemia 30min, reperfu-sion 30min and 90min). The time difference of peak shortening between an anteriorand a posterior wall segment was used as systolic dyssynchrony (SDys) index.Results: LD did not worsen isovolumic relaxation (tau) during ischemia and early reper-fusion (30min) (49+37 vs 48+32 msec, p ¼ 0.69 and 49+24 vs 47+10 msec p ¼ 0.6respectively), while EI significantly prolonged tau (75+50msec vs 49+36msec p ¼0.012 and 169+141 vs 50+12msec, p ¼ 0.019, at ischemia and early reperfusionrespectively). Prolongation of isovolumic relaxation (dtau%) was increased when theafterload was imposed late (EI), compared with LD (Ischemia: 62+79% vs –1.3+8%,p ¼ 0.018; Reperfusion 30min: 154+156% vs 2.4+27%, p ¼ 0.009). Both LD and EIworsened SDys at ischemia (108+50 vs 96+54msec, p ¼ 0.03 and 129+40 vs97+52msec, p ¼ 0.049, respectively). During late reperfusion (90min), none of thealterations significantly affected diastolic function and dyssynchrony indices.Conclusions: Deterioration of left ventricular diastolic function depends on the phaseof the cardiac cycle where the increased afterload is imposed. In addition, acute after-load changes induce mechanical dyssynchrony. Finally, during late reperfusion, myo-cardium is less sensitive to afterload changes, reflecting partial restoration of functionafter adequate reperfusion.

ACUTE HEART FAILURE (THERAPY)

P1166Treatment at discharge of AHF-related hospitalisation: The OFICA study

D. Logeart1; JN. Trochu2; R. Isnard3; P. Degroote4; M. Galinier5; T. Damy6; JC. Eicher7;P. Gibelin8; F. Delahaye9; Y. Neuder10

1AP-HP - Hospital Lariboisiere, Department of cardiology, Paris, France; 2UniversityHospital of Nantes, Institut of the Thorax, Nantes, France; 3AP-HP - HospitalPitie-Salpetriere, Department of Cardiology, Paris, France; 4Hospital Regional Universityof Lille - Cardiological Hospital, Lille, France; 5University Hospital of Toulouse - RangueilHospital, Departments of Cardiology, Toulouse, France; 6AP-HP - University HospitalHenri Mondor, Department of Cardiology, Creteil, France; 7University Hospital Center,Department of Cardiology, Dijon, France; 8University Hospital of Nice - Hospital Pasteur,Nice, France; 9University Hospital of Lyon - Hospital Louis Pradel, Department ofCardiology, Lyon, France; 10University Hospital of Grenoble, Department of Cardiology,Grenoble, France

Aims: OFICA is a nationwide, observational study of characteristics, management andoutcome of acute heart failure (AHF) during hospitalization as well as after discharge.Methods: A single-day snapshot was performed on 2009 in 170 French public and pri-vates hospitals. Investigators were encouraged to include all hospitalized patients witha diagnosis of AHF. Relevant data was recorded about whole hospitalizations. Amongsurvivors, outcome was assessed during 12 months after discharge.Results: The survey included 1658 patients with confirmed diagnosis (76+13y, 45%females, 30% of preserved LVEF). In-hospital mortality was 8.2%. Among the 1517 survi-vors, treatment at discharge included diuretics in 84.0% of cases, ACE-I in 53.1%, ARB in11.9%, betablockers in 53.5%, aldosterone inhibitors in 17.5%, digoxin in 9.4%, calciumblockers in 17.1%, amiodarone in 22.3% and anticoagulants in 43%. Among patients withLEVF ≤ 0.40, these rates were: diuretics in 87.6% with a mean dose of 138mg/d, ACE-I orARB in 73.5% with a mean% of the target dose of 42%, betablockers in 65.7% with amean% of the target dose of 36% and aldosterone inhibitors in 25.2% cases. Amongpatients with history of HF before admission, there were significant increase of rates ofprescription between admission and discharge. By using logistic regression stepwiseanalysis, parameters associated with the lack of prescription of ACE-I/ARB were: age(OR 0.98 95CI 0.96-0.99), natriuretic peptides quartiles levels (OR 1.50 95CI 1.10-2.04),LVEF (OR 1.69 95CI 1.10-2.61) as well as renal function (1.02 95CI 1.00-1.02). For beta-blockers, these parameters were COPD (OR 0.63 95CI 0.51-0.90), age (OR 0.98 95CI0.96-0.99) and non-ischemic heart disease (1.34 95CI 1.21-2.14).Conclusion: The OFICA survey is a valuable tool for analyzing the management ofAHF in the real life because of a large inclusion of unselected patients in differenttypes of hospitals as well as departments. As compared to guidelines, gaps remainin treatments at discharge. Some parameters such as COPD, renal insufficiency aswell as non-ischemic etiology lead to frequent lacks in treatment.

P1167Incidence and Predictors of Hyperkalemia in Patients With Heart Failure inMorocco

SALMA. Fadili; NOUHAD. Jardi; NAIMA. Baaddy; AHMED. Bennisdepartment of cardiology university hospital ibn rochd casablanca, Casablanca,Morocco

Introduction: Potassium (K) concentration plays a significant role in cell metabolismand membrane excitability. The imbalance of serum potassium is important becauseit can lead to life-threatening events. Potassium balance may be lost both throughthe neurohormonal mechanisms involved in cardiovascular diseases and through thedrugs used in the treatment of this illness. Avoiding both hypo- and hyperkalemia isbeneficial in several cardiovascular diseases, especially heart failure. Electrolyte

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abnormalities are frequently seen complications in subjects with heart failure. Malig-nant ventricular arrhythmias and sudden cardiac death are particularly feared compli-cations in K+ instability.Objectives: We explored the incidence and predictors of hyperkalemia in a broadpopulation of heart failure patients during one period between May 2006 and Septem-ber 2010 in 1353 patients. According to our central laboratory, hypekaliemia weredefined as potassium levels . 5,5 mmol/l.Background: When used in optimal doses to treat patients with heart failure,renin-angiotensin-aldosterone system (RAAS) inhibitors improve clinical outcomesbut can cause hyperkalemia.Results:The prevalence of Hyperkaliemia was 29.92% and hypokaliemia was 0.79%.The mean age of our population was 64.5 years (20–97), with a male predominance65% Independent of treatment assignment, the risk of hyperkalemia increased withage ≥75 years, male gender, creatinine ≥ 2.0 mg/dl, K ≥ 5.0 mmol/l, and backgrounduse of angiotensin-converting enzyme inhibitors,use of angiotensin-receptor blockersor spironolactone, ejection fraction ≤ 30%.There was a correlation between value of potassium levels and severity of heart failure.The population with hyperkaliemia : age ≥75 years was in 27,46% and male predomi-nance in (61, 34%),history of diabetes in 32, 78% renal dysfunction (clairence ofcreatinin ≤30ml/min) in 24, 37% use of spironolactone in 25, 15,%, use of angiotensin-converting enzyme inhibitors in 24, 52%, depressed left ventricular ejection fraction(LVEF ≤30%) in 25, 27%.Conclusions: The risk of hyperkalemia is increased in symptomatic heart failurepatients with advanced age, male gender,baseline hyperkalemia, renal failure, dia-betes, or combined RAAS blockade. Although these groups derive incremental clinicalbenefit from various combinations of neurohumoral antagonists, careful surveillance ofserum potassium and creatinine is particularly important.

P1168Prediction of acute effect of tolvaptan on urine output in decompensated heartfailure patients -a substudy of QUEST trial

M. Fukunami1; M. Matsuzaki2; M. Hori3; T. Izumi41Osaka General Medical Center, Osaka, Japan; 2Yamaguchi University Graduate Schoolof Medicine, Ube, Japan; 3Osaka Medical Center for Cancer and CardiovascularDiseases, Osaka, Japan; 4Kitasato University, School of Medicine, Sagamihara, Japan

Aim: QUEST study, a multicenter. placebo-controlled, double-blinded, randomized trialin Japan, has recently shown the efficacy and safety of tolvaptan, a novel vasopressinV2 antagonist, in heart failure patients with volume overload sustained in spite of con-ventional diuretic treatment. However, it remains to be elucidate in which subpopulationof such patients tolvaptan might be more effective. Therefore, we tried to predict theacute effect of tolvaptan on urine output by analysing a variety of the backgrounddata of the patient.Method: A total of 107 acute heart failure patients with water volume still overloaded inspite of conventional diuretics use were administered once dailly tolvaptan (15mg/d) orplacebo for a week, after being randomly assigned to tolvaptan group (n ¼ 52) andplacebo group (n ¼ 57). The multiple step-wise regression analysis was employed topredict the urine output (y) on the first day of administration, using background vari-ables; sex(1 if female), age, NYHA functional class(I to IV), the presence (1 ifpresent) of ischemic heart disease (IHD), diabetic mellitus (DM), or hypertension,systolic and diastolic blood pressures (mmHg), heart rate (HR;/min), serum creatine(Cr;mg/dl), plasma concentration of vasopressin (AVP;pg/ml) or brain natriureticpeptide (BNP;pg/ml), use (1 if used) of ACE inhibitors or ARBs or beta-blockers(BB), flusemide equivalent dose (D;mg) of diuretics, baseline body weight (kg) andurine output (ml/d). In the step-wise method, variables were supposed to be significantif p value was less than 0.20.Result: There were no significant differences in the background data between tolvap-tan and placebo groups. Five variables in tolvaptan group and 8 variables in placebogroup were chosen. The multiple regression equations obtained were as follows.Tolvaptan group (R¼ 0.637); y¼ 5019.5-468.6(Sex)-23.6(Age)-638.7(IHD)-409.5(Cr)+3.5(D)Placebo group (R ¼ 0.610); y ¼ 1887.1-189.7(Sex)-7.95(Age)+8.1(HR)+200.8(DM)-79.61(AVP)-0.4(BNP)+3.5(D)-320.1(BB)Conclusion: Tolvaptan might be more effective in younger, male patients not havingIHD and showing lower serum Cr level, although the regression is obtained as wellin placebo group. The regression equation for prediction of tolvaptan efficacy wouldbe of clinical use if this effectiveness of this equation wolud be proved in externalsamples as well.

P1169Impact of atrial fibrillation on mortality, morbidity, and quality of life of heartfailure patients

FDC. Cruz; FD. Cruz; VS. Issa; SF. Ayub; J. Vieira; JR. Lanz; FG. Baptista; EA. BocchiHeart Institut, Sao Paulo, Brazil

Background: atrial fibrillation (AF) and heart failure (HF) are frequently associated. AFonset may accentuate HF symptons, worsening patients quality-of-life (QoL).Objective: to evaluate mortality, morbidity, and QoL (Minnesota Living with HeartFailure Questionnaire-MLWHF) in HF patients with AF.Methods: three hundred thirty seven HF patients followed in a specialized HF clinicduring 9.4, mean age 52+10 years, 70% male. A total of 45 patients (7.4%) had AF.HF patients with AF (G1) had a survival of 3.6+2.3 years versus 3.8+2.5 years inthe HF patients without AF (G2) (p = ns); Left ventricle ejection fraction (LVEF) was

31+4% (G1) versus 31.2% (G2) (p = ns); maximal oxygen consumption (VO2) was12+5 kg/min versus 15+6 kg/min (p = ns); number of admissions: 1.3+2.6versus 1.4+5.8 (p = ns); hospitalization length was 13.6+19.2 days versus19.5+57 days (p = ns); Global QoL outcomes were 60+32 versus 53+24 (p = ns).Conclusion: our study suggests that AF has lack of impact no impact on mortality,morbidity, or quality of life in this group of patients.

ANIMAL MODELS AND EXPERIMENTATION

P1170Alteration in systolic and diastolic cardiac function in murine model ofatherosclerosis (ApoE/LDLR-/- mice)

U. Tyrankiewicz1; T. Skorka1; M. Jablonska1; S. Chlopicki21Institute of Nuclear Physics, Polish Academy of Sciences, Department of MagneticResonance Imaging, Krakow, Poland; 2Jagiellonian University Medical College,Department of Experimental Pharmacology, Krakow, Poland

Purpose: The goal of this study was to assess alteration in LV systolic and diastoliccardiac function at rest as well as to assess functional systolic and diastolic cardiacreserve in response to different doses of b-adrenergic stimulation in mice withadvanced atherosclerosis.Methods and Materials: ApoE/LDLR-/- mice and the aged matched control groupwere used for MRI studies at rest and after dobutamine injections (0.5 and 5 mg/kg).Cardiac function was calculated after assessment of: End Systolic/ Diastolic Area(ESA/ EDA), Fractional Area Changes (FAC), Ejection/ Filling Rate (ER, FR), IsovolumicRelaxation Time (IVRT) and Heart Rate then compared between two groups (pre andpost each dobutamine injection).Results: ApoE/LDLR-/- mice at the age of 8 months with advanced atherosclerosis(assessed on the basis of standard techniques, e.g. ORO-staining) did not displayany significant difference in systolic and diastolic function at rest, as compared withcontrol mice. Dobutamine at low doses induced a comparable decrease in ESA,EDA and increase in FAC in both groups. ER increased only in ApoE/LDLR-/- micewhile FR only in control animals. In turn, high dobutamine dose cause progressivedecrease in ESA and EDA parameters in ApoE/LDLR-/- and control mice. ER increasedonly in arteriosclerotic mice while FR in ApoE/LDLR-/- mice and control mice. Interest-ingly, IVRT increased with dose dependent manner for atherosclerotic mice whereas forthe control group IVRT increased in response to low and decreased in response to highdobutamine dose.Conclusion: Despite advance atherosclerosis basal systolic and diastolic cardiac func-tion in ApoELDLR-/- mice is unchanged. However, in response to dobutamine stimu-lation ApoELDLR-/- mice display increased systolic responsiveness to b-adrenergicstimulation with simultaneous impairment of diastolic reserve and isovolumetricrelaxation.This work was supported from European Regional Development Fund,Innovative Economy; Measure: 1.1.2.

P1171Myocardial expression of steroid 5-alpha-reductase and androgen receptoralong with testosterone and dihydrotestosterone concentrations in male pigswith tachycardia-induced cardiomyopathy

MW. Zacharski1; A. Tomaszek2; L. Kiczak3; J. Bania3; U. Paslawska3; A. Janiszewski3;A. Noszczyk-Nowak3; D. Zysko4; Jankowska2; P. Ponikowski21Regional Specialist Hospital in Wroclaw - Research and Development Centre,Wroclaw, Poland; 2Wroclaw Medical University, Department of Heart Diseases, Wroclaw,Poland; 3Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland;4Wroclaw Medical University, Department of Rescue Medicine, Wroclaw, Poland

Background: Deranged androgen metabolism is presumed to participate in the patho-physiology of heart failure (HF). Circulating androgens are depleted in men with HF, butevidence on androgens metabolism in myocardium is limited. We investigated myocar-dial concentrations of testosterone (T) and dihydrotestosterone (DHT), and mRNAexpression of androgen receptor (AR) and steroid 5-alpha-reductase (SRD5A2) in leftventricle (LV) in male pigs with tachycardia-induced cardiomyopathy, an experimentalmodel of chronic HF.Methods: Homogenous male siblings of White Large breed swine (n ¼ 19) underwenta continuous right ventricular (RV) pacing at 170/min resulting in HFsymptoms development. Pigs underwent euthanasia at subsequent stages of HF: mild(n¼ 5, 7+2 weeks), moderate (n¼ 5, 11+3 weeks) and severe HF (n¼ 4, 19+4weeks). Sham-operated animals served as controls (n¼ 5). A- and B-type natriureticpeptide (ANP, BNP), AR and SRD5A2 expression in LV were analyzed using RT-PCR.T and DHT levels were measured in serum and LV homogenates using ELISA.Results: RV pacing resulted in a development of HF symptoms, accompanied by animpairment of LV systolic function (in all comparisons: controls/mild/moderate/severeHF, LVEF: 52+4/40+6/23+5/20+4%, p ¼ 0.02), BNP (1.4+1.5/17+16/102+89/120+62 arbitrary units [AU], p ¼ 0.02) and ANP overexpression in LV (1+1/0.9+0.5/14+37/66+79 AU, p ¼ 0.02) and increased serum BNP (248+248/558+468/649+439/906+198 pg/ml, p ¼ 0.02). The HF progression wasaccompanied by a gradual increase in myocardial expression of SRD5A2 (1.0+0.8/1.9+0.7/2.7+2.0/3.1+1.6 AU), a reduction of AR mainly in pigs with severe HF(1.0+1.0/1.5+1.2/1.4+0.8/0.4+0.2 AU), and a decrease in myocardial concen-trations of T and DHT in severe HF (T: 1081+807/1108+757/2736+1590/657+356

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pg/g, moderate HF vs severe HF: p , 0.05; DHT: 387+505/280+139/1104+599/119+150 pg/g, moderate HF vs the other HF groups: p , 0.05). MyocardialSRD5A2 expression correlated with BNP expression (r ¼ 0.64, p ¼ 0.003) and serumT concentration (r ¼ 0.48, p ¼ 0.033). In serum DHT correlated with BNP (r ¼ 20.51,p ¼ 0.03). In myocardium AR expression correlated with ANP expression (r ¼ 20.62,p ¼ 0.005) and DHT concentration (in HF pigs : r ¼ 20.55, p ¼ 0.04). In pigs withHF, LVEF correlated with serum T (r ¼ 0.55, p ¼ 0.04) and DHT (r ¼ 0.56, p ¼ 0.03).Conclusions: The HF progression and myocardial remodeling is followed by adecrease in AR expression and an increase in SRD5A2 expression in failing maleporcine myocardium. DHT and T levels in myocardium and peripheral blood markedlydecrease in pigs with severe HF and are related to neurohormonal activation and LVsystolic dysfunction.

P1172MMP9-NGAL-TIMP1 complexes constitute myocardial pool of inactive MMP9 inmale pigs with tachycardia-induced cardiomyopathy

L. Kiczak1; A. Tomaszek2; J. Bania1; MW. Zacharski3; U. Paslawska1; A. Janiszewski1;I. Rybinska2; J. Gajek4; Jankowska2; P. Ponikowski21Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland; 2WroclawMedical University, Department of Heart Diseases, Wroclaw, Poland; 3RegionalSpecialist Hospital in Wroclaw - Research and Development Centre, Wroclaw, Poland;4Wroclaw Medical University, Department of Cardiology, Wroclaw, Poland

Background: MMP9 (matrix metalloproteinase 9) plays a pivotal role in tissue remodel-ing, including cardiac extracellular matrix. There is evidence from neoplasmatic tissuesthat the complex regulation of MMP9 activity involves not only tissue inhibitor of metal-loproteinases type 1 (TIMP1), but also neutrophil gelatinase-associated lipocalin(NGAL). NGAL is expressed within normal and failing myocardium, but its roleremains unclear. We investigated the expression of NGAL, MMP9 and TIMP1, as wellas MMP9-TIMP1-NGAL interactions in left ventricle (LV) from male pigs with tachycar-dia-induced cardiomyopathy (TIC), an experimental model of chronic heart failure (HF).Methods: Homogenous siblings of White Large breed swine (n ¼ 19) underwent con-tinuous right ventricular (RV) pacing at 170 bpm, whereas 5 sham-operated subjectsserved as controls. Pigs underwent euthanasia at subsequent HF stages: mild (n ¼5, 7+2 weeks of pacing), moderate (n ¼ 6, 11+3 weeks) and severe HF (n ¼ 4,19+4 weeks). LV homogenates were blotted against aMMP9, aNGAL and aTIMP1antibodies. Co-immunoprecipitations (CO-IP) using antibodies against MMP9, NGALand TIMP1 were performed on LV lysates. LV lysates were incubated for distinct timeperiods and analyzed using gelatin zymography (GZ) and western blotting (WB).Results: Paced animals developed symptoms of HF, accompanied by LV dilatation(LVEDD: 5.8+0.4 vs 7.2+0.4 cm, p , 0.001) impaired LV systolic function (LVEF:52+4 vs 28+4%, p , 0.001), and BNP overexpression in LV tissue (BNP: 1.4+1.1vs 76.6+74.8, p ¼ 0.01). The use of aMMP9 antibodies in WB revealed the presenceof bands of about 130, 150 and 190 kDa in LV homogenates from both TIC and controlpigs. Co-IP using aNGAL, aMMP9 and aTIMP1 antibodies demonstrated that eachcomplex contained MMP9, TIMP1 and NGAL. The semi-quantitative WB demonstratedthat 190-kDa complex was the most abundant. None of these 3 complexes revealedgelatinolytic activity. Bands corresponding to free proMMP9, TIMP1 and NGAL werenot observed.Conclusions: In porcine LV homogenates there are 3 complexes of MMP9-TIMP1-NGAL (130, 150 and 190 kDa) which constitute myocardial pool of inactive MMP9. Inthe course of HF progression this pool could sustain the bioavailability of activeMMP9 contributing to adverse myocardial remodeling.

P1173A natural p300-specific histone acetyltransferase inhibitor, curcumin, inaddition to ACE Inhibitor exerts beneficial effects on left ventricular systolicfunction after myocardial infarction in rats

T. Morimoto1; S. Sunagawa2; H. Wada3; T. Takaya3; A. Shimatsu3; T. Kimura2; M. Fujita2;K. Hasegawa3

1University of Shizuoka, Shizuoka, Japan; 2Kyoto University, Graduate School ofMedicine, Kyoto, Japan; 3Kyoto Medical Center, National Hospital Organization, Kyoto,Japan

Purpose: While nuclear acetylation is being recognized as a critical event during myo-cardial cell hypertrophy, pharmacological heart failure (HF) therapy that targets thispathway has yet to be established. Recently, we found that curcumin, a p300histone acetyltransferase inhibitor, prevents deterioration of the systolic function intwo independent models of rat HF caused by myocardial infarction and hypertension.To clinically apply this novel therapy to humans, it should be clarified whether or notcurcumin exhibits additional effects on conventional HF therapy involving angioten-sin-converting enzyme inhibitors (ACEI). Thus, we examined the effect of ACEI/curcu-min combination therapy on HF after myocardial infarction (MI).Methods: Rats were subjected to a sham operation or MI. One week later, we per-formed left ventricular (LV) functional studies by employing echocardiography in all sur-viving rats. The rats with a moderate size of MI (fractional shortening (FS) , 40%) werethen randomly assigned to 4 groups: 1: solvents (control) (n ¼ 8), 2: enalapril (ACEI, 10mg/kg/day) alone (n ¼ 8), 3: curcumin (50 mg/kg/day) alone (n ¼ 8), and 4: curcuminplus enalapril (n ¼ 8). Oral treatments with these agents were repeated everyday andcontinued for 6 weeks.Results: There were no differences among the 4 groups in any LV geometric and func-tional data examined before treatment. ACEI, but not curcumin treatment, decreased

the blood pressure in post-MI rats. After treatment, LVFS was significantly (p , 0.05)higher in the ACEI (29%) and curcumin (29%) groups than in the vehicle group(22%). Notably, LVFS significantly (p , 0.05) increased on ACEI/curcumin combinationtherapy (35%) compared with therapy involving either ACEI or curcumin alone. The LVwall thickness and cardiomyocyte diameter were significantly smaller in the ACEI/cur-cumin than the ACEI group. Moreover, perivascular fibrosis was significantly reduced inthe ACEI and curcumin groups compared with the vehicle group. This reduction wasfurther augmented by the ACEI/curcumin combination therapy.Conclusions: A p300 histone acetyltransferase inhibitor, curcumin, restores the post-MI LV systolic function in rats without affecting the blood pressure. This natural non-toxic dietary compound in addition to ACEI exerts beneficial effects on LV systolicfunction.

ARRHYTHMIAS AND TREATMENT

P1174Significance of time to symptoms during head-up tilt test in patients withrecurrent syncope

A. Sousa; AS. Correia; A. Lebreiro; C. Sousa; S. Oliveira; M. Paiva; I. Rangel; V. Ribeiro;J. Freitas; MJ. MacielH. Sao Joao, Porto, Portugal

Purpose: Neurocardiogenic syncope is the most frequent cause of loss of conscious-ness. Head-up tilt test (HUTT) is a valuable diagnostic tool, particularly in patients withunexplained syncope with atypical clinical presentation. Limited data is availableregarding the significance of time to symptoms during HUTT. In this study we aimedto assess the influence of time to symptoms in syncopal recurrence and its relationwith the type of response to HUTT.Methods: We retrospectively analyzed clinical records of 234 consecutive patients witha history of recurrent syncope and a positive HUTT, between January 1995 and Decem-ber 2005. Socio-demographic, prodroms, post-syncopal symptoms, time to symptomsand response type to HUTT were assessed. Follow-up (FUP) was made by telephonicinterview in December 2010 for the purpose of this study. Patients without FUP wereexcluded from the analysis.Results: We studied 99 patients, 64 (64.6%) women, mean age 35+17 years. Mostpatients (50.5%) presented a vasodepressor response, 16.2% had a predominant car-dioinhibitory response and 33.3% a mixed reaction. Median (25th-75th percentile) timeto symptoms during HUTT was 32 (18-44) minutes. Mean FUP time was 108+23months. On FUP 55.6% patients had syncope recurrence [median (25th-75th percen-tile) value of episodes per year was 0.5 (0.2-2.0)]. Median (25th-75th percentile) time tosymptoms during HUTT was similar between patients with and without syncope recur-rence [32 (19-44) vs 34 (15-43) minutes, p ¼ 0.779]. Median (25th-75th percentile) timeto symptoms during HUTT was lower in patients with cardioinhibitory response whencompared to patients with vasodepressor [20 (15-25) vs 39 (20-40) minutes, p ¼0.024] or mixed reaction [20 (15-25) vs 42 (21-44) minutes, p ¼ 0.036]. In a model oflogistic regression, a lower time to symptoms during HUTT was associated with a car-dioinhibitory response probability, even after adjustment for gender and age.Conclusions: Time to symptoms during HUTT did not correlate to syncope recur-rence, but may be a predictor of neurocardiogenic response type.

P1175An in vitro method for studies of arrhythmogenesis in the heart -

Y. Shao; AZRA. Mijatovic; ELMIR. OmerovicSahlgrenska University Hospital, Wallenberg Laboratory for Cardiovascular Research,Gothenburg, Sweden

Purpose: Sudden death due to malignant ventricular arrhythmias (VA) is the mostimportant cause of death in acute myocardial infarction and heart failure. Increasingknowledge about pathophysiology behind VA is essential in a search for new pharma-cological targets and anti-arrhythmic agents. Lysophophatidylcholine (LPC), a hydroly-sis product of (membrane) phospholipid degradation, is one of the most potent pro-arrhythmic substances that accumulate in the human heart in the setting of myocardialischemia. The aim was to set up an in vitro experimental system for studies of effects ofLPC on electrophysiological remodeling in beating cardiomyocytes and heart slices.Methods and results: Spontaneously beating mouse HL-1 cardiomyocytes wereplated onto MEA micro-chips and cultured for 3 days for the recording of electricalactivity in the form of field potentials (FP). FP were recorded at base line and afteradditions of 2, 4, 8, 12, 16, 20, and 24 mM of LPC to the cell medium (n ¼ 27).We found that the heart rate (HR) and peak-peak amplitude (PP) of FP significantlydecreased at 12 mM and was inversely proportional to increase in LPC concentration.Half-maximal effect concentrations (EC50) were 11.52+0.90 and 12.50+1.60 mMrespectively. The duration of FP (FPdur), which reflects the Q-T interval, was signifi-cantly prolonged with LPC above 12 mM and was dose-dependent, with EC50 of12.25+1.40 mM. Moreover, LPC induced arrhythmic activity systematically at the con-centrations of 16, 20, and 24 mM. The induced arrhythmia could persist even after LPCwashout. The similar findings were confirmed in experiments performed on heart slices(200 mM) from mice.Conclusions: LPC is a potent arrhythmogenic substance with immediate pro-arrhyth-mic effects in cardiac tissue. These methods can be a valuable experimental tool forbasic studies of arrhythmogenic mechanisms in the human heart.

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ATRIAL FIBRILLATION

P1176Implication of AGE-RAGE axis in atrial fibrillation in patients with heart failure

S. Raposeiras Roubin1; BK. Rodino Janeiro1; L. Grigorian Shamagian2;A. Seoane Blanco1; M. Moure Gonzalez1; A. Varela Roman1; E. Alvarez1;JR. Gonzalez Juanatey1

1University Clinical Hospital of Santiago de Compostela, Santiago de Compostela,Spain; 2Hospital de Meixoeiro, Vigo, Spain

Introduction: Recent studies suggest that interaction of advanced glycation end-pro-ducts (AGE) and its receptor (RAGE) may be promoted by inflammation and oxidativestress. Increasing evidence indicates that both processes contribute to pathogenesis ofAF, but their role remains poorly defined. The AGE-RAGE system axis appears to play akey role in this process. We studied the association of AGE-RAGE system axis withatrial fibrillation (AF) in diabetic and non-diabetic patients.Methods: 97 consecutive outpatients with chronic heart failure (CHF) were included inthis transversal study. 61 patients were in sinus rhythm (SR) and 36 in permanent AF.We measured fluorescent AGE and soluble RAGE (sRAGE). Comparisons betweenpatients with or without AF were performed. A multivariate logistic regression analysiswas made to define the independent factors associated to AF.Results: Fluorescent AGE and sRAGE were higher in AF groups (74.9+25.6 vs61.8+20.1 AU for fluorescent AGE, p ¼ 0.006; 1714.2+1105.5 vs 996.1+820.7 pg/mL for sRAGE, p ¼ 0.001). This difference was specially marked in non-diabeticpatients. High levels of sRAGE resulted as a marker of AF independent of left atrial dis-tension, diabetes and other confounding variables.Conclusions: AGE and sRAGE plasma levels were higher in patients with AF and CHF,independently of the presence of diabetes mellitus, indicating an implication of AGE-RAGE axis in the arrhythmogenic structural atrial remodelling.

P1177The value of atrial fibrillation on exercise capacity and haemodynamicparameters at dilated cardiomyopathy patients

TA. Abdullaev1; BU. Mardanov2; AS. Eshpulatov2; ST. Mirzamukhamedova2

1Republic Specialized Center of Cardiology, Tashkent, Uzbekistan; 2The RepublicanSpecialized Center of Cardiology, Tashkent, Uzbekistan

The aim: To study of prevalence of atrial fibrillation (AF) at dilated cardiomyopathy (DC)patients, and its relationships with exercise capacity and haemodynamic parameters.Methods: The 217 (95 women and 122 men, 44,3+7,2yrs) patients with idiopathic DCwere investigated. Definitions of a NYHA functional class, 6-minute walking test(6MWT), ECG, Holter ECG and echocardioscopy were applied.Results: At 59 (27,2%) included patients it is revealed AF. For studying of association ofdisease current and basic rhythm the patients divided on two: I (patients with AF, n ¼59, 47,8+2,3 yrs) and II (without AF, n ¼ 52, 42,6+1,9 yrs) groups. It is noticed, that atI group rather were more defined LV insufficiency symptoms (dyspnea, high head-board in bed, moist rales), accompanied by a non-significant prevalence of averageNYHA class (3,2+0,1 and 2,9+0,15 accordingly, p ¼ 0,2). The 6MWT distance atpatients with AF was less then II group on 17% (216+12,2 and 252+10,8m accord-ingly, p ,0,05). The further analysis showed that patients with AF were characterisedby lower values (on 7,4%) os SBP (100,6+2,5 vs 108,3+2,9 mm Hg, p ,0,05). Echohas not revealed an significant difference of the LV EF (41,8+2,4% vs 34,2+1,6%).The distinctions depending on AF presence/absence are revealed at the analysis ofthe LA and RV volumes: LA linear size – 5,2+0,3 vs 3,6+0,22mm, and RV -31,9+2.3 vs 24,8+1,7mm accordingly (both p , 0,05).

Conclusion: The prevalence of AF at DC patients is 27.2%. it is noticed, that presenceof AF associated by reduction of exercise capacity and aggravation of LA and RV dila-tation. The dependence of remodeling from a heart rhythm demands continuation ofresearches in this field.

P1178Inflammatory syndrome and missing tooth in Romanian patients withcardiovascular disease and atrial fibrillation; possible role in atrial fibrillationpathogenesis

IA. Gutiu1; LI. Gutiu2; FS. Radulescu1; L. Dumitrescu3

1University of Medicine and Pharmacy "Carol Davila", Bucharest, Bucharest, Romania;2Central Emergencies Military Hospital, Bucharest, Romania; 3Private Dental Office,Chiajna, Ilfov, Romania

Purpose: We hypothesized on patients with cardiovascular disease that in chronicatrial fibrillation (CAF) pathogenesis the missing tooth and dental state play a role byan increase of inflammation level generated by chronic gum infections (periodontitisand/or periodontosis).Methods: In a cross sectional study of patients with cardiovascular disease, we ana-lyzed 204 patients with cardiovascular disease: recent myocardial infarction – 33(16%), angina pectoris – 126 (62%), stroke – 35 (17%), ischemic cardiomyopathy -10 (5%), all with complete investigations including clinical, laboratory and echocardio-graphy data. Mean age of the group was 59+14 years; male 82 (40%). Eighty patients(39,2%) had CAF: mean age 70,3+10,5 years, male ¼ 24 (30%). For comparison, 124patients without CAF: mean age 66,3+13,2 years, male ¼ 54 (43,5%). Chronic inflam-mation was detected by serum fibrinogen level (sF), CPR level, BSR, number of serumleukocytes. Dental state was appreciated by an index calculated by sum of missingteeth with non-treated carries, an index already used in other published studies,facile to measure by clinical consult.Results: Statistically, the CAF group differs from non-CAF group mainly by: age (P ,

0,0001), dental state index (24,4+8,4 versus 14,7+7,8, P , 0,0001), sF (449,1+138,2versus 373,7+89,8, P , 0,0001), CRP (15,4+14,2 versus 9,4+8,1, P , 0,01). For leu-kocytes number and BSR we do not find a significant difference. By logistic regression,after adjusting for age, we obtained following OR: sF-1,891 (CI 95%: 1,144-3,127, P ,

0,013), dental index -1,575 (CI 905%:1,021-2,432, P , 0,040), CRP-1,236 (o,856-1,784,P , 0,053).Conclusions: Our data indicate that dental state is more poorly in patients with CAFand cardiovascular disease. After our knowledge is a new finding that dental statemay play a role in supporting and maintenance of chronic inflammatory syndromeimplied in pathogenesis of CAF. This finding has practical consequences concerninga rigorous dental control and treatment in patients with CAF beside the all other thera-peutic measures, possible with beneficial consequences.

BETA BLOCKERS

P1179Does beta-blockers intolerance in systolic heart failure really exists?

GE. Conceicao-Souza; PR. Chizzola; VS. Issa; F. Bacal; SM. Ayub-Ferreira; FD. Cruz;GV. Guimaraes; EA. BocchiHeart Institute -InCor, Sao Paulo, Brazil

Purpose: Beta-blockers(BB) intolerance in systolic heart failure (SHF) has beenreported to be variable, ranging from 20 to 50% in large randomized clinical trials.Data regarding it’s intolerance in clinical practice are lacking. Thus, we sought to

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evaluate the prevalence of and the reasons for BB intolerance in an specialized heartfailure unit in a tertiary hospital; also, we assessed the effect of re-introducing BB inthese patients.Methods: Cross sectional study, followed by a cohort. During the month of july 2007,three hundred eleven patients were included consecutively in our heart failure unit.Male patients were 77,4%, the average age was 51,9 years, most (74,2%) were in func-tional class(NYHA) I or II, average left ventricle(LV) diastolic diameter was 70,2mm andaverage LV ejection fraction(LVEF) was 25,2%. All of them had LVEF ,40%. Patientswithout BB therapy in the beggining of consultation were divided in two groups:group one (G1) - in which BB was tryied once again; group two (G2) - in which BBre-introduction was not tryied (by attending physician decision). These groups werefolowed for four months. Death of any cause, SHF admission and BB intolerance wereassessed. The latter outcome was defined as two or more unsuccessful trials of re-intro-ducing BB with, at least, two different types of BB (carvedilol, bisoprolol or metoprolol).Results: From the 311 patients, eleven(3,5%) were not on BB. The main reasons were:prior bronchoespasm (5 pts), bradycardia - HR , 50 bpm (3 pts), bifascicular block (1pt) and hypotension - SBP , 80mmHg (2 pts). Eight of these were put on BB (G1) andthree were not (for hypotension or bradicardia). At four month follow-up, there were twoHF adminssions which resulted in 2 deaths among G2 patients. There were no admis-sions or deaths among group 1 patients and only one was out of BB. The final overallprevalence of BB intolerance was 4 in 311 patients (1,3%) and the reasons for thiswere: hypotension (2 pts), bradicardia (1 pt) and persistent bronchoespasm (1pt).Conclusions: BB intolerance prevalence in severe SHF, in this sample, was extremelylow and could be even lower with agressive clinical strategies. BB intolerance seem tobe predictor of worse prognosis.

P1180Comparison of the outcome in men and women who were on beta blocker andRAS blocker treatment with chronic heart failure

G. Kozdag; G. Ertas; M. Yaymaci; U. Celikyurt; Y. Akay; H. Ekren; T. Sahin; T. Kilic;G. Kahraman; D. UralKocaeli University, Faculty of Medicine, Department of Cardiology, Kocaeli, Turkey

Background: Recent studies have suggested some gender-related differences inresponse to therapy and outcome in chronic heart failure patients. The majority ofstudies have proposed a better survival for women compared to men. However, theunder-representation of women in clinical trials leads to some uncertainty regardingthe survival benefit. Some data suggest the possibility that ACE-inhibitors may be lessbeneficial in women as compared to men. Beta-blockers seem to be effective both inwomen and men. Our purpose to clarify that beta blockers and RAS blockers mayhave different impacts on outcomes between in female and male patients with CHF.Methods: We examined outcomes (cardiac mortality) in patients discharged from ourhospitals between January 2003 and December 2009 after hospitalization for chronicdecompensated HF. 637 patients with CHF (409 male, 228 female, mean age,64+13 years; mean ejection fraction, 26.5+9%) were included in these prospectiveobservational study.Results: 223 patients (35%) [139 male (34%), 84 females] (37) died because of cardi-ovascular reasons during follow up (p ¼ NS). Although, in male group, 29% of patientswith beta blocker treatment died, 43% of patients without beta blocker treatment diedduring follow-up (p ¼ 0.006). While 34% of female patients with beta blocker treatmentdied, 45% of female patients without beta blocker treatment died during follow-up (p ¼NS). ACE-I and ARB treatment had no useful effects on outcome in both genders.Conclusion: Beta blocker treatment has good effect on male gender for outcomes. Femalepatients with beta blocker treatment may have less benefit than male gender in their outcome.

CANCER / CARDIOTOXICITY

P1181A new index to predict heart failure in patients receiving trastuzumab

M. Arao; Y. Kitahara; K. SetsutaTokyo Metropolitan Komagome Hospital, Tokyo, Japan

Purpose: Previous studies have demonstrated that trastuzumab (T) induces left ventri-cular (LV) dysfunction and heart failure, but this phenomenon is sometimes difficult topredict or detect. The goal of this study was to characterize T-induced changes incardiac function and identify potential predictors of T-induced cardiac dysfunction.Methods: This study included 72 consecutive female breast cancer patients (meanage, 57+11 years) who received treatment with T for at least six months. The LV diam-eter in diastole/systole (LVDd/s), LV end-diastolic volume (LVEDV), LV end-systolicvolume (LVESV), interventricular septal thickness (IVST), posterior wall thickness(PWT), LV ejection fraction (LVEF), ratio of early to late ventricular filling velocity (E/A), Tei index (TI), relative wall thickness (RWT), left ventricular mass (LVM), LVMindex (LVMI), diameter of inferior vena cava (IVC), systolic blood pressure (BPs), dias-tolic blood pressure (BPd), and the new index, TIMCO=(TI×MCO), where MCO is themitral closing-to-opening time (msec), were calculated. In addition, the total amount ofT (ST), ST to body surface area (BSA), and velocity of dosage (ST/day) were calcu-lated, and the relationship between these values and the amount and rate of changein the LVEF (DLVEF%) and LVM (DLVM%) was analyzed.Results: Treatment with T did not affect PWT, E/A and IVC but did result in significantincreases in BPs/d (p , 0.001), LVDd/s (p , 0.000001), IVST (p , 0.05), LVEDV (p ,

0.00001), LVESV (p , 0.00001), TI (p , 0.01), LVM (p , 0.01), LVMI (p , 0.01) and

TIMCO (p , 0.001). Furthermore, T treatment resulted in significant decreases in LVEF(p , 0.001) and RWT (p , 0.001). No significant correlation was observed between thedosage of T and the rate of change in cardiac function indices. After treatment with T, sixpatients developed cardiac dysfunction with heart failure (group CHF; mean age, 55+9years), while the 66 other patients did not (group NCHF; mean age, 57+11 years). Therewas no significant difference between the two groups in BPd/s, LVDd/s, LVEDV, LVESV,IVST, PWT, LVEF, IVC, E/A, LVM or LVMI before administration of T. By contrast, pretreatmentdifference between the two groups were observed in TI (p , 0.01) and even more so inTIMCO (CHF, 271+98 vs. NCHF, 131+42; p , 0.0003; cutoff value, 200).Conclusion: T therapy induced significant LV systolic dysfunction and a significant increasein the LVM, but this effect was not dependent on T dosage. Patients with pretreatmentTIMCO . 200 may be at high risk for developing trastuzumab-induced cardiac dysfunction.

P1182The anti-neoplastic ErbB2-antibody 2C4 produces left ventricular dysfunction inmurine hearts

Tocchetti1; C. Coppola1; A. Barbieri1; D. Rea1; G. Ragone1; G. Palma1; C. Arra1;C. De Lorenzo2; RV. Iaffaioli1; N. Maurea1

1National Cancer Institute, G. Pascale Foundation, Naples, Italy; 2Federico II University,Naples, Italy

Purpose: Anti-ErbB2 therapies have greatly improved the prognosis of patients withbreast cancer. Unfortunately, such treatments are associated with an increased riskof left ventricular (LV) dysfunction. Trastuzumab (Herceptin), the prototypical ErbB-tar-geted therapy, increases the frequency of asymptomatic decrease in LV ejection frac-tion (LVEF) by 3-18%, and the risk of heart failure (HF) by 2–4%. The newer ErbB2antibody rhuMAb 2C4 (pertuzumab) seems to affect ligand induced ErbB signalingin a more direct fashion, affecting EGFR/ErbB2 dimerization; yet, its cardiac sideeffects are only beginning to emerge. Here, we test whether the murine 2C4 inducescardiac dysfunction in normal mice.Methods: In vivo cardiac function was measured with LV fractional shortening (FS) byM-mode echocardiography in sedated C57BL/6 mice (2–4 mo. old) at day 0, and after2 and 6 days of daily i.p. administration of 2C4 (2.25 mg/g/day) or Doxorubicin (Doxo,2.17 mg/g/day) as a positive control, and in sham animals. With Speckle Tracking echo-cardiography (ST) we also evaluated radial myocardial strain (%), a very sensitive par-ameter which can predict LV dysfunction.Results: After only 2 days of treatment, FS was reduced with 2C4: 58+1%, p=.01 vs sham(60+0.4%). The reduction in FS obtained with Doxo was even larger: 52+0.2%,p=.0000001 vs sham, p=.00004 vs 2C4. Myocardial strain was similarly reduced in both2C4 (40+8%) and Doxo-treated mice (43+3%) compared to sham (66+0.6%; p=.02vs 2C4, and p=.0005 vs Doxo). After 6 days of treatment, LV dysfunction was exacerbated,with FS further reduced to similar values by 2C4 (39+5%) and Doxo (46+2%, p ¼ NS vs2C4; both p,.05 vs sham and vs 2 days), and strain decreased to 31+7% (2C4) and40+7% (Doxo, p ¼ NS vs 2C4; both p=.01 vs sham and p¼ NS vs 2 days).Conclusions: The murine ErbB2 antibody 2C4 is cardiotoxic in mice. The reduction in FS ismilder than Doxo early at 2 days, but comparable to Doxo after 6 days. The clear mechan-isms of anti ErbB2-induced cardiotoxicity are to be elucidated. Further studies will be crucialto establish the cardiotoxic mechanisms of ErbB2-antagonists, and to influence the designof future anticancer therapies in an attempt to retain anticancer effects, while minimizingcardiac toxicity. We also plan to apply speckle tracking echocardiography to clinicalstudies, in order to evaluate the impact of early identification of ErbB2-blockers cardiotoxi-city in the treatment of women with breast cancer.

CARDIAC RESYNCHRONISATION THERAPY

P1183Analysis of mortality events in ischemic heart failure patients after coronaryartery bypass grafting and concomitant cardiac resynchronization therapy:results from multicenter study

A. Romanov; E. Pokushalov; V. Shabanov; D. Prokhorova; I. Stenin; D. ElesinState Research Institute of Circulation Pathology, Novosibirsk, Russian Federation

Purpose: To evaluate the reasons of mortality events in patients with ischemic heartfailure that underwent coronary artery bypass grafting (CABG) alone or concomitantwith epicardial cardiac resynchronization therapy (CRT).Methods: One hundred and seventy eight consecutive patients with severe ischemicheart failure and LV dyssynchrony were enrolled in two groups: CABG alone (n ¼87) and epicardial CRT implantation during CABG (n ¼ 91). The mean follow up was19.4+2.5 months. We analysed the reasons of 32 deaths using the Hinkle-Thalerclassification system as well as a clinical classification system to determine the inci-dence of sudden cardiac death (SCD) and the incidence of cardiac death due to theprogression of heart failure.Results: There were five deaths in the early postoperative period. In the CABG-group,one patient died due to ventricular fibrillation four days after operation and three patientsdied due to the progression of heart failure. In the CABG+CRT group, one patient dieddue to preoperative myocardial infarction. During 6 to 12 months of follow-up, 8 (9.1%)CABG patients and 3 (3.3%) CABG+CRT patients died. Finally, in CABG group 23patients (26.4%) died at 18 month follow up compared with 9 (9.9%) in CABG+CRTgroup (p ¼ 0.006). All of the observed deaths were cardiovascular (14 sudden cardiacand 18 pump failure deaths). In the CABG group the SCD was observed in 11 (78.6%)compared with 3(21.4%) patients in CABG+CRT group (p , 0.0001).

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Conclusions: Epicardial implantation of CRT concomitantly with CABG has a low risk ofSCD and overall mortality compared with CABG alone in patients with ischemic heart failure.

P1184Outcomes of cardiac resynchronization therapy in chronic chagasiccardiomyopaty

M. Martinelli; S. Martins; R. Molina; S. Siqueira; SAD. Nishioka; R. Alkmim-Teixeira;AAA. Pedrosa; GL. Peixoto; R. Costa; JAF. RamiresHeart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, SaoPaulo, Brazil

Introduction: Cardiac resynchronization therapy (CRT) in chronic chagasiccardiomyopathy (CCC) is rarely described and the clinical efficacy of such therapy inthat population is under investigation. We aimed to identify independent variables ofclinical and mortality benefit in patients undergoing CRT taking into considerationchagasic patients and other different heart diseases, named non chagasic patients(NCP).Methods: Among the 1,065 patients from our CRT cohort, we included selectedpatients who needed any hospital admission in the last 5 years, excluding patientsyounger than 18yo and with non regular clinical follow-up in the last year. Clinicaland echocardiographic variables were evaluated in respect to possible influenceon all-cause mortality and HF functional class (NYHA) in 2 moments: after 1 yearof CRT and at the last ambulatory visit. The statistical analysis tests included:non-parametric sign-test, Cox model, McNemar, Chi-square, Kaplan-Meyer.Results: 290 patients were enrolled: 193 (66.6%) men; mean age: 60.6+11.9yo; meanfollow: 3.3 years. The prevalence of patients with CCC was 63 (21.7%). The NCP were:88 (30.3%) ischemic, 96 (33.1%) idiopathic, 10 (3.4%) heart valve disease and 33(11.4%) others. 37 patients with CCC and 164 with NCP were in NYHA I-II after oneyear of implant. At the last follow-up visit 43 CCC and 171 NCP remained in NYHAI-II. After one year of follow up, left-ventricle ejection fraction (OR ¼ 1.1; 95%CI 1.03-1.16; P ¼ 0.006) and NCP etiology (OR ¼ 4.1; 95%CI 1.6-10.10; P ¼ 0.002) were ident-ified as independent predictors for being NYHA I-II. No variable was associated withNYHA at the last follow-up visit. There were 18 deaths in the CCC group and 27 inthe NCP. NCP (OR ¼ 2.6; 95%CI 1.32-5.08; P ¼ 0.006) and smaller left atrial dimen-sions (OR ¼ 1.1 95%CI 1.03 to 1.13, P ¼ 0.001) were independent predictors forlower rate of death.Conclusion: CCC has a worse prognosis in patients undergoing CRT compared withother heart diseases, considering mortality rate and NYHA behavior.

P1185Development of a clinical and late gadolinium enhancement CMR index topredict cardiac events after cardiac resynchronization therapy

A. Valle1; J. Estornell2; M. Corbi1; E. Lucas3; P. Garcia3; O. Fabregat3; A. Pirola3;A. Quesada3; R. Paya3; F. Ridocci Soriano3

1Complejo Hospitalario Universitario, Albacete, Spain; 2ERESA.Consorcio HospitalGeneral Universitario, Valencia, Spain; 3Hospital General Universitario de Valencia,Valencia, Spain

Purpose: Cardiac resynchronization therapy (CRT) reduces long-term morbidity andmortality in patients with moderate or severe heart failure and markers of cardiac dys-synchrony, but not all patients respond to a similar extent. Many baseline character-istics associated with heart failure may influence prognosis after CRT. We aimed todevelop a prognostic risk index of cardiovascular events after CRT.Methods and Results: We included in a prospective cohort study 131 patients with heartfailure (New York Heart Association class III or IV, LVEF , 35% and QRS . 120ms) whounderwent CRT. All patients underwent assessment of risk factors, echocardiography vari-ables including dyssynchrony, and cardiovascular magnetic resonance (CMR) measuresof myocardial scarring (late gadolinium-enhancement (LGE) before implantation. Clinicalevents were assessed after a median follow-up of 842 (interquartile range541–1265) days.At follow-up, 16/131 (12%) of patients died from cardiovascular causes, 67/131 had anycardiovascular events (cardiovascular mortality, heart failure hospitalization or arrhythmicevent). In Cox proportional hazards analyses, presence of atrial fibrillation, non-optimizedtreatment (p,, 0.0001) and both- ischemic-type and nonischemic-type patterns of LGE

emerged as independent predictors of cardiovascular events. The prognosis index (PI),derived from these variables combined, emerged as a powerful predictorof cardiovascularevents. Cardiovascular events in patients with the high PI were 17.3 times higher (95% CI10.11-34.12) compared to patients with a low PI.Conclusion: The prognostic index, derived from clinical variables, myocardial scarringby LGE-CMR and presence of atrial fibrillation before implantation, is a powerful predic-tor of cardiovascular events after CRT.

