TY - JOUR
AB - Poster Session 3 Friday, 09 May 2014, 14:00-18:00 P436 Early left ventricular systolic and diastolic dysfunctions in patients with newly diagnosed obstructive sleep apnoea and normal left ventricular ejection fraction D Lisulov-Popovic1, M Zdravkovic2, M Krotin2, M Vukcevic2, R Pokrajac1, J Saric1, V Galijan1, M Brajkovic1 1University Hospital Center Bezanijska Kosa, Belgrade, Serbia 2University Hospital Medical Center Bezanijska Kosa, University of Belgrade, School of Medicine, Belgrade, Serbia Topic: Obesity (Prevention & Epidemiology) Background: The aim of the study was to evaluate whether obstructive sleep apnea (OSA) contributes directly to left ventricular (LV) diastolic dysfunction in newly diagnosed obstructive sleep apnoea (OSA) and normal left ventricle ejection fraction. Methods: According to the study eligible criteria 160 consecutive patients among overall number of 792 patients were prospectively enrolled in the study.Control group consisted of 78 asymptomatic agematched healthy subjects who did not have any cardiovascular and respiratory symptoms. All patients had undergone overnight polysomnography and complete standard transthoracic and advanced tissue imaging echocardiogram have been also performed next morning. Results: Even 81 (51%) had severe newly diagnosed OSA. The E/A ratio and the peak E wave at mitral flow were significantly lower and the peak A wave at mitral flow was significantly higher in OSA patients compared with control subjects. Left ventricle isovolumetric relaxation time (IVRT) and mitral valve flow propagation (MVFP) were significantly longer in OSA patients than in controls. Significant difference in S amplitude of septal part of the mitral valve and E wave both at the lateral and septal part of the mitral valve were noted between OSA patients compared to control group. Conclusions: At the time of the diagnosis, newly diagnosed OSA patients have already impaired diastolic function and despite normal global ejection fraction, significantly impaired regional longitudinal systolic function. These changes are closely related to the SaO2 level. P437 Obesity and cardiovascular risk: the role of epicardial fat measured by echocardiography L Arvigo1, G Novo1, M Guglielmo1, M Lo Presti1, S Giambanco1, MR Sutera1, S Verga1, S Novo1 1University of Palermo, Department of Cardiology, Palermo, Italy Topic: Obesity (Prevention & Epidemiology) Purpose: The aim of this study was to measure, by transthoracic echocardiographic, the thickness of epicardial fat in a population of obese patients and to evaluate its role as an indicator of increased cardiovascular risk. Methods: We examined 52 obese patients. Were defined obese if Body Mass Index (BMI) results = 30 kg/m2. All patients were subjected to an anamnestic and clinic evaluation for the detection of weight, height, BMI, waist circumference, cardiovascular risk factors and previous cardiovascular events; they were also subjected to instrumental investigation wich included a 12-lead ECG, a transthoracic echocardiogram and an ultrasound scan of Supra-Aortic Trunks (SAT) in order to measure carotid Intima Media Thickness (IMT). Results: The obese population was made up for 51.9% of male subjects, the average age was 47.85 ± 11.8 years. The BMI and waist circumference showed respectively a mean value of 40.6 ± 8.3 kg/m2 and 119.2 ± 13.2 cm. Among these, 28.8% had a previous cardiovascular event (acute myocardial infarction and/or unstable angina). The thickness of the epicardial fat had a mean value of 6.4 ± 3.14 mm. Among patients observed, 34 of them shown diastolic dysfunction (20 grade I dysfunction, 14 grade II dysfunction). Thickness of epicardial adipose tissue above the mean was statistically related to increased waist circumference (p = 0.032), systemic arterial hypertension (p = 0.036), male gender (p = 0.023), previous cardiovascular events (p = 0.038), reduced E / A ratio (p = 0.017) and the increased thickness of interventricular septum in diastole (p = 0.001). The relationship between increased epicardial fat and the presence of preclinical atherosclerosis assessed by ultrasound scan of SAT (p = 0.037), was also significant. Finally, considering the multivariate analysis, which included all statistically significant variables on univariate analysis, the clinical / echocardiographic characteristics independently associated with increased epicardial fat, were waist circumference (p = 0.0038) and the E / A ratio decreased (p = 0.0446). Conclusions: The epicardial fat could represent a new marker of cardiovascular risk more accurate than visceral fat to which is nevertheless related. The measurement of epicardial fat by echocardiography, that is not invasive, repeatable and low cost, could allow a more precise stratification of cardiovascular risk in obese patients, to identify subgroups at risk of developing cardiac failure, to treat with tailored prevention program and targeted therapeutic approach. P438 Body fat mass and arterial stiffness in patients with abdominal obesity O Listopad1, E Bazhenova1, E Baranova1 1First Pavlov State Medical University of Saint-Petersburg, Saint-Petersburg, Russian Federation Topic: Obesity (Prevention & Epidemiology) Purpose: To evaluate body fat mass and arterial stiffness parameters in patients with abdominal obesity. Methods: 103 patients with abdominal obesity (criteria IDF, 2005) and 57 men and women with normal waist circumference 25 to 55 years old were investigated. Weight, height and waist circumference were measured. Thickness of skinfolds was measured at three points with an electronic digital caliper according to recommendations of A.S.Jackson and M.L.Pollock (1978,1980). Body fat mass was calculated according to formula J.Brozek. Arterial stiffness parameters Cardio Ankle Vascular Index (CAVI), Knee-Cardio Ankle Vascular Index (kCAVI) and carotid-femoral pulse wave velocity (PWV) were measured using sphygmomanometer VaSera VS-1500N. Results: Body fat mass was significantly higher in patients with abdominal obesity as compared to patients with normal waist circumference (34,5±0,9% and 19,3±1,0% respectively, p<0,0001). PWV was significantly higher in patients with abdominal obesity as compared to patients without abdominal obesity (PWV median are 7,1 m/sec (5,3-18,5) and 6,8 m/sec (5,4-9,2) respectively, p<0,0001). CAVI was significantly lower in patients with abdominal obesity as compared to patients with normal waist circumference (6,7±0,1 and 7,1±0,1 respectively, p=0,02). No significant difference between kCAVI in patients with and without abdominal obesity was revealed (6,8±0,1 and 7,1±0,1 respectively, p=0,2). No significant difference between parameters of arterial stiffness in patients with abdominal obesity, who had normal and high value of body fat mass, was revealed (p>0,05). Conclusions: Body fat mass was higher in patients with abdominal obesity as compared to patients with normal waist circumference. PWV was higher, but CAVI was lower in patients with abdominal obesity as compared to patients without abdominal obesity. No significant difference between kCAVI in patients with and without abdominal obesity was revealed. No significant difference between parameters of arterial stiffness in patients with abdominal obesity, who had normal and high value of body fat mass, was revealed. P439 Efficacy of an intensive cardiovascular primary prevention program: 6 and 12 months follow up. S E Masnaghetti1, S Sarzi Braga1, M Peraro1, T Marinoni1, R Brugnera1, F Maslowsky1, RFE Pedretti1 1IRCCS Foundation Salvatore Maugeri, Department of Cardiology, Tradate, Italy Topic: Obesity (Prevention & Epidemiology) Background Good cardiovascular risk factors control reduces global risk but it's rarely achieved in overweight and obese patients (pts). Aims To evaluate if intensive primary prevention office care improves cardiovascular risk factors control. Methods: At first visit (V1) anamnesis and clinical parameters were collected. Pts were treated and advised for smoking and physical activity according to guidelines. We enrolled 50 pts with BMI > 25 (62% male (M), 38% female (F), 32% diabetic (D), 16% smokers, 94% hypertensive, 76% hypercholesterolemic). Follow up (FU) was planned at 6 (V2) and 12 (V3) months. Results: All parameters improved except total cholesterol in D and waist circumference (WC) in F and D at V2 and WC in M at V3 (see the Table). At V2 and V3 more pts practiced physical activity (not significantl). 8 pts were smokers at V1 (4 quitted at FU, no statistical analisys). Good blood pressure control (< 135/85 mmHg) was reported in M (45% at V1, 74% at V2 and 77% at V3, p<0.003), F (58% at V1, 89% at V2 and 100% at V3, p<0.01) and D pts (38% at V1, 75% at V2 and 88% at V3, p<0.006). Conclusions: An intensive primary prevention program can improve cardiovascular risk factors control in overweight and obese pts even if D. A larger number of patients is needed to confirm our data and to evaluate if such approach is worth. Results F=19 M=31 D=16 Total cholesterol (mg/dl) p p p V1 225 219 206 V2 192 V2 vs V1 p= 0,01 194 V2 vs V1 p= 0,03 185 V2 vs V1 p= ns V3 195 V3 vs V1 p= 0,00 196 V3 vs V1 p= 0,01 191 V3 vs V1 p= ns Weight (Kg) V1 84 96 100 V2 82 V2 vs V1 p= 0,03 94 V2 vs V1 p= 0,00 97 V2 vs V1 p= 0,02 V3 82 V3 vs V1 p= 0,01 96 V3 vs V1 p= 0,00 97 V3 vs V1 p= 0,01 BMI (Kg/m2) V1 33 36 35 V2 32 V2 vs V1 p= 0,02 35 V2 vs V1 p= 0,00 34 V2 vs V1 p= 0,01 V3 31 V3 vs V1 p= 0,01 34 V3 vs V1 p= 0,00 34 V3 vs V1 p= 0,00 WC (cm) V1 114 115 119 V2 111 V2 vs V1 p= ns 112 V2 vs V1 p= 0,01 117 V2 vs V1 p= ns V3 110 V3 vs V1 p= 0,04 116 V3 vs V1 p= ns 115 V3 vs V1 p= 0,01 F=19 M=31 D=16 Total cholesterol (mg/dl) p p p V1 225 219 206 V2 192 V2 vs V1 p= 0,01 194 V2 vs V1 p= 0,03 185 V2 vs V1 p= ns V3 195 V3 vs V1 p= 0,00 196 V3 vs V1 p= 0,01 191 V3 vs V1 p= ns Weight (Kg) V1 84 96 100 V2 82 V2 vs V1 p= 0,03 94 V2 vs V1 p= 0,00 97 V2 vs V1 p= 0,02 V3 82 V3 vs V1 p= 0,01 96 V3 vs V1 p= 0,00 97 V3 vs V1 p= 0,01 BMI (Kg/m2) V1 33 36 35 V2 32 V2 vs V1 p= 0,02 35 V2 vs V1 p= 0,00 34 V2 vs V1 p= 0,01 V3 31 V3 vs V1 p= 0,01 34 V3 vs V1 p= 0,00 34 V3 vs V1 p= 0,00 WC (cm) V1 114 115 119 V2 111 V2 vs V1 p= ns 112 V2 vs V1 p= 0,01 117 V2 vs V1 p= ns V3 110 V3 vs V1 p= 0,04 116 V3 vs V1 p= ns 115 V3 vs V1 p= 0,01 Open in new tab Results F=19 M=31 D=16 Total cholesterol (mg/dl) p p p V1 225 219 206 V2 192 V2 vs V1 p= 0,01 194 V2 vs V1 p= 0,03 185 V2 vs V1 p= ns V3 195 V3 vs V1 p= 0,00 196 V3 vs V1 p= 0,01 191 V3 vs V1 p= ns Weight (Kg) V1 84 96 100 V2 82 V2 vs V1 p= 0,03 94 V2 vs V1 p= 0,00 97 V2 vs V1 p= 0,02 V3 82 V3 vs V1 p= 0,01 96 V3 vs V1 p= 0,00 97 V3 vs V1 p= 0,01 BMI (Kg/m2) V1 33 36 35 V2 32 V2 vs V1 p= 0,02 35 V2 vs V1 p= 0,00 34 V2 vs V1 p= 0,01 V3 31 V3 vs V1 p= 0,01 34 V3 vs V1 p= 0,00 34 V3 vs V1 p= 0,00 WC (cm) V1 114 115 119 V2 111 V2 vs V1 p= ns 112 V2 vs V1 p= 0,01 117 V2 vs V1 p= ns V3 110 V3 vs V1 p= 0,04 116 V3 vs V1 p= ns 115 V3 vs V1 p= 0,01 F=19 M=31 D=16 Total cholesterol (mg/dl) p p p V1 225 219 206 V2 192 V2 vs V1 p= 0,01 194 V2 vs V1 p= 0,03 185 V2 vs V1 p= ns V3 195 V3 vs V1 p= 0,00 196 V3 vs V1 p= 0,01 191 V3 vs V1 p= ns Weight (Kg) V1 84 96 100 V2 82 V2 vs V1 p= 0,03 94 V2 vs V1 p= 0,00 97 V2 vs V1 p= 0,02 V3 82 V3 vs V1 p= 0,01 96 V3 vs V1 p= 0,00 97 V3 vs V1 p= 0,01 BMI (Kg/m2) V1 33 36 35 V2 32 V2 vs V1 p= 0,02 35 V2 vs V1 p= 0,00 34 V2 vs V1 p= 0,01 V3 31 V3 vs V1 p= 0,01 34 V3 vs V1 p= 0,00 34 V3 vs V1 p= 0,00 WC (cm) V1 114 115 119 V2 111 V2 vs V1 p= ns 112 V2 vs V1 p= 0,01 117 V2 vs V1 p= ns V3 110 V3 vs V1 p= 0,04 116 V3 vs V1 p= ns 115 V3 vs V1 p= 0,01 Open in new tab P440 Hypertension and psychological distress in the indigenous population of suriname ISKK Krishnadath1, CCF Antonius1, A Hofman2, J Toelsie1 1Faculty of Medicine, Anton de Kom University Suriname, Paramaribo, Suriname 2Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands Topic: Hypertension (Prevention & Epidemiology) Introduction: There is no conclusive evidence regarding the association of hypertension and psychological distress. This association as well as the distribution of hypertension and psychological distress was not examined before in the indigenous population of Suriname. Aim: This study assessed the prevalence of hypertension and psychological distress as well as their association in the indigenous population of the hinterland of Suriname. Methods: Three Maroon (Saramaccan, Aucan and Matawai) and one Amerindian (Trio) communities in the hinterland of Suriname were random selected. Blood pressure was measured and the Kessler Psychological Distress Scale (K10) was completed in 555 participants. The Kessler Psychological Distress Scale divided the participants into 4 categories (Kscales) of psychological distress: A: no indications for mental health disorders, B: indications for mild mental health disorders, C: indications for moderate mental health disorders and D: indications for severe mental health disorders. Data was post- stratified for sex age and region. Results: The prevalence of hypertension was 24.1%. Percentages of hypertension in the subgroups were as follows 27.5% in the Saramaccan, 24.8% in the Matawai 22.3% in the Aucan, and 11.5% in the Trio community. The prevalence of the Kscale B, C and D was respectively 10%, 12.2% and 17.2%. The distribution of Kscales, C and D together was respectively 37.1% for the Saramaccan, 35.7% for the Aucan, 0.9% for the Matawai and 0% for the Trio community. Hypertension was equally distributed in all four groups of psychological distress. Conclusions: These results suggest that in the Trio community the distribution of hypertension as well as of psychological distress is significantly lower. No relation was observed between hypertension and psychological distress. The low percentage of hypertension as well as the low percentage of psychological distress within the Trio community in comparison to the other communities needs to be explored further. P441 Effect of Heated water-based Exercise training on blood pressure in resistant arterial hypertension: a randomized controlled Trial (HEx trial) GV Guimaraes1, LGB Cruz1, MM Fernandes-Silva1, EL Dorea2, EA Bocchi1 1Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil 2University of Sao Paulo Faculty of Medicine (FMUSP), Sao Paulo, Brazil Topic: Hypertension (Prevention & Epidemiology) Background: Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heated water-based exercise (HEx). This study examines the effects of HEx on BP 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; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32oC), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM). Results: 32 patients (HEx n=16; control n=16) were randomized; none were lost of follow-up. HEx decreased 24-hour systolic (from 137±23 to 120±12 mmHg, p=0.001) and diastolic BP (from 81±13 to 72±10 mmHg, p=0.009); daytime systolic (from 141±24 to 120±13 mmHg, p<0.0001) and diastolic BP (from 84±14 to 73±11 mmHg, p=0.003); nighttime systolic (from 129±22 to 114±12 mmHg, p=0.006) and diastolic BP (from 74±11 to 66±10 mmHg, p<0.0001). The control group after 12 weeks significant increase in systolic and diastolic BPs, respectively 24-hour (3.0±0.1 and 2.1±1.2 mmHg); daytime (4.4±2.2 and 3.5±2.1 mmHg) and nighttime diastolic (3.1±1.9 mmHg). No adverse events occurred during the study. Conclusions: HEx reduced 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients P442 The metabolomic of hypertension: a powerful tool for early diagnosis and prevention. M Biagioli1, L Tenori2, X Hu2, P Pantaleo1, B Alterini1, C Luchinat2, I Bertini2, A Montereggi1, A Leone1, GF Gensini1 1University of Florence, Department of Heart and Vessels, Florence, Italy 2CERM - Centro di Ricerca di Risonanze Magnetiche, Florence, Italy Topic: Hypertension (Prevention & Epidemiology) This study analyzed the metabolomic features of hypertension in a cohort of 126 patients with essential hypertension regularly followed up on an outpatient basis. A cohort of 904 healthy blood donors and a cohort of 90 patients with first time diagnosis of hypertension were enrolled for comparison purposes. Blood samples from patients and control subjects were obtained and NMR spectrography and metabolomical analysis were performed. CPMG, NOESY and DIFF spectra were obtained. Supervised and unsupervised analysis were performed. The metabolomical analysis was able to discriminate patients with hypertension from healthy subjects with high accuracy (>99%) when applied in a supervised regimen in NOESY, CPMG and DIFF spectra whilst the unsupervised analysis demonstrated a low accuracy. The same results were obtained when the analysis compared patients with first-time diagnosed hypertension and healthy blood donors. A further analysis was performed to compare the two hypertension groups. A low accuracy was achieved when the analysis tried to predict hypertension in the first-time-diagnosis group applying the hypertension metabolomic fingerprint obtained by the other hypertension group. Histidine, serine, citrate, acetate, dimethylglycine and methionine were the most significant elements of the hypertension metabotype in both patients groups. These results demonstrate the power of metabolomic to identify pathological conditions and suggest the possible role of therapy in metabotype modifications. Basing on these results, metabolomics could be hypothesized to be a diagnostic and monitoring tool in hypertension and it may provide insights upon disease mechanisms. P443 National trends in risk factors for cardiovascular disease C Koopman1, A Blokstra2, I Vaartjes1, ML Bots1, WMM Verschuren2, I Van Dis3 1University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands 2National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands 3Dutch Heart Foundation, The Hague, Netherlands Topic: Hypertension (Prevention & Epidemiology) Introduction: Favorable trends in risk factor levels in the general population may partly explain the decline in cardiovascular mortality. Our aim is to present long-term national trends in risk factors for cardiovascular disease in the Netherlands. Methods: We used data from several large scale population based surveys. A 3-year moving average was used to present age-standardized time trends in mean systolic blood pressure, total cholesterol and BMI from 1988 to 2009/2010 in the Netherlands (age 35-60 years). Trends in the prevalence of physical activity (age 12+ years) were presented from 2001 to 2011 and trends in the prevalence of cigarette smoking (age 15+ years) from 1988 to 2012. Results: From 1988 to 2009/2010, mean systolic blood pressure increased from 125 to 132 mmHg in men and from 119 to 121 mmHg in women, while mean total cholesterol decreased from 5,84 to 5,48 mmol/l in men and from 5,72 to 5,36 mmol/l in women. Mean BMI increased in men (from 25,5 kg/m2 in 1988 to 26,2 kg/m2 in 2009/2010), but stabilized in women (25,1 kg/m2 in 1988 and 25,1 kg/m2 in 2009/2010). From 1988 to 2012, the prevalence of smoking decreased from 37% to 27% in men and from 29% to 25% in women. The prevalence of physical activity increased from 52% in men and women in 2001 to 59% in men and 58% in women in 2011. Conclusions: The rise in systolic blood pressure and BMI are worrying trends. Monitoring of population-wide risk factor levels is warranted and additional population-wide interventions are needed to ensure a continuing decline in cardiovascular morbidity and mortality. P444 Lower omega-3 index can be a marker of increased propensity of hypertensive rat heart to malignant arrhythmias. B Bacova1, C Viczenczova1, T Benova1, P Sec2, M Certik3, N Tribulova1 1Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic 2Institute of Biochemistry and Genetic of Animals, Slovak Academy of Sciences, Bratislava, Slovak Republic 3Slovak University of Technology, Bratislava, Slovak Republic Topic: Hypertension (Prevention & Epidemiology) Background: Low ?-3 index was suggested as a risk factor for cardiovascular diseases and sudden cardiac death. We have previously shown that hypertensive rats benefit from ?-3 fatty acid (FA) intake. Aim of this study was to explore relationship between ?-3 index and susceptibility of aged male and female spontaneously hypertensive rats (SHR) to ventricular fibrillation (VF). Methods: One year-old SHR and age-matched healthy Wistar rats (WR) fed with ?-3FA (Vesteralens, Norway, EPA+DHA 200mg/day/2month) were compared with untreated rats. Gas chromatography was used for analysis of RBC ?-3FA composition: alfa-linolenic acid, eicosapentanoic acid (EPA), docosahexanoic acid (DHA) and ?-6FA composition: linoleic acid, arachidonic acid (AA), gama-linolenic acid. ?-3 index was calculated as RBC level of EPA + DHA expressed in percentage of total FA. Susceptibility of the heart to electrically induced VF was examined using Langedorff-perfused heart preparation. Results: RBC levels of EPA and particularly DHA were lower in SHR than WR regardless the sex. Comparing to healthy WR ?-3 index was lower in both male and female SHR, i.e. 0.73 and 0.44 versus 1.75 and 1.17. This parameter was significantly increased due to ?-3 FA intake to 2.38 and 3.34 in male and female SHR. Moreover, treatment was associated with a decrease in AA/EPA ratio in SHR. Non-treated male and female SHR were much prone to inducible VF (100% males and 65% females) comparing to WR (65% males and 35% females) but this propensity was significantly reduced to 35% in males and 25% in females SHR due to ?-3FA intake. Conclusions: Results suggest an inverse relationship between ?-3 index and susceptibility of hypertensive rats to VF. Findings support the hypothesis that lower ?-3 index might be a marker of increased propensity of the heart to malignant arrhythmias. P445 Metabolic syndrome and target-organs damage in relatively healthy population of bank employers OP Rotar1, EG Malev1, EV Moguchaya1, OB Dubrovskaya1, MA Boyarinova1, EP Kolesova1, VN Solntsev1, AO Konradi1, EV Shlyakhto1 1Federal Almazov Medical Reseach Centre, Saint-Petersburg, Russian Federation Topic: Hypertension (Prevention & Epidemiology) Aim Different components of metabolic syndrome and risk factors can play independent role in the development of target-organ damage (TOD). The aim of our study was to assess the relation of metabolic syndrome (MS) with left ventricular mass index (LVMI), arterial stiffness and carotid atherosclerosis in the population of mentally employed people. Design and methods. 1600 mentally working subjects (bank employers) were screened for MS. 377 (127 males and 250 females) subjects who had at least one component of MS, who had no established cardiovascular events and severe concomitant diseases and who agreed to participate in the study passed echocardiography and carotid artery examination (Vivid 7). LVMI was calculated as an index of left ventricular hypertrophy (LVH). Pulse wave velocity (PWV) was performed by SphygmoCor (AtCor). MS was defined according to JIS-2009 criteria. Results: The mean value of LVMI was 98±21 g/m2 in females and 100±24 g/m2 in males. The proportion of patients with LVH according to ASE 2005 criteria (LVMI > 95 g/m2 and >115 g/m2 in males) in females was 50,8% (n=127) vs 36,2% in males (n=46). Stepwise regression analysis (included MS, systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), triglycerides, glucose, HDL, age) was performed. PWV was significantly associated with SBP in females (B=0,18, p=0,005) and age (B=0,33, p=0,003), tryglicerides (B=0,19, p=0,003) in males. LVMI was significantly associated only with age (B=0,217, p=0,0002) and SBP (B=0,347; p<0,0001) in both genders. Intima-media thickness (IMT) was significantly associated with age B=0,686 (p=0,001) in females and age (B=0,341, p=0,001) in males. MS had no independent association with any of TOD. Conclusions: Age and SBP but not MS and obesity appear to be the major determinants of TOD in general population. P447 Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events SAE Peters1, R Huxley2, M Woodward3 1University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands 2University of Queensland, Brisbane, Australia 3University of Sydney,The George Institute for Global Health, Sydney, Australia Topic: Diabetes Type 1/2 (Prevention & Epidemiology) Objectives: A previous pooled analysis suggested that women with diabetes are at substantially increased risk of fatal coronary heart disease (CHD) compared with affected men. Additional findings from several larger and more contemporary studies have since published on the sex-specific associations between diabetes and incident CHD. We performed an updated systematic review with meta-analysis so as to provide the most reliable evidence of any sex difference in the effect of diabetes on subsequent risk of CHD. Methods: PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between on January 1, 1966 and February 13, 2013. Eligible studies had to have reported sex-specific estimates of the relative risk (RR) for incident CHD associated with diabetes, and its associated variability that had adjusted at least for age. Random effects meta-analyses with inverse variance weighting were used to obtain sex-specific RRs and their ratio (RRR). Results: Data from 64 cohorts including 858,507 individuals and 28,203 incident CHD events were included in the analysis. The RR for incident CHD associated with diabetes compared with no diabetes was 2.83 (95% confidence interval [CI]: 2.37, 3.38) in women and 2.11 (95% CI: 1.79, 2.50) in men. The multiple-adjusted RRR for incident CHD was 44% greater in women with diabetes than it was in men with diabetes (RRR 1.44 [95% CI: 1.27; 1.63]) with no significant heterogeneity between studies (I2=20%). Conclusions: Women with diabetes have more than a 40% greater risk of incident CHD compared with men with diabetes. Sex disparities in pharmacotherapy are unlikely to explain much of the excess risk in women but future studies are warranted to more clearly elucidate the mechanisms responsible for the substantial sex-difference in diabetes-related risk of CHD. P448 Copeptin, IGFBP-1 and cardiovascular prognosis in patients with type 2 diabetes during and after acute myocardial infarction MI Smaradottir1, SB Catrina2, K Brismar2, V Gyberg1, K Malmberg1, L Ryden1, LG Mellbin1 1Karolinska Institute, Department of Medicine, Stockholm, Sweden 2Karolinska Institute, Department of Molecular Medicine & Surgery, Stockholm, Sweden Topic: Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: The prognosis after acute myocardial infarction (AMI) is more serious for patients with type 2 diabetes (T2DM) than for those without. The reasons are not fully explored and a search for novel risk factors and/or markers is important. We have previously reported that copeptin, a marker for vasopressin, measured at hospital admission for AMI in patients with T2DM is an independent predictor of cardiovascular events and at least partly seems to explain the dismal prognostic impact of IGFBP-1. The objective with this study was to explore if these findings remain in a longitudinal follow-up. Methods: Copeptin and IGFBP-1 were analyzed in patients (age: 70, male: 70%) with T2DM and AMI participating in the DIGAMI 2 trial at admission (n=393), discharge (n=309) and after three months of follow up (n=288). The primary endpoint was cardiovascular events (cardiovascular death, AMI, and stroke). Results: The median copeptin levels at admission were 21.8 pmol/l, at discharge 8.5 pmol/l and after three months 8.4 pmol/l. The corresponding median IGFBP-1 levels were 23.0 µg/l, 33.0 µg/l and 36.0 µg/l. There were significant correlations between copeptin and IGFBP-1 levels at admission (r = 0.53; p<0.0001), discharge (r = 0.31; p<0.0001) and after three months (r =0.14; p<0.015). Both biomarkers were, at all occasions, independent predictors of cardiovascular events in unadjusted Cox Regression Hazard analyses. Copeptin was the only remaining predictor in a multiple model including both biomarkers. In the final multiple model, including copeptin, age and creatinine clearance, copeptin remained as an independent predictor at admission (HR 1.35, 95%CI 1.16-1.57; p<0.001) and after three months (HR 1.56, 95%CI 1.15-2.11; p=0.004) and with borderline significance also at discharge (HR 1.26, 95%CI 0.99-1.59; p=0.057). Conclusions: In the present population of patients with T2DM and AMI copeptin was elevated at admission, decreased fast and were at similar levels at discharge and after three months. There was a relationship between copeptin and IGFBP-1 throughout the study period. Copeptin, expressing vasopressin activation, was a predictor for cardiovascular events. These findings may have pathophysiologic implications for understanding the association between diabetes and cardiovascular disease. It opens for experimental studies on the possibility to impact prognosis by blocking the vasopressin activation. P449 LDL particle size and distribution in children with type 1 diabetes S Alabakovska1, D Labudovic1, K Tosheska Trajkovska1 1Institute of Medical and Experimental Biochemistry, Medical Faculty, Skopje, Macedonia, The Former Yugoslav Republic of Topic: Diabetes Type 1/2 (Prevention & Epidemiology) Purpose: The role of small dense low-density lipoprotein (sLDL) subclasses in atherosclerosis has been demonstrated in many studies. Among other metabolic changes, alteration in LDL lipoprotein subclass distribution and size has been proved in diabetic adults. Because there is not enough literature data presenting LDL subclass distribution in childhood, the aim of this study was to examine LDL subclass profile in diabetic children compared with healthy control. Methods: In this study we evaluated 130 children, 30 children with type I diabetes mellitus and 100 controls, ages 9-18 years, matched for age, sex, and BMI. Plasma LDL subclasses were analyzed using non-denaturing polyacrilamide gradient (3-31%) gel electrophoresis. Conventional plasma lipid and apoprotein parameters which are thought to affect LDL size were determined as well. Results: The prevalence of small LDL particles (phenotype B) was in 86.7% of diabetic children, compared to control group (11%), with significant difference (c2=50.45; p<0,0001). The smallest, LDL4 subclass was not found to be dominant in control children whereas in diabetic ones it was noted in 23%. Mean LDL particle size in diabetic children (24.64 ± 0.59) was significantly smaller than in the control children (26.37± 0.68 nm; p<0.0001). The values for all measured conventional plasma lipid and apoprotein parameters in both groups were within the normal range for age of the children population. In diabetic children, LDL size was inversely correlated with plasma levels of triglycerides, and positively correlated with plasma HDL cholesterol and BMI. Overall, LDL size was not correlated with plasma concentrations of total cholesterol, LDL cholesterol, glucose, apoproteins and age in diabetic children. Conclusions: Although lipid and apoprotein plasma levels were within the normal range, increased frequency of LDL phenotype B confirms greater risk for atherosclerosis development in children with diabetes mellitus. LDL size measurement may potentially help to assess cardiovascular risk and adapt the treatment goals thereafter. P450 Risk assessment of diabetes in men with different cardiovascular risk M Mamedov1, M Kovrigina1, Z Toguzova1, E Akhmedova1, Y Balanova1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Diabetes Type 1/2 (Prevention & Epidemiology) The aim of the study. Identification and assessment of the risk of diabetes in patients with different risk of cardiovascular complications in cardiology practice. Materials and methods: The study included 300 men aged 40 to 69 years with low-to-moderate (<5% on the scale of SCORE, n = 100), high (5-10% on a scale of SCORE, n = 101) and very high (> 10 % on the scale of SCORE, n = 99), cardiovascular risk without clinical manifestations of CVD and diabetes. Questioning the patients was conducted by Russian version of a standard questionnaire ARIC (Atherosclerosis Risk in Communities). Predicted risk of developing T2DM in the next 10 years was determined by questionnaire FINDRISC. All patients underwent tool (BP measurement, calculation BMI, waist circumference) and laboratory (lipids, C reactive protein, uric acid, immunoreactive insulin, fasting glucose and 2 hours after taking 75 g of glucose) study. Results: In the studied cohort of men with different levels of cardiovascular risk by SCORE scale in 28% of cases, revealed a low risk of developing T2DM, with 32.3% of those found moderately-high risk, whereas about 40% of men at the time of examination of a very high risk of developing T2DM. Among men with high and very high risk of developing T2DM in 53.8% of cases are of a very high cardiovascular risk. The men in the low-to-moderate cardiovascular risk pre-diabetes is detected in 21% of cases in individuals at high cardiovascular risk in 40% of cases, while 62% of men with very high cardiovascular risk is diagnosed early disorders of carbohydrate metabolism. Predicted risk of diabetes has the highest correlation with the level of fasting and after load blood glucose, immunoreactive insulin, with the cardiovascular risk by SCORE, BP, total cholesterol, LDL cholesterol and triglycerides. Mild but significant correlation was found between the risk of developing diabetes and uric acid, C-reactive protein, HDL cholesterol, left ventricular hypertrophy. Conclusions: Thus, the application of the scale FINDRISK significantly expands the capabilities of primary care physicians to identify at-risk of developing diabetes. In the future, conducting advanced diagnostics in the form of glucose tolerance test to determine the tactics of prevention and medical correction to slow down and prevent diabetes in men with high and high cardiovascular risk. P451 Physical activity among T2DM patients and its influence on HbA1c V Bralic Lang1, B Bergman Markovic2 1Private GP office affiliated to Department of Family Medicine, University of Zagreb, Zagreb, Croatia 2Department of Family Medicine, University of Zagreb School of Medicine, Zagreb, Croatia Topic: Diabetes Type 1/2 (Prevention & Epidemiology) AIM: To determine physical activity habits among T2DM patients and its influence on HbA1c in clinical practice in GP offices. Methods: Between 2008 and 2010, 449 GP from all Croatian regions recruited first 20-25 participants of both sex with T2DM diagnosed at least 3 year prior to study entry, aged =40 years, who visited a practice for any reason (10274 participants). Blood samples were analysed in accredited laboratories (HbA1c) and physical activity habits were analysed from medical questionnaire created for this study. Patients were stratified for gender and age groups. Results: Mean age among participans was 65,7 yrs (range 40-96), female 5335 (51,9%). Mean HbA1c was 7,57% (range 3,8-15,4; 95% CI for the mean 7,54-7,60; SD 1,58) and 41,3% of analysed diabetic patients had HbA1c less than 7%. 78,9 % were not enough physically active. Patients with not enough total physical activity were 1,4 times more likely to have increased HbA1c than those with enough physical activity (OR = 1,4; 95% CI = 1,23-1,49). Among working patients (36,4%) those who walk or cycle to work between 15 to 30 minutes were less likely (0,4 times or 40%) to have increased HbA1c (OR = 0,6; 95% CI = 0,49-0,78), and those who walk or cycle to work more than 30 minutes were less likely (0,5 times or 50%) to have increased HbA1c (OR =0,5; 95% CI = 0,37-0,60), compared with those who walk or cycle to work less than 15 minutes. Patients who received doctor's advice on increasing physical activity were more likely to have increased HbA1c than those who did not receive such advice (OR = 1,1; 95% CI = 1,02-1,22). Conclusions: Most of analysed T2DM patients were not enough physically active. Doctor's advice on increasing physical activity should not be reserved for those with increased HbA1c but incorporated in daily routine. Moderate to vigorous physical activity of =150 min/week is recommended for prevention and control of T2DM. P452 Left ventricle myocardial remodeling at hypertensive patients with type 2 diabetes or impaired glucose tolerance I Sapozhnikova1, EI Tarlovskaya1, AK Tarlovski2 1Kirov State Medical Academy, Kirov, Russian Federation 2Kirov Regional Hospital, Kirov, Russian Federation Topic: Diabetes Type 1/2 (Prevention & Epidemiology) Objectives: to study features of remodeling of the myocardium of the left ventricle in patients with arterial hypertension and other status of glucose metabolism: type 2 diabetes mellitus (DM), impaired glucose tolerance (IGT) and normoglycemia. Materials and Methods: 241 patients with degree 1 and 2 arterial hypertension were studied. They were compared according to their age and gender. Of them, group 1 included 100 patients with type 2 DM. Group 2 included 41 patients with impaired glucose tolerance (IGT). Group 3 included 100 patients with normal tolerance to glucose. Laboratory investigations such as echocardioscopy were performed. Results: The patients of group 1 had obesity, dyslipidemia and non-compensated DM. The patients of group 2 also had obesity and dyslipidemia. The patients with type 2 DM more often had concentric hypertrophy of the left ventricle in comparison with the patients with normoglycemia (36% vs 7%, p=0.000, including the patients without obesity (19% vs 1.8%, p=0.025), and patients with IGT (36% vs 17,1%, p=0.044). Patients with type 2 DM more often had disorders of the diastolic function of the left ventricle in comparison with the patients with normoglycemia (93% vs 58%, p=0.000) and patients with IGT (93% vs 68,3%, p=0.00). Disorders of the diastolic function were more obvious in association of type 2 DM with concentric variants of heart remodeling. Conclusions: 1) Patients with hypertension and type 2 DM more often had concentric hypertrophy of the left ventricle. 