TY - JOUR
AB - Poster Session 4 Saturday, 10 May 2014, 08:30-12:30 P601 Comparison of body mass index, waist circumference and epicardial adipose tissue for assessment of metabolic impairment in children and adolescents I Schusterova1, FH Leenen2, M Kuchta3, J Saligova4 1Eastern Heart Institute, Kosice, Slovak Republic 2University of Ottawa Heart Institute, Ottawa, Canada 3Kosice University Medical School, Kosice, Slovak Republic 4Children Faculty Hospital, Kosice, Slovak Republic Topic: Obesity (Prevention & Epidemiology) Background Epicardial adipose tissue (EAT) is the visceral fat deposit around the heart and is commonly increased in obese subjects. EAT is related to cardiometabolic risk factors and non-alcoholic fatty liver disease (NAFLD) in adults, but this relationship is not well known in children. Objectives: The aim of our study was to assess by echocardiography the EAT in overweight and obese children and its relationship to cardiometabolic risk factors, insuline resitance, NAFLD markers and hyperuricemia Study group and Methods: In 25 (mean age 13.0 ± 2.3) overweight and obese subjects and 24 lean controls, blood pressure (BP), WC, fasting plasma glucose and insulin, lipids, uric acid and hepatic enzymes were estalished and EAT thickness measured by transthoracic echocardiography. Results: In overweight and obese subjects, EAT was significantly higher compared to normal weight children. Overweight and obese children had significantly higher body mass index (BMI), WC, BP, triglycerides (TAG), low-density lipoprotein and total cholesterol, hepatic enzymes alanine aminotransferase (ALT) and g-glutamyl transferase, and lower high-density lipoprotein cholesterol (HDL-C). EAT correlated significantly with BP, TAG, uric acid, HDL-C, apoprotein B and ALT. Correlation coefficients were similar or better than for WC, but similar or lower than for BMI. In conclusion EAT thickness in children is associated with an unfavorable cardiometabolic risk profile including biochemical signs of NAFLD and hyperuricaemia, but is not a stronger indicator than BMI. P602 Revisiting the relationship between body mass index, obesity and cardiovascular risk S K Malyutina1, G Simonova1, V Gafarov1, YU Nikitin1, E Veryovkin1 1Institute of Internal Medicine SB RAMS, Novosibirsk, Russian Federation Topic: Obesity (Prevention & Epidemiology) The rising prevalence of obesity and metabolic disorders is emerging issue in public health. The obesity is associated with cardiovascular risk factors, but the associations with cardiovascular outcomes are not always consistent. Purpose: We aimed to study the impact of body mass index (BMI) and obesity on 9-year risk of cardiovascular diseases (CVD) incidence and mortality in a general population. Methods: The baseline risk factors were assessed in Novosibirsk (Russia) by population survey in the frame of the WHO MONICA Project. Obesity was defined in those with BMI= 30 kg/m2. The cohorts of 4,897 men and 3,268 women aged 25-64 were followed-up during on the average 9.5 and 8.4 years, respectively. For the end points, we included myocardial infarction (MI), fatal MI, stroke (STR), fatal STR, CVD deaths and deaths from all causes. Multivariable-adjusted Cox s proportional-hazards models were applied for analysis. Results: Totally 750 outcomes occurred during follow-up in the studied cohort. In age-adjusted models among men the relationship between BMI and MI incidence and mortality or STR incidence and mortality was approximately J-shaped. Among women, these relations were not consistent. The relationship between BMI and CVD deaths was approximately U-shaped, and between BMI and all-cause deaths – approximately L-shaped both in men and women. Unadjusted relative risk (RR) of fatal MI, fatal STR and CVD death was elevated 2-5 times (p=0.002 – 0.02) in obese men and 2-3 times (p=0.03 – 0.05) in obese women compared to those with normal BMI (< 25 kg/m2). However, after controlling for covariates (age, hypertension, smoking, blood lipids, alcohol intake) the association was attenuated to insignificant. Conclusions: In studied cohort the unadjusted relationship between BMI and