P1186The role of stress myocardial perfusion to predict left ventricular reverseremodeling in patients with ischemic cardiomyopathy treated byresynchronisation therapy

M-A. Morales1; A. Gimelli1; U. Startari2; L. Panchetti2; A. Rossi2; P. Marzullo1; M. Piacenti11Institute of Clinical Physiology of CNR, Pisa, Italy; 2Gabriele Monasterio Foundation,Pisa, Italy

Purpose: Cardiac resynchronization therapy (CRT) improves quality of life and left ven-tricular (LV) function in patients (pts) with heart failure; however, improvement in LVfunction is known to be less evident in ischemic (IC) rather than in non ischemic cardi-omyopathy. Assessment of baseline perfusion defects has been used for the predictionof response to CRT in IC; little is known on the effects of myocardial ischemia at thetime of implantation on LV reverse remodeling at follow up (FU) in pts treated by CRT.Methods: Fortysix IC pts treated by CRT were studied. All were in NYHA Class III, LVEF,35%, left bundle branch block with a QRS duration of 154+8 msec, under optimalmedical therapy for ischemia and heart failure and no indications to percutaneous orsurgical revascularization. Pts underwent conventional echocardiography and stress/rest myocardial scintigraphy – effort in 28, i.v. dipyridamole in 18 - within 3 weeksbefore CRT. Among scintigraphic variables, summed rest (SRS), summed stress(SSS) and summed difference score (SDS) were quantitatively analyzed.Results: Pts were divided according to the extension of ischemic area detected bymyocardial scintigraphy: Group I (n 32): pts in whom SDS was ≤4, Group II (n 14):pts with SDS .4. No differences were observed between Group I and II in NYHAClass, baseline LVEF, site of previous myocardial infarction, myocardial perfusionscore (SRS: 12.4+1.2 vs 10.5+1.6) and pre-CRT echocardiographic end systolicdimensions (ESD): 56.2+1.2 vs 56.3+1.6 mm. At 12+1 month FU, clinical improve-ment (≥1 NYHA Class reduction) was found in 29/46 pts, 23 in G I pts and 6 in G II pts(p=.05); however, a significant reduction in echocardiographic ESD was seen in G Ipts, while no significant changes in ESD could be reported in G II (-9.1+1.2%, vs20.9+1.1%, p ¼ 0.01). In the total population, no relation (r ¼ 0.12) existed betweenbaseline perfusion and changes in ESD at FU.Conclusions: Extension of ischemia evaluated by stress myocardial scintigraphy pro-vides more reliable information than baseline perfusion on LV reverse remodeling in ICpts with no revascularization options treated by CRT.

P1187Cardiac resynchronization therapy – prognosis of patients with upgrade fromconventional pacing

H. Dores; JM. Santos; J. Abecasis; S. Leal; MJ. Correia; S. Fartouce; C. Aguiar;FB. Morgado; A. Aleixo; M. MendesServico de Cardiologia, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal

Introduction: Chronic right ventricular pacing (RVP) can induce heart failure (HF) dueto dyssynchrony, left ventricular dysfunction and remodeling. Upgrade (UPG) tocardiac resynchronization therapy (CRT) can restore these anomalies and have prog-nostic impact.Aim: To compare the prognosis of patients (pts) undergoing UPG-PVD or implantationde novo CRT-P.Methods: Retrospective analysis of consecutive pts who underwent CRT-P. Inclusioncriteria: HF in New York Heart Association (NYHA) class III or IV, left ventricular ejectionfraction (LVEF) ≤ 35%, QRS ≥ 120 ms and optimal tolerated therapy. Sample subdivi-sion into two groups: UPG-PVD and non-UPG. At 3, 12 and 24 months (M) were eval-uated: NYHA class, 6’ walking distance (WD6), LVEF, Minnesota Quality of LifeQuestionnaire (MQLQ), natriuretic peptide (NT-proBNP), telesystolic LV diameter

Cumulative Proportion Surviving (Abstract P1183 Figure)

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(TSD), rehospitalization for HF and overall mortality. Mortality was compared byKaplan-Meier curves. Echocardiographic parameters of mechanical dyssynchronywere also studied between the two groups.Results: Sixty four pts, 19 UPG-PVD were included. Age, gender, HF etiology, NYHAclass, NT-proBNP, QRS lenght and mechanical dyssynchrony weren’t significantlydifferent between the two groups. UPG-PVD group had higher MQLQ (61.5+11.6 vs51.5+16.6, p ¼ 0.019), tendency to lower LVEF (25.8+9.1 vs 30.3+10.4%, p ¼0.094) and lower WD6 (223+141 vs 312+131m, p ¼ 0.098). The endpoints (Table)didn’t vary significantly and the survival was similar (log-rank, p . 0.5).Conclusion: In this study, patients with UPG to CRT had a similar clinical response,reverse remodeling and prognosis than patients undergoing de novo CRT.

Endpoints%UPG-PVD 3M

non-UPG3M

UPG-PVD12M

non-UPG12M

UPG-PVD24M

non-UPG24M

NYHA decrease 78.6 70.0 100 96.3 90.0 88.2WD6 increase 100 88.9 100 81.8 100 50.0IncreaseFEVE ≥ 15%

76.9 65.5 57.1 68.4 62.5 64.7

MQLQ decrease 87.5 85.7 83.3 61.5 100 87.5NTproBNPdecrease

83.3 69.2 57.1 48.0 71.4 61.1

DecreaseTSD ≥ 15%

36.4 24.0 25.0 5.9 33.3 41.2

HF hospitalization 17.6 10,0 17.6 10,0 22.1 11.1Overall mortality 5.6 4.8 5.6 10.5 22.2 17.6

P1188Diastolic function in patients with cardiac resynchronization therapy

O. Londono Sanchez1; J. Perez2; S. Pacreu3; E. Frigola3

1Medical and Cardiology Centre, Dr. Londono, Barcelona, Spain; 2University HospitalBellvitge, barcelona, Spain; 3Hospital del Mar, Barcelona, Spain

Aim: Resynchronization therapy improves heart failure symptoms, functional capacityand ejection fraction of the left ventricle (LV) decreasing his volume and increasing LVpump efficiency, survival in patients with not response to pharmacological treatmentand in patients with left bundle branch block. Our aim was determine which changescan offer CRT on diastolic dysfunction in patients with chronic heart failure.Methods and results: To understand the effects of CRT on diastolic function we rea-lized a study with 100 patients (mean age, 68.4b+20.7 with mean ejection fraction(EF) 25+7% with chronic heart failure. We performed strain rate doppler to get flowpropagation velocities at four mitral annular sites and mitral E/e ratio, estimating LVpump efficiency. As additional information we performed a quantity determination ofBNP levels three days before implantation. We found not important differences in dias-tolic dysfunction with the Tissue Doppler Imaging and the BNP levels decreased withimportant remarked.Conclusions: We can conclude that CRT improved diastolic in some patients, declin-ing in LV end-systolic volume .7,8%. Septal E/e (15.79+7.09 vs 9.7+3.93, P , 0.01),E/Vp (3,56+2.08 vs 2.81+0.79, P , 0.001), left atrial volume index (53.65+13.98 vs51.87+19.07 mL/m2, P , 0.001), and plasma BNP levels (289 (28-3265) vs 56.9pg/ml(6-795)) with significant decreased, but in those patients (8%) there was no significantchanges. Left ventricular diastolic changes normally are associated to the decreasedlevels of BNP.

Basic clinical characteristics

Table 1. Baseline clinical characteristics of the patientsParameterYear 59,5+12,5Gender male 89Diabetes 19Hypertension 60Coronary artery disease 53Plasma BNP levels 423 (20-2557)Decline in LVESV . 10% 42

P1189Outcomes of biventricular pacemaker upgrade

Brito; P. Carmo; D. Cavaco; K. Reis Santos; F. Morgado; F. Costa; M. Santos;P. Adragao; M. MendesHospital Santa Cruz, Carnaxide, Portugal

Purpose: Chronic right ventricular (RV) pacing induces left ventricle (LV) dyssynchronywith detrimental effects on LV function. On the other hand, some patients with animplantable cardioverter defibrillator (ICD) need cardiac resynchronization therapy

(CRT) due to worsening heart failure (HF). Considering the scarce data on thissubject, this study aims to describe a population which underwent upgrading to CRTand to evaluate the outcomes of this procedure.Methods: From January 2003 to November 2009, 401 patients underwent CRT in ourhospital. Of these, 45 (11.2%) corresponded to upgrade from either RV pacemaker(n ¼ 22) or ICD (n ¼ 23). In a population with 86.7% male and a mean age of68+11 years, we evaluated the incidence of cardiovascular death and hospitalizationdue to HF, as well as improvement of NYHA functional class, LV ejection fraction (LVEF)and QRS duration.Results: In patients with previous RV pacemaker, the reason for the implantation of thefirst device was high degree atrioventricular (AV) block in 63.6%, symptomatic brady-cardia with AV conduction disturbances in 22.7%, recurrent syncope in 9.1% andpost-AV node ablation in 4.6%. All of those patients ultimately developed chronic RVpacing and worsening HF. In the group of patients with ICD, the reason for the firstdevice was primary prevention in 47.8% and the reason for the upgrade was worseningHF plus left bundle branch block (74%) or chronic RV pacing (26%). In the whole popu-lation, 46.7% had ischemic cardiomyopathy, 33.3% had valvular disease and 20% hadidiopathic dilated cardiomyopathy. During the mean follow-up period of 26+23 monthsthere were 5 deaths (11.1%), of which 2 (4.4%) occurred due to cardiovascular cause. 1patient underwent heart transplantation 65 months after the upgrade procedure. In theperiod of 1 year before the upgrade, 69% of the patients had been hospitalized due toHF, a number which was reduced to 13% in the period of 1 year following the procedure(p , 0.0001). Mean survival free of hospitalizations due to HF was 21+14 months.There was improvement in NYHA functional class in 82% of patients, with a meandecrease of 0.98+0.6 grades (p , 0.0001). The QRS duration decreased44.8+25.2 ms in average (p , 0.0001) and there was a mean increase of LVEF of5.2+8% (p ¼ 0.006). The type of initial device (either RV pacemaker or ICD) had noinfluence on outcomes.Conclusions: Upgrade to CRT shows favorable long-term outcomes, leading toimprovement in functional status and decrease of hospitalizations due to HF.

P1190The effect of cardiac resynchronization therapy in patients with atrial fibrillationand non-left bundle branch block morphology: the role of atrioventricular nodeablation

AD. Demir1; S. Cay2; O. Ozeke1; R. Atak3

1Acibadem Hospital, Eskisehir, Turkey; 2GATA Haydarpasa Training Hospital, Istanbul,Turkey; 3Ankara Education and Research Hospital, Ankara, Turkey

Background: The clinical and mortality benefit of CRT in patients with AF has beenreported previously. However, no clear data is present regarding this benefit in AFpatients with non-LBBB pattern.Aim: The aim of the present study was two-fold: first, to assess the clinical and echo-cardiographic benefit of CRT in AF patients with non-LBBB pattern compared topatients with LBBB pattern; second, to investigate the role of AVN ablation in patientswith AF and non-LBBB pattern undergoing CRT.Methods and results: A total of 41 HF patients either with LBBB (n ¼ 19) or IVCD (n ¼22) requiring CRT were included in the study. After 2 months of implantation, patientswith ineffective biventricular pacing (n ¼ 10 in LBBB group, n ¼ 11 in IVCD group)underwent AVN ablation. Clinical (NYHA functional class) and echocardiographic(left ventricular ejection fraction and mitral regurgitation grade) parameters were fol-lowed-up for a mean follow-up period of 32.9+8.9 months. At the end of this period,both LBBB and IVCD patients with or without AVN ablation showed an improvementin the NYHA functional class, mitral regurgitation grade and left ventricular ejection frac-tion. The improvement in LVEF was significantly better in IVCD patients compared toLBBB patients without ablation (6.8%+7.2 vs. 12.5%+3.0, p ¼ 0.027). However, atthe end, there were no significant differences among 4 groups regarding thechanges of clinical and echocardiographic parameters from the baseline except forthe above (all p . 0.05).Conclusion: The benefit obtained by CRT in non-LBBB patients with or without abla-tion has demonstrated that these patients should be evaluated for this important treat-ment modality of heart failure.

P1191Heart failure and cardiac resynchronization therapy: clinical characteristics andlong term mortality

Tettamanti; J. Lopez Diaz; JA. San Roman Calvar; L. De La Fuente Galan; R. Arnold;E. Garcia Moran; C. Tapia Ballesteros; I. Gomez Salvador; A. Recio Platero;A. Puerto SanzUniversity Hospital of Vallodolid, ICICOR, Valladolid, Spain

Purpose: to know the long term mortality of a cohort of heart failure (HF) patients (P)and their clinical characteristics. In cardiac resynchronization (CRT) P, to assess therelation of clinical response to CRT with long term mortality.Methods: 33 HF P (21 CRT candidates) were enrolled (November 2007 - November2008) and followed up to 6 months for ocurrence of events (admissions for HF,cardiac death or heart transplantation). A basal quality of life score (QOL) was per-formed. Response to CRT was defined as increase ≥ 10% in 6’WT 6 months afterimplantation and the absence of events during that period of time.

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After 6 months of follow up (FU), P were followed according to physicians’discretion. In November 2010, we decided to perform a long term survival analysisof the cohort.Results: All P were followed up for a median (IQR) of 30,2 months (26,6 – 33,9). Six outof 30 P died during FU (20%). All of them were in the CRT group and all were nonre-sponders. CRT P were followed up for a median (IQR) of 25,1 months (20,2 – 30,1) andthe survival was 66,7%; survival in non CRT P was 100%, p 0,034.In CRT P, responders (n ¼ 6) survival was 100% vs 40% in nonresponders (n ¼ 10), p0,025. P who died were older than survivors (72,5+3 vs 62+9), and had a lower sys-tolic pressure at basal visit (98+10 vs 121+12 mmHg), p , 0,001 for both. Theyreferred orthopnea at basal visit more frequently than P who are alive (67 vs 17%, p0,029).Basal blood chemistry showed significant differences among dead P and survivors(see table). QOL score was higher in P who died vs survivors (82+5 vs 49+19), p, 0,001.Conclusions: three year mortality for a HF cohort of P was 20%. All P who died wereolder, sicker in terms of functional capacity and QOL and had a worst clinical and poss-ibly nutrional status according to basal blood chemistry. CRT P had higher long termmortality than non CRT P. Non responders to CRT had a high mortality rate at threeyears.

Basal blood chemistry

Dead P Survivors p value

Hemoglobin (g%) 12+1 14+2 0,08Creatinine (mg%) 1,4+0,4 1,1+0,3 0,04Total Cholesterol (mg%) 138+3 168+36 0,06Albumine (g%) 3,6+0,5 4,3+0,3 , 0,001creatin kinase (IU/l) 42+18 99+53 0,01

P1192Short-term CRT effects on patients implanted according to guidelines

M. Brambatti; S. Molini; F. Guerra; M. Morelli; S. Guardiani; A. Romandini;A. Giovagnoli; MV. Matassini; M. Marchesini; A. CapucciMarche Polytechnic University of Ancona, Department of Cardiology, Ancona, Italy

Background: About 30% of patients do not show benefits to CRT. The aim of this studywas to assess clinical and echocardiographical response to CRT.Methods: We enrolled 34 patients with NYHA class III-IV, LVEF , 35% and QRS ≥120ms, undergoing CRT between December 2009 and September 2010. We collectedpre-implantation instrumental and clinical data for all patients, 19 were subsequentlyrecalled for a follow-up 3 months later. Interventricular dyssynchrony was consideredas aorto-pulmonary pre-ejection delay .40ms. The intraventricular dyssynchronywas measured by TDI velocity curves and defined as septal-lateral wall delay.60ms. An increase of LVEF . 10% defined an echo response whereas the improve-ment of at least 1 NYHA class defined clinical response.Results: After 3 months mean NHYA class improved from 3.1 to 2.1 (p , 0.001), andMinnesota Heart Failure Living Questionnaire (MHFLQ) decreased from 40.7 to 22.0(p ¼ 0.014). Spontaneous QRS decreased from 145 to 120 ms (p ¼ 0.005) and LVEFimporved from 25.7 to 34.7% (p ¼ 0.001). Both the left ventricular diastolic and systolicdiameters were reduced (from 71.6 to 64.7 mm; p ¼ 0.002 and from 60.2 to 52.7 mm;p ¼ 0.003 respectively). There was also a reduction of inter-and intra-ventricular dys-synchrony. SDANN increased from 50.5 to 84.7ms (p ¼ 0.017) and footprint widenedfrom 25.4 to 35.5% (p ¼ 0.026). There was a significant increase in the use of beta-blockers (from 44 to 81% of patients; p ¼ 0.009) after CRT implant. Our populationwas stratified in: full-responders (53%), echo responders (26%), clinical responders(12%) and nonresponders (6%).Conclusions: CRT implantation improved quality of life, LV reverse remodeling andreduced intra- and interventricular dyssynchrony. The reduction of the spontaneousQRS showed a possible electrical remodeling. However, the pre-implantation echocar-diographic analysis of ventricular dyssynchrony was not predictive either of echo orclinical response.

CARDIOMYOPATHY

P1193Desmin expression in cardiomyocytes and mitochondrial alteration inidiopathic dilated cardiomyopathy

A. Pawlak1; J. Rzezak1; A. Nasierowska-Guttmejer1; E. Czarnowska2; K. Gil1;K. Byczkowska1; RJ. Gil31Central Clinical Hospital MSW i A, Warsaw, Poland; 2The Children’ Memorial HealthInstitute, Department of Pathology, Warsaw, Poland; 3Institute of Experimental & ClinicalMedicine, Polish Academy of Science, Warsaw, Poland

Background: Experimental studies indicate that the defect in the desmin organizationmay lead to mitochondrial damage. If the desmin cytosceleton remodeling is pivotal for

mitochondrial alterations, remains not clear. Understanding the mechanisms betweenthe abnormal expression of desmin and mitochondria could provide a scientific back-ground for diagnosis of unfavorable disease stages.Aim: Determination of the effect of desmin on mitochondrial changes (number, size,morphology).Material and methods: The study population consisted of 60 patients (88,89% ofmales, mean age 47,62+12,89 years) with LVEF , 45%. During DMB five sampleswere taken from left ventricle. DES expression and localization were investigated in his-tological section by immunohistochemical method using antibody anti-desmin (DAKO)and Western-blotting methods.Results: Investigation of DES expression in immunohistochemical and W-B reveledfour groups of myocardial tissue samples: gr I – normal DES expression (10 pts), grIIA – increase physiological pattern (19 pts), gr IIB – increase pathological pattern(granular form) (20pts), gr III – low or lack DES expression (6 pts). Analysis showedthat abnormal DES expression pattern is association with mitochondria alteration.(See table).Conclusions: It seems that movement of mitochondria to perinuclear area and theirincreased proliferation in cardiomyocytes with increase desmin expression (type IIA)meets energy demands. Futher increased of desmin expression (type IIB) and thendecrease or lack of desmin in cardiomyocytes associated with cytoskeleton injuryand lost of mitochondria heterogeneity might be predictors of unfavorable diseaseprogression.

Desmin expression vs mitochondria

Localization NumberSize[mm2] Shape

Cardiomyocytehypertrophy

Gr I Between contractilapparatus

Normal orslightlyincreased

30 Oval,plymorphic

Isolatedcardiomyocytes,compensatoryhypertrophy

Gr IIA Between contractilapparatus, perinucleararea (clusters)

Significantlyincreased

40 Oval,polymorphic

All cardiomyocytecompensatoryhypertrophy

Gr IIB Perinuclear area Areasof miofibrils absence

Increased 44 Round Degenerativehypertrophy

Gr III Areas of miofibrilsabsence

Decreased 35 Round Degenerativehypertrophy

P1194The value of global myocardial index to detect cardiac dyssynchrony in patientswith non-ischemic dilated cardiomyopathy

C. Mornos; M. Nicolin; A. Ionac; A. Mornos; S. Pescariu; SI. DragulescuInstitute of Cardiovascular Diseases, Timisoara, Romania

A variety of parameters has been proposed in left ventricular (LV) asynchrony evalu-ation. It was showed that 49% of heart failure patients had both positive and negativecriteria for dyssynchrony during echocardiography. Global myocardial index (GMI) is asensitive indicator of overall cardiac functionAim: To evaluate if GMI might be a qualitative parameter to detect cardiac dyssyn-chrony in patients with non-ischemic dilated cardiomyopathy (DCM).Methods: Echocardiography was performed in 95 patients with DCM, in sinus rhythm.GMI was measured and TDI was performed at six basal and six mid-segments of LV.Time to peak systolic velocity (Ts) was measured from the beginning of the QRScomplex to the peak myocardial systolic velocity. Absolute difference in Ts betweenany two of the four basal septal, lateral, inferior, and anterior LV segments, absolutedifference in Ts between any two of the six basal LV segments, absolute difference inTs between any 2 of the 12 basal and mid LV segments, and standard deviation ofTs of the 12 basal and mid LV segments were determined as validated dyssynchronyparameters (≥65 ms, ≥110 ms, ≥100 ms and ≥32.6 ms, repectively). A compositescore was calculated combining the above four dyssynchrony parameters, with avalue of 1 or 0 given to each positive or negative parameter.Results: The mean age of our patients was 58+15 years and the mean LV ejectionfraction was 31+13%. GMI had a mean value of 0.57+0.25. A minimum oneecocardiographic sign for cardiac dyssyncrony was found in 64 patients (67%) ofour patients with DCM in sinusal rhythm, but only 12 patients with asincronism pre-sented all four criteria of mecanical dyssyncrony (19%). All GMI differed significantlyamong dyssynchrony groups (score 0: 0.31+0.08, score 1: 0.46+0.09, score 2:0.65+0.10, score 3: 0.82+0.18, score 4: 1.06+0.27, each p , 0.01). GMI presentedan area under receiver operating characteristic-curve of 0.94 to detect patients withall four dyssyncrony criteria (score ¼ 4) and 0.95 to detect patients with at least threedyssyncrony criteria (score ¼ 3). The optimal cut-off for GMI was 0.72 with 95%sensitivity and 86% specificity to detect patients with all four dyssyncrony criteria,and 73% sensitivity and 90% specificity to detect patients with at least three dyssyncr-ony criteria.Conclusions: GMI could be used as qualitative simple echocardiographic parameterto detect ventricular desynchronization in patients with non-ischemic DCM.

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P1195Congestive heart failure in patients with hypertrophic cardiomyopathy

NS. Krylova; EV. Avdeeva; NG. PoteshkinaRussian State Medical University, Moscow, Russian Federation

Purpose: This study sought to determine factors that lead to congestive heart failure(CHF) development in patients with hypertrophic cardiomyopathy (HCM).Methods: We examined 86 patients with HCM 21 to 88 years old. The patients weredivided into 2 groups: without (group I) and with CHF (group II).Results: Group I included 53 patients, average age 62,5+1,8 years; group II - 33patients, average age 67,1+1,6 years. Prevalence of women was observed in groupII. Left ventricular (LV) concentric hypertrophy was revealed in group II more oftenthan in I. There was no significantly difference in LV outflow tract obstruction (LVOT)prevalence between two groups. Left atrium (LA) end-diastolic size more than 50mm, right ventricular (RV) dilatation and pulmonary hypertension (PH) were revealedmore often in group II. Prevalence of permanent atrial fibrillation (AF) was higher ingroup II. 2 patients in group I and 4 – in II had dilated phase of HCM with systolicLV dysfunction (ejection fraction (EF) , 50%).Statistic analysis showed correlations between CHF and following parameters: women(r ¼ 0,25; p ¼ 0, 018), LA size (r ¼ 0,23; p ¼ 0,047), LV concentric hypertrophy (r ¼0,24; p ¼ 0,02), end-diastolic LV volume (r ¼ 20,18; p ¼ 0,02), PH heaviness (r ¼0,4; p ¼ 0,04), right atrium dilatation (r ¼ 0,7; p ¼ 0,0004), dilated phase of HCM (r ¼0,2; p ¼ 0,04), permanent AF (r ¼ 0,36; p ¼ 0,009).Conclusions: Three different pathophysiological mechanisms that lead to CHF devel-opment in HCM were revealed: LV concentric hypertrophy with reduced LV end-dias-tolic volume accompanied by LV diastolic dysfunction and RV systolic dysfunction;dilated phase of HCM with systolic LV dysfunction; chronic AF. Women develop con-gestive heart failure more often than men.

Parameters of HCM patients

Parameters Group I (n ¼ 53) Group II (n ¼ 33) P

Women 25% 52% 0,04*LV concentric hypertrophy 15,4% 42% 0,02*LVOT 51% 42% 0,5LA end-diastolic size . 50 mm 11,5% 31,2% 0,01*RV dilatation 4,3% 26,3% ,0,05*Pulmonary hypertension 41% 78% 0,02*Permanent AF 9% 33% 0,000012**Dilated phase of HCM 3,8% 12% , 0,0001**

* p , 0,05; ** p , 0,001

P1196Evaluation of hemodynamic, echocardiographic and laboratory parameters asprognostic factors in non-ischemic dilated cardiomyopathy in 2.5-years follow-up

W. Jachec1; CA. Wojciechowska1; A. Gala2; K. Krzemien-Wolska2;E. Nowalany-Kozielska1

1Medical University of Silesia, 2nd Department of Cardiology, Zabrze, Poland;2Specialist Hospital in Zabrze, Zabrze, Poland

Purpose: To determine which clinical, laboratory, echocardiographic and hemody-namic parameters are prognostic factors of death, OHT or clinical improvement innon-ischemic dilated cardiomyopathy (DCM) patients in 2.5-years follow-up.Methods: 111 patients, (15 female) mean age 44,7+10,4 years, with DCM (LVEF21,06+7,58%, NYHA class II–66, III–45pts) whose underwent clinical examinationsand right heart catheterization (RHC). All patients were on optimal pharmacologicaltherapy.Methods: Age, duration of disease, treatment, laboratory parameters (NT-proBNP,creatinine, sodium, bilirubin, haemoglobin), as well as echocardiographic parametersincluding dimensions of left ventricle, LVEF, mitral and tricuspidal insufficiency, AcTvalue and hemodynamic data obtained during RHC were included into uni- and multi-variate Cox regression analysis. Criterion of clinical improvement included: decrease ofNT-proBNP concentration below 600 pg/ml, decrease of NYHA class at least by 1 to ≤ 2and increase of LVEF by 5% points above 30%.Results: 15 deaths, 12 OHT procedures and 48 clinical improvements during 2.5-yearsfollow-up were observed. Multivariate Cox regression analysis showed that indepen-dent risk factors of death were transpulmonary gradient (TPG) HR–1.15, 95%CI[1.04-1.27] and creatinine HR–1.05, 95%CI [1.019-1.074]. Increase of NT-proBNP con-centration by 100 pg/ml caused 8% highest risk of OHT. Risk of OHT were also highestin pts under amiodarone and immunosupression treatment, respectively 4.41 and 4.8times (p , 0.05).Prognostic factors of death or OHT were: NT-proBNP concentration (p , 0,05), TPG(p , 0,05) and mean systemic pressure (mABP) as well as 6-minute walking test dis-tance (6-MWTd) – increase by 1 m decreased risk by 0.6% (p , 0.05). Increase ofmABP by 10 mmHg decreased risk of death or OHT by 4.2% (p , 0.05). Echocardio-graphic parameters no reveal prognostic properties both for death as well as OHT. Theindependent factors of clinical improvement were NT-proBNP concentration HR–0.952

95%CI [0.892-0.988], LVESD HR–0,881 95%CI [0.803-0.968] and disease durationtime HR–0,818 95%CI [0,713-0,939]. Necessity of ICD implantation was consideredwith 81.1% reduction of probability of fulfil of clinical improvement criteria (p , 0.05).Conclusions: Obtained data confirm the universal role of NT-proBNP concentration asprognostic factor in heart failure. Prognostic role of transpulmonary gradient as deathand death or OHT predictor suggest usefulness of RHC in risk evaluation of non-ischemic DCM patients.

P1197Echocardiography, ECG and holter monitoring indices and c-reactive proteinvalues in the hypertrophic cardiomyopathy patients with heart failure ofdifferent functional classes

OO. Bilostotska; KYU. Kinoshenko; VI. TseluykoKharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

Purpose: To study the differences in instrumental indices and laboratory levels of basicC-reactive protein (CRP) in the Hypertrophic cardiomyopathy (HCM) patients depend-ing on the heart failure functional class (HF FC).Methods: 100 HCM patients (52% males and 48% females, mean age 51,2+1,5 year)have been examined. The patients underwent general clinical investigation, theirmedical history and family history have been studied, 12-lead ECG has been takenwith corrected QTc interval evaluation, B-mode Echocardiography and Doppler withtransmitral flow, Holter 24-hour ECG monitoring have been carried out and basicCRP level was evaluated with enzyme immunoassay.Results: The patients have been divided into 3 groups depending on NYHA FC: FC I – 21patient, FC II – 59 patients, FC III – 20 patients. Comparison of the indices in differentgroups demonstrated that the CF FC I patient’s age was significantly lower (40,0+3,0year) compared to CF FC II data of 53,4+1,9 and 56,8+2,8 year in CF FC III group(p , 0,01). According to the ECG data the FC I patients showed QTc significantly lowerthan 0,42+0,01 s compared to the respective value of 0,44+0 s in FC II group, p ,

0,05, and 0,45+0,01 s in FC III group, p , 0,01. According to the EchoCG data the IIIFC patients demonstrated prevailed left atrial dimensions of 4,9+0,2 cm (4,34+0,08cm and 3,98+0,15 cm in FC II and FC I, respectively, p , 0,05), right atrial 3,85+0,16cm (3,46+0,06 cm and 3,38+0,09 cm, p , 0,05), right ventricular 2,26+0,06 cm(2,05+0,03 cm and 2,01+0,05 cm, p , 0,05) and left ventricular posterior wall thickness1,31+0,08 cm (1,16+0,04 cm and 1,05+0,04 cm, p , 0,05). Left ventricular ejectionfraction value was significantly higher in the FC I patients - 69,57+1,54%, 64,81+0,95%in FC II and 61,4+2,95% in FC III, p , 0,05. ECG Holter monitoring evaluation revealedthat ventricular arrhythmia in FC I patients was registered significantly more rarely -8,05+3,16 extrasystoles per 24 hrs compared to the FC II group - 441,6+150,32, and167,59+74,1 in FC III group, p , 0,05 (insignificant difference between II and III FC).CRP basic level was the lowest in FC I group - 2,83+0,73 mg/l, that made the verified differ-ence with FC II 8,34+0,85 mg/l and FC III 9,81+2,04 mg/l, p , 0,01.Conclusion: Heart failure functional class rise in the patients with HCM is associatedwith the older age and is characterized with the worsening of the instrumental evalu-ation findings and the significantly increased basic C-reactive protein level.

P1198Peripartum Cardiomyopathy in pregnant women positive to Chagas disease

O. Londono Sanchez1; S. Pacreu2; C. Muntaner3; E. Frigola1

1Medical and Cardiology Centre, Dr. Londono, Barcelona, Spain; 2Hospital del Mar,Barcelona, Spain; 3University Hospital Bellvitge, barcelona, Spain

Introduction: As we know peripartum cardiomyopathy occurs in absense of estructuralheart disease. Hemodynamic stress leads to pregnancy-mediated volume overload,which increased before delivery and is reduced after it.Aim: Was to determine if HF developed as a cause of peripartum cardiomyopathy inpatients with Chagas Disease, has the same mechanism.Material and methods: We decide to performe a follow-up with 30 pregnants womenChagas disease serology positive (all them from South America). We performed anechocardiography study during 1 year. The clinical symptoms were similar to thosewith other form of systolic HF, developed the last month of pregnancy of within thefirst 5 post-partum months. As additional information we performed a quantity determi-nation of BNP levels before first clinical presentation. We found not important differ-ences in diastolic disfunction with the Tissue Doppler Imaging and the BNP levelsdecreased with important remarked.Conclusions: The mechanism we found for this heart failure in presense of peripartumcardiomyophaty was the chronic effect of Tripanzmi Cruzzi, as a responsible of HF. EFof most of the patients were lower than typical peripartum cardiomyopathy, so under45%, until 34%. Of 30 patients 25 had abnormal NT-proBNP plasma levels, when com-pared with healthy mothers post-partum.Confusions may arise when we have patients with diabetes, pregnancy-induced hyper-tension, but in our contingent there were not data to this pathologies. The recovery foEF was not marked as in normal peripartum cardiomyopathy. 64% keeps actualy theEF lows, but hemodynamicaly estability.In our study we can not consider peripartum cardiomyopathy as a cause of HF,because we had a Chagas disease as a pathology reason.

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Table II. Comparative results between the 3 groups of cardiomyopathy

Groups

Peripartum cardiomyopathy:With dysfunction and withoutdysfunction

IdiopathicCardiomyopathy P value

Age (years) 25+4 23+5,1 28,4+6 NSEF before pregnancy (%) 45,6+3* 57,4+4,3 34,5+6,3* NS*Cardiac complication 4(25,4%)** 2(12,3%) 7(57,3%)** P ¼ 0,01**Maternal death 1(9,1%) - 1(12,2%) NSEF post pregnancy(%) 47.2+3,2*** 56,2+3,5*** 41,3+3,5*** NS***

EF= left ventricular ejection fractions; *p . 0.05 – comparative analysis between EF of peri-partum cardiomyopathy with dysfunction and idiopathic dilated cardiomyopathy; **p ,

0.05 – comparative analysis regarding the incidence of maternal cardiac complication ofperipartum cardiomyopathy with dysfunction and idiopathic dilated cardiomyopathy;***p . 0.05- comparative analysis between EF before and after pregnancy in the 3 groups

P1199Peripartum cardiomyopathy

NAJ. Yamoul; K. Chraibi; R. Habbal; L. Azzouzi; A. BennisIbn Rochd University Hospital, Casablanca, Morocco

Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy of unknown etiol-ogy that is associated with significant morbidity and mortality. It is characterized byheart failure in the last month of pregnancy or in the 5 months following delivery, itstill frequent in Africa.The aim of this work was to assess the echocardiographic abnormalities of the PPCMand to determine on 12 patients the evolution and the prognostic factors of thisdisease. The cases of peripartum cardiomyopathy treated from January 2008, toJanuary 2011 in our service were reviewed,The abnormalities of the wall motion, con-stantly found, were diffuse in all patients and localized or prevalent on the interventri-cular septum or the left ventricular posterior wall in the other cases. The cardiacchambers were dilated in all patients. The left ventricular systolic dysfunction was con-stant. The other abnormalities were: restrictive mitral profil (6 patients) low mitral andaortic flow (3 cases), the mitral (10 cases) and tricuspid regurgitation (8). Duringfollow up, all patients improved to Class I of NYHA, 2 patients improved their echocar-diographic parameters. and one patient died after a subsequent pregnancy.The factors associated with the absence of normalization of the echocardiographic par-ameters. were: the gestity, the parity, the cardiothoracic ratio, the left ventricularvolumes, and the parameters of left ventricular function.In conclusion, Symptoms improve over time in a significant numbers of patients, whichis corroborated by improvement of the LV function as assessed by echocardiography.Certain variables at initial evaluation can help in identifying high risk subsets with peri-partum cardiomyopathy.

CARDIO-RENAL SYNDROME

P1200NGAL for the prediction of acute kidney injury in acute heart failure

T. Breidthardt; T. Socrates; B. Dexler; T. Klima; M. Potocki; M. Noveanu; T. Reichlin;J. Steiger; CH. MuellerUniversity Hospital Basel, Basel, Switzerland

Background: The accurate prediction of acute kidney injury (AKI) in patients with acuteheart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin(NGAL) is a novel sensitive and specific marker of AKI.Methods: A total of 207 consecutive patients presenting to the emergency departmentwith AHF were enrolled. Plasma NGAL was measured in a blinded fashion at presen-tation and serially thereafter. The potential of plasma NGAL levels to predict AKI wasassessed as the primary endpoint. We defined AKI according to the AKI Networkclassification.Results: Overall 60 patients (29%) experienced AKI. These patients were more likely tosuffer from pre-existing chronic cardiac or kidney disease. At presentation, creatinine(median 140 [IQR, 91-203] umol/l vs. 97 [76-132] umol/l, p , 0.01) and NGAL (105[65–200] ng/ml vs. 74 [60-113] ng/ml, p , 0.01) levels were significantly higher, andestimated glomerular filtration rate (eGFR) was significantly lower (37 [24-56] ml/minvs. 54 [36-74] ml/min, p , 0.01) in AKI compared to Non-AKI patients. The prognosticaccuracy for measurements obtained at presentation, as quantified by the area underthe receiver operating characteristic curve was mediocre and comparable for all threemarkers (creatinine 0.70; 95%CI 0.61-0.80 vs. eGFR 0.69; 95%CI 0.59-0.79 vs. NGAL0.67; 95%CI 0.57-0.77). Serial measurements of NGAL did not further increase theprognostic accuracy for AKI. Creatinine, but not NGAL, remained an independent pre-dictor of AKI (HR 1.15; 95%CI 1.01-1.31; p ¼ 0.04) in multivariable regression analysis.Similar results were found for the prediction of in-hospital worsening renal function.Conclusion: Plasma NGAL levels do not adequately predict AKI or in-hospital worsen-ing renal function in patients with AHF.

P1201Blood urea nitrogen: the best renal predictor for mortality in patients withdecompensated heart failure

S. Barra; F. Caetano; L. Paiva; C. Faustino; P. Gomes; R. Providencia; I. Almeida;A. Leitao MarquesHospital Center of Coimbra, Coimbra, Portugal

Purpose: Hospitalization for decompensated (d) Heart Failure (HF) is associated withhigh mortality post-discharge and high rate of re-admission. Renal dysfunction (RD)has adverse prognostic impact in these patients with recent studies suggestingblood urea nitrogen (BUN) may have particular value. The aim of this study is to estab-lish the prognostic importance of multiple renal function evaluation parameters inpatients admitted for dHF and their usefulness in predicting 1-year mortality risk.Methods: 162 patients discharged after admission for dHF (age 73.9+10.7y, 50.6%males, 29.8% of ischaemic aetiology). Data collected: BUN and creatinine (CRT),both at admission, pre-discharge and highest value; glomerular filtration rate (GFR)at admission, pre-discharge and lowest value; BUN*CRT at admission and pre-dis-charge; complete analytical study at admission and pre-discharge echocardiogram.Patients followed for 12 months. The prognostic value of each parameter wasstudied and multivariable analysis performed for establishing model predictor ofmortality.Results: All parameters for renal function evaluation were predictors for 12-month mor-tality in univariate analysis, in particular BUN pre-discharge . 20 mg/dL (66.7% vs.29.1%, OR 4.88, p ¼ 0.001). In multivariate analysis including renal predictors only,the variable BUN pre-discharge was considered an independent predictor for mortality(OR 1.118, p , 0.001). Including other clinical, analytical and echocardiographic par-ameters, the predictive model included admission glycaemia (OR 1.218, p ¼ 0.050),pulmonary artery systolic pressure [PSAP] (OR 1.038, p ¼ 0.048) and ischaemic etiol-ogy (OR 8.066, p ¼ 0.006). In patients with non ischaemic dHF, predictive model for 12-month mortality included BUN pre-discharge (OR 1.123, p ¼ 0.018), natremia (OR0.780, p ¼ 0.050) and PSAP (OR 1.081, p ¼ 0.054).Conclusions: RD has adverse prognostic impact irrespective of parameters used.BUN pre-discharge has particular importance, as it was the only independent predictorfor 12-month mortality when other clinical, analytical and echocardiographic variableswere included in the analysis. These data support the findings of recent studies whichsuggest that high levels of BUN (independent of the GFR) are likely to reflect the cumu-lative effects of haemodynamic and neuro-humoral alterations that result in renal hypo-perfusion, thus adding prognostic value to the simple measure of the GFR and beingmore powerful than the latter.

P1202NGAL as a new biomarker of renal dysfunction in acute heart failure.Methodological implications

M. Bonadies; S. Mazzetti; P. Delfino; I. Fracchioni; E. D’elia; V. Casali; G. Specchia;A. MortaraPolyclinic of Monza, Department of Cardiology, Monza, Italy

In patients admitted for acute heart failure (AHF) deterioration of renal function duringhospitalization has been shown to affect prognosis. The detection of renal damage isusually achieved by serial measurements of plasma creatinine (Cr) and estimated glo-merular filtration rate (eGFR), but their rising trends may occur late in the process ofkidney injury. A new protein, a lipocalin associated with neutrophil gelatinase (NGAL)has been proposed as an early marker of tubular damage. This biomarker has beenstudied in patients with kidney disease and after cardiac surgery, but few data are avail-able in AHF. Moreover important methodological issues are still unsolved, such astiming of measurements and pathological threshold.The aim of this ongoing study was to evaluate in a group of consecutive patientsadmitted for AHF (dyspnoea, BNP .300 pg/ml, and need for furosemide iv .40mg) the value of serum NGAL (Biosite system), Cr and eGFR (MDRD mod) accordingto two different protocols: 1) at both entry and discharge (mean hospitalization 6+2days) (group A) and 2) at entry and every days until the 5th day of hospitalization ifat least one value of NGAL was ≥60 ng/ml (measurable limit of the system), or onlyfor 3 days if the values of NGAL were always ,60 ng/ml (group B). We present theresults of the first 20 patients (10 in each group) of mean age 73.3+11 yrs, BNP809.3+498.3 pg/ml, mean diuretic dose 91.7+63.5 mg.

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In group A, NGAL at entry was significantly related with baseline Cr (r ¼ 0.80, p ,

0.001) and eGFR (r ¼ 0.67, p , 0.03), but not with values at discharge (Cr r ¼ 0.32,GFR r ¼ 0.48). Deterioration of renal function was observed in 5 out of 10 pts but base-line value of NGAL wasn’t significantly different between pts with and without kidneyinjury. In group B, 4 out of 10 pts showed a rise in Cr and eGFR, respectively at day2 (n ¼ 1), at day 3 (n ¼ 2) and at day 4 (n ¼ 1). In all cases NGAL increased signifi-cantly in the previous 24h (average 95%, range 25-200%). In the 6 pts with normalNGAL levels, no changes in Cr and eGFR occurred.In conclusion, a correct timing of NGAL measurement seems crucial to accuratelypredict those pts admitted for acute heart failure, who will develop worsening renalfunction. NGAL value at entry is related with baseline Cr and eGFR, but does notseem to predict kidney damage during hospitalization. Probably at this early stage ofknowledge, a daily measurement of NGAL gives more clinical information since itmay predict kidney injury within a short period of time.

P1203Risk factors for heart failure decompensation in patients who undergo creationof an arterio-venous fistula for chronic intermittent ultrafiltration therapy

E. Repasos1; J. Terrovitis1; A. Ntalianis1; E. Kaldara1; C. Pantsios1; S. Vakrou1;S. Sventzouri1; G. Alexopoulos2; J. Kanakakis2; J. Nanas1

1University of Athens, School of Medicine, 3rd Cardiology Dept., Athens, Greece;2Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece

Background: Ultrafiltration appears as a promising method for treating congestion inheart failure patients with cardiorenal syndrome. However, the hemodynamic impactof arterio-venous fistulas is controversial. The aim of this study is to identify high riskcharacteristics in heart failure patients who underwent this type of intervention.Methods: 10 consecutive end-stage heart failure patients with cardiorenal syndrome,treated with optimal medical therapy at maximal tolerated doses, with diuretic resist-ance, defined as poor diuretic response with po furosemide dose of at least 250mgdaily, were enrolled Due to persisting congestion despite IV diuretic treatment, initiationof intermittent extracorporeal ultrafiltration sessions was decided. All patients under-went arterio-venous grafts implantation and were subjected to ultrafiltration threetimes weekly. They were divided in two groups according to their clinical response;group A: patients with improvement in symptoms and group B: patients with worseningheart failure symptoms after graft implantation.Results: Median event-free (hospitalization or death) survival at 6 months was 12weeks for Group A and 1 week for Group B patients (log rank test, p ¼ 0.002). Baselinecharacteristics did not differ etween the two groups: age (60+11 vs 70+8 years, p ¼NS), NYHA functional class (3.8+0.8 vs 3.6+0.5, p ¼ NS), serum hemoglobulin(10.6+0.8 vs 11.6+1.3g/dl, p ¼ NS), serum creatinine (1.9+0.4 vs 2.7+0.9mg/dl,p ¼ NS), serum sodium (135+5 vs 135+6mEq/Lt, p ¼ NS), systolic blood pressure(95+8 vs 100+21mmHg, p ¼ NS), PCWP (25+5 vs 23+5mmHg, p ¼ NS), cardiacindex (2+0.9 vs 1.9+0.1 ml/min/m2, p ¼ NS), ejection fraction (31+10 vs 25+6,p ¼ NS) and right ventricular systolic pressure (57+13 vs 69+14mmHg, p ¼ NS),for Groups A and B, respectively. However, Group B patients had significantly higherlevels of bilirubin (2.6+0.9 vs 1.2+0.6mg/dl, p ¼ 0.02), right atrial pressure (22+6vs 13+4mmHg, p ¼ 0.022) and more frequent severe tricuspid regurgitation (p ¼0.018).Conclusions: Increased right atrial pressure, severe tricuspid regurgitation andincreased serum bilirubin were identified as risk factors for severe hemodynamicdecompensation following creation of an arteriovenous fistula, underscoring the impor-tance of right ventricular function for the tolerance of the volume overload resulting fromthis intervention. When selecting end-stage heart failure patients with cardiorenal syn-drome for chronic ultrafiltration therapy, the presence of these factors should lead toconsideration of alternative vascular access and avoidance of arteriovenous fistulas.

P1204Cardiac functional capacity and kidney failure: is there a correlation?

R. Lagioia1; R. Raimondo2; G. Farinola1; M. Iacoviello3; F. Monitillo3; M. Gesualdo3;A. Zito3; S. Favale3; R. Pedretti2; D. Scrutinio1

1S. Maugeri Foundation, Cassano Murge, Italy; 2IRCCS Foundation Salvatore Maugeri,Department of Cardiology, Tradate, Italy; 3University of Bari, Department of Cardiology,Bari, Italy

Background: Data emerging from literature demonstrate an increasingly important roleof the kidney failure in heart failure. The two diseases in the same patient undoubtedlyworsen the clinical conditions and functional capacity, and aggravate the prognosisespecially in older subjects.The aim of this study was to assess the relationship between kidney function and func-tional capacity of patients with chronic heart failure.Methods: retrospective, multicenter, not randomized study carried out in patients withchronic heart failure (NYHA class II-III) with systolic dysfunction and EF ,35%. Renalfunction was assessed by determining serum creatinine and glomerular filtrateaverage (MDRD). The functional capacity was evaluated by the peak VO2 during car-diopulmonary testing.Results: Were enrolled 474 patients with a mean age of 61 + 11 years, NYHA class2.3 + 0.5, left ventricular EF of 28 + 7%, BMI of 27 + 5 and peak VO2 of 15 + 5.2.The 87% of patients were male and 13% had atrial fibrillation. The 20% had an AICD,the 7% a biventricular PM. The 97% of patients were treated with ACE inhibitors or

angiotensin receptor blockers, 82% with beta-blockers, 85% with diuretics (furosemide)and 49% with potassium-sparing.The multivariate analysis has shown a statistically significant direct correlation betweenpeak VO2 and male sex, left ventricular EF and hemoglobin (p ,0,0001) and aninverse correlation between age and NYHA class (p ,0,0001); R2 ¼ 0,33. Regardingrenal function, were found to be more correlated with VO2 peak the creatinine(p ,0,0076) and MDRD (figure).Conclusions: In patients with chronic heart failure, in NYHA class II-III, the reduction ofkidney functionality is responsible for a greater impairment in the functional capacity ofsuch patients.

CELLULAR BIOLOGY

P1205EPA protects the cultured cardiac myocytes against oxidative stress viaautophagy

CH. Chiang1; HC. Hsu2; MF. Chen2; CY. Chen1

1National Taiwan University, Taipei, Taiwan; 2National Taiwan University Hospital, Taipei,Taiwan

Dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFAs) like eicosapentaenoicacid (EPA) protects the heart via reducing the cardiovascular risk factors and decreas-ing the mortality in patients with heart failure, but the underlying mechanisms areunclear. In this study, we examined the protective role of EPA against oxidativestress in cardiomyocytes and tried to identify its molecular mechanism, especiallythe self-recovery function of autophagy.Methods: H9c2 cells were grown in media containing EPA (80 mM) for 24 hrs and thenexposed to H2O2 (400 mM) to induce oxidative stress.Results: Oxidative stress caused severe cell death, especially apoptosis; whereas EPAsignificantly improved cell viability and apoptosis in response to oxidative stress.3-methyladenin (3-MA), autophagic inhibitor, abrogated the protective effect of EPAon cell viability against oxidative stress. Induction of oxidative stress decreased theprotein expression of autophagy-related protein (beclin 1 and LC3II) and lysosomalenzyme, cathepsin D. Whereas EPA increased the protein expression of beclin1,LC3II, and cathepsin D in cardiomyocytes exposed to oxidative stress. To further eluci-date the upstream regulation of autophagy by EPA’s protection, the expression of Aktand ERK was analyzed, and the results showed that EPA activated the autophagicfunction via activating ERK- and inhibiting Akt- dependent pathway, therefore attenu-ated the oxidative damage in cardiomyocytes. However, the protective role of EPAwas in an AMPK- independent manner.Conclusion: oxidative stress inhibited the autophagic function in cardiomyocytes,whereas EPA activated autophagy and reduced oxidative stress-induced cell death,implying that autophagy partially contributed to the improvement of EPA on cardiomyo-cyte death resulting from oxidative stress.

P1206Gene expression profile of atherosclerotic coronary artery disease of inpatients of different ethnicity in Malaysia

MH. Ngoo Abdullah1; Z. Othman2; H. Mohd Noor1; R. Jamal2; AK. Mohd Yusof3;AR. Abdul Rahman1

1Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia; 2UKM MedicalMolecular Biology Institute (UMBI), Kuala Lumpur, Malaysia; 3Institut Jantung Negara,Kuala Lumpur, Malaysia

Introduction: The molecular basis of coronary artery disease (CAD) has been widelystudied in the Western world but there is no published work on the Malaysian

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population. This study looked at the global gene expression profiling of the peripheralwhole blood of patients with CAD from the 3 main ethnic groups in Malaysia.Materials and Methods: Male case subjects selected were based on angiographicallyconfirmed CAD (≥30% stenosis) and normal control subjects (0% stenosis) with agerange of 53.5+8.5 and 51.0+7 years respectively (p = ns). The global geneexpression of 12 angiographically documented CAD and 12 matched control subjectswere performed.Result: Total of 593 and 479 up and down regulated differential expression (DE) genes,respectively, were identified in this study at the fold change of 1.3 with fault discoveryrate (FDR) of 1%. Of the 18 genes, 6 are up regulated DE genes (GHRL, LGALS2, LTA,CAV1, CAV3, and VEGFA) and 12 are down regulated DE genes (CBS, HP, ITGA2B,IL18R1, IL18RAP, IL1B, ITGB3, MMP9, OLR1, PLA2G7, SOD2, and UTS2) in the com-bined group samples. The Malays have 6 DE genes up regulated (GHRL, LTA, CBS,HP, ITGA2B and OLR1) and 8 DE genes down regulated (LGALS2, IL1B, ITGB3,MMP9, PLA2G7, SOD2, UTS2, and CAV3). The Chinese have 4 DE genes up regulated(LGAL2, CAV1, CAV3 and VEGFA) and 9 DE genes down regulated (CBS, HP, IL18RAP,IL1B, ITGA2B, ITGB3, MMP9, OLR1, and SOD2). The Indians have 2 DE genes upregulated (GHRL and, LGALS2) and 8 DE genes down regulated (CBS, HP, IL18R1,IL18RAP, ITGA2B, MMP9, OLR1 and CAV1). This study also identified 81 and 56 upand down regulated DE genes, respectively, which was never previously describedto be associated with CAD. The IL1B, MMP9 and SOD2 genes were down regulatedin all the 3 ethnic groups making them potential biomarkers candidates for CAD thatneed further verification in a cohort study.Conclusion: There are ethnic differences in the expression of the 18 genes known tobe associated with CAD and IL1B, MMP9 and SOD2 genes were down regulated in allthe 3 ethnic groups and may yield as potential biomarker for CAD.

