TY - JOUR
AB - EAPC Essentials 4 You - ePosters P269 https://esc365.escardio.org/Presentation/217312/abstract A comparison of coronary artery calcium scores vs. maximal stenosis vs. aggregate stenosis for the cardiovascular risk assessment of aircrew J Jennifer Holland1, E Nicol1, L Eveson1, D Holdsworth2, J D'arcy2 1Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland 2Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain & Northern Ireland Topic: Cross-Modality and Multi-Modality Imaging Topics Background: The role of Computed Tomography Coronary Angiography (CTCA) in assessing occupational risk in aircrew with suspected CAD has not been fully explored. We investigated how CTCA alters occupational disposition compared with coronary artery calcium scores (CACS), and functional imaging data, currently used by aviation regulatory bodies. Methods: Data from aircrew undergoing CTCA over 6 consecutive years were analysed. Demographics, CTCA (maximal stenosis and aggregate stenosis), CACS and occupational disposition pre- and post-CTCA were captured. Results: 71 pilots (29% single seat, 26% rotary and 45% dual seat pilots) underwent CTCA. Initially, all aircrew were grounded due to an abnormal exercise test (48%), resting ECG (42%), cardiac symptoms (13%) or ≥2 cardiovascular risk factors (25%). After CTCA, 59% of pilots returned to unrestricted flying duties, 13% returned with occupational restrictions, with 28% remaining downgraded. In those with a CACS of <10, 7% had a stenosis of >50%. 12 (17%) of pilots with aeromedically significant CAD (as defined by EASA/CAA) would not have been detected on functional testing (i.e. those with a maximal stenosis <70%) and would have been returned to work. Conclusions: CTCA can exclude CAD in most aircrew, allowing return to unrestricted flying. A substantial number of pilots with occupationally significant stenoses are not identified with either a CACS, or functional imaging. The current use of these investigations by regulatory authorities (EASA/CAA) allows pilots at significant risk of coronary events to return to unrestricted flying. CTCA appears to be the most accurate non-invasive test to confirm and/or exclude suspected CAD in pilots and other high-hazard occupations. Abstract No: P269 P273 https://esc365.escardio.org/Presentation/221554/abstract Coronary artery calcium score is a predictor for the development of cardiovascular disease in patients with diabetes mellitus D Djamshid Payziev1, BA Alyavi2, JK Uzokov1, MG Mukhamedova3, AX Abdullaev1 1Republican Specialized Scientific-Practical Medical Center Therapy and Medical Rehabilitation, Tashkent, Uzbekistan 2Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan 3Tashkent Postgraduate Medical Institute, Tashkent, Uzbekistan Topic: Cross-Modality and Multi-Modality Imaging Topics Background: Type 2 Diabetes mellitus (T2DM) is considered risk factor for the atherosclerotic disease and coronary heart disease. Aim of the present study was to evaluate coronary artery calcium score (CACS) detected by multi slice computed tomography (MSCT) for the development of future cardiovascular disease (CVD) in patients with T2DM. Methods: 120 consecutive diabetic patients without history of cardiovascular disease and 60 healthy subjects were enrolled in this study. Multi slice computed tomography was conducted to estimate CACS and all patients were followed-up during the mean 48±12.7 months. All laboratory and instrumental measurements were performed at baseline and during the follow up period. Statistical analysis were done by using STATA software. Results: Compared with controls, patients with T2DM had a higher degree of CACS (112.8±91.7 vs. 12.9±16.4, P<0.05). During the mean follow-up period in 58 patients CVD have occurred in patients with T2DM and in 2 patients in control group. Higher CVD have been occurred in patients with CACS 1-10 (6.0%), 10-100 (35.0%), >100 (59.0%). Among risk factors ã insulin resistance (HR 15.0, CI 95% 6.50-25.24, P<0.05), high HbA1c (HR 14.0, CI 95% 7.50-21.20, P<0.05), high LDL cholesterol (HR 13.0, CI 95% 7.50-21.40, P<0.05), abdominal obesity (HR 2.4, CI 95% 1.28-3.85, P<0.05), hypertension (HR 3.6, CI 95% 1.6-7.5, P<0.05) are predictors of future CVD. As well as, cox regression analysis has revealed that CACS>110 (HR 15.2.4, CI 95% 7.685-28.50, P<0.05) is a predictor of future CVD. Conclusion: This study demonstrate that CACS detected by MSCT is a useful method for the prognosis of future CVD in patients with T2DM. P274 https://esc365.escardio.org/Presentation/221563/abstract Exponential increase of prevalence and female predominance of mitral annular calcification D Dawood Sharif1, E Azzam1, A Sharif-Rasslan2 1Bnai Zion Medical Center, Haifa, Israel 2The Academic Arab College, Mathematics, Haifa, Israel Topic: Cross-Modality and Multi-Modality Imaging Topics Mitral annular calcification (MAC) is linked to atherosclerotic burden, stroke and cardiovascular mortality. Since age and gender differences are present in cardiovascular atherosclerotic disease, it is relevant to examine disparities in subjects with MAC. Aim: evaluate age and gender related differences in subjects with MAC. Methods: 19000 echocardiographic studies and clinical files were screened and evaluated for atherosclerotic risk factors, associated diseases, echocardiographic findings and age and gender differences were assessed. Results: Prevalence of MAC increased exponentially with age. Though the exponential increase in prevalence of MAC was evident in both genders, higher prevalence of MAC was found throughout all age groups in females. The age of subjects with severe MAC was 81.4±9 yrs and 86% had hypertension while 56% had hyperlipidemia. Stroke, peripheral vascular disease and hemodilaysis were found in 19%, 12% and 2% respectively in subjects with severe MAC. Larger aortic diameters and higher grades of mitral regurgitation were found in subjects with severe MAC. Conclusions: Prevalence of MAC increases exponentially with age and is characterized by female predominance in all age groups. MAC is characterized with high prevalence of hypertension and hyperlipidemia. Stroke, peripheral vascular disease and hemodilaysis were encountered in subjects with severe MAC. P620 https://esc365.escardio.org/Presentation/223125/abstract Social-occupational impact and level of satisfaction in patients included in a remote monitoring pacemaker programme. P Pedro Perez Diaz1, E Campos Perez De Madrid1, MC Bastante Diaz1, A Fernandez Trujillo1, L Cano Rosado1, J Jimenez Diaz1, F Higuera Sobrino1, N Bermejo Calvillo2, AM Casas De Miguel1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2Hospital General de Ciudad Real, General practitioner, Ciudad Real, Spain On Behalf of: University General Hospital of Ciudad Real, Ciudad Real, Spain. Funding Acknowledgements: No sources of funding were provided for this work. Topic: Arrhythmias, General – Treatment Background: When patients fitted with pacemakers have to attend arrhythmia appointments, this often reduces their independence and involves their caregivers having to take time off work, along with an increase in spending on healthcare transport. Purpose: We describe the impact of remote monitoring of pacemaker implemented by our Arrhythmia Unit in our patient´s live and the reduction in social, occupational and financial impact on these patients. Methods: Prospective observational study including 160 patients on the remote monitoring pacemaker programme between January 2016 and January 2017. We handed a satisfaction survey to these patients after the face-to-face monitoring appointment, which analysed variables such as waiting time, attention and treatment received, need for accompaniment of a relative, method of travel and kilometres travelled, level of satisfaction with the remote monitoring system, proposals for improvement, etc. Results: The patients spent a median of 60 +/- 30 minutes on the remote monitoring, with a distance travelled of 1.4 +/- 4.9 km, rating their level of satisfaction at the remote monitoring as excellent (35%), good (61%) and average (3%) (Figure 1). In the face-to-face appointment, most of them were accompanied (86%) and arrived by private car (66%), with 54% of family members needing to take time off work. 19.4% of patients arrived by ambulance and 8.8% by bus. The median time spent was 150 +/- 120 minutes, and the distance travelled was 63 +/- 105 km. Conclusions: The remote monitoring pacemaker programme in our health district has a very positive healthcare and social-occupational impact, which is manifested both from an objective point of view (greater independence, less time spent per appointment, less distance travelled, fewer healthcare transport needs and less workplace absenteeism by family members, etc.) and a subjective point of view (lower impact of appointments on patients' lives and greater perception of satisfaction from the patients and their companions). Satisfaction survey P622 https://esc365.escardio.org/Presentation/223106/abstract Carbon footprint as a marker of environmental impact in patients included in a remote monitoring pacemaker programme. P Pedro Perez Diaz1, J Jimenez Diaz1, F Higuera Sobrino1, MC Bastante Diaz1, E Campos Perez De Madrid1, A Fernandez Trujillo1, L Cano Rosado1, N Bermejo Calvillo2, AM Casas De Miguel1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2Hospital General de Ciudad Real, General practitioner, Ciudad Real, Spain On Behalf of: University General Hospital of Ciudad Real, Ciudad Real, Spain. Funding Acknowledgements: No sources of funding were provided for this work. Topic: Arrhythmias, General – Treatment Background: When patients fitted with pacemakers have to attend arrhythmia appointments, this often involves their caregivers having to take time off work, along with an increase in spending on transport and the amount of CO2 emissions into the atmosphere (carbon footprint). The remote monitoring of pacemakers implemented at our Arrhythmia Unit reduces the social, occupational, financial and environmental impact. Purpose: We describe the impact of remote monitoring of pacemaker implemented by our Arrhythmia Unit in our patient´s live and the reduction in social, occupational and financial impact on these patients. and we quantify the decrease in CO2 emissions. Methods: Prospective observational study including 160 patients on the remote monitoring programme between 2016 and 2017. We handed a satisfaction survey to these patients after the face-to-face monitoring appointment, which analysed variables such as waiting time, attention and treatment received, need for accompaniment of a relative, method of travel and kilometres travelled, etc. Finally, we quantified the carbon footprint of each patient's journey and compared the level to the results if all the monitoring appointments had been in person. Results: Patients spent a median of 60 +/- 30 minutes in remote monitoring, with a distance travelled of 1.4 +/- 4.9 km. In face-to-face appointments, most patients were accompanied (85.6%) and arrived by private car (66.3%), with 54% of family members needing to take time off work. The median time spent was 150 +/- 120 minutes, and the distance travelled was 63 +/- 105 km. The carbon footprint emitted by individuals included in the remote monitoring programme was 138 +/- 114, with an estimated saving of 15 +/- 33 kg of CO2 (9.6%) per remote monitoring cycle (Figure1). Conclusions: The remote monitoring pacemaker programme in the health district of Ciudad Real has a very positive healthcare, social-occupational and environmental impact, which is manifested both from an objective point of view (greater independence, less time spent per appointment, less distance travelled, fewer healthcare transport needs, less workplace absenteeism by family members and approximately a 10% reduction in CO2 emissions per monitoring cycle) and a subjective point of view (lower impact of appointments on patients' lives and greater perception of satisfaction from the patients and their companions). Social impact and carbon footprint P624 https://esc365.escardio.org/Presentation/217015/abstract Anthropometric indicators of visceral obesity as predictors of atrial fibrillation V Podzolkov1, A Tarzimanova1, R Radik Gataulin1, K Oganesyan1, N Lobova1 1I.M. Sechenov First Moscow State Medical University, Therapy department #2, Moscow, Russian Federation Topic: Arrhythmias, General – Treatment Objective: To study correlations between anthropometric indicators of visceral obesity and frequency of atrial fibrillation (AF) paroxysms in patients with obesity. Materials and methods: The study included 82 obese patients with paroxysmal form of AF. The duration of follow-up was 1 year. Patients were divided into 2 groups: 42 patients with frequent AF paroxysms (more than 3 paroxysms within a month) were included into group I. 40 patients with rare AF paroxysms (less than 3 paroxysms within a month) were designed as group II. The mean age was comparable in both studied groups: 60.9±6.2 years in group I and 57.2±6.5 years in group II. All patients had evaluation of anthropometric indicators of visceral obesity: body mass index (BMI), waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios. Also, patients had echocardiographic measurement of epicardial adipose tissue (EAT) thickness. Results: There were no significant differences in BMI between 2 groups. Anthropometric indicators of visceral obesity were significantly higher in I group of patients in comparison with II group: waist-to-hip ratio was 1.37±0.09 and 0.84±0.06 respectively (p=0.002), waist-to-height ratio was 0.8±0.02 and 0.69±0.01 respectively (p<0.01). EAT thickness was significantly higher in I group in comparison with the II group: 9.6±1.12 and 6.09±1.08 respectively, p=0.003. There was a strong positive correlation between EAT thickness and frequency of AF paroxysms in I group of patients (r=0.613, p=0.024). Conclusion: Increased thickness of EAT is associated with high frequency of AF paroxysms in patients with visceral obesity. P805 https://esc365.escardio.org/Presentation/217060/abstract Inflammation as the additional risk for stroke in patients with atrial fibrillation S Svetlana Grigoryan1, LG Hazarapetyan1, AA Stepanyan2, DM Andreasyan3 1Yerevan State Medical University after M. Heratsi, Yerevan, Armenia 2Gjumry Medical Center, Gjumry, Armenia 3National Institute of Health, Yerevan, Armenia Topic: Atrial Fibrillation - Stroke Prevention Introduction: Atrial fibrillation (AF) is associated with atrial structural changes that may have an inflammatory basis. Various inflammation markers such as interleukin-6 (IL-6) and C-reactive protein (hsCRP) have been linked with AF. Several prothrombotic factors have been found to be elevated in AF, which contributed to an increased risk for stroke. The aim of this study is to investigate the relationship between inflammation markers (hsCRP and IL-6) and risk of dynamic cerebrovascular accident or stroke, including the impact of this interaction on the outcome in patients with AF Material and methods. We observed 441 patients with nonvalvular AF during 5 years. Clinical examination of patients included a study of complaints (especially HF, dynamic cerebrovascular accident and stroke), physical, laboratory and instrumental examination, also additional biochemical blood tests , such as tissue factor (TF) as a principal initiator of the coagulation cascade, and levels of hsCRP and IL-6. All of blood tests were determined by ELISA on the analyzer "Stat Fax 303 Plus". Treatment regimens carried out in all patients included standard therapy, which is held in the hospital for the treatment of AF. Studies were conducted on the basis of simple randomized open-label protocols, using the universal statistical packages SPSS 13.0 Results: Analysis of all 5 years results have shown that among 441 patients with AF within 5 years, heart failure was detected in 137 patients, 96 had either a cerebral circulation disorder or a stroke. It was found that in patients undergoing dynamic cerebrovascular accident or stroke there was a significant increase in inflammatory markers (levels of hsCRP and IL-6 and coagulation cascade compared with other patients with A. So, the significant differences between the levels of hsCRP are 6, 7± 1.8 vs 3.2±0.6 p = 0.002 and level of IL-6 is 4.2± 0.8 vs. 2.6± 1.1 p = 0.043 accordingly. We revealed that in patients with dynamic cerebrovascular accident or stroke the level of TF is improved as compared the other patients with AF (1200± 50.vs 850±31.9 p = 0.026). Moreover plasma levels of hsCRP were higher among AF patients at "high" risk of stroke by CHA2DS2-VASc Score (p = 0.003). Besides the levels of hsCRP and IL-6 are markedly elevated in patients with dilated left atrium and poorly functioning left atrial appendage.The similar tendency of hsCRP, IL-6 and TF was also observed in patients with AF and heart failure. Conclusion: we have demonstrated that inflammation markers such as hsCRP and IL-6, together with coagulation cascade markers, are additional criteria that contribute to the development of dynamic cerebral circulation disorders or stroke in patients with AF P806 https://esc365.escardio.org/Presentation/217311/abstract 5-year prognosis of patients with atrial fibrillation that developed after cardiac surgery with sternotomy L Abazova1, E Lubinskaya1, E Demchenko1 1Almazov National Medical Research Centre, Saint Petersburg, Russian Federation Topic: Atrial Fibrillation - Stroke Prevention Background: Paroxysms of atrial fibrillation (AF) are the most common complication of cardiac surgery with sternotomy: their frequency reaches 30% of cases with coronary artery bypass grafting (CABG), 40% with heart valve surgery, and up to 50% with combined interventions and associated with a twofold increase in the risk of death, a 5-fold increase in stroke and increases the duration of in-patient rehabilitation by 1.5-2 times. The long-term prognosis, the duration of antiarrhythmic and anticoagulant therapy in case of development of postoperative AF requires clarification. Purpose: To evaluate the 5-year prognosis and practice of outpatient management of patients with AF paroxysm, which developed for the first time after cardiac surgery with sternotomy. Methods: The study included 110 patients (63.6% - men, 65.5 ± 9.4 years) in whom cardiac surgery with sternotomy (CABG - 70%, prosthetic heart valves - 11.8%, combined surgery (18.2%) was complicated by the development of AF. The source of information on cardiovascular events, drug therapy in the long-term period (58.4 ± 6.8 months) was medical documents, face-to-face survey data and patient examinations or telephone interviews Results: The single AF paroxysm in the early postoperative period occurred in 75.5%, repeated AF in 24.5% of the operated patients. The average developmental period of AF was 4.8±1.9 days (1-5 days), duration - 11.2±4.5 hours, 56.4% of paroxysm was stopped with amiodarone infusion, 1.8% with cardioversion. Amiodarone was prescribed orally for 22.7% of the patients before discharge, 3.6% - sotagexal, and 73.7% - beta-blockers. After 3 months, amiodarone was taken 2%, sotagexal - 1.8%, beta-blockers - 79.3%, by the end of the observation period - 8%, 6.3% and 85.7% of patients, respectively. 92% of patients were constantly monitored by a cardiologist for 3 months, 56% - during the entire observation period. AF recurrence developed in 32.7% of patients: in 7.3% after 1-3 months, in 13.7% during the first and in 19.2% the second year after surgery. The average AF recurrence rate was 6.5% per year according to a 5-year follow-up. Anticoagulant therapy at discharge was prescribed to 38.2% of patients, 27.5% of patients took it regularly after 12 months, 15.4% - after 24 months. and 9% at the end of the observation period. 1.8% of patients underwent stroke, 10% - recurrence of angina pectoris, 2% - myocardial infarction, 27% were hospitalized urgently Conclusion. The frequency of AF recurrence in patients after cardiac surgery with sternotomy was 6.5% per year according to a 5-year follow-up. The highest probability of recurrence of AF (13.7%) was observed at 1 year after surgery. Stroke developed in 1.8% of patients with recurrent AF who did not receive anticoagulants. The rationale for the duration of anticoagulant and antiarrhythmic drugs at the outpatient stage, the principles of the dynamic observation and adherence to treatment of these patients require further study. P807 https://esc365.escardio.org/Presentation/221585/abstract Safety of NOAC therapy in very elderly patients with atrial fibrillation: a clinical review M Mariia Gabitova1, A Sokolova1, D Napalkov1, V Fomin1 1I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Topic: Atrial Fibrillation - Stroke Prevention Background: Atrial fibrillation (AF) is one of the most widespread arrhythmias in a very elderly population. Because of the high ischemic risk according to the CHA2DS2-VASC score, all of these patients have to be anticoagulated. NOACs are prescribing more often not only because they do not need to be controlled using INR as well as they have even higher safety and effectiveness level in comparing with vitamin-K antagonists. However, there is still a question, which NOAC is the best to be prescribed in very elderly patients because of the increased bleeding risk in this age group. Purpose: To find out, which NOAC is the safest when prescribed to very elderly patients with AF. Methods: Very elderly patients (≥75 y.o.) with AF taking dabigatran (110mg twice a day), apixaban (2,5 or 5mg twice a day) or rivaroxaban (20 or 15 mg a day) in full or reduced dosage were included in the trial. Those who had hemorrhagic or iatrogenic strokes were excluded. Previous experience of NOAC treatment from the very beginning of therapy or the point a patient reaches 75 years was considered. Episodes of NOAC change, as well as hemorrhagic and ischemic events associated with taking an anticoagulant, were marked. The mandatory observational period was 18 months. Results: 102 patients (m/w=39/63) with an average age was 79.4 ± 4.1 years were included in the trial: 32 patients were in dabigatran group, 34 patients - in apixaban group and 36 patients - in rivaroxaban group. Groups significantly differed only by middle age; patients taking apixaban were the eldest (p=0,003 when comparing apixaban and dabigatran; p=0,008 when comparing apixaban and rivaroxaban). There were 19 clinically significant bleedings recorded, 10 occurred in patients taking dabigatran and 9 in those taking rivaroxaban (5 in those who took 20 mg and 4 in those who took 15 mg). No hemorrhagic events in apixaban group were observed. Large hematomas, hematuria and intensive nasal bleedings were the most frequent events. There was no reason to withdrawal the NOACs even in case of bleeding. No NOAC associated fatal outcomes were registered. Conclusion: In very elderly patients, all NOAC (dabigatran, rivaroxaban and apixaban) demonstrated no major bleedings within a 1.5-year follow-up period. During the same intake period, apixaban showed the highest level of safety in comparing with dabigatran and rivaroxaban. P809 https://esc365.escardio.org/Presentation/217020/abstract Association of rs2230806 polymorphism with the development of acute cerebrovascular event A Anna Chernova1, S Nikulina1, S Tretyakova1, V Shulman1, D Nikulin1, V Maksimov2 1Krasnoyarsk State Medical University named prof. V. F. Voino-Yasenecky, Krasnoyarsk, Russian Federation 2Institute of Internal Medicine SB RAMS, Novosibirsk, Russia, Novosibirsk, Russian Federation Topic: Atrial Fibrillation - Stroke Prevention Purpose: to study SNP rs556621 association (G> T) with development of Acute Cerebrovascular Event in the patients with cardiovascular pathology and risk factors of its development who are representatives of the east Siberian population. Material and methods. 260 patients with Acute Cerebrovascular Event participated in a research (age [57.0; 51.0-62.0]) and 272 patients of control group (age [55.0; 51.0-62.0].). Among the patients who transferred Acute Cerebrovascular Event, 157 men and 103 women. The control group included 170 men and 102 women. Inspection of the main group included: collecting complaints, anamnesis, clinical examination, computer tomography of a brain, electrocardiography, echo, ultrasonic of arteries, daily monitoring of arterial blood pressure and cardiac rhythm, analysis of a coagulant system of blood. Patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, supraventricular tachycardia, dislipidemiya, atherosclerosis brachiocephalic of arteries, disturbances of a system of a hemostasis. The control group is examined within the international HAPIEE project. The molecular and genetic research was conducted by PCR method in real time. Statistical processing of material was carried out with use of set of the Statistica for Windows 7.0, Excel and SPSS 22 application programs. Results: In all analyzed groups and subgroups of patients statistically significant connection between a genotype of CC and an allele of C SNP of rs662799 is established (A> G) and the increased risk of Acute Cerebrovascular Event. Conclusion: A genotype of CC and an allele of C SNP of rs2230806 (C> T) the risk of development of an Acute Cerebrovascular Event in patients regardless of the previous cardiovascular pathology and risk factors, including at patients with arterial hypertension, supraventricular tachyarrhythmias, atherosclerosis the brachiocephalic of arteries, disturbance of lipidic exchange and the system of a hemostasis raises. P810 https://esc365.escardio.org/Presentation/217011/abstract Advantages of rivaroxaban vs aspirin for the primary prevention of cardiovascular events in patients with atrial fibrillation T Saralidze1, M Noniashvili2, T Svanidze2, I Mamatsashvili2 1Tbilisi State Medical University (TSMU), Department of Internal Medicine N 1, Tbilisi, Georgia 2Tbilisi State Medical University (TSMU), Tbilisi, Georgia Topic: Atrial Fibrillation - Stroke Prevention Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia leading to significant morbidity and mortality. Often patients (P) donã t know they have AF before cardiovascular events (CVE) occur and receive aspirin as antiaggregant therapy (P with diabetes, arterial hypertension (AH), atherosclerosis, chronic coronary disease (CCD), heart failure (HF) or deny to receive Warfarin to avoid regular investigation of INR. Our aim was to compare effectiveness of Rivaroxaban (R) and Aspirin (A) for the primary prevention of CVE in P with AF. We investigated retrospectively 100 outpatients with AF who received the drugs at least 1 year. 50 P received A (16 men (age 54-85y), 34 women (age 60-90y), 50 P received ã R (14 men (age 55-85y), 36 women (age 64-90y). These 2 groups (gr) were comparable according to anamnesis ã all had AH, grade II or III, non-valvular AF, in I gr Diabetes, type 2 had 15 P, in II ã 14, in both gr P had chronic HF (class II or III), amount of P with preserved ejection fraction (EF) in I gr was 7, in II-6, P with mid-range EF in I gr was ã 30, in II ã 31, P with reduced EF in each gr was 13. In I gr every P received A 100mg/a day, in II gr first 3 months all P received R 20mg/day, after 3months P>75y, received R 10mg/day, P<75, received R 15mg/day. Most P had permanent AF, in I gr -35 P, in II- 36; Paroxysmal AF had in I gr -8 P, in II -7P; Persistent AF had in each gr ã 7 P. Our study showed decrease of the episodes of significant tachycardia (HR- 120-140) in P with permanent and persistent forms of AF and repeated episodes of paroxysmal AF in II gr (8 cases), compared with I gr (21 cases). In both gr P with reduced EF received Carvedilol 6,25mg/d to maintain normocardia, P with preserved or mid-ranged EF ã Metoprolol 25 -50mg/d. Bleeding episodes was similar in both gr ã 2 cases of mild gastrointestinal bleeding and 2 cases of hematuria in each gr. Increase of creatinine level was revealed in 3 cases only in II gr. Other complications were less in II gr. 4 cases of stroke, 4 cases of unstable angina (UA), 8 cases of acute myocardial infarction (AMI, 5- NSTEMI, 3-STEMI) and 2 cases of pulmonary thromboembolism were observed in I gr, while only 2 cases of UA and 2 cases of AMI (NSTEMI) were observed in the II gr. Results of our study shows significant advantage of the use of Rivaroxaban for the primary prevention of cardiovascular events in patients with atrial fibrillation. P124 https://esc365.escardio.org/Presentation/217314/abstract A review of prescription of guideline directed medical therapy, and its association with reduced hospitalisations for acute decompensated heart failure P Peter Wheen1, D O'callaghan1, P Murray2, C Daly1 1St James Hosptial, Dublin, Ireland 2Adelaide & Meath Hospital, Dublin, Ireland Topic: Chronic Heart Failure – Treatment Background and Aim: Heart Failure (HF) is associated with a high mortality and hospitalisation rate. For new patients referred to our HF programme, we aimed to assess the mortality rate, and the rate of hospitalisations for acute decompensated heart failure (ADHF), and to assess any association with prescription of Guideline Directed Medical Therapy (GDMT). Methods: We reviewed all patients who were enrolled in our hospitalã s HF programme between January 1st 2017 and December 31st 2017, and reviewed their most recent follow up using the Electronic Patient Record. Data was collected on the number of admissions each patient had to hospital for treatment of ADHF since their initial HF outpatient review, as well as their prescriptions for GDMT at programme enrolment, and on program completion. Results: There were 366 patients referred to our HF programme in 2017. Of these, 169 were new diagnoses, and enrolled into our HF clinic, of whom 150 patients attended a minimum of one appointment. Mean (mean (+/- SD)) follow up was 17.5 months (+/- 7.7). The all-cause mortality rate for patients who attended our outpatient HF programme for a minimum of one appointment was 18% (n=27). 52 patients (34.7%) had at least one ADHF admission during follow up. The median (median (IQR)) number of heart failure hospitalisations for the 150 patients was 0 (0-1), with mean number of 0.57 (+/- 0.97) hospitalisations. The patients who died had a higher rate of hospitalisations in the 12 months prior to their death. (p=0.0004) The annualised rates (mean admissions/year) of hospitalisation for patients stratified as per GDMT at program enrolment is as follows: on both ACE/ARB/ARNI and BB; 0.21, on ACE/ARB/ARNI without BB; 0.24, on BB without ACE/ARB/ARNI: 0.62, on neither ACE/ARB/ARNI or BB; 1.37. The annualised rates of hospitalisation for patients stratified as per GDMT at program completion is as follows: on both ACE/ARB/ARNI and BB; 0.28, on ACE/ARB/ARNI without BB; 0.26, on BB without ACE/ARB/ARNI: 0.70, on neither ACE/ARB/ARNI or BB; 1.2. Conclusion: Both mortality and hospitalisation rates remain high for patients with HF. In this retrospective observational study, GDMT was strongly associated with reduced hospitalisations for heart failure. Intolerance of beta blocker was not associated as strongly with hospitalisations for heart failure, as was intolerance of ACE/ARB/ARNI. Abstract graph P126 https://esc365.escardio.org/Presentation/217097/abstract Role of soluble ST2 in prognosis of chronic heart failure progression in patients who received beta-blocker therapy K Kristina Kopeva1, EV Grakova1, AT Teplyakov1, AA Van-Tin-Gao1, AA Garganeeva1 1Cardiology Research Institute, Tomsk National Research Medical Centre, Tomsk, Russian Federation Topic: Chronic Heart Failure – Treatment Objective: The objective of this study was to evaluate prognostic value of sST2 biomarker in chronic heart failure (HF) progression during the 12month follow-up period in patients with ischemic heart failure with preserved and midrange ejection fraction undergoing coronary revascularization who received β-blockers. Methods: A total of 87 patients (67.8% men, median age of 62 [56; 69] years) with ischemic heart failure and baseline LVEF of 63% [64; 65]% were enrolled in the study. Serum sST2 levels were measured at baseline before revascularization. The progression of HF was assessed as a decrease in LVEF (> 5%), an increase in end-diastolic volume and end-systolic volume, a decrease of 1 or more NYHA functional class of HF (according to 6-minute walk distance), a present of new signs/symptoms of HF, repeated hospitalizations due to HF decompensation. All β-blocker doses were converted to total daily dose of metoprolol succinate extended release equivalents from each beta-blocker total daily dose (according to data of the PROTECT study) at the following ratios: metoprolol tartrate immediate release, carvedilol*4,bisoprolol*20, propranolol*0.833, and sotalol/1.2. Results: Among patients receiving β-blockers at any dose, there were no cases of HF progression in group with a physiological level of sST2 (≤35 ng/mL; n=37), when in group with baseline elevated sST2 levels (>35 ng/mL; n= 35) HF progression was observed in 10 (28.6%) cases. In patients, who did not receive β-blockers, HF progression was diagnosed in 6 (40%) cases (p = 0.004). Moreover, in patients with sST2 overexpression, who received β-blocker doses equivalent of ≥100 mg of metoprolol succinate, HF progression was less frequently observed (p=0.041) in comparison to patients with sST2 overexpression who received low β-blocker: 4 (25.0%) and 6 (31.6%) cases, respectively. However, the median value of baseline sST2 in patients with HF progression (n=16) was over twofold higher (p <0.0000001) than in patients (n = 71) without signs of HF progression (70.48 [46.04; 78.77] ng/mL and 34.18 [24.15; 39.06] ng/mL, respectively). After the 12-month follow-up period there was a tendency to a decrease in LVEF by 6.7% from 53.0 [41.5; 63.0] to 46.3 [41.0; 62.0]%, an increase in end-systolic dimension by 9.5%, end-diastolic volume by 15%, end-systolic index by 12.6% in patients with HF progression. Conclusion: Our data suggest that ST2 may be considered a non-invasive biomarker for prediction of chronic heart failure progression during the 12month follow-up period in patients with ischemic heart failure with preserved and mid-range ejection fraction undergoing coronary revascularization who received beta-blocker therapy. It can be used for personified optimization of prevention and treatment, in particular, with more intensive use of β-blockers in group of patients with an increased risk of heart failure progression. P127 https://esc365.escardio.org/Presentation/217009/abstract A look at physician adherence to the ESC heart failure guidelines to medical and device therapies in an irish university teaching hospital. D Daniel O Callaghan1, P Wheen1, C Daly1 1St. James's Hospital, Dublin, Ireland Funding Acknowledgements: No financial support was obtained for this study. Topic: Chronic Heart Failure – Treatment Background/Aim: Adherence to guideline directed medical therapy (GDMT) and device therapies are associated with improved outcomes for patients with heart failure (HF). We aimed to assess our HF unitã s adherence to the European Society of Cardiology (ESC) Heart Failure guidelines for medication prescribing rates and device implantation rates. Methods: The medical records of all new referrals who attended our HF programme in the year 2017 were reviewed. Data was collected on HF medication prescription rates at time of programme completion. Data was collected on device implantation rates at 12-month follow-up post programme completion. Results: A total of 150 new referrals attended a minimum of one HF clinic appointment in 2017, of whom 87% (n=131) attended follow up and reached maximum tolerated GDMT. GDMT use was as follows; ACE/ARB/ARNI, 111 (84%); Beta-blocker, 118 (90%); Mineralocorticoid receptor antagonist (MRA), 49 (37%); Ivabradine, 4 (3%). At time of programme completion, there were 23 patients with persisting left ventricular ejection fractions (LVEF) <35% and had a NYHA >1; 14 of these (61%) were on an MRA. Of the 9 patients not on an MRA, mean potassium (mean (+/-SD)) was 4.7mmol/L (+/- 0.44) and mean creatinine was 109.2mmol/L (+/- 33.9). There were 4 patients on ivabradine, 3 of whom were also on a beta-blocker and had a mean heart rate of 72bpm. Of symptomatic HF patients with no history of atrial fibrillation/flutter, there were 11 patients prescribed a beta-blocker with persisting HR >70bpm, 5 of whom had previous MI. At 12-month follow-up, there were 16 patients with persistent LVEF <35% and a NYHA class of 2 or more. Of these, 7 patients had ischaemic cardiomyopathy of whom 1 had an ICD at time of enrolment and 1 received 1 in the follow-up period. The 9 other patients had non-ischaemic aetiology, of which 1 of these received an ICD in the follow-up period. When applying the ESC guidelines for consideration of CRT implantation at our HF unit, only 2 of the 131 patients at programme completion meet all ESC guideline criteria for consideration of a CRT device, that is: they had symptomatic HF with NYHA >1 for patients in sinus rhythm or NYHA >2 for patients with atrial fibrillation/flutter; they had persistent LVEF <35%; and had QRS ≥ 130msecs. Conclusion: This review demonstrates that heart failure programmes can achieve high levels of adherence to guideline directed medical therapies. MRA use is limited by high serum potassium and creatinine levels. Ivabradine therapy is infrequently used, and may be under prescribed as per GDMT. Our ICD implantation rate is low and could likely be improved upon. Applying the ESC treatment algorithm, only two patients (1.5%) met all the criteria required to prompt a physician to evaluate the need for CRT implantation. P129 https://esc365.escardio.org/Presentation/217031/abstract Daily physical activity levels in patients with heart failure with preserved ejection fraction: clinical correlates and subjective perception of activity H Lin1, P Hartley1, F Forsyth1, C Deaton1 1University of Cambridge, Public Health and Primary Care, Cambridge, United Kingdom of Great Britain & Northern Ireland On Behalf of: Optimise HFpEF Investigators Funding Acknowledgements: National Institute of Health Research School for Primary Care Research Topic: Chronic Heart Failure – Treatment Introduction: Patients with heart failure with preserved ejection fraction (HFpEF) are older, often multi-morbid and frail, and may lack confidence and motivation to be physically active. Although evidence is limited, physical activity (PA) is beneficial in patients with HFpEF but little is known about PA in community dwelling older patients. Purpose: The aim of this analysis was to objectively measure PA and sedentary behaviour (SB) in patients with HFpEF, analyse associations between demographic and clinical variables, PA, and patientsã subjective assessment of regular exercise. Methods: Longitudinal cohort study: Patients with presumed HFpEF recruited from primary care received baseline diagnostic evaluation, clinical assessment, and wore a tri-axial accelerometer over seven days. PA was estimated by calculating the Euclidean norm minus one (ENMO) with moderate to vigorous PA (MVPA) defined as > 80 milligravity (mg) units, and sedentary behaviour (SB) as ENMO < 13 mg. Data were analysed using R. Results: Of 127 patients with presumed HFpEF recruited, 71 (56%) had confirmed HFpEF.ÂPatients with HFpEF had a median age of 79, 38% were female, median BMI 31, and 52% were pre-frail or frail. Median 6 minute walk distance (6MWD) was 292 metres, median gait speed 1.1 m/s, median daily MVPA was 10 minutes (IQR: 2.8 ã 25.8)and median daily sedentary time was 17.3 hours (IQR 16.3 ã 18.2). Despite low levels of MVPA, 41% of patients stated that they completely agreed with the statement "I exercise regularly". Best subset analysis of predictors of physical activity (average acceleration) over the 7 days found gait speed to be the best univariate predictor (adjusted R2 0.39). Including four variables in the model: gait speed, the Symptom Severity Heart Failure Questionnaire, presence of lower limb oedema, history of smoking, improved the adjusted R2 value to 0.56, without evidence of overfitting (as assessed by Bayesian Information Criterion) or increasing the prediction error (k-fold cross validation). Conclusion: Even using low parameters to define MVPA and SB, patients had low levels of activity, associated with gait speed, symptoms, leg oedema and previous smoking. Patients would benefit from exercise training tailored to their characteristics and limitations. P131 https://esc365.escardio.org/Presentation/217010/abstract A review of the comorbidities associated with new referrals to a heart failure programme in Ireland and the response to medical therapy. D O Callaghan1, P Wheen1, C Daly1 1St. James's Hospital, Dublin, Ireland Funding Acknowledgements: No financial support was obtained for this study. Topic: Chronic Heart Failure – Treatment Background and Aim: Heart Failure (HF) is a major public health issue in Ireland, with over 10,000 new diagnoses per year. We aimed to assess all patients referred to our HF programme within a 12 month period, and review their prevalence of co-morbidities. We also aimed to review their response to medical therapy, by assessment of their repeat symptomatic, echocardiographic and biochemical data. Methods: All new and appropriate referrals to our HF programme were included between January 1st 2017, and December 31st 2017. We reviewed their symptoms, and their echocardiographic and biochemical data at time of referral, and at time of programme completion. Results: 150 new patients (93 male, 62%) attended a minimum of one appointment following referral. The mean age (mean (+/- SD)) at enrolment was 70.0 years (+/- 16.6). The prevalence of co-morbidities in our cohort were as follows: atrial fibrillation, 81 (54%); hypertension 73 (49%); ischaemic heart disease, 70 (46%); diabetes, 36 (24%); dyslipidaemia, 29 (19%); stroke/TIA, 19 (13%). The mean New York Heart Association (NYHA) class at time of enrolment was 2.6 (+/- 0.61), which improved to 1.8 (+/- 0.59) at programme completion. 87% (n=131) made it to programme completion (i.e. optimised medically) in a mean time interval of 2.9 months (+/- 2.5). 95% (n=142) of patients had a NT-proBNP level at time of referral, with a mean level of 6570pg/ml (+/- 9862). 85% (n=112) had a NT-proBNP level done at programme completion with a mean of 1960pg/ml (+/- 2599). The mean left ventricular ejection fraction (LVEF) at referral was 32.8% (+/- 13.4), improving to a mean LVEF of 37.4% (+/- 11.5) at programme completion. 99% (n=148) had an echo at time of referral: 62% (n=92) had HFrEF (EF ≤40%); 22% (n=32) had HFmrEF (EF 40-49%); and 16% (n=24) had HFpEF (EF ≥50%). 106 patients who reached programme completion had an exit echocardiogram, of which: 48% (n=51) had HFrEF (EF ≤40%); 29% (n=31) had HFmrEF (EF 40-49%); and 23% (n=24) had HFpEF (EF ≥50%). Conclusion: Atrial fibrillation, hypertension, and ischaemic heart disease are the most frequently associated co-morbidities in our HF cohort. For patients who were referred our heart failure programme and reach programme completion, there are significant improvements in their NYHA class, LVEF and NT-proBNP levels. HF Category Comparison Pre and Post P443 https://esc365.escardio.org/Presentation/217073/abstract Magnesium orotate improves symptoms, myocardial function, exercise capacity and quality of life in operated valvular heart disease: results from a randomized, open-label, case-control 2-year study I Ilshat Gaisin1, AS Gazimzyanova2, NI Maximov3, AA Galimova2, MA Voronova2, VM Abseeva2, ER Sabirzyanova2, EA Chernikch2, TV Korotaeva2, MA Gushchevarova2, IA Kuznetcova2 1State Medical Academy, Izhevsk, Russian Federation 2Clinical Diagnostic Centre of the Udmurt Republic, Izhevsk, Russian Federation 3Izhevsk State Medical Academy, Izhevsk, Russian Federation Topic: Chronic Heart Failure: Rehabilitation Background: Successful surgery for valvular heart disease prolongs life and generally improves symptoms and cardiac function. Nevertheless, myocardial dysfunction and health-related quality of life (QoL) impairment may persist and worsen postoperatively. Purpose: We aimed to evaluate the safety and efficacy of nonsteroidal anabolic magnesium orotate (MO) in long-term treatment of patients with heart valve prosthesis. Methods: 220 patients [aged 58.6±4.5 years; 68% males; 65% NYHA class III, 35% NYHA FC II; 42% concomitant SCAD, 24% CABG; median (IQR) 6-min walk distance (6-MWD) 348 (152ã442) m; mean (SE) left ventricular ejection fraction (LVEF) 53.2 (2.0)%] 2ã4 weeks after conventional aortic (n=128) or mitral (n=92) valve replacement by mechanical (95%) or biological (5%) prostheses (42% due to degenerative, 28% rheumatic, 16% myxomatous, 9% congenital valve diseases and 5% infective endocarditis) were randomized 1:1 to receive either optimal standard therapy (vitamin K antagonists, ACEIs/ARBs, beta-blockers, diuretics, MRAs, statins and digoxin) or magnesium orotate 500 mg t.i.d. added to conventional treatment. Efficacy endpoints included changes from preoperative baseline in 6-MWD, NYHA FC, echo-parameters, heart failure hospitalizations and all-cause mortality. QoL was assessed by the Short Form (SF-36 v.1) Health Survey. Results: There were no significant differences between MO and control groups at baseline. Patients reported poor postoperative QoL. At month 24, patients receiving MO (n=110) had a mean increase in 6-MWD of 248 m (p<0.0001); control patients (n=110) had a mean 6-MWD increase of 195 m (p<0.001), with a control-adjusted difference of +53 m (p=0.008). NYHA status improved by two classes in 65% of MO vs. 53% of controls (p=0.020), by one class in 35% vs. 47% (p=0.020). MO delayed the time to clinical worsening (p=0.0053) and reduced the heart failure admissions (p=0.0035). Improvements were noted in control-adjusted changes in supraventricular (p=0.0015) and ventricular arrhythmias (p=0.022) and in postoperative heart remodeling, e.g. in mean LVEF (+3.2%; p=0.0082), left ventricular end-diastolic diameter (ã5.6 mm; p=0.0018) and end-systolic diameter (ã3.5 mm; p=0.0055). Combination therapy with MO was well tolerated. In both groups, SF-36 scores substantially rose after follow-up. MO patients had significantly higher improvements in QoL over time compared to controls. One patient died in the control group (p=0.80). Conclusion: Long-term magnesium orotate therapy for patients with heart valve prostheses improves symptom status, cardiac function, exercise capacity and QoL. The study provides the evidence that magnesium orotate is a new promising therapy in operated valvular heart disease. P446 https://esc365.escardio.org/Presentation/221567/abstract Identification of diastolic dysfunction on cardiopulmonary exercise testing and its prognostic value JP Joao Pedro Dias Ferreira Reis1, A Castelo1, C Martins1, S Silva1, P Rio1, R Cruz Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal Topic: Chronic Heart Failure: Rehabilitation Introduction: Diastolic dysfunction (DD) is an important pathophysiological mechanism underlying heart failure (HF) with both reduced and preserved ejection fraction. Cardiopulmonary exercise testing (CPET) variables have been extensively studied in systolic dysfunction, but its role in evaluating DD remains to be determined. Purpose: To determine predictive factors of the DD and evaluate its prognostic effect in the population of the cardiac rehabilitation (CR) appointment who performed CPET. Methods: Retrospective analysis of CR appointment patients (P) who underwent CEPT between 2014 and 2017 in a single tertiary center. Epidemiological, clinical, laboratory, echo and CEPT-related data were retrieved. We determined predictors of DD (defined as an E/e' ratio>14) and evaluated its prognostic impact regarding mortality (M), cardiovascular mortality (CV) and mortality/ HF hospitalization (MH). Results: 207 P (83.6% men) were included, with a mean age of 57 years and a mean follow-up time of 36 months. Ps presented a mean LVEF of 53.7% (14-83%) and a mean E/e' ratio of 10.1. The majority (87.9%) was referred for CR with ischemic cardiopathy (AMI or stable or unstable coronary disease), 9.2% with heart failure and 9.2% with valvulopathy. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason) and 7.3% presented MH. Comparing Ps with DD to Ps without, similar clinical characteristics were found, although the former were older (p=0.001) and presented both lower basal LVEF (p<0.001) and peak VO2 (p<0.001). There was a statistically significant difference between a higher value of E/e' ratio and higher age (r=0.303, p<0.001), diabetes (p = 0.021), chronic kidney disease (p=0.013), left ventricular ejection fraction<35% (p<0.001), higher BNP (r = 0.489, p <0.001), a lower peak VO2 (r =0.507, p<0.001), a higher cardiorespiratory optimal point (r =0.338,p<0.001) and a lower circulatory power (r =0.325,p<0.001). Of these, independent predictors of higher E/e' ratio a lower peak VO2 (p=0.012) and a LVEF<35% (p <0.001). The presence of DD (E/e' ratio>14) was a predictor of M (HR=8.24, IC [1.38-47.4], p=0.021), CV (HR=16.36, IC [1.69-157.57], p=0.016) and MH (HR=7.93, IC [2.23-28.19], p=0.001). Ps with DD presented a lower 30 months survival than Ps with an E/e' ratio<14 (86.3%vs100%, log rank p=0.006). Conclusion: An E/e' ratio>14 was associated to a higher rate of events in our population. Both peak VO2 and a LVEF<35% are independent factors for the presence of DD. P692 https://esc365.escardio.org/Presentation/217036/abstract Effect of exercise training in moroccan patients with chronic heart failure in cardiac rehabilitation N Mouine1, N El Malki Berrada1 1Military Hospital Mohammed V, cardiac rehabilitation unit, cardiology centre , Rabat, Morocco Topic: Chronic Heart Failure: Rehabilitation Introduction: Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and therapeutic education. The aim of our study is to determinate the impact of exercise training in patients with chronic heart failure in cardiac rehabilitation. Materials and methods: Itã s a prospective study included 70 patients with chronic heart failure with reduced ejection fraction (HFrEF), admitted in Cardiac Rehabilitation unit, Cardiology centre of our hospital, all of them had clinical evaluation, echocardiography and cardio respiratory capacities evaluation Results: The average age of patients was 67,36±9,2 years with male predominance, they have more than three cardiovascular risk factors dominated by smoking and hypertension, coronary artery disease is the most frequent aetiology, they had reduced ejection fraction (EF: 32±6,3%). After 20 sessions of exercise training based essentially on muscle building and respiratory physiotherapy ; patients have a good quality of life, they become less symptomatic (dyspnea class III to II of NYHA), they significantly improve the maximal work load (from 50,6 ±10,9 watt to 65,.2 ± 20,8 watt) and VO2max (from 12,1 ± 4,9 ml/kg/min to 18,7 ± 5,7 ml/kg/ min). Conclusion: This study demonstrated that exercise training is clearly benefit for patients with chronic heart failure to improve their exercise capacities and quality of life. P685 https://esc365.escardio.org/Presentation/223108/abstract Combined aerobic and resistance training in de novo heart transplant recipients: an effective and feasible strategy R Stein1, G Carvalho2, G Zubaran2, S Bastos Da Motta2, AC Nique De Souza2, R Goncalves Schmidt2, L Tolfo Franzoni1, RM Nery2, A Donelli Da Silveira2, J Beust De Lima1 1Federal University of Rio Grande do Sul, Porto Alegre, Brazil 2Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil On Behalf of: Exercise Cardiology Research Group Funding Acknowledgements: FIPE/HCPA and CNPq Topic: Heart Transplantation Background: Exercise training after heart transplantation has a established benefit. However, the effect of combined physical training (CPT) in very recent heart transplant recipients (VRHTx) has not been studied. Purpouse: To evaluate the impact of a CPT program in VRHTx. Methods: Case series. A maximal CPET was performed at baseline and after 36 sessions of CPT. Two sessions a week of one periodized protocol of CPT were performed. Training variables were adjusted for each microcycle. Both aerobic and strength exercise were performed at moderate intensity controlled by subjective exertion perception scales (BORG and OMNI scale, respectively). Results: Fourteen patients were included, eight men (57%), mean age 48±13 years old, body mass index 25.8±3.6. Training started on average 68 days after surgery. Table 1. Conclusion: After 36 sessions of CPT, a marked VO2peak improvement was associated with a higher heart rate reserve, increased OUES and O2pulse, despite the absence of changes in HRRec. Moreover, this periodized protocol of CPT was well tolerated inde novoHTxR(Support: FIPE, CAPES and CNPq). Variables From Baseline to Follow-Up CPET variables Pre-CPT Post-CPT VO2 peak 17.3 ± 3,4 21.4 ± 3,8* HR peak 133 ± 14 150 ± 11* O2pulse 9.6 ± 1,6 10.9 ± 1,7* R 1.29 ± 0,1 1.31 ± 0,1 OUES 1.234 ± 0.25 1.483 ± 0.31* VE/VCO2slope 38 ± 4.2 36.1 ± 5.1 HR reserve 38 ± 11 52 ± 10* HR recovery 5 ± 4 2 ± 7 Variables From Baseline to Follow-Up CPET variables Pre-CPT Post-CPT VO2 peak 17.3 ± 3,4 21.4 ± 3,8* HR peak 133 ± 14 150 ± 11* O2pulse 9.6 ± 1,6 10.9 ± 1,7* R 1.29 ± 0,1 1.31 ± 0,1 OUES 1.234 ± 0.25 1.483 ± 0.31* VE/VCO2slope 38 ± 4.2 36.1 ± 5.1 HR reserve 38 ± 11 52 ± 10* HR recovery 5 ± 4 2 ± 7 CPET, cardiopulmonary exercise test; HR, heart rate; Ve, ventilation; R, respiratory exchange ratio; VCO2, carbon dioxide production.*P<0.05. Open in new tab Variables From Baseline to Follow-Up CPET variables Pre-CPT Post-CPT VO2 peak 17.3 ± 3,4 21.4 ± 3,8* HR peak 133 ± 14 150 ± 11* O2pulse 9.6 ± 1,6 10.9 ± 1,7* R 1.29 ± 0,1 1.31 ± 0,1 OUES 1.234 ± 0.25 1.483 ± 0.31* VE/VCO2slope 38 ± 4.2 36.1 ± 5.1 HR reserve 38 ± 11 52 ± 10* HR recovery 5 ± 4 2 ± 7 Variables From Baseline to Follow-Up CPET variables Pre-CPT Post-CPT VO2 peak 17.3 ± 3,4 21.4 ± 3,8* HR peak 133 ± 14 150 ± 11* O2pulse 9.6 ± 1,6 10.9 ± 1,7* R 1.29 ± 0,1 1.31 ± 0,1 OUES 1.234 ± 0.25 1.483 ± 0.31* VE/VCO2slope 38 ± 4.2 36.1 ± 5.1 HR reserve 38 ± 11 52 ± 10* HR recovery 5 ± 4 2 ± 7 CPET, cardiopulmonary exercise test; HR, heart rate; Ve, ventilation; R, respiratory exchange ratio; VCO2, carbon dioxide production.*P<0.05. Open in new tab 24 https://esc365.escardio.org/Presentation/221558/abstract Diagnosis of microvascular angina with a new method by evaluating the nociceptive flexor reflex VB Petrova1, SA Boldueva1, IA Leonova1, AB Petrova2, AI Petrova2 1North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation 2Federal Almazov Medical Research Centre, Saint Petersburg, Russian Federation Topic: Coronary Artery Disease The purpose of this study was to study the diagnostic value of the nociceptive flexor reflex (NFR) method in patients with microvascular angina. Materials and methods. The study included 49 patients with MVA (main group), 40 patients with classical angina II-III f.c. (comparison group 1), 42 patients with silent myocardial ischemia (comparison group 2) and 32 healthy volunteers (control group). Criteria for inclusion in the group with MVA: chest pain, positive stress test, unchanged coronary arteries according to coronary angiography, the presence of myocardial perfusion disturbance and reduction of the coronary reserve according to positironemission tomography of the myocardium at rest, with adenosine and cold one test. Chest pain syndrome was observed in all 49 patients. All subjects studied the functional activity of nociceptive and antinociceptive systems using the nociceptive flexor reflex method on the equipment of expert class electromyography system, the pain threshold (Pb) values, the reflex threshold (Pr) were calculated and the ratio of pain and reflex threshold was calculated to calculate the pain threshold / threshold reflex (Pb/Pr), which in healthy people is about 0.91.0. Results and discussion. In te study of NFR in patients with MVA in the group as a whole, a decrease in the pain threshold, reflex threshold and Pb/Pr ratio compared with normal values were found. The pain threshold in patients in the group was lower (statistically significantly) when compared with the group 1, the group 2 and the control group (p <0.0001; p <0.0001; p <0.0001, respectively). The reflex threshold in patients of the MVA group was also significantly lower when compared with the group 1, the group 2 and the control group (p <0.001; p <0.0001; p <0.001, respectively). Due to the fact that the low pain threshold was found in 84.4% of the examined patients with MVA who had microvascular dysfunction according to positronemission tomography, we evaluated the prognostic value of the NFR method for diagnosing the disease. To do this, an assessment was made of the odds ratio (OR) of identifying MVA in groups of patients with different levels of index K (the ratio of the pain threshold value to the reflex threshold value). We have chosen the value of index K with the highest specificity and high sensitivity equal to 0.8892. Based on the data obtained, the diagnostic value of the NFR method was calculated during the verification of the MVA. When conducting a mathematical analysis, it was found that this technique has high sensitivity (84.4%), specificity (95.12%), positive (90.48%) and negative predictive value (91.76%). We have not found information in the literature on the use of the NFR assessment method and its diagnostic value in MVA. Findings: Due to the high diagnostic value of determining the NFR, we propose to include this method in the MVA diagnostic algorithm as an additional one. 337 https://esc365.escardio.org/Presentation/217054/abstract High triglyceride glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention E Erfei Luo1, D Wang2, C Tang2 1Zhongda Hospital, Southeast University, nanjing, China 2Zhongda Hospital , Department of Cardiology, Nanjing, China Funding Acknowledgements: National Natural Science Foundation of China (Research Grant #81670237 and #81800244) Topic: Coronary Artery Disease Background: Insulin resistance (IR) is considered to be a pivotal risk factor for cardiometabolic diseases and the triglycerideãglucose index (TyG index) has emerged as a reliable surrogate marker of IR. Although several recent studies have shown the association of TyG index with vascular disease, no studies have further investigated the role of TyG index in acute ST-elevation myocardial infarction (STEMI). The objective of the present study is to evaluate the potential role of TyG index as a predictor of prognosis in STEMI patients after percutaneous coronary intervention (PCI). Methods: The study included 1092 STEMI patients who underwent PCI. The patients were divided into 4 quartiles according to TyG index levels,Q1 (n=273, TyG index≤ 8.691), Q2 (n=273, 8.692≤ TyG index≤ 9.097), Q3 (n=273, 9.098≤ TyG index≤ 9.607), Q4(n=273, TyG index≥ 9.608). Clinical characteristics, fasting plasma glucose (FPG), triglycerides (TG) and other biochemical parameters, and the incidence of major adverse cardiovascular and cerebral events (MACCE) during the follow-up period were recorded. TyG index was calculated as formula: ln[fasting TG (mg/dL) × FPG (mg/dL)/2]. Results: It was found that the incidence of MACCE and all-cause mortality within 30 days, 6 months and 1 year after PCI were higher among STEMI patients with TyG index levels in the highest quartile. TyG index was significantly associated with increased risk of MACCE in STEMI patients within 1 year after PCI independent of confounding factors with a value of 1.650 (95% CI: 0.983-2.839) for those in the highest quartile. The results also revealed that Killip class>1, anemia, albumin, uric acid, and left ventricular ejection fraction (LVEF) were independent predictors of MACCE in STEMI patients after PCI (all P<0.05). Conclusions: The study indicated an association between higher TyG index levels and increased risk of MACCE for the first time and TyG index might be a valid predictor of clinical outcomes in STEMI patients undergoing PCI. Figure 1 MACCE-free survival curve Award Winning Science - Population Science & public health section 369 https://esc365.escardio.org/Presentation/217402/abstract Sex differences in symptom presentation in acute coronary syndrome: a systematic review and meta-analysis AR De Boer1, REM Van Oosterhout1, AHEM Maas2, FH Rutten1, ML Bots1, SAE Peters3 1University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands (The) 2Radboud University Medical Center, Cardiology, Nijmegen, Netherlands (The) 3University of Oxford, The George Institute for Global Health, Oxford, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: Dutch Heart Foundation: Grant "Facts and Figures" Topic: Coronary Artery Disease Background: Timely recognition of patients suspected for acute coronary syndromes (ACS) is important for successful treatment with reperfusion therapies. Previous research has suggested that women with ACS present with different symptoms compared with men. Purpose: This review assesses the extent of sex differences in symptom presentation in patients with confirmed ACS, defined as a diagnosis of myocardial infarction or unstable angina. Methods: A systematic literature search was conducted in PubMed, Embase and the Cochrane library up to June 2019. Title-abstract screening and subsequent full-text screening was independently done by two reviewers according to predefined in- and exclusion criteria. Methodological quality of the relevant studies was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% confidence intervals (CI) of a symptom being present in women relative to men were calculated using aggregated and cumulative meta-analyses as well as sex-specific pooled prevalences (PP) for each symptom. Results: Twenty-seven studies were included. Compared to men with ACS, women with ACS had a higher odds of presenting with pain between the shoulder blades (OR 2.15; 95%CI 1.95-2.37), nausea or vomiting (OR 1.64; 95%CI 1.48-1.82) and shortness of breath (OR 1.34; 95%CI 1.21-1.48). Women had a lower odds than men of presenting with chest pain (OR 0.70; 95% CI 0.63-0.78) and diaphoresis (OR 0.84; 95% CI 0.76-0.94). Both men and women presented most often with chest pain (PP men 79%; 95%CI 72-85, PP women 74%; 95%CI 72-85) and other symptom prevalence also showed substantial overlap. The presence of sex differences has already been established in the early 2000ã s, and newer studies have mainly been confirmatory and did not materially change the cumulative findings. Conclusions: Women with ACS do have different symptoms at the time of presentation than men with ACS, but also show considerable overlap. Since these differences have been shown for years, symptoms of ACS should no longer be labelled as either ã atypicalã or ã typicalã. Award Winning Science - Primary care & risk factor management section 83 https://esc365.escardio.org/Presentation/217398/abstract An extracellular vesicle based biomarker signature to detect stress induced ischemia in women presenting with chest pain M Dekker1, F Waissi1, J Bennekom1, MJM Silvis1, N Timmerman1, IEM Bank2, DE Grobbee1, RJ De Winter3, A Mosterd4, DPV De Kleijn1, L Timmers2 1University Medical Center Utrecht, Utrecht, Netherlands (The) 2St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The) 3Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The) 4Meander Medical Center, Amersfoort, Netherlands (The) Funding Acknowledgements: Two of the listed authors received a research grant by the Dutch Heart Foundation, CVON 2017-05 pERSUASIVE. Topic: Coronary Artery Disease Aim: Diagnosis of stable ischemic heart disease (IHD) is complicated, especially in females. Currently, no blood test is available. Using plasma extracellular vesicle (EV) protein levels, we aim to identify stress induced ischemia due to stable ischemic heart disease in chest pain patients Methods: We analysed 250 patients suspected for stable IHD who were referred for 82Rb PET/CT in the outpatient clinic. Myocardial perfusion was evaluated according to the 17 segment model of the AHA. Blood samples were collected before PET/CT and plasma EVs were isolated in 3 plasma sub-fractions (LDL, HDL, TEX). In total 6 proteins, identified by proteomics, were quantified in each of these sub-fractions using immuno-bead assays. Results: Cystatin C, SerpinC1 and CD14 were significantly different between patient with and without ischemia in the LDL and the HDL fraction while SerpinG1 differed only in the HDL fraction. Combining Serpin G1 and Cystatin C in the HDL fraction significantly increased the AUC of the clinical model from 0.73 to 0.78, P-value <0.001. Stratified on sex, showed that the added value of the biomarkers is completely adjudicated to the effect in females with an AUC increase from 0.73 to 0.87 (P value for comparison < 0.001, p value males 0.221). Conclusion: Plasma EV-proteins levels are associated with the presence of stable ischemic heart disease in females presenting with chest pain. This finding, if confirmed in larger cohort studies could be a crucial step in improving diagnostic assessment of females suspect for IHD. ROC Curves diagnostic models EAPC Essentials 4 You - ePosters P137 https://esc365.escardio.org/Presentation/217376/abstract Relationship between carotid intima media thickness and telomere length in coronary artery disease patients: influence of risk factors M Mariana Gois1, RP Simoes1, HS Hirakawa1, P Driusso1, BA Santana-Lemos2, RT Calado2, PHM Andrade3, FF Anibal3, AM Catai1 1Federal University of Sao Carlos, Physical Therapy, Sao Carlos, Brazil 2Medical School of Ribeirão Preto, Department of Internal Medicine, Ribeirao Preto, Brazil 3Federal University of Sao Carlos, Department of Morphology and Pathology, Sao Carlos, Brazil Funding Acknowledgements: Research Grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/PNPD/Brazil, no. 23038.006927/2011-92. Topic: Coronary Artery Disease Background: The telomere length (TL) has been used as a biological marker and its shortening is associated with risk factors, atherosclerotic process and cardiovascular disease. A way to analyze the subclinical atherosclerotic process is by measuring carotid artery intima-media thickness (CIMT). However, this relationship has not yet been well established and to our knowledge, no studies have explored this relationship in coronary artery disease (CAD) patients, verifying which risk factors are associated with TL. Purpose: to verify if there is a relationship between CIMT and TL and, to investigate which risk factors are related to TL in CAD patients. Methods: 50 men aged between 40 and 65 years included, CAD (n=28) and healthy subjects (n=22). The CIMT was evaluated in supine position by carotid ultrasonography. Quantitative real-time polymerase chain reaction was used to measure leukocytes TL. The risk factors hypertension, obesity, type 2 diabetes, dyslipidemia, average CIMT (ACIMT), presence of carotid atherosclerotic plaques (CAP) and number of coronary vessels involved (NCVS) were utilized to multivariate regression analysis to determine the variables affecting the TL. Pearson correlation was applied to verify the relationship between CIMT and TL. Results: Lower TL (CAD=0.38±0.012; Healthy=0.70±0.09; p<0.0001) and higher CIMT (CAD=0.08±0.02; Healthy=0.06±0.01 cm; p<0.0001) was observed in CAD patients. A strong and negative relationship between ACIMT and TL were observed (figure). Dyslipidemia is the main risk factor related to TL shortening (table). Conclusions: The increase in CIMT is associated with the TL shortening in CAD patients. Dyslipidemia is the main risk factor related to the TL shortening. Furthermore, factors related with advanced stage of the atherosclerotic process such as presence of CAP and the NCVI are associated with TL reduction. Variables Regression coefficient 95% CI p-value Hypertension -0.016 -0.0639-0.0308 0.4811 Obesity -0.007 -0.0180-0.0375 0.4143 Type 2 diabetes -0.006 -0.05447-0.0428 0.8040 Dyslipidemia -0.042 -0.0870-0.0012 0.0456‡ ACIMT -1.390 -2.7003- -0.0798 0.0383‡ CAP -0.117 -0.1857- -0.0486 0.0015‡ NCVI -0.035 -0.0665- -0.0048 0.0248‡ Variables Regression coefficient 95% CI p-value Hypertension -0.016 -0.0639-0.0308 0.4811 Obesity -0.007 -0.0180-0.0375 0.4143 Type 2 diabetes -0.006 -0.05447-0.0428 0.8040 Dyslipidemia -0.042 -0.0870-0.0012 0.0456‡ ACIMT -1.390 -2.7003- -0.0798 0.0383‡ CAP -0.117 -0.1857- -0.0486 0.0015‡ NCVI -0.035 -0.0665- -0.0048 0.0248‡ CI = confidence interval; ACIMT = average carotid intima-media thickness; CAP = presence of carotid atherosclerotic plaques; NCVS = number of coronary vessels involved. ‡ Significant. Open in new tab Variables Regression coefficient 95% CI p-value Hypertension -0.016 -0.0639-0.0308 0.4811 Obesity -0.007 -0.0180-0.0375 0.4143 Type 2 diabetes -0.006 -0.05447-0.0428 0.8040 Dyslipidemia -0.042 -0.0870-0.0012 0.0456‡ ACIMT -1.390 -2.7003- -0.0798 0.0383‡ CAP -0.117 -0.1857- -0.0486 0.0015‡ NCVI -0.035 -0.0665- -0.0048 0.0248‡ Variables Regression coefficient 95% CI p-value Hypertension -0.016 -0.0639-0.0308 0.4811 Obesity -0.007 -0.0180-0.0375 0.4143 Type 2 diabetes -0.006 -0.05447-0.0428 0.8040 Dyslipidemia -0.042 -0.0870-0.0012 0.0456‡ ACIMT -1.390 -2.7003- -0.0798 0.0383‡ CAP -0.117 -0.1857- -0.0486 0.0015‡ NCVI -0.035 -0.0665- -0.0048 0.0248‡ CI = confidence interval; ACIMT = average carotid intima-media thickness; CAP = presence of carotid atherosclerotic plaques; NCVS = number of coronary vessels involved. ‡ Significant. Open in new tab ACIMT and TL Pearson correlation P139 https://esc365.escardio.org/Presentation/217324/abstract Body mass index in acute coronary syndromes H Santos1, H Miranda1, I Almeida1, M Santos1, L Almeida1, C Sousa1, C Sa1, S Almeida1, J Chin1, L Santos1, J Tavares1 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal On Behalf of: Portuguese Registry of Acute Coronary Syndromes Funding Acknowledgements: none Topic: Coronary Artery Disease Background: Overweight and obesity are associated with higher prevalence of acute coronary syndromes (ACS). Nonetheless, several studies suggest that these individuals have a better prognosis in case of ACS. Objective: Evaluate the impact of the body mass index (BMI) in ACS. Methods: Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in four groups: A ã underweight (≤18.5 kg/m2); B - normal weight (18.6-24.9 kg/m2); C - overweight (25-29.9 kg/m2); and D - obese (≥30 kg/m2). Were excluded patients without a previous cardiovascular history or clinical data on the admission. According with the four groups was performed a Kaplan-Meier test to establish the survival rates, total and cardiovascular re-admission at one year of follow up. Results: 7860 patients were included, 55 in group A (0.7%), 2419 in group B (30.8%), 3550 in group C (45.2%) and 1836 in group D (23.4%). All groups were similar regarding the time until the onset of symptom and the first medical contact, admitted directly to cat lab, previous ACS, previous heart failure, chronic kidney disease, Killip classification, admission blood samples, admission rhythm and revascularization strategy. Group B presented a higher smoking status (27.3 vs 34.9 vs 28.5 vs 26.9%, p<0.001), ST-segment elevation myocardial infarction (STEMI) at admission (41.8 vs 44.1 vs 43.0 vs 38.7%, p<0.001), B-type natriuretic peptide (338±556 vs 928±1259 vs 394±638 vs 317±502, p<0.001) and de novo atrial fibrillation (2.7 vs 5.1 vs 3.9 vs 3.5%, p<0.001). On the other hand, Groups C and D had more males (34.5 vs 69.6 vs 78.3 vs 72.7%, p<0.001), arterial hypertension (52.7 vs 62.7 vs 70.7 vs 79.8%, p<0.001), diabetes (18.9 vs 24.0 vs 29.3 vs 39.6%, p<0.001), dyslipidemia (43.4 vs 52.0 vs 62.3 vs 67.0%, p<0.001), total cholesterol (183±36 vs 181±45 vs 188±47 vs 188±46, p<0.001), low-density lipoprotein (111±34 vs 114±40 vs 118±41 vs 118±41, p=0.005), triglycerides (100±47 vs 121±74 vs 144±92 vs 163±105, p<0.001) and multivessel disease (30.6 vs 46.8 vs 50.1 vs 48.1%, p=0.023). Curiously, group A was elderly (74±14 vs 68±14 vs 66±13 vs 64±13, p<0.001), higher percentage of left ventricular ejection fraction < 50% (50.4 vs 41.3 vs 38.2 vs 35.8%, p<0.001), de novo heart failure (21.8 vs 17.6 vs 15.8 vs 15.1%, p<0.001), atrioventricular block (4.8 vs 2.9 vs 2.3 vs 2.1%, p=0.004) and death (8.6 vs 4.7 vs 3.2 vs 3.3%, p<0.001). Mortality rates at one year of follow up revealed that overweight at admission was associated with low mortality rates, p<0.001. Re-admission for all causes, p=0.004, showed a better prognosis for overweight patients. On the other hand, regarding re-admission on the follow up for cardiovascular causes non-significant differences were found, p=0.162. Conclusions: Overweight and obesity seems to have a better prognosis for early and long term follow up in ACS patients. P141 https://esc365.escardio.org/Presentation/217328/abstract Cardiovascular risk factors and mortality in acute coronary syndromes H Santos1, M Santos1, H Miranda1, I Almeida1, L Almeida1, C Sousa1, S Almeida1, C Sa1, J Chin1, L Santos1, J Tavares1 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal On Behalf of: Portuguese Registry of Acute Coronary Syndromes Funding Acknowledgements: none Topic: Coronary Artery Disease Background: Acute coronary syndromes (ACS) patients had frequent several risk factors (CVRF). Some of them can have more or less influence in the prognosis of theses patients. Objective: Evaluate if CVRF can be used in the prediction of intrahospital mortality in patients readmitted for ACS. Methods: Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A ã patients the survivor to re-ACS and B ã patients that died in that readmission for ACS. CVFR was defined by diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess if CVFR was predictors of mortality in patients readmitted for ACS. Results: 4931 patients were included, 4764 in group A (96.6%) and 167 in group B (3.4%). Both groups were similar regarding arterial hypertension, diabetes, neoplasia, first medical contact and admitted directly to cat lab. As expected, group B presented higher CVFR, body mass index (27.6±4.2 vs 26.6±3.9, p=0.019), dyslipidemia (76.8 vs 14.6%, p<0.001), valvulopathies (5.3 vs 10.8%, p=0.003), heart failure (13.4 vs 27.5%, p<0.001), stroke (9.6 vs 20.4%, p<0.001), peripheral arterial disease (11.9 vs 21.6%, p<0.001) and chronic kidney disease (10.9 vs 25.6%, p<0.001). Curiously the group A exhibited higher prevalence of smoking status (20.4 vs 13.8%, p=0.035), dyslipidemia (76.8 vs 68.3%, p=0.010) and chest pain at admission (91.5 vs 74.5%, p<0.001). On the other hand, group B presented more females (21.2 vs 28.1%, p=0.031), was elderly (69±12 vs 77±12, p<0.001), ST-segment elevation myocardial infarction at admission (23.2 vs 34.7%, p<0.001) with a culprit lesion on the left anterior descending artery (46.3 vs 64.8%, p=0.008), Killip-Kimball classification ≥ II (17.6 vs 61.0%, p<0.001), multivessel coronary disease (63.3 vs 81.9%, p<0.001) and left ventricular ejection fraction <30% (6.4 vs 43.4%, p<0.001). Logistic regression revealed that the presence of 3-4 CVRF compared to the presence of 0-2 CVFR (odds ratio (OR) 0.70, confidence interval (CI) 0.46-1.06) as well the presence of 5-7 CVRF compared to the presence of 0-2 CVFR (OR 0.982, CI 0.50-1.91) were not predictors of intrahospital mortality in patients re-admission for ACS. Conclusions: The presence of more CVRF were not predictors of intrahospital mortality in re-admission for ACS. P142 https://esc365.escardio.org/Presentation/217338/abstract Do football matches affect cardiovascular events? L Lukasz Kuzma1, K Struniawski1, S Pogorzelski1, P Sielatycki1, M Zalewska-Adamiec1, P Kralisz1, K Nowak1, H Bachorzewska-Gajewska1, S Dobrzycki1 1Medical University of Bialystok, Bialystok, Poland Topic: Coronary Artery Disease Introduction: Acute coronary syndrome (ACS) could be triggered by emotions, often associated with watching sport events. Purpose: To assess the influence of stress caused by football matches played by professional local team on the frequency of hospital admissions for ACS. Material and methods: The study was based on medical records of 26,595 patients treated in the local Department of Invasive Cardiology in 2007ã2018. All of official matches of the local team at the same time were qualified to the analysis. Poisson regression with time of 0 and +1 day was used to assess the effect of matches. Results: A total of 10,529 inhabitants of the city and city county, with a mean age of 66.6 years (SD=12), hospitalized for ACS were qualified to the study, of which 62% were men. The mean daily number of ACS was 2.4 (SD=1.7). Since 2007, local professional football team had played 451 matches in the European Cups and the national Top League. Excluding seasonal impact, the number of male admissions for ACS raised by 9 % for matches played at home was noted (OR 1.09, 95% CI 0.89ã1.24, P=0.53) and this effect was significant after lost matches (OR 1.27, 95% CI 1.02ã1.58, P=0.03). Conclusions: The results achieved by the local professional football team were associated with the occurrence of ACS in the male population. Mental and emotional stress caused by lost games play an important role as a factor triggering ACS in males. P143 https://esc365.escardio.org/Presentation/217614/abstract Do diabetics have higher Lp (a)? Prevalence of Lp (a) in diabetic and non diabetic patients R Regine Gottfried-Kwasniok1, D Stoyanova1, M-R Poudel1, J Gilis-Januszewski1, V Rudolph1, K-P Mellwig1 1Heart and Diabetes Center NRW, Bad Oeynhausen, Germany Topic: Coronary Artery Disease Purpose: Diabetes and high lipoprotein (a) levels are well known cardiovascular risk factors. There is a causal and proportional association known of high Lp (a) levels and an early manifestation of coronary artery disease (mendelian randomization studies). Patients and Methods 52 894 patients (20 002 [27.8%] women and 32892 [62.2%] men, mean age 71.37 (±16.39 yrs), admitted to our hospital between 2004 and 2014 were screened and 48227 patients were enrolled in this study. Gender, age, low density lipoprotein (LDL), high density lipoprotein (HDL), HbA1c and lipoprotein (a) were evaluated. Results: 30331 patients (62.9%) were non diabetics and 17896 (37.1%) diabetic patients with a mean Lp (a) of 26.94±34.94 mg/dl (non diabetics) and 23.48±32.44 mg/dl (diabetics). The patients were devided in 4 groups based on Lp (a) < 30mg/dl, Lp (a) 30-60 mg/dl, Lp (a) 61-100 mg/dl and Lp (a) >100 mg/dl) relating to diabetes. In the group of diabetic patients 13588 pts (75.9%) had a Lp (a) <30 mg/dl, 2034 pts (11.3%) a Lp (a) 30-60 mg/dl, 1595 pts (8.9%) a Lp (a) 61-100 mg/dl and 679 pts (3.8%) were in the high risk group with a Lp (a) >100 mg/dl. In the group of non-diabeticts 21896 pts (72.2%) a Lp (a) <30 mg/dl could be found, 3513 pts (11.6%) had a Lp (a) 30-60 mg/dl and 3509 pts (11.6%) a Lp (a) 61-100 mg/dl. In the high risk group with a Lp (a) >100 mg/dl were 1413 pts (4.7%). Conclusion: High levels of Lp (a) >60 mg/dl are well known risk factors for cardiovascular disease in young age. In our study a significant difference was seen in the mean Lp (a) in diabetic and non diabetic patients (p<0.0001) with higher mean Lp (a) in the patient group without diabetes. In the groups with high (>60-100 mg/dl) and very high Lp (a) (>100 mg/dl) the prevalence was at about 15% in both patient groups. Measurements of Lp (a) at least once in a life time are important in diabetic and non diabetic patients to reduce cardiovascular risk. More studies are needed to evaluate a potential causal correlation between lower lipoprotein (a) in diabetic patients, probably because of a better drug treatment. P145 https://esc365.escardio.org/Presentation/217369/abstract Predictors of de novo heart failure in patients readmitted for acute coronary syndromes H Santos1, M Santos1, H Miranda1, I Almeida1, L Almeida1, C Sousa1, J Chin1, C Sa1, S Almeida1, L Santos1, J Tavares1 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal On Behalf of: Portuguese Registry of Acute Coronary Syndromes Funding Acknowledgements: none Topic: Coronary Artery Disease Background: Acute coronary syndromes (ACS) are frequent in adult patients, being the cardiovascular risk factors (CVRF) predictors, even in cases of re-admission for ACS. Heart failure (HF) after an ACS is a common complication and the CVRF can influence its manifestation. Objective: Evaluate predictors of de novo HF and the relevance of CVFR in patients readmitted for ACS. Methods: Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A ã without de novo HF and B ã with de novo HF. CVFR was defined by diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of de novo HF in patients readmitted for ACS. Results: 3983 patients were included, 3290 in group A (82.6%) and 693 in group B (17.4%). Both groups were similar regarding body mass index, dyslipidemia, first medical contact and admitted directly to cat lab. Curiously the group A exhibited higher prevalence of smoking status (21.4 vs 14.6%, p<0.001). On the other hand, group B presented more females (20.0 vs 28.3%, p<0.001), age > 75 years old (21.4 vs 14.6%, p<0.001), arterial hypertension (82.0 vs 88.9%, p<0.001), diabetes mellitus (40.3 vs 55.4%, p<0.001), valvulopathies (4.4 vs 11.4%, p<0.001), stroke (8.9 vs 15.3%, p<0.001), peripheral arterial disease (10.8 vs 19.4%, p<0.001), chronic kidney disease (9.3 vs 21.1%, p<0.001), neoplasia (5.3 vs 7.9%, p=0.003), chronic obstructive pulmonary disease (COPD) (5.4 vs 10.9%, p<0.001), ST-segment elevation myocardial infarction at admission (22.6 vs 26.0%, p=0.038) with a culprit lesion on the left anterior descending artery (43.8 vs 60.5%, p<0.001), heart rate > 100 bpm at admission (9.7 vs 24.1%, p<0.001), systolic blood pressure < 90 mmHg (1.9 vs 6.1%, p<0.001), Killip-Kimball classification ≥ II (9.2 vs 67.3%, p<0.001), atrial fibrillation at admission (6.4 vs 14.0%, p<0.001), multivessel coronary disease (61.4 vs 79.2%, p<0.001) and left ventricular ejection fraction (LVEF) <50% (39.3 vs 74.9%, p<0.001). Logistic regression revealed the presence of 3-4 CVRF (odds ratio (OR) 1.60, p<0.001, confidence interval (CI) 1.30-1.98), ≥5 CVFR (OR 2.25, p<0.001, CI 1.54-3.29), female (OR 1.31, p=0.019, CI 1.05-1.64), >75 years old (OR 2.15, p<0.001, CI 1.76-2.64), valvulopathies (OR 1.59, p=0.007, CI 1.13-2.23), previous stroke (OR 1.56, p=0.001, CI 1.19-2.04), COPD (OR 1.66, p=0.004, CI 1.18-2.33), systolic blood pressure < 90 mmHg (OR 2.56, p<0.001, CI 1.53-4.28), heart rate > 100 bpm (OR 1.56, p<0.001, CI 1.21-2.02), multivessel coronary disease (OR 1.90, p<0.001, CI 1.45-2.48) and LVEF <50% (OR 3.18, p<0.001, CI 2.58-3.94) as predictors of HF in patients re-admission for ACS. Conclusions: The presence of more CVRF were clinical predictors of HF in re-admission for ACS. P147 https://esc365.escardio.org/Presentation/217347/abstract Exposure to air pollution - A trigger for myocardial infarction? L Kuzma1, K Struniawski1, S Pogorzelski1, K Nowak1, P Kralisz1, M Zalewska - Adamiec1, H Bachorzewska-Gajewska1, S Dobrzycki1 1Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland Topic: Coronary Artery Disease Introduction: Air pollution is a documented risk factor for circulatory diseases. Many studies demonstrated that the influence of air pollution on acute coronary syndrome (ACS) may be associated with the destabilization and rupture of atherosclerotic plaques as a result of oxidative stress, inflammation, endothelial dysfunction, and imbalance of the autonomic nervous system. Purpose: To assess the influence of air pollution on the number of hospital admissions for ACS. Patients and methods: The study was conducted in university hospital in northãeastern Europe. The medical records of 26,695 patients hospitalized for ACS in the local Department of Invasive Cardiology in 2009ã2017 were examined. Weather conditions and the following components of air pollution were analyzed: sulfur dioxide, nitrogen dioxide, and particulate matter with a diameter of 2.5 mm or less (PM2.5) and a diameter of 10 mm or less (PM10). Results: A total of 2645 inhabitants of the city were qualified for the study. All patients lived within the borders of the city, with the maximal distance from the measure station being 6 km. PM2.5 norm was exceeded on 24.58% days, while PM10 norm was exceeded on 5.32% days In the group of patients hospitalized for NSTEMI a delayed effect (LAG 1) on a greater number of hospital admissions associated with an increased concentration of PM2.5 (RR 1.10, 95% CI 1.01ã1.21, P= 0.048) was noted. Additionally, for patients with NSTEMI an increase in concentration of NO2 by 10 µg/m3 was associated with 19% increased number of hospitalizations (RR 1.19, 95% CI 1.01ã1.41, P= 0.048). Similarly, an increase in concentration of NO2 was associated with 17% greater number of hospitalizations for unstable angina (UA) (RR 1.17, 95% CI 1.02ã1.36, P= 0.031). The temperature drop by 10 °C resulted in 11% increased number of hospitalizations due to STEMI (OR 1.11, 95% CI 1.01ã1.21, P= 0.01). Conclusion: Increased exposure to air pollution is associated with a greater occurrence of ACS, in particular NSTEMI and UA. The main hospitalization-affecting air pollutants are PM2.5 and NO2. P148 https://esc365.escardio.org/Presentation/223130/abstract The effect of Metformin on adiponectin expression in adipocytes of various fat depots in patients with coronary artery disease diseases and heart defects Y Yulia Dyleva1, O Gruzdeva1, D Borodkina1, E Uchasova1, E Belik1, K Kosyrin1, O Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Funding Acknowledgements: The study was supported by the Russian Science Foundation (Grant Number: 17-75-20026) Topic: Coronary Artery Disease Objective: To study the character of adiponectin gene expression and its concentration in adipocyte culture of different localization and the influence of different doses of Metformin on these processes in patients with coronary heart disease and heart defects. Materials: The study included 84 patients with coronary artery disease (CAD) undergoing training for coronary artery bypass surgery and 50 patients with heart defects. Samples of subcutaneous adipose tissue (SAT), epicardial (EAT) and perivascular (PVAT) were collected during coronary artery bypass surgery and surgery on heart valves. Adipocytes isolation was performed according to the established protocol developed by Carswell (2012). Cultivation of isolated adipocytes during the 1 day with 1 and 10 µmol/l metformin. Expression of the adiponectin gene (AdipoQ) after 1 day of cultivation was evaluated by quantitative real-time polymerase chain reaction (qPCR) using TaqManTM Gene Expression Assays in the ViiA 7 Real-Time PCR System. The levels of adiponectin in the culture medium adipocytes on the 1st day of cultivation were measured using commercially available enzyme immunoassay kits. Results: Adipocytes SAT, EAT and PVAT differed in the level of adiponectin secretion and expression of its gene. After 24 hours of cultivation, adiponectin gene expression was lower in the culture of EAT in comparison with SAT and PVAT in a group of patients with CAD and with heart defects. In a group of patients with CAD the adiponectin content in the culture of adipocytes of EAT and PVAT was lower in comparison with SAT. In the group of patients with heart defects the content of adiponectin in the culture of adipocytes of EAT was lower than in PVAT and SAT. At the same time, the level of adiponectin among patients with heart defects was higher in comparison with patients with CAD. The addition of 1 µmol/l Metformin to cell cultures increased the expression of the adiponectin gene and secretion in the adipocytes of SAT and EAT in the group of patients with CAD. In the group of patients with heart defects the addition of 1 µmol/l Metformin increased the level of expression of the adiponectin gene and its secretion in adipocytes regardless of their location, 10 µmol/l Metformin also increased the expression of the adiponectin gene in adipocytes of EAT and PVAT. Similarly, the concentration of adiponectin in the culture of adipocytes changed. Conclusion: Metformin at a concentration of 1 µmol/l was more effective compared to a concentration of 10 µmol/l among patients with CAD and increased the level of gene expression and adiponectin content in the culture of adipocytes of SAT and EAT. While in the group of patients with heart defects Metformin at concentrations of 1 and 10 µmol/l increased the level of gene expression and adiponectin content in the culture of adipocytes of all three cultures, however, in the culture of EAT 1 µmol/l Metformin was more effective. P149 https://esc365.escardio.org/Presentation/217081/abstract Optimising lipid treatment following myocardial infarction C Cartmill1, I Menown1, G Klabbers2 1Craigavon Cardiac Centre, CRAIGAVON, United Kingdom of Great Britain & Northern Ireland 2Faculty of Health, Medicine and Life Sciences Maastricht University, Global Health, Maastricht, Netherlands (The) Topic: Coronary Artery Disease Introduction: ESC guidelines recommend intensive control of LDL cholesterol (LDL-C) following myocardial infarction (MI) to improve outcome. Early assessment of lipids post MI is confounded by acute phase response requiring re-testing to guide need for up-titration +/-additional treatment. Method: We studied patients admitted with MI across a healthcare region including 2 acute receiving hospitals over two years(2017-2018). Diagnosis, cardiovascular (CV) risk factors, CV history (Hx), lipid treatment before admission, lipid profile on admission, lipid treatment on discharge, lipid profiles at first and second follow up, changes to lipid treatment and readmission were recorded. Results: Of 638 acute MI admissions, 227(35.6%) had ST-elevation MI, 464(72.7%) were male, 174(27.3%) female. Baseline CV risk factors included diabetes 137(22.3%), family Hx 291(52.8%), smoking [current 188(30.9%); ex 164(26.9%)], CV Hx 359(58.1%). Lipid profile was tested on admission in 431(67.7%) subjects. For those already on lipid treatment, mean LDL-C was 2.22mmol/l; for those not, mean was 2.91mmol/l. Almost all (98.3%) were prescribed lipid lowering therapy (Atorvastatin 92.0%, Simvastatin 2.1%, Rosuvastatin 5.1%, Pravastatin 0.3%, Ezetimibe 0.5%). High intensity statin was used in 94.4% of the sample. Mean time to first follow-up lipid profile was 5.65months. Follow up profiles were available in 85.6% in whom mean LDL-C was 1.67mmol/l. At first follow up 349(54.7%) met the 2018 ESC target <1.8mmol/l. For those not at target, 62(32.8%) received no further lipid testing and 13(6.9%) had therapy increased. At final lipid test, 62.7% achieved LDL-C <1.8mmol/l. Males (p = <0.1) and diabetics (p = 0.01) were more likely to achieve target. Females were more likely to receive a lower dose of Atorvastatin (p = 0.004). There was no significant relationship between diabetes and discharge on higher intensity therapy (p > 0.05). Only 207 (37.9%) achieved the 2019 ESC target <1.4mmol/L, 36(6.6%) still had high LDL-C >3mmol/L and 23(4.3%) had very high LDL-C >3.5mmol/L. Post discharge, 105(16.7%) received changes to lipid therapy; 32(5%) increased, 73(11.4%) decreased. A cardiac-related readmission occurred in 140(21.9%). Conclusion: In this large sample, baseline lipid profiles were available in only 2/3 patients and although follow up samples were available in 85.6%, the mean time for first follow up was double the recommended 3 months losing early opportunity for up-titration. Such follow up is of high clinical importance as, despite high use of intensive statin therapy, over 1/3 patients failed to achieve LDL-C <1.8mmol/L. Fewer female patients were discharged on 80mg dose and were less likely to achieve target highlighting the importance of follow up in this group. At follow up only <5% met current NICE guidelines for use of PCSK9i yet 2/3 failed to achieve the current LDL-C target <1.4mmol/L, suggesting a need for greater use Ezetimibe +/- PCSK9i therapy. P150 https://esc365.escardio.org/Presentation/217123/abstract Treatment of anxiety improves quality of life of patients with ischemic heart disease A Aleksei Ibatov1 1Sechenov Moscow medical academy , Moscow, Russian Federation Topic: Coronary Artery Disease The purpose: to study influence of treatment of anxiety on quality of life of the patients with ischemic heart disease (IHD) and anxiety. Materials and methods: The first group - 44 patients with clinical expressed anxiety (score ≥11 on Hospital Anxiety and Depression Scale - HADS) and IHD from 38 till 68 years (average age 54.6±1.2 years) were examined. The second group - 93 patients without anxiety (score ≤ 7 on HADS) and IHD (average age 56.8±0.8 years) were examined. All patients had the angina pectoris (II-IV functional class). A level of quality of life was estimated by Seattle Angina Questionnaire of quality of life (SAQ). Results: The level of anxiety was 12.8±0.3 score in the first group, and 4.7±0.3 score in the second group (p < 0.0001). The quality of life in the first group was 56.7±4.1 score on Physical limitation scale, 36.3±2.6 score - on Angina stability scale, 47.9±2.7 score - on Angina frequency scale, 54.8±2.5 score - on Treatment satisfaction scale, 42.5±2.3 score - on Disease perception scale, 52.1±1.7 score on Total score scale of quality of life. The quality of life in the second group was 59.9±1.9 score on Physical limitation scale (p > 0.05), 50.9±2.7 score - on Angina stability scale (p < 0.01), 58.0±2.5 score - on Angina frequency scale (p < 0.01), 67.4±1.2 score - on Treatment satisfaction scale (p < 0.01), 54.2±1.5 score - on Disease perception scale (p < 0.01), 60.2±1.3 score - on Total score scale of quality of life (p < 0.01). 25 patients of the first group were treated by anxiolytic lorazepam in a dose 2.5 mg /day during 4 weeks. After course of anxiolytic treatment the decreasing of level of anxiety, improvement of mood, sleep, emotional status were observed. The decreasing of level of anxiety on 39.1 % (p < 0.001) was estimated by HADS after course of anxiolytic treatment. The improvement of quality of life +45.6% on Angina stability scale SAQ (p < 0.01), +41.3% on Disease perception scale SAQ (p < 0.01), +22.0% score on Total score scale of quality of life SAQ (p < 0.01) in the first group in comparison with the second group were observed after course of anxiolytic treatment. Conclusion: anxiety worsens quality of life of the patients with ischemic heart disease. Treatment of anxiety improves quality of life of the patients with ischemic heart disease and anxiety. P152 https://esc365.escardio.org/Presentation/217077/abstract Metabolic and inflammatory biomarkers in evaluation of coronary arteries anatomical stenosis in patients with stable coronary artery disease O Olga Koshelskaya1, O Kharitonova1, O Zhuravleva1, I Kologrivova1, T Suslova1 1Tomsk National Research Medical Center of Russian Academy od Sciences, Cardiology Research Institute, Tomsk, Russian Federation Topic: Coronary Artery Disease Purpose: to reveal the statistically significant determinants of the coronary artery stenosis ≥70% in patients with stable chronic coronary artery disease (CAD) receiving optimal medication therapy, including statins. Methods: The study included 68 patients (m 38/f 30, 59.6±6.4 years) with stable CAD and optimal medication therapy. Coronary angiography was performed in all patients. Patients were divided into 2 groups: Gr.1 ã coronary artery stenosis ≥70% (n=53) and Gr.2 ã coronary artery stenosis <70% (n=15). Basic parameters of carbohydrate and lipid metabolism were evaluated; serum concentration of cytokines, adipokines and high sensitive C-reactive protein (hsCRP) were determined by ELISA. The epicardial adipose tissue (EAT) thickness was measured by B-mode echocardiography. A classification model based on logit regression was developed for classifying patients into groups with coronary artery stenosis <70% and ≥70%. Results: Coronary artery stenosis ≥70% correlated with levels of triglycerides (Rs=0.31), HDL (Rs= -0.28) and male gender (Rs= 0.24). We have revealed significant differences between Gr.1 and Gr.2 for the following independent indicators: gender (p=0.049), levels of triglycerides (p=0.011), HDL (p=0.023) and hsCRP (p = 0.050). The patientsã classification model was created, allowing to determine probability P for coronary artery stenosis of 70% or more for each patient using formula P=1/(1+exp(-L), where L=0.89 - 1.09 × gender + 0.51 × triglycerides - 0.28 × HDL + 0.24 ×hsCRP. If calculated P value falls into interval (0; 0.228) the patient should be classified into the group with the risk of coronary artery stenosis≥ 70%, while if calculated P value falls into interval (0.228; 1), the patient should be classified into group with coronary artery stenosis below 70%. Even though EAT was indistinguishable determinant of coronary artery stenosis≥ 70% in our study, its inclusion into the model as a fifth variable allowed to increase the model quality: area under ROC-curve (AUC) in the model without EAT constituted 0.708 (p=0.009), and increased up to 0.879 (p=0.011) after EAT inclusion. Conclusions: In our sample of CAD-patients male gender, level of triglycerides, HDL and hsCRP appeared to be statistically significant determinants of coronary artery stenosis ≥70%, whereas EAT can only be used as an additional marker of coronary atheroclerosis severity. The presence of the triglycerides and HDL levels in the created model underscores an important contribution of these lipid fractions into modulation of the residual cardiovascular risk in patients receiving optimal medication therapy, including statins. P153 https://esc365.escardio.org/Presentation/217379/abstract Sortilin: association with FoxP3+ Treg lymphocytes and metabolic status in patients with stable coronary artery disease I Irina Kologrivova1, O Koshelskaya1, T Suslova1, O Haritonova1, O Trubacheva1, M Sirotina1 1Cardiology Research Institute Tomsk National Research Medical Centre Russian Academy of Sciences, Tomsk, Russian Federation Topic: Coronary Artery Disease Background/Introduction. Sortilin has been shown to input the development of cardio-vascular disorders, and to be involved both in the development of inflammation and metabolic control. Key sortilin-mediated pathways are not fully explored yet. Purpose: The purpose was to study the relationships between sortilin, metabolic parameters and function of FoxP3+ T-regulatory lymphocytes (Treg) in patients with stable coronary artery disease (CAD), depending on the quality of glucose control. Methods: In total 23 CAD patients were recruited in study. Patients with fasting glucose < 6.5 mM and postprandial glucose <8 mM were classified as those with sufficient glycemic control (n=16; gr. 1). Patients who did not reach either or both target values of glucose were classified as those with insufficient glucose control (n=7; gr. 2). Concentration of sortilin was detected by ELISA. Frequency of FoxP3+ Treg-lymphocytes was evaluated by flow cytometry. Nuclear translocation of FoxP3 has been evaluated by imaging flow cytometry in 6 patients. Standard parameters of lipid spectrum were also evaluated. Results: Patients from gr. 2 tended to have decreased sortilin levels compared to gr. 1 patients (5.23 (4.86; 7.48) ng/ml vs. 16.19 (10.44; 116.08 ng/ml; p=0.056)) and increased concentration of triglycerides (TG) (1.78 (1.48; 1.96) mM vs. 1.25 (0.97; 1.46) mM; p=0.036). Frequency of Treg did not differ significantly between groups and constituted 3.04 (1.80;4.31)% and 4.62 (2.56; 5.49)% in gr. 1 and gr. 2, respectively. We have revealed strong positive correlation between the level of nuclear translocation of FoxP3 in Treg cells and serum concentration of sortilin (Rs=0.886; p=0.019) and negative correlations between sortilin and fasting glucose (Rs=-0.772; p=0.009); sortilin and serum TG (Rs=-0.770; p=0.009); sortilin and ration TG/high-density lipoproteins cholesterol (Rs=-0.685; p=0.029). Fasting glucose level and degree of FoxP3 nuclear translocation tended to have negative associations (Rs=-0.771; p=0.072). Conclusions: Our results underscore the involvement of sortilin in regulation of metabolic control and immune parameters during coronary artery disease. Insufficient glycemic control in CAD patients is associated with unfavorable changes in sortilin-lipid metabolism axis. To our knowledge we are the first to show that serum sortilin is associated with nuclear translocation of FoxP3. This fact should be considered during elaboration of new approaches for secondary prevention in patients with coronary artery disease. P155 https://esc365.escardio.org/Presentation/217329/abstract Cardiovascular risk factors in patient with previous acute coronary syndromes H Santos1, I Almeida1, M Santos1, H Miranda1, L Almeida1, C Sousa1, S Almeida1, J Chin1, C Sa1, L Santos1, J Tavares1 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal On Behalf of: Portuguese Registry of Acute Coronary Syndromes Funding Acknowledgements: none Topic: Coronary Artery Disease Background: Several cardiovascular risk factors (CVRF) were associated with acute coronary syndromes (ACS). Some of them had a bigger impact, nevertheless the presence of various was considering a bigger risk for the patient. Even in patients with a previous ACS, that is expected to be controlled, the CVRF are a marker of risk for another ACS and its prognosis. Objective: Evaluate the impact of CVRF in patients with previous ACS. Methods: Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in three groups: A ã ≤ 2 CVFR; B ã 3-4 CVFR and C - ≥5 CVFR. CVFR was defined by diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Were excluded patients without a previous cardiovascular history or clinical data on the admission. According with the three groups was performed a Kaplan-Meier test to establish the survival rates, total and cardiovascular re-admission at one year of follow up. Results: 4931 patients were included, 2025 in group A (41.1%), 2619 in group B (53.1%) and 287 in group C (5.8%). Group C had more males (77.2 vs 78.7 vs 86.8%, p<0.001), was elderly (69±13 vs 69±12 vs 70±10, p=0.035), obesity (19.3 vs 27.6 vs 26.3%, p<0.001), smoking status (10.7 vs 23.1 vs 19.2%, p<0.001), arterial hypertension (89.6 vs 95.9 vs 100%, p<0.001), diabetes (14.2 vs 60.3 vs 88.2%, p<0.001), dyslipidemia (54.4 vs 91.3 vs 97.2%, p<0.001), chronic kidney disease (2.2 vs 13.3 vs 57.8%, p<0.001), peripheral arterial disease (1.4 vs 14.0 vs 71.8%, p<0.001), neoplasia (2.0 vs 7.1 vs 20.6%, p<0.001), Killip Kimball classification ≥ II (14.0 vs 21.2vs 34.3%, p<0.001), triglycerides > 150 mg/dL (27.4 vs 40.8 vs 42.5%, p<0.001), multivesssel disease (59.2 vs 65.9 vs 73.3%, p<0.001), left ventricular ejection fraction < 50% (44.6 vs 45.1 vs 58.2%, p<0.001) and presented higher mortality rates in the admission for re-ACS (3.2 vs 3.3 vs 6.7%, p=0.008). On the other hand, group A presented more chest pain at admission (92.3 vs 90.6 vs 87.7%, p=0.013), ST-segment elevation myocardial infarction (26.8 vs 22.7 vs 15.3%, p<0.001), was admitted directly to the cat lab (7.9 vs 6.3 vs 4.6%, p=0.035) and total cholesterol (167±45 vs 167±48 vs 156±47, p=0.004). Mortality rates at one year of follow up revealed that the presence of more CVFR was associated with higher mortality rates, p<0.001, as well to re-admission for all causes, p<0.001, and cardiovascular re-admission p<0.001. Conclusions: The presence of more CVRF in patients with previous ACS was associated with worse prognosis to early and long term follow up in the re-admission for a new ACS. P450 https://esc365.escardio.org/Presentation/223126/abstract ST segment elevation myocardial infarction (STEMI) due to left circumflex coronary artery stenosis: electrocardiographic parameters, infarct size, reperfusion delay and prognosis. P Pedro Perez Diaz1, A Jurado Roman2, I Sanchez Perez1, MT Lopez Lluva1, J Abellan Huerta1, R Maseda Uriza1, J Piqueras Flores1, N Bermejo Calvillo3, R Frias Garcia1, A Moron Alguacil1, F Lozano Ruiz Poveda1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2University Hospital La Paz, Cardiology, Madrid, Spain 3Hospital General de Ciudad Real, General practitioner, Ciudad Real, Spain On Behalf of: University General Hospital of Ciudad Real, Ciudad Real, Spain. Funding Acknowledgements: No sources of funding were provided for this work. Topic: Coronary Artery Disease Background: Left circumflex (LCx) occlusion is underdiagnosed in most of studies about myocardial infarction, due to its poor electrocardiographic expressiveness and late diagnosis, which leads to longer higher reperfusion time. Purpose: To compare peak of cardiac biomarkers, electrocardiographic abnormalities, reperfusion delay, hospital stay and survival in STEMI, due to left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) stenosis. Methods: Observational prospective study including 323 patients with STEMI in a single university hospital between 2016 and 2018. We analyzed clinical presentation, peak of markers, electrocardiogram and reperfusion delay. Average hospital stay and long-term mortality were assessed in case of occlusion of left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) occlusion (TIMI = 0). Results: LCx was occluded in 13% (culprit lesion in 14%). Peak of troponin was 75 +/- 51, 47 +/- 57 and 37 +/- 64 ng/ml in LAD, LCx and RCA stenosis respectively (p<0.01). The most frequent ECG finding in LCX stenosis was "ST depression in V1-V4 leads and ST elevation in inferior leads" (sensitivity 11%; specificity 96%; positive predictive value 29%, negative predictive value 86%). Median time from symptoms onset to emergency department was 139 +/- 3131, 157 +/- 220 and 166 +/- 116 minutes respectively (p=0.101). No differences in median time from emergency unit to invasive cardiology department were detected (p=0.767). 305 patients underwent percutaneous coronary intervention (PCI): 142 thrombectomy (47%) and 270 direct stenting or predilatation and stenting technique (89%). Median syntax score was 12 +/- 16, and success rate 99%. Patients with LDA occlusion presented lower systolic function after AMI (43% , 52% and 54%; p<0.001), and higher rate of all-cause mortality before discharge (p= 0.009), 6 months (0.014) and 1 year after myocardial infarction (p=0.036). Conclusions: ST depression in V1-V4 leads and ST elevation in inferior leads seems to be a low sensitive but highly specific electrocardiographic parameter in STEMI due to LCx stenosis. We did not detect a higher infarct size nor longer reperfusion time in these patients, but patients with STEMI due to LAD occlusion presented higher short and medium-term mortality. Reperfusion delay P451 https://esc365.escardio.org/Presentation/223115/abstract Left circumflex coronary artery as the culprit vessel in myocardial infarction: electrocardiographic parameters, infarct size, reperfusion delay and prognosis. P Pedro Perez Diaz1, A Jurado Roman2, I Sanchez Perez1, MT Lopez Lluva1, J Abellan Huerta1, R Maseda Uriza1, J Piqueras Flores1, N Bermejo Calvillo3, R Frias Garcia1, VM Munoz Garcia1, F Lozano Ruiz Poveda1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2University Hospital La Paz, Cardiology, Madrid, Spain 3Hospital General de Ciudad Real, General practitioner, Ciudad Real, Spain On Behalf of: University General Hospital of Ciudad Real, Ciudad Real, Spain. Funding Acknowledgements: No sources of funding were provided for this work. Topic: Coronary Artery Disease Background: Left circumflex (LCx) occlusion is underdiagnosed in most of studies about myocardial infarction, due to its poor electrocardiographic expressiveness and late diagnosis, which leads to longer higher reperfusion time. Purpose: To compare peak of cardiac biomarkers, electrocardiographic abnormalities, reperfusion delay, hospital stay and survival in acute and subacute myocardial infarction, due to left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) occlusion. Methods: Observational prospective study including 873 patients with acute coronary syndrome in a single university hospital between 2016 and 2017. We analyzed clinical presentation, peak of markers, electrocardiogram, reperfusion delay, average hospital stay and long-term mortality in left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) occlusion (TIMI = 0). Results: 873 patients with acute coronary syndrome were analyzed, of which LCx was occluded in 10%. 38, 52, and 10% of cases with LCx occlusion presented as Non-ST Segment Elevation Myocardial Infarction (NSTEMI), ST Segment Elevation Myocardial Infarction (STEMI) and subacute myocardial infarction respectively. Peak of troponin was 53, 37 and 40 ng/ml in LAD, LCx and RCA respectively (p=0,002). The most frequent ECG finding in NSTEMI due to LCX occlusion was "repolarization abnormalities or ST depression in lateral leads" (sensitivity 22%; specificity 99%; positive predictive value 88%, negative predictive value 87%). No differences in median time from symptoms onset to emergency department were detected (p=0.184), but mean time from emergency unit to invasive cardiology department was 285, 1604 and 343 minutes respectively (p<0.001) (figure 1). 829 patients underwent percutaneous coronary intervention (PCI), with mean syntax score of 17, and success rate 98%. No differences in average hospital stay were detected, but patients with LDA occlusion presented lower systolic function after AMI (p<0.001), and higher rate of all-cause mortality before discharge (p=0.030), 1 month and 6 months after myocardial infarction (p=0,037; p=0,022). Conclusions Isolated ST depression in lateral leads seems to be a low sensitive but highly specific electrocardiographic parameter in NSTEMI due to LCx occlusion. Our study has showed a higher reperfusion delay in patients with acute coronary syndrome due to LCx occlusion, but it was not associated with higher infarct size because of greater territory irrigated by LAD. Reperfusion delay P452 https://esc365.escardio.org/Presentation/217310/abstract 10-year prognosis in patients with microvascular angina I Irina Leonova1, S Boldueva1, N Bodnar1, A Shakhbazyan1, O Zakharova1 1North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation Topic: Coronary Artery Disease The prognosis in patients with microvascular angina (MVA) has not been fully investigated. Some authors indicate that the frequency of major adverse cardiovascular events (MACE) in these patients is significantly lower than in patients with coronary artery atherosclerosis. Other authors note that in patients with MVS there is a 1.5-fold increase in mortality compared to patients without documented myocardial ischemia. But all researchers agree on the idea that the quality of life in such patients remains low. Therefore, a study was conducted of the incidence of MACE in patients with MVS and the quality of life was evaluated 10 years after the diagnosis was verified. Materials and Methods: The study included 88 patients with MVA proved by symptoms, positive stress-test, normal coronary angiography (no evidence of coronary lesions), impaired reserve of endothelium - dependent vasodilation (cold pressor test) by positron - emission myocardial tomography, the presence of endothelium dysfunction ED be reactive hyperemia index< 1.67 according to peripheral arterial tonometry. All patients were included between Jan 2006 and Dec 2010. Full follow-up was obtained in 59 patients (84% female, 16% male, average age 68±5 years). Median follow-up was 10 years. 29 patients were lost from follow-up (changed phone number, etc). Assessment of the quality of life (QOL) and characteristics of pain was done using the Seattle Angina Questionnaire (SAQ). Results: The sample taken into consideration includes 59 patients and among these no cardiovascular death occurred. 1 patient (1,7%) reported MI and stenting of infarct-related artery, 1 (1,7%) patient underwent new coronarography without stenosis, 2 (3,4%) patient had anamnesis of non-fatal stroke, 1 (1,7%) patient had anamnesis of non-fatal oncology. Most patients noted a decrease in exposure to a provocative factor (chronic stress at work), in general, perception of the disease in most patients improved. On baseline 3 class of angina (Canadian Classification) described 60% of patients, class 2 - 40% of the patients, during the follow-up the functional class of angina decreased and angina of 3 class was described by less than 50% of patients. The characteristics of pain and quality of life (QOL) were assessed using the Seattle Angina Questionnaire (SAQ), consisting of 19 questions divided into five scales: physical limitation (PL), angina stability (AS), angina frequency (AF), treatment satisfaction (TS), and disease perception (DP). There was a significant (p<0.05) improvement in all indicators during a 10-year follow-up compared with baseline values. Conclusion: the presented work demonstrated a rather good prognosis in patients with MVS, which differs from the data of some previous studies. The reason for this, in our opinion, is the use of more stringent criteria for the selection of patients (exclusion of patients with minimal atherosclerosis of the coronary arteries) P453 https://esc365.escardio.org/Presentation/217354/abstract Leading personality trends and psychological defense meanisms of patients with acute coronary syndrome E Elena Efremova1, AM Shutov1, MV Menzorov2, TV Mashina2, AS Podusov1, AS Bykova1, AN Cheremnykh1, NA Samsonova1 1Ulyanovsk State University, Ulyanovsk, Russian Federation 2Cardiac Surgery Center "Alliance Clinic", Ulyanovsk, Russian Federation Topic: Coronary Artery Disease Features of personal status of patients with acute coronary syndrome (ACS) are an important aspect of the successful rehabilitation and socialization. Timely identification of personality disorders, anxiety and depressive will allow to distinguish groups of patients requiring a multidisciplinary approach. However, personal status and motivational features of patients underwent ACS and percutaneous coronary intervention (PCI), have not been insufficiently studied. The aim of this study was to investigate personal status of patients with ACS after PCI. Materials and methods: 80 patients (60 males and 20 females, mean age was 61.6±10.3 years) admitted to hospital with ACS were studied. ACS with ST-segment elevation (STE-ACS) and without ST segment elevation (NSTE-ACS) were diagnosed according to ESC Guidelines (2017 and 2015, respectively). STE-ACS was diagnosed in 19 (23.8%) patients, NSTE-ACS - in 61(76.2%) patients. All patients had cardiovascular pathology before hospitalization: 76 (95%) patients had arterial hypertension, 65 (81.3%) - coronary artery disease, 18 (22.5%) patients - myocardial infarction in history. Psychological status was performed on the third day of hospitalization. the Hospital Anxiety and Depression Scale, scale of depression PHQ-9 were used to assess personal profile of patients with ACS. "Index of life style" Plutchik-Kellerman-Conte was estimated for mechanisms of psychological protection. Results: Subclinical anxiety was detected in 18 (22.5%) patients, and clinically expressed anxiety - in 15 (18.8%) patients. 