European Journal of Preventive Cardiology

doi: 10.1177/2047487315586741pmid: 26078081

Moderated Poster Session IV - Prevention, Epidemiology & Population Science Friday, 15 May 2015, 15:30-16:30 P421 High cardiorespiratory fitness abolishes the negative effect of long sedentary time on cardiovascular risk factor clustering. The HUNT Study, Norway J Nauman1, D Stensvold1, J Coombes2, U Wisloff1 1Department of Circulation and Medical Imaging, DMF, NTNU , Trondheim, Norway 2University Of Queensland, School of Human Movement Studies, The University of Queensland, St. Lucia, Brisbane, Australia Topic: Sports cardiology Purpose:Finding effective ways of preventing cardiovascular risk factors (CV-RF) clustering is a major aim in preventive medicine and an important goal of current recommendation for physical activity (PA). Whether a high level of cardiorespiratory fitness (CRF) can modify the deleterious health consequences related to high sedentary time (ST) is not known. The aim of this study was to examine the potential modifying effect of CRF on the association between ST and CV-RF clustering. Methods:Cross-sectional study of 12274 men and 14209 women (=20 years) without known cardiovascular disease in Norway. Self-reported ST measurements during a regular day were divided into three sample specific equally sized groups (=4, 5-<7, and =7 hours/day). CRF was estimated using a previously validated non-exercise model. Using logistic regression analyses, adjusted odds ratios (OR) were estimated for the association of ST with CV-RF clustering, and for the potential modifying effect of CRF. Results:Each hour increase in ST was associated with 5% and 4% greater likelihood of having a CV-RF clustering independent of PA in men and women, respectively. Among participants with higher levels of fitness (VO2peak>43.3 mL·kg-1·min-1 in men, and VO2peak>35.2 mL·kg-1·min-1 in women), the adjusted ORs associated with =7 h/day of ST were 0.92 (95% CI, 0.56-1.51) for men, and 1.16 (95% CI, 0.49-2.74) for women with high fitness levels, compared with the men and women with low ST (=4 h/day) and high fitness levels. In combined analyses of fitness, PA and ST, compared with the reference group of participants meeting the recommendations, =4 h/day of ST and high fitness, the adjusted ORs were 0.63 (95% CI, 0.27-1.44) and 0.65 (95% CI, 0.14-3.07) in fit men and women with =7 h/day of ST, and not meeting the recommendations. Men and women meeting the PA recommendations, but being unfit (VO2peak<35.7 mL·kg-1·min-1 for men, and VO2peak<28.4 mL·kg-1·min-1 for women) had significantly increased odds of having CV-RF clustering across different levels of ST. Conclusion:High levels of CRF abolished the increased odds of having a clustering of CV-RF associated with high ST, even among those individuals who did not meet current PA recommendations. P422 Long-term cardiovascular disease risk estimation in low-incidence European populations: the CAMUNI-MATISS risk score M Ferrario1, G Veronesi1, S Giampaoli2, LE Chambless3, F Gianfagna1, G Grassi4, G Cesana5 1University of Insubria, Varese, Italy 2Istituto Superiore di Sanit|, Rome, Italy 3University of North Carolina, Chapel Hill, United States of America 4IRCCS MultiMedica Sesto San Giovanni, Sesto San Giovanni, Italy 5University of Milan-Bicocca, Milan, Italy Topic: Sports cardiology Purpose:Cross-sectional studies suggested a potential for improving currently adopted preventive strategies in low-incidence Countries by using long-term risk estimation models. We aim to develop the 20-year CVD risk score for the Italian population. Methods:The CAMUNI–MATISS Cohorts Collaboration Study comprises 7 population-based cohorts enrolled either in Northern (Brianza area, MONICA-Brianza and PAMELA studies) or in Central (Latina area, MATISS study) Italy between 1983 and 1996. Baseline risk factors assessment followed a MONICA-like protocol. Subjects aged 35 to 69 and free of CVD at baseline were followed-up for the occurrence of first coronary event, including revascularizations, or ischemic stroke, fatal and non-fatal. We used the Brianza and the Latina cohorts as derivation and validation sets, respectively. The score is based on sex-specific Cox regression models including age, total- and HDL-cholesterol, systolic blood pressure, anti-hypertensive treatment, cigarette smoking and diabetes. We tested the hypothesis of no differences in the strength of the association between predictors and events in the derivation and in the validation populations by fitting two sex-specific Cox models on the whole data with predictor*set interactions. We estimated model calibration (Pearson chi-square statistic) and discrimination (Area Under the ROC curve, AUC) in the validation set; as well as the Net Benefit for using the score as second-level screening in subjects at low predicted 10-year risk (SCORE model<5% in men and <4% in women, no diabetes). Results:The median follow-up length was 16 years (IQR: 12-20). The 20-year cumulative risks of event were 14% in the validation and 16% in the derivation sets (log-rank test p-value=0.003) in men; and 7.0% vs. 6.1% in women (p-value=0.8). There was no evidence of differences in predictors' effect between derivation and validation sets. In the validation set calibration (Pearson chi-square statistic: 8.1 in men, 10.5 in women) and discrimination (AUC=0.734, 95%CI: 0.728-0.740 in men and 0.802, 0.796-0.809 in women) were satisfactory. When used as second level screening, the score had a Net Benefit of 3.9 (95%CI:2.1-5.7) and 2.9 (1.7-4.3) in men and women, respectively, significantly higher than a strategy based on no further screening. The CAMUNI-MATISS risk score, estimated on the pooled data, had a model discrimination of 0.742 (95%CI 0.718-0.758) in men and 0.805 (0.778-0.827) in women. Conclusions:The CAMUNI-MATISS risk score is suited for long-term CVD risk estimation in Italy, and it may improve the currently adopted primary prevention strategy. Subjects age 40-79 not taking any CVD medication: 1482 ASCVD ECVDRS ASCVD Risk calculator returning no value Low Risk Intermediate Risk High Risk Low Risk Intermediate Risk High Risk 209 (14%) 677 (46%) 181 (12%) 415 (28%) 618 (42%) 484 (33%) 380 (26%) Abnormal CIMT 272 (40%) 61 (34%) 156 (38%) 113 (18%) 211 (44%) 244 (64%) Abnormal C2 162 (24%) 50 (28%) 126 (30%) 59 (10%) 150 (31%) 192 (51%) Subjects age 40-79 not taking any CVD medication: 1482 ASCVD ECVDRS ASCVD Risk calculator returning no value Low Risk Intermediate Risk High Risk Low Risk Intermediate Risk High Risk 209 (14%) 677 (46%) 181 (12%) 415 (28%) 618 (42%) 484 (33%) 380 (26%) Abnormal CIMT 272 (40%) 61 (34%) 156 (38%) 113 (18%) 211 (44%) 244 (64%) Abnormal C2 162 (24%) 50 (28%) 126 (30%) 59 (10%) 150 (31%) 192 (51%) Open in new tab Subjects age 40-79 not taking any CVD medication: 1482 ASCVD ECVDRS ASCVD Risk calculator returning no value Low Risk Intermediate Risk High Risk Low Risk Intermediate Risk High Risk 209 (14%) 677 (46%) 181 (12%) 415 (28%) 618 (42%) 484 (33%) 380 (26%) Abnormal CIMT 272 (40%) 61 (34%) 156 (38%) 113 (18%) 211 (44%) 244 (64%) Abnormal C2 162 (24%) 50 (28%) 126 (30%) 59 (10%) 150 (31%) 192 (51%) Subjects age 40-79 not taking any CVD medication: 1482 ASCVD ECVDRS ASCVD Risk calculator returning no value Low Risk Intermediate Risk High Risk Low Risk Intermediate Risk High Risk 209 (14%) 677 (46%) 181 (12%) 415 (28%) 618 (42%) 484 (33%) 380 (26%) Abnormal CIMT 272 (40%) 61 (34%) 156 (38%) 113 (18%) 211 (44%) 244 (64%) Abnormal C2 162 (24%) 50 (28%) 126 (30%) 59 (10%) 150 (31%) 192 (51%) Open in new tab P423 AHA/ACC Pooled-cohort equations to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk vs. early/current CVD risk score (ECVDRS), an evidence based medicine risk scoring system A Sabatini1, M El Shahawy2 1Careggi University Hospital (AOUC), School of Medicine and Surgery, Florence, Italy 2Cardiovascular Center of Sarasota, Cardiovascular Health Assessment Center, Sarasota, FL, United States of America Introduction:Numerous Risk scores have been conceived and used with the aim to quantify the risk for CVD. Framingham Risk Score, one of the most used risk scoring systems, was developed when the modern diagnostic tools were unavailable, and seems to denote inefficiencies in stratifying CVD risk, especially in women. We compared risk assessment using the ECVDRS with the ACC/AHA Pooled Cohort Equations 10-year ASCVD Risk estimator. Methods:We screened 2406 asymptomatic subjects, age 20-79, for CVD risk using ECVDRS, which consists of 10 tests: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post mild exercise (PME), Carotid Intima Media Thickness (CIMT), abdominal aorta and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro-BNP. Abnormal BP rise PME was defined as systolic BP rise >30mmHg post 3-min-walk at 7% elevation, 2.5mph. The AHA-ACC Pooled Cohort Equations 10-year ASCVD Risk Calculator was used in conjunction with Microsoft Office Excel Macro-Programming. Results:Among the 2406 subjects (1258 Female and 1148 Male), 1482 were in the age range 40-79, not taking any CV medication. Prevalence of abnormal structural and functional abnormalities utilizing both risk scoring systems (10-year-ASCVD and ECVDRS) are shown in Table. Conclusion:1. Based on our data, the ACC/AHA 10-year ASCVD Risk calculator – implementing the Pooled Cohort Equations, underestimates the presence of subclinical atherosclerosis (CIMT) and abnormal vascular elasticity (C2) in all groups, particularly in the high risk category. 2. Therefore, we advocate the use of ECVDRS for CVD risk stratification and early therapeutic interventions. 3. Our data supports the notion of personalized and patient centered diagnosis and treatment. 4. Preventive interventions and treatment recommendations should be made based on current, early, structural and functional abnormalities rather than on the presumed 10 years risk P424 Long-term time trends in hospitalisation rates for myocardial infarction in the English population: a database study, 1968-2011 L Wright1, N Townsend1, K Smolina1, MJ Goldacre1 1University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom Topic: Sports cardiology Purpose:The relatively few long-term studies of trends in hospitalised myocardial infarction (MI) have found that hospitalisation rates in westernised countries have fallen since the 1980s. However, there are limited national population-based epidemiological data on MI for England spanning several decades. We examined long-term temporal trends in MI hospitalisation rates in England from 1968 to 2011. Methods:We identified all hospital admissions with a primary diagnosis of MI between 1968 and 2011 using a national routine hospital statistics dataset. We calculated annual age-standardised rates by the direct method and examined age-specific hospitalisation rates in 5-year age groups for eight 5-year time periods separately for men and women. Results:The study included 1.96 million admissions for MI (63% men). Age-standardised MI admission rates increased in the late 1960s and 1970s, peaked in the mid-1980s and then declined for both sexes thereafter. Age-specific rates are shown in the Figure. The largest rate decrease in men was in those aged 40-44 years (57% reduction in the average rate from 1968/70 to 2007/11) and in women it was in those aged 60-64 years (45% reduction). However, amongst those aged 75 years or older, a further peak was observed in the early 2000s, and overall rates in these elderly age groups rose substantially with the largest increase found in both men and women aged 80-84 years (60% increase). Conclusion:Improvements in coronary prevention and treatment are likely to have influenced the overall reduction in MI hospitalisations over several decades. However, there has been a more recent shift in MI hospitalisations from the middle-aged to the elderly, highlighting the need for continued surveillance and for coronary prevention efforts particularly in the elderly. Open in new tabDownload slide Mi Hospitalisation Rates in England P425 Outreach providers administering the NHS health check CVD prevention programme target people at higher CVD risk M Woringer1, HW Watt1, EC Cecil1, KC Chang1, AM Majeed1, MS Soljak1 1Imperial College London, London, United Kingdom Objectives:In April 2009, the Department of Health in England implemented the NHS Health Check Programme aimed at preventing vascular disease. Critics of the programme point to a lack of an evidence base and argue for a more targeted approach. The programme targeting high risk groups has been shown to be cost effective. The objective of this analysis was to assess whether delivering the NHS Health Check Programme with outreach providers compared to delivering the programme in primary care resulted in increased CVD risk case finding. Methods:41,570 Health Check attendees served by outreach providers from Jan 2008 to Oct 2013 were compared to 20,409 Health Check attendees who continuously registered with 509 practices across England between Apr 2009 and Mar 2013. The proportion of high risk individuals and the relation between risk factor prevalence and deprivation was compared using Chi Squared tests among 40-59 and 60-74 year olds. Results:Compared to primary care population, outreach providers targeted more individuals aged 40-59 (74.9% vs 64.7%), fewer men (38% vs 45%) and a larger proportion of South Asians (7.7% vs 3.2%). Outreach providers served a bigger proportion of the population in North East and North West (63.4% vs 21.96%) but fewer in South Central, South East and London areas (12.64% vs 41.63%). Whereas nearly half of the population served by outreach providers was in the most deprived fifth, the primary care population was evenly distributed by deprivation. High risk case finding was highest among individuals served by outreach providers in 40-59 year olds (0.70% compared to 0.33%) and 60-74 year olds (16.95% vs 12.50%) at p<0.001. Higher CVD risk case finding was despite the fact that the population served by outreach providers in both age groups contained fewer hypertensive, overweight, obese people and people with raised cholesterol levels. When risk factors were analysed by deprivation gradient, a stronger association was found with deprivation in the population served by outreach providers in relation to hypertension, obesity, overweight and smoking. This may be due to a stronger association between deprivation and risk factors in the North of the country. Conclusions:Outreach providers are targeting more deprived areas and communities and are case finding more high CVD risk than primary care. Hence third party provision of Health Check Programme is an effective way to deliver the programme. If the programme is successful in motivating individuals to lower their CVD risk, this has the potential to reduce health inequalities associated with CVD. P426 Social variations in secondary prevention drug use in patients with acute myocardial infarction (AMI), Sweden. M Novak1, K Toren2, M Soderberg2, M Fu3, A Rosengen3 1Sahlgrenska Academy, Dep't of Health Care Science, Gothenburg, Sweden 2University of Gothenburg, Occupational and Environmental Medicine, Gothenburg, Sweden 3University of Gothenburg, Molecular and Clinical Medicine, Gothenburg, Sweden Purpose -- To which extent post-AMI patients continue their pharmaceutical treatment long-term and whether the uptake of treatment varies with age, gender, ethnicity, and socioeconomic position? Methods:?128; We used data from the Swedish national hospital discharge register on consecutive patients registered between 2005 and 2010 with a principal diagnosis of AMI. The primary outcome was continuing use of antithrombotic, statin, and beta-blocking agents. We categorized and compared populations depending on their gender, education and ethnic background (ex. women with high education and born in Sweden or women with high education and non-Swedish, etc). Information on education was collected and merged from the LISA registry (Longitudinal Integrated database for labour market research). Results ?128; We assessed data for 84 152 AMI patients (40% women) aged 25-84 years. After adjustment for age, there was a significant difference between all social groups in males where the risk for discontinuation of antithrombotic medicine was highest among non-Swedish male with low education (OR 2.07 CI 1.80 – 2.38) compared to high educated Swedish male (referent). Whereas no differences were observed in female patients except that high educated female with foreign background had highest risk of discontinuation (OR 1.48 CI 1.15-1.92) not only compared to high educated Swedish females but also to low educated females with foreign background. Similar trends were found for the risk of discontinuation for beta-blockers and statins. Conclusions:?128; This study provides some important insight into the complex associations between different social determinants and health related factors. As well as indicating that different social stratification e.g. high education or low education are not homogenous categories, rather they differ depending on other key social features like gender and ethnicity. P427 Physical activity level, novel biomarkers and subclinical atherosclerosis in middle-aged men. Results of longitudinal over 25 years prospective observation. M Kwasniewska1, T Kostka2, A Jegier3, E Rebowska1, E Dziankowska-Zaborszczyk1, J Kozinska1, W Drygas1 1Medical University, Department of Preventive Medicine, Lodz, Poland 2Medical University of Lodz, Department of Geriatrics, Lodz, Poland 3Medical University of Lodz, Department of Sports Medicine, Lodz, Poland Topic: Sports cardiology Purpose:The purpose of the study was to investigate the influence of lifetime physical activity (PA) patterns on selected indices of low-grade inflammation and atherosclerosis in longitudinal observation of middle-aged men. Methods:The subject of the study was a cohort of 101 men aged 50-77 years (mean age 59,7 ± 9,0 years), free of cardiovascular symptoms and treatment, participating in regular follow-up examinations in the years 1980/90-2011/12. Self-report PA was assessed by interviewer-administered Seven-Day PA Recall and Historical PA questionnaire. Serum inflammatory markers (high-sensitivity C-reactive protein, oxidized LDL, homocysteine, interleukine 6, TNF alpha, adiponectine, adhesion molecules, leptin and resistine) were determined using Elisa kit. Subclinical atherosclerosis was measured by assessing the coronary artery calcification (CAC) using multi-slice computed tomography; the carotid intima-media thickness (CIMT) using high-resolution B-mode ultrasound; and the reactive hyperemia index (RHI) using peripheral arterial tonometry (EndoPAT2000). The participants were divided according to tertiles of exercise-related energy expenditure (EE) in kcal/week at baseline, i.e. <2050 (moderate; n=33), 2050-3840 (high; n=34), >3840 (very high; n=34). Results:The moderate, high and very high PA groups were comparable in terms of age, education, family history and atherosclerosis risk factors at baseline. The most pronounced association between PA and inflammatory markers was found for hsCRP, oxLDL and leptin with the significantly lower concentrations among men with maintained high PA. The mean hsCRP was 2.65, 2.40 and 2.82 mg/L; the mean oxLDL was 106.4; 89.19 and 161.11 ng/ml; the mean leptin was 9.09±7.92; 5.43±4.00; 7.79±7.95 in the moderate, high and very high PA group, respectively (p<0.05). The group with stable high PA level (EE 2050-3840 kcal/week) had also the most favorable profile of the indices of atherosclerosis (mean CAC of 10.7±28.9 Agatston units; CIMT of 0.64±0.15 mm and RHI of 2.15±0.4) with no cases of CAC > 400, CIMT =0.9 mm and RHI < 1.67. Conclusions:Maintaining regular PA level with EE 2050-3840 kcal/week through young and middle adulthood is associated with the most favorable inflammatory status and may protect against atherosclerosis in men. Higher PA level is associated with increased low-grade inflammation and less beneficial atherosclerosis indices, as measured by hs-CRP, ox-LDL, leptin, CAC, IMT and RHI. P428 Risk factors for cardiovascular mortality in a large cohort of well treated post-mi patients I Van Dis1, JM Geleijnse2, D Kromhout2 1Netherlands Heart Foundation, The Hague, Netherlands 2Wageningen University, Wageningen, Netherlands Background:In Europe, SCORE risk charts predicting 10-year cardiovascular (CVD) mortality are used to assess CVD risk in persons with multiple risk factors without manifest CVD. However, there is also a need for risk stratification in patients with established CVD. Topic: Sports cardiology Purpose:To identify risk factors which contribute to CVD mortality risk in post-myocardial infarction (MI) patients and eventually to develop risk charts predicting CVD mortality risk. Methods:From 2002-2006, data on risk factors were collected of 4.837 post-MI patients participating in the Dutch Alpha Omega Trial. Patients were followed until 1 January 2012. For the present purpose the baseline risk factor data were analyses in relation tot CVD mortality from an observational perspective. Cox's multivariable proportional hazard models were used to identify which factors significantly contribute to the CVD mortality risk. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) are presented, by standard deviation and/or generally agreed cut-offs. Results:At baseline, patients were 60-80 years old and 78% was men. Of these patients 98% received anti-thrombotics, 90% antihypertensives and 85% statins. During a mean follow-up of 6.3 years, 397 patients (8.2%) died from CVD. Preliminary analysis showed that total/HDL cholesterol (HR 0.98, 95% CI 0.91-1.06) was not related to CVD mortality but systolic blood pressure (HR 0.88, 95% CI 0.80-0.97) was inversely related. However, smoking (HR 1.43, 95% CI 1.11-1.84) and diabetes (HR 1.29, 95% CI 1.02-1.62) were strong predictors of CVD mortality. Moreover, resting heart rate (HR 1.16, 95% CI 1.06-1.28), high-sensitive C-Reactive Protein (HR 1.15, 95% CI 1.04-1.26) and estimated Glomerulo Filtration Rate based on cystatin-C (HR 1.78, 95% CI 1.54-2.07) were also related to CVD mortality. Conclusions:In stable, elderly patients with a history of MI smoking, diabetes, resting heart rate, hs-CRP and kidney function were stronger predictors than the well-treated classical risk factors cholesterol and blood pressure. © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586731pmid: 26078060

Differentiating physiology from pathology in elite athletes Thursday, 14 May 2015, 16:30-18:00 82 Sub-epicardial gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie? F Schnell1, G Claessen2, A La Gerche3, J Bogaerts4, PA Lentz5, P Claus6, PH Mabo7, F Carre1, H Heidbuchel8 1Inserm U1099, Rennes, France 2Gasthuisberg University Hospital, Department of Cardiology, Leuven, Belgium 3St Vincent's Hospital, Department of Medicine, Melbourne, Australia 4Gasthuisberg University Hospital, Department of Radiology, Leuven, Belgium 5Hospital Pontchaillou of Rennes, Department of Radiology, Rennes, France 6University of Leuven, Department of Cardiovascular Imaging and Dynamics, Leuven, Belgium 7University Hospital of Rennes - Hospital Pontchaillou, Department of Cardiology and Vascular Disease, Rennes, France 8Heart Centre Hasselt, Hasselt, Belgium Topic: Sports cardiology Purpose:The prognostic relevance of sub-epicardial late gadolinium enhancement (LGE) patches without underlying cardiomyopathy, and likely the result of prior silent myocarditis, in asymptomatic athletes is unknown. Therefore, management is challenging and medical clearance for competitive sports participation is debated. This case series aims to relate this pattern of LGE in athletes to outcome. Methods:We report on 7 young asymptomatic athletes (26.1±4.9 years of age) with isolated sub-epicardial LGE. All underwent a comprehensive initial investigation in order to assess LV function at rest and exercise (exercise CMR and/or exercise echocardiography) and occurrence of arrhythmias (exercise test, 24h-ECG Holter, electrophysiological study). All underwent a careful follow-up with biannual evaluation. Results:The athletes were referred because of abnormalities on their regular screening examination, i.e. T wave inversions on ECG (n=4) or ventricular arrhythmias on exercise test (n=3). All athletes had extensive sub-epicardial LGE (12.0±4.8% of LV myocardial volume), predominantly in the lateral wall. Three athletes had nonsustained ventricular arrhythmias, two of them had subnormal LV function at rest and no contractile reserve at exercise. These 3 athletes stopped sports. During a follow-up of 3.0±1.5 years in the 4 remaining athletes, two had symptomatic VT and one showed deterioration of LV function. Hence, 6 out of 7 athletes had to be excluded from competitive sports participation. Conclusions:Sub-epicardial LGE in an asymptomatic athlete is not benign and should require a careful evaluation at exercise and a strict follow-up. The findings question whether extreme exercise during silent myocarditis may facilitate fibrosis generation and/or promote adverse remodeling. Open in new tabDownload slide LGE pattern in the 7 athletes © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586746pmid: 26078065

Cardiac Heart Failure: Old syndrome, New questions Saturday, 16 May 2015, 08:30-10:00 715 High intensity interval training attenuates endothelial dysfunction in heart failure with preserved ejection fraction (HFpEF) T Fischer1, M Alves2, N Rolim2, S Werner1, N Schuett1, TS Bowen1, U Wisloff2, V Adams1 1University Leipzig, Heart Center, Leipzig, Germany 2Norwegian University of Science and Technology, Trondheim, Norway Background:More than 14 million Europeans suffer from heart failure (HF), with ~50% characterized to have a preserved ejection fraction (HFpEF). Morbidity and mortality remains high in HFpEF, with limited benefits observed following large-trial pharmacological interventions. HFpEF patients demonstrate endothelial dysfunction, which is an independent risk factor for future cardiovascular events. At least in HF with reduced ejection fraction (HFrEF), exercise training is known to be a beneficial therapeutic intervention that reduces endothelial dysfunction, but whether the same also occurs in HFpEF is unclear. The present study therefore examined, in an animal model of HFpEF, the impact of high intensity interval exercise training (HIT) on endothelial function whilst identifying possible molecular mechanisms. Methods:Seven week old female Dahl salt-sensitive rats were randomized into the following groups: (1) control: animals fed with a diet containing 0.3% NaCl, n=10; (2) HFpEF: animals fed with a diet containing 8% NaCl, n=11; (3) HFpEF-HIT: animals fed with a diet containing 8% NaCl who performed treadmill exercise 3x38 min/week, at a maximum heart rate of 60% with 4 intervals of 4 min at 90%, n=11. At 28 weeks, echocardiography and invasive hemodynamic measurements confirmed HFpEF was developed, and the aorta was removed and endothelial depended and independent vasodilation measured in vitro. Expression of eNOS and AGE (advanced glycation end product)-modified proteins were quantified by western blot, and MMP-2 and 9 activities were measured by zymography. Data are presented as arbitrary units. Results:HFpEF significantly reduced both endothelium-dependent and endothelium-independent vasodilation, but HIT prevented these impairments. HFpEF significantly reduced protein expression of eNOS compared to controls and HFpEF-HIT rats (0.60±0.09 vs. 1.12±0.20 and 1.00±0.12, respectively). MMP-2 and MMP-9 activity significantly increased in HFpEF compared to controls (MMP-2: 0.82±0.05 vs. 2.35±0.16; MMP-9: 0.25±0.07 vs. 0.42±0.0.04), but this was not observed following HIT (MMP-2: 1.84±0.15; MMP-9: 0.26±0.03). Expression of AGE-modified proteins was increased in HFpEF compared to controls (0.86±0.08 vs. 1.78±0.36), however this was prevented by HIT. Conclusion:Endothelial dependent and endothelial-independent vasodilation is impaired in HFpEF, which is associated with reduced expression of eNOS, increased MMP activity, and increased AGE mediated protein crosslinking. HIT, however, was able to prevent endothelial dysfunction and the associated molecular alterations observed in HFpEF. © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586743pmid: 26078083

Poster Session III Friday, 15 May 2015, 08:30-12:30 P452 Improved efficiencies in cardiac rehabilitation through service redesign A Maiorana1, J Smith1, J Garton-Smith2, J Redfern3, A Bremner4, D Hendrie5, J Rankin1, L Dimer6, T Briffa4 1Royal Perth Hospital, Cardiology, Perth, Australia 2Royal Perth Hospital, Perth, Australia 3The George Institute for Global Health, Sydney, Australia 4The University of Western Australia, Perth, Australia 5Curtin University, Perth, Australia 6Heart Foundation, Perth, Australia Topic: Sports cardiology Purpose:Cardiac rehabilitation (CR) is widely recommended following acute coronary syndrome (ACS) but is both underutilised and under-resourced. An alternative model of CR for cost effective secondary prevention (ACCES) was implemented and evaluated at a West Australian tertiary hospital. The project aimed to increase the proportion of patients receiving four guideline-advocated CR components: an initial assessment, individualised plan, education and follow-up, through service redesign in an environment of unchanged staff resources. Methods:Patients discharged from cardiology wards with a primary diagnosis of ACS 1/4/2013-31/3/2014 (ACCES group) were compared to patients discharged 1/4/2011-31/3/2012 (controls). Patients transferred directly to another hospital for continuing cardiology care, aged >80 years, or deceased within four weeks of discharge were excluded. A quality improvement framework involving key stakeholders (74 patients, 52 hospital staff, 18 General Practitioners) was undertaken to inform processes to support change. Ward nurses assumed a more active role in inpatient CR, supported by a new CR needs assessment tool. This enabled CR specialist nurses to focus on post discharge service provision. An automated referral process was established that generated a daily list of eligible patients for follow-up by CR staff post discharge. Results:The ACCES model was associated with a significant increase in the provision of each one of the four CR components (Table 1) and resulted in a near doubling in the proportion of patients who received all four components, culminating in follow-up. This equates to an increase of 264 patients per 1000 admissions. Conclusion:Clinical service redesign was associated with efficiencies in CR, doubling patient numbers serviced for no additional staffing. This finding has important implications for the many CR programs that have limited staff resources or relatively low levels of uptake. Improved access to CR is associated with changing the clinical course post ACS. Component Controls (n=999) ACCES (n=862) P-value Initial assessment 723 (72.4) 835 (96.9) <0.001 Individualised CR plan 544 (54.5) 648 (75.2) <0.001 Education 504 (50.5) 638 (74.0) <0.001 Follow up 291 (29.1) 478 (55.5) <0.001 Component Controls (n=999) ACCES (n=862) P-value Initial assessment 723 (72.4) 835 (96.9) <0.001 Individualised CR plan 544 (54.5) 648 (75.2) <0.001 Education 504 (50.5) 638 (74.0) <0.001 Follow up 291 (29.1) 478 (55.5) <0.001 Open in new tab Component Controls (n=999) ACCES (n=862) P-value Initial assessment 723 (72.4) 835 (96.9) <0.001 Individualised CR plan 544 (54.5) 648 (75.2) <0.001 Education 504 (50.5) 638 (74.0) <0.001 Follow up 291 (29.1) 478 (55.5) <0.001 Component Controls (n=999) ACCES (n=862) P-value Initial assessment 723 (72.4) 835 (96.9) <0.001 Individualised CR plan 544 (54.5) 648 (75.2) <0.001 Education 504 (50.5) 638 (74.0) <0.001 Follow up 291 (29.1) 478 (55.5) <0.001 Open in new tab P453 Effect of different protocols for cardiac rehabilitation phase I in the performance of six-minute walk test in patients after coronary artery bypass grafting M Zanini1, RM Nery2, AD Da Silveira1, RP Buhler1, JB De Lima1, GC Nascimento1, FS Santos1, R Stein1 1Federal University of Rio Grande do Sul, Porto Alegre, Brazil 2Hospital de Cl?cas de Porto Alegre, Porto Alegre, Brazil Topic: Sports cardiology Purpose:After coronary artery bypass graft (CABG) patients reduce functional capacity, pulmonary function and respiratory muscle weakness. Our aim was to compare 2 different protocols of cardiac rehabilitation phase 1 after CABG in relation to distance walked in six-minute walk test (6MWT) at the time of hospital discharge. Methods:In this randomized clinical trial, subjects were assessed on the day of hospitalization (before surgery) using the 6MWT. After surgery they were randomized to Group I (respiratory therapy, physical exercise of upper and lower limbs, progressive distance walking and inspiratory muscle training) and Group II (respiratory therapy and inspiratory muscle training). All patients underwent the intervention twice a day for 6 days. All patients were evaluated at the time of discharge. Results:Nineteen patients (G1, n=9; G2, n=10) were evaluated. After randomization, clinical and functional characteristics were the same in the 2 groups. The mean age was 58 ± 5 years (G1) and 59 ± 8 years (G2), with a male predominance. The distance walked pre and postoperative was: G1; 409 ± 63 vs 375 ± 74 and Group II; 384 ± 71 vs 275 ± 77. There was difference (P = 0.01) between groups after seven days postoperatively. Conclusions:A protocol that incorporates physical exercise of the upper and lower limbs and progressive distance walking to respiratory therapy and inspiratory muscle training seems to improve functional capacity after CABG. This protocol elicits the potential benefits of a more extensive phase 1 rehabilitation program. P454 Individualized combined exercise is superior to group based exercise in improving health related quality of life in heart disease patients JW Christle1, A Schlumberger1, M Halle1, A Pressler1 1Technical University of Munich, Department of Prevention and Sports Medicine, Munich, Germany Topic: Sports cardiology Purpose:Improving health- related quality of life (HRQoL) is an important goal in phase III cardiac rehabilitation (CR). Patients with heart disease and low exercise capacity (< 6 MET) have higher risk for future cardiac events and lower HRQoL compared to low risk patients. There is few data on this form of therapy and HRQoL, and no studies comparing traditional group based CR to other modes of exercise therapy on HRQoL in moderate to high risk patients. The current study compared the weekly individualized combined exercise (ICE) with group-based CR (GCR) on changes in HRQoL in heart disease patients with low exercise capacity. Methods:Seventy patients (70 ± 9 y, 38% female) with AHA class C risk status performed cardiopulmonary exercise testing and were randomized 1:1 to once-weekly ICE or GCR for six months. ICE consisted of 30 minutes of endurance exercise at 60-70% VO2peak and two sets of five large muscle-group resistance exercises at 40-60% of one-repetition maximum. At baseline and six months, HRQoL was assessed by SF-36, GMS and MacNew instruments. Results:ICE was significantly superior to GCR in improving vitality, emotional and social health, and positive and negative affect. Conclusions:ICE has a more positive influence on HRQoL in heart disease patients with moderate to high cardiovascular risk status compared to GCR. p-value is for between group differences at six months. Differences in other domains were not significant ICE GCR Variable Baseline Six months Baseline Six months p-value SF-36 Vitality 60.86 ± 20.96 63.94 ± 16.09 52.73 ± 15.57 52.58 ± 15.67 0.005 GMS Negative affect 13.33 ± 8.16 12.64 ± 7.56 15.53 ± 7.06 16.53 ± 8.23 0.049 GMS Positive affect 27.00 ± 8.33 29.39 ± 7.05 24.50 ± 6.90 24.44 ± 6.32 0.004 MacNew Emotional 5.57 ± 1.10 5.77 ± 0.93 5.33 ± 1.20 5.27 ± 1.05 0.049 MacNew Social 5.72 ± 1.10 6.04 ± 0.90 5.37 ± 1.11 5.33 ± 1.01 0.005 ICE GCR Variable Baseline Six months Baseline Six months p-value SF-36 Vitality 60.86 ± 20.96 63.94 ± 16.09 52.73 ± 15.57 52.58 ± 15.67 0.005 GMS Negative affect 13.33 ± 8.16 12.64 ± 7.56 15.53 ± 7.06 16.53 ± 8.23 0.049 GMS Positive affect 27.00 ± 8.33 29.39 ± 7.05 24.50 ± 6.90 24.44 ± 6.32 0.004 MacNew Emotional 5.57 ± 1.10 5.77 ± 0.93 5.33 ± 1.20 5.27 ± 1.05 0.049 MacNew Social 5.72 ± 1.10 6.04 ± 0.90 5.37 ± 1.11 5.33 ± 1.01 0.005 Open in new tab p-value is for between group differences at six months. Differences in other domains were not significant ICE GCR Variable Baseline Six months Baseline Six months p-value SF-36 Vitality 60.86 ± 20.96 63.94 ± 16.09 52.73 ± 15.57 52.58 ± 15.67 0.005 GMS Negative affect 13.33 ± 8.16 12.64 ± 7.56 15.53 ± 7.06 16.53 ± 8.23 0.049 GMS Positive affect 27.00 ± 8.33 29.39 ± 7.05 24.50 ± 6.90 24.44 ± 6.32 0.004 MacNew Emotional 5.57 ± 1.10 5.77 ± 0.93 5.33 ± 1.20 5.27 ± 1.05 0.049 MacNew Social 5.72 ± 1.10 6.04 ± 0.90 5.37 ± 1.11 5.33 ± 1.01 0.005 ICE GCR Variable Baseline Six months Baseline Six months p-value SF-36 Vitality 60.86 ± 20.96 63.94 ± 16.09 52.73 ± 15.57 52.58 ± 15.67 0.005 GMS Negative affect 13.33 ± 8.16 12.64 ± 7.56 15.53 ± 7.06 16.53 ± 8.23 0.049 GMS Positive affect 27.00 ± 8.33 29.39 ± 7.05 24.50 ± 6.90 24.44 ± 6.32 0.004 MacNew Emotional 5.57 ± 1.10 5.77 ± 0.93 5.33 ± 1.20 5.27 ± 1.05 0.049 MacNew Social 5.72 ± 1.10 6.04 ± 0.90 5.37 ± 1.11 5.33 ± 1.01 0.005 Open in new tab P455 Improvement of flow mediated dilatation in patients with coronary disease after 6 months cardiac rehabilitation I H Jung1, K J Rhee1, H Y Lee1, Y S Byun1, C W Goh1, B O Kim1 1Inje University, Seoul, Korea, Republic of Background:Flow-mediated dilatation (FMD) is one of the accepted techniques to assess endothelial function, which has been well known as an independent predictor of cardiovascular outcomes. And also, every recent major evidence-based guideline regarding the management and prevention of coronary heart disease provides a class 1 level recommendation for referral to a cardiac rehabilitation program (CR). We investigated whether the endothelial function of the patients who had received percutaneous coronary intervention (PCI) was improved or not after 6 months CR. Methods:We evaluated the relationship between FMD in 119 patients (104 males, mean age; 54.9 ± 9.1 years) who had treated with PCI. The patients were divided into 2 subgroups; 69 patients with acute coronary syndrome and 50 stable angina patients. All patients were examined on the second or third day after PCI, and 6 months from discharge. They received CR after discharge according to the study protocol. Results:There was no significant difference of FMD at baseline (8.1% in angina vs. 7.7% in ACS, p=0.18) and 6 months follow-up (9.2% vs. 8.9%, p=0.61) between the patients with angina and ACS. However, FMD which was measured after 6 months CR was significantly improved on both groups (increase by 1.1% in angina; 0.1-2.0, p=0.03 vs. 1.1% in ACS group; 95% CI: 0.5-1.8, p=0.002). Conclusion:Even though there was no significant difference of FMD on ACS and angina patients, FMD was improved after CR program in patients with PCI. And this beneficial effect was noted equally on both groups. Our results support that improvement of endothelial function is one of the important effect of CR reducing cardiovascular risk in patients with coronary disease. Open in new tabDownload slide P456 The Samba protocol for cardiac rehabilitation TC Carvalho1, AI Gonzales1, HO Braga1, SW Sties1, LS Mara1, GD Carvalho1, AS Netto1, DP Lima1, PAB Araujo1, AV Souza1 1State University of Santa Catarina, Florianopolis, Brazil Topic: Sports cardiology Purpose:The ballroom dancing has been proven effective in improving cardiorespiratory capacity in patients with cardiovascular disease. The Brazilian samba dance modality is very popular and can be performed in differences intensities. The aim of this study was to develop and evaluate a Samba protocol aiming physical training in cardiac rehabilitation. Methods:Fifteen patients with stable coronary artery disease (CAD), aged 60.74 ± 5.96 years, underwent maximal cardiopulmonary exercise test with determination of heart rate (HR) corresponding to the peak VO2 and first and second ventilatory thresholds. During six sessions, patients underwent twenty Samba steps, in three music tempo classified by a metronome in slow, medium and fast. Posteriorly, underwent three sessions for verify the HR behavior and perception of effort. Descriptive analysis was used to characterize the sample and check the HR, the t test or Wilcoxon test were used to compare the HR behavior (in different sessions) with significance level of 5%. Results:In samba sessions patients remained most of the time (86.57% ±4.17) between 60 and 90% of HRpeak, which is the zone proposed for rehabilitation training. When considering the target zone ideal, with HR situated between the ventilatory thresholds, patients remained 76.79 ±2.28 time. While patients danced they reported perception of mild to moderate effort. Conclusion:The patients showed good adaptation to Samba Protocol, which is able to be adopted as a proposal for training in cardiac rehabilitation. P457 The impact of aerobic exercise training with vascular occlusion in patients with chronic heart failure Y Tanaka1 1Yodogawa Christian Hospital, Osaka, Japan Topic: Sports cardiology Purpose:Aerobic exercise training is an important adjunct to medical therapy in patients with chronic heart failure (CHF). However, the effect of aerobic exercise training with vascular occlusion in patients with CHF on improving exercise capacity is unknown. This study aimed to evaluate the impact of aerobic exercise training with vascular occlusion in patients with CHF. Methods and Results:Twenty patients with CHF due to ischemic cardiomyopathy (New York Heart Association functional class I to II) were randomized to an interventional exercise group (IG, n = 10) or a control exercise group (CG, n = 10). Exercise was performed at an intensity of 40–70% of the maximum peak VO2/W for 15 min three times a week for 6 months. Patients in the IG group remained seated on the saddle of the cycle ergometer with their feet on the pedals. Pneumatic tourniquets (width: 90 mm, length: 700 mm) were applied to the proximal ends of their thighs with appropriate pressure resulting in a 20–40 mmHg increase in the systolic blood pressure that is required for vascular occlusion (209 ± 8.0 mmHg). We evaluated the safety and efficacy of the intervention, and its effect on exercise capacity and serum brain natriuretic peptide (BNP) level. There were no significant differences between the 2 groups at study entry (IG vs. CG; age: 55.0 ± 4.7 vs. 55.5 ± 4.5 years; height: 153.6 ± 7.2 vs. 152.6 ± 7.1 cm; weight: 66.1 ± 4.9 vs. 66.3 ± 4.9kg; ejection fraction: 51.5 ± 4.7 vs. 48.4 ± 4.7%; peak VO2/W: 16.0 ± 6.5 vs. 13.8 ± 5.4 mL·kg-1·min-1; BNP: 92.9 ± 10.0 vs. 88.5 ± 9.3 pg/mL; right thigh circumference: 43.0 ± 4.7 vs. 42.8 ± 4.3 cm; left thigh circumference: 43.2 ± 4.7 vs. 42.7 ± 4.3 cm). Peak VO2/W in the IG group significantly increased compared with that in the CG group (29.1 vs. 12.4%, p < 0.05), and the change in the serum BNP level was significantly larger in the IG group than in the CG group (-31.0 ± 7.6 vs. 5.0 ± 6.4 pg/mL, p < 0.05). Conclusion:These results suggest that aerobic exercise training with vascular occlusion can improve exercise capacity and serum BNP levels in patients with CHF without serious adverse events. P458 Exercise capacity improvement and sustainability with cardiac rehabilitation: is there a role for left ventricular systolic dysfunction? G Pestana1, JA Rocha2, M Tavares-Silva1, R Pinto1, AR Godinho1, JD Rodrigues1, V Araujo1, FP Parada2, MJ Maciel1 1Sao Joao Hospital, Cardiology, Porto, Portugal 2Sao Joao Hospital, Physical Medicine and Rehabilitation, Porto, Portugal Topic: Sports cardiology Purpose:Cardiac rehabilitation (CR) improves exercise capacity in acute coronary syndrome (ACS) patients. Exercise capacity itself is independently associated with improved quality of life and reduction of subsequent cardiovascular events. Still, important gaps remain in our understanding of how impaired systolic function (SF) affects the response to exercise capacity.?128;¨ We aimed to assess how the degree of initial systolic dysfunction (SD) might affect exercise capacity improvement and sustainability after CR in post-ACS patients. Methods:?128;¨We conducted a post-hoc analysis of prospectively collected sociodemographic, clinical and functional data from 527 consecutive patients referred to CR after hospitalization for ACS. Patients were stratified as having normal SF (ejection fraction =55%), mild (45-54%) or moderate to severe (<45%) SD as evaluated by echocardiogram before discharge. Exercise capacity was evaluated as the maximum duration of a treadmill stress test using the Bruce protocol, assessed before and after the exercise training program and at 12 months follow-up. Patients with missing data were excluded.?128;¨ We used a mixed model (between-within group) analysis of variance (ANOVA) to compare exercise capacity response to CR and differences across SD groups. Results:?128;¨207 patients were included in the analysis, with mean age 54 years (ranging from 27 to 91 years); 85% were male. 126 patients (60.9%) had normal SF, 45 (21.7%) had mildly impaired SF and 36 (17.4%) had moderate or severely impaired SF.?128;¨ All groups showed similar improvements in exercise capacity throughout CR (within groups: Wilk's lambda=0,481, p<0,001; between-groups: p=0.474). After CR exercise capacity increased from 8min28sec to 10min19sec in the normal SF group, from 8min33sec to 10min31sec in the mild SD group and from 8min02sec to 9min50sec in the moderate or severe SD group (p<0.001 for all comparisons). This was followed by a trend towards decreasing exercise capacity at 12 months, only marginally significant in the normal SF group (10min19sec to 10min, p=0.06). Conclusions:CR effectively increases exercise capacity in ACS patients, an effect independent of baseline systolic dysfunction. This effect, however, tends to weaken with time after conclusion of exercise training. Therefore, it is mandatory not only to develop strategies to improve patient referral and participation in CR but also to assure sustainability of this results over time. P459 Addressing inequalities in cardiovascular health: a novel cardiac rehabilitation programme in a socio-economically disadvantaged community ME Cupples1, J Turnbull2, J Cunningham3, C Mcmaster4 1UKCRC Centre of Excellence for Public Health Northern Ireland (NI), Belfast, United Kingdom 2West Belfast Partnership, Belfast, United Kingdom 3Belfast Health and Social Care Trust, Cardiac Rehabilitation, Belfast, United Kingdom 4Public Health Agency, Northern Ireland, Belfast, United Kingdom Topic: Sports cardiology Purpose:Age-standardised death rates for cardiovascular disease (CVD) in West Belfast, an area of high socioeconomic disadvantage in Northern Ireland (NI), are 1.5 times higher than the national average (129 v 81/ 100,000). A community based initiative (Healthy Hearts in the West) was designed to address this inequality, by aiming to raise people's awareness of risk factors and to support self-managed lifestyle changes. In response to a recent report which highlighted the need for collaboration between public, community, voluntary and private sectors to build mutual reliance and respect in addressing the social determinants of health inequalities, a novel cardiac rehabilitation (CR) programme was also designed for the community. Method:The programme was developed using a logic model approach, building on local knowledge and social, cultural and material assets. It was set up in January 2012. Patients who had experienced an acute cardiac event or intervention were invited to attend an 8-week programme, in a community centre. A multidisciplinary team delivered a similar programme as had been delivered in a local hospital but the CR nurses, in addition, developed links with community health and social care staff and volunteers to facilitate patients' access to counselling and complementary therapy services within the centre. Good communication was established with others involved in patients' care: information about attendance, risk factors, psychosocial health status, and medication was posted to the cardiologist and general practitioner at the start and completion of the programme, and when indicated. Patients formed links with community groups, to encourage maintenance of active and healthy lifestyles. Changes in risk factors were measured and patients' perceptions of the programme were assessed by postal questionnaire. Results:Overall, 41.9%(137/327) of eligible patients attended in the first year: uptake of CR in NI was 38% during the previous year, with lower uptake in areas of socio-economic disadvantage. Patients also attended a range of community services, including smoking cessation and alcohol and weight management; 30(22%) attended counselling, 53(39%) received complementary therapy; 96(70%) enrolled in follow-up programmes. Questionnaire data indicated that the on-site services facilitated achievement of goals and promoted attendance; 94%(63/67) of respondents said they would recommend the programme to others. Conclusions:Our findings suggest that a community-based collaborative approach can support the delivery of CR and help address health inequality related to cardiovascular risk. P460 Effects of cardiac rehabilitation in young patients after an acute coronary syndrome. M Sanchez Martinez1, S Del Prado Diaz2, R Dalmau Gonzalez-Gallarza2, A Castro Conde1, D Hernandez Munoz3, C Vindel Martinez3, A Araujo Avendano3, H Arranz Rodriguez3, M Marin Santos3, JL Lopez Sendon2 1University Hospital Virgen de la Arrixaca, Department of Cardiology, Murcia, Spain 2University Hospital La Paz, Madrid, Spain 3Hospital Cantoblanco, Madrid, Spain Topic: Sports cardiology Purpose:We aim to analyze the cardiovascular risk profile and impact of cardiac rehabilitation program (CRP) in young patients after an acute coronary syndrome (ACS). From a cohort of 833 patients, were analyzed retrospectively patients =45 years of age included in the CRP between August 2006 and March 2014. Results:116 consecutive patients (91.1% male, mean age 39.9 ± 4.4 years) were included. The most common indication for cardiac rehabilitation was ST elevation myocardial infarction (STEMI) in 93% of cases with anterior location (45%). Percutaneous coronary intervention (PCI) was made in 99.1% of cases and complete revascularization was achieved in 85% of patients. The presence of classical cardiovascular risk factors was high: 21.6% hypertension, 12% diabetes; 62% of patients were dyslipidemic, 25.9% obese (mean BMI 28 ± 5 kg/m 2), 77.6% smokers with a mean 28.7 pack-years and a 61.2% of them had =2 CVRF. A quotient TG / HDL> 3.5 (indirect measure of insulin resistance) in 73.1% of patients were detected. 87.1% underwent a standard PRC, with a dropout rate of 13.8%. Most of them had a good basal functional capacity with a mean of 9.6 ± 2.4 METS. At the end of the CRP, control target LDL <70 mg / dl was achieved in 55.7% of cases, HDL> 35 mg/dl in a 48.5% and TG <150 mg/dl in a 75, 2%. Smoking abstinence confirmed by co-oximetry were 74.2% and 65.1% at 3 and 6 months respectively. Significant reductions in LDL cholesterol, TG, quotient TG / HDL and abdominal circumference (p <0.001) as well as an increased HDL (p <0.03) were obtained. At discharge, a significant functional improvement was observed with a mean of 12.6 ± 2.1 METS (p <0.001). Conclusions:In young patients, smoking is the main risk factor for developing ACS. Cardiac rehabilitation is useful for improving the lipid profile, insulin resistance, functional capacity and to consolidate tobacco abstinence. BMI: body mass index; EFLV: ejection fraction of left ventricle. Variable Baseline levels (Mean ±standar deviation) Discharge levels (Mean ±standar deviation) Relative (%) 95% CI p BMI (kg/m2) 28,12±4,96 27,78±4,49 1,21 [-0,06-0,37] 0,155 Abdominal circumference (cm ) 99,71 ±12,01 97,8 ±10,84 1,9 [1,43-2,77] <0,001 Hemoglobin A1c (%) 5,9±1,59 5,68±0,63 4,37 [-0,09-0,61] 0,14 EFLV (%) 49,41±12,9 52,17±9,9 5,59 [-9,26- -4,77] <0,001 Functional capacity (METS) 9,65±2,4 12,63±2,17 30,88 [-3,51- - 2,61] <0,001 Variable Baseline levels (Mean ±standar deviation) Discharge levels (Mean ±standar deviation) Relative (%) 95% CI p BMI (kg/m2) 28,12±4,96 27,78±4,49 1,21 [-0,06-0,37] 0,155 Abdominal circumference (cm ) 99,71 ±12,01 97,8 ±10,84 1,9 [1,43-2,77] <0,001 Hemoglobin A1c (%) 5,9±1,59 5,68±0,63 4,37 [-0,09-0,61] 0,14 EFLV (%) 49,41±12,9 52,17±9,9 5,59 [-9,26- -4,77] <0,001 Functional capacity (METS) 9,65±2,4 12,63±2,17 30,88 [-3,51- - 2,61] <0,001 Open in new tab BMI: body mass index; EFLV: ejection fraction of left ventricle. Variable Baseline levels (Mean ±standar deviation) Discharge levels (Mean ±standar deviation) Relative (%) 95% CI p BMI (kg/m2) 28,12±4,96 27,78±4,49 1,21 [-0,06-0,37] 0,155 Abdominal circumference (cm ) 99,71 ±12,01 97,8 ±10,84 1,9 [1,43-2,77] <0,001 Hemoglobin A1c (%) 5,9±1,59 5,68±0,63 4,37 [-0,09-0,61] 0,14 EFLV (%) 49,41±12,9 52,17±9,9 5,59 [-9,26- -4,77] <0,001 Functional capacity (METS) 9,65±2,4 12,63±2,17 30,88 [-3,51- - 2,61] <0,001 Variable Baseline levels (Mean ±standar deviation) Discharge levels (Mean ±standar deviation) Relative (%) 95% CI p BMI (kg/m2) 28,12±4,96 27,78±4,49 1,21 [-0,06-0,37] 0,155 Abdominal circumference (cm ) 99,71 ±12,01 97,8 ±10,84 1,9 [1,43-2,77] <0,001 Hemoglobin A1c (%) 5,9±1,59 5,68±0,63 4,37 [-0,09-0,61] 0,14 EFLV (%) 49,41±12,9 52,17±9,9 5,59 [-9,26- -4,77] <0,001 Functional capacity (METS) 9,65±2,4 12,63±2,17 30,88 [-3,51- - 2,61] <0,001 Open in new tab P461 Exercise capacity improvement in cardiac rehabilitation: role of echocardiographic modifications/adaptations J C Duarte Rodrigues1, MTS Tavares Silva1, GP Pestana1, RP Pinto1, AG Godinho1, FM Filipa Melao1, VA Vitor Araujo1, JAR J Afonso Rocha2, FP Fernando Parada2, MJM Maria Julia Maciel1 1Sao Joao Hospital, Department of Cardiology, Porto, Portugal 2Sao Joao Hospital, Department of Physical and Rehabilitation/ Exercise Training/Cardiac, Porto, Portugal Topic: Sports cardiology Purpose:In the evaluation of patients with acute coronary syndromes (ACS), echocardiography has a pivotal role in non-invasive diagnosis and risk stratification. Exercise capacity after ACS is a strong predictor of future cardiovascular morbidity and mortality and can be effectively modified by exercise training/cardiac rehabilitation (CR). However, the exact mechanisms of improvement in exercise tolerance after cardiac rehabilitation program are not fully understood. We aimed to evaluate the contribution of echocardiographic features in exercise capacity increase in CR setting. Methods:Patients admitted to CR within 3 months of ACS were included. Transthoracic echocardiograpy study was performed at baseline (within 48-72 h after hospital admission), at the end of two-month CR program consisting of biweekly exercise training sessions and at 12 months follow-up. An estimate of left ventricular filling pressure was made using pulsed wave (PW) Doppler and Tissue Doppler Imaging (TDI), in particular, E/e' (the ratio between peak early mitral inflow velocity (E) and the average of the peak early septal and lateral annulus velocity (e') that indicates left ventricular diastolic function. Other conventional measurements were also made. Serial treadmill exercise test were performed during all phases. Results:A total of 333 patients (86.5 % male), aged 53± 9.5 years were referred to CR after ACS between 2009 and 2013. No significant differences of E/e' values were seen at the three phases despite a trend towards decreased relaxation time (8.3± 2.7 for phase 1; 8.1± 2.6 for phase 2; 7.9 ± 2.1 for phase 3). The gain in exercise capacity was substantial after the 12 months follow-up period (p < 0.001 for phase 2 and 3) and it was significantly correlated with E/e' value (r= -0.42; p< 0.001). Despite improvement in left ventricular ejection fraction (p< 0.001 for phase 2 and 3) no other correlations were found between exercise capacity and other echocardiographic measurements. Conclusions:Exercise training in post-acute myocardial infarction patients results in a significant improvement in exercise capacity with a potential role of diastolic ventricular function exercise-induced modifications. P462 Cardiac rehabilitation after acute coronary syndrome - do all patients have the same benefit? S Aguiar Rosa1, A Abreu1, R M Soares1, P Rio1, I Rodrigues1, A Monteiro1, D Mesquita2, A Gaspar3, S Silva1, R Cruz Ferreira1 1Hospital de Santa Marta, Cardiology, Lisbon, Portugal 2Hospital N.S. Rosario, Cardiology, Barreiro, Portugal 3Hospital dos Capuchos, Internal Medicine, Lisbon, Portugal Topic: Sports cardiology Purpose:Cardiac rehabilitation(CR) demonstrated to improve exercise capacity in patients(pts) with acute coronary syndrome(ACS). The aim of this study is to understand, after CR, which pts benefit the most in functional capacity(FC). Methods:Retrospective analysis of consecutive ACS pts who underwent CR and cardiopulmonary exercise testing(CPET), Jan/04 and Dec/13. CPET was performed pre and post CR. CPET parameters: peak oxygen uptake(pVO2), %of predicted pVO2, minute ventilation/CO2 production(VE/VCO2) slope, VE/VCO2slope/pVO2 and peak circulatory power(PCP) (pVO2xpeak SBP). The difference between prepVO2 and postpVO2(?O2) was calculated. Pts were analysed according to pre pVO2(<20vs=20ml/kg/min) and left ventricular ejection fraction(LVEF)(<50vs=50%). Results:130pts, 86% male, mean age 56.8+10.9years. 113pts had STEMI. Both pVO2<20ml/kg/min (pVO2A)(31pts) and pVO2=20ml/kg/min (pVO2B)(99pts) had FC improvement after CR (table). pVO2A showed a greater increase in pVO2 than pVO2B (?O2 4.39±7.31vs0.85±5.67; p=0.049). In pVO2A 71% of pts got an increase in pVO2>10% comparing to 40% in pVO2B(p=0.0029). There was a CPET parameters improvement in LVEF<50% (LVEFA)(34pts) and LVEF=50% (LVEFB)(96pts), particularly in pVO2 and CPET duration. In LEVFA pVO2 increased from 24.8±6.3 to 28.1±7.1ml/kg/min (p=0.003) and CPET duration from 13.6±2.4 to 15.2±3.3minutes (p=0.002). In LVEFB pVO2 (25.9±7.0 to 27.8±7.4ml/kg/min; p=0.005) and CPET duration (13.3±3.3 to 15.3±2.5 minutes; p<0.001) increased. A greater ?akVO2 was documented in LVEFA than in LVEFB (3.37±5.67vs2.72±8.51; p=0.681) and more pts had pVO2 increase>10% in LVEFA (55.9% vs 44.8%; p=0.266). Conclusion:Worst baseline FC pts have more improvement after CR, evaluated by CPET. LV dysfunction pts seem to have more benefit with CR program. pVO2<20 (n=31) pVO2=20 (n=99) CPET parameters Before CR After CR p-value Before CR After CR p-value Peak VO2 (ml/kg/min) 17.7±1.8 22.1±7.2 0.002 28.1 ±5.6 29.7±6.2 0.004 %predicted peak VO2 68.6±12.3 86.5±33.0 0.008 96.3±21.7 99.3±24.0 0.181 VE/VCO2 slope 29.2±6.1 28.6±5.8 0.425 25.8±5.5 24.9±4.8 0.062 PCP (mmHg.ml/kg/min) 2863.7±581.6 3746.9±1432.0 <0.001 4817.3±1302.2 5078.3±1219.4 0.043 (VE/VCO2slope)/pVO2 1.67±0.41 1.42±0.61 0.02 0.95±0.28 0.86±0.39 0.001 Duration (minutes) 10.5±3.2 13.2±2.4 <0.001 13.2±4.5 15.9±2.6 <0.001 pVO2<20 (n=31) pVO2=20 (n=99) CPET parameters Before CR After CR p-value Before CR After CR p-value Peak VO2 (ml/kg/min) 17.7±1.8 22.1±7.2 0.002 28.1 ±5.6 29.7±6.2 0.004 %predicted peak VO2 68.6±12.3 86.5±33.0 0.008 96.3±21.7 99.3±24.0 0.181 VE/VCO2 slope 29.2±6.1 28.6±5.8 0.425 25.8±5.5 24.9±4.8 0.062 PCP (mmHg.ml/kg/min) 2863.7±581.6 3746.9±1432.0 <0.001 4817.3±1302.2 5078.3±1219.4 0.043 (VE/VCO2slope)/pVO2 1.67±0.41 1.42±0.61 0.02 0.95±0.28 0.86±0.39 0.001 Duration (minutes) 10.5±3.2 13.2±2.4 <0.001 13.2±4.5 15.9±2.6 <0.001 Open in new tab pVO2<20 (n=31) pVO2=20 (n=99) CPET parameters Before CR After CR p-value Before CR After CR p-value Peak VO2 (ml/kg/min) 17.7±1.8 22.1±7.2 0.002 28.1 ±5.6 29.7±6.2 0.004 %predicted peak VO2 68.6±12.3 86.5±33.0 0.008 96.3±21.7 99.3±24.0 0.181 VE/VCO2 slope 29.2±6.1 28.6±5.8 0.425 25.8±5.5 24.9±4.8 0.062 PCP (mmHg.ml/kg/min) 2863.7±581.6 3746.9±1432.0 <0.001 4817.3±1302.2 5078.3±1219.4 0.043 (VE/VCO2slope)/pVO2 1.67±0.41 1.42±0.61 0.02 0.95±0.28 0.86±0.39 0.001 Duration (minutes) 10.5±3.2 13.2±2.4 <0.001 13.2±4.5 15.9±2.6 <0.001 pVO2<20 (n=31) pVO2=20 (n=99) CPET parameters Before CR After CR p-value Before CR After CR p-value Peak VO2 (ml/kg/min) 17.7±1.8 22.1±7.2 0.002 28.1 ±5.6 29.7±6.2 0.004 %predicted peak VO2 68.6±12.3 86.5±33.0 0.008 96.3±21.7 99.3±24.0 0.181 VE/VCO2 slope 29.2±6.1 28.6±5.8 0.425 25.8±5.5 24.9±4.8 0.062 PCP (mmHg.ml/kg/min) 2863.7±581.6 3746.9±1432.0 <0.001 4817.3±1302.2 5078.3±1219.4 0.043 (VE/VCO2slope)/pVO2 1.67±0.41 1.42±0.61 0.02 0.95±0.28 0.86±0.39 0.001 Duration (minutes) 10.5±3.2 13.2±2.4 <0.001 13.2±4.5 15.9±2.6 <0.001 Open in new tab P463 The relationship between carotid intima-media thickness and baroreflex sensitivity in coronary patients M Gois1, RP Simoes1, VC Kunz1, SCM Moura-Tonello1, P Driusso1, HS Hirakawa1, N Montano2, A Porta3, AM Catai1 1Federal University of Sao Carlos, Physical Therapy, Sao Carlos, Brazil 2University of Milan, Department of Clinical Sciences, Milan, Italy 3University of Milan, Department of Technologies for Health, Milan, Italy Topic: Sports cardiology Purpose:to evaluate the relationship between carotid intima-media thickness (IMT) and baroreflex a-index in two groups: coronary artery disease patients and healthy subjects. Methods:37 subjects between 45 and 65 years old were divided in 2 groups: coronary artery disease patients (CAD group, n=18) and healthy subjects (H group, n=19). The patients of CAD group had a diagnosis of CAD confirmed by coronary angiography examination. The carotid ultrasound was performed in the supine position with a 12 MHz linear transducer. The common carotid intima-media thickness (IMT) was evaluated 1 cm from to the carotid bifurcation and site of carotid plaques were excluded of the measurement. The IMT of the wall was evaluated as the distance between the lumen–intima interface and the media–adventitia interface and the average of three measurements from the right and left common carotid artery was used for analyses. The subjects remained at rest for 10 minutes and the data were collected in the standing position. The recording of R-R interval (R-Ri) of the ECG was performed in the MC5 lead and the arterial pressure (AP) was recorded by a finger plestysmographic device (Finometer Pro, Finapres Medical Systems). Signals were sampled at 1000 Hz and the visual inspection of series (R-Ri and SAP) was performed in order to select the sections with the highest signal stability. Ectopic beats were excluded and 256 consecutives data points were used in the analysis. The BRS a index was calculated using a cross-spectral analysis by a bivariate autoregressive model between R-Ri and SAP in the LF frequency (LF): 0.04 Hz a 0.15Hz. The data distribution was verified by the Shapiro–Wilk test and the data were expressed in mean and standard deviation. One-way ANOVA test was applied to compare age and anthropometrics variables. Pearson's test was used to verify the correlation between the carotid IMT and BRS a index. Type 1 error occurrence was established at 5% for all tests (a = 0.05). Results:there were no differences in age (H=52.89±7.10; CAD=57.86±6.26 years), weight (H=81.9±12.2; CAD=76.4±16.8kg), height (H=1.74±0.08; CAD=1.67±0.07m) and body mass index (BMI), (H=27.19±3.56; CAD=27.20±4.61 kg/m2) between the groups. Non-significant correlation coefficient was observed between carotid IMT and BRS a-index (r=-0,13 and p=0,35). Conclusions:There were no correlation between IMT and baroreflex a-index in the standing position suggesting that these variables cannot be replaced for each other. P465 Effectiveness of high intensity interval training on cardiac remodelling in cardiac resynchronization therapy responders and non-responders: a randomized control trial VT Santos1, A Abreu2, R Pinto1, X Melo1, P Cunha2, M Oliveira2, R Ferreira2, LB Sardinha1, B Fernhall3, H Santa Clara1 1University of Lisbon, Faculty of Human Kinetics, Lisbon, Portugal 2Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal 3University of Illinois, College of Applied Health Sciences, Chicago, United States of America Background:A growing body of evidence suggests that high intensity interval training (HIIT) leads to major benefits in cardiac remodelling parameters in patients with chronic heart failure (CHF). However, up to 30% of patients receiving cardiac resynchronization therapy (CRT) do not have a positive clinical or reverse remodelling response. CRT response was determined based on the a sustained improvement of =1 NYHA functional class and echocardiographic evidence of reverse remodelling (defined as an increase in LVEF of = 15%). Topic: Sports cardiology Purpose:Since HIIT and CRT modalities have a different mode of action, the purpose of this study was to assess the effects of CRT on cardiac remodeling of left ventricular mass in clinical responders and non-responders. Methods:We studied 42 patients (mean age: 67±10.6 years), left ventricular ejection fraction (LVEF) at baseline (27±7%) in CHF III–IV NYHA functional class, referred for CRT. Patients were randomized in two groups: an exercise group (ExG) (n=21) who underwent a supervised HIIT program at 90-95% peak heart rate, 2 times a week for 6 months, and a control group (CG) (n=21) who underwent CRT. LVEF, systolic and diastolic volumes and left ventricular mass were evaluated with echocardiography. Paired samples t-tests and non-parametric Mann–Whitney test were used to evaluate overall changes in echocardiographic outcomes. Differences between groups, changes over time within each group and any interaction were assessed by two-way repeated measures. Results:Among responders in the ExG, [n= 14 (70%)], we found a significant decrease (22%) in the left ventricular mass (baseline values 328.3±32.8 g and at 6 months 256.4±27.5 g, p<0.05), that could not be explained by changes in VO2peak or mean arterial pressure. There were no significant differences in left ventricular mass in responders in the CG (baseline values 322.8±23.0 g and at 6 months 291.6±57.5 g, p>0.05). In both responders groups there were a significant decrease in NYHA (ExG: 2.92±0.5 to 1.33±0.5, p=0.000 and CG: 2.78±0.4 to 1.22±0.7, p=0.000) and systolic volumes (ExG: 128.7±48.9 ml to 88±51.5 ml, p=0.004 and CG: 162.7±77.4 ml to 119.8±58.8 ml, 0.002), and an increase in LVEF (ExG: 27.5±6.8% to 42.08±9.4%, p=0.000 and CG: 25.09±8.9% to 42.09±7.5%, p=0.000). Conclusion:In CRT responders patients, an HIIT program leads to further improvements in cardiac remodelling. P466 Favorable effects of the in-patient transitional care for elderly patients with congestive heart failure: a 3-month follow-up. L Dalla Vecchia1, M Monelli1, A Lucini1, C Lastoria1, F Di Paola2, R Furlan2 1Salvatore Maugeri Foundation, IRCCS - Center of Milan, Milan, Italy 2Internal Medicine - Humanitas Clinical and Research Center, Rozzano, Milan, Italy Topic: Sports cardiology Purpose:Heart Failure (HF) is a main reason for hospitalization among older adults. HF hospitalization has poor prognosis with a mortality and readmission rate approaching 15% and 30%, respectively, within 30-60 days. In Italy, the Sub-Acute Care (SAC) represents a novel form of transitional in-patient care for older adults following an acute HF. Aim of the present study was to analyze the effects of this approach. Methods:We selected all the HF pts discharged from our SAC department from January to October 2013. Telephone contacts were established to determine the 3 month follow-up. Results:149 patients were discharged home after a program of titration of medical therapy, management of comorbidities, education, and individualized training. 144 patients were interviewed by phone. The relative Registry Office (RO) was contacted for the missing pts. Ultimately, out of the 146 pts (3 were lost as they moved) included in this retrospective study, 6 (4.1%) died within 3 months (3 for HF), 7 (4.7%) were readmitted to the hospital (3 for HF). Clinical characteristics are shown in the table. Conclusions:We found a favorable effect of a transitional in-patient care on the 3-month mortality and hospital readmission rate in HF patients, suggesting a positive effect in terms of quality of life and financial costs. Although hospital admission could simply herald disease progression, there is some evidence that hospital related interventions also contribute to poor outcomes, through increased neuro-hormonal and inflammatory activation, haemodynamic compromise, end-organ damage, and worsening of comorbidities. A period of care aimed to manage these complications might represent a key factor to improve outcomes. CIRS, Cumulative Illness Rating Scale; Barthel, index of activities in daily life; MMSE, Mini Mental State Examination ALL 3 month deaths 3 month re-admission Pts, # 146 6 (4.1 %) 7 (4.7 %) Age, ys 76±12 80±5 69±8 F/M 74/72 3/3 3/4 CIRS 4.4±2.4 4.5±1.6 3.4±1.5 Barthel 75±22 67±26 93±10 MMSE 25±9 24±4 26±4 ALL 3 month deaths 3 month re-admission Pts, # 146 6 (4.1 %) 7 (4.7 %) Age, ys 76±12 80±5 69±8 F/M 74/72 3/3 3/4 CIRS 4.4±2.4 4.5±1.6 3.4±1.5 Barthel 75±22 67±26 93±10 MMSE 25±9 24±4 26±4 Open in new tab CIRS, Cumulative Illness Rating Scale; Barthel, index of activities in daily life; MMSE, Mini Mental State Examination ALL 3 month deaths 3 month re-admission Pts, # 146 6 (4.1 %) 7 (4.7 %) Age, ys 76±12 80±5 69±8 F/M 74/72 3/3 3/4 CIRS 4.4±2.4 4.5±1.6 3.4±1.5 Barthel 75±22 67±26 93±10 MMSE 25±9 24±4 26±4 ALL 3 month deaths 3 month re-admission Pts, # 146 6 (4.1 %) 7 (4.7 %) Age, ys 76±12 80±5 69±8 F/M 74/72 3/3 3/4 CIRS 4.4±2.4 4.5±1.6 3.4±1.5 Barthel 75±22 67±26 93±10 MMSE 25±9 24±4 26±4 Open in new tab P467 Changes on anxiety and depression in patients with heart disease into cardiac rehabilitation program P Perafan1, O Quintero1, A Murillo1, CJ Herrera1, D Espinosa1, DC Carrillo1, JS Villadiego1 1fundacion valle del lili, cali, Colombia Topic: Sports cardiology Purpose:To determine the prevalence of anxiety and depression disorders in patients with cardiovascular disease on medical or surgical management admitted to the cardiac rehabilitation program (CRH). Methods:Retrospective study of patients with cardiovascular disease with medical or surgical management between January 2005 to December 2013. Adults screened for anxiety and depression with the Anxiety Hospital and Depression Scale (HADS) at admission and at the end of the program were included. Cardiac transplant patients were excluded. Demographic variables stratified by medical or surgical management and scales of HADS were compared for each group at the entry and the end of the RHC Results:1219 patients were included. The median age was 61 y/o, 68% males and 58% have some degree of obesity. On admission, the median HADS-Anxiety was 3 and 11% of patients had anxiety by the scale. The median HADS-D was 3 and 5.71% had clinical depression. 37 patients had anxiety and depression. At the end of RHC there were improvement in anxiety score (mean 1.875, 95% CI 1.6-2.14 p=0.00) as well as for depression (mean 1.46 95% CI 1.2-1.72 p=0.00). For surgical therapy the diference in HADS-A was 1.48 (95% CI 1.18-1.78 p=0.00) and depression 1.83 (95% CI 1.53-2.12 p=0.00). Conclusions:RHC programs decrease mortality in patients who have the indication. At the end of RHC program there were improvement in anxiety and depression scales. *values expressed in median (interquartile range), BMI: Body Mass Index (kg/m2), HADS-A: Anxiety, HADS-D: Depression Variable Medical Therapy (654) n(%) Surgical Therapy (565) n(%) p Age* 62 (53-71) 60 (52-68) 0.01 Male sex 452 (69.11) 380 (67.38) 0.35 BMI 26.5 (24.2-28.8) 24.8 (22.6-27.3) 0.00 Arterial hypertension 380 (57.93) 288 (50.97) 0.00 Diabetes mellitus 146 (22.26) 98 (17.38) 0.00 Smoking 218 (33.23) 155 (27.48) 0.00 Sedentary 403 (61.72) 340 (60.50) 0.00 HADS-A admission* 5 (2-8) 4 (2-7) 0.00 HADS-D admission* 3 (1-6) 3 (2-6) 0.39 HADS-A final* 3 (1-6) 3 (1-6) 0.13 HADS-D final* 2 (0-4) 2 (0-4) 0.78 Variable Medical Therapy (654) n(%) Surgical Therapy (565) n(%) p Age* 62 (53-71) 60 (52-68) 0.01 Male sex 452 (69.11) 380 (67.38) 0.35 BMI 26.5 (24.2-28.8) 24.8 (22.6-27.3) 0.00 Arterial hypertension 380 (57.93) 288 (50.97) 0.00 Diabetes mellitus 146 (22.26) 98 (17.38) 0.00 Smoking 218 (33.23) 155 (27.48) 0.00 Sedentary 403 (61.72) 340 (60.50) 0.00 HADS-A admission* 5 (2-8) 4 (2-7) 0.00 HADS-D admission* 3 (1-6) 3 (2-6) 0.39 HADS-A final* 3 (1-6) 3 (1-6) 0.13 HADS-D final* 2 (0-4) 2 (0-4) 0.78 Open in new tab *values expressed in median (interquartile range), BMI: Body Mass Index (kg/m2), HADS-A: Anxiety, HADS-D: Depression Variable Medical Therapy (654) n(%) Surgical Therapy (565) n(%) p Age* 62 (53-71) 60 (52-68) 0.01 Male sex 452 (69.11) 380 (67.38) 0.35 BMI 26.5 (24.2-28.8) 24.8 (22.6-27.3) 0.00 Arterial hypertension 380 (57.93) 288 (50.97) 0.00 Diabetes mellitus 146 (22.26) 98 (17.38) 0.00 Smoking 218 (33.23) 155 (27.48) 0.00 Sedentary 403 (61.72) 340 (60.50) 0.00 HADS-A admission* 5 (2-8) 4 (2-7) 0.00 HADS-D admission* 3 (1-6) 3 (2-6) 0.39 HADS-A final* 3 (1-6) 3 (1-6) 0.13 HADS-D final* 2 (0-4) 2 (0-4) 0.78 Variable Medical Therapy (654) n(%) Surgical Therapy (565) n(%) p Age* 62 (53-71) 60 (52-68) 0.01 Male sex 452 (69.11) 380 (67.38) 0.35 BMI 26.5 (24.2-28.8) 24.8 (22.6-27.3) 0.00 Arterial hypertension 380 (57.93) 288 (50.97) 0.00 Diabetes mellitus 146 (22.26) 98 (17.38) 0.00 Smoking 218 (33.23) 155 (27.48) 0.00 Sedentary 403 (61.72) 340 (60.50) 0.00 HADS-A admission* 5 (2-8) 4 (2-7) 0.00 HADS-D admission* 3 (1-6) 3 (2-6) 0.39 HADS-A final* 3 (1-6) 3 (1-6) 0.13 HADS-D final* 2 (0-4) 2 (0-4) 0.78 Open in new tab P468 Treatment of myocardial ischemia in Cardiac Rehabilitation M Abeytua1, JI Castillo-Martin1, C Torres1, EM Cramaroc1, A Pintor1, T Martinez-Castellanos1, MA Ortega1, A Fernandez-Gonzalez1, D Ruiz-Molina1, F Fernandez-Aviles1 1University Hospital Gregorio Maranon, Madrid, Spain Topic: Sports cardiology Purpose:Phisical exercise with or without ischemic preconditioning produces cytoprotective molecular adaptations and reduces almost all pathophysiological mechanisms of ischemia / reperfusion. The aim of this study is to assess possible improvement of the ischemia in patients treated in Cardiac Rehabilitation with ischemic preconditioning. Methods:8 patients were studied with previous acute coronary syndrome undergoing coronary reperfusion. All patients had the following features: A) effort angina pectoris grades I to III / IV. B) ischemia diagnosed with conventional stress test. C) ischemia in stress echocardiogram. Patients were treated in cardiac rehabilitation program for 3 months (36 sessions), with treadmill exercise for 20 minutes below the threshold positivity in the stress test. Later load was increased until ischemia in 12-lead electrocardiogram, holding ischemia for 5 minutes, if clinically was tolerated without other complications. Results:Thresholds angina and ischemia started later at the end of the program in 8 patients. METS increased from 5 to 6.5 in 5 of them. Conventional treadmill test became negative in the other 3. Myocardial ischemia segments, unchanged in 2 patients, improved in 4 and became negative for ischemia in the other 2. . Angina and ECG changes returned without other complications. One patient suffered pre-syncope. Another time the training was stopped by frequent premature beats and bigeminism. Conclusions:Ischemia training improvement tolerance to ischemia and in some cases ventricular function during exercise. Large randomized research are needed to study its superiority to regular train P469 Home-based exercise training in coronary artery bypass grafting patients S Pomeshkina1, E Loktionova1, Y Argunova1, N Arkhipova1, O Barbarash2 1Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Rehabillitation Laboratory, Kemerovo, Russian Federation 2Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Objective:To evaluate the efficacy and safety of home-based exercise training (HBET) as a part of outpatient rehabilitation program for patients, who have undergone coronary artery bypass grafting (CABG). Material:112 patients (mean age 56.8 ± 5.5 years) with coronary artery disease (CAD), who have undergone CABG, were examined. One month after CABG, patients were enrolled into three groups, comparable in demographic and clinical characteristics: Group 1 with supervised cycling training (CT) (n = 35), Group 2 – home-based walking training (HBWT) (n = 36) and the comparison group (n = 41). Subjects did 3 trainings per week for 3 months. Patients were examined 1 month, 4 months and one year after CABG. Methods:Echocardiography (ECHO-CG), the 6-min walk test (6MWT), bicycle ergometer (BE) with drug therapy. Results:4 months after CABG ECHO-CG findings reported positive dynamics of left ventricular ejection fraction (LVEF) in Group 1 (p = 0, 01), in Group 2 (p = 0,03) and in the comparison group (from 54.5 ± 4.9 to 58.9 ± 5.7%, p = 0,04). However, this dynamics was more significant in Group 1 and 2. The assessment of effects of different types of cardiac rehabilitation on exercise capacity was performed by measuring the 6MWT in patients, undergoing CABG. The obtained results reported that increased exercise capacity 4 months after CABG was found in Groups 1 and 2 in comparison with the baseline (p = 0.02 and p = 0.04, respectively). There was no significant increase of walking distance in patients without HBET. A 6-minute walk test distance was significantly higher in Group 1 after 4 months compared to patients without HBET in the corresponding period (p = 0.01). Group 2 reported the tendency to higher exercise capacity 4 months after CABG, compared to patients without HBET (p = 0.06). There were no significant changes in the dynamics of exercise capacity in all groups comparing one year and 4 months findings after CABG. However, Group 1 and 2 reported significantly better values than those without HBET (p = 0.01 and p = 0.01, respectively). The assessment of effect of different types of cardiac rehabilitation on exercise capacity with the BE in patients, undergoing CABG, reported its increase in three groups 4 months after CABG. Thus, exercise capacity was higher in Group 1, compared to Group 2 (p = 0.03) and in patients without HBET (p = 0.04). The group differences leveled off one year after CABG. Conclusion:Home-based walking training is safe and results in the optimization of cardiac hemodynamic parameters, increased exercise capacity; thus, it is less efficient than supervised cycling training. P470 One year outcomes of combined use of warfarin and oral antiplatelet agents in patients with chronic obstructive pulmonary disease, atrial fibrillation and acute coronary syndrome. J Ramazanov1, T Batyraliyev2, I Pershukov3, A Omarov4, Z Karben2, L Shulzhenko5, L Petrakova2, B Sidorenko6, Y Belenkov7 1Central Hospital of Oil Workers, Cardiology, Baku, Azerbaijan 2Sani Konukoglu Medical Center, Gaziantep, Turkey 3Voronezh Regional Clinical Hospital No1, Voronezh, Russian Federation 4Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan 5Regional Clinical Hospital, Krasnodar, Russian Federation 6Presidential Medical Center , Moscow, Russian Federation 7Lomonosov State University, Moskow, Russian Federation Background:Although atrial fibrillation (AF) occurs frequently in patients with chronic obstructive pulmonary disease (COPD) and hospitalized with acute coronary syndrome (ACS), strategies for prevention of thromboembolic complications are poorly characterized. We sought to examine exposure to warfarin and P2Y12 inhibitors and clinical outcomes among patients with COPD, AF and ACS. Material and Methods:Patients age >65 years hospitalized in our clinics with primary diagnosis of ACS and a secondary diagnoses of COPD and AF between 2008 and 2012 were identified and included in interclinic Registry. Medication exposure was ascertained during a 90-day period following the index discharge using guidelines drug claims. Among patients who were alive and not readmitted during the ascertainment period, we examined the cumulative incidence of all-cause mortality and all-cause readmission by medication exposure at 1 year. Results:A total of 1266 patients met the inclusion criteria. Among the 722 patients (61%) who were alive and not readmitted during the 90-day ascertainment period, 27.0% received warfarin, 38.9% received P2Y12 inhibitors, 10.2% received combination therapy, and 23.9% received neither therapy. Readmission rates were high in all groups at 1 year ( warfarin-47.5%, P2Y12 inhibitors-46.6%, combination therapy-38.0%, and neither therapy-39.3%), and the overall 1-year mortality rate was 12.5%. Conclusion:Among old patients with COPD, AF and ACS, combination therapy with warfarin and P2Y12 inhibitors was uncommon during the 90-day ascertainment period, and more than one-quarter of patients had no claims for warfarin or P2Y12 inhibitors. Rates of all-cause readmission and mortality within 1 year of hospitalization for ACS were high. P471 Exercise capacity evolution and readaptation impact after LVAD HeartWare implantation. M Lamotte1, M Antoine2, G Van Nooten2 1Erasme Hospital (ULB), Physiotherapy and cardiac surgery department, Brussels, Belgium 2Erasme Hospital (ULB), Cardiac surgery department, Brussels, Belgium Background:LVAD are more and more efficient and proposed to an increased amount of heart failure patient. Actually, 20000 devices have been implanted around the world and approximately 1500 are now implanted yearly. Those device allow not only to reduce the mortality of the patient, but also lead the patient on a more optimal status to the transplantation when, as in our country actually, only the "bridge to transplant" indication is recognized. Population:Our data are based on a population of 50 consecutive patients implanted on a period of three years, by the continuous "HeartWare®" device. The variable are measured during 80 maximal cardiopulmonary exercise testing (CPET : VO2, VCO2, Ve, RER, ãÎ). Tests are realized at 1, 6, 12 and 24 month after implantation. Some of our patients follow a structured rehabilitation. Results:The exercise capacity (VO2p) of our patient at one month is 46 % of de predicted value (PV), for a RER of 1.27 and a Ve/VCO2 slope of 36. At 6 month, mean workload is 77 W (47 % of PV), mean VO2p 16.8 ml/:kg.min (55 % of PV), mean Ve/VCO2slope is 35.4, mean Ve reserve is 55 %. Mean individual VO2p increase from 1 to 6 month but is stable or slightly decrease from 6 to 12 month after implantation. In the same time, their weight is increasing and the Ve/VCO2 slope also. We observe a large variation between patients. For example, at six month, VO2p varies from 33 to 98 % of the predicted value. The maximal workload achieved is actually 180 Watts (6 month) and illustrate the possible recovery of some patient after such an intervention. An important factor that explains those differences is the participation to a rehabilitation program as illustrate on a sub-group of our patient who complete the program. Our readapted patients seems to be older (50 versus 44 year old, NS), their exercise capacity are higher (VO2p : 67 versus 45 % of PV, p<0.01, Workload : 58 versus 36 % of PV, p<0.001) and the Ve/VCO2 slope seems to be lower (33 versus 37, NS). Conclusions:LVAD allows the patient to recover an active life and allow them to follow a structured exercise rehabilitation program. At six month, the exercise capacity is severely depressed in some patient but nearly restored in some other particularly if a rehabilitation program is performed. Unfortunately, after the first six month (active period of rehabilitation), the exercise capacity decrease and the mean weight of the patient increase. This underline the importance of a structure supervised rehabilitation on a long term basis. P472 Left ventricular versus biventricular assist devices: does it make a difference in exercise capacity? I D Laoutaris1, S Adamopoulos1, A Dritsas1, A Gkouziouta1, L Louca1, P Sfyrakis1 1Onassis Cardiac Surgery Center, Athens, Greece Topic: Sports cardiology Purpose:Due to lack of donor hearts, patients with ventricular assist devices (VAD) are increasing. We aimed to investigate whether patients with left VAD (LVAD) present with a better functional capacity compared to patients with biventricular support (Bi-VAD), late after device implantation. Methods:Out of 23 patients with VAD (Berlin Heart GmbH, Germany) bridged to HTx, 11 patients with LVAD (9 males/2 females) and body mass index (BMI) 25.8±3.9, kg/m2, of mean age 38.4±15.1 years, classified according to Interagency Registry for Mechanically Circulatory Support (INTERMACS) scale as 1 (n=1), 2 (n=10) and 12 patients with Bi-VAD (12 males) and BMI 23.9±3.9 kg/m2 of mean age 37.3±14 years, INTERMACS 1 (=3), 2 (n=4), 3 (n=5) underwent cardiopulmonary exercise testing for measuring peak oxygen consumption (peakVO2), and the 6-minute walk test (6MWT), 6±3.7 months post-implantation. Results:The LVAD group was matched with the BiVAD group for age, gender and BMI. Exercise capacity in patients with LVAD vs. patients with BiVAD as assessed by peakVO2 (14.9±3 vs. 16.3±3.8 ml/kg/min, p=ns), as well as exercise time (8.3±2.9 vs. 9.2±2.1 min), VE/VCO2 slope (37.8±7.4 vs. 40±5.3, p=ns), VE (45.8±12.9 vs. 55.8±15.9 L/min, p=ns), and VO2 at anaerobic threshold (11.6±4 vs. 12.5±4.6 ml/kg/min, p=ns) respectively, did not differ significantly. The 6MWT distance was comparable between LVAD patients and Bi-VAD patients (439±87 vs. 493±59 meters, p=ns). Conclusion:There were no differences in neither maximal or submaximal exercise capacity between patients with LVAD and Bi-VAD long-term after device implantation, Our findings indicate that exercise capacity in patients with VAD is independent of univentricular or biventricular support. P473 The effects of table tennis training on cardiac autonomic dysfunction in persons with spinal cord injury G Vogiatzi1, E Kouidi1, V Tsimaras2, K Christoulas3, A Deligiannis1 1Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece 2Aristotle University of Thessaloniki, Laboratory of Developmental Pediatrics and Special Education , Thessaloniki, Greece 3Aristotle University of Thessaloniki, Laboratory of Ergophysiology-Ergometry, Thessaloniki, Greece Cardiac autonomic nervous system (ANS) dysfunction is a frequent complication in people with spinal cord injury (SCI). Due to altered sympathetic-parasympathetic balance (reduced overall sympathetic activity below the level of injury and unopposed vagal outflow), cardiovascular complications, as dysrhythmias and cardiac arrest, are often. The effects of exercise training on ANS dysregulation in SCI remain unclear. Thus, the aim of the study was to examine the effects of a long-term table tennis program on cardiac ANS in quadriplegics. Fourteen males (aged from 32 to 47 yrs old) with chronic spinal cord injury (C6-C7 level) without other disease participated in the study. They were randomly divided into 2 groups: seven quadriplegics (Group A), followed a six-month program with table tennis, three times per week, while the other 7 (Group B), served as controls. Additionally, 7 healthy sedentary men (aged 40.0 ± 6.1 yrs old- Group C) were used as healthy controls. At baseline and the end of the study, all persons underwent 24hour ambulatory ECG monitoring for heart rate variability (HRV) measurements based on time- and frequency domain analysis and assessment of upper-limb exercise tolerance and muscle strength. In group A, HRV was continuously monitored during table tennis by a HR monitor (Polar S810i) to evaluate the acute ANS response to exercise. Results:At baseline, there were no significant differences in long-term HRV indices between the two patient groups. On the other hand, SDNN was lower in group A compared to C (109.0±9.4 vs 146.5±8.8 ms, p<0.05), while the differences in the rMSSD, LF, HF and LF/HF weren't significant. At the end of the study, group A showed an increase in SDNN (116.7±6.5 vs 109.4±9.4 ms, NS), rMSSD (48.5±4.8 vs 41.2±6.2ms, p<0.05), LF (72.7±12.4 vs 56.9±8.4nu, p<0.05), HF (51.8±12.4 vs 39.7+±12.8 nu, NS) and a decrease in LF/HF (1.43±0.6 vs 1.40±0.4, NS) compared to the pre-training values. After training, resting upright posture short ANS measurements showed that the rMSSD and HF were decreased by 8.3% and 10.7% (p<0.05), while LF and LF/HF did not change significantly; as response to acute exercise, the reduction of rMSSD and HF and the increase of LF and LF/HF were significantly higher after training. Moreover, table tennis training significantly improved upper limbsmaximal exercise tolerance by 69.9% and muscle strength by 35.7%. Conclusion:Our results indicate that a 6-month table tennis training program in quadriplegics has the potential to promote a better balance between sympathetic and vagal activity, mainly during upright posture at rest and exercise. P474 The influence of different training modalities on the effect of exercise training in patients with chronic heart failure: a meta-analysis T Vromen1, JJ Kraal1, N Peek2, G Van Valkenhoef3, J Kuiper4, HM Kemps5 1Dept of Medical Informatics, Academic Medical Centre, Amsterdam, Netherlands 2University of Manchester, Health e-Research Centre, Inst. of Population Health, Manchester, United Kingdom 3University Medical Center Groningen, Dept. of Epidemiology, Groningen, Netherlands 4University Medical Center Groningen, Dept of epidemiology, Groningen, Netherlands 5Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands Introduction:Studies have convincingly shown beneficial effects of exercise training (ET) on physical fitness and quality of life and to hospital admissions in patient with chronic heart failure (CHF). Aerobic exercise training for CHF patients is therefore strongly recommended in current guidelines. In recent years, there has been a debate in the literature about appropriate training intensities in aerobic ET. Previous systematic reviews indicated that the differences in outcomes of ET might not be caused by training intensity alone, but by other training parameters as well. Topic: Sports cardiology Purpose:To determine which ET parameter (aerobic training frequency, intensity, duration and volume) is the strongest determinant of exercise training effects on maximum oxygen uptake (pVO2). Methods:A systematic search in EMBASE and MEDLINE was performed for papers published between 1 april 2007 and 1 september 2013, comparing ET with usual care or other training modalities in adult CHF patients. Only randomized controlled trials were included that reported peak oxygen uptake as an outcome measure. Univariate meta-regression analyses were performed on the following training parameters: training intensity (%pVO2), session duration (minutes), weekly session frequency, program duration (weeks), session energy expenditure (EE, intensity*duration), weekly EE (frequency*session EE) and total EE (program duration*weekly EE). Results:Twenty-one trials were included, accounting for a total of 1093 patients. Overall, weekly session frequency appeared to be the best predictor for improvement in exercise capacity (p=0.0009), with 0,30 ml/min/kg increase in peak VO2 for every extra session per week (95% CI 0.12-0.47). Total EE (0,16 ml/min/kg 95% CI 0,06-0,26 per 100J/kg), weekly EE (0,97;0,31-1,6 per 100J/kg) and session intensity (0,69; 0,05-1,34 per 10% increase in exercise intensity) were also associated with increase in exercise capacity (p=0.0027, p=0.0039 and p=0,0347 respectively). For session EE, program duration, and session duration no association with exercise capacity was found. For all modalities there was little to none heterogeneity in the effect size (I2 ranging from 0 to 28%) indicating that there was little unmeasured confounding. Conclusion:Weekly session frequency was the strongest predictor of change in peak oxygen uptake in CHF patients undergoing exercise training. P475 Baseline titer of short physical performance battery and ten-meter walking speed determine six-minute walk distance above 300 meters after the ambulatory independent discharge for elderly PROgram A Uehara1, H Obata2, Y Izumi1, H Watanabe2, T Izumi1 1Niigataminami Hospital, niigata, Japan 2Niigata University Graduate School of Medical and Dental Sciences, Department of Cardiovascular Biology and Medicine, niigata, Japan Topic: Sports cardiology Purpose:In countries such as Japan, which have an aging society and few births, there is a large population of elderly patients with frailty that requires repetitive hospitalization due to various diseases. With the Ambulatory Independent Discharge for Elderly PROgram (AIDE-PRO), patients are discharged from the hospital on achieving independent gait. We investigated the factors contributing to achieving a 6-min walk distance (6MWD) more than 300 m after the AIDE-PRO to return home-stay. Methods:We evaluated 58 consecutive patients (mean age, 82 years; 31 women [53 %]) who were discharged on achieving independent gait, with a short physical performance battery (SPPB) score less than 12 points before the AIDE-PRO. The AIDE-PRO consists of stretching, lower limb muscle and balance strengthening, and aerobic exercises. The outcome assessment was SPPB score, isometric knee extension muscle strength (IKEMS), functional reach test (FRT), one leg standing time (OLST), 10-m walking speed (10MWS), and 6MWD before and after the AIDE-PRO. Results:After 30 days of rehabilitation, the IKEMS, FRT, OLST, and 10MWS values improved significantly from 31 % to 35 %, 21 cm to 26 cm, 5 s to 12 s, and 0.77 m/s to 0.98 m/s, respectively. The balance test, gait speed test, and chair stand test scores of the SPPB significantly improved from 2.8 to 3.6, 2.2 to 3.0, and 1.9 to 2.8, respectively. As a result, the total SPPB score improved from 6.8 at baseline to 9.5 points after rehabilitation, and 13 patients (22 %) attained a perfect score. After the AIDE-PRO, 27 patients achieved a 6MWD of 284 m. These patients were divided into two groups according to their 6MWD after the AIDE-PRO. Group A comprised 13 patients with a 6MWD more than 300 m, and Group B comprised 14 patients with a 6MWD less than 300 m. Age and rehabilitation period was 78 years and 30 days, respectively, in Group A, and 83 years and 36 days in Group B, respectively, with no significant difference in both groups. Before the AIDE-PRO, IKEMS, FRT, OLST values did not significantly differ between two groups (Group A: 29 %, 26 cm, 12 s; Group B: 28 %, 20 cm, 3 s). The SPPB scores for Group A and Group B, respectively, were as follows: balance test, 3.4 and 2.6; gait speed test, 2.5 and 1.9; chair stand test, 2.6 and 1.9; total score, 8.5 and 6.4. Group A showed better SPPB scores than Group B, with a significantly higher total SPPB score. The 10MWS was significantly faster in Group A than Group B (0.91 m/s vs. 0.69 m/s). Conclusions:The baseline titer of total SPPB score and 10-m walking speed determine achieving a 6MWD more than 300 m after the AIDE-PRO . ?variation in % With Diastolic Dysfunction Without Diastolic Dysfunction Parameters Before CR After CR ? , % p value Before CR After CR ? , % p value NT_proBNP ( pg /mL) 1173 ±1503 471 ±432 -35.2 ±43.5 0.021 462 ±543 157 ±154 -50.2 ±30.7 <0.001 pVO2 (mL/Kg/min) 23.3 ±7.3 25.2 ±26.9 11.9 ±27.6 ns 26.0 ±6.5 27.9 ±7.1 9.5 ±29.2 0.003 VE/VCO2 slope 26.7 ±5.9 26.8 ±5.4 -2.8 ±23.5 ns 25.6 ±5.1 24.9 ±4.4 -1.1 ± 16.1 0.048 LVEF (%) 46.8 ±12.9 49.0 ±11.7 9.3 ±29.4 ns 54.8 ±9.5 56.1 ±9.8 3.4 ±14.7 ns GLS (%) -14.9 ±2.9 -15.9 ±2.6 10.4 ±33.1 ns -15.3 ±3.9 -16.5 ±3.9 16.8 ±18.1 0.049 E/ératio 27.2 ±54.9 13.0 ±9.7 -16.8 ±53.9 0.002 7.8 ±1.7 7.9 ±1.7 4.66 ±28.7 ns With Diastolic Dysfunction Without Diastolic Dysfunction Parameters Before CR After CR ? , % p value Before CR After CR ? , % p value NT_proBNP ( pg /mL) 1173 ±1503 471 ±432 -35.2 ±43.5 0.021 462 ±543 157 ±154 -50.2 ±30.7 <0.001 pVO2 (mL/Kg/min) 23.3 ±7.3 25.2 ±26.9 11.9 ±27.6 ns 26.0 ±6.5 27.9 ±7.1 9.5 ±29.2 0.003 VE/VCO2 slope 26.7 ±5.9 26.8 ±5.4 -2.8 ±23.5 ns 25.6 ±5.1 24.9 ±4.4 -1.1 ± 16.1 0.048 LVEF (%) 46.8 ±12.9 49.0 ±11.7 9.3 ±29.4 ns 54.8 ±9.5 56.1 ±9.8 3.4 ±14.7 ns GLS (%) -14.9 ±2.9 -15.9 ±2.6 10.4 ±33.1 ns -15.3 ±3.9 -16.5 ±3.9 16.8 ±18.1 0.049 E/ératio 27.2 ±54.9 13.0 ±9.7 -16.8 ±53.9 0.002 7.8 ±1.7 7.9 ±1.7 4.66 ±28.7 ns Open in new tab ?variation in % With Diastolic Dysfunction Without Diastolic Dysfunction Parameters Before CR After CR ? , % p value Before CR After CR ? , % p value NT_proBNP ( pg /mL) 1173 ±1503 471 ±432 -35.2 ±43.5 0.021 462 ±543 157 ±154 -50.2 ±30.7 <0.001 pVO2 (mL/Kg/min) 23.3 ±7.3 25.2 ±26.9 11.9 ±27.6 ns 26.0 ±6.5 27.9 ±7.1 9.5 ±29.2 0.003 VE/VCO2 slope 26.7 ±5.9 26.8 ±5.4 -2.8 ±23.5 ns 25.6 ±5.1 24.9 ±4.4 -1.1 ± 16.1 0.048 LVEF (%) 46.8 ±12.9 49.0 ±11.7 9.3 ±29.4 ns 54.8 ±9.5 56.1 ±9.8 3.4 ±14.7 ns GLS (%) -14.9 ±2.9 -15.9 ±2.6 10.4 ±33.1 ns -15.3 ±3.9 -16.5 ±3.9 16.8 ±18.1 0.049 E/ératio 27.2 ±54.9 13.0 ±9.7 -16.8 ±53.9 0.002 7.8 ±1.7 7.9 ±1.7 4.66 ±28.7 ns With Diastolic Dysfunction Without Diastolic Dysfunction Parameters Before CR After CR ? , % p value Before CR After CR ? , % p value NT_proBNP ( pg /mL) 1173 ±1503 471 ±432 -35.2 ±43.5 0.021 462 ±543 157 ±154 -50.2 ±30.7 <0.001 pVO2 (mL/Kg/min) 23.3 ±7.3 25.2 ±26.9 11.9 ±27.6 ns 26.0 ±6.5 27.9 ±7.1 9.5 ±29.2 0.003 VE/VCO2 slope 26.7 ±5.9 26.8 ±5.4 -2.8 ±23.5 ns 25.6 ±5.1 24.9 ±4.4 -1.1 ± 16.1 0.048 LVEF (%) 46.8 ±12.9 49.0 ±11.7 9.3 ±29.4 ns 54.8 ±9.5 56.1 ±9.8 3.4 ±14.7 ns GLS (%) -14.9 ±2.9 -15.9 ±2.6 10.4 ±33.1 ns -15.3 ±3.9 -16.5 ±3.9 16.8 ±18.1 0.049 E/ératio 27.2 ±54.9 13.0 ±9.7 -16.8 ±53.9 0.002 7.8 ±1.7 7.9 ±1.7 4.66 ±28.7 ns Open in new tab P476 Impact of cardiac rehabilitation on diastolic dysfunction: is there a positive effect? P Rio1, A Abreu1, R Soares1, S Aguiar Rosa1, T Pereira-Da-Silva1, A Viveiros Monteiro1, I Rodrigues1, M Afonso Nogueira1, S Silva1, R Cruz Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Topic: Sports cardiology Purpose:Diastolic dysfunction is common in patients (pts) with coronary artery disease. Exercise training improves exercise capacity of these pts, primarily duo to peripheral adaptations. The contribution of left ventricular (LV) diastolic filling is not yet well understood. The aim of the present study is to evaluate the impact of cardiac rehabilitation (CR) in pts with diastolic dysfunction (WDD). Methods:Retrospective analysis of consecutive pts with coronary artery disease (CAD) who underwent CR program (2004-2013), in a single center. Cardiopulmonary exercise testing (CPET), echocardiogram and blood tests were performed at baseline and after 36 exercise training sessions. Exercise sessions were performed in hospital, three times a week, 60 minutes duration. Peak oxygen uptake (pVO2), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), ratio early diastolic pulse wave Doppler and Tissue Doppler Imaging (E/e') and natriuretic peptides (NT_proBNP) were evaluated. Patients were divided and analysed according to diastolic function estimated by E/A ratio, E/e' ratio and left atria dimension. Results:We analysed 169 pts, 83% male, mean age 57.2±10.4 years. There were 55 (33%) pts WDD and 114 (67%) without diastolic dysfunction (WODD). Comparing both groups, NT_proBNP decrease 35.2% in WDD vs 50.2% in WODD (p=0.03), GLS increase 16.8% in WODD vs 10.4% in WDD (p=0.045) and E/e' ratio decrease 16.8% in WDD vs and increase of 4.7 in WODD (p=0.03). Conclusion:Patients with diastolic dysfunction achieved significant benefit in diastolic function, with a statistical significant decrease of E/e' ratio. On the contrary, they did not obtain greater increase in global longitudinal strain and reduction in NT_proBNP, comparing to patients without diastolic function. P477 Neuroendocrine response to Heated water-based Exercise training on resistant hypertensive patients: a randomized controlled Trial (HEx trial) L G B Cruz1, GV Guimaraes1, EA Bocchi1 1Heart Institute (InCor) - University of Sao Paulo Medical School, Sao Paulo, Brazil Background:Heated water based EXercise training (HEx) is a new alternative intervention in cardiac rehabilitation, and it has been studied about its effects on cardiovascular adaptations; but still there is no data is about neuroendocrine effects of this training. This study examines the effects of HEx on neuroendocrine response in resistant hypertensive patients. Methods:This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 44 patients fulfilled the study requirements and had their blood analyzed for the concentration of plasma catecholamines (dopamine, adrenaline and noradrenaline), endothelin -1, nitric oxide (NO), plasma aldosterone concentration and plasma renin activity (PRA) than the patients were divided in two groups, one group was trained in a heated pool (32oC) for 12 weeks , 3 times a week; and the other group was the control group. The sessions were performed for 60 minutes and were consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. After 12 weeks all patients repeated the blood tests. Results:44 patients (HEx n=28; control n=16) were randomized; there was no loss during the follow-up and no adverse events occurred during the study. HEx decreased plasma concentration of dopamine (from 145±88 to 26±21 ng/ml, p<0.0001), adrenaline (from 353±156 to 169±93 ng/ml, p=0.009), noradrenaline (from 720±255 to 307±137 ng/ml, p=0.001), andothelin-1 (from 42±14 to 26±8 pg/ml, p=0.003), aldosterone (from 94±48 to 77±22 pg/ml, p=0.006) PRA (from 35±14 to 3±3 mmHg ng/ml/H, p<0.0001); and increased NO (from 25±7 to 77±22 uM, p= 0.001).The control group after 12 weeks did not have any changes on blood analysis results. Conclusion:HEx was able to improve important neuroendocrine adaptations in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients. P480 The role of Pacemaker remote follow-up in early detection and management of lead complications and patient medical care. O Al-Razo1, E Gonzalez1, M Alejandre1, T Represa1, J Silvestre1, JM Mesa1 1University Hospital La Paz, Department of Cardiac Surgery, Madrid, Spain Introduction:In the recent years, several studies have demonstrated that (PM) remote follow-up is safe, cost effective and reliable in early detection of arrhythmia and lead complications. In this study we report our experience in PM remote follow-up and the impact of using this technology on patient's medical care. Patients and methods:2200 patients with PM were included in the remote follow-up clinic between February 2008 and November 2014 (1000 patients with CareLink, Medtronic, 727 patients with Home monitoring, Biotronik, 285 patients with Merlin.net, St. Jude Medical and 188 patients with Latitude, Boston Scientific). They patients were completely followed up by remote monitoring after the third month post implant. Results:396 (18%) arrhythmia alert were reported (atrial fibrillation and/or atrial tachycardia). In 20% of these alerts, a new onset atrial fibrillation was diagnosed. A complete event informs were sent to these patients to be delivered to their cardiologist. Thirty-seven alerts for lead dysfunction were received, most of which were due to lead impedance changes. Sixteen cases of lead displacement were diagnosed and one case of rupture of lead insulation. Conclusions:This study demonstrates that PM remote follow-up is effective in early detection of lead problems and arrhythmias and thus plays an important role in the prevention of patient's morbidity. P481 Telerehabilitation in coronary artery disease (TRIC-Study), 12 months data K Wallner1, J Altenberger1, S Klausriegler1, B Kogler1, I Mairinger1, R Mueller1, R Rieder1, H Zauner1 1SKA-RZ Grossgmain (PV), Grossgmain, Austria Topic: Sports cardiology Purpose:The aim was to evaluate feasibility, efficacy and safety of home-based telerehabilitation following shortened inpatient cardiac rehabilitation in comparison to a regular inpatient cardiac rehabilitation program in patients suffering uncomplicated coronary artery disease (CAD). Methods:This prospective non-randomised parallel group study assigned 45 male patients for shortened 2 weeks inpatient rehabilitation followed by a 10 weeks telerehabilitation program (TRG) versus 47 patients who completed a conventional 4 weeks inpatient rehabilitation program (CG). Outcome measures were assessed after 12 months using cardiopulmonary function (Watt (W)peak, Wpeak/kgBW(Bodywight), WVAT1(ventilatory aerobic treshold1), VO2peak/kg, VO2VAT1/kg, With L(lactate)2mmol/l, With L(lactate)4mmol/l), laboratory parameters (total cholesterol (TC), high density lipoprotein (HDL)-C; low density lipoprotein (LDL)-C; TC/HDL-C quotient)), physical parameter (body weight (BW); body mass index (BMI), waste circumference (WC), body fat (BF)). Results:Baseline demographics were equally distributed between the groups, except age (CG younger). No adverse events were observed in both groups during rehabilitation. After 12 month in the TRG (n=41), Wpeak (+23,.1%; p<0.001), Wpeak/kgBW (+24.7%; p<0.001), WVAT1 (+11.2%; p=0.014), VO2peak/kg (+7.4%; p=0.008), and VO2VAT1/kg (+4.7%; p=ns) were increased. In the CG (n=45) only Wpeak and Wpeak/kgBW increased by +3.5% (p=ns) and +3.2% (p=ns) respectively. In contrast WVAT1, VO2VAT1/kg and VO2peak/kg decreased by -15.1% (p= 0.002), -11.1% (p= 0.006), and -1.3%(p= ns) respectively. The difference between TRG and CG was highly significant for VO2VAT1/kg (p=0.016), Wpeak (p=0.019), Wpeak/kg (p=0.005), and WVAT1 (p=0.002). In TRG concentrations of LDL-C (-22.7%; p< 0.001), TC (-14.5%; p< 0.001), TG (-17.2%; p=ns), and TC/HDL-C (-16.9%; p= 0.001) decreased significantly during the twelve months. HDL-C (+1.2%; p=0.087) did not increase statistically significant. In CG non of the laboratory parameters statistically significant changed. After 12 months except HDL-C all parameters showed a statistically significant difference between the groups in favour of the TRG. Physical parameters showed no statistical significant difference within and between the two groups after twelve months. Conclusions:Home-based telerehabilitation can be regarded as safe and feasible for patients with uncomplicated CAD. In addition we could show significant improvements due to physical fitness and change in risk factors in the TRG compared to regular four weeks inpatient rehabilitation. P482 What is the impact of telemonitoring on the continuity of care for heart failure patients? A Malhotra1, H Dhutia1, W Lewis1, M Papadakis1, J Ah-Fong1, L Mccloughan2, J Hanley2, P Fairbrother2, B Mckinstry2, H Pinnock2 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom 2University of Edinburgh, Centre for Population Health Sciences, Edinburgh, United Kingdom Topic: Sports cardiology Purpose:Management of congestive heart failure (CHF) costs the UK health service £625 million per year with costs expected to rise worldwide as patient numbers increase along with a greater burden on resources. Telemonitoring (TM) aims to delivering a cost-effective, patient-centred service with increased continuity of care through the use of audio, video and other telecommunication technologies. The efficacy of TM is debated. This study investigates the impact of TM on the continuity of care from the perspective of patients with CHF and their health care providers (HPs). Methods:NHS Lothian created a TM pilot service to monitor their CHF patients and assess its effects. A qualitative design was used to evaluate participants' views between June 2013-14. 