2) Disorders of the diastolic function were revealed at 93% patients with hypertension and type 2 DM. 3) Patients with IGT had intermediate status of echocardiographic parameters between patients with type 2 diabetes and patients with normoglycemia. P453 Preventing dyslipidemia in chronic viral B hepatitis patients treated with nucleozidic analogous. Are statins safe? A 2-year study in Constanta County, Romania A I Suceveanu1, I R Parepa1, A Suceveanu1, L Mazilu1, D Catrinoiu1 1"OVIDIUS" University of Constanta, Faculty of General Medicine, CONSTANTA, Romania Topic: Lipid Disorders (Prevention & Epidemiology) Background. Dyslipidemia is currently noted to be an adverse effect of oral therapy against hepatitis B virus, thus increasing the cardiovascular risk in this particular category of patients. Aim: To investigate if statins are safe and efficient in chronic B hepatitis patients who experience dyslipidemia during oral antiviral treatment. Method: 150 patients with chronic B hepatitis being treated at least 24 months with lamivudin (a nucleozidic analogous) were included. All patients were tested for lipid profile and transaminases levels at baseline and monthly. We randomized patients in two groups, matched by sex, age, hystopathological stage of liver disease, baseline DNA-HBV (hep B virus) and baseline transaminases and LDL-chol levels: the witness group (n=75) receiving lamivudin, and the active group (n=75) receiving lamivudin and adding low-dose rosuvastatin (5mg/day, or 10 mg/day if necessary) in patients experiencing a significant increase in LDL-chol levels (>130mg/dl, anytime during antiviral treatment). Results: Mean baseline LDL-chol was 99±6 mg/dl in the witness group, respectively 98±7 mg/dl in the active group. In the witness group lamivudin raised the LDL-chol in 36 patients (48%) with the maximal LDL-chol rise at 2 years of exposure and a total cardiovascular risk raised with 16% (RR 1.7; 95% CI 0.52–1.02). In the active group LDL-chol raised in 38 patients (50.6%), whom we added statin. Only 1 patient (2.6%) had a 3-fold increase in transaminases levels and needed to stop statin; the other 37 (97.4%) had transaminases level near baseline or mildly elevated, permitting continuation of statin therapy. In the active group the total cardiovascular risk raised only with 4% (RR 0.4; 95% CI 0.61–1.17), showing a significantly lower raise comparing with witness group (p=0.016). Conclusions: In our study, statin therapy proved to be safe and efficient for chronic viral B hepatitis patients who developed dyslipidemia during nucleozid analogous treatment. P454 Familial hypercholesterolemia in Polish population - clinical and molecular diagnosis. A Wegrzyn1, M Fijalkowski1, M Taszner1, M Chmara2, B Wasag2, J Limon2, A Rynkiewicz1, M Gruchala1 1Medical University of Gdansk, 1st Department of Cardiology, Gdansk, Poland 2Medical University of Gdansk, Department of Biology & Genetics, Gdansk, Poland Topic: Lipid Disorders (Prevention & Epidemiology) Purpose: Familial hipercholesterolemia (FH) is a common genetic disorder of lipoprotein metabolism characterized by high LDL-cholesterol plasma levels and premature cardiovascular events. Early identification of persons with FH is essential to prevent premature atherosclerosis and sudden cardiac death. The aim of our study was to evaluate the usefulness of modified Dutch Lipid Clinic Network-WHO Diagnostic Criteria in selecting patients for genetic testing in Polish population, especially in younger patients (age <40 yrs). Methods: We examined 151 adult patients with clinical diagnosis of FH according to modified Dutch Lipid Clinic Network-WHO Diagnostic Criteria referred from the GP. The promoter region and all exons of the LDLR gene were screened by DNA sequencing and MLPA technique. The fragment of APOB exon 26 was sequenced. Results: In a cohort of patients with clinical diagnosis of FH mean age was 48 (±13) yrs, mean total cholesterol level was 350 (±69) mg/dl, LDL-cholesterol 263 (±65) mg/dl. LDLR and APOB mutations were identified in 66% patients. The LDLR gene mutations alone were found in 59% patients. The APOB gene mutation alone (p.R3527Q) we identified in 8 % patients. 2% of patients had both APOB and LDLR mutations (double heterozygous). Analyzing the groups with genetically confirmed and nonconfirmed FH we found that the patients with LDLR and APOB mutations were younger (46±15 vs 52±10 age) and had significantly higher concetrations of LDL-C (280± 71 vs 232± 33 mg/dl), TC (364±76 vs 321±41 mg/dl), respectively p<0.05. In patients with definite clinical diagnosis of HeFH LDLR and APOB mutations were found in 92%. We examined also patients with possible (3-5 points) and probable FH (6-8 points) confirmimg molecular diagnosis in 48% and 63 %, respectively. In a young patients age <40 yrs molecular diagnosis of FH was confirmed in 90,2% vs. 56% for age =40 yrs. Positive family history of hypercholesterolaemia was present in 85,4% patients age <40 yrs and 53% age =40 yrs (p<0,05). Conclusions: Our findings confirm usefulness of the modified Dutch Lipid Clinic Network diagnostic criteria for familial hypercholesterolemia in Polish population. Young patients with FH with 100-fold cardiovascular risk had signifivantly lower TG levels, positive family history of FH and high rate of LDLR and APOB detections rate. The molecular diagnosis with cascade screening and effective primary prevention can simply save their lives. P455 Hdl blood levels and frequency of fish consumption in a young student population A Avezum1, LAM Cesar1, DJB Saraiva1, JRZ Mendes1, CC Magalhaes1, J F Kerr Saraiva1 1SOCESP Cardiology Society of Sao Paulo, Sao Paulo, Brazil Topic: Lipid Disorders (Prevention & Epidemiology) Objectives: To evaluate the lipid profile in the association with fish consumption in children and adolescents 7 to 18 years old, both genders, from public schools of the metropolitan city of Campinas, Brasil. Methods: A cross-sectional epidemiological study with sampling from a school population pool was carried out. Eleven schools were randomly selected in central and peripheral city areas. The assessment protocol comprised a structured questionnaire, anthropometry, and a non fasting lipid profile. In 2010, 4699 students (47,14% of the male sex; mean age, 11.07±2.9 years) were evaluated. The results were as follows: One fourth (25.89%) of the students reported meat ingestion once a week and 37.33% reported that fish was not even sporadically present in their diets. On the other hand daily consumption of sweets and soft drinks was 26.62% and 26.77% respectively. Prevalence of overweight (>+1SD) and obesity (>+2SD) for the whole population was 15.7% and 16% respectively. A lipid profile was aleatorily performed in 2452 children. Medium values were: total cholesterol 130.5±33.2mg/dL, HDLc 42.86±14.48mg/dL, LDLc 80.12±30.29mg/dL, triglycerides 99.19±54.35mg/dL. While 3.61% of the children had total cholesterol above 200mg/dL and 6.26% LDLc above 130mg/dL, 47.31% presented with HDLc levels below 35mg/dL. On the other hand, as expected, the habit of eating fish correlated positively with higher HDLc levels: 42,6 ± 14,5 mg/dL for no consumption in opposition to 47,1 ± 15,5 mg/dL for daily consumption of fish (p=0,0233). Conclusions: Although a large parcel of this young population had inadequate levels of HDLc, the healthy habit of fish consumption showed higher levels of HDLc and should be stimulated in school meals. Parents should be warned of the repercussions of unhealthy diets in the lipid profile and change to more cardiovascular protective habits. P456 12-weeks of lipid-lowering therapy decrease exercise tolerance without affecting endothelial function or arterial stiffness among subjects with primary untreated hypercholesterolemia P Sosner1, M Gayda2, G Mitchell3, J Lalonge2, S Lacroix2, M Juneau2, J-C Tardif4, A Nigam2 1CHU de Poitiers, Cardiologie; Université de Poitiers, Laboratoire MOVE (EA 6314), Poitiers, France 2Montreal Heart Institute and University of Montreal, Cardiovascular Prevention Centre (Centre EPIC), Montreal, Canada 3Cardiovascular Engineering Inc., 1 Edgewater Drive, Norwood, United States of America 4Montreal Heart Institute affiliated with the University of Montreal, Medicine & Research Center Dept, Montreal, Canada Topic: Lipid Disorders (Prevention & Epidemiology) Purpose: Conduit vessel non-compliance and endothelial dysfunction may be manifestations of a similar process which lead to atherosclerosis. Statin therapy may have beneficial effects on these parameters, despite adverse effects on muscle function. We sought to study the effect of statin therapy on endothelial function, aortic stiffness, and their potential impact on exercise tolerance. Methods: In this double-blind, placebo-controlled trial, 22 patients with primary untreated hypercholesterolemia and free of other risk factors or cardiovascular disease (56±9 years, 12 men, BMI: 27±4 kg.m-2, blood pressure: 127/79±12/5 mmHg) were randomized 1:1 to placebo or pravastatin 40 mg daily for 12 weeks. Endothelial function (ultrasound-guided brachial artery flow mediated dilatation (FMD)), aortic stiffness (tonometry-derived carotid-femoral pulse wave velocity (cfPWV)), and submaximal and maximal exercise tolerance were measured. Results: Despite a significant reduction in total and LDL-cholesterol in the treatment group (total-cholesterol: 6.18±0.94 vs. 5.23±0.79 mmol.L-1, P=0.03; LDL: 4.15±0.72 vs. 3.03±0.73 mmol.L-1, P=0.005 in placebo and treatment groups respectively), no between-group differences were observed for endothelial function (FMD: 10.05±4.73 vs. 9.23±2.90 %, P=0.8), vascular compliance (cfPWV: 8.50±2.07 vs. 8.65±2.12 m.s-1, P=0.9), submaximal (submaximal exercise time: 1229±862 vs. 1561±948 sec, P=0.5), or maximal exercise tolerance (VO2 peak: 25.59±4.60 vs. 28.93±9.62 mL.min-1.kg-1, P=0.7). However, we observed in pre/post comparisons, a significant decrease in VO2 peak in the statin group (29.07±6.20 vs. 25.59±4.60 mL.min-1.kg-1, P=0.008) and an improvement in VO2 peak in the placebo group (26.86±9.00 vs. 28.93±9.62 mL.min-1.kg-1, P=0.005). Conclusions: In patients with previously untreated hypercholesterolemia, 12-weeks of statin therapy had no effect on endothelial function or arterial stiffness, but had deleterious effects on maximal exercise tolerance. P458 Non HDLc and cardio-metabolic risk DE Baibata1, SG Ionescu1, OC Iancu1, S Mancas1 1University of Medicine & Pharmacy Victor Babes, Timisoara, Romania Topic: Lipid Disorders (Prevention & Epidemiology) Background:The concept of cardiometabolic risk and the risk stratification for cardiovascular events are two distinct entities related with different stages of vascular development of the atherogenic process. In our analytical transversal study we analyzed non-HDLc behavior and the correlation with traditional cardiovascular risk factors in a subpopulation with angina-like pain and indication for angiocoronarography. We tried to build a mathematical model to predict the NonHDLc, allowing additional cardiovascular risk reclassification. Methods: We included 214 patients hospitalized for symptoms and signs suggestive of coronary pain and with indication of vascular invasive evaluation. The protocol of the vascular evaluation included: assessment of cardiovascular risk for fatal cardiovascular event in the next 10 years, the lipidic risk profile, angiocoronarography and statistical analysis. Aim of the study: to analyze non-HDLc behavior and the parameters of cardio-metabolic risk in patients with high and very high risk for cardiovascular events. Results: We obtained a statistically significant positive correlation between non-HDLc and the amount of lipidic risk parameters. Correlation between metabolic syndrome and non-HDLc was also positive (r = 0.190, p = 0.005). Furthermore we found a positive and highly statistically significant association between carotid artery intima-media thickness (c-IMT) and non-HDLc value (p <0.001). The mathematical model of linear regression showed variability of non-HDLc depending on numeric variables : total cholesterol (TC), LDL, triglycerides (TG), metabolic syndrome (MS); 97.5% of the non-HDLc variability was dependent on these variables. Conclusions: Non-HDLc is a useful prognostic factor in cardio-metabolic risk quantification.The cut-off value for lipid risk was exceeded in all analyzed subgroups. This clearly justifies the screening of non-HDLc and its aggressive management especially in patients with elevated triglycerides.The interdependent relation between non-HDLc and cardio-metabolic risk factors justifies the inclusion of this parameter in cardio-metabolic risk prediction equation in subjects with metabolic syndrome. Key words: non-HDLc, cardio-metabolic risk, metabolic syndrome, atherosclerosis P459 Does use of gul (smokeless tobacco) increase the risk of coronary heart disease in Bangladesh? MA Rahman1, N Spurrier2, MA Mahmood2, M Rahman3, SR Choudhury4, S Leeder5 1Australian Catholic University, Melbourne, Australia 2University of Adelaide, Adelaide, Australia 3Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh 4National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh 5University of Sydney, Sydney, Australia Topic: Smoking (Prevention & Epidemiology) Background:Gul, powder form of commercially available smokeless tobacco (SLT) product, is commonly used in Bangladesh. Objectives:To explore the association between coronary heart disease (CHD) and gul use among non-smoking adults in Bangladesh. Methods:Non-smoking Bangladeshi adults, aged 18-75 years were included in this matched case-control study. CHD cases and hospital controls were selected from two large cardiac hospitals. Community controls were selected from neighbourhood residents of the CHD cases. Each case was matched with four community controls and one hospital control. Cases and controls were reclassified using the Rose Angina Questionnaire (RAQ). Results:Participants included 302 CHD cases, 1208 community controls and 302 hospital controls. Current use of gul was slightly more common among cases (5%) compared to either group of controls (2%). Among 48 exclusive gul users, 45 (94%) of them were heavy users (at least once a day) and 58% were users for long duration (>10 years). There was a strong association between current use of gul and CHD when both control groups were combined (adjusted odds ratio 2.9, 95%CI 1.3-6.7). However, when never smokers were considered only, there was no association between gul use and CHD (adjusted odds ratio 1.4, 95%CI 0.4-5.2). Frequency and duration of gul use was also not associated with an increased risk of CHD among never smokers. Re-classification with the RAQ also did not change the results. Conclusions:Further research in other parts of the country, specifically utilising rural population, is warranted to confirm the findings of this study. P460 Depression and cardiorespiratory fitness: A meta-analysis. T Papasavvas1, M Al-Hashemi2, D Micklewright1 1University of Essex, Colchester, United Kingdom 2Heart Hospital, Hamad Medical Corporation, Doha, Qatar Topic: Psychosocial factors/Quality of life (Prevention & Epidemiology) Background: Cardiorespiratory fitness (CRF) is increased by exercise, which has also been reported to improve depression. Purpose: To assess the relationship between depression and CRF in healthy and depressed adults. Methods: The PubMed, Cochrane Library, Google Scholar and ProQuest databases were browsed for English-language studies published from January 2000 to September 2012. Studies reporting correlation between a depression scale and VO2peak, as well as studies from the data of which this correlation could be calculated were included. Correlation coefficients (CCs) were converted to Fischer s z and were analysed using a random-effects model. Then, summary effects and 95% confidence intervals (CI) were converted back to CCs. Results: Thirteen studies (3931 participants) were included. A modest correlation between depression and CRF was found (CC -0.17, 95% CI -0.22 to -0.11), appearing stronger in male (CC -0.22, 95% CI -0.26 to -0.18) than female (CC -0.12, 95% CI -0.19 to -0.05) participants (p = 0.015). There was no difference in the summary effect between healthy and depressed adults (p = 0.23). Age and publication year were not related to studies effects (p = 0.12 and p = 0.07, respectively). Two of the 8 included trials performed data collectors blinding, while 3 of the 13 included studies used Respiratory Exchange Ratio = 1.1 as an objective termination criterion of the cardiopulmonary exercise test. Conclusions: Depressed adults, especially men, tend to be unfit and vice-versa. Apart from its prognostic implications, this finding encourages the research on the effects of improving CRF on depression and vice-versa, while also indicates that there may be a biological link between depression and CRF, although this needs to be confirmed in studies controlling potential moderators. P461 Coronary artery disease and arrhythmia in relation to depressive symptoms J Piwonski1, A Piwonska1, E Sygnowska1, T Zdrojewski2 1National Institute of Cardiology, Warsaw, Poland 2Medical University of Gdansk, Gdansk, Poland Topic: Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: cardiovascular patients very often suffered from concomitant diseases. From the other hand EBM confirmed the role of psychosocial factors in pathogenesis of many diseases. We hypothesized that depressive symptoms (DS) were independently associated with history of coronary artery disease (CAD) in general, myocardial infarction (MI), coronary artery bypass graft procedure (CABG), and arrhythmia (ARH) in Polish adult population. Methods: the random sample of Polish population (6392 men and 7153 women), aged 20-74, was examined in 2003-2005 in the frame of WOBASZ study. The prevalence of self-reported cardiovascular diseases (CAD, MI, ARH), and additionally CABG procedure were assessed by questionnaire and the prevalence of DS using Beck depression inventory (DS when = 10pts BDI), separately in men and women. Results: Out of examined persons, CAD was found in 12,1% men and 11,0% women. Persons with CAD were older, more often primary educated and large commune residents and more often had obesity, hypertension, diabetes and hyperlipemia compared to those without CAD. DS were found more often in persons with CAD than without, both in men (46,7% vs 21,2%, p<0.0001), and women (60,5% vs 20,7%, p<0.0001). Persons with DS had from one and a half to twice more higher chance of having CAD, MI, ARH or CABG compared to persons without DS [(men: OR CAD=2,15, OR MI=1,58, OR CABG=2,19, and OR ARH=1,52; p<0.001 for each); (women: OR CAD=1,96, OR MI=1,55, OR CABG=1,70, and OR ARH=2,09; p<0. 001 for each)], after adjustment for age, smoking habit, hypertension, hyperlipidemia, diabetes, BMI, education, and the place of residence. Conclusions: The history of coronary artery disease, myocardial infarction, CABG procedure, and arrhythmia occurred to be related to depressive symptoms in Polish adult population, independently of classical CVD risk factors. P462 External validation of the CAMUNI score, a long-term cardiovascolar disease risk prediction equation for low-incidence populations G Veronesi1, C Donfrancesco2, LE Chambless3, F Gianfagna1, L Palmieri2, G Mancia4, G Cesana4, S Giampaoli2, MM Ferrario1 1University of Insubria, research center in epidemiology and preventive medicine, Varese, Italy 2Istituto Superiore di Sanità National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy 3University of North Carolina at Chapel Hill, department of biostatistics, Chapel Hill, United States of America 4University of Milano-Bicocca, departmento of clinical and preventive medicine, Monza, Italy Topic: Other risk factors (Prevention & Epidemiology) Purpose: To assess the external validation, on a "new" set of subjects, of the CAMUNI 20-year risk score, developed in a northern Italian population. Although an external validation analysis is recommended before adopting a score in clinical practice, it is rarely performed in long-term prediction equations as it requires different cohorts with similar follow-up. Methods: The CAMUNI risk score was developed to estimate the 20-year risk of first coronary or ischemic stroke event, fatal or non-fatal, in 5247 (2574 men) 35-69 subjects free of CVD at baseline enrolled in late 1980s-early 1990s in Brianza, northern Italy (derivation set). The score is based on gender-specific Cox models, including age, total- and HDL-cholesterol, systolic blood pressure, anti-hypertensive treatment, cigarette smoking and diabetes. The validation set consisted in 5307 (2418 men) subjects enrolled in the Rome area in the same time span (MATISS Study). Both the derivation and the validation cohorts shared the same procedures for baseline risk assessment and follow-up procedures, including MONICA definition of acute events. We evaluated the performance of the CAMUNI score in the validation set in comparison to the Framingham CVD risk score (FRS). The absolute predicted risk from both scores was re-calibrated to the 20-year risk observed in the validation set. We assessed the calibration slope (a value different from 1 indicates a different strength in predictors effect) and the Area Under the ROC-curve (AUC) in the validation set, compared to the AUC in the derivation set corrected for over-optimism. Results: The median length of follow-up was 15 and 17 years in the derivation and validation set, respectively. The 20-year Kaplan-Meier risk of event was 16.1% (derivation set; 315 events) and 13.2% (validation set; 238 events) in men, and 6.1% (123 events) and 5.6% (119 events) in women. The calibration slope for the CAMUNI score did not significantly differ from 1 in men (1.1; 95% confidence interval 0.9-1.2) nor in women (1.0; 0.8-1.2). The FRS performed equally well in men (1.1; 0.9-1.2) but worse in women (1.3; 1.1-1.6). In the derivation set, the over-optimism corrected AUC for the CAMUNI model was 0.737 (men) and 0.801 (women); corresponding figures in the validation set were 0.732 (95% CI: 0.727-0.738) in men, and 0.801 (0.794-0.808) in women. The FRS performed less well in men (0.722; 0.717-0.727) and in women (0.705; 0.699-0.711). Conclusions: Based on these preliminary results, the CAMUNI 20-year risk score seems to be appropriate for long-term risk prediction in Italy and, more generally, in low-incidence populations. P463 Echocardiographic features in relation to alcohol in a population with diverse alcohol consumption S K Malyutina1, A Ryabikov2, S Shakhmatov1, E Voronina1, N Yasyukevich1, YU Nikitin1 1Institute of Internal Medicine SB RAMS, Novosibirsk, Russian Federation 2Novosibirsk State Medical University, Novosibirsk, Russian Federation Topic: Other risk factors (Prevention & Epidemiology) There is widely reported U-shaped association between regular alcohol intake and cardiovascular mortality. The hazardous effect of excessive alcohol consumption on the heart is largely described in experiments or clinical group of alcoholics. There are scarce knowledge on relationship between alcohol intake and cardiovascular phenotypes in a general population. Purpose: To investigate the relationship between alcohol intake and echocardiographic (Echo) phenotypes in a population sample (Novosibirsk, Russia). Methods: The data came from the population surveys conducted in random samples in Novosibirsk (Russia) within WHO MONICA Project in 1988/89 and 1994/95. A random subsample was examined with Doppler-Echocardiography (n=2006; men, women, 25-64). Chamber quantification, left ventricle (LV) mass calculation (indexed by body surface area) and diastolic transmitral flow evaluation were performed. The frequency of drinking, alcohol intake per session and during the last week were assessed by structured questionnaire. Cardiovascular risk factors were evaluated by standardized epidemiological methods. Results: We found the wide diversity of alcohol consumption in studied sample. The mean occasional alcohol dose comprised 114.9(SD 66.45) g of ethanol in men and 29.8(22.9) g in women. In unadjusted analysis, LV ejection fraction in men increased by frequency of drinking (p=0.001) or occasional alcohol dose (p<.001), and was suggestively related to binge drinking (>80 g per session, p=0.057). LV stroke volume also increased by drinking frequency in men (p=0.003). The half of the sum of LV wall thickness was higher among binge drinking men (p=0.033) then in non-drinkers. In multivariable models, in men, the odd of increased LV mass was 2 times higher in rare drinking (less then once a month) compared to non-drinkers (OR=1.96; 1.08-3.57). We failed to reveal association of any alcohol measure with neither LV diastolic diameter index nor transmitral flow patterns. Surprisingly, left atrium diameter index was inversely while inconsistently related to drinking frequency or alcohol amount in studied sample. In women, alcohol intake was not associated with any Echo measures. Conclusions: In studied Russian population sample we found high alcohol intake per session and high prevalence of binge drinking in men, and modest alcohol intake in women. Among Echo parameters, the measures of cardiac output and LV hypertrophy were independently related to alcohol in men. These findings are consistent with a view that potential effect of excessive alcohol on heart might be through sympathoadrenal activation. P464 Chronic Kidney Disease and Metabolic Syndrome in Korean middle-aged Adults from 1998 through 2009 S Y Jang1, EY Ju2, SW Park1, DK Kim1 1Samsung Medical Center, Cariovascular Imaging Center, Cardiac and Vascular Center, Seoul, Korea, Republic of 2Seoul National University, Graduate School of Public Health, Seoul, Korea, Republic of Topic: Other risk factors (Prevention & Epidemiology) Purpose The aim of this study is to investigate the association between metabolic syndrome (MetS)and chronic kidney disease (CKD) after adjustment for socioeconomic position and health behavior factors in the general representative population in Korea in 1998 through 2009. Methods The first, second, third and fourth Korea National Health and Nutrition Examination Survey (KNHANES I, II, III, and IV) was conducted by the Korea Institute for Health and Social Affairs for the Korean Ministry of Health and Welfare in 1998, 2001, 2005 and 2007-2009. The sample included 11,289 Korean men and women aged 45-64 years. Subjects were classified into two groups based on their baseline glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration equation: 1) greater than or equal to 60 mL/min/1.73 m2 (non-CKD group; normal and mild renal dysfunction), and 2) less than 60 mL/min/1.73 m2 (CKD group; moderate, severe renal dysfunction, and renal failure). The MS was determined using National Cholesterol Education Program Adult Treatment Panel III criteria and the Asia-Pacific criteria for obesity based on waist circumference. Results The distribution of CKD was 1.8%, 6.8%, 3.6% and 2.9% in 1998, 2001, 2005, and 2007-2009, respectively. The distribution of MetS was 41.4%, 41.9%, 39.7% and 34.3%, respectively. The adjusted odds ratio for MS was 6.26 (95% Confidence Interval (CI) 1.78-21.9), 2.96 (95% CI 1.02-8.54), 2.55 (95% CI 0.50-13.0), and 1.89 (95% CI 1.19-3.02) after adjustment for confounding factors, respectively. Conclusions This community-based random sample drawn from the entire Korean middle aged population showed that MS was significantly associated with CKD. P465 Bariatric surgery improves metabolic profile and diastolic left ventricular function in morbid obesity V Hernandez Jimenez1, J Saavedra2, A Gonzalez2, P Iglesias3, S Civantos2, G Guijarro2, C Toran2, S Monereo2 1Hospital General de Ciudad Real, Ciudad Real, Spain 2Hospital Universitario de Getafe, Madrid, Spain 3Hospital Juan Carlos, mostoles, Madrid, Spain Topic: Other risk factors (Prevention & Epidemiology) INTRODUCTION AND OBJECTIVES: Obesity deteriorates metabolic profile and induces structural and functional heart changes. We analyzed the evolution of cardiovascular risk factors and heart changes of morbidly obese patients after bariatric surgery (BS). Methods: We studied 22 morbidly obese patients who had undergone BS. Anthropometric, biochemical and echocardiographic data were analyzed before surgery and after six months. Their median age was 43.5 years and 86% were women. Results: The average of body mass index (BMI) was 48.3 kg/m2, the average of hip circumference and waist circumference before surgery were 130.8 and 124.7 cm respectively. Six months after BS, we observed a significant reduction of these 3 parameters. The blood glucose as triglycerides and systolic blood pressure (SBP) also decreased significantly (Table 1). Respect to heart changes: 73.7% of patients presented an abnormal diastolic pattern of left ventricle. Six months after of BS, the diastolic function improved in 44% of the patients (p=0.016). Conclusions: According to our results, weight loss after bariatric surgery leads to: 1.- A significant improvement in metabolic profile of the patients. 2.- A significant improvement in diastolic function of left ventricle. Table 1 Average of reduction at 6 months 95% Confidence interval p BMI (Kg/m2) 13.9 12.03-15.79 < 0.001 Waist circumference (cm) 24.25 18.08-30.4 < 0.001 Hip circumference (cm) 22.71 15.91-29.5 < 0.001 SBP (mmHg) 19 10.7-27.29 <0.001 Blood glucose (mg/dl) 23.76 7.48-40 0.006 Cholesterol (mg/dl) 9.71 -4.88-24.31 ns Triglycerides (mg/dl) 25.52 6.42-44.24 0.011 Average of reduction at 6 months 95% Confidence interval p BMI (Kg/m2) 13.9 12.03-15.79 < 0.001 Waist circumference (cm) 24.25 18.08-30.4 < 0.001 Hip circumference (cm) 22.71 15.91-29.5 < 0.001 SBP (mmHg) 19 10.7-27.29 <0.001 Blood glucose (mg/dl) 23.76 7.48-40 0.006 Cholesterol (mg/dl) 9.71 -4.88-24.31 ns Triglycerides (mg/dl) 25.52 6.42-44.24 0.011 Open in new tab Table 1 Average of reduction at 6 months 95% Confidence interval p BMI (Kg/m2) 13.9 12.03-15.79 < 0.001 Waist circumference (cm) 24.25 18.08-30.4 < 0.001 Hip circumference (cm) 22.71 15.91-29.5 < 0.001 SBP (mmHg) 19 10.7-27.29 <0.001 Blood glucose (mg/dl) 23.76 7.48-40 0.006 Cholesterol (mg/dl) 9.71 -4.88-24.31 ns Triglycerides (mg/dl) 25.52 6.42-44.24 0.011 Average of reduction at 6 months 95% Confidence interval p BMI (Kg/m2) 13.9 12.03-15.79 < 0.001 Waist circumference (cm) 24.25 18.08-30.4 < 0.001 Hip circumference (cm) 22.71 15.91-29.5 < 0.001 SBP (mmHg) 19 10.7-27.29 <0.001 Blood glucose (mg/dl) 23.76 7.48-40 0.006 Cholesterol (mg/dl) 9.71 -4.88-24.31 ns Triglycerides (mg/dl) 25.52 6.42-44.24 0.011 Open in new tab P466 The relationship between obstructive sleep apnea and reactive hyperemia by peripheral arterial tonometry J Oh1, S Park1, JC Youn1, GR Hong1, SH Lee1, SM Kang1, D Choi1 1Yonsei University College of Medicine, Cardiology Division, Seoul, Korea, Republic of Topic: Other risk factors (Prevention & Epidemiology) Introduction: Obstructive sleep apnea (OSA) has been shown to be an important risk factor for metabolic syndrome and cardiovascular disease. Endothelial dysfunction plays a pivotal role in the pathophysiology of these diseases. However, little is known about the relationship between sleep apnea and endothelial dysfunction, especially digital reactive hyperemia by peripheral arterial tonometry. Methods: The study population consisted of 80 patients (mean age 48 ± 12 years-old, 65 men, 59 hypertension, 8 dyslipidemia, 7 diabetes mellitus, mean body mass index 27.3 ± 3.4). We measured apnea–hypopnea index (AHI) and reactive hyperemia index (RHI) derived from peripheral arterial tonometry (PAT) as measurement of endothelium-mediated vasodilatation. Mild OSA was defined as 5 < AHI <15 and moderate OSA as AHI = 15. Results: There were 61 OSA patients in the study population(AHI 21.5 ± 16.7 vs. 2.7 ± 1.6 in non-OSA, p<0.001). There were no significant differences in RHI and peripheral augmentation index (pAIx) between OSA and no-OSA group (RHI 2.04 ± 0.48 vs. 2.06 ± 0.42 p=0.894, pAIx 21.7 ± 24.0% vs. 21.7 ± 30.0% p=1.000, respectively). Also, there was no significant differences in RHI and pAIx between mild (n=31) and moderate (n=30) OSA group (RHI 2.10 ± 0.47 vs. 1.98 ± 0.49 p=0.333, pAIx 24.2 ± 20.7% vs. 19.0 ± 27.2% p=0.407, respectively), either. In overall group, no correlations between AHI and RHI were observed (r=-0.023, p=0.837). The other OSA severity indices such as oxygen desaturation index (ODI), mean and minimum oxygen saturation were not correlated with RHI or pAIx. In OSA group, we could find any significant relationships between AHI and PAT parameters, either. Conclusions: OSA was not observed to be associated with reactive hyperemia measured by PAT. P467 Erectile dysfunction in men with high cardiovascular risk and metabolic disorders G Sharvadze1, Y Balanova1, A Yevdokimova1, E Akhmedova1, M Mamedov1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Other risk factors (Prevention & Epidemiology) Objective. To evaluate the frequency of androgen deficiency and erectile dysfunction (ED) in men with metabolic syndrome and high cardiovascular risk on SCORE. Methods: The study included 300 men aged 30-59 with metabolic syndrome (IDF criteria, 2005) and high cardiovascular risk on SCORE (>5%). All participants were measured HDL cholesterol, LDL cholesterol, triglycerides and fasting glucose as well as waist circumference and BP. Androgen deficiency was diagnosed if level of total testosterone was decreased (<12 nmol/l) and/or level of free testosterone was decreased (<0,255 nmol/l) and if symptoms of hypogonadism were present. ED was evaluated by IIEF (<21 points). Results: Androgen deficiency was diagnosed in 17% (n=52) of men with metabolic syndrome and high cardiovascular risk, but ED – in 60,7% (n=182). In all cases androgen deficiency was combined with ED of different degrees (18% mild, 33,7% mild-moderate and 9% moderate). Hypogonadism was diagnosed in 28,6% of patients with ED and high cardiovascular risk. Among men with ED (including the subgroup with hypogonadism). The patients with ED in 22,6% had 3 component, 29,4% - 4 component and 8,7% of men had all 5 components of metabolic syndrome. Conclusion. Every second man with metabolic syndrome and high cardiovascular risk has ED, one third – hypohonadism. P469 A study of lipoprotein associated phospholipase A2 (LpPLA2) as a better marker than highly sensitive C Reactive protein (hs-CRP) and lipoprotein(a) in Indians with coronary artery disease S Das1, S K Gupta1, G Mp2, P C Ray1 1Maulana Azad Medical College, New Delhi, India 2GB Pant Hospital, New Delhi, India Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Background : Lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, mainly associated with LDL, hydrolyzes its phospholipids producing proinflammatory compounds like lysophosphatidylcholine and oxidized non-esterified fatty acids. Accumulating evidence suggests Lp-PLA2 to be very good marker of coronary artery disease (CAD) and predictor of an acute event. However its role has not been documented clearly in Indians. The aim of this study was to explore the association of LpPLA2 with CAD and compare it with other established markers like hs-CRP and Lipoprotein (a) [Lp(a)] in Indians. Methods:100 adult patients, above 19 years of age, with angiographically proven CAD of which 50 patients were of stable angina(Group I), 50 patients with acute coronary syndrome [Group II - 35 patients with unstable angina +15 patients with acute MI] and 50 age and sex matched healthy controls were studied in a tertiary health care center, New Delhi, India, over a period of 1 year. The serum levels of LpPLA2, hs-CRP and Lipoprotein(a) were measured by ELISA and routine lipid profile was measured by automated analyzer. Angiographic clinical vessel scoring was also done for all the patients. Data is presented as Mean±S.D. and relationships were determined by Pearson correlations and Receiver Operating Characteristic Curve (ROC) analysis. Results : The mean age of the patients was 49±8.8 years (84% men, 16%women). The mean serum LpPLA2 levels [274.30±33.16 ng/ml] for stable angina (Group I), and acute coronary syndrome (Group II) [287.39±35.61 ng/ml] were significantly higher than in controls [196.64±21.4 ng/ml] [p<0.001]. Within Group -II, LpPLA2 levels were significantly higher in acute MI patients than in unstable angina patients. High LpPLA2 values correlated with higher angiographic clinical vessel scores indicating a more severe CAD both in stable angina patients[r=0.384, p<0.001] and unstable angina patients[r=0.459, p<0.001]. LpPLA2 [AUC=0.995] was found to be better marker than LDL-C [AUC=0.780], total cholesterol [AUC=0.759], hs-CRP [AUC=0.970], Lp(a) [AUC=0.969] by ROC analysis. Conclusions:Lipoprotein associated phospholipase A2 is a better marker of CAD than LDL-C, hs-CRP and Lp(a). Our results also suggest that LpPLA2 is an emerging marker of Coronary Artery Disease and its severity. P470 Beyond Framingham Risk Factors and Coronary Calcification: Does Aortic Valve Calcification improve Risk Prediction? The Heinz Nixdorf Recall Study H Kaelsch1, N Lehmann1, AA Mahabadi1, M Bauer1, K Kara1, P Hueppe1, S Moebus2, S Moehlenkamp1, K-H Joeckel2, R Erbel1 1Department of Cardiology, university clinic duisburg-essen, Essen, Germany 2University of Duisburg-Essen, Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Background: Aortic valve calcification (AVC) is considered a manifestation of atherosclerosis. In this study, we investigated whether AVC adds to cardiovascular risk prediction beyond Framingham risk factors and coronary artery calcification (CAC). Methods: A total of 3944 subjects from the population-based Heinz Nixdorf Recall Study (59.3±7.7 yrs; 53% females) were evaluated for coronary events, stroke and cardiovascular disease (CVD) events (including all plus CV death) over 9.1±1.9 years. To quantify AVC CT-scans were performed. Cox proportional hazards regressions and Harrell's c were used to examine AVC as event predictor in addition to risk factors and CAC. Results: During follow-up, 138 (3.5%) subjects experienced coronary events, 101 (2.6%) had a stroke and 257 (6.5%) CVD events occurred. In subjects with AVC>0 vs. AVC=0 the incidence of coronary events was 8.0% vs. 3.0% (p<0.001) and of CVD events 13.0% vs. 5.7% (p<0.001). Frequency of events increased significantly with increasing AVC-scores (p<0.001). After adjustment for Framingham risk factors, high AVC-scores (3rd tertile) remained independently associated with coronary events (HR (95%CI): 2.21 (1.28-3.81)) and CVD events (HR 1.67 (1.08-2.58)). After further adjustment for CAC-score, hazard ratios were attenuated (coronary events: 1.55 (0.89-2.69), CVD events: 1.29 (0.83-2.00). When adding AVC to the model containing traditional risk factors and CAC, Harrell s C indices did not increase for coronary (0.744-0.744) or CVD events (0.759-0.759). Conclusions: AVC is