17 (21.3%) patients had subclinical depression , 14 (17.5%) - clinically severe depression. Accoding to the PHQ-9 depression scale, half of the patients (39; 48.8%) had mild depression, and 15 (18.8%) - had moderate depression. Moderate and severe depression requiring active treatment was observed in 5 (6%) patients. All protective mechanisms in patients with ACS did not exceed 60 standard points. The most intense were mechanisms of the type "projection" (53.7 ±26.2%), "denial" (46.9 ±18.9%) and "rationalization" (36.1 ±18.3%). The presence in patients with ACS high rates of the psychological protection mechanism "denial" shows rejection of the disease as deliberately unacceptable. The presence of lower indicators by the type "regression" (14.1 ±11.9%) and "substitution" (14.3 ± 10.7%) indicates maladjustment of the individual to a pathological state due to the inability to influence the trigger factors of stressful situations. Conclusions: Every fourth patient with ACS has subclinical anxiety and depression, every fifth patient has clinically expressed anxiety and depression. Every second patient with ACS requires dynamic monitoring and counseling by a psychotherapist. Maladaptive and primitive psychological protection mechanism are characteristic for patients with ACS, which requires a multidisciplinary approach in the development of a cardio rehabilitation program for patients with ACS. P454 https://esc365.escardio.org/Presentation/221551/abstract Clinical and anamnestic characteristics, comorbidity in patients after myocardial infarction without and with arterial hypertension (data from the RECVASA-CLINIC registry) AN Makoveeva1, MM Loukianov1, EYU Okshina1, EYU Andreenko1, VA Dindikova1, VG Klyashtorny1, E V Kudryashov1, EA Stolboushkina1, OM Drapkina1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Coronary Artery Disease Aim: To provide a comparative analysis of age, gender characteristics and combined cardiovascular and non-cardiovascular pathology in patients after myocardial infarction (MI) without and with arterial hypertension (AH), according to the registry of cardiovascular diseases (CVD). Methods: The registry RECVASA-CLINIC includes 3023 patients with history MI who were hospitalized to the National Medical Research Center for Preventive Medicine with pronounced symptoms of CVD from 01.04.2013 to 31.03.2018. The data of the medical information system "MEDIALOG" were analyzed. Comparison groups: 205 (7.2%) patients without AH (MI without AH) and 205 patients randomized out of 2818 patients with AH (MI+AH). Methods of descriptive and nonparametric statistics, logistic regression were used. Odds ratio (OR) and 95% confidence interval (CI) were determined. Results: The age of patients in the groups 'MI without AH' and 'MI+AH' was 61±9.3 and 68.4±8.3 years (p<0.001); primary MI developed at the age of 54.5 and 60.7 years, respectively (p<0.001). In the groups of MI without and with AH the incidence of recurrent MI was 14.6% and 13.0%; stroke-6.8% and 23.3%; chronic heart failure (CHF)-50.2% and 57.1%; atrial fibrillation (AF)-18% and 22.4%, respectively (non-significant after adjustment to age and sex, p>0.05). The period between the primary and recurrent MI was 4.0±2.6 and 7.0±5.7 years (p<0.05), i.e. was significantly less in patients with MI history without AH. In the group MI without AH the left ventricle ejection fraction (LVEF) below 40% was registered in 45.1% and 19.2% of CHF cases; (OR 2.0; CI 1.11-4.0; p=0.02). Percutaneous coronary interventions (PCI) were performed more often in the group MI without AH (52.7% compared with 40.5%; p=0.01). In patient to the group with MI+AH, compared with the group MI without AH, were also more often diagnosed: diabetes (29.4% and 9.8%; OR 3.16; CI 1.78-5.76; p<0.001), chronic kidney disease (36.3% and 17%; OR 2.05, CI 1.25-3.39; p=0.004) and obesity (31.8% and 13.7%; OR 3.22; CI 1.90-5.59; p<0.001). There were no significant differences between two groups of the indefinite of respiratory diseases (37.5% and 32.3%), digestive diseases (75.6% and 78.1%), anemia (5.0% and 8.5%), p>0.05. The number of CVDs 2.79±0.70 (median 3) and 1.68±0.63 (median 2) and non-CVD 2.15±1.25 (median 2) and 1.58±0.95 (median 1), as well as the total the number of diseases 4.94±1.61 (median 5) and 3.27±1.25 (median 3) were higher in the group of MI+AH, p<0.001. Conclusion. According to the RECVASA-CLINIC registry, the age of patients on the date of primary MI was younger in the group of post-MI patients without AH, compared with group MI+AH. Despite the less number of CVD and non-CVD in the group MI without AH, there were no significant differences of the incidence of recurrent MI, AF, stroke and CHF between compared groups, while the proportion of CHF cases with low LVEF and the number of PCI were higher in patients without AH. P455 https://esc365.escardio.org/Presentation/217115/abstract The prognostic significance of hsCRP dynamics in stable CAD patients after coronary stenting GV Shlevkova1, A Filatova1, AV Potekhina1, AK Osokina1, EA Noeva1, AM Shchinova1, VP Masenko1, TI Arefieva1, SI Provatorov1 1National Medical Research Center of Cardiology, Moscow, Russian Federation Topic: Coronary Artery Disease Background: Inflammatory mechanisms play a key role in the process of atherogenesis, neointimal proliferation and restenosis. The objective was to evaluate the relationship between the pre- and post-procedural values of high-sensitive C-reactive protein (hsCRP) or low density lipoprotein (LDL) blood levels with the development of endovascular events 12 months after coronary stenting (CS). Methods: 91 patients (mean age 60.5±8.7 years) with stable angina and coronary stenting were enrolled. 12 months later, 60 patients underwent coronary angiography. The restenosis of the previously stented segment was observed in 8 patients. The progression of coronary AS was detected in 18 patients. 8 patients faced the need of repeated revascularization. And 35 patients demonstrated no significant changes in coronary arteries disease after 12 months. HsCRP and LDL blood content was evaluated before coronary stenting and 1, 3, 6 and 12 months after CS. Results: ROC analysis showed the association of pre-procedural hsCRP blood level ≥2.5 mg/l or LDL >3.2 mmol/l with the increased risk of coronary atherosclerosis progression and the need for repeated revascularization within a year after the intervention (AUC 0.74 (95% CI 0.82-0.98), sensitivity 83%, specificity 84%, p=0.02, AUC 0.68 (95% CI 0.76-0.96), p=0.03, respectively). The elevation of hsCRP blood level (by 0.9 mg /l or more) or absolute hsCRP level >3.0 mmol/l 1 month after CS were associated with the increased risk of restenosis within a year after the intervention (AUC 0.93 (95% CI 0.85-1.0), sensitivity 88%, specificity 91%, p=0.00009, AUC 0.82 (95% CI 0.68-0.96), p=0.0007, respectively). Conclusion: Pre-procedural hsCRP blood level ≥2.5 mg/l before CS could be a risk marker for accelerated atherosclerosis progression. The elevation of hsCRP after CS may be associated with the risk of restenosis. P456 https://esc365.escardio.org/Presentation/217130/abstract Ventricular remodeling in patients with myocardial infarction and preserved ejection fraction: does physical activity make a difference? R Raluca Tomoaia1, D Zdrenghea1, RS Beyer2, A Dadarlat-Pop1, FI Fringu1, G Simu1, D Gurzau1, IA Minciuna3, B Caloian1, H Comsa1, D Pop1 1Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania 2Heart Institute Nicolae Stancioiu, Cardiology, Cluj-Napoca, Romania 3Rehabilitation Hospital Cluj Napoca, Cluj Napoca, Romania Topic: Coronary Artery Disease Introduction: Ventricular remodeling (VR) is one of the main determinants in the prognostic of patients with myocardial infarction (MI). The occurrence of VR can be related to the time to revascularization and to several cardiovascular risk factors. Purpose: This study aimed to assess the impact of physical activity on remodeling after MI. Methods: We retrospectively evaluated the relationship between gender, age, clinical symptoms and VR and the influence of physical activity on the development of VR, in patients diagnosed with NSTEMI in our Cardiology Department.VR was analysed using the classical systolic (LVEF) and diastolic parameters (E/A, E/eã , average eã , LA volume, maximum velocity of tricuspid regurgitation), and novel parameters (global longitudinal and circumferential strain). Results: There were 52 patients included (42% were sedentary, 58% were active), mean age 72±2 years vs. 75±3 years. All patients had a preserved left ventricular ejection fraction (LVEF). Out of all patients, 58 % were active (moderate physical activity of more than 60 minutes/week). Age and global longitudinal strain (GLS) were not associated with the presence of unfavorable VR when compared in the two groups (p=0.62), neither were the classical diastolic dysfunction parameters ã E/A (p=0.1), average eã (p=0.09), E/eã (p=0.08), LA volume (p=0.21), maximum velocity of tricuspid regurgitation (p=0.56), but active patients had more preserved global circumferential strain (GCS) (p=0.04) than sedentary patients. There was a statistically significant correlation between the clinical symptoms and GCS. Patients with a more reduced GCS presented more than one symptom on admission (angina, dyspnea, palpitations, nausea). Conclusion: In sedentary patients with MI, VR occurs more frequently due to remodeling of the circumferential myocardial fibers. Longitudinal fibers are affected in both sedentary and active patients with MI. The classical systolic and diastolic parameters din not correlate to unfavorable VR. GCS-VS sedentary active N 22 30 Mean -8.44 -14.37 CI 95% 0.92 0.89 Std dev 2.2 2.5 T test (p) 0.04 GCS-VS sedentary active N 22 30 Mean -8.44 -14.37 CI 95% 0.92 0.89 Std dev 2.2 2.5 T test (p) 0.04 GCS-VS=global circumferential strain of the left ventricle Open in new tab GCS-VS sedentary active N 22 30 Mean -8.44 -14.37 CI 95% 0.92 0.89 Std dev 2.2 2.5 T test (p) 0.04 GCS-VS sedentary active N 22 30 Mean -8.44 -14.37 CI 95% 0.92 0.89 Std dev 2.2 2.5 T test (p) 0.04 GCS-VS=global circumferential strain of the left ventricle Open in new tab Relationship strain - physical activity P458 https://esc365.escardio.org/Presentation/221544/abstract Albumin blood levels on admission affect outcome of primary coronary angioplasty D Dawood Sharif1, Y Sharif2, A Sharif-Rasslan3 1Bnai Zion Medical Center, Haifa, Israel 2Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel 3The Academic Arab College, Mathematics, Haifa, Israel Topic: Coronary Artery Disease Albumin maintains colloid osmotic pressure, participates in free radical scavenging, inhibits platelet function, acts as anti-inflammatory and affects on vascular permeability. Aim: Evaluate the effects of albumin blood levels on coronary and myocardial flow and left ventricular function in patients with acute anterior acute ST elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PPCI). Methods: 175 Consecutive patients with acute anterior STEMI treated by PPCI were divided into 4 groups: albumin blood level<3.5; 3.5-4; 4-4.5 and >5 gr/dl. TIMI and myocardial blush grades, ST-elevation resolution, left anterior descending coronary artery flow parameters and left ventricular ejection fraction (LVEF) were assessed. Results: Patients with lower albumin blood levels had higher prevalence of women and previous history of coronary disease, lower hemoglobin and cholesterol levels but higher C-reactive protein (CRP) blood levels on admission. Angiographic flow parameters were similar between the groups; however, ST elevation extent was the smallest before and after PPCI in patients in highest quartile of albumin. While LAD flow- parameters were similar on admission, diastolic deceleration times were longer at discharge in those with higher albumin levels. LVEF at admission was larger in those with higher albumin levels. Conclusions: Lower albumin blood levels in patients with STMI treated by PPCI are associated with lower hemoglobin and cholesterol blood levels and higher CRP admission levels. Higher albumin levels are associated with less ST elevation and present with higher LVEF. P460 https://esc365.escardio.org/Presentation/217322/abstract Autopsy data of reasons of 2-type myocardial infarction I Irina Leonova1, S Boldueva1, D Oblavatsky1, M Ryzhikova1 1North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation Topic: Coronary Artery Disease The information on the problem of 2 type myocardial infarction (IM-2) demonstrates a rather high variability, and often the inconsistency of data on the prevalence and leading causes of the development of IM-2. Objective: to assess the role of IM-2 in the structure of hospital mortality in a multidisciplinary hospital. Describe the main causes of development, demographic characteristics, the condition of the coronary artery, the hospitalization profile of patients with a diagnosis of type 2 IM verified by autopsy in comparison with the type 1 IM group. It was retrospective study of 1574 autopsy protocols between 01.01.2010 and 12.31.2016 in cardiology and non-cardiology departments. In 360 cases - 22.87% - the cause of death was MI, and more than a third of them - 137 cases - were fatal IM-2. The ratio of men to women was comparable, the highest incidence of IM-2 in the elderly - 48.2% - and senile - 34.3% - age was noted The average age of patients with IM-2 was 71.7 years, among men - 68.3 years and 75.3 among women, which was comparable to the average age of patients who died of type 1 IM (IM-1). The reasons of MI were: tachysystolic cardiac arrhythmias - 59.12% of cases, hypoxia of various etiologies - 35.29% of cases. The absence of a significant lesion was significantly more common with IM-2 - 32.84%, while in IM-1 only 1.79%. Multivascular damage was noted in 31.38% of cases, and only 4.38% of patients had total coronary artery occlusion. Only 29.2% of patients with IM-2 were treated in cardiology department. 45.25% of patients were died in the therapeutic department and 25.5% of IM-2 patients died during/after planned or emergency non-cardiac surgery. Conclusion: the main reasons of IM-2 were tachysystolic arrhythmias and severe hemic hypoxia. 25,5% patients died during/after non-cardiac surgery P462 https://esc365.escardio.org/Presentation/221555/abstract Coronary CT angiography as gatekeeper in patients with chest pain M Martijn Scherrenberg1, H Scherrenberg2, J Schouteden2, L Van Droogenbroeck2, M Vandewinkel2, P Dendale1 1Heart Centre Hasselt, Hasselt, Belgium 2Hasselt University, Hasselt, Belgium Topic: Coronary Artery Disease Ischemic heart disease (IHD) constitutes one of the most predominant causes of morbidity and mortality worldwide. It is important to identify patients with IHD quickly and accurately to prevent unnecessary investigations and costs. However, there are sparse European guidelines about which diagnostic tool is the preferred option in the diagnostic (non)invasive work-up of a patient with chest pain. Still, good assessment of chest pain is crucial because 30% of the patients presenting with new onset angina pectoris will have a cardiac event in the next two years. Methods: This study is a retrospective, non-randomized cohort study. A group referred first to coronary computed tomography angiography (CCTA) was compared to a group that was allocated directly to an invasive coronarography. Both groups included 150 patients and were matched for the pre-test probability of coronary artery disease. The objective of the study was to evaluate the non-inferiority of CCTA as first step in the assessment of chest pain compared with the use of an invasive coronarography in predicting major adverse cardiovascular events (MACEs). The mean follow-up was three years. Results: A single logistic regression model showed an increased risk for MACE in the group of patients who were allocated directly to an invasive coronarography in comparison to patients referred for CCTA as first step in their diagnostic work-up (P = 0,002).The multiple logistic regression model showed that peripheral artery disease (P = 0,043), the degree of stenosis in LAD (P = 0,015) and RCA (P = 0,028) significantly increased the occurrence of a MACE in our population. Logistic regression analysis showed that the Agatston-score (P = 0,009) could significantly predict the occurence of a MACE. Conclusion: Based on these results, CCTA is non-inferior to invasive coronarography in the assessment of angina pectoris. So, it can be considered in the diagnostic work-up of angina pectoris such as demonstrated in recent trials. However, more research is needed about the cost-effectiveness of CCTA. Lastly, this research confirmed that the Agatston-score can be used as a prognostic parameter in CCTA. P465 https://esc365.escardio.org/Presentation/223116/abstract Non-ST segment elevation myocardial infarction (NSTEMI) due to left circumflex coronary artery stenosis: electrocardiographic parameters, infarct size, reperfusion delay and prognosis. P Pedro Perez Diaz1, A Jurado Roman2, I Sanchez Perez1, MT Lopez Lluva1, J Abellan Huerta1, R Maseda Uriza1, J Piqueras Flores1, N Bermejo Calvillo3, R Frias Garcia1, J Martinez Del Rio1, F Lozano Ruiz Poveda1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2University Hospital La Paz, Cardiology, Madrid, Spain 3Hospital General de Ciudad Real, General practitioner, Ciudad Real, Spain On Behalf of: University General Hospital of Ciudad Real, Ciudad Real, Spain. Funding Acknowledgements: No sources of funding were provided for this work. Topic: Coronary Artery Disease Background: Left circumflex (LCx) occlusion is underdiagnosed in most of studies about myocardial infarction, due to its poor electrocardiographic expressiveness and late diagnosis, which leads to longer higher reperfusion time. Purpose: To compare peak of cardiac biomarkers, electrocardiographic abnormalities, reperfusion delay, hospital stay and survival in non-ST segment elevation myocardial infarction (NSTEMI), due to left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) stenosis. Methods: Observational prospective study including 455 patients with NSTEMI in a single university hospital between 2016 and 2018. We analyzed clinical presentation, peak of markers, electrocardiogram and reperfusion delay. Average hospital stay and long-term mortality were assessed in case of occlusion of left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) occlusion (TIMI = 0). Results: LCx was occluded in 7% (culprit lesion in 16%). Peak of troponin 0,96 +/- 3,78; 7 +/- 15 and 1,5 +/- 8 ng/ml in LAD, LCx and RCA stenosis respectively (p<0.01). The most frequent ECG finding in LCX stenosis was "repolarization abnormalities or ST depression in lateral leads" (sensitivity 22%; specificity 99%; positive predictive value 88%, negative predictive value 87%). Median time from symptoms onset to emergency department was 161 +/- 353, 180 +/- 236 and 231 +/- 412 minutes respectively (p=0.223). No differences in median time from emergency unit to invasive cardiology department were detected (p=0.058). 265 patients underwent percutaneous coronary intervention (PCI): 19 thrombectomy (4%) and 245 direct stenting or predilatation and stenting technique (92%). Median syntax score was 13 +/- 18, and success rate 96%. No differences in average hospital stay, left systolic function, complications after procedure and all-cause mortality before discharge and 1 year after discharge were detected. Conclusions: Isolated ST depression in lateral leads seems to be a low sensitive but highly specific electrocardiographic parameter in NSTEMI due to LCx stenosis. We detected a higher infarct size in these patients due to its poor electrocardiographic expressiveness, but no differences in reperfusion delay were showed. Reperfusion delay P466 https://esc365.escardio.org/Presentation/223127/abstract Subacute myocardial infarction due to left circumflex coronary artery stenosis: electrocardiographic parameters, infarct size, reperfusion delay and prognosis P Pedro Perez Diaz1, A Jurado Roman2, I Sanchez Perez1, MT Lopez Lluva1, J Abellan Huerta1, R Maseda Uriza1, J Piqueras Flores1, N Bermejo Calvillo3, R Frias Garcia1, M Negreira Caamano1, F Lozano Ruiz Poveda1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2University Hospital La Paz, Cardiology, Madrid, Spain 3Hospital General de Ciudad Real, General practitioner, Ciudad Real, Spain On Behalf of: University General Hospital of Ciudad Real, Ciudad Real, Spain. Funding Acknowledgements: No sources of funding were provided for this work. Topic: Coronary Artery Disease Background: Left circumflex (LCx) occlusion is underdiagnosed in most of studies about myocardial infarction, due to its poor electrocardiographic expressiveness and late diagnosis, which leads to longer higher reperfusion time. Purpose: To compare peak of cardiac biomarkers, electrocardiographic abnormalities, reperfusion delay, hospital stay and survival in subacute myocardial infarction, due to left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) stenosis. Methods: Observational prospective study including 95 patients with subacute myocardial infarction in a single university hospital between 2016 and 2018. We analyzed clinical presentation, peak of markers, electrocardiogram and reperfusion delay. Average hospital stay and long-term mortality were assessed in case of occlusion of left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) occlusion (TIMI = 0). Results: LCx was occluded in 8% (culprit lesion in 13%). Peak of troponin was 7.3 +/- 45, 27 +/- 38 and 20 +/- 32 ng/ml in LAD, LCx and RCA stenosis respectively (p<0,190). The most frequent ECG finding in LCX stenosis was "deep Q waves and inverted T waves in leads II, III and AVF" (sensitivity 17%; specificity 99%; positive predictive value 67%, negative predictive value 89%). No differences in median time from symptoms onset to emergency department were detected (p=0.121), but median time from emergency unit to invasive cardiology department was 316 +/- 894, 1427 +/- 3485 and 167 +/- 827 minutes respectively (p=0.009). 74 patients underwent percutaneous coronary intervention (PCI): 14 thrombectomy (19%) and 73 direct stenting or predilatation and stenting technique (98%). Median syntax score was 13 +/- 13.5, and success rate 98%. Patients with acute left circumflex occlusion showed higher rate of periprocedural complications (75%, 25% and 0%; p=0,019), all-cause mortality before discharge (25%, 0% and 0%; p=0.036) and 6 months and one year after myocardial infarction (p=0.036). Conclusions: The poor electrocardiographic expressiveness of acute left circumflex occlusion leads to longer reperfusion time in patients with subacute myocardial infarction. This reperfusion delay is not associated with higher infarct size because of greater territory irrigated by LAD, but our study has detected a higher rate of short and medium-term mortality in these patients. Reperfusion delay P467 https://esc365.escardio.org/Presentation/217050/abstract Functional capacity in patients with coronary artery disease R Rodica Lucia Avram1, C Delcea2, AC Nechita1, MN Popescu3, M Teodorescu3, E Lechea3, D Turcu3, LN Ghilencea3, M Berteanu3 1St. Pantelimon Emergency Hospital, Bucharest, Romania 2Colentina University Hospital, Bucharest, Romania 3Elias Emergency Universitary Hospital, Bucharest, Romania Topic: Coronary Artery Disease Walking speed and Timed up and Go (TUG) test have been used lately to determine functional capacity in patients with cardiovascular disease. Both of them are associated in different studies with all-cause mortality and the rate of re-hospitalization especially in the elderly population. Few studies have evaluated the relationship between these tests and cardiovascular risk factors and their variations during hospitalization. We prospectively analyzed a group of 38 patients admitted consecutively in the Cardiology Clinic of one hospital in Romania in the period 1-30 September 2019. Two groups of patients were analyzed one with chronic coronary syndrome (CCS) and the second group with STEMI. We evaluated the walking speed and TUG test close to the time of admission and at discharge. Low walking speed was defined as a value below 0.8 m/s. Exclusion criteria were: impossibility of walking for any reason and previously documented changes of walking. Our study group had a mean age of 62.7 ± 12.1 years. 57.9% (n=22) of patients were admitted with the diagnosis of CCS and the remaining number with STEMI. The average walking speed of the whole group was 0.97 ± 0.2 m/s. Regarding the association between walking speed and cardiovascular risk factors such as diabetes mellitus, arterial hypertension, dyslipidemia and obesity, no significant correlation was observed. Of the associated comorbidities analyzed, there were no differences in walking speed between patients with or without peripheral arterial disease, chronic kidney disease (CKD), stroke, COPD and heart failure (HF). Patients with low walking speed were older (69.9 ± 12.84 vs. 59.9 ± 10.32 years, p = 0.02) and had lower serum hemoglobin (12.38 ± 1.20 g/dl vs. 13.72 ± 2.07 g/dl, p = 0.02). The mean value of TUG test of the whole group was 12.34 ± 3.9 seconds. The initial TUG test had a longer duration in patients with CCS (13.4 sec vs. 9.6 sec, p = 0.008), previous documented ischemic heart disease (13.2 sec vs. 9.6 sec, p = 0.02), stroke (20.5 sec vs. 11.3 sec, p <0.001), CKD (18.8 sec vs. 11.8 sec, p = 0.01) and HF (14.05 sec vs. 10.8 sec, p = 0.02). TUG test was influenced by patients' age (r=0.567, p = 0.02), serum creatinine value (r=0.409, p = 0.03) and creatinine clearance (r=0.398, p = 0.04). Echocardiographic dilatation of right heart chambers was associated with an increased value of TUG test (r=0.399, p = 0.03). The walking speed was significantly improved during hospitalization (p = 0.035) after applying the optimal treatment (interventional or medical). Conclusion: The results of our study show that walking speed and the TUG test can be used safely in patients with CCS and STEMI and that they are mainly influenced by age, thus having a greater utility in the elderly population. The fact that the walking speed was improved during the hospitalization period after optimal individualized therapy needs to be evaluated in future studies for establishing the prognosis importance. P468 https://esc365.escardio.org/Presentation/217086/abstract Potential adherence to treatment of patients hospitalized with acute coronary syndrome K Kristina Pereverzeva1, S Yakushin1, A Vorobyev1, A Novoselova1 1Ryazan State Academician Medical University, Ryazan, Russian Federation Topic: Coronary Artery Disease Introduction: Adherence to treatment is one of the key factors ensuring the quality of therapy and directly affecting the prognosis. In Russia, in 2017, the first quantitative adherence questionnaire (QAQ)-25 was presented, which assesses the adherence by percentage: the level of potential adherence (PA) in the range of up to 50% is interpreted as "low", in the range of 51ã75% as "medium", and in the range of more than 75% as "high". Aim: Analyze the PA to treatment of patients hospitalized with a diagnosis of acute coronary syndrome (ACS) using the QAQ-25 questionnaire. Materials and methods. The study included 133 patients, of which 67.7% were men. The median age was 64 [58; 70] years. Results: The median total patient PA to treatment was 37.8% [32.2; 54.7]. Median PA to lifestyle modification was 43.7% [28.3; 48.6], to medical support - 28.9% [42.0; 61.1], to drug therapy - 33.6% [33, 8; 58.3]. In the group with medium PA to lifestyle modification, the duration of the history of coronary heart disease was 4 [2.75; 10] years and was significantly shorter than the duration of the disease in the group of patients with a low level of adherence, where it was 10 [4; 10] years, p <0.05. A significantly larger number of patients with a disease duration of more than 5 years had a low PA for lifestyle modification compared to patients who were ill for less than 5 years (83.1% versus 67.6%, p <0.05). Lonely patients were significantly more likely to have low PA to medical support compared to those with a family (82.4% versus 42.1%, p <0.05). Male patients were significantly more likely to have low PA to drug therapy (69.8% versus 46.7%, p <0.05). Among patients with Q-MI, compared with patients hospitalized with other acute forms of coronary artery disease, low overall PA to treatment was registered significantly more often (86.7% versus 65.1%, p <0.05). Conclusion: 1. Among PA indicators, lifestyle modification was the highest ã 43.7% [28.3; 48.6], and medical support was the lowest −28.9% [42.0; 61.1] (p> 0.05). 2. Factors that statistically significantly influenced the patients PA were sex, duration of the disease, family status, and the type of acute form of CHD. Parameter Low-adherent patients, % from n Medium-adherent patients, % from n High-adherent patients, % from n Overall PA to treatment 71.4 22.6 6.0 PA to lifestyle modification 78.2 16.5 5.3 PA to drug therapy 62.4 28.6 9.0 PA to medical support 39.8 48.9 11.3 Parameter Low-adherent patients, % from n Medium-adherent patients, % from n High-adherent patients, % from n Overall PA to treatment 71.4 22.6 6.0 PA to lifestyle modification 78.2 16.5 5.3 PA to drug therapy 62.4 28.6 9.0 PA to medical support 39.8 48.9 11.3 Open in new tab Parameter Low-adherent patients, % from n Medium-adherent patients, % from n High-adherent patients, % from n Overall PA to treatment 71.4 22.6 6.0 PA to lifestyle modification 78.2 16.5 5.3 PA to drug therapy 62.4 28.6 9.0 PA to medical support 39.8 48.9 11.3 Parameter Low-adherent patients, % from n Medium-adherent patients, % from n High-adherent patients, % from n Overall PA to treatment 71.4 22.6 6.0 PA to lifestyle modification 78.2 16.5 5.3 PA to drug therapy 62.4 28.6 9.0 PA to medical support 39.8 48.9 11.3 Open in new tab P469 https://esc365.escardio.org/Presentation/223104/abstract Anti-inflammatory effect of Metformin in adipocyte culture of local fat depots in patients with heart disease Y Yulia Dyleva1, O Gruzdeva1, D Borodkina1, E Uchasova1, E Belik1, M Sinitsky1, A Sotnikov1, K Kosyrin1, O Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Funding Acknowledgements: The study was supported by the Russian Science Foundation (Grant Number: 17-75-20026) Topic: Coronary Artery Disease Objective: to evaluate the role of metformin in the regulation of tumor necrosis factor expression in local fat depots. Materials: The study protocol was developed according to the World Medical Associationã s Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, 2000 edition. The study design was approved by the local ethics committee. The study included 84 patients with coronary artery disease (CAD) undergoing training for coronary artery bypass surgery and 50 patients with heart defects hospitalized in our Research Institute for Complex Issues of Cardiovascular Diseases (Russia). Samples of subcutaneous adipose tissue (SAT), epicardial (EAT) and perivascular (PVAT) were collected during coronary artery bypass surgery and surgery on heart valves. Adipocytes isolation was performed according to the established protocol developed by Carswell (2012) in sterile conditions under class II laminar flow hood. Cultivation of isolated adipocytes during the 1 day with 1 and 10 µmol/l metformin. Expression of the TNF-a gene after 1 day of cultivation was evaluated by quantitative real-time polymerase chain reaction (qPCR) using TaqManTM Gene Expression Assays in the ViiA 7 Real-Time PCR System. The levels of TNF-a in the culture medium adipocytes on the 1st day of cultivation were measured using commercially available enzyme immunoassay kits. Statistical processing of the results was performed using nonparametric criteria. A critical level of significance in testing statistical hypotheses was less than 0.05. Results: Adipocytes of PVAT in patients of both groups showed the most active expression of TNF-α gene, in comparison with EAT and SAT in both study groups. The least active expression occurred in adipocytes of the SAT. The concentration of TNF-α in the supernatant of cell cultures, despite the intensity of expression, in adipocytes of PVAT, was the lowest in the presence of CAD. In patients with heart defects, the secretion indices corresponded to the expression indices, and TNF-α concentration was maximal in adipocytes of EAT and PVAT compared to culture of adipocytes of SAT. In the group of patients with heart defects, the content of pro-inflammatory TNF-α was higher in the culture of EAT and PVAT compared with the group of CAD. The addition of metformin to the culture of adipocytes of the pancreas did not have a significant effect. Of 1 and 10 mmol/l Metformin reduced the level of expression of the TNF-α gene and its content in the culture of EAT and PVAT in both groups of patients. At the same time, the concentration of 10 mmol/l of Metformin was more effective. Conclusion: Metformin has an anti-inflammatory effect on EAT and PVAT adipocytes and reduces TNF-α expression in patients with CAD and heart defects. The revealed effect is dose-dependent and the concentration of 10 mmol/l of Metformin is more effective. P470 https://esc365.escardio.org/Presentation/223119/abstract Predictors of cardiofibrosis and cachexia epicardial adipose tissue in the late period of myocardial infarction OV Gruzdeva1, DA Borodkina1, YUA Dyleva1, E Ekaterina Belik1, EG Uchasova1, NK Brel1, AN Kokov1, TB Pecherina1, VV Kashtalap1, VN Karetnikova1, EE Bychkova1, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Funding Acknowledgements: The study was supported by the Russian Science Foundation (17ã75-20026) Topic: Coronary Artery Disease Aim: to assess the dynamics of biochemical markers in the hospital period, the relationship with the degree of cardiofibrosis and thickness of epicardial adipose tissue (EAT) one year after myocardial infarction (MI). Materials and methods. 88 patients (65 men and 23 women) with MI were examined. The percentage of cicatricial changes in the myocardium and the thickness of the EAT were measured by magnetic resonance imaging (MRI) one year after MI. In the hospital period (1st and 12th day) and 1 year after the transfer, the concentration of N-terminal propeptide of brain natriuretic peptide (NT-proBNP), stimulating growth factor (ST2), interleukin-33 (IL-33) and type I collagen (COL-1) was determined in the blood serum of patients. The data were analyzed using the methods of descriptive statistics, correlation and ROC analysis and logistic regression (Statistica 9.0). Results: It is shown that a year after MI, cicatricial changes of the myocardium were detected in 68 (77 %) patients: 27 people had cardiofibrosis less than 5 % of the myocardium, 22 patients - from 5 to 15 %, and 19 people had cardiofibrosis more than 15 % of the total mass of the myocardium. It was established that the formation of cardiofibrosis in the post-infarction period is preceded by an unfavorable anamnestic profile of the patient, complicated clinical course of the hospital period and higher concentrations of ST2, NT-proBNP, COL-1 compared with patients without cardiofibrosis. High concentrations of ST2, NT-proBNP increase the risk of cardiofibrosis by 1.2 and 1.8 times in the posthospital period, respectively. In patients with cardiofibrosis of more than 15%, the level of protective IL-33 was statistically significantly lower on day 1 of MI. It was found that the thickness of the EAT increases with fibrosis from 5 to 15 %. An increase in the thickness of the left (EAT LV) and right ventricles (EAT RV) by 1.33 times and 1.34 times, respectively, increases the risk of cardiofibrosis (EAT LV, mm (OR 1.33; 95% CI (1.08-1.4), AUC 0.75; EAT RV, mm (OR 1.34; 95% CI (1.15-1.43), AUC 0.79). With scarring changes of more than 15 % of the myocardium, the thickness of the EAT decreases and correlates with an increase in the concentration of NT-proBNP in the acute period and a year after the MI.Conclusion: the development of cardiofibrosis one year after MI is associated with an increase in ST2, NT-proBNP, COL-1, both in the hospital period and 1 year after MI. The decrease in IL-33 concentration in the hospital period is accompanied by the development of fibrosis with damage to more than 15 % of the myocardial surface. P471 https://esc365.escardio.org/Presentation/217344/abstract Embologenic myocardial infarction due to atrial fibrillation I Irina Leonova1, S Boldueva1, M Ryzhikova1, D Oblavatsky1 1North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation Topic: Coronary Artery Disease The incidence of embologenic myocardial infarction (MI) is unknown, it is usually considered rare. In most studies, atrial fibrillation (AF) is recognized as the most common cause of such MI. The question of antithrombotic therapy for this type of MI in patients with AF remains open. Materials and methods: analysis of case histories of 1520 patients with MI for 6 years (2013-2018). The criteria developed by the SUITA study were used to verify the diagnosis of embolic MI. Results: From 2013 to 2018 among all 1520 patients with MI, 8 embolic MI associated with AF was registered, which is 0.53% of all patients with MI and 2.95% among patients with MI and history of AF. Among patients with embolic MI, 6 patients (75%) and 2 women (15%) predominate. The average age was 64 ± 12.8 years, 75% male and 15% female. 4 patients (57%) had a paroxysmal form of AF, and 3 (43%) had a constant form of AF. Myocardial infarction occurred either absence of anticoagulant therapy or inadequate monitoring of INR with Warfarin. 50% of patients did not require revascularization, thrombospiration and angioplasty were performed in 25% of cases, and thrombaspiration and stenting were performed in 25% of cases. 4 patients with embolic MI (50%) were assigned triple antithrombotic therapy (oral anticoagulant (AC) + acetylsalicylic acid + clopidogrel) for 1 month, then double therapy (AC + clopidogrel) for 12 months, followed by transition to AC. 4 patients (50%) received dual therapy (AK + clopidogrel) for 12 months. As part of multicomponent antithrombotic therapy, non-vitamin K antagonists (NOAC) have always been used. Conclusion: thus, embologenic AF-related MI occurs in 0.53% of cases of MI in the absence of proper anticoagulant therapy. All patients with embolic MI were prescribed AK (NOAK) as part of triple or double antithrombotic therapy. P694 https://esc365.escardio.org/Presentation/223112/abstract Inflammatory potential of adipocytes of epicardial, perivascular and subcutaneous adipose tissue depending on the presence of coronary atherosclerosis OV Gruzdeva1, YUA Dyleva1, DA Borodkina1, E Ekaterina Belik1, NK Brel1, AN Kokov1, EV Fanaskova1, VN Karetnikova1, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Funding Acknowledgements: This work was supported by the Russian Science Foundation grant № 17-75-20026 Topic: Coronary Artery Disease Aim: To determine the features of production of markers of inflammation by adipocytes of subcutaneous, epicardial and perivascular adipose tissue in patients with coronary heart disease and heart defects. Materials and methods. The main group consisted of 84 patients with coronary artery disease (CAD) and myocardial infarction (MI) in history, the control group consisted of 50 patients with heart defects. During the scheduled surgery (coronary artery bypass grafting (CABG) or heart valve replacement), all patients underwent epicardial adipocyte (EAT) and subcutaneous adipose tissue (SAT) and perivascular adipose tissue (PVAT) followed by culture and preparation of the supernatant. In the supernatant, the expression of interlicin genes 1 β and 10 (IL-1β, IL-10) and the content of their expression products were determined by enzyme immunoassay using BioVendor test systems (USA). Results: PVAT adipocytes demonstrated maximum IL-1 mRNA expression in both patients with coronary heart disease and heart defects compared to EAT and SAT. Moreover, in patients with heart defects, the expression level was 1.6 times higher than in patients with coronary heart disease. When assessing the secretion of IL-1β, patterns similar to the genome of adipocytes in relation to the studied cytokine were revealed. Patients with heart defects were characterized by higher concentrations of IL-10 in the supernatant of all three cultures and more intense expression of its gene. EAT adipocytes were characterized by the lowest intensity of IL-10 gene expression compared to SAT and PVAT. At the same time, the highest concentration of IL-10 in the supernatant was characteristic of EATadipocytes. Conclusion: The most active secretion of IL-1β is characteristic of PVAT adipocyte culture compared to others (EAT and SAT), and the presence of CAD suppresses this property. Patients with CAD were characterized by higher IL-1 expression and lower IL-10 expression. The presence of CAD negatively affects the production of IL-10 in adipocytes regardless of their location. P695 https://esc365.escardio.org/Presentation/217339/abstract Dynamics of morphological changes in coronary arteries in patients with various forms of coronary artery disease K Averchenko1, E Lubinskaya2, E Demchenko2 1Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation 2Almazov National Medical Research Centre, Saint Petersburg, Russian Federation Topic: Coronary Artery Disease Background: One of the approaches to improving the prognosis of patients with coronary heart disease (CHD) can be the individualization of drug therapy, aggressive correction of cardiovascular risk factors and dynamic follow-up mode, taking into account data on the nature and progression rate of morphological changes in coronary arteries. Analysis of the data of repeated coronary angiogram (CA) will allow us to assess the severity and dynamics of atherosclerotic lesions of the coronary arteries in patients with different clinical course of the disease. Purpose: To analyze the nature and speed of the dynamics of angiographic changes in coronary arteries and their association with the clinical manifestations of coronary artery disease. Methods: The study included 82 patients with CHD (54 men) aged 54ã85 years (60.1 ± 9.1 years), who were admitted to the hospital to repeated CA (CA-2). Angiographic changes detected in CA-2 compared with primary CA (CA-1) are combined in 3 options: A - restenosis of the stenting area / patency of coronary bypass grafts, B - progression of stenoses of native arteries to hemodynamically significant (≥70%), C - newly identified (de novo) hemodynamically significant stenoses of native arteries. The interval between CA-1 and CA-2 was from 6 months to 6 years Results: The basis for CA-2 in 46.3% of cases was the development of acute coronary syndrome (ACS), in 53.7% - a positive stress test against recurrence of angina pectoris. on the CA-2 in 92.7% of patients revealed negative angiographic dynamics. In the first 2 years after CA-1, the leading changes were option A (85.7%) and B (76.2%). Isolated variant A (restenosis of stents) occurred in 28.6% of patients and was accompanied by relapse of angina in only 33.3% of cases. In all patients with options B, C and a combination of A-B-C, relapse was noted. 3 years after CA-1, option B prevailed (76.2%); of them - in 68.8%, option B was isolated, in 45.5% of these patients relapse of angina was detected; in 31.2% of cases, option B was combined with A and / or B; recurrence of angina pectoris diagnosed in 80% of them and MI diagnosed - in 8%. After 4 years, the dominant options were B (80%) and C (91.7%) in combination with each other or option A (26.7%); in the majority (73.3%) of patients, ST recurred. Conclusion: During the analyzed period, remission of angina pectoris remained in 28% of patients. The leading options for negative dynamics in the first 2 years after CA-1 were stent restenosis (85.7%) and progression of stenosis of native arteries (76.2%), after 3 years - progression of stenosis of native arteries (76.2%), after 4 years - the formation (91.7%) or progression of stenosis (80%) of the native arteries. Isolated stent restenosis was accompanied by a ST relapse in 33.3% of cases, isolated progression of stenosis of native arteries in 45.5%, combined changes in most (> 70%) patients. P696 https://esc365.escardio.org/Presentation/223128/abstract The effect of coronary heart disease on the production of fibroblast growth factor-21 local fat depots OV Gruzdeva1, DA Borodkina1, YUA Dyleva1, EG Uchasova1, E Ekaterina Belik1, AN Kokov1, NK Brel1, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Funding Acknowledgements: The study was supported by the Russian Science Foundation (17ã75-20026) Topic: Coronary Artery Disease Aim: To determine the characteristics of the production of fibroblast growth factor-21 (FGF-21) subcutaneous, epicardial and perivascular adipocytes in patients with coronary heart disease and heart defects. Materials and methods. The study included 84 patients with coronary atery disease (CAD) and a history of myocardial infarction (MI) and 50 patients with heart defects. During the planned surgical intervention (coronary artery bypass grafting (CABG) or heart valve replacement), all patients underwent epicardial adipocyte (EAT) and subcutaneous adipose tissue (SAT) and perivascular adipose tissue (PVAT) followed by cultivation and obtaining a supernatant. Medium was carefully taken from the bottom of the wells for subsequent determination of the expression of the FGF-21 gene, as well as the content of its expression products by enzyme-linked immunosorbent assay. The data were analyzed using the statistical software package Statistica 9.0. Results: Among patients without coronary artery disease, there was no significant difference in FGF-21 gene expression in all three adipocyte cultures. Whereas, among patients with coronary artery disease, adipocytes of EAT were characterized by a lower level of gene expression - 3.3 times lower than in the culture of SAT and 3.11 lower than in the culture of PVAT. The studied groups did not significantly differ in the level of expression of the FGF-21 gene in SAT and PVAT cultures. Data on the secretion of FGF-21 corresponded to the expression of its gene. Thus, the lowest concentration of FGF-21 was recorded in the supernatant of adipocytes of EAT in patients with CAD and was almost two times lower than in other cultures. Whereas the secretion of FGF-21 in the supernatant of adipocytes SAT and PVAT did not significantly differ, neither between groups of patients, nor between cultures. Conclusion: EAT in patients with CAD is characterized by suppression of FGF-21 secretion compared with patients without damage to the coronary arteries and other fat depots. P698 https://esc365.escardio.org/Presentation/217374/abstract Prevention of expanding metabolic injury and continuing myocardial dysfunctionand other complications in patients with acute MIby GIP and long-term treatment with Meldonium T Tamari Svanidze1, T Saralidze1, I Mamatsashvili1, T Bediashvili1, M Noniashvili1 1Tbilisi State Medical University (TSMU), Internal Medicine N1, Tbilisi, Georgia Topic: Coronary Artery Disease Metabolic changes during acute myocardial infarction(AMI) include increased secretion of catecholamines and production of circulating free fatty acids(FFAs). As myocardium depends on aerobic metabolism increased FFAs exert toxic effect on myocardium resulting in metabolic mismatch and decreased cardiac function. Our purpose was to study impact of metabolic therapy(MT) -polarizing solution of high dose glucose-insulin potassium(GIP-25% glucose 1000ml, 50IU insulin, 4%KCL 144ml) and Meldonium(M) in patients(P) with AMI. We studied 50 P with STsegment elevation AMI (STEMI) who did not undergo reperfusion therapy because of different reasons. 30P beside guideline were treated with GIP and M (I group), 20P compiled control group. P with diabetes mellitus and heart failure (Killip class 3-4) were not included in our study. GIP was infused during first 24 hours of AMI. M was given during 3 months (1.0 g/day i/v for the first 10 days and then 1.0 g/day p/o for 3 months). Functional condition of heart was evaluated by ECG and echocardiography(Echo). ST elevation normalized in 4-5 days in I group and in 7-8 days in control group. After 10 days ejection fraction(EF) in I group increased by 5% while in control by 1,1%. After 3 months Echo showed significant improvement of EF by 16% and stroke volume(SV) by17% in I group while in control group EF (by 4,5%) and SV (by 6,8%) were increased slightly. Improvement of diastolic function was also prominent in I group that was revealed by decreased diastolic volume & left ventricular filling pressure(LVFP). Before treatment LVFP was increased in 10P from the I group and in 7P in control group. In I group increased LVFP significantly decreased in 8P and moderately in 2, while in control group LVFP was only decreased moderately in 4 and slightly in 3 P. In I group end diastolic diameter(EDD) diminished by 6%, end systolic diameter(ESD)-by 5,9%, end diastolic volume(EDV)-by 12% and end systolic volume (ESV)-by 16% while in control group EDD was decreased by 1,9%, ESD-by 2,8%, EDV-by 4,7% and ESVby 4,1%. MT by GIP is based on fact that glucose increases anaerobic glycolysis while insulin increases consumption of glucose, that evolves augmentation of ATP and in the presence of potassium corrects electrolyte disbalance resulting in normalization of STsegment elevation. Action of M is based on carnitine biosynthesis inhibition to prevent accumulation of cytotoxic intermediate products of fatty acid beta oxidation in ischemic tissues to block this highly oxygen utilization process. High dose GIP and i/v M during first hours of STEMI significantly improved heart electrical function and contraction, as compared to control group. Using GIP and M as part of combination therapy in the early post-infarction period & continuing with M following months were observed to have clinical & Echo improvement, reduction of angina attacks, decrease in the number of arrhythmic and ischemic episodes. P699 https://esc365.escardio.org/Presentation/217014/abstract Analysis of cardiovascular events, heart failure and remodeling in 2-years follow-up outcomes in patients with STEMI after manual thrombaspiration I Irina Leonova1, S Boldueva1, D Maznev1 1North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation Topic: Coronary Artery Disease MATERIALS AND METHODS: A prospective analysis of 367 cases of STEMI treated by percutaneous coronary intervention (PCI) was performed. The average age of patients was 60.8±1.3 years, 248 men (68%) and 118 women (32%). In 64.8% of patients, STEMI was a debut of coronary artery disease. RESULTS: 182 patients were treated by PCI only and 185 patients PCI plus manual thromboaspiration (MT). Patients were similar by gender, age, localization of MI; 95.9% of patients had TIMI 3 coronary blood flow after PCI. MBG<3 scale was 8.2% in the group without MT and 4.1% in patients with MT (p<0.05). The debris was obtained in 88.4%. The incidence of no-reflow syndrome was similar in both groups ã 1.8% in group with MT and 1.3% in group without MTA (p<0.05). The frequency of stroke during PCI was similar. The mild systolic dysfunction (SDf) of the LV- 29% of patients in the group without MT and 12.1% with MT (p<0.05); moderate SDf - 6.2% vs. 2.0%, respectively (p<0.05). Severe SDf was not observed in both group. At discharge 46% patients without MT and 56.32% with MT had no symptoms of HF. The I functional class of HF by NYHA was almost the same in both groups ã 38.5% versus 41.8% (p>0.05), II functional class ã 56.6% without MT and 57.0% with MT (p<0,05); III functional class ã 4.8% / 1.2% respectively (p<0,05). After 2 years of follow-up, those trends with HF were similar. During of 2-years follow-up the incidence of repeat urgent revascularization due to acute coronary syndrome was similar: 1.08% in MT group vs. 1.6% in PCI only group (p>0.05). 3 patients (2 from MT- and 1 from MT+ groups) died from acute heart failure (no autopsy). The difference in most echocardiographic parameters after 2 years of observation between the groups was not. However, there was a significant difference in the groups in the index of sphericity of the left ventricle. Moreover, a lower value of this parameter occurs in the group of patients who underwent manual thrombospiration (0,649±0,05 MT-/0,626±0,05 MT+ p=0,007), which indicates a less pronounced postinfarction remodeling of the left ventricle in these patients. In addition, after 2 years of follow-up, patients were examined with such a parameter as LV PGD (-13,46±5,3 MT- and -15,38±3,19 MT+<0,05), and it turned out that, despite the fact that in both groups this indicator was below normal, the changes in the group of patients with MT+ were less pronounced. CONCLUSIONS: In STMI patients treated by PCI plus MT less significant in-hospital and 2-years of follow-up SDf and HF were observed compared with patients without MT. There was no difference in stroke in both groups. It is difficult to assess the impact on the prognosis due to the small number of cardiac events. In patients STMI, who underwent PCI and MTA, there was a decrease in the severity of heart failure, as well as a more favorable option for LV remodeling compared with the group of patients without MTA during long-term follow-up (2 years after MI). P700 https://esc365.escardio.org/Presentation/221553/abstract Comparative efficacy of clopidogrel and prasugrel on platelet function in patients with coronary artery disease and metabolic syndrome S Shukhratjon Azizov1, JK Uzokov2, DD Payziev2, AX Abdullaev1, SA Iskhakov2 1Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan 2Republican Specialized Scientific-Practical Medical Center Therapy and Medical Rehabilitation, Tashkent, Uzbekistan Topic: Coronary Artery Disease Background: Many studies have confirmed the reduction of clopidogrel response in patients with coronary artery disease (CAD) after percutaneous intervention. Prasugrel has shown to be more effective to reduce the major adverse cardiac events in these patients. Metabolic syndrome (MetS) is a collection of several components that increase the risk of cardiovascular disease and type 2 diabetes mellitus. Prevalence of the syndrome is high among population and expected to double in the following decade. Purpose of the study was to compare of clopidogrel and prasegrel actions on platelet function in patients with CAD and MetS. Methods: A total of 46 patients with CAD and MetS were enrolled in this study (aged 42-68 years; mean age 54.3±14.0 year; male=58%). Patients were divided into 2 groups by 23. The first group patents were provided 60 mg loading dose followed by 10 mg maintenance dose of prasugrel + 100 mg aspirin vs. second group patients 600 mg loading dose followed by 75 mg maintenance dose of clopidogrel + 100 mg aspirin during the 10 days. Platelet function were assessed by light transmission aggregometry following 5 and 20 µM ADP at baseline, 12 and 48 hours (h) after the loading dose. Results: Inhibition of platelet function was greater in the first group patients than clopidogrel group with 5 µM ADP both after 12 h (92% vs. 86% respectively, P<0.05) and 48 h (90% vs. 83% respectively, P<0.05). Similar results were obtained with 20 µM ADP (95% vs. 80%, P<0.05 after 12 h; 93% vs. 81%, P<0.05 after 48 h). After adjusted by sex it was not noted any differences between genders. Conclusion: Prasugrel was associated significantly inhibition of the platelet function in patients with CAD and MetS. P159 https://esc365.escardio.org/Presentation/217323/abstract Blood pressure response to a single session of isometric handgrip exercise in patients with aortic coarctation: a descriptive study. KF Goessler1, VA Cornelissen2, RB Buys2 1University of Sao Paulo, Applied Physiology & Nutrition Research Group; Faculty of Medicine, Sao Paulo, Brazil 2KU Leuven, Leuven, Belgium Funding Acknowledgements: This work is partially supported by FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo), process 2019/18039-7 for KG. Topic: Diseases of the Aorta - Treatment Introduction: Following aortic coarctation (COA) repair, patients are at increased risk of developing hypertension later in life. Possible mechanisms for the development of hypertension in this population include local vascular bed pathology, local and systemic hemodynamic changes, altered geometric shape of the aortic arch post-repair and impaired mechanoreceptor sensitivity. Growing evidence shows that low intensity isometric exercise training (IHG) has potencial effect to reduce blood pressure (BP) in healthy pre- and hypertensive individuals. However, whether IHG is also safe and beneficial for BP management of patients with COA is unclear. Purpose: The aims of this descriptive study were: (1) to describe the BP response during IHG and (2) to assess changes in office BP after a single session of IHG in COA patients. Methods: Five men (mean age 39,9 years, range 22-58) with isolated COA (age at repair median 2,89 year, range 0,2 ã 12,9 year) and BP ≥ 120/80 mmHg performed one seated sham training session and two unilateral IHG sessions in randomized order. After 10 minutes of rest, seated office was measured according to current guidelines. Subsequently, beat to beat BP was recorded (pre-intervention) for 10 minutes using an external analog-to-digital converter and non-invasive finger photophlethysmography at the middle finger. During each of the IHG sessions patients performed a unilateral IHG protocol (1 session left arm; 1 session right arm) consisting of four sets of 2-minute sustained contraction at 30% of maximal volutional contraction (MVC) separated by 3-minute rest periods using a digital hand dynamometer. During the IHG session, beat to beat BP was recorded following the same protocol mentioned above. During the sham training session, patients were holding the handgrip device without doing effort, for the same amount of time as the IHG session (mimicking 4 bouts of 2 minutes with 3 minutes of rest). After the interventions, patients remained seated for 1 hour (post-intervention). An ambulatory BP (ABP) monitoring device, measured BP and HR immediately post-intervention and every 20 minutes during 1 hour post-intervention. Results: During the sham session, SBP remained stable over the whole protocol (from rest to 2-min) (A) while a DBP reduction (D) at first and second minute compared to rest was observed. For both IHG sessions (B, C, E, F) an increase in SBP and DBP (5mmHg for both) was observed. During recovery, BP was lower compared to baseline, with a reduction of around 5 mmHg after IHG session compared to -2mmHg following sham session following 20 minutes. Conclusions: These preliminary data suggest that IHG intervention is safe. Further, the observed post-exercise hypotension shows that IHG can also induce a hypotensive effect in the first hour following IHG. Larger studies are now warranted to investigate the longer-term effect of this intervention in this clinical population. 30 https://esc365.escardio.org/Presentation/217084/abstract Peripheral artery disease in hypertensive individuals: results from a portuguese local screening J Ferreira1, M Fonseca1, JM Farinha1, AF Esteves1, A Pinheiro1, R Marinheiro1, S Goncalves1, C Costa1, Q Rato1, R Caria1 1Hospital Center of Setubal, Cardiology, Setubal, Portugal Topic: Peripheral Vascular and Cerebrovascular Disease – Clinical Background: Peripheral artery disease (PAD) is associated with a higher risk for major adverse cardiovascular events and hypertension is one of its main risk factors. However, since it is often asymptomatic, PAD is underdiagnosed. The ankle-brachial index (ABI) is considered an accurate method for the diagnosis of PAD and is often also used for screening. Despite the availability of a simple screening tool, studies of prevalence of PAD in the Portuguese population are still lacking. Purpose: To evaluate the prevalence of PAD in a Portuguese sample of high to very high-risk hypertensive patients. Methods: We conducted an observational study including individuals with hypertension considered at high or very high cardiovascular risk, according to their calculated SCORE of ≥ 5% and ≥ 10%, respectively. The sample was recruited at a local cardiovascular screening event that took place in Portugal in May 2019. The subjects were screened for peripheral artery disease through the ABI. Systolic blood pressures were measured in all limbs by trained examiners using the Doppler method. PAD was defined as an ABI ≤ 0.9. Results: The sample consisted of 81 individuals, with a median age of 70 years. The majority of the sample (86%) had at least one risk factor other than hypertension. 78% had dyslipidemia, 44% had diabetes and 19% were smokers. The prevalence of PAD was 23%, only 5% of these individuals were symptomatic and none had a previous diagnosis of PAD. The mean systolic blood pressure (measured in the screening) in the group with PAD was higher than in the group with a normal ABI (166.6 vs 154.5; p=0.023) and systolic blood pressure was independently associated with increased likelihood of PAD (OR 1.04; 95% CI 1.002-1.069; p=0.035). A history of previous cardiovascular events was also independently associated with PAD (OR 6.67; 95% CI 1.435-31.021; p=0.016). Conclusion: Our results confirm that PAD is common among hypertensive individuals but is still underdiagnosed. The association between higher systolic blood pressure and PAD among hypertensive patients highlights the importance of an optimal control of cardiovascular risk factors. 341 https://esc365.escardio.org/Presentation/223131/abstract The prevalence of peripheral arterial disease in a high-moderate cardiovascular risk population A Antonio Candjondjo1, M Fonseca1, J Farinha1, A Esteves1, J Ferreira1, R Marinheiro1, S Goncalves1, Q Rato1, A Lopes1, R Caria1 1Hospital Center of Setubal, Setubal, Portugal Topic: Peripheral Vascular and Cerebrovascular Disease – Clinical INTRODUCTION: Peripheral arterial disease (DAP) is an independent risk factor for cardiovascular and all-cause mortality, being frequently underdiagnosed. PURPOSE: To evaluate the prevalence and predictors of peripheral arterial disease in an occasional urban population with a high-moderate cardiovascular risk in 2019. METHODS: We performed a PAD screening in an occasional sample of urban population with a high-moderate cardiovascular risk, according to their calculated SCORE. The population was divided into two groups according to the presence or absence of PAD (defined as a ankle-brachial index (ABI)≤0.90). The statistical analysis was performed using the SPSS 22 (Statists Package for Social Sciences version 22). RESULTS: We included a total of 103 participants (mean age 72.9 ± 9.1 years), 53 (56%) were male, 81 (78,6%) had hypertension, 77 (74,8%) had dyslipidemia, 43 (41,7%) were diabetic and 21 (28,4%) were active smokers. Regarding the control of cardiovascular risk factors, 72 (69,9%) were treated with antihypertensive drugs, 57 (55,3%) with hypolipidemic drugs and 39 (37,9%) with hypoglycemic drugs. PAD was diagnosed in 25 patients (24.3%).There were no significant differences in the prevalence of risk factors between both groups. Systolic arterial pressure (OR 1.070; 95% CI 1.029-1.113; p = 0.001) measured at the day of screening was the only independent variable associated with a high risk of PAD. CONCLUSION: In a population at a high-moderate cardiovascular risk PAD is frequent, affecting about a quarter of patients. The measurement of the ankle-brachial index can contribute to a better stratification of patients in relation to their real cardiovascular risk category and thus allow to intensify pharmacological measures and control of cardiovascular risk factors. EAPC Essentials 4 You - ePosters P475 https://esc365.escardio.org/Presentation/221556/abstract Determinants of progression after supervised exercise therapy through technology in patients with intermittent claudication: the PROSECO-IC trial's design and rationale N Nils Cornelis1, R Buys1, I Fourneau2, J Claes1, E Vermeulen1, M Mahieu1, G Leysen1, C De Wilde1, V Cornelissen1 1KU Leuven, Rehabilitation sciences, Leuven, Belgium 2KU Leuven, Cardiovascular sciences, Leuven, Belgium Topic: Peripheral Vascular and Cerebrovascular Disease – Clinical Background: Supervised exercise therapy (SET) is internationally recognized as the first line treatment in patients with intermittent claudication (IC). Although evidence is ubiquitous, both logistic and patient-related barriers limit uptake and adherence to SET. In addition, observed heterogeneity in SET outcomes might be another obstacle to implement SET as an efficient first line therapy. Design and methods. The PROSECO-IC trial is a prospective study which will recruit eighty patients with IC (Rutherford II-III, ABI≤0.9 and/or ABI decrease after exercise ≥20%) between March 2019 and June 2020 at the vascular center of University hospitals Leuven. Participants will follow a 12-week SET program involving one center-based and two technology-monitored home-based walking sessions per week (figure). The home sessions will be monitored through walking GPS uploads using a commercial wrist-worn physical activity tracker. By these means, individually tailored exercise instructions will be progressively adapted to increase maximal and pain-free walking distance. Feasibility of the interventionsã material, content and sustainability will be evaluated using Likert scale feedback in addition to an analysis of adherence to all aspects of the program (wearable use, home-based and center-based sessions). Clinical effectiveness will be evaluated and used to construct both univariate logistic regression and multivariate analysis using forward feature selection. Both models will include demographics and clinical history, objectively measured physical activity and fitness, baseline ambulatory capacity, treatment expectations, disease specific measures and both (non)traditional cardiovascular risk factors (table). Trial registration can be found at clincaltrails.gov: NCT03995589. Conclusions: The PROSECO-IC trial is designed to evaluate a mixed SET approach in patients with IC using wearable technology. Prediction models will be developed that will identify patients that are more likely to respond favorably to SET. Exercise intervention Exercise adherence and volume Home-based sessions Center-based sessions Extra-training sessions Physical activity Sensewear® Mini Physical fitness Cardiopulmonary exercise test on a cycle ergometer Ambulatory capacity Walking impairment questionnaire (WIQ) Treadmill Gardner-Skinner protocol 6-MWT Treatment expectation Credibility and Expectancy Questionnaire (CEQ) Cardiovascular risk factors Blood lipids and fasting blood glucose Office blood pressure Age Anthropometrics (weight, BMI, body fat, waist- and hip circumference) Vascular stifness (Arteriograph®) Autonomic function Disease specific information Lesion location (MR or CT-scan) Local metabolism using NIRS (Portamon®) Ankle-brachial index Exercise intervention Exercise adherence and volume Home-based sessions Center-based sessions Extra-training sessions Physical activity Sensewear® Mini Physical fitness Cardiopulmonary exercise test on a cycle ergometer Ambulatory capacity Walking impairment questionnaire (WIQ) Treadmill Gardner-Skinner protocol 6-MWT Treatment expectation Credibility and Expectancy Questionnaire (CEQ) Cardiovascular risk factors Blood lipids and fasting blood glucose Office blood pressure Age Anthropometrics (weight, BMI, body fat, waist- and hip circumference) Vascular stifness (Arteriograph®) Autonomic function Disease specific information Lesion location (MR or CT-scan) Local metabolism using NIRS (Portamon®) Ankle-brachial index Open in new tab Exercise intervention Exercise adherence and volume Home-based sessions Center-based sessions Extra-training sessions Physical activity Sensewear® Mini Physical fitness Cardiopulmonary exercise test on a cycle ergometer Ambulatory capacity Walking impairment questionnaire (WIQ) Treadmill Gardner-Skinner protocol 6-MWT Treatment expectation Credibility and Expectancy Questionnaire (CEQ) Cardiovascular risk factors Blood lipids and fasting blood glucose Office blood pressure Age Anthropometrics (weight, BMI, body fat, waist- and hip circumference) Vascular stifness (Arteriograph®) Autonomic function Disease specific information Lesion location (MR or CT-scan) Local metabolism using NIRS (Portamon®) Ankle-brachial index Exercise intervention Exercise adherence and volume Home-based sessions Center-based sessions Extra-training sessions Physical activity Sensewear® Mini Physical fitness Cardiopulmonary exercise test on a cycle ergometer Ambulatory capacity Walking impairment questionnaire (WIQ) Treadmill Gardner-Skinner protocol 6-MWT Treatment expectation Credibility and Expectancy Questionnaire (CEQ) Cardiovascular risk factors Blood lipids and fasting blood glucose Office blood pressure Age Anthropometrics (weight, BMI, body fat, waist- and hip circumference) Vascular stifness (Arteriograph®) Autonomic function Disease specific information Lesion location (MR or CT-scan) Local metabolism using NIRS (Portamon®) Ankle-brachial index Open in new tab P476 https://esc365.escardio.org/Presentation/217372/abstract Prevalence of peripheral arterial disease in a diabetic population at a cardiovascular screening event AF Ana Fatima Esteves1, M Fonseca1, JM Farinha1, A Pinheiro1, J Ferreira1, R Marinheiro1, S Goncalves1, Q Rato1, N Fonseca1, R Caria1 1Hospital Center of Setubal, Setubal, Portugal Topic: Peripheral Vascular and Cerebrovascular Disease – Clinical Background: Peripheral arterial disease (PAD) is an atherosclerotic disease associated with an increased global cardiovascular (CV) risk and mortality. Its prevalence in diabetic patients is high, but there are still few data regarding this issue in the Portuguese population. Purpose: To assess prevalence and potential predictors of PAD in a population of patients with type 2 diabetes mellitus (T2DM). Methods: In a population screening event we identified people with T2DM and evaluated the ankle-brachial index (ABI) through Doppler ultrasound measurement of systolic arterial blood pressure in the four limbs (in accordance with 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery). We determined basal characteristics of these patients, including presence of symptoms, cardiovascular risk factors and previous CV events. Patients with an ABI ≤ 0.9 were defined as having PAD. Results: In this population, 43 people had T2DM, median age 69 years (interquartile range 8), 30.2% male. Of these, 36 (83.7%) had arterial hypertension, 35 (81.4%) had dyslipidaemia, 6 (14%) were active smokers and 20 (46.5%) were obese. The majority (88.4%) had two or more CV risk factors in addition to T2DM. Of note, 4 patients had a previous myocardial infarction (MI) and 3 a previous stroke. PAD was present in 10 (23.3%) patients and 6 were symptomatic. None of these had a previous PAD diagnosis. The majority of these patients were medicated for CV risk factors: 90% for arterial hypertension, 90% for T2DM and 70% for dyslipidaemia. Previous MI was present in 75% of patients with PAD. In multivariate analysis, previous MI was an independent predictor of PAD (OR 15.42, 95% CI 1.327-178.968, p-value 0.029). Conclusion: In this population with type 2 diabetes mellitus we found a high prevalence of PAD, largely undiagnosed. The clear association between previous MI and the presence of PAD shows its importance as a marker of atherosclerosis and increased CV risk. P478 https://esc365.escardio.org/Presentation/217367/abstract Predictive parameters of atrial fibrillation in the follow-up of the patient with high blood pressure F Peris Castello1, A Romero Valero1, L Nunez Martinez1, P Guedes Ramallo1, FM Rodriguez Santiago1, C Benavent Garcia1, M Garcia Carrilero2, J Quiles Granado2, J Castillo Castillo1, V Bertomeu Martinez2, PJ Morillas Blasco1 1GENERAL UNIVERSITY HOSPITAL OF ELCHE, Elche, Spain 2University Hospital San Juan de Alicante, Alicante, Spain Topic: Hypertension – Treatment Introduction: It is known that high blood pressure (HBP) behaves as a thrombotic risk factor in patients with atrial fibrillation (AF), as stated on the CHA2DS2VASc scale. However, there is little information on which conditions may promote AF in the hypertensive patient. Objectives: To establish which clinical, analytical and echocardiographic parameters correlate with the development of AF in the follow-up of the patient with hypertension. Methods: Observational, longitudinal and prospective study in which hypertensive patients from the Arterial Hypertension Unit were included. Clinical variables, cellular apoptosis markers, electrocardiographic data and echocardiographic measurements were determined. An average follow-up of 7 years was carried out in which the newly diagnosed AF was collected as an event. Results: 160 patients with HBP were recruited. The mean age was 57 years. 67% men. 19% diabetics and 45% dyslipemics. 40% had renal damage in the form of microalbuminuria, alteration of albumin/creatinine ratio or deterioration of glomerular filtrate. 6% developed AF during follow-up. In bivariate analysis, patients who developed AF had a higher proportion of diabetes mellitus (50% versus 17%; p=0.009) and renal damage (80% versus 37%; p=0.008). HBP evolution time was longer (18±12.06 vs 10±11.15; p=0.036) and a significant elevation of cellular apoptosis markers was observed: sTNFRI (1750.71±276.14 vs 1465.12±397.93; p=0.027) and MMP1 (100±38.80 vs 76.49±33.35; p=0.044) significantly higher. In addition, they had greater left ventricular hypertrophy (LVH) measured by echocardiography (13.99±3.02 vs 10.97±2.63; p=0.001) and greater left atrial area (44±6.19 vs 40±5.36; p=0.044). In multivariate analysis, HBP evolution time (p=0.010), apoptosis markers sTNFRI (p=0.035) and MMP1 (p=0.008) and LVH (p=0.030) were significantly associated with AF at follow-up. Conclusions: Plasma apoptosis markers sTNFRI and MMP1 are independently associated with increased risk of AF during follow-up in patients with HBP. On the other hand, HBP evolution time and HVI echocardiographic parameters were also related to the presence of AF at follow-up. P480 https://esc365.escardio.org/Presentation/221559/abstract Different aerobic exercise programs pari passu affect cardiac autonomic modulation and hemodynamics in hypertension: data from EXERDIET-HTA study AMDA Martinezaguirre-Betolaza1, IM Mujika2, SF Fryer3, PC Corres4, IGA Gorostegi-Anduaga4, JPA Perez-Asenjo5, S Maldonado-Martin4 1University of the Basque Country (UPV/EHU), Department of Physical Education and Sport, VITORIA-GASTEIZ, Spain 2UNIVERSITY OF THE BASQUE COUNTRY (UPV/EHU), PHYSIOLOGY, LEIOA, Spain 3University of Gloucestershire, School of Sport and Exercise, Gloucester, United Kingdom of Great Britain & Northern Ireland 4University of the Basque Country. Department of Physical Education and Sports., VITORIA-GASTEIZ, ARABA/ALAVA (BASQUE COUNTRY), Spain 5Igualatorio Médico Quirúrgico (IMQ-Amárica), Cardiology Unit., Vitoria-Gasteiz, Spain On Behalf of: LAKET (Live Active, Keep Exercising & Training) Funding Acknowledgements: BASQUE GOVERNMENT-PREDOCTORAL GRANTS FOR IGA,AMDA, PC Topic: Hypertension – Treatment INTRODUCTION. Primary hypertension (HTN) is associated with dysfunctional autonomic cardiovascular control, both at rest and in response to exercise. Although it has been demonstrated that exercise training (ExT) induces positive changes in hemodynamic, autonomic and cardiac adaptations in individuals with HTN, there are no investigations analyzing the impact of aerobic ExT programs which differ in intensity and volume on resting, submaximal exercise, peak and recovery autonomic modulation, and long-term blood pressure variability (BPV) in overweight/obese adults suffering from HTN. PURPOSE. To analyze the effects of 16 weeks of different aerobic ExT programs with diet on cardiac autonomic modulation and hemodynamics in non-physically active and overweight/obese adults with HTN, and the possible differences among ExT programs and their effects on heart rate (HR), blood pressure (BP), and long-term BPV. METHODS. Overweight/obese non-Hispanic white participants (n=249, 53.7±8.0 years) with HTN were randomly assigned into an attention control (AC) group (physical activity recommendations) or one of three supervised ExT groups: high-volume of moderate-intensity continuous training, high-volume and high-intensity interval training (HIIT), and low volume-HIIT. 24h ambulatory BP monitoring was used to analyze systolic (SBP) and diastolic (DBP), HR and BPV. A cardiopulmonary exercise test was performed to determine peak oxygen uptake (VO2peak). RESULTS. Following intervention, resting and submaximal exercise (HR, SBP and DBP), along with diurnal and nocturnal SBP and DBP values decreased (P<0.05) in all groups with no differences between groups. When the ExT groups were combined, submaximal SBP (P=0.048) and DBP (P=0.004), VO2peak (P=0.014) and HR reserve (P=0.030) were significantly improved compared to AC. Intervention did not have significant effects on BPV. CONCLUSIONS. In the present study better improvements in the autonomic nervous system were seen when the aerobic ExT was individually designed and supervised with pari passu effects irrespective of exercise intensity and volume. Low volume-HIIT ExT combined with a healthy diet should be considered as a time efficient and safe mechanism for reducing the cardiovascular risk in hypertensive individuals. P481 https://esc365.escardio.org/Presentation/217099/abstract Seasonal variations of blood pressure may influence prevention strategy in hypertensive patients V Vladimir M Gorbunov1, MI Smirnova1, YN Koshelyaevskaya1, NV Furman2, PV Dolotovskaya2, YS Slepchenko2, AD Deev1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation 2Research Institute of Cardiology Saratov State Medical University named after V.I. Razumovsky , Saratov, Russian Federation Topic: Hypertension – Treatment Background: The seasonal changes of blood pressure (BP) in hypertensive patients have attracted an increasing scientific interest during the past two decades. One of the key steps in the investigation of the problem is the individual-level BP data analysis. Purpose: The aim of the study was the examination of seasonal variations of individual office and 24-hour BP levels of hypertensive patients in two regions of the Russian Federation, Ivanovo and Saratov. Methods: We included patients aged 40-79 years who visited ambulatory clinics for various reasons. The main inclusion criteria were office BP 130/85-139/89 mm Hg, hypertension stage 1 (European Society of Hypertension Guidelines, 2007) or long-term antihypertensive therapy. All participants provided written informed consent. The ambulatory blood pressure monitoring (ABPM) was performed with the BPLab device twice in all patients: in winter (December-February 2012-2014) and in summer (June-August 2012-2014). The interval between ABPMs was 6 months ±7 days. The selection criteria for ABPM records were: duration ≥23.5 hours, absence of data gaps >1 hour, ≥56 readings per 24 hours. We analyzed the individual ambulatory and office seasonal BP differences in each patient. The scale spacing was 5 mm Hg. Results: 770 patients completed both visits ã 499 from Ivanovo (mean age 52±10 years, 181 men), and 271 from Saratov (mean age 58±11 years, 151 men). The mean winter-summer difference (M±SD) in the cohort was 1.5±14.5 mm Hg for 24-hour ambulatory systolic BP (SBP, p<0.05) and 4.5±15.3 mm Hg for office SBP (p<0.001). The marked variability of the individual seasonal office BP dynamics was found. In 34% of patients, the office SBP levels in winter exceeded the corresponding summer levels by >10 mm Hg. A completely opposite pattern was observed in 14% of patients. There was a considerable divergence between office and daytime BP data in the marginal sextiles. In the first sextile (winter-summer difference >10 mm Hg), it was 43%, whereas in the sixth one (summer-winter difference >10 mm Hg), it reached 69%. At the same time the strong correlation between office and ambulatory seasonal BP variability was found. For instance, the r value was 0.42 (p<0.0001) for office vs. daytime SBP, and 0.47 (p<0.0001) for office vs. daytime diastolic BP. Conclusions: The importance of these data lies in their expected impact on hypertension diagnostics and efficacy of treatment assessment. The prognostic value of the winter-summer BP difference warrants further investigation. P482 https://esc365.escardio.org/Presentation/221656/abstract Comparative effects of 12-weeks of aerobic versus combined exercise training on short term blood pressure variability in patients with hypertension G Giuseppe Caminiti1, A Mancuso1, A Franchini1, M Montano2, V Cioffi1, A Cerrito1, F Iellamo2, M Volterrani2 1IRCCS San Raffaele Pisana Hospital, Rome, Italy 2University of Rome Tor Vergata, Rome, Italy Topic: Hypertension – Treatment Background: Exercise training effectively reduces blood pressure (BP) values. However its effect on short term BP variability has not been clarified yet. Study aim: to compare the effects on BP variability of two different exercise modalities during a cardiac rehabilitation program in hypertensive patients. Methods: We enrolled 56 males patients with arterial hypertension. Patients were randomly assigned either to an aerobic training (AT) group or to a combined training group (CT), this latter including aerobic and resistance training. The training program lasted 12 weeks for each group. Short term BP variability was evaluated, at baseline and after 12 weeks, by 24/h ambulatory BP monitoring (ABPM) Results: Systolic and diastolic BP values decreased significantly in both groups, without between groups differences. 24/systolic BP variability decrease in both groups (AT= from 8.2±2.3 to 7.8±1.8, p0.07 ; CT= from 8.4±1.9 to 7.1±1.3, p 0.02)with a greater decrease in CT (between groups p= 0.04). Nocturnal BP variability decreased in CT (from 7.4±1.6 to 6.0±1.3, p=0.008) and remained unchanged in ACT (from 7.0±2.0 to 6.7±1.3, p=0.09). Diurnal BP variability decreased mildly in both groups without between groups differences. Conclusions: 12 weeks of CT were more effective than AT for reducing short-term variability in hypertensive patients. CT appears as the more appropriate exercise modality when there is need for targeting both BP values and variability. P485 https://esc365.escardio.org/Presentation/221586/abstract Supervised exercise training vs. physical activity advice in overweight/obese adults with primary hypertension: long-term effects on lipid and glycemic profile in the EXERDIET-HTA study P Corres1, A Martinezaguirre-Betolaza1, I Gorostegi-Anduaga1, I Arratibel-Imaz1, J Perez-Asenjo2, S Sara Maldonado-Martin3 1University of the Basque Country. Department of Physical Education and Sports., VITORIA-GASTEIZ, ARABA/ALAVA (BASQUE COUNTRY), Spain 2Igualatorio Médico Quirúrgico (IMQ-Amárica), Cardiology Unit., Vitoria-Gasteiz, Spain 3University of the Basque Country, Vitoria-Gasteiz, Spain On Behalf of: LAKET (Live Active, Keep Exercising & Training) Funding Acknowledgements: BASQUE GOVERNMENT-PREDOCTORAL GRANTS FOR IGA,AMDA, PC Topic: Hypertension – Treatment Introduction: Prymary hypertension (HTN), obesity, and abnormal lipid and glycemic profile have been all associated with a higher risk of cardiovascular disease. Guidelines recommend appropriate lifestyle changes, including non-pharmacological treatment, for the prevention and treatment of HTN and obesity and to improve lipid and glycemic profile. No known studies have analyzed the long-term effects of intervention after six-months (6M) of unsupervised physical activity advice on lipid and glycemic profile in this specific population. PURPOSE. To determine whether improvements in lipid and glycemic profile previously seen after a 16-week exercise intervention (POST) with hypocaloric diet, are maintained following 6M of unsupervised physical activity advice. Methods: Overweight/obese, physically inactive participants with HTN (n=177, 53.3±7.6 years) were randomly assigned into an attention control (AC) group (physical activity recommendations) or an exercise training (ExT) group. After POST, all participants received diet and physical activity advice for the following 6M but no supervision. All fasting lipid and glycemic profile measurements were taken pre and post the 16-week supervised intervention period, as well as after 6M of no supervision. Results: After 6M: 1) Compared to POST, total cholesterol (POST: 197.1±35.4 mmol/L, 6M: 207.8±36.1, D=5.4%), low density lipoprotein cholesterol (POST: 127.3±31.6 mmol/L, 6M: 134.8±31.5 mmol/L, D=5.9%) and glucose concentrations (POST: 96.8±22.5 mmol/L, 6M: 101.1±29.7 mmol/L, D=4.4%) were higher (P<0.005) with no difference from pre-intervention; 2) Triglycerides concentration was lower compared to pre-intervention (PRE: 125.2±49.8 mmol/L, 6M: 109.8±43.2 mmol/L, D=-12.3%, P<0.005) but there was no change from POST; and 3) High density lipoprotein cholesterol (HDL-C) was higher from POST (POST: 48.5±11.2 mmol/L, 6M: 51.0±12.7 mmol/L, D=5.2%, P<0.005) and higher from pre-intervention (PRE: 48.6±11.0 mmol/L, D=4.9%, P<0.005). There were no significant differences between AC and ExT groups. Conclusions: When an overweight/obese population with HTN attains significant improvements in lipid and glycemic profile POST intervention with diet restriction, there is a significant reduction following 6M when exercise and diet supervision is removed, and only recommendations were applied (except for HDL-C, with improvements after 6M of unsupervised period). The overall results suggest the need for a regular, systematic and supervised diet and exercise programs to avoid subsequent declines in cardiometabolic health. P486 https://esc365.escardio.org/Presentation/217616/abstract Evolution of vascular elasticity indices under conventional active RASS medication: ramipril vs eprosartan NC Sapojnic1, V Moscalu1, AP Caraush1, NV Ciobanu1, AS Durnea1, AN Moiseev1, AI Bitca1, MA Caraush2 1Institute of Cardiology , Hypertension, Chisinau, Moldova (Republic of) 2Rehabilitation Hospital, Cardiovascular Recovery, Iasi, Romania On Behalf of: Academy of Sciences of Moldova Topic: Hypertension – Treatment Background: In hypertension, arterial elasticity of central arteries (C1) and of the distal circulation ( C2) have been reported to be reduced and some recent studies demonstrated that alteration in C1 and C2 indices were significantly associated with cardiovascular events, independent of age. PURPOSE: to investigate the elasticity of large and small arteries in relation to different type of conventional active RASS medication (Ramipril vs Eprosartan). Methods: Arterial elasticity indices (C1, C2) were derived from pulse wave analysis based on a modified Windkessel model in 101 hypertensive subjects, (mean age 51.08±0.79 yrs; 48.51% of men, SBP/DBP: 202.49±7.41/106.7±5.54 mmHg, BMI- 29.38±0.22 kg/m2), without other co-morbidities. They were randomly assigned to ramipril (R-gr; n=56, mean dose=15,3mg±1,2 mg/d) or eprosartan (E-gr; n=45, mean dose=850±12,4 mg/d). Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE)were performed at baseline and after 6, 12- months period of treatment. Diastolic dysfunction patterns were appreciated according to ASE/EACVI 2016 guidelines. Alterated arterial elasticity was considered for C1< 10 ml/mm Hg×10, C2 <6 ml/mm Hg×100. Results: The baseline characteristics of arms are shown in Fig 1. At baseline, C1 and C2 were compromised in both arms (10,7± 0,5 and 10,4± 0,4, respectively, p>0.05). During treatment period, both pharmacotherapic regimens have progressively improved the indices of vascular elasticity (p<0.001). At the same time, treatment with Eprosartan have proved to be more effective in recovering these indices to physiological ones (p<0,05), Table 1. Conclusion: In hypertensive patients with reduced vascular elasticity indices, both ramipril and eprosartan drug-regiment progressively improve vascular elasticity of the central arteries (C1) and of the distal circulation (C2), but with greater efficency in the Eprosartan-medicated arm, probably due to additional sympatholytic effect of its moiety. Variables Baseline 6 months 12 months Group C1, ml/mm Hg×10 10,7± 0,5 10,4± 0,4 11,5± 0,9* 11,2± 0,6* 12,3±0,6* 12,4±0,7* R-gr E-gr p>0.05 p < 0,05 p < 0,05 C2, ml/mm Hg×100 4,5± 0,3 4,6 ±0,3 4,9± 0,3* 5,3 ±0,3* 8,1±0,3* 8,5±0,2* R-gr E-gr p>0.05 p < 0,05 p < 0,05 Variables Baseline 6 months 12 months Group C1, ml/mm Hg×10 10,7± 0,5 10,4± 0,4 11,5± 0,9* 11,2± 0,6* 12,3±0,6* 12,4±0,7* R-gr E-gr p>0.05 p < 0,05 p < 0,05 C2, ml/mm Hg×100 4,5± 0,3 4,6 ±0,3 4,9± 0,3* 5,3 ±0,3* 8,1±0,3* 8,5±0,2* R-gr E-gr p>0.05 p < 0,05 p < 0,05 Note: *p- <0.001 from baselineFigure 1. Evolution of vascular elasticity indices according to medication Open in new tab Variables Baseline 6 months 12 months Group C1, ml/mm Hg×10 10,7± 0,5 10,4± 0,4 11,5± 0,9* 11,2± 0,6* 12,3±0,6* 12,4±0,7* R-gr E-gr p>0.05 p < 0,05 p < 0,05 C2, ml/mm Hg×100 4,5± 0,3 4,6 ±0,3 4,9± 0,3* 5,3 ±0,3* 8,1±0,3* 8,5±0,2* R-gr E-gr p>0.05 p < 0,05 p < 0,05 Variables Baseline 6 months 12 months Group C1, ml/mm Hg×10 10,7± 0,5 10,4± 0,4 11,5± 0,9* 11,2± 0,6* 12,3±0,6* 12,4±0,7* R-gr E-gr p>0.05 p < 0,05 p < 0,05 C2, ml/mm Hg×100 4,5± 0,3 4,6 ±0,3 4,9± 0,3* 5,3 ±0,3* 8,1±0,3* 8,5±0,2* R-gr E-gr p>0.05 p < 0,05 p < 0,05 Note: *p- <0.001 from baselineFigure 1. Evolution of vascular elasticity indices according to medication Open in new tab Fig.1 P703 https://esc365.escardio.org/Presentation/217116/abstract The psychological status scale scores correlated with clinical and ambulatory blood pressure in patients with arterial hypertension G Galiya Andreeva1, V Gorbunov1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Hypertension – Treatment Objective: The aim of our study was to determine associations between the psychological testing data and clinical, ambulatory blood pressure in untreated patients with arterial hypertension (AH). Design and Methods: We analyzed database of several studies (200 AH patients without serious concomitant diseases). ABPM monitor was applied after the washout period. After ABPM session each patient completed the Russian version of the psychological questionnaire "Minnesota Multiphasis Personality Inventory" (MMPI). We analyzed the following evaluation and basic MMPI scales: L – lie scale, F – aggravation scale, K – correction scale, 1 (Hs) – hypochondria, 2 (D) – depression, 3 (Hy) – hysteria, 4 (Pd) – psychopathy, 6 (Pa) – rigidity of affect, 7 (Pt) – psychasthenia, 8 (Sc) – schrizothemia, 9 (Ma) – hypomania. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The initial mean ambulatory daytime systolic BP (SBP) was 142.1±14.2, diastolic (DBP) - 89.5±10.1 mm Hg (M±SD), clinical SBP was 147.7±16.4, clinical DBP - 94.2±11.7 mm Hg (M±SD), age - 52,7±12.2 years. We found the following significant negative correlations between 9 (Ma) scale scores (level of activity, energy, good mood) and: 1)clinical SBP level (r=-0,22, p<0,05); 2) 24-hours DBP load (r=-0,20, p<0,05); 3) 24-hours SBP load (r=-0,21, p<0,05); 4) daytime SBP load (r=-0,21, p<0,05). Thus, 9 (Ma) scale scores (level of activity, energy, good mood) had negative correlation with clinical SBP levels, 24 hours and daytime BP loads. Conclusions: Thus, level of activity, energy, good mood was negatively associated with clinical BP and ambulatory BP load. Probably, a high level of cheerfulness may prevent blood pressure rise, and reduce BP load both in 24 hours and in the daytime. P704 https://esc365.escardio.org/Presentation/217121/abstract The social components of the quality of life was related with seasonal ambulatory blood pressure increase in patients with arterial hypertension G Galiya Andreeva1, V Gorbunov1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Hypertension – Treatment Objective: The aim of our study was to determine correlations between ambulatory seasonal blood pressure increase and quality of life (QL) components (psychological, social and others) in untreated patients with arterial hypertension (AH) ) in Moscow region. Design and Methods: We analyzed database of several studies (380 AH patients without serious concomitant diseases). ABPM monitor was applied after the washout period. After ABPM session patients completed the QL questionnaire (J. Siegrist). The coefficient of seasonal BP fluctuations were assessed as the delta between the reference BP level (average annual BP level) and the patients BP level in a evaluated season. We analyzed following QL scale scores: 0 scale - mood at the doctorã s visit , I scale - physical well-being; II scale - physical performance; III scale - positive psychological well-being; IV scale - negative psychological well-being; V scale - psychological performance; VI scale - social well-being; VII scale - social performance. We used General Linear Model (GLM) Procedure for statistical analysis adjustment for age, sex and duration of AH and Fisher's (F) test. Results: We found the following significant associations between the coefficient of seasonal BP fluctuations and: 1) VI scale scores of QL questionnaire (reflects the level of social support of family, friends, colleagues), F= -6,62 p<0,01 (for night seasonal SBP dynamics); 2) VI scale scores, F= -11,12, p<0,001 (for daytime seasonal SBP fluctuations); 3) VI scale scores, F= - 4,06, p<0,04 (for daytime seasonal DBP dynamic), 4) age, F=5,57, p<0,01 (for night seasonal SBP fluctuations). Thus, the coefficient of seasonal BP fluctuations had negative correlations with the social support from family, friends, colleagues (VI scale scores of QL questionnaire). Conclusions: The social QL components (social support from family, friends, colleagues) was negative associated with seasonal BP fluctuations (daytime, night). Thus, a high level of social support probably may prevent seasonal blood pressure rise. P706 https://esc365.escardio.org/Presentation/217117/abstract The relationship between social support level and ambulatory blood pressure indices in patients with arterial hypertension G Galiya Andreeva1, V Gorbunov1, O Isaykina1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Hypertension – Treatment Objective: The aim of our study was to determine correlations between quality of life (QL) components (psychological, social and others) and ambulatory blood pressure indices in untreated patients with arterial hypertension (AH). Design and Methods: We analyzed database of several studies (250 AH patients without serious concomitant diseases). ABPM monitor was applied after the washout period. After ABPM session patients completed the QL questionnaire. We analyzed following QL scale scores: 0 scale - mood at the doctorã s visit , I scale - physical well-being; II scale - physical performance; III scale - positive psychological well-being; IV scale - negative psychological well-being; V scale - psychological performance; VI scale - social well-being; VII scale - social performance. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The initial mean ambulatory daytime systolic BP (SBP) was 141.7±10.4; diastolic (DBP) - 81.1±9.0 mm Hg (M±SD), age - 55,1±10.8 years. We found the following significant negative correlations between VI scale scores (social well-being, social support of friends, relatives etc.) and: 1) age (r=-0,31,p<0.001); 2) SBP level in 24 hours (r=-0,22, p<0,05); 3) maximum SBP level in 24 hours (r=-0,22, p<0,05); 4) daytime SBP (r=-0,20, p<0,05); 5) night SBP (r=-0,20, p<0,05); 6) maximum night SBP level (r=-0,20, p<0,05). Also, VII scale scores had correlations with age (r=-0,24,p<0.001) and height (r=0,20, p<0,05). Thus, the VI scale scores (social well-being, social support of friends, relatives etc.) had negative correlation with ambulatory SBP levels (daytime, night, in 24 hours). Conclusions: The social components of QL (such as social well-being, social support) was negative associated with ambulatory SBP level. Thus, a high level of social support probably may prevent extreme blood pressure rise. P707 https://esc365.escardio.org/Presentation/217028/abstract Composite endpoint was related to the psychological component of the qualityof life in treated patients with arterial hypertension G Galiya Andreeva1, M Smirnova1, V Gorbunov1, Y Koshelyaevskaya1, V Gorbunov1, A Kurekhyan1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Hypertension – Treatment Objective: The aim of our study was to determine relationship between quality of life (QL) scale scores and composite endpoint in treated patients with arterial hypertension (AH). Design and Methods: We analyzed database of treated AH patients (n=125) with concomitant chronic diseases without exacerbation or in the compensation stage. We asseessed relationships between the initial social, demographic indicators, QL scale scores, ambulatory blood pressure monitoring (ABPM) data and composite endpoint (death for any reason, transient ischemic attack, arterial revascularization, development of chronic heart failure, frequent ventricular extrasystole, atrial fibrillation, angina pectoris) after 30.1 ± 7.6 months from the inclusion visit. QL questionnaires (J.Siegrist) was completed initially, at the second (after 6 months) and at the third visit (after 12 months), the ABPM session was performed initially and at the third visit, antihypertensive therapy was corrected at all visits. We analyzed following QL scale scores: 0 scale - mood at the doctorã s visit , I scale - physical well-being; II scale - physical performance; III scale - positive psychological well-being; IV scale - negative psychological well-being; V scale - psychological performance; VI scale - social well-being; VII scale - social performance. We used ANOVA (analysis of variance) for statistical analysis. Results: The baseline mean daytime systolic BP (SBP) was 125.1±10.5; diastolic (DBP) - 76.1±7.3 mm Hg (M±SD), age-62.6±8.8 years. We found following negative correlations between composite endpoint (21 cases) and: 1) III scale scores (positive psychological well-being) (F=-5.3, p<0,05); 2) 0 scale (mood at the doctorã s visit) (F=-5.6, p<0,05). Also, we identified a positive correlation between endpoint data and V scale scores (physical performance) (F=12.2, p<0.001). The composite endpoint data were not correlated with sex, age, body mass index, smoking, ambulatory and clinical levels of blood pressure, the number of drugs in concomitant therapy, pulmonary forced vital capacity. At the end of the study, we recorded 21 cases included in the composite endpoint: death (2), transient ischemic attack (1), arterial revascularization (4), frequent ventricular extrasystole (3), atrial fibrillation (8), angina pectoris (3). Conclusions: Psychological QL component, such as positive psychological well-being (scale I), good mood at the doctorã s visit (scale 0) had negative correlation with composite endpoint data. At the same time, the physical performance (scale V) had positive relationship with composite endpoint results. P709 https://esc365.escardio.org/Presentation/221546/abstract Association between body composition, cardiorespiratory fitness and dietary patterns in overweight/obese adults with primary hypertension: data from the EXERDIET-HTA study IGA Gorostegi-Anduaga1, PC Corres1, AMDA Martinezaguirre-Betolaza1, JPA Perez-Asenjo2, BJI Jurio-Iriarte1, S Sara Maldonado-Martin1 1University of the Basque Country, Vitoria-Gasteiz, Spain 2Igualatorio Médico Quirúrgico (IMQ-Amárica), Cardiology Unit., Vitoria-Gasteiz, Spain On Behalf of: LAKET (Live Active, Keep Exercising & Training) Funding Acknowledgements: BASQUE GOVERNMENT-PREDOCTORAL GRANTS FOR IGA,AMDA, PC Topic: Hypertension – Treatment Background: Primary hypertension (HTN), obesity and low cardiorespiratory fitness (CRF) are associated with an increased risk of a cardiovascular event. The Healthy Diet Indicator (HDI), supported by the World Health Organization, the Mediterranean diet (MED), and The Dietary Approaches to Stop Hypertension (DASH) are some of the healthy dietary patterns associated with significant reduction in total mortality and cardiovascular disease. Purposes: To analyze dietary habits and the adherence to different types of dietary patterns in overweight/obese patients with HTN analyzing the potential sex differences, and to determine whether the type of diet is associated with body composition and the level of CRF. Methods: Body composition, CRF (peak oxygen uptake, VO2peak by cardiopulmonary exercise test) and dietary intake (by two non-consecutive 24-h recalls) were assessed in overweight/obese and sedentary non-Hispanic white participants (n=168, 53.8±8.2 yrs) with HTN. All dietary data was calibrated in Easy Diet computer program and dietary nutritional composition was obtained. Adherence to the MED, DASH diet and HDI were obtained. Results: No statistically significant differences were obtained between sex in the adherence to dietary patterns (P>0.05). The highest adherence was observed in DASH diet (46.25%), followed by MED diet (45.5%), whereas the lowest adherence was in HDI (41.7%). When diets were associated with body composition and CRF, a positive relation was found between age (p=0.01), body mass index (BMI, p=0.003) and VO2peak (ml·kg-1·min-1) (p=0.005) with DASH when the model was adjusted, being the β coefficient of 0.251 for VOpeak. Positive relations were found between age and HDI dietary pattern (p=0.002) and between BMI (Kg·m2) and MED diet (p=0.010). Conclusions: The adherence to the MED, DASH and HDI dietary pattern is similar in both sexes. Those with high adherence of DASH dietary patterns appeared to have higher CRF, so DASH diet may be considered as a cardiovascular health protector. Nevertheless, considering that our study is a cross sectional study, it should not be ignored that those with a better health condition may have a better dietary habit. P710 https://esc365.escardio.org/Presentation/217012/abstract Age dependents effect of different antihypertensive combinations with indapamide on pulse wave indices, hypertrophy and diastolic function in mild-moderate hypertensives K Lazareva1, K Amosova1, I Amat Santos2, YU Rudenko1, P Lazariev1, J Lopez Diaz2, J San Roman Calvar2, O Nishkumay1 1National O.O. Bohomolets Medical University, Internal Medicine #2, Kiev, Ukraine 2University Hospital Clinic of Valladolid, Valladolid, Spain Topic: Hypertension – Treatment Objective: To compare 6 month (M6) effects of renin-angiotensin system inhibitor (RAS) and calcium channel blocker (CCB)±indapamide on pulsatile load, hypertrophy and diastolic function in mild-moderate uncomplicated hypertensives (AH). Materials and methods: In randomized study with blinded endpoints assessment treatment-naive non-diabetic AH, predominantly mild <65 and ≥65 years of age were randomized into ACE-inhibitor (ACEI)/angiotensin receptor blocker (ARB) or CCB (groups A<65 years (n=71) pts per protocol and C<65 (n=66) pts, A≥65 (n=60) pts and C≥65 (n=87) pts). Group A<65 (age 52,6±0,02 years) was treated with perindopril 8,1±0,01 mg pd (n=37) or olmesartan 15,5±0,02 mg pd (n=34) and group C<65 (age 55,2±0,75 years) with lercanidipine 7,5±0,01 mg pd (n=66), group A≥65 (age 70,83±0,65 years, p>0,05) with perindopril 9,2±0,02 mg pd (n=34) or olmesartan 16,7±0,04 mg pd (n=26), group C≥65 (age 70,3±0,56 years, p>0,05) with fixed amlodipine±indapamide combination (5-10/1,5 mg pd). Study endpoints were office brachial systolic blood pressure (bSBP), aortic SBP, augmentation index (IA 75%) (SphygmoCor) at M6, M6-M0 difference in aSBP (∆aSBP) and carotis-femoral pulse wave velocity (∆PWV), left ventricle mass and left atrial volume indexes (LVMI, LAVI) and E/e¢ at M6 Results: Four groups didn`t differ in gender, degree AH, smoking rate, BMI, cholesterol and GFR, as well as indapamide co-treatment (52%, 69%, 88, 100%). Data on pulse wave indices and Echo-parameters are presented in the table. Conclusion: While in pts <65 years positive effect of 6 months therapy of ACE inhibitors/ARB and CCB indapamide on bSBP and pulse wave indices was comparable in elderly the combination of amlodipyne+indapamide has had an advantage over such an ACE inhibitors/ARB on reduction of pulsatile load, PWV and was associated with LVMI regression and LAVI, E/e¢ lowering. Group Time bSBP, mm Hg aSBP, mm Hg ∆aSBP, mm Hg IA 75, % PWV, m/s DPWV, m/s LVMI, g/m2 LAVI, ml/m2 E/e ¢ A<65 M0 153,3±1,27 138,6±1,07 -17,5±1,70 24,8±1,13 10,7±0,30 -1,2±0,46 109,8±3,32 26,5±0,88 7,17±0,25 M6 127,4±1,19*** # 121,1±1,17*** 21,4±1,0* 9,5±0,16** 101,6±3,13 24,4±0,77 7,21±0,20 C<65 M0 154,8±1,53 141,1±1,43 -22,3±2,02* 26,3±1,1 10,8±0,24 -1,1±0,27 113,7±3,01 27,2±0,78 7,4±0,20 M6 125,9±1,43*** 119,4±1,39*** 22,6±0,88** 9,7±0,15*** 105,1±2,63* 25,3±0,70 7,6±0,22 A≥65 M0 152,8±1,32 140,1±1,29 -16,3±1,94 29,1±1,01 °° 11,6±0,24 -1,1±0,33 116,2±3,49 31,86±1,41 °° 8,6±0,33 °° M6 131,2±1,31** 124,3±1,32*** 26,6±0,95 10,5±0,21** 114,1±3,30 31,09±1,06 8,1±0,23 C≥65 M0 153,9±1,24 141,9 ± 1,15 -23,2±1,34DD 29,1 ± 0,77 °° 12,5± 0,23 -2,3±0,35 ##DD 122,1±3,01 ° 30,0±1,31 ° 8,6±0,27 °° M6 125,7 ± 0,91 *** DD 118,7 ± 0,89 *** DD 24,2 ± 0,62 *** D 10,2 ± 0,15 *** 106,8±2,32*** 26,7±0,10* DD 7,84±0,17* Group Time bSBP, mm Hg aSBP, mm Hg ∆aSBP, mm Hg IA 75, % PWV, m/s DPWV, m/s LVMI, g/m2 LAVI, ml/m2 E/e ¢ A<65 M0 153,3±1,27 138,6±1,07 -17,5±1,70 24,8±1,13 10,7±0,30 -1,2±0,46 109,8±3,32 26,5±0,88 7,17±0,25 M6 127,4±1,19*** # 121,1±1,17*** 21,4±1,0* 9,5±0,16** 101,6±3,13 24,4±0,77 7,21±0,20 C<65 M0 154,8±1,53 141,1±1,43 -22,3±2,02* 26,3±1,1 10,8±0,24 -1,1±0,27 113,7±3,01 27,2±0,78 7,4±0,20 M6 125,9±1,43*** 119,4±1,39*** 22,6±0,88** 9,7±0,15*** 105,1±2,63* 25,3±0,70 7,6±0,22 A≥65 M0 152,8±1,32 140,1±1,29 -16,3±1,94 29,1±1,01 °° 11,6±0,24 -1,1±0,33 116,2±3,49 31,86±1,41 °° 8,6±0,33 °° M6 131,2±1,31** 124,3±1,32*** 26,6±0,95 10,5±0,21** 114,1±3,30 31,09±1,06 8,1±0,23 C≥65 M0 153,9±1,24 141,9 ± 1,15 -23,2±1,34DD 29,1 ± 0,77 °° 12,5± 0,23 -2,3±0,35 ##DD 122,1±3,01 ° 30,0±1,31 ° 8,6±0,27 °° M6 125,7 ± 0,91 *** DD 118,7 ± 0,89 *** DD 24,2 ± 0,62 *** D 10,2 ± 0,15 *** 106,8±2,32*** 26,7±0,10* DD 7,84±0,17* *p<0,05; ** p<0,01; *** p<0,001 compared to M0; # p<0,05; ## p<0,01 compared to ACEI/ARB<65#x0003C;0,05; p<0,01 compared to ACEI/ARB ≥65 Open in new tab Group Time bSBP, mm Hg aSBP, mm Hg ∆aSBP, mm Hg IA 75, % PWV, m/s DPWV, m/s LVMI, g/m2 LAVI, ml/m2 E/e ¢ A<65 M0 153,3±1,27 138,6±1,07 -17,5±1,70 24,8±1,13 10,7±0,30 -1,2±0,46 109,8±3,32 26,5±0,88 7,17±0,25 M6 127,4±1,19*** # 121,1±1,17*** 21,4±1,0* 9,5±0,16** 101,6±3,13 24,4±0,77 7,21±0,20 C<65 M0 154,8±1,53 141,1±1,43 -22,3±2,02* 26,3±1,1 10,8±0,24 -1,1±0,27 113,7±3,01 27,2±0,78 7,4±0,20 M6 125,9±1,43*** 119,4±1,39*** 22,6±0,88** 9,7±0,15*** 105,1±2,63* 25,3±0,70 7,6±0,22 A≥65 M0 152,8±1,32 140,1±1,29 -16,3±1,94 29,1±1,01 °° 11,6±0,24 -1,1±0,33 116,2±3,49 31,86±1,41 °° 8,6±0,33 °° M6 131,2±1,31** 124,3±1,32*** 26,6±0,95 10,5±0,21** 114,1±3,30 31,09±1,06 8,1±0,23 C≥65 M0 153,9±1,24 141,9 ± 1,15 -23,2±1,34DD 29,1 ± 0,77 °° 12,5± 0,23 -2,3±0,35 ##DD 122,1±3,01 ° 30,0±1,31 ° 8,6±0,27 °° M6 125,7 ± 0,91 *** DD 118,7 ± 0,89 *** DD 24,2 ± 0,62 *** D 10,2 ± 0,15 *** 106,8±2,32*** 26,7±0,10* DD 7,84±0,17* Group Time bSBP, mm Hg aSBP, mm Hg ∆aSBP, mm Hg IA 75, % PWV, m/s DPWV, m/s LVMI, g/m2 LAVI, ml/m2 E/e ¢ A<65 M0 153,3±1,27 138,6±1,07 -17,5±1,70 24,8±1,13 10,7±0,30 -1,2±0,46 109,8±3,32 26,5±0,88 7,17±0,25 M6 127,4±1,19*** # 121,1±1,17*** 21,4±1,0* 9,5±0,16** 101,6±3,13 24,4±0,77 7,21±0,20 C<65 M0 154,8±1,53 141,1±1,43 -22,3±2,02* 26,3±1,1 10,8±0,24 -1,1±0,27 113,7±3,01 27,2±0,78 7,4±0,20 M6 125,9±1,43*** 119,4±1,39*** 22,6±0,88** 9,7±0,15*** 105,1±2,63* 25,3±0,70 7,6±0,22 A≥65 M0 152,8±1,32 140,1±1,29 -16,3±1,94 29,1±1,01 °° 11,6±0,24 -1,1±0,33 116,2±3,49 31,86±1,41 °° 8,6±0,33 °° M6 131,2±1,31** 124,3±1,32*** 26,6±0,95 10,5±0,21** 114,1±3,30 31,09±1,06 8,1±0,23 C≥65 M0 153,9±1,24 141,9 ± 1,15 -23,2±1,34DD 29,1 ± 0,77 °° 12,5± 0,23 -2,3±0,35 ##DD 122,1±3,01 ° 30,0±1,31 ° 8,6±0,27 °° M6 125,7 ± 0,91 *** DD 118,7 ± 0,89 *** DD 24,2 ± 0,62 *** D 10,2 ± 0,15 *** 106,8±2,32*** 26,7±0,10* DD 7,84±0,17* *p<0,05; ** p<0,01; *** p<0,001 compared to M0; # p<0,05; ## p<0,01 compared to ACEI/ARB<65#x0003C;0,05; p<0,01 compared to ACEI/ARB ≥65 Open in new tab P711 https://esc365.escardio.org/Presentation/221683/abstract The influence of renal denervation treatment on blood pressure in patients with resistant hypertension A Anna Moiseeva1, A Caraus1, V Moscalu1, O Calenici2, N Ciobanu1, N Sapojnic1, A Bitca1, A Durnea1, L Popescu1, M Abras1, A Surev1, N Chiriliuc1, E Calenici1, N Nacu1, M Caraus3 1Institute of Cardiology, Chisinau, Moldova (Republic of) 2Hospital Center of Caux Vallée de Seine, Lillebonne, France 3St Spiridon University Hospital, Iasi, Romania Topic: Hypertension – Treatment Background: Arterial hypertension is the main preventable risk factor for premature death and disability worldwide. Despite the great advances in hypertension pharmacotherapy, most of hypertensive patients remain resistant to treatment, presenting an increased risk category for major cardiovascular events. The recognition of the major role of the SNS in the etiopathogenesis of HTN has led to the elaboration of the minimally invasive treatment by renal artery denervation, which modulates the activity of the SNS and presenting actually a new stage with a high potency in the therapy of hypertensive patients. Purpose: Comparative evaluation of drug treatment therapy with SNS-blockers versus renal denervation on blood pressure values. Methods: The study included 75 patients with resistant HTN without comorbidities with a mean age of 50.88 ± 1.34 years. After ambulatory daily treatment with Amlodipine 10 mg, Losartan 100 mg and Indapamid 1.5 mg for 3 weeks the patients were randomized into 3 groups depending on the medication supplemented to the previous one: group I M - Moxonidine 0.6 mg / day, group II B - Bisoprolol 10 mg / day and group III D - RDN. The estimation of the office and ambulatory blood pressure values were performed initially, at 3 and 6 months follow-up. Renal denervation was performed using Medtronic Spyral catheters. Results: All three treatment regimens reduced statistically significant both office and ambulatory BP values starting with 3 months follow-up, the beneficial effect being maintained until the end of the study. The group of patients who underwent renal artery denervation demonstrated a higher potency in reducing office SBP values and a higher net effect in reducing office DBP (Tab.) and 24-hr SBP and DBP values (Fig.). Conclusion: Modulation of SNS activity by renal denervation in patients with resistant HTN has shown superior efficacy in reducing office and ambulatory BP values versus pharmacological treatment with central (Moxonidin) and peripheral (Bisoprolol) SNS blockers. Baseline 3 months 6 months SBP DBP SBP DBP SBP DBP Group I M 188±3.06 112.2±2.38 174.6±3.68 -13.4±2.7*** 102.48±1.87 -8.76±1.45*** 168.16±2.87 -19.84±1.9*** 99.44±1.47 -11.8±1.75*** Group II B 193.3±3.21 114.6±1.68 175.6±3.53 -17.72±3.97*** 104.6±2.02 -10.0±2.06*** 170.0±3.58 -23.32±4.2*** 100.2±2.07 -14.4±2.07*** Group III D 189.8±1.16 112.1±0.67 170.36±0.88 -19.48±1.16*** 95.8±0.68 -16.32±0.75*** 163.2±0.82 -26.64±1.41*** 91.56±0.61 -20.56±0.67*** p >0,05 >0,05 >0,05 <0,01 >0,05 <0,001 Baseline 3 months 6 months SBP DBP SBP DBP SBP DBP Group I M 188±3.06 112.2±2.38 174.6±3.68 -13.4±2.7*** 102.48±1.87 -8.76±1.45*** 168.16±2.87 -19.84±1.9*** 99.44±1.47 -11.8±1.75*** Group II B 193.3±3.21 114.6±1.68 175.6±3.53 -17.72±3.97*** 104.6±2.02 -10.0±2.06*** 170.0±3.58 -23.32±4.2*** 100.2±2.07 -14.4±2.07*** Group III D 189.8±1.16 112.1±0.67 170.36±0.88 -19.48±1.16*** 95.8±0.68 -16.32±0.75*** 163.2±0.82 -26.64±1.41*** 91.56±0.61 -20.56±0.67*** p >0,05 >0,05 >0,05 <0,01 >0,05 <0,001 SBP - systolic blood pressureDBP - diastolic blood pressure Open in new tab Baseline 3 months 6 months SBP DBP SBP DBP SBP DBP Group I M 188±3.06 112.2±2.38 174.6±3.68 -13.4±2.7*** 102.48±1.87 -8.76±1.45*** 168.16±2.87 -19.84±1.9*** 99.44±1.47 -11.8±1.75*** Group II B 193.3±3.21 114.6±1.68 175.6±3.53 -17.72±3.97*** 104.6±2.02 -10.0±2.06*** 170.0±3.58 -23.32±4.2*** 100.2±2.07 -14.4±2.07*** Group III D 189.8±1.16 112.1±0.67 170.36±0.88 -19.48±1.16*** 95.8±0.68 -16.32±0.75*** 163.2±0.82 -26.64±1.41*** 91.56±0.61 -20.56±0.67*** p >0,05 >0,05 >0,05 <0,01 >0,05 <0,001 Baseline 3 months 6 months SBP DBP SBP DBP SBP DBP Group I M 188±3.06 112.2±2.38 174.6±3.68 -13.4±2.7*** 102.48±1.87 -8.76±1.45*** 168.16±2.87 -19.84±1.9*** 99.44±1.47 -11.8±1.75*** Group II B 193.3±3.21 114.6±1.68 175.6±3.53 -17.72±3.97*** 104.6±2.02 -10.0±2.06*** 170.0±3.58 -23.32±4.2*** 100.2±2.07 -14.4±2.07*** Group III D 189.8±1.16 112.1±0.67 170.36±0.88 -19.48±1.16*** 95.8±0.68 -16.32±0.75*** 163.2±0.82 -26.64±1.41*** 91.56±0.61 -20.56±0.67*** p >0,05 >0,05 >0,05 <0,01 >0,05 <0,001 SBP - systolic blood pressureDBP - diastolic blood pressure Open in new tab Ambulatory BP values P712 https://esc365.escardio.org/Presentation/217383/abstract TGF beta 1 concentration in patients with controlled and uncontrolled course of hypertension. R A Gataulin1, N N Nebieridze1, T A Safronova1, VI Podzolkov1 1I.M. Sechenov First Moscow State Medical University, 2nd Internal Medicine ( 2nd Faculty Therapy) Department, Moscow, Russian Federation Topic: Hypertension – Treatment Background: Transforming growth factor β1 (TGFβ1), a pleiotropic polypeptide, that regulates proliferation, apoptosis, differentiation, migration. The result of its influence is an increasing activity of fibroblast proliferation and collagen synthesis. The consequence of these processes is tissue fibrosis, which in its turn contributes to the progression of hypertension. It is also known that TGFβ1 induced by components of the renin-angiotensin-aldosterone system (RAAS), and the RAAS regulates a blood pressure. Purpose: We conducted a comparative analysis of TGFβ1 concentration in three groups. Group I - patients with uncontrolled course of hypertension, group II - patients with controlled course of disease, group III - a control group. We studied the correlation analysis of TGF β1 level with clinical and laboratory data. Methods: We included 80 patients in our study: group I – 28 patients, group II - 23, group III - 27 patients. The following procedures have been performed - questioning of patients, measurement of blood biochemical parameters, including: concentration of TGFβ1 in the blood serum and 24hour BP monitoring. The criteria for including in group II :the constant use of correctly selected therapy for hypertension, the 24hour BP monitoring with hypertensive index of systolic and diastolic blood pressure within the reference values and also absence of the hypertensive crises during the last year. Results: The concentration of TGFβ1 in group I was 22693 [17968-25265] pg/ml , in group II – 19672 [17293-25252] pg/ml and in group III - 18926 [16333-24709] pg/ml. There was significant difference in concentrations of TGFβ1 only between I and III groups (p <0,05), but not between the others. We found a positive correlation between the level of TGFβ1 and the total cholesterol level (r =0,477); triglycerides level ( r=0,487); and very low density lipoproteins (r=0,510);( p<0,05). Also positive correlation was found between TGFβ1 and percent of stenosis of common carotid artery (r=0,894 ;r< 0,05) in this group. It has been revealed, that in second group TGFβ1 associates with left ventricle end diastolic volume ( r=0,786; p< 0.05) and daytime average diastolic blood pressure ( r= 0,481; p<0,05). Uric acid and blood glucose levels were not associated with TGFβ1 in both groups, (p> 0.05). There was no significant difference between smokers and non-smokers in all groups and no significant correlations with any clinical or laboratory data in control group. Conclusions: Significant increase in TGFβ1 level has been revealed in patients with uncontrolled course of hypertension in comparison with healthy subjects. In the group with a controlled course of hypertension, there was a tendency to decrease the level of TGFβ1, but this degree of decrease was not significant. EAPC Essentials 4 You - Young Investigators Awards - Population Science & public health section 365 https://esc365.escardio.org/Presentation/217401/abstract Population study on the predictive value of blood pressure and BMI in childhood and adolescence for subclinical atherosclerosis one decade later J Bueschges1, A Schaffrath Rosario1, S Sarganas1, K Koenigstein2, A Schmidt-Trucksaess2, H Neuhauser1 1Robert Koch Institute, Department of Epidemiology & Health Monitoring, Berlin, Germany 2Institute of Exercise and Health Sciences, Department of Sport, Exercise and Health, Basel, Switzerland Funding Acknowledgements: Robert Koch Institute, Federal Ministry of Health, Federal Ministry of Education & Research, German Center for Cardiovascular Research (DZHK) Topic: Risk Factors and Prevention – Epidemiology Background: Data on subclinical arteriosclerosis in unselected adolescents and young adults are scarce and prognostic thresholds remain vague. Recently, automated contour detection and real-time software-based quality control could be implemented in the measurement of carotid intima media thickness (cIMT). cIMT measurement was standardized for the first time for a national health examination survey. Novel statistical techniques allow improved centile estimation according to several parameters, i.e. age and height, yielding less biased definitions of increased cIMT. Purpose: This study aims to 1) provide reference centiles of cIMT for adolescents and young adults (14-29 years) by age, sex and height and 2) to investigate the association between blood pressure and obesity and cIMT with robust population data. Methods: The KiGGS cohort is based on the German Health Examination Survey for Children and Adolescents. It includes cIMT measurements by high resolution B-mode sonography of the distal common carotid artery in 4,716 participants aged 14 to 29 in its follow-up. Semi-automated contour detection and ECG-gated real-time quality control software was used. Blood pressure, height and weight were measured according to an identical standardized protocol at baseline (age 3-17) and at follow-up 11 years later. Hypertensive blood pressure was defined according to German guidelines (>= P95 systolic or diastolic for age, height and sex according to KiGGS percentiles and >=140/90 mmHg from age 18). Obesity was defined as BMI>= P97 for age and sex according to Kromeyer-Hauschild percentiles and BMI >=30 kg/m2 from age 18). cIMT centiles were estimated by age and height separately for male and female participants (see Fig. 1), using the novel generalized additive model for location, scale and shape implemented in the R software environment. Predictive values and relative risks from log-binomial regression were estimated using STATA. Results: Hypertensive blood pressure at baseline was associated with a 33% increased risk of having an elevated cIMT (>=P75 for age, height and sex) eleven years later (RR 1.33, 95% CI 1.08-1.65). Obesity at baseline was associated with a 38% increased risk (RR 1.38, 95% CI 1.07-1.77). For those who were hypertensive or obese both at baseline and at the 11-year follow-up, the risk increase was even more pronounced (63%, 95% CI 1.15-2.29) and 53%, CI 1.06-2.21, respectively). Positive predictive values of hypertensive blood pressure and obesity for elevated cIMT were modest (e.g. 42% PPV of hypertensive BP at baseline for elevated CIMT 11 years later). Conclusion: After reports from convenience samples, we could now show in a large general population sample that hypertensive blood pressure and obesity in children and adolescents aged 3-17 years are predictive for elevated cIMT over a decade later. However, positive predictive values are only moderate. Further analyses will include associations with stiffness parameters. Abstract No: 365 Fig: 1: Percentile curves for cIMT EAPC Essentials 4 You - Young Investigators Awards - Primary care & risk factor management section 82 https://esc365.escardio.org/Presentation/217399/abstract Association of lifestyle with life expectancy with and without heart failure MAM Limpens1, E Asllanaj1, MA Ikram1, M Kavousi1, T Voortman1 1Erasmus University Medical Centre, Rotterdam, Netherlands (The) Funding Acknowledgements: Horizon 2020 - BigMedilytics Topic: Risk Factors and Prevention – Epidemiology Background/Introduction: Several modifiable lifestyle factors are independently associated with increased risk for heart failure (HF) and mortality. However, the combined effect of an overall healthy lifestyle on HF, mortality and life expectancy remains unknown. Purpose: The aim of this study was to estimate and quantify the association of a healthy lifestyle score with HF risk and life expectancy among men and women from a general population. The lifestyle score was composed of five modifiable lifestyle factors including physical activity, diet, smoking, alcohol, and body mass index (BMI). Methods: This study was performed among 6303 participants (mean age 65.8±9.7 year; 58.5% women) from a large prospective population-based cohort study among middle-aged and older adults. A continuous lifestyle score was created based on five lifestyle factors: smoking, alcohol consumption, diet quality, physical activity and BMI. The lifestyle score was divided into three categories: unhealthier (reference), intermediate and healthier. Multistate life tables were constructed to calculate the effects of lifestyle on life expectancy with and without HF, adjusted for confounders. For our population we build 3 health states, namely healthy, heart failure, death. Results: During an average follow-up of 11.3 years, 699 incident HF events and 2309 deaths occurred. In men, the healthier lifestyle category was associated with a lower risk of HF (Hazard Ratio (HR) 0.54 (95% CI 0.37-0.81)) and mortality (HR 0.62 (95% CI 0.50-0.77)) compared to the unhealthier lifestyle category. A similar trend was found in women, with hazard ratios of respectively, 0.73 (95% CI 0.50-1.07) and 0.69 (95% CI 0.56-0.85) for HF and mortality. At the age of 45 years, men in the healthier lifestyle category lived overall 4.9 years longer compared to men in the unhealthier lifestyle category (see figure). Among women, this difference in total life-expectancy was 4.4 years. Men and women who had a healthier lifestyle lived 0.3 and 0.6 years shorter with HF. Life expectancy without HF was 5.2 years longer in men and 5.0 years longer in women with a healthy lifestyle. Conclusion: An overall healthy lifestyle has a positive impact on total life expectancy and the years lived without HF. The beneficial impact of healthy lifestyle seems to be more pronounced in men compared to women. Life expectancy per lifestyle category EAPC Essentials 4 You - ePosters P167 https://esc365.escardio.org/Presentation/217364/abstract Panomics- New tool for advancements in preventative cardiology: systematic data mining & creation of a database of the key omics databases & studies in cardiology D Dina Radenkovic1, DV Vakili2, DB Bhatt3 1Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland 2Imperial College London, Heart & Vascular Center, London, United Kingdom of Great Britain & Northern Ireland 3Brigham And Women'S Hospital, Harvard Medical School, Heart & Vascular Center, Boston, United States of America Funding Acknowledgements: No funding available for this research. Topic: Risk Factors and Prevention – Epidemiology The medical data revolution has applied big data to address limitations presented by biological variability. Currently validated models fit patientsã clinical parameters against population means to generate risk scores identifying those who may benefit from intervention. Their predictive power can be improved with omic technologies accounting for differences caused by genes, resident microbial flora and daily lifestyle activity. "Omic" fields record these and panomics merge multiple forms of omic datasets into a systematic database to characterise drivers of health and disease. Population-based databases were found using the following keywords: “GWAS”, “Genomic”, “Phenomic”, “Clinomic”, “Proteomic”, “Metabolomic”, “Methylomic”, and “Transcriptomic” on Pubmed/Medline and internet searches for existing database websites and gene mutation directories. Individual publications were traced backwards and where data missing from supplementary material, authors were contacted. Databases were included if they contained genomic and at least one other omic parameter linked with clinical outcome. Selected key publications in the field of cardiology were summarised for each database. At the end of the data mining exercise, 104 studies were identified, of which 66 met inclusion criteria. 