CVD risk was J- or U-shaped, however the excess risk of CVD in obese men and women was attenuated to insignificant after adjusting for covariates. The findings support the implication that excess CVD risk in obesity is largely mediated by hypertension and blood lipids. P603 Association between Obesity and Short sleeping hour in Korean Young Adults S Y Jang1, EY Ju2, DK Kim1, SW Park1 1Samsung Medical Center, Cariovascular Imaging Center, Cardiac and Vascular Center, Seoul, Korea, Republic of 2Seoul National University, Graduate School of Public Health, Seoul, Korea, Republic of Topic: Obesity (Prevention & Epidemiology) Purpose: The aim of this study is to investigate the association between short sleep hour and body mass index (BMI) obesity after adjustment for socioeconomic position and health behavior factors in the general representative population in Korea in 2007-2009. Methods: The fourth Korea National Health and Nutrition Examination Survey was conducted by the Korea Institute for Health and Social Affairs for the Korean Ministry of Health and Welfare in 2007-2009. The sample included 6,424 Korean Young adults aged 20-44 years (male 3,400 and female 3,017). Sleep duration was grouped by hours slept but was also classified into two categories: short sleepers (<6 h/night) and normal sleepers (6–9 h/night). Results: The distribution of short sleepers and normal sleepers was 9.5% and 90.5%, respectively. The distribution of obesity was 27.8%. The adjusted odds ratio (OR) for obesity was 1.39 (95% Confidence Interval (CI) 1.09-1.77) after adjustment for confounding factors. In male, the adjusted OR for obesity was not significant difference, however, in female, the adjusted OR for obesity was 1.66 (95% CI 1.14-2.40) Conclusions: This community-based random sample drawn from the entire Korean young adults population showed that short sleep hour was significantly associated with obesity, especially, female. P604 The Systematic COronary Risk Evaluation (SCORE) in the prediction of subclinical atherosclerosis in overweight adults LI Graur1, L Mihalache1, C Grosu1, O Nita1, DS Popescu1, A Gherasim1, M Graur1 1"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania Topic: Obesity (Prevention & Epidemiology) Purpose: Atherosclerotic cardiovascular disease (CVD) is the leading cause of death world-wide. Risk prediction models, such as Systematic COronary Risk Evaluation (SCORE) algorithm, are widely used in clinical settings. Imaging for subclinical atherosclerosis on top of conventional risk factor assessment may improve risk prediction for the occurance of CVD events in certain populations. Obesity, defined as body mass index (BMI) = 30 kg/m2 is without doubt seen as a cardiovascular risk factor. As for overweight (BMI = 25-29.9 kg/m2), some studies have found contradictive results. The aim of this study was to assess how ultrasound measurements of carotid intima-media thickness (CIMT) compare with the SCORE in the overweight population. Methods: We used a representative sample of individuals aged 18 or over from the general population in a large rural community - 3248 adults registered in the data bases of the general practitioners. Carotid ultrasonography was performed for measuring CIMT. We assessed CVD risk using SCORE high risk algorithm. The study had the approval of the Ethical Committee of our University. Results: A total of 254 individuals (40.2 % male) with a mean age of 54.8 (SD 16.9) were included. Two percent of the study population was underweight, 31.1 % was of normal weight, 37.8 % were overweight and 29.1 % were obese, with no statistically significant differences between genders (p>0.05). There was a linear positive correlation between BMI and SCORE (R=0.154, p=0.014). However, there was no statistically significant difference between the SCORE level of the overweight compared to the normal weight (p>0.05), and compared to the obese individuals. There was a positive linear correlation between BMI and CIMT (R=0.299, p<0.001). Overweight women had a significant higher CIMT than normal weight women (p=0.023) and equal to obese women (p=0.504). In men, overweight individuals