18 patients and 5 HPs underwent interviews which were recorded, transcribed and analysed. The key themes of continuity of care to be assessed were reassurance and accessibility, trust, relationship continuity and management continuity. Results:Reassurance and accessibility- Patient groups were positive about TM offering a sense of security and reassurance. Patients felt more involved with their management through the daily recording of their physiological parameters. HPs were positive about monitoring patients on a daily basis. There were concerns that TM may encourage patients to adopt a sick dependency role. Both groups responded positively about data accessibility with measurable quantitative data being transmitted directly to a healthcare professional. Trust- Both groups were positive about TM fostering trust between the HP and the patient. Relationship continuity- Patient groups were negative about relationship continuity. Many patients noted they would have preferred to have seen their own GP. HPs reported that TM would work better if they knew the patient. Management continuity- Patient groups were positive about the integration of technology as part of their management and found use of the technology to be relatively easy. HPs found there was insufficient information to adequately plan management. There was insufficient information about pre-existing decisions. A lack of communication between HPs and a lack of clarity as to leadership was noted. Conclusion:Both groups acknowledged that TM had an overall positive effect on continuity of care with the management of people with CHF. Relationship continuity and management continuity issues need to be overcome to meet the objectives of the service. Further work is also required to ascertain the quantitative effects of TM on CHF and overall cost-effectiveness of the TM service. P484 Heart rate variation during cardiopulmonary exercise testing in patients with heart failure: don't forget the basics S Guerreiro1, A Ferreira1, M Mendes1 1Hospital de Santa Cruz, Lisbon, Portugal Topic: Sports cardiology Purpose:to assess the prognostic value of a novel index combining heart rate (HR) reserve and recovery in patients with heart failure undergoing cardiopulmonary exercise testing (CPET). Methods:Retrospective, single-centre study of 144 patients with heart failure and depressed left ventricular ejection fraction (111 males, mean age 54±11 years) who underwent CPET between June 2009 and August 2013. Patients who were not taking beta-blockers and/or were not in sinus rhythm were excluded. Patients were classified in quintiles of HR reserve and HR recovery. Quintile categorizations were summed in a score ranging from 2 to 10. The prognostic value of this score was compared with classic CPET parameters: peak oxygen uptake (peak V02) and minute ventilation-carbon dioxide production relationship (VE/VCO2 slope). The primary endpoint was a composite of death from any cause or heart transplantation. Results:During a median follow-up of 3.1 years (interquartile range 2.0-3.9), 22 patients died and 10 others received a heart transplant. The incidence of the primary endpoint was significantly higher for lower HR index scores (Fig1). In Cox regression analysis, the prognostic power of the HR index was not shown to be independent of peak V02 (HR 0.92; IC 0.77-1.10, p=0.37). Despite this, its discriminate ability as measured by the area under the ROC curve was good (AUC 0.71, 95%CI 0.62-0.81, p<0.001), and only tendentiously inferior to the discriminative ability of peak V02 (AUC 0.79, 95%CI 0.72-0.87, p<0.001), p=0.08 for the difference between the two AUCs. Conclusions:Among patients with heart failure, the HR index score is a marker of bad prognosis. Our findings suggest that this simple non-invasive parameter can be used as an alternative to V02 measurements in settings where CPET is not available. Open in new tabDownload slide P485 Exercise evaluation in young adults after repaired coarctation of the aorta: is bicuspide aortic valve a threat? A Monteiro1, A Abreu1, A Agapito1, P Rio1, SA Rosa1, I Rodrigues1, TP Silva1, MA Nogueira1, S Silva1, RC Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Background:Bicuspid aortic valve (BAV) is one of the most congenital cardiac conditions. In coarctation of the aorta (ACo), BAVs are common, but their relation with exercise hemodynamic response is unknown. The purpose of this investigation was to study the impact of BAV in successful surgical repaired ACo using exercise stress doppler echocardiography. Methods:Thirty consecutive patients (51.9% male) were studied after ACo repair (age at repair 3.3+/-2.6 years) and underwent, at 30.1 ± 8.25 years of age, an exercise treadmill testing with echocardiographic examination. The following parameters were evaluated: peak and mean doppler gradients and velocities in ascendant and descendent aorta (at rest and at maximum stress). Results:All patients underwent test exercise (15.93 ± 4.0 minutes) with no severe complications such as syncope, ischemic or arrhythmic events. Fifty percent of the patients had evidence of BAV (Group A). At maximum stress, Group A presented a significant increase in peak gradient and velocity in descendent aorta (respectively from 24.4 ± 10.8 to 50.5 ± 22.8; p<0.001 and from 2.36 ± 0.8 to 3.38 ± 0.9; p<0.001). In patients with tricuspid aortic valve (Group B), peak gradient and velocity in descent aorta also raised respectively from 22.1 ± 7.3 to 51 ± 16.4 (p<0.001) and from 2.17 ± 0.4 to 3.33 ± 0.8 (p=0.013). However, although an overall similar increase in doppler echocardiographic findings, when comparing both BAV and non BAV patients, no significant differences were found in descendent aorta parameters (?ak gradient 23.3±18.8 vs 32.6±17.5, p=0.998; ?ak velocity 0.65±0.7 vs 0.65±0.8, p=0.223). The same trend was verified in ascendant aorta values. Conclusions:BAV in AoC patients was frequent. Despite BAV patients seem to have a smaller increase in aorta doppler parameters, this didn't seem to be different or more danger when compared to patients with normal aortic valves. P486 Stroke in Chagas disease: impact of a rehabilitation program A Souza1, HS Costa1, GR Sousa1, MMO Lima2, LL Gusmao1, F Almeida1, LAP Sousa1, MOC Rocha1, MCP Nunes1 1Federal University of Minas Gerais, School of Medicine, Postgraduate Course of Tropical Medicine, Belo Horizonte, Brazil 2Federal University of Jequitinhonha and Mucury Valleys, Diamantina, Brazil Topic: Sports cardiology Purpose:Regardless of cardiac manifestation, ChD is a well-defined risk factor for stroke. ChD and stroke are stigmatizing diseases and can determine important sequelae, so long-term rehabilitation becomes needed. This study aimed to investigate the effects of an aerobic training program on the functional capacity and quality of life (QOL) in chagasic stroke patients (ChSP), comparing with chagasic patients without stroke (ChPWS). Methods:This was a prospective study, carried out at the University of Minas Gerais, Belo Horizonte, Brazil. The inclusion criteria included: ChD with or without stroke; 30 - 65 years; ability to walk for 20 minutes; clinical stability for at least 3 months. Patients were excluded if they present severe aphasia, pain or serious imbalance during gait, pacemaker or other cardiac, neurological or systemic disorders. The functional capacity evaluation was performed through the 6-minute walk test (6MWT), and the 6MWT distance was calculated. The Brazilian version of the 36-Item Short-form Health Survey (SF-36) questionnaire was used to measure patients' QOL. All volunteers, with or without stroke, participated in a 12-weeks aerobic training program conducted 3 times a week, supervised by physiotherapists. Each session was tailored to individual limitations and included 5-10 min warm up, 30 - 40 min walking, and 5 - 10 min cooling down. Training intensity was calculated using the Karvonen formula and gradual adjustments were done along the training program period in order to achieve target HR training intensity. Results:Eleven ChSP and nineteen ChPWS were included. There was no diference between groups regarding age, sex and clinical conditions. The data were analysed for delta values (? = end - baseline). After intervention, both of groups had significant increases in functional and QOL parameters (p<0,05). Compared with the ChPWS, the ChSP showed more significant increases in QOL: ? domains general health (11,8 vs. 21,9; p=0,02), ? functional classification (12,6 vs. 20,5; p=0,02), ? domains general health (11,8 vs. 21,9; p=0,018), ? physical aspects (12,8vs. 20,1; p=0,03), ? general health status (12,1vs. 21,4; p=0,005) and ? vitality (11,2 vs. 22,9; p=0,000). There was no difference between ChSP and ChPWS in ? 6MWT distance (16,4 vs. 13,9; p=0,471), and ? pain (13,4 vs. 19,1; p=0,085), and ? social aspects (14,1 vs. 17,9; p=0,268), and ? emotional aspects (16,7 vs. 13,4; p=0,328). Conclusion:In ChSP, aerobic training was safe and associated with a major improvement in functional capacity and QOL, in many aspects, more significant than ChPWS. P487 High-intensity interval training in patients with cancer - a pilot study LDT Trachsel1, HG Gottschalk1, CD Deluigi1, PE Eser1, MW Wilhelm1 1Bern University Hospital, Preventive Cardiology & Sports Medicine, Bern, Switzerland Topic: Sports cardiology Purpose:Cardiorespiratory fitness (peak VO2) is an important predictor for overall mortality in healthy subjects and patients with cardiovascular diseases and cancer. High-intensity interval training (HIIT) is a relatively new training modality that improves cardiorespiratory fitness. Superiority of HIIT to the established moderate intensity continuous exercise modality (MICE) has been demonstrated in cardiac patients. We investigated the effects of HIIT on peak VO2 in patients with cancer in an outpatient rehabilitation setting. Methods:In February 2013, the ambulatory rehabilitation program at our institution was extended to cancer patients. In the first six months patients completed a 3-month program with 2 to 3 supervised sessions of MICE/week. After six months, HIIT was introduced in the program and patients performed MICE in the first month, followed by 2 months of HIIT. Data was analyzed retrospectively for the present study. Measurements included clinical status and cardiopulmonary exercise testing before start and after completion of the program. Relative changes in peak VO2 and work rate were compared between groups using independent t-tests or Mann-Whitney tests as appropriate. Results:A total of 20 consecutive patients (14 females) with a diagnosis of cancer (breast cancer 50%, lymphoma 40%) were included in the analysis. 10 patients performed MICE and 10 patients HIIT. Compliance was comparable between groups with a mean of 30 sessions in the MICE group (83%) and 31 sessions (87%) in the HIIT group (p=0.53). There were no sex differences between the groups. Mean age tended to be younger in HIIT (42.4 vs. 49.4 years, p=0.08). Baseline values of BMI (24.6 kg*m-2 vs. 24.8 kg*m-2, p=0.92), peak VO2 (25.6±3.5 vs. 26.3±5.7 ml*kg-1*min-1, p=0.75), work rate (1.90±0.41 vs. 1.97±0.38 Watt*kg-1, p=0.71) and percentage of predicted work rate (85%±18%vs. 94%±23%, p=0.34) were comparable between groups. In HIIT, there was a significantly greater increase in peak VO2 (25% vs. 1%; p=0.001) and peak work rate (31% vs. 18%, p=0.03) over the training period, compared to MICE. No adverse events related to HIIT occurred. Conclusion:In our small study, HIIT was well tolerated in cancer patients and led to a significantly greater improvement of cardiorespiratory fitness, compared to the more established MICE modality. P488 P.U.E.D.E.S., a new approach for an old challenge in sports medicine. M A Fernandez-Gomez1, D Cascado-Caballero2, J L Sevillano-Ramos2 1University of Seville, Sports Medical Unit. SADUS, Seville, Spain 2University of Seville, Robotics and Technology of Computers Laboratory, Seville, Spain Topic: Sports cardiology Purpose:Integrated into an online platform, an adapted and expanded version of the position stand from the EACPR (1) is presented, for the assessment of cardiovascular risk (CVR) in relation to the practice of physical activity (PA). This prototype considers the valuation of a wider population, including young people over 18 years and the full range of intensities of PA and sports. Methods:A web platform has been created with multiple functions and roles to facilitate the cardiovascular (CV) and metabolic (M) evaluation in the field of sports medicine. The target population is students and staff of our University (N:50000). The module for the clinical evaluation is based on electronic versions, adapted from previously proposed self-administered questionnaires (Q). The aim is twofold: first, to control the level of PA using the international PAQ (IPAQ) long form; and second, to check the health status using both a PA Readiness Q (PARQ) adapted form and an expanded American Heart Association-American College of Sports Medicine (AHA-ACSM) form (1, 2), which includes personal history, CVR factors, and a more detailed family history, as indicated elsewhere (3). A number of functions have been implemented that automate the management and evaluation of the collected data, which ultimately generate recommendations, always based on scientific evidences. As reference, we use clinical practice guidelines (e.g. to estimate CVR or M risk (4)) and the positioning of Expert Groups (1, 2). Furthermore, based on the previously proposed algorithms (AL) to promote health in adults over 35 years through PA (1), we extend them to include young people over 18 years and to add other types of PA, such as high intensity or competitive sports. Results:Adapted questionnaires and expanded decision AL, developed for sedentary and active subjects, are integrated into the web platform prototype (5). A first set of 53 subjects have used the platform and provided feedback about usability and acceptability issues. Their comments have been used to improve the site's friendliness and ease of use. Conclusions:The modifications and adaptations performed on the decision AL allow an automated valuation and generation of recommendations focused on the practice of healthy PA, tailored to each subject. In addition, the platform would permit not only individual but also group or population assessments and early preventive actions on CV and M prevalent diseases. P491 Cardiovascular preventive medication and achievement of treatment targets in patients with osteoarthritis: Results from the MUST-Heart study S Rollefstad1, E Ikdahl1, N Oesteraas2, TK Kvien2, AG Semb1 1Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway 2Diakonhjemmet Hospital, Department of Rheumatology, Oslo, Norway Topic: Sports cardiology Purpose:Undertreatment and poor goal attainment of blood pressure (BP) and lipids in both primary and secondary prevention has been reported in the general population. Our aim was to evaluate cardiovascular (CV) primary and secondary preventive treatment and attainment of recommended goals in patients with osteoarthritis (OA) in the Musculoskeletal pain in Ullensaker STudy (MUST). Methods:The MUST is a population-based postal survey and a comprehensive clinical examination of persons with self-reported OA (n=630), of which 438 fulfilled the American College of Rheumatology criteria for OA. In the MUST-Heart study, usage of primary and secondary CV preventive medication as lipid lowering agents (LLA), anti-hypertensive medication (a-HT) and anti-thrombotic medication (AT) (acetylsalicylic acid and dipyridamole) was recorded. Guideline recommended BP goal is =140/90 mmHg, and low density lipoprotein cholesterol (LDL-c) goals for primary/secondary prevention are =2.5/=1.8 mmol/L, respectively. Attainment of BP and lipid targets for patients on the respective medications were evaluated. Results:Secondary or primary CV prevention was indicated in 72 and 26 patients, respectively. The female/male ratios 45/27 and 5/21 and the median (IQR) age was 68.5 (65.0, 75.8) years and 66.5 (65.0, 73.8) years. Total Cholesterol (TChol) was: 5.17 (1.25) (SD) mmol/L/5.97 (1.19) mmol/L, high density lipoprotein cholesterol (HDL-c): 1.49 (0.46) mmol/L/1.22 (0.29) mmol/L, LDL-c: 2.97 (1.06) mmol/L/3.82 (1.06) mmol/L, BP was 140.5 (18.7)/82.4 (8.3) mmHg/155.7 (14.5) mmHg/87.2/10.1 mmHg, for the secondary/primary prevention groups. Of the 72 patients with diagnosed CV disease, 38 (52.8%) were using LLA, 47 (65.3%) a-HT medication and 25 (34.7%) were on AT medication. Of the 125 patients (without CV disease) who had hypertension, 57 (45.6%) used a-HT medication. Of the 26 patients with a calculated CV risk by SCORE =5%, 2 (7.7%) used LLA.Of the patient who were using a-HT medication, BP goal attainment was 20/47 (42.6%) and 0/57 (0%) for patients in the secondary and primary prevention groups. Of all patients using LLA, patients with CV disease achieved goals for TChol were 12/38 (31.6%) and LDL-c: 9/38 (23.7%). Conclusions:There was a substantial underuse of cardio-protective drugs in persons with OA in the MUST-Heart study, which resulted in poor attainment of recommended BP and lipid targets. The goal achievement of BP and lipids in patients with OA was even lower than what is reported for the general population. P493 Markers of arterial stiffness according to daily monitoring and office measurement in patients with diabetes in combination with hypertension V Oleinikov1, NV Sergatskaya1, LI Gusakovskaya1, NT Nagapetyan1 1Penza State University, Penza, Russian Federation Objective:a comparative assessment of the indicators characterizing the structural and functional properties of the vascular wall in patients with type 2 diabetes mellitus (DM) and arterial hypertension (AH) and hypertensive patients without metabolic disorders. Methods:The study involved 73 people aged 40 to 65 years. Group 1 included 46 patients with type 2 diabetes. Obligatory condition was the presence of hypertension of 1-2 degrees, the average age - 56,4 ± 8,6 years, body mass index (BMI) - 35,3 ± 5,9 kg/m2; systolic blood pressure (SBP) - 147,5 (140; 160) mm Hg, diastolic blood pressure (DBP) - 90 (80, 95) mm Hg. Group 2 included 27 patients with hypertension, the average age - 53,7 ± 9,0 years, BMI - 24,1 (23,2; 27,5) kg/m2; SBP - 145 (143; 157,5) mm Hg, DBP - 95 (90; 100) mm Hg. Patients were matched for age, sex, height, office SBP. Structural and functional properties of the large arteries were assessed by ambulatory blood pressure monitoring (ABPM) and rigidity by Vasotens technology. The mean daily values of the central (aortic) pressure: SBPpao, DBPao, PPao were determined. Among the stiffness parameters the augmentation index in the aorta (Aixao), the propagation time of the reflected wave (RWTT), stiffness index (ASI) and the maximum rate of blood pressure increase (dPdt)max were analyzed. Results:The patients did not differ on the SBPao level: in diabetic patients - 126 (119; 139) mm Hg, AH - 129 (125; 133) mm Hg. In patients with DM the values of DBPao were significantly lower (80,9 ± 8,8 mm Hg), than in patients with hypertension - 88,9 ± 7,9 mmHg (p <0,01). PPao in the studied groups was 46 (41; 53) and 38 (35; 44) mm Hg, respectively (p <0.01). Among the parameters characterizing the stiffness of the peripheral arteries in diabetic patients the prevalence of ASI values (167 (149; 220) mm Hg) and (dPdt)max (637 (534; 764) mm Hg/s) has been reported, in contrast to those in subjects with hypertension (147,5 (132; 177), and 526 mm Hg (480; 627) mmHg/s, respectively) (p <0,01). Whereas the RWTT parameter in group 1 had significantly lower value (128,7 ± 11,04 ms), than in group 2 (143 (137; 149) ms) (p <0,01). Parameter Aixao in diabetic patients was 26,9 ± 14,7%, in patients with hypertension - 26,7 ± 12,1% (ns). Conclusions:the observed differences in central hemodynamics and vascular stiffness in patients with type 2 diabetes mellitus in combination with hypertension compared with patients suffering from hypertension without metabolic disorders are due to severe structural changes of arteries of different caliber. P494 Diabetes: the most important predictor of new cardiovascular events after acute coronary syndrome? R Ferreira1, J Neves1, A Gonzaga1, M Bastos1, J Santos1 1Centro Hospitalar do Baixo Vouga, Cardiology, Aveiro, Portugal Topic: Sports cardiology Purpose:Coronary heart disease is a chronic condition and patients who have recovered from an acute coronary syndrome are at high risk for new events and premature death. Methods:Retrospective observational analysis of 431 patients admitted on a coronary intensive care unit with acute coronary syndrome for 2 consecutive years. Patients were followed-up until the 31st october 2013 or until another event (new acute coronary syndrome, stroke, heart failure, arrhythmia or cardiac death). Results:431 patients were included, 72.4% were male, with mean age of 67 ± 13 years, 27.6% with the previous diagnosis of Diabetes. During the mean follow-up of 22 ± 10 months, 73 cardiovascular events were recorded and 48 deaths, 15 of which were of cardiac cause. On Cox multivariate analysis adjusted to potential confounding factors (diabetes, hypertension, dyslipidemia, obesity and tabagism) only diabetes (with Hazzard Ratio of 0.61; IC 95% 0.368-1.011; p< 0.05) was sustained as an independent predictor of new cardiovascular events. Comparing diabetic versus non diabetic patients, diabetic had higher values of glycaemia on admission, serum creatinine, pro-B-type natriuretic peptide and C-reactive protein. They also had higher values ?128;??128;?of systolic blood pressure and heart rate on admission. Atrial fibrillation and electrocardiographic dynamic changes in the inferior wall were also more frequent in this group. Killip class IV (2.5% vs 1.6%), severe depression of left ventricle ejection fraction (11% vs 10%) and 3-vessel disease (32.6% vs 12.8%) were more prevalent in the diabetes group. Non-diabetic patients were younger and had higher values of hemoglobin, troponin I and total cholesterol. Conclusion:Diabetes was the only cardiovascular risk factor that was sustained as a predictor of new cardiovascular events. Thus, patients with acute coronary syndrome present an opportunity for targeted screening for diabetes and institution of effective management strategies aimed to improve cardiovascular outcome. P495 The experience of the "School of self-control for patients with type 2 diabetes" (SSCD2) at the outpatient stage EN Martsynik1, LN Pastarus2, LD Kalashnikova3, MA Chukmasova4, VN Burchak2, IV Tyshchenko1 1SE Dnipropetrovsk medical academy, Dnipropetrovsk, Ukraine 2CE Dnipropetrovsk city clinical hospital 9, Dnipropetrovsk, Ukraine 3Dnipropetrovsk Regional Society of patients with diabetes, Dnipropetrovsk, Ukraine 4Dnipropetrovsk Regional Clinical Hospital, Dnipropetrovsk, Ukraine Topic: Sports cardiology Purpose:to study the importance of SSCD as a guide to action for patients (pts) with type 2 diabetes (D) on ways to improve the efficiency of treatment and quality of life (QL). Methods:SSCD was organized in 2001 under the auspices of the Society pts with diabetes. Pts were informed about SSCD by district endocrinologists, during admission and through media. Lessons of 45-60 minutes once in 2 weeks in groups of 30-60 pts were held at different sites by leading endocrinologists and specialists in diabetic foot (DF) and retinopathy. The cycle of 6 lessons included lectures, questions and answers, the issuance of booklets, brochures, definition using glucometer glycemia (G) to all pts, training of calculation individual diets and correction of medication in different situations. Topics: the concept and diagnosis of D, self-control (SC), HbA1c monitoring, diet and physical activity in D, diabetic drug therapy and its correction, diagnosis and monitoring of chronic complications, the patient's behavior in unusual situations. All the participants with their consent were surveyed using specially designed questionnaire. Results:during 10 yrs 2243 listeners were registered. Each year SSCD was visited by 223 ± 25 pts with D (36.6% men, 63.4% women, mean age 58.3 ± 3.4 yrs). 89.5% of participants - the inhabitants of Dnipropetrovsk, 10.5% - the inhabitants of the nearby districts. 60.8% of registered pts visited full course, 11.8% listened to course 2-3 times. After determining of G 39.8% of pts needed individual counseling of the doctor to correct medication and diet and about 3% required urgent hospitalization. All surveyed pts had raised awareness about D and assessed the usefulness of the training: 74.3% for self-construction diet, 81.2% for self-foot care and prevention of DF, 88.9% for the understanding of necessity of regular SC. 44.8% pts expressed a desire to continue learning. For many pts SSCD became a kind of Club where they shared their experiences of life with D. 65.2% of participants noted the positive socio-psychological impact of SSCD: the increasing interest in communication, improving mood, reducing negative attitudes towards D. 41.3% of pts noted: use of the acquired knowledge helps them better to live with D. Conclusions:SSCD had demonstrated expediency of the work. Training in the SSCD had raised the awareness of pts about D, contributed to the understanding of their role in the health-care process and of the importance of SC to improve the QL. To improve the efficiency the work of SSCD should be systematic, constant, and innovative, with using educational and analytical tools. P496 A contemporary health check-up as a one-time intervention with individual lifestyle coaching can substantially lower diabetes risk in patients with pre-diabetes - the PF study J Scholl1, P Kurz2 1Dr. Scholl Prevention First GmbH, Prevention First R?im, R?im am Rhein, Germany 2Dr. Scholl Prevention First GmbH, Prevention First M?, R?im am Rhein, Germany Topic: Sports cardiology Purpose:A recent Cochrane meta-analysis concluded, that general health check-ups were useless. (1) The data that were used mainly stemmed from the 60s to 80s of the past century, when neither the knowledge nor the means of preventive interventions were comparable to the current possibilities. We examined the impact of a one-time contemporary health check-up on the risk of progression from pre-diabetes to diabetes. Methods:Between 2001 and 2014, n=1852 men (age 46,0±6,4 years) und n=960 women (age 46,3±5,6 years) participated at least twice in a health check-up offered to them by their respective employer. All participants gave a written consent to the scientific evaluation of the check-up results. Details of the health check-up have been described elsewhere. Pre-Diabetes was defined according to the ADA Definition (IFG =100 mg/dl and/or HbA1c =5,7-6,4%). A separate analysis was done using only an HbA1c =6,0-6,4% and/or IFG =100 mg/dl. Patients who fulfilled the criteria for pre-diabetes received a motivational lifestyle coaching including an understandable explanation of the pathophysiology of insulin resistance and its relation to diet, exercise, and diabetes risk. All patients were provided with a individualized exercise prescription (endurance and resistance training) and an individual dietary counselling with the objective to follow a Mediterranean-style low-glycemic-load diet. Results:744 of 1852 men (40,2%) and 248 of 960 women (25,8%) fulfilled the criteria for pre-diabetes. Within a follow-up of 3,9 years in men and 3,5 years in women only 2,55% of men and 0,81% of women with pre-diabetes progressed to type 2-diabetes. This translates into a very low progression rate of 6,5/1000 person-years in men and 2,3/1000 person-years in women. If HbA1c 6,0-6,4% was used instead of 5,7-6,4%, the respective rates were 7,2/1000 in men and 3,8/1000 in women. A recent meta-analysis of 70 prospective studies reported a much higher progression rate from pre-diabetes to type 2-diabetes of 35/1000 up to 70/1000 person-years depending on the definition used for pre-diabetes.(2) Conclusion:In this the evaluation of a contemporary health check-up as a one-time intervention with motivational lifestyle coaching we observed an exceptionally low progression rate from pre-diabetes to type 2 diabetes, which clearly demonstrates the effectiveness of this strategy for diabetes prevention. P497 Prevalence of the cardiovascular risk factors in bulgarian female population N Runev1, E Manov1, S Naydenov1, T Donova1 1UMHAT Alexandrovska, Sofia, Bulgaria Objective:To evaluate the risk profile and the level of control of some modifiable cardiovascular risk factors (RF) in Bulgarian female population. Methods:Pooled data from 3 cross-sectional studies, organized by the Working group of the Bulgarian Society of Cardiology on cardiovascular risk in women. These studies were performed between year 2011 and 2014, including consecutively a total number of 214 women, mean age 58.5±11.7 (22-87) years. The clinical investigations included: blood pressure (BP) measurement, waist circumference (WaC), height, weight and body mass index (BMI) calculation. All women completed a questionnaire, specifying the presence of cardiovascular risk factors and diseases as well as some demographic characteristics. Using a self-assessment test introduced by the National U.S Diabetes Association we assessed the risk for development of type 2 diabetes mellitus (DM) among the non-diabetic women. Results:Arterial hypertension is the most prevalent cardiovascular risk factor present in 72.4% (n=152), followed by overweight/obesity – 63.9% (n=106), dyslipidemia – 31.0% (n=65), type 2 DM – 14,5,7% (n=31), smoking – 10.3% (n=22) and hormone-replacement therapy with oestrogenes – 4.2% (n=9). The mean value of the systolic and diastolic BP is 139.5±18.8 (90-194) and 86.9±12.1 (60-120) mmHg respectively. The mean value of BMI is 28.4±6.4 (18-51) kg/m2 and WaC – 95.4±15.8 (56-132) ?¼. The calculated risk for development of type 2 DM in the non-diabetic female population is 9.88±4.4 (0-20). Conclusion:Arterial hypertension is the most prevalent RF for cardiovascular complications among the analyzed Bulgarian female population, followed by overweight/obesity and dyslipidemia. The risk for development of type 2 DM in the non-diabetic women is moderate to high. The control of the most common modifiable cardiovascular RF remains unsatisfactory despite the available non-pharmacological and pharmacological options. P498 Mortality risk due to electrocardiographic disturbances in elderly Russian population S Shalnova1, G Muromtseva1, A Kapustina1, A Deev1, Y Balanova1, E Tuaeva1, S Evstifeeva1, D Smirnov1, M Shkolnikova2 1National Research Center for Preventive Medicine, Moscow, Russian Federation 2Research Clinical Institute of pediatrics, Moscow, Russian Federation Topic: Sports cardiology Purpose:to assess the prevalence of major and minor electrocardiographic (ECG) abnormalities, as well as their impact into all cause and CVD mortalities among Muscovites aged=55 years. Methods:The data came from a population-based sample of 1876 Muscovites aged=55 years who participated in SAHR (Survey on Stress, Aging, and Health in Russia).During a median of follow-up period of 5.36 years, 332 deaths were identified. Standard 12-lead ECG was recorded. ECG abnormalities were divided into six groups (using Minnesota code (MC)): major QQS (MC: 1.1,1.2 without 1.2.8.), major ischemia (MC: 4.1,4.2, 5.1,5.2 without 3.1, 3.3), conduction defects (CD) (MC: 6.1,6.2,7.1), atrial fibrillation (AF) (MC:8.3) and minor QQS abnormalities (MC: 1.2.8, 1.3.-), minor ischemia (4.1- 4.4, 5.1-5.4 with 3.1, 3.3). Cox regression to estimate hazard ratios (HR) for an association between ECG abnormalities and CVD and total mortality was performed. Results:The prevalence of major ECG abnormalities was slightly higher among men than among women (26.7% vs 22.4%, p <0.05), whereas minor ECG – in women (21.9% vs 17.5%, p<0.05). The most difference between sexes was found in groups of major QQS (8.1% vs 2.8%, p<0.01) in men and women, respectively. The prevalence of all abnormalities increased with age. While using Cox regression model with entire ECG block of ECG variables (age, sex-adjusted) for total mortality the following were significant. AF (HR 1.630, 95%CI: 1.096; 2,423), CD (3.017: 1.743; 5.219), major ischemia (1.610: 1.184; 2.189), minor ischemia (1.338: 1.009; 1.772). Conclusions:The prevalence of major ECG abnormalities was slightly higher among men. AF and CD have much greater effect on mortality in comparison with middle-aged subjects. Variables RR 95%CI p-level Atrial fibrillation or flatter 1.837 1.142 2.956 0.0122 Conduction defects 3.163 1.589 6.298 0.0010 QQS MAJOR 1.736 1.135 2.653 0.0109 QQS MINOR 0.731 0.358 1.495 0.3906 ISCHEMIA MAJOR 1.707 1.150 2.533 0.0080 ISCEMIA MINOR 1.546 1.082 2.211 0.0168 Variables RR 95%CI p-level Atrial fibrillation or flatter 1.837 1.142 2.956 0.0122 Conduction defects 3.163 1.589 6.298 0.0010 QQS MAJOR 1.736 1.135 2.653 0.0109 QQS MINOR 0.731 0.358 1.495 0.3906 ISCHEMIA MAJOR 1.707 1.150 2.533 0.0080 ISCEMIA MINOR 1.546 1.082 2.211 0.0168 Open in new tab Variables RR 95%CI p-level Atrial fibrillation or flatter 1.837 1.142 2.956 0.0122 Conduction defects 3.163 1.589 6.298 0.0010 QQS MAJOR 1.736 1.135 2.653 0.0109 QQS MINOR 0.731 0.358 1.495 0.3906 ISCHEMIA MAJOR 1.707 1.150 2.533 0.0080 ISCEMIA MINOR 1.546 1.082 2.211 0.0168 Variables RR 95%CI p-level Atrial fibrillation or flatter 1.837 1.142 2.956 0.0122 Conduction defects 3.163 1.589 6.298 0.0010 QQS MAJOR 1.736 1.135 2.653 0.0109 QQS MINOR 0.731 0.358 1.495 0.3906 ISCHEMIA MAJOR 1.707 1.150 2.533 0.0080 ISCEMIA MINOR 1.546 1.082 2.211 0.0168 Open in new tab P499 Age and sex differences of risk factors associated with obesity in Saint-Petersburg inhabitants. A Orlov1, O Rotar1, M Boyarinova1, A Alieva1, E Dudorova1, V Solntsev2, E Baranova2, A Konradi1, E Shlakhto2 1Federal Almazov Medical Research Centre, Hypertension Department, Saint-Petersburg, Russian Federation 2Federal Almazov Medical Research Centre, Saint-Petersburg, Russian Federation Objective:The aim of our study was to estimate age and sex characteristics of obesity-related risk factors (RF) in general population of St.Petersburg, Russia. Design and methods. As a part of all-Russian epidemiology survey ESSE-RF random sampling of 1600 Saint-Petersburg inhabitants 25-64 years stratified by age and sex was performed - (573 (36%) men and 1027 (64%) women). All subjects were stratified in 4 age decades: 25-35 (309 subjects (19,3%)), 36-45 (316 (19,8%)), 46-55 (457 (28,6%)) and 56-65 (518 (32,4%)) y/o. All participants signed informed consent and filled in the questionnaire regarding physical activity, education, and nutrition. Anthropometry (weight, height with body-mass index (BMI) calculation, waist circumference (WC)) was performed. Results:The high education had 277 (47,3%) men and 504 (49,1%) women. No impact of educational level on behavioral RF was observed. Obesity was more often detected in females according to different WC criteria: 88 sm for females/102 sm for males - in women 667 (46%), in men 291 (30%) (?=30,7, p<0,001) and 80 sm for females/ 94 sm for males – 470 (66%) and 168 (51%) (?=41,4, p<0,001). No differences in obesity prevalence were found according to BMI criteria – in 178 (31%) women and 352 (35%) men. The increase of obesity with age was found: BMI - 1,6 kg/m2/decade ((?1,6, 95% CI 1,4 - 1,8), p<0,001), WC in women - 5,2 sm/decade (?5,2, 95% CI 4,5 - 6,0, p<0,001) and WC in men – 2,8 sm/decade (?2,8, 95% CI 1,8 – 3,6), p<0,001). Optimal level of physical activity (walking>300 minutes/day) was equally documented in both genders - 540 (61,2%) women and 286 (58,9%) men. It was higher in the oldest age group (301 (70%)), compared with any younger subgroup (p<0,001). Walking time/week increased in 30 min/decade (?30, 95% CI 13 – 46), p<0,001). Interestingly, no association between physical activity level and BMI or WC was found. Daily intake of sweets was recorded higher in women 539 (52,5%) than in men 228 (39,8%), (?=23,7, p<0,001); it was associated with obesity only in subjects older 45 y/o (by BMI, ?=12,7, p<0,001). Conclusions:The increase with age of obesity prevalence and BMI and WC was observed, 2 times higher (by WC) in females. Education was not associated with lifestyle behavior. Surprisingly, physical activity lower in younger age groups, which may be connected with increased sedentarism in modern lifestyle in European population including Russia. P500 The prognostic impact of antithrombotic drugs in acute coronary syndromes: the results of a National Registry database D Caldeira1, I Cruz1, G Morgado1, AC Gomes1, C Martins1, H Pereira1 1Hospital Garcia de Orta, Department of Cardiology, Almada, Portugal Topic: Sports cardiology Purpose:The antithrombotic drugs are essential for the treatment of patients with Acute Coronary Syndromes (ACS). The availability of multiple drugs, enables a number of possible combinations that does not have robust evidence to support their use. In this work we intended to evaluate the impact of these drugs and their combinations on the prognosis of patients with ACS. Methods:We used data from the ACS National Registry on consecutive patients registered between October 2010 and October 2013. We sought data about population characteristics, prior/inhospital use of antithrombotic drugs (antiplatelet and anticoagulant), and antithrombotic drugs prescriptions at discharge. The prognostic impact of these drugs and their most common combinations was evaluated in terms of mortality and cardiovascular (CV) hospitalization at 1 year. Data were analyzed using Cox regression to estimate the hazard ratio (HR) and 95% confidence intervals (95%CI). Results:There were 8186 patients with ACS included in the National Registry. The inhospital mortality was 3.9%. The composite of mortality and CV hospitalization at 1 year was 22%, with 16.4% of the events owing to CV hospitalizations. About 60 % of the patients were not taking any antithrombotic drug prior to the index event. The absence of antithrombotic drugs was more common in patients with ACS and ST-segment elevation (STEMI) [76.5 %] compared to patients with ACS without ST-segment elevation (NSTEMI) [49.2 %]. Evaluating all combinations of antithrombotic drugs, it was found that the strongest predictor of 1-year mortality was the previous use of acetylsalicylic acid (HR 1.34, 95%CI 1.01-1.78) or other antiplatelet drugs, after multivariable logistic regression analysis. Regarding the composite outcome of mortality and CV hospitalization within 1 year, prior dual antiplatelet therapy (HR 1.39, 95%CI 1.03-1.88, p=0.03), and the inhospital use of dual antiplatelet plus Glycoproteins IIbIIIa inhibitors plus Unfractionated Heparin plus Enoxapation, showed significant association with this composite endpoint (HR 1.89, 95%CI 1.09-3.31, p=0.025 ). This latter antithrombotic drugs combination was associated with increased risk CV readmission after discharge (HR 3.36, 95%CI 1.47-7.68, p=0.004). Conclusions:About one fourth of ACS patients with STEMI and 50% of patients NSTEMI had antithrombotic drugs previous to the index event. Patients that received prior single or dual antiplatelet therapy were associated to significantly increase of the risk death and CV readmission. P502 Education status as a predictor in the 10-year (2004-2014) all cause mortality and cardiovascular disease incidence, among Acute Coronary Syndrome patients, in Greece. V Notara1, D B Panagiotakos1, C Pitsavos2, Y Kogias3, P Stravopodis4, G Papanagnou5, S Zombolos6, C Stefanadis2 1Harokopio University, Athens, Greece 2Hippokration Hospital, University of Athens, Athens, Greece 3Cardiology Clinic, General Hospital of Karditsa, Karditsa, Greece 4Cardiology Clinic, General Hospital of Zakynthos Island, Zakynthos, Greece 5Cardiology Clinic, General Hospital of Lamia, Lamia, Greece 6Cardiology Clinic, General Hospital of Kalamata, Kalamata, Greece Topic: Sports cardiology Purpose:To investigate the association between education status and 10-year risk for Acute Coronary Syndrome (ACS) and all-cause mortality. Methods:From October 2003 to September 2004 a sample of 6 Greek hospitals was selected and almost all consecutive 2,172 ACS patients were enrolled. In 2013-14, the 10-year follow-up (2004-2014) was performed in 1,918 participants (88% participation rate). Education status was classified as low (<9 years of school), intermediate (9-14 years) and high (>14 years). Results:The low–to–high education status all cause mortality rate was 2.1-to-1 (p<0.001); the 10-yr incidence of CVD was higher in the low education status as compared with the middle and high (42% vs. 30% vs. 35%, p<0.001); no gender-by-education group interactions on the investigated outcomes were observed. Moreover, patients in the highest education group were more physically active, had better financial status and were less likely to have hypertension, diabetes and ACS, compared to those with the lowest educational level (p<0.001); when the aforementioned patients' characteristics were accounted for, together with lifestyle habits, no mediating effect as regards the significance of education status on all-cause mortality and ACS incidence was observed. Conclusions:Low educated ACS patients were at higher risk for death or recurrent events, irrespective of their clinical and lifestyle characteristics. Nevertheless, the highly educated patients should not be considered as entirely protected due to their social status; public health policies should be targeted on different social groups to eliminate the overall burden of cardiovascular disease morbidity. P503 Differences in prevalence of depressive symptoms and other cardiovascular risk factors between urban and general population. J Piwonski1, T Zdrojewski2, A Piwonska1, M Rutkowski2, P Bandosz2, Z Gaciong3 1National Institute of Cardiology, Warsaw, Poland 2Medical University of Gdansk, Gdansk, Poland 3Medical University of Warsaw, Warsaw, Poland Topic: Sports cardiology Purpose:In many worldwide populations there was a difference in territorial prevalence of classical risk factors. The urbanization can multiply the risk of prevalence of cardiovascular risk factors in the urban population. We analyzed the CVD risk factors profile of residents of the capital of Poland in comparison to general adult Polish population. Methods:The data on Warsaw population (1081 persons; 870, aged 20+, examined in 2012 in the frame of WAW-KARD study and 207 persons, aged 20-74, examined in 2011 as a part of EHES study). The data on general population came from NATPOL 2011, a representative sample of Polish population (N=2413, aged 18-79, screened in 2011). Questionnaire, physical examination and laboratory data were collected. Results:Analyzing major CVD risk factors we found hypertension to be much more prevalent in Warsaw residents - 42% (54% in men and 44% in women) than in general population - 32% (respectively 35% and 31%), the same with increased (=5.0mmol/l) total cholesterol level that was found in 77% of Warsaw residents (76% in men and 79% in women) vs 62% in general population (61% in men and 63% in women). Also mean total cholesterol concentration was higher in Warsaw population (men-5,4mmol/l, women-5,5mmol/l) than in general population (men-5,1mmol/l vs 5,2mmol/l). The opposite situation was observed in smoking habit that was more prevalent in general population [16% of regular smokers among Warsaw residents (19% in men and 15% in women) vs 27% in general population (respectively 32% and 24%)]. Both analyzed populations did not differ in obesity (27% in both) and diabetes prevalence (respectively 6% and 5%). Besides, Warsaw residents presented more often depressive symptoms compared to general population, especially women (men: 28% vs 23%; women: 46% vs 36%). Conclusions:Big city residents presented more cardiovascular risk factors compared to general population, more often had hypertension, hypercholesterolemia and depressive symptoms compared to the general population. Baseline mental cumulative summary score 1st quartile n=50 in % 2nd quartile n=50 in % 3rd quartile n=50 in % 4th quartile n=51 in % p-value Rehospitalisation during 12 months 48 34 23 24 0.019 HADS-Anxiety=8, during 12 months 58 46 20 10 0.000 Blood pressure < 140/90 mmHg, 12 months 62 53 68 82 0.02 LDL cholesterol, 12 months 50 30 45 41 0.41 HbA1c < 6.5%, 12 months 92 80 91 84 0.32 Waist M/F < 102/88 cm, 12 months 39 57 58 70 0.004 Smoking at admission 54 49 42 22 0.001 Physical activity=30 min = 5 days/week at baseline 36 48 42 76 0.000 Baseline mental cumulative summary score 1st quartile n=50 in % 2nd quartile n=50 in % 3rd quartile n=50 in % 4th quartile n=51 in % p-value Rehospitalisation during 12 months 48 34 23 24 0.019 HADS-Anxiety=8, during 12 months 58 46 20 10 0.000 Blood pressure < 140/90 mmHg, 12 months 62 53 68 82 0.02 LDL cholesterol, 12 months 50 30 45 41 0.41 HbA1c < 6.5%, 12 months 92 80 91 84 0.32 Waist M/F < 102/88 cm, 12 months 39 57 58 70 0.004 Smoking at admission 54 49 42 22 0.001 Physical activity=30 min = 5 days/week at baseline 36 48 42 76 0.000 Open in new tab Baseline mental cumulative summary score 1st quartile n=50 in % 2nd quartile n=50 in % 3rd quartile n=50 in % 4th quartile n=51 in % p-value Rehospitalisation during 12 months 48 34 23 24 0.019 HADS-Anxiety=8, during 12 months 58 46 20 10 0.000 Blood pressure < 140/90 mmHg, 12 months 62 53 68 82 0.02 LDL cholesterol, 12 months 50 30 45 41 0.41 HbA1c < 6.5%, 12 months 92 80 91 84 0.32 Waist M/F < 102/88 cm, 12 months 39 57 58 70 0.004 Smoking at admission 54 49 42 22 0.001 Physical activity=30 min = 5 days/week at baseline 36 48 42 76 0.000 Baseline mental cumulative summary score 1st quartile n=50 in % 2nd quartile n=50 in % 3rd quartile n=50 in % 4th quartile n=51 in % p-value Rehospitalisation during 12 months 48 34 23 24 0.019 HADS-Anxiety=8, during 12 months 58 46 20 10 0.000 Blood pressure < 140/90 mmHg, 12 months 62 53 68 82 0.02 LDL cholesterol, 12 months 50 30 45 41 0.41 HbA1c < 6.5%, 12 months 92 80 91 84 0.32 Waist M/F < 102/88 cm, 12 months 39 57 58 70 0.004 Smoking at admission 54 49 42 22 0.001 Physical activity=30 min = 5 days/week at baseline 36 48 42 76 0.000 Open in new tab P504 Challenges in researching CVD inequalities between Aboriginal and non-Aboriginal Australians - examples of trusted approaches that do not always work JM Katzenellenbogen1, D Derrick Lopez1, P Bradshaw1, FM Sanfilippo2, THK Teng1, MW Knuiman2, MST Hobbs2, SC Thompson1 1The University of Western Australia, Western Australian Centre for Rural Health, Perth, Australia 2The University of Western Australia, School of Population Health, Perth, Australia Topic: Sports cardiology Purpose:Using 3 separate studies, we illustrate how age-standardisation, Global Registry of Acute Coronary Events (GRACE) risk scores and multiple regression were unable to adequately elucidate inequalities in cardiac disease and care between Aboriginal and non-Aboriginal Western Australians. Methods:Study 1, a cohort incidence study, used linked hospital admissions and death data to determine disparities in age-standardised incidence of myocardial infarction (MI) between the two populations aged 25-74. Study 2 assessed the performance of the GRACE risk score for predicting mortality in Aboriginal acute coronary syndrome (ACS) cases using clinical data from medical notes and linked mortality records. In Study 3, linked data and multiple regression modelling were used to control for demographic, co-morbidity and admission factors, to investigate disparities in transfers to urban hospitals for rural Aboriginal MI patients. The impact of these factors on rate ratios was assessed through progressive adjustment of covariates in regression models (Table). Results:Study 1: The age-standardised Aboriginal to non-Aboriginal incidence rate ratio for MI (25-74 years) was 4.4, yet the rate ratio was 16.4 for 25-4 years, reducing with age to 2.7 for 65-74 years. Study 2: The mean GRACE scores and crude mortality were lower for Aboriginal ACS patients, with evidence of under-estimation of the risk of death to 6 months from hospital discharge. Study 3: see Table. Conclusions:Age-standardisation diluted the inequality in MI incidence. The dominance of age in GRACE models means that risk may be underestimated given the younger age of Aboriginal cases. Adjustment through progressive regression models explains disparities in access to services, leading to interpretations of ?128;?no difference' when the inequalities lie in the dissimilar distributions of risk factors. Researchers should use statistical tools critically when studying inequalities in cardiac health and care between main and disadvantaged populations. P505 Economic crisis influences adherence to medication and determines all-cause mortality and cardiovascular (CVD) prognosis among Acute Coronary Syndrome patients, in Greece. V Notara1, D B Panagiotakos1, C Pitsavos2, Y Kogias3, P Stravopodis4, G Papanagnou5, S Zombolos6, Y Mantas7, C Stefanadis2 1Harokopio University, Athens, Greece 2Hippokration Hospital, University of Athens, Athens, Greece 3Cardiology Clinic, General Hospital of Karditsa, Karditsa, Greece 4Cardiology Clinic, General Hospital of Zakynthos Island, Zakynthos, Greece 5Cardiology Clinic, General Hospital of Lamia, Lamia, Greece 6Cardiology Clinic, General Hospital of Kalamata, Kalamata, Greece 7Cardiology Clinic, General Hospital of Chalkida, Chalkida, Greece Topic: Sports cardiology Purpose:To investigate the impact of the recent economic crisis on medication adherence and its potential long-term effect on the management of co-morbidities among Acute Coronary Syndrome (ACS) patients. Methods:From October 2003 to September 2004, a sample of six Greek hospitals was selected and almost all consecutive 2172 ACS patients were enrolled. In 2013-14, the 10-year follow-up was performed in 1,918 participants (88% participation rate). Adherence to medical treatment was recorded through self-reports and patients' financial status was classified as low (<9.000?) moderate (<18.000?), good (<28.000?) and very good (>48.000?). Results:During the 10-year of follow up, the overall all-cause mortality was n=703 (32.4%) (31.6% in men, 34.8% in women, p=0.17); causes of death were AMI 52.8%, stroke 8.3%, other CVD 8.3%, cancer 8.7% and the rest 21.9% were due to other causes. The overall-cause mortality for the "low" financial status patients was 29.4 % vs 17.6% of the "very good" financial group (p<0.001); while the 10-year CVD incidence rate was 31.4% vs 39.2% (p=0.22), respectively. 38% of the "low" financial status patients reported poor compliance due to economic restraints compared to "very good" financial group (20.8%). Accordingly, 23.8% of the "low" financial status patients have replaced drugs to more affordable vs 12.2% of the "good" financial group; whereas satisfaction with the public health care services was higher among "good/very good" financial groups as compared to "low/moderate" groups. Conclusions:Decreased medical compliance is an important clinical and public health issue. Discontinuation of medical treatment results in adverse disease prognosis, increased mortality rates and impose a large economic burden in healthcare services among societies. Adherence involves a multi-dimensional approach that encompasses behavioural and social interventions. There is no argument that management of medical adherence in ACS patients should be a priority in health policy agenda regarding secondary prevention strategies. P506 N-3 LC PUFAs in infant formula and blood pressure in early childhood LPM Pluymen1, CSPM Uiterwaal1, GW Dalmeijer1, HA Smit1, CK Van Der Ent2, L Van Rossem1 1University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands 2University Medical Center Utrecht, Department of Pediatric Respiratory Diseases, Utrecht, Netherlands Topic: Sports cardiology Purpose:The protective effect of breastfeeding on risk levels for cardiovascular diseases (CVD) might be explained by its content of n-3 long chain polyunsaturated fatty acids (LC PUFAs). Since 2007, most infant formulas are supplemented with these fatty acids. We assessed whether children who received supplemented formula had a lower blood pressure than children who received unsupplemented formula. Methods:We used the ongoing WHeezing Illnesses STudy LEidsche Rijn (WHISTLER), a birth cohort that included children who were born between 2001 and 2011. Data on infant feeding was obtained by questionnaire. At age 5 (currently: all children born before May 2007), blood pressure was measured. We performed linear regression analyses on 202 children who had complete data on type of formula feeding and blood pressure. Analyses were adjusted for predictors of blood pressure. Results:5 year old children who received infant formula with n-3 LC PUFAs (n=15) had a lower systolic (-3.68 mmHg, 95% CI -7.67, 0.32) and diastolic ( -2.32 mmHg, 95% CI -6.32, 1.67) blood pressure (adjusted for smoking during pregnancy, birth weight and gestational age), compared to children who received unsupplemented formula (n= 187). After additional correction for BMI, the association with systolic blood pressure was slightly attenuated (-3.05 mmHg, 95%CI -6.93, 0.83) while the association with diastolic blood pressure remained the same. Conclusions:These results suggest a protective effect of n-3 LC PUFAs in infant formula on blood pressure in early childhood. Further follow-up will increase power to draw firmer conclusions on whether the protective effect remains. P507 Self-reported physical activity is associated with cardio-pulmonary exercise testing parameters in a large population-based cohort from Northeast Germany M Bahls1, R King1, S Gross1, T Ittermann2, M Doerr1 1University Medicine of Greifswald, Internal Medicine B, Greifswald, Germany 2University of Greifswald, Institute for Community Medicine, Greifswald, Germany Introduction:Increasing physical activity (PA) in the general population is an important tool for the prevention of cardiovascular diseases. Increased PA is believed to improve cardiopulmonary exercise capacity. Cardiopulmonary exercise testing (CPET) is the gold standard for assessing physical fitness. For large population-based cohorts CPET applicability is limited because of its expensive and time consuming nature. Thus, questionnaires are often used to measure PA behavior. Unfortunately, very few of these questionnaires have been validated against physiological parameters of CPET. We measured PA behavior with a questionnaire in a large population-based cohort from Northeast Germany and related the results with maximal oxygen consumption (VO2peak) and oxygen consumption at the anaerobic threshold (VO2@AT). Methods:Cross-sectional data of 1,708 subjects (49% male; age: 25 – 85 years) from the follow-up of the Study of Health in Pomerania (SHIP-1) were used for analysis. PA behavior was assessed using an adapted Baecke questionnaire. VO2peak and VO2@AT were measured during standardized CPET on a cycle ergometer using a modified Jones protocol. All adjusted models were corrected for sex, age, body mass index and smoking status. An adjusted linear regression was fitted to scores related to voluntary [sports score (SS), sports index (SI), and leisure time index (LTI)] as well as involuntary PA scores [work index (WI)]. Results:SS [? 138.24 (95%-CI: 117.08; 159.39) ml/min], SI [? 197.99 (95%-CI: 171.76; 224.22) ml/min] and LTI [? 129.00 (95%-CI: 99.12; 159.88) ml/min] were significantly positively associated with VO2peak and VO2@AT [SS: ?2.04 (95%-CI: 1.76; 2.32) ml/min/kg; SI: ? 2.97 (95%-CI: 2.62; 3.31) ml/min/kg; LTI: ? 1.99 (95%-CI: 1.60; 2.39) ml/min/kg]. A significantly inverse relationship was found between WI and VO2peak [? -44.46 (95%-CI: -79.15; -9.76) ml/min] as well as VO2@AT [? -0.51 (95%-CI: -0.97; -0.05) ml/min/kg]. Conclusion:Scores from the adapted Baecke questionnaire were strongly related with VO2peak as well as VO2@AT. Therefore, this questionnaire may be used in large population-based cohorts to assess PA behavior as a marker for cardiopulmonary exercise capacity. Interestingly, Baecke scores based on leisure time and voluntary PA had a positive relationship, while items asking about PA at work had an inverse association with cardiorespiratory fitness. Consequently, increasing voluntary PA is the key to prevent future cardiovascular diseases. 14 Greater excess risk of all-cause mortality and vascular events in women than in men with type 1 diabetes: a systematic review with meta-analysis SAE Peters1, RR Huxley2, G Mishra2, M Woodward1 1University of Oxford, The George Institute for Global Health, Oxford, United Kingdom 2University of Queensland, Brisbane, Australia Background:Studies have suggested that the mortality rate associated with type 1 diabetes differs between women and men. We performed a meta-analysis to provide the most reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause and cause-specific mortality. Methods:PubMed MEDLINE was systematically searched for all studies published between January 1, 1966 and March 24, 2014. Eligible studies had to have reported sex-specific estimates of the standardized mortality ratio (SMR) associated with type 1 diabetes either for all-cause mortality or cause-specific mortality. Random effects meta-analyses with inverse variance weighting were used to obtain sex-specific SMR and their pooled ratio (women:men) for all-cause mortality, and mortality due to coronary heart disease, stroke, cardiovascular disease, renal disease, cancer, and accident and suicide associated with type 1 diabetes. Results:Data from 23 studies including 93,846 individuals and 6,434 events were included. The pooled ratio of the women: men SMR for all-cause mortality was 1.43 (95% CI: 1.19-1.72), for incident stroke 1.37 (1.03-1.81) and for renal disease 1.44 (1.02-2.05). For coronary heart disease events the sex difference was more extreme; the pooled ratio of SMR was 2.54 (95% CI: 1.80–3.60). There was no significant evidence of a sex difference for mortality associated with type 1 diabetes from cancer, or from accident and suicide. Conclusion:Women with type 1 diabetes have more than a 40% greater excess risk of all-cause mortality, and double the excess risk of vascular events, compared with similarly affected men. P508 Educational inequalities in receiving PCI are influenced by patient's age: A CVDNOR project E Sulo1, O Nygard2, SE Vollset1, G Sulo1, J Igland1, G Egeland3, M Ebbing3, GS Tell1 1University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway 2Haukeland Hospital, Institute of Medicine, University of Bergen, Department of Heart Disease, Bergen, Norway 3Norwegian Institute of Public Health, Department of Health Registries, Bergen, Norway Topic: Sports cardiology Purpose:Health outcomes are associated with socioeconomic inequities which are also influenced by in inequities in receiving treatment. We aimed to explore possible educational inequities in receiving percutaneous coronary intervention (PCI) among patients with an incident (first) acute myocardial infarction (AMI) and whether inequities vary by age. Methods:– All hospitalized AMI patients aged 35-89 years in Norway during 2001-2009 were obtained from the Cardiovascular Disease in Norway project. Information on highest attained education was obtained from The Norwegian Education Database and categorized into primary, secondary and tertiary. Educational inequities in receiving PCI were explored using Poisson regression analysis. An interaction between age and education was found (p<0.01), analyses were therefore stratified by age. Results are expressed as relative risk (RR) and 95% CI of receiving PCI treatment for secondary or tertiary versus primary (reference category) education. Results:Of 104,836 patients hospitalized with an incident AMI [mean age (SD) 71.1 (12.7) years; 37.3% women), 30.2% received PCI within 28 days. Overall, patients with secondary or tertiary education had higher rates of PCI compared to those with primary education only [RR=1.12, 95% CI; 1.10 - 1.14 and RR=1.21, 95% CI; 1.17 - 1.24, respectively]. Educational inequities (both for secondary versus primary and tertiary versus primary comparisons) were associated with increasing age. Conclusion:– Middle-aged and elderly patients with secondary or tertiary education had higher PCI rates compared to those with primary education only. Further studies should evaluate whether such differences are explained by differences in risk factors and disease severity. Open in new tabDownload slide Education inequities in receiving PCI P509 Expected effect of ESC recommendations on diet and physical activity, on CAD attack rate in northern Spain: the REGICOR Study. IR Degano1, M Grau1, I Subirana1, J Vila1, R Elosua1, J Marrugat1 1Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain Purpose: To estimate the effect of ESC recommendations on diet and physical activity (PA) on coronary artery disease (CAD) attack rate in a European region with low CAD risk. Methods:The CASSANDRA model, based on the Framingham-REGICOR CV risk function, was used to estimate CAD attack rate until 2025. The model was applied using the demographic distribution of the REGICOR population (Girona, Spain), the prevalence of CV risk factors at baseline (2005), the probable trend of CV risk factors until 2025, and the effect of diet and PA recommendations on hypercholesterolemia and hypertension prevalence. The latter was obtained by multiple linear regression, assuming the maximum expected effect of recommendations on blood pressure and LDL cholesterol to the candidate population. Results:CAD attack rate is expected to increase in Girona until 2025 (267 to 298/100,000 in men, and 75 to 84/100,000 in women, 4th scenario Figure). If those not following current recommendations on diet and PA did so, a smaller increase would be expected (267 to 279/100,000, and 75 to 81/100,000) based on the decrease of hypercholesterolemia and hypertension prevalence (3rd scenario Figure). In men, this reduction mimics the expected by the probable trends on diabetes and smoking prevalence (-3.8% and -1.85%, 2nd scenario Figure). In women, the observed reduction would compensate the expected increase (75 to 87/100,000) by the probable trends on diabetes and smoking prevalence (3.3% and 3.6%). Conclusions:Current diet and PA recommendations are predicted to reduce CAD attack rates in a low risk European region. In women, this reduction would compensate probable unfavorable trends on diabetes and smoking. The effect of diet and PA recommendations in European regions with higher CAD risk would probably be larger. Open in new tabDownload slide Predicted CAD attack rate in Girona P510 Is the hypertriglyceridemic-waist phenotype important in coronary heart disease prediction? A cohort Norway and CVDNOR Linkage Study G Egeland1, J Igland2, O Nygard3, G Sulo2, GS Tell2 1Norwegian Institute Of Public Health, The Cardiovascular Registry, Bergen, Norway 2Dept of Global Public Health and Primary Care, Bergen, Norway 3Haukeland University Hospital, Bergen, Norway Topic: Sports cardiology Purpose:To evaluate the utility of the hypertriglyceridemic-waist phenotype in the prediction of coronary heart disease. Methods:Men (n=55,560) and women (n=60,551) participants of regional Norwegian health surveys (Cohort Norway) who were free of heart disease at baseline (1994-2003), were followed through 2009 by record linkages to The Cause of Death Registry and hospital discharge diagnoses through the CVDNOR project. Hazard ratios (HR) and 95% confidence intervals (CI) for acute myocardial infarction (AMI) associated with the phenotype was evaluated in multivariate Cox regression adjusting for conventional risk factors: baseline age, daily smoking, systolic blood pressure (mm Hg), self-reported diabetes, HDL-C and nonHDL-C (mmol/L), and frequency of alcohol consumption. Results:During a mean follow-up of 11.5 yrs, 2,538 men and 1,086 women developed an AMI. Prevalence of an enlarged waist (>102 cm for men, and >88 cm for women) increased from the lowest to highest quartile of triglycerides for men (4.9% to 22.5%) and women (6.5% - 42.1%; P for trend < 0.01). The presence of an enlarged waist and elevated triglyceride (>1.7 mmol/L) was associated with a HR for AMI of 1.68 (95% CI 1.48-1.90) for men and 1.95 (95% CI 1.66-2.29) for women compared to those with normal waist and triglyceride level after adjusting for age, smoking and time since last meal. However, when considering all conventional risk factors no significant association was observed between the phenotype and AMI. Conclusion:The phenotype had no utility beyond that of conventional risk factors in predicting AMI. Similar to metabolic syndrome, we foresee limited practical applications of the hypertriglyceridemic-waist phenotype in the clinical management of patients or in population-based risk prediction algorithms. P511 4-second exercise test: normative values for healthy adults aged 18 to 81 years old CG Araujo1, CL Castro2, JF Franca2, PS Ramos3 1Federal University of Rio de Janeiro, Heart Institute Edson Saad/CLINIMEX, Rio de Janeiro, Brazil 2Exercise Medicine Clinic - CLINIMEX, Rio de Janeiro, Brazil 3Faculty of Medical Sciences - SUPREMA, Therezinha de Jesus Hospital, Juiz de Fora, Brazil Topic: Sports cardiology Purpose:Physiological reflexes primarily modulated by vagus allow heart rate to decrease and to increase rapidly after a deep inspiration followed by fast limb movements. These are the physiological basis of the 4-s exercise test (4sET) that has been pharmacologically validated (Clin Autonom Res 1992) for the evaluation of vagal modulation on the cardiac chronotropism. The aim of the study was to establish reference values for the 4sET results in healthy adults. Methods:Revising 4sET data from 1994 to 2013 and after application of rigid inclusion/exclusion criteria, we obtained a sample of 1,605 healthy adults (61% men) aged between 18 and 81 years old. In the 4sET, a cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two electrocardiogram RR-intervals: 1) after 4-s of a fast full inspiration and immediately before start to pedal the cycle and 2) at the end of 4-s of fast unloaded (no resistance added) cycling. Results:CVI was negatively related to age (r=-.33; p<.01) and the linear regression's intercepts and slopes were similar to men and women (p>.05) and so, the results for subjects of both genders were grouped for further analysis. Considering the heterocedasticity and the skewness of CVI distribution as related to age, it was preferable to report the reference values as percentiles to eight different age-groups (years): 18-30 (N=282), 31-40 (N=449), 41-45 (N=260), 46-50 (N=239), 51-55 (N=128), 56-60 (N=110), 61-65 (N=76) e 66+ (N=61). It was found that CVI median values progressively declined from 1.63 to 1.24. Conclusions:Availability of CVI's age-percentile reference values would possibly facilitate a broader clinical application of the 4sET, a simple, valid and safe tool to assess the vagal modulation of the chronotropic response. Open in new tabDownload slide P512 Ivabradine increases haemodynamic exercise performance after cardiac transplantation : a prospective study J Jaussaud1, MA Billes1, H Douard1 1Hospital Haut Leveque, Bordeaux-Pessac, France Introduction:Cardiac graft denervation induces permanent sinus tachycardia that can be reduced with If channel antagonist Ivabradine. We aim to investigate the impact of long term Ivabradine treatment on cardiopulmonary performance in heart transplant recipients. Methods:This prospective cross-over study included 16 patients (12 males; 53± 8 years) transplanted since 5 ± 4 years with stable sinus rhythm and normal graft systolic function. Each patient performed a cardiopulmonary exercise test after a 3 months period without and after 3 months of Ivabradine therapy (5 mg bid) in a randomized order. Results:Heart rhythm (HR) at rest, at first ventilatory threshold and at peak exercise were significantly reduced (99±5 bpm to 77±7 bpm (p < 0.001); 123±9 bpm to 103±11 bpm (p < 0.001) and 151± 9 bpm to 134±11 bpm (p<0.001)). A trend to an improvement of peak aerobic (VO2 max) and exercise performance (from 20± 5 to 21±5 ml/kg/min and from 110± 33 to 116± 43 watts -p=ns-) and at ventilatory threshold (14±3 to 15±5 ml/kg/min -p=ns-) were observed. VE/VCO2 slope was stable (from 35± 6 to 36± 5 - p = ns-). Nevertheless, peak oxygen pulse was significantly increased by Ivabradine therapy from 46 +/- 6 % to 55± 8 % of theorical value -p = 0.03- assessing a probable improvement of stroke volume during exercise. No side effect nor significant changes in immunosuppressive drug dosages were detected during treatment periods. Blood pressure were not statically changed during exercise measurements. Conclusion:Despite a slight but not significant improvement in oxydative and exercise capacities, chronic Ivabradine therapy in heart transplant recipients induces a significant increase of peak exercise stroke volume assessed by oxygen pulse. This could be explained by a significant reduction of HR and then a longer left ventricular diastolic filling time during exercise. P514 Seasonal changes of 24-hour arterial stiffness parameters in two regions of the Russian Federation. Results of the cohort study. V M Gorbunov1, MI Smirnova1, MM Loukianov1, SA Boytsov1, DA Volkov1, AD Deev1, YN Koshelyaevskaya1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Sports cardiology Purpose:The arterial stiffness variability may be one of the causes of blood pressure seasonal variations in hypertensive patients. The investigation of this problem in Russia deserves particular interest due to great contrasts in climate conditions across different regions. The aim of the study was to assess the dynamics of arterial stiffness (winter vs. summer) in two sites of Russia – Ivanovo ("north") and Saratov ("south"). Methods:We included patients from general population who visited ambulatory clinics for various reasons. The main inclusion criterion was office blood pressure 130/85-139/89 mm Hg or long-term antihypertensive therapy. Ambulatory blood pressure monitoring (ABPM) was performed twice: in winter (December-February) and in summer (June-August). The interval between ABPMs was 6 months±7 days. The selection criteria for ABPM records were: duration =23.5 hours =56 readings per 24 hours. The ABPM waveforms were analyzed by an automatic algorithm calculating the central pulse wave parameters from the peripheral pulse wave. Results:1423 patients completed the first visit - 641 from Ivanovo (mean age 52±9 years, 244 men), 782 from Saratov (mean age 58±12 years, 449 men). The data of 745 patients with adequate quality of both ABPMs were analyzed. We found no seasonal or intraregional differences for pulse wave velocity (see table). At the same time, the values of both augmentation indices were higher in winter. Conclusions:Our results show the decrease of 24-hour arterial stiffness associated with higher temperature. Further individual analyses of these data, as well as prospective studies in this field, are needed. PWV - pulse wave velocity, AIx - Augmentation index, ao - aortic, b - brachial, s - summer, w - winter, * - p<0,05 (w vs. s), *** - p<0,001 (w vs. s), ^^^ - p<0,001 (Ivanovo vs. Saratov), ^^^^ - p<0,0001 (Ivanovo vs. Saratov) Parameter (M±SD ) Ivanovo Saratov PWVw m/s 11,6±1,4 11,7 ±7,4 PVWs m/s 11,6 ±1,9 11,6 ±4,8 AIxbw % -17,0 ±21,7 -12,6 ±22,3^^^ AIxbs % -19,9 ±23,5* -10,8 ±35,2^^^^ AIxaow % 21,0 ±12,3 24,4 ±14,6^^^^ AIxaos % 18,6 ±13,4*** 24,2 ±15,3^^^^ Parameter (M±SD ) Ivanovo Saratov PWVw m/s 11,6±1,4 11,7 ±7,4 PVWs m/s 11,6 ±1,9 11,6 ±4,8 AIxbw % -17,0 ±21,7 -12,6 ±22,3^^^ AIxbs % -19,9 ±23,5* -10,8 ±35,2^^^^ AIxaow % 21,0 ±12,3 24,4 ±14,6^^^^ AIxaos % 18,6 ±13,4*** 24,2 ±15,3^^^^ Open in new tab PWV - pulse wave velocity, AIx - Augmentation index, ao - aortic, b - brachial, s - summer, w - winter, * - p<0,05 (w vs. s), *** - p<0,001 (w vs. s), ^^^ - p<0,001 (Ivanovo vs. Saratov), ^^^^ - p<0,0001 (Ivanovo vs. Saratov) Parameter (M±SD ) Ivanovo Saratov PWVw m/s 11,6±1,4 11,7 ±7,4 PVWs m/s 11,6 ±1,9 11,6 ±4,8 AIxbw % -17,0 ±21,7 -12,6 ±22,3^^^ AIxbs % -19,9 ±23,5* -10,8 ±35,2^^^^ AIxaow % 21,0 ±12,3 24,4 ±14,6^^^^ AIxaos % 18,6 ±13,4*** 24,2 ±15,3^^^^ Parameter (M±SD ) Ivanovo Saratov PWVw m/s 11,6±1,4 11,7 ±7,4 PVWs m/s 11,6 ±1,9 11,6 ±4,8 AIxbw % -17,0 ±21,7 -12,6 ±22,3^^^ AIxbs % -19,9 ±23,5* -10,8 ±35,2^^^^ AIxaow % 21,0 ±12,3 24,4 ±14,6^^^^ AIxaos % 18,6 ±13,4*** 24,2 ±15,3^^^^ Open in new tab P515 Prognosis masked hypertension in five years I Osipova1, A Miroshnichenko2, O Antropova1, N Pyrikova1, A Zaltsman2 1Altay State Medical University, Barnaul, Russian Federation 2Railway Clinical Hospital, Barnaul, Russian Federation Objective:explore prognosis masked hypertension in men with occupational stress without cardiovascular disease (CVD). Materials and Methods:A total of 99 drivers and their assistants. Conducted identification of hypertension and masked hypertension. The survey was conducted at intervals of five years. The masked hypertension determined from the stress test "Mathematical expense." The test was positive for growth in systolic blood pressure (sBP) > 7% and/or increment of heart rate > 10%. Identified 2 groups: the first group - a man with a masked hypertension (n = 40, age 42,8 ± 9,8 years); 2nd group - men with normal blood pressure (BP) (n = 59, age 42,3 ± 8,4 years). Results:In both groups, according to stress test a marked rise in BP and heart rate. The highest values ?128;??128;?of BP and heart rate were the men of the 1st group. Important growth indicators, since it was he who reflects stress reactivity examined. In men, the first group compared with the second stress test on the increase sBP was 2.2 times higher (p < 0,001) increase in heart rate 2.3 times higher (p < 0,001). Increase in diastolic BP (dBP) in the 1st group was higher by 24% (p < 0,05). Risk factors in the 1st group compared with the second: a history of CVD met 2,2 times more often (? = 9,22, p < 0,002) (58% in the 1st group and 27% in the 2nd group); smoking status 1,8 times more often (frequency 77,5%) (? = 11,9, p < 0,0005); abdominal obesity is 2,3 times more often (? = 6,69, p < 0,001) (42.4% in the 1st group and 18.6% in the 2nd group); Hypercholesterolemia was defined more by 2,3 times (? = 10,07, p < 0,001) and was 55%. After 5 years, have been re-examination of the two groups of men with a diagnosis of hypertension and masked hypertension. For 5 years, hypertension was detected in 25% (10 of 40) - all of these men belonged to the group of individuals with masked hypertension. After 5 years, the stress test was positive in the same men as in the first survey, which indicates the constancy of stress reactivity hemodynamics. Conclusions:The incidence of hypertension in individuals with masked hypertension within 5 years is 25%. Application of a stress test "Mathematical account" allows to diagnose in the early stages of hemodynamic changes and start timely prevention. Stress-reactivity is stable hemodynamic changes in the cardiovascular system and in the presence of additional risk factors such as smoking, hypercholesterolemia, and abdominal obesity, realized within five years hypertension. P516 Circadian blood pressure profile in patients with decompensated chronic pulmonary heart in combination with arterial hypertension. N Aidargalieva1, A Teleusheva1 1Kazakh National Medicine University, Almaty, Kazakhstan The purpose:This study examined the circadian blood pressure profile in patients with decompensated chronic pulmonary heart (dCPH) disease in combination with arterial hypertension (AH) of the 1st and 2nd degrees using ambulatory blood pressure monitoring (ABPM). Materials and Methods:102 patients were studied using ABPM. The mean age was 65,6 ± 2,9 years. The patients were divided into 3 groups: the first group - 36 patients with dCPH of functional class (FC4) (NYHA) and combined with AH of the 1st degree RF4, second – 36 patients with dCPH of FC4 (NYHA) associated with AH of the 2nd degree RF4, 3rd control group included 30 patients with dCPH FC4 (NYHA). Results:Patients with dCPH have an increase of night diastolic blood pressure (DBP) to 80,05±2,7mm.Hg (normally 75 mm.Hg) (p<0,05), which is likely due to increase of pulmonary hypertension and the absence of nocturnal physiologic blood pressure decrease, which may be a sign of the formation of the so-called "pulmonary" arterial hypertension. At association of AH 1 and 2 degree the increase of night DBP was higher (86,05±1,7mm.Hg and 100,1±1,8 mm.Hg) (p<0,01), than in patients with dCPH, which was possibly due to a combination of "pulmonary" diastolic hypertension and superimposed arterial hypertension. In patients with AH the time indices significantly increase, which testify to marked impact of load falling on target-organs not only due to an increase of blood pressure, but also to decompensation of cardiopulmonary failure. So, time index of systolic BP (TISBP) in 1st group in daytime increased up to 65,7 ± 4,7% and in 2nd group up to 87,4 ± 2,7% (p <0.05). Time index of DBP (TIDBP ) was up to 43,5 ± 4,9 (p <0.01) in patients in 1st group, and 74,1 ± 3,0% (p <0.01) – in 2nd group. In the night in 2nd group TISBP made 93,05 ± 4,3% (p <0.01), in 1st group - 77 ± 4,8%. TIDBP at night was equal to 90,9 ± 4,3% (p <0.01) in the 2nd group. In 1st group this index was equal to 79,5 ± 8,1%. Mean pulse pressure was increased up to 63,83 ± 1,3 mm Hg (p <0.01) in 2nd group, that was 15% higher than in the 1st group (norm of PBP is 53 mm Hg). The magnitude of the morning rise of DBP in 2nd also increased, it was 10% above the norm reaching 40,3 ± 3,7 mm Hg (p <0.01). Conclusions:The result revealed that the features of hypertension in patients with decompensated chronic pulmonary heart disease is a significant increase of night DBP, increase of pulse pressure and the value of morning rise in DBP, the increase of the load on the target organs. All above-mentioned may lead to an increased risk of cardiovascular complications. P517 Serum neurokinin b levels in newly diagnosed non-dipper hypertensive patients C Dursun Akkoyun1, A Akyuz1, A Seref1 1Namik Kemal University Faculty of Medicine, Tekirdag, Turkey Topic: Sports cardiology Purpose:Cardiovascular diseases are more common in patients with non-dipper hypertension (NDHT) compared with those with dipper hypertension (DHT). The purpose of this study is to evaluate the serum neurokinin B levels in DHT and NDHT patients. Methods:The study population consisted of newly diagnosed hypertensive patients who were not under antihypertensive treatment. A total of 77 patients were evaluated with ambulatory blood pressure monitoring and divided into two groups as NDHT (n=42) and DHT (n=35). Plasma neurokinin B levels were measured with ELISA method. Results:Serum neurokinin B levels were significantly higher in the NDHT group compared with the DHT group (254(180-888) pg/mL and 207(116-752) pg/mL, respectively; p=0.024). There is a positive correlation between the mean nighttime systolic blood pressure and plasma neurokinin levels (r=0.590; p<0.001). On regression analysis, neurokinin B level was found to be only related to mean nighttime systolic blood pressure (Unstandardized ? ?2.02 ±9.59; p<0.001). Conclusion:In conclusion, plasma neurokinin B level is higher in patients with NDHT indicating an unfavorable cardiovascular prognosis, and it can be used for the diagnosis and the follow up of the NDHT patients. BP: blood pressure, bpm=beats per min. ?he difference between systolic BP in nighttime and daytime Nondipper Hypertension (n=42) Dipper Hypertension (n=35) P value Daytime systolic BP, mmHg 145±15 144±13.5 0.321 Daytime diastolic BP, mmHg 91±11 92±10.5 0.550 Nighttime systolic BP, mmHg 141±18 125±11 0.039 Nighttime diastolic BP, mmHg 87±11 80±9.5 0.253 ?ystolic BP 3.6(0-9) 13(10-23) <0.001 ?iastolic BP 5.5(1-10) 15(11-28) <0.001 Heart rate, bpm 85.3±10.7 83.6±11.2 0.496 Daytime heart rate, beats/min 85.3±10.7 83.6±11.2 0.496 Nighttime heart rate, beats/min 68.3±10.3 67.6±11.4 0.694 Neurokinin B, pg/ml 254(180-888) 207(116-752) 0.024 Nondipper Hypertension (n=42) Dipper Hypertension (n=35) P value Daytime systolic BP, mmHg 145±15 144±13.5 0.321 Daytime diastolic BP, mmHg 91±11 92±10.5 0.550 Nighttime systolic BP, mmHg 141±18 125±11 0.039 Nighttime diastolic BP, mmHg 87±11 80±9.5 0.253 ?ystolic BP 3.6(0-9) 13(10-23) <0.001 ?iastolic BP 5.5(1-10) 15(11-28) <0.001 Heart rate, bpm 85.3±10.7 83.6±11.2 0.496 Daytime heart rate, beats/min 85.3±10.7 83.6±11.2 0.496 Nighttime heart rate, beats/min 68.3±10.3 67.6±11.4 0.694 Neurokinin B, pg/ml 254(180-888) 207(116-752) 0.024 Open in new tab BP: blood pressure, bpm=beats per min. ?he difference between systolic BP in nighttime and daytime Nondipper Hypertension (n=42) Dipper Hypertension (n=35) P value Daytime systolic BP, mmHg 145±15 144±13.5 0.321 Daytime diastolic BP, mmHg 91±11 92±10.5 0.550 Nighttime systolic BP, mmHg 141±18 125±11 0.039 Nighttime diastolic BP, mmHg 87±11 80±9.5 0.253 ?ystolic BP 3.6(0-9) 13(10-23) <0.001 ?iastolic BP 5.5(1-10) 15(11-28) <0.001 Heart rate, bpm 85.3±10.7 83.6±11.2 0.496 Daytime heart rate, beats/min 85.3±10.7 83.6±11.2 0.496 Nighttime heart rate, beats/min 68.3±10.3 67.6±11.4 0.694 Neurokinin B, pg/ml 254(180-888) 207(116-752) 0.024 Nondipper Hypertension (n=42) Dipper Hypertension (n=35) P value Daytime systolic BP, mmHg 145±15 144±13.5 0.321 Daytime diastolic BP, mmHg 91±11 92±10.5 0.550 Nighttime systolic BP, mmHg 141±18 125±11 0.039 Nighttime diastolic BP, mmHg 87±11 80±9.5 0.253 ?ystolic BP 3.6(0-9) 13(10-23) <0.001 ?iastolic BP 5.5(1-10) 15(11-28) <0.001 Heart rate, bpm 85.3±10.7 83.6±11.2 0.496 Daytime heart rate, beats/min 85.3±10.7 83.6±11.2 0.496 Nighttime heart rate, beats/min 68.3±10.3 67.6±11.4 0.694 Neurokinin B, pg/ml 254(180-888) 207(116-752) 0.024 Open in new tab P518 The changes of systemic inflammation markers in women with arterial hypertension depending on reproductive age OM Bilovol1, LR Bobronnikova1, IA Ilchenko1 1L.T.Malaya Institute of Therapy, Clinical Pharmacology, Kharkiv, Ukraine Topic: Sports cardiology Purpose:To establish the relationship between the markers of systemic inflammation and cardiovascular parameters in women with arterial hypertension (AH) of different reproductive ages. Methods:The study involved 86 women with stage II hypertension (mean age 52.4 ± 2.42 years) with different reproductive function according to STRAW classification. The following data were analyzed: C-reactive protein (CRP), interleukin-6 (IL-6), estradiol, echocardiography, the carotid intima-media thickness (CIMT), endothelium-dependent vasodilation (EDVD) of the brachial artery, ambulatory blood pressure monitoring (ABPM). The control group included 20 healthy women (mean age - 51.6 ± 0.8 years). Results:The levels of CRP and IL-6 in women with AH were 42% and 45% higher than the ones in the control group (CRP: 4.68 ± 0.14 mg/ml, control group 2.12 ± 0.06 mg/ml; p <0.05; IL-6: 8.76 ± 0.27 ng/L, control group 4.16 ± 0.08 ng/L; p <0.01). The increasing age of women with AH was characterized by elevation of systemic inflammation markers (early and late reproductive age in comparison with the control group: CRP 24% and 39% higher, IL-6 30% and 51% higher, respectively). Estradiol levels weakly correlated with IL-6 (r = -0.27, p <0.05) in women with premenopause. The moderate correlation between estradiol and CRP, IL-6 levels was found in women with postmenopause (r = -34, r = -0.40, p <0.01), respectively. The indexes of systemic inflammation were associated with changes of the cardiovascular parameters in women with hypertension and postmenopause: the level of IL-6 correlated with myocardial mass index, CIMT and EDVD of brachial artery (r = 0.29, r = -0.34, r = -0.37, p <0.01, respectively), the CRP level correlated with CIMT and EDVD values (r = 0.38, r = -0,35, p <0.01, respectively). At the same time no correlation was found between pro-inflammatory markers and ABPM indexes. Conclusions:The activation of systemic inflammation can be considered as a pathogenetic factor of adverse influence of menopause on the cardiovascular system in women with arterial hypertension. P519 Insufficient knowledge of adults in Poland on criteria of arterial hypertension and its complications. Results of the NATPOL 2011 Survey K Suligowska1, M Gajewska2, J Stokwiszewski2, P Bandosz1, Z Gaciong3, B Wojtyniak2, M Rutkowski1, D Cianciara2, B Wyrzykowski4, T Zdrojewski1 1Medical University of Gdansk, Department of Prevention and Education, Gdansk, Poland 2National Institute of Cardiology, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland 3Medical University of Warsaw, Department of Internal Medicine, Hypertension and Angiology, Warsaw, Poland 4Medical University of Gdansk, Department of Hypertension and Diabetology, Gdansk, Poland Background:Arterial hypertension is one of the most widespread cardiovascular disease risk factors. Among the basic conditions of effective prevention, detection and treatment is appropriate knowledge in the general population about hypertension. Material and methods:The analysis was based on the results obtained in the research program NATPOL 2011. The survey covered a representative sample of adults in Poland: 2413 randomly selected subjects aged 18–79 years [1245 females (F) and 1168 males (M)]. Rated answers to the two open questions on upper limits of normal blood pressure and complications of untreated hypertension were assessed and calculated with regard to age, gender, education and place of residence. Statistical analysis was performed using multivariate logistic regression. To simplify the analysis of results, for upper limits of normal blood pressure were taken: 139–140 mm Hg and 89–90 mm Hg, for systolic and diastolic blood pressure, respectively Results:Studies indicate that in Poland knowledge of blood pressure within normal limits is small. In terms of age (18-39 years; 40-59 years; 60-79 years) only 5.5%; 10.8%; 9.6% W and 5.9%; 7.8%; 6.1% M answered the questions correctly. Considering education (basic/essential; average; higher) percentage of W providing correct answers was 4.8%; 9.5%; 10.4%, and the percentage of M 3.4%; 9.4%: 8.4%. Furthermore, there was a very large discrepancy between the declared and actual knowledge of Poles, on the upper limits of normal blood pressure (for W: 79.4% vs. 8.4%; for M: 74.8% vs. 6.7%). Among all respondents in 2413 only 3 persons (0.1%) reported fully correct criteria HTN. Among the most frequently mentioned by respondents HTN complications were heart disease (69.8%), and stroke or cerebral ischemia (66%). In very little is known relationship between untreated HTN, and renal failure (11%) and blurred vision (7.7%). The study showed no significant differences in the knowledge W and M on the knowledge of the upper limits of normal blood pressure and complications of untreated HTN. Exceptions were: stroke (W: 72.1%; M: 59.6%), kidney damage (W: 14.4%; M: 7.4%) and blurred vision (W: 9.1%; M: 6.2%), where the women showed significantly better knowledge. Conclusions:Knowledge of Poles about HTN criteria and complications that can be caused untreated HTN is insufficient. Therefore, it is necessary to conduct intensive educational activities in this field, and the results should provide guidance for the planning and implementation of these activities. P522 Lipid abnormalities remain high among hypertensive patients with stable CHD: results of the Dyslipidemia International Study (DYSIS) II Russia RG Oganov1, V Kukharchuk2, AK Gitt3, B Ambegaonkar4, V Ashton4, M Horack3, D Lautsch5, P Brudi4, O Maneshina6 1State Research Centre for Preventive Medicine, Moscow, Russian Federation 2Institute of Clinical Cardiology named after A.L. Myasnikov of the Federal State Institution, Moscow, Russian Federation 3Stiftung Institut fur Herzinfarktforschung, Ludwigshafen am Rhein, Germany 4Merck Sharp & Dohme Corp., Whitehouse Station, United States of America 5MSD, Wien, Austria 6MSD, Moscow, Russian Federation Topic: Sports cardiology Purpose:Despite treatment with lipid lowering therapy (LLT), patients with coronary heart disease (CHD) and hypertension continue to have elevated lipid abnormalities putting them at risk for future cardiovascular events. We aim to identify the prevalence of lipid abnormalities and unmet needs among hypertensive patients with stable CHD in Russia currently on LLT. Methods:DYSIS II is a multicenter, observational cross-sectional chart review conducted from November 2012-July 2013 in 93 outpatient care centers in Russia. Eligible adult patients had a documented history of CHD (past acute coronary syndrome (ACS) events >3 months before enrollment), full lipid profile available 0-12 months prior to enrollment, on LLT for =3 months or not treated at all, and were not participating in randomized clinical trials involving medication. Patient characteristics, risk factors, treatment patterns, and laboratory values were collected. LDL-C lipid target achievement was assessed based on local guidelines. Patients were identified as having hypertension based on data collected through the study case report form. Results:Among 567 hypertensive stable CHD patients (74.8% male, mean age 62.5 ± 9.3 years), 95.2% had hypercholesterolaemia, 80.1% history of ACS, 71.9% previous percutaneous coronary intervention or coronary artery bypass graft, 61.6% left ventricular hypertrophy, 53.5% family history of CHD, 40.9% congestive heart failure, and 18.6% type 2 diabetes mellitus. 93.7% (n=531) of patients were on LLT (99.4% statin and 9.2% non-statin), with only 11.3% achieving LDL-C <70 mg/dl. Mean atorvastatin equivalent dose was 21 ± 13 mg/day, 8.7% of treated patients received combination therapy with 2.1% receiving ezetimibe plus statin. Conclusion:Approximately 89% of LLT treated hypertensive patients with stable CHD in Russia did not achieve the recommended LDL-C target. Additional effective lipid lowering strategies are needed among these very high risk patients to prevent future cardiovascular events. LLT Treated Patients n=531 Low density lipoprotein (LDL) cholesterol 106.9 ± 35.3 mg/dl Total cholesterol 178.8 ± 40.8 mg/dl Triglycerides 141.0 ± 70.3 mg/dl Non-HDL cholesterol 133.3 ± 39.7 mg/dl LLT Treated Patients n=531 Low density lipoprotein (LDL) cholesterol 106.9 ± 35.3 mg/dl Total cholesterol 178.8 ± 40.8 mg/dl Triglycerides 141.0 ± 70.3 mg/dl Non-HDL cholesterol 133.3 ± 39.7 mg/dl Open in new tab LLT Treated Patients n=531 Low density lipoprotein (LDL) cholesterol 106.9 ± 35.3 mg/dl Total cholesterol 178.8 ± 40.8 mg/dl Triglycerides 141.0 ± 70.3 mg/dl Non-HDL cholesterol 133.3 ± 39.7 mg/dl LLT Treated Patients n=531 Low density lipoprotein (LDL) cholesterol 106.9 ± 35.3 mg/dl Total cholesterol 178.8 ± 40.8 mg/dl Triglycerides 141.0 ± 70.3 mg/dl Non-HDL cholesterol 133.3 ± 39.7 mg/dl Open in new tab P523 Pleiotropic effects of rosuvastatin in patients with chronic obstructive pulmonary disease and dyslipidemia E Samorukova1, G Rosliakova2, T Adasheva1, V Zadionchenko1 1Moscow State Medical and Dental University, Therapy and family medicine, Moscow, Russian Federation 2City Hospital of St. Vladimir, laboratory diagnostics, Moscow, Russian Federation Topic: Sports cardiology Purpose:to analyze the 3-Hydroxy-3-Methyl-Glutaryl Coenzyme A (HMG-CoA) reductase inhibitor rosuvastatin influence on chronic low-grade systemic inflammation, endothelia dysfunction and clinical current in patients with chronic obstructive pulmonary disease (COPD). Methods:we investigated 60 patients men (age 64 ± 7,6 years) with COPD II-III stages (Global Initiative for Chronic Obstructive Lung Disease 2011) in remission period. The patients were without myocardial infarction, stroke, coronary artery disease. We used of a risk estimation system such as SCORE (Systematic Coronary Risk Estimation) to estimate total cardiovascular risk our patients. A calculated SCORE was 11.31±4 (high and very high risk). The patients were divided into 2 groups. One group (40 patients) received rosuvastatin 5-10 mg during one year. The other group was control (20 patients). The target level for low-density lipoprotein-cholesterol (LDC-?) was = 1,8 mmol/l. The basic therapy COPD did not change. The patients used the combination of anticholinergic agents (ipratropium bromide, tiotropium bromide) with beta-2-adrenomimetic fenoterol. High sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule type 1 (VCAM-1) were estimated before and after the treatment period. We analyzed spirometry (severity of airflow limitation), quantity of exacerbations. The symptoms of COPD, health status were analyzed using the St. George's Respiratory Questionnaire (SGRQ) before and after the rosuvastatin treatment. Results:all patients reached target values LDC-?. Hs-CRP decreased from 4.5 [3,3; 8,77] mg/l to 3,2 [1,2; 4,1] mg/l (p<0,001). VCAM-1 – marker of endothelial dysfunction decreased from 1066,6 [870; 1381] ng/ml to 795,2 [(670; 1020] ng/ml (p<0,001). The symptoms activity of COPD decreased from 76,3 ± 23,1 to 60,8±11,3 (p<0,05). There was a 21% decrease of COPD exacerbations (p < 0,001). Forced expiratory volume in 1 second (FEV1) 5.2% increase was revealed (p=0,002). The control group did not have statistically significant dynamics in a year. Conclusions:rosuvastatin has anti-inflammatory and endothelial protective effects, improves lung function, and reduces the exacerbations number in patients with COPD. It is important because chronic systemic inflammation and endothelia dysfunction are basic mechanisms of vascular impairments and development of cardiovascular diseases in patients with COPD. P524 Rosuvastatin induced carotid plaque regression in patients with inflammatory joint diseases: The RORA-AS study S Rollefstad1, E Ikdahl1, J Hisdal2, IC Olsen3, I Holme4, HB Hammer3, GD Kitas5, TR Pedersen6, TK Kvien3, AG Semb1 1Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway 2Oslo University Hospital, Aker, Section of Vascular Investigations, Oslo, Norway 3Diakonhjemmet Hospital, Department of Rheumatology, Oslo, Norway 4Oslo University Hospital, Ullevaal, Department of biostatistics, epidemiology and health economics, Oslo, Norway 5Dudley Group NHS Foundation Trust, West Midlands, United Kingdom 6Oslo University Hospital, Ullevaal, Centre of Preventive Medicine, Oslo, Norway Topic: Sports cardiology Purpose:Patients with rheumatoid arthritis (RA) and carotid artery plaques (CP) have increased risk of acute coronary syndromes. Statin treatment with low density lipoprotein cholesterol (LDL-c) goal < 1.8 mmol/L is recommended for patients with CP in the general population. In the ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases (RORA-AS) study, the aim was to evaluate the effect of 18 months intensive lipid lowering with rosuvastatin on change in CP height. Methods:Eighty-six patients (60.5% female) with CP and IJD [RA (n=55), ankylosing spondylitis (n=21) and psoriatic arthritis (n=10)] were treated with rosuvastatin to obtain LDL-c goal. CP height was evaluated by B–mode ultrasound. Results:Age was 60.8±8.5 years (mean±SD). At baseline, median number and height of CP was 1.0 (range 1-6) and 1.80 mm (IQR 1.60, 2.10). Change in CP height after 18 months rosuvastatin treatment was -0.19±0.35 mm (p<0.001). Baseline and change in LDL-c was 4.0±0.9 mmol/L and -2.3±0.8 mmol/L (p<0.001). Mean LDL-c level during 18 months rosuvastatin treatment was 1.7±0.4 mmol/L. The degree of CP height reduction was independent of the LDL-c level exposure during the study period (p=0.36). Attainment of LDL-c < 1.8 mmol/L or the change in LDL-c did not influence the degree of CP height reduction (p=0.44 and p=0.46, respectively). The higher the CP was at baseline - the larger height reduction after 18 months with rosuvastatin treatment (p< 0.001). Joint disease activity during the study period was inversely associated with change in CP height (p=0.02), so that patients with the highest disease activity had the smallest change in CP height and vice versa. Conclusion:This is the first clinical study showing that intensive lipid lowering with statin induced regression of atherosclerosis in patients with IJD. Our results indicate that joint disease activity may influence the effect of anti-atherosclerotic treatment. P525 Patients with dyslipidemia on a diet have a healthier dietary intake than the general population P Marques-Vidal1, P Vollenweider2, M Grange2, I Guessous3, G Waeber2 1University Hospital Center Vaudois (CHUV), Lausanne, Switzerland 2University Hospital Center Vaudois (CHUV), Department of Internal Medicine, Lausanne, Switzerland 3Geneva University Hospitals, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva, Switzerland Background:dietary measures effectively complement hypolipidemic drug treatment, but little is known regarding the composition of hypolipidemic diets in Switzerland. Objective:To characterize the dietary intake of subjects aged 40 to 80 years according to diagnosis of dyslipidemia and presence of a hypolipidemic diet. Methods:cross-sectional study conducted between 2009 and 2012 on 4289 participants (2274 women) living in Lausanne, Switzerland, of which 1370 (32%) reported a diagnosis of dyslipidemia, of which 242 (18%) reported a hypolipidemic diet. Dietary intake was assessed using a validated food frequency questionnaire. Results:compared to participants with dyslipidemia not on a diet, those on a diet consumed more fruits (mean±standard deviation: 2.5±1.9 vs. 1.9±1.7 portions/ day), vegetables (1.6±1.0 vs. 1.4±0.9 portions/day) and fish (1.9±1.4 vs. 1.6±1.1 portions/week) and less meat (4.5±2.7 vs. 5.2±2.9 portions/week). They also had a higher intake of total carbohydrates (50.1±8.6 vs. 47.1±8.3 % total energy intake), monounsaturated (39.9±5.4 vs. 39.4±4.3 % total fat) and polyunsaturated (15.6±4.3 vs. 14.2±4.1 % total fat) fatty acids and a lower intake of total fat (34.2±7.4 vs. 36.6±7.0 % total energy intake) and saturated fatty acids (35.1±6.2 vs. 37.8±5.7 % total fat). Finally, participants with dyslipidemia on a diet complied to more nutritional recommendations (2.1±1.0 vs. 1.7±0.9) than participants with dyslipidemia but not on a diet. Compared to non-dyslipidemic participants, participants with dyslipidemia on a diet had a higher consumption of fruits, fish and total carbohydrates, mono and polyunsaturated fats, and a lower consumption of total and saturated fats. Conclusion:when implemented, hypolipidemic diets lead to a healthier dietary intake than in the general population. P526 Self-perception of salt consumption and its intake among adults living in three urban units in Praia, Cape-Verde D Alves1, Z Santos1, M Amado2, R Simoes1, I Craveiro1, J Cabral1, L Lapao1, A Delgado3, A Correia4, L Goncalves1 1Institute for Hygiene and Topical Medicine, Lisbon, Portugal 2Faculty of Science and Technology UNL, Lisbon, Portugal 3Directorate-General of Health - Cape-Verde, Praia, Cape Verde 4National Center for Health Development - Cape-Verde, Praia, Cape Verde Topic: Sports cardiology Purpose:Cardiovascular diseases are the main cause of death in Cape-Verde (35% of deaths by noncommunicable diseases, estimated to account for 69% of total deaths) [WHO 2014]. It was estimated that 47.7% of men and 38.4% of women over 25 years suffer from Hypertension [WHO 2013]. High levels of dietary sodium (consumed as common salt) are associated with raised blood pressure and adverse cardiovascular health [Dariush et al. 2014]. Kerry at al. (2005) stated that in many sub-Saharan African countries, particularly in less urbanized settings, the main source of dietary sodium is from salt added to food for preservation, taste and in the cooking process. The guideline for salt daily consumption is up to 5000mg/day (equivalent to 2000mg/day of sodium) [WHO 2012]. This study aimed to analyze self-perception of salt consumption and sodium daily intake. Methods:A Food Frequency Questionnaire (FFQ) was applied, as part of the UPHI-Stat questionnaire, to a random sample of 1912 participants from three urban units in Praia (Formal, Informal and Transition) to assess self-perception of salt consumption in diet. A 24-hour dietary recall was applied, in order to assess sodium daily intake, to 599 participants. Results:According to FFQ, in an ordinal scale - none, low, medium and high - 44.1% and 50.9% of the sample referred low and medium salt consumption, respectively. The participants from Formal unit referred a higher percentage of low and a lower percentage of medium consumption. The median sodium daily intake for the sub-sample was 3156mg/day [IQR: 1901-4948], with Transition unit presenting a lower value (2451mg/day [IQR: 1599-4124]) than the other two units (p<0.001). Therefore, 73.7% of this sub-sample did not comply with the recommendation. Moreover, 3.7% presented a sodium daily intake higher than 10000mg/day (5.1% in Informal unit). The non-compliance with the recommendation was 83.3% and 61.8% in Informal and Transition units (p<0.001) and, by sex, 79.9% and 70.4% on men and women, respectively (p=0.024). Analyzing the quantity of sodium intake for each category of self-perception of salt consumption, it was found that at least 70% of participants presented sodium daily intake above the recommendation, for all categories. Conclusions:In the study urban units, sodium daily intake does not fit nutritional and dietary recommendations, even though their self-perception of salt consumption by FFQ was mainly referred as low or medium consumption. This demonstrates the emerging need for specific content development within the public health and community nutrition for the development of food skills. P527 Oleacein translation from extra virgin oil to stabilization of atherosclerotic plaque. M Naruszewicz1, A Filipek1, ME Czerwinska1 1Medical University of Warsaw, Department of Pharmacognosy and Molecular Basis of Phytotherapy, Faculty of Pharmacy., Warsaw, Poland Topic: Sports cardiology Purpose:Oleacein is one the most abundant compound of phenolic fraction of extra virgin olive oil. Taking into account anti-oxidative and anti-inflammatory effects of oleacein, we examined its potential influence on the stabilisation process of carotid plaque ex vivo. A direct effect of oleacein on the macrophage phenotype were also evaluated. Methods:The effect of oleacein on MMP-9, MMP-9/NGAL, IL-10, HO-1 and HMGB1 secretion from human carotid atherosclerotic plaques obtained from TIA patients were measured by ELISA assays. The expression of CD 163 and IL-10 in macrophage cells was determined by Flow Cytometry. The expression of CD163 receptor was confirmed by Real-time quantitative RT-PCR. Results:We have shown that oleacein in dose-dependent manner (from 5 to 20µmol/L) significantly decrease secretion of proteases, such as MMP-9 and complex MMP-9/NGAL as well as HMG1 and TF by the plaque stimulated by LPS. At the same time we observed increase IL-10 and HO-1 secretion. Complexes of oleacein with hemoglobin and haptoglobin 1-1 and 2-2 stimulate the expression of CD163 macrophage scavenger receptor and IL-10. This process can lead to changes macrophage phenotype cells from pro-inflammatory M1 to anti-inflammatory M2. Conclusions:Oleacein may play significant role in the stabilization of human carotid plaque and could be potentially useful in the reduction of the risk of ischemic stroke. P529 Inverse association between central obesity and arterial stiffness in Korean subjects with metabolic syndrome: a cross-sectional cohort study K-B Won1, H-J Chang2, I-J Cho2, C-Y Shim2, G-R Hong2, N Chung2 1Keimyung University Hospital Dongsan Medical Center, Cardiology, Daegu, Korea, Republic of 2Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Cardiology Division, Seoul, Korea, Republic of Introduction:Metabolic syndrome (MetS) is associated with increased risks of diabetes and atherosclerotic cardiovascular disease. Whether central obesity (CeO) is a prerequisite for the diagnosis of MetS in the International Diabetes Federation (IDF) definition is a substantial issue because it may influence the clinical value of MetS for predicting subclinical atherosclerosis. Methods:We investigated the relation between MetS, as defined by the National Cholesterol Education Program–Adult Treatment Panel III criteria, and arterial stiffness measured using brachial-ankle pulse wave velocity (baPWV) according to CeO status in 2,560 healthy Korean subjects who participated in a community-based cohort study. Results:The prevalence of MetS was 40%; 85% of MetS subjects had CeO. The prevalence of diabetes was higher in MetS subjects than in non-MetS subjects (30 vs. 8%, p<0.001). The number of MetS components (MetSN) was correlated with baPWV (r=0.311, p<0.001). In a subgroup analysis of MetS subjects, the prevalence of diabetes was not significantly different in MetS subjects with and without CeO. MetS subjects without CeO had higher baPWV than those with CeO (1654±315 vs. 1578±270 cm/s, p=0.002). Multiple regression models revealed that CeO was inversely associated with baPWV in MetS subjects. Conclusion:Despite the significant correlation between MetSN and arterial stiffness, there appeared to be an inverse association between CeO and arterial stiffness in MetS subjects. In contrast to the IDF definition, CeO might not be crucial for the diagnosis of MetS in healthy Koreans having multiple metabolic risk factors with respect to subclinical atherosclerosis reflected in arterial stiffness. P530 The obesity paradox and survivors of ischemic stroke P Wohlfahrt1, F Lopez-Jimenez2, A Krajcoviechova1, M Jozifova1, O Mayer3, J Vanek3, J Filipovsky3, E Llano4, R Cifkova1 1Thomayer University Hospital, Center for CV Prevention, Prague, Czech Republic 2Mayo Clinic, Rochester, United States of America 3Center of Preventive Cardiology, 2nd Department of Internal Medicine, Charles University, Medical Fa, Pilsen, Czech Republic 4University of Texas Southwestern Medical School, Dallas, United States of America Background:While obesity is a risk factor for stroke and achieving normal weight is advocated to decrease stroke risk, the risk associated with obesity and weight loss after stroke has not been well established. Aim:To assess the association of obesity at the time of stroke admission and weight loss after stroke with total mortality. Methods:We analyzed 736 consecutive patients (mean age 66±11 years, 58% male) hospitalized for their first ischemic stroke. Body weight at hospital admission and at the outpatient visit during follow-up was used in the analysis. Results:After multivariate adjustment, obesity at admission was associated with lower mortality risk as compared with normal weight (HR 0.50, p=0.03). At the outpatient visit, with a median follow-up time of 16 months, 21% of patients had lost >3kg of weight. Stroke severity, heart failure, transient ischemic attack and depression after stroke were independently associated with significant weight loss. Weight loss >3kg was associated with increased mortality risk (HR 5.87, p=0.001) independently of other factors. Similar results were seen when weight loss was defined as losing over 3% of baseline weight, (HR 4.97, p=0.004). Weight gain >5% of the baseline weight tended to be associated with better survival when compared with no weight change (long-rank test p=0.07). Conclusions:Normal weight at hospital admission and weight loss after ischemic stroke are independently associated with increased mortality. Overweight and obesity at baseline do not decrease the risk associated with weight loss. P531 Assessing the risk for cardiovascular diseases using PROCAM/HeartScore in obese patients. A survey with 960 employees S Hossain1, A Raethling1, R Gottfried1, T Bitter1, O Oldenburg1, G Noelker1, K Gutleben1, D Horstkotte1, KP Mellwig1 1Heart and Diabetes Center NRW, Ruhr-University of Bochum, Department of Cardiology, Bad Oeynhausen, Germany Topic: Sports cardiology Purpose:Obesity has long been identified as important risk factor for a number of health problems. Body Mass Index (BMI) is the most frequently used measure to determine levels of body fat, provides a proxy measure of total adiposity (the amount of fat around the body). The aim of the present project is to apply the PROCAM and HeartScore for association of adiposity with morbidity and mortality of cardiovascular diseases in employees of different companies undergoing a cardiovascular screening program. Method:960 employees of different companies were investigated between May 2013 –September 2014. The cardiovascular risk was determined using the PROCAM score (allows the early detection of the risk of contracting a disease thereby providing the possibility of a timely prevention, especially in high risk groups whose disorders have not manifested clinically yet) and HeartScore (The tool for predicting and managing the risk of heart attack in Europe). Results:We examined 388 women and 572 men (age 43±10.77 years). 