CO-MORBIDITIES (INC COPD, ANAEMIA, CACHEXIA)

P1207Reduced bone mineral density is associated with cachexia in heart failure andcan identify patients at risk of adverse prognosis

P. Zotos1; J. Terrovitis1; E. Kaldara1; A. Ntalianis1; S. Vakrou1; L. Katsaros1;S. Sventzouri1; A. Chalazonitis2; D. Kontoyannis2; J. Nanas1

1University of Athens, School of Medicine, 3rd Cardiology Dept., Athens, Greece;2Alexandra University Hospital, Athens, Greece

Background: The presence of cachexia in Chronic Heart Failure (CHF) is associatedwith impaired prognosis. Early recognition of cachectic CHF patients is extremelyimportant; however there are difficulties in applying the definition of cachexia in clinicalpractice and there is no simple screening test for cachexia in CHF. In addition, the influ-ence of cardiac cachexia on bone status has not been thoroughly investigated.Methods: Bone mineral density (BMD) of total body (TB) was examined using dualenergy X-ray absorptiometry (DEXA) in 60 male patients with CHF (age: 56+11).BMD, T-score and Z-score were also measured in the femur (F). The combined clinicalendpoint was death, left ventricular assist device (LVAD) implantation or need for ino-tropes, during a follow up of 2 years.Results: According to the standard definition of cardiac cachexia, 9 out of 60 patients(15%) were in cachectic status (NYHA III/IV: 4/5). Cachectic patients had significantlyincreased brain natriuretic peptide (2018+1254 vs. 813+911 pg/ml; p: 0.001),increased wedge pressure (27+6 vs. 17+8 mmHg; p: 0.003), reduced cardiacindex (1.6+0.5 vs. 2+0.6 ml/min; p:0.03). Cachectic patients exhibited significantdifferences in all three body compartments (bone, lean and fat tissue), either in totalbody or in specific regions of the body. In particular, TBBMD (p: 0.002) and FBMD(p: 0.004) were significantly associated with the presence of cachexia. ROC curveanalysis showed that TBBMD (area under the curve [AUC]: 0.804 and p: 0.004) andFBMD (area under the curve [AUC]: 0.82 and p: 0.005) could identify cachecticpatients. Values of TBBMD below 1.150 g/cm2 discriminate cachectic patients with sen-sitivity of 67% and specificity of 86%. Values of FBMD below 0.786 g/cm2 identifycachectic patients with sensitivity of 63% and specificity of 78%. The presence ofcachexia had independent prognostic value for adverse outcome in CHF patients(hazard ratio 5.9; 95% confidence interval CI; 2.1 to 16.0; p: 0.001).Conclusions: Patients in advanced stages of CHF are at increased risk of developingcachexia, a condition related to unfavorable outcome. TBBMD and FBMD could bevaluable tools for distinguishing CHF patients at risk of cachexia and allow early diag-nosis and treatment.

P1208Heart failure plus common co-morbidites and their outcomes in a multi-ethnicAsian cohort in Singapore

K T G. Leong; Y. Cao; M. Tan; S. Buhari; S. Lim; Y. Yeo; K. Poh; PP. GohChangi General Hospital, Singapore, Singapore

Purpose: Heart failure (HF) is commonly associated with the elderly (aged ./ ¼ 65years), hypertension (HTN), type II diabetes mellitus (T2DM), and stroke. We willlook at these and outcomes in this studyMethods: Patients with a discharge primary diagnosis of HF, and admission to ourhospital in 2008, were enrolled. Diagnosis of heart failure was prospectively definedand reviewed by two cardiology teams. Patients’ case records were reviewed or

families were interviewed follow-up outcomes information. Aged ./ ¼ 65 years andcommon co-morbidities- T2DM, HTN, CVA, and IHD as cause of HF were evaluated.Results: There were 454 enrolees in 2008. The mean age (SD) was 69.3 (12.5) years.67.6% were elderly. Ethnic Chinese, Malay, and Indian constituted 46.5%, 34.8%, and12.8% of the cohort respectively. Prevalence of T2DM, hypertension, combined T2DMand HTN, CVA and IHD as cause of HF were 61.5%, 75.8%, 51.8%, 11.5% and 68.3%respectively. Mean LVEF (SD) was 36.9 (17.9)%. 41.3% of the cohort had LVEF ./ ¼45%.30D day and 12M all cause mortality rates were 2.6% and 19.4% respectively. 30D allcause and HF readmission rates were 24.7%, and 9% respectively. There were no sig-nificant differences in mortality amongst the co-morbidities or aged ./ ¼ 65 Years.For 12M all cause readmissions, there were significantly more T2DM v non T2DM(77.1% v 64.0%, p ¼ 0.004), combined T2DM and HTN v absence of T2DM and HTN(77% v 66.7%, p ¼ 0.016), and IHD v non-IHD (75.2% v 65.3%, p ¼ 0.03). 30D HF read-mission rates were significantly higher in the elderly cohort (11.1% v 4.8%, p ¼ 0.04)Patient with LVEF ./ ¼ 45% were significantly more likely to be elderly (47.5% v 28.3%,p , 0.001), and significantly less likely to have IHD as cause of HF (32.7% v 59.9%, p ,

0.001). Patients with HF and T2DM were significantly more likely to be Indian (17.2% v5.7%, p , 0.001). Patient with HF and combined T2DM and HTN were significantly lesslikely to be Chinese (40.4% v 53%, p ¼ 0.008) and significantly more likely to be Indian(16.2% v 9.1%, p ¼ 0.03). Elderly HF patients were significantly less likely to be Malay(28.3% v 48.3%, p , 0.001) and significantly more likely to be Chinese (52.8% v 33.3%,p , 0.001).Conclusions: In a Multi-Ethnic Asian heart failure Cohort in Singapore, the elderly,HTN, T2DM, stroke and IHD as etiology of HF are common. These co-morbiditieshad significant correlations with ethnicity. Certain co-morbidities were significantlyassociated with increased morbidity. There were no significant associations betweenall studies co-morbidities and 30D or 12M mortality outcomes.

P1209The relation between malnutrition evaluated by the Mini-Nutritional Assessment(MNA) in ambulatory patients with heart failure, quality of life (QoL) assessedby the MLHFQ test and NtProBNP

M. Satendra; C. Santos De Sousa; L. Sargento; I. Almeida; M. Teixeira; F. Salazar;N. Lousada; R. Palma Dos ReisCardiology II Department, Pulido Valente Hospital, Centro Hospitalar Lisboa Norte,Lisboa, Portugal

Purpose: To assess the relation between malnutrition assessed by the MNA, QoLassessed by the Minnesota quality of life score (MLHFQ) test and neurohormonal acti-vation assessed by estimation of the NtProBNP in patients with heart failure regularlyfollowed in a Heart Failure Outpatient Clinics.Methods: 50 patients (62% M), age 68,6+12,9 years old, body mass index27,95+5,35 Kg/m2, all with impaired global systolic left ventricle function, NtProBNPmedian 1823 pg/mL, regularly followed in a Heart Failure Outpatient Clinic. BothMNA and MLHFQ tests were applied to all patients. Statistical evaluation by Studentt test or Mann-Whitney for non-parametric data; Pearson correlation coefficient determi-nation to assess the association between variables.Results: (1) First assessment of the MNA score: 24% patients had a higher risk of mal-nutrition. Final MNA score results: 86% had no malnutrition; 10% had a higher risk ofmalnutrition and 4% had malnutrition. (2) Patients with higher risk of malnutrition had ahigher MLHFQ (48,6+14,8 vs 28,5+14,7; p ¼ 0,001). (3) Inverse relation between theinitial MNA score results and the MLHFQ score (r ¼ 20,547; p, 0,001) and NtProBNP(r ¼ 20,414; p ¼ 0,003).Conclusion: The risk of malnutrition in patients with heart failure is relevant and is sig-nificantly associated with a poorer quality of life and a higher NtProBNP. These associ-ations can most likely predict a worse long term prognosis.

P1210Cardiac remodeling in elderly patients with heart failure: obesity influence

L. Malinova1; T. Denisova2; T. Silina2

1Scientific research institute of cardiology, Saratov, Russian Federation; 2Saratov StateMedical University, Saratov, Russian Federation

Purpose: Cardiac remodelling as heart failure (HF) substrate in elderly is still within thearea of uncertainty. Progression from adulthood to senescence affects cardiac contrac-tile properties and myocardial substrate metabolism independent of HF. Aging alsoassociates with increase of adiposity. Recent evidence demonstrates that obesitycan result in a cardiac specific "lipotoxicity". The clinical complexities of HF andobesity in elderly patients and paucity of data causes this study.Methods: 122 patients with heart failure 75 years of age and older were included inthestudy. Serum B-type natriuretic peptide (BNP), adiponectin (Ad), leptin (Lp),tumour necrosis factor-a (TNF-a), and interleukin-6 (IL-6) were measured in duplicateusing commercially available enzyme-linked immunosorbent assay kits. Myocardialstructure and contractile function was assumed by echocardiography.Results: Percent body fat (PBF) functions of BNP, Ad, Lp, TNF-a,and IL-6 (estimated byhigh degree polynomial approximation) were of non linear character. BNP concen-tration increase up to 37.25% PBF was followed by significant diminishing with meanrate -0.01 ng%/ml. Initial PBF augmentation (27.3-36.7%) was associated with IL-6level reduction while Ad concentration decreased throw several local extremums with

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mean rate-0.13 mcg%/ml. Similar dynamics had been detected in TNF-a. During BNPsignificant variations Lp concentration remained stable up to 43.1% PBF, and it’sincrease (mean rate 8.39ng%/ml) was associated with "restoration" of BNP level. PBFincrease positively correlated with left ventricular diastolic dysfunction type, and nega-tively correlated with left ventricle ejection fraction (p ¼ 0.002, and 0.0378,respectively).Conclusions: Comparison within PBF functions of BNP, Ad, Lp, TNF-a,and IL-6revealed significant delays in adipokine-cytokine interactions in elderly patients withHF which can be considered as indication on involutional modulation of intracellularsignals in cardiac cells.

P1211Chronic obstructive pulmonary disease diagnosed based on the lower limit ofnormal does not worsen survival in chronic heart failure patients

MK. Lizak1; M. Zakliczynski2; A. Jarosz3; M. Zembala2; Z. Kalarus4

1Silesian Centre for Heart Disease, Dpt. of Cardiology, Congenital Heart Diseases &Electrotherapy, Zabrze, Poland; 2Medical University of Silesia, Silesian Centre for HeartDis., Dpt Cardiac Surgery & Transplantology, Zabrze, Poland; 3Medical University ofSilesia, Zabrze, Poland; 4Medical University of Silesia, SCHD, Dpt. of Cardiology,Congenital Heart Disease & Electrotherapy, Zabrze, Poland

Purpose: Spirometry (PFT) is the only standard for COPD diagnosis. There is little evi-dence of PFT-based COPD diagnosis impact on prognosis in chronic heart failure(CHF). Prognostic value of Lower Limit of Normal (LLN) based COPD diagnosis hasnot been evaluated in CHF yet.Material and Methods: 178 consecutive CHF pts on chronic beta-antagonist treatmentwith a CPET and PFT record (30 women, 52+9 years, BMI 26+4; PeakVO2 13+3ml/kg/min, LVEF 24+7%) evaluated in heart transplantation clinic were divided intogroups basing on PeakVO2 result:Group 1 (N ¼ 26) – PeakVO2,10ml/kg/min,Group 2 (N ¼ 40) – PeakVO2 10.1–12ml/kg/min,Group 3 (N ¼ 42) – PeakVO2 12.1–14ml/kg/min,Group 4 (N ¼ 70) – PeakVO2.14ml/kg/min.Impact of COPD diagnosed basing on the classic (FEV1%FVC , 70) or LLN(FEV1%FVC , LLN) criteria on survival time, number and duration of cardiac andall-cause hospitalisations was assessed.LLN set at the 5th‰ of PFT values’ normal distribution in a refference population isspecific to each patient’s age, sex and height.Chi2, U Mann-Whitney, ANOVA Ranks and Kaplan-Meier analysis were performed. p ,

0.05 was significant.Results: COPD had no impact on survival time independently of diagnostic criterionused. Impact of COPD on morbidity is showed on the example of Group 4 in table1. [tab 1]LLN based COPD diagnosis named prognosis in the most groups and was statisticallystrongest when measured with the Z-score.Conclusion: COPD has no impact on mortality but significantly influences cardiac andall-cause morbidity in CHF pts. LLN spirometry criteria should be used for diagnosingCOPD in CHF.

P1212A retrospective study of systematic research of chronic obstructive pulmonarydisease in a systolic heart failure population

B. Arnaudis; O. Lairez; J. Roncalli; A. Pathak; R. Escamilla; M. GalinierUniversity Hospital of Toulouse - Rangueil Hospital, Toulouse, France

Background: Chronic obstructive pulmonarydisease (COPD) is an independent riskfactor for cardiovascular disease (CVD)including heart failure (HF) and coronaryarteries diseases, which are one ofthe leading causes of morbidity and mortality inCOPD patients. Thus, COPDcould deteriorate HF and explain the worst prognostic ofthe association of thetwo diseases. Actually, there is no information about the realprevalence of COPDassessed by systematic pulmonary function test in HF patients.Purpose: Describe the prevalenceof COPD in a systolic HF population.

Methods: COPD was systematically researched by pulmonary function test in 274patients (216 men) followed for systolicHF between April2002 and April 2009.Degrees of COPD were defined according to the GOLD classification.Results: In the348systolicHFpatientsmean agewas 60+14years and meanejection frac-tion (EF) was 31+10% with 149 (43%) patients with ischemic systolic HF. There was 132(38%) of COPD with 68 (19.5%), 50 (14.4%), 10 (2.9%) and 4 (1.1%) GOLD 1, 2, 3 and 4respectively. Therewas not difference between no-COPD and COPD groups in sex (75 vs78.8% men;p ¼ 0.4) and NYHA stage (mean 2.3+0.8 vs 2.3+0.8; p ¼ 0.8) but patientswith COPDwere older (57+14 vs 65+11 years; p , 0.001) and had better EF (30+9vs33.2+12%; p ¼ 0.004). There was 52.3% ischemic heart failure in the COPD groupver-sus 43.9% in the no-COPD group (p¼ 0.12) and COPD group had more statintreatment(50.8 vs 35.2%; p ¼ 0.004). Mean follow up was 56+42 month. COPD grouphad worstprognostic than no-COPD group with a total mortality of 54% versus42% (p = 0,04).Conclusion: COPD has a highprevalence in systolic HF population but clinical diag-nostic is difficultbecause of the lack of specificity of dyspnoea assessed by NYHAstage. HFpatients with COPD are older and have a better EF suggesting that dyspnoeafrompulmonary disease is interpreted as a symptom of HF. Yet, COPD decrease global-prognostic in systolic heart failure.

P1213Cardiac and non-cardiac comorbidity in elderly patients with HFREF and HFPEF

N. Solomakhina; BelenkovFirst Moscow State Medical Univercity, Moscow, Russian Federation

Aim: to analyze comorbidity, cardiac and non-cardiac in elderly patients with heartfailure with reduced and preserved left ventricle ejection fraction (HFREF and HFPEF).Material and methods: data from 81 patients with HFREF (EF , 40%, 60 males and 21females) and 86 with HFPEF (34 males and 52 females), aged from 65 till 99(80.0+1.2) were analyzed. All patients were presented with heart failure, accordingto ESC criteria. Chi-square and Fischer’s tests were used to determine significanceof differences. P ,0.05 was considered significant.Results: HFREF patients had significant excess of CAD, especially MI (85.2+4.0% vs37.2+5.2%; p , 0.001 ), including recurrent (more than 2 in 33.3+5.3% vs 5.8+2.5%;p, 0.001), alcohol abuse (22.2+4.6% vs 7.0+2.8%; p ¼ 0.005), and sports orextreme physical activity in anamnesis (9.9+3.3% vs 2.3+1.6%; p ¼ 0.04). InHFREF patients was significantly increase prevalence on periphery artery disease(23.5+4.7% vs 5.8+2.5%; p , 0.001) and COPD (34.6+5.3% vs 8.1+3.0%; p ,

0.001), probably due to high prevalence of current or past smoking (40.7+5.5% vs11.6+3.5%; p, 0.001). In HFPEF patients it was found increased prevalence of hyper-tension (76.7+4.6% vs 44.4+5.6%; p , 0.001), obesity (33.7+5.1% vs 19.7+4.5%;p ¼ 0.042) and impaired glucose tolerance (12.8+3.6% vs 3.7+2.1%; p ¼ 0.034).But the prevalence of diabetes mellitus were without significant difference betweengroups (29.1+4.9% vs 19.8+4.5%; p ¼ 0.16). HFPEF patients more often sufferedfrom mental disorders, such as vascular dementia (14.0+3.8% vs 3.7+2.1%; p ¼0.021), and infections, especially (25.6+4.7% vs 7.4+2%; p ¼ 0.002), and venousinsufficiency (40.7+5.3% vs 21.0+4.6%; p ¼ 0.006).Conclusions: patients with HFREF and HFPED have different comorbidity profiles. InHFREF it was found more cardiac comorbidities, including CAD and PAD, mostly maleswith extreme physical activity in anamnesis in some cases. In HFPEF group it wasfound increased prevalence of hypertention and non-cardiac comorbidities, such asmetabolic and mental disorders.

P1214Vulnerability and protective factors of non-resilience in a sample of Portuguesepatients with heart failure

MM. Fontelonga Bento; C. Fonseca; F. Marques; I. Araujo; A. Leitao; F. CeiaHospital Sao Francisco de Xavier, Lisboa, Portugal

The families of and patients with heart failure (HF), a distress disease with poor prog-nosis, adapt (positively or not) and try to change negative adverse effects (e.g. physicalincapacity, dependency, fatigue), according to their own resources. Such resourcesinclude vulnerable and resilient protective factors, as well as supportive health interven-tions. Aim: To analyse vulnerable bio-psychosocial factors that predict non-resilience inHF patients.

Table 1. Impact of COPD on morbidity-G4 (Abstract P1211 Table).

FEV1%FVC,LLN FEV1%FVC≥LLN FEV1%FVC , 70 FEV1%FVC ≥ 70 FEV1%IVC , 70 FEV1%FVC ≥ 70N 53 6 59 9 47 13

Number of cardiac hosp./1yr mean+SD 0.59+0.21 0.34+0.68 0.43+0.31 0.33+0.65 0.42+0.33 0.34+0.72p 0.007 0.04 0.031Z -2.71 -2.06 -2.15

Duration of cardiac hosp./1yr [days] mean+SD 6.3+5.8 2.7+7.2 4.5+5.3 2.6+6.9 3.6+4.7 2.9+7.6p 0.003 0.017 0.028Z -3.01 -2.4 -2.19

Number of all-cause hosp./1yr mean+SD 0.75+0.28 0.41+0.8 0.54+0.4 0.4+0.77 0.5+0.4 0.42+0.84p 0.006 0.049 NSZ -2.75 -1.79 -

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Methods: 51 HF patients (according to ESC), NYHA class I-IV, male 66,6%, mean age72,94+12,65 years. Sociodemographic and clinical data were obtained from medicalrecords and other bio-psychosocial factors, (including non-resilience), were obtainedby Structured Interview of Symptoms and Concerns. Symptoms of depression wereassessed by Beck Depression Inventory (BDI-II). A qualitative question was asked forthe most positive aspects of patients’s life. Prevalence of non- resilience was deter-mined and predictors were analysed by multiple regression.Results: 17,6% of the patients were non-resilient. Factors associated with non-resili-ence were: difficulty of communication (p ¼ 0,006), small social network (p ¼ 0,013),negative perception of social support (p ¼ 0,004), anxiety (p ¼ 0,053), depression(p ¼ 0,002), dispneia (p ¼ 0,002), NYHA class III-IV (p ¼ 0,019) and non-adherenceto medication (p ¼ 0,016). After multiple regression analysis adjusting for age,anxiety and hopelessness, predictors of non-resilience were: NYHA class (OR,28,309; 1,102-727,1), depression (OR, 29,898; 138-645,7), and difficulty of communi-cation (OR ¼ 17,24; 1,047-283,9).Conclusions: Higher severity of HF (NYHA class) and depression predict non-resili-ence, which suggests that both could change the patient’s resilience. Depressionand difficulty of communication could be more permanent vulnerable factors that con-tribute to non-resilience. In addition, non-resilient patients compared to resilientpatients have more difficulty finding positive aspects, have lower personalpsychological valuation. It would be valuable to identify which are the most importantresilience resources and their potential limits in supporting patients with greater severityof HF.

P1215Comparison of functional and laboratory indicators at patients with CHF andanemia, depending on aetiology of disease

TA. Abdullaev; IA. Tsoi; BU. MardanovRepublic Specialized Center of Cardiology, Tashkent, Uzbekistan

The aim: To study interrelation between haemoglobin (Hb) level, functional and labora-tory indicators at patients with an anaemia and chronic heart failure (CHF) of variousaetiology.Methods: Two groups were compared in this study: I (n ¼ 44, without any valvedefeats) and II (n ¼ 38, patients with CHF, caused rheumatic heart disease). Bothgroups had NYHA III-IV, and also an anaemia (A) (level of Hb for men - less then 13g/dl, for women - below 12g/dl). I gr patients depending on aetiology of CHF were dis-tributed as follows: coronary desease- at 31 pts, rheumatic heart disease (RHD)- at 3pts, dilated cardiomyopathy- at 9 pts, congenital heart desease- at 1pt. Besides an esti-mation of a functional condition, were defined Hb level, inflammatory indicators, andcorrelation with creatinin level and urea.Results: The Hb level, in groups has appeared comparable, compounding10,36+1,37g/dl. According to the six-minute walking test (6MWT) the lower distancein group of pts with RHD is defined, in comparison with the general group(173,19+88,71m vs 246,32+101,36m), and the given condition is characterisedalso by younger age which CHF was developed at (43,08+10,78 and54,86+14,16yrs). The analisis of corellation at pts with RHD has revealed reliabledirect interrelation between Hb level and the 6MWT distance (173,19+88,71m, r ¼0,329; p ¼ 0,047). However, in II group, it has been revealed return strong corellationbetween Hb level and indicators of kidney‘s function such as creatinin averaged127+75 mkmol/l (r ¼ 20,332; p ¼ 0,025), versus group of patients with RHD (creatinin- 100,37+41,31mkmol/l, r ¼ 20,271; p ¼ 0,1).Despite it, patients with CHF rheumatic aetiology had the direct dependence betweenindicators of an inflammation and creatinin level, indirectly reflecting function of kidneys(mean level of CRP -15,23+17,22, r ¼ 0,531; p ¼ 0,01). At pts with CHF of differentaetiology such correlation has not been revealed (CRP mean - 13,5+12,75,r ¼ 20,276; p .0,05).Thus, by results of our research younger age of patients with RHD, and also lower PWCin this group are noted. Relation between Hb level and creatinin at pts with CHF ofvarious aetiology is noted. However, deterioration of kidney‘s function at RHD has adirect corellation with inflammatory indicators in blood.

CYTOKINES AND INFLAMMATION

P1216Short term effects of reperfusion therapy on biomarkers of apoptosis andinflammation in patients with acute myocardial infarction

A. Iakovleva; O. Mirolyubova; K. Holmatova; I. DvoryashinaNorthern State Medical University, Arkhangelsk, Russian Federation

Purpose: To assess possible effect of reperfusion therapy on biomarkers of apoptosisand inflammation in acute myocardial infarction (AMI).Methods: 48 patients with AMI (female – 25%) were included. The age of patients withSTelevation MI (STEMI) was 57.6+10.4 years, NSTEMI – 62.6+10.6 years. Proportionof STEMI/NSTEMI patients was 43 (89.6%)/5 (10.4%). Interventional strategy was usedin 2 patients with NSTEMI. Reperfusion therapy in STEMI patients was following:primary percutaneous coronary intervention (p-PCI) – 14 (32.6%), intravenous throm-bolysis (IV TL) alone – 7 (16.3%), IV TL + PCI – 13 (30.2%), no reperfusion – 9 (20.9%).

TL was pre-hospital in 90% cases. Plasma measurements of soluble Fas-ligand(sFasL), leptin and adiponectin were performed by ELISA at two weeks after AMI. Allstatistics were calculated using SPSS 17.0. Data are presented as M+SD.Results: All patients had the following risk factors: obesity (39.6%), smoking (62.5%),diabetes (29.2%), hypertension (85.4%) and atherogenic dyslipidemia (81.3%). MeansFasL, leptin and adiponectin concentrations were 77.92+36.54 pg/ml,130.38+43.47 ng/ml and 3.73+0.77 mg/ml respectively in patients with AMI. Levelsof sFasL correlated with body mass index (BMI) (20.321, p ¼ 0.029), HDL-cholesterol(0.325, p ¼ 0.029), TG/HDL-C ratio (-0.298, p ¼ 0.052), leptin (-0.336, p ¼ 0.048) andfibrinogen (-0.325, p ¼ 0.033) levels. Correlation between Leptin/Adiponectin ratioand TG/HDL-C ratio was 0.370 (p ¼ 0.040). Besides higher sFasL concentration(81.78+37.98 pg/ml vs. 55.29+12.06 pg/ml, p ¼ 0.029) was associated with hyper-tension. Reperfusion therapy was used in 79.1% of STEMI patients. The type of reper-fusion strategy had significant effect on the level of sFasL at two weeks after AMI: F (3,39) ¼ 4.661, p ¼ 0.007. Post hoc test revealed the combination of TL and PCI to beresponsible for the highest sFasL level in comparison with p-PCI: 106.93+55.81 pg/ml vs. 64.61+12.51 pg/ml (p ¼ 0.01). But there was no impact of reperfusiontherapy on the levels of leptin and Leptin/Adiponectin ratio.Conclusions: We demonstrate a significant effect of reperfusion therapy on biomarkerof apoptotic signaling (sFasL) in STEMI patients. After the dominant reperfusion strat-egy p-PCI in STEMI patients there was the lowest level of sFasL at two weeks timepoint. As well the correlations between metabolic and inflammatory characteristicsand sFasL concentration in patients with AMI were revealed.

P1217Effectiveness of the relative lymphocyte count to predict one-year mortality inpatients with acute heart failure

M. Olivares; J. Nunez; G. Minana; J. Sanchis; V. Bodi; P. Palau; E. Nunez; FJ. Chorro;A. LlacerHospital Clınico de Valencia, Valencia, Spain

Purpose: cumulative evidence support a pathogenic role of inflammation in patientswith heart failure (HF). Previous authors have suggested a significant associationbetween low relative lymphocyte count (RLC%) with worse outcomes in selectedpatients with HF. Nevertheless, the role of RLC% for risk stratification in a large andnon-selected population of acute heart failure (AHF) has not yet well established. Wesought to determine the relationship between low-RLC% and 1-year mortality inpatients with AHF.Methods: we analyzed 1192 consecutive patients admitted for AHF. Total white bloodcells (WBC) and differential counts were measured on admission. RLC% (calculated asabsolute lymphocyte count/total WBC count) was categorized in quintiles and itsassociation with all-cause mortality at 1-year assessed with Cox regression.Results: at 1-year, 286 deaths (24%) were registered. A negative trend was observedbetween 1-year mortality rates and quintiles of RLC%: 31.5, 27.2, 23.1, 23 and 15.5%from quintiles 1 to 5 respectively (p for trend ,0.001). In multivariate setting, onlypatients in the lowest quintile (,9.7%) showed an increased risk of mortality (HR ¼1.76, CI 95% 1.17-2.65; p ¼ 0.006). When RLC% was modeled with restricted cubicsplines, an exponential increase in risk was observed among Q1 patients (Figure).Thus, those with RLC%,7.5% and ,5% showed a 1.95 and 2.66 fold increased riskof death compared to those in the top quintile (Figure).Conclusion: in patients with AHF, RLC% is a simple, widely available, and inexpensivebiomarker, with potential for identifying patients at increased risk for 1-year mortality.

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ICD THERAPY

P1218Efficacy of Ivabradine in patients with chronic heart failure after myocardialinfarction

V. Moiseev1; A. Potapenko1; O. Abdulasisov1; L. Dyatchuk2; I. Meray1; G. Kiyakbaev1;ZH. Kobalava1

1Peoples Friendship University of Russia (RPFU), Moscow, Russian Federation; 2CityClinical Hospital 64, Moscow, Russian Federation

Objective: To assess the effect of ivabradine on clinical, hemodynamic and prognosticmarkers in patients with chronic heart failure (CHF) after myocardial infarction (MI).Methods: 49 (40 men - 81.6%, mean age 63+8.1 years) patients (pts) with previous MI,left ventricular ejection fraction (LVEF) ,40% and CHF III-IV class (NYHA). Arterial hyper-tension was found in 85.7%, type 2 diabetes mellitus in 40.8% of pts. All pts received stan-dard therapy of CHF, 26 of them were randomized to receive Ivabradine (I group) and 23patients in the control group (II group). Ivabradine was administered at a dose of 5 mgincreasing up to 7.5mg twice a day. Duration of follow-up was 36.1+6.2 months. Analysisof frequency of cardiovascular death, hospitalizations and nonfatal MI was done. We alsoanalyzed dynamics of heart rate (HR), blood pressure (BP), EchoCG and ECG par-ameters, the level of Na +, K +, Cl2, and creatinine in blood plasma.Results: Both groups were comparable in terms of basic clinical and demographiccharacteristics. During follow up cardiovascular death was registered in 6 pts 2 (7.6%)in group I and 4 (17.4%) in group II (p ¼ 0.4), hospitalization due to heart failure in 9pts: 3 (11.5%) in group I and 6 (26.1%) in group II (p ¼ 0.273), nonfatal MI in 2 (7.6%)and 3 (13.0%) pts (p ¼ 0.655) respectively. The frequency of the combined end point(hospitalization rate, recurrent nonfatal MI and death) was 7 (30.4%) and 13 (56.5%)respectively in I and II groups (p ¼ 0.046). HR in ivabradine group decreased from 71(64.5, 79.3) to 64 bpm (57.0, 68.0, p ¼ 0.009) and from 67 (62.0, 74.8) to 65 (59.0,71.0, p ¼ 0.193) in group II. Changes in mean systolic and diastolic BP in bothgroups were not statistically significant. LVEF increased from 35.2 (31.2, 38.1) to36.5% (32.7, 39.0, p ¼ 0.387) and from 33.0 (30.0, 38.0) to 35.7% (31.2, 35.7, p ¼0.005) in group I and II respectively. No changes of ECG, electrolyte composition ofplasma and creatinine levels were found at the end of the observation.Conclusion: Therapy with ivabradine in addition to the standard therapy of CHF afterMI showed a significant reduction in the incidence of combined end point (hospitaliz-ation rate, recurrent nonfatal MI and cardiovascular death).Therapy with ivabradine wasaccompanied with significant decrease in HR without changes of blood pressure andLVEF.

P1219Laboratory results and death rate in patients with decompensated chronic heartfailure and hyperurikemia

E. Sinyutina; L. Aleksandriya; V. MoiseevRussian Peoples Friendship University, Moscow, Russian Federation

Objective: to study the incidence of hyperurikemia, as well as laboratory resultsaccording to the level of uric acid in patients with decompensated chronic heartfailure (CHF).Materials and methods: a total of 170 patients (99 males and 71 females of 40–85years old, the median age is 66.5+8.8 years ) were included in the trial. They allhad chronic heart failure NYHA II-IV. Chronic heart failure was caused by coronaryartery disease, hypertension or heart valve disease. Hyperurikemia was diagnosed ifthe level of uric acid was over 416 mmol/l.The patients were divided into two groups: 85 patients with a normal value of uric acidand 85 patients with hyperurikemia. Values were given in IU [25%; 75%].Results: Males were hospitalized more often due to the decompensation of heartfailure. Gout was diagnosed in 2 out of 85 patients with hyperurikemia (value range416 – 820 mmol/l). In patients with Class II CHF average uric acid value was 386[305; 466] mmol/l, Class III CHF – 413 [358; 550] mmol/l, Class IV CHF – 473 [410;516] mmol/l. In Group 1 the average UA value was 356 [291; 393] mmol/l, in Group2- 520 [466; 595] mmol/l, (p , 0,001); CRP – 1.51[0.5; 3.4], 3.0 [1.35; 11.1] mg/dl,(p , 0.001), Hb 139 [124; 146], 133 [113; 148] g/l, (p , 0.90); creatinine – 98 [85.5;108]; 110[97; 132] mmol/l, (p , 0.001); GFR 63.6 [56.4; 74.13], 56.7 [43.0; 66.3] ml/min, (p , 0,001); BNP- 661.7 [226.9; 1200], 928,3 [461,2; 1789], (p ¼ 0.02).Conclusion: In patients with decompensated chronic heart failure hyperurikemia wasdiagnosed in 85 cases (50%). Patients with hyperurikemia demonstrated high levels ofCRP, creatinine, GFR and BNP; however, the values of their ejection fraction, hemo-globin did not differ.

DIAGNOSIS OF HEART FAILURE AND BIOMARKERS

P1220Rapid point-of-care NT-proBNP optimal cut-off point for heart failure diagnosisin a primary health care center

JM. Verdu1; J. Comin-Colet2; M. Domingo3; J. Lupon4; L. Molina2; M. Gomez2; A. Mena5; MA. Munoz6; JM. Casacuberta1; J. Bruguera2

1Primary Health Care Center Sant Marti Provencals, Barcelona, Spain; 2Hospital del Mar,Department of Cardiology, Heart Failure Program, Barcelona, Spain; 3Primary HealthCare Center Sant Roc, Badalona, Spain; 4Germans Trias I Pujol University Hospital,Badalona, Spain; 5Primry Health Care Center Congres, Barcelona, Spain; 6Institut Catalade la Salut, Barcelona, Spain

Background: Measurement of natriuretic peptides may be recommended prior toechocardiography in patients with suspected heart failure (HF) for optimizing resourceuse.Purpose: To assess the optimal diagnostic cut-off value of NT-proBNP on a communitypopulation attended in primary care and to compare different cut-off point recommen-dations of NT-proBNP to rule out the presence of HF.Methods: Prospective diagnostic accuracy study of a rapid point- of-care NT-proBNPtest in a primary healthcare centre. Consecutive patients referred by their general prac-titioners to echocardiography due to suspected HF were included. Clinical history,physical examination, electrocardiogram, chest x-ray, NT-proBNP measurement andechocardiogram were performed. HF diagnosis was made by a cardiologist blindedto NT-proBNP value, using the European Society of Cardiology diagnosis criteria (clini-cal and echocardiographic data).Results: 220 patients were evaluated (65.5% women; median age 74 years [IQR 67-81]). HF diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with LVEF ,

50% (39.6%+5.1). Median values of NT-proBNP were 715 pg/ml (IQR 510.5-1575,min 290, max 3000) and 77.5 pg/ml (IQR 58-179.75, min 32, max 1741) for patientswith and without HF respectively. The best cut-off point was 280 pg/ml, with an areaunder the ROC curve to rule out HF of 0.94 (IQR 0.91-0.97). 6 patients with HF diagno-sis (11.5%) had NT-proBNP values ,400 pg/ml. Sensitivity, specificity and predictivevalues and results using other recommended optimal cut-off points are shown in thetable. No patient without HF had depressed LVEF.Conclusion: In a community population attended in primary care, the best cut-off pointof NT-proBNP to rule out HF was 280 pg/ml.

P1221Usefulness of Framingham clinical criteria, ECG and NT-proBNP in patients withsuspected heart failure in a primary health care center

JM. Verdu1; J. Comin-Colet2; M. Domingo3; J. Lupon4; S. Fuentes5; A. Mena6;JM. Baena7; MA. Munoz7; JM. Casacuberta1; J. Bruguera2

1Primary Health Care Center Sant Marti Provencals, Barcelona, Spain; 2Hospital del Mar,Department of Cardiology, Heart Failure Program, Barcelona, Spain; 3Primary HealthCare Center Sant Roc, Badalona, Spain; 4Germans Trias I Pujol University Hospital,Badalona, Spain; 5Primary Health Care Center Santa Rosa, Santa Coloma de Gramanet,Spain; 6Primary Health Care Center Congres, Barcelona, Spain; 7Institut Catala de laSalut, Barcelona, Spain

Background: The accuracy of clinical criteria for the diagnosis of heart failure (HF) inprimary care is poor. ECG and NT-proBNP measurement can help general practitionersto correct identify patients with HF.Purpose: To asses the diagnostic usefulness of ECG and NT-proBNP added to Fra-mingham criteria in the diagnosis of HF in a community population attended inprimary care.Methods: Sub-analysis of a prospective diagnostic accuracy study of a rapid point-of-care NT-proBNP test in a primary healthcare centre. Consecutive patients referred bytheir general practitioners to echocardiography due to suspected HF were included.Clinical history and physical examination with Framingham criteria by a general prac-titioner, ECG, chest x-ray, NT-proBNP measurement and echocardiogram were per-formed. HF diagnosis was made by a cardiologist blinded to NT-proBNP value,using the European Society of Cardiology diagnosis criteria (clinical and echocardio-graphic data). Sensitivity, specificity, positive and negative predictive values of Fra-mingham criteria, ECG and NT-proBNP alone and in combination were analysed.Results: 220 patients were evaluated (65.5% women; median age 74 years [IQR 67-81]). HF diagnosis was confirmed by cardiologist in 52 patients (23.6%). The diagnos-tic cut-off point of NT-proBNP used was 280 pg/ml. The best accuracy for one test alonewas obtained with NT-proBNP, being quite low for clinical and ECG alone. However, the

Diagnostic cut-off points of NTproBNP (Abstract P1220 Table)

Cut-off point Sensitivity SpecificityPositive predictivevalue

Negative predictivevalue

Likelihoodpositive

Likelihoodnegative

Best in our study (280 ng/L) 1 0.88 0.72 1 2.95 02008 ESC guidelines 2010 NICE guidelines (400 ng/L) 0.88 0.90 0.73 0.96 8.4 0Recommended by Manufacturer (Europe) (125 ng/L) 1 0.66 0.48 1 9.29 0.13Hildebrandt et al. *(for detecting systolic dysfunction): , 50 years (50 ng/L); 50-75 years(75 ng/L); . 75 years (250 ng/L)

1 0.70 0.50 1 3.33 0

Results of different recommended diagnostic cut-off points applied in our study population

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addition of the three variables resulted in a significant improvement of diagnostic accu-racy (p ¼ 0.005) (Table).Conclusion: Diagnostic accuracy for HF in a primary care setting improved by the useof the three variables (Framingham criteria, ECG and NT-proBNP).

P1222Endothelial and platelet -derived circulating microparticles - correlations withlipoprotein-associated phospholipase A2, paraoxonase and myeloperoxidasein heart failure

DS. Marta1; R. Huica1; I. Serban2; I. Serban3; G. Catalin4; S. Huica5; E. Moldoveanu1

1Victor Babes National Institute of Pathology, Bucharest, Romania; 2University ofMedicine and Pharmacy Carol Davila, Bucharest, Romania; 3Institute of CardiovascularDiseases "Prof. Dr. CC Iliescu", Bucharest, Romania; 4Titu Maiorescu University, Facultyof Medicine and Dental Medicine, Bucharest, Romania; 5Med-As clin, Bucharest,Romania

Purpose: Cellular microparticles (MP) are intact vesicles resulting through an exocyto-tic process from budding of the plasma membrane. Their release occurs both in phys-iological conditions (proliferation/apoptosis) and in various pathological mechanismsincluding hypoxia and inflammation. There is evidence of an increase endothelial-derived circulating MP (EMP) levels in cardiovascular disease. Platelet-derived MP(PMP) are also involved in vascular diseases, as well as in hypercoagulability, hyper-tension, atherosclerosis and systemic inflammatory diseases. LDL associated phos-pholipase A2 (LpPLA2), myeloperoxidase (MPO) are two enzymes implicated inoxidative stress and inflammation and paraoxonase (PON) has antioxidant properties.The purpose of this study was to determine whether there is a correlation between cir-culating MP concentration in plasma and the level of these enzymes in patients with HF.Methods: The study included 40 patients, men and women with documented, clinicallystable heart failure. The control group consisted of 20 healthy individuals, men andwomen. Plasma enzyme levels were determined by spectrophotometric method.EMP and PMP were investigated by flow cytometry for the expression of CD31,CD62E and CD42b antigens relative to the total MP population.Results: In HF patients we found that CD31+/CD42b2, CD31+/CD62E+ andCD31+/CD42b-/CD62E+ EMP expression was increased 2.5-fold, 5.8 and 6.2-fold,respectively. There was also a CD31+CD42b+ PMP increase higher than 5-fold.LpPLA2 and MPO levels were increased in HF patients (413+67 U/L and 311+15U/L respectively) comparative with control (225.65+20.8 U/L and 248.0+21.3) andPON was decreased (52+24 U/L vs. 88.17+12.07). We found that CD31+CD42b2

and CD31+CD62E+ EMP correlated well positively with MPO and negatively withPON levels and that CD31+CD42b+ PMP increase was correlated with all threeenzymes (positively with LpPLA2 and MPO and negatively with PON).Conclusion: Our findings suggest that in HF patients the EMP increase correlates posi-tively with MPO and negatively with PON, whereas PMP show an additional positivecorrelation with LpPLA2.The present study was supported by the Grant 42-146/2008.

P1223Left ventricular diastolic dysfunction in patients at high risk for the developmentof heart failure: gender differences

R. Dankowski; M. Wierzchowiecki; M. Michalski; A. Nowicka; K. Szymanowska;A. Pajak; A. SzyszkaPoznan University of Medical Sciences, 2nd Department of Cardiology, Poznan, Poland

Background: Left ventricular diastolic dysfunction (DD) develops early in most cardiacdiseases and is associated with worse prognosis. Most of the patients (pts) at high riskfor the development of heart failure (HF) are undetected unless the symptoms appear.Current data about the incidence of DD in such pts are sparse and contradictory.Aim: We studied diastolic function in pts at high risk for the development of HF.Methods: 527 primary care pts (mean age 59 years, 211 men) with the presence of atleast 1 risk factor for the development of HF (ischemic heart disease, hypertension, dia-betes, obesity, hypercholesterolemia, renal failure) underwent thorough clinical workupincluding echocardiography. Pts were classified as having left ventricular diastolic dys-function when tissue Doppler velocity of e‘-wave measured at septal segment of themitral annulus was less than 8 cm/s.Results: In whole group DD was recognized 298 pts (56,5%). According to the genderDD was observed in 63% of men (133 of 211 pts) and in 52% of women (133 of 316 pts)and this difference was statistically significant (p ¼ 0,02).

Conclusions: Incidence of diastolic dysfunction in patients at risk for the developmentof heart failure is high. In this population left ventricular diastolic dysfunction occursmore often in men.

P1224Evolution of ferrokinetics and inflammatory parameters in patients with chronicheart failure

A. Martinez-Ruiz; PL. Tornel-Osorio; J. Sanchez-Mas; MC. Asensio-Lopez; JA. Vilchez;F. Pastor-Perez; IP. Garrido-Bravo; A. Lax; P. Martinez-Hernandez; DA. Pascual-FigalUniversity Hospital Virgen De La Arrixaca, Murcia, Spain

Purpose: To study the evolutionary changes of ferrokinetics and inflammatory par-ameters and observe their correlation with cardiac parameters in patients withchronic heart failure (CHF) for one year.Methods: 59 outpatients in stable condition (54+14 years, 83% male) with CHF (ejec-tion fraction of left ventricle of 28+10%) were studied. Blood samples were obtained atthe study baseline and after 12 months of follow up. We studied the changes inparameters of iron metabolism (ferritin, iron, transferrin, soluble transferrin receptor,hepcidin), inflammatory (C-reactive protein (CRP), soluble receptor tumor necrosisfactor I (TNFRI), interleukin 6) and function heart (B-type natriuretic peptide N-terminal(NT proBNP), growth differentiation factor 15 (GDF15).Results: No statistically significant differences in ferrokinetics parameters and cardiacfunction. However we also found a significant increase in inflammatory markers suchas TNFRI (p ¼ 0,007) and CRP (p ¼ 0.025). This increased inflammatory state corre-lated significantly with GDF15 (r ¼ 0.35, p ¼ 0.006,) but not with NT proBNP (r ¼ 0.10,p ¼ 0.424).Conclusions: In patients with CHF, evolutionary changes during the monitoring yearwere caused by inflammatory parameters, mainly the TNFRI and not by ferrokineticsparameters. We showed a correlation with cardiac parameters inflammatory conditionsuch as GDF15.

P1225Combining electrocardiography and a B-type natriuretic peptide cutoff of 50 pg/mL provides an effective screen for asymptomatic left ventricular dysfunction :a report from the STOP – HF STUDY

G. Murtagh; R. O’Connell; IR. Dawkins; MT. Ledwidge; E. Tallon; R. O’Hanlon;KM. Mc DonaldSt Vincent’s University Hospital, Heart Failure Unit, Dublin, Ireland

Purpose: Screening for asymptomatic left ventricular systolic dysfunction (ALVSD)could result in earlier detection and commencement of treatment, reducing the socio-economic burden associated with this condition. However this practice has not beenadopted, and is not recommended in either ESC / ACCF / AHA guidelines. Theprimary obstacle has been the lack of an effective screening tool. Although B-typenatriuretic peptide (BNP) has been suggested as a potential diagnostic aid, concernsremain regarding high rates of false positive results.However, in the case of many recognised screening tools, rates of sensitivity and speci-ficity are considered acceptable despite suboptimal performance. For example, in thecase of Papanicolaou smears for cervical cancer, specificity in the 90–95% range cor-responds to sensitivity in the 20–35% range.We hypothesised that focussing on high risk patient cohorts, and the addition of ECGanalysis, may reduce the rate of false positives and allow for more effective screening.Methods: This study involved 924 high cardiovascular risk subjects, as part of the STOP-HF programme. The mean age was 65 years. Each patient had an electrocardiogram(ECG), Doppler echocardiography and BNP analysis. Sensitivity and specificity were cal-culated for a BNP cutoff of 20 pg/mL and 50 pg/mL. We then evaluated these parametersfor those with either an abnormal ECG or a BNP level of . 50 pg/mL.Results: Using a BNP cutoff level of 20 pg/mL alone resulted in a sensitivity of 88% andspecificity of 45% for detecting an EF , 50%. In the case of patients with EF ,50% andBNP .50 pg/mL, the sensitivity and specificity were 69 and 76% respectively.If we take those subjects with either an abnormal ECG or BNP level of .50 pg/mL andrepeat the analysis, we obtain a sensitivity of 88% and specificity 64%.Hence, in order to achieve a target sensitivity of 88%, a cut-off of BNP .20 pg/mL wouldbe required, which gives a poor specicifity of 45%. However, in the combined test a sen-sitivity level of 88% can still be achieved, but with a higher specificity level of 64%.Conclusions: Using both ECG and BNP in a manner where only patients with either aBNP .50 pg/mL or a BNP ,50 pg/mL with an abnormal ECG will be screened pro-vided excellent sensitivity and specificity.

Diagnostic test in Heart Failure (Abstract P1221 Table)

Sensibility Specificity Predictive + Value Predictive - Value Likelihood (+) Likelihood (-) Accuracy

Framingham criteria (+) 0.73 0.67 0.40 0.88 2.19 0.4 0.68Abnormal ECG 0.96 0.5 0.37 0.97 1.2 0.08 0.61NT-proBNP .280 pg /ml 1 0.88 0.72 1 8.4 0 0.91Framingham criteria (+) and abnormal ECG 0.69 0.81 0.52 0.89 3.63 0.38 0.78Framingham criteria (+) and NT-proBNP .280 pg /ml 0.73 0.94 0.84 0.92 12 0.29 0.89Abnormal ECG and NT-proBNP .280 pg /ml 0.96 0.93 0.80 0.98 13 0.04 0.77Framingham criteria (+), abnormal ECG and NT-proBNP .280 pg /ml 0.69 0.96 0.84 0.90 19 0.32 0.97

Sensibility, specificity and predictive values of Framingham criteria, electrocardiogram (ECG) and NT-proBNP in patients with heart failure

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P1226Relationship between end-tidal carbon dioxide tension and severity of heartfailure with reduced systolic function

T. Lelyavina; TA. Lelyavina; MYU. Sitnikova; AV. Beresina; EV. ShlyakhtoAlmazov Federal Center of Heart Blood & Endocrinology, Saint Petersburg, RussianFederation

Purpose: Patients with cardiac diseases, especially those with congestive heart failure(HF), show a heightened ventilatory response to exercise. Thus, the ventilatory equiv-alent for carbon dioxide (CO2) output are abnormally high in these patients. End-tidalcarbon dioxide tension (PETCO2) is decreased in patients with a decreased cardiacoutput.Aim: To examine PETCO2 at rest, its response to exercise and its relation to functionalcapacity in patients with systolic heart failure and to compare these parameters withthose in health people.Methods and results: 112 HF patients FC II-IV (mean age 58+0,7 years, 65 men, BMI27+0,5, mean left ventricular ejection fraction – 30,6+1,9%) and 109 normal individ-uals (mean age 50+0,3 years, 50 men, BMI 25+0,4) performed exercise tests withbreath-by-breath gas analysis. End-tidal PCO2 at rest and during exercise was signifi-cantly lower in HF patients than in normal subjects, and this difference progressed withseverity of HF (at rest, 6,1+0,1kPa in health people, 4,3+0,1kPa in NYHA class IIpatients, 3,9+0,2kPa in NYHA class III patients, 3,2+0,3 kPa in NYHA class IVpatients). PETCO2 at rest and during exercise strongly correlated with left ventricularejection fraction (r ¼ 20,4, p , 0,05); and inversely correlated with Vd/Vt ratio andpeak oxygen consumption.Conclusion: PETCO2 at rest and during exercise can be used to evaluate the func-tional capacity of patients with systolic heart failure.

P1227Persistent myocardial necrosis and prognosis of patients with chronic heartfailure

EN. Golovenko; DA. Napalkov; VA. SulimovI.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

Background: Chronic heart failure (CHF) progression is accompanied by remodelingof muscular, collagen and vascular elements of myocardium. This can lead to increasein serum concentrations of cardiac troponin I (cTrI), which seem to correlate with poorprognosis in patients with CHF.Purpose: To estimate correlations between cTrI serum concentrations and diseaseseverity and prognosis in CHF patients.Methods: Fifty eight patients (male: 35 patients (60,3%); age: 68,8 [54,75; 71,25]years) with CHF of different etiology were. Patients with acute myocardial infarctionand unstable angina (within 90 days before onset of the study), cardiac surgery or per-cutaneous transluminal coronary angioplasty (within 6 months before onset of thestudy) were excluded. Physical examination, clinical and biochemical blood assays,chest X-ray examination, echocardiography and ECG daily monitoring were carriedout at baseline. TrI levels were estimated by electrochemiluminescence immunoassay.The follow-up period was 6 months. The following end points were used: CHF worsen-ing caused hospital admission, acute myocardial infarction, and lethal outcome.Results: cTrI concentration was significantly higher in patients with CHF of NYHA classIII-IV than in those with CHF of NYHA clacc I-II (0,06 [0,035; 0,075] ng/ml vs.0,02 [0.01;0,03] ng/ml; p , 0.001). Negative correlation was revealed between cTrI level and ejec-tion fraction (rho ¼ 20,602; p , 0.001). cTrI concentration was significantly higher inpatients with life-threatening ventricular arrhythmia than in patients without it (0,06[0,04; 0,08] ng/ml vs. 0,02 [0,01; 0,04] ng/ml; p ¼ 0,001). In addition, cTrI level was sig-nificantly higher in patients with registered end points than in those with stable CHFcourse (0,06 ng/ml [0,05; 0,09] ng/ml vs, 0,02 [0.01; 0,05] ng/ml; p ¼ 0.001). cTrIlevels higher than 0,04 ng/ml were associated with elevated risk of adverse outcome(OR ¼ 3,5; p ¼ 0,003).Conclusions: cTrI correlates with CHF severity and probably has prognostic value inthese patients.