had similar values of CIMT with normal weight men (p>0.05) and significantly lower values than obese men (p=0.009). Conclusions: Overweight women have higher subclinical atherosclerosis than overweight men, and equal to obese women. SCORE underestimates risk of atherosclerosis in overweight women. Measurement of CIMT, a noninvasive estimate of current atherosclerotic burden, is feasible in clinical setting and can be integrated into the CHD risk assessment models for the overweight population. P605 Visceral obesity and risk factors of cardiovascular diseases in men with professional stress NV Pyrikova1, IV Osipova2, AG Zalzman1, IV Kalinina2, ON Antropova2 1Railway Clinical Hospital, Barnaul, Russian Federation 2Altay State Medical University, Barnaul, Russian Federation Topic: Obesity (Prevention & Epidemiology) Aim: To assess of body composition and risk factors of cardiovascular diseases in men with professional stress. Materials and methods: The study included 50 men, machinists and their assistants (40,4±11,1 years). Bioimpedance was performed on the body composition analyzer Tanita BC- 418 (Japan), measured the percentage of visceral fat, the range of 1 to 12 - normal, 13 to 59 - an increased level of visceral fat; studied the risk factors of cardiovascular disease. Results. Visceral obesity by bioimpedance found in 44%. Man (24%) with a waist circumference >94 cm, but without visceral obesity compared to individuals with normal waist circumference and visceral fat have median visceral fat is more than 2 times (8,0±3,1 and 3,9±2,9, p=0,002) muscle mass is less than 7% (74 and 81%, p=0,02) of water is more than 5% (57 and 62%, p = 0,02), lack of muscle mass was detected most 6 times (57 and 9%; ?2=4,26; p=0,04), triglyceride level was 2 fold higher (1,91±0,89 and 0,98±0,40 mmol/l, p<0,05). A strong positive correlation between the level of visceral fat with diastolic blood pressure (p=0,001), the average strength of association with plasma glucose levels and systolic blood pressure (p=0,001). Individuals with visceral obesity smoked least 2.4 times (?2=4,21, p=0,029), hypertension they detected more frequently by 3.6 times (24 and 88%; ?2=13,3, p = 0,0003), dyslipidemia 2 times (?2=4,75, p=0,028), increase in blood glucose - 1.1 times (5,29±0,93 and 4,58±0,5 mmol/l, p=0,03) compared with those without visceral obesity. Conclusions: Determination of visceral fat and body composition monitoring by bioimpedance in men with professional stress can identify individuals with a poor prognosis and provide targeted prevention recommendations to reduce the risk of cardiovascular disease. This method allows you to specify the diagnosis of the metabolic syndrome: abdominal obesity in normal weight, lack of obesity at high values ??of body mass index in patients with well-developed muscular system. P606 Prevalence of weight excess in a young student population J F Kerr Saraiva1, DJB Saraiva1, LAM Cesar1, A Timerman1, A Avezum1, JRZ Mendes1, CC Magalhaes1 1SOCESP Cardiology Society of Sao Paulo, Sao Paulo, Brazil Topic: Obesity (Prevention & Epidemiology) Objectives: To evaluate the prevalence of overweight and obesity in children, 7 to 18 years, both genders, from public schools of the metropolitan city of Campinas, Brazil. Methods: In this cross-sectional epidemiological study eleven schools were randomly selected, from representative city areas. Study protocol included a structured questionnaire, anthropometry, and blood pressure measurement. A non fasting lipid profile was obtained for further analysis. A sample of 4,699 students (47.1% male; mean age, 11.1 ± 2.9 yr) were evaluated. Results: About 3,092 students walked daily to school; complementary physical activity included 1.54h weekly for school classes and 2.23h weekly for outside school activity. Sedentary habits (television, videogames and computers) accounted for 3.29h daily. Dietary records showed meat consumption once a week in 25.9% and 37.3% did not have any fish consumption. Daily consumption of sweets and soft drinks was 26.6% and 26.8%, respectively. Fast food consumption, once a week, was present in 25.8%. Overweight (>+1SD) and obesity (>+2SD) were present in 15.7% and 16%. Weight excess was more prevalent in the younger group: 33.9% for ages 7-12 y. and 26.8% for 13-18y. Conclusions: The association of sedentary lifestyle and unhealthy dietary habits, with consequently high prevalence of overweight and obesity, firmly confirm the need for effective interventions starting before school age to effectively reverse unfavorable trends for cardiovascular risk and potential cardiovascular disease in the today's society. P607 Preclinical atherosclerosis and metabolic syndrome increase cardio and cerebro-vascular events in a 20-years follow up S Novo1, F Guarneri1, A Peritore1, RL Trovato1, D Di Lisi1, G Novo1 1Polyclinic P. Giaccone of the University of Palermo, Department of Internal & Specialist Medicine, Palermo, Italy Topic: Obesity (Prevention & Epidemiology) Background: Intima-Media Thickness (IMT) is a validated marker of subclinical preclinical atherosclerosis and a predictor of cardiovascular events. Methods: We studied a population of 529 asymptomatic patients (age 62 ± 12.8 years), divided into 2 groups according to the results of the carotid ultrasound evaluation: one without atherosclerotic lesions and a second one with preclinical atherosclerosis (increased IMT or asymptomatic carotid plaque). In each group, we identified two subgroups of subjects with and without Metabolic Syndrome (MetS). Cardiovascular endpoints were investigated in a 20-years follow-up. Results: There were 242 cardiovascular events, 144 among patients with MetS and 98 among healthy controls (57.4 % vs. 35.2 %; P < 0.0001). 63 events occurred in patients with normal carotid arteries while 179 events occurred in patients with preclinical atherosclerosis (31.8 % vs. 54.1 %; P < 0.0001). Among 144 total events occurred in patients with MetS, 36 happened in the subgroup with normal carotid arteries and 108 in the subgroup with preclinical atherosclerosis (45% vs. 63.15%; P = 0.0099). Ninety-eight events occurred in patients without MetS, of which 27 in the subgroup with normal carotid arteries and 71 in the subgroup with preclinical atherosclerosis (22.88 % vs. 44.37 %; P = 0.0003). In addition, considering the 63 total events occurred in patients without atherosclerotic lesions, 36 events were recorded in the subgroup with MetS and 27 events in the subgroup without MetS (45% vs. 22.88%; P= 0.0018). Finally, in 179 total events recorded in patients with preclinical carotid atherosclerosis 108 happened in the subgroup with MetS and 71 happened in the subgroup without MetS (63.15 % vs. 44.37 %; P = 0.0009). The Kaplan-Meier function showed an improved survival in patients without atherosclerotic lesions compared with patients with carotid ultrasound alterations (P = 0.01, HR: 0.7366, CI: 0.5479 to 0.9904). Conclusions: Preclinical atherosclerosis lead to an increased risk of cardiovascular events, especially if it is associated with MetS. P608 Study of risk factors and left ventricular mass and function in normotensive offsprings of hypertensive parents S Bansal1, A Dua1, D Gulati1 1Safdarjung Hospital, New Delhi, India Topic: Hypertension (Prevention & Epidemiology) Purpose- Nature and time of onset of metabolic and morphological changes in offsprings of hypertensives is unclear. Methods: Height,weight,BMI,fasting/ postprandial glucose and left venticular echocardiographic parameters were measured in 30 normotensive offsprings with atleast one hypertensive parent and age, weight and height matched normotensive controls who had normotensive parents. Results: are given in table- Conclusions- In offsprings of hypertensives preventive strategies must start very early as metabolic and morphological changes start very early. Though these may be within normal limits they are still significantly deranged compared to their peers with normotensive parents. Results Controls Cases p value BMI 24.5±1.4 25.6±2.2 <0.05 sBP 117.3±4.9 125.7±6.8 <0.01 dBP 79.7±3.9 82.2±5.1 <0.05 FBS 94.6±6 103.4±6.7 <0.001 PP BS 104.7±7.5 121.7±8.8 <0.001 Chol 173.8±8.2 191.9±16.6 <0.001 LDLC 90.7±3.9 94.6±8.7 <0.01 HDLC 44.1±2.7 41.1±2.6 <0.001 LVEDV(ml) 87.0±2.7 