134 employees (13.96%) had BMI values above 30 kg/m2. The PROCAM-Score was = 20 in 5 employees of the adiposity group (3.73%) and in 14 of the non-adiposity group (1.90%). HeartScore was = 5 in 19 patients (14.18%) of the adiposity group and in 55 patients (6.66%) of the non-adiposity group. Increased systolic and diastolic blood pressure (> 140 / > 90 mmHg) was found in 31.34 % of the obese patients and in 13.44 % of the non-obese group. However there was a slightly higher amount of smokers in the obese group (36.57%) compared to the non-obese group (34.99%). The percentage of high LDL-Cholesterol levels was almost double in the obese group (20.9 % vs. 11.86 %). The percentage of high HbA1c values was almost five times higher in the obese group (14.93 % vs. 3.15 %). There was an approximate 3:1 ratio of males to females in our obese collective. Conclusion:Although there was only a small percentage of obese employees (~15%), the significant higher risk for cardiovascular disease was apparent in both score systems (more than double). Therefore extensive diagnostic measures in prevention are required. Total number BMI (kg/m2) (mw/range) HeartScore total number PROCAM total number HeartScore (mw/range) PROCAM (mw/range) Group A (BMI >30) 134/960= 13.96% 33.04±3.53/ 30 - 47.9 19/134= 14.18% 5/134= 3.73% 2.17±2.24/ 1 - 16 5.50±7.32/ 0 - 54 Group B (BMI<30) 826/960= 86.04% 24.03±3.05/ 16.3 - 29.9 55/826= 6.66% 14/826= 1.69% 1.74±1.84/ 1 - 15 3.02±5.25/ 0 - 45 Total number BMI (kg/m2) (mw/range) HeartScore total number PROCAM total number HeartScore (mw/range) PROCAM (mw/range) Group A (BMI >30) 134/960= 13.96% 33.04±3.53/ 30 - 47.9 19/134= 14.18% 5/134= 3.73% 2.17±2.24/ 1 - 16 5.50±7.32/ 0 - 54 Group B (BMI<30) 826/960= 86.04% 24.03±3.05/ 16.3 - 29.9 55/826= 6.66% 14/826= 1.69% 1.74±1.84/ 1 - 15 3.02±5.25/ 0 - 45 Open in new tab Total number BMI (kg/m2) (mw/range) HeartScore total number PROCAM total number HeartScore (mw/range) PROCAM (mw/range) Group A (BMI >30) 134/960= 13.96% 33.04±3.53/ 30 - 47.9 19/134= 14.18% 5/134= 3.73% 2.17±2.24/ 1 - 16 5.50±7.32/ 0 - 54 Group B (BMI<30) 826/960= 86.04% 24.03±3.05/ 16.3 - 29.9 55/826= 6.66% 14/826= 1.69% 1.74±1.84/ 1 - 15 3.02±5.25/ 0 - 45 Total number BMI (kg/m2) (mw/range) HeartScore total number PROCAM total number HeartScore (mw/range) PROCAM (mw/range) Group A (BMI >30) 134/960= 13.96% 33.04±3.53/ 30 - 47.9 19/134= 14.18% 5/134= 3.73% 2.17±2.24/ 1 - 16 5.50±7.32/ 0 - 54 Group B (BMI<30) 826/960= 86.04% 24.03±3.05/ 16.3 - 29.9 55/826= 6.66% 14/826= 1.69% 1.74±1.84/ 1 - 15 3.02±5.25/ 0 - 45 Open in new tab P532 Comparison of anthropometric indices as predictors of cardiovascular disease risk factors in portuguese adult population: importance of waist-to-height ratio A M Pereira1, R Palma Dos Reis2, R Rodrigues1, S Gomes1, AC Sousa1, E Henriques1, M Rodrigues1, S Freitas1, D Pereira1, MI Mendonca1 1Hospital Dr. Nélio Mendon? Research unit, Funchal, Portugal 2New University of Lisbon, Cardiology, Lisbon, Portugal Background:Obesity is associated with diabetes mellitus, hypertension, dyslipidemia and increased cardiovascular disease (CVD) risk. Anthropometric indeces, such body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), were evaluated as predictors of the presence of CVD risk factors in Portuguese adults. Methods and Results:The study contained a 2555 representative sample of Portuguese adults 1952 male aged 52.5 ± 8.2 years and 603 female aged 53.5 ± 8.8 years. All anthropometric indices correlated significantly with fasting glucose level, systolic and diastolic Blood Pressure, Tryglicerides and inversely with the high-density lipoprotein (HDL-C) level (p<0.0001). The WHtR showed higher correlation with CVD risk factors than WC and BMI in both men (p<0.0001, r correlation of 0.21,0.20,0.18,0.15 and -0.2 respectively) and female (P<0.0001, 0.28,0.27,0.24,0.3,-0.37). Regarding Diabetes, Hypertension and Low HDL-C the area under the receiver (AUCs) operating characteristic (ROC) curve for WHtR was higher than that for WC or BMI in the male group. In female group the ROC curve increased from the BMI to WC, beeing highest for WHtR. WC was a better predictor for High cholesterol and LDL in men. The AUCs for WHtR were highest for Diabetes (AUC=0.74 and Hypertension (AUC=0.74) in female group and male group (AUC=0.66 and AUC=0.68). The WHtR cut-off value to predict diabetes mellitus, hypertension, and dyslipidemia was approximately 0.57 in men and 0.58-0.62 in women. The WC cut-offs varied from 92 to 101 cm in men and from 88 to 97 cm in women. The optimal BMI cut-off point varied from 21.7 to 29.1 kg/m2 in women and from 26 to 29 Kg/m2 in men. Conclusions:WC or WHtR were better predictors of CVD risk factors than BMI in Portuguese Adult Population. P533 Pericardial adipose tissue may play an important role in the course of coronary artery disease J Henzel1, R Pracon1, K Kryczka1, M Marczak2, M Demkow1 1National Institute of Cardiology, Coronary Artery and Structural Heart Diseases Dept., Warsaw, Poland 2National Institute of Cardiology, Cardiovascular MRI Laboratory, Warsaw, Poland Topic: Sports cardiology Purpose:Obesity is associated with greater prevalence of coronary artery disease (CAD), however, lower mortality was noted in obese patients with CAD ('obesity paradox'). It may be hypothesized that metabolically active pericardial adipose tissue (PEAT) impacts coronary collateral circulation development by secreting wide range of vasoactive cytokines, and thus may influence the course and prognosis of CAD. In this study we sought to compare quantity of PEAT as well as body mass index (BMI) between patients presenting with chronically occluded left anterior descending coronary artery (LAD) and acute anterior myocardial infarction with ST-segment elevation (STEMI). Methods:Consecutive patients presenting between 2008 and 2013 with chronically occluded LAD (CTO) or anterior STEMI with LAD as culprit artery and who also had myocardial viability assessed by means of MRI were retrospectively enrolled. Myocardial viability assessment with cardiac MRI was performed within 1 month of coronary anatomy assessment. PEAT quantity was obtained from MRI images by manually tracing EAT area in 4 chambers view and expressed in cm2. Traditional cardiovascular risk factors were collected by telephone and medical records review. Results:57 patients (mean age 62.9 ± 9.9 yrs, 12.1% women) were included in the CTO group and 33 patients (mean age 59.8 ± 10.6 yrs, 27.3% women) were included in the STEMI group. There was no significant difference in BMI between the CTO and STEMI groups (27.2 ± 0.5kg/m2vs. 27.2 ± 5.0kg/m2respectively, p=0.99). However, average PEAT quantity was significantly higher in CTO compared to STEMI group (50.3 ± 23.0 cm2vs. 36.9 ± 16.1 cm2respectively, p=0.004). This association remained significant after adjustment for age, sex, BMI and traditional cardiovascular risk factors such as hypertension, diabetes, dyslipidaemia, tobacco use and family history (p=0.014, OR 1.04). Conclusions:Despite comparable BMI scores, patients presenting with anterior STEMI had less PEAT compared to those with chronically occluded LAD. Pericardial distribution of adipose tissue may therefore play an important role in the course of CAD. P535 General and central obesity measurement associations with markers of chronic inflammation and type 2 diabetes SR Millar1, IJ Perry1, CM Phillips1 1University College Cork, Epidemiology and Public Health, Cork, Ireland Topic: Sports cardiology Purpose:Inflammation has been suggested a possible mechanism linking adiposity with type 2 diabetes. Central obesity indicated by waist circumference (WC) measurement is thought to be a greater risk factor for chronic inflammation compared to general obesity characterised by body mass index (BMI). However, evidence for this association is still equivocal. In this study we compare biomarker relationships with BMI and WC measures and type 2 diabetes. We examine a range of pro-inflammatory cytokines, acute-phase response proteins, coagulation factors, white blood cell counts and a combination of these markers to determine which measurement is more strongly associated with diabetes-related inflammation. Methods:This was a cross-sectional study involving a random sample of 2,002 men and women aged 50-69 years. Correlation and logistic regression analyses were used to explore general and central obesity measurement relationships with non-optimal biomarker levels, biomarker combinations and type 2 diabetes. Results:When compared with BMI, WC was more strongly related to a majority of inflammatory markers, adverse biomarker clustering and type 2 diabetes. In multivariable analysis, only WC remained significantly associated with type 2 diabetes (OR: 2.96, 95% CI: 1.93-4.55) after adjusting for BMI (OR: 0.73, 95% CI: 0.49-1.10) four or more markers (OR: 4.67, 95% CI: 2.64-8.27) and other potential confounders. Conclusions:These data suggest that central obesity is a greater risk factor for type 2 diabetes and associated chronic inflammation. However, our results also demonstrate that the relationship between obesity and inflammation cannot be completely accounted for by surrogate adiposity measures. P536 Impact of type D personality on adverse cardiovascular prognosis in patients in one year after coronary artery bypass grafting OI Raykh1, AN Sumin1, EV Korok1, AV Osokina1, MG Moskin1 1Research Institute of Complex Problems of cardiovascular disease, Kemerovo, Russian Federation Psychosocial stress is acknowledged as one of risk of development of cardiovascular pathology. The interrelation between existence personality type D and prevalence of atherosclerosis is recently established. However, predictive value of type D personality in different cultures and the countries are not fully understood. Topic: Sports cardiology Purpose:Study aim was to investigate the association of type D personality with the development of cardiovascular complication in patients in one year after coronary artery bypass grafting (CABG) in russian patients. Materials and Methods:Evaluation of psychological status and combined risk of nonfatal (strokes, nonfatal myocardial infarctions, repeat procedures of revascularization and hospitalization due to relapse or progression of angina pectoris) and fatal (general and cardiovascular mortality) cases before and in one year after CABG. Patients with chronic ischemic heart disease (n=683, 127 (18.5%) females and 556 (81.5%) males, mean age=57,7±7,3 years.) who had had CABG were included in the study. Who were formed in two groups: patients with the presence of type D (n= 152) and patients without type D (n=531). The study of the psychological status was carried out using questionnaire DS-14, validated in Russian. Results:During the one year frequency of fatal cases in both groups amounted 0.40% and 0.38% (p=0,145), in turn nonfatal end-points in group with type D amounted 31.8%, and 14.6% in group without type D (p=0,049). Statistically significant correlation between their probability and type D (p=0.002), type 2 diabetes mellitus (p=0,01), multifocal atherosclerosis (p=0,003). Presence of type D personality at initial examination increased 3.21 times combined risk of nonfatal and fatal cases (odds ratio[OR] 3.21, 95% confidence interval [CI] 2,02-6,14, p=0.002). Conclusion:Accumulated proofs indicate that in detection of patients at risk of development of stress induced cardiac complications after CABG it is reasonable to use approach which involves consideration of personality type. P537 Relationship between psychological state, quality of life scale scores and left ventricular mass index in hypertensive patients G F Andreeva1, A D Deev1, V M Gorbunov1, O V Molchanova1 1State Research Center for Preventive Medicine, Moscow, Russian Federation Objective:The aim of our study was to determine psychological and quality of life (QL) LVH possible predictors in untreated stable hypertensive patients. Design and Methods:We studied 90 hypertensive patients (40 males and 50 females; mean age 52,6 ± 1,1 years). Ambulatory blood pressure (ABP) monitoring (Spacelabs 90207) was performed twice in each patient at interval of 3-4 days after the 2 weeks washout period. After the ABP monitoring each patient completed the Russian version of the psychological questionnaire "Minnesota Multiphasis Personality Inventory" (MMPI) and QL questionnaire (J. Siegrist and all.,1989). Only patients with stable hypertension (daytime ABP ³140/90 mmHg) and normal psychological scale scores (40-60 T-balls) were included into the study. Left ventricular mass index (LVMI) (L. Teichholtz 1976) was measured using echocardiography (Acuson 128XP). We analyzed the following evaluation and basic MMPI scales: L – lie scale, F – aggravation scale, K – correction scale, 1 (Hs) – hypochondria, 2 (D) – depression, 3 (Hy) – hysteria, 4 (Pd) – psychopathy, 6 (Pa) – rigidity of affect, 7 (Pt) – psychasthenia, 8 (Sc) – schrizothemia, 9 (Ma) – hypomania. Results:The mean ABP avd LVMI in the examined group were (M± SD): 24-hour systolic BP – 140,2 ± 11,2; 24-hour diastolic BP- 90,1 ± 8.2, LVMI – 122,1±21,9 g/m2. We found an adverse correlation between LVMI and scale 9 scores (level of activity, energy, good mood; r=-0.32, p<0.05). There were no significant links between LVMI and QL scales scores. Conclusions:Hypertensive patients with low level of activity, energy, mood have higher probability of development of LVH. It is possible that scale 9 scores are psychological LVH predictors. QL scales scores probably have no prognostic value. P538 Subdepression in patients with prior myocardial infarction: association with clinical characteristics of chronic coronary artery disease and comorbidities O Tsygankova1, D Platonov2, T Kostyuk2, E Zubrykina2 1Novosibirsk State Medical University, Novosibirsk, Russian Federation 2Regional Clinical Hospital, Tver, Russian Federation Topic: Sports cardiology Purpose:To assess the prevalence of subdepression in patients with prior myocardial infarction (MI) and associated clinical characteristics of chronic coronary artery disease. Material and methods:In outpatient clinic, 245 patients of both sexes aged 35-60 years with prior MI were interviewed for current symptoms and history, and examined for cardiac status (vital signs, ECG, Holter, echo, stress test), as well as for mood disorder with Zung questionnaire. Subdepression (SbD) was defined as 50-59 points at Zung's scale. Patients with more serious mood disorders (60+ points) were excluded from analysis. Multiple clinical and instrumental factors were assessed: stable angina (SA) and its grade, chest pain (CP) of any type, symptoms of chronic cerebral ischemia (SCCI), symptoms of arrhythmia (SAr), symptoms of low limb ischemia (SLLI), time to prior MI (TMI), arterial hypertension (AH), obesity (Ob), family history of heart disease (FHHD), ventricular arrhythmias (VA), Q waves (QW) and ischemic ST depression (ISTD) on ECG and Holter, systolic and diastolic dysfunction (SDF, DDF) on echo, functional capacity (FC) in stress test. Univariate logistic regression analysis was done sequentially with SbD as dependent categorical variable and all mentioned factors to identify significant associations and select factors for further multivariate stepwise backward logistic regression analysis. Odds ratios (OR) were calculated from regression coefficients with 95% confidence intervals. Results:Overall SbD was found in 29 (22.8%) men and 42 (35.6%) women. In univariate analysis, OR of SbD for female sex was 2.2 (1.3-3.9), age >50 years – 2.8 (1.5-5.0), SA – 7.0 (2.4-20.5), CP – 9.2 (2.1-39.6), SCCI – 4.7 (2.2-10.3), TMI >1 year – 2.2 (1.3-4.0), FHHD – 2.1 (1.2-3.9), VA – 1.9 (1.1-3.4), ISTD – 2.3 (1.2-4.2), FC < 75 W – 4.8 (2.1-11.0). No statistically significant associations were found between SbD and SAr, SLLI, AH, Ob, QW, SDF, DDF. In multivariate model (overall accuracy 0.80, pseudo-R square by Neigelkerke 0.495), independent associations with SbD were confirmed for older age (OR 2.8; 1.5-5.2), presence of CP (OR 3.7; 1.1-12.4), low FC (OR 2.3; 1.1-4.6), TMI >1 year (OR 2.2; 1.1-4.2), presence of SCCI (OR 3.3; 1.4-7.7). Female sex was no longer a significant factor (OR 1.9; 0.5-7.2). Presence of any type CP, as well as low FC were more important factors than presence of SA and its grade. Conclusion:Special attention should be reasonably paid to SbD and its multiple associated and predisposing factors to improve medical care and potentially prevent the post-MI patients from overt depression. P539 Subdepression in patients with prior myocardial infarction: association with demographic and socioeconomic factors O Tsygankova1, D Platonov2, T Kostyuk2, E Zubrykina2 1Novosibirsk State Medical University, Novosibirsk, Russian Federation 2Regional Clinical Hospital, Tver, Russian Federation Topic: Sports cardiology Purpose:To assess the prevalence of subdepression in patients with prior myocardial infarction (MI) and associated demographic and socioeconomic factors. Material and methods:In outpatient cardiology clinic, 245 randomly selected patients of both sexes aged 35-60 years with prior MI were examined with complex questionnaire for education (Ed), income (Inc), occupation (Oc), family status (FS), and subdepression (SbD, defined as 50-59 points at Zung's scale). Patients with more serious mood disorders (60+ points at Zung's scale) were excluded from further analysis. Univariate, bivariate and multivariate stepwise backward logistic regression analysis was done with SbD as dependent categorical variable, and sex, age, Ed, Inc, Oc, FS as independent categorical factors without and with interaction modes. Odds ratios (OR) were calculated from regression coefficients with 95% confidence intervals (CI). Results:Overall SbD was found in 29 (22.8%) men and 42 (35.6%) women. In univariate analysis, ORs of SbD were 2.2 (1.3-3.9) for female sex, 2.8 (1.5-5.0) for older age (above median), 2.8 (1.4-5.5) for lower Ed (Ed other than higher), 3.9 (2.1-7.4) for lower Inc (below median), 4.5 (2.5-8.3) for lack of Oc, and 4.4 (2.4-8.2) for living without family. In multivariate model (overall accuracy 0.75), independent associations with SbD were confirmed for female sex (OR 1.8; 1.1-3.0), older age (OR 2.3; 1.2-4.6), lower Inc (OR 2.4; 1.2-4.9), lack of Oc (OR 2.9; 1.5-5.8), and lack of family (OR 3.8; 1.9-7.7). Positive multiplicative interactions were found in bivariate logistic regression models for SdD between female sex and all above mentioned factors: older age, lower Inc, lower Ed, lack of Oc, and lack of family, – stressing the fact of excessive female vulnerability to numerous hazardous factors for mood disorders. In multivariate regression models for SbD that were separately built for men and women the above mentioned variables behaved somewhat differently: in men the most important factors associated with SbD were lower Inc (OR 3.2; 1.2-8.4) and lack of family (OR 2.6; 1.2-5.8), in women – lack of Oc (OR 13.2; 2.6-66.4), lack of family (OR 8.9; 2.9-27.3), and older age (OR 3.0; 1.1-8.8). It has to be pointed out that in females the regression model explained the SbD variability to much greater extent than in males (pseudo-R square by Neigelkerke 0.515 vs 0.118). Conclusion:Special attention should be reasonably paid to gender aspects of SbD and its multiple associated and predisposing factors to improve medical care and potentially prevent the post-MI patients from overt depression. P540 Is watching national team matches in World Cup Soccer 2014 on TV and associated with increasing of ventricular arrhythmia? T Shiozawa1, K Shimada1, G Sekita1, H Hayashi1, H Tabuchi1, S Yamagami2, S Suwa3, M Sumiyoshi4, Y Nakazato5, H Daida1 1Juntendo University Graduate School of Medicine, Department of Cardiology, Tokyo, Japan 2Juntendo Tokyo Koto Geriatric Medical Center, Department of Cardiology, Tokyo, Japan 3Juntendo University Shizuoka Hospital, Department of Cardiology, Izunokuni, Japan 4Juntendo University Nerima Hospital, Department of Cardiology, Tokyo, Japan 5Juntendo University Urayasu Hospital, Department of Cardiology, Urayasu, Japan Background:Psychological triggers such as emotional stress increase the incidence of acute cardiovascular events. The association between soccer championships and the risk of cardiovascular events are controversial. World Cup Soccer (WCS) involving the national team might be a trigger strong enough to induce cardiac arrhythmia. However, there are no reports which investigated the relationship between WCS and cardiac arrhythmia in the Japanese population. Methods:We assessed 28 patients who were evaluated ischemic changes and/or arrhythmia by 24-hour Holter ECG during WCS 2014 in 4 Cardiology Divisions. The patients were divided into two groups [Watching group (n=10) patients who watched WCS on live-TV on June 20 (Japan vs. Greece) or July 25, 2014 (Japan vs. Colombia), and No-watching group (18 patients)]. The heart rates, arrhythmia, and ischemic changes were evaluated. Results:There were no significant differences of clinical characteristics, heart rates, frequency of premature atrial contractions, and ischemic changes between the two groups. The frequency of premature ventricular contractions (PVCs) were significantly higher in the Watching group than in the No-watching group (2893±3657 vs. 237±472, P=0.005). Notably, the frequency of PVCs were significantly higher during live-TV in the Watching group than in the No-watching group (124±187 vs. 3.3±5.4, P=0.0003). No sustained ventricular tachycardia or fibrillation was recorded. Conclusions:A significant association between watching WCS and the frequency of PVCs was observed. These data suggest that emotional stress while watching national team soccer matches may induce stress-related cardiovascular events. P541 Evaluation of the efficacy of cardiovascular prevention in the framework of the World Heart Day N Pogosova1, A Evdokimova1, A Ausheva1 1National Center for Preventive Medicine, Moscow, Russian Federation On the eve of World Heart Day, which is held annually around the world on September 29 at the initiative of the World Heart Federation, a number of activities were organized on September 22-29, 2014 in the state medical organizations of the public healthcare system by the Ministry of Healthcare of the Moscow city (currently more than 12 million people live in Moscow according to the official data). The aim of these activities was to attract attention of inhabitants to modern possibilities of prevention of cardiovascular diseases (CVD), risk factors and CVD complications, importance of timely referral, and new approaches in treatment of CVD. As a part of these activities a campaign «Is your patient's cholesterol level optimal?" has been held. In the frame of this campaign patients of the public healthcare system of the Moscow city, who have passed health-checks in the first quarter of 2014, were invited to out-patient clinics for re-examination of total cholesterol. The aim was to assess the effectiveness of a previously recommended lifestyle changes and/or lipid-lowering medications. 2392 patients participated in the campaign, of this 835 patients (during health-checks in the first quarter of 2014) were diagnosed to have coronary heart disease and 1557 patients - high CVD risk (>5% risk according to the high-risk countries SCORE scale). More than half of patients reported that they followed a low-fat diet, up to 16% noted that they had increased their physical activity, although less than 1.5% gave up smoking. Every third patient without coronary heart disease has been recommended statins. Special attention was paid to the minority of patients with slight negative (11%) or without dynamics (7%) of total cholesterol. In most patients was found an improvement of cholesterol level. The results served as the basis of analysis of clinical cases without positive cholesterol dynamics in preventive departments. P542 Time to medical treatment and one-year survival after an acute coronary event according to the first medical contact unit (primary care or hospital): results from the ERICO study. I S Santos1, AC Goulart1, RCO Santos1, ALX Kisukuri1, RM Brandao1, D Sitnik1, HL Staniak1, MS Bittencourt1, PA Lotufo1, IM Bensenor1 1University of Sao Paulo, Sao Paulo, Brazil Topic: Sports cardiology Purpose:The importance of timely and efficient first medical contact (FMC) in the acute coronary syndrome (ACS) treatment is widely recognized. However, little is known about the outcomes of individuals who initially seek a primary care unit for an ACS event. The aim of the present study is to determine if FMC at primary care (PC-FMC) or at hospital (H-FMC) are determinants of time to medical treatment and/or one-year survival in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods:The ERICO study is a cohort study of individuals treated for an ACS event between 2009 and 2013 in Hospital Universit?o, a community hospital in the borough of Butant?S?Paulo, Brazil. Follow-up was performed at 30 days, 180 days and one year after the index event, by telephone contact. We revised data from 701 ERICO participants (87 with PC-FMC and 614 with H-FMC). We used Wilcoxon test to determine if time from FMC to the administration of aspirin, clopidogrel and heparin (in individuals with non-ST elevation ACS) and thrombolysis (in individuals with ST-elevation ACS) was different according to the FMC unit. We built Cox regression models adjusted for age, sex and ACS subtype to study if the FMC unit predicted one-year survival in the sample. Results:Administration of aspirin, clopidogrel and heparin was almost universal (100.0%, 97.7% and 97.7% in PC-FMC and 98.5%, 96.6% and 96.4% in H-FMC groups. Individuals with non-ST elevation ACS in the PC-FMC group received aspirin earlier than in the H-FMC group (median time, 2.40 vs 2.53 hours, p<0.001). There was also a trend towards an earlier administration of aspirin in ST-elevation ACS patients in the PC-FMC group (median time, 0.70 vs 1.13 hours, p=0.075). Time to thrombolysis in ST-elevation ACS patients was non-significantly lower in H-FMC group (median time, 1.03 vs. 1.15, p=0.19). Complete vital status data was available for 669 (95.4%) participants. We had eight (9.9%) and 67 (11.4%) deaths during follow-up in the PC-FMC and H-FMC groups, respectively. FMC unit was not a predictor for one-year survival in this sample. The adjusted hazard ratio for PC-FMC was 1.03 (95% confidence interval 0.50–2.16). Conclusions:Our findings suggest that primary care can be a suitable setting for the evaluation of acute chest pain, once timely evaluation, safe transportation and access to hospital treatment are warranted. Respecting the characteristics of local health systems, policy makers should consider to organize such strategy for the system-of-care during a suspected ACS event. P544 The impact of cardiovascular risk reduction on subsequent sickness absence C Fernandez-Labandera1, C Catalina-Romero1, M Cabrera Sierra1, L Quevedo-Aguado1, M Ruiz-Moraga1, LM Ruilope2, MA Sanchez-Chaparro3, P Valdivielso3, A Gonzalez-Quintela4, E Calvo-Bonacho1 1Ibermutuamur, Madrid, Spain 2Doce de Octubre Hospital, Madrid, Spain 3UGC Medicina Interna. Hospital Universitario ?128;?Virgen de la Victoria?128;?. , M?ga, Spain 4Department of Internal Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain Topic: Sports cardiology Purpose:We have recently demonstrated that an increased CV risk promotes a significant increase in length and cost of sick leave episodes. Now we assess the impact of the improvement in cardiovascular risk (CVR) on sickness absence. Methods:Prospective cohort study of 179,186 workers from the ICARIA (Ibermutuamur Cardiovascular Risk Assessment) study. Workers' CVR was assessed by the SCORE system in two consecutive years (365 ±90 days). Cardiovascular risk was categorized in low and moderate-to-high and subjects were finally classified in four groups created according to the change or stability between the two measures of their CVR: always low CVR (166,547), worsening in CVR (4,321), improvement in CVR (3,422), and always moderate-to-high CVR (4,896). 1-year follow up was carried out to assess sickness absence. The total count of sickness absence days during 1-year follow-up was the outcome in Poisson regression analysis in order to test the differences in sickness absence among the four groups. Always moderate to high CVR workers were the reference group. Rate Ratios (RR) were adjusted by sex, age, occupation, changes in smoking consumption and previous sickness absence. The improvement in CVR, and always moderate-to-high CVR groups were compared in order to clarify the specific cardiovascular risk factors that improved from the first to the second CVR assessment (chi-squared test). Results:After adjusting for covariates, the group of workers that improved their CVR showed a reduced count of sickness absence than always moderate-to-high CVR group (RR=0.91, 95%CI: 0.84-0.98). Such decrease was observed when non-work-related (RR=0.89, 95%CI: 0.81-0.96) and cardiovascular diseases (RR=0.66, 95%CI: 0.61-0.71) were considered separately, but not in the case of occupational injuries and work-related diseases (RR=0.96, 95%CI: 0.87-1.05). The most striking differences between the groups of workers with moderate-to-high CVR improving or not their CVR in the second assessment were lower percentages of smokers (51.3 vs.69.5, p=<0.001) and that of workers with high blood pressure (55.1vs. 81.7, p<0.001) in the group that improved CVR. Conclusion:The change in CVR level throughout a 1-year period is significantly associated with changes in the subsequent sickness absence. Our results suggest that the improvement in CVR level from moderate-to-high to low CVR is associated with a decrease in sickness absence during the next year. Smoking cessation and better control of blood pressure were the main differences between workers who improved and not improved their moderate-to-high CVR. P545 Gender Differences in Risk Factors for Atrial Fibrillation N Yagihara1, H Watanabe1, T Watanabe2, Y Aizawa3, T Minamino1 1Niigata University Graduate School of Medical and Dental Sciences, Department of Cardiovascular Biology and Medicine, Niigata, Japan 2Niigata Health Foundation, Niigata, Japan 3Tachikawa General Hospital, Nagaoka, Japan Introduction:There have been various risk factors for atrial fibrillation (AF) such as cardiac and non-cardiac diseases, and atherosclerotic factors (e.g., diabetes, hypertension, and obesity). The aim of this study was to investigate the gender differences in the impact of risk factors on development of AF in the general population. Methods:This community-based prospective observational cohort study was based upon an annual health check-up program in Niigata, Japan. The annual examination consists of interviews about medical history, physical examinations, blood examinations, urine tests, chest radiographs, and 12-lead electrocardiograms. This study included 223,877 individuals without AF at baseline who were followed more than one year (152,322 women [68%]; age, 61±12 years). Results:During a follow up of 5.9±2.4 years, AF developed in 1,840 men (incidence, 4.55; 95% confidence interval, 4.34-4.76) and 1,107 women (incidence, 1.21; 95% confidence interval, 1.14-1.28). Men developed AF from younger age compared to women. In women, development of AF was rare before the age of 60 years and thereafter the incidence of AF increased steeply. Among atherosclerotic risk factors, obesity and hypertension were associated with risk of development of AF in both genders. However, impaired glucose tolerance was associated with AF only in men but not in women, and low HDL-cholesterol was associated with AF only in women but not in men. Elevated triglycerides were not associated with AF in each gender. Decreased LDL-cholesterol was associated with AF in both genders, supporting the cholesterol paradox in AF as we and others have recently identified. Heart disease and metabolic syndrome were associated with increased risk of AF in both genders. Elevated uric acid was associated with AF in women but not in men, and chronic kidney disease was associated with AF in women but the association was weak in men. Non-alcoholic fatty liver disease was associated with risk of AF in women but not in men. Conclusion:The age-dependent trends in the incidence of AF and the effects of various risk factors on development of AF were different between men and women. Our study indicates that the pathogenic of AF is affected by gender. P548 Gender differences in the severity and in-hospital treatment of patients with an acute myocardial infarction (AMI) S Myftiu1, I Sharka1, XH Belshi1, E Saja1, E Sulo2, A Shkoza3, G Sulo2 1"University Hospital Center ""Mother Theresa""", Department of Cardiology, Tirana, Albania 2Department of Global Public Health and Primary Care, Bergen, Norway 3University Hospital Center Mother Theresa, Department of Biomedical Sciences, Tirana, Albania Topic: Sports cardiology Purpose:Gender differences in the characteristics of patients with an AMI can influence the treatment and explain (partially or totally) the observed gender differences in survival. We aimed at exproring gender differences in AMI severity and treatment among patients hospitalized at the University Hospital Center. Methods:A total of 266 consecutive patients [mean age (SD), 64.9 (12.2) years; 22.6% women] were included in the study. Information on socio demographic variables, coronary risk factors, treatment and severity of the disease (defined as congestive heart failure and major arrhythmias) were obtained from the patients' journal by two cardiology residents. Logistic regression models were used to explore gender differences in severity and in-hospital treatment among AMI patients. Models were adjusted for age. Results are expressed as odds ratios (OR) and 95% CI for women versus men. Results:Women were more likely to be obese (OR=2.46; 95% CI, 1.10-5.51) and have diabetes (OR=2.14; 95% CI, 1.15-3.99) but smoked less than men (OR=0.08; 95% CI, 0.04-0.17) while no gender differences were observed with regard to hypertension and dyslipidemia. Clinical manifestation of AMI (defined as presence of major arrhythmias and/or congestive heart failure) was more severe among women (OR=2.16; 95% CI, 1.16-4.01). Women were also less likely to receive PCI (OR=0.45; 95%CI, 0.20-0.98) and aspirin (OR=0.30; 95%CI, 0.10-0.90) compared to men while no gender differences were observed with regard to receiving statins, beta-blockers and ACE-inhibitors/ARBs. Conclusions:- Further studies including information on pre-hospitalization conditions are required to further explore reasons for such gender differences in some risk factors and treatment of the acute phase of MI. P549 First evidence for occurrence of exercise oscillatory ventilation in a general population at cardiovascular risk: insights from the EURO(pean) EX(ercise) population-based study M Pellegrino1, G Generati1, F Bandera1, V Donghi1, V Labate1, E Alfonzetti1, M Gaeta2, O Ferraro2, S Villani2, M Guazzi1 1IRCCS Policlinico San Donato, Heart Failure Unit, San Donato M.se, Italy 2University of Pavia, Unit of Biostatistics and Clinical Epidemiology, Pavia, Italy Background:Cardiopulmonary exercise testing (CPET) allows functional evaluation of cardiopulmonary diseases. Among CPET variables, exercise oscillatory ventilation (EOV) identifies heart failure patients with worse prognosis, but the occurrence is not described in literature in the general population at risk for cardiovascular (CV) diseases without previous CV events. We aimed at assessing the prevalence of EOV in a general population enrolled in the EUROEX study. Methods:557 healthy subjects (age 60±14 years; male 51%) underwent maximal CPET (personalized incremental ramp protocol). A subgroup (n=205) also underwent rest echocardiography. Results:A prevalence of 16% EOV was observed. The EOV group showed higher prevalence of diabetes (n=24, 25% vs n=67, 14%; p<.05) and female sex(n=69, 75% vs n=216, 47%; p<.05); an impaired exercise tolerance, of all VO2-related variables (peak VO2 and % of predicted VO2, O2 pulse, VO2@AT) and ventilator efficiency; a lower heart rate (HR) at peak exercise and heart rate recovery (HRR). Echocardiographic data showed a reduction of end-systolic dimensions of both ventricles and right atrial area in the EOV Group (n=41 vs n=164). At a multivariate analysis the EOV determinants were: TAPSE (OR: 0.16; p: 0.03); E/A (OR: 0.07; p: 0.04); BMI (OR: 1.12; p: 0.09). Conclusion:EOV patients exhibited a higher prevalence of diabetes, worse exercise performance and ventilation efficiency. These findings may provide the bases for a more in-depth prediction of CV risk. Variables EOV (n=93) No EOV (n=464) P Value Age, y 64±13 59±14 <.01 BMI, kg/m2 33±7 29±5 .07 Peak VO2, ml/kg/min 15.1±3.8 20±7.2 <.01 Peak O2pulse, ml/beat 9.6±3 11.3±3.8 <.01 VE/VCO2 slope 27.7±4.6 25.7±3.6 <.01 Peak HR, bpm 125±21 135±23 <.01 HRR, beats 14±9 16±9 <.05 LV end-systolic volume index, ml/mq 13.5±4 15.5±6 <.05 Right atrial area, cmq 14.8±4 16.8±4 <.01 RV end-systolic area, cmq 6.9±1.6 7.8±2 .01 TAPSE, mm 23.6±3 25.2±4 .07 Variables EOV (n=93) No EOV (n=464) P Value Age, y 64±13 59±14 <.01 BMI, kg/m2 33±7 29±5 .07 Peak VO2, ml/kg/min 15.1±3.8 20±7.2 <.01 Peak O2pulse, ml/beat 9.6±3 11.3±3.8 <.01 VE/VCO2 slope 27.7±4.6 25.7±3.6 <.01 Peak HR, bpm 125±21 135±23 <.01 HRR, beats 14±9 16±9 <.05 LV end-systolic volume index, ml/mq 13.5±4 15.5±6 <.05 Right atrial area, cmq 14.8±4 16.8±4 <.01 RV end-systolic area, cmq 6.9±1.6 7.8±2 .01 TAPSE, mm 23.6±3 25.2±4 .07 Open in new tab Variables EOV (n=93) No EOV (n=464) P Value Age, y 64±13 59±14 <.01 BMI, kg/m2 33±7 29±5 .07 Peak VO2, ml/kg/min 15.1±3.8 20±7.2 <.01 Peak O2pulse, ml/beat 9.6±3 11.3±3.8 <.01 VE/VCO2 slope 27.7±4.6 25.7±3.6 <.01 Peak HR, bpm 125±21 135±23 <.01 HRR, beats 14±9 16±9 <.05 LV end-systolic volume index, ml/mq 13.5±4 15.5±6 <.05 Right atrial area, cmq 14.8±4 16.8±4 <.01 RV end-systolic area, cmq 6.9±1.6 7.8±2 .01 TAPSE, mm 23.6±3 25.2±4 .07 Variables EOV (n=93) No EOV (n=464) P Value Age, y 64±13 59±14 <.01 BMI, kg/m2 33±7 29±5 .07 Peak VO2, ml/kg/min 15.1±3.8 20±7.2 <.01 Peak O2pulse, ml/beat 9.6±3 11.3±3.8 <.01 VE/VCO2 slope 27.7±4.6 25.7±3.6 <.01 Peak HR, bpm 125±21 135±23 <.01 HRR, beats 14±9 16±9 <.05 LV end-systolic volume index, ml/mq 13.5±4 15.5±6 <.05 Right atrial area, cmq 14.8±4 16.8±4 <.01 RV end-systolic area, cmq 6.9±1.6 7.8±2 .01 TAPSE, mm 23.6±3 25.2±4 .07 Open in new tab P550 Arterial hypertension control and association with other risk factors in remote period after myocardial infarction and ischemic stroke. A V Yagensky1, I Sichkaruk1, M Pavelko1 1Lutsk City Hospital, Lutsk, Ukraine Objectives:In Ukraine cardiovascular mortality is one of the highest in Europe. Arterial hypertension (AH) is one of the most important modifiable risk factors and its active control is a cornerstone of primary and secondary prevention. Design: Secondary prevention assessment was performed in Ukrainian city Lutsk in representative sample of 235 patients after ischemic stroke (PostIS) (age 62,6 ± 10,3 years, 124 men) and 312 patients after myocardial infarction (PostMI) (age 62,2 ± 9,9 years, 218 men) selected from 2229 patients hospitalized in one city hospital. The home-based blood pressure (BP), anthropometric measurements, questionnaire, and laboratory tests were performed. Results:The trend to higher AH prevalence was found in PostIS patients (88,9% vs 83,6%, p=0,09). AH was treated in the same proportion of patients (88,6 PostIS and in 87,7% PostIM), but BP goals of <140/90 mmHg was reached only in 11,9% PostIS and 21,3% PostIM patients (p=0,007). This finding corresponded with higher BP in PostIS patients (systolic 161,8±28,0 vs 156,0±26,8 mmHg in PostIM, p=0,02, diastolic 95,7±13,7 vs 92,7±15,0 mmHg, p=0,02). Worse AH control in PostIS patients was associated with less tight physician control (35,4% vs 64,7% PostMI patients contacted to doctor during last 3 months, p=0,004), taking less antihypertensive drugs (1,7±0,8 vs 2,0±0,9 in PostMI; p=0,001), lower physical activity (46,0% in PostIS vs 62,0% in PostMI had regular activities; p=0,004). Both groups had similar compliance to treatment (73,0% and 71,9%). No difference in BP self-monitoring, prevalence of obesity, smoking, diabetes, lipids, glucose and hs-CRP levels was detected. Thus, the main reason for the difference between PostIS and PostMI patients is the worse physician control in PostIS patients. Conclusions:Inadequate AH control was found in both PostIS and PostMI patients. The worse situation in PostIS patients first of all is due to the worse physician control. Active efforts in guidelines implementation should be made to improve situation. P552 Higher prevalence of cardiac abnormalities including diastolic dysfunction in gout patients with low cardiovascular risk profile using cardiac MRI and echocardiography EOF Van Gorselen1, MS Stob2, J Van Es3, IL Meek4, LJ Wagenaar3, HE Vonkeman5, C Von Birgelen6 1Slingeland Hospital, Cardiology, Doetinchem, Netherlands 2Scheper Hospital, Cardiology, Emmen, Netherlands 3Medical Spectrum Twente, Cardiology, Enschede, Netherlands 4Radboud University Medical Centre, Rheumatology, Nijmegen, Netherlands 5Medical Spectrum Twente, Rheumatology, Enschede, Netherlands 6University of Twente, Enschede, Netherlands Topic: Sports cardiology Purpose:Gout is associated with increased cardiovascular (CV) morbidity and mortality. To investigate gout-specific CV pathology a pilot study was performed to study cardiac abnormalities on echocardiography and MRI in low CV risk profile gout patients. Methods:10 male patients with chrystal proven gout were recruited from the Arthritis Center Twente CardioVascular Disease database. For inclusion only one of the following CV risk factors smoking, hypercholesterolemia or hypertension was allowed. Exclusion criteria were previous CV disease, age <18 or >75 years, kidney dysfunction, diabetes mellitus and BMI > 30. Results:Median age was 61.5 years, median BMI was 26 kg/m2, no current smoking. 50% of patients had no CV risk factors. Three patients had elevated blood pressure; median SBP was 138 mmHg, DBP 79 mmHg. Two patients used statins. Median LDL was 2.9 mmol/L. Eight out of 10 patients used urate lowering medication and median serum urate was 0,59 mmol/L. One patient did not undergo echocardiography. 70% had diastolic dysfunction. One patient had asymptomatic atrial fibrillation, 4 left ventricular hypertrophy with concentric remodelling, 3 valvular calcification without significant stenosis and 1 had dilatation of the ascending aorta. Cardiac MRI showed no myocardial edema, but in one patient late gadolinium enhancement and in two regional wall motion abnormalities. Conclusions:Low CV risk profile gout patients had substantial cardiac abnormalities on echocardiography and cardiac MRI, in particular diastolic dysfunction. The presence of gout-specific CV risk is suggested. Non-invasive cardiac imaging may be useful to detect early subclinical CV pathology. LV: left ventricle, EF: ejection fraction, LAVI: left atrial volume index, RV: right ventricle LV function echocardiography LV function MRI 2D EF (%) 55.4 (51.1-65.6) LVEF (%) 59,5 (52.2-66.6) 3D EF(%) 57.5 (43.2-63.0) RVEF (%) 57.3 (51.0-65.0) LV mass/BSA (g/m2) 79,7 (50.6-101.2) LV mass/BSA (g/m2) 48.5 (31.0-60.0) Diastolic dysfunction grade (n=) Normal 3 LAVI (ml/m2) 29,0 (19-35) I 5 II 2 E/A ratio 0.87 (0.76-1.20) LV function echocardiography LV function MRI 2D EF (%) 55.4 (51.1-65.6) LVEF (%) 59,5 (52.2-66.6) 3D EF(%) 57.5 (43.2-63.0) RVEF (%) 57.3 (51.0-65.0) LV mass/BSA (g/m2) 79,7 (50.6-101.2) LV mass/BSA (g/m2) 48.5 (31.0-60.0) Diastolic dysfunction grade (n=) Normal 3 LAVI (ml/m2) 29,0 (19-35) I 5 II 2 E/A ratio 0.87 (0.76-1.20) Open in new tab LV: left ventricle, EF: ejection fraction, LAVI: left atrial volume index, RV: right ventricle LV function echocardiography LV function MRI 2D EF (%) 55.4 (51.1-65.6) LVEF (%) 59,5 (52.2-66.6) 3D EF(%) 57.5 (43.2-63.0) RVEF (%) 57.3 (51.0-65.0) LV mass/BSA (g/m2) 79,7 (50.6-101.2) LV mass/BSA (g/m2) 48.5 (31.0-60.0) Diastolic dysfunction grade (n=) Normal 3 LAVI (ml/m2) 29,0 (19-35) I 5 II 2 E/A ratio 0.87 (0.76-1.20) LV function echocardiography LV function MRI 2D EF (%) 55.4 (51.1-65.6) LVEF (%) 59,5 (52.2-66.6) 3D EF(%) 57.5 (43.2-63.0) RVEF (%) 57.3 (51.0-65.0) LV mass/BSA (g/m2) 79,7 (50.6-101.2) LV mass/BSA (g/m2) 48.5 (31.0-60.0) Diastolic dysfunction grade (n=) Normal 3 LAVI (ml/m2) 29,0 (19-35) I 5 II 2 E/A ratio 0.87 (0.76-1.20) Open in new tab P553 Effect of primary cardiovascular prevention on the prevalence of metabolic syndrome S Masnaghetti1, AM Lucioni1, M Peraro1, S Freri1, A Mazzola1, RFE Pedretti1 1IRCCS Foundation Salvatore Maugeri, Department of Cardiology, Tradate, Italy Topic: Sports cardiology Purpose:Metabolic syndrome (MS) is strongly related to cardiovascular events. We tested if the prevalence of MS was reduced in the otupatients referred to our primary cardiovascular prevention programme. Methods:Aims of primary cardiovascular prevention programmes are to control risk factors, to improve adherence to healthy behaviour and therapy and to prescribe targeted diagnostic evaluation. Visits at baseline and control at 1 year were performed. Counselling on diet and physical activity were given. Optimization of therapy was attempted and diagnostic tests were proposed. IDF and NCEPT ATP III definitions of MS were considered. In the outpatients referred to our primary cardiovascular prevention programme (66 women and 80 males) prevalence of MS and its determinants at baseline and 1 year were compared. Results:Diagnosis of MS was impossible in 7 women and 4 men at baseline and in 4 women and 3 men at 1 year according to IDF criteria and in 5 women and 4 men at baseline and 4 women and 3 men at 1 year according to NCEPT ATP III criteria. At 1 year a significant improvement in HDL and diastolic blood pressure control and a reduction of the prevalence of MS according to NCEPT ATP III criteria in whole population (p 0,04) and in women (p 0,03) and to IDF criteria in men (p 0,04) were achieved. Results are resumed in table 1. Conclusion:In patients referred to primary cardiovascular prevention programme a significant improvement of HDL cholesterol and diastolic blood pressure control was achieved. Prevalence of MS was significantly reduced in total population and in women according to NCEPT ATP III and in men according to IDF criteria. Population women men baseline 1 year p baseline 1 year p baseline 1 year p Waist (cm) mean (SD) 104,94 + 21,89 105,48 + 15,55 0,78 102 + 65,76 102 + 17,52 0,87 107 + 72,12 109 + 8,49 0,61 Systolic blood pressure (mm Hg) mean (SD) 136,99 + 16,32 137,37 + 18,48 0,85 134 + 14,14 137 + 20,39 0,48 139 + 7,07 138 + 7,07 0,66 Diastolic blood pressure (mm Hg) mean (SD) 83,12 + 8,35 81,02 + 8,61 0,03 81 + 14,14 79 + 8,5 0,18 85 + 7,07 82 + 0 0,1 HDL cholesterol (mg/dl) mean (SD) 47,36 + 18,81 51,47 + 17,30 0,04 52 + 6,36 55 + 18,91 0,34 44 + 19,09 49 + 48,79 0,06 Tryglicerids (mg/dl) mean (SD) 134,22 + 83,08 124,42 + 58,46 0,28 119 + 50,91 116 + 50,46 0,74 147 + 187,38 131 + 101,82 0,3 Fasting glycaemia (mg/dl) mean (SD) 104,34 + 43,51 106,26 + 38,29 0,69 106 + 44,55 107 + 41,92 0,9 103 + 12,02 105 + 100,41 0,65 Metabolic Syndrome(IDF) N (%) 80 (59 %) 76 (55%) 0,24 34 (58%) 38 (61%) 0,47 46 (61%) 38 (49%) 0,04 Metabolic Syndrome (NCEPT ATP III) N (%) 67 (49%) 56 (40%) 0,04 36 (59%) 28 (45%) 0,03 31 (41%) 28 (36%) 0,42 Population women men baseline 1 year p baseline 1 year p baseline 1 year p Waist (cm) mean (SD) 104,94 + 21,89 105,48 + 15,55 0,78 102 + 65,76 102 + 17,52 0,87 107 + 72,12 109 + 8,49 0,61 Systolic blood pressure (mm Hg) mean (SD) 136,99 + 16,32 137,37 + 18,48 0,85 134 + 14,14 137 + 20,39 0,48 139 + 7,07 138 + 7,07 0,66 Diastolic blood pressure (mm Hg) mean (SD) 83,12 + 8,35 81,02 + 8,61 0,03 81 + 14,14 79 + 8,5 0,18 85 + 7,07 82 + 0 0,1 HDL cholesterol (mg/dl) mean (SD) 47,36 + 18,81 51,47 + 17,30 0,04 52 + 6,36 55 + 18,91 0,34 44 + 19,09 49 + 48,79 0,06 Tryglicerids (mg/dl) mean (SD) 134,22 + 83,08 124,42 + 58,46 0,28 119 + 50,91 116 + 50,46 0,74 147 + 187,38 131 + 101,82 0,3 Fasting glycaemia (mg/dl) mean (SD) 104,34 + 43,51 106,26 + 38,29 0,69 106 + 44,55 107 + 41,92 0,9 103 + 12,02 105 + 100,41 0,65 Metabolic Syndrome(IDF) N (%) 80 (59 %) 76 (55%) 0,24 34 (58%) 38 (61%) 0,47 46 (61%) 38 (49%) 0,04 Metabolic Syndrome (NCEPT ATP III) N (%) 67 (49%) 56 (40%) 0,04 36 (59%) 28 (45%) 0,03 31 (41%) 28 (36%) 0,42 Open in new tab Population women men baseline 1 year p baseline 1 year p baseline 1 year p Waist (cm) mean (SD) 104,94 + 21,89 105,48 + 15,55 0,78 102 + 65,76 102 + 17,52 0,87 107 + 72,12 109 + 8,49 0,61 Systolic blood pressure (mm Hg) mean (SD) 136,99 + 16,32 137,37 + 18,48 0,85 134 + 14,14 137 + 20,39 0,48 139 + 7,07 138 + 7,07 0,66 Diastolic blood pressure (mm Hg) mean (SD) 83,12 + 8,35 81,02 + 8,61 0,03 81 + 14,14 79 + 8,5 0,18 85 + 7,07 82 + 0 0,1 HDL cholesterol (mg/dl) mean (SD) 47,36 + 18,81 51,47 + 17,30 0,04 52 + 6,36 55 + 18,91 0,34 44 + 19,09 49 + 48,79 0,06 Tryglicerids (mg/dl) mean (SD) 134,22 + 83,08 124,42 + 58,46 0,28 119 + 50,91 116 + 50,46 0,74 147 + 187,38 131 + 101,82 0,3 Fasting glycaemia (mg/dl) mean (SD) 104,34 + 43,51 106,26 + 38,29 0,69 106 + 44,55 107 + 41,92 0,9 103 + 12,02 105 + 100,41 0,65 Metabolic Syndrome(IDF) N (%) 80 (59 %) 76 (55%) 0,24 34 (58%) 38 (61%) 0,47 46 (61%) 38 (49%) 0,04 Metabolic Syndrome (NCEPT ATP III) N (%) 67 (49%) 56 (40%) 0,04 36 (59%) 28 (45%) 0,03 31 (41%) 28 (36%) 0,42 Population women men baseline 1 year p baseline 1 year p baseline 1 year p Waist (cm) mean (SD) 104,94 + 21,89 105,48 + 15,55 0,78 102 + 65,76 102 + 17,52 0,87 107 + 72,12 109 + 8,49 0,61 Systolic blood pressure (mm Hg) mean (SD) 136,99 + 16,32 137,37 + 18,48 0,85 134 + 14,14 137 + 20,39 0,48 139 + 7,07 138 + 7,07 0,66 Diastolic blood pressure (mm Hg) mean (SD) 83,12 + 8,35 81,02 + 8,61 0,03 81 + 14,14 79 + 8,5 0,18 85 + 7,07 82 + 0 0,1 HDL cholesterol (mg/dl) mean (SD) 47,36 + 18,81 51,47 + 17,30 0,04 52 + 6,36 55 + 18,91 0,34 44 + 19,09 49 + 48,79 0,06 Tryglicerids (mg/dl) mean (SD) 134,22 + 83,08 124,42 + 58,46 0,28 119 + 50,91 116 + 50,46 0,74 147 + 187,38 131 + 101,82 0,3 Fasting glycaemia (mg/dl) mean (SD) 104,34 + 43,51 106,26 + 38,29 0,69 106 + 44,55 107 + 41,92 0,9 103 + 12,02 105 + 100,41 0,65 Metabolic Syndrome(IDF) N (%) 80 (59 %) 76 (55%) 0,24 34 (58%) 38 (61%) 0,47 46 (61%) 38 (49%) 0,04 Metabolic Syndrome (NCEPT ATP III) N (%) 67 (49%) 56 (40%) 0,04 36 (59%) 28 (45%) 0,03 31 (41%) 28 (36%) 0,42 Open in new tab P554 Is low diffusion lung capacity a predictor for cardiac remodeling? S Altarev1, M Katsyuba2, Y Slepynina1, O Polikutina1, V Karetnikova1 1Research Institute for Complex Issues of Cardiov. Dis. - Siberian Branch RAMS Institution Scientific, Kemerovo, Russian Federation 2Kemerovo Cardiology Centre, Emergency Cardiology Department #1, Kemerovo, Russian Federation Cardiac remodeling after myocardial infarction remains a frequent complication and, despite recent advances in acute coronary syndrome treatment, in some cases, seems unavoidable. There is evidence that cardiac remodeling is associated with myocardial damage size, coronary arteries patency, coronary revascularization, or inflammation status but a few data exist that explain interconnection between diffusion lung capacity and cardiac remodeling. So, our hypothesis is that low diffusion lung capacity is a predictor for cardiac remodeling in one year after myocardial infarction. Methods:Patients with ST elevated myocardial infarction hospitalized within 24 hours from symptoms onset were included in the study. Diffusion capacity of lung for carbon monoxide (DLCO) was measured on 10th to 14th days after a patient had been admitted to the hospital. Transthoracic cardiac echo was done on 10th hospital stay day and in one year after myocardial infarction. The statistical analysis was done with statistical software package SPSS for Windows, version 13.0 (SPSS Inc., USA). Factors independently associated with cardiac remodeling were determined with the discriminant analysis. A logistic regression analysis was done to see if a low DLCO was an independent predictor for cardiac remodeling. A p<0.05 was considered statistically significant. Results:107 patients (mean age 56.1±9.3 yrs) were included in the study, of which 88 (82%) males. In one year after myocardial infarction, 31 patients (29.0%) developed cardiac remodeling. Univariate analysis showed that early (by 10th hospital stay day) cardiac remodeling, patients' age, body mass index, left ventricle ejection fraction, mean pulmonary artery pressure, low DLCO, number of coronary arteries with stenosis >50%, and inflammation status were predictors for cardiac remodeling. Discriminant analysis revealed that independent predictors for cardiac remodeling were low DLCO, early myocardial remodeling, and number of coronary arteries with stenosis >50% (Wilks' Lambda 0.47, p<0.001). This model allowed 88.5% of cases to be correctly classified with area under the ROC-curve 0.84 (95% confidence interval 0.73 to 0.95, p<0.001). A logistic regression analysis showed that, after adjustment for all possible confounding factors, low DLCO increases possibility for cardiac remodeling to be seen with odds ratio 13.8 (95% confidence interval 2.1 to 91.8, p=0.007). Conclusions:our data showed that cardiac remodeling in one year after myocardial infarction could be associated with low diffusion lung capacity. P556 Cardiovascular risk factors and systemic endothelial function in patients with erectile dysfunction S Krasnyak1, OI Apolikhin1, EA Efremov1, YI Melnik1, SD Dorofeev1, VV Simakov1 1Research Institute of Urology, Moscow, Russian Federation Topic: Sports cardiology Purpose:Myocardial infarction and ischemic stroke are the main causes of death in adult males. According to many studies, time interval from onset of erectile dysfunction (ED) to cardiovascular complaints is 2-3 years and to vascular accident (myocardial infarction or stroke) - 4-5 years. The highest predictive value of ED as a marker of vascular disease is manifested in patients aged 40-59 years. In addition, the identification of ED may indicate the presence of these disorders in a patient in a latent form, according to some authors. Materials and methods:We conducted an assessment of endothelial function in 143 men complaining of erectile dysfunction (42,6 ± 6,8 years). All patients filled the International Index of Erectile Function questionnaire (IIEF). Waist circumference, blood pressure, blood chemistry and penile duplex Doppler ultrasound were also assessed. Results:Among patients with ED incidence of risk factors of cardiovascular disease was: dyslipidemia - 68%, hypertension - 38%, abdominal obesity - 37% insulin resistance - 21%. Furthermore, the presence of risk factors somatic diseases and diseases of the heart and vascular distribution varied forms of ED in severity. Thus, in patients without accompanying cardiovascular system, mild ED occurred in 25% of cases, moderate ED - 38%, the average - 28% of patients, severe ED - 14%. For patients with cardiovascular these figures were 18%, 30%, 28% and 24%, respectively. The regression analysis and determination of the Spearman rank correlation coefficient (p < 0.05) was performed. The analysis shown a high degree of correlation of endothelial dysfunction with increased blood glucose more than 6.0 mmol/l (r = 0,73), moderate with a waist circumference greater than 94 cm (r = 0,65), age (r = 0,63), increased triglycerides (r = 0,6), decreased high density cholesterol levels (r = 0,5), increased low density cholesterol (r = 0,48), reduced number of points by IIEF (r = 0,45), the lowest degree of association with the identified reduced peak systolic velocity (r = 0,31), low Index of resistance (r = 0,29), end diastolic velocity (r = 0,18), elevated blood pressure> 130 mm Hg (r = 0,24), retention time of blood flow in deep dorsal vein > 15 minutes (r = 0,11). Conclusion:The evaluation of postcompressive reactive hyperemia index is a highly accurate method of assessing systemic endothelial function in the complex diagnosis of ED. ED is a predictor of cardiovascular dysfunction, and it is necessary to examine not only the local penile blood flow, but also to assess systemic endothelial function. P557 Differences in an adjusted index of diastolic function in apparently healthy obese young patiens R Gascuena1, M Molina1, N Acosta1, C Novo1 1Hospital Universitario Severo Ochoa, Madrid, Spain An adjusted index of diastolic function, easily determined by tissue doppler velocities measured at the level of mitral annulus (Ea/(Sa x Aa)), showed prognostic value in general population. Nevertheless, its value has not been sufficiently studied in population at risk. Obesity carries out a higher risk. We study the presence of differences in this index in a population of apparently healthy obese patients. Methods:376 patients (44.7% from them with obesity, Body Mass Index 33,9 vs 25.7), without a known cardiovascular disease were studied by conventional and tissue Doppler echocardiography. Anthropometric, biochemical and blood pressure mesurements were obtained, and risk score determined (DORICA score, a Framingham formula validated on Spanish bariatric surgery patients). The adjusted index of diastolic function and the rest of parameters were compared between obese and not obese patients. Predictors for that index were investigated by linear regression methods, considering the above mentioned parameters, sex, age, and heart rate. Results:Mean age was 42.2 years. 85% were male. We found no differences in cardiac dimensions indexed by body surface. Left ventricle from obese patients was slighty more hyperdinamic (LVEF 74 vs 69%;p 0.012) . The adjusted diastolic index was a 20.41% inferior in obese patients (0.1057, SD 0.05 vs. 0.1328, SD 0.06) (Difference of means 0.027;IC95% 0.01-0.044)(p 0.001). The predictor factors for this index were Body Mass Index, Abdominal Perimeter, Total Cholesterol Levels, and the DORICA Risk Score. Conclusions:The Adjusted Index of Diastolic Function determined by tissue Doppler was diminished in obese patients. This index correlates with Risk Score and Total Cholesterol. Its prognostic value is being investigated in this on-going study. P558 The role of cardiovascular risk factors in patients with rheumatic heart diseases D Bursacovschi1 1State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of Introduction:Rheumatic heart diseases lead to chronic heart failure and reduced quality of life in many patients. Ischemic heart disease represents the major role in the structure of morbidity and mortality worldwide. Traditional risk factors for vascular disease are important in, but do not fully account for, the increased risk of ischemic heart disease in population. Purpose and Objectives:To evaluate cardiovascular risk factors and appreciate the risk of cardiovascular death in patients with rheumatic heart diseases. Materials and Methods:We examined a sample of 65 patients with rheumatic heart diseases according to the diagnostic criteria. We applied the SCORE scale and divided the sample into two groups. The first one with SCORE <5% (30 patients) and the second one with SCORE =5% (35 patients).We assessed traditional and novel risk factors of cardiovascular diseases by clinical and laboratory methods, and made a comparative analysis of modern risk factors. Results:The study group included 26 men (40%) and 39 women (60%) with mean age 59.5 +0.03. In the study group predominated mitral valvulopathy in 46 (70.7%) patients vs 19 (29.2%) patients with aortal one. From the traditional risk factors the most significant ones for the increased cardiovascular risk were outlined by hypertension in 22 (62.9%) cases, followed by dyslipidemia - 19 (54.3%) cases and obesity - 10 (28.6%) cases. From modern risk factors a major role had the left ventricular hypertrophy assessed on ECG which was found mainly in patients with SCORE =5% - 10 (28.6%) patients vs 6 (20%) patients with SCORE <5%. Also, the patients with SCORE =5% had a higher prevalence of other modern risk factors, such as: metabolic syndrome, a high CRP level, a low glomerular filtration rate, and a high level of anxiety determined by using Spilbenger test. On the other hand, the patients with SCORE <5% were appreciated mainly with concentric hypertrophy, in 7 (23.3%) cases vs 5 (14.3%) cases in patients with SCORE =5%. Therefore, the concentric hypertrophy is considered being a negative factor for the cardiovascular events. Conclusion:Patients with rheumatic heart diseases have an increased cardiovascular risk, influenced not only by traditional risk factors, but also by the modern ones. P559 Subclinical atherosclerosis is associated with increased SCORE risk values in a population without cardiovascular disease O Mitu1, F Mitu1, M Roca1, I-C Roca1, M-M Leon1, M Mitu1, L Arhire1, O Nita1, L Mihalache1, M Graur1 1University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania Topic: Sports cardiology Purpose:Cardiovascular diseases (CVD) represent the main cause of mortality worldwide. European guidelines recommend the use of SCORE risk chart in asymptomatic subjects with no evidence of CVD. However, the risk charts have their limitations particularly in the moderate risk population for assessing the real CV risk. The aim of our study was to determine whether subclinical atherosclerosis is associated with increased SCORE values in a population free of CVD. Methods:In the current prospective study, we have randomized from an urban general population 71 subjects free of any CVD and medical treatment, aged 35-75. All participants underwent the following: CV risk factor assessment, systolic and diastolic blood pressure (SBP, DBP) measurement and CV risk evaluation by applying SCORE chart. Subclinical atherosclerosis was determined by multiple investigations: left ventricular mass index (LVMI) and ejection fraction (EF) by echocardiography, intima-media thickness (IMT) and carotid plaques by carotid ultrasound, ankle-brachial index (ABI) and aortic stiffness parameters (pulse wave velocity – PWV, augmentation indexes, central SBP). All measurements were performed by the same operator with the same device. The study was approved by the University ethics committee and all participants signed an informed consent. The statistical analysis was performed in SPSS v 16.0. Results:Mean age of participants was 49.93±9.4 years, with 34% male gender. Mean SBP and DBP were 125.93±16.0, respectively 79.85±12.26 mmHg. IMT was 0.83±0.12 mm while PWV was 7.99±1.65 m/s. The SCORE risk in this population was moderate: 2.34±1.94. Among the markers of subclinical atherosclerosis, an increased SCORE risk was positively associated with higher IMT and presence of carotid plaques (r=0.47, p<0.001; and r=0.70, p<0.001), SBP and DBP (r=0.41, p=0.001; and r=0.35, p=0.002) and LVMI (r=0.25, p=0.03). Regarding aortic stiffness markers, PWV and aortic SBP were directly correlated with high SCORE risk (r=0.29, p=0.01; and r=0.4, p=0.001). No positive correlations were found between increased SCORE risk and lower EF or ABI. Conclusions:High SCORE values are strongly associated with markers of subclinical atherosclerosis such as increased IMT, carotid plaques, left ventricular hypertrophy, PWV or central SBP. The use of these methods can modify the risk assessed by SCORE chart if subclinical atherosclerosis is evidenced, especially in asymptomatic population with moderate risk. P560 Features of the vascular remodeling in men with prehypertension V Kondakov1, O Antropova1, I Osipova1, E Besklubova2 1Altay State Medical University, Barnaul, Russian Federation 2Railway Clinical Hospital, Barnaul, Russian Federation Aim:to explore the features of vascular remodeling in patients with prehypertension compared with hypertension. All patients were divided into groups: the 1-st - 30 men with prehypertension (PHTN), second - 30 men with diagnosed hypertension (HTN), control group-30 healthy volunteers. The age was 46.1±8.3, 47.7±8.5 and 48.1±7.4 years. The CV risk factors, atherosclerosis markers, endothelium dependent vasodilatation (EDVD) were evaluated. The arterial stiffness and central systolic blood pressure (CBP) were performed on the SphygmoCor (AtCor Medical Pty Limited.). Results:PHTN patients were at a comparable rate of modifiable risk factor, has a lower incidence of abdominal obesity (16%), compared to the HT patients - (40%) (p <0.05). ABI <0.9 was found in 30% and 38% of patients in the 1st and 2nd group, 18% in the control group (p <0,005). IMT was 0,7 ± 0,02 and 0,8 ± 0,08 mm in both groups. Carotid atherosclerosis were diagnosed in 30% of the PHTN and 55% of HTN (p <0,005), 17% in the control (p <0,005). Endothelial dysfunction was found in 57.6% In the 1st group and in 42.4% in 2nd (? = 5,6, p <0.05). The combination of endothelial dysfunction and atherosclerosis was in the 54.3% for the 1st group and 82,1% - 2nd , (p <0,05). Arterial stiffness index (SI) was 5,5 ± 1,85 m/s in the control group, 7,20±1,99 m/s in the 1st group, 8,90±1 85 m/s in the 2nd, which is higher than in the control group (p <0,005). The reflection index (RI) was higher in the both test groups compared to control (35,46 ± 14,50%, 36,59 ± 15,43% and 30,39 ± 13,43% respectively, p <0,005). AI in the groups was comparable with healthy volunteers. PWV> 10 m/s was found in 3% and 5% in the 1st and 2nd groups, respectively. According to the age, among the 31-50 years old patients, 80% in the 1st group and 70% in the 2nd had a higher then a normal PWV (6.6 m/s). At the age of 50, 66% in the 1st group and 50% in the 2nd group had the result higher than 8.5 m/s. AIx and AIx75 in HT patients were higher than in the control group by 10% (p <0,005), Spa at 20 mm Hg (p <0,005). Conclusions:PHTN men under the age of 55 years have a lower incidence of carotid atherosclerosis and comparable signs of lower limbs atherosclerosis, comparable incidence of arteriosclerosis. However, these figures differ from healthy patients. Already at the age of 31-50 years, the majority of patients (80%) have indicators of vascular stiffness, not corresponding to the normal values. In these patients there is a tendency to increasing CBP. Endothelial dysfunction in PHTN is more common than in patients with hypertension, but it is less combined atherosclerosis. P561 Does admission hyperglycaemia add prognostic value to the GRACE score? JL Martins1, R Ferreira1, J Viana1, JA Santos1 1Centro Hospitalar do Baixo Vouga, Cardiology, Aveiro, Portugal Introduction:Hyperglycaemia at admission (AH) is a well documented major risk factor for mortality in the acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including Global Registry of Acute Coronary Events - GRACE (GS). Methods:We studied 431 consecutive patients admitted to our coronary care unit with an ACS [age: 67 ± 13 years, 26% female, 30,6% STEMI]. Our primary endpoint was the occurrence of all-cause mortality at mean follow-up of 22 ± 10 months. Patients were categorized in 6 groups according to their AG combined with GS. The ability of the two logistic regression models (GS categorized alone and in combination with AG as continuous variable or using the cutoff >140) to predict death was asseded by binary logistic regression, calculating ROC curves and the corresponding areas under the curve (AUC). Comparative analysis between different AUC was performed by non-parametric method described by DeLong. Continuous net reclassification improvement (NRI) were also calculated. Results:The best cut-point for AG was 140 mg/dl (sensitivity 63% and specificity 60%), and 42,9% of the patients had increased levels. This group was elderly, had more prevalence of hypertension, hyperlipidemia and worse renal function. GRACE score and troponin levels were also more elevated and had more frequent Killip class =2 and FEVE =35%. In multivariate Cox analysis adjusted to potential confounding factors (gender, obesity, hemoglobin level, pro-BNP, prior events, hyperlipidemia, grace score and AG), only AG (HR 1,004; IC 95% 1,000-1,007; p = 0,035), and GS (HR 1,02; IC 95% 1,003-1,02; p = 0,006) were sustained as independent predictors of mortality. AG = 140 was associated to lower survival at follow up (32,6±0,9 vs 35,5±0,6 months, log rank test p=0,006). The inclusion of AG, as a continuous variable, in a logistic regression model with GS, increased the area under the ROC curve from 0.647 to 0.705 (p=0.01) and was associated with an improvement in the NRI (30,6% [ 0.0091 - 0.6023 ]; p-value: 0.04), suggesting effective reclassification. Nevertheless when used as categorical variable in a logistic regression model with GS, the increased area under the ROC curve was only 0,02 without statistical signification (p=0,57). Conclusion:In our study AG had a predictive cardiovascular prognosis when added to GS. The addition of AG to the GS may further improve risk stratification and prediction of mortality in patients with ACS. P562 Circulating microRNAs can predict future fatal myocardial infarction in healthy asymptomatic individuals A Bye1, H Roesjoe2, G Da Silva1, T Follestad1, J Nauman1, T Omland2, U Wisloeff1 1Norwegian University of Science and Technology, Trondheim, Norway 2Akershus University Hospital, Oslo, Norway Background:Cardiovascular disease (CVD) is the predominant cause of morbidity and mortality in developed countries. To manage this pandemic, improved tool for CVD risk prediction, including more sensitive biomarkers is needed. Recently, microRNAs (miRs) have emerged as promising biomarkers of disease, as large amounts of stable miRs can enter the circulation. Previously, increased circulating levels of miR-1 and miR-423 have been associated with myocardial infarction (MI) and heart failure, respectively. This imply that expression profiles of circulating miRs may have potential as a multi-biomarker tool that could offer more sensitive analysis for determination of CVD risk. The main objective of this study was to assess whether circulating miRs can predict future fatal MI in currently healthy individuals. Methods:This is a retrospective study analyzing participants from the Nord-Tr?ag Health Study part 2 and 3 (HUNT2 and HUNT3). 368 miRs were analyzed in serum samples collected from 112 apparently healthy men and women (40-70 years) without any signs of CVD, where half of them suffered from fatal MI within the next 10 years, and the other half still reported to be healthy 10 years after. The cases and controls were age- and gender matched, and the controls were chosen to ensure no significant differences in BMI, cholesterol, glucose, triglycerides and blood pressure between the groups. 16 candidate miRs from the screening cohort were further analyzed in a new cohort of 50 cases and 50 controls, selected on the same criteria as the screening cohort. DIANA miR-Path software was used to search for pathways associated with the differentially expressed miRs. Logistic regression analyses were performed using SPSS to find the miRs that best predicted future MI. Results:In the screening cohort, 20 miRs were significantly differentially expressed between the cases and controls (p<0.05). A significant over-representation of miRs associated with cardiac hypertrophy were found among the differentially expressed genes (n=13, p<0.01). Based on the results from the screening cohort, the best prediction model of future MI consisted of a combination of 4 different miRs, providing a sensitivity of 84.2 % and a specificity of 72.7 %. (The results from the validation cohort will be ready in time for the conference.) Conclusion:The preliminary results from this study suggest that circulating miRs may represent early biomarkers of future MI in apparently healthy individuals. P563 Social determinants of daily smoking in the cross-sectional survey in Brno, Czech Republic, 2013-2014. Preliminary results NK Movsisyan1, O Sochor1, E Kralikova2, R Cifkova3, H Ross1, I Tomaskova1, J Fiala1, V Soska1, R Prosecky1, F Lopez-Jimenez4 1International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic 2First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic 3Charles University of Prague , Center for Cardiovascular Prevention of the First Faculty of Medicine, Prague, Czech Republic 4Mayo Clinic, Rochester, United States of America Topic: Sports cardiology Purpose:Smoking as a major modifiable risk factor contributes to excess morbidity and mortality worldwide. The social gradient in smoking varies across time and place. The purpose of this study was to identify the socioeconomic determinants of daily smoking in a cross-sectional survey in Brno, Czech Republic. Methods:A population-based survey was conducted in 2013-2014 to assess cardiovascular risk factors in a stratified random sample of Brno residents aged 25-64. This study assessed the respondents' socioeconomic status through two proxy indicators, the average monthly household income and educational attainment. Data analysis included descriptive statistics and the chi-square test. Results:The analysis included the first 1954 respondents, of which 55.1% were women; mean age 47.5 years (±11.3). A total of 21.6% of the respondents had primary or apprenticeship education while 39.3% had secondary or special post-secondary, and 39.0% had higher education. Respondents with low, middle and high income represented 35.2%, 31.1%, and 16.2% of the sample, respectively; those in the lowest and highest income strata comprised 8.7% each. Daily smoking prevalence was 22.2% in the analyzed population sample, 20.7% for women and 23.9% for men (p=0.09). Prevalence of daily smoking was inversely proportional to income strata and level of education, (p<0.001 for trend for both). No significant differences in daily smoking prevalence between men and women were found in the total analyzed sample; however, men smoked significantly more than women in the low (p=0.03) and very low (p=0.05) income groups. Conclusion:This study found remarkable social inequalities in daily smoking in a population sample of the second largest city in Czech Republic. To improve the population health and promote health equity, future interventions should address the smoking-related inequities, possibly by enhancing access to smoking cessation services and tailoring awareness campaigns to the less advantaged population. P564 Comparison of smoking habits between Jewish and Arabic youth in Israel E Klainman1, I Gilboa1, A Yarmolovsky1, G Fink1 1Pulmonary Institute, Kaplan MC, Exercise Physiology U., Rehovot, Israel Aim of study:To investigate and compare the smoking habits and behavior between Jewish and Arabic youth in Israel. Material and Methods:5353 high school students were studied. 51% were males, 54% Jews and 46% Arabs. Among the Arabs – 40% were Muslims, 38% Bedouins, 16% Christians and 6% Druzzians. All participants were asked to fill a detailed and intensive questionnaire including general habits and behavior at school and home, smoking habits or smoking trials, physical activities, eating habits among others. Results:454 out of the 5353 participants (8.5%) reported of constant smoking, while 40.4% of the total participants reported about smoking history in their families. The vast majority (81.7%) of the 454 smokers were males. 191 (42.1%) of them were Jews and 263 Arabs, a significant difference of 15% which might indicate a higher cultural trend of smoking within the Arabic population in Israel. On the other hand, only 13.7% (36) among the Arabic smokers were females compared to 24.6% (47) of the Jewish smokers. As referred to general habits and behavior, no significant differences between the two populations were observed on time of cellular phone conversations or Facebook chats. But, when compared to the whole group, the smokers used those two communication tools much more than the total group – 15.7% vs 6.6% and 23.7% vs 11.7% respectively, for more than five hours daily. A slitter difference of book readers were observed between the smokers and the total group: 5.5% vs 3.6%, respectively, but when compared between Arabs and Jews in the whole group, 7% of the Arabs used to read more than 5 hours daily compared to only 1% of the Jews. 45.3% of the whole group used to eat breakfast regularly compared to 39% of the smokers. 9.6% of the smokers are acting physically more than 9 hours weekly, compared to 7.4% of the total group. 2% of the Jewish compared to 3.2% of Arabs smokers have started smoking under the age of 7 years. Conclusions:The Arabic youth tend to adapt smoking habits in Israel more than the Jewish ones. The finding of 2-3% of smokers who started smoking under the age of 7 is worrying and might recommend an adequate education even from the kindergarten ages. Significant differences in habit trends were observed between the smokers and the nonsmokers, and less differences or none between the Arabic and the Jewish smokers. P565 Setting up a smoking cessation service - what can we expect from the first year? D Schneider1, A Meienberg1, A Deman1, T Burkard1 1University Hospital Basel, Basel, Switzerland Topic: Sports cardiology Purpose:According to the WHO, smoking is the single most important preventable cause for premature death worldwide. Since different guidelines support to offer specialised tobacco treatment programs to smokers, we started a physician-led smoking cessation service (SCS) at a tertiary university hospital in 2012. SCS consultations on an individual basis were done by junior-physicians, supervised by senior physicians with special interest in smoking cessation. The present study presents our results of the first year of the SCS according to self-reported quit-rate and patient satisfaction. Methods:In this cross-sectional study we included all patients (pts) consulting our SCS between 1.6.2012 – 31.5.2013. Baseline and treatment characteristics were obtained from pts charts. Pts were contacted by telephone or if not possible by letter for a standardized interview or questionnaire in February 2014 and self-reported smoking status and satisfaction with consultations (0=low, 10=high) were asked. Results:80 pts had their first SCS consultation during the first year. Follow-up (FU) data could be obtained from 68 pts, the remaining 12 were considered to be smokers. Mean FU was 430±95 days after their first SCS consultation. 41% of pts were male, mean age was 54±12 years, median Fagerstr?ependency Level was 5 [4-7], 79% of pts had at least 1 smoking-associated comorbidity. Mean number of consultations was 2.9±2.3. 28.8% of all pts reported to be persistent abstinent (PA) over the past 7 days. Factors associated with PA were number of consultations and use of vareniclin. Comparing pts with =2 vs. >2 consultations PA rates were 20% vs. 40% (p=0.05). Median patient satisfaction was 8 [6-10], with 86.8% of pts stating that they would recommend the SCS to other smokers. Conclusion:Our results show, that it is feasible to achieve persistent abstinence rates of 30% after a mean FU of 61 weeks and a high patient acceptance of the SCS - even in the first year. Our outcome in real-life pts is comparable to results of smoking cessation trials and could encourage further centers to set up a SCS. P566 Success of smoking cessation is associated with immediacy of quitting after an acute coronary syndrome M Snaterse-Zuidam1, WJM Scholte Op Reimer2, M Minneboo3, HT Jorstad3, SM Boekholdt3, G Terriet4, RJG Peters3 1Amsterdam University of Applied Sciences, School of Nursing, Amsterdam, Netherlands 2Amsterdam University of Applied Sciences, School of Nursing/Academic Medical Center, Amsterdam, Netherlands 3Academic Medical Center, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands 4Academic Medical Center of Amsterdam, General Practice, Amsterdam, Netherlands Background:Guidelines stress the importance of smoking cessation and recommend intensive follow-up. Successful nonpharmacological strategies for smoking cessation in cardiovascular disease (CVD) patients are, however, still scarce. Methods:We used data from the Randomised Evaluation of Secondary Prevention for ACS patients coordinated by Outpatient Nurse SpEcialists (RESPONSE) trial (n=754). The study was designed to quantify the impact of a hospital-based nurse-coordinated prevention programme. For the current analysis we included all smokers (324/754 (43%)). Results:The majority of successful quitters succeeded to quit immediately after the event and remained quitted up to one year of follow-up, without extra help (128/156 (82%)). Having higher education (33% vs. 15%, p<0.01) and no history of CVD (87% vs. 74%, p<0.01), were associated with successful quitting. Conclusion:The majority of successful quitters had stopped immediately after their ACS. It was in their own ability to quit and they remain quitted up to one-year follow-up. There is no evidence to support relapse prevention in ACS patients who stop smoking immediately after the event, and our study indicates that there is no need for it. 1 Defined as non-smoking at outcome assessment date; 2 Between successful quitters and smokers; 3 Note that these 30 relapsers are a subgroup of the 168; SBP systolic blood pressure; LDL low density cholesterol; BMI body mass index; ?128; <30 min./5 times a week Successful quitters n=156 Smokers n=168 P-value Male, n (%) 127 (81%) 125 (74%) 0.13 College or university 49 (33%) 25 (15%) p<0.01 No history of CVD, n (%) 136 (87%) 124 (74%) p<0.01 Risk profile at baseline SBP >140 mmHg 36 (24%) 33 (20%) 0.12 LDL >2.5 mmol/L 46 (31%) 66 (39%) 0.15 BMI >25 kg/m2 116 (74%) 115 (68%) 0.12 Inadequate physical activity? 89 (57%) 98 (58%) 0.81 Risk profile at one-year follow-up SBP >140 mmHg 41 (28%) 43 (26%) 0.79 LDL >2.5 mmol/L 32 (22%) 62 (37%) p<0.01 BMI >25 kg/m2 127 (81%) 112 (67%) p<0.01 Successful quitters n=156 Smokers n=168 P-value Male, n (%) 127 (81%) 125 (74%) 0.13 College or university 49 (33%) 25 (15%) p<0.01 No history of CVD, n (%) 136 (87%) 124 (74%) p<0.01 Risk profile at baseline SBP >140 mmHg 36 (24%) 33 (20%) 0.12 LDL >2.5 mmol/L 46 (31%) 66 (39%) 0.15 BMI >25 kg/m2 116 (74%) 115 (68%) 0.12 Inadequate physical activity? 89 (57%) 98 (58%) 0.81 Risk profile at one-year follow-up SBP >140 mmHg 41 (28%) 43 (26%) 0.79 LDL >2.5 mmol/L 32 (22%) 62 (37%) p<0.01 BMI >25 kg/m2 127 (81%) 112 (67%) p<0.01 Open in new tab 1 Defined as non-smoking at outcome assessment date; 2 Between successful quitters and smokers; 3 Note that these 30 relapsers are a subgroup of the 168; SBP systolic blood pressure; LDL low density cholesterol; BMI body mass index; ?128; <30 min./5 times a week Successful quitters n=156 Smokers n=168 P-value Male, n (%) 127 (81%) 125 (74%) 0.13 College or university 49 (33%) 25 (15%) p<0.01 No history of CVD, n (%) 136 (87%) 124 (74%) p<0.01 Risk profile at baseline SBP >140 mmHg 36 (24%) 33 (20%) 0.12 LDL >2.5 mmol/L 46 (31%) 66 (39%) 0.15 BMI >25 kg/m2 116 (74%) 115 (68%) 0.12 Inadequate physical activity? 89 (57%) 98 (58%) 0.81 Risk profile at one-year follow-up SBP >140 mmHg 41 (28%) 43 (26%) 0.79 LDL >2.5 mmol/L 32 (22%) 62 (37%) p<0.01 BMI >25 kg/m2 127 (81%) 112 (67%) p<0.01 Successful quitters n=156 Smokers n=168 P-value Male, n (%) 127 (81%) 125 (74%) 0.13 College or university 49 (33%) 25 (15%) p<0.01 No history of CVD, n (%) 136 (87%) 124 (74%) p<0.01 Risk profile at baseline SBP >140 mmHg 36 (24%) 33 (20%) 0.12 LDL >2.5 mmol/L 46 (31%) 66 (39%) 0.15 BMI >25 kg/m2 116 (74%) 115 (68%) 0.12 Inadequate physical activity? 89 (57%) 98 (58%) 0.81 Risk profile at one-year follow-up SBP >140 mmHg 41 (28%) 43 (26%) 0.79 LDL >2.5 mmol/L 32 (22%) 62 (37%) p<0.01 BMI >25 kg/m2 127 (81%) 112 (67%) p<0.01 Open in new tab P568 Correlations between NT-proBNP and high sensitivity cardiac troponin in runners - literature review and current perspectives E Vilela1, R Bettencourt-Silva2, M Passos Silva1, JPL Nunes3, V Gama1 1Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal 2Sao Joao Hospital, Department of Endocrinology, Diabetes and Metabolism, Porto, Portugal 3Faculty of Medicine University of Porto, Porto, Portugal Topic: Sports cardiology Purpose:Running is a physiologic human activity. Recent reports have described high-sensitivity cardiac troponin (hs-cTn) elevation in runners, apparently without associated cardiac damage. Similar data has been published concerning natriuretic peptides. NT-proBNP is of importance for the diagnosis and prognosis of heart failure. The aim of our work was to present the current state of the art concerning the relationship, if any, between NT-proBNP and hs-cTn after running. This would help explain the phenomenon of hs-cTn elevations after running. Methods:A literature search was conducted on three databases (Pubmed, ISI and Scopus) up to February 2014. The queries used were "brain natriuretic peptide AND running", "BNP AND running", "NT-proBNP AND running". Additional records were identified through review of the literature. Studies comprising less than ten participants or written in languages other than English were excluded. Studies selecting participants based on a specific pathology were outside the scope of our review, which intended to describe a healthy (or presumably healthy) population. Results:A total of 460 articles were found, and of those 6 reported correlations between NT-proBNP and hs-cTn. A total of 409 runners were evaluated. In 5 articles (400 runners), no correlation was described between NT-proBNP and hs-cTn. Only one report (assessing 9 ultramarathoners) described a correlation between these biomarkers - peak levels of NT-proBNP being significantly higher in those who had hs-cTnT above the 99th percentile value. Conclusions:Most reports do not present a correlation between hs-cTn and NT-proBNP levels. This supports the notion that they may represent different mechanistic pathways. More studies, with a larger number of participants, are needed to confirm this hypothesis. Overview of studies correlating NT-proBNP and hs-cTn (literature up to February 2014) Study Year n Distance Troponin Assessed Salvagno et al 2014 18 Ultramarathon (60 km) hs-cTnI Tian et al 2012 26 Constant load treadmill run (90 minutes) hs-cTnT Scherr et al 2011 102 Marathon hs-cTnT Mingels et al 2010 43; 38; 10; 85 5; 15; 21; 42 km hs-cTnT Saravia et al 2010 78 Marathon hs-cTnT Giannitsis et al 2009 10 (only 9 assessed) Ultramarathon (216 km) hs-cTnT Study Year n Distance Troponin Assessed Salvagno et al 2014 18 Ultramarathon (60 km) hs-cTnI Tian et al 2012 26 Constant load treadmill run (90 minutes) hs-cTnT Scherr et al 2011 102 Marathon hs-cTnT Mingels et al 2010 43; 38; 10; 85 5; 15; 21; 42 km hs-cTnT Saravia et al 2010 78 Marathon hs-cTnT Giannitsis et al 2009 10 (only 9 assessed) Ultramarathon (216 km) hs-cTnT Open in new tab Overview of studies correlating NT-proBNP and hs-cTn (literature up to February 2014) Study Year n Distance Troponin Assessed Salvagno et al 2014 18 Ultramarathon (60 km) hs-cTnI Tian et al 2012 26 Constant load treadmill run (90 minutes) hs-cTnT Scherr et al 2011 102 Marathon hs-cTnT Mingels et al 2010 43; 38; 10; 85 5; 15; 21; 42 km hs-cTnT Saravia et al 2010 78 Marathon hs-cTnT Giannitsis et al 2009 10 (only 9 assessed) Ultramarathon (216 km) hs-cTnT Study Year n Distance Troponin Assessed Salvagno et al 2014 18 Ultramarathon (60 km) hs-cTnI Tian et al 2012 26 Constant load treadmill run (90 minutes) hs-cTnT Scherr et al 2011 102 Marathon hs-cTnT Mingels et al 2010 43; 38; 10; 85 5; 15; 21; 42 km hs-cTnT Saravia et al 2010 78 Marathon hs-cTnT Giannitsis et al 2009 10 (only 9 assessed) Ultramarathon (216 km) hs-cTnT Open in new tab P569 Evaluation of left ventricular mass in adolescent athletes H Krysztofiak1, A Folga2 1Mossakowski Medical Research Centre, Warsaw, Poland 2National Center of Sports Medicine, Warsaw, Poland Changes in body height and mass in adolescents limit the accuracy of indexing of left ventricular mass and make it difficult to compare left ventricular mass (LVM). The study was undertaken to evaluate changes of LVM in adolescent athletes and to compare methods of LVM indexing. Sixty nine athletes (58 boys and 11 girls; age 8-19) practicing sports with predominance of high dynamic component (HD) and 23 (15 boys and 8 girls; age 9-18) practicing sports with predominance of low dynamic component (LD), who underwent echocardiography during preparticipation examination, were included in this retrospective, cross-sectional study. The HD and LD groups were similar in terms of age, body mass and height. Each group was also divided into two subgroups, based on median for age: HD into one subgroup above the median (AHD) and the second below the median (BHD) and the LD group into ALD and BLD subgroup, respectively. LVM indexed to BSA (LVM/BSA), to height raised to an exponential power of 2,7 (LVM/H2,7) and to body mass (LVM/BM) and relative wall thickness (RWT) were calculated. Correlations and t tests were used for statistical testing. LVM indexes were higher in HD vs LD: LVM/BSA 79,0±14,1 vs 69,3±8,2 g/m2, p<0,005; LVM/H2,7 33,1±5,6 vs 28,0±3,8 g/m(2,7), p<0,0001 and LVM/BM 2,42±0,35 vs 2,10±0,24 g/kg, p<0,0001. There was no difference in RWT between HD and LD. When only girls were taken into account there were no differences in LVM indexes in HD vs LD, but if only boys were take into account the indexes were different (LVM/BSA 80,5±14,6 vs 70,0±9,0 g/m2, p<0,01; LVM/H2,7 33,6±5,8 vs 27,5±3,9 g/m(2,7), p<0,0005 and LVM/BM 2,45±0,34 vs 2,12±0,24 g/kg, p<0,0005) and RWT was different (0,35±0.04 vs 0,32±0,03, p<0,01) in HD vs LD, respectively. In subgroups, LVM/BSA was higher in ALD vs BLD (74,1±7,6 vs 65,0±6,3, p<0,005) but there were no differences in LVM/H2,7 and LVM/BM between the subgroups. In AHD subgroup, LVM/BSA and LVM/H2,7 were higher compare to BHD (88,4±15,2 vs 71,8±7,8, p<0,0001; 35,1±6,7 vs 31,5±3,8, p<0,01, respectively) but there was no difference in LVM/BM between AHD and BHD, although the body mass was different in both groups (70,0±13,6 vs 38,2±10,7 kg, p<0,0001), respectively. In correlations between age and the LVM indexes there was low correlation with LVM/BSA (r2=0,28, p<0,0001) and there were no correlations with LVM/H2,7 and LVM/BM. Exercise, with high dynamic component, during development period, give additional impact for the left ventricle growth. Indexing to height, but also simple indexing to body mass, seems to be better than to BSA, because not confounded by age. P570 Prevalence of ECG abnormalities in novice versus experienced endurance runners and normal controls J Sydow1, P Aagaard1, C Holmquist1, B Mogensen2, H Skuladottir2, T Pottgiesser3, F Braunschweig4 1Karolinska Institute, Cardiology unit, Stockholm, Sweden 2Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden 3University of Freiburg, Dept of Cardiology, Freiburg, Germany 4Karolinska University Hospital, Dept of Cardiology, Stockholm, Sweden Analysis of the 12-lead ECG is recommended as part of pre-participation evaluation prior to endurance sport events but misinterpretation is common. The prevalence of ECG abnormalities in recreational, middle-aged or elderly endurance runners is not well established. Furthermore, the impact of different levels of training experience on this prevalence has not been characterized. Methods:We studied 770 subjects: 1) 279 first-time participants (novice; NOV) in the world's largest cross-country race (Liding?pet, 30 km); 2) 279 age- and gender matched subjects who had participated at least 6 times before (experienced; EXP); 3) 212 controls (CON), randomly invited from the general population, with similar age- and gender characteristics, without significant cardiovascular disease or training background. A 12-lead ECG was taken after 5 minutes of rest. All participants underwent a brief physician exam and filled in a questionnaire about medical history and training habits. Results:All groups had a mean age of 52 years and included 21% women. NOV, EXP and CON had an average of 3.3, 4.7 and 1.0 hours/week of endurance training during the past 4 months (p<0.001). Main results are shown in table. Common training related ECG changes (1st degree AV-block, early repolarization (ER), Sokolow criteria of left ventricular hypertrophy) were more common in NOV and EXP than CON. More NOV and EXP had ECG abnormalities that may require additional evaluation (QTc above 440 ms and inverted T-waves). CON had a higher heart rate (HR) and shorter QRS compared with NOV and EXP. Conclusion:Training related ECG alterations are common in recreational, middle-aged or elderly endurance runners compared with normal control subjects. The prevalence of these ECG changes does not significantly further increase in experienced versus novice runners. Only a minority of athletes had ECG abnormalities requiring additional evaluation. Knowledge about the prevalence of ECG abnormalities is important for all clinicians involved in the care and/or pre-participation evaluation of endurance race participants. *:p<0.001 compared with NOV or EXP. #:<0.05 compared with NOV HR (bpm) QRS (ms) AV-block I (%) ER (%) Sokolow (%) Inverted T (%) QTc>440ms (%) NOV 58.2 97.0 8.2 29.7 11.5 3.6 9.0 EXP 56.5# 97.9 11.1 36.2 16.1 3.6 8.6 CON 64.2* 93.7* 1.4* 7.1* 4.2* 0.5* 0.5* HR (bpm) QRS (ms) AV-block I (%) ER (%) Sokolow (%) Inverted T (%) QTc>440ms (%) NOV 58.2 97.0 8.2 29.7 11.5 3.6 9.0 EXP 56.5# 97.9 11.1 36.2 16.1 3.6 8.6 CON 64.2* 93.7* 1.4* 7.1* 4.2* 0.5* 0.5* Open in new tab *:p<0.001 compared with NOV or EXP. #:<0.05 compared with NOV HR (bpm) QRS (ms) AV-block I (%) ER (%) Sokolow (%) Inverted T (%) QTc>440ms (%) NOV 58.2 97.0 8.2 29.7 11.5 3.6 9.0 EXP 56.5# 97.9 11.1 36.2 16.1 3.6 8.6 CON 64.2* 93.7* 1.4* 7.1* 4.2* 0.5* 0.5* HR (bpm) QRS (ms) AV-block I (%) ER (%) Sokolow (%) Inverted T (%) QTc>440ms (%) NOV 58.2 97.0 8.2 29.7 11.5 3.6 9.0 EXP 56.5# 97.9 11.1 36.2 16.1 3.6 8.6 CON 64.2* 93.7* 1.4* 7.1* 4.2* 0.5* 0.5* Open in new tab P571 High intensity endurance training in women is associated with atrial structural and functional remodelling. L Sanchis Ruiz1, M Sanz1, B Bijnens2, G Giraldeau3, G Grazioli1, M Marin1, M Sitges1 1Hospital Cl?c, Barcelona, Spain 2Instituci??talana de Recerca i Estudis Avan?s (ICREA), Barcelona, Spain 3Montreal Heart Institute, Montreal, Canada Topic: Sports cardiology Purpose:High intensity training has been associated with atrial remodelling and atrial arrhythmias in men. However, few data has been reported about female athletes. Our purpose was to analyze atrial performance in female endurance athletes. Methods:We included 35 women: 18 athletes (>10 hour/week endurance training) and 17 controls (<3 hour training/week). Left and right atrial (LA and RA) function was assessed using 2D echocardiography to determine atrial ejection fraction (EF) and atrial strain-rate by speckle-tracking: a-wave strain-rate (SRa) as a surrogate of atrial contractile function and s-wave (SRs) as a surrogate of atrial reservoir function. Results:Mean age was similar in both groups (36.9±5 vs.37.4±6 y.o., p=0.489). Atrial indexed volumes [ml/m2] were larger in the athlete group (LA 27.1±6 vs 15.8±4, p<0.001; RA 22.3±4 vs 14.3±4, p<0.001) with no differences in EF [%] (LA 48±13 vs 44±17, p=0.42; RA 34±15 vs 31±17, p=0.53). SRa (s-1) was reduced in both atria in athletes as compared to controls (LA -1.59±0.47 vs -2.01±0.55, p=0.021; RA -1.91±0.39 vs -2.35±0.56, p=0.025). SRs (s-1) was only reduced in the RA of athletes without differences in the LA as compared to controls (LA 1.68±0.41 vs 1.67±0.44, p=0.932; RA 2.01±0.32 vs 2.35±0.05, p=0.536). Conclusions:The atria of female athletes shows specific remodelling as compared to sedentary females, with larger size and lower deformation at rest, particularly for the RA. These findings are similar to those observed in male athletes and indicate a potential larger contractile reserve but at the cost of larger atrial wall stress. Open in new tabDownload slide Atrial size and function P572 Upper limits and clinical correlates of blood pressure response to exercise in Olympic athletes. S Caselli1, A Vaquer Segui1, R Assorgi1, B Di Giacinto1, E Lemme1, FM Quattrini1, FM Di Paolo1, C Pisicchio1, A Spataro1, A Pelliccia1 1Institute of Sport Medicine and Science CONI, Rome, Italy Purpuse:We sought to define the upper limits of blood pressure response in elite athletes and describe clinical and morphologic characteristics of those with higher values. Methods:1,930 athletes, divided according to type of sport (skill, power, mixed and endurance) underwent cardiac evaluation, with echocardiography and maximal bicycle exercise test. Results:Peak Systolic and Diastolic Blood Pressure (SBP and DBP) were 184±22 mmHg and 74±8 mmHg. The 95th percentile were 220mmHg in male and 200mmHg in female for SBP and 90mmHg in male and 80mmHg in female for DBP; 116 athletes (6%) had either SBP and/or DBP above the 95th percentile for gender. Clinical and echocardiographic characteristics of these are shown in table. Stepwise regression analysis showed that: peak SBP was explained by maximum workload (R2=0.34, p<0.001) with basal SBP, left ventricular wall thickness and body surface area (BSA) showing lower additional value (R2=0.47, p<0.001). Peak DBP was explained by basal DBP (R2=0.20; p<0.001) with a lower additional value for age, BSA and maximum workload (R2=0.27; p<0.001). Conclusion:the present study shows the normal blood pressure response to exercise that could be implemented in athletes's evaluation to identify hypertensive individuals. Normal exercise BP High exercise BP p value Age (years) 25 ± 6 25 ± 6 0.219 Positive Family Hx (n,%) 445 (25%) 35(30%) 0.173 BSA (m2) 1.89 ± 0.23 2.00 ± 0.25 <0.001 Basal SBP (mmHg) 114 ± 11 124 ± 10 <0.001 Basal DBP (mmHg) 73 ± 7 77 ± 7 < 0.001 Basal Heart rate (bpm) 58 ± 11 57 ± 10 0.318 Max Heart Rate (bpm) 166 ± 10 165 ± 10 0.235 Max workload (Watts) 242 ± 59 261 ± 62 0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.1 ± 1.1 <0.001 LV diameter (mm) 52 ± 5 54 ± 5 <0.001 EF (%) 65 ± 6 65 ± 6 0.954 LA diameter (mm) 34 ± 4 36 ± 4 <0.001 LV Mass (mm) 191 ± 55 214 ± 58 <0.001 E/A 1.9 ± 0.5 1.9 ± 0.4 0.974 Normal exercise BP High exercise BP p value Age (years) 25 ± 6 25 ± 6 0.219 Positive Family Hx (n,%) 445 (25%) 35(30%) 0.173 BSA (m2) 1.89 ± 0.23 2.00 ± 0.25 <0.001 Basal SBP (mmHg) 114 ± 11 124 ± 10 <0.001 Basal DBP (mmHg) 73 ± 7 77 ± 7 < 0.001 Basal Heart rate (bpm) 58 ± 11 57 ± 10 0.318 Max Heart Rate (bpm) 166 ± 10 165 ± 10 0.235 Max workload (Watts) 242 ± 59 261 ± 62 0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.1 ± 1.1 <0.001 LV diameter (mm) 52 ± 5 54 ± 5 <0.001 EF (%) 65 ± 6 65 ± 6 0.954 LA diameter (mm) 34 ± 4 36 ± 4 <0.001 LV Mass (mm) 191 ± 55 214 ± 58 <0.001 E/A 1.9 ± 0.5 1.9 ± 0.4 0.974 Open in new tab Normal exercise BP High exercise BP p value Age (years) 25 ± 6 25 ± 6 0.219 Positive Family Hx (n,%) 445 (25%) 35(30%) 0.173 BSA (m2) 1.89 ± 0.23 2.00 ± 0.25 <0.001 Basal SBP (mmHg) 114 ± 11 124 ± 10 <0.001 Basal DBP (mmHg) 73 ± 7 77 ± 7 < 0.001 Basal Heart rate (bpm) 58 ± 11 57 ± 10 0.318 Max Heart Rate (bpm) 166 ± 10 165 ± 10 0.235 Max workload (Watts) 242 ± 59 261 ± 62 0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.1 ± 1.1 <0.001 LV diameter (mm) 52 ± 5 54 ± 5 <0.001 EF (%) 65 ± 6 65 ± 6 0.954 LA diameter (mm) 34 ± 4 36 ± 4 <0.001 LV Mass (mm) 191 ± 55 214 ± 58 <0.001 E/A 1.9 ± 0.5 1.9 ± 0.4 0.974 Normal exercise BP High exercise BP p value Age (years) 25 ± 6 25 ± 6 0.219 Positive Family Hx (n,%) 445 (25%) 35(30%) 0.173 BSA (m2) 1.89 ± 0.23 2.00 ± 0.25 <0.001 Basal SBP (mmHg) 114 ± 11 124 ± 10 <0.001 Basal DBP (mmHg) 73 ± 7 77 ± 7 < 0.001 Basal Heart rate (bpm) 58 ± 11 57 ± 10 0.318 Max Heart Rate (bpm) 166 ± 10 165 ± 10 0.235 Max workload (Watts) 242 ± 59 261 ± 62 0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.1 ± 1.1 <0.001 LV diameter (mm) 52 ± 5 54 ± 5 <0.001 EF (%) 65 ± 6 65 ± 6 0.954 LA diameter (mm) 34 ± 4 36 ± 4 <0.001 LV Mass (mm) 191 ± 55 214 ± 58 <0.001 E/A 1.9 ± 0.5 1.9 ± 0.4 0.974 Open in new tab P573 Right ventricle remodeling in female endurance athletes M Sanz1, G Giraldeau2, B Bijnens3, J Marin1, G Grazioli1, M Sitges1 1Barcelona Hospital Clinic, Barcelona, Spain 2Montreal Heart Institute, Montreal, Canada 3ICREA, Instituci??talana de Recerca i Estudis Avan?s, Barcelona, Spain Background:High intensity endurance exercise has been related with a specific right ventricle (RV) remodeling. Most of studies though, have been conducted on male athletes, having so far few data available in female. Our aim was to analyze RV remodeling and response to exercise in female athletes as compared with untrained females. Methods:19 highly trained female athletes (> 10 hours endurance training/week) and 21 control age-matched (<3 hours sport/week) were included. In all subjects an echocardiography at rest and at maximum effort was performed. Analysis consisted on standard and speckle tracking echocardiographic assessment of both ventricles. RV segmental strain was also determined at the base (inlet), mid and apical regions of the RV free wall. Results:At rest, LV volume was larger in athletes than in controls (62,5 ± 8,2 vs 45,6±6,9 ml/m2) with no differences in LV systolic function. RV size was also larger in athletes (10,5 ± 1,40 vs 7,8±1,5 cm2 / m2) with no differences in RV global systolic function. Segmental RV deformation analysis showed no differences between the two groups. With exercise, both groups increased cardiac output (CO) proportionally to the amount of exercise performed (%?CO: 210,2±40,3 vs 158, 6± 49,0; Watts : 174,1±27,8 vs 118,1±20,0). Thus, the increase in LV strain was higher in athletes group (+33,5 ± 14,6 vs +23,1 ± 11,7). However, the increase in RV global strain was lower in athletes ( +13,5 ± 10,4 vs +20,6±13,8) and mainly induced by an increase in RV basal segmental strain (Figure). Conclusion:We confirmed a similar pattern of RV remodeling in female athletes to that previously observed in male athletes characterized by RV dilatation and a major contribution of its basal segment to the increased demand in cardiac output during exercise. Open in new tabDownload slide Changes in LV and RV Strain P574 An investigation of cardiac disease in british army recruits in whom a murmur is detected during the initial medical: a retrospective observational study AT Cox1, DE Cannie2, I Parsons3, R Chamley3, E Behr1, D Wilson3, S Sharma1, RG Bogle2 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom 2St George's Healthcare NHS Trust, London, United Kingdom 3Royal Centre of Defence Medicine, Birmingham, United Kingdom In military populations cardiac conditions are a potentially preventable cause of mortality and morbidity. Many of these conditions are identifiable with a history and physical examination and investigation with ECG or echocardiogram. Aims:To establish the prevalence of cardiac conditions, in British Army recruits, in whom a murmur is detected. Methods:Recruits were screened with a questionnaire and physical examination by military occupational physicians. Those with cardiac symptoms, a history suspicious for cardiac disease, or with hypertension on examination, were referred to their civilian Primary Care Doctor for further investigation. Those recruits with an isolated murmur on auscultation underwent an ECG, echocardiogram and cardiology review in a military clinic and are the subject of retrospective review in this study. Results:Over a seven year period 11,420 consecutive recruits aged 15-32 years were evaluated. Cardiac disease was strongly suspected or diagnosed in 921 recruits; a positive predictive value (PPV) of 8.06%. Of these 298 (2.61%) were conditions associated with an increased risk of sudden death, including 98 (0.85%) recruits with probable cardiomyopathy, 22(1.9%) recruits with accessory pathways and 30 (0.26%) recruits with possible channelopathies. A bicuspid aortic valve was seen in 124 (1.09%) recruits of which 84 (67.7%) demonstrated valvular dysfunction, aortopathy, coarctation of the aorta or left ventricular dysfunction. Males accounted for 89.0% of the population and 91.9% of those with disease; no male disease preponderance was seen (p=0.117). Discussion:When detected by occupational physicians, as part of a cardiac screening program, an isolated murmur has a low PPV, but does identify potentially serious structural abnormalities in asymptomatic individuals. This study also characterises a significant burden of incidental heart muscle and primary electrical diseases in a young, fit and asymptomatic population. Many of the conditions discovered are not associated with a murmur and in the absence of an ECG would have been overlooked had an incidental murmur not been present. The addition of a routine ECG to the British Army cardiac screening protocol should therefore be considered in order to improve the detection rate of potentially serious cardiac diseases. P575 Right ventricular echocardiography in the elderly: first results of ActiFE-Ulm study R Laszlo1, T Baumann1, D Dallmeier2, K Machus1, J Klenk3, D Rothenbacher3, W Koenig2, JM Steinacker1 1University of Ulm, Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm, Germany 2University of Ulm, Department of Internal Medicine II, Ulm, Germany 3University of Ulm, Institute of Epidemiology and Medical Biometry, Ulm, Germany Introduction:Concerning cardiac function and physical capacity, importance of the right ventricle (RV) is more and more attended. Echocardiographic image quality in the elderly is often poor due to a steep cardiac axis with consecutive impossibility of correct probing, poor identifiability of RV free wall or ageing-lung emphysema. Methods:ActiFE-Ulm study (Activity and Function in the Elderly with a focus on physical activity and co-morbidities) is a population-based cohort study including a representative sample of people = 65 years old living in the region of Ulm, Germany. Feasibility of right ventricular echocardiography was evaluated in a cardiovascular follow-up of 631 of 1506 subjects of this population (mean age 77.0 ± 5.8 years, 58% male). Results:Sufficient B-mode echocardiography of the right ventricle (apical 4-chamber view) was possible in only 35% of all subjects (nomenclature see ref. 1): RVD1 38 ± 7 mm, RVD2 34 ± 8 mm, RVD3 76 ± 11 mm, RVEDA 23.3 ± 6.0 cm2, RVESA 13.7 ± 4.2 cm2, RVFAC 41 ± 10 %. Right atrium (RA) could be described adequate in only 38% (endsytolic): RA-area 18.7 ± 5.1 cm2, RA (transverse) 41 ± 8 mm, RA (longitudinal) 50 ± 7 mm. In contrast, right ventricular outflow tract (RVOT) and TAPSE was assessable in 87% (RVOT) and, respectively, 93% (TAPSE) of all subjects: RVOTd 36 ± 6 mm, RVOTs 20 ± 7 mm, RVOT-SF 45 ± 14 %, TAPSE 25 ± 5 mm. Tissue-doppler images (RV free wall 1 cm below TV-annulus) of adequate quality were assessed in 88% of all subjects: S' 13.7 ± 2.9 cm/s (n=572), E' -10.6 ± 3.1 cm/s (n=570), A' -15.6 ± 3.8 cm/s (n=544 of 600 subjects without AF during examination), IVCT 83 ± 21 ms (n=558), Ejct 284 ± 42 ms (n=557), IVRT 60 ± 26 ms (n=559), MPI (Tissue) 0.52 ± 0.16 (n=557). Conclusion:RV echocardiography in the elderly is often a challenge: not every right ventricular echocardiographic parameter was assessable due to the above-mentioned limitations. Nevertheless, a basic statement concerning right ventricular morph and function was possible in almost every elderly person. © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586726pmid: 26078058

Stress – public health enemy number 1? Thursday, 14 May 2015, 08:30-10:00 4 High depressive symptoms is inversely associated with ideal cardiovascular health in 10 157 from the paris prospective study 3. B Gaye1, C Prugger1, MC Perier1, F Pannier2, F Thomas2, P Boutouyrie1, X Jouven3, JP Empana1 1National Institute of Health and Medical Research (INSERM home), Paris, France 2Centre d'Investigations Preventives et Cliniques, Paris, France 3Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France Topic: Sports cardiology Purpose:The Ideal Cardiovascular Health is a new tool defined by the American Heart Association with the aim to promote cardiovascular health by assessing 7 modifiable health behaviors and biological risk factors. We investigated the hypothesis that high depressive symptoms represent a barrier to reach ideal cardiovascular health (ICVH). Methods:Between 2008 and 2012, 10 157 men and women 50-75 years of age were examined in a large health center and enrolled in the Paris Prospective Study III. Ideal cardiovascular health comprises 4 behavioral components (nonsmoking, body mass index >18 kg/m2 and <25 kg/m2, physical activity at goal level, and pursuit of an appropriate diet) and 3 biological components (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/80 mmHg, and untreated fasting blood glucose <100 mg/dL). Participants with 0-2, 3-4 and 5-7 ideal health components were categorized as having poor, intermediate and ideal cardiovascular health, respectively. High depressive symptoms were defined as a score = 7 on the 13-item Questionnaire of Depression 2nd version, Abridged or the use of antidepressants. Linear regression analyses were performed to examine the relationship of high depressive symptoms with the number of ICVH items, distinguishing between behavioral and biological components. Regression models were adjusted for age, sex, living status, educational level and perceived health. Results:Mean age of participants was 59.11 (SD 6.3) years and 60.16% were males. A total of 839 (8.26%) showed high depressive symptoms, 5.43% in men and 12.68% in women. Poor, intermediate and ideal cardiovascular health was observed in respectively 48.10% (56.6% in men and 34.55% in women), 44.32% (38.4% in men and 53.92% in women) and 7.56% (5% in men and 11.53% in women) of study participants. After multivariate adjustment, there was an inverse relationship between high depressive symptoms and the number of ICVH items (?-0.17, p<0.001). This inverse association existed with the behavioral component of ICVH (?= -0.13, p<0.001) but not with the biological component (?= 0.002, p=0.5) of ICVH. All these results were consistent among men and women. Conclusion:Participants with high depressive symptoms have a substantially reduced chance of reaching ideal cardiovascular health, especially its behavioral components. High depressive symptoms may represent a barrier to reach ideal cardiovascular health. © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586744pmid: 26078062