DISEASE MANAGEMENT AND PATIENT EDUCATION

P1228ESC guidelines implementation in the management of outpatients with systolicheart failure by cardiologists and general practitioners in Poland

Jankowska1; B. Kurian2; C. Zajaczkowski2; W. Banasiak3; P. Ponikowski11Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland; 2MerckSp. z o.o., Warsaw, Poland; 3Center for Heart Diseases, Military Hospital, Wroclaw,Poland

Aim: We sought to determine how ESC guidelines are currently implemented in themanagement of outpatients with systolic heart failure (HF) by cardiologists (Cs) andgeneral practitioners (GPs) in Poland.Methods: Registry DATA-HELP (Diagnostic And TherApeutic methods, used inpatients with systolic HEart failure, Living in Poland) was performed in X-XII 2009 inPoland and comprised randomly selected 500 Cs and 290 GPs. Each physician pro-vided questionnaire-based information about 10 consecutive outpatients aged ≥18years with the clinical diagnosis of HF and confirmed LVEF ≤ 45%. Finally, the datawere available in 5563 HF patients (3394 - managed by Cs, and 2169 - by GPs).

Results: Outpatients managed by GPs were older (68+10 vs 66+12 years, p ,

0.001), more frequently women (42% vs 33%, p , 0.001), had higher BMI (28.4+4.4vs 28.1+4.3 kg/m2, p , 0.01), higher LVEF (38+6% vs 35+8%, p , 0.001), moresymptomatic HF (NYHA class III-IV: 42% vs 39%, p , 0.05), higher prevalence of hyper-tension (74% vs 66%, p , 0.001), stroke/TIA (21% vs 16%, p , 0.001), diabetes (40%vs 30%, p , 0.001), COPD (14% vs 11%, p , 0.001), but less common: myocardialinfarction (49% vs 59%, p , 0.001) and renal dysfunction (10% vs 14%, p , 0.01).The following diagnostic tests were perfomed in GPs’ vs Cs’ patients during preceding12 months: ECG (98% vs 99%, p ¼ 0.50), chest X-ray (77% vs 69%, p , 0.001), echo-cardiography (70% vs 88%, p , 0.001), natriuretic peptides (8% vs 20%, p , 0.001),ECG exercise test (18% vs 18%, p ¼ 0.97), coronary angiography (18% vs 30%, p ,

0.001). The following therapies/procedures were administered in GPs’ vs Cs’ patients:angiotensin converting enzyme inhibitor (85% vs 85%, p ¼ 0.90), angiotensin receptorblocker (21% vs 15%, p , 0.001), beta-blocker (95% vs 97%, p , 0.01), aldosteroneantagonist (56% vs 64%, p , 0.001), loop diuretic (61% vs 64%, p , 0.05), thiazidediuretic (28% vs 24%, p , 0.001), digoxin (20% vs 21%, p ¼ 0.23), statin (83% vs81%, p ¼ 0.09), antiplatelet drug (79% vs 75%, p , 0.001), PCI (33% vs 44%, p ,

0.001), CABG (11% vs 16%, p , 0.001), ICD (4% vs 10%, p , 0.001), CRT (1% vs5%, p , 0.001). Daily oral dose of loop diuretic was higher in patients treated by Csthan GPs (54+51 vs 48+36 mg/24h, p , 0.001).Conclusions: The perfomed registry provides detailed evidence on differences incurrent clinical practice in a representative sample of outpatients with systolic HFsupervised by cardiologists and general practitioners in modern Poland. The datacould be useful for the long-term strategies optimizing the systems of complex man-agement of HF patients in Europe.

P1229Heart failure integrated care management programs are the key to reducerehospitalizations

G. Borelli1; L. Rondinini1; S. Mosa1; F. Bellini1; P. Rossi2; M. Polselli2; B. Gavini2;A. Balbarini1; R. Mariotti11Cisanello Hospital, Cardio-thoracic Department, HF Unit, Pisa, Italy; 2USL1, Massa, Italy

Objectives: Chronic heart failure [HF] is a growing public health problem with an enor-mous economic impact meanly for frequent rehospitalization. The aim of this study wasto evaluate the long-term results on prognosis of a HF integrated care managementprogram [HF-CMP] in a mountain region of Tuscany with high-prevalence of elderlypeople difficult to get specialistic medical care. Furthermore too many patientsreceive neither a corrected diagnosis nor treatment according to current HF guidelines.Methods: We prospectively followed for a median follow-up of 24 months, 185advanced HF outpatients aged over 65 years, enrolled in this HF managementprogram. Patients were periodically assessed with clinic or home visits by twotrained nurses under supervision of dedicated cardiologists. During each visit was eval-uated clinical status, adherence to medication and, when necessary, was also gatheredvenous blood samples for laboratory analysis recorded an electrocardiogram or per-formed an echocardiographic exam. In addition, was provided key information regard-ing disease management to patients as well as to their care-givers.Results: Our population presented a median age of 80 years with omogeneous distri-buction of gender, with a baseline NYHA class of 2.7+0.4 and a mean left ventricularejection fraction [LVEF] of 47+12%, a predominance of ischemic etiology (44%) andan high prevalence of comorbidity pathologies (Charlson comorbidity index3.9+2.7, 64% of patients with moderate to severe renal impairment, 42% withCOPD, 47% with anaemia and 35% with diabetes mellitus). HF-CMP significantlyimproved adherence to optical medical therapy [OMT] with introduction and tailoredtitration of beta-blockers, ace-inhibitors/sartans, diuretics and aldosterone antagonists(final prevalence were 78, 87, 94 and 32%, respectively). In addiction 9% of patientsbenefited of advanced HF treatment (ICD-CRT in 4.5% of patients, interventional or sur-gical AVR in 1.0% of patients, mitral valve correction in 1.0%, coronary revascularizationin 2.5%). During follow up period we observed a hightly significative reduction of HF-rehospitalization (from 22.9 to 4.3% for year, p , 0.0001) an improvement in NYHAclass (p , 0.01) and a 24-months overall survival of 77%.Conclusion: HF-CMP could be a strong weapon to significantly reduce economic impactof HF-pandemia with a hightly significative reduction of HF rehospitalizations. This strat-egy could also led to a remarkable improvement in HF OMT prevalence and adherence.

P1230A french heart failure management program :a comparative study

F. Dany1; P. Virot2; C. Daragon1; F. Dalmay2; PM. Preux2; M. Icarlim Network Members1

1ICARLIM, Limoges, France; 2University Hospital of Limoges, Pole ICARLIM, Limoges,France

A multidisciplinary management system for patients (Pts) with severe heart failure(HF)needs periodical evaluation, despite the consensus of the guidelines. It seems dif-ficult, now, to continue with randomized prospective studies. We, then, have tried toevalue our network, comparing each active patient hospitalized for HF, included inthe system (A pts) to the following HF pt, not included as a control group (C ).Thestudy compared retrospectively 110 A pts to 101 C pts.Mean follow up 400 daysResults: 1/the comparison between the two groups shows that pts selected for adisease management system were slightly younger than the control pts(76,7 vs 77,9NS), they have a more severe HF ( EF 37,69 vs 46,82; p 0,09);they were more oftendiabetics (41% vs 34%) and in atrial fibrillation (66% vs 51%)

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2/despite these differences, the mortality of A group was 19% lower at one year (45/109vs 45/88 with 13 lost in view for C Group ; p00,9) (Fig 1)3/In contrast the rehospitalization rate (fig 2 ) was a little higher (1OO stays vs 77; NS) butwith a tendency of less rehospitalizations during the six first months, explaining that thetime to the first rehospitaliszation was longer in A group than in C group (241 days vs 193).Conclusion : the present study confirm that a comparative evaluation of the outcomesof HF patients included in management systems, remains difficult, because of selectionbias; However, it reflects the reality of our behavior,and trends to demonstrate,a positiveeffect of the system in terms of mortality, but only a transcient effet on rehospitalizationrate.

P1231Effect of a patient education programme on quality of life among patients withchronic heart failure

M-F. Seronde; R. Chopard; S. Janin; Y. Bernard; N. Meneveau; F. SchieleUniversity Hospital of Besancon - Hospital Jean Minjoz, Besancon, France

Background: To deal with the complex management of chronic heart failure, patienteducation programmes have become widespread, focusing on optimising patientautonomy and self-management. We aimed to evaluate the efficacy of patient edu-cation in improving quality of life (QoL) in these patients.Methods: Participation was on an outpatient basis, starting at least one month after dis-charge. Individual and group sessions were held with a multidisciplinary team compris-ing a nurse, a cardiologist and a dietician. During group sessions, four themes werediscussed: chronic heart failure and warning signs; treatment; low salt diet and phys-ical activity. Patients were seen at inclusion, then once a month for four months, then at6 months after the end of the programme. Primary endpoint was evaluation of QoL asmeasured by the Minnesota questionnaire, at the start, and 6 months after the end ofthe programme.Result: A significant improvement was obtained in QoL among all participants: overallMinnesota score 39+25 at the start, vs 25+17 after the programme, p , 0.0001;physical dimension score 18 vs 12 start vs end respectively, p , 0.0001; emotionaldimension 6 vs 4, start vs end respectively p , 0.0001). There was no significant differ-ence between patients whose QoL improved after the programme, and those whoseQoL remained stable or disimproved, for any demographic, clinical or therapeuticcharacteristic, except initial QoL, which was worse among patients who improved(49+22 vs 20+18, pts who improved QoL vs stable/worse, p , 0.0001).Conclusion: Patient education improves compliance with treatment and lifestyle rec-ommendations, and can thus contribute to delaying and/or avoiding adverse eventsand improving prognosis. The participation of a multidisciplinary team is essential.

DRUG THERAPY, OTHER

P1232Is aspirin use associated with mortality risk in heart failure? Results from alarge community based cohort

M. Bermingham; MK. Shanahan; S. Miwa; I. Dawkins; R. O’hanlon; K. Mcdonald;M. LedwidgeSt Vincent’s University Hospital, Heart Failure Unit, Dublin, Ireland

Background: The use of aspirin therapy in heart failure (HF) is controversial. There iscontradictory evidence on the impact of aspirin on attenuation of ACE inhibitor benefitsand several studies have suggested an adverse impact on morbidity in this setting.Unlike secondary prevention of cardiovascular disease, there are no large studiessuggesting a mortality benefit of aspirin in HF. This retrospective study evaluated theassociation of aspirin therapy with mortality in a community based HF cohort withlong term follow-up.

Methods: This is a retrospective cohort study of patients attending a HF Disease Man-agement Programme with mean follow-up of more than 3 years. Chart review con-firmed aspirin prescription, dose and duration of use, as well as prescription of otherantiplatelet agents and warfarin. The primary endpoint was the association with mor-tality of aspirin compared to no aspirin over long-term follow-up using unadjustedand adjusted Cox-proportional hazards modelling with Kaplan-Meier survival curves.Results: Data were available for 1294 patients (age 70.6+11.5 years) of whom 64%were male and 809 (62.5%) were taking aspirin. The mean dose of aspirin at baselinewas 88.5mg and 79.0% of patients were prescribed the drug for the entire follow upperiod. Aspirin was prescribed alone in 48.9%, in combination with other antiplateletagents in 22.9% and in combination with warfarin in 28.2% of aspirin patients. Theaspirin group was older, more likely to have a history of myocardial infarction,angina and diabetes and less likely to have to have atrial fibrillation. Aspirin patientswere prescribed more beta blockers, nitrates and proton-pump inhibitors and wereless likely to be on warfarin. The aspirin group had higher BNP levels. A total of 202(25.0%) patients in the aspirin group and 139 (28.7%) in the non-aspirin group diedduring follow up (p ¼ 0.306). However, when adjusted for age, sex, medication, co-morbidity and BNP differences, aspirin use was associated with reduced mortality(HR 0.697, 95% CI (0.507-0.958), p ¼ 0.027). In adjusted analyses there was no associ-ation of warfarin alone or of combination antithrombotic therapy with reduced mortality.Conclusion: Unlike previous reports, this retrospective evaluation of low-dose aspirintherapy in HF patients shows a beneficial mortality effect with long-term follow up whenadjusted for key population differences including BNP. Randomised, prospectivestudies are required to clarify the role of aspirin therapy in HF.

P1233Dynamics of collagen matrix and renal dysfunction parameters in patients withchronic heart failure treated with ivabradine

N. Koziolova; M. Surovtseva; A. ChernyavinaMedical Academy, Perm, Russian Federation

Objective: to estimate possibilities of ivabradine to correct remodelling of renal col-lagen matrix and renal arteries in patients with ischemic CHF and renal dysfunction.Materials and methods: 3 groups of patients with CHF and stable angina with an eGFRless than 60 mL/min/1.73 m2 were examined. The groups were of 20 patients each. Thepatients were divided into the groups depending on antiischemic therapy. Withincomplex treatment the patients of the first group were treated with perindopril (averagedose – 5.2+1.8 mg), bisoprolol (average dose – 3.1+1.9 mg) and ivabradine(average dose – 11.6+1.9 mg), the patients of the second group were treated with peri-ndopril (average dose – 5.1+1.6 mg) and ivabradine (average dose – 11.4+1.6 mg),the patients of the third group were treated with perindopril (average dose - 4.6+1.4mg) and bisoprolol (average dose - 3.9+2.1 mg). Average age of the patients madeup 57.0+4.6 years. Average functional class of angina made up 2.25+0.36, averageFC of CHF made up 2.43+0.30. Therapy lasted for 6 months. Serum creatinine, eGFR(MDRD) and parameters of extracellular collagen matrix in kidneys and renal arteriessuch as levels of tissue inhibitor of matrix matalloproteinases (TIMP-1) and C-terminal tel-opeptide of 1st type collagen (CTP-1) were evaluated before and after therapy.Results: during therapy an eGFR increased significantly within the first group by8.67+3.27% (p1 ¼ 0.005), within the second group – by 7.01+2.95% (p2 ¼ 0.048),and eGFR dynamics within the first and the second groups was significantly highercompared to the third group that is 3.18+2.67% (p3 ¼ 0.440, pmg ¼ 0.04). TIMP-1level within the first and the second groups decreased equivalently and made up17.65+3.45% and 17.5+3.36% (p1-2 ¼ 0.890) respectively. Within the third groupthis parameter didn’t change reliably but tended to increase – 3.37+2.43% (pmg ,

0.001). CTP-1 increased to the maximum within the first group and made up21.49+3.21% versus 18.92+3.12% of the second group (p1-2 ¼ 0.014). CTP-1decreased within the third group by 3.52+1.28% (pmg , 0.001).Conclusions: ivabradine within complex treatment of patients with ischemic CHF andrenal dysfunction has a nephroprotection effect accompanied with significant positive

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dynamics of an eGFR and parameters of extracellular collagen matrix in kidneys andrenal arteries.

P1234The effect of 5-lipoxygenase inhibitor on ventricular repolarization variability inpatient with mild-to-moderate chronic heart failure (NYHA II-IV)

S. Kozhukhov; A. Parkhomenko; T. Sosnitska; A. Shumakov; A. StepuraNSC “Institute of Cardiology”, Kiev, Ukraine

Background: Automated techniques were developed for the measurement of cardiacrepolarisation using magnetocardiography (MCG). This study was designed to investi-gate the impact of 5-lipoxygenase inhibitor Quercetin (Q) in the dynamic changes ofthe parameters of ventricular repolarization heterogeneity of chronic heart failure(CHF) subjects.Methods: Eleven males patients (mean age 67.5+2.7 years) with mild-to-moderate CHF(NYHA II-IV) where studied. All the participants underwent a complete clinical examin-ation, including 12-channel ECG, high resolution ECG, echocardiography and MCGbefore 20 min infusion i.v. form Q and were repeated after two hour of treatment. MCGwas recorded by means of 4x3-channel MCG system in an unshielded setting.Results: At baseline QRS duration in high-resolution methods and MCG where similarand no significantly changed after two hour of treatment. End-systolic, end-diastolicvolume indexes where also similar. Ejection fraction increase from 39.9+2.1 to41.4+2.2% (NS). Terminal T wave interval (Tapex-Tend) MCG based parametersshowed a significant difference between two measurements, 156.3+15.5 compare to140.0+17.1 ms (p ¼ 0.018). In addition, MCGs were better able to identify end of T-wave.Conclusions: These data suggest that therapy with Q reducing the heterogeneity ofventricular repolarization in CHF subjects. MCG is sensitive to changes in thecardiac electrical pathway.

P1235Potential market for ivabradine in an outpatient-based heart failure unit in alarge university hospital

M-F. Seronde; R. Chopard; S. Janin; Y. Bernard; N. Meneveau; F. Briand; F. SchieleUniversity Hospital of Besancon - Hospital Jean Minjoz, Besancon, France

Background: Current treatment available for heart failure (HF), including beta blockersand ACE inhibitors, improves cardiovascular mortality and re-hospitalisation rate inthese patients, but prognosis remains fair. Ivabradine has recently been shown toreduce cardiovascular mortality or re-hospitaliation for HF in patients whose heartrate (HR) remains .70 bpm despite optimal therapy. We aimed to identify the pro-portion of patients in our centre who could yield a benefit from ivabradine therapy.Methods: In our outpatient-based heart failure unit, all patients participate in patient-education initiatives with a multidisciplinary team, and receive optimal medicaltherapy in accordance with current guidelines. We considered that all patients insinus rhythm with HR. ¼ 70 bpm and who had systolic left ventricular (LV) dysfunctionwould be eligible for ivabradine therapy.Results: 202 patients with chronic HF (NYHA class I to IV) with a mean LV ejection frac-tion of 30+8% were treated in our unit from 2004 to 2010. 99% were treated with renin-angiotensin system inhibitors, 96% with beta blockers, of whom 50% were at maximumdose. Eight patients had no beta blocker therapy (for bradycardia in 1, asthma in 2,poorly tolerated hypotension in 5). Overall average HR was 67+12 bpm. 44 patients(21%) were considered to be suitable for ivabradine therapy. Among these, averageHR was 79+9 bpm (range 70-108). All 44 patients were under beta blocker therapy,of whom 24 were at maximum dose and 20 were not at maximum dose because ofpoorly tolerated hypotension.Conclusion: In our outpatient-based HF unit, despite optimal therapy, almost onequarter of patients have a HR .70 bpm, and could potentially yield a benefit from ivab-radine in association with beta blocker therapy.

P1236Marked reverse remodelling with medical therapy of heart failure

A. Ventosa; C. Aguiar; Costa; G. Cardoso; M. Trabulo; J. Ferreira; J. Aniceto Silva;M. MendesHospital Santa Cruz, Carnaxide, Portugal

In pt with HF, main therapeutic targets are survival and symptoms. LVEF and volumes arestrongly associated with mortality and are important markers of the efficacy of therapy.Some pt have notable response to medical therapy, with marked reverse remodelling.Among patients in an HF program, we identified those that had an increase in LVEF.10%, to a final value .35% (without CRT therapy).In 101 pt, we identified 9 with those criteria, in a 3.9+2.7 y follow-up (5 female, age51+9). 2 had CAD, and 7 dilated myocardiopathy (p ¼ 0,063) (including 1 post-partum, 1 moderate alcohol intake, 3 possible myocarditis). 3 had LBBB. The tableresumes the initial and most recent status. One CAD pt had a CDI. The only eventwas a VT episode in another CAD pt, that had a CDI implant thereafter.The notable improvement in LV function observed in these small number of pt, can berelated to non-coronary ethiology, to a preserved renal function, and to optimization ofmedical therapy, namely reaching high doses of beta-blockers and ACEI and not usinghigh doses of diuretics.

Initial Final p

NYHA class (III-II-I) 2 5 2 0 2 7 ,0,06BP 115+9 / 76+10 117+14 / 68+9 ns / 0,06HR 80+12 66+9 ,0,05Creatinine 0,81+0,20 0,93+0,22 ,0,05K 4,5+0,4 4,7+0,4 0,15NTproBNP 3624+4337 105+84 0,15EF 28+7 51+9 ,0,0002EDV 195+66 133+42 ,0,02

Meds (n, mean dose)Furosemide 4 30 3 33,3 ns nsCarvedilol 5 11,3 9 44,4 0,085 ,0,001Lisinopril 1 5 3 33,3 0,196 ,0,006Ramipril 4 4,4 6 8,3Captopril 1 18,8 0Digoxine 1 0,13 0 ns nsCandesartan 0 1 8 ns nsEspironolactone 0 2 18,75 ns ns

P1237Impact of recent clinical trials on management of heart failure patients

R. Noad; N. Mckeag; L. Hill; J. Davidson; L. DixonRoyal Victoria Hospital, Regional Medical Cardiology Centre, Belfast, United Kingdom

Purpose: The most recent European Society of Cardiology clinical practice guidelinesfor acute and chronic heart failure recommend aldosterone antagonists for patientswith a left ventricular ejection fraction ≤35%, New York Heart Association functionalclass III or IV and receiving treatment with an optimal dose of a beta-blocker and anangiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker(ARB). Ivabradine does not currently feature in these guidelines. Two recently pub-lished large multicentre, randomised, placebo-controlled trials have the potential toexpand the role of these agents in the management of heart failure: SHIFT (SystolicHeart failure treatment with the If inhibitor ivabradine Trial) and EMPHASIS-HF (Epler-enone in patients with systolic heart failure and mild symptoms).Methods: Information on patients attending the nurse led heart failure clinic at our ter-tiary centre is entered into a computerised database. We reviewed this information toidentify the number of individuals suitable for treatment with ivabradine and eplere-none, based upon the patients enrolled in the above studies.Results: Between 1st January and 8th December 2010, 232 patients attended thenurse led heart failure clinic. Of these, 30 (13%) met main inclusion criteria for theSHIFT study (left ventricular ejection fraction ≤35%, New York Heart Association func-tional class II, III or IV, treatment with ACE-I and/or ARB and beta-blocker (unlesscontra-indicated), sinus rhythm, resting heart rate ≥70 bpm). Fourteen (6%) metmain inclusion criteria for the EMPHASIS study (left ventricular ejection fraction≤30%, New York Heart Association functional class II, treatment with ACE-I and/orARB and beta-blocker (unless contra-indicated), not already receiving an aldosteroneantagonist, serum potassium ≤5.0 mmol/L (most recent assessment), estimated glo-merular filtration rate ≤30 (most recent assessment)).Conclusions: This study provides an indication of the potential "real world" impact oftwo recent large multicentre, randomised, placebo-controlled trials in the setting ofchronic heart failure management, in a tertiary referral centre. Further analysis is under-way to determine the potential reduction in mortality, morbidity, hospitalisation andcost-effectiveness of these new drug indications.

P1238Short term evaluation of prostaglandin infusion in severe heart failure withpulmonary hypertension

W. Serra1; ML. Musiari2; AM. Montanari2; AD. Ardissino1; LB. Boeti2; AC. Cattabiani1;TG. Gherli31Cardiology Division AOU Parma, Parma, Italy; 2Semeiotica Institute, Parma, Italy;3Hospital of Parma, Cardiac Surgery Institute, Parma, Italy

Prostaglandin E1 (PGE1) is a potent vasodilating drug, which has been used in thetreatment of primary pulmonary hypertension and also has been proposed as a thera-peutic tool in patients with end-stage heart failure.The aim of this study was to assess the clinical and instrumental effects of this agentin patients with severe heart failure, with pulmonary hypertension. Additional end-point are the changes of BNP, endothelin-1(ET-1), P selectin, VCAM-1, ICAM-1,ADMA,SDMA.Methods: To investigate the effects of PGE1 in congestive heart failure we select 20 (15males, 5 females, mean age 60+4 years) in mean NYHA class III, because they hadleft ventricular ejection fraction (LVEF) ≤ 35% and mPAP .25mm/Hg and Transpul-monary gradient (GTP) .12mm/Hg at right heart catheterization.Haemodynamic evaluation was carried out before starting the PGE1 infusion. PGE1was infused in 10 at a mean dose of 5 ng/kg/min for a total of 24 hours over threeconsecutive days every two months. Before starting and after three months, clinical,instrumental (Echo,CPET,6MWT) and endothelial biomarkers (BNP,P-selectina,VCAM-1, ICAM-1, ET-1, ADMA ed SDMA). A control group received an optimizedoral treatment with beta-blockers,with ACE-inhibitors,with furosemide and digitalis.

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Statistical analysis will be performed by means of repeated measures ANOVA, followedby post hoc tests and a p value of 0.05 will be always considered as significant.Results: in PGE1 group, BNP decreased from 488.7+127.9 to 373.8+106 pg/mL(p , 0.05), mean FEVS improve from 33.1+1.5 a 42.5+3%(p , 0.05), PAPsdecreased from 53.8+3.44 to 41.8+3.2 mm/Hg (p , 0.05), TAPSE improve from17.1+1.7 to 20.4+1.2mm(p , 0.05),the runned distance at 6MWT improve from263.9+33.9 to 296.4+32.7mt(p , 0.05). In control group these parameters was’ntstatistically significant (BNP from 249+29.6 to 273+22 pg/mL, FEVS from35.1+1.6 to 35.5+1.3%, PAPS from 55.6+6.5 to 49.8+5 mmHg, TAPSE from16.2+1.7 to 17.5+2.4 mm, distance from 314+13.35 to 310.2+14.2mt). InPGE1 group, ET-1 decreased from 1.22+0.14 to 0.89+0.13pg/ml (p , 0.005), ICAM-1from 786.3+49.3 to 695+34.5 ng/ml (p , 0.05), P-selectin from 115.5+7.9 to89+3.8(p , 0.01). These data was’nt statistically significant in control group: (ET-1from 0.97+0.15 to 1.2+0.2 pg/ml). In both groups, was’nt significative changes ofCPET parameters, of VCAM-1, ADMA and SDMA.Conclusion: These short term results suggest that intermittent PGE1 infusion is ableto improve instrumental and clinical data in advanced congestive heart failure It hasassociated to endothelial biomarkers improvement.

P1239Levosimendan improves hemodynamics and renal function and reduces NT-proBNP in stable patients with advanced heart failure

M. Stahlberg; I. Lofman; E. Ottenblad; I. Hagerman; LH. LundKarolinska Institutet, Stockholm, Sweden

Purpose: Levosimendan is an ino-dilator drug recommended for use in acute decom-pensated heart failure (HF). The purpose of this study was to investigate the hemody-namic effect as well as the effect on renal function and NT-proBNP of 24 hourslevosimendan infusion in patients with stable, advanced HF.Methods: We included 17 patients in stable, advanced systolic HF (NYHA III-IV; 60+16yrs; male, n ¼ 16; AF, n ¼ 4; ischemic ethiology, n ¼ 9). Patients received a 24 hourinfusion of levosimendan and were evaluated before and after drug infusion insimilar settings. Blood samples were drawn for analysis of NT-proBNP and creatininin all patients. In a subgroup of 11 patients, arterial blood pressure and cardiacoutput (CO) was measured, at rest, using an inert gas rebreathing technique. Total per-ipheral resistance (TPR) was calculated as the ratio of mean arterial blood pressure toCO.Results: CO was significantly higher (3.9+0.5 L/min vs. 3.3+0.7 L/min, p ¼ 0.04) andTPR significantly lower (1400+500 dyn.s.cm-5 vs. 1900+700 dyn.s.cm-5, p ¼ 0.003)after levosimendan infusion. In patients with creatinine above the upper limit of normal(.100mmol/L) at baseline (n ¼ 7) creatinine was significantly reduced after infusion(156+27mmol/L vs. 175+38 mmol/L, p ¼ 0.02). Body weight was unchanged compar-ing baseline (83.0+28.5 kg) and after (82.8+28.4 kg, p ¼ 0.41) levosimendan infu-sion. NT-proBNP was reduced (3300+2040 ng/L vs. 2410+1470 ng/L, p ¼ 0.0003)after infusion in the whole patient group.Conclusions: This study demonstrates that a 24 hours infusion of levosimendanimproves hemodynamics and reduces NT-proBNP in stable patients with advancedHF. Moreover, in patients with renal impairment, levosimendan improves kidney func-tion. These findings imply that levosimendan may also be beneficial regarding treat-ment of stable HF patients. Possible clinical applications may include repeatedinfusions in selected patients, e.g. those on the heart transplant waiting list.

ECHOCARDIOGRAPHY

P1240Percutaneous mitral commissurotomy in the pregnant woman

F. Wadrahmane; RG. Kongo; HS. HajibIbn Rochd University Hospital, Casablanca, Morocco

The mitral stenosis (MS) is the most common valvular disease in the Maghreb; youngwomen of procreation age are most concerned.Percutaneous mitral commissurotomy (PMC) has changed the prognosis of sympto-matic MS of pregnant woman.We report our experience on eighty-three patients requiring PMC during the third trime-ster of pregnancy, between March 1998 and May 2010.Their mean age was 29+4, 9 years; the presumed age of pregnancy was 27.5+2.9weeks of gestation. Fifteen were in New York Heart Association class II; fifty in classIII and eighteen in class IV. Twelve patients with atrial fibrillation. Wilkins score calcu-lated in all patients with an average 7+2.No fetal deaths were noted after the procedure. 1 case of stroke, transient. No abor-tions occurred following the procedure.We report a maternal death fifteen days after delivery. All patients have improved afterthe surgery at least one class of NYHA.Mitral surface area and hemodynamic parameters improved significantly after PMC;mean left atrial pressure fell from 30+6.3 to 12.2+7 mmHg, mean transmitral gradientfrom 21+7.2 to 6.1+3.2mmHg and mitral valve area from 0.8+0.15 to 2.15+0.2 cm2During pregnancy the PMC is the treatment of choice of MS must be performed by anexperienced team because the angle of the trans septal puncture is subject to changesin pregnant women.

P1241Diagnostic accuracy of Doppler diastolic parameters in revealing of moderate-severe chronic heart failure in patients with elevated LV filling pressures

AG. Ovchinnikov; AG. Azizova; Z. Blankova; FT. AgeevRussian Cardiology Research Center, Moscow, Russian Federation

Background: Clinical severity of chronic heart failure (CHF) mainly depends on leftventricular (LV) filling pressures. Several Doppler diastolic parameters reasonably cor-rectly reflect LV filling pressures. It is not clear, however, which of these parameters arebetter related with functional status of patients with CHF.Objective: to compare LV diastolic function in patients with elevated mean left atrialpressure and different severity of CHF and to reveal diastolic parameters betterrelated with patient’s functional status.Methods: Doppler diastolic parameters related with LV filling pressures and N-terminalfragment of brain natriuretic peptide (NT-proBNP) were assessed in 50 patients withstable CHF (31 with LV ejection fraction ≥50%) and elevated mean left atrial pressure(pseudonoral or restrictive left ventricular filling pattern).Results: Compared with patients with II NYHA functional class (n ¼ 29), patients with IIIfunctional class (n ¼ 21) had lesser systolic filling fraction of pulmonary venous flow(43+7 vs. 39+9%, correspondingly; p , 0.01), shorter deceleration time of early LVfilling velocity (166+26 vs. 146+23 ms; p , 0,05), deceleration time of anterogradediastolic velocity of pulmonary venous flow (DDT, 166+26 vs. 146+23 ms; p , 0,05)and isovolumetric relaxcation time (81+18 vs. 69+18 ms; p , 0.05), higher E/e′

(13.2+3.5 vs. 17.2+3.5; p , 0.01), E/Vp (2,4+0,6 vs. 2,7+0,8; p , 0.05) and mitralE/A (1.7+0.6 vs. 2.2+0.7; p , 0.01) ratios and longer time difference between durationof Ar and duration of A velocities (Ar-A, 25+23 vs. -10+25 ms; p , 0.01), as well higherlevel of NT-proBNP (612 [393;1565] vs. 989 [478;1587] pg/ml; p , 0.05). ROC-analysisshowed the highest diagnostic accuracy in revealing patients with III functional classfor E/e′ ratio (AUC 0.76; 95% CI 0.62–0.87) and for DDT (AUC 0.74; 95% CI 0.60–0.85), but the least for E/A ratio (AUC 0.55; 95% CI 0.41–0.69) and for E/Vp ratio (AUC0.57; 95% CI 0,43–0.71). Of note, NT-proBNP had sufficiently high diagnostic accuracy(AUC 0.73; 95% CI 0.58–0.87), comparable with E/e′ and ratio DDT.Conclusion: in patients with elevated LV filling pressures E/e′ ratio and DDT have thehighest diagnostic accuracy in revealing patients with moderate-severe CHF.

P1242Three-dimensional assesment of left atrial mechanical and structuralremodelling in patients with heart failure and atrial fibrillation

Benedek; I. Kovacs; Z. Suciu; B. Jako; M. Chitu; IA. Sarbu-Pop; I. Benedek Jr;T. BenedekUniversity Emergency Hospital, Targu Mures, Romania

Introduction: Atrial fibrillation (AF) is a condition associated with complex electrical,structural and mechanical remodelling. The aim of our study was to use the Computer-ized 3D Echocardiography (C3DE) for complex and objective assesment of left atrial(LA) structural and mechanical remodelling extension and identify predictors for recur-rence of AF after cardioversion.Methods: We enroled 40 patients with heart failure and atrial fibrillation shorter than 6months, in whom we performed C3DE immediately after cardioversion and at 1month. In all cases we performed a computerized analysis of LA shape, geometry andvolumes, using an adapted Qlab software in which reference points were identified atpulmonary vein insertions and mitral annulus, followed by manual adjustment of LAtracing borders. Contraction amplitude of left atrium myocardial fibers was determinedbased on the amplitude of endocardial border movement and displayed as graphicalrepresentation and bulls-eye chart. The following parameters were determined: leftatrial contraction amplitude, left ventricular ejection fraction, left atrial volume and diam-eter. Follow-up was performed at 1 month and 3 months to analyse the recurrence of AF.Results: 25 patients converted to sinus rhythm maintained the sinus rhythm at 3months (group 1) and 15 presented AF recurrence (group 2). Both mechanical andstructural remodelling were more pronounced in patients who presented AF recur-rence. Parameters characterising structural remodelling at 1 month were: LAmaximum volumes - 53,2 ml in gr.1 and 62.3 ml in gr 2 (p ¼ 0.005), LA maximum diam-eters - 43 mm in gr.1 compared with 52 mm in gr.2 (p ¼ 0.002). Analysis of mechanicalremodelling parameters showed a superior contraction amplitude in the rhythm controlgroup – 2.0 mm, compared with recurrence group – 1.7 mm (p ¼ 0.01). Ventricularfunction was superior in the rhythm control group –LVEF 46.5%, compared with therecurrence group - LVEF 45.3% (p ¼ 0.02)Conclusions: C3DE analysis identified several predictors for rhythm ouctome, like par-ameters charaterising left atrial structural (increase of LA diameters and volumes) ormechanical remodelling process (LA contraction amplitude), while ventricular functionwas more depressed in patients with AF recurrence. However, extension of structuralremodelling showed a higher correlation with AF recurrence than contractile remodelling.

P1243Preejection velocity spikes of the left ventricular wall in patients with heartfailure

FQ. Huang; RS. TanNational Heart Centre Singapore (NHCS), Singapore, Singapore

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Background: Pulsed tissue Doppler imaging is widely used to record mitral annularmotion and evaluate the left ventricular (LV) function. The two spikes (positive pre-aand negative pre-b) of the LV wall motion just before the ejection or during the preejec-tion period can be seen in healthy individuals. We aim to assess the pre-a and pre-bvelocities in patients with heart failure.Methods:Total of 62 patients (mean LVEF 55%, mean age 44y) with heart failure wasenrolled. All subjects were divided into two groups:38 patients (LVEF 65%) withE/Em ranging from 8-15 and 24 patients (LVEF 40%) with E/Em . 15. Two-dimensional,pulsed Doppler and pulsed tissue Doppler echocardiography were performed in allpatients. The pre-a and pre-b velocities were also measured at the septal and lateralmitral annulus using tissue Doppler inaging.Results: The pre-a and pre-b velocities of the mitral annulus motion significantlyreduced in patients with E/Em . 15 compared to those with E/Em ranging from 8-15(Table 1). In all echocardiography parameters, the pre-a and pre-b correlated withLVEF (r ¼ 0.26, P , 0.01) and left atriual volume index (r ¼ 20.52, P , 0.01).Conclusion: The pre-a and pre-b velocity measurement may be easy and useful toevaluate the left ventrcular systolic and diastolic dysfunction.

Table 1. The prea and preb velocities of

E/Em8-15 E/Em . 15 P value

lat prea (cm/s) 5.07+2.11 2.22+0.82 ,0.001lat preb(cm/s) 5.54+2.71 2.02+0.64 ,0.001sep prea(cm/s) 5.81+2.54 3.70+0.91 ,0.001sep preb(cm/s) 4.00+1.63 2.46+1.05 ,0.001

lat prea: prea velocity in lateral mitral annulus; lat preb : preb velocity in lateral mitralannulus; sep prea : sep prea velocity in septal mitral annulus; sep preb: sep preb velocityin septal mitral annulus; E/Em: the ratio of mitral flow E velocity and mitral annulus Emvelocity.

P1244NtProBNP and systodiastolic left ventricular function in patients with heartfailure secondary to left ventricular impairment. A 2D Strain study

Santos De Sousa; M. Satendra; L. Sargento; I. Almeida; M. Teixeira; F. Salazar;N. Lousada; R. Palma ReisHospital Lisbon North, Hospital Pulido Valente, Lisbon, Portugal

Purpose: To evaluate, in patients (pts) regularly followed in a Heart Failure OutpatientClinics (HFOC) with heart failure due to left ventricular impairment, the relation betweenthe NtProBNP and echocardiographic parameters of systolic and diastolic function ofthe left ventricle.Methods: 40 pts (60% M), age 72,5+10 years old regularly followed in a HFOC, ejec-tion fraction of the left ventricle(LV) 31,6+8,5%, cardiac output 4,04+1,16, NtProBNP4167,0+5860 pd/mL (median 2050), LV end diastolic diameter 7,03+1,06 cm. Weestimated the NtProBNP and performed a complete echocardiographic study using2D, Doppler, mitral and tricuspid annulus TDI and myocardial deformation with 2Dstrain. Systolic function of the LV: peak systolic velocity by TDI (TDI-MtS), globalstrain% (LV GS), peak systolic longitudinal strain rate (LV GSRs). Diastolic function:waves E and A (MtE and MtA) of mitral annulus by TDI, peak e and a longitudinalstrain rate (LV GSRe and LV GRSa). The relation between NtProBNP and the other vari-ables was determined by Pearson correlation coefficient and linear regression model(backward method).Results: (1) Systolic function: the NtProBNP was directely correlated with LV GS% (r ¼0,592; P ¼ 0,001), LV GSRs (r ¼ 0,592, p ¼ 0,001) and inversely correlated with TDIMtS (r ¼ 20,471, p ¼ 0,023).(2) Diastolic function: correlation with TDI MtE (r ¼ 20,604, p ¼ 0,003), TDI MtA(r ¼ 20,645, p ¼ 0,005), LV GSRe (r ¼ 20,456, p ¼ 0,015), LV GSRa (r ¼ 0,604, p ¼0,001).(3) The LV GSRe (p ¼ 0,011), LV GSRa (p ¼ 0,026) and TDI MtE (p ¼ 0,002) were inde-pendent predictors of NtProBNP.Conclusion: In this group of patients followed in a HFOC with impaired LV systolicfunction the NrProBNP was mainly influenced by Tissue Doppler and myocardial defor-mation diastolic parameters of the LV.

P1245Impact of common echocardiographic measures in the progression of mitralregurgitation in assintomatic patients

P. Gomes; S. Barra; R. Providencia; AM. Leitao MarquesHospital Center of Coimbra, Coimbra, Portugal

Purpose: Mitral regurgitation, is a commonly encountered cardiac pathology. Anunderstanding of the underlying etiologies and pathophysiology of the condition is criti-cal to direct appropriate treatment.The goal of our study was to assess the prognosticimpact of common echocardiographic measures in the progression of mitralregurgitationMethods: 142 patients(pts), 66.92+2.21 years, 59% male, with asymptomatic chronicmoderate mitral regurgitation were included at the time of diagnosis. The pts with Ejec-tion Fraction(EF) inferior to 45%, relevant wall motion abnormalities and concomitant

significant valvulopathies were excluded. Subsequent echocardiographys performedthree years later were analysed and the population sample was divided into twogroups, those who maintained moderate mitral regurgitation (group A, n ¼ 119) andthose who progressed to severe mitral regurgitation(group B, n ¼ 23). The followingechocardiographic measures were analysed: Left ventricle(LV) diastolic dimen-sion(LVd), LV systolic dimension(LVs), LV septal wall(LVSW), LV posterior wall(LVPW), Left atrial dimension(LA), EF - teich this measures were evaluated in paraester-nal long axis view.The body mass index (BI) and corporeal area (CA) were alsoassessed.Results: Group A vs Group B: LVd (60.33mm vs 65.70mm; p ¼ 0.23), LVs(42.06mm vs47,43mm ; p ¼ 0.41), no significant differences were found in the other parameters.Conclusions: The evaluation of the LVd and LVs proved to be an useful tool in the pre-diction of risk of progression of mitral disease in patients with compensated heartfailure.

EXERCISE TESTING & TRAINING

P1246Red cell distribution width (RDW) is better prognostic marker in heart failurepatients than cardiopulmonary exercise test parameters

E. Straburzynska-Migaj; A. Gwizdala; S. Grajek1st Dept. of Cardiology, Poznan University of Medical Sciences, Poznan, Poland

Red cell distribution width (RDW) is found to be a novel independent prognostic markerin patients with chronic and acute heart failure. The mechanisms of increased RDW inheart failure patients are investigated. Preliminary evidence suggests that it has similarprognostic power when compared with NT-proBNP. It has not been compared withexercise capacity measures.Our aim was to evaluate prognostic power of RDW in comparison with cardiopulmon-ary exercise test (CPET) parameters which are established prognostic markers inchronic heart failure (CHF).Methods: Fifty six CHF patients underwent CPET on treadmill (age 50+9 yrs, 19 CAD,10 female, LVEF 26,6+7,4%, NYHA 2,6+0,8, BMI 27,7+4,4 kg/m2). Peak VO2, VE/VCO2 slope and heart rate recovery at 1 min (HRR) were analysed. Blood wassampled for routine analysis including hemoglobin, RDW, sodium levels.Results: Mean RDW at baseline in the whole group was 13,4+1,2%, Hb – 9,1+0,8mmol/l, E – 4,7+0,5; L – 7,5+2,1; Hct – 44,7+4,1%. During follow-up of median26,1 months 9 (16%) patients died due to cardiac causes. Patients who died hadworse CHF at baseline as shown by a significantly higher NYHA class (3,1+0,9 vs2,4+0,7; p ¼ 0,015), worse LV function, and lower peak VO2 (15,1+4,8 vs17,6+4,9 ml/kg/min; p ¼ 0,16), HRR (15,1+10,2 vs 23,9+10,4; p ¼ 0,02) as wellas significantly higher VE/VCO2 slope (43,1+9,1 vs 33,6+6,5; p ¼ 0,0005) andRDW (14,5+1,0 vs 13,2+1,1%; p ¼ 0,002). Also BMI, and sodium levels were signifi-cantly lower whereas hemoglobin and creatinine levels as well as age, ESR and leuko-cytes count were similar in both groups. Multivariate analysis (Cox proportional hazardmodel) has shown that RDW was the strongest independent predictor of mortalitytogether with age, BMI, and HRR. Hemoglobin, peak VO2 and VE/VCO2 slope werenot independent predictors of outcome.Conclusion: We have shown for the first time that red cell distribution width provideshigher prognostic value than peak VO2 and VE/VCO2 slope. Only HRR at 1 min hassimilar independent prognostic value to RDW.

P1247Psychological distress in cardiac rehabilitation: a dual relationship

Oliveira; A. Rocha; AS. Correia; C. De Sousa; A. Lebreiro; A. Sousa; V. Araujo;JD. Sousa; F. Pereira-Parada; MJ. MacielSao Joao Hospital, Porto, Portugal

Introduction: Previous studies had pointed that psychological distress is not only a riskfactor for coronary artery disease (CAD), but also adversely affects recovery after CADevents. Cardiac rehabilitation programs (CRP) enhance physical performance, survivaland improve quality of life. In this study we explored the mutual influence of anxiety anddepression on functional status at the end of PRC.Methods: We retrospectively analyzed records of patients enrolled in a CRP after anacute coronary syndrome (ACS), from 04/09 to 06/10. Clinical, psychological andfunctional data were evaluated (at beginning and at 6 months). Depression was esti-mated with the Patient Health Questionnaire (PHQ-9) (score ≥ 8). Hospital Anxietyand Depression Scale (HADS) was used to detect anxiety (score ≥ 8). Functionalstatus was estimated by performance at the exercise test (maximum METsachieved).Results: We analyzed 106 patients (95 men) recruited for CRP, with a mean age of54+9 years and mean number of sessions of 14.3+5.5. The majority had suffereda non-STEMI ACS (n ¼ 57, 53.8%) and were submitted to percutaneous coronary inter-vention (n ¼ 81, 76.4%). At the beginning of the program, 35 (33%) patients presentedan HADS-anxiety score ≥8 and 36 (34%) a PHQ9 score ≥8. CRP was associated with asignificant decrease of anxiety (6.6+4.5 vs 5.5+4.1, p ¼ 0.012) and depression(6.3+5.3 vs 5.2+5.4, p ¼ 0.034) symtpoms. Patients who were both anxious anddepressive had poorer physical performance, as assessed by METs, not only at thebeginning of the CRP (9.9+2.1 vs 11.5+1.9, p ¼ 0.018) but also at the end(9.2+2.2 vs 11.2+2.0, p ¼ 0.06). Those who became non-anxious or non-depressivedid not show any significant difference regarding functional capacity, compared to

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those who remained with high anxiety or depression levels, respectively. Patients,whose anxiety level increased during the program, achieved a worse functionaloutcome at follow up (METs: 9.3+1.4 vs 11.5+2, p ¼ 0.012). Patients who developeddepression at follow-up, also accomplished a poorer functional capacity (METs:9.5+2.8 vs 11.4+2.0, p ¼ 0.06). The development of anxiety was significantly associ-ated with increase of depression (p ¼ 0.06).Conclusion: CRP exerts a beneficial effect on psychological status but worsening ofanxiety and depression symptoms can impair functional recovery. Therefore, systema-tic assessment of anxiety and depression is highly recommended in order to allowearly recognition and adjusted intervention.

P1248Cognitive impairment affects physical recovery of patients with heart failureundergoing exercise training

F. Ranghi; S. De Benedetti; M. Volterrani; G. Caminiti; D. Battaglia; A. Franchini;B. Sposato; G. RosanoIRCCS San Raffaele Pisana Hospital, Rome, Italy

Purpose: To determine whether the presence of cognitive impairment (CI) affects phys-ical recovery of patients with chronic heart failure (CHF) undergoing a physical trainingprogram (PTP) after a recent episode of acute decompensationMethods: The study enrolled 80 patents with CHF (M/F ¼ 52/26) and ejection fraction(EF) ,40% consecutively admitted to our cardiac rehabilitation centre after an episodeof acute decompensation. CI was evaluated by means of the Mini-Mental State Exam-ination (MMSE), with a score of ,24 indicating impairment; Exercise tolerance wasevaluated by six minute walking test (6mwt) performed at admission and at the endof PTP. All patients underwent an intensive 8-week program of aerobic PTP at 70%VO2. At admission patients were divided into two group according to their MMSE(group A . 24; group B , 24)Results Overall 43 patients (54%) had MMSE ,24. The score obtained at MMSEresulted directly related to EF (r 0.42; p 0.03), and it was inversely related to creatininelevels (r -0.36 p 0.04) and atrial fibrillation rate (r 0.34; p 0.07). At the end of PTP patientsof group B had a lower increase of distance walked at 6MWT than group A (98+16 mand 131+28 m respectively, p 0.008).Moreover patients of B group had a longer in-hospital stay and needed more pharmacological interventions than group A. 2/80patients (2.5%) died during the hospitalization all of which were in the B group. In amultivariate logistic regression model, including age, gender, renal failure, EF and dia-betes, MMSE , 24 predicted a reduced performance at 6MWT in the overall population(OR 1.4, 95% CI 1.7 to 2.4) and in women (OR 1.31; 95% CI 1.20–1.62), while it was notpredictive in males.Conclusions: CI is a marker of advanced CHF and is an independent predictor of loweexercise recovery in female gender.

P1249Impact of ageing in peak VO2 and VE/VCO2 slope in heart failure patients

G. Guimaraes1; JA. Neder2; LN. Pascoalino3; VO. Carvalho3; S. Ayub-Ferreira1;VS. Issa1; JM. Roque3; GC. Sousa1; JFC. Belli3; EA. Bocchi11Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital,Sao Paulo, Brazil; 2Federal University of Sao Paulo, Respiratory Function and ClinicalExercise Physiology, Sao Paulo, Brazil; 3Laboratory of Physical Activity and Health -CEPEUSP, Sao Paulo, Brazil

Background: The incidence and prevalence of heart failure (HF) increase with age.The age-associated decline in maximal aerobic capacity is express by decreases inpeak oxygen uptake (peak VO2, ml/min/kg). Peak VO2 is usually considered in riskstratification of patients with HF. However, recently VE/VCO2 slope has been shownto be similar or even superior than peak VO2 in many studies. Considering thatageing by itself has a negative effect on these variables, its relation with them hasnot been studied in patients with HF.Methods: We retrospectively evaluated 483 (132 female) patients with HF, age 20 – 88years, LVEF 31+11%, weight 72+15 kg, etiology non-ischemic (n ¼ 362), ischemic(n ¼ 74) and chagas’s disease (n ¼ 47). All patients performed a treadmill cardiopul-monary exercise testing.Results: peak VO2 declined across age ranges: 20-29 yrs (n ¼ 28), 18.8+6.6*; 30-39yrs (n ¼ 67), 17.5+5.7#; 40-49 yrs (n ¼ 152), 16.7+5‡; 50-59 yrs (n ¼ 143),16.2+4.6; 60-69 yrs (n ¼ 75), 14.9+4.2*, # and . 70 yrs (n ¼ 18), 13.0+2.4*, #, ‡(*, #, ‡p , 0.05). The VE/VCO2 slope was not different across age ranges: 20-29yrs, 35+15; 30-39 yrs, 34+12; 40-49 yrs, 35+8; 50-59 yrs, 35+10; 60-69 yrs,35+9 and . 70, 35+9 (p ¼ ns).Conclusion: the maximal aerobic capacity is influenced by aging in HF. The VE/VCO2slope, as an index of ventilatoy response to exercise did not change with age in thesepatients. These differences in peak VO2 could have important clinical implications forolder adults. In some clinical settings the use of the VE/VCO2 slope represents a vari-able independent of the age to prognostic evaluation in HF.

P1250Functional capacity and quality of life improvement among women and elderlypatients referenced to a cardiac rehabilitation program

A. Lebreiro; A. Rocha; M. Paiva; A. Sousa; P. Lourenco; S. Oliveira; AS. Correia;V. Araujo; F. Parada; MJ. MacielSao Joao Hospital, Porto, Portugal

Introduction: In spite of substantial medical advances that improve outcomes ofpatients following cardiac ischemic events, gender and age differences in the treatmentand course of recovery of these patients (pts) with coronary artery disease continue toexist.Purpose: Assess functional capacity and quality of life perception improvement amongwomen and elderly pts participating in an ambulatory cardiac rehabilitation program(CRP).Methods: A transversal study was performed regarding a group of pts referenced to aCRP after an acute coronary syndrome, recruited between September 2008 andAugust 2010. Information on clinical and functional data, as well as quality of life per-ception parameters, was collected. Functional capacity was evaluated in metabolicequivalents (METS) and determined by exercise stress testing. Quality of life was eval-uated through Medical Outcomes Study Short Form 36 (MOS-36 SF-36) questionnaire.Results: Of the 186 pts included, 16 (8.6%) were women and 23 (12.4%) had ≥ 65years. A significant improvement of METS after CRP was documented in all pts andsub-groups (,65 years (3,93+1,5; p , 0,001); ≥ 65 years (2,7+1,84; p , 0,001);men (3,9+1,6; p , 0,001) and women (3,0+1,6; p , 0,001)). However, when com-pared to younger patients, the elderly have shown lower functional capacity improve-ment (2,7+1,8 vs 3,9+1,5; p ¼ 0,001) as did women, when compared to men(3,0+1,6 vs 3,9+1,6; p ¼ 0,048). Regarding quality of life assessment, there wereno differences between elderly and younger patients, neither in the physical (50% vs59%, p ¼ 0,55) nor in the mental (73% vs 75%, p ¼ 0,95) components of SF-36;between women and men, there were also no differences in the physical (75% vs76%, p ¼ 1, 0) or in the mental (69% vs 57%, p ¼ 0,53) components of SF-36.Conclusion: The elderly and women had similar improvements on quality of life per-ception than the rest of the pts, but albeit their significant improvement of METSafter CRP, functional capacity improvement was found to be lower than the rest ofthe population. More studies on cardiac rehabilitation programs efficacy on thesespecial sub-groups are needed in order to adjust programs and provide the best strat-egy management for all patients.