91.4±5.1 <0.001 LVESV(ml) 47.2±3.1 46.9±3.6 NS LVEF% 67.5±1.9 67.2±3.0 NS LVSV(ml) 69.5±2.4 70.3±3.7 NS IVSd(mm) 8.8±0.3 9.3±0.6 <0.001 LVIDs(mm) 28.7±1.4 33.7±12.9 <0.05 LVIDd(mm) 44.3±2.5 48.1±2.4 <0.001 LVmass 120.3±13.2 152.4±20.2 <0.001 Controls Cases p value BMI 24.5±1.4 25.6±2.2 <0.05 sBP 117.3±4.9 125.7±6.8 <0.01 dBP 79.7±3.9 82.2±5.1 <0.05 FBS 94.6±6 103.4±6.7 <0.001 PP BS 104.7±7.5 121.7±8.8 <0.001 Chol 173.8±8.2 191.9±16.6 <0.001 LDLC 90.7±3.9 94.6±8.7 <0.01 HDLC 44.1±2.7 41.1±2.6 <0.001 LVEDV(ml) 87.0±2.7 91.4±5.1 <0.001 LVESV(ml) 47.2±3.1 46.9±3.6 NS LVEF% 67.5±1.9 67.2±3.0 NS LVSV(ml) 69.5±2.4 70.3±3.7 NS IVSd(mm) 8.8±0.3 9.3±0.6 <0.001 LVIDs(mm) 28.7±1.4 33.7±12.9 <0.05 LVIDd(mm) 44.3±2.5 48.1±2.4 <0.001 LVmass 120.3±13.2 152.4±20.2 <0.001 Open in new tab Results Controls Cases p value BMI 24.5±1.4 25.6±2.2 <0.05 sBP 117.3±4.9 125.7±6.8 <0.01 dBP 79.7±3.9 82.2±5.1 <0.05 FBS 94.6±6 103.4±6.7 <0.001 PP BS 104.7±7.5 121.7±8.8 <0.001 Chol 173.8±8.2 191.9±16.6 <0.001 LDLC 90.7±3.9 94.6±8.7 <0.01 HDLC 44.1±2.7 41.1±2.6 <0.001 LVEDV(ml) 87.0±2.7 91.4±5.1 <0.001 LVESV(ml) 47.2±3.1 46.9±3.6 NS LVEF% 67.5±1.9 67.2±3.0 NS LVSV(ml) 69.5±2.4 70.3±3.7 NS IVSd(mm) 8.8±0.3 9.3±0.6 <0.001 LVIDs(mm) 28.7±1.4 33.7±12.9 <0.05 LVIDd(mm) 44.3±2.5 48.1±2.4 <0.001 LVmass 120.3±13.2 152.4±20.2 <0.001 Controls Cases p value BMI 24.5±1.4 25.6±2.2 <0.05 sBP 117.3±4.9 125.7±6.8 <0.01 dBP 79.7±3.9 82.2±5.1 <0.05 FBS 94.6±6 103.4±6.7 <0.001 PP BS 104.7±7.5 121.7±8.8 <0.001 Chol 173.8±8.2 191.9±16.6 <0.001 LDLC 90.7±3.9 94.6±8.7 <0.01 HDLC 44.1±2.7 41.1±2.6 <0.001 LVEDV(ml) 87.0±2.7 91.4±5.1 <0.001 LVESV(ml) 47.2±3.1 46.9±3.6 NS LVEF% 67.5±1.9 67.2±3.0 NS LVSV(ml) 69.5±2.4 70.3±3.7 NS IVSd(mm) 8.8±0.3 9.3±0.6 <0.001 LVIDs(mm) 28.7±1.4 33.7±12.9 <0.05 LVIDd(mm) 44.3±2.5 48.1±2.4 <0.001 LVmass 120.3±13.2 152.4±20.2 <0.001 Open in new tab P609 Control of cardiovascular risk factors with ursodeoxycholic acid and indapamide in postpreeclamptic nursing mothers: results from a randomized, case-control 1-year study IR Gaisin1, AS Iskchakova2, LV Shilina2 1State Medical Academy, Izhevsk, Russian Federation 2Clinical Diagnostic Centre of the Udmurt Republic, Izhevsk, Russian Federation Topic: Hypertension (Prevention & Epidemiology) Background: Preeclampsia has been recognized as an important risk factor for CVD in women. Therefore, lifestyle modifications, regular blood pressure control, and control of metabolic factors are recommended after delivery, to avoid complications in subsequent pregnancies and to reduce maternal CV risk in the future. There are no uniform recommendations for the treatment of post-partum dyslipidaemia and hypertension yet. Methods: In a case-control, open-label 1-year study, 30 postpreeclamptic dyslipidaemic hypertensive breastfeeding women [aged 24–38 years; body mass index 26.4±4.2 (SD) kg/m2] were randomized 1:1 to receive either ursodeoxycholic acid 250 mg t.i.d. plus indapamide 1.5 mg daily or adjusted-dose methyldopa. No significant differences observed between two groups at baseline. Results: No maternal and offspring adverse effects were registered in both groups. After comprehensive follow-up, blood pressure was not found to differ substantially between two groups (122±6/75±4 mmHg vs. 126±6/78±5 mmHg). Treatment with ursodeoxycholic acid significantly improved atherogenic lipid profile: total cholesterol reduced from 7.35±0.21 to 5.84±0.10 mmol/L (p=0.0022), low-density lipoprotein-cholesterol decreased from 4.41±0.15 to 3.53±0.08 mmol/L (p=0.0078), high-density lipoprotein-cholesterol increased from 0.99±0.02 to 1.49±0.05 mmol/L (p=0.00024), and apolipoprotein (apo) B:apoA1 ratio decreased from 1.38±0.07 to 1.06±0.05 (p=0.00085). No significant lipid/apo changes were observed in the control group. There was a significant difference in weight reduction, in favour of ursodeoxycholic acid plus indapamide (–8.4 kg vs. –2.1 kg, p=0.00085), as well as in decrease of microalbuminuria (–193.2 mg/24 h vs. –42.8 mg/24 h, p=0.00032) and left ventricular mass index (–28.4 g/m2 vs. –10.4 g/m2, p=0.0018). Treatment with ursodeoxycholic acid and indapamide significantly improved endothelial