Poster Session IV Friday, 15 May 2015, 14:00-18:00 P577 Adaptation to interval hypoxia-hyperoxia improves exercise tolerance and cardio-metabolic profile in patients with coronary artery diseases O Glazachev1, F Kopylov1, E Zagaynaya1, E Dudnik1 1I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Background:Cardiac rehabilitation is an important component of complex treatment in stable CAD patients. It is generally known exercise-based cardiac rehabilitation is effective in reducing total and CV mortality, morbidity progression and hospital admissions. In our study we use normobaric intermittent hypoxic-hyperoxic training (IHHT) as a new alternative cardio-protective technique, experimentally proved and introduced in our pilot studies (2011-2013). Methods:From September 2011 to October 2014 we enrolled 46 patients with CAD, class II-III, Canadian Cardiovascular Society (18 men, 28 women; 63,6±8,7 years, 16 – with prior MI) randomly divided to receive 15 sessions of IHHT (IHHT group, n=27) and to breath with the same machine by normoxic gas mixture (placebo group, n=19) in 3 weeks. For IHHT group each breathing session consisted of 5-7 hypoxic periods (12-10% oxygen, 4–6 min) with 3-min hyperoxic (35% oxygen) intervals. Duration of hypoxic and hyperoxic episodes was set up following the results of hypoxic test (on a feed-back principle from SaO2 min, ReOxy Cardio device). Controls inhaled normoxic air only via the same facial mask. Study participants were advised not to change medications, nutrition and levels of physical activity during the study period. Cardiopulmonary exercise test on treadmill (peak VO2, METs, time to fatigue, anaerobic threshold – AT), EchoCG, ECG, blood and biochemical determinations were performed for all patients 2-3 days before IHHT course, 2-3 days after and 30 days later IHHT program. Results:At the study beginning demographic characteristics and prevalence of risk factors were similar in both groups. After 3 weeks of breathing program in patients of IHHT group peak VO2 and AT increased significantly already after (p=0,027, p=0,036) and 1 month after IHHT completion (p=0,019, p=0,011). No changes have been revealed in controls. Improved exercise tolerance and aerobic capacity in IHHT group were accompanied with significant hypotensive effects (stable decrease of SBP and DBP), decrease of total cholesterol level, triglycerides, mild reticulocytosis, positive dynamics in myocardial contractile function (EchoCG), significant improvements in all scales of Seattle Angina Questionnaire. Conclusion:Normobaric intermittent hypoxic-hyperoxic training might increased exercise tolerance reducing cardio-metabolic risk-factors in patients with stable CAD and can be useful in cardiac rehabilitation. Further studies are needed to determine the influence of IHHT on MACE and to compare IHHT with exercise-based cardiac rehabilitation. P579 Non-cardiac readmissions are reduced in patients attending a nurse-coordinated prevention program: results from the RESPONSE randomised clinical trial HT Jorstad1, WJM Scholte Op Reimer1, JGP Tijssen1, RJG Peters1 1Academic Medical Center, Amsterdam, Netherlands Topic: Sports cardiology Purpose:To quantify the impact of an outpatient nurse-coordinated prevention program (NCPP) on hospital readmissions and emergency room (ER) presentations in acute coronary syndrome (ACS) patients. Methods:We analyzed hospital readmissions and emergency room presentations in RESPONSE, a multicenter, randomized clinical trial in 754 post-ACS patients. In total, 375 patients were randomized to the NCPP (interventions), consisting of 4 visits in 6 months, focusing on 1) healthy lifestyles, 2) biometric risk factors, 3) medication adherence, 4) counseling and motivation, on top of usual care. Controls received usual care only. Out main outcome was cardiac and non-cardiac hospital readmissions, interventions, and ER presentations in the first year post-ACS. Results:During 1-year follow-up, there were no differences between interventions and controls in the number of readmissions for ACS (17 vs. 21, p=ns), acute interventions (12 vs. 17, p=ns), or elective interventions (48 vs. 50, p=ns). However, non-cardiac admissions and ER presentations were significantly less frequent in interventions as compared to controls (41 vs. 87, p<0.001). Conclusion:Non-cardiac hospital admissions and ER presentations were markedly lower in patients attending the NCPP. Our findings may indicate that counseling and support provided by the NCCP decrease anxiety, increase confidence, or both. These effects contribute to the cost-effectiveness of post-ACS NCCPs. Open in new tabDownload slide 10653. P580 The impact of an exercise program based on nordic walking on patients with a recent acute coronary syndrome R Dalmau1, JM Carrera Pons2, A Castro Conde1, M Marin Santos1, S Espinosa1, A Araujo3, MD Hernandez3, C Vindel3, H Arranz3, JL Lopez Sendon1 1University Hospital La Paz, Madrid, Spain 2Escuela de Esqu?aspirineo, Huesca, Spain 3University Hospital La Paz, Department of Cardiology, Cardiac Rehabilitation Unit, Madrid, Spain Topic: Sports cardiology Purpose:Both sedentarism and non-adherence to exercise are growing problems in our modern society. Nordic walking (NW) is an attractive option of aerobic exercise, in which brisk walking is complemented with coordinated arm movements using special poles. This technique allows the patient to exercise both upper and lower muscles. NW is adaptable to most patients, and is not an expensive activity. We analysed the impact of a cardiac rehabilitation program (CRP) based on NW on the adherence to exercise among patients with a recent acute coronary syndrome (ACS). Methods:80 successive patients referred to a CRP after a recent admission for ACS were randomized 1:1 to receive either a standard exercise program (indoor exercise with bicycle or treadmill) or a NW program (NW sessions outdoor). All patients were offered 16 sessions of exercise supervised by a physiotherapist (75 min, 2 per week during 8 weeks), with a recommendation of doing similar exercise on their own, in order to complete 5-6 days/week of training. Life style group education sessions were offered as well. A symptom-limited treadmill test was performed at baseline, and at 3 and 6-month follow up visits. Adherence to exercise was analysed at the 6-month follow up visit. Results:we found no differences in baseline characteristics: mean age 56,1, 87,5% male, mean LVEF 53%, mean basal exercise capacity 8,2 METS. 61,3% of patients were sedentary at baseline. At the end of the program an improvement in functional capacity was reached in both groups, with no significant differences. At the 6-month follow up visit, 90% of patients claimed to do exercise, with no significant differences in the number of days/week nor hours/week between groups. Only 19% of patients of the NW group continued to practice NW. Conclusions:NW is an attractive outdoor sport activity, it can be practiced in a group and it involves more muscle groups than conventional walking. Despite a good acceptance during the CRP, NW did not improve adherence to exercise in coronary patients. NW group Control group p METS Baseline 8.1 8.3 NS METS 6-month 11.5 11.4 NS N of hours of training/week (6-month) 5.8 6 NS Non-adherence to exercise (6-month) 7,7% 2,4% NS NW group Control group p METS Baseline 8.1 8.3 NS METS 6-month 11.5 11.4 NS N of hours of training/week (6-month) 5.8 6 NS Non-adherence to exercise (6-month) 7,7% 2,4% NS Open in new tab NW group Control group p METS Baseline 8.1 8.3 NS METS 6-month 11.5 11.4 NS N of hours of training/week (6-month) 5.8 6 NS Non-adherence to exercise (6-month) 7,7% 2,4% NS NW group Control group p METS Baseline 8.1 8.3 NS METS 6-month 11.5 11.4 NS N of hours of training/week (6-month) 5.8 6 NS Non-adherence to exercise (6-month) 7,7% 2,4% NS Open in new tab P583 Hospital-based and telemonitoring guided home-based training program: effects on exercise tolerance and qol in patients with heart failure, receiving crt therapy E Smolis-Bak1, R Dabrowski1, E Piotrowicz1, T Chwyczko1, I Kowalik1, B Kazimierska1, B Jedrzejczyk1, K Gepner1, H Szwed1 1National Institute of Cardiology, Warsaw, Poland Background:Cardiac resynchronization therapy with defibrillator function (CRT-D) along with an optimal medical therapy improves symptoms, cardiac efficiency, quality of life (QoL) and prognosis in patients with heart failure (CHF). The aim of the study was to assess the effects of exercise training, hospital-based and home-based with telemonitoring (TELE) on the levels of exercise capacity, QoL and prognosis in patients with advanced CHF and CRT-D. Methods:The study was conducted in 52 patients, aged 45-75 years (mean 62 ±9.3), with CHF, NYHA III, with CRT-D. Group CRT-Ex (n=26) underwent initial exercise training in the hospital setting and continued training program at home with TELE (8 weeks). The CRT-Control group (n=26) consisted of patients who had no rehabilitation after discharge. Results:After 3-4 months the CRT-Ex group achieved better results in VO2 peak, VCO2 peak and treadmill test duration. But after 12 months the improvement in most of the measurements was maintained in the CRT-Control group, while in the CRT-Ex group the measurements returned to the baseline values. In the CRT-Ex group the distance in a six-minute walk test (6-MWT) significantly increased at 3 months compared to baseline. At 12 months, the distances remained similar. No significant differences were observed between two groups in distances of 6-MWT. Echocardiographic evaluation showed significant reduction of left ventricular dimensions and improvement in the ejection fraction, in both groups ( CRT-Ex group, p=0.0213 and CRT-Control group, p=0.0001). Significant improvement in all domains of QoL was observed in the CRT-Ex group, while the CRT-Control patients declared only higher energy levels and less pain. Intensity of TELE-guided home-based exercise training was low. Most of the pts did not continue exercise training after completing the TELE-guided programme. In the 12-month follow-up there were no differences in the mortality or hospitalization rates between the groups. Conclusions:A structured exercise training program in the hospital setting and further home-based with telemonitoring was safe option of treatment and improved physical fitness, quality of life and echocardiographic parameters in patients with NYHA III CHF and CRT-D. However, patients starting home-based cardiac rehabilitation with telemonitoring must be confident that their knowledge of physical exercise and its impact on their health, continuous access to the monitoring centre staff and telemonitoring guidance guarantee safety of the training programme. P584 Dance provides greater gain cardiorespiratory fitness and less chance of sexual dysfunction than conventional rehabilitation program. AI Gonzales1, SW Sties1, HO Braga1, GD Carvalho1, LS Mara1, AS Netto1, DP Lima1, PAB Araujo1, AV Souza1, T Carvalho1 1State University of Santa Catarina, Florianopolis, Brazil Topic: Sports cardiology Purpose:There is a relationship between sexual dysfunction and cardiovascular diseases, being the physical exercise effective in the treatment of both. The ballroom dancing has provided cardiovascular effects similar to those of conventional exercise, and it is plausible the hypothesis that can also benefit sexual function. The aim of this study was valuate sexual function and physical performance in hypertensive and coronary cardiovascular rehabilitation and ballroom dance practitioners. Methods:Cross-sectional study with 102 individuals of both sexes (67.6% men), divided into three groups: ballroom dance practitioners (BDG; n = 34; 66.47 ± 6.66 years), cardiovascular rehabilitation participants (CRG; n = 34; 66.61 ± 6.3) and sedentary (SG; n = 34; 66.17 ± 6.73). The men were evaluated for sexual function by International Index of Erectile Function (IIEF), and women for Index of Female Sexual Function (IFSF); and cardiorespiratory capacity determined by cardiopulmonary exercise testing. In statistical analysis was used Korgomorov-Smirnov test, Mann-Whitney, Kruskal-Wallis and logistic regression analysis, considered confidence interval of 95%, adjusted for gender with significance level of 5%. Results:Men and women ballroom dance practitioners showed less possibility to present sexual dysfunction (OR= 0.352; p = 0.020; OR= 1.05; p = 0.041, respectively). In the BDG was observed peak VO2 and VO2 in the first threshold, higher than the other groups (<0.001), and VO2peak 16% higher than the CRG and 21% higher than the SG. Conclusion:Men and women coronary and hypertensive ballroom dance practitioners had higher cardiorespiratory capacity and reduced chance of sexual dysfunction, compared to participants in conventional rehabilitation program and sedentary. P585 The NOR-COR (NORwegian CORonary) study: identification of CHD patients with poor adherence to secondary prevention and their perceived needs for follow-up J Munkhaugen1, E Sverre1, K Peersen2, E Gjertsen1, T Liodden2, L Gullestad3, JE Otterstad2, J Perk4, E Husebye1, T Dammen5 1Vestre Viken HF Drammen Hospital, Medicine, Drammen, Norway 2Vestfold Hospital, Tonsberg, Norway 3Oslo University Hospital, Oslo, Norway 4Linnaeus University, Kalmar, Sweden 5University of Oslo, Oslo, Norway Background:Randomized intervention studies on secondary prevention show varying results in patients with coronary heart disease (CHD) and 40-70% of these patients do not participate in cardiac rehabilitation or receive optimal secondary prevention. New strategies are therefore needed. A better understanding of the non-compliant patient and his/her perceived needs may be important for improving the intervention strategies. Topic: Sports cardiology Purpose:The NOR-COR projects identify underserved, high risk CHD patients with poor adherence to secondary prevention and low participation in rehabilitation programs, and reveal their perceived needs for secondary preventive follow-up. The first study tests whether illness attribution influences CHD patients`perceived needs for follow-up, and the associations to age, education, drug adherence, risk factor control, time since the event, type of event, somatic and psychosocial comorbidity. Methods:A cross-sectional, observational study was designed to explore a large number of cardiovascular, behavioural, psychosocial, and health care related factors in patients with a coronary event (myocardial infarction, percutaneous coronary intervention, and/or coronary by-pass operation) from 2011-14. An extensive self-report questionnaire, clinical examination and laboratory data were included. CHD patients, nurses, preventive cardiologists, and researchers in epidemiology and psychosomatic medicine contributed to development of the questionnaire and a pilot test on 20 random selected CHD patients has been performed. Patients who refused study participation will be asked to give their consent to compare journal data (age, gender, type and number of events, risk factors, and somatic and psychiatric comorbidity) with those participating. Results:From the catchment (380,000) of two representative Norwegian hospitals (Drammen and Vestfold), we identified 1608 patients aged 18-80 years with established CHD. After excluding 291 patients, 1317 patients were invited, and 1125 (85.4%) participated. Preliminary results including current participation in primary and secondary programs, perceived needs for further secondary preventive follow-up, beliefs regarding what caused their CHD, illness attribution and risk factor perceptions will be presented at EuroPRevent 2015. Conclusion:The study will provide new insights that may be useful for increasing participation in secondary prevention and improving patient information programs. Moreover, this may promote the development of tailored prevention programs applying to patient groups with different perceived needs and behaviour profiles. P586 The influence of water-based training on arrhythmia in patients after myocardial infarction with preserved left ventricular function. I Kubacka1, MB Bilinska Maria2, RB Baranowski Rafal2, EP Piotrowicz Ewa3, RB Piotrowicz Ryszard1 1Institute of Cardiology in Anin, Cardiac rehabilitation and noninvasive electrocardiology, Warsaw, Poland 2Institute of Cardiology in Anin, Dept. of Arrhythmia, Warsaw, Poland 3Institute of Cardiology in Anin, Telecardiology Center, Warsaw, Poland Topic: Sports cardiology Purpose:Water immersion may cause adverse cardiovascular events, e.g. arrhythmia in post MI patients. So far there have been rather few reports on arrhythmia induced by water training in CAD patients. The aim of the study was to assess the influence of exercise training in moderately cold water on arrhythmia in patients after myocardial infarction (MI) with preserved left ventricular function. Methods:62 post MI men, mean age 50.9±7.9 years with preserved LV function(EF 57.8±22.6 %), underwent 16 40-minute swimming pool trainings (SPT) twice a week in water at 28-30 ?C. Each subject underwent 24h Holter on-land monitoring (Holter-24) before SPT and twice in-water Holter monitoring (Holter-W) performed with a waterproof pack during SPT. Before and after SPT cardiopulmonary exercise test (CPET) was performed. Arrhythmic events (mean number of VEBs and SVEBs per patient) were assessed during selected 55-min periods of Holter-24 and Holter-W. Moreover, the evaluation included the percentage of men who developed arrhythmia during CPET versus Holter-24 and versus Holter-W. Results:SPT significantly improved patients' physical capacity, pVO2 increased by 15.3% (p<0.05). During SPT 36 (58%) men developed VEBs and 39 (62%) SVEBs. No complex arrhythmia was recorded. The mean number of VEBs per patients on Holter-W and Holter-24 did not differ significantly (4.93±16 vs 6.92±20) but the number of SVEBs recorded in Holter-W was significantly higher (3.63±9.6 vs 0.12±3.3, p<0.05). SPT provoked arrhythmia much more often than did CPET (VEBs, p<0.05 and SVEBs, p<0.01) and normal daily activity assessed during Holter-24 (VEBs, p<0.01and SVEBs, p<0.01). Conclusions:SPT generated arrhythmia significantly more often than did CPET and normal daily activity. SPT is an effective and safe form of physical training in men after MI with preserved LV function. P587 Baseline factors determining the continuation of physical activity 12 months after cardiac rehabilitation R Pinto1, M Tavares-Silva1, G Pestana1, AR Godinho1, J Rodrigues1, V Araujo1, JA Rocha2, F Parada2, MJ Maciel1 1Sao Joao Hospital, Cardiology, Porto, Portugal 2Sao Joao Hospital, Physical Medicine and Rehabilitation, Porto, Portugal Topic: Sports cardiology Purpose:Cardiac Rehabilitation Programs have gained tremendous importance in the prevention of cardiovascular disease. However, the long term benefits are dependent on the ability of the participants to continue unsupervised regular physical activity after the phase II has ended. The aim of this study was to determine the factors that influence the physical activity habits 12 months after the phase II of the Cardiac Rehabilitation Program. Knowledge of this factors can allow the development of more tailored programs. Methods:The study included 147 patients from a single center referred to CRP after an ACS, from whom 12 month data for physical activity was prospectively assessed by the International Physical Activity Questionnaire (IPAQ). Baseline risk factors, demographic, psychosocial and physical variables were collected at the start of the program and regularly throughout. The IPAQ was administered before the start of the program and at 12 months. We performed logistic regression to the baseline variables deemed to possibly have an impact on the levels of physical activity at 12 months Results:Patients' mean age was 53.±9.1 years, 12% of whom were females. At the beginning of the program 80.5% of the patients reported low levels of activity, while at 12 months this percentage decreased to 38.1%. Using univariate analysis, female sex OR 0.233 (CI 0.083-0.657), being unemployed OR 0.353 (CI 0.139-0.929), the Physical function of the SF-36 OR 1.05 (1.009-1.099) and the Intensity of the first exercise teste in METS OR 1.378 (1.150-1.661) have shown to be significant predictors for the intensity of physical activity at 12 months. Conclusions:Despite the well-known effects of a CRP after an ACS, a significant proportions of patients does not maintain regular physical activity. Both social, demographic and baseline exercise capacity factors influence this outcome. P588 The effect of high interval training in acute myocardial infarction patients with drug eluting stent C Kim1, HE Choi2 1Inje University, Sanggye Paik Hospital, Seoul, Korea, Republic of 2Inje University, Haeundae Paik Hospital, Pusan, Korea, Republic of Topic: Sports cardiology Purpose:Peak oxygen uptake (VO2peak) is a strong predictor of survival in cardiac patients. The aim of this study was to compare the effects of high interval training (HIT) and moderate continuous training (MCT) on VO2peak and to identify the safety of HIT in acute myocardial infarction (AMI) patients with drug-eluting stent (DES). Methods:Twenty-eight AMI patients with DES were randomized to either the HIT or MCT groups, and exercise training started within 3 weeks after PCI, three times per week for 6 weeks at the hospital and usually with a minimum of 1 week or three sessions of MCT mode before starting HIT. The HIT group exercised for a total of 45 minutes. The program consisted of a 10-min warm-up at 50–70% of HRR, followed by four times four minutes intervals of walking on a treadmill at 85–95% of HRR with three active pauses of 3-min of walking at 50–70% of HRR, and a 10-min cool-down at 50–70% of HRR. The MCT group exercised for a total of 45 minutes. Their program consisted of a 10-min warm-up, followed by 25-min walk on a treadmill continuously at 70–85% of HRR, and a 10-min cool-down. All training sessions were supervised by medical staff and monitored by ECG, heart rate, and BP using a telemetry monitoring system, and subjective rate of perceived exertion. All study subjects received a symptom-limited exercise tolerance test (ETT) using the modified Bruce protocol including a pretest an average of 17.07 days (HIT group) and 18.57 days (MCT group) after AMI. Follow-up tests were performed after completing the 6-week exercise training. Primary outcome was VO2peak at baseline and after CR. Results:Both HIT and MCT groups showed significant increases in VO2peak and heart rate recovery, and significant decreases in serum levels of low-density lipoprotein cholesterol and high-sensitive C-reactive protein after 6 weeks of training. The 22.16 % improvement of VO2peak in the HIT group was significantly greater than the 8.48 % improvement of that in the MCT group (P = 0.021). There were no cardiovascular events related with both HIT and MCT. Conclusion:HIT is more effective than MCT for improving VO2peak in AMI patients with DES. These findings may have important implications for more effective exercise training in CR program. P589 Effect of Eccentric Endurance Training in subjects after recent cardiovascular surgery. F Maslowsky1, M Pribetich1, E Milani1, G Lo Bello1, A Mazzola1, C Franzin1, S Sarzi Braga1, R Pedretti1 1IRCCS Foundation Salvatore Maugeri, Department of Cardiology, Tradate, Italy Introduction:Eccentric muscle work is a part of our daily activities; usually people use eccentric muscle work during walking, and in particular when walking downhill, to convert potential energy into heat. Eccentric muscle action is characterized by a low metabolic demand for a high power output. Recent studies have drawn attention to the benefits of eccentric muscle training in patients with coronary artery diseases. Aim this study evaluated the effects of eccentric endurance training (EET) in male/female (2/18) subjects (age range 61,5 ± years) after recent cardiac surgery i.e. coronary artery by-pass or cardiac valves replacement Methods:Twenty consecutive patients were participating in the inpatient cardiac rehabilitation program at our institute. Ten patients were randomized in concentric endurance training (CET) and ten in EET. Six minute walking test (6MWT) quality of life (EuroQol) Visual analogic scale (VAS) for leg pain, Borg RPE-scale (0-10 rating) were performed before and after the training period. EET or CET was integrated into a standard comprehensive rehabilitation program such that light calisthenics, stretching and relaxation procedures were identical for all subjects. CET group was underwent one session a day with speed at 80% of speed reached at 6MWT and positive inclination of degrees 5%, whereas the EET group was trained with speed at 80% of speed reached at 6MWT and negative inclination of 5% degrees. The mean of training session was 11,8 ± 5,5 for the two group; CET and EET were carried out five times per week for half an hour. Results:No muscular injury was reported and no rhythm troubles were found during training. No patients reached rate of perceived exertion over 10, the two groups was homogeneous for type of surgery, age, EF, Hemoglobin content and number of training session. No significant difference was found in two groups in distance during 6MWT, quality of life, leg pain and heart rate, while significant difference was found in in Borg RPE scale in EET group, EET group reported a significantly lower fatigue level than that perceived by the ECT Group. Conclusion:eccentric exercise training is feasible in middle-aged patients with recent cardiac surgery and without musculoskeletal complication. The results indicate small but not significant improvement in walk capacity whereas significant differences in reduction of fatigue to perform the same work. Because the small energy demand relative to the force produced, eccentric training may be an attractive alternative for patients with limited cardiovascular exercise tolerance. P590 Effects of exercise training after an acute coronary syndrome on echocardiography evaluation and health status. A R Godinho1, AS Correia1, I Rangel1, A Rocha2, J Rodrigues1, V Araujo1, F Macedo3, MJ Maciel3 1University of Porto, Cardiology, Porto, Portugal 2University of Porto, Physical Medicine and Rehabilitation, Porto, Portugal 3Faculty of Medicine University of Porto, Cardiology, Porto, Portugal Despite the role of both diastolic and systolic function in prognosis after acute coronary syndrome (ACS), diastolic function is often overlooked in comparison to improvement of ventricular systolic function and health status. An adequate cardiac rehabilitation program (CRP) after ACS can improve global and cardiac mortality. We studied echocardiography parameters and EuroQol5D scale, before and after CRP, in patients who had ACS and were included on CRP. Methods:Study of 121 patients who completed a two month CRP consisting of biweekly exercise training sessions, nutrition counseling and psycho-educational group intervention. Patients were enrolled between January 2011 and December 2012. All subjects underwent echocardiography and EuroQol5D scale before and at the end of the CRP. Results:Mean age was 53.8 years (SD 9.1) and 81.8 % were male. ACS with ST-segment elevation occurred in 53,8% of cases while 36,8% were admitted with ACS without ST-segment elevation. The majority of patients had one vessel coronary disease (63,2%), with 18.8% having 2-vessel disease, and most underwent percutaneous revascularization (90,6%). Most patients were medicated with angiotensin- converting - enzyme inhibitor(80,3%) and beta blockers (90,6%). The EuroQol5D scale improved after CRP (p=0,000). The mean of left ventricular systolic function (LVSF) before CRP was 58,5% (DP 8,5) and after 60,5% (DP 8,0), p<0,001. When we analyzed separately the patients with reduction of LVSF (Ejection Fraction (EF) <55%) (n=26), mean was 46,1% (DP 7,6) before CRP and improved for 51,1% (DP 10,4) after CRP , p=0,000 as well as patients with normal LVSF (FE=55%) (n=95), mean before CRP was 62,1% (DP 4,5) and after 63,3% (DP 4,5), p=0,021. At the end of CRP there was no significant differences on echocardiography diastolic parameters like E/A [1,18(DP 0,3) versus 1,23(DP 0,3)]; before and after CRP, respectively; p=0,123, deceleration time [215,1 msec (DP 44,9) versus 215,6 msec (DP 56,8 ); p=0,935], E/E` [8,46 (DP 2,8) versus 8,36(DP 2,5); p=0,616], left auricular diameter [38,9 mm (DP 3,9) versus 39,2 mm (DP 3,6); p=0,194]. There was also no significant improved on right ventricular systolic function (RVSF) after CRT: peak systolic velocity [13,36 cm/s (DP1,9) versus 13,33cm/s (DP 2,0); p=0,884] and TAPSE [23,19 mm (DP 4,3) versus 23,78 mm (DP 3,6); p=0,582] , Conclusion:Diastolic function and RVSF did not change significantly after CRP on patients who had ACS, but the program improved health status and LVSF. So, cardiac rehabilitation can be of value and should be implemented after ACS. P591 Ballroom dancing improves functional capacity in cardiac rehabilitation phase III outpatient program E Venturini1, M Siragusa1, L Lo Conte1, R Testa1 1Department of Cardiology - Civic Hospital , Cecina (LI), Italy Topic: Sports cardiology Purpose:aerobic exercise can improves, functional capacity in cardiac patients (P). The longer the duration of physical activity, the greater its effectiveness. The conventional forms of exercise offered in Cardiac Rehabilitation (CR) can be little attractive. Therefore we evaluate, in a preliminary outpatient program (OP), the ballroom dancing (BD) as a strategy to increase physical activity and adherence to exercise. Methods:we studied 10 P after myocardial infarction (9 men, mean age 64±10 y) enrolled in a CR OP of BD. Dance sessions were performed in an external gym 2 times a week for 8 weeks, lasting 1 hour. The maximal intensity of training was calculated as the HR corresponding to 75-85% of the peak reached during the exercise stress test (EST). At the entry and at the end each P underwent EST and echocardiogram. In each session, were measured basal and maximal exercise blood pressure (BP). All the P completed the protocol. Results:the BD OP significantly improved the total duration of EST by 11%. The Rate Pressure Product increase by 8% and also the intensity of energy expenditure, in METs (+7%) and in Watts units (+10%), p not significant. The BP during maximal exercise, and the diastolic basal BP were statistically reduced; also basal SBP fell down, but not significantly. Ejection fraction and E/A ratio improved but not statistically. There were no untoward events. Conclusions:an OP of CR based on BD can increase functional capacity with a better control of BP at rest and during exercise. The hypotensive effect of BD allows it to tackle a greater exercise time, limiting the effort energy expenditure. The short duration of the study may explain the neutral effect on echocardiographic parameters. The emotional dimension of dancing, adds value to the aerobic exercise, improving adherence to the physical activity. BD can be useful, safe and at low-cost in CR Phase III OP, combined with traditional aerobic exercise or in alternative in P, who prefer dancing to other forms of exercise. Entry End p Entry End p EST 579±115 645±138.3 <.0008 SBP exer. 162.2±14.3 152.4±9.7 <.0009 RPP 24005±3238 26145±4641 ns DBP exer. 87±3.8 80.5±1.1 <.0007 METs 6.6±1.5 7.1±1.6 ns SBP basal 148.1±18.8 132.8±12.5 ns Watt 139.2±24.4 153.±32.2 ns DBP basal 80.5 ±5.8 74.2 ±6.7 <.002 Entry End p Entry End p EST 579±115 645±138.3 <.0008 SBP exer. 162.2±14.3 152.4±9.7 <.0009 RPP 24005±3238 26145±4641 ns DBP exer. 87±3.8 80.5±1.1 <.0007 METs 6.6±1.5 7.1±1.6 ns SBP basal 148.1±18.8 132.8±12.5 ns Watt 139.2±24.4 153.±32.2 ns DBP basal 80.5 ±5.8 74.2 ±6.7 <.002 Open in new tab Entry End p Entry End p EST 579±115 645±138.3 <.0008 SBP exer. 162.2±14.3 152.4±9.7 <.0009 RPP 24005±3238 26145±4641 ns DBP exer. 87±3.8 80.5±1.1 <.0007 METs 6.6±1.5 7.1±1.6 ns SBP basal 148.1±18.8 132.8±12.5 ns Watt 139.2±24.4 153.±32.2 ns DBP basal 80.5 ±5.8 74.2 ±6.7 <.002 Entry End p Entry End p EST 579±115 645±138.3 <.0008 SBP exer. 162.2±14.3 152.4±9.7 <.0009 RPP 24005±3238 26145±4641 ns DBP exer. 87±3.8 80.5±1.1 <.0007 METs 6.6±1.5 7.1±1.6 ns SBP basal 148.1±18.8 132.8±12.5 ns Watt 139.2±24.4 153.±32.2 ns DBP basal 80.5 ±5.8 74.2 ±6.7 <.002 Open in new tab P592 Feasibility of an exercise stress test as an indicator of disease severity in cardiac rehabilitation patients A Salzwedel1, A Rieck1, H Voller1 1University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany Introduction:Training is a core component of cardiac rehabilitation (CR). There is evidence for large benefit of CR for patients with low exercise capacity at admission. But patients without baseline values were not sufficiently considered. Therefore, we aimed to identify predictors for the feasibility of an initial exercise stress test (EST). Methods:In a prospective multicenter registry, 1094 patients (71±7 years, 78% men) were enrolled (9 days after hospital stay), predominantly after CABG (33%), PCI (21%), and heart valve replacement (14%). We analysed sociodemographic and clinical variables (e.g. risk factors, comorbidities, complications, 6-min walking distance [6MWD]) with respect to the feasibility of an EST. In addition, we considered therapy volume (total minutes) in different categories (e.g. training, nursing care, patient education). Results:166 patients (15%) were not able to perform an initial EST. In multivariable logistic regression, the probability of obtaining an EST was significantly higher for men (OR 1.89, p=0.01), a longer 6MWD (per 10m, OR 1.07, p<0.01), higher education level (OR 2.85, p<0.01), but lower for patients with diabetes mellitus (OR 0.48, p<0.01), NYHA-class III/IV (OR 0.27, p<0.01), osteoarthritis (OR 0.39, p<0.01), and a longer hospital stay (OR 0.97, p=0.02). Age had no effect (p=0.67). Patients who did not perform an EST received less therapy units of training and education but more units of nursing car and physiotherapy (Fig). Conclusion:Feasibility of an initial EST early after an acute cardiac event is an indicator of disease severity. Routine EST will help to better tailor CR to the needs of patients with poor health status. However, there is a justified need not only for exercise based, but also for the comprehensive, interdisciplinary CR. Open in new tabDownload slide Total therapy volume during CR P593 Exercise-based cardiac rehabilitation for adults after heart valve surgery K Laerum Sibilitz1, SK Berg1, L Tang1, SS Risom1, C Gluud2, J Lindschou2, L Kober1, C Hassager1, RS Taylor3, AD Zwisler1 1Rigshospitalet, Department of Cardiology, Copenhagen, Denmark 2Rigshospitalet - Copenhagen University Hospital, Copenhagen Trial Unit, Copenhagen, Denmark 3University of Exeter, Health Services Research, Exeter, United Kingdom Background:Exercise-based cardiac rehabilitation may benefit heart valve surgery patients. This systematic review of randomised trials aims to assess the benefits and harms of exercise-based cardiac rehabilitation in adults following heart valve surgery. Methods:This Cochrane systematic review was conducted according to our published protocol. We included randomised trial irrespective of publication date, type, language and status investigating exercise-based interventions compared with no exercise intervention or treatment as usual in adults who had undergone heart valve surgery. Two review authors independently extracted data and assessed the risk of bias. We undertook meta-analyses and trial sequential analyses to assess the risk of random errors. Results:We identified 2 trials published in 1987 and 2004 with a total of 148 participants. Both trials had high risk of bias. There was inadequate evidence to determine the impact of exercise-based rehabilitation on the primary outcomes of mortality, serious adverse events, or health-related quality of life, or secondary outcomes (left ventricular ejection fraction, New York Heart Association class, return to work, costs, or cost-effectiveness). However, we did find that, compared with control, exercised-based rehabilitation may increase the secondary outcome of exercise capacity (-0.47 standard deviation units, 95% CI -0.81 to -0.13, p=0.006, I2 statistic=0%). Conclusions:This Cochrane review suggests that exercise-based rehabilitation for adults after heart valve surgery compared with no exercise, may improve exercise capacity. Further randomised trials with low risk of bias are needed in order to assess the impact of exercise-based rehabilitation on patient-relevant outcomes including mortality and quality of life. P594 Clinic results in a modern cardiac rehabilitation unit J A Alarcon1, C Del Bosque1, FJ Madruga1, J Reparaz1, X Arrazola1, M Lavado1, M Rocandio1, F De La Cuesta1 1Donostia Hospital, Donostia, Spain Background:It is well known the benefit of cardiac rehabilitation (CR) in terms of morbidity and mortality. We present the results of our Cardiac Rehabilitation Unit (CRU), analyzing the data on control of different cardiovascular risk factors (CVRF) just before recruitment( Pre-Program:PP) and after completing the programme in CRU(FP), and MACE during the programme and 1 year after the hospital admission with ACS(acute coronary sindrome). Methods:In our CRU ,coordinated by cardiologist, we performe strict control of CVRF and stratification of patients, we have also smoking cessation programme , nursing consultation, gym work (with nurse and physiotherapist on-site and telemetry- ECG) with continuous and intervalic aerobic exercise and strength exercise (50% of MR for a total of 9 muscle groups,including dumbbells, floor exercises and leg press machine) ,rehabilitation physician and clinical psychologist, and educational sessions with the patients. We have treated 1160 patients referred from December 2008-February 2014 : 53% STEMI, NSTEMI 36%, 7% stable angina, 4% other . In total, 45% low risk, medium risk 32%, 23% higher risk (according to criteria of the AACVPR). 83% male. Mean age 58 years (29-82a) .We have analyzed the latest 124 patientes treated between July 2013 and February 2014(no differences in basal features with global group) Results:Blood pressure (average): PP 136/75, FP 129/72.Heart rate<70bpm PP68%, FP 86%. Waist circumference > 102 cm in men: PP46%, FP31% ; > 88cm in women: PP65%, FP 35% .Weight loss(this data in non-smokers): 69% of patients (-2,7Kg on average), weight gain 21% of patients (mean +1,4kg), equal 10%.Smoking cessation at 7 months (6-9) from admission with acute coronary syndrome(ACS): 78% (confirmed by co-oximetry) . In diabetic patientes, HbA1c (%) : a) <7: PP56%, FP75%, b) 7-8% PP13% ,FP13 c)> 8: PP31% ,FP12%. LDL-C <70 mg / dl: 25% PP, FP40%; LDLc 70-100mg / dl: PP43% FP 48%. HDL> 45 mg / dl: 35% PP, FP 54% .Functional capacity (METs, on average): PP 9METs vs FP 11.7 . PREDIMED diet adherence: PP 7/14, FP 12/14 .We had no cardiovascular mortality nor acute miocardial infarction(AMI) during the program. At one year from index ACS, only one cardiovascular death(intracranel hemorrage), and no newer AMI. Conclusions:good control of CVRF is achieved with modern CR programmes with a clear benefit added to conventional cardiac pre-program control. We must implement the use of CR, still underused in our environment. P595 Added value of physiotherapy in patient receiving Left Ventricular Assistance Devices. M Lamotte1, E Mkeidze1, G Van Nooten2, M Antoine2 1Erasme Hospital (ULB), Physiotherapy and cardiac surgery department, Brussels, Belgium 2Erasme Hospital (ULB), Cardiac surgery department, Brussels, Belgium Background:: LVAD are more and more efficient and proposed to an increased amount of heart failure patient. Actually, 25000 devices have been implanted around the world and approximately 2000 are now implanted yearly. Those devices allows not only to reduce the mortality of the patient, but also lead the patient on a more optimal status for the transplantation when, only the "bridge to transplant" indication is recognized. Waiting for the Expert flow chart of the ESC, exercise guidelines or recommendations for exercise training in such a population are not clearly established and actually based on CHF recommendation. Supervision parameters need to be clarified. Our study present the rehabilitation proposed in our centre. This rehabilitation is divided in post-operative intra-hospital phase and in ambulatory exercise training sessions. Our population is composed by 50 patients implanted on a period of three years, by a continuous "HeartWare®" device. Exercise capacity variable are obtained during a maximal cardiopulmonary exercise testing (CPET). A sub-group of patients follows a structured rehabilitation. Results:The physiotherapy proposed during the immediate post-operative period (means hospital stay is 4 weeks) is a "classical" post-operative program for heart surgery patient and consist of respiratory physiotherapy, mobilisation and ambulation. The ambulatory phase's program consists of interval training on bicycle ergometer, treadmill, rowing machine, step based on the CPET results (workload, not HR or blood pressure not accurate in this kind of patient), and different resistance training exercises realised progressively at 75 % of 1-RM. The mean stay in ICU is 7 days, patients are discharged from the hospital after a mean of 28 days. The exercise capacity (VO2p) of our patient at one month after implantation is 46 % of PV, for a RER of 1.27. At 6 and 12 month, VO2p is at 60 and 57% of PV. We observe a large variation between our patient in terms of VO2p : for example, at 6 month, from 33 to 98 % of PV. An important factor that explains those differences is the participation to a readaptation program as illustrate on a sub-group of our patient who did it regularly (VO2p : 67 versus 45 % of PV). Conclusion:: LVAD allows the patient to recover an active life and allow them to follow a structured rehabilitation. The exercise capacity is severely depressed in some patient, but increase during the first 6 month. Only patient following a structured program of exercise recover significantly. Our study demonstrates the feasibility and the efficacy of exercise training in such patient. P597 Quality of life on long-term follow-up after acute coronary ischemia N Pogosova1, V Vygodin1, A Karpova1, Y Pozdnyakov1 1National Center for Preventive Medicine, Moscow, Russian Federation Low quality of life is known to be associated with poor prognosis in patients after cardiovascular events. The aim was to study the gender-specific differences of quality of life in coronary heart disease patients on long-term follow-up. Methods:190 consecutive patients (aged 35-80) hospitalized for acute coronary ischemia (ACI) to a city hospital were identified retrospectively and interviewed in average 2 years after the event. Quality of life (QL) was studied by means of EQ-5D and SF-12v2 questionnaires. Results:10.5% patients (mean age 64,5±10,9) died: 3.2% in hospital and 7.4% during follow-up. 82.1% patients were interviewed. The total QL EQ-5D score at the end of follow-up was 0,7±0,19 (0,6±0,18 in women and 0,7±0,19 in men). According to the SF-12v2 questionnaire women had significantly lower QL after ACI as compared to men. This finding was true for both integral parameters of QL and most subscales of QL (Table 1). Especially low QL was found in women older 60 years. Conclusions:Quality of life in women is substantially lower 2 years after ACI. This could be result of lower participation of women in cardiac rehabilitation programs, higher drop-out of these programs, and need special attention. *-p<0.01 Total Men Women Physical Component Summary ( PCS ) 36 . 53±8 . 95 37 . 91±8 . 85 33 . 01±8 . 28 < 40 (%) 65 . 22 58 . 33 82 . 69 * < 30 (%) 24 . 46 18 . 18 40 . 38 * Mental Component Summary ( MCS ) 45 . 33±9 . 88 46 . 34±9 . 45 42 . 79±10 . 58 < 40 (%) 26 . 6 25 . 0 30 . 77 * < 30 (%) 7 . 07 4 . 55 13 . 46 Physical Functioning (PF) 37 . 11±11 . 32 38 . 75±11 . 1 33 . 26±11 . 04 Role Physical (RO 38 . 59±9,21 39,28±9,55 36 . 94±8 . 23 Bodily Pain (BP) 44.17±11.09 45.67±11.33 40.64±9.72 General Health (G H) 33 . 27±8 . 52 34 . 37±8 . 54 30 . 72±8 . 02 Vitality (VT) 45 . 79±9 . 95 46 . 23±10 . 32 44 . 78±9 . 06 Social Functioning ( SF ) 43,40±10,93 44,50±10,63 40 . 83±11 . 30 Role Emotional ( RE) 39 . 51±10 . 52 40 . 72±10,32 36 . 7±10 . 57 Mental Health (MH) 46 . 32±9 . 94 47 . 08±9 . 39 44 . 53±11 . 03 Total Men Women Physical Component Summary ( PCS ) 36 . 53±8 . 95 37 . 91±8 . 85 33 . 01±8 . 28 < 40 (%) 65 . 22 58 . 33 82 . 69 * < 30 (%) 24 . 46 18 . 18 40 . 38 * Mental Component Summary ( MCS ) 45 . 33±9 . 88 46 . 34±9 . 45 42 . 79±10 . 58 < 40 (%) 26 . 6 25 . 0 30 . 77 * < 30 (%) 7 . 07 4 . 55 13 . 46 Physical Functioning (PF) 37 . 11±11 . 32 38 . 75±11 . 1 33 . 26±11 . 04 Role Physical (RO 38 . 59±9,21 39,28±9,55 36 . 94±8 . 23 Bodily Pain (BP) 44.17±11.09 45.67±11.33 40.64±9.72 General Health (G H) 33 . 27±8 . 52 34 . 37±8 . 54 30 . 72±8 . 02 Vitality (VT) 45 . 79±9 . 95 46 . 23±10 . 32 44 . 78±9 . 06 Social Functioning ( SF ) 43,40±10,93 44,50±10,63 40 . 83±11 . 30 Role Emotional ( RE) 39 . 51±10 . 52 40 . 72±10,32 36 . 7±10 . 57 Mental Health (MH) 46 . 32±9 . 94 47 . 08±9 . 39 44 . 53±11 . 03 Open in new tab *-p<0.01 Total Men Women Physical Component Summary ( PCS ) 36 . 53±8 . 95 37 . 91±8 . 85 33 . 01±8 . 28 < 40 (%) 65 . 22 58 . 33 82 . 69 * < 30 (%) 24 . 46 18 . 18 40 . 38 * Mental Component Summary ( MCS ) 45 . 33±9 . 88 46 . 34±9 . 45 42 . 79±10 . 58 < 40 (%) 26 . 6 25 . 0 30 . 77 * < 30 (%) 7 . 07 4 . 55 13 . 46 Physical Functioning (PF) 37 . 11±11 . 32 38 . 75±11 . 1 33 . 26±11 . 04 Role Physical (RO 38 . 59±9,21 39,28±9,55 36 . 94±8 . 23 Bodily Pain (BP) 44.17±11.09 45.67±11.33 40.64±9.72 General Health (G H) 33 . 27±8 . 52 34 . 37±8 . 54 30 . 72±8 . 02 Vitality (VT) 45 . 79±9 . 95 46 . 23±10 . 32 44 . 78±9 . 06 Social Functioning ( SF ) 43,40±10,93 44,50±10,63 40 . 83±11 . 30 Role Emotional ( RE) 39 . 51±10 . 52 40 . 72±10,32 36 . 7±10 . 57 Mental Health (MH) 46 . 32±9 . 94 47 . 08±9 . 39 44 . 53±11 . 03 Total Men Women Physical Component Summary ( PCS ) 36 . 53±8 . 95 37 . 91±8 . 85 33 . 01±8 . 28 < 40 (%) 65 . 22 58 . 33 82 . 69 * < 30 (%) 24 . 46 18 . 18 40 . 38 * Mental Component Summary ( MCS ) 45 . 33±9 . 88 46 . 34±9 . 45 42 . 79±10 . 58 < 40 (%) 26 . 6 25 . 0 30 . 77 * < 30 (%) 7 . 07 4 . 55 13 . 46 Physical Functioning (PF) 37 . 11±11 . 32 38 . 75±11 . 1 33 . 26±11 . 04 Role Physical (RO 38 . 59±9,21 39,28±9,55 36 . 94±8 . 23 Bodily Pain (BP) 44.17±11.09 45.67±11.33 40.64±9.72 General Health (G H) 33 . 27±8 . 52 34 . 37±8 . 54 30 . 72±8 . 02 Vitality (VT) 45 . 79±9 . 95 46 . 23±10 . 32 44 . 78±9 . 06 Social Functioning ( SF ) 43,40±10,93 44,50±10,63 40 . 83±11 . 30 Role Emotional ( RE) 39 . 51±10 . 52 40 . 72±10,32 36 . 7±10 . 57 Mental Health (MH) 46 . 32±9 . 94 47 . 08±9 . 39 44 . 53±11 . 03 Open in new tab P598 Supplementation with resveratrol does not affect muscle oxidative capacity in coronary artery disease patients in the short term. A Avila1, M Diaz2, E Coeckelberghs1, L Vanhees1, V Cornelissen1 1KU Leuven, Rehabilitation Sciences, Leuven, Belgium 2Manchester Metropolitan University, Health Care Science, Manchester, United Kingdom Resveratrol is a polyphenol phytoalexin derived from red grapes, peanuts and berries with many functions including anti-inflammatory, antioxidant and immunomodulatory effects. In vivo studies have shown that resveratrol improves mitochondrial function. In humans, the oxidative capacity of skeletal muscles decreases with aging partly as a consequence of a lower number of mitochondria units. Hence, we hypothesize that resveratrol might improve oxidative capacity in humans by improving mitochondrial function. Exercise-onset VO2 kinetics has been shown to be a reliable tool for the evaluation of oxidative capacity of skeletal muscle. Therefore, we aimed to assess the effect of short term supplementation with resveratrol on muscle oxidative capacity, by means of exercise-onset VO2 kinetics in coronary artery disease patients Methods:A controlled single blind cross-over study was performed to investigate the immediate effect of resveratrol on muscle oxidative capacity in 10 coronary artery disease patients (9 men, mean age 67.2 ± 7.45 years, mean BMI of 27.1 ± 4 kg/m2) participating in phase 3 of cardiac rehabilitation. Patients completed two blinded exercise sessions which included two six-minute constant load bouts at 30% of their maximal load, separated by a 6-minute recovery rest interval. The first session was performed after placebo supplementation; the second was performed after resveratrol supplementation (3 days, 1 g/day). Oxygen uptake (VO2 mL/min) was measured breath-by-breath and averaged every 10 seconds. Muscle oxidative capacity was assessed by calculation of exercise onset oxygen uptake kinetics and expressed as mean response time (MRT). Statistical analyses were performed by means of Wilcoxon Test. Statistical significance was set at P<0.05. Results:Muscle oxidative capacity, expressed as MRT, median 46.3 (24.37-92.35) under placebo didn't change significantly following short-term resveratrol supplementation, median 42.3 (22.5-69.55 MRTs; p=0.67). VO2 steady-state median 1194 (756-1585ml/min) didn't change after resveratrol supplementation, median 1101 (756-1628ml/min; p=0.67). No effect of resveratrol was observed for Oxygen Deficit (p=0.85) or actually achieved VO2 (p=0.76). No adverse effects were reported following resveratrol supplementation. Conclusions:In patients with coronary artery disease, the results of the present study suggest that in the short-term resveratrol does not improve muscle oxidative capacity. However, further studies are warranted with longer treatment time to elucidate the potentials of resveratrol on muscle metabolism and oxygen on kinetics. P599 Effects of a physical rehabilitation program for impaired ambulatory function in patients older than 80 years: the Ambulatory Independent Discharge for Elderly (AIDE) project H Obata1, T Izumi2, A Uehara2, H Watanabe1, T Minamino1 1Niigata University, Niigata, Japan 2Niigata Minami Hospital, Niigata, Japan Background:Japan is thought to have the highest proportion of elderly people in the world; 26% are aged 65 years or above, and 13% aged 75 years or above. Accordingly, there are a large number of elderly persons with impaired gait who need rehabilitation. The Ambulatory Independent Discharge for Elderly (AIDE) project is our original rehabilitation program based on cardiac rehabilitation methods for restoration of independent gait in elderly inpatients. In this study, we studied the effects of AIDE rehabilitation in ambulatory function in very elderly patients, aged over 80 years. Methods:AIDE rehabilitation is comprised of prescribed, progressive aerobic, resistance, and balance trainings. In order to continue daily trainings at home after discharge, resistance and balance trainings were performed using the participants' own bodyweight, and not a special machine. AIDE rehabilitation was performed in inpatients who had ambulatory impairments during hospitalization. We compared the effects of AIDE rehabilitation program on gait speed and various physical performance measurements between patients aged from 60 to 79 years (elderly group) and those aged 80 years or above (very elderly group). Results:This study included 69 consecutive inpatients who received AIDE rehabilitation with patients' own body weight (20 patients in elderly group, 49 patients in very elderly group). The mean age was 86 ± 4 years, and 28 patients (57%) were women. Decreased gait speed <0.8 m/s was more common in very elderly group (63%) than elderly group (33%). Low knee extension strength <0.4 kgf/kg body weight was common in very elderly group (77%) than elderly group (53%); However the frequency of short functional reach <30 cm, and short one-leg standing duration <15 s were similar between two groups. By AIDE rehabilitation during 32 ± 20 days, the mean walking speed was significantly improved in both groups. The physical performance measurements including knee extension strength, functional reach, and one-leg standing duration were also improved in both groups. The improvement of gait speed was similar between very elderly group (36 ± 41%) and elderly group (35 ± 38%). The frequency of patients who restored independent gait at the time of discharge was similar between very elderly group (28%) and elderly group (24%). Conclusions:The simple exercise program of AIDE rehabilitation project, mainly by using the participants' own bodyweight, was effective in restoration of independent gait in elderly patients regardless of age. P600 The influence of training modalities on the effect of exercise training in patients with coronary artery disease: a meta-analysis J J Kraal1, T Vromen1, HMC Kemps2, G Van Valkenhoef3, J Kuiper3, N Peek4 1Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands 2Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands 3University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands 4University of Manchester, Department of Health eResearch Centre, Manchester, United Kingdom Topic: Sports cardiology Purpose:Exercise training in patients with coronary artery disease (CAD) improves their exercise capacity and long-term survival. However, training modalities (intensity, frequency, duration) differ between studies and it is unclear which training modality is most effective for improving exercise capacity. Therefore, we conducted a meta-analysis to study the influence of the different training modalities on the effect of exercise training. Methods:A systematic search was conducted in MEDLINE and EMBASE for papers published between 1 April 2007 and 1 September 2013, addressing CAD patients performing aerobic exercise training during cardiac rehabilitation. We included randomized studies that compared aerobic exercise training programs with other training regimes or with usual care, and that evaluated peak oxygen uptake as outcome measure. We performed univariate random effects meta-regressions on each of the following training modalities: training intensity (% heart rate), session duration (minutes), weekly session frequency, program duration (weeks), session energy expenditure (EE, intensity*duration), weekly EE (frequency*session EE) and total EE (program duration*weekly EE). The resulting models were ranked according to their fit. Results:A total of 14 studies were included, involving 747 patients. Overall, training intensity appeared to be the best predictor for improvement in exercise capacity. Peak oxygen consumption improved with 3.3 ml VO2.min-1.kg-1 for each 10% increase in exercise intensity (95%CI 1.35 to 5.32 ml VO2.min-1.kg-1, p=0.001). Total EE and weekly EE were significantly associated with exercise capacity as well (p=0.002 and p=0.020 respectively), while session EE, program duration and session duration were not. Weekly session frequency showed borderline significance (p=0.051). However, for all training modalities there was considerable heterogeneity in effect size (I2 ranging from 69% to 84%), indicating that there was unmeasured confounding. Conclusions:In CAD patients, exercise intensity appears to be the most important determinant of the improvement in exercise capacity after physical training. However, the considerable heterogeneity demands a cautious interpretation of the results. P601 Predictors of improvement of autonomic nervous system function in patients after cardiac rehabilitation P Rio1, A Abreu1, R Soares1, R Pereira-Da-Silva1, S Aguiar Rosa1, A Viveiros Monteiro1, I Rodrigues1, M Afonso Nogueira1, T Alves1, R Cruz Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Topic: Sports cardiology Purpose:Autonomic nervous system (ANS) can be evaluated, in the clinical practice, by measuring resting heart rate (RHR), heart rate recovery (HRR) or heart rate variability (HRV) during exercise test. These parameters have prognostic significance in secondary prevention. The aim of the present study is to assess the cardiac rehabilitation (CR) benefit on ANS and to determine which factors are associated with its improvement. Methods:Retrospective analysis of consecutive patients (pts) who underwent CR program (2004-2013), in a single center. 24-hour Holter HRV study, cardiopulmonary exercise testing (CPET), echocardiogram and blood tests were performed at baseline and after 36 exercise training sessions. The following parameters were evaluated: standard deviation of NN intervals (SDNN), ms, HRR, RHR, peak HR, bpm, peak oxygen uptake (pVO2), mL/Kg/min, production (VE/VCO2) slope, left ventricular ejection fraction (LVEF), %, glycaemia, sedimentation velocity (SV), high sensitive protein c reactive (hs-CRP), cholesterol level and natriuretic peptides. We studied the association of CAD risk factors, CPET, echocardiogram and blood tests parameters with SDNN, HRR and RHR improvement. Results:We analysed 208 pts, 85% male, mean age 56.7±10.4 years. Of these, 113 pts (55%) had ST-elevation myocardial infarction (STEMI) diagnosed. There were significant differences between pre- and post-CR values in: SDNN (120.5±41.2 vs 127.5±42.1, p=0.022), HRR (23.9±13.8 vs 26.7±12.4, p=0.029), basal HR (71.4±11.1 vs 69.3±10.6, p=0.01), peak HR (136.4±21.7 vs 139.2±21.9, p=0.025), HR reserve (64.9±21.3 vs 69.9±21.6, p<0.001), pVO2 (25.4±6.8 vs 27.4±7.2, p<0.001), VE/VCO2 (26.1±5.4 vs 24.4±4.8, p=0.049), LVEF (53.1±11.4 vs 54.7±10.5, p=0.031). Baseline non-obese (OR 2.75, 95% CI 1.4-5.4, p=0.004), hypertension (OR 1.87, 95% CI 1.0–3.5, p=0.047) and beta-blocker use (OR 4.84, 95% CI 1.1–22.3, p=0.043) were associated with RHR improvement; baseline non-diabetes (OR 3.4, 95% CI 1.4–8.7, p=0.009), LVEF > 35% (OR 4.6, 95% CI 1.1–20.3, p=0.044) and E/A ratio < 1 (OR 2.8, 95% CI 1.2–6.3, p=0.017) were associated with SDNN improvement; baseline reduced hs-CRP levels (OR 0.98, 95% CI 0.97–1, p=0.031), increased HDL (OR 1.04, 95% CI 1–1.07, p=0.021) and normal LVEF (OR 2.1, 95% CI 1.1–4.3, p=0.034) were associated with HRR improvement. Conclusion:CR program induced a positive modulation of the ANS function in different clinical settings. The absence of diabetes and obesity, as well, as the presence of normal LVEF and high HDL-cholesterol level predicted larger benefit on ANS balance. P602 Cardiac rehabilitation effectiveness: how good is it in stable coronary artery disease? P Rio1, A Abreu1, R Soares1, S Aguiar Rosa1, T Pereira-Da-Silva1, I Rodrigues1, A Viveiros Monteiro1, G Portugal1, M Afonso Nogueira1, R Cruz Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Topic: Sports cardiology Purpose:Cardiac Rehabilitation (CR) programs are effective in improving functional capacity and in reducing total and cardiovascular mortality. It is not completely clarified which groups of patients (pts) benefit more with exercise training. The aim of the present study is to compare the impact of CR in different clinical settings of pts with coronary heart disease and evaluate specifically the gain obtained in stable coronary artery disease (CAD) patients. Methods:Retrospective analysis of consecutive CAD pts who underwent CR program (2004-2013), in a single center. 24-hour Holter HRV study, cardiopulmonary exercise testing (CPET), echocardiogram and blood tests were performed at baseline and after 36 exercise training sessions. Exercise sessions were performed in hospital, three times a week, 60 minutes duration. The following parameters were evaluated: standard deviation of the average of NN intervals (SDNN), ms, basal heart rate (HR), peak HR, HR recovery, HR reserve, peak oxygen uptake (pVO2), %, left ventricular ejection fraction (LVEF), %, sedimentation velocity (SV), mg/dL, high density cholesterol (HDL), mg/dL, and natriuretic peptides (NT_proBNP), pg/mL. Patients were divided and analysed according previous event, in three groups: ST-elevation myocardial infarction (STEMI), non-STEMI and stable CAD. Results:We analysed 192 pts, 85% male, mean age 56.3±10.12 years. Of these, 113 pts (59%) had STEMI, 52 pts (27%) had non-STEMI and 27 pts (14%) had stable CAD. There were significant differences between pre- and post-CR values in: basal HR (71.2±10.6 vs 68.8±10.3, bpm, p=0.009), peak HR (137.7±21.8 vs 141.7±20.7, bpm, p=0.002), HR recovery (23.7±13.8 vs 27.6±12.2, bpm, p=0.003), HDL (38.5 ±10.6 vs 41.5±9.8, mg/dL, p<0.001), SDNN (120.1±40.4 vs 127.9±42.3, ms, p=0.015) and in the variables showed on the table. There were significant differences pre- and post-CR, between pts with STEMI and stable CAD in SV (?% 9.2 ±72.6 vs -17.9 ±45.1, p=0.042), NT_proBNP (?% -46.6 ±46.2 vs -0.1 ±65.9, p=0.007), pVO2 (? 10.2 ±30 vs -0.8 ±20.6, p=0.029) and LVEF (?% 4.5 ±16.6 vs 9.7 ±13.8, p=0.048). Conclusion:Cardiac rehabilitation program induced significant improvement of functional capacity, autonomic nervous system, cardiac function, HDL, and systemic inflammation in different clinical settings of coronary heart disease. Patients with stable CAD, although achieving less benefit in functional capacity, obtained a greater benefit in systolic function and in systemic inflammation reduction than patients with acute coronary syndromes. P603 The benefits of using short combined aerobic-resistance training versus load match aerobic training for cardiorespiratory responses in coronary heart disease PM Lepretre1, R Feron2, M Bulvestre1, T Porcher2, M Ghannem2 1University of Picardie Jules Verne, UFR-STAPS, Lab. Physiological Adaptations to Exercise and Rehabilitation (APERE), EA-3300, Amiens, France 2Centre de réadaptation Cardiaque , Tracy-Le-Mont, France Exercise was a component of secondary prevention in cardiac rehabilitation but its beneficial effects seemed to depend of type, duration and intensity of physical activity. To compare the effect of exercise modalities on cardiorespiratory responses, 16 men with coronary heart disease (59.2±6.5y, 1.75±0.07m, 84.3±14.9kg, LVEF: 0.53±0.08) performed 4 weeks of exercise rehabilitation based on combined aerobic – resistance training (CT, n=8) or aerobic training (AT, n=8) with similar training load, quantified using the session rating of perceived exertion. Maximal tolerated power (MTP), peak values of oxygen uptake (VO2peak) and heart rate and VO2 associated at the ventilatory anaerobic threshold (VAT) were determined during an incremental cycling exercise. Both training induced significant increases in VO2peak (15.5±2.8 vs. 19.2±5.3 mL.min-1.kg- 1, and 15.9±4.1 vs. 17.3±4.4 mL.min-1.kg-1, for CT and AT, respectively, p<0.05)) and MTP (CT: 110.4±24.9 vs. 139.6±24.8 watts and AT: 109.0±27.8 vs. 133.3±36.9 watts, p<0.01). In each group, a closer look at individual data show that training effects on VO2peak occurred in 6 out of 8 subjects (figure). In these subjects, improvements in VO2peak were larger after CT (+33.9 ± 17.9 % of pre-training VO2peak, i.e. +5.3 ± 2.8 mL.min-1.kg-1) than observed after AT (+13.4 ± 4.7 % of pre-training VO2peak, i.e. +2.0 ± 1.0 mL.min-1.kg-1) (p<0.01). Such observations could not be made for MTP (p>0.05). VO2 associated to VAT was significantly improved after CT but not after AT. In conclusion, these results suggested that short CT and AT programs improved cardiorespiratory responses with different central and peripheral adaptations. This might be taken into account for exercise rehabilitation according initial patient limitations. Open in new tabDownload slide Change in VO2peak with training P604 Mindfulness training in post-myocardial infarction patients with elevated depressive symptoms: a pilot study of feasibility and effectiveness O Lundgren1, P Garvin2, L Nilsson1, M Kristenson2, L Jonasson1 1Linkoping University, Department of medical and health sciences, division of cardiovascular medicine, Linkoping, Sweden 2Linkoping University, Department of medical and health sciences, division of community medicine, Linkoping, Sweden Topic: Sports cardiology Purpose:Depression is associated with an increased risk of recurrent cardiac events in patients with previous myocardial infarction (MI). Still, it remains a challenge to identify patients with depressive symptoms and offer appropriate treatment. In this study, we first investigated whether depressive symptoms remained one year after an MI. Secondly; we tested the feasibility and effectiveness of mindfulness-based stress reduction (MBSR) in post-MI patients with elevated depressive symptoms. Methods:Depressive symptoms were assessed by using the CES-D scale in 160 consecutive patients, one and twelve months after an MI. Based on these results, we defined an inclusion criterion for depressive symptoms and started a new screening of 171 patients. Patients were invited to participate in an 8-week MBSR group intervention. CES-D scores and GAD-7 scores (anxiety) were determined before and after the program. Results:The first screening showed CES-D scores of median 7 (IQR 3;12) at 1 month, and remained unchanged after 12 months, median 7 (3;12). In the second screening, 79 patients with CES-D scores > 7 at 1 month were invited to participate in MBSR. Twenty-nine patients accepted, of whom 24 started MBSR and 16 completed the full program. In this group, mean CES-D scores were 19.2 (median 18) at screening, 19.8 (18) pre-MBSR and 13.3 (14) post-MBSR; a decrease by 33 %, (p=0.006). Mean GAD-7 scores changed from 7.5 (median 7,5) to 4.3 (4.5) after the intervention; a decrease by 43% (p=0.004). Conclusions:Data from the yearlong follow-up of post-MI patients showed unchanged levels of depressive symptoms. We invited patients with CES-D > 7 to an 8-week MBSR intervention and found that 20 % accepted to participate and also completed the program. Depressive symptoms and anxiety were significantly reduced, lending support to MBSR as a promising tool for selected post-MI patients. P605 Recognition of depression in medical settings N Pogosova1, A Kursakov1, V Vygodin1 1National Center for Preventive Medicine, Moscow, Russian Federation Depression is a well established cardiovascular risk factor. Depression and even minor depressive symptoms are associated with lower medication adherence and worse prognosis. Although depression is highly prevalent, it is still underdiagnosed and undertreated. The use of short screening questionnaires may improve the recognition of depression in different medical settings. The Patient Health Questionnaire (PHQ -9) has become increasingly popular in research and practice over the past decade in a number of countries, and have not been adapted for Russian-speaking populations before the current study. Aim:We conducted this study to evaluate the validity of the Russian version of PHQ-9 as a screening tool for detecting depression in a sample of general medical practice patients. Methods:193 consecutive patients (63 men and 130 women; mean age 34.6+11.4 years) attended a general medical practice setting completed the PHQ-9 questionnaire and then were interviewed by a psychiatrist in a blind manner. The gold standard was the structured diagnostic interview, based on the International Classification of Diseases-10 criteria for depressive episode. Statistical analysis has been done to estimate sensitivity, specificity and positive predictive value and posttest likelihood of a negative test. Results:The results are presented in the Table 1. The optimal cut-off point for detecting depression was 10 (with sensitivity of 68.9% and specificity of 93.3%). Conclusions:The brief Patient Health Questionnaire (PHQ-9) was found to have acceptable screening properties for detecting depression in the primary care setting for cuff-of point 10. cut-off score Sensitivity, % Specificity, % Positive predictive value , % Posttest likelihood of a negative test, % =5 97.3 (72/74) 40.3 (48/119) 50.3 4 =10 68.9 (51/74) 93.3 (111/119) 86.4 17.2 =15 68.9 (51/74) 100 (119/119) 99.6 29.2 =20 10.9 (8/74) 100 (119/119) 98.8 35.8 cut-off score Sensitivity, % Specificity, % Positive predictive value , % Posttest likelihood of a negative test, % =5 97.3 (72/74) 40.3 (48/119) 50.3 4 =10 68.9 (51/74) 93.3 (111/119) 86.4 17.2 =15 68.9 (51/74) 100 (119/119) 99.6 29.2 =20 10.9 (8/74) 100 (119/119) 98.8 35.8 Open in new tab cut-off score Sensitivity, % Specificity, % Positive predictive value , % Posttest likelihood of a negative test, % =5 97.3 (72/74) 40.3 (48/119) 50.3 4 =10 68.9 (51/74) 93.3 (111/119) 86.4 17.2 =15 68.9 (51/74) 100 (119/119) 99.6 29.2 =20 10.9 (8/74) 100 (119/119) 98.8 35.8 cut-off score Sensitivity, % Specificity, % Positive predictive value , % Posttest likelihood of a negative test, % =5 97.3 (72/74) 40.3 (48/119) 50.3 4 =10 68.9 (51/74) 93.3 (111/119) 86.4 17.2 =15 68.9 (51/74) 100 (119/119) 99.6 29.2 =20 10.9 (8/74) 100 (119/119) 98.8 35.8 Open in new tab P606 The effects of thyroid hormones and inflammatory markers on health-related quality of live in coronary artery disease patients admitted for cardiac rehabilitation program J Brozaitiene1, N Mickuviene1, M Staniute1, N Kazukauskiene1, R Bunevicius1 1Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania The aim of the study was to evaluate the effects of thyroid hormones and inflammatory markers on health-related quality of live (HRQoL) in coronary artery disease (CAD) patients depending on the severity of the disease. Methods:640 CAD patients, 2 weeks after acute myocardial infarction (MI) or unstable angina pectoris, admitted for rehabilitation program (RP), were invited in the study. All patients (mean age 58±9 years, 76% male) were evaluated for demographic, clinical data, the New York Heart Association (NYHA) class and HRQoL using the 36-item Short Form Medical Outcome Questionnaire (SF-36). Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety (HADS-A) and depression (HADS-D) symptoms. Serum concentrations of high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), thyroid hormones: free T3 (T3), free thyroxine (T4), reverse T3, total T4 were analyzed. Univariate and multivariate linear regression models were used to examine relationships between all thyroid hormones, inflammation markers and HRQoL separately for NYHA I-II and NYHA III class patients. Results:In sum, 420 patients (63%) were after MI, 429 (67%) – after percutaneous coronary intervention, 521 (81%) were NYHA I-II, 119 (19%) – NYHA III class. Multivariate linear regression analyses, adjusted for gender, age, angina pectoris class, HADS-A and HADS-D score revealed that in NYHA I-II class patients higher hs-CRP (?-.097, p<.05), IL-6 concentrations (?-.141, p<.01) were associated with poorer physical functioning, lower IL-6 - with less pain (?-.088, p<.05) and higher free T3 (?.093, p<.05) - with fewer role limitation due to physical problems. In NYHA III class patients, after controlling for potential confounders, higher concentrations of hs-CRP was associated with more role limitations due to emotional problems (?-.212, p<.05), more expressed pain (?-.224, p<.05). Better perception of mental health was related with higher reverse T3 (?.183, p<.05), lower free T3 (?-.173, p<.05), and greater energy/vitality - with higher reverse T3 (?.208, p<.05). Conclusions:In CAD patients post-acute cardiac events with NYHA I-II class admitted for RP higher concentrations of hs-CRP, IL-6 and lower free T3 are associated with poorer physical problems and pain components of HRQoL. In NYHA III class patients lower reverse T3 level is associated with worse mental health, lower energy/vitality and elevated levels of hs-CRP, IL-6 – with poorer mental and increased pain components of HRQoL. This research was funded by the European Social Fund under the Global Grant measure, Grant VP1-3.1-SMM-07-K-02-060. P607 Smoking cessation intervention after acute myocardial infarction, predictors of relapse R A Mori Junco1, R Dalmau Gonzalez Gallarza1, A Castro Conde1, O Gonzalez Fernandez1, C Alvarez Ortega1, Z Blazquez Bermejo1, J Caro Codon1, I Ponz De Antonio1, JL Lopez Sendon1 1University Hospital La Paz, Cardiology, Madrid, Spain Background:Taking into account the burden of tobacco in cardiovascular prognosis, smoking cessation is a priority in secondary prevention programs. We analysed the predictors of relapse of a smoking cessation intervention in coronary disease patients. Methods:448 smoker patients (85,5% male) referred to a cardiac rehabilitation program after a recent admission for acute myocardial infarction were analyzed. Most of them were heavy smokers (mean consumption of 24,5 cig/day, 41,2 pack-year). The intervention was based in an average of 3 individual visits during the first 3 months, one group session, and one follow-up visit after 6 months. Diet and exercise counselling was given. First line smoking cessation pharmacotherapy was offered to all patients as a possibility. Smoking abstinence was confirmed with co-oximetry at 3 and 6-month follow-up visits. A multivariate analysis was performed in order to study the predictors of relapse. Results:mean age was 53.6, 57% were hypertensive, 23% diabetic, 60% dislipidaemic, 27% obese and 7% had been previously diagnosed with chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation was requested in 31%, varenicline was used in 57% of them, nicotine replacement therapy in 33% and bupropion in 10%. Patients lost to follow-up (3% at month 3, 6% at month 6) were considered as having relapsed. Abstinence rate was 76,6% at month 3, and 71% at month 6. Following a multivariate analysis, the predictors of relapse were found to be the number of cigarettes smoked per day, the number of pack-year, the use of smoking cessation drugs, dropping out of the program, and having a previous condition of COPD. Conclusion:smoking cessation interventions after an acute myocardial infarction are effective. A high degree of motivation facilitates the abstinence even in the absence of pharmacotherapy. A high degree of addiction and dependence, the need of smoking cessation drugs, lack of adherence and a previous condition of COPD were predictors of relapse. Abstinence Relapse p Cig/day 23,2 29,5 <0,001 Pack-year 38,4 51,6 <0,001 Non adherence to the program 6,3% 29,5% <0,001 Pharmacotherapy use 19,8%% 54,3% <0,001 Abstinence Relapse p Cig/day 23,2 29,5 <0,001 Pack-year 38,4 51,6 <0,001 Non adherence to the program 6,3% 29,5% <0,001 Pharmacotherapy use 19,8%% 54,3% <0,001 Open in new tab Abstinence Relapse p Cig/day 23,2 29,5 <0,001 Pack-year 38,4 51,6 <0,001 Non adherence to the program 6,3% 29,5% <0,001 Pharmacotherapy use 19,8%% 54,3% <0,001 Abstinence Relapse p Cig/day 23,2 29,5 <0,001 Pack-year 38,4 51,6 <0,001 Non adherence to the program 6,3% 29,5% <0,001 Pharmacotherapy use 19,8%% 54,3% <0,001 Open in new tab P608 Effects of smoking cessation on autonomic nervous system among patients attending a cardiac rehabilitation program P Rio1, A Abreu1, R Soares1, T Pereira-Da-Silva1, A Viveiros Monteiro1, S Aguiar Rosa1, I Rodrigues1, M Afonso Nogueira1, P Pinto-Teixeira1, R Cruz Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Topic: Sports cardiology Purpose:Tobacco use leads to an increased sympathetic nerve activity and therefore a dysfunction of autonomic nervous system (ANS). These alterations may play an important role in the relation between smoking and mortality. Smoking cessation alone has been associated with ANS improvement. The objective of this study is to evaluate the effect of cardiac rehabilitation (CR) and smoking cessation on ANS in patients (pts) with coronary artery disease (CAD). Methods:Retrospective analysis of CAD pts who underwent CR program (2004-2013), in a single center. 24-hour Holter HRV study and cardiopulmonary exercise testing were performed at baseline and after 12-week training program. Exercise sessions were performed three times a week, 60 minutes duration. The following parameters were evaluated: standard deviation of the average of NN intervals (SDNN), resting heart rate (RHR) and heart rate recovery (HRR) in the first minute. Pts were analysed according to tobacco use and smoking cessation. Results:We analysed 168 pts, 85% male, mean age 57.3±10.4 years. Of these, 47% were smokers and 61% of these quit smoking. According to non-smoking vs smoking patients, there were no significant differences, between basal values of: RHR (72 ±11 vs 71±11, p=ns), HRR (24±12 vs 22±12, p=ns), SDNN (115±38 vs 121±43, p=ns). In the group of persistent smoking there were not significant difference between pre and post-CR values of: RHR (70 ±11 vs 71±11, p=ns), HRR (25±12 vs 25±12, p=ns), SDNN (117±37 vs 115±36, p=ns). There were significant differences between pre and post-CR values of RHR, HRR and SDNN, in non-smokers patients and those who quit smoking. This analysis is shown on the table. Conclusion:Non-smoking and smoking cessation significantly enhances cardiac autonomic function in patients with coronary artery disease after a cardiac rehabilitation program. Instead, patients who sustained smoking habits have not improved the autonomic nervous system. *for the differences between the two groupsCR = cardiac rehabilitationns = not significant Non-smoking Smoking Cessation Parameters Before CR After CR Variation, % p value Before CR After CR Variation, % p value p value* Resting HR ( bpm ) 72 ± 11 69 ±9 - 2.3 ±16 0.004 71 ± 9 67 ±10 -6.2 ±10 0.01 0.038 HR recovery ( bpm ) 24 ±11 29 ± 12 4.2 ± 12 0.001 24 ±10 32 ±14 6.9 ± 12 0.02 ns SDNN ( ms ) 115 ±38 128 ±44 16 ±40 0.002 121 ±31 134 ±38 13 ±29 0.03 ns Non-smoking Smoking Cessation Parameters Before CR After CR Variation, % p value Before CR After CR Variation, % p value p value* Resting HR ( bpm ) 72 ± 11 69 ±9 - 2.3 ±16 0.004 71 ± 9 67 ±10 -6.2 ±10 0.01 0.038 HR recovery ( bpm ) 24 ±11 29 ± 12 4.2 ± 12 0.001 24 ±10 32 ±14 6.9 ± 12 0.02 ns SDNN ( ms ) 115 ±38 128 ±44 16 ±40 0.002 121 ±31 134 ±38 13 ±29 0.03 ns Open in new tab *for the differences between the two groupsCR = cardiac rehabilitationns = not significant Non-smoking Smoking Cessation Parameters Before CR After CR Variation, % p value Before CR After CR Variation, % p value p value* Resting HR ( bpm ) 72 ± 11 69 ±9 - 2.3 ±16 0.004 71 ± 9 67 ±10 -6.2 ±10 0.01 0.038 HR recovery ( bpm ) 24 ±11 29 ± 12 4.2 ± 12 0.001 24 ±10 32 ±14 6.9 ± 12 0.02 ns SDNN ( ms ) 115 ±38 128 ±44 16 ±40 0.002 121 ±31 134 ±38 13 ±29 0.03 ns Non-smoking Smoking Cessation Parameters Before CR After CR Variation, % p value Before CR After CR Variation, % p value p value* Resting HR ( bpm ) 72 ± 11 69 ±9 - 2.3 ±16 0.004 71 ± 9 67 ±10 -6.2 ±10 0.01 0.038 HR recovery ( bpm ) 24 ±11 29 ± 12 4.2 ± 12 0.001 24 ±10 32 ±14 6.9 ± 12 0.02 ns SDNN ( ms ) 115 ±38 128 ±44 16 ±40 0.002 121 ±31 134 ±38 13 ±29 0.03 ns Open in new tab P609 Differences in lipid profile between current smokers and non smokers after acute myocardial infarction Z Blazquez Bermejo1, R Mori Junco1, R Dalmau1, A Castro1, C Alvarez1, J Caro Codon1, I Ponz De Antonio1, D Gemma1, SO Rosillo1, JL Lopez-Sendon1 1University Hospital La Paz, Cardiology, Madrid, Spain Topic: Sports cardiology Purpose:Smoking is an important risk factor of cardiovascular disease, whose deleterious effect is enhanced by the induction of smoking-related l?d abnormalities. We compared the l?d profile of patients with a recent acute myocardial infarction (AMI) according to their smoking status. Methods:611 patients admitted to a cardiac rehabilitation program after an AMI were analyzed. 84% were male, 57% current smokers, 22% former smokers. We analyzed the lipid profile from a fasting blood test performed during admission. Results (see table): Active smokers with AMI were on average 8 years younger, nevertheless sedentarism was more prevalent in smokers. Obesity was more prevalent in non smokers, but obesity and being overweight were also common conditions in active smokers, despite the anorexic properties of nicotine. L?d profile in current smokers was particularly unfavorable, with significantly lower level of HDL cholesterol (HDL-c), and higher level of triglycerides (TG). Smokers were more likely to have HDL=35 mg/dl (57% vs 40%, p<0,001), and TG>150 mg/dl (41% vs 29%, p=0,003). The TG to HDL ratio, an accepted predictor of insulin resistance when =3,5, was significantly higher in smokers. Conclusion:Active smoking is commonly related to other lifestyle abnormalities, whose interaction promotes a particularly atherogenic l?d profile, and a higher insulin resistance. Besides the smoking cessation intervention, a complete lifestyle correction should be a target in secondary prevention programs. BMI: body mass index Current smokers Non smokers p Age 53,6 61,3 <0,001 Sedentarism 67% 56% 0,018 Diabetes 25% 29% NS Hypertension 41% 67% <0,001 Total colest. (mg/dl) 117,7 167,1 0,009 HDL-c (mg/dl) 35,5 37,9 0,001 LDL-c (mg/dl) 116,1 105,6 0,001 TG (mg/dl) 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 TG/HDL-c =3,5 61,4% 38,3% 0,006 BMI (kg/m2) 27,4 28,6 0,001 Current smokers Non smokers p Age 53,6 61,3 <0,001 Sedentarism 67% 56% 0,018 Diabetes 25% 29% NS Hypertension 41% 67% <0,001 Total colest. (mg/dl) 117,7 167,1 0,009 HDL-c (mg/dl) 35,5 37,9 0,001 LDL-c (mg/dl) 116,1 105,6 0,001 TG (mg/dl) 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 TG/HDL-c =3,5 61,4% 38,3% 0,006 BMI (kg/m2) 27,4 28,6 0,001 Open in new tab BMI: body mass index Current smokers Non smokers p Age 53,6 61,3 <0,001 Sedentarism 67% 56% 0,018 Diabetes 25% 29% NS Hypertension 41% 67% <0,001 Total colest. (mg/dl) 117,7 167,1 0,009 HDL-c (mg/dl) 35,5 37,9 0,001 LDL-c (mg/dl) 116,1 105,6 0,001 TG (mg/dl) 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 TG/HDL-c =3,5 61,4% 38,3% 0,006 BMI (kg/m2) 27,4 28,6 0,001 Current smokers Non smokers p Age 53,6 61,3 <0,001 Sedentarism 67% 56% 0,018 Diabetes 25% 29% NS Hypertension 41% 67% <0,001 Total colest. (mg/dl) 117,7 167,1 0,009 HDL-c (mg/dl) 35,5 37,9 0,001 LDL-c (mg/dl) 116,1 105,6 0,001 TG (mg/dl) 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 TG/HDL-c =3,5 61,4% 38,3% 0,006 BMI (kg/m2) 27,4 28,6 0,001 Open in new tab P611 Strong correlation of central hemodynamic and peripheral skeletal muscle function in stable heart failure patients C Deluigi1, M Nil1, D Herzig1, J-P Schmid1, P Eser1, M Wilhelm1 1Bern University Hospital, Cardiology, Bern, Switzerland Background:Reduced exercise capacity is a prominent limiting symptom in patients with congestive heart failure (CHF), and attributable to both central and peripheral factors. We aimed to investigate the relationship between peak oxygen uptake (VO2), cardiac output (CO), and peripheral muscle function in chronic, stable CHF patients. Methods:CHF patients, who had completed a 3-months outpatient cardiac rehabilitation program at our institution within the last 5 years were contacted. Clinically stable patients with a history of CHF of at least 6 months were included. A cross-sectional observational study design was chosen. Participants underwent a symptom limited cardiopulmonary exercise test (CPET) for assessment of peak VO2, followed by isometric knee-extension force measurements (Fmax) and peripheral quantitative computed tomography for measurement of thigh cross-sectional muscle area (CSAthigh). During a separate session, stress hemodynamic measurement by means of inert gas rebreathing (IGR) was performed to assess maximum CO. Parameters were indexed for body weight, body surface area or CSAthigh, as appropriate. Correlations were assessed using Pearson's R. Results:A total of 27 patients were included in the study. Isometric knee-extension force data was of sufficient quality in 25, and data of CO measurements in 17 patients. Mean age was 63±9 years, mean body mass index 28.1±5.7 kg/m2, resting left ventricular ejection fraction was 35±11%. During CPET, peak VO2 was 17.7±5.2 ml*min-1*kg-1 (range 9.8 to 28.9 ml*min-1*/kg-1), and maximum work rate was 1.39±0.57 W*kg-1. IGR revealed a resting cardiac index (CI) of 1.5±0.3 L*min-1*m-2, and a peak CI of 4.9±1.1 L*min-1*m-2. Fmax was 444.8±159.1 N, Fmax*kg-1 was 5.3±1.5 N*kg-1, and Fmax*CSAthigh-1 was 5.4±1.3 N*cm-2. There were significant correlations of peak VO2 with absolute parameters: peak work rate (r =0.926, p<0.001), CO (r=0.839, p<0.001), and Fmax (r=0.854, p<0.001), and also for peakVO2*kg-1 with normalized parameters: peak CI (r =0.793, p<0.001), Fmax*kg-1 (r=0.793, p<0.001), and Fmax*CSAthigh-1 (r=0.676, p<0.001). The duration of CHF showed no correlation with exercise capacity and parameters of muscle function. Conclusion:In our sample of chronic, stable CHF patients, exercise capacity was strongly related to both central and peripheral factors. This may be due to reciprocal adaptation of hemodynamic and muscular parameters over time. P612 Exercise NT-pro-BNP and global longitudinal strain in systemic lupus erythematosus patients G Gusetu1, D Pop1, D Pop-Mindru1, D Zdrenghea1 1University of Medicine and Pharmacy, Cluj-Napoca, Romania Background:Systemic lupus erythematosus (SLE) patients present many times myocardial involvement, this being recommended to be early detected to optimize the treatment and to avoid or postpone the cardiac decompensation. Methods:There were studied 41 SLE patients, 46±11.79 years, 75.6% females and 20 healthy controls 48.2±9.82 years, 75% females. All SLE patients did not present clinical heart diseases. All subjects were submitted to an echo Doppler examination diastolic and systolic function, including global longitudinal strain (GLS) being determinated. All SLE patients but not healthy controls performed a cardiopulmonary exercise testing (CPE) on cycloergometer, peak exercise capacity being determined. Before exercise, at peak effort and two hours after exercise venous blood samples were obtained and NT-pro-BNP determined using ELISA method. Results:The LVEF was more than 50% in all healthy controls and SLE patients. In turn global longitudinal strain was significantly less in SLE patients (19.15%±1.21 vs 20.45%±1.49, p=0.045). 38.9% of SLE patients presented diastolic dysfunction, in this group GLS being less than in patients with normal diastolic function (18.77±0.84 % vs 19.49±0.91%). This suggest an early involvement of systolic performance, more important in patients with already diastolic dysfunction. During CPE the patients performed a mean 74.77%±10.96% of predicted VO2 Max. The mean values of NT-pro-BNP were: 134.15±64.2pg/ml at rest, 190.17±134.20 pg/ml at peak effort and 233.22±161.13 pg/ml post effort, p>0.005. No correlation was registered between GLS and peak VO2, being known the absence of correlation between systolic performance and exercise capacity even in heart failure patients. In turn it was a negative significant correlation between GLS ant NT-pro-BNP at peak effort (r=-0.499) and post exercise (r=-0.513). Conclusion:The results suggest that exercise NT-pro-BNP can be used together with GLS for early detection of systolic dysfunction in SLE patients. P614 The presence of glucose metabolic disorders and subclinical renal insufficiency in patients with ischemic heart disease S Kostic1, I Tasic2, D Djordjevic2, D Lovic3, D Mijalkovic4 1Institute for Therapy & Rehabilitation "Niska Banja", Niska Banja, Nis, Serbia 2University of Nis, Medical Faculty, Nis, Serbia 3Clinic for internal disease InterMedica-dr Lovic, Nis, Serbia 4Clinic for internal disease "Kardiomedika", Nis, Serbia Microalbuminuria is the earliest indicator of renal disease attributable to diabetes. Several studies has shown microalbuminuria to be predictive of total mortality and cardiovascular mortality and morbidity. Topic: Sports cardiology Purpose:To evaluate the presence of glucose metabolic disorders and subclinical renal insufficiency in patients with ischemic heart disease Metod:The study included 142 patients, with coronary heart disease (mean age 64,01±8,6 years, 108 (76 %) men,) who were in a rehabilitation at the Institute for Treatment and Rehabilitation "Ni?ka Banja". For all patients there was determined: presence of risk factors for cardiovascular disease (hypertension, hyperlipidemia, smoking, diabetes, obesity, gender, age), laboratory analyses, anthropometric measurements, creatinine clearance (CrCl) using Cocroft – Gault equation, eGFR, albumin/creatinine ratio (ACR), oral glucose tolerance test (OGTT) for subjects without diabetes. Results:According to the presence of diabetes patients were divided into two groups. The first group (I) consisted of subjects without DM, n=99 (69,7%), the second (II) group patients with DM, n=43 (30,3%). The first group had a significantly higher average number of risk factors (p<0,0001) but no significant differences in age and the presence of hypertension. Abnormal OGTT was found in 43 (43,4%) of patients from the first group: 19 (19,2%) had diabetes, 24 (24%) impaired glucose tolerance and was correlated with age. Decline in CrCl (< 89 ml/min) was found in 58% patients I gr. vs 63 % in II gr., <60 ml/min in 24,4:25,6%, n.s. Abnormal ACR was found in 34(34%) of patients I gr. vs 18 (41%) in II gr., n.s. There was no significant difference in mean creatinine and CrCl (I gr. 84±29 vs II gr.79,8±23) between the two groups. Conclusion:Patients with unknown history of diabetes have a high incidence of glucose metabolic disorders and subclinical renal insufficiency. OGTT and ACR can identify individuals with subclinical disease requiring a more aggressive treatment of risk factors and more intensive therapy. P617 Depression and cardiovascular disease in the diabetic patient: probably more than just a fling SL Mosteoru1, G Mut-Vitcu2, R Timar2, S Mancas1, D Gaita1 1University of Medicine Victor Babes, Cardiology, Timisoara, Romania 2University of Medicine Victor Babes, Diabetes, Nutrition and Metabolic disorders Department, Timisoara, Romania Recent studies have brought to light that people with diabetes mellitus (DM) have twice the risk compared to the general population of developing long-term symptoms of depression, which represents a risk factor for coronary heart disease. We have designed a study aimed at uncovering if depressed diabetic patients have a higher incidence of cardiovascular complications and have also evaluated the relationship between the presence of depression and glycemic control in patients suffering from diabetes mellitus. We have conducted a cross-sectional study on 1346 patients suffering from DM admitted to the Diabetes Department of the Emergency County Hospital between January and December 2012. All relevant information was extracted from patient charts: demographic data, DM type and duration, DM treatment, weight status, HbA1c, presence of cardiovascular complications. Out of the 1346 patients included in our study 54% were males. 8.5 % of the entire population has been also diagnosed with depression. Depression was found in 7.9% of patients with type 1 DM, while the prevalence of depression was 8.6% in the type 2 DM category. There was statistical significance between diabetes mellitus and depression (p < 0.05). The mean value of HbA1c was 9.2% in patients suffering from both DM and depression and 8.9% in diabetic patients only. Patients with DM and depression were able to achieve the < 8% HbA1c target in 29.31% of the cases, while those without depression in 32.59% of the cases. Our conclusions highlight the need for active screening for depression in diabetic patients due to the potential of this complication being overlooked and also in order to ensure that preventive action is taken. Further research is necessary to disentangle causal relationships among depression, diabetes complications, cardiovascular disease and mortality. P620 Prevalence of unknown polyvascular arterial disease in patients with coronary artery disease and its impact on the major adverse events S Kostic1, I Tasic2, D Djordjevic2, D Lovic3, D Mijalkovic4 1Institute for Therapy & Rehabilitation "Niska Banja", Niska Banja, Nis, Serbia 2University of Nis, Medical Faculty, Nis, Serbia 3Clinic for internal disease InterMedica-dr Lovic, Nis, Serbia 4Clinic for internal disease "Kardiomedika", Nis, Serbia Topic: Sports cardiology Purpose:The aim of the study is to evaluate the prevalence of polyvascular arterial disease (carotid and peripheral disease) in patients with coronary artery disease and its impact on the major adverse events. Methods:The study involved 100 patients with coronary heart disease (mean age 59.7± 10 years, 55% men) who were in a rehabilitation at the Institute. For all patients there was determined: presence of risk factors for cardiovascular disease (hypertension, hyperlipidemia, smoking, diabetes, obesity, age), laboratory analyses, anthropometric measurements, ankle–brachial index (ABI), carotid ultrasound imaging and coronarography. ABI was calculated as the ratio of pressure in the pedal segments of tibial arteries to that in brachial artery. Intraluminal lesions carotid artery were documented using B-mode imaging and defined as carotid intima-media thickness (CIMT) and plaques as focal intimal protuberances. Results:The average number of risk factors was 2,79±1,03, the most common were hypertension 80.0% and dyslipidaemia 86.0%. The average number of atherosclerosis involved coronary blood vessels was 2.22±0.81. All the patients had atherosclerotic changes, in 46.0% observed in three blood vessels, in 30.0% in two, and in 24.0% in one vessel. The average value of ABI was 1.02±0.21, ranged from 0.71 to 1.50. Patological value ABI was found in 59(59%) patients, 41,0% had reduced ABI values (=0.9), 18.0% higher values (>1.3). The average value of CIMT was 0,98±0,21. Abnormal CIMT values ?128;??128;?were observed in 51% of patients, 71% had one or more carotid plaques with an average stenosis 35,3±20,8%. Carotid stenosis higher than 50 % had 17 % patients. Polyvascular disease (PVD) - the changes in coronary, carotid and peripheral arteries at the same time, was found in 47(47%) participants. There was a significant correlation between the presence of PVD and age, the average number of risk factors and the presence of diabetes. After 4 years, a major adverse cardiac event (MACE) had 13(16.7%) patients; 3(3.8%) patients had cardiac death, 5% myocardial infarction, 5% new PCI and 2,5% stroke. Among patients with polyvascular disease MACE were significantly higher 10 (21%) v.s 3 (5,6%), p=0,02. Conclusion:Patients with ischaemic heart disease often have multiple arterial disease. Patients with PVD are at higher risk for future cardiovascular events. P622 Abnormal findings in resting electrocardiograms and their association with hypertension. A Piwonska1, W Piotrowski1 1Institute of Cardiology, Warsaw, Poland Topic: Sports cardiology Purpose:the evaluation of abnormal findings in resting electrocardiograms (ECGs) of hypertensive persons (treated or untreated) compared to healthy persons, and the association between the ecg findings and hypertension status. Methods:random sample of 2783 men and 2835 women, aged 35-64, examined in the frame of Pol-MONICA study in 1984, 1988, and 1993. Hypertension (HT) was defined as BP = 140/90mmHg or hypotensive treatment. Resting ECGs were coded using Minnesota code. The following ECG categories were created: abnormal Q wale (Q), ST depression (ST), abnormal T wave (T), AV blocks, His bundle branch blocks (HBBB), left ventricle hypertrophy (LVH), arrhythmia (atrial flutter or fibrillation (ARR), and ischemic ECG findings (IEF: Q or ST or T). Results:HT was found in 1515 (54.4%) men and 1345 (47.4%) women. In hypertensive persons the most often observed ECG finding were HBBBs (10% In both genders), and additionally in men T (4.2%), Q (3.3%) and ST (2.4%), and in women T (5.8%) and ST (3.5%). Abnormal findings were 3-times more often found in hypertensive persons compared to normotensives, except for HBBBs, AV-blocks in both genders, and additionally ARR in men. IEF were significantly more often observed in persons with HT compared to healthy persons (men: 6.9% vs 2.8%, p=0.001; women: 7.9% vs 4.2%, p=0.001). Analyzing 3 groups: persons with treated HT, persons with untreated HT and healthy persons we found the highest percentage of persons with abnormal ECG in the group of persons with treated HT. ST and T in men and T in women occurred significantly and independently of coronary artery disease history and age associated with HT status. Conclusions:Abnormal ECG findings were observed significantly more often in resting electrocardiograms of hypertensive persons compared to healthy persons, and most often in persons with treated hypertension. Abnormal T wave and ST depression occurred significantly associated with hypertension independently of age and the history of coronary artery disease. P623 Ethnic differences in self-reported risk profile of stroke survivors in urban suriname A V Jarbandhan1, S M Baldew1, F S Diemer2, J Q Aartman3, G A Van Montfrans3, G P Oehlers2, L M Brewster3, J R Toelsie4, H E J Veeger5, L Vanhees1 1Catholic University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium 2Academic Hospital Paramaribo, Department of Cardiology, Paramaribo, Suriname 3Academic Medical Center of Amsterdam, Vascular Medicine, Amsterdam, Netherlands 4Anton de Kom University of Suriname, Physiology, Paramaribo, Suriname 5VU University, Faculty of Human Movement Sciences, Amsterdam, Netherlands Topic: Sports cardiology Purpose:Describe ethnic disparities in cardiovascular risk factors among stroke survivors. Methods:1478 persons aged 18-70 years participated in the HELISUR study. Participants were asked about their history of hypertension, diabetes, smoking, hypercholesterolemia and TIA. Logistic regression explored the association between ethnicity and the prevalence of stroke. Results:Stroke was reported by 4.1% South Asians, 3.6% Creole, 2.0% Indonesian and 1.8% Maroons. The first exploratory logistic regression analyses showed that South Asians have a significant 2.5 times higher chance of experiencing stroke compared to Maroons. Other comparisons between ethnic groups appeared not to be significant. Conclusion:Preliminary findings show that significant ethnic disparities may exist in stroke prevalence. Multiple regression analyses should be performed to account for potential confounding effects of CVD risk behavior. Future results should indicate whether targeted secondary prevention will be necessary to decrease differences among South Asian stroke survivors. Significance level was set at 0.05 Ethnic groups South Asians (N=544) Creole (N=388) Indonesian (N=150) Maroons (N=396) Stroke crude prevalence (%) (N) 4.1 % (22) 3.6% (14) 2.0% (3) 1.8% (7) Age-groups: 30-40 years 2.8 1.2 3.7 2.1 40-50 years 3.6 3.8 2.0 1.6 50-60 years 6.5 10.9 4.3 2.3 60-70 years 11.2 2.4 0 6.2 Gender (M/F) (N) 17/5 8/6 1/2 2/5 Smoking (%) 7.3 6.7 1.8 3.2 Hypertension (%) 6.4 8.6 3.4 7.6 Diabetes mellitus (%) 11 10.8 0 6.2 TIA (%) 25 41.6 100 14.2 Hypercholesterolemia (%) 8.1 6.8 0 0 Logistic regression Significance OR Creole compared to South Asian 0.73 0.89 Indonesian compared to South Asian 0.25 0.49 Maroons compared to South Asian 0.05 0.43 Ethnic groups South Asians (N=544) Creole (N=388) Indonesian (N=150) Maroons (N=396) Stroke crude prevalence (%) (N) 4.1 % (22) 3.6% (14) 2.0% (3) 1.8% (7) Age-groups: 30-40 years 2.8 1.2 3.7 2.1 40-50 years 3.6 3.8 2.0 1.6 50-60 years 6.5 10.9 4.3 2.3 60-70 years 11.2 2.4 0 6.2 Gender (M/F) (N) 17/5 8/6 1/2 2/5 Smoking (%) 7.3 6.7 1.8 3.2 Hypertension (%) 6.4 8.6 3.4 7.6 Diabetes mellitus (%) 11 10.8 0 6.2 TIA (%) 25 41.6 100 14.2 Hypercholesterolemia (%) 8.1 6.8 0 0 Logistic regression Significance OR Creole compared to South Asian 0.73 0.89 Indonesian compared to South Asian 0.25 0.49 Maroons compared to South Asian 0.05 0.43 Open in new tab Significance level was set at 0.05 Ethnic groups South Asians (N=544) Creole (N=388) Indonesian (N=150) Maroons (N=396) Stroke crude prevalence (%) (N) 4.1 % (22) 3.6% (14) 2.0% (3) 1.8% (7) Age-groups: 30-40 years 2.8 1.2 3.7 2.1 40-50 years 3.6 3.8 2.0 1.6 50-60 years 6.5 10.9 4.3 2.3 60-70 years 11.2 2.4 0 6.2 Gender (M/F) (N) 17/5 8/6 1/2 2/5 Smoking (%) 7.3 6.7 1.8 3.2 Hypertension (%) 6.4 8.6 3.4 7.6 Diabetes mellitus (%) 11 10.8 0 6.2 TIA (%) 25 41.6 100 14.2 Hypercholesterolemia (%) 8.1 6.8 0 0 Logistic regression Significance OR Creole compared to South Asian 0.73 0.89 Indonesian compared to South Asian 0.25 0.49 Maroons compared to South Asian 0.05 0.43 Ethnic groups South Asians (N=544) Creole (N=388) Indonesian (N=150) Maroons (N=396) Stroke crude prevalence (%) (N) 4.1 % (22) 3.6% (14) 2.0% (3) 1.8% (7) Age-groups: 30-40 years 2.8 1.2 3.7 2.1 40-50 years 3.6 3.8 2.0 1.6 50-60 years 6.5 10.9 4.3 2.3 60-70 years 11.2 2.4 0 6.2 Gender (M/F) (N) 17/5 8/6 1/2 2/5 Smoking (%) 7.3 6.7 1.8 3.2 Hypertension (%) 6.4 8.6 3.4 7.6 Diabetes mellitus (%) 11 10.8 0 6.2 TIA (%) 25 41.6 100 14.2 Hypercholesterolemia (%) 8.1 6.8 0 0 Logistic regression Significance OR Creole compared to South Asian 0.73 0.89 Indonesian compared to South Asian 0.25 0.49 Maroons compared to South Asian 0.05 0.43 Open in new tab P625 Age gradient of carotid intima-media thickness and plaques and their prospective determinants in women of elder age in a general population S K Malyutina1, YU Polekhina2, A Ryabikov1, S Shakhmatov1, M Bobak3 1Institute of Internal Medicine SB RAMS, Novosibirsk, Russian Federation 2Novosibirsk State Medical University, Novosibirsk, Russian Federation 3University College London, London, United Kingdom Objective:Carotid intima-media thickness (CIMT) and atherosclerotic carotid plaques (CP) are proven predictors of cardiovascular outcomes and are strongly associated with aging. The pattern of age gradient of these phenotypes and their determinants are sex- and population specific, have not been well studied in women. In this prospective study, we examined the age gradient and the prospective determinants of the structural characteristics of carotid arteries in older women in a Russian population sample. Methods:A random population sample of women in Novosibirsk, Russia was examined twice over 8.5 years interval (n=338, aged 45-69 years old at baseline and 52-79 years old at the repeated survey). Cardiovascular risk factors were measured at both occasions. In the second survey, we measured mean-mean CIMT on the far wall of both common carotid arteries and identified CP with high-resolution ultrasound. CP were categorized as absent, single and multiple. Linear regression analysis was applied for analysis of cross-sectional and prospective associations. Results:The mean value of CIMT was (M±SE) 0,79±0.01mm, the frequency of any CP was of 54%. CIMT increased by 0.06-0.07mm per age decade, the frequency of CP increased from 31% at age 52-59 to 73% at age 70-79. In cross-sectional analysis, CIMT was positively associated with age, systolic blood pressure (SBP) and history of treated diabetes. Prospective predictors of CIMT included age, SBP and menopausal status at baseline. In cross-sectional analysis, CP were positively associated with age, SBP, smoking, history of cardiovascular diseases (CVD) and negatively associated with alcohol intake. Prospective predictors of CP included age, SBP, low-density lipoprotein cholesterol (LDL-C) and smoking at baseline. Conclusion:In this population sample of women aged 52-79 in Russia, the increment of CIMT comprised 0.06-0.07mm per age decade and the frequency of CP doubled in older age decade in studied age range. Age, SBP and menopausal status at baseline predicted CMIT 8.5 years later, while age, SBP, smoking, and LDL-C at baseline predicted CP. These factors contribute to the age gradient in vascular ageing and carotid wall lesion in elder women in Russian population. The study is sponsored by the the Russian Scientific Foundation (#14-45-00030). P626 Changes in the etiology of congenital heart disease in the Korean population SY Jang1, EY Ju2, SR Seo3, JY Choi4, DK Kim4, SW Park4 1Samsung Medical Center, Division of Cardiology, Department of Medicine, Center for Cardiovascular and Stroke Imaging, Seoul, Korea, Republic of 2Seoul National University, Graduate School of Public Health, Seoul, Korea, Republic of 3The National Health Insurance Service, Seoul, Korea, Republic of 4Samsung Medical Center, Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center , Seoul, Korea, Republic of Objective The aim of this study is to assess changes in the causes of congenital heart diseases between 2006 and 2013 in Korea. Research Design and Methods Data were collected from the National Health Insurance Corporation in Korea from 2006 through 2013. These data consisted of primary diagnoses related to congenital heart disease diagnosed regardless of other conditions. Congenital heart disease included congenital malformations of cardiac chambers and connections (Q20: Q20.0~20.9), congenital malformations of cardiac septa (Q21: Q21.0~21.9), congenital malformations of pulmonary and tricuspid valves (Q22: Q22.0~22.9), congenital malformations of aortic and mitral valves (Q23: Q23.0~23.9), other congenital malformations of heart (Q24: Q24.0~24.9), congenital malformations of great arteries (Q25: Q25.0~25.9), congenital malformations of great veins (Q26: Q26.0~26.9), other congenital malformations of peripheral vascular system (Q27: Q27.0~27.9), and other congenital malformations of circulartory system (Q28: Q28.0~28.9). The age-standardized prevalence of congenital heart diseases was calculated with the direct method using the estimated Korean population in 2010 as the reference. Results For male, the age-standardized cumulative prevalence of Q20, Q21, Q23, Q24, and Q26 in over 65 years was 0.02, 0.05, 0.16, 0.09, and 0.01 per 100,000 persons in 2006 and 0.27, 1.69, 0.79, 1.03, and 0.06 in 2013. For female, the age-standardized cumulative prevalence of Q21, Q22, Q24, and Q26 in over 65 years was 0.09, 0.42, 0.21, 0.004, and 0.01 per 100,000 persons in 2006 and 14.9, 1.08, 1.28, 1.03, and 0.04 in 2013. The age-standardized cumulative prevalence of Q25, Q27, and Q28 did not change dramatically between 2006 and 2013 year in over 65 years. Conclusions:The overall age-standardized cumulative prevalence of Q20, Q21, Q23, Q24, and Q26 in male and Q21, Q22, Q24, and Q26 in female increased between 2006 and 2013, especially in those older than 65 years. These changes should be considered in future designs of cardiovascular healthcare services in rapidly aging countries. P629 Role of the waist/height ratio in the cardiometabolic risk assessment, classified according to body mass index R Rodrigues1, R Palma Dos Reis2, A Pereira1, S Gomes1, AC Sousa1, M Rodrigues1, I Ornelas1, S Borges1, D Pereira1, MI Mendonca1 1Hospital Dr. Nélio Mendon? Research unit, Funchal, Portugal 2New University of Lisbon, Cardiology, Lisbon, Portugal Background:Body Mass Index (BMI) is widely used to assess the impact of obesity on cardiometabolic risk but it does not always relate to central obesity. The WHtR (waist/height), is a contant anthropometric marker of central adiposity, has been advocated as a superior indicator of cardiometabolic risk. Methods:Cross-sectional cardiometabolic risk factor variables on 2555 adults (23.6% female and 76.4% male), 30-65 years of age were used. Based on BMI, the population was classified as obese if BMI was>30 (n=1759, 68.8%) and non obese if BMI <30 (n=796, 31.2%). The risk profiles of each group based on the WHtR (<0.6, no central obesity versus = 0.6, central obesity) were compared. Results:24.9% of the non obese group were centrally obese (WHtR =0.6) and 10.1% among the obese were not (WHtR < 0.6). 32.2% of the non Obese with Central Obesity group had Type 2 Diabetes, as compared to 15.7% of the non Obese without Central Obesity (P<0.0001). 74.7% of the non Obese with Central Obesity had metabolic syndrome as compared to 36.7% of the non Obese without Central Obesity (p < 0.0001). On multivariate analysis the non obese with central adiposity were 1.78, 1.4, and more likely to have significant adverse levels of tryglicerides, glucose and 0.55 less times to have higher HDL, respectively. In the obese group, those without central obesity were 3.49 times likely to have significant adverse levels of HDL cholesterol (p < 0.0001), as compared to those with central obesity. Conclusion:In our population WHtR was found to further stratify cardiometabolic risk factor levels beyond BMI percentile category alone. It not only detects central obesity and related adverse cardiometabolic risk among non obese population, but also identifies those with predisposition to Glucose metabolism impairment, which has implications for primary care practice. P630 Heterogeneity of cardiovascular risk factors and disease characteristics and cardiovascular outcomes in patients with rheumatoid arthritis across 10 countries A G Semb1 1Diakonhjemmet Hospital, Oslo, Norway Topic: Sports cardiology Purpose:Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD). CVD risk scores for the general population do not accurately predict CVD events in RA. Heterogeneity of traditional CV risk factors and RA characteristics across various countries may be associated with varying impacts on CVD events. We aimed to compare the impact of classical CV risk factors and RA characteristics on CVD outcomes in RA patients from 10 countries. Methods:RA cohorts from 13 rheumatology centers in UK, Norway, Netherlands, US, Sweden, Greece, South Africa, Spain, Canada and Mexico were compared. Data on CV risk factors and RA characteristics were collected at baseline for each cohort; CVD outcomes were collected prospectively using standardized definitions. Cox models with random effects for center were used to compare the impact of CV risk factors and RA characteristics on CVD events. Classical CV risk factor effects were adjusted for age and sex; RA characteristic effects were adjusted for age, sex and CV risk factors. Results:5685 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 76% female). During a mean follow-up of 6.1 years (31155 person years), 476 patients developed CVD events. RA duration varied by center: 4 with early RA (<1 year), 7 established (mean 9-13 years) RA and 2 with both. Mean age varied from 37 to 61 years (younger in the early RA cohorts - p<0.001); females varied from 66% to 90% (p<0.001). 