15 of the 66 studies are presented in Figure 1. Some of these databases have specificity to certain study designs; The UK BioBank is currently the most complete panomic resource with general applicability. The largest proteomic datasets were found in the Framingham study whereby plasma proteins expressed in cardiovascular disease participants have identified upstream genomic variants. The Netherlands Twins registry and Twins UK are useful for studies which quantify genetic and environmental effects towards phenotypes. LifeLines follows participant families across 3 generations making useful in studies of ageing and heritability and includes faecal banking. 100,000 genomes is specialised towards insights into rare diseases, and finally the Nord-Trøndelag Health study and FINRISK started recruitment in 1984 and 1972, respectively, and have clinical data over longer follow-up periods. Microbiomic data was the least common, found in only 20 of the 66 the databases. However, early findings from the LifeLines database already identified the microbomic patterns of butyrate producing bacteria that may be implicated in cardiovascular disease. While this rapidly developing field is still in its infancy, it is certain that in the future panomics may be used to improve cardiovascular risk prediction and personalise prevention. Selected Panomics Databases P175 https://esc365.escardio.org/Presentation/221578/abstract Preconception lifestyle intervention in obese women improves echocardiographic indices of cardiac structure and function in their offspring: follow up of a randomised controlled trial T Den Harink1, RBJB Gemke2, A Hoek3, H Groen3, NA Blom4, TJ Roseboom1, AW Van Deutekom5 1Amsterdam UMC - Location Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The) 2Amsterdam UMC - Location VUmc, Department of Paediatrics, Amsterdam, Netherlands (The) 3University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, Netherlands (The) 4Amsterdam UMC - Location Academic Medical Center, Department of Paediatric Cardiology, Amsterdam, Netherlands (The) 5Erasmus University Medical Centre, Department of Paediatric Cardiology, Rotterdam, Netherlands (The) Funding Acknowledgements: Dutch Heart Foundation: 2013T085, European Comission - Horizon2020 project: 633595 Dynahealth Topic: Risk Factors and Prevention – Epidemiology Background: Maternal obesity has emerged as a risk factor for cardiovascular disease, as offspring of obese mothers are prone for hypertension, ischemic heart disease and type 2 diabetes. Animal studies and small observational human studies suggest that maternal obesity directly affects fetal cardiovascular development, which may explain the increased health risk in the offspring. As the incidence of maternal obesity worldwide is rapidly rising, preventive strategies are needed to reduce cardiovascular disease burden in two generations. Purpose: To assess the effects of a preconception lifestyle intervention in obese women on echocardiographic indices of cardiac structure and function in the offspring at the age of 6 years. We hypothesize that children born form obese mothers that received a lifestyle intervention prior to pregnancy will have enhanced echocardiographic markers of cardiac health. Methods: This study is embedded in the WOMB project, which is a follow up of a randomised controlled trial that included 577 obese sub/infertile women. A 6 months preconception lifestyle intervention aimed at weight loss prior to fertility care was given to the intervention group and a control group received fertility care as usual. We conducted complete transthoracic echocardiograms in the offspring at age 6-7 years. The clinician performing the echocardiograms and offline measurements was blinded to group allocation. We used EchoPAC analysis software for offline measurements of dimension, mass and stroke volume of the cardiac chambers. Results: We included 44 children, mean age 6.1 years (SD 0.9), 57% girls. Children of women in the intervention group (n= 17) had a thinner interventricular septum (Z-score -0.6% [SD 0.7] vs 0.2% [SD 0.4], p <0.001) a lower left ventricular mass index (53.4 g/m2 [SD 9.1] vs 59.9 g/m2 [SD 7.0], p= 0.01) and an increased ejection fraction (60.9% [SD 3.5] vs. 56.6% [SD 4.6], p=0.004) compared to children of controls (n=27). These are all indices of better cardiovascular health Conclusion: Preconception lifestyle intervention in obese women results in a thinner interventricular septum, a lower left ventricular mass and higher ejection fraction in the offspring at age 6, suggesting better cardiovascular development and function. This is the first experimental human evidence of the effect of improving (pre)pregnancy maternal lifestyle to enhance cardiovascular function and potentially reduce cardiovascular disease risk in the next generation. P177 https://esc365.escardio.org/Presentation/217356/abstract Marital status and cardiovascular mortality: a prospective cohort study of community of Western Siberia (Russia) G Pushkarev1, VA Kuznetsov1, AD Lezhnyakova1, EV Akimova1 1Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Scienc, Tomsk, Russian Federation Topic: Risk Factors and Prevention – Epidemiology Background: Several studies have indicated a significant association between marital status and cardiovascular mortality risks. However, in the Russian Federation this association has not been studied sufficiently. Purpose: To assess the relationship between marital status and risk of cardiovascular mortality in male and female population of Western Siberia (Russia). Methods: A representative sample of 795 men and 813 women aged 25-64 years living in our city, Russia, was examined with standard epidemiological methods. Cardiovascular death rate was studied during 12-year prospective follow-up. The relationship between cardiovascular mortality and marital status was evaluated using Cox proportional hazards model. Hazard ratio (HR) was calculated after adjustment for the following confounders: for age, systolic and diastolic blood pressure, body mass index, smoking status, total cholesterol, triglycerides, high-density-lipoprotein cholesterol, history of coronary artery disease and hypertension, and social risk factors. Results: During 12-year prospective follow-up, a total of 118 deaths (85 men, 33 women) occurred. HR was lower in married men – 0.28 (95% confidence interval (CI) 0.18-0.44; p<0.001) compared to unmarried men. After adjusting for all mortality risk factors HR was significantly higher in single - 4.08 (95% CI 2.12-7.83), widowed - 3.19 (95% CI 1.22-8.34) and divorced men - 3.18 (95% CI 1.90-5.34) compared to married men. In female cohort after adjustment for potentially confounding variables married women showed higher risks of mortality from cardiovascular disease ã HR = 4.01, (95% CI 1.55-10.18) compared with unmarried women. However, compared to single women HR was not significantly higher in married women - 6.19 (95% CI 0.87-43.9), widowed - 2.90 (95% CI 0.27-30.9) and divorced women - 2.03 (95% CI 0.17-23.6). Conclusions: Married status was associated with a lower risk of cardiovascular mortality than was unmarried status only for men, but not for women. Single status, divorce and widowhood were associated with elevated risk for men. P487 https://esc365.escardio.org/Presentation/217371/abstract Prevalence and prognostic impact of cardiovascular risk factors among patients undergoing primary percutaneous coronary intervention: data from a rural centre in a middle income country N Nagwa Thabet1, D Labib2, A Samir3, M Hosny3, A Elfaramawy3, M Elmahdi3, K Said3, A Samaan3, M Hassan3, A Elguindy2, M Yacoub4 1Aswan Heart Centre, Aswan university, Aswan, Egypt 2Aswan Heart Centre, Adult Cardiology Department, Aswan, Egypt 3Cairo University, Cardiology department, Cairo, Egypt 4Imperial College London, Cardiothoracic department, London, United Kingdom of Great Britain & Northern Ireland Topic: Risk Factors and Prevention – Epidemiology Background: The type and behavior of coronary heart disease are known to be influenced by both genetic and epigenetic factors, which in turn are influenced by ethnicity. Currently, there are no data relating to these factors in Upper Egypt. Purpose and methods: We studied the prevalence and the prognostic impact of cardiovascular risk factors in 1268 consecutive patients presenting with ST-segment elevation myocardial infarction (STEMI), who underwent primary PCI at a tertiary cardiovascular centre in Upper Egypt between January 1st, 2014 and December 31st, 2017. Data on cardiovascular risk factors and baseline clinical and laboratory evaluation were analyzed and impact on in-hospital mortality was determined by logistic regression analysis. Results: Mean age was 56.8 ± 12 years; 78% of patients were males. Smoking, hypertension, diabetes mellitus, dyslipidemia, and positive family history of ischemic heart disease were present in 67%, 59%, 55%, 29%, and 11%, respectively. In all, 81(6.4%) patients died during hospitalization. Significant univariable predictors of in-hospital mortality were age, diabetes mellitus, smoking, baseline systolic blood pressure, serum creatinine, Killip class ≥II, contrast-induced nephropathy, and stent thrombosis. On multivariable analysis, age, diabetes mellitus, baseline systolic blood pressure, serum creatinine, and contrast-induced nephropathy remained significant, with odds ratios (95% confidence intervals) of 1.07 (1.03-1.11), 3.40 (1.32-8.78), 0.98 (0.96-0.99), 1.48 (1.15-1.91), and 6.46 (2.29-18.22), respectively, and p-values of 0.001, 0.01, 0.001, 0.003, and <0.001, respectively. Conclusion: Compared to previously reported European cardiovascular disease statistics of 2017, acute STEMI affects younger patients in our population, with a very high incidence of potentially correctable risk factors. Age and diabetes mellitus appear to be significant predictors of in-hospital mortality. Intensified prevention programs targeting cardiovascular risk factors need to be implemented to reduce the burden of coronary heart disease and improve survival following primary PCI in our population. P488 https://esc365.escardio.org/Presentation/217373/abstract Prevalence of tobacco-related risk behaviors among amateur rugby players, coaches and referees. F Frederic Chague1, J Israel2, JP Guinoiseau2, G Garet2, E Reboursiere2, P Ngassa2, JP Hager2, M Geneste2, JC Dincher2, Y Cottin1, M Zeller3 1University Hospital of Dijon, Cardiology department, Dijon, France 2French Rugby Federation, Marcoussis, France 3University of Bourgogne Franche-Comté, PEC2, EA 7460, Dijon, France Topic: Risk Factors and Prevention – Epidemiology Background: high prevalence of smoking has been documented in France and new patterns of tobacco and nicotine consumption are emerging, especially in some sports. In amateur rugby population, such attitudes could be harmful but data are scarce as well as their knowledge of the risk. Purpose: we analyzed tobacco consumption in French amateur players, coaches and referees. Methods: each amateur player [ >12-y/o], coach and referee licensed in the French Rugby Federation and participating in the Burgundy amateur championship was invited to answer to an electronic anonymous questionnaire during the 2017-2018 sport season. Results: 683 [sex ratio M/F = 0.9] answers were obtained and fit for analysis. Among them, 559 (81.8%) were players, 167 (24,5%) were coaches and 74 (10.8%) were referees. 176 subjects (25.8%) were current smokers, 126 (18.4%) daily smokers, 54 (37% of usual smokers) smoked more than 10 cigarettes a day and 97 (14.2%) were ex-smokers. Moreover, 24 referees (32.4%) and 47 coaches (28.2%) were current smokers. Most smoked 2 hours before or after a rugby session (86.4% of smokers) including coaches (89.4%) and referees (89%). Although 109 smokers (61.9%) considered quitting, only 27 (24.8%) considered vaping to aid them. Only 28 subjects (4.1%) usually vaped, of whom 15 daily (1.9%); 21 of them (75%) vaped in the 2 hours before or after a rugby session. Number of cigarettes in the 19 dual users was not different compared with non-vaping smokers. Among the 28 vapers, motivation to vape included: lower risk than smoking (13), consider to quit (12), cheaper than smoking (8), festive and socializing (6), avoid to smoke (3), respect the performance (2). Other tobacco or nicotine products were infrequent: waterpipe (7), dry snuff (1) and none used snus. The knowledge about risk was incomplete: 35 (5.1%) subjects do not know that smoking is dangerous for their health and 12 (1.8%) think it is not. 246 (36%) and 195 (28.6%) do not know if smoking is more dangerous more dangerous in the 2 hours before or after sport; 45 (6.6%) and 18 (2.6%) think it is not. Moreover, 27.5% of coaches were unaware on the risk of smoking before a sport session and 19.2% on the risk after. 244 subjects (35.7%) do not know if vaping is less dangerous than smoking; 272 (39.8%) are not informed of the potential risk of nicotine when vaping. Conclusion: prevalence of smoking is high in the French rugby amateur rugby players, coaches and referees. Smokers usually smoke in the 2 hours before or after the sport session. This is dangerous for them and for their peers. The low knowledge about the risk is of great concern, especially considering the coaches and referees who have a symbolic position and education role. Vaping and other patterns of nicotine exposure are infrequent. Education programs are urgently needed to reduce the acute and chronic risk of tobacco consumption in this population. P489 https://esc365.escardio.org/Presentation/221677/abstract Risk factors associated with specific types of atrial fibrillation in men and women in a general population cohort study H Espnes1, ML Lochen1, T Wilsgaard1, J Ball2, I Njolstad1, EB Mathiesen3, E Sharashova1 1UiT The Arctic University of Norway, Department of Community Medicine, Tromso, Norway 2Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia 3UiT The Arctic University of Norway, Department of Clinical Medicine, Tromso, Norway Funding Acknowledgements: University of Tromsø The Arctic University of Norway Topic: Risk Factors and Prevention – Epidemiology Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with life threatening complications such as stroke, heart failure, and premature death. With its increasing prevalence and substantial disease burden, AF has been well investigated over the last few decades. However, there is still a lack of evidence on risk factors for various AF subtypes. Purpose: To investigate risk factors associated with paroxysmal/persistent versus permanent AF in men and women in a general population cohort study, with a focus on systolic blood pressure (SBP) and body mass index (BMI). Methods: The study is a large population-based study with seven surveys conducted from 1974 to 2016. We used data from the fourth survey collected in 1994-1995. A total of 24,842 men and women aged 25 years or older and free of AF at baseline were followed up for incident AF until the end of 2013. Cox regression analysis was conducted to provide sex- and AF type-specific hazard ratios (HRs) for SBP (mmHg) and BMI (kg/m2), and the models were additionally adjusted for age, smoking, physical activity, total cholesterol, diabetes mellitus, heart attack and angina. Results: Over a mean follow-up of 15.7 ± 5.5 years, incident AF occurred in 878 (7.5%) men (455 with paroxysmal/persistent AF and 423 with permanent AF), and in 756 (5.8%) women (401 with paroxysmal/persistent AF and 355 with permanent AF). In men, increasing BMI was independently associated with an increased risk of permanent AF (HR 1.13, 95% CI 1.10-1.16), but not paroxysmal/persistent AF (HR 1.03, 95% CI 1.00-1.06). Higher SBP in men was associated with an increased risk of paroxysmal/persistent AF (HR 1.01, 95% CI 1.01-1.02), but not permanent AF (HR 1.00, 95% CI 0.99-1.01). In women, increasing BMI was associated with an increased risk of paroxysmal/persistent AF (HR 1.02, 95% CI 1.00-1.05), and to a higher extent with permanent AF (HR 1.08, 95% CI 1.06-1.10). The association between SBP and increased risk of AF in women was seen for both paroxysmal/persistent AF (HR 1.01, 95% CI 1.01-1.02) and permanent AF (HR 1.01, 95% CI 1.00-1.10). Conclusions: This study demonstrates that elevated BMI as an independent risk factor for AF was more important for development of permanent AF than for paroxysmal/persistent AF. Conversely, SBP was more strongly associated with the development of paroxysmal/persistent AF than permanent AF. These differences were more pronounced in men compared to women. P490 https://esc365.escardio.org/Presentation/217065/abstract Left ventricular hypertrophy and body fat distribution in general population M Chlabicz1, J Jamiolkowski1, M Paniczko1, P Sowa1, M Lapinska1, M Szpakowicz1, N Jurczuk1, M Kondraciuk1, A Raczkowski1, E Sawicka1, K Kaminski1 1Medical University of Bialystok, Department of Population Medicine and Prevention of Civilization Diseases, Bialystok, Poland Topic: Risk Factors and Prevention – Epidemiology Introduction: Left ventricular hypertrophy (LVH) is response to chronic pressure overload and important risk factor for atrial fibrillation (AF), diastolic and systolic heart failure (HF) and sudden death. Identification of individuals in the community with asymptomatic LVH may allow initiation of further diagnosis and treatment. Electrocardiography (ECG) is commonly used to detect LVH because it is easy to do, available and inexpensive. Aim: Estimate of the incidence of LVH in the total population, search for factors affecting the LVH, especially body fat distribution and evaluate of known ECG indicators of LVH to recognize asymptomatic LVH. Methods: 750 volunteers randomly chosen from the local population were examined (mean age 49 years, 58.7% female). 69 people had severe CVD (e.g. coronary heart disease 33, HF 10, peripheral artery disease 7, stoke 6, heart surgery 2, heart defect 11). Moreover, 226 probands (30.1%) had hypertension, 59 (7.9%) diabetes, 26 (3.5%) AF and 155 (20.8%) smoked cigarettes. This study was approved by the local ethics committee. We showed that 11.2% of the analyzed population had LVH. There was no gender difference. Individuals with LVH were older (p<0.001), had higher BMI (p<0.001), higher systolic (p<0.001) and diastolic (p=0.045) blood pressure. On univariate analysis variables associated with LVH had higher fasting glucose (p=0.002), 2-h glucose in oral glucose test tolerance (OGTT) (p<0.001), homeostatic model assessment of insulin resistance (HOMA-IR) (p=0.003), hemoglobin A1c (HbA1c) (p<0.001), C-reactive protein (CRP) (p<0.001), high-sensitivity troponin T (hs-TnT) (p<0.001), N-terminal pro-brain natriuretic peptide (NT-proBNP) (p<0.001), and lower high-density lipoprotein (HDL) cholesterol (p=0.025). In the analysis of body measurement and fat distribution, with LVH correlated higher WHR (p=0.004), total fat (TF) mass (p<0.001), legs fat mass (p=0.004), android fat mass (p<0.001), android lean mass (p=0.004), gynoid fat mass (p<0.001), visceral mass (p<0.001), android/gynoid (A/G) fat mass ratio (p<0.001), android/total fat mass (A/TF) ratio (p<0.001), while LVH were associated with lower gynoid/total fat mass (G/TF) ratio (p=0.002) and legs/total fat (L/TF) mass ratio. In ECG, LVH was associated with longer P wave time, wider QRS complex, higher Cornell index (p<0.001) and Lewis index (p<0.001), while no relation to Sokolow-Lyon index was shown (p=0.932). ROC curve analysis of Sokolow-Lyon index (AUC:0.496; p=0.932) did not show a significant predictive ability to diagnose LVH, while ROC curve analysis of Cornell index (AUC:0.670; p<0.001) and Lewis index (AUC:0.705; p<0.001) showed a significant predictive ability to diagnose LVH (Fig.1). Conclusions About 11% of the total population had LVH and it correlated with android-type obesity, which is also reflected in association with insulin resistance in laboratory tests. Cornell or Lewis index are better than Sokolow-Lyon index to recognize LVH. Figure 1. P500 https://esc365.escardio.org/Presentation/221654/abstract Association of physical activity and blood pressure in girls aged 12-17 years E Gakova1, E Akimova1, A Gakova1, M Kayumova1, V Kuznetsov1 1Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tyumen, Russian Federation Topic: Risk Factors and Prevention – Epidemiology Background: Low physical activity is a global epidemic of modern society. In individuals with low physical activity, coronary artery disease (CAD) and arterial hypertension (AH) develop 1.5-2.4 times more often than in individuals leading a physically active lifestyle. Purpose: To assess the epidemiological situation regarding the main risk factors for AH in the Tyumen population of schoolchildren in order to develop the main directions of preventive intervention. Methods: Within a cross-sectional epidemiological study of randomly selected population of schoolchildren aged 7-17 years in one of Tyumen districts, 1332 girls were examined with response of 87.7%, 835 of them were 12-17 years old. The screening was conducted with the help of a survey on standard questionnaires with obtaining passport data, medical history data, data on physical activity; anthropometry; blood pressure (BP) measurement using standardized method with criteria for elevated SBP/DBP in children: 12 years - >120/75 mmHg; 13-14 years - >130/80 mmHg; 15-17 years - >135/85 mmHg; 12-year-old girls underwent pedometry. Mathematical processing of the results was carried out using “Statistika 6.0” software; differences were considered statistically significant at p<0.05. Ethical standards were fulfilled. Results: The prevalence of elevated BP was 10.8% in schoolgirls; isolated DBP was found more often. Low physical activity was revealed in more than 1/3 of pupils. Only every fifth girl did morning exercises, 9.0% of girls did not attend physical education classes, and 52.2% of girls did not go in for sports as extracurricular activity (p<0.05). Even higher prevalence of low physical activity was detected in the group of girls with increased Quetelet Index - 39.4% (p<0.05). The time devoted to sports by girls with normal BP levels was significantly higher and amounted to 5.1±4.5 hours per week than in individuals with high blood pressure - 3.9±3.4 hours per week (p<0.001). According to the 7-day pedometry, locomotor activity of 12-year-old girls was 108.4±11.6 thousand locomotions per week or 15.5±1.6 thousand locomotions per day, which is 1.5 times lower than the recommended standard of locomotor activity (p<0.05). Correlation analysis showed inverse statistically significant relationship between levels of SBP and DBP and the number of locomotions (r=-0.23; r=-0.43, p<0.05). Relative risk for AH development in girls with low physical activity was almost 1.2 times higher. According to multivariate regression analysis, it was found that physical activity was the reason for about 28% of BP events (p=0.01). Conclusion: Thus, when analyzing results of the cross-sectional epidemiological study of the Tyumen female population aged 12-17 years, high level of main risk factors for AH was established such as elevated BP, low physical activity. The relationship of physical activity with BP was shown, requiring immediate corrective preventive measures since childhood. P506 https://esc365.escardio.org/Presentation/221595/abstract Vaccination in heart failure, a forgotten disease modifying strategy BV Silva1, N Cunha1, T Rodrigues1, S Couto Pereira1, J Brito1, P Alves Da Silva1, P Silverio Antonio1, P Morais1, R Santos1, I Aguiar Ricardo1, J Rigueira1, A Ferreira1, I Silva2, A Valadas2, D Costa Gomes2 1Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal 2Santa Maria University Hospital (CHULN), Department of Medicine, Lisbon, Portugal Topic: Risk Factors and Prevention – Epidemiology Introduction: Respiratory infections are a major cause of morbidity and mortality in patients with heart failure. Vaccination against influenza virus and Streptococcus pneumoniae in these patients was associated with a low incidence and/or severity of such conditions and help preventing both heart failure decompensation and hospitalizations. Purpose: To evaluate the prevalence of vaccination against Influenza and Streptococcus pneumoniae in a population of hospitalized patients with primary or secondary diagnostic of heart failure. Methods: Patients over 65 years-old admitted with the diagnosis of chronic Heart Failure between 01/11/2019 and 15/02/2019 were included. Clinical and demographic characteristics and respiratory virus screening results were retrospectively analysed. The Health Data Platform was consulted to gather information on the vaccination status for influenza virus and Streptococcus pneumoniae for the 2017/2018 and 2018/2019 vaccination seasons. Results: A total of 153 patients were included (53.9% female) with a mean age of 81.14 ± 9.25 years and a median length of stay of 6 days (IQR 5). Vaccination coverage for influenza in the 2017-218 season was 44.7% and in 2018-2019 was 38.8%. Of these, last 67.7% were vaccinated in the early vaccination season. Vaccination in two consecutive seasons occurred in 27.6% of patients. Only 10.46% had vaccine coverage for both Influenza and Streptococcus pneumoniae. Respiratory infections were the cause of admission in 51.9% (n=79), with influenza A isolation in 20.1% (n=8), seven of which were not vaccinated. Regarding patients admitted with respiratory infection, 34.5% had simultaneously heart failure decompensation. Considering the comorbidities evaluated, only the presence of coronary artery disease and cancer influenced positively the number of vaccinated patients (p=0.02, p=0.02, respectively). There was no association between vaccination and age or number of comorbidities (p=0.954, p=0.601; p=0.234, respectively). Conclusions: This study allows us to demonstrate that the vaccination rate is below expectations. Our results also revealed that patients are intermittently vaccinated with a decrease in vaccination coverage from 2017-2018 season to 2018-2019, which follows the international trend. Influenza vaccination is a safe and easily accessible intervention and should be seen as a disease-modifying strategy in heart failure, as respiratory infections are a frequent cause of hospitalization in this population. P713 https://esc365.escardio.org/Presentation/217091/abstract Prevalence of cardiovascular health risk behaviours in college-going women in a major metropolis in india P Priya Chockalingam1, V Natarajan1, T Sekar1 1Cardiac Wellness Institute, Chennai, India Topic: Risk Factors and Prevention – Epidemiology Introduction: There is an increasing burden of cardiovascular disease (CVD) in Indian men and women of younger ages. As lifestyle risk behaviours are strongly associated with the occurrence of CVD, understanding and addressing the health related behaviour of adolescents and young adults is important. Research related to these risk behaviours in college-going women is lacking in India. Purpose: The purpose of this study is to understand the prevalence of cardiovascular health risk behaviours in college-going women in Chennai, a major metropolis in India, and thereby design targeted intervention strategies to mitigate the risk of CVD. Methods: A cross sectional survey was carried out among students of two womenã s colleges in our city. An anonymised self-administered questionnaire distributed online was used to collect demographic data and risk behaviours. The survey had questions to address the four stipulated recommendations namely (1) at least 5 portions of vegetables and fruits per day (2) at least 150 minutes of aerobic exercise per week (3) sleep duration of 6-8 hours per day and (4) avoidance of tobacco use and a few other relevant risk behaviours were assessed. Results: Of the 554 students who responded to the survey, 92% were in the 15-20 years age group and 8% in the 21-30 years group. The number of students meeting each of the four stipulated healthy lifestyle recommendations is shown in the Table. While 24% of students adhered to the first recommendation, only 8% of students adhered to all four recommendations as shown in the Figure. Only 16% of students were consuming whole grain products on a daily basis. Pre-packed snacks and readymade foods high in sodium content and unhealthy fats were consumed regularly by 55% of students. Thirty-nine percent of students answered ã yesã to the question “ would you say you are chronically stressed or worried?" Conclusions: Modifiable cardiovascular risk behaviours are widely prevalent among urban college-going women in India. It is imperative to improve awareness about a heart-healthy lifestyle and provide targeted intervention to help students increase the intake of fruits, vegetables and whole grains, do brisk aerobic exercise and strength training regularly and manage their emotional wellness and sleep routine better. Healthy lifestyle recommendation Number of students meeting recommendation n (%) 1. At least 5 portions of vegetables and fruits / day 131 (24) 2. At least 150 minutes of aerobic exercise / week 66 (12) 3. 6-8 hours of sleep / day 399 (72) 4. Avoidance of tobacco use 537 (97) Healthy lifestyle recommendation Number of students meeting recommendation n (%) 1. At least 5 portions of vegetables and fruits / day 131 (24) 2. At least 150 minutes of aerobic exercise / week 66 (12) 3. 6-8 hours of sleep / day 399 (72) 4. Avoidance of tobacco use 537 (97) Open in new tab Healthy lifestyle recommendation Number of students meeting recommendation n (%) 1. At least 5 portions of vegetables and fruits / day 131 (24) 2. At least 150 minutes of aerobic exercise / week 66 (12) 3. 6-8 hours of sleep / day 399 (72) 4. Avoidance of tobacco use 537 (97) Healthy lifestyle recommendation Number of students meeting recommendation n (%) 1. At least 5 portions of vegetables and fruits / day 131 (24) 2. At least 150 minutes of aerobic exercise / week 66 (12) 3. 6-8 hours of sleep / day 399 (72) 4. Avoidance of tobacco use 537 (97) Open in new tab Adherence to multiple recommendations P716 https://esc365.escardio.org/Presentation/217055/abstract Impact of atherosclerotic risk factors on non-ischemic heart failure JP Jose Pedro Sousa1, L Reis1, JG Lopes1, C Lourenco1, L Goncalves2 1Centro hospitalar de Coimbra, Coimbra, Portugal 2Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Cardiology, Coimbra, Portugal Topic: Risk Factors and Prevention – Epidemiology Background: Classic cardiovascular risk factors are well-studied and display an immense effect on the context of atherosclerotic entities, namely coronary artery disease. However, their impact on the natural history of non-ischemic heart processes is muss less characterized. Purpose: To ascertain the influence of key coronary risk factors on the outcome of patients with non-ischemic heart failure (HF). Methods: Retrospective single-center study comprising patients consecutively admitted into a cardiac intensive care unit, during 7 years, for de novo or decompensated acute HF. Patients with significant coronary artery disease (CAD), as assessed by means of invasive coronary angiography, were excluded. De novo or previous diagnoses of arterial hypertension (HTN), type 2 diabetes mellitus (T2DM), obstructive sleep apnea (OSA) and chronic kidney disease (CKD) were considered. In-hospital mortality was evaluated and follow-up was performed targeting hospital readmission for acute HF and all-cause mortality. All statistical analysis was performed using SPSS version 25. Results: 331 patients were hospitalized. Of these, 128 were found to have significant CAD and were, so, excluded. Of the remaining, mean age was 69.5 ± 14.3 years and 30% were female. The most common etiologies for HF were valvular heart disease (27.1%) and alcoholic dilated cardiomyopathy (17.7%), whereas in 12.8% of patients no specific disease was held accountable. Prevalence of the selected coronary risk factors were as following: HTN 62.6%, T2DM 30.0%, OSA 14.8% and CKD 25.1%. Median follow-up period was 13 months. In-hospital mortality was 13.3%, while readmission for HF and death during follow-up occurred in 36.5% and 44.3% of patients, respectively. CKD was associated with a higher risk of death, both in index hospitalization [ZRES 2.5, OR 2.8 (95% CI 1.2-6.5), p=0.018] and during follow-up [ZRES 3.7, OR 3.4 (95% CI 1.7-6.6), p<0.001], while OSA was linked to a greater risk of readmission for HF [ZRES 3.2, OR 4.6 (95% CI 1.7-12.3), p=0.001]. Neither HTN nor T2DM diagnoses displayed significant influence on both HF rehospitalization and mortality. On the other hand, OSA and CKD were not associated with death and readmission for HF, respectively. Conclusion: Main cardiovascular risk factors seem to play a lesser role on the outcome of patients with non-ischemic HF than on those with CAD. However, in the former population, OSA and CKD might increase HF rehospitalization and mortality, respectively. P720 https://esc365.escardio.org/Presentation/217357/abstract Medications in TV advertising targeted at children and adolescents in the Russian Federation Y Yulia Balanova1, A Imaeva1, A Kontsevaya1, A Kapustina1, J Breda2 1National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russia, Moscow, Russian Federation 2WHO European Office for the Prevention and of Noncommunicable Diseases (NCD Office), Moscow, Russian Federation Topic: Risk Factors and Prevention – Epidemiology In the Russian Federation, children 4-17 years old watch TV approximately 115 minutes a day. Objective: to evaluate the extent and nature of medications advertising to children and adolescents less than 16 years on Russian TV channels. Methods: The study was conducted based on the adapted WHO methodology «Monitoring food and beverage marketing to children via television and the Internet". TV broadcasts of the 5 most popular TV channels among children and adolescents (Carousel, Disney, STS, TNT, Friday) were recorded during two weekdays and two weekend days between 06.00 and 22.00 hours from March to May 2017. The coding of advertisements was carried out in accordance with the indicators described in the WHO Regional Office for Europe Protocol. The medications were divided into “banned” (if there was information about the ban on the taking that medication by persons under the age of 18), “permitted with age restrictions” and “permitted". Statistical analysis was performed using the STATA program version 14. Results: All television data was screened for advertisements by two researchers. Totally 11 678 advertisements were coded in accordance with the State Register of Medications and the Register of Medications of Russia and analyzed. In the frequency of advertising, medications came second, falling behind only “food and drink” category. On Disney and Friday channels, medications were the most popular category advertised. During ads there was information about the necessity to consult a doctor. Advertisements with prescription drugs that are forbidden to be shown on TV in the Russian Federation were not found. The prevalence of medications advertising was significantly higher compared to dietary supplements&vitamins (81% vs 13%, p<0.0001), regardless of a TV channel. The percentage of the advertising of the medications banned for use by children ranged from 12.9% (Friday) to 5.1% (Disney). About 50% of all advertised drugs had age restrictions for taking by children. Conclusions. On Russian TV channels targeted at children and adolescents, food&beverages are the first most frequent products in the structure of advertisements, medications advertising is the second most popular demonstrated types of advertising. At the same time, only 40% of all advertised medications were included into category permitted, and about 10% were the drugs from the category banned for children. Abstract No: P720 The prevalence of medications advertisin P721 https://esc365.escardio.org/Presentation/217380/abstract Student heart program C Carla Janice Baister Lantieri1, S Quaranta Damiao2, K Corcione Turke1, K De Angelis1, A Aparecida De Araujo1, A Silva Tenorio1, G Castilho Russo Tavares1, M Messias Loureiro1, F Alves Da Costa1, S Maria Cury Ismael3, I Biscegli Jatene3, R Krakauer1, J Fernando Monteiro Ferreira1, A Carlos Palandri Chagas1 1ABC Medical School, Sao Paulo, Brazil 2University of Sao Caetano do Sul, Sao Caetano do Sul, Brazil 3Hospital for the Heart (Hcor), Sao Paulo, Brazil Topic: Risk Factors and Prevention – Epidemiology Introduction: According to the World Health Organization (WHO), cardiovascular diseases (CVD) are the leading cause of death in the world. Risk factors for atherosclerosis may be present from childhood. Exposure to these contributes to the development of cardiovascular disease. Therefore, there is an emergency need for programs aiming the implementation of educational actions on prevention and health promotion for children and adolescent. Purpose: Identify epidemiological characteristics and analyze student adherence to cardiovascular prevention methods during a cardiovascular education program. Methods: Cross-sectional study. The sample consists of children and adolescents regularly enrolled in public schools in the state of São Paulo-Brazil, between the ages of 6 and 18 years and who participated in the “Heart Day at School". During the educational activities, risk and protective factors for cardiovascular diseases are discussed. The program has 4 essential pillars: monitors training day; heart day at school; continuing cardiovascular education program and extension of the project to the society. The International Physical Activity Questionnaire, the Food Diversity and Ultra-Processed Consumption Questionnaire and The Socio-Economic Questionnaire were applied. Results: 13.882 students were included, 51.2% were female and the mean age was 14.4 years. 41.9% of student family providers have completed elementary school and completed high school. The time of physical activity is still insufficient. The median time spent doing mild, moderate and vigorous physical activity over one week was 49, 58 and 63 minutes respectively, below the level recommended by the WHO. The median sitting time was 214 minutes per day and 25% did not walk 10 continuous minutes at home or at work as a means of transport to one place to another per week. High percentages of processed and ultra-processed foods were found. 41.2% had consumed leafy vegetables the previous day, 58.1% fruit, 85.3% carbohydrates like rice or pasta, 47.4% legumes, 79.7% meat/chicken, 62.2% soft drinks/sodas, 45.9% sausages, and 53,2% candy. Conclusion: The project aims to promote cardiovascular health and prevention of atherosclerosis in children and adolescents, in order to reduce the mortality rates from cardiovascular diseases. It characteristic is the presence of interprofessionality and intersectoriality sectors. P722 https://esc365.escardio.org/Presentation/217315/abstract Adherence to a healthy lifestyle in the Russian Federation Y Yulia Balanova1, S Shalnova1, A Kapustina1, A Imaeva1, G Muromtseva1, S Evstifeeva1, N Karamnova1, S Maksimov1, A Dotsenko1 1National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russia, Moscow, Russian Federation Topic: Risk Factors and Prevention – Epidemiology Aim: to evaluate the prevalence of healthy lifestyle (HLS) according the healthy lifestyle adherence index (HLAI) in the Russian Federation (RF). Material and methods: A cross-sectional study was carried out in 27 Russian regions (2018-2019) using modified the WHO STEPS approach. Standard epidemiological methods and criteria were used. Randomly selected males (N=19019) and females (N=25308) aged 18+ years were examined. HLAI included the following 5 components: no smoking; fruit and vegetable consumption of at least 400 g per day, at least 150 minutes of moderate physical activity or 75 min. of vigorous-intensity physical activity (>600 metabolic equivalents (MET) per week, lack of harmful use of alcohol and normal salt intake (<5 g per day). Two level of adherence to a HLS according the HLAI have been identified: 1) satisfactory (no smoking + 3 any other component of HLS); 2) high (all HLS components are present). The calculations and analysis were performed in MS SQL Server 2008 R2 (Transact-SQL). Results: In the Russian population aged 18+ the smoking prevalence was higher among males 33.5% [32.9-34.2], among females ã 7.1% [6.8-7.4]; low fruit& vegetable consumption ã 76,9% [76.2-77.7] and 73,2% [72,5-73,8] accordingly. In the RF 5.2% of males and 3.1% females abuse alcohol. The excessive salt intake ãmales 32.2% [31.0-33.4], 24.7% [23.7-25.8] among females; insufficient physical activity was higher among females than males (27.1% vs 24.2%, p<0,001). Based on the prevalence of risk factors, the components of HLAI were calculated. The prevalence of satisfactory HLAI among the Russian population was 39.2%, higher for females than for males (45.0% vs 31.6 %, p<0,001). The prevalence of high HLAI was 13.3%, higher for females than for males (15.9% vs 9.9 %, p<0,001) with no age differences. Conclusion: The prevalence of healthy lifestyle in the RF remains high. There is as a result, insufficient adherence to healthy lifestyle. However females were more adherent to a HLS than males. Award Winning Science - Secondary prevention & rehabilitation section 48 https://esc365.escardio.org/Presentation/217395/abstract Combination of depression and decreased physical function further worsens the prognosis of patients with cardiovascular disease K Kenya Osada1, M Yamaoka-Tojo2, Y Kato1, A Yuyama1, M Axiangu1, A Aoyama1, H Kariya3, S Obara4, K Kamiya2, C Noda5, A Matsunaga2, J Ako5 1Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan 2Kitasato University School of Allied Health Sciences, Department of Rehabilitation, Sagamihara, Japan 3Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan 4Kitasato University East Hospital, Department of Rehabilitation, Sagamihara, Japan 5Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan Topic: Depression and Heart Disease Background/introduction: Patients with cardiovascular disease (CVD) have a high rate of depression and decreased physical function; both these features are poor prognostic factors of CVD. Additionally, physical function has been reported to decline in patients with depression. However, there is no clear relationship between depression and physical function in patients with CVD. Moreover, the effects of the combination of depression and decreased physical function on prognosis are unclear. Purpose: The purpose of this study is to clarify the relationship between depression tendency, physical function and prognosis in patients with CVD. Methods: This study included 472 patients with chronic CVD who underwent evaluation for depression [hospital anxiety and depression scale (HADS)] and physical function. HADS is a self-administered scale developed to assess depression and anxiety. We investigated seven items of depression and defined eight or more points as depression tendency. We determined grip strength, quadriceps isometric strength (QIS), 10-m comfortable gait speed and 6-minute walking distance (6MD) to assess physical function. Furthermore, we assessed the relationship between physical function and HADS via covariance analysis. We also investigated the presence and duration of cardiovascular events as prognostic indicators for up to 50 months. We divided the patients into four groups according to the presence of depression tendency and decreased physical function. We used log-rank test, KaplanãMeier analysis and Cox proportional hazards regression analysis to investigate the relationship between depression, physical function and cardiovascular events. Results: Among the 472 patients (mean age, 71.5 ± 8.6 years; 70.8% men), 109 (23.1%) had depression tendency according to HADS. Even after adjusting for covariates in covariance analysis, all physical function indices showed significantly low values in combination with depression tendency (P < 0.05). Cardiovascular events occurred in 65 (13.8%) patients during a median follow-up of 38 months (interquartile range, 20ã50 months). KaplanãMeier analysis followed by the log-rank test revealed that the incidences of cardiovascular events were higher in patients with depression tendency and decreased physical function than in those with only one feature. The 6MD findings are shown in Figure 1. In patients with CVD, combination of depression tendency and decreased physical function further increased in the risk of cardiovascular events (respectively P < 0.05). In multivariate Cox regression analysis, 6MD [hazard ratio (HR): 5.00, 95% confidence interval (CI): 2.36–10.50], gait speed (HR: 4.04, 95% CI: 1.81–8.99), QIS (HR: 3.38, 95% CI: 1.54–7.42) and grip strength (HR: 3.05, 95% CI: 1.54–6.03) were associated with cardiovascular events. Conclusion: In patients with CVD, depression tendency is associated with decreased physical function, and their combination is associated with a poor prognosis. KaplanãMeier analysis EAPC Essentials 4 You - ePosters P507 https://esc365.escardio.org/Presentation/221659/abstract Depression levels in open population of middle urbanized Siberian city: gender differences E Akimova1, E Gakova1, V Gafarov2, V Kuznetsov1 1Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tyumen, Russian Federation 2Research Institute of Therapy and Prevention, Novosibirsk, Russian Federation Topic: Depression and Heart Disease Purpose: To establish levels of depression in males and females in the age range in open population of middle urbanized Siberian city. Methods: Cross-sectional epidemiology study was conducted among people of both sexes aged 25-64 years in Tyumen. A representative sample was formed from voting lists of citizens selected randomly - 2000 people with response of 85.0% in males and 70.3% in females. Analysis of depression was carried out according to the questionnaire of WHO MONICA- Psychosocial. We estimated depression levels as low, medium and high. Age standardization was performed using direct method. In assessing statistical significance of differences between sample sizes of population in two groups, the Pearson chi-square test was used. For critical level of significance in testing statistical hypotheses, p<0.05 was taken. Results: In the open population and in age-sex groups depression prevalence of medium level over high level was revealed; in age categories of 25-34 and 35-44 years, significantly higher prevalence of a high level of depression in females was detected. Age-standardized population-wide indicator of high level of depression in males aged 25-64 years was 4.6%, in females - 7.8%, indicator of medium level of depression - 19.0% and 22.9%, respectively; statistically significant sex differences in the prevalence of depression in population were not found. In men, high level of depression reached its absolute maximum in the age category of 55-64 years compared with other age groups of 25-34 years (1.1%, p<0.001), 35-44 years (1.8%, p<0.001) , 45-64 years (5.6%, p<0.05) and general population indicator of 25-54 years (5.9, p<0.001). In women, high level of depression reached its absolute maximum in the age category 55-64 years (9.3%), however, there were no statistically significant differences with similar indicators in other age categories and with general population indicator of 25-54 years. Conclusion: Thus, in open population of middle urbanized Siberian city, a need has arisen to develop integrated approach to the prevention of non-infectious, and especially cardiovascular diseases, since it has been established that prevention programs reduce the burden of depression, and effective approaches to prevent psycho-emotional conditions at the level of individual communities include school-oriented programs for teaching positive thinking among population, starting from a young age. P508 https://esc365.escardio.org/Presentation/217066/abstract Left ventricular remodeling at patient with ischemic heart disease and depression A Aleksei Ibatov1 1Sechenov Moscow medical academy , Moscow, Russian Federation Topic: Depression and Heart Disease Purpose: to study left ventricular remodeling (LVR) at patients with ischemic heart disease (IHD) and depression. Materials and methods: Depression was estimated by Beck's depression questionnaire (if the score was more than 19 there were the clinical level of depression, if the score was less than 11 there were no depression). Left ventricular hypertrophy (LVH) was estimated if the left ventricular myocardial mass index was above 110 g/m2 for the women and 134 g/m2 for the men. 60 patients with IHD (angina pectoris II - III function class), (average age - 54.3±1.2 years) and depression were examined. The comparison group were 73 patients (average age 54.4±1.0 years; p > 0.05) with IHD (angina pectoris II - III function class) and without depression. Results: The groups did not differ on age, duration IHD and therapy. The patients with IHD and depression had such echocardiographic parameters accordingly: left ventricular end-diastolic volume (EDV) - 145.0±5.8 ml; left ventricular end-systolic volume (ESV) - 67.0±4.7 ml; left ventricular ejection fraction (EF%) - 57.4±1.3 %; left ventricular myocardial mass index (LVMMI) - 143.2±4.7 g/m2; patients with LVH (%) - 60.0 %. Concentric LVH was 16.7 % and eccentric LVH - 43.3 %. The patients with IHD and without depression had such echocardiographic parameters accordingly: EDV - 129.1±4.7 ml (p < 0.05); ESV - 56.7±3.9 ml (p > 0.05); EF% - 57.3% (p > 0.05); LVMMI - 146.4±5.7 g/m2 (p > 0.05); patients with LVH - 52.0% (p > 0.05). Concentric LVH was 27.3 % (p > 0.05) and eccentric LVH ã 24.6 % (p < 0.05) from patients of comparison group. Conclusion: The patients with IHD and depression, in comparison with the patients without depression, had more ones with eccentric left ventricular hypertrophy, that has a negative prognosis for these people. 88 https://esc365.escardio.org/Presentation/217026/abstract Circulating vitamin D and vitamin K status in relation to underlying mechanisms of cardiovascular health, and all-cause mortality: the Hoorn Study E Elisa Dal Canto1, JWJ Beulens1, P Elders1, F Rutters1, C Stehouwer2, G Nijpels1, AJ Van Ballegooijen1 1Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The) 2Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The) Topic: Nutrition, Malnutrition and Heart Disease Background: A low vitamin D and vitamin K status has been associated with increased cardiovascular (CV) risk, but the evidence of their combined effect on CV health is limited. Purpose: This study aimed to assess whether 25-hydroxyvitamin D (25(OH)D) and desphospho-uncarboxylated matrix-gla protein (dp-ucMGP), an indicator of vitamin K status, were synergistically associated with unfavorable measures of cardiac structure and function and with all-cause mortality in older Dutch subjects. Methods: We included 610 subjects of the Hoorn Study, a population-based cohort. A subgroup of 337 subjects underwent an echocardiogram at baseline 2000-2001 and between 2007-2009. Vitamin D and K status were assessed at baseline by 25(OH)D and dp-ucMGP (high dp-ucMGP is indicative for low vitamin K status). The vital status was assessed in 2018. We studied the association of categories of 25(OH)D (≤/>50 mmol/L) and dp-ucMGP (≤/>median) with echocardiographic measures using linear regression and with all-cause mortality using multivariable Cox proportional hazards models. Results: Compared to the reference with high vitamin D/high vitamin K, a low vitamin D/low vitamin K status was prospectively associated with increased left ventricular mass index (LVMI): 7.0 g/m2.7, 95% CI: 3.0;11.0) in both men and women and with depressed left ventricular ejection fraction (LVEF) only in women (-4.1%, 95% CI: -10.5;2.3) after adjusting for potential confounders. Cox regression analysis showed an increased risk of all-cause mortality for the low vitamin D and K group after 17 years of follow-up with a hazard ratio of 1.59 (95% CI: 1.13-2.23) versus the reference. We could not observe significant causal mediation for LVMI or LVEF in the relationship between vitamin D and K categories and all-cause mortality. Conclusions: This study showed an association of low vitamin D and K levels with increased LVMI in men and women and with depressed LVEF in women after 8 years of follow-up, and with increased risk of all-cause mortality after 17 years of follow-up. P725 https://esc365.escardio.org/Presentation/223120/abstract Red meat consuption in the general working age population: socio-economic and health-related determinants V Victoria Serebryakova1, VS Kaveshnikov1, IA Trubacheva1 1Cardiology Research Institute Tomsk National Research Medical Centre Russian Academy of Sciences, Tomsk, Russian Federation Topic: Nutrition, Malnutrition and Heart Disease Objective: To study red meat intake and its link to social demographic and health-related factors in the general working age population. Materials and methods: Population-based cross-sectional study conducted in our city. The cohort 25-64 years old (n=1600, 59% women) was randomly recruited from the general population. We studied red meat consumption, reported as the ordered categories (never, 1-2 times a month, 1-2 times a week, daily), and analyzed its association with social demographic and health-related factors. Prosperity level was defined as 5 categories from meet basic needs to purchases luxury. Multiple proportional odds regression models were fitted to analyze associations. Results: A total 52% of men and 41.9% of women reported to consume red meat daily (p<0.001). Significant determinants of red meat intake were prosperity level (the higher the prosperity, the more the red meat intake; p<0.001), age (OR=0.84 for 10-year increase; p<0.001), secondary vs. higher education (OR=1.3; p=0.012), amount of children (OR=1.17; p=0.009), hostel/room in an apartment vs. separate apartment (OR=0.56; p=0.012) and self-reported non-vascular heart disease (OR=0.63; p=0.01). Red meat consumption considerably declined with age in women (OR=0.79; p<0.001), but not in men. As well, prosperity level and amount of children were statistically significant in women only (OR=1.26; p=0.007 and OR=1.32; p<0.001, accordingly). In turn, effect of prosperity level was significantly lower in women with higher vs. secondary education (OR=1.26; p=0.007 and OR=1.57; p=0.02, accordingly). Conclusions: The present research supports the hypothesis of significant association to red meat consumption of key social demographic factors, specifically gender, prosperity level, education, type of housing, number of children, but failed to show any association to marital status, occupational, cardiovascular disease. This field of research needs further investigation to discover tools by which to reduce unhealthy patterns of red meat intake, and to promote healthy dietary habits. P727 https://esc365.escardio.org/Presentation/217393/abstract Which score of adherence to Mediterranean diet actually uncover differences in eating habits between healthy subjects and patients with coronary heart disease? MG Monica Gianna Giroli1, M Amato1, A Bonomi1, F Laguzzi2, F Veglia1, JP Werba1, E Tremoli1 1Cardiology Center Monzino IRCCS, Milan, Italy 2Karolinska Institutet, Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden Funding Acknowledgements: This work has been supported by funding from the ã Ricerca Correnteã of the Ministry of Health, Italy Topic: Nutrition, Malnutrition and Heart Disease Background: observational and interventional studies show an inverse association between adherence to the Mediterranean Diet (MD) and coronary heart disease (CHD) and different scores have been proposed to assess adherence to the MD. Whether the results of these scores overlap and which among them better discriminates the eating habits of patients with CHD and healthy subjects is not known. Purpose: to assess the concordance between different MD scores and to investigate which of them is more accurate to distinguish between the dietary pattern of patients with CHD and healthy subjects. Methods: case-control study including 179 patients with CHD (cases) and 155 healthy volunteers (controls), all Italians, age- and gender- frequency matched (age 62.3 ± 7.7 years, 93% males). Eating habits were inquired using the food-frequency questionnaire of European Prospective Investigation into Cancer and Nutrition (EPIC). Adherence to MD was estimated by: 1) Mediterranean Diet Score (MDS), a 9-point index designed to estimate the Greek variant of MD; 2) Italian Mediterranean Index (IMI), a 11-items adaptation of the MDS to the Italian population; 3) Mediterranean Diet Adherence Screener score (MEDAS score), a 14-items instrument developed and validated for the Spanish PREDIMED trial. Concordance between MD scores was assessed by Spearman correlation. Association of MD scores with CHD was evaluated by computing Odds Ratios (OR, 95% confidence interval) for CHD according to tertiles of each MD score. Results: the MD scores correlated significantly (p<0.0001) but moderately with each other (MDS vs. IMI r=0.36; MDS vs. MEDAS score r=0.45; IMI vs. MEDAS score r= 0.51). Only MDS was significantly associated with CHD (Figure). Conclusion: even though the various MD scores correlate significantly, MDS is the only score that identifies differences of eating habits between patients with CHD and healthy subjects. These findings prompt the utilization of MDS to assess adherence to MD, at least in a population such as Italians who already follow a Mediterranean background dietary style. P728 https://esc365.escardio.org/Presentation/221547/abstract Association between dietary mediterranean-ness, intake of antioxidants and biological markers of oxidative stress in patients with coronary artery disease S Basilico1, M Amato2, B Porro2, A Di Minno2, V Cavalca2, S Barbieri2, MG Giroli2, JP Werba2, L Vigo2, F Veglia2, E Tremoli2 1University of Milan, Milano, Italy 2IRCCS Centro Cardiologico Monzino, Milan, Italy Funding Acknowledgements: Italian Ministry of Health RF-2011-02352056 Topic: Nutrition, Malnutrition and Heart Disease Background: Antioxidants contained in food may play a role in the protective effects of diets on cardiovascular health. Purpose: To assess whether the dietary mediterranean-ness in secondary cardiovascular prevention is associated with the intake of antioxidants and whether this is related to biological markers of oxidative stress. Methods: 130 patients with coronary heart disease (CHD), aged 30-75y, were randomized to a personalized intensive Mediterranean Diet (MD; n=64) or to a low-fat heart-healthy diet (HHD; n=66). As index of dietary Mediterranean-ness, the MD Score (MDS), a 9-item tool developed by Trichopoulou (2003) was computed from data collected through a 7-day food diary obtained two months after randomization. Only food diaries compiled in full detail in terms of quantity and quality were considered (29 MD, 23 HHD). Intake of antioxidants was estimated using: a) the online database Phenol-Explorer for polyphenols and b) the Pellegrini methods for Total Antioxidant Capacity (TAC), which includes Trolox® Equivalent Antioxidant Capacity (TEAC), Total Radical Trapping Parameter (TRAP), and Ferric Ion Reducing Antioxidant Power (FRAP). At 3 months, hemoglobin, cholesterol (TC), reduced and oxidized glutathione (GSH and GSSG), α-tocopherol (α-TH) and gamma-tocopherol (g-TH) were determined in blood, whereas 8-iso-prostaglandin F2 α (8-iso-PGF2-α) in urine. Results: MDS correlated positively with the intake of polyphenols (r=0.51, p<.0001), TEAC (r=0.34, p=.01) and TRAP (r=0.44, p=.001) but not with FRAP. The intake of polyphenols correlated positively with α-TH/TC and g-TH/TC. The TAC components correlated positively with g-TH/TC; besides, TRAP correlated negatively with GSSG/Hb and positively with GSH/GSSG. The intake of antioxidants did not correlate with 8-iso-PGF2-α (Table). Conclusions: Adherence to MD is linked to an increased consumption of antioxidants and this intake favorably affects the balance of oxidative stress. Polyphenols TAC TEAC TRAP FRAP r p r p r p r p GSH/Hb 0.14 0.34 0.05 0.72 0.14 0.33 -0.13 0.35 GSSG/Hb -0.20 0.15 -0.18 0.21 -0.32 0.02 -0.22 0.12 GSH/GSSG 0.23 0.11 0.14 0.32 0.29 0.04 0.11 0.43 α-TH/TC 0.30 0.03 0.08 0.57 0.20 0.16 0.18 0.18 g-TH/TC 0.34 0.01 0.26 0.07 0.28 0.05 0.31 0.02 8-iso-PGF2α 0.02 0.89 0.12 0.39 0.03 0.87 -0.01 0.94 Polyphenols TAC TEAC TRAP FRAP r p r p r p r p GSH/Hb 0.14 0.34 0.05 0.72 0.14 0.33 -0.13 0.35 GSSG/Hb -0.20 0.15 -0.18 0.21 -0.32 0.02 -0.22 0.12 GSH/GSSG 0.23 0.11 0.14 0.32 0.29 0.04 0.11 0.43 α-TH/TC 0.30 0.03 0.08 0.57 0.20 0.16 0.18 0.18 g-TH/TC 0.34 0.01 0.26 0.07 0.28 0.05 0.31 0.02 8-iso-PGF2α 0.02 0.89 0.12 0.39 0.03 0.87 -0.01 0.94 r: Spearmanã s correlation coefficient; p: p-value Open in new tab Polyphenols TAC TEAC TRAP FRAP r p r p r p r p GSH/Hb 0.14 0.34 0.05 0.72 0.14 0.33 -0.13 0.35 GSSG/Hb -0.20 0.15 -0.18 0.21 -0.32 0.02 -0.22 0.12 GSH/GSSG 0.23 0.11 0.14 0.32 0.29 0.04 0.11 0.43 α-TH/TC 0.30 0.03 0.08 0.57 0.20 0.16 0.18 0.18 g-TH/TC 0.34 0.01 0.26 0.07 0.28 0.05 0.31 0.02 8-iso-PGF2α 0.02 0.89 0.12 0.39 0.03 0.87 -0.01 0.94 Polyphenols TAC TEAC TRAP FRAP r p r p r p r p GSH/Hb 0.14 0.34 0.05 0.72 0.14 0.33 -0.13 0.35 GSSG/Hb -0.20 0.15 -0.18 0.21 -0.32 0.02 -0.22 0.12 GSH/GSSG 0.23 0.11 0.14 0.32 0.29 0.04 0.11 0.43 α-TH/TC 0.30 0.03 0.08 0.57 0.20 0.16 0.18 0.18 g-TH/TC 0.34 0.01 0.26 0.07 0.28 0.05 0.31 0.02 8-iso-PGF2α 0.02 0.89 0.12 0.39 0.03 0.87 -0.01 0.94 r: Spearmanã s correlation coefficient; p: p-value Open in new tab P729 https://esc365.escardio.org/Presentation/217334/abstract Compliance to a mediterranean diet and to a low fat heart-healthy diet in coronary patients M Manuela Amato1, MG Giroli1, JP Werba1, LM Vigo1, B Porro1, A Bonomi1, E Tremoli1, F Veglia1 1Cardiology Center Monzino IRCCS, Milan, Italy Funding Acknowledgements: Italian Ministry of Health RF-2011-02352056 Topic: Nutrition, Malnutrition and Heart Disease Background: Dietary recommendations for secondary cardiovascular prevention evolved in recent years towards an increasing emphasis on “Mediterranean-ness". Indeed, the most recent guidelines (2019) moved from the previous concept of a low-fat heart-healthy diet (HHD) (2013) to the advice of a higher intake of olive oil, nuts, legumes and oily fish. However, to which extent patients with coronary heart disease (CHD) are able to achieve and maintain in the long-term the Mediterranean-ness of their prescribed diets is not known. Purpose: To evaluate, in a cohort of coronary patients, the short-term and long-term compliance to an intensive Mediterranean diet (MD) or a low-fat heart-healthy diet. Methods: 130 patients with CHD (aged 30-75y) were randomized to a personalized intensive MD (n=64) or to a low-fat heart-healthy diet (n=66). All patients were followed with monthly visits for 3 months (m) and then reevaluated 12m after randomization. As index of dietary Mediterranean-ness, the Mediterranean Diet Adherence Screener (MEDAS) score, a 14-item tool developed for the PREDIMED trial, was computed in both the diets prescribed by the nutritionists and the diets actually reported by patients at baseline and follow-ups. The individual compliance was assessed as the gap between the MEDAS score of reported diet and prescribed diet. Results: MEDAS score of diets reported by patients at baseline was 6.8 in both groups (p=0.55, figure). The mean MEDAS score of prescribed diets was 12.9 and 9.3 for MD and HHD, respectively. 120 and 107 patients completed 3m and 12m of dietary intervention, with a similar rate of dropout in both groups. MEDAS score significantly augmented at 3m by a mean of 2.6 points and 1.0 point in MD and HHD (p<.0001 for both), respectively (figure). These changes were significantly different between groups (p<.0001). At 12m, MEDAS score decreased only slightly in both groups (0.7 points and 0.3 points in MD and HHD, respectively) but still remained significantly different from baseline (p<.0001 and p=0.025, respectively) and between groups (p=0.003). However, neither of the groups achieved the MEDAS score of their corresponding prescribed diets. Conclusions: coronary patients may increase their dietary Mediterranean-ness with both MD and HHD in the short term (3 m) and these changes are similarly maintained in the long-term (12 m). Likewise, the rate of dropout was comparable. Given the purported cardio-protective properties of MD, a more stringent MD may be administered in secondary prevention without compromising dietary compliance. New strategies of nutritionist ã patient interaction (e.g. cooking classes, dietary-focused text messaging) might help to further reduce the gap between the Mediterranean-ness that the nutritionist recommends and that which the patient actually manages to follow. Abstract No: P729 Figure 90 https://esc365.escardio.org/Presentation/217027/abstract Combined effects of renin-angiotensin system inhibition and fitness on mortality risk in hypertensive and/or diabetic patients P Peter Kokkinos1, C Faselis2, P Karasik2, A Pittaras3, E Nylen2, M Doumas4, L Sidossis5, H Grassos6, H Moore2, S Gandhi2, J Myers7 1Veterans Affairs Medical Center, Washington, DC and Rutgers University, Brunswick, NJ, Washington, DC, United States of America 2Veterans Affairs Medical Center (VAMC), Washington, United States of America 3Asklepieion Voulas General Hospital, Athens, Greece 4Aristotle University of Thessaloniki, Thessaloniki, Greece 5Rutgers University, Kinesiology and Health, New Brunswick, United States of America 6KAT General Hospital, Athens, Greece 7Veterans Affairs Health Care System, Palo Alto, United States of America Topic: Physical Inactivity and Exercise Introduction: Renin-Angiotensin System Inhibition (RAS-I) decreases mortality risk in patients with type 2 diabetes mellitus (DM2) and/or hypertension (HTN). Cardiorespiratory fitness (CRF) is associated with lower mortality risk. However, the combined effects of CRF and RAS-I on mortality risk have not been assessed. Purpose: Assess the independent and interactive effects of RAS-I therapy and CRF on mortality risk in high risk patients. Methods: We identified 13,975 patients (age 59.1±10.8 years) with either DM2 or HTN and 5,234 with both conditions. We established four CRF categories based on age-specific quartiles of peak metabolic equivalents (METs) achieved: Least-Fit; Low-Fit; Moderate-Fit and High-Fit. Additionally, we formed two groups (RAS-I and No-RAS-I) within each CRF category for a total of 8 groups to evaluate the impact of CRF/RAS-I interaction on mortality risk. Cox proportional hazards analyses (adjusted for age, medications and comorbidities) were used to assess risk associations. Results: During the follow-up period (median 13.3 years), we observed 26.4 events/1,000 person-years of observation in those with HTN or DM2 and 25.3/1,000 person-years in those with both HTN and DM2. Patients treated with RAS-I had 30% lower mortality risk compared to those not treated (HR 0.70; 95% CI: 0.65-0.75). The CRF-mortality risk association was inverse and graded. The risk was 12% lower for each 1-MET increase in exercise capacity (HR 0.88; 95% CI: 0.87-0.89). Compared to Least-Fit, the risk was 29%; 46% and 65% lower for Low-Fit, Moderate-Fit and High-Fit patients, respectively. When CRF-RAS-I interaction was considered, the Least-Fit patients not treated with RAS-I had 40% higher risk compared to those treated with RAS-I (HR 1.40; 95% CI 1.25-1.55). Mortality risk then declined progressively with increased CRF, regardless of RAS-I status. However, the combination of increased CRF and RAS-I treatment was synergistic, resulting in lower mortality risk than either therapy alone. For example, compared to Least-Fit patients treated with RAS-I, High-Fit patients not treated with RAS-I had 34% lower mortality risk (HR 0.66; 95% CI 0.58-0.74). For High-Fit patients treated with RAS-I, the risk was 63% lower (HR 0.37; 95% CI 0.31-0.44). Conclusions: In patients with either DM2, HTN or both, the CRF-mortality risk association was inverse and graded in those treated and not-treated with RAS-I. The combination of RAS-I therapy and CRF was synergistic, resulting in lower mortality risk than either therapy alone. P184 https://esc365.escardio.org/Presentation/217377/abstract Sitting for too long stiffens arteries independent of blood pressure and physical activity A Mahmud1, T Dalton2, O Merrigan3, J Nalin3, M Nalin3, A Soud3, R Hamadah4 1King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia 2Royal College of Surgeons in Ireland, Dublin, Ireland 3Royal College of Sugeons in Ireland, Medical University of Bahrain, Bahrain, Bahrain 4Arabian Gulf University, Bahrain, Bahrain Topic: Physical Inactivity and Exercise Background: Arterial stiffness (AS) and physical activity are independent cardiovascular(CV) risk factors and predict outcome. We and others have shown that PA is associated with AS; however, the data is largely derived from older, Caucasian populations assessing PA with questionaires. The aim of this study was to explore the relationship between AS and PA using actigraphy in a young Arab population, hitherto not studied. Methods : 320 apparently healthy subjects ( mean age 20.7±3 years, 52% females) were enrolled in this cross-sectional study. After recording socio-demographic and clinical data, anthropometric measurements were performed including body weight, height, waist and hip circumference, total body fat(%) , visceral fat(%) and muscle mass(%). Aortic blood pressure(AoBP), pulse wave velocity (PWV) and augmentation index(AIx) were measured using the SphygmoCor and Mibilograph devices as measures of AS after 15 minutes of supine rest. Participants received an accelerometer (ActiGraph) to wear on the wrist for 7 consecutive days. The average minutes/day spent at different PA intensities (min/day) was determined according to established cut-points as well as metabolic equivalents(METS). Results: PWV was associated with age ( r=0.25, p<0.001), brachial systolic BP(r=0.57, p<0.0001), aortic systolic BP( r=0.65, p<0.0001), cardiac output(r=0.39, p<0.0001), METS achieved( r=-0.42, p<0.0001), light activity ( r=-0.25, p<0.001), moderate-to-vigorous (r=-0.29, p<0.001), sedantary time (r=0.45, P<0.0001), waist( r=0.47, p<0.0001), visceral fat( r=0.39, p<0.001) and muscle mass(r=-0.31, p<0.01). In a stepwise regression model with PWV as the dependent variable, age, MAP, gender, METS achieved and sedentary time emerged as independent determinants of PWV(R2=0.39, p<0.0001), independent of BMI and physiacl activity. Conclusions: Our results demonsrate the deleterious effect of sitting time on arterial function, independent of BP, BMI and PA in a young, healthy Arab population, highlighting the importance of exercise and PA prompotion in this region. P185 https://esc365.escardio.org/Presentation/221679/abstract Sportsmen who used to smoke don't compensate their unhealthy life-style by increasing training load. C Dausin1, R De Bosscher2, G Claessen2, M Claeys2, S Van Soest2, D Thijs3, D Vermeulen4, K Goetschalckx2, A La Gerche5, L Herbots3, H Heidbuchel4, V Cornelissen6, P Hespel1, R Willems2 1KU Leuven, Department of Movement sciences, Leuven, Belgium 2KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium 3Heart Centre Hasselt, Hasselt, Belgium 4UZA, Division of Cardiology, Antwerp, Belgium 5Baker Heart and Diabetes Institute, Melbourne, Australia 6KU Leuven, Department of Rehabilitation sciences, Leuven, Belgium On Behalf of: the Master@heart study group Funding Acknowledgements: This study was funded by a grant from the Fund for Scientific Research Flanders (FWO) Topic: Physical Inactivity and Exercise Background: Cigarette smoking leads to an increased risk of coronary artery disease, peripheral vascular disease and stroke. On the other hand, a physically active lifestyle reduces the risk of cardiovascular diseases. Purpose: The Master@heart project studies the effect of life-long exercise on coronary artery disease in men between 45 and 70 years. In volunteering candidates for this study we explored the hypothesis that ex-smokers would compensate for their unhealthy smoking history by exercising more than non-smokers. Methods: Master@heart started recruiting participants in February 2019 by a large-scale media campaign. An online survey was performed for the selection of participants. By October 2019 2367 candidates filled in the questionnaire. Participants were asked for basic anthropometrics, smoking behaviour and sports participation. Time of endurance exercise was defined as hours of training per week of running, cycling, swimming or rowing. Participants were characterised as physically active or inactive (more or less than 3 hours of exercise/week respectively). The total hours of exercise was defined as endurance exercise plus all other physical exercise. Smoking duration was divided into long-term versus short-term smoking (>10 vs. <10 years, respectively) whereas smoking cessation was characterised as recent (<20 years) or long-time (>20 years). For all analyses differences were considered significant at p<0.05. Results: 2367 questionnaires (64,8% non-smokers, 34.2% ex-smokers) were analysed (Age 55.9 ± 6.8 years). Non-smokers were younger (55.1 ± 6.5 vs. 57.4 ± 7.0 years) and had a lower body mass index (24.3 ± 2.7 vs. 25.0 ± 2.9 kg/m²) compared to ex-smokers. There were no differences between non-smokers and ex-smokers in time of endurance exercise (7.5 ± 5.1 vs. 7.1 ± 4.8 hours/week) or total hours of exercise (7.7 ± 5.2 vs. 7.4 ± 4.8 hours/week). Further, time of endurance exercise was not statistically different between long-term smokers and short-term smokers (p>0.05) or between ex-smokers who stopped recently or a long time ago (p>0.05). Physically inactive ex-smokers weighed more (82.8 ± 12.5 vs. 80.6 ± 12.2 kg), but didnã t exercise more, than non-smokers. Physically active ex-smokers were older (57.2 ± 7.0 vs. 54.7 ± 6.4 years) and had a higher body mass index (24.8 ± 2.7 vs. 24.0 ± 2.4 kg/m²) than physically active non-smokers. Physical activity was not different between active ex-smokers and non-smokers. Conclusions: Male ex-smokers do not exercise more than non-smokers. In our population, ex-smokers were older and had a higher BMI compared to non-smokers, although self-reported sports participation was the same. P510 https://esc365.escardio.org/Presentation/217351/abstract Impact of physical activity on the improvement in exercise capacity during maintenance phase of cardiac rehabilitation M Okamura1, K Iwata2, M Konishi2, K Akaishi1, K Suwa1, R Nakashima2, M Nitta2, J Uesugi1, Y Kanamori3, T Sugano2, K Tamura2, T Nakamura3 1Yokohama City University Hospital, Department of Rehabilitation Medicine, Yokohama, Japan 2Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan 3Yokohama City University Graduate School of Medicine, Department of Rehabilitation Medicine, Yokohama, Japan Topic: Physical Inactivity and Exercise Background: As in acute and recovery phases, cardiac rehabilitation is recommended also in the maintenance phase. However, the relationship between physical activity and the improvement in exercise capacity during maintenance phase remains unclear. Purpose: The purpose of this study is to investigate the relationship between physical activity and exercise capacity during maintenance phase of cardiovascular disease. Methods: Forty-two patients (66.2±22.2 years old, 69% males) who completed cardiac rehabilitation in acute and recovery phases were enrolled. During the maintenance phase, the cardiac rehabilitation in a medically supervised facility was not performed. Cardiopulmonary exercise testing was performed at the beginning and the end of maintenance phase cardiac rehabilitation for three months, and anaerobic threshold (AT) and peak VO2 were assessed as exercise capacity. The physical activity during the maintenance phase was assessed using International Physical Activity Questionnaire (IPAQ) short form. IPAQ assesses MET×time per a week of walking (3.3 METs), moderate (4.0 METs), vigorous (8.0 METs), and total physical activity. Results: The study cohort consists of patients with ischemic heart disease (n=23, 55%), heart failure (n=11, 26%), post surgery (n=5, 12%), and peripheral arterial disease (n=3, 7%). The AT was improved in 55% of patients whereas the peak VO2 was improved in 52 % of patients, respectively. Walking, moderate, vigorous and total physical activity (MET-min/week) were 1102.1±1173.7, 306.2±512.0, 64.8±218.2, and 1473.0±1336.7, respectively. Moderate physical activity was significantly associated with percentage change of AT (r=0.345, p=0.025) and percentage change of peak VO2 (r=0.514, p<0.001). Total physical activity was significantly associated with percentage change of peak VO2 (r=0.352, p=0.022). Age, sex, diagnosis, walking physical activity and vigorous physical activity were not related to the change in the exercise capacity. In multivariate logistic regression analysis, moderate physical activity was independently associated with the greater improvement in peak VO2 defined by the median value: 101.7% (OR=1.210 for 100 MET-min/week, 95%CI [1.010-1.45], p=0.042). Conclusions: Moderate and total physical activity may have a favorable impact on the improvement in exercise capacity during maintenance phase cardiac rehabilitation. P511 https://esc365.escardio.org/Presentation/221670/abstract Physical activity and social gradient in males and females of open urban population A Akimov1, V Kuznetsov1, V Gafarov2, E Akimova1 1Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tyumen, Russian Federation 2Research Institute of Therapy and Prevention, Novosibirsk, Russian Federation Topic: Physical Inactivity and Exercise Purpose: To investigate physical activity in people of both sexes aged 25-64 years in open urban population depending on social gradient. Methods: A study of attitude towards physical activity was conducted within cardiac screening in a representative sample of open population among 25-64-year-old Tyumen males and females by applying the WHO MONICA-psychosocial standard questionnaire «Knowledge and attitude to your health». Professional education was assessed by three parameters: higher, secondary and primary; nature of work was determined by four parameters: managers; specialists; manual workers and unemployed persons; marital status was estimated by two parameters: has / does not have a life partner. Pearson's chi-squared test using the Bonferroni correction was used to check the statistical significance of the differences between the groups. Value of p≤0.05 was considered statistically significant. Results: Statistically significant differences between males and females who answered the question: “Do you do physical exercises (excluding workplace exercises)?" were found in groups of people who had secondary (18.3-4.7%, p<0.001) and higher education (10.4-2.7%, p<0.001). Such category of answers as “I have to do physical exercises, but I donã t" was significantly more common among females (48.1-56.4%, p<0.01), the trend continued in the group of people who had secondary education (46.0-57.5%, p<0.01). The answer about physical exercises “I tried, but unsuccessfully" was much more common among females compared to males as well as in general population (16.6-21.0%, p<0.05), and in the group of people who had higher education (14.8-22.2%, p<0.05). Physical activity over the past 12 months has significantly increased in males compared to females in the group of specialists (17.5-10.9%, p<0.05) and decreased in unemployed females compared to unemployed males (46.6-19.9%, p<0.001). Assessment of their own physical activity “I am much more active" in comparison with other people of the same age was given mainly by males in the group of specialists (17.5-10.9%, p<0.05). Statistically significant differences (to the question: “Do you do physical exercises (excluding workplace exercises)?" - the answer “I do not need this") were obtained among married males compared to married females: 14.4-3.0%, p<0.001. On the contrary, the answer “I donã t do it, but I have to do it”, was given significantly more often by females who had life partner, compared to males of similar marital status (58.9-49.3%, p<0.01). Conclusion: Thus, the greatest tendency to increased physical activity was found in females, mostly in those who had secondary and higher education. Depending on the nature of labor, the highest physical activity was determined mainly in males from group of specialists, as well as among unemployed females. The greatest adherence to healthy lifestyle, regardless of marital status, was revealed in females. P512 https://esc365.escardio.org/Presentation/217355/abstract Lifestyle related risk factors and cognitive performance in elderly hypertensive patients M German-Sallo1, Z Preg1, T Pal2, D Balint-Szentendrey1, C Tatar3, KJ Szocs4 1George Emil Palade University of Medicine, Pharmacy, Science, and Technology, County Emergency Clinical Hospital, Cardiac Rehabilitation Department, Targu Mures, Romania 2Emergency Institute for Cardiovascular Diseases and Transplantation, Department of Cardiology, Targu Mures, Romania 3George Emil Palade University of Medicine, Pharmacy, Science, and Technology, County Emergency Clinical Hospital, IInd Department of Internal Medicine, Targu Mures, Romania 4George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania Topic: Physical Inactivity and Exercise Introduction: Unhealthy lifestyle choices, such as physical inactivity, obesity, smoking, alcohol consumption play an important role not only in the development and progression of cardiovascular diseases but also in the deterioration of cognitive functions. Purpose: To investigate the relationship between cognitive dysfunction (CD) and four modifiable cardiovascular risk factors, such as lack of physical activity (PA), obesity, smoking, and alcohol consumption in hypertensive patients. Methods: 50 hypertensive patients were enrolled (female: 30 pts, male: 20 pts; mean age: 70.42 ±4.81 years). Cognitive abilities were measured with two different tests, the Mini Mental State Examination (MMSE) (cut off value 24 from 30 points) and the Montreal Cognitive Assessment (MoCA) (cut off value 26 from 30 points). For the assessment of physical activity, the shortened form of the International Physical Activity Questionnaire (IPAQ-s) was used. Participants were questioned about alcohol intake utilising the standardised Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Obesity was defined as body mass index (BMI) above 30kg/m2. According to smoking habits, we categorised patients in two groups, one group without smoking history and the other one with active, passive, or former smokers. Two equal number groups were made based on MoCA and MMSE tests, the CD group: MoCA scores <26 and MMSE scores in the normal range and the non-CD group where both tests were in normal ranges. Results: Moderate physical activity per week was present in 43%, while a low level of PA in 22% and a high level in 35%. The mean global physical activity measured as MET-min/week was significantly higher in the non-CD group compared to the CD group 3805.84 vs. 1697.17 MET-min/week (p=0.024). The prevalence of low levels of PA was significantly higher in the non-CD group (p=0.047). CD group has significantly higher BMI (32.5 vs. 27.8 kg/m2, p=0.007). 58% of the participants have never smoked. Their proportion was higher in both groups (p=0.322). The alcohol intake was more common in the non-CD group (p=0.168). Conclusions: Some of the unhealthy lifestyle-related behaviours have an impact on cognitive deterioration. Any level of regular physical activity and lower body mass index may protect against cognitive impairment. History of smoking and alcohol consumption may have no influence on cognitive functions in elderly hypertensive patients. P513 https://esc365.escardio.org/Presentation/217384/abstract The acute effects of aerobic vs. resistance exercise on arterial stiffness and its relationship with cardiopulmonary fitness A Azra Mahmud1, C Forde2, J Feely2, J Hussey2 1King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia 2Trinity College Centre for Health Sciences, Dublin, Ireland Funding Acknowledgements: Irish Research Council for Science, Engineering & Technology Topic: Physical Inactivity and Exercise Background Arterial stiffness and cardiorespiratory fitness (CRF) are independent predictors of all-cause and CV mortality. We compared the acute effects of aerobic versus resistance exercise on arterial stiffness. Methods: Eighteen healthy subjects (9 male, age 23±3 yrs) were randomised in a cross-over design to aerobic and resistance exercise. Fitness was determined by oxygen consumption (VO2max). Brachial and aortic blood pressures (BP), augmentation index(AIx) and amplification were measured before and immediately after exercise. Results: CRF was related inversely with AIx and positively with AMP, independent of gender and BP. Despite higher BP following aerobic exercise, there was a significant reduction in AIx and increase in AMP compared with resistance exercise. Conclusions: Impaired CRF is associated with stiff arteries, highlighting the impaired buffering capacity of the arteries in young but unfit individuals. Resistance exercise stiffens arteries and should be prescribed with caution. Baseline Post exercise Aerobic Mean SD Mean SD HR (bpm) 73.40 13.00 119.94*†‡ 15.09 Brachial SP (mmHg) 126.26* 10.94 173.41†‡ 19.12 Brachial DP (mmHg) 73.00 6.90 81.17†‡ 14.13 Brachial PP (mmHg) 53.26* 10.77 92.23*†‡ 19.90 Aortic SP (mmHg) 105.07 8.19 136.70†‡ 15.30 Aortic PP (mmHg) 30.46* 5.64 50.58*‡ 11.07 Amp (mmHg) 21.20* 5.65 36.70*†‡ 8.98 AIx (%) -2.93 9.89 -10.41† 12.96 Resistance HR (bpm) 71.20 18.70 87.375†‡ 19.90 Brachial SP (mmHg) 124.80* 7.77 143.12*†‡ 15.19 Brachial DP (mmHg) 69.40 7.29 68.31† 9.29 Brachial PP (mmHg) 55.40 10.32 74.81*†‡ 13.56 Aortic SP (mmHg) 103.20 5.98 118.00†‡ 10.73 Aortic PP (mmHg) 32.90 6.35 46.6875‡ 10.14 Amp (mmHg) 21.60 6.65 25.12† 7.15 AIx (%) -0.70 8.03 7.68†‡ 10.61 Baseline Post exercise Aerobic Mean SD Mean SD HR (bpm) 73.40 13.00 119.94*†‡ 15.09 Brachial SP (mmHg) 126.26* 10.94 173.41†‡ 19.12 Brachial DP (mmHg) 73.00 6.90 81.17†‡ 14.13 Brachial PP (mmHg) 53.26* 10.77 92.23*†‡ 19.90 Aortic SP (mmHg) 105.07 8.19 136.70†‡ 15.30 Aortic PP (mmHg) 30.46* 5.64 50.58*‡ 11.07 Amp (mmHg) 21.20* 5.65 36.70*†‡ 8.98 AIx (%) -2.93 9.89 -10.41† 12.96 Resistance HR (bpm) 71.20 18.70 87.375†‡ 19.90 Brachial SP (mmHg) 124.80* 7.77 143.12*†‡ 15.19 Brachial DP (mmHg) 69.40 7.29 68.31† 9.29 Brachial PP (mmHg) 55.40 10.32 74.81*†‡ 13.56 Aortic SP (mmHg) 103.20 5.98 118.00†‡ 10.73 Aortic PP (mmHg) 32.90 6.35 46.6875‡ 10.14 Amp (mmHg) 21.60 6.65 25.12† 7.15 AIx (%) -0.70 8.03 7.68†‡ 10.61 *p<0.05 males vs females. †p<0.05 aerobic vs resistance exercise. ‡p<0.05 baseline vs. post exercise. Open in new tab Baseline Post exercise Aerobic Mean SD Mean SD HR (bpm) 73.40 13.00 119.94*†‡ 15.09 Brachial SP (mmHg) 126.26* 10.94 173.41†‡ 19.12 Brachial DP (mmHg) 73.00 6.90 81.17†‡ 14.13 Brachial PP (mmHg) 53.26* 10.77 92.23*†‡ 19.90 Aortic SP (mmHg) 105.07 8.19 136.70†‡ 15.30 Aortic PP (mmHg) 30.46* 5.64 50.58*‡ 11.07 Amp (mmHg) 21.20* 5.65 36.70*†‡ 8.98 AIx (%) -2.93 9.89 -10.41† 12.96 Resistance HR (bpm) 71.20 18.70 87.375†‡ 19.90 Brachial SP (mmHg) 124.80* 7.77 143.12*†‡ 15.19 Brachial DP (mmHg) 69.40 7.29 68.31† 9.29 Brachial PP (mmHg) 55.40 10.32 74.81*†‡ 13.56 Aortic SP (mmHg) 103.20 5.98 118.00†‡ 10.73 Aortic PP (mmHg) 32.90 6.35 46.6875‡ 10.14 Amp (mmHg) 21.60 6.65 25.12† 7.15 AIx (%) -0.70 8.03 7.68†‡ 10.61 Baseline Post exercise Aerobic Mean SD Mean SD HR (bpm) 73.40 13.00 119.94*†‡ 15.09 Brachial SP (mmHg) 126.26* 10.94 173.41†‡ 19.12 Brachial DP (mmHg) 73.00 6.90 81.17†‡ 14.13 Brachial PP (mmHg) 53.26* 10.77 92.23*†‡ 19.90 Aortic SP (mmHg) 105.07 8.19 136.70†‡ 15.30 Aortic PP (mmHg) 30.46* 5.64 50.58*‡ 11.07 Amp (mmHg) 21.20* 5.65 36.70*†‡ 8.98 AIx (%) -2.93 9.89 -10.41† 12.96 Resistance HR (bpm) 71.20 18.70 87.375†‡ 19.90 Brachial SP (mmHg) 124.80* 7.77 143.12*†‡ 15.19 Brachial DP (mmHg) 69.40 7.29 68.31† 9.29 Brachial PP (mmHg) 55.40 10.32 74.81*†‡ 13.56 Aortic SP (mmHg) 103.20 5.98 118.00†‡ 10.73 Aortic PP (mmHg) 32.90 6.35 46.6875‡ 10.14 Amp (mmHg) 21.60 6.65 25.12† 7.15 AIx (%) -0.70 8.03 7.68†‡ 10.61 *p<0.05 males vs females. †p<0.05 aerobic vs resistance exercise. ‡p<0.05 baseline vs. post exercise. Open in new tab P514 https://esc365.escardio.org/Presentation/221571/abstract Is the investment in phase 3 cardiac rehabilitation really important? NPD Cunha1, I Aguiar-Ricardo1, T Rodrigues1, J Rigueira1, R Santos1, A Nunes-Ferreira1, P Alves Da Silva1, P Assuncao Sousa1, S Pires1, R Pinto2, M Lemos Pires3, V Angarten3, H Santa-Clara2, FJ Pinto1, A Abreu1 1Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal 2Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal 3Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal Topic: Physical Inactivity and Exercise Introduction: It is well recognised that phase 2 cardiac rehabilitation is beneficial, reducing hospitalizations and symptoms and improving quality of life. The role of ongoing phase 3 cardiac rehabilitation is less clear. Purpose: To evaluate the impact in quality of life and physical activity level of a phase 3 cardiac rehabilitation program. Methods: Prospective, observational study including consecutive patients after completion of phase 2 cardiac rehabilitation. All patients were submitted to a clinical evaluation, echocardiogram and cardiopulmonary exercise test after and before the CRP. Upon completion of phase 2, all patients were advised to continue an exercise program at a specialized specialized cardiac rehabilitation center (CRECUL). After one year of follow-up, the quality of life and the level of physical activity were assessed by an health-related quality of life questionnaire (HeartQoL) and by the short version of the International Physical Activity Questionnaire (IPAQ), respectively. The patients who continued a phase 3 program in CRECUL were compared with the remaining patients. Results: 78 patients (60.3±11 years, 84.6% men, 85.9% ischemic disease, mean LVEF 48.6±13%) were included in a phase 2 CRP. All patients completed the program except one patient who dropped out. 19 patients (24.4%) continued a phase 3 CRP in CRECUL (89.5% men, mean age 62±10 years). Of this group of patients, 63.2% (n=12) had hypertension, 68.4% dyslipidemia, 26.3% diabetes and 68.4% were active or former smokers. The prevalence of cardiovascular risk factors did not vary between the 2 groups (CRECUL patients and the remaining patients). After a follow-up of 356.15±132.6 days, quality of life was assessed through Heart_QoL questionnaire and the group of CRECUL patients had, on average, better quality of life that the remaining patients (2.46±0.78 vs 2.09±0.86, p=NS). Although this difference was not statistically significant, possibly related to the sample size. The activity level was superior in CRECUL group (2.9±0.3 vs 2.3±0.7, p=0.007). Conclusions: The investment of a phase 3 cardiac rehabilitation in a specialized center seems to benefit the quality of life and is associated with a higher level of physical activity. This work reinforces the importance of health professionals encouraging patients to participate in such programs. P516 https://esc365.escardio.org/Presentation/217333/abstract Complementary behavioral medicine for patients with ischemic heart disease: achieving additional physical activity in the daily travel routine T Batool1, A Neven1, P Dendale2, P Vandervoort3, Y Vanrompay1, C Smeets4, M Scherrenberg2, V Storms5, D Janssens1, G Wets1 1Hasselt University, Transportation Research Institute (IMOB), Hasselt, Belgium 2Virga Jesse Hospital, Department of Cardiology, Hasselt, Belgium 3Hospital Oost-Limburg (ZOL), Cardiology Department, Genk, Belgium 4Hospital Oost-Limburg (ZOL), Future Health department, Genk, Belgium 5Hasselt University, Mobile Health Unit, Hasselt, Belgium Funding Acknowledgements: Higher Eduction Commission (HEC), Pakistan Topic: Physical Inactivity and Exercise Introduction: Various studies have found that achieving the recommended level of physical activity (PA) has a protective effect against Ischemic Heart Disease (IHD). However a large number of patients do not adhere to the standard PA level, but do make trips. On average 82 minutes/day are spent on daily travel by the general population. Walking and cycling are easy forms of attaining PA and can be incorporated in patientsã daily life by replacing passive transport modes (i.e. car, bus) by active ones. Purpose: The aim of the study is to analyse the travel behaviour of IHD patients and to help them in realizing an improved PA level by providing a personalized feedback report using information on their travel routines. Methods: Our pilot study found that in 70 IHD patients up to 1.9 (SD ± 1.6) trips per day are replaceable by active transport modes because they are within a 5 km distance range (excluding other factors). Performing these trips by walking or biking can contribute additional PA in a day. The travel behavior (location, purpose, timing, duration, transportation mode and travel partner, distance) of patients is monitored using a smartphone app. The patients are randomised in two groups. Three weeks of data is analyzed automatically, after which the patients in the experimental group receive a personalised feedback report. The report gives an Active Travel Score (ATS), based on duration, intensity and transport mode of the trips. After this intervention report, travel behaviour is monitored again for 3 weeks. The control group only receives a feedback report after 6 weeks. Results: Data of the 7 IHD patients in the experimental group shows that 3 patients increased their ATS in the second monitoring period while 4 patients had a lower ATS score. These results are compared with the travel behaviour patterns of the 3 patients in the control group, which did not get the feedback report but were monitored during the same period as the experimental group. All patients in the control group show a decline in their ATS when comparing the first 3 weeks with the second 3 weeks. This could mean that an external factor has influenced the travel behaviour pattern. The most intuitive explanation is that while it was sunny and dry during the first 3 weeks, the last 3 weeks were rainy, which influenced the walking and biking possibilities. Still, under these circumstances, 3 out of 7 patients in the experimental group have shown an increase in active travel behaviour after receiving the feedback report. The results of the study are promising, showing that behavioural change can be realized, but need to be confirmed in a larger trial. Conclusion: This study motivates IHD patients to improve their PA level during daily trips as a complimentary tool in the management of their condition and showed that three patients improved their travel behavior. The framework also provides an opportunity for caretakers to support patients with personalized care. 92 https://esc365.escardio.org/Presentation/217118/abstract The relationship between ECG/HRV variables and socio-economic factors : results of mass screening in the rural region of Ukraine I Illya Chaikovsky1, E Lebedev2, V Ponomarev2, A Nechiporuk3 1Glushkov Institute for cybernetics, Kiev, Ukraine 2Taras Shevchenko National University, Applied statistics, Kiev, Ukraine 3Medical Center of primary aid, Shepetovka, Ukraine Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Background: Advanced electrocardiogram and heart rate variability (HRV) and analysis is still one of the most promising instruments in several aspects of preventive cardiology. The main purpose of this work is to multidimensional statistical analysis in order to build a regression model that will allow to evaluate the impact of the socio-economic environment on the highest possible amount of ECG/HRV variables. Methods: Mass screening using ECG and HRV examination was carried out in 18 rural districts of Khmelnitsky region. In total, more than 22 thousand people were examined. In each district, there is a sample of local residents and 110 ECG and HRV indicators were known for each sample element. 