function, non-invasively assessed by flow-mediated dilatation of the brachial artery using high-resolution ultrasound (+9.3% vs. +3.2%, p=0.021). Moreover, ursodeoxycholic acid and indapamide demonstrated good safety profile and led to high adherence to treatment. No significant changes in glucose metabolism and renal function were found in both groups. Conclusions: The results provide support for ursodeoxycholic acid and indapamide as a promising therapy for postpreeclamptic patients with dyslipidaemia and hypertension. P610 Arterial stiffness in children with essential hypertension and white coat hypertension A Jurko1, I Tonhajzerova2, T Jurko1, Z Visnovcova2, M Mestanik2, A Jurko1 1Pediatric Cardiology, Martin, Slovak Republic 2Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University, Martin, Slovak Republic Topic: Hypertension (Prevention & Epidemiology) Purpose: Increased arterial stiffness is an independent predictor of cardiovascular disease and mortality in middle-aged and older adults. The studies regarding the arterial stiffness in children with risk factors for the early progression of systemic atherosclerosis are rare. Thus, the purpose of this study was to study the arterial stiffness and early atherosclerotic changes in children suffering from essential hypertension and white coat hypertension using noninvasive markers. Methods: We have examined 28 children (14 boys) with essential hypertension (EH) and white coat hypertension (WCH) without clinical symptoms of other cardiovascular diseases and 28 age and gender-matched healthy controls. The age-period of all children ranged from 17 to 18 years. Evaluated parameters - cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (baPWV) and carotid-femoral PWV (cfPWV) - were assessed using the system VaSera 1500 (Japan). In addition, mean heart rate was evaluated. Results: Mean heart rate and baPWV were significantly higher in chidren with WCH than healthy subjects (p<0.01). However, CAVI and cfPWV mean values did not differ significantly between EH (5.35± 1.06; 8.7± 3.0, respectively), WCH (5.58 ± 0.79 ; 7.7 ± 2.5, respectively) and control groups (5.02 ± 0.71; 7.9 ± 2.0, respectively). Conclusions: Our study revealed the significant higher brachial-ankle pulse wave velocity and heart rate in white coat hypertension indicating a potential sympathetic overactivity as a major pathomechanism leading to the development and stabilisation of hypertension. Furthermore, we did not found significant differences in other parameters between individual diagnoses at this age-period. Thus, further research and longitudinal study of the potential atherosclerotic changes using the sensitive noninvasive parameters in children, adolescents and young adults suffering from EH and WCH are important. P611 Ambulatory hypotensive effect of physical training: a reappraisal through a meta-analysis of selected moderators P Sosner1, T Guiraud2, V Gremeaux3, D Arvisais4, L Bosquet5 1CHU de Poitiers, Cardiologie; Université Poitiers, Laboratoire MOVE (EA 6314), Poitiers, France 2Inserm U1048, Université Paul Sabatier; Clinique Saint-Orens, Centre de Rééducation Cardiovasculaire, Toulouse, France 3CHU de Dijon, Pôle Rééducation-Réadaptation, Université Bourgogne, Inserm U1093, Dijon, France 4University of Montreal, Direction of Libraries, Montreal, Canada 5Université Poitiers, Faculté des Sciences du Sport, Laboratoire MOVE (EA 6413), Poitiers, France Topic: Hypertension (Prevention & Epidemiology) Objectives: The effectiveness of chronic exercise to decrease blood pressure (BP) is well established. However, this hypotensive effect may be altered by a number of variables including the participants characteristics, the physical activity program characteristics and other co-interventions including diet or medication. Therefore, the purpose of this study was to assess the effect of these moderators on ambulatory blood pressure through a meta-analysis of the existing literature. Methods: Three databases were searched using relevant terms and strategies (from 1945 to 2013-Oct-19). Inclusion criteria were: randomised controlled trials with quality score using