2 cohorts consisted of Hispanics, the rest Caucasians. CVD event rates varied across countries with the lowest observed in Norway and UK and the highest in South Africa, Netherlands, US-Mayo and Sweden. Age effects were fairly consistent (hazard ratios [HR] ranged from 1.6-1.8 per 10 year increase in age), but male sex varied from no effect to a doubled effect (HR=1.0-2.3). Varied effects were also seen for current smoking (HR=1.1-2.1), hypertension (HR=0.6-2.0), total cholesterol: high-density lipoprotein ratio (HR=0.9-1.2) and diabetes mellitus (HR=0.7-2.8). Effects were also varied for RA characteristics, including rheumatoid factor and/or anti-citrullinated protein antibody seropositivity (HR=0.7-1.4), disease activity score [DAS28] (HR=0.9-1.2) and RA disease duration (HR=0.7-1.1 per 10 years). Conclusions:Major heterogeneity exists in CVD event rates and in the effects of classical CV risk factors and RA characteristics on CVD outcomes among patients with RA across different countries. This must be considered in the generation of a CVD risk calculator for RA that will be generalizable to patients in different countries. P631 Trajectories of traditional risk factors and novel biomarkers before the onset of type 2 diabetes, the Doetinchem Cohort Study G Hulsegge1, AMW Spijkerman1, HA Smit2, YT Van Der Schouw2, WMM Verschuren1 1National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands 2University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands Topic: Sports cardiology Purpose:To examine whether trajectories of risk factors and biomarkers differ for those who develop type 2 diabetes and controls over a follow-up of 15-to-20 years. Methods:A total of 350 incident type 2 diabetes cases (self-reported and/or random glucose =11.1 mmol/L) were identified between 1987 and 2012 in a prospective population-based cohort of 7,768 adults aged 20-59 years at baseline. At the wave that type 2 diabetes was ascertained for cases and the same wave for age- and sex-matched controls, retrospective trajectories were analysed using generalized estimating equations. Results:In general, 15-20 years before case ascertainment levels of risk factors and biomarkers were similar for those with type 2 diabetes and controls. However, trajectories in HDL-cholesterol, triglycerides, body mass index, waist circumference, random glucose, alanine aminotransferase, gamma glutamyltransferase, uric acid and C-reactive protein were significantly worse for those with type 2 diabetes (P-value for interaction<0.10). For example, compared to controls, increases in body mass index were 3 times larger for men and 4 times larger for women with type 2 diabetes (Figure 1). In contrast, trajectories in blood pressure, total cholesterol, albumin and estimated glomerular filtration rate were similar. Differences between men and women were small, but differences in trajectories of alanine aminotransferase and gamma glutamyltransferase were somewhat larger in men, while differences in triglycerides and uric acid were larger in women. Conclusions:Our results add knowledge about the pathophysiological changes that lead to the development of type 2 diabetes. Unfavourable changes in risk factors and biomarkers occured among all adults but were much larger in those with incident type 2 diabetes. Open in new tabDownload slide Figure 1 P632 Ethnic differences in arterial stiffness - the HELIUS study MB Snijder1, K Stronks1, CO Agyemang1, WB Busschers1, RJ Peters2, BJ Van Den Born3 1Academic Medical Center of Amsterdam, Department of Public Health, Amsterdam, Netherlands 2Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands 3Academic Medical Center of Amsterdam, Department of Internal and Vascular Medicine, Amsterdam, Netherlands Topic: Sports cardiology Purpose:Well-known ethnic differences in cardiovascular risk exist, which may be explained by ethnic differences in arterial stiffness. Our aim was to assess ethnic differences in arterial stiffness, and to explore whether these differences are acquired during life by studying whether they are accounted for by conventional cardiovascular risk factors and whether they increase with age. Methods:Data of 1535 Dutch, 1368 South-Asian Surinamese, 1584 African Surinamese, and 1203 Ghanaian participants of the HELIUS study (aged 18-70 years) were used. Arterial stiffness was assessed by duplicate pulse wave velocity (PWV) measurements using the Arteriograph system. Results:Linear regression showed that South-Asian Surinamese had higher PWVs as compared with Dutch (age-adjusted mean difference (95% CI) was 0.55 (0.38-0.72) m/s in men and 0.77 (0.56-0.98) m/s in women). These differences were largely, but not completely, explained by conventional risk factors (MAP, HT, diabetes, BMI, WHR, total cholesterol, HDL, smoking). Furthermore, these ethnic differences were not found at young age (<35 years). African Surinamese and Ghanaians had higher PWVs as compared with Dutch across the entire age range (ranging from 0.19 (0.01-0.37) m/s in African Surinamese men to 1.13 (0.92-1.34) m/s in Ghanaian women), but these differences disappeared after adjustment for risk factors (except in Ghanaian women). Conclusion:PWV levels paralleled the well-known ethnic differences in cardiovascular risk. Our results support the hypothesis that higher PWV in South-Asian and African ethnic groups are acquired during life due to higher exposure to cardiovascular risk factors. P633 Association between hepatic steatosis, serum transaminases and risk for atrial fibrillation MRP Markus1, PJ Meffert2, W Lieb3, M Koch3, SE Baumeister2, SB Felix4, M Doerr4, G Targher5, H Voelzke2 1University Medicine of Greifswald, DZHK (German Centre for Cardiovascular Research), Greifswald, Germany 2University Medicine of Greifswald, Institute for Community Medicine, Greifswald, Germany 3Christian-Albrechts-University Kiel, Institute of Epidemiology, Kiel, Germany 4University Medicine of Greifswald, Department of Internal Medicine B, Greifswald, Germany 5University of Verona, Department of Medicine, Verona, Italy Topic: Sports cardiology Purpose:Atrial fibrillation (AF) is a common heart rhythm abnormality that affects up to 2% of the general adult. On the other hand, unfavorable lifestyle behaviors such as the increase in sedentary lifestyles, and high caloric food intake are accompanied by the increase in the prevalence of obesity, dysglycemia, diabetes and hepatic steatosis (HS). HS is the most common cause of elevated serum transaminase levels and is now regarded as a pathogenic component of the metabolic syndrome. The aim of our large population-based study was to examine the associations of ultrasonographically determined HS and elevated serum transaminases with the risk of prevalent AF. Methods:Cross-sectional data of 3,039 men and women, aged 20-81 years, from the population-based Study of Health in Pomerania (SHIP-0) was used. HS was defined as the presence of a hyper-echogenic ultrasound pattern of the liver. Three liver transaminases were measured photometrically: alanine transaminase (ALT), aspartate transaminase (AST) and gamma-glutamyl-transaminase (GGT). Presence of AF was ascertained by resting electrocardiograms. Results:AF was present in 46 individuals (1.51% of the whole cohort). After adjustment for age, sex, height and weight, individuals with HS had no significant higher risk for prevalent AF when compared with those without HS (odds ratio [OR] = 1.27; 95% confidence interval [CI], 0.63 to 2.57; p=0.510). In contrast, the risk for prevalent AF increased with higher transaminases levels. The adjusted (for age, sex, height and weight) -ORs for prevalent AF, per 1-SD increase in each serum transaminase, were 1.50 (95% CI: 1.14 to 1.97; p=0.003) for ALT, 1.41 (95% CI: 1.15 to 1.73; p=0.001) for AST and 1.38 (95% CI: 1.21 to 1.57; p<0.001) for GGT, respectively. Sensitivity analyses with additional adjustments for ejection fraction, myocardial infarction, valvular heart disease, left ventricular hypertrophy, alcohol consumption, systolic blood pressure, Hb1ac and use of antihypertensive and antidiabetic medication did not change the overall results. Conclusions:Our results indicate that, in a general population, increased serum transaminase levels are significantly associated with a higher risk of prevalent AF, while the ultrasonographic diagnosis of HS is not. A possible explanation for these findings is that the adverse effects of increased levels of inflammatory mediators released by a steatotic and inflamed liver (NASH, which is typically characterized by increased serum transaminase levels) are more important for the association with AF than the simple presence of fat inside the liver. P634 Low efficiency of current guidelines: low diagnostic performance of non-invasive ischemia testing in patient with intermediate pretest probability P Rio1, T Pereira-Da-Silva1, R Ramos1, C Barbosa1, M Afonso Nogueira1, P Pinto-Teixeira1, A Viveiros Monteiro1, A Fiarresga1, D Cacela1, R Cruz Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Background:Non-invasive ischemia testing (NIST) is recommended in symptomatic patients with intermediate pretest probability (IPP) of obstructive coronary artery disease (OCAD) for triage for invasive cardiac catheterization (ICA). Purpose: We sought to determine the predictors of CAD in a contemporary sample of patients with intermediate pretest probability and assessed the incremental diagnostic value of NIST. Methods:Among patients referred for elective ICA in a single tertiary-care center (2006 -2011), those with an IPP were retrospectively identified. To understand the relative value of the factors in predicting OCAD, a model of stepwise logistic regression analysis was performed starting with Framingham risk score (FRS), symptomatic status, left ventricular (LV) function and finally the NIST results by this specific order. The discriminatory power of this model was assessed by the area under de ROC curve (AUC). Results:From a total of 2600 patients, 525 were included: 61.6 ±10.2 years, 61.7% female, 20% diabetics, mean 10-year Framingham risk 14.4%, 20.6% typical angina and 7% of LV dysfunction. NIST was performed in 82.5% (56% treadmill exercise ECG, 38.3% SPECT). At ICA only 105 patients (20%) had obstructive CAD. Independent predictors of OCAD included male gender (OR 3.49; 95% CI, 1.36-9.93), presence of typical angina (OR 37.59; 95% CI, 12.59-112.27), smoking (OR 3.83; 95% CI, 1.42-10.32), and LV dysfunction (OR 6.78; 95% CI, 2.35-19.58), (all p<0.01). Stepwise analysis shown in the figure. Conclusions:A low proportion of patients with IPP were found to have OCAD. The incorporation of NIST in the previous models had no significant effect over the clinical evaluation. To increase the predictability of CAD in this population another tests are needed. Open in new tabDownload slide Predictability of CAD P635 Peak VO2 and physical health predict survival after heart transplantation M Yardley1, O E Havik2, I Grov1, A Relbo1, L Gullestad1, K Nytroen1 1Oslo University Hospital, Department of Cardiology, Rikshospitalet, Oslo, Norway 2University of Bergen, Department of Clinical Psychology, Bergen, Norway Topic: Sports cardiology Purpose:Does physical capacity predict survival in heart transplant (HTx) recipients? Method:This retrospective study investigated two different HTx populations regarding predictors for long-term survival. Cohort1 includes patients who completed a VO2peak test during their annual follow-up between 1990 and 2003. Cohort2 includes patients who completed a SF-36 v1 questionnaire between 1998 and 2000. Background information and other central variables were collected from our center's HTx database. Results:Cohort1; N=132, Mean age: 51(12) years, Men: 92%, Median time after HTx: 2(4) years, Mean VO2peak: 19,9(5,3) ml/kg/min, Mean years under observation: 15(6). Cohort2; N=133, Mean age: 54(11) years, Men: 78%, Median time after HTx: 5(6) years, SF-36 Median Physical Component Sumscore (PCS): 90 (30), Mean years under observation: 15(5). Predictive variables were analysed using cox regression (enter method) based on p-values<0.2 from univariate regression and clinical aspects. The two best predictive models (adjusted for gender) were: Cohort1; Age (p=0.005), VO2peak (p=0.016), Ischemic time (p=0.021) and Cardiac Output (p=0.052). Cohort2: Age (p<0.001), years after HTx (p<0.001), PCS (p=0.003), Smoking (p=0.003), and cardiovascular disease (p=0.079). Other univariate significant predictors that did not reach statistical significance in multivariate regression were: Etiology of HTx, donor age, BMI, ejection fraction, blood pressure, creatinine, Hgb and SF-36 Mental Component Sumscore. Kaplan-Meier analysis showed that groups divided by median VO2peak and PCS had significantly different survival-time. Conclusion:VO2peak level and self-reported physical health are both strong predictors for survival in HTx recipients. VO2peak is a crucial measurement, and should be more frequently used after HTx. Open in new tabDownload slide Survival-time divided by groups P637 Effects of physical exercise and regular training in renal transplantation L Stefani1, GM Mascherini1, CP Pedri1, LF Francini1, MG Gianassi1, IC Corsani1, AP Pacini1, EM Minetti1, GG Galanti1 1University of Florence, Florence, Italy Topic: Sports cardiology Purpose:Regular physical exercise contrasts metabolic syndrome. The study aims to assess the effects after 6 months of individualized moderate exercise training program,in renal solid organ recipients. Methods:14 renal transplant recipients were submitted to Cardiopulmonary Test, echocardiographic exam, ca skin fold, bioimpedance analysis and test of strength for the lower anf higher limbs .Exercises consisted in 30 minutes of aerobic training , 3 times a week, and 2 sets of 20 repetitions at 35% of the maximum load for each. Results:EF is significantly enhanced. The anaerobic threshold improved . Skin folds were significantly reduced at pectoral level. Conclusion:A short period of mixed aerobic and resistance exercise , improves cardiovascular performance and reduces risks factors linked to the visceral fat. Any other effects on other will need of a longer follow - up . T 0 T6 p value Age 51.6±6.2 Time from transplant (yrs) 6.2±6.1 Anthropometrics Weight (Kg) 69.8±12.2 69.2±12.8 NS BMI (kg/m2) 23.4±3.5 23.2±3.5 NS Skin fold Pectoral (mm) 13.3±7.1 6.4±3.8 <0.01 Abdomen (mm) 16.0±9.4 12.4±8.6 < 0.05 Body Composition Fat Mass (%) 15.1±6.8 12.4±5.5 < 0.05 Fat Mass (kg) 10.1±4.9 8.4±4.5 < 0.05 Aerobic Threshold VO2(mlO2/kg/min) 11.1±7.9 10.5±6.1 NS Anaerobic Threshold VO2(mlO2/kg/min) 14.5±6.9 19.2±10.0 <0.05 T 0 T6 p value Age 51.6±6.2 Time from transplant (yrs) 6.2±6.1 Anthropometrics Weight (Kg) 69.8±12.2 69.2±12.8 NS BMI (kg/m2) 23.4±3.5 23.2±3.5 NS Skin fold Pectoral (mm) 13.3±7.1 6.4±3.8 <0.01 Abdomen (mm) 16.0±9.4 12.4±8.6 < 0.05 Body Composition Fat Mass (%) 15.1±6.8 12.4±5.5 < 0.05 Fat Mass (kg) 10.1±4.9 8.4±4.5 < 0.05 Aerobic Threshold VO2(mlO2/kg/min) 11.1±7.9 10.5±6.1 NS Anaerobic Threshold VO2(mlO2/kg/min) 14.5±6.9 19.2±10.0 <0.05 Open in new tab T 0 T6 p value Age 51.6±6.2 Time from transplant (yrs) 6.2±6.1 Anthropometrics Weight (Kg) 69.8±12.2 69.2±12.8 NS BMI (kg/m2) 23.4±3.5 23.2±3.5 NS Skin fold Pectoral (mm) 13.3±7.1 6.4±3.8 <0.01 Abdomen (mm) 16.0±9.4 12.4±8.6 < 0.05 Body Composition Fat Mass (%) 15.1±6.8 12.4±5.5 < 0.05 Fat Mass (kg) 10.1±4.9 8.4±4.5 < 0.05 Aerobic Threshold VO2(mlO2/kg/min) 11.1±7.9 10.5±6.1 NS Anaerobic Threshold VO2(mlO2/kg/min) 14.5±6.9 19.2±10.0 <0.05 T 0 T6 p value Age 51.6±6.2 Time from transplant (yrs) 6.2±6.1 Anthropometrics Weight (Kg) 69.8±12.2 69.2±12.8 NS BMI (kg/m2) 23.4±3.5 23.2±3.5 NS Skin fold Pectoral (mm) 13.3±7.1 6.4±3.8 <0.01 Abdomen (mm) 16.0±9.4 12.4±8.6 < 0.05 Body Composition Fat Mass (%) 15.1±6.8 12.4±5.5 < 0.05 Fat Mass (kg) 10.1±4.9 8.4±4.5 < 0.05 Aerobic Threshold VO2(mlO2/kg/min) 11.1±7.9 10.5±6.1 NS Anaerobic Threshold VO2(mlO2/kg/min) 14.5±6.9 19.2±10.0 <0.05 Open in new tab P640 Severe blood pressure spikes during 24hr ambulatory blood pressure monitoring, more common than we think? P Ting1, LH Wong2 1National Heart Centre, Singapore, Singapore 2University College Cork, Cork, Ireland Topic: Sports cardiology Purpose:Ambulatory blood pressure measurement (ABPM) is becoming increasingly important in the management of hypertension. Apart from the average BP, BP variability and exaggerated morning surges have been shown to be independent predictors of cardiovascular risk. While modest increase in morning waking BP is believed to be physiological, less is known about BP spikes that may occur during other parts of the day. We describe the frequency and characteristics of extreme blood pressure spikes during 24 hour ABPM at our Institution. Methods:We conducted a retrospective analysis of 220 subjects who had 24 hour ABPM performed within a 5 month period in 2013 at a single hospital for suspected or known hypertension. Severe spikes in BP were defined as SBP=180mmHg or DBP=110mmHg or an increase in the BP =30mmHg above the day or night time average. Subjects with one or more severe spikes in BP were labeled as "Spikers", and those without "Non-spikers". Both groups were compared, and the characteristics of the spikes analysed. Results:"Spikers" made up 54.5% (120) of the total subjects and on average had 5.3 spikes each. Age, BMI, gender and ethnicity were not significantly different between groups. "Spikers" tended to have higher average systolic (142 vs. 131mmHg, p<0.01) and diastolic pressures (85 vs. 78mmHg, p<0.01), and systolic variability (SD 14 vs. 11mmHg, p<0.01). Of the 80 subjects with normal average systolic blood pressure (<135/85mmHg), 38.8% (31) were "Spikers". Nocturnal dipping status was not significantly different between the two groups. Spikes were not restricted to the mornings, but occurred throughout the day, even at night. Spikes also often did not occur with concomitant rises in heart rate. Conclusions:In our study cohort, severe spikes in blood pressure were common and not limited to just morning surges. Poorer average BP control and greater variability were associated with more spikes, however it is important to note that significant spikes can also occur with normal or mildly elevated average BP. The pathophysiologic mechanism and clinical significance of frequent severe blood pressure spikes needs to be further studied. P642 Correlation of sugar sweetened beverage consumption with cardiovascular risk factors in Mexican adolescents M A Gomez Martinez1, VCA Vergara Castaneda2, CML Castillo Martinez1, MVM Martinez Valdivia2 1National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico 2University La Salle, Mexico City, Mexico Background:Mexico has positioned itself as the largest consumer of soft drinks , registering an increase of 12 % between 2000 and 2009. Beverages intake represents a large share of total energy consumption.It has been proposed that the consumption of sweetened beverages is associated with increased prevalence of overweight and obesity as well as other cardiovascular risk factors, including hypertension. Objective:To determine the relationship between the consumption of sugar sweetened beverages with cardiovascular risk indicators in a community of adolescents in Mexico City. Material and methods:A cross sectional study including adolescents aged 11-16 years was conducted in Mexico City; anthropometric measurements (weight, height, and waist circumference) were taken as well as blood pressure according to AHA recommendations and a 24h recall was obtained. Body mass index and Waist to Height Ratio were calculated. T student test and Spearman correlations were performed. Results:242 adolescents were evaluated, the average aged was 12 ± 1.9 y, 50.4% of population were boys. 45% of sample presented a higher value for WtHR and 27% was classified with abdominal obesity according to waist circumference, without differences between gender. Mean systolic blood pressure was higher in boys compared with girls (103.11.4 ± 11.4 vs 99.8± 10.5; p<0.05), meanwhile no differences were found in diastolic blood pressure. Also, higher prevalence of hypertension was observed in men than women (13.9 vs 11.7 % ; p < 0.05). Excessive consumption of sugars was recorded with a value of 5 ± 5.8 servings a day, being higher in males ( 5.6 ± 6.8 servings per day ) compared to women ( 4.4 ± 4.4 servings per day) and from these , soft drinks and juices are consumed by an average of 2.39 ± 4.5 and 1.29 ± 2.3 servings per day, respectively. No relations to BMI to weight, BMI and sugar sweetened drinks were found.A good correlation between the consumption of soft drinks and juices with waist circumference (r = 0.523 was found ; r = 0.463 ; p < 0.001 , respectively) and a high correlation between soft drink and juices consumption and systolic blood pressure (r = 0.985 p < 0.001; r = 0.987 ; p < 0.001, respectively). Meanwhile the correlations for diastolic blood pressure and soft drinks and juices intake were r=0.987 and r=0.613, both with a p<0.001. Conclusions:The prevalence of cardiovascular risk factors are higher than the reported in the national surveys in this target population. The soda consumption and juice is associated with SBP and DBP. In relation of SBP it was associated with sex and weight. P644 Alimentary fats and hypertension in a urban high school adolescents in Mexico City M A Gomez Martinez1, CML Castillo Martinez1, VCA Vergara Castaneda2 1National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico 2University La Salle, Mexico City, Mexico Background:The different types of consumed fatty acids in diet; saturated and the index n6/n3 can be related in the development of SBP and DBP, respectively. On the other hand the systemic hypertension has been associated with anthropometric parameters, like waits to height ratio. Previous studies only a few has report the indexn6/n3 associated with hypertension in this particular age but no in adolescence. Objective:To examine the relation between saturated fats, the index of fatty acids omega 6 and omega 3 with hypertension diagnosis among high school adolescents. Methodology:247 adolescents were evaluated on a cross sectional study, in public high school of low socioeconomic status in México City. BP was measured according to the TASK FORCE and National Health and Examination Survey from United States. A 24-hour intake recall was obtained. Subjects were classified in high saturated fat intake group (HIG) if >10% of the total energy intake and the recommended intake group (RIG) <10% of the total energy intake, also the Reason n6/n3 with more of recommended consumption > 4:1. Also the anthropometric measures were performed: weight, height, waist circumference according toãÎ..and waist–to-height ratio (WtHR) was calculated. Results:Mean age was 11±.5years, the prevalence of diastolic hypertension is 65.8% and systolic hypertension is 21%, for other hand the systolic blood pressure (SBP) was 120 ± 20.5 mmHg blood pressure (DBP) 80 ±15 mmHg. The 70% belonged to HIG group and 29% of the RIG group for saturated fats. When these groups were compared prevalence of systolic hypertension was 1% in RIG group vs 4.6% HIG (p=0.030), in diastolic blood pressure the values was 60 vs 65 mmHg in a HIG and RIG total fats (p= 0.048). Also the index n6/n3 it was 10/1 in our study when in the literature report 4/1, we compare this index between the hypertensive diastolic vs normotensive subjects (p=0.034). Conclusion:Prevalence of hypertension among high school adolescents is higher than reported in Mexican surveys as well as a high fat diet intake. The systolic hypertension was associated with saturated fats, in another hand the diastolic hypertension was associated with index n6/n3. P645 Hypertension, and awareness and treatment of hypertension in Europe. Results from the EHES Pilot Project HK Tolonen1, S Giampaoli2, K Kuulasmaa1, JS Mindell3, S Mannisto1, CM Dias4, P Koponen1 1National Institute for Health and Welfare (THL), Helsinki, Finland 2Superior Institute of Health, Rome, Italy 3University College London, London, United Kingdom 4National Health Institute Doutor Ricardo Jorge, IP, Lisbon, Portugal Topic: Sports cardiology Purpose:Prevalence of raised blood pressure has been defined as one of the target indicators for the World Health Organization Global Action Plan for the prevention and control of non-communicable diseases. Therefore, it is important to be able to monitor changes in population level hypertension prevalence, as well as changes in awareness and treatment of hypertension. We assessed the prevalence, and awareness and treatment of hypertension using standardized methods in defined adult populations in 12 European countries. Methods:The European Health Examination (EHES) Pilot Project was conducted in 2009-2012(the Czech Republic, Finland, Germany, Greece, Italy, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia and UK/England planned and prepared for their national health examination survey (HES) and conducted a fieldwork pilot survey among adults aged 25-64 years in at least 1-2 towns/regions. Standardized measurement protocol and questionnaire were used to obtain information on blood pressure, hypertension treatment and awareness of hypertension. Results:The prevalence of hypertension was on average 33% among men and 23% among women. Among hypertensives, 51% of men and 70% of women were aware of their condition, and 31% of men and 40% of women were on drug treatment. Of those on treatment, 59% of men and 61% of women had their blood pressure under control. There was large variation in prevalence of hypertension, and awareness and treatment of hypertension between surveys. Conclusions:Our pilot findings indicate that there is still a need for improvement in prevention and primary care, to better meet the needs for detection, monitoring and control of hypertension at the population level. Nationally representative data from European countries are needed to monitor hypertension status and to allow better evaluation of possible effects of national health care systems and treatment guidelines on observed differences between surveys. P646 Relation between the severity of the obstructive sleep apnea and serum copeptin levels in prehypertensive patients C Dursun Akkoyun1, A Akyuz1, R Alp1 1Namik Kemal University Faculty of Medicine, Tekirdag, Turkey Topic: Sports cardiology Purpose:We sought to evaluate the serum copeptin levels in newly diagnosed prehypertensive patient with obstructive sleep apnea syndrome (OSAS). Methods:Eighty-four prehypertensive patients were evaluated with polysomnography and divided in to two as OSAS (n=41) and control (n=43) groups. Serum copeptin levels were measured with ELISA method. Results:Lowest SpO2 was 77±8% in OSAS group and 90±5% in the control group (p<0.001). Mean apnea hypopnea index (AHI) was 26.8 (6-102) in OSAS group and 2 (1-4) in the control group (p<0.001). Copeptin levels were significantly higher in OSAS group compared to control group (146 (93-739) pg/ml vs. 111 (33-253) pg/ml, respectively, p<0.001). Regression analysis have revealed that AHI and lowest SpO2 were related to serum copeptin levels (unstandardized ? 1.02±0.40, p=0.014 and unstandardized ? -3.1± 0.9, p=0.048 respectively). Conclusion:According to results of our study serum copeptin levels are higher in prehypertensive patients with OSAS compared to control group. Therefore in the assessement of the severity of OSAS, serum copeptin level can be used as a biochemical marker in addition to polysomnographic findings. AHI: apnea-hypopnea index, BP: blood pressure, LVEF: left ventricular ejection fraction, OSAS: obstructive sleep apnea syndrome, SpO2: oxygen saturation, OSAS group (n=41) Control group (n=43) P values Age, years 50.5±9.8 50.2±11.1 0.878 Gender (M), n(%) 29(70) 29(67) 0.744 BMI, kg/m2 34.2±8.4 32.7±5.2 0.337 Systolic BP, mmHg 129±4.8 127±5.2 0.608 Diastolic BP, mmHg 83±3.6 82±4.1 0.711 LVEF, % 56.9±9.8 57.7±3.2 0.808 AHI 26.8 (6-102) 2 (1-4) <0.001 Mean SpO2, % 93 ± 2 94±3 0.844 Lowest SpO2, % 77±8 90±5 <0.001 Copeptin, pg/mL 146 (93-739) 111 (33-253) <0.001 OSAS group (n=41) Control group (n=43) P values Age, years 50.5±9.8 50.2±11.1 0.878 Gender (M), n(%) 29(70) 29(67) 0.744 BMI, kg/m2 34.2±8.4 32.7±5.2 0.337 Systolic BP, mmHg 129±4.8 127±5.2 0.608 Diastolic BP, mmHg 83±3.6 82±4.1 0.711 LVEF, % 56.9±9.8 57.7±3.2 0.808 AHI 26.8 (6-102) 2 (1-4) <0.001 Mean SpO2, % 93 ± 2 94±3 0.844 Lowest SpO2, % 77±8 90±5 <0.001 Copeptin, pg/mL 146 (93-739) 111 (33-253) <0.001 Open in new tab AHI: apnea-hypopnea index, BP: blood pressure, LVEF: left ventricular ejection fraction, OSAS: obstructive sleep apnea syndrome, SpO2: oxygen saturation, OSAS group (n=41) Control group (n=43) P values Age, years 50.5±9.8 50.2±11.1 0.878 Gender (M), n(%) 29(70) 29(67) 0.744 BMI, kg/m2 34.2±8.4 32.7±5.2 0.337 Systolic BP, mmHg 129±4.8 127±5.2 0.608 Diastolic BP, mmHg 83±3.6 82±4.1 0.711 LVEF, % 56.9±9.8 57.7±3.2 0.808 AHI 26.8 (6-102) 2 (1-4) <0.001 Mean SpO2, % 93 ± 2 94±3 0.844 Lowest SpO2, % 77±8 90±5 <0.001 Copeptin, pg/mL 146 (93-739) 111 (33-253) <0.001 OSAS group (n=41) Control group (n=43) P values Age, years 50.5±9.8 50.2±11.1 0.878 Gender (M), n(%) 29(70) 29(67) 0.744 BMI, kg/m2 34.2±8.4 32.7±5.2 0.337 Systolic BP, mmHg 129±4.8 127±5.2 0.608 Diastolic BP, mmHg 83±3.6 82±4.1 0.711 LVEF, % 56.9±9.8 57.7±3.2 0.808 AHI 26.8 (6-102) 2 (1-4) <0.001 Mean SpO2, % 93 ± 2 94±3 0.844 Lowest SpO2, % 77±8 90±5 <0.001 Copeptin, pg/mL 146 (93-739) 111 (33-253) <0.001 Open in new tab P648 Is there an improvement in the degree of control of patients with chronic ischemic heart disease in the last 5 years? Statin use in the BARIHD study O Ferreiro Uriz1, E Rodriguez Moldes1, JL Gomez Vazquez1, MJ Vazquez Lopez1, E Outeirino Lopez1, A Castro Cives1, T Vazquez Rodriguez1, R C Vidal Perez1, F Otero-Ravina1, JR Gonzalez-Juanatey1 1University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Topic: Sports cardiology Purpose:In the chronic phase of coronary artery disease (CAD) it is not clear whether the degree of control of risk factors has shifted in recent years by the influence of changes in clinical practice guidelines and the best use of drug resources in particular statins. We evaluated whether there has been an improvement in these aspects for the long term in a cohort with chronic ischemic heart disease (CIHD) followed by primary care physicians (PCP). Methods:BARIHD was a cross-sectional multicentric study made with the collaboration of 73 PCP. The PCP included during February 2007,patients(p) that fulfil the inclusion criteria: coronary artery disease (CAD) with at least 1 year of follow up since diagnosis, diagnosis clear established (stable angina-SA, unstable angina-UA or myocardial infarction-MI) in a discharge summary from cardiology department. Follow-up was done by clinical review and we applied as control criteria the ESC guidelines of Stable Coronary Artery Disease. We compared the current situation with 5 years ago when the cohort started. Results:1038p were included, the differences in the degree of control achieved by cohort are shown in the table. The only difference was found in the LDL-Cholesterol parameter. The use of lipid-lowering drugs was 88.9% in 2007 and 85,2% in 2013 % (p=0.016). In 2013 we found no statin use in 172p (16.6%), and the reasons were good control (47.1%), myopathy (1.7%), intolerance (6.4%) and other causes (44.8%). Conclusions:There is still room for improvement in all control parameters. We found a significant improvement in LDL control, despite a striking percentage of patients not receiving statins with a CIHD. NS: No significant 2007 (%) 2013 (%) p-Value Blood pressure control 61,7 65,5 NS LDL-Cholesterol <70 mg/dl 8,4 20,8 <0,001 Triglycerides <200 mg/dl 88,9 88,4 NS HDL Cholesterol >40 mg/dl ?153; or >45 mg/dl ?153;? 63,2 61,8 NS Absence of obesity 60,0 59,7 NS Active smoking 10,7 7,3 NS 2007 (%) 2013 (%) p-Value Blood pressure control 61,7 65,5 NS LDL-Cholesterol <70 mg/dl 8,4 20,8 <0,001 Triglycerides <200 mg/dl 88,9 88,4 NS HDL Cholesterol >40 mg/dl ?153; or >45 mg/dl ?153;? 63,2 61,8 NS Absence of obesity 60,0 59,7 NS Active smoking 10,7 7,3 NS Open in new tab NS: No significant 2007 (%) 2013 (%) p-Value Blood pressure control 61,7 65,5 NS LDL-Cholesterol <70 mg/dl 8,4 20,8 <0,001 Triglycerides <200 mg/dl 88,9 88,4 NS HDL Cholesterol >40 mg/dl ?153; or >45 mg/dl ?153;? 63,2 61,8 NS Absence of obesity 60,0 59,7 NS Active smoking 10,7 7,3 NS 2007 (%) 2013 (%) p-Value Blood pressure control 61,7 65,5 NS LDL-Cholesterol <70 mg/dl 8,4 20,8 <0,001 Triglycerides <200 mg/dl 88,9 88,4 NS HDL Cholesterol >40 mg/dl ?153; or >45 mg/dl ?153;? 63,2 61,8 NS Absence of obesity 60,0 59,7 NS Active smoking 10,7 7,3 NS Open in new tab P649 The relationship between the achievement of the target values of lipids and observance of healthy lifestyle in patients with moderate cardiovascular risk V S Gurevich1, SA Urazgildeeva1, MV Musalevskaya2, AA Temirov3, AV Tregubov4 1Saint-Petersburg state university, Saint-Petersburg, Russian Federation 2North-west state medical university, Saint-Petersburg, Russian Federation 3Almazov's Federal Center of Heart, Blood and Endocrinology, Saint-Petersburg, Russian Federation 4Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russian Federation Purpose of this study was to investigate the effect of adherence to physical exercise and dieting on the effectiveness of lipid-lowering therapy in patients with moderate cardiovascular risk. Methods:The case record forms of 1023 out-patients with initially elevated lipid levels were analyzed. Evaluation of cardiovascular risk was performed with usage of SCORE tables at first visit and after 1 year of follow up. Adherence to lipid-lowering therapy and achieving the target values ?128;??128;?were estimated based on the records in the outpatient charts. Also a selective survey of out-patients during annual visit was performed. Results:Only 35% of patients at the initial examination were aware of their level of lipids. It has been found that the recommendations to correct diet received about 95 % of all patients of moderate cardiovascular risk on SCORE scale and 25% of them were recommended statins. Only half of patients on lipid-lowering therapy advised physical activity. Physical exercise along with diet and lipid-lowering therapy was prescribed by doctors for 78 % of men and 32% of women. At the same time it was found in a selective survey of out-patients that the compliance with the newly prescribed physical activity demonstrated 62% of women and only 27% of men. Adherence to medication as well as the achievement of lipid level targets was positively correlated with compliance for physical activity (r = 0.480) and diet (r = 0.330). Interruption of statin treatment occurred in 9 % of cases and was not associated with exercise intolerance. Conclusions:The recommendations for physical exercise were less common than those for diet in patients of moderate cardiovascular risk. Adherence to diet and exercise in these patients was associated with effective lipid-lowering therapy P650 Association of lone severe primary hypertriglyseridemia with syndrome X and its effect on angiographic myocardial perfusion in presence of normal coronary arteries O Beton1, H Kaya2, E Saricam3, H Yucel2, A Zorlu2, HE Pamukcu1, LD Asarcikli1, Z Kucuksu4, MB Yilmaz2 1Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey 2Cumhuriyet University, Cardiology, Sivas, Turkey 3Cag Hospital, Cardiology, Ankara, Turkey 4Mengucek Gazi Training and Research Hospital, Erzincan, Turkey Topic: Sports cardiology Purpose:Hypertriglyceridemia has been considered as a risk factor for cardiovascular diseases(CVD). However, triglyceride levels are influenced by many clinical and lipid risk factors. When triglyceride levels are adjusted by these variables, its effect as a risk factor becomes minimal or negligible. Therefore, its association with CVD is uncertain. Myocardial blush grade (MBG) has been developed as a simple angiographic parameter to describe the effectiveness of microvascular perfusion. Aim of our study is to evaluate the possible relationship of lone severe primary hypertrigliseridemia(LSPH) with syndrome X and its effect on MBG in the presence of normal coronary arteries. Methods:Total of 1795 consecutive patients who had fasting blood triglyseride level of =500mg/dl were included in our study. Patients scheduled to undergo coronary angiography(CAG) were included in the study. Exclusion criterias were previous MI, HF, coronary artery ectasia, DM, hypertension, valvular heart disease, cardiomyopathy, conduction disturbances, impaired renal or liver function, presence of secondary casuses of hypertriglyceridemia, impaired blood glucose and BMI>30 kg/m2. In all patients, extracardiac causes of chest pain, including musculoskeletal and esophageal causes, were ruled out. The diagnosis of syndrome X was based on the presence of typical exercise induced angina pectoris, transient ischemic ST-segment depression (>1 mm) during exercise, and angiographically normal coronary arteries in the absence of left ventricular hypertrophy and systemic hypertension. Patients with hypertriglyseridemia divided into 2 groups, patients with syndrome X (group 1) and patients without syndrome X (group 2). Control subjects who had normal lipid profile and normal coronary arteries were included in the study (group 3). Indication for CAG in group 2 and 3 was typical chest pain. Treadmill exercise ECG was negative in group 2 and 3. Results:Fifty two, 42 and 45 patiens were included in group1, group 2 and group 3, respectively. Mean age and gender ratio were similar in three groups. Mean triglyseride, LDL and HDL levels were 590.4±144.4, 96.6±37.7, 35.0±11.8 in patients with hypertriglyseridemia and these levels were similar in group 1 and 2. Total MBG score of coronary arteries were 7.9±0.5, 8.2±0.6 and 8.8±0.4 in group 1, group 2 and group 3, respectively (p<0,001). Conclusion:It was shown for the first time that LSPH has association with syndrome X. LSPH causes imparement in angiographic myocardial perfusion which could explaned by endothelial dysfunction. LSPH should be taken into account as CAD when planning medication. P651 The association of EPA AA ratio with subclinical atherosclerosis in different generations without DM Multi-slice CT study Y Suzuki1, S Murase1, O Matsuda1, A Murata1, M Ehara1, T Ito1 1Nagoya Heart Center, Nagoya, Japan Objective:Eicosapentaenoic acid (EPA) of the omega-3 polyunsaturated fatty acids (?#137;-3 PUFA) family plays important roles in the prevention of cardiovascular disease (CVD), while, arachidonic acid (AA) of the ?#137;-6 PUFA family promotes inflammatory and prothrombotic influences. However, there have been few reports investigating the relationship between plasma EPA/AA ratio and the prevalence of coronary atherosclerosis in multi-slice CT (MSCT) study. The aim of this study was to investigate the association between the plasma EPA/AA ratio and the prevalence of subclinical atherosclerosis in different generations without DM. Methods:This study consisted of consecutive 230 suspected coronary artery disease (CAD) patients from 40's- to 70's-year-old underwent 128-MSCT. They all were non-DM patients without any lipid-lowering intervention. To examine the plasma fatty acid level, blood samples were obtained. We investigated the prevalence of coronary plaque based on MSCT findings and patients were divided into different generations (40's; N=31, 50's; N=48, 60's; N=72, 70's; N=79). We investigated the association between the plasma EPA/AA ratio and the prevalence of subclinical coronary atherosclerosis. Results:The results are shown in the table. The plasma EPA/AA ratio was significantly higher in the older generation. In all generations except 70's, the plasma EPA/AA ratio was significantly lower in the patients with coronary artery plaque. The ROC analysis showed the cut-off value of the plasma EPA/AA ratio, sensitivity, and specificity as shown in the table. Conclusions:In non-DM young patients with suspected CAD, the low plasma EPA/AA ratio was significantly associated with a high prevalence of subclinical coronary atherosclerosis. Open in new tabDownload slide Table P653 Effect of low doses of long chain n-3 PUFA intake on daytime heart rate variability: results from the MARINA study. AM Pinto1, WL Hall1, TAB Sanders1 1King's College London, Diabetes & Nutritional Sciences, London, United Kingdom Topic: Sports cardiology Purpose:Heart rate variability (HRV), a term that refers to a range of parameters that reflect the variability in the length of the interbeat interval (IBI), is regarded as an indirect measure of cardiac autonomic function, and it may be influenced by long-chain n-3 polyunsaturated fatty acids (n-3 PUFA): eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Low HRV indicates reduced functional regulation of heart rate (HR) by the autonomic nervous system and is a powerful predictor of sudden cardiac death. This study tested the hypothesis that supplementation with low doses of n-3 PUFA equivalent to consuming 1, 2 or 4 portions of oily fish per week increases daytime HRV in non-smoking healthy men and women (aged 45-70y). Methods:The MARINA study (ISRCTN66664610) was a parallel design, randomised controlled trial that compared the intake of 0.45, 0.9 and 1.8g/d of encapsulated EPA + DHA-rich triacylglycerols with matched placebo capsules containing an oleic acid-rich triacylglycerol consumed for 1y. Actiheart monitors (CamNtech Ltd, Cambridge, UK) were fitted following a clinic visit and heart rate IBI were recorded over 24h following a 1 month run-in on placebo and at 6 and 12 months following randomisation to treatment. Data was processed from day-time and night-time periods separately using Actiheart 4 (v.4.0.91) and Kubios HRV software (v.2.1). Complete data on the HRV parameters (frequency domain, time domain and non-linear) were available for 214 participants (89 men, 125 women). Nocturnal (sleep-time) data has been reported previously; here we report the results of the daytime data analysis. The following HRV parameters are reported: SDNN, estimates of overall variability; high frequency (HF) power, a short-term component of HRV reflecting vagal modulation; and SDANN and very low frequency (VLF) power, indicating longer-phase variability. Results:No significant treatment effects were found for the different components of daytime HRV and there was a large variation in the data, in contrast to the night-time data showing statistically significant increases in longer-phase components of HRV (SDANN, VLF and Ti) following n-3 PUFA supplementation compared to placebo. Conclusions:Daytime data was collected from subjects under ambulatory conditions and subject to the influence of a number of external stimuli that are difficult to control, unlike night-time data where external stimuli is reduced. If we are to detect subtle dietary effects on HRV we need to control the degree and number of external stimuli. These results have important implications for the design of future studies. P654 Changes in fat intake in adult Warsaw population in the 28 year period A Waskiewicz1, A Aranowska1, D Szczesniewska1 1National Institute of Cardiology, Warsaw, Poland Topic: Sports cardiology Purpose:Studies results indicate a relationship between the intake and type of dietary fats and the occurrence of cardiovascular diseases. Evaluation of changes in fat intake and fat sources in the diet consumed by an adult Warsaw residents in 1984-2012 years. Methods:Independent, representative population samples of Warsaw residents aged 35-64 were examined in the frame of Pol-MONICA Projects (in 1984 year - 2552 persons; 1988 year - 1381 persons; 1993 year - 1460 persons; 2001 year – 843 persons) and WAW-KARD (in 2012 year - 614 persons). Nutrition patterns were assessed by interview of food intake in the 24-hours before the study. Results:In 2012 in comparison to 1984, 23% decrease in fat and 40% decrease in dietary cholesterol consumption in men and women was noticed. However, in relation to saturated (SFA) and polyunsaturated (PFA) fatty acids (expressed as percentage of energy) course of changes in 1984-2001 and 2001-2012 was different. In the first period there was 20% decrease of SFA and 70% increase of PFA, in the second one the reversal of the trend was observed - increase SFA (men 13% and woman 20%) and decrease PFA (by 5% and 13%). Above mentioned changes resulted in course of atherogenicity level of diet as expressed by Keys score, significant reduction in 1984-2001 (men 56,5 to 43,0 and woman 56,7 to 41,7), and then increase in 2012 (respectively to 47,7 and to 49,3) was noted. This was associated with changes in preferences the type of fat used spreads and cooking. At first, after the growing interest in margarine and oils which was the cause of the increase in consumption of vegetable fats, the trend has been reversed, and again became more popular butter. Conclusions:A positive tendency in fat consumption observed in 1984-2001 was further until 2012 inhibited and even reversed. P656 Body mass index, insulin-like growth factor 1 and other factors in children with insulin resistance A Tohatyova1, E Joppova1, N Fatulova1, D Stromplova1, I Schusterova2 1Safarik University, Faculty of Medicine, Kosice, Slovak Republic 2East-Slovak Institute of Cardiovascular Diseases, Kosice, Slovak Republic Topic: Sports cardiology Purpose:Adult study showed an inverse association between the insulin-like growth factor I (IGF-I) and the risk of impaired glucose tolerance or diabetes mellitus. These data suggested a protective effect of IGF-I against the development of metabolic syndrome. However, there are only few data in children population. Aim of our study was to association between IGF-I and obesity and insulin resistance (IR). Methods:In 21 child (mean age 13.38 ± 2.69) with IR and 34 (mean age 12.32 ± 4.5) controls without IR, insulin-like growth factor 1 (IGF-l), growth hormone (HGH), hepatic enzymes, uric acid, lipids were measured. For the diagnosis of IR, 3.16 was used as the cut-off value of homeostasis model assessment of insulin resistance (HOMA-IR). Presence of metabolic syndrome was determined according to IDF 2007 criteria. Results:In children with IR, there were only significant differences in body mass index (BMI) (p < 0.001), and body weight (p < 0.001). No differences were found in IGF-1 in spite of correlations of HOMA-IR with some of MS components; positive correlation with BMI (p < 0.001), body weight (p= 0.001), and with uric acid (p = 0,037), and negatively with HDL cholesterol (p = 0.031). Conclusions:IR in childhood is s related to normal IGF-1 children and it seems that BMI and body weight both are more associated with IR than IGF-l. More study is required to elucidate biological mechanism of this complex relationship. P657 Improved cardio-metabolic risk factors at three months after laparoscopic sleeve gastrectomy in morbidly obese individuals RS Gavril1, AC Oprescu2, A Gherasim1, LI Graur1, L Mihalache1, SS Padureanu1, M Graur1 1"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania 2St Spiridon University Hospital, Diabetes, Nutrition and Metabolic Diseases, Iasi, Romania Topic: Sports cardiology Purpose:Obesity is correlated with increased cardio-vascular risk. However, pharmacological therapy for weight loss is scarce, and diet and exercise is insufficient for morbidly obese patients. Currently, bariatric surgery is the most efficient treatment for these patients. While Roux-en-Y gastric by-pass is the "gold-standard" procedure, the newer laparoscopic gastric sleeve (LGS) is beginning to show comparable results with fewer complications and long-term nutritional deficits. The aim of this study was to assess the modification in cardio-vascular risk factors in obese subjects after LSG. Methods:We studied a group of obese patients who underwent LSG during 2013-2014 in our hospital. We evaluated the following clinical and biological parameters before and three months after surgery: body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose, glycated haemoglobin (HbA1c), total cholesterol, HDL-cholesterol, triglycerides and uric acid. The study conformed to the principles of the Declaration of Helsinki. Results:We studied a group of 28 patients (21 women), mean age of 41.4±11.7 years. Anthropometric and metabolic parameters improved significantly at three months after surgery, except for HDL-cholesterol, but the decrease in SBP and DBP was not statistically significant, as can be seen in Table 1. Conclusions:LSG produced a significant weight loss after three months and had beneficial effects on metabolic parameters. SBP and DBP were not as much influenced by the weight reduction. *mean value+/-standard deviation Parameter Before LSG* 3 months after LSG* Sig. (p) BMI (kg/m2) 43.2±6.9 33.8±6.7 <0.001 WC (cm) 126.6±18.2 107.6±17.9 <0.001 SBP (mmHg) 130±16.8 129±17.5 0.391 DBP (mmHg) 79.3±9.2 74±11.4 0.638 fasting plasma glucose (mg/dl) 116.4±43.3 98.9±21 0.013 HbA1c (%) 5.9±0.7 5.6±0.8 0.054 total cholesterol (mg/dl) 200.6±40 197.4±43 0.041 HDL-cholesterol (mg/dl) 45.9±12.6 44.5±12.7 0.014 triglycerides (mg/dl) 142±64.7 123.7±53.7 0.097 uric acid (mg/dl) 6.3±1.1 5.5±1.5 0.078 Parameter Before LSG* 3 months after LSG* Sig. (p) BMI (kg/m2) 43.2±6.9 33.8±6.7 <0.001 WC (cm) 126.6±18.2 107.6±17.9 <0.001 SBP (mmHg) 130±16.8 129±17.5 0.391 DBP (mmHg) 79.3±9.2 74±11.4 0.638 fasting plasma glucose (mg/dl) 116.4±43.3 98.9±21 0.013 HbA1c (%) 5.9±0.7 5.6±0.8 0.054 total cholesterol (mg/dl) 200.6±40 197.4±43 0.041 HDL-cholesterol (mg/dl) 45.9±12.6 44.5±12.7 0.014 triglycerides (mg/dl) 142±64.7 123.7±53.7 0.097 uric acid (mg/dl) 6.3±1.1 5.5±1.5 0.078 Open in new tab *mean value+/-standard deviation Parameter Before LSG* 3 months after LSG* Sig. (p) BMI (kg/m2) 43.2±6.9 33.8±6.7 <0.001 WC (cm) 126.6±18.2 107.6±17.9 <0.001 SBP (mmHg) 130±16.8 129±17.5 0.391 DBP (mmHg) 79.3±9.2 74±11.4 0.638 fasting plasma glucose (mg/dl) 116.4±43.3 98.9±21 0.013 HbA1c (%) 5.9±0.7 5.6±0.8 0.054 total cholesterol (mg/dl) 200.6±40 197.4±43 0.041 HDL-cholesterol (mg/dl) 45.9±12.6 44.5±12.7 0.014 triglycerides (mg/dl) 142±64.7 123.7±53.7 0.097 uric acid (mg/dl) 6.3±1.1 5.5±1.5 0.078 Parameter Before LSG* 3 months after LSG* Sig. (p) BMI (kg/m2) 43.2±6.9 33.8±6.7 <0.001 WC (cm) 126.6±18.2 107.6±17.9 <0.001 SBP (mmHg) 130±16.8 129±17.5 0.391 DBP (mmHg) 79.3±9.2 74±11.4 0.638 fasting plasma glucose (mg/dl) 116.4±43.3 98.9±21 0.013 HbA1c (%) 5.9±0.7 5.6±0.8 0.054 total cholesterol (mg/dl) 200.6±40 197.4±43 0.041 HDL-cholesterol (mg/dl) 45.9±12.6 44.5±12.7 0.014 triglycerides (mg/dl) 142±64.7 123.7±53.7 0.097 uric acid (mg/dl) 6.3±1.1 5.5±1.5 0.078 Open in new tab P659 Adipokine and incretin levels in metabolically healthy obese patients M Boyarinova1, O Rotar1, E Moguchaya1, E Kolesova1, K Sysoev2, E Vasilieva1, V Yudina1, V Solntsev1, A Konradi1 1Federal Almazov Medical Research Centre, Saint Petersburg, Russian Federation 2Saint Petersburg Pavlov State Medical University, Saint Petersburg, Russian Federation Objective:Obesity is believed to be associated with cardiovascular and metabolic complications; while a small proportion can be considered "metabolically healthy" obese (MHO) individuals, who have normal insulin sensitivity, lipid profile, and blood pressure. Absence if inflammation and neurohumoral activation can be an explanation for such phenomenon. The aim of the study was to assess the adipokine and incretin levels in obese individuals with and without metabolic disorders. Design and methods:1600 relatively healthy bank employers were screened for metabolic syndrome (MS) in Saint-Petersburg (Russia). 155 participants were randomly selected out of subjects who had at least one component of MS and had no established cardiovascular events and severe concomitant diseases. Informed consent was obtained from all participants. Anthropometry and blood pressure measurement were performed according to standard protocols. Fasting plasma glucose and lipid profile were determined (Hitachi-902). Adipokines and incretins were measured on BioPlex Protein Array System (BioRad, USA). Insulin resistance (IR) was calculated using the HOMA IR formula. The threshold level for IR was considered 2,7. Metabolic health was defined as the presence of 0-1 cardiometabolic abnormalities according to the Wildman criteria, 2008. Nonparametric statistic was applied. Results:From 155 subjects only 65 participants had obesity according to body mass index = 30 kg/m2: 10 participants were MHO (group 1) and 55 had metabolic disorders (group 2). Groups were matched for sex and age. The mean age was 47.6 years in the group 1 and 49.0 – in the group 2. There were no significant differences in levels of ghrelin, GIP, GLP-1, resistin, insulin and leptin between groups. Significantly different levels of PAI-1 13425.4 (7518.9; 30570.7) vs 33291 (13265.0; 48860.1) pg/ml, p = 0.04, and visfatin 388.4 (6.8; 625.1) vs 1354.0 (354.4; 2061.7) pg/ml, p = 0.006. Both were higher in the obese patients with metabolic disorders. Conclusions:Visfatin and plasminogen activator inhibitor 1 are considered as pro-inflammatory markers and are related to endothelial dysfunction and atherosclerosis. Increase of these adipokines in obese patients might contribute to association of obesity with metabolic abnormalities. P660 Cardiovascular risk reduction in obese patients submited to bariatric surgery persists over time M Faustino1, S Bravo Baptista1, M Nedio1, C Monteiro1, E Lourenco1, V Gil1, C Morais1 1Hospital Prof. Dr. Fernando Fonseca, EPE, Amadora, Portugal Topic: Sports cardiology Purpose:Obesity associates with increased cardiovascular risk. Bariatric surgery (BS) has been demonstrated to result in relevant weight loss in the first moths after surgery and consequent improvement of most obesity-associated cardiovascular risk factors. However questions remain if this benefit persists long term. This study aims to evaluate long-term evolution of anthropometric and laboratorial parameters and functional capacity on a cohort of obese patients, submitted BS. Methods:Patients were prospectively examined before BS (Eval1), 6 month (Eval2) and 3 years after BS (Eval3). Anthropometric parameters, lipid profile and glycaemia were obtained and a six-minute walk test (6mWT) was performed. Results:Forty-one obese patients were included (mean age 46 years ±11; 38 women); The median time between BS and Eval2 was 217 days (IQR 93) and between Eval2 and Eval3 was 918 days (IQR 343). Results are presented in the table1. Weight and BMI continued to improve between Eval2 and 3, as did glucose and CRP values. The gain obtained in LDL-C values was not lost and HDL-C increased even further in Eval3. Conclusion:The effect of BS on body weight persists after 3 years, with additional benefit. The initial improvement of metabolic and hemodynamic parameters and functional capacity, that accompanied weight loss, not only persisted but also improved additionally at 3 years, even after a very important weight loss had occurred. Analysis (Eval2 vs Eval1) and (Eval3 vs Eval2). *p< 0.0001; **p=0,017; § p=0,015 (number of patients on anti-hypertensive therapy Eval1-11, Eval3-5); #p=0,0036; Eval1 Eval2 Eval3 Anthropometric parameters IMC (Kg/m2) 42.9±4.0 29.6±3.6* 27.4±3.1* Weigh (kg) 113.5±12.8 78.5±11.8* 72.6±10.3* Heart rate (1/min) 70.0±8.9 61.7±10.3* 61.0±7.5 Systolic blood pressure (mmHg) 129±16 124±21 135±22 § Laboratorial parameters Glycaemia (mg/dl) 100 (28) 85(8)* 82 (10)# Total cholesterol (mg/dl) 194.4±45.4 169.2±304* 177.0±29.7 LDL cholesterol (mg/dl) 123.8±39.2 100.7±25.3* 95.4±26.9 HDL cholesterol (mg/dl) 45.9±10.2 51.8±13.0* 64.7±15.6* High sensitive CRP(mg/ml) 1.33(1.54) 0.64 (1.05)* 0.29 (0.02)* 6mWT Distance (m) 454±93 524±76* 539±77 Eval1 Eval2 Eval3 Anthropometric parameters IMC (Kg/m2) 42.9±4.0 29.6±3.6* 27.4±3.1* Weigh (kg) 113.5±12.8 78.5±11.8* 72.6±10.3* Heart rate (1/min) 70.0±8.9 61.7±10.3* 61.0±7.5 Systolic blood pressure (mmHg) 129±16 124±21 135±22 § Laboratorial parameters Glycaemia (mg/dl) 100 (28) 85(8)* 82 (10)# Total cholesterol (mg/dl) 194.4±45.4 169.2±304* 177.0±29.7 LDL cholesterol (mg/dl) 123.8±39.2 100.7±25.3* 95.4±26.9 HDL cholesterol (mg/dl) 45.9±10.2 51.8±13.0* 64.7±15.6* High sensitive CRP(mg/ml) 1.33(1.54) 0.64 (1.05)* 0.29 (0.02)* 6mWT Distance (m) 454±93 524±76* 539±77 Open in new tab Analysis (Eval2 vs Eval1) and (Eval3 vs Eval2). *p< 0.0001; **p=0,017; § p=0,015 (number of patients on anti-hypertensive therapy Eval1-11, Eval3-5); #p=0,0036; Eval1 Eval2 Eval3 Anthropometric parameters IMC (Kg/m2) 42.9±4.0 29.6±3.6* 27.4±3.1* Weigh (kg) 113.5±12.8 78.5±11.8* 72.6±10.3* Heart rate (1/min) 70.0±8.9 61.7±10.3* 61.0±7.5 Systolic blood pressure (mmHg) 129±16 124±21 135±22 § Laboratorial parameters Glycaemia (mg/dl) 100 (28) 85(8)* 82 (10)# Total cholesterol (mg/dl) 194.4±45.4 169.2±304* 177.0±29.7 LDL cholesterol (mg/dl) 123.8±39.2 100.7±25.3* 95.4±26.9 HDL cholesterol (mg/dl) 45.9±10.2 51.8±13.0* 64.7±15.6* High sensitive CRP(mg/ml) 1.33(1.54) 0.64 (1.05)* 0.29 (0.02)* 6mWT Distance (m) 454±93 524±76* 539±77 Eval1 Eval2 Eval3 Anthropometric parameters IMC (Kg/m2) 42.9±4.0 29.6±3.6* 27.4±3.1* Weigh (kg) 113.5±12.8 78.5±11.8* 72.6±10.3* Heart rate (1/min) 70.0±8.9 61.7±10.3* 61.0±7.5 Systolic blood pressure (mmHg) 129±16 124±21 135±22 § Laboratorial parameters Glycaemia (mg/dl) 100 (28) 85(8)* 82 (10)# Total cholesterol (mg/dl) 194.4±45.4 169.2±304* 177.0±29.7 LDL cholesterol (mg/dl) 123.8±39.2 100.7±25.3* 95.4±26.9 HDL cholesterol (mg/dl) 45.9±10.2 51.8±13.0* 64.7±15.6* High sensitive CRP(mg/ml) 1.33(1.54) 0.64 (1.05)* 0.29 (0.02)* 6mWT Distance (m) 454±93 524±76* 539±77 Open in new tab P662 Return to work after acute coronary syndrome in independent workers F Latil1, M-C Iliou2, C Boileau1, C Lechien1, P Ha-Vnh1, C Guimond1 1Service medical RSI, Paris, France 2Corentin Celton - APHP, Cardiac Rehabilitation and secondary prevention, Issy Les Moulineaux, France Introduction:Failure in return to work (RTW) after an acute cardiac syndrome (ACS) can turn a medical success into turmoil such as job loss, weight gain or depression. The aim of this study was to assess the frequency and cause of delayed RTW after a first ACS in independent workers. Methods:154 consecutive patients (independent craftsmen or shopkeepers) who underwent a first hospitalisation for acute coronary syndrome (ACS) were included.Primary outcome was RTW at 90 days. For patients who had not resumed work at90 days, social, medical and psychological processes were investigated via self-report questionnaires and medical examination. Results:Among the 154 patients, 63 (40%) did not RTW on time at 90 days, as stated by the national guide-line. Among these 42 for medical, administrative or psychological reasons but 21 of those (15.7%) were ready to resume, had no reason to stand-by and were only waiting for the go-ahead from the cardiologist. Secondary outcome: uptake in medical knowledge of the disease was better 70,7 % , than the occupational knowledge (53.4%) Conclusion:We suggest that, a lot of the stand-by patients could resume work sooner if on time decision and education were implemented. P663 Gender related differences in psychological distress and polyvascular disease in patients with coronary artery disease A N Sumin1, EV Korok1, OI Raich1, RA Gayfulin1, AV Bezdenezhnyh1, OL Barbarash1 1RAMS Scientific-Research Institute for Complex Studying of Cardiovascular Diseases, Kemerovo, Russian Federation Background:No doubt, polyvascular disease (PolyVD) worsens treatment outcomes in patients with coronary artery disease (CAD). Current medical literature report that PolyVD patients are more likely to have type D (distressed) personality, compared to patients with isolated atherosclerotic lesions. However, the impact of gender related differences on the relationship between psychological distress and PolyVD are still poorly understood. Objective:To study the prevalence of psychological distress based on the presence of PolyVD and gender. Material and methods:709 patients with stable CAD were examined and treated in the NII KPSSZ for the period from 1 February 2009 to 31 January 2010. Patients were assigned into four groups according to their gender and the presence of PolyVD: Group 1 – females without PolyVD (n = 108), Group 2 – females with PolyVD (n = 23), Group 3 – males without PolyVD (n = 471), Group 4 – males with PolyVD (n = 107). PolyVD was diagnosed as a combination of stenotic lesions >50% of two or more arteries. Trait anxiety levels were assessed with the Spielberger-Hanin anxiety test. Depression severity was assessed with the Depression Scale. Results:Severe psychological distress is associated with unfavorable psychological profile in PolyVD patients of both genders. They had higher levels of depression and trait anxiety, compared to patients with isolated coronary lesions (Table 1). Conclusion:CAD patients presenting with PolyVD had higher levels of depression and anxiety, regardless of gender. The relationship between psychological distress and PolyVD may be regarded as one of the factors affecting the prognosis in CAD patients. PolyVD – polyvascular disease; * - p<0.05 in comparison with females without PolyVD; # - p<0.05 in comparison with females suffering from PolyVD; $ - p<0.05 in comparison with males without PolyVD Indicators Females without PolyVD (n=108) Females with PolyVD (n=23) Males without PolyVD (n=471) Males with PolyVD (n=107) p Levels of depression 51.5 [48;54] 55 [49;57]* 53 [48;56]# 54 [49;56]*$ 0.029 Trait anxiety levels 30.5 [29;35] 35 [31;43]* 32 [29;40] 34 [30;44] 0.006 Indicators Females without PolyVD (n=108) Females with PolyVD (n=23) Males without PolyVD (n=471) Males with PolyVD (n=107) p Levels of depression 51.5 [48;54] 55 [49;57]* 53 [48;56]# 54 [49;56]*$ 0.029 Trait anxiety levels 30.5 [29;35] 35 [31;43]* 32 [29;40] 34 [30;44] 0.006 Open in new tab PolyVD – polyvascular disease; * - p<0.05 in comparison with females without PolyVD; # - p<0.05 in comparison with females suffering from PolyVD; $ - p<0.05 in comparison with males without PolyVD Indicators Females without PolyVD (n=108) Females with PolyVD (n=23) Males without PolyVD (n=471) Males with PolyVD (n=107) p Levels of depression 51.5 [48;54] 55 [49;57]* 53 [48;56]# 54 [49;56]*$ 0.029 Trait anxiety levels 30.5 [29;35] 35 [31;43]* 32 [29;40] 34 [30;44] 0.006 Indicators Females without PolyVD (n=108) Females with PolyVD (n=23) Males without PolyVD (n=471) Males with PolyVD (n=107) p Levels of depression 51.5 [48;54] 55 [49;57]* 53 [48;56]# 54 [49;56]*$ 0.029 Trait anxiety levels 30.5 [29;35] 35 [31;43]* 32 [29;40] 34 [30;44] 0.006 Open in new tab P664 The psychological status of youngsters I N Ryamzina1, AS Ragel2 1Perm State National Research University, Perm, Russian Federation 2Perm State Medical Academy, Perm, Russian Federation Topic: Sports cardiology Purpose:It is actual to discuss a role of psychological abnormalities in a development of cardiovascular disease (CVD). The aim of present study was to assess a psychological status of youngsters. Methods:The study involved 160 students of the Medical Academy (53 males). Age of the respondents was 23.22 ± 0.17 years. HADS test was performed to identify anxiety and depression. Also we studied traditional CVD risk factors: body mass index (BMI), blood pressure (BP), glucose and cholesterol levels, tobacco-smoking and volume exercise Results:According to HADS test results 14.7% of the students observed subclinical anxiety and 7.35% clinical anxiety, 47.7% subclinical depression and 8.82% - clinical. The students indicated a high overload of educational process. 20% of them complained on weakness and fatigue, 8% - on decrease of capacity of work. Duration of sleep was less than 7 hours in 38.4% of the students. The average systolic blood pressure (SBP) was 113.68 ± 1.82 mm Hg, diastolic blood pressure (DBP) - 71,62 ± 0,99 mm Hg. BP = 140/90 mm Hg was found in 5.88%. It should be noted that the SBP was increased in students with significant anxiety / depression and decrease of physical activity. Conclusion:Our data show that psychological abnormalities (anxiety and depression) are associated with arterial hypertension in youngsters. There is a need to promote a healthy lifestyle, including psychological support of the students. We suppose that a correction of educational program could be useful in this case. P666 Implications of Literacy for health for blood pressure M Cunha1, LS Nunes2, A Dias1, O Ribeiro1 1CI&DETS, Superior Health School , Polyrechnic Institute of Viseu, Viseu, Portugal 2Escola Nacional de Sa??a, Lisboa, Portugal Topic: Sports cardiology Purpose:This research aims to show how blood pressure is influenced by health literacy, salt intake habits, the use of sugar and herbs and spices in cooking. Methods:A descriptive and transversal study was undertaken to collect data on a selected sample of 508 Portuguese individuals, aged 44-48. It was used the European Health Literacy Survey Questionnaire, (HLS- EU-Q) Health Literacy Survey in Portuguese (HLS-EU-PT) and a survey was created on salt intake, as well as on herbs and spices in cooking. Blood pressure was also measured. Results:The majority of people who participated in the survey (35.83%) have both normal diastolic (PAS >130mmHg) and systolic blood pressure (PAD>85 mmHg); about 32.28% have high blood pressure, Stage 1 Hypertension, (systolic > 140-159 and diastolic > 90-99 mmHg). The participants who had a salt intake superior to the recommended maximum of 5 g/day got higher diastolic blood pressure measurements. Higher blood pressure levels were found in individuals who consumed either high levels of sugar (men 36 g/day and women > 20g/day) or did not use herbs and spices in cooking. Although participants who consume too much salt or sugar and those who do not use herbs and spices got higher blood pressure measurements, statistical differences among the groups are considered to be not significant. These data demonstrate that participants with inadequate health literacy, have higher blood pressure levels, have poorer health and suffer from more heart diseases when compared to those with good health literacy. Conclusions:The study confirms that health status is directly correlated to literacy skills. Although there is no statistical significance, health literacy has an effect on blood pressure levels. Thus, it is both pertinent and necessary to invest in literacy as a promoter of this health indicator, while valuing clinical relevance. P667 Gender and nationality effect on quality of life after beta-blocker up-titration in patients with heart failure: results from the CIBIS-ELD trial HD Duengen1, E Tahirovic1, C Zelenak1, T Trippel1, M Fritschka1, V Celic2, S Apostolovic3, B Pieske1, ML Chavanon4, C Herrmann-Lingen4 1Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany 2University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", Cardiology Department; Faculty of Medicine, University of Belgrade, Belgrade, Serbia 3Clinical Center of Nis, Cardiology, Nis, Serbia 4Georg-August University, Department of Psychosomatic Medicine and Psychotherapy, Gottingen, Germany Objective:Previous research showed that quality of life (QoL) is based on the patient's emotional and social situation and characteristics of the treatment setting. Assumptions are that cultural aspects might influence the perception of psychosocial treatment aspects, but they have rarely been taken into account. In order to probe effects of cultural background on QoL independent of clinical improvement due to beta-blocker up-titration, we analyzed QoL data from the Cardiac Insufficiency Bisoprolol Study in Elderly (CIBIS-ELD). Methods:German (G) and Serbian (S) patients were randomly assigned in CIBIS-ELD trial to up-titration with bisoprolol or carvedilol. The physical and psychosocial component scores on the short-form health survey (SF36) were recorded at baseline and after 3 months. Besides the design factors Sex, Nation and Time, all analyses accounted for age and clinical parameters such as NYHA functional class (I-II vs. II-IV) at baseline, objective physical performance in the 6-min walk test, LVEF, initial medication and final dosage of study medication at follow-up (0, ?155;, ¼, ½, >½ of the targeted dose). Complete data were available for 136 G (67 f) and 426 S (117 f). We controlled the number of unplanned visits and its interaction with NYHA class and nation in order to rule out QoL differences of that origin. Results:Comparison of data showed that in both sexes and nations, both physical and mental QoL scores improved from baseline to follow up (d>.17, ps<=.001). However, differences in sexes have been noticed: men reported better both physical and mental QoL, F>6.6, ps<.01. When comparing the effect of nation: S showed a greater response on physical and mental QoL compared to G (S d=0.3-0.34 vs. G d=0.07-0.12). It was also shown that cultural differences in treatment response were strongest for facets that are less affected by beta-blockers. Treatment effects associated to NYHA class were only observed on physical QoL, F=9.38, p=.002. For patients in NYHA classes III-IV the treatment resulted in a lager improvement of physical QoL than for NYHA I-II and their physical QoL was not different from that of patients with less severe heart failure at follow-up anymore, p>.10. Conclusion:This researched showed clear cultural differences in QoL change: S showed a stronger positive response to treatment compared to G. This effect might be associated with national differences when it comes to prevention and health care service or cultural aspects related to the perception of interpersonal factors as nation effects were more pronounced on the psychosocial than on the physical QoL facet. P668 Hurdles and expectations towards preventative measures in urban women (from the BEFRI study): tailoring prevention to selective needs S Oertelt-Prigione1, U Seeland1, M Ruecke1, V Regitz-Zagrosek1 1Charité - Universit?medizin Berlin, Institute of Gender in Medicine, Berlin, Germany Topic: Sports cardiology Purpose:Preventative measures and lifestyle changes are essential strategies towards population health. We sought to explore lifestyle measures, uptake barriers and expectations in the female urban population, as well as subjective health information sources to define overall subgroup patterns in lifestyle choices. Methods:Within the BEFRI (Berlin Female Risk Evaluation) study, we enrolled 1062 women aged 25-74 years. Participants completed questionnaires and attended an extensive clinical examination. Lifestyle factors, subjectively perceived hurdles and expectations and health information sources were elicited. Behavioral patterns, wishes and hurdles were evaluated in multivariate analysis using social, economic and clinical variables as independent explanators. Results:49.6% of the study participants reported lifestyle measures (e.g. weight control, physical activity, relaxation techniques, smoking cessation etc.) in the last 12 months, with no significant age-related differences. Target groups were successfully addressed, e.g. overweight and diabetic women more frequently engaged in weight management effort (adjusted, OR = 3.9, C.I.= 1.7-9.3 and OR = 4, C.I.= 1.5-10.8). Subjectively perceived hurdles for participation varied. Older women (OR= 1.8, C.I.= 1.0-3.4 for each of 5 age strata) and women with hypercholesterolemia (OR= 3.4, C.I.= 1.3-8.9) feared of inability to change. Overweight women (OR=3.2, C.I.=1.3-8.1) and women living alone (OR=2.4, C.I.= 1.1-5.8) feared lack of physical ability. Expectations diverged, e.g. social rewards were most relevant in women living alone, proximity to work for women with children and higher earning brackets and opportunity to perform measures at home for overweight women and women with a history of tumor disease. Health information sources also differed. Physicians and pharmacists were only reported as primary sources if frequent access was granted, i.e. women having had medical contact in the last three months or with frequent follow-up visits. Magazines and newspapers were the main source for older women and TV for women with low-income jobs. Internet consultation for health information significantly decreased with income (OR=0.8, C.I.= 0.7-0.9, for each of 5 wage brackets). Conclusions:Our analysis identified specific patterns, expectations and limitations for the uptake of preventative lifestyle measures by different subgroups of urban women. These data, combined with the reported differences in information access, should be taken in consideration for the development of future information campaigns and for general health counseling. P669 Sports history and timing of first myocardial infarction in normal weight men younger than 65 years P Eser1, C Janggen1, C Graeni1, L Raeber1, M Wilhelm1 1Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne, Berne, Switzerland Background/Aim:Regular physical activity delays the onset of atherosclerosis through positive modification of cardiovascular risk factors (CVRF). However, vigorous exercise may lead to acute plaque rupture and premature myocardial infarction (MI) in patients at risk. Our retrospective cohort study assessed sports history and age at first MI in young to middle aged normal weight men with MI. Methods:The registry of consecutive percutaneous coronary interventions (PCI) at the University Hospital Bern was analyzed from March 2009 until January 2012. Male patients with acute MI between 18 and 65 years and body mass index =25kg/m2 were included. Sports history was assessed by telephone interview. Patients were grouped according to starting age with sports =1 h/week outside school sports (EARLY:<18 years, CONTROL:=18 years or never). Cumulative lifetime training hours, CVRF and circumstances of MI were recorded. The primary end-point was age at first MI. Sub-group analyses were performed for two age groups (20-55 years vs. 56-65 years). Groups were compared by independent t-, Mann-Whitney, or Chi square test, as appropriate. Results:Of 4394 consecutive patients who underwent PCI, 212 fulfilled the inclusion criteria and were interviewed (EARLY 133, 62.7% and CONTROL 79, 37.3%). Age at first MI was significantly lower in EARLY compared to CONTROL. This was solely due to the earlier onset of first MI in the subgroup of 20-55 years (mean ± SD 46.8 ± 6.0 vs. 49.8 ± 4.6 years; p=0.006), while the subgroup of 56-65 years showed no differences (60.0 ± 2.9 vs. 60.5 ± 2.6; p=0.49). The proportion of exercise-related acute MI was not different between the groups (11.3% vs. 12.6%; p=0.66). In EARLY mean yearly training hours were higher than in CONTROL for both subgroups (p<0.001). Patients in EARLY had fewer CVRFs (1.7 vs 2.2; p=0.003). Fewer EARLY patients had hypertension or hypercholesterinemia (p=0.011), but groups were comparable for diabetes mellitus and family history. Smoking was equally high in EARLY and CONTROL (58% and 59%). For the subgroup 20-55 years, patients in EARLY exhibited more frequently one-vessel disease and ST-elevation MI (51.9% vs. 31.0%; p=0.027, and 76.5% vs. 57.1%; p=0.026, respectively). Conclusions:Unexpectedly, in patients aged 55 and younger, occurrence of first MI was 3 years earlier in those who started regular sports activity before age 18, despite a more favorable CVRF profile. Exercise may exhibit negative effects on an endothelium altered by smoking and/or in the presence of genetic risk factors. P670 Early and late aortic propagation velocity values in STEMI patients after successful primary PCI M Yaman1, O Beton2, HE Pamukcu2, A Aksakal1, A Hakan1, S Aktag1, O Yucel1, O Dogdu3 1Samsun Education and Research Hospital, Samsun, Turkey 2Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey 3Firat University, Cardiology, Elazig, Turkey Aim Atherosclerosis is a generalized disease that mainly manifested in medium-sized vessels and also present in the great vessels, such as the thoracic aorta. Atherosclerosis leads to arterial stiffness. M-mode propagation velocity of the descending thoracic aorta or aortic velocity propagation (AVP) is a novel method for the measurement of the aortic stiffness. It is not known yet whether AVP value could change after effective treatment in STEMI patients. We aimed to investigate the difference between early and late values of AVP after successful primary PCI in STEMI patients. Methods:A total of 100 consecutive patients without previously known coronary artery disease who presented with STEMI without hemodynamic comprimise and undergone successful primary percutaneous coronary intervention (PCI) were selected prospectively. Presence of more than 50% lesion in coronaries other than culprit vessel and hemodynamic comprimise in ICU after primary PCI were exclusion criterias. Transthorasic ecocardiography (TTE) was performed to all of patients after primary PCI at 12-24 hour in ICU (early measurements) and during the third month control (late measurements) after discharge. All patients received guidelines based optimal medical therapy during hospital stay and after discharge. Doppler echo, 2D and AVP measurements were recorded. Haematological and serum biochemical parameters of the study group were recorded. Results:The study group was consisted of 77 male and 23 female patients with 175.6±120.4 min symptom onset-to-balloon time. There was no difference between 2D echocardiography measurements between early and late evaluations. AVP values increased at late control in all patients. Mean AVP values were 33.7± 11.6 cm/sn and 44.4±10.5 cm/sn at early and late measurements, respectively (p<0.001). Increase of AVP value (difference between early and late) was more prominent in patients with hypertension(n=49) in comparison with patients without hypertension, 12.5±7.2 cm/sn and 8.9±8.7 cm/sn, respectively (p=0.027). While, this difference is not significant between patient with and without diabetes mellitus. There were significant correlations between difference of AVP and neutrophil lymphocyte ratio between early and late measurements (r = ?.699, P < 0.001). Conclusion:It was shown for the first time that AVP values could improve after successful treatment in STEMI patients. Increments in AVP values were closely correlated with decrements in neutrophil lymphocyte ratio. It can be postulated that AVP has strong relationship with acute inflammatory process P671 Impact of cardiovascular polypill based therapy on healthy lifestyle behavior R Webster1, C Bullen2, A Patel3, A Rodgers1, V Selak2, S Thom4 1The George Institute for Global Health, Cardiovascular, Sydney, Australia 2National Institute for Health Innovation, Auckland, New Zealand 3The George Institute for Global Health, Office of the Chief Scientist, Sydney, Australia 4Imperial College London, London, United Kingdom Background:The effectiveness of a polypill strategy in improving adherence to recommended CVD preventive medications has been established. However there are concerns that this strategy may deflect attention from lifestyle measures of prevention. The Single Pill to Avert Cardiovascular Events (SPACE) collaboration is a prospective, individual participant data meta-analysis of three trials conducted from 2009 to 2013 comparing polypill-based care with usual care in patients with established CVD or similarly high risk. Patients in the SPACE trials knew they were taking the polypill. This setting enables assessment of changes in beneficial lifestyle behaviours in those who were randomised to the polypill group. Aim:To assess the effect of polypill-based care on CVD preventive lifestyle behavior. Methods:The SPACE trials include: UMPIRE (India, n=1000; Western Europe, n=1004), Kanyini-GAP (Australia, n=623) and IMPACT (New Zealand, n=513). The 3 trials had similar protocols and used the same polypill (containing aspirin, lisinopril, simvastatin and either atenolol or hydrochlorothiazide). Analyses were conducted on a combined dataset using a log-binomial model with treatment group as a fixed effect and trial as a random effect. Analysis of continuous measures used a linear mixed model (baseline value and treatment arm as fixed effects) and a random trial intercept and random trial-by-treatment interaction. Results:At 12 months, no difference was seen between polypill and usual care groups for BMI (mean difference 0.0 kg/m2, 95% CI -0.1 to 0.2, p=0.68), waist circumference (mean difference 0.1cm, 95% CI -0.3 to 0.5, p=0.73), smoking (RR 0.96, 95% CI 0.81 to 1.14, p=0.65), or quitting smoking before month 12 (RR 1.00, 95% CI 0.66 to 1.51, p=0.99). Similar findings were seen in high-risk primary prevention and secondary prevention patient populations, with tight confidence intervals around a null effect on BMI, waist circumference and smoking measures in both groups. Conclusions:These data provide the first randomised evidence that use of a polypill does not adversely impact beneficial lifestyle behaviour in both primary and secondary prevention populations. P672 Effect of preventive measures for major metabolic parameters in patients with non-alcoholic fatty liver disease and cardiovascular risk OV Kolesnikova1, VD Nemtsova2 1L.T.Malaya Institute of Therapy, Cardiology, Kharkiv, Ukraine 2Kharkiv National Medical University, Cardiology, Kharkiv, Ukraine The purpose - the dynamic assessment of the preventive measures impact on the main metabolic parameters in patients with nonalcoholic fatty liver disease (NAFLD) in combination with obesity with low and moderate cardiovascular risk (CVR). Materials and methods:In 184 patients aged 40-62 years with NAFLD and obesity with low and moderate CVR was studied the effect of a personalized diet with a gradual reduction of daily energy intake (400 kcal every 2 weeks) and with the dose of physical activity to 250 minutes or more per week in combination with strength training 90 minutes a week on the main of basic anthropometric, metabolic (lipid profile) and hormonal (adiponectin, resistin) parameters and the relative value of CVR. In addition, ursodeoxycholic acid (UDCA) at a dose of 1000 mg/day was recommended to all patients. Evaluation of the data was performed directly before treatment and after 12 months. Adiponectin, resistin, insulin, tumor necrosis factor-a (TNF-a), C-reactive protein (CRP) in serum were determined by enzyme immunoassay. Assessment of the hepatic steatosis degree and the measurement of the thickness of carotid intima-media complex (IMT) were performed by ultrasound scanner. Results:Under the influence of the lifestyle modification in NAFLD patients with low and moderate CVR was obtained significant improvement of basic anthropometric parameters: body mass index and waist circumference reduction (p = 0.0000), levels of systolic and diastolic blood pressure (p = 0.005 and p = 0.004, respectively). A significant improvement of the hormonal (increase of the adiponectin level, decrease of the resistin, TNF-a, CRP levels, p <0.005) and metabolic (increased cholesterol of HDL and decreased triglycerides (p=0,05), a significant reduction in insulin levels (p = 0.0002) parameters was shown. Moreover, 50% of studied patients that have reduced body weight at 10% of the initial, showed optimal results of these indicators. There was a significant tendency in the decreasing of IMT values (p = 0.02). Clinically significant result in the dynamics of 12 months observation was a redistribution in groups of studied patients the level of CRV - increase the part of patients with low CVR (54.76%) compared to the moderate CVR (45.23%), p = 0.01, a significant decrease in median relative CVR (p = 0.03). Conclusions:Timely individual prevention of cardiovascular diseases in patients with NAFLD significantly improves the basic metabolic indexes and reduces the degree of CVR, which is essential in prevention of the complications development and improve life quality. P673 HRV spectra shed light upon heart rate control during sleep R M Negoescu1, I-E Csiki1 1Institute of Public Health Bucharest, Bucharest, Romania Background:Autonomic control of heart during sleep is poorly understood: e.g. occurrence of arrhythmias in certain stages contrasts the protection brought about by higher vagal tone. Methods:9 normals 19-31 y were studied during 2 nonconsecutive nights by EEG (O1–O2), oblique EOG, ear temperature, thermistor respiration, ear lobe plethysmogram, and lead II ECG producing RR series. Sleep stages were scored every minute cf. conventional criteria, and power spectra of 256 second-long quasi-stationary RR epochs were got by: 1) resampling at 0.5 s; 2) mean substraction and normalization; 3) zero padding towards 512 points; 5) Sande-Tukey FFT. Power was summed over adjacent bands as follows: VLF/nonstationarity&trends (.007–.035Hz), LF/vasomotor (–.166), HF/respiratory (–.39), and total (.007– .5). Results:Table 1 shows data from 41 RR spectra as per stages 1+2 = NREM1 (shallow, n=as shown), 3+4 = NREM2 (profound), and REM, one spectrum per stage. P points to non-matched/2 tails Wilcoxon. Discussion. Results show increase of HF with sleep deepness and converse trend in LF. REM features tachycardia bursts alternating with low variability bradycardia "plains" that jointly elicit enrichment of VLF and VF. While plains evoke sinus arrhythmia attenuation under mental loading while vigil, burst pattern and mean RR slightly lower vs NREM2 suggest a sympathetical revival. Increased dual autonomic tone (IDAT) in REM evokes early reports of Skinner & Guilleminault on arrhythmic potential of high level dual balance under ischemia and of REM in coronary pts. Conclusion:In REM, medullary centers are perhaps overridden by a neural inflow of cortical origin on an IDAT background, arguing for REM interpretation as a wakefulness sui generis promoting arrhytmias in certain cases. NREM to REM reciprocal dynamics of HF and VLF powers may conceivably help the automatic sleep scoring. variable/stage REM (12) P NREM1(21) P NREM2(8) P REM(12) mean RR [ms] 1192 NS 1238 NS 1261 <.02 1192 SD [ms] 113.8 <.02 93.8 NS 84.6 <.03 113.8 total power [a.u.] 0.38 <.001 0.21 <.03 0.15 <.001 0.38 VLF power/total 0.392 <.001 0.207 NS 0.164 <.001 0.392 LF power/total 0.285 NS 0.278 NS 0.200 <.005 0.285 HF power/total 0.280 <.001 0.457 NS 0.607 <.001 0.280 variable/stage REM (12) P NREM1(21) P NREM2(8) P REM(12) mean RR [ms] 1192 NS 1238 NS 1261 <.02 1192 SD [ms] 113.8 <.02 93.8 NS 84.6 <.03 113.8 total power [a.u.] 0.38 <.001 0.21 <.03 0.15 <.001 0.38 VLF power/total 0.392 <.001 0.207 NS 0.164 <.001 0.392 LF power/total 0.285 NS 0.278 NS 0.200 <.005 0.285 HF power/total 0.280 <.001 0.457 NS 0.607 <.001 0.280 Open in new tab variable/stage REM (12) P NREM1(21) P NREM2(8) P REM(12) mean RR [ms] 1192 NS 1238 NS 1261 <.02 1192 SD [ms] 113.8 <.02 93.8 NS 84.6 <.03 113.8 total power [a.u.] 0.38 <.001 0.21 <.03 0.15 <.001 0.38 VLF power/total 0.392 <.001 0.207 NS 0.164 <.001 0.392 LF power/total 0.285 NS 0.278 NS 0.200 <.005 0.285 HF power/total 0.280 <.001 0.457 NS 0.607 <.001 0.280 variable/stage REM (12) P NREM1(21) P NREM2(8) P REM(12) mean RR [ms] 1192 NS 1238 NS 1261 <.02 1192 SD [ms] 113.8 <.02 93.8 NS 84.6 <.03 113.8 total power [a.u.] 0.38 <.001 0.21 <.03 0.15 <.001 0.38 VLF power/total 0.392 <.001 0.207 NS 0.164 <.001 0.392 LF power/total 0.285 NS 0.278 NS 0.200 <.005 0.285 HF power/total 0.280 <.001 0.457 NS 0.607 <.001 0.280 Open in new tab P674 The relation of ambulatory heart rate with all-cause mortality among middle-aged men: a prospective cohort study E Clays1, M Lidegaard2, F Kittel3, K Van Herck1, G De Backer1, D De Bacquer1, A Holtermann2, M Korshoj2 1Ghent University, Ghent, Belgium 2National Research Centre for the Working Environment, Copenhagen, Denmark 3Free University of Brussels (ULB), Brussels, Belgium Topic: Sports cardiology Purpose:The aim of this study was to investigate the association between average 24-hours continuously measured ambulatory heart rate and all-cause mortality, while adjusting for resting clinical heart rate, cardiorespiratory fitness, occupational and leisure time physical activity as well as classical risk factors. Methods:A group of 439 male workers free of baseline coronary heart disease and aged 40-55 years from the prospective Belgian Physical Fitness Study was included in the analysis. Data were collected by questionnaires and clinical measurements and examinations from 1976 to 1978. All-cause mortality was collected from the national mortality registration with a mean follow-up period of 16.5 years, with a total of 48 events. Results:After adjustment for all before mentioned confounders in a Cox proportional hazards regression analysis, a significant increased risk for all-cause mortality was found among the tertile of workers with highest average ambulatory heart rate compared to the tertile with lowest ambulatory heart rate (Hazard ratio = 3.21, 95 % confidence interval: 1.22-8.44). No significant independent association was found between resting clinic heart rate and all-cause mortality. Conclusions:The study indicates that average 24-hour continuously measured ambulatory heart rate is a strong predictor of all-cause mortality independently from resting clinic heart rate, cardiorespiratory fitness, physical activity and other classical risk factors among healthy middle-aged workers. P675 Self-reported psychosocial stress and risk of atrial fibrillation - From The Birkebeiner Ageing Study M Myrstad1, AH Ranhoff1, DS Thelle2, EE Solberg1 1Diakonhjemmet Hospital, Oslo, Norway 2University of Oslo, Oslo, Norway Topic: Sports cardiology Purpose:Psychosocial stress increases the sympathetic tone and is a risk factor for coronary heart disease (CHD). Autonomic imbalance is among the suggested underlying mechanisms for AF among endurance-trained individuals, but an association between stress and atrial fibrillation (AF) has not been established. Therefore, we explored the association between stress and risk of AF among male non-elite senior cross-country skiers and men from the general Norwegian population. Methods:The study was designed to investigate the association between endurance exercise and risk of AF. In order to cover the broad range from physical inactivity to repeated participation in a long-distance endurance competition, this cohort study was based upon 2 distinct cohorts: 3114 men who had previously completed the 54-kilometer Birkebeiner cross-country ski race and 1185 men who had participated in a population-based health study. Altogether 4999 men aged >53 years were invited to take part in the study. Stress during the previous 5 years was self-reported by questionnaires and categorized into "No-", "Periodical-" and "Continuous" stress. Self-reported AF was confirmed by electrocardiograms (ECGs) reviewed from medical records. Results:3712 men (74%) participated in the study (mean age 66 (53-92) years). 254 cases of AF were confirmed by ECG. After multivariable adjustments, the adjusted odds ratios for AF were 1.66 (95% confidence interval (CI) 1.23-2.23) for periodical and 1.81 (CI 0.98-3.33) for continuous stress. Conclusions:Self-reported stress at home during the previous 5 years was positively associated with AF. However, as AF might have preceded stress, this study is not designed to conclude about the direction of the association or causality. P676 Cardiovascular risk factors: underdiagnosis before admission due to acute coronary syndrome. B Samaniego Lampon1, E Hernandez Martin1, G Alvarez Cuervo1, A Arias Suarez1, V Cabrera Garcia1, M Fernandez Garcia1, I Garcia Ruiz1, M Martin Suarez1, S Morala Gonzalez1, E Segovia Martinez De Salinas1 1Hospital de Cabuenes, Cardiology Department, Gijon, Spain Topic: Sports cardiology Purpose:To be aware and to control cardiovascular risk factors is essential to prevent cardiovascular events. We analyse the underdiagnosis of major cardiovascular risk factors in very high risk cardiac patients admitted for acute coronary syndrome (ACS), by collecting risk factors that patients are known to present and studing their real prevalence. Methods:Descriptive study including 50 patients with ACS from December 2013 to March 2014. We conducted a survey at admission to register the prevalence of known or treated hypertension, diabetes or dyslipidemia, smoking habits and body mass index. We took the mean of blood pressure measurement at 8 am, before morning medication, on two consecutive days and considered hypertension if =140/90. We used fasting plasma glucose and glycated haemoglobin to establish the diagnosis of diabetes or pre-diabetes. As LDL-cholesterol is recommended as target for treatment and the LDL-cholesterol goal depends on total cardiovascular risk (CVR), we estimated the CVR before the ACS using the ESC classification based on the SCORE chart and compared LDL-cholesterol levels to goals. We evaluated again the CVR before the ACS, taking into account the unknown new diagnosed risk factors, and compared the two estimations. Results:Mean age was 68 ± 13 years, 74% of patients were male. A previous cardiovascular event was suffered by 38% of patients. The percentage of current smokers was 32%, with 32% being ex-smokers and 36% having never smoked. Obesity was present in 6% of cases, overweight in 54%. Hypertension was known or treated in 48% of patients, diabetes in 30% and dyslipidemia in 42%. Based on the data obtained during hospitalization, the real prevalence was 62% for hypertension, 42% for diabetes and 72% for dyslipidemia. We also found pre-diabetes in 16% of patients. Attending only to the previously known risk factors, the CVR before admission was very high in 58%, high in 14%, moderate in 24% and low in 4% of patients. Taking into account the new diagnosed risk factors, 12% of cases were reclassified to a superior level of CVR: 3 patients changed from high to very high risk level, 1 patient from moderate to high and 2 patients from moderate to very high. Conclusions:Major cardiovascular risk factors were remarkably infradiagnosed and undertreated before admission for acute coronary syndrome, with 14% of new diagnosis of hypertension, 12% of diabetes, 16% of pre-diabetes and 30% of patients with LDL-cholesterol above goals. P677 New-onset chronic obstructive pulmonary disease and its clinical significance among patients with STEMI OLGA Polikutina1, EVGENY Bazdyrev1, OLGA Barbarash1 1Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, kemerovo, Russian Federation Topic: Sports cardiology Purpose:To study the incidence of new-onset chronic obstructive pulmonary disease and its clinical significance among patients with ST-elevated myocardial infarction (STEMI). Materials and methods:154 STEMI patients were enrolled into the study. All the patients underwent pulmonary function test with bronchodilatatory test performance and body plethysmography. The level of ultra-sensitive C-reactive protein (CRP) at 10-14th days from the beginning of STEMI clinical implications was determined. Results:34 (22%) out of 154 patients were known to have a history of COPD. Among 120 patients without a history of pulmonary pathology, 24 (20%) patients revealed new-onset irreversible post-bronchodilatatory respiratory obstruction and were diagnosed with COPD as a result of our examination. All the patients with new-onset chronic obstructive pulmonary disease had respiratory symptoms of varying intensity before the present hospitalization, but they didn't seek for medical help. Among STEMI patients with concomitant COPD the lower values of diffusing lung capacity were registered, however there were higher values of CRP. Recurrent myocardial infarction, early postinfarction angina were registered more often and the degree of pneumonia incidence during the hospital phase of myocardial infarction reached significant differences. Conclusion:It is necessary to perform screening spirometry in order to identify COPD among patients with CAD, which will allow to reduce the risk of complications and improve the prognosis in this group of patients. P679 Kidney injury: an important predictor to remember in acute coronary syndrome R Ferreira1, J Neves1, A Gonzaga1, M Bastos1, J Santos1 1Centro Hospitalar do Baixo Vouga, Cardiology, Aveiro, Portugal Topic: Sports cardiology Purpose:Morbidity associated with chronic kidney disease (CKD) has increased with the growth of aging populations. CKD is strongly associated with increased mortality rate and accelerated cardiovascular disease. Methods:Retrospective observational analysis of 431 patients admitted on a coronary intensive care unit with acute coronary syndrome for 2 consecutive years. Patients were followed-up until the 31st october 2013 or until another event (new acute coronary syndrome, stroke, heart failure, arrhythmia or cardiac death). Results:431 patients were included, 72.4% were male, with mean age of 67 ± 13 years, 33.2 % with kidney injury on admission. The multivariate Cox analysis adjusted for potential confounders (sex, hypertension , diabetes, dyslipidemia, obesity , family history, previous events, kidney injury and anemia) showed that the only variables that remained as independent predictors of new events were the existence of previous events (HR 1.759; 95% CI 1335-2138 with p = 0:00), kidney injury (HR 0572; 95% CI 0340-0961, p = 0.035), and anemia (HR 0.484; 95% CI 0.265- 0.883 with p = 0.018 ) . Dividing patients into two groups based on the presence of kidney injury, we found that patients with kidney injury had higher values ?128;??128;?of systolic blood pressure and heart rate at admission; they had more advanced Killip class and more often had episodes of atrial fibrillation. Kaplan- Meier's survival curves showed that these patients had worse event-free survival (log rank of 10,912 with p < 0.001). Conclusion:The presence of kidney injury was one of the most important predictors of new cardiovascular events, highlighting the importance of early identification of these patients in order to adopt individualized therapeutic strategies to prevent new cardiovascular events and to reduce the progression of kidney disease. P680 Cardiovascular disease knowledge, health behaviors, physician communication, health self-efficacy and health education in ultra-orthodox jewish female teachers E Langner-Leiter1, K Greenberg1, M Donchin2, M Nubani1, S Siemiatycki3, C Lotan1, D Zwas1 1Hadassah University Medical Center, Cardiology Department, Jerusalem, Israel 2Hadassah-Hebrew University, Braun School of Public Health, Jerusalem, Israel 3Bishvilaych, The Evelyne Barnett Womens Medical Center, Jerusalem, Israel Topic: Sports cardiology Purpose:The Ultra-Orthodox Jewish (UOJ) community represents 10% of Israel's population. UOJ women engage in lower levels of health behaviors (HB) and have higher rates of diabetes and obesity. Barriers are likely cultural, religious and socio-economic (i.e. large families, modesty, restricted exposure to secular media and education, and poverty). Research in this population is scant. This study explored cardiovascular disease (CVD) knowledge, HB (i.e. diet and physical activity (PA)), and physician communication (PC) in UOJ female teachers and investigated the relationship of health self-efficacy (HSE) and health education (HE) to HB. Methods:As part of an ongoing health promotion program, 285 female UOJ high school teachers from 3 schools in Israel completed questionnaires. Questions included demographic, HB and knowledge items and a HSE scale. HE was defined as self-reported education or training in nutrition and PA. Knowledge items included correct identification of heart attack symptoms (HASx) and correct identification of CVD risk factors. PC was defined as having one's physician discuss specified topics. Results:Teachers' age range was 21-71, mean number of children was 6 (range= 0-17), 37% were below poverty level, 32% were overweight and 17% were obese. Thirty four percent reported >150 minutes/week of moderate PA, 11% reported >75 minutes/week of vigorous PA, 26% reported eating >5 fruits and vegetables/day, and 19% reported eating >3-4 servings of whole grains/day. Transfat usage was 41%. Only 2% correctly identified all HASx and 2% all CVD risk factors. Knowledge of CVD risk factors and HE in nutrition were each associated with eating >5 fruits and vegetables/day (p=.045 and p=.01) and less transfat (p=.094 and p=.056). HE in PA was associated with engaging in >75 minutes/week of vigorous PA (p=.002). PC about weight or nutrition were each associated with eating the recommended servings of fruits and vegetables (p=.008 and p=.002) and whole grains (p=.016 and p=.062). PC about exercise was not associated with PA. HSE was associated with eating the recommended servings of whole grains and fruits and vegetables, less transfat, and engaging in the recommended amount of moderate and vigorous PA (p=.076, p<.0001, p=.051, p=.004, p=.0007). Conclusions:This study is the first investigating HSE, HE, CVD knowledge, PC, and HB in an UOJ population. UOJ teachers reported engaging in moderate to low levels of PA and healthy eating as well as limited CVD knowledge. Exposure to HE, PC, and increased HSE may improve the rates of these preventive health behaviors. P681 Association of earlobe crease with cardiovascular risk factors and diseases: the CoLaus study M Aligisakis1, P Vollenweider2, P Marques-Vidal2 1University of Lausanne, Lausanne, Switzerland 2University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland Background:Earlobe crease (ELC) has been associated with cardiovascular disease (CVD) or risk factors (CVRF). However, the associations were usually limited to a small number of CVRF and the mechanisms involved are poorly understood. Methods:Data from the population-based CoLaus study (n=4635, 46.7% men) conducted between 2009 and 2012 in Lausanne, Switzerland. Results:Presence of ELC was associated with age, male gender, higher body mass index (BMI), abdominal obesity, hypertension, higher glucose and insulin levels, diabetes, insulin resistance, dyslipidaemia (especially lower HDL cholesterol and higher triglycerides levels), metabolic syndrome (MS) and history of CVD. In multivariate analyses adjusting for age and gender, ELC remained significantly associated with abdominal obesity [odds ratio and (95% confidence interval) 1.20 (1.02; 1.42)]; hypertension [1.41 (1.18; 1.67)]; diabetes [1.43 (1.15; 1.79)]; high HOMA-IR [1.53 (1.18; 1.99)]; lower HDL cholesterol and higher triglycerides levels (p-value < 0.05), MS [1.28 (1.08; 1.51)] and history of CVD [1.55 (1.21; 1.98)]. However, when BMI was added to the model, only the associations between ELC and hypertension [1.30 (1.08; 1.56)], glucose level (p-value <0.05) and history of CVD [1.55 (1.21; 1.98)] remained significant. Conclusion:In this community-based sample we observed a significant association between ELC and some classical cardiovascular risk factors (particularly higher BMI and hypertension) but also with a positive history of CVD. P682 Evaluation of oral anticoagulation therapy in patients with atrial fibrillation and high thromboembolic risk M Zlatar1, D Matic1, B Zlatar2, D Jelic1, M Marjanovic3, T Potpara3, M Gajic4 1Cardiology Clinic, Emergency Department, Clinical Center of Serbia, Belgrade, Serbia 2City Institute of Public Health, Belgrade, Serbia 3Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia 4University of Belgrade, School of Medicine, Institute for Medical Statistics and Health Research, Belgrade, Serbia Topic: Sports cardiology Purpose:Anticoagulation is the cornerstone of therapeutic measures for prevention of thromboembolic complications in patients with atrial fibrillation. This therapy is particularly important to apply in patients with atrial fibrillation and high thromboembolic risk. The aim of our study was to investigate the use of anticoagulation in patients with atrial fibrillation and high risk of thromboembolic complications. Methods:Our study included 229 patients with electrocardiographic evidence of atrial fibrillation who were treated in cardiology ambulance of Emergency Center in Belgrade from 1/2009 to 12/2012. Thromboembolic risk was assessed according to CHADS2 score. In high thromboembolic risk considered patients with CHADS2 score =2. Results:Out of 229 patients included in our study who had proven atrial fibrillation and high thromboembolic risk, anticoagulant therapy was performed in 100 patients (43.7%). There was no statistically significant difference between patients receiving oral anticoagulant therapy compared to patients without oral anticoagulant therapy in terms of demographics (age and sex) and the presence of other risk factors and co morbidities (smoking, hypertension, hyperlipidemia, diabetes mellitus, congestive heart failure, previous stroke, chronic renal failure and hyperthyroidism). Patients who received oral anticoagagulant therapy had more frequently coronary artery disease (31.0% vs. 17.0%; p = 0.013), prior myocardial infarction (18.0% vs 7.8%; p = 0.019), control examination by internal medicine specialist (61.0% vs. 21.7%; p = 0.000) and less frequently received oral antiplatelet therapy (16.0% vs. 69.0%; p = 0.000) than those without anticoagulant therapy. Conclusion:In our study, oral anticoagulation is not prescribed in a large percentage of patients with atrial fibrillation and in high thromboembolic risk as it was recommended by European Guidelines. Patients receiving oral anticoagulant therapy had more frequently coronary artery disease, history of myocardial infarction, are often controlled by a physician specializing in internal medicine and less frequently received concomitant antiplatelet therapy than those without anticoagulation. P683 Cardiovascular risk in the working population of Ryazan region (Meridian-Ro study) E Philippov1, S Iakushin1 1Ryazan State Academician I.P. Pavlov Medical University, Ryazan, Russian Federation In Russia, cardiovascular mortality remains very high, which has a significant impact on life expectancy. It is comparable to CVD mortality in Finland 70s and is different from the present (2011) is more than 2.5 times. Back in the 50s, it was shown that the main contribution to the development of CVD risk factors contribute, so the conventional concept of mortality reduction is to fight with them. Their prevalence in the Russian Federation are high, however, in some regions still remains unknown. Objective:To investigate the prevalence of major risk factors for CVD in the region and their complex influence on cardiovascular risk. Methods:The study included 1622 human urban and rural population aged 25-64 years without diagnosed CHD (mean age - 43,4 ± 11,4 years, 46.2% male) randomly selected by sectional sample. They conducted a survey on a standardized questionnaire, electrocardiogram, measurement of blood pressure, heart rate, waist circumference, height, weight, intake of biological samples for the determination of biochemical risk profile, a comprehensive assessment of cardiovascular risk. The study was an open, prospective, cross-sectional. Results:It was found that 4.3% of persons surveyed had very high 10-yrs risk on a scale HeartSCORE (city - 4.3%, rural - 4.2%, p> 0.05). The high risk group had a total of 15.0% (city - 14.1%, rural - 17.9%, p> 0.05), moderate - 54.9% (city - 53.8%, country side - 58 2%, p> 0.05), the lowest - 25.8% (city - 27.9%, rural - 19.7%, p> 0.05). The study was 17.7% rural and 13.4% urban with atherosclerosis and related diseases. When evaluating the biochemical markers, it was found that the CRP (6.89 vs. 5.7 mmol / l, p = 0.0001), LDL (3.55 vs. 3.28 mmol / l, p = 0.05), cholesterol (5.65 vs. 5.16 mmol / l, p = 0,05) and uric acid (335 against 302 mmol / l, p = 0.0001) were higher in the high risk group. In addition, HDL were lower in the high risk group (1.25 vs. 1.33 mmol / l, p = 0.05). In the analysis of medical consultations in the high-risk group showed significant greater number of outpatient visits (82.8% vs. 73.5%, p = 0.0001), appeals by ambulance (20.2% vs. 10.0%, p = 0.0001) and hospitalization (24.5% vs. 14.2%, p = 0.0001). Conclusion:The prevalence of high-risk individuals on a scale HeartSCORE in Ryazan region was 19.3%. Significant impact on the risk is the presence of hypertension and dyslipidemia. Persons at high risk on a scale HeartSCORE had more adverse biochemical profile and more likely to seek medical care. P685 Gender specific differences in cardiovascular risk and their impact on left ventricular ECG parameters in primary prevention M E Moellenberg1, C Berndt2, D Dellweg2, D Horstkotte1, KP Mellwig1 1Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany 2Fachkrankenhaus Kloster Grafschaft, Department of Pulmonology, Intensive Care and Sleep Medicine, Schmallenberg, Germany Topic: Sports cardiology Purpose:The aim of the present study was to analyse gender specific prognostic differences of cardiovascular risk factors (CVRF) in primary prevention and their impact on left ventricular ECG parameters. Method:In 529 basically German employees (Age 30 - 65 years, ?153;? 49 %, ?153; 51 %) common CVRF were obtained and ECG (CardioLine®) was automatically analyzed. As parameter for left ventricular alterations we used the averaged r-amplitude in I and aVL ((I+aVL)/2) (avR-Amp), which has found to be a more appropriate tool to assess early left ventricular alterations than Sokolow-Lyon index. The avR-Amp was correlated for gender regarding CVRF like age, LDL/HDL ratio, BMI, mean arterial pressure (MAD), HbA1C, trigycerides and nicotine. Furthermore, we correlated avR-Amp to PROCAM and HEART Score. Results:Males presented a higher percentage of CVRF earlier in life than females ( table). Furthermore, there was a significant correlation of avR-Amp to the following risk factors: age (?153;?p=0.001, ?153; p<0.0001), LDL/HDL-ratio (?153;? p=0.013, ?153; p=0.0005), BMI (?153;? p<0.0001, ?153; p<0.0001), MAP (?153;? p=0.002, ?153; p<0.001), HbA1C (?153; p=0.02), triglycerides (?153;? p<0.0001, ?153; p<0.001), PROCAM-Score (?153;? p=0.002, ?153; p<0,0001) and Heart-Score (?153; p<0.0001). No correlation was found between avR-Amp and HbA1C (?153;? p=0.211), nicotine (?153;? p=0.29, ?153; p<0.430) and Heart Score (?153;? p=0.2). The Sokolow-Lyon index neither correlated to the CVRF mentioned above nor to the PROCAM and HeartScore. Conclusion:The averaged r-amplitude seems to be an appropriate ECG parameter to evaluate cardiovascular risk in primary prevention. Due to the absence of threshold values for this approach only dynamic changes in the course may allow an evaluation. LDL/HDL > 3 BMI>30 kg/m² MAD > 107 mmHg HbA1C > 6.5% Triclycerides > 150 mg/dl Nicotine PROCAM Score > 10% Heart Score > 3% females 8% 8% 18% 0.4% 23% 29% 1.2% 2.3% males 73% 17% 27% 3.4% 55% 36% 14.2% 20% LDL/HDL > 3 BMI>30 kg/m² MAD > 107 mmHg HbA1C > 6.5% Triclycerides > 150 mg/dl Nicotine PROCAM Score > 10% Heart Score > 3% females 8% 8% 18% 0.4% 23% 29% 1.2% 2.3% males 73% 17% 27% 3.4% 55% 36% 14.2% 20% Open in new tab LDL/HDL > 3 BMI>30 kg/m² MAD > 107 mmHg HbA1C > 6.5% Triclycerides > 150 mg/dl Nicotine PROCAM Score > 10% Heart Score > 3% females 8% 8% 18% 0.4% 23% 29% 1.2% 2.3% males 73% 17% 27% 3.4% 55% 36% 14.2% 20% LDL/HDL > 3 BMI>30 kg/m² MAD > 107 mmHg HbA1C > 6.5% Triclycerides > 150 mg/dl Nicotine PROCAM Score > 10% Heart Score > 3% females 8% 8% 18% 0.4% 23% 29% 1.2% 2.3% males 73% 17% 27% 3.4% 55% 36% 14.2% 20% Open in new tab P686 Epicardial adipose tissue and cardiac simpathetic derangement in heart failure patients V Parisi1, T Pellegrino2, G Pagano1, A Bevilacqua1, G Ferro1, G Rengo1, D Leosco1, A Cuocolo2, P Perrone Filardi2, N Ferrara1 1University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy 2Federico II University of Naples, Advanced Biomedical Science, Naples, Italy Topic: Sports cardiology Purpose:Adrenergic overactivity represents an hallmark of heart failure (HF). It induces cardiac beta-adrenergic receptor dysfunction and sympathetic myocardial denervation. Epicardial adipose tissue (EAT) is a local source of hormones, cytokines, and vasoactive substances. EAT increase is associated with adrenergic overactivity and with sympathovagal imbalance, detected by heart rate variability. In the present study, we aimed to evaluate in HF patients the relationship between EAT thickness and cardiac sympathetic nerve derangement assessed by 123I-metaiodobenzylguanidine (123I-MIBG). Methods:N.110 patients (mean age 64.74±10.50 yrs) with systolic HF (mean ejection fraction, 38.1±9.3) underwent echocardiographic evaluation of EAT thickness and 123I-MIBG planar [early heart to mediastinum ratio (H/M) and late H/M] and SPECT imaging [total defect score (TDS)]. EAT was also measured in n. 27 controls matched for age, gender, and BMI. Results:EAT thickness was increased compared to controls (8.6±2.55 mm vs 5.57±1.16 mm; p<0.001). EAT thickness significantly correlated with early H/M (r= -0.3; p<0.001) and late H/M (r= -0.3; p<0.001), and TDS (r=0.7; p<0.001). At multivariate analysis, EAT and left ventricular ejection fraction (LVEF) were both predictors of TDS and late H/M, while EAT was the only predictor of early H/M. We also evaluated the additional predictive value of EAT on 123I-MIBG parameters utilizing a model of increasing global chi-square (Figure 1, Model 1 includes age, sex, NYHA, ischemic etiology, diabetes, hypertension, dyslipidemia). Conclusions:The present study indicate that EAT thickness is increased in HF, shows a strong correlation with cardiac sympathetic derangement, and improves the predictive value on MIBG parameters when added to clinical variables and LVEF. Open in new tabDownload slide P689 Gender inequality in a population presenting with suspected paroxysmal atrial fibrillation and potential impact on diagnosis PJ Howlett1, M Mahmoudi1, J Morritt2, L Greswell2, R Jabr1, CH Fry3, EW Leatham2 1University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom 2Royal Surrey County Hospital, Cardiology , Guildford, United Kingdom 3University of Bristol, Bristol, United Kingdom Topic: Sports cardiology Purpose:Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Paroxysmal AF (PAF) comprises approximately half of AF cases and poses an equivalent risk of thromboembolism compared to other AF sub-types. It is well established that AF is more common in males than females. In spite of this, it is also recognised that men access healthcare service less readily than women. We aim to determine whether gender difference impacts on attendance and ultimately diagnosis of PAF in an arrhythmia screening clinic. Methods:Patients attending the clinic and meeting the following criteria were recruited: suspected PAF (defined as palpitations or detection of an irregular pulse); aged 40 years and over; no previously documented atrial arrhythmia; sinus rhythm confirmed with a 12-lead ECG; no significant electrolyte disturbance. Participants were issued with an automated cardiac event recorder for 1-week, deemed standard practice (R Test Evolution 4, Novacor). They also used a handheld ECG monitor (OMRON Portable ECG Monitor HCG-801), recording 30-second segments twice-daily and with relevant symptoms, for a 12-week period. Recordings were analysed by a blinded cardiologist. Results:177 patients attended the clinic, 120 of whom were female (68%). 134 (75%) participants were subsequently recruited with a mean age of 66 years. A significant majority of participants were female (n=91, 68%; p = 0.004, Fisher's). 83% were referred with palpitations and 17% with detection of an irregular pulse. 