associated with incident coronary and CVD events independent of Framingham risk factors. However, AVC fails to improve cardiovascular event prediction over cardiovascular risk factors and CAC. P471 Implementation of cardiovascular prevention by evaluation of practice, the Swedish experience A Kiessling1, K Hambraeus2, L Nilsson3, L Svennberg4, J Perk5 1Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden 2Falun Hospital, Department of Cardiology, Falun, Sweden 3Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden 4Gävle County Hospital, Gävle, Sweden 5Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: A healthy lifestyle including non-smoking, non-hazardous use of alcohol, physical activity and healthy eating habits can prevent coronary artery disease. However, cardiovascular prevention (CVP) after acute myocardial infarction (AMI) has been more focused on pharmacological treatment of risk factors than implementation of life style changes. This project aims to describe the implementation of strategies to integrate support of healthier life style with pharmacological CVP by evaluation of practice quality on a national level. Methods: The first Swedish National Guidelines for Methods of Preventing Disease was presented in 2012 and provide recommendations on how to change unhealthy lifestyle habits. To evaluate the implementation of these guidelines we have used SWEDEHEART, the national quality registry for all patients hospitalized for acute coronary syndromes. This registry also provides follow-up CVP data for AMI-patients < 75 years of age. Registered variables: Health related quality of life, symptoms of heart disease, rehospitalisation, tobacco use, physical activity, participation in cardiac rehabilitation, medication, lipids and blood pressure. The SWEDEHEART Quality Index is a tool for "Quality-at-a glance" where target achievement for important quality measures forms an index reported publically at hospital level. It was altered in 2012 to focus on the above CVP measures in addition to quality measures of acute cardiac care. The composite Quality Index is based on defined cut-off levels for 0.5 and 1 point for each component. Results: Data 2012 for 6430 followed patients one-year post-AMI shows that 40 % had participated in a physical training programme, 39% were engaged in moderate physical activity > 30 minutes a day, 5 days a week. 30 % were smokers at inclusion and 55 % of them had quit smoking after one year. 15 % had participated in a diet programme. There were no difference in mean target achievements for the life style variables compared to 2011, but an overall improvement in the SWEDEHEART- index from 4.6 to 5.6 points Conclusions: The use of the SWEDEHEART registry to show the results of strategies supporting lifestyle changes for post-AMI patients is promising. Public reporting of target achievement rates for individual hospitals has not yet though affected the results one year after the introduction. There is still need for improvement in adherence to life style guidelines, and there are substantial quality differences regarding prevention between different hospitals in Sweden. P472 An immunomodelating fatty acid analogue targeting mitochondria exerts anti-atherosclerotic effect beyond plasma cholesterol-lowering activity in apoE-/- mice R Vik1, BB Bjorndal1, M Musnelli2, C Parolini2, S Holm3, P Bohov1, BB Halvorsen3, T Brattelid4, S Manzini2, GS Ganzetti2 1University of Bergen, Bergen, Norway 2Universita degli Studi di Milano, Milano, Italy 3Oslo University Hospital Rikshospitalet, Oslo, Norway 4National Institute of Nutrition and Seafood Research (NIFES), Bergen, Norway Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Objectives: Tetradecylthioacetic acid (TTA) is a hypolipidemic antioxidant with immunomodulating properties involving activation of peroxisome proliferator-activated receptors (PPARs) and mitochondrial proliferation. This study aimed to penetrate the effect of TTA on the development of atherosclerotic lesions in apolipoprotein (apo) E-/- mice. Methods: 24 apoE-/- mice were divided in two groups and fed a high-fat control diet or a high-fat diet containing 0.3% (g/100g diet) TTA for 12 weeks. At sacrifice, aortic arch and heart was harvested for atherosclerotic plaque estimation. In addition, lipid classes were determined in plasma and liver, cytokine levels were measured in plasma, fatty acid composition and gene expression analysis was performed in heart, liver and aorta, and enzyme activities were measured in liver. Results: Plasma cholesterol was increased by TTA administration and triacylglycerol levels in plasma and liver were decreased, concomitant with increased hepatic mitochondrial fatty acid oxidation and reduced lipogenesis. TTA administration changed the fatty acid composition in the heart, and the amount of arachidonic acid and eicosapentaenoic acid was reduced and increased, respectively. The gene expression of inducible nitric oxidase (NOS2) was decreased, while catalase was increased in the heart of TTA-treated mice. Moreover, the mean mRNA levels of NOS2, VCAM-1, ICAM and MCP-1 in the aortic arch from six animals were decreased. Finally, reduced plasma levels of the inflammatory mediators IL-1a, IL-6, IL-17, TNFa and IFNg were detected in TTA-treated mice. This was accompanied by a significant reduced atherosclerotic plaque area in the aortic arch and heart sinus. Conclusions: These data show that TTA reduces atherosclerotic plaque development in high-fat fed apoE-deficient mice and modulates the risk factors related to atherosclerotic disorders. TTA probably acts at both systemic and vascular levels in a manner independent of changes in plasma cholesterol, and triggers TAG metabolism with improved mitochondrial function. P473 The impact of social deprivation on cardiac revascularization outcomes within the National Health Service in England and Wales B Matata1, M Shaw1, J Mcshane1, J Lucy2, T Grayson1, M Jackson3 1Liverpool Heart and Chest Hospital, Liverpool, United Kingdom 2Public Health Wales, Swansea, United Kingdom 3Institute of Cardiovascular Medicine & Science, Liverpool, United Kingdom Topic: Atherosclerosis/CAD (Prevention & Epidemiology) In the UK, concerns have been raised regarding the disparities in the provision of acute cardiac services within the National Health Service. This study explored whether differences exist in (a) duration before hospital presentation, (b) attributes and indicators of severity and disease burden, and (c) treatment outcomes (hospital stay and mortality) on the basis of the index of multiple deprivation (IMD) status derived from the area of residence. A retrospective analysis of data from NHS databases for patients that had undergone cardiac revascularisation at our hospital between 2007-2012. The data was analysed by descriptive, univariate and multivariate statistics to explore the association between the IMD quintiles (Q1-Q5) and severity of disease, time of presentation, hospital stay and mortality. The results indicated that patients from IMD Q5 (most deprived) compared with Q1 had significantly delayed presentation to hospital and greater admission by emergency pathways. In addition, patients from IMD Q5 compared with Q1, had significantly greater morbidity: angina class =III, NYHA class =III, diabetes and Charlson score >5, significantly prolonged hospital stay, and poorer 5-year follow-up survival. IMD quintile 5 was independently associated with 57% increase in risk of death (Table 1). In Conclusions, there is evidence to suggest that social deprivation is a major factor associated with cardiac health inequalities and disparities in the provision of acute cardiac services in the UK. Table 1 Risk Factors Hazard Ratio 95% CI p-value Age 1.07 1.06, 1.08 <0.001 LVEF <30% 2.77 2.32, 3.31 <0.001 Charlson score = 5 4.27 3.36, 5.42 <0.001 NYHA class = III 1.50 1.30, 1.74 <0.001 Diabetes 1.48 1.28, 1.71 <0.001 Complex cardiac surgery (excludes valves) 1.32 1.10, 1.59 0.003 IMD quintile 5 (most deprived) 1.57 1.28, 1.94 <0.001 IMD quintile 4 1.23 0.96, 1.56 0.10 IMD quintile 3 1.15 0.90, 1.47 0.28 IMD quintile 2 1.01 0.79, 1.29 0.92 IMD quintile 1 (referent category) 1 - - Risk Factors Hazard Ratio 95% CI p-value Age 1.07 1.06, 1.08 <0.001 LVEF <30% 2.77 2.32, 3.31 <0.001 Charlson score = 5 4.27 3.36, 5.42 <0.001 NYHA class = III 1.50 1.30, 1.74 <0.001 Diabetes 1.48 1.28, 1.71 <0.001 Complex cardiac surgery (excludes valves) 1.32 1.10, 1.59 0.003 IMD quintile 5 (most deprived) 1.57 1.28, 1.94 <0.001 IMD quintile 4 1.23 0.96, 1.56 0.10 IMD quintile 3 1.15 0.90, 1.47 0.28 IMD quintile 2 1.01 0.79, 1.29 0.92 IMD quintile 1 (referent category) 1 - - Risk factors influencing 5-year survival Open in new tab Table 1 Risk Factors Hazard Ratio 95% CI p-value Age 1.07 1.06, 1.08 <0.001 LVEF <30% 2.77 2.32, 3.31 <0.001 Charlson score = 5 4.27 3.36, 5.42 <0.001 NYHA class = III 1.50 1.30, 1.74 <0.001 Diabetes 1.48 1.28, 1.71 <0.001 Complex cardiac surgery (excludes valves) 1.32 1.10, 1.59 0.003 IMD quintile 5 (most deprived) 1.57 1.28, 1.94 <0.001 IMD quintile 4 1.23 0.96, 1.56 0.10 IMD quintile 3 1.15 0.90, 1.47 0.28 IMD quintile 2 1.01 0.79, 1.29 0.92 IMD quintile 1 (referent category) 1 - - Risk Factors Hazard Ratio 95% CI p-value Age 1.07 1.06, 1.08 <0.001 LVEF <30% 2.77 2.32, 3.31 <0.001 Charlson score = 5 4.27 3.36, 5.42 <0.001 NYHA class = III 1.50 1.30, 1.74 <0.001 Diabetes 1.48 1.28, 1.71 <0.001 Complex cardiac surgery (excludes valves) 1.32 1.10, 1.59 0.003 IMD quintile 5 (most deprived) 1.57 1.28, 1.94 <0.001 IMD quintile 4 1.23 0.96, 1.56 0.10 IMD quintile 3 1.15 0.90, 1.47 0.28 IMD quintile 2 1.01 0.79, 1.29 0.92 IMD quintile 1 (referent category) 1 - - Risk factors influencing 5-year survival Open in new tab P474 Percentiles for oscillometric pulse wave velocity in childhood and adolescence J Elmenhorst1, R Oberhoffer1 1Technische Universitä Institute of Preventive Pediatrics, München, Germany Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Pulse wave velocity, a surrogate for arterial stiffness, has an independent predictive value for all-cause mortality and further cardiovascular disease (CVD). Prevention of CVD and screening for risk factors has to start early to detect reversible levels of arterial stiffening. Aim of the study was to establish reference percentiles for pulse wave velocity (PWV). Methods: The study population consisted of 1556 probands (725 male) from 8-22 years with a mean age of 13.6 ± 2.9 years (girls) and 13.1 ± 2.6 years (boys). PWV was measured with an oscillometric device (Mobil-O-Graph, IEM, Germany) after 5 minutes rest in supine position. Reference values and percentiles are calculated using LMS chartmaker pro (MRC, Great Britain). To fit smooth centile curves the changing distribution according to some covariate is presented as median (M), coefficient of variation (S) and skewness (L). Reference centiles refer to age and body height. A separate presentation for girls and boys was chosen, respecting sex-typical different growth patterns regarding age and body height (no observations from hypertensive and/or obese subjects were used to calculate centiles). Results: PWV increases from 4.43 ± 0.34 [m/s] (8 year olds) to 4.98 ± 0.33 [m/s] (21 year olds) in girls and from 4.26 ± 0.18 [m/s] to 5.22 ± 0.46 [m/s] in boys, respectively (mean ± SD in [m/s]: boys= 4.70 ± 0.38; girls= 4.69 ± 0.31). PWV varies in youth and young adults with age and body height changes; however, the overall increase is roughly below 1m/s in the observed 14 years. In the 8-12 year olds PWV is higher in girls than in boys (e.g. PWV in 10 year olds: girls= 4.55 ± 0.28; boys= 4.46 ± 0.21 [m/s]; p=.03). With 13 years, there are no sex differences any more (girls= 4.77 ± 0.32; boys= 4.7 ± 0.29 [m/s]; p=.186). Afterwards from pubertal rise on (around 14 years) the PWV increase is more pronounced in boys than in girls (all p<.05). Conclusions: Smoothed percentiles for age- and height-dependent PWV can now be used to detect subjects with elevated PWV already in childhood. At present different measurement techniques (oscillometric, tonometric) lead to divergent results and further efforts are needed to harmonize these results to enable comparability. P475 Acute atherogenic effect of single fatty meal on healthy volunteer M A K Abdel Wahab1, A M Ibrahim1, T M Abdel Rahman1 1El Minya univeristy hospital, El Minya, Egypt Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Acute atherogenic effect of single fatty meal on healthy volunteer Postprandial state could be hazardous in healthy subjects mostly through acute hyperlipacidemia. However, limited evidence exists on the effect of single high-fat meal on healthy subjects. Endothelial cell damage or dysfunction is associated with the onset and progression of atherosclerosis. Aim: to study the effect of single fatty meal on early atherosclerotic changes of healthy volunteer. Methods: 40 volunteers aged from 23 to 50 years old were included in this study. They were subjected to: history taking, clinical examination, measurement of body mass index, 12 lead electrocardiogram and trans thoracic Echo-Doppler study. They also subjected to measurement of flow mediated dilatation (FMD %) and dilatation ratio (DIL %) using colored duplex ultrasound as a reliable measurments of endothelial function at 2 occasions before and 3 hours after taking single fatty meal (50 gm fat) Results: Mean FMD % was significantly decreased in the postprandial phase (7.1 ± 6.53) than preprandial (13.1 ± 9.33) (P=0.001). Furthermore, Dilatation ratio was significantly decreased in the postprandial (52.7 ± 59.99) than preprandial phase (79.82 ± 51.12) (P=0.02). on the other hand, no significant differences between preprandial (18.2 ± 8.83) and postprandial GTN (16.9 ± 10.39) (P=0.43). Conclusions: acute lipaemia affects the ability of endothelial cells to increase their NO secretion (the endothelial function reserve). This result emphasizes the importance of reducing dietary levels of saturated fat as a vital component in preventing cardiovascular diseases. P476 Clinical profile of acute coronary syndrome in elderly patients M T Lopez Lluva1, V Hernandez Jimenez1, V Mazoteras Munoz1, M Marina Breysse1, N Pinilla Echeverri1, J Piqueras Flores1, AL Moreno Reig1 1Hospital General Universitario de Ciudad Real, Ciudad Real, Spain Topic: Atherosclerosis/CAD (Prevention & Epidemiology) INTRODUCCTION: Our society is aging at an accelerated pace. Since the incidence and prevalence of coronary heart disease increases with age, more and more elderly patients are hospitalized for acute coronary syndrome (ACS) OBJECTIVE, DESING AND METHOD: The aim of study was to describe the epidemiological and clinical characteristics of a cohort of 49 octogenarian patients with ACS, admitted from January 2010 to January 2011, who underwent percutaneous coronary intervention (PCI). We carried out a prospective observational study. Results: Demographic and angiographic characteristics are shown in Table 1. 65.3 % of patients consulted for atypical symptoms. The mean time to first medical contact was 18 hours. The average stay in coronary care unit was 3.3 ± 2.8 days and 7.6 ± 4.5 days in Cardiology hall. Cardiovascular complications were common. Moreover, 40.8% had renal failure after PCI. Conclusions: The management of patients who suffer SCA octogenarians is usually complicated. These are patients with high comorbidity who present atypical symptoms. In addition, there is high incidence of multivessel disease. Therefore, despite a high rate of target lesion revascularization, the incidence of complications during admission is high. The choice of treatment in this age group must be individualized, regardless of chronological age a limiting factor, and in order to maintain the status of previous functional Independence. Table 1. Age, mean, range (years) 82,5, 80-88 Male sex 33 (67,3%) Hypertension 34 (69,4%) Diabetes mellitus 15 (30,6%) Dyslipidemia 17 (34,7%) - Current / Past smoker 3 (6,1%) /17 (34,7%) - Previous angina - Previous Acute MyocardialInfarction 4 (8,2%) 11 (22,4%) STEMI / NSTEMI 22 (44,9%) / 27(55,1%) Killip-Kimballclass I-II on admission 35 (71,4%) - Absence ofsignificant coronary lesions - Severe illness ofone vessel 1 (2%) - Severe two-vesseldisease 13 (26,5%) - Severe 3-vessel disease 11 (22,4%) 22 (44,9%) Ejection fraction =35% (ventriculography) 27 (55,1%) Complete revascularizationat first intervention 22 (44,9%) Target lesionrevascularization 44 (88,6%) Age, mean, range (years) 82,5, 80-88 Male sex 33 (67,3%) Hypertension 34 (69,4%) Diabetes mellitus 15 (30,6%) Dyslipidemia 17 (34,7%) - Current / Past smoker 3 (6,1%) /17 (34,7%) - Previous angina - Previous Acute MyocardialInfarction 4 (8,2%) 11 (22,4%) STEMI / NSTEMI 22 (44,9%) / 27(55,1%) Killip-Kimballclass I-II on admission 35 (71,4%) - Absence ofsignificant coronary lesions - Severe illness ofone vessel 1 (2%) - Severe two-vesseldisease 13 (26,5%) - Severe 3-vessel disease 11 (22,4%) 22 (44,9%) Ejection fraction =35% (ventriculography) 27 (55,1%) Complete revascularizationat first intervention 22 (44,9%) Target lesionrevascularization 44 (88,6%) Open in new tab Table 1. Age, mean, range (years) 82,5, 80-88 Male sex 33 (67,3%) Hypertension 34 (69,4%) Diabetes mellitus 15 (30,6%) Dyslipidemia 17 (34,7%) - Current / Past smoker 3 (6,1%) /17 (34,7%) - Previous angina - Previous Acute MyocardialInfarction 4 (8,2%) 11 (22,4%) STEMI / NSTEMI 22 (44,9%) / 27(55,1%) Killip-Kimballclass I-II on admission 35 (71,4%) - Absence ofsignificant coronary lesions - Severe illness ofone vessel 1 (2%) - Severe two-vesseldisease 13 (26,5%) - Severe 3-vessel disease 11 (22,4%) 22 (44,9%) Ejection fraction =35% (ventriculography) 27 (55,1%) Complete revascularizationat first intervention 22 (44,9%) Target lesionrevascularization 44 (88,6%) Age, mean, range (years) 82,5, 80-88 Male sex 33 (67,3%) Hypertension 34 (69,4%) Diabetes mellitus 15 (30,6%) Dyslipidemia 17 (34,7%) - Current / Past smoker 3 (6,1%) /17 (34,7%) - Previous angina - Previous Acute MyocardialInfarction 4 (8,2%) 11 (22,4%) STEMI / NSTEMI 22 (44,9%) / 27(55,1%) Killip-Kimballclass I-II on admission 35 (71,4%) - Absence ofsignificant coronary lesions - Severe illness ofone vessel 1 (2%) - Severe two-vesseldisease 13 (26,5%) - Severe 3-vessel disease 11 (22,4%) 22 (44,9%) Ejection fraction =35% (ventriculography) 27 (55,1%) Complete revascularizationat first intervention 22 (44,9%) Target lesionrevascularization 44 (88,6%) Open in new tab P477 Carotid artery ultrasound dopplerography for detection of coronary artery disease severity estimated by Gensini score N Gavrilova1, V Metelskaya1, E Yarovaya1, S Boytsov1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Carotid artery ultrasound is often used to evaluate for significant stenosis related to atherosclerotic disease. This study aimed to reveal a relationship between carotid ultrasound findings and coronary artery disease (CAD) severity measured by Gensini score. Methods: CAD patients aged 33-85 who were underwent to invasive coronary angiography and carotid artery ultrasound dopplerography (n=194; M/F 126/68) were included into the study. The mean common carotid artery intima-media thickness (IMT) was evaluated during carotid artery ultrasound dopplerography. Gensini score was used for evaluation of the CAD severity on the angiogram. Results: Sensitivity and specificity for carotid artery ultrasound in detection coronary atherosclerosis were 92.4% and 27%, respectively. Positive predictive value for carotid atherosclerosis in predicting severe CAD was 84%. Patients with mean IMT =0.9 mm had significantly higher Gensini score than patients without thickening (32.5 vs 11, p=0.003). Similarly, patients having carotid plaques had significantly higher Gensini score than those without carotid atherosclerosis (32 vs 3.5, p=0.012). Patients with coronary atherosclerosis usually had multiple lesions of carotid arteries (more than three carotid plaques; p<0.01) and in most cases these plaques were heterogeneous (p=0.03). The highest Gensini score was found in patients with localization of plaques in the field of the common carotid artery - 43.5. Conclusions: The efficiency of carotid duplex ultrasonography to diagnose CAD severity was demonstrated in our study. Indeed, abnormal findings on carotid artery ultrasound were associated with CAD severity estimated by Gensini score and probably could predict angiographically confirmed stenoses in coronary vessels. The mean IMT, presence of carotid plaques and their localization provide useful information for predicting the presence and complexity of CAD. P478 Significance of circulating endothelial cells and CD4+CD28null T-lymphocytes for cardiovascular risk stratification in primary ischemic heart disease prevention A Iakovleva1, O Mirolyubova1, YU Vakhrusheva1 1Northern State Medical University, Arkhangelsk, Russian Federation Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: To analyze the possibility to use circulating endothelial cells (CECs) and CD4+CD28null ? cells whole blood levels along with classic factors for cardiovascular (CV) risk stratification in healthy individuals. Methods: 31 healthy Arkhangelsk city residents aged 43.9±8.5 yrs. without ischemic heart disease (IHD) and diabetes mellitus were scrutinized as to assess a CV risk profile (including SCORE stratification) and measure the levels of systemic inflammation marker high sensitive C-reactive protein (hsCRP). Using flow cytometry we measure whole blood CECs and CD4+CD28null ? cells concentrations. Results: Excessive body mass/obesity occupied the 1st place (54.8 %) among all risk factors. The frequency of family CV disease history, chronic social stress and hypodynamia was equal (45.2%). 38.7 % of individuals suffered from dyslipidemia. According to the SCORE 25 pts. (80.6%) were in low CV risk group with the LDL-c exceeding target level in 11 cases, 6 pts. (19.4%) were in moderate CV risk group with non-target LDL-c level in 5 cases. BP level correlated both with BMI (? sp.=0.465; p=0.008) and hsCRP concentration (? sp.=0375, p=0.031), hsCRP being abnormally high more than 2.0 mg/l in 7 cases (23%). As well the level of CD4+CD28null ?-cells correlated with BP (? sp.=0,446, p=0,013) and was higher in people with LDL-cholesterol concentration exceeded Me (3.29 mmol/l): 5.13±3.78 vs. 2.48±1.64% (p=0.020). The frequency of CECs varied from 0 to 5 760 cells in 1 ml, BMI being higher in adults with CECs detection: 26.9±0.5 vs. 24.5±0.8 kg/m2 (p=0,048). Glucose level demonstrated the same tendency: 5.4±0.1 vs. 4.9±0.4 mmol/l in CECs absence (p=0.034). Conclusions: Excessive body mass/obesity, dyslipidemia, BP and glycemia are associated with endothelial dysfunction markers CD4+CD28null ?-cells and CECs allowing to discuss their significance in primary IHD prevention. P480 A new state health screening program: first results N Pogosova1, A Ausheva1, A Kursakov1, A Karpova1 1National Center for Preventive Medicine, Moscow, Russian Federation Topic: Atherosclerosis/CAD (Prevention & Epidemiology) A new state health screening program: first results In 2013 a new state health screening program has started in Moscow. The aim of the program is: (a) to reveal the cardiovascular risk factors (smoking, obesity, abdominal obesity, physical activity level, unhealthy diet, total cholesterol, glucose, high blood pressure, SCORE, excessive alcohol intake) and noncommunicable diseases according to a standard screening protocol depending on sex and age; (b) to offer high risk individuals and patients with non-communicable diseases a risk factors management program. Risk factors management includes: (a) GPs short counseling in regard to individual risk factors profile, (b) life style education in special preventive care units, counseling for smoking cessation by trained physicians, counceling on healthy diet and body mass lowering. During 2013 more than 1 million citizens of Moscow were enrolled into the program: 42.9% aged 21- 36 years, 40% - 49-60 years, and 17.1% - more than 60 years. According to the comprehensive screening results 35% were recognized to be healthy, 28.3% - to have high and very high risk of diseases (mostly high very high risk of cardiovascular diseases according to SCORE scale for high risk countries) and 36.6% - to have noncommunicable diseases (cardiovascular diseases, chronic lung diseases, diabetes and cancer). The last group needed active treatment and secondary prevention. 143 new cases of arterial hypertension very revealed per 100 000 population. A special attention has been paid to the group of high and very high risk. The risk factors management program in this group has been aimed to the achievement of risk factors goals. The full results of the program will be estimated in the beginning of 2014. P481 Evaluation of lipid control in patients undergoing percutaneous coronary intervention. Why don't we reach the recommended target levels? E Bosch Peligero1, M Bonet Alvarez1, R Flores Clotet1, D Valcarcel Paz1, M Diaz Nuila Alcazar1, M Santalo Corcoy1, JC Oliva Morera1, J Guindo Soldevila1, A Martinez Rubio1 1Hospital of Sabadell, University Institute Parc Taulí UAB), Department of Cardiology, Sabadell, Spain Topic: Atherosclerosis/CAD (Prevention & Epidemiology) OBJECTIVES: To assess the control of total cholesterol (TC), LDL-C, HDL-C, and triglycerides (TG) in patients undergoing percutaneous coronary intervention (PCI). We registered the use of lipid lowering drugs and if treatment changes during follow-up were appropiate or inappropiate according to the values ??of LDL achieved. METHODS AND Results: we analyzed 307 patients undergoing PCI from Jan-2007 to Sep-2009. During follow-up we evaluated all the plasma measures (CT, LDL-C, HDL-C and TG), as well as the incidence of cardiovascular (CV) events (myocardial infarction, stroke, readmission for ACS, or new revascularization procedure), CV mortality, and overall mortality. We also designed an algorithm to determine if the treatment strategy was appropiate or inappropiate, according to the LDL-C value achieved in every control (with two different target levels of 70 mg/dL, and 100 mg/dL). Mean follow-up was 44.9 ± 16.11 months. After PCI 293/307 patients (95.4%) were treated with statins. Before PCI, the mean values were: TC 194.9 ± 40.77mg/dL, LDL-C 114.7 ± 34.48mg/dL, HDL-C 48.2 ± 14.25mg/dL, and TG 154.6 ± 95.74mg/dL. The mean values at the end of follow-up were: CT 162.9 ± 37.93mg/dL, LDL-C 89,2 ± 30.72 mg/dL, HDL-C 45,8 ± 12.48 mg/dL, and TG 145.1 ± 98.73mg/dL. In 46 patients we could not find any LDL-C determination after PCI. Excluding these, 261 patients were analyzed, with an average of 1.02 ± 0.03 LDL-C determinations per patient and per year. We analyzed 1.087 determinations of LDL-C from 261 patients. Only in 28.97% of these cases, the target level of LDL-C <70 mg/dL was achieved. Considering a target level of LDL-C <100 mg/dl, this was achieved in 72.40%. Depending on the values of LDL-C, we analyzed the therapeutic strategy adopted by the physician in 1.008 cases. Considering a target level of LDL-C <70 mg/dL the change in the therapeutic strategy was appropriate only in 34.92% of cases. If we consider a target level of LDL-C <100 mg/dL, the therapeutic strategy was appropriate in 72.40% of cases. Conclusions : After PCI, despite a high rate of statin therapy (95.4%) and a significant reduction in mean values ??of cholesterol (from 194.9 to 162.9 mg/dL) and LDL-C (from 114.7 to 89.2 mg/dL), a high proportion of patients did not achieve the target level of LDL-C. Only in 28.97% of cases a value of LDL <70 mg/dL was achieved. Considering a target level of LDL-C <70 mg/dL the therapeutic strategy was appropriate only in 34.92% of cases. If we consider a target level of LDL-C <100 mg/dL, the therapeutic strategy was appropriate in 72.40% of cases. P482 Premature rehospitalization after acute coronary syndrome M T Rodriguez Esteban1, P Couto Comba1, R Pimienta1, R Llorens Leon2, S Nunez1, A Cabrera De Leon1, JJ Aleman Sanchez1, JS Hernandez Afonso1 1University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain 2Hospital Rambla, Santa Cruz de Tenerife, Spain Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: To investigate the factors involved and causes of early cardiovascular readmission in survivors of an acute coronary syndrome (ACS). Methods: Study of a cohort of patients admitted consecutively to an universitary hospital with the diagnosis of myocardial infarction or unstable angina. We analyze the frequency of readmission in the first month and the originating causes. Through a logistic regression study we examine the clinical and functional factors that determine the new hospitalization. Results: Between January 2007 and December 2010 were recruited 1912 patients, aged 63.9 ±12.6 years, 71.1 % were male and 35.1 % were diabetic. During index hospitalization, 83.4 % of them received invasive management and hospital mortality rate was 5.9 %. The study population consists of 1719 surviving patients in which follow could be performed. In the first month 64 patients (3.7 %) were readmitted, eighteen of them (0.9%) in the first week after discharge. The most common cause for that was a new ischemic event (45.3 %), followed by decompensated heart failure (21.9 %). There were no differences between those who were readmitted early and those who did not in age (65.1 ± 11.6 vs 63.6 ±12.6 years, p = 0.33), sex (males 75 % vs 70.8 %, p = 0.46), presence of diabetes (39.1% vs. 35.3 %, p = 0.54), left ventricular systolic dysfunction (17.5% vs 16.9 %, p = 0.91), invasive management during hospitalization (84.4% vs. 85.1 %, p = 0.95) or type of ACS. Only renal failure (RF) at admission (28.1% vs 13.2 %, OR 2.24 (95 % CI: 1.24-4.06), p = 0.008) and the development of heart failure (HF) during the episode (23.4% vs. 11.1 %, OR 2.05 (95 % CI: 1.1-3.82), p = 0.025) were predictors of rehospitalization for cardiovascular reason. These factors persist as predictors of events one year after discharge (HR 1.69 (95% CI: 1.24-2.29), p = 0.001, for RF) and (HR 2.48 (95% CI: 1.83-3.35), p < 0.001, for HF), although differences in event -free survival appear early after adjusting for clinical and functional variables. Conclusions: Kidney failure and the development of heart failure during hospitalization for ACS are predictors of early readmission, being the most common cause of it a new ischemic event. P483 Modifiable cardiovascular risk factors and erectile dysfunction - an analysis of the patients awareness of such factors in males suffering from ischemic heart disease D Kalka1, ZA Domagala2, A Rakowska3, K Womperski4, R Franke4, E Sylwina-Krauz5, J Stanisz6, M Pilot7, J Gebala8, W Pilecki1 1Wroclaw Medical University, Department of Pathophysiology, Wroclaw, Poland 2Wroclaw Medical University, Department of Normal Anatomy, Wroclaw, Poland 3Centre of Cardiac Prevention and Rehabilitation "Creator", Wroclaw, Poland 4Hospital of Ministry of Interior, Cardiac Rehabilitation Unit, Glucholazy, Poland 5Medinet Heart Center Ltd, Wroclaw, Poland 6Pulmonary Allergy Center, Cardiac Rehabilitation Unit, Karpacz, Poland 7Center of Cardiac Rehabilitation and Prevention, Glucholazy, Poland 8Centre for Men's Health, Wroclaw, Poland Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Introduction: 40% of erectile dysfunction cases originate from vascular disturbances, which result from the atherosclerotic process. The direct concomitances between ischemic heart disease (IHD) and erectile dysfunction (ED) result from a similar pathogenesis of both conditions, in which modifiable risk factors play an important role. The patients'awareness of the damaging effects of these factors seems to be the key element in initiating preventive measurements. Aim of study: The aim of the study was to evaluate the patients' awareness of the influences of the modifiable risk factors for CVD on ED, in patients suffering from IHD. Material: The analysed group of patients included 502 males,(mean age 61,69±8,74) treated for IHD and undergoing cardiac rehabilitation. Methods: The patients' knowledge on modifiable risk factors has been assessed by means of a survey, which encompassed questions on the presence of six modifiable risk factors for CVD (tobacco smoking, sedentary lifestyle, hypertension, overweight and obesity, hyerlipidemia and diabetes) as well as an evaluation of the respondents'awareness of the negative influences of these factors on erectile function. The questions were formulated in a closed manner. The intensity of physical activity has been estimated based on the Framingham survey. A weekly physical activity with an calorie loss of less than 1000kcal/week has served as a guideline to recognizing a sedentary lifestyle. Results: The most common risk factor present in the respondents was low physical activity 94,33%. Overweight and obesity was present in 76,49% of the patients. Tobacco smoking was a risk factor in 69,12% of the respondents. Hypertension comprised 61,61% and hyperlipidemia 52,95% of the analyzed patients. The least common risk factor was diabates, present only in 24,24% of the respondents. The analysis regarding the awareness of the negative influences of the modifiable risk factors on erectile function and the patients'ability to classify them as such, has proven to be significant in tobacco smoking, hyertension, diabetes and dyslipidemia. Regaring those risk factors, the respondents had a significantly greater awareness of their negative impact, if the disease was present in the individual patient. No statistical significances have been observed regarding the patients'knowledge on overweight and obesity as well as a sedentary lifestyle. Conclusions: The conducted study demonstrates a complete lack of knowledge on the negative influences on erectile function of two of the most common modifiable risk factors affecting patients suffering from cardiovascular disease. P484 Pre-hypertension or pre-diabetes: which is better for predicting cardiovascular conditions? A Khosravi1, M Gharipour2, A Balouchi1, Z Khosravi3, M Talaie2, M Sadeghi4, N Sarrafzadegan2 1Isfahan Cardiovascular Interventional Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) 2Isfahan Univ. of Medical Sciences, Cardiovascular Research Institute/Cardiovascular Research Center, Isfahan, Iran (Islamic Republic of) 3Isfahan Univ. of Medical Sciences, Cardiovascular Research Institute/Hypertension Research Center, Isfahan, Iran (Islamic Republic of) 4Isfahan Univ. of Medical Sciences, Cardiovascular Research Institute/Cardiac Rehab. Research Center, Isfahan, Iran (Islamic Republic of) Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Background: Despite partially demonstrated the role of pre-hypertension and pre-diabetes in development of atherosclerotic conditions; it remained questioned which of these factors can predict cardiovascular conditions more effectively. In this regard, this study designed to assess the value of these factors to predict cardiovascular conditions including brain stroke, myocardial infarction, and sudden cardiac death in general population. Methods: A cross-sectional survey was conducted representing a great sample of the general Iranian population, aged 18 years and older, from the Isfahan Province and determined using a random, multistage cluster sampling scheme. The three endpoints considered as study outcome were acute occurrence of brain stroke, myocardial infarction, and sudden cardiac death. Results: 536 subjects of the 5398 studied subjects scheduled for assessing diabetes state, were diabetics and 623 were pre-diabetics and other were non-diabetics. Besides, 506 subjects of 6323 participants who scheduling for assessment of blood pressure abnormalities, had hypertension, 461 had pre-hypertension, and other ones were normotensive. Adjusted for gender and age variables, pre-diabetes status could effectively predict occurrence of myocardial infarction (OR = 1.965, 95%CI: 1.135-3.401, P = 0.016), but did not predict appearance of brain stroke or sudden cardiac death. In the similarly logistic models, pre-hypertension status could not predict any of these conditions after adjustment for gender and age. Conclusions: This study provide valuable evidences on triggering role of pre-diabetes in development of acute ischemic conditions even in healthy individuals. In this line, the value of pre-diabetes for predicting acute myocardial infarction is clearly superior to pre-hypertension status. P485 Changes in cardiovascular and non-cardiovascular comorbidities in 24,878 ambulatory outpatients with cardiac dysfunction 1999-2012 JMO Arnold1, A Ignaszewski2, P Liu3, J Howlett4, M-H Leblanc5, A Kaan2, G Marchiori1 1University Hospital, London, Canada 2St. Paul's Hospital, Vancouver, Canada 3University of Ottawa Heart Institute, Ottawa, Canada 4Foothills Medical Centre, Calgary, Canada 5Quebec Heart Institute, Laval Hospital, Quebec, Canada Topic: Heart Failure (Prevention & Epidemiology) Purpose: Ventricular dysfunction is common in patients with cardiac risk factors and includes both systolic and preserved left ventricular function. The consequences for patients are significant with reduced mobility and increased limiting symptoms. We wished to determine the extent of co-morbidities in a large contemporary outpatient cohort. Methods: We analyzed a large prospective outpatient cohort of 24,878 subjects in the Canadian Heart Failure Network database 1999-2012 who had cardiac dysfunction, systolic or diastolic. Twenty-nine clinical sites across Canada contributed data and this included both academic and community sites. Results: At the first clinic visit, 68.8% were male, 51% had an ischemic etiology, mean age was 65.5±14.3 (sd) yrs, mean LVEF was 32±6.1, NYHA class distribution (1-4) was 15.0, 41.5, 39.8, 3.7%, BMI 28.8±6.1, cardiovascular comorbidities 3/person and non-cardiovascular 1/person. Over the 14 years documented, mean comorbidities increased from 2.8 in 2001 to 7.1 in 2012, cardiovascular comorbidities from 2.0 in 2001 to 4.1 in 2012, non-cardiovascular comorbidities from 0.6 in 2001 to 1.2 in 2012, and cardiac procedures from 0.2 in 2001 to 1.7 in 2012. Conclusions: In this large prospective outpatient cohort of ambulatory patients encompassing a broad range of clinical sites with both reduced and preserved cardiac function, our data showed very stable characteristics in male/female distribution, age, gender, BMI, NYHA