PEDro scale and van Tulder scale =5, presence of relevant details about training intervention and subjects characteristics, and pre and post-training measurements of ambulatory blood pressure (ABPM). Results: Thirty studies from 676 identified records met inclusion criteria. The overall effect was a standardized mean difference (SMD) reached for systolic / diastolic 24h ABPM -0.47/-0.44 mmHg (95% CI -0.59 to -0.35 / -0.60 to -0.27 respectively; P<0.01), for day-time systolic / diastolic ABPM -0.70/-0.65 mmHg (95% CI -0.98 to -0.42 and -0.92 to -0.37 respectively; P<0.01). Moderators associated with ABPM improvement were the following: an initial casual BP =140/90 mmHg (hypertensive or uncontrolled BP subjects), diet co-intervention, training program duration longer than 12 weeks, and cumulative number of exercises more than 40 sessions. These improvements were significant or higher for day-time systolic BP than other BP variables. We found no differences for gender, age, or presence of antihypertensive drugs. Conclusions: Antihypertensive effects of aerobic training assessed by ABPM appear modest but significant, and our meta-analysis highlights favourable moderators as initial high BP, diet, and training cumulative duration. P613 Epidemiology of arterial hypertension in working population of Chelyabinsk region in 2002-2007 SL Levashov Sergey1, MR Redkina Marina1, AG Gorbunova Anastasia1, EG Volkova1 1South Ural State Medical University, Chelyabinsk, Russian Federation Topic: Hypertension (Prevention & Epidemiology) Purpose: to assess based on 5 years of monitoring the incidence of arterial hypertension and the dynamics of blood pressure levels according to gender, age and treatment Materials and Methods: A cross-sectional population based epidemiological study was conducted in 2002 and 2007. Representative samples of the population of Chelyabinsk region aged 18-64 were selected from lists of Health Insurance Fund. In 2002 was selected 4,000 men and women, a response rate was 63.1%, in 2007 - 3000 respondents, a response rate was 65.2 %. All respondents were divided into groups by sex and by age - 18-24, 25-34, 35-44, 45-54, 55-64 years. The survey included measurement of blood pressure and evaluation treatment of arterial hypertension (AH). Results: Analysis of the 5 year prevalence of AH showed an increase from 36,6% in 2002 to 43,1% in 2007 in general (p<0,03): 27,3% vs 31,1% in men, 33,9% vs 41,5% in women (p<0,001). Average systolic blood pressure (SBP) in the population as a whole has increased by 1,1 mmHg: 126,9±0,45 mmHg in 2002 vs 128,0±045 mmHg in 2007 (p=0,001), mainly due to the age group 18-24 years. In people with AH the SBP decreased - 140,8±22,9 in 2002 vs 138,2±18,5 mmHg in 2007, (p=0,02). In the age group 25-34 there was identified significant increase of average SBP by 7,7 mmHg (p=0,003), in age groups 18-24 and 35-44 average SBP increased insignificantly, in age group 45-54 mean SBP decreased by 3.6 mmHg (p=0,07), and in age group 55-64 mean SBP decreased by 8,2 mmHg (p=0,001). Diastolic blood pressure (DBP) decreased - 88,0±12,4 vs 85,6±10,1 mmHg, (p=0,001). There was also an increase in the proportion of people with antihypertensive therapy: 36,5% in 2002 vs 63,8% in 2007 in general (p<0,01), 32,3% vs 55,1% in men (p<0,01) and 39,0% vs 67,9% in women respectively (p<0,01). Among men and women receiving antihypertensive therapy, the most significant decrease in the SBP and DBP levels was observed in the age group 55-64: in men from 152,4±18,5 to 143,6±13,6 mmHg (p=0.016) and in women from 157,2 ±25,3 to 147,2±19,6 mmHg (p=0.002). DBP decreased in men from 93,9±10,0 to 87,9±9,3 mmHg (p=0.007) and from 94,1±13,1 to 89,0±9,3 mm Hg in women respectively (p=0.002). Conclusions: The increase of the prevalence of AH in the population is accompanied by an increase of the number of persons, receiving antihypertensive therapy, and by reduction of mean levels of SBP and DBP in people with AH, most significant in 55-64 age group. These positive trends are associated with the reduction of mortality from circulatory diseases among the 55-64 age group of the South Ural region P614 