P1251Cardiac vulnerability decrease by reduction of catecholaminergic response andhaemodinamic overload during maximal effort. The role of aerobic traning

Pastormerlo; A. Giannoni; F. Bramanti; C. Mammini; G. Mirizzi; C. Passino; M. EmdinGabriele Monasterio Foundation, Pisa, Italy

Background: the presence of ongoing myocardial damage (OMD) in patients with sys-tolic congestive heart failure (CHF) detected even by low increase of troponine I (TnI)has proven physiopathological and prognostic implications. Haemodinamic overloadand cathecolaminergic activation have recently been indicated as possible mechan-isms of it. Aerobic training has been indicated as an important tool in CHF patients,possibly reducing neurhormonal activation and hemodinamic overload.Purpose: we hypothesized that aerobic training could reduce myocardial vulnerabilityduring maximal exercise in CHF patients by decreasing neurhormonal activation andhemodinamic overload.Methods: we prospectically selected 10 CHF patients (mean age 68+5, mean EF29+6) equally divided according to ischemic/non ischemic etiology. All patientswere on optimal medical therapy. They were referred for clinical evaluation, Dopplerechocardiography, neurhormonal evaluation and cardiopulmonary exercise stresstest. Along with it blood samples in order to measure BNP, NT-proBNP, norepineprhine(NE) and TnI were collected at basal conditon, peak exercise and 4 hour after the endof exercise. Then patients underwent a three-months aerobic training program at 60%of the maximal oxigen uptake. Basal characterization was repeated after the trainingprogram.Results: before aerobic training 5 patients (50%) had at basal condition TnI valueshigher than 0.04 ng/L, the cut-off considered as prognostic in literature while consider-ing blood samples 4 hour after maximal exercise 7 (70%) patients had values higherthan that cut-off. After aerobic training, maximal exercise did not cause rise in TnI inpatients with low basal values (p ¼ 0.06). Moreover aerobic training caused a trendtoward decreased elevation of NE and cardiac natriuretic peptide during maximaleffort compared to basal characterization. Interestingly the only predictors of myocar-dial vulnerability reduction (DTnI) after aerobic training were the reduction of NT-proBNP (DNT-proBNP) and NE (DNE) peak values (r ¼ 20.925, p ¼ 0.00001 andr ¼ 20.641, p ¼ 0.046 respectively).Conclusions: the association of OMD reduction with the decrease of NE and BNPresponse during effort, shows aerobic training capability of reducing cathecolaminergicactivation and hemodinamic overload in determining lower myocardial vulnerability.

P1252Rehabilitation patients after myocardial infarction with systolic dysfunction andconcomitant arterial hypertension

I. Malynovska; V. Shumakov; I. Gotenko; L. Kisilevich; L. Prohna; L. Tereshkevysh;O. YanusInstitute of Cardiology, Kiev, Ukraine

The heart failure is one of the main complication of acute myocardial infarction (MI).Under this opinion the object of investigation was to study the clinical and functionalrecovery of patients with acute MI and systolic dysfunction with concomitant arterialhypertension (AH). All patients received basic therapy according to standard treatment.71 patients with acute MI and in 3 and 6 months were examined. They were divided intothree groups: 48 patients (1st gr) were with AH and ejection fraction (EF) more than

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45%; 12 patients (2nd gr) - with AH and systolic dysfunction; 11 patients (3rd group) -without AH and EF . 45%. During the observation in 1st gr the EF was almost notchanged and was 55,7+0,9% at 1st, 53,7+1,6% at 2nd and 55,1+1,4% at 3rdexam. In 2nd gr the EF was increased best of all from 42,4+0,8 to 47,0+0,9 and50,3+1,1% (p , 0,05). In 3rd gr the level of EF was the best - 56,4+0,8, 53,9+0,7and 58,0+0,6% (p , 0,05), respectively. In patients of 1st and 3rd groups the pro-gressive improvement of tolerance to physical load was observed and the level ofwork in 1st group was 26,4+2,1 at 1st, 60,3+5,9 at 2nd (p , 0,05) and 81,7+6,9kJ at 3rd exam (p , 0,05). In 3rd group during the first and second exams theseindexes were like the 1st group 29,8+4,5 and 62,5+8,1 kJ (p , 0,05); the bestincreasing of level of physical work was achieved to the third exam (97,2+8,5 kJ,p , 0,05). While in 2nd group the lowest level of tolerance to physical load was21,4+4,7 kJ at the first exam with some increasing to the second exam (30,0+7,2kJ, p . 0,05). The significant increasing to 78,0+8,1 kJ (p , 0,05) was observedonly at the third exam. In conclusion the development of systolic dysfunction inacute MI in patients with concomitant AH led to the worsening of tolerance to physicalload not only at the first exam but also in early postinfarction period. Nevertheless appli-cation up-to-date therapy allows to recover physical activity even in such serious cat-egory of patients although this process is postponed.

HAEMODYNAMICS / CORONARY AND PERIPHERALCIRCULATION

P1253The "paradox" of cardiac output reduction following surgical ventricularreconstruction not associated with clinical worsening

M. Di Donato1; F. Fantini1; V. Dor2; LAM. Menicanti31Dept Critical Care Medicine, University of Florence, Florence, Italy; 2Monaco Cardio-Thoracic Centre, Monaco, Monaco; 3Cardiac Surgery department, San DonatoMilanese, Italy

The main and universally accepted notion is that the reduction of cardiac output relativeto the metabolic needs, is the most important pathogenetic mechanism of heart failure.This notion leads to the concept that a reduction in cardiac output induced by any treat-ment, is "by definition" associated with clinical worsening. Surgical ventricular recon-struction (SVR) may induce a reduction of SV as documented by various registryand recent papers, while clinical status is significantly improved in all the reportedseries. One explanation for such contradictory response is the modality of SV measure-ment, i.e. the difference between end diastolic and end systolic volumes obtained bytransthoracic echo seems inadequate.Aim: We report cardiac index (CI) changes following SVR as measured by thermodilu-tion method at baseline, at discharge and 1 year after surgery.Patients: 147 pts (65+9 yrs) submitted to SVR; CABG was associated in all pts.Results: As an average CI went from 2.72+-0.6 to 2.61+0.5 to 2.75+0.6 L/min/m2 at1 year(NS). Within the group 76 pts had CI decrease (G1) and 71 had an increase or nochange (G2). Median values of CI went from 3.0 to 2.45 to 2.7 L/min/m2 in G1 (dis-charge vs baseline: p 0.01,) and from 2.4 to 2.8 to 2.7 in G2 ( discharge and FUP vsbaseline: p 0.01). At 1 year CI recovers in G1 and the difference is no longerpresent. Despite CI reduction the clinical status has improved in both groups. NYHAclass from 2.5+0.9 to 1.5+0.8 in G1 and from 2.5+1 to 1.5+0.7 in G2, p 0.0001).Pts with CI reduction after SVR have higher resting CI (median 3 vs 2.45 L/min/m2, p0.01); ROC analysis to predict a reduction of CI after SVR shows a CI cut off value of2.75L/mn/m2 (AUC 0.77; CI 0.713-0,823, p 0.000). Analyzing LV geometry G1 ptshave a pattern of eccentric remodeling, while pts with increase or no change in CIhave a pattern of concentric remodeling with smaller internal diameter, greater relativewall thickness and less surgical volume reduction.Ejection Fraction was progressively reduced in eccentric geometric pattern, while itwas relatively preserved in the second. The post-operative increase of CI in pts withconcentric remodeling pattern and reduced baseline SVI, might be the result of ventri-cular afterload reduction while the postoperative CI decrease seems the result of pre-load reduction in eccentric geometric pattern.Conclusions: Different LV baseline geometric patterns may influence the hemody-namic response to SVR and may explain the apparent paradox of reduced cardiacoutput with improved clinical status.

P1254Characteristics of arterial stiffness in patients with systolic heart failure

R. Akhmetov1; I. Goncharov1; S. Villevalde1; Y. Kotovskaya1; L. Alexandria1;A. Safarova2; V. Moiseev1

1Peoples Friendship University of Russia (RPFU), Moscow, Russian Federation; 2CityClinical Hospital N 64, Moscow, Russian Federation

Objective: To perform central pulse wave analysis in hypertensive patients with systolicheart failure.Methods: Pulse wave analysis and pulse wave velocity (PWV) measurements weredone in 48 hypertensive patients (age 61.9+8.4 years, history of myocardial infarction50%, diabetes mellitus 25%) ejection fraction (LVEF) ,40% (mean 32.2+7.6%,minimal 18%, maximal 38%), symptoms and signs of heart failure and NT-pro-BNP .

100 ng/ml were included. Sphygmocor (AtCor, Australia) device was used. Spearmancorrelation analysis was performed. P , 0.05 was considered significant.

Results: Mean brachial blood pressure (BP) was 130.5+13.4/79.1+10.9 mmHg,Heart rate 65+15 beats per min. Central systolic BP was 119.8+11.3, pulse pressure(PP) 38.8+8.7 mmHg. Time of reflection wave was 135.3-17.9 ms, PP augmentationindex (AI)@HR75 23.6+9.4%, PP amplification 132.2+13.9%, PWV 13.1+3.7 m/s.there was significant correlation between PWV and left atrium diameter (LAD) (r ¼0.49), aorta diameter (r ¼ 0.60), right ventricle diameter (r ¼ 0.71). Negative significantcorrelation between PP AI@HR 75 (r ¼ 20.34) and LAD (r ¼ 20.33) was found. Reflec-tion wave time significantly correlated with LVEF (r ¼ 0.39), end systolic diameter(r ¼ 20.45) and volume (r ¼ 20.45), end diastolic diameter (r ¼ 20.43) and volume(r ¼ 20.40).Conclusion: In patients with documented systolic heart failure the results indicate mul-tiple significant correlations between arterial stiffness indices and reflection wavecharacteristics and systolic function and heart remodeling.

P1255Left ventricle diastolic function after myocardial infarction in patients treatedwith primary angioplasty (pPCI)

M. Misztal1; A. Gackowski1; K. Zmudka2; W. Piwowarska1; J. Nessler11John Paul II Hospital, Department of Coronary Disease, Krakow, Poland; 2JagiellonianUniversity, John Paul II Hospital, Dept of Haemodynamic and Angiocardiography,Krakow, Poland

Purpose: More than 5% of patients aged over 65 years have been found to developheart failure and over half of them preserve normal left ventricular systolic function.The aim of our study was to assess changes of LV diastolic function in early phaseof myocardial infarction.Methods: This prospective study was carried out in 162 patients. Patients were evalu-ated up to 6 months after primary PCI. Evaluation was performed three times: within thefirst 24 hours after primary PCI, on day 7 after PCI and at 6 months after PCI. We ana-lyzed relationship between the severity of LV diastolic dysfunction and atherosclerosisrisk factors, infarction site, levels of cardiac necrotic markers, CRP protein levels, angio-plasty effectiveness, reperfusion time, TIMI and TMPG grade.Results: Most patients with STEMI infarction treated with primary PCI demonstrated leftventricle diastolic dysfunction on the first day of MI. Levels of cardiac biomarkers weresignificantly higher in patients with restrictive filling pattern. The inflammatory response(CRP levels) was found to have an important role in the development of diastolicabnormalities. There was a close relationship between diastolic and systolic function.Average values of LV ejection fraction in patients with restrictive filling pattern were sig-nificantly lower than in those with impaired relaxation (44,7 vs. 52,7%; p , 0,001) andnormal filling (54,2%; p ¼ 0,002). Diastolic function of LV does not correlate with infarct-related artery.Conclusions: More than half of patients with a first STEMI infarction have left ventriclediastolic dysfunction within the first day after PCI and these abnormalities are stillpresent six months after PCI. Time and effectiveness of reperfusion, CRP level, TnImax, CPK max and CK-MB max levels as well as LV ejection fraction have an importantinfluence on the development of diastolic dysfunction. Infarct extension contributes sig-nificantly to the process.

HEART TRANSPLANTATION / ASSIST DEVICES

P1256Factors predicting successful prednisolone cessation in heart transplantrecipients

Mckenzie; MR. Brown; DG. Platts; J. Maddicks-Law; G. JavorskyThe Prince Charles Hospital, Brisbane, Australia

Introduction: Prednisolone is a routine part of early immunosuppressant therapy postcardiac transplantation but as a long term therapy it is associated with myriad undesir-able side effects. Within our transplant program approaches for prednisolone doseminimization have changed over time but always aimed to ensure a prednisolonedose of no more than 10mg per day by 6 months post transplant. We sought toassess our experience of weaning to cessation.Methods: A retrospective analysis of all heart transplant cases (20 years) at our insti-tution was performed. We excluded patients who had multi-organ transplantation,less than 6 months follow up (due to death or recent transplant) or for whom insufficientdata was available. Results were based upon the patient status at time of last review.Results: 133/256 patients (52%) successfully ceased prednisolone. In 70/256 patients(27%) prednisolone weaning was never attempted despite no difference in theirnumber or timing of rejection episodes. Successful prednisolone cessation could notbe predicted by age, gender, recipient CMV status, presence of panel reactive anti-bodies or concomitant immunosuppressant. Donor - recipient gender mismatch didnot predict successful prednisolone cessation. Use of mechanical or inotropicsupport pre-transplant did not predict successful prednisolone cessation. The onlyidentifiable factor that could predict successful prednisolone cessation was the timetaken to reach 10mg per day. Patients successfully ceasing prednisolone took amean of 74.7 days compared with 88.9 days (p ¼ 0.02; 95% CI 2.22 to 26.19) forthose unsuccessful. This occured despite no significant difference in the meannumber of rejection episodes occurring prior to weaning to 10mg (0.41 episodes forsuccessful, 0.53 for unsuccessful p ¼ 0.297; 95% CI -0.10 to 0.353).

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Conclusions: Prednisolone was successfully ceased in just over half the heart trans-plant recipients. A longer duration of time taken to reduce prednisolone to 10mgdaily predicted a lower likelihood of successful cessation.

P1257Noninvasive criteria of acute cellular rejection transplanted heart

T. Vaikhanskaya; I. Sidorenko; Y. OstrovskiyRepublican Scientific and Practical Center "Cardiology", Minsk, Belarus

The first experience of orthotopic heart transplantation (OHT) in our center has inducedus to search of the noninvasive criteria, allowing to estimate electrophysiologicalchanges of the allograft rejection.Material and methods: Operation of orthotopic heart transplantation are performed at27 patients (25 men and 2 woman, average 42,1+13,9 years) in our center at 2009-2010 years. The data of multiple HM-ECG (HRV, HRT, dispersion QTc) the researchesexecuted at 24 o’clock in advance, has compared with the data serial endomyocardialbiopsy (n ¼ 58) for the period from 6 to 18 months of follow-up. Intensity of acute cel-lular allograft rejection was estimated on classification ISHLT. Acute cellular rejection isrevealed in 25 serial biopsies samples in various postoperative periods of supervision:17 - easy degree(1R), 5- moderate reaction (2R), 3- severe (3R) and cellular rejectionwere absent in 33 histologic tissue sampling (0R).Results: At the analysis of results HM at all patients after OHT is revealed naturally lowHRV (since the transplanted heart is organum with denervation), indicator SDNN hason the average 46,8+13,4 ms., but parameters HRV of patients with reaction acute cel-lular rejection differed on parameters without histologic signs rejection (SDNN36,3+0,19ms, SDNNi 6,9+1,88ms, rMSSD10,9+3,22ms versus SDNN57,3+8,99ms, SDNNi 18,7+2,55ms, rMSSD 37,9+4,13ms; p , 0,001). Pathologicalturbulence of a heart rhythm (HRT0.0%) also are observed at all patients after OHTeven with clinically small-for-date ventricular ectopy, but values of HRT"onset" ingroup with allograft rejection significant exceed this parameter HRTO in groupwithout rejection (HRT0 1,62+0,13% versus 0,66+0,19%; p , 0,001). Paroxysmsunstable VT, SVT, pathological polymorphological V-ectopy and dysfunction SA-con-ductivity were registered in patients after OHT with signs rejection in 84% at HM.Also extension QRS-complex and pathological dispersion QTc are observed in patientswith acute cellular rejection (QRS 111+8,41ms, QTcd 76,8+9,44ms) in comparisonwithout rejection (QRS 89,1+5,23ms, QTcd 26,8+9,61ms; p , 0,001).Conclusions: Thus, the pathophysiology of allograft rejection is characterize by acomplex ECG changes: rhythm and conductivity dysfunctions, changes of character-istics HRV and HRT, prolongation QRS complex and pathological dispersion QTc.The research conducted by us has shown necessity of use HM in a complex of nonin-vasive methods of inspection of patients after OHT for early revealing of allograft rejec-tion, for the further definition of optimal diagnostic tactics.

P1258Driveline infections in patients supported with a continuous flow LVAD:incidence, microbiology, biomarkers and outcome

T. Bomholt1; C. Moser2; S. Boesgaard1; L. Kober1; K. Sander3; PS. Olsen3;PB. Hansen4; SA. Mortensen1; F. Gustafsson1

1Rigshospitalet – Copenhagen University Hospital, Heart Centre, Department ofCardiology, Copenhagen, Denmark; 2Rigshospitalet, Department of MedicalMicrobiology, Copenhagen, Denmark; 3Rigshospitalet - Copenhagen UniversityHospital, Heart Centre, Department of Cardiothoracic Surgery, Copenhagen, Denmark;4Rigshospitalet – Copenhagen University Hospital, Heart Centre, Department ofAnaesthesia, Copenhagen, Denmark

Purpose: To investigate the incidence and outcome of driveline infections in patientssupported with a continuous flow left ventricular assist device (HeartMate II (HMII))and to study the microbiological aetiology.Methods: Retrospective analysis of 31 patients implanted with a HMII (25 patientsbridge-to-transplantation and 6 destination therapy). Follow-up lasted from implan-tation to either device explantation at the time of transplantation or recovery, death or

study closure. Infections were divided into superficial, deep or systemic and culture,Gram stain, biomarkers and clinical course were evaluated.Results: The median age was 43 years and the median device support duration was317 (range: 5 – 1132) days. Diabetes was present in 16%. Driveline infection occurredin 39% of the patients and annual incidence was 1.7 episode per patient (Figure 1). Wecould not identify clinical baseline characteristics which predicted driveline infection.Only 3 deep infections occurred. Staphylococcus aureus (33%) and Escherichia coli(19%) were the most common bacterial etiology followed by corynebacteria and enter-ococci. Infections were managed on an outpatient basis in 88% but more than twoweeks of treatment was required in 81% of the patients. In terms of detecting drivelineinfections, leucocyte count and CRP demonstrated poor sensitivities of 27% and 28%,respectively. Plasma pro-calcitonin was found to be normal in all cases.Conclusions: Driveline infections are common in HMII recipients. However, they pri-marily remain superficial, are easily managed and should not be considered anobstacle for long-term device support. Infectious agents mostly originate from theskin and gastrointestinal tract. Blood biomarkers did not appear to be helpful in detect-ing driveline infections.

P1259Histology of the donor heart and graft dysfunction in heart transplantation

S. Mangini; ML. Higuchi; S. Palomino; MM. Reis; AI. Fiorelli; A. Benicio;PMA. Pomerantzeff; NG. Stolf; F. Bacal; EA. BocchiHeart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil, SaoPaulo, Brazil

Background: heart transplantation is the treatement of choice for refractory heartfailure and its outcome depends on appropriate donors. Brain death is a fundamentalcondition for donation and is characterized by intense sympathetic activation that maycause myocardial changes in the potential donor with consequent impairment of theresults of heart transplantation. The aim of this study is to evaluate whether changesin the myocardium of the donor heart may correlate with mortality for graft dysfunctionat 30 days post-heart transplantation.Methods: from June 2009 to October 2010 were studied 20 donor hearts that wereused for transplantation; samples were collected from right ventricle septum immedi-ately before implantation and submitted to histology, including hematoxylin-eosin (con-traction bands) and immunohistochemistry (CD3 and CD68). After 30 days, patientswho have died of graft dysfunction were compared to non-died on the basis ofdonor heart histological data.Results: 90% of donors were male; mean age 31.5+10 years; 4.2+2.9 days of braindeath; head trauma was the main cause of brain death in 75%; 85% were on vasopres-sors; ischemic time was less than 4 hours in all cases. There were 8 deaths 30 daysafter transplantation (5 for graft dysfunction, 2 for infection and one for rejection). His-tology showed the presence of contraction bands in 75% of donors, confirming themyocardial injury mediated by cathecolamines; CD3 5.82+5.23 cells/mm2, CD6833.1+28 cells/mm2. Patients who died of graft dysfunction in the first 30 days demon-strated more lymphocyte infiltration in the myocardium of the donor (12+4.6cells/mm2) compared to those not died (3.75+3.57 cells/mm2) (p 0.011).Conclusion: graft dysfunction after heart transplantation may be related to lymphocyticinflammatory infiltrate in the myocardium of the donor being a possible risk factor forearly mortality.

P1260The "hub & spoke" model for long-distance bridging of patients on MechanicalCirculatory Support (MCS)

G. Guzzi1; M. Maiani1; V. Tursi1; I. Vendramin1; C. Daffarra1; L. Vetrugno2; D. Miani1;U. Livi11"Santa Maria della Misericordia" University Hospital, CardioThoracic Dept, Udine, Italy;2"Santa Maria della Misericordia" University Hospital, Institute of Anestesiology andResuscitation, Udine, Italy

Objective: Regional referral networks (so called hub-and-spoke) have been extensivelycreated to facilitate transfer of critically-ill patients. This model is not well established forthose on Mechanical Circulatory Support (MCS), even if improving results with ventri-cular assist devices forwards their wider clinical application.Materials and methods: Between 2005 and 2010, 6 patients [5 males, mean(median)age 56(58)+6 years (range 46-62)] were transferred to our Institution supported byMCS; IntraAortic Balloon Pump counterpulsation (IABP) + ExtraCorporeal MembraneOxygenation (ECMO) in 2, left centrifugal pump after IABP/ECMO in 3, and ECMOalone in 1. Indications for MCS were cardiogenic shock following acute myocardialinfarction in 3 patients and post cardiotomy in 1, dilated cardiomyopathy in 1, andH1N1-related respiratory failure in 1. Mean distance was 487(264)+488 kilometers(range 84-1100); 4 patients transferred by ground, 2 by air+ground. After referral, 2centrifugal pumps were bridged to pulsatile Left Ventricular Assist Devices (LVADs).All but one were on mechanical ventilation; 2 patients required Continuous Veno-Venous Hemofiltration (CVVH)/dialysis before referral, 2 afterwards.Results: During transportation, all patients were hemodinamically stable, no problemsoccurred. One patient died after overall 40 days of assistance for multi-organ failuredue to sepsis. Four patient were successfully transplanted 20(2)+38 days (range0-76); H1N1 patient was weaned by ECMO after 11 days.At 35(40)+24 months follow-up, all patients are alive and well but the female, died forneoplasia 34 months after transplant.Time-to-driveline-infection

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Conclusions: Our experience seems to validate the hub-and-spoke model for man-agement of these critically ill patients. Key of success of this approach is presenceof skilled teams and a close collaboration among peripheral (spoke) and experienced(hub) centers.

P1261Fontan like circulation as a criterion for heart transplantation in right ventricularcardiomyopathies. A single center experience

J. Altenberger1; G. Poelzl2; B. Strohmer2; R. Steinacher2; C. Schernthaner2; M. Pichler21Paracelsus Private Medical University, Salzburg, Austria; 2Paracelsus MedicalUniversity; Department of Internal Medicine II, Cardiology, Salzburg, Austria

Introduction: Right ventricular cardiomyopathies (RVC) are most often associated withworse prognosis. Standard evaluation criteria for heart transplantation (HTx) do notnecessarily apply to this condition. Hemodynamic perturbation such as Fontan-like-cir-culation (FLC) indicates advanced right heart failure. Right heart catheterization may behelpful for the assessment of optimal timing for HTx.Methods and Results: We report on 4 patients (2 males, 41+9 years) with advancedRVC who underwent invasive hemodynamic testing for the evaluation for HTx. Theextent of common clinical signs of right heart failure such as leg edema, jugular and/orhepatic vein distension, ascites, and elevation of liver function tests were strikingly hetero-geneous. Also, NYHA classification (2,25+0,5) and NT-proBNP (2870+1851,9) did notadd unequivocally to decision-making. Right heart hemodynamics revealed markedlyreduced CI (2,14+0,64) and FLC with equilibrated pressure tracings between the rightatrium (RAm16+4 mmHg) and the pulmonary artery (PAPm16+5 mmHg). In this con-dition blood is propelled passively through the right heart using the left atrium asdriving force. Based on these findings all patients were listed for HTx with three of thembeing already successfully transplanted and one still on the waiting list.Conclusion: In patients with right ventricular cardiomyopathies evidence of Fontan-like-circulation may substantially contribute to evaluation for HTx particularly in patientsnot clearly fulfilling standard criteria.

HORMONES / NEUROHUMORAL REGULATION

P1262fT3 to fT4 ratio predicts 5 year survival in heart failure patients

M. Nikolaou; J. Parissis; F. Kolokathis; C. Michalakeas; S. Gaitani; P. Rafouli-Stergiou;K. Tsitlakidis; DT. Kremastinos; M. Anastasiou Nana; G. FilippatosAttikon Hospital, 2nd University Department of Cardiology, Athens, Greece

Purpose: Thyroid dysfunction has been investigated in critically ill patients, but itsprognostic role in heart failure patients has not been extensively elucidated.Methods: We retrieved thyroid function measurements (T3, T4 and/or fT3, fT4 andTSH) from our heart failure population. Patients’ data such as left ventricular ejectionfraction (LVEF), NYHA class, exercise capacity, natriuretic peptides and creatinineare recorded. Medication of each patient is also available. All cause mortality duringfive year of follow-up was the end-point of the study.Results: One hundred eighty-five patients with thyroid measurements available wereincluded in the study. Among 162 male and 23 female, the study cohort included127 non ischemic and 58 ischemic cardiomyopathy patients. The mean age of thepopulation was 63,4+26 years and the mean LVEF 28+9%. Fifty two patients havedied, in a mean follow up of 27+19 months. In the multivariate Cox regressionmodel that included parameters that are associated with survival (fT3, fT4, TSH,LVEF, NYHA class, age, 6-minute walk test, BNP, amiodarone treatment, thyroidrelated treatment) low fT3 (HR ¼ 0,148, p ¼ 0,011) and high fT4 (HR ¼ 3,533, p ¼0,021) were the strongest independent predictors of survival. FT3 to fT4 ratio was cal-culated and mortality rates are presented as survival plots for each quartile in the figure(log rank p , 0.001). The cut-off levels used are 1,25, 1,74 and 2,17.Conclusion: fT3 to fT4 ratio is a strong predictor of 5 year survival and may be veryuseful for risk stratification of heart failure patients.

P1263Euthyroid sick syndrome management in congestive heart failure

I. Shatynska-Mytsyk; YU. Kyyak; O. MakarLviv National Medical University n.a. Danylo Halytsky, Lviv, Ukraine

Recent data indicate that chronic heart failure may alter thyroid metabolism resulting intriiodthyronine (T3) concentration decrease that correlate with functional degree ofheart failure and is associated with worse outcome. Several evidences suggest thataltered thyroid status in congestive heart failure could modify cardiac gene expressionand contribute to impaired cardiac function. It is known that N-terminal-pro-B-typenatriuretic peptide (NT-proBNP) levels increase in cardiac failure, however, NT-proBNP levels in different thyroid states are still unclear.Objectives: The purpose of prospective study was to evaluate the effect of congestiveheart failure on the concentrations of thyroid hormones and metabolites, determine thelevels of NT-proBNP.Materials and methods: Blood samples were obtained from 47 patients with chronicheart failure of III-IV stages NYHA on admission, (mean age 63+11 years, mean leftventricular ejection fraction, EF, 32+11%) and 23 age, sex and body mass index-matched control subjects. Thyroid-stimulating hormone, thyroid-binding globulin, freethyroxin, total T3, free T3, reverse T3 were measured by radioimmunoassay. All patientswere assessed by echocardiography, levels of NT-proBNP were determined by electro-chemiluminescence immunoassay. Patients with low T3 syndrome were managed withthyroid replacement therapy with low doses of thyroxin to achieve euthyroid status.Results: Values of total T3 and free T3 were significantly decreased in heart failurepatients, reverse T3 demonstrated a greater than twofold elevation, thyroid-binding glo-bulin was decreased (p , 0.05 respectively). Thyroid-stimulating hormone and freethyroxin levels remained within normal ranges (p . 0.05). Low T3 syndrome was diag-nosed in 21 (45%) heart failure patients. Mean levels of NT-proBNP in heart failurepatients without low T3 syndrome were higher than in hypothyroid patients (p ,

0.01) and control (p , 0.01), while patients with low T3 syndrome and control subjectshad equivocal levels of NT-proBNP (p . 0.05).Conclusions: Advanced stages of chronic heart failure results in the "euthyroid sicksyndrome" in 45% of patients which is characterized by depression of T3 and freeT3 concentrations with a concomitant increase in reverse T3 levels and normal concen-trations of thyroid-stimulating hormone and free thyroxin. Hypothyroid status may affectthe levels of NT-proBNP in heart failure patients thus resulting in the possible diminish-ing of it’s prognostic value in patients with low T3 syndrome.

HYPERTENSION / LV HYPERTROPHY

P1264Blood pressure variability increased is associated with heart rate turbulence inhypertensive patients

E. Silva; E. Sierra; JJ. Villasmil; A. Gonzalez; M. Bracho; C. Esis; G. Calmon; S. BricenoInstituto Regional De Investigacion Y Estudios De Enfermedades Cardiovasculares,Universidad Del Zul, Maracaibo, Venezuela

Background and Purpose: Blood pressure (BP) variability (BPV) and heart rate turbu-lence (HRT) represent the functional status of autonomic nervous system, whose dys-function is associated with high cardiovascular risk in hypertensive patients. Thus, thisstudy analyzes associations between BPV values and HRT in patients with hypertension.Methods: The group consisted of 50 hypertensives, age 23-84 years, males (n ¼ 20)and females (n ¼ 30). All patients were studied with a Holter monitoring for 24 hours,which allowed recording ventricular premature complexes (VPCs). The Holterrecords were analyzed to quantify HRT through two numerical parameters: the turbu-lence onset (TO), as a percentage, and the turbulence slope (TS) as millisecondsper beat. Those subjects with analyzable VPCs on the Holter were underwent to 24hours ambulatory blood pressure monitoring (ABPM) to register the systolic and dias-tolic ABP during periods of 24 hours, awake and sleep. The BPV was estimated for sys-tolic and diastolic BP as the standard deviation of BP values in each studied period. Forthe statistical analysis was used the t-test to compare means; the variance ratio test tocompare BPV values between groups, and the Spearman’s rank correlation to deter-mine the association between BPV values and HRT parameters.Results: The systolic and diastolic BPV values during 24-hours were 12.73/8.71 in all,11.4/9.17 in males and 13.79/7.90 in females (p: NS). Likewise, TO/TS values were-5.4+7/19.4+4 for all subjects, 25.7+7/19.4+13 for females and 24.9+7/19.3+1 for males (P: NS). There was a highly significant negative associationbetween systolic BPV in 24-hours and TS (r ¼ 20.312, p , 0.02), but it was notshowed association between systolic BPV in 24-hours and TO (r ¼ 20.147, p: NS).For an additional analysis, patients were classified according to systolic BPV inawake period in two groups: those with BPV values , 12 mmHg (normal BPV), andthose with values ≥ 12 mmHg (high BPV). Only in the group with high BPV it was evi-denced a statistically significant association between TS and systolic BPV in awakeperiod (20.317, p , 0.028).Conclusions: The BPV is associated with HRT in hypertensive patients. These resultsshowed that the TS must be considered as the best HRT parameter to assess itsassociation with systolic BPV during 24-hours and awake periods in these patients.

P1265Atherosclerotic process and immunological factors in essential hypertension

M. Rivera1; JR. Calabuig1; E. Rosello1; N. Carpena1; L. Almenar1; V. Miro1; L. Grigorian2;P. Morillas3; M. Portoles1; V. Bertomeu3Survival plots according to fT3:fT4

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1Hospital La Fe, Valencia, Spain; 2University Clinical Hospital of Santiago deCompostela, Santiago de Compostela, Spain; 3Hospital de San Juan de Alicante,Alicante, Spain

Purpose: Essential hypertension (HT) is a major risk factor for atherosclerotic cardio-vascular disease. Selectins play a role in the initiation of atherosclerosis. sP-selectin(P-sel) can mediate normal levels of rolling in the absence of other selectins. sE-selectin(E-sel) appears less important, except in the absence of P-sel. Abnormal levels of pro-thrombotic markers have been described in HT and raised levels of P-sel were predic-tive of myocardial infarction. Nevertheless, the relationship between immunologicactivation and changes in P-sel and E-sel remains unknown. Therefore the purposeof this study was to investigate the relationship of P-sel and E-sel with cytokine levels.Methods: We have studied 250 asymptomatic patients, age 60+13, that had beendiagnosed of HT and 30 control subjects. A HT questionnaire and echo-Dopplerstudy were performed on these patients. All plasma samples were centrally analysedand P-sel (ng/ml) and E-sel (ng/ml) were calculated. Furthermore IL-8, sTNF-RI,sTNF-RII, IL-1ra, IL-6 and sFAS (all pg/ml) were determined. We also measured systolicblood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), body massindex (BMI), glomerular filtration rate (eGFR) and left ventricular mass index (LVMI).Results: For the whole population P-sel was 97+71, E-sel 65+32, IL-8 7.8+5.2,sTNF-RI 474+331, sTNFRII 969+571, IL-6 2.8+2.3, IL-1ra 231+178 and sFAS1432+467. When we correlated P-sel with IL-8, sFas and IL-1ra we found (p ,

0.0001, p , 0.0001 and p , 0.05). When we correlated E-sel with IL-1ra we foundp ¼ 0.008). Furthermore, to investigate whether plasma cytokine levels are indepen-dent predictors of P-sel a multivariate analysis was performed. When the multivariatemodel was applied using P-sel as dependent variable (age, gender, LVMI, PP, BMI,known hypertension duration, eGFR, diabetes, IL-8, sTNF-RI, sTNF-RII, IL-1ra, IL-6,sFAS and medication), we found that IL-8 (p , 0.0001), sFas (p ¼ 0.004) and LVMI,emerge as independent factors, r2 ¼ 0.34, p , 0.0001. When the multivariate modelwas applied using E-sel as dependent variable, we found that IL-1 ra (p , 0.0001)and sFas (p ¼ 0.032) emerge as independent factors, r2 ¼ 0.39, p , 0.0001.Conclusions: Cytokine levels were significantly correlated with P-sel and E-sel. Multi-variate linear regression reported that plasma IL-8, sFas and IL-1ra were independentfactors of P-sel and E-sel. These findings support the hypothesis that the immunesystem is closely related with the progression of the atherosclerotic process in patientswith HT.

P1266Acute heart failure post myocardial infarction: arterial hypertension, animportant risk factor

FC. Adam; RM. Ianula; AI. Popa; M. Dasoveanu; CL. Andrei; VP. Chioncel; LN. Axente;M. Anastasiu; DE. Mincu; CJ. SinescuBagdasar Emergency Hospital, Bucharest, Romania

Purpose: As we know from the literature, arterial hypertension (HTA) represents one ofthe factors which influence in a negative way the evolution of the patients with acutemyocardial infarction (AMI). In our study, we intend to verify if the associationbetween AMI and HTA favors the appearance of acute heart failure (AHF) and its aggra-vation in the first week after the acute event on patients who did not receive reperfusiontherapy.Methods: We checked out 310 patients with AMI, 47% with HTA, 53% without HTA. Wenoticed that on the onset of AMI, the hypertensives develop AHF more frequent thannormotensives, mainly for Killip III (9% vs 2,4%) and Killip IV classes (4,7% vs 1,2%).At those in Killip I class on the onset of AMI, the evolution toward superior Killipclasses happened previously on hypertensives in comparison with normotensives(10% vs 2,7%).Results: The patients with HTA and AHF from the very beginning of AMI, aggravatedtheir hemodynamic statue more frequent than normotensives (12,1% vs 3,77%).Conclusions: History of HTA seems to be a risk factor for AHF on the onset of unreper-fused AMI and for unfavorable evolution in a short time.

P1267Tissue-type plasminogen activator plasma levels are related with systolic andpulse pressure and left ventricular mass in patients with essential hypertension

M. Rivera1; E. Rosello1; JR. Calabuig1; JR. Gonzalez Juanatey2; P. Morillas3; V. Miro1;T. Lozano4; P. Orosa5; M. Portoles1; V. Bertomeu3

1Hospital La Fe, Valencia, Spain; 2University Clinical Hospital of Santiago deCompostela, Santiago de Compostela, Spain; 3University Hospital of San Juan, Alicante,Spain; 4Hospital Villajoyosa, Villajoyosa, Spain; 5Hospital de Gandia, Gandia, Spain

Purpose: It has been published that enhanced coagulative activity and lowered fibrino-lytic activity characterize essential hypertension (HT) and that medication may correctthis disorder. Furthermore before any medical treatment, there are significantly higherlevels of tissue-type plasminogen activator (tpa) compared with normal volunteers. Indespite of the recognition of the several changes in the coagulation activity of HTpatients, the role of tpa in essential hypertension (HT) and its relationship with systolic(SBP), diastolic (DBP) and pulse pressure (PP), has never been reported. The purposeof this study was to investigate the relationship of tpa with blood pressure and left ven-tricular mass index in a group of patients diagnosed of HT and treated appropriatelywithout dilated, coronary or valvular cardiomyopathy or permanent arrhythmia.Methods: We have studied 260 patients, age 60+13, that had been diagnosed of HTand 45 age and sex matched controls. A hypertension questionnaire and echo-Dopplerstudy were performed on these patients. We also collected blood samples. All plasma

samples were centrally analyzed and tpa (pg/ml) levels were determined. We alsomeasured SBP and DBP, PP and left ventricular mass index (LVMI).Results: In hypertensive patients we found for tpa 529+461 (non-hypertrophic group,(n ¼ 146), 456+360, hypertrophic group, (n ¼ 112), 607+521, p , 0.0001), SBP149+20, DBP 87+11, PP 62+18 and LVMI 126+29. In control subjects (45) wefound for tpa 329+186, p , 0.05, SBP 120+14, p , 0.0001, DBP 73+12, p ,

0.0001 and PP 47+10, p , 0.0001. When we correlated tpa with SBP, we found r ¼0.2, p , 0.01. When we correlated tpa with PP, we found r ¼ 0.13, p , 0.05. Whenwe correlated tpa with DBP, we found, NS. When we correlated tpa with LVMI, wefound r ¼ 0.25, p , 0.0001. When we divided LVMI in quartiles and we calculatedtpa (435+304, 462+422, 490+270, 687+635), we found p , 0.001.Conclusions: In this study we found that in a group of patients diagnosed of essentialhypertension without dilated, coronary or valvular cardiomyopathy or permanentarrhythmia, SBP and LVMI are related with tpa plasma levels. This maybe relatedwith the fact that under certain pathological conditions, some coagulative and fibrino-lytic components (i.e. tpa ) may directly or indirectly be activated by the vasoconstric-tion in the smooth muscle cells. This may also reassure the importance of controllingSBP in patients diagnosed of essential HT.

LEFT VENTRICULAR FUNCTION

P1268Early signs of global left ventricular dyssynchrony at real-time 3-dimensionalechocardiography in high-risk type 2 diabetes patients correlate with highercoronary calcium score and predict IMT

E. De Marco; A. Colucci; G. Savino; FA. Gabrielli; R. Natali; G. Comerci; M. Savino;B. Garramone; M. Lotrionte; F. LoperfidoCatholic University of the Sacred Heart, Rome, Italy

Background: Detection of pre-clinical diabetic cardiomyopathy is important to preventthe progression to overt heart failure. Longitudinal dyssynchrony (LD) at TissueDoppler imaging (TDI) is an early sign of left ventricular (LV) dysfunction in diabeticpatients. Global LV dyssynchrony can be detected by real-time 3-dimensional echocar-diography (RT-3DE) measuring the Systolic Dyssynchrony Index (SDI).Purpose: To determine the prevalence of global (i.e. longitudinal, radial or circumferen-tial) LV dyssynchrony in asymptomatic patients at high arterosclerotic risk and therelation of SDI with type II diabetes, coronary calcium score (CAC) and marker ofpre-clinical arterosclerosis (intima media thickness (IMT)).Methods: We examined 60 consecutive asymptomatic high-risk pts (Framingham riskscore . 20%) with QRS length , 120 msec. In all patients, presence of ischemic heartdisease was carefully excluded by negative exercise ECG testing and no evidence ofcoronary artery lumen reduction at 64-slices computed tomography (CT).Echocardiographic studies were performed using an ie33 Philips system, and IMTwas assessed with high-resolution ultrasound. LD was measured by TDI as septal-to-lateral peak systolic velocities delay (SLD).Global LV dyssynchrony was measuredby RT-3DE as SDI (derived as the time dispersion to minimum regional volume apartfrom 16 LV segments time-volume curves), using a dedicated software (Q-LAB).CT Agatston CAC score was assessed in all patients.Results: There were 34 men and 26 women, mean age of 61+7 yrs, all in sinusrhythm. LV ejection fraction (EF) was 60+8%, 14pts (23%) had compensated type IIdiabetes (HbA1c 5.9 + 1.2%) and 46 (77%) were not diabetic. Diabetic and non-dia-betic patients were similar with regard to age (64+8 vs 61+7 years), gender, HDL(56+ 16 vs 49+14 mg/dl) and LDL cholesterol (96+ 23 vs 110+43 mg/dl), BP(p . 0.5), and smoking status (56% vs 60%). RT-3DE SDI and SLD at TDI werehigher in pts with type II diabetes (7.1%+7 vs 2.6%+2, p , 0.0001; 58+34 vs28+19 p ,0.0001). CT CAC score was higher in pts with type II diabetes (66+106vs 16+31 HU, p ¼ 0.02). CAC score moderately related to SLD (r: 0.64, p , 0.05)and well related to SDI at RT-3DE (r: 0.72, p , 0.001). At multivariate analysis onlySDI and SLD predicted IMT (0,003 and 0,02). There was a good correlation betweenTDI-SLD and RT-3DE SDI (r: 0.87; p , 0.001) and between SDI and SLD and EF(p , 0.001).Conclusions: In high-risk pts with type II diabetes global LV dyssynchrony can bedetected by RT-3DE, as a possible sign of pre-clinical LV dysfunction, relates wellwith CAC score and predicts IMT.

P1269Are there different profiles of patients with type 2 diabetes and diastolicdysfunction?

LJM. Boonman-De Winter1; FH. Rutten2; MJ. Landman3; AH. Liem4; MJM. Cramer5;AW. Hoes2

1Center for Diagnostic Support in Primary Care (SHL), Scientific and Contract Research(WECOR), Etten-Leur, Netherlands; 2University Medical Center Utrecht - Julius Centrefor Health Sciences and Primary Care, Utrecht, Netherlands; 3Cardiologist, Leusden,Netherlands; 4Admiraal de Ruyter Hospital, Goes, Netherlands; 5University MedicalCenter Utrecht, Department of Cardiology, Utrecht, Netherlands

Background: Diastolic dysfunction is very common in patients with type 2 diabetes. Itis not clear whether patients with diastolic dysfunction and moderate ejection fraction(45-55%) differ from those with an ejection fraction .55%.Purpose: Do (echocardiographic) parameters of patients with type 2 diabetes anddiastolic dysfunction and a LVEF 45-55% differ from those with a LVEF .55%?

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Methods: In a cross-sectional study with patients 60 years and older and type 2 dia-betes, 581 patients, unknown with a cardiologist-confirmed diagnosis of heart failureunderwent a diagnostic assessment, including extensive echocardiography.Results: Mean age was 71.6 (SD7.4) years, and 53.4% were male. The median dur-ation of diabetes was 5.5 years (IQR 3.0-15.2). Of the 581 patients, 320 (55.1%) haddiastolic dysfunction.Conclusion: We could not find significant differences in patient characteristics andechocardiographic parameters related to relaxation, LV stiffness and filling pressuresbetween patients with type 2 diabetes and diastolic dysfunction and LVEF 45–55%and those with LVEF .55%.

LVEF 45–55 LVEF .55

Diastolic dysfunction N 90 199Age (years) 72.7 (7.4) 72.3 (7.3)% Male sex 54.4% 48.2%Systolic BP (mmHg) 165.6 (18.0) 160.1 (21.7)Diastolic BP (mmHg) 90.7 (8.5) 89.9 (10.4)Duration diabetes (years) 6.8 (5.9) 7.6 (6.1)LA volume (mm3) 55.5 (15.3) 59.0 (19.8)Deceleration time E wave (ms) 225 (64) 227 (60)E/A (SD) 0.71 (0.16) 0.78 (0.47)% E/A ≤ 0.75 74.7% 64.9%Septal e’ (SD) 0.06 (0.02) 0.06 (0.02)E/e’ (SD) 10.2 (3.1) 10.4 (4.4)

Values in means (SD) unless stated otherwise.

P1270Global left ventricular function is related to coronary artery calcification score inpatients with chronic ischemic heart disease

I. Burazor1; Z. Radovanovic2; M. Burazor1; P. Bosnjakovic2; V. Erakovic1

1Clinical Center, Clinic for Cardiovascular Diseases, Nis, Serbia; 2Clinical Center, Nis,Serbia

The tridimensional estimation of global left ventricular (LV) function by using multi slicecomputer tomography might be a useful clinical tool in addition to detection of coron-ary calcium score and stenosis of both native coronary arteries and bypass grafts. Theaim of our study was to evaluate the diagnostic performance of 64 MSCT scanning ofthe global LV function obtained by 3D imaging modality and possible interrelationshipwith coronary calcification in patients with chronic ischemic heart disease.Methods: Out of 754 persons who were referred to 64 slices MSCT, the total of 115patients (age 50 to 69 years, 64% males) in sinus rhythm with chronic coronary arterydisease were included in the study. Coronary artery calcification (CAC) score was calcu-lated. Non invasive coronary angiography was performed in order to detect significantlesions (. 50% diameter reduction). Global LV function was assessed by using MSCT(ejection fraction, stroke volume, cardiac output, LV volume, LV mass, end-systolic andend-diastolic volumes were calculated). All traditional risk factors were noted.Results: All patients had coronary artery calcifications ranging from 1 to 1000. Coron-ary artery calcium score between 1 and 100 was detected in 26% of patients, between101 and 399 in 21%, between 400 and 999 in 29%. The total of 24% had CAC scoreabove 1000 and in these patients further evaluation of significant lesion was based

on individual coronary artery calcification levels assessment instead of total score cal-culation. There was a correlation between CAC and global left ventricular function.Higher CAC correlated with lower ejection fraction (p ¼ 0.01), stroke volume (p ¼0.05), end –systolic volume (p ¼ 0.01) and end-diastolic volume (p ¼ 0.05).Conclusions: Our results suggest that higher coronary artery calcification is related tolower global left ventricular function in patients with chronic ischemic heart disease.Further studies as a means to triage patients towards more complex diagnostic butalso drugs treatment tools are need and will determine the ultimate role of CACscore and its relationship global left ventricular function.

METABOLISM / DIABETES MELLITUS

P1271Clinical and biochemical predictors of carotid intima media thickness inadolescents with type 2 diabetes

R. Gaber; NESREN. Kotbtanta univeristy hospital, Tanta, Egypt

Background: Overweight children and adolescents are at increased risk of type 2 dia-betes and early development of atherosclerotic lesions and cardiovascular compli-cations. The aim of this study was to identify clinical parameters associated withincreased carotid intima media thickness (CIMT) in adolescents with type 2 diabetes.Patients and Methods: Patients were selected among diabetics who presented to diabetesout patients’ clinic. Criteria for selection were age (12 – 19 years), being overweight (BMIbetween 25-30kg/m2 and obese BMI . 30kg/m2), normal or high C- peptide, and negativestudies for islet cellantibodies.Ageandgendermatched healthy subjects, wereenrolled as acontrol group. Laboratory investigations included lipid profile, hypersensitive C- reactiveprotein (hs-CRP), HbA1c and assessment of insulin resistance by HOMA. According toHbA1c, patients were divided into, uncontrolled group (with HbA1c . 6.5) and controlledgroup (with HbA1c ≤ 6.5). Ultrasonographic analysis of CIMT was performed for all partici-pants and its association with risk variables was analyzed.Results: BMI, triglycerides, C -reactive protein, HbA1c and HOMA were significantlyhigher in diabetic patients than the controls. CIMT, HbA1c, systolic blood pressure, tri-glycerides, HOMA and C- reactive protein were significantly higher in uncontrolled thancontrolled diabetics, while there was no significant difference between the two groupsas regard BMI, total cholesterol, LDL, HDL and C- peptide. In diabetic patients, CIMTcorrelated positively with BMI, duration of diabetes, systolic and diastolic bloodpressure, HbA1c, HOMA, and C reactive protein.Conclusion: CIMT is increased in adolescents with type 2 diabetes as compared tocontrol subjects. Poor glycemic control, HOMA, increased C reactive protein, BMI, dur-ation of diabetes and elevated blood pressure are associated with early atherosclerosisin these patients.

P1272Body mass index or nutritional status to stratify prognosis in heart failure?

P. Gastelurrutia1; J. Lupon2; M. Domingo3; N. Ribas3; M. Noguero3; A. Bayes-Genis2

1Germans Trias i Pujol Health Sciences Research Institute, Badalona, Spain; 2GermansTrias I Pujol University Hospital, Badalona, Spain; 3Hospital de la Santa Creu i Sant Pau,Barcelona, Spain

Purpose: The obesity paradox in heart failure (HF) has been criticized in part for thelimitation of body mass index (BMI) for a correct classification of overweight or

Survival according to nutritional status (Abstract P1272 Figure)

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obese patients. A better assessment of nutritional status other than BMI is required inHF patients. We aimed to assess nutritional status, its relationship with BMI, and its sig-nificance in terms of survival in HF.Methods: Fifty five HF patients were assessed by anthropometry [tricipital skinfold(TS), subscapular skinfold (SS), arm muscle circumference (AMC)] and biochemicalnutritional markers (albumin, total proteins, total lymphocyte count). Presence of ≥2of these indexes below normal ranges defined undernourishment. Patients were alsostratified by BMI using the WHO classification.Results: Across BMI strata, no patient was underweight, 31% of patients were normal-weight, 42% overweight, and 27% were obese. Nutritional data revealed that 53% ofnormal-weight patients, 26% of overweight, and none of the obese group were under-nourished (p ¼ 0.004). Undernourished patients had a trend towards higher mortality inthe whole cohort (p ¼ 0.06), which reached statistical significance for normal-weightpatients (p ¼ 0.04) (figure). Among the nutritional indicators studied, the best variablefor predicting mortality was SS. Patients with SS below the 5th percentile had highermortality (p ¼ 0.0014). In the multivariable analysis (backward step conditional) includ-ing age, sex, NYHA functional class, NTproBNP, BMI and SS below 5th percentile, onlythe latter (HR ¼ 4.722[1.408-15.833]) and NYHA functional class (HR ¼ 2.951[0.917-9.498]) remained in the model.Conclusion: BMI does not reveal true nutritional status in HF. Patient classification asnourished/undernourished instead of BMI categories may enable better riskstratification.