class, MLWHFQ score, and LVEF over 12 years. However in these subjects with cardiac dysfunction, total comorbidities, cardiovascular comorbidities, and cardiac procedures increased over the time frame that may reflect either increasing awareness or increasing prevalence. Open in new tabDownload slide Total Comorbidities P486 Prevention of heart failure in patients after regression of chronic B-cell lymphoid leukemia: response to zofenopril B Samura1 1Zaporozhye State Medical University, Zaporozhye, Ukraine Topic: Heart Failure (Prevention & Epidemiology) Purpose: The aim of this study was to determine the protective effect of zofenopril in in patients after regression of chronic B-cell lymphoid leukemia. The natural history of cardiovascular events in patients with oncohematological diseases, as well as its response to cardiovascular therapy, remains poorly defined. Hence, evidence-based recommendations for prevention of heart failure in this group of patients are still lacking. Zofenopril proved to be effective in patients with coronary artery disease and myocardial infarction, thanks to its unique effective mechanism of action for improving blood pressure control, left ventricular function and myocardial ischemia burden, as well as angiotensin-converting enzyme inhibition. Rituximab is a monoclonal antibody to CD20 that has activity in leukemia and lymphoma. This study aims to describe the complications and outcomes of a subset of patients after regression of chronic B-cell lymphoid leukemia who were treated with immunochemotherapy. Methods: Patients who were treated with rituxmab, doxorubicin, cyclophosphamide, vincristine, and prednisolone therapy and reached regression of chronic B-cell lymphoid leukemia was planned were enrolled in the study. We included in the study 29 patients in zofenopril and 10 patients in control groups. In the zofenopril group, 7.5 mg twice-daily oral zofenopril was given during 12 months. The patients were evaluated with echocardiography before and after chemotherapy. Left ventricular ejection fraction (EF) and systolic and diastolic diameters were calculated. Results: At the end of 12 months of follow-up, 2 patient in the zofenopril group and 3 in the control group had died. Control EF was below 50% in 3 patient in the zofenopril group and in 4 in the control group. The mean EF of the zofenopril group was similar at baseline and control echocardiography (62.6 vs. 59.8, respectively; p = 0.3), in the control group the mean EF at control echocardiography was significantly lower (62.7 vs. 47.2; p < 0.001). Both systolic and diastolic diameters were significantly increased compared with basal measures in the control group. In Doppler study, whereas E velocities in the zofenopril group decreased, E velocities and E/A ratios were significantly reduced in the control group. Conclusions: Prophylactic use of zofenopril in patients with diffuse large B-cell lymphoma receiving immunochemotherapy may protect both systolic and diastolic functions of the left ventricle. P487 Essential echocardiographic predictors of positive response to cardiac resynchronization therapy M Zlobina1, A Sokolov1, E Kaygorodova2, S Popov1 1FSBI Research Institute of Cardiology SB RAMS, Tomsk, Russian Federation 2Siberian State Medical University, Tomsk, Russian Federation Topic: Heart Failure (Prevention & Epidemiology) Purpose: To identify essential echocardiographic indicators predicting positive response to cardiac resynchronization therapy (CRT). Methods: 46 patients with NYHA functional class III heart failure (HF) were included in the study; mean age was 51±12 years; 75% were men. Dilated cardiomyopathy (DCM) group included 24 patients; ischemic cardiomyopathy (ICM) groups included 22 patients. All patients had indications for CRT. The study complied with the Declaration of Helsinki. All patients received cardiac ventriculography. Efficacy of CRT was evaluated 7 days and 12 months after beginning of treatment. Echocardiographic study was performed by using EnVisor cv HDI (Philips). All measurements were taken according to ASE recommendations. To evaluate interventricular mechanical delay (IVMD), the difference between left (LV) and right ventricular (RV) pre-ejection periods was determined. Local contractile reserve was studied by assessing dynamics of systolic myocardial velocity (Sm) by the method of TDI at rest and at the peak of anti-orthostatic stress test (AOST). To evaluate RV systolic function, systolic velocity of fibrous ring of tricuspid valve (Srv) was measured. Decrease in end systolic volume by =15% six months after CRT compared with corresponding value before treatment was considered a criterion of reverse remodeling. Six-minute walk test was used to determine exercise tolerance before and after CRT. Statistical processing of data was done with SPSS software. Results: Initially, DCM and ICM groups did not significantly differ. Data showed that 63% of patients had reverse LV remodeling (CRT responder group). The highest rate of non-responders was found in ICM group. ROC analysis showed that contractile reserve preservation (AUC 0.89; CI 0.77–0.99; p=0.001) verified with AOST was as strong predictor of response to CRT as dyssynchrony (AUC 0.83; CI 0.71–0.95; p=0.001). In group of non-responders, AOST data showed an increase in end diastolic pressure suggesting an increase of LV wall stiffness in these patients. These patients had RV dysfunction before CRT. Pre-CRT value of Srv <10 cm/c was a predictor of the absence of response to CRT with sensitivity of 85% and specificity of 83%. In our study, IVMD value failed to predict response to CRT (AUC 0.48; CI 0.32–0.67; p=0.8). Conclusions: Combined approach with the use of echocardiographic parameters indicative of intraventricular and interventricular dyssynchrony, contractile reserve, and RV systolic function may significantly contribute to correct identification of CRT candidates and decrease of non-responder rate. P488 Toxic metal barium in children heart tissue O Koval1, N Nagorna1, I Mokryk2, G Dubova1, O Novack2, O Muzichin2, S Gaida2, O Shvedka3, A Bilyk3, N Usenko1 1M. Gorky Donetsk National Medical University, Donetsk, Ukraine 2Government Institution Institute of Urgent and Recovery Surgery named after V.K. Gusak National Aca, Donetsk, Ukraine 3First City Hospital, Donetsk, Ukraine Topic: Other Heart Disease (Prevention & Epidemiology) Purpose: investigation of barium content in heart issues of children with and without congenital heart diseases (CHD). Methods: We had divided children in 2 groups. In first group we had included 36 children (aged from 14 days to 17 years) and 1 fetus (22 gestations weeks) with various cardiovascular malformations. The second group were 15 children and fetuses without CHD, died from different reasons. All patients were examined by the spectral analysis of toxic metal barium in intraoperative and autopsy biopsies of endocardium, myocardium, pericardium, aorta by methods of the atomic emission spectrometry in the inductively coupled plasma and atomic absorption spectrometry with electrothermal atomization. Results: we had determined exceed of acceptable barium level in 59,0±7,9% (p<0.05) of patients with cardiovascular malformations and in 20,0±10,3% children without CHD. In children with CHD we discovered dependence of the barium level concentration and the topography of biopsy: at the location of the malformation – in locus of aortic coarctation, valve atresia, in septum of septal defects barium concentration was significantly (p<0.05) higher than in other heart and vessels areas. Children with elevated barium level in heart tissue significantly frequently (p<0.05) had combined CHD. logical conclusion from this is that the population of the children must have common it sources. ?ONCLUSIONS: The above mentioned is the basis for suggestion about possible barium role in cardiogenesis violation in humans. Future development of this methods may possible serve as addition diagnostic tool in detection of congenital heart diseases in fetus and kids. According to our results one of the way to prevent CHD can be limitation of contact with sources of barium for future parents P489 Exercise testing in patients with a normal ABI and an abnormal lowest ABI. D Armstrong1, D Brouillard1, U Jurt1, C Tobin1, M Matangi1 1Kingston Heart Clinic, Kingston, Canada Topic: Vascular disease (Prevention & Epidemiology) Purpose: Of our PAD testing, 2,184 have normal ABIs bilaterally (0.90-1.30). In 246 (11.3%) of these normals the other "lowest ABI" is abnormal (<0.90). This occurs in 1 ankle (8.8%) or both ankles (2.5%). The "lowest ABI" is the ratio of the lowest ankle systolic pressure divided by the highest brachial systolic pressure. Post-exercise ABI measurements may be a method of detecting abnormal lower limb perfusion in this group. The purpose of this study is to compare 4 groups, see Table 1 for group definitions. Methods: Our database was searched for patients who had undergone post-exercise measurement of ABI and fitted into one of the 4 groups. Patients were exercised for 5 minutes at 10 degrees and a speed of 2mph. The test was stopped for symptoms or when the 5 minutes was completed. The ankle pressures and highest brachial pressure were measured at rest and post-exercise. Five post-exercise measurements were recorded as quickly as possible. An abnormal ABI response to exercise was any fall to <0.90 in the first or second post-exercise measurement. ANOVA and Chi-squared analysis were used where appropriate. Results: Group 1 comprised 120 patients and 11 had an abnormal response (9.2%). Group 2 comprised 172 patients and 75 had an abnormal response (43.6%). Group 3 comprised 12 patients and 9 had an abnormal response (75%), Group 4 comprised 61 patients and 50 had an abnormal response (82%), P<0.0001 using Chi-squared analysis. Conclusions: Post-exercise ABIs should be performed in all patients with normal resting ABIs (0.90-1.30) in both legs and either leg symptoms, femoral bruits or an abnormal lowest ABI, and in the case of the abnormal lowest ABI groups, even in the absence of leg symptoms or femoral bruits. Table 1. AbN/N (%) Rest ABI Ex1 ABI Ex2 ABI Ex3 ABI Ex4 ABI Ex5 ABI P value Gp1 11/109 (9.2%) 1.14±0.07 1.09±0.12 1.11±0.12 1.12±0.13 1.14±0.13 1.13±0.12 <0.0001 Gp2 75/97 (43.6%) 1.09±0.09 0.95±0.16 1.00±0.14 1.02±0.13 1.03±0.12 1.05±0.12 <0.0001 Gp3 9/3 (75%) 1.02±0.09 0.90±0.13 0.95±0.12 0.96±0.10 0.96±0.08 0.97±0.10 <0.0001 Gp4 50/11 (82%) 1.00±0.08 0.83±0.18 0.90±0.14 0.92±0.12 0.93±0.11 0.95±0.12 <0.0001 P value <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 AbN/N (%) Rest ABI Ex1 ABI Ex2 ABI Ex3 ABI Ex4 ABI Ex5 ABI P value Gp1 11/109 (9.2%) 1.14±0.07 1.09±0.12 1.11±0.12 1.12±0.13 1.14±0.13 1.13±0.12 <0.0001 Gp2 75/97 (43.6%) 1.09±0.09 0.95±0.16 1.00±0.14 1.02±0.13 1.03±0.12 1.05±0.12 <0.0001 Gp3 9/3 (75%) 1.02±0.09 0.90±0.13 0.95±0.12 0.96±0.10 0.96±0.08 0.97±0.10 <0.0001 Gp4 50/11 (82%) 1.00±0.08 0.83±0.18 0.90±0.14 0.92±0.12 0.93±0.11 0.95±0.12 <0.0001 P value <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 Gp1= All 4 ABIs normal, no leg symptoms, no femoral bruits. Gp2 All 4 ABIs normal ± leg symptoms ± femoral bruits. Gp3 Normal ABI, abnormal lowest ABI, no symptoms, no femoral bruits. Gp4 Normal ABI abnormal lowest ABI ± symptoms ± femoral bruits. Open in new tab Table 1. AbN/N (%) Rest ABI Ex1 ABI Ex2 ABI Ex3 ABI Ex4 ABI Ex5 ABI P value Gp1 11/109 (9.2%) 1.14±0.07 1.09±0.12 1.11±0.12 1.12±0.13 1.14±0.13 1.13±0.12 <0.0001 Gp2 75/97 (43.6%) 1.09±0.09 0.95±0.16 1.00±0.14 1.02±0.13 1.03±0.12 1.05±0.12 <0.0001 Gp3 9/3 (75%) 1.02±0.09 0.90±0.13 0.95±0.12 0.96±0.10 0.96±0.08 0.97±0.10 <0.0001 Gp4 50/11 (82%) 1.00±0.08 0.83±0.18 0.90±0.14 0.92±0.12 0.93±0.11 0.95±0.12 <0.0001 P value <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 AbN/N (%) Rest ABI Ex1 ABI Ex2 ABI Ex3 ABI Ex4 ABI Ex5 ABI P value Gp1 11/109 (9.2%) 1.14±0.07 1.09±0.12 1.11±0.12 1.12±0.13 1.14±0.13 1.13±0.12 <0.0001 Gp2 75/97 (43.6%) 1.09±0.09 0.95±0.16 1.00±0.14 1.02±0.13 1.03±0.12 1.05±0.12 <0.0001 Gp3 9/3 (75%) 1.02±0.09 0.90±0.13 0.95±0.12 0.96±0.10 0.96±0.08 0.97±0.10 <0.0001 Gp4 50/11 (82%) 1.00±0.08 0.83±0.18 0.90±0.14 0.92±0.12 0.93±0.11 0.95±0.12 <0.0001 P value <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 Gp1= All 4 ABIs normal, no leg symptoms, no femoral bruits. Gp2 All 4 ABIs normal ± leg symptoms ± femoral bruits. Gp3 Normal ABI, abnormal lowest ABI, no symptoms, no femoral bruits. Gp4 Normal ABI abnormal lowest ABI ± symptoms ± femoral bruits. Open in new tab P491 The role of ankle-brachial index for predicting peripheral arterial disease and guiding the antiagregant regimen after acute coronary syndrome L Iliuta1, E Panaitescu1, M Rac Albu1 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Topic: Vascular disease (Prevention & Epidemiology) Objectives: 1.To evaluate the prevalence of peripheral arterial disease (PAD) in patients admitted in hospital or within 6 months after an acute coronary syndrome (ACS). 2.To identify the main clinical variables associated with a higher risk of PAD and the role of Ankle/Brachial Index (ABI) for predicting cardiovascular events. 3.To establish the role of the type of the antiagregant regimen for preventing cardiovascular events at 6 months. Matherial and method: Open-label, multicentric, prospective study in 2683 patients with an ACS within the last 6 months. Data on demographic characteristics, cardiovascular risk factors, comorbidities, ABI values, antiplatelet treatment at baseline and after 6 months, major acute cardiovascular events (MACE) occurring during 6 month follow-up were collected. Statistical analysis used SPSS ver 15 for logistic regression analysis and for the relative risks and the correlation coefficients calculation. Results: 1. ABI was <0.9 in 66.7% of the study group and the incidence of PAD increased with age, the highest (69.40%) in age group 71-80 years. 2. There was a strong association between ABI<0.9 and the presence of other cardiovascular risk factors (p=0.0005); this cut-off value should be included in the routine clinical practice for the calculation of the cardiovascular risk score and for predicting PAD in these patients. 3. Decreased ABI had an independent and incremental prognostic value for cardiovascular death, the rate of occurrence of MACE being significantly different in patients with ABI=0.9 (28%) and ABI<0.9 (72%) (p<0.04). 4. Stratification of the study group depending on the PAD severity (using the cutt-off value of ABI = 0.4) showed a significantly higher rate for MACE in patients with severe PAD (RR=8.25, p<0.0001). 5. The risk of MACE was higher for acetylsalicylic acid (ASA) alone versus thienopyridines (p= 0.0012, RR=3.88) or thienopyridines+ASA (p=0.0009, RR=3.37), irrespective of ABI values, thienopyridines constituting as a protective factor for these events (RR=9.6, p<0.01). Conclusions: 1. ABI<0.9 is strongly associated with other cardiovascular risk factors; this cut-off value should be included in the calculation of the cardiovascular risk score. 2. ABI was found an atherosclerotic predictor, permitting to identify patients at high risk for cardio or cerebrovascular events; it should be incorporated into routine clinical practice. 3. In patients with an ACS in the last 6 months thienopyridines alone or in combination with other antiagregants have significantly reduced the risk of cardiovascular mortality or MACE, regardless of ABI. P492 Vascular risk factors of mild cognitive impairment and alzheimers disease JA Gonzalez Caceres1, OFC Otman Fernandez Concepcion1 1National Institute of Neurology and Neurosurgery, La Habana, Cuba Topic: Vascular disease (Prevention & Epidemiology) Introduction: Alzheimer's disease (AD) is the leading cause of dementia and is characterized by a progressive deterioration of cognitive functions. Although the presence of disease and vascular risk factors were considered exclusion criteria for the clinical diagnosis of AD; recent studies have suggested that this concurrency, so common in the elderly, has a causal relationship. Objectives. Determine and characterize the behavior of mild cognitive impairment (MCI) and AD and its association with vascular risk factors in people = 60 years of the population served by a clinic in the town Plaza, Havana. Participants and methods. A study was conducted in two phases, the first one descriptive, cross-sectional, door to door, aimed at all persons aged = 60 years, served by an office of the Plaza municipality. The second is an analytical, observational case-control study. The sample consisted of 543 patients, who were administered the modified STEPS Instrument surveillance of risk factors of non-communicable chronic diseases, neuropsychiatric test and diagnostic criteria. Patients were classified into three groups: cases with AD (n=39), cases with MCI (n=98) and controls (n=268), for further analysis. Results. The prevalence of dementia syndrome was 11.6% (n=63), 18% (n = 98) for mild cognitive impairment and 7.1% (n=39) for the AD. Compared with controls, patients with AD were more likely to have vascular diseases (odds ratio, 95% confidence interval) (2.2 1.3 to 4.5; p 0.00), Diabetes Mellitus (3.0; 1.5 to 6.3; p 0.000), alcohol consumption (3,0; 1.2 to 4.4 p 5 0.006), hypercholesterolemia (4.5 2.2-9.2; p 0.000), smoking (4.0 1.8-7.3; p 0.000), metabolic syndrome (3.5 1.7 to 7.1; p 0.000), Arterial hypertension (5.2; 2.4-10.0; p 0.000), global cardiovascular risk (4.0 1.9-6.3; p 0.000). On the other hand the physical activity (0.3 0.2 and 0.6; p 0.001) behaved as a protective factor. Conclusions: The study shows that among the risk factors for MCI and AD are cardiovascular risk factors with a strong association. The MCI and AD risk increased with the number of vascular risk factors. P493 NT-pro-BNP serum level is an independent predictor of intima-media thickness of the common carotid artery in asymptomatic patients of a primary prevention study Z Bagyura1, L Kiss1, ZS Szelid1, R Vadas1, P Soos1, O Szenczi1, B Merkely1 1Semmelweis University, Heart Center, Budapest, Hungary Topic: Vascular disease (Prevention & Epidemiology) Purpose: Determination of novel biomarkers of subclinical vascular diseases is a main target of primary prevention efforts. NT-pro-BNP represents a well-known prognostic marker in both systolic and diastolic heart failure. Recently, however its association with coronary atherosclerosis and incidence of vascular events in symptomatic patients with peripheral artery disease has been confirmed. The aim of this study on asymptomatic patients was to analyse factors predictive to increased intima-media thickness of the common carotid artery (CCIMT), a widely used marker of subclinical atherosclerosis. Relationship between CCIMT, traditional risk factors and NT-pro-BNP serum level were analysed. Methods: Carotid ultrasound and offline semi-automatic measurement of CCIMT were performed and anamnestic, anthropometric data and laboratory test results were collected in 559 subjects with preserved left ventricular ejection fraction (EF=55%), without echo signs of diastolic dysfunction and without any cardiovascular symptoms. The mean, maximal and minimal value of CCIMT was determined at a segment of 200 (±10) measurement points of the common carotid artery 1 cm proximal to the carotid bifurcation at both sides. Results were correlated with serum NT-pro-BNP levels determined using a commercially available method. Results: The mean age was 52,3 (± 14,4) the proportion of males was 41,5%. CCIMT values were categorised as normal (<0,9 mm) or increased (above 0.9 mm). NT-Pro-BNP plasma levels were significantly higher in the group with increased carotid intima-media thickness (p<0.001), and NT-pro-BNP level showed correlation with average CCIMT (r=0.3; p<0.001). In multivariate model adjusted for age, gender, body mass index, hypertension, diabetes mellitus, hypercholesterolemia, smoking habits, NT-pro-BNP remained independently associated with increased CCIMT (p=0.04) Conclusions: Serum level of NT-pro-BNP is an independent predictor of increased CCIMT in asymptomatic patients with normal left ventricular ejection fraction. Therefore determination of NT-pro-BNP serum level may serve as an additional biomarker in the screening of subclinical carotid artery disease. P494 Reference values of aortic pulse wave velocity in adults using oscillometric method (Arteriograph) B Benczur1, R Bocskei2, M Illyes3 1Geza Hetenyi County Hospital and Outpatient Centre, Department of Cardiology, Szolnok, Hungary 2Semmelweis Medical University, Department of Pulmonology, Budapest, Hungary 3University of Pecs, Heart Institute, Division of Interventional Cardiology, Pecs, Hungary Topic: Vascular disease (Prevention & Epidemiology) Elevated aortic pulse wave velocity (aoPWV) is a strong and independent predictor of cardiovascular morbidity and mortality. There are, however, no widely accepted normal or reference values for aoPWV due to the different used methods and devices. The aim of this work was to define these values for oscillometric method ("occluded artery"). Patients and Methods: AoPWV was assessed in seemingly healthy, asymptomatic patient populations using oscillometric device (TensioMed Arteriograph) and data were collected into a large database of 9076 subjects without any antihypertensive, antidiabetic or antilipemic medication. This huge amount of data was divided into age decades in order to determine the age-specific reference values for aoPWV. Results: Mean age was 47.6±15.1 and 48.6±13.4 ys in males and females, respectively (p=NS). Mean aoPWV differed significantly between genders (8.54±2,25 m/s vs. 9.44±2,56 m/s; p<0,001). Median aoPWV values in the age subgroups by decades were determined (6.69, 7.29, 8.38, 9.81, 10.15, 10.41, 11.02 m/s from the age of 18 to 90 ys, respectively). The 75th and 95th percentiles of the samples were used to determine the upper limit of aoPWV reference values. Conclusions: The value above 10 m/s suggested as a threshold for elevated aoPWV by ESH 13 hypertension guideline can be questioned as PWV depends on the method used to calculate the travel distance. Our results derived from a huge healthy general population including wide range of age suggest that aoPWV values are highly dependent on age and gender. Therefore, these results might serve as age and gender specific reference values for aoPWV measured with oscillometric device. P495 The role of mitochondrial targeted anti-oxidants in the modulation of reactive oxygen species mediated signalling in human endothelial cells A Sanyal1, K Herbert2 1University of Leicester, School of Medicine, Leicester, United Kingdom 2University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom Topic: Vascular disease (Prevention & Epidemiology) Endothelial cells play a key role in the maintenance of vascular homeostasis and in preventing cardiovascular dysfunction. Oxidative stress arising from excessive mitochondrial reactive oxygen species (ROS) production has been implicated in endothelial cell dysfunction thus predisposing to cardiovascular diseases such as atherosclerosis. The lack of evidence to support the efficacy of dietary antioxidant therapies against the development of cardiovascular disease suggests that there is a clear need in clinical medicine for an alternative therapy to be designed. Our aims were to investigate the effects of mitochondrial targeted antioxidants on ROS production and cell death in endothelial cells under oxidative stress. Human EA.hy endothelial cells were cultured with sub-cytotoxic levels of the mitochondrial electron transport chain inhibitor Antimycin A (AA) which stimulated oxidative stress measured as dihydroethidium (DHE) fluorescence by flow cytometry. An increase in ROS was accompanied by a dose-dependent increase in subsequent cell death measured as propidium iodide uptake by flow cytometry. N-acetylcysteine (NAC) reduced ROS levels and protected from necrosis but as the levels of AA increased protection was lost. The mitochondrial targeted antioxidants MitoQ and MitoTEMPO also reduced ROS and cell death, however, this capacity was maintained at higher AA concentrations. MitoTEMPO was effective at lower concentrations than MitoQ. For the first time, a direct comparison has been made between the global antioxidant NAC and the mitochondrial targeted antioxidants MitoQ and MitoTEMPO. Our research notably suggests that lower concentrations of MitoTEMPO may be just as effective as MitoQ in reducing mitochondrial ROS and protecting the cell from endothelial dysfunction. These compounds provide research tools to investigate the role that mitochondrial ROS might play in the signalling mechanisms of endothelial cells and may suggest mechanisms for modulation of endothelial function in cardiovascular disease. P496 Treadmill test in identifying preclinical electrical instability of myocardium in healthy subjects. M Krestjyaninov1, VI Ruzov2, RH Gimaev2, VA Razin2, H Khalaf1 1Ulyanovsk Hospital Of Word War Veterans, Ulyanovsk, Russian Federation 2Ulyanovsk State University, Ulyanovsk, Russian Federation Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Sudden cardiac death occurring in young persons is a consequence of cardiovascular diseases in 15-30% of cases. One of reasons of sudden cardiac death is development of ventricular arrhythmias. Established that the development of ventricular arrhythmias associated with electrical instability of myocardium. The purpose of the study to determine the significance of the stress test in detecting myocardial electrical instability in healthy subjects before it clinical manifestation. Materials and Methods: 113 young (mean age 20 (1.5) years) man and women were enrolled. In all persons were performed treadmill test (by Bruce), were determined heart rhythm variability and the presence of ventricular late potentials before and in 5 minutes after treadmill test ending. Treadmill test was performed before reaching sub-maximal heart rate values. To study the electrical instability of the myocardium high resolution ECG was performed. Were measured values ??TotalQRS, LAS40, RMS40, LF/HF. The statistical significance was defined at the level of methods for p<0,05. According to the results of high resolution ECG, all persons were divided into 3 groups. 1st group (n = 13; 11.5%) - ventricular late potentials were before and after the treadmill test. 2nd group (n = 61; 54%) - ventricular late potentials not detected either before or after the treadmill test. 3rd group (n = 39; 34.5%) - ventricular late potentials appeared after the treadmill test. Values of ventricular late potentials and heart rhythm variability indicators are shown in Table 1. Thus, performing treadmill test allows to reveal hidden electrical myocardial instability in young healthy subjects prior to its clinical manifestation. Hidden electrical myocardial instability in young persons is characterized by stable prevalence of sympathetic activity. Exercises and electrical instability before treadmill test after treadmill test 1st group 2nd group 3rd group 1st group 2nd group 3rd group Total QRS, ms 116.5 (4) 113.2 (4) 112.8 (4) 118 (4)* 114.4 (3) 118.3 (4)* RMS40, mkV 14.7 (4) 26.7 (6) 21.6 (2) 14.4 (4) 24.4 (4) 15.5 (3)* LAS40, ms 45.4 (7) 31.5 (6) 35.9 (4) 47.5 (7) 34.1 (4) 39.5 (4) LF/HF 1.3 (0.6) 1.1 (0.6) 1.39 (1.1) 0.9 (0.4) 1.3 (0.3) 1.21 (0.8) before treadmill test after treadmill test 1st group 2nd group 3rd group 1st group 2nd group 3rd group Total QRS, ms 116.5 (4) 113.2 (4) 112.8 (4) 118 (4)* 114.4 (3) 118.3 (4)* RMS40, mkV 14.7 (4) 26.7 (6) 21.6 (2) 14.4 (4) 24.4 (4) 15.5 (3)* LAS40, ms 45.4 (7) 31.5 (6) 35.9 (4) 47.5 (7) 34.1 (4) 39.5 (4) LF/HF 1.3 (0.6) 1.1 (0.6) 1.39 (1.1) 0.9 (0.4) 1.3 (0.3) 1.21 (0.8) * - p<0.05 in comparison with values before treadmill test in the same group Open in new tab Exercises and electrical instability before treadmill test after treadmill test 1st group 2nd group 3rd group 1st group 2nd group 3rd group Total QRS, ms 116.5 (4) 113.2 (4) 112.8 (4) 118 (4)* 114.4 (3) 118.3 (4)* RMS40, mkV 14.7 (4) 26.7 (6) 21.6 (2) 14.4 (4) 24.4 (4) 15.5 (3)* LAS40, ms 45.4 (7) 31.5 (6) 35.9 (4) 47.5 (7) 34.1 (4) 39.5 (4) LF/HF 1.3 (0.6) 1.1 (0.6) 1.39 (1.1) 0.9 (0.4) 1.3 (0.3) 1.21 (0.8) before treadmill test after treadmill test 1st group 2nd group 3rd group 1st group 2nd group 3rd group Total QRS, ms 116.5 (4) 113.2 (4) 112.8 (4) 118 (4)* 114.4 (3) 118.3 (4)* RMS40, mkV 14.7 (4) 26.7 (6) 21.6 (2) 14.4 (4) 24.4 (4) 15.5 (3)* LAS40, ms 45.4 (7) 31.5 (6) 35.9 (4) 47.5 (7) 34.1 (4) 39.5 (4) LF/HF 1.3 (0.6) 1.1 (0.6) 1.39 (1.1) 0.9 (0.4) 1.3 (0.3) 1.21 (0.8) * - p<0.05 in comparison with values before treadmill test in the same group Open in new tab P497 The prevalence of early repolarisation pattern in young Indian population R Narain1, G Mellor1, H Dhutia1, A Merghani1, N Kumar2, L Millar1, A Malhotra1, M Papadakis1, E Behr1, S Sharma1 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom 2Birmingham Heartlands Hospital, Birimingham, United Kingdom Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Background: The early repolarisation (ER) pattern has been associated with sudden cardiac death. The prevalence of this has not been described in the Indian population. Its prevalence varies in various ethnic groups. Aims and Objectives The aim of this study was to look at the incidence of ER in healthy young Indian population and compare it with other ethnic origins. Methods: ECGs were obtained from 554 apparently healthy Indian individuals attending cardiac screening. Participants completed a questionnaire stating symptoms, medical and family history, and physical activity (42% = 10 hr. /wk.). Individuals were aged from 12 to 35. Heart rate, QRS duration, QTc interval and voltage criteria for LVH was reported. The presence of ER was reported independently by three cardiologists (RN, GM, NK), with decisions by consensus. If required, a senior colleague (EB) adjudicated. ER was defined as J-point elevation of =0.1mV in two consecutive inferior or lateral leads and classified as notched or slurred. ST segments were defined as rapidly ascending or horizontal/descending. Results: ER was seen in 52 individuals, 48% in lateral, 42% in inferior and 21% in infero-lateral leads. J waves were notched in 56% and slurred in 62%. 90% of ER was associated with a rapidly ascending ST segment. The higher mean age was also seen in lateral (20.8±5.8 vs 18.1±4.8), inferior (22.2±6.8 vs 18.6±5.2), notched (22.6±8.0 vs 18.5±5.2) and up-sloping ST segment (21.4±6.8 vs 17.9±4.7) groups. 18-35yr olds exercised more than under 18s (62.0% vs 31.2% =10 hours/week). ER was associated with lower heart rate and shorter QTc. ER was more common in males and the one who were physically active. Conclusions: ER is present in 9.4% of healthy young Indians. This is comparable to population studies although lower than in African Americans and athletic white Caucasians. The study population was young and active and prevalence was expected to be higher. Our study shows individuals with ER were older in contrast to previous studies that have associated ER with younger age. This may reflect the youth of our population, endocrine influences at puberty and higher exercise levels in 18-35yr olds. There may therefore be a peak prevalence of ER in the late teenage years or early 20s. Larger studies are required. P498 Low dose dietary fish oil increases omega-3 index, reduces sub-maximal heart rate and improves heart rate recovery after intense exercise in fit and healthy males G Peoples1, M Macartney1, L Hingley1, M Brown1, P Mclennan1 1University of Wollongong, Wollongong, Australia Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Purpose: Elevated heart rate (HR) and impaired heart rate recovery (HRR) are risk factors for cardiovascular mortality, particularly sudden (arrhythmic) death and heart failure. Intake of fish oil increases myocardial incorporation of long chain omega-3 polyunsaturated fatty acid (LCn-3PUFA) docosahexaenoic acid (DHA) and is associated with lower resting heart rate and lower cardiovascular mortality. Studies to date have supplemented fish oil at concentrations that would be difficult to derive directly from an average human diet. The current study examined whether dietary achievable dosage of LCn-3PUFA could provide cardio-protection in physically fit humans. Methods: Using a double-blind design, 28 highly trained males (aerobic capacity: 336±32W) were supplemented with (2x1g/d) soy oil (control) or high DHA tuna fish oil (NuMega Lipids) (FO), delivering daily: DHA 560mg and eicosapentaenoic acid (EPA) 140mg, for 8weeks. Heart rate and heart rate variability were recorded during rest, sub-maximal, repeat-bout supra-maximal exercise with active recovery and a 5 min work capacity trial followed by supine recovery. Fatty acid composition of red blood cells (rbc) was analysed at baseline and 8w. Results: The omega-3 index (rbc % EPA+DHA) at baseline ((mean±SEM) Control: 4.2±0.2, n=14; FO: 4.7±0.2 n=14) was not different between groups. After 8w the omega-3 index was unchanged in control (3.9±0.2) but increased in FO group (6.3±0.3) P< 0.01). Resting HR recorded during sleep (Control: 50±7, FO: 52±6) or awake rest (Control: 56±10, FO: 59±9) were very low and were not affected by FO, yet heart rate variability demonstrated a trending decease in PNS activity in the FO group (SD1/SD2) (Control: 0.02±0.01, FO: -0.05±0.02 P=0.18). Peak HR (Control: 174±6, FO: 176±8) was also not affected by FO. However, during sub-maximal exercise, total beats over 5min were reduced in the FO group (-22±6 (=-4.5/min)) but not in control (+1±4) (P<0.05). Supine HRR after work capacity trial was significantly quicker following FO supplementation (Control: -0.4±1.2s; FO: -8.0±1.7s, P<0.05) with no difference in parasympathetic tone. Conclusions: Fish oil reduced HR during exercise without compromise to maximal HR and improved cardiac recovery, against a background of high physical fitness. While resting HR was very low and could not be further lowered by dietary fish oil, the observations of: less parasympathetic tone during resting conditions; no contribution of parasympathetic tone to the quicker HRR; and increased omega-3 index, support a role for cellular incorporation of DHA in reducing intrinsic beat rate of the heart. P499 Phylloquinone concentrations and the risk of vascular calcification in healthy women G W Dalmeijer1, YT Van Der Schouw1, S Booth2, PA De Jong3, JWJ Beulens1 1University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands 2Tufts University, JM USDA-HNRCA, Boston, United States of America 3University Medical Center Utrecht, Department of Radiology, Utrecht, Netherlands Topic: Nutrition (Prevention & Epidemiology) Background: Observational studies do not show an association between phylloquinone intake and coronary artery calcification (CAC). However, intervention studies show improved vascular elasticity and reduced progression of CAC in response to phylloquinone supplementation. Objectives: To investigate the association of plasma phylloquinone concentrations with CAC and vascular calcification. Design: In a prospective cohort of 508 postmenopausal women, plasma phylloquinone concentrations were measured by high-pressure liquid chromatography. Calcification was measured in the coronary arteries (continuous), aortic valve (none, mild and severe), mitral valve (none, mild and severe) and thoracic aorta (none, mild, moderate and severe) by multi-detector computed tomography. To combine these calcification scores, we dichotomized each of the four areas into present or absent. Because of the continuous measurement of CAC, we categorized this as calcification present if Agatston score was >0 and calcification score was calculated as the sum of the calcified areas. Multivariate adjusted prevalence ratios (PR) and odds ratios (OR) were estimated using Poisson regression and multinomial logistic regression. Results: After 8.5 years follow-up, 22% of the women had no calcification while 5% had calcification in all measured areas. Detectable phylloquinone concentrations were associated with increased CAC compared to non-detectable phylloquinone concentrations with a PR of 1.34 (95%CI: 1.01-1.77). When dividing women with detectable phylloquinone concentrations in low-detectable (>0-0.70 nmol/L) and moderate to high-detectable (>0.70 nmol/L) phylloquinone concentrations versus non-detectable phylloquinone concentrations, both were associated with increased CAC with a PR of 1.32 (95%CI: 0.99-1.76) and 1.36 (95%CI: 1.02-1.81). Detectable phylloquinone concentrations were not associated with the number of calcified areas with an OR (no vs =3 areas calcifications) of 1.60 (95%CI: 0.65-3.99 p=0.31). Conclusions: Detectable phylloquinone concentrations are not associated with reduced vascular calcification, but seemed to be associated with an increased prevalence of CAC. P500 Vitamin D and components of the metabolic syndrome: the Rotterdam Study A Vitezova1, MC Zillikens2, A Hofman1, AG Uitterlinden2, OH Franco1, JC Kiefte-De Jong1 1Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands 2Erasmus Medical Center, Department of Internal Medicine, Rotterdam, Netherlands Topic: Nutrition (Prevention & Epidemiology) Purpose: To evaluate the association between vitamin D status, measured as dietary vitamin D intake and serum 25-hydroxyvitamin D (25OH vitamin D) levels and serum 1,25-dihydroxy vitamin D (1,25OH2 vitamin D) levels, and the prevalence of metabolic syndrome (MetS). The second aim was to evaluate the association between vitamin D and separate components of the MetS (serum glucose, triglycerides (TG), HDL cholesterol (HDL-C), waist circumference (WC), blood pressure (BP)). Methods: This study was embedded in The Rotterdam Study, a population-based cohort study among middle aged and elderly aged 45 years and older. At baseline visit (1991-1993) total dietary intake of vitamin D [mic/day] was assessed by a food frequency questionnaire (N=4919), and serum vitamin D levels were measured in a subgroup (N=1251 for 25OH serum vitamin D and N=1256 for 1,25(OH)2 serum vitamin D). At the third visit to the research center (1997-1999) components of the MetS were measured. MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity (2009). Results: No overall association was found between vitamin D status and MetS. However, serum 1,25(OH)2 vitamin D levels were