81 digital socio-economic indicators for each district were known as well. In addition, an “etalon" group, consisted of 1069 young healthy volunteers underwent ECG/HRV examinations, was collected and analyzed. For each district, the Mahalanobis distance was calculated, between the “etalon" sample and the sample of residents of the district. This integral indicator characterizes the degree of deviation each district sample from the “etalon" sample. Further, a regression model of exponential type was proposed, to describe the impact of the socio-economic environment. In this model, as the resulting variable is the normalized Mahalonobis distance between samples. The explanatory variables are the principal components, calculated on socio-economic factors based on spectral analysis of corresponding correlation matrix. The selection of the number of principal components is determined by their total information content and the number of observations. Results: It is found, that four principal components contain almost 70% of the information of the socio-economic environment. The most valuable socio-economic indicators were number of number of pensioners, yearly income and peopleã s access to housing. Conclusion : The proposed multidimensional analysis of mass screening results seems to be useful approach in order to define the most important socio-economic indicators 93 https://esc365.escardio.org/Presentation/217126/abstract Underuse of lipid lowering drugs in diabetic patients : An analysis of EPHESUS study O Ozcan Basaran1, V Dogan2, B Ozlek1, E Ozlek1, O Celik1, C Cil1, IH Ozdemir3, I Rencuzogullari4, FA Karadeniz5, M Tekinalp6, L Askin7, S Demirelli5, E Gencer8, M Biteker2, M Kayikcioglu9 1Mugla Sitki Kocman Training and Research Hospital, Mugla, Turkey 2Sitki Kof#x000F5;man Universty- School of Medicine, Cardiology, Mugla, Turkey 3Nizip State Hospital, Cardiology, Nizip, Turkey 4Kafkas University, Kars, Turkey 5Regional Training and Research Hospital, Erzurum, Turkey 6Necip Fazil State Hospital, Kahramanmaras, Turkey 7Adiyaman University, Adiyaman, Turkey 8Kilis State Hospital, Kilis, Turkey 9Ege University, Izmir, Turkey On Behalf of: Ephesus Funding Acknowledgements: None Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Background: The risk of cardiovascular disease (CVD) is increased in patients with diabetes and the latest European Society of Cardiology (ESC) guidelines on diabetes and dyslipidemias have classified patients with diabetes into three risk categories. In this post-hoc analysis of Evaluation of Perceptions, Knowledge and Compliance with tHE Guidelines for Secondary Prevention in Real Life Practice: A survey on the Under-treatment of HypercholeSterolemia (EPHESUS) study we aimed to investigate the use of lipid lowering drugs (LLD) and goal attainment across different risk categories in diabetic patients. Methods: Patients with CVD or at risk of CVD were evaluated by a survey in EPHESUS study. Diabetic patients were included and divided into four groups according to risk level; moderate risk (no risk factors for CVD), high risk (risk factor(s) for CVD), very high risk (three or more risk factors for CVD), and very high risk CVD (diabetes and CVD) for the present analysis. Past medical history, demographic characteristics and use of LLD were noted. Cholesterol levels and target attainment of those groups were than compared. Results: Of the 873 patients 24 were at moderate risk, 188 were at high risk, 90 were at very high risk and 571 were at very high risk with CVD. Older patients were at higher risk and most of the patients in high and very high risk groups were female (Table 1). Statin use in moderate, high, very high and very high with CVD groups were 3 (12.5%), 52 (27.7%), 37 (41.1%), 378 (66.2%) respectively (p<0.001). None of our patients were on ezetimibe. Goal attainment for LDL-C according to 2019 ESC guidelines and the impact of LLD on LDL-C were summarized in Figure 1. Conclusion: The control of dyslipidemia was poor in patients with diabetes and even poorer in patients with risk factors. A special attention should be given to patients with diabetes and established CVD but our study revealed there was a big gap between guidelines and real-life practice. There is a clear need for better implementation of guidelines in terms of use of higher doses of statins and also non-statin therapies in patients with diabetes to reach targets. Moderate risk n=24 (2.7%) High risk n=188 (21.5%) Very high risk n=90 (10.3%) Very high risk with CVD n=571 (65.4%) p Age, median (Qs) 51 (45-55) 57 (50-63) 66 (59-71) 64 (56-76) <0.001 Female, n (%) 10 (41.7) 127 (67.6) 67 (74.4) 221 (38.7) <0.001 Non-HDL-C, median (Qs) 161 (148-181) 164 (133-189) 190 (158-225) 142 (107-178) <0.001 TRG, median (Qs) 153 (126-250) 172 (125-226) 184 (131-243) 157 (119-216) 0.045 Moderate risk n=24 (2.7%) High risk n=188 (21.5%) Very high risk n=90 (10.3%) Very high risk with CVD n=571 (65.4%) p Age, median (Qs) 51 (45-55) 57 (50-63) 66 (59-71) 64 (56-76) <0.001 Female, n (%) 10 (41.7) 127 (67.6) 67 (74.4) 221 (38.7) <0.001 Non-HDL-C, median (Qs) 161 (148-181) 164 (133-189) 190 (158-225) 142 (107-178) <0.001 TRG, median (Qs) 153 (126-250) 172 (125-226) 184 (131-243) 157 (119-216) 0.045 Abbreviations: CVD; Cardiovascular disease, non-HDL-C; non high density lipoprotein, Qs; 25th-75th quartiles, TRG; triglycerides Open in new tab Moderate risk n=24 (2.7%) High risk n=188 (21.5%) Very high risk n=90 (10.3%) Very high risk with CVD n=571 (65.4%) p Age, median (Qs) 51 (45-55) 57 (50-63) 66 (59-71) 64 (56-76) <0.001 Female, n (%) 10 (41.7) 127 (67.6) 67 (74.4) 221 (38.7) <0.001 Non-HDL-C, median (Qs) 161 (148-181) 164 (133-189) 190 (158-225) 142 (107-178) <0.001 TRG, median (Qs) 153 (126-250) 172 (125-226) 184 (131-243) 157 (119-216) 0.045 Moderate risk n=24 (2.7%) High risk n=188 (21.5%) Very high risk n=90 (10.3%) Very high risk with CVD n=571 (65.4%) p Age, median (Qs) 51 (45-55) 57 (50-63) 66 (59-71) 64 (56-76) <0.001 Female, n (%) 10 (41.7) 127 (67.6) 67 (74.4) 221 (38.7) <0.001 Non-HDL-C, median (Qs) 161 (148-181) 164 (133-189) 190 (158-225) 142 (107-178) <0.001 TRG, median (Qs) 153 (126-250) 172 (125-226) 184 (131-243) 157 (119-216) 0.045 Abbreviations: CVD; Cardiovascular disease, non-HDL-C; non high density lipoprotein, Qs; 25th-75th quartiles, TRG; triglycerides Open in new tab Figure 1 P114 https://esc365.escardio.org/Presentation/217078/abstract Method for the diagnosis of masked hypertension in ambulatory patients Y Yana Koshelyaevskaya1, M Smirnova1, V Gorbunov1, A Deev1, N Furman2, P Dolotovskaya2 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation 2Saratov State Medical University, Saratov, Russian Federation Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Objective: The masked hypertension (MHT) is associated with the risk of adverse outcomes. Aim: The aim of our study was to create the mathematical model (MM) to estimate the risk of MH among patients with clinical blood pressure (CBP) < 140/90 mm Hg. Design and methods: The patients from the ambulatory BP monitoring database (ABPM; n>2000) were selected according to the following criteria: age 40-77 years, absence of diagnosis of hypertension and any antihypertensive treatment, CBP < 140/90 mm Hg, medical history and anthropometry data, ABPM data and CBP measurements initially and after 6 months. The standard statistical methods and multivariate analysis were used for search factors, associated with reproducible phenotype MH. The MM was developed based on the parameters logistic regression (p <0.05) Results: 306 patients were selected: age 48.5±6.8 years, 33.9% of men, BMI 27.7±4.3 kg/m², CBP 125.6±10.4/78.1±7.8 mm Hg, CBP in orthostasis (ort) 125.9±11.0/80.1±8.6 mm Hg, Hrort 76.0±10.0 bpm. Reproducibility of MH ã 35.8%. In a multivariate analysis of the issue of reproduced phenotypes, the four parameters (BMI, Diastolic CBP [CDBP], Orthostasys Systolic BP and HR) indicated in the description of the formula turned out to be positively interconnected with the MH (p <0.0001). Then, from the data of multivariate analysis, the formula presented in the MM was compiled and the criterial value of the coefficient of MH (CMH) was determined, which determines the indications for the appointment of BPM. CMH=2.097*cBMI+2.152*cCDBP+1.031*cSBPort+0.773*cHrort-1.052, cBMI=0, if BMI<26.4, else cBMI=0; cCDBP=0, if CDBP<76, else cCDBP=1; cSBPort=0, if SBPort<=123, else cSBPort=0=1; cHRort=0, if HRort<79, else cHRort=1. If CMH>=1.94, we can suspect high risk (more than 88%) of MH. Testing the developed MM in a sample of 355 patients showed a sensitivity of 90.1%, specificity - 41.3%. Conclusions: Moreover, MM allows to suspect MH, including in the daytime (for example, during the working hours) and at night; indicators used in it are easily determined at a routine reception in a short time; Calculation of CMH does not require complex mathematical calculations, so it can be use in routine medical practice. P190 https://esc365.escardio.org/Presentation/217119/abstract The role of 24 hour central aortic pressure in ventriculo-arterial coupling in asymptomatic hypertensive patients N Neli Georgieva1, A Borizanova - Petkova1, B Krastev1, E Kinova1, A Goudev1 1University Hospital Tsaritsa Yoanna, Sofia, Bulgaria Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Background: The 24-hour central aortic pressure is an early predictor of cardiovascular complications in hypertension. However, the association between arterial stiffness and left ventricular dysfunction is poorly understood. PURPOSE: To assess 24 hour monitoring of parameters of arterial stiffness and their relation with ventriculo ã arterial coupling (VAC). METHODS: A total 95 consecutive patients with hypertension adapted by age, gender and BMI, were separated in two groups: 22 patients with normal VAC and 73 hypertensive patients with disturbed VAC, measured by arterial elastance/ventricular elastance ratio. All patients underwent standard two - dimentional echocardiography with Speckle tracking analysis for left ventricle (LV) global longitudinal strain (GLS). End ã systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and ã systolic pressure/stroke volume and end ã systolic pressure/end ã systolic volume. Parameters for arterial stiffness ã 24 - hour central systolic pressure (cSys24h), central pulse pressure (cPP24h), augmentation index 24h (Aix24h) and 24 - hour pulse wave velocity (PWV24h) were measured non ã invasively with oscillometric method by Mobil-O-graph PWA. RESULTS: Statistically significant differences in parameters of vascular stiffness were found in patients with normal EA/Ees ratio in comparison decreased EA/Ees (table 1). There were no statistically significant differences in PWV24h and Aix24h between two groups. There are negative correlation between cSys24h and EA/Ees (r = -0.218, p= 0.033) and moderate positively with AE (r=0.351, p< 0.0001). cPP24h correlate positively with Ees (r = 0.224, p= 0.029) and with E/Em (r = 225, p = 0.028). CONCLUSION: The 24 hour central aortic pressure determines early alterations in LV function in asymptomatic hypertensive patients. Further investigations could open new opportunities for prevention and treatment of early LV dysfunction in this group. PARAMETERS Normal VAC n: 22 Disturbed VAC n: 73 P value cSys24h, (mm Hg) 107.63 ± 9.18 116.34 ± 16.73 0.02 cPP24h (mmHg) 40.22 ± 11.83 48.07 ± 10.51 0.04 E/Em ratio 9.64±3.16 10.91±2.38 0.04 LV - GLS, (%) -17.83±0.91 -15.62±1.5 0.0001 Arterial Elastance(AE) 2.07±0.55 1.87±0.29 0.002 Ventricular Elastance(Ees) 2.96±0.75 4.15±0.97 0.0001 AE/Ees ratio (VAC) 0.73±0.27 0.46±0.8 0.0001 PARAMETERS Normal VAC n: 22 Disturbed VAC n: 73 P value cSys24h, (mm Hg) 107.63 ± 9.18 116.34 ± 16.73 0.02 cPP24h (mmHg) 40.22 ± 11.83 48.07 ± 10.51 0.04 E/Em ratio 9.64±3.16 10.91±2.38 0.04 LV - GLS, (%) -17.83±0.91 -15.62±1.5 0.0001 Arterial Elastance(AE) 2.07±0.55 1.87±0.29 0.002 Ventricular Elastance(Ees) 2.96±0.75 4.15±0.97 0.0001 AE/Ees ratio (VAC) 0.73±0.27 0.46±0.8 0.0001 Open in new tab PARAMETERS Normal VAC n: 22 Disturbed VAC n: 73 P value cSys24h, (mm Hg) 107.63 ± 9.18 116.34 ± 16.73 0.02 cPP24h (mmHg) 40.22 ± 11.83 48.07 ± 10.51 0.04 E/Em ratio 9.64±3.16 10.91±2.38 0.04 LV - GLS, (%) -17.83±0.91 -15.62±1.5 0.0001 Arterial Elastance(AE) 2.07±0.55 1.87±0.29 0.002 Ventricular Elastance(Ees) 2.96±0.75 4.15±0.97 0.0001 AE/Ees ratio (VAC) 0.73±0.27 0.46±0.8 0.0001 PARAMETERS Normal VAC n: 22 Disturbed VAC n: 73 P value cSys24h, (mm Hg) 107.63 ± 9.18 116.34 ± 16.73 0.02 cPP24h (mmHg) 40.22 ± 11.83 48.07 ± 10.51 0.04 E/Em ratio 9.64±3.16 10.91±2.38 0.04 LV - GLS, (%) -17.83±0.91 -15.62±1.5 0.0001 Arterial Elastance(AE) 2.07±0.55 1.87±0.29 0.002 Ventricular Elastance(Ees) 2.96±0.75 4.15±0.97 0.0001 AE/Ees ratio (VAC) 0.73±0.27 0.46±0.8 0.0001 Open in new tab P191 https://esc365.escardio.org/Presentation/217319/abstract Association of characteristics of vascular control and A1666C A>C polymorphism in the angiotensin 1 receptors gene, T207M C>T polymorphism in the angiotensinogen gene in young individuals AYE Elkina1, NSA Akimova1, YGS Shvarts1 1Saratov State Medical University, Faculty therapy department, Saratov, Russian Federation Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Introduction: Vascular control (VC) disorder significantly impairs quality of life and is one of the cardiovascular risk factors and may be a predictor of the development of sustained hypertension. Obviously, the detection of pre-clinical stages of vascular malformations has potential. From this standpoint, one of the directions can be gene identification, which mutations predispose to the development of vascular control disorder. Purpose: To study the relationship of polymorphism A1666C A>C of the AGTR1 gene, polymorphism T207M C>T in the AGT gene and Vascular control parameters (blood pressure −BP and heart rate −HR) when performing an orthostatic test in young individuals. Subjects and methods. The study involved 75 relatively healthy Caucasian volunteers aged 20-25 years, after receiving their informed consent. The study was performed in accordance with the declaration of Helsinki. The study protocol was approved by Local Ethics Committee of our Medical University. The exclusion criterion was the presence of cardiovascular and central nervous pathologies. Vascular control was assessed by conducting an active orthostatic test. Identification of gene polymorphism was carried out by the method of deoxyribonucleic acid pyrosequencing. Results: Persons with the presence of the risk C allele of the A1666C A>C polymorphism in the AGTR1 gene have a lower heart rate in the supine position. The pulse pressure (PP) of these persons in the first minute after standing up remained at higher values. The highest levels of PP in the first minute as well as heart rate were observed in individuals whose genotype simultaneously contains the risk allele in the A1666C A>C polymorphism in the AGTR1 gene and T207M C>T polymorphism in the AGT gene. After 1 min of orthostasis in individuals carrying the mutant allele in the A1666C A>C polymorphism in the AGTR1 gene diastolic blood pressure (DBP) increased lesser, and the pulse pressure decreased “weaker" in relation to the initial values. The presence of the M268T T>C polymorphism in the AGT gene in the genotype was associated with a less high systolic blood pressure (SBP) at the first minute of orthostasis, as well as a less significant increase in DBP. Conclusion: Simultaneous presence of the C allele of the A1666C polymorphism in the AGTR1 gene and C allele of the T207M C>T polymorphism in the AGT gene is associated with much higher levels of PP and heart rate in orthostasis, what can be considered from cardiovascular risk standpoint and may be a predictor of early development of hypertension. P193 https://esc365.escardio.org/Presentation/217610/abstract Blood pressure level, vascular microinflammation and carotid wall remodeling YB Khovaeva1, L Ermachkova1, AP Shavrin1, BV Golovskoy1 1E.A.Vagner Perm State Medical University, Perm, Russian Federation Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Purpose: To determine the carotid intimae-media thickness (IMT) and inflammatory markers in healthy subjects with different levels of BP. Methods: 194 subjects (93 men, 101 women, average age 43.2±0.9) were split into 5 groups according to the BP level. Group 1 - 35 subjects with BP level <110/70 mm Hg, group 2 - 41 subjects with BP level 110/70 ã 119/79 mm Hg, group 3 – 41 subjects with BP 120/80-129/84 mm Hg, group 4 – 39 subjects with high normal BP (130/85 – 139/89 mm Hg), and group 5 consisted of 38 subjects with BP ≥140/90 mm Hg. Groups were matched in age and sex (p>0.05). The carotid IMT was determined by ultrasonic scanning (Vivid 7, GE, Germany). The levels of high-sensitivity C-reactive protein (hsCRP) and cytokines: tumor necrosis factor alpha (TNF-α), interleukins (IL) -1, -8 were studied by enzyme immunoassay test systems (SeroELISA, DSL, USA). Results: There was no difference in IMT in groups 1-3 (p>0.05), but in groups 4 and 5 its value differed significantly (p1,2,3-4,5=0.01-0.001). The significant difference in hsCRP and proinflammatory cytokines' levels was detected between groups 1,2,3 and 4,5 (p1,2,3-4,5=0.01-0.001). In groups 4 and 5 correlation analysis revealed a direct link between systolic BP and hsCRP (r=0.49-0.57, p=0.02-0.01), and between IMT and hsCRP, IL-1, IL-8, TNF-α (r=0.37-0.65, p=0.04-0.01). Conclusions: The IMT increase was associated with BP level and proinflammatory cytokines' concentrations. The vascular wall remodeling accompanied by vascular microinflammation was noted in subjects with high normal BP as well as in patients with arterial hypertension. P197 https://esc365.escardio.org/Presentation/217621/abstract Relationships of total testosterone levels with traditional cardiovascular risk factors in healthy middle-aged men N Nataliya Lebedeva1, VV Gofman2 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation 21Federal State Public Healthcare Institution ã Federal Rescue Service of the Ministry of Internal Aff, Kemerovo, Russian Federation Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Aim: To evaluate the relationships of total testosterone levels with elevated cardiovascular risk factors in men aged over 40 years old without prior cardiovascular disease. Methods: 200 male patients aged 44-60 years old (the mean age of 48.44 (45.2; 52.4) years), who underwent routine medical examination at the Federal State Public Healthcare Institution were included in the study. In addition to the clinical and instrumental examination, the international index of erectile function (IIEF-5) was calculated. Total testosterone levels were measured with ELISA using the enzyme-linked immunosorbent analyzer Evolis Twin Plus. Patients with known cardiovascular disease, endocrine disease, mental disorders, chronic somatic diseases were excluded from the study. Results: All the patients were stratified into the SCORE risk groups: low (n=45 (22.5%), moderate (n=145 (17.5%), high (n=9 (4.5%) and very high risk (n=1 (0.5%). After adjustment to the additional cardiovascular risk factors (metabolic syndrome, GFR <60 mL/min, high total cholesterol (>8 mmol/L), the presence of extracranial artery plaques), 35 (17.5%) patients remained in the low risk group, 93 (46.5%) patients had moderate risk, 71 (35.5%) were of high risk, and one patient (0.5%) had very high risk. 98 (49%) men had total testosterone levels below 12 nmol/mL. Of them, 42 (42.8%) patients suffered from decreased libido and had erectile dysfunction of varying severity. High-risk patients were more often present with clinical signs of androgen deficiency than low-risk patients (52.1% vs. 14.3%, respectively (p = 0.002). The mean total testosterone level was higher in the low-risk group compared with the high-risk group (22.95 ± 9.40 nmol/mL vs. 14.78 ± 2.49 nmol/mL, respectively (p = 0.025). Conclusion: Half of middle-aged male patients without cardiovascular disease had elevated or high cardiovascular risk associated with a more pronounced decrease in total testosterone levels compared with low-risk male patients. P198 https://esc365.escardio.org/Presentation/217320/abstract Associations of characteristics of vascular control and -482 C>T polymorphism in the apolipoprotein C3 gene, L55M A>T polymorphism in the paraoxonase-1 gene in young, relatively healthy individuals AYE Elkina1, N Natalia Akimova1, YGS Shvarts1 1Saratov State Medical University, Faculty therapy department, Saratov, Russian Federation Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Introduction: Vascular control disorder (VC) significantly impairs quality of life and is one of the cardiovascular risk factors and may be a predictor of the development of sustained hypertension. Obviously, the detection of pre-clinical stages of vascular malformations has potential. From this standpoint, one of the directions can be identification of genes, which mutations predispose to the development of vascular control disorder. Formation of VC is associated with multiple affections on vessel wall, as well as the state of lipid exchange. However, contribution of genes involved in lipid exchange is rather small, but corresponds with the polygenetic nature of VC formation and arterial pressure (AP). Purpose: To study the relationship of polymorphism -482 C>T in the APOC3 gene, polymorphism L55M A>T in the PON1 gene and Vascular control parameters (blood pressure −BP and heart rate −HR) when performing an orthostatic test in young individuals. Subjects and methods. The study involved 75 relatively healthy Caucasian volunteers aged 20-25 years, after receiving their informed consent. The study was performed in accordance with the declaration of Helsinki. The study protocol was approved by Local Ethics Committee of our Medical University. The exclusion criterion was the presence of cardiovascular and central nervous pathologies. Vascular control was assessed by conducting an active orthostatic test. Identification of gene polymorphism was carried out by the method of deoxyribonucleic acid pyrosequencing. Results: Persons whose genotype contains the T allele of the L55M A>T polymorphism in the PON1 gene had a lower SBD and PP in the supine position. The presence in the genotype of the T allele of the -482 C>T polymorphism in the APOC3 gene is associated with lower rates of DBP in the supine position and SBP on the first minute after standing up. Also these individuals showed a more pronounced heart rate increase after standing up. Conclusions: According to orthostatic test, young individuals with the A allele of the L55M A>T polymorphism in the PON1 gene, as well as persons with the T allele of the -482 C>T polymorphism in the APOC3 gene have greater cardiovascular risk compared to those having the risk alleles of studied polymorphic genetic variations, hence they may have higher probability of early development of hypertension. P199 https://esc365.escardio.org/Presentation/217390/abstract Unmasking the hidden morbidity of CVD in primary care for rural and isolated populations M Maria Antonopoulou1, K Chliveros2 1Spili Health Center, Rethymno, Greece 2University of the Mountains, Heraklion, Greece Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Background: CVD prevalence is considered to be relative low for Greek general population, classifying Greece in low risk countries, according to SCORE Risk Charts. However, dramatically lifestyle changes of the recent decades, as well as the ongoing financial crisis, induced important but still obscure rise in CHD, even in rural areas where the traditionally healthy habits like Mediterranean diet has been gradually and conclusively abandoned. Primary care as the site of the first and essential contact of patients, may determinately contribute in unmasking unknown cases of CVD. Purpose: We conducted a population-based cohort study to assess the cardiovascular risk factors of local residents in rural and isolated populations and the associated CVD burden. Methods: In order to identify individuals at high risk for CHD, we organized integrated interventions at small and isolated communities. Public awareness for cardiovascular risk factors was proceeded, through guided lectures using video projections in gathering halls. Then we called the audience to be evaluated and further investigated in local GPs offices. For persons aged ≥40 years their SCORE was calculated based on gender, age, total cholesterol, systolic blood pressure and smoking status. Personal and family history of CVD and other comorbidity was also collected, in regards for signs of depression and dementia, by using standardized questionnaires for primary care (Mini Mental State Examination and Geriatric Depression Scale). Results: Of the first cohort of 148 individuals, permanent inhabitants (94 women, mean age 65.5 years) high risk for CVD according to SCORE (Score >5%, defined as high and very high risk) was found in 80 (54.5 %) patients. Current smokers were 21%, while 29% had diabetes. 63 (42,6%) of them had been evaluated thoroughly for CVD due to multiple risk factors, mainly hypertension and dyslipidemia, but only 10 of them reported a major cardiovascular event. Office BP measurements were higher than 140/90 in 62 patients- 10 of them were not treated for hypertension-. LDL treatment goals levels were not achieved in 26 of them, according to ESC Guidelines. Depression appeared to be higher in female patients with known CVD, while memory disorders were associated with the co-existence of multiple CVD factors. Conclusions: The preliminary findings of this ongoing study suggesting that social isolation is associated with a high CVD risk in rural populations, make community-based primary care interventions crucial to reduce the CVD burden in otherwise “healthy" individuals. P200 https://esc365.escardio.org/Presentation/217022/abstract Can being overweight be beneficial? An association of asian body mass index and severity outcomes of coronaryangiogram J Jastisse Arnaldo Tejada1 1Mary Mediatrix Medical Center, Batangas, Philippines Funding Acknowledgements: None Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Background: Obesity is considered as an independent risk factor for cardiovascular diseases (CVD) being the top leading cause of mortality in the Philippines. Several studies demonstrated the significance of the ã obesity paradoxã in the outcome of coronary artery disease (CAD) severity. This study aims to determine the association of BMI and CAD. This local study will provide information on the relationship of BMI and CAD severity among the Asian population. Compared with previous studies done in relation with Obesity Paradox, “Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Purpose: CAD is the leading cause of morbidity and mortality globally. This local study will provide information on the relationship of BMI and CAD severity among the Filipino population. Methods: This is a retrospective cross-sectional study among adult Filipino patients from the from 2015 to 2017. Review of records of the baseline characteristics, BMI category for Asians and CAD severity outcomes were collected. Descriptive analysis of the baseline profile was determined using the frequency and percentage for categorical variables and mean and standard deviation was used to describe the BMI and age. Chi square test, and multiple logistic regression analysis were used to determine the association between BMI and CAD severity. Results There were 335 patients that underwent a coronary angiogram within the period of 2015 to 2017. The mean age was 63.84 (SD 10.17) and 68.7% were males. The mean BMI was 25.73 (SD 4.13). There were 37.9% smokers, 64.8% hypertensive and 34.3% diabetic. There were 38% with obese 1 BMI and 49% have CAD. Using multiple logistic regression analysis, age, smoking, hypertension, diabetes mellitus and BMI were significantly associated with CAD with p-value of less than 0.05. Overweight patients were 4 times more likely to have severe CAD, Obese 1 were 8 times more likely to have severe CAD, while obese 2 were 11 times more likely to have severe CAD as compared to normal BMI. Conclusions: As the BMI category increases the risk of CAD severity double. The finding ã obesity paradoxã is not applicable in the country. The results of this study are comparable with the Philippine Heart Association Acute Coronary Syndrome(PHA-ACS) Filipino registry wherein more males had CAD as compared to females, the majority were 60 years and above, overweight and obesity were likely to have severe CAD. P201 https://esc365.escardio.org/Presentation/217021/abstract Aviation cardiology: how to overcome age limitations of air transport pilots? - A cardiovascular risk assessment concept R Rene Maire1, R Simons2 1Cardiological Practice, Maennedorf, Switzerland 2Netherlands Organization for Applied Scientific Research TNO, Soesterberg, Netherlands (The) On Behalf of: Netherlands Organization for Applied Scientific Research TNO (the Netherlands) Funding Acknowledgements: Direct Contract EASA.2017.C29/Commitment Number: 500009009 (EASA = European Union Aviation Safety Agency) Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Introduction: Single pilot commercial air transport (CAT) operations by pilots aged over 60 years are prohibited by the European Union Aviation Safety Agency (EASA) in line with the International Civil Aviation Organization (ICAO). It is widely recognised that there should be an attenuation of this strict age rule. Purpose: EASA launched a study aimed at establishing scientific data which might enable mitigation of the risk of sudden in-flight incapacitation of pilots by systematic cardiovascular health screening rather than by an age limit. Methods: In a first stage of risk stratification of age-dependent cardiovascular diseases (CVD) specific risk estimation tools are used. The various widely applied CVD risk estimators were analysed with regard to its accuracy to distinguish low, intermediate, and high risk conditions. Pilots with an elevated CVD risk need a cardiological examination for enhanced risk assessment, whereby modern cardiological techniques are used like CT coronary angiography (CTCA), single positron emission tomography, coronary angiography. Available methods were analysed based on the following criteria: soundness of scientific basis, clarity and scientific justification of decision criteria, practicality, and cost-effectiveness. Results: The best risk estimation tool is the one which is based on a derivation cohort that is representative for the national health status, which uses risk factors that are considered to be crucial, which has a good discriminatory power, and which predicts the risk for a relevant outcome and endpoint (i.e. fatal and non-fatal CVD, stroke). For the interpretation of the results of applied enhanced cardiovascular techniques a flow chart was developed, which is aimed to support the aeromedical examiner in the process of deciding about a pilotã s fitness to fly. CTCA came out as a preferred method for enhanced risk assessment. Conclusions: 1) The correct application of cardiovascular risk scores and enhanced cardiovascular methods allows an adequate distinction of the sudden incapacitation risk in pilots aged 60+. 2) CTCA plays an important role in this risk stratification cascade. 3) The proposed concept would allow for an extension of the age limit for single flying CAT pilots over the age 60. P520 https://esc365.escardio.org/Presentation/217087/abstract Practice of Moroccan cardiologists in cardiovascular prevention: a national survey N Mouine1, N El Malki Berrada1, M Alami2 1Military Hospital Mohammed V, cardiac rehabilitation unit, cardiology centre , Rabat, Morocco 2private practice cardiology, casablanca, Morocco Topic: Risk Factors and Prevention – Cardiovascular Risk Assessment Introduction: Cardio vascular prevention is very important to reduce cardio vascular risk factors and cardio vascular events; the aim of the survey is to evaluate the interest of cardiologists in cardio vascular prevention Materials and Methods: We realize a survey designed to cardiologists, it's about their specialty interest, their role to reducing cardio vascular mortality, the role of cardiac rehabilitation, routine examination, the time dedicate to patients, the steps to take for changing lifestyle and education program Results: it was 112 cardiologists who participated to survey, only 30 % of cardiologists have chosen prevention and cardiac rehabilitation in their top 3 fiels of interest meanwhile 51% of cardiologists selected Echocardiography and Cardiac imaging , 62% of cardiologists propose to educate more their patients at the risk and giving more time to explain it; 73% of cardiologists confirm that cardiac rehabilitation reduce morbi mortality, for monitoring of patients, 57% of cardiologists control every 3mounth their patients; for treatment adherence, 94% of cardiologists consider patient compliant when he take 80% of his medication Conclusion: This survey shows that cardiologists are poorly interested in cardio vascular prevention and dedicate little time for patient 'education. Further survey should focus on how to make cardiologists more involved in preventing cardiovascular diseases. 650 https://esc365.escardio.org/Presentation/221653/abstract A validated non-clinical alternative for established CVD risk scores C Schiborn1, T Kuehn2, K Muehlenbruch1, O Kuxhaus1, C Weikert3, A Fritsche4, R Kaaks2, MB Schulze1 1The German Institute of Human Nutrition, Molecular Epidemiology, Potsdam, Germany 2German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg, Germany 3German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany 4Eberhard-Karls University of Tubingen, Department of Internal Medicine, Tuebingen, Germany Funding Acknowledgements: Grant from the German Federal Ministry of Education and Research and the State of Brandenburg to the German Center for Diabetes Research (82DZD00302) Topic: Prevention – Cardiovascular Risk Assessment: Scores An abundance of prognostic risk scores is available to estimate individual cardiovascular disease (CVD) risk. However, most of these models include clinical parameters limiting the application to settings where this information is accessible. The German Diabetes Risk Score (GDRS) has been developed to predict an individualã s 5-year risk for type 2 diabetes. It is based on a two stage approach with an initial non-clinical version and a clinical extension. As type 2 diabetes and CVD share many risk factors, a score based on a shared risk factor set would facilitate risk assessment of the two cardiometabolic diseases in physician-independent and clinical settings. The aim of the project was to develop and externally validate a non-clinical 10 year CVD risk score with a clinical extension in German adults, based on the predictor set of the GDRS and to compare the performance to established CVD risk scores. We defined CVD as non-fatal and fatal myocardial infarction and stroke and used data of the EPIC Potsdam cohort (n=25,992 cases=683) to derive the scores. Associations between different predictor sets and CVD were estimated using Cox proportional hazards regression. Predictors were selected based on the following criteria: improvement of performance, assumed availability in physician-independent settings or routine care, consistency of the estimate with previous evidence and robustness of the association. Performance of the scores was assessed in the EPIC Potsdam and EPIC Heidelberg (n=23,544 cases=696) cohorts and compared among others to the Pooled Cohort Equation (PCE). Discrimination was examined by calculating Harrellã s C-index and calibration by calibration plots grouped by deciles of predicted risk and expected-to-observed (EO) ratios. The non-clinical score included age, gender, waist circumference, smoking, hypertension, diabetes, family history of CVD and intake of whole grains, red meat, coffee, soft drinks and plant oil; the clinical score additionally contained diastolic and systolic blood pressure, total and HDL cholesterol. C-index consistently indicated very good discrimination of the developed non-clinical score with only slight improvement when adding clinical parameters in EPIC Potsdam (non-clinical 0.793, 95%CI 0.743-0.839; clinical 0.802, 95%CI 0.752-0.847) and EPIC Heidelberg (non-clinical 0.766, 95%CI 0.718-0.811; clinical 0.773, 95%CI 0.725-0.817), which is comparable to established clinical risk scores. Calibration plots showed very good calibration. However, there was slight overestimation of risk in the highest group, supported by EO ratios (EPIC Heidelberg: non-clinical 1.07, 95%CI 1.00-1.16; clinical 1.26, 95%CI 1.17-1.36). We derived and externally validated a non-clinical 10-year CVD risk score with comparable discrimination and better suited calibration for the German general population than established clinical CVD risk scores, allowing risk assessment in settings where clinical measures are not readily available. Calibration plots and risk distributions P522 https://esc365.escardio.org/Presentation/221572/abstract Is unknown hyperglycemia recorded in cardiac rehabilitation predictive of very long-term mortality? SE Sergio Enea Masnaghetti1, S Sarzi Braga1, RFE Pedretti2, R Vaninetti1 1ICS Maugeri, Tradate, Italy 2Istituti Clinici Scientifici Maugeri IRCCS, Cardiology, Pavia, Italy Topic: Prevention – Cardiovascular Risk Assessment: Scores Background: although unknown hyperglycemia predicts poor outcome in many acute clinical settings, few data are available on its potential prognostic role in cardiac rehabilitation setting. In a retrospective study on 2490 consecutive patients, admitted from 2005 to 2009 for an in-hospital rehabilitation program, we reported that a single value of fasting glycemia exceeding 110 mg/dl in non-diabetic patients predicted longer hospital stay and higher risk of clinical complications in comparison to patients with normal fasting glycemia. A trend to higher, but not statistically significant after adjustment for covariates, mortality was also demonstrated Purpose: to evaluate the possible prognostic role of a single high glycemic value in non-diabetic patients admitted to an in-hospital cardiac rehabilitation program at long term follow up. Method: Single Centre retrospective study including 2490 patients admitted to cardiac rehabilitation program. Mean age 66.1 years, 68.5% males, 56.1% hypertensive, average BMI 25.6, mean left ventricular ejection fraction 51.8 ± 12.3%. Study end-point was death from any cause. Based on clinical history of diabetes and glycemic value detected at admission to hospital, according with diabetes guidelines, 3 patients groups were defined: Group 1: patients with no history of diabetes and a value of fasting glycemia ≤ 110 mg/dl or less [normal glucose regulation (NGR) ã n=1590 patients, 67%] Group 2: patients with no history of diabetes and a value of fasting glycemia > 110 mg/dl [altered fasting glycemia (AFG) ã n=252 patients, 11%] Group 3: patients with clinical history of diabetes or prediabetes (DM) ã n=522 patients, 22%. Mean follow up (evaluable in 95% patients was 11± 1.2 years. Results: after adjustment for covariates (age, gender, BMI, hypertension, ejection fraction and entry-diagnosis) mortality risk was significantly higher in AFG and DM patients compared with NGR patients OR=1.3 (IC95% 1.02-1.64) - p=0.03 and OR=1.8 (IC95% 1.53-2.13) - p<0.00 respectively (see figure). Other independent variables affecting mortality in this population were: cardiac surgery (p<0.00), and hemoglobin (p=0.008) which predicted a positive outcome while age at admission, smoking habit, ejection fraction, NYHA class, creatinine, former atrial fibrillation and the prescription of therapy for diabetes, anti-aggregating drugs or diuretics at discharge (p<0.05) predicted a negative outcome. Conclusion: in patients not known to be diabetic, the finding of hyperglycemia at admission to a cardiac rehabilitation program is an independent predictor of very long term mortality. Mortality curves are reported in Figure 1. Figure 1: survival curves P524 https://esc365.escardio.org/Presentation/217122/abstract The utility of cardiovascular risk scores in predicting the severity of coronary artery disease G Gaurav Arora1, R Varma1, J Kishore1, AH Ansari1, S Ahamad1, HS Isser1, S Bansal1, A Gupta1, D Bhasin1, S Agastam1, P Gupta1 1Safdarjung Hospital, New Delhi, India Funding Acknowledgements: None Topic: Prevention – Cardiovascular Risk Assessment: Scores Cardiovascular disease risk scores have been validated to predict the cardiovascular disease events. Little is known about their relation with severity of coronary artery disease. The aim of the study was to look into the correlation between the Framingham CVD , ASCVD , Qrisk2 and JBS 3 risk scores with Syntax score and the presence of triple vessel disease. Methods: This was a cross sectional study done over a period of six months in the Department of Cardiology of our Hospital. We enrolled 207 consecutive patients referred for coronary angiography after excluding severe valve disease, CKD (egfr<60ml/min), previous revascularization procedures (PTCA or cardiac surgery), congenital heart disease or those with normal coronary arteries. 159 patients presented with ACS and 58 had SIHD. We analysed the risk factors in these patients and calculated Framingham CVD , ASCVD , Qrisk2 and JBS 3 risk scores, assuming that they had come to us a day before for risk assessment. We calculated Syntax score from the coronary angiogram. Results: The mean age of patients was 53.88±9.42 years and 79% patients were men. Dyslipidemia was the most common risk factor seen in 86% patients, followed by smoking (70.3%) in men and hypertension (61.9%) in women. Low HDL(<40 mg% in men, <50 mg% in women) was the most common form of dyslipidemia in 59.9% patients, followed by high triglyceride (≥150 mg%) in 43.47% patients. Elevated TC (≥200 mg%) was there in 14.01% patients and elevated LDL (≥130mg%) was in 8.6% patients. Qrisk 2 score >23.3 best predicted Syntax score≥33 with (AUC=0.807; sens.=75%;spec.=76.3%). Also Qrisk 2 >23.3 best predicted the presence of triple vessel disease (AUC=0.707; sens.=62.5%; spec.=77.4%). ASCVD risk score and Framingham risk score did not predict the severity of coronary artery disease significantly. Conclusion: Qrisk 2 score best predicted the severity of coronary artery disease in our study population disease in south Asian population. Correlation of risk scores with SYNTAX score Risk score r P value* Qrisk 2 score 0.2049 0.0031 JBS 3 score 0.2355 0.001 Framingham CVD risk score 0.102 0.14 ASCVD risk score 0.17 0.08 * Spearman rank test Correlation of risk scores with SYNTAX score Risk score r P value* Qrisk 2 score 0.2049 0.0031 JBS 3 score 0.2355 0.001 Framingham CVD risk score 0.102 0.14 ASCVD risk score 0.17 0.08 * Spearman rank test There was a weak but significant correlation between Syntax score and Qrisk 2 (r=0.20 ,P<0.01) and JBS 3 risk scores (r=0.23, P=0.23). Open in new tab Correlation of risk scores with SYNTAX score Risk score r P value* Qrisk 2 score 0.2049 0.0031 JBS 3 score 0.2355 0.001 Framingham CVD risk score 0.102 0.14 ASCVD risk score 0.17 0.08 * Spearman rank test Correlation of risk scores with SYNTAX score Risk score r P value* Qrisk 2 score 0.2049 0.0031 JBS 3 score 0.2355 0.001 Framingham CVD risk score 0.102 0.14 ASCVD risk score 0.17 0.08 * Spearman rank test There was a weak but significant correlation between Syntax score and Qrisk 2 (r=0.20 ,P<0.01) and JBS 3 risk scores (r=0.23, P=0.23). Open in new tab Abstract No: P524 Reciever Operator Characteristic curves P525 https://esc365.escardio.org/Presentation/217382/abstract Summary 10-year risk of death from cardiovascular diseases in Russian men aged 25-64 years G Pushkarev1, V Kuznetsov1, A Lezhnyakova1, E Akimova1 1Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Scienc, Tomsk, Russian Federation Topic: Prevention – Cardiovascular Risk Assessment: Scores Purpose: To define total 10-year cardiovascular mortality risk in Russian males in dependence on conventional and psychosocial risk factors (RF) and to design the algorithm of its estimation. Methods: The study included non-organized population of Central Administrative district of our city. Epidemiological study, based on the representative selection of 1000 males aged 25-64 years, was conducted in 1996-1997. Screening respond was 79.5%. Cardiovascular mortality rate within 10 years was studied. Totally, 83 cases of cardiovascular death were registered in male cohort within 10 year observation. Cox proportional hazard model was applied to estimate correlation between RF and cardiovascular death rate. Relations between mortality rate and factors such as age, smoking, education, occupation, marital status, systolic and diastolic blood pressure (SBP and DBP), body mass index, total cholesterol, cholesterol of low and high density lipoproteins were analyzed. Results: To build a model of total cardiovascular risk, six statistically significant indicators were selected: age (hazard ratio ã 1.044, 95% confidence interval (CI) 1.018-1.071), DBP (1.043, 95% CI 1.008-1.080), total cholesterol (1.007, 95% CI 1.001-1.013), primary education (2.227, 95% CI 1.323-3.749), work associated with heavy physical labor (2.458, 95% CI 1.259-4.798), and single marital status (3.429, 95% CI 2.181-5.391). Based on these data, model for total cardiovascular mortality risk in males was designed with good predictive accuracy (AUC was 0.746). Conclusion: Thus, created mathematical model, built on the basis of statistically significant traditional and psychosocial RF, makes it possible to effectively predict the total cardiovascular risk at the individual level in the male population. P527 https://esc365.escardio.org/Presentation/217063/abstract Is PSI score useful to predict a cardiovascular event in acute Pneumonia? L Lucas Tojal Sierra1, I Juanes Dominguez1, J Poyo Molina2, MC Bello Mora1, AM Alonso Gomez1, MB Lahidalga Mugica2, JL Lobo Beristain2, JA Garcia-Fuertes2 1University Hospital of Araba, Cardiology, Vitoria, Spain 2University Hospital of Araba, Pneumology, Vitoria-Gasteiz, Spain Topic: Prevention – Cardiovascular Risk Assessment: Scores INTRODUCTION: Recently community acquired pneumonia (CAP) has been described as a risk factor to develop cardiovascular events. However, PSI score prognosis has not been properly validated to predict these events. PURPOSE: to analyze if PSI score is useful to detect patients with high risk to develop cardiovascular events during a year of follow up after CAP episode. MATERIALS AND METHODS: Retrospective study that includes patients with CAP admitted to Pneumology Service of our Hospital during 2017. Demographic variables, comorbidities, laboratory data and vital signs on admission were collected. Also were collected in 1 year of follow-up: mortality and cardiovascular event delovement (acute coronary syndrome with ST elevation and without ST elevation, atrial fibrillation / atrial flutter, heart failure, pulmonary thromboembolism and stroke). For the statistical analysis, Chi-Square test was used to compare qualitative variables and T-Student for quantitative variables. SPSS statistical package was used for statistical data management. RESULTS: 329 patients were included in the study with a medium age of 66 ±17.5 years, 38.9% women. Demographic data are collected in table 1. Previous cardiovascular disease can predict the development of a new cardiovascular event in a statistically significant way (p<0,001). Within comorbidities, only chronic kidney disease by itself was related to the event (p <0.001). A high PSI (³ 3) at the CAP episode was significant related to mortality and also to the development of any cardiovascular event during the year after admission (p <0.001). C-reactive protein (CRP) or Brain Natriuretic Peptide (BNP) are not significant related by themselves to cardiovascular event development. The association between PSI with either CRP or BNP or both, increased the possibility the appearance of a cardiovascular event (p <0.00001). CONCLUSIONS: 1, The PSI score predicts the development of cardiovascular events, in the studied population. 2, Neither BNP and CRP are independent cardiovascular events predictors in our study. 3, The association with admission to pneumonia, of BNP and / or PCR to the PSI scale, could be useful to identify patients with a higher risk of suffering cardiovascular events. table 1 P528 https://esc365.escardio.org/Presentation/221549/abstract Cardiovascular risk and vascular age in adults with schizophrenia compared to a healthy population according to physical, physiological, biochemical parameters: data from CORTEX-SP study M Tous-Espelosin1, N Iriarte2, A Martinezaguirre-Betolaza1, P Corres1, I Arratibel-Imaz1, P Sanchez2, A Ortiz De Zarate2, E Elizagarate2, C Pavon2, I Hervella2, N Ojeda3, A Sampedro3, J Pena3, N Ibarretxe-Bilbao3, S Maldonado-Martin1 1University of the Basque Country. Department of Physical Education and Sports., VITORIA-GASTEIZ, ARABA/ALAVA (BASQUE COUNTRY), Spain 2Osakidetza, Mental Health Service, Vitoria-Gasteiz, Spain 3University of Deusto, -Department of Methods and Experimental Psychology, Bilbao, Bizkaia, Basque Country, Spain Funding Acknowledgements: Insituto de Salud Carlos III. Ministerio de Economia y Competitividad. Gobierno de España Topic: Prevention – Cardiovascular Risk Assessment: Scores Background: People with schizophrenia (SP) show worse physical health and reduced life expectancy compared to the general population. The higher cardiovascular risk (CVR) mortality is associated to unhealthy lifestyles, including physical inactivity and tobacco use, social and economic factors and side effects of treatments. Purpose: To estimate CVR and vascular age profiles taking into account some key physical, physiological and biochemical markers of health status in adults with SP and compared them with a healthy sample. Methods: A total of 85 participants with SP (16.2% women, 42.1±10.0 yr old) were compared with 30 HEALTHY participants (60.0% women, 40.0±9.0 yr old). Body composition, blood pressure (BP) through ambulatory BP monitoring during 24h; cardiorespiratory fitness (CRF) with peak oxygen uptake (VO2peak) through cardiopulmonary exercise test, actigraphy-based sleep analysis, and fasting biochemical profile were assessed. Cardiovascular disease risk was calculated using Systematic Coronary Risk Estimation (SCORE), Framingham Risk Score-Cardiovascular Disease (FRS-CVD), relative risk SCORE and vascular age. Results: In body composition, SP showed overweight (body mass index=27.1±6.1 kg∙m-2), obesity (fat mass=26.8±10.4%) and high metabolic risk (waist circumference=95.1±13.4 cm), while HEALTHY were in normal values. Both groups presented normotensive BP values (SP=115/71 mmHg, HEALTHY=113/68 mmHg). Regarding CRF, lower (P<0.001) values were observed in SP (22.0±9.0 mL·kg-1·min-1) compared to HEALTHY (50.0±12.0 mL·kg-1·min-1). Although total sleep time in SP was longer (P<0.001) than HEALTHY (547.5±142.7 vs. 415.3±70.6 min), sleep efficiency (91.4±5.8 vs. 92.4±3.5 %) was similar (P=0.590) in both groups. Concerning biochemical profile, SP showed lower to optimal values in high-density lipoprotein cholesterol (HDL-C, 39.0±12.0 mg/dL), and upper to optimal values in low-density lipoprotein cholesterol (118.2±39.6 mg/dL), cholesterol ratio (total cholesterol, TC/HDL-C=5), and C-reactive protein (5.0±6.5 mg/L), whereas HEALTHY were in optimal values. Considering SCORE both groups were in low risk values with higher (P<0.001) values in SP (0.6±1.0 vs. 0.1±0.4). However, according to relative risk SCORE and FRS-CVD, SP showed medium risk (2.0±1.0; 6.7±12.3), and HEALTHY low (1.0±0.4; 2.6±2.8) risk, respectively. Vascular age was higher (P<0.001) in SP than HEALTHY (48.0±26.0 vs. 36.0±24.0 yr). Conclusion(s): Patients suffering from SP compared to HEALTHY showed higher CVR, and poorer physical, physiological and biochemical status. In consequence, SP could be classified as metabolically abnormal obese. These results strongly suggest the promotion of a healthy lifestyle behavior in order to optimize risk factors. 652 https://esc365.escardio.org/Presentation/217088/abstract Prediction of adverse cardiovascular outcomes in patients with hypertension in combination with chronic obstructive pulmonary disease A Anastasiia Melenevych1 1Kharkiv National Medical University, Kharkiv, Ukraine Topic: Prevention – Cardiovascular Risk Assessment: Biomarkers Background: Deterioration of patients with mild and moderate chronic obstructive pulmonary disease (COPD) is often associated with adverse cardiovascular events. Hypertension (HT) is the most common comorbid pathology in COPD patients, which has an adverse impact on future prognosis. Desaturation is considered as a predictor of adverse cardiovascular outcomes. Long-term maintenance of systemic inflammation is the basis of comorbidity progression. Understanding pathogenesis is the first step to improvement treatment and prevention measures. Purpose: to evaluate levels of proinflammatory interleukin (IL)-18 and anti-inflammatory IL-10 in patients with COPD in combination with HT depending on their clinical and functional state. Methods: In total, 69 COPD (GOLD 2, group B) patients in remission combined with HT stage II (57 males and 12 females) 55,80 ± 5,51 years old were monitored. Of these, 39 patients showed desaturation (decrease oxygen saturation (SpO2) more than 4% from baseline or below 90%) and exercise intolerance during the six-minute walking test (6MWT). IL-18 and IL-10 in the serum were determined by ELISA using a test system «Bender MedSystems, GmbH» (Austria). Pulse oximetry was performed on device «Heaco CMS 50C» (Great Britain). Echocardiography was performed on ultrasound device RADMIR Ultima PA (Ukraine). Results: Desaturation during physical activity is associated with an imbalance of inflammatory response with increasing proinflammatory IL-18 (3296,24 [2356,03; 3978,92] pg/ml; p<0,01) and decreasing anti-inflammatory IL-10 (61,12 [48,34; 79,63] pg/ml; p<0,01). Correlation analysis in COPD patients in combination with HT demonstrated a direct correlation between IL-18 and desaturation (r=0,41; p<0,05), an inverse correlation between IL-10 and desaturation (r=-0,44; p<0,05), IL-18 and IL-10 (r=-0,46; p<0,05). Comorbid patients with desaturation during the 6MWT showed significant (p<0,05) changes in the right heart chambers, indicating an increase in their overload. Moderate direct correlation between the results of the analysis of quality of life (QOL) and echocardiographic parameters of the right heart was established, which indicates a deterioration in QOL of patients with comorbid pathology with increasing signs of overload of the right heart. It was found that with the worsening of the clinical and functional state of patients with COPD in combination with HT (decline in exercise tolerance, increasing breathlessness and reduction in SpO2 after 6MWT; p<0,05) signs of diastolic dysfunction of the right ventricle increased. Conclusion: Imbalance of inflammatory response with increasing proinflammatory IL-18 and decreasing anti-inflammatory IL-10 associated with reduction in SpO2 during 6MWT more than 4% from baseline in patients with HT in combination with COPD. 653 https://esc365.escardio.org/Presentation/223123/abstract Screening for cardiac disease with advanced ECG, CTCA, protein biomarkers and metabolomics M Mark Bekhit1, C Dugo2, Y Wynne1, S Semple1, K Smith1, P Larsen2, P Shepherd3, E Zarate3, S Vilas-Boas3, T Schlegel4, P Gladding1 1Waitemata District Health Board, Auckland, New Zealand 2University of Otago, Dunedin, New Zealand 3The University of Auckland, Auckland, New Zealand 4Karolinska Institute, Stockholm, Sweden Topic: Prevention – Cardiovascular Risk Assessment: Biomarkers Introduction: Identifying patients with early stage cardiac disease with CT coronary angiography (CTCA) or novel biomarkers holds promise in the prevention of cardiovascular events. We undertook an exploratory study in patients undergoing CTCA to evaluate the diagnostic value of several novel low-cost methods, including advanced ECG (A-ECG) and metabolomics. Methods: 153 patients referred with chest pain underwent advanced 5-min A-ECG, CTCA, as well as hs-troponin, NT-proBNP testing and targeted plasma metabolomics using gas chromatography-mass spectrometry. A validated cardiac disease A-ECG score was calculated for each patient. Results were correlated with the presence of severe coronary artery disease (CAD) on CTCA, myocardial infarction from hospital admissions data, and measures of gender-specific left ventricular mass (LVmass) on CTCA. Severe CAD was defined as any obstructive coronary disease seen on CTCA. Segment involvement and segment severity scores were calculated from CT text reports using natural language processing. Results: 14 (9.2%) had mildly increased LVmass on CTCA which was associated with the segment involvement score (AUC 0.75, [0.613-0.871], P = 0.00006) and HbA1c (AUC 0.72, [0.577-0.852], P = 0.006), and discriminated by hs-troponin (AUC 0.66 [0.491-0.811], P = 0.18), 5-min A-ECG score for disease (AUC 0.68 [0.54-0.804], P = 0.004), inclusive of the spatial peaks QRS-T angle, and NT-proBNP (AUC 0.67 [0.47-0.841], P = 0.1). Severe CAD occurred in 39 (25.5%) and was associated with glycine (AUC 0.76 [0.657-0.839], P = 0.00001), aminomalonic acid (AUC 0.75 [0.658-0.838], P = 0.00003), serine (AUC 0.68 [0.571-0.769], P = 0.0006) and spatial peaks QRS-T Angle by Kors (AUC 0.65 [0.553-0.749], P = 0.03). Future myocardial Infarction occurred in 4 patients (2.6%) within 4 months of CTCA with citraconic acid (AUC 0.93 [0.878-0.977], P = 0.008), 5-min A-ECG score (AUC 0.91 [0.832-0.973], P = 0.002), hsTnI (AUC 0.90, [0.826-0.963], P = 0.10) providing the best discrimination. Conclusion: Novel biomarkers such as A-ECG and metabolomics have significant potential in the identification of mild and severe cardiovascular disease processes. Of these aminomalonic acid is a promising biomarker for CAD as it has been identified in atherosclerotic plaque and is involved with protein-calcium binding. Award Winning Science - Primary care & risk factor management section 81 https://esc365.escardio.org/Presentation/217124/abstract Trimetazidine: the future and reality in the prevention of anthracycline cardiotoxicity in patients with breast cancer. VV Nesvetov1, E Yuschuk1, E Shkolnik2, M Scherbak1, YU Vasyuk1 1Moscow State University Of Medicine And Dentistry, Moscow, Russian Federation 2Yale-New Haven Health Bridgeport Hospital, therapy, Bridgeport, United States of America Funding Acknowledgements: without financial supports Topic: Prevention – Cardiovascular Risk Assessment: Biomarkers Intro: In recent years, there has been a significant reduction in mortality from cancer. Moreover, the prevention of myocardial damage is most effective until the clinical manifestations of cardiomyopathy and a significant reduction in contractility of the left ventricle. Aim. Evaluation of the effectiveness of trimetazidine modified release in the prevention of cardiotoxic effects of chemotherapeutic drugs in patients with breast cancer. Matherial and methods. The study included 50 patients with breast cancer. All patients had a collection of anamnesis, echocardiography with 2d strain, were performed before the study. All patients were prescribed chemotherapy with anthracycline, after which the patients included in the study were randomly randomized into two groups. Patients of the first group, in which 26 patients were included, were additionally prescribed trimetazidine of modified release in a daily dose of 70 mg, the control group consisted of 24 patients who received only chemotherapy. In 22 patients (11 patients from the main group and 11 people from the control group), a venous blood test was performed to determine the level hs-TnT and ST2. Results.When studying the dynamics of biochemical parameters, the initial groups did not significantly differ from each other, however, 6 months after the start of chemotherapy treatment, the group showed a significant increase in hsTnT (from 3.82 ± 1.17 ng/ml to 7.45 ± 3.8 ng/ml p = 0.008). In the trimetazidine MR group, there was only a tendency to increase this marker (from 4.73 ± 2.11 ng/ml to 6.09 ± 3.0 ng/ml). When studying the marker ST-2 in the control group, its significant increase was noted (from 16.8 ± 9.4 ng/ml to 20.2 ± 10.4 ng/ml p = 0.038), while in the group trimetazidine MR increase in the level of ST-2 was insignificant (from 14.6 ± 4.2 to 16.4 ± 4.1 ng/ml). In general, in the groups of trimetazidine MR and control, there was a tendency to a decrease in global longitudinal deformation of the LV against the background of a six-month follow-up, but it did not reach a reliable level (from -20.6 ± 1.6% to -19.7 ± 0.9% in the group trimetazidine MR and from -20.5 ± 1.3% to -20.1 ± 1.4% in the control group). Analysis of the dynamics of global longitudinal systolic LV deformity during long-term follow-up (11 months) revealed a significant decrease in this indicator only in the control group (from -20.5 ± 1.3 to -19.7 ± 1.5 p = 0.05), but not in the trimetazidine MR group (from -20.6 ± 1.6 to -19.9 ± 1.6). Conclusions. Therapy with trimetazidine MV prevents a decrease in global longitudinal deformation of the left ventricle, an increase in the level of highly sensitive troponin T and the marker of myocardial fibrosis ST-2, which indicates myocardial cytoprotection, while in the comparison group there is a significant negative dynamics of these indicators. EAPC Essentials 4 You - ePosters P735 https://esc365.escardio.org/Presentation/217093/abstract Relationship between hs-CRP and cardiovascular disease risk factors N Nenad Ratkovic1, N Rancic1, V Peric2, M Stojanovic1, M Stanic1 1Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade, Serbia 2Clinical Center Kragujevac, Kragujevac, Serbia Topic: Prevention – Cardiovascular Risk Assessment: Biomarkers Background/Aim: The association of hs-CRP with risk for cardiovascular disease (CVD) has been described in many studies. However, approximately one-third of individuals with 1 or without risk factor develop CVD. The aim of this study was that analysed relationship between hs-CRP and CVD risk factors. Metods: Observational cross-sectional study included 205 active duty military personnel. Pearsonã s correlation coefficient used to test the relationship between hs-CRP and other CVD risk factors. Results: Average years of participants in the study was 39 (SD ±5.8) and average value of hs-CRP was 1.59 mg/L (±2.87). Among participants, there was 161 (78.5%) with hs-CRP <2 mg/L and 44 (21.5%) with hs-CRP >2 mg/L. There was an important positive correlation of quartiles of hs-CRP concentrations with age (r=0.216, p<0.002); BMI 26.96 kg/m2 (±3.23) (r=0.211, p=0.002), Reynolds risk score (r=0.380, p<0.001); glucose level 5.52 mmol/L (±0.56) (r=0.211, p=0.002); with metabolic syndrome (r=0.267, p<0.001); number of risk factors (0-5) (r=0.210, p<0.003); negative correlation with HDL 1.32 mg/L (±0.86) (r=-0.159, p=0.023). There was no statistically important correlation between cholesterol 5.36 mmol/l (±1.09) (r=0.050, p=0.479); LDL cholesterol 3.45 mg/L (±0.88) (r=0.056, p=0.430); triglycerides 1.39 mmol/L (±0.84) (r=0.132, p=0.060); systolic blood pressure 123.53 mmHg (±10.7) (r=0.090, p=0.200); diastolic blood pressure 79.99 mmHg (±8.2) (r=0.120, p=0.080). Conclusions: In population of active duty military personnel in Republic of Serbia hs-CRP is not correlated with all risk factors for CVD, but it is correlated with number of risk factors. Measurement of hs-CRP may provide a more comprehensive view of the patientã s overall risk profile in the population of military personnel of Serbia. P737 https://esc365.escardio.org/Presentation/217611/abstract Cardiovascular risk factors are associated with inflammation markers in healthy individuals YB Khovaeva1, L Larisa Ermachkova1, AP Shavrin1, BV Golovskoy1 1E.A.Vagner Perm State Medical University, Perm, Russian Federation Topic: Prevention – Cardiovascular Risk Assessment: Biomarkers Purpose. To study the carotid intimae-media thickness (IMT) and inflammation markers in the individuals with cardiovascular risk factors (CV RF). Methods. A cohort of 106 healthy individuals (44 men, 62 women, average age 43.7±1.1) was examined for the following CV RF: smoking, the increased BP, dyslipidemia, overweight, physical inactivity, family history of CVD. The level of high-sensitivity C-reactive protein (hsCRP) and cytokines: tumor necrosis factor alpha (TNF-α), interleukins (IL) -1, -8 have been studied by enzyme immunoassay test systems. The IMT and carotid atherosclerotic plaques were determined by ultrasonic scan in B-mode. The correlation, factor and cluster analysis was used for statistical data processing (Statistica 10.0). Results. By means of cluster analysis all patients were divided into 3 groups (clusters) that significantly differed in the carotid IMT from each other (p=0.04-0.02). The IMT of carotid arteries was 0.58±0.02 mm in group 1, 0.77±0.01 mm in group 2, 1.09±0.02 mm in group 3 (p=0.04ã0.02). All groups were matched by age and sex (p>0.05). The performed analysis revealed significant difference between these groups in the blood levels of hsCRP and cytokines (p<0.05). In group 2 correlation analysis revealed a close link between IMT and hsCRP (r=0.36; p=0.02), IMT and TNF-α (r=0.51; p=0.01). The study also found a direct correlation between IMT and hsCRP (r=0.41, p=0.01), IMT and TNF-α (r=0.54; p=0.01), IMT and IL-8 (r=0.59, p=0.01) in group 3. However, these significant correlations were not found in group 1. Conclusions. The increase of IMT and blood levels of hsCRP and cytokines was detected in healthy individuals with CV RF. The presence of atherosclerotic plaques was associated with a significant increase in hsCRP and TNF-α levels. P741 https://esc365.escardio.org/Presentation/221671/abstract Platelet to lymphocyte ratio as novel predictor biomarker of 6 months heart failure incidence in acute coronary syndrome patients at limited resource hospital R Intan1, T Octora1, F Alkaff2, F Suslina3, A M Ambari4, B Setianto4, D Balti5 1Faculty of Medicine, Airlangga University, Surabaya, Indonesia 2Faculty of Medicine, Airlangga University, Department of Pharmacology, Surabaya, Indonesia 3Padjajaran University, Interventional Cardiology Fellowship Training, Bandung, Indonesia 4National Cardiovascular Center Harapan Kita, Cardiovascular Preventive and Rehabilitative Department, Jakarta, Indonesia 5RSUD DR. R. Koesma, Department of Cardiology and Vascular Medicine, Tuban, Indonesia Topic: Prevention – Cardiovascular Risk Assessment: Biomarkers Background: Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality world wide. Risk stratification is important for prevention and management of ACS. Inflammation has been a crucial role in mechanism of coronary artery disease (CAD) and heart failure. The need of novel inflammatory biomarker that can be easily calculated and widely available for ACS is important. PLR is a relative novel inflammatory biomarker and has been associated to some cardiovascular disorder, however study of PLR as predictor heart failure incidence after ACS is still limited, especially in limited resource hospital or in rural area. Purpose: The aim of this study was to investigate whether PLR is an independent predictor of 6 month heart failure incidence and predictor of secondary outcomes in patients with acute coronary syndrome (ACS). Method: This was a retrospective cohort study from medical record of all patients diagnosed with ACS in 2018, in a non PCI hospital in rural area of East Java, Indonesia, that met the inclusion criteria. PLR biomarker was calculated from complete blood count when the patient first came in the emergency room(ER). The primary outcome measured was new heart failure incidence within 6 month, while secondary outcome were GRACE mortality risk score, left ventricle ejection fraction (LV EF) during hospitalization, length of stay (LOS) during hospitalization, and major adverse cardiac events (MACE) in 6 months. Result: There were 92 patients who met our inclusion criteria. The mean age was 55.9 years, 66 % were men, and 51.1 % presented with STEMI. For bivariate analysis PLR is positively correlated with 6 months HF incidence based on ROC curve with area under curve (AUC) 0.83 (P<0.001) with the best cut off PLR level at 87 ( sensitifity 89% and specitifity 63%, RR 2.92, 95% CI 1.55-5.50). In multivariate analysis, a logistic regression was performed. After controlling other co founding factors, PLR was remain statically significant as independent predictor of HF incident in 6 month, with the higher PLR level, the higher risk to develop HF (RR 1.07 95% CI 1.03-1.11). Multivariate cox regression for PLR ≥ 87 showed hazard ratio to develop HF was 4.5 (95% CI 1.8 - 11.0, p=0.001). For secondary outcome, PLR is positively correlated with GRACE score and negatively correlated with LV EF (p=0.004, r=0.27 and p=0.001, r=-0.39 respectively). Meanwhile there were no correlation between PLR with LOS and MACE in 6 months (p=0.417 and 0.277 respectively). Conclusion: Platelet to Lymphocyte Ratio (PLR) is an independent predictor of 6 month heart failure incidence in patients with acute coronary syndrome. PLR also have a positive correlation with GRACE risk score and negative correlation with LV ejection fraction in patient with ACS. PLR can be benefit as novel biomarker for predicting ACS outcome, especially in limited resource hospital or in rural area. P742 https://esc365.escardio.org/Presentation/221668/abstract Leukocyte telomeres length in patients with moderate cardiovascular risk O Zaprovalna1, O Kolesnikova1, T Bondar1, A Radchenko1 1SI “LT.Malaya Therapy Institute NAMSU", Kharkiv, Ukraine Topic: Prevention – Cardiovascular Risk Assessment: Biomarkers Background: Ageing is a major risk factor for cardiovascular disease (CVD). Telomeres shorten with age, so leukocyte telomere length (LTL) can serve as a marker of biological age. Available data allow us to judge the relationship of shortened LTL with early vascular ageing, atherosclerosis, the risk of myocardial infarction, chronic heart failure, and other age-related diseases. There is a hypothesis that LTL can be integrated into modern models of risk prediction and stratification of cardiovascular diseases and can be used in precise personalized treatment. Purpose: to determine the relationship between LTL and factors of risk CVD in patients of different ages without clinical manifestations CVD. Methods: We selected 97 patients (48 women and 49 men) aged 31ã60 years with moderate cardiovascular risk without clinical symptoms of CVD. All patients did not receive regular drug therapy. Consenting subjects had a physical assessment including blood pressure (BP) determination, heart rate, anthropometric measurements (body mass index (BMI), waist circumference (WC)), blood sampling for laboratory analyses, electrocardiogram recording. The SCORE scale was used for evaluation of the 10-year risk of fatal stroke and fatal myocardial infarction. In addition, 40 control individuals aged 31ã60 years (20 men and 20 women), were also included in the study. LTL was determined by a polymerase chain reaction in real-time. Multiple logistic regression analysis was used to develop a prediction model. Results: We observed a difference in health status between the main group and the control group. The measures of BP and metabolic status were significantly higher in the main group than in the control group: BP (p = 0.021), BMI (p = 0.038), HOMA index (p = 0.0012). Study subjects were categorized according to age into 2 groups, of 31 to 44 years (group 1, n= 45, mean age was 39.37±7.92 year) and of 45 to 60 years (group 2, n = 52, mean age was 52.84±8.73 year). There were no significant differences in the sex, anthropometric measurements, and levels of BP between the groups. The control group were also categorized by age into 2 corresponding groups of 20 people in each group. For the study subjects the LTL (mean ± SD) were 1.10 ± 0.29 (group 1) and 0.86 ± 0.33 (group 2). Mean LTL in the study and control groups aged 31 - 44 years did not differ (p = 0.78). But LTL in the study and control groups aged 45-60 years differed significantly (p = 0.036). According to the data of regression analysis, LTL is independently associated with age, inflammation marker - C-reactive protein, BMI and WC, HOMA insulin resistance index, plasma glucose level. The most significant predictor was the HOMA index (p = 0.0045). Conclusion: Detection of factors associated with cellular aging can determine the most successful targets for effective interventions for the purpose of early and effective prevention of CVD. P731 https://esc365.escardio.org/Presentation/223122/abstract Relationship between pulmonary arterial hypertension and Galectin in patients with human immunodeficiency virus infection OG Goldag1, AYTf#156;L Yildirim2, DILARA Inan3 1BOZUYUK DEVLET HASTANESI, Bilecik, Turkey 2Akdeniz University Hospital, DEPARTMENT OF CARDIOLOGY, Antalya, Turkey 3Akdeniz University Hospital, Clinical Microbiology and Infectious Diseases, Antalya, Turkey On Behalf of: ESC PROFESSIONAL MEMBER TRIALER Funding Acknowledgements: N/A Topic: Prevention – Cardiovascular Risk Assessment: Imaging Objectives: Pulmonary arterial hypertension(PAH)rate in patients with human immunodeficiency virus(HIV)infection is 2500 times greater than in general population.In patients with unexplained dyspnea,transthoracic echocardiography(TTE)is indicated to detect HIV-related cardiovascular complications.Previous studies showed that Galectin-3(Gal-3)levels increase in HIV infections.There were other studies in which high levels of Gal-3 were detected in patients with high pulmonary artery pressure(PAP).Our study was planned to determine predictive value of serum Gal-3 level for PAH presence in HIV-infected adults with dyspnea,by evaluating estimated systolic pulmonary artery pressure(PAPs),right ventricular(RV)function and STRAIN findings via TTE. Materials and Methods: The study was a single-center,prospective trial.30 adults with HIV infection with unexplained dyspnea underwent TTE.Participants were grouped due to mean Gal-3 level.Participants' estimated PAPs were calculated over tricuspid regurgitant flow maximum velocity(TRMAXVEL).Values over 30 mmHg were associated with elevated PAPs. Results: 9(30%)of the participants were female and 21(70%)was male.3(10%)of the participants had estimated PAPs of over 30 mmHg.Mean Gal-3 level of these 3 participants was 20,26±3.41 ng/ml,mean TAPSE was 19,33±2.51,mean S' 14,26±2.73,mean RVFAC as 40,93±11.86,mean RVSTRAIN was -25,6±3.7.When groups were compared due to Gal-3 levels,there was not a significant difference between two groups for RV systolic function parameters.Participants with higher Gal-3 levels were older in age.Mean Gal-3 value of participants was found to be higher than mean Gal-3 level of healthy population. Conclusion: Is high Gal-3 level an early finding in this group of patients without significant change in PAP and RV function?TTE follow-up parameters of these cases with high and low Gal-3 levels will help to test this hypothesis.Right heart catheterization was not administered,which is gold standard method for assessment of PAP.Due to low proportion of HIV in etiology of PAH,we can assume that study population is limited.Randomized studies with larger populations,different Gal-3 cut-off values and administering right heart catheterization may provide different information about relationship between Gal-3 levels and PAH in HIV. Award Winning Science - Secondary prevention & rehabilitation section 45 https://esc365.escardio.org/Presentation/217396/abstract Decreased instrumental activities of daily living frequency as a predictor for all-cause mortality in patients aged 65 years and older with cardiovascular disease H Kariya1, M Yamaoka-Tojo2, N Hamazaki1, S Obara3, C Noda4, K Osada5, Y Kato5, A Yuyama5, K Nozaki1, T Ichikawa1, K Kamiya2, E Sekine6, Y Takahashi6, A Matsunaga2, J Ako4 1Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan 2Kitasato University, Department of Rehabilitation, School of Allied Health Sciences, Sagamihara, Japan 3Kitasato University East Hosipital, Department of Rehabilitation, Sagamihara, Japan 4Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan 5Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan 6Kitasato University East Hosipital, Department of Nursing, Sagamihara, Japan Topic: Secondary Prevention Background: Cardiovascular disease (CVD) is known to be a leading cause of mortality in most developed countries, and the number of patients with CVD has increased with ageing. Some studies have reported that impaired instrumental activities of daily living (IADL) predicts poor prognosis and lower physical performance in community-dwelling older patients. However, the relationship between IADL frequency and prognosis remains unknown in older patients with CVD. Purpose: To investigate whether IADL frequency predicts all-cause mortality in patients aged ≥ 65 years with CVD. Methods: A total of 632 consecutive patients (75.0 ± 5.5 years, 193 females) who received outpatient care for CVD and who had been in a stable condition at least 6 months before the study were examined. Patients requiring activities of daily living assistance were excluded from this study. Clinical characteristics including body mass index, risk factors for CVD, medications, left ventricular ejection fraction on echocardiogram, estimated glomerular filtration rate and blood haemoglobin A1c, albumin and brain natriuretic peptide levels were obtained from clinical records. Patients completed the Frenchay Activities Index (FAI) questionnaire for assessment of IADL frequency. We followed up these patients for 4 years and investigated their all-cause mortality. Patients were divided into three groups based on the tertile of FAI for each sex: low FAI (with < 19 and < 25 points for males and females, respectively), moderate FAI (19–26 and 25–32) and high FAI (26 ≤ and 32 ≤) groups. The survival rate among the three groups was compared using the KaplanãMeier method with log-rank test. To clarify the relationship between FAI and all-cause mortality, univariate and multivariate Cox regression analyses were performed. Results: Thirty-nine patients (6.2%) died during the median follow-up period of 4.0 years (interquartile range 2.3–4.0 years). Four-year cumulative mortality incidences were 11.3%, 4.7% and 3.0% in low, moderate and high FAI groups, respectively. The survival rate in the low FAI group was significantly lower than that in the other two groups (Figure 1, log-rank: 17.232, P < 0.001). In the univariate analysis, FAI was a significant predictor of all-cause mortality (hazard ratio [HR] for FAI increase of 1 point: 0.951, 95% confidence interval [CI]: 0.924–0.980, P = 0.001). The FAI remained a significant and independent predictor of all-cause mortality even after adjusting for clinical confounding factors in the multivariate Cox regression analysis (adjusted HR: 0.957, 95% CI: 0.920–0.996, P = 0.031). Conclusion: This is the first study demonstrating that decreased IADL frequency independently predicted all-cause mortality in patients aged ≥ 65 years with CVD. Our findings suggest that the IADL frequency is not only useful for physical performance assessment but also as a risk stratification marker in these patients. Award Winning Science - Secondary prevention & rehabilitation section 49 https://esc365.escardio.org/Presentation/217394/abstract Can follow-up with an app improve adherence of exercise capacity one year post cardiac rehabilitation? A randomized controlled trial P Pernille Lunde1, A Bye1, A Bergland1, J Grimsmo2, E Jarstad3, BB Nilsson1 1OsloMet - Oslo Metropolitan University, Oslo, Norway 2National Association for Pulmonary and Cardiac Disease, Jessheim, Norway 3Norwegian Institute of Sports Medicine, Oslo, Norway Funding Acknowledgements: This study is internally funded by Oslo Metropolitan University. Topic: Secondary Prevention Background: Despite well demonstrated effects of cardiac rehabilitation (CR), lifelong adherence to adapted healthy behaviour is challenging for many patients. Smartphone-applications (apps) have been proposed as promising interventions to handle challenges regarding adherence in patients post-CR. Purpose: The purpose of the present study was to assess the effect of individualized follow-up with an app for one year on exercise capacity, in patients post-CR. Methods: A single-blinded randomized controlled trial. The intervention group (IG) received individualized follow-up enabled with an app for one year, while the control group (CG) received usual care. The primary outcome was difference in peak oxygen uptake (VO2peak). In addition, exercise performance, body weight, exercise habits, HRQoL and health status were evaluated. ANOCOVA was used to analyse differences between groups. Results: A total of 113 patients completing CR (88 men/25 women, mean age 59 ± 8.7 years, 38.9% with acute coronary syndrome, 34.5% with coronary artery disease, 16.8 after valve surgery and 9.8% with other heart diseases) were randomly allocated to the IG or CG. There was a statistically significant difference in VO2peak between the groups at one-year follow-up of 2.2 ml/kg/min, 95% confidence interval (CI) 0.9-3.5 (P=0.001). Statistically significant differences also emerged in exercise performance, body weight and in exercise habits. There were no statistically significant differences in HRQoL or health status. Conclusions: Individualized follow-up for one year with an app improved adherence of exercise capacity, exercise performance, body weight and exercise habits in patients completing CR. CG Basline (n=54) CG 1 year (n=54) Change IG baseline (n=48) IG 1 year (n=48) Change Cardiopulmonary exercise test VO2peak (ml/kg/min) VO2peak (l/min) Time to exhaustion (sec) Support criteria HRmax (beats/min) RER at VO2peak RPE BORG 6-20 29.5±6.5 2.57±0.69 601±102 161±20 1.16±0.09 17.8±1.0 28.7±6.9 2.48±0.68 632±119 164±20 1.20±0.08 17.5±1.2 -0.08±3.3 -0.09±0.29* 31±85* 3±12 0.05±0.1** -0.3±1.1 29.8±9.1 2.63±0.76 602±155 160±18 1.14±0.11 17.7±1.1 31.2±8.8 2.71±0.74 675±131 164±17 1.21±0.08 17.9±1.1 1.4±3.5††* 0.08±0.26†* 72±92†** 4±14* 0.07±0.1** 0.2±1.6 Body weight (kg) 88.5±17.0 88.6±17.6 0.1±4.4 92.0±16.9 90.4±16.6 -1.6±4.1†* Exercise habits 1.3±1.5 1.9±1.6 0.6±1.1** 1.6±1.6 3.0±1.9 1.4±1.5††** HeartQoL Physical Emotional Global 2.48±0.54 2.30±0.68 2.44±0.55 2.57±0.51 2.31±0.68 2.49±0.49 0.09±0.45 0.01±0.57 0.05±0.46 2.43±0.59 2.43±0.58 2.43±0.54 2.64±0.51 2.52±0.65 2.61±0.51 0.21±0.47* 0.09±0.54 0.18±0.43* EQ VAS 72±14 75±12 3±16 69±18 78±16 9±16** CG Basline (n=54) CG 1 year (n=54) Change IG baseline (n=48) IG 1 year (n=48) Change Cardiopulmonary exercise test VO2peak (ml/kg/min) VO2peak (l/min) Time to exhaustion (sec) Support criteria HRmax (beats/min) RER at VO2peak RPE BORG 6-20 29.5±6.5 2.57±0.69 601±102 161±20 1.16±0.09 17.8±1.0 28.7±6.9 2.48±0.68 632±119 164±20 1.20±0.08 17.5±1.2 -0.08±3.3 -0.09±0.29* 31±85* 3±12 0.05±0.1** -0.3±1.1 29.8±9.1 2.63±0.76 602±155 160±18 1.14±0.11 17.7±1.1 31.2±8.8 2.71±0.74 675±131 164±17 1.21±0.08 17.9±1.1 1.4±3.5††* 0.08±0.26†* 72±92†** 4±14* 0.07±0.1** 0.2±1.6 Body weight (kg) 88.5±17.0 88.6±17.6 0.1±4.4 92.0±16.9 90.4±16.6 -1.6±4.1†* Exercise habits 1.3±1.5 1.9±1.6 0.6±1.1** 1.6±1.6 3.0±1.9 1.4±1.5††** HeartQoL Physical Emotional Global 2.48±0.54 2.30±0.68 2.44±0.55 2.57±0.51 2.31±0.68 2.49±0.49 0.09±0.45 0.01±0.57 0.05±0.46 2.43±0.59 2.43±0.58 2.43±0.54 2.64±0.51 2.52±0.65 2.61±0.51 0.21±0.47* 0.09±0.54 0.18±0.43* EQ VAS 72±14 75±12 3±16 69±18 78±16 9±16** Change from baseline to 1-year follow-up within each group, *p<0.05, **p<0.001; between group, †p<0.05, ††p<0.001. n is given for primary outcome. CG, control group; IG, intervention group; VO2peak, peak oxygen uptake; HR, heart rate; RER, respiratory exchange ratio; RPE, rate of perceived exertion. Open in new tab CG Basline (n=54) CG 1 year (n=54) Change IG baseline (n=48) IG 1 year (n=48) Change Cardiopulmonary exercise test VO2peak (ml/kg/min) VO2peak (l/min) Time to exhaustion (sec) Support criteria HRmax (beats/min) RER at VO2peak RPE BORG 6-20 29.5±6.5 2.57±0.69 601±102 161±20 1.16±0.09 17.8±1.0 28.7±6.9 2.48±0.68 632±119 164±20 1.20±0.08 17.5±1.2 -0.08±3.3 -0.09±0.29* 31±85* 3±12 0.05±0.1** -0.3±1.1 29.8±9.1 2.63±0.76 602±155 160±18 1.14±0.11 17.7±1.1 31.2±8.8 2.71±0.74 675±131 164±17 1.21±0.08 17.9±1.1 1.4±3.5††* 0.08±0.26†* 72±92†** 4±14* 0.07±0.1** 0.2±1.6 Body weight (kg) 88.5±17.0 88.6±17.6 0.1±4.4 92.0±16.9 90.4±16.6 -1.6±4.1†* Exercise habits 1.3±1.5 1.9±1.6 0.6±1.1** 1.6±1.6 3.0±1.9 1.4±1.5††** HeartQoL Physical Emotional Global 2.48±0.54 2.30±0.68 2.44±0.55 2.57±0.51 2.31±0.68 2.49±0.49 0.09±0.45 0.01±0.57 0.05±0.46 2.43±0.59 2.43±0.58 2.43±0.54 2.64±0.51 2.52±0.65 2.61±0.51 0.21±0.47* 0.09±0.54 0.18±0.43* EQ VAS 72±14 75±12 3±16 69±18 78±16 9±16** CG Basline (n=54) CG 1 year (n=54) Change IG baseline (n=48) IG 1 year (n=48) Change Cardiopulmonary exercise test VO2peak (ml/kg/min) VO2peak (l/min) Time to exhaustion (sec) Support criteria HRmax (beats/min) RER at VO2peak RPE BORG 6-20 29.5±6.5 2.57±0.69 601±102 161±20 1.16±0.09 17.8±1.0 28.7±6.9 2.48±0.68 632±119 164±20 1.20±0.08 17.5±1.2 -0.08±3.3 -0.09±0.29* 31±85* 3±12 0.05±0.1** -0.3±1.1 29.8±9.1 2.63±0.76 602±155 160±18 1.14±0.11 17.7±1.1 31.2±8.8 2.71±0.74 675±131 164±17 1.21±0.08 17.9±1.1 1.4±3.5††* 0.08±0.26†* 72±92†** 4±14* 0.07±0.1** 0.2±1.6 Body weight (kg) 88.5±17.0 88.6±17.6 0.1±4.4 92.0±16.9 90.4±16.6 -1.6±4.1†* Exercise habits 1.3±1.5 1.9±1.6 0.6±1.1** 1.6±1.6 3.0±1.9 1.4±1.5††** HeartQoL Physical Emotional Global 2.48±0.54 2.30±0.68 2.44±0.55 2.57±0.51 2.31±0.68 2.49±0.49 0.09±0.45 0.01±0.57 0.05±0.46 2.43±0.59 2.43±0.58 2.43±0.54 2.64±0.51 2.52±0.65 2.61±0.51 0.21±0.47* 0.09±0.54 0.18±0.43* EQ VAS 72±14 75±12 3±16 69±18 78±16 9±16** Change from baseline to 1-year follow-up within each group, *p<0.05, **p<0.001; between group, †p<0.05, ††p<0.001. n is given for primary outcome. CG, control group; IG, intervention group; VO2peak, peak oxygen uptake; HR, heart rate; RER, respiratory exchange ratio; RPE, rate of perceived exertion. Open in new tab EAPC Essentials 4 You - ePosters 654 https://esc365.escardio.org/Presentation/217370/abstract Preoperative skeletal muscle density incrementally improved prognosis of postoperative sarcopenia in cardiovascular disease patients M Masashi Yamashita1, K Kamiya2, A Matsunaga2, T Kitamura3, N Hamazaki4, K Nozaki4, T Ichikawa4, E Maekawa5, K Meguro5, M Yamaoka-Tojo2, J Ako5, K Miyaji3 1Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan 2Kitasato University, School of Allied Health Sciences, Sagamihara, Japan 3Kitasato University School of Medicine, Department of Cardiovascular Surgery, Sagamihara, Japan 4Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan 5Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan Topic: Secondary Prevention Introduction: Sarcopenia is strongly associated with mortality, and its treatment by performing cardiac rehabilitation is very important in cardiovascular disease (CVD) patients. In particular, preoperative physical status is strongly related to progress in postoperative cardiac rehabilitation. Poor preoperative physical status may lead to postoperative sarcopenia. Purpose: To strengthen the prognostic model of sarcopenia, we evaluated the potential incremental improvement in prognostic ability when adding preoperative skeletal muscle density (SMD) in CVD patients. Methods: We reviewed 907 CVD patients who underwent preoperative abdominal computed tomography (CT) and measurement of postoperative physical status. The SMD cutoff was found to be 45 Hounsfield units in a previous study. The Asia Working Group of Sarcopenia definition was used. Receiver operating characteristic (ROC) curve analysis and time-dependent ROC (tdROC) curve analysis were performed to evaluate the potential incremental improvement in prognostic ability of SMD for sarcopenia. Results: The median patient age was 68 years (64.3% males). During the 2.01-year median follow-up period (interquartile range: 0.80–4.04 years), 63 (6.9%) deaths occurred, and the maximum follow-up was 5 years. In the ROC curve analysis, the SMD cutoff indicated incremental prognostic improvement for postoperative sarcopenia (0.587 vs. 0.671, P = 0.004). Additionally, in the tdROC analysis, the SMD cutoff provided additional prognostic information about postoperative sarcopenia, especially mid- and long-term mortality (Figure 1). Conclusion: The SMD cutoff estimated by preoperative CT enabled incremental prognostic improvement for postoperative sarcopenia in CVD patients. The preoperative SMD cutoff may be useful for decision making about potential progress during postoperative cardiac rehabilitation. Figure 1 656 https://esc365.escardio.org/Presentation/217325/abstract Cardiac rehabilitation in underrepresented groups: uptake and clinical outcomes from a tertiary referral center in Switzerland N Gonzalez-Jaramillo1, S Matter2, A Bano1, OH Franco1, P Eser2, M Wilhelm2 1University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland 2Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne, Berne, Switzerland Topic: Secondary Prevention Introduction: Participation rates in cardiac rehabilitation (CR) programs remain consistently low across time, especially for women, elderly patients, and migrants. In addition, factors associated with low uptake may be also associated with less clinical benefit from CR. Objective: To evaluate the association of age, sex, and migration status with CR uptake and clinical outcomes of a hospital committed to treatment equity (member of Swiss Hospitals for Equity initiative) in a Swiss urban setting, where CR is reimbursed by compulsory health insurance and travel distances are small. Methods: Longitudinal cohort study. We retrospectively included all consecutive records of patients who underwent PCI after acute or chronic coronary syndromes at our University Hospital from 2006-2017. We analysed CR uptake, and its clinical benefit in terms of gain in peak exercise capacity in metabolic equivalents (MET) and changes in cardiometabolic profile, including body mass index (BMI), blood pressure (BP), LDL-cholesterol and glycated hemoglobin (HbA1c) in patients with diabetes mellitus. To assess the associations of age, sex, and migratory status with CR uptake, a logistic regression model adjusted for marital status and German/French language was performed, and to assess these effects on clinical benefits, linear regression models adjusted for number of attended weekly training sessions were performed. Results: We included 2785 records corresponding to patients living in the service area of the hospital. Overall CR uptake was 33.7% (43.2% among migrants, 25% among women). Of the 517 patients who enrolled in CR, 52% had an acute coronary syndrome. CR uptake significantly declined with increasing age (-47% per decade, p<0.0001) and was smaller in single/divorced/widowed patients than patients living with partner (-34%, p=0.001). After adjustment for age, there was no difference in CR uptake between sexes or patients with native/foreign origin. The clinical benefit was analysed in 517 participants. We observed statistically significant changes from before to after CR in exercise capacity (+0.8 MET or 13%, p=<0.0001) as well as improvement in LDL-cholesterol (median -0.3 mmol/L or -13%, p<0.0001) and glycated hemoglobin in diabetic patients (median -0.4 mmol/mol or 5%, p=0.0002), while BMI and systolic BP did not change. The change in MET was independently associated with the number of attended sessions per week in patients younger than 65 yrs (0.4 MET per weekly session, p<0.0001). Increasing age was associated with a decrease in improvement of exercise capacity (-0.2 MET per decade, P<0.0001). Neither age, sex, migration status nor number of attended training sessions had an effect on changes in BMI, systolic BP, LDL-C, nor HbA1c in patients with diabetes. Conclusion: In a Swiss urban setting, older age was the only barrier to participate in CR and reduced the clinical benefit of CR. CR uptake and benefit were not reduced by female sex nor migration status. P121 https://esc365.escardio.org/Presentation/221577/abstract Pharmacological treatment in coronary patients: is there a gender gap? P Vynckier1, K Kotseva2, S Gevaert1, D De Bacquer1, D De Smedt1 1Ghent University, Ghent, Belgium 2National University of Ireland, Galway, Ireland On Behalf of: EUROASPIRE studygroup Funding Acknowledgements: ESC, fonds voor hartchirurgie (Belgium) Topic: Secondary Prevention Background: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in Europe, accounting for about 45% of all deaths. It is sometimes thought of as a disease that mainly effects men. The age of onset however, differs between gender, with women being at lower risk at younger age. There is increasing awareness about the risk of CVD in women, however evidence suggest that there is still a substantial difference in the diagnosis and treatment of CVD across gender. The regularly updated European guidelines on CVD prevention guide the physicians in prescribing evidence based (EB) medication to reach cardiovascular risk factors targets. Little is known about gender differences in prescribed medication at discharge after a coronary event. PURPOSE: The aim of this study was to identify gender differences in cardiac medication prescription at hospital discharge after a coronary event. Methods: Analyses were based on the EUROASPIRE V (EUROpean Action on Secondary and Primary Prevention through Intervention to Reduce Events) survey including patient information from 131 centres across 27 countries. Patients between 18 and 80 years old, hospitalised for an elective or emergency CABG, elective or emergency PCI, acute myocardial infarction or acute myocardial ischaemia were included. Information on personal and demographic details, risk factors and medical treatment was obtained from medical records and discharge letters. Findings on prescribed medication were compared with the European-CVD prevention guidelines. Multilevel logistic regression analyses adjusted for age, diabetes, and type of coronary event were performed. Results: Data was available for 8261 patients of which 25.8% were women. Women were older than men (mean age = 65.2 vs. 63.0 years) and were more likely to have a history of hypertension (80.4% vs. 72.9%), dyslipidaemia (67.2% vs. 63.7%), obesity (35.7% vs. 27.6%), and diabetes (28.1% vs. 23.2%). No significant differences were seen in the prescription of aspirin/antiplatelet (92.9% vs. 94.5%), ACE-I/ARBs (75.3% vs. 74.7%), beta-blockers (81.4% vs. 81.6%) and diuretics (36.5% vs. 31.1%), but women were more often prescribed calcium channel blockers (23.5% vs. 17.9%, p<0.001). Furthermore, no significant difference was seen in the prescription of statins (83.6% vs. 85.2%). A closer look at ACE-I/ARBs, revealed that ACE were more often prescribed in men and ARBs were more often prescribed in women. The latter finding was consistent across countries. The combined EB therapy of aspirin/antiplatelet plus statins did not differ between gender (82.1% vs. 84.3%). Conclusion: Overall, these findings suggest little gender differences in prescribed medication at hospital discharge. Further research is needed to understand the sex-differential prescription of ACE-I and ARBs. P203 https://esc365.escardio.org/Presentation/217330/abstract Change in aerobic capacity and cardiovascular risk factors in obese patients with coronary disease after phase II of the cardiac rehabilitation program NG Uribe Heredia1, R Arroyo Espliguero2, LG Piccone Saponara3, M Viana Llamas2, H Alvaro Fernandez1, E Vallejo Sacristan1, B Garcia Magallon2, C Toran Martinez2, A Castillo Sandoval2, A Perez Sanchez2, JL Benitez Peyrat2, C Solorzano Guillen2, I Rodriguez Guinea2, S Moreno Reviriego2, R Angulo Llanos2 1University Hospital of Guadalajara, Cardiac Rehabilitation Unit, Guadalajara, Spain 2University Hospital of Guadalajara, Cardiology department, Guadalajara, Spain 3Hospital General de Ciudad Real, Nefrology, Ciudad Real, Spain Topic: Secondary Prevention Introduction: Obesity is the most prevalent cardiovascular risk factor in developed countries in people with established coronary disease, besides being the least improvement factor in this type of patients. The objective of our study is to determine whether the evolution of aerobic capacity and cardiovascular risk factors is as good as in non-obese patients. Methods: Prospective observational study. A total of 278 patients were included consecutively in a PRC between March 2015 to July 2019, performing daily exercise for 8 weeks (phase II of the CRHP). An ergometry was performed with expired gas analysis and blood analysis before and after phase II. Results: 278 patients were analyzed, the average age was 57,9±9,2 years, 37,4% obese (n=104 patients),14,4%women, LVEF half 56,8±9,7%, 48,6% in functional class II-III (NYHA) prior to the CRHP, 52,9% AH, 74,8% dyslipidemia, 27% diabetes, 69,7% smokers and 12,9% moderate-severe bronchopathy. Within the baseline characteristics, no significant differences were obtained, such as age and LVEF between obese and non-obese, except in the percentage of smokers (78,8% Vs 64,4%; p=0,02) and hypertensive patients (63,5% Vs 46,6%; p=0,007) who were higher in the obese group. The comparison of the differences in the variables of oxygen consumption (VO2 indexed per kilogram of lean mass) and analytical parameters are detailed in the Table 1. Conclusions: In our study, obese patients showed improvement in their aerobic capacity after phase II of the CRHP in a similar way to non-obese patients, achieving a greater reduction in glycosylated hemoglobin, but a lower reduction in LDL cholesterol levels and prognostic analytical markers such as CRP and B- BNP unlike non-obese. PARAMETERS OBESE NON OBESE PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 33,5 ± 3,7 32,9 ± 3,6 <0,001 25,9 ± 2,4 25,7 ± 2,3 <0,001 HbA1c (%) 6,02 ± 0,97 5,85 ± 0,68 0,01 5,8 ± 0,8 5,7 ± 0,6 0,24 LDL (mg/dL) 77,8 ± 22,4 71,8 ± 23,8 0,003 80,6 ± 29,9 67,0 ± 21,0 <0,001 CRP (mg/L) 4,80 ± 7,94 3,84 ± 6,17 0,28 2,88 ± 4,39 1,56 ± 2,03 <0,001 B- BNP (pg/mL) 81,3 ± 136,6 71,0 ± 140,9 0,13 94,9 ± 233,5 67,3 ± 110,2 0,02 SBP rest (mmHg) 122,8 ± 14,3 119,9 ± 11,3 0,04 121,9 ± 15,2 117,9 ± 11,6 0,001 VO2 peak (ml/kg/min) 19,1 ± 4,9 21,1 ± 6,0 <0,001 23,1 ± 5,9 25,8 ± 6,4 <0,001 Foretold VO2 (%) 81,7 ± 17,4 87,9 ± 20,7 <0,001 84,1 ± 18,3 93,3 ± 20,2 <0,001 VO2 peak (ml/kglean mass/min) 30,9 ± 6,9 33,7 ± 8,5 <0,001 33,1 ± 8,1 36,7 ± 8,8 <0,001 PARAMETERS OBESE NON OBESE PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 33,5 ± 3,7 32,9 ± 3,6 <0,001 25,9 ± 2,4 25,7 ± 2,3 <0,001 HbA1c (%) 6,02 ± 0,97 5,85 ± 0,68 0,01 5,8 ± 0,8 5,7 ± 0,6 0,24 LDL (mg/dL) 77,8 ± 22,4 71,8 ± 23,8 0,003 80,6 ± 29,9 67,0 ± 21,0 <0,001 CRP (mg/L) 4,80 ± 7,94 3,84 ± 6,17 0,28 2,88 ± 4,39 1,56 ± 2,03 <0,001 B- BNP (pg/mL) 81,3 ± 136,6 71,0 ± 140,9 0,13 94,9 ± 233,5 67,3 ± 110,2 0,02 SBP rest (mmHg) 122,8 ± 14,3 119,9 ± 11,3 0,04 121,9 ± 15,2 117,9 ± 11,6 0,001 VO2 peak (ml/kg/min) 19,1 ± 4,9 21,1 ± 6,0 <0,001 23,1 ± 5,9 25,8 ± 6,4 <0,001 Foretold VO2 (%) 81,7 ± 17,4 87,9 ± 20,7 <0,001 84,1 ± 18,3 93,3 ± 20,2 <0,001 VO2 peak (ml/kglean mass/min) 30,9 ± 6,9 33,7 ± 8,5 <0,001 33,1 ± 8,1 36,7 ± 8,8 <0,001 Open in new tab PARAMETERS OBESE NON OBESE PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 33,5 ± 3,7 32,9 ± 3,6 <0,001 25,9 ± 2,4 25,7 ± 2,3 <0,001 HbA1c (%) 6,02 ± 0,97 5,85 ± 0,68 0,01 5,8 ± 0,8 5,7 ± 0,6 0,24 LDL (mg/dL) 77,8 ± 22,4 71,8 ± 23,8 0,003 80,6 ± 29,9 67,0 ± 21,0 <0,001 CRP (mg/L) 4,80 ± 7,94 3,84 ± 6,17 0,28 2,88 ± 4,39 1,56 ± 2,03 <0,001 B- BNP (pg/mL) 81,3 ± 136,6 71,0 ± 140,9 0,13 94,9 ± 233,5 67,3 ± 110,2 0,02 SBP rest (mmHg) 122,8 ± 14,3 119,9 ± 11,3 0,04 121,9 ± 15,2 117,9 ± 11,6 0,001 VO2 peak (ml/kg/min) 19,1 ± 4,9 21,1 ± 6,0 <0,001 23,1 ± 5,9 25,8 ± 6,4 <0,001 Foretold VO2 (%) 81,7 ± 17,4 87,9 ± 20,7 <0,001 84,1 ± 18,3 93,3 ± 20,2 <0,001 VO2 peak (ml/kglean mass/min) 30,9 ± 6,9 33,7 ± 8,5 <0,001 33,1 ± 8,1 36,7 ± 8,8 <0,001 PARAMETERS OBESE NON OBESE PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 33,5 ± 3,7 32,9 ± 3,6 <0,001 25,9 ± 2,4 25,7 ± 2,3 <0,001 HbA1c (%) 6,02 ± 0,97 5,85 ± 0,68 0,01 5,8 ± 0,8 5,7 ± 0,6 0,24 LDL (mg/dL) 77,8 ± 22,4 71,8 ± 23,8 0,003 80,6 ± 29,9 67,0 ± 21,0 <0,001 CRP (mg/L) 4,80 ± 7,94 3,84 ± 6,17 0,28 2,88 ± 4,39 1,56 ± 2,03 <0,001 B- BNP (pg/mL) 81,3 ± 136,6 71,0 ± 140,9 0,13 94,9 ± 233,5 67,3 ± 110,2 0,02 SBP rest (mmHg) 122,8 ± 14,3 119,9 ± 11,3 0,04 121,9 ± 15,2 117,9 ± 11,6 0,001 VO2 peak (ml/kg/min) 19,1 ± 4,9 21,1 ± 6,0 <0,001 23,1 ± 5,9 25,8 ± 6,4 <0,001 Foretold VO2 (%) 81,7 ± 17,4 87,9 ± 20,7 <0,001 84,1 ± 18,3 93,3 ± 20,2 <0,001 VO2 peak (ml/kglean mass/min) 30,9 ± 6,9 33,7 ± 8,5 <0,001 33,1 ± 8,1 36,7 ± 8,8 <0,001 Open in new tab P204 https://esc365.escardio.org/Presentation/221583/abstract Results and lesson learned of Sweaty Hearts M Martijn Scherrenberg1, M Ilardi2, B Mayr3, E Kouidi4, P Lugosi5, J Niebauer3, A Deligiannis4, I Kulcsar5, D Forgione6, Z Kovacs7, P Dendale1, A Biffi2 1Hasselt University, Hasselt, Belgium 2Institute of Sport Medicine and Science CONI, Rome, Italy 3Universitaetsklinikum Salzburg, Salzburg, Austria 4Aristotle University of Thessaloniki, School of Physical Education & Sport Science, Thessaloniki, Greece 5Balatonfured State Cardiology Hospital, Balatonfured, Hungary 6Associazione ISES, Rome, Italy 7DEKUT, Debrecen, Hungary Funding Acknowledgements: This project has been funded by the Erasmus+ Programme of the European Union. The European Commission support for this publication does not constitute Topic: Secondary Prevention Background: The beneficial effects of cardiac rehabilitation (CR) are well known. However, the participation in CR is disappointingly low in Europe and also the long-term adherence to the physical activity recommendations is poor. Sweaty Hearts is an European collaborative partnership to develop, implement and evaluate a model of long-term physical activity and behavioural change in coronary artery disease patients (CAD). Centers from Austria, Belgium, Greece, Italy and Hungary participated. Methods: Sweaty Hearts is a demonstration project where the intervention was adapted to the local needs and culturally differences between the five participating countries. First, patients participated in a center-based CR for 24 weeks with exercise and education. Hereafter, patients were monitored by a two-weekly or monthly transmission of their step count measured with the Google fit application, with the iHealth application or a smartwatch. Patients received feedback and new goals via e-mail or by telephone based on the transmitted step counts. After 24 weeks they were invited back to the rehabilitation center for exercise testing and questionnaires. The main goal was to test whether this model was feasible in different European countries and to learn about the cultural differences of CR in Europe. Results: 103 patients (63.7 years ± 8.9; 79.6% males) entered into this study. There was a drop-out of 29 patients (28%) with a clear gender effect (38% for females and 25% for males). Furthermore, SF-36 scores increased in every country after 48 weeks. The overall CAD knowledge was higher after the 24 weeks in-center CR but were decreased after 48 weeks. Flexibility and muscle strength were higher in all countries after 48 weeks. Peak power on cyclo-ergometry was higher after 12 months (Peak power baseline 144.1 W; Peak power 24 weeks 155.1 W; Peak power 48 weeks 156.1 W). VO2 peak was higher after 12 months (VO2peak baseline: 22.5; VO2peak 24 weeks 23.6; VO2peak 48 weeks 22.9). Conclusion: This demonstration project showed that locally and culturally adapted phase III CR is feasible with a drop-out similar to other telerehabilitation trials. The intervention had in all countries a positive impact on quality of life, flexibility and muscle strength. However, knowledge of CAD decreased when patients were independent. This suggests that regular booster session might be needed. Lastly, more attention is needed for a possible gender effect in rehabilitation and digital health trials and more research is needed to find alternative ways to convince and motivate women to stay physically active. P206 https://esc365.escardio.org/Presentation/217049/abstract Frailty is highly common in patients with cardiovascular disease but lacks uniformity in assessment: a systematic review N Marinus1, C Vigorito2, F Giallauria2, P Dendale3, P Feys1, R Meesen4, A Timmermans4, J Spildooren4, D Hansen5 1Hasselt University, Faculty of Rehabilitation Sciences and Faculty of Medicine and Life Sciences, Diepenbeek, Belgium 2Federico II University of Naples, Department of Translational Medical Sciences, Naples, Italy 3Hasselt University and Jessa Hospital, Faculty of Medicine and Life Sciences and Heart Centre Hasselt, Diepenbeek and Hasselt, Belgium 4Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium 5Hasselt University and Jessa Hospital, Faculty of Rehabilitation Sciences/Faculty of Medicine and Life Sciences and Heart Centre Hasselt, Diepenbeek and Hasselt, Belgium Topic: Secondary Prevention Introduction: Clinicians are increasingly confronted with aged patients (≥70 years) with cardiovascular disease (CVD). Such ageing increases the likelihood to suffer from frailty, which relates to significantly worse outcomes. However, how frailty is assessed in older CVD patients, and the exact prevalence of frailty, remains to be updated in a systematic manner. Purpose: To identify which tools are currently used to detect frailty in CVD patients and to assess the prevalence of frailty in older CVD patients. Methods: This systematic review adhered to PRISMA guidelines. Inclusion criteria were: (i) studies up to October 2019, including patients (men and women) aged ≥60 years (ii.) suffering from any CVD with or without cardiac surgery (iii.), which examined the presence of frailty with a well-defined and validated frailty tool and (iv.) reported prevalence rates of frailty in these patients. The methodological quality of the included studies was assessed by validated instruments. Results: Nine studies of moderate-to-good methodological quality with a total sample size of 7155 participants were included. The prevalence of frailty ranged from 6% up to 75% depending on the type of the frailty tool used and on the specific CVD. Four different frailty tools (phenotype of Fried, Short Physical Performance Battery (SPPB), Tilburg Frailty Index (TFI) and Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), which mainly focused on the physical domain of frailty, were used. The highest prevalence rates of frailty were reported in heart failure patients (75%). Conclusion: Frailty is a significant issue in patients with CVD, especially in those with heart failure. However, the lack of uniformity in defining frailty, as well as the variety of factors associated with CVD, re-iterates the importance of developing a well-defined and valid frailty assessment tool. P207 https://esc365.escardio.org/Presentation/217343/abstract Eligibility of patients with cardiovascular disease for dual pathway inhibition in a large community cardiology practice R Kamel1, T Thom Haghighat Talab1, J Niznick1 1Ottawa Cardiovascular Centre, Ottawa, Canada Funding Acknowledgements: Bayer Topic: Secondary Prevention Background: To optimize vascular risk across the broad-spectrum of patients with cardiovascular disease (CVD), it is essential to identify and apply the latest medical advances to eligible candidates, which is often difficult due to the overwhelming logistical barriers of clinical practice. The COMPASS trial showed the benefit of dual pathway therapy with ASA (acetylsalicylic acid) plus low-dose rivaroxaban compared with either ASA or rivaroxaban alone in patients with stable atherosclerotic vascular disease in terms of death, stroke or MI (myocardial infarction). This study was conducted in a large community cardiology practice with 40,000 active patients. A retrospective analysis of 1,000 sequential current patients were reviewed for eligibility of dual pathway therapy. Methods: 1. Exclusion criteria included those with atrial fibrillation or valvular heart disease requiring full systemic anticoagulation. 2. Eligibility criteria included: a) Established coronary artery disease (CAD) with or without peripheral vascular disease (PVD) b) For those under 65, two of the following risk factors were required for eligibility: -Atherosclerosis in two vascular beds -Current smoker -Diabetes Mellitus (DM) -eGFR (estimated glomerular filtration rate) < 60 -Heart Failure -Non-lacunar ischemic stroke 3. The prevalence of each criteria was collected and analysed in order to determine the extent of the care gap between current care and optimized dual pathway therapy. Results: The mean age was 63. The number (percentage) of patients < 65 who had two or more risk factors was 37 (3.7%) and the number (percentage) of patients > 65 with established CAD was 246 (24.6%), totalling 283 (28.3%) patients eligible for dual pathway antiplatelet therapy. Of the 1,000, 7 patients (0.7%) were currently on dual pathway antiplatelet therapy. Conclusions: Based on this analysis it can be anticipated that almost 1/3 of all patients could be eligible for dual pathway therapy to prevent cardiovascular death, stroke or MI. This treatment gap should be addressed with structured interventions to bridge this identified care gap. Number CAD 328 (32.8%) Diabetes Type 1 6 (0.6%) Type 2 204 (20.4%) Smoker 60 (6%) eGFR < 60 92 (9.2%) Heart failure 81 (8.1) Number CAD 328 (32.8%) Diabetes Type 1 6 (0.6%) Type 2 204 (20.4%) Smoker 60 (6%) eGFR < 60 92 (9.2%) Heart failure 81 (8.1) Open in new tab Number CAD 328 (32.8%) Diabetes Type 1 6 (0.6%) Type 2 204 (20.4%) Smoker 60 (6%) eGFR < 60 92 (9.2%) Heart failure 81 (8.1) Number CAD 328 (32.8%) Diabetes Type 1 6 (0.6%) Type 2 204 (20.4%) Smoker 60 (6%) eGFR < 60 92 (9.2%) Heart failure 81 (8.1) Open in new tab P208 https://esc365.escardio.org/Presentation/221657/abstract Coronary CTA and cardiovascular prevention: a perfect match E Emilio Arbas Redondo1, R Dalmau Gonzalez-Gallarza1, ID Poveda Pinedo1, D Tebar Marquez1, I Marco Clement1, L Martin Polo1, C Merino Argos1, L Martinez Marin1, B Terol Espinosa De Los Monteros1, G Guzman Martinez1, A Castro Conde1, T Lopez Fernandez1, JL Lopez Sendon1 1University Hospital La Paz, Madrid, Spain Topic: Secondary Prevention BACKGROUND: SCOT-HEART trial in 2018 demonstrated a significantly lower rate of the combined endpoint of cardiovascular death or non-fatal myocardial infarction in patients in whom coronary computed tomography angiography (CTA) was performed as part of the assessment of suspected coronary artery disease (CAD). These results are partially explained by changes in treatment for cardiovascular prevention. Indeed, these changes were made in the group of confirmed coronary artery disease in CTA, a group that is classified as high cardiovascular risk according to the last 2019 ESC guidelines and that could benefit from more incisive primary or secondary prevention strategies. The aim of this study is to verify if coronary CTA results are taken into account by clinicians and whether they eventually result in optimization of antiplatelet or lipid-lowering strategies. METHODS. A sample of 56 individuals were selected from a retrospective database of patients which were referred to coronary CTA as part of their chest pain assessment from January to June 2019 in a tertiary hospital. Changes on antiplatelet drugs and statins prescription were examined according to different groups based on the coronary CTA results. RESULTS. The mean age of the study population was 63.0 years (SD 13.3 years) and 71.4% of the patients were female. There was a low smoking prevalence (9.3%) and just 6 patients (10.7%) were diagnosed with diabetes mellitus. The prevalence of dyslipidemia was 58.9% and the mean blood LDL-cholesterol was 105.1 mg/dL (SD 32.3 mg/dL). Only 25% of the patients were taking aspirin before the coronary CTA was performed. This percentage lightly raised up to the 30.4% after knowing the test results. On the other hand, 31 patients (55.4%) were taking statins, but only 19.6% of them were taking high potency statins. After knowing the coronary CTA results, the percentage of statins prescription did not change significantly (58.9%), but more patients began to take high potency statins (28.6%). Figure 1 shows that adding antiplatelet drugs (aspirin or P2Y12 inhibitors), adding statins or switching to a high potency statin was significantly more frequent in patients with CAD demonstrated on the CTA. When normal coronary arteries are shown in the CTA, clinicians discontinue antiplatelet drugs in only 20% of these patients. However, only 6/13 patients (46.2%) from the group of non-obstructive coronary atherosclerosis were sent home with antiplatelet drugs, only 4/13 patients (30.7%) were prescribed statins by their clinicians after knowing these CTA results and only 5/13 patients (38.5%) were switched to a high potency statin. CONCLUSIONS. The coronary CTA results can help clinicians to guide treatment in order to prevent cardiovascular events in patients with demonstrated coronary artery disease. Although in our daily clinical practice we tend to do so, the percentage of patients with optimized treatment is still low. Figure 1 P684 https://esc365.escardio.org/Presentation/217623/abstract Secondary prevention prescribing in a medium sized district general hospital - Implications of adopting latest evidence base practice A Manukyan1, R Duffield1, N Yarahmadi1, T Edwards1 1Dorset County Hospital, Dorchester, United Kingdom of Great Britain & Northern Ireland Topic: Secondary Prevention Background: New evidence from PEGASUS-TIMI 54 trial has shown benefit from longer term Dual Antiplatelet Therapy (DAPT) with Ticagrelor post myocardial infarction (MI) and the COMPASS study has shown benefit from low dose Rivaroxaban in addition to aspirin for stable coronary artery disease (CAD). There is likely an overlap of these patient groups more than 1 year post MI. Guidelines for additional antithrombotic therapy are not widely adopted at our institution. Purpose: To assess the clinical benefits and the practical and financial implications of adopting the European guidelines for long term DAPT and low dose Rivaroxaban to our local population for secondary prevention of cardiovascular disease.㨠Method: Of 1238 patients, coded as ACS or CAD admitted between April 2017 - April 2018, a random sample of 150 records were selected (90% accuracy for extrapolation to total cohort). Eligibility for long term DAPT (Group 1) and Rivaroxaban (Group 2) was assessed according to the inclusion criteria of the randomised trials. Patients were also grouped based on DAPT score ≥2 (Group 3) and DAPT score <2 yet eligible for Rivaroxaban (Group 4). Prescribing cost for 1 year was estimated from the retail cost of the drugs adjusting for noncompliance rates in the trials. Clinical benefits were extrapolated from the absolute risk reduction in the trials. Results: See table below. Conclusion: Majority of patients admitted with a coded diagnosis of CAD would be eligible for additional secondary prevention. Many patients more than 1 year post MI are eligible for both DAPT and low dose Rivaroxaban. A policy of DAPT for patients with DAPT score ≥2 and low dose Rivaroxaban for the remaining patients who meet criteria would be optimal. Potential implications to our institution would be 953 extra appointments per year and a prescribing cost of £590380. Clinical benefits may be 12 less cases of death, stroke or MI and reductions in hospitalisation. Limitations of this study are the small sample size to estimate numbers and the prescribing rates. Prescribing rates, and therefore costs, are likely to be less than estimated from randomised trials but this study provides useful information for service development. Total of sample Estimated cost to total population Cases of cardiovascular death, MI and stroke risk reduction Group 1 Long term DAPT 74 / 150 49.3% £395,731.97 7.5 Group 2 Rivaroxaban 108 / 150 72% £537,800.70 11.6 Group 3 DAPT score ≥2 35 / 150 23.3 % £187029.51 3.5 Group 4 DAPT score <2 eligible for Rivaroxaban 81/ 150 54% £403,350.53 8.7 Total Group 3 + Group 4 116/ 150 77.3% £590,380.04 12.2 Total of sample Estimated cost to total population Cases of cardiovascular death, MI and stroke risk reduction Group 1 Long term DAPT 74 / 150 49.3% £395,731.97 7.5 Group 2 Rivaroxaban 108 / 150 72% £537,800.70 11.6 Group 3 DAPT score ≥2 35 / 150 23.3 % £187029.51 3.5 Group 4 DAPT score <2 eligible for Rivaroxaban 81/ 150 54% £403,350.53 8.7 Total Group 3 + Group 4 116/ 150 77.3% £590,380.04 12.2 Open in new tab Total of sample Estimated cost to total population Cases of cardiovascular death, MI and stroke risk reduction Group 1 Long term DAPT 74 / 150 49.3% £395,731.97 7.5 Group 2 Rivaroxaban 108 / 150 72% £537,800.70 11.6 Group 3 DAPT score ≥2 35 / 150 23.3 % £187029.51 3.5 Group 4 DAPT score <2 eligible for Rivaroxaban 81/ 150 54% £403,350.53 8.7 Total Group 3 + Group 4 116/ 150 77.3% £590,380.04 12.2 Total of sample Estimated cost to total population Cases of cardiovascular death, MI and stroke risk reduction Group 1 Long term DAPT 74 / 150 49.3% £395,731.97 7.5 Group 2 Rivaroxaban 108 / 150 72% £537,800.70 11.6 Group 3 DAPT score ≥2 35 / 150 23.3 % £187029.51 3.5 Group 4 DAPT score <2 eligible for Rivaroxaban 81/ 150 54% £403,350.53 8.7 Total Group 3 + Group 4 116/ 150 77.3% £590,380.04 12.2 Open in new tab P745 https://esc365.escardio.org/Presentation/221564/abstract Fear of movement after an acute cardiac event, experiences, beliefs, barriers and support needs in patients and their caregiver. P Keessen1, CHM Latour1, B Visser1, ICD Van Duijvenbode1, A Van Proosdij1, D Reen1, WJM Scholte Op Reimer2 1Amsterdam University of Applied Sciences , ACHIEVE - Amsterdam Centre for Innovative Health Practice, Amsterdam, Netherlands (The) 2Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The) Funding Acknowledgements: NWO teachers grant Topic: Secondary Prevention Background: Fear of movement (Kinesiophobia) after an acute cardiac hospitalization (ACH) is associated with reduced physical activity (PA) and non-adherence to cardiac rehabilitation (CR). In order to stimulate PA and the uptake of CR, more insight is needed in 1) experiences, beliefs and barriers associated with kinesiophobia and 2) support needs in patients and spouses concerning PA and CR. Purpose: To investigate factors (i.e. experiences, beliefs and barriers) related to the presence of kinesiophobic traits after an ACH. Methods: 16 participants (9 women, mean age 63) with an ACH were included in this study. Nine patients were identified with high levels of kinesiophobia (Tampa Scale for Kinesiophobia Diutch version >28). Patients participated in semi-structures interviews 2-3 weeks after hospital discharge. All interviews were analyzed with an inductive content analysis. Results: Six main themes were identified as experiences, beliefs and barriers related to kinesiophobia: 1) negative experience hospital, 2) lack of information and support, 3) distressing body signals, 4) Fear of injury, 5) passive coping style and 6) Lack of support. Patients formulated the following support needs: 1) consistent information about their cardiac event/intervention and building up PA after ACH, 2) contact with a health care professional during and after hospital discharge to be reassured and develop and active lifestyle. Conclusion: This study reveals important factors that are related to kinesiophobia and describes the support needs of patients with kinesiophobia. These findings can be used to develop a tailored intervention to prevent kinesiophobia and potentially bridge the gap from hospital discharge to CR. Kinesiophobia themes P748 https://esc365.escardio.org/Presentation/217017/abstract Application of ESPVR in preventive cardiology RM Rachad M Shoucri1 1Royal Military College of Canada, Kingston, Canada Topic: Secondary Prevention Background: The End-Systolic Pressure-Volume Relation (ESPVR) is the relation between pressure Pm and volume Vm in the left ventricle of the heart when the myocardium reaches its maximum state of activation near end-systole. A mathematical relation between Pm and Vm has been derived that describes the ESPVR. Three main areas under the ESPVR are SW = Pm (Ved ã Vm) the stroke work, PE =(1/2) Pm (Vm ã Vom) corresponds to energy absorbed by the internal metabolism of the myocardium, and CW = (1/2) (Pisom ã Pm) (Ved ãVm) corresponds to energy absorbed by the passive medium of the myocardium, TW = SW + PE + CW is the total area under the ESPVR (Ved = end-diastolic volume; Vom = intercept of the ESPVR with the volume axis when Pm = 0; Pisom = peak active pressure developed by the myocardium). Purpose: The mathematical formalism derived is applied to clinical data taken from the literature in order to study the ESPVR. A relation between the ejection fraction (EF) and the percentage occurrence of heart failure (HF) has been extended in a way to obtain new relations between the percentage occurrence of HF and parameters describing the ESPVR. As an example the figure shows the relation between percentage occurrence of HF and Emax/eam (left side) (Emax = max. ventricular elastance, eam = arterial elastance). Note the minimum of the curve around the normal group (*), other clinical groups are scattered around, like aortic stenosis (o). Methods: When ratio of pressures is used, numerical calculation can be carried out on clinical data obtained in a non-invasive way, otherwise Pm can be estimated from blood pressure in a non-invasive way. The right side of the figure shows the calculation of the energetic efficiency of the myocardium = (a CW + b SW)/TW (energy absorbed by the load / total energy). Note that the maximum efficiency corresponds to the normal clinical group (*) observed around Emax/eam = 2. Results: Results indicate that the EF is just one index of many indexes that can be calculated in a non-invasive way in order to assess the performance of the left ventricle. It is observed that bivariate (or multivariate) analysis of data gives better segregation between different clinical groups than univariate analysis. Calculation indicates that ESPVR allows a classification of the state of the myocardium into three states: SW < SWx (normal state), SW ≈ SWx (mildly depressed state of the heart), SW > SWx (severely depressed state of the heart) (SWx =max. stroke work observed around Emax/eam = 1). Conclusion: No one index gives a perfect segregation between all clinical groups, some indexes are better than others depending on the clinical groups considered. The study indicates that important information can be derived from the parameters describing the ESPVR for diagnostic and prognostic applications, and can help in understanding the problem of HFpEF. occurrence of HF & efficiency v. Emx/eam P749 https://esc365.escardio.org/Presentation/217341/abstract Effectiveness in improving aerobic capacity and cardiovascular risk factors according to type of physical training in a cardiac rehabilitation program in patients with coronary heart disease NG Uribe Heredia1, H Alvaro Fernandez1, LG Piccone Saponara2, E Vallejo Sacristan1, N Curvi Maldonado1, M Calvo Prieto1, R Arroyo Espliguero3, M Viana Llamas3, B Garcia Magallon3, C Toran Martinez3, A Castillo Sandoval3, A Perez Sanchez3, ME Jimenez Martinez3, MA San Martin Gomez3, JL Balaguer Recena3 1University Hospital of Guadalajara, Cardiac Rehabilitation Unit, Guadalajara, Spain 2Hospital General de Ciudad Real, Nefrology, Ciudad Real, Spain 3University Hospital of Guadalajara, Cardiology department, Guadalajara, Spain Topic: Secondary Prevention Introducction: Interval training (IT) consists of alternating a medium intensity exercise for 1-2 minutes to increase to maximum intensity tolerated during the same time or somewhat less. This type of aerobic training has allowed healthy people to activate metabolism much more. Continuous training (CT) is the training that most of the cardiac rehabilitation programs (CRHP) perform in our environment, it is a low or medium intensity exercise. The objective of our study is to determine if there are differences in the gain of oxygen consumption and in the control of cardiovascular risk factors (CVRF) according to the type of training. Methods: Prospective observational study. Patients were included consecutively in a CRHP between March 2015 to July 2019, performing daily exercise for 8 weeks (phase II of the CRHP). An ergometry was performed with expired gas analysis and blood analysis before and after phase II. Results: 278 patients were analyzed, 170 patients (61.2%) in CT and 108 in the IT (38.8%). The average age was 57,9±9,2 years and LVEF half 56,8±9,7%. Regarding baseline characteristics such as age, BMI, CVRF and LVEF between the 2 types of training, there were no statistically significant differences, only difference in the percentage of active smokers was observed in the interval group (62,9% Vs 80,6%; p=0,002). The comparison of the differences in the variables are detailed in the Table 1. Conclusions: In our study, interval training showed a greater increase in peak oxygen consumption and an improvement in anaerobic threshold compared to continuous training, as well as a smaller reduction in the abdominal perimeter; however, it did not show significant differences in the control of the different CVRFs, both were equally effective. PARAMETERS CONTINUOUS INTERVAL P Abdominal circumference (cm) -1,19 ± 2,5 -1.9 ± 2,1 0,02 BMI -0,33 ± 0,78 -0,47 ± 0,65 0,09 LDL (mg/dL) -12,4±31,1 -8,3±21,7 0,24 HDL (mg/dL) 2,6 ± 6,9 1,8 ± 5,3 0,37 B- BNP (pg/mL) -16,4 ± 90,7 -29,2 ± 169,9 0,49 VO2 peak (ml/kg/min) 1,9 ± 3,0 2,9 ± 3,2 0,02 Foretold VO2 (%) 6,7 ± 11,9 9,9 ± 12,8 0,05 Anaerobic threshold (ml/kg/min) 0,3 ± 4,1 1,9 ± 4,5 0,007 PO2 at máximum charge (ml/lat) 0,24 ± 6,68 1,21 ± 1,77 0,13 Foretold PO2 (%) 6,4 ± 12,1 9,6 ± 12,5 0,06 PARAMETERS CONTINUOUS INTERVAL P Abdominal circumference (cm) -1,19 ± 2,5 -1.9 ± 2,1 0,02 BMI -0,33 ± 0,78 -0,47 ± 0,65 0,09 LDL (mg/dL) -12,4±31,1 -8,3±21,7 0,24 HDL (mg/dL) 2,6 ± 6,9 1,8 ± 5,3 0,37 B- BNP (pg/mL) -16,4 ± 90,7 -29,2 ± 169,9 0,49 VO2 peak (ml/kg/min) 1,9 ± 3,0 2,9 ± 3,2 0,02 Foretold VO2 (%) 6,7 ± 11,9 9,9 ± 12,8 0,05 Anaerobic threshold (ml/kg/min) 0,3 ± 4,1 1,9 ± 4,5 0,007 PO2 at máximum charge (ml/lat) 0,24 ± 6,68 1,21 ± 1,77 0,13 Foretold PO2 (%) 6,4 ± 12,1 9,6 ± 12,5 0,06 Open in new tab PARAMETERS CONTINUOUS INTERVAL P Abdominal circumference (cm) -1,19 ± 2,5 -1.9 ± 2,1 0,02 BMI -0,33 ± 0,78 -0,47 ± 0,65 0,09 LDL (mg/dL) -12,4±31,1 -8,3±21,7 0,24 HDL (mg/dL) 2,6 ± 6,9 1,8 ± 5,3 0,37 B- BNP (pg/mL) -16,4 ± 90,7 -29,2 ± 169,9 0,49 VO2 peak (ml/kg/min) 1,9 ± 3,0 2,9 ± 3,2 0,02 Foretold VO2 (%) 6,7 ± 11,9 9,9 ± 12,8 0,05 Anaerobic threshold (ml/kg/min) 0,3 ± 4,1 1,9 ± 4,5 0,007 PO2 at máximum charge (ml/lat) 0,24 ± 6,68 1,21 ± 1,77 0,13 Foretold PO2 (%) 6,4 ± 12,1 9,6 ± 12,5 0,06 PARAMETERS CONTINUOUS INTERVAL P Abdominal circumference (cm) -1,19 ± 2,5 -1.9 ± 2,1 0,02 BMI -0,33 ± 0,78 -0,47 ± 0,65 0,09 LDL (mg/dL) -12,4±31,1 -8,3±21,7 0,24 HDL (mg/dL) 2,6 ± 6,9 1,8 ± 5,3 0,37 B- BNP (pg/mL) -16,4 ± 90,7 -29,2 ± 169,9 0,49 VO2 peak (ml/kg/min) 1,9 ± 3,0 2,9 ± 3,2 0,02 Foretold VO2 (%) 6,7 ± 11,9 9,9 ± 12,8 0,05 Anaerobic threshold (ml/kg/min) 0,3 ± 4,1 1,9 ± 4,5 0,007 PO2 at máximum charge (ml/lat) 0,24 ± 6,68 1,21 ± 1,77 0,13 Foretold PO2 (%) 6,4 ± 12,1 9,6 ± 12,5 0,06 Open in new tab P750 https://esc365.escardio.org/Presentation/217359/abstract Myocardial revascularization in octogenarian patients: the incidence of frailty syndrome, cognitive impairment and standard cardiovascular risk factors T Petrova1, E Lubinskaya2, E Demchenko2 1Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation 2Almazov National Medical Research Centre, Saint Petersburg, Russian Federation Topic: Secondary Prevention Background: Coronary heart disease (CHD) increases rapidly with advancing age and remains the major cause of death among elderly. The number of elderly and senile patients undergoing myocardial revascularization is gradually increasing. The frailty syndrome in patients with CHD is an important risk of incomplete rehabilitation and worse outcomes after surgery. Purpose: To identify the prevalence of frailty syndrome, cognitive functions and risk-factors modification in CHD octagenarian patients referred to myocardial revascularization Methods: 102 Russian octagenarian CHD patients (48% male, middle age - 84,4±2,7 y.o.) admitted for myocardial revascularization were included in our study. To identify frailty syndrome, cognitive impairment, anxiety or depression we used screening questionnaire validated in the Russian Federation "Age is not an obstacle”, Clinical Frailty Scale, Mini-Cog, MoCA, MMSE, handgrip test, one-leg balancing test, Hospital Anxiety and Depression Scale (HADS), SF-36, Benton visual retention test. Information about medical treatment, drug therapy, results of laboratory and instrumental examinations before surgery was obtained by medical history taking and analysing medical records. Results: At the time of surgery 14,7% of patients smoked, 30,4% of them had diabetes, 36,3% - obesity; 94,1% - arterial hypertension; 47,1% - osteoporosis; 51% - myocardial infarction, 14,7% - stroke, 7,8% - bone fractures in the past. In 55,9% patients highly probable frailty syndrome were revealed. Frailty syndrome was diagnosed in 25,5% of patients, anxiety ã in 25.5%, depression - in 19.6%. Mild cognitive impairment according to the MoCA and MMSE was in 58.8% cases, dementia was not detected. While assessing the quality of life of patients at the pre-hospital stage, it pays attention to the significant decrease in the Physical and Role-Physical Functioning, a strong Bodily pain. Conclusion. Mild cognitive impairment was in more than half of patients. One quarter of patients have frailty syndrome and anxiety, fifth part ã depression, which is higher than similar data in younger CHD patients. The received data can help in assessment of patientã s physical, mental and emotional status before myocardial revascularization, and must be taken into account when developing prehabilitation and early rehabilitation program to recuse the risk of complications and improvement of surgery effectiveness in octogenarian CHD patients P210 https://esc365.escardio.org/Presentation/221665/abstract Frequency and dosing impact of the novel lipid lowering agent proprotein convertase subtilisin-kexin type 9 inhibitors to reduce low density lipoprotein cholesterol in high risk patients MR Poudel1, D Stoyanova1, R Gottfried1, TK Rudolph1, V Rudolph1, KP Mellwig1 1Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Clinic for General and Interventional Cardiology/Angiology, Bad Oeynhausen, Germany Topic: Lipids Background: Elevated levels of lowã density lipoprotein cholesterol (LDLã C) are well established to be associated with the development of atherosclerotic cardiovascular disease (ASCVD). In large controlled clinical trials novel lipid lowering agents proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK-9) have been evaluated in selective patients showing a robust LDL-C lowering effects up to 50-60%. Additionally, reduction in mortality and a favourable safety profile have been shown. We sought to analyze whether interval prolongation and dose increase of the PCSK9 inhibitors has results in further LDL-C reduction. Methods: 54 patients have been prospectively enrolled (mean age 61.92 ± 10.04 (33 – 77) years, 49.02 % male) with documented atherosclerosis and/or familial hypercholesterolemia, in this observational registry at our center. All patients fulfilled current indications for PCSK9 inhibitor therapy according to the German Federal Joint Committee (G-BA) standards. Follow-up of our patient cohort was two years with repeated lipid analyses in a 2-week interval. Cardiovascular events as well as drug side effects were recorded according to a detailed questionnaire. Results & laboratory assessments: 80.8% patients had severe coronary artery disease (CAD), 9.8% patients had peripheral artery disease and 15.6% patients had extracranial carotid stenoses. 