P1273Decrease of glycated hemoglobin more than 1% is associated with increase ofexercise capacity in heart failure patients with type 2

V. Mareev1; O. Narusov2; YU. Lapina2; N. Baklanova2; YU. Belenkov1

1M.V. Lomonosov Moscow State University, Moscow, Russian Federation; 2RussianCardiology Research Center, Moscow, Russian Federation

Purpose: To assess influence of strict glycemic control on exercise capacity and leftventricular ejection fraction (LV EF) in heart failure patients with type 2 diabetes.Methods: 75 patients with systolic (left ventricular ejection fraction , 45%) congestiveheart failure (CHF) II-III functional classes NYHA and with type 2 diabeteswere includedin the study. Ischemic heart disease was an aetiology CHF in 88% of patients, arterialhypertension in 7%, and dilated cardiomyopathy in 5% respectively. All patients wereon ACE-inhibitor, beta-blockers, diuretics and glucose-lowering agents (59% – oral,41% – insulin). We measured level of glycated haemoglobin (Hb A1c), exercisecapacity (by 6-minutes walk test), and LV EF at baseline and 6 months of follow-up.For final analysis all patients were divided into 3 groups according to changes of HbA1c during the study: 1st group- decrease of Hb A1c ≥ 1% (n ¼ 18), 2nd – decreaseof Hb A1c , 1% (n ¼ 26) and 3rd – increase of Hb A1c (n ¼ 31).Results: There were no significant differences in LV EF and 6 minutes walk test betweengroups at baseline. The Hb A1c significantly changed in all groups and LV EF increased in1st and 3rd groups. But significant improvement of 6-minutes walk test was only detectedin group with maximal decrease of Hb A1c (1st group) (see table).Conclusion: Decrease of Hb A1c more than 1% is associated with increase of exercisecapacity in heart failure patients with type 2 diabetes.

Changes in 3 groups during the study

GroupHbA1c,%

6-min walktest, m LV EF,%

Baseline 6 month Baseline 6 month Baseline 6 month

1-st 8.75 (7.7;9.4) 6.63(6.1;7.2)** 331(278;394) 372(316;398)* 38(28;42) 39(32;46)*2-d 7.05(6.6;7.6) 6.45(6.2;7.2)* 357(251;402) 326(250;390) 39(35;44) 40(34;44)3-rd 6.76 (6.1;7.2) 7.44(6.8;8.5)** 350(280;385) 340(2.63;422) 38(32;40) 40(31;44)*

*- p,.05; ** -p,.001.

P1274Metabolic therapy of chronic heart failure in patients with alcoholiccardiomyopathy

A. Vertkin; A. SkotnikovMoscow State Medical Stomatological University, Moscow, Russian Federation

The defeat of the internal organs due to alcohol intake is the cause of death in patientsof therapeutic profile in 11,2% of cases. Heart failure due to alcoholic cardiomyopathyis a cause of death is about one-third (28,1%) of these patients. Clinicians prescribemetabolic therapy in these patients only in 23.6% of cases. The aim of our studywas to determine the effectiveness of trimethylhydrazinium propionate (mildronat) inthe complex treatment of alcoholic cardiomyopathy in patients with somatic pathology.The study included 177 patients with alcoholic cardiomyopathy, admitted to the thera-peutic department multidisciplinary hospital in Moscow. The mean age was 57,1+7,4years. Patients were divided into 2 groups. Patients of the main group during the firstthree days of hospitalization was appointed mildronat intravenously at a dose of 500mg twice a day, and then for twenty-seven days continued his oral dose of 250 mg 4times a day. The course of treatment was 30 days. For patients of control group meta-bolic therapy has not been appointed. In the group of patients who received mildronat,

shortness of breath decreased by 26,9% (p , 0,05), and the frequency of paroxysmaldisorders of heart rhythm decreased by 19,9% (p , 0,05). In the control group theserates decreased by 17,1% and 11,4% respectively. Reducing the concentration ofC-reactive protein in the group mildronat was 17.6% compared to 8,1% in thecontrol group (p ,0,05). Thus, we demonstrated that metabolic therapy by mildronathelps reduce the frequency of anginal episodes and paroxysmal cardiac arrhythmia,decrease dyspnea, and also prevents myocardial remodeling and reduces inflam-mation in myocardium, improving the quality of life in patients with chronic heartfailure due to alcoholic cardiomyopathy.

ISCHEMIA / REPERFUSION / PRECONDITIONING

P1275Myocardial structural changes in human severe sepsis/septic shock in pediatricpatients undergoing surgery for congenital heart repair

SG. Ramos; MS. Oliveira; WVA. Vicente; EZ. Martinez; EM. FlorianoUniversity of Sao Paulo, Ribeirao Preto, Brazil

Purpose: Perioperative myocardial damage still remains the most common cause ofmorbidity and death after technically successful surgical correction. However, the situ-ation is further complicated in patients with complex congenital cardiac malformationsrepair which developed septic shock/sepsis. The aim of the present study was toanalyze the correlation between cell damage and oxidative stress in congenital heartdisease (CHD) and septic patients’ submitted to cardiac surgery.Methods: The infants were divided into three groups: Group 1, 16 cases who under-went operations for CHD on cardiopulmonary bypass (CPB) with clinically diagnosedcardiogenic shock; Group 2, six cases who underwent operations for CHD on CPB inwhom septic shock /sepsis developed, and Group 3 (control group), five cases with noCHD or sepsis/septic shock who died from other causes. The myocardial injuries andoxidative stress mechanisms were assessed by histopathology and immunohisto-chemistry for hydroxinonenal (4-HNE) and nitrotyrosine (3-NT), and were quantifiedby morphometrical analyses.Results/ Conclusions: Contraction band necrosis and dystrophic calcification werefound primarily in infants of Group 1. Colliquative myocytolysis, coagulation necrosisand healing were prominent in Group 2. The control group showed no significant myo-cardial lesions. Lipid peroxidation demonstrated by 4-HNE was the principal mechan-ism of oxidative stress accounting for the myocardial lesions observed in group 1. Onthe other hand, an increased concentration of 3-NT proteins adducts were observed inhuman septic hearts, suggesting that protein nitration could be the most prevalentoxidative stress mechanism found in septic patients.

P1276Predictors of heart failure at 6 month follow up after Acute coronary syndrome

R. Faria; N. Marques; J. Mimoso; ILIDIO. JesusHospital Faro, Faro, Portugal

Purpose: The heart failure (HF) in a patient after an acute coronary syndrome (ACS) isa predictor of mortality. Identification of predictors of heart failure after an ACS could beimportant in management and prognostic definition of this set of patients. The aim ofthis study was evaluate predictors of Heart Failure 6 months after an ACS.Methods: We studied 2398 (pts) admitted into an intensive coronary care unit between01/01/2005 and 31/12/2009 with ACS. From the 2398 pts contacted by phone, wecould get a follow-up in 1830 pts (76,3%). The pts were allocated in 2 groups:Group A without heart failure (NYHA:I) 1313 pts and Group B with NYHA . 1 (517pts). The following parameters were compared: age, sex, cardiovascular risk factors,prior cardiovascular events and classification of SCA.Results: In the group A the mean age was 68,0+12,8 years, and 66% were male. Inthe group B the mean age was 65,1+12,8 years (p , 0,001) and 74,2% were male(p , 0,001). According to NYHA functional class, pts were distributed as follows: I-1313 (71,7%), II- 488 (26,7%), III- 27 (1,5%), IV- none. There wasn’t diference in thetype of ACS. The pts from the group B with more prevalence of hypertension (p ¼0,02) and lower ejection fraction of left ventricule (p , 0,001), and with less ofprimary PTCA (p , 0,001). The presence of rthis 3 factors were independent predictorsof heart failure at 6 months.Conclusion: HTA, lower ejection fraction of left ventricule, and primary PTCA (nega-tive) were independent predictors of heart failure 6 months after a ACS.

MOLECULAR BIOLOGY / GENETICS

P1277A potential role for DNA methylation in hypoxia induced cardiac fibrosis

CJ. Watson1; C. Robinson1; M. Xu1; P. Collier1; M. Ledwidge2; K. Mcdonald2; J. Baugh1

1University College Dublin, Dublin, Ireland; 2Heart Failure Unit, St Vincent’s UniversityHospital, Dublin, Ireland

Purpose: Prolonged ischemia caused by coronary artery disease and myocardialinfarction leads to aberrant ventricular remodelling and cardiac fibrosis. This isthought to occur through the accumulation of gene expression changes in interstitial

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fibroblasts, resulting in an overactive fibrotic phenotype. Long term adaption to thishypoxic insult is likely to require significant modification of chromatin structure inorder to maintain the fibrotic phenotype. We propose that epigenetic modificationsplay an important role in dictating cellular responses to chronic hypoxia and the pro-gression of cardiac fibrosis. Therefore, the aim of this study was to investigate thepro-fibrotic impact of hypoxia on cardiac fibroblasts, and in particular, whether altera-tions in DNA methylation could play a role in this process.Methods: Primary human cardiac fibroblasts were cultured at 21% or 1% oxygen for upto 8 days. The effects of TGFb treatment (10ng/ml) under these conditions were inves-tigated. Alpha smooth muscle actin (ASMA), as an indicator of myofibroblast differen-tiation, was quantified using real-time PCR and Western blotting. Changes in collagen 1gene expression were also measured. In addition, cells were assessed for globalchanges in DNA methylation using an antibody directed to 5-methylcytidine and quan-tified by flow cytometry. Changes in expression of the DNA methyltransferases(DNMT1, DNMT3a, and DNMT3b) were also investigated.Results: Prolonged hypoxia resulted in increased expression of both ASMA and col-lagen 1. The impact of TGFb stimulation was significantly enhanced under hypoxicconditions. These hypoxia-induced changes were associated with global DNA hyper-methylation in the cardiac fibroblast cells, accompanied by a significant increase inDNMT3B gene and protein expression.Conclusion: These data suggest that hypoxia-induced global changes in DNA methyl-ation may play an important role in cardiac fibrosis, which may be mediated throughchanges in DNMT3B expression. Whether or not these changes in DNA methylationare required for maintaining a viable hypoxic phenotype, or whether they are directlyinvolved in the enhanced fibrotic response requires further investigation.

P1278TIMP-4 single nucleotide polymorphism influences systolic dysfunction inpatients with heart failure

A. Alaves1; Y. Rivlin2; U. Rosenschein2; JA. Duarte1; M. Sagiv3; J. Oliveira1;E. Goldhammer21University of Porto, Faculty of Sport, Research Centre in Physical Activity, Health &Leisure, Porto, Portugal; 2Bnai Zion Medical Center, Haifa, Israel; 3Zinman College/Wingate Institute, Netanya, Israel

Background: Tissue inhibitors of matrix metalloproteinases (TIMP) play an importantrole in cardiac remodeling and the gene expression of several TIMPs decreases inheart failure.Purpose: To evaluate the influence of a single nucleotide polymorphism in the promo-ter of TIMP-4 (rs3755724) on the cardiac function and structure of patients with heartfailure.Methods: Forty patients with heart failure and mild systolic dysfunction (LVEF: 45% to55%) were recruited to this study. All patients were assessed for LVEF, mitral inflow vel-ocities (E/A ratio), deceleration time of early filling (DT), end-diastolic diameter (EDD)and end-systolic diameter (ESD). The TIMP-4 polymorphism genotypes were detectedby restriction length fragment polymorphisms analysis.Results: The TIMP-4 genotypes showed similar left ventricle function and cardiac diam-eters in patients with normal and moderate to severe systolic function. In contrast,patients with CC genotype showed lower LVEF (47.53+0.53%, p ¼ 0.032) andhigher ESD (3.25+0.03 cm, p ¼ 0.008) than CT genotypes (49.70+0.57% and3.09+0.04 cm). These differences were not observed in patients with TT genotype(49.50+1.17% and 3.20+0.07 cm).Conclusions: The present data suggest that TIMP-4 gene polymorphism influencescardiac contractility and remodeling in patients with mild systolic dysfunction.

MRI, NUCLEAR CARDIOLOGY AND CT (IMAGING)

P1279Detection of left ventricular thrombus in patients with decreased systolicfunction: Magnetic resonance imaging or echocardiography?

A. Musschoot1; F. Mouquet1; C. Goeminne1; G. Goyault2; M. Fertin1; N. Lamblin1;JP. Beregi2; P. De Groote1

1Hospital Regional University of Lille - Cardiological Hospital, Lille, France; 2HospitalRegional University of Lille – Cardiological Hospital, Department of Radiology, Lille,France

Purpose: Left ventricular (LV) thrombi are responsible for systemic embolizations. Theidentification of thrombus in patients with depressed systolic function remains challen-ging. We aimed to compare the ability of cardiac magnetic resonance imaging (MRI)and echocardiography to identify LV thrombus in patients with systolic dysfunction.Methods : Between 2003 and 2008, 363 patients with systolic dysfunction (LV ejectionfraction ,45%), with stable heart failure under optimal medical treatment underwentprognostic evaluation including physical examination, 12 leads ECG, blood sample,echocardiography, metabolic stress test and cardiac MRI.Results: Mean age was 55+13, with 297 (82%) men. The majority of patients were inNYHA class 2 (n ¼ 275, 76%). The etiology of cardiomyopathy was ischemic in 48%,and the mean LV ejection fraction was 36+12%. 31 patients (8.5%) had atrial fibrilla-tion, and 33 (9.1%) had a history of systemic embolizations. Three patients (0.8%) pre-sented LV thrombus on echocardiography whereas 8 (2.2%) were identified by MRI.The presence of thrombus was associated with the presence of myocardial lateenhancement of ischemic pattern. Only the ischemic etiology was associated with LV

thrombus (p ¼ 0.03). Patients with LV thrombus tended to have lower LVEF (30% vs36%, p ¼ 0.18) and larger LVEDV (232mL vs 184mL, p ¼ 0.86). After a mean followup of 1405+615 days, the presence of thrombus tended to increase cardiovascularmortality (p 0.07, see figure).Conclusions : Cardiac MRI is superior to echocardiography to detect the presence ofLV thrombus. As the presence of LV thrombus increases the risk of cardiovascular mor-tality, larger multicentric registries are mandatory to confirm the pivotal role of cardiacMRI to detect LV thrombus and prevent the risk of systemic embolization.

P1280Pericardial fat, a new marker of impaired left ventricle diastolic dysfunction

A. Faustino; R. Providencia; L. Paiva; P. Mota; M. Costa; A. Leitao-MarquesHospital Center of Coimbra, Coimbra, Portugal

Purpose: Compression of the heart by pericardial (PF) or intrathoracic (IF) fat depositsmay decrease left ventricle diastolic filling. This study aims to examine a possibleassociation between adiposity measures (PF, IF, body mass index -BMI) and left ventri-cle diastolic dysfunction (LVDD).Methods: Retrospective study of 78 consecutive patients (P) who underwent cardiacMDCT (Phillips Brilliance, 16-slices) and diastolic function assessment by echocardio-graphy: 33.3% men, 63+13 years, 23.1% diabetics, 83.3% hypertensive, 55.1% withdyslipidemia and 50.6% with LVDD. Thoracic fat tissue volumes (cm3) were measuredwith a workstation (Aquarius 3D, TeraRecon). PF was defined as adipose tissue locatedwithin the pericardial sac, and IF as the difference between adipose tissue within thechest and PF. The association between LVDD and PF, IF and BMI was assessed byROC curve. P were divided into 2 groups: Group PF+ (PF ≥ 44.1cm3, 61.5%) andGroup PF- (PF , 44.1cm3, 38.5%), which were then compared regarding demo-graphics, cardiovascular risk factors (CRF), analytical and echocardiographicparameters.Results: Adiposity measures were assessed by ROC curve and only PF showed a sig-nificant relation with LVDD (AUC: 0.66, CI95%: 0.54-0.78, p ¼ 0.016). The best PFthreshold for PF was chosen: 44.1cm3 (72% sensibility, 50% specificity). PF+ hadhigher pulse pressure (65+23 vs 56+17mmHg, p ¼ 0.05), higher BMI (31+5 vs28+4Kg/m2, p ¼ 0.02), lower HDL cholesterol levels (1.3+0.3 vs 1.5+0.4mmol/L,p ¼ 0.04) and higher left ventricle diastolic diameter (LVDd:5.4+0.7 vs 4.5+1.7cm,p ¼ 0.01). LVDD was present in 59.6% of PF+ (vs 36.7% in PF-, p ¼ 0.05). On multivari-able regression, none of these parameters was an independent predictor of LVDD. Nodifferences were found regarding demographics or other CRF, analytical or echocardio-graphic parameters.Conclusions: LVDD is correlated with PF, specially for values ≥44.1cm3. This associ-ation seems to be related to a higher BMI, higher pulse pressure and lower HDL levels,and possibly leads to a higher LVDd. These results suggest that the systemic effects ofobesity on cardiac structure and function may overstep the local pathogenic effects ofpericardial fat.

NATRIURETIC PEPTIDES

P1281Valve replacement and NT pro-BNP level: influence of atrial fibrillation presenceand class of heart failure

A. Zhadan1; V. Tseluyko1; O. Romanenko2

1Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine; 2CIty ClinicalHospital #8, Kharkiv, Ukraine

Kaplan Meier, Survival

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Objectives: To evaluate NT pro-BNP level at patients before and after valve replace-ment in dependence from atrial fibrillation (AF) presence and class of heart failure (HF).Methods and Results: 99 patients (mean (SD) age 54,6+11,6 years) with aortic andmitral valve disease (aortic stenosis (AS) – 32 patients, aortic regurgitation (AR) – 28patients, mitral stenosis (MS) – 22 patients, mitral regurgitation (MR) – 19 patients)underwent valve replacement. 10 patients had more than 1 valve lesion. Before, 1month and 6 months after valve replacement NT pro BNP level checked. 46 patientshad atrial fibrillation, 53 patients had not atrial fibrillation. Mean class of HF in groupwith AF was 2,4, without AF – 2,2. 59 patients had II class of HF NYHA and 40 hadIII class of HF before operative treatment.At baseline more significant increase of NT pro-BNP level observed at patients withatrial fibrillation and patients with III class of HF (table 1). 1 month after valve replace-ment it was insignificant decrease of NT pro-BNP level in both groups and insignificantincrease in group without AF and at patients with II class of HF. 6 months after operativetreatment most significant decrease of NT pro-BNP level observed at patients with IIIclass of HF at baseline: 853.1+145.2 pg/dl before and 472.4+100.4 pg/dl after oper-ation (p , 0.005). And it was not difference between groups with II and III class of HFlike it was at baseline. A change of NT pro-BNP level was not depended from type ofvalve lesion. 6 months after operative treatment 72 patients had II class of HF and 27patients had II class of HF.Conclusions: Most significant decrease of NT pro-BNP level 6 months after valvereplacement observed at patients with III class of HF by NYHA. It was not dependedfrom type of valve lesion. Progression of HF evaluated with NT pro-BNP level aftervalve replacement is the same at patients with II and III class of HF.

Table 1.

NT pro BNP, pg/dlBefore valvereplacement

1 month aftervalve replacement

6 months aftervalve replacement

Patients with AF (n ¼ 46) 640.2+120,2* 583.9+106,2 590.3+110,3Patients without AF (n ¼ 53) 421.4+98,6* 518.7+102.7 351.4+86.3Patients with II class of HF(n ¼ 59)

304.3+83.6** 503+101.2 456.2+97.9

Patients with III class of HF(n ¼ 40)

853.1+145.2** 613.6+119.7 472.4+100.4&

*, ** - p , 0.005 - p , 0.005 vs baseline

P1282An emerging risk factor for diabetic cardiomyopathy:Is B-type natriureticpeptide associated with persistent nondipping nocturnal blood pressure over 1year in patients with hypertension and diabetes?

KJ. Voon1; U. Bhutta1; D. Phelan1; CJ. Watson2; O. Elrasheed1; N. Murphy1; R. O’Hanlon1; MT. Ledwidge1; D. O’Shea3; KM. Mc Donald1

1St Vincent’s University Hospital, Heart Failure Unit, Dublin, Ireland; 2University CollegeDublin, Conway Institute, Dublin, Ireland; 3St Columcille’s Hospital, Dublin, Ireland

Purpose: Heart failure (HF) is commonly preceded by risk factors like hypertension(HTN), diabetes (DM) and left ventricular (LV) remodeling. Nocturnal non-dippingblood pressure ("Non-dipping") identified by 24-hour ambulatory monitoring (ABPM)has been shown to confer additional risk of progressive LV dysfunction and remodel-ing. The study aims to define the natural history of non-dipping in a cohort of patientswith HTN and DM over one year follow-up.Methods: This is a prospective analysis with a mean follow up of 1.2+0.3 years on 107patients (age 59.7+10.5 years, male 66%, diabetes 51%, estimated glomerularfiltration rate 114.1+38.5 ml/min/1.73m2, LVEF 67+8%) to determine the associationbetween non-dipping status, B-type natriuretic peptide (BNP) and echocardiographicparameters of LV dysfunction in patients with HTN and DM.Results: Persistent non-dipping patients (n ¼ 19) had significantly higher BNP com-pared to persistent dipping (n ¼ 56) at baseline (T0) (58+95.4 vs 17.1+22.2 pg/mL,p ¼ 0.003) and follow up (T1) (50.3+60.5 vs 25.3+41.2 pg/mL, p ¼ 0.047) respect-ively. This is despite improvement in daytime blood pressures and left ventricularmass indexes (LVMI) in all patients with conventional blood pressure management.Elevated BNP in persistent non-dipping patients was evident in patients with HTNand DM, but not with HTN alone and was associated with worsening left atrialvolume indexes (LAVi) from T0 to T1 (29.1+10, 31.6+11.1 mL/m2).Conclusion: Plasma BNP elevation is associated with persistent non-dipping statusover one year in patients with HTN and DM. It is linked to increased LAVi, a surrogatefor early diastolic dysfunction, and may reflect an active fibro-inflammatory pathologynot resolved by conventional blood pressure lowering strategies. More work isneeded to understand the causes of persistent non-dipping and elevated BNP in thispatient population.

P1283Prognostic factors of mid-term clinical outcome in congestive heart failurepatients

M. Feola1; E. Lombardo1; C. Taglieri1; S. Piccolo1; A. Vado2

1Cardiovascular Rehabilitation-Heart Failure Unit, Fossano, Italy; 2Cardiology Division,Cuneo, Italy

Stratification in congestive heart failure (CHF) patients is based on a variety of clinicaland laboratory variables. We analysed different parameters (renal function, plasmaBNP, water composition, echocardiographic and functional determinations) in predict-ing mid-term outcome in CHF patients discharged after decompensation.Methods: All subjects with NYHA class II-IV were enrolled at hospital discharge. NYHAclass, BNP, water body composition, non-invasive cardiac output and echocardiogramwere analysed. Death, cardiac transplantation and hospital readmission for CHF werescheduled.Results: Two-hundred and thirty-seven (64.5% males, age 71) patients were dis-charged after obtaining normal hydration; left ventricular ejection fraction (LVEF) was43.2+16.2%, cardiac output was 3.8+1.1 l/min and BNP at discharge resulted401.3+501.7 pg/ml. During the 14-month follow-up 15 (6.3%) patients died, one(0.4%) underwent cardiac transplantation and 18 (7.6%) were readmitted for CHF(event group); in 203 (85.6%) no events were observed (no-event group). HigherNYHA class (2.1+0.7 vs 1.9+0.4 p ¼ 0.01), BNP at discharge (750.2+527.3 pg/mlvs 340.7+474.3 pg/ml, p ¼ 0.002) and impaired LVEF (33.7+15.7% vs 44.5+15.8%p ¼ 0.0001) and creatinine (1.7+0.6 vs 1.2+0.8 mg/dl, p ¼ 0.004) were noticed inthe event group. At multivariate Cox analysis LVEF (p ¼ 0.0009), plasma creatinine(p ¼ 0.006) and BNP at discharge (p ¼ 0.001) were associated withadverse outcome. Kaplan-Meier survival curves demonstrated that adding cut-offpoints for creatinine 1.5 mg/dl and discharged BNP of 250 pg/ml discriminated signifi-cantly prognosis (p ¼ 0.0001; log rank 21.09).Conclusions: In predicting mid-term clinical prognosis in CHF patients, BNP atdischarge ≥ 250 pg/ml added with a plasma creatinine .1.5 mg/dl are strongadverse predictors.

P1284Single centre observational study examines the diagnostic value of natriureticpeptides in the assessment of de-compensating heart failure in patients withpreserved left ventricular function

CC. Lewis; K. Morgan; J. O’farrell; B. McadamBeaumount Hospital Supportive Heart Unit, Dublin, Ireland

Purpose: The use of natriuetic peptides to assess for de-compensating heart failure inpatients with left ventricualr systolic dysfunciton is well recognised. However, due to re-modelling differences the use of natriuretic peptides to assess for de-compensatingheart failure in patients with preserved left ventricular function is less definitive. Weexamined natriuretic peptides in patients with preserved left ventricular function withan episode of de-compensating heart failure.Methods: A retrospective study examined the natriuretic peptides (BNP) of 20 patients(mean age 78.3 years, mean eGFR 47.15 ml/min, mean creatinine 115.5 umol/L) withan EF ≥ 45% and an episode of de-compensating heart failure. Results were examinedpre and post treatment. All patients were treated with either an increase in oral diureticsor one dose of intravenous therapy followed by an increase in oral diuretics.Results: Pre-treatment BNP levels were examined in relation to symptoms classifiedas NYHA and clinical signs of de-compensation. For the purposes of analysis BNPwas divided into categories of ≤100 pg/ml, 100–199 pg/ml and 200-300 pg/ml with300 being the highest level of BNP identified. Results showed no signficant increasein pre-treatment BNP levels {H(2) ¼ 0.592, p , 0.05} in comparison to severity ofsymptoms with the majority of patients presenting in NYHA III. This indicates thatpre-treatment BNP levels did not reflect severity of symptoms among patients. Exam-ination of post treatment BNP levels revealed no significant changes in comparison tosymptomatic improvements{H(2) ¼ 0.082, p , 0.05). All patients with significant clini-cal signs had no significant increase in pre-treatment BNP levels{H(2) ¼ 0.812, p ,

0.05}. Participants lost between 0-3kg post treatment with an average loss of1.37kg. Post treatment BNP levels were compared with weight reduction and didnot change significantly or improve even in the presence of weight loss{H(2) ¼0.389, p , 0.05}.

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Conclusion: This single centre observational study demonstrates that the use ofnatriuretic peptides in the assessment of de-compensating heart failure in this cohortof patients did not reflect severity of symptoms and clinical signs. The BNP levelseither did not change or improve post treatment even in the presence of symptomaticimprovements and weight reduction.

NURSING

P1285Optimisation of medical therapy after cardiac resynchronisation: a nursingopportunity not to be missed

S. Russell1; J. Bell2; J. Davies3; H. Rose3; L. Edmunds3; ZR. Yousef31Cardiff University School of Medicine, Wales Heart Research Institute, Cardiff, UnitedKingdom; 2Cardiff University School of Medicine, Cardiff, United Kingdom; 3Cardiff andVale LHB, Cardiff, United Kingdom

Introduction: Optimisation of medical therapy for heart failure (HF) is often restricteddue to hypotension or bradycardia. After cardiac resynchronisation therapy (CRT),blood pressure and cardiac output improve, thus allowing further up-titration ofmedical therapy. We conducted the present study to evaluate the potential to furtheroptimise HF medications after CRT.Methods: We conducted a retrospective analysis of our CRT database. All patientsreferred to our service underwent nurse-lead force up-titration of HF medicationsaccording to national guidelines (e.g. National Institute of Clinical Excellence; NICE)before and after CRT implantation. We recorded the rates of successful initiation andmaximum achieved doses of beta blockers (bb), ACE inhibitors/angiotensin receptorblockers (ACE-I/ARB) and aldosterone antagonists before and 6 months after CRT.Daily dose equivalences (mg/day) of an exemplar in each drug class were used forcomparison: e.g. bisoprolol for bb (10mg ¼ 50mg carvedilo), lisinopril for ACE-I/ARB, spironolactone for aldosterone antagonists and furosemide for loop diuretics.Results: Between Oct ’09 and Jun ’10, 74 patients (67+11 yrs; 86% male) received aCRT device (table). CRT facilitated the initiation bb in 10% of previuosly naive patients.In addition, we significantly up-titrated the daily doses of bb and ACE-I/ARB, and down-titrated the daily dose of loop diuretics following CRT.Conclusion: The haemodynamic benefits of CRT provides an opportunity to signifi-cantly optimise heart failure therapies proven to improve symptoms, quality of life,and survival. The post-implant period therefore offers an important window of opportu-nity not to be missed.

P1286Implementation and testing of the digital pen to support patients with heartfailure and their health care providers in detecting early signs of deteriorationand monitor adherence – a pilot study

L. Lind1; L. Klompstra2; T. Jaarsma2; A. Stromberg3

1Department of Biomedical Engineering, Linkoping University, Linkoping, Sweden;2Department of Social- and Welfare Studies, Linkoping, Sweden; 3Linkoping University,Department of Medical and Health Sciences, Linkoping, Sweden

Remote monitoring equipment must be possible to use effortlessly for patients. Thedigital pen and paper technology is a new application of an "old" technology nowused to support the patient and health-care provider to detect early signs of deterio-ration of heart failure and monitor drug intake. The digital pen has been proven user-friendly for remote monitoring of pain in cancer patients receiving palliative care.Aim: To implement and evaluate the digital pen on five levels:1. Effectiveness regarding physical outcomes (palliation of symptoms)2. Patient and family satisfaction (quality of care, participation, perceived control, tech-nology acceptance and usability)3. Patient self-care management and knowledge on heart failure self care4. Feasibility, safety and organisational implementation of the intervention5. Health-economical efficiency.Methods: Developmental and implementation phase: Researchers within medicaltechnology and heart failure care will together with physicians and nurses fromadvanced hospital-based home care and primary care, a small group of users(patients) and companies develop a heart failure management tool based on digitalpen and paper and implement it in clinical practice.

Evaluation phase: This self-care management tool will be tested in ten heart failurepatients admitted to advanced hospital-based home care. The technical equipmentand clinical follow up routines will be evaluated (reliability, stability, acceptance, userfriendliness, and patient- and staff satisfaction). The patients will monitor and registershortness of breath, intake of medications, weight, blood pressure, pulse and satur-ation daily. They will also be able to write messages, e.g. about other symptoms.Data will be collected through patient and staff interviews and observations as well asthrough questionnaires evaluating health-related quality of life, heart failure self-careand knowledge, quality of care, participation and perceived control. Health care andorganisational costs will be estimated from patient and staff records.Results: So far three patients with heart failure from a hospital-based unit for advancedhome care have been included in this pilot study. We plan to continue to recruit patientsduring spring and preliminary results will be presented during the conference.Innovative aspects and significance of the study:There is a great need for less labor-intensive and more cost-effective innovations thatimprove care and facilitate follow up of patients with moderate to severe heart failureand at high risk for deterioration needing hospitalisation.

P1287Educational level and self-care behaviour in heart failure patients

B. Gonzalez; J. Lupon; L. Cano; R. Cabanes; M. De Antonio; M. Arenas; E. Crespo;M. Rodriguez; A. Urrutia; A. Bayes-GenisGermans Trias I Pujol University Hospital, Badalona, Spain

Background: Self-care is important for heart failure (HF) management and might beinfluenced by patient’s educational level.Aims: To assess the relationship of patients’ educational level with their baseline self-care behaviour and its changes after one year of nurse intervention, using the 9-itemversion of the European Heart Failure Self-care Behaviour Scale (EHFScBS_9), in acohort of HF outpatients attended in a multidisciplinary HF Unit.Patients: 335 HF patients were studied (245 men and 90 women). Median age was 69years [IQR 57-75]. Median duration of HF was 6 months [IQR 1-36]. Aetiology of HFwas mainly ischemic heart disease (53.4%). Median LVEF was 30% (IQR 24-37%).Most of patients were in NYHA in class II (66.3%) and III (25.7%). Educational levelwas: very low 17.3%; low 62.1%; medium or high: 20.6%.Results: median scores obtained by our patients differed both in the initial (19 [IQR 15-26] vs 16 [IQR 13-21] vs 15 [IQR 12.5-15.5] and in the one-year evaluation (15 [IQR 13-17] vs 13 [IQR 11-15] vs 12 [IQR 10-14] for educational levels very low, low andmedium-high respectively (figure). Differences were highly statistically significantbetween educational levels (p ¼ 0.007 to p , 0.001) except between low andmedium-high education at one-year (p ¼ 0.057). In the one-year evaluation patientsshowed a significant improvement in self-care behaviour in all three educationalgroups (p , 0.001). The magnitude of improvement was similar in the 3 groups,without statistical significant differences.Conclusions: self-care behaviour at baseline and after one year of nurse interventionwas better in patients with higher educational level. However, the improvementobtained with the nurse intervention was similar irrespective the educational level.

OTHER

P1288Osteoporosis in chronic heart failure is associated with severity of clinicalsymptomatic, impaired renal function, secondary hyperparathyroidism andvitamin D deficiency

E. Reznik; G. Gendlin; V. Guschina; I. Ganieva; G. StorozhakovRussian State Medical University, Moscow, Russian Federation

Purpose: Recent studies revealed an association between chronic heart failure (CHF)and low bone mineral density (BMD). Our aim was to estimate presence of

Medical therapy before and after CRT.

Pre-CRT Post-CRT P value

b blocker: exemplar bisoprolol Freq% 78 88Dose 5.3+3.1 6.9+3.2 p , 0.01

ACE-I/ARB: exemplar lisinopril Freq% 93 93Dose 11.8+4.5 12.4+3.8 p ¼ 0.02

Aldosterone antagonist: exemplarspironolactone

Freq% 32 28Dose 16.6+6.2 15.5+7.3 p ¼ 0.32

Loop diuretic: exemplar furosemide Freq% 100 100Dose 63.0+5.8 48.1+8.4 p , 0.01

Freq%= frequency (%): Dose= Daily dose equivalent (mg/day)

EHFScBS_9 scores and educational level

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osteoporosis and its relationship with clinical symptomatic, renal and cardiac function,calcium, phosphorus, vitamin D and parathyroid hormone (PTH) status in CHF.Methods: 36 CHF patients I-IV NYHA class without primarily renal, endocrine, auto-immune, oncological and bone diseases were included [median (interquartile range)of age – 64.0(53.0;69.0) years; left ventricular ejection fraction (LVEF, Simpson) –34.6(27.6;38.5)%, 86.1% males]. We estimated serum intact PTH, 25-OH-vitamin D, cal-citonin, phosphorus and calcium corrected for albumin, urinary albumin excretion(UAE, immunoenzymatic assay), glomerular filtration rate (GFR, MDRD), results ofthe Kansas City Cardiomyopathy Questionnaire (KCCQ). BMD measurements usingdual-energy X-ray absorptiometry (DXA) were performed at the femur (Neck, Total)and lumbar spine (L1-L4). All patients were stable on optimal medical therapy inaccordance with contemporary guidelines.Results: BMD was 0.84(0.77;0.93), 1.07(0.93;1.21), 0.99(0.91;1,12), 1.13(1.03;1.26) g/cm2 and T-score was 21.22(22.15;20.55), 0.005(21.1;0.56), 20.44(21.35;0.54),20.47(21,2;0.55) SD in Neck, Total, L1, L4 respectively, GFR – 61.8(55.4;77.8) ml/min/1.73m2, UAE – 15.4(7.8229)mg/24h. Osteopenia (T-score -122.4 SD) was in44.4(95%CI 25.4-63.4)%, osteoporosis (T-score,-2.5 SD) – in 27.8(95%CI 10.4-45.2)%, secondary hyperparathyroidism – in 66.7(95%CI 48.5-84.9)%, vitamin Ddeficiency – in 38.1(95%CI 19.5-56.7)% of patients. BMD correlated with KCCQ phys-ical performance (for ability of climbing a flight of stairs without stopping r ¼ 0.73, p ¼0.027 for Neck; r ¼ 0.68, p ¼ 0.046 for Total), serum creatinine (r ¼ 20.50, p ¼ 0.048for Neck), GFR (r ¼ 0.57, p ¼ 0.039 for Neck; r ¼ 0.7, p ¼ 0.005 for L1), presence ofmicroalbuminuria (r ¼ 20.66, p ¼ 0.036 for Neck; r ¼ 20.69, p ¼ 0.026 for Total).T-score correlated with all of these parameters and serum PTH (r ¼ 20.47, p ¼ 0.033for Neck; r ¼ 20.47, p ¼ 0.033 for Total; r ¼ 20.51, p ¼ 0.019 for L1; r ¼ 20.53, p ¼0.014 for L4) and 25-OH-vitamin D (r ¼ 0.63, p ¼ 0.029 for L4). T-score and BMDwere not associated with age, smoking, alcohol use, medications, serum calcium,phosphorus, calcitonin, NYHA class and LVEF.Conclusions: Osteoporosis and osteopenia are common in CHF patients and relatedwith severity of clinical symptomatic, renal dysfunction, secondary hyperparathyroid-ism and vitamin D deficiency. Nephroprotection and vitamin D therapy may improvephysical activity and quality of life in these patients.

P1289Mortality and admission rates among heart failure (HF) patients with preservedejection fraction (HF-PEF) and reduced ejection fraction (HF-REF) in Sweden

G. Wikstrom1; J. Stalhammar2; R. Ariely3; R. Linder4; A. Ogbonnaya5; L. Stern5

1Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden;2Uppsala University, Department of Public Health and Caring Sciences, Uppsala,Sweden; 3Novartis Pharmaceuticals Corporation, East Hanover, United States ofAmerica; 4Pygargus AB, Stockholm, Sweden; 5Analytica International, New York, UnitedStates of America

Purpose: Heart failure is a disease associated with an adverse prognosis. The studyobjective was to evaluate all-cause and heart failure (HF) mortality and admissionrates among primary care real life HF-PEF and HF-REF patients (pts) in Sweden.Methods: This retrospective study identified pts with an ICD-9 or ICD-10 diagnosiscode for HF from 01/07/2005 to 31/12/2006 from electronic medical records ofprimary care centers in Uppsala County Council. Pts were categorized as having HF-PEF (LVEF . 45%) or HF-REF (LVEF ≤ 45%) at index date. Both the rates and timeto all-cause and HF mortality were evaluated following the index date.Results: The study cohort included 451 HF pts: 199 (44%) HF-PEF and 252 (56%) HF-REF. HF-PEF pts were older and had a higher proportion of females. Mean diastolicblood pressure (BP) was similar in both groups, while mean systolic BP was higherin the HF-PEF group. Average follow-up time was similar in the two groups (18months). The most common comorbidities were hypertension, atrial fibrillation, dia-betes, myocardial infarction, and cardiovascular (CV) diseases. Nearly all pts receivedtreatment with diuretics, ACE inhibitors, beta blockers, vasodilators, and/or statins. Atleast one CV or HF related hospitalization occurred in 62% vs. 66% and 47% vs.57% of HF-PEF and HF-REF pts, respectively. All-cause and HF mortality rates at theend of the follow-up period were 25% vs. 23% and 2% vs. 2% in the HF-PEF andHF-REF groups, respectively. Majority of all-cause (16% vs. 17%) and HF (1% vs.2%) mortality in the HF-PEF and HF-REF groups occurred within one year after theindex date. There was no significant difference in the time to all-cause and HF mortalitybetween the two HF groups.Conclusions: Mortality rate was high among these HF pts. These pts also have signifi-cant concomitant conditions in addition to their disease. Pts with many comorbiditiesconsume a considerable amount of healthcare resources.

P1290Preliminary results of the heart function assessment registry trial in SaudiArabia in patients followed at the heart failure clinic (HEARTS-HFC)

A. Elasfar1; K. Alhabib2; H. Albackr2; F. Alshaer2; H. Alfaleh2; A. Hersi2; T. Kashour1;A. Qasim1; M. Youssef11Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2KingFahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh,Saudi Arabia

Purpose: The heart function assessment registry trial in Saudi Arabia (HEARTS) is thefirst national project to study the clinical features, management, and outcomes ofpatients with heart failure. We describe here the preliminary results of patients followedup at the heart failure clinic (HFC).

Methods: We conducted a prospective registry in two tertiary care hospitals with estab-lished multidisciplinary HFC in Saudi Arabia between October 2009 and December2010. Only patients with heart failure who were at high risk for re-admission wereenrolled in the clinic.Results: 368 patients were enrolled with mean age of 56.9+15.5 years, 71.7% menand 95.3% Saudis. Risk factors included diabetes mellitus (53%), hypertension(74%), and smoking (43%). Reasons for referral to the HFC included severe LV dys-function (68%), two or more HF admissions over last one year (13%), and poor com-pliance with medical treatment (12%). The main etiologies of HF were ischemic heartdisease (40.1%), non-ischemic dilated cardiomyopathy (45.1%), and hypertension(10.7%). Symptoms included NYHA class III/IV (63.4%), orthopnea/PND (27.7%), andfatigue (53.3%). Left bundle branch block on ECG was 11.3%, median NT-proBNPwas 2511 pg/ml (interquartile range 2410pg/ml), and severe LV dysfunction was75.3%. Therapies included diuretics (89.2%), beta-blockers (96.4%), ACE-I/ARB(86.7%), aldosterone inhibitor (54.7%), hydralazine (11.8%), long acting nitrates(13.7%), warfarin (18.4%), ICD (29%), and CRT (8%).Conclusions: Out-patients with high-risk heart failure in Saudi Arabia are younger,have much higher prevalence of diabetes mellitus and hypertension, and predomi-nantly have LV systolic dysfunction compared with developed countries. The rate of evi-dence-based therapies use was reasonable, but the ICD/CRT implantation rate waslow. Further improvements in management; and potentially clinical outcomes, are yetto be shown with long-term follow-up at the HFC.

P1291Erectile dysfunction and chronic heart failure: correlation between ed and theseverity of symptoms at the 6 minutes walk test

N. Zoubeir; H. Najih; FZ. Wadrahmane; S. Abderrazak; A. BennisIbn Rochd University Hospital, Casablanca, Morocco

Objectives: To analyze the relation between the erectile dysfunction (ED) and the 6minutes walk test (6MWT) in patients with chronic heart failure (CHF).Methodes and Results: The study population consisted of 75 men,aged 35 to 74years(mean age 61 years),with CHF and left ventricular dysfunction.Erectile dysfunction was evaluated with the international index for erectile functionquestionnaire-5(IIEF5), ED (IIEF-5, 21-5) was present in 42,6% (n ¼ 32), and no ED(IIEF-5,22-25) in 57,3%(n ¼ 43),erectile dysfunction was found in 35% of patients with6MWT ,200m,compared with 12% of patients with 6MWT .300m (the differencewas statistically significant).Patient with 6MWT , 200m had more severe erectile dysfunction than patients with6MWT . 300m,6MWT , 200m is correlated with erectile dysfunction.Conclusion: The prevalence of erectile dysfunction is higher in patient with 6MWT ,

200m compared with patient with 6MWT .300m of similar demographiccharacteristics.Erectile dysfunction affects patient quality of life, underlining the need for vigorousresearch of this condition and appropriate management.

P1292Markers of oxidative stress in STEMI patients with acute heart failure

M. Tomandlova1; J. Tomandl1; J. Parenica2; P. Kala2; M. Poloczek2; E. Taborska1;J. Spinar21Masaryk University, Faculty of Medicine, Department of Biochemistry, Brno, CzechRepublic; 2Masaryk University, Faculty Hospital Brno, Department of Internal CardiologyMedicine, Brno, Czech Republic

In patients with myocardial infarction or heart failure oxidative stress may contribute tomyocyte apoptosis, decrease nitric oxide bioavailability or have direct negative inotro-pic effect.Purpose: The aim of the study was to determine levels of parameters of oxidativestress (malondialdehyde – MDA, TNFa) and antioxidants (vitamins A and E, uricacid) and their relation to the extent of myocardial infarction and heart failure in patientswith STEMI.Methods: Cohort of 179 subjects (mean age 60, range 38–80 years) consecutivelyadmitted to the CCU (from 10/2005 to 10/2008) with first STEMI, treated by PCI.Excluded were non-collaborating patients, elderly over 80 years or patients withserious diseases predicting poor life prognosis. Blood samples were taken 24 hoursafter the onset of chest pain and EDTA-plasma aliquots were frozen at 275 8C. Echo-cardiography was done 3–5 days after MI, left ventricular systolic dysfunction wasassessed according to ejection fraction (EF) and end-diastolic volume corrected forBSA (EDV/BSA).Results: Levels of lipophilic vitamins A and E were almost within reference ranges.Levels of MDA and TNFa were elevated in 18% and 46% of patients, respectively.MDA correlated positively both with TNFa (r ¼ 0.43, p , 0.02) and with vitamin A (r¼ 0.49, p , 0.001). Besides, TNFa correlated positively with uric acid (r ¼ 0.47, p ,

0.005) and negatively with vitamin E (r = 20.45, p , 0.01). Significant positive corre-lations were found between evaluated vitamins (r ¼ 0.57, p , 0.001) and betweenvitamin A and uric acid (r ¼ 0.53, p , 0.001). Vitamin E significantly correlated withLVEDP (r ¼ 0.40, p , 0.05). Surprisingly, no effects of smoking or diabetes mellituswere observed on the evaluated parameters of oxidative stress.Patients in the highest tertile of TNFa level had significantly higher EDV/BSA than thosein the lowest tertile (p , 0.02). We did not find any relation between NT-proBNP andlevels of TNFa, MDA, vitamins A and E.

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Conclusions: Both lipid peroxidation (MDA) and activated macrophages (TNFa) areinvolved in acute STEMI patients. Levels of vitamin A and E correspond with theextent of lipid peroxidation and negatively with macrophage activation, respectively,but endogenous antioxidant uric acid does not.

P1293Survival and prognosis of patients with chronic heart failure and left venticulardysfunction

B. Kanazirev1; K. Domuschiev2; N. Konjarova2; L. Shipchanova3

1Varna University Hospital, Varna, Bulgaria; 2District Medical Center, Burgas, Bulgaria;3District Hospital, Pleven, Bulgaria

Purpose: To evaluate the prognostic significance of echocardiographic wall motionindex score as a measure of segmental dysfunction, ECG duration of QRS complexas a measure of electrical disturbance and sinus rhytm vs atrial fibrillation in anattempt to create a risk stratification model for the 2-year survival of patients withchronic heart failure and left ventricular systolic dysfunction.Methods: 133 patients (mean age 60+11) with chronic HF on standard treatmentNYHA classes II/III and left ventricular systolic dysfunction with reversed wall motionscore index (WMI) of 0.87+0.15 (0.3- 1.65) with initial demographic, biochemicaland instrument data (ECG, echocardiography, stress test) were followed prospectivelyfor a period of 2 years.Results and conclusion: In multiple regression analysis we couldn’t find any statisticalsignificance for survival of wall motion score index, QRS period and presence or absenceof atrial fibrillation for this group of patients to create a risk model for survivalWedid find however statistical significance for survival in thisgroup ofpatients betweensub-groups with respect to WMI with a cutoff point of 1.2 with log rank test significance of 0.44

Multiple regression analysis of survival

B SE Wald df Sig. Exp(B)95,0% CI forExp(B)

Lower Upper Lower Upper Lower Upper Lower Upper

WMI -,333 ,330 1,017 1 ,313 ,717 ,375 1,369QRS ,000 ,003 ,010 1 ,921 1,000 ,994 1,005Rhythm -,188 ,183 1,046 1 ,306 ,829 ,579 1,188

WMI-Wall Motion Index, QRS complex, Rhythm -sinus vs non-sinus

PATHOPHYSIOLOGY

P1294Vitamin D deficiency In heart failure with normal ejection fraction

AJ. Lagoeiro Jorge1; Ribeiro1; L C M. Fernandes1; Lanzieir1; B A L. Jorge1; Licio2;Mesquita1

1Universidade Federal Fluminense, Niteroi, Brazil; 2Universidade Federal do Rio dejaneiro, Rio De Janeiro, Brazil

Background: Low levels of vitamin D have high prevalence and is a factor of poorprognosis in heart failure (HF) with reduced ejection fraction. HF with normal ejectionfraction(HFNEF) is now the most common form of HF particularly affecting theelderly with comorbidities and the relationship between low vitamin D and HFNEF isnot established. Aim of the study was assess the prevalence of vitamin D deficiencyin outpatients with HFNEF and its correlation with diastolic dysfunction(DD).Methods: A prospective study with 79 outpatients (age 70.7+11.4years, female72%)(BR latitude -228 South) with EF . 50%. 30 pts were classified as HFNEF and49 in the control group. All pts submitted measurement of 25(OH)D, ECG, B-type

natriuretic peptide(BNP) and tissue Doppler imaging. HFNEF diagnosis was estab-lished by the criteria of the European Society of Cardiology. Results: Pts with HFNEFhad higher values of BNP and indices of DD (table). 25 (OH)D was lower in thegroup HFNEF, with statistical significance (34.3+13.0 vs 45.6+18.3 mcg / L, p ¼0.004) and 47% of patients with HFNEF had vitamin D deficiency (25(OH)D ,30mcg /L) against 24% in the group control. Moderate correlation was observedbetween vitamin D and E/E‘ (r -0.278 p ¼ 0.013), but not between age, BNP,LVEF,LAV-I and E‘ (r ¼ 20.133 p ¼ 0.244; r ¼ 20.154 p ¼ 0.176; r ¼ 0.051 p ¼ 0.656;r ¼ 20.114 p ¼ 0.319; r ¼ 0.134 p ¼ 0.238).Conclusions: Patients with HFNEF had, on average, lower levels of serum 25 (OH) Dthan the control group. Correlation was observed between 25 (OH)D and E/E‘ a non-invasive marker of LV filling pressure.

Subject characteristics

HFNEF Control p

age(years) 76.2+10.9 67.4+10.4 0.001LVEF(%) 70.1+8.8 73.8+8.1 0.051E/E’ 14.9+6.7 7.6+2.1 ,0.0001LAV-I ml/m2 42.8+12.2 29.1+7.1 ,0.0001E’ cm/s 7.4+2.6 9.6+2.5 ,0.0001BNP pg/ml 131.6+93.3 29.7+41.4 ,0.000125(OH)D mcg/L 34.3+13.0 45.6+18.3 0.004

P1295Age features of cellular membranes in patients with chronic heart failure incarvedilol therapy

T. Rebrova; S. Afanasiev; O. Putrova; V. Perchatkin; A. RepinInstitute of Cardiology, Tomsk, Russian Federation

Objective: To study the effects of therapy nonselective b-adrenergic blocker carvedilolin the state of lipid peroxidation, the activity of Na +, K+ATPase, and microviscosity ofcell membranes in patients with CHF of different ages.Methods: The study included 40 patients with CHF II-III NYHA Class. Were formed twoage groups: group 1 - patients with heart failure at the age of 35 to 50 years; group 2 -patients with chronic heart failure at the age of 60 to 75 years. Patients in both agegroups treated with carvedilol in daily doses of 6,25-25 mg. The studied groups didnot differ in clinical and demographic characteristics. We assessed lipid peroxidationin blood serum, the activity of Na+, K+ATPase in erythrocyte membranes.Investigation of the structural properties of the lipid phase of membranes was per-formed on the membranes of red blood cells by measuring the intrinsic fluorescenceand determine the spectral characteristics of the interaction of membranes with fluor-escent probe pyrene.Results: It was shown that differences in the content of lipid peroxidation products inblood serum of patients were not statistically significant in the both groups. After 3months of carvedilol therapy in patients of both groups revealed a significant decreasein content of lipid peroxidation products with respect to values obtained beforetreatment.Older patients were marked by the lower activity of Na +, K+ATPase in erythrocytemembranes with respect to the 1-st group. After carvedilol therapy there was a signifi-cant increase in activity of transmembrane enzyme in both groups, but it was less pro-nounced in patients 2-nd group.Investigation of the microviscosity of erythrocyte membranes revealed age-dependentincrease in this index. Carvedilol therapy has reduced the microviscosity of the mem-branes in both groups of patients, which was most marked in group 1 patientsConclusion: In older patients with CHF, an increase of microviscosity of erythrocytemembranes and decreased activity of Na +, K+ATPase are revealed. The effect of car-vedilol therapy on the intensity of lipid peroxidation and microviscosity of the mem-branes depended on the age of the patients.