associated with lower risk of decreased HDL-C levels (OR=0.95, 95%CI(0.946,0.954) for each 10 pmol/l increase in vitamin D) and inversely associated with increased WC (OR=0.94, 95%CI(0.936,0.943) for each 10 pmol/l increase in vitamin D). Serum 25(OH) vitamin D levels were inversely associated with increased serum TG (OR=0.95, 95%CI(0.945, 0.955) for each 10 nmol/l increase in vitamin D). After adjusting for baseline risk factors of MetS the effect estimates were markedly attenuated and no longer statistically significant. Conclusions: Vitamin D levels are associated with subtle differences in serum HDL-C, serum TG and WC but not with the overall prevalence of MetS in middle aged and elderly. However, these associations seem to be explained by risk factors of the MetS at baseline. P502 The management of patients with multiple risk factors through strategic planning improves the success rate of medium term goals. VD Martire1, E R Pis Diez1, D O Portillo1 1CESALP. Fundación Horacio Corrada, La Plata, Buenos Aires., Argentina Topic: Health economics (Prevention & Epidemiology) Objetives: Despite the progress in physiopathological knowledge and the importance of control of cardiovascular risk factors (CVRF), this control is still poor due to multiple factors: doctor-patient relationship, health systems, socioeconomic and cultural conditions, etc. In attempting to improve this situation we have designed a multidisciplinary assistance system, both in the public and private healthcare sectors, based on a uniform strategic planning (SP) process, and a follow-up assistance system based on predefined processes (FAPP), using ISO 9001:2008 standards of quality, with the purpose of evaluating the success rate of the objetive achievement and comparing it to the routine management knwon so far. Methods: A follow-up study has been done on 310 patients, 192 males and 118 females, aged 59±11 years old, in primary (n:206),and secondary (n:104) prevention, all of them with 2 or more CVRF. The sample was randomly divided into two groups according to the follow-up system used: Group 1 (n:160: FAPP) and Group 2 (n:150, routine follow-up). The time and periods for de FAPP were previously set by Gantt graphs in 4 three-month periods and it was implemented by PERT real-time event tools. After a year, the latter was compared between both groups. Results: The expected control goals were achieved as follows: Group 1: 93 patients (58%), Group 2: 48 patients (32%). (p value <0,05.) (Graph). Conclusions: A correct strategic planning and the use of ISO 9001:2008 standards of quality, determines a higher success rate in the control of cardiovascular risk factors Open in new tabDownload slide Control risk factors rate. Open in new tabDownload slide Risk of Atrial Fibrillation - model B P503 Exercise capacity and muscle strength in late adolescence and subsequent risk of arrhythmias - a cohort study of 1,4 million men K Andersen1, C Held1, M Neovius2, P Tynelius3, F Rasmussen3, J Sundstrom1 1Uppsala University Hospital, Department of Medical Sciences, Cardiology, Uppsala, Sweden 2Karolinska Institutet, Clinical Epidemiology Unit, Department of Medicine, Stocholm, Sweden 3Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden Topic: Exercise/Exercise training (Prevention & Epidemiology) Purpose: To investigate the association of exercise capacity and muscle strength in late adolescence with risk of subsequent arrhythmias. Methods: We conducted a prospective cohort study of all Swedish men born between 1949 and 1976 who participated in military conscription, at a median age of 18.2 years. All Swedish conscripts undergo tests of maximal exercise capacity and muscle strength. We used Cox proportional hazard model to evaluate the association of maximal exercise capacity and muscle strength at conscription to subsequent risk of arrhythmias. The model was adjusted conscription office, conscription date, education level, socioeconomic position, maximal exercise capacity/maximal muscle strength, BMI, blood pressure at conscription, and interim ischemic heart disease and heart failure. We evaluated the shapes of the associations using splines. Results: Higher exercise capacity was associated with higher incidence of arrhythmias (hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.12-1.24; for 5th vs. 1st quintile), and so was higher muscle strength (HR 1.16; 95% CI 1.10-1.22; for 5th vs. 1st quintile). These associations were almost completely driven by a higher incidence of risk of atrial fibrillation (exercise capacity; HR 1.52; 95% CI 1.42-1.63; for 5th vs. 1st quintile; muscle strength; HR 1.34 95% CI 1.25-1.44). Shapes of the models are shown in the figure. No associations of exercise capacity or muscle strength to brady arrhythmias, supra ventricular arrhythmias or ventricular arrhythmias/sudden cardiac death was found. Conclusions: Higher maximal exercise capacity and muscle strength at age 18 are associated with higher risk of arrhythmias. This was driven by a higher risk of atrial fibrillation. P504 The association between exercise and non-exercise steps with cardio-metabolic risk factors in healthy adults I Heinonen1, M Hirvensalo2, CG Magnussen1, T Tammelin3, R Huupponen4, A Jula5, M Kahonen6, T Lehtimaki7, JSA Viikari8, OT Raitakari1 1University of Turku, Research Centre of Applied and Preventive Cardiovascular Medicine, Turku, Finland 2University of Jyväskylä, Department of Sport Sciences, Jyväskylä, Finland 3University of Jyväskylä, LIKES Research Center for Sport and Health Sciences, Jyväskylä, Finland 4University of Turku, Department of Pharmacology, Drug Development and Therapeutics, Turku, Finland 5National Institute for Health and Welfare, Turku, Finland 6Tampere University Hospital, Department of Clinical Physiology, Tampere, Finland 7University of Tampere, Department of Clinical Chemistry, Tampere, Finland 8Turku University Hospital, Department of Medicine, Turku, Finland Topic: Physical Inactivity (Prevention & Epidemiology) Purpose: Emerging evidence suggests that in addition to more formal exercise training type-activity aiming at improving physical fitness, also non-exercise physical activity (PA) may have beneficial effects on health. In the present study we sought to investigate the cross-sectional associations of exercise and non-exercise ambulatory PA on wide range of cardiovascular and metabolic risk factors in a large population of healthy adults. Methods: Daily PA was objectively quantified by pedometers worn for 7-days. Exercise steps were measured as continuous step sessions lasting longer than 10 min performed at a pace of at least 60 steps/min and with less than 1 min break in the session. Non-exercise steps were all other steps taken during the day. Results were sex-stratified (984 women and 701 men, age 37.5±5.0 and 37.4±5.0 years, respectively) and analyzed in multivariable models adjusting for age, smoking (pack years), quality of diet, socioeconomic status, and month and location of pedometer collection. Additional adjustment was also performed for waist circumference (WC). Results were regarded significant if p<0.05. Results: Women took on average 2362±2098 and men 1462±1822 exercise steps, and 5544±1890 and 5704±2150 non-exercise steps, respectively, per day. Neither exercise nor non-exercise steps associated with systolic or diastolic blood pressure, or total or LDL cholesterol in either sex. Exercise, but not non-exercise steps, associated indirectly with glucose in women, but not in men, and the association in women did not remain significant after additional adjustment for WC. Both exercise and non-exercise steps associated indirectly with insulin in men but not in women, and the results in men remained significant also after adjustment for WC. In both sexes, exercise and non-exercise steps associated indirectly with triglycerides, but results remained significant only in case of non-exercise steps in men after additional adjustment for WC. Exercise steps, but not non-exercise steps were directly associated with HDL-cholesterol, but this association did not remain significant in women after adjustment for WC. Increasing exercise steps associated with increasing apolipoprotein A-1 concentration also after adjustment for WC in men, but not in women, and indirect association between exercise steps and apolipoprotein B did not remain significant in either sex after all adjustments. Conclusions: In addition to exercise-type PA, also more informal non-exercise activity appears to associate favorably with some cardio-metabolic risk factors, most notably with insulin and triglyceride levels in men. P505 How much is physical activity deficit in men with metabolic syndrome - a pilot accelerometric study A Kisko1, L Dernarova1, N Kishko2, G Skreckova1 1University in Presov, Faculty of Health Care, Presov, Slovak Republic 2Uzhgorod National University, Medical Faculty, Uzhgorod, Ukraine Topic: Physical Inactivity (Prevention & Epidemiology) The main consequences of physical inactivity are overweight and obesity, followed by circulatory and metabolic disorders. For this reason sedentary lifestyle is recognized as a main risk factor of metabolic syndrome (MS), especially in men. An effective lifestyle intervention can be developed for these patients (pts) based on the objectively detected deficiency in physical activity (PA). Several methods of the assessment of the amount of PA exist, but currently accelerometry seems to be most appropriate for this purpose. 86 male subjects (mean age 57,5±2,7 year) enrolled into the pilot study formed two groups: the research group of 46 pts with MS according to the IDF criteria and the control group of 40 age matched practically healthy men without any serious somatic or metabolic disorders. Accelerometry as an objective method of the assessment of PA for 4 days (2 working and 2 weekend days) was used. Actigraph GT3X+ accelerometers and Actilife 5 software were used for the assessment of metabolic equivalents, time spent at various levels of PA, energy expenditure and the number of steps taken during the evaluating period. In the MS group of the pts there was a significant deficiency in the total amount of PA measured in metabolic equivalents (1,08METs/1,22 METs, p<0.02) and the time spent in sedentary was significantly longer (84,4% / 74,2%, p<0.0001) against that in the group of healthy men. There was a tendency to lower energy expenditure (2942,4 kCal/3274,5 kCal, p=0.05) and significantly less steps taken per day (15 628/36 782, p<0.01) in the research group against the control group, that objectively indicate on the PA deficit in MS pts. Accelerometry showed to be technically simple but enough accurate and precise method for the quantitative and qualitative assessment of the amount of PA, and can be recommended for use in preventive medicine, especially in MS. It demonstrated a significant deficiency of PA and sedentary lifestyle in MS male pts. The results of this pilot study predispose for the interventions into the habitual lifestyle of the men with MS to improve prognosis and outcomes of the disease. P506 Determinants of attaining and maintaining a low cardiovascular risk profile: the doetinchem cohort study G Hulsegge1, HA Smit2, YT Van Der Schouw2, ML Daviglus3, 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 3Northwestern University, Department of Preventive Medicine, Chicago, United States of America Topic: Physical Inactivity (Prevention & Epidemiology) Introduction: Increasing the proportion of adults who attain and maintain low cardiovascular risk profile is essential in the prevention of cardiovascular disease (CVD). It is unknown which factors are associated with attaining and maintaining a low risk profile. We investigate the association of 6 demographic, 4 lifestyle, 3 CVD history, and 4 psychosocial determinants with 1) attaining and 2) maintaining a low risk profile. Method: CVD risk factors and determinants were measured at baseline (1987-1991) and 5-year intervals until 2013 among 6,390 adults initially aged 20-59. Participants were categorized into low risk (i.e., ideal levels of blood pressure, cholesterol, and body mass index, not smoking and no diabetes) and medium or high risk profile at baseline. Those with low risk profile maintained or lost their low risk status, whereas those with medium/high risk profiles maintained that risk profile or attained a low risk profile during follow-up. Determinants of change in risk profiles were examined using modified Poisson regression to obtain risk ratios (RR) and 95% confidence intervals (95%CI) and generalized estimating equations to combine multiple 5-year comparisons. Results: A small proportion of participants (3%) with medium/high risk profile attained a low risk profile during the following 5 years. Compared to those who maintained a medium/high risk profile, one unit increment in Mediterranean (healthy) diet score was associated with 9% (RR: 1.09, 95%CI: 1.02-1.16) and being physical active compared to being inactive with a 118% (RR: 2.18, 95%CI: 1.19-4.00) higher likelihood to attain a low risk profile. Older age (RR: 0.58, 95%CI: 0.53-0.64), male gender (RR: 0.34, 95%CI: 0.27-0.43), low (RR: 0.42, 95%CI: 0.33-0.53) and intermediate (RR: 0.61, 95%CI: 0.48-0.79) education, and low (RR: 0.61) and intermediate (RR: 0.73) education of partner were significantly associated with lower chance to attain low risk status. Of those having a low risk profile, 40% maintained that low risk profile over 5 years. For those with low risk profile, only older age (RR: 0.75, 95%CI: 0.67-0.84), low educational level (RR: 0.78, 95%CI: 0.63-0.96) and male gender (RR: 0.72, 95%CI: 0.56-0.92) were significantly inversely associated with maintaining low risk profile. Conclusions: Low education level had an unfavorable impact on changes in risk profiles. This underscores the need to target preventive efforts at individuals with low education in the prevention of CVD. A healthy diet and physical activity were the only modifiable risk factors that were favorably associated with attaining low risk profile. P507 Associations between physical activity and palpitations B Morseth1, ML Lochen1 1University of Tromso, Faculty of Health Sciences, Department of Community Medicine, Tromso, Norway Topic: Physical Inactivity (Prevention & Epidemiology) Purpose: Endurance training has recently been associated with higher prevalence of atrial fibrillation. This may also apply to those who practice vigorous leisure time physical activity in the general population. However, only a handful studies have examined habitual physical activity in relation to development of atrial fibrillation and palpitations. The aim of this study was to examine the association between leisure time physical activity and palpitations in a general population. Methods: A population-based cohort of 19 172 men and women aged 12-69 years who attended the third Troms?dy in 1986-87 were included in this study. Leisure time physical activity (four levels), smoking habits, and diabetes status were assessed by a self-administered questionnaire. Weight, height, and systolic blood pressure were measured with standard procedures at the examination. Presence of palpitations was measured with the question: "Have you noticed sudden changes in your pulse rate or heartbeat in the past year?". Associations were determined by multiple logistic regression. Analyses were performed for the total population and stratified by sex. Results: Mean age was 37 years (SD 11.28). Prevalence of palpitations decreased with increasing physical activity (P <0.001), as shown in Table 1. When adjusted for sex, age, body mass index, smoking, systolic blood pressure, and diabetes, the risk of palpitations decreased with increasing activity level (P <0.001). The most active subjects had 32% lower risk of palpitations than the sedentary (P <0.001) (Table 1). Associations remained when stratifying by sex. Conclusions: Our data from a general population showed that the risk of palpitations decreased as physical activity level increased. Further studies are warranted to examine whether these findings also apply to atrial fibrillation. Table 1. Risk of palpitations Physical activity level n Prevalence of palpitations, n(%) OR 95% CI Sedentary 4258 18.1% (771) 1.0 (reference) Light activity 10982 15.1% (1658) 0.81 (0.74-0.89) Moderate/vigorous activity 3932 10.2% (402) 0.68 (0.59-0.78) Physical activity level n Prevalence of palpitations, n(%) OR 95% CI Sedentary 4258 18.1% (771) 1.0 (reference) Light activity 10982 15.1% (1658) 0.81 (0.74-0.89) Moderate/vigorous activity 3932 10.2% (402) 0.68 (0.59-0.78) OR=Odds ratio. CI=Confidence interval. Adjusted for sex, age, body mass index, smoking, systolic blood pressure, and diabetes. Open in new tab Table 1. Risk of palpitations Physical activity level n Prevalence of palpitations, n(%) OR 95% CI Sedentary 4258 18.1% (771) 1.0 (reference) Light activity 10982 15.1% (1658) 0.81 (0.74-0.89) Moderate/vigorous activity 3932 10.2% (402) 0.68 (0.59-0.78) Physical activity level n Prevalence of palpitations, n(%) OR 95% CI Sedentary 4258 18.1% (771) 1.0 (reference) Light activity 10982 15.1% (1658) 0.81 (0.74-0.89) Moderate/vigorous activity 3932 10.2% (402) 0.68 (0.59-0.78) OR=Odds ratio. CI=Confidence interval. Adjusted for sex, age, body mass index, smoking, systolic blood pressure, and diabetes. Open in new tab P508 Identifying solutions, to increase participation in physical activity interventions within a socio-economically disadvantaged community: a qualitative study ME Cupples1, CL Cleland2, RF Hunter1, MA Tully1, D Scott1, F Kee1, L Prior1, M Donnelly1 1UKCRC Centre of Excellence for Public Health Northern Ireland (NI), Belfast, United Kingdom 2Institute of Health and Society, Newcastle upon Tyne, United Kingdom Topic: Physical Inactivity (Prevention & Epidemiology) Purpose: There is an urgent need to increase population levels of physical activity, particularly amongst those who are socio-economically disadvantaged. Multiple factors influence physical activity behaviour but the generalisability of current evidence to such hard-to-reach population subgroups is limited by difficulties in recruiting them into studies. Also, rigorous qualitative studies of lay perceptions and perceptions of community leaders about public health efforts to increase physical activity are sparse. We sought to explore, within a socio-economically disadvantaged community, residents and community leaders perceptions of physical activity (PA) interventions, and issues regarding their implementation, in order to improve understanding of needs, expectations, and factors relevant to future interventions. Methods: Within an ongoing regeneration project (Connswater Community Greenway), in a socio-economically disadvantaged community in Belfast, we collaborated with a Community Development Agency to purposively sample leaders from public- and voluntary-sector community groups and residents. Individual semi-structured interviews were conducted with 12 leaders. Residents (n=113), of both genders and a range of ages (14 to 86 years) participated in focus groups (n=14). Interviews and focus groups were recorded, transcribed verbatim and analysed using a thematic framework. Results: Three main themes were identified: awareness of interventions; components of interventions; and barriers to participation in interventions. Participants reported awareness only of interventions in which they were involved directly, highlighting a need for better communications, both inter- and intra-sectoral, and with residents. Meaningful engagement of residents in planning/organisation, tailoring to local context, supporting volunteers, providing relevant resources and an exit strategy were perceived as important components of successful interventions. Negative attitudes such as apathy, disappointing experiences, information with no perceived personal relevance and limited access to facilities were barriers to people participating. Conclusions: The findings illustrate the complexity of influences on a community s participation in PA interventions and support a social-ecological approach to promoting PA. They highlight need for cross-sector working, effective information exchange, involving residents in bottom-up planning and providing adequate financial and social support. An in-depth understanding of a target population s perspectives is of key importance in translating PA behaviour change theories into practice. P510 Daily values of central pressure and arterial stiffness in patients older than 60 years with systolic-diastolic, and isolated systolic hypertension V Oleinikov1, L Gusakovskaya1, N Sergatskaya1, Y Tomashevskaya1 1Penza State University, Penza, Russian Federation Topic: Hypertension (Rehabilitation & Implementation) Objectives: to make a comparative assessment of a central (aortic) blood pressure and arterial stiffness in patients older than 60 years with isolated systolic (ISH), and systolic-diastolic hypertension (SDH) 1-2 degrees. Material and Methods: 47 patients aged 60 to 74 years. The first group consisted of 20 patients with ISH, mean age 67,7 ± 3,6 years. The second group included 27 patients with SDH, mean age 67,2 ± 4,1 years. The diagnosis was verified by measuring blood pressure three times by auscultatory method (ESC recommendations). The groups were randomized by age, sex, anthropometric indicators, office systolic blood pressure. Structural and functional properties of arteries were evaluated using the technology Vasotens ("Peter Telegin", Russia). Daily mean values of the central (aortic) pressure: systolic (SBP), diastolic (DBP), mean hemodynamic (MBPao), pulse pressure (PP) were determined. Besides augmentation index in the aorta (Aixao) and central pulse wave velocity (PWVao) was evaluated. Results are presented as M ± SD for a normal distribution, with asymmetric as Me (Q 25%; Q 75%). Results: compared groups did not differ in the SAD: in patients with ISH - 140,0 ± 10,9, SDH - 140,4 ± 8,5 mm Hg. MBPao in the group 1 was 115.0 (102.0, 117.0) mm Hg, in group 2, respectively, 115,2 ± 8,5 mm Hg (P> 0.05). In patients with ISH values of DBP ??were significantly lower (78,3 ± 5,6 mm Hg) compared with SDH patients - 87.5 (86.0, 94.0) mm Hg (P <0.01). Mean daily PP in group 1 exceeded the corresponding value in Group 2 (61,5 ± 8,1 and 50,8 ± 6,5 mm Hg, respectively (p <0.01). The Aixao in ISH patients was 41,3 ± 9,7%, SDH - 37.0 (24.0, 39.0)% (p <0.01). Compared groups did not differ in daily value of PWVao: Group 1 - 8.1 (7, 8, 8.3) m / s, in group 2 - 7,8 ± 0,5 m / s (p> 0.05). Conclusions: based on the ambulatory monitoring of aortic blood pressure and vascular stiffness, the elderly patients with ISH were significantly different from those with SDH, which is obviously due to the more pronounced changes in the aortic wall, leading to an isolated increase of systolic blood pressure. P511 Effects of cardiovascular rehabilitation on endothelial function in diabetic patients M Deljanin Ilic1, S Ilic2, D Simonovic1, G Kocic3, R Pavlovic3 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: Diabetes Type 1/2 (Rehabilitation & Implementation) Purpose: To evaluate the effects of cardiovascular rehabilitation on the endothelial function, assessed through changes of circulating blood markers of endothelial function: Asymmetric Dimethylarginine (ADMA), Symmetric Dimethylarginine (SDMA), Xanthine Oxidase (XO), and on the levels of hs-CRP, Uric Acid (UA) and Glucose (Glu) in diabetic patients (pts) with coronary artery disease (CAD). Methods: 23 pts with CAD (after myocardial infarction; all man) were studied. At baseline and 3 weeks later, in all pts values of ADMA, SDMA, XO, UA, hs-CRP and Glu were evaluated. After the initial study, pts were randomized to group without diabetes (no-DM group, n=12, 57.67±5.29 years) and group with diabetes (DM group, n=11, 55.45±5.83 years). All pts underwent a supervised 3 weeks aerobic exercise training (3 sessions per day) at residential center. Results: Baseline values of ADMA, SDMA and XO were similar in no-DM and DM group. After 3 weeks values of ADMA, as well as, of SDMA decreased in both groups: ADMA in no-DM group from 0.307±0.04 to 0.235±0.059 µmol/l (P=0.001) and in DM group from 0.326±0.047 to 0.261±0.048 µmol/l (P=0.001); SDMA in no-DM group from 0.277±0.061 to 0.226±0.05 µmol/l (P=0.002) and in DM group from 0.279±0.066 to 0.248±0.065 µmol/l (P=0.074). Compared to the baseline, value of XO at the end of the study was significantly lower in both groups (P<0.0005, both) with mean difference higher in DM than in no-DM group (129.89±18.94 vs118.60±16.96, ns). Value of hs-CRP significantly decreased in both groups (no-DM group, P<0.0005; DM group P=0.033), but the mean difference was higher in no-DM group (1.01±0.39 vs 0.76±1.31, P=0.016). Compared to the baseline, values of UA after 3 weeks were significantly lower in both groups (no-DM group, P<0.0005; DM group, P=0.017) with significantly lower second value in no-DM than in DM group (260.88±48.59 vs 319.97±34.57, P=0.007). Mean decrease of Glu level was higher in DM than in no-DM group (0.59±0.62 vs 0.072±0.65, ns). Conclusions: Residential cardiovascular rehabilitation induced improvement in endothelial function in diabetic patients with coronary artery disease, expressed through significant decrease of ADMA, SDMA and XO. Higher reduction in XO and glucose in DM than in no-DM pts suggests that cardiovascular rehabilitation leads to more pronounced benefit in diabetic than in no diabetic pts. P512 Information needs in patients attending cardiac rehabilitation: the role of demographics J Gallagher1, R Buckmaster1, F Doyle2, B Hannon1, N Pender1, B Mcadam1 1Beaumont Hospital, Dublin, Ireland 2Royal College of Surgeons in Ireland, Dublin, Ireland Topic: Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: Accurate information regarding health and coronary artery disease (CAD) is necessary for patients to make informed choices and to self-manage their cardiac illness effectively. Although clinical guidelines typically stipulate that interventions as part of cardiac rehabilitation (CR) should be tailored and 'menu-driven', little is known about what patients' informational priorities are during this process. The aim of the current study was to undertake a systematic investigation of informational needs in a cohort of patients attending CR, and to examine the impact of demographic variables on these stated needs. Methods: A cross-sectional study design was employed with a cohort of cardiac patients attending a hospital-based CR programme. 121 patients [71.3% male; mean age 66.73 (SD=10.83)] completed a questionnaire investigating their educational needs during CR. In addition to demographic information, patients were requested to complete the Information Needs in Cardiac Rehabilitation (INCR) tool (Ghisi et al., 2013). All data were analysed using SPSS 18.0. Independent t-tests examined the relationship between informational needs and age and gender respectively. Results: Regarding the 10 subject areas of the scale, patients rated emergency/safety, diagnosis and treatment, and the heart as the areas with the greatest information needs; and risk factors, general/social concerns, and work/vocational/social as their lowest information priorities. There were no differences between older (>60 years) and younger (<60 years) patients regarding informational needs. Female patients were more likely to seek information regarding when they should call 999 or go to the emergency room (p=0.019). Male patients were more likely to prioritise the following informational needs: what foods they should avoid while taking cardiac medictions (p=0.035), information on how both to cope with stress (p=0.006) and to reduce stress in their daily lives (p=0.007), information regarding which cardiac risk factors are controllable (p< 0.0001) and what can be done to control such risk factors (p=0.058). Conclusions: To optimise the benefits patients derive from CR, programmes should attempt to incorporate cardiac patients' informational preferences into educational interventions. Where feasible, particular attention should be paid to gender differences in information priorities. P513 Young age and ethnicity are risk markers for developing psychological distress after cardiac revascularisation in patients with ischemic heart disease A Holdgaard1, R Poulsen1, M Frederiksen1, E Prescott1, H Kruuse Rasmusen1 1Bispebjerg Hospital of the Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark Topic: Psychosocial factors/Quality of life (Rehabilitation & Implementation) Aim: In patients with ischemic heart disease (IHD) psychological distress is associated with increased morbidity and mortality and reduced quality of life. It is therefore important to identify patients of risk. We wanted to identify risk markers for developing psychological distress in IHD patients after cardiac revascularization. Methods: All consecutive patients discharged from our hospital with acute coronary syndrome (ACS) or stable ischemic heart disease (IHD) in 32 months from February 2011 were evaluated for psychological distress by using a modified 5 questionnaire MD Prime Scoring at the beginning of their cardiac rehabilitation (CR). A positive answer to more than one question was defined as having psychological distress including signs of anxiety and/or depression. Results: 526 patients (attendance rate 67%) participated in CR. Index event was STEMI (24%), NSTEMI (26%), unstable angina (16%) and stable CHD (34%). Mean age was 64 years (range 25-93 years), 128 (24%) were women and 86 (16%) belonged to an ethnic minority. 78% were treated with percutaneous coronary intervention (PCI), 16% with coronary by-pass surgery (CABG) and 6% with only medical treatment. All were scored with a modified Prime MD questionnaire. 49 (9%) had psychological distress and 43 were referred to a Liaison nurse for cognitive therapy. Patients with psychological distress were younger for both gender in men (mean±SD) 55±9 vs. 62±10 years (P for difference compared to not having psychological distress <0,001) and in women 59±8 vs. 66±11 years (P<0,02). Belonging to an ethnic minority induced an increased risk of psychological distress (P<0,03) especially in male (P<0,01) conversely there was a tendency towards more female ethnic Danish patients having psychological distress (P=0,074). Education and marital status did not have any influence on psychological distress nor did index event or revascularization treatment. Conclusions: Results of this study indicate that young age and belonging to an ethnic minority are risk markers for developing psychological distress in patients with ischemic heart disease. P514 Social participation during and after cardiac rehabilitation: frequency, perceived restrictions and satisfaction N Ter Hoeve1, RT Van Domburg2, HJ Stam3, ME Van Geffen4, M Sunamura4, HJG Van Den Berg-Emons3 1Erasmus Medical Center, Rotterdam, Netherlands 2Erasmus Medical Center, Department of Cardiology, Rotterdam, Netherlands 3Erasmus Medical Center, Department of Rehabilitation Medicine, Rotterdam, Netherlands 4CAPRI Hartrevalidatie Rotterdam, Rotterdam, Netherlands Topic: Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: Cardiac rehabilitation (CR) aims to optimize social participation in different domains such as domestic, occupational and recreational activities. Social participation is a multidimensional concept, consisting of both frequency of participation and an individual s own perception of participation. Most studies focused only on frequency of occupation. The aim of this study was to describe different dimensions of social participation (frequency, experienced restrictions and satisfaction) in various domains before and after CR. Additionally, we explored how changes in these different dimensions were related to changes in health related quality of life (QoL). Methods: A total of 129 patients with coronary artery disease (mean age 57 years; 80% men) who participated in a cardiac rehabilitation program were included in this prospective cohort study. Social participation was assessed with the USER-Participation questionnaire; QoL with the MacNew Heart Disease Health related Quality of Life questionnaire. All measurements were taken pre-CR (T0) and post-CR (T1), a follow-up measurement was performed one year after start of CR (T2). Results: At T0, most patients experienced restrictions in participation (70% of patients) in various domains such as work, housekeeping and physical exercise. At T1 this improved to 41% (p<0.001) and at T2 this improved further to 29% (p<0.001 versus T1). Persisting restrictions at T2 were mainly experienced in the physical exercise domain. At T0, 71% of patients was dissatisfied with their social participation. This improved to 49% at T1 (p<0.001) and this improvement was maintained at T2 (53,4%, p<0.001 versus T0). Persisting dissatisfaction at T2 was most prevalent in contact with friends and in the physical exercise domain. Frequency of participation remained unchanged during and after CR. Improvements in experienced restrictions and satisfaction with participation were related to improvements in QoL (B=0.635, p<0.001; B=0.022, p<0.001). In contrast, improvements in frequency of participation were not related to improvements in QoL (B=-0.003, p=0.467). Conclusions: Although experienced social participation problems improved during rehabilitation, some persisting restrictions in and dissatisfaction with participation were observed. In addition to frequency of participation, it is therefore also important to address experienced restrictions and dissatisfaction during rehabilitation. Especially since improvements in these two dimensions of participation are related to an improved QoL. P515 Importance of psychological intervention during cardiac rehabilitation programs D Iglesias Del Valle1, B Arbulo1, A Garcia1, E Martinez1, I Soler1, NE Martinez1, C Casanova1, R Cano1, C Tejero1, I Plaza1 1Hospital Infanta Sofia, San Sebastian de los Reyes, Spain Topic: Psychosocial factors/Quality of life (Rehabilitation & Implementation) INTRODUCTION: Psychological intervention seeks to modify those psychological factors related with heart disease, to diminish emotional complications, to improve psychological well-being and quality of life and to promote reincorporation to a normal working and social activity. The objective of this study is to analyze the effect of psychological intervention during a cardiac rehabilitation program on the main psychological factors associated to cardiovascular disease, depression and anxiety. Methods: The study included all patients undergoing the cardiac rehabilitation program since June 2011 who completed psychological tests. We analyzed the results of depression and anxiety questionnaires conducted before and after the program. The Beck Depression Inventory (BDI) primarily evaluates clinical symptoms of melancholy and intrusive aspects present in depressive states. Scores corresponding to the severity of the symptoms are: 0-13 no depression, 14-19 mild depression, 20-28 moderate depression, >29 severe depression. The State-Trait Anxiety Inventory (STAI) is designed to evaluate two independent concepts of anxiety as a state (transient emotional condition) and trait (relatively stable anxious tendency). The scores are transformed into decatypes. Psychological intervention in the program is done through relaxation sessions, psychological education and group therapy. Results: We obtained the tests before and after the program in 71 patients. The indication for cardiac rehabilitation was: NSTE-ACS 40 (56.3%), STEMI 18 (25.4%), stable angina 11 (15.5%) and heart failure 2 (2.8%). The average score on the BDI test decreased from 12.2 to 7.1 (P<0.001). The average decatype for STAI state questionnaire increased from 7.4 to 5.7 (P<0.001) and for STAI trait from 6.2 to 5.7 (P<0.001). Conclusions: The psychological intervention during the cardiac rehabilitation programs is extremely important because it produces a significant improvement in those negative psychological factors associated with cardiovascular disease. Initial Final NSTE-ACS BDI STAI-S STAI-T 13.6 7.6 6.3 8.0 5.8 5.9 STEMI BDI STAI-S STAI-T 10.8 7.3 6.3 6.2 5.7 5.7 Stable angina BDI STAI-S STAI-T 10.0 7.1 5.4 5.3 5.2 5.0 Heart failure BDI STAI-S STAI-T 10.0 7.0 6.0 4.5 5.5 5.5 Initial Final NSTE-ACS BDI STAI-S STAI-T 13.6 7.6 6.3 8.0 5.8 5.9 STEMI BDI STAI-S STAI-T 10.8 7.3 6.3 6.2 5.7 5.7 Stable angina BDI STAI-S STAI-T 10.0 7.1 5.4 5.3 5.2 5.0 Heart failure BDI STAI-S STAI-T 10.0 7.0 6.0 4.5 5.5 5.5 Open in new tab Initial Final NSTE-ACS BDI STAI-S STAI-T 13.6 7.6 6.3 8.0 5.8 5.9 STEMI BDI STAI-S STAI-T 10.8 7.3 6.3 6.2 5.7 5.7 Stable angina BDI STAI-S STAI-T 10.0 7.1 5.4 5.3 5.2 5.0 Heart failure BDI STAI-S STAI-T 10.0 7.0 6.0 4.5 5.5 5.5 Initial Final NSTE-ACS BDI STAI-S STAI-T 13.6 7.6 6.3 8.0 5.8 5.9 STEMI BDI STAI-S STAI-T 10.8 7.3 6.3 6.2 5.7 5.7 Stable angina BDI STAI-S STAI-T 10.0 7.1 5.4 5.3 5.2 5.0 Heart failure BDI STAI-S STAI-T 10.0 7.0 6.0 4.5 5.5 5.5 Open in new tab P516 Efficient correction of depressive disorders in patients with coronary heart disease AN Repin1, TG Nonka1, TN Sergienko1, EV Lebedeva1 1Research Institute of Cardiology SB of RAMS, Tomsk, Russian Federation Topic: Psychosocial factors/Quality of life (Rehabilitation & Implementation) Purpose: To study the influence of depressive disorders and their correction in the heart rate variability (HRV) in patients after myocardial infarction. Research methods. The study included 73 patients with chronic coronary heart disease (CHD) (with angina pectoris II-III class), acute myocardial infarction more than six months ago. Were divided into two groups: basic (39 CHD patients with depression) and control group (34 patients with coronary artery disease without depressive symptoms). The diagnosis of depressive disorder was verified by psychiatrist. The patients of basic group was received antidepressants (fluvoxamine, fluoxetine). All patients underwent Holter monitoring of electrocardiography. The registration of ECG performed for 24 hours at baseline and after 6 months of observation. Recording was analyzed with the use of SCHILLER MT - 200 Holter - ECG (Switzerland). Statistical analysis of the data was conducted using the software package Statistica for Windows ver 6.0 company Stat Soft, Inc . In a time of database was created, the database editor MS Access 97 was used. Data are expressed as M ± SD; n (%); Me [25%, 75%]. Results: The groups were matched on key clinical and demographic characteristics, by functional class of angina. In patients with depression compared with those without mental disorders found a significant decrease of all analyzed characteristics HRV: SDNN (95 [86, 108] vs 110 [98, 127], p = 0,005), SDANN (77,4 ± 18,2 vs 91 ± 16,9, p = 0,003), SDNNindx (49, 1 ± 15,6 vs 57,0 ± 14,5, p = 0,04), rMSSD (29 [23, 36] vs 33 [29, 45], p = 0,04), pNN50% (3,9 [2,2; 5,4] vs 5,7 [2,9; 12], p = 0.02). In the analysis of heart rate variability in 6 months significant differences between the core group and a comparison group disappeared in terms of SDNN (96 [84, 111] vs 106 [98, 124], p = 0,1), SDANN (77 [65, 95] vs 83 [68, 104], p = 0,2), and rMSSD (28 [24; 32,5] vs 32,5 [26, 39], p = 0,2). Thus, antidepressants of the selective serotonin reuptake inhibitors have effect on the cardiovascular system. Conclusions: Depressive disorders in the CHD contribute significantly reduction of HRV parameters, which is a poor prognostic factor of coronary heart disease course after myocardial infarction. Against the background of the therapy with antidepressants the overall activity of the vegetative nervous system is increased, the inhibition of sympathetic and activation of the parasympathetic tone take place. P517 Low referral rate to cardiac rehabilitation after primary percutaneous coronary intervention predicted by clinical variables M Sunamura1, N Ter Hoeve1, R Steenaard2, HJ Van Den Berg2, ML Geleijnse2, HJ Stam2, E Boersma2, R T Van Domburg2 1Capri Hartrevalidatie, Roterdam, Netherlands 2Erasmus Medical Center, Thoraxcenter, Rotterdam, Netherlands Topic: Other risk factors (Rehabilitation & Implementation) Purpose: According to the guidelines, patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention.(pPCI) are to be referred to Cardiac Rehabilitation (CR). However, it is known that not all patients (pts) are referred. The objective of the present study was to investigate which factors are related with referral to CR. Methods: Between 2009 and 2011 consecutive patients who underwent a pPCI at the Erasmus Medical Center were referred to CR. A control group was selected of those patients who were not referred to CR. All patients alive were sent a postal mailing. The following data were collected: demographics (age, gender), clinical characteristics (diabetes, hypertension, smoking, dyslipidemia, smoking, familiar), cardiac history, social status (working status, education, marital status) as well as subjective health status (SF-12). Results: In total, 797 responders were included in the study. Of these, 427 pts were referred (53%) of whom 387 pts (49%) attended CR. Referred pts were 5 years younger (58 yrs vs 63 yrs), were more working (48% vs 35%), had less cardiac history (11% vs 21%) and had more cardiac risk factors (1.9 vs 1.4). Patients who attended CR were younger of age, were more obese (OR 7.96; 95%CI 3.52-17.96), had less prior myocardial infarction (OR 0.37;95%CI 0.20-0.66), more cardiac risk factors (OR 2.18;95%CI 1.57-3.02) and scored lower on the mental health status (OR 1.75;95%CI 1.26-2.43). Conclusions: This study showed that younger age, obesity with multiple cardiac risk factors and lower mental state were predictive of higher CR referral. P518 High levels of risk factors but lack of follow up and poor secondary prevention for people treated for coronary heart disease (CHD) in Jordan A Ashour1, DONNA Fitzsimons1, PAUL Slater1, BRENDA O'neill1, MARWAN Al Nemri2, MOHAMD Jarrah3, HUSEIN Amrat4 1University of Ulster, Jordanstown, United Kingdom 2Queen Alia Heart Institute, Amman, Jordan 3King Abdullah University Hospital, Irbid, Jordan 4Prince Hamza Hospital, Amman, Jordan Topic: Other risk factors (Rehabilitation & Implementation) Purpose: Secondary prevention is a priority after coronary revascularization for effective long term cardiovascular care but evidence confirms that adherence to guidelines on cardiovascular disease prevention is suboptimal. CHD is a major health problem in Jordan and the leading cause of death, but little is known about the current provision of secondary prevention strategies for these patients. This study is designed to evaluate risk factors, describe lifestyle and explore the current provision of secondary prevention in patients treated for established CHD in Jordan. Methods: A quantitative repetitive measures research design was used using a quota sample of patients admitted to 3 interventional hospitals after: acute myocardial infarction (AMI) treated medically, Percutaneous Coronary Intervention (PCI) and coronary artery bypass graft (CABG). Data were collected during hospitalisation and 6 months later using self-reported questionnaires and medical records review.The European guidelines on CHD prevention 2012 were used to define recommended targets. Results: Of the 180 patients at discharge 77% were obese or overweight, 59% were smokers, 59% had low levels of physical activity, 51% had elevated LDL, 44% were hypertensive and, 36% were diabetic. Recording of risk factor history and current status was incomplete. Glucose control was poor, with 81% of diabetics having raised HbA1c. None of patients had psychological risk factors or dietary assessment. Of the 169 patients at follow up 47% continued to smoke, 53% not made any dietary changes, 52% not exercised regularly and 62% never lost weight. Recording of risk factor measurement at follow up was insufficient to evaluate achievement of therapeutic targets. There was no cardiac rehabilitation, smoking cessation or secondary prevention available post discharge. The vast majority of received brief physician advice about medications 72% and smoking 49%. The use of prophylactic drug therapies at discharge was as follows: Aspirin 99%, lipid lowering drug 91%, beta-blockers 87%, ACE inhibitors 49% but no diabetics received rennin angiotensin receptor blockers as recommended. Conclusions: These findings confirm that despite extremely high prevalence of risk factors in this population, the provision of secondary prevention and lifestyle changes are poor while self-reported medication adherence was good. There is much greater focus on medical treatment and medication rather than lifestyle modification. Secondary prevention of CHD in Jordan requires urgent improvement and nurses contribution to prevention should be enhanced in line with other European nations. P519 Changes in cardiorespiratory data and quality of life with two different types of exercise: Moderate continuous exercise versus high intensity interval training. K Villelabeitia1, I Diaz Buschmann1, C Hernandez De La Pena1, C Lazaro Gomez1, A Garcia Romero1, A Nunez Cortes1, J Castillo Martin2, M Abeytua Jimenez2 1Hospital Infanta Elena, Madrid, Spain 2University General Hospital Gregorio Maranon, Madrid, Spain Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Background: In the care of coronary artery disease patients (CAD), the benefits of exercise therapy are established. Moderate continuous training (MCT) is the best established training modality for this patients. However, a body of evidence has begun to emerge demonstrating high intensity aerobic interval training (AIT) can be performed safely with improvements in functional capacity and quality of life. Purpose: The primary aim of this randomized controlled study was therefore to compare the effect of 8 weeks of MCT versus AIT on VO2peak and on the first aerobic threshold (VT1). Secondary outcome measures were: HR recovery, resting HR and health-related quality of life (MacNew). METHOD: Seventy-two stable CAD patients with left ventricular ejection fraction > 40% who were undergoing optimal medical treatment, were randomized (1:1) to supervised AIT versus MCT on cycle ergometer, three times a week for 8 weeks (24 sessions). Moderate intensity (MCT) corresponds to a work at Ventilatory Threshold (VeT), VeT was determined by visual inspection of the breakpoints in the VE/VO2 and PETO2 data curves. This work intensity was applied in the 12 training sessions (first month) and VeT +10% (ml/kg/min) in the second month. AIT consisted in 20 seconds work phases alternating with 40 seconds recovery phases. The work rate was 50/10% of the maximum achieved during a steep ramp test (increments of 25 w/10 s). After 12 sessions a new ramp test was performed to adjust workloads for the remaining sessions. Each training session had a total time duration of 40 minutes preceded by a standarized warm-up and a active recovery phase. Results: All of the participants improved exercise capacity, VO2 peak increased more after AIT (23%) from 19,4±4,7 to 23,9±4,8 mL/kg(min (P<0.001) than after MCT (12%) from 20,3±5,0 to 22,8±6,5 mL/kg(min (P<0.001). The improvement in the first aerobic threshold (VT1) were more significant in AIT (21%) than in MCT (12%). Resting heart rate did not change from baseline with both exercise modes. Only after AIT we find significants improvement in heart rate recovery (P=0.041). Health-related quality of life(MacNew) was significantly improved in both groups with greater benefits realized with the intervalic former program. Conclusions: The results of the current study indicate that the exercise intensity have important implications for exercise training in rehabilitation programs Considering the significant cardiovascular adaptations associated with high-intensity exercise, such exercise should be considered among patients with coronary heart disease. P521 Cost reduction by an internet-based telerehabilitation program in coronary artery disease patients after the acute rehabilitation phase I Frederix1, N Van Driessche2, D Hansen3, J Berger3, K Bonne3, T Alders3, P Dendale3 1Catholic University of Leuven, Leuven, Belgium 2Hasselt University, Hasselt, Belgium 3Jessa Hospital, Hasselt, Belgium Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: The Telerehab II trial run over 24 months in the Jessa Hospital revealed that coronary artery disease patients receiving an internet-based telerehabilitation program after the acute in-hospital rehabilitation phase show a trend toward fewer rehospitalisations during the study follow-up period (P=0.09). We investigated the related cost savings. Methods: 80 patients were included in the randomised, controlled trial after admission for PCI or CABG during phase II of the cardiac rehabilitation programme. Patients with a defibrillator, important arrhythmias or severe heart failure (NYHA class III and IV) were excluded. Patients in the intervention group (n=40) did wear a motion sensor continuously during the day for 18 weeks and received weekly feedback via SMS or e-mail designed to gradually increase their activity level. Patients in the control group (n=40) wore the motion sensor in week 1, 6 and 18 for measurement purposes. They could not monitor their activities and did not receive feedback. The hypothesis was that the reduction in rehospitalisation rate seen in the intervention group, could translate in associated cost savings. The Mann Whitney U test was used to compare the mean cost per patient per day for rehospitalisations for cardiovascular diseases for the intervention group and the control group. Results: Figure 1, illustrates the mean (± SD) cost per patient per day for the patients in the intervention group and those in the control group during the study follow-up period. The mean cost per patient in the intervention group 1.20 (± 5.20), was smaller than the mean cost per patient in the control group 4.19 (±11.89) (P= 0.14). Conclusions: The addition of an internet-based telerehabilitation programme can reduce the costs associated with rehospitalisations. Open in new tabDownload slide Figure 1. Mean cost per patient per day P522 Compliance to a cardiac rehabilitation program provides benefits and prognosis impact A Ramirez Moreno1, JR Siles-Rubio1, M Noureddine-Lopez2, J Munoz-Bellido1, C Pera-Rojas3, L Fernandez-Lopez4, L Inigo-Garcia4, FJ Bravo-Marques4, F Martinez-Garcia4 1Cardiology Department. Hospiten,, Estepona, Spain 2Servicio de Medicina Interna. Hospiten, Estepona, Spain 3Anaesthesia Department. Hospiten, Estepona, Spain 4Hospital Costa del Sol, Marbella, Spain Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Introduction: Cardiac rehabilitation programs (CRP) have consistently demonstrated the ability to improve cardiac risk factors and reduce morbi-mortality. Thus, compliance to CRP is an essential requirement to achieve the goals of secondary cardiovascular prevention. Objectives: To assess the clinical benefits and CRP compliance impact on prognosis, in a coronary heart disease population. Methods: We evaluated a total of 241 patients referenced to a CRP after an acute coronary syndrome (ACS), recruited between September 2009 and November 2011. Functional capacity was assessed in metabolic equivalents (METS), determined by exercise stress testing. Telephonic interview to patients with at least 12 months of follow-up after index event was performed to assess the occurrence of composite endpoint of overall mortality and nonfatal cardiovascular events. Results: Study population consisted of 241 patients, mostly male (89%), aged 54 ± 10 years (range 28-80). Non compliance was found in 24 (10%) patients and it was more common in women than men (23% versus vs 8%; p = 0.030) and in obese patients (18% vs 8%; p = 0.024). No significant differences were found in other baseline characteristics, including ACS type and severity indicators. At 6 to 12 months post index event, health status comparison between the 2 groups demonstrated that compliers achieved better control of cardiovascular risk profile: higher smoking cessation rate (70% vs 18%, p = 0.001) and higher rates of adequate physical activity (= 600 METS/minute/week) 82% vs 25%, p = 0.022. A significant improvement was found, only in the compliant group (CG), regarding functional capacity +0.8 (1.6) METS, p < 0.001 vs -0.6 (0.9) METS, p = 0.208 in CG vs non-CG, respectively; and lipid profile (LDL-cholesterol LDL-C : -39.1 39.6, p < 0.001; HDL-C: +3.2 8.7, p < 0.001 and triglycerides Tg : -38.7 102.7, p < 0.001 vs LDL-C: -9.6 37.1, p = 0.434; HDL-C: +3.6 6.4, p = 0.096 and Tg: -10.8 58.6, p = 0.554). Composite endpoints were found in 23 (10%) patients and tended to be more frequent in non-CG (17% vs 9%; p = 0.182). With Cox regression analysis, non-compliance behavior was associated with a higher likelihood of composite endpoint occurrence, although no statistical significance was achieved (HR: 2.2, 95% CI: 0.7-6.4). Conclusions: CRP compliant patients have a significant higher improvement in cardiovascular risk profile, functional capacity and tend to suffer less cardiovascular events than non compliant patients. Specific strategies are needed, in order to prevent drop-out and maximize the benefit of CRP. P523 Exercise capacity after myocardial infarction in patients with preserved left ventricular ejection fraction M Dekleva1, J Suzic Lazic2, A Stevanovic3, S Mazic4, A Arandjelovic1 1University Clinical Center Zvezdara, Belgrade, Serbia 2Clinical Hospital Center Dr D Misovic, University Clinic for Internal Medicine, Belgrade, Serbia 3Railway Health Care Institute, Belgrade, Serbia 4Institute of Medical Physiolgy, Belgrade, Serbia Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) There is evidence that minute ventilation/carbon dioxide production (VE/VCO2) slope during cardiopulmonary exercise testing (CPET) is a sensitive marker for evaluation and prediction of heart failure. To best of our knowledge there is no data about role of CPET in stratification of patients with diastolic impairment of left ventricle (LV) after myocardial infarction (MI). Aim: We evaluated cardiopulmonary data during exercise testing in relation to LV remodeling and function measured by Doppler echocardiography. Methods: Thirty one consecutive patients after first MI with preserved left ventricular ejection fraction (LVEF) and isolated diastolic dysfunction (LVDD) and 20 controls were included. Doppler echocardiography was performed in first week, after 6 months. Left ventricular (LV) performance and function were obtained by LV dimensions and volumes (EDV, ESV), LV ejection fraction (LVEF), peak early and late diastolic velocities (E, A), deceleration time of E wave (dec t E), ratio of early trans-mitral to early annular diastolic velocities (E/e), left atrium (LA) dimension and volume. Variables obtained by CPET were: oxygen uptake at peak exercise (VO2 peak), ventilatory equivalent for oxygen (VE/VO2) and VE/VCO2 slope. All patients and controls performed CPET on bicycle, negative for ischemia. Results: Exercise capacity in patients after MI was significantly lower than in controls according to VO2 peak (23.8 vs. 26.3 ml/kg/min, p=0.04). Maximal heart rate was also lower (143 vs. 147, p<0.001) and VE/VO2 (32.4 vs. 29.9, p=0.02), and VE/VCO2 were higher (32.2 vs. 27.6, p<0.001) The most sensitive CPET index which correlated to degree of LV remodeling (EDV and ESV) was VE/VCO2 (B = 0.974, p <0.001) with close relation between VE/VCO2 =32 and ESV =35ml/m2(B = 20.93, p = 0.016) (area under the ROC curve = 0.74, p = 0.03) Conclusions: Patients with isolated LVDD after MI had decreased functional exercise capacity comparing to controls. The VE/VCO2 slope is, possibly, functional reflection of advance post-infarction LV remodeling. P524 Early inpatient engagement improves cardiac rehabilitation enrollment of patients with coronary artery disease P Ting1, T Chong1, SL Ho1, SC Tan1, F Dawood1, FY Yip1, GH Low1, J Jumari1, LJ Fu1, SW Tan1 1National Heart Centre, Singapore, Singapore Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: Despite substantial evidence showing the clinical benefits of cardiac rehabilitation (CR), poor enrollment of eligible patients remains prevalent. We aim to examine the impact of early inpatient engagement of patients admitted to a single large tertiary hospital with coronary artery disease (CAD) on CR enrollment. Methods: Prior to Dec 2012, discharged CAD patients were referred to a CR clinic for assessment before enrollment. From Dec 2012, CR nurses actively engaged inpatients soon after their cardiac events. Suitability was assessed and CR benefits promoted. Agreeable patients were directly entered into CR upon discharge. We retrospectively analyzed the impact of this new practice on enrollment and adherence rates. Results: After implementation, the enrollment rate increased 93% to 8.9% within a 10 month period (Dec 2012 – Sept 2013) from an average of 4.6% in a comparable period of the preceding 5 years. The early engagement group commenced CR 1 week earlier. The difference between adherence rates of 53% from early engagement compared to 60% in earlier periods was not statistically significant. Conclusions: Engagement of CAD inpatients early after a major cardiac event led to earlier commencement of CR and also increased subsequent enrollment rates by 93%. These findings suggest that patients might be more receptive to participating in CR when approached early after a major cardiac event. Innovative CR referral mechanisms and programming may be effective in increasing CR uptake and should be explored further to address the issue of poor enrollment. Comparison of CR enrollment rates Enrollment CAD admissions* Enrollment rate Adherence rate After implementation: Complete 12 wks Period Dec 2012- Sep 2013 348 3918 8.9% 53.0% Before implementation: Period Dec 2011 - Sept 2012 193 4264 4.5% 60.0% Period Dec 2010 - Sept 2011 207 4335 4.8% 58.0% Period Dec 2009 - Sept 2010 193 4501 4.3% 63.0% Period Dec 2008 - Sept 2009 207 4149 5.0% 60.0% Period Dec 2007 - Sept 2008 190 4214 4.5% 57.0% 5 year average for the Period 198 4292.6 4.6% 59.6% Enrollment CAD admissions* Enrollment rate Adherence rate After implementation: Complete 12 wks Period Dec 2012- Sep 2013 348 3918 8.9% 53.0% Before implementation: Period Dec 2011 - Sept 2012 193 4264 4.5% 60.0% Period Dec 2010 - Sept 2011 207 4335 4.8% 58.0% Period Dec 2009 - Sept 2010 193 4501 4.3% 63.0% Period Dec 2008 - Sept 2009 207 4149 5.0% 60.0% Period Dec 2007 - Sept 2008 190 4214 4.5% 57.0% 5 year average for the Period 198 4292.6 4.6% 59.6% * CAD admission broadly includes stable angina, UAP, NSTEMI, AMI (not limited to first time presentation) Open in new tab Comparison of CR enrollment rates Enrollment CAD admissions* Enrollment rate Adherence rate After implementation: Complete 12 wks Period Dec 2012- Sep 2013 348 3918 8.9% 53.0% Before implementation: Period Dec 2011 - Sept 2012 193 4264 4.5% 60.0% Period Dec 2010 - Sept 2011 207 4335 4.8% 58.0% Period Dec 2009 - Sept 2010 193 4501 4.3% 63.0% Period Dec 2008 - Sept 2009 207 4149 5.0% 60.0% Period Dec 2007 - Sept 2008 190 4214 4.5% 57.0% 5 year average for the Period 198 4292.6 4.6% 59.6% Enrollment CAD admissions* Enrollment rate Adherence rate After implementation: Complete 12 wks Period Dec 2012- Sep 2013 348 3918 8.9% 53.0% Before implementation: Period Dec 2011 - Sept 2012 193 4264 4.5% 60.0% Period Dec 2010 - Sept 2011 207 4335 4.8% 58.0% Period Dec 2009 - Sept 2010 193 4501 4.3% 63.0% Period Dec 2008 - Sept 2009 207 4149 5.0% 60.0% Period Dec 2007 - Sept 2008 190 4214 4.5% 57.0% 5 year average for the Period 198 4292.6 4.6% 59.6% * CAD admission broadly includes stable angina, UAP, NSTEMI, AMI (not limited to first time presentation) Open in new tab P525 Eccentric training in chronic heart failure: feasibility and functional effects - results of a comparative study VG Gremeaux1, D Besson2, C Joussain1, C Morisset2, Y Laurent3, JM Casillas1, D Laroche2 1CHU de Dijon, Pôle Rééducation-Réadaptation, Université Bourgogne, Inserm U1093, Dijon, France 2CIC-P Inserm 803, plateforme d investigation technologique, CHU de Dijon, Dijon, France 3, Pôle Rééducation-Réadaptation CHU Dijon, Dijon, France Topic: Heart Failure (Rehabilitation & Implementation) Introduction: The positive effects of exercise training in chronic heart failure (CHF) have been demonstrated for concentric exercises (CON). However, eccentric training (ECC) could represent an valuable alternative to CON, thanks to its larger impact on muscle unction, despite lower requirements for the cardiorespiratory system. This is mainly due to the absence of consensus on personalization strategy, exposing to muscle deleterious effects. Our objective was to evaluate the feasibility, safety and functional improvement related to ECC cycling exercise compared to CON in CHF. Methods: 30 patients were randomized either to ECC (n = 15) or CON (n = 15) cycling training (20 sessions). ECC training was personalized on the level of perceived exertion (RPE, 9-11 on Borg scale), while CON was based on the power corresponding to the first ventilatory threshold. Tolerance was assessed by visual analog scale (VAS) at the end of the sessions and heart rate (HR) during training. Functional capacity was evaluated with 6-minute walk (6MWT), with VO2 measurement during the last 30 seconds. Results: Two patients were excluded due to adverse events in each group. ECC sessions were well tolerated and patients remained within the training intensity target (RPE 9-11 in the ECC group and 12-14 in the CON group). VAS remained close to 0 for both groups with HR increasing only in the CON group during training. The 6MWT distance improved in both groups (ECC: 53±27m; CON: 33± 17 m) and VO2 remained unchanged in the ECC group, but increased in the CON group. Conclusion. The ECC training tailored with RPE is an effective and safe alternative in CHF reconditioning. Functional improvement was similar to that obtained during training CON with less stress on the cardiovascular system. Conclusions: The ECC training tailored with RPE is an effective and safe alternative in CHF reconditioning. Functional improvement was similar to that obtained during training CON with less stress on the cardiovascular system. P526 Distance walked in field tests correlates with peak oxygen uptake in chagasic patients and identifies patients with low functional capacity H Silveira Costa1, R Leite Alves1, M Noman De Alencar1, MC Pereira Nunes1, MM Oliveira Lima2, MOC Rocha1 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: Heart Failure (Rehabilitation & Implementation) Background: Chagas heart disease (CHD), the most severe clinical manifestation of Chagas disease, is associated with worse prognosis and symptoms like fatigue and dyspnea, which contribute to a progressive reduction in functional capacity (FC). The cardiopulmonary exercise test (CPET), the gold standard in the analysis of FC, is expensive and not well tolerated by some patients. Field tests like Six-minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT) are simple, easy to administer and inexpensive. When the CPET is not available, field tests can provide information that would allow early detection of changes in FC and facilitate the adoption of more effective therapeutic strategies. Nevertheless, no studies were found that correlated the distance walked in field tests with peak oxygen uptake (VO2peak) directly measured in patients with CHD. Objectives: To correlate the distance walked in the 6MWT and ISWT with VO2peak by CPET and verify the effectiveness of field tests to identify chagasic patients with low FC. Methods: Thirty five patients with CHD (47.1±8.2 years; 23 male; NYHA I-III) underwent echocardiography and were evaluated according to the FC, assessed by CPET, 6MWT and ISWT guided by international guidelines. The correlation between variables was carried out with Pearson or Spearman correlation test. The Wilcoxon Signed Rank Test was performed to verify the difference between distances walked in field tests. A ROC curve was constructed to investigate the accuracy of distance walked in 6MWT and ISWT for predicting low values of VO2peak according to Weber classification (<20 ml.Kg.min). Results: The FC evaluated by CPET, 6MWT and ISWT was 26.3±8.1 ml.Kg.min, 552.68±82.0 m and 530.3±261.6 m, respectively. The VO2peak correlated with distance walked in 6MWT (r=0.577; p<0.001) and in ISWT (r=0.587; p<0.001). There was no significant difference between the distances walked in field tests (p= 0.694). The area under the ROC curve was 0.758 and 0.821 for 6MWT and ISWT, respectively, in predict a VO2peak value of, at least, 20 mL.kg.min. Conclusions: Both field tests showed good correlation with the direct measurement of VO2 in patients with CHD, as well as good accuracy in predicting low levels of VO2 and can be used in the evaluation of FC in these patients. P527 Factors predicting changes in the cardio-respiratory fitness of the cardiac rehabilitation patients M Almodhy1, G Sandercock1, G Pepera2 1Centre for Sports and Exercise Science, Department of Biological Sciences, University of Essex, Colchester, United Kingdom 2Department of Physiotherapy, TEI of Lamia, Lamia, Greece Topic: Other Heart Disease (Rehabilitation & Implementation) Purpose : Cardio-respiratory testing is an important prognostic tool. While the incremental shuttle walking test (ISWT) is the most commonly used cardio-respiratory test in UK cardiac rehabilitation, few data are available regarding factors associated with changes in test performance. This study aims to determine predictors of changes in ISWT performance during outpatient cardiac rehabilitation (CR) and to provide reference values for fitness improvements during CR. Methods: A retrospective analysis of 525 patients (63.3 ± 11.3 years) who completed the ISWT pre- and post-cardiac rehabilitation at four UK hospitals were included. The primary outcome measures were ISWT distance (m) and speed (mcs-1). Differences in pre- and post-rehabilitation values were evaluated with a paired samples t-test. Correlation and stepwise linear regression analyses were used to identify factors associated with change in ISWT performance. The population was divided into two groups, a development group and a validation group. A Pearson s product moment coefficient and the intraclass correlation coefficient (ICC) were also used to assess the validation of the equation model developed by the development group. Results: Fitness improved significantly following the CR programs, with a mean increase of 122.8 ± 99.0 m in distance walked, equivalent to an increase in maximal walking speed (0.22±0.18 mcs-1). Age was a negative independent predictor (B-coefficient = -1.776, P < 0.001) while stature was positively associated (B-coefficient = 1.457, P < 0.001) with the change in distance walked. Weight was the only predictor of change in maximal ISWT speed (B-coefficient = -0.002, P < 0.001). The validation of the equation showed a moderate correlation between actual improvement of distance (Pearson s r = 0.36, P < 0.001) and the predicted distance improvement. A high correlation existed between the predicted and the actual improvement in ISWT speed (Pearson s r = 0.82, P < 0.001). The ICC between the predicted and actual ISWT distance and speed were 0.29 (P < 0.001) and 0.81 (P < 0.001), respectively. Conclusions: These prognostic standard results benefit CR services that use ISWT by helping them to stratify patients at the program s beginning, apply an appropriate exercise prescription and determine when to discharge patients from the CR program. Considering the reference value results when assessing a patient s fitness using ISWT might help in designing a tailored program based on these factors with realistic goals that could be achieved by each patient. P528 Cardiovascular risk factors and return-to work after cerebrovascular disease M Cabrera Sierra1, C Catalina-Romero1, C Fernandez-Labandera1, 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 Virgen de la Victoria ., Málaga, Spain 4Department of Internal Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain Topic: Vascular disease (Rehabilitation & Implementation) BACKGROUND AND Purpose: To analyze the association between previous cardiovascular risk factors (CVRF) and return-to-work (RTW) after a cerebrovascular disease. Methods: A cohort of 485 patients who experienced an episode of sickness absence due to cerebrovascular disease was selected from the ICARIA study (Ibermutuamur CArdiovascular RIsk Assessment). The association between demographic, work-related, CVRF and RTW after a cerebrovascular disease was analyzed. Bivariate (chi-square) and multivariate (logistic regression) analyses were performed. Results: 71.1% of the subjects returned to work after cerebrovascular disease, 26.6% received a work disability pension and 2.3% died. The median of lost working years due to work disability or death was 12 years. After multivariate analysis, the following major CVRF remained associated with a higher likelihood of RTW after cerebrovascular disease: absence of hypertension before stroke (OR 2.49 95% CI 1.48 to 4.19); non-smoker status (OR 2.45 95% CI 1.52 to 3.95), and no previous diabetes (OR 1.96 95% CI 1.18 to 3.26), Table 1. Conclusions: The absence of several CVRF before cerebrovascular disease, predicts higher RTW rates after the event. As far as they are significantly related to functional outcome, control of hypertension, tobacco consumption and diabetes are important aims in multidisciplinary rehabilitation, secondary and tertiary prevention programs after cerebrovascular disease. Association of CVRF with CVD Variable n Crude OR (CI 95%) p-value n Adjusted OR * (CI 95%) p-value Hypertension 454 448 No 197 2.87 (1.82-4.50) <0.001 194 2.49 (1.48-4.19) 0.001 Yes 257 1 254 1 Tobacco consumption 464 458 No 192 2.32 (1.50-3.59) <0.001 191 2.45 (1.52-3.95) <0.001 Yes 272 1 267 1 Diabetes mellitus 458 455 No 367 2.38 (1.48-3.83) <0.001 364 1.96 (1.18-3.26) 0.009 Yes 91 1 91 1 Variable n Crude OR (CI 95%) p-value n Adjusted OR * (CI 95%) p-value Hypertension 454 448 No 197 2.87 (1.82-4.50) <0.001 194 2.49 (1.48-4.19) 0.001 Yes 257 1 254 1 Tobacco consumption 464 458 No 192 2.32 (1.50-3.59) <0.001 191 2.45 (1.52-3.95) <0.001 Yes 272 1 267 1 Diabetes mellitus 458 455 No 367 2.38 (1.48-3.83) <0.001 364 1.96 (1.18-3.26) 0.009 Yes 91 1 91 1 * Adjusted by sex, age, occupation, type of contract, level of income, relationship with working conditions and employment status at the end of sickness absence. Open in new tab Association of CVRF with CVD Variable n Crude OR (CI 95%) p-value n Adjusted OR * (CI 95%) p-value Hypertension 454 448 No 197 2.87 (1.82-4.50) <0.001 194 2.49 (1.48-4.19) 0.001 Yes 257 1 254 1 Tobacco consumption 464 458 No 192 2.32 (1.50-3.59) <0.001 191 2.45 (1.52-3.95) <0.001 Yes 272 1 267 1 Diabetes mellitus 458 455 No 367 2.38 (1.48-3.83) <0.001 364 1.96 (1.18-3.26) 0.009 Yes 91 1 91 1 Variable n Crude OR (CI 95%) p-value n Adjusted OR * (CI 95%) p-value Hypertension 454 448 No 197 2.87 (1.82-4.50) <0.001 194 2.49 (1.48-4.19) 0.001 Yes 257 1 254 1 Tobacco consumption 464 458 No 192 2.32 (1.50-3.59) <0.001 191 2.45 (1.52-3.95) <0.001 Yes 272 1 267 1 Diabetes mellitus 458 455 No 367 2.38 (1.48-3.83) <0.001 364 1.96 (1.18-3.26) 0.009 Yes 91 1 91 1 * Adjusted by sex, age, occupation, type of contract, level of income, relationship with working conditions and employment status at the end of sickness absence. Open in new tab P529 Effects of transcutaneous electrical nerve stimulation on walking distance in patients with peripheral artery disease M Labrunee1, T Guiraud1, JM Senard1, A Pathak1 1Inserm U858, I2MR, Team 8, Toulouse, France Topic: Vascular disease (Rehabilitation & Implementation) Introduction: Exercise programs are a core component of rehabilitation in peripheral artery disease (PAD) patients. To date, there is no consensus about the optimal method for training in PAD, as pain remains the main barrier to exercise training. The aim of this study was to verify the favourable effects of Transcutaneous Electrical NeuroStimulation (TENS) on the improvement of training efficiency and patient comfort. Method: After a baseline assessment of the walking velocity leading to pain onset after 300m, fifteen PAD subjects underwent in a random order four exercise sessions consisting of 5 walking bouts until pain on a treadmill, interspersed by 10 min of recovery. These 4 sessions were preceded by a 45-minute TENS session with different modalities: 80Hz, 10Hz, SHAM TENS (presence of electrodes without stimulation) or control (no electrodes). Patients had no feed-back concerning the walking distance achieved. Results: Total walking distance for the 5 bouts was significantly different between T10, T80, SHAM and CON (p<0.0003): 2944 ± 1323, 2628 ± 1290, 2299 ± 1101 and 1390 ± 335 meters, respectively. No difference was observed between T10 and T80 but T10 was different from SHAM and CON. SHAM, T10 and T80 were all different from CON (p<0.001). No difference was observed in heart rate and blood pressure between each condition. Conclusions: TENS seems to be an innovative tool to improve walking distance in class II PAD patient, with superior efficacy of TENS 10 Hz. This non-pharmacological strategy deserves further investigations in those patients. Open in new tabDownload slide Sum of the walking distance P531 Effect of myocardial ischemia on heart rate response during incremental exercise S Yoshida1, H Adachi1, J Tomono1, S Oshima1 1Gunma Prefectural Cardiovascular Center, Division of Cardiology, Maebashi, Japan Topic: Vascular disease (Rehabilitation & Implementation) Purpose: It is well known that myocardial ischemia deteriorates cardiac pump function, resulting in the insufficient oxygen supply to the peripheral tissues and mismatched energy production to the exercise. To relieve the insufficient oxygen supply, there are several compensation mechanisms. Increase of heart rate response is one of them since cardiac output is a product of heart rate and stroke volume. However, little is reported about the heart rate response to the myocardial ischemia yet. The aim of this study was to clarify the effect of myocardial ischemia on heart rate response during exercise. Methods: Consecutive 41 subjects who performed cardiopulmonary exercise testing (CPX) to detect myocardial ischemia were enrolled. Protocol of CPX was as follows: 10 watt/min ramp exercise, using a cycle-ergometer and until exhaustion or significant expression of myocardial ischemia. According to the existence of myocardial ischemia, subjects were assigned into two groups. Those who showed ST depression with significant (>75%) coronary arterial stenosis was into Group A, and who did not show ST depression was into Group B. HR response to the exercise was evaluated during two periods; early phase and latter phase. Early phase was defined as the period of the initial 1 to 3 minutes of the incremental exercise. Latter phase was defined as the following two minutes after the onset of ST depression in Group A, or the last two minutes of incremental exercise in Group B. HR response was evaluated using a parameter of HR increase per every watt (HR/watt), and VO2/HR/watt was considered as an index of stroke volume response to the exercise. Results: No significant differences were observed in age, sex and BMI between Group A and B. Ejection fraction in Group A and B were 59.0±13.4 and 71.3±7.2%, respectively (p<0.01). Group A was higher in the prevalence of hypertension, diabetes mellitus and dyslipidemia than Group B. Administration rate of beta-blocking agent was greater in Group A than Group B (53.6 vs. 0%, respectively, p<0.01). VO2/HR/watt showed no difference between early and late phase in Group B. On the other hand, in Group A, it was smaller (p<0.01) in latter phase (0.54±0.35 mL/beat/watt) than in early phase (0.90±0.41mL/beat/watt). HR/watt became greater at the latter phase than at the early phase in Group A (0.88±0.22 vs. 0.64±0.22, p<0.01), even though some of the subjects were taking beta-blocking agent. While it stayed constant in Group B. Conclusions: Heart rate response was revealed to exaggerate during myocardial ischemia concomitant with impaired cardiac pump function. P532 Origins and development of cardiovascular prevention and rehabilitation in Spain. MA Ruescas-Nicolau1, M Guardiola-Sabater2, PC Aguirre-Marco3 1University of Valencia, Department of Physiotherapy, Valencia, Spain 2University Hospital La Fe, Valencia, Spain 3Institute of the History of Medicine "López Piñero" (UV-CSIC), valencia, Spain Topic: Health economics (Rehabilitation & Implementation) Purpose: In Spain, only between 2 and 4% of coronary heart disease