3.7% patients suffered from familial hypercholesterolemia presenting without manifest atherosclerosis. 66.6 % patients had recently undergone percutaneous coronary intervention (PCI), and 35.2% patients coronary artery bypass graft surgery. 21.5 % patients were under statin therapy at the beginning of our study, but failed to achieve target LDL values, while the remaining patients had a statin intolerance. 68.6 % patients were treated with alirucumab, 37.5 % pats. received double dose of alirocumab (300 mg) after 4 weeks in every 4 weeks (E4W). PCSK9 inhibitor therapy resulted in an overall LDL reduction after 4 weeks to 80.6 ± 45.3 mg/dl (p<0.0001), but showed no further reduction after 52 weeks (76.3±41.0 mg/dl (p=0.32) and 104 weeks (82.4±26.0 mg/dl (p=0.28), which translates into a total LDL reduction of 48.0%. The achieved reduction of LDL-C after adjustment of both PCSK-9 inhibitors from single dose in E2W to double dose in EW4 was similar, LDL-C reduction of 49.0%. (p=0.998). Due to significant side effects such as serious depression, fulminant dermatitis, hair loss and myalgia PCSK9 therapy had to be interrupted in 6 patients. Conclusion: PCSK9-inhibitors therapy leads to a statistically significant LDL-C level reduction of 48.0% within 4 weeks of therapy, while this effect was no longer statistically significant after one and two years (p=0.36). In both investigated PCSK9-inhibitors adjustment from single to double dose did not further reduce LDL-C. Reduction of LDL-C 49.0%) (p=0.998) but it was accompanied by 11.1% more treatment-related adverse events. P211 https://esc365.escardio.org/Presentation/217079/abstract New ESC guidelines on dyslipidaemias: are PCSK9 inhibitors up to the task? I Irene Marco Clement1, DI Poveda1, L Martin1, R Dalmau1, A Castro1, C Merino1, F Moreno Ramos1, E Arbas1, D Tebar1, LA Martinez1, L Rodriguez1, JM Garcia De Veas1, JL Lopez Sendon1 1University Hospital La Paz, Madrid, Spain Topic: Lipids Introduction: New European lipid guidelines have considerably lowered target levels for LDL cholesterol (LDLc). PCSK9 inhibitors (PCSK9i) represent our strongest weapon to lower LDLc levels in high or very high cardiovascular (CV) risk patients when statins and ezetimibe are insufficient or when faced to statin intolerance. Our aim was to evaluate LDLc reduction with PCSK9i in our clinical practice in the light of new recommendations. Methods: Observational, retrospective study using a prospective database of patients who started treatment with PCSKi from October 2016 and October 2019. PCSKi treatment is restricted in our center to patients at high or very high CV risk with LDLc >100 mg/dl despite maximum tolerated statin and ezetimibe dose or statin intolerance. Patients were randomly assigned to receive evolocumab or alirocumab. Results: We included 86 patients (36% women, age 62.0±11.5 years). Baseline characteristics are summarized in Table 1. After 3-6 months, LDLc levels decreased to 66.2±36.5 mg/dl, with a mean reduction of 81.9±51.7 mg/dl (p<0.001). Among patients at very high CV risk (68, 79.1%) LDLc <50 mg/dl was achieved in 47.3% and LDLc<70 mg/dl in 69.1% of cases. LDLc<70 mg/dl was reached in 60% of patients at high CV risk. During PCSK9i treatment, ezetimibe was discontinuated in 4 patients and statin was lowered or discontinuated in 4 patients. It was noted that alirocumab was only titrated from 75 mg to 150 mg in 8 patients. Conclusions: Despite PCSK9i consistently reducing LDLc levels, only half of the patients at very high CV risk reached target levels below 50 mg/dL. Closer follow-up is essential in order to up-tritate alirocumab and discontinuation of statins or ezetimibe should always be avoided. Total (n=86) Alirocumab (n=43) Evolocumab (n=43) p Age, years (mean±SD) 62.0±11.5 59.3±13.3 64.7±8.8 0.03 Women, n(%) 31 (36) 13 (30.2) 18 (41.9) 0.261 Basal LDLc (mean±SD) 142.9±48.1 131.8±35.4 154.1±56.3 0.036 Peripheral artery disease, n(%) 8 (9.3) 4 (9.3) 4 (9.3) 1 Coronary heart disease, n(%) 65 (75.6) 35 (81.4) 30 (69.8) 0.209 Cerebrovascular disease, n(%) 4 (4.7) 2 (4.7) 2 (4.7) 1 Familiar hypercholesterolemia, n(%) 32 (37.2) 14 (32.6) 18 (41.9) 0.372 Statin intolerance, n(%) 24 (27.9) 14 (32.6) 10 (23.3) 0.336 Ezetimibe, n(%) 67 (77.9) 29 (67.4) 38 (88.4) 0.019 Treatment discontinuation, n(%) 5 (5.8) 2 (4.7) 3 (7) 0.314 Total (n=86) Alirocumab (n=43) Evolocumab (n=43) p Age, years (mean±SD) 62.0±11.5 59.3±13.3 64.7±8.8 0.03 Women, n(%) 31 (36) 13 (30.2) 18 (41.9) 0.261 Basal LDLc (mean±SD) 142.9±48.1 131.8±35.4 154.1±56.3 0.036 Peripheral artery disease, n(%) 8 (9.3) 4 (9.3) 4 (9.3) 1 Coronary heart disease, n(%) 65 (75.6) 35 (81.4) 30 (69.8) 0.209 Cerebrovascular disease, n(%) 4 (4.7) 2 (4.7) 2 (4.7) 1 Familiar hypercholesterolemia, n(%) 32 (37.2) 14 (32.6) 18 (41.9) 0.372 Statin intolerance, n(%) 24 (27.9) 14 (32.6) 10 (23.3) 0.336 Ezetimibe, n(%) 67 (77.9) 29 (67.4) 38 (88.4) 0.019 Treatment discontinuation, n(%) 5 (5.8) 2 (4.7) 3 (7) 0.314 Open in new tab Total (n=86) Alirocumab (n=43) Evolocumab (n=43) p Age, years (mean±SD) 62.0±11.5 59.3±13.3 64.7±8.8 0.03 Women, n(%) 31 (36) 13 (30.2) 18 (41.9) 0.261 Basal LDLc (mean±SD) 142.9±48.1 131.8±35.4 154.1±56.3 0.036 Peripheral artery disease, n(%) 8 (9.3) 4 (9.3) 4 (9.3) 1 Coronary heart disease, n(%) 65 (75.6) 35 (81.4) 30 (69.8) 0.209 Cerebrovascular disease, n(%) 4 (4.7) 2 (4.7) 2 (4.7) 1 Familiar hypercholesterolemia, n(%) 32 (37.2) 14 (32.6) 18 (41.9) 0.372 Statin intolerance, n(%) 24 (27.9) 14 (32.6) 10 (23.3) 0.336 Ezetimibe, n(%) 67 (77.9) 29 (67.4) 38 (88.4) 0.019 Treatment discontinuation, n(%) 5 (5.8) 2 (4.7) 3 (7) 0.314 Total (n=86) Alirocumab (n=43) Evolocumab (n=43) p Age, years (mean±SD) 62.0±11.5 59.3±13.3 64.7±8.8 0.03 Women, n(%) 31 (36) 13 (30.2) 18 (41.9) 0.261 Basal LDLc (mean±SD) 142.9±48.1 131.8±35.4 154.1±56.3 0.036 Peripheral artery disease, n(%) 8 (9.3) 4 (9.3) 4 (9.3) 1 Coronary heart disease, n(%) 65 (75.6) 35 (81.4) 30 (69.8) 0.209 Cerebrovascular disease, n(%) 4 (4.7) 2 (4.7) 2 (4.7) 1 Familiar hypercholesterolemia, n(%) 32 (37.2) 14 (32.6) 18 (41.9) 0.372 Statin intolerance, n(%) 24 (27.9) 14 (32.6) 10 (23.3) 0.336 Ezetimibe, n(%) 67 (77.9) 29 (67.4) 38 (88.4) 0.019 Treatment discontinuation, n(%) 5 (5.8) 2 (4.7) 3 (7) 0.314 Open in new tab P218 https://esc365.escardio.org/Presentation/217609/abstract Achievement of low-density lipoprotein cholesterol target values in light of the 2019 ESC dyslipidaemia guidelines: real world data from an ambulatory cardiovascular rehabilitation program M Matthias Haegele1, S Frey1, R Lange1, T Burkard1, O Pfister1 1University Hospital Basel, Basel, Switzerland Topic: Lipids Background: Although strict low-density lipoprotein cholesterol (LDL-C) control is a cornerstone of secondary prevention, recommended LDL-C guideline targets are insufficiently achieved in clinical practice. With the advent of the latest dyslipidaemia guidelines of the European Society of Cardiology (ESC), the recommended LDL-C target has become even more ambitious (LDL-C <1.4 mmol/L). To date, the percentage of patients achieving this new LDL-C target in real world secondary prevention programs remains unknown. Purpose: To evaluate patient characteristics and target achievement rates according the 2016 and 2019 ESC dyslipidaemia guidelines in a cohort of patients who completed an ambulatory cardiovascular rehabilitation program (CR). Methods: We conducted a retrospective analysis of patients, who completed a 12-week ambulatory CR due to Coronary Artery Disease (CAD) in 2018. Primary endpoint was percentage of patients achieving the ESC guideline targets of the 2016 and 2019 guidelines. Secondary endpoint was difference in patient and medication characteristics. Results: 198 patients completed the CR (87.9% male). Median age was 61 years (IQR 54-69) and 76.3% suffered from ACS (STEMI 55.8%, NSTEMI 44.2%). After CR statin therapy was prescribed to 96.0%, high potency statins to 91.4%, Ezetimibe to 13.6%, PCSK9-inhibitors to 1% and Fibrate to 0.5% of patients. Seven of 198 patients (3.5%) had statin side effects. Median LDL-C at baseline was 1.6mmol/L (IQR 1.2-2) and decreased to 1.5mmol/L (IQR 1.2-1.8) after CR (p=0.017). 139 patients (75.1%) reached the 2016 ESC guideline target of <1.8mmol/L LDL-C and 82 patients (44.3%) reached the 2019 ESC target of <1.4mmol/L. When stratifying the cohort for LDL-C at termination of CR into three groups (>1.8mmol/L (group 1), 1.8-1.4mmol/L (group 2), <1.4mmol/L (group 3)), group 1 reveals more female patients (p=0.008) and more patients with a positive family history for CAD (p=0.012). Furthermore, group 3 contains more patients who have had ACS (p=0.013) and STEMI (p=0.014). Considering medication, group 1 had more Statin side effects (p=0.001) and more Ezetimibe therapy (p=0.004), whereas group 3 had more high potency Statins (p=0.013). Conclusions: This analysis reveals a high rate of lipid lowering therapy as well as high percentage of LDL-C control in a cohort of CAD patients completing CR (75.1% target achievement according the 2016 guidelines). Surprisingly, analysis also revealed a 44.3% target achievement rate according the 2019 guidelines. Patients with poor LDL-C control in this cohort were more often female and had less ACS and STEMI. Furthermore, poor LDL-C control was associated with more frequent Statin side effects and more Ezetimibe prescription. These patients could potentially benefit from PCSK9-inhibitor therapy. P219 https://esc365.escardio.org/Presentation/221573/abstract LDL> 190 mg/dl cholesterol, high-risk patients: what are their characteristics and treatment? GA Gustavo Anibal Cortez Quiroga1, AB Diaz Caler1, C Rus Mansilla1, J Leon Dominguez1, MJ Nozal Martinez1 1HOSPITAL ALTO GUADALQUIVIR, Andújar, Spain Topic: Lipids Introduction: The AHA/ACC guidelines on the management of blood cholesterol (2013 and 2018) classified the LDL-c >190 mg/dl as high-risk patients, with the indication of high-intensity statins. Recently the 2019 ESC guidelines also classify these patients as high cardiovascular (CV) risk. Objective: we want to know about the characteristics and treatment of these patients.Methods: retrospectively, those patients with LDL> 190 mg/dl were selected, and their lipid profile and treatment evolution were followed over time. Results: Between July 1, 2017, and June 31, 2018, 31784 lipid profiles were performed, of which 301 (0.94%) had LDL-c> 190 mg/dl without secondary cause. The mean age was 57.9 (±12) years old, 53,3% were women, with an average LDL-C of 212 (±25) mg/dl, with an average total cholesterol of 293 (±54) mg/dl, 45,2% with triglycerides greater than 200 mg/dl, and 12.6% with low HDL-c. 12.3% were diabetics, 16.6% smokers, 39.2% hypertensive and 45.2% with no other cardiovascular risk factor. 85% has a high CV risk, 15% very high CV risk, 6.3% with documented CV disease. 79% of patients were never seen by cardiology or vascular risk unit. At the time of the lipid profile, 19.5% were treated with statins, but 55% of these patients had ever received statins. After the index lipid profile, 67% were treated with statins (24.5% high, 68.6% moderate and 7% low-intensity), 7.7% fibrates, 6% ezetimibe and 0.6% IPCSK9. During the follow-up, 77.4% had at least one other lipid profile, with a 30.8% reduction in LDL-c (211 mg/dl vs 146 mg/dl, p < 0.001), 15,9% achieved the goal of the 2016 ESC guide and only 2.1% of the 2019 ESC guide, 15% persisted with LDL-c> 190 mg/dl, and 66.5% underwent therapeutic inertia (51.6% same treatment, 21.3% treatment were suspended, 16.1% continued without treatment and 11 % treatment was reduced). In those who took an active behavior, 26.3% vs. 5.8% achieved the 2016 ESC goals (p <0.001), and in this group, those who were with high-intensity statins 50% achieved the goal vs 30% who were with moderately low-intensity statins (p <0.001) Conclusions: This is a very poorly treated and controlled population, with fluctuating lipid-lowering treatment, in which the health group is not aware of its risk since it does not exert active behavior in the reduction of LDL-c. P220 https://esc365.escardio.org/Presentation/217069/abstract Lipid-lowering Therapy (LLT) during and after cardiac rehabilitation (R) in 1,100 patients with coronary heart disease: the LLT-R registry C Bongarth1, H Voeller2, K Eckrich3, V Heinze4, B Schwaab5, M Guha6, A Axel Schlitt4 1Clinic Hohenried, Bernried, Germany 2University of Potsdam, Potsdam, Germany 3Clinic Tharandter Wald - Hetzdorf, Halsbrücke, Germany 4Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany 5Curschmann-Clinic , Timmendorfer Strand, Germany 6Rehabilitation Clinic Sendesaal, Bremen, Germany Funding Acknowledgements: This registry was supported by an unrestricted grant from Sanofi-Aventis Germany Topic: Lipids Background and objective: Cardiac rehabilitation, as a part of tertiary prevention, improves quality of life and prognosis in patients with coronary heart disease (CHD) through interventions that support patients in abstaining from nicotine use, complying with exercise and nutritional recommendations, and, in particular, in adhering to drug therapy. Methods: The primary objective of this prospective, multicenter registry study from six German rehabilitation clinics was to record how lipid-lowering therapy (LLT) was adapted and maintained according to current guidelines from the ESC during and after cardiac rehabilitation in 1,100 patients with CHD over a period of 12 months after discharge. Results: The mean age was 63.4 ± 10.4 years, the mean BMI 28.5 ± 4.7 kg / m2, and 24.1% of the patients were female. Additionally, 12.2% were active smokers, 91.6% reported dyslipoproteinemia, 33.9% suffered from diabetes mellitus, and 86.5% had arterial hypertension. In the majority of patients, the main indications for rehabilitation treatment were NSTEMI (31.6%), STEMI (29.6%), or after CABG surgery (26.4%). The proportion of statin-treated patients increased from 96.3% at admission to 98.4% at discharge (p<0.001 compared to admission), falling to 96.3% and 94.1% after three and 12 months, respectively. Overall, 8.9% of patients were taking ezetemibe at admission, 28.5% at discharge (p<0.001 compared to admission), 23.5% at three months, and 25.8% at 12 months (Figure 1). PCSK9 inhibitors were used at all times in 0.1-0.3% of patients (Figure 1). After adjusting LLT during cardiac rehabilitation, median LDL values of 2.27mmol/l (1.80/2.84) at admission, 1.97mmol/l (1.57/2.47) at discharge (p<0.001 compared to admission), 1.94mmol/l (1.57/2.49) at three months and 1.94mmol/l (1.53/2.40) at 12 months were observed. Conclusion: As part of cardiac rehabilitation, LLT can be effectively adapted, significantly reducing LDL cholesterol in patients with CHD. This multicenter registry study of six rehabilitation clinics in Germany shows that adhering to LLT is an effective part of cardiac rehabilitation. P221 https://esc365.escardio.org/Presentation/221658/abstract Cost effectiveness and freedom from apheresis through proprotein convertase subtilisin/kexine 9 Inhibitor in very high cardiovascular risk patients with lipid apheresis: 2-years real world experience MR Poudel1, D Stoyanova1, R Gottfried1, TK Rudolph1, V Rudolph1, KP Mellwig1 1Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Clinic for General and Interventional Cardiology/Angiology, Bad Oeynhausen, Germany Topic: Lipids Background: Efficacy of the novel lipid lowering medication, proprotein convertase subtilisin/kexine type 9 (PCSK-9) inhibitors have already been evaluated in large controlled clinical trials. They demonstrated robust low density lipoprotein cholesterol (LDL-C) lowering effects up to 50-60%. Lipid Apheresis (LA) is an important treatment for reducing LDL-C in patients with familial hypercholesterolemia (FH) and very high cardiovascular-risk patients, who did not achieve target LDL-C values recommended by current European Society of Cardiology (ESC) guidelines (< 55 mg/dl). LA is an extracorporeal technique selectively removing LDL-C, but also lipoprotein(a) (Lp(a). The LA is much more expensive than PCSK- 9 inhibitors and requires trained staff and appropriate facilities. The aim of this study was to evaluate the cost-effectiveness through PCSK9 inhibitor in LA patients who were free from LA or reduce LA interval. Patients and Methods: Twelve patients (m: 9, age 58.3±9.7 years) with multi vessel coronary heart disease CHD and multiple intervention before apheresis: PCI: 9 pats, CABG: 6 pats, PCI+CABG: 3 pat) underwent regular (once a week) lipid apheresis. We applied 140 mg of the PCSK9 inhibitor evolocumab subcutaneously at a 2-week interval after lipid apheresis. Prior to lipid apheresis, mean total cholesterol was 241±44 mg/dl, LDL-C 158±30 mg/dl and mean Lp(a) (5 pats) 83±8 mg/dl. The mean number of lipid apheresis procedures in these patients was 493 (range 34 – 1025) in last years with an at least 60% LDL-C reduction. Results: Only 2 weeks after the first administration of evolocumab under continued weekly lipid apheresis and statin/ezetimibe therapy, evolocumab was able to reduce total cholesterol by 34.6% and LDL-C by 48.9%, while Lp(a) reduction only amounted to 19.68%. This effect was still present after 4, 24, 52 and 105 weeks. After 8 weeks the interapheresis interval could be prolonged from 1 to 2 weeks in only 1 pat. In 3 (25%) pats. LA could be discontinued. The cost of the LA is currently about 950 euros per LA in our center. It corresponds to around 49.400 euros per annum. The cost of the PCSK-9 inhibitor is about 520,49 euros for 2 syringes (140mg evolocumab). This corresponds to around 6766,37 euros per annum. Conclusion and discussion: After two years an effective reduction of LDL-C by PCSK9 inhibitor administration was evident despite a prolonged apheresis interval or an interrupted apheresis therapy in a small collective. PCSK9 inhibitor evolocumab showed that a few numbers of patients (25% in our collective) with heterozygous familial hypercholesterolemia and very high cardiovascular-risk patients might either stop LA or reduce LA frequency. PCSK9 inhibitor did show very good cost-effectiveness (86.33% cost saving). This cost-effectiveness analysis may be informative for payers, health systems, and clinicians regarding the appropriate use and value of lipid-lowering therapies. P222 https://esc365.escardio.org/Presentation/221565/abstract Fulfillment of LDL-c objectives in cardiovascular secondary prevention, comparison of our cardiac rehabilitation unit versus Euroaspire V registry GA Gustavo Anibal Cortez Quiroga1, C Rus Mansilla1, C Rus Mansilla1, C Rus Mansilla1, C Recuerda Casado1, C Recuerda Casado1, C Recuerda Casado1, MJ Nozal Martinez1, MJ Nozal Martinez1, MJ Nozal Martinez1, AB Diaz Caler1, AB Diaz Caler1, AB Diaz Caler1, J Leon Dominguez1, J Leon Dominguez1, J Leon Dominguez1 1HOSPITAL ALTO GUADALQUIVIR, Andújar, Spain Topic: Lipids Introduction: The objectives of the ESC guide of dyslipidemia emphasize achieving a reduction of LDL-c greater than 50% and levels below 70 mg/dl, the new objectives of the 2019 guideline are more ambitious, LDL-c less than 55 mg/dl. Objective: Compare our population of the cardiac rehabilitation unit (CRU) versus the results of the Euroaspire V registry (E-V-R) Methods: We selected the patients of our CRU on the same dates of the E-V-R, we compared population characteristics, compliance with LDL-c targets less than 70 mg/dl, and the prescription of lipid-lowering drugs. Results: We compared 146 patients of our CRU versus 8261 patients of the E-V-R. The populations are not completely homogeneous, our population is a bit younger, with fewer % of women, but with a higher % of cardiovascular risk factors and a higher proportion of obese. Despite this, 84% of the patients in our unit meet the LDL-c objective vs 29% of the EVR (p <0.01), and 50% of the patients in our CRU achieve an LDL-c less than 55 m/dl. This is achieved by a higher prescription of high intensity statins (95.8% vs. 49.9%, p <0.01), higher association of ezetimibe/statins (45.8% vs. 8%, p <0.01), higher prescription of IPCSK9 (15.2% vs. 0.4%, p <0.01), lower number of patients without statins (1.4% vs. 16%, p <0.01). Conclusions: The fulfillment of the objectives of LDL-c is possible, it depends on the potency of statins used, the association of lipid-lowering agents and active behavior in the search for the fulfillment of the objectives CRU( 146 pts) Euroaspire-V (8261 pts) p Years 61,5(±15,3) 63,9(±9,6) <0,05 Women% 21,3 25,7 <0,05 Smokers 44 19 <0,05 Obesity% 45 38 <0,05 Hypertension% 61 42 <0,05 Diabetes% 33,5 29 <0,05 LDL<70mg/dl% 84 29 <0,05 CRU( 146 pts) Euroaspire-V (8261 pts) p Years 61,5(±15,3) 63,9(±9,6) <0,05 Women% 21,3 25,7 <0,05 Smokers 44 19 <0,05 Obesity% 45 38 <0,05 Hypertension% 61 42 <0,05 Diabetes% 33,5 29 <0,05 LDL<70mg/dl% 84 29 <0,05 Open in new tab CRU( 146 pts) Euroaspire-V (8261 pts) p Years 61,5(±15,3) 63,9(±9,6) <0,05 Women% 21,3 25,7 <0,05 Smokers 44 19 <0,05 Obesity% 45 38 <0,05 Hypertension% 61 42 <0,05 Diabetes% 33,5 29 <0,05 LDL<70mg/dl% 84 29 <0,05 CRU( 146 pts) Euroaspire-V (8261 pts) p Years 61,5(±15,3) 63,9(±9,6) <0,05 Women% 21,3 25,7 <0,05 Smokers 44 19 <0,05 Obesity% 45 38 <0,05 Hypertension% 61 42 <0,05 Diabetes% 33,5 29 <0,05 LDL<70mg/dl% 84 29 <0,05 Open in new tab P533 https://esc365.escardio.org/Presentation/223105/abstract Are we ready for the new dyslipidaemias guidelines? ID Poveda Pinedo1, I Marco1, C Merino1, V Barreto1, A Castro1, R Dalmau1, S Espinosa1, M Marin1, D Hernandez1, MJ Rodriguez1, A Araujo1, H Arranz1, E Arbas1, D Tebar1 1University Hospital La Paz, Madrid, Spain Topic: Lipids Introduction: European Society of Cardiology has recently published new guidelines for the management of dyslipidaemias to reduce cardiovascular risk. An LDL reduction ≥ 50% from baseline and an LDL-C goal of < 55 mg/dL are recommended for very high risk patients in secondary prevention. Purpose: Our aim is to analyse if this is a feasible target for a 302 patients cohort with atherosclerotic cardiovascular disease from a Cardiac Rehabilitation Unit in a tertiary centre in Spain. Methods: This is an observational study using a prospective database of patients who participated in a Cardiac Rehabilitation program between August 2004 and December 2018 and who undergo follow up in an outpatients Cardiology clinic. Results: There were 302 patients with mean age 68,82 (range 29 to 87); 83,4% males. The main diagnosis was angina for 8% patients, ST elevation myocardial infarction for 51,5% patients and non ST elevation myocardial infarction for 40,5%. There were 91 patients (30,1%) with LDL cholesterol serum level <55 mg/dL, 186 patients (61%) with LDL cholesterol above target level and 25 (8,3%) who missed control. Among those who did not reach goals, there were 47 (15,6%) with maximum titrated treatment (high intensity statin at maximum dose + ezetimbe) and who would not accomplish criteria for iPCSK9 prescription. Another 109 (36%) patients had treatment with maximum tolerated statin dose without ezetimibe, with average LDL serum levels 73,1 mg/dL. Last 32 (10,6%) patients had medium statin dose which could be increased to maximum tolerated dose. Conclusion: In our 302 cohort from a Cardiac Rehabilitation Unit 30,1% of patients accomplish LDL goal of new guidelines; 15,6% patients have not reached goal under maximum available treatment; 36% can only have up-titration treatment adding ezetimibe and 10,6 % are not yet under maximum statin dose treatment. P534 https://esc365.escardio.org/Presentation/221574/abstract LDL-cholesterol levels in secondary prevention in young patients after STEMI, regarding the new recommendations. J Borrego Rodriguez1, JC Echarte Morales1, E Sanchez Munoz1, R Bergel Garcia1, C Gonzalez Maniega1, J Maillo Seco1, PL Cepas Guillen2, P Mendendez Suarez1, L Garcia Bueno1, M Montes Montes1, MC Olalla Gomez1, ME Tundidor Sanz1, M Rodriguez Santamarta1, A Garcia Del Egido1, F Fernandez-Vazquez1 1HOSPITAL OF LEON (COMPLEJO ASISTENCIAL UNIVERSITARIO DE LEON), Leon, Spain 2Barcelona Hospital Clinic, Barcelona, Spain Topic: Lipids BACKGROUND: ST-elevation myocardial infarction (STEMI) is the main cause of cardiovascular mortality and morbidity, occurring mostly in patients older than 40 years of age. Nevertheless, when STEMI happens in young adults carries significant consequences: like psychological effects, and a worse treatment adherence, increasing in this way the risk of new future cardiovascular events. AIMS: The aim of the present study is to analyze the prevalence of dyslipidemia in this population at admission; and the last LDL-cholesterol levels regarding the new LDL-c goals recommendations. METHODS: A total of 101 consecutive young patients (aged ≤ 40 years) presenting with STEMI admitted at our center between 2006 and 2017 were included. There were no exclusion criteria. We collect demographic, clinical information and lab values at the time of the cardiovascular event, as well as during follow-up to nowadays. RESULTS: Out of 101 patients, 89 were male (88.1%). Mean age was 35.87 ± 4.07 years. Among the classic cardiovascular risk factors, dyslipidemia (44.5%) was the second one most prevalent in our cohort, after smoking (93.1%). 52.9% of patients had LDL-c levels above 115 mg/dl at the event, 84.3% of patients had HDL-c under 50 mg/dl, and 42.9% of patients had triglycerides (TG) above 150 mg/dl. High, Low-density lipoprotein (HDL and LDL), and TG mean values at admission were 38.7 ± 14.4, 114.3 ± 53.4, 192.60 ± 132.8 respectively. During following-up, 79.1% and 58.2% of patients have the last LDL-value above 55 mg/dl, and 70 mg/dl respectively; despite of statin, or statin plus ezetimibe (69.0% and 22.5%). Nobody takes PSK9 inhibitors. Thirteen patients (12.9%) suffered reinfarction during the follow-up. CONCLUSIONS: Dyslipidemia plays and essential role in STEMI in young adults which presents[c1] a percentage of reinfarction during mean follow-up that is not negligible. Insufficient control in LDL levels in this population has been observed, despite of treatment; being necessary a big effort in order to achieve the objectives. Last LDL-cholesterol value after STEMI. P535 https://esc365.escardio.org/Presentation/221590/abstract The impact of doctors' educational course on adherence to statin therapy YV Yulia Lukina1, NA Dmitrieva1, NP Kutishenko1, OV Lerman1, VP Voronina1, SY Martsevich1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation On Behalf of: on behalf of PRIORITAS study investigators Topic: Lipids Background: Typically, atherosclerotic diseases have little or no symptoms before complications occur. Hypolipidemic therapy requires a long time to prevent disease complications. All these facts usually result in poor adherence to such therapy. Purpose. To assess the effect of training based on recent ESC guidelines, on physiciansã and patientsã adherence to statin treatment and efficacy of this therapy. Material and methods. The study was multicenter prospective observational. A total of 298 patients (pts) of high and very high cardiovascular risk (pts with coronary artery disease, other atherosclerotic diseases, diabetes mellitus etc.) were included in the study in different regions in Russia. Before study initiation, a special short-term physicians' training course, based on ESC guidelines, was conducted. Patients were monitored for 12 weeks with 3 visits (inclusion (V0), 1 and 3 months after V0 (V1; V3). Initial treatment with statins (V0) and its changes at all three visits was assessed. Low-density-lipoprotein cholesterol (LDL-C) level was registered at each visit. Special questionnaire (SQ) was used at V1 and V3 to assess ptsã adherence to statin therapy. Patients, who were taking statins for all 12 weeks, defined as adherent, pts, who did not start statin therapy, were non-adherent, and those, who had begun to take statins, but stopped it, considered partly adherent. Results: Initially, 112 (37,5%) of 298 pts did not take statins. At V0 statins were recommended to everybody. According to SQ at V1 13 pts did not start prescribed statin therapy (non-adherent pts), 7 pts started therapy, but stopped it due to various reasons (partly adherent pts). At V3 another 25 pts stopped taking prescribed statins, however, 12 pts, who initially refused to take statin therapy, started it. Overall, 262 pts took statins from V0 to V3 (adherent). The target level of LDL-C was achieved at V0 only in 11 (3,7%) pts, at V1 in 47 (15,8%) pts, at V3 in 121 (40,6%) pts. Physicians appreciated LDL-C level as a target in 16 (5,4%) pts at V0, in 67 (22,5%) pts at V1 and in 142 (47,7%) pts at V3. Dose titration was performed only in 56 pts at V1. Conclusion: A special training course, based on ESC guidelines, in general substantially improved physiciansã adherence to clinical guidelines. It also has a positive effect on patientsã adherence to treatment. However, a number of doctors, despite the educational course, misinterpreted target LDL-C levels and showed clinical inertia in dose titration. P538 https://esc365.escardio.org/Presentation/217068/abstract Lipidic control (LDLc) in patients after acute coronary syndromes: our experience in 2018. W Delgado1, JE Puche1, D Villanueva1, E Silva1, R Vazquez1 1UNIVERSITY HOSPITAL PUERTA DEL MAR, Cadiz, Spain Funding Acknowledgements: None Topic: Lipids Background: Raised LDLc plasma concentration is a major risk factor for atherosclerotic cardiovascular disease. Thus, its optimal control should be achieved, mainly after an acute coronary syndrome (ACS). However, a poor success rate is achieved. Purpose: To determine the degree of control of LDLc levels in patients who presented an ACS and were attended in 2018 in our Hospital. Methods: From 348 patients admitted by ACS, 217 are being monitored in our Hospital, thus constituting the sample for this study. LDLc levels were measured in their admission and in their subsequent outpatient follow-up (median of 12±6 months). Depending on the degree of lipid control achieved, patients were classified into 3 groups: LDLc <70mg/dL, between 70-100mg/dL and >100mg/dL. We analyzed the lipid-lowering therapy prescribed in these patients. Results: At the time of admission, 24.4% of patients had LDLc <70, 21.6% between 70-100 and 53.9% LDLc >100. At follow-up, 51.9% had LDLc <70, 36.4% levels between 70-100 and 12.9% persisted with LDLc >100. The prescribed treatment in the follow-up was: isolated statins in 85%, statin+Ezetimibe in 12% and statin+Ezetimibe+PCSK9i in 3% of patients. A poor therapeutic adherence was detected in 35% of those with >100mg/dL, and 58% were not prescribed an optimal lipid-lowering treatment due to limiting pluripatology. In the subgroup of patients with LDLc between 70-100, 76% of them were with statin MTD+Ezetimibe, while 24% received suboptimal treatment. Conclusions: 52% of patients treated by ACS in our center in 2018 have LDLc values <70 mg, which was the lipid target set by the 2016 European CPGs. These results are better than the national and European results presented in the EUROASPIRE V register. Even so, they have a considerable margin for improvement, specially in the subgroup of 70-100mg/dL in which PCSK9i could play a main role. New 2019 CPGs recommendations (a target of LDLc <55mg/dL) may help in this regard. P539 https://esc365.escardio.org/Presentation/221570/abstract Influence of low glycemic diet to triglycerides and glycated hemoglobin in patients with atherosclerotic coronary artery disease M Muyassar Mukhamedova1, JK Uzokov2, DD Payziev2 1Tashkent Institute Postgraduate Medical Education, Tashkent, Uzbekistan 2Republican Specialized Scientific-Practical Medical Center Therapy and Medical Rehabilitation, Tashkent, Uzbekistan Topic: Lipids Background: Aim of this study was to estimate the low glycemic diet on triglycerides and glycated hemoglobin (HbA1c) in patients with atherosclerotic coronary artery disease (CAD). Methods: This study was conducted from 2016 June till 2019 January enrolling with 156 patients (male=49; aged 38-75 years; mean age 57.6±11.8 years ;) with diagnosed atherosclerotic CAD. The patients divided into two groups by 78. In the first group, patients were assigned low glycemic diet and in second (control) group patients were advised to continue their routine diet during the 3 months on the background of standard therapy. Laboratory and instrumental data were obtained at baseline and after the 12 weeks of the intervention. Results: There were no statistically differences in biochemical data between two groups at their baseline characteristics. Low glycemic diet had a positive impact on triglyceride in the first group than controls (from 245.6±37.3 mg/dL to 159.2±25.6 mg/dL vs. from 226.9±34.8 mg/dL to 192.1±26.5 mg/dL; P<0.05). HbA1c also decreased significantly in the first intervention group patients than second one (respectively: from 6.9±1.9 % to 4.8±1.2 % vs. 6.7±1.6 % to 6.2±1.4%; P<0.05 ). Conclusion: Low glycemic diet is superior to routine diet to reduce triglycerides and HbA1c in patients with atherosclerotic cardiovascular disease. P540 https://esc365.escardio.org/Presentation/221666/abstract Impact of exercise upon lipid profile of competitive football players after 3 months of training GAMELA Nasr1, BASSEM Zarif2, KHALED Elnady1 1Suez Canal University, Cardiology , Ismailia, Egypt 2National Heart Institute, Cairo, Egypt On Behalf of: Prevention working group, Egyptian Society of cardiology Topic: Lipids Background and aim : The relationship between cardiovascular disease and lipid profile is well known. Apart from a heart-healthy diet, exercise is the primary factor that can modify this lipid-associated cardiovascular risk. The aim of the study was to evaluate potential changes in the levels of triglycerides, total cholesterol (TC), low-density lipoprotein-cholesterol (LDLc), and high-density lipoprotein-cholesterol (HDLc), as well as atherogenic indices (TC/HDLc and LDLc/HDLc), and also to analyse the diet over 3 months of training in competitive football players. Patients and Methods: The lipid profile of 20 competitive football players was analysed on Day T0 (pre-season) and Day T11 (after 3 months of training). The consumption of fats by the players was estimated using a food frequency questionnaire. RESULTS: By the end of the study, the LDLc levels and both atherogenic indices of the players had decreased (p < 0.05) compared to the values obtained at baseline. In addition, the diet of the players contained 33.5 ± 2.2% of fats. Their score for the (monounsaturated + polyunsaturated fatty acid)/saturated fatty acid ratio was 1.88 ± 0.3, same as the recommended ≥ 2. CONCLUSION: These data indicate that the athletic activity of the competitive football players during the 3 months of training in the season was heart healthy and friendly, as their lipid profile improved, despite adequate intake of daily requirements of fats. P541 https://esc365.escardio.org/Presentation/217083/abstract PCKS9 inhibitors in cardiac rehabilitation a single center experience G Giuseppe Vitale1, C Nugara2, S Sarullo3, S Vitale4, FM Sarullo1 1Hospital Buccheri La Ferla, Cardiovascular Rehabilitation, Palermo, Italy 2University of Palermo. IRCSS Centro Neurolesi Bonino Pulejo, Messina; Buccheri La Ferla Hospital; , Cardiovascular Rehabilitation Unit, Palermo, Italy 3University Hospital Paolo Giaccone, Cardiology Unit, Palermo, Italy 4University of Palermo, Medical Biotechnology and Molecular Medicine, Palermo, Italy Funding Acknowledgements: none Topic: Lipids Background: Hypercholesterolemia is an established risk factor for atherosclerotic major adverse cardiovascular events. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been approved for treating hyperlipidemia to achieve low-density lipoprotein cholesterol (LDL-C) target on top of optimal hypocholesterolemic therapy and in statin intolerant patients. Our aim was to observe the effects of PCSK9 inhibitors on LDL-C in ambulatory cardiac rehabilitation patients. Methods. We retrospectively included 25 patients referred to our cardiac rehabilitation center with hypercholesterolemia either statin intolerants or treated with maximally tolerated statins. All patients included must have baseline low-density lipoprotein cholesterol (LDL-C) levels above desired target. Lipid profiles were repeated every 6 months after starting administration of PCSK9 inhibitors.Results. At baseline 13 patients (52%) were statin intolerant, 8 patients (33%) had heterozygous familial hypercholesterolemia. All patients had a previous cardiovascular event or evidence of atherosclerotic disease. After a mean follow-up of 12.4±9.6 months, total cholesterol decreased from 212.3±37 to 130.3±35.5 mg/dl (38% reduction, p<.0001), triglycerides decreased from 171.6±74.5 to 138.5±35.9 mg/dl (19% reduction, p=.008), LDL-C decreased from 134±30 to 56±29 mg/dl (58% reduction, p<.0001). We observed a non statistically significant increase of high-density lipoprotein cholesterol (44.2±10.3 to 46.3±12.6 mg/dl; p=.20), Two patients interrupted PCSK9 inhibitors treatment because of persistent flu-like symptoms and cachectic evolution of pancreas cancer respectively. At follow-up statin dose was reduced from 25±12 to 20±12 mg (p=.026). One patient (4%) had an acute coronary syndrome. Statin-associated muscle symptom (SAMS) clinical index decreased from 4.8±2.4 to 2.4±1.8 (p=.046). Conclusion. PCSK9 inhibitors are effective in reducing LDL-C in high-risk cardiac rehabilitation patients; optimization of cholesterol lowering therapy may allow reduction of self-assessed SAMS in this clinical setting. P542 https://esc365.escardio.org/Presentation/221562/abstract Exploring the role of nutraceutics (Red yeast Rice) in secondary prevention. A new pathway can be opened S Santiago Dios Perez1, E Fernandez Carrion2, JJ Parra Fuertes3, J Antona Makoshi4, R Miguel Montero4, H Fleites Cardenas1, I Zegri5, C Mitroi6, E Selva Bello4, G Feltes7, E Zatarain8, A Esteban1, JL Zamorano1 1University Hospital La Zarzuela, Madrid, Spain 2Complutense University of Madrid, Madrid, Spain 3University Hospital 12 de Octubre, Department of Cardiology, Madrid, Spain 4HM Universitario Madrid, Madrid, Spain 5Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 6University Hospital Puerta de Hierro Majadahonda, Madrid, Spain 7Hosital Virgen del mar, madrid, Spain 8University Hospital Gregorio Maranon, Madrid, Spain Topic: Lipids Background: Long term survival in acute coronary syndrome has increased steadily in the last decades. New treatments, the implementation of the guidelines and management strategies bring us to a new scenario initially more favourable, in where our patients survive to their first coronary event.Assuming this increased risk, the control objectives of their cardiovascular risk factors become more ambitious. In this field, control of Cholesterol levels, particularly LDL-C, have arisen as a priority target in patients with Coronary arterial disease (CAD).Therefore, seems relevant to provide new strategies to achieve the optimization of the lipid profile in patients in secondary prevention Study Objectives:The Aim of the study is to stablish the role of functional food, in particular read yeast rice (RYR), in secondary prevention. To determine the additional capacity to reduce LDL-C in patients that despite of optimal classic treatment (maximum tolerated dose of stain plus ezetimibe) are still out of control objectives. Results:The variation of T-Col, LDL-C and Triglicerides(trig) were statistically significant. A reduction in LDL-C was of 10,73mg/dL. Which means and 10,93% of additional reduction over the standard therapy the patients were receiving. Concerning security, the 35,2% of the patients showed side effects at the baseline. NO relevant side effects where reported when adding RYR, even in a relevant percentage, (35,4%) myalgia disappeared (especially when down titraing the statin dose). Conclusions: Adding Red yeast rice in patients on secondary prevention in combination with standard treatment seems to be a effective alternative to achive the optimization of LDL-C levels and get closer to the target stablished in Guidelines, without adding relevant side effects, event getting better tolerance to statins. Although without any doubt the number of patients included in the study is limited, and is an observational study, RYR could be an alternative for those patients aut of target and are no candidates to PCSK9 inhibitors or statin dose could not be titrated (or even has to be reduced). Further studies, randomized, and with a greater population should be conducted to confirm these statements P224 https://esc365.escardio.org/Presentation/217092/abstract Quitting smoking increases weight but leads to little dietary changes in Swiss community dwellers. P Pollyanna Patriota1, I Guessous2, P Marques-Vidal3 1Federal University of The Triangulo Mineiro, Uberaba, Brazil 2Geneva University Hospitals, Division of primary care medicine, Department of primary care medicine, Geneva, Switzerland 3Lausanne university hospital, Department of Medicine, Internal Medicine, Lausanne, Switzerland Funding Acknowledgements: Research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation Topic: Tobacco Background/introduction: quitting smoking frequently leads to increase weight and changes in dietary intake. Although smokers tend to have an unhealthier diet than nonsmokers, most studies on smoking cessation and dietary intake were conducted in the nineties. Purpose: assess the changes in dietary intake occurring after quitting smoking. Methods: prospective study conducted among Swiss community dwellers. The first survey was conducted between 2009 and 2012 and the second between 2014 and 2017. Dietary intake before and after quitting smoking was assessed using a validated food frequency questionnaire. Results: 127 participants (44% women, aged 55.7±9.9 years) reported quitting smoking between the two surveys (median follow-up time: 5 years). Their weight increased 2.0 ± 0.4 kg on average, 70/121 participants gained at least 1 kg and nine (7.1%) participants reported being on a diet to reduce after quitting. Fish and total and animal protein intake increased, dairy intake decreased, while no significant changes were found for all other nutritional markers considered (table). Conclusion: quitting smoking is associated with weight gain in most quitters, and is not accompanied by significant changes in dietary intake. Systematic dietary support should be provided to all smokers wishing to quit. Before After P-value Weight (kg) 71.9 ± 15.6 74.1 ± 16.3 <0.001 * Body mass index (kg/m2) 24.9 ± 4.4 25.8 ± 4.7 <0.001 * Total calories 1815 [1393 - 2260] 1763 [1374 - 2251] 0.302 Total protein (% cal) 14.4 [12.9 - 16.4] 15.1 [13.4 - 18.0] 0.005 Vegetal protein (% cal) 4.6 [3.8 - 5.3] 4.4 [3.7 - 5.3] 0.676 Animal protein (% cal) 9.6 [8.1 - 12.2] 10.8 [8.5 - 13.6] 0.007 Carbohydrates (% cal) 45.1 [38.7 - 51.7] 44.0 [38.9 - 50.8] 0.226 Total fat (% cal) 34.6 [29.6 - 39.1] 34.9 [30.2 - 39.3] 0.620 Dairy (g/d) 169 [86 - 287] 149 [71 - 243] 0.009 Red meat 37 [18 - 64] 38 [24 - 64] 0.304 Fruit 216 [95 - 383] 238 [135 - 370] 0.214 Fish 27 [18 - 46] 37 [19 - 55] 0.021 Before After P-value Weight (kg) 71.9 ± 15.6 74.1 ± 16.3 <0.001 * Body mass index (kg/m2) 24.9 ± 4.4 25.8 ± 4.7 <0.001 * Total calories 1815 [1393 - 2260] 1763 [1374 - 2251] 0.302 Total protein (% cal) 14.4 [12.9 - 16.4] 15.1 [13.4 - 18.0] 0.005 Vegetal protein (% cal) 4.6 [3.8 - 5.3] 4.4 [3.7 - 5.3] 0.676 Animal protein (% cal) 9.6 [8.1 - 12.2] 10.8 [8.5 - 13.6] 0.007 Carbohydrates (% cal) 45.1 [38.7 - 51.7] 44.0 [38.9 - 50.8] 0.226 Total fat (% cal) 34.6 [29.6 - 39.1] 34.9 [30.2 - 39.3] 0.620 Dairy (g/d) 169 [86 - 287] 149 [71 - 243] 0.009 Red meat 37 [18 - 64] 38 [24 - 64] 0.304 Fruit 216 [95 - 383] 238 [135 - 370] 0.214 Fish 27 [18 - 46] 37 [19 - 55] 0.021 Results expressed as average±standard deviation or median [interquartile range]. Between-group comparisons performed using studentã s t-test (*) or sign test. Open in new tab Before After P-value Weight (kg) 71.9 ± 15.6 74.1 ± 16.3 <0.001 * Body mass index (kg/m2) 24.9 ± 4.4 25.8 ± 4.7 <0.001 * Total calories 1815 [1393 - 2260] 1763 [1374 - 2251] 0.302 Total protein (% cal) 14.4 [12.9 - 16.4] 15.1 [13.4 - 18.0] 0.005 Vegetal protein (% cal) 4.6 [3.8 - 5.3] 4.4 [3.7 - 5.3] 0.676 Animal protein (% cal) 9.6 [8.1 - 12.2] 10.8 [8.5 - 13.6] 0.007 Carbohydrates (% cal) 45.1 [38.7 - 51.7] 44.0 [38.9 - 50.8] 0.226 Total fat (% cal) 34.6 [29.6 - 39.1] 34.9 [30.2 - 39.3] 0.620 Dairy (g/d) 169 [86 - 287] 149 [71 - 243] 0.009 Red meat 37 [18 - 64] 38 [24 - 64] 0.304 Fruit 216 [95 - 383] 238 [135 - 370] 0.214 Fish 27 [18 - 46] 37 [19 - 55] 0.021 Before After P-value Weight (kg) 71.9 ± 15.6 74.1 ± 16.3 <0.001 * Body mass index (kg/m2) 24.9 ± 4.4 25.8 ± 4.7 <0.001 * Total calories 1815 [1393 - 2260] 1763 [1374 - 2251] 0.302 Total protein (% cal) 14.4 [12.9 - 16.4] 15.1 [13.4 - 18.0] 0.005 Vegetal protein (% cal) 4.6 [3.8 - 5.3] 4.4 [3.7 - 5.3] 0.676 Animal protein (% cal) 9.6 [8.1 - 12.2] 10.8 [8.5 - 13.6] 0.007 Carbohydrates (% cal) 45.1 [38.7 - 51.7] 44.0 [38.9 - 50.8] 0.226 Total fat (% cal) 34.6 [29.6 - 39.1] 34.9 [30.2 - 39.3] 0.620 Dairy (g/d) 169 [86 - 287] 149 [71 - 243] 0.009 Red meat 37 [18 - 64] 38 [24 - 64] 0.304 Fruit 216 [95 - 383] 238 [135 - 370] 0.214 Fish 27 [18 - 46] 37 [19 - 55] 0.021 Results expressed as average±standard deviation or median [interquartile range]. Between-group comparisons performed using studentã s t-test (*) or sign test. Open in new tab P226 https://esc365.escardio.org/Presentation/217342/abstract Electronic cigarettes: prevalence in the Russian Federation Y Yulia Balanova1, A Kapustina1, S Shalnova1, A Imaeva1, G Muromtseva1, S Evstifeeva1, S Maksimov1, A Dotsenko1 1National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russia, Moscow, Russian Federation Topic: Tobacco Aim: To evaluate the prevalence of electronic cigarettes (e-cigarettes) use among Russian population aged 18+. Material and methods: A cross-sectional study was carried out in 27 regions representing all 8 federal districts of the Russian Federation (RF) using modified the WHO STEPS approach (2018-2019). Standard epidemiological methods and criteria were used. Randomly selected males (N=15936) and females (N=21687) aged 18+ years were examined. A set of questions "E-cigarettes Use" was added to the Tobacco Use module. The calculations and analysis were performed in MS SQL Server 2008 R2 (Transact-SQL). Results: In the RF the prevalence of e-cigarette use was just 0.7%, higher among males than females (1.1% vs 0.4%, p<0,001). For both sexes, the highest prevalence of e-cigarettes use was observed in the younger age groups: among males ã 2.1% in 18-24-year age group and 2.4% in 25-34-year age group; among females 1.7% in 18-24-year age group. The prevalence of e-cigarettes among ex-users was 1.5% among males (the highest ã 3.1% in 18-24 age group), 0.7% among females (the highest ã 1.6% in 25-34 age group). Conclusion: electronic cigarette use is increasing worldwide. The prevalence of e-cigarettes use among Russian population aged 18+ was 0.7%. The highest frequency of e-cigarettes use among young people is alarming. The Russian Federation still lacks legal regulation of e-cigarette use under active marketing campaign. P227 https://esc365.escardio.org/Presentation/221582/abstract Psychosocial factors among smoking apparently healthy young medical students. Z Zumriyat Akhmedova1, L Vasil'eva2, N Druzhinina2, A Bragina2, M Pisarev2, V Podzolkov2 1I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation 2I.M. Sechenov First Moscow State Medical University, 2nd Internal Medicine (2nd Faculty Therapy) Department, Moscow, Russian Federation Topic: Tobacco Background: According to the 2018 ESC/ESH Guidelines low socio-economic status, stress at work and at home, social isolation, anxiety and depression, mental disorders contribute to the risk and worse prognosis of cardiovascular diseases (CVD). Smoking is an established risk factor for comorbidity and fatal outcomes from many diseases, including CVD. Aim: To study the psychosocial factors among apparently healthy young adults smokers. Methods: 217 healthy medical university students volunteers (74 males and 143 females) took part in the study. The mean age was 20.8 ± 1.9 years. There was no significant age difference between the group of smokers and non-smokers. All participants completed standard questionnaires, HADS (Hospital Anxiety and Depression Scale) and the Scale of Perceived Stress questionnaires. Statistica 10.0 software was used for data management and statistical analysis. Results: Compared to non-smokers smokers had higher prevalence of sleep quality disturbance (37,5 vs 33,1%, p<0,05), previous experience of medical job (16,7% vs 6,0%, p<0,05), additional work place (29,2% vs 15,1%, p<0,05), responsibility for self-paid education (8,3% vs 3,6%, p<0,05), as well as marital status (6,3% vs 3,6%, p<0,05), the presence and amount of children (6,3% vs 2,4%, p<0,05). Subclinical / clinical depression prevalence was significantly higher in the non-smoking group (15,0/4,8% vs 6,3/4,2 % among smokers, p<0,05). Conclusion: young apparently healthy smokers had higher prevalence of sleep disorders, previous experience of medical job, additional work place, responsibility for self-paid education, marital status, presence and amount of children. In opposite for non-smokers more typical was a higher prevalence of depression. P228 https://esc365.escardio.org/Presentation/217378/abstract Some risk factors of cardiovascular diseases among students of medical university (compared data 2009 vs 2019) I Irina Leonova1, S Boldueva1, E Belyaeva1, N Zaporozhan1 1North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation Topic: Tobacco Society is faced with the task of reducing the incidence of cardiovascular diseases, which are the most frequent cause of disability and a decrease in the quality of life. The purpose: to identify some risk factors of cardiovascular diseases among students of medical university Materials and methods: 468 students of 4 grade of training were surveyed in 2009 and 264 in 2019, which assessed gender, age, heredity for cardiovascular diseases (sudden death, arterial hypertension (AH), coronary heart disease (CHD), stroke, blood pressure, level of physical activity. All smoked students had smoke questionnaire. Results: from 468 students in 2009 (age 19-22 y.o average age 20.5+/- 0.45; 134 male (28,6%) and 334 female(71,4%)) 225 (48,08%) had cardiovascular disease in relatives: AH in 141 (30,1%), IHD in 10 (2,8%), the combination of AH and IHD in 38 (8,1%). 36 (7.7%) respondents had sudden death episodes among relatives. 122 students had AH. 75 of them (61,5%) had burdened heredity of AH. 191 (40,8%) had an active lifestyle and went to sport, 277 students noted the lack of physical activity. 119 (25,4%) students had 3 and more CV risk factors, 130 (27,8%) ã 2 risk factors, 134 (28,6%) ã 1 risk factor. Only 85 students (18,2%) had no risk factors. Tobacco smoking: 21% from interviewed students smoked, from whom 47% were male and 53% female. The average smoking experience was 5+/- 0,8 years (from 0,5 years to 15 years), in 25% - 0,5-1,5 years, in 45% - 2-4 years, 27% - 5-9 years, 3% 10-15 years. Thus, 2/3 students began to smoke already being study at the university. The degree on nicotine addiction (according to the test) was very weak in the majority ã 103 (56%) and only in 10% addiction was high and very high. Attempt to stop smoke had the majority 83% students, of whom 73% respondents tried to stop from 1 to 3 times. In 2019 year the prevalence of major risk factors (AH, heredity) remained at the 2009 level, 55% students had an active lifestyle and went to sport 1-3 times/week. 16% of students had excessive weight and obesity. 23,1% from interviewed students smoked. The average smoking experience was 4+/- 1,2 years (from 0,5 years to 15 years), in 21% - 0,5-1,5 years, in 45,9% - 2-4 years, 26% - 5-9 years, 3,3% 10-15 years. Thus, in 2019 2/3 students began to smoke already being study at the university. Attempt to stop smoke had the majority 68,8% students, of whom 80% respondents tried to stop from 1 to 5 times. The majority of smoked (93%) didnã t recommend smoking to friends and mates. Unfortunately, despite active propaganda, smoking remains the main risk factor for medical students in both 2009 and 2019 years. 657 https://esc365.escardio.org/Presentation/217042/abstract Epicardial obesity as one of the significant predictors of prediabetes and subclinical atherosclerosis of the brachiocephalic arteries A Ott1, G Chumakova2 1Altay Regional Cardiology Centre, cardiology, Barnaul, Russian Federation 2Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Topic: Obesity Obesity is one of the leading predictors of cardiometabolic disorders. It is known that it is visceral obesity (VO), which is a neuroendocrine organ that synthesizes biologically active substances (BAS), which determines cardiovascular risk. The effect of epicardial obesity (EO) on the development of prediabetes and atherosclerosis of various localizations is studied. Objective: To study the contribution of various criteria for obesity: EO, body mass index (BMI), waist circumference (WC) in the development of prediabetes and subclinical atherosclerosis of brachiocephalic arteries (BCA). Materials and methods: The study included 120 men 45.2 ± 4.3 years old with arterial hypertension (AH) of the 1-3 degree and the absence of clinical manifestations and anamnesis of atherosclerosis of any localizations with a BMI of 20-35 kg /m2 and abdominal obesity according to WC ≥ 94 cm. Patients were divided into two groups depending on the thickness of the epicardial adipose tissue (EAT), measured by echocardiography. Group 1 consisted of 60 patients with epicardial obesity (EAT ≥7 mm), group 2 included patients without epicardial obesity (EAT <7 mm). The parameters of insulin resistance (IR) were assessed for all subjects as a criterion for prediabetes; BCA subclinical atherosclerosis was assessed using duplex brachiocephalic arteries. Results: In group 1, insulin levels and the HOMA-IR index were significantly higher than in group 2 (9.37 μIU/ml (7.7; 11.02) versus 5.97 μIU/ml (4.62; 6, 93), p = 0.01; (2.16 (1.46; 2.86) versus 1.35 (1.14; 1.56), p = 0.01, respectively. The glucose level did not significantly differ in the studied groups (p = 0.39). In group 1, 11 patients had IR (HOMA-IR ≥ 2.7). In group 2, no IR was detected. Using linear regression analysis the threshold value of EAT was determined, from which IR with HOMA-IR ≥ 2.77 began to be determined. This indicator was 9.5 mm. The analysis revealed a positive correlation between honey index HOMA-IR and EAT in group 1 and 2 (r = 0.76, p = 0.01; r = 0.68, p = 0.01, respectively). Traditional criteria for obesity: BMI and WC did not correlate with the HOMA-IR index in the studied groups. When assessing the thickness of the intima-media of the carotid arteries (TIM), a subclinical marker of BCA atherosclerosis, higher average TIM values in group 1 (EAT ≥7 mm) were revealed (1, 09 ± 0.34 mm versus 0.74 ± 0.05 mm in group 2 (EAT <7 mm) (p = 0.0001). As a result of discriminant analysis, it was revealed that only EAT (p = 0.02) influenced the development of BCA atherosclerosis (TIM more than 1.3 mm). WC and BMI did not affect the development of BCA subclinical atherosclerosis (p = 0.21; p = 0.24, respectively). Conclusions: EO (EAT ≥7 mm) is an early risk factor for prediabetes and subclinical atherosclerosis of BCA, in contrast to the traditional criteria for obesity (BMI, WC), so patients with EO need additional examinations and the appointment of preventive measures. Award Winning Science - Primary care & risk factor management section 84 https://esc365.escardio.org/Presentation/217400/abstract Systematic review and metanalysis of low fat vs low carb diets for weight loss D Radenkovic1, SC Chawla1, RA Antoni2, FT Tessarolo3, SM Medeiros3, RM Mekary4 1Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland 2University of Surrey, Nutrition & Diets, Guildford, United Kingdom of Great Britain & Northern Ireland 3Sao Paulo University Medical School, Sao Paulo, Brazil 4Harvard School of Public Health, Boston, United States of America Funding Acknowledgements: No funding available for this research. Topic: Obesity Cardiovascular disease (CVD) is the leading cause of death globally, contributing to 31% of annual deaths. Being overweight is a major risk factor for CVD, diabetes and several types of cancers. However, there remains a fervent debate on which diets best address cardiovascular health and body weight regulation, with the majority of the debate centering around low-carbohydrate versus low-fat diets; the composition of such diets is poorly defined and highly variable between studies. We therefore sought to compare the impact of low-fat and low-carbohydrate diets on body weight. A search was performed in MEDLINE (PubMed) and Web of Science. The review, registered on Prospero, included randomised controlled trials comparing the effects of low-carbohydrate and low-fat diets on weight change and lipid profile. Two independent authors conducted screening. Pooled mean differences comparing low-carbohydrate to low-fat diets were calculated using the random-effects model. Heterogeneity among studies was assessed with the I-squared value (%). To address heterogeneity sources, results were stratified by study duration (1-3 months, 3.6 months; 6-12 months; and >12 months). The search yielded 2753 results; 185 full-text articles were reviewed against eligibility criteria and 41 studies were included in the final analysis. For the pooled average weight change, it was shown that participants on low-carbohydrate diets lost more body weight as compared to those on low-fat diets for different study durations (P-interaction: 0.02) of 1-3 months (mean difference: -1.30 kg; 95% CI: -1.88, -0.72, I2: 81.7%, 27 studies); 3-6 months (mean difference: -2.61 kg; 95% CI: -3.53, -1.70, I2: 94.5%,11 studies); and 6-12 months (mean difference: -1.01 kg; 95% CI: -1.76, -0.25, I2:66.1%, 20 studies). Beyond 12 months, the pooled mean difference was not statistically significant (mean difference: 0.24 kg; 95% CI: -2.13, 2.62; I2: 0%, 2 studies). The effect of low-carbohydrate diet on body weight loss is more pronounced than the low-fat diet up to 1 year. Beyond 1 year, the difference was no longer significant according to the only 2 studies that were found. More studies are needed for long term weight loss beyond 1 year. Prisma Flow Diagram EAPC Essentials 4 You - ePosters P544 https://esc365.escardio.org/Presentation/217056/abstract Impact of bariatric surgery on body composition and aerobic exercise capacity N Zhou1, V Faoro1, M Klass2, JJ Moraine1, S Corentin2, K Forton1 1Université libre de Bruxelles (ULB), Faculty of Motor Science, Laboratory of Exercise Physiology, Brussels, Belgium 2Université libre de Bruxelles (ULB), Faculty of Motorskills Sciences, Laboratory of Biometry and exercise Nutrition, Brussels, Belgium Funding Acknowledgements: NA Topic: Obesity Introduction: Weight loss reduced by bariatric surgery (BS) directly and indirectly affecting obesity subjectã s aerobic exercise capacity. Purpose: To determine how the heart, lungs and muscles contribute to influence the physical condition 6 months after BS. Methods: 13 healthy obese subjects (BMI: 39 ± 4 kg/cm²) underwent BS. Body composition (BC) determined by dual-energy X-ray absorptiometry, respiratory and limbs muscle strength measurements, pulmonary function testing, and a cyclo-ergometer incremental cardiopulmonary exercise test (CPET) before and 6 months after BS. Results: The main comparison results are summarized in the table 1. The correlation results show that, the changes (Δ) in O2 pulse was positively associated with Δ absolute peak VO2 and ventilator threshold (VT). Δ percentage of VT was positively associated with Δ resting lung function and Δ VE at VT which was also positively associated with Δ percentage of FEV1. Δ lean mass (LM) was positively associated with Δ peak VO2 divide by LM. Δ fat mass trunk was negatively correlated with Δ Maximal Inspiratory Pressure (MIP) which negatively correlated with Δ VO2/W slope. Δ FM/LM ratio was negatively related to Δ relative quadriceps strength. Conclusion: Six months after BS there is fat mass loss which is concomitant to visceral fat and lean mass loss without affecting maximal aerobic exercise capacity, but with a reduction of the ventilatory threshold. The autonomic nervous system balance and resting lung function were improved. The decrease in aerobic exercise capacity was related to muscular deconditioning aggravated by loss of lean mass, although the static muscular strength did not decrease. Pre-surgery (n=13) Post-surgery (n=13) p value Total fat mass (kg); visceral fat (kg) 53.3 ± 9.6; 2.7 ± 1.4 35.4 ± 9.4; 1.5 ± 0.8 •••; ••• Total lean mass (kg) 56.4 ± 10.1 49.5 ± 8.4 ••• Mean arterial pressure at rest (mmHg); Heart rate at rest (bpm) 97 ± 13; 83 ± 14 84 ± 13; 78 ± 14 ••; ns O2 pulse (ml/beat-1) 11.6 ± 3.0 13.3 ± 2.1 ns Peak VO2 (L min-1); Peak VO2/BW (mL kg min-1) 2.2 ± 0.6; 19.9 ± 3.9 2.0 ± 0.4; 23.8 ± 4.9 ns; • VO2 at VT (L min-1); VO2/BW at VT(mL kg min-1) 1.4 ± 0.4; 12.2 ± 3.1 1.0 ± 0.3; 11.9 ± 2.4 ••; ns VO2 % VO2 peak (%) 61.5 ± 9.9 50.5 ± 5.9 • VO2/W slope 10.0 ± 1.9 8.9 ± 2.2 ns Ventilation (VE) at VT (L min-1) 39.1 ± 10.4 28.6 ± 7.2 •• forced expiratory volume in one second predicted (FEV1) (l) 3.5 ± 0.8 3.8 ± 0.8 • MIP (cmH2O); Relative quadriceps strength 63.8 ± 21.6; 0.5 ± 0.1 73.6 ±17.9; 0.6 ± 0.1 ns; ••• Pre-surgery (n=13) Post-surgery (n=13) p value Total fat mass (kg); visceral fat (kg) 53.3 ± 9.6; 2.7 ± 1.4 35.4 ± 9.4; 1.5 ± 0.8 •••; ••• Total lean mass (kg) 56.4 ± 10.1 49.5 ± 8.4 ••• Mean arterial pressure at rest (mmHg); Heart rate at rest (bpm) 97 ± 13; 83 ± 14 84 ± 13; 78 ± 14 ••; ns O2 pulse (ml/beat-1) 11.6 ± 3.0 13.3 ± 2.1 ns Peak VO2 (L min-1); Peak VO2/BW (mL kg min-1) 2.2 ± 0.6; 19.9 ± 3.9 2.0 ± 0.4; 23.8 ± 4.9 ns; • VO2 at VT (L min-1); VO2/BW at VT(mL kg min-1) 1.4 ± 0.4; 12.2 ± 3.1 1.0 ± 0.3; 11.9 ± 2.4 ••; ns VO2 % VO2 peak (%) 61.5 ± 9.9 50.5 ± 5.9 • VO2/W slope 10.0 ± 1.9 8.9 ± 2.2 ns Ventilation (VE) at VT (L min-1) 39.1 ± 10.4 28.6 ± 7.2 •• forced expiratory volume in one second predicted (FEV1) (l) 3.5 ± 0.8 3.8 ± 0.8 • MIP (cmH2O); Relative quadriceps strength 63.8 ± 21.6; 0.5 ± 0.1 73.6 ±17.9; 0.6 ± 0.1 ns; ••• Open in new tab Pre-surgery (n=13) Post-surgery (n=13) p value Total fat mass (kg); visceral fat (kg) 53.3 ± 9.6; 2.7 ± 1.4 35.4 ± 9.4; 1.5 ± 0.8 •••; ••• Total lean mass (kg) 56.4 ± 10.1 49.5 ± 8.4 ••• Mean arterial pressure at rest (mmHg); Heart rate at rest (bpm) 97 ± 13; 83 ± 14 84 ± 13; 78 ± 14 ••; ns O2 pulse (ml/beat-1) 11.6 ± 3.0 13.3 ± 2.1 ns Peak VO2 (L min-1); Peak VO2/BW (mL kg min-1) 2.2 ± 0.6; 19.9 ± 3.9 2.0 ± 0.4; 23.8 ± 4.9 ns; • VO2 at VT (L min-1); VO2/BW at VT(mL kg min-1) 1.4 ± 0.4; 12.2 ± 3.1 1.0 ± 0.3; 11.9 ± 2.4 ••; ns VO2 % VO2 peak (%) 61.5 ± 9.9 50.5 ± 5.9 • VO2/W slope 10.0 ± 1.9 8.9 ± 2.2 ns Ventilation (VE) at VT (L min-1) 39.1 ± 10.4 28.6 ± 7.2 •• forced expiratory volume in one second predicted (FEV1) (l) 3.5 ± 0.8 3.8 ± 0.8 • MIP (cmH2O); Relative quadriceps strength 63.8 ± 21.6; 0.5 ± 0.1 73.6 ±17.9; 0.6 ± 0.1 ns; ••• Pre-surgery (n=13) Post-surgery (n=13) p value Total fat mass (kg); visceral fat (kg) 53.3 ± 9.6; 2.7 ± 1.4 35.4 ± 9.4; 1.5 ± 0.8 •••; ••• Total lean mass (kg) 56.4 ± 10.1 49.5 ± 8.4 ••• Mean arterial pressure at rest (mmHg); Heart rate at rest (bpm) 97 ± 13; 83 ± 14 84 ± 13; 78 ± 14 ••; ns O2 pulse (ml/beat-1) 11.6 ± 3.0 13.3 ± 2.1 ns Peak VO2 (L min-1); Peak VO2/BW (mL kg min-1) 2.2 ± 0.6; 19.9 ± 3.9 2.0 ± 0.4; 23.8 ± 4.9 ns; • VO2 at VT (L min-1); VO2/BW at VT(mL kg min-1) 1.4 ± 0.4; 12.2 ± 3.1 1.0 ± 0.3; 11.9 ± 2.4 ••; ns VO2 % VO2 peak (%) 61.5 ± 9.9 50.5 ± 5.9 • VO2/W slope 10.0 ± 1.9 8.9 ± 2.2 ns Ventilation (VE) at VT (L min-1) 39.1 ± 10.4 28.6 ± 7.2 •• forced expiratory volume in one second predicted (FEV1) (l) 3.5 ± 0.8 3.8 ± 0.8 • MIP (cmH2O); Relative quadriceps strength 63.8 ± 21.6; 0.5 ± 0.1 73.6 ±17.9; 0.6 ± 0.1 ns; ••• Open in new tab P545 https://esc365.escardio.org/Presentation/217030/abstract Correlation analysis between body composition and exercise capacity in obesity subjects N Zhou1, M Klass2, J Closset3, P Loi3, V Faoro1 1Université libre de Bruxelles (ULB), Faculty of Motor Science, Laboratory of Exercise Physiology, Brussels, Belgium 2Université libre de Bruxelles (ULB), Faculty of Motorskills Sciences, Laboratory of Biometry and exercise Nutrition, Brussels, Belgium 3Erasme Hospital (ULB), Department of Gastrointestinal Surgery, Brussels, Belgium Topic: Obesity Introduction: Obese individuals may have excessive subcutaneous, visceral tissue mass (VAT) which can impair cardiorespiratory fitness and muscle quality, although obesity subjects have more total muscles mass than normal weight subjects. However, there are less report on the association of body composition with others indicators related to exercise capacity. Purpose: To compare the correlation between body composition and the indicators related to exercise capacity in obese and normal weight subjects. Methods: This is a observational study included 26 health obese subjects and 26 control subjects matched with gender, age and height (men / women: 9/17; age: 47 ± 13 & 48± 13 years; height: 169 ± 9 cm & 171 ± 10, body composition index (BMI): 39 ± 4 & 23 ± 2 kg/m2). Body composition determined by dual-energy X-ray absorptiometry, respiratory and limbs muscle strength, pulmonary function, global physical activity questionnaire and aerobic exercise capacity determined by cyclo-ergometer incremental cardiopulmonary exercise test were performed. Results: Visceral adipose tissue (VAT) was negatively correlated with VO2 divide by lean mass (VO2/LM) at peak and ventilatory threshold (VT), both in obesity and control groups; VAT positively correlated with VE/VO2slope and weekly sedentary activities time only in control group. Total and regional (gynoid and legs) fat mass/ lean mass ratio (FM/LM ratio) were negatively correlated with maximal expiratory pressure (MEP) and quadriceps strength, both in obesity and control groups; the maximal inspiratory pressure (MIP) was negatively correlated with trunk fat mass and lean mass ratio (FM/LM) in obesity group and with total FM/LM ratio in control group. The negatively correlation between total FM/LM ratio and resting lung function and sniff nasal inspiratory pressure (SNIP) were only in control group; but total and regional FM/LM ratio were negatively correlated with relative quadriceps strength, physical and mental score, only in obesity group; android FM/LM ratio was negatively correlated with weekly moderate activities time, only in obesity group. Total and regional FM/LM ratio were negatively correlated with absolute and relative peak VO2normalized by body weight, and workload maximal, only in obesity group; negatively correlated with minute ventilation maximal (VE max) and heart rate reserve (HRR), only in control group. Conclusions: Higher VAT lead to lower VO2/LM at peak and at VT, and higher FM/LM ratio caused by excessive FM lead to lower relative quadriceps strength, both in obesity and control subjects. The VAT, trunk and android FM/LM ratio, especially negatively associated with maximal aerobic exercise capacity (absolute peak VO2and workload maximal) in obesity subjects. Increase of VAT associated with more weekly sedentary time in control subjects, increase of FM/LM ratio impaired physical and mental score in obesity subjects. P546 https://esc365.escardio.org/Presentation/221584/abstract Results of a center-based weight reduction program for obese patients M Martijn Scherrenberg1, K Bonne2, P Dendale1 1Heart Centre Hasselt, Hasselt, Belgium 2Virga Jesse Hospital, REGO, Hasselt, Belgium Topic: Obesity Background: Obesity is a chronic disease and a major health problem, which increases worldwide over a few decades at an alarming rate. Obesity is now recognized as the most important risk factor contributing to the health burden of the world, as it is associated with numerous complications, including type 2 diabetes, hypertension, cardiovascular disease, non-alcoholic fatty liver disease, arthritis and depression. In the present study, we aimed to investigate the effectiveness of a medically supervised, out-patient-based intervention program. Methods: A non-randomized, observational cohort study was performed. Patients who participated in an out-patient-based weight loss program in one Hospital were included. In total 118 patients were included. Demographic, clinical and exercise data were collected. A multiple linear regression analysis was conducted to detect variables that influence weight loss during a medically supervised, out-patient-based weight loss program. Results: 118 patients (29,7% males) started a medically supervised, out-patient-based weight loss program. The mean weight at the start of the program was 102,98 +- 17,74. 23 patients (19,5%) were smoking at baseline and 9 patients (7,5%) had diabetes mellitus at baseline. 57 patients (48,3%) participated in resistance training during the intervention program. The mean amount of sessions was 29,12 +- 7,05. The mean duration of session was 76,54 +- 12,97 minutes. At the end of the weight loss program, the mean weight loss was 6,93 +- 4,08 kg. Multiple linear regression analysis showed that duration of the sessions and the weight at the start of the program had a significant effect on the weight loss at the end of the program. Surprisingly, the number of sessions had no significant influence on the weight loss at the end of the program. Conclusion: This study showed that a medically supervised, out-patient-based intervention program in one hospital was an effective intervention for weight loss in obese patients. The study showed that the number of sessions had no significant influence on the weight loss. However, the duration of the sessions and the weight at baseline were significant predictors for the total weight loss during the program. P547 https://esc365.escardio.org/Presentation/221687/abstract Weight reduction under the influence of optical illusion M Schusser1, J Sykora2 1Carinthia University of Applied Sciences, Health Sciences & Social Work, Klagenfurt, Austria 2Private Hospital Maria Hilf, Klagenfurt, Austria Topic: Obesity Background/Introduction A health survey carried out by Statistics Austria in 2014 revealed that in the age group 15-29 years, every third man and every fifth woman is affected by obesity or extreme obesity. With increasing average age, these numbers are rising sharply. Thus, in the age of 60-75 years, well over half of all persons living in Austria are overweight or obese. It is well known that obesity is a major risk factor for cardiovascular and other diseases. Purpose: The purpose of the clinical study is to determine whether an optical illusion of food intake can influence the feeling of hunger or satiety and whether it is possible to support obese persons in reducing their weight. Methods: The randomized controlled study with a duration of 12 months will involve 60 patients who are participating in an ambulatory cardiovascular rehabilitation. During the first 8 weeks of the study, the participants of the intervention group must consume as many meals as possible (at least 50%) from a specially prepared plate (see attached picture). On this plate, a mirror is attached, which shows an optical illusion with twice the amount of food. The control group uses in this 8 weeks their normal dishes. Except for the use of the prepared plates, the study has no influence on the lifestyle of the participants. During this clinical study, the following parameter will be controlled after four weeks and eight weeks: bodyweight, BMI, vital signs, and waist circumference. Six months after the completion of the study there will be a control measurement as follow-up with the same parameter. Results: In a preclinical study, the effect of the optical illusion was tested on 11 healthy persons. The results showed that people who consumed meals with the prepared plate could no longer assess the portion size. Another important observation of the pretest was that the subjectã s perception of the food from the prepared dish was not irritating. Conclusion: If it is possible to help patients lose weight by eating less with the support of this optical illusion, it could have an positive impact on the prevention and treatment of cardiovascular disease. half portion with optical illusion P548 https://esc365.escardio.org/Presentation/221593/abstract Therapy specifics and treatment adherence in obese patients of outpatient registry YV Yulia Lukina1, OV Lerman1, NP Kutishenko1, SY Martsevich1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Obesity Purpose: To evaluate physiciansã recommendations, patientsã attitude and adherence to obesity treatment based on the results of a patientsã survey in a framework of the prospective outpatient registry. Material and methods. A total of 347 patients from the outpatient register of the special cardiologic department were obese (BMI≥30 kg/m2). They were asked to take a survey with a special questionnaire, which included self-assessment questions regarding their own body weight, recommended obesity treatment, patients' adherence to the implementation of these recommendations, propensity to self-medication and information about personal financial costs for the obesity treatment. Forty-two (12.1 %) patients refused to participate in the survey. From 305 patients (138 men), who answered the questionnaire, 213 people (69.8%) had the 1st degree obesity, 63 (20.7%) had the 2nd degree obesity and obesity grade 3 was diagnosed in 29 people (9.5%). Mean age was 63.9±11.3 years. Only 16 patients had not any cardiovascular comorbidity. Results: Only one in four patients (26.6%) thought he was obese, the others denied having the disease. Most respondents have received recommendations for the non-drug treatment of obesity. For 242 patients (79.3%) reducing of caloric intake was recommended, 194 (63.6%) patients were recommended to increase physical activity. According to the survey results, only one in four patients (25.2%) knew about the possibility of drug treatment of obesity. Only 37 (12.1%) obese patients were recommended obesity drug treatment for weight correction. At the time of the survey, none of the patients was taking drugs to treat obesity. Medical treatment of obesity was more often recommended for patients with 2 and 3 degrees of the disease than for patients with 1 degree obesity. (p<0.0001). Patients with more severe obesity (2 or 3 degrees) took drugs significantly more often than patients with 1 degree obesity (p<0.0001). Despite the fact that no doctor has recommended dietary supplements for the treatment of obesity, seven patients took them to lose weight. Most patients (more than 70%), in principle, are not ready to spend money on the obesity treatment, and drugs are considered an extra item of expenditure almost 90% of obese patients. There is a significant relationship (p= 0.008) between the severity of the disease and patients ' spending on obesity treatment: the higher the degree of obesity, the more patients agree to spend more money for the treatment of the disease. Conclusion: According to the results of the survey, doctors prescribe medical treatment of obesity rarely. Apparently, this fact explains the extremely low awareness of patients about the possibilities of drug therapy in obesity treatment and the popularity of dietary supplements in obese patients. Adherence depends on the severity of obesity and patients with 2-3 degree of obesity are more compliant to treatment. P549 https://esc365.escardio.org/Presentation/221575/abstract Obesity and inflammation in patients included in a cardiac rehabilitation unit MJ Nozal Martinez1, C Carmen Rus Mansilla1, GA Cortez Quiroga1, AB Diaz Caler1, J Leon Dominguez1, D Fatela Cantillo1 1Hospital Alto Guadalquivir, Andujar, Spain Funding Acknowledgements: No Topic: Obesity Introduction: The main cause of morbidity and mortality in the XXI century is cardiovascular disease (CVD). Obesity is a known cause of CVD and recently has been related to low-grade inflammation. Also, inflammation contributes to both the cause and the progression of cardiovascular disease, making the obesity-inflammation circle a problem of increasing magnitude. Purpose: analyze the relationship between obesity and inflammation in a very high-risk population through the high sensitive C-reactive protein (hsCRP) Methods: Patients included in the Cardiac Rehabilitation Unit (CRU) from 2015 to 2018 were evaluated. We split into two groups: patients with body mass index (BMI) less than 30 and patients with BMI 30 or more. In all patients were registered cardiovascular risk factor, anthropometric measurements, lipid control and blood pressure (BP). We measured hsCRP and compared between both groups. Results: We included 192 patients, 153 (79,7%) men. Mean age was 60,5 (11,4) years. There were 86 patients with obesity (44,8%). Basal characteristics were described in table 1. Obese patients had more hypertension and more diabetes. Mean hsCRP was 1,94 in group and 2,97 in group 2 (BMI 30 or more), with statistically significant differences (p<0,01). There weren't differences in blood pressure, lipid levels or heart rate. No obese patients had better functional capacity (9,61 METS versus 8,74, p<0,05) Conclusion(s): this study supports the obesity-inflammation theory even in a very high-risk population as the one included in a cardiac rehabilitation unit. Obese patients had hsCRP levels over the threshold of residual inflammatory risk. GROUP 1 (BMI<30) GROUP 2 (BMI 30 or more) p Age (years) 60,91 59,60 n.s. Sex (% male) 81,1 78,8 n.s. Hypertension 52,8% 72,8% P<0,01 Dyslipemia 62,3% 63,5% n.s. Diabetes 23,6% 41,2% P<0,01 Smokers 50% 41,2% n.s. BMI mean 26,23 33,94 GROUP 1 (BMI<30) GROUP 2 (BMI 30 or more) p Age (years) 60,91 59,60 n.s. Sex (% male) 81,1 78,8 n.s. Hypertension 52,8% 72,8% P<0,01 Dyslipemia 62,3% 63,5% n.s. Diabetes 23,6% 41,2% P<0,01 Smokers 50% 41,2% n.s. BMI mean 26,23 33,94 Open in new tab GROUP 1 (BMI<30) GROUP 2 (BMI 30 or more) p Age (years) 60,91 59,60 n.s. Sex (% male) 81,1 78,8 n.s. Hypertension 52,8% 72,8% P<0,01 Dyslipemia 62,3% 63,5% n.s. Diabetes 23,6% 41,2% P<0,01 Smokers 50% 41,2% n.s. BMI mean 26,23 33,94 GROUP 1 (BMI<30) GROUP 2 (BMI 30 or more) p Age (years) 60,91 59,60 n.s. Sex (% male) 81,1 78,8 n.s. Hypertension 52,8% 72,8% P<0,01 Dyslipemia 62,3% 63,5% n.s. Diabetes 23,6% 41,2% P<0,01 Smokers 50% 41,2% n.s. BMI mean 26,23 33,94 Open in new tab P550 https://esc365.escardio.org/Presentation/217619/abstract Obesity versus diabetes: cardiovascular risk factors A Vasileva1, A Konradi1, O Moiseeva1 1Almazov National Medical Research Centre, St-Petersburg, Russian Federation Funding Acknowledgements: This work was supported by Russian Science Foundation grant project № 17-75-30052. Topic: Obesity Background: The prevalence of type 2 diabetes mellitus (DM) is increasing worldwide, and the frequency of obesity has increased dramatically in recent years. It is known that obesity is among the leading causes of elevated cardiovascular disease (CVD) mortality and morbidity. A comprehensive understanding of their risk factors is desirable. Purpose: The aim of our study is to investigate and improve the knowledge on the profile of risk factors of obese patients versus diabetic patient. Materials and methods. A cross-sectional study of 46 type 2 DM patients and 19 obese patients. Blood samples were analyzed in accredited laboratories (HbA1c), measurements were made (blood pressure, body mass index, waist circumference), Left ventricular sistolic and diastolic functions were assessed by echocardiography, endothelial function was measured as reactive hyperaemia index, using the EndoPAT 2000 machine, pulse wave analysis was performed by applanation tonometry and then processed with dedicated software. PWV was calculated from electrocardiogram-gated waveforms of the right carotid and right femoral artery obtained by applanation tonometry. Patients were stratified for gender and age groups. Results: Diabetes is characterized predisposing risk factors that contribute to the development of cardiovascular complications. Diabetic patients have more expressed markers of atherosclerosis, as evidenced by the increase in the thickness of the intima-media complex (TIM) of the carotid arteries; as well as a decrease in the reactive hyperemia index (RHI), which indicates the development of structural changes in the vascular wall and endothelial dysfunction. Also there are signs of diastolic dysfunction in diabetic patients. At the same time obese patients have risk factors comparable to those with type 2 diabetes mellitus, such as LVMI, LAVI, and global longitudinal strain (GLS). It is noteworthy that the pulse wave velocity (PWV) in both groups was not significantly different (p> 0.05), which indicates that vascular remodeling occurs in obesity, as in diabetes, which leads to increased arterial stiffness - an important early marker of cardiovascular diseases. Groups differed in office BP, but obese patients had higher central blood pressure, that can be considered as an additional risk factor. Conclusions: The high frequencies of risk factors in obese patients implies an increased risk of cardiovascular disease and the need for special attention. Accordingly, obesity should be considered as a disease requiring prevention in the general population. 640 https://esc365.escardio.org/Presentation/217059/abstract Importance of frequency and intensity in exercise training on heart rate variability in type 2 diabetes MS Shelver1, SMHS Hollekim-Strand2, C Bjork Ingul1 1Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Trondheim, Norway 2Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology,, Trondheim, Norway Topic: Diabetes and the Heart BACKGROUND: Type 2 diabetes mellitus (T2D) is associated with a decrease in heart rate variability (HRV), which reflects autonomic nervous system modulation of cardiac activity and is associated with increased mortality. HRV is the physiological phenomenon of variation in the time interval between heartbeats. Nighttime HRV provides a more unambiguous measurement of changes in the autonomic nervous systems regulation compared to 24-hour HRV. PURPOSE: To compare the effects of two-volume and intensity matched exercise protocols of different frequencies on HRV in individuals with T2D METHODS: 54 subjects with T2D were recruited and randomly assigned to either a high-frequency high-intensity training protocol (HF, n=29; 10-minutes exercise bouts, 12 sessions/week) or low-frequency high-intensity interval training protocol (LF, n=25; 30-minutes exercise bouts, four sessions/week). Both groups were matched for volume and intensity, and the study participants exercised for a total of 120 minutes/week for 12 weeks. 24-hour time-domain HRV measurements, including nighttime root mean square of differences between NN intervals (rMSSD), were selected for analysis. Aerobic capacity (VO2peak) and glycosylated hemoglobin (HbA1c) were also measured. RESULTS: HRV improved only in the LF group, with a significant decrease in nighttime heart rate and an increase in nighttime HRV (rMSSD) (Table). Both the HF and LF group significantly improved aerobic capacity by 9% (3.0 ml from baseline 33.2 ml/kg/min) and 10% (3.3 ml from baseline 32.1 ml/kg/min), respectively, with no significant difference between groups. A significant decrease of 5% in HbA1c was observed in the LF group only (p=0.001). CONCLUSION: In individuals with type 2 diabetes, longer duration high-intensity interval training four times/week seems to be more effective in improving heart rate variability and glycemic control than short-duration high-intensity exercise 12 times/week. This finding is of relevance and should be considered when designing exercise programs for enhanced cardiovascular health in a population with an elevated risk of cardiovascular morbidity and mortality. Baseline high-frequency training Post high-frequency training P-value Baseline low-frequency training Post low-frequency training P-value Nighttime heart rate (beats/minute) 61±10 61±7 0.40 69±11 64±10 0.005 Nighttime hear rate variability (rMSSD)(ms) 29±13 35±17 0.36 27±13 32±17 0.02 Baseline high-frequency training Post high-frequency training P-value Baseline low-frequency training Post low-frequency training P-value Nighttime heart rate (beats/minute) 61±10 61±7 0.40 69±11 64±10 0.005 Nighttime hear rate variability (rMSSD)(ms) 29±13 35±17 0.36 27±13 32±17 0.02 rMSSD, root mean square of differences between NN intervalsP-values of the changes from baseline to post intervention. Open in new tab Baseline high-frequency training Post high-frequency training P-value Baseline low-frequency training Post low-frequency training P-value Nighttime heart rate (beats/minute) 61±10 61±7 0.40 69±11 64±10 0.005 Nighttime hear rate variability (rMSSD)(ms) 29±13 35±17 0.36 27±13 32±17 0.02 Baseline high-frequency training Post high-frequency training P-value Baseline low-frequency training Post low-frequency training P-value Nighttime heart rate (beats/minute) 61±10 61±7 0.40 69±11 64±10 0.005 Nighttime hear rate variability (rMSSD)(ms) 29±13 35±17 0.36 27±13 32±17 0.02 rMSSD, root mean square of differences between NN intervalsP-values of the changes from baseline to post intervention. Open in new tab EAPC Essentials 4 You - ePosters P229 https://esc365.escardio.org/Presentation/221561/abstract Eligibility of patients with cardiovascular disease and diabetes mellitus for SGLT2 inhibitors in a large community cardiology practice. R Kamel1, T Thom Haghighat Talab1, J Niznick1 1Ottawa Cardiovascular Centre, Ottawa, Canada Topic: Diabetes and the Heart Background: In order to optimize vascular risk across the broad-spectrum of patients with cardiovascular disease [CVD], it is essential to identify eligible candidates for the latest medical advances and apply these advances across the entire population of eligible patients as quickly as possible. Such continuing medical implementation is often difficult due to the overwhelming logistical barriers of clinical practice. A number of clinical trials have demonstrated that the drug class SGLT2 inhibitors (sodium glucose cotransporter 2 inhibitors) have a proven benefit on cardiovascular outcomes in diabetic [DM] patients including reduced all cause mortality, reduced cardiovascular mortality and reduction in heart failure incidence. The study was conducted in a large community cardiology practice with 40,000 active patients. In order to assess the extent of the care gap in the application of SGLT2 inhibitors to a contemporary diabetic population we conducted a sequential retrospective analysis of the electronic medical records on 1,000 cardiovascular patients to determine eligibility and use of SGLT2 inhibitors. Methods: 1. Data regarding the prevalence of DM, CVD risk factors and co-morbidities was collected in a sequential sample of 1000 patients. 2. We identified patients who met the eligibility criteria for SGLT2 inhibitors as per the EMPA-Reg trial including: a. Established type II DM b. Concomitant CVD c. A1C > 7.0 d. eGFR > 30 3. Data regarding the prevalence of each criteria was collated and analysed in order to determine the extent of the care gap between current care and optimized care with the use of SGLT2 inhibitors. Results: The mean age of the sample was 63 and there was a total of 213 (21.3%) DM patients. Prevalence of DM and CVD was 10.5 %. 105 patients, which constitutes 49 % of DM population were eligible for SGLT2 inhibitors. Of the eligible patients, only 38 (36.2 %) were currently on SGLT2 inhibitors and 67 (63.8%) were eligible but not currently on SGLT2 inhibitors. Conclusions: We have demonstrated a considerable care gap in the application of SGLT2 inhibitors to a population of DM patients with CVD. Potential causes of this care gap include jurisdictional uncertainty, clinical inertia, polypharmacy aversion and clinical time lag. A coordinated and structured effort is required to bridge this care gap. Patients with Diabetes Mellitus (% all patients) Diabetes Mellitus Patients with CVD (% all patients) Diabetes Mellitus Patients with Heart Failure (% all patients) Total 213 (21.3%) 105 (10.5%) 20 (2%) Type 2 206 (20.6%) 101 (10.1%) 18 (1.8%) Type 1 7 (0.7%) 4 (0.4%) 2 (0.2%) Patients with Diabetes Mellitus (% all patients) Diabetes Mellitus Patients with CVD (% all patients) Diabetes Mellitus Patients with Heart Failure (% all patients) Total 213 (21.3%) 105 (10.5%) 20 (2%) Type 2 206 (20.6%) 101 (10.1%) 18 (1.8%) Type 1 7 (0.7%) 4 (0.4%) 2 (0.2%) Open in new tab Patients with Diabetes Mellitus (% all patients) Diabetes Mellitus Patients with CVD (% all patients) Diabetes Mellitus Patients with Heart Failure (% all patients) Total 213 (21.3%) 105 (10.5%) 20 (2%) Type 2 206 (20.6%) 101 (10.1%) 18 (1.8%) Type 1 7 (0.7%) 4 (0.4%) 2 (0.2%) Patients with Diabetes Mellitus (% all patients) Diabetes Mellitus Patients with CVD (% all patients) Diabetes Mellitus Patients with Heart Failure (% all patients) Total 213 (21.3%) 105 (10.5%) 20 (2%) Type 2 206 (20.6%) 101 (10.1%) 18 (1.8%) Type 1 7 (0.7%) 4 (0.4%) 2 (0.2%) Open in new tab P230 https://esc365.escardio.org/Presentation/221681/abstract Suboptimal cardiac performance relates to exercise intolerance in type 2 diabetes patients L Van Ryckeghem1, C Keytsman1, J Verwerft2, P Dendale3, V Bito4, D Hansen5 1Hasselt University, Faculty of Rehabilitation Sciences and Faculty of Medicine and Life Sciences, Diepenbeek, Belgium 2Virga Jesse Hospital and Heart Center Hasselt, Department of cardiology, Hasselt, Belgium 3Virga Jessa Hospital and Hasselt University, Heart Center Hasselt and Faculty of Medicine and Life Sciences, Hasselt and Diepenbeek, Belgium 4Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium 5Virga Jessa Hospital and Hasselt University, Heart Center Hasselt, Faculty of Rehabilitation Sciences and Faculty of Medicine and Life Sciences, Hasselt and Diepenbeek, Belgium Funding Acknowledgements: Not applicable Topic: Diabetes and the Heart Background: Exercise intolerance is a strong predictor of cardiovascular complications in type 2 diabetes mellitus (T2DM). Whether exercise intolerance is accompanied with impaired cardiac performance in T2DM remains unknown. Purpose Evaluate cardiac performance and exercise capacity simultaneously in T2DM. Methods: Exercise echocardiography (semi-supine bicycle) was combined with ergospirometry in T2DM patients (no history of coronary artery disease). Exercise tolerance (peak oxygen uptake (V̇O2peak) was evaluated and % of predicted V̇O2peak (V̇O2predicted(%)) was used for group classification (V̇O2predicted(%) <80% for T2DMEX-Intolerant, n=21 and ≥80% for T2DMEX-tolerant, n=26). Longitudinal strain (LS) and cardiac output were measured at rest and exercise (respiratory exchange ratio >1.03). Linear regression for V̇O2predicted(%) and LSexercise was performed. Results LSexercise was higher in the T2DMEX-Tolerant group (22.9±3.1% vs. 19.5±3.7%). As shown in figure 1, V̇O2predicted(%) accounted for 16.1% of the variation in LSexercise (F(1, 34) = 7.7, p< 0.05). Conclusion Cardiac performance was significantly related to exercise tolerance. This highlights the link between T2DM and elevated cardiovascular risks. Such relation was only detectable with exercise echocardiography. Exercise training studies including exercise echocardiography are necessary to unravel whether cardiac performance benefits from improvements in exercise tolerance in T2DM. T2DMEX-Intolerant (n=21, 5 females) T2DMEX-Tolerant (n=26, 5 females) Age (years) 60 ± 11 62 ± 7 BMI (kg/m²) 30.1 ± 4.6 27 ± 4 *a HbA1c (%) 7.1 ± 0.9 6.7 ± 0.7 Workloadpeak (W) 96 ± 23 129 ± 36 *a V̇ O2peak (L/min) 1.29 ± 0.36 1.84 ± 0.45 *a V̇ O2predicted(%) 61.9 ± 14.2 92.7 ± 10.1 *b LSrest (%) 16.8 ± 2.5 17.4 ± 3 LSexercise (%) 19.5 ± 3.7 22.9 ± 3.1 *a COrest (L/min) 4.9 ± 1.2 4.5 ± 1.2 COexercise (L/min) 10.8 ± 3.3 11.7 ± 2.8 T2DMEX-Intolerant (n=21, 5 females) T2DMEX-Tolerant (n=26, 5 females) Age (years) 60 ± 11 62 ± 7 BMI (kg/m²) 30.1 ± 4.6 27 ± 4 *a HbA1c (%) 7.1 ± 0.9 6.7 ± 0.7 Workloadpeak (W) 96 ± 23 129 ± 36 *a V̇ O2peak (L/min) 1.29 ± 0.36 1.84 ± 0.45 *a V̇ O2predicted(%) 61.9 ± 14.2 92.7 ± 10.1 *b LSrest (%) 16.8 ± 2.5 17.4 ± 3 LSexercise (%) 19.5 ± 3.7 22.9 ± 3.1 *a COrest (L/min) 4.9 ± 1.2 4.5 ± 1.2 COexercise (L/min) 10.8 ± 3.3 11.7 ± 2.8 BMI; Body mass index (kg/m²), HbA1c; blood glycated haemoglobin (%), V̇O2peak; peak oxygen uptake (L/min), V̇O2predicted (%); percentage of predicted peak oxygen uptake, LSrest; longitudinal strain at rest (%), LSexercise; longitudinal strain at exercise (%), COrest; cardiac output at rest (L/min), COexercise; cardiac output at exercise (L/min) * p<0.05, a Independent Sample T-test, b Mann-Whitney U-Test Open in new tab T2DMEX-Intolerant (n=21, 5 females) T2DMEX-Tolerant (n=26, 5 females) Age (years) 60 ± 11 62 ± 7 BMI (kg/m²) 30.1 ± 4.6 27 ± 4 *a HbA1c (%) 7.1 ± 0.9 6.7 ± 0.7 Workloadpeak (W) 96 ± 23 129 ± 36 *a V̇ O2peak (L/min) 1.29 ± 0.36 1.84 ± 0.45 *a V̇ O2predicted(%) 61.9 ± 14.2 92.7 ± 10.1 *b LSrest (%) 16.8 ± 2.5 17.4 ± 3 LSexercise (%) 19.5 ± 3.7 22.9 ± 3.1 *a COrest (L/min) 4.9 ± 1.2 4.5 ± 1.2 COexercise (L/min) 10.8 ± 3.3 11.7 ± 2.8 T2DMEX-Intolerant (n=21, 5 females) T2DMEX-Tolerant (n=26, 5 females) Age (years) 60 ± 11 62 ± 7 BMI (kg/m²) 30.1 ± 4.6 27 ± 4 *a HbA1c (%) 7.1 ± 0.9 6.7 ± 0.7 Workloadpeak (W) 96 ± 23 129 ± 36 *a V̇ O2peak (L/min) 1.29 ± 0.36 1.84 ± 0.45 *a V̇ O2predicted(%) 61.9 ± 14.2 92.7 ± 10.1 *b LSrest (%) 16.8 ± 2.5 17.4 ± 3 LSexercise (%) 19.5 ± 3.7 22.9 ± 3.1 *a COrest (L/min) 4.9 ± 1.2 4.5 ± 1.2 COexercise (L/min) 10.8 ± 3.3 11.7 ± 2.8 BMI; Body mass index (kg/m²), HbA1c; blood glycated haemoglobin (%), V̇O2peak; peak oxygen uptake (L/min), V̇O2predicted (%); percentage of predicted peak oxygen uptake, LSrest; longitudinal strain at rest (%), LSexercise; longitudinal strain at exercise (%), COrest; cardiac output at rest (L/min), COexercise; cardiac output at exercise (L/min) * p<0.05, a Independent Sample T-test, b Mann-Whitney U-Test Open in new tab Figure 1 P234 https://esc365.escardio.org/Presentation/221685/abstract Trend of SGLT2 inhibitor use in diabetics with Ischemic cardiomyopathy a comparison between 2015 and 2018 N Neelabh Sharma1, S Thakur1, S Sutcliffe1, G Starmer1 1Cairns Hospital, Cairns, Australia Topic: Diabetes and the Heart Background: The use of Sodium-glucose cotransporter-2 inhibitor (SGLT2 inhibitor) in patients with ischemic cardiomyopathy has been highlighted in major trials. It has proven to be useful in reducing the cardiac mortality in diabetics with ischemic cardiomyopathy. Since the EMPAREG outcome in the year 2016 , itã s use has been highly advocated for cardiac patients. Purpose: This quality assurance(QA) activity aims to identify the use of SGLT2 inhibitors in diabetics with ischemic cardiomyopathy and to document changes in clinical practice from 2015 to 2018. Methods: We have obtained the data of patients presented with Myocardial infarction (MI) from September to December in 2015 and 2018 through case-mix. By chart review we screened patients with diabetes and use of SGLT2 inhibitor in both cohorts. The major limiting factors identified were - glycated haemoglobin (HBA1C) <7 and renal function(eGFR<40). Trend analysis was performed to assess the change in practice for the targeted years. Results: There were 247 hospital presentations in 2018 as compared to 202 in year 2015. 84(34%) patients in 2018 were diabetic with almost equal proportion of male(52%) and females(48%). 46 (54%) patients have identified themselves as Caucasians, 34(40%) as aboriginal and Torres street islander and 4(4.7%) belonged to others. In 2018 cohort the mean age of presentation was 66.72± 12.14,with median of 65 ,25th quartile of 57.25 and 75th quartile of 76. 15(17%)patients were on SGLT2 inhibitor. HbA1C <7%(23% )and poor renal function(22% with eGFR<40) were the major limiting factors in commencing SGLT2 inhibitors. In 2015, out of 67(33%) diabetic patients, 34(50.74%) male and 33(49.25%) females were identified. 31(46%) patients identified themselves as Caucasians, 29(43%) as aboriginal and Torres street islander and 7(10%) as others. Mean age of presentation was 68.28±12.14, with median of 68.5, 25th quartile of 61 and 75th quartile of 75. 3(4%) patients in 2015 cohort were on SGLT2 inhibitors. 17(25%) patients with HbA1C <7% and 12 patients with eGFR<40 were the major limiting factor for SGLT2 commencement. Conclusion: This QA activity found, increased use of SGLT2 inhibitors in diabetics with ischemic cardiomyopathy as evident by its use in 17% patients in 2018 compared to 4% in 2015. However, we also identified 10 patients in 2018 with HbA1C >7% and normal renal function who were not on this medication. This warrants a better clinical awareness in practicing physicians. Interestingly there was a large number of patients with HbA1c <7% which was a limiting factor in starting this medication as per our current federal funding guidelines. Given strong evidence of cardioprotective effect of this medication it remains a relevant question that whether we should start using SGLT2 inhibitors as a 1st line medication in diabetic with high cardiac risk profile. P235 https://esc365.escardio.org/Presentation/217358/abstract Monocentric randomised prospective intraindividual parallel group comparison study to calculate hbA1c from self-monitored blood glucose values using a special diary with biofeedback system HE Hans-Eckart Sarnighausen1, HU Sarnighausen2, C Willner-Sarnighausen1 1Praxis, Lueneburg, Germany 2Medical University of Innsbruck, Innsbruck, Austria On Behalf of: Praxis Oedeme Funding Acknowledgements: no financial support Topic: Diabetes and the Heart Introduction: Diabetic patients with long duration of the disease and intensified insulin treatment are at high or very high cardiovascular risk. To achieve an hbA1c value within individual target range without increasing hypoglycemic events is challenging in primary care. Purpose: We wanted to demonstrate that hbA1c values in target can achieved, when glucose values were documented in a special diary. Should hbA1c be calculated from average blood glucose values? Methods: 100 well trained patients (type 1 and 2) had been screened from Sep 2012 to Apr 2013 prospectively. Patients randomised to group A documented the first and to group B the last three months. HbA1c values were measured every three months and blood glucose measurements were captured digitally. Statistic differences were calculated with paired t-test between groups. Correlation between average glucose and hbA1c was calculated. Results: 93 participants were randomised. 86 patients attended study visit at 3 months and 81 the last study visit. Results are shown in the Table. Average glucose (AG) linear correlated with hbA1c significantly: AG (mg/dl) = 26,2 × hbA1c (%) ã 36,2, p<0,0001, r2=0,7 for documented blood glucose values. The dotted line marks the AG value 222 mg/dl at which HbA1c-values from 6,8% to 9,9% were found (Figure). Conclusions: Participants significantly lower hbA1c from 7,7% about 0,4 percentage points over a 6 months period by documenting blood glucose values without increased hypoglycemic episods. The calculation of hbA1c from average glucose, although significantly correlated, should be used with caution. Group A, n=45 Group B, n=48 age 52,9 (19-78) 54,7 (20-85) % female 46,7 54,2 % type 1 53,3 52,1 duration of diabetes/y 17,2 (0-49) 17,3 (1-55) Random, n=45 3 months, n=40 6 months, n=40 Random, n=48 3 months, n=46 6 months, n=41 HbA1c % 7,71±0,16 7,48±0,16 7,3±0,15 7,67±0,13 7,65±0,16 7,48±0,15 Average Glc(mg/dl) 159,8±5,7 156,8±5,7 158,9±4,3 163,0±4,5 BG ≤50 mg/dl 15,4 16,1 13,9 13,4 Group A, n=45 Group B, n=48 age 52,9 (19-78) 54,7 (20-85) % female 46,7 54,2 % type 1 53,3 52,1 duration of diabetes/y 17,2 (0-49) 17,3 (1-55) Random, n=45 3 months, n=40 6 months, n=40 Random, n=48 3 months, n=46 6 months, n=41 HbA1c % 7,71±0,16 7,48±0,16 7,3±0,15 7,67±0,13 7,65±0,16 7,48±0,15 Average Glc(mg/dl) 159,8±5,7 156,8±5,7 158,9±4,3 163,0±4,5 BG ≤50 mg/dl 15,4 16,1 13,9 13,4 In group A the HbA1c value was lowered not significantly about 0,23 percentage points after 3 months and significantly about 0,185 percentage points (*p<0,05) after 6 months. HbA1c was lowered about 0,413 percentage points (**p<0,01) over 6 months in Group A. In group B HbA1c was lowered when they started to document after 3 months about 0,195 percentage points not significantly. Open in new tab Group A, n=45 Group B, n=48 age 52,9 (19-78) 54,7 (20-85) % female 46,7 54,2 % type 1 53,3 52,1 duration of diabetes/y 17,2 (0-49) 17,3 (1-55) Random, n=45 3 months, n=40 6 months, n=40 Random, n=48 3 months, n=46 6 months, n=41 HbA1c % 7,71±0,16 7,48±0,16 7,3±0,15 7,67±0,13 7,65±0,16 7,48±0,15 Average Glc(mg/dl) 159,8±5,7 156,8±5,7 158,9±4,3 163,0±4,5 BG ≤50 mg/dl 15,4 16,1 13,9 13,4 Group A, n=45 Group B, n=48 age 52,9 (19-78) 54,7 (20-85) % female 46,7 54,2 % type 1 53,3 52,1 duration of diabetes/y 17,2 (0-49) 17,3 (1-55) Random, n=45 3 months, n=40 6 months, n=40 Random, n=48 3 months, n=46 6 months, n=41 HbA1c % 7,71±0,16 7,48±0,16 7,3±0,15 7,67±0,13 7,65±0,16 7,48±0,15 Average Glc(mg/dl) 159,8±5,7 156,8±5,7 158,9±4,3 163,0±4,5 BG ≤50 mg/dl 15,4 16,1 13,9 13,4 In group A the HbA1c value was lowered not significantly about 0,23 percentage points after 3 months and significantly about 0,185 percentage points (*p<0,05) after 6 months. HbA1c was lowered about 0,413 percentage points (**p<0,01) over 6 months in Group A. In group B HbA1c was lowered when they started to document after 3 months about 0,195 percentage points not significantly. Open in new tab Correlation of AG and HbA1c P551 https://esc365.escardio.org/Presentation/217108/abstract The effect of social factors on the prevalence of atrial fibrillation in hypertensive patients. C Liakos1, E Karpanou2, C Grassos3, M Markou4, G Vyssoulis1, D Tousoulis1 11st University Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece 21st Cardiology Clinic, Antihypertension Center, Onassis Cardiosurgery Center, Athens, Greece 3ã KATã General Hospital of Attica, ESH Center of Excellence for Hypertension, Cardiology Department, Athens, Greece 4Hippokration General Hospital , Cardiology Department, Athens, Greece Topic: Stress, Psycho-Social and Cultural Aspects of Heart Disease Background/Introduction: Atrial fibrillation (AF) is a common arrhythmia in hypertensive patients. Several conditions are deemed to be associated with AF. Purpose: This study examined the effect of social factors (sex, age, obesity, smoking, alcohol consumption and marital status) on AF prevalence in a large cohort of hypertensive patients. Methods: The study comprised 30785 hypertensives (52.4% men, age 58.8±12.9 years, office blood pressure 165.2±10.6/99.1±9.8 mmHg). Sex, age (years), smoking status (current, former, never), alcohol consumption (rare, light, moderate, heavy), and marital status (married, single, divorced) were recorded. Body mass index (BMI, kg/m²), body surface area (BSA, m²), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR) and sphericity index (SI=BMI/BSA, kg/m4) were calculated. Results: Sinus rhythm (SR) was prevalent in 90.1%, paroxysmal AF (PAF) in 5.5% and sustained AF (SAF) [including (Long-standing) Persistent AF or Permanent AF] in 4.4% of patients. In SR, PAF, SAF groups, men were 52.1%, 52.7%, 57.3% and women were 47.9%, 47.3%, 42.7%, respectively (p for trend<0.01). In SR, PAF, SAF male and female subgroups, mean age was 56.1, 65.9, 73.2 and 59.1, 68.5, 75.1, mean BMI 28.04, 28.71, 30.07 and 29.19, 31.32, 30.67, mean WHR 0.919, 0.942, 0.968 and 0.845, 0.889, 0.896, mean WSR 0.574, 0.600, 0.635 and 0.562, 0.603, 0.614, mean SI 13.99, 14.34 14.96 and 16.39, 17.33, 17.58, current smokers were 38.3%, 26.5% 26.3% and 29.7%, 20.0%, 25.0% of patients, former smokers 14.4%, 29.4% 35.1% and 7.8%, 12.9%, 20.8% of patients, light alcohol consumption was present in 56.7%, 46.6% 23.8% and 38.0%, 65.1%, 53.5% of patients, moderate alcohol consumption in 14.9%, 42.2%, 56.4% and 3.1%, 25.3%, 21.4% of patients, heavy alcohol consumption in 3.0%, 9.9%, 18.3% and 0.4%, 1.4%, 4.6% of patients, married were 82.1%, 87.4% 90.4% and 86.6%, 81.4%, 90.9% of patients, single 13.7%, 8.2%, 4.0% and 9.4%, 14.0%, 4.5% of patients and divorced 4.2%, 4.4%, 5.6% and 4.0%, 4.6%, 4.6% of patients, respectively (in men all p for trend<0.01, in women p for trend<0.01 only for age, WHR, WSR, SI, former smoking, heavy alcohol consumption). Conclusions: All the examined social factors (sex, age, obesity, smoking, alcohol consumption and marital status) seem to be associated with AF prevalence in hypertensive patients, especially in men. P554 https://esc365.escardio.org/Presentation/217613/abstract Components of internal picture of health optimization in patients with acute coronary syndrome during their rehabilitation R Nesterak1, M Gasyuk2, V Sovtus1, I Drapchak1, N Tymochko1, I Vakaliuk1, O Prytuliak1, N Savchuk1 1Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine 2Vasyl Stefanyk Precarpathian National University, Ivano-Frankivsk, Ukraine Topic: Stress, Psycho-Social and Cultural Aspects of Heart Disease Introduction: A patient-centred approach is important in the rehabilitation of ACS patients. The goal is patients' engagement in rehabilitation programs, improving their physical activity, and participation in training sessions on behavioural responses, and stress factors. We created a rehabilitation program based on the internal picture of health (IPH) of patients. The IPH is an attitude to the health expressed in its value awareness and realized in sensitive, emotional, cognitive, value-motivational and behavioural components. The purpose was to analyse the efficacy of the program for CVD patients by their IPH. Methods: The CVD patients were proposed to participate in the program. It included a discussion, 5 interactive sessions with training, individual psychological counselling, and post-diagnosis. The patients kept diaries, where they evaluated the IPH using relevant scales. We used diagnostic methods: HADS, PHQ-9, SF-36, SAQ, RPE, 6MWT, statistical data analysis, conversation, and observation. They were applied before the program, and a month later. Results: We examined 450 NSTEMI patients at rehabilitation. We found out low and moderate levels of IPH in most of them before the program, which improved later. E. g., the low level of emotional response was in 33.0% patients, moderate in 48.0%, and high in 18.7% before and 11.0%, 23.0%, and 66.0% respectively after the program. The 6MWT results showed its contribution to exercise tolerance, distance walking, increased BP and HR (see the table). Conclusions: Alongside bettered exercise indices, intentional behaviour aimed at preserving and restoring health has been formed. The program contributed to conscious attitude to health, broader knowledge on the causes of the disease, treatment options, and treatment compliance. Index, unit Before the program (n=450) After the program (n=450) Before Exercise After Exercise BeforeExercise After Exercise SBP, mmHg 128.0±2.1 152.2±1.6 Δ+18.9 132.2±2.1 143.7±1.28* Δ+8.70 DBP, mmHg 77.4±2.3 86.0±1.9 Δ+11.11 74.4±1.8 80.6±1.8 Δ+8.33 HR, bpm 75.2±2.9 87.3±2.6 Δ+16.09 74.6±2.1 79.4±1.3* Δ+6,43 Feeling, score 1.4±0.07 2.78±0.09 Δ+98.57 1.36±0.08 2.32±0.08* Δ+70,59 Dyspnea, score 1.08±0.09 1.32±0.06 Δ+22.22 1.06±0.07 1.15±0.04 Δ+8.49 Angina pectoris,score 0.99±0.06 1.192±0.03 Δ+20.40 0.94±0.05 1.03±0.04* Δ+9.57 Traveled distance, m 384.2±12.8 420.1 ±11.1* Δ+9.34 Index, unit Before the program (n=450) After the program (n=450) Before Exercise After Exercise BeforeExercise After Exercise SBP, mmHg 128.0±2.1 152.2±1.6 Δ+18.9 132.2±2.1 143.7±1.28* Δ+8.70 DBP, mmHg 77.4±2.3 86.0±1.9 Δ+11.11 74.4±1.8 80.6±1.8 Δ+8.33 HR, bpm 75.2±2.9 87.3±2.6 Δ+16.09 74.6±2.1 79.4±1.3* Δ+6,43 Feeling, score 1.4±0.07 2.78±0.09 Δ+98.57 1.36±0.08 2.32±0.08* Δ+70,59 Dyspnea, score 1.08±0.09 1.32±0.06 Δ+22.22 1.06±0.07 1.15±0.04 Δ+8.49 Angina pectoris,score 0.99±0.06 1.192±0.03 Δ+20.40 0.94±0.05 1.03±0.04* Δ+9.57 Traveled distance, m 384.2±12.8 420.1 ±11.1* Δ+9.34 1. * the significance of indicators difference after the program in comparison to values before it (<0,01). 2. Δ percentage increase (+) compared to the values before exercise. Open in new tab Index, unit Before the program (n=450) After the program (n=450) Before Exercise After Exercise BeforeExercise After Exercise SBP, mmHg 128.0±2.1 152.2±1.6 Δ+18.9 132.2±2.1 143.7±1.28* Δ+8.70 DBP, mmHg 77.4±2.3 86.0±1.9 Δ+11.11 74.4±1.8 80.6±1.8 Δ+8.33 HR, bpm 75.2±2.9 87.3±2.6 Δ+16.09 74.6±2.1 79.4±1.3* Δ+6,43 Feeling, score 1.4±0.07 2.78±0.09 Δ+98.57 1.36±0.08 2.32±0.08* Δ+70,59 Dyspnea, score 1.08±0.09 1.32±0.06 Δ+22.22 1.06±0.07 1.15±0.04 Δ+8.49 Angina pectoris,score 0.99±0.06 1.192±0.03 Δ+20.40 0.94±0.05 1.03±0.04* Δ+9.57 Traveled distance, m 384.2±12.8 420.1 ±11.1* Δ+9.34 Index, unit Before the program (n=450) After the program (n=450) Before Exercise After Exercise BeforeExercise After Exercise SBP, mmHg 128.0±2.1 152.2±1.6 Δ+18.9 132.2±2.1 143.7±1.28* Δ+8.70 DBP, mmHg 77.4±2.3 86.0±1.9 Δ+11.11 74.4±1.8 80.6±1.8 Δ+8.33 HR, bpm 75.2±2.9 87.3±2.6 Δ+16.09 74.6±2.1 79.4±1.3* Δ+6,43 Feeling, score 1.4±0.07 2.78±0.09 Δ+98.57 1.36±0.08 2.32±0.08* Δ+70,59 Dyspnea, score 1.08±0.09 1.32±0.06 Δ+22.22 1.06±0.07 1.15±0.04 Δ+8.49 Angina pectoris,score 0.99±0.06 1.192±0.03 Δ+20.40 0.94±0.05 1.03±0.04* Δ+9.57 Traveled distance, m 384.2±12.8 420.1 ±11.1* Δ+9.34 1. * the significance of indicators difference after the program in comparison to values before it (<0,01). 