90% of participants completed the study and 99% of recordings were suitable for analysis. Atrial arrhythmias were identified in 32 patients (24%). Of these cases, 26 were diagnosed with PAF, 5 with atrial flutter and 1 with atrial tachycardia. A higher proportion of atrial arrhythmias were diagnosed in women than men (n=21, 66%; p = 0.3). Conclusions:Significantly less men present to a screening clinic for PAF than would be expected statistically and, as a likely consequence, a reduced rate of detection is observed in this gender. Future health campaigns to promote awareness of AF should target the male population. P690 Gender does not determine prognostic differences in a cohort with chronic ischemic heart disease, data from long-term follow-up of the BARIHD study O Rego Ojea1, M Otero Mata1, A Lado Llerena1, R Besada Gesto1, M Sanchez Loureiro1, I Pazos Del Olmo1, C Caneda Villar1, R C Vidal Perez1, F Otero-Ravina1, JR Gonzalez-Juanatey1 1University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Topic: Sports cardiology Purpose:The outcome differences in the chronic phase of coronary artery disease (CAD) by gender are controversial. We assessed the influence of gender on long-term prognosis in a cohort with chronic ischemic heart disease (CIHD) followed by primary care physicians (PCP). Methods:BARIHD was a cross-sectional multicentric study made with the collaboration of 73 PCP. The PCP included during February 2007,patients(p) that fulfil the inclusion criteria: coronary artery disease (CAD) with at least 1 year of follow up since diagnosis, diagnosis clear established (stable angina-SA, unstable angina-UA or myocardial infarction-MI) in a discharge summary from cardiology department. Follow-up was done by clinical review or telephone contact and death or CV events were recorded, as well as the cause of death. Results:1038p with a complete follow up after a median follow up of 2304 [2-2612]days. 73% (758p)male sex, first diagnosis of CAD: male vs. female SA (21 vs.29.3%,p<0.001), UA (19.3 vs.27.9%,p<0.001) and MI (59.8 vs. 42.9%,p<0,001), time of evolution after the 1st diagnosis was higher in male 8.2±6.3 vs. 6.9±5.2 years. Women were older (mean age 72.4±10.5) and had a worse risk profile, with more hypertension (78.9%), diabetes (34.6%).There were no differences in dyslipidaemia, atrial fibrillation, stroke or prior heart failure, but women had less COPD and more valvular and kidney disease (glormerular filtration<60 defined by MDRD). Less coronariography were performed in women (78.9%vs.67.9%). There was no difference in medical treatment. Outcome by gender without differences (table) Conclusions:Gender was not related with differences in the long-term prognosis for patients with CIHD CV: Cardiovascular Mortality (%) CV Mortality (%) CV admissions (%) CV Death and/or CV admissions(%) Men (n=758) 194 (25.6) 103 (13,6) 294 (38,8) 317 (41,8) Women (n=280) 66 (23.6) 39 (13,9) 100 (35,7) 111 (39,6) Mortality (%) CV Mortality (%) CV admissions (%) CV Death and/or CV admissions(%) Men (n=758) 194 (25.6) 103 (13,6) 294 (38,8) 317 (41,8) Women (n=280) 66 (23.6) 39 (13,9) 100 (35,7) 111 (39,6) Open in new tab CV: Cardiovascular Mortality (%) CV Mortality (%) CV admissions (%) CV Death and/or CV admissions(%) Men (n=758) 194 (25.6) 103 (13,6) 294 (38,8) 317 (41,8) Women (n=280) 66 (23.6) 39 (13,9) 100 (35,7) 111 (39,6) Mortality (%) CV Mortality (%) CV admissions (%) CV Death and/or CV admissions(%) Men (n=758) 194 (25.6) 103 (13,6) 294 (38,8) 317 (41,8) Women (n=280) 66 (23.6) 39 (13,9) 100 (35,7) 111 (39,6) Open in new tab P691 Educational level and risk profile and risk control in patients with established coronary heart disease J Bruthans1, O Mayer2, D De Bacquer3, D De Smedt4, ? Reiner5, K Kotseva6, R Cifkova1 1First Faculty of Medicine, Charles University and Thomayer Hospital, Center for Cardiovascular Prevention, Prague, Czech Republic 2Faculty of Medicine Pilsen, Charles University, Czech Republic, 2nd Department of Internal Medicine, Pilsen, Czech Republic 3University Hospital , Department of Public Health , Ghent, Belgium 4Ghent University , Department of Public Health , Ghent, Belgium 5University Hospital Center, University Zagreb, Department of Internal Medicine, Zagreb, Croatia 6National Heart and Lung Institute, Imperial College , International Centre for Circulatory Health, London, United Kingdom Objective:To ascertain in which way conventional risk factors, compliance with recommended risk factor control and medication, and the effect of medication were associated with education in patients with established coronary heart disease (CHD). Methods:The EUROASPIRE IV study was a cross-sectional survey undertaken 2012-2013 in 24 European countries to ascertain how recommendations on secondary CHD prevention are being followed in clinical practice. Consecutive patients, men and women <80 years of age who had been hospitalized for an acute coronary syndrome or revascularization procedures, were identified retrospectively. Data were collected through an interview with examinations at least six months after hospitalization. Results:A total of 7937 patients (1934 women) were evaluated. Patients with primary education were older, with a larger proportion of women. In women only, body mass index, waist circumference, systolic and diastolic blood pressure, fasting triglycerides, and fasting glucose were negatively associated with educational level. The control of risk factors, as defined by JES 4 and JES 5 guidelines, was significantly better with higher education for current smoking (p=0.001), overweight and obesity (p=0.047 and p=0.029 respectively), low physical activity (p<0.001) and low HDL-cholesterol (p=0.011) in men, and for obesity (p=0.005), low physical activity (p=0.001), low HDL-cholesterol (p=0.023), diabetes (p<0.001) and high blood pressure (p=0.001) in women. Taking high education as reference, a significantly higher risk was observed in men for overweight (OR 1.22 and 1.29 for secondary and primary education), smoking (OR 1.30 and 1.55), low HDL (OR 1.33 for primary education) and low physical activity (OR 1.72 for primary education) and in women for overweight (OR 1.50 for primary education), obesity (OR 1.74 for primary education), diabetes (OR 1.53 and 2.22, for secondary and primary education, respectively), high blood pressure (OR 1.36 and 2.06), low HDL (OR 1.6 for primary education) and low physical activity (OR 1.88 and 2.75). The patients with primary and secondary education were more often treated with diuretic and antidiabetic drugs (p=0.014 and p=0.020 respectively). Compared to the previous EUROASPIRE II report (1999-2000), the differences in cardiovascular risk factors prevalence and control according to educational level remained similar. Conclusions:Particular risk communication and control are needed in secondary CHD prevention for patients with lower educational status. This substudy was supported by IGA, Ministry of Health, Czech Republic, grant No NT/13186 P692 The association between perceived ethnic discrimination and the components of the metabolic syndrome across ethnic minority groups MUZ Ikram1, MB Snijder1, CO Agyemang1, CO Agyemang1, AH Schene2, K Stronks1, RJG Peters3, AE Kunst1 1Academic Medical Center of Amsterdam, Department of Public Health, Amsterdam, Netherlands 2Radboud University Medical Centre, Department of Psychiatry, Nijmegen, Netherlands 3Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands Topic: Sports cardiology Purpose:To investigate whether perceived ethnic discrimination (PED) is associated with metabolic syndrome and its individual components across ethnic minority groups, and to assess the contribution of PED to the metabolic syndrome. Methods:Cross-sectional data from the HEalthy Living In an Urban Setting (HELIUS) study were collected from January 2011 until July 2014, including 2186 South-Asian Surinamese, 2059 African Surinamese, 1685 Ghanaians, 2162 Turks, and 2117 Moroccans aged 18-70 years living in Amsterdam, the Netherlands. PED was measured using the Everyday Discrimination Scale. Metabolic syndrome was defined according to the harmonised definition. Analyses were done with logistic regression, adjusted for potential confounders (demographics, education and other psychosocial stressors) and mediators (health behaviours and depression). Population attributable fractions (PAF) were used to calculate the contribution of PED to metabolic syndrome. Results:PED was significantly positively associated with metabolic syndrome in the total sample (odds ratio 1.06; 95% confidence interval 1.00-1.13), South-Asian Surinamese (1.12; 0.98-1.28), African Surinamese (1.15; 1.00-1.32), and Moroccans (1.19; 1.03-1.37). In these groups, PED overall tended to have positive associations with all individual components of metabolic syndrome. The PAFs were 5% in South-Asian Surinamese and Moroccans, and 7% in African Surinamese. Conclusion:PED contributes to metabolic syndrome and has positive associations with the individual components of metabolic syndrome in some ethnic minority group. Public health policies should explicitly focus on ethnic discrimination to improve cardiovascular health of ethnic minority groups. P694 Contribution of cardiac electrophysiologic testing for etiologic ischemic stroke of undetermined causes in young adults MB Bouame1, A Mekarnia1, MT Bouafia1 1Central Hospital of the Army, Algiers, Algeria Introduction:Despite the recently described new syndromes, about a third of ischemic stroke (AIC) in young adults remains unexplained. The works, Attuel, Four Ducrocq and suggest the cause of ischemic stroke (AIC) unexplained young adults, the role of atrial vulnerability (VA), substratum of paroxysmal atrial fibrillation (PAF) we studied prospectively in 121 patients. Patients-Methods:Patients 17 to 55 victims admitted to AIC services Neurology and Internal Medicine, are subject to a systematic review referred to etiological. An electrophysiological study was performed ear in case of unknown aetiology in patients consenting, as described by Attuel, within 90 days after the AIC. In addition to the usual parameters were measured conduction time intra atrial refractory periods, latent vulnerability index, prior to the completion of atrial stimulation Programmed:In this study, the vulnerability has been refined over the outbreak of supra ventricular arrhythmia (FA, Flutter, TA) sustained (> 1 min), or other supra ventricular rhythm disorder in the presence of minors disturbed settings. Clinical, neuroimaging and embolic recurrence were compared by chi 2 test or Fischer, according to the presence or absence of atrial vulnerability. results:Of 121 patients, mean age 40.89 years, Sex ratio 1.63, 53 (43.8%) had a positive atrial vulnerability in the form of time and FA 22 10 flutter and atrial tachycardia times 9 times. There is no evidence of significant difference in the type and location of the AIC, with a significant difference against tobacco (risk = 2.4), birth control pills (risk = 3.6), the presence> 70 ESA on holter ECG (risk = 3.7) and septal defects (PFO and / or ASIA with a risk = 2.89). On a mean follow up of 06 months, 12 patients presented with cerebral embolic recurrence in the 10 + VA group and 02 patients in the VA-group, as predictors multi analysis varied VA inducible and pathological holter Conclusion:With a sensitivity of 83% and a specificity of 61% and a negative predictive value of 97%; The presence of inducible atrial vulnerability with a pathological ECG Holter (ESA) exposed to a high risk of recurrence and embolic requiring anti-arrhythmic therapy and discussion of anticoagulant treatment. P695 The role of Holter monitoring in the examination of young elite athletes L Makarov1, V Komoliatova1, I Kiseleva1, N Fedina1, D Bessportochny1 1Center for Syncope and Cardiac arrhythmia in children and adolescents of FMBA of Russia. DKB # 38, Moscow., Russian Federation Athletes are special professional group with regular increased stress of the cardiovascular system and accordingly the risk of cardiac complications, the most serious of which is Sudden Cardiac Death (SCD). Holter monitoring (HM) one of the first informative method for detection of the cardiac pathology. Few studies are devoted to daily heart rhythm in athletes. Aim of the study was reveal role of HM in examination of the young elite athletes. Methods:HM (MARS, GE Healthcare, USA) were performed in 86 from 500 young elite athletes, members of national teams 12 - 18 years old. Indication for HM were arrhythmias, syncope, QT prolongation, family history sudden death and other abnormalities during prescreening examination before competition. We excluded cardiomyopathy and other structure and organic diseases of the heart. Results:Were revealed ABV block 1- 3 degree in 13 – 15% (one hockey player had one episode asymptomatic AVB III at night period with pause 7789 mc. Supravenricular extrasystolies were detected in all athletes from single till 20000, ventricular arrhythmias were revealed in 13 athletes (15%). One athlete with VT had 3 transient major criteria of the ARVC/ARDV (epsilon wave, negative T in the right precordial leads, VT). Maximum prolongation of the QT interval were detected at the second part of the night and not exceed 530 ms (normal value less than 480 ms). HM informative in examination of elite young athletes. Possibly it would be useful to use HM more actively for routine screening at young elite athletes. P696 Effect of hemoglobin concentration on left ventricular mass in healthy adolescent athletes H Krysztofiak1, A Folga2 1Mossakowski Medical Research Centre, Warsaw, Poland 2National Center of Sports Medicine, Warsaw, Poland According to the Fick's law, concentration of hemoglobin affects the arterio-venous difference and consequently the oxygen uptake. Lower concentrations of hemoglobin ([Hb]) in women than in men, seem to be responsible for their lower than in men maximal oxygen uptake during exercise. Reduced [Hb] causes a compensatory cardiovascular response and can induce cardiac growth. However, there is little information about the relationship between hemoglobin concentration and left ventricular mass in young people without heart disease. The aim of this retrospective, cross-sectional study, was to evaluate the influence of hemoglobin concentration on the cardiac growth in adolescent athletes. In particular, in relation to sex. Healthy athletes, 69 boys (B) and 19 girls (G), age range 9-19, practicing different sports, who underwent echocardiography and laboratory tests with determination of [Hb], during pre-participation examination in sports medicine center, were included in this study. The groups B and G were of a similar age (13,5±2,8 vs. 13,6±2,8 yrs; p=0,95). Left ventricular mass (LVM), indexed to body surface area (LVM/BSA) and to height raised to an exponential power of 2,7 (LVM/H2,7) were calculated. Analysis of correlation of LVM indexes with [Hb] were performed in both groups. Unpaired t-tests were performed to compare the value of indexes below and above median for [Hb] within both groups. The [Hb] was significantly lower in G vs. B (13,2±0,7 vs. 14,1±1,2 g/dL; p<0,005). It was high, significant, negative correlation of LVM/H2,7 with [Hb] (r2=0,43; p<0,005) and intermediate, significant, negative correlation of LVM/BSA with [Hb] (r2=0,31; p<0,05) in girls group (G). There were no correlation of LVM indexes with [Hb] in boys (B). In comparison of value of the LVM indexes below and above the median for [Hb] within groups, the both LVM indexes were significantly higher below the median (n=10) vs. above the median (n=9) in group G (LVM/H2,7: 31,5±3,2 vs. 27,7±3,0 g/m(2,7), respectively; p<0,05 and LVM/BSA: 73,7±5,9 vs 66,3±8,4 g/m2, respectively; p<0,05). There were no age difference in the below vs. the above the median sub-group in G (13,7±3,3 vs. 13,4±2,4 yrs, respectively; p=0,85). In boys, there were no differences of LVM indexes, in the sub-groups relative to their median for [Hb]. Hemoglobin concentration seems to be an important factor in cardiac growth, especially in female athletes. The lower concentrations of hemoglobin correspond to the higher LVM indexes. This effect can be explained by referring to Fick's law. However, why this effect was not observed in male subjects requires further study. P697 Cardiac adaptation in elite cyclists; overlap with disease phenotypes. T Keteepe-Arachi1, A Malhotra1, G Mellor1, H Dhutia1, L Miller1, R Narain1, K Prakash1, V Gabus1, M Papadakis1, S Sharma1 1St George's University of London, St Geor, London, United Kingdom Topic: Sports cardiology Purpose:Regular, intensive exercise results in structural cardiac adaptations that in extremes may mimic cardiac pathology. The type of exercise affects the degree to which these adaptations occur. The aim of this study was to examine differences in cardiac adaptation between elite endurance cyclists and elite non-endurance athletes. Methods:Between 2009 and 2013, 39 elite endurance cyclists underwent 12-lead ECG and echocardiography as part of pre-participation screening. They were compared to 39 age, sex and ethnicity-matched elite athletes from a variety of non-endurance disciplines including football, rugby and cricket. Results:The cyclists exhibited significantly greater measurements of all echocardiographic parameters with the exception of ejection fraction (EF), compared to non-endurance counterparts (Table). Extremes of left atrial diameter (>45mm) were noted in 10% (n=4) cyclists. Left ventricular cavity dimensions (LVEDd) considered to overlap with dilated cardiomyopathy (DCM) (>60mm) were identified in 33% (n=13) of cyclists. Left ventricular hypertrophy (>12 mm) was present in 31% (n=12) of cyclists but none exceeded a maximal wall thickness of 14mm. No cyclist exhibited an EF <50%. Conclusions:Our data confirms that endurance athletes exhibit more pronounced cardiac adaptation compared to non-endurance counterparts. A significant proportion exhibits LVEDd that overlaps with DCM making differentiation between physiology and pathology challenging in endurance athletes with ECG anomalies or symptoms. Echocardiographic parameter Endurance Athletes (Cyclists) Mean Values (standard deviation) Range (mm) Non-Endurance Athletes Mean Values (standard deviation) Range (mm) p value LA diameter (mm) 40 (±3.2) 34-51 35 (±3.5) 27-42 <0.001 Ao diameter (mm) 35 (±3.2) 30-42 31 (±3.6) 22-39 <0.001 LVEDd (mm) 59 (±3.9) 53-74 54 (±3.4) 47-63 <0.001 IVS thickness (mm) 11 (±1.0) 9-13 9 (±1.2) 7-11 <0.001 PW thickness (mm) 10 (±0.8) 9-14 9 (±1.1) 7-11 <0.001 EF (%) 62 (±6.1) 50-73 52 (±9.1) 39-76 NS Echocardiographic parameter Endurance Athletes (Cyclists) Mean Values (standard deviation) Range (mm) Non-Endurance Athletes Mean Values (standard deviation) Range (mm) p value LA diameter (mm) 40 (±3.2) 34-51 35 (±3.5) 27-42 <0.001 Ao diameter (mm) 35 (±3.2) 30-42 31 (±3.6) 22-39 <0.001 LVEDd (mm) 59 (±3.9) 53-74 54 (±3.4) 47-63 <0.001 IVS thickness (mm) 11 (±1.0) 9-13 9 (±1.2) 7-11 <0.001 PW thickness (mm) 10 (±0.8) 9-14 9 (±1.1) 7-11 <0.001 EF (%) 62 (±6.1) 50-73 52 (±9.1) 39-76 NS Open in new tab Echocardiographic parameter Endurance Athletes (Cyclists) Mean Values (standard deviation) Range (mm) Non-Endurance Athletes Mean Values (standard deviation) Range (mm) p value LA diameter (mm) 40 (±3.2) 34-51 35 (±3.5) 27-42 <0.001 Ao diameter (mm) 35 (±3.2) 30-42 31 (±3.6) 22-39 <0.001 LVEDd (mm) 59 (±3.9) 53-74 54 (±3.4) 47-63 <0.001 IVS thickness (mm) 11 (±1.0) 9-13 9 (±1.2) 7-11 <0.001 PW thickness (mm) 10 (±0.8) 9-14 9 (±1.1) 7-11 <0.001 EF (%) 62 (±6.1) 50-73 52 (±9.1) 39-76 NS Echocardiographic parameter Endurance Athletes (Cyclists) Mean Values (standard deviation) Range (mm) Non-Endurance Athletes Mean Values (standard deviation) Range (mm) p value LA diameter (mm) 40 (±3.2) 34-51 35 (±3.5) 27-42 <0.001 Ao diameter (mm) 35 (±3.2) 30-42 31 (±3.6) 22-39 <0.001 LVEDd (mm) 59 (±3.9) 53-74 54 (±3.4) 47-63 <0.001 IVS thickness (mm) 11 (±1.0) 9-13 9 (±1.2) 7-11 <0.001 PW thickness (mm) 10 (±0.8) 9-14 9 (±1.1) 7-11 <0.001 EF (%) 62 (±6.1) 50-73 52 (±9.1) 39-76 NS Open in new tab P698 Right ventricular structure and function in senior and scholar elite footballers D Oxborough1, E Popple1, J Somauroo1, S Sharma2, V Utomi1, R Lord1, R Cooper3, J Forster4, K George1 1Liverpool John Moores University, Sports and Exercise Science, Liverpool, United Kingdom 2St George's University of London, Cardiology, London, United Kingdom 3Liverpool Heart and Chest Hospital, Liverpool, United Kingdom 4Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom Topic: Sports cardiology Purpose:To determine whether the extent of RV structural and functional adaptation is mediated by age in professional footballers. Methods:We recruited 20 senior and 20 scholar professional footballers at three Premier League Clubs. All players underwent 2D, Doppler, tissue Doppler and strain (e) echocardiography with a focused assessment on the right heart. A range of structural and functional indices were derived and indexed allometrically where appropriate. Peak RV e, strain rate (SR) and time to peak e and SR were also calculated. All data were compared between groups as well as against normal values. Results:Allometrically scaled RVOTplax was significantly larger in the senior compared to the scholar players (25.5 ± 2.2 mm[m]0.31 and 23.2 ± 3.6 mm[m2]0.31, P = 0.02). Individual and absolute values for the RV outflow tract measured in a parasternal long axis orientation (RVOTplax) and the basal inflow (RVD1) were often above the normal range cut-offs (40% and 20 % for RVOTplax (see figure) and 50 % and 25 % for RVD1 in senior and scholar players respectively). All functional parameters were within normal limits, however systolic SR (SRS) was lower in the senior players compared to scholar players (-1.4 ± 0.30 l/s and -1.3 ± 0.16 l/s, p = 0.015 respectively) with a moderate correlation to indexed RVOTplax (r = 0.314). Conclusions:Some degree of RV structural adaptation occurs in both senior and scholar football players, with senior players having significantly larger RVOTplax dimensions. Although senior players have slightly lower peak SRS than scholar players, all global e and SR are within normal ranges. Open in new tabDownload slide P699 Screening in female athletes: The outcomes of the largest mandatory pre-participation screening programme for women in the UK. A Malhotra1, L Robinson1, S Cheadle2, A Sood1, J Ariyaratnam1, R Birt1, R Mehta2, M Papadakis1, I Beasley2, S Sharma1 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom 2The Football Association, Medical Department, Wembley Stadium, London, United Kingdom Topic: Sports cardiology Purpose:Women are participating in greater numbers at the highest levels of sport. The Football Association (FA) runs the largest, mandatory pre-participation screening (PPS) programme for female athletes in the UK. With a health questionnaire, 12-lead electrocardiogram (ECG) and echocardiogram (echo), the programme strives to identify athletes with an underlying cardiac condition that increases their risk of sudden cardiac death (SCD) with exercise. The aim of this study was to evaluate the outcomes of this unique process for female athletes. Methods:Between June 2009-May 2014, 426 female footballers were screened at national team selection. Each player completed a screening questionnaire and underwent an ECG and echo that was reviewed independently by 2 cardiologists. All abnormal cases were further evaluated comprehensively at a dedicated sports cardiology clinic. Results:The footballers were aged 17.8±2.4 years with a follow-up period of 3.8 years. 402 players (94.4%) were cleared to participate after initial screening. 24 (5.6%) required further evaluation. An abnormal ECG accounted for half of referrals for further evaluation, while an abnormal echo accounted for the other half. A cardiac condition was identified in 13 (3.1%) players (Table 1). 1 player was advised not to continue playing football. Of the remaining 11 in whom a condition was not identified, 9 were discharged and 2 kept under annual surveillance. Conclusions:Although The FA's cardiac PPS programme is effective at identifying pathology in elite female footballers, our data suggest that the majority of these were detected by echo, consisting largely of minor valvular pathologies though a bicuspid aortic valve was found in 2 players . While no condition was diagnosed in those with ECG repolarisation anomalies, only one serious case was identified by ECG for which disqualification was advised. Further refinement of the process is required to reduce the false positive burden of ECG screening in female athletes. Group (n=24) Condition Outcome Valvular (8) Bicuspid aortic valve (x2) Mixed pulmonary valve disease Aortic regurgitation (x3) Mitral regurgitation (x2) Yearly review All clear Yearly review Yearly review Repolarisation (10) T wave inversion V1-V3 (x7) T wave inversion V1-V5 (x3) Yearly review Yearly review Structural (4) Trabeculated left/ right ventricle Atrial septal defect (x3) All clear All clear Electrical (2) Long QT (borderline) Long QT Syndrome Yearly review Advised not to participate Group (n=24) Condition Outcome Valvular (8) Bicuspid aortic valve (x2) Mixed pulmonary valve disease Aortic regurgitation (x3) Mitral regurgitation (x2) Yearly review All clear Yearly review Yearly review Repolarisation (10) T wave inversion V1-V3 (x7) T wave inversion V1-V5 (x3) Yearly review Yearly review Structural (4) Trabeculated left/ right ventricle Atrial septal defect (x3) All clear All clear Electrical (2) Long QT (borderline) Long QT Syndrome Yearly review Advised not to participate Open in new tab Group (n=24) Condition Outcome Valvular (8) Bicuspid aortic valve (x2) Mixed pulmonary valve disease Aortic regurgitation (x3) Mitral regurgitation (x2) Yearly review All clear Yearly review Yearly review Repolarisation (10) T wave inversion V1-V3 (x7) T wave inversion V1-V5 (x3) Yearly review Yearly review Structural (4) Trabeculated left/ right ventricle Atrial septal defect (x3) All clear All clear Electrical (2) Long QT (borderline) Long QT Syndrome Yearly review Advised not to participate Group (n=24) Condition Outcome Valvular (8) Bicuspid aortic valve (x2) Mixed pulmonary valve disease Aortic regurgitation (x3) Mitral regurgitation (x2) Yearly review All clear Yearly review Yearly review Repolarisation (10) T wave inversion V1-V3 (x7) T wave inversion V1-V5 (x3) Yearly review Yearly review Structural (4) Trabeculated left/ right ventricle Atrial septal defect (x3) All clear All clear Electrical (2) Long QT (borderline) Long QT Syndrome Yearly review Advised not to participate Open in new tab P700 Myocardial contractility dynamics of the LV during staged maximal exercise testing in adolescent elite footballers as measured by 2-D strain echocardiography G E Pieles1, L V Gowing2, A G Stuart3, C A Williams2 1Bristol Heart Institute, NIHR Cardiovascular Biomedical Research Unit, Bristol, United Kingdom 2Sport and Health Sciences, University of Exeter, Exeter, United Kingdom 3Bristol Royal Infirmary, Bristol Congenital Heart Centre, Bristol, United Kingdom Topic: Sports cardiology Purpose:Cardio-pulmonary exercise testing (CPET) is a recommended secondary screening tool in youth athletes but cannot assess cardiac function. Left ventricular (LV) training adaptation in youth athletes has so far only been reported at rest and no data exists describing myocardial dynamics during exercise. We have performed CPET with simultaneous echocardiography using 2-D speckle-tracking-echocardiography to describe LV contractility response. Methods:14 male professional football academy players (mean age 15.4±.8y; stature 176.9±8.4cm; body mass 64±8.5kg) underwent echocardiography at rest, during exercise and recovery (rec) while completing an incremental CPET on a recumbent cycle ergometer (25W?153;3min increments). Echocardiography at rest was performed following Football Association screening guidelines. LV contractility was serially assessed during exercise and recovery measuring longitudinal (LS) and circumferential (CS) systolic 2-D strain. Results:End-diastolic LV (LVWT) and septal (VS) wall thickness and LV end-diastolic diameter (LVEDD) were as follows: LVWT 10.1±1.4 (8.1–12.6)mm; VS 9.8±1.5 (7.8–12)mm; LVEDD 46.9±3.9 (42-55)mm. Systolic and diastolic function at rest were normal. Athletes achieved a peak oxygen uptake (VO2peak) of 51.7±6.2 ml/min/kg and a max work rate of 203±25W, HRpeak exercise was 177.9±7.9bpm. LS and CS showed a linear relationship with significant differences across increasing work rates compared to rest and recovery. LV LS and CS increased significantly from rest to peak exercise (p<0.01) with significant moderate Pearson's correlations between LSrest and LSpeak (r=0.64, p=0.01) and CSrest and CSpeak (r=0.7, p=0.01). There was significant moderate correlation between LSpeak and LSrec (r=0.57, p=0.04) and CSpeak and CSrec (r=0.56, p=0.04). LSpeak significantly correlated to HRmax (r=0.59, p=0.03). A positive, yet non-significant correlation existed between LSpeak and work-rate (r=0.45, p>0.05). Weak and non-significant correlations were found between LSpeak and VO2max, LSpeak and work-rate and LVPWd with LSpeak and CSpeak (r=-0.2–0.4, p>0.05) but not between LVEDD and LSpeak or CSpeak. Conclusion:LV longitudinal and circumferential systolic motion both contribute to the linear contractility response to maximal CPET in adolescent elite footballers. LV resting contractility but not LV diameters correlate to exercise contractility in this cohort. CS and LS during exercise and recovery might allow differentiation between physiological and pathological cardiac exercise response in athletes with borderline or abnormal resting echocardiographic parameters. P702 Dynamics of echocardiographic and electrocardiographic findings in child and adolescent athletes T Svanishvili1, E Tataradze1, N Chabashvili1, Z Sopromadze1, M Sopromadze1, L Malania2, E Chumburidze2, Z Kakhabrishvili1 1Tbilisi State Medical University, Tbilisi, Georgia, Republic of 2LTD "City Sport" medical-diagnostic center, Tbilisi, Georgia, Republic of Topic: Sports cardiology Purpose:The purpose of our study was to observe dynamics of electrocardiographic (ECG) and echocardiographic findings among child and adolescent athletes, considering there is a limited amount of data available concerning this subject in medical literature. Methods:We observed 140 male athletes aged 6 to 13 years, who underwent regular semi-annual pre-participation screening during several years, using ECG and echocardiography. 16 children and adolescents were evaluated for four consequent years, 50 - for three years, 54 - for two years and 30 - for one year. Control group was made up of 44 healthy non-athletes of the same age range. Results:Among the athletes, a distinct trend was noted towards increase of heart dimensions during the observational period, namely there was a linear increase of mean values of thickness of interventricular septum, thickness of posterior wall of the left ventricle and left ventricular end-diastolic volume, from 5.85 mm to 7.60 mm, from 6.07 mm to 8.20 mm and from 36.13 ml to 38.30 ml, respectively. While the rate of growth of three above-mentioned parameters was somewhat slower in the control group, the difference was not statistically significant (5.83 to 7.20 mm; 5.70 o 7.60 mm and 36.00 to 38.06 ml, respectively). When comparing the athletes of the same age categories, we could not find a significant difference in heart sizes with respect to duration of engagement in sports activities; as an example, mean thickness of interventricular septum among 13-year old boys with 2-year experience of sports participation was 7.21 mm, while the same value in athletes with 4-year experience was 7.75 mm, but the difference was not statistically significant. It is noteworthy that mild degree of mitral valve regurgitation (MVR) was found in 32% of athletes, as compared to only 15% in the control group. As for ECG changes, incomplete right bundle branch block (RBBB) was found in 34% of athletes and 18% of non-athletes (statistically significant difference). Conclusion:Based on our study results we can conclude that significant myocardial hypertrophy does not occur in athletes aged up to 13 years and the rate of growth of heart dimensions does not exceed the rate in non-athletes of the same age; besides, in this age group, heart sizes do not correlate with duration of sports participation. No significant ECG changes can be observed. Increased prevalence of MVR in athletes is notable and requires further investigation. © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586733pmid: 26078063

Poster Session I Thursday, 14 May 2015, 08:30-12:30 P100 Ventricular tachyarrhythmias reduction in heart failure by modulation of cardiac autonomic nervous system with cardiac rehabilitation D Mesquita1, A Abreu1, G Portugal1, S Rosa1, P Rio1, M Oliveira1, P S Cunha1, V Santos2, H Santa-Clara2, R Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal 2Human Motricity Faculty, Lisbon University, Lisbon, Portugal Topic: Sports cardiology Purpose:Autonomic nervous system (ANS) dysfunction plays a central role in chronic heart failure (HF). Patients (P) with severe left ventricle (LV) systolic dysfunction have increased risk of malignant ventricular tachyarrhythmias (VT/VF). Besides the cardioverter-defibrillator (ICD) and optimal medical therapy no other strategies have shown to reduce the negative impact of VT/VF on survival. It has been suggested that cardiac rehabilitation programs can induce a positive modulation of ANS. It's uncertain whether this can be translated in clinical practice by a reduction of VT/VF. Our aim was to assess if a phase 2 cardiac rehabilitation program could reduce the occurrence of sustained VT/VF in P with chronic HF and documented ANS dysfunction. Methods:Prospective study in a cohort of 108P submitted to cardiac resynchronization therapy (CRT), with an ICD in a primary prevention strategy. All P performed cardiac scintigraphy with 123 metaiodo-benzylguanidine in the 48h previous to CRT implant to assess cardiac ANS dysfunction. We considered cardiac ANS dysfunction parameters of Early and Late "heart to mediastinum" rate – HMR - below 1,5 or a washout rate (WR) above 30%. Afterwards, P were randomized to perform a phase 2 cardiac rehabilitation program (30 programed and surveyed sessions) or no rehabilitation. We assessed the medium (3months) to long-term (2 years) occurrence of VT/VF by the interrogation of the CRT device. Results:There were 67,9% male, with 68,1±9,9 years, and a mean LV ejection fraction of 27±7%, with ischemic etiology in 33,3% and diabetes in 38,9%. Sixty three P (57,8%) were in class III of NYHA and 73% on beta blockers. There were no significant differences between basal characteristics of the 2 groups, namely the occurrence of cardiac ANS (early HMR: p=0,810, late HMR: p=1,0 and WR: p=1,0). The rehabilitation group had a higher rate of previous cardiac surgery (p=0,023). During a follow-up of 630,8 ± 309,7 days, 16P (14,8%) had VT/VF with appropriate treatment via ICD. The occurrence of VT/VF was higher in the cohort of P with cardiac ANS dysfunction, as assessed by the early HMR (p=0,034). P with baseline cardiac ANS dysfunction that did not underwent cardiac rehabilitation were at higher risk of VT/VF (Odds Ratio 4,38; p=0,035), whereas the occurrence of VT/VF was similar in P that completed the cardiac rehabilitation program compared to P without cardiac ANS dysfunction (p=0,597). Conclusions:HF is associated with a high incidence of cardiac ANS dysfunction. Cardiac rehabilitation seems to modulate ANS in these population and contribute to reduce the incidence of VT/VF. P101 Six-minute walk distance predicts the readmission due to decompensated heart failure in patients with chronic heart failure M Tabata1, M Kato2, R Shimizu2, A Akiyama2, Y Kamada2, S Tanaka2, N Hamazaki2, A Aoyama2, K Kamiya3, T Masuda2 1Toyohashi SOZO University, School of Health Sciences, Toyohashi, Japan 2Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan 3Kitasato University Hospital, Rehabilitation center, Sagamihara, Japan Background:Patients with chronic heart failure (CHF) who show lower exercise capacity are more frequently readmitted to the hospital. Although six-minute walk distance (6MWD) is a clinical measure to assess exercise capacity and prognosis, the relationship between 6MWD and readmission was rarely documented in them. This study aimed to investigate whether the 6MWD at hospital discharge predicted the readmission due to decompensated heart failure in CHF patients. Methods:Patients who had the first hospitalization due to CHF with NYHA ?or ?were prospectively followed up for 3 years after the discharge. Consequently, we studied 276 patients (69±12 years, 166 males) and assessed their 6MWD at the discharge and readmission over 3 years. Patients were classified into middle-age (<65 years; n=106), early elderly (65-74 years; n=108) and late elderly (ãÏ75 years; n=62) groups. Multivariate logistic regression analysis and the area under the ROC curve were used to determine significant factors affecting the readmission due to CHF and their cut-off values, in which patients' characteristics including 6MWD were adopted as independent variables. Results:Of 276 patients, 114 were readmitted within 3 year after the discharge. The 6MWD at discharge was detected as a significant limiting factor for readmission (P<0.001). The odds ratios of readmission were 2.12, 1.34, and 1.37 with each 10-meter decrease of 6MWD (P<0.001, respectively), and their cut-off values of 6MWD were 425, 405, and 345 meters for the middle-age, early elderly and late elderly groups, respectively (Figure). Conclusion:The 6MWD was shown as the strongest predictor for readmission due to decompensated heart failure in CHF patients. The predictive cut-off values of 6MWD were 425, 405, and 345 meters in the three groups, respectively. Open in new tabDownload slide ROC to predict readmission using 6MWD P102 Cardiopulmonary exercise testing variables as independent predictors of return to work in cardiac rehabilitation participants H Voller1, A Salzwedel1, R Reibis2, S Kaminski3, H Buhlert3, S Eichler1, K Wegscheider4 1University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany 2Cardiac Outpatient Clinik Park Sanssouci, Potsdam, Germany 3Klinik am See, Ruedersdorf, Germany 4University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany Introduction:Cardiopulmonary exercise testing (CPX) has an independent prognostic value, especially in cardiovascular patients. We aimed to evaluate parameters of CPX as predictors for return to work (RTW) at discharge of cardiac rehabilitation (CR). Methods:We analysed sociodemographic and clinical data from a prospective registry of 489 patients (mean age 51.5±6.9 years, 87.9% men), who were referred to shortterm (3 weeks) inpatient CR between 06/2009 to 12/2011, predominantly after PCI (62.6%), CABG (17.2%) and heart valve replacement (9.0%). At admission, patients underwent noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and a psychodiagnostic screening (HADS). CPX was performed at discharge for defining fitness. Results:During a mean follow up of 26.5±11.9 months 373 (76.3%) patients returned to work, 116 (23.7%) did not and 60 (12.3%) were retired. A higher number of comorbidities (p=0.011) and heavy work (p<0.001) were negatively associated with RTW whereas a higher exercise capacity at entry of CR (p<0.001) and elective PCI (p=0.02) increased the probability of RTW. After adjustment for covariates, max. work load (Watt) at CPX termination and the VE/VCO2-slope had an independent prognostic significance for RTW. A higher work load increased (p=0.009) while a higher VE/VCO2-slope decreased (p=0.027) the probability of RTW. Even for retirement, CPX had a prognostic value: the likelihood of retirement was smaller with increasing VO2AT (p=0.016). Conclusion:CPX is a meaningful objective tool to assess patients' ability for return to work. Therefore it should be an essential part of functional assessment in CR for predicting participation in employment during two years after CR. P103 Effects of cardiac rehabilitation in obese patients with coronary artery disease I Silveira1, MJ Sousa1, P Rodrigues1, B Brochado1, A Barreira1, S Viamonte1, J Preza Fernandes1, A Luz1, JP Lopes Gomes1, S Torres1 1Hospital Center of Porto, Cardiology, Porto, Portugal Topic: Sports cardiology Purpose:Obesity is a common risk factor in patients (pts) with coronary artery disease (CAD).Several studies show a reduction in functional capacity in this group of pts. Our aim was to evaluate the impact of a cardiac rehabilitation program (CRP) in functional capacity and cardiovascular risk factors in Obese (OB) vs Non Obese(NOB) pts. Methods:We performed an analysis from a prospectively collected registry including 1340 consecutive pts that participated in a multidisciplinary CRP from 2008 to 2013.From those, we enrolled 834 pts with CAD.They underwent a supervised aerobic exercise training protocol,2 times/week during 3 months.Several parameters were collected at the beginning and at the end of the CRP.The pts were divided according to their body max index (BMI), being OB if BMI=30 and NOB if BMI<30.We evaluated risk factor control,namely, blood pressur(BP), lipid profile, glycated hemoglobina (HbA1c),BMI, daily physical activity (through International Physical Activity Questionnaire), functional capacity (maximal exercise capacity on treadmill stress test estimated in metabolic equivalents(METS).Statistical analysis was performed using SPSS software version 20.0, with a level of statistical significance p<0.05. Results:In our study, from a total of 834 pts included, 17%(n = 143) were OB (mean BMI 32,7±2,7 vs mean BMI 25,5±2.6kg/m2 in NOB pts). The mean age in both groups was 60±10 years old. In the baseline profile, OB pts had a higher percentage of men (78.8% vs 64,3%;p>0,001),a lesser percentage of hypertension and dyslipidemia (30% vs 40,9%;p=0.004 and 18,8% vs 30,8%;p=0.010) and a similar proportion of diabetic pts(61,1% vs 64,8%;p=0.055). Baseline functional capacity was similar in both groups (7,6±2.2 vs 8,7±2.4 METS;p=0.072).After CRP, both groups showed a statistically significant increase in functional capacity (7,6±2,2 to 9,0±2,0 vs 8,7±2,4 to 10,3±2.2 METS;p<0.001), without differences between groups. They also displayed a significant improvement in daily physical activity (703±1417 to 2414±1994 vs 826±1245 to 2488±2073 MET-minutes/week;p<0.001). In relation to BMI reduction, there was a statistically significant difference between the groups, being higher in the OB pts (?BMI 1,26±1.38 vs 0.66 ±0.94 kg/m2;p<0.001).In the other risk factors, CRP had a positive impact without main differences between groups. Conclusion:In our study, obesity is not a limiting factor to the improvement of functional capacity after CRP. Secondary prevention programs cannot ignore the challenge of obesity management in CAD pts and the need for special approaches to weight control. P104 A combined exercise intervention results in increased physical activity in heart disease patients with low exercise capacity JW Christle1, A Schlumberger1, M Halle1, A Pressler1 1Technical University of Munich, Department of Prevention and Sports Medicine, Munich, Germany Topic: Sports cardiology Purpose:Patients who have suffered a cardiac event and have very low exercise capacity have low levels of physical activity (PAL). Phase III cardiac rehabilitation (CR) has a central role in sustaining the increased PAL levels ideally realized during phase I and II CR. There are very few data comparing the effects of Phase III CR on PAL in moderate to high risk patients. The current study investigated the effects of individualized combined endurance-resistance exercise (ICE) and traditional group-based exercise in cardiac rehabilitation (GCR) on PAL in moderate to high risk patients. Methods:Seventy CR participants with American Heart Association class C risk status (70 ± 9 y, 38% female) performed exercise testing and were randomized 1:1 to once-weekly ICE or GCR for six months. At baseline and six months, PAL was assessed by IPAQ questionnaire and three-dimensional accelerometry. Results:ICE decreased median sitting time (-65 min/day), increased vigorous PA (+15.1 MET-min/day) and improved PA category (+0.40 points) compared to no change in HG (all between groups p < 0.05). Conclusions:Weekly individualized combined exercise resulted in clinically relevant improvements in PAL after six months in moderate to high risk cardiac rehabilitation participants. Given the importance of PAL on health and fitness, the integration of ICE into CR may be warranted. ICE: Individualized Combined ExerciseGCR: Group- based Cardiac RehabilitationMET: Metabolic Equivalent Task§: Within- group significance p < 0.05 ICE GCR Variable Baseline Six months Baseline Six months p-value Accelerometry PAL 1.47 ± 0.18 1.48 ± 0.14 1.47 ± 0.22 1.44 ±0.15 0.308 IPAQ (Median (IQR)) Total activity (MET-min/d) 289.2 (401.6) 393.6 (411.6) 450.0 (427.1) 371.3 (504.9) 0.676 Vigorous (MET-min/d) 11.4 (20.0) 26.5 (45.7)§ 11.4 (40.0) 5.7 (25.7) 0.009 Moderate (MET-min/d) 102.8 (227.1) 111.4 (173.6) 205.7 (240.0) 120.0 (211.4) 0.426 Walking (MET-min/d) 115.5 (216.9) 183.9 (316.5) 198.0 (247.5) 148.5 (278.1) 0.877 Sitting (min/d) 380.0 (255.0) 315.0 (180.0)§ 300.0 (300.0) 300.0 (270.0) 0.027 IPAQ PA Category 2.2 ± 0.61 2.6 ± 0.57§ 2.5 ± 0.65 2.4 ± 0.63 0.014 ICE GCR Variable Baseline Six months Baseline Six months p-value Accelerometry PAL 1.47 ± 0.18 1.48 ± 0.14 1.47 ± 0.22 1.44 ±0.15 0.308 IPAQ (Median (IQR)) Total activity (MET-min/d) 289.2 (401.6) 393.6 (411.6) 450.0 (427.1) 371.3 (504.9) 0.676 Vigorous (MET-min/d) 11.4 (20.0) 26.5 (45.7)§ 11.4 (40.0) 5.7 (25.7) 0.009 Moderate (MET-min/d) 102.8 (227.1) 111.4 (173.6) 205.7 (240.0) 120.0 (211.4) 0.426 Walking (MET-min/d) 115.5 (216.9) 183.9 (316.5) 198.0 (247.5) 148.5 (278.1) 0.877 Sitting (min/d) 380.0 (255.0) 315.0 (180.0)§ 300.0 (300.0) 300.0 (270.0) 0.027 IPAQ PA Category 2.2 ± 0.61 2.6 ± 0.57§ 2.5 ± 0.65 2.4 ± 0.63 0.014 Open in new tab ICE: Individualized Combined ExerciseGCR: Group- based Cardiac RehabilitationMET: Metabolic Equivalent Task§: Within- group significance p < 0.05 ICE GCR Variable Baseline Six months Baseline Six months p-value Accelerometry PAL 1.47 ± 0.18 1.48 ± 0.14 1.47 ± 0.22 1.44 ±0.15 0.308 IPAQ (Median (IQR)) Total activity (MET-min/d) 289.2 (401.6) 393.6 (411.6) 450.0 (427.1) 371.3 (504.9) 0.676 Vigorous (MET-min/d) 11.4 (20.0) 26.5 (45.7)§ 11.4 (40.0) 5.7 (25.7) 0.009 Moderate (MET-min/d) 102.8 (227.1) 111.4 (173.6) 205.7 (240.0) 120.0 (211.4) 0.426 Walking (MET-min/d) 115.5 (216.9) 183.9 (316.5) 198.0 (247.5) 148.5 (278.1) 0.877 Sitting (min/d) 380.0 (255.0) 315.0 (180.0)§ 300.0 (300.0) 300.0 (270.0) 0.027 IPAQ PA Category 2.2 ± 0.61 2.6 ± 0.57§ 2.5 ± 0.65 2.4 ± 0.63 0.014 ICE GCR Variable Baseline Six months Baseline Six months p-value Accelerometry PAL 1.47 ± 0.18 1.48 ± 0.14 1.47 ± 0.22 1.44 ±0.15 0.308 IPAQ (Median (IQR)) Total activity (MET-min/d) 289.2 (401.6) 393.6 (411.6) 450.0 (427.1) 371.3 (504.9) 0.676 Vigorous (MET-min/d) 11.4 (20.0) 26.5 (45.7)§ 11.4 (40.0) 5.7 (25.7) 0.009 Moderate (MET-min/d) 102.8 (227.1) 111.4 (173.6) 205.7 (240.0) 120.0 (211.4) 0.426 Walking (MET-min/d) 115.5 (216.9) 183.9 (316.5) 198.0 (247.5) 148.5 (278.1) 0.877 Sitting (min/d) 380.0 (255.0) 315.0 (180.0)§ 300.0 (300.0) 300.0 (270.0) 0.027 IPAQ PA Category 2.2 ± 0.61 2.6 ± 0.57§ 2.5 ± 0.65 2.4 ± 0.63 0.014 Open in new tab P105 Can we expect changes in serum NT pro-BNP after a cardiac rehabilitation program and are these correlated to functional capacity improvement? I Rodrigues1, A Abreu1, P Rio1, A Monteiro1, S Rosa1, G Portugal1, R Soares1, S Silva1, R Ferreira1 1Hospital de Santa Marta, Cardiology, Lisbon, Portugal Topic: Sports cardiology Purpose:Cardiac rehabilitation (CR) is a powerful tool in the management of patients with known heart disease. Previous studies suggest that exercise training has a significant effect on N-terminal pro-B-type natriuretic peptide (NT pro-BNP) expression and in peak oxygen consumption (VO2peak), two of the most valuable variables used to assess the degree of cardiac impairment and functional capacity respectively. The aim of this study is to assess the variation in NT pro-BNP levels with a CR program and to evaluate its correlation with variation of VO2peak. Methods:Retrospective analysis of consecutive patients (pts) who underwent a CR program (2004-2012) in a single center. Data collection regarding baseline characteristics, blood tests, echocardiogram and cardiopulmonary exercise test were performed at baseline and after a three months CR program. The parameters evaluated included circulating levels of NT pro-BNP, percent predicted peak VO2 (%PPVO2) and left ventricular ejection fraction (LVEF). Results:We analyzed 116 pts, 86% men, mean age 55±9 years, 40% smokers, 53%hypertension, 18%diabetes, 62%hypercholesterolemia. 90% of patients had ischemic heart disease. The mean LVEF at the baseline was 55±11%. NT pro-BNP levels significantly decreased (from 575±752pg/ml to 254±327pg/ml, mean difference -326±531pg/ml, p<0,001) and %PPVO2 had a significant improvement (from 91±24% to 97±23%, mean difference 7±17%, p<0,001) with exercise training program. After stratification by baseline LVEF (LVEF=35%, LVEF 36-54%, LVEF=55%), the decrease of NT pro-BNP levels and the increase of %PPVO2 remained significant in every subgroup, with the exception of improvement in %PPVO2 in patients with normal EF, which didn't reach a difference statistically significant (LVEF= 35%: ?NT pro-BNP -730±985pg/ml, p<0,03,?%PPVO2 15±22%, p<0,03; LVEF 36-54%: ?NT pro-BNP -397±510pg/ml, p<0,001,?%PPVO26±19%, p<0,03; LVEF=55%: ?NT pro-BNP -188±277pg/ml, p<0,001,?%PPVO2 6±29, p= 0,61). There was no significant correlation between ?NT pro-BNP levels and ?%PPVO2 (r=0,3, p<0,01) regarding the overall population, but a moderate correlation (r=0,6, p<0,05) was found when assessed in patients with severely depressed LVEF (LVEF=35%). Conclusion:In patients referred to CR, an exercise-based program has a favorable effect in blunting NT pro-BNP over expression and improving functional capacity measured by %VO2peak. Additionally, it seems like there is a strong correlation between the changes of this two variables only in the subgroup of patients with greater LV cardiac dysfunction. P106 Reducing inequities in Aboriginal Australian heart health through culturally specific cardiac rehabilitation A Maiorana1, E Chevis2, M Venables2, K Dubrawski2, T Dowling3, L Dimer4 1Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia 2The University of Western Australia, School of Medicine, Perth, Australia 3Derbarl Yerrigan Health Service, Perth, Australia 4Heart Foundation, Perth, Australia Topic: Sports cardiology Purpose:Aboriginal Australians under age 55 years of age experience myocardial infarctions, heart failure and atrial fibrillation at 6, 4 and 10 times the age-standardised rate for non-Aboriginal Australians. However, they are underrepresented in cardiac rehabilitation (CR), with less than 5% of eligible patients attending conventional programs. This study sought feedback from participants in a culturally specific CR program, the first of its kind, based in an Aboriginal Community Controlled Medical Service. Program components included multifactorial health education, monitoring, exercise prescription and social support. Methods:Culturally sensitive methodology was applied. Participatory action research, involving a cycle of planning (in consultation with stakeholders), acting, observing and reflecting was employed in the design and implementation of a survey to evaluate participants' experiences of the program. A validated research method called ?128;?yarning' was used to establish relationships, build trust and rapport, as well as exchange knowledge between staff and program participants. Surveys were conducted by interview and consisted of 14 open ended questions about participants' experiences of the CR program, including barriers and enablers to attending. Recurring themes were identified by a process of triangulation involving 3 qualitative researchers Results:Thirty one participants were surveyed with five primary recurring themes identified. Supporting quotes are provided in support of the themes. 1. The provision of comprehensive but accessible health education was highly valued: ?[Health information] is explain[ed] in detail, but easily understandable?, ?I never heard back from [the hospital], I had questions regarding my health I needed to ask? 2. The importance of social support through the program: ?companionship and sharing experiences gives hope and support? 3. Involvement of family supports participants' attendance and is valued: ?important your family understands your health issues and their impact? 4. The culturally specific design is key: ?yarning to others, gives us hope to keep going? 5. Lack of transportation can be a barrier to attendance. Conclusions:Culturally specific CR programs provide Aboriginal Australians with much needed support and hope to understand and navigate the challenges of managing cardiovascular conditions, which are responsible for high rates of premature death and disability. Such programs are well received and should be more broadly available to the Aboriginal population. P107 Impact of cardiac rehabilitation on functional capacity in patients after acute coronary syndrome with frequent premature ventricular contractions A Monteiro1, A Abreu1, R Soares1, P Rio1, I Rodrigues1, SA Rosa1, D Mesquita1, A Gaspar1, S Silva1, RC Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Background:In the presence of an underlying heart disease, premature ventricular contractions (PVC) usually signify susceptibility toward more malignant arrhythmias and sudden death. Cardiac rehabilitation (CR) improves morbidity and mortality among patients with coronary heart disease, but its impact on patients with PVC has been poorly described. This study intend to assess the safety and efficacy of an intensive exercise-based CR in patients with frequent PVC after an acute coronary syndrome (ACS). Methods:We compared baseline characteristics of 209 consecutive ACS patients with (Group A) and without (Group B) PVC burden >20%/day who completed a CR program (60 minutes, twice a week sessions) between Jan/2004 and Dec/2013 in a tertiary center. CR outcomes were evaluated by cardiopulmonary exercise testing (CPET) (pre and post CR) comparing the degree of change in peak oxygen uptake (pVO2), percentage of predicted pVO2 (%predicted pVO2), minute ventilation/CO2 production (VE/VCO2) slope. Also, the difference between pre and post echocardiographic examination was assessed. Results:VPC were detected in 24 patients (11.5% of the entire population, 75.0% male). Before rehabilitation, patients with PVC had a non significant higher baseline heart rate (72.7±11.7 vs 71.6±11.6, p=0.683), elevated pro-BNP values (968±1233.4 vs 721±1028.8, p=0.407) and lower LVEF (48.7±11.0 vs 53.21±10.8, p=0.064). After CR, in Group B, pVO2 increased from 25.0+6.7 to 27.2+6.8 ml/kg/min (p<0.001); percentage of predicted pVO2 increased from 89.0+22.9% to 93.1+25.0 (p=0.020) and VE/VCO2 slope decreased from 26.08+5.6 to 24.44+4.7 (p=0.089). Group A, on the other hand, got only a trend for an increase in pVO2 (from 24.4+7.4 to 28.8+9.5 ml/kg/min, p=0.075), without other significant CPET improvements. No subjects had sustained arrhythmias during pre and post CPET. Also, biplane LVEF only increased significantly in non PVC patients (Group A: from 48.7±11.0 to 49.9±11.5, p=0.321; Group B: from 53.21±10.8 to 54.6±10.6, p=0.008). Conclusions:Acute coronary syndrome patients with frequent PVC achieved mild improvement in VO2 peak, however inferior to patients without frequent PVC, after a period of intensive, exercise-based cardiac rehabilitation. CPET appeared to carry minimal risk for exercise induced sustained arrhythmia in this ischemic CR population. Regarding left ventricular function, it only increased significantly in non PVC patients. P109 Metabolical, functional and smoking cessation response after a cardiac rehabilitation program: a gender comparative. A Roldan Sevilla1, R Dalmau Gonzalez-Gallarza2, T Roldan Sevilla3, A Castro Conde2, JL Lopez Sendon2 1University Hospital 12 de Octubre, Madrid, Spain 2University Hospital La Paz, Cardiology, Madrid, Spain 3Brigham and Women's Hospital, Anticoagulation Management Service, Boston, United States of America Objective:Women inclusion and therefore, the knowledge about women improvement achieved in cardiac rehabilitacion programs, is limited. We studied the women's metabolic and functional improvements and to compare them to men's. Methods:We studied 961 patients referred to a cardiac rehabilitation program. 84 % of patients were men and 16 % were women. We analyzed and compared changes in several metabolic parameters in addition to changes in METS (metabolic equivalents) reached at the treadmill before and after the program (two months). Moreover, we measured the rate of smoking cessation at 6 months follow up and the program withdrawals. Results:We did not find any significant difference in metabolic response between genders. Women and men got, respectively, an improvement in the total cholesterol levels, -43.25 vs. -35.14 mg/dl; HDL-cholesterol, 1.49 vs. 0.92 mg/dl; triglycerides, -31.61 mg/dl vs. -42.16; glycated hemoglobin levels, -0.09 vs. 0.23% and BMI (body mass index), -0.21 vs. -0.38 pts respectively. We did not observe any discrepancy in the functional response either, with an absolute gain of 2.56 vs. 2.7 METS. Although, a non-significant tendency to a higher relative gain was noticed in women compared to men (53.71 vs. 44.25%; p= 0.074). Also, the smoking cessation levels and the number of program withdrawals did not differ significantly. Conclusions:We could not find significant differences between genders. However, these results evidence the necessity to incorporate more women in these programs, since they are going to be benefitted in the same way men are. Hb1Ac: Glycated hemoglobin; BMI: Body mass index; METS: Metabolic equivalents; Mujeres (N=156) Hombres (N=805) Nivel de significaci??p) ? Colesterol total (mg/dl) -43.25 -35.14 0.091 ? Colesterol-HDL (mg/dl) +1.49 +0.92 0.492 ? Triglicéridos (mg/dl) -31.61 -42.16 0.155 ? Hb1Ac (%) -0.09 -0.23 0.240 ? IMC (peso (kg)/ altura (m2)) -0.21 -0.38 0,135 ? METS absoluta (METS) +2.56 +2.7 0.495 ? METS relativa (%) +53.71 +43.28 0.074 Abandono tabaco (%) 66.66 74.8 0.149 Abandono programa (%) 14.7 10.7 0.341 Mujeres (N=156) Hombres (N=805) Nivel de significaci??p) ? Colesterol total (mg/dl) -43.25 -35.14 0.091 ? Colesterol-HDL (mg/dl) +1.49 +0.92 0.492 ? Triglicéridos (mg/dl) -31.61 -42.16 0.155 ? Hb1Ac (%) -0.09 -0.23 0.240 ? IMC (peso (kg)/ altura (m2)) -0.21 -0.38 0,135 ? METS absoluta (METS) +2.56 +2.7 0.495 ? METS relativa (%) +53.71 +43.28 0.074 Abandono tabaco (%) 66.66 74.8 0.149 Abandono programa (%) 14.7 10.7 0.341 Open in new tab Hb1Ac: Glycated hemoglobin; BMI: Body mass index; METS: Metabolic equivalents; Mujeres (N=156) Hombres (N=805) Nivel de significaci??p) ? Colesterol total (mg/dl) -43.25 -35.14 0.091 ? Colesterol-HDL (mg/dl) +1.49 +0.92 0.492 ? Triglicéridos (mg/dl) -31.61 -42.16 0.155 ? Hb1Ac (%) -0.09 -0.23 0.240 ? IMC (peso (kg)/ altura (m2)) -0.21 -0.38 0,135 ? METS absoluta (METS) +2.56 +2.7 0.495 ? METS relativa (%) +53.71 +43.28 0.074 Abandono tabaco (%) 66.66 74.8 0.149 Abandono programa (%) 14.7 10.7 0.341 Mujeres (N=156) Hombres (N=805) Nivel de significaci??p) ? Colesterol total (mg/dl) -43.25 -35.14 0.091 ? Colesterol-HDL (mg/dl) +1.49 +0.92 0.492 ? Triglicéridos (mg/dl) -31.61 -42.16 0.155 ? Hb1Ac (%) -0.09 -0.23 0.240 ? IMC (peso (kg)/ altura (m2)) -0.21 -0.38 0,135 ? METS absoluta (METS) +2.56 +2.7 0.495 ? METS relativa (%) +53.71 +43.28 0.074 Abandono tabaco (%) 66.66 74.8 0.149 Abandono programa (%) 14.7 10.7 0.341 Open in new tab P110 Effects of cardiac rehabilitation on endothelial function and its prognostic value on recurrent chest pain in patients with stable coronary artery disease, 30 months follow up M Deljanin Ilic1, S Ilic2, D Simonovic1, G Kocic3, R Pavlovic3, V Stoickov2 1Institute of Cardiology, University of Nis, Niska Banja, Serbia 2Institute of Cardiology, Medical Faculty University of Nis, Niska Banja, Serbia 3Institute of Biochemistry, University of Nis, Nis, Serbia Topic: Sports cardiology Purpose:To evaluate the effects of cardiac rehabilitation on circulating blood markers of endothelial function: nitric oxide - (NOx) and asymmetric-dimethylarginine (ADMA), and their prognostic significance on recurrent chest pain. Methods:47 patients (pts) (57.9 ± 3.6 years, all men) were admitted to cardiac rehabilitation after myocardial infarction (MI). All patients underwent a supervised 3 weeks exercise training. At baseline and after 3 weeks in all pts values of NOx and ADMA were determined. Clinical long-term follow-up (30 months) was performed. All medical therapy was documented, and for this analysis, we focused on recurrent anginal chest pain. Results:After 30 months there were no cardiovascular (CV) hard end points (CV death, MI, stroke), however 24 pts (51%) had episodes of typical anginal chest pain (AP group) while 23 pts (49%) were without anginal chest pain (no-AP group). During rehabilitation NOx increased in both groups: in no-AP group (from 33.3 ± 6.9 to 47.1 ± 10.3 µmol/L, p < 0.0005) and in AP group (from 35.9 ± 10.9 to 39.9 ± 10.4 µmol/L, p < 0.0005) with significantly higher second measurement in no-AP group (p = 0.025). The mean NOx increase in no-AP group was higher than in AP group (13.7 ± 10.5 vs 4.03 ± 4.7, p = 0.009). ADMA levels were decreased in both groups (p < 0.0005, both). The mean ADMA decrease in no-AP group was higher than in AP group (0.08 ± 0.041 vs 0.021 ± 0.014, p < 0.0005). A positive correlation was found between NOx increase and ADMA decrease in all pts (r = 0.954, p < 0.0005); also in no-AP group (r = 0.977, p < 0.0005) and in AP group (r = 0.931, p < 0.0005); with higher "r" values in no-AP group (r = 0.977 vs r = 0.931, p < 0.05). Univaried logistic regression analyses were performed and showed that second NOx values (OR 0.934, CI 0.877 - 0.995, p = 0.034) and NOx increased values (OR 0.836, CI 0.745 - 0.938, p = 0.002) significantly predict a 30 months period without anginal chest pain. Conclusion:Residential cardiovascular rehabilitation, in patients with stable coronary artery disease, induced improvement in endothelial function. Patients who had a higher increase of NOx, and greater reduction in ADMA values after 3 weeks of specialized cardiac rehabilitation, during 30 months of follow up, were without anginal chest pain and without any CV event. NOx has been proven to be an independent predictor of period without recurrent anginal chest pain. P111 Impact of a rehabilitation program on erectile dysfunction. PHILIPPE Blanc1, S Jhowry1, C Dufay1, E Bouveret1, N Berrejeb1, C Morice1, S Maunier1 1Cardiac and Pulmonary Rehabilitation, Ste Clotilde & YlangYlang Rehabilitation Center. Reunion, Reunion Topic: Sports cardiology Purpose:Erectile dysfunction is frequent in cardiac patients. The aim of this prospective study was to evaluate the impact of a holistic ambulatory cardiac rehabilitation (CR) program on erectile dysfunction (ED) Methods:809 men (56.7+-9.8 years) were included in the study. All patients performed a 6-week program including exercise training, psychological screening and support as well as education concerning lifestyle. Reasons of admission were: coronary heart disease artery bypass graft surgery (28%), angioplasty percutaneous coronary interventions and stent (41%), angor pectoris or myocardial infarction (7%), aortic or mitral valve replacement or repair (7%), other (17%). ED was systematically screened by the psychologist before and after the CR program. ED was measured via the IIEF-5 questionnaire. Results:Among the 809 men, 608 (55.4+-10.2 years) had an ED defined by a IIEF-5 score = 21/25, representing a prevalence of 75%. Before the program, the mean IIEF-5 score for men with ED was 15.4/25. At the end of the program a significant improvement of erectile dysfunction was found, with a + 16% increase in mean IIEF-5 score (15.4/25 to 18.3/25), p < 0.001. Conclusions:A 6-week holistic multidisciplinary program improves erectile dysfunction in cardiac rehabilitation patients. P112 Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function and functional capacity: randomized controlled trial M Karsten1, C Cargnin1, JCVC Guaragna2, P Dal Lago1 1Universidade Federal de Ci?ias da Sa?e Porto Alegre, Sciences of Rehabilitation, Porto Alegre, Brazil 2Hospital Sao Lucas, Porto Alegre, Brazil Topic: Sports cardiology Purpose:To analyze the effects of inspiratory muscle training (IMT) as a therapeutic strategy after heart valve replacement surgery. Methods:Double-blinded randomized clinical trial that included patients undergoing to elective surgery, without postoperative complications, which were allocated into two groups: IMT group (IMT-G) and IMT placebo group (IMT-PG). The IMT has started on the third day after surgery, being performed twice daily, for one month. Pulmonary function, inspiratory muscle strength (MIP), functional capacity and quality of life were assessed in the preoperative and at the end of training. Statistical significance was set as p=0.05. Results:The IMT-G recovered inspiratory muscle strength and pulmonary function values after training. This group also had an increase in walked distance during the six-minute walk test (6-MWD). In IMT-PG, the values of MIP were bellow than those found in the preoperative, with impairment of lung function and lower 6-MWD in the final evaluation. At the end of IMT, MIP was correlated with the 6-MWD, with the spirometric variables and with the SF-36's domains: functional capacity, pain, general health, social aspects and mental health. Conclusion:This study is an original work that was developed to test the effects of inspiratory muscle training in patients undergoing to the heart valve replacement surgery. The IMT performed for four weeks after valve replacement surgery is effective in restore the values of inspiratory muscle strength and lung function to the preoperative level, and to increase the functional capacity assessed by the distance walked in 6-MWD, with association between lung function and functional capacity, showing the clinical relevance of the use of IMT in the process of rehabilitation of these patients. P113 Age-dependency of clinical characteristics of patients participating cardiovascular rehabilitation R Nebel1, B Rauch2 1medicos.Osnabr?ardiology, Osnabr?ermany 2Stiftung Institut f?zinfarktforschung, Ludwigshafen, Germany Background:Cardiovascular rehabilitation in Germany traditionally is offered as in-patient service often located far from patient`s residence, and ambulatory rehabilitation still represents a minority. The German Registry of Ambulatory Cardiac Rehabilitation (KARREE) was designed to contribute to rehabilitation quality assurance and to evaluate clinical characteristics of patients participating in ambulatory rehabilitation centers. Methods:In four ambulatory rehabilitation centers 2,989 patients were consecutively registered from 2008 to 2011 and evaluated with respect to social status, cardiovascular diagnoses and risk factors, psychological status, medication and short term clinical and social outcome. Results:Most patients referred to the ambulatory cardiac rehabilitation had an acute cardiovascular event, with patients after acute coronary syndrome representing the majority (59.9%). Female were strongly underrepresented (16.7 %). Patient`s clinical characteristics varied with the age groups evaluated (< 50 years, 50 – 70 years, > 70 years). Whereas the reported physical inactivity, overweight and cigarette smoking was declining with age, diabetes and hypertension significantly increased. Furthermore the reported and evaluated psychosocial stress was declining with age. From the patients still employed 43.8% were estimated as fit for work directly at the end of rehabilitation, whereas a stepwise reintegration into employment was performed in 16.7%. The majority of patients was transferred to ambulatory heart groups or other forms of after care for stabilizing regular physical activity. Conclusions:The large variation of the characteristics of patients participating cardiac rehabilitation underscore the need of an individualized approach for a successful implementation of secondary prevention and reintegration of these patients into their social life. P114 Bruce Protocol: Common errors in the evaluation of functional capacity and in exercise prescription with heart disease. K Villelabeitia Jaureguizar1, C Hernandez De La Pena1, MJ Arriaza Gomez1, B Lopez Cabarcos1, C Lazaro Gomez1, A Nunez Cortes1, E Sanz Monedero1, L Ruiz Bautista1, J Castillo Martin2, M Abeytua Jimenez2 1Hospital Infanta Elena, Madrid, Spain 2University General Hospital Gregorio Maranon, Madrid, Spain Background:The uses of exercise test with larger increments in workload can loss the relationship between VO2 and heart rate. The lack of data to consider the maximal heart rate can be the reason of submaximal work load during exercise training. We perform an indirect and a direct exercise test to determine the variability in functional capacity and the variability in training heart rate. Methods:29 patients with coronary artery disease performed an indirect exercise test (Bruce Protocol) and a direct exercise test (ergospirometry), in a period of less than four weeks. We analyzed work, metabolic and cardiac parameters. Results:Bruce Protocol overestimates functional capacity in 8.1%. Maximal heart rate was 125 bpm in the Bruce Protocol and 132 bpm in the ergospirometry test. Aerobic and anaerobic thresholds occurred at 99 vs 119 bpm respectively. Workload intensity designed from Bruce Protocol and following the 75-85% of maximal heart rate method was 95 vs 107 bpm. Using the 60 – 80% Karvonen method was 103 vs 113 bpm. Conclusions:The maximal oxygen consumption is overestimate using standardized Bruce protocol. Exercise prescription based on a percentage of heart rate can make us work in a submaximal way. The Karvonen method allows us to estimate an optimal exercise prescription. P115 Cardiac rehabilitation in a South Asian cohort: Factors influencing patient participation P Chockalingam1, N Sakthi Vinayagam1, N Ezhil Vani1, S Bhaskar1, V Chockalingam2 1Cardiac Wellness Institute, Chennai, India 2Dr. MGR Medical University, Chennai, India Topic: Sports cardiology Purpose:The higher risk for coronary heart disease (CHD) in South Asians at a younger age is attributed to conventional risk factors. However, cardiac rehabilitation (CR) is lagging in India. We aimed to analyse the factors that influence participation in CR. Methods:All patients with CHD seen between May and October 2014 were included. Clinical assessment was followed by intake counselling and program assignment. Typical CR (TCR) consisted of two sessions per week, modified CR (MCR) had one session per week and home-based CR (HCR) was followed predominantly at home with a fortnightly/monthly visit to the facility. Each session had an exercise component and an education/counselling component on diet, activity, self-management, or psychosocial factors. Results:The study cohort included 53 subjects with CHD (61±10 years, 83% males) who were working (n=22), retired (n=22) or homemakers (n=9). Subjects resided within the city of the CR facility (n=36, 68%) or outside (n=17, 32%) with commute time >3 hours. CR was followed by 51% (n=27) subjects, 85% (n=23) of whom lived within the city, 7% (n=2) lived outside but stayed in the city for CR and 7% (n=2) commuted from outside. TCR was followed by 12 subjects, MCR by 10 and HCR by 5. Of those not enrolled (n=26), 50% (n=13) lived outside the city. There was a significant difference (p=0.008) in the number of subjects living outside the city and participating or rejecting CR. Conclusions:Secondary prevention of CHD is the definitive solution to the growing rate of complications and spiralling healthcare costs in India. This study has demonstrated that patients can be motivated to attend a structured CR program, with some modifications to suit their requirements. Lack of easily accessible CR facilities is a deterring factor for participation. Open in new tabDownload slide P116 Effectiveness of different types of psychophysical rehabilitation programs in elderly patients after myocardial infarction with stable angina NP Korzhenkov1, MA Osadchuk1, KS Solodenkova1 1I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Topic: Sports cardiology Purpose:The problem of effective cardiac rehabilitation (CR) in patients with stable coronary artery disease (SCAD) is still very actual. The purpose of this study was to assess and compare the impact of different types of psychophysical rehabilitation programs on patient-reported health-related quality of life (HRQoL), clinical and instrumental data and prognosis in elderly patients after myocardial infarction (MI) with stable angina (SA). Methods:312 pts with SA ranged in Canadian Cardiovascular Society (CCS) functional class (FC) from II through III (152 pts with SA II FC and 160 pts with III FC) and randomized in a 1:1 ratio, depending on the nature of ongoing training (individual or group). All patients in both groups received a standard clinical laboratory and instrumental examination, as well as the definition of psychological status. We used Short Form-36 (SF-36) to assess HRQoL, C.D. Spielberger's Scale - "Self-evaluation Questionnaire" (STAI) to assess anxiety, Zung Self-Rating Depression Scale to assess the severity of depressive syndrome, Morisky-Green test to assess compliance. Results:at month 12 of individual education we observed FC reduction of SA (p<0.05), decreased angina attacks frequency (p<0.05), increased physical exertion tolerance (p<0.05) and improvement of HRQoL (p<0.05) in patients with SA while no significant change was observed in control group. Conclusions:psychophysical rehabilitation based on individual form of education decreases FC of SA, improves HRQoL, reduces anxiety and depressive disorders in patients with SCAD. P117 Acceptance and short term effects on psychological variables of a mindfulness based meditation program in outpatients affering to a cardiac rehabilitation unit D Silvestri1, A Fessha2, C Barbara1, A Cariati3, S Rovai4, T Zappulla1, T Cornero1, P Clavario1, S Domenicucci1 1ASL 3 Genovese, Cardiac Rehabilitation, Genoa, Italy 2Buddhist Higher Studies, stockholm, Sweden 3San Martino-IST, Surgery, Genoa, Italy 4University of Siena, Physiotherapy Postgraduate Studies, Siena, Italy Topic: Sports cardiology Purpose:Mindfulness (M) is a set of techniques, inherited from Tibetan Buddhism, that uses posture, breathing and visualizations to help in different clinical situations and to improve well-being. It enhances doctor-patient relation, heightens immune activity, decreases anxiety and depression, induces neuroplasticity and reduces symptoms of heart failure. We want to examine acceptance and feasibility of M as complement to standard Cardiac Rehabilitation (CR), as well as effects on anxiety, depression and well-being in the short term. Methods:28 Outpatients affering to a CR setting were enrolled in 8-weeks M course. The teachers were a Lama, with 36 years of practice in meditation, and a Cardiologist with a 4-year training period in the matter. The method, explained with audiovisual support and a manual, was adapted by the authors with the aim to be simple, effective and without religious references. It is based on two among the most used techniques in research, Focused Attention (FA) and Open Monitoring (OM) meditation. FA means focusing attention on a chosen object or perception, usually breathing, to calm the mind. OM is monitoring without judgement the content of experience, moment by moment, to recognize the nature of emotional and cognitive patterns. Tests were administered at the beginning and at the end (Zung anxiety-depression, EQ-5D, VAS for perceived well-being), or only at the end (anonymous questionnaire). Results:28 Patients and 6 Caregivers were divided in 4 groups for the meetings. Analysis was performed only on Patients, 19 males and 9 females, age 61,8 years (11 PTCA, 5 CABG, 10 valve and 2 vascular surgery). Attendance was 80%. Zung-anxiety (34 to 32,8, p=0,15), EQ-5D (0,76 to 0,81, p=0,13) and VAS (7,28 to 7,75, p=0,03) improved, depression did not (35,7 to 35,3, p=0,83). In the anonymous questionnaire 97% wanted to prolong the meetings, 81% with the same format, 39% asked individual meetings; self-perceived improvement was high for mental (81%) and physical (65%) well-being and anxiety (65%), but also evident for depression (42%), sleep (35%), panic (29%), symptoms (19%), sexual activity (19%). Conclusion:attendance is index of acceptance for the program. The wish to prolong the meetings is indicative of acceptance too, but expresses need for further intervention, like the request of individual meetings. Reduced anxiety and improved well-being are expected, and coherent with self perception. Depression did not reduce, perhaps for the short time of intervention. A M program for outpatients in CR setting is feasible, accepted, reduces anxiety and promotes well-being. P118 Effets d un programme de readaptation cardiaque sur la variation de poids de sujets en sevrage tabagique post-infarctus A Lasserre1, N Debourneuf1, Y Cazenoves1, P Caillard1, J-C Verdier1 1Institut Coeur Effort Sante, Readaptation cardiaque, Paris, France Introduction:La réadaptation cardiaque est aujourd'hui un élément essentiel de la prise en charge des pathologies cardiovasculaires. Le contrôle du poids est l'un des objectifs de la prise en charge en réadaptation cardiaque. Cependant, de nombreuses études montrent que le sevrage tabagique s'accompagne d'une prise de poids de 1 `10 kg, le maximum se faisant dans les 6 premiers mois post-sevrage. La présente étude a pour but de déterminer dans un premier temps l'impact de la réadaptation cardiaque sur la variation de poids, puis d'étudier, dans un second temps, les effets du sevrage tabagique sur cette variation de poids. Matériels et méthodes:Un groupe initial (GI) de 74 sujets (54 hommes et 20 femmes), ?eacute;s de 35 `75 ans, sous traitement standard incluant des B?bloquants, a suivi un programme de réadaptation cardiaque, dans les 6 mois post infarctus. Le protocole était en accord avec les recommandations internationales : Endurance en continue, couplée `des séances d'interval training. La mesure du poids a été réalisée au début de chaque séance, sous contrôle de l'équipe de réadaptation. La moyenne des poids de 3 premi?s séances détermine le poids initial (P0) et la moyenne des poids des 3 derni?s séances détermine le poids post-réadaptation (P1). Deux groupes de 32 sujets ont ensuite été aléatoirement formés `partir du groupe initial : un groupe non-fumeur (GNF) et un groupe fumeur en sevrage (GF), afin d'étudier l'impact du sevrage tabagique sur la variation de poids au décours d'un programme de réadaptation cardiaque. Résultats:Suite au programme de réadaptation cardiaque, aucune différence significative (p<0,28) n'a été observée au niveau du poids pour le GI (P0 = 73,5kg +/- 11,1 vs P1 = 73,2kg +/- 11,1). La réadaptation cardiaque a permis un gain fonctionnel moyen de 20.6% pour les GF et GNF. Concernant la variation de poids, pour le GF, on note une absence de prise de poids (p<0,8) entre P0 (74,3kg +/- 11,6) et P1 (74,4kg +/- 11,8). En revanche, pour le GNF, le poids diminue de mani? significative (p<0,03) entre le début de la réadaptation (P0 = 73,4kg +/- 10,4) et la fin de la réadaptation (P1 = 72,6kg, +/- 10,4). Conclusion:Un programme de réadaptation cardiaque post-infarctus chez des tabagiques permet d'éviter la prise de poids et semble représenter une solution intéressante pour les sujets souhaitant limiter le gain de poids reconnu dans les 6 premiers mois post-sevrage tabagique. Pour les non-fumeurs, la prise en charge en réadaptation semble permettre la perte de poids, en parall? d'un gain fonctionnel important au décours de la réadaptation. P119 Progression of cardiac rehabilitation and comparison of six minute walking distance after modified surgical ventricular reconstruction K Saitou1, A Hiraoka2, M Kuinose3, S Yuguchi1, T Morisawa4, G Chikazawa2, T Totsugawa2, K Tamura2, H Yoshitaka2, T Sakaguchi2 1The Sakakibara Heart Institute of Okayama, Cardiac rehabilitation, Okayama, Japan 2The Sakakibara Heart Institute of Okayama, Cardiovascular Surgery, Okayama, Japan 3Kawasaki Medical School, Cardiovascular Surgery, Kurashiki, Japan 4Hyogo University of Health Sciences, Rehabilitation, Kobe, Japan Topic: Sports cardiology Purpose:The STICH trial reported that better outcomes were not obtained after surgical ventricular reconstruction (SVR) in patients with severe ischemic cardiomyopathy and conventional SVR was not able to lead a greater improvement in symptoms or exercise tolerance. The purpose of this study is to evaluate the efficacy of cardiac rehabilitation in the progression of rehabilitation and exercise tolerance after SVR. Methods:Twelve patients underwent modified SVR technique "Endoventricular Spiral Plication" in our institution between March 2010 and February 2014. All male patients (age: 63.8 ± 9.0 years, body surface area: 1.5±0.2 kg/m2) with severe cardiomyopathy were involved in this study (left ventricular ejection fraction: 22.9±7.2%, left ventricular end systolic volume index: 120.6 ± 49.2ml/? preoperative brain natriuretic peptide: 876.3 ± 784.2pg/dl). Concomitant operations were as follows; coronary artery bypass grafting: 11, (91%), mitral valve surgery: 8, (66%), aortic valve replacement: 1, (8%), tricuspid annuro plasty: 3, (25%), Maze procedure: 1, (8%). Progression of cardiac rehabilitation and 6-minute walk test were retrospectively evaluated. This study was investigated in accordance with the World Medical Association Declaration of Helsinki. Results:There were no death in hospital stay after operation. Stroke occurred in one patient. Postoperative ICU stay and postoperative hospital stay were 8.1 ± 2.7 days and 31.5 ± 9.5 days, respectively the percent of home return was 91.6%. Data of progression of cardiac rehabilitation were as follows, start sitting; 6.1 ± 1.6 days, start standing; 8.1 ± 4.2 days, start ambulation; 10.8 ± 7.4 days, independent ambulation; 17.4 ± 8.5 day and independent activities of daily living (ADL) ; 21.6 ± 6.1days (1 patient was not independent ADL due to complication of stroke). 6-minute walk test improved at 1 month (330.1±91.2m) and 4months (342.5±43.4m) after operation compared to preoperative data (262.5±169.7m). Conclusions:Although long hospital stay was required after modified SVR in patients with severe dilated cardiomyopathy, it was suggested that cardiac rehabilitation contributed to an improvement of ADL and exercise tolerance. P120 Relations between age, pulse wave velocity and psychometric scores of patients in cardiologic rehabilitation H Janik1, N Greiffenhagen1, J Bolte2, K Kraft1 1University Medicine Rostock, Chair of Complementary Medicine, Rostock, Germany 2Strandklinik Boltenhagen, Boltenhagen, Germany Topic: Sports cardiology Purpose:Aortic stiffness is a prognostic marker of aging and disease. It may be measured by pulse wave velocity (PWV). Its value has a strong correlation with cardiovascular events and all-cause mortality. The aim of this study was to explore potential relations between age, psychometric scores and PWV. Methods:The PWV of N = 25 male patients (age: 59.2 ± 6.9 years, BMI: 28.2 ± 3.9 kg/m²; mean ± SD) was investigated in addition to the standard procedure in a cardiologic rehabilitation clinic. Exclusion criteria were i.e. absolute arrhythmia, pacemaker, treatment with insulin, and acute inflammation. A portable 24 h blood pressure recorder working on an oscillometric cuff-based principle was applied. It provides the ability to calculate PWV by using curve analysis included in the accompanying software. The Hospital Anxiety and Depression Scale (HADS-D) comprises the dimensions anxiety (A) and depression (D) with a range from 0 to 21 for each dimension. The Type D Scale-14 (DS14) consists of the dimensions negative affectivity (NA) and social inhibition (SI) with a range from 0 to 28 for each dimension. Results:Mean PWV was 8.1 ± 1.2 m/s. Mean outcomes of the HADS-D were 7.2 ± 3.5 for A and 5.0 ± 3.4 for D. Results for DS 14 were 10.2 ± 5.0 for NA and 12.9 ± 5.5 for SI. Spearman's rank correlation coefficients are depicted in Tab.1. Anxiety, depression and age have a strong connection with PMV for example. Conclusions:Various high correlations between age, psychometric scores and PWV indicate that these parameters may be important for identification of cardiovascular risk and for applied procedures during patients rehabilitation. *p<0.05; **p<0.01 anxiety depression negative affectivity social inhibition age PWV anxiety 1 0.758** 0.495* 0.387 0.622** 0.584** depression 0.758** 1 0.469* 0.502* 0.536** 0.550** negative affectivity 0.495* 0.469* 1 0.515** 0.376 0.356 social inhibition 0.387 0.502* 0.515** 1 0.110 0.125 age 0.622** 0.536** 0.376 0.110 1 0.903** PWV 0.584** 0.550** 0.356 0.125 0.903** 1 anxiety depression negative affectivity social inhibition age PWV anxiety 1 0.758** 0.495* 0.387 0.622** 0.584** depression 0.758** 1 0.469* 0.502* 0.536** 0.550** negative affectivity 0.495* 0.469* 1 0.515** 0.376 0.356 social inhibition 0.387 0.502* 0.515** 1 0.110 0.125 age 0.622** 0.536** 0.376 0.110 1 0.903** PWV 0.584** 0.550** 0.356 0.125 0.903** 1 Open in new tab *p<0.05; **p<0.01 anxiety depression negative affectivity social inhibition age PWV anxiety 1 0.758** 0.495* 0.387 0.622** 0.584** depression 0.758** 1 0.469* 0.502* 0.536** 0.550** negative affectivity 0.495* 0.469* 1 0.515** 0.376 0.356 social inhibition 0.387 0.502* 0.515** 1 0.110 0.125 age 0.622** 0.536** 0.376 0.110 1 0.903** PWV 0.584** 0.550** 0.356 0.125 0.903** 1 anxiety depression negative affectivity social inhibition age PWV anxiety 1 0.758** 0.495* 0.387 0.622** 0.584** depression 0.758** 1 0.469* 0.502* 0.536** 0.550** negative affectivity 0.495* 0.469* 1 0.515** 0.376 0.356 social inhibition 0.387 0.502* 0.515** 1 0.110 0.125 age 0.622** 0.536** 0.376 0.110 1 0.903** PWV 0.584** 0.550** 0.356 0.125 0.903** 1 Open in new tab P121 A novel low intensity cardiopulmonary exercise testing protocol for functional capacity assessment after transcathether aortic valve implantation - feasibility and safety in very old patients G Portugal1, A Abreu1, A V Monteiro1, L Patricio1, D Cacela1, R Soares1, P Pinto Teixeira1, S Silva1, R Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal Background:Exercise functional capacity is a significant prognostic factor after transcathether aortic valve implantation (TAVI). In regard to this frail and older population, the 6-min walk test (6MWT) is most usually employed as a functional capacity assessment tool. However, the 6MWT does not provide information on several clinically relevant variables such as oxygen consumption, anaerobic threshold (AT) and heart rate recovery. Topic: Sports cardiology Purpose:To investigate the feasibility and safety of a modified, low-intensity cardiopulmonary treadmill protocol in the functional assessment of patients submitted to TAVI. Methods:We designed a low-intensity treadmill exercise protocol, composed of a short warm-up stage and 5 subsequent 3-minute stages of increasing speed and %grade. The exercise protocol was symptom-limited and capped at 15 minutes. For validation, fifteen consecutive TAVI patients were prospectively enrolled, and data was collected on baseline characteristics, cardiopulmonary testing (CPT) results and adverse events. Results:All fifteen patients were successfully submitted to CPT after TAVI. Mean age 80.5 (+/-6,7 yrs), body mass index 25,7 (+/-3.8Kg/m2), mean logistic Euroscore 15.3 ± 7.7, Frailty index 9.4 ± 5.8. Resting heart rate (HR) was 78.2(+/- 20.4 bpm) with sinus rhythm in 9 (60%), atrial fibrillation in 4 (26%) and pacemaker rhythm in 2 (13%), CPT results: Mean exercise duration 8.37 (1.5 to 15) minutes, mean maximum HR 116 (+/- 31.4 bpm). Mean Heart rate recovery at 1 minute was 12.9 (+/- 6.6) bpm. Peak VO2 was 14.4 (+/- 5.1) ml/kg/min, corresponding to 86.1% +/- 28.5% of predicted peak VO2. AT was attained in 11 patients (73.3%), after a mean time of 5.2 minutes of exercise. No adverse events were observed during CPT. Conclusion:Despite being employed in an older, frail population of patients submitted to TAVI, cardiopulmonary testing with a low-intensity exercise protocol appears to be feasible and safe. SPT yielded additional functional capacity data, which may help guide the management of this complex population, namely with cardiac rehabilitation. P122 Comparison of functional status between patients with mechanical circulatory support and patients after heart transplantation I D Laoutaris1, S Adamopoulos1, A Dritsas1, A Gkouziouta1, L Louca1, P Sfyrakis1 1Onassis Cardiac Surgery Center, Athens, Greece Topic: Sports cardiology Purpose:Ventricular assist device (VAD) implantation is increasingly used. We compared the functional status between VAD recipients and patients after heart transplantation (HTx). Methods:Fifteen patients with VAD (LVAD [n=7]/ BiVAD [n=8], Berlin Heart), (14 males, 1 female), age 38.3±15.9 yrs, bridged to HTx with body mass index (BMI) 23.6±4.2 kg/m2 and 14 patients (12 males, 2 females) after orthotopic HTx, age=43±11 years and BMI=24±4.9 kg/m2 were studied. Exercise capacity was tested using cardiopulmonary exercise testing on a treadmill and the 6-min walk-test (6MWT) at least 3 months post-surgery. Dyspnea was measured using the Borg scale at the end of the 6MWT. Results:Patients with VAD were matched for age, gender and BMI to HTx patients. HTx patients achieved a higher mean peakVO2 compared to VAD patients (20.4±3 vs. 16.2±3.8 ml/kg/min, p=0.005), longer treadmill exercise time (11.5±1.2 vs 9.1±2.4 min, p=0.004) and higher VO2 at anaerobic threshold (16.2±3 vs. 12±5 ml/kg/min, p=0.01), respectively. The 6MWT distance in patients with HTx was comparable to that covered by VAD patients (478±71 vs. 452±75 m, p=ns), however, dyspnea tended to be more for patients with VAD (9.2±1.5 vs. 10.5±1.3, p=0.03). Conclusions:Maximal exercise capacity in patients after HTx is higher than in patients with VAD. However, submaximal exercise capacity which may be more important in determining daily activities does not differ significantly between those two groups. Rehabilitation programs could contribute to a further improvement in exercise capacity and sensation of dyspnea of VAD recipients. P123 A single session of respiratory muscle training using a slow deep breath with inspiratory load ameliorates autonomic imbalance in patients with chronic heart failure N Hamazaki1, T Masuda2, K Kamiya1, R Matsuzawa1, K Nozaki1, M Tabata3, S Tanaka4, A Aoyama4, E Maekawa5, J Ako5 1Department of Cardiac Rehabilitation, Kitasato University Hospital, Sagamihara, Japan 2Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan 3Department of Physical Therapy, School of Health Sciences, Toyohashi SOZO University, Toyohashi, Japan 4Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan 5Department of Cardiovascular medicine, Kitasato University School of Medicine, Sagamihara, Japan Background:A long-term respiratory muscle training (RMT) using a slow deep breath (SDB) with inspiratory load has been shown to increase respiratory muscle strength, resulting in the reduction of sympathetic hyperactivity. However, its immediate effect is still unknown in patients with chronic heart failure (CHF). We investigated the immediate effect of SDB with inspiratory load on autonomic imbalance in them, as compared to that without inspiratory load. Methods:We studied 30 male patients with compensated CHF (67.0±10.8 years) who underwent a cardiac rehabilitation during hospitalization. Maximum inspiratory pressure (PImax) was measured as a respiratory muscle strength. Patients performed a SDB with 4-sec inspiratory time, respiratory rate of 6/min and inspiratory load of 30% PImax for 10 min as the RMT. They also performed SDB without inspiratory load based on cross-over design. Heart rate and blood pressure were continuously monitored during the session. Low-frequency (LF) component in blood pressure variability and high-frequency (HF) component in heart rate variability were analyzed to assess sympathetic and parasympathetic activities, respectively. Two-way ANOVA was performed to compare the differences in autonomic activity between the SDB with and without inspiratory load. Results:The changes in autonomic activity during RMT session are shown in Figure. In SDB with inspiratory load, LF significantly decreased and HF increased after RMT as compared with those before (P<0.01, respectively). SDB with inspiratory load showed significantly lower LF and higher HF after RMT than SDB without inspiratory load (P<0.05, respectively). Conclusion:A single session of RMT using a SDB with inspiratory load suppressed sympathetic activity and activated parasympathetic activity in CHF patients. Open in new tabDownload slide Effects of the RMT on autonomic activity P124 Effects of exercise training on carotid intima-media thickness in patients with combined type 2 diabetes and coronary artery disease R Byrkjeland1, KH Stensaeth2, IU Njerve1, S Anderssen3, H Arnesen1, I Seljeflot1, S Solheim1 1Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway 2Oslo University Hospital, Oslo, Norway 3The Norwegian School of Sport Sciences, Oslo, Norway Topic: Sports cardiology Purpose:Carotid intima-media thickness (cIMT) holds prognostic information for future cardiovascular disease (CVD) in healthy individuals and in patients with either type 2 diabetes or known coronary artery disease (CAD). cIMT is also associated with the extent of coronary atherosclerosis. Previous studies have indicated reduced progression of atherosclerosis after exercise in patients with established CAD and in patients with elevated CVD risk. However, few studies have investigated effects of exercise on progression of atherosclerosis in high-risk patients with both type 2 diabetes and CAD. The aim of the present trial was to study the effect of exercise training on cIMT progression in patients with type 2 diabetes and CAD. Methods:Patients with type 2 diabetes and CAD (n=137) were randomised to exercise training or standard follow-up (control group). The exercise program contained 150 minutes per week of combined aerobic (65 – 95% of HRpeak) and resistance training for 12 months. Two supervised, group based exercise sessions and one individual exercise were performed weekly. High-resolution ultrasonography of the distal part of the common carotid artery (CCA) was performed before and after the intervention. All cIMT measurements were done in the far wall in end-diastole by standardised protocol. The CCA and the carotid bulb were scanned for the presence of atherosclerotic plaques. The cIMT measurements were performed in the same region (without plaque formation) at baseline and 12 months. Between group differences in changes were calculated by one-way ANCOVA. Results:Mean baseline cIMT was 0.866±0.180 mm in men (n=115) (age 63.3 years) and 0.793±0.102 mm in women (n=22) (age 61.7 years). There were no differences in changes from baseline to 12 months between the exercise group and controls (–0.016mm (95%CI –0.037 to 0.006) vs. -0.007mm (95%CI –0.029 to 0.015), p=0.57). There was a significant interaction between the treatment principle and presence of carotid plaques (n=58) (p=0.013) (two-way ANCOVA), and a significant reduction of cIMT was observed in the exercise group compared with controls in patients without carotid plaques (-0.034mm (95%CI –0.060 to 0.008) vs. 0.013mm (95%CI –0.011 to 0.038), p=0.010). Conclusion:One year of combined aerobic and resistance training in patients with type 2 diabetes and CAD did not significantly change cIMT progression. However, presence of carotid plaques interacted with the treatment principle, and in patients without carotid plaques cIMT was significantly reduced in the exercise group compared with controls. P127 Lipid control goals after acute myocardial infarction, a gap between guidelines and real practice. R Dalmau1, A Castro1, Z Blazquez2, I Ponz2, J Caro2, R Mori2, C Alvarez2, O Gonzalez2, AM Iniesta2, JL Lopez Sendon2 1University Hospital La Paz, Department of Cardiology, Cardiac Rehabilitation Unit, Madrid, Spain 2University Hospital La Paz, Madrid, Spain Topic: Sports cardiology Purpose:lipid control goals are clearly defined in guidelines. Nevertheless, in real practice these goals are difficult to reach despite the use of high-dose statins. We analyzed the proportion of patients that reached the lipid goals after an acute myocardial infarction (AMI). Methods:a cohort of 680 patients referred to a cardiac rehabilitation program after an AMI was prospectively analyzed. Pharmacotherapy was according to guidelines, a lifestyle correction program based on diet, exercise and smoking cessation counseling was implemented. A fasting lipid profile performed 3 months after the AMI was compared to the first fasting profile obtained during AMI admission. Results:680 patients, mean age 57,1 (SD 10,2), 87,6% male, 61,7% had a previous condition of dyslipidemia. High-dose statins (atorvastatin 80 mg or rosuvastatin 20 mg) were prescribed in 92,3% and lipid drug combinations were used in 2,6%. Main reasons for nor prescribing high-dose statins were: digestive intolerance, muscle pain, polymedication, advanced age, or a previous statin prescription tailored to tolerance or lipid goals. An LDL-cholesterol <70 mg/dl was reached in 55,1% of patients, a non-HDL-cholesterol < 100 mg/dl in 68,7%. Mean reduction in LDL-c was 30%, and a reduction =50% was reached in 27,1% of the global cohort, but only in 8,1% of patients who didn't reach an LDL-c <70 mg/d. After a univariate analysis, predictors of not reaching the LDL-c goal were: a previous condition of dyslipidemia, and basal levels of total cholesterol, LDL-c and HDL-c. In a multivariate analysis only basal level of LDL-c and having a previous condition of dyslipidemia were found to be predictors of not reaching an LDL-c <70 mg/dl. Conclusion:In real practice, the lipid goals recommended in guidelines for secondary prevention are difficult to reach, despite the use of high-dose statins and life style correction. Recent evidence suggests that trying to reach the goals beyond the use of statins should be considered. Patients reaching an LDL< 70 mg/dl (n=378, 55,1%) Patients not reaching an LDL< 70 mg/dl (n=302, 44,9%) p Basal total cholest. mg/dl 163,7 183,0 <0,001 Basal LDL-c mg/dl 103,5 120,1 <0,001 Basal HDL-c mg/dl 36,0 37,5 0,041 Previous dyslipidemia 53,7% 71,4% <0,001 Patients reaching an LDL< 70 mg/dl (n=378, 55,1%) Patients not reaching an LDL< 70 mg/dl (n=302, 44,9%) p Basal total cholest. mg/dl 163,7 183,0 <0,001 Basal LDL-c mg/dl 103,5 120,1 <0,001 Basal HDL-c mg/dl 36,0 37,5 0,041 Previous dyslipidemia 53,7% 71,4% <0,001 Open in new tab Patients reaching an LDL< 70 mg/dl (n=378, 55,1%) Patients not reaching an LDL< 70 mg/dl (n=302, 44,9%) p Basal total cholest. mg/dl 163,7 183,0 <0,001 Basal LDL-c mg/dl 103,5 120,1 <0,001 Basal HDL-c mg/dl 36,0 37,5 0,041 Previous dyslipidemia 53,7% 71,4% <0,001 Patients reaching an LDL< 70 mg/dl (n=378, 55,1%) Patients not reaching an LDL< 70 mg/dl (n=302, 44,9%) p Basal total cholest. mg/dl 163,7 183,0 <0,001 Basal LDL-c mg/dl 103,5 120,1 <0,001 Basal HDL-c mg/dl 36,0 37,5 0,041 Previous dyslipidemia 53,7% 71,4% <0,001 Open in new tab P129 Obesity in cardiac patients: what difference does it make? C A Alvarez-Ortega1, R Dalmau1, A Castro1, I Ponz1, Z Blazquez1, O Gonzalez1, R Mori1, JL Lopez-Sendon1 1University Hospital La Paz, Cardiology, Madrid, Spain Background:and aim: Obesity is growing in prevalence, and its impact on cardiovascular risk (CVR) has proved to be controversial. We analyse the prevalence of obesity and its impact on CVR profile in a cohort of cardiac patients. Methods:703 patients referred to a cardiac rehabilitation program after a recent cardiac episode were retrospectively analysed. Metabolic profile was analysed from a fasting blood sample performed during hospital admission. ANOVA test and Chi-square test were used for continuous and categorical variables respectively. Results:(see table) 85,8% were male, mean age 56,6, 93,9% of them referred after an acute coronary syndrome, 3,1% after cardiac surgery, 3% after a heart failure episode. According to standard body mass index (BMI) categories, 26,5% were obese and 47,7% had overweight. Obesity was more prevalent in women (28,7% vs 26,1%) and overweight in men (49,8% vs 33%, p=0,01). The prevalence of hypertension, diabetes and dyslipidemia increases as the BMI categories do. Despite the fact that nicotine has anorexigenic effects, smoking was common in obese and overweight patients. Insuline resistance markers, and glycemic metabolic parameters deteriorate as the BMI increases. Conclusions:Obesity and overweight are common conditions in cardiac patients, and give rise to CVR factors prevalence and life style abnormalities. A multifactorial approach is necessary in order to cut the vicious circle. Normal weight: BMI <25 (n=182) Overweight BMI 25-30 (n=335) Obesity BMI=30 (n=186) p Mean age 56,1 57,9 54,7 0,003 Fasting glucose (mg/dl) 110,8 109,4 120,1 0,007 LDL-c (mg/dl) 107,7 112,7 111,5 NS HDL-C (mg/dl) 38,5 37,6 33,7 <0,001 Triglycerides (mg/dl) 131,4 145,1 175 <0,001 A1C % 5,8 6,1 7,7 0,004 Hypertension 33% 49,90% 67,70% <0,001 Diabetes 15,90% 17,90% 45,70% <0,001 Dyslipidemia 49,50% 58,80% 69,40% 0,001 Sedentarism 47,80% 62,40% 72,60% <0,001 Smoking 64,80% 50,10% 53,20% 0,013 Normal weight: BMI <25 (n=182) Overweight BMI 25-30 (n=335) Obesity BMI=30 (n=186) p Mean age 56,1 57,9 54,7 0,003 Fasting glucose (mg/dl) 110,8 109,4 120,1 0,007 LDL-c (mg/dl) 107,7 112,7 111,5 NS HDL-C (mg/dl) 38,5 37,6 33,7 <0,001 Triglycerides (mg/dl) 131,4 145,1 175 <0,001 A1C % 5,8 6,1 7,7 0,004 Hypertension 33% 49,90% 67,70% <0,001 Diabetes 15,90% 17,90% 45,70% <0,001 Dyslipidemia 49,50% 58,80% 69,40% 0,001 Sedentarism 47,80% 62,40% 72,60% <0,001 Smoking 64,80% 50,10% 53,20% 0,013 Open in new tab Normal weight: BMI <25 (n=182) Overweight BMI 25-30 (n=335) Obesity BMI=30 (n=186) p Mean age 56,1 57,9 54,7 0,003 Fasting glucose (mg/dl) 110,8 109,4 120,1 0,007 LDL-c (mg/dl) 107,7 112,7 111,5 NS HDL-C (mg/dl) 38,5 37,6 33,7 <0,001 Triglycerides (mg/dl) 131,4 145,1 175 <0,001 A1C % 5,8 6,1 7,7 0,004 Hypertension 33% 49,90% 67,70% <0,001 Diabetes 15,90% 17,90% 45,70% <0,001 Dyslipidemia 49,50% 58,80% 69,40% 0,001 Sedentarism 47,80% 62,40% 72,60% <0,001 Smoking 64,80% 50,10% 53,20% 0,013 Normal weight: BMI <25 (n=182) Overweight BMI 25-30 (n=335) Obesity BMI=30 (n=186) p Mean age 56,1 57,9 54,7 0,003 Fasting glucose (mg/dl) 110,8 109,4 120,1 0,007 LDL-c (mg/dl) 107,7 112,7 111,5 NS HDL-C (mg/dl) 38,5 37,6 33,7 <0,001 Triglycerides (mg/dl) 131,4 145,1 175 <0,001 A1C % 5,8 6,1 7,7 0,004 Hypertension 33% 49,90% 67,70% <0,001 Diabetes 15,90% 17,90% 45,70% <0,001 Dyslipidemia 49,50% 58,80% 69,40% 0,001 Sedentarism 47,80% 62,40% 72,60% <0,001 Smoking 64,80% 50,10% 53,20% 0,013 Open in new tab P130 Validation of the Acti'MET calculator :a new tool to assess physical activity in cardiac patients J Satge1, T Guiraud2, R Granger2, M Labrunee3 1Toulouse Rangueil University Hospital (CHU), Department of Cardiac Rehabilitation, Toulouse, France 2Clinic of Saint-Orens, Cardiovascular and Pulmonary Rehabilitation Centre, Toulouse, France 3Institute of Cardiovascular and Metabolic Diseases, Toulouse, France Topic: Sports cardiology Purpose:A new tool for Physical Activity (PA) assessment, "the Acti'MET® calculator" has been created by our team to estimate quickly the weekly Energy Expenditure. Acti'MET® is a small rule (21.5 * 9 cm) easy-to-use and directly inspired by directly inspired by the Compendium of Physical Activities. The aim of this study was to assess the metrological properties of the Acti'MET® calculator in cardiac rehabilitation (CR) patients. Methods:To validate the Acti'MET® calculator sixty five cardiac patients were included in this study and were then divided into two groups. The reliability of the Acti'MET® was studied in Acti'MET® group (n=33) ; patients were successively evaluated with the Acti'MET® calculator and other classical methods for the measurement of PA such as PA questionnaires, the six minute walking test (6MWT) and the cardiopulmonary maximal exercise test. The "Accelerometer" group (N=32) wore an accelerometer for a week (MyWellnessKey (MWK)), the Energy Expenditure (EE, in Kcal) was compared to Acti'MET® estimation in the same period. Results:A very strong inter-rater and intra-rater reliability of the measurement was observed, (r=0.87 (p< 0.0001)) and (r = 0.98 (p<0.0001)), respectively. Concerning the questionnaires, we found a moderate correlation with the "Dijon Physical Activity Score" (SAP) (r =0.39 (p<0.05)) and a strong correlation with the "International Physical Activity Questionnaire" (IPAQ) (r = 0.88 (p<0.0001)). No correlation was found between Acti'MET® measurements and the peak power output while the correlation was significant with 6MWT parameters (r = 0.54 (p<0.01)). In the "Accelerometer" group, the total weekly EE estimated with Acti'MET® was strongly correlated with MWK measurement (r = 0.94 (p<0.0001)). Furthermore, we found strong correlations in the different activity levels especially in light intensity (r = 0.58 p <0.0005) and in moderate intensity (r = 0.61, p <0.0002). Conclusion:The Acti'MET® calculator is a reliable, easy-to-use and original tool to assess PA in CR patients. P131 Coronary heart disease patient perspectives on exercise participation: a narrative review D Campbell1, L Campkin2, J Boyd3 1University of Calgary, Medicine and Community Health Sciences, Calgary, Canada 2University of Calgary, Kinesiology, Calgary, Canada 3University of Calgary, Community Health Sciences, Calgary, Canada Topic: Sports cardiology Purpose:Participation in exercise programs post myocardial infarction is highly protective against future events and mortality. Unfortunately, patient uptake and maintenance of exercise participation has been documented as being low. This is thought to be due to myriad barriers. Qualitative research is a powerful tool to explain behaviours. We sought to summarize existing qualitative literature exploring patient perspectives of participation in exercise after a cardiac event. Methods:Building upon a previous meta-synthesis, we undertook a narrative review to identify qualitative literature which was not previously captured. We used grounded formal theory to synthesize the qualitative findings in the selected literature. This process led to the development of a comprehensive conceptual framework for understanding the determinants of exercise participation. Results:We found that external, internal and cultural factors work together as umbrella themes to influence exercise initiation and continued participation in patients who have experienced a cardiac event. Internal factors expand into physical, cognitive and emotional domains, which include: fear, motivation and mood. External factors include the domains of pragmatic and social considerations such as: safety, accessibility and social support networks. Cognitive and social domains were the most frequently cited factors influencing participation in exercise programs. Conclusions:The framework we outline allows for a more complete understanding of the factors that influence the exercise behaviors of coronary heart disease patients. Cardiac rehabilitation programs should address the key areas and capitalize on this knowledge, making these factors facilitators rather than barriers to exercise participation. Open in new tabDownload slide Conceptual Framework for Participation P132 Effect of sildenafil on physical activity in patients with coronary artery disease. A I Kravchenko1 1State Establishment "Dnipropetrovsk Medical Academy" of Health Ministry of Ukraine, Propedeutics of internal medicine, Dnepropetrovsk, Ukraine Risk factors for erectile dysfunction (ED) and atherosclerosis are the same. ED - a clinical syndrome of generalized vascular disease. In 80% of men with ED have a vascular disease. Population studies of recent years have shown that ED is determined at 2/3 of men with uncontrolled hypertension. The incidence of death in patients with coronary artery disease (CAD) during sexual activity (SA) is very low. However, the fear of patients with CAD and their partners - this is a common psychological problem. Physiological responses during SA: increase in heart rate (HR), blood pressure (BP), respiratory rate - can be interpreted as symptoms of cardiovascular events. Objective:to estimate the effect of Sildenafil on tolerance psycho-emotional and physical stress due to SA in patients with CAD. Results:We examined 30 men with CAD and ED - aged 35 - 68 years old (mediana- 48.4 years). These patients had a diagnosis of stable angina II - III FC, and 1 and 2, the level of risk at Princeton classification. This patients had monitoring of electrocardiogram (ECG) and blood pressure during wakefulness, including episodes of SA without medical support, and on the background of Sildenafil. A positive result was considered an effective SA based on the questionnaire of patients. Patients with poor activity prescribe of Sildenafil if was no contraindications in a dose of 100 mg. Examination was carried out in a familiar environment for patients, with regular sexual partner. Functional response psychoemotional sphere and the cardiovascular system were analyzed using the index of adaptation. For analyze the quality of sexual life questionnaire was used "LIEF". On the background of Sildenafil during the SA we recorded significantly smaller increase in heart rate and blood pressure (systolic and diastolic) and the manifestations of ischemia. Coital angina was almost 95% of patients without the use of Sildenafil, and in 56% of patients on the background of Sildenafil. All symptoms were correlated with an increase in scores on the LIEF. Analysis of the dynamics of the index of adaptation during SA showed that on the background of Sildenafil, the growth rates of acute stress reaction and degree of emotional load was significantly less than in patients without prescribe of Sildenafil. Conclusions:The use of Sildenafilbin patients with CAD and ED indicate the possibility of the treatment of ED and significant increase tolerance to the psycho-emotional and physical coital stress. P134 Cardiovascular disease risk factors and the activity of systemic inflammation in case of rheumatoid arthritis J Starodubova1, I Osipova2, I Sopotova1 1City hospital 4, Barnaul, Russian Federation 2Altay State Medical University, Barnaul, Russian Federation The purpose is to analyze CVD risk factors and reveal the correlation with the activity of systemic inflammatory process and cardiovascular risk in women with rheumatoid arthritis (RA). Materials and methods:Fifty women were included into the study. The average age was 55,8 years (32;74). RA was diagnosed by the criteria ACR\EULAR 2010. The average age of the onset of RA was 47 years (30; 73). The average time of RA was 8,8 years (1;31). Results:98% patients suffering from RA had CVD risk factors. The average number of risk factors for a patient was 7,4 (0;13) at the age of 55+9,5 years. The number of risk factors increases in 1,9 times (p<0,05) every 10 years in people over 55 years. According to the frequency risk factors can be ranked as follows arterial hypertension - 92%, abdominal obesity - 80%, unbalanced diet - 78%, anxiety and depression - 68%, increased cholesterol level - 66%, family history of early CVD - 64%, menopause under 50 years - 56%, obesity - 52%, the decreasing of physical activity - 38%, sleep disturbance - 32%, the pathology of pregnancy - 32%, smoking - 6%, hyperglycemia - 4%, alcohol - 2%. The affected organs were left ventricle hypertrophy - 90%, lower limb arterial calcification - 54%, (Ankle Brachial Index 1,4) - 46%, stenosis of lower limb vessels (0,8) - 8%. The associated clinical conditions were ischemic heart disease in 40 % of patients, transient ischemic attack -18%, chronic kidney disease -8%, increased ESR - 94% ( 37,2 (16;70) mm\h), C- reactive protein (CRP)- 92% (19,2 (0;86,0) mg\L), rheumatoid factor (RF) - 94% (111,1 (0; 602)mg\L); cyclic citrullinated peptide antibody (anti-CCP) - 54% (211 (100; 426) unit\ml), blood cholesterol level - 66%, average level - 5,1 (3,1; 10,2) mmol\L. The risk of cardiovascular complications according to the SCORE scale was high and very high in 38% of cases, mild and low risks were in 12%. The correlation between CRP, blood cholesterol level, RF, anti-CCP and the number of risk factors and the severity of the disease was detected. Thus, 52% of patients with increased level of blood cholesterol (p<0,05) had the increased CRP, RF and anti-CCP and vice versa. Conclusion:Thus, the patients with rheumatoid arthritis have the increased risk of CV complications (76%) caused by the great number of risk factors (in average 7,4), at the average age of 55 and in case of atherosclerosis (54%) and pathogenetic mechanisms of the disease the risk factors correlate (in 52%) with the activity of systemic inflammatory process. It should be considered assessing the CV risk in patients with RA. P135 Safety of aspirin therapy in patients for elective coronary artery bypass grafting K Krivoshapova1, OL Barbarash1 1Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russian Federation Objective:To evaluate safety of coronary artery surgeries with preoperative aspirinmanagement. Materials and Methods:103 patients, treated with aspirin in the preoperative period, were included in the current study (Group I). The comparison group (Group II) included 218 patients, who did not receive aspirin preoperatively. Intra- and postoperative blood loss, the rate of redo procedures, caused by bleedings, the rate of blood transfusions as well as blood product volumes were evaluated. The data were analyzed sis using the SPSS 13.0 software package for Windows (SPSS Inc.; Chicago, IL). Results:The intraoperative blood loss was similar in both groups (495.2 ± 66.8 ml in Group I vs. 490.5 ± 68.6 ml in Group II, p = 0,62), whereas postoperative blood loss within 6 h and 12 h was significantly higher in Group I (mean difference 35.3 ml; CI 95%; from 6.7 to 63.9 ml, p = 0.001;within 6 h of surgery - 160.2 ± 99.2 ml, p <0.01; within 12 h of surgery – 242.4 ± 159.1 ml, p <0.01) compared to Group II – mean difference 66.2 ml (CI 95%; from19.7 to 112.7 ml, p <0,001; within 6 h - 124.9 ± 75.4 ml, p <0.01; within 12 h - 176.2 ± 125.2 ml, p <0,01). However, there were no significant differences in the total blood loss within 24 h (314.7 ± 250.8 ml in Group I vs. 250.8 ± 127.4 ml in Group II, p = 0, 13; mean difference 63.9 ml, CI 95% from 0.7 to 128.5 ml, p = 0,13). The rates of blood transfusions were significantly higher in Group I (91.9%) compared to Group II (16.2%, p <0,01); thus, resulting in increased rate of red cell concentrate transfusions ( 25.7% vs. 6.8% respectively, p = 0,002) and platelet concentrates transfusions (90.5% vs. 4.1%, respectively, p <0,001). However, the rates of fresh frozen plasma transfusion were similar in both groups (20.3% vs. 10.8%, respectively, p = 0,11). It should be noted that the average volume of blood product transfusions for each patient did not significantly differ in both groups. Moreover, the rates of redo procedures, caused by bleedings, were similar in both groups (1.4% in Group I vs. 2.7% in Group II, p = 1,0). Conclusions:Patients, receiving aspirin before elective CABG, reported a significant increase in postoperative blood loss within 6 h and 12 h as well as increased need in blood product transfusions. Nevertheless, the total blood loss within 24 h as well as the redo rates, caused by bleedings, did not differ significantly. P136 The possibility of selection bias in exercise clinical trials: a subanalysis of the SAINTEX-CAD N Pattyn1, P Beckers2, E Coeckelberghs1, C De Maeyer2, G Frederix2, K Goetschalckx1, N Possemiers2, EM Van Craenenbroeck2, V Conraads2, L Vanhees1 1Catholic University of Leuven, Department of Cardiovascular Diseases, Leuven, Belgium 2University of Antwerp Hospital (Edegem), Department of Cardiology, Antwerp, Belgium Background:In general, women are less likely to enroll in cardiac rehabilitation programs. In addition, drop-out rates are often higher in women and patients with a lower socio-economic status or lower education levels. We wanted to investigate if there are differences between patients agreeing to participate in a clinical trial on cardiac rehabilitation (inclusions) compared to patients that refuse to participate (non-inclusions), and between the completers and the dropouts of the trial. Methods:A retrospective analysis was done on 375 coronary artery disease (CAD) patients referred for cardiac rehabilitation between November 2010 and March 2013 and eligible for participation in the SAINTEX-CAD, a multicenter exercise intervention clinical trial. Differences between inclusions and non-inclusions and between completers and dropouts were analysed with ANOVA, Fisher exact test and chi² test. Results:Age did not differ significantly between inclusions (n=200) and non-inclusions (n=175) or between completers (n=174) and dropouts (n=26). Significantly more men agreed to participate compared to women (p=0.001) and in addition, more women dropped out (p=0.002). Inclusions differed significantly from non-inclusions in terms of education: more non-inclusions only finished primary school (p=0.01); and in terms of profession: inclusions were less houseman/housewife (p=0.02) and tended to be more active in middle (p=0.07) and senior (p=0.06) management. No differences between inclusions and non-inclusions or between completers and dropouts were found on educational level for technical school, high school, or university; or on professional level for clerks and laborers. Conclusions:We can conclude that a selection bias may occur in clinical trials on cardiac rehabilitation, with more higher educated men participating compared to women and patients with a lower education or professional level. More support is needed for women and patients with lower educational levels to enroll in and complete clinical trials. P138 Exercise capacity and heart rate reserve of patients with metabolic syndrome PC Celebioglu1, AA Akyuz1, DCA Akkoyun1, US Sener2, NG Guler1, HE Erdogan2 1Namik Kemal University Faculty of Medicine, Cardiology, Tekirdag, Turkey 2Namik Kemal University Faculty of Medicine, Physiology, Tekirdag, Turkey Introduction:The lack of a heart rate response to exercise and decreased exercise capacity are related to cardiac events. The prevalence of metabolic syndrome gradually increases with obesity, diabetes and hypertension. Metabolic syndrome is one of the reasons for the development of an abnormal exercise response. However, a number of conflicting studies in the literature demonstrate whether a relationship exists between metabolic syndrome and heart rate reserve. Thus, in this study, we aimed to evaluate the values of heart rate reserve (%) and the beats per minute in individuals both with and without metabolic syndrome. Methods:The study included 80 patients with metabolic syndrome (31 males, mean aged 53.8 ±8.3 years) and 78 patients without metabolic syndrome (34 males, mean aged 51.5 ±9.6 years). Results:The values of heart rate reserve beats per minute (62.5 ±18 vs 71 ±19.5 beats/ min, p= 0.005), heart rate reserve percentage [19(3-66) vs 25.7 (4-96), p=0.002] and exercise capacity [8.5 (4.6-13.5) vs 10 (4.8-15.7), p= 0.03] were lower in patients with metabolic syndrome compared to those without. According to the results of univariate and multivariate logistic regression analyses, fasting glucose (?