patients have access to Cardiovascular Prevention and Rehabilitation (CVPR) programmes. In addition, such interventions are scarcely implemented in the health care system. To find an explanation for these facts, blibiometric methods could be used to follow scientific ideas during time, thus evidencing how medical practice has specialized on this therapy. Therefore, our aim is to study the scientific production published in the most representative Spanish journals of Cardiology and of Rehabilitation Medicine, from 1922 to 2007. Methods: A bibliometric study of 995 publications was carried out. Based in previous specialized research, the five principal Spanish journals of Cardiology and of Rehabilitation Medicine were our data source. All types of citable documents about conservative management of coronary heart diseases were compiled by hand, directly consulting these journals in paper or digital formats. The most useful, simple and applicable bibliometric indexes were calculated. The scientific production was analysed by chronological order, by authors and institutions (productivity, collaboration, identification and analysis of coauthorship networks), and by subjects. Results: Publications were principally gathered from Cardiology journals (89.4%), during an interrupted period of 64 years, from 1923 to 2007. They were mainly published in the last 25 years. The prevalent type of document (58%) was the original production (articles and congress abstracts). Only 646 publications identified their authorship, which belonged to 1563 researchers, with a mean collaboration index of 3.8. Cardiologists showed the highest level of productivity (> 25 publications). Two of them were the ones who had worked on CVPR the most and had leaded the more specialized coauthorship networks. Among institutions, Spanish centers predominated (134 institutions). National publications were originated in Madrid (33.1%), followed by Catalonia (19%) and Valencia (12.9%). As international production is concerned, European institutions participated the most (Italy, 27%, and France, 24.3%). Quantitatively, the core subjects were "pharmacotherapy", "secondary prevention" and "rehabilitation therapy". All of them determined different specialization levels of authors and institutions. Conclusions: According to our results, the principal development of the CVPR in Spain happened from 1982 to 2007, thanks to the contribution of cardiologists. They focused on the management of these diseases by means of either pharmacotherapy, or secondary prevention and rehabilitation. P533 Prognostic value of submaximal measures of exercise capacity in patients with coronary artery disease: a preliminary analysis E Coeckelberghs1, R Buys1, D Schepers1, VA Cornelissen1, L Vanhees1 1Catholic University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium Topic: Exercise/Exercise training (Rehabilitation & Implementation) Background: Maximal exercise capacity is established as an independent predictor for mortality in patients with coronary artery disease (CAD). However, sometimes exercise tests are stopped prematurely due to medical and motivational reasons and for these cases submaximal exercise measures have been introduced in order to interpret the exercise capacity. So far, it remains unclear whether these submaximal measures can predict mortality. Therefore the aim of this study was to assess the prognostic value of several submaximal exercise variables for cardiovascular mortality in patients with CAD. Methods: In this preliminary analysis, we report data on 618 patients with CAD (age 60.2 ±9.9 years; 531 male, 87 female), who underwent cardiopulmonary exercise testing at the occasion of enrollment in the ambulatory cardiac rehabilitation program between 2000 and 2007. Oxygen uptake at the ventilatory anaerobic threshold (VAT) was determined by the V-slope method and expressed by ml/kg/min. Oxygen uptake efficiency slope (OUES), oxygen uptake versus work rate slope (VO2/WR-slope) and ventilatory efficiency slope (VE/VCO2-slope) were calculated by robust regression analysis and corrected for body weight. Follow-up information on mortality was obtained by checking the patients medical files or by contacting the patients general practitioners. Cox proportional-hazards multiple regression analysis were used to assess the relation between submaximal exercise variables and cardiovascular mortality. Results: During a follow-up of 8.9 ± 2.7 years (range 0.25 to 13.4 years), 44 patients died for cardiovascular reasons. At single Cox analysis, OUES (hazard ratio: 0.911, p=0.0002) and VAT (hazard ratio: 0.848, p=0.003) were significantly related to cardiovascular mortality among submaximal exercise parameters. On multiple Cox regression analysis, only OUES (hazard ratio: 0.923, p=0.003) remained significantly related with cardiovascular mortality, along with age (hazard ratio: 1.051, p=0.006). Conclusions: The OUES is an independent predictor for cardiovascular mortality in patients with CAD. P534 Gender differences in cardiac rehabilitation patient characteristics and treatment results across Europe W Benzer1, B Rauch2, J-P Schmid3, A-D Zwisler4, P Dendale5, A Abreu6, C Davos7, A Simon8, D Gaita9, H Mc Gee10 1Academic Hospital, Department of Interventional Cardiology, Feldkirch, Austria 2Center for Outpatient Rehabilitation at the University Hospital, Ludwigshafen, Germany 3Bern University Hospital, Cardiovascular Prevention and Rehabilitation, Bern, Switzerland 4Heart Center, Copenhagen University Hospital, Copenhagen, Denmark 5Hasselt University, Heart Centre, Hasselt, Belgium 6Cardiology Department, Hospital Santa Marta, Lisboa, Portugal 7Biomedical Research Foundation, Academy of Athens, Athens, Greece 8State Hospital for Cardiology, Balatonfüred, Hungary 9University of Medicine & Pharmacy Victor Babes, Clinic of Cardiology, Timisoara, Romania 10Royal College of Surgeons in Ireland, Dublin, Ireland Topic: Exercise/Exercise training (Rehabilitation & Implementation) Objectives: Cardiac rehabilitation (CR) is widely recognized as an essential part of treatment after a cardiac event. Less admission rate of women to CR has been demonstrated in European countries. The purpose of this study was to analyse if women experience similar treatment results than men after participating in a CR program in Europe. Methods: European Cardiac Rehabilitation Database (EuroCaReD) was introduced to get information in patient characteristics and outcomes in CR across Europe. From this database patients characteristics and CR outcome data of 2.095 patients from 13 European countries (505 female= 24% and 1.590 male= 76%) were derived between 2010 and 2012. Results: At the start of the CR program no difference in age could be observed between women and men (54.0 (51.0-57.0) and 54.5 (45.5-58.5) years). Less women than men were married (71.5% vs. 82.3%; p<0.0001) but more women than men were widowed (13.4% vs. 4.9%; p<0.0001). More women than men were retired (54.6% vs. 45.5%; p<0.001). Significant differences could be observed in history of risk factors between women and men. Fewer women than men reported a history of cigarette smoking (25.4% vs. 45.9%; p<0.0001) and more women than men had history of depression (17.3% vs. 4.4%; p<0.0001). Less women than men were regularly physical active (2.6% vs. 4.1%; p<0.001). In current risk factors at program start no difference between women and men could be observed. During CR program similar number of recurrent events occurred in women and men (9.6% and 9.0%; p=0.77). Similar number of women and men completed the CR program as prescribed (86.0% and 84.6%; p=0.59). At the end of the CR program women experienced the same improvement of current risk factors than men (BMI (kg/m2) -0.2±3.0 and -0.2±1.9; p=0.09, blood pressure sys (mm/Hg) -5.4±18.1 and -3.8±17.6; p=0.49; LDL-C (mg/dl) -16.4±36.2 and -16.1±32.5; p=0.38, triglycerides (mg/dl) -12.4±68.0 and -14.6 ± 76.5; p=0.19, fasting glucose (mg/dl) -5.1±25.4 and -7.4±23.3; p=0.11). Women could improve their physical exercise capacity measured in watts achieved to the same amount than men (+21.7±18.3 and +25.1±22.8; p=0.17). Conclusions: In European countries women benefit equally well from a CR program than men. Therefore because of the less admission rate of women to CR compared with men after a cardiac event particularly women should be encouraged to participate in a CR program. P535 Reproducibility of kinetics of skeletal muscle deoxygenation during onset of submaximal exercise in patients with chronic heart failure G Buskermolen1, V M Niemeijer2, R F Spee2, P F F Wijn3, H M C Kemps2 1Eindhoven University of Technology, Eindhoven, Netherlands 2Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands 3Maxima Medical Centre, Department of Medical Physics, Veldhoven, Netherlands Topic: Exercise/Exercise training (Rehabilitation & Implementation) Purpose: The rate of decrease in oxygen saturation in skeletal muscle during onset of submaximal exercise has been shown to reflect the temporal adaptation of muscle oxygen delivery to oxygen utilization in patients with chronic heart failure (CHF). The tissue saturation index (TSI) is novel absolute measure of skeletal muscle oxygenation derived from spatially resolved spectroscopy (SRS) Near Infrared Spectroscopy (NIRS) that is impervious to blood volume changes and therefore potentially applicable during exercise testing. The purpose of the present study was to investigate the reproducibility of TSI onset kinetics in CHF patients during moderate constant load exercise. Methods: 29 stable CHF patients (NYHA II-III) were included. All subjects performed two consecutive submaximal constant load exercise test at 80% of the ventilatory threshold on two separate days. In order to assess changes in the skeletal muscle TSI, NIRS was applied at the vastus lateralis muscle. TSI kinetics were assessed by the mean response time (MRT-TSI), which is expressed as the sum of the time constant of the mono-exponential TSI-decrease (tau-TSI) and the initial time delay (TD-TSI). Reproducibility of MRT-TSI was assessed by determining the coefficient of variation (CV) and limits of agreement (LA) between the first measurement of the first day and the first measurement of the second day. Results: There was no significant difference between MRT- TSI for the first day and the second day (24 ± 6 versus 23 ± 6 sec, p<0.05). The coefficient of variation for MRT-TSI was 27.1 %. The limits of agreement for MRT-TSI and tau-TSI were -11.3 and 13.2 sec. Conclusions: The results of the present study show that MRT-TSI has acceptable reproducibility as an index of the ratio of skeletal muscle oxygen delivery and utilization during cycling exercise. Therefore, NIRS seems a clinical applicable tool to assess the contributions of deficits in oxygen transport and skeletal muscle impairments to exercise intolerance in CHF patients. P536 Are ventilatory treshold and 6-minute walk test heart rates interchangeable ? MD Morard1, L Bosquet2, D Besson3, G Deley4, JM Casillas5, V Gremeaux6 1, Pôle Rééducation-Réadaptation CHU Dijon, Dijon, France 2aboratoire MOVE (EA6314), Faculté des Sciences du Sport, Université Poitiers, 8 rue Jean Monnet, Poitiers, France 3CIC-P Inserm 803, plateforme d investigation technologique, CHU de Dijon, Dijon, France 4Centre d'expertise de la Performance, Faculté des Sciences du Sport, Université Bourgogne, Dijon, France 5CHU de Dijon, Pôle Rééducation-Réadaptation, Université Bourgogne, Inserm U1093, Dijon, France 6Montreal Heart Institute Cardiovascular and Prevention Centre (Centre ?IC), Montreal, Quebec, Canad, Montreal, Canada Topic: Exercise/Exercise training (Rehabilitation & Implementation) Introduction: Heart rate (HR) at the ventilatory threshold (VT) remains a benchmark often used in the prescription of exercise intensity in cardiac rehabilitation. Some studies have reported no significant difference between the mean HR at VT and HR measured at the end of the a 6 minutes walk test (6MWT). The aim of this work was to assess the potential equivalence between those parameters with a more appropriate statistical approach. Method: 3 groups of subjects performed a stress test and a 6MWT: 22 healthy elderly subjects (GES, 7 ±3.7 years), 10 patients in cardiac rehabilitation after a myocardial infarction (GMI, 53.9±4.2 years) and 30 patients with chronic heart failure (GHF, 63,3±10 years). We analyzed the correlation, bias, 95% confidence interval (95% CI) of the bias and the magnitude of the bias between the HR at the end of 6MWT and HR at the ventilatory threshold. Results: There was no significant difference in the mean HR of 6MWD and at VT in the 3 groups, but the 95% CI was wide (30% for the GES, 15% for GMI, 40% for the GHF). The correlation was moderate for GMI (r = 0.78), and low for GES and GHF (r = 0.48 and 0.55, respectively). Conclusions: The HR of 6MWT and HR at VT do not appear interchangeable at the individual level in these groups of subjects. To this date, when trainining prescription aims to target HR at VT, it remains necessary to perform a stress test, or to develop other walk tests after with an exhaustive study of their cardiometabolic requirements. P537 Physical exercise and compliance with nonpharmacologic treatment of patients with coronary artery disease undergoing coronary artery bypass grafting S Pomeshkina1, EB Loktionova1, NV Arkhipova1, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS, Kemerovo, Russian Federation Topic: Exercise/Exercise training (Rehabilitation & Implementation) Objectives: To evaluate the effect of physical exercises on the postoperative dynamics of compliance with nonpharmacologic treatment of patients undergoing coronary artery bypass grafting (CABG). Material and Methods: 64 males (the mean age 54.7 ± 4.6 yrs) with coronary artery disease (CAD), who have undergone CABG, were enrolled in the study. The state of patients was assessed on day 5-7 days before CABG and 1 year after. Patients were randomized into 2 groups sharing similar demographic data, clinical and functional characteristics. The comparison group (n = 35) underwent common medical rehabilitation program: basic drug, lifestyle modifications; the studied group (n = 29) underwent common medical rehabilitation program with long-term cycling training (CT, 3 month program). Body mass index (BMI), waist circumference, clinical and functional parameters were measured at each stage of the study. Instrumental method was used to determine lipid profile. Specifically designed questionnaires were filled out by the patients and reflected the social and demographic data, risk factors for CAD. Lipid profile assessment reported that patients with CT and without it have shown a significant decrease in total cholesterol (5.6 ± 1.4 to 4.2 ± 1.1 mmol/l, p = 0.001 vs. 5.5 ± 1.4 to 4.7 ± 1.2 mmol/l, p = 0.002, respectively); however, a significant increase in high-density lipoproteins has been found in patients with CT (0.96 ± 0.21 to 1.33 ± 0.34 mmol/l, p = 0.013). 1 year after CABG the number of patients, who have achieved compensation of arterial hypertension (AH), has increased by 21% in the group with CT (58 to 79%, p = 0.03). There was no significant dynamics in the group without CT (55 to 64%). The dynamics assessment of modifiable CVD risk factors stated that the number of smokers has significantly decreased in the group with CT (45 to 28%, p = 0.02). Only 3 (9%) patients have given up smoking after surgery in the group without CT (p = 0.21). Mean BMI has significantly reduced in patients with CT within 1 year after CABG (28.1 ± 2.8 to 26.9 ± 2.0, p = 0.04); in the group without CT it tended to increase (27.5 ± 2.5 to 28.8 ± 3.0, p = 0.07). Mean waist circumference hasn t significantly changed in the group with CT after CABG, whereas it has significantly increased in the group without CT (p = 0.04). Conclusions: The long-term CT as a part of the complex rehabilitation ensures the compliance with nonpharmacologic treatment of patients after CABG, helping to reduce smoking, to optimize waist circumference size, BMI, to normalize lipid profile, to achieve AH compensation. P538 Physical exercise for late life Major Depression: the SEEDS study G Toni1, M Belvederi Murri2, S Zanetidou3, M Menchetti4, G Ermini5, F Tripi6, A Piras7, C Mussi8, M Piepoli9, M Amore2 1San Sebastiano Hospital, Correggio, Italy 2University of Genova, Department of Neurosciences, Ophthalmology and Genetics, Genova, Italy 3AUSL Bologna, Department of Mental Health, Bologna, Italy 4University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy 5Primary Care Physician, Bologna, Italy 6AUSL Modena, Department of Public Health, Unit of Sports Medicine, Modena, Italy 7University of Bologna, Department of Biomedical and Neuromotor Sciences, Bologna, Italy 8University of Modena and Reggio Emilia, Dep. of Endocrinology, Metabolism and Geriatric Medicine, Modena, Italy 9G. Da Saliceto Hospital, Heart Failure Unit, Piacenza, Italy Topic: Exercise/Exercise training (Rehabilitation & Implementation) Purpose: Major Depression (MD) among the elderly causes sufferance and disability, is associated to increased cardiovascular risk and is often resistant to treatments. Physical exercise could be a valid therapeutical agent for late life MD, but few studies investigated this issue. The study Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) is a multicentric trial comparing one protocol of training aerobic physical activity (PA), one socializing physical activity (SA) - both associated to antidepressant drug therapy (sertraline) - versus antidepressant drug therapy alone (AD). Methods: Patients suffering from MD aged 65-85 were recruited from Primary Care and randomized to three treatment arms for 6 months. The efficacy of the treatments was evaluated by psychiatrists, geriatricians and cardiologists (maximum oxygen intake, VO2max, heart rate variability). Primary outcome was the remission from depressive symptomatology (Hamilton Depression Rating Scale, HDRS score=10) at 12 and 24 weeks. Results: In the four study centers 121 patients were randomized to the three interventions (females, 69.8%; age 74.9 ±6.1). The PA and SA interventions showed good tolerability, with rare adverse effects and less than 10% dropouts. In the PA and SA interventions significant improvements of VO2max were observed compared with baseline values, while they were not in the AD arm. The rates of remission from MD at 24 weeks were 78% for PA, 73% for SA and 50% for AD (p<0.05). There were significant correlations between improvements in Vo2max and improvements in HDRS scores (r= 0.25; p=0.03). Conclusions: Preliminary results show that treatments integrating physical activity and antidepressant drug are feasible and more efficacious for MD among the elderly compared to the antidepressant drug therapy alone. Further, the integrated treatments were associated with improvements of physical fitness even among older patients with MD. These data suggest a role for physical activity in the treatment of older patients with MD. P539 The Impact of structured exercise on heart rate recovery in patients with ischemic heart disease MR Fernandez Olmo1, S Isaza-Arana1, J Torres-Llergo2, J Vallejo-Carmona1, A Lopez-Lozano1, JA Exposito-Tirado1, A Martinez-Martinez1 1University Hospital of Virgen del Rocio, Seville, Spain 2Hospital of Jaen, Jaen, Spain Topic: Exercise/Exercise training (Rehabilitation & Implementation) INTRODUCTION:Heart rate recovery has proven to be a predictor of morbidity and mortality in patients with ischemic heart disease. There are few studies linking physical training of a Cardiac Rehabilitation Program (CRP) with the improvement in the rate of heart rate recovery (HRRR: peak heart rate (HR) -HR recovery at 1st minute) Objectives: To evaluate if the CRP improves the HRRR and its influence on prognosis.MATERIAL AND Methods:We analyzed 163 consecutive patients included in the CRP in 2010 and defined two groups at the beginning and end of the CRP on the basis of HRRR (< 12 bpm abnormal and =12 bpm normal). Prognosis was assessed by clinical monitoring.RESULTS : The percentage of patients with HRRR < 12 bpm was lower at the end of the CRP (28,8 % vs 13,5 %, p < 0.001). Those who obtained a HRRR < 12 bpm after the program had higher peripheral arterial disease (16,1 vs 1,6%, p < 0.001), smoking (76 % vs 52,2 %, p = 0.02) and decreased ejection fraction (EF) (40 % vs 18,7 %, p= 0.018). In the multi variant analysis, predictors of HRRR <12 bpm at the end of the CRP were partial revascularization (HR 4,13, CI95% 1-15.7, p = 0.03) decreased EF (HR 4,6 CI95% 1.4 to 15.7, p= 0.014) and functional capacity < 8.4 METS at the end of the program (HR 15,1 CI95% 4.6 - 49.5, p < 0.0019). Average follow-up time was of 19.6 ± 4 months. The group that improved their HRRR (start-abnormal and end-normal) equaled on events to the group that showed a normal HRRR since the beginning (11.1% vs 17,1%, p = 0.3) and significantly reduced events compared to the group who continued with abnormal HRRR (11.1% vs 46.15 %, p= 0.07)CONCLUSION:HRRR improves after completion of the CRP, improving the prognosis of patients who manage to normalize their HRRR. Decreased EF, lower functional capacity at the end of the program and partial coronary revascularization (vs total) have an influence in presenting a poor HR recovery rate. P540 Heidelberg competence training as a mental training for lifestyle changes in cardiac rehabilitation (HECTALIS-Study) R M Nechwatal1, L Glatz1, A Dillenburg1, W Knoerzer2 1Rehaklinik Heidelberg Koenigstuhl, Heidelberg, Germany 2Paedagogische Hochschule Heidelberg, Heidelberg, Germany Topic: Exercise/Exercise training (Rehabilitation & Implementation) Introduction: Lifestyle changes during cardiac rehabilitation are difficult to achieve and positive effects are often not maintained during the course of time. For that purpose we introduced the Heidelberg Competence Training (HCT) as a mental training in cardiac rehabilitation to facilitate individual lifestyle changes. HCT has already been sucessfully introduced in athletes and students. Methods: 51 patients with coronary artery disease and/or metabolic syndrome were admitted to an in-hospital cardiac rehabilitation for three weeks. For changes in lifestyle they received in addition to exercise training and dietic counseling HCT. Target lifestyle changes were daily exercise measured by pedometers and weight loss as well as amelioration of diabetic control and blood lipids. Body weight, BMI, calculation of daily activity, HbA1c, Cholesterol, LDL and 6-minute walk tests were performed at the beginning and the end of the rehabilitation and after 3 months. Results: Of 51 patients, there were 43 men and 8 women. Mean EF was 58,3+- 9,1%. table Conclusions: HCT as a mental training seems to be a promising tool in order to achieve lasting risk factor modifications by lifestyle changes in cardiac rehabiliation. Follow-up over 1 year will demonstrate longterm effects. results admission: 0 end: 1 3 months: 3 6 minutes walk test 516,5+-67,9 587,6+-72 § 603,8+-71,2 § BMI > 27 (n=40) 32,4 31,3 § 30,1 § prediabetic Hba1c (n=18) 5,96+-0,26 5,8+-0,25 * diabetic HbA1c (n=13) 7,3+-0,67 6,7+-0,79 * pedometer /month 9401 10170 11142 Cholesterol 177 141 * 160 LDL 103 76,7 * 85,7 * admission: 0 end: 1 3 months: 3 6 minutes walk test 516,5+-67,9 587,6+-72 § 603,8+-71,2 § BMI > 27 (n=40) 32,4 31,3 § 30,1 § prediabetic Hba1c (n=18) 5,96+-0,26 5,8+-0,25 * diabetic HbA1c (n=13) 7,3+-0,67 6,7+-0,79 * pedometer /month 9401 10170 11142 Cholesterol 177 141 * 160 LDL 103 76,7 * 85,7 * prediabetic: HbA1c 5,7-6,4diabetic : HbA1c >=6,5* p<0,05; § p<0,001 Open in new tab results admission: 0 end: 1 3 months: 3 6 minutes walk test 516,5+-67,9 587,6+-72 § 603,8+-71,2 § BMI > 27 (n=40) 32,4 31,3 § 30,1 § prediabetic Hba1c (n=18) 5,96+-0,26 5,8+-0,25 * diabetic HbA1c (n=13) 7,3+-0,67 6,7+-0,79 * pedometer /month 9401 10170 11142 Cholesterol 177 141 * 160 LDL 103 76,7 * 85,7 * admission: 0 end: 1 3 months: 3 6 minutes walk test 516,5+-67,9 587,6+-72 § 603,8+-71,2 § BMI > 27 (n=40) 32,4 31,3 § 30,1 § prediabetic Hba1c (n=18) 5,96+-0,26 5,8+-0,25 * diabetic HbA1c (n=13) 7,3+-0,67 6,7+-0,79 * pedometer /month 9401 10170 11142 Cholesterol 177 141 * 160 LDL 103 76,7 * 85,7 * prediabetic: HbA1c 5,7-6,4diabetic : HbA1c >=6,5* p<0,05; § p<0,001 Open in new tab P541 The factors that influence improvements in physical activity in cardiac patients G Mckee1, M Mooney1, S O'donnell1, F O'brien1, DK Moser2 1Trinity College, Dublin, Ireland 2University of Kentucky, Lexington, United States of America Topic: Exercise/Exercise training (Rehabilitation & Implementation) Purpose: Physical activity has long been seen as a positive health attribute and inactivity is identified as a risk factor in coronary heart disease. Yet a large proportion of the cardiac population do not meet the general Guidelines on Physical Activity of at least 30 minutes a day of moderate activity 5 days a week. The aim of this study was to determine the factors that influence the physical activity of Acute Coronary Syndrome (ACS) patients 12 months post cardiac admission. Methods: Patients with ACS who were admitted to 1 of 5 hospital sites were recruited to the study. Patients were excluded from the study if they had not participated in their normal physical activity regime in the week prior to admission. Physical activity was assessed using the short form International Physical activity questionnaire (IPAQ) at baseline and 12 months post admission. Bivariate and multiple regression analysis was used to examine the influence of age, gender, marital status, insurance status, admission diagnosis, depression, anxiety, knowledge, attitudes and beliefs, baseline physical activity on change in physical activity in METs (metabolic equivalents). Results: A total of 383 ACS patients completed the IPAQ questionnaire. Their profile was: 21.4% female; BMI 27.89; current diagnosis: unstable angina 36%, STEMI 25%, NSTEMI 39%; and mean age was 62.83. At 12 months participation in physical activity had improved with 77% achieving the recommended physical activity level, those with the least activity at baseline improving most. While all the variables influenced physical activity in bivariate analysis, in multivariate analysis physical activity changes were significantly influenced only by baseline physical activity levels. The final regression model was significant (F (9, 216) = 3.947, p<0.001) explaining 11% of the variance in physical activity. Conclusions: At 12 months post cardiac admission a much smaller proportion of the at risk population do not participate in physical activity at the recommended levels. Improvements since admission were most influenced by past physical activity and not other factors. The fact that the least physical active improved most is strong support for the trends to include the aged, females and the low physically active in rehabilitation as there are benefits to be gained. P542 Walking tests: a possible assessment tool to predict maximal heart rate for coronary heart disease patients ? V Gremeaux1, JM Casillas1, C Joussain1, C Moreau2, A Hannequin2, A Rapin3, Y Laurent2, C Benaim2 1CHU de Dijon, Pôle Rééducation-Réadaptation, Université Bourgogne, Inserm U1093, Dijon, France 2, Pôle Rééducation-Réadaptation CHU Dijon, Dijon, France 3University Hospital of Reims - Hospital Robert Debre, Reims, France Topic: Exercise/Exercise training (Rehabilitation & Implementation) Introduction: Given the prevalence of coronary artery diseases (CAD), it would be useful to have an alternative to cardiopulmonary exercise test (CPET) to predict maximal heart rate (HRmax) and fix a target HR based on estimated HR reserve for exercise training during cardiac rehabilitation. Based on earlier works designed to predict VO2 max, we aimed to develop a new predictive model based on two walking tests at different speeds, combined with anthropometric parameters. Methods: 148 CAD patients (133 men) successively performed a 6-minute walk test, a 200m fast-walk test (200mFWT), and a CPET at the end of a cardiac rehabilitation program (CRP). An all-possible regression procedure was used to determine the best predictive regression models of HRmax. The best model was compared with the Fox equation in terms of predictive error of HRmax using the paired T test. Results: The results of the two walking tests correlated significantly with HRmax determined during the CPET, whereas anthropometric parameters and resting HR did not. The simplified predictive model with the most acceptable mean error was: HRmax = 130 - 0.6 x age + 0.3 x 200mFWT HR (R2= 0.24). This model was superior to the Fox formula (R2= 0.138). The relationship between target HR calculated from measured reserve HR and that established using the simplified predictive model was statistically significant (r = 0.528, p<10-6). Conclusions: This study showed that a safe simple fast walk test is useful to predict HRmax and target HR in stable CAD patients undergoing CRP. P544 The impact of work and intensity-matched aerobic interval vs continuous training on left ventricular morphology and function in healthy obese women A Khalil1, D Oxborough2, K Birch1 1University of Leeds, Leeds, United Kingdom 2Liverpool John Moores University, Liverpool, United Kingdom Topic: Obesity (Sports Cardiology) Introduction: Aerobic interval training has been shown to be more beneficial than continuous training in improving cardiac function. It is not clear whether this is mediated by the higher intensities used or the oscillatory nature of the exercise. Obesity is a well-established independent cardiac risk factor, inducing unfavourable changes in left ventricular (LV) structure and function. Aerobic exercise is known to restore LV function in obese subjects with subclinical LV dysfunction, however the quantity and quality of exercise is yet to be defined. Purpose: The aim of this study is to compare between the effects of work and intensity-matched aerobic interval and continuous training on LV morphology and function in healthy obese women. Methods: Twenty healthy obese women (BMI 32 ± 2.5 Kg/m2) aged 41 ± 6.2 years were randomly assigned to either an interval (INT) or continuous (CON) training group after being matched for age and BMI. Both groups trained twice a week for 12 weeks at high intensity (above lactate threshold). The INT training sessions consisted of repeated 40 second duty cycles at 70% work rate delta (WR-delta; the difference between maximal WR and WR at lactate threshold), separated by 80 second intervals of active recovery cycling at 20 W for a total duration gradually increased from 20 to 40 minutes. The CON training sessions consisted of continuous cycling at 20% WR delta and the duration of the session was adjusted so that the total volume of work is equivalent to the work each individual participant would achieve if they were to perform an INT training session. Standard two-dimensional (2D), tissue Doppler imaging (TDI) and 2D speckle-tracking (2DST) echocardiography was used to assess LV morphology and function before and after the training period. Results: After 12 weeks of training, both groups showed a significant improvement in early diastolic myocardial velocity (P=0.01), myocardial performance index (P=0.03), systolic longitudinal strain rate (P=0.04), peak circumferential strain (P=0.01) and late diastolic circumferential strain rate (P=0.02) with no significant difference between both groups. The was no significant change in LV morphology after training. Conclusions: Twelve weeks of aerobic training improve LV systolic and diastolic function in healthy obese women. After matching both types of exercise for intensity and work, interval training does not seem to have any superior benefit over continuous training on LV function. Finally, standard echocardiography is less sensitive than TDI and 2DST in detecting subtle changes in LV function in response to aerobic training. P545 Blood pressure response to exercise in moderate static sports N M Panhuyzen-Goedkoop1, JLRM Smeets1 1Radboud University Nijmegen Medical Centre, Heartlung Centre, Nijmegen, Netherlands Topic: Hypertension (Sports Cardiology) Purpose to evaluate BP response to exercise in moderate static sports (class II). Methods Study population: athletes 15-35 yr, participating in class II competitive sports during previous 6 month, exercising >8 hrs/wk, had prospectively pre-participation screening (PPS) including exercise testing. Methods: athletes were devided in low (class IIA) and high dynamic - moderate static sports (class IIC). All had bicycle exercise testing untill exertion. Heart rate (HR), BP, VO2 max and ECG at rest, each increment, and recovery were recorded. BP was measured manually (Riva-Rocci) at the left arm hanging aside. Results in class IIA 109 athletes and in IIC 185 were included. Gradual increase of systolic BP with increasing workload was seen in both groups, being less in class IIC (125 --> 190mm Hg) compared to class IIA (120 -->210 mm Hg). In class IIC a sytolic BP decrease (<20 mm Hg) prior to exertion was observed. In both groups diastolic BP response almost didnot fluctuate (class IIA 70--> 75 mm Hg, class IIC 70-->80 mm Hg). Conclusion BP response to exercise in moderate static sports demonstrates a gradual increase in systolic BP and almost no fluctuation in diastolic BP. There is different BP response in low (class IIA) and high dynamic - moderate static sports (class IIC). The gradual increase of systolic BP with increasing workload was higher in class IIA. In class IIC there was a slight systolic BP decrease prior to exertion. Further studies are necessary. P546 Are exercise induced premature ventricular beats related to a high risk of sports related cardiac events? N M Panhuyzen-Goedkoop1, JLRM Smeets1 1Radboud University Nijmegen Medical Centre, Heartlung Centre, Nijmegen, Netherlands Topic: Other risk factors (Sports Cardiology) Exercise induced premature ventricular beats (X-PVB) indicate increased risk of life-threatening cardiovascular events, which might be prevented by pre-participation screening Purpose to describe the outcome of X-PVB and associated possible risk for cardiac events in athletes and sports participants Methods in 2006-2009 sports physicians in SMCPapendal performed pre-participation cardiovascular screening including exercise-ECG. Inclusion in this observational study: referral for X-PVB requiring cardiovascular evaluation according to established recommendations. Based on these findings recommendations for sports participation were given Results sports physicians screened 5712 athletes and sports participants, and referred 66 (1,2%) with X-PVB, 59 male, age 20-71 (mean 49,3) years, 61 >35 years, 38 competitive athletes, predominantly endurance sports, 2-12 (mean 6) training hours/wk. X-PVB was due to coronary artery disease (5) or dilated cardiomyopathy (1), associated with hypertension (16), >2 major risk factors (8), other arrhythmia (atrial fibrillation 1, WPW 1), or AV-block (1). In 32 no cardiac cause. Recommendations for sports participation: no sport (0), low static-dynamic type of sports (1), moderate static-dynamic sports (16), symptom limited (7), no restrictions (42) Serious cardiovascular events during mean follow-up of 1.5 years: sudden cardiac death (SCD) (1, no post-mortem study), coronary revascularisation (1) Conclusion X-PVB in this study group of predominantly older male endurance athletes and sports participants was a predictor for SCD in 1, associated with hypertension (24,2%), major risk factors for cardiac disease (12,1%), and due to coronary artery disease (7,5%) or cardiomyopathy (1,5%). In 48% of cases there was no cardiac cause identified. In few cases restriction for sports participation was given. P547 High incidence of arteriosclerosis in assumed healthy, elderly men detected by cardiovascular screening before exercise training U Koepp1, G Eivindson1, S Berntsen2, G Paulsen3, FT Gjestvang1 1Sorlandet Hospital, Kristiansand, Norway 2Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway 3Norwegian School of Sport Sciences, Oslo, Norway Topic: Atherosclerosis/CAD (Sports Cardiology) Methods: The need of preparticipating cardiovascular screening in elderly athlethes has to be determined. In conduction with an investigation of the effect of antioxidants on muscle growth and strength induced by resistance exercise in elderly men not exercising on a regular base, we performed screening including medical history, physical examination, 12 leads-ECG, routine 2-D/doppler- echocardiography, carotid duplex imaging and bicycle exercise test. Participants were recruited through advertising in the local newspaper and were asked not to suffer from any cardiovascular symptoms or diseases at present. Results: 68 men at mean age of 68.2 (± 5.8) years were randomly selected to participate in the study. Baseline risk factors for CVD included hereditarily history of premature CHD in 25%, a mean BMI of 26, mean total cholesterol of 6.3mmol/l. mean HDL-cholesterol of 1.4 mmol/l, current and former smokers status in 9%/42%, treated hypertension in 25%, renal dysfunction in 2.9%, but no diabetes mellitus. Known cardiovascular disorders embraced[UK1] CAD in 2.9%, PAD in 2.9%, TIA/stroke in 2.9%, atrial fibrillation in 2.9% and aortic ascendens aneurysm in 2.9%. Distribution and proportion of different types of arteriosclerosis are given in table I. Conclusions: In a cohort of elderly, norwegian males without established overt cardiovascular symptoms or diseases screening revealed a high degree of different types of arteriosclerotic manifestations. Preparticipating cardiovascular screening in this populations can be useful and may prevent cardiovascular complications Distribution of artreriosclerosis Carotis plaque burden - none 16.1% Carotis plaque burden - mild 33.8% Carotis plaque burden - moderate 41.2% Carotis plaque burden - severe 8.8 % Carotis ACC IMT > 1 mm 45.6% Aortic ascendens aneurysm (>3.5 cm) 20.6% Aortic abdominalis aneurysm (>3.0 cm) 5.9% Pos. exercise test with CAD on invasive angiogram 10.3% Myocardial infarction on echocardiography 2.9% Carotis plaque burden - none 16.1% Carotis plaque burden - mild 33.8% Carotis plaque burden - moderate 41.2% Carotis plaque burden - severe 8.8 % Carotis ACC IMT > 1 mm 45.6% Aortic ascendens aneurysm (>3.5 cm) 20.6% Aortic abdominalis aneurysm (>3.0 cm) 5.9% Pos. exercise