2. Δ percentage increase (+) compared to the values before exercise. Open in new tab P556 https://esc365.escardio.org/Presentation/217037/abstract Effect of the laugh in the management of Moroccan patients in cardiac rehabilitation O Hlal1, N Mouine1, N El Malki Berrada1 1Military Hospital Mohammed V, cardiac rehabilitation unit, cardiology centre , Rabat, Morocco Topic: Stress, Psycho-Social and Cultural Aspects of Heart Disease Introduction: The laugh is a complementary medicine that has therapeutic virtues. The aim of study is to evaluate the impact of the laugh in the management of patients in cardiac rehabilitation. Materials and Methods It's a prospective study included 40 patients admitted in cardiac rehabilitation unit of our hospital. All of them had a clinical evaluation, biological assessment, transthoracic echocardiography, cardio respiratory evaluation; they were divided in 2 groups: group 1 made collective workshops with laughing and group 2 made collective workshops without laughing Results: The average age of patients is 57.29 ± 10.1 years, with male predominance (32 Men / 8 Women); they have more than three cardiovascular risk factors dominated by smoking and hypertension, Coronary artery disease is the most frequent etiology. After 20 sessions of physical training and therapeutic workshops, patients in group 1 improved their quality of life, communicated optimistic responses, in joviality reflecting better therapeutic adherence compared to group 2 Conclusion: This study shows that the laugh is a new approach in the management of patients in cardiac rehabilitation, this result is encouraging and it will be the beginning of the future studies. P558 https://esc365.escardio.org/Presentation/217048/abstract Features of emotional status of men and women with chronic heart failure A Aleksei Ibatov1 1Sechenov Moscow medical academy , Moscow, Russian Federation Topic: Stress, Psycho-Social and Cultural Aspects of Heart Disease Purpose: to study gender features of emotional status of patients with ischemic heart disease (IHD) and chronic heart failure (CHF). Methods: 56 patients (men and women) with ischemic heart disease and chronic heart failure II-III functional class NYHA at the age of 42 to 65 years were examined. Patients were divided into 2 groups. The first group included 18 women, average age ã 58.3 ± 1.2 years. The second group included 48 men, average age ã 56.8 ± 1.5 years (p> 0.05). The level of anxiety and depression was investigated by the Hospital Anxiety and Depression Scale (HADS), personality characteristics - by the MMPI questionnaire. Results: the groups did not differ in age, duration of IHD and CHF, functional class of heart failure, therapy. The level of anxiety and depression were in 1st group accordingly - 9.3 ± 0.7 and 6.9 ± 0.7 scores, in 2nd group accordingly - 5.6 ± 0.7 (p <0.05) and 5.7 ± 0.7 (p> 0.05) scores. MMPI test parameters in the first and second group were, accordingly: on scale of Hypochondriasis ã 60.2 ± 1.2 and 55.8 ± 1.4 (p <0.05) scores; on scale of Depression ã 55.7 ± 3 , 6 and 50.6 ± 2.0 (p> 0.05) scores; on scale of Hysteria ã 56.4 ± 1.5 and 50.1 ± 1.3 (p <0.01) scores; on scale of Psychopathic Deviate ã 53.4 ± 2.7 and 45.5 ± 1.7 (p <0.05) scores; on scale of Paranoia ã 58.5 ± 3.0 and 52.1 ± 1.8 (p> 0.05) scores; on scale of Psychasthenia ã 53.5 ± 2.3 and 49.7 ± 2.1 (p> 0.05) scores; on scale of Schizophrenia ã 59.7 ± 3.5 and 47.1 ± 1.7 (p <0.01) scores; on scale of Hypomania ã 58.1 ± 1.6 and 44.3 ± 2.4 points (p <0.001) scores. Conclusions: women with chronic heart failure had a more high level of anxiety and more expressed personality characteristics, as compared to men with chronic heart failure, this must be considered when planning treatment. 15 https://esc365.escardio.org/Presentation/217053/abstract High peak exercise blood pressure in athletes is proportional to exercise capacity. K Janssens1, G Claessen2, S Faulkes1, L Rowsell1, D Flannery1, E Howden1, A La Gerche1 1Baker Heart and Diabetes Institute, Melbourne, Australia 2Gasthuisberg University Hospital, Leuven, Belgium Topic: Exercise Testing An abnormal blood pressure (BP) response to exercise is an important physiological variable associated with a risk of sub-clinical hypertension. Reference values are poorly defined and lack contextualization to physiological demands that can be obtained among very active populations. PURPOSE: To assess the relationship between systolic BP (SBP) and workload and to determine reference values of SBP response to exercise in endurance athletes. METHODS: We recruited 123 current and former endurance athletes (76% male), aged 16-80 years. BP was measured every 2 min during a maximal bicycle cardiopulmonary exercise test using a TangoM2 automated BP monitor. Relationship between SBP measured at 25%, 50%, 75% and 100% of maximum workload and power output during exercise were determined by linear regression analysis using STATA software. RESULTS: SBP increased from 128 ±13 mmHg in males (age 40±18 years) and 116 ± 12 mmHg in females (age 35±14 years) to peak 223 ± 27 mmHg and 203 ± 19 mmHg, respectively (P<0.0001). The majority of participants demonstrated an exaggerated SBP response to exercise (72% of males and 82% of females) as defined by the American Heart Association guidelines. There was a strong correlation between power output and SBP (r2 = 0.67, P<0.001, Figure 1). Males achieved 123±18% and females 134±26% of their predicted VO2 max (P<0.01). There was no statistical difference in exercise SBP response according to age or BMI. Gender and hypertensive medication did have a statistically significant, but weak correlation to SBP (P<0.01 and P<0.001 respectively r2 =0.03 for both) CONCLUSION: High SBP values are observed in athletes at peak exercise, frequently exceeding ã normal valueã definitions. However, SBP increases can be explained by the supra-normal exercise capacity, thus, should be considered in the context of exercise capacity. EAPC Essentials 4 You - ePosters P241 https://esc365.escardio.org/Presentation/217385/abstract The effect of age on determinants of exercise tolerance in healthy individuals A Fuller1, N Okwose1, L Greaves2, GA Macgowan3, DG Jakovljevic3 1Newcastle University, Cardiovascular Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland 2Newcastle University, Biosciences Research Institute, Faculty of Medical Sciences, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland 3The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Department of Cardiology, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: NHR Newcastle Biomedical Research Centre for Ageing Topic: Exercise Testing Objective: Exercise tolerance, represented by peak O2 consumption, is an important determinant of functional capacity, quality of life and functional independence in older age. The aim of the present study was to assess the effect of age on mechanisms of exercise intolerance. Methods: Ninety-four healthy individuals were divided into two groups according to their age i.e. younger (≤40 years of age, N=52, 23 females); and older (≥50 years of age, N=42, 24 females). All participants underwent maximal graded cardiopulmonary exercise stress testing using cycle ergometer with simultaneous non-invasive gas-exchange and central haemodynamic measurements. Using the Fick equation, arteriovenous oxygen difference was calculated as the ratio between O2 consumption and cardiac output. Results: The mean age of younger participants was 27.5±7.0 years, and for older 65.1±6.8 years. Peak oxygen consumption was significantly lower in older compared to the younger age group (absolute values 1.54±0.50 vs 2.27±0.76 L/min, p<0.01; and relative value 18.1±6.0 vs 33.0±9.9 ml/kg/min, p<0.01). Peak exercise cardiac output and cardiac index were not significantly different between the younger and older age groups (21.9±5.26 vs 23.1±5.20 L/min, p=0.28; and 11.7±2.21 vs 12.5±1.79 L/min/m2, p=0.08). Despite demonstrating significantly lower peak heart rate by 31 beats/min (138±19.8 vs 169±22.8, p<0.01), older participants demonstrated higher peak exercise stroke volume and stroke volume index by 37 ml/beat (i.e. 167±38.9 vs 130±32.2 ml/beat, p<0.01), and 15 ml/beat/m2 (87.0±16.6 vs 72.2±16.5 ml/beat/m2, p<0.01). Arteriovenous oxygen difference was significantly lower in older compared to younger age group participants (8.0±3.3 vs 15.7±4.4 mlO2 / 100 ml blood, p<0.01). Conclusions: Ability of skeletal muscles to extract delivered oxygen represented by reduced arteriovenous O2 difference at peak exercise appears to be the key determinant of exercise tolerance in healthy older individuals. Older people demonstrate ability to increase their stroke volume in order to maintain cardiac output despite significant reduction in peak exercise heart rate. P243 https://esc365.escardio.org/Presentation/221667/abstract Integrated physiological responses during incremental and supra-maximal exercise protocols MCM Frade1, T Beltrame1, MO Gois1, SN Linares1, A Petronilho1, GLA Sanches1, RL Hughson2, RS Torres3, AM Catai1 1Federal University of Sao Carlos, Department of Physical Therapy , Sao Carlos, Brazil 2University of Waterloo, Department of Kinesiology , Waterloo, Canada 3State University of Campinas (UNICAMP), Institute of Computing, Campinas, Brazil Funding Acknowledgements: FAPESP (2016/22215-7; 2017/09639-5; 2018/19016-8; 2018/22818-9); CNPq (168866/2017-0); CAPES (88887.362954/2019-00) Topic: Exercise Testing Background: Maximal oxygen uptake (VO2max) is correlated with all-cause mortality and it measures the overall power of the oxygen transport and utilization system. However, direct VO2max measuring imposes a variety of experimental challenges related to volitional fatigue and effort perception of subjects during incremental exercise protocols. Consequently, the highest oxygen uptake (VO2peak) does not represent the actual upper ceiling of the aerobic system power. Therefore, some authors are indicating a validation exercise protocol to differentiate VO2peak from VO2max. Purpose. Compare the integrated physiological responses at the peak effort between incremental and supra-maximal validation protocols as proposed by Poole and Jones, 2017. Methods. The variables related to the oxygen transport and utilization system at the peak of each protocol were vastus lateralis deoxy-hemoglobin concentration (HHb in ΔµM), cardiac output (CO in l/min), vastus lateralis muscle recruitment (by the root mean square, RMS in % of the maximal voluntary contraction), and the VO2; estimated by near-infrared spectroscopy, photoplethysmography, surface electromyography and metabolic cart. Initially, 21 participants (27±5 years old, 66±10kg, 170±7cm, VO2max of 44±7ml/kg/min), 11 males, completed a maximal incremental exercise followed by an until-exhaustion supra-maximal constant workload validation protocol. The workload of the validation protocol was 110% of the maximal workload reached during the incremental protocol. Peak responses were considered as the mean responses of the last 20 and 5 seconds of the incremental and validation protocol, respectively. Variables were compared between incremental and validation protocol by paired t-test with a statistical significance level set at 5%. Results. Following the criteria to classify VO2peak as VO2max, all participants reached the VO2max during the validation protocol. However, the VO2max during the validation protocol was still statistically (p<0.001) 5% lower in comparison to the VO2max during the incremental protocol. In order to statistically pair the maximal metabolic rate between protocols, participants with the highest differences in VO2max between protocols were removed from the sample recursively until no statistical difference was observed. From all participants, only 12 (26±6 years old, 64±11kg, 169±8cm, VO2max of 43±7ml/kg/min), 7 males, remained in the sample until no statistical (p=0.093) difference was found in VO2max between the incremental and the validation protocol. In Figure, even with a lower central oxygen delivery (B=CO), peripheral oxygen extraction (C=HHb) and muscle recruitment (D=RMS), the same maximal metabolic rate (VO2max) was reached during the validation protocol. Conclusion. Due to differences in the dynamic responses of the analyzed variables between the incremental and the validation protocol, the same aerobic power can be reached by different physiological strategies between protocols. Comparison between variables. P244 https://esc365.escardio.org/Presentation/221674/abstract Predictors of cardiorespiratory optimal point in patients enrolled in a cardiac rehabilitation program A Alexandra Castelo1, P Rio1, V Ferreira1, P Bras1, T Mano1, A Goncalves1, J Reis1, AS Silva1, S Alves1, R Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal Topic: Exercise Testing Introduction: The cardiopulmonary exercise test (CPET) allows the evaluation of peak and sub-maximal tolerance to the effort, giving us relevant information for making clinical decisions. The Cardiorespiratory Optimal Point (COP), calculated as the minimum ratio between ventilation and oxygen consumption and (VE / VO2), may be a good predictor of events and may be influenced by some factors. Purpose: The aim was to characterize the population of the cardiac rehabilitation (CR) appointment who performed CPET and to determine predictive factors of the COP. Methods: Retrospective analysis of CR appointment patients who underwent CEPT between 2014 and 2017 in a single center. We evaluated clinical, laboratory and echocardiographic characteristics and determined predictors of COP value. Results: 207P (83.6% men) were included, with a mean age of 57 years. The mean COP was 24.86 +-0.41 (IC [24.06-25.66]). The majority (96.6%) had a cardiovascular disease or risk factor (diabetes in 24.6%, hypertension in 55.1%, dyslipidemia in 71.5%, excess weight or obesity in 75.4%, with mean body mass index of 27.3, family history in 16.4%, acute myocardial infarction (AMI) in 19.3%, smoking in 44.4% and other diseases in 51.2%). 99% were medicated (91.3% acetylsalicylic acid, 65.2% clopidogrel, 23.7% ticagrelor, 92.8% beta-blocker, 91.3% ACEI / ARB, 90.3% statin). The majority (88,78%) was referred for CR with isquemic cardiopathy (AMI or stable or unstable coronary disease), 9.27% with heart failure (HF) and 1.95% with valvulopathy. The predictors of a highest value of COP were higher age (CC=0.269, p<0.001), female sex (p = 0.008), heart failure (p = 0.028), previous acute myocardial infarction (p = 0.003), lower ejection fraction (CC = -0.124, p = 0.011), lower haemoglobin (CC = -0.170, p <0.001), higher BNP (CC = 0.233, p <0.001) and higher erythrocyte sedimentation rate (CC = 0.171, p = 0.004). Of these, independent predictors of higher COP were age (p <0.001), lower haemoglobin (p = 0.042) and higher BNP (p <0.001). Conclusion: The COP value is related to multiple factors, of which the age, the BNP value and the haemoglobin value are independent factors. P245 https://esc365.escardio.org/Presentation/221686/abstract Ventilatory potency as a predictor of outcomes in patients enrolled in a cardiac rehabilitation program A Alexandra Castelo1, P Rio1, J Reis1, V Ferreira1, P Bras1, J Viegas1, AS Silva1, S Alves1, R Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal Topic: Exercise Testing Introduction: The cardiopulmonary exercise test (CPET) allows the evaluation of peak and sub-maximal tolerance to the effort, giving us relevant information for making clinical decisions. The Ventilatory Power (VP), calculated as the ratio between peak systolic blood pressure and VE/VCO2 slope, may be a good predictor of events. Purpose: The aim was to characterize the population of the cardiac rehabilitation (CR) appointment who performed CPET and to evaluate VP as a predictor of events. Methods: Retrospective analysis of CR appointment patients who underwent CEPT between 2014 and 2017 in a single center. We evaluated clinical, laboratory and echocardiographic characteristics. We compared the mortality and hospitalizations according to VP values and evaluated sub-groups in which it has the highest power as a predictor of events. Results: 207 Patients (P) (83.6% men) were included, with a mean age of 57 years. The mean VP was 5.3 +-0.099 (IC [5.1085-5.5002]). The majority had a cardiovascular disease or risk factor (diabetes in 24.6%, hypertension in 55.1%, dyslipidemia in 71.5%, excess weight or obesity in 75.4%, with mean body mass index of 27.3, family history in 16.4%, acute myocardial infarction (AMI) in 19.3%, smoking in 44.4% and other diseases in 51.2%). 99% were medicated (91.3% acetylsalicylic acid, 65.2% clopidogrel, 23.7% ticagrelor, 92.8% beta-blocker, 91.3% ACEI / ARB, 90.3% statin). The majority (88,78%) was referred for CR with isquemic cardiopathy (AMI or stable or unstable coronary disease), 9.27% with heart failure (HF) and 1.95% with valvulopathy. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason). Lower VP values correlated with higher number of cardiovascular (CV) hospitalization (B = -0.255, p = 0.04), heart failure (HF) hospitalization (B = -0.702, p = 0.037), and combined endpoints mortality and CV hospitalization (B = -0.255, p = 0.039) and mortality and HF hospitalization (B = -0.569, p = 0.048). VP did not correlate with mortality (p = 0.868). Despite these correlations it was not a good predictor of either endpoint in the global population. However, when we did a sub-analysis only with the ischemic patients, it was actually a good predictor of HF hospitalization (AUC 0.88) and a reasonable predictor of the combined endpoint mortality and HF hospitalization (AUC 0.75). A cut off value of 4.54 had 100% sensitivity (S) and 76% specificity (E) for HF hospitalization. Values below this cut off correlate with more HF hospitalizations (p = 0.013). Conclusion: VP was a good predictor of HF hospitalization and a reasonable predictor of the combined endpoint mortality and HF hospitalization. In our population the cut off 4.54 for VP had the greatest S and E for predicting HF hospitalization. P246 https://esc365.escardio.org/Presentation/217624/abstract Using machine learning to assess prognosis in heart failure patients evaluated by CPET: a decision tree based algorithm AD Anderson Donelli Silveira1, FL Scolari1, WR Menegazzo1, FC Barros1, MN Branchi1, EF Englert1, M Antonello1, JL Custodio1, EG Pianca1, LE Ritt1, R Stein1 1Federal University of Rio Grande do Sul (UFRGS), Department of Cardiology, Porto Alegre, Brazil Topic: Exercise Testing Background: Cardiopulmonary exercise testing (CPET) is widely used for prognostication in heart failure, with peak oxygen consumption (peakVO2) and the slope of ventilatory equivalents for carbon dioxide (VE/VCO2 slope) known as the best predictors of adverse outcomes. Decision tree learning uses a decision tree predictive model to go from observations about an item (represented in the branches) to conclusions about the item's target value (represented in the leaves). Chi-square automatic interaction detection (CHAID) is a decision tree learning technique, based on adjusted significance testing (Bonferroni testing). Exhaustive CHAID is modification of CHAID, which examines all possible splits for each predictor. Purpose: To asses the prognostic ability of an algorithm generated by decision tree learning using peakVO2 and VE/VCO2slope in heart failure patients. Methods: Retrospective cohort study with patients with HFrEF that realized CPET for prognostic stratification between 2010 and 2018. All CPET were realized in treadmill with incremental ramp protocol. Primary outcome was all-cause death. A classification tree was built using exhaustive CHAID technique as growing method, with significance level for splitting nodes <0.05 and chi-square likelihood ratio statistic. Significance values were adjusted by Bonferroni method. For model estimation a maximum number of 10,000 iterations and a minimum change in expected cell frequencies of 0.0001 were allowed. Statistical analysis was performed using SPSS Version 23.1. Results: 541 patients were included (mean age 55±12; 60,2% male; mean ejection fraction (EF) 32±11% and 30% with ischemic etiology. After a mean follow-up of 34±18 months, the primary outcome occurred in 94 (17.1%) patients. The decision tree algorithm generated is highlighted in figure 1. In the first node peakVO2 (cutpoints 20.06 and 13.57) correctly classified the sample in low, moderate or high risk (7.4, 18.1 and 30.6% of death, P<0.001). Furthermore, VE/VCO2 slope (cutpoint 36.9) classified the intermediate risk group in high or low risk (9.2% and 29.2%, P=0.001). Conclusion: In this cohort, decision tree learning was useful to predict all-cause death in heart failure patients. The proposed algorithm correctly classified patients into high or low risk of death using two prognostic variables from CPET. Further studies are welcome to validate this proposed classification in different samples. Fig: 1 - Mortality Risk Decision Tree P248 https://esc365.escardio.org/Presentation/217107/abstract The effect of Calanus Finmarchicus oil (Calanus Oil ) on maximal oxygen uptake: a randomized controlled study T Trine Karlsen1, L Taucheck2, R Rosbjorgen2, H Dalen2, T Larsen3 1Nord University, Bodo, Norway 2Norwegian University og Science and Technology , Trondheim, Norway 3UiT The Arctic University of Norway, Department of Medical Biology, Tromso, Norway Funding Acknowledgements: Calanus AS Topic: Exercise Testing Purpose: to investigate the long-term effect of daily Calanus® Oil supplementation on maximal oxygen uptake (VO2max) in healthy 30-50 year old human participants. VO2max is the single best measure of human endurance capacity, as well as a predictor of longevity and cardiovascular disease mortality. Systematic exercise training increases VO2max and has beneficial health effects. The copepod-based omega-3 rich Calanus® Oil supplementation has previously been shown to increase VO2max in diet-induced obese mice. The present study is a follow-up study in healthy human participants. Method: in a double-blinded study, 71 participants were randomized to receive 2 grams x day-1 of Calanus® Oil or placebo supplementation for a total of 6 months. The participants underwent exercise testing and clinical investigations at baseline, 3 months and 6 months. The main study outcome was change in VO2max from baseline to 6 months. Results are given as mean ± standard deviation. Results: a total of 58 participants (baseline age, years: Calanus® Oil, 39.7 ± 4.5 and placebo, 38.8 ± 5.3; baseline BMI, kg x m2: Calanus® Oil, 24.8 ± 2.2 and placebo, 24.8 ± 2.8; baseline VO2max , ml x kg-1 x min-1: Calanus® Oil, 50.4 ± 9.1 and placebo 50.2 ± 8.8) completed the 6-month test and were included in the final data analysis. There were no between group differences at baseline. There were no between group changes in VO2max measured in L·min-1 (Calanus® Oli, 3.78 ± 0.79 and placebo, 3.79 ± 0.90) or normalized to body weight (Calanus® Oil 50.1 ± 9.6 ml·kg-1·min-1 and Placebo 49.5 ± 9.2 ml·kg-1·min-1) from baseline to 6 months (6 month values). No other clinical measures changed over the 6-month study period. Conclusion: Six months of Calanus® Oil supplementation did not change maximal oxygen uptake in physically fit, healthy, normal to overweight middle age men and women between 30-50 years of age. 13 https://esc365.escardio.org/Presentation/221581/abstract Prognostic utility of dynapenia in elderly patients with cardiovascular disease: comparison with sarcopenia. S Shota Uchida1, K Kamiya2, N Hamazaki3, K Nozaki3, T Ichikawa3, T Nakamura1, M Yamashita1, K Aida1, Y Kootaka1, E Maekawa4, H Kariya3, M Yamaoka-Tojo2, A Matsunaga2, J Ako4 1Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan 2Kitasato University, Department of Rehabilitation, School of Allied Health Sciences, Sagamihara, Japan 3Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan 4Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan Topic: Cardiovascular Rehabilitation Background: Dynapenia is an ageing-related loss of muscle strength. Like sarcopenia, dynapenia has been reported to be a risk factor for mortality. However, no reports have compared the impact of dynapenia and sarcopenia on mortality in elderly patients with cardiovascular disease (CVD). Purpose: This study compared the prognostic utility of dynapenia and sarcopenia in elderly patients with CVD. Methods: We examined a total of 2,148 elderly patients with CVD, aged ≥60 years (73.0 [68.0, 78.0]; 1,585 males), who were admitted to our hospital and participated in an inpatient cardiac rehabilitation programme. Dynapenia was defined according to Maniniã s criteria, consisting of low grip strength (<26 and <18 kg in males and females, respectively) and low quadriceps isometric strength (QIS) (45% and 35% body weight in males and females, respectively). Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia. Survival rates between dynapenia and non-dynapenia groups and between sarcopenia and non-sarcopenia groups were compared using the KaplanãMeier method, log-rank test and Cox regression analysis. Moreover, we determined whether dynapenia and sarcopenia had complementary predictive capability in the multivariate-adjusted model was determined by constructing receiver operating characteristic (ROC) curves and areas under the curves (AUC) for all-cause mortality using three models: multivariate-adjusted model only, multivariate-adjusted model + dynapenia and multivariate-adjusted model + sarcopenia. Results: Over a median follow-up period of 1.7 years (interquartile 0.7ã3.6) years, 294 deaths occurred in the population. The KaplanãMeier method and log-rank test showed that there was a significant increase in the all-cause mortality in the dynapenia and sarcopenia groups (log-rank, P < 0.05). Cox regression analysis, even after adjusting for prognostic models, showed significantly poor prognosis in the dynapenia and sarcopenia groups (dynapenia group, hazard ratio [HR] =1.86, 95% confidence interval [CI] = 1.42ã2.43, P < 0.05; sarcopenia group, HR = 2.02, 95% CI = 2.66–4.77, P < 0.05). AUCs on ROC curve analysis were 0.70 (95% CI = 0.66–0.73) for multivariate-adjusted model only, 0.72 (95% CI = 0.68–0.75) for multivariate-adjusted model + dynapenia and 0.70 (95% CI = 0.67–0.74) for multivariate-adjusted model + sarcopenia. AUC of the multivariate-adjusted model was not significantly different from that of the multivariate-adjusted model + sarcopenia (P = 0.15). However, AUC of the multivariate-adjusted model + dynapenia was significantly higher than that of the multivariate-adjusted model only (P < 0.05). Conclusion: In elderly patients with CVD, sarcopenia or dynapenia had poor prognoses; moreover, dynapenia is more useful than sarcopenia in predicting all-cause mortality, suggesting the importance of evaluating dynapenia in elderly patients with CVD. EAPC Essentials 4 You - ePosters 344 https://esc365.escardio.org/Presentation/221655/abstract Cardiac rehabilitation do not diminish the socioeconomic disparity in cardiovascular health in the elderly; the EU-CaRE study I Ingunn Kjesbu1, N Mikkelsen2, KL Sibilitz2, M Wilhelm3, CP Gil4, MC Iliou5, U Zeymer6, EP Meindersma7, D Ardissino8, AE Van Der Velde9, AWJ Van't Hof9, EP De Kluiver9, E Prescott1 1Bispebjerg University Hospital, Copenhagen, Denmark 2Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark 3University of Bern, University Clinic of Cardiology, Inelspital, Bern, Switzerland 4University Hospital of Santiago de Compostela, Cardiology, Santiago de Compostela, Spain 5Hopital Europeen Georges Pompidou- University Paris Descartes, Department of cardiac rehabilitation, Paris, France 6Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany 7Radboud University Medical Center, Cardiology, Nijmegen, Netherlands (The) 8Hospital of Parma, Cardiology, Parma, Italy 9Isala Clinics, Heart Centre, Zwolle, Netherlands (The) On Behalf of: EU-CaRE study group Funding Acknowledgements: Horizon 2020 Topic: Cardiovascular Rehabilitation Background Socioeconomic status is a strong predictor of cardiovascular health. The aim of this study was to address whether participation in cardiac rehabilitation (CR) may help diminish the socioeconomic gap. Methods: Patients ≥65 years with coronary heart disease or heart valve surgery participating in CR were consecutively included from 8 CR sites in 7 European countries. Data were obtained at baseline, end-of-CR and at 1-year follow up. Educational level as a marker for socioeconomic status was divided into basic, intermediate and high. Primary outcome was exercise capacity (VO2peak). Secondary outcomes were cardiovascular risk factors, psychological distress and medical treatment. Results: A total of 1,626 patients were included; 28% had basic, 48% intermediary and 24% high education. A total of 1,515 and 1,448 patients were available for follow up analyses at end-of-CR and 1-year, respectively. We found a socioeconomic gradient in VO2peak, lifestyle related cardiovascular risk factors (HbA1c, BMI, diet score) and psychological distress at all timepoints. The socioeconomic gap in VO2peak increased following CR. In contrast, use of evidence-based medication was good in all socioeconomic groups. Conclusions: We found a strong socioeconomic gradient in VO2peak and cardiovascular risk factors that was unaffected by CR. To address inequity in cardiovascular health, CR according to socioeconomic needs should be considered. Baseline characteristics High Intermediate Basic p-value n=1,626 388 (24%) 778 (48%) 460 (28%) Age, median (IQR) 72 (68,76) 71 (68,75) 74 (70.78) <0.001* Gender Women 50 (13.2%) 157 (20.7%) 141 (32.6%) <0.001* Index event ACS 179 (46.1%) 435 (55.9%) 260 (56.5%) <0.001** Stable CHD 154 (39.7%) 254 (32.6%) 125 (27.2%) Valve 55 (14.2%) 89 (11.4%) 75 (16.3%) Revascularization Yes 333 (85.8%) 667 (85.7%) 365 (79.3%) 0.004** No 55 (14.2%) 111 (14.1%) 95 (20.7%) Hypertension 237 (61.2%) 528 (68.0%) 339 (73.7%) <0.001 Hypercholesterolemia 263 (68.1%) 523 (67.3%) 309 (67.2%) 0.950 Diabetes mellitus 68 (17.6%) 196 (25.2%) 135 (29.4%) <0.001 Cardiac history prior to event 171 (44.1%) 340 (43.7%) 241 (52.5%) 0.007 Baseline characteristics High Intermediate Basic p-value n=1,626 388 (24%) 778 (48%) 460 (28%) Age, median (IQR) 72 (68,76) 71 (68,75) 74 (70.78) <0.001* Gender Women 50 (13.2%) 157 (20.7%) 141 (32.6%) <0.001* Index event ACS 179 (46.1%) 435 (55.9%) 260 (56.5%) <0.001** Stable CHD 154 (39.7%) 254 (32.6%) 125 (27.2%) Valve 55 (14.2%) 89 (11.4%) 75 (16.3%) Revascularization Yes 333 (85.8%) 667 (85.7%) 365 (79.3%) 0.004** No 55 (14.2%) 111 (14.1%) 95 (20.7%) Hypertension 237 (61.2%) 528 (68.0%) 339 (73.7%) <0.001 Hypercholesterolemia 263 (68.1%) 523 (67.3%) 309 (67.2%) 0.950 Diabetes mellitus 68 (17.6%) 196 (25.2%) 135 (29.4%) <0.001 Cardiac history prior to event 171 (44.1%) 340 (43.7%) 241 (52.5%) 0.007 Data presented as n(%) unless otherwise specified. *adjusted for country **adjusted for gender, age, country. Abbreviations: IQR: interquartile range, CHD: coronary heart disease Open in new tab Baseline characteristics High Intermediate Basic p-value n=1,626 388 (24%) 778 (48%) 460 (28%) Age, median (IQR) 72 (68,76) 71 (68,75) 74 (70.78) <0.001* Gender Women 50 (13.2%) 157 (20.7%) 141 (32.6%) <0.001* Index event ACS 179 (46.1%) 435 (55.9%) 260 (56.5%) <0.001** Stable CHD 154 (39.7%) 254 (32.6%) 125 (27.2%) Valve 55 (14.2%) 89 (11.4%) 75 (16.3%) Revascularization Yes 333 (85.8%) 667 (85.7%) 365 (79.3%) 0.004** No 55 (14.2%) 111 (14.1%) 95 (20.7%) Hypertension 237 (61.2%) 528 (68.0%) 339 (73.7%) <0.001 Hypercholesterolemia 263 (68.1%) 523 (67.3%) 309 (67.2%) 0.950 Diabetes mellitus 68 (17.6%) 196 (25.2%) 135 (29.4%) <0.001 Cardiac history prior to event 171 (44.1%) 340 (43.7%) 241 (52.5%) 0.007 Baseline characteristics High Intermediate Basic p-value n=1,626 388 (24%) 778 (48%) 460 (28%) Age, median (IQR) 72 (68,76) 71 (68,75) 74 (70.78) <0.001* Gender Women 50 (13.2%) 157 (20.7%) 141 (32.6%) <0.001* Index event ACS 179 (46.1%) 435 (55.9%) 260 (56.5%) <0.001** Stable CHD 154 (39.7%) 254 (32.6%) 125 (27.2%) Valve 55 (14.2%) 89 (11.4%) 75 (16.3%) Revascularization Yes 333 (85.8%) 667 (85.7%) 365 (79.3%) 0.004** No 55 (14.2%) 111 (14.1%) 95 (20.7%) Hypertension 237 (61.2%) 528 (68.0%) 339 (73.7%) <0.001 Hypercholesterolemia 263 (68.1%) 523 (67.3%) 309 (67.2%) 0.950 Diabetes mellitus 68 (17.6%) 196 (25.2%) 135 (29.4%) <0.001 Cardiac history prior to event 171 (44.1%) 340 (43.7%) 241 (52.5%) 0.007 Data presented as n(%) unless otherwise specified. *adjusted for country **adjusted for gender, age, country. Abbreviations: IQR: interquartile range, CHD: coronary heart disease Open in new tab Figure 1 Development following CR Award Winning Science - Secondary prevention & rehabilitation section 46 https://esc365.escardio.org/Presentation/217397/abstract Telemonitoring and remote guiding of exercise therapy after a phase II cardiac rehabilitation programme: 2-year results of the TRiCH study on physical activity and fitness. J Claes1, A Avila1, R Buys1, K Goetschalckx2, N Cornelis1, V Cornelissen1 1KU Leuven, Rehabilitation sciences, Leuven, Belgium 2KU Leuven, Cardiovascular sciences, Leuven, Belgium Topic: Cardiovascular Rehabilitation Background: Remote monitoring and guiding of exercise is increasingly used in the field of cardiac rehabilitation (CR) as an alternative or adjunct method that could enhance uptake and lifelong compliance to a physically active (PA) lifestyle in patients with cardiac diseases. Whereas these interventions have shown promising results in the short-term, little is known about their effectiveness on physical activity and physical fitness (PF) on the longer-term. Purpose: To evaluate the sustainability of a 3-month telemonitoring intervention on PA and PF levels two years after completion of a phase II programme. Methods: The TRiCH-study randomized 90 patients with coronary artery disease completing a phase II CR programme into three groups: a center-based exercise group (CB), a telemonitored and guided home-based group (HB) and a usual care group (UC). Patients in the CB group continued the supervised ambulatory exercise training programme for another three months , patients in the HB group received a personal exercise prescription, telemonitoring (sports watch) and weekly feedback on their PA behavior via e-mail or telephone for three months, the UC group was advised to remain physically active according to current guidelines. Two years following completion of the programme, we reassessed PA (Sensewear Mini) and PF (maximally graded cardiopulmonary exercise test). Outcome measures for PA were weekly minutes of moderate to vigorous PA (MVPA) and the number of daily steps. Outcome measures for PF included peak oxygen consumption (VO2), ventilation, load and heart rate (HR) as well as oxygen uptake and workload at first ventilatory threshold (VT1). Results: 54 patients (7 women; 18 HB group, 21 CB group, 15 UC group), participated in the two-year follow-up measurements. Overall, the average number of steps (8377 ± 2671 vs. 6913 ± 3313; p=0.021) and the weekly minutes of MVPA (155 ± 84 vs. 123 ± 76; p=0.04) was significantly lower at two years follow-up. Peak VO2 did not differ (2138 ± 570 ml/min vs. 2091 ± 604 ml/min; p=0.644) but, submaximal exercise indices were significantly decreased as can be seen in the percentage of peak VO2 (74 ± 15% vs. 62 ± 9%; p<0.001), absolute VO2 (1551 ± 472 ml/min vs. 1285 ± 409 ml/min; p=0.003), workload (128 ± 39 W vs. 99 ± 33 W; p<0.001) and HR (110 ± 23 bpm vs. 96 ± 11 bpm; p<0.001) at VT1. No differences were observed among the three groups over time (p-interaction >0.05) Conclusions: Two years after graduating from a phase II CR programme, physical activity and physical fitness levels had significantly declined regardless of the use of prolonged center-based training or the implementation of a three month telemonitoring and exercise guiding intervention in patients with coronary artery disease. Future research might want to elucidate if other methods or better patient profiling can prolong the effects of phase III CR on PA and PF. EAPC Essentials 4 You - ePosters P252 https://esc365.escardio.org/Presentation/217618/abstract Multiple interventions following an acute coronary syndrome event increases uptake of cardiac rehabilitation. M Michael Lawless1, AS Harrison1, P Doherty1 1University Of York, York, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: British Heart Foundation Topic: Cardiovascular Rehabilitation Introduction: Cardiac rehabilitation (CR) improves morbidity and mortality in patients. The most recent BHF funded National Audit of CR (NACR) reports uptake into CR programmes is around 50% for patients following acute coronary syndrome (ACS). Patient number entering into CR is known to be dependent on the management strategy received: lower following percutaneous coronary intervention (PCI), higher following coronary artery bypass grafting (CABG). Purpose: The purpose of this study was to investigate differences in uptake into CR following an ACS event for those patients receiving multiple treatment strategies. Methods: Clinical data from the NACR database between 1st April 2016 and 31st March 2019 was analysed. Patients presenting with ACS were grouped based on the following coding: myocardial infarction (MI) type e.g. ST-elevated MI and non-ST elevated MI, heart failure with MI, unstable angina and any ACS. Patients were coded as receiving medical therapy alone, any PCI, CABG, any valve surgery and any device therapy. Treatment strategy was determined as medical therapy alone (no intervention), any one of the above (1 intervention), any two of the above in combination (2 interventions) or greater than three interventions (≥3 interventions). Baseline descriptive statistics and logistic regression were used to analyse the association of these treatment interventions on uptake into CR. Results: A sample of 8342 patients presenting with ACS was studied. 48% of patients started CR, of those 23% were female and mean age was 66 (SD 12). Those not starting CR had a mean age 69 (SD 13). Using logistic regression patients who received increasing therapeutic interventions were more likely to start a CR programme (Odds ratios: 2.15, 1 intervention; 2.42, 2 interventions; 5.78, ≥3 interventions; p<0.001). This relationship was associated with being younger, male, partnered and having any comorbidity. Length of stay in hospital was negatively correlated with an uptake to CR. Past medical history including musculoskeletal, respiratory and peripheral vascular pathologies, were associated with an increased uptake to CR whereas patients with a history of angina, diabetes and stroke were associated with a decreased uptake to CR. Conclusion: This current study is the first to use a unique method of coding of treatment and has shown that increased number of interventions following any ACS event is a significant predictor of uptake into a CR programme. In contrast, the analysis also showed that patients having increasing age, unpartnered and female are less likely to attend CR, suggesting focus must be placed on such patient demographics to encourage starting CR. P253 https://esc365.escardio.org/Presentation/221672/abstract Predictive factors of major complications during cardiovascular rehabilitation after valvular heart surgery F Francesco Maranta1, S Pellegrino2, A Bonaccorso2, V Rizza2, C Meloni1, S Sacchi1, MGP Pala1, M Avitabile1, M Panciullo1, A Tettamanti1, A Castiglioni2, M De Bonis2, O Alfieri2, D Cianflone2 1San Raffaele Scientific Institute, Milan, Italy 2University Vita-Salute San Raffaele, Milan, Italy Topic: Cardiovascular Rehabilitation Background: Valvular heart disease is a relevant and growing problem and valvular heart surgery is still required as a treatment of-choice in many cases. Cardiovascular Rehabilitation (CR) following intervention is fundamental for the post-surgical functional recovery and for the monitoring and management of complications that may occur after surgery. Aim of the study: The aim of this study is to identify predictors of major complications in patients undergoing an in-patient CR program after valvular surgery. We defined as major complications the following those requiring an in-patient management: severe anemia needing transfusions, infection of the sternal surgical wound requiring an antibiotic treatment, a positive hemoculture in the presence of systemic signs of infection and pericardial effusion requiring surgical drainage. Methods and statistical analysis: We studied 1600 patients (median age 64 years; 60% males) who have been hospitalized in our CR Unit after cardiac surgery. We evaluated the demographic and anamnestic data, the type of cardiac surgery intervention, the clinical course in the Cardiac Surgery Unit and in the CR Unit, the in-hospital length of stay, the 6 minutes-walking tests and main blood tests. Results: The multivariate analysis showed chronic renal dysfunction [OR 1,902 (CI 1,103-3,280), p=0,021], complex cardiac intervention [OR 1,554 (CI 1,030-2,344), p=0,036], sternal re-synthesis [OR 4,671 (CI 1,659-13,152), p=0,004], early post-surgical transfusions [OR 1,670 (CI 1,083-2,573), p=0,020] to be the independent predictors of major complications. Furthermore, hemoglobin values [OR 0,677 (CI 0,566-0,810), p<0,001] resulted as related in a positive way with the outcomes taken into consideration. Conclusions: The identification of predictors of major complications allows to identify the patients at major risk in order to individualize the patient management, defining a specific clinical and instrumental monitoring. A tailored CR period might help in optimizing the available resources and in achieving a better final outcome. P257 https://esc365.escardio.org/Presentation/217019/abstract Association of cardiac rehabilitation sessions with mortality reduction after aortic and mitral valve surgery: a community-based study MI Barillas Lara1, JR Medina-Inojosa1, TP Ladas1, JR Smith1, S Fortin-Gamero1, TP Olson1, F Lopez-Jimenez1, VT Nkomo1, A Amanda Bonikowske1 1Mayo Clinic, Rochester, United States of America Topic: Cardiovascular Rehabilitation Introduction: Cardiac rehabilitation (CR) reduces total mortality in patients with valve replacement. The association between the number of sessions and reduction in mortality after CR in patients with valve replacement has not been extensively studied. Hypothesis: We hypothesized that completing a greater number of CR sessions after valve surgery would be associated with reduced mortality. Methods: We included 92 consecutive patients who underwent left sided valve replacement and attended outpatient CR between 2000 to 2019. Clinical and echocardiographic data were extracted from the medical record and passive followã up was performed using a record linkage system for death from any cause. The association between short and average course of CR, defined as completing 25 sessions (25 sessions was chosen as the cut point as this was the median number of sessions and the point at which the effect of mortality was observed). Mortality was assessed by Kaplan-Meier curves and Cox-proportional hazard models. Results: Among 92 patients completing 25±11 CR sessions, 16 (17%) patients died over mean follow up of 6±3 years. Surgical interventions included surgical aortic valve repair/replacement (SAVR; 44), transcatheter aortic valve replacement (TAVR; 8), SAVR and coronary artery bypass grafting (CABG; 24), SAVR and mitral valve repair/replacement (MVR; 7), SAVR, MVR and CABG (1), MVR (5), and robotic MVR (3). Prior to surgery, patients completing >25 sessions had higher rates of atrial fibrillation, greater beta blocker use, lower ejection fraction, larger aortic valve area, and higher right ventricle systolic pressure on echocardiography (p<0.05). Predictors of mortality were age, diabetes, hypertension, pre-CR peak VO2, 6 minute walk distance achieved at baseline, symptomatic presentation before surgery, and bicuspid aortic valve (p<0.05). There was a significantly reduced risk of death in those who completed >25 sessions (HR= 0.46, 95% CI 0.1458-1.4965, p=0.008). Conclusions: A long-term course of CR in patients after valve replacement leads to a reduction in all-cause mortality. These results highlight the critical importance of CR enrollement and attendance after valve surgery. Kaplan-Meier Curves of CR Sessions P259 https://esc365.escardio.org/Presentation/221580/abstract Prognostic power of peak oxygen pulse in a population undergoing cardiac rehabilitation JP Joao Pedro Dias Ferreira Reis1, A Castelo1, S Silva1, C Martins1, P Rio1, R Cruz Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal Topic: Cardiovascular Rehabilitation Introduction: The peak O2 pulse (OP) provides an estimate of left ventricular (LV) stroke-volume changes during exercise. It has proven to be an independent predictor of mortality in patients with heart disease and a predictor of myocardial ischemia Purpose: To characterize the population of the cardiac rehabilitation (CR) appointment that performed cardiopulmonary exercise test (CEPT), evaluate OP as a predictor of events and determine the best cut off for our population. Methods: Retrospective analysis of CR appointment patients (P) who performed CEPT between 2014 and 2017 in a single tertiary center. Epidemiological, clinical, laboratory, echo and CEPT-related data were retrieved. We then determined predictors of OP and established the appropriate Cut Off for our population and compared the occurrence of events - composite endpoints of mortality/ hospitalization due to heart failure (MH), mortality/ hospitalization due to cardiovascular cause(MC) and mortality/ hospitalization due to heart failure/ need for revascularization (MHR)- according to it. Results: 207 P (83.6% men) were included, with a mean age of 57 years and a mean follow-up time of 36 months. 96.6% of P had a cardiovascular disease or risk factors and 99% were medicated, with a mean LVEF of 53.7% (14-83%). The majority (87.9%) was referred for CR with ischemic cardiopathy (AMI or stable or unstable coronary disease), 9.2% with heart failure and 9.2% with valvulopathy. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason) and 7.3% presented MH. Mean OP was 13.3±4.4mL/beat. A lower OP was associated with an older age (CC=0.399, p<0.001), female sex (p<0.001), diabetes (p=0.007), previous arrhythmias (p=0.015), chronic kidney disease (p=0.018), peripheral artery disease (p=0.040), a lower basal LVEF (CC.0325, p<0.001). It also correlated with a lower peakVO2 (CC=0.732, p<0.001), a lower cardiorespiratory optimal point (CC=0.514, p<0.001), a lower circulatory power (CC=0.502, <0.001) and a higher VE/VCO2 slope (CC=0.358, p=0.001). Values of OP below a cut-off of 11.5 predict the composite endpoint of MH (HR 7.31, IC [2.01-26.62], p=0.003), MC (HR 2.03, IC [1.21-3.38], p=0.007) and MHR (HR 1.97, IC [1.04-3.74], p=0.039). Ps with OP values below present a 40 months survival of 76.2% comparing to 97.3% if the peak OP is above the aforementioned cut-off (log-rank p<0.001). CR lead to a statistically significant improvement in peak OP (from 14.2 to 23.5 mL/ beat, p<0.001), however it wasn't associated to a lower rate of coronary events or revascularization. Conclusion: In our analysis, peak OP was improved after completion of CR program and a value below 11.5 mL/ beat was a predictor of cardiac events in our population. P262 https://esc365.escardio.org/Presentation/221673/abstract Predictive factors of post-operative atrial fibrillation in patients undergoing cardiac rehabilitation after valvular surgery F Francesco Maranta1, A Bonaccorso2, S Pellegrino2, V Rizza2, C Meloni1, S Sacchi1, MGP Pala1, M Avitabile1, P Cervi1, A Tettamanti1, A Castiglioni2, M De Bonis2, O Alfieri2, D Cianflone2 1San Raffaele Scientific Institute, Milan, Italy 2University Vita-Salute San Raffaele, Milan, Italy Topic: Cardiovascular Rehabilitation Background: Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. It occurs in approximately one third of cardiac surgery patients. POAF may occur within 2-4 days after surgery (acute phase) as well as later, within 1 month (subacute phase). Atrial fibrillation occurring in the subacute phase (sPOAF) is associated with several postoperative complications both in the mid- and long- term. Therefore, POAF is not just an acute phenomenon but it may beget long-term risk of atrial fibrillation. Aim of the study. The aim of this study was to assess the predictors of postoperative atrial fibrillation in the subacute phase (sPOAF) in a cohort of patients who underwent cardiac surgery. Materials and methods. 843 patients (mean age 60,74±13,63; 63,4% male) who underwent cardiac surgery and subsequently admitted to the Cardiovascular Rehabilitation Unit were enrolled. During all the in-patient rehabilitation period, subjects underwent continuous monitoring with 12-lead ECG telemetry. We assessed the predictive value of anamnestic, clinical and laboratory variables on sPOAF onset. Results: The incidence of sPOAF was 23,1%. Those who developed sPOAF were older (64,46±11,52 years vs 59,58±14,046 years; p<0,001), had a history of atrial fibrillation prior to surgery (45,9% versus 21,8%; p<0,001), had a worse functional result at the 6-minutes walk test (256,15±105,02 vs 286,71±116) at the admission to the Cardiac Rehabilitation Unit, had greater values of neutrophil-lymphocite ratio at baseline [median 2,2 (1,6-2,9) vs median 1,8 (2,3-3,29); p= 0,013] when compared to those who did not develop POAF. At the multivariable logistic regression, the occurrence of POAF in the acute phase (OR 3,254; 95% CI 2,246-4,713; p<0,001) and mitral valve surgery (OR 1,747; 95% CI 1,162-2,626; p= 0,007) were found to be independent predictors of sPOAF after cardiac surgery. Conclusion: Atrial fibrillation is a common complication following cardiac surgery. Mitral valve surgery and the occurrence of POAF in the acute phase were shown to be predictors of sPOAF in a cardiac surgery population during the rehabilitation period. P264 https://esc365.escardio.org/Presentation/217361/abstract Neurohumoral modulation in cardiovascular patients following exercise N Neil Grech1, M Abela1, CJ Magri1, RG Xuereb1 1Mater Dei Hospital of Malta, Msida, Malta Topic: Cardiovascular Rehabilitation Background: N-terminal pro-Brain Natriuretic peptide (NT-proBNP) appears to be the most powerful neurohumoral predictor of left-ventricular function and prognosis. NT-pro BNP has a longer half-life and therefore has become a more attractive assay than BNP, both for study design and clinical management. Objectives: To determine whether NT-proBNP levels significantly decrease following exercise among patients referred for cardiac rehabilitation at our Hospital. Methods: The study included all patients referred for cardiac rehabilitation in 2018. Baseline characteristics included age, gender, medical comorbidities and change in medical therapy. Baseline and post-intervention NT-proBNP levels. Exercise interventions included i) home exercise (HE) training (30 minutes for at least 5 days per week) and the ii) MDH cardiac rehabilitation exercise programme (EP). A minimum of 8 EP sessions were required to include a patient in the EP group (12 session program). Descriptive statistics were presented as percentages. Continuous data was presented as medians and interquartile ranges (data not normally distributed). Mann-Whitney U test was used to compare 2 groups (NE vs EP/HE/EP&HE, EP vs HE, EP & HE vs HE). Results: 259 patients met the inclusion criteria from 480 originally referred patients. Most were male (n=221, 85.3%). Mean age was 61±10.22 years of age. Close to half (46.9%) of the cohort were obese. Patients were categorized into 4 groups according to the patients' preference (table 1). A significant decrease in NT-proBNP was found in groups 2, 3 and 4 (as one cohort) compared to group 1 (p=<0.0001). Furthermore, group 2 (HE & EP) and group 4 (HE only) faired significantly better in decreasing NT-proBNP after intervention compared to EP alone (HE&EP vs EP [p=<0.0001], HE vs EP [p=0.001]) (Figure 1). No factors predicted a change in NT-proBNP with univariate analysis. Factors assessed included age, gender, BMI, smoking, diabetes, hypertension, hyperlipidaemia and significant change in medications. Conclusion: Findings emphasise the importance of encouraging home exercise, along with an intensive cardiac rehabilitation EP. Future studies may also help determine whether NT-proBNP may help predict long-term outcomes in patients attending an EP. Intervention Group Group Number Frequency (n) Percentage (%) No Exercise (NE) 1 54 20.8 Home Exercise & Exercise Program (HE & EP) 2 99 38.2 Exercise Program (EP) 3 49 18.9 Home Exercise (HE) 4 57 22.0 Intervention Group Group Number Frequency (n) Percentage (%) No Exercise (NE) 1 54 20.8 Home Exercise & Exercise Program (HE & EP) 2 99 38.2 Exercise Program (EP) 3 49 18.9 Home Exercise (HE) 4 57 22.0 N/A Open in new tab Intervention Group Group Number Frequency (n) Percentage (%) No Exercise (NE) 1 54 20.8 Home Exercise & Exercise Program (HE & EP) 2 99 38.2 Exercise Program (EP) 3 49 18.9 Home Exercise (HE) 4 57 22.0 Intervention Group Group Number Frequency (n) Percentage (%) No Exercise (NE) 1 54 20.8 Home Exercise & Exercise Program (HE & EP) 2 99 38.2 Exercise Program (EP) 3 49 18.9 Home Exercise (HE) 4 57 22.0 N/A Open in new tab Figure 1:NtproBNP of Intervention Groups P265 https://esc365.escardio.org/Presentation/221576/abstract Peak circulatory power is a strong prognostic factor in patients undergoing cardiac rehabilitation JP Joao Pedro Dias Ferreira Reis1, A Castelo1, C Martins1, S Silva1, P Rio1, R Cruz Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal Topic: Cardiovascular Rehabilitation Introduction: Peak circulatory power (PCP - peak oxygen uptake × peak systolic blood pressure) is and has been used for the clinical evaluation of patients with heart failure, coronary artery disease and idiopathic pulmonary arterial hypertension, being a strong prognostic factor in these populations. Purpose: To characterize the population of the cardiac rehabilitation (CR) appointment that performed CEPT, evaluate PCP as a predictor of events and determine the best cut off for our population. Methods: Retrospective analysis of CR appointment patients who performed CEPT between 2014 and 2017 in a single tertiary center. Epidemiological, clinical, laboratory, echo and CEPT-related data were retrieved. We then determined predictors of PCP and established the appropriate Cut Off for our population and compared the occurrence of events - composite endpoint of mortality/ hospitalization due to heart failure (MH) - according to it Results: 207 P (83.6% men) were included, with a mean age of 57 years and a mean follow-up time of 36 months. The Ps presented a mean LVEF of 53.7% (14-83%). The majority (87.9%) was referred for CR with ischemic cardiopathy (AMI or stable or unstable coronary disease), 9.2% with heart failure and 9.2% with valvulopathy. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason) and 7.3% presented MH. Mean PCP was 3702.5±1974.2 mmHg.ml.kg−1min−1 (249-23180) and in Ps with heart failure was 1989 as opposed to 3858 in Ps without heart failure. A lower PCP was associated with an age>65 years (p<0.001), female sex (p=0.02), diabetes (p=0.005), previous acute coronary syndrome (p=0.021), LVEF<35% (p<0.001), a higher basal BNP value (CC=0.287, p<0.001), higher VE/VCO2 slope (CC=-0.298, p<0.001) and a more negative basal global longitudinal strain (CC=0.353, p<0.001). Ps with a peak VO2<14ml/min/kg also presented a lower PCP (a peak VO2<14ml/min/kg). Values of PCP below a cut-off of 2924 predict the composite endpoint of MH (HR 28.1, IC [3.66-216.29], p=0.001), with these Ps presenting a 40 months survival of 75.4% comparing to 98.8% in Ps with PCP values above the aforementioned cut-off (log-rank p<0.001). However, that cut-off didn't correlate with all cause hospitalization, need for further coronary revascularization or cardiac device. Conclusion: PCP was predictor of cardiac events in our population, with Ps with a PCP value<2924 presenting a statistically significant lower survival. P268 https://esc365.escardio.org/Presentation/221589/abstract The impact of chronotropic incompetence markers in a population undergoing cardiac rehabilitation JP Joao Pedro Dias Ferreira Reis1, A Castelo1, C Martins1, S Silva1, P Rio1, R Cruz Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal Topic: Cardiovascular Rehabilitation Introduction: During Cardiopulmonary exercise testing (CEPT), a low heart rate recovery at one minute (HRR1) and a low heart rate reserve (HRr) have been assumed to be index of autonomic imbalance and chronotropic incompetence, which are associated with a poor prognosis in several forms of heart disease. Several studies and the AHA/EACPR CPET guidelines showed a correlation between a low HRR1 and a worse outcome in several forms of heart disease. Purpose: To characterize the population of the cardiac rehabilitation (CR) appointment that performed CEPT and to evaluate basal HRR1 and HRr as predictors of events. Methods: Retrospective analysis of CR patients (P) who performed CEPT between 2014 and 2017 in a single tertiary center. Epidemiological, clinical, laboratory, echo and CEPT-related data were retrieved. We evaluated which variables were associated to a low HRR1/ HRr and compared the composite endpoint of mortality/ hospitalization due to heart failure (MH) according to HRR1<16 and HRr<62 beats (both calculated cut-offs for our population). Results: 207 P (83.6% men) were included, with a mean age of 57 years and a mean follow-up time of 36 months. Ps presented a mean LVEF of 53.7% (14-83%). The majority (87.9%) was referred for CR with ischemic cardiopathy (AMI or stable or unstable coronary disease), 9.2% with heart failure and 9.2% with valvulopathy. Mean HRR1 was 23.7 beats and mean HRr was 61.8 beats. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason) and 7.3% presented MH. A HRR<16 was associated with an older age (61.2vs55.8, p=0.017), diabetes (41.2%vs23.3%, p=0.014), chronic kidney disease (61.5%vs32.4%, p=0.042), previous myocardial infarction (40.0%vs24.1%, p=0.043) and LVEF<35% (18.5%vs4.9%, p=0.008). It also correlated with a higher LDL value pre-CR (170vs111, p=0.034), with a peak VO2<14ml/min/kg (58.1%vs22.5%, p<0.001) and lower circulatory and ventilatory power (2967.5vs3992.2, p=0.001 and 4.9vs5.9, p=0.019, respectively). Values of HRR<16 were good predictors of MH (HR=3.38, IC [1.14-10.07], p=0.029). However, HRR<16 did not correlate with all cause hospitalization or need for cardiac device. A value of HRr<62 was associated to an age>65 years (49.9vs65.2, p<0.001), a LVEF<35% (63.2%vs42.7%, p=0.009), a higher VE/VCO2 slope (CC=0.289, p<0.001) and a higher cardiorespiratory optimal point (r=0.395, p<0.001). Values of HRr<62 were good predictors of MH (HR=7.31, IC [1.62-33.07], p=0.010 and AUC=0.703). Conclusion: Ps with HRR1 < 16 or HR < 62 presented a worse prognosis regarding the composite endpoint of MH. Both are easily obtained auxiliary parameters that reflect altered autonomic tone. P439 https://esc365.escardio.org/Presentation/221660/abstract Diaphragm dysfunction and ultrasound imaging after cardiac surgery: assessments in cardiac rehabilitation F Francesco Maranta1, V Rizza2, I Cartella3, A Bonaccorso2, S Pellegrino2, C Meloni1, S Sacchi1, MGP Pala1, M Avitabile1, M Arosio1, A Tettamanti1, A Castiglioni2, M De Bonis2, O Alfieri2, D Cianflone2 1San Raffaele Scientific Institute, Milan, Italy 2University Vita-Salute San Raffaele, Milan, Italy 3University of Milan-Bicocca, Cardiology, Milan, Italy Topic: Cardiovascular Rehabilitation Background: Diaphragm dysfunction is a common but often underdiagnosed complication of cardiac surgery. It can lead to dyspnoea, decreased exercise performance and respiratory failure in more severe cases. Ultrasonography (US) is a valuable, non-invasive technique for the assessment of diaphragm function. Only few trials have been conducted using US to evaluate diaphragm functional recovery after cardiovascular rehabilitation (CR). Aim The aim of the study was to assess the incidence of post-cardiac surgery diaphragm dysfunction using US and to analyse the impact of an inpatient CR programme on diaphragm functional recovery. Methods: We performed a single-centre prospective cohort study, enrolling 153 patients hospitalized in our CR unit: 82 patients underwent mitral valve repair or replacement, 22 tricuspid valve repair or replacement, 45 aortic valve replacement, 24 coronary artery bypass grafting, 46 combined surgery and 13 other surgical procedures. Diaphragm US was performed at admission and after 10 rehabilitative sessions. We assess the following parameters on quiet breathing: excursion, time of inspiration, time of a respiratory cycle and contraction velocity (slope) in M-mode on the right anterior subcostal projections and thickening fraction (TF) in B-mode on the right intercostal projections. TF was defined as [(thickness at end inspiration–thickness at end expiration)/thickness at end expiration]. Results: The median excursion at admission was 1.63 cm, below the lower limit of normal proposed for the general population (2 cm). Patients with excursion < 2 cm were considered with diaphragm dysfunction. Following cardiac surgery, the incidence of diaphragm dysfunction and paralysis was 71% and 1% respectively. Patients with excursion < 2 cm at admission gained an important benefit from rehabilitation, with a significant improvement in TF (p<0.001), excursion (p<0.001), time of inspiration (p<0.001), time of a respiratory cycle (p<0.001) and slope (p<0.001). Conversely, in patients with excursion ≥ 2 cm there was no significant improvement in time of inspiration (p=0.078), slope (p=0.5) and excursion (p=0.314). At the final assessment, diaphragm function recovered in 51% of the patients, whilst 49% had a failure of recovery (excursion relative change between admission and discharge < 33%). The multivariate analysis identified combined surgery (OR 2.85; 95% CI 1.28-6.34, p=0.01) and post-surgical pneumothorax (OR 3.1; 95% CI 1.08-8.34, p=0.036) as independent predictors of failure of diaphragm function recovery. Conclusions: US might be a valuable part of routine clinical practice for initial and follow-up assessment of patients after cardiac surgery. CR has been shown to be an effective strategy to improve diaphragm parameters in patients with post-surgical dysfunction. Patients undergoing combined surgery or developing post-surgical pneumothorax might benefit from a personalised rehabilitation programme to improve diaphragm function. P562 https://esc365.escardio.org/Presentation/217353/abstract Knowledge, attitudes and practices survey of cardiac rehabilitation among cardiologists and cardiac surgeons RF Farah1, DR Groot1, DR Pavlova1 1Faculty of Health, Medicine and Life Sciences Maastricht University, Maastricht, Netherlands (The) Funding Acknowledgements: no financial support Topic: Cardiovascular Rehabilitation Introduction: Cardiovascular diseases (CVD) are among the leading causes of morbidity and mortality worldwide. Over three quarters of the cardiovascular deaths take place in low- and middle-income countries. Despite the benefits, Cardiac Rehabilitation (CR) is still not routinely and not universally available. Numerous studies have found that barriers to access to CR are correlated with providers, patients and environment characteristics. Physicians play an important role in CR referral and enrolment. Purpose: This first national survey on CR assesses the knowledge, attitudes and practices among physicians. In addition, the study identifies what the main barriers to access to CR are and provides suggestions for the implementation of CR in the country. This study takes into consideration the recommendations of cardiologists and cardiac surgeons for further expansion of CR practice. Until 2018, no local comprehensive CR program had been realised. Nevertheless, secondary cardiovascular preventive programs such as CR are not a priority. Methods: A quantitative cross-sectional study design was adopted using a structured, self-administrated questionnaire. The survey was conducted in December 2018 among cardiologists and cardiac surgeons. A 25-item questionnaire was used to collect information on CR. Responses were analysed using descriptive statistics SPSS software (version 24). Results: The respondents rate was 41.5% (n=83). Results show that the cardiologists have medium knowledge about CR and its multidisciplinary content. Physicians support the implementation of a "Cardiac Rehabilitation Program" in the country. 50% of the physicians recommended first to solve the financial issues before implementing a CR program. Supplementary learning about the benefits of CR is highly recommended to enrol more patients with CVD into CR. The main barriers were identified to implement CR. Financial barriers need to be overcome. Conclusions: The role of physicians in promoting patient enrolment should be optimized and exploited in the country. The access barriers identified can help to develop CR programs and to improve CR referral and enrolment rates. Funds from private parties and a budget from the government are needed to launch new CR programs in the country. Further research is needed. P563 https://esc365.escardio.org/Presentation/217128/abstract Utilizing 6 Minute walking distance test as independent predictor of improved functional capacity in young adult underwent phase II cardiac rehabilitation post CABG procedure: 5 years analytical study SA Said1, AR Adrian Reynaldo Sudirman1, S Annadya1, RE Intan1, B Dwiputra1 1National Cardiovascular Center Harapan Kita, Cardiology, Jakarta, Indonesia Topic: Cardiovascular Rehabilitation Introduction: Indonesian Ministry of Health estimated that Coronary Heart Disease (CHD) will be the most common cause of death in 2020 among Indonesian. The benefit of coronary artery bypass grafting (CABG) is well established as an effective management of CHD. Despite the widespread use of treadmill exercise testing as a prognostic parameters of functional capacity post CABG, most of the healthcare facilities in Indonesia are not well equipped with treadmill test facility. In this case, the six minutes walking distance (6MWD) test is considered as a simple and efficient method to assess directly the functional capacity of the patients in the postoperative period of CABG, yet currently there is no standardized test result that can reflect and predict on improved functional capacity among post rehabilitation patients. Purpose: To assess the possibility of 6MWD test as an independent functional capacity predictor among post CABG young adult patients who underwent phase II cardiac rehabilitation (CR) program in healthcare facility that have limitation in performing treadmill test. Method: Retrospective analytics study was conducted on data obtained from the National Cardiovascular Center cohort registry on post-CABG patients under 45-years-old who were admitted between 2014 and 2018 and had completed phase II cardiac rehabilitation program. The 6MWD test was performed after the completion of the program. METS score was used as the functional capacity indicator in this study. The association between variables was analyzed using logistic regression model. Result: There were 50 post CABG subjects in this study who completed phase II CR program. The T test analysis shows significant difference on 6MWD test result between group with METS score <6 and ≥6 (p=0.05, mean 377.52 until ±65.41 meter vs 291.71 until ±56.35 meter respectively). The ROC curve on 6MWD test indicates the best cut-off for the result was 304 meter (AUC = 0.847, sensitivity 83.7%, specificity 71.4%, p= 0.003). After controlling other cofounding factors, the multivariate logistic regression analysis shows 6MWD test result >304 meter served as an independent predictors of METS ≥6 (p=0.006, OR=12.8; 95%CI: 2.06-80.05). Other factors such as NYHA functional class, hypertension, smoking, diabetes mellitus, overweight, and dyslipidemia did not indicate significant association in predicting functional capacity. Conclusion: Among young adult patients who underwent CABG procedures and phase II CR program, the 6MWD test result provide reliable result as an independent predictor on functional capacity assessment. Therefore, we recommend distance >304 meter in 6MWD test as a minimum distance to be achieved after underwent phase II cardiac rehabilitation program in healthcare facility that was unable to perform treadmill test. ROC curve analysis of 6MWD test result P564 https://esc365.escardio.org/Presentation/217101/abstract Six-minute walking test and cardiopulmonary parameters pre and post-rehabilitation in the functional and prognostic evaluation of cardiac patients L Leandro Sanesi1, A Russo1, L Filippucci1, A Faleburle1, G Pucci1, G Vaudo1 1University of Perugia, Perugia, Italy Topic: Cardiovascular Rehabilitation ackground: Cardiopulmonary testing (CPET) identifies the cause of functional limitation and guides a rehabilitation process. The six minutes walking test is useful for measuring the response to therapeutic interventions in cardiac or pneumopathic patients. Purpose: To evaluate the functional capacity and tolerance to physical exercise through gait tests and cardiorespiratory parameters before and after rehabilitation and to carry out a comparative analysis of the two techniques for functional and prognostic stratification of a population of cardiopathic subjects. Methods: 30 patients undergoing a rehabilitation program at the Rehabilitative and Preventive Cardiology of the Grocco Services Center in Perugia between January and December 2019 after performing cardiopulmonary and 6MWT tests at the beginning and end of the rehabilitation cycle. The 6 MWTD was considered normal if 80% of the predicted distance by age and body mass index was reached and an improvement in functional capacity was certified if there was an increase of 54 Meters at the end of program (Minimum clinically important difference MCID). Results: 30 patients (76% M) average age 55 (± 14) years, average ejection fraction 53 (± 13), NYHA I class 47%, NYHA II 40%, NYHA III 13% , with a history of chronic coronary syndrome (60%), congenital or valvular heart disease (30%), cardiac transplant (3%) and dilated cardiomyopathy (7%). The 6MWTD was 512 M pre-rehabilitation and 567 M post-rehabilitation. The mean VO2 peak value is 63% pre-retraining and 74% post retraining (+11%, p<0.01). The 6MWT was pathological in 33% in the pre-retraining phase, MCID was reached by 40% of patients. There is no statistical correlation between 6MWTD and VO2 peak and VO2 pre and post-retraining threshold (respectively p = 0.19, p = 0.43) in terms of functional limitation detection. In the subgroup of the subjects with pathological 6MWTD, the 6MWTD correlates with the variation of the VO2 peak (R = 0.70, p <0.01); while there is no correlation between 6MWTD and VO2 peak at the baseline (p = 0.99). In terms of prognostic stratification, the 6 MWT has no correlation with VE/VCO2 at the threshold (p = 0.16), with the VE/VCO2 slope (p = 0.91) and with LT in the pre and post-rehabilitation phase (p = 0.55 ) while there is an inverse relationship between delta 6MWTD and delta MECKI score with a statistical significance of p = 0.05. Conclusion (s): Our study confirmed that 6MWT is a technique of dubious utility in healthy subjects or those with moderate functional impairment and is not reliable in predicting the effectiveness of rehabilitation. The CPET, in addition to assessing the effectiveness of a rehabilitation program, allows a prescription for individualized physical exercise aimed at improving the dependent CPET parameters (VO2 peak and at threshold, identification of the LT, ventilatory efficiency) which are important prognostic indicators of cardiovascular mortality in cardiac patients. 16 https://esc365.escardio.org/Presentation/221664/abstract Effectiveness of mobile guided cardiac rehabilitation as alternative strategy for non-participation to cardiac rehabilitation among elderly patients in Europe: the EU-CaRE randomised clinical trial A Aernout Snoek1, EI Bossano Prescott2, A Van Der Velde1, TMH Eijvogels3, LF Prins4, E Kolkman4, E Meindersma3, JR Gonzalez-Juanatey5, C Pena-Gil5, MC Iliou6, T Marcin7, P Eser7, M Wilhelm7, AWJ Van 'T Hof7, EP De Kluiver1 1Isala Hospital, Zwolle, Netherlands (The) 2Bispebjerg University Hospital, Copenhagen, Denmark 3University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The) 4Diagram, Zwolle, Netherlands (The) 5University Hospital of Santiago de Compostela, Santiago de Compostela, Spain 6Hopitaux Universitaires Paris Ouest, Paris, France 7Bern University Hospital, Inselspital, Bern, Switzerland Funding Acknowledgements: European Unionã s Horizon 2020 research and innovation programme [grant number 634439] and Swiss State Sec for Education, Research and Innovation Topic: Rehabilitation: Exercise Programmes Background: Despite its proven effectiveness, the uptake of cardiac rehabilitation (CR) is limited, especially in the elderly population. Purpose: To assess whether a 6-month mobile cardiac rehabilitation (mCR) programme with telemonitoring and telecoaching is an effective therapy for elderly patients with coronary artery disease (CAD) or a valvular intervention who decline participation in conventional cardiac rehabilitation (CR). Methods: This multi-centre study randomised 179 patients to mCR (n=89) or controls (CON, n=90). mCR consisted of 6 months of home-based CR with telemonitoring and coaching. CON patients did not receive any form of CR throughout the study period. Primary outcome was peak oxygen uptake (VO2peak) at 6 months. Secondary outcomes were a.o. changes in VO2peak, bloodpressure, self-reported physical activity (PA) and HbA1c. Results: VO2peak improved significantly in mCR at 6 and 12 months (+1.6 mL∙kg-1min-1 (95% CI 0.9–2.4) and +1.2 mL∙kg-1min-1 (95% CI 0.4–2.0), respectively) whereas there was no improvent in CON (+0.2 mL∙kg-1min-1 (95% CI -0.4–0.8) and +0.1 mL∙kg-1min-1 (95% CI -0.5–0.7), respectively). Differences between groups were significant at both timepoints (p=0.015) (p=0.040), respectively. Moreover HbA1c was significantly higher in CON when compared to mCR at 12 months, diastolic blood pressure was significantly lower in mCR when compared to CON at 6 months and increase in self-reported PA at 12 months was twice as high in mCR when compared to CON. Conclusion: A 6-months home-based mCR programme with telemonitoring and telecoaching for patients ≥65 years with CAD or a valvular intervention who decline participation in conventional CR is superior in improving VO2peak when compared to no CR. These findings underline the power of mCR as an effective and alternative secondary prevention strategy among a difficult to target patient group usually not included in CR trials. Netherlands Trial Register:NL5168 mCR P value Control 0 months 6 months 12 months Δ0-6 Δ0-12 0 months 6 months 12 months Δ0-6 Δ0-12 VO2peak ∙kg-1 18.9 ± 5.4 20.6 ±6.0 20.3 ± 5.7 <0.001 0.003 20.3 ± 5.7 20.5 ± 5.4 20.5 ± 5.4 0.534 0.831 DBP 78 ± 11 76 ± 12 74 ± 13 0.118 0.011 76 ± 12 78 ± 11 74 ± 11 0.026 0.047 HBa1C 42.6 ± 9.4 42.7 ± 10.0 42.0 ± 8.1 0.885 0.519 40.0 ± 5.7 40.8 ± 6.0 42.0 ± 8.2 0.055 0.004 PA 4.2 ± 2.6 5.8 ± 1.7 <0.001 4.3 ± 2.5 5.2 ± 2.5 0.008 mCR P value Control 0 months 6 months 12 months Δ0-6 Δ0-12 0 months 6 months 12 months Δ0-6 Δ0-12 VO2peak ∙kg-1 18.9 ± 5.4 20.6 ±6.0 20.3 ± 5.7 <0.001 0.003 20.3 ± 5.7 20.5 ± 5.4 20.5 ± 5.4 0.534 0.831 DBP 78 ± 11 76 ± 12 74 ± 13 0.118 0.011 76 ± 12 78 ± 11 74 ± 11 0.026 0.047 HBa1C 42.6 ± 9.4 42.7 ± 10.0 42.0 ± 8.1 0.885 0.519 40.0 ± 5.7 40.8 ± 6.0 42.0 ± 8.2 0.055 0.004 PA 4.2 ± 2.6 5.8 ± 1.7 <0.001 4.3 ± 2.5 5.2 ± 2.5 0.008 VO2peak: peak oxygen uptakeDBP: diastolic blood pressurePA: physical activity in days per week more than 30 minutes active Open in new tab mCR P value Control 0 months 6 months 12 months Δ0-6 Δ0-12 0 months 6 months 12 months Δ0-6 Δ0-12 VO2peak ∙kg-1 18.9 ± 5.4 20.6 ±6.0 20.3 ± 5.7 <0.001 0.003 20.3 ± 5.7 20.5 ± 5.4 20.5 ± 5.4 0.534 0.831 DBP 78 ± 11 76 ± 12 74 ± 13 0.118 0.011 76 ± 12 78 ± 11 74 ± 11 0.026 0.047 HBa1C 42.6 ± 9.4 42.7 ± 10.0 42.0 ± 8.1 0.885 0.519 40.0 ± 5.7 40.8 ± 6.0 42.0 ± 8.2 0.055 0.004 PA 4.2 ± 2.6 5.8 ± 1.7 <0.001 4.3 ± 2.5 5.2 ± 2.5 0.008 mCR P value Control 0 months 6 months 12 months Δ0-6 Δ0-12 0 months 6 months 12 months Δ0-6 Δ0-12 VO2peak ∙kg-1 18.9 ± 5.4 20.6 ±6.0 20.3 ± 5.7 <0.001 0.003 20.3 ± 5.7 20.5 ± 5.4 20.5 ± 5.4 0.534 0.831 DBP 78 ± 11 76 ± 12 74 ± 13 0.118 0.011 76 ± 12 78 ± 11 74 ± 11 0.026 0.047 HBa1C 42.6 ± 9.4 42.7 ± 10.0 42.0 ± 8.1 0.885 0.519 40.0 ± 5.7 40.8 ± 6.0 42.0 ± 8.2 0.055 0.004 PA 4.2 ± 2.6 5.8 ± 1.7 <0.001 4.3 ± 2.5 5.2 ± 2.5 0.008 VO2peak: peak oxygen uptakeDBP: diastolic blood pressurePA: physical activity in days per week more than 30 minutes active Open in new tab Award Winning Science - Sports Cardiology & exercise section 397 https://esc365.escardio.org/Presentation/217404/abstract Acute effects of interval vs. continuous exercise in post-myocardial patients referred to cardiac rehabilitation: a randomised control trial M Novakovic1, D Kosuta1, J Trsan2, B Krevel1, J Tasic1, T Vizintin Cuderman1, U Rajkovic3, M Bozic Mijovski1, Z Fras1, B Jug1 1University Medical Centre Ljubljana, Department of Vascular Diseases, Ljubljana, Slovenia 2University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia 3University of Maribor, Faculty of Organisational Sciences, Kranj, Slovenia On Behalf of: ReKoBo study group Topic: Rehabilitation: Exercise Programmes Introduction: Interval and continuous exercise training are the two most established and commonly recommended modalities for cardiac rehabilitation in patients with coronary artery disease. In the present study, we sought to compare the immediate effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on vascular function in patients after a myocardial infarction. Methods: Patients referred to cardiac rehabilitation after a myocardial infarction were randomised (1 : 1) to either HIIT or MICT. HIIT consisted of 7 cycles of 1.5 min of 80-90% VO2peak and 3 min of 65-70% VO2peak intensity; MICT consisted of 32 min of 75% VO2peak intensity, with comparable total energy expenditure. Vascular function was assessed using ultrasound appraisal of endothelium-dependent flow-mediated dilation (FMD) of the brachial artery at three time points: before (FMD A), immediately after (FMD B) and 1 hour after (FMD C) a single bout of HIIT or MICT exercise training in the beginning session of the cardiac rehabilitation programme. ANCOVA was used for comparison of the effects of two intervention modalities with baseline values as covariates. Independent predictors were assessed with logistic regression analysis. Results: A total of 90 patients were included (55 +/- 10 years, 19 % of females), 45 in each group. There were no differences between HIIT and MICT groups in baseline clinical characteristics, FMD A before (5.0 vs. 4.8%, respectively, p=0.858) and FMD B immediately after exercise (4.8 vs. 4.6% respectively, p=0.829); FMD C 1 hour post-exercise, however, was significantly lower after HIIT as compared to MICT (4.0 vs. 6.1%, respectively, p=0.048). Statistical significance was maintained after applying ANCOVA with separately using both time points (FMD A and FMD B) as covariates (p=0.039 and p=0.042, respectively). Figure 1 depicts trends of FMD in all the 3 time points. MICT and baseline FMD A were independent predictors of normalization of vascular function even after adjusting for age, gender, BMI, exercise performance, natriuretic peptide levels and smoking status. Conclusion: Acute HIIT leads to diminished endothelium-dependent vascular function in the immediate post-exercise period, whereas vascular function is quickly restored and even improved after a bout of MICT. Future studies are warranted to assess long-term effects of HIIT and MICT on vascular function. Figure 1. Changes in FMD EAPC Essentials 4 You - ePosters P566 https://esc365.escardio.org/Presentation/221682/abstract The impact of exercise training started early after acute st-elevation myocardial infarction on cardiac remodeling and exercise capacity F Latsch1, K Esefeld1, A Sigl1, F Stegmueller1, M Halle1 1Clinic rechts der Isar of the University of Technology, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Munich, Germany Topic: Rehabilitation: Exercise Programmes Background: Deterioration of left ventricular ejection fraction (LVEF) is frequently observed after ST-elevation myocardial infarction (STEMI). Few data have indicated that exercise may have anti-remodeling effects when started during the acute phase, however comparing different doses including higher intensity exercise after a week post STEMI has not been investigated before. Purpose: This study aims to contribute to the scientific progress in clinical rehabilitation after STEMI by investigating, whether exercise training in general and especially which intensity level is beneficial early after acute myocardial infarction regarding anti-remodeling and cardio-pulmonary exercise capacity. Methods: Therefore, we randomized (1:1:1) 19 patients with STEMI (58.0±7.1 years, 5% female) and reduced LVEF (<55%) to a) Moderate continuous training (MCT; 50-60% VO2peak training intensity), b) Higher intensity interval training (HIIT; up to 80-85% VO2peak training intensity) or c) Usual care (UC). Exercise groups (EG: MCT and HIIT) started on day seven after STEMI (24 weeks of tailored supervised exercise program), assessing parameters of 3D-echocardiography and cardiopulmonary exercise testing (CPET) at baseline, after 12 and 24 weeks. Results: At baseline, impairment was observed for LVEF (46.3±6.5%) as well as exercise capacity (VO2peak: 17.8±4.4ml/(kg*min)). After 12 weeks, no significant differences between the groups were detected, whereas after 24 weeks, EG significantly improved compared to UC regarding LVEF and VO2-VT1 (LVEF: mean change +7.3±3.5% in EG vs. +2.3±2.3% in UC; p=0.007 (Fig. 1); VO2-VT1: mean change +3.4±2.3ml/(kg*min) in EG vs. +0.5±1.7ml/(kg*min) in UC p=0.037 (Fig. 2)). However, HIIT was not superior to MCT regarding any of the measured parameters at any time. One death occurred in the MCT group unrelated to the training intervention. Conclusion: Even higher intensity interval training as well as moderate continuous training early after acute STEMI seem to induce anti-remodeling effects and to have beneficial effects on cardio-pulmonary-exercise-capacity. Both exercise groups (MCT and HIIT) improved more than UC, without increasing clinical events compared to the special population of STEMI patients. Abstract No: P566 Change in LVEF and Oxygen Uptake at VT-1 P571 https://esc365.escardio.org/Presentation/217047/abstract Feasibility and effectiveness of an additional resistance and balance training in cardiac rehabilitation of older patients after valve surgery or intervention E Tamuleviciute-Prasciene1, N Icking2, A Beigiene1, V Barasaite3, K Balne4, MJ Thompson5, R Kubilius1, B Bjarnason-Wehrens2 1Lithuanian University of Health Sciences, Department of Rehabilitation, Kaunas, Lithuania 2German Sports University Cologne, Institute for Cardiology and Sports Medicine, Dep. Preventive and Rehabilitative Sport Medicine and , Cologne, Germany 3Hospital of Lithuanian University of Health Sciences, Rehabilitation hospital of Kulautuva, Kaunas, Lithuania 4Lithuanian University of Health Sciences, Kaunas, Lithuania 5Arete Statistics, Argovia, Switzerland Topic: Rehabilitation: Exercise Programmes Introduction: The number of elderly patients admitted to cardiac rehabilitation (CR) following surgical treatment of valvular heart disease has increased significantly in recent years. Until now, only few studies have focused on the special CR-needs of these patients. Purpose: To evaluate the feasibility and effectiveness of an additional resistance and balance training compared to a standard CR program to improve physical performance in patients after valve surgery/intervention. Methods: A prospective, single-center, randomized controlled study. Inclusion criteria: age ≥65 years, valve surgery/intervention, ability to start CR within 4 weeks post-surgery, 6-minute walking distance ≥100- ≤350 m, written patientã s agreement. The study population (N=112, 75.7±6.8 years; 50.9% male; following valve surgery/intervention, in 35.7% cases combined with bypass surgery) was randomly stratified by gender assigned (1:1 ratio) to intervention group (IG n=57), or control group (CG n=55). All patients completed 3-week exercise-based inpatient CR, including aerobic endurance training on cycle ergometer (30 min, 5 d/w), additional aerobic exercises (sitting or standing, 30 min, 5 d/w) and respiratory training (15 min, 7 d/w). The IG participated in additional exercise sessions 3 d/w, including 15 min balance training and 30 min resistance training. The short physical performance battery test (SPPB) was used to assess physical performance before beginning (T1), after completion (T2) and 3 months after completion of CR (T3). T test, ANOVA analysis and logistic regression were used to evaluate the data. Results: At baseline, there was no significant differences in patientã s characteristic between the groups. As a result of the CR the SPPB score improved significantly in both groups comparing T1 vs T2, but only in IG the significant difference remain after 3 months (T1 vs T3 and T2 vs T3). IG T1: 8,42±0,48 to T2: 9,76±0,46 to T3: 10,46±0,27; T1 vs T2 p<0,001; T1 vs T3 p<0,001; T2 vs T3 p=0,036; CG T1: 8,56±0,5 to T2: 9,0±0,59 to T3: 9,75±0,41; T1 vs T2 p<0,01; T1 vs T3 p=0,063.; T2 vs T3 p=0,164). ANOVA analysis revealed no statistical significance among IG and CG groups (T1 p=0,44, T2 p=0,242, T3 p=0,063), although logistic regression with number of attended training sessions revealed the additional training session raises the standardised SPPB score by about 25% (se±7%). The additional training proved feasible and safe for the IG, and no adverse effects/events occurred causing premature termination of the study. Conclusions: The results demonstrated, that the additional balance and resistance training, was well accepted and tolerated by the older patients. Although there no significant difference was detected among groups every single additional resistance and balance training session improves SPPB score. P576 https://esc365.escardio.org/Presentation/217070/abstract Long-term efficacy of a supervised exercise training programme in patients with acute coronary syndrome N Nuria Santaularia1, A Arnau1, T Jaarsma2, N Tora1, G Vazquez-Oliva1 1Fundacio Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Spain 2Linkoping University, Faculty of Health Sciences, Department of Social & Welfare Studies, Norrkoping, Sweden Funding Acknowledgements: Support of the Health Department of Generalitat de Catalunya. Instrumental action of intensification of nursing professionals (SLT006/17/00186) Topic: Rehabilitation: Exercise Programmes Introduction: Previous systematic reviews and meta-analyses have demonstrated that exercise-based cardiac rehabilitation programmes (CRP) can reduce all-cause and cardiovascular mortality but their effects on readmission rates are unclear. Although evidence has been regularly updated and record the constant changes in clinical practice, concerns have been raised about the applicability of CRP in the real world in the era of acute revascularization and routine medication with statins. Additionally, the long-term effects of exercise-based CRP has not been conclusively established due to the great heterogeneity of study designs, type of exercise-based and CRP the follow-up periods (from 1 to 10 years). Purpose: To evaluate the efficacy of a supervised exercise-based CRP on cardiac readmissions in patients with acute coronary syndrome at five years. Secondary outcomes assessed were all-cause readmission, all-cause hospital emergency visits, physical activity level, quality of life and return to work. Methods: Open, controlled, randomized, unicentric, hospital-based clinical trial. All patients who consecutively were discharged from hospital with acute coronary syndrome as a primary diagnosis between June 2010 and June 2012 were screened for eligibility. Patients were assigned either to the control group (CG) who received standard care or to the intervention group (IG) who participated in a supervised exercise programme. It comprised 3 hours a week of supervised exercise training for a 10-week period. Patients were evaluated at 5 years. Results: Of 478 patients assessed for eligibility, 86 were randomized to the CG (n=44) or the IG (n=41). Between April and June 2018, patients who were still alive were invited to participate in the 5-year follow-up study. In total, 76 patients (41 CG, 35 IG, mean age 59.2 (SD 10.4), 82.9% men) were analysed at 5 years follow-up. Cardiac readmission rates at 5 years were 24% in the CG compared to 9% in the IG (p=0.068), and readmission rates for all causes were 42% in the CG and 23% in the IG (p=0.085). Emergency care for cardiac disease was required more frequently in the CG (17% vs 11%, p=0.486). IG patients performed more regular and intensive exercise (62% vs. 33%, p=0.088). In both groups there were significant deterioration in systolic and diastolic blood pressure, body mass index, waist circumference, HbAc1, triglycerides, LDL and diet, and a significant increase in HDL. Conclusions: Although patients who participated in the supervised exercise training programme were readmitted less often than controls for cardiac disease and for all causes at 5 years of follow-up, the reduction was not statistically significant. Control of cardiovascular risk factors deteriorated in both groups. P578 https://esc365.escardio.org/Presentation/217046/abstract Exercise oscillatory ventilation impairs oxygen delivery/extraction in male patients with chronic heart failure GS Ribeiro1, L Luis Fernando Deresz2, P Dal Lago1, D Hansen3, P Agostoni4, M Karsten5 1Federal University of Health Sciences of Porto Alegre , Porto Alegre, Brazil 2Federal University of Juiz de Fora, Governador Valadares, Brazil 3Hasselt University, Hasselt, Belgium 4Centro cardiologico Monzino, Milan, Italy 5State University of Santa Catarina, Florianopolis, Brazil Topic: Rehabilitation: Exercise Programmes Background: Exercise oscillatory ventilation (EOV) is a common phenomenon among chronic heart failure (CHF) patients, being considered an independent predictor of death. The oxygen uptake/work rate (VO2/WR) slope is a parameter of the efficiency of the muscle oxygen delivery and/or oxygen extraction obtained in the cardiopulmonary exercise test (CPX). Purpose: To compare oxygen delivery/extraction in CHF male elderly patients with EOV and without EOV. Methods: A convenience sample composed of CPX data from 30 male CHF patients (15 EOV and 15 non-EOV) was randomly selected from an Italian cardiology specialized centre. CPX was done in cycle-ergometer (personalized incremental ramp protocol) with gas exchange analysed breath-by-breath. ∆VO2/∆WR slope (ml.min-1.W-1) was estimated by linear regression between work rate and oxygen uptake, excluding data preceding 10W of workload. The Mann-Whitney test was used to compare the work efficiency (one-tailed, p<0.05), and the Wilcoxon signed rank test was applied to compare the metabolic efficiency of the EOV and non-EOV groups with theoretical cut-off (10 ml.min-1.W-1). Data are showed as median and interquartile range [25%; 75%]. Results: EOV group had lower metabolic efficiency than non-EOV group (9.5 [8.5; 10.6] vs 11.6 [11.3; 12.1] ml.min-1.W-1; p<0.001). Furthermore, regarding ∆VO2/∆WR slope theoretical cut-off, EOV group was similar (p=0.283) and the non-EOV group was higher (p<0.001) than it. Conclusion: These preliminary data suggest that CHF+EOV patients present worse oxygen delivery/extraction, indicating possible EOV-related metabolic impairment at peripheral level. Metabolic equivalent P581 https://esc365.escardio.org/Presentation/221676/abstract Predictors of quality of life one year after a cardiac rehabilitation program TE Graca Rodrigues1, I Aguiar-Ricardo1, N Cunha1, J Rigueira1, A Nunes-Ferreira1, R Santos1, B Silva1, P Morais1, J Brito1, S Pires1, M Lemos Pires2, H Santa Clara3, FJ Pinto1, A Abreu1 1Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal 2Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal 3Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal Topic: Rehabilitation: Exercise Programmes Introduction: Despite the recent advancements concerning prevention, diagnosis and treatment, cardiovascular diseases account for a high morbidity worldwide and loss of quality of life. Cardiac rehabilitation (CR) is a multi-factorial intervention designed to limit the physiological and psychological effects of cardiovascular disease, manage symptoms, and reduce the risk of future events. Aim: To determine predictors of quality of life 1 year after an hospital CR phase 2 program. Methods:Prospective st. including consecutive patients, after completion of phase 2 CR. A cardiorespiratory exercise test (CPET) was performed after phase 2 completion. The patients were advised to continue the phase 3 CR at a specialized cardiac rehabilitation center. After 1 year of fup, the quality of life (QoL) was assessed by completing the Heart Quality of Life Questionnaire (HeartQoL). Through logistic regression analysis, predictors of better QoL were determined after 1 year of phase 2 CR program. Results:78 patients (60.3±11 years, 84.6% men, 85.9% ischemic disease, mean LVEF was 48.6±13) were included in a phase 2 cardiac rehabilitation program. Of the cardiovascular risk factors, hypertension was the most frequent (73.1%), followed by diabetes (69.2%), active smoking 39.7% and dyslipidemia 35.9%. All patients completed the phase 2 program except 1 patient who dropped out. At the end of phase 2 CR, 55.8% of the patients were at class II of NYHA and the others were at class I NYHA. The mean LVEF was 51.5±12%, LV end-diastolic volume 121+53mL, LV end-systolic volume 71.5+52mL and TAPSE 19.9+4.3mm. In a CPET performed on a cycle ergometer the mean of maximum workload was 128.5±42W, the duration of the test was 9.4±2.5min, the VO2 peak was 17.7±5.5 ml/kg/min, corresponding to 67.8±16.6% of the predicted maximum VO2, the VE/VCO2 slope was 29.8±5.6 and MYERS score 8.3±5.2 points. After 1 year of phase 2 completion the mean value of HeartQoL score was 2.2±0.84 (0 meaning worse QoL and 3 better QoL). In a univariate analysis non-smoking, MYERS score, maximum workload (MWL), peak VO2, VE/VCO2 slope and duration of CPET were associated with a higher score (p<0.05). CRECUL patients had, on average, better QoL that the remaining patients (2.46±0.78 vs 2.09±0.86, p=NS) and higher levels of physical activity were also associated with better QoL (p=0.06). Conclusion: The MWL, duration of CPET, peak VO2, VE/VCO2 slope and MYERS were associated to a higher level of physical activity 1 year after phase 2 CR. The MYERS score, in our study, that included also patients without heart failure, was associated with better QoL, suggesting that this score may have some value in other populations. Although not statistically significant, possibly related to the sample size, higher levels of activity level seems to associate to better QoL and so, patients should be motivated to maintain physical activity. P582 https://esc365.escardio.org/Presentation/217317/abstract Analysis of the effects of implementing balance exercises in cardiac rehabilitation in elderly patients. N Krauze1, H Rymuza1, I Kowalik1, E Smolis-Bak1, H Szwed1, R Dabrowski1 1Institute of Cardiology in Warsaw, Warsaw, Poland Topic: Rehabilitation: Exercise Programmes Introduction: In Poland population ageing can be noted. In senior citizens, another goal of rehabilitation (not linked with a disease) is to improve balance levels and to reduce the risk of falls. Aim: The study sought to analyse the effects of exercises aimed at improving postural stability and gait on balance in elderly patients after myocardial infarction (MI) who participated in post-hospital cardiac rehabilitation. Material and methods. The study included 32 patients aged 75-87 after MI. The patients were divided into 3 groups: C–control group (16 pts) not subjected to any rehabilitation procedures, CE–the group subjected to endurance training (9 pts), CB–the group that underwent endurance training and balance exercises (7 pts). Training sessions took place twice a week over a period of 3 months. Balance was assessed using the following tests: Rombergã s, Babinski-Weill, Unterberger, Baranyã s and Timed Up&Go. In each group, the tests were carried out four times: on entering the examination procedure as well as after 3, 6 and 12 months. Results: In the C group balance test results in examinations 1 and 2 did not differ significantly. Between examinations 1 and 3, results deteriorated in the Baranyã s test (p=0.0455). Compared to examination 1, scores obtained in the Babinski-Weill test worsened significantly in examination 4 (p=0.0143). In the CE group balance test results did not differ significantly across all the examinations. The CB group exhibited significantly better results in examination 2 than in examination 1 in the Babinski-Weill test (p=0.0210) and the Timed Up and Go test (p=0.0465). Results obtained in examinations 3 and 4 did not differ compared to examination 1. Conclusions: 1. Balance exercises led to an improvement in stability and gait velocity in the examined group. 2. In order to produce a constant improvement in balance levels and a reduction in the risk of falls, it is necessary to perform exercises on a regular basis. 3.Taking up physical activity in the form of endurance training enables patients aged 75+ to keep constant balance levels. 4. Avoiding physical activity may lead to a deterioration in balance levels in elderly persons. P583 https://esc365.escardio.org/Presentation/217120/abstract The role of cardiac rehabilitation program on left ventricular function in coronary artery disease patients D Bursacovschi1, E Vataman1, J Cazacu1, D Lisii1 1Institute of Cardiology, Chisinau, Moldova (Republic of) Topic: Rehabilitation: Exercise Programmes Background/Introduction Heart failure treatment through cardiac exercise has been improving the patients` quality of life, however, the functional consequences on the left ventricle regarding systole and diastole is still controversial. Purpose: To appreciate the short-term echocardiographic outcomes of the home-based cardiac rehabilitation through telephonic follow-up. Methods: The study was conducted on 77 patients previously admitted to the cardiac rehabilitation department of the Institute of Cardiology between 2015 and 2018. A sample of 74, 9% of males and 25, 1% females with the median age of 63±0, 5 years that underwent coronary artery bypass grafting, percutaneous coronary angioplasty, or MI, with New York Heart Association classes II and III were included into the exercise-based rehabilitation program and received rehabilitation for 12 months. A baseline, 3, 6 and 12 months echocardiographic follow-up was done to assess the left ventricular function as well as patients` telephonic follow-up. Results: The step-assessment of the echocardiographic parameters until the 12th month of rehabilitation and follow-up showed the reducing values of the LV diameter in systole (40,52±1,21 to 33,92±2,30 ), the LVPW thickness(10,56±0,20 to 8,21±0,50) and the LV tele-diastolic volume (143,47 ± 5,70 to 123,57 ± 4,60) for the study sample, as well as the improvement of the LV EF (36,75±0,75 to 48,8±0,9) after rehabilitation. According to the diastolic function of left ventricle, cardiac rehabilitation program improved septal e' and E/A significantly. The 6 minute walk test showed at 12 months follow-up an improved distance in 76% of participants, walking distance increased by 220 ± 23 m in those who completed the rehabilitation. Conclusion(s): Program rehabilitation may have short-term beneficial effects on LV systolic and diastolic function with positive LV remodelling and good response to cardiac exercise. Award Winning Science - Secondary prevention & rehabilitation section 47 https://esc365.escardio.org/Presentation/217064/abstract Know your numbers: risk factor perceptions and lack of control in patients after an acute coronary syndrome N Ter Hoeve1, HT Jorstad2, M Sunamura3, V Janssen4, WJM Scholte Op Reimer5, M Snaterse5 1Erasmus University Medical Centre, Department of Rehabilitation Medicine, Rotterdam, Netherlands (The) 2Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The) 3Capri Cardiac Rehabilitation, Rotterdam, Netherlands (The) 4Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The) 5Amsterdam University of Applied Sciences, ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam, Netherlands (The) Funding Acknowledgements: Capri Cardiac Rehabilitation; SIA/NWO Topic: Rehabilitation: Education Background: Patients perceptions of the cause(s) of their cardiovascular disease (CVD) and their control over modifiable risk factors is central in achieving lifestyle changes during cardiac rehabilitation (CR) and long-term adherence to a healthy lifestyle. Purpose: To determine what patients perceive as the main cause for developing CVD and the association with these factors and actual risk factors. Second, to describe the relation between perceived risk and patient participation in CR lifestyle counselling sessions. Methods: A total of 914 patients who were referred to CR after an acute coronary syndrome (ACS) and participated in the OPTICARE trial were included. The 3-month CR program consisted of exercise sessions (twice weekly) and optional lifestyle counseling sessions (stress, smoking cessation, diet). At start of CR, patients completed an illness perception questionnaire to report what they perceived as the three main causes for their disease (perceived risk factors). Actual risk factors were based on the discharge letter by a cardiologist. Participation in CR lifestyle counselling sessions was extracted from CR records. Descriptive statistics were used to present outcomes. Results: A total of 693 patients (76%) (57.5 years, 80% male) completed the questionnaire. Risk factors that were most often perceived by patients as main cause for ACS were stress (reported by 50%), smoking (38%) and having a family history of CVD (36%) (Figure). Patients most often underestimated the role of hypertension (not reported by 89% of patients with hypertension), hyperlipidemia (88%), overweight (81%) and diabetes (79%). Patients participated on average in 21 CR exercise sessions. Of patients that reported stress as main cause for ACS, 33% participated in stress counselling sessions; of patients that reported smoking as main cause 9% participated in a smoking cessation program, however, 71% of smoking patients stopped smoking immediately after the event; of patients that reported overweight as main cause 28% participated in dietary counselling sessions. Conclusion: There is a pronounced disparity between perceived and actual risk factors in ACS patients attending CR. This disparity is present in a highly informative setting where information about etiology and pathophysiology of CVD is readily available. Patients mainly underestimate the role of risk factors that they can control, and place emphasis on external factors (i.e. stress, family history). Furthermore, there is a disconnect between perceived main cause(s) of the disease and participation in CR lifestyle counselling sessions addressing these same risk factors. Greater focus is needed on tailored risk factor communication which can change perceptions and lack of control in ACS patients. perceived and actual risk factors EAPC Essentials 4 You - ePosters P586 https://esc365.escardio.org/Presentation/217089/abstract Predictors of physical inactivity 1 year after a cardiac rehabilitation program I Aguiar Ricardo1, T Rodrigues1, N Cunha1, J Rigueira1, R Santos1, A Nunes-Ferreira1, SC Pereira1, PS Antonio1, P Morais1, B Silva1, R Pinto2, S Miguel3, H Santa-Clara2, FJ Pinto1, A Abreu1 1Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal 2Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal 3Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Physical Medicine and Rehabilitation, Lisbon, Portugal Topic: Rehabilitation: Education Introduction: Physical activity practice presents an inverse relation with risk factors of cardiovascular disease, with positive effects in quality of life. Cardiac Rehabilitation (CR) programs are effective in guiding patients with cardiovascular disease to safely and sustainably incorporate lifestyle physical activity (PA) changes, however its impact in long-term follow-up is unknown. Purpose: To determine predictors of PA 1 year after an hospital cardiac rehabilitation phase 2 program Methods: Observational study including consecutive patients, after completion of phase 2 CR. All the patients were submitted to a clinical and echocardiographic evaluation and performed a cardiorespiratory stress test after phase 2 cardiac rehabilitation program completion. The patients were advised to continue the phase 3 CR at a specialized cardiac rehabilitation center (CRECUL). After one year of follow-up, the level of PA activity was assessed by completing the International Physical Activity Questionnaire (IPAQ) by telephone. Through logistic regression analysis, predictors of physical activity were determined after 1 year of phase 2 CR program. Results: 78 patients (60.3±11 years, 84.6% men, 85.9% ischemic disease, mean LVEF was 48.6±13) were included in a phase 2 cardiac rehabilitation program. Of the cardiovascular risk factors, hypertension was the most frequent (73.1%), followed by diabetes (69.2%), smoking 39.7% and dyslipidemia 35.9%. All patients completed the phase 2 program except one patient who dropped out. At the end of phase 2 CR, 55.8% of the patients were at class II. The mean LV ejection fraction was 51.5±12%, LV end-diastolic volume 121+53mL, LV end-systolic volume 71.5+52mL and TAPSE 19.9+4.3mm. In a cardiorespiratory stress test the mean of maximum workload was 128.5±42W, the duration of the test was 9.4±2.5min, the VO2 peak was 17.7±5.5 ml/kg/min, corresponding to 67.8±16.6% of the predicted maximum VO2, the slope was 29.8±5.6 and MYERS score 8.3±5.2 points. After 1 year of phase 2 completion, the IPAQ showed that 10.9% of patients had a low level of PA, 34.8% a moderate level and 54.3% had an high PA level. In multivariable analysis the participation in phase 3 CR program in CRECUL was an independent predictor of higher level of physical activity (p=0.017) as was the MYERS score (P=0.002). No cardiovascular risk factor, echocardiographic or isolated cardiorespiratory stress test variable were associated with a higher level of physical activity one year after the completion of phase 2 of CR. Conclusion: The MYERS score and the participation in phase 3 CR in CRECUL were independent predictors of higher level of physical activity 1 year after phase 2 CR completion. So, after investing in phase 2 cardiac rehabilitation, it is critical to encourage patients to participate in phase 3 specialized programs to maintain lifestyles with higher level of physical activity. P589 https://esc365.escardio.org/Presentation/217331/abstract Changes in the intensity of pain syndrome and psychopathic symptomatics in patients with stable ischemic heart disease after psychological rehabilitation I Irina Leonova1, V Ishinova2, S Boldueva1 1North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation 2«Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht» of the Minis, St-Petersburg, Russian Federation Topic: Rehabilitation: Education Coronary heart disease (CHD) belongs to the group of psychosomatic diseases, such patients are shown psychotherapy focused on optimizing the emotional state and reducing the intensity of anginal pain. Objective: to study changes in the intensity of anginal pain at the beginning and at the end of a course of medical rehabilitation and the assessment of the personality-characterological characteristics of patients with CHD. Materials and methods. 39 patients with CHD-stable angina pectoris (35 men and 4 women, mean age 54.00 ± 0.99 years) were examined. 28 (71.8%) patients had myocardial infarction. 34 pts (87.2%) had angina pectoris II class Canadian classification, 2 (5.1%) III class., 3 patients (7.7%) I class, no patients with IV class angina. All patients received optimal antianginal therapy. Psychological testing was carried out at the onset and at the end of the course of medical rehabilitation. To assess the intensity of anginal pain, the Pain scale from the SF-36 questionnaire was used. To determine the level of neuroticism, the Eysenck questionnaire was used. The severity of psychopathological symptoms was determined using the SCL-90-R questionnaire. Assessment of personality and characterological features was carried out using the Schmishek questionnaire. To reduce the intensity of anginal pain and optimize the emotional state in the medical rehabilitation, a course of 10 sessions of empathotechnics (45 min) was conducted. Results: On baseline anginal pain of a high degree of intensity (40.28±2.16) was noted, which was accompanied by a moderate level of neurotism, expressed by psychopathological symptoms. The study of the personality and characterological features of patients showed tendencies to accentuations of the emotive and stuck types, which was manifested in increased emotionality, sensitivity, anxiety in patients of this group. Correlation analysis showed (r =0.5 p<0.05) the presence of a dependence of the level of neurotism, anxiety, depression, interpersonal sensitivity on the intensity of anginal pain. A negative correlation was also found between the pain indicator and the personality characteristics of the emotive type (r = - 0.46 p <0.05). With an increase in the intensity of anginal pain, an increase in the manifestations of increased sensitivity, emotionality, and sensitivity of patients with coronary heart disease (r = 0.45 p <0.05) was noted. At the end of the medical rehabilitation there was a significant (p <0.001) decrease in the intensity of anginal pain (63.32±2.84), a decrease in levels of anxiety, interpersonal sensitivity, depression, hostility, and also neurotism (emotional lability). A negative relationship was found between pain, depression, anxiety (r = -0.048 p<0.05) and the absence of a correlation between pain and neuroticism. The study found a decrease in the intensity of anginal pain, the level of neurotism and the severity of psychopathological symptoms at the end of the medical rehabilitation. P590 https://esc365.escardio.org/Presentation/217075/abstract Managing erectile dysfunction in men attanding cardiac rerhabilitation in an Irish Model 3 hospital L Keating1, G Hogan1, D O Gorman2, S Heshe2 1Naas Hospital, Cardiac Rehabilitation, Naas Co. Kildare, Ireland 2Naas General Hospital, Naas Co. Kildare, Ireland Topic: Rehabilitation: Education Background and Purpose: Links between erectile dysfunction (ED), and cardiovascular disease (CVD), are well recognised. However due to the sensitivity of the issue and under resourcing, determining ED is not always a priority. A cardiac rehabilitation (CR) programme provides an ideal opportunity to identify, diagnose, and treat ED in an effective and respectful manner by establishing an open, honest relationship with patients. Our purpose is to demonstrate the effectiveness of an ED clinic, within the CR setting, which will assess, diagnose and safely treat ED patients for the safe use of PDE 5 Inhibitors. Methods: Between October 2018 and August 2019 the link between ED and CVD was discussed with all men during their assessment in phase 1(in hospital) and continued into phase 4 (community). Risk factors including a psychological assessment were assessed during CR and the severity of ED was identified using a validated questionnaire (IIEF5) with scores ranging from 1-25 (1-7=sever ED, 17-21 mild ED, 12-16mild/moderate ED, 17-21-mild ED and 21- 25 no ED). Patients were then referred to the ED cardiology clinic following their CR course to assess suitability for the safe use of PDE5 inhibitors. Results: 79 men attending CR were assessed for ED with 73 of these completing the IIEF 5 questionnaire. 48/73 (66%) of patients were diagnosed with ED symptoms, and the duration ranging from 2-120 months, with an average symptom duration of 38 months. The average IIEF 5 score on diagnosis was 14.5 (mild-moderate ED). After three months of treatment with PDE 5 inhibitors the IIEF5 score increased to 17.2 (mild ED). Conclusion- Providing male CR patients the opportunity to discuss ED as a symptom of their cardiac condition increases referrals to an ED clinic. Questionnaires within the CR setting are an appropriate way to diagnose severity of ED and identify patients suitable for referral to an ED clinic. Cardiology ED clinics are an effective way to assess patient suitability and safely treat ED through the use of PDE5 inhibitors in a controlled and monitored setting. 