POPULATION STUDIES / EPIDEMIOLOGY

P1296Prevalence of diastolic left ventricular dysfunction in European populationsbased on cross-validated diagnostic thresholds

T. Kuznetsova1; M. Kloch-Badelek2; W. Sakiewicz3; V. Tikhonoff4; A. Ryabikov5;S. Malyutina5; K. Stolarz-Skrzypek2; K. Narkiewicz3; K. Kawecka-Jaszcz2; J. Staessen1

1University of Leuven, Leuven, Belgium; 2Jagiellonian University, Cracow, Poland;3Medical University of Gdansk, Gdansk, Poland; 4University of Padova, Padova, Italy;5Institute of Internal Medicine, Siberian Branch of the Russian Academy of MedicalSciences, Novosibirsk, Russian Federation

Aims: Different diagnostic criteria limit comparisons between populations in the preva-lence of diastolic LV dysfunction. We aimed to compare across populations age-specific echocardiographic criteria for diastolic left ventricular (LV) dysfunction aswell as its correlates and prevalence.Methods and results: We measured the E and A peaks of transmitral blood flow bypulsed wave Doppler and the Ea and Aa peaks of mitral annular velocities by tissue

Survival according WMI with cutoff 1.2

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Doppler imaging (TDI) in 2 cohorts randomly recruited in Belgium (n ¼ 782; 51.4%women; mean age, 51.1 years) and in Italy, Poland and Russia (n ¼ 476; 44.5%;44.5 years). In stepwise linear regression, the multivariable-adjusted correlates of thetransmitral and TDI diastolic indexes were almost identical in the 2 cohorts andincluded sex, age, body mass index, blood pressure and heart rate. Similarly, cut-offlimits for the E/A ratio (2.5th percentile) and E/Ea ratio (97.5th percentile) in 338 and185 healthy subjects selected respectively from both cohorts were consistent within0.02 and 0.26 units (median across 5 age groups). The 2.5th percentile of the E/Aratio decreased by ~0.10 per age decade in healthy subjects. The healthy subsampleprovided age-specific cut-off limits for normal E/A and E/Ea ratios. In the 2 cohortscombined, diastolic dysfunction groups 1 (impaired relaxation), 2 (possible elevatedLV end-diastolic filling pressure) and 3 (elevated E/Ea and abnormally low E/A)included 114 (9.1%), 135 (10.7%), and 40 (3.2%) subjects, respectively. We used leftatrium volume index (.28 mL/m2) and/or differences in duration between the mitralA and reverse pulmonary vein flow during atrial systole (Ad , ARd+10) to confirmpossible elevation of LV filling pressure in group 2.Conclusion: The age-specific criteria for diastolic LV dysfunction were highly consist-ent across populations with an age-standardized prevalence of 22.4% vs. 25.1% (P ¼0.09). This consistency suggests that currently proposed thresholds, while awaitingvalidation in prospective studies, might be used in clinical practice.

P1297Ethnic differences in patient characteristics at time of first referral tospecialized heart failure clinics

JMO. Arnold1; J. Howlett2; P. Liu3; H. Haddad4; M-H. Leblanc5; A. Ignaszewski6;S. Zieroth7; S. Baker8; D. Murthy9; G. Marchiori11University Hospital, London, Canada; 2Foothills Medical Centre, Calgary, Canada;3University Health Network, Toronto, Canada; 4Ottawa Heart Institute, Ottawa, Canada;5Institut de Cardiologie de Quebec, Quebec City, Canada; 6St.Paul’s Hospital,Vancouver, Canada; 7St Boniface General Hospital, Winnipeg, Canada; 8COACH,Penticton, Canada; 9Pasqua Hospital, Regina, Canada

Background: Heart failure (HF) affects all ethnic groups but ethnic identities maypresent with different characteristics. The Canadian HF Network (CHFN) links special-ized outpatient HF clinics across Canada through a common longitudinal database.Patients with HF are referred based on local referral practices.Methods: Between 1999 and 2009, 14315 HF patients with a specific ethnic back-ground were identified in the CHFN database. Baseline physical and biochemical vari-ables were extracted from the first CHFN clinic data entry and compared among majorethnic groups.Results: There were no significant differences in% females among the five ethnicgroups. Aboriginal were referred at the youngest age vs Caucasian the oldest age(p , 0.001) and had the highest weight vs East Asian the lowest (p , 0.001). AfricanBlacks had the lowest LVEF vs Asian (p , 0.05), the lowest serum creatinine vs Abori-ginal (p , 0.01), and the lowest serum K+ vs South Asian (p , 0.01). South Asian hadthe lowest systemic systolic pressure and lowest diastolic pressure vs African Blackswith the highest (both p , 0.001).Conclusions: Significant differences exist in baseline characteristics among HFpatients from different ethnic groups within the same country. These differences mayresult in varied pharmacologic responses and complications to similar doses of evi-dence-based recommended treatments. This represents an important gap in currentguideline recommendations for community physicians.

P1298Epidemiology of heart failure in the Hungarian patient population usingadministrative health data

P. Soos1; E. Belicza2; D. Becker1; A. Apor1; L. Geller1; B. Merkely1

1Semmelweis University Heart Center, Budapest, Hungary; 2Semmelweis UniversityHealth Services Management Training Center, Budapest, Hungary

Purpose: progressive heart failure (HF) is a significant public health problem of indus-trialized countries. Incidence of HF in the European population is about 0.4-2% and hasa strong correlation to age: above 85 years it’s incidence may be more than 10% andlifetime-prevalence may be up to 20%. There are no data available about the incidenceand mortality of HF in Hungary. A nationwide analysis was made based on the Inter-national Statistical Classification of Diseases and Related Health Problems (ICD)codes to summarize incidence and mortality data of HF.

Methods: based on the official administrative data of all the Hungarian hospitals a ret-rospective study was performed to analyze HF incidence. Mortality data were collectedfrom national registers. Patient data were available at the National Health InsuranceFund register between 2000-2007. A clinically relevant heart failure was representedby the following ICD codes: hypertensive heart disease with heart failure (I11.),dilated cardiomyopathy (I42.0), heart failure (I50.), cardiogenic shock (R57.0).Results: the number of lately diagnosed HF cases represented by the above-men-tioned ICD codes as main diagnosis tended to 0.3% of the population during theobserved years: 35,194 (2004); 32,205 (2005); 30,325 (2006). Cases with HF diagnosticcodes appeared in any form in the documentation were the followings: 79,466 (2004);76,493 (2005); 70,027 (2006). Incidence of HF as main diagnosis (new cases/10,000citizen) in 2006 was 28.0 (men) and 32.0 (women). The average of one year mortalityof heart failure patients on active hospital units was ca. 25% during the observationperiod.Conclusion: administrative health data are appropriate to analyze the epidemiology ofHF. Official administrative data of hospitals are only suitable to estimate the epidemiol-ogy since these data are only categorical descriptives of clinical signs and symptoms.Our results demonstrate that incidence of HF in Hungary approaches the values of theEuropean population mean.

P1299The comparative heart failure profile at five years interval in a romanian generalhospital

D. Pop; G. Gusetu; O. Penciu; A. Sitar Taut; DT. ZdrengheaUniversity of Medicine and Pharmacy, Cluj-Napoca, Romania

Background: Heart failure, as end stage heart disease, is more and more a publichealth problem with frequent hospitalization, high cost, low quality of life and decreasesurvival. In turn, treatment can improve the evolution, if applied in according to thecurrent guidelines, and adapted to rapid changing clinical profile of the patientswhich has to be periodically reevaluated.Purpose: To compare the clinical profile of heart failure patients at five years interval ina Clinical Romanian General Hospital.Methods: There were studied two cohorts, admitted in the Cardiology Department ofRehabilitation Hospital, with a diagnosis of chronic heart failure NYHA II-IV class.First cohort study (2004) included 414 patients 67+10.59 years, 43.1% beingfemales. The second cohort study (2009), included 500 patients, 67.3+11.27 years,45.2% females.Results: The mean age wasn’t different for the two cohorts, except 2009 cohortfemales significantly older (69.91+9.96 years vs 67.71+10.42 years; p , 0.05). In2004, the percent of females over 75 years and the males under 65 years increased.LVEF wasn’t different for the two cohorts, and even increased in females(60.49+13.41 vs 64.42+13.79%; p , 0.05), but decreased in males over 65 years(40+9.2 vs 23.7+7.8%). For females probability to have a LVEF , 40% was greaterin 2004 – OR ¼ 1.573. Heart failure with preserved EF was more prevalent infemales in both 2004 (78.2 vs 54.2%) and 2009 (85 vs 57.3%), but the prevalence ofNYHA IV class increased from 14% to 22.10% (p , 0.05) in females, remainingunchanged in males. In 2009 cohort LVEF increased both in young oldies (59.08 vs55.35%) and old oldies (62.28 vs 56.79%). For 2004 cohort, it isn’t any relationshipbetween LVEF and age of the patients – ANOVA test 0.001 (2009) vs 0.714 (2004).Ischemic heart disease was the main underlying cause for both cohorts, with significantdifferences between the two sexes: OR ¼ 0.448 for 2004 and 0.814 for 2009.Conclusions: Heart failure has the same clinical profile at five years distance,suggesting nothing changed or improved in severity of the disease or treatment ofthe patients. Heart failure is more severe in males over 65 years. The females areolder and usually with preserved LVEF. Ischemic heart disease represents the dominantetiology but is less in females.

P1300Comparison of elderly heart failure patients with younger based on SwedishNational Heart Failure Registry

A. Holmstrom; L. Ma; R. Sigurjonsdottir; M. Edner; A. Jonsson; U. Dahlstrom; M. FuSahlgrenska Academy, Univ. of Gothenburg, Dept of Molecular & Clinical Medicine/Cardiology, Gothenburg, Sweden

Background: As the main body of heart failure (HF) population, heart failure in theelderly remains poorly understood.

Characteristics (Abstract P1297 Table)

Variable Caucasian East Asian African Black Aboriginal South Asian p value

N 13350 293 265 210 197Female% 30.8 35.6 37.2 31.6 27.4 0.056Age years ×+sd 67.6+14.3 63.8+15.5 63.8+15.1 60.4+14.6 62.4+14.5 ,0.001Mass kg ×+sd 80.5+17.8 66.5+15.2 79.5+17.8 82.2+16.6 73.5+16.5 ,0.001LVEF% ×+sd 32.1+14.5 34.8+17.1 29.1+13.8 33.6+14.8 32.8+13.6 ,0.05Cr mmol/L ×+sd 121.5+71 125.7+123 113.6+55 145.4+124 119.8+68 ,0.01K mmol/L×+sd 4.4+0.5 4.4+0.5 4.3+0.5 4.4+0.5 4.5+0.5 ,0.01SBP mmHg ×+sd 119.0+22.1 116.2+22.7 120.8+22.9 117.5+22.4 109.9+24.4 ,0.001DBP mmHg ×+sd 69.4+12.0 69.4+13.1 72.8+14.3 69.7+12.4 65.7+11.3 ,0.001

x ¼mean; sd ¼ standard deviation;LVEF ¼ left ventricular ejection fraction; Cr ¼ Creatinine; K ¼ potassium; SBP ¼ systolic blood pressure; DBP ¼ diastolic blood pressure

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Aims: The internet-based Swedish National Heart Failure Registry enables us to gainknowledge about epidemiology and characterization of elderly HF patients. Thereforethe present study was aimed to compare characterizations in senior HF patients withthose in the younger based on register database.Methods and results: The present study has included 8347 younger HF patients(, 65 years ) and 15889 senior HF patients which was further divided into 2 sub-groups: 11412 patients between 84-90 years and 4477 patients .90 years. Ourresults demonstrated that, as compared with younger, senior HF patients exhibitedhigher systolic blood pressure (SBP), higher pulse pressure, lower body-mass index,at least 2-3 times higher NT-proBNP or BNP levels, and 30% of them have preservedsystolic function. As a matter of fact, 65,9% of older HF patients have hypertensionwith SBP .140 mmHg as compared with 22,6% in the younger. Likewise, 15,5% ofold HF patients have tachcardy (.100 bpm) compared with 6,8% in the younger. Bycomparing systolic HF, heart failure with preserved systolic function displayed morefemale, higher SBP and almost half plasma level of NT-proBNP, regardless youngeror older. However, in the elderly HF patients with preserved systolic function, thereare more frequent atrial fibrillation as compared with systolic HF, which is not thecase in the younger HF population. Comorbidity is another important characteristicsfor senior HF population. By using estimated GFR, 81,8% of male and 84,2% offemale senior HF patients have GFR , 60 ccs/min (moderate renal failure), and26,6% of male and 36,8% of female have GFR , 30 ccs/min (severe renal failure),whereas in the younger only 8,1% of male and 15,9% of female have GFR , 60 ccs/min, and 1,5% of male and 2,4 of female have GFR , 30 ccs/min. In addition, 16,7%of older HF patients have hemoglubulin , 110 g/L whereas in the younger only6,5%. By reviewing medical history, 56% of old HF patients have atrial fibrillation,twice as much as that in the younger. Finally, older HF patients received less treatmentwith recommended medications such as beta-blockers and ACE inhibitors.Conclusion: Our study clearly demonstrated that heart failure in the elderly, in particu-lar . 85 years old, has its distinct entity, being different from younger heart failurepatients, which must deserve more attention and more studies in the future.

PROGNOSIS (OTHER)

P1301Effect of Arterial Stiffness on Development of Cardio – Vascular Complicationsof patients with Chronic Heart Failure

Kosheleva; RebrovSaratov State Medical University, Saratov, Russian Federation

Aim: To assess effect of Arterial Stiffness on Development of cardiovascular compli-cations (CVC) for patients with Chronic Heart Failure (CHF).Material and methods: 207 CHF subjects (mean age 55,3+6,4 years) were includedin the study. The analysis of a pulse wave was carried out using the arteriograph "Ten-sioClinic, Hungary" with "Tensiomed" program. During one year of follow – up therewere 68 cases of CVC: 45 cases of decompensation CHF, 18 - unstable angina, 11– repeated myocardial infarctions, 17 deaths.Results: Aortic pulse wave velocity (PWV) was significantly associated with age, witharterial hypertension, systolic and diastolic arterial pressure level, inventricularseptum and left ventricular posterior wall thickness, left ventricular myocardial massindex, left atrial end-systolic dimension, systolic pulmonary artery pressure, NT-proBNP, CHF functional class. The patients were divided into two groups: group Ienrolled patients with aortic PWV , 12 m/s (134 patients), group II enrolled patientswith aortic PWV . 12 m/s (73 patients). Comparison of Kaplan – Maier survivalcurves confirmed that for patients with aortic PWV . 12 m/s cumulative probabilityof decompensation CHF (p ¼ 0,001), of repeated myocardial infarctions (p ¼ 0,01),of deaths (p ¼ 0,001) and of total number CVC (p ¼ 0,01) was significantly morethan for patients with aortic PWV , 12 m/s. For patients with aortic PWV . 12 m/s,the relative risk (RR) of development of CVC was 2 times more for patients withaortic PWV , 12 m/s (RR ¼ 2,02, 95% CI 1,01 – 4,03).Conclusions: In the multivariate model, independent predictors of CVC were bodymass index, heart rate, cholesterol, left ventricular ejection fraction and aortic PWV.Aortic PWV as marker of arterial stiffness for persons with CHF is a predictor of CVCirrespective of age and classic risk factors.

P1302Hyponatremia – available and reliable predictor in acute heart failure patients

I. Varga; P. Lesny; P. Solik; M. Luknar; B. Liska; E. GoncalvesovaNational Institute of Cardiovascular Diseases (NICVD), Bratislava, Slovak Republic

Purpose: Aim of the study was to identify the value of hyponatremia as in-hospital mor-tality predictictor and its relation to defined characteristics in non-selected population ofpatients hospitalized for acute heart failure (AHF).Methods: We used the data from SLOVASeZ, a nationwide multicenter AHF survey,with 860 consecutive patients enrolled during 3 months in 11 hospitals throughout Slo-vakia. Hyponatremia was defined as serum sodium , 135 mmol/l at admission. Weanalysed forty-four variables in relation to clinical manifestation of AHF in univariateanalysis. Significant of them (p , 0.05) were subsequently entered into linearregression model for multivariate analysis.Results: Hyponatremia was present in 118 patients (14%). Mean age of them was 72years and 61% were male. Patients with hyponatremia had higher in-hospital mortality(20.0 vs. 6.3%, p ¼ 0,006) and hyponatremia was also independent predictor of in-

hospital mortality (p , 0.05). There were identified nine significant parameters associ-ated with hyponatremia in univariate analysis. Hyponatremia was significantly morecommon in patients admitted due to acute decompensation of chronic heart failure(p ¼ 0.004), in NYHA class III/IV (p , 0.05), admitted with jugular venous distension(p , 0.001), hypotension – systolic blood pressure , 100 mmHg (p , 0.001), atrialfibrillation / flutter (p , 0.05) and QRS complex . 120 ms (p ¼ 0,008). Hyponatremiawas also more frequent in patients with anemia – according to the WHO criteria (p ¼0.001), uremia . 8.5 mmol/l (p , 0.001) and hyperbilirubinemia – serum bilirubin .

25 umol/l (p , 0.001). Acute decompensation of chronic heart failure as cause ofadmission, hypotension and hyperbilirubinemia according to upper criteria were inde-pendently associated with hyponatremia (for all three p ¼ 0.03).Conclusion: Hyponatremia is frequent and simply identifiable finding in AHF patients.It is reliable and independent predictor of in-hospital mortality. Hyponatremia is moreoften associated with acute worsening of chronic heart failure, hypotension and hyper-bilirubinemia which makes it useful parameter in detection of advanced hypoperfusionand therefore worse prognosis of hyponatremic patients.

P1303Absence of restrictive pattern in lung function tests predicts better survival inchronic heart failure patients with peak oxygen consumption below the cut-offpoint for heart transplantation listing

Lizak1; M. Zakliczynski2; A. Jarosz3; M. Zembala2; Z. Kalarus4

1Silesian Centre for Heart Disease, Dpt. of Cardiology, Congenital Heart Diseases &Electrotherapy, Zabrze, Poland; 2Medical University of Silesia, Silesian Centre for HeartDis., Dpt Cardiac Surgery & Transplantology, Zabrze, Poland; 3Medical University ofSilesia, Zabrze, Poland; 4Medical University of Silesia, SCHD, Dpt. of Cardiology,Congenital Heart Disease & Electrotherapy, Zabrze, Poland

Purpose: Restrictive pattern in spirometry (PFT) is commonly seen in chronic heartfailure (CHF), but its prognostic value is poorly documented. Utility of Lower Limit ofNormal (LLN) in PFT interpretation has not been evaluated in CHF yet. The focus ofthis study was the impact of pulmonary restrictive pattern defined accordingly to theclassic or LLN criteria on mortality and morbidity in CHF pts with peak oxygen con-sumption (PeakVO2) ≤ 12ml/kg/min (the cut-off point for OHT listing).Methods: 108 consecutive CHF pts on chronic b-antagonist treatment withPeakVO2≤12ml/kg/min (89 men, 53+8 years, BMI 26+4; LVEF 24+8%, 62%ischemic) evaluated in the OHT clinic divided into groups based on their PFT result:Group 1 (N ¼ 52) – classic criteria: no restrictive pattern,Group 2 (N ¼ 26) – classic criteria restrictive pattern present,Group 3 (N ¼ 34) – LLN criteria: no restrictive pattern,Group 4 (N ¼ 31) – LLN criteria: restrictive pattern present,Control group (N ¼ 30) - PeakVO2.20ml/kg/min and no restrictive pattern defined byclassic criteria or obturation defined as FEV1%FVC , 70.Restrictive pattern: classic criteria - FEV1%FVC ≥ 70 and IVC%,70,LLN criteria - FEV1%FVC≥LLN and IVC , LLNLLN set at the 5th‰ of PFT values’ normal distribution in a refference population isspecific to each patient’s age, sex and height.Observation time: 2000-2008; start: day of CPET and PFT evaluation; end: patient’sdeath.End-points: time to death, 1- and 2-year mortality.Chi2, U Mann-Whitney and Kaplan-Meier analysis were performed. P , 0.05 wassignificant.Results: Survival time is showed in Figure 1. [fig 1]1-year mortality in groups 1 (9.6%) and 3 (11.8%) did not differ significantly from thecontrol (0%).Conclusion: Patients with no restrictive pattern in PFT have better survival prognosisthan the PeakVO2 result would suggest.

P1304Prognostic value of 24h Blood Pressure variability in Chronic Heart Failure

M. Berry; J. Fourcade; O. Lairez; A. Pathak; B. Chamontin; J. Roncalli; D. Carrie;M. Galinier

Figure 1. Restrictive pattern & survival

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University Hospital of Toulouse - Rangueil Hospital, Departments of Cardiology,Toulouse, France

Purpose: Systolic blood pressure (SBP) level is positively correlated with survival inchronic heart failure (CHF) and negatively with arterial hypertension disease. A highlevel of blood pressure variability (BPV) represents, especially in arterial hypertensiondisease, a stronger cardiovascular risk. The aim of our study was to evaluate the prog-nostic impact of 24h-BPV level in CHF.Methods: We prospectively collected ambulatory monitoring blood pressure (AMBP)of 288 patients hospitalized for CHF in the department of Cardiology of the UniversityHospital, between 1999 and 2006. Follow up was realized retrospectively using phys-ician, patient or family phone contact during 2010. The composite outcome wasdefined by all causes of death, heart transplant, defibrillator shock and assistancedevice.Results: Mean age was 59+12 years with xx (79%) men. Mean left ventricular ejectionfraction was 28+9% and mean arterial blood pressure was 110+15/68+9 mmHg.During a mean follow up of 7 years, the composite outcome was observed for 71(32.2%) patients. After multivariate analysis, NYHA class (I/II vs. III/IV) and 24h-BPV(. vs. , 23 mmHg – mean median value) were found to be the two independentfactors of survival with an odds ratio of 5.1 (95% IC: 3 - 8.8; p , 0.01) and 1.8 (95%IC 1.1 - 2.9; p , 0.02) respectively.Conclusion: In a population of CHF, high level of 24h-BPV (.23 mmHg) is a positiveprognostic value for survival.

P1305Red cell distribution width, anemia and mortality in heart failure patients

J. Diez ManglanoInternal medicine Department. Hospital Royo Villanova., Zaragoza, Spain

Purpose: To compare the prognostic value of red cell distribution width (RDW) andanemia in patients with heart failure (HF).Methods: All patients discharged from an Internal Medicine department with a main orsecondary diagnose of HF between January 1, and December 31, 2007 were included.At admission, age, gender, clinical information and biological parameters (haemo-globin, RDW and creatinine) were collected. We used WHO criteria for anemia and. 14.1% for high RDW. eGFR was calculated with MDRD equation.Results: 244 patients, 154 women, with a mean (SD) age of 80.9 (9.6) years wereincluded. Overall 142 (58.2%) had anemia and 180 (73.8%) had a high RDW.Median of follow up was 383 days (1-1107). 103 (43.5%) patients died after a yearand 123 (50.4) during follow-up. Patients with anemia had lesser median of survival(386 vs 1107 days). In Cox regression model, age (HR 1.09 95% CI 1.05-1.12, p ¼0.003) and high RDW (HR 2.24, 95% CI 1.30-3.88, p ¼ 0.0006) but not anemia (HR1.34, 95% CI 0.88-2.03, p ¼ 0.17) were associated with mortality after one year andalso during the follow up.Conclusion: RDW is a strong and better than anemia predictor of mortality in heartfailure patients.

P1306Impact of hyponatremia in short-term prognosis of heart failure, data from anheart failure registry

Moreira; Rodrigues; Correia; Santos; Nunes; SantosHospital Sao Teotonio, Viseu, Portugal

Background: Hyponatremia is increasingly recognized as an adverse prognosticfactor in terms of morbidity and mortality in decompensated heart failure (HF).Purpose: To determine the prognostic impact of natremia measured at hospital admis-sion in patients hospitalized due to decompensated HF by and endpoint defined as

death and readmission for HF over a period of three months. Methods: Prospectivestudy started in April 2009, with 416 patients – 47.8% men and 52.2% women –divided into two groups (G): GA, with sodium levels ,135mmol/l and GB withsodium levels ≥135mmol/l. It were compared clinical, laboratorial and ecochardio-graphic parameters. Statistical analysis: chi-square test for categorical variables andStudent t-test for numerical variables with statistical significance if p ≤ 0.05.Results: Distribution of patients by groups: A -18.8%, B-81.2%, with 52.6% males in GAand 46.7% in GB. Both groups have mean age of 77years. GA has lower rate of acutemyocardial infarction (7.7% vs 17.5%, p ¼ 0.02) in medical past history and hyperten-sion (56.4% vs 71.3% in GB, p ¼ 0.03); GA is more medicated with loop diuretics(71.9% vs 59.6%, p ¼ 0.03) and spironolactone (39.7% vs 18.2%, p , 0.05). At admis-sion, GA has lower systolic arterial pressure (126mmHg vs 142mmHg, p , 0.01) andlower diastolic arterial pressure (75mmHg vs 80mmHg, p , 0.05); GA has lower hemo-globin (11.8g/dl vs 12.8g/dl, p , 0.01), higher B-type natriuretic peptide (1087.4pg/mlvs 653.9pg/ml, p ¼ 0.01) and higher C-reactive protein levels (3.78mg/dl vs 2.56mg/dl,p , 0.01). In echocardiogram GA has a larger diameter of left atrium (53.3mm vs47.6mm, p ¼ 0.03), higher systolic pulmonary artery pressure (54.8mmHg vs44.6mmHg, p , 0.05); there were no differences in the values of left ventricular dias-tolic volume, E/e’ or left ventricular ejection fraction (LVEF). GA has higher average hos-pital stay (12.0days vs 7.9days, p ¼ 0.01) and reached the primary endpoint withstatistical difference compared with GB (44.1% vs 20.0%, p , 0.01); GB has oddsratio of 0.317, with confidence interval of [0.172-0.586] for the primary endpointstudied.Conclusion: Hyponatremia at admission is an adverse prognostic factor in heartfailure, similar to verified in other similar studies and is useful for this purpose.

P1307Do risk scores for silent atherosclerosis underestimate disease risk?

F. Moscoso Costa; J. Ferreira; PEDRO. Goncalves; SALOME. Carvalho; G. Cardoso;P. Santos; M. Santos; C. Aguiar; M. Trabulo; M. MendesHospital West Lisbon, Hospital Santa Cruz, Department of Cardiology, Lisbon, Portugal

Purpose: HeartSCORE (HS) and Framingham Score (FS) are recommended tools forestimating global cardiovascular (CV) risk in patients (Pts) without established CVdisease. The aim of this study is to evaluate the effectiveness of these risk scores topredict high CV risk in Pts without established CV disease admitted for an AMI.Methods: We studied 221 Pts, mean age 60+11 years, 82% male and 50% withSTEMI, all without previous CV disease. Total, HDL and LDL-cholesterol, and triglycer-ides were measured in the first 24 hours after admission. High CV risk prior to the AMIwas defined as the presence of history of diabetes (DM), an absolute 10-year CV deathrisk ≥5% estimated by HS or an absolute 10-year coronary events risk ≥20% esti-mated by FS. Pts with and without high CV risk were compared with respect to demo-graphic and clinical features, hospital mortality, and 1-year mortality.Results: DM was present in 28 Pts. Median [IQR] was 2% [1% to 4%] for HS and 16%[8% to 20%] for FS. High CV risk prior to the AMI was idenfied in 43 Pts by HS and 69Pts by FS (NS). Pts at high CV risk by HS or FS were older, more often male and hyper-tensive. No significant differences on mortality were observed in high vs no high CV riskPts stratified using HS or FS (table 1).Conclusions: In our study of Pts without previous CV disease presenting with AMI onlya minority was identified as high risk before the event. Mortality was similar in patientsat high or no high CV risk.

Table 1

HeartSCORE Framingham Score

High RiskNo HighRisk P High Risk

No HighRisk P

Age 70,3+7,6 56,6+10,7 ,0,001 63,8+12,3 57,4+10,6 ,0,001Male 93% 77,3% 0,021 95,7% 72,6% ,0,001Dyslipidemia 55,8% 44,7% 0,197 55,1% 42,7% 0,1Smoking 34,9% 41,3% 0,446 53,6% 32,3% 0,04Hypertension 65,1% 46,7% 0,03 73,9% 37,9% ,0,001Obesity 16,7% 18,9% 0,745 20% 17,5% 0,675STEMI 46,5% 52,7% 0,477 52,2% 50,8% 0,855Killip I 83,7% 86% 0,708 82,6% 87,1% 0,396Hospital Mortality 2,3% 1,3% 0,643 0% 2,4% 0,0921-year Mortality 8,1% 4,7% 0,4 7,3% 4,5% 0,467

P1308Endothelial dysfunction in chronic heart failure is associated with increasedmortality risk and predicts long-term cardiovascular-related events

S. Radovanovic1; M. Krotin1; DV. Simic2; A. Djokovic1; M. Zdravkovic1;A. Savic-Radojevic3; M. Pljesa-Ercegovac3; M. Matic3; M. Zaja-Simic1; T. Simic3

1University Hospital Bezanijska Kosa, Belgrade, Serbia; 2Clinical Center of Serbia,Department of Cardiology, Belgrade, Serbia; 3Institute of Biochemistry, University ofSchool of Medicine, Belgrade, Serbia

Background:Impaired endothelial function is known to be associated with congestiveheart failure and impaired functional capacity.

Kaplan-Meier survival curve

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Aim:To examine whether endothelial dysfunction in patients with chronic heart failure(CHF) and previously angiographically confirmed coronary artery disease (CAD) isassosiated with higher mortality risk and increased frequency of adverse (new) cardi-ovascular events (ACVE).Material and methods: One hundred and twenty patients suffering from CHF wereincluded in the study. The criterion for admission was left ventricular ejection fraction(LVEF),45%. All patients were assessed brachial flow-mediated dilation (FMD)during reactive hyperemia after 5 minutes of cuff occlusion in the upper arm. Accordingto the values of FMD patients were divided into the two groups: Group 1 with FMDequal to or below 5% (n ¼ 75) and Group 2 with FMD values lower than 5% (n ¼45). All patients were subjected to one-year follow-up for adverse cardiovascularevents including death, myocardial infarction and new episodes of non-stabileangina pectoris.Results: Median overall survival in Group 2 was lower in comparison to that found inGroup 1 (324; 95% CI:309-340 vs. 342; 95% CI:333-356 days, respectively) duringthe study period. Although one year survival rate was also lower in Group 2 (86.7%)in comparison to Group 1 (97.7%), Kaplan-Meier survival analysis revealed no signifi-cant differences (p ¼ 0.066). During the follow-up, 11 patients died, out of which 9had belonged to the Group 2. The relative risk of mortality was significantly higher inpatients with FMD equal to or less than 5% compared to those with FMD above 5%(OR ¼ 1.52, CI:1.2-1.94; p , 0.05). The frequency of ACVE also differed significantlybetween the two groups. Namely, all AMI that appeared during the one-year follow-up were among the patients with FMD less than 5% (p, 0.05). The frequency ofnew episodes of non-stable angina pectoris was higher in Group 2 (p , 0.05).Conclusion: Endothelial dysfunction in CHF as assessed by FMD in the brachial arteryis associated with an increased mortality risk and predicts long-term cardiovascular-related events particulary acute miocardial infarction.

P1309Impact of fibrinogen, protein C and apolipoprotein B genes on prognosis inpatients with chronic heart failure who suffered troponin-positive acutecoronary syndrome

N. Koziolova; E. PolyanskayaMedical Academy, Perm, Russian Federation

Objective: to evaluate peculiarities of the genotype and its impact on prognosis inpatients with HF who suffered acute coronary syndrome (ACS) depending on troponinI related to the ACS onset.Materials and methods: 162 patients with ACS and HF underwent a two-stage exam-ination. A single-step clinical examination was performed at the first stage during thefirst three days beginning from ACS development. At this very stage genotypes of fibri-nogen, apoB100 and protein C genes as well as clinical symptoms, troponin I level,lipid spectrum, severity of HF through echocardiography and NT-proBNP, myocardialcollagenolisis through determining TIMP-1 were evaluated. The second stage con-sisted of two-year monitoring during which cardio-vascular events were recorded.Results: patients with a high level of troponin I made up 42.0%. Patients with a low levelof troponin I made up 58.0%. In both groups unfavourable allele A of fibrinogen gene,allele TT of apoB100 gene, and allele CC of protein C gene occurred with equal fre-quency (98,5% and 79,8% (p ¼ 0,426), 10,3% and 11,7% (p ¼ 0,990), 35,3% and27,7% (p ¼ 0,556) respectively). The combination of two or three unfavourable geno-types occurred significantly more rarely in the troponin-positive group (30.9%) com-pared to another group (11.7%), (p ¼ 0.024). Positive troponin I test related to theACS onset associated with males (p ¼ 0.014) with no symptoms of CAD (p , 0.001)and CHF (p , 0.001) in their histories. Troponin-positive patients appeared to have sig-nificantly lower LVEF compared to the group of patients with a low level of troponin I:54.4+7.6% vs 51.5+6.5% (p ¼ 0.012). The first group showed a significantly higher NT-proBNP level compared to the second group that is 904.0+722.1 versus 701.2+278.8ng/dL (p ¼ 0.014), and a higher TIMP-1 level that is 603.2+76.0 vs 568.0+10.,7 ng/dL(p ¼ 0.019). No significant differences between the two groups in terms of lipid spec-trum parameters, including apolipoprotein A and apolipoprotein B were detected.The first group showed poor prognosis in 42.6% of the cases and the second groupshowed poor prognosis in 29.8% of the cases (p ¼ 0.036).Conclusions: ACS with troponin I increasing develops more often in males withoutprevious CAD and CHF in their histories and is characterized by more severe newonset HF with lower LVEF but less myocardial collagenolisis activity. Elevated troponinI related to the ACS onset correlates with presence of the combination of unfavorablealleles of the fibrinogen, apoB100 and protein C genes in a genome and that isappeared to be a predictor of poor prognosis within the next two years.

P1310Cardiac resynchronization therapy: is there background to use age as acriterion?

C. Gomes; D. Anjo; A. Meireles; M. Vieira; M. Santos; C. Roque; P. Vieira; V. Lagarto;H. Reis; S. TorresCentro Hospital Porto - Hospital Santo Antonio, Porto, Portugal

Purpose:Cardiac resynchronization therapy(CRT) has shown to improve the morbidityand mortality in patients(pts) with heart failure(HF).As the elderly population is poorlyrepresented in clinical trials,our objective was to compare the benefit of CRT in differentage groups.Methods:We included 145 pts undergoing CRT implantation between January 2000and December 2009.All pts were in NYHA functional class(FC)≥II,under optimal

medical therapy,left ventricular ejection fraction(EF),35% and QRS duration . 120ms.The population was divided into three quartiles according to their age:Group A ,

60 years(n ¼ 26),group B 60-75 years(n ¼ 104) and group C . 75 years(n ¼ 15).Results:The baseline population had pts with mean age 68+11 years,64% male,meanEF 25+7%,with the following FC:II 6%,III 70% and IV 24%.The etiology of heart failurewas ischemic in 43% of the pts;49% had CRT with defibrillator(CRT-D) and 51% hadCRT alone(CRT-P).There were no statistically significant differences between thegroups in relation to gender,EF,FC and HF etiology.The groups differed only in thetype of device (CRT-D in 81% in group A, 51% in group B and 27% in group Cversus CRT-P in 19% in group A, 49% in group B and 73% in group C, p,0.0001).During an average follow-up of 40+25 months there was a clinical responseto CRT (improvement of FC ≥ I) in 87% of pts (81% in group A,86% in group B and 87%in group C,p ns).The overall mortality rate was 37%:27% in group A,40% in group Band 37% in group C,p ns. In the survival analysis of Kaplan Meier,survival did notdiffer between the three groups(log-rank ns).Conclusion:In this population, CRT was associated with improvement in FC in thethree groups.Despite a smaller percentage of CRT-D in the older group,there wereno differences in terms of survival compared with other age groups.

P1311Ventricular Late Potential Detected by Signal Averaged Electrogram wasPredicted Heart Failure Death in Patients With Chronic Heart Failure

Y. Furukawa; T. Yamada; T. Morita; K. Tanaka; Y. Iwasaki; M. Kawasaki; Y. Kuramoto;T. Naito; T. Fujimoto; M. FukunamiOsaka General Medical Center, Osaka, Japan

Background: A lot of studies havedemonstrated that the ventricular late potential (VLP)detected bysignal-averaged electrogram (SAE) is a useful predictor for lethal ventricu-lararrhythmias or sudden cardiac death (SCD) in patients with myocardialinfarction andnon-ischemic cardiomyopathy. However, little information is available on the relationofVLP to heart failure death (HFD). The purpose of this study is to investigate therelation between VLP andthe mode of death (HFD or SCD) in patients with left ventri-cular (LV) systolicfunction impaired.Methods: We enrolled 106chronic heart failure patients whose LV ejection fraction lessthan 40% (male81, average age; 63.6+11.7). In SAErecorded at the entry, wemea-sured three parameters: 1) the filtered QRS duration (fQRSd: Normally , 120ms), 2)the RMS voltage of the terminal 40 ms in the filtered QRS wave (RMS40: Normally.17mV), and 3) the duration of low-amplitudesignal ,40mV in the terminal filteredQRS wave (LAS40:Normally ,40ms). VLP wasdefined as the presence of 2 abnormalparameters of these.Results: At the entry, 54of 106 patients had VLP. Duringthe mean follow up of 6.7+3.5yaers, 32 patients had the primary endpoint (HFD in 11 andSCD in 21 patients).Kaplan-Meieranalysis revealed that patients with VLP had higher incidence of HFDthan thosewithout VLP (17% vs. 4%, p , 0.05: RR 4.42), while there was no significant-difference in the incidence of SCD between the patients with and without VLP(13% vs26%, p ¼ n.s.; RR 0.49). Hazardratios of fQRSd, RMS40 and LAS40 for HFD were 1.019(p , 0.01),0.961 (p ¼ 0.28) and 1.020 (p ¼ 0.08), respectively.Conclusion: In patients withchronic heart failure, VLP, especially fQRSd, would be auseful predictor forthe heart failure death rather than sudden cardiac death.

Kaplan-Meier curves: survival and age

Kaplan-Meier curves of HFD

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P1312Mitral Regurgitation after an acute myocardial infarction: predictors andprognosis impact at a 2-year follow-up

Paiva; S. Barra; R. Providencia; P. Gomes; A. Botelho; A. Leitao-MarquesHospital Center of Coimbra, Coimbra, Portugal

Ischemic heart disease (MI) causing mitral regurgitation (MR) is known to be associ-ated with poor outcomes. However its long-term prognostic importance isn’t yet com-pletely understood.Purpose: Determine clinical and analytical predictors of MR complicating MI, andestablish its prognostic value at a 2-year follow-up, namely on mortality and heartfailure (HF) decompensations.Methods: 796 patients admitted consecutively with MI 68.8+13.4, 63.2% males,36.6% diabetics, 44.6% with STEMI. Analytical parameters, risk scores, coronariogra-phy and pre-discharged transthoracic echocardiogram (TTE) data were evaluated.Clinical and analytical predictors of moderate to severe MR were investigated and itsprognostic impact at 24 months, particularly in those with less severe MR.Results: In the multivariate analysis, intra-hospitalar mortality (IHMo) Grace score (OR1.023, p , 0.001) and left atrial transverse diameter, were the most potent independentpredictors of moderate to severe MR. Univariate analysis revealed that moderate tosevere MR is associated with higher mortality rates at 2 years (OR 3.32, p , 0.001),however unable to predict HF decompensations. Mortality at 24 months was pro-portional to the MR severity assessed on pre-discharge TTE (38.5% – severe MR,37.5% – moderate MR, 27.1% – low MR, 12% -absence/subvalvular). Small MR (vs.absence/subvalvular) correlated with increased mortality risk (OR 0.24, p ¼ 0.014)and HF decompensations (OR 2.55, p ¼ 0.001). Mortality predictor model at 2 yearsincluded MR classes (for each MR severity increment the risk rose 1.5x, p ¼ 0.013),age (OR 1.065, p , 0.001) and acute HF on admission (OR 2.43, p ¼ 0.005).Conclusions: In this sample IHMo Grace score and left atrial transverse diameterrevealed to be important independent predictors of moderate to severe MR. The MRclasses predicted mortality at a 2-year follow-up, with a continuous risk augmentationas MR worse, even taking into account the less severe MR stages. This parameter addsvalue to other variables usually used to evaluate outcomes in this set (age, Killip-Kimbalclasses on admission). The fact that HF decompesations are seen more frequently insmall MR than in those with subvalvular/absence of MR, proves the prognostic impactof even reduce MR.

P1313Peak vO2 and predicted vO2 in patients under beta blocker therapy - lower cut-off for heart transplantation

M. Paiva; S. Amorim; P. Viana; E. Martins; M. Campelo; B. Moura; J. Silva Cardoso;MJ. MacielSao Joao Hospital, Porto, Portugal

Introduction: Beta-blocker(BB) therapy has shown to improve survival without chan-ging peak VO2, and this implies the need to establish a lower cut-off value in thisgroup of patients (pts).Methods: A transversal study was performed on a group of patients with dilated cardi-omyopathy of all causes, who performed cardiopulmonary testing, for all-cause mor-tality and for occurrence of death or urgent transplantation. Cut-off values of peakVO2 of 12mlO2/kg/min and of predicted VO2 of 50% were established and analysisthrough Kaplan-Meier survival curves was performed.Results: From a group of 83 pts, 12 were lost for follow-up. Of 71, 57 (80.3%) weremen; the age at the time of cardiopulmonary testing was 50+12 years and followedby 75+51 months. Mean left ventricular ejection fraction was 27.1+10.3% andmean peak VO2 was 18.2+6.8 ml02/kg/min. Sixty pts(84.5%) were under BB.Fifteen (22.1%) died during follow-up and 11 (15.5%) were submitted to heart trans-plantation. Peak VO2 and predicted VO2 revealed difference in survival between thegroup of pts treated with BB and those who were not (p ¼ 0.002 and p ¼ 0.001). Inpts treated with BB, compared with those not on BB, at one and five years of follow-up, survival for the group of peak VO2≫12ml/kg/min was 98% vs 80% and 86% vs40%, respectively; and for peak VO2,12ml/kg/min was 91% vs 75% and 58% vs0%, respectively (p ¼ 0.002). Regarding predicted VO2≫50% cumulative survival for

1 and 5 year follow-up was 96% vs 67% for both and in pts with predictedVO2,50% it was 93% vs 83% and 66% vs 0%. (p ¼ 0.001).Conclusions: Pts with BB showed higher survival and an excellent survival rate at 1and 5 years follow-up when peak VO2≫12mlO2/kg/min and predicted VO2≫50%.With BB therapy a lower cut-off value of peak VO2 should be used when decidingtransplantation.

PROGNOSIS (USING BIOMARKERS)

P1314N-terminal pro-B-type natriuretic peptide is a marker of reversible myocardialdysfunction after non-ST-elevation acute coronary syndrome

K. Broch1; C. Eek1; R. Wergeland2; T. Ueland3; R. Skaardal4; P. Aukrust4; H. Skulstad1;L. Gullestad1

1University of Oslo, Rikshospitalet University Hospital, Department of Cardiology, Oslo,Norway; 2University of Oslo, Rikshospitalet University Hospital, Department of MedicalBiochemistry, Oslo, Norway; 3University of Oslo, Rikshospitalet University Hospital,Research Institute for Internal Medicine, Oslo, Norway; 4University of Oslo,Rikshospitalet University Hospital, Oslo, Norway

Purpose: In acute coronary syndrome (ACS), myocardial function is often impaired.Some of this impairment may be due to reversible phenomena, including myocardialstunning. N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponin T (TnT)are released in proportion to the size of the myocardial injury. Our aim was to investi-gate the association between plasma levels of these biomarkers and the developmentin left ventricular (LV) function and size after non-ST-elevation (NSTE-) ACS.Methods: In 119 patients, age 58+9 years, admitted for NSTE-ACS, echocardiogra-phy and blood sampling were performed at baseline and at follow-up after 8+3months. LV systolic function was assessed by speckle tracking echocardiography asglobal longitudinal strain (GLS), negative values representing myocardial shortening.In 50 patients, final infarct size was determined by magnetic resonance imaging. Base-line levels of NT-proBNP and TnT were determined by high-sensitive assays, and theirassociation with myocardial functional recovery, LV intra ventricular volumes, andinfarct size were determined by linear regression.Results: Levels of TnT and NT-proBNP were associated with baseline myocardial func-tion, described as GLS (r ¼ 0.46; p , 0.001 and r ¼ 0.42; p , 0.001, respectively).Neither biomarker was associated with LV volumes. NT-proBNP was associated withthe decline in GLS between baseline and follow-up: The higher the NT-proBNP, thelarger the myocardial recovery (r = - 0.40; p , 0.001: illustration 1). This associationwas independent of the functional impairment at baseline, infarct size and time toreperfusion.Conclusion: In NSTE-ACS, elevated levels of NT-proBNP are independently associ-ated with improved myocardial performance after 8 months.

P1315Prognostic role of red cell distribution width (RDW) variations among patientswith chronic heart failure

N. Pezzali; M. Metra; E. Vizzardi; C. Lombardi; L. Lupi; C. Ciccarese; B. Piovanelli;L. Dei CasSec. of Cardiovasc. Diseases, Department of Experimental and Applied Med., Universityand Hospital, Brescia, Italy

Purpose: We assessed the possible prognostic role of: 1- red cell distribution width(RDW) serial follow-up evaluations, 2- RDW variations from baseline values (deltaRDW),in a group of ambulatory patients with chronic heart failure (HF). The endpoints weredeath for cardiovascular (CV) causes+ HF hospitalizations.Methods: The patients underwent routine clinical and instrumental assessment withfollow-up visits, echocardiography, cardiopulmonary exercise stress test, laboratoryK-M Srvival Curves

Illustration 1

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exams and were reassessed after 202+78 days after baseline. Follow-up wasperformed.Results: We studied 304 ambulatory patients with chronic heart failure due to left ven-tricular systolic dysfunction (LVEF 36+9%, age 67+12 years, 42% idiopathic dilatedcardiomyopathy, 58% ischemic dilated cardiomyopathy), on optimal medical therapy(89% ACE-inhibitors-ARBs, 97% beta-blockade, 45% aldosterone antagonists, 79%loop diuretics, 32% amiodarone). The clinical characteristics were evenly distributedamong the patients subdivided according to RDW2 (RDW follow-up value) anddeltaRDW ≤ or . median, except for a higher incidence of atrial fibrillation amongpatients with RDW2 and deltaRDW . median value and for a worse LVEF among sub-jects with RDW2 . median value. Cumulative event-free survival for cardiovasculardeath+heart failure hospitalizations was worse among patients with RDW2. medianvalue (HR 2.95, 95% IC 1.78-4.88, p , 0.0001) and deltaRDW . median value (HR2.61, 95% IC 1.58-4.29, p ¼ 0.0002). At multivariable cox proportional hazardsregression analysis, age (HR 1,04 for one unit increase, 95% IC 1,01 - 1,07, p ¼0,01), LVEF (HR 0,93 for one unit increase, 95% IC 0,90 - 0,96, p, 0.0001), diabetes(HR 2,3 for presence vs absence, 95% IC 1,29 - 4,09, p ¼ 0.005), deltaBUN (HR 1for one unit increase, 95% IC 0,98 – 1,01, p ¼ 0.06), deltaRDW (HR 1,21 for one unitincrease, 95% IC 1,03 - 1,42, p ¼ 0,02) were independent prognostic factors for cardi-ovascular death + HF hospitalizations. Conclusions: among patients with chronic heartfailure (HF), the variations of RDW values (deltaRDW) have prognostic significance andidentify patients with increased mortality for CV causes and HF hospitalizations.

P1316Quality of life predictors in stable chronic heart failure

L. Voronkov1; 0. Lutsak1; P. Babich2; A. Lyashenko1

1NNC Strazhesko Institute of Cardiology, Heart Failure Department, Kyiv, Ukraine; 2StatePharmacological Center, Ministry of Healh Care, Kyiv, Ukraine

Background and Aim: The data about medical predictors of health-related quality oflife (HRQL) in chronic heart failure (CHF) are still limited and, in part, controversial.The aim of study was to assess the spectrum of HRQL predictors in clinically stableCHF patients (pts).Methods: HRQL score by Minnesota Living with Heart Failure Questionnaire (MHFLQ)was calculated in 200 NYHA II – IV CHF pts of ischemic and non- ischemic (dilated car-diomyopathy) origin. Predictors of worse (above-median) Minnesota HRQL score weredetermined by claster analysis performed for each of 34 main routine clinical, demo-graphic, laboratory variables and also in Beck depression questionnaire score (0-4 –absent or minimal, 5-7 – mild, 8-15 – moderate, 16-22 – severe).Results: The strongest predictors of poor HRQL were smoking, previous myocardialinfarction and Beck depression score . 10. Less strong, but significant predictors ofworse HRQL were chronic obstructive pulmonary disease, normal or low cholesterollevel, hemoglobin , 130 g/l, low left ventricular (LV) ejection fraction, substantial LVhypertrophy.Conclusion: Cessation of smoking, management of depression and use of beta-block-ers may be considered as a impotent potential targets in HRQL and need furtherinvestigation.

Predictors of quality of life in CHF pts

Variables OR 95% CI P

Smoking 10,90 1,27-95,31 0,026Previous myocardial infarction 5,10 1,55-17,07 0,010Beck depression score . 10 4,70 2,50-8,80 ,0,001Non-use of beta-blocker 2,08 0,24-0,92 0,040Chronic obstructive pulmonary disease 2,06 1,09-3,85 0,035Cholesterol , 5,1 mmol/l 2,04 0,27-0,87 0,023Hemoglobin , 130 g/l 2,02 0,26-0,90 0,033LV ejection fraction , 35% 2,01 0,28-0,87 0,023LV myocardial mass . 339 g 1,90 1,06-3,38 0,042

P1317High sensitivity ST2 and prognosis in ambulatory heart failure patients

A. Bayes-Genis; M. De Antonio; A. Galan; A. Urrutia; R. Cabanes; L. Cano; B. Gonzalez; C. Diez; T. Pascual; J. LuponGermans Trias I Pujol University Hospital, Badalona, Spain

Background: Despite recent therapeutic advances, heart failure (HF) still has a poorprognosis and new tools to identify high-risk patients are needed. ST2 is a novel bio-marker that provides prognostic information in several clinical settings.Aim: To examine whether soluble ST2 levels improve risk stratification in a non-selectedoutpatient population with HF, and to test if the combination of ST2 + NT-proBNP isactually better than either separately.Patients and Methods: 891 patients (71.6% men, median age 70.2 years [IQR 60.5-77.2]) were studied. Median LVEF was 34% [IQR 26-43%]. Most patients were inNYHA class II (65.5%) or III (26.1%). Median follow-up was 33.4 months [IQR 15.8-50.2]. ST2 was measured from -808C stored plasma samples via a highly sensitivesandwich monoclonal immunoassay. NT-proBNP was also measured via a highly sen-sitive sandwich monoclonal immunoassay, processed by an automatic analyser.