test with CAD on invasive angiogram 10.3% Myocardial infarction on echocardiography 2.9% Open in new tab Distribution of artreriosclerosis Carotis plaque burden - none 16.1% Carotis plaque burden - mild 33.8% Carotis plaque burden - moderate 41.2% Carotis plaque burden - severe 8.8 % Carotis ACC IMT > 1 mm 45.6% Aortic ascendens aneurysm (>3.5 cm) 20.6% Aortic abdominalis aneurysm (>3.0 cm) 5.9% Pos. exercise test with CAD on invasive angiogram 10.3% Myocardial infarction on echocardiography 2.9% Carotis plaque burden - none 16.1% Carotis plaque burden - mild 33.8% Carotis plaque burden - moderate 41.2% Carotis plaque burden - severe 8.8 % Carotis ACC IMT > 1 mm 45.6% Aortic ascendens aneurysm (>3.5 cm) 20.6% Aortic abdominalis aneurysm (>3.0 cm) 5.9% Pos. exercise test with CAD on invasive angiogram 10.3% Myocardial infarction on echocardiography 2.9% Open in new tab P548 Patterns of left ventricular diastolic function in Olympic athletes. S Caselli1, F Di Paolo1, B Di Giacinto1, C Pisicchio1, F Quattrini1, R Assorgi1, A Spataro1, NG Pandian2, A Pelliccia1 1Institute of Sport Medicine and Science, CONI, Rome, Italy 2Tufts Medical Center, Division of Cardiology and the CardioVascular Center, Boston, United States of America Topic: Other Heart Disease (Sports Cardiology) Background: The aim of the present study was to provide original data on diastolic function in Olympic athletes. Methods: 1146 elite athletes (61% male) engaged in skill, power, mixed and endurance disciplines and 154 controls (matched for age and gender), underwent echocardiographic, Doppler and Tissue Doppler (TDI) examination. Results: Athletes had similar E velocity but a significant decrease in A velocity compared to controls consequently the E/A ratio was significantly increased (table). All the athletes and controls had E/A ratio = 1.0. Isovolumic-relaxation (IVRT) and Deceleration Times (DT) were longer in athletes compared to controls. TDI e and a were lower in athletes than in controls but their ratio was not different between groups; E/e ratio was mildly higher in athletes. Subgroup analysis according to type of sport showed that endurance athletes had the lowest A and a velocities wave and the largest E/A ratio (table). Gender analysis revealed that males had significantly lower E and A velocities, e, e /a, and E/e ratio and higher IVRT and a wave (p<0.01) compared to females. Stepwise regression analysis showed that E/A ratio was mostly influenced by the heart rate (R2=0.11; p<0.001) while, e and IVRT were mostly influenced by left ventricular wall thickness (respectively R2=0.13 and 0.23; p<0.001). Conclusions: This study provides information on diastolic function in Olympic athletes that may be implemented in the routine assessment of athlete s heart, as referral normative values. Controls n= 154 Skill (S) n= 226 Power (P) n= 178 Mixed (M) n= 339 Endurance (E) n= 403 E wave (cm/s) 89 ± 15 88 ± 15 86 ± 14 87 ± 15 86 ± 15 A wave (cm/s) 56 ± 12* 49 ± 11 E 49 ± 10 E 47 ± 9 E 44 ± 10 E/A ratio 1.6 ± 0.4* 1.89 ± 0.54 1.83 ± 0.48 1.90 ± 0.46 2.02 ± 0.51 S,P,M IVRT (ms) 71 ± 16* 80 ± 11 80 ± 14 86 ± 14 P 84 ± 12 DT (ms) 181 ± 37* 199 ± 41 198 ± 33 211 ± 40 S 204 ± 49 e' wave (cm/s) 16.1 ± 3.7* 14.0 ± 2.0 13.9 ± 2.3 13.9 ± 2.2 13.6 ± 2.2 a' wave (cm/s) 8.6 ± 2.1* 7.6 ± 2.2 E 7.5 ± 1.6 E 7.2 ± 1.7 6.9 ± 1.6 e'/a' ratio 2.0 ± 0.7 1.99 ± 0.67 1.94 ± 0.53 2.06 ± 0.64 2.09 ± 0.60 E/e' 5.7 ± 1.3* 6.43 ± 1.25 6.33 ± 1.17 6.32 ± 1.23 6.40 ± 1.17 Controls n= 154 Skill (S) n= 226 Power (P) n= 178 Mixed (M) n= 339 Endurance (E) n= 403 E wave (cm/s) 89 ± 15 88 ± 15 86 ± 14 87 ± 15 86 ± 15 A wave (cm/s) 56 ± 12* 49 ± 11 E 49 ± 10 E 47 ± 9 E 44 ± 10 E/A ratio 1.6 ± 0.4* 1.89 ± 0.54 1.83 ± 0.48 1.90 ± 0.46 2.02 ± 0.51 S,P,M IVRT (ms) 71 ± 16* 80 ± 11 80 ± 14 86 ± 14 P 84 ± 12 DT (ms) 181 ± 37* 199 ± 41 198 ± 33 211 ± 40 S 204 ± 49 e' wave (cm/s) 16.1 ± 3.7* 14.0 ± 2.0 13.9 ± 2.3 13.9 ± 2.2 13.6 ± 2.2 a' wave (cm/s) 8.6 ± 2.1* 7.6 ± 2.2 E 7.5 ± 1.6 E 7.2 ± 1.7 6.9 ± 1.6 e'/a' ratio 2.0 ± 0.7 1.99 ± 0.67 1.94 ± 0.53 2.06 ± 0.64 2.09 ± 0.60 E/e' 5.7 ± 1.3* 6.43 ± 1.25 6.33 ± 1.17 6.32 ± 1.23 6.40 ± 1.17 * p<0.01 controls vs athletes group. The small superscript letters (S,P,M,E) identify the groups with significant differences among athletes. Open in new tab Controls n= 154 Skill (S) n= 226 Power (P) n= 178 Mixed (M) n= 339 Endurance (E) n= 403 E wave (cm/s) 89 ± 15 88 ± 15 86 ± 14 87 ± 15 86 ± 15 A wave (cm/s) 56 ± 12* 49 ± 11 E 49 ± 10 E 47 ± 9 E 44 ± 10 E/A ratio 1.6 ± 0.4* 1.89 ± 0.54 1.83 ± 0.48 1.90 ± 0.46 2.02 ± 0.51 S,P,M IVRT (ms) 71 ± 16* 80 ± 11 80 ± 14 86 ± 14 P 84 ± 12 DT (ms) 181 ± 37* 199 ± 41 198 ± 33 211 ± 40 S 204 ± 49 e' wave (cm/s) 16.1 ± 3.7* 14.0 ± 2.0 13.9 ± 2.3 13.9 ± 2.2 13.6 ± 2.2 a' wave (cm/s) 8.6 ± 2.1* 7.6 ± 2.2 E 7.5 ± 1.6 E 7.2 ± 1.7 6.9 ± 1.6 e'/a' ratio 2.0 ± 0.7 1.99 ± 0.67 1.94 ± 0.53 2.06 ± 0.64 2.09 ± 0.60 E/e' 5.7 ± 1.3* 6.43 ± 1.25 6.33 ± 1.17 6.32 ± 1.23 6.40 ± 1.17 Controls n= 154 Skill (S) n= 226 Power (P) n= 178 Mixed (M) n= 339 Endurance (E) n= 403 E wave (cm/s) 89 ± 15 88 ± 15 86 ± 14 87 ± 15 86 ± 15 A wave (cm/s) 56 ± 12* 49 ± 11 E 49 ± 10 E 47 ± 9 E 44 ± 10 E/A ratio 1.6 ± 0.4* 1.89 ± 0.54 1.83 ± 0.48 1.90 ± 0.46 2.02 ± 0.51 S,P,M IVRT (ms) 71 ± 16* 80 ± 11 80 ± 14 86 ± 14 P 84 ± 12 DT (ms) 181 ± 37* 199 ± 41 198 ± 33 211 ± 40 S 204 ± 49 e' wave (cm/s) 16.1 ± 3.7* 14.0 ± 2.0 13.9 ± 2.3 13.9 ± 2.2 13.6 ± 2.2 a' wave (cm/s) 8.6 ± 2.1* 7.6 ± 2.2 E 7.5 ± 1.6 E 7.2 ± 1.7 6.9 ± 1.6 e'/a' ratio 2.0 ± 0.7 1.99 ± 0.67 1.94 ± 0.53 2.06 ± 0.64 2.09 ± 0.60 E/e' 5.7 ± 1.3* 6.43 ± 1.25 6.33 ± 1.17 6.32 ± 1.23 6.40 ± 1.17 * p<0.01 controls vs athletes group. The small superscript letters (S,P,M,E) identify the groups with significant differences among athletes. Open in new tab P549 Prevalence and significance of anterior T wave inversion in females. A Malhotra1, H Dhutia1, S Ghati1, H Dores1, N Sheikh1, L Millar1, R Narain1, A Merghani1, M Papadakis1, S Sharma1 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom Topic: Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: Anterior T wave inversion (V1-V4) is the hallmark of arrhythmogenic right ventricular cardiomyopathy (ARVC). However, it is widely perceived that anterior T wave inversion is also common in female individuals. Previous studies in small cohorts of female athletes have demonstrated a highly variable prevalence of anterior T wave inversion of up to 14%. This study investigated the prevalence and significance of anterior T wave inversion in a large, unselected cohort of female athletic and non-athletic individuals who underwent cardiac screening. Methods: Between May 2007 and September 2013, 17,708 individuals (n=5,234; 29.6% females) aged 14-35 underwent cardiac screening with health questionnaire, 12-lead ECG and consultation with a cardiologist. Further evaluation was dictated by initial results. The ECGs of female subjects were analysed placing emphasis on the presence of anterior T wave inversion, defined as T wave inversion in =2 contiguous anterior leads. Results: T wave inversion was present in 322 (6.2%) females, the majority confined to the anterior leads; 73% anterior, 14% lateral, 13% inferior. Anterior T wave inversion was more prevalent in competitive athletes compared to non-athletes (7.02% vs 3.78%, p<0.001) and in black females compared to white females (14.62% vs 4.21%, p<0.001). Anterior T-wave inversions persisted in 5.29% of females >16 years of age. The majority of anterior T wave inversion (n=171; 73%) was confined to leads V1-V2, with only 1.2% of females exhibiting T wave inversion beyond V2, raising the suspicion of ARVC. Multivariate analysis identified black ethnicity as the sole, independent predictor for the presence of anterior T wave inversion (OR 3.1, 95% CI 1.2-8.4, p=0.03). Conclusions: In the largest unselected cohort of females to date, the overall prevalence of anterior T wave inversion was higher (4.5%) than those in previously reported studies. This was also the case for females of Caucasian ethnicity. Anterior T wave inversion persisted in a considerable proportion of females >16 years, excluding the 'juvenile' pattern. Although we did not identify ARVC in any females with anterior T wave inversion, given the low prevalence of T wave inversion beyond V2, particularly in Caucasian individuals (1.06%), such patterns not be considered a normal finding and should trigger further clinical evaluation. P550 Cardiac benefits of endurance training: 40 years old is not too late to start D Matelot1, F Schnell1, C Ridard2, G Kervio3, N Ville3, F Carre1 1Inserm U1099, Rennes, France 2University Hospital of Rennes - Hospital Pontchaillou, Rennes, France 3Inserm, CIC-IT 804, Rennes, France Topic: Exercise/ Exercise training (Sports Cardiology) Purpose: To evaluate if the age at which endurance training has been started alters cardiovascular parameters in healthy senior men (HSM). Methods: We compared 40 HSM (55-70 years old) without known cardiovascular risk factor: 10 have never practiced for more than 2 hours of training per week during their lives (NT), 30 trained >5 hours a week since >5 years in cycling or running and have started before 30 (T30, n=16) or after 40 years old (T40, n=14). Maximal exercise test, echocardiography at rest and during submaximal exercise, and heart rate (HR) variability analysis during 5 min supine were performed. Results: T30 and T40 have been training continuously during 40.8±5.0 and 18.2±6.1 years (p<0.001), since the age of 22.1±5.4 and 47.9±7.3 years old (p<0.001), respectively. Resting HR (58.1±10 bpm for T30, 60.6±6.9 bpm for T40, and 69.7±9.3 bpm for NT) only differed between NT and both trained groups (p<0.05). Maximal oxygen uptake was 46.6±6.9 ml/min/kg, 43.4±4.5 ml/min/kg (NS) and 32.9±4.3 ml/min/kg (p<0.001 vs. both trained groups) for T30, T40, and NT, respectively. Maximal HR did not differ beyond the three groups. Left ventricle (LV) and both atria were bigger in T30 and T40 than in NT (p<0.01). Furthermore, NT exhibited thicker walls than T30 and T40 (p<0.05). Thus, cardiac remodelling seems different between both trained groups and NT subjects. Concerning diastolic function, mitral flow showed diastolic dysfunction (E < A) in 44%, 50%, and 80% of subjects in T30, T40 and NT, respectively, even if E/e was normal in all groups (6.3±1.2, 6.8±1.8, and 9.0±5.7 in T30, T40, and NT, respectively). Thus, diastolic function seems better in T30 and T40 than in NT at rest. During exercise, no difference was noted between the three groups. No difference was observed for systolic function, neither LV ejection fraction nor LV global longitudinal strain differed beyond the groups, at rest or during exercise. HR variability analysis showed higher high frequency variability in T30 and T40 vs. NT (p<0.05). LF/HF ratios were 2.2±1.5, 2.2±1.0 (NS), and 4.1±3.1 (p<0.05 with T30) in T30, T40, and NT, respectively. Thus, sympathovagal balance seems different in both trained groups vs. NT. Conclusions: Regardless of the age at which it has been started, relatively intensive endurance training presents the same benefits on heart and its regulation by autonomic nervous system in healthy senior men. P551 Cardiovascular findings in assumpted healthy elderly men by screening before vigorous exercise training U Koepp1, GE Eivindson1, S Berntsen2, G Paulsen3, FTG Gjestvang1 1Sorlandet Hospital, Kristiansand, Norway 2Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway 3Norwegian School of Sport Sciences, Oslo, Norway Topic: Exercise/ Exercise training (Sports Cardiology) Methods: The need of preparticipating cardiovascular screening in elderly athlethes has to be determined. In conduction with an investigation of the effect of antioxidants on muscle growth and strength induced by resistance exercise in elderly men not exercising on a regular base, we performed screening including medical history, physical examination, 12 leads-ECG, echocardiography, carotid duplex imaging and (maximal) bicycle exercise test. Given the vigorous exercise program, exclusion criteria were any symptoms or findings indicating significant cardiovascular disease. Participants were recruited through advertising in the local newspaper and were asked not to conseal cardiovascular symptoms or diseases. Results: 68 men at mean age of 68 (+/- 5.8) years were randomly selected to participate in the study. All conducted the screening tests. Baseline risk factors and cardiovascular disorders (CVD) included a mean BMI of 26, total cholesterol of 6.3mmol/l. HDL-cholesterol of 1.4 mmol/l, current and former smokers status in 9%/42%, treated hypertension in 25%, CAD in 2.9%, PAD in 2.9%, TIA/stroke in 2.9%, atrial fibrillation in 2.9% and aortic ascendens aneurysm in 2.9%. Based on abnormal test results requiring further investigations or treatment, 18 of 68 attendees (26.5%) were excluded from the exercise study. The remaining participants fulfilled the exercise study without any cardiovascular complications. Conclusions: In a cohort of elderly, norwegian males without established overt cardiovascular symptoms or diseases, cardiovascular screening revealed disorders or abnormal tests findings not reconcilable with vigorous, resistance exercise training in 26.5% of attendees. Preparticipating cardiovascular screening in this populations can be useful and may prevent cardiovascular complications. Abnormal cardiovascular test findings Unknown myocardial infarction 2.9 % Abnormal exercise test (STT-depr.> 2mm) 13.2 % Uncontrolled hypertension (180/100 mmHg) 2.9 % Aorticascendensaneurysm(> 5cm) 4.4 % Hypertrophic cardiomyopathy 1.5 % Mitral regurgitationIV○ (-prolapse) 1.5 % Unknown myocardial infarction 2.9 % Abnormal exercise test (STT-depr.> 2mm) 13.2 % Uncontrolled hypertension (180/100 mmHg) 2.9 % Aorticascendensaneurysm(> 5cm) 4.4 % Hypertrophic cardiomyopathy 1.5 % Mitral regurgitationIV○ (-prolapse) 1.5 % Open in new tab Abnormal cardiovascular test findings Unknown myocardial infarction 2.9 % Abnormal exercise test (STT-depr.> 2mm) 13.2 % Uncontrolled hypertension (180/100 mmHg) 2.9 % Aorticascendensaneurysm(> 5cm) 4.4 % Hypertrophic cardiomyopathy 1.5 % Mitral regurgitationIV○ (-prolapse) 1.5 % Unknown myocardial infarction 2.9 % Abnormal exercise test (STT-depr.> 2mm) 13.2 % Uncontrolled hypertension (180/100 mmHg) 2.9 % Aorticascendensaneurysm(> 5cm) 4.4 % Hypertrophic cardiomyopathy 1.5 % Mitral regurgitationIV○ (-prolapse) 1.5 % Open in new tab P552 Palpitations are the most frequent symptom in a physically active population referred to a clinic in sports cardiology L V Kaiser-Nielsen1, S Glasius Tischer1, E Prescott1, H Kruuse Rasmusen1 1Bispebjerg Hospital of the Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark Topic: Exercise/ Exercise training (Sports Cardiology) Purpose: To evaluate the most prevalent symptoms in a physically active population referred for evaluation in the first Out-patient Sports Cardiology Clinic in Denmark, the subsequent diagnoses and long-term consequences in this population. Methods: Retrospective analysis of data from medical records on all patients referred for evaluation of primarily cardiac symptoms or ECG changes in 2008-2012. Demographic data including sport and amount of training, referral reason, symptoms, examination results, diagnosis, and recommended sports activity were obtained. Data on subsequent hospitalization and death was collected through a national database. Results: The study population consisted of 177 patients, 68% men, mean age 32 years (range 13-66). The majority of patients (87%) participated in sports with a highly static or dynamic component or both. In the population 80% exercised >4 hours/week and 24% =15 hours/week. The most frequent symptom in the population was palpitations (24%) followed by chest pain (22%), dyspnoea (13%), syncope (12%), dizziness (12%), reduced exercise capacity (9%) and other (8%). Cardiac conditions were diagnosed in 84 patients (figure). The majority was diagnosed with arrhythmias (42 patients) with atrial fibrillation seen in 14 patients. Only one patient was permanently recommended against competitive sports participation due to hypertrophic cardiomyopathy. No later hospitalization for other cardiac conditions and no deaths have occurred with an average follow-up of 40 months (range 11-72). Conclusions: In a physically active population referred for evaluation in a Sports Cardiology clinic palpitations were the most prevalent symptom and atrial fibrillation was the most frequent diagnosis. Only one patient was recommended against competitive sports participation. Open in new tabDownload slide Diagnoses overall and cardiac diagnoses P554 Addition of yoga therapy to standard lifestyle modification improve cardiovascular autonomic function and metabolic derangement in prehypertensive subjects: a randomized controlled study T Ramkumar1, S Senthil Kumar1, P Pravati1, P Gopal Krushna1, T Madanmohan2, Z Bobby1, D Ashok Kumar1 1Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India 2Mahathma Gandhi Medical College and Research Institute, Pondicherry, India Topic: Hypertension (Exercice & Translational Science) Purpose: Blood pressure (BP) in prehypertension category (systolic BP 120-139 mmHg and/or diastolic BP 80-89 mmHg) hold 3 times more risk for CVD than normal BP. Though pharmacological therapies standardized to reduce BP and experimented in prehypertensive subjects, it has negative side-effects, difficult dosage adherence and high cost. The alternative lifestyle intervention with positive side-effects, inexpensive and socio-culturally accepted to Indians (now by Westerns) is Yoga. Therefore, we planned (parallel active controlled randomized controlled study) to use standard lifestyle modification (LSM) and Yoga therapy on prehypertensive subjects to improve BP, cardiovascular autonomic function (CAF), insulin resistance (IR), oxidative stress and inflammation. Methods: Individuals with prehypertension without known CVD were recruited (age 20-60 year of both gender) during Aug 2010 to Feb 2013. Prehypertensive subject (n=184) were randomized (unblinded) to LSM or LSM+Yoga group using serially numbered, opaque sealed envelope. Subjects who completed 12 weeks of respective intervention (LSM (n=49) and LSM+Yoga (n=51)) were only considered for statistical analysis (intention-to-treat). Results: Before intervention, conventional cardiovascular risk factors were comparable between groups and markers of CAF, IR, oxidative stress and inflammation also did not differ between groups. Twelve week of LSM or LSM+Yoga intervention significantly improved all the above mentioned parameters. Additional benefit of yoga therapy as compared to standard LSM are presented in Table 1. Conclusions: Yoga therapy produced additional significant improvement in BP, CAF, IR, oxidative stress and inflammation, as compared to standard LSM. Further research on the preventive aspect of yoga therapy may warrant its use as an adjunct to standard LSM. Trial Registration: CTRI/2012/09/003017 Table 1 Systolic BP LF/HF ratio RMSSD CRP TNF-a TBARS TAC Mean difference 1.932 * 0.386* -4.646* 0.413* 4.419** 0.142* -0.171** Confidence interval 0.061 to 3.892 0.003 to 0.769 -9.214 to -0.079 0.027 to 0.798 1.244 to 7.595 0.002 to 0.283 -0.275 to -0.067 Systolic BP LF/HF ratio RMSSD CRP TNF-a TBARS TAC Mean difference 1.932 * 0.386* -4.646* 0.413* 4.419** 0.142* -0.171** Confidence interval 0.061 to 3.892 0.003 to 0.769 -9.214 to -0.079 0.027 to 0.798 1.244 to 7.595 0.002 to 0.283 -0.275 to -0.067 Mean difference is difference between groups. CRP, C-reactive protein; LF/HF, ratio between low and high frequency power; RMSSD, square root of the mean of the successive standard deviations in R to R interval ; TAC, total antioxidant capacity; TNF-a, tumor necrosis factor alpha and TBARS, thio barbituric acid reactive substance. *P < 0.05 and **P < 0.01. Open in new tab Table 1 Systolic BP LF/HF ratio RMSSD CRP TNF-a TBARS TAC Mean difference 1.932 * 0.386* -4.646* 0.413* 4.419** 0.142* -0.171** Confidence interval 0.061 to 3.892 0.003 to 0.769 -9.214 to -0.079 0.027 to 0.798 1.244 to 7.595 0.002 to 0.283 -0.275 to -0.067 Systolic BP LF/HF ratio RMSSD CRP TNF-a TBARS TAC Mean difference 1.932 * 0.386* -4.646* 0.413* 4.419** 0.142* -0.171** Confidence interval 0.061 to 3.892 0.003 to 0.769 -9.214 to -0.079 0.027 to 0.798 1.244 to 7.595 0.002 to 0.283 -0.275 to -0.067 Mean difference is difference between groups. CRP, C-reactive protein; LF/HF, ratio between low and high frequency power; RMSSD, square root of the mean of the successive standard deviations in R to R interval ; TAC, total antioxidant capacity; TNF-a, tumor necrosis factor alpha and TBARS, thio barbituric acid reactive substance. *P < 0.05 and **P < 0.01. Open in new tab P555 Cardiovascular fitness assessment in renal organ transplants G Galanti1, L Stefani1, G Mascherini1, M Gianassi1, E Minetti1, A Pacini1 1University of Florence, Florence, Italy Topic: Other risk factors (Exercice & Translational Science) PURPOSE Regular Physical exercise is a new method to reduce the metabolic syndrome in presence of solid transplantations. An Italian pilot study is going to assess the benefits of a supervised exercise training program, in renal solid organ recipients. Methods: By the informed consent, 6 renal transplant recipients patients, were submitted to supervised aerobic exercise program, whose intensity, duration and frequency were established after a cardiopulmonary exercise test. An echocardiographic exam, skin fold, bio impedance analysis, and test of strength for the lower limbs (leg press for the quadriceps and calf) and higher limb (arm curl, french press and lateral lift) were also performed. The exercises consisted in 30 minutes of aerobic training at the intensity of aerobic threshold and 2 sets of 20 repetitions at 35% of the maximum load for each resistance exercise. RESULTS. All the echocardiographic parameters are normal (LVDd mm 48.0±3.6; LVSd mm 30.0±5.4;CMI (m/m2) 116.8±21.7;EF%62.0±3.2;E peck cm/sec 85.2±15.2;DT cm/sec 212.7±58.0). These values will then be updated every six months to adapt the program that will end after one year of training. CONCLUSION: Cardiovascular fitness assessment after renal transplantation is an essential requirement to start with an aerobic and resistance exercise program. The physical exercise is a promising tool in this special category despite the eventual long term positive impact is not yet demonstrated. P556 Safety of the CO-rebreathing blood volume method in patients with coronary artery disease T Karlsen1, IM Leinan1, IL Aamot2, A Stoylen3 1Norwegian University og Science and Technology, Trondheim, Norway 2St. Olavs University Hospital, Department of Clinical Service, Trondheim, Norway 3St. Olavs Hospital, Department of Cardiology, Trondheim, Norway Topic: Atherosclerosis/CAD (Exercice & Translational Science) Purpose: To investigate the safety of the improved carbon monoxide (CO) re-breathing method for measuring total blood volume (BV) and hemoglobin mass (Hb-mass) in patients with stable coronary artery disease (CAD). The major concern with the method is that the increased in CO bound to hemoglobin (COHb%) will induce myocardial ischemia and arrhythmias. METHOD: 18 patients with stable CAD (16 men, 2 women) having participated in outpatient cardiac rehabilitation was recruited (Age 62±7 years, Body weight 82±11 kg, 23±6 months since diagnosis, myocardial infarct (n=12), hypertension (n=7), percutaneous coronary intervention (n =12), coronary artery bypass grafting (n=6). Before, during and up-to 2 hours after the test, EKG, blood pressure, arterial oxygen saturation, COHb%, and heart function was measured. 24 hours after the test patients met for blood sampling and COHb% and Troponin-T measured. Results: COHb% increased from 1.5±0.4% to 5.9±0.6% after the test, and COHb% decreased to 4.6±0.5% and 1.3±0.4%, 2 and 24hr after the test. Resting heart rate, stroke volume, cardiac output and ejection fraction was 63±11 beats/min, 93.9±16.5 ml/beats, 5.84 ± 1.00 L, 48.5 ± 5.7 % respectively before the test. During and 10 minutes after the test the parameters was not significantly different from baseline. 16 patients were in sinus rhythm during the 2-hour observation period, and 2 patients registered short periods with atrial fibrillation. Systolic and diastolic blood pressure was 143±16 mmHg and 86±7 mmHg before the test and gradually decreased during the two-hour observation period to 132±8 and 79±10mmHg (p £ 0.05). Troponin-T was normal (<10 ng/L) in 14 patients and slightly elevated in 3 patients (11, 12 and 14 ng/L) 24 hours after the test. Mean BV, Erythrocyte volume (EV) and Hb-mass was 5.97±0.79 L, 2.42±0.44 L and 825±164 grams respectively. Relative to body mass BV and Hb-mass was 73.7±10.9 ml×kg-1 and 10.1 ± 1.9 g×kg-1 respectively, and in correspondence with reference values for normal untrained subjects. CONCLUSION: The improved CO-rebreathing test for measuring total BV and HB-mass did not negatively affect resting cardiovascular function in this selection of stable CAD patients when COHb% increased to ~6%. This indicates that the method is safe to perform in stable CAD patients. P557 Myocardial infarction rapidly induces diaphragm muscle weakness N Mangner1, TS Bowen1, S Werner1, S Glaser1, A Schrepper2, T Doenst2, A Linke1, G Schuler1, V Adams1 1University of Leipzig, Heart Center, Leipzig, Germany 2Friedrich Schiller University Jena, Department of Cardiothoracic Surgery, Jena, Germany Topic: Heart Failure (Exercice & Translational Science) Chronic heart failure (CHF) induced by myocardial infarction (MI) results in diaphragm muscle weakness, with increased inflammation and oxidative stress directly implicated. It remains unknown, however, if diaphragm muscle function is impaired immediately post-MI and whether this is associated with increased markers of inflammation and oxidative stress. Methods: Ligation of the left coronary artery to induce MI (n=21; confirmed by echocardiography) or sham operation (n=22) was performed on 8 wk old C57BL/6 mice. Three days later, in vitro isometric force of diaphragm muscle fibre bundles was assessed. Results: Specific force was depressed (p<0.05) between frequencies of 80-300 Hz post-MI, as was maximal tetanic force (25±1 vs. 21±1 N/cm2). MI had no influence on local mRNA expression of TNF-a and IL-6, but both were increased (p<0.05) at the systemic level. Compared to sham, MI increased (p<0.05) mRNA expression and enzyme activity of xanthine oxidase (65% and 19%, respectively) and NADPH oxidase (140% and 44%, respectively) in the diaphragm, however antioxidant enzymes remained unchanged. Conclusions: Diaphragmatic contractile dysfunction is rapidly induced following MI, and this is associated with increased systemic inflammation and markers of local oxidant production. These findings suggest diaphragm muscle weakness is early-onset in CHF, potentially mediated by inflammation and oxidative stress. P558 Acute Effects of a Submaximal Endurance Training on Arterial Stiffness in Healthy Middle- and Long-Distance Runners J Mueller1, M Wilms1, R Oberhoffer1 1Institute of Preventive Pediatrics, Technische Universitä München, Munich, Germany Topic: Exercise/ Exercise training (Exercice & Translational Science) Objectives: Measures of arterial stiffness are surrogates for cardio-vascular health and predict cardiovascular events. Arterial stiffness is responsive to acute physiologic stressors like exercise. However, the acute effect of intensive exercise and recovery on arterial stiffness is unknown. Patients and Methods: thirty-seven healthy middle- and long-distance runners (33 male, mean age 26.5 ± 6.6 years, mean 10km personal best time 33:20 ± 2:55 min) underwent evaluation of their cardiovascular stiffness. Baseline levels were assessed after 10 minutes rest in sitting position using the oscillometric Mobil-O-Graph. A second measurement was performed directly after 15 minutes warm up and a third directly after vigorous running (3000m with individual 10km performance pace). Finally after 10 minutes cool down and another 15 minutes rest in sitting position a fourth measurement was conducted. Results: Peripheral and central blood pressure, as well as augmentation index (AI) and Pulse wave velocity (PWV) increased (p<.001, ANOVA) at peak exercise in comparison to baseline. 30 minutes after terminating exercise there was a drop in peripheral (p=.033) and central blood pressure (p=.048) below baseline. AI (p=.756) and PWV (p=.800) just returned to baseline values (Table 1). Conclusions: Arterial stiffness is increased during intensive exercise. However, in the recovery period there is an augmented decrease in peripheral and central blood pressure below baseline levels. Further research is needed focusing on gender differences and the dose response of volume and intensity of exercise on arterial stiffness. Measures of arterial stiffness Baseline Warm-up Directly After exercise Recovery p-value* Peripheral blood pressure (mmHG) 129 ± 12 137 ± 11 161 ± 17 120 ± 10 p<.001 Central Blood Pressure (mmHG) 112 ± 10 118 ± 10 139 ± 16 105 ± 9 p<.001 Augmentation index (%) 8 ± 8 16 ± 9 34 ± 12 11 ± 8 p<.001 Pulse Wave velocity (m/s) 5.4 ± 0.6 5.7 ± 0.6 6.5 ± 0.8 5.2 ± 0.6 p<.001 Baseline Warm-up Directly After exercise Recovery p-value* Peripheral blood pressure (mmHG) 129 ± 12 137 ± 11 161 ± 17 120 ± 10 p<.001 Central Blood Pressure (mmHG) 112 ± 10 118 ± 10 139 ± 16 105 ± 9 p<.001 Augmentation index (%) 8 ± 8 16 ± 9 34 ± 12 11 ± 8 p<.001 Pulse Wave velocity (m/s) 5.4 ± 0.6 5.7 ± 0.6 6.5 ± 0.8 5.2 ± 0.6 p<.001 *ANOVA for repeated measurement Open in new tab Measures of arterial stiffness Baseline Warm-up Directly After exercise Recovery p-value* Peripheral blood pressure (mmHG) 129 ± 12 137 ± 11 161 ± 17 120 ± 10 p<.001 Central Blood Pressure (mmHG) 112 ± 10 118 ± 10 139 ± 16 105 ± 9 p<.001 Augmentation index (%) 8 ± 8 16 ± 9 34 ± 12 11 ± 8 p<.001 Pulse Wave velocity (m/s) 5.4 ± 0.6 5.7 ± 0.6 6.5 ± 0.8 5.2 ± 0.6 p<.001 Baseline Warm-up Directly After exercise Recovery p-value* Peripheral blood pressure (mmHG) 129 ± 12 137 ± 11 161 ± 17 120 ± 10 p<.001 Central Blood Pressure (mmHG) 112 ± 10 118 ± 10 139 ± 16 105 ± 9 p<.001 Augmentation index (%) 8 ± 8 16 ± 9 34 ± 12 11 ± 8 p<.001 Pulse Wave velocity (m/s) 5.4 ± 0.6 5.7 ± 0.6 6.5 ± 0.8 5.2 ± 0.6 p<.001 *ANOVA for repeated measurement Open in new tab P559 Exercise training reduces high mobility group box-1 levels in women with breast cancer: the DIANA (diet and androgens)-5 project F Giallauria1, M Gentile2, P Chiodini3, A Mattiello2, L Maresca1, A Vitelli1, M Mancini1, F Berrino4, S Panico2, C Vigorito1 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy 2University of Naples Federico II, Department of Clinical Medicine and Surgery, Naples, Italy 3Second University of Naples, Department of Mental and Physical Health and of Preventive Medicine, Naples, Italy 4Department of Preventive and Predictive Medicine, National Cancer Institute, Milan, Italy Topic: Exercise/ Exercise training (Exercice & Translational Science) Purpose: Studies indicate some clues on the potential beneficial anti-inflammatory effect of exercise training intervention in patients with cancer. Among inflammatory mediators, the high-mobility group box 1 protein (HMGB1) is emerging as a potential important mediator. This study tested the hypothesis that exercise training might exert anti-inflammatory effect by reducing HMGB1 levels in BC women. Methods: We analyzed monocentric data from the DIANA (DIET AND ANDROGENS)-5 PROJECT. Study population consisted of 94 patients randomized into two groups: 61 patients (53±8 yrs, training group) were assigned to a structured exercise training intervention (3 times/week for the first 3 months, and once /week for the following 9 months); whereas 33 patients (52±7 yrs, control group) followed only the general indications to adhere to the life-style intervention suggestions of the DIANA protocol. At the study enrollment and after 12 months, all patients underwent anthropometrical and biochemical assessment (HMGB1), cardiovascular clinical examination, and cardiopulmonary exercise stress testing. Results: There were no significant differences between groups in baseline anthropometrical data and lipid profile. After stratifying the study population according to the level of adhesion to the exercise intervention, HMGB1 levels were lower among patients more compliant to exercise either at study entry (p for trend = 0.025) or after 1-year (p for trend = 0.001). After adjusting for age, body mass index and baseline values, 1-year HMGB1 levels were significantly and inversely associated to the level of adhesion to the exercise intervention (B=-0.97, SE=0.43, p=0.01). Conclusions: Moderate intensity exercise training in BC survivors is associated with reduced HMGB1 levels that are proportional to the level of adhesion to the exercise intervention. Further studies are needed in order to evaluate whether the reduction of HMGB1 levels has prognostic value in BC women. Sports cardiology in practice Saturday, 10 May 2014, 08:30-10:00 567 Left ventricular hypertrophy in athletes: the gray-zone revisited S Caselli1, M Maron2, JA Urbano Moral2, NG Pandian2, A Spataro1, BJ Maron3, A Pelliccia1 1Institute of Sport Medicine and Science, CONI, Rome, Italy 2Tufts Medical Center, Division of Cardiology and the CardioVascular Center, Boston, United States of America 3Minneapolis Heart Institute Foundation, Minneapolis, United States of America Topic: Other Heart Disease (Sports Cardiology) Background: Differential diagnosis of hypertrophic cardiomyopathy (HCM) from athlete s heart is challenging when absolute left ventricular (LV) wall thickness falls into the gray-zone. Aim of the study was to reassess criteria for differential diagnosis between HCM and athlete s heart when LV wall thickness ranges 13-15 mm. Methods: Twenty-eight athletes free of cardiovascular disease were compared to 25 HCM patients, matched for LV wall thickness (13-15 mm), age, gender, race and body size. Clinical, electrocardiographic (ECG) and morphologic variables were compared. Results: Athletes had larger end-diastolic LV cavity (60±3 vs. 45±5mm; p<0.001), aortic root (34±3 vs. 30±3; p<0.001) and left atrium (42±4 vs. 33±5mm; p<0.001) than HCM patients. LV end-diastolic diameter of 54 mm was the best criterion to distinguish HCM from athlete s heart (sensitivity and specificity, 100%; p<0.001). Diastolic function in athletes showed lower A-wave velocity (44±8 vs. 57±18cm/s; p<0.001) and E/e ratio (6.6±1.2 vs. 9.2±2.5; p<0.001). The e velocity was higher in HCM patients (12.5±1.9 vs. 9.3±2.3; p<0.001) and values <11.5 cm/s yielded high accuracy for HCM diagnosis (sensitivity 81%; specificity 61%; p<0.001). Finally, absence of diffuse T-wave inversion on ECG (specificity 92%) and negative family history of HCM (specificity 100%) also proved useful for excluding HCM. Conclusions: In athletes with LV hypertrophy falling in the gray-zone of overlap with HCM, LV diastolic cavity size appears the most reliable criterion, with a cut-off value of 54 mm for differentiation from physiologic athlete s heart. Additional criteria, derived from TDI-imaging, electrocardiogram and family screening provide additional information to aid in the differential diagnosis. Open in new tabDownload slide 568 Right ventricular morphological and functional adaptations in top-level athletes during the season: a speckle-tracking, prospective, longitudinal study F D'ascenzi1, V Curci1, F Alvino1, M Cameli1, M Lisi1, M Focardi1, C Meniconi2, M Bonifazi3, S Mondillo1 1University of Siena, Department of Cardiovascular Diseases, Siena, Italy 2medical staff Mens Sana Basket, Siena, Italy 3University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy Topic: Exercise/ Exercise training (Sports Cardiology) Purpose: Recent data suggest a possible exercise-induced right ventricular (RV) dysfunction in highly trained athletes. Although previous studies have determined the acute effects of endurance exercise, longitudinal data investigating the in-seasonal adaptations of the RV are not yet available. The aim of this prospective study was to analyzed the in-seasonal changes in RV morphology and function in top-level athletes, using 2D speckle-tracking echocardiography, a new tool to estimate myocardial deformation dynamics. Methods: Thirty top-level players were enrolled in this study. Echocardiographic measurements were performed at the beginning of the study, after 3, and after 6 months of training, corresponding to pre-season, mid-, and pre-end-season periods. Results: At mid-season time point RV end-diastolic basal diameter (p<.05), RV end-diastolic area (p=0.001), and RV end-systolic area (p<0.001) increased in comparison with pre-season data, with a slight reduction at pre-end-season time point. RV fractional area change did increase at mid-season time point (p=.005 vs. pre-season data). Conversely, E/A ratio and E/e ratio did not significantly vary. Both RV sphericity index and ratio between RV and left ventricular end-diastolic volume did not significantly change (overall p=.073 and =.176, respectively), suggesting a global and physiological remodeling of the heart. Free wall global strain and strain rate remained stable during the season (overall p=. 522 and =.227, respectively). However, when differences in regional myocardial deformation were analyzed, while basal and middle free wall strains did not change, an increase of apical free wall strain was observed (p=.005 vs. pre-season time point). None of the participants experienced a pathological reduction of RV strain values. Conclusions: This study demonstrated that changes in RV myocardial morphology and deformation occur in top-level athletes during the season. However, in this study none of the athletes experienced a marked asymmetric dilatation of the right ventricle or a pathological reduction of RV strain values, suggesting that the observed training-related changes can be interpreted as a physiological response to training load and considered as complementary features of athlete s heart. © The European Society of Cardiology 2014 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 2014
TI - Poster Session 3 – Afternoon
JF - European Journal of Preventive Cardiology
DO - 10.1177/2047487314534582
DA - 2014-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-3-afternoon-7Xy11dW9j2
SP - S84
EP - S113
VL - 21
IS - 1_suppl
DP - DeepDyve
ER -