17 https://esc365.escardio.org/Presentation/217038/abstract Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: update of the Cardiac Rehabilitation Outcome Study A Annett Salzwedel1, K Jensen2, B Rauch3, P Doherty4, M-I Metzendorf5, M Hackbusch2, H Voller1, J-P Schmid6, C H Davos7 1University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany 2University of Heidelberg, Heidelberg, Germany 3IHF Gmbh - Institut Fuer Herzinfarktforschung, Ludwigshafen, Germany 4University Of York, York, United Kingdom of Great Britain & Northern Ireland 5Heinrich Heine University, Duesseldorf, Germany 6Clinic Barmelweid, Barmelweid, Switzerland 7Academy of Athens Biomedical Research Foundation, Athens, Greece Funding Acknowledgements: Pfizer AG Switzerland, German Heart Foundation, German Soc. of Cardiovasc. Prev. a. Rehab, Swiss Working Gr. for Cardiovasc. Prev., Rehab. a. Sports C Topic: Rehabilitation: Outcomes Background: Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation (CR) is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only CR interventions based on published standards and core components to evaluate CR delivery and effectiveness in improving patient`s prognosis. Design: Systematic review and meta-analysis Methods: Randomized controlled trials (RCT) and retrospective and prospective controlled cohort studies (rCCS, pCCS) evaluating patients after acute coronary syndrome (ACS), coronary bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) published until Sep 2018 were included. Results: Based on CROS inclusion criteria out of 7,096 abstracts 6 additional studies including 8,671 additional patients were identified (2 RCT, 2 rCCS; 2 pCCS). Thereby a total of 31 studies including n=228,337 patients was available for this meta-analysis (3 RCT, 9 pCCS, 19 rCCS; patients after ACS: n=50,653, after CABG: n=14,583, mixed CAD populations: n=163,101; follow-up periods ranging from 9 months up to 14 years). Heterogeneity in design, CR delivery, biometrical assessment and potential confounders was considerable. CCS showed a significantly reduced mortality after CR participation in patients after ACS [pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI): 0.20-0.69; rCCS: HR 0.64, 95% CI 0.53-0.76; pCCS: odds ratio (OR) 0.20, 95% CI 0.08-0.48], but the single RCT fulfilling the CROS inclusion criteria showed neutral results (Figure). CR participation also was associated with reduced mortality in patients after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70), and mixed CAD populations (2 out of 10 CCS with neutral results). Conclusion: CROS II confirms the effectiveness of CR participation after ACS and after CABG in actual clinical practice by reducing total mortality under the conditions of current evidence-based CAD treatment. The CROS II approach to more strictly predefine CR intervention and to include controlled registry based studies represents a valid hybrid approach that has clear utility in clinical decision-making. Total mortality in ACS patients EAPC Essentials 4 You - ePosters 408 https://esc365.escardio.org/Presentation/217365/abstract Patient-reported outcomes as determinants of return to work and health-related quality of life 6 months after comprehensive cardiac rehabilitation A Annett Salzwedel1, I Koran2, E Langheim3, A Schlitt4, J Nothroff5, C Bongarth6, M Wrenger7, K Wegscheider8, H Voller2 1University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany 2Klinik am See, Cardiology, Rüdersdorf, Germany 3Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, Teltow, Germany 4Paracelsus Harz Clinic Bad Suderode, Quedlinburg, Germany 5MediClin Reha-Zentrum Spreewald, Burg, Germany 6Clinic Hohenried, Bernried, Germany 7Caspar Heinrich Klinik, Cardiology, Bad Driburg, Germany 8The University Medical Center Hamburg-Eppendorf, Medical Biometry and Epidemiology, Hamburg, Germany On Behalf of: OutCaRe study group Funding Acknowledgements: German Pension Insurance Topic: Rehabilitation: Outcomes Objectives: Multi-component cardiac rehabilitation (CR) is conducted to achieve improved prognosis, superior health-related quality of life (HRQL) and social integration. We aimed to identify predictors of returning to work (RTW) and HRQL among cardiovascular risk factors and physical performance as well as patient-reported outcome measures (PROMs) modifiable during CR. Methods: Between 05/2017 and 05/2018, 1,586 patients in 12 German rehabilitation centers were enrolled in the prospective occupational multi-center study regardless of their primary allocation diagnoses (e.g. acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), coronary artery disease (CAD), valvular disease). Besides general data (e.g. age, gender, diagnoses), parameters of risk factor management (e.g. smoking, lipid profile, hypertension, lifestyle change motivation), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance), and PROMs (e.g. depression, heart-focused anxiety, HRQL, subjective well-being, somatic and mental health, pain, general self-efficacy, pension desire as well as self-assessment of occupational prognosis using several questionnaires) were documented at CR admission and discharge. 6 months after discharge, status of RTW and HRQL (SF-12) were captured by a follow-up (FU) survey and analyzed in multivariable regression models. Results: Most of the 1,262 patients (54±7 years, 77% men), who responded to the follow-up survey, were assigned to CR primarily due to AMI (40%) or CAD without myocardial infarction (18%), followed by heart valve diseases in 12% of patients and CABG (8%). 864 patients (69%) returned to work within the follow-up period. Pension desire, negative self-assessed occupational prognosis, heart-focussed anxiety, major life events, smoking and heart failure were negatively associated with RTW, while higher endurance training load, HRQL and work stress were positively associated (Figure). HRQL after 6 months was determined more by PROMs (e.g. pension desire, heart-focused anxiety, physical/mental HRQL in SF-12, physical/mental health in indicators of rehab-status questionnaire (IRES-24), stress, well-being in the World Health Organization well-being index and self-efficacy expectations) than by clinical parameters or physical performance. Conclusions: Return to work and physical as well as mental health-related quality of life half a year after CR were predominantly determined by patient-reported outcome measures, whereas patientsã pension desire and heart-focussed anxiety had a dominant impact on all investigated endpoints. Changes in PROMs during CR affected the occupational and health-related prognosis, underscoring the importance of the multi-component approach in cardiac rehabilitation. Predictors of returning to work P591 https://esc365.escardio.org/Presentation/217062/abstract Inpatient cardiac rehabilitation in patients supported with left ventricular assist device: a single-centre retrospective analysis of functional outcomes and survival. D Daniela Bacich1, A Marzolla1, L San Biagio2, S Bernazzali3, S Sterzi4, G Faggian2, G Gerosa5, T Bottio5 1MADONNA DELLA SALUTE C.D.C Health Centre, Porto Viro, Italy 2Civil Hospital Maggiore at Borgo Trento, Verona, Italy 3Polyclinic Santa Maria alle Scotte, Siena, Italy 4Campus Biomedico, Rome, Italy 5University of Padua, Padova, Italy Topic: Rehabilitation: Outcomes Background: Left ventricular assist devices (LVAD) have become an increasingly established treatment option in advanced heart failure. However, structured cardiac rehabilitation (CR) strategies are poorly implemented in this population. The aim was to report on the characteristics of a larger cohort of newly implanted LVAD patients at admission to CR, analyse their clinical and functional outcomes, and assess whether performance at discharge might have prognostic implications. Methods: This single-centre retrospective observational study included postoperative adult (above 18 years old) LVAD patients who completed their first inpatient cardiac rehabilitation between March 2013 and September 2019. Patient records were used to document relevant medical information, including preimplant data and blood chemistry tests at admittance. Functional capacity was assessed by means of six-minutes walking test (6 MWT) and cardiopulmonary exercise test (CPET). Functional independence was assessed with Barthel Index (BI) and Functional Independence Measure (FIM). After discharge patients were followed-up at dedicated out-patient clinics. Occurrence and time of transplantation and all-cause mortality were documented. Results: The population sample included 92 patients (80% male, mean age 59 ±9 years, range 29-74; 19 HVAD, 24 Jarvik 2000, 5 Heartmate 2, 44 Heartmate 3). Patients were classified into three cohorts: Bridge to transplant (BTT; 76%), Destination therapy (DT; 22%) and Bridge to decision (BTD; 2%). Mean time from implant at admittance was 33±18 days (range 15-89 days), while mean length of stay (LOS) was 24±6 days (range 15-47days). LOS showed inverse correlation with FIM (r=-0.65, p=0.00) and BI (r=-0.55, p= 0.00) at admittance, and no correlation with preimplant data, blood chemistry or 6MWT at admittance. Improvement of functional independence was significant after CR program: mean BI increasing from 55 to 83 (p<0.005) and FIM from 84 to 112 (p<0.001). Nevertheless, final CPET, carried out by only 47 patients, still showed a depressed peak VO2 (mean value 10.0 ± 2.1 ml/Kg/min). Only 56 patients were able to perform 6MWT at admittance (229 ± 107 m), and improved during CR (389 ± 105 m; p=0.001). At discharge 90 patients were able to perform the test (328 ± 130m): patients walking over 300 mt were classified as better performers (65%), the rest of them poor performers. Kaplan-Meier survival curves for three cohorts of patients (BTT still waiting for transplant, BTD, DT) are shown in figure 1. Within the DT group, better performers show a 75% survival rate, and poor performers a 60% survival rate at 36 months follow up. Conclusions: LVAD recipients are a heterogeneous population requiring tailored approach in CR, which leads to significant improvement of functional capacity and functional independence. Pre-discharge assessment of functional capacity might have prognostic implication, which needs validation in larger cohorts. figure 1 P767 https://esc365.escardio.org/Presentation/217029/abstract Coronary bypass surgery patients rehabilitation results I Istvan Albert1, A Albert1 1Albert Optimun Medicals, Sfantu Gheorghe, Romania Topic: Rehabilitation: Outcomes Cardiovascular rehabilitation is an important step to improve the prognosis of coronary artery disease. The primary and secondary risk factors are monitories by long term follow up program. Method: Were followed 208 patients with Chronic Coronary Syndrome, after MI 10 years long. With stent implantation 85 patents, 28 after coronary bypass surgery, 68 with high LDL- cholesterol level, 59 with moderate high blood pressure, 20 with diabetes mellitus type 2, smokers 87 and 68 with vasculo-retineal eye modifications. All the patients were medically treated and attended an home based exercise training and complex rehabilitation program after the major event. Results: 10 years cardiac mortality in post MI group 46 (22,12%). In stent group is a mortality of 7%, p<0.001 with RR (CI 95%) of 0.38 (0.08-2.29) and in bypass surgery group 4 cases, 14%, p=0.02 with RR (CI 95%) of 0.16 (0.11-0.85). In coronary bypass surgery group the blood pressure control efficient in 88%, the smoke cessation vas 92%. The metabolic disorders as hypercholesterolemia with cardiac mortality of 25%, p=0.03, with RR (CI 95%) of 0.08 (0.01-0.97) is independent risk factor. In the vasculo-retieal eye modifications group the presence of cardiac events is 29,3%, p=0.009 with RR (CI 95%) of 0.7 (0.21-0.97), compared with the 19% cardiac events in the non vasculo-retieal eye modifications group. Conclusions: A focus on healthy lifestyles, such as healthier eating patterns, with more fruits and vegetables and lower sodium intake and regular participation in physical activity are the best means for preventing reinfarction, heart failure at coronary bypass surgery patients. The long-term prognosis of patients with Chronic Coronary Syndrome depends on stent or surgical intervention range and LDL- cholesterol level. The vasculo-retineal eye changes are an independent prognostic factor in coronary artery disease. P769 https://esc365.escardio.org/Presentation/217052/abstract Health-related quality of life in patients undergoing comprehensive cardiac rehabilitation and risk-reduction programs P Priya Chockalingam1, T Sekar1, V Natarajan1, M Ramprasad1 1Cardiac Wellness Institute, Chennai, India Topic: Rehabilitation: Outcomes Introduction: Comprehensive lifestyle intervention programs are known to improve health-related quality of life (HRQoL) and other clinical and functional parameters leading to better long-term outcomes in cardiovascular disease (CVD) patients. However, there is no literature to show that such programs improve HRQoL in Indian patients. Purpose: To assess the effect of comprehensive cardiac rehabilitation (CR) and risk-reduction programs on HRQoL in patients with cardiovascular risk factors and/or a cardiac diagnosis. Methods: All patients who had completed the Medical Outcomes Study Short-Form 36 Health Status Survey (SF-36) before and after a CVD prevention program (n=23) or cardiac rehabilitation program (n=23) at our preventive cardiology centre between 2016 and 2019 were included in the study. A multidisciplinary team of healthcare professionals including a physician, physiotherapist, nutritionist and psychologist provided the programs. The core components of the program included exercise training, nutritional counselling, goal-setting to promote behaviour modification, psychosocial counselling, and education about risk factors, adherence to treatment, resuming normal activities and self-management. Sociocultural and emotional needs of the patients were taken into consideration while designing the programs. Paired t-test was used for analysis; p<0.05 was considered significant. Results: Out of the 46 subjects in the study (56±15 years, 76% male), diabetes mellitus and hypertension were present in 21 and 22 subjects respectively. Indications for CR were coronary artery disease, heart transplantation and dilated cardiomyopathy in 20, 2 and 1 subjects respectively. Heart failure was present in 5 subjects. Coronary artery bypass graft and angioplasty had been performed in 3 and 16 subjects respectively in the CR group. BMI (27±5 kg/m2), heart rate (77±13 beats per minute), systolic BP (131±17 mmHg) and diastolic BP (79±11 mmHg) did not change significantly from the baseline but there was a significant improvement in 6-minute walk distance (6MWD, pre 395±115 metres, post 433±107 metres) and HRQoL (Figure) after attending 11±3 exercise sessions and 7±3 education/counselling sessions. Conclusion: Comprehensive cardiac rehabilitation and risk-reduction programs that include exercise, education and counselling components improve HRQoL in Indian patients. Larger studies are needed to confirm the results of this single-centre study. Effects of intervention program on HRQoL P771 https://esc365.escardio.org/Presentation/217326/abstract Cardiac rehabilitation program in patients with history of atrial fibrillation and/or flutter. Does it have a positive impact in reducing recurrences based on weight loss? V Virginia Barreto Caceres1, I Aguilera Garcia2, I Marco Clemente2, ID Poveda Pinedo2, H Arranz Rodriguez2, A Araujo Avendano2, D Hernandez Munoz2, MJ Rodriguez Nunez2, S Espinosa Garcia2, M Marin Santos1, A Castro Conde1 1UNIVERSITY HOSPITAL NUESTRA SEÑORA DE LA CANDELARIA, Santa Cruz de Tenerife, Spain 2University Hospital La Paz, Madrid, Spain Topic: Rehabilitation: Outcomes Introduction: The connection between atrial fibrillation (AF) and obesity has already been stablished. The LEGACY study has shown that weight loss reduces AF recurrences and maintains long-term normal sinus rhythm. The main objective of this study was to evaluate the impact of cardiac rehabilitation programs (CRP) in the modification of lifestyle and the maintenance of short and middle-term normal sinus rhythm in patients who had been subdued to ablation or electrical cardioversion (ECV) of AF or atrial flutter and who had a body mass index (BMI) higher than 25 kg/m2. Methods: Prospective study in which we included overweight and obese subjects (BMI >25 kg/m2) with history of paroxysmal AF or atrial flutter reverted to SR after ablation or ECV who followed an 8 week CRP. Patients were examined at the end of the program and at the end of the follow up of this study (6 to 18 months). The variables used to evaluate the subjects were: the BMI, the percentage of visceral fat, the adhesion to physical activity and the presence of sinus rhythm. Results: The study involved 13 subjects who were 56.62 years old in average and 53.8% of which were males. 9 months later, 70% of the subjects present sinus rhythm. 1. 66.7% of them experienced an average reduction of visceral fat of 1.3% at the end of the CRP; 44.4% of them at the end of the follow up experienced an average reduction on the BMI of 1.75%. 2. 66.7% of the patients kept good adhesion to physical activity. 3. 88.9% of the subjects reduced their BMI at the end of the CRP and 77.8% maintained a lower BMI than at the start. 4 patients had recurrences of their arrhythmia between the eighth week (the discharge of the program) and the reevaluation after 9 months. The variable most associated to recurrences was the not reduction of the BMI (3 of 4 subjects). Conclusions: CRP have a positive impact in maintaining sinus rhythm by improving the control of cardiovascular risk factors. The reduction in visceral fat and the adherence to physical activity were the variables more associated to remaining in sinus rhythm. It was also observed that the benefit from CRP is lower through time. Therefore, in this type of patients it could be necessary to develop "reinforcement" sessions regularly in order to preserve the adherence to a healthy lifestyle. P773 https://esc365.escardio.org/Presentation/217035/abstract Effect of a combined continuous-variable resistance and strength training in a phase II cardiac rehabilitation program after acute coronary syndrome E Arias1, J Iglesies1, S Blanco1, G Ariza1, E Pujol1, M Berenguel1, P Fluvia1, E Brugue1, R Gonzalez1, M Buxo1, J Vilaro1, R Ramos1, M Paz1, R Brugada1 1University Hospital de Girona Dr. Josep Trueta, Girona Biomedical Research Institute-IDIBGI, Parc Hospitalari Martí i Julià, Edifici M2, Salt 17190,, Girona, Spain On Behalf of: Unitat de Prevenció CV i Rehabilitació Cardíaca - Hospital Santa Caterina Topic: Rehabilitation: Outcomes Introduction and objectives Cardiac rehabilitation has the highest level of evidence in the medical reference guidelines. We studied the effect of an interdisciplinary program after acute coronary syndrome (ACS) in a secondary prevention phase II intervention. Methods Between 2008 and 2018, we included 484 post-ACS patients with mean EF = 53.83 ± 8.69 in a 12-week long cardiac rehabilitation program. We applied an aerobic continuous-variable resistance training, an increasing self-loading strength training combined with nutritional counselling and psychological and educational therapy. Results: A total of 421 patients finished. There was a clinically significant increase in functional capacity in the stress test (+1.77METS; 95% CI 1.59 to 1.96, p <0.001) and in the six-minute walk test (+33.35m; 95% CI 30.1- 36.6, p <0.001). We found a decrease in dyspnoea score (-0.07 units; 95% CI -0.12 to -0.02, p = 0.006) and leg fatigue score (-0.10 units; 95% CI -0.18 to -0.03, p = 0.01) on the Borg Scale, a decrease of body weight (-0.74kg; 95% CI -1.10 to -0.38, p <0.001), of the abdominal perimeter (-1.51cm; 95% CI -2, 10 to -0.92, p <0.001) and in the percentage of adipose tissue (-0.78%; 95% CI -1.05 to -0.51, p <0.001). We also found and increased physical leisure activity in the IPAQ questionnaire (+691.90min; 95% CI 521.64 to 862.16, p <0.001) and improved eating habits in the PREDIMED test (+2.66 units; 95% CI 1.73 to 3.60, p <0.001). Conclusions: Patients included in the program increased functional capacity, decreased dyspnoea, leg fatigue, body weight, abdominal perimeter and adipose tissue They also improved physical activity time and eating habits after three months of intervention. P776 https://esc365.escardio.org/Presentation/221663/abstract Effect of exercising while fasting on alternate basis upon weight loss and lipid profile BASSEM Zarif1, GAMELA Nasr2, KHALED Elnady3 1National Heart Institute, Cairo, Egypt 2Suez Canal University, Cardiology , Ismailia, Egypt 3Maadi military hospital, Cardiology , Cairo, Egypt On Behalf of: Prevention working group, Egyptian Society of cardiology Topic: Rehabilitation: Outcomes Background and aim : Alternate day fasting (ADF) combined with exercise is effective for weight loss. The aim of this study was to examine effect of exercising while fasting on weight loss that occur when ADF is combined with exercise. Also to evaluate potential changes in the levels of triglycerides, total cholesterol (TC), low-density lipoprotein-cholesterol (LDLc), and high-density lipoprotein-cholesterol (HDLc), as well as atherogenic indices (TC/HDLc and LDLc/HDLc), Patients and Methods: Obese subjects based on BMI >30 (n = 200) of both gender (110 males and 90 females) were randomized to 1 of 4 groups: 1) combination (ADF + endurance exercise in the form of walking for 30 minutes ), 2) ADF alone, 3) endurance exercise only, or 4) control, for 12 weeks. Levels of triglycerides, total cholesterol (TC), low-density lipoprotein-cholesterol (LDLc), and high-density lipoprotein-cholesterol (HDLc), as well as atherogenic indices (TC/HDLc and LDLc/HDLc) were assessed , RESULTS: Body weight decreased (P < 0.05) in the combination group (6± 3 kg), ADF (4 ± 1.5 kg), exercise group (1 ± 1 kg), with no change in the control group (0 ± 0 kg). By the end of the study, the LDLc levels and both atherogenic indices had decreased (p < 0.05) compared to the values obtained at baseline. Females showed better response CONCLUSION: These findings suggest that endurance exercise is an excellent adjunct therapy to ADF more in females that may contribute to long-term steady weight loss with favorable impact on lipid profile and thus cardiovascular risk P777 https://esc365.escardio.org/Presentation/221652/abstract 1 Minute heart rate recovery (HRR-1) as predictor of functional capacity post cardiac rehabilitation program in young adult patients after cardiac surgery V F Joseph1, B Setianto1, B Radi1, A Santoso1, A M Ambari1, B Dwiputra1, R Hamdani1, E Susilowati1, F Tulrahmi1, S Azzahro1, R Intan1 1National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Topic: Rehabilitation: Outcomes Background: HRR-1 (1 minuted heart rate recovery) and functional capacity from treadmill test (TMT) are important indicators for evaluation in cardiac rehabilitation program. HRR-1 is a marker of parasympathetic function that can be used as predictor of mortality in cardiovascular disease. However, the effect of HRR-1 on functional capacity is still unknown. Purpose : The aim of this study to analyze whether HRR-1 is an independent predictor of functional capacity from TMT in young adult post cardiac surgery patients who completed phase II cardiac rehabilitation. Method: This is a single center, retrospective cohort study of 281 young adult patients (18-40 years old) who completed cardiac rehabilitation (CR) phase II after cardiac surgery in a referral cardiovascular center at Indonesia from January 2017 until June 2019. TMT after CR were done to evaluate CR program result. Outcome in this study was functional capacity after CR, measured from TMT and categorized into 2 groups with cut-off 6 METs. Independent variable was 1 minute heart rate recovery (HRR-1) on TMT, categorized to normal (>12 bpm) and abnormal HRR-1 (≤12 bpm). Bivariate analysis using chi square and multivariate analysis using logistic regression were performed to analyze association between independent and dependent variable, and to control other co founding factors. Result: There were 281 subjects in this study who completed cardiac rehabilitation program post cardiac surgery, which consisted of heart valve surgery (62.3%) and congenital heart disease surgery (37.7 %). Majority (87.12%) of the population had METs ≥ 6. HRR abnormality from TMT was found on 83 patients (29.64%). Bivariate analysis with chi square showed relative risk (RR) of normal HRR-1 for METs ≥ 6 meters was 3.50, 95% CI 1.67-7.33, p=0.001. Multivariate logistic regression analysis result showed that normal HRR-1 , along with man gender, sinus rhythm, TMT duration, and maximum systolic blood pressure are independent predictors for METs ≥ 6. After controlling other co founding factors, the odd of achieving METs ≥ 6 in TMT is 4.7 times bigger in normal HRR-1 group compared to abnormal HRR-1 group. (95% CI 1.49 – 14.79, p = 0.008) Conclusion: Normal HRR-1 is an independent predictor of optimal functional capacity, measured by TMT after cardiac rehabilitation (CR) program in young adult post cardiac surgery patients. Cardiac rehabilitation after cardiac surgery is essential to achieve better functional capacity in young adults patients. P778 https://esc365.escardio.org/Presentation/217113/abstract The outcomes of comprehensive cardiac rehabilitation programs in India: a multicentre study P Priya Chockalingam1, J Patel2, V Natarajan1, R Manova Devanesan3, A Rajaram3, A Contractor2 1Cardiac Wellness Institute, Chennai, India 2Sir H N Reliance Foundation Hospital, Cardiac rehabilitation, Mumbai, India 3Frontier Lifeline Hospital, Cardiac rehabilitation, Chennai, India Topic: Rehabilitation: Outcomes Introduction: Comprehensive cardiac rehabilitation (CR) is a Class 1 Level A recommendation in the management of cardiovascular disease (CVD) but there is a severe dearth of literature regarding CR programs in India. Purpose: To analyse the outcomes of comprehensive CR programs in patients with CVD in India. Methods: All patients who had undergone CR in the 3 participating centres from 2014 to 2018 with documented pre and post 6-minute walk distances (6MWD) were included. Subjects with BMI≥25kg/m2, SBP≥140mmHg and/or DBP≥90mmHg and/or LVEF≤40% were termed as "affected subjects" for computational purposes. Using the paired t-test p<0.05 was considered statistically significant. Results: Primary indications for CR (n=298, 61±12 years, 72% male) are shown in Figure. Time interval between diagnosis and initiation of CR was <2 years in 83%. Median number of CR sessions was 24 (IQR 12-40) and median duration of CR was 12 (IQR 7-26) weeks. Post CR evaluation showed significant reduction in BMI, SBP and DBP and a significant improvement in LVEF and 6MWD (Table). Conclusions: Comprehensive CR leads to a significant improvement in anthropometry, blood pressure, functional capacity and cardiac function. Further studies on the long-term benefits of CR programs in India are warranted. Parameter Pre CR Post CR p Heart rate, bpm (mean±SD, n=296) 78±14 79±12 ns SBP, mmHg (mean±SD, n=297) 119±17 118±14 ns DBP, mmHg (mean±SD, n=296) 70±10 68±9 ns BMI, kg/m2 (mean±SD, n=258) 27.1±4.8 26.7±4.5 ns LVEF, % (mean±SD, n=187) 50±11 53±11 0.0004 6MWD, metres (mean±SD, n=298) 358±104 461±114 <0.0001 Affected: Overweight / Obese subjects BMI, kg/m2 (mean±SD, n=174) 29.3±4 28.7±3.9 <0.0001 Affected: Hypertensive subjects SBP, mmHg (mean±SD, n=33) 152±15 133±11 <0.0001 DBP, mmHg (mean±SD, n=33) 80±15 71±12 0.02 Affected: Heart failure group LVEF, % (mean±SD, n=42) 34±6 39±9 <0.0001 Parameter Pre CR Post CR p Heart rate, bpm (mean±SD, n=296) 78±14 79±12 ns SBP, mmHg (mean±SD, n=297) 119±17 118±14 ns DBP, mmHg (mean±SD, n=296) 70±10 68±9 ns BMI, kg/m2 (mean±SD, n=258) 27.1±4.8 26.7±4.5 ns LVEF, % (mean±SD, n=187) 50±11 53±11 0.0004 6MWD, metres (mean±SD, n=298) 358±104 461±114 <0.0001 Affected: Overweight / Obese subjects BMI, kg/m2 (mean±SD, n=174) 29.3±4 28.7±3.9 <0.0001 Affected: Hypertensive subjects SBP, mmHg (mean±SD, n=33) 152±15 133±11 <0.0001 DBP, mmHg (mean±SD, n=33) 80±15 71±12 0.02 Affected: Heart failure group LVEF, % (mean±SD, n=42) 34±6 39±9 <0.0001 6MWD ã 6-minute walk distance, BMI ã body mass index, CR ã cardiac rehabilitation, DBP ã diastolic blood pressure, HFrEF ã heart failure with reduced ejection fraction, LVEF ã left ventricular ejection fraction, ns ã not significant, SBP ã systolic blood pressure Open in new tab Parameter Pre CR Post CR p Heart rate, bpm (mean±SD, n=296) 78±14 79±12 ns SBP, mmHg (mean±SD, n=297) 119±17 118±14 ns DBP, mmHg (mean±SD, n=296) 70±10 68±9 ns BMI, kg/m2 (mean±SD, n=258) 27.1±4.8 26.7±4.5 ns LVEF, % (mean±SD, n=187) 50±11 53±11 0.0004 6MWD, metres (mean±SD, n=298) 358±104 461±114 <0.0001 Affected: Overweight / Obese subjects BMI, kg/m2 (mean±SD, n=174) 29.3±4 28.7±3.9 <0.0001 Affected: Hypertensive subjects SBP, mmHg (mean±SD, n=33) 152±15 133±11 <0.0001 DBP, mmHg (mean±SD, n=33) 80±15 71±12 0.02 Affected: Heart failure group LVEF, % (mean±SD, n=42) 34±6 39±9 <0.0001 Parameter Pre CR Post CR p Heart rate, bpm (mean±SD, n=296) 78±14 79±12 ns SBP, mmHg (mean±SD, n=297) 119±17 118±14 ns DBP, mmHg (mean±SD, n=296) 70±10 68±9 ns BMI, kg/m2 (mean±SD, n=258) 27.1±4.8 26.7±4.5 ns LVEF, % (mean±SD, n=187) 50±11 53±11 0.0004 6MWD, metres (mean±SD, n=298) 358±104 461±114 <0.0001 Affected: Overweight / Obese subjects BMI, kg/m2 (mean±SD, n=174) 29.3±4 28.7±3.9 <0.0001 Affected: Hypertensive subjects SBP, mmHg (mean±SD, n=33) 152±15 133±11 <0.0001 DBP, mmHg (mean±SD, n=33) 80±15 71±12 0.02 Affected: Heart failure group LVEF, % (mean±SD, n=42) 34±6 39±9 <0.0001 6MWD ã 6-minute walk distance, BMI ã body mass index, CR ã cardiac rehabilitation, DBP ã diastolic blood pressure, HFrEF ã heart failure with reduced ejection fraction, LVEF ã left ventricular ejection fraction, ns ã not significant, SBP ã systolic blood pressure Open in new tab Indications for cardiac rehabilitation P780 https://esc365.escardio.org/Presentation/221662/abstract Effect and determinant of early phase II cardiac rehabilitation program on functional capacity in grown up congenital heart disease (GUCH) patients underwent cardiac surgery B Radi1, R Intan2, E Susilowati2, B Dwiputra1, V F Joseph1, R Hamdani1, A Santoso1, B Setianto1, A M Ambari1 1National Cardiovascular Center Harapan Kita, Cardiovascular Preventive and Rehabilitative Department, Jakarta, Indonesia 2National Cardiovascular Center Harapan Kita, Intern of Cardiovascular Preventive and Rehabilitative Department, Jakarta, Indonesia Topic: Rehabilitation: Outcomes Background: Previous studies have shown that congenital heart disease (CHD) patients have lower exercise capacity compared with healthy population. Functional capacity also known to be reduced after cardiac surgery. Exercise based phase II cardiac rehabilitation (CR) program is well known to improve functional capacity after various cardiac surgery, however its effect and determinant of functional capacity after early phase II CR program in GUCH population who underwent cardiac repair surgery are still less known. Purpose: This study aimed to analyse the effects and determinant variables of early phase II CR program on functional capacity in GUCH patients underwent cardiac repair surgery. Method: Clinical data of 106 patients who registered in early exercise-based CR program after cardiac repair surgery of GUCH (above 18 years old) at a national cardiovascular center in Indonesia from January 2017 until June 2019, were retrieved and analyzed. Functional capacity evaluation was analyzed from six minutes walking test (6-MWT) before and after CR program, Paired sample T-test was used to evaluate the effect of early phase II CR program on six minutes walking distance (6-MWD) improvement. Pearson or spearman correlation was used for bivariate analysis between possible determinant variables with functional capacity, meanwhile multivariate regression analysis was used to identify determinants and to generate a reference equation for functional capacity after CR program. Result: There were 106 GUCH patients in this study who completed CR program post cardiac surgery for 12 sessions. Most of the patients were female (67%), have ASD abnormality (64.15%) , with complex surgery in 33.96% patients. The median age of the population was 25 years old. Effect of exercise-based CR program on functional capacity was represented by the improvement of 6-MWD (334±58 to 398±46 meters, p<0,001). In bivariate analysis, included variables with p<0.25 were age, gender, cyanotic status, pulmonal hypertension (PH) status, surgery complexity, resting blood pressure, resting heart rate, left ventricle ejection fraction, body weight, body height, diuretic use, ACE inhibitor use, anticoagulant use. After analysis using multivariate regression, age, body weight, and body height were identified as determinants of functional capacity after CR (p=0.001, 0.020, and 0.016 respectively). Conclusion: Early phase II CR program have significant effect on functional capacity improvement in GUCH patient after cardiac surgery. For functional capacity evaluation after CR, the determinant variables are age, body weight, and body height. P783 https://esc365.escardio.org/Presentation/217386/abstract The effects of cardiac rehabilitation plus inotrope therapy in older patients with heart failure: a propensity score-matched analysis. N Naoya Yanagi1, K Kamiya1, N Hamazaki2, K Nozaki2, T Ichikawa2, T Nakamura1, M Yamashita1, S Uchida1, T Noda1, E Maekawa3, H Kariya2, T Koike4, M Yamaoka-Tojo5, A Matsunaga1, J Ako3 1Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan 2Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan 3Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan 4Kitasato University Hospital, Department of Intensive Care Center, Sagamihara, Japan 5Kitasato University School of Allied Health Sciences, Department of Rehabilitation, Sagamihara, Japan Topic: Rehabilitation: Outcomes Background: Older adults hospitalized for heart failure (HF) are particularly vulnerable to the adverse effects arising from muscle atrophy, disability and comorbidities. Although physical activity is recommended as part of the guidelines for recovery in patients hospitalized for HF, majority of older patients with HF remain sedentary. Outcomes in inotrope-treated patients with HF, particularly in those requiring intravenous inotropes, who receive inpatient cardiac rehabilitation, have not been well characterized. Purpose: This study aimed to investigate the effects of inpatient cardiac rehabilitation during inotrope use in older patients with HF. Methods: This study was a retrospective cohort study consisting of 357 patients (age ≥65 years) with HF who were admitted and treated by inotropes within 48 hours. We performed a propensity score-matched analysis to access the outcomes. The primary outcomes included in-hospital mortality, all-cause mortality, readmission and duration of hospital stay, whereas the secondary outcome included physical function at hospital discharge. Results: During follow-up (median, 294 days; interquartile range [IQR], 53–642 days), 43 patients died. We matched 83 pairs of patients comprising both who received and who did not receive cardiac rehabilitation with inotrope therapy according to the propensity score. In this matched cohort, intervention with cardiac rehabilitation was neither associated with in-hospital mortality (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.59–2.23), all-cause mortality (HR 0.96, 95% CI 0.53–1.75) nor readmission (HR 0.83, 95% CI 0.53–1.30). Contrastingly, intervention with cardiac rehabilitation was associated with decreased duration of hospital stay (median 21 days, IQR 18–26 vs 29 days, IQR 23–35; P = 0.013). Moreover, intervention with cardiac rehabilitation was associated with handgrip strength in physical function (median 21.8 kg, IQR 18.5–22.8 vs 18.7 kg, IQR 16.4–20.5; P = 0.009)(Figure 1). Conclusions: Here, we found that active cardiac rehabilitation along with inotrope use was significantly associated with decreased duration of hospital stay in older patients with HF. Also, cardiac rehabilitation therapy was significantly associated with muscle strength at hospital discharge. Thus, a combined cardiac rehabilitation plus inotrope therapy might prevent deterioration in muscle strength and improve outcomes in older patients with HF. Figure 1 P784 https://esc365.escardio.org/Presentation/217318/abstract Association of acute kidney injury occurrence in critical care setting with low physical function in patients with cardiovascular disease N Naoya Yanagi1, K Kamiya1, N Hamazaki2, K Nozaki2, T Ichikawa2, T Nakamura1, M Yamashita1, S Uchida1, A Sato1, E Maekawa3, H Kariya2, T Koike4, M Yamaoka-Tojo5, A Matsunaga1, J Ako3 1Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan 2Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan 3Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan 4Kitasato University Hospital, Department of Intensive Care Center, Sagamihara, Japan 5Kitasato University School of Allied Health Sciences, Department of Rehabilitation, Sagamihara, Japan Topic: Rehabilitation: Outcomes Background: Acute kidney injury (AKI) is a common complication in patients with cardiovascular disease (CVD) and critical illness. Besides, AKI occurrence in critical care setting is associated with an increased risk for frailty status. Therefore, patients with CVD in whom AKI had occurred may exhibit lower physical function. However, little is known regarding the association between AKI occurrence in the critical care setting and the physical function of patients with CVD. Purpose: This study aimed to investigate whether the occurrence and severity of AKI in critical care setting are associated with physical function and limitation of patients with CVD. Methods: The study population comprised 465 adult patients with CVD admitted to the intensive care units (ICU) between April 2014 and January 2018 who underwent physical function evaluation at hospital discharge. We defined AKI status based on serum creatinine standards of the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. We classified the patients by the presence or absence of AKI into ã with AKIã and ã without AKIã groups, respectively and further divided the ã with AKIã group by the severity of AKI, according to the KDIGO criteria. The short physical performance battery (SPPB) (≤9 points), usual gait speed (<1.0 m/s), leg strength (≤40% BW), handgrip strength (male: <26 kg, female: <18 kg) and 6-minutes walking distance (6MWD) (≤400 m) were measured as the established evaluation of physical function and determining physical limitation. Results: The study population (male: 66.2%) had a median age of 70 years (interquartile range [IQR]: 59–77 years). AKI occurred in 182 patients (39.1%) and severity of AKI, stage 1, 2 and 3 occurred in 113 (24.3%), 31 (6.7%) and 38 (8.2%) patients, respectively. AKI occurrence was associated with each physical limitation after adjusting for age, sex and body mass index: SPPB (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.41–4.57; P = 0.022), usual gait speed (OR 1.57, 95% CI 1.03–2.41; P = 0.038), leg strength (OR 2.15, 95% CI 1.42–3.24; P < 0.001), handgrip strength (OR 2.00, 95% CI 1.30–3.07; P = 0.002) and 6MWD (OR 1.86, 95% CI 1.20–2.89; P = 0.005), respectively. After adjustments for age, sex and body mass index, relative to the without AKI group, stage 3 AKI group recorded lower SPPB, leg strength and handgrip strength (P < 0.001, respectively), slower usual gait speed (P < 0.001) and shorter 6MWD (P < 0.001) (Figure). Conclusions: Here we demonstrated that the occurrence of AKI in a critical care setting was associated with physical limitations in patients with CVD. Furthermore, high severity of AKI was associated with low physical function. These findings suggest that the occurrence of AKI influences physical limitations in patients with CVD. Figure. Results of ANCOVA 345 https://esc365.escardio.org/Presentation/217040/abstract Electrocardiographic and echocardiographic insights from a prospective registry of Asian athletes TJ Tee Joo Yeo1, M Wang2, R Grignani2, J Mckinney3, LP Koh1, FHY Tan4, GCT Chan4, N Tay5, SP Chan1, CH Lee1, D Oxborough6, A Malhotra7, S Sharma8, AM Richards1 1National University Heart Centre, Department of Cardiology, Singapore, Singapore 2National University Hospital, Singapore, Singapore 3University of British Columbia, SportsCardiologyBC, Vancouver, Canada 4Singapore Sports Institute, Singapore, Singapore 5Cavendish Doctors, Family Medicine Department, Auckland, New Zealand 6Liverpool John Moores University, Sport and Exercise Sciences, Liverpool, United Kingdom of Great Britain & Northern Ireland 7University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom of Great Britain & Northern Ireland 8St George's University of London, Cardiology Clinical Academic Group, London, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: National University of Singapore Clinician Scientist Program Grant Topic: Sports Cardiology Background: Asian representation in sport is increasing in recent years, yet there remains a lack of reference values for the Asian athleteã s heart. Consequently, current guidelines for cardiovascular screening in athletes recommend using Caucasian athletesã norms to evaluate Asian athletes. Objectives: This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athleteã s heart using a Singaporean prospective cross-sectional registry of Southeast (SE) Asian athletes. Methods: 150 athletes with a mean age of 26.1 ± 5.7 years (50% males, 88% Chinese) were evaluated using a health questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analysed using the International Recommendations (2017) for athletes. Echocardiographic data were presented by gender and sporting discipline. Results: The prevalence of abnormal ECGs among SE Asian athletes was 6.7%, which is higher than reported figures for Caucasian athletes. The abnormal ECGs comprised largely of anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had structural abnormalities on echocardiography. Male athletes had reduced global longitudinal strain compared to females (-18.7 ± 1.6 vs. -20.7 ± 2.1%, p<0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to existing data for non-Asian athletes (Table 1). Conclusion: SE Asian athletes have a disproportionately high abnormal ECG rate compared to Caucasian athletes, with particular reference to ATWI. SE Asian athletes also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities. Selected Echocardiographic Parameters Gender Dynamic Component of Sport Total ( n = 150) Male (n = 75) Female (n = 75) High (n = 101) Low to moderate (n = 49) IVSd (mm) 9.4 ± 1.2 (7-13) 7.7 ± 1.1 (5-11) 8.9 ± 1.4 (6-13) 7.9 ± 1.3 (5-10) 8.6 ± 1.5 (5-13) LVIDd (mm) 51.6 ± 3.7 (43-63) 47.7 ± 3.6 (40-57) 50.2 ± 4 (42-63) 48.5 ± 4.2 (40-57) 49.6 ± 4.1 (40-63) LVIDd/BSA (mm/m2) 27.6 ± 2.4 (23-35) 29 ± 2.7 (21-34) 28.7 ± 2.7 (23-35) 27.6 ± 2.4 (21-32) 28.3 ± 2.6 (21-35) LV mass/BSA (g/m2) 97 ± 22.5 (62-160) 74.2 ± 17.7 (39-130) 91.5 ± 23.4 (39-160) 73.4 ± 17.4 (40-129) 85.6 ± 23.2 (39-160) Sep E/e' 6.3 ± 1.1 (3.3-8.8) 7.3 ± 1.5 (4.1-10.9) 6.8 ± 1.4 (4.4-10.6) 6.7 ± 1.5 (3.3-10.9) 6.8 ± 1.4 (3.3-10.9) GLS (%) 18.7 ± 1.6 (-16 - -22) 20.7 ± 2.1 (-15 - -24) 19.6 ± 2 (-15 - -24) 19.9 ± 2.2 (-16 - -24) 19.7 ± 2.1 (-15 - -24) Selected Echocardiographic Parameters Gender Dynamic Component of Sport Total ( n = 150) Male (n = 75) Female (n = 75) High (n = 101) Low to moderate (n = 49) IVSd (mm) 9.4 ± 1.2 (7-13) 7.7 ± 1.1 (5-11) 8.9 ± 1.4 (6-13) 7.9 ± 1.3 (5-10) 8.6 ± 1.5 (5-13) LVIDd (mm) 51.6 ± 3.7 (43-63) 47.7 ± 3.6 (40-57) 50.2 ± 4 (42-63) 48.5 ± 4.2 (40-57) 49.6 ± 4.1 (40-63) LVIDd/BSA (mm/m2) 27.6 ± 2.4 (23-35) 29 ± 2.7 (21-34) 28.7 ± 2.7 (23-35) 27.6 ± 2.4 (21-32) 28.3 ± 2.6 (21-35) LV mass/BSA (g/m2) 97 ± 22.5 (62-160) 74.2 ± 17.7 (39-130) 91.5 ± 23.4 (39-160) 73.4 ± 17.4 (40-129) 85.6 ± 23.2 (39-160) Sep E/e' 6.3 ± 1.1 (3.3-8.8) 7.3 ± 1.5 (4.1-10.9) 6.8 ± 1.4 (4.4-10.6) 6.7 ± 1.5 (3.3-10.9) 6.8 ± 1.4 (3.3-10.9) GLS (%) 18.7 ± 1.6 (-16 - -22) 20.7 ± 2.1 (-15 - -24) 19.6 ± 2 (-15 - -24) 19.9 ± 2.2 (-16 - -24) 19.7 ± 2.1 (-15 - -24) IVSd = interventricular septum indiastole; LVIDd = left ventricular internal diameter in diastole; BSA = body surface area; GLS = globallongitudinal strain Open in new tab Selected Echocardiographic Parameters Gender Dynamic Component of Sport Total ( n = 150) Male (n = 75) Female (n = 75) High (n = 101) Low to moderate (n = 49) IVSd (mm) 9.4 ± 1.2 (7-13) 7.7 ± 1.1 (5-11) 8.9 ± 1.4 (6-13) 7.9 ± 1.3 (5-10) 8.6 ± 1.5 (5-13) LVIDd (mm) 51.6 ± 3.7 (43-63) 47.7 ± 3.6 (40-57) 50.2 ± 4 (42-63) 48.5 ± 4.2 (40-57) 49.6 ± 4.1 (40-63) LVIDd/BSA (mm/m2) 27.6 ± 2.4 (23-35) 29 ± 2.7 (21-34) 28.7 ± 2.7 (23-35) 27.6 ± 2.4 (21-32) 28.3 ± 2.6 (21-35) LV mass/BSA (g/m2) 97 ± 22.5 (62-160) 74.2 ± 17.7 (39-130) 91.5 ± 23.4 (39-160) 73.4 ± 17.4 (40-129) 85.6 ± 23.2 (39-160) Sep E/e' 6.3 ± 1.1 (3.3-8.8) 7.3 ± 1.5 (4.1-10.9) 6.8 ± 1.4 (4.4-10.6) 6.7 ± 1.5 (3.3-10.9) 6.8 ± 1.4 (3.3-10.9) GLS (%) 18.7 ± 1.6 (-16 - -22) 20.7 ± 2.1 (-15 - -24) 19.6 ± 2 (-15 - -24) 19.9 ± 2.2 (-16 - -24) 19.7 ± 2.1 (-15 - -24) Selected Echocardiographic Parameters Gender Dynamic Component of Sport Total ( n = 150) Male (n = 75) Female (n = 75) High (n = 101) Low to moderate (n = 49) IVSd (mm) 9.4 ± 1.2 (7-13) 7.7 ± 1.1 (5-11) 8.9 ± 1.4 (6-13) 7.9 ± 1.3 (5-10) 8.6 ± 1.5 (5-13) LVIDd (mm) 51.6 ± 3.7 (43-63) 47.7 ± 3.6 (40-57) 50.2 ± 4 (42-63) 48.5 ± 4.2 (40-57) 49.6 ± 4.1 (40-63) LVIDd/BSA (mm/m2) 27.6 ± 2.4 (23-35) 29 ± 2.7 (21-34) 28.7 ± 2.7 (23-35) 27.6 ± 2.4 (21-32) 28.3 ± 2.6 (21-35) LV mass/BSA (g/m2) 97 ± 22.5 (62-160) 74.2 ± 17.7 (39-130) 91.5 ± 23.4 (39-160) 73.4 ± 17.4 (40-129) 85.6 ± 23.2 (39-160) Sep E/e' 6.3 ± 1.1 (3.3-8.8) 7.3 ± 1.5 (4.1-10.9) 6.8 ± 1.4 (4.4-10.6) 6.7 ± 1.5 (3.3-10.9) 6.8 ± 1.4 (3.3-10.9) GLS (%) 18.7 ± 1.6 (-16 - -22) 20.7 ± 2.1 (-15 - -24) 19.6 ± 2 (-15 - -24) 19.9 ± 2.2 (-16 - -24) 19.7 ± 2.1 (-15 - -24) IVSd = interventricular septum indiastole; LVIDd = left ventricular internal diameter in diastole; BSA = body surface area; GLS = globallongitudinal strain Open in new tab 347 https://esc365.escardio.org/Presentation/217129/abstract Validation of the cardio pulmonary resuscitation app CPR 11 AL Antonio Luis Arrebola Moreno1, JP Arrebola2, L Serratosa3 1HOSPITAL HLA INMACULADA, Granada, Spain 2University of Granada, Preventive Medicine and Public Health Department, Granada, Spain 3University Hospital Quironsalud Madrid, Ripoll y de Prado Sport Clinic, Centro Médico de Excelencia FIFA, Madrid, Spain Topic: Sports Cardiology Introduction: Sudden cardiac death (SCD) is a tragic event that may occur during sport competitions and more than 90% of sport related sudden deaths occur in the context of recreational sports. Early cardiopulmonary resuscitation (CPR) plays a key role in increasing the chances of survival. Patients who receive bystander CPR have a two to three times higher survival rate. The initiatives to increase the number of early initiated CPR are costly and the effectiveness of training unselected lay responders in CPR is quite uncertain. A number of systems have been developed using mobile phone technology in order to enhance the participation of bystander responders. CPR11 is an easy-to-use app oriented to football players and athletes of other sports that, in only 11 steps, offers clear and simple instructions on how to perform ventilation and chest compressions in an appropriate way and the management of an external automatic external defibrillator (AED). Purpose: The objective of this study was to evaluate the efficacy of the 11 step easy-to-use CPR11 app on the time and quality of response in a cardiac arrest situation scenario in untrained individuals. Methods: In this study, a secondary school and a football club were approached for the recruitment of CPR untrained young individuals in February 2019. The evaluation of skills and knowledge was performed in 2 steps (baseline and after using the CPR 11 App), each of them including a simulation time of 3 minutes. A modified version of the Cardiff test adapted to the ERC guidelines of 2010 and CPR training simulators (little Anne QCPR(R) and Zoll(R) defibrillator simulators) were used for the evaluation. Results: From the initial 60 participants assessed for eligibility a total of 52 participants (44% males; mean age of 13 yrs.) were included in the study. Both the score of the modified Cardiff test (14.07 vs 21.94; p<0.001) and the total score offered by the CPR simulator (9.7 vs 29.29; p<0.001) were significantly improved after the CPR11 App visualization in the overall population. Although the global compression score was significantly improved (p<0.001), the global ventilation score did not reach significant improvement (p=0.20). Both males and females significantly improved the modified Cardiff test and the global simulator score. Better results were related to height, weight, number of hours of exercise and male gender and were mainly mediated by a better percentage of compressions with adequate depth. Conclusions: A single use of the CPR11 mobile App was able to significantly improve the modified Cardiff Test punctuation and the overall punctuation of a CPR simulator in young adolescents. Special interest should be applied to ventilation technique to reach better results. Cardiac compressions technique should be emphasized mainly in female, short, lightweight and sedentary young individuals to be able to compensate the likelihood of weaker cardiac compressions. 348 https://esc365.escardio.org/Presentation/217337/abstract Diagnostic yield of genetic testing in the BEAT-IT screening program M Abela1, S Xuereb1, K Yamagata1, J Bonello1, W Camilleri1, J Fleri Soler1, L Buttigieg1, A Callus1, T Felice1, M Burg1, RG Xuereb1, MA Sammut1, L Monserrat2, M Papadakis3, S Sharma3 1Mater Dei Hospital of Malta, Cardiology, Msida, Malta 2Institute of Biomedical Research of La Coruna (INIBIC), A Coruna, Spain 3St George's University of London, MSc Sports Cardiology, Cardiology clinical academic group, London, United Kingdom of Great Britain & Northern Ireland On Behalf of: BEAT-IT Investigators Funding Acknowledgements: Research, Innovation & Development Trust (UoM); Malta Heart Foundation Topic: Sports Cardiology Introduction: Cardiac screening in competitive athletes is now recommended by most scientific and sporting organisations. Screening non-athletic young individuals has been challenged. Absence of a definite phenotype can falsely reassure those screened. Genetics may possibly help identify those with a pre-clinical state. Objectives: To explore the diagnostic yield of genetic testing in a de novo national screening program, designed to identify Maltese adolescents at risk of sudden death. Methodology: 2708 students aged 14-16 years underwent cardiac screening with a questionnaire and a 12-lead electrocardiogram (ECG) at school. Those with a cardiomyopathy or channelopathy suspicion underwent genetic testing. Pathogenicity was classed according to current recommendations from the American College of Medical Genetics and Genomics. Inconclusive variants were considered potentially pathogenic if they were a) absent or rare in health controls, b) previously linked to disease onset, c) functionally relevant variants and d) co-segregation with disease in multiple affected family members in a gene known to cause the clinical phenotype. Probands and family members were classified according to genotype (G), ECG and phenotype (P). Results: Following recruitment, 102 (3.7%) were advised to undergo secondary evaluation. Fifteen (0.6%) agreed to undergo a comprehensive evaluation because of a cardiomyopathy or channelopathy suspicion. Only 2 (0.07%) of these had a definite clinical phenotype (n=1 HCM, n=1 LQTS). Familial evaluation in first degree relatives (n=38) was also performed. A definite clinical phenotype was identified in 3 different families (n=6, 15.8%) (Figure 1, Red Boxes). All fifteen individuals were subjected to genetic testing. Gene testing was negative in the majority (n=6, 40.0%). Three (20%) had a likely pathogenic mutation in the absence of a definite clinical phenotype (Figure 1, Blue Boxes). One of these had definite evidence of disease in the family (Father [HCM], G+ ECG+ P+). Another six (40.0%) were reported as inconclusive. Five relatives in two of these families were found to harbour a clinical phenotype consistent with the probandã s diagnosis (n=4, LQTS) or clinical suspicion (n=1, HCM) (Figure 1, Green Boxes). All 5 relatives harboured the same inconclusive genetic variant as the proband. Conclusion: Up to 20.0% (n=3) had a likely pathogenic mutation. 15.4% (n=2) of probands without a clinical phenotype were identified with a likely pathogenic mutation. These findings may support using genetic testing in the clinical evaluation of adolescents who may be harbouring a pre-clinical phenotype. Genetic testing in the BEAT-IT cohort Award Winning Science - Sports Cardiology & exercise section 395 https://esc365.escardio.org/Presentation/217408/abstract Diagnostic yield of cardiac magnetic resonance in a large cohort of athletic and non-athletic individuals with pathological T wave inversion M Mattia Zampieri1, A Kasiakogias1, A Malhotra1, H Maclachlan1, A Potterton1, C Miles1, P Poveda-Velazquez1, M Abela1, N Bunce1, S Sharma1, M Papadakis1 1St George's Healthcare NHS Trust, London, United Kingdom of Great Britain & Northern Ireland Topic: Sports Cardiology Introduction: The electrocardiogram (ECG) has a central role in cardiac screening for the prevention of sudden cardiac death. T-wave inversion (TWI) is a common finding in cardiomyopathies and warrants further investigation. Cardiac Magnetic Resonance (CMR) has gained momentum for imaging of individuals with TWI as it provides incremental yield. Purpose: We retrospectively analysed the yield of CMR and its additional diagnostic value over echocardiography in a large cohort of athletes and non-athletes with TWI. Methods: We reviewed consecutive individuals without known cardiovascular disease who were referred for CMR for the investigation of TWI between April 2011 and July 2019. Patients also underwent echocardiography, exercise test and 24h-Holter monitor as deemed necessary by the responsible physician. Imaging results were classified as normal, suggestive of myocardial disease or pathological. Results: The study population comprised of 411 individuals (68% males, mean age 35±17 years old, 44% Caucasian/21% Afro-Caribbeans/35% other or unknown), of whom 44% participated in regular sports (training >6 hours per week). The distribution of TWI was 55% in the lateral leads, 29% in the anterior leads and 15% in the inferior leads. A definite cardiac condition was diagnosed on initial evaluation in 84 (20%) cases, with an additional 7 cases diagnosed during a follow up of 26±21 months. The most common diagnoses were hypertrophic cardiomyopathy (47%), myocarditis (13%), Takotsubo cardiomyopathy (11%), dilated cardiomyopathy (9%) and arrhythmogenic cardiomyopathy (8%). A diagnosis was more common in individuals with lateral TWI (28%) compared to anterior (15%) or inferior TWI (14%) (p<0.001), and in non-athletes (34%) compared to athletes (7%) (p<0.001). Interestingly, all of the patients with a diagnosis were over 18 years old. However, there was no association between gender or ethnicity and reaching a diagnosis. Of the 91 patients with a definite diagnosis, CMR findings were pathological in 80% of cases and suggestive in 11%. CMR was reported as pathological in 68 patients of the entire study population whose echocardiogram was reported as normal or only suggestive of disease. Conclusions: In individuals with TWI, extensive testing provided a diagnostic yield of 22%. The diagnostic yield was higher in individuals with lateral TWI, non-athletes and adults. CMR re-classified imaging findings as diagnostic in one fifth of the cohort who had initially normal or suggestive findings on echocardiography. Award Winning Science - Sports Cardiology & exercise section 396 https://esc365.escardio.org/Presentation/217109/abstract The high-sensitivity C-reactive protein response following strenuous physical exercise is attenuated by cod-liver oil supplements: NEEDED 2014 (The North Sea Race Endurance Exercise Study) M Hansen1, S Orn1, CB Erevik1, M Bjorkavoll-Bergseth1, O Skadberg2, TH Melberg1, O Kleiven1 1Stavanger University Hospital, Department of Cardiology, Stavanger, Norway 2Stavanger University Hospital, Department of Biochemistry, Stavanger, Norway On Behalf of: The North Sea Race Endurance Exercise Study Funding Acknowledgements: Stavanger University Hospital, Abbott Diagnostics, The Norwegian Health Association, Laerdal Foundation ang grants from the North Sea Race foundation Topic: Sports Cardiology Background: Dietary supplement use among recreational athletes is common, with the intention of reducing inflammation and improve recovery. The underlying evidence of the supplementã s effects, however, is very limited. Purpose: To describe the relationship between the uses of dietary supplement with cod-liver oil, vitamin D and omega-3, and circulating levels of C-reactive protein (CRP) following strenuous exercise. Methods: We measured serial CRP concentrations in 1002 healthy recreational athletes before, and 3 and 24 hours after a 91-km bicycle race (The North Sea Race). Self-reported use of supplements was collected, and the association between supplement use and the exercise-induced CRP response was assessed in unadjusted and adjusted models. Results: CRP increased from baseline (0.7 (25th-75th percentile: 0.4-1.3) mg/L) to maximal values at 24 hours following the race (6.9 (4.0-11.8) mg/L, p<0.001). In total, 296 subjects reported regular use of one (n=231) or more (n=65) of the following supplements: cod-liver oil (n=173), vitamin D (n=65) and omega-3 (n=120). Subjects who used cod-liver oil had significantly lower CRP concentrations before and after the race (p<0.001). In unadjusted models, the use of cod-liver oil was associated with a 34 (95 % confidence interval (CI): 19-49) % decrease in CRP response (p<0.001, Table). After adjusting for for age, sex, race duration, body mass index, estimated glomerular filtration rate, creatine kinase response and systolic blood pressure, use of cod-liver oil was still associated with 25 (95 % CI: 11-38) % decrease in delta CRP response, p<0.001. Regular use of vitamin D or omega 3 supplements was not associated with an attenuated CRP response. Conclusion: The exercise-induced CRP response in healthy recreational cyclists is attenuated in subjects who uses cod-liver oil supplement regularly. No such effect was observed for users of vitamin D or omega-3 supplements. Future studies are needed to gain insight into the mechanisms and the benefits of lower CRP concentrations in cod-liver oil users following physical stress. Model 1 Model 2 Model 3 Model 4 Regular use of cod-liver oil - 34 (-49 - -19) % p<0.001 -31 (-47 - -16) % p<0.001 -24 (-38 - -11) % p=0.001 -25 (-38 - -11)% p<0.001 Model 1: Unadjusted, Model 2: Adjusted for age and sex, Model 3: As for Model 2, but also adjusted for body mass index and race duration, Model 4: As for Model 3, but also adjusted for systolic blood pressure, delta creatine kinase (baseline-24h post-race) and estimated glomerular filtration rate Model 1 Model 2 Model 3 Model 4 Regular use of cod-liver oil - 34 (-49 - -19) % p<0.001 -31 (-47 - -16) % p<0.001 -24 (-38 - -11) % p=0.001 -25 (-38 - -11)% p<0.001 Model 1: Unadjusted, Model 2: Adjusted for age and sex, Model 3: As for Model 2, but also adjusted for body mass index and race duration, Model 4: As for Model 3, but also adjusted for systolic blood pressure, delta creatine kinase (baseline-24h post-race) and estimated glomerular filtration rate Table: Association between regular use of cod-liver oil and change in concentrations of CRP from baseline to 24 hours following strenuous exercise (B (95 % confidence interval)). Open in new tab Model 1 Model 2 Model 3 Model 4 Regular use of cod-liver oil - 34 (-49 - -19) % p<0.001 -31 (-47 - -16) % p<0.001 -24 (-38 - -11) % p=0.001 -25 (-38 - -11)% p<0.001 Model 1: Unadjusted, Model 2: Adjusted for age and sex, Model 3: As for Model 2, but also adjusted for body mass index and race duration, Model 4: As for Model 3, but also adjusted for systolic blood pressure, delta creatine kinase (baseline-24h post-race) and estimated glomerular filtration rate Model 1 Model 2 Model 3 Model 4 Regular use of cod-liver oil - 34 (-49 - -19) % p<0.001 -31 (-47 - -16) % p<0.001 -24 (-38 - -11) % p=0.001 -25 (-38 - -11)% p<0.001 Model 1: Unadjusted, Model 2: Adjusted for age and sex, Model 3: As for Model 2, but also adjusted for body mass index and race duration, Model 4: As for Model 3, but also adjusted for systolic blood pressure, delta creatine kinase (baseline-24h post-race) and estimated glomerular filtration rate Table: Association between regular use of cod-liver oil and change in concentrations of CRP from baseline to 24 hours following strenuous exercise (B (95 % confidence interval)). Open in new tab Award Winning Science - Sports Cardiology & exercise section 398 https://esc365.escardio.org/Presentation/217406/abstract Associations between cardiac remodeling and exercise capacity in athletes: machine learning based prediction of peak oxygen uptake M Marton Tokodi1, BK Lakatos1, Z Toser2, M Csakvari2, A Fabian1, M Babity1, C Bognar1, N Sydo1, H Vago1, O Kiss1, B Merkely1, A Kovacs1 1Semmelweis University Heart and Vascular Center, Budapest, Hungary 2Argus Cognitive, Inc., Lebanon, NH, United States of America Topic: Sports Cardiology Background: Regular vigorous exercise induces significant adaptive changes in cardiac morphology and function, and increases aerobic performance. However, the spectrum of exercise-induced cardiac remodeling and the concomitant changes in exercise capacity are challenging to explore. Artificial intelligence may overcome this difficulty and may enable the prediction of peak oxygen uptake (VO2/kg) using resting markers of athleteã s heart without cardiopulmonary exercise testing. Purpose: We aimed to explore the associations between resting left (LV) and right ventricular (RV) morphology and mechanics, and peak exercise capacity using machine learning techniques. Methods: We enrolled 396 competitive athletes (20±6 years, 70% male, 15±8 training hours/week) and 56 sedentary healthy volunteers (20±4 years, 53% male, 3±2 training hours/week) who underwent 3D echocardiographic evaluation at rest. Myocardial mechanics was quantified as 3D global longitudinal (GLS) and circumferential strain (GCS) in both ventricles. Cardiopulmonary exercise testing was performed to determine VO2/kg. After selecting the optimal set of input features using recursive feature elimination, random forest regression with 10-fold cross-validation was applied to predict VO2/kg from demographics, vitals and 3D echocardiographic parameters. T-distributed Stochastic Neighbor Embedding was used for 2D visualization of the high dimensional data. Results: Athletes had higher LV and RV end-diastolic volumes (LVEDVi: 81±13 vs. 62±11 mL/m², RVEDVi: 82±14 vs. 63±11 mL/m², both p<0.001), higher LV mass (LVMi: 87±15 vs. 66±12 g/m², p<0.001), lower LV and RV ejection fraction (LVEF: 57±4 vs. 61±5 %, RVEF: 55±5 vs. 59±4 %, both p<0.001), and lower resting heart rate compared to untrained controls (68±12 vs. 79±15 BPM, p<0.001). LVGLS (-19±2 vs. -21±2 %, p<0.001), LVGCS (-28±3 vs. -31±4 %, p<0.001) and RVGCS (-24±6 vs. -29±8 %, p<0.001) were decreased in athletes, whereas there was no difference in RVGLS compared to controls (-29±6 vs. -29±5 %, p=0.852). In the combined cohort of athletes and untrained controls, VO2/kg correlated with LVEDVi (r=0.49, p<0.001), RVEDVi (r=0.49, p<0.001), LVMi (r=0.41, p<0.001), LVEF (r=-0.23, p<0.001), RVEF (r=-0.22, p<0.001), LVGLS (r=0.28, p<0.001), LVGCS (r=0.21, p<0.001), RVGCS (r=0.18, p<0.001), resting heart rate (r=-0.21, p<0.001) and the weekly training hours (r=0.11, p=0.017). Our random forest model predicted VO2/kg with mean absolute error of 4.388 mL/kg/min and adjusted R² of 0.463. We were also able to visualize the spectrum of cardiac adaptation to exercise training (Figure). Conclusion: Higher LV and RV volumes but lower biventricular systolic function at rest were associated with increased peak oxygen uptake. By harnessing these associations between cardiac adaptation and aerobic performance, our machine learning based approach was capable of predicting VO2/kg based on resting 3D echocardiographic data. Abstract No: 398 Award Winning Science - Sports Cardiology & exercise section 399 https://esc365.escardio.org/Presentation/217405/abstract Anterior T-Wave inversion in peripubertal individuals: prevalence and clinical yield from a De-Novo national cardiac screening program. M Mark Abela1, K Yamagata1, R Xuereb1, S Xuereb1, L Buttigieg1, E Abela2, K Sapiano2, M Bonello2, J Fleri Soler1, T Felice1, M Burg1, RG Xuereb1, MA Sammut1, M Papadakis3, S Sharma3 1Mater Dei Hospital of Malta, Cardiology, Msida, Malta 2Mater Dei Hospital of Malta, Internal Medicine, Msida, Malta 3St George's University of London, MSc Sports Cardiology, Cardiology clinical academic group, London, United Kingdom of Great Britain & Northern Ireland On Behalf of: BEAT-IT Investigators Funding Acknowledgements: Research, Innovation & Development Trust (UoM); Malta Heart Foundation Topic: Sports Cardiology Background: T wave inversion (TWI) in the right precordial leads is a common finding in adolescent individuals. In the absence of symptoms or significant family history, TWI in 2 contiguous chest leads is regarded as a normal variant (Juvenile ECG pattern). Objectives: The first is to assess the prevalence of TWI beyond V1 in a large cohort of individuals aged <16 years. The second is to assess the clinical yield of those with persistent anterior TWI beyond V2 after the age of 16. Methodology: Cardiac screening (questionnaire/ECG) was carried out in 2672 students (14-17 years) attending year 11 classes during the 2017/2018 scholastic year (3991 eligible citizens). Individuals with TWI in V1-V2 were considered normal variants. Echocardiography was performed in subjects with TWI in V1-V3 and V1-V4. These participants were advised to repeat an ECG in a yearã s time. Those with persistent TWI beyond V2 after the age of 16 years were referred for a more comprehensive evaluation. Results: Participants were aged 15 ± 0.32 years (14-17 years) with both genders represented equally. Most were Caucasian (95.8%). A third (31.8%) of the cohort were competitive athletes. A juvenile ECG pattern was observed in 142 (5.3%) subjects. Five (0.2%) were excluded because of medical reasons (n=1 HCM, n=1 VSD, n=1 AVSD repair, n=2 under investigation). Most subjects with a juvenile ECG pattern had TWI in V1-V2 (n=90, 3.4%). A further 43 (1.6%) in V1-V3 and 4 (0.1%) in V1-V4. Females were 1½ times more likely to present with a juvenile ECG pattern when compared to males (6.4% vs 3.9%, p=0.0037) (Figure 1). It is more common in adolescent females athletes (8.7% vs 5.6%, p=0.0542), specifically when extending beyond V2 (4.5% vs 2.2%, p=0.0324). Participants with TWI beyond V2 were re-contacted one year later. Most consented for the re-evaluation (n=36, 76.6%). This group consisted of 27 (75.0%) females and 9 (25.0%) males. Most (n=30, 83.3%) normalised after the age of 16. Six (0.2%) were referred for further evaluation because of persistent TWI beyond V2 (M=1 and F=6, p=0.1012). No definite clinical phenotype was identified in any of the 6 subjects at the first comprehensive evaluation. One (2.8%) has however been offered an implantable loop recorder because of a short run of non-sustained ventricular tachycardia on her 24-hour ECG monitor. No relevant clinical phenotype was identified in any first-degree relatives (n=19). Conclusion: The prevalence of anterior TWI is known to be higher in females. Chest wall anatomy and various levels of sympathetic innervation are some of the postulated reasons for this difference. The juvenile ECG pattern in this cohort is more common in females (6.4% vs 3.9%, p=0.0037). Female adolescent athletes are also more likely to present with TWI beyond V2 when compared to their non-athletic counterparts (4.5% vs 2.2%, p=0.0324). These findings support a more conservative approach in female adolescent athletes with TWI beyond V2. Abstract No: 399 Anterior T-Wave Inversion in BEAT-IT EAPC Essentials 4 You - ePosters P752 https://esc365.escardio.org/Presentation/223114/abstract Junior versus senior: an observational prospective study on differences in cardiopulmonary fitness status between junior and senior professional handball players L Wolf1, J Oesterschlink1, H Omran1, A Fruend2, D Dumitrescu1, V Rudolph1, KP Mellwig1 1Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Clinic for General and Interventional Cardiology/Angiology, Bad Oeynhausen, Germany 2Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Department of Physiotherapy, Bad Oeynhausen, Germany Topic: Sports Cardiology Background: For cardiopulmonary (CP) fitness evaluation by cardiopulmonary exercise testing (CPET) in professional athletes, it is unclear whether all subjects should be tested with the same protocol, or whether it is necessary to use separate protocols for junior and senior athletes. Furthermore, it is unclear whether other gas exchange parameters apart from VO2max may add relevant information on integrative CP fitness. Purpose: In this study, we sought to detect differences in CP fitness status between junior and senior professional handball players by analyzing key gas exchange parameters during exercise, reflecting maximal oxygen uptake (VO2 max) and circulatory efficiency. Methods: We examined 49 professional handball players (n=49) and divided them into a junior (j) (n=19; mean age 17.7 ±1.4) and a senior (s) (n=30; mean age 25.9±5.6) subgroup. Both groups underwent extensive cardiopulmonary checkup including echocardiography and maximal CPET (treadmill CPET). We used a standardized incremental protocol starting at 10 kilometers per hour (km/h) with a constant slope of 1.5%. Speed was increased by 2 km/h every 3 minutes. VO2 at the anaerobic threshold (VO2 VT1), VO2 max and O2 pulse were determined by gas exchange. Results: There was no significant difference in weight-adapted VO2 VT1 and VO2 max between the subgroups (s vs j: VO2 VT1 45.5±4.9 vs 46.13±4.5 ml/min/kg, p= 0.58; VO2 max 52.6±4.3 vs 52.9±4.5 ml/min/kg, p= 0.86). We noted a significant difference in absolute values for VO2 VT1 and VO2 max between the subgroups (s vs j: VO2 VT1 absolute 4.3±0.6 vs 3.9±0.6 L/min, p= 0.063; VO2 max absolute 4.9±0.5 vs 4.5±0.7 L/min, p= 0.008). At peak exercise there was a significant difference in O2 pulse (s vs j: O2 pulse VT1 25.2±3.2 vs 23.2±3,76ml/beat, p= 0,54; O2 pulse at VO2 max 26.5±3.1 vs 23.9±3.8 ml/beat, p= 0.012). There were no significant differences in HR, or Hb concentration between the groups, respectively. Conclusion: There was no significant difference in weight-adapted VO2 max and VO2 VT1 between junior and senior professional handball players, supporting the approach of using the same exercise protocol for junior and senior athletes. The significant difference in O2 pulse at peak exercise between the groups may indicate a lower circulatory efficiency at peak exercise in junior athletes. As the O2 pulse is calculated from absolute VO2 values, without weight correction, an additional role for absolute VO2max values in the evaluation of cardiopulmonary fitness in professional athletes may be discussed. P756 https://esc365.escardio.org/Presentation/223113/abstract Influence of endurance training on right heart function in competitive athletes L Wolf1, J Oesterschlink1, H Omran1, A Fruend2, D Dumitrescu1, L Faber1, V Rudolph1, KP Mellwig1 1Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Clinic for General and Interventional Cardiology/Angiology, Bad Oeynhausen, Germany 2Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Department of Physiotherapy, Bad Oeynhausen, Germany Topic: Sports Cardiology Background: The term "athlete´s heart" describes a physiological adaptation due to endurance training. Echocardiographic findings suspicious of an athlete´s heart are mostly derived from left heart parameters, as an interpretation of right heart adaptations remain challenging due to its complex geometry. The influence of training on right heart function in competitive athletes has not been studied profoundly. Purpose: The aim of this study was to examine right heart function in male professional handball players and to investigate if right heart status differs between junior and senior players. Methods: We examined 50 professional handball players (n= 49) and divided them into a junior (j) (n=19; mean age 17.7 ±1.4) and a senior (s) (n=30; mean age 25.9±5.6) subgroup. All athletes underwent extensive cardiopulmonary checkup including cardiopulmonary exercise testing (CPET) and echocardiography. To evaluate right heart status, we measured right atrial (RA) area, right atrium diameter indexed to body surface area (RAD index), basal right ventricular end diastolic diameter (RVEDD), fractional area change (FAC), tricuspid annular plain systolic excursion (TAPSE) and presence of pericardial effusion (PE). All analyzed parameters were compared to published normal values according to the recommendations of the American Society of Echocardiography. To evaluate effects of right heart status on exercise capacity and ventilatory efficiency, we analyzed peak oxygen uptake (VO2 max), relationship between ventilation and carbon dioxide output (VE/VCO2 slope) and the ventilatory equivalent for carbon dioxide (EqCO2) during CPET. Results: In the overall collective, we found elevated values for RA area (18.1±3.6 cm²). All other parameters were within the normal values. There was a significant difference in basal RVEDD between the two subgroups (s vs j: 32±5.6 vs 36.5±7.1 mm; p= 0.02). There was no significant difference in VO2 max, VE/VCO2 slope or EqCO2 nadir between the groups (s vs j: VO2 max 52.6±4.3 vs 52.8±4.5 ml/min/kg, p= 0.86; VE/VCO2 slope 25.2±3.3 vs 27.3±3.8, p=0.066; EqCO2 nadir 21.9±1.5 vs 22.3±2.3, p=0.52). Conclusion: Analyzing right heart status, we found a mild RA enlargement in our cohort of professional handball players. All other parameters were within normal range. The increased RA area is consistent with published data and might be interpreted as a remodeling process due to endurance training. There was a significant difference in RVEDD between the subgroups, where RVEDD was higher in senior handball players. There was no difference in peak oxygen uptake or ventilator efficiency between the groups. This suggests that long term endurance training might result in larger right ventricular dimensions, however without any negative impact on exercise gas exchange. P757 https://esc365.escardio.org/Presentation/217039/abstract Electrocardiogram analysis from a cardiac screening program in elite Australian cricketers J Orchard1, JW Orchard2, A La Gerche3, A Kountouris4, H Raju5, M Young6, R Puranik2, C Semsarian7 1University of Sydney, Heart Research Institute / CPC, Sydney, Australia 2University of Sydney, Sydney, Australia 3Baker Heart and Diabetes Institute, Melbourne, Australia 4Cricket Australia, Melbourne, Australia 5Macquarie University, Sydney, Australia 6Qsportsmedicine, Brisbane, Australia 7Royal Prince Alfred Hospital, Centenary Institute and the University of Sydney, Sydney, Australia Funding Acknowledgements: JWO, AK and MY are consultants/employees of Cricket Australia. JJO is supported by an Australian Government Research Training Program scholarship Topic: Sports Cardiology Background: Australian cricket implemented a formal cardiac screening policy for elite players in 2016. Under the policy, it is recommended, although not compulsory (opt-out), that players undertake cardiac screening prior to participating in elite cricket. This program covers all elite male and female cricket squads from 16 years upwards, including state and national squads, with complete records for all players covered stored in a central database. Purpose: To report the compliance and results of an electrocardiogram (ECG) cardiac screening program in a well-defined cohort of male and female elite Australian cricket players. Methods: Players who consented provided a personal and family history, and underwent physical examination and resting 12-lead ECG. Follow-up tests were conducted if required. An audit (1 February 2019) examined all cardiac screening records for male and female players in all Australian Cricket state squads from 16 years upwards. Data extracted from the database included the number of players who underwent cardiac screening; signed waivers opting out; and had follow-up tests. ECGs were re-reviewed by sports cardiology experts according to the International Criteria for athlete ECG interpretation. Results: 710 players were included in the audit cohort (mean age 20.4±4.9 years, 62% male). 692 (97.5%) players underwent recommended cardiac screening (including ECG) or signed a waiver (1.1%). 173 (24.4%) players were screened (or signed a waiver) more than once during the period. Follow-up testing was conducted for 59 (6.9%) cases. No players were excluded from sport due to a cardiac problem and no major cardiac incidents occurred during the period. Review of 830 ECGs showed benign athlete heart changes, including sinus bradycardia (33.5%), left ventricular hypertrophy (16.3%), and incomplete/partial right bundle branch block (8.4%), were common but abnormal screening ECGs were uncommon (2.0%). Left ventricular hypertrophy was 15 times more prevalent in male cricketers than females (25.0% vs 1.6%; p<0.0001). Males also had significantly more sinus bradycardia (37.4% vs 27.0%; p=0.002) and left axis deviation (2.7% vs 0.3%; p=0.01) than females. However, any T-wave inversion (excluding leads aVR, III and V1) was more common in females than males (8.0% vs 1.2%; p<0.0001). CONCLUSIONS: an audit of a cardiac screening program in elite Australian cricketers found excellent compliance. A small proportion required follow-up testing and no player was excluded from sport due to a cardiac problem. ECG analysis suggested cricket is a sport of moderate cardiac demands, with benign athlete heart changes common. Analysis also shows some sex differences in ECG features in line with previous studies. The study illustrates the successful implementation of a cardiac screening program in an elite sporting cohort. P758 https://esc365.escardio.org/Presentation/217090/abstract Prescription of exercise loads for young athletes in the presence of connective tissue dysplasia - Plays a role or not? K Kamilia Mekhdieva1, V Timokhina1, YU Zinovieva2, A Zakharova1 1Ural Federal University, Yekaterinburg, Russian Federation 2Sverdlovsk Regional Clinical Hospital 2, Yekaterinburg, Russian Federation On Behalf of: Sport technologies study group Funding Acknowledgements: The work was supported by Act 211 Government of the Russian Federation, contract #02.A03.21.0006 Topic: Sports Cardiology Background: Inherited disorders of collagen synthesis and maturation are associated with arising of connective tissue dysplasia (CTD), including dysplastic heart forming. There is lack of data on appropriate exercise loads prescription for these individuals tacking into particular consideration peculiarities of cardiovascular adaptation and functional cardiac reserve. Purpose: to estimate possible interrelations between CTD manifestation degree and effectiveness of adaptation to exercise loads and functional reserve of left ventricle (LV) in young athletes. Methods: Twenty-five qualified cross-country skiers with CTD aged 15 were recruited for the study (height ã 174.6±8.7 cm, weight ã 64.6±7.0 kg, BMI ã 21.2±1.8 kg/m2). Athletes were divided into two groups according to the criteria of CTD degree. All studied individuals underwent cardiopulmonary stress-test with oxygen consumption (VO2) and heart rate (HR) monitoring, standard transthoracic echocardiography (TTE) before and immediately after maximal cycle stress-test. The degree of mechanical LV asynchrony was evaluated with the use of further image processing of TTE data based on three short-axis and one long-axis LV sections. Calculated value of variation coefficient of regional ejection fraction (Cv r-EF, %) was used as a measure of LV mechanical asynchrony. One-way ANOVA and Spearman correlations were used for statistical analysis. Results: The parameters of aerobic capacity conformed to age-appropriate normal values for athletes (VO2max=56.8±8.7 ml/kg/min, HRmax=182.9±10.1 bpm). Meanwhile, we revealed that athletes with higher degree of CTD achieved higher values of VO2max (p<0.001), maximum relative power (p<0.0001) with significant lower maximum HR during stress-test (p<0.05). These findings point at more effective cardiac adaptation to increasing exercise loads in athletes with more pronounced CTD manifestation. High degree of LV mechanical asynchrony was registered in all studied athletes. Mean values of Cv r-EF were as follows: at rest ã 28.9±16.5 % (normally, Cv r-EF is less than 20 %), after stress-test ã 35.9±15.8 %. Data from correlative analysis showed that: (i) more pronounced CTD was associated with higher extent of LV mechanical asynchrony at rest (r=,559, p<0.01); (ii) athletes with higher degree of CTD had lower degree of asynchrony immediately after stress-test (r=-,575, p<0.01). Results of one-way ANOVA confirm that CTD degree may impact on LV mechanical asynchrony and lower its increase under exercise conditions (p=0.02, F=3.06). Conclusion Although CTD may serve as an underlying condition for cardiac abnormalities, CTD prevalence rate is rather high among athletic population. Based on obtained data there is no evidence for exercise limitation in individuals with CTD, meanwhile precise preparticipation cardiac screening definitely prevents from negative events during competitive activity in these group. P762 https://esc365.escardio.org/Presentation/221560/abstract Electrocardiogram findings in brazilian female athletes etnicity and literature comparison C Colombo1, B B Bassaneze1, LCA Albuquerque1, T G Garcia1, R Contesini1, R Alo1, N Ghorayeb1 1Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil Funding Acknowledgements: Instituto Dante Pazzanese de Cardiologia Topic: Sports Cardiology Background: An appropriate evaluation of ECG abnormalities is essential to detect underlying conditions associated with sudden cardiac death in athletes. Cardiac adaptation to exercise is influenced by gender and ethnicity. Most studies on athleteã s ECG pattern have included predominantly Caucasian males and there is no gender differentiation in the recommendations for interpreting the athletes ECGã s findings. Recently, some differences in the female athleteã s ECG pattern have been described. Purpose: To investigate the prevalence of the ECGã s findings in Brazilian female athletes compared to the literature data and their association with ethnicity. Methods: From 2019 March to November, we evaluated 100 female athletes (62% football, 18% basketball, 20% run, triathlon or athletics), mean age 18,2 +- 7,5 (11-45) years who underwent 12-lead rest ECG in a pre-participation screening. The athletes did not have previous known cardiovascular diseases. The ECGs were analysed by 2 different experienced cardiologists and the findings were classified as normal, abnormal and borderline, following the International recommendation criteria. Athletes presenting abnormal findings underwent additional investigation with echocardiogram, exercise testing and/or cardiac magnetic resonance (CMR). The athletesã ethnicity was based on self-report and defined as Caucasian (CAU)(57%), Afro-Caribbean descendent (AFRO)(19%) or mixed-race (MIX) (24%), and its correlation with the findings was investigated. Results: The most common ECG findings were early repolarisation (ER)(47% of all athletes), sinus bradycardia(36%) and ectopic atrial rhythm (14%). The mean HR was 62,5 +- 11,1. Other normal findings were left ventricular hypertrophy (LVH)(5%)and first AV block(2%) (Table 1). ER was more frequent in CAU athletes (45%) than in AFRO (21%) or MIX (37%), but only AFRO presented LVH. T wave inversion (TWI) was an abnormal ECG finding observed in 3 athletes, 1 characterised as "black athlete repolarisation variant"(AFRO) and 2 suggestive of pathology (1 AFRO and 1 MIX). The complementary tests did not identify cardiac diseases. Interestingly, a short PR interval was observed in 8% of all athletes. Conclusions: Brazilian female athletes exhibit common athleteã s ECG findings but its prevalence is different from the literature data. ER was more frequent in this population than previously described (39%x29%) and more associated with CAU ethnicity whereas LVH less common than reported in other groups (5%x14%). LVH and TWI findings were related to AFRO ethnicity, but not to pathology. Short PR interval has not been described as a common finding in the athleteã s ECG but it seems to be fairly common in this cohort. Possible explanations for the differences are the young age and low prevalence of AFRO athletes in this group. Further studies including a large number of female athletes are necessary to a better characterisation of the ECG adaptations to exercise in women. 342 https://esc365.escardio.org/Presentation/217018/abstract Association between electrographic left ventricular hypertrophy and incident hypertension among the Tokyo 1964 Olympic athletes: a 50-year follow-up study. K Kohei Ashikaga1, K Yoneyama2, H Musha2, S Yamada3, S Ishizuka3, H Aono3, Y Akashi2, T Kawahara4 1Kawasaki Municipal Tama Hospital, Division of Cardiology, Kawasaki, Japan 2St.Marianna University School of Medicine, Department of Internal Medicine, Division of Cardiology, Kawasaki, Japan 3Japan Sport Association, Sport Sciences Laboratory, Tokyo, Japan 4Japanese Society of Clinical Sports Medicine, Tokyo, Japan Topic: Cardiovascular Disease in Special Populations Athlete's heart is a change in heart structure due to the influence of long-term, high-intensity training mainly in elite athletes. Left ventricular hypertrophy (LVH) triggered by hard training is generally normalized after athlete retirement; whereas sometimes LVH remains. No long-term follow-up studies have been conducted on athletes with LVH; thus, the long-term influence is not fully clarified yet. In elite athletesã training, it is indispensable to understand the long-term influence of training on their bodies. Here, we investigated the long-term influence of the presence / absence of LVH in the athletes participating in the 1964 Tokyo Olympic Games. Methods Among all 380 athletes participating in the 1964 Tokyo Olympic Games, the initial electrocardiograms of 72 athletes taken in 1968 were firstly selected and evaluated. Of these, those of 63 athletes could be assessed whether they had hypertension or not; finally, 63 Japanese (53 men and 10 women) from various types of sports were included. The mean age was 29.0 ± 4.2 years old when the electrocardiograms were recorded; and the body mass index was 22.5 ± 2.5 kg/m2. After the Olympics, all of these athletes were regularly checked up every 4 years. The check-ups included the physical measurements and questionnaire. LVH was evaluated by electrocardiography using the Peguero-Lo Presti criteria. Outcome was defined as incident hypertension. RESULTS During the mean follow-up period of 47.6 ± 5.0 years, 28 athletes had incident hypertension, 7 athletes had diabetes mellitus, and 14 athletes had cardiovascular disease. The study population was divided into LVH positive at baseline (n = 23) or negative (n = 40). The LVH positive group had a significantly higher rate of incident hypertension compared with the LVH negative group (60.7% vs 25.7%, p = 0.02). Multivariate Cox regression models indicated that LVH was associated with incident hypertension after adjusting for initial systolic blood pressure (LVH: Hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.0-4.7, p<0.05). However, the relationship was attenuated by including smoking at baseline (LVH: HR 2.0, 95% CI 0.9-4.4, p=0.08). CONCLUSION In the present cohort, the athletes with electrocardiographic LVH associated with incident hypertension, but the association which was attenuated by smoking. Our findings would be explained by a potential linking between electrocardiographic LVH and smoking history Olympic athletes. P279 https://esc365.escardio.org/Presentation/217016/abstract Antithrombotic therapy in the elderly: triple therapy is out of the line. I Irene Marco Clement1, L Rodriguez1, DI Poveda1, L Martin1, C Merino1, J Caro1, LA Martinez1, E Arbas1, D Tebar1, JR Rey1, AM Iniesta1, J Fernandez De Bobadilla1, L Pena1, I Antorrena1, JL Lopez Sendon1 1University Hospital La Paz, Madrid, Spain Topic: Cardiovascular Disease in Special Populations Introduction: Drug combination choice in patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) with stenting is nowadays controversial. This choice is particularly challenging in elderly patients, a group at high risk of bleeding and ischemic events. The aim of our study was to assess differences in treatment and outcomes in patients ≥75 years. Methods: Observational retrospective study from a prospective database selecting all patients with AF admitted to undergo PCI from September 2016 to January. We recorded bleeding episodes, ischemic events (non-fatal infarction, stroke, and hospitalization for unstable angina) as well as cardiovascular deaths and total deaths during follow up. Results: We included 92 patients (22.8% women, age 73.9+-8.9 years). Baseline characteristics are summarized in Table 1. Patients ≥ 75 years had a higher profile risk illustrated by higher Charlson Comorbidity Index, CHA2DS VASc and HAS-BLED scores. They received non-vitamin K antagonist oral anticoagulants (NOAC) in a higher proportion (21, 45.7% versus 10, 21.7 % p=0.027). Likewise, double therapy combinations (clopidogrel with acenocumarol or NOAC) were used in 17 (37%) of patients ≥75 versus 6 (13%) of younger patients, (p=0.016). During follow-up (median time 9.5 months (IQR 5-15)), there were no statistical differences between groups in bleeding requiring medical attention (30.4% vs 37%, p=0.659), major bleeding (13% vs 13%, p=1), ischemic events (19.6% vs 15.2%, p=0.582), cardiovascular death (0% vs 4.3%, p=0.495) or total death (0% vs 8.7%, 0.117). Conclusions: In elderly patients the higher use of NOAC and double therapy combinations versus triple antithrombotic therapy resulted in a similar risk of bleeding and ischemic events during follow-up, despite being at higher risk at baseline. Age<75 (n=46) Age ≥75 (n=46) p Age (years, mean±SD) 70±14.6 83.7±3.9 <0.001 Women n(%) 5 (10.9) 16 (34.8) 0.01 Hypertension n(%) 40 (87) 42 (91.3) 0.739 Dyslipidaemia n(%) 28 (60.9) 32 (69.6) 0.511 Current smoker n(%) 12 (26.1) 2 (4.3) 0.004 Diabetes mellitus n(%) 17 (37) 21 (45.7) 0.525 Charlson Comorbidity Index (mean±SD) 5.1±1.7 7.1±1.8 <0.001 CHA2DS2 VASc score (mean±SD) 3.8±1.3 5.5±1.4 <0.001 HAS BLED score (mean±SD) 3.3±1 3.9±1 0.003 Age<75 (n=46) Age ≥75 (n=46) p Age (years, mean±SD) 70±14.6 83.7±3.9 <0.001 Women n(%) 5 (10.9) 16 (34.8) 0.01 Hypertension n(%) 40 (87) 42 (91.3) 0.739 Dyslipidaemia n(%) 28 (60.9) 32 (69.6) 0.511 Current smoker n(%) 12 (26.1) 2 (4.3) 0.004 Diabetes mellitus n(%) 17 (37) 21 (45.7) 0.525 Charlson Comorbidity Index (mean±SD) 5.1±1.7 7.1±1.8 <0.001 CHA2DS2 VASc score (mean±SD) 3.8±1.3 5.5±1.4 <0.001 HAS BLED score (mean±SD) 3.3±1 3.9±1 0.003 Open in new tab Age<75 (n=46) Age ≥75 (n=46) p Age (years, mean±SD) 70±14.6 83.7±3.9 <0.001 Women n(%) 5 (10.9) 16 (34.8) 0.01 Hypertension n(%) 40 (87) 42 (91.3) 0.739 Dyslipidaemia n(%) 28 (60.9) 32 (69.6) 0.511 Current smoker n(%) 12 (26.1) 2 (4.3) 0.004 Diabetes mellitus n(%) 17 (37) 21 (45.7) 0.525 Charlson Comorbidity Index (mean±SD) 5.1±1.7 7.1±1.8 <0.001 CHA2DS2 VASc score (mean±SD) 3.8±1.3 5.5±1.4 <0.001 HAS BLED score (mean±SD) 3.3±1 3.9±1 0.003 Age<75 (n=46) Age ≥75 (n=46) p Age (years, mean±SD) 70±14.6 83.7±3.9 <0.001 Women n(%) 5 (10.9) 16 (34.8) 0.01 Hypertension n(%) 40 (87) 42 (91.3) 0.739 Dyslipidaemia n(%) 28 (60.9) 32 (69.6) 0.511 Current smoker n(%) 12 (26.1) 2 (4.3) 0.004 Diabetes mellitus n(%) 17 (37) 21 (45.7) 0.525 Charlson Comorbidity Index (mean±SD) 5.1±1.7 7.1±1.8 <0.001 CHA2DS2 VASc score (mean±SD) 3.8±1.3 5.5±1.4 <0.001 HAS BLED score (mean±SD) 3.3±1 3.9±1 0.003 Open in new tab P281 https://esc365.escardio.org/Presentation/217114/abstract The prognostic impact of an adequate anticoagulation strategy in very frail patients with atrial fibrillation: the impact of a simple scoring system A Ana Sofia Martinho1, J Almeida1, A Freitas1, C Ferreira1, J Ferreira1, J Milner1, R Baptista1, F Franco1, A Girao1, A Carvalho1, L Goncalves1 1University Hospitals of Coimbra, Coimbra, Portugal Topic: Cardiovascular Disease in Special Populations Background: In the setting of patients with AF, older age and frailty increase the risk of both thromboembolic and haemorrhagic complications. One tool to evaluate frailty is through the Katz Index of activities of daily living (KI). Purpose: We hypothesized that among a frail population, non-necessarily an elderly one, the net clinical benefit of anticoagulation persists. Methods: We conducted a retrospective, observational study of 800 patients with AF admitted to an Internal Medicine ward and grouped the population according to the KI (mean 2.6; SD 2.5): KI=0 (totally dependent: n=293, 39%) and KI>0 (non-totally dependent: n=455, 61%). Patients were stratified whether they were adequately anticoagulated [with low molecular weight heparin, warfarin or direct oral anticoagulant (DOAC) at correct dose] or inadequately anticoagulated (discharged with no anticoagulant or anticoagulant at an incorrect dose). Finally, we assessed the incidence of 1-year adverse outcomes (death, ischemic or haemorrhagic stroke and major bleeding). Results: Patients with KI=0 were slightly older (86±7 vs 81±8, p<0.001) than patients with KI>0, with a similar gender distribution (57% women). A KI=0 conferred a 3-fold higher risk of dying than a KI>0 (p<0.01). There was a significant interaction between anticoagulation adequacy and mortality: inadequately anticoagulated patients with KI=0 had a 1.6-fold higher mortality compared to those adequately anticoagulated, after adjusting for age and sex (63% vs 47%), HR 1.60 (95% CI 1.05-2.45, Log Rank p=0.026). Conversely, no interaction was found between the adequacy of anticoagulation and the risk of events in KI=0 patients (ischemic stroke n=1, 2.3%; haemorrhagic stroke n=4, 0.6% major bleeding n=6, 3.5% in inadequately anticoagulated). Among patients with KI>0 inadequately anticoagulated, the interaction for mortality was 1.6 OR (95% CI 1.203-2.302; p=0.002); regarding events, the prescription of an inadequate anticoagulation strategy was associated with a higher incidence of events 2.7 OR (95% CI 1.038-7.074, p=0, 042), this association non-persist after adjusting for age and sex. Conclusions: Although we cannot exclude prescription bias, in extremely frail, totally dependent patients a benefit was found from an adequate anticoagulation strategy, if the focus is all-cause mortality. The ischemic and hemorrhagic event rate was similar among groups, eventually due to underreporting. In KI>0 patients, the benefit was clear both for mortality and events. Thus, we want to reinforce the importance of evaluating variables other than fragility at the time of the decision to anticoagulate. Kaplan Meier Survival Curves P283 https://esc365.escardio.org/Presentation/217058/abstract Impact of continuous glucose monitoring on improving quality of life among adult patients with type 1 diabetes mellitus: meta-analysis A Klak1, M Manczak1, J Owoc1, J Obiala1, R Robert Olszewski1 1National Institute of Geriatrics Rheumatology and Rehabilitation, Warsaw, Poland Topic: Cardiovascular Disease in Special Populations Background The long duration type 1 diabetes (TD1) may seriously affect numerous organs with cardiovascular diseases being one of its major risks. An insulin therapy plays an important clinical role in treatment of TD1 and maintaining normal blood glucose levels. Optimizing glycemic control reduces fear of hypoglycemia and improves patientsã quality of life. Purpose: To compare differences in quality of life (incl. fear of hypoglycemia) among adult patients with diabetes mellitus type 1 that use Continuous Glucose Monitoring (CGM) systems or conventional self-monitoring of blood glucose (SMBG). Methods: The MEDLINE/PubMed, the Cochrane Library/Embase, CINAHL, Scopus, Web of Science, ProQuest databases were searched from 2013 to October 30, 2019 using various combinations of key terms: continuous glucose monitoring, adults, quality of life, hypoglycemia fear survey. Reference lists of selected studies were hand-searched. Randomised controlled trials (RCTs) comparing retrospective or real-time CGM with conventional self-monitoring of blood glucose levels or with another type of CGM system in TD1 patients. Primary outcomes were health-related quality of life, glycaemic control and fear of hypoglycemia. The inclusion criteria were: adults (> 18 years of age), study duration (> 8 weeks), RCTs, CGM, SMBG, general or diabetes-specific validated quality of life measure, fear of hypoglycemia, English studies. The anxiety of hypoglycemia in the included studies was measured with "worry domain" in Hypoglycemia Fear Survey. A random-effects model was used to estimate pooled mean difference of these values between patients using CGM and SMBG. Results: Of the 1380 records identified, 6 studies including 677 patients (average age of 51 years old) were included in the meta-analysis. The usage of CGM system reduced the level of anxiety by about 3 points: mean difference = -3.42, p = 0.007; 95% Cl -5.88 to - 0.95. Conclusions: The results indicate that using CGM systems reduce fear of hypoglycaemia. source sample, n age, mean mean difference (95%CI) p weight % 1 Walker TC, et al., 2014 10 42.6 -11.00 (-31.82; 9.82) 0.300 1.40% 2 Little SA, et al., 2014 96 48.6 -1.00 (-8.15; 6.15) 0.784 11.86% 3 Polonsky WH, et al., 2016 285 70.7 -4.40 (-8.40; -0.40) 0.031 37.85% 4 Kropff J, et al., 2016 32 47.0 -0.10 (-7.04; 6.84) 0.977 12.59% 5 Polonsky WH, et al., 2017 158 48 -4.25 (-8.78; 0.28) 0.066 29.54% 6 Little SA, et al., 2018 96 49 -3.10 (12.57; 6.37) 0.521 6.76% overall 677 51 -3.42 (-5.88; -0.95) 0.007 100.00% source sample, n age, mean mean difference (95%CI) p weight % 1 Walker TC, et al., 2014 10 42.6 -11.00 (-31.82; 9.82) 0.300 1.40% 2 Little SA, et al., 2014 96 48.6 -1.00 (-8.15; 6.15) 0.784 11.86% 3 Polonsky WH, et al., 2016 285 70.7 -4.40 (-8.40; -0.40) 0.031 37.85% 4 Kropff J, et al., 2016 32 47.0 -0.10 (-7.04; 6.84) 0.977 12.59% 5 Polonsky WH, et al., 2017 158 48 -4.25 (-8.78; 0.28) 0.066 29.54% 6 Little SA, et al., 2018 96 49 -3.10 (12.57; 6.37) 0.521 6.76% overall 677 51 -3.42 (-5.88; -0.95) 0.007 100.00% Open in new tab source sample, n age, mean mean difference (95%CI) p weight % 1 Walker TC, et al., 2014 10 42.6 -11.00 (-31.82; 9.82) 0.300 1.40% 2 Little SA, et al., 2014 96 48.6 -1.00 (-8.15; 6.15) 0.784 11.86% 3 Polonsky WH, et al., 2016 285 70.7 -4.40 (-8.40; -0.40) 0.031 37.85% 4 Kropff J, et al., 2016 32 47.0 -0.10 (-7.04; 6.84) 0.977 12.59% 5 Polonsky WH, et al., 2017 158 48 -4.25 (-8.78; 0.28) 0.066 29.54% 6 Little SA, et al., 2018 96 49 -3.10 (12.57; 6.37) 0.521 6.76% overall 677 51 -3.42 (-5.88; -0.95) 0.007 100.00% source sample, n age, mean mean difference (95%CI) p weight % 1 Walker TC, et al., 2014 10 42.6 -11.00 (-31.82; 9.82) 0.300 1.40% 2 Little SA, et al., 2014 96 48.6 -1.00 (-8.15; 6.15) 0.784 11.86% 3 Polonsky WH, et al., 2016 285 70.7 -4.40 (-8.40; -0.40) 0.031 37.85% 4 Kropff J, et al., 2016 32 47.0 -0.10 (-7.04; 6.84) 0.977 12.59% 5 Polonsky WH, et al., 2017 158 48 -4.25 (-8.78; 0.28) 0.066 29.54% 6 Little SA, et al., 2018 96 49 -3.10 (12.57; 6.37) 0.521 6.76% overall 677 51 -3.42 (-5.88; -0.95) 0.007 100.00% Open in new tab Figure 1. Hypoglycemia Fear Survey P284 https://esc365.escardio.org/Presentation/217044/abstract Evaluation of urinary 8-iso-prostaglandin F2a for risk assessment of plaque rupture in diabetic patients with unstable angina pectoris G Su1, SW Zhuang2, T Zhang3, HX Yang3, WL Dai3, SH Mi3 1Shanghai General Hospital Baoshan Branch, Shanghai, China 2Shanghai Seventh People's hospital, Shanghai, China 3Beijing Anzhen Hospital, Cardiology, Beijing, China Funding Acknowledgements: Outstanding Clinical Discipline Project of Shanghai Pudong (PWYgy 2018-05); Beijing Health Special Foundation (JING 15-10). Topic: Cardiovascular Disease in Special Populations Background Enhanced isoprostanes-related oxidative stress was reported to play a key role in established risk factors of cardiovascular diseases. The relationship between urinary 8-iso-prostaglandin F2α (8-iso-PGF2α) and coronary plaque rupture has not been fully elucidated. The aim of this study was to evaluate the assessment of rupture of culprit lesions in diabetic patients with unstable angina pectoris (UAP) by the use of urinary 8-iso-PGF2α. Methods A total of 132 diabetic patients with UAP were included in this observational and case-control study. 66 patients with plaque rupture were matched by age and gender with other 66 patients without plaque rupture. The characteristics of ruptured culprit plaque were identified by intravascular ultrasound. Fasting urinary 8-iso-PGF2α level was measured and corrected by creatinine clearance. Results Under the same age and gender conditions, patients with ruptured plaque had greater plasma hemoglobin A1c (HbA1c, 7.6±1.2 vs. 7.2±1.2 %, P=0.038), high sensitive C reactive protein [hs-CRP, 1.9 (1.1, 3.9) vs. 0.9 (0.6, 3.4) mg/dl, P=0.043], urinary 8-iso-PGF2α levels [147.5 (68.6, 217.9) vs. 108.9 (59.5, 182.3) pmol/mmolCr, P=0.009], and more positive remodeling plaques than patients with non-ruptured plaque. In multivariate analysis, high urinary 8-iso-PGF2α, plasma hs-CRP and positive remodeling index were significantly associated with incidence of plaque rupture, but HbA1c was not. Conclusions Urinary 8-iso-PGF2α levels appeared to be correlated with plaque rupture in culprit lesions, which may be useful to assess the cardiovascular outcomes in diabetic patients. Variables Univariate Multivariate OR (95% CI) P-value OR (95% CI) P-value Current smoking 2.087 (1.042-4.184) 0.038 Remodeling index (> 1.05) 3.195 (1.383-7.407) 0.007 3.717 (1.522-9.091) 0.004 TC (≥ 5.15 mmol/L) 2.320 (0.916-5.882) 0.076 HbA1c (> 7%) 1.988 (0.913-4.329) 0.084 hs-CRP (> 3mg/L) 2.665 (1.254-5.661) 0.011 2.557 (1.104-5.952) 0.029 Urinary 8-iso-PGF2α (Upper quartile, ≥160.5 pmol/mmolCr) 3.640 (1.580-8.386) 0.002 3.745 (1.565-8.926) 0.003 Variables Univariate Multivariate OR (95% CI) P-value OR (95% CI) P-value Current smoking 2.087 (1.042-4.184) 0.038 Remodeling index (> 1.05) 3.195 (1.383-7.407) 0.007 3.717 (1.522-9.091) 0.004 TC (≥ 5.15 mmol/L) 2.320 (0.916-5.882) 0.076 HbA1c (> 7%) 1.988 (0.913-4.329) 0.084 hs-CRP (> 3mg/L) 2.665 (1.254-5.661) 0.011 2.557 (1.104-5.952) 0.029 Urinary 8-iso-PGF2α (Upper quartile, ≥160.5 pmol/mmolCr) 3.640 (1.580-8.386) 0.002 3.745 (1.565-8.926) 0.003 Independent predictors of ruptured plaque in diabetic patients with unstable angina Open in new tab Variables Univariate Multivariate OR (95% CI) P-value OR (95% CI) P-value Current smoking 2.087 (1.042-4.184) 0.038 Remodeling index (> 1.05) 3.195 (1.383-7.407) 0.007 3.717 (1.522-9.091) 0.004 TC (≥ 5.15 mmol/L) 2.320 (0.916-5.882) 0.076 HbA1c (> 7%) 1.988 (0.913-4.329) 0.084 hs-CRP (> 3mg/L) 2.665 (1.254-5.661) 0.011 2.557 (1.104-5.952) 0.029 Urinary 8-iso-PGF2α (Upper quartile, ≥160.5 pmol/mmolCr) 3.640 (1.580-8.386) 0.002 3.745 (1.565-8.926) 0.003 Variables Univariate Multivariate OR (95% CI) P-value OR (95% CI) P-value Current smoking 2.087 (1.042-4.184) 0.038 Remodeling index (> 1.05) 3.195 (1.383-7.407) 0.007 3.717 (1.522-9.091) 0.004 TC (≥ 5.15 mmol/L) 2.320 (0.916-5.882) 0.076 HbA1c (> 7%) 1.988 (0.913-4.329) 0.084 hs-CRP (> 3mg/L) 2.665 (1.254-5.661) 0.011 2.557 (1.104-5.952) 0.029 Urinary 8-iso-PGF2α (Upper quartile, ≥160.5 pmol/mmolCr) 3.640 (1.580-8.386) 0.002 3.745 (1.565-8.926) 0.003 Independent predictors of ruptured plaque in diabetic patients with unstable angina Open in new tab P287 https://esc365.escardio.org/Presentation/221569/abstract Influence of cardiopulmonary performance on diastolic function in elderly people A Huonker1, K Esefeld1, S Mueller1, M Halle1 1Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany Topic: Cardiovascular Disease in Special Populations Background: There is a decreasing left ventricular compliance with aging, which may explain the high incidence of heart failure with preserved ejection fraction (HFpEF) in elderly people. It is unclear whether this is due to aging or to a reduced physical activity, and how to prevent diastolic dysfunction with aging. Purpose: To examine a possible correlation of exercise performance and diastolic function in an elderly cohort by comparing Master athletes with patients with a cardiovascular disease or HFpEF. Methods: We performed cardiopulmonary exercise test and echocardiography to determine VO2peak and E/é as a marker of diastolic dysfunction in 25 Master athletes (19 males, aged 74 ± 4 yrs, 49 ± 39 MET*h/week). Data was compared to two control groups: a) 25 elderly patients with coronary heart disease and diabetes (19 males, aged 76 ± 3 yrs) and b) 25 elderly patients with HFpEF (19 males, aged 74 ± 4 yrs). Results: Master athletes showed significantly greater exercise capacity (VO2peak) (36 ± 8.2 ml/min/kg vs 18.0 ± 5.8 ml/min/kg vs 17.2 ± 5.0 ml/min/kg; p<0.001) and diastolic function (E/é) (8.2 vs 11.5 vs 12.6; p<0.001) compared to both control groups. There was a significant inverse correlation between VO2peak and E/é (p<0.001, rs -0.398) (figure 1). Conclusion: Lifelong exercise training seems to preserve left ventricular diastolic function in elderly. Abstract No: P287 figure 1 P288 https://esc365.escardio.org/Presentation/217622/abstract Risk stratification of patients with amyotrophic lateral sclerosis by means of heart rate variability analysis B Beatrice De Maria1, G Mora1, K Marinou1, R Sideri1, A Porta2, LA Dalla Vecchia1 1IRCCS Istituti Clinici Scientifici Maugeri, Milano, Italy 2University of Milan, Department of Biomedical Sciences for Health , Milan, Italy Funding Acknowledgements: AriSLA, Fondazione Italiana di Ricerca per la Sclerosi Laterale Amiotrofica Topic: Cardiovascular Disease in Special Populations Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that involves upper and lower motor neurons. In the last years, signs and symptoms of autonomic nervous system involvement have been described in ALS patients, including altered cardiovascular neural control. The pathophysiology, clinical impact and related prognosis of this impairment in ALS is not so clear. Purpose: The aim of this study is to correlate the cardiac neural control indices with ALS patientsã clinical features to assess their prognostic significance. Methods: We studied 82 ALS patients (42 males; age: 64.61±11.07 ys; body mass index: 23.27±5.43 kg/m2) without history of cardiac disease. We considered the following clinical indices: 1) the patientsã functional status, evaluated with the Revised ALS Functional Rating Scale (ALSFRS-R) score, ranging from 48 (normal) to 0, and 2) the rate of disease progression (RDP), calculated as the difference between two ALSFRS-R scores at two different evaluation times divided by the months between them. All patients underwent a complete echocardiographic examination. We continuously acquired the electrocardiogram (ECG) for 10 minutes in supine position. From the ECG, the RR interval (RR) variability series was obtained. Parametric power spectral analysis was performed on RR series to obtain the sympathovagal indices. Mean and variance of the RR series were calculated as well. Pearson correlation coefficient, r, between clinical markers and the RR variability indices was calculated. A p<0.05 was considered significant. Results: We found a significant positive correlation between ALSFRS-R and the mean RR (r=0.286; p=0.035) and between ALSFRS-R and the RR variance (r=0.283; p=0.026). A significant negative correlation was found between RDP and mean RR (r=-0.277; p=0.028). No other significant correlations were found. Besides, none of the patients showed structural heart disease and the echocardiographic parameters resulted within normal limits. Conclusion: Our results suggest that high heart rate is associated with a worse patientã s functional status and RDP, and that low RR variance is associated with a worse functional status. Vice versa, lower heart rate and higher RR variance seem to imply a better prognosis. Interestingly, the altered ANS indices are independent from structural heart disease. We conclude that simple cardiac indices could help physicians in ALS patientsã risk stratification. P592 https://esc365.escardio.org/Presentation/221680/abstract Statins and antiplatelet therapy in secondary prevention in nonagenarians. JC Echarte Morales1, J Borrego Rodriguez1, E Tundidor Sanz1, A Martin Centellas1, M Rodriguez Santamarta1, MC Olalla Gomez1, F Fernandez-Vazquez1 1HOSPITAL OF LEON (COMPLEJO ASISTENCIAL UNIVERSITARIO DE LEON), Leon, Spain Topic: Cardiovascular Disease in Special Populations Background: Acute coronary syndrome (ACS) in the elderly population are becoming more and more frequent. Use of antiplatelet therapy and statins in elderly patients in secondary prevention is not entirely clear. Purpose: The aim of this study is to evaluate in secondary prevention the usefulness of statins and antiplatelet therapy in nonagenarian patients who have suffered a previous ACS. Methods: We included retrospectively all nonagenarian patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) admitted to our department between 2000 and 2018. Aterogenic index (AI), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), as well as demographic clinical and procedural data were collected. All-cause mortality was assessed at 1-year follow-up. Results: A total of 140 patients (mean age 92.0 years) were included. 50.71% were male. 69 patients suffered NSTEMI. 32 patients had dyslipidemia at admission, and only 12.80% of total patients took statins previously. In-hospital mortality was 16.43%, and 50.71% at 1-year following-up. Treatment at discharge was the next one: aspirin in 100 patients, clopidogrel in 49 patients, dual antiplatelet therapy (DAPT) in 42 patients, and statins in 64 patients. Values of TC, HDL, LDL and AI were completely studied in 110 patients. The mean value of TC was 164.4 mg/dl ± 38.8mg/dl. Women had higher TC levels compared to men 73.3mg/dl ± 38.1mg/dl vs 155.4 mg/dl ± 37.7mg/dl, p =0.0120). HDL levels was higher in women than in men (44mg/dl ± 12mg/dl in men, 51mg/dl ± 14 mg/dl in women, p=0.01), however there was no difference in LDL levels, among them. AI was higher in patients with NSTEMI than in STEMI (31.25% vs. 12.1%, p=0.015). Statins were more frequently indicated in patients with STEMI (67.9% vs. 44.4%, p = 0.01). Mortality assessed at 1-year following-up was higher in patients with antiplatelet monotherapy compared with DAPT (53.80% versus 21.40%, p=0.0009). Patients who were treated with statins at hospital discharge had lower mortality at 1-year following-up. (29.60% versus 51.90%, p=0.0149). Conclusions: ACS in nonagenarian patients is an important cause of hospital mortality and during the following up. Group of patients with DAPT and statins at hospital discharge showed less mortality at 1-year, in comparison with the other groups. Percutaneous intervention and coronary revascularization, could play an essential role in these results. 