±SE: 0.07 ±0.019, p<0.001), HDL cholesterol (?plusmn;SE: -0.114 ±0.036, p=0.02), serum triglyceride level (?±SE: 0.019 ±0.005, p<0.001), abdominal circumference (?plusmn;SE: 0.235 ±0.12, p=0.049) and resting systolic blood pressure (?±SE: 0.097 ±0.03, p=0.001) were found to be significant predictors of metabolic syndrome. Although the values of heart rate reserve percentage and beats/minute were significant for the presence of metabolic syndrome, they were not found to be predictors for metabolic syndrome. Conclusion:Compared to those without metabolic syndrome, the patients with metabolic syndrome had a lower exercise capacity, heart rate recovery and heart rate reserve. However, decreased heart reserve was not a predictor for metabolic syndrome. P139 Estimation of the anaerobic threshold by easily accessible variables R King1, S Gross1, M Hattendorf2, S Glaeser1, R Ewert1, H Voelzke3, MRP Markus3, M Grunze2, SB Felix1, M Dorr4 1Ernst Moritz Arndt University of Greifswald, Department of Internal Medicine B, Greifswald, Germany 2MediClin Klinikum of Trassenheide, Trassenheide, Germany 3Ernst Moritz Arndt University of Greifswald, Institute of Community Medicine, Greifswald, Germany 4Ernst Moritz Arndt University of Greifswald, Greifswald, Germany Background:The anaerobic threshold (AT) is an important variable for an individualized exercise training protocol for both patients and healthy individuals that aim to improve their exercise capacity. However, estimation of the AT by the gold standard, cardiopulmonary exercise testing (CPET), is time consuming, expensive and not always available. Various methods have been developed aiming to estimate the AT without exercise testing. However, these methods are often limited by a poor accuracy as compared to the gold standard estimation. Our aim was to estimate the AT using variables that can be easily measured in the general population, such as heart rate and breathing rate. We furthermore aimed to compare this estimation to CPET and to existing methods and to test potential influencing determinants including BMI, hypertension, diabetes and intake of beta-blockers. Methods:Among 1758 volunteers (mean age 51.1 , 49.1% females) of the population-based Study of Health in Pomerania, the anaerobic threshold was estimated for each individual based on the results of a standardized symptom-limited CPET on a cycle ergometer. A heart and breathing rate, conditional upon the covariates, was selected that minimized the mean squared deviation of the absolute excess CO2 compared to the CO2 level at the AT associated with this heart and breathing rate. Due to the large sample size, half the sample was used to provide model estimates and other half (replication sample) was used to compare with existing anaerobic threshold estimation methods, such as those of "Haskell and Fox" and "Karvonen". Results:Using heart rate provided much more accurate estimations than breathing rate in our sample. In addition, for all the covariates conditioned upon, only resting heart rate and maximum heart rate significant reduced the mean squared deviation of the absolute excess CO2 and therefore not only are these two covariates easy to measure, but are also the most potent variables for estimating the individual anaerobic threshold. This method provided more accurate results than the existing AT estimation techniques. Conclusions:Out method allows estimation of the individual anaerobic threshold based on resting and maximum heart rates with a higher accuracy compared to other commonly used estimation methods. Importantly, potential other factors such as BMI, hypertension, diabetes and intake of beta-blockers did not affect the estimation accuracy significantly. Therefore our method could be an easy to use tool to be applied to exercise training among various populations including specific patient groups and healthy subjects. P140 High intensity interval training versus strength training to improve cardiovascular risk factors in women with polycystic ovary syndrome. A randomized controlled trial I Almenning1, A Rieber-Mohn1, KK Garnaes1, KM Lundgren1, TS Lovik1, T Moholdt1 1Norwegian University of Science and Technology, Trondheim, Norway Topic: Sports cardiology Purpose:Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 6-20% of reproductive-age women. PCOS associates with adverse CVD profile. Our aim was to assess the effects of high intensity interval training (HIT) and strength training (ST) on cardiovascular risk factors and reproduction-related hormones in women with PCOS. Methods:Thirty-one women with PCOS were randomized to: HIT (n=10), ST (n=11) three times/week for ten weeks, or a control group (n =10). Primary outcome measure was change in HOMA-IR. Secondary outcomes: maximum oxygen uptake, endothelial function, body composition, reproduction-related hormones, lipids. Changes in outcome variables within groups are reported as estimated margin of the mean (EMM) with 95% confidence interval (CI). We used Bonferroni-adjusted covariance analysis with baseline values as covariate and group as fixed factor to assess differences between groups. Results:Six women dropped out. Adherence to exercise was 87% in ST and 90% in HIT. Main results are presented in the table. Conclusion:High intensity interval training for ten weeks improved IR, endothelial function, maximum oxygen uptake, HDL cholesterol and body composition in women with PCOS. ST improved body composition and some reproductive-function related hormones. These changes were seen without change in body weight. VO2max = maximum oxygen uptake, FMD = flow-mediated dilatation, HOMA-IR = homoeostatic assessment of insulin resistance, FAI = free androgen index (serum testosterone x 100/serum sexual hormone binding globulin), AMH = Antim?an Hormone Strength training (n= 8) High intensity interval training (n=8) Control group (n = 9) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) p Weight, kg 77±20.9 78.1±20.0 1.1(-1.2, 3.5) 68.3±14.1 68.5±14.2 0.2(-1.0, 1.4) 75.0±17.0 75.5±17.5 0.4(-1.8, 2.6) 0.66 Fat mass, % 33.1±9.7 31.6±9.4 -1.6(-2.5,-0.7)* 30.2±8.1 29.3±8.0 -0.9(-1.8,-0.01)* 33.6±7.0 32.9±7.3 -0.7(-2.2,0.9) 0.39 VO2max, ml/min/kg 39.3±10.2 40.2±8.5 0.9(-1.2,2.9) 37.4±4.7 41.1±3.8 3.7(2.6,4.8)* 36.8±7.8 36.0±6.9 -0.8(-2.7,1.0) <0.01 FMD, % 5.8±2.4 6.2±1.4 0.4(-1.0,1.8) 4.0±1.3 6.0±1.9 2.0(0.1,4.0)* 6.1±2.0 4.9±1.9 -1.1(2.3,0.03) 0.08 HOMA-IR 3.3±1.3 3.1±1.5 -0.3(-0.5,0.03) 4.9±1.7 4.1±1.4 -0.8(-1.5,-0.2)* 3.6±2.1 4.3±2.8 0.7(-0.4,1.7) 0.01 HDL, mmol/L 1.6±0.5 1.6±0.4 0.0 (-0.1,0.2) 1.7±0.4 2.0±0.5 0.2(0.02,0.5)* 1.6±0.4 1.6±0.4 0.0(-0.1,0.2) 0.04 FAI 2.8±1.7 2.1±1.1 -0.7(-1.3,-0.1)* 1.5±1.2 1.9±1.8 0.3(-0.6,1.2) 2.6±1.4 2.6±2.5 0.0(-1.1,1.1) 0.28 AMH, pmol/L 48.5±30.5 33.7±16.5 -14.8(-21.2,-8.4)* 78.5±56.0 67.1±31.3 -11.5(-26.8,3.9) 57.4±38.9 52.0±28.2 -5.4(-13.2,2.3) 0.04 Strength training (n= 8) High intensity interval training (n=8) Control group (n = 9) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) p Weight, kg 77±20.9 78.1±20.0 1.1(-1.2, 3.5) 68.3±14.1 68.5±14.2 0.2(-1.0, 1.4) 75.0±17.0 75.5±17.5 0.4(-1.8, 2.6) 0.66 Fat mass, % 33.1±9.7 31.6±9.4 -1.6(-2.5,-0.7)* 30.2±8.1 29.3±8.0 -0.9(-1.8,-0.01)* 33.6±7.0 32.9±7.3 -0.7(-2.2,0.9) 0.39 VO2max, ml/min/kg 39.3±10.2 40.2±8.5 0.9(-1.2,2.9) 37.4±4.7 41.1±3.8 3.7(2.6,4.8)* 36.8±7.8 36.0±6.9 -0.8(-2.7,1.0) <0.01 FMD, % 5.8±2.4 6.2±1.4 0.4(-1.0,1.8) 4.0±1.3 6.0±1.9 2.0(0.1,4.0)* 6.1±2.0 4.9±1.9 -1.1(2.3,0.03) 0.08 HOMA-IR 3.3±1.3 3.1±1.5 -0.3(-0.5,0.03) 4.9±1.7 4.1±1.4 -0.8(-1.5,-0.2)* 3.6±2.1 4.3±2.8 0.7(-0.4,1.7) 0.01 HDL, mmol/L 1.6±0.5 1.6±0.4 0.0 (-0.1,0.2) 1.7±0.4 2.0±0.5 0.2(0.02,0.5)* 1.6±0.4 1.6±0.4 0.0(-0.1,0.2) 0.04 FAI 2.8±1.7 2.1±1.1 -0.7(-1.3,-0.1)* 1.5±1.2 1.9±1.8 0.3(-0.6,1.2) 2.6±1.4 2.6±2.5 0.0(-1.1,1.1) 0.28 AMH, pmol/L 48.5±30.5 33.7±16.5 -14.8(-21.2,-8.4)* 78.5±56.0 67.1±31.3 -11.5(-26.8,3.9) 57.4±38.9 52.0±28.2 -5.4(-13.2,2.3) 0.04 Open in new tab VO2max = maximum oxygen uptake, FMD = flow-mediated dilatation, HOMA-IR = homoeostatic assessment of insulin resistance, FAI = free androgen index (serum testosterone x 100/serum sexual hormone binding globulin), AMH = Antim?an Hormone Strength training (n= 8) High intensity interval training (n=8) Control group (n = 9) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) p Weight, kg 77±20.9 78.1±20.0 1.1(-1.2, 3.5) 68.3±14.1 68.5±14.2 0.2(-1.0, 1.4) 75.0±17.0 75.5±17.5 0.4(-1.8, 2.6) 0.66 Fat mass, % 33.1±9.7 31.6±9.4 -1.6(-2.5,-0.7)* 30.2±8.1 29.3±8.0 -0.9(-1.8,-0.01)* 33.6±7.0 32.9±7.3 -0.7(-2.2,0.9) 0.39 VO2max, ml/min/kg 39.3±10.2 40.2±8.5 0.9(-1.2,2.9) 37.4±4.7 41.1±3.8 3.7(2.6,4.8)* 36.8±7.8 36.0±6.9 -0.8(-2.7,1.0) <0.01 FMD, % 5.8±2.4 6.2±1.4 0.4(-1.0,1.8) 4.0±1.3 6.0±1.9 2.0(0.1,4.0)* 6.1±2.0 4.9±1.9 -1.1(2.3,0.03) 0.08 HOMA-IR 3.3±1.3 3.1±1.5 -0.3(-0.5,0.03) 4.9±1.7 4.1±1.4 -0.8(-1.5,-0.2)* 3.6±2.1 4.3±2.8 0.7(-0.4,1.7) 0.01 HDL, mmol/L 1.6±0.5 1.6±0.4 0.0 (-0.1,0.2) 1.7±0.4 2.0±0.5 0.2(0.02,0.5)* 1.6±0.4 1.6±0.4 0.0(-0.1,0.2) 0.04 FAI 2.8±1.7 2.1±1.1 -0.7(-1.3,-0.1)* 1.5±1.2 1.9±1.8 0.3(-0.6,1.2) 2.6±1.4 2.6±2.5 0.0(-1.1,1.1) 0.28 AMH, pmol/L 48.5±30.5 33.7±16.5 -14.8(-21.2,-8.4)* 78.5±56.0 67.1±31.3 -11.5(-26.8,3.9) 57.4±38.9 52.0±28.2 -5.4(-13.2,2.3) 0.04 Strength training (n= 8) High intensity interval training (n=8) Control group (n = 9) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) Baseline 10 weeks Change (?) p Weight, kg 77±20.9 78.1±20.0 1.1(-1.2, 3.5) 68.3±14.1 68.5±14.2 0.2(-1.0, 1.4) 75.0±17.0 75.5±17.5 0.4(-1.8, 2.6) 0.66 Fat mass, % 33.1±9.7 31.6±9.4 -1.6(-2.5,-0.7)* 30.2±8.1 29.3±8.0 -0.9(-1.8,-0.01)* 33.6±7.0 32.9±7.3 -0.7(-2.2,0.9) 0.39 VO2max, ml/min/kg 39.3±10.2 40.2±8.5 0.9(-1.2,2.9) 37.4±4.7 41.1±3.8 3.7(2.6,4.8)* 36.8±7.8 36.0±6.9 -0.8(-2.7,1.0) <0.01 FMD, % 5.8±2.4 6.2±1.4 0.4(-1.0,1.8) 4.0±1.3 6.0±1.9 2.0(0.1,4.0)* 6.1±2.0 4.9±1.9 -1.1(2.3,0.03) 0.08 HOMA-IR 3.3±1.3 3.1±1.5 -0.3(-0.5,0.03) 4.9±1.7 4.1±1.4 -0.8(-1.5,-0.2)* 3.6±2.1 4.3±2.8 0.7(-0.4,1.7) 0.01 HDL, mmol/L 1.6±0.5 1.6±0.4 0.0 (-0.1,0.2) 1.7±0.4 2.0±0.5 0.2(0.02,0.5)* 1.6±0.4 1.6±0.4 0.0(-0.1,0.2) 0.04 FAI 2.8±1.7 2.1±1.1 -0.7(-1.3,-0.1)* 1.5±1.2 1.9±1.8 0.3(-0.6,1.2) 2.6±1.4 2.6±2.5 0.0(-1.1,1.1) 0.28 AMH, pmol/L 48.5±30.5 33.7±16.5 -14.8(-21.2,-8.4)* 78.5±56.0 67.1±31.3 -11.5(-26.8,3.9) 57.4±38.9 52.0±28.2 -5.4(-13.2,2.3) 0.04 Open in new tab P142 Nocturnal heart rate variability measurements: a valid tool for monitoring sleep quality in elite athletes? D Herzig1, M Testorelli1, D Schaefer1, P Eser1, M Wilhelm1 1Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne, Berne, Switzerland Background/Aim:High sleep quality is essential for good health and well-being in the general population, as well as for recovery after training and performance in athletes in particular. Slow-wave sleep (SWS) is characterized by a high Delta wave power of the EEG spectral analysis and is an indicator of sleep quality. The aim of this study was to develop an algorithm to identify SWS phases by means of HRV measurements, as these measurements can be performed at home as part of the athletes' self-monitoring. Methods:Eleven elite alpine skiers (age 25 ± 5 yrs), all members of the Swiss national team, were recruited for this study. In each athlete, HRV and EEG activity were measured during sleep from two nights. For the EEG signal power spectral density was analysed of the delta frequency band (0.5-3 Hz) for each 30 s segment. Power was then normalized to its respective total power and expressed in normalised units (DFn.u.). For the HRV signal correlation coefficients of the Poincaré plot (rRR) over 30 beat segments were calculated. The rRR reflects total variance over 30 beats divided by the beat-to-beat variance. RRR has previously been found to be low in SWS. Pearson correlation coefficients were determined between rRR and DFn.u. of each 30 s segment over the first 4 hours of the night for multiple time lags (from -6 min to +1 min, at 30 s intervals). The highest correlation between HRV and EEG determined the optimal lag. Slow wave sleep phases were determined from the EEG and HRV signal as follows: 1) the EEG signal was smoothed using a moving average of 60 s and SWS had to exceed a threshold of 0.8 for DFn.u.; 2) for HRV rRRs were calculated for 300 beat segments and SWS was determined when the rRR was below the mean rRR over the 4 hours – 0.08. Total duration of SWS during the first 4 hours of the night was summed for EEG and HRV separately and correlated with each other. Results:Two nights of four athletes were included in the preliminary analysis of this study. Mean correlation between DFn.u. and rRR was -0.59±0.14 and ranged from -0.35 to -0.71. Optimal time lag between EEG and the HRV was 233±125 s, implying that rRR increased steeply at a mean 4 min before DFn.u. increased. Mean correlation coefficient between total time spent in SWS according to EEG activity and HRV was R=0.62. Conclusions:Our method has reliably identified SWS phases by HRV and will allow athletes to self-monitor their sleep pattern and quality. P145 Incidence of diabetes mellitus among patients with ischemic heart disease : a comparative analysis between indian and bulgarian patients C James1, S Tisheva1, D Yakova1, M Hristov1, K Gospodinov1, N Stancheva1, S Ohri1, T Attacheril2, S Jose3 1Medical University Pleven, Pleven, Bulgaria 2Lourde Heart Institute and Neuro Sciences, Kochi, India 3MOSC Medical College, Kolenchery, India Objective:The objective of this study was to analyse and compare the incidence of Diabetes Mellitus among patients with ischemic heart disease in Bulgaria and India. Design: Cross-sectional study among patients with established Coronary Artery Disease admitted in the Department of Cardiology. Methods:Study was carried out in the patients admitted with Ischemic Heart disease in the Cardiology Departments in the respective hospitals in Bulgaria and India . 496 patients who were admitted in the Cardiology Department in the hospital in India between 1st June 2012 and 31st Dec 2012 and 476 patients who were admitted in the Cardiology Department in Bulgaria between 1st of January 2012 and 31st Dec 2013 with acute coronary syndrome or coronary angiographic or Electrocardiography evidence of ischemic heart disease were included in the study. Patients were analysed for incidence of Diabetes Mellitus and Impaired Glucose tolerance. Data collected from the patients, old medical records, Clinical Examination and Laboratory results including HbA1c, Fasting and Post-prandial blood sugar values and treatment history for Diabetes Mellitus were analyzed for the study. Results:From the study, it was seen that the incidence of Diabetes Mellitus is 57% among Indian patients with Ischemic Heart Disease, whereas 34% of Bulgarian patients are with Diabetes Mellitus (p >0.01). The Incidence of Impaired Glucose Tolerance among the Indian patients is 21% and among the Bulgarian patients is 19% (p value <0.01). Conclusion:There is statistically significant difference in the incidence of Diabetes Mellitus among patients with Ischemic Heart Disease in Indian and Bulgaria, but in the Incidence of Impaired Glucose Tolerance there is no statistically significant difference between the two populations. The prevalence and incidence of CAD along with the risk factor profile vary greatly across the regions of the world. Early detection Diabetes Mellitus and control of glycaemic status by drugs and dietary modifications in case of impaired Glucose tolerance play a significant role in the prevention of CAD in both populations. A cost-effective preventive strategy will need to focus on reducing risk factors both in the individual and in the population at large. P150 Anomalous chronotropic response is related to obesity and sedentarism in young adults R Gascuena1, M Molina1, N Acosta1, C Rico1, B Terol1 1Hospital Universitario Severo Ochoa, Madrid, Spain Chronotropic incompetence predicts adverse cardiovascular outcomes and mortality. Obesity and Sedentarism increase risk, but their effects on chronotropism have not been extensively studied. Metods:370 patients, ( mean age 43, 44% obese,85% male) performed an exercise test on treadmill following Bruce's Protocol. Rest ECG, biochemistry, and echocardiogram were obtained. 29.9% from obese and 17.3% of non-obese subjects were also considered sedentary. Maximal expected heart rate was considered 208-0.7xage. Heart rate reserve and the Percentage of adjusted heart reserve were obtained. Previously published chronotropic risk markers were also considered: Heart Rate(HR) at rest >75 bpm; HR increase <89 bpm; HR decrease < 25 bpm at minute 1 of recovery after Exercise Test. Differences for obesity, sedentarism, and subanalisis of sedentarism in obese patients were analyzed, adjusting by age, sex, risk score, blood pressure, smoking, and heart rate at rest. Results:HR at rest was higher (79 vs 71 bpm obese vs non obese; 86 vs 72 bpm sedentary vs active) but non adjusted HR reserve was higher in obese (91 vs 102 bpm) and sedentary (100 vs 84 bpm) patients. Sedentarism yielded similar results between obese subjects. Proportion of patients reaching chronotropic risk markers was also higher in obese and sedentary. (p<0.001 for all comparisons). Risk Score and Heart Rate at rest predict a less HR reserve and risk chronotropic markers (p<0.0005). Conclusions:Obesity and sedentarism are associated with a higher heart rate at rest and an anomalous chronotropic response after exercise on treadmill. Risk Score and a higher heart rate at rest predict chronotropic risk markers, and could select patients who would benefit from diet and exercise. P152 Long term prognosis determinants in a cohort of chronic ischemic heart disease patients from a primary care setting, findings of the BARIHD study F Berrocal De Partearroyo1, O Ferreiro Uriz1, O Rego Ojea1, A Soilan Rodriguez1, L Vazquez Fernandez1, C Blanco Iglesias1, R Castelo Dominguez1, R C Vidal Perez1, F Otero Ravina1, JR Gonzalez-Juanatey1 1University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Topic: Sports cardiology Purpose:There are few studies about prognostic determinants in the chronic phase of coronary artery disease(CAD). We assessed the long term prognosis markers in a cohort with chronic ischemic heart disease(CIHD) followed by primary care physicians (PCP) Methods:BARIHD was a cross-sectional multicentric study made by 73 PCP. The PCP included during February 2007,patients(p) that fulfil the inclusion criteria: CAD with at least 1 year of follow up since diagnosis, diagnosis clear established (stable angina, unstable angina or myocardial infarction-MI) in a discharge summary from cardiology department. Follow-up was done by clinical review or telephone contact and death or CV events were recorded, as well as the cause of death. Results:1038p with a complete follow up after a median of 2304[2-2612]days. 73%(758p) male sex, age at inclusion 69.05±11.05 years old, time of evolution after the 1st diagnosis CAD 7.84±6.05 years. MI cases were 55.2%. We found hypertension 64.7%, diabetes 30.1%, prior heart failure 10.1%, atrial fibrillation 14.3%, stroke 8.4%; left bundle branch block 10.2%, glomerular filtration rate < 60ml/min/1.73m² 38.5%. 19.2% had a cardiovascular (CV) admission in the previous year before inclusion. Aspirin use was 75.6%, statins 88.1%, betablockers 61%, RAAS Inhibitors 59%, exercise 77%. CV mortality was 13.7%, all-cause mortality 25%, CV admissions 38%. Multivariate analysis for CV mortality is shown (table) Conclusions:The determinants of CV death in our population with CIHD from primary care are diverse but important protective strategies such as beta blockers and exercise were found and should be considered whenever possible. CI 95%- Confidence interval 95%; CV -Cardiovascular HR IC-95% Valor-p Female sex 0.63 0.43-0.94 0.024 Age 1.05 1.02-1.082 <0.001 Diabetes Mellitus 1.69 1.20-2.37 0.002 Prior Heart Failure 3.72 2.49-5.54 <0.001 Glomerular filtration rate <60 ml/min/1.73m² 1.61 1,07-2.42 0.020 Left bundle branch block 2.10 1.41-3.12 <0.001 Betablockers 0.56 0.40-0.79 0.001 Exercise 0.59 0.41-0.85 0.004 CV admisi??n previous year before inclusion 1.66 1.12-2.44 0.010 HR IC-95% Valor-p Female sex 0.63 0.43-0.94 0.024 Age 1.05 1.02-1.082 <0.001 Diabetes Mellitus 1.69 1.20-2.37 0.002 Prior Heart Failure 3.72 2.49-5.54 <0.001 Glomerular filtration rate <60 ml/min/1.73m² 1.61 1,07-2.42 0.020 Left bundle branch block 2.10 1.41-3.12 <0.001 Betablockers 0.56 0.40-0.79 0.001 Exercise 0.59 0.41-0.85 0.004 CV admisi??n previous year before inclusion 1.66 1.12-2.44 0.010 Open in new tab CI 95%- Confidence interval 95%; CV -Cardiovascular HR IC-95% Valor-p Female sex 0.63 0.43-0.94 0.024 Age 1.05 1.02-1.082 <0.001 Diabetes Mellitus 1.69 1.20-2.37 0.002 Prior Heart Failure 3.72 2.49-5.54 <0.001 Glomerular filtration rate <60 ml/min/1.73m² 1.61 1,07-2.42 0.020 Left bundle branch block 2.10 1.41-3.12 <0.001 Betablockers 0.56 0.40-0.79 0.001 Exercise 0.59 0.41-0.85 0.004 CV admisi??n previous year before inclusion 1.66 1.12-2.44 0.010 HR IC-95% Valor-p Female sex 0.63 0.43-0.94 0.024 Age 1.05 1.02-1.082 <0.001 Diabetes Mellitus 1.69 1.20-2.37 0.002 Prior Heart Failure 3.72 2.49-5.54 <0.001 Glomerular filtration rate <60 ml/min/1.73m² 1.61 1,07-2.42 0.020 Left bundle branch block 2.10 1.41-3.12 <0.001 Betablockers 0.56 0.40-0.79 0.001 Exercise 0.59 0.41-0.85 0.004 CV admisi??n previous year before inclusion 1.66 1.12-2.44 0.010 Open in new tab P153 Hospital revascularization capability and quality of care after an acute coronary syndrome J Welker1, R Auer1, B Gencer2, J Cornuz1, S Windecker3, CM Matter4, TF Luscher4, F Mach2, N Rodondi5, D Nanchen1 1Polyclinic Medical University (PMU), Cardiovascular prevention, Lausanne, Switzerland 2Geneva University Hospitals, Cardiology, Geneva, Switzerland 3Bern University Hospital, Cardiology, Bern, Switzerland 4University Hospital Zurich, Cardiology, Zurich, Switzerland 5Bern University Hospital, General Internal Medicine, Bern, Switzerland Background:The use of evidence-based therapies for cardiovascular prevention is subject to geographic disparities. Availability of percutaneous coronary intervention (PCI) facilities at hospitals may influence care of patients with acute coronary syndrome (ACS). We aim to compare guidelines-recommended secondary prevention interventions in patients with ACS discharged at hospitals with and without PCI facilities in Switzerland. Methods:We studied 720 patients with ACS who were admitted in a university hospital in Switzerland between September 2009 and March 2013. After angiography, according to their places of life, patients were either transferred within 48 hours in peripheral hospitals without PCI facilities or directly discharged from the university hospital with PCI facilities. In both type of hospitals, we measured prescription and contra-indications rates of evidence-based recommended therapies after ACS, including aspirin, statins, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin-II receptors blockers (ARB), as well as attendance to cardiac rehabilitation and in-hospital smoking cessation intervention. Results:Overall, 541 patients (75.1%) were discharged at the university hospital with PCI facilities, and 179 (24.9 %) were discharged at peripheral hospitals without PCI facilities. At discharge, the concomitant prescription of aspirin, beta-blockers, ACE inhibitors or ARB and statins was similar at hospitals with and without PCI facilities, reaching 83.9% and 85.5%, respectively (p=0.62). By contrast, 55.5% of ACS patients discharged at hospital with PCI facilities and 65.7% at hospitals without PCI attended cardiac rehabilitation (p=0.02). In-hospital smoking cessation interventions were performed exclusively the university hospital with PCI facilities. Conclusion:Quality of care at discharge for patients hospitalized with ACS was similar in hospitals with or without PCI facilities. However, in-hospital smoking cessation counseling needs to be implemented in peripheral hospitals that take care of patient with ACS. P154 Lower extremity and coronary artery disease prevalence registry GJ Morgado1, PJ Sousa1, AC Gomes1, D Caldeira1, IR Cruz1, B Stuart1, MJ Loureiro1, H Pereira1 1Hospital Garcia de Orta, Almada, Portugal Topic: Sports cardiology Purpose:Peripheral artery disease (PAD) is a continuous process of atherosclerosis, with risk factors that are similar to those of Coronary artery disease (CAD). The presence of PAD in patients with CAD is estimated to be 20%. The primary objective of this study is to evaluate the prevalence of PAD in patients with suspected CAD. The secondary objective is to determine clinical variables associated with either disease. Methods:We performed a single center prospective registry of consecutive patients referred to non-emergent coronary angiography between July and December of 2013. We recorded each patient's age, gender, cardiovascular risk factors and co-morbidities. The presence of CAD was defined as a 70% or greater coronary lumen stenosis in the angiogram. The presence of symptoms of PAD was evaluated submitting the patient to the Edinburgh Claudication Questionnaire. The ABI (the ratio of ankle and arm systolic blood pressure) was calculated and considered abnormal and diagnostic of PAD when under 0.90 or above 1.40. We tested possible associations between clinical variables and CAD, PAD, or both. Results:From 585 coronary angiographies performed, 35 were repeated procedures, 166 were urgent procedures and 136 had some missing data, resulting in a final sample of 248 patients. Our population had an average age of 66.5 years, with 68.5% males, 42.3% with diabetes, 81.8% with hypertension, 76.2% with dislypidemia and 45.9% were current or former smokers. Amongst co-morbidities, 24.2% had a personal history of acute coronary syndrome, 31.5% had a prior coronary intervention, 2.8% had severe chronic kidney disease and 5.2% had documented cerebrovascular disease. The prevalence of 1 vessel CAD was 22.6%, of multi-vessel CAD was 43.1% and the prevalence of PAD was 25.4% (6.9% had a previous diagnosis, 5.7% had symptoms of PAD, 19% had a pathological ABI). The prevalence of PAD in patients with CAD was 28.8% (47/163 patients), compared to a 18.8% (16/85) prevalence in those without CAD (OR 1.75, IC95% 0.92-3.32). Male gender was associated with the presence of CAD (OR 2.1, IC95% 1.2-3.7). Past or current smoking (OR 1.8, IC95% 1.03-3.26), severe chronic kidney disease (OR 7.8, IC95% 1.5-41.5) and cerebrovascular disease (OR 3.7, IC95% 1.2-11.6) were associated with the presence of PAD. Conclusions:There is a significant prevalence of undiagnosed PAD in patients referred to coronary angiography. This prevalence may be higher amongst those with documented CAD. The Edinburgh Claudication Questionnaire and the ABI are useful, cheap and non-invasive tools to identify those patients. P155 Carotid plaque score is more predictive of cardiovascular events than either carotid plaque area or maximal CCA IMT. M Matangi1, E Mcintyre1, U Jurt1, D Armstrong1, D Brouillard1, A Johri2 1Kingston Heart Clinic, Kingston, Canada 2Queen's University, Kingston, Canada Topic: Sports cardiology Purpose:Determine using Cox proportional hazard modelling the clinical and carotid imaging parameters that best predict cardiovascular outcomes. Methods:Males 40-70 years and females 50-70 years were selected. Patients with a minimum of 1 year of follow up were included. Patients with diabetes, or a history of prior vascular disease were excluded. The first carotid examination was used for analysis. Patients or their surviving relatives were contacted by phone and any vascular events were confirmed by reviewing local hospital records, office records, or coroner's records. As patients often had multiple vascular events, only the first vascular event was used in this analysis. In the case of cardiovascular death, the death was taken as the only event for that patient. Plaque score was calculated using the Rotterdam method with a minimum score of "0" and a maximal score of "6". Plaque area was measured in the carotid bulbs and both ICAs. Total plaque area was the sum of all plaque measured in the longitudinal view. Maximal CCA IMT was measured in the far wall of the CCA, offline, using commercially available GE software. Independent predictors of CV morbidity and mortality and hazard ratios were determined using Cox proportional hazards modeling for combined fatal and nonfatal CV events. A P value of <0.05 was considered significant. Results:The results of the 4 separate Cox models are seen in Table 1. Plaque score using the Rotterdam method was the only independent predictor of cardiovascular outcome. Conclusions:Plaque score is the best predictor of cardiovascular outcomes. The major advantages of plaque score are that it is quick and simple. Cox model 1 P-value Hazard Ratio [95% CI] Cox model 2 P-value Hazard Ratio [95% CI] Age 0.540 1.01 [0.97-1.05] Age 0.836 1.00 [0.96-1.05] Sex 0.076 0.60 [0.35-1.05] Sex 0.153 0.66 [0.38-1.17] Max CCA IMT <0.0001 2.62 [1.89-3.65] Plaque area <0.0001 1.01 [1.01-1.02] Cox model 3 P-value Hazard Ratio {95% CI] Cox model 4 P-value Hazard Ratio [95% CI] Age 0.598 0.99 [0.95-1.03] Age 0.537 0.99 [0.95-1.03] Sex 0.118 0.64 [0.37-1.12] Sex 0.164 0.67 [0.38-1.18] Plaque score <0.0001 1.65 [1.41-1.93] Max CCA IMT 0.146 1.39 [0.89-2.17] Plaque area 0.499 1.00 [1.00-1.01] Plaque score 0.002 1.45 [1.14-1.84] Cox model 1 P-value Hazard Ratio [95% CI] Cox model 2 P-value Hazard Ratio [95% CI] Age 0.540 1.01 [0.97-1.05] Age 0.836 1.00 [0.96-1.05] Sex 0.076 0.60 [0.35-1.05] Sex 0.153 0.66 [0.38-1.17] Max CCA IMT <0.0001 2.62 [1.89-3.65] Plaque area <0.0001 1.01 [1.01-1.02] Cox model 3 P-value Hazard Ratio {95% CI] Cox model 4 P-value Hazard Ratio [95% CI] Age 0.598 0.99 [0.95-1.03] Age 0.537 0.99 [0.95-1.03] Sex 0.118 0.64 [0.37-1.12] Sex 0.164 0.67 [0.38-1.18] Plaque score <0.0001 1.65 [1.41-1.93] Max CCA IMT 0.146 1.39 [0.89-2.17] Plaque area 0.499 1.00 [1.00-1.01] Plaque score 0.002 1.45 [1.14-1.84] Open in new tab Cox model 1 P-value Hazard Ratio [95% CI] Cox model 2 P-value Hazard Ratio [95% CI] Age 0.540 1.01 [0.97-1.05] Age 0.836 1.00 [0.96-1.05] Sex 0.076 0.60 [0.35-1.05] Sex 0.153 0.66 [0.38-1.17] Max CCA IMT <0.0001 2.62 [1.89-3.65] Plaque area <0.0001 1.01 [1.01-1.02] Cox model 3 P-value Hazard Ratio {95% CI] Cox model 4 P-value Hazard Ratio [95% CI] Age 0.598 0.99 [0.95-1.03] Age 0.537 0.99 [0.95-1.03] Sex 0.118 0.64 [0.37-1.12] Sex 0.164 0.67 [0.38-1.18] Plaque score <0.0001 1.65 [1.41-1.93] Max CCA IMT 0.146 1.39 [0.89-2.17] Plaque area 0.499 1.00 [1.00-1.01] Plaque score 0.002 1.45 [1.14-1.84] Cox model 1 P-value Hazard Ratio [95% CI] Cox model 2 P-value Hazard Ratio [95% CI] Age 0.540 1.01 [0.97-1.05] Age 0.836 1.00 [0.96-1.05] Sex 0.076 0.60 [0.35-1.05] Sex 0.153 0.66 [0.38-1.17] Max CCA IMT <0.0001 2.62 [1.89-3.65] Plaque area <0.0001 1.01 [1.01-1.02] Cox model 3 P-value Hazard Ratio {95% CI] Cox model 4 P-value Hazard Ratio [95% CI] Age 0.598 0.99 [0.95-1.03] Age 0.537 0.99 [0.95-1.03] Sex 0.118 0.64 [0.37-1.12] Sex 0.164 0.67 [0.38-1.18] Plaque score <0.0001 1.65 [1.41-1.93] Max CCA IMT 0.146 1.39 [0.89-2.17] Plaque area 0.499 1.00 [1.00-1.01] Plaque score 0.002 1.45 [1.14-1.84] Open in new tab P156 Hypertriglyceridemia epidemiology in the Russian population (PROMETHEUS study) YU Karpov1, YU Khomitskaya2 1Russian Cardiology Research and Production Complex, Moscow, Russian Federation 2AstraZeneca company, Medical, Moscow, Russian Federation Topic: Sports cardiology Purpose:The primary goal of the study was to estimate a percentage of patients with hypertriglyceridemia (HTG) in Russia. The secondary objectives were to evaluate a proportion of patients with borderline high (triglycerides (TG) level = 1.7 < 2.3 mmol/L), high (= 2.3-<5.6 mmol/L) and very high (= 5.6 mmol/L) HTG, with severe (= 10.0 mmol/L) HTG, with mixed hyperlipoproteinaemia (Fredrickson Type 2b with elevated levels of TG, total cholesterol and low density lipoprotein cholesterol). Methods:It was cross-sectional study based on INVITRO laboratory database over the period of time from 01.01.2011 till 31.12.2013. The full dataset includes 357 073 patients. A regression analysis model is used to predict TG level change as a result of one unit change in the independent variable while all the predictors are held constant. Descriptive and inference statistic analyses were performed for all variables and for all strata (by age groups, sex, year). Results:A percentage of patients with any HTG, borderline high, high and very high HTG was found to be 29.2 %, 16.2 %, 12.9 % and 0.11 %, accordingly. A percentage of patients with severe HTG consisted of 0.011 % of the population. A proportion of patients with mixed hyperlipoproteinaemia for the full dataset equals 19.19 % (CI 95%: 19.06 – 19.32). Mean age of the whole analysed population was 48.2 years old for males and 51 years - for females. There were 38.4 % males in the full dataset. Males had 1.25 (CI 95% 1.24 - 1.26) times higher risk for HTG than females. The model shows that males have 16.4% higher level of TG than females. Prevalence of HTG increased in males from 21.95 % in 18-29 age group up to 42.80 % in 40-49 age group and then gradually decreased down to 12.00 % in "90 and older" age group. Prevalence of HTG in females started to increase from 10.63 % in 18-29 age and reached its peak in 60-69 age group at 34.42%. Then it gradually decreased down to 15.36 % in "90 and older" age group. The model predicts 0.61 % increase in TG level with each 1 year of life (p<0.0001). There was a consistent increase of HTG prevalence through years 2011-2013 (28.27 %, 28.39 %, and 30.07 % in 2011, 2012, 2013 accordingly (p<0.0001)). The prevalence of severe HTG was 0.0042 %, 0.0066 %, and 0.016 % in 2011-2013 accordingly (p<0.05). Conclusion:Almost a third of Russian population has HTG. There are very few patients with very high and severe HTG. Males has a higher risk for HTG than females. Prevalence of HTG increases with age and reaches its peak in 60-69 age in women and in 40-49 age in men. HTG prevalence was rising through years 2011-2013. P157 Correlates of sport participation in adults with long-standing illness or disability N Heron1, MA Tully1, ME Cupples1, F Kee1 1Queen's University of Belfast, Department of General Practice, Belfast, United Kingdom Purpose/Background:Little is known about why people with long-standing illness/disability are less likely to participate in sport than others. This study aimed to identify, for the first time, sport participation levels and their correlates, among Northern Ireland (NI) adults who report long standing illness/disability. Method:Using the Continuous Household Survey data, pooling years 2007/8 to 2010/11, descriptive statistics were derived for the total sample, those with a long-term illness/disability and those with no long-term health issues. Chi-squared tests were used to compare characteristics of those with a long-term illness/disability and those not reporting any long-term health problems. Uni-variate binary regression analysis for the whole population and those with a long-standing illness/disability, using sport participation as the dependent variable, was performed, variables with a p-value of 0.1 or less being taken into a multi-variate analysis. Results:The sample included 13,683 adults; 3550(26%) reported having long-term illness/disability. Fewer of those with, than without, long-term illness/disability reported sport participation in the previous year (868/3550(24.5%) v 5615/10133(55.6%)). Multi-variate analysis showed that, for those with long-standing illness/disability, being single and less socio-economically deprived correlated positively with sport participation. For both those with long-standing illness/disability and the full sample, sport participation correlated positively with being male, aged <56 years, access to a household car/van, sports club/organisation membership, health being ?128;?fairly good' or ?128;?good' in the previous year, doing paid/unpaid work, and living in an urban location. For the full sample but not those with long-standing illness/disability, sport participation correlated positively with being a non-smoker, with higher educational status and personal internet access. Of note, personal internet access was less for those with, than without, long-term illness/disability(41% v 70%). Conclusions:Focused efforts to promote sport participation for people with long-standing illness/disability may usefully target older females, living rurally, who are married/co-habiting, socio-economically deprived and who report their health as ?128;?not good' in the past year. Approaches should be considered which do not rely on the internet, to which these people may not have ready access. Our findings should inform public health policy and help in developing initiatives to support sport participation and to reduce health inequalities. P158 Olive oil consumption and acute coronary syndrome 10-year (2004-2014) survival: The Greec study of acute Coronary Syndrome. M Kouvari1, V Notara1, D B Panagiotakos1, Y Kogias2, P Stravopodis3, G Papanagnou4, S Zombolos5, Y Mantas6, C Pitsavos7 1Harokopio University, Athens, Greece 2Cardiology Clinic, General Hospital of Karditsa, Karditsa, Greece 3Cardiology Clinic, General Hospital of Zakynthos Island, Zakynthos, Greece 4Cardiology Clinic, General Hospital of Lamia, Lamia, Greece 5Cardiology Clinic, General Hospital of Kalamata, Kalamata, Greece 6Cardiology Clinic, General Hospital of Chalkida, Chalkida, Greece 7Hippokration Hospital, University of Athens, Athens, Greece Topic: Sports cardiology Purpose:Adherence to the Mediterranean diet has been strongly associated with decreased risk of cardiovascular disease (CVD) in the general population; nevertheless, less is known about the influence of olive oil consumption on the prognosis of Acute Coronary Syndrome (ACS) patients. We sought to evaluate whether there is an association between long-term olive oil consumption and CVD outcome of patients who already have suffered from ACS. Methods:From October 2003 to September 2004 a sample of 2.172 ACS consecutive patients from 6 major Greek hospitals was selected. In 2013-14, the 10-year follow-up was performed in 1.918 participants (88% participation rate). Logistic regression models were applied to evaluate the effect of olive oil consumption (as assessed by using a validated semi-quantitative food frequency questionnaire) on the development of CVD. Results:An inverse association was observed between olive oil consumption and CVD incidence, after taking into account various potential confounders, [odds ratio=0,342 (95% confidence interval 0,11, 1,06, p=0,063)]. Moreover, the aforementioned relationship was more prominent among normal and overweight males [0,20 (95% confidence interval 0,03, 1,00, p=0,05)], whereas no significant association was observed among women and obese patients. Conclusion:Olive oil consumption seems to reduce incidence of ACS among cardiac patients. Thus, promotion of olive oil use in daily cooking should be enhanced in order to reduce the burden of CVD events in the population. P159 Spousal concordance for hypertension and related disease MH Lee1, DJ Kim2, HC Kim1 1Yonsei University , College of Medicine, Seoul, Korea, Republic of 2Ajou University School of Medicine, Department of Endocrinology and Metabolism, Suwon, Korea, Republic of Topic: Sports cardiology Purpose:The aim of this study is to estimate the spousal association of hypertension in Korean couples. In addition, we estimated whether people whose spouse has a specific disease are at increased risk of the same disease. Methods:We examined spousal concordance for hypertension in 296 married couples (592 individuals) aged 60 years or older who participated in The Korean Social Life, Health, and Aging Project which is a population-based longitudinal study. Face-to-face interviews and health examinations were performed. Results:There was strong positive spousal concordance of hypertension. Husbands whose wives had hypertension had 2.04 (95% CI: 1.25-3.33) times higher risk having hypertension, compared to those whose wives did not. Wives whose husbands had hypertension were also at 1.82 (95% CI: 1.12-2.98) times higher risk having hypertension. Couples married for over 45 years showed an increased concordant odds ratio (husband: OR=2.85 (95% CI: 1.37-5.93), wife: OR=2.88 (95% CI: 1.37-6.06)), however couples married less than 45 years did not show a statistically significant concordance. Significant spousal concordance of dyslipidemia, ischemic heart disease and depression was also observed. Conclusions:There was significant spousal concordance for hypertension and related diseases in Koreans, which implies shared environmental factors contribute to the development of diseases. *Odds ratio of having disease in one spouse whose partner had same disease, compared those whose partner did not.**Adjusted for age, smoking status, alcohol consumption and stress intensity. Husband Wife OR* (95% CI) OR* (95% CI) Age-adjusted Multivariate** -adjusted Age-adjusted Multivariate** -adjusted Hypertension 1.94 (1.20-3.15) 2.04 (1.25-3.33) 1.85 (1.14-3.01) 1.82 (1.12-2.98) Dyslipidemia 1.63 (1.02-2.59) 1.62 (1.02-2.58) 1.67 (1.05-2.65) 1.64 (1.03-2.62) Ischemic heart disease 3.62 (1.30-10.04) 3.65 (1.28-10.41) 3.43 (1.22-9.62) 4.35 (1.49-12.67) Diabetes 1.69 (0.90-3.18) 1.69 (0.90-3.20) 1.61 (0.86-3.02) 1.59 (0.84-3.01) Depression 4.17 (2.24-7.73) 3.75 (1.98-7.11) 4.39 (2.39-8.07) 5.25 (2.60-10.62) Husband Wife OR* (95% CI) OR* (95% CI) Age-adjusted Multivariate** -adjusted Age-adjusted Multivariate** -adjusted Hypertension 1.94 (1.20-3.15) 2.04 (1.25-3.33) 1.85 (1.14-3.01) 1.82 (1.12-2.98) Dyslipidemia 1.63 (1.02-2.59) 1.62 (1.02-2.58) 1.67 (1.05-2.65) 1.64 (1.03-2.62) Ischemic heart disease 3.62 (1.30-10.04) 3.65 (1.28-10.41) 3.43 (1.22-9.62) 4.35 (1.49-12.67) Diabetes 1.69 (0.90-3.18) 1.69 (0.90-3.20) 1.61 (0.86-3.02) 1.59 (0.84-3.01) Depression 4.17 (2.24-7.73) 3.75 (1.98-7.11) 4.39 (2.39-8.07) 5.25 (2.60-10.62) Open in new tab *Odds ratio of having disease in one spouse whose partner had same disease, compared those whose partner did not.**Adjusted for age, smoking status, alcohol consumption and stress intensity. Husband Wife OR* (95% CI) OR* (95% CI) Age-adjusted Multivariate** -adjusted Age-adjusted Multivariate** -adjusted Hypertension 1.94 (1.20-3.15) 2.04 (1.25-3.33) 1.85 (1.14-3.01) 1.82 (1.12-2.98) Dyslipidemia 1.63 (1.02-2.59) 1.62 (1.02-2.58) 1.67 (1.05-2.65) 1.64 (1.03-2.62) Ischemic heart disease 3.62 (1.30-10.04) 3.65 (1.28-10.41) 3.43 (1.22-9.62) 4.35 (1.49-12.67) Diabetes 1.69 (0.90-3.18) 1.69 (0.90-3.20) 1.61 (0.86-3.02) 1.59 (0.84-3.01) Depression 4.17 (2.24-7.73) 3.75 (1.98-7.11) 4.39 (2.39-8.07) 5.25 (2.60-10.62) Husband Wife OR* (95% CI) OR* (95% CI) Age-adjusted Multivariate** -adjusted Age-adjusted Multivariate** -adjusted Hypertension 1.94 (1.20-3.15) 2.04 (1.25-3.33) 1.85 (1.14-3.01) 1.82 (1.12-2.98) Dyslipidemia 1.63 (1.02-2.59) 1.62 (1.02-2.58) 1.67 (1.05-2.65) 1.64 (1.03-2.62) Ischemic heart disease 3.62 (1.30-10.04) 3.65 (1.28-10.41) 3.43 (1.22-9.62) 4.35 (1.49-12.67) Diabetes 1.69 (0.90-3.18) 1.69 (0.90-3.20) 1.61 (0.86-3.02) 1.59 (0.84-3.01) Depression 4.17 (2.24-7.73) 3.75 (1.98-7.11) 4.39 (2.39-8.07) 5.25 (2.60-10.62) Open in new tab P160 Effect of diabetes on age-specific long-term cardiovascular outcomes following first myocardial infarction: a population-based study L Nedkoff1, M Knuiman1, J Hung2, T Briffa1 1University of Western Australia, Perth, Australia 2Sir Charles Gairdner Hospital, The University of Western Australia, Perth, Australia Topic: Sports cardiology Purpose:Morbidity and mortality risk after myocardial infarction (MI) is higher in patients with diabetes but it is unclear if the long-term relative risk is the same for all age groups across a range of outcomes. We assessed the effect of diabetes on age-specific risk of cardiovascular outcomes in MI patients at a population-level. Methods:All 30-day survivors of first MI occuring between 2003-10, aged 35-84 years, were identified from the state-wide Data Linkage System. Primary outcomes were re-MI, heart failure, stroke, and CVD mortality, with 8.5yrs maximum followup. Cox regression models were used to estimate the independent effect of diabetes for men and women stratified by age group, and were adjusted for diabetes, age, indigenous status, comorbidities and baseline revascularisation. Interactions between diabetes and age group were examined for each endpoint. Results:There were 16,537 incident MI cases (25.2% with diabetes). The multivariate adjusted risk of re-MI was elevated in diabetic men (HR 1.54, 95% CI 1.35, 1.76) and women (HR 1.71, 95% CI 1.41, 2.08) with limited variation in relative risk by age (interaction p=0.07 men, p=0.04 women). The risk for heart failure in men with versus without diabetes was greater in the youngest age group (interaction p<0.0001) as was the risk for stroke (interaction p=0.006) (Table). In women, the risk of heart failure was greater in 35-54 and 55-69 year olds with diabetes (interaction p<0.0001) but there was no significant difference in risk of stroke by age. The effect of diabetes on the risk of CVD mortality varied with age in men and women (interaction p<0.0001 men, p=0.0007 women). Conclusion:There are significant differences in the risk of adverse long-term outcomes after incident MI in diabetic patients by age. The risk of heart failure and CVD mortality is particularly elevated in the younger age groups. These data highlight the need for continued surveillance and long-term secondary prevention efforts particularly in younger people with diabetes. Hazard ratios, 95% confidence intervals. Men Women 35-54 yrs 55-69 yrs 70-84 yrs 35-54 yrs 55-69 yrs 70-84 yrs Heart failure 5.01 (2.88,8.72) 2.66 (1.91,3.70) 1.32 (1.09,1.61) 3.11 (1.38,7.04) 3.25 (1.89,5.59) 1.41 (1.12,1.79) Stroke 4.52 (1.76,11.61) 1.84 (0.95,3.58) 1.23 (0.83,1.83) 5.81 (0.90,37.61) 3.05 (1.24,7.45) 1.49 (0.94,2.35) CVD mortality 1.52 (0.77,3.0) 1.75 (1.20,2.55) 1.12 (0.93,1.36) 4.42 (1.39,14.01) 2.38 (1.24,4.57) 1.42 (1.13,1.78) Men Women 35-54 yrs 55-69 yrs 70-84 yrs 35-54 yrs 55-69 yrs 70-84 yrs Heart failure 5.01 (2.88,8.72) 2.66 (1.91,3.70) 1.32 (1.09,1.61) 3.11 (1.38,7.04) 3.25 (1.89,5.59) 1.41 (1.12,1.79) Stroke 4.52 (1.76,11.61) 1.84 (0.95,3.58) 1.23 (0.83,1.83) 5.81 (0.90,37.61) 3.05 (1.24,7.45) 1.49 (0.94,2.35) CVD mortality 1.52 (0.77,3.0) 1.75 (1.20,2.55) 1.12 (0.93,1.36) 4.42 (1.39,14.01) 2.38 (1.24,4.57) 1.42 (1.13,1.78) Open in new tab Hazard ratios, 95% confidence intervals. Men Women 35-54 yrs 55-69 yrs 70-84 yrs 35-54 yrs 55-69 yrs 70-84 yrs Heart failure 5.01 (2.88,8.72) 2.66 (1.91,3.70) 1.32 (1.09,1.61) 3.11 (1.38,7.04) 3.25 (1.89,5.59) 1.41 (1.12,1.79) Stroke 4.52 (1.76,11.61) 1.84 (0.95,3.58) 1.23 (0.83,1.83) 5.81 (0.90,37.61) 3.05 (1.24,7.45) 1.49 (0.94,2.35) CVD mortality 1.52 (0.77,3.0) 1.75 (1.20,2.55) 1.12 (0.93,1.36) 4.42 (1.39,14.01) 2.38 (1.24,4.57) 1.42 (1.13,1.78) Men Women 35-54 yrs 55-69 yrs 70-84 yrs 35-54 yrs 55-69 yrs 70-84 yrs Heart failure 5.01 (2.88,8.72) 2.66 (1.91,3.70) 1.32 (1.09,1.61) 3.11 (1.38,7.04) 3.25 (1.89,5.59) 1.41 (1.12,1.79) Stroke 4.52 (1.76,11.61) 1.84 (0.95,3.58) 1.23 (0.83,1.83) 5.81 (0.90,37.61) 3.05 (1.24,7.45) 1.49 (0.94,2.35) CVD mortality 1.52 (0.77,3.0) 1.75 (1.20,2.55) 1.12 (0.93,1.36) 4.42 (1.39,14.01) 2.38 (1.24,4.57) 1.42 (1.13,1.78) Open in new tab P161 Time trends of case fatality rates in men and women aged 25-69 years, hospitalized with an acute myocardial infarction: the MONICA register Ghent, 1983-2009. K Van Herck1, S Gevaert2, W Alvarado Hernandez1, L Vandendaele1, P Vannoote1, G De Backer1, D De Bacquer1 1Ghent University, Department of Public Health, Ghent, Belgium 2Ghent University Hospital (UZ), Department of Cardiology, Ghent, Belgium Background:to study age and gender-specific long-term trends in 28-days case fatality rates (CFR) based on a MONICA register in 25-69 years old patients hospitalized with an acute myocardial infarction (AMI), 1983-2009. Methods:Regional and municipality mortality registers and hospital records were screened retrospectively. Records suggestive of an AMI in age- and residence-eligible people were studied and classified using the MONICA methodology and case definition. Record forms consisted of personal characteristics (gender, date of birth and date of onset of the AMI), and medical and diagnostic data (hospital case or managed elsewhere; first or recurrent event; patient survival at 28 days; symptoms, electrocardiograms, serum enzymes and necropsy findings). Results:CFR clearly improved each decade, from 22% in the 1980ies to 15% in the last decade in men, and from 31% to 20% in women. Despite the more important reduction in the CFR in women, CFR in men are still markedly lower. Splitting the data by age group reveals important reductions in CFR have been achieved in both genders and both age groups, even if the slopes of the reduction differ. While the trend by decade gradually decreases in 55-69 year-old men, women aged 55-69 as well as men aged 22-54 showed the most important reduction in the 1990ies, whereas for the 25-54 year old women this was after 2000. The contribution of mortality within the 1st hour has not changed in any of the groups. Conclusions:A clear and important progress in acute cardiovascular care, reducing the CFR in patients hospitalized with an AMI. Nevertheless, important health gains can still be achieved in female patients; AMI in patients aged 55-69 years remained fatal in 1/6 men and 1/5 women in 2000-2009. Open in new tabDownload slide CFR over time, by gender and age P162 Abdominal fat distribution and vascular characteristics in healthy 5 year-old children G W Dalmeijer1, FLJ Visseren2, CK Van Der Ent3, DE Grobbee1, CSPM Uiterwaal1 1University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands 2University Medical Center Utrecht, Department of Vascular Medicine, Utrecht, Netherlands 3University Medical Center Utrecht, Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, Utrecht, Netherlands Topic: Sports cardiology Purpose:It is unknown if fat distribution in childhood already affects the young vascular system. Extending on an earlier preliminary study, we assessed the association between body fat distribution and vascular characteristics in healthy 5-year-old children. Methods:In 863 5-year-olds of the Wheezing-Illnesses-Study-Leidsche-Rijn (WHISTLER ) birth cohort, abdominal fat distribution was measured in mm with sonographic measurements. Carotid intima-media thickness (CIMT) and arterial stiffness were obtained ultrasonographically. Univariable linear regression was performed with vascular characteristics as dependent and measurements of body fat distribution as independent variable. We adjusted for sex, age, birth weight and BMI. Results:Overall mean CIMT was 387.9 µm (SD 41.4) and mean distensibility was 94.9 MPa-1 (SD 27.9). Increased intra-abdominal fat was associated to thicker CIMT (linear regression coefficient 1.04 µm/mm, 95% CI 0.57; 1.51) and lower distensibility (-0.767 MPa-1/mm, 95%CI -1.10; -0.44). Subcutaneous fat was not associated with CIMT (0.72, 95% CI -0.20; 1.64) and distensibility (-0.99 95CI% -2.28; 0.30). Conclusion:More intra-abdominal fat is related to thicker and stiffer arteries already in young healthy childhood. P163 Diagnosing chronotropic incompetence on Exercise Testing: a comparison of three formulae R Gascuena1, N Acosta1, M Molina1, B Terol1, C Rico1 1Hospital Universitario Severo Ochoa, Madrid, Spain Chronotropic Incompetence is an adverse prognostic marker in ischemic cardiopathy and heart failure. Age and treatment with beta-blockers make its diagnosis difficult on Exercise Testing. Different formulae have been published, but its value on routine praxis has not been comparatively studied. Methods:We compare 3 previously published formulae based on a different definition of maximal expected heart rate (A=220-age, B=208-0.7xage,C=164-0.7xage), adjusted by the percentage of heart rate reserve reached on Exercise Test on Treadmill. 190 consecutive patients sent for diagnostic or review assessment of ischemic disease, performed a Bruce Protocol. Mean age was 63.6 a??(15-87), 34.7% female, BMI 28.7 (18-45.3), 48% under betablocker treatment (BB), and achieved a mean of 9.2 METs. Resultados:Chronotropic Incompetence (CI) was diagnosed in 38,42% (40.4% under BB). Variation Coefficient was better for Formulae B (5.7 ?128;°)and C (7.8 ?128;°) fue tan with the classical Formula A (8.6 ?128;°). Adjustment by heart reserve increased diagnosis of CI in a 25.3-35.1% (A), 30.3-32.9% (B) and 7.7-9.1% (C). In patients not taking BB, formula B increases diagnosis of CI in 11%. Until 52.7% of patients under BB are overediagnosed by the classical formula A until a 52.7% of patients, Adjusted formula C allows reclassification (p= 0.003). Patients with CI were older (66.8 vs 61.6 y.o.), heart rate at rest was lower (66.4 vs 72.6 bpm), and obtained a lower functional capacity (8.4 vs 9.7 METs). No difference was observed about treatment other than BB, cardiovascular risk factors, echocardiographic ejection fraction, first degree or bundle branch block, ventricular ectopic beats, or ischemic response. Conclusions:Adjustment by percentage of heart rate reserve increases diagnosis of chronotropic incompetence on exercise test on treadmill. Combining Formula B for patients not taking beta-blocker s, and formula C for those underbeta-blockers, allows a more precise diagnosis than classical formula A. P164 Assymptomatic patients with positive, inconclusive or doubtful exercise test. Can the Duke Treadmill score identify those who are safe not to pursue with the investigation? S Madeira1, A Ferreira1, A Tralhao1, H Marques2, A Damasio3, G Cardoso1, MS Carvalho1, M Santos1, N Cardim2, F Machado2 1Hospital de Santa Cruz, Lisbon, Portugal 2Hospital Luz, Lisbon, Portugal 3Hospital Espirito Santo de Evora, Evora, Portugal IntroductionDespite being controversial, exercise test (ET) is often performed for screening coronary artery disease (CAD) in asymptomatic individuals. The aims of this study were: 1) assess the prevalence of obstructive CAD in asymptomatic individuals with positive, inconclusive or doubtful ET referred for Coronary Computed Tomographic Angiography (CCTA), 2) evaluate the potential usefulness of the Duke Treadmill Score (DTS) in identifying patients who are safe not to pursue with the investigation. Methods:In a prospective registry of 1860 patients who underwent CCTA on the suspicion of CAD between January 2007 to November 2013, there were selected 309 asymptomatic individuals (203 males, median age was 59 IQ [53-63] years) with positive, inconclusive or doubtful ET. The results of CCTA were categorized as "no CAD" (no coronary plaques), "non-obstructive CAD" (plaques with <50% stenosis) or "obstructive CAD" (at least one plaque with = 50% stenosis). The discriminative power of DTS for identifying obstructive DC was evaluated by analyzing the respective ROC curve. Results:The ET was positive in 88% of cases (n = 272), 82%,6% and 0.3% were positive according to electrocardiographic criteria, both clinical and electrocardiographic criteria and exclusively by clinical criteria respectively. The remaining ET were considered doubtful (9%, n = 28) or inconclusive (3%, n = 9). The median DTS was 0.5 IQ [-2.5-3.0], 86% (270), 13% (39) and 1% (3) of the patients were classified as moderate, low and high risk respectively. Of the 309 individuals evaluated, 58 (19%) had significant stenosis, 142 (46%) had non-obstructive CAD, and 109 (35%) showed no CAD. DTS was not significantly different between patients with and without obstructive CAD (median 1.5 vs. 0.5, p = 0.187)-Figure. The discriminative power of the DTS for identifying patients with obstructive DC was not statistically significant, with an area under the ROC curve 0.56 (95% CI: 0.48-0.63, p = 0.190). Conclusion:About one fifth of the asymptomatic individuals with positive, inconclusive or doubtful ET referred for CCTA had obstructive CAD identified by this method. The DTS showed to be insufficient to discriminate patients in whom it is safe not to pursue with further investigation. P169 Aldosterone levels and development of electrophysiological remodelling in hypertensive patients M Krestjyaninov1, RH Gimaev2, VA Razin2 1Ulyanovsk Regional Hospital of War Veterans, Functional diagnostics, Ulyanovsk, Russian Federation 2Ulyanovsk State University, Ulyanovsk, Russian Federation Aldosterone play significant role in development of structural, functional changes and in electrophysiological remodelling of the heart in hypertensive patients. The purpose of our study was to evaluate effect of aldosterone levels on development of electrophysiological remodelling in hypertensive patients. Methods:Were examined 145 patients with hypertension 1-3 grade complicated by HF I-II NYHA functional class. The mean age of patients - 53.6 (6) years. Patients with acute myocardial infarction in history, diabetes mellitus were excluded from the study. In all patients was performed ECG in 12 standard leads, Holter ECG monitoring, EchoCG (ASE/EAE guidelines 2005), were evaluated plasma levels of aldosterone (levels equal to 40-310 ng/L were defined as low; levels >310 ng/L - high). HF NYHA functional class was determined by using the 6MWT. Ventricular extrasystoles types were determined by Lown B. classification. Mean ejection fraction - 65 (6)%. The comparison of frequency of arrhythmias occurrence in patients with different levels of aldosterone was performed by Chi² test. Statistical significance was defined at the level of methods for p<0,05. Results:As it can be seen from table 1. the frequency of occurrence of frequent supraventricular premature beats (SVPB), paired/group SVPB and ventricular extrasystoles 3-4 grade was statistical significant higher in patients with high levels of aldosterone. Conclusion:Thus, results of our study indicates role of high levels (>310 ng/L) of aldosterone in arrhythmias development in hypertensive patients. SVPB - supraventricular premature beats Aldosterone levels Chi² p Arrhythmias types 40-310 ng/L > 310 ng/L n n Total SVPB 111 34 1.66 0.19 - rare SVPB 85 21 0.15 0.7 - frequent SVPB 26 13 4.42 0.03 Paired/Group SVPB 24 13 5.44 0.02 Total ventricular extrasystoles 94 29 1.65 0.19 - rare ventricular extrasystoles 75 19 0.28 0.59 - frequent ventricular extrasystoles 19 10 3.8 0.05 - ventricular extrasystole 3-4 grade 21 13 4.3 0.03 Aldosterone levels Chi² p Arrhythmias types 40-310 ng/L > 310 ng/L n n Total SVPB 111 34 1.66 0.19 - rare SVPB 85 21 0.15 0.7 - frequent SVPB 26 13 4.42 0.03 Paired/Group SVPB 24 13 5.44 0.02 Total ventricular extrasystoles 94 29 1.65 0.19 - rare ventricular extrasystoles 75 19 0.28 0.59 - frequent ventricular extrasystoles 19 10 3.8 0.05 - ventricular extrasystole 3-4 grade 21 13 4.3 0.03 Open in new tab SVPB - supraventricular premature beats Aldosterone levels Chi² p Arrhythmias types 40-310 ng/L > 310 ng/L n n Total SVPB 111 34 1.66 0.19 - rare SVPB 85 21 0.15 0.7 - frequent SVPB 26 13 4.42 0.03 Paired/Group SVPB 24 13 5.44 0.02 Total ventricular extrasystoles 94 29 1.65 0.19 - rare ventricular extrasystoles 75 19 0.28 0.59 - frequent ventricular extrasystoles 19 10 3.8 0.05 - ventricular extrasystole 3-4 grade 21 13 4.3 0.03 Aldosterone levels Chi² p Arrhythmias types 40-310 ng/L > 310 ng/L n n Total SVPB 111 34 1.66 0.19 - rare SVPB 85 21 0.15 0.7 - frequent SVPB 26 13 4.42 0.03 Paired/Group SVPB 24 13 5.44 0.02 Total ventricular extrasystoles 94 29 1.65 0.19 - rare ventricular extrasystoles 75 19 0.28 0.59 - frequent ventricular extrasystoles 19 10 3.8 0.05 - ventricular extrasystole 3-4 grade 21 13 4.3 0.03 Open in new tab P170 Hypertension and lifestyle in three urban units in Praia, Cape-Verde R Simoes1, Z Santos1, D Alves1, M Amado2, I Craveiro1, J Cabral1, L Lapao1, A Delgado3, A Correia4, L Goncalves1 1Institute for Hygiene and Topical Medicine, Lisbon, Portugal 2Faculty of Science and Techonology UNL, Lisbon, Portugal 3Directorate-General of Health - Cape-Verde, Praia, Cape Verde 4National Center for Health Development - Cape-Verde, Praia, Cape Verde Topic: Sports cardiology Purpose:Studies have reported that black race is more vulnerable to the effects of hypertension when compared with caucasian, presenting a higher prevalence, severity and risk of developing hypertension [Peixoto et al. 2014]. The major risk factors for the development of cardiovascular disease described in literature are: poor diet, alcohol consumption, smoking, physical inactivity, overweight and obesity and hypertension [WHO 2014] in addition to socio-economic factors [Timmis et al. 2014]. The aim of this study was to explore the influence of risk factors of cardiovascular disease in self-reported hypertension. Methods:After a detailed analysis of the morphology of Praia, Cape-Verde, there were identified three units with distinct urban planning (Formal, Informal and Transition). A probabilistic sampling method based on geographic coordinates was used to select participants (n=1912). A questionnaire was applied through an interview that addressed, among other aspects, habits and lifestyles. Statistical analysis included descriptive statistics, nonparametric tests and simple and multiple binary logistic regression models for seeking hypertension determinants. Results:Analyzing differences by urban unit, there was a lower level of education (p<0,001) and a higher level of unemployment in the Informal area (p<0,001). The proportion of subjects who self-reported suffering from hypertension was 15.7% (CI: 14.1%-17.4%). With regard to habits and lifestyles, the practice of physical activity was reported by 73.7% of participants, higher in the Transition area (p=0,008). The majority (89.1%) of participants referred never smoking and 56.3% reported alcohol consumption. The frequency of consumption of foods preserved in salt (daily, weekly or monthly basis) was referred by about 25%, with a higher percentage in the Informal area (33.5%). Based on self-reported BMI, the proportion of individuals with overweight and obesity was 29.2% and 10.3%, respectively. In accordance with the simple binary logistic regression models, the self-reported hypertension seems to be associated with the urban unit, sex, age, educational level, self-reported BMI, physical inactivity and alcohol consumption. After the adjustment, the multiple model revealed that the level of education and physical inactivity were not significant. Conclusions:The inhabitants of the Informal and Transition urban units present an increased risk of developing hypertension, independently of age and other cardiovascular diseases risk factors. Overweight and obesity in Praia reaches worrying levels and is transversal in the three urban units. P171 Relation of nocturnal blood pressure and the presence and severity of hypertensive retinopathy T Duarte1, S Goncalves1, R Brito2, R Rodrigues1, C Sa1, A Fernandes1, A Guerreiro1, I Silvestre1, L Bernardino1, L Soares1 1Servi?de Cardiologia, Setubal, Portugal 2Hospital Center of Setubal, Servi?de Oftalmologia, Setubal, Portugal Introduction:Nocturnal high pressure and non-dipping of Blood pressure (BP) during sleep (either attenuated dippers or risers) have been associated with a worse cardiovascular prognosis.Although hypertensive retinopathy (HR) is a common target organ damage, its relation with nocturnal BP pattern and values is not yet fully established. Aim:To evaluate the association between the prevalence and severity of HR and nocturnal systolic and diastolic BP and non-dipping patterns. Methods:We prospectively studied hypertensive patients (pts) submitted to a 24-h-ambulatory BP monitoring (ABPM). Presence and severity of HR was evaluated using Scheie Classification. Total population was divided in 2 groups according to the presence or absence of lesions and compared according to basal characteristics, BP control (mean 24h systolic BP < 125mmHg and diastolic BP < 80mmHg), sleep BP pattern and mean nocturnal systolic and diastolic BP values. Four sleep BP patterns have been defined: dippers (> 10% BP fall during sleep), non-dippers (< 10% fall), inverted dippers/ risers (< 0% fall) and extreme dippers (> 20% fall). Results:Forty-six pts (46% male, aged 63±12 years) were analysed and 91%(n=42) of them were under hypertensive treatment. Seventy percent of pts (n=33) had uncontrolled BP measurements. HR was diagnosed in 83% pts (n=38). Pts with HR were older (65 ± 9 vs 53±18 years, p=0,014), had a longer hypertension duration (18 ±12 vs 6 ±5 years, p=0,027) and a higher mean systolic nocturnal BP (151±23 vs 130±13 mmHg, p=0,008). Pts with increased HR severity (Scheie stage =2) had higher nocturnal BP values (153 ±25 vs 140 ± 16mmHg, p=0,04). Higher diurnal systolic BP were associated with the presence of HR but no difference was seen regarding severity. There was no statistical significant difference between the presence of HR and nocturnal BP sleep pattern or BP control. Conclusions:In this population HR was a common target organ lesion and its prevalence and severity was associated with a higher systolic nocturnal BP. No relation was observed between nocturnal sleep BP pattern and the presence of RH but a larger population is necessary to confirm these results. P172 Blood pressure telemonitoring effectiveness in patients with uncontrolled hypertension, impact of anxiety and depression. MV Ionov1, IS Iudina1, NG Avdonina1, IV Emelyanov1, NE Zvartau1, DI Kurapeev1, AO Konradi1 1Federal Almazov Medical Research Centre, Cardiology Department, Saint-Petersburg, Russian Federation Objective:To estimate the efficacy of home blood pressure (BP) telemonitoring in patients with uncontrolled hypertension (UCHT) from specialized hypertension excellence center. Methods:We invited 43 ambulant patients with prior diagnosis of UCHT (without goal BP level achievement after 3 months of usual care with rational dual antihypertensive therapy, which was confirmed by 24hours BP monitoring ) to assign into this pilot study. All patients signed the informed consents and filled in HADS scale. 37 patients were included: 27 (73%) males, 10 (27%) females 47±6 years old. 5 (13,5%) participants (4 females, 1 male) were excluded from data analysis during 3 month follow-up period due to non-adherence to BP telemonitoring protocol. BP level changes were evaluated by office BP measurements at 2,4, 8,12 week visits. Mean home BP measurements by subjects themselves was 14 per week. Results:Mean office BP level (152±5 /93±3 mmHg) reduced to 138±7 /87±5 mmHg (p<0,05) after 3 months. Treatment regimen correction was required in 5 (15,6%) patients due to insufficient BP index. In 27 cases (84,4%) target BP was achieved. Furthermore, 4 (14,8%) subjects achieved BP targets at first 4 weeks, 13 (48,15%) - after 8 weeks and 10 (37%) patients achieved target BP by the end of study. Despite of triple full-dose antihypertensive therapy 2 (6,25%) participants remain truly resistant. Systolic BP degree reduction was associated with male gender (OR= 1,6, p<0,05) and age (r=-0,37, p<0,05). The adherence to BP telemonitoring was associated with high level of HADS score. Increased level of anxiety was detected in 19 (59,4%) compliant patents (= 8 points HADS) and depression in 8 (25%) (= 8 points HADS). Conclusion:Home BP telemonitoring is an effective method for clinical improvement in patients with UCHT. This method is can be even more effective in males, in younger age and in the presence of anxiety and depression. P173 Automated office BP, same results seen in normal waiting room. E Mcintyre1, D Armstrong1, U Jurt1, D Brouillard1, M Matangi1, M Myers2 1Kingston Heart Clinic, Kingston, Canada 2Sunnybrook Health Sciences Centre, Toronto, Canada Background:Measurement of office BP using fully automated systems which take multiple readings with the patient resting quietly alone has been called automated office BP (AOBP). Most AOBP research has involved the patient resting alone in an examining room which is impractical in a clinical setting. The possibility that valid AOBP can be obtained with the patient resting quielty in a normal waiting room was examined. Methods:422 consecutive patients undergoing 24hr ABPM monitoring also underwent BpTRU measurements on returning the monitor. The BpTRU recordings were performed with the patient resting quietly in a common waiting room. The relationship between AOBP and the awake ambulatory BP (AABP) was examined including the use of Bland-Altman plots and estimates of sensitivity, specificity and accuracy. Results:In the 422 patients the mean systolic AABP was similar to the AOSBP (139.4 ± 13.4 vs 140.4 ± 19,8mmHg, P=NS), with both values being significantly lower than a single routine office systolic BP (155.1 ± 18.7, P<0.0001). The sensitivity, specificity accuracy and Bland-Altman plots are seen below. Conclusions:AOBP recordings in a waiting room arre comparable to AABP making it possible to obtain AOBP in clinical practice without the need to occupy an examining room. Open in new tabDownload slide Diastolic BP values are in parentheses. Awake SBP=135(DBP=85) Awake SBP<135(DBP<85) AOSBP=135(DBP=85) 200(119) 43(65) 243(184) PPV=82.3%(64.3%) AOSBP<135(DBP<85) 73(40) 106(198) 179(238) NPV=59.2%(83.2%) Sensitivity=73.3%(74.8%) Specificity=69.7%(75.3%) 422(422) Accuracy=72.5%(75.1%) Awake SBP=135(DBP=85) Awake SBP<135(DBP<85) AOSBP=135(DBP=85) 200(119) 43(65) 243(184) PPV=82.3%(64.3%) AOSBP<135(DBP<85) 73(40) 106(198) 179(238) NPV=59.2%(83.2%) Sensitivity=73.3%(74.8%) Specificity=69.7%(75.3%) 422(422) Accuracy=72.5%(75.1%) Open in new tab Diastolic BP values are in parentheses. Awake SBP=135(DBP=85) Awake SBP<135(DBP<85) AOSBP=135(DBP=85) 200(119) 43(65) 243(184) PPV=82.3%(64.3%) AOSBP<135(DBP<85) 73(40) 106(198) 179(238) NPV=59.2%(83.2%) Sensitivity=73.3%(74.8%) Specificity=69.7%(75.3%) 422(422) Accuracy=72.5%(75.1%) Awake SBP=135(DBP=85) Awake SBP<135(DBP<85) AOSBP=135(DBP=85) 200(119) 43(65) 243(184) PPV=82.3%(64.3%) AOSBP<135(DBP<85) 73(40) 106(198) 179(238) NPV=59.2%(83.2%) Sensitivity=73.3%(74.8%) Specificity=69.7%(75.3%) 422(422) Accuracy=72.5%(75.1%) Open in new tab P174 The prevalence of and risk factors for masked effect in the controlled hypertensive population. E Mcintyre1, D Brouillard1, U Jurt1, M Matangi1 1Kingston Heart Clinic, Kingston, Canada Background:Masked effect (ME) is defined as present when a patient (P) has a normal office BP (OBP) <140/90 and an abnormal average daytime (ADT) 24hr ABPM (=135/85) in the presence of antihypertensive therapy (AHT). ME is important as it indicates a P with uncontrolled BP. Our purpose was to determine the prevalence of ME and the risk factors predisposing to ME. Methods:We selected P with a normal OBP who were taking AHT. We defined ADT ABPM as 7am to 10pm. Group 1, P whose ADT ABPM was either =135/85, or =135 and <85 or <135 and =85 (ME) and group 2, P whose ADT ABPM was <135/85 (normotensive). Only the first ABPM was used. Chi-squared analysis and unpaired t-test were used where appropriate. A p value of <0.05 was considered significant. Results:1,711 P were treated and normotensive and 309 P exhibited ME, prevalence 15.3%. When compared to the normotensive group, P with ME were of similar age, 62.5 ± 13.2 vs 61.8 ± 12.9 years (P=0.3818), but had higher ADT SBP, 137.9 ± 6.5 vs 121.1 ± 8.0mmHg (p<0.0001), higher ADT DBP, 78.1 ± 9.2 vs 70.5 ± 7.4mmHg (p<0.0001), higher OSBP, 133.4 ± 5.7 vs 129.0 ± 8.2mmHg (p<0.0001) and higher ODBP, 76.8 ± 9.6 vs 75.2 ± 8.6mmHg (p<0.005). Systolic ME was present in 208 P (67.3%), systolic and diastolic ME was present in 43 P (13.9%) and diastolic ME was present in 58 P (18.8%), Chi-squared p<0.0001. For analyses of various risk factors see Table 1. Conclusions:ME occurs in 1 of every 7 treated P seen with a normal OBP. ME is more common in males, relative risk 1.15 (95% CI, 1.03-1.28). There was no significant difference in the age between P with ME or the controlled hypertensive. P with ME have normal but significantly higher OSBP and ODBP compared to controlled hypertensives. Systolic ME is much more common in the hypertensive population likely related to their advanced age. Either home BP monitoring or periodic 24hr ABPM should be used to monitor hypertension. No other variables tested were significantly different between ME or controlled hypertensives. N M/F Obesity Smoking Diabetes Sleep apnea Alcohol excess NSAIDs Normal. 1711 790/921 868/843 163/1548 355/1356 179/1532 62/1649 117/1594 Masked 309 164/145 173/136 28/281 78/231 36/273 17/292 19/290 P value <0.05* NS NS NS NS NS NS The relative risk of masked effect for males is 1.15 compared to females (95% CI, 1.03-1.28) N M/F Obesity Smoking Diabetes Sleep apnea Alcohol excess NSAIDs Normal. 1711 790/921 868/843 163/1548 355/1356 179/1532 62/1649 117/1594 Masked 309 164/145 173/136 28/281 78/231 36/273 17/292 19/290 P value <0.05* NS NS NS NS NS NS The relative risk of masked effect for males is 1.15 compared to females (95% CI, 1.03-1.28) Open in new tab N M/F Obesity Smoking Diabetes Sleep apnea Alcohol excess NSAIDs Normal. 1711 790/921 868/843 163/1548 355/1356 179/1532 62/1649 117/1594 Masked 309 164/145 173/136 28/281 78/231 36/273 17/292 19/290 P value <0.05* NS NS NS NS NS NS The relative risk of masked effect for males is 1.15 compared to females (95% CI, 1.03-1.28) N M/F Obesity Smoking Diabetes Sleep apnea Alcohol excess NSAIDs Normal. 1711 790/921 868/843 163/1548 355/1356 179/1532 62/1649 117/1594 Masked 309 164/145 173/136 28/281 78/231 36/273 17/292 19/290 P value <0.05* NS NS NS NS NS NS The relative risk of masked effect for males is 1.15 compared to females (95% CI, 1.03-1.28) Open in new tab P176 Familiar hipercholesterolemia in patients with acute coronary syndrome: an underdiagnose genetic disease T Duarte1, S Goncalves1, R Rodrigues1, C Sa1, L Rassi1, F Seixo1, Q Rato1, L Soares1 1Servi?de Cardiologia, Setubal, Portugal Introduction:Familiar Hypercholesterolemia (FH) is a genetic autossomic disorder caused, in the majority of patients (pts), by total or partial absence of low density lipoprotein receptors (LDRD) and associated with premature cardiovascular (CV) disease. In Portugal, according to OMS, 20 000 individuals may be affected but only a minority of them is identified. Aim:To determine the prevalence of "possible" HF diagnosis in a population of pts with Acute Coronary Syndrome (ACS). Methods:We performed a retrospective analysis of 619 consecutive pts admitted to a coronary care unit with ACS. Pts were divided in 2 groups regarding the presence or absence of "possible HF" using the adapted Simon-Broome criteria recommended for Portuguese population (Total cholesterol > 290mg/dl or LDL>190mg/dl and family history of premature cardiovascular disease). Groups were compared according to their clinical characteristics, type of ACS, severity of coronary heart disease and in-hospital adverse clinical events (re-infarction, heart failure and in-hospital death). Results:Two percent of the pts fullfilled the "possible" FH criteria (n=13). Mean total colesterol was com 293 ± 46,3 mg/dl and mean LDL level was 221 ± 40 mg/dl. Possible FH pts were yonger (59 ± 12 vs 67± 13 years, p= 0,032). Three pts (23%) had 3-vessel disease and two (15,4%) had left main artery significant lesions but no statistical significant difference was found when compared to the remaining population. The incidence of in-hospital clinical events was similar in both groups. Conclusions:Heterozygous FH is a common but underdiagnosed disease, associated with premature CV events. In this population higher cholesterol levels were associated with a younger age of presentation. A larger population would be necessary in order to determine differences in outcomes or in coronary artery disease severity. Definite diagnose in these pts requires genetic confirmation. The correct identification of the affected pts and their relatives allows the institution of aggressive preventive measures. P177 Early diagnosis of familial hypercholesterolemia as a preventive measure for coronary heart disease in relatives of already diagnosed patients J Nuche Berenguer1, R Dalmau Gonzalez-Gallarza2, Z Blazquez Bermejo2, A Castro Conde2 1University Hospital 12 de Octubre, Cardiology, Madrid, Spain 2University Hospital La Paz, Madrid, Spain Topic: Sports cardiology Purpose:Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder that affects the LDL receptor gene. FH affects 1 in 400 people and is the most common monogenic disorder associated with the early onset of cardiovascular disease. It has been shown that 50% of men and 20% of women with heterozygous FH not receiving adequate treatment suffer a coronary event in their early 50s. Because treatment with statins has shown to reduce mortality in FH patients, we propose that diagnosis of the disease at an early stage followed by immediately initiation of appropriate treatment will help to prevent the development of ischemic heart disease. Methods:Control of cardiovascular risk factors was performed in 976 patients referred to the Cardiac Rehabilitation Unit of a tertiary hospital. Patients with premature cardiovascular disease and those who despite treatment with statins, had elevated LDL cholesterol values (>190 mg./dl.), were established as suspected FH. Suspected FH patients underwent genetic testing for FH that, when positive, was also performed in first-degree relatives. In relatives with positive FH testing and with high cholesterol levels, treatment with high potency statins was initiated. Those relatives with positive FH testing but with normal cholesterol levels were referred to their Primary Care Physician for surveillance. Results:Of all the patients, 28% had early heart disease, 22.9% were diabetic, 50.4% were hypertensive, 59.4% had hypercholesterolemia, 80.5% were current or former smokers and 26% were obese. 33 patients (3.38%; 11 women and 22 men) met the criteria for screening of FH. Of these patients, 2 did not undergo genetic testing; 26 tested negative; and 5 tested positive. Of the 5 patients who tested positive, 4 had developed early heart disease (mean age 46.6 years). 16 first-degree relatives underwent genetic testing. None of them had developed ischemic heart disease. 7 of them (43.8%) had a positive result. 2 of them (28.6%) had elevated cholesterol levels at diagnosis and statin treatment was started as primary prevention; 5 of them (71.4%) had normal cholesterol levels and were referred to their primary care physician for surveillance. Conclusions:Identification of FH in patients with premature coronary arterial disease and/or in patients unable to control LDL with conventional high-dose therapy is of extreme importance. The diagnosis of FH in these patients, and the screening of their first-degree relatives facilitate the initiation of aggressive treatment for hypercholesterolemia as a primary prevention measure for ischemic heart disease. P178 Asymtptomatic carotid plaques in RA patients is associated with increased HDL function S Rollefstad1, B Halvorsen2, T Skarpengland2, T Torresdatter2, I Gregersen2, S Provan1, A G Semb1 1Diakonhjemmet Hospital, Oslo, Norway 2Oslo University Hospital, Research Institute of Internal Medicine, Oslo, Norway Topic: Sports cardiology Purpose:Reverse cholesterol transport (RCT) is an anti-atherogenic function of high density lipoprotein cholesterol (HDL-c) and has been shown to be related to disease activity in patients with rheumatoid arthritis (RA). We evaluated if atherosclerosis affects the HDL-c function differently in RA patients compared to healthy controls. Methods:RA patients from the Oslo RA and EUIDISS registers and healthy controls without CVD, not using statins or biologic medication were included. RCT was measured as plasma induced 14C-cholesterol efflux from 14C-cholesterol loaded human THP1 macrophages as previously described. Apolipoprotein A1 (ApoA1) and paraoxgenase-1 (PON-1) activity was measured in serum. Results:20 RA patients with (n=10) and without (n=10) carotid plaques (CP), and 10 controls were age and gender matched. Traditional and un-traditional CVD risk factors/biomarkers as CRP, ESR and proBNP were also comparable across the 3 groups. None had diabetes. RA disease factors were comparable between RA patients with and without CP. Efflux capacity was significantly increased in RA patients with CP compared both to controls without CP (p=0.03) and controls with CP (p=0.01)(Fig). Likewise, both ApoA1 and PON-1 activity was increased in RA patients with CP compared to controls (p=0.02 and p=0.05, respectively). Further, APOA1 and PON-1 were comparable between RA patients without CP and controls (p=0.58 and p=0.69, respectively). Conclusions:The cholesterol efflux capacity was increased in RA patients with atherosclerosis compared to controls, independent of HDL-c level and CRP. Our findings indicate an association between atherosclerosis and upgraded HDL-c function in RA patients with when disease activity is low, possibly as a compensatory mechanism to the atherosclerotic process. Open in new tabDownload slide Figure P179 Investigation of metabolic and inflammatory parameters in obese patients with left ventricular diastolic dysfunction. OM Drapkina1, A Kaburova1 1I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Topic: Sports cardiology Purpose:Increased body fat is considered as an important source of low-grade systemic inflammation and accompanied by regional fat deposition, glucose metabolism disturbance and left ventricular diastolic dysfunction (LVDD). Epicardial fat (EF) is a particular form of visceral fat with paracrine or mechanical effects on myocardial function, which provokes LV fibrosis and hypertrophy – hallmarks of LVDD. The objective of this study was to examine the association of body mass index (BMI), EF, high-sensitivity C-reactive protein (hs-CRP) and C-peptide levels with myocardial structure in patients with LVDD. Methods:This retrospective study included sixty-five (mean age 62,2±9,4 years) obese patients (mean BMI value 33,25±6,53kg/m2) with echocardiographically confirmed LVDD. M-mode measurements of LV structure were taken: interventricular septum (IVS), LV end diastolic posterior wall thickness (LVPWd), LA diameter, LA major axis, LA minor axis, LV mass. EF thickness was determined by 2-dimensional echocardiography. The levels of hs-CRP and C-peptide were obtained. Results:The mean ± standart deviation value of EF was 1.19±0.22 cm, IVS 1,31±0,15 cm, LVPWd 1,21±0,12 cm, LA diameter 4,2±0,33 cm, LA major axis 5,48±0,52 cm, LA minor axis 4,49±0,37 cm, LV mass 189,78±32 g. Mean values of hs-CRP and C-peptide were 5,79±7,17 mg/l and 3,72±1,78 ng/ml respectively. The results of correlation analysis are presented in the table, all with p<0,05. All results with p<0,05 BMI EF IVS LVPWd LA diameter LA major axis LA minor axis LV mass BMI - 0,69 0,32 0,41 0,49 0,31 0,40 0,43 EF 0,69 - 0,45 0,38 0,55 0,29 0,49 0,48 hs-CRP 0,26 - - 0,33 - - - - ?-peptide 0,48 0,35 - 0,37 0,40 - 0,48 - BMI EF IVS LVPWd LA diameter LA major axis LA minor axis LV mass BMI - 0,69 0,32 0,41 0,49 0,31 0,40 0,43 EF 0,69 - 0,45 0,38 0,55 0,29 0,49 0,48 hs-CRP 0,26 - - 0,33 - - - - ?-peptide 0,48 0,35 - 0,37 0,40 - 0,48 - Open in new tab All results with p<0,05 BMI EF IVS LVPWd LA diameter LA major axis LA minor axis LV mass BMI - 0,69 0,32 0,41 0,49 0,31 0,40 0,43 EF 0,69 - 0,45 0,38 0,55 0,29 0,49 0,48 hs-CRP 0,26 - - 0,33 - - - - ?-peptide 0,48 0,35 - 0,37 0,40 - 0,48 - BMI EF IVS LVPWd LA diameter LA major axis LA minor axis LV mass BMI - 0,69 0,32 0,41 0,49 0,31 0,40 0,43 EF 0,69 - 0,45 0,38 0,55 0,29 0,49 0,48 hs-CRP 0,26 - - 0,33 - - - - ?-peptide 0,48 0,35 - 0,37 0,40 - 0,48 - Open in new tab P182 Evaluation of the parameters of the Euro QoL- 5D questionnaire among patients with ischemic heart disease with normal and elevated BMI. C James1, S Ohri1, S Tisheva1, S Jose2, D Mary Sabu1 1Medical University Pleven, Pleven, Bulgaria 2MOSC Medical College, Kolenchery, India Objective:The epidemic of obesity and obesity related morbidities is an important public health challenge, and is paralleled by growing incidence of metabolic syndrome which acts as a strong and significant risk factor for Ischemic heart disease and other atherosclerotic vascular events. The psychological impact of these chronic conditions can be very disturbing. In practical terms the functional effect of an illness and its therapy upon a patient, as perceived by the patient – could be estimated by introducing the quantitative approach of – Health Related Quality of Life (HRQoL). Aim:The aim of this study is to evaluate the impact of obesity on quality of life of patients with ischemic heart disease. Design and method:Questionnaire based cross sectional study was conducted among patients with established Coronary Artery Disease admitted in the Department of Cardiology in the University Hospital. 520 patients who were admitted in the Cardiology Department between 1st of January 2012 and 30th June 2014 with acute coronary syndrome or coronary angiographic or Electrocardiography evidence of ischemic heart disease were included in the study, stratified by age, sex and BMI ( normal weight 18.5 – 24.9, overweight 25 – 29.9, obese 30 and above). EuroQol – 5D (EQ-5D) was administered in the patients during their hospital stay. EQ-5D comprises 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The height, weight and basic laboratory parameters were recorded. Results:Mean age of the participants was 65.1± 10.6 years. Male female ratio was 0.76. The distribution of patients in BMI groups was 36.8%/ 24.4%/ 38.8%. Statistically significant differences between BMI groups were seen in Usual activity (p=0.005) and self-care (p=0.044) dimensions of EQ-5D-5L with poorest outcome in the obese. We have found significantly positive correlation between BMI and usual activities (R=0.234, p=0.001) and between age and anxiety (R= 0.366 p=0.045). Mean BMI of patients with extreme problems with extreme problems with usual activities is significantly greater than those with lower intensity of problems. Patients with extreme anxiety tend to have higher mean age. Conclusion:Our study revealed that Ischemic heart disease patients with obesity had impaired QoL in terms of health, mobility, usual activity, discomfort and anxiety. Hence non-obese ischemic heart disease patients had a better sense of overall wellbeing. P184 Exercise gas exchange phenotypes in a population at risk according to levels of oxygen consumption at peak exercise: findings from the EURO(pean) EX(ercise) population-based study M Pellegrino1, G Generati1, F Bandera1, V Labate1, V Donghi1, E Alfonzetti1, M Gaeta2, O Ferraro2, S Villani2, M Guazzi1 1IRCCS Policlinico San Donato, Heart Failure Unit, San Donato M.se, Italy 2University of Pavia, Unit of Biostatistics and Clinical Epidemiology, Pavia, Italy Background:Cardiopulmonary exercise testing (CPET)-derived variables have a well-established prognostic role in heart failure patients. Exercise tolerance has a strong prognostic role also in healthy populations. There is lack of functional characterization in literature addressing the functional differences in a population at cardiovascular (CV) risk and normal left ventricular (LV) ejection fraction according to different levels of VO2. A functional characterization focused on exercise tolerance may help to define CV risk profile. Methods:557 healthy subjects (age 60±14 years; male 49%) underwent a maximal CPET (personalized ramp protocol). A subgroup (n=205) also underwent rest echocardiography. Results:The population was divided into 3 groups according to % of predicted VO2. From group A to C prevalence of male sex (A: n=16 27%; B: n=134 40%; C: n=124 76%), age, high physical activity (PA) (A 6%; B 19%; C 35%), peak VO2 and VO2 at anaerobic threshold (@AT) progressively increased; while prevalence of diabetes (A: n=14 24%; B n=50 15%; C: n=26 16%) hypertension (A: n=47 78%; B n=224 67%; C: n=104 64%)and low PA(A 47%; B 35%; C 24%) decreased. Group C had higher peak O2 pulse, workload and lower rest HR; greater LV, RV and right atrium and LV stoke volume. Conclusions:In a population at risk, higher exercise tolerance was associated with lower prevalence of CV risk factors and of low PA, older age, higher prevalence of male gender and more favourable behavior of VO2-realted variables. Group A (n=60) <50% predicted VO2 Group B (n=334) 50-79% predicted VO2 Group C (n=163) >79% predicted VO2 P value A vs B P value B vs C Age, y 55±14 60±13 63±15 0.01 0.01 BMI, kg/mq 33±7 29±5 26±4 <0.01 <0.01 Peak VO2, ml/min/kg 12.7±3.2 17.5±4.3 24.9±8.6 <0.01 <0.01 VO2 @ AT, ml/min/kg 10.9±3 13.2±3 18.6±6.7 <0.01 <0. 01 Peak O2 pulse 9.7±3.9 10.1±3.1 13.3±3.7 Ns <0.01 Rest HR, bpm 81±15 81±16 78±15 Ns 0.01 Peak workload, Watt 110±43 115±48 129±51 Ns <0.01 LV EDV index, ml/mq 41.2±9.8 42.8±10.1 47.2±12.2 Ns <0.05 Stroke volume, ml 51±14 51±14 57±15 Ns 0.01 Right atrial area, cmq 15.4±3.3 15.9±3.7 18.1±3.8 Ns <0.01 RV end-diastolic area, cmq 13.7±2.9 14.9±5 16.5±3.7 Ns <0.05 Group A (n=60) <50% predicted VO2 Group B (n=334) 50-79% predicted VO2 Group C (n=163) >79% predicted VO2 P value A vs B P value B vs C Age, y 55±14 60±13 63±15 0.01 0.01 BMI, kg/mq 33±7 29±5 26±4 <0.01 <0.01 Peak VO2, ml/min/kg 12.7±3.2 17.5±4.3 24.9±8.6 <0.01 <0.01 VO2 @ AT, ml/min/kg 10.9±3 13.2±3 18.6±6.7 <0.01 <0. 01 Peak O2 pulse 9.7±3.9 10.1±3.1 13.3±3.7 Ns <0.01 Rest HR, bpm 81±15 81±16 78±15 Ns 0.01 Peak workload, Watt 110±43 115±48 129±51 Ns <0.01 LV EDV index, ml/mq 41.2±9.8 42.8±10.1 47.2±12.2 Ns <0.05 Stroke volume, ml 51±14 51±14 57±15 Ns 0.01 Right atrial area, cmq 15.4±3.3 15.9±3.7 18.1±3.8 Ns <0.01 RV end-diastolic area, cmq 13.7±2.9 14.9±5 16.5±3.7 Ns <0.05 Open in new tab Group A (n=60) <50% predicted VO2 Group B (n=334) 50-79% predicted VO2 Group C (n=163) >79% predicted VO2 P value A vs B P value B vs C Age, y 55±14 60±13 63±15 0.01 0.01 BMI, kg/mq 33±7 29±5 26±4 <0.01 <0.01 Peak VO2, ml/min/kg 12.7±3.2 17.5±4.3 24.9±8.6 <0.01 <0.01 VO2 @ AT, ml/min/kg 10.9±3 13.2±3 18.6±6.7 <0.01 <0. 01 Peak O2 pulse 9.7±3.9 10.1±3.1 13.3±3.7 Ns <0.01 Rest HR, bpm 81±15 81±16 78±15 Ns 0.01 Peak workload, Watt 110±43 115±48 129±51 Ns <0.01 LV EDV index, ml/mq 41.2±9.8 42.8±10.1 47.2±12.2 Ns <0.05 Stroke volume, ml 51±14 51±14 57±15 Ns 0.01 Right atrial area, cmq 15.4±3.3 15.9±3.7 18.1±3.8 Ns <0.01 RV end-diastolic area, cmq 13.7±2.9 14.9±5 16.5±3.7 Ns <0.05 Group A (n=60) <50% predicted VO2 Group B (n=334) 50-79% predicted VO2 Group C (n=163) >79% predicted VO2 P value A vs B P value B vs C Age, y 55±14 60±13 63±15 0.01 0.01 BMI, kg/mq 33±7 29±5 26±4 <0.01 <0.01 Peak VO2, ml/min/kg 12.7±3.2 17.5±4.3 24.9±8.6 <0.01 <0.01 VO2 @ AT, ml/min/kg 10.9±3 13.2±3 18.6±6.7 <0.01 <0. 01 Peak O2 pulse 9.7±3.9 10.1±3.1 13.3±3.7 Ns <0.01 Rest HR, bpm 81±15 81±16 78±15 Ns 0.01 Peak workload, Watt 110±43 115±48 129±51 Ns <0.01 LV EDV index, ml/mq 41.2±9.8 42.8±10.1 47.2±12.2 Ns <0.05 Stroke volume, ml 51±14 51±14 57±15 Ns 0.01 Right atrial area, cmq 15.4±3.3 15.9±3.7 18.1±3.8 Ns <0.01 RV end-diastolic area, cmq 13.7±2.9 14.9±5 16.5±3.7 Ns <0.05 Open in new tab P185 Exploring the physical activity levels and sedentary behaviour of employees within a workplace environment E Mcintyre1, M Newell2, G Flaherty2 1Galway University Hospital, Galway, Ireland 2National University of Ireland, School of Medicine, Galway, Ireland Topic: Sports cardiology Purpose:Key modifiable risk factors for cardiovascular disease (CVD) include physical inactivity and sedentary behaviour (SB). Considering that adults spend sixty percent of their waking hours at work, the workplace environment represents a significant domain where short bouts of physical activity (PA) can be accrued and counted towards the recommended guidelines, reducing CVD risk. The aim of this research is to compare and contrast the PA levels and SB of employees within a workplace environment. Methods:An observational cross-sectional study was chosen. PA and SB patterns of 83 employees across 6 occupational groups within a hospital workplace were measured using a mixed methodology analysis during a typical working week. Pedometers objectively measured steps per day, and the International Physical Activity Questionnaire (IPAQ-SF) indirectly measured energy expenditure (EE). Results:Based on IPAQ-SF data 50% of employees reached current national PA guidelines during working hours and were sufficiently active to reduce CVD risk. However, according to pedometer-based data only 6% achieved PA recommendations and of concern 30% were sedentary. Employees took a median of 6205 steps/day. Steps/day varied significantly between occupation (p=<0.015) as did EE (p=<0.012). Approximately 64% of employees were aware of national PA guidelines Conclusions:Current PA levels, among certain occupational groups, in this workplace environment are not sufficiently adequate to reduce CVD risk and patterns of SB are high. Implications of this study include steering local hospital health promotion policies towards PA initiatives which support cardiovascular health, including reducing SB among employees. Promoting the concept that short bouts of PA can be accrued during working hours rather than considered solely a leisure time activity, seems a realistic approach to reducing CVD risk. P186 Six-Minute-Run distance and age are independent predictors for quality of life in children and adolescents J Elmenhorst1, J Mueller1, T Giegerich1, R Oberhoffer1 1Technische Universit? Institute of Preventive Pediatrics, M?, Germany Objective:Health-related quality of life (HrQoL) is a broad multidimensional concept that usually includes self-reported measures of physical and mental health. There are different factors that influence HrQoL. This study aims to identify independent factors of HrQoL with regard to anthropometric measures, physical fitness and cardiovascular parameters. Patients and Methods:From April 2012 to July 2013, we prospectively examined 528 apparently healthy children (13.8 ± 2.3 years, 258 girls) for their physical fitness and their quality of life. Six-minute run test was performed to evaluate to physical fitness and the KINDL® questionnaire was used to assess HrQoL. A stepwise linear regression model was used to determine independent predictors for HrQoL. Results:In general, children and adolescents presented a good HrQoL (101.3 ± 14.4 % predicated reference value), achieved 1064 ± 178 meter during their six-minute run test and had a mean blood pressure 119.7 ± 9.8 mmHg. Linear regression revealed children with younger age (f#159;=-0.279, p<.001) and higher six-minute run distance (f#159;=0.220, p<.001) to have better quality of life. There was no independent influence of sex, body weight, body height and systolic blood pressure on HrQoL. Conclusions:In general, health-related quality of life in children and adolescents is good but declines with proceeding age and reduced physical fitness. Strategies for adolescents are needed to improve physical fitness in this age group to maintain HrQoL. Therefore, a school-based setting seems to be most suitable. P187 Exercise capacity in patients with spinal cord lesion after completing primary rehabiliation M Zen Jurancic1, T Erjavec1 1University rehabilitation institut Republic Slovenija , Ljubljana, Slovenia Topic: Sports cardiology Purpose:Patients in acute phase after the spinal cord lesion lose great part of their exercise capacity. Extent of the reduction depends on the height and completeness of the lesion, associated chronic diseases and occurance of the secondary complications. Exercise capacity increases for about a year after the lesion, mainly due to the improvement in the remaining muscle mass and the improvement of the autonomic dysfunction. The purpose of the study was to analyse the exercise capacity after discharge from primary rehabilitation into the home environment on average one year after the lesion. Methods:15 patients with cervical in thoracic spinal cord lesion were included in the study. There were 2 women in the group, average age was 43,9 year (SD 12,4). 12 patients were wheelchair users, 3 patients used walking aids, all have been involved in the guided acivities after discharge. They performed exercise testing at the end of the primary rehabilitation (average 207 days after the lesion, SD 88,24). We conducted ambulatory re-testing again (average 378 days, SD 182). We performed exercise testing on the hand cycle ergometer according to a standard ramp protocol. Results:Average values before discharge were: VO2 max 19,5 ml/min/kg (SD 5,9), PP 94,7 W (SD 50), BP max 140,6 /84,1 mmHg (SD 38,6/16,7), HR max 79,1% (SD 15,8). Average re-testing values were: VO2 max 20,8 ml/min/kg (SD 5,4), PP 103,9 W (SD 52,3), BP max 140,9 /80,7 mmHg (SD 15,6/9,9), HR max 80, 9%, (SD 17,6). There are not a statistically significant difference (p> 0.05) among the parameters. Conclusions:Average value of Vo2 max is low. The exercise capacity did not deteriorate on the re-testing, because the majority of patients were using manual wheelchair and they were involved in a variety of guided acitivities at home. Subjects with spinal cord lesion are due to low capacity at high risk for cardiovascular disease. P189 Effects of smoking and alcohol abuse in acute coronary syndrome J G Goncalves Pereira1, B Marmelo1, D Moreira1, L Abreu1, A Delgado1, R Silverio2, L Ferreira Dos Santos1, L Oliveira Santos1 1Hospital Sao Teotonio, Cardiology, Viseu, Portugal 2Hospital Sao Teotonio, Internal Medicine, Viseu, Portugal Topic: Sports cardiology Purpose:Several studies show that both smoking and alcohol abuse are associated with coronary death. In this study the authors compare mortality rates during hospital stay and at one year follow-up in patients with and without smoking habits and a history of alcohol abuse. Methods:In a retrospective study of patients admitted to the Cardiology Department of a centralized hospital for acute coronary syndrome, the authors analyze the rates of alcohol abuse and smoking habits. Clinical outcome during hospitalization and one year after discharge are also evaluated. Statistical analysis was made using SPSS v17. Results:The study population consists of 1120 patients, 68.9% male, age 69.12±12.67 years old, of which 20.5% had smoking habits and 3.2% had a history of alcohol abuse. Patients were divided into 2 groups in regards to smoking habit: group A – smokers (93.1% male, age 59.55±12.25 years old) and group B – non-smokers (62.9% male, age 71.62±11.56 years old). A statistical difference in gender was observed (p<0.001), but not in age (p=0.116). The mortality rates in group A vs group B during hospitalization was 6.0% vs 8.7% (p=0.191) and at one year follow-up was 3.1% vs 5.1% (p=0.239), none of which were significant. The study population was also divided into 2 groups depending on whether or not they had a history of alcohol abuse: group C – with alcohol abuse (94.4% male, age 65.86±12.88 years old) and group D – without alcohol abuse (69.8% male, age 68.67±13.35 years old). Once again, a statistical difference was found in regards to gender (p=0.002) but not age (p=0.730). The mortality rates in group C vs group D during hospitalization was 25.0% vs 9.6% (p=0.003), a statistically significant difference, in contrast to at one year follow-up, which was 3.8% vs 6.6%% (p=0.577). Conclusions:The study of this population showed no significant differences in outcome when comparing smoking habits. However, when comparing patients with and without a history of alcohol abuse, there was a significantly lower mortality rate during hospitalization in the group without alcohol abuse that was not observed at one year follow-up. P190 Associations between depression and traditional risk factors among middle-aged Russian population S Shalnova1, S Evstifeeva1, Y Balanova1, A Konradi2, E Oschepkova3, A Deev1, S Boytsov1 1National Research Center for Preventive Medicine, Moscow, Russian Federation 2Federal Almazov Medical Research Centre, Saint Petersburg, Russian Federation 3Russian Cardiology Research and Production Complex, Moscow, Russian Federation Aim:To evaluate relationships between depression and main traditional risk factors in Russia Methods:Data came from multicenter epidemiological study called "Epidemiology of cardiovaScular riSk factors and disEases in some regions of Russian Federation (ESSE-RF)". Eleven independent cross-sectional population surveys were conducted in 2012-2013 with randomly selected subjects aged 25-64 years. Total number of surveyed was 18241 (6881 men). The surveys were made by a single core protocol using a standard methods and criteria. Socio-demographic characteristics, smoking status, alcohol intake, body mass index (BMI=30,0), abdominal obesity (AO), high blood pressure level (HBP=160/90 mm Hg), hypertension, lipid levels [serum total cholesterol (TC), high density lipoproteins (HDL), triglycerides (TG)] were considered. Depression and anxiety were defined by HADS questionnaire HADS-D and HADS-A, respectively. Increased HADS-D was determined by 8 and more points. A moderate HADS-A defined as =8 and =11, high - >11 were used. Logistic regression was performed for linking depression with variables of interest using odds ratios (OR) and 95%CI. Results:As we already described earlier Russian regions characterized by high level of elevated scores depression and anxiety =8,0 (46,3% and 25,6%, respectively), varying by sex, age and region. Using multivariate logistic regression analysis by sex after correction for mentioned parameters the significant association between increased HADS-D score and, obesity and non drinking were found in both sexes. As expected the strongest relations were with moderate (OR: 3.101, 95%CI: 2.776; 3.466) and high (OR:7.446, 95%CI 6.605; 8.393,) HADS-A in women; and (OR: 4.735, 95%CI: 4.029; 5.566 and OR:14.494, 95%CI: 11.849; 17.730, respectively) in men. Additional associations with HBP (1.269, 1.118; 1.441) and strong drinking (1.483, 1.068; 2.060) in women and with current smoking (1.383, 1.146; 1.669) and hypertension (1.305, 1.111;1.532) in men were observed. Conclusion:Depression among Russians related to hypertension or HBP level, obesity and anxiety. Special for women are association with strong drinking, for men – current smoking. P191 Cluster analysis of psychosocial and environmental factors: a useful technique to identify rural adults at risk of low physical activity levels post cardiac rehabilitation K Ferrar1, J Quirk2, G Parfitt1, J Dollman1 1University of South Australia, Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, Adelaide, Australia 2University of South Australia, School of Health Sciences, Adelaide, Australia Topic: Sports cardiology Purpose:Despite advances in health care, there remains significant inequality in cardiovascular health of rural people. Cardiac rehabilitation aims to support patients to preserve or assume their proper place in society typically through physical activity (PA) and education. Unfortunately, maintenance of PA recommendations post cardiac rehabilitation is poor, and worse still in rural adults. There is limited understanding about the factors associated with PA behaviour in rural adults beyond rehabilitation. Cluster analysis is a novel, innovative technique that can identify patterns and subgroups in data to allow identification and targeting of interventions. The aims of this study were 1) to identify rural adult subgroups based on psychosocial and environmental variables and 2) to determine if these subgroups differ in relation to PA levels post cardiac rehabilitation. Methods:This cross-sectional study analysed data from 98 rural Australian adults (71% male; mean age = 68.3 years) recruited from The Integrated Cardiovascular Clinical Network South Australia database. A self-report questionnaire was distributed to a simple random sample who previously participated in cardiac rehabilitation; 128 questionnaires were returned (40% response rate; n=20 excluded due to missing data). Psychosocial and environmental variables and current physical activity guideline adherence were assessed using the questionnaire. A two-step cluster analysis was conducted on 11 psychosocial and environmental variables. Chi squared analysis was used to compare physical activity guideline adherence across cluster groups. Results:Two stable and meaningful clusters were identified. Cluster 1 (n = 35) was characterised by low levels of self-regulatory self-efficacy, relapse self-efficacy and barriers self-efficacy. Conversely, Cluster 2 (n = 63) had high levels of these same self-efficacy variables. Interestingly, none of the remaining eight social, variables significantly contributed to cluster characterisation. There were significant differences in adherence to physical activity guidelines (p = 0.001), with Cluster 1 less likely to report adequate physical activity levels. Discussion:These clusters could be used to identify at risk rural adults post cardiac rehabilitation. The results highlight the importance of examining how psychosocial and environmental variables cluster and suggest self-regulatory, relapse and barrier self-efficacy should be incorporated into targeted interventions to improve physical activity levels and reduce inequality in cardiovascular health of rural adults beyond cardiac rehabilitation. P194 Screening for cardiovascular risk factors & sudden cardiac death in the young; Experience from an underprivileged area in sub-urban India R Narain1, H Dhutia1, A Malhotra1, A Merghani1, L Millar1, K Prakash1, T Keteepe-Arachi1, A D'silva1, M Papadakis1, S Sharma1 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom Topic: Sports cardiology Purpose:The majority of sudden cardiac deaths (SCD) are attributed to atherosclerosis and affect the older section of the population. Ischaemic heart disease in India accounts for 61,000,000 deaths per year, despite the youth of its population, with 65% of individuals aged <35 years. Although a high prevalence of cardiovascular risk factors in the young appears the most plausible explanation, there are no supporting data. The objective of the study was to define the prevalence of cardiovascular risk factors & inherited heart disease in a cohort of young, apparently healthy Indians. Methods:A cohort of 551 individuals (69% male) with a mean age 21 years (range 15-45 years) underwent screening with a health questionnaire relating to cardiac symptoms, cardiovascular risk factors and family history of cardiovascular disease or premature (<40 years) SCD and physical examination. All participants underwent a blood pressure measurement, capillary blood glucose ,lipid profile analysis and ECG. Individuals with abnormal ECG and murmur underwent Transthoracic Echocardiograghy on site. Results:During initial evaluation 47 (8.5%) individuals were flagged as positive: 8 (1.45%) individuals with hypercholesterolaemia defined as a total cholesterol > 6mmol/l, 9 (1.6%) with elevated blood pressure defined as systolic blood pressure >140mmHg, 7 (1.2%) with high blood sugar defined as a fasting glucose >7mmol.l), 7 (1.2%) with a cardiac murmur. All individuals with elevated cholesterol and blood pressure were assigned a diagnosis of hypercholesterolemia and hypertension, respectively on repeated measurements. Echocardiography revealed moderate mitral stenosis (n=4), mild aortic stenosis (n=3) & Hypertrophic cardiomyopathy(n=2). An additional 7 (1.2%) people were classed as obese (BMI>30). All individuals received life style modification advice, treatment and follow-up as appropriate. Conclusion:We know that there is a strong co-relation between the above mentioned risk factors with Cardiac Event(CE) & SCD, people with different pathologies at the camp were totally unaware of their with condition, many of which could have led to a CE and even death if left undiagnosed and untreated. Several risk scoring algorithms have been suggested based on the assessment of multiple factors; none have been validated prospectively. Patients at high risk should be considered for risk factor modification and medical therapy. Hence, there is a need to have appropriate screening programme in place to prevent future tragedies & especially SCD in the young which is grossly underestimated in this region. P195 Are tests within therapeutic range the same as Rosendaal method in the assessment of anticoagulation quality with Vitamin K antagonists? D Caldeira1, G Morgado1, I Cruz1, B Stuart1, AC Gomes1, C Martins1, I Joao1, H Pereira1 1Hospital Garcia de Orta, Department of Cardiology, Almada, Portugal Introduction: The Time in Therapeutic Range Time (TTR) is a measure of anticoagulation quality with vitamin K antagonists. The methodology most commonly used in clinical trials is based on Rosendaal method (RM) which implies linear interpolation of INR values. However this method is complex and the use of such tool in clinical practice needs further involvement. The method of tests (MT) within the range, rather than MR TTR, is more easily applicable. We aimed to evaluate the relationship of MT with RM TTR. Methods:Through an observational, retrospective study, we evaluated all patients who attended the Cardiology Anticoagulation Consultation of a single hospital between January 2011 and July 2013, whose target INR was between 2.0 and 3.0. To better characterize the quality of long-term anticoagulation, we excluded all patients with less than 2 months of follow-up tests or less than 5 INR tests. For each patient we checked all INR values and calculated the RM TTR (linear interpolation method) and MT (tests within therapeutic range/all tests). To better characterize the relationship of these methods we used Bland-Altman plots and correlation tests. Regression tests were used to further analyze any systematic differences between methods. Results:From January 2011 to July 2013 501 VKA-treated patients were observed, of which 377 (72.4% non-valvular atrial fibrillation) met the inclusion criteria. Patients were followed for a mean period of 471 days. A statistically significant correlation between MT and RM (p <0.001 Spearman Rho 0.88, 95% CI from 0.86 to 0.90) was observed. The Bland-Altman method suggests a mean difference of -5.1% in TTR (95% CI -12.9 to 23.1%) using the method of tests within range. The Passing-Bablok linear regression confirmed the existence of significant systematic differences of -4.1% (95% CI -6.6 to -1.2%) among the evaluated methods, however the dispersion of the data around the estimated linearity featured high values ?128;??128;?