Results: 244 patients died during follow-up. Both ST2 (HR 1.009 [1.007-1.011], p ,

0.001) and NT-proBNP (HR 1.00004 [1.00003-1.00005], p , 0.001) were good prog-nostic biomarkers. After adjustment for other significant clinical and therapeutic vari-ables, both remained as independent prognostic factors. When patients weregrouped according to NT-proBNP and ST2 median values, the combination of thetwo biomarkers increased significantly their prognostic discriminator capacity, asshown in Kaplan-Meier survival curves (figure). Taking as reference both valuesbelow the median, the HR for patients with both NT-proBNP and ST2 ≥ the medianwas 5.463 [3.777-7.902], p , 0.001.Conclusions: ST2 was a marker of risk in this unselected ambulatory HF cohort, and incombination with NT-proBNP improved the long-term prognostic accuracy.

P1318Early measurement of sP-selectin in patients with ST elevation acute coronarysyndrome undergone coronary stenting

EAS. Shmidt; SA. Berns; OL. Barbarash; AV. OsokinaSiberian Branch RAMS Institution Scientific-Research Institute for Complex Problems ofCardiov. Dis., Kemerovo, Russian Federation

The purpose of the study was to assess changes in sP-selectin levels between day 1and day 10 after the onset of the disease and their impact on the outcome of patientswith ST elevation acute coronary syndrome (ACS) undergone percutaneous coronaryintervention (PCI).Materials and methods: 154 ST elevation ACS patients undergone emergency PCIwith bare metal stent implant into infarct-related artery were studied. All the patientshad their serum sP-selectin concentrations measured by the quantitative enzyme-linked immunosorbent assay at day 1 and day 10. The patients were assigned intogroups based on recurrent myocardial infarction (MI) rate within 12+3 months.Group I included patients who developed a recurrent MI (n ¼ 42), and group II enrolledpatients with a favourable outcome (n ¼ 112).Results: Initial sP-selectin levels (Day 1) were high in both groups (320,0 (232,4; 476,4)ng/ml in group I and 323,5 (234,2; 562,6) ng/ml in group II; p ¼ 0,489).At day 10 after PCI group I had significantly higher levels of sP-selectin than a groupwith no recurrent MI (283,1 (180,8; 362,5) ng/ml vs. 127,5 (102,8; 289,1) ng/ml; p ¼0,043).The levels of sP-selectin had decreased significantly by day 10 in group II (from 323,5to 127,5 ng/ml; p ¼ 0,003). At the same time group I did not have a significant decreasein sP-selectine levels (from 320,0 to 283,1 ng/ml; p ¼ 0,210) which demonstrates theassociation of increased sP-selectin concentrations and recurrent MI within a yearafter the onset of the disease.Conclusions: Increased plasma sP-selectin levels in STelevation ACS patients at day 1are due to massive platelet activation, endothelial damage and thrombus formation ininfarct-related arteries. Early recurrent MI prevention strategy in these patients is inmonitoring sP-selectin levels at day 10 after intervention and defining a group ofpatients with enhanced sP-selectin expression who need a closer follow-up within ayear after the onset of the disease.

P1319Analytical parameters and long-term prognosis of heart failure patientsregularly followed on a home health care programme provided by a heart failureunit. 24 months of follow-up.

M. Satendra; C. Santos De Sousa; L. Sargento; N. Lousada; R. Palma Dos ReisCardiology II Department, Pulido Valente Hospital, Centro Hospitalar Lisboa Norte,Lisboa, Portugal

Background: Home healthcare (HHC) nurse led programme enables patients (pts) tostay at home rather than use institutional-based nursing care. We aimed to identifyanalytical parameters associated with long-term prognosis of heart failure (HF) ptson a HHC follow-up programme provided by our HF Unit.Methods: 67 pts (62.5% male), mean age 72.+10.0years, 48.1% NYHA II and 51.9%NYHA III, average Nt-proBNP 1823.5 pg/mL, all with ,45%LVEF and monitored by

Survival according to ST2 and NT-proBNP

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HHC nurse led programme provided by our HF Unit. Studied variables: blood count(Hb, Plat) with Red Cell Distribution Width (RDW), creatinine(creat), glomerular filtrationrate(GFR) by MDRD method and Nt-proBNP. For each parameter we determined quar-tiles of risk and significant cut-offs. Clinical follow-up period: 24 months (15.0+7.4months, median 17 months).Events: all cause death and hospitalization. Statistics: Fisher’s test, survival curve withlog-rank testand multivariate Cox regression with calculation of relative risk. Results: (1)The mortality rate was 28.2% and the survival curve (log rank test) was determined byGFR , 30ml/min(p ¼ 0.016), Creat . 1.48 mg/dl(p ¼ 0.016) and RDW . 14.5%(p ,

0.046).(2) The rate of hospitalization was 56.3%. Nt-proBNP . 3810pg/mL (p ¼0.046),Hb , 13.6 g/dL (0.035), Platelets , 179,000/ml (p ¼ 0.067) and RDW . 14.5%(p ¼ 0.020) were predictors of the hospitalization curve (log rank test). (3) Multivariateanalysis with Cox Regression: Creat ≥ 1.48 mg/dL (p ¼ 0.024, RR 3.13 95% CI 1.16-8.4) was an independent predictor of death, whereas RDW . 14.5% (p ¼ 0.028, RR2.26 95% CI 1.09-4.71) and Hb , 13.6 g/dL(p ¼ 0.046, RR 2.23 95% CI 1.01-4.89)were independent predictors of hospitalization.Conclusions: Renal function (creat) and blood count (Hb and RDW) are independentpredictors of the long-term mortality and hospitalization in HF pts with HHC.

P1320Which measure of renal function provides most prognostic information inpatients with heart failure?

J. Zhang; R. Antony; A. Yassin; N. Sherwi; L. Buga; P. Pellicori; O. Khaleva; AL. Clark;KM. Goode; JGF. ClelandThe university of Hull, Department of Cardiology, Postgraduate Medical Institute, Hull,United Kingdom

Background: Renal function is an important predictor of prognosis in patients with car-diovascular disease, including heart failure. However, the prognostic power of differentmeasures of renal dysfunction has rarely been compared. The purpose of this studywas to investigate which measure(s) of renal function is the best predictor of one-year all-cause mortality in patients with suspected heart failure.Methods: Demographic measurements, symptoms and signs and tests were collectedroutinely from patients referred with suspected heart failure from the local communitybetween 2000 and 2009. The relationships amongst urea, creatinine, urea-creatinineratio (UCratio), estimated glomerular filtration rate (eGFR) using a 4-variable and Crea-tinine Clearance measured using the Cockroft-Gault equation (CG-CrCl) were testedusing the scatter plots and Pearson/Spearman correlation coefficients. Univariateand multivariate Cox-regression models were used to identify variables associatedwith mortality. Variables with statistical significance in the univariate analysis wereentered into a multivariable Cox-regression model adjusted for age, ischaemic heartdisease, diabetes, lung disease, body mass index, heart rate and rhythm, systolicblood pressure (BP), diastolic BP, sodium, presence of structural heart disease includ-ing severity of left ventricular systolic dysfunction (LVSD), QRS width (quintile) and useof BB, digoxin, aldosterone antagonists and diuretic dose. Sex and ACEi were alsoconsidered although not significant predictors in the univariate analysis. Multicolinearitywas checked before model building.Results: Of 3487 patients, the median age was 72 (IQR: 65-78) years, 2137 (61%) weremen, 24% were in NYHA class III/IV and 59% had LVSD. There was a high correlationbetween creatinine and eGFR, urea and creatinine, urea and UCratio, eGFR and urea,and eGFR and CG-CrCI (Pearson’s correlation coefficient: r ¼ 20.703, 0.750, 0.579,-0.643 and 0.765 respectively, p , 0.001 for all). Urea (quintiles), creatinine (quintiles),UCratio (quintiles), eGFR (quintiles) and CG-CrCI (quintiles) all predicted mortality inthe univariate model (x2 ¼ 146, 98, 61, 89 and 106 respectively; p , 0.001 for all)with serum urea performing best in both univariate and multi-variable analyses. Nomeasure of renal function added to the prognostic information provided by ureaalone, often due to the high colinearity of different measures.Conclusions: Serum urea is a stronger predictor for all-cause mortality than is serumcreatinine, urea-creatinine ratio, eGFR and CG-CrCI.

PULMONARY HYPERTENSION

P1321Exercise hemodynamics as a distinction tool between pre-capillary and post-capillary pulmonary hypertension

P. Lesny; M. Luknar; I. Varga; P. Solik; E. GoncalvesovaNational Institute for Cardiovascular Diseases, Bratislava, Slovak Republic

Background: The cut-off values of pulmonary capillary wedge pressure (PCWP) fordistinguishing classes of pulmonary hypertension (PH) vary between 12 and 18 mmHg in several pulmonary artery hypertension studies and registries. Distinctionbetween pre-capillary and post-capillary PH is crucial for the treatment decisionmaking. The role of exercise hemodynamics has not been determined yet.Aim: To evaluate the role of exercise hemodynamics between pre-capillary and post-capillary PH in patients (pts) with dyspnea, echocardiography-based suspicion of pul-monary arterial hypertension, normal left ventricular systolic function, mean pulmonaryartery pressure (mPAP) . 20 mm Hg and PCWP between 12 and 18 mm Hg at rest.Patients and methods: Thirteen pts fulfilling the study criteria were evaluated betweenJanuary and December 2010. All but one were women, mean age was 59.9+11.4years. Average mPAP was 29.3+10.6 mm Hg and PCWP 14.4+4.7 mm Hg. In allpatients, left ventricular ejection fraction was .50%, there was no significant valvedisease or significant lung disease, and resting arterial oxygen saturation was.95%. Right heart catheterization was performed using Swan-Ganz thermodilutioncatheter. Exercise test was performed using bicycle ergometry (work load increase20 W every 2 minutes, symptom-limited or submaximal). Left sided-heart failure wasdiagnosed if PCWP at exercise increased to .18 mm Hg. Normal left ventricular dias-tolic function was considered if PCWP remained ≤18 mm Hg.Results: The study criteria were fulfilled by 35% of consecutive pts examined for suspi-cion of PAH (13 of 37 pts). In 13 pts exercise hemodynamics was performed. In 11 pts,mean PAP at exercise increased to . 30 mm Hg, in 7 of them with a concurrentelevation of PCWP to .18 mm Hg (post-capillary PH) and in 4 pts, PCWP remained ≤18 mm Hg (pre-capillary PH). Both mPAP and PCWP decreased during exercise in 2pts and no PH was concluded.Conclusion: Excercise hemodynamics could be an effective tool for distinctionbetween pre-capillary and post-capillary PH in pts with ambiguous PCWP values. Inpts with rest PCWP 12-18 mm Hg, exercise-induced increase of PCWP over 18 mmHg could predict diastolic heart failure, which precludes further management.However, the exact cut-off values, methodology of the exercise test and outcomes ofexercise PCWP-guided treatment require further study.

P1322Right ventricular dysfunction in acute pulmonary embolism: direct correlationbetween troponin and AngioCT.

B. Rodrigues; H. Correia; E. Correia; LF. Santos; D. Moreira; A. Figueiredo; J. Pipa;I. Beirao; O. SantosHospital Sao Teotonio, Viseu, Portugal

Introduction: Cardiac troponin I (TnI) is a specific and sensitive marker of myocardialinjury. In patients with pulmonary embolism (PE) of intermediate/high risk, theincreased pulmonary artery pressure conditions a progressive right ventricular dys-function (RVD), with consequent ischaemia / necrosis.Purpose: Evaluate the correlation between increased levels of TnI and the impact onAngio CT right heart dimensions, in patients with PE.Methods: Retrospective study of 95 patients (Female -60%) consecutively admitted toPE (intermediate /high risk) in a coronary care unit (Jan. 2007 to Nov. 2010). Assessedimages from CT angiography of 87 patients (MDCT 16 cuts) and constituted twogroups(G) according to the maximum levels of TnI: GA (n ¼ 45) ,0,1; GB (n ¼42).0,1 ng/ml. Compared the clinical, analytical, ECG, echocardiography(ECHO)and AngioCT parameters. Statistical analysis with SPSS.Results: The total age average was 62,2 years (+19,1), identical in G, with womankindprevailing in both(+58%).At the symptoms in the time of admission, it was found thatdyspnea/ tachypnea(p-0,012) and syncope/fainting (p-0,05) prevailed in GB, with nocorrelation found at the Geneva and Wells scores. The blood pressure profiles revealedto be lower in the GB. At the ECG, HR (97 vs 107 bpm; p-0,039), the rate of RBBB,T-wave inversion (v1-v3) and S1Q3T3 showed themselves to be higher in GB. Labora-tory tests showed the GB with lower values on Ratio PO2/FiO2 and CrCl (p-0,003). InECHO, the PASP values revealed no linear relation.In AngioCT, GB had RV diameters (p-0,01) and the ratio RV/LV higher (1,22 vs 1,45;p-0,017). The diameter of the pulmonary artery showed no difference betweenG(+30mm), differing from the AP/Aorta ratio (GA: 0,88 GB vs 0,95; p-0.107). The diam-eters of the superior vena cava and azygos vein were higher in the GB, being identicalat the coronary sinus, which is reflected in a higher Qanadli Score (15,18 vs 20,52; p ,

0.001). The rates of overhead in interventricular septum,reflux in the inferior vena cavaand azygos vein (p-0,003) were higher in GB, revealing the TnI as an independent pre-dictor of RVD (TnI. 0,1 OR: 4,03 CI1,28 to 12,62; p-0.013). The percentage of fibrino-lytic treatment was higher in GB (46,7 vs 75,6%; p-0,006) with no differences inmortality between G(Global-5,7%).Conclusions: The value of TnI possesses a strong association with the parameters ofRVD at AngioCT (enhancing the sensitivity that has been recognized at this level),allow-ing an early evaluation of patients with severe PE, candidates to more aggressivetreatments.

Mortality curve by RDW

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P1323Bisoprolol efficacy in patients with chronic heart failure and pulmonaryhypertension due to diastolic dysfunction.

O. Pashuk; E. AtroshtchenkoRepublican Scientific and Practical Centre “Cardiology”, Minsk, Belarus

Objective: To study the effect of beta-blocker bisoprolol and enapril on the LV diastolicfunction and level of systolic pressure in pulmonary artery in pts. with CHD, compli-cated CHF and pulmonary hypertension due to diastolic dysfunction.Materials and methods: 23 patients at the age from 45 to 70 with post-infarction ather-osclerosis, complicated II FC (NYHA) CHF and secondary pulmonary hypertensionsyndrome were examined. Exclusion criteria: arterial hypertension higher thandegree II, obliterating lower extremities atherosclerosis, heart valvular disease. Allpatients were implemented with: ECG, echocardiography (Echo-CG), 6-min walktest. Life quality (LQ) was assessed with the use of Minnesota Life with Heart Failurechecklist. All studies were carried out initially, in 3 and 6 months from the beginningof the therapy. Bisoprolol was administered in initial dose of 1, 25 mg/day withfurther dose titration to 10mg/day if well tolerated, enapril from 2,5mg/day withfurther dose titration to 20 mg/day.Results: After 6 months of treatment the following indicators decreased evidently: Thetime of isovolumetric relaxation (IVRT) decreased considerably (from 116,73+8,56 to102,53+5,10 ms), E/A decreased considerably(from1,31+0,49 to 0,99+0,39(p ,

0,05)) and early diastolic filling (DT) slow-down time went up (from 138,3+1,9 to150,7+1,8 ms (p , 0,03). The level of pressure in pulmonary artery (PASP) decreasedstatistically significantly from 40,64+1,32 to 34,5+5,01 mm Hg. (p ¼ 0,01) As a resultof the therapy patient better tolerance to exercise was observed: a 6-min walk distanceincreased from 305+4,8+meters to 348,9+2,7 meters and patient life quality (LQ)improved indicator went down from 40,79+1,2 to 33,5+0,5 points(p ≤ 0,05)Conclusion: Bisoprolol and enalapril combined therapy improves significantly LV dias-tolic function and some indicators that characterize LV diastolic function in the period of6 months which is attended by pulmonary artery pressure lowering, exercise toleranceincrease and patient CHF FC II (NYHA) LQ complicated by secondary PH

SURGERY (CABG, VALVULAR, ARTIFICIAL HEART, OTHER)

P1324Prognosis following coronary artery bypass grafting in patients withpolyvascular atherosclerosis

KSS. Shafranskaya; OLB. Barbarash; VVK. Kashtalap; LSB. BarbarashSiberian Branch RAMS Institution Scientific-Research Institute for Complex Problems ofCardiov. Dis., Kemerovo, Russian Federation

Purpose: Compare the frequency of adverse cardiovascular event development a yearafter coronary artery bypass grafting (CABG) in relation to the extent of polyvascularatherosclerosis.Materials and methods: 232 patients undergone CABG in 2006 due to symptomaticcoronary atherosclerosis were enrolled in the study. Before surgery all the patientshad had an ultrasound examination of lower limb arteries and extracranial arteries per-formed. According to the ultrasound results, all the patients were divided into 3groups depending on the number of diseased vascular beds. More than 50% stenoseswere considered to be clinically significant. Group I included lower limb atherosclerosispatients (n¼ 14, 6%), group II, patients with extracranial artery lesions (n¼ 67, 28,8%)and group III, patients with both extracranial artery and lower limb lesions (n¼ 20,8,6%). The comparison of clinico-anamnestic characteristics showed that group I hadmore smoking patients than groups II and III: 11 (78,6%), 27 (40%) and 12 (60%),respectively (p¼ 0,03). Previous strokes were more often observed in group II patientsthan in group III: (7,5%) vs. 4(20%) individuals, respectively (p¼ 0,2). Group III patientswere in higher angina functional classes than the patients of group I and II (p¼ 0,03).Thefrequency of the development of adverse cardiovascular events, e.g. cardiac death,myocardial infarction (MI), stroke, readmission for unstable angina, was assessed ayear after CABG. Any of these events was considered to be an adverse CABG outcome.Results: After a year of follow-up the groups turned out to be similar in the frequency ofMI development. Group II patients more often developed stroke than the patients ofgroup III: 12 (18%) vs. 2 (10%) cases, respectively (p ¼ 0,6). There were no strokesin group I. Still high angina classes were observed in the patients of group II comparedto the patients of group I and III: 58 (87%), 9 (64,3%) and 14 (70%), respectively (p ¼0,01). 2 (14,3%) patients of group I, 5 (7,5%) patients of group II and 2 (10%) patients ofgroup III developed a fatal outcome (p ¼ 0,8).Conclusions: Non-coronary atherosclerosis is associated with long-term adverse out-comes in patients undergone CABG. The number of the diseased vascular bedsdoesn’t have any significant impact on the adverse outcome development.

P1325Coronary surgery with arterial grafts in patients with chronic heart failure: theuse of calcium antagonists to reduce the risk of postoperative complicationsand improve long-term prognosis

M. Dyakova; Y. Vechersky; V. Zatolokin; K. EremenkoResearch Institute of Cardiology SB of RAMS, Tomsk, Russian Federation

Purpose: to evaluate the effect of calcium antagonists on the development of post-operative complications and survival in patients with heart failure undergoing coronaryartery bypass grafting (CABG) using two or more arterial grafts.Methods: The study included 106 patients with multivessel coronary disease, and CHFII - III NYHA class, aged 58,4+8,0 years, who underwent CABG with the use of two ormore autoartery as a conduits. For prevention of systemic hemodynamic disorders ofarterial grafts calcium antagonists were administered systemically and arterial graftswere exposed to nifedipine during surgery. Depending on the tactics of pre- and post-operative period all pts were divided into 3 groups: in group I (n ¼ 51) amlodipine (5mg/day) was used. In group II (n ¼ 25) felodipine (5 mg/day) was administered,in group III (n ¼ 30) calcium antagonists were not administered. Groups were similarin terms of preoperative and intraoperative variables including NYHA Class. The follow-ing clinical parameters were assessed: ischemia, myocardial infarction (MI), death,hypotension, tachycardia. The average follow-up was one year.Results: In group I in 3,9% cases suffered perioperative infarction, in 5.9% cases - tran-sient myocardial ischemia developed in the early postoperative period, in 3,9%cases tachycardia was observed and in 31,3% cases - hypotension. All complicationswere resolved without lethal consequences on the background correction of treatmentand in some cases, reducing the dose of amlodipine, or its temporary cancellation. Ingroup II - incidents of ischemia and infarction were not observed, in 12% cases - supra-ventricular tachycardia (SVT)developed and in 28% - hypotension, also corrected withdecrease in dose. Group III marked the largest number of complications: in 10% casesintra-operative MI was developed, of which in 3,3% case was fatal due to MI in thebypassed area with radial artery graft, in 20% cases - revealed symptoms of myocardialischemia in the early postoperative period and in 40% cases - SVT has occurred andrequired correction of the treatment. Occlusion or stenosis of arterial grafts were notrevealed in conducting an autopsy (n ¼ 1), as well as angiography (n ¼ 5) in allpatients with MI. Thus, the development of both intra-and postoperative complicationswere attributed to the phenomena of transient spasm, and reduction of blood flow inarterial grafts.Conclusion: Appointment of calcium antagonists allows for effective primary preven-tion of vasospasm during and after coronary bypass grafting with multiple arterialgrafts with high efficacy in the prevention of myocardial ischemia.

P1326Morbidity and mortality prediction in aortic valve surgery: comparison of tworisk stratification models.

E. Pereira; G. Silva; M. Ponte; O. Sousa; D. Caeiro; R. Carvalho; A. Albuquerque;L. Simoes; J. Primo; V. GamaCentro Hospitalar Vila Nova Gaia, Porto, Portugal

Purpose: The European System for Cardiac Operative Risk Evaluation (EuroSCORE)and the Society of Thoracic Surgeons mortality risk score (STS) are commonly usedto predict operative mortality in cardiac surgery. Our aim was to compare this two stra-tification models with regard to prediction of 30-day and 1-year mortality and morbidityafter aortic valve replacement (AVR). Methods: A total of 214 cases of isolated AVR(patients with severe aortic stenosis) performed at our center were retrospectivelyreviewed. Score validity was assessed by calculating the area under (AUC) the receiveroperating characteristics (ROC) curve [accompanied by 95% confidence intervals (CI)and p value]. 30-day morbidity was defined by 5 points of outcome [stroke (S), myo-cardial infarction (MI), renal failure, required pacemaker, mediastinitis] and 1-year mor-bidity by 6 points (S, MI, hospital readmission, prosthetic valve replacement, bleedingand thromboembolic events). We excluded 13 patients (pts) with incomplete follow-up.Results: Mean age was 70.2+9.9 years; 56.1% were female. The predicted overallmortality using STS was 2.4+1.6% and 7.5+6.4% using the logistic EuroSCORE. Mor-tality rates were 2.8% at 30-days and 6.5% at 1-year. The 2 scores showed moderatedcorrelation (r ¼ 0.55, p , 0.001). The discriminatory power of the 2 score algorithms forthe outcome measures are presented. The logistic EuroSCORE had a significantlybetter discriminatory power for 1-year mortality among males (F:AUC ¼ 0.94, CI[0.88-1.0], p ¼ 0.003 vs C:AUC ¼ 0.64, CI [0.40-0.88], p ¼ 0.297) and younger pts(,75: AUC ¼ 0.86, CI [0.67-1.0], p ¼ 0.001 vs ≥75: AUC ¼ 0.69, CI [0.59-0.80], p ¼0.351). Conclusions: In pts undergoing isolated AVR, logistic EuroSCORE yieldedthe highest predictive value for 1-year mortality, particularly in males and youngerpts. It may also be useful to predict 30-day morbidity. The correlation between STSand logistic EuroSCORE was only moderate in our population.

Validity of scores

30-day mortality(AUC (CI);p value)

1-year mortality(AUC (CI);p value)

30-day morbidity(AUC (CI);p value)

1-year morbidity(AUC (CI);p value)

LogisticEuroSCORE

0.51 (0.1-0.92);p ¼ ns

0.79 (0.64-0.93);p ¼ 0.004

0.64 (0.54-0.75);p ¼ 0.007

0.53 (0.42-0.64);p ¼ ns

STS 0.63 (0.34-0.93);p ¼ ns

0.64 (0.49-0.78);p ¼ ns

0.56 (0.46-0.66);p ¼ ns

0.54 (0.43-0.64);p ¼ ns

AUC = area under ROC curve; CI ¼ 95% confidence interval; ns = p value not significant(.0.05).

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CASES

P1327Pneumonia versus cardiogenic pulmonary edema: serious managementimplications

F. Simoes Marques Assuncao Caetano1; J. Silva1; P. Mota1; P. Coutinho1; A. Botelho1;M. Antunes2; A. Leitao Marques1

1Hospital Center of Coimbra, Coimbra, Portugal; 2University Hospitals of Coimbra,Coimbra, Portugal

Introduction: Acute dyspnea is a relatively common problem with multiple etiologies(cardiac, respiratory or even psychogenic). Treatment typically depends on the under-lying cause, which can sometimes be misleading.Case report: A 62 year-old woman, without relevant past medical history, was admittedfor severe dyspnea and fever with 4 days duration. On admission she presented with:apical pansystolic murmur; bilateral apico-caudal rales; paO2 42mmHg; leukocytosiswith neutrophylia and high C-reactive protein; troponin I 4.6ng/mL; massive bilateralhaziness more extensive in the right hemithorax; electrocardiogram showed inferiorfibrosis and anterior ST-segment depression. Initial transthoracic echocardiography(Echo) showed: hypercontractile left ventricle without wall motion abnormalities; leftatrium slightly enlarged; eccentric mitral regurgitation (MR). She was admitted in theIntensive Care Unit with the diagnosis of community acquired pneumonia (CAP), onmechanical ventilation, vasopressor amines and antibiotherapy (ATB). Transesopha-geal Echo (TEE) showed: significant posterior leaflet prolapse of mitral valve probablydue to chordae rupture; image consistent with vegetation on the ventricular side of thisleaflet; severe MR. She completed 7 days (D) of ATB and in D10 she was transferred tothe Cardiac Intensive Care Unit. The recognition of the importance of MR in the etiologyof the respiratory distress led to the suspension of vasopressor amines and emphasison vasodilator therapy. She was always mildly febrile. TEE (D14) showed an increase inthe dimensions of the image consistent with vegetation. Empiric ATB directed to infec-tive endocarditis (IE) was begun (D14) and treatment with levosimendan (D15) per-formed. Pulmonary congestion improved and patient was extubated on D19. Cardiaccatheterization on D28, revealed a giant v wave and a 99% lesion on the postero-lateral branch of the right coronary artery. After 4 weeks of ATB she was submittedto successful surgical mitral valve repair.Discussion: This case is paradigmatic of the diagnostic challenge that some patientsrepresent. Being interpreted as a CAP with shock criteria, she was put on vasopressoramines with subsequent worsening of concomitant severe MR. Regarding etiology,was it a silent inferior myocardial infarction complicated with chordae rupture or IE ina patient with previous ischemic MR, the question remains.

P1328Fatal low cardiac output syndrome in a young male patient with celiac sprueand accompanying cytomegalovirus infection

L. Toth; ZS. Surinya; G. Szalai; J. SiposErzsebet Teaching Hospital, Sopron, Hungary

Purpose: Over the recent years numerous articles has drawn attention to the possiblerelationship between celiac sprue not treated with the correct diet and dilatative cardi-omyopathy. Other studies have not found proof of this relationship. Many articles dealtwith virusinfections in celiac sprue. With this case of ours we would like to draw atten-tion to the possibility that celiac sprue not treated correctly with diet either in itself or ascause of sensitivity to virusinfections can lead to severe myocardiac disease.Materials and methods: In our case a 39 years old male patient was admitted to ourdepartment with progressive dyspnea that started about 6 weeks earlier. By his admis-sion we found symptoms of heart failure/left and right ventricle insufficiency and lowblood pressure. The echocardiography showed diffuse hypokinesis, significant dilata-tion of both ventricles, and cardiomegaly with impaired systolic and diastolic left ven-tricle function. This patient had not had any cardiac complaints earlier and had nottaken any medication. With diuretic treatment his state did not show any improvement,moreover, he needed catecholamine for his low cardiac output. The diastolic dysfunc-tion was accompanied by systolic dysfuntion as well. Amyloidosis was excluded. Thepatient’s allover state gradually and uncontrollably worsened, so there was no myocar-dium biopsy done. After a few days of treatment the patient died in uncontrollable sys-tolic insufficiency.Results: We received the results of virus serology after his death showing extreme highlevel of anticytomegalovirus antibodies. In the course of autopsy an extreme cardiome-galy (a heart of 850 gr) was found with dilated caves and suffusions in the myocardium.In the histology there was interstitial fibrosis and typical cells of cytimegalovirus infec-tion found.Conclusions: In our opinion the celiac sprue, not treated correctly with diet, in associ-ation with cytomegalovirus infection caused systolic and diastolic dysfunction and leadto the deterioration of the patient’s state and his death. Therefore regular cardiologicalcontrol examinations and in case of any new symptoms virus serology would be veryimportant to prevent such cases in the future

P1329Hypocalcemia as a reversible cause of heart failure

I. Rangel1; G. Barbosa2; C. Sousa1; S. Oliveira1; A. Lebreiro1; A. Sousa1; PB. Almeida1;M. Campelo1; T. Pinho1; MJ. Maciel1

1Sao Joao Hospital, Porto, Portugal; 2Centro Hospitalar do Tamega e Sousa, Penafiel,Portugal

Introduction: The central role of calcium in the myocardial contraction and relaxation iswell established. Hypocalcemia is an uncommon cause of heart failure, with fewreports on the literature describing this causal relationship.Clinical case: The authors report the case of a thirty-five-year-old woman, with no priorhistory of cardiac events, who underwent a total thyroidectomy for a euthyroid largemultinodular goiter. In the early post-operative, she developed a clinical presentationconsistent with acute pulmonary edema. The electrocardiogram showed sinus tachy-cardia with corrected interval QT (QTc) discreetly enlarged (481ms). Chest radiographyshowed evidence of pulmonary congestion. The echocardiogram showed a normalcardiac chambers size, severe global dysfunction of left ventricle and a transmitralflow with a restrictive pattern. A rise in the myocardial necrosis biomarkers wasdetected (troponin I: 1,43 ng/ml), as well as hypocalcaemia (ionized calcium: 0.88mmol/L), associated with a hypoparathyroidism (parathormone: 29,7 pg/ml). Thyroidfunction tests were normal.The patient was admitted in the Cardiology Intensive Care Unit with cardiogenic shock,requiring inotropic support for 24 hours. She showed several tetany episodes whichwere solved with calcium supplement.After the clinical and haemodynamics stabilization, she repeated the echocardiogram,under normocalcemia and normal QTc interval, which showed the recovery of the leftventricle function, without any asymmetries in the segment contractility and with anormal transmitral flow pattern. The cardiac catheterization showed angiographicallynormal coronary arteries. The patient underwent a cardiac magnetic resonance,which didn’t show any change either. Screening for autoimmune disorders wasnegative.The patient was discharged in an asymptomatic state receiving calcium carbonate, cal-citriol and levotiroxin.Conclusion: Acute hypocalcaemia induced by iatrogenic hypoparathiroidism, incontext of total thyroidectomy, can lead to severe clinical manifestations. This caseenhances the importance of considering hypocalcemia as a reversible cause ofmiocardiopathy.

P1330Lethal outcome of a takotsubo cardiomyopathy due to cardiogenic shock in a83 y old lady

A. Fleig; K. SeitzKKH Sigmaringen, Sigmaringen, Germany

During the last years takotsubo cardiomyopathy or apical ballooning was increasinglyrecognized as a condition mimicking myocardial infarction with an estimated incidenceof 1-2% of all acute coronary syndromes. Despite remaining uncertainties concerningpathophysiology and treatment, apical ballooning is usually regarded as a ratherbenign condition with typically complete recovery of left ventricular function withinseveral weeks and usually an excellent prognosis.We present the case of a 83 y old lady undergoing an artificial hip replacement due toosteonecrosis of the hip. 4 weeks ago a preoperatively performed echocadiographyhad shown a completely normal LV-function. Shortly after extubation the lady was com-plaining of a progressive dyspnea, resulting from pulmonary edema. Troponin T wassomewhat elevated (0,49ng/ml) and the ECG showed slight ST-segment elevationsin 1, avL. Unfortunately the clinical condition of the patient deteriorated rapidly andthe lady had to be reintubated.The urgently performed invasive diagnostic procedure showed a massive reduction ofleft ventricular contractility resulting in an ejection fraction of only about 15 to 20%. Onlythe very basal parts of the ventricle were still contracting. Coronary arteries showedsome irregularities but no significant stenoses, thus defining takotsubo cardiomyopa-thy. Due to hemodynamic instability an IABP was inserted. Despite intensive caremeasurements the patient developed multiple organ failure and died only one dayafter hip replacement due to progressive cardiogenic shock.In conclusion, despite the generally excellent prognosis, in single cases takotsubocardiomyopathy can result in a rapid deterioration of left ventricular contractility evenwith lethal outcome.

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P1331Acute heart failure: an unexpected etiology

F. Simoes Marques Assuncao Caetano; L. Paiva; P. Mota; J. Trigo; S. Basso; L. Araujo;A. Leitao MarquesHospital Center of Coimbra, Coimbra, Portugal

Introduction: Acute heart failure is a medical emergency requiring at the same timediagnostic and therapeutic strategies. The absence of clinical improvement with stan-dard measures and the presence of continued hemodynamic instability pose a dualproblem, not easy to solve.Case report: A 62 year-old man was admitted for worsening dyspnoea, along 3 weeks.He presented in NYHA IV. Previous medical history of high blood pressure and perma-nent atrial fibrillation. On examination: blood pressure 85/55mmHg, heart rate 95bpmand tachypnoea (40cpm). Ancillary tests at admission showed: hypoxemia with meta-bolic alkalosis, hypokalemia, renal insufficiency, troponin I 0.66ng/mL, NT-pro-BNP4060pg/mL and C-reactive protein 7.6g/dL; cardiomegaly and left pleural effusion onchest x-ray; electrocardiogram showed non-diagnostic abnormalities. Diuretic and anti-biotic intravenous therapy were started, with little clinical improvement. Bedside trans-thoracic echocardiography (TTE) showed: non dilated left ventricle, with normal wallthickness and severe depression of left systolic function, mild pericardial effusion.Levosimendan perfusion on the fourth day of hospitalization and cumulative negativefluid balance produced no clinical improvement. Angiography excluded coronarydisease. By day 7 patient status stayed unchanged: tachypnoea, hypotension, tachy-cardia; clear lungs, worsening renal and hepatic functions; prostate specific antigen57.6ng/mL. TTE was repeated: a bulky mass in the basal portion of the inferior andposterior walls of both ventricles was detected, with intermediate and heterogeneousechogenicity, apparently adherent to the myocardium. Thoracic computed tomographyrevealed multiple mediastinic lymph nodes, forming conglomerates; a heterogeneousand nodular mass (12cm X 3cm) interesting the atrioventricular grooves, apparentlyadherent to the myocardium. Balancing lymphoproliferative versus metastaticdisease, the Hematologist decided to perform empiric chemotherapy, with excellentand rapid clinical improvement; the Urologist prescribed LH-RH agonist. Biopsy ofsupraclavicular node showed Diffuse Large Cell Lymphoma. Three weeks laterpatient was discharged in NYHA II.Discussion: This case report was a diagnostic and management challenge. The clini-cal instability of the patient precluded access to better diagnostic procedures (such asmagnetic resonance or mediastinic biopsy). The severe clinical presentation althoughapparently common hid an unusual etiology. Initial prognosis which was very poorturned out to be good after appropriate treatment.

P1332Arrythmogenic right ventricular dysplasia as a cause of heart failure. Casereport

I. Rilo Miranda; JR. Beramendi Calero; A. Izaguirre-Yarza; M. Castillo-Judez; S. Bianco;R. Garcia-Martin; T. Echeverria Garcia; E. Uribe-EcheverriaHospital Donostia, San Sebastian, Spain

A 30 years woman without medical precedents and whose parents where cousins infirst grade, 2 days after anormal childbirth presents short of breathness, edema andorthopnea with an EKG that demostrated epsilon wave in the right precordial leads( v1 to v3 ). In the ecocardiography presents a dilated left ventricle with a severlyimpaired left ventricular function and a dilated right ventricle with decreased func-tion.The epsylon wave in EKG ( arrow in figure 1) and a Cardio Magnetic Resonancethat demostrated fatty infiltration of the myocardion with a severily impaired functionof the two ventricles gave us the diagnosis of arrytmogneic right ventricular myocardio-pathy with involment of the LV.Conclusions: Arrytmogenic right ventricular dysplasia is a diagnostic alternative inyoung patiens with heart failure and impaired function of left and right ventricles.TheLV involvement may occur early in the course of the disease with some frecuency.

P1333The possible role of the new neurohormonal system in hronic heart failure

O. KaterenchukRegional Clinical Cardiological Center, Poltava, Ukraine, Ukraine

During the last decades great progress in understanding of pathology of chronic heart-failure was made. First of all the understanding of changes in functioning of thehormo-nal systems makes possible to provide new effective drugs (ACE inhibitors,b-

blockers)for treatment heart failure patients. But do we find all newpossible therapeuti-cally targets nowadays?During the last year about 28 patients with chronicheart failure of III-IV class of NYHAwere observed in our clinic. In thisobservation were enrolled patients with known pre-vious myocardial infarction(18 patients), with dilated cardiomyopathy (9 patients) myo-carditis (1patient). Despite the different aethyology many common changes forthesepatients were found. First of all for evaluation of their mental status the HAD(Ha-miltonquestionnaire) score was used. Its interesting that in 26 patients were foundahigh score for depressive status (more than 10 score). Secondly, all of thesepatientshad a dyslipidaemia of different types. Third, one of the mostprevalent complaint (26patients) was the lose of appetite. During the periodof 3-6 months prior for hospitaliz-ation 20 patients confirmed the body mass losefor about 3-12 kg.All this findings - bodymass lose, lose of appetite, dyslipidemia, weaknessand depression are commonresults of the endogenous cannabinoid system blockade (CR type 1 blockade). In almodern scientific abstracts endogenous cannabinoidsystem is characterized asshort-acting system, that works in"demand-regime". But lets look that most hormonalsystems in human organismhas not only stimulated secretion, but also - a basalsecretion. Its possiblethat in advanced chronic heart failure patients the dysfunctionof eCS ispresent. So the implementation of cannabinoid-like drugs could possiblyhelp inmanagement of this kind of patients. Its may be looks unbelievable but letsre-main that morphine (drug used ar anesthetic of central type) has positivehaemody-namic influence in acute heart failure. So why cannabinoid-likesynthetic drugscouldn’t be helpful in advanced heart failure by modifyingmental status, lipid profile,weight and haemodynamical status. Furtherinvestigations in this way might be interest-ing and useful.

P1334Dengue myocarditis simulating acute myocardial infarction - a case report

Figueiredo1; Carneiro1; Randt1; Siqueira2; Werner1; BE. Quirino1; Maia1; Melo1

1Hospital Life Center, Belo Horizonte, Brazil; 2INSTITUTO HERMES PARDINI, BELOHORIZONTE, Brazil

Background: Dengue is an arbovirus infection, endemic in tropical countries, as Brazil,transmitted to humans by Aedes aegypti mosquito.It is manifested by sudden onset ofhigh fever, severe headache, myalgias, arthralgias and characteristical bright red pete-chia on the lower limbs and chest, because of low platelets. Cardiac complications arerare and myocarditis is the most commonly documented. However, no more than 50cases of dengue myocarditis are reported in the literature, with variable prognosis.Because of common clinical and eletrocardiographyc manifestations myocarditis canmimic acute myocardial infarction (AMI). Cardiac magnetic resonance is helpful in dif-ferentiating them. Methods: We report a case of dengue myocarditis, simulating acutemyocardial infarction, with a good outcome. Results: A 32 ys old, previously asympto-matic man, with no risk factors for AMI, living in a dengue endemic area, started withhigh fever, severe headache, myalgias and arthralgias. Symptoms lasted three days.He was kept at home. Seven days later, suddenly developed diffuse and oppressivechest pain. Physical examination showed tachicardia, normal blood pressure andcardiac auscultation, with no pulmonary rales. ECG revealed ST-segment elevation inV1-V5. Emergency cardiac catheterization showed normal coronary arteries and ventri-culogram. Cardiac troponin I was elevated. There was also lymphocytopenia andnormal platelet count. Cardiac magnetic resonance (MR) showed late gadoliniumenhancement of the mid-wall, without subendocardial involvement, suggestive of anon-ischemic etiology (Myocarditis) of the anterior, inferior and septal walls. Biventricu-lar function was normal. Serological examination for Dengue IgM was positive, confirm-ing acute infection. The patient was monitorized at the intensive care unit and receivediburofen. He experienced rapid improvement in symptoms and was withdrawn from thehospital when cardiac troponin and ECG normalized, completely asiymptomatic, sevendays after admission. At six months of follow-up, he remains asymptomatic, and had nonew cardiac event. Conclusions: The present case showed that myocarditis, a rarecomplication of dengue, simulated AMI. Cardiac MRI helped to differentiate both enti-ties. Early diagnosis was important for good outcome.

P1335Satisfactory clinical response of autologous stem cells implant in one severeidiopathic dilated myocardiopathy patient, by magnetic resonance imagingCase Report.

Greco1; A. Souza2; JLB. Jacob1; MA. Ruiz1; MR. Lago1; AC. Abreu1

1Institute of Cardiovascular Diseases (IMC), Sao Jose do Rio Preto, Brazil; 2Ultra-XRadiologia, Sao Jose do Rio Preto, Brazil

Case Report: 62 years-old male patient referred to our institute in Sao Jose do RioPreto with evident congestive cardiac failure New York Health Association (NYHA) func-tional class IV. The electrocardiogram (ECG) showed atrium fibrillation rhythm withimportant left ventricle overload and alteration in the ventricle repolarization. Themaximum VO2 was 10.52 ml (kg/min) and the Echo bi-dimensional (ECO) showedthe left ventricle ejection fraction (LVEF) of 19% (Sympsom Method) with left ventriclediastolic diameter of 64mm and systolic diameter of 57mm, indicating severe idiopathicdilated myocardiopathy and left ventricle hypocinesia. Due to the previously mentionedclinical history, the patient was submitted to autologous BMSC implant (3.03x108 cell/mm3), via intracoronary, before followed all ethical guidelines of National ResearchEthics Committee (CONEP Number: 15,342; Clinical Trial number: NCT00800657).Twelve months after the BMSC implant, the patient had a good evolution in the post-implant with improvement of NYHA functional class to II, with optimized medication

echo

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use. There was also an improvement of the additional exams such as cineventriculo-graphy, ECO (LVEF ¼ 55.3%), radioisotopic ventriculography and maximum VO2 of16.28 ml (kg/min). However, the result that showed better response and compatibleto the clinical history was the magnetic resonance imaging (Figure 1) where in thepre-implant the LVEF was 24.8%, the final diastolic volume was 335.7ml and final sys-tolic volume was 252.5ml, both on left ventricle. The same exam in the post-BMSCimplantation showed LVEF of 56.5%, diastolic volume of 134.7ml and final systolicvolume of 58.6ml. The muscle cardiac mass also had a slight improvement, from216.4g to 214.0g.Conclusion: Patient with severe idiopathic dilated myocardiopathy and congestiveheart failure refractive to medication treatment had a good clinical response to theimplant of autologous stem-cells, with significant reduction of the systolic and diastolicvolume of the left ventricle by magnetic resonance imaging. So, we believe that BMSCis a safe procedure and possible to be applied in patients with dilated myocardiopathyrefratary to conventional therapeutics.

P1336The iron heart; the story of a refractory heart failure in a 37 years old man withidiopathic hemochromatosis

D. Bartos; AM. Daraban; E. BadilaEmergency Hospital Bucharest, Bucharest, Romania

Introduction: Idiopathic hemochromatosis is the most common, identified, genetic dis-order in the Caucasian population characterized by a progressive iron overload sec-ondary to high intestinal iron absorption. After a latent period of many years,manifestations of liver cirrhosis, diabetes mellitus, cardiac failure, hypogonadism,skin hyperpigmentation and arthropathy can occur. In the past, cardiac disease wasthe presenting manifestation in up to 15 percent of patients with hemochromatosisthus, the absence of other characteristic findings of hemochromatosis should not pre-clude the diagnosis.Case report: We report the case of a 37 years old male, with no family history and nocardiovascular risc factors, with a five years evolution of cardiac failure, increased pig-mentation of the skin, liver disease and recent involvement of thyroid gland and dia-betes mellitus associated with biochemical markers of iron overload. The cardiacinvolvement consisted in dilated cardiomiopathy with severe disfunction of the left ven-tricle and severe cardiac failure and cardiac arrhythmias – atrioventricular conductionblock (type I and tipe III) and ventricular tachyarrhythmia consisting in bigeminy, trige-miny, but also ventricular tahicardia with syncope that required implantation of a defi-brillator. Even under maximum treatment for heart failure the evolution was towardsevere sistolo-diastolic disfunction and dilatation of the left and right ventricle andrefractoriness to all treatment options. The association of liver chirrosis, diabetes melli-tus and hypothyroidism are all manifestation of hemochromatosis that aggravated theprognosis of the patient. Therapeutic phlebotomy is the effective way to remove accu-mulated iron in non-anemic patients with iron overload and has a variety of benefits,including improvement in or resolution of varices, reduction in the degree of hepaticfibrosis if cirrhosis is absent, reversal of left ventricular dysfunction, and some reversalof secondary hypogonadism in men but is contraindicated in patiens with heart failureor uncontrolled heart disease excluding this type of treatment in the patient presented.Conclusions: This case presented best illustrates the complete spectrum of cardiacmanifestations of idiopathic hemochromatosis.

P1337Left ventricular non-compaction with diaphragmatic hernia and heartdisplacement to the right side of the thorax (functional dextroversion)

P. Rubis1; T. Miszalski-Jamka2; J. Podolec3; M. Kostkiewicz1; A. Lesniak-Sobelga1;E. Suchon1; T. Senderek1; M. Szuksztul1; P. Podolec1

1Department of Cardiac and Vascular Disease, John Paul II Hospital, Institute ofCardiology, Krakow, Poland; 2John Paul II Hospital, Department of Diagnosis,Prevention and Telemedicine, Krakow, Poland; 3Jagiellonian University, John Paul IIHospital, Dept of Haemodynamic and Angiocardiography, Krakow, Poland

We report a 45-year-old man with "dextroversion" diagnosed in childhood, with a2-month history of breathlessness, fatigue and irregular heart rate. At presentation he

was stable with a HR of 100/min, BP of 140/90 mmHg, SpO2 98%, NYHA class II.On physical examination he was euvolemic, with normal jugular venous pressureand clear lung fields. Standard 12-lead ECG showed atrial fibrillation, low R-wavesvoltage and deep S-waves with non-specific ST changes in V1-V6. After electrodeswere replaced to the right side of the thorax, ECG revealed prominent R-waves in pre-cordial leads. A chest X-ray showed an enlarged cardiac silhouette. Computed tom-ography revealed an anterior Morgagni-type congenital diaphragm hernia resulting inthe heart dislocation to the right side. A transthoracic echocardiogram revealed anenlarged and hypertrophied left ventricle (LV) with severe global systolic impairment.Cardiac magnetic resonance demonstrated heart displacement caused by abdominalhernia with systolic dysfunction of the enlarged LV (end-diastolic volume 197 ml, ejec-tion fraction 20%). A thinned apex (4.5 mm) coupled with increased trabeculation (up to15 mm) at the apex, posterior, lateral and anterior wall was indicative of LV non-com-paction. Moreover, the examination revealed the persistent left superior vena cava(arrow) draining to the coronary sinus. Coronary angiography excluded coronaryartery disease and other pathological findings. Left ventriculogram confirmed globalLV systolic dysfunction and two-layered LV structure with deep recesses. Right heartcatherization showed no intra-cardiac shunts, normal cardiac output of 4.3 l/min,mean pulmonary artery pressure of 25 mmHg, PWCP of 12 mmHg, and pulmonaryvascular resistance of 3 Wood units. This case is an illustrate of a first ever coincidenceof LV non-compaction, persistent left superior vena cava with a congenital anterior Mor-gagni-type diaphragm hernia, resulting in heart displacement to the right side of thethorax, mimicking dextroversion. In summary, we established LV non-compaction asthe true reason for the patient’s heart failure. The patient has been disqualified fromthoracic reconstructive surgery and was prescribed with pharmacotherapy, includingbeta-blockers, angiotensin-converting enzyme inhibitor and aldosterone antagonist,along with oral anticoagulation. The patient remains as an outpatient in the heartfailure clinic.

P1338Heart failure with normal ejection fraction in a patient with unclassifiablemultiple endocrine neoplasya

AI. Popa; CL. Andrei; VP. Chioncel; RM. Ianula; DE. Mincu; FC. Adam; LN. Axente;M. Dasoveanu; M. Anastasiu; CJ. SinescuBagdasar Emergency Hospital, Bucharest, Romania

We report the case of a patient, T.E., 71 years old, admitted in the emergency room forrest dyspnoea, fatigue and drowsiness started two weeks ago. Clinical examinationrevealed obesity, rough skin, bradycardia, BP ¼ 160/80 mmHg (without any treatment),moderate systemic congestion, bradylalia, drowsiness, bass voice. On initial electro-cardiogram: sinus rhythm, 60 beats/minute and non-specific T wave inversion inlateral leads; after several days occurred persistent junctional rhythm. Chest X-rayrevealed cardiomegaly, interstitial oedema and a right subclavicular opacity, 30 mmin diameter. Thoracic and abdominal TC scan performed to elucidate the aetiologyof this pulmonary opacity excluded a lung neoplasya but described a right suprarenalmass 6/6.5/6 cm, with heterogenic iodofily and without net limit to the kidney. The lab-oratory test were suggestive for myxedema (TSH 41.35mU/ml, FT3 1.33 pmol/l, FT4 7.3pmol/l); we note also high values of parathormon (276 pg/ml); normal calcitonin andcatecholamine values and NT proBNP 35000 pg/ml. Echocardiography and thoracicscan revealed important left ventricular hypertrophy (IVS/PW ¼ 20/18 mm), withoutsub aortic gradient, left atrial dilatation, an ejection fraction of 60%; Doppler examin-ation of mitral flow showed prolonged deceleration time of E wave and the value of sys-tolic pulmonary pressure based on tricuspid regurgitation was 50 mm Hg. Thyroidechography was suggestive for Hashimoto disease, confirmed by the presence ofthyroid antibodies. Echo and TC scan have not revealed a parathyroid tumour. The cer-ebral MRI diagnosed a hypophysar cystic mycroadenoma. The presence of the suprar-enal tumour (without clinical and biological signs of pheocromocytoma) concomitantwith a hypophysar cystic mycroadenoma and hyperparathyroidism, with normalvalues of calcitonin and echographyc findings of Hashimoto disease, excluding amedullar thyroid carcinoma leads us to diagnose an unclassifiable multiple endocrineneoplasya (MEN) associated with hypertrophic cardiomyopathy (due to hyperparathyr-oidism) and heart failure.

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POSTER SESSION 5puma.isti.cnr.it/rmydownload.php?filename=cnr.ifc/... · 95%:1,84-6,59); p , 0,001; C3 vs. C1: HR ¼ 3,18 (IC 95%:1,62-6,21); p ¼ 0,001. Conclusions: In patients

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