1-year mortality following-up. P599 https://esc365.escardio.org/Presentation/217389/abstract The influence of sports at a young age on the prevention of cardiovascular disease in middle-aged men of a sedentary lifestyle S Bondarev1, E Achkasov1, V Smirnov2, Z Waskiewicz3 1Sechenov University, Moscow, Russia, Moscow, Russia, Russian Federation 2Saint Petersburg State Pediatric Medical Academy, the Department of hospital therapy, Saint Petersburg, Russian Federation 3Jerzy Kukuczka Academy of Physical Education, Institute of Sport Science, Katowice, Poland Topic: Cardiovascular Disease in Special Populations Introduction: According to the WHO, physical activity is an important element in the prevention of heart disease. However, the role of physical activity at a young age is not sufficiently studied for the prevention of cardiac pathology in middle-aged people. Purpose: To identify the preventive role of playing sports at a young age for middle-aged patients with heart diseases. Methods: Men 55 ± 3.4 years of a sedentary lifestyle with heart disease. Group 1 - 38 people trained endurance quality of 78 ± 7%, strength quality of 27 ± 4% 270 ± 35 min per week for ages 5 to 30 years, group 2 - 36 people did not play sports. Methods: examination, biochemical blood tests, electrocardiography (ECG), echocardiography (EchoCG), coronarography. Results: Both groups were diagnosed with coronary heart disease, functional class 2 angina and hypertension stage 2 stage 2, the risk of complications 3 degrees (group 1, 69 ± 8% and 73 ± 6%, group 2, 73 ± 6% and 80 ± 7 %, p> 0.05). No differences were found in blood glucose (group 1 and 2, 5.7 ± 0.6 and 5.6 ± 0.2 mmol / l), total cholesterol (group 1 and 2, 4.7 ± 0.6 and 4.9 ± 0.4 mmol / l), low and high density lipoprotein cholesterol (Group 1 and 2 2.6 ± 0.4 and 2.9 ± 0.4 mmol / L; 1.3 ± 0.1, 2 and 1.4 ± 0.1 mmol / L). EchoCG, indicators of systolic and diastolic function (ejection fraction 58 ± 6% and 64 ± 6%, E / e 7.2 ± 1.2 and 7.5 ± 1.8, p> 0.05) myocardial mass left ventricle (LV) (167 ± 24 g. And 156 ± 18 g., p> 0.05) the dimensions of the cardiac cavities are also statistically insignificant. ECG hypertrophy LV (1 group in 42 ± 5%, 2 group in 39 ± 8%, p> 0.05), rhythm disturbances and conduction (35 ± 8% and 29 ± 7%, p> 0.05). Coronarography performed 42 patients. In group 1 are 18 people, and in group 2 are 24 people. Hemodynamically significant stenosis of at least one coronary artery was detected in 56% in group 1 and 58% in group 2, p> 0.05. Conclusion: Moderate physical activity in young athletic age does not have a preventive effect on the development of cardiovascular pathology in middle age. P601 https://esc365.escardio.org/Presentation/217072/abstract Magnesium orotate for the treatment of preexisting hypertension in pregnant patients with nondifferentiable connective tissue dysplasia I Ilshat Gaisin1, RM Valeeva2, NI Maximov2, LV Shilina3, OP Garifullina3, ES Samartceva3 1State Medical Academy, Izhevsk, Russian Federation 2Izhevsk State Medical Academy, Izhevsk, Russian Federation 3Clinical Diagnostic Centre of the Udmurt Republic, Izhevsk, Russian Federation Topic: Cardiovascular Disease in Special Populations Background: Hypertension (HT) during pregnancy still remains the main cause of maternal and neonatal morbidity and mortality worldwide. Nondifferentiable connective tissue dysplasia (CTD) affects both cardiovascular and reproductive systems. Purpose: To assess the safety and efficacy of nonsteroidal anabolic magnesium orotate in pregnant patients with preexisting essential hypertension (HT) with/without CTD. Methods: In a regional cardiology/cardiosurgery clinic, we studied 137 women: 32 patients with HT (1st group) received conventional treatment (methyldopa, calcium channel blockers), 35 with HT in addition to optimal standard therapy from 2nd trimester received magnesium orotate, MO 1000 mg t.i.d. for 1 week, followed by 500 mg t.i.d. (2nd group), 38 patients with HT+CTD were also treated with both antihypertensive drugs and MO (3rd group) and 32 of healthy controls (4th group). Results: HT+CTD had significantly more expressed clinical syndromes at baseline, compared to HT alone. CTD was associated with pronounced cardialgic syndrome (in 100% of patients of the 3rd group vs. 28.1% of the 1st and 31.4% of the 2nd; p1-3,2-3<0.001), neurological (89.5% vs. 53.1% and 51.4% respectively; p1-3,2-3<0.01), asthenic (84.2% vs. 31.3% and 28.6%; p1-3,2-3<0.01), vertebrogenic (81.6% vs. 25% and 20%; p1-3,2-3<0.001), visceral (76.3% vs. 34.3% and 28.6%; p1-3<0.05, p2-3<0.01), cosmetic (73.7% vs. 12.5% and 11.4%; p1-3,2-3<0.001), hemorrhagic (52.6% vs. 9.4% and 8.6%; p1-3,2-3<0.001), arrhythmic (50% vs. 15.6% and 17.1%; p1-3,2-3<0.01), broncho-pulmonary (47.4% vs. 18.8% and 17.1%; p1-3,2-3<0.01), vascular (42.1% vs. 21.9% and 22.9%; p1-3,2-3<0.05) and immunologic (36.8% vs. 12.5% and 11.4%; p1-3,2-3<0.05) syndromes and vegetative dysfunction (65.8% vs. 15.6% and 14.3%; p1-3,2-3<0.01). Application of medications and nondrug measures facilitated regress of clinical symptoms of HT and HT+CTD, favorable course of pregnancy and successful delivery. Pre-eclampsia occurred in 21.9% (1st group), 17.1% (2nd group), 18.4% (3rd group) and 3.13% (4th group) (p1-2,1-3,2-3>0.05; p1-4,2-4,3-4<0.05); preterm delivery was in 15.6%, 0, 2.6% and 0 (p1-2,1-3,1-4<0.05); perinatal mortality rate was 31.2ã°, 0, 0 and 0 respectively (p1-2,1-3,1-4<0.01). In all groups, no mother died. Magnesium orotate had no maternal and offspring adverse effects. Conclusions: Except for its own various clinical syndromes, connective tissue dysplasia worsens signs of preexisting HT in pregnancies. Antihypertensive and metabolic (magnesium orotate) treatment at comprehensive gestational follow-up improves symptoms of HT and connective tissue dysplasia and contributes to successful pregnancy outcomes. The study provides support for magnesium orotate as a new therapy for pregnant women with preexisting HT with/without nondifferentiable connective tissue dysplasia. P602 https://esc365.escardio.org/Presentation/221675/abstract Predictors of malnutrition in Egyptian children with congenital heart disease GAMELA Nasr1, BASSEM Zarif2, KHALED Elnady3 1Suez Canal University, Cardiology , Ismailia, Egypt 2National Heart Institute, Cairo, Egypt 3Maadi military hospital, Cardiology , Cairo, Egypt On Behalf of: Prevention working group, Egyptian Society of cardiology Topic: Cardiovascular Disease in Special Populations Background and aim: To assess predictors of malnutrition among children with congenital heart disease (CHD). Patients and Methods: Between May 2008 and May 2012, a cross-sectional survey was conducted among 189 children, at the national insurance hospital cardiology clinic. Study population: were male and female children younger than 18 years, diagnosed with congenital heart disease. Weight/Age (W/A), Height/Age (H/A) and Weight/Height (W/H) were used to measure nutritional status; Z scores greater than -2 was the case definition of malnutrition. Predictors investigated were age, gender, perinatal history, dietary factors and nutritional supplementation, socioeconomic status, and family composition and educational status. Four CHD groups were studied: acyanotic with and without pulmonary hypertension (APH, AWPH) and, cyanotic with and without pulmonary hypertension (CPH, CWPH). RESULTS: APH was the most frequent CHD (62.7%), followed by CWPH (19.6%), AWPH (10.5%), and CPH (7.2%). Malnutrition was identified in 40.9% children with the W/A index, in 24.6% with the H/A index; and in 31.1% with the W/H index. Infants and the CPH group had the worst nutritional status. Risk factors associated with malnutrition were: having a cyanotic CHD (OR 2.43; 95%CI, 0.99-4.78), lack of nutritional supplementation (OR 2.18; 95%CI, 1.05-5.14), and a greater number of family members (OR, 1.33; 95%CI, 0.99-2.05). Older children were more likely to be well-nourished (OR 0.82; 95%CI, 0.88-0.96) with a tendency towards less severe congenital heart disease. CONCLUSION: Malnutrition is frequent among children with CHD; it is more common in younger children and in those with cyanotic CHD. Health educational programs directed to the families of these children are needed to combat frequency of malnutrition. P788 https://esc365.escardio.org/Presentation/217110/abstract The influence of L-Carnitine on the insulin resistance level, endothelial and renal function in patients with chronic coronary artery disease and prostate adenocarcinoma O Oksana Sirenko1, O Kuryata1, V Stus'1, N Polion1, I Osenniy1 1SE Dnipropetrovsk medical academy, Dnipro, Ukraine Topic: Cardiovascular Disease in Special Populations The aim of the study is to evaluate the effect of L-Carnitine on the dynamics of inflammation, insulin resistance (IR), functional status of kidneys in the complex therapy of patients with coronary heart disease in combination with prostate adenocarcinoma. Materials and methods.: 42 men with prostate adenocarcinoma and coronary heart disease (CAD) were enrolled. The patients were randomly and blindly divided into 2 groups: Group I patients were treated with L-Carnitine in addition to standard treatment; Group II patients received only conventional treatment. Standard laboratory blood tests, lipid profile, glucose, renal and liver function tests, serum C-reactive protein (CRP), insulin, testosterone levels, endothelium dependent vasodilatation (EDVD) by Celemajer method were performed for all patients as baseline and after 10 days of treatment. Results: Median level of HOMA index was 3.1 [1.9; 4.8] mg/ml. Insulin Resistance was established in 54.8% patients of Group I and 40% patients of control group (p<0.05). In the Group I the mean insulin level and HOMA index decreased by 15.4% (p = 0.001) and 19.2% (p = 0.003), respectively. After 10 days of treatment EDVD improved by 34.9% (p=0.0002) in 1st group, in 2nd group ã by 12.9% (p>0.001). The supplementation of L-Carnitine in standard therapy contributed to a significant decrease in serum creatinine level and an increase in the level of GFR in Group I patients (p <0.001). Conclusion.: The supplementatiıon of L-Carnitine in the complex therapy of patients with coronary artery disease in combination with prostate adenocarcinoma contributes to a significant decrease in insulin resistance, improves endothelial function, functional state of kidneys. P792 https://esc365.escardio.org/Presentation/217074/abstract Magnesium orotate is a new promising therapy for not closed atrial or ventricular septal defect in pregnant patients I Ilshat Gaisin1, LV Shilina2, ES Samartceva2, OP Garifullina2, ES Smirnova2, ZV Vavilkina2 1State Medical Academy, Izhevsk, Russian Federation 2Clinical Diagnostic Centre of the Udmurt Republic, Izhevsk, Russian Federation Topic: Cardiovascular Disease in Special Populations Background: According to the ESC 2018 guidelines, women with unoperated atrial or ventricular septal defect (ASD/VSD) have small increased risk of maternal mortality or moderate increase in morbidity. Nevertheless, maternal cardiac complications occur in 12% of completed pregnancies. Offspring complications are more frequent than in the general population. Magnesium orotate (MO) is a non-steroidal anabolic plus Mg2+ approved for pregnant patients. Objective: To evaluate the safety and efficacy of MO in pregnant women with not closed ASD/AVD. Methods: We studied 64 consecutive women with unoperated ASD (n=42) or VSD (n=22), aged 26±7 years, who were referred to our regional cardiology/cardiosurgery clinic before conception (n=29) or during the first two months of pregnancy (n=35). Patients were randomized to control group with conventional follow-up (n=32) and MO-group (n=32); in addition to standard therapy, from 2nd trimester they received MO 1000 mg t.i.d. for 1 week, followed by 500 mg t.i.d. The primary endpoints were a major adverse cardiovascular event (MACE), which included death, heart failure (HF), thrombo-embolic event, pulmonary arterial hypertension (PAH), and arrhythmia and pregnancy outcomes. Baseline and outcome data were analysed and compared for control patients vs. MO-group. Results: At baseline, there were no significant differences between control and MO-group. NYHA functional class I had 27 (84.4%) and 26 (81.3%) patients, NYHA II had 5 (15.6%) and 6 (18.7%) patients, respectively (p>0.05). Atrial and/or ventricular ectopic beats had 29 (90.6%) and 32 (100%) patients (p>0.05). No maternal mortality and no thrombo-embolic event occurred in both groups. In 15 control patients, at least one MACE occurred (46.9%): 9 worsened or developed HF (28.1%), 3 had atrial flutter (9.4%), 2 had ventricular tachyarrhythmias (6.3%), and 1 patient developed PAH (3.1%). In MO-group, no patient developed a MACE (p=0.008). MO reduced the HF occurrence during pregnancy (p=0.035). Improvements were noted in control-adjusted changes in HF signs (ã37.5%; p=0.012) and in frequency of ectopic beats (ã53.1%; p=0.006). Perinatal mortality rate was 0 in the cohort, premature birth occurred in 8 controls (25%) followed by being small for gestational age (n=5; 15.6%) vs. 0 in MO-group (p=0.032). MO had no maternal and offspring adverse effects. Conclusions: Long-term MO therapy for pregnant patients with not closed ASD/VSD prevents MACEs, improves symptom status, and contributes to successful obstetric and foetal outcomes. The study provides the evidence that metabolically acting MO may be a new additional therapy for pregnant patients with congenital heart disease. P793 https://esc365.escardio.org/Presentation/217033/abstract Diseases of cardiovascular system among railway workers in Georgia M Noniashvili1, T Saralidze1, T Kandashvili1 1Tbilisi State Medical University (TSMU), Tbilisi, Georgia Topic: Cardiovascular Disease in Special Populations Our Aim was investigation of the epidemiology of the diseases of cardiovascular system (CVD) and CVD risk factors (RF) among railway workers (RW) in Georgia and developing methodological recommendations for their early detection and prevention. Material and methodology: We investigated 762 RW from 20 to 69 years in clinical center "NewMed" in 2018-2019 y. Epidemiological research was held in 2 stages. At I stage was held screening by questionnaire that helped to learn cases of increased blood pressure, angina pectoris, previous myocardial infarction, intermediated claudication, hypercholesterolemia, information about such RF as smoking, obesity, sedentary lifestyle according to WHO criteria, also dietary type. At the II stage was held clinical and diagnostic research: assessment of serum glucose and creatinine level, ECG, Echocardiography (Echo), vascular dopplerography, ophthalmoscopy, consultations of cardiologist, endocrinologist and neurologist. Data of the results were statistically manipulated using SPSS-22 program. Results: Among 762 RW men were 49%, women-51%, average age was 41,5. CVD was revealed in 336 persons - 44%; 52,8% of them didnã t know about their disease. In 50,8% of men and 44,5% of women was revealed arterial hypertention (AH), p<0,01. High level of AH should be linked to the psycho-emotional overload of RW. Ischemic heart disease was diagnosed in 11%, heart failure in 9%, silent angina in 4,8%, alcoholic dilated cardiomyopathy(DCM) in 15%, nonalcoholic DCM in 3,1%, hypertrophic CM in 5%, in 9 persons (40-59y) was revealed non-ST-elevation myocardial infarction. Heart valvular diseases were revealed in 11,2%: most of all were aortic in 63.8%, mitral in 26,6%. Subacute septic endocarditis confirmed by blood culture was revealed in 7 cases, latent pericarditis ã in 8 cases. By Echo left ventricular (LV) hypertrophy without AH was observed in 15,7% (19,7% of men & 12,2% of women), mitral valve prolapse ã in 16%, LV false tendonãin 13%. 31% of RW had undergone invasive cardiac procedures or surgery: 18% - coronary stenting, 7%- coronary artery bypass grafting, 6% - valve prosthetics. High frequency of CVD RF was also revealed among RW. 47,5% had AH, 60,8% - hypercholesterolemia, 32% were overweight, 52% of men and 20% of women were smokers. Imbalanced diet was revealed in 76%, family history of CVD ã in 52%. Conclusion: Complex approach for the revealing of CVD and RF among RW showed high frequency of CVD and RF in this contingent. Notable that in the 52,8% of the patients (every second) CVD was diagnosed for the first time. Results of our study shows that prophylactic investigations of RW is reasonable for timely revealing CVD and RF to take primary and secondary preventive measures to avoid development of the disease or disease complications and work out strategy to diminish frequency of CVD in RW (lifestyle change, work regimen improvement etc). P794 https://esc365.escardio.org/Presentation/217327/abstract Cardio-metabolic monitoring in patients on depot antipsychotic medication A Cole1, J Abreu1, J Whitson1, T Walton1, M Howlett1 1St George's University Hospital NHS Foundation Trust, Greater London, United Kingdom of Great Britain & Northern Ireland Topic: Cardiovascular Disease in Special Populations Background- Patients with severe mental health conditions have a reduced life-expectancy of 10-20 years (1). Cardiovascular disease the leading cause of death in these patients and there is 2- to 3- fold increased risk of cardiovascular disease compared to baseline population (2). Adequately addressing comorbid risk factors is a growing area of concern (3). Additionally, antipsychotic medications can have a number of cardiovascular side effects including arrhythmias, myocarditis and heart failure. Poor healthcare engagement, limited resources and a lack of robust systems limit application of preventative cardiac risk stratification and impacts ability to prevent cardiovascular disease. The purpose of this audit was to improve uptake of physical health monitoring in a cohort of patients that were receiving depot antipsychotic medications. Methods- This was a two cycle audit of physical health monitoring. The following attributes were assessed: BMI, Blood Pressure, Cholesterol, Blood Sugar/HbA1c, ECGs. Patient records were accessed on RIO software, Electronic Patient Records and GP summaries. The first audit cycle of 45 patients took part from 1st February 2018 to 31st January 2019. Interventions following this included: patient and staff education, Junior Doctor assistance in Depot clinics and liaison visits with local GPs. The second audit cycle of 45 patients occurred from 1st February 2019 to 1st October 2019. Results- The number of patients that had complete physical health data rose from 8.9% to 33.3%. Rates of completed ECGs rose from 16.2% to 61.8%. Cholesterol monitoring improved from 81% to 88%, of those that were tested, 20% were found to have newly abnormal results. Glucose monitoring improved from 81% to 94% of those that were tested 18.8% had newly abnormal results. Blood pressure monitoring was achieved at a comparable 92% and 12.9% of abnormal results were found. BMI monitoring decreased from 83.8% to 64.7% and this was abnormal in 77.3% of patients. Conclusion- Simple interventions within a depot clinic structure can result in major improvements in physical health monitoring. Monitoring appropriate physical health attributes allows clinicians to risk stratify patients, which is vital to prevent cardiovascular mortality and morbidity. P795 https://esc365.escardio.org/Presentation/221669/abstract Parameters of inflammatory response, vascular wall elasticity and bone mineral composition are triggers of socially significant diseases in postmenopausal women T Tatiana Petelina1, KS Avdeeva1, NA Musikhina1, SG Bykova1, LI Gapon1, EA Gorbatenko1, EV Zueva1, LL Valeeva1 1Tyumen Cardiology Research Center, Tyumen, Russian Federation Funding Acknowledgements: the study had no sponsor support Topic: Cardiovascular Disease in Special Populations Introduction: The association of vascular immune-inflammatory response and hormonal profile in pathogenesis of arterial stiffness and destructive bone changes is of great importance for prevention of socially significant diseases development even at subclinical level. Purpose: To investigate the role of markers of immune inflammation as predictors for cardiovascular and degenerative bone changes in postmenopausal women with arterial hypertension (AH). Methods: 164 female patients (mean age 56.52±6.28 years) were examined and divided into three groups. Gr.1 included 42 healthy individuals, Gr.2 - 58 patients with AH and Gr.3 - 64 postmenopausal women with AH and osteoporosis (OP). Patients of Gr.2 and Gr.3 were comparable by age. Parameters of 24-hour blood pressure monitoring; sphygmography (pulse-wave velocity (PWV), osteodensitometry (standard deviation of the peak T-Score); inflammatory markers (high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), homocysteine, interleukin (IL) 1 β, 6, 8); endothelial dysfunction markers (endothelin-1, nitrites); lipid profile parameters; sex hormones (estradiol, progesterone and testosterone) and parameters of metabolism (vitamin D, calcitonin, parathyroid hormone) were measured. Results: In patients of Gr.3 significant excess of hs-CRP concentration, level of homocysteine, IL-8, parathyroid hormone, total cholesterol, atherogenic lipid fractions, endothelin-1 was detected with significant decrease in the level of sex hormones, calcium and vitamin D. Besides, in Gr.3, negative correlations of peak T-Score with age, PWV, office SBP and DBP, duration of menopause, IL-6, hs-CRP, homocysteine were registered; PWV and estradiol had negative correlations; positive correlations between T-Score with progesterone and between PWV with IL-6, LDL cholesterol, hs-CRP, TNF-alpha, endothelin-1, mean daytime SBP and mean daytime SBP and DBP variability were found. By the method of logistic regression, there was calculated risks of remodeling of the vascular wall and bone destructive changes. In Gr.2 increase of PWV more than 12.05 m/s was revealed as significant parameter associated with the risk of vascular wall remodeling and osteoporosis by 3.8 times. In Gr.3 increased levels of IL-6 and 8, TNF-α, hs-CRP, parathyroid hormone and reduced levels of progesterone and IL-10 involved in remodeling of the vascular wall and aggravating the degree of bone tissue destruction. Conclusions: Timely conducted set of biochemical and instrumental research methods may become the basis for development of prevention and personalized therapy in postmenopausal women with AH to prevent socially significant diseases. P796 https://esc365.escardio.org/Presentation/223103/abstract Alterations in the cardiovascular system in patients with cirrhosis - Assessment of a haemodynamic profile. M Maciej Kusztal1, A Bodys1 1Medical University of Warsaw, Warsaw, Poland Funding Acknowledgements: Grant "Najlepsi z najlepszych 4.0" from Polish Ministry of Science and Higher Education, Mini-grant from Warsaw Medical University Topic: Cardiovascular Disease in Special Populations Background/Introduction: Cirrhotic cardiomyopathy (CCM) is a condition concerning heart muscle dysfunction, occurring among patients with cirrhosis. Cirrhosis leads to the development of a hyperdynamic syndrome, which is manifested by high cardiac output, increased heart rate and effective arterial blood volume, accompanied by reduced total systemic vascular resistance. Purpose: The aim of the study is to screen patients with cirrhosis, which may lead to earlier diagnosing CCM and hyperdynamic syndrome with its consequences among them. Methods: The study included 70 patients over 18 years old, with cirrhosis, caused by alcohol ([ALD], 22), autoimmune (26), viral (9) other reasons (13), qualified for liver transplantation. 39 of them were male. Median age was 47. We disqualified patients with a history of cardiovascular diseases. Each patient had a 6-minute walking test (6MWT) done and a hemodynamic monitoring using non-invasive hemodynamic monitor device was also performed. Results: Median NTproBNP level was highest in ALD group (253pg/ml) and viral group (177,5 pg/ul) compared to autoimmune group (51 pg/ul) and other (114 pg/ml). Median QTc interval was more prolonged in patients with viral aetiology (456ms) and ALD aetiology (441ms) than autoimmune aetiology (422ms) and other aetiology (431ms). Highest median CO were observed in viral group (6L/min) and ALD group (5,7L/min) and lower in autoimmune group (5,35L/min) and other (5,2L/min). There was no statistical difference in distance median value between aetiological groups (407m in ALD patientsã group, 412,5m in autoimmune patientsã group, 384m in viral patientsã group and 400m for other aetiology patientsã group; p=NS). DBP was positively correlated with MELD score (r=-0,25; p=0,009) and Child-Pugh score (r=-0,31; p=0,003). The distance was negatively corelated with severity of the liver disease based on MELD score (r=-0,34; p=0,0048) score and Child- Pugh score (r=-0,321; p=0,0072). Preliminary results show statistically significant correlations between distance in 6MWT and eGFR (r=0,78;p=0,0082), Systemic Vascular Resistance(SVR) at the end of 6MWT (r=0,197;p=0,0011), Diastolic Blood Pressure (DBP) at the end of 6MWT (r=0,45;p=0,014) and NT-proBNP (r=0,28;p=0,0008) level, patientã s weight (r=0,286; p=0,044) and height (r=0,37; p=0,008). Conclusion(s): Preliminary results show that it is possible to detect subclinical alterations in patientsã circulatory parameters by non-invasive haemodynamic monitoring. Patients with viral and ALD etiology presented more advanced liver cirrhosis stages and more pronounced manifestations of hyperdynamic syndrome which may later progress to CCM. Positive correlation of liver cirrhosis stage and NTproBNP, QTc and 6MWT distance may suggest heart function impairment in course of liver disease. P797 https://esc365.escardio.org/Presentation/217363/abstract Objective evaluation of the evolution of aerobic capacity and cardiovascular risk factors in women with coronary disease after phase II of the cardiac rehabilitation program NG Uribe Heredia1, J Balaguer Recena1, LG Piccone Saponara2, H Alvaro Fernandez1, R Arroyo Espliguero3, M Viana Llamas3, B Garcia Magallon3, C Toran Martinez3, A Castillo Sandoval3, ME Jimenez Martinez3, JL Garcia Gonzalez3, MA San Martin Gomez3, A Perez Sanchez3, E Novo Garcia3, E Diaz Caraballo3 1University Hospital of Guadalajara, Cardiac Rehabilitation Unit, Guadalajara, Spain 2Hospital General de Ciudad Real, Nefrology, Ciudad Real, Spain 3University Hospital of Guadalajara, Guadalajara, Spain Topic: Cardiovascular Disease in Special Populations INTRODUCTION: There are differences in aerobic capacity between men and women, influenced by differences in anthropometric measurements, body fat percentage, hormonal influence, etc. The objective is to determine whether the improvement or increase in oxygen consumption and the control of risk factors in women with heart disease by undergoing a cardiac rehabilitation program (CRP) is similar to that of men. METHODS: Prospective observational study. The patients were included consecutively in a PRC between March 2015 to July 2019, performing daily exercise for 8 weeks (phase II of the CRP). RESULTS: 278 patients were analyzed, average age 57,9±9,2 years, 40 women (14,4%), LVEF half 56,8±9,7%, 48,6% in functional class II-III (NYHA) prior to the CRP, 52,9% AH, 74,8% dyslipidemia, 27% diabetes and 37,4% obese. Regarding baseline characteristics such as age, BMI, RFCV and LVEF between men and women there were no statistically significant differences, only difference in the percentage of active smokers was observed, being taller in boys (73,1% Vs 50,0%; p=0,01). The comparison of the differences in the variables of oxygen consumption and analytical parameters are detailed in the Table 1. In the multivariate analysis it was determined that being a woman is a predictor of less increase in recovery time to exercise (0,7±7,6 Vs 2,4±6,6) with a OR 1,06 (IC 95% 1,01-1,13; p=0,03) and a smaller increase in oxygen consumption (1,2±2,5 Vs 2,6±3,2) at the end of the CRP with a OR 1,21 (IC 95% 1,04-1,21; p= 0,02). CONCLUSIONS: In our study, the percentage of participation of women in the PRC is markedly lower than men. Being a woman is a predictor for a lower increase in peak oxygen consumption and recovery time after exercise after phase II of the PRC, nor did they show significant reduction in some prognostic analytical markers such as BNP and PCR, improvements that if they obtained males. PARAMETERS PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 28,8 ± 4,6 28,5 ± 4,4 <0,001 28,5 ± 5,4 28,2 ± 5,2 0,002 LDL (mg/dL) 79,4 ± 28,5 67,9 ± 22,4 <0,001 80,3 ± 20,7 73,6 ± 20,5 0,07 Triglycerides(mg/dL) 118,9 ± 59,8 104,2 ± 56,3 <0,001 106,1 ± 42,6 97,2 ± 49,9 0,11 CRP (mg/L) 3,78 ± 6,38 2,36 ± 4,29 0,001 2,46 ± 2,64 2,60 ± 3,66 0,74 B- BNP (pg/mL) 90,6 ± 217,7 68,2 ± 129,6 0,01 85,4 ± 76,2 71,5 ± 66,8 0,12 HR at maximum charge (bpm) 133,6 ± 20,4 135,5 ± 18,1 0,03 130,2 ± 21,0 128,5 ± 15,7 0,57 Recovery time (beat/1er min) 16,3 ± 8,0 18,6 ± 8,5 <0,001 15,3 ± 8,7 15,9 ± 7,3 0,57 VO2 peak (ml/kg/min) 22,5 ± 5,9 25,0 ± 6,6 <0,001 17,4 ± 3,2 18,6 ± 3,8 0,009 PARAMETERS PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 28,8 ± 4,6 28,5 ± 4,4 <0,001 28,5 ± 5,4 28,2 ± 5,2 0,002 LDL (mg/dL) 79,4 ± 28,5 67,9 ± 22,4 <0,001 80,3 ± 20,7 73,6 ± 20,5 0,07 Triglycerides(mg/dL) 118,9 ± 59,8 104,2 ± 56,3 <0,001 106,1 ± 42,6 97,2 ± 49,9 0,11 CRP (mg/L) 3,78 ± 6,38 2,36 ± 4,29 0,001 2,46 ± 2,64 2,60 ± 3,66 0,74 B- BNP (pg/mL) 90,6 ± 217,7 68,2 ± 129,6 0,01 85,4 ± 76,2 71,5 ± 66,8 0,12 HR at maximum charge (bpm) 133,6 ± 20,4 135,5 ± 18,1 0,03 130,2 ± 21,0 128,5 ± 15,7 0,57 Recovery time (beat/1er min) 16,3 ± 8,0 18,6 ± 8,5 <0,001 15,3 ± 8,7 15,9 ± 7,3 0,57 VO2 peak (ml/kg/min) 22,5 ± 5,9 25,0 ± 6,6 <0,001 17,4 ± 3,2 18,6 ± 3,8 0,009 Open in new tab PARAMETERS PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 28,8 ± 4,6 28,5 ± 4,4 <0,001 28,5 ± 5,4 28,2 ± 5,2 0,002 LDL (mg/dL) 79,4 ± 28,5 67,9 ± 22,4 <0,001 80,3 ± 20,7 73,6 ± 20,5 0,07 Triglycerides(mg/dL) 118,9 ± 59,8 104,2 ± 56,3 <0,001 106,1 ± 42,6 97,2 ± 49,9 0,11 CRP (mg/L) 3,78 ± 6,38 2,36 ± 4,29 0,001 2,46 ± 2,64 2,60 ± 3,66 0,74 B- BNP (pg/mL) 90,6 ± 217,7 68,2 ± 129,6 0,01 85,4 ± 76,2 71,5 ± 66,8 0,12 HR at maximum charge (bpm) 133,6 ± 20,4 135,5 ± 18,1 0,03 130,2 ± 21,0 128,5 ± 15,7 0,57 Recovery time (beat/1er min) 16,3 ± 8,0 18,6 ± 8,5 <0,001 15,3 ± 8,7 15,9 ± 7,3 0,57 VO2 peak (ml/kg/min) 22,5 ± 5,9 25,0 ± 6,6 <0,001 17,4 ± 3,2 18,6 ± 3,8 0,009 PARAMETERS PRE CR-P POST CR-P P PRE CR-P POST CR-P P BMI 28,8 ± 4,6 28,5 ± 4,4 <0,001 28,5 ± 5,4 28,2 ± 5,2 0,002 LDL (mg/dL) 79,4 ± 28,5 67,9 ± 22,4 <0,001 80,3 ± 20,7 73,6 ± 20,5 0,07 Triglycerides(mg/dL) 118,9 ± 59,8 104,2 ± 56,3 <0,001 106,1 ± 42,6 97,2 ± 49,9 0,11 CRP (mg/L) 3,78 ± 6,38 2,36 ± 4,29 0,001 2,46 ± 2,64 2,60 ± 3,66 0,74 B- BNP (pg/mL) 90,6 ± 217,7 68,2 ± 129,6 0,01 85,4 ± 76,2 71,5 ± 66,8 0,12 HR at maximum charge (bpm) 133,6 ± 20,4 135,5 ± 18,1 0,03 130,2 ± 21,0 128,5 ± 15,7 0,57 Recovery time (beat/1er min) 16,3 ± 8,0 18,6 ± 8,5 <0,001 15,3 ± 8,7 15,9 ± 7,3 0,57 VO2 peak (ml/kg/min) 22,5 ± 5,9 25,0 ± 6,6 <0,001 17,4 ± 3,2 18,6 ± 3,8 0,009 Open in new tab Abstract No: P797 P289 https://esc365.escardio.org/Presentation/217061/abstract Infuence of estimated glomerular filtration rate on the drug therapy administration rate in patients with a history of myocardial infarction K Kristina Pereverzeva1, S Yakushin1, A Vorobyev1 1Ryazan State Academician Medical University, Ryazan, Russian Federation Topic: Cardiovascular Pharmacotherapy Introduction: Optimal drug therapy is the only proven way to improve prognosis in patients with a history of myocardial infarction (MI) and chronic kidney disease (CKD). Aim: To evaluate and compare the administration rate of the drugs that affect the prognosis in MI, depending on the estimated glomerular filtration rate (eGFR) according to the Chronic Kidney Desease Epidemiology Collaboration formula, basing on the results of a registry study. Materials and methods. The study included 266 patients with a history of MI who addressed local outpatient department in 2012-2013, of which 48.9% were men, and the median age was 70 [60; 77] years. In 15.1% of patients, the eGFR was ≥ 90 ml/ min/1.73 m2, in 48.3% it was in the range of 60–89 ml/min/1.73 m2 inclusive, in 26% in the range of 45–59 ml/min/1.73 m2 inclusive, in 7.5% of patients, the eGFR was 30-44 ml/min/1.73 m2. 2.3% of patients had the eGFR <30 ml/min/1.73 m2, while the eGFR <15 ml/min/1.73 m2 was registered in 0.8%. Results: The administration rate of antiplatelet agents with eGFR ≥60 ml/min/1.73 m2 was 82.1%, with eGFR 45-59 ml/min/1.73 m2 ã 82.6%, with eGFR 30-44 ml/min/1.73 m2 and 15-29 ml/min/1.73 m2 ã 65.0% and 66.7%, respectively (p> 0.05). The administration rate of ACE inhibitors and sartans with an eGFR ≥ 60 ml/min/1.73 m2 was 72.0%. It increased to 78.3% and 85.0% with eGFR of 45-59 ml/min/1.73 m2 and 30-44 ml/min/1.73 m2, respectively, and decreased to 66.7% with eGFR of 15-29 ml/min/1.73 m2 (p> 0.05). The administration rate of statins with eGFR ≥60 ml/min/1.73 m2 was 58.9%, with eGFR 30-59 ml/min/1.73 m2 and 30-44 ml/min/1.73 m2 ã 43.5% and 20.0%, respectively, and with eGFR 15-29 ml/min/1.73 m2 ã 16.7%. Moreover, the differences in the statin administration rate with eGFR of 45-59 ml/min/1.73 m2 and eGFR of 30-44 ml/min/1.73 m2 were statistically significant (p <0.05). Differences in the administration rate of statins with eGFR of 15-29 ml/min/1.73 m2 did not have statistically significance compared to their administration rate with eGFR of 30-44 ml/min/1.73 m2, but were significantly less in comparison with their statin administration rate in the group of patients with eGFR ≥ 60 ml/min/1.73 m2 and also with eGFR of 45-59 ml/min/1.73 m2 (p <0.05). Conclusion: 1. There was no statistically significant difference in the administration rate of antiplatelet agents, ACE inhibitors, and sartans in patients with myocardial infarction with decreased eGFR. 2. The statin administration rate in patients with a history of MI had significantly decreased in case decreased eGFR: from 58.9% with eGFR ≥ 60 ml/min/1.73 m2 to 20.0% with eGFR 30-44 ml/min/1.73 m2 ( p <0.05). P292 https://esc365.escardio.org/Presentation/217316/abstract Analysis of previous adherence to therapy in patients with acute coronary syndrome E Elena Efremova1, AM Shutov1, MV Menzorov2, TV Mashina2, AS Podusov1, AS Bykova1, AN Cheremnykh1, NA Samsonova1 1Ulyanovsk State University, Ulyanovsk, Russian Federation 2Cardiac Surgery Center "Alliance Clinic", Ulyanovsk, Russian Federation Topic: Cardiovascular Pharmacotherapy Adherence to therapy determines the success of prevention and treatment of patients with cardiovascular diseases. Low adherence to medical recommendations in both primary and secondary prevention may lead to cardiovascular events. Previous adherence to treatment of patients with acute coronary syndrome (ACS) has not been insufficiently studied. The aim of this study was to investigate previous adherence to therapy patients ACS. Materials and methods. 51 patients (36 males and 15 females, mean age was 61.4±9.3 years) admitted to hospital with ACS were studied. ACS with ST-segment elevation (STE-ACS) and without ST segment elevation (NSTE-ACS) were diagnosed according to ESC Guidelines (2017 and 2015, respectively). STE-ACS was diagnosed in 9 (17.6%) patients, NSTE-ACS - in 42(82.4%) patients. All patients had cardiovascular pathology before hospitalization: 48 (94.1%) patients had arterial hypertension, 46 (90.2%) - coronary artery disease, 15 (29.4%) patients - myocardial infarction in history. Adherence to therapy was assessment with MMAS-4 and MMAS-8. Patients were asked clarifying questions about taking drugs a month before the present coronary event. Results: High adherence to treatment according to the scale MMAS-4 was observed in only 8 (15.7%) patients, low adherence to treatment - 43 (84.3%) patients before ACS. According to MMAS-8 scale, as more detailed and currently, similar results were obtained: 8 (15.7%) patients had high adherence to treatment , 10 (19.6%) patients - medium adherence to treatment, 33 (64.7%) patients - low adherence to treatment before coronary event. In the analysis of ambulatory treatment , only 25 (49.1%) patients took ACE inhibitors and sartans , 36 (70.6%) patients - antiplatelet therapy, 22 (43.1%) - beta-blockers, 16 (31.4%) patients - statins , 27 (52.9%) patients - diuretics, 8 (15.7%) patients -mineralocorticoid receptor antagonists. Main cause of nonadherence were large number of recommended drugs (22;43.1% patients), irregular forgetfulness (20;39.2%), frequent replacement of drugs during treatment (16;31.4%). Conclusion: The majority of patients with ACS were not adherent to ambulatory treatment. High adherence to optic medication therapy was extremely low - only every third patient took statins, every second - blockers of the renin-angiotensin-aldosterone system. Formation and monitoring of high adherence to treatment is required at both the outpatient and inpatient stages, thus avoiding cardiovascular events. 336 https://esc365.escardio.org/Presentation/221592/abstract The relation of sleep disturbances and adherence to pharmacological therapy in patients with hypertension M Labuz1, B Jankowska-Polanska2, N Swiatoniowska2, A Szymanska-Chabowska3 1Wroclaw Medical University, Studentsã Club of Nursing in Internal Medicine, Wroclaw, Poland 2Wroclaw Medical University, Division of Nursing in Internal Medicine, Department of Clinical Nursing,, Wroclaw, Poland 3Wroclaw Medical University, Dept of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw, Poland Topic: Cardiovascular Nursing and Allied Professions Introductions: Insomnia and hypertension are both common in the elderly and have a wide range of effects on the overall health status of this population. The number of the patients with insomnia and arterial hypertension is significantly higher than those with insomnia and without arterial hypertension. Insomnia is defined as "a persistent difficulty with sleep initiation, duration, consolidation, or quality and results in some form of daytime impairment, especially the quality of life, adherence and functional activity. The aim of the study was the evaluation of the sleep disturbances influencing the adherence to treatment of arterial hypertension. Material and methods. 102 patients were enrolled into the study. The following questionnaires were used: Athens Insomnia Scale (AIS), which allows the qualitative measurement of insomnia symptoms according to ICD-10 criteria and Morisky Adherence Scale for the evaluation of adherence of pharmacological therapy in arterial hypertension. Results: The patients with sleep disturbances were older that the patients without sleep disturbances (67.7 ±7.6 vs 63.2 ±8.8), measured often their blood pressure only in contact with physician (38.5% vs 13.5%) or in malaise (21.54% vs 8.11%), longer suffered from arterial hypertension (18±8.4 vs 12.5±9.3), had higher systolic blood pressure (157.4±13.3 vs 134.7 ± 15.9 mmHg) and diastolic (92.3±8 vs 83.1±10.1) and had higher cognitive impairment (MMSE 21.2 ± 3.4 vs 18.3± 4.1). What is more, the patients with sleep disturbances rarely had self-control diary (49.2% vs 86.5%) and had worse adherence (MMAS 2.44 vs 5.88). The correlation quotient between sleep disturbances and adherence was 0.613 (p<0,05), and negative dependence showed that the higher sleep disturbance, the worse adherence. In multiple regression analysis there was no correlation between insomnia and adherence, but there was strong relation between the cognitive function and adherence (0.952; p<0.001). Conclusions: The sleep disturbances are not the independent predictor of adherence to treatment of arterial hypertension. However, the patients with insomnia have worse blood pressure control and worse adherence to pharmacological therapy. The independent determinant of adherence are the cognitive impairments, which significantly depend on sleep disturbances. EAPC Essentials 4 You - ePosters 403 https://esc365.escardio.org/Presentation/217034/abstract Do interactive exergames find their application in cardiac rehabilitation? A pilot study. E Edyta Smolis-Bak1, I Sarna1, A Mierzynska1, E Noszczak1, P Troscianko1, J Wolszakiewicz1, R Piotrowicz1 1Institute of Cardiology, Warsaw, Poland Topic: Cardiovascular Nursing and Allied Professions Background: The limited physical activity and aging of patients with cardiovascular disease (CVD) causes reduction of muscular strength, coordination, and motion,balance. Therefore there is a need for incorporating new rehabilitation forms covering those areas into Cardiac Rehabilitation. Aim of the study The aim of the study was to assess the effectiveness, safety, and attractiveness of exergames with the Kinect camera and fall protection equipment (ActiveLife) in trainings of CVD patients. Methods: The study group consisted of 43 consecutive patients with various CVD (after myocardial infarction, cardiosurgical procedure, with heart failure) admitted to the Department of Cardiac Rehabilitation. All subjects participated in four-week programme with standardized trainings (endurance training and general conditioning exercises with elements of resistance and balance exercises). 20 patients (group A) were offered additional trainings (five times per week) with the use of ActiveLife. Before and after rehabilitation all patients underwent tests assessing the strength of lower limbs, 6MWT, and the Up&Go test. Patients also filled out a questionnaire regarding use of ActiveLife. Results: Both groups significantly improved in all tests: strength of lower limbs [number of repetitions/30 sec] ã group A: 11.21±.61 vs 13,37±3.96, p <0.001; control group: 9.96±3.34 vs 13.12±3.99, p <0.001; 6MWT [m] ã group A: 369.06±129.1 vs 462.50±104.88, p <0.03; control group: 366.53±121.76 vs 457.81±102.2, p <0.006; Up & Go test [sec] ã group A: 7.74 ± 2.75 vs 6.74±1.8, p <0.006; control group: 8.35±2.75 vs 7.27±3.51, p <0.006. There was also significant increase in the precision and speed of movements in subsequent trainings. 94.7% of patients evaluated Active Life as "very good”, 89.5% - "comfortable/very comfortable”, 100% - safe, 79.0% - useful in achieving rehabilitation goals and 68.4% assessed it as more attractive than standardized training. Conclusions: Cardiac rehabilitation using exergames is seen by patients as attractive, safe, and useful in achieving their goals. Although the test results has improved for both groups, there is a need for longer observation and increased training time to reliably compare effectiveness of both forms of training. The ActiveLife device is safe and useful for cardiac rehabilitation. 405 https://esc365.escardio.org/Presentation/217321/abstract Autonomic symptoms and associated factors in patients with chronic heart failure H Da Silva1, E Deschepper2, S Pardaens3, M Vanderheyden3, J De Sutter4, B Celie1, M De Pauw5, L Demulier5, P Calders1 1Ghent University, Departement of Rehabilitation Sciences, Gent, Belgium 2Ghent University, Biostatistics Unit, Gent, Belgium 3Olv Hospital Aalst, Aalst, Belgium 4AZ Maria Middelares, Gent, Belgium 5University Hospital Ghent, Gent, Belgium Topic: Cardiovascular Nursing and Allied Professions Background: Autonomic disorder is a frequent co-morbidity in chronic heart failure (CHF) which leads to significant physical and mental impairments. The presentation of autonomic symptoms (AS) and its associated factors are still unclear. As a result, these symptoms are often misunderstood, therefore poorly taken into account in the management of CHF. Objective: Our primary goal was to investigate the autonomic symptom profile of patients with CHF and its subgroups, respectively heart failure with reduced (HFrEF), mild (HFmEF) and preserved (HFpEF) ejection fraction. Secondly, we intended to identify factors associated with autonomic symptoms and quality of life (QoL). Purpose: Hundred and twenty-one patients and 122 gender and age matched control subjects participated in this study. COMPASS 31 questionnaire was used to assess AS. Three other validated questionnaires were used to assess quality of life (short-form 36, SF 36), fatigue (Checklist of individual strength, CIS), anxiety and depression (Hospital Anxiety and Depression Scale, HADS). Differences between CHF (subgroups) and control were analyzed by Mann-Whitney U test for continuous variables and chi-square test (X²) for categorical variables. A multivariate regression analysis was performed to evaluate determinants of autonomic function and QoL. Results: The total AS score was higher in the CHF population compared to control participants (p<0.001), particularly for orthostatic intolerance, vasomotor and secretomotor symptoms. No significant differences in AS were found among the CHF subgroups. A stepwise linear analysis showed that fatigue (R² = 0.181) and depression (R²= 0.153) are both determinant factors for autonomic symptoms in CHF. QoL(p<0.001) is significant lower in CHF and associated with more autonomic symptoms in this population (R² = 0.247). Conclusion: Patients with CHF reported higher scores for autonomic symptoms than controls, particularly for orthostatic intolerance, vasomotor and secretomotor symptoms. Fatigue and depression are the most important contributors of autonomic symptoms in CHF. Higher scores for autonomic symptoms were associated with lower scores for QoL. Award Winning Science - Secondary prevention & rehabilitation section 44 https://esc365.escardio.org/Presentation/217104/abstract Tele-rehabilitation based on nursing home secondary prevention program versus usual care in patients after acute coronary syndrome: the SPRING trial C Fernandez Pombo1, G Aldama Lopez1, P Urones Cuesta1, M Lorenzo Carpente2, M Lopez Perez2, R Marzoa Rivas2, JM Vazquez Rodriguez1 1University Hospital A Coruna, CARDIOLOGY SERVICE, A Coruna, Spain 2University Hospital Ferrol, CARDIOLOGY SERVICE, Ferrol, Spain On Behalf of: SPRING GROUP Funding Acknowledgements: Spanish Heart Foundation Project for Clinical Research in Cardiology 2019 financed by the Spanish Cardiology Society Topic: Cardiovascular Nursing and Allied Professions BACKGROUND: Patients after an Acute Coronary Syndrome (ACS) should be included in Secondary Prevention Programs in order to avoid the occurrence of new events. To improve adherence rates, these programs have to be universal and remote. PURPOSE: To determine the impact on heart life habits in patients with ACS one-year after the implementation a Nursing Home Secondary Prevention Program (SPRINGP) compared to Usual Secondary Prevention Program (USPP). METHODS : Multicenter randomized clinical trial, performed in a Third Level and Regional Hospital. Eighty-two patients with ACS with or without ST segment elevation were enrolled: 41 patients were randomized to control group (CG) and included in USPP (coordinated by Cardiologist) and 41 patients to interventional group (IG) and included in SPRINGP (coordinated by Cardiologist and Secondary Prevention Specialist Nurse) (Image 1). This study was registered in clinicaltrials.gov. RESULTS: Groups were well balanced except for age (CG 64.2 ± 8.5 vs IG 59.4 ± 9.2, p = 0.017). Male sex was present in 78% (n: 32). Out of 41 patients included in each group, 30 in the IG (73.2%) and 35 in the CG (85.4%) completed the one-year follow-up. Table 1 described results at first and last consultation post ACS. CONCLUSION: Tele-rehabilitation based on Nursing Home in Secondary Prevention Program improves, one-year after, heart life habits in patients with ACS compared with usual care. First Consultation CONTROL GROUP First month post ACS First Consultation INTERVENTIONAL GROUP First month post ACS p Last Consultation CONTROL GROUP 12 MONTH POST ACS Last Consultation INTERVENTION GROUP 12 MONTH POST ACS p Adherence Cardio Feeding - PREDIMED 26.8 (11) 26.8 (11) 1.000 42.9 (15) 100 (30) 0.000 Moderate Physical Acticity - IPAQ 65.9 (27) 51.2 (21) 0.370 51.4 (18) 86.7 (26) 0.002 Smokers 31.7 (13) 36.6 (15) 0.862 8.6 (3) 0 (0) NA Low Tobbaco Dependence - Fagerstrom 61.5 (8) 40 (6) 0.509 100 (3) 0 (0) NA High Motivation to quit smoking - Richmond 100 (13) 73.3 (11) 0.132 66.7 (2) 0 (0) NA Alcohol Consumption 12.2 (5) 2.4 (1) 0.624 66.7 (2) 0 (0) NA High Alcohol Consumption - SAC 20 (1) 0 (0) NA 50 (1) 0 (0) NA Adherence of Medication - ASK-12 11.9 ± 2.1 12.4 ± 2.8 0.372 11.6 ± 2.4 11.0 ± 0.2 0.05 Emotional Support - SF-36 70.3 ± 16.1 71.9 ± 15.9 0.662 81.2 ±13.0 87.8 ± 10.7 0.029 First Consultation CONTROL GROUP First month post ACS First Consultation INTERVENTIONAL GROUP First month post ACS p Last Consultation CONTROL GROUP 12 MONTH POST ACS Last Consultation INTERVENTION GROUP 12 MONTH POST ACS p Adherence Cardio Feeding - PREDIMED 26.8 (11) 26.8 (11) 1.000 42.9 (15) 100 (30) 0.000 Moderate Physical Acticity - IPAQ 65.9 (27) 51.2 (21) 0.370 51.4 (18) 86.7 (26) 0.002 Smokers 31.7 (13) 36.6 (15) 0.862 8.6 (3) 0 (0) NA Low Tobbaco Dependence - Fagerstrom 61.5 (8) 40 (6) 0.509 100 (3) 0 (0) NA High Motivation to quit smoking - Richmond 100 (13) 73.3 (11) 0.132 66.7 (2) 0 (0) NA Alcohol Consumption 12.2 (5) 2.4 (1) 0.624 66.7 (2) 0 (0) NA High Alcohol Consumption - SAC 20 (1) 0 (0) NA 50 (1) 0 (0) NA Adherence of Medication - ASK-12 11.9 ± 2.1 12.4 ± 2.8 0.372 11.6 ± 2.4 11.0 ± 0.2 0.05 Emotional Support - SF-36 70.3 ± 16.1 71.9 ± 15.9 0.662 81.2 ±13.0 87.8 ± 10.7 0.029 ACS: Acute Coronary Syndrome; ASK-12: Adherence Starts with Knowledge; IPAQ: International Physical Activity Questionnaire. PREDIMED: Mediterranean Diet Questionnaire; SAC: Short Alcohol Consumption Questionnaire; SF-36: Short Form Health Survey. Qualitative and quantitative variables expressed % (n) and x ± Standard Deviation. Tests used: t-Student for continuous variables (normally distributed), MannãWhitney for continuous variables (non-normally distributed) and chi-square for categorical variables. Open in new tab First Consultation CONTROL GROUP First month post ACS First Consultation INTERVENTIONAL GROUP First month post ACS p Last Consultation CONTROL GROUP 12 MONTH POST ACS Last Consultation INTERVENTION GROUP 12 MONTH POST ACS p Adherence Cardio Feeding - PREDIMED 26.8 (11) 26.8 (11) 1.000 42.9 (15) 100 (30) 0.000 Moderate Physical Acticity - IPAQ 65.9 (27) 51.2 (21) 0.370 51.4 (18) 86.7 (26) 0.002 Smokers 31.7 (13) 36.6 (15) 0.862 8.6 (3) 0 (0) NA Low Tobbaco Dependence - Fagerstrom 61.5 (8) 40 (6) 0.509 100 (3) 0 (0) NA High Motivation to quit smoking - Richmond 100 (13) 73.3 (11) 0.132 66.7 (2) 0 (0) NA Alcohol Consumption 12.2 (5) 2.4 (1) 0.624 66.7 (2) 0 (0) NA High Alcohol Consumption - SAC 20 (1) 0 (0) NA 50 (1) 0 (0) NA Adherence of Medication - ASK-12 11.9 ± 2.1 12.4 ± 2.8 0.372 11.6 ± 2.4 11.0 ± 0.2 0.05 Emotional Support - SF-36 70.3 ± 16.1 71.9 ± 15.9 0.662 81.2 ±13.0 87.8 ± 10.7 0.029 First Consultation CONTROL GROUP First month post ACS First Consultation INTERVENTIONAL GROUP First month post ACS p Last Consultation CONTROL GROUP 12 MONTH POST ACS Last Consultation INTERVENTION GROUP 12 MONTH POST ACS p Adherence Cardio Feeding - PREDIMED 26.8 (11) 26.8 (11) 1.000 42.9 (15) 100 (30) 0.000 Moderate Physical Acticity - IPAQ 65.9 (27) 51.2 (21) 0.370 51.4 (18) 86.7 (26) 0.002 Smokers 31.7 (13) 36.6 (15) 0.862 8.6 (3) 0 (0) NA Low Tobbaco Dependence - Fagerstrom 61.5 (8) 40 (6) 0.509 100 (3) 0 (0) NA High Motivation to quit smoking - Richmond 100 (13) 73.3 (11) 0.132 66.7 (2) 0 (0) NA Alcohol Consumption 12.2 (5) 2.4 (1) 0.624 66.7 (2) 0 (0) NA High Alcohol Consumption - SAC 20 (1) 0 (0) NA 50 (1) 0 (0) NA Adherence of Medication - ASK-12 11.9 ± 2.1 12.4 ± 2.8 0.372 11.6 ± 2.4 11.0 ± 0.2 0.05 Emotional Support - SF-36 70.3 ± 16.1 71.9 ± 15.9 0.662 81.2 ±13.0 87.8 ± 10.7 0.029 ACS: Acute Coronary Syndrome; ASK-12: Adherence Starts with Knowledge; IPAQ: International Physical Activity Questionnaire. PREDIMED: Mediterranean Diet Questionnaire; SAC: Short Alcohol Consumption Questionnaire; SF-36: Short Form Health Survey. Qualitative and quantitative variables expressed % (n) and x ± Standard Deviation. Tests used: t-Student for continuous variables (normally distributed), MannãWhitney for continuous variables (non-normally distributed) and chi-square for categorical variables. Open in new tab Secondary Prevention Program of ACS EAPC Essentials 4 You - ePosters P294 https://esc365.escardio.org/Presentation/221568/abstract Impact of fatigue on compliance with therapeutic recommendations of patients with arterial hypertension N Swiatoniowska1, E Gierczak2, A Szymanska-Chabowska3, G Mazur3, B Jankowska-Polanska1 1Wroclaw Medical University, Division of Nursing in Internal Medicine, Department of Clinical Nursing,, Wroclaw, Poland 2Wroclaw Medical University, Studentsã Club of Nursing in Internal Medicine, Wroclaw, Poland 3Wroclaw Medical University, Dept of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw, Poland Topic: Cardiovascular Nursing and Allied Professions In Europe, the average non-observance of therapeutic recommendations in hypertension is 44%, in Poland this level reaches as much as 60%, some respondents even give a non-adherence level of 70%. Almost half of patients stop hypotensive therapy after just one year from the beginning of treatment, after 4 years only 23% of patients declare regular use of drugs. Fatigue is one of the symptoms of hypertension and a factor influencing compliance with the recommendations in chronic diseases. It also causes a decrease in the motivation to follow the therapeutic recommendations. Non-compliance with therapeutic recommendations in the long term leads to the occurrence of many organ complications. The aim of the study was to evaluate the influence of fatigue on the level of compliance with therapeutic recommendations of patients with hypertension. Materials and methods. 101 patients of the internal ward (59 women; mean age 57.5±13.2) with diagnosed arterial hypertension of I and II degree according to ESC were examined by means of standardized questionnaires: Morisky's Self-Reported Measure of Medication Adherence (MMAS 8 Item), Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone Scale) and modified scale of exposure to fatigue MFIS. Socio-clinical data were obtained from medical records. Results: 53.8% of patients showed an average level of compliance with therapeutic recommendations, while 29.7% showed an optimal level of compliance with pharmacological recommendations. In one-way analysis, patients with lower observance of pharmacological recommendations (MMAS-8) scored fewer points in all domains of the MFIS scale (higher level of fatigue) than patients with optimal level, respectively: overall score 53.6±17.3 vs. 39.9±10.1, cognitive domain 22.6±8.0 vs. 15.9±5.2; p<0.001, physical domain 25.9±8.2 vs. 20.3±6.1; p=0.008, psychological domain 5.1±2.5 vs. 3.7±1.7; p=0.012). Multifactorial analysis showed that independent predictors of high compliance with therapeutic recommendations were lack of fatigue (β=-0.440; p<0.001) and the number of diseases below 2 (β=0.243; p=0.006). Conclusions: Patients with hypertension have average adherence level. Fatigue and fewer than two coexisting diseases are independent predictors of adherence to therapeutic recommendations. P295 https://esc365.escardio.org/Presentation/217620/abstract Patients after acute coronary syndromes with the frailty syndrome - Are they always ready for hospital discharge? Preliminary results MH Magdalena Hanna Lisiak1, O Kowalska2, R Wyderka2, J Jaroch2, I Uchmanowicz1 1Wroclaw Medical University, Department of Clinical Nursing , Wroclaw, Poland 2Specialist Hospital. T. Marciniak, Department of Cardiology, Wroclaw, Poland Topic: Cardiovascular Nursing and Allied Professions Introduction: Frailty syndrome (FS) is becoming one of the priority concepts for a geriatric cardiology due to an aging population of people with acute coronary syndromes (ACS) and the relationship between the elderly and an occurrence of FS. The identification of people with FS may be an important notification in the decision-making process, e.g. in terms of the patient's readiness for hospital discharge. Purpose: To assess the influence of the coexistence of FS on the readiness for hospital discharge after ACS. Methods: The study included a group of 50 patients (29 men) hospitalized due to ACS in the Cardiology Department. The mean age of the respondents was 76 y/o. The standardized tools were used: the Tilburg Friability Index (TFI) and the Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD MIS). The analysis assumed a significance level p<0.05. Results: FS was present in more than half of the respondents (27%). People with FS in comparison to people without FS scored lower on the following scales: the subjective knowledge assessment (SKA) (M=16.48; SD=3.49 vs M=18.52; SD=2.94, p=0.019); expectations (E) (M=8.63; SD=6.22 vs M=13.43; SD=8.20, p=0.042); overall score (RHDS): (M=42.52; SD=8.56 vs M=50.57; SD=6.22, p=0.009). The analysis revealed statistically significant negative relationships between TFI and RHDS MIS results (rho=-0.434; p<0.01, objective knowledge assessment (OKA): rho=-0.418; p<0.01, SOW: rho=-0.317; p<0.05 and expectations: rho=-0.330; p<0.5. Conclusions: Patients with coexisting FS are characterized with a low degree of preparation for hospital discharge. The group of these patients requires an intensification of activities aimed at improving the support of the therapeutic process through profiled education. The research confirmed conducted the elderly patients after ACS are still going to become a great clinical challenge. P608 https://esc365.escardio.org/Presentation/221594/abstract Translation and cultural adaptation of Polish version of the Communication Assessment Tool (CAT-P) N Swiatoniowska1, A Bialoszewski2, G Mazur3, B Jankowska-Polanska1 1Wroclaw Medical University, Division of Nursing in Internal Medicine, Department of Clinical Nursing,, Wroclaw, Poland 2Medical University of Warsaw, Warsaw, Poland 3Wroclaw Medical University, Dept of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw, Poland Topic: Cardiovascular Nursing and Allied Professions In Europe, the average non-observance of therapeutic recommendations in hypertension is 44%, in Poland this level reaches as much as 60%, some respondents even give a non-adherence level of 70%. Almost half of patients stop hypotensive therapy after just one year from the beginning of treatment, after 4 years only 23% of patients declare regular use of drugs. Fatigue is one of the symptoms of hypertension and a factor influencing compliance with the recommendations in chronic diseases. It also causes a decrease in the motivation to follow the therapeutic recommendations. Non-compliance with therapeutic recommendations in the long term leads to the occurrence of many organ complications. The aim of the study was to evaluate the influence of fatigue on the level of compliance with therapeutic recommendations of patients with hypertension. Materials and methods. 101 patients of the internal ward (59 women; mean age 57.5±13.2) with diagnosed arterial hypertension of I and II degree according to ESC were examined by means of standardized questionnaires: Morisky's Self-Reported Measure of Medication Adherence (MMAS 8 Item), Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone Scale) and modified scale of exposure to fatigue MFIS. Socio-clinical data were obtained from medical records. Results: 53.8% of patients showed an average level of compliance with therapeutic recommendations, while 29.7% showed an optimal level of compliance with pharmacological recommendations. In one-way analysis, patients with lower observance of pharmacological recommendations (MMAS-8) scored fewer points in all domains of the MFIS scale (higher level of fatigue) than patients with optimal level, respectively: overall score 53.6±17.3 vs. 39.9±10.1, cognitive domain 22.6±8.0 vs. 15.9±5.2; p<0.001, physical domain 25.9±8.2 vs. 20.3±6.1; p=0.008, psychological domain 5.1±2.5 vs. 3.7±1.7; p=0.012). Multifactorial analysis showed that independent predictors of high compliance with therapeutic recommendations were lack of fatigue (β=-0.440; p<0.001) and the number of diseases below 2 (β=0.243; p=0.006). Conclusions: Patients with hypertension have average adherence level. Fatigue and fewer than two coexisting diseases are independent predictors of adherence to therapeutic recommendations. 406 https://esc365.escardio.org/Presentation/217103/abstract Suitability of exercise guidelines for the calculation of personalized exercise targets and progress monitoring in a telerehabilitation setting C Bonneux1, M Scherrenberg2, S Sankaran1, G Rovelo Ruiz1, D Hansen3, P Dendale2, K Coninx1 1UHasselt - tUL, Expertise Centre for Digital Media, Diepenbeek, Belgium 2UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium 3UHasselt, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium Funding Acknowledgements: Special Research Fund (BOF) of Hasselt University Topic: e-Cardiology Background: Determination of the appropriate intensity of exercise training is critical to achieve the benefits of cardiac rehabilitation. Clinical guidelines and decision support systems (e.g. EXPERT tool) assist clinicians in selecting appropriate exercise intensities for patients. However, a recent study indicated that guideline-based intensity domains for CVD patients seem inconsistent. Purpose: We aim to investigate the applicability and suitability of the exercise guidelines for the calculation of personalized exercise targets and progress monitoring in a telerehabilitation setting. Methods: In an app-based telerehabilitation program, we prescribed guideline-based personalized exercise targets with the EXPERT tool. The targets were converted into Metabolic Equivalent of Task (MET) values using the guideline-based exercise intensity domains and ACSM's guidelines for exercise testing and prescription. Patients could log cardio (e.g. walking) and non-cardio (e.g. gardening) physical activities in the app. Progress towards the targets was determined using ACSM's guidelines and activity specific MET values from the Compendium of Physical Activities. We evaluated our approach in a crossover trial with 32 coronary artery disease patients who used the app for 7-10 weeks. Application logs and CPET data (collected before and after using the app) were analysed. Results: During the crossover trial, 4 patients dropped out and 4 patients did not log any activities. Of the remaining 24 patients, 83% achieved their minimum exercise targets every week and 8% reached their maximum targets at all times. In general, 63% of patients achieved their maximum exercise targets for at least half of the weeks. However, amongst patients who reached their maximal targets 70% of the time there was no significant difference in VO2 max (P=0.268). For example, one patient exceeded his maximum exercise target at all time, but still did not improve VO2 max. Furthermore, 46% of the patients reported mostly non-cardio physical activities, including household chores, gardening, and mowing the lawn. We found a significant difference in achieving the minimum (P=0.018) / maximum (P=0.001) exercise target when considering only cardio activities or all physical activities logged in the app. CONCLUSION: The guideline-based intensity domains and activity specific MET values from the Compendium of Physical Activity seem non-optimal for determining personalized exercise targets to improve maximal exercise capacity. Patients often overachieved their prescribed exercise targets and yet failed to gain a significant increase in maximal exercise capacity. Therefore, the approach of this relatively short study was not sufficient to increase maximal exercise capacity but may be sufficient to have a positive effect on health and submaximal exercise capacity. 407 https://esc365.escardio.org/Presentation/217345/abstract Evaluation of a novel, 12-lead electrocardiogram app for easy on-field use shows good agreement with the gold standard 12-lead electrocardiogram in elite, adolescent footballers H Harvey Johnson1, N Duarte2, D Ryding3, D Perry4, S Mcnally4, AG Stuart5, C Williams6, G Pieles5 1University of Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland 2Bristol Royal Hospital for Children, Bristol, United Kingdom of Great Britain & Northern Ireland 3Manchester United FC, Physiotherapy, Manchester, United Kingdom of Great Britain & Northern Ireland 4Manchester United FC, Football Medicine & Science Dept., Manchester, United Kingdom of Great Britain & Northern Ireland 5Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland 6University of Exeter, Children's Health and Exercise Research Centre, Exeter, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: University of Bristol Topic: e-Cardiology Background: The 12-lead electrocardiogram (ECG) is the primary cardiac screening and diagnostic tool for athletes. However, limited portability hampers its use at the pitch-side where it would be invaluable in making fast and reliable cardiac diagnoses. Recently, smartphone apps have become available that can record 12-lead ECGs using only 4 electrodes. This could increase the accessibility of ECG recording in the training and competition setting, reduce time-to-diagnosis and improve the detection of arrhythmias. Purpose: To identify any clinically significant differences in parameter accuracy between a 12-lead ECG app and the gold standard 12-lead ECG. Methods: In this study, a novel, 12-lead ECG app (cECG), was compared with the gold standard 12-lead ECG (nECG) in the same cardiac screening session in a population of elite adolescent footballers (n=31). Heart Rate, PR Interval, QRS duration, QTc interval, QRS axis, P-wave axis, T-wave axis, QRS amplitude, P-wave duration, P-wave amplitude, T-wave amplitude, Q-wave amplitude, Q-wave duration, rhythm, T-wave character and ST segment positions were measured in 62 ECGs (31 12-lead nECGs and 31 12-lead cECGs). Data analysis was performed using Prism 8 to conduct Wilcoxon/paired t-tests and statistical agreement tests using Bland-Altman plots. Results: Agreement between the two ECG devices was clinically acceptable for Heart Rate (bias=0.613 bpm), PR Interval (bias=0.173 ms), QRS duration (bias=7.05 ms), QTc interval (bias=2.03 ms), T-wave axis (bias=6.55°), P-wave duration (bias=-0.941 ms), Q-wave amplitude (bias=0.0195 mV), Q-wave duration (bias=1.69ms), rhythm (bias=0.0667), T-wave character (bias=-0.046) and ST-segment position (bias=-0.0629). Unsatisfactory agreement was observed in QRS axis (bias=-19.4°), P-wave axis (bias=-0.670°), QRS amplitude (bias=-0.660 mV), P-wave amplitude (bias=0.0400 mV) and T-wave amplitude (-0.0675 mV). Conclusion: Data from the novel ECG app is in agreement with the gold standard sufficiently for 'on-field' use in athletic training facilities. In particular, there was good agreement in T-wave axis assessment in all leads, a core parameter when differentiating training-related changes from cardiac pathology. However, further reliability and validity studies are required before this technology can replace the gold standard for cardiac screening due to imprecision in amplitude and P-wave/QRS axis readings. P800 https://esc365.escardio.org/Presentation/221587/abstract Sweaty Hearts: minimal digital intervention in phase III cardiac rehabilitation M Martijn Scherrenberg1, W Hillen2, J Vanhees2, N Laghmouch2, P Dendale1 1Heart Centre Hasselt, Hasselt, Belgium 2Hasselt University, Hasselt, Belgium Funding Acknowledgements: This project has been funded by the Erasmus+ Programme of the European Union. The European Commission support for this publication does not constitute Topic: e-Cardiology The beneficial effects of cardiac rehabilitation and the positive impact on exercise capacity (EC) are well known. However, patients often lose some of the gained EC in the first months after cardiac rehabilitation. Some evidence stated that minimal interventions delivered via smartphone can drive short-term health behavior changes and improve adherence to physical activity (PA). Therefore, the Sweaty Heart project investigated the use of a minimal digital intervention (MDI) to minimalize the loss of EC in the first 6 months after cardiac rehabilitation. Methods: A prospective cohort study was performed in coronary artery disease patients (CAD). Patients participated in a center-based CR for 24 weeks. Hereafter, patients were monitored by a two-weekly transmission of their step count measured with the Google fit application, with the iHealth application or with a smartwatch. Patients received feedback and new goals via e-mail every two weeks based on the transmitted step counts. After 24 weeks patients were invited back to the rehabilitation center for a new cyclo-ergometry and to fill in the IPAQ questionnaire. The primary objective was to examine the evolution of step count. As secondary outcomes we looked for the evolution of peak power during cyclo-ergometry (watt) and VO2peak between the end of the cardiac rehabilitation and the end of the minimal digital intervention. Furthermore, we examined the average workload for health professionals and the compliance of patient transmissions. Results: 11 patients (63.5 years ± 5.1; 90.9% males) participated in this trial. The average step count was 8730 steps per day. IPAQ was not significantly higher after the intervention (IPAQ baseline 4972.7 ± 3679 Mets/week; IPAQ 6 months 4731.8 ± 3504; Paired T-test: P <0.721). Peak power on cyclo-ergometry was higher after 6 months however not significant (Peak power baseline 175.9 ± 45.1; Peak power 6 months 179.9 ± 43.9; Paired T-test: P <0.455). VO2 peak was significantly lower after 6 months (VO2peak baseline: 24.5 ± 3.9; VO2peak 6 months 22.8 ± 3.3; Paired T-test: P <0.034). The average step count of month 6 of the minimal digital intervention was higher than average step count of month 1 however it was not significant different. (Average step count month 1: 7792.5 ± 3455; Average step count month 6: 9139 ± 4545; Paired T-test: P <0.080). The average time spend by the health care professionals every two weeks was 65 min which is 5.9 min per patient. The patient compliance for the step count transmission every two weeks was 94.7% Conclusion: This study showed that a MDI with low workload can be used to increase daily step count of CAD. These results suggest that a MDI could help to deliver cheap options for maintaining long term PA after CR. However, the MDI in this study was not associated with an increase or status quo of the VO2 peak. Therefore, bigger studies are needed to prove that these low cost MDI are effective in maintaining long term PA P802 https://esc365.escardio.org/Presentation/217100/abstract SharedHeart: a digital shared decision making approach to increase physical activity levels of patients with coronary artery disease C Bonneux1, G Rovelo Ruiz1, M Scherrenberg2, P Dendale2, K Coninx1 1UHasselt - tUL, Expertise Centre for Digital Media, Diepenbeek, Belgium 2UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium Funding Acknowledgements: Special Research Fund (BOF) of Hasselt University Topic: e-Cardiology Background: Physical activity is a key component of cardiac rehabilitation. Achieving long-term behaviour change for physical activity is challenging. The majority of coronary artery disease (CAD) patients do not reach the recommended minimum physical activity level at long-term follow-up. They experience difficulties interpreting exercise targets and monitoring their physical activity. To bring the newly formed habits from the supervised rehabilitation to the home environment, we propose to use a shared decision making approach (SDM) that includes the patientã s preferences, next to clinical evidence and expert opinions. PURPOSE: We propose an approach and supporting digital tools to assist physiotherapists and patients for SDM when building an exercise program during supervised rehabilitation. The ultimate goal is to have a positive long-lasting effect on patients' lifestyle reducing their CVD risk. Methods: Cardiac rehabilitation is a multidisciplinary field involving many stakeholders, including patients and varying caregivers (e.g. cardiologists, physiotherapists, dieticians). To incorporate all these perspectives, we followed a multidisciplinary, user-centred approach to design digital tools. By iteratively designing and gathering patient and caregiver perspectives in meetings and workshops, we strive to detect usability issues early in the process and ensure a good fit in clinical practice. Results: We developed the SharedHeart approach consisting of three applications to support physiotherapists in involving their patients in SDM for physical activity. Before their first SDM encounter, patients use the IPrefer tablet application to indicate their preferences for physical activity. During the encounter, the physiotherapist and patient collaboratively construct an exercise program. The SharedHeart web application supports them in the discussion by offering suggestions of activities and demonstrating how they fit with the patient's preferences and exercise guidelines. This application allows physiotherapists to remotely monitor their patients. Between the sessions, patients follow up on their physical activity with the SharedHeart mobile app. In the next SDM encounter, the patient and physiotherapist discuss the patient's adherence to the exercise program and update the program accordingly with the web application. This process repeats until the end of the supervised rehabilitation, when the most suitable exercise program for the patient has been found, and can be used by the patient at home. Conclusion: We designed and propose SharedHeart, a SDM approach supported by three applications to actively involve patients in the decision making process for physical activity to reduce their CVD risk. To verify the effectiveness of our approach, we start a RCT in which we investigate changes in CAD patients' quality of life, exercise capacity, motivation to exercise, perception of rehabilitation and engagement in the decision making process. The SharedHeart approach P803 https://esc365.escardio.org/Presentation/217094/abstract Remote monitoring of ECG using portable device "Ritmer" in patients after cardiac surgery M Maria Sokolskaya1, V Shvartz1, O Bockeria1 1Bakoulev Center for Cardiovascular Surgery RAMS, Moscow, Russian Federation Funding Acknowledgements: Project of the Russian Science Foundation, grant no. 18-74-10064. Topic: e-Cardiology Background. The detection of hemodynamically significant arrhythmias after cardiac surgery during the rehabilitation stage is a very important strategic goal of the secondary prevention of adverse events in these patients. It allows to perform timely correction of drug therapy and to make a decision about invasive treatment. Despite the existence of a huge number of gadgets on the world market, the role of home-monitoring in the detecting of arrhythmias in these patients has not been determined. It is necessary to accumulate data in this area. Purpose. To evaluate the efficiency of home-monitoring of cardiac arrhythmias in patients after cardiac surgery, using a portable device "Ritmer". Methods. The research is conducted in Bakoulev Scientific Center for CVS. It started in June 2019. All patients who were smartphone users were offered to record 5 minute ECG 2 times a day using the device "Ritmer". Those records were reviewed by the doctor daily.The scheme of the system is shown in the figure. The components of the system are: (1) a device for recording an ECG signal, (2) a smartphone on iOS or Android platforms; (3) a server for storing data; (4) a web application "Ritmer" with the interface for analyzing the data received by a doctor. Data analysis included two directions: 1- demand and compliance of the deviceã s usage among patients, 2-the effectiveness of various kinds of cardiac arrhythmias detection, including asymptomatic. Results: Currently, 47 patients (27 men), average age 58 ± 12 years are included. Initially, 15% of patients refused to participate in the study because they were not skilled smartphone users. A typical portrait of the patient who agreed to take part in this observation is a working person with higher education, about 40-64 years old, an active Internet user, who uses e-mail and social networks daily and lives remotely from the clinic. During this time, there were no refusals to continue participation in the study. About 40% of patients had occasional irregularities and missed records. The skipping share was about 20-30%. It was detected 28 patients (60%) with various rhythm disturbances using home-monitoring. The most frequent were the single and paired ventricular extrasystoles (14 patients), supraventricular extrasystoles (8 patients). Atrial fibrillation was registered in 2 patients who initially had a persistent form of it and they had radiofrequency ablation of pulmonary veins. In 6 patients after the aortic valve replacement, we observed the dynamics of heart rate reduction, which caused the reduction of the beta-blockers dose. Conclusions. The use of a portable device "Ritmer" is the effective tool for remote home dynamic monitoring after hospital discharge. Such control increases the adherence of patients to the therapy, self-monitoring of their health, provides the possibility of timely correction of therapy and hospital admission. The scheme of the system "Ritmer" P804 https://esc365.escardio.org/Presentation/217348/abstract Feasibility and usability of a home-based cardiac tele-rehabilitation program for patients with myocardial infarction: results of the MI-PACE study W Wim Stut1, E Ensom2, D Albuquerque2, N Erskine2, A Peterson2, E Dickson2, E Ding2, J Piche2, Z Wang2, J Escobar2, A Alonso2, R Makam2, N Botkin2, D Mcmanus2 1Philips Research Europe, Eindhoven, Netherlands (The) 2University of Massachusetts, School of Medicine, Worcester, United States of America Topic: e-Cardiology Introduction: Exercise-based cardiac rehabilitation (CR) has shown to reduce mortality, prevent hospital readmission, and improve quality of life after myocardial infarction (MI). Nevertheless, CR is underutilized and the beneficial effects of CR are often not maintained over time. In this pilot study, we developed and assessed the feasibility of delivering a home-based cardiac tele-rehabilitation program to MI survivors. Methods: We enrolled hospitalized MI survivors at an academic medical center in the US who were medically cleared for a CR exercise stress test. Participants received a watch monitoring heart rate (HR) and walking, and a tablet with an application that displayed progress towards accomplishing weekly walking and exercise goals. Results were transmitted to a CR nurse via a secure internet connection. For 12 weeks, participants exercised at home using HR and walking targets, and participated in weekly phone counseling sessions with the CR nurse who used a dashboard to provide personalized CR problem solving and standardized CR education (i.e. diet, weekly goals). We assessed use of the system, walking and exercise level, counseling session attendance, angina stability (Seattle Angina Questionnaire) and system usability (System Usability Scale). Results: Twenty participants enrolled and 18 completed the 12-week tele-rehabilitation program; mean age was 59 (SD 7) years, 35% were women, and 35% had an ST-elevation MI. Participants (n=18) wore the watch for a median of 86% of days (IQR: 66%, 98%) for a median of 12.9 hours per day (IQR: 11.3, 14.2). Participants on average had 121 walking minutes per week and spent 189 minutes per week in their personal exercise heart rate zone; both remained stable. Participants reported greater angina stability (p=0.0002). The median SUS score was 82.5 (IQR: 65.0, 90.0), which means that patients experienced excellent usability. Conclusions: This tele-rehabilitation pilot study with MI patients demonstrated high rates of adherence to watch use, exercise recommendations, and phone counseling sessions with no associated adverse outcomes. The number of walking and exercise minutes were very high and stable during the 12-week program. Participants generally expressed great enthusiasm for their user experience with the system. Tele-rehabilitation may be an acceptable, if not desirable, alternative for those unable to participate in center-based cardiac rehabilitation. Additional studies with larger patient samples are warranted to compare differences between center-based rehabilitation on patient outcomes and healthcare resource utilization. 334 https://esc365.escardio.org/Presentation/217125/abstract Type 2 diabetes and coronary diseases in Italy: the real-world healthcare evidence through the analysis of a huge administrative database from 2013 to 2017 AP Maggioni1, S Calabria2, L Dondi2, G Ronconi2, C Piccinni2, A Pedrini2, I Esposito3, N Martini2 1ANMCO Foundation For Your Heart, Heart Care Foundation, Florence, Italy 2Research and Health Foundation, Casalecchio Di Reno, Italy 3Drugs and Health srl, Rome, Italy Funding Acknowledgements: Partially supported by an unrestricted grant by AstraZeneca Topic: Public Health and Health Economics Introduction: Evidence of correlations between type 2 diabetes (T2DM) and cardiovascular (CV) diseases are known, but not yet contextualized in a multi-morbidity care pathway. Purpose. To describe patients affected by T2DM with and without coronary artery disease (CAD) and/or stroke, from 2013 to 2017, in terms of demographics, comorbidities, hospitalizations and healthcare costs in charge of the National Health System (NHS). Methods. From the ReS database, T2DM subjects were selected in 2015 (accrual period) through the record linkage of reimbursed drugs (antidiabetics, excluded insulin), hospital discharges and exemption. Out of these, patients hospitalized for CAD (or with a revascularization procedure) and/or stroke were identified from 2013 to 2015 (cases). Each case was associated (1:1) with a diabetic without CAD and/or stroke (control). Comorbidities (dyslipidaemia, hepatopathies, atrial fibrillation, heart failure, depression, arterial hypertension, neoplasia, chronic kidney disease, chronic lung disease) were analysed in the accrual period, while free filled drug prescriptions (ATC codes, DDD) and hospitalizations (ICD-IX codes) in one-year follow-up. Mean per patient integrated healthcare costs (reimbursed drugs, hospitalizations, outpatient care) were analysed in two-year follow-up, in the perspective of the NHS. Results. Out of >7 million inhabitants of the ReS database, 435,977 were affected by T2DM, in 2015. Of these, 7.6% were discharged with CAD and/or stroke from 2013 to 2015 (mean age 73 years; 64.9% males). Prevalence rates (total 4.5 per 1,000 inhabitants) increased with age in both genders. Subjects without CAD and/or stroke were on average 67 y.o. and 51.3% females. Over the accrual, cases had more CV and non-CV comorbidities than controls, except depression equally distributed. The most frequent were arterial hypertension (93.8% of cases, 75.6% of controls), dyslipidaemia (76.2%, 48.8%) and chronic lung diseases (22.1%, 12.0%) both for cases and for controls. In the 1st follow-up year: antithrombotic agents were the most prescribed drugs to cases (338.5 -vs 261.7 to controls- mean DDD/treated patient) and antidiabetics to controls (356.8 -vs 389.3 to cases- mean DDD/treated patient); 50.5% of cases and 14.2% of controls were hospitalized, congestive heart failure was the main cause for both. On average, in the 1st follow-up year, the NHS spent 6,719⪯case (24.2% for drugs; 59.4% for hospitalizations; 16.4% for outpatient care, of total expenditure) and 2,297⪯control (45.7%; 32.9%; 21.4%), while 4,771⪯case and 2,518⪯control in the 2nd follow-up year. Conclusions. This real-world data analysis showed that patients affected by T2DM and with coronary diseases largely differ from those without, in terms of age and comorbidities. In line with their clinical conditions, the economic burden for the NHS was higher in cases than in controls. Findings can help policy makers to integrate healthcare pathways where necessary. Award Winning Science - Population Science & public health section 368 https://esc365.escardio.org/Presentation/217403/abstract The contribution of unhealthy diet to the economic burden from cardiovascular diseases in the Russian Federation in 2016 D Dinara Mukaneeva1, A Kontsevaya1, Y Balanova1, A Myrzamatova1, M Khudyakov1, O Drapkina1 1National Medical Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Public Health and Health Economics Introduction: Unhealthy diets largely determine the high morbidity and mortality from cardiovascular diseases (CVD) worldwide. The greatest contribution is made by such eating habits as a lack of whole grains, nuts and seeds, fruits, fish, excessive salt and processed red meat in the diet. The prevalence of these components of unhealthy diet is very high in the Russian population. Thus, according to the ESSE-RF epidemiological study, the prevalence of low consumption of vegetables&fruits and fish was 41.9% and 36.9%, respectively, and excess consumption of salt and processed red meat was recorded in 49.9% and 22.5 % surveyed. The purpose of this study is to estimate the economic burden of cardiovascular diseases attributable to unhealthy diet in the Russian Federation in 2016 Methods: We first obtained CVD risk estimates for intakes of both protective (vegetables, fruits, and fish) and harmful foods (salt, processed red meat). Based on information on the prevalence of excess salt intake and processed red meat, of low vegetables&fruits and fish consumption in Russian population and relative risks (RR), according to meta-analyzes and large studies, we calculated population attributable risk (PAR) for CVD. To assess the economic burden, the proportion of the analyzed risk factor in the morbidity and mortality from CVD was determined, and then the proportion in the economic burden of the CVD. Then we estimated attributable costs by multiplying PAR outcomes with estimated 2016 annual direct health care and indirect costs for CVD. We used data from the Federal State Statistics Service, parameters of Annual Forms of Federal Statistical Monitoring, the results of Program of state guarantees for free medical care and the corresponding diagnosis-related groups for 2016. Results: The calculated PAR, associated with excess salt intake, for CVD mortality and morbidity was 5% and 7% respectively; for stroke: in mortality −17%, in morbidity −10%. The daily of processed red meat consumption determine 8.6% contribution to the morbidity of coronary heart disease. PAR of low fish consumption for CVD mortality was 3%, in morbidity ã11%. Low consumption of fruits and vegetables makes 5% contribution to the morbidity and mortality of all CVDs. The economic burden of CVD associated with an unhealthy diet in the Russian Federation in 2016 amounted to 388.2 billion rubles. Excessive salt intake and low consumption of vegetables and fruits make the largest contribution to this burden. The losses in the economy due to premature mortality (323.9 billion rubles) prevail in the structure of the main burden. Direct medical expenses amounted to 64.3 billion rubles with predominance in the structure of costs associated with low fish consumption (27.2 billion rubles). Conclusion An assessment of the economic burden will be an argument to justify the feasibility of investing in the prevention of CVD associated with unhealthy diet. EAPC Essentials 4 You - ePosters P302 https://esc365.escardio.org/Presentation/221566/abstract Health care utilization associated with cardiovascular events in a 3 year follow up period among high-risk patients with stable coronary artery disease in Greece - Insights from the TIGREECE study D Dimitrios Tsounis1, M Elisaf2, G Hahalis3, C Karvounis4, I Kogias5, I Lekakis6, A Manolis7, I Mantas8, T Tourtoglou1, D Gourlis1 1AstraZeneca Greece, Athens, Greece 2University Hospital of Ioannina, Internal Medicine, Ioannina, Greece 3University Hospital of Patras, Cardiology, Patras, Greece 4Ahepa General Hospital of Aristotle University, Cardiology, Thessaloniki, Greece 5Karditsa General Hospital, Cardiology, Karditsa, Greece 6Attikon University Hospital, Cardiology, Athens, Greece 7Asklipieio Voulas Hospital, Cardiology, Voula, Greece 8General Hospital of Chalkida, Chalkida, Greece On Behalf of: TIGREECE study investigators Funding Acknowledgements: AstraZeneca Topic: Public Health and Health Economics Objective/Methods: TIGREECE was a multicenter, observational, prospective, longitudinal cohort study, with a 3-year follow-up, in order to assess the long-term risk, clinical management and healthcare resource utilization among patients with stable coronary artery disease (CAD) who had suffered a myocardial infraction (MI) 1-3 years before study entry and had at least one additional cardiovascular (CV) risk factor, as defined in PEGASUS TIMI 54 study, in Greece. The primary objectives were to estimate the event rate for the composite of MI, unstable angina with urgent revascularization, stroke or death from any cause and to depict the healthcare resource utilization (HCRU) associated with these events in a 3-year follow-up period. The study was carried out by cardiologists and general practitioners practicing in both the primary and secondary healthcare sector. Results: A total of 305 eligible consented patients (81.3% males, median age 67.3 years) were enrolled and analyzed. During the 3-year study observation period, a total of 29 confirmed primary composite endpoint events were reported for 9.2% (N=28) of the patients and a total of 2139 visits/hospitalizations (excluding the study visits) were reported for 74.1% (226/305) of the patients. Of these, 352 occurred in 38.0% (116/305) of the patients for CV reasons, 6 by 2.0% (6/305) due to bleeding event occurrence and the remaining 1784 visits/hospitalisations were performed by 65.9% (201/305) due to other reasons. The incidence rates of HCRU for CV reasons among the overall population and the subpopulation with a primary composite event were: 33.9 versus 125.6 visits per 100 patient-years, for visits to office-based physicians/outpatient facilities; 1.8 versus 5.3 visits per 100 patient-years, for visits to emergency rooms not requiring hospital admission; and 4.4 versus 23.0 hospitalisations per 100 patient-years. Moreover, the incidence rate of HCRU for CV reasons was 99.08 versus 36.84 visits/hospitalisations per 100 patient-years among patients with versus without chronic non-end stage renal dysfunction (p=0.031); 49.48 versus 13.58 (p=0.001) among patients with versus without hypertension; and 70.67 versus 16.11 (p=0.021) among patients with versus without a family history of premature CAD. Conclusion: Among high CV risk post MI patients with stable CAD in a 3-year observation period most visits/hospitalizations were performed due to CV reasons and patients that experienced primary composite endpoint events utilized more healthcare resources for CV reasons during the study observation period than those that did not experience such an event. P304 https://esc365.escardio.org/Presentation/217336/abstract Developing multimedia educational resources utilizing a novel interprofessional collaboration scheme for patients with acute myocardial infarction N Mukundu Nagesh1, MM Gandhi1 1Royal Devon & Exeter Hospital, Exeter, United Kingdom of Great Britain & Northern Ireland Topic: Public Health and Health Economics Background: There is a profound physical and psychological impact on patients presenting with acute ST elevation myocardial infarction (STEMI) during symptom onset, transit to hospital, during primary percutaneous coronary intervention (PPCI), and prior to discharge. There is little multimedia support for patients during this acute admission phase. Purpose: A novel interprofessional collaboration (IC) scheme will utilize experiences and insights from key health professionals who support STEMI patients during the early phase of an acute admission. This study aims to (i) undertake a survey of healthcare professionals and students about patient support for STEMI, and (ii) develop multimedia resources to provide educational and psychological support for patients. Methods: A mixed methods questionnaire survey about communication and patient education was prospectively self-administered to members of the IC. Results were thematically analyzed and key points were used to develop multimedia resources that provide patient centered education and psychological support. Resources were hosted on a website and mobile application to ease patient accessibility. Results: A total of 53 members contributed to the IC (8 cardiologists, 5 ambulance paramedics, 6 coronary care nurses, 5 cardiac rehabilitation nurses, 5 cardiac physiologists, 2 cardiac catheterisation nurses, 8 non cardiology doctors, 15 medical and nursing students). 51% rated the current education resources for acute MI patients as "inadequate". 74% felt that these education resources should be contained in an online/mobile resource and 79.6% felt it should be delivered via an interactive film. 92.5% felt there was insufficient psychological support for STEMI patients. An interactive educational film of the acute admission pathway and psychological support including mindfulness for STEMI patients were developed and hosted on a website and mobile application (eHeartAttack) for patients during an acute admission (Figure 1). Conclusions: This IC survey identified a gap in educational and psychological support resources for patients with STEMI during the acute admission. Interactive multimedia resources were been developed to enhance patient centered education and support. These resources will be piloted amongst STEMI patients during an acute admission. Fig 1: Multimedia hosted in mobile app P306 https://esc365.escardio.org/Presentation/217346/abstract Evaluation of the impact of air pollution on the mortality for cardiovascular diseases. L Lukasz Kuzma1, K Struniawski1, S Pogorzelski1, K Nowak1, M Zalewska-Adamiec1, P Kralisz1, H Bachorzewska-Gajewska1, S Dobrzycki1 1Medical University of Bialystok, Bialystok, Poland Topic: Public Health and Health Economics Background: Cardiovascular diseases (CVD) are the biggest threat and the most common cause of death in Europe. According to the European Environment Agency, air pollution contributes to the premature death of approximately 500,000 citizens of the European Union (EU) every year. Purpose: To assess the impact of air pollution on the mortality for CVD. Material and methods: The statistics concerning mortality of inhabitants of metropolitan city were achieved from Statistical Office in 2008ã2017. Concentrations of SO2, NO2, PM2.5, PM10 and weather conditions were analyzed. We used the International Statistical Classification of Diseases (ICD), 10th Revision, to define deaths due to CVD: (I00-I99). Multivariate Poisson regression test was used for statistical analysis (P <0.05). Results: A total of 34,005 deaths were reported in the analyzed period, of which 52.31% were for CVD. The mortality rate for cardiovascular reasons was 52.31% (N=8451), with a mean age of 81.29 years (SD=8.99) in females vs. 44.36% (N=7919), with a mean age of 72.18 years (SD=12.12) in males (P<0.001). Excluding seasonal changes, there was no significant impact of air pollution on deaths for CVD in female group, yet 10o C decrease of temperature was associated with increased daily mortality (RR 1.08, 95% CI 1.04ã1.13, P<0.001). In male group exceeded concentration of PM2.5 increased the risk of death for CVD (RR 1.07, 95% CI 1.02–1.12, P=0.01). No impact of temperature on men mortality was noted. Conclusions: An elevation in concentration of PM2.5 increased the cardiovascular mortality in males. Temperature changes are associated with increased mortality in females. P307 https://esc365.escardio.org/Presentation/217098/abstract Screening for familial hypercholesterolemia. Extending a role for blood programs in promoting public health S Stephen Eason1, MH Sayers2, A Khera2, O Gore3 1Carter BloodCare, Dallas, United States of America 2University of Texas Southwestern Medical Center, Dallas, United States of America 3University of Colorado, Division of Cardiology, Aurora, United States of America Topic: Public Health and Health Economics Background/Introduction: Familial hypercholesterolaemia (FH) is a genetic disorder characterized by high levels of cholesterol with evidence of coronary arterial disease at an early age. Early identification and treatment is recommended (2019 ESC/EAS Guidelines for the Management of Dyslipidaemias), however the disorder is largely underdiagnosed. A number of blood programs has recognised the opportunity that blood donation provides to identify ostensibly healthy individuals who might be unaware of risks to their health. These programs have included such assays as non-fasting total cholesterol (TC) and hemoglobin A1C. They have also taken steps to notify individuals whose results suggest risk for cardiovascular disease or diabetes. Purpose: Since our program has a history of providing donors information about their TC, we decided to find out if some individuals with high TC met the criteria for FH. Methods: We reviewed unlinked TC results from volunteers donating between 2015 and 2019. Cholesterols were measured on a chemistry analyzer (Beckman Coulter AU680). For volunteers donating more than once, we included only their highest TC recording. TC was classified by American Heart Association (AHA) 2020 Goal Metrics as high, if ≥240 mg/dL (6.2 mmol/L) in donors age ≥20 and ≥200 (5.1 mmol/L) in donors age <20. We applied the MEDPED diagnostic criteria for FH (FH is diagnosed when TC exceeds 270 mg/dL (7.0 mmol/L) in individuals less than 20, 290 mg/dL (7.5 mmol/L) in individuals 20 to 29, 340 mg/dL (8.8 mmol/L) in individuals 30 to 39, and 360 mg/dL (9.3 mmol/L) in individuals 40 years of age and older). Results: There were 432,389 unique donors during the study period. The overall prevalence of high cholesterol, 11.1% and the prevalence of FH 0.24% are similar to published data for the general population. As shown in the table, the prevalence of FH was highest in 20 to 29 year olds and decreased in older donors, while the prevalence of high TC increased with age. Conclusion: There is a subset of blood donors, at all ages who can be identified as satisfying FH diagnostic criteria. This subset might benefit, along with their close family members, from history, examination and additional testing. Donors, by Age Group, Meeting High and FH Cholesterol Criteria Age Groups (years) <20 20-29 30-39 ≥40 Total Total Numbers 122229 71273 65096 173791 432389 Number (%) with High TC 10862 (8.9) 3046 (4.3) 6163 (9.5) 27785 (16.0) 47855 (11.0) Number (%) with FH * 346 (0.28) 306 (0.43) 103 (0.16) 277 (0.16) 1032 (0.24) * FH identified by MEDPED criteria Donors, by Age Group, Meeting High and FH Cholesterol Criteria Age Groups (years) <20 20-29 30-39 ≥40 Total Total Numbers 122229 71273 65096 173791 432389 Number (%) with High TC 10862 (8.9) 3046 (4.3) 6163 (9.5) 27785 (16.0) 47855 (11.0) Number (%) with FH * 346 (0.28) 306 (0.43) 103 (0.16) 277 (0.16) 1032 (0.24) * FH identified by MEDPED criteria Open in new tab Donors, by Age Group, Meeting High and FH Cholesterol Criteria Age Groups (years) <20 20-29 30-39 ≥40 Total Total Numbers 122229 71273 65096 173791 432389 Number (%) with High TC 10862 (8.9) 3046 (4.3) 6163 (9.5) 27785 (16.0) 47855 (11.0) Number (%) with FH * 346 (0.28) 306 (0.43) 103 (0.16) 277 (0.16) 1032 (0.24) * FH identified by MEDPED criteria Donors, by Age Group, Meeting High and FH Cholesterol Criteria Age Groups (years) <20 20-29 30-39 ≥40 Total Total Numbers 122229 71273 65096 173791 432389 Number (%) with High TC 10862 (8.9) 3046 (4.3) 6163 (9.5) 27785 (16.0) 47855 (11.0) Number (%) with FH * 346 (0.28) 306 (0.43) 103 (0.16) 277 (0.16) 1032 (0.24) * FH identified by MEDPED criteria Open in new tab Award Winning Science - Primary care & risk factor management section 80 https://esc365.escardio.org/Presentation/221588/abstract Text-mining in electronic healthcare records for efficient recruitment and data-collection in cardiovascular trials: a multicenter validation study WB Wouter Bastiaan Van Dijk1, ATL Fiolet1, E Schuit1, A Zabihi-Sammani1, TKJ Groenhof1, R Van Der Graaf1, MC De Vries2, M Alings3, J Schaap3, FW Asselbergs1, DE Grobbee1, RHH Groenwold2, A Mosterd1 1University Medical Center Utrecht, Utrecht, Netherlands (The) 2Leiden University Medical Center, Leiden, Netherlands (The) 3Amphia Hospital, Breda, Netherlands (The) On Behalf of: ETHMIRE group Funding Acknowledgements: This work was primarily supported by the Netherlands Organisation for Health Research and Development (ZonMW) (grant number 91217027). Topic: Research Methodology Background: Recruitment and source data collection in clinical trials is a labor intensive, expensive endeavor. Text mining of Electronic Healthcare Records (EHRs) could reduce costs and improve efficiency related to participant identification and automated baseline source data-collection. This study aimed to validate participant recruitment and compare extracted baseline data using EHR text mining of structured and unstructured data to those from an ongoing trial on the effects of low dose colchicine in patients with stable coronary artery disease. Methods: In three medical centers participating in a multicenter trial with different EHR vendors, text-mining was used to automatically search and extract EHR data. First, the number of eligible trial participants by automated EHR searching was compared to the number of patients identified using conventional search methods. Second, automated and manual collection of the trialã s baseline variables were compared regarding accuracy. Results: 568 (0·6%) of the 92,466 patients visiting the out-patient cardiology departments of the three medical centers were enrolled in the trial during its recruitment period (Oct 1, 2016ãDec 1, 2018). Automated EHR data screening of all patients based on the trialã s eligibility criteria resulted in a reduction of 73,863 (79·9%) patients that needed to be screened for trial participation. The remaining 18,603 (20·1%) contained 458 (2·5%) of the actual trial participants (82·4% of participants) (Figure 1). In trial participants, availability of 19 baseline characteristics differed by a median 2·8% (IQR across all variables 0·4-8·5%) between data extracted from EHR compared to conventionally collected trial data. Overall accuracy of EHR extracted data was 88·0% (IQR 84·7-92·8%). Conclusion: Data extracted from EHRs using text-mining can be used to identify patients for trial participation and for the collection of baseline data. Hence, automatically collecting data from EHRs can reduce time and costs related to recruitment and data-collection in clinical trials. EAPC Essentials 4 You - ePosters P612 https://esc365.escardio.org/Presentation/217387/abstract The evolution of microRNA associated with the VEGF pathway during normal pregnancy and their relation with vascular function I Witvrouwen1, D Mannaerts2, J Ratajczak1, L Van Den Eeden3, AH Van Craenenbroeck4, Y Jacquemyn2, EM Van Craenenbroeck1 1University of Antwerp, Cardiovascular diseases, GENCOR, Antwerp, Belgium 2University of Antwerp, Research Group ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, Antwerp, Belgium 3University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium 4University of Antwerp, Laboratory of Experimental Medicine and Pediatrics, Antwerp, Belgium Funding Acknowledgements: IW is supported by the Fund for Scientific Research Flanders with a predoctoral fellowship (1194918N) Topic: Basic Science - Cardiac Diseases Background: Pre-eclampsia is a hypertensive pregnancy disorder, characterized by insufficient placentation due to systemic endothelial dysfunction. VEGF (vascular endothelial growth factor) and PLGF (placental growth factor) are crucial in healthy placentation. An increased soluble Flt-1 (VEGF receptor 1) to PLGF ratio was recently recognized as a biomarker of pre-eclampsia. Purpose: In this observational longitudinal study, we explore the relation of circulating VEGF-related microRNA with placentation characteristics and vascular function measures during healthy pregnancy. Methods - Plasma levels of miR-16, miR-29b, miR-126, miR-155 and miR-200 were analyzed using RT qPCR at 12 and 26 weeks of pregnancy. Data were normalized using Cel-miR-39 and presented as relative expression. At 12 and 35 weeks, pulsed wave velocity (PWV), heart rate-corrected augmentation index (Aix@75), flow-mediated dilation (FMD), modified FMD (mFMD), low-flow mediated constriction (LFMC) and reactive hyperemia index (RHI) were recorded. sFlt-1 and PLGF were assessed at 26 weeks using ELISA. Results Thirty healthy, non-smoking, pregnant women (mean age 29.5 ± 3.5 years, BMI 23.7 ± 4.5) were included. Blood pressure at 12 weeks pregnancy and at labor was normal (respectively 125 ± 14mmHg/71 ± 10mmHg and 120 ± 24mmHg/74 ± 6mmHg). Levels of miR-200 and miR-16 changed significantly during pregnancy (respectively -3.28 to -3.03, p <0.05 and 1.88 to 1.64, p <0.05). sFlt-1, PLGF and sFlt-1/PLGF ratio were all within normal range. None of the miRNA correlated with sFlt-1, PLGF or their ratio (p >0.05). miR-155 at 12 weeks was inversely correlated with RHI at 12 weeks (r=-0.477, p <0.05) and mFMD at 35 weeks (r=-0.377, p <0.05). Conclusions During the course of a healthy pregnancy, plasma miR-200 increases whereas plasma miR-16 decreases. MiR-155, implicated in eNOS expression and placentation, is inversely related to endothelial function at 12 and 35 weeks, and is therefore a promising biomarker of pregnancy-related endothelial dysfunction. Whether this finding is confirmed in pre-eclamptic pregnancies has to be evaluated. Vascular function 12 weeks 35 weeks p-value Aix@75 (%) 0.68 ± 13.2 2.79 ± 11.4 0.214 PWV (m/s) 6.15 ± 0.7 5.97 ± 1.4 0.386 RHI 2.21 ± 0.6 1.55 ± 0.4 <0.001 FMD (%) 9.50 ± 4.4 9.82 ± 4.8 0.682 mFMD (%) 9.57 ± 4.9 12.21 ± 5.5 0.004 LFMC (%) -0.03 ± 2.2 -1.96 ± 3.3 0.002 Vascular function 12 weeks 35 weeks p-value Aix@75 (%) 0.68 ± 13.2 2.79 ± 11.4 0.214 PWV (m/s) 6.15 ± 0.7 5.97 ± 1.4 0.386 RHI 2.21 ± 0.6 1.55 ± 0.4 <0.001 FMD (%) 9.50 ± 4.4 9.82 ± 4.8 0.682 mFMD (%) 9.57 ± 4.9 12.21 ± 5.5 0.004 LFMC (%) -0.03 ± 2.2 -1.96 ± 3.3 0.002 Open in new tab Vascular function 12 weeks 35 weeks p-value Aix@75 (%) 0.68 ± 13.2 2.79 ± 11.4 0.214 PWV (m/s) 6.15 ± 0.7 5.97 ± 1.4 0.386 RHI 2.21 ± 0.6 1.55 ± 0.4 <0.001 FMD (%) 9.50 ± 4.4 9.82 ± 4.8 0.682 mFMD (%) 9.57 ± 4.9 12.21 ± 5.5 0.004 LFMC (%) -0.03 ± 2.2 -1.96 ± 3.3 0.002 Vascular function 12 weeks 35 weeks p-value Aix@75 (%) 0.68 ± 13.2 2.79 ± 11.4 0.214 PWV (m/s) 6.15 ± 0.7 5.97 ± 1.4 0.386 RHI 2.21 ± 0.6 1.55 ± 0.4 <0.001 FMD (%) 9.50 ± 4.4 9.82 ± 4.8 0.682 mFMD (%) 9.57 ± 4.9 12.21 ± 5.5 0.004 LFMC (%) -0.03 ± 2.2 -1.96 ± 3.3 0.002 Open in new tab P613 https://esc365.escardio.org/Presentation/217105/abstract The degree of stenosis of internal carotid artery is associated with circulating T-helpers 17 level. A Filatova1, EA Pylaeva1, AK Osokina1, AV Potekhina1, MI Tripoten1, OA Pogorelova1, TV Balakhonova1, EA Noeva1, NYU Ruleva1, TI Arefieva1 1National Medical Research Center of Cardiology, Moscow, Russian Federation Funding Acknowledgements: The work was supported by the Russian Foundation for Basic Research (grant № 17-04-00127) Topic: Basic Science - Cardiac Diseases Chronic inflammation plays a key role in atherosclerosis progression. Lymphocyte subpopulations are differently involved in inflammatory reactions. T-helpers (Th) 1 promote inflammation and atherosclerosis, while regulatory T-cells (Treg) possess anti-inflammatory and anti-atherogenic activity. Th17 contribution is ambiguous. We aimed to explore the relationship between T-cell blood frequencies and the abundance of carotid atherosclerosis in different segments of carotid arteries. Methods: 67 patients underwent duplex sonography to determine the degree of stenosis of distal segment of the common carotid artery (CCA), CCA bifurcation or internal carotid artery (ICA). Blood lymphocyte subpopulations were analyzed via direct immunofluorescence and flow cytometry. sCD25 and interleukin(IL)-10 levels were measured with an Immulite 1000 analyzer, IL-17a blood level was assayed by ELISA. 33 patients underwent carotid ultrasound at admission and in 1 year after the enrollment. Results: Patients with ICA stenosis ≥35% had increased Th17 level vs. patients with ICA stenosis <35%. Th17 level ≥ 1% of CD4+T-cells was associated with more severe stenosis of ICA (OR 7.1 (1.6-31.3), p<0.05 for ICA stenosis ≥35% and 5.6 (1.0-29.3), p<0.05 for ICA stenosis ≥50%). Patients groups with different severity of CCA and CCA bifurcation stenosis did not differ in any of the analyzed immunological parameters. No differences in CD4+CD25highCD127low and CD4+Foxp3+ Treg, CD4+CD25lowCD127high activated T-cells, CD4+IL10+ producing T-cells, Th1 blood content and analyzed cytokine levels were observed. In patients with ICA atherosclerosis progression the basal Th17 content was higher vs. patients without ICA atherosclerosis progression. Conclusion: The degree of ICA stenosis and ICA stenosis progression are associated with increased circulating Th17 level. P614 https://esc365.escardio.org/Presentation/217112/abstract The NF-kB/miR-425-5p/MCT4 axis: a novel insight into diabetes induced endothelial dysfunction E Erfei Luo1, D Wang2, C Tang2 1Zhongda Hospital, Southeast University, nanjing, China 2Zhongda Hospital , Department of Cardiology, Nanjing, China Funding Acknowledgements: National Natural Science Foundation of China (Research Grant #81670237 and #81800244) Topic: Basic Science - Cardiac Diseases Background: Endothelial dysfunction is an initiating and crucial factor in diabetic vasculopathy, but the underlying mechanisms are not fully understood. Endothelial cells (ECs) rely primarily on glycolysis for their energy metabolism, and the final product of glycolysisã lactate acidã is transferred out of cells via monocarboxylate transporter 4 (MCT4). Our previous study showed that the downregulation of MCT4 is involved in diabetic endothelial injury. However, the underlying regulatory mechanisms of MCT4 in diabetes remain unclear, and the current study performed an in-depth research on the mechanism involved. Methods: We identified a candidate miRNA, miR-425-5p, with potential binding sites in the 3ã -UTR of MCT4 mRNA by using three computational prediction programmes, and we determined the changes in miR-425-5p expression in diabetic patients and human umbilical vein endothelial cells (HUVECs) treated with high glucose (HG) and interleukin-1β (IL-1β). A dualã luciferase reporter gene assay was used to verify whether MCT4 was the target gene of miRã 425ã 5p. To investigate the effect of miR-425-5p on MCT4 expression and EC function, HUVECs were transfected with miR-425-5p mimics, inhibitor or negative control (NC) and MCT4 expression and cell apoptosis were detected. To further determine whether nuclear factor kappa B (NFã κB) signalling had an effect on promoting miR-425-5p expression, regulating the expression of MCT4 and inducing EC injury, a dualã luciferase reporter gene assay was used, and miR-425-5p levels, MCT4 expression and apoptosis were measured after treatment with HG, IL-1β and/or SN50, an NF-κB inhibitor. Results: It was shown that miR-425-5p was significantly upregulated in diabetic patients and HUVECs treated with HG and IL-1β. MCT4 was shown to be the direct target gene of miRã 425ã 5p, and miR-425-5p expression led to MCT4 downregulation, lactate acid accumulation and a pH drop in HUVECs. In addition, miR-425-5p promoted HUVEC apoptosis and inhibited HUVEC viability and migration. Our results also indicated that activation of NFã κB signalling increased miR-425-5p levels and induced MCT4 downregulation, lactate acid accumulation and a pH drop, ultimately increasing the apoptosis rate in HUVECs. In contrast, inhibition of NFã κB signalling decreased miR-425-5p levels, induced upregulation of MCT4 and reduced apoptosis in HUVECs. Conclusions: Our study provides evidence showing that the activation of the NF-κB/miR-425-5p/MCT4 axis plays a crucial role in the EC injury induced by HG and IL-1β. Therefore, inhibiting NF-κB signalling and miR-425-5p expression would be a novel and effective strategy for treating diabetic vascular complications. miR-425 induced downregulation of MCT4 P616 https://esc365.escardio.org/Presentation/217023/abstract Cardioprotective potential of the water extracts of pscilocybe cubensis magic mushrooms on angiotensin II-induced hypertrophy in rat cardiomyoblast cells SM Nkadimeng1, CLM Steinmann2, CJ Botha1, JN Eloff1 1University of Pretoria, Pretoria, South Africa 2Sefako Makgatho Health Sciences University, Physiology, Pretoria, South Africa Funding Acknowledgements: Health and welfare sector education and training authority (HWSETA) Topic: Basic Science - Cardiac Diseases Background: Depression is a burden to society and a leading factor in suicidal deaths globally. Psilocybin and psilocybin mushrooms are known to have evident antidepressant effect and the use of psilocybin mushrooms in society is growing. Since depression is associated with aging people who are prone to cardiovascular diseases such as hypertension and heart failure, examining safety of psilocybin mushroom usage in these conditions is essential. Pathological cardiac hypertrophy is the main course of heart failure and is characterised by enlargement and apoptotic loss of cardiomyocyte. Purpose: We investigate the safety or risks of Psilocybe cubensis (P. cubensis), one of the most commonly used psilocybin mushrooms on angiotensin II-induced hypertrophy in H9C2 rat cardiomyoblast cells. Methods: P. cubensis mushrooms were oven dried and extracted with cold and hot water. The extracts were tested for cytotoxicity using the tetrazolium bromide assay on H9C2 cardiomyoblast cells. When confluent, cells were induced with (10 μM) angiotensin II and then treated with the two extracts (50μg/mL) over 48 hours. Cell surface area, mitochondrial activity, cellular reactive oxygen species (ROS), nitric oxide (NO) and extracellular calcium levels were measured. Atrial natriuretic peptide and tumor necrosis factor alpha (TNFα) concentrations were also determined. Losartan, an angiotensin II inhibitor (100μM), and Nw-nitro-L-arginine methyl ester (L-NAME) (100μM), a nitric oxide synthase inhibitor were used as positive controls. Results: The results showed that angiotensin II decreased cell viability (19.1%) and significantly increased cell surface measurement (p<0.001; 30.613 ± 1.125), NO (p<.001; 2.744 ± 0.134) and ROS (p<0.001; 84.500 ± 5.526) levels compared to the non-treated control. The two extracts reduced the ANP levels although non-significantly. The extracts also increased NO levels and cell viability in a pattern comparable to losartan and LNAME. These effects were more pronounced with the cold water extracts. Cold water also significantly reduced the ROS (p=0.013) and cell measurements (p<0.001) close to the non-treated control. Hot water extract on the other hand showed protective effects by significantly reducing TNFα concentrations (p=0.02) and reversing ROS (p<0.001) and cell measurements (p<0.001) close to losartan. The hot water extracts also increased extracellular calcium content (p=0.039) of the cells significantly higher than losartan and this effect could play a role in the calcium signalling pathways. Conclusion: The results suggested that the water extracts did not worsen the angiotensin II-induced hypertrophic condition in the concentrations tested. The study also suggest for the first time the beneficial cardioprotective potential of Psilocybe cubensis water mushrooms in heart failure conditions; however more investigation is required to further establish this effect and caution is needed with higher concentrations. P617 https://esc365.escardio.org/Presentation/217071/abstract Low-frequency variability in photoplethysmographic waveform and heart rate during on-pump cardiac surgery with or without cardioplegia V Vladimir Shvartz1, M Sokolskaya1, A Kiselev2, E Borovkova3, O Bockeria1 1Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia, Russian Federation 2Saratov State Medical University, Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov, Russian Federation 3National Research Saratov State University, Department of Dynamic Modeling and Biomedical Engineering, Saratov, Russian Federation Funding Acknowledgements: This study was supported by the Russian Science Foundation (grant number 18-74-10064) Topic: Basic Science - Cardiac Diseases Objectives: We studied the properties of low-frequency (LF) heart rate variability (HRV) and photoplethysmographic waveform variability (PPGV) and their interaction under conditions where the hemodynamic connection between them is obviously absent, as well as the LF regulation of PPGV in the absence of heart function. Methods: The following spectral indices of PPGV and HRV were ertimated: the total spectral power (TP), the high-frequency (HF) and the LF ranges of TP in percents (HF% and LF%), and the LF/HF ratio. We assessed also the index S of synchronization between the LF oscillations in finger photoplethysmogram (PPG) and heart rate (HR) signals. Results: It is shown that the mechanisms leading to the occurrence of oscillations in the LF range of PPGV are independent of the mechanisms causing oscillations in the LF range of HRV. At the same time, the both above-mentioned LF oscillations retain their activity under conditions of artificial blood circulation and cardioplegia (the latter case applies only to LF oscillations in PPG). In artificial blood circulation, there was a coupling from the LF oscillations in PPG to those in HR, whereas the coupling in the opposite direction was absent. Conclusion: The coupling from the LF oscillations in PPG to those in HR has probably a neurogenic nature, whereas the opposite coupling has a hemodynamic nature (due to cardiac output). Patients TPHRV LF%HRV HF%HRV LF/HFHRV LF%PPGV HF% PPGV LF/HFPPGV S, % Patients without cardioplegia Patient A 0.080 46 39 1.18 11 83 0.13 6 Patient B 0.042 20 73 0.27 49 44 1.11 26 Patient C 0.044 27 63 0.43 15 83 0.18 14 Patient D 0.041 33 54 0.61 36 61 0.59 12 Patient E 0.067 21 66 0.32 27 64 0.42 53 M±SD 0.054±0.018 30±11 59±13 0.56±0.37 28±15 67±16 0.49±0.40 22.2±18.7 Patients with cardioplegia Patient F 24 71 0.34 Patient G 36 57 0.63 Patient H 27 70 0.38 Patient I 47 42 1.13 Patient J 63 23 2.70 M±SD 39±16 53±20 1.04±0.98 Patients TPHRV LF%HRV HF%HRV LF/HFHRV LF%PPGV HF% PPGV LF/HFPPGV S, % Patients without cardioplegia Patient A 0.080 46 39 1.18 11 83 0.13 6 Patient B 0.042 20 73 0.27 49 44 1.11 26 Patient C 0.044 27 63 0.43 15 83 0.18 14 Patient D 0.041 33 54 0.61 36 61 0.59 12 Patient E 0.067 21 66 0.32 27 64 0.42 53 M±SD 0.054±0.018 30±11 59±13 0.56±0.37 28±15 67±16 0.49±0.40 22.2±18.7 Patients with cardioplegia Patient F 24 71 0.34 Patient G 36 57 0.63 Patient H 27 70 0.38 Patient I 47 42 1.13 Patient J 63 23 2.70 M±SD 39±16 53±20 1.04±0.98 Spectral components in HRV and PPGV in patients with and without cardioplegia Open in new tab Patients TPHRV LF%HRV HF%HRV LF/HFHRV LF%PPGV HF% PPGV LF/HFPPGV S, % Patients without cardioplegia Patient A 0.080 46 39 1.18 11 83 0.13 6 Patient B 0.042 20 73 0.27 49 44 1.11 26 Patient C 0.044 27 63 0.43 15 83 0.18 14 Patient D 0.041 33 54 0.61 36 61 0.59 12 Patient E 0.067 21 66 0.32 27 64 0.42 53 M±SD 0.054±0.018 30±11 59±13 0.56±0.37 28±15 67±16 0.49±0.40 22.2±18.7 Patients with cardioplegia Patient F 24 71 0.34 Patient G 36 57 0.63 Patient H 27 70 0.38 Patient I 47 42 1.13 Patient J 63 23 2.70 M±SD 39±16 53±20 1.04±0.98 Patients TPHRV LF%HRV HF%HRV LF/HFHRV LF%PPGV HF% PPGV LF/HFPPGV S, % Patients without cardioplegia Patient A 0.080 46 39 1.18 11 83 0.13 6 Patient B 0.042 20 73 0.27 49 44 1.11 26 Patient C 0.044 27 63 0.43 15 83 0.18 14 Patient D 0.041 33 54 0.61 36 61 0.59 12 Patient E 0.067 21 66 0.32 27 64 0.42 53 M±SD 0.054±0.018 30±11 59±13 0.56±0.37 28±15 67±16 0.49±0.40 22.2±18.7 Patients with cardioplegia Patient F 24 71 0.34 Patient G 36 57 0.63 Patient H 27 70 0.38 Patient I 47 42 1.13 Patient J 63 23 2.70 M±SD 39±16 53±20 1.04±0.98 Spectral components in HRV and PPGV in patients with and without cardioplegia Open in new tab © The European Society of Cardiology 2020 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 2020
TI - EAPC Essentials Abstract Supplement
JF - European Journal of Preventive Cardiology
DO - 10.1177/2047487320935268
DA - 2020-07-01
UR - https://www.deepdyve.com/lp/oxford-university-press/eapc-essentials-abstract-supplement-DlYx9vjsyQ
SP - S1
EP - S119
VL - 27
IS - 1_suppl
DP - DeepDyve
ER -