(residuals 95% CI -12.8 to 12.8%). Conclusions:The MT correlates significantly with RM, but the systematic application of method of tests within therapeutic range decreases on average 5%, however the dispersion of data is large and clinically significant. Data from this study do not support systematic use of the percentage of the target INR test method as an equivalent of Rosendaal method. P196 Priorities in primary and secondary cardiovascular prevention J Bruthans1, J Critchley2 1First Faculty of Medicine, Charles University and Thomayer Hospital, Center for Cardiovascular Prevention, Prague, Czech Republic 2University of London, Dept. of Population Health Sciences and Education, London, United Kingdom Topic: Sports cardiology Purpose:The decrease of cardiovascular (CV) mortality, better control of some, and increasing prevalence of other CV risk factors and progress in therapies are changing the importance and priorities of CV prevention. The opinion of specialists and personalities with executive and legislative powers (stakeholders) on priorities of CV prevention and treatments is of particular significance. Methods:An electronic questionnaire on various aspects of CV prevention was developed and sent to personalities involved in CV prevention and public health in 9 European countries. The addressees were asked to assign priority scales to particular aspects of CV prevention. In this communication, we present the Czech data obtained from Czech responders. Results:A total of 30 personalities (20 specialists and 10 "politicians") were approached, 21 of them responded (66%), with better compliance among medical experts. Top priority was most frequently assigned to legislation and fiscal policies relating to food (91% of responders), support of physical activities (82%), cooperation with the food industry (73%), cardiovascular rehabilitation, smoking cessation initiatives and preventing the adolescents to start smoking, legislation and fiscal policies relating to tobacco use and smoking (64% each). In purely medical approach, acute coronary heart syndrome treatments, especially direct PCI and proper use of drugs in secondary CVD prevention were preffered (64%). On the contrary, the polypill and psychological counselling received much less support (27%). The policy makers, compared to medical specialists, were more sceptical about legislation and fiscal policies. The priorities identified in the Czech part of this survey are fairly similar to those reported in the other European countries. Conclusions:Medical experts and policy makers prefer specified, whole population and target-oriented preventive measures, supported by legislation and governmental regulations to ill-defined "general" preventive and educational programmes. Paradoxically, medical experts more than politicians are prone to prefer political and fiscal policies. Primary prevention is considered to be more important than the secondary prevention. This study was partly supported by IGA, Ministry of Health, Czech Republic, grant No NT/13186, and an EU grant (EuroHeart II Project). P197 Long term benefits of a contemporary health check-up with evidence-based risk communication and motivational coaching - the PF study J Scholl1, P Kurz2 1Dr. Scholl Prevention First GmbH, Prevention First R?im, R?im am Rhein, Germany 2Dr. Scholl Prevention First GmbH, Prevention First M?, R?im am Rhein, Germany Topic: Sports cardiology Purpose:A Cochrane meta-analysis concluded, that general health check-ups were useless. (1) The data that were used mainly came from the 60s to 80s of the past century, when neither the knowledge nor the means of preventive interventions were comparable to the current possibilities. We examined the benefit of a modern health check-up on the long-term risk for cardiovascular disease (CVD). Methods:Between 2001 and 2014, n=1852 men (age 46,0±6,4 years) und n=960 women (age 46,3±5,6 years) participated at least twice in a health check-up offered to them by their respective employer. All participants gave a written consent to the scientific evaluation of the check-up results. The check-up included a questionnaire (family and personal history, lifestyle, nutrition, physical activity), a physical exam, a blood sample with all relevant CVD risk factors, the measurement of carotid IMT as a surrogate marker for "vascular age", a fitness test with spiroergometry to maximum exhaustion and an individual coaching session including risk communication and motivational counseling with respect to lifestyle changes, nutrition, physical activity and management of risk factors. Results:The first and the last check-up of each participant were analyzed on an intention-to-treat basis. We calculated the lifetime risk for CVD based on the Reynolds' Risk equations (2;3) as the CVD risk with 80 years. 3,6% of men had a very high (>40%) and 10,7% a high (30-39,9%) lifetime risk, whereas only 2,6% of women had a lifetime risk of >20%. After a mean follow-up of 3,8 years (men) and 3,5 years (women) the lifetime risk in the respective groups was reduced from 47,1% to 33,5%, from 34,1% to 28,7% and from 25,4% to 21,3% (RRR 28,9%, 15,8% and 16,1%, p <0,001 for men, women n.s.). Improvements in risk profile were seen in hypertensive patients (BP -14/-7 mmHg in men, BP-16/-5 mmHg in women), in patients with the Metabolic Syndrome (prevalence lowered by >40%), in smokers (smoking cessation rate 44,9% in men, 25,2% in women) and in unfit participants below the 25th percentile for age (men: +0,94 MET and women: +0,37 MET). Conclusion:Contrary to the Cochrane meta-analysis derived from old data, general health check-ups are not useless. As shown, this contemporary health check-up with a strategy for evidence-based risk communication and motivational lifestyle coaching is effective in lowering the CVD risk of middle-aged employees with a high lifetime risk for CVD. P198 Plasma glycine and risk of acute myocardial infarction in patients with suspected coronary artery disease YP Ding1, ER Pedersen1, GFT Svingen1, PM Ueland1, OK Nygard1 1University of Bergen, Institute of Clinical Science, Bergen, Norway Topic: Sports cardiology Purpose:Glycine is an amino acid which is closely involved in metabolic regulation, anti-oxidative reactions and neurotransmission. The associations between glycine and diabetes mellitus and obesity have been widely researched, while little evidence is available from population-based studies on coronary artery disease (CAD). We evaluated the relationship between plasma glycine and risk of acute myocardial infarction (AMI) in a large prospective cohort of patients with suspected CAD. Methods:A total of 4155 participants underwent coronary angiography for suspected stable angina pectoris (SAP) were followed from 2000-2004 to the end of 2006. Hazard ratios and 95% confidence intervals were calculated using Cox regression and are reported per (log-transformed) standard deviation increment. We first evaluated the association of plasma glycine with AMI occurrence in a simple model by adjusting for age and gender, and further in a multivariate model by adjusting for hypertension, diabetes mellitus, smoking behavior, obesity, angiographic extent of CAD (0-3), estimated glomerular filtration rate, apo A1, apo B, and triglycerides as well as an extended model adjusted additionally for C-reactive protein (CRP). Correlations between glycine and lipid parameters were also investigated by Spearman's rank correlation coefficient. Results:During a median follow-up of 4.6 years, 344 patients (8.3%) experienced an AMI (median age of the cohort was 62 years and 72% were men). In age and gender adjusted analysis, plasma glycine was significantly associated with a decreased risk of AMI (HR: 0.85 [0.76-0.96]; P=0.006). This estimate was minimally attenuated by multivariate adjustment (HR: 0.86 [0.76-0.98]; P=0.022). However, the association was attenuated after adjusting for CRP (HR: 0.90 [0.79-1.02]; P=0.095). In addition, plasma glycine showed moderate correlations with Apo A1 (rho=0.21, P<0.001) and triglycerides (rho=0.22, P<0.001) while high correlation with plasma serine (rho=0.50, P<0.001). Notably, we also observed a weak but significant correlation of plasma glycine with CRP (rho=-0.14, P<0.001). Conclusion:Elevated plasma glycine is associated with decreased AMI risk in patients with SAP independent from established CAD risk factors but attenuated by CRP. Our results motivate further researches on the underlying pathomechanisms of glycine-related associations with CAD. P199 Complex of non-invasive biomarkers for coronary atherosclerosis severity detection N Gavrilova1, V Metelskaya1, S Boytsov1, N Gumanova1, N Gomyranova1, E Yarovaya1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Sports cardiology Purpose:To estimate the severity of coronary artery disease (CAD) (=46 points by Gensini score, GS) using complex of non-invasive imaging and biochemical markers. Methods:CAD patients aged 33-85 who were underwent to invasive coronary angiography and carotid artery dopplerography (n=205;M/F 136/69) were included into the study; 94% of patients were on statin therapy. The severity of carotid atherosclerosis was evaluated using the mean common carotid artery intima-media thickness (IMT) and presence of atherosclerotic plaques (ASP). The Duke Treadmill Score (DTS) was calculated basing on exercise tolerance test. Concentration of high-sensitivity C-reactive protein (hsCRP) as a low grade inflammation parameter, and leptin and adiponectin levels as parameters of visceral adipose tissue metabolism were used as biochemical markers. CAD severity was measured by GS on the angiogram. The severe CAD was defined by GS =46. Results:The areas under the ROC curves for IMT and ASP to predict high GS were 0.597 (95% CI:0.519–0.675;p=0.019) and 0.594 (95% CI:0.515–0.674;p=0.023), respectively. The areas under the ROC curves for the severe carotid stenosis and the DTS to predict high GS were 0.607 (95% CI:0.528–0.686;p=0.01) and 0.294 (95% CI:0.231–0.356;p=0.000), respectively. At cut-off point for IMT of 0.9 mm the sensitivity of this test was 91% and the specificity was 23% to predict the high GS. At cut-off point for ASP>2 and carotid artery stenosis >45% the sensitivity was 64% and 31%, respectively, and the specificity was 50% and 84%, respectively. At cut-off point for DTS=-11 the sensitivity of the test was 69% and the low specificity was 14% for the high GS. The hsCRP cut-off point =3 mg/l to predict severe coronary atherosclerosis had the sensitivity 55% and the specificity 58%. The odds ratio (OR) associated with the IMT >0.9 mm for prediction of the serious CAD was 3.2 (95% CI:1.3–7.9;p=0.012). The ORs associated with the hsCRP =3.0 mg/l and the adiponectin <8.0 mkg/ml for prediction of the high GS were 2.0 (95% CI:1.1–3.9;p=0.029) and 2.3 (95% CI:1.2–4.5;p=0.016), respectively. Conclusion:The analysis of the imaging and biochemical parameters, allowed us to offer a complex marker for the severe CAD estimated as GS =46. This complex included IMT >0.9 mm, hsCRP level =3.0 mg/l and adiponectin level <8.0 mkg/ml. Sensitivity and specificity for this marker to detect severe CAD were 68% and 63%, respectively. Positive predictive value for severe CAD was 86%. Thus, increased IMT, elevated hsCRP and low adiponectin provide useful information for predicting the severity of CAD. P200 Is there a synergistic effect between renal failure and metabolic syndrome for the occurrence of major adverse cardiac events in patients with stable angina? A T Timoteo1, M Alves1, M A Nogueira1, C Soares1, R Cruz Fereira1 1Hospital Santa Marta, CHLC, Lisbon, Portugal Background:Renal failure (RF) is a risk factor for Major Adverse Cardiac Events (MACE) in the context of coronary disease. Metabolic syndrome (MS) impact is controversial. We sought to evaluate the prognostic impact of MS in patients with stable angina as well as if there is a synergistic effect of MS and RF on cardiovascular outcomes. Methods:Patients admitted for coronary angiography due to stable angina, with significant angiographic coronary disease. We evaluated clinical and laboratorial variables on admission. RF was defined by an estimated glomerular filtration rate (GFR) < 60 mL/min/1.73 m2. MS was defined by the NCEP-ATP III definition. Patients were divided into four groups according to the presence or absence of MS and RF (without RF/MS; MS; RF; with MS and RF). We used Kaplan-Meier curves to analyse the influence of RF and MS in the time to occurrence of MACE (all-cause mortality, non-fatal myocardial infarction or revascularization) during a three-year follow-up. The interaction between both variables was tested by multivariable Cox regression. Results:From the 2709 patients admitted for coronary angiography, 1724 (64%) had significant angiographic coronary disease and were included in the study. Mean age was 66 ± 9 years, 74% males. In this group 24% had a previous history of myocardial infarction, 30% previous coronary angioplasty and 11% previous coronary artery bypass grafting. In the present admission, 52% underwent coronary angioplasty. We had 65.7% of patients with MS and 25.4% had RF. In the follow-up we had MACE in 4.6% of the patients (mortality in 3.6%). RF was associated with time to MACE occurrence (Log-rank, p<0.001) but not MS (Log-rank, p=0.490). In the four-group analysis, we had a progressive increase in the occurrence of MACE (3.1%, 3.3%, 9.6% and 7.7%, p<0.001). No difference in outcome was obtained in patients with MS compared to patients without RF/MS (Log-rank, p=0.843). The association RF/MS had a worst outcome in the follow-up compared to isolated MS alone (Log-rank, p=0.003). On the contrary, the association had an identical outcome compared to isolated RF (Log-rank, p=0.473). RF was an independent predictor of MACE (HR 1.69, 95% CI 1.01 – 2.83, p=0.045) but not MS (HR 0.94, 95% CI 0.60 – 1.50, p=0.944). No interaction was found between MS and RF (p-value for interaction = 0.562). Conclusion:MS had no influence in outcome of patients with stable coronary disease. We also confirmed the worst outcome associated with RF, but no interaction was found with MS. P204 ABCA1 InsG319 polymorphism as a marker of a favorable course of coronary heart disease at women of young and middle age I A Leonova1, V Feoktistova1, O Sirotkina1, S Boldueva1, Y Vavilova1, L Gaykovaya1 1North-Western Sate Medical University named I.I. Mechnikov, St-Petersburg, Russian Federation In recent decades, the incidence of coronary heart disease (CHD) has been increase among young and middle-aged women. The important role in the development of coronary atherosclerosis is given to a breach of from peripheral tissues to the liver of high-density lipoproteins. The main protein of reverse cholesterol transport is ATP - binding cassette transporter A1 (ABCA1). Currently, a large number of known polymorphic markers ABCA1 gene, but its role in the development and course of coronary heart disease in young and middle age is still not clear. Objective:To study the distribution of genotype frequencies of polymorphisms ins319, C69T gene reverse cholesterol transporter ABCA1 in young and middle-aged with CHD and study the influence of genetic markers for the disease. Materials and Methods:The study of the distribution of allelic variants ins319, C69T gene reverse cholesterol transporter ABCA1 performed by PCR followed by restriction analysis in 121 women (52,1 ± 6,0 years) with CHD and coronary angiography verified coronary atherosclerosis (stenosis of more than 70 vessels %), 99 of them - with myocardial infarction (MI) and a history of 22 - without MI. Results:In the group of women with MI revealed the following distribution of genotype frequencies of the polymorphism S69T gene ABCA1 - 37%, 47% and 16% in the group without MI - 36%, 50% and 14% for the SS, ST and TT, respectively. No significant differences in the groups studied were found. For ABCA1 gene polymorphism ins319 genotype distribution in MI group was as follows - 78%, 21%, 1%, in women without MI - 56%, 44%, 0% to NN, GN, GG, respectively. Found a statistically significant increase in the frequency of the mutant allele G in the hetero- and homozygous gene ABCA1 in the group of women with CHD and without a history of MI (p = 0.03). Conclusions:The carriage of the G allele at position 319 of the gene ABCA1 in women with CHD in young and middle-aged stands protective factor in relation to the development of MI. P205 Vascular damage in patients with type 2 diabetes mellitus is related to the levels of myeloperoxidase M Rocha1, S Rovira-Llopis1, R Castello1, R Falcon1, C Banuls1, A Hernandez-Mijares1, VM Victor Gonzalez1 1FISABIO, Hospital Dr Peset, Endocrinology, Valencia, Spain Topic: Sports cardiology Purpose:Atherosclerosis and cardiovascular disease (CVD) are the leading cause of death among diabetic patients. Myeloperoxidase (MPO), a heme protein derived from leukocytes, plays a key role in leukocyte mediated vascular injury responses in inflammatory CVD. Therefore, the aim of this study was to evaluate the correlation between the levels of MPO and endothelial function in type 2 diabetic patients. Methods:Our study population consisted of 66 patients (age 53±7) consecutively diagnosed with type 2 diabetes according to criteria of the American Diabetes Association (ADA) and 25 control subjects (age 50±8) after confirming that they did not fulfill any of the criteria determined by the ADA. We determined anthropometric and metabolic parameters, serum MPO concentration, serum levels of the cytokine TNF-a and the adhesion molecules VCAM-1, E-selectin and ICAM-1, and leukocyte-endothelium interactions (rolling flux, rolling velocity and adhesion) in polymorphonuclear leukocytes (PMN). Results:Patients with type 2 diabetes showed higher levels of MPO compared to controls (11923.9±1236.1 pmol/l vs 6709.5±683.9 pmol/l, respectively). In addition, diabetic patients showed increased leukocyte-endothelium interactions due to an undermining of polymorphonuclear leukocytes (PMN) rolling velocity and increased rolling flux and adhesion, which was accompanied by a rise in levels of the proinflammatory cytokine TNF-a and the adhesion molecule VCAM-1 and E-selectin. Furthermore, MPO levels were positively correlated with PMN rolling flux (r=0.855, p<0.01) and adhesion (r=0.682, p<0.05). Conclusion:Our results lead to the hypothesis that increased MPO levels in diabetic patients may be worsening endothelial function in these patients. P206 Improved endothelial function is associated with reduced arterial stiffness and atherosclerotic regression in rosuvastatin treated patients with inflammatory joint diseases E Ikdahl1, J Hisdal2, S Rollefstad1, IC Olsen3, TK Kvien3, TR Pedersen4, AG Semb1 1Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway 2Oslo University Hospital, Aker, Section of Vascular Investigations, Oslo, Norway 3Diakonhjemmet Hospital, Department of Rheumatology, Oslo, Norway 4Oslo University Hospital, Ullev? Centre of Preventive Medicine, Oslo, Norway Endothelial dysfunction is the first step in the formation of atherosclerotic lesions and can be quantified by the degree of flow mediated vasodilation (FMD) of the brachial artery. Low FMD is a predictor of cardiovascular events. In addition, FMD is lower in patients with inflammatory joint diseases (IJD) compared to the general population. Our aim was to investigate if long-term rosuvastatin treatment in IJD patients with carotid plaques (CP) improves FMD. Furthermore, associations between change in FMD (?FMD) and change in CP height, arterial stiffness [aortic pulse wave velocity (aPWV) and augmentation index (AIx)], lipids and inflammatory variables were evaluated. Eighty five statin na? IJD patients (rheumatoid arthritis: 53, ankylosing spondylitis: 24, psoriatic arthritis: 8) with ultrasound verified CP received treatment with rosuvastatin for 18 months to obtain low density lipoprotein cholesterol goal =1.8 mmol/L. All patients underwent assessment of FMD, aPWV, AIx and carotid ultrasound at baseline and at study end. The mean±SD FMD was significantly improved from 7.10±3.14% at baseline to 8.70±2.98% at study end (p<0.001). Multiple linear regression analyses with ?FMD as the dependent variable revealed a significant association with area under the curve erythrocyte sedimentation rate (p= 0.04), improvement in AIx (p=0.05) and CP height regression (p=0.001). The final linear regression model explained 31.1% of the variance in ?FMD (R2=0.311) (Table). Long-term intensive lipid lowering with rosuvastatin improved FMD in IJD patients with atherosclerotic disease. The improved endothelial function was associated with reduced arterial stiffness, CP height decrement and level of inflammation. The numbers are beta coefficients with confidence interval (CI). ?: Change from baseline to study end, AUC: Area under the curve, ESR: Erythrocyte sedimentation rate, AIx: Augmentation index, CP: Carotid plaque Demogr. model AUC ESR model ? AIx model ? CP height model Final model Age -0.063 (-0.14;0.01) p=0.09 -0.09 (-0.17;-0.02) p=0.02 -0.03 (-0.11;0.04) p=0.38 -0.039 (-0.11;0.03) p=0.28 -0.04 (-0.12;0.03) p=0.21 Gender 0.306 (-0.96;1.57) p=0.63 0.536 (-0.70;1.77) p=0.39 0.94 (-0.37;2.26) p=0.16 0.566 (-0.67;1.80) p=0.37 1.458 (0.19;2.73) p=0.03 AUC ESR 0.084 (0.02;0.15) p=0.01 0.084 (0.00;0.16) p=0.04 ? AIx -0.091 (-0.18;0.00) p=0.05 -0.086 (-0.17;0.00) p=0.05 ? CP height -3.439 (-5.23;-1.65) p < 0.001 -3.23 (-5.00;-1.46) p=0.001 R2 0.038 0.118 0.085 0.193 0.311 Demogr. model AUC ESR model ? AIx model ? CP height model Final model Age -0.063 (-0.14;0.01) p=0.09 -0.09 (-0.17;-0.02) p=0.02 -0.03 (-0.11;0.04) p=0.38 -0.039 (-0.11;0.03) p=0.28 -0.04 (-0.12;0.03) p=0.21 Gender 0.306 (-0.96;1.57) p=0.63 0.536 (-0.70;1.77) p=0.39 0.94 (-0.37;2.26) p=0.16 0.566 (-0.67;1.80) p=0.37 1.458 (0.19;2.73) p=0.03 AUC ESR 0.084 (0.02;0.15) p=0.01 0.084 (0.00;0.16) p=0.04 ? AIx -0.091 (-0.18;0.00) p=0.05 -0.086 (-0.17;0.00) p=0.05 ? CP height -3.439 (-5.23;-1.65) p < 0.001 -3.23 (-5.00;-1.46) p=0.001 R2 0.038 0.118 0.085 0.193 0.311 Open in new tab The numbers are beta coefficients with confidence interval (CI). ?: Change from baseline to study end, AUC: Area under the curve, ESR: Erythrocyte sedimentation rate, AIx: Augmentation index, CP: Carotid plaque Demogr. model AUC ESR model ? AIx model ? CP height model Final model Age -0.063 (-0.14;0.01) p=0.09 -0.09 (-0.17;-0.02) p=0.02 -0.03 (-0.11;0.04) p=0.38 -0.039 (-0.11;0.03) p=0.28 -0.04 (-0.12;0.03) p=0.21 Gender 0.306 (-0.96;1.57) p=0.63 0.536 (-0.70;1.77) p=0.39 0.94 (-0.37;2.26) p=0.16 0.566 (-0.67;1.80) p=0.37 1.458 (0.19;2.73) p=0.03 AUC ESR 0.084 (0.02;0.15) p=0.01 0.084 (0.00;0.16) p=0.04 ? AIx -0.091 (-0.18;0.00) p=0.05 -0.086 (-0.17;0.00) p=0.05 ? CP height -3.439 (-5.23;-1.65) p < 0.001 -3.23 (-5.00;-1.46) p=0.001 R2 0.038 0.118 0.085 0.193 0.311 Demogr. model AUC ESR model ? AIx model ? CP height model Final model Age -0.063 (-0.14;0.01) p=0.09 -0.09 (-0.17;-0.02) p=0.02 -0.03 (-0.11;0.04) p=0.38 -0.039 (-0.11;0.03) p=0.28 -0.04 (-0.12;0.03) p=0.21 Gender 0.306 (-0.96;1.57) p=0.63 0.536 (-0.70;1.77) p=0.39 0.94 (-0.37;2.26) p=0.16 0.566 (-0.67;1.80) p=0.37 1.458 (0.19;2.73) p=0.03 AUC ESR 0.084 (0.02;0.15) p=0.01 0.084 (0.00;0.16) p=0.04 ? AIx -0.091 (-0.18;0.00) p=0.05 -0.086 (-0.17;0.00) p=0.05 ? CP height -3.439 (-5.23;-1.65) p < 0.001 -3.23 (-5.00;-1.46) p=0.001 R2 0.038 0.118 0.085 0.193 0.311 Open in new tab P207 Role of thq gender factor in the development of carbohydrate profile changes in HIV - patients on effective HAART therapy I Komarova1, I Chukaeva1, A Kravthenko2, T Kushakova2 1Russian State Medical University, Moscow, Russian Federation 2Central Research Institute of Epidemiology, Moscow, Russian Federation Introduction:Nowadays there are a lot data about HAART influence on carbohydrate profile in HIV – infected patients, which can bring to the development of cardiovascular diseases in this subpopulation. It is known, that RBP – 4 is a predictor of the carbohydrate profile changes in general population. But it is lack of evidences about RBP – 4 level in HIV – infected patient on HAART Aim:To evaluate the role of gender factor in the development of carbohydrate profile changes in HIV – infected patients on effective HAART Materials and methods:79 HIV – infected patients on HAART (viral load less than 50 copies\ml), average age 33,85 ±4,17 years, 53 men, 26 women, CD 4+ cells level 466,24 ± 142,84\mkl in men, 527,97 ± 216,51\mkl in women (p ?0,05), without previous cardiovascular diseases In all patient was evaluated the level of fasting glucose, fasting insulin, fasting RBP – 4. Results:Was found statistically significant increase of glucose and insulin levels as in HIV – infected men, so in HIV – infected women on effective HAART [men: 4,43 (3,95 – 4,87 vs 4,91 (4,41-5,26) mmol\l, 2,0 (2,0-8,33) vs 5,70 (3,17-10,76) mkIU\ml; women: 4,26 (4,08-4,58) vs 4,60 (4,29-4,80) mmol/l; 2,0(2,0-4,04) vs 4,17 (3,70-6,71) mkIU\ml, p < 0,05]. Was found statistically significant decrease of RBP – 4 level in HIV infected men and women on effective HAART [67,40 (47,50 – 85,50) vs 21,43 (16,29-36,0), 63,9 (41,0-81,10) ?????? 20,7 (17,07 – 24,46) mkg\ml, p < 0,05, correspondingly] Conclusion:As a result of our investigation we haven't found any significant differences in carbohydrate profile changes in HIV – infected men and women on effective HAART. So we can suggest, that men and women on HAART have the same risk of the development of carbohydrate profile changes. We have statistically significant increase of glucose and insulin levels in both sexes, that's why we suggest, that HIV – infected patients on HAART have higher risk of diabetes mellitus and cardiovascular diseases development. Also we have found statistically significant decrease of RBP – 4 level in men and women on HAART. Role of RBP – 4 is not clear now and more investigations are needed for its specification. P209 The impact of various clinical, biochemical and genetic factors on the development of coronary artery disease (CAD) in young and middle-aged women I A Leonova1, V Feoktistova1, S Boldueva1, O Sirotkina1, T Vavilova1, L Gaykovaya1 1North-Western Sate Medical University named I.I. Mechnikov, St-Petersburg, Russian Federation Traditional risk factors of coronary artery disease are well known. However, due to the increasing incidence of coronary heart disease in young women, need to search for other risk factors for the disease. Purpose of study:assessing the impact of various clinical, biochemical and genetic factors on the development of coronary artery disease (CAD) in young and middle-aged women. Material and methods:109 women were investigated. 62 women (middle age 50,7 ± 6,4 y.o) had history of CAD. 47 women of control group (middle age 52,3 ± 9,2 y.o.) had no history of CAD. Standard clinical and biochemical investigation were carried out. Additional methods were genetic investigation of 4a4d+4a4a gen of endothelial NO synthase and number of circulated desquamated endothelial cells. Of the 16 indicators : total cholesterol , LDL and HDL cholesterol , triglycerides , glucose levels , the number of circulated desquamated endothelial cells, waist circumference ( OT) , the ratio of the waist and the hips ( ON / OF ) , body mass index ( BMI) , 4a4d +4 a4a of endothelial NO synthase, menopause , smoking, family history of CAD, thyroid disease, gynecological disease , increased atherogenic factor ( KA) of more than 3.5 , which would be responsible for the development of CAD among young and middle -aged women, in the process of building a logistic regression model was selected the 9 most significant indicators Obtained in our study model shows that women with abdominal obesity , family history of CAD , smoking history, the TG level of 1.3 mmol / L glucose more than 6.6 mmol / L, and the KA more than 3.5, the number of circulating desquamated endothelial cells more than 3 cells / ml and the carriage of the mutant allele 4a of endothelial NO synthase , the chance of developing coronary atherosclerosis increases 94 fold . Despite the fact that the genetic risk factor predictive value does not take first place , when you try to remove this factor from the constructed model , the chance of developing coronary heart disease among women decreased to 64 times . P212 The influence of body mass index and metabolic risk variables on pulse wave velocity in healthy population A Pereira1, MI Mendonca1, R Rodrigues1, S Gomes1, AC Sousa1, S Freitas1, E Henriques1, C Freitas1, D Pereira1, R Palma Dos Reis2 1Hospital Dr. Nélio Mendon? Research unit, Funchal, Portugal 2New University of Lisbon, Cardiology, Lisbon, Portugal Measurement of femoral-carotid pulse wave velocity (PWV) is recognized as a simple and practical method for assessing arterial stiffness. We determined whether the PWV of asymtomatic population with no detectable Coronary artery disease is affected by obesity and its associated metabolic risk variables. Methods:A cross-sectional sample of 1231 controls (26.5% female and 73.5% male), aged 30-65 years, were recruited for this study. PWV was measured by a simple automatic oscillometric technique. Adiposity measures, blood pressure, serum lipoproteins, fasting glucose were obtained. Results:The PWV of the controls was significantly higher in men (8.4±1.8) than in women (7.4±1.6, p<0.0001 and increased with age in both genders specially in the female population (male r=0.504, p<0.0001, female r=0.689 p<0.0001). After being statistically adjusted for age and gender, PWV was significantly correlated with waist-to-height ratio (r=0.235 p<0.0001), systolic and diastolic blood pressures (r=0.576 p<0.0001), mean arterial pressure (r=0.569 p<0.0001) and fast glicose (r=0.217). Low correlation with triglycerides, BMI (Body Mass Index), Atherogenic ?ex of Plasma were found. In the multivariate regression analysis, BMI , systolic and diastolic blood pressure and age were found to be significant determinants of PWV (P<0.001). An increasing number of clustered risk variables, including high values (75% quartiles) of Systolic and Dyastolic Pressure, BMI, waist-to-height ratio, and atherogenic index showed a graded association with PWV. Conclusions:These results suggest that obesity and its associated metabolic abnormalities are important factors in the increased PWV of healthy population and that may be useful in investigating early arterial wall changes in this population. Open in new tabDownload slide Clustered risk variables and mean PWV P213 Do early follow-up appointments reduce 30-day hospital readmissions in an underserved multi-racial population? A Janakiraman1, B Mc Cauley1, A Headly1, K Hunter1, M Torjman2 1Cooper University Hospital, Camden, United States of America 2Thomas Jefferson University, Philadelphia, United States of America Topic: Sports cardiology Purpose:Based on data collected by the Centers for Medicare & Medicaid Services, congestive heart failure (CHF) is the most common reason for hospitalization in the Medicare program, accounting for 1.4 million hospitalizations and nearly $17 billion in 2010. The rate of readmission in minority populations is high. The disparity between races is prevalent in Camden, where minorities make up nearly 95% of the population. It has been shown that early follow-up (post discharge visit within seven days) was associated with lower rates of 30-day readmission among Medicare beneficiaries. The current practice has been to take measures that ensure early follow-up, prescribe appropriate medications at the time of discharge, and provide patient education as dictated by the American Heart Association (AHA). Methods:Patients of all races admitted to a tertiary urban medical center from the Camden, NJ zip code with acute decompensated volume overloaded heart failure (ADVOHF) from January 2011 to December 2011 were selected (n=170). A retrospective chart review was conducted. All patients with early follow-up were followed to determine if readmission occurred within 30 days. Results:The study populations demographics were minority mean age of 63 and white mean age of 61, male (59%), minority (70%). Early follow-up appointments for all patients occurred in 113 patients (63%), resulting in an 8.8% readmission rate within 30-days. In the 57 patients who did not receive an early follow-up appointment there was a readmission rate of 47.4% (p<.001). Conclusion:In a city such as Camden, where many disparities exist between races, early follow-up, regardless of race shows a significant reduction in the rate of readmission within 30-days. Efforts to ensure early follow-up appointment is scheduled at the time of discharge will lead to better outcomes and a reduction in healthcare spending for patients with CHF. P214 Social and economic inequalities in behavior cardiovascular risk factors prevalence in Russian Federation A Kontsevaya1, S Shalnova1, A Deev1, J Balanova1, A Konradi2, O Rotar2, J Zhernakova3, S Boytsov1 1National Research Center for Preventive Medicine, Moscow, Russian Federation 2Federal Almazov Medical Research Centre, Saint Petersburg, Russian Federation 3Russian Cardiology Research and Production Complex, Moscow, Russian Federation There is evidence of social and economic inequalities in many aspects of health, including risk factors prevalence. Understanding these inequalities is important step for developing target and effective preventive programs. Aim:to investigate association between CVD risk factors prevalence and social and economic variables such as education, welfare and living in rural area. Methods:A cross-sectional survey - Epidemiology of cardiovaScular riSk factors and disEases in some regions of Russian Federation (ESSE-RF) was carried out in randomly selected males (N=3284) and females (N=4041) aged 25-44 years in 11 Russian cities (Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Samara, Orenburg, Tomsk, Tyumen regions, St.Petersburg, Republic of North Ossetia-Alania), response rate>80%. Association between CVD risk factors prevalence (smoking, alcohol abuse, low physical activity, low vegetables and fruits consumption, low fish consumption, high salt intake) and social and economic parameters (education, level of welfare by self assessment and living in rural area) was studied by logistic regression analysis. Results:Education had significant inverse association with all analyzed CVD risk factors, the highest level of education was associated with lowest risk factors prevalence (for example, OR of smoking in low educated males was 1,9 compared with high educated group (CI 1,5;2,4, p<0,05) and 1,8 in low educate females (CI 1,8; 3,3, p<0,05) compared with high educated. Welfare level had different association with CVD risk factors. Low physical activity had inverse association with welfare level (the highest level of welfare was associated with lowest prevalence of low physical activity in males, OR 0,7; CI 0,5;1,0, p<0,05) and females (OR 0,5 CI 0,4;0,6, p<0,05). But smoking, alcohol abuse, low consumption of fruits and vegetables and low fish consumption had direct association with welfare level (the highest level of welfare was associated with highest prevalence of risk factor). For example in males of highest level of welfare OR of alcohol abuse was 2,6 (p<0,05), and it was insignificant in females; for low vegetables and fruits consumption OR were 2,3 (p<0,05) in males and 1,4 in females (p<0,05) in highest level compared with the lowest quartile. Living in rural area had low association with CVD risk factors. Conclusion:Social and economic inequalities in behavior cardiovascular risk factors prevalence have some specific in Russian Federation compared with western society, it is necessary to consider it in preventive measures development. P215 Income inequalities and stroke mortality trends in Sao Paulo, Brazil, 1996 to 2011. P Lotufo1, TG Fernandes2, IM Bensenor1 1Hospital Universitario - University of Sao Paulo, Sao Paulo, Brazil 2Amazonas Federal University, Medicine, Manaus, Brazil Purposte:It is not clear the relationship between stroke mortality trends and socioeconomic inequalities, particularly in low- and middle-income countries. Methods:We analyzed in the city of Sao Paulo, Brazil, the intra-urban distribution of age-adjusted stroke death rates from 1996 to 2011 for persons aged 35 to 74 years-old according to family income. We applied an ecological design comparing the stroke rates tendencies in three homogenous areas classified according to household income. Statistical analyses applied the "Joinpoint Regression Program 4.1.0", a log-linear model using Poisson regression that permits the calculation of annual percent change (APC) with a 95% Confidence Interval. The log-linear model was fitted with year as explanatory and considered the variance of the Poisson model as correction for heteroscedasticity.. We tested pairwise differences between two regression mean functions to verify if they are parallel or not. When the test "failed to reject parallelism" (p>0.05) between two areas, it is possible to consider that the APC of these two areas are not significantly different, and was calculated the APC combined between two areas tested when there was parallelism. Results:In the period a total of 77,848 stroke deaths were confirmed with 51,4% of them among persons aged 35 to 74-years-old. For all areas there was parallelism between sexes and the annual percent change combined was -5.2 (-5.7 to -4.6) from 1996 to 2005 and -3.0 (-4.3 to -1.7) from 2005 to 2011. The full period average APC of age-adjusted rates between persons living in the high-income area and low-income area were, respectively, -5.4 and -4.2 (p=0.002) for men and -5.9 vs -4.9 (p=0.017) for women. The difference between the affluent area and the low-income area increased over time in both sexes with the risk of stroke crescent and more than two-fold in the all period. Conclusions:Trends in stroke mortality were more favorable among higher than among lower socioeconomic groups with socioeconomic disparities crescent in both sexes in Sao Paulo, Brazil. P217 Increased thickness of the heart muscle as a measure of fitness in some sports, not a marker of pathology YM Ivanova1, V Pavlov1, AS Sharykin1, PA Subbotin1, AV Pachina1 1Moscow scientific and practical center medical reabilitation and sport medicine - Sportmed Clinic, Moscow, Russian Federation The main purpose of preventive and sports medicine is to determine the level of exercise tolerance without causing pathological cardiac remodeling, that criteria currently known. The goal of the study of the study to determine the presence of such a process in high-level athletes with different specificity of physical activity at the moment. Material and Methods:We examined 370 male athletes leading clubs in Russia in team sports. There are 250 soccer players (predominantly endurance training) and 120 ice hockey players (predominantly weight training). The average age of the athletes in soccer was 23,3 ± 4,7 years, and the players in ice hockey was 24,6 ± 3,8 years. We performed echocardiography and stress testing these athletes. Results and discussion:In the group of ice hockey players interventricular septum thickness in diastole was 11,3 ± 1,9 mm, the thickness of the posterior wall of the left ventricle 10,1 ± 1,1 mm. End diastolic dimension of the left ventricle 55,6 ± 3,9 mm, end systolic left ventricular size - 37,0 ± 3,7 mm. End-diastolic left ventricular volume was 152,6 ± 24,8 ml, end-systolic volume 59,5 ± 13,7 ml, ejection fraction (EF) 61,3 ± 5,4%. Left ventricular mass (LVM) in the group of ice hockey players was 243,9 ± 42,44 g. In the group of soccer players interventricular septum thickness in diastole was 10,0 ± 1,4 mm, the thickness of the posterior wall of the left ventricle 9,2 ± 1,2 (p<0,05) . End-diastolic size of the left ventricle was 53,1 ± 4,4 mm, end systolic left ventricular size of the left ventricle - 34,5 ± 3,8 mm. End-diastolic left ventricular volume at soccer player was 136 ± 25 ml, end-systolic volume - 50 ± 12 ml, EF was 63,7 ± 4,5%. LVM in the group of players was 227,1 ± 55,7 g (p<0,05). In these groups, appeared in 118 athletes (hockey and soccer) interventricular septum thickness in diastole values were in the range of 12 to 14 mm. In the group of athletes with high values respectively was significantly higher and myocardial mass (p <0,05), left ventricular end-diastolic, end-systolic (p <0.05) and left ventricular stroke volume (p <0,05). Thus in this group and performance parameters were significantly higher. We noted significantly higher peak oxygen consumption, lower rates of maximum heart rate, and heart at anaerobic threshold level (p <0,05). Conclusions:We can assume that the group of athletes with large values of different interventricular septum thickness greater fitness. Hypertrophy is not always a marker of disease, and may be a consequence of the different training-competitive pressures in different sports. P218 Elevated levels of cardiac enzymes in athletes during normal training conditions NA Polyanskiy1, V Pavlov1, ZG Ordzhonikidze1, VA Badtieva1, PA Subbotin1 1Moscow scientific and practical center medical reabilitation and sport medicine - Sportmed Clinic, Moscow, Russian Federation It is known that cardiac enzymes are one of the diagnostic methods of detection of acute myocardial injury. One of the most commonly used in medical practice indicators is the Creatine Kinase MB Isoenzyme (MB CK). There are cases of increasing cardiac enzyme in athletes after extremely heavy prolonged endurance events (Ironman triathlon, supermarathon and others). It is interesting the behavior of the cardiac enzyme under standard ordinary training and competitive process. The goal of the study is analyze cases of increase cardiac enzymes in athletes of different sports. Materials and methods:a medical examination of 455 professional athletes was performed in Sports Medicine Clinic of Moscow. 209 of them were female athletes, and 236 were male athletes. For all athletes performed basic biochemical analysis of blood (including MB CK), ECG in supine position at rest, heart ultrasound examination and other studies necessary for excluding cardiovascular disease. The maximum normal level of creatine kinase MB (reference value) was 25 U/l. The average age of the athletes was 19,0±4,1 years (athletes from 14 to 30 years). Results and discussion:elevated level of CK-MB had 85 athletes (18,6% of all athletes), and results 51 athletes, had the highest rates of creatine kinase MB were analyzed. 10 (80,4%) of athletes with elevated MB CK were male, and 10 (19,6%) were female (p <0,001 compared with all population of athletes). The average age of the athletes with elevated CK-MB did not differ significantly. 9 athletes (17,65%) in the study group of athletes engaged in rugby, 7 athletes (13,73%) participated in different styles of fight, 5 athletes (9,80%) participated in the ice hockey and the same practiced the track and field (picture). The highest CK-MB level CK-MB were registered in male athletes 18 years aged engaged in Water polo (216,4 U/l, which exceeds the reference values 8,7 times). All athletes (100%) had an increase MB CK had high training load for the day before the study. None of the athlete, who had an increase MB CK, registered damage to the heart muscle at a more profound examination. Conclusions:Approximately at 1/6 parts of professional athletes during normal training conditions, found to have elevated MB CK, sometimes reaching of very high, which is not a sign of a clinically significant myocardial damage. This can cause a false positive diagnosis of myocardial infarction. The percentage of male athletes who had a high level of MB CK was higher than percentage of female athletes, which may suggest the role of muscle mass in raising the probability of elevating the level of CK-MB. P703 Pre-participation cardiovascular screening of football referees: clinical findings and experience L Maskhulia1, V Akhalkatsi1, K Chelidze1, Z Kakhabrishvili1, M Matiashvili1, N Chabashvili1, T Chutkerashvili1 1Tbilisi State Medical Unversity, Tbilisi, Georgia, Republic of Football referees experience similar physical workloads to professional players during a match as well as long-term, frequent, intensive weekday training. Therefore referees are at the same risk for exercise-related sudden cardiac death (SCD) due to underlying cardiac disorder. Topic: Sports cardiology Purpose:to analyze cardiovascular findings obtained in the pre-participation screening (PPS) of the national category Georgian football referees. Methods:In January 2014, 67 professional male football referees underwent pre-participation cardiovascular(CV) screening with medical history,physical examination, 12-lead resting and exercise ECG,and transthoracic echochardiography (TTE). Results:Mean±SD values for the 67 referees were:age 37,2±4,1 years,body mass index 24,7±2,43kg/m2, body surface area 1,8±0,17m2. None of them reported family history of SCD. Hypertension at rest was found in 5(7,5%) referees. Resting ECG revealed common/training–related ECG alterations in 25(37,3%) referees, as well as uncommon/training-unrelated changes:T-wave inversion in inferior leads in 2(3%), left axis deviation in 2(3%),frequent premature ventricular contractions in 3(4,5%), though based on the further examination these findings were not associated with presence of CV pathology. Echocardiographic data were following:interventricular septum and posterior wall in diastole 9,89±1,47mm and 9,57±1,51mm respectively,LV end diastolic diameter 52,74±2,67mm,LV mass index 118,2±19,83g/m2; LV ejection fraction(65,8±3,4) and diastolic function(E/A-1,8±0,22, E/E'-6±0,34).TTE revealed mitral valve prolapse in 4(6%) referees and bicuspid aortic valve in 1(1,5%). Maximal oxygen uptake of referees was 50,4±2.7ml/kg/min. During exercise testing none of them complained about symptoms relevant to myocardial ischemia, whereas 2(3%) referees showed ST segment depression =2mm in leads V4-V6. As in the athletes aged =35 years SCD is most commonly associated with coronary heart disease(CHD), both referees were directed to further CV investigation. Of these 2 referees one(42 y.o) showed coronary abnormality requiring treatment. Exercise hypertension was revealed in 7 referees(10,4%), though all of them had normal blood pressure at rest and no pathological echo findings. No relevant arrhythmias were revealed during exercise ECG. Conclusions:PPS is useful to identify referees at risk for exercise-induced SCD and should be repeated on a regular base. Exercise testing should be included in the PPS protocol to reveal referees with occult CHD. Hypertension frequently present in referees but seems not to be a limiting factor, however further investigations are needed. P219 Screening for cardiovascular disease in british army recruits with or without an additional electrocardiogram and echocardiography AT Cox1, H Burrows2, R Garner2, J Attwood2, I Parsons3, R Chamley3, D Cannie4, E Behr1, D Wilson3, S Sharma1 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom 2Echotech Ltd, Portsmouth, United Kingdom 3Royal Centre of Defence Medicine, Birmingham, United Kingdom 4St George's Healthcare NHS Trust, London, United Kingdom Background:The British Army Initial Recruit Medical includes a history and physical examination. The study objective was to compare the incremental value of adding an electrocardiogram (ECG) and echocardiogram to this medical, in order to detect cardiac disease. Methods:A physical examination, ECG and echocardiogram were prospectively performed in volunteers when there was no history suggestive of cardiac disease. Electrocardiograms and echocardiograms were analysed according to published criteria. Further investigations were determined by clinical need. A pragmatic ?128;?Gold standard' of ECG, echocardiogram and other investigations elsewhere, when clinically indicated, was used. Enlistment eligibility was decided using military guidelines. Results:812 candidates volunteered. A murmur was detected in 73 (8.9%) candidates, 98 (12.1%) had an ECG abnormality and 161 (19.8%) had either a murmur or ECG abnormality. Sixteen candidates were diagnosed with disease on the day. Seventeen candidates (2.1%) required further cardiac investigations with disease ultimately excluded in sixteen (2.0%). Cardiac disease was detected in seventeen (2.1%) candidates with six conditions associated with sudden death in asymptomatic individuals. Thirteen (1.6%) candidates were prevented from enlisting. Diagnostic test evaluation:Physical examination only: Sensitivity: 52.94%, Specificity: 91.95%, Positive Predictive Value: 12.33%, Negative Predictive Value: 98.92%. Additional electrocardiogram: Sensitivity: 88.24%, Specificity: 81.53%, Positive Predictive Value: 9.26%, Negative Predicted Value: 99.69%. Conclusions:Adding an ECG to the Initial Recruit Medical is more sensitive in identifying disease than physical examination alone, but has a higher false-positive rate. When physical examination or ECG abnormalities are discovered additional echocardiography reduces the failure rate on the day to 4.1%. P220 Comparative evaluation of the impact strength and aerobic training on the biological reserves of adaptation to physical exercise in healthy people T Lelyavina1, MYU Sitnikova1, EV Shlyakhto1 1Almazov Federal Center of Heart Blood & Endocrinology, Saint Petersburg, Russian Federation Topic: Sports cardiology Purpose:to perform comparative evaluation of the impact strength and aerobic training on the biological reserves of adaptation to physical exercise (PE) in healthy people. Methods:The study included 25 healthy people (21 men) age - 27,0+/-5,7, BMI, 25+/-2,8 kg/m2. Participants were divided into two groups of 12 and 13 people. First group for the 12 weeks performed aerobic training (AT), consisting in the daily running of 40-60 minutes with heart rate not exceeding 130 bpm. Second group for the 12 weeks perform strength training (ST) of 8 major muscle groups. Cardiopulmonary testing (CPET) was performed initially and after 12 weeks of training on treadmill using equipment «F#158;??¾? Pro». For each participant was created individual exercise protocol continuously increasing load, composed in such a way that the maximum effort reached in 12-15 min. Studied were instructed to perform maximum effort (respiratory exchange relations (RER) above 1.15, the achievement of a «plateau» in the curve of VO2). The cubital venous catheter was inserted in all subjects before CPET. Blood samples were taken at baseline and at 1-minute intervals during test. PH, lactate and HCO3- concentration were estimated using analyzer i-STAT, cartridge CG4 (Abbot, USA). The state of biological reserves of adaptation to the PE was determined by changes in the level of lactate, pH, and HCO3 in venous blood and change of gas exchange. Results:In both groups it was registered a significant increase in VO2 after 12 weeks of training compared with the initial rates. In AT group - 32+/-3,1 ml/min/kg to 38+/-2.5 ml/min/kg, p<0.01; in ST group - 31+/-2,8 ml/min/kg to 36+/-3.0 ml/min/kg, p<0.05., there were substantial differences in change of lactate and pH at peak exercise in AT and ST groups. Lactate levels at the peak of exercise initially and after 12 weeks in AT group were 6.5+/-1,7 and 7.5+/-1,2 mmol/l, respectively, p<0.05. In ST Lactate levels at the peak of exercise group initially and after12 weeks were 6.4 of+/-1.5 and 12.7+/-3,5 mmol/l, respectively, p<0.001. pH-levels at the peak exercise initially and after 12 weeks in AT group were 7.34+/-0.03 and 7.32+/-0.02 mmol/l, respectively, p>0.05. In ST group pH-levels at the peak exercise initially and after12 weeks were 7.33+/-0.03 and 7.19+/-0.03 mmol/l, respectively, p<0.001. Conclusion:The strength training have significantly more marked effect on increasing the buffer adaptation reserves to physical exercise than aerobic training. P221 Comparing the left ventricular wall thickness and chamber diameter of South-East Asian, Caucasian and Afro-Caribbean footballers. A Malhotra1, D Stuckey1, H Dhutia1, R Narain1, T Keteepe-Arachi1, A De Silva1, K Prakash1, G Finnochiaro1, M Papadakis1, S Sharma1 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom Topic: Sports cardiology Purpose:While Caucasian and Afro-Caribbean footballers comprise the vast majority of professional footballers in the UK (75% and 20% respectively), players of South-East (SE) Asian ethnicity (Indian subcontinent) are an emerging as a growing entity at all levels. The cardiac parameters of this particular group has not been well-described as a cohort. This study aimed to evaluate the maximum left ventricular wall thickness (MLVWT) and end diastolic diameter (LVEDD) in a group of SE Asian footballers and compare these to Caucasian and Afro-Caribbean footballers. Methods:Between May 2000- July 20104, 80 SE Asian, 641 Afro-Caribbean and 3,712 Caucasian male professional footballers underwent echocardiography as part of a cardiac pre-participation screening. The left ventricular measurements were observed by 2 independent cardiologists trained in echocardiography. Results:Caucasian footballers demonstrate a significantly greater LVEDD than both Afro-Caribbean and SE Asian players (52.2 vs 51.0 mm, p<0.001; 52.2 vs 50.7mm, p=0.0024 respectively). Conversely, a significantly greater MLVWT was observed in Afro-Caribbean footballers when compared with both Caucasians (11.1 vs 10.7mm, p<0.001) and SE Asians (11.1 vs 10.7mm, p=0.0488). No statistically significant difference was noted between the MLVWT of SE Asians and Caucasians (p=0.93). These findings are summarised in Table 1. Those with MLVWT and LVEDD higher than conventionally accepted upper limits were investigated comprehensively at a dedicated sports cardiology clinic with no cardiomyopathy identified. Conclusions:SE Asian footballers exhibited similar MLVWT measurements to Caucasians, but lower that those observed in Afro-Caribbean athletes. These data provide important physiological data relating to the left ventricle which should facilitate the differentiation between athlete's heart and hypertrophic cardiomyopathy in athletes of South-East Asian origin, who are participating in greater numbers in competitive sport. Ethnicity Mean LVEDD±SD (mm) Range (mm) Mean MLVWT ±SD (mm) Range (mm) Caucasian 52.2 ± 4.2 30-66 10.7 ± 1.6 6-15 Afro-Caribbean 51.0 ± 4.2 38-62 11.1 ± 1.9 7-16 South-East Asian 50.7 ± 3.1 44-58 10.7 ± 2.0 6-15 Ethnicity Mean LVEDD±SD (mm) Range (mm) Mean MLVWT ±SD (mm) Range (mm) Caucasian 52.2 ± 4.2 30-66 10.7 ± 1.6 6-15 Afro-Caribbean 51.0 ± 4.2 38-62 11.1 ± 1.9 7-16 South-East Asian 50.7 ± 3.1 44-58 10.7 ± 2.0 6-15 Open in new tab Ethnicity Mean LVEDD±SD (mm) Range (mm) Mean MLVWT ±SD (mm) Range (mm) Caucasian 52.2 ± 4.2 30-66 10.7 ± 1.6 6-15 Afro-Caribbean 51.0 ± 4.2 38-62 11.1 ± 1.9 7-16 South-East Asian 50.7 ± 3.1 44-58 10.7 ± 2.0 6-15 Ethnicity Mean LVEDD±SD (mm) Range (mm) Mean MLVWT ±SD (mm) Range (mm) Caucasian 52.2 ± 4.2 30-66 10.7 ± 1.6 6-15 Afro-Caribbean 51.0 ± 4.2 38-62 11.1 ± 1.9 7-16 South-East Asian 50.7 ± 3.1 44-58 10.7 ± 2.0 6-15 Open in new tab P222 Prevalence and clinical significance of U-wave in elite athletes G Finocchiaro1, H Dhutia1, E San Damaso1, M Papadakis1, S Sharma1 1St George's University of London, London, United Kingdom Background:and aim: Electrocardiographic (ECG) U waves (Uw) are considered a benign finding in the general population but have also been associated with disease states such as myocardial ischemia. There is also an impression that UW are frequently present in the athlete's ECG, but its exact prevalence and its potential association with athletic activity remains unknown. The aim of the study was to describe the prevalence of U waves in a large cohort of athletes and to investigate its relationship with clinical and echocardiographic parameters. Methods:We evaluated a cohort of 340 elite athletes (mean age 20±5 years, males 55%, Caucasian 88%) and a sex and age matched sedentary control population (n=246), consecutively studied with ECG and echocardiogram. U-waves were defined as positive deflections following the T wave seen in at least two consecutive leads. Left ventricular mass (LVM) was calculated using the ASE formula and indexed for BSA. Results:U-waves were observed in 71% of athletes (n=244) and in 42% of sedentary population (n=103), p<0.001. The prevalence of U-waves was similar in male and female athletes (75% vs. 67%, p=0.13) and did not correlate with age, ethnicity, type of sport or hours of exercise per week. Athletes with U-waves had similar mean heart rate to those without U-waves (61±11 vs. 62±13 bpm, p=0.43). Of the echocardiographic indices, only LV mass was significantly higher in the presence of Uw (92±18 g/m2 vs. 87±19 g/m2, p=0.04). None of the athletes was diagnosed with underlying cardiomyopathy. Conclusions:U-waves are significantly more common in elite athletes than in sedentary population and are not associated with pathology. They are associated with increased LVM, indicating a potential association with training related left ventricular hypertrophy. Open in new tabDownload slide P223 Ventricular ectopy in athletes: should we worry? K Prakash1, H Dhutia1, E San Damaso1, A Malhotra1, G Mellor1, A Meghani1, R Narain1, L Millar1, M Papadakis1, S Sharma1 1St George's University of London, London, United Kingdom Topic: Sports cardiology Purpose:This study aimed to evaluate the prevalence of ventricular ectopy (VE) in athletes and to identify if there is any correlation between the presence of VE and echocardiographic parameters. Methods:Data was reviewed from a database of 19,888 individuals (14-35 years) who underwent cardiac evaluation with an ECG between 2011-2013. Athletes (those participating in regular competition or =10 hours of exercise per week) comprised of 32% (n=6407) of the overall cohort. Individuals with =1 VE on the standard 12-lead ECG were identified. Echocardiographic features of athletes with VE were compared with a group of healthy athletes (n=306) with a normal ECG who underwent ECG and ECHO as part of standard screening. Results:The prevalence of VE was similar in both groups: 0.6% (n=36) in athletes, 0.6% (n=75) in non-athletes. The commonest type of ectopy was of right ventricular outflow tract origin in both groups (figure). Comparison of ECHO indices between athletes with VE and the control athletes group failed to identify any significant differences with respect to left ventricular cavity size (LVIDd), maximum and relative wall thickness, fractional shortening or right ventricular dimensions. Individuals with =2 ectopics however, exhibited significantly larger LVIDd (54.3mm) compared to the control group (52mm), p<0.05. Conclusions:The current study identified a prevalence of VE on the 12-lead ECG of 0.6% in young individuals. Our results do not support an association of VE with athletic activity, as the burden of VE was similar in athletes and non-athletes. Although athletes with =2 VE exhibited greater LVIDd compared to controls, further investigations and long term follow-up are necessary to delineate whether this represents physiological adaptation or structural heart disease. Open in new tabDownload slide © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586739pmid: 26078078

Young Investigator Award II - Exercise Basic & Translational Research Friday, 15 May 2015, 11:00-12:30 389 Evaluation of cardioprotective effect of glucagon-like peptide-1 analog in experiment TP Tuchina1, VA Zykov1, AY Babenko1, IB Krylova1, DA Lebedev1 1Federal Almazov Medical Research Centre, I, Saint Petersburg, Russian Federation The aim of the study was to evaluate the cardioprotective effects of insulin and exenatide, in a model of acute myocardial infarction(AMI) in diabetes mellitus type 2(T2DM). 40 white rats was modeled with T2DM (by injection of streptozotocin). For the selection of the rats were carried out to assess the level of glycemial. Groups (5-10 animals): -A insulin administration for 1.5 hours before ischemia (ISC) -B exenatide administration for 1.5 hours before ISC -C insulin administration after ISC -D exenatide administration after ISC - A control group of animals with T2DM 0 (start point) - Simulation of AMI. 40 minutes after AMI - removing the ligature in all groups. Continued therapy in groups A and B and initiation of therapy in groups C and D. 240 minutes from the main point-conducted morphological assessment by the size of the ischemic focus. There was evaluated the interrelation of necrosis toward ischemic area. In the group A, necrosis was 34.7%, B - 12.2%, C - 16.43%, D-21.5%. Conclusion:using of exenatide previous to developing of ischemia showed cardioprotective efficiency. 1-B exenatide (Byetta) for 1.5 hours before ischemia.2 - control group of animals with type 2 diabetes mellitus3-A-insulin for 1.5 hours before ischemia4-S-insulin after ischemia.5-D-exenatide (Byetta) after ischemia Group Byetta before ischemia Control Insulin before ischemia Insulin Byetta % of necrosis 12,02 18,63 34,7 16,43 21,5 average deviation ±2,2 ±3,1 ±3,4 ±2,2 ±2 Group Byetta before ischemia Control Insulin before ischemia Insulin Byetta % of necrosis 12,02 18,63 34,7 16,43 21,5 average deviation ±2,2 ±3,1 ±3,4 ±2,2 ±2 Open in new tab 1-B exenatide (Byetta) for 1.5 hours before ischemia.2 - control group of animals with type 2 diabetes mellitus3-A-insulin for 1.5 hours before ischemia4-S-insulin after ischemia.5-D-exenatide (Byetta) after ischemia Group Byetta before ischemia Control Insulin before ischemia Insulin Byetta % of necrosis 12,02 18,63 34,7 16,43 21,5 average deviation ±2,2 ±3,1 ±3,4 ±2,2 ±2 Group Byetta before ischemia Control Insulin before ischemia Insulin Byetta % of necrosis 12,02 18,63 34,7 16,43 21,5 average deviation ±2,2 ±3,1 ±3,4 ±2,2 ±2 Open in new tab Open in new tabDownload slide The percentage of necrosis from the risk 390 Reduced angiogenic capacity of human umbilical cord-derived vascular cells in offspring of pre-eclamptic pregnancy G Yu1, L Newton1, C Yang2, E Davis1, A Lewandowski1, T Kyriakou3, C Aye1, S Watt2, P Leeson1 1University of Oxford, Cardiovascular Clinical Research Facility, Cardiovascular Medicine, Oxford, United Kingdom 2Oxford University Hospitals NHS Trust, Stem Cell Institute, Oxford, United Kingdom 3University of Oxford, Wellcome Trust Center for Human Genetics, Oxford, United Kingdom Topic: Sports cardiology Purpose:Offspring of mothers who develop pre-eclampsia, defined as de novo onset of hypertension and proteinuria in pregnancy, are themselves at increased risk of hypertension. We tested the hypothesis that this relates to dysfunctional perinatal microvascular development in early life. Methods:We identified human umbilical cord vein endothelial cells (HUVECs) and linked clinical data, for babies born to both healthy and pre-eclamptic pregnancies, collected within a vascular tissue bioresource. As microtubule formation following HUVEC culture is a marker of angiogenic potential we analysed (1) HUVEC microtubule formation based on a Matrigel assay and verified findings using a bone marrow stromal co-culture assay; (2) proliferative ability was determined using the CyQUANT assay. Multiple linear regression was used to identify perinatal factors that predicted microtubule formation. Results:Samples from 29 human umbilical cords were studied (pre-eclamptic n=16, healthy controls n=13). In both Matrigel and bone marrow stromal co-culture assays, pre-eclamptic HUVECs had reduced total vascular tubule length (p=0.02 and p=0.03) and branch points (p=0.01 and p=0.02) compared to HUVECs from healthy donors, as well as decreased cell proliferative abilities (p<0.001). The main predictor of variation in microtubule formation parameters was a diagnosis of preeclampsia and this association remained significant (p=0.03) after accounting for other perinatal factors including gestational age and birth weight. Conclusions:Vascular cells derived from umbilical cords of offspring born following preeclampsia demonstrate significant reductions in their ability to develop complex microtubular networks. This reduced angiogenic capacity may be an early precursor of the cardiovascular dysfunction observed in offspring of pre-eclamptic mothers. 391 Effects of aerobic interval training versus continuous training on endothelial progenitor cells and endothelial microparticles in patients with coronary artery disease: A substudy from SAINTEX-CAD EM Van Craenenbroeck1, G Frederix1, N Pattyn2, A Gevaert1, PJ Beckers1, N Possemiers1, V Cornelissen2, CJ Vrints1, L Vanhees2, VY Hoymans1 1University of Antwerp Hospital (Edegem), Cardiology, Antwerp, Belgium 2KU Leuven, Department of Rehabilitation sciences, Leuven, Belgium Topic: Sports cardiology Purpose:Alterations in endothelial progenitor cells (EPC) and endothelial microparticles (EMP) might explain training-induced improvements in endothelial function in patients with coronary artery disease (CAD). We aimed to asses the differential effect of training modality (continuous versus interval training) on cellular blood markers of endothelial integrity, in relation to endothelial function. Methods:Two-hundred CAD patients (LVEF >40%, 90% male, age 58.4±9.1 years) were randomized on a 1:1 base to a supervised 12-week cardiac rehabilitation program of either aerobic interval training (AIT, 85-95% of peak HR) or aerobic continuous training (ACT, 65-75% of peak HR). At baseline and after 12 weeks, numbers of circulating CD34+/KDR+/CD45dim EPC and CD31+/CD42b- EMP were analysed by flow cytometry and peripheral endothelial function was assessed by flow-mediated dilation (FMD). Results:Mean training intensity was 88% of peak HR in the AIT group and 80% of peak HR in the ACT group. Peak VO2 and FMD increased significantly in both groups after 12 weeks (Table 1), with equal improvements in both training groups. After 12 weeks, numbers of circulating EPC and EMP were comparable to baseline levels, in both groups. Whereas the improvement in peak VO2 correlated to improvement in FMD (Pearson r = 0.17, p = 0.039), a direct correlation between baseline and training-induced changes EPC/EMP with endothelial function was absent. Conclusions:In this large randomized, multicentre trial we failed to demonstrate significant changes in numbers of EPC or EMP following exercise training in CAD, despite improvement in endothelial function. This is in contrast to known acute exercise-induced effects on EPC and EMP, suggesting that endothelial adaptation occurs gradually following exercise training. Mean (±SD) or Median (range) * p< 0.001, NS: not significant. EPC and EMP data were log transformed before analysis. ANCOVA with age and pathology as covariates was performed to test time, and interaction effects. AIT ACT 0 weeks 12 weeks 0 weeks 12 weeks F value time F value Interaction VO2peak (ml/kg/min) 23.5 (±5.7) 28.6 (±6.9) 22.4 (±5.6) 26.8 (±6.7) 28.18 * 0.16 NS FMD (%) 5.26 (±3.02) 6.47 (±2.79) 5.61 (±2.36) 6.68 (±3.04) 7.28 * 0.06 NS EPC (/106events) 8.2 (0-51) 7.4 (0-53) 9.5 (0-37) 10.6 (0-106) 0.13 NS 1.8 NS EMP (ul) 129 (47-756) 192 (47-755) 227 (80-715) 260 (60-922) 0.0 NS 0.8 NS AIT ACT 0 weeks 12 weeks 0 weeks 12 weeks F value time F value Interaction VO2peak (ml/kg/min) 23.5 (±5.7) 28.6 (±6.9) 22.4 (±5.6) 26.8 (±6.7) 28.18 * 0.16 NS FMD (%) 5.26 (±3.02) 6.47 (±2.79) 5.61 (±2.36) 6.68 (±3.04) 7.28 * 0.06 NS EPC (/106events) 8.2 (0-51) 7.4 (0-53) 9.5 (0-37) 10.6 (0-106) 0.13 NS 1.8 NS EMP (ul) 129 (47-756) 192 (47-755) 227 (80-715) 260 (60-922) 0.0 NS 0.8 NS Open in new tab Mean (±SD) or Median (range) * p< 0.001, NS: not significant. EPC and EMP data were log transformed before analysis. ANCOVA with age and pathology as covariates was performed to test time, and interaction effects. AIT ACT 0 weeks 12 weeks 0 weeks 12 weeks F value time F value Interaction VO2peak (ml/kg/min) 23.5 (±5.7) 28.6 (±6.9) 22.4 (±5.6) 26.8 (±6.7) 28.18 * 0.16 NS FMD (%) 5.26 (±3.02) 6.47 (±2.79) 5.61 (±2.36) 6.68 (±3.04) 7.28 * 0.06 NS EPC (/106events) 8.2 (0-51) 7.4 (0-53) 9.5 (0-37) 10.6 (0-106) 0.13 NS 1.8 NS EMP (ul) 129 (47-756) 192 (47-755) 227 (80-715) 260 (60-922) 0.0 NS 0.8 NS AIT ACT 0 weeks 12 weeks 0 weeks 12 weeks F value time F value Interaction VO2peak (ml/kg/min) 23.5 (±5.7) 28.6 (±6.9) 22.4 (±5.6) 26.8 (±6.7) 28.18 * 0.16 NS FMD (%) 5.26 (±3.02) 6.47 (±2.79) 5.61 (±2.36) 6.68 (±3.04) 7.28 * 0.06 NS EPC (/106events) 8.2 (0-51) 7.4 (0-53) 9.5 (0-37) 10.6 (0-106) 0.13 NS 1.8 NS EMP (ul) 129 (47-756) 192 (47-755) 227 (80-715) 260 (60-922) 0.0 NS 0.8 NS Open in new tab 392 Correlation between apoptosis reduction and functional capacity improvement after cardiac resynchronization in heart failure patients MA Nogueira1, A Abreu1, T Pinheiro2, H Santa Clara2, PS Cunha1, M Oliveira1, G Portugal1, M Selas2, R Soares1, R Cruz Ferreira1 1Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal 2Technical Superior Institute, Lisbon, Portugal Background:Apoptosis consists of an important pathomechanism in the progression of Chronic Heart Failure (CHF). Cardiac Resynchronization Therapy (CRT) is aimed to ameliorate functional capacity and induce reverse remodelling, but its effects on apoptosis are not well documented. Topic: Sports cardiology Purpose:To evaluate the apoptotic response modification in CHF patients after CRT and its potential correlation with improvement in functional capacity. Methods:We assessed a cohort of 64 CHF patients (P) consecutively implanting CRT, 64 % of which were male, with mean age 68±10 (34-87) years old. 25% of P had ischemic cardiomyopathy (ICM) and 75% nonischemic cardiomyopathy (NICMP). 67% of P were in class III and 33% in class II (NYHA), with left ventricular ejection fraction (LVEF) < 35%, under optimal pharmacological treatment. Both ischemic and nonischemic P had comparable clinical and demographic characteristics. Blood samples in order to evaluate the serum levels of soluble Fas Ligand (sFasL) and peak oxygen consumption (VO2) determined in cardiopulmonary exercise stress test were collected immediately before and at 3 and 6 months after CRT. Results:There was a statistically significant variation in sFasL levels from baseline (56.1 ± 24.9 pg/mL) to 3 months (62.7±32.2 pg/mL) and to 6 months post-CRT (60.6 ± 17.3 pg/mL), with p = 0.0001. There was also a statistically significant variation in peak VO2 from baseline (14.7 ± 2.9 mL/kg/min) to 3 months (16.8 ± 5.6 mL/kg/min) with p = 0.0001 and to 6 months post-CRT (16.7 ± 2.1 mL/kg/min) with p = 0.005. Finally, there was a statistically significant correlation between the variation of sFasL and peak VO2 at 6 months in both ischemic (R = 1.0; P = 0.01) and non-ischemic patients (R = -0.9; P = 0.05). Conclusions:In this cohort of chronic heart failure patients, there is a significant improvement in apoptosis after CRT, independently of the ischemic or nonischemic etiology of the cardiomyopathy and this correlates with an increase in functional capacity. Although this benefit becomes clear only after 6 months post-CRT implantation, further studies will be needed to corroborate these findings. 393 Physical activity to reduce blood pressure in young adults with increased cardiovascular risk: a systematic review and meta-analysis WJ Williamson1, H Reid2, P Kelly3, AJ Lewandowski1, H Boardman1, N Roberts4, C Foster2, P Leeson1 1University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom 2University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom 3University of Edinburgh, Physical Activity for Health Research Centre, Edinburgh, United Kingdom 4University of Oxford, Bodleian Health Care Libraries, Oxford, United Kingdom Topic: Sports cardiology Purpose:Young adults with cardiovascular risk factors, such as hypertension, may gain long-term risk benefits from effective, targeted lifestyle interventions. We performed a systematic review and meta-analysis of randomised control trials (RCTs) in young adult populations with cardiovascular risk factors to understand the potential impact of physical activity on blood pressure (BP) in this age group. Methods:Inclusion criteria included: RCTs with at least 12 weeks follow-up; exercise or lifestyle interventions with defined physical activity component; blood pressure primary outcome; mean age of participants 20 to 40 years or within one standard deviation of this range. An information specialist (NR) performed the database searches. Publications up to May 2014 were included. In pairs, four authors (WW, PK, AL, HR), screened the eligibility of trials. Titles selected for full review were discussed and disagreement settled with an independent pair of authors (CF and PL). Meta-analysis was completed using a random effects model imputing post intervention BP. Study protocol available on PROSPERO:CRD42014009604. Results:In total 8293 titles/abstracts were reviewed for eligibility, 603 were selected for full review, 13 studies satisfied all inclusion criteria. At baseline mean age of participants was 42.7 years (SD6.4) (n=3338). 11 trails targeted increased moderate to vigorous physical activity (MVPA) either via supervised exercise (n=8) or via behavioural counselling (n=3). One trial investigated effects of resistance exercise and 1 study implemented a yoga trial. Meta-analysis was restricted to the trials targeting increased MVPA with analysis performed according to duration of follow-up. In total 10 studies (n=2716) reported 3 to 6 months outcomes, mean reduction in systolic BP was –4.4mmHg (95%CI -5.8 to -3) and mean reduction in diastolic BP was –4.3 mmHg (95%CI -5.6 to -3.0). The sustained effectiveness at 3 to 5 year follow-up (3 studies, n=2553) was mean reduction in systolic BP of -1.3 mmHg (95%CI -2.9 to 0.3) and mean reduction in diastolic BP of –1.2 mmHg (95%CI -2.3 to -0.2). Conclusions:This review supports increasing MVPA through supervised exercise or behavioural counselling to achieve clinically significant improvements in blood pressure in younger adults with early cardiovascular risk. However, studies targeting blood pressure reduction in participants below the age of 40 years with cardiovascular risk factors are limited in number. It remains unclear how to translate short-term intervention effects into sustained reduction in blood pressure and cardiovascular risk. 394 Left ventricular geometry in preterm individuals at 3 months post-partum: insights from echocardiographic shape analysis R Upton1, C Aye1, E Davis1, A Lewandowski1, P Lamata2, P Leeson1 1University of Oxford, Oxford, United Kingdom 2King's College London, London, United Kingdom Introduction:Preterm birth is associated with abnormal left ventricular (LV) structure and function in adulthood. This may be due to abnormal in utero ventricular development, occur postnatally due to a premature transition to postnatal circulation or emerge during childhood. Objective:To develop and apply novel echocardiographic shape analysis techniques to determine whether differences in LV geometry are already evident by three months post-partum in preterm-born infants. Methods:- 35 preterm- and 18 term-born individuals (gestational age 34.32±2.4 and 38.71±1.1 respectively) underwent an echocardiographic examination at three months post-partum. Both endocardial and epicardial borders for apical four chamber views were manually contoured offline using TomTec CPA and exported as a binary coordinate file. Each contour was independently encoded with 52 degrees of freedom using cubic interpolation. Principal component analysis was performed to determine the different modes of geometric variation in the LV. Results:Significant differences were already evident by three months of age based on the apical four chamber view. Mode 1, which assesses overall size and shape of the LV (Fig. 1), demonstrated that preterm babies have significantly smaller ventricles in both length and diameter (P<0.001). Furthermore, mode 5 highlighted more spherical ventricles in preterm-born individuals (P<0.05) specifically in the lateral wall. Conclusion:– This novel echocardiographic shape analysis approach identifies significant LV geometric variation in preterm babies at three months post-partum, consistent with previous observations in adults born preterm. To prevent abnormal cardiac changes in those born preterm interventions in the perinatal period may be required. Open in new tabDownload slide © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586742pmid: 26078082

Rapid Fire Abstract Session II - Cardiac Rehabilitation & Exercise Basic & Translational Research Friday, 15 May 2015, 16:30-18:00 441 Cardiac rehabilitation for coronary patients in Europe: Results from the EUROASPIRE IV survey K Kotseva1, D De Bacquer2, C Jennings1, D Wood1 1National Heart and Lung Institute, Imperial College London, London, United Kingdom 2Ghent University, Ghent, Belgium Topic: Sports cardiology Purpose:To describe lifestyle and risk factor management, and the use of cardioprotective drug therapies in coronary patients participating in cardiac rehabilitation programme (CRP) compared to those who do not. Methods:The EUROASPIRE IV survey was a cross-sectional study undertaken at 78 centres from 24 European countries. Consecutive patients aged <80 years after CABG, PCI or acute coronary syndrome were identified from hospital records and interviewed and examined at least 6 months after their coronary event. Results:A total of 16,426 medical records were reviewed and 7998 patients (24.4% females) interviewed on average 16 months after having experienced a cardiac event. Overall, 50.7% of patients were advised to participate in a CRP after hospitalisation for a coronary event and 81.3% of these patients attended at least half of the sessions; being only 41.2% of the whole study population. There were wide variations between countries, ranging from 0.0% in Greece and Cyprus to 91.1% in Lithuania. Comparing coronary patients who participated in CRP (at least one session) with those who did not, the prevalences of the risk factors were as follows (p-values adjusted for age, gender and center): current smoking 14.1% vs. 17.4% (p<0.0001); obesity (BMI = 30 kg/m2) 35.1% vs. 39.6% (p=0.01); raised blood pressure (BP = 140/90 mmHg, = 140/80 mmHg in patients with diabetes) 42.8% vs. 42.7% (p=0.002); elevated LDL-cholesterol (= 1.8 mmol/l) 80.2% vs. 80.6% (p=0.08). Reported use of prophylactic drug therapies for the same comparison was: antiplatelets 94.0% vs. 93.6% (p=0.16); beta-blockers 84.1% vs. 81.5% (p=0.001); ACE inhibitors/ARBs 75.6% vs. 74.6% (p= 0.26); and statins 87.3% vs. 84.4% (p<0.0001). Conclusions:Just over 40% of coronary patients reported attending a CRP. Although the control of smoking, obesity and the use of cardioprotective medication is better in those who attended CPR many patients had not achieved the lifestyle and risk factor targets. There is an urgent need to offer comprehensive, multidisciplinary prevention programmes addressing all aspects of the lifestyle, other risk factors and therapeutic management for all patients with established coronary or other atherosclerotic disease. 443 The value of nutritional status in the prognostic assessment of heart failure M T La Rovere1, R Maestri1, A Caporotondi1, M De Salvo1, F Olmetti1, O Febo1 1Fondazione S. Maugeri, IRCCS, Montescano (Pavia), Italy Topic: Sports cardiology Purpose:Despite the recognized value for malnutrition in HF, the assessment of nutritional status is generally not incorporated in existing risk prediction models except for body weight or the BMI. We tested the hypothesis that an objective nutritional index (Controlling Nutritional Status, CONUT score, obtained from serum albumin level, total cholesterol and lymphocyte count) might add to a prediction model based on a on a clinical score including BMI (MAGGIC) and functional capacity (six minute walking test, 6MWT) obtained at pre-discharge. Methods:We analysed data from 466 consecutive patients (mean age 61±11 years, NYHA class 2.6±0.6, LVEF 34±11%, BMI 27.2±4.5, Hb 13.5±1.8 g/dl, serum albumin 4.6±0.4 mg/dl, creatinine 1.4±0.4 mg/dl, Na 138±2.8 mEq/l) who had pre-discharge data to compute the MAGGIC and the CONUT score and who were able to complete a pre-discharge 6mWT. Nutritional status by CONUT was classified as normal (0-1), mild (2-4), moderate (5-8), and severe (9-12). Cox regression models were used to assess the association between predictors and all-cause mortality. Results:Signs of mild or moderate undernourishment (CONUT > 1) were present in 251 patients (54%) despite no difference in BMI (27.1±4.5 vs 27.3±4.6). None of the patients showed a CONUT score > 8 indicating severe malnutrition. Undernourished patients were older, with more advanced NYHA class, lower systolic arterial pressure and hemoglobin levels, higher creatinine levels and increased atrial fibrillation (all p<0.001). The MAGGIC score and the 6MWT also differed significantly (p<0.0001). The 12-month event rate was 7.7% (36 events), passing from 4% for well-nourished to 11 % for undernourished patients (p=0.008). The CONUT score was predictive for all-cause mortality [HR 1.70, 95%CI 1.36-2.12, p<0.0001]. Multivariate analyses showed that the CONUT significantly added to the combination of MAGGIC + 6MWT. The addition of CONUT improved predictive discrimination (c-index: 0.819, 95% CI 0.754-0.884 vs 0.804, 95% CI 0.737-0.872 with and without CONUT) and this improvement was statistically significant (integrated discrimination improvement 0.028, 95% CI 0.015-0.081). Conclusions:In HF patients assessment of nutritional status, significantly improves prediction of 12-month mortality on top of the information provided by clinical evaluation and functional capacity and should be incorporated in the overall assessment of HF patients. 444 Investigating the effectiveness of an internet-based telerehabilitation program on coronary artery disease and heart failure patients' physical activity level and physical fitness I Frederix1, D Hansen1, N Van Driessche2, K Coninx1, P Vandervoort3, P Dendale2 1Hasselt University, Hasselt, Belgium 2Heart Centre Hasselt, Hasselt, Belgium 3Hospital Oost-Limburg (ZOL), Cardiology Department, Genk, Belgium Topic: Sports cardiology Purpose:Most cardiac patients return to their sedentary lifestyle after the acute rehabilitation phase (after 6 weeks of rehabilitation). We evaluated whether the addition of an internet-based telerehabilitation program to conventional rehabilitation could result in an increase in patients' daily physical activity level and/or physical fitness. Methods:This study is a multi-centric randomized controlled trial, that runs from February 2013-2015. Cardiac patients initially hospitalized for coronary artery disease or heart failure were included during phase II of their cardiac rehabilitation program. Patients in the intervention group (n=70) were stratified in different subgroups according to cardiovascular risk factor profile and exercise tolerance to achieve a personalised exercise protocol for the telerehabilitation program. Patients wore a motion sensor for 6 months. Each week they received feedback messages (via e-mail and/or SMS) to gradually increase their activity level conform their prescribed exercise protocol. A webpage enabled the patients to monitor the progression of their activities. In the control group (n=70), patients wore the motion sensor three times for 9 days (week 1, 6 and 24) for measurement purposes only. They did not receive feedback. Results:Preliminary data are presented for the 6-week follow-up period. The Wilcoxon test showed a significant increase in daily activity level (both regular and aerobic steps) between week 1 and week 6 (P=0.003 and P=0.009 respectively) in the intervention group, and VO2max (% predicted) increased from 89.9±17.4 to 93.7±18.9 (P=0.0165). In the control group only regular daily steps increased during follow-up period (p=0.02) (Table 1). Conclusions:The addition of a 6-week internet-based patient specific telerehabilitation intervention to standard cardiac rehabilitation was effective in further increasing the cardiac patient's daily physical activity level and physical fitness. Changes in mean (SD) regular and/or aerobic daily steps and mean (SD) VO2 max. § indicates a significant increase between week 1 and 6. Week 1 Week 6 Week 6-week 1 P-value Week 1 Week 6 Week 6-week 1 P-value Intervention Group Control group Regular daily steps 7813.0 (3986.0) 9120.0 (6232.0) 1307.0 (3123.0) 0.003§ 6278.0 (3442.0) 7238.0 (2998.0) 960.0 (1839.0) 0.02§ Aerobic daily steps 3878.0 (3772.0) 4952.0 (6306.0) 1054.0 (3063.0) 0.009§ 2540.0 (2615.0) 2770.0 (2833.0) 230.0 (2439.0) 0.381 VO2 max (% predicted) 89.9 (17.4) 93.7 (18.9) 3.8 (8.9) 0.0165§ 87.8 (20.2) 87.3 (18.7) -0.5 (10.2) 0.6960 Week 1 Week 6 Week 6-week 1 P-value Week 1 Week 6 Week 6-week 1 P-value Intervention Group Control group Regular daily steps 7813.0 (3986.0) 9120.0 (6232.0) 1307.0 (3123.0) 0.003§ 6278.0 (3442.0) 7238.0 (2998.0) 960.0 (1839.0) 0.02§ Aerobic daily steps 3878.0 (3772.0) 4952.0 (6306.0) 1054.0 (3063.0) 0.009§ 2540.0 (2615.0) 2770.0 (2833.0) 230.0 (2439.0) 0.381 VO2 max (% predicted) 89.9 (17.4) 93.7 (18.9) 3.8 (8.9) 0.0165§ 87.8 (20.2) 87.3 (18.7) -0.5 (10.2) 0.6960 Open in new tab Changes in mean (SD) regular and/or aerobic daily steps and mean (SD) VO2 max. § indicates a significant increase between week 1 and 6. Week 1 Week 6 Week 6-week 1 P-value Week 1 Week 6 Week 6-week 1 P-value Intervention Group Control group Regular daily steps 7813.0 (3986.0) 9120.0 (6232.0) 1307.0 (3123.0) 0.003§ 6278.0 (3442.0) 7238.0 (2998.0) 960.0 (1839.0) 0.02§ Aerobic daily steps 3878.0 (3772.0) 4952.0 (6306.0) 1054.0 (3063.0) 0.009§ 2540.0 (2615.0) 2770.0 (2833.0) 230.0 (2439.0) 0.381 VO2 max (% predicted) 89.9 (17.4) 93.7 (18.9) 3.8 (8.9) 0.0165§ 87.8 (20.2) 87.3 (18.7) -0.5 (10.2) 0.6960 Week 1 Week 6 Week 6-week 1 P-value Week 1 Week 6 Week 6-week 1 P-value Intervention Group Control group Regular daily steps 7813.0 (3986.0) 9120.0 (6232.0) 1307.0 (3123.0) 0.003§ 6278.0 (3442.0) 7238.0 (2998.0) 960.0 (1839.0) 0.02§ Aerobic daily steps 3878.0 (3772.0) 4952.0 (6306.0) 1054.0 (3063.0) 0.009§ 2540.0 (2615.0) 2770.0 (2833.0) 230.0 (2439.0) 0.381 VO2 max (% predicted) 89.9 (17.4) 93.7 (18.9) 3.8 (8.9) 0.0165§ 87.8 (20.2) 87.3 (18.7) -0.5 (10.2) 0.6960 Open in new tab 445 In-class active videogame supplementation and adherence to cardiac rehabilitation: a pilot randomized controlled study J Ruivo1, K Karim2, R Oshea2, J Gormley1 1Trinity College Centre for Health Sciences, Dublin, Ireland 2Kerry General Hospital, Kerry Co, Ireland Topic: Sports cardiology Purpose:The application of active videogames (AVGs) during Cardiac rehabilitation (CR) sessions could potentially facilitate patients' adherence, reducing future cardiovascular (CV) mortality. We aimed to investigate the feasibility, safety and efficacy of in class AVG supplementation as an alternative to conventional phase II programs. Methods:A pilot, evaluator blinded, intention-to-treat, randomized controlled trial was conducted. Thirty-two low-moderate risk CR participants were recruited and allocated to conventional or AVG-supplemented exercise. In the intervention arm, 2 conventional circuit stations were replaced by sports AVGs. Both groups were subject to equal exercise load, twice weekly for 6 weeks. Patients were assessed at baseline, at the end of the program and again after 8 weeks of follow up. Compliance and safety related outcomes were the primary endpoints. Secondary outcomes included exercise capacity (maximal treadmill stress test), daily physical activity (activity monitor) and psychometric profiling (PANAS, HADS and MacNew Heart Disease HRQL questionnaires) change. Results:Demographically, 81% of the patients were males (60±10 years), presenting with the typical CV risk factors and similar baseline testing results. The majority of AVG participants (93%) did not perceive to be at increased risk, and 87% considered them user-friendly. Although 93% of participants enjoyed them, only 47% found the AVGs an extra-stimulus to attend classes. Eighty percent found themselves to be more talkative due to the interactive experience. At the end of the program there was a lower tendency for discontinuation among AVG participants (6 vs. 19%, p>0,05), signifying a number needed to treat (NNT) of 8. No significant difference in adverse medical events was reported, nor in exercise capacity evolution. AVG participants revealed a significant improvement in physical activity [322 vs. 247 AAU/min, p=0.047], and related energy expenditure per body weight [13 vs. 11 KCal/Kg/day, p=0.04] compared to controls. No change difference between groups was reported at 6th and 14th week in affect towards exercise, anxiety, depression or quality of life. Conclusions:The additional use of AVGs during CR sessions is a feasible and safe intervention. It has also shown to effectively improve daily physical activity and energy expenditure. A clinically significant NNT of 8 to prevent 1 additional dropout was reported, making in class AVG supplementation a promising strategy to increase CR adherence in the future. 446 Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation - a systematic review and descriptive meta-analysis. J Cornelis1, J Taeymans2, W Hens1, P Beckers3, C Vrints3, D Vissers1 1University of Antwerp, Department of Physiotherapy (REVAKI), Antwerp, Belgium 2Bern University of Applied Sciences, Health, Bern, Switzerland 3University of Antwerp Hospital (Edegem), Department of Cardiology, Antwerp, Belgium Topic: Sports cardiology Purpose:The purpose of this review was to describe the occurrence of prognostic variables as derived from cardiopulmonary exercise testing (CPET) in patients with heart failure (HF), presenting exercise oscillatory ventilation (EOV) compared to patients without EOV. The effect of EOV on peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2) slope, oxygen uptake efficiency slope (OUES), rest and peak pulmonary end-tidal carbon dioxide pressure (PETCO2) was meta-analysed. Methods:A systematic search strategy was performed in five databases (Pubmed, Cochrane Library, PEDro, Science Direct and Web of Science), assessing 252 articles for eligibility. Nineteen citations met the inclusion criteria totalling 3032 patients with HF (EOV=1111; non-EOV=1921). The risk of bias was assessed by two researchers. Extracted data were pooled using random or fixed effects meta-analysis, if appropriate. The level of significance was set at P =0.05. Results:Overall, presentation of EOV significantly indicated aggravated prognostic markers. Sub-study analysis revealed left ventricular ejection fraction (LVEF) and mode of CPET protocol as independent factors, whereas defining EOV significantly influenced the results. A meta-analysis of studies reporting hazard ratios for cardiovascular events demonstrated that HF patients with EOV run a fourfold risk for an adverse event compared to HF patients without EOV. Conclusions:These findings suggest that the presence of EOV in patients with HF is associated with a deterioration of prognostic CPET parameters. Therefore, EOV could be an important marker in prognosis of patients with HF. Based upon these results, we suggest to include the assessment of EOV in the standard evaluation protocol of cardiopulmonary exercise testing. 447 The micro-RNA miR483is upregulated in diabetes mellitus type 2 and limits vascular repair response after injury N Kraenkel1, K Kuschnerus1, M Mueller2, N Berardi3, R Klingenberg2, TF Luescher2, U Landmesser1 1Charité - Universit?medizin Berlin, Berlin, Germany 2University Hospital Zurich, Heart Center, Zurich, Switzerland 3University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland Patients with diabetes mellitus show an accelerated loss of endothelial function. We have observed higher levels of the miR-483-3p in circulating cells of patients with type 2 diabetes mellitus (T2D). The role of this micro-RNA in vascular biology is so far unclear. We therefore investigated the role of the miR-483-3p for the maintenance of endothelial homeostasis and for the response to acute vascular injury. Methods:Myeloid early outgrowth cells (EOC) were obtained from healthy volunteers (H), as well as from patients with stable coronary artery disease (CAD) with or without additional type 2 diabetes mellitus (T2D). commercially available human aortic endothelial cells (HAEC) or EOC were transfected with mimic of miR-483-3p (mi483), Power Inhibitor of miR-483-3p (anti483), or scrambled control oligonucleotide (scr) by electroporation. Expression of miR-483-3p was verified by RT-qPCR. Apoptosis of HAEC was assessed by flow cytometry at 1, 2, 3 and 4 days after transfection to determine the time point of the main effect. The ability of the transfected HAEC and EOC to support in vitro and in vivo re-endothelialization were assessed after 1 (in vitro) and after 3 days (in vivo). RT2 profiler qPCR assay was used to screen for potential targets. Results:Transfection of HAEC with mir-483 induced apoptosis in HAEC with a maximal effect after 24h (mi483: 13.6±3.1% vs. scr: 4.2±1.7%; p=0.004) and limited in vitro re-endothelialization (mi483: -0.5±3.2% vs. scr: 7.9±1.0%; p=0.03). Transfection of H-EOC with mi483 reduced their capacity to support re-endothelialization in vitro and in a mouse model of acute vascular injury (mi483: 33.5±3.2% vs. scr: 24.8±2.3%; p<0.05). Vice versa, transfection of T2D-EOC with anti483 enhanced their capacity to support in vivo re-endothelialization (anti483: 31.2±3.1% vs. scr: 21.6±2.6%; p=0.03). Three adaptor proteins of the extrinsic pathway of apoptosis induction - CFLAR, TRADD and NOL-3 – were identified as potential targets of miR-483-3p. Conclusion:Upregulation of miR-483-3p in CAD and T2D may limit the capacity of endothelial cells to resist the initiation of apoptosis, thereby endangering endothelial survival as well as the repair response towards vascular injury. We have shown that overexpression of miR-483-3p in two cell types critical for vascular function – endothelial cells and EOCs, which paracrinally support endothelial function – can reduce endothelial regeneration after an acute injury in vitro and in vivo. Decreasing miR-483-3p levels in patients with T2D could help to rescue endothelial repair capacity and potentially endothelial function. 448 Utility of speckle tracking parameters for the assessment of two exercise training protocols on congestive heart failure Y Blumberg1, O Ertracht2, I Gershon1, D Barequet1, S Atar3 1Bar-Ilan University, Faculty of Medicine, Safed, Israel 2Nahariya Hospital for the Western Galilee, Eliachar Research Laboratory, Nahariya, Israel 3Nahariya Hospital for the Western Galilee, Cardiology, Nahariya, Israel Introduction:Congestive heart failure (CHF) patients suffer from functional aerobic impairment. It is accepted that exercise improves their quality of life; yet the effect on the failing myocardium is unclear. We evaluated the utility of classic echocardiographic measurements as well as novel speckle tracking echocardiography (STE) for determining the effect of exercise on cardiac function in CHF. Methods:18 rats underwent left anterior descending artery ligation. At baseline, pre-training and upon exercise training completion the rats underwent exercise capacity test (VO2 max) and parasternal short axis apical (AP) and papillary muscle level (PM) echocardiography. LV end systolic and diastolic areas, and functional indices - fractional shortening (FS) and ejection fraction (EF) were derived. These scans were post-processed by speckle tracking echocardiography (STE). STE assesses LV global and segmental circumferential strain (SC) (presented as % from the diastolic state). Establishment of CHF was based on the decrease in exercise capacity, and changes in cardiac structural and functional parameters. Following the establishment of CHF, the animals were assigned to an eight-weeks training program of sedentary (SED), moderate aerobic training (MAT) or high intensity training (HIT) (n=6 each). Results:Five weeks after surgery, rats' exercise capacity was impaired, their LV was dilated, and EF and FS attenuated. Their global SCs increased significantly (Apex: -22±5% to -11±4%, PM -21±4% to -10±4 %). Upon completion of the exercise program, no improvements in VO2 max, traditional structural or functional parameters were noted in the SED and MAT groups, while in the HIT group those parameters improved. STE parameters indicate cardiac improvement in MAT and HIT. The global SC of SED group deteriorated, whereas of the MAT and HIT groups decreased towards baseline at the AP: -9±4%, -13±7%, -17±7%* and at the PM level: -8±2%, -13±5% and -16±4%*, respectively). A dose response between exercise intensity and segmental SC data was also noted. At the PM level the SED, MAT and HIT septum SC were -11±2%, -15±6% and -20±5%*, respectively and at the anterior -7±5%, -11±6% and -18±4%*, respectively. Conclusions:Exercise training induces improvement in cardiac function in an animal model of CHF. However, only using advanced tools such as the STE these effects can be detected. Further, there is a possible correlation between the exercise intensity and its effect on the cardiac function. 449 Microvascular structure in infants at birth and 3 months of age: impact of pregnancy complications C Y L Aye1, E Davis1, AJ Lewandowski1, Y Kenworthy1, R Upton1, C Smedley1, G Yu1, P Leeson1 1University of Oxford, Cardiovascular Clinical Research Facility, Oxford, United Kingdom Topic: Sports cardiology Purpose:Preterm offspring have reduced microvascular density in adult life, which may underlie their increased blood pressure. We studied whether microvascular rarefaction is already present in infancy in individuals born preterm and the impact of other perinatal factors, such as preeclampsia, on the microvasculature. Methods:We studied 64 infants at birth and at 3 months of age. Microvascular structure was assessed by using a Side Stream Dark Field (SDF) imaging device (Microscan, Microvision Medical, Amsterdam) to image their axillary small vessel network. Three videoclips showing different 1mm2 fields of view were recorded. Capillaries were manually delineated and flow characterized. Total vessel density (TVD) and Perfused Vessel Density (PVD) were then automatically calculated for each clip by specialised software (AVA 3.0, MicroVision Medical) and averaged for each infant. Results:We divided the cohort into 3 groups; those born at term to healthy pregnancies, those born at term following a preeclamptic, hypertensive pregnancy (PET) and those born preterm to a normotensive mother (PTN). Mean gestational age was 39.35±1.36 weeks, 39.01±1.39 and 33.50±1.22 respectively. There were no significant differences in average TVD and PVD at birth between the three groups. However, by 3 months the PTN group had significantly lower TVD and PVD compared to the controls (21.77±4.26 vs 25.25±5.84, p=0.04 for TVD and 21.77±4.38 vs 25.25±5.84, p=0.04 for PVD). Furthermore, in those born at term but whose mother had preeclampsia, there was a trend for lower TVD (21.54±4.63, p=0.07) and PVD (21.54±4.63, p=0.08). Conclusion:These preliminary data suggest that alterations in microvascular structure may emerge during the first 3 months of life in offspring of pregnancies complicated by either preterm birth or preeclampsia, which may be relevant to their later increased risk of hypertension. 450 Relation between physical activity and morbi-mortality of Elderly people : The Proof cohort study D Hupin1, F Roche1, M Garet1, V Gremeaux2, JC Barthelemy1, M Oriol3, E Achour1, A Devun1, D Maudoux1, P Edouard1 1University Hospital of Saint-Etienne, Saint-Etienne, France 2University Hospital of Dijon, Dijon, France 3Department of Public Health, Hygee Centre, Lucien Neuwirth Cancer Institute , St-Priest en Jarez, France Background:The aging of the world population is growing and is inevitable. Aging prevention is a public health issue. Epidemiological studies are likely to confirm the benefits of regular physical activity on health. These studies have shown that the average risk of death was reduced by 30% if the recommendations of exercise (30 minutes at least 5 days per week or 150 min/wk) were observed. Objective We aimed to define a negative correlation between the level of physical activity and the risk of mortality in the french elderly. Methods:A French cohort of 1011 subjects aged 65 in 2001 was followed over a period of 12 years. Their physical activity was assessed by self-administered questionnaire POPAQ. Physical activity was categorized by MET-h/week in 5 levels: <1, 1-3,74, 3,75-7,49 (equivalent to brisk walking for up to 150 min/wk), 7,5-15 and >15 MET-h/wk. Mortality and events (cardiovascular and cancers) were recorded. The association of leisure time physical activity with morbi-mortality was examined with the estimation of Odds Ratio (95% CI) via the Khi2 statistic test. Results:644 (64%) subjects and 66 (10%) deaths were reported. The risk of death was reduced by 57% (OR=0.43 [95% CI : 0.19-0.98], p<0.05) for subjects practicing physical activity at a level equal or higher than the recommendations of 150 minutes per week (7,5-15 MET-h/wk). Also a very low level of physical activity (1-3,74 MET-h/wk vs <1 MET-h/wk) resulted in 51% reduction in mortality risk (OR=0.49 [95% CI: 0, 25-0.97] p<0.05). Start or restart a physical activity during retirement, reduced the risk of death by 66% (OR=0.34 [95% CI: 0.1-0.88] p=0.01) and the risk of events by 45% (OR=0.55 [95% CI: 0.36- 0.84] p=0.004). In contrast, any reduction of even low physical activity exposed the elderly to the risk of death that is multiplied by 3 (OR=3 [95% CI: 1-9] p=0.01) and the risk of morbidity by 2 (OR=1.82 [95% CI: 1.2-2.8], p=0.004). Conclusion:1)- A negative correlation was found between the level of physical activity and the risk of mortality in the french elderly in a comparable manner to international cohorts. 2)- This relationship is dose-dependent, i.e. the risk of mortality will be even more decreased as physical activity is regular and of high intensity. 3)- The PROOF study corroborates previous studies on the protective effect of a low dose of exercise (below current recommendations) on health. 4)- These results may help to adapt future recommendations to the elderly. © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015

doi: 10.1177/2047487315586738pmid: 26078077

Is it really a lost generation? Lifestyle, sedentary behaviour and early preventive measures in childhood and adolescence. Friday, 15 May 2015, 11:00-12:30 378 5 year follow-up of an inpatient lifestyle intervention program in overweight and obese children and effects on lipid levels and physical activity M Siegrist1, B Geilhof1, H Langhof2, T Giegerich3, R Oberhoffer3, M Heitkamp1, M Halle4 1Department of Prevention, Rehabilitation and Sports Medicine, Technische Universit?M?, Munich, Germany 2Rehabilitation Clinic Sch?cht, Berchtesgaden, Germany 3Institute of Preventive Pediatrics, Technische Universit?M?, Munich, Germany 4Department of Prevention, Rehabilitation and Sports Medicine, DZHK (Munich Heart Alliance), Else Kr?-Fresenius-Zentrum, Technische Universit?M?, Munich, Germany Topic: Sports cardiology Purpose:Obesity in childhood often leads to early cardiometabolic comorbidities as hypertension and changes in lipid profile as well as increased morbidity and mortality in adulthood. Therefore effective and particularly sustainable lifestyle intervention programs for children are mandatory. Methods:We examined 168 overweight and obese children after 5 yr follow-up (mean age therapy start: 13.5±2.3 years, mean BMI: 32.8±5.9 kg/m2, 104 girls), who had previously underwent a standardized lifestyle intervention program (10 h/week structured physical activity, 6h/week unstructured physical activity, calorie restricted balanced diet, behavioural counselling) for 4 to 6 weeks. Anthropometric parameters, blood pressure, blood samples and physical activity (questionnaire) were examined at therapy start and after five years. Children were divided in BMI categories (overweight > 90th percentile; obese > 97th percentile, severely obese > 99.5th percentile) according to age- and sex-specific percentiles for BMI. Results:1. After 5 yr follow-up, 58 children (34.5%) showed improved BMI category compared to therapy start, 90 children (53.7%) remained in the same BMI category and 20 children (11.9%) had an increase in BMI category. 2. Children with sustainable BMI reduction showed a better lipid profile after 5 years than children with stable or increased BMI category (HDL < 40 mg/dl: 8.6 % versus 20.0 %; triglycerides = 150 mg/dl: 13.8 % vs. 27.3 %). Elevated blood pressure (= 130/85 mm Hg) after 5 years was found in 32.8 % of children with improved BMI category compared to 50.0 % of children with unchanged or increased BMI category. 3. The number of days with physical activity = 60 min/days was 3.2±2.2 days/week in children with sustainable BMI reduction compared to 2.9±2.2 days/week in children with stable or increased BMI category (p=0.361). The amount of physical activity after five years remained unchanged compared to therapy start. Conclusions:Children with sustainable BMI reduction long-term after a lifestyle intervention program had a better cardiometabolic risk profile than those who gained weight during the five years of follow-up. No significant difference between self-reported physical activity and long term BMI changes was observed. © The European Society of Cardiology 2015 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2015