Atherosclerosis in patients with prediabetes and type 2 diabetes is associated with more significant microcirculation abnormalities VM Shyshko1, TV Mokhort1, EE Konstantinova2, NL Tsapaeva1 1Belarusian State Medical University, Minsk, Belarus 2Belarus Cardiology Centre, Minsk, Belarus Topic: Diabetes Type 1/2 (Prevention & Epidemiology) It is known that patients with prediabetes (impaired glucose tolerance and impaired fasting glucose) and type 2 diabetes (T2D) have micro-and macrovascular complications. It was estimated that vascular changes begin in the smallest vessels that lead to microcirculation abnormalities. Purpose: to estimate microcirculation abnormalities in patients with prediabetes and T2D and concomitant CHD and atherosclerosis. Materials and Methods: 181 patients were divided into 5 groups: 1 – 27 patients with prediabetes, 2 – 28 patients with prediabetes and concomitant CHD (effort angina, functional class 1-2), 3 – 20 patients with prediabetes and concomitant CHD and atherosclerosis in distal vessels, 4 – 47 patients with T2D and concomitant CHD and 5 – 59 almost healthy person. Microcirculation was measured by computer based conjunctival biomicroscopy (Malaja L.T.), results were evaluated by the set of criteria for quantitative evaluation of conjunctival microcirculation: FC (number of active capillary tubes), AVA (arteriovenous anastomosis), Mean (vascular tortuosity), Sl (sludge), Mtr (microthrombosis). Severity of each criteria was scored and more severy changes had higher degree. Results: Microcirculation abnormalities (increased Mean) were revealed in patients with prediabetes (0,37+0,039) without concomitant CHD compared to almost healthy person (0,27+0,009, p<0,05). In patients with prediabetes and concomitant CHD (group 2) and atherosclerosis (group 3) microcirculation abnormalities consisted in Mean (0,4+0,039, 0,5+0,048 correspondingly), development of Sl (2,4+0,22, 2,5+0,24 correspondingly vs 1,81+0,05) and development of Mtr (2,2+0,15, 2,08+0,14 correspondingly vs 0,72+0,006) compared to almost healthy person (p<0,05, p<0,01 ? p<0,001; p<0,001, p<0,01 ? p<0,001 correspondingly). The lowest number of FC was revealed in patients with T2D and CHD (2,77+0,11) compared to group 5, (1,94+0,06, (p<0,001). Consequently all patients with impaired glycemic states had microcirculation abnormalities Conclusions: Minimal microcirculation abnormalities were revealed in patients with prediabetes without concomitant diseases. In the presence of CHD or atherosclerosis intensity of symptoms increases. Maximal changes were revealed in patients with T2D and CHD. P615 Is it possible to prevention of acute myocardial infarction in patients with purulent complications of type 2 diabetes? E Shalaeva1, A Shalaeva1, B Babajanov2, B Janabaev2, A Bababekov2 1Tashkent Medical Academy, Tashkent, Uzbekistan 2Republican specialized center of purulent surgery and complications of diabetes mellitus, Tashkent, Uzbekistan Topic: Diabetes Type 1/2 (Prevention & Epidemiology) Purulent complications (gangrene, abscess, and cellulitis) in patients with type 2 diabetes require emergency surgery for health reasons. Aim: Determine the frequency and causes of acute myocardial infarction (MI) in patients with type 2 diabetes with purulent complications. Materials and methods: In 2013, 320 patients (142 women and 178 men) aged 52.8±of 8.2 years were operated in the Republican specialized center of purulent surgery and complications of diabetes mellitus. All patients had severe decompensated type 2 diabetes mellitus with purulent complications of the lower limbs (gangrene, abscess, and cellulitis), as well as the high comorbidity. Patients before surgery conducted a full range of tests. Results: Before the operation, patients were taking aspirin, beta-blockers, ACEI or ARB II, insulin in individually selected doses; heparin 5000 IU 4 times a day subcutaneously, atorvastatin 20 mg orally were added. Development of purulent complications accompanied by a sharp deterioration of the general condition. Arterial hypertension 1st degree detected in 15% (n=48), 2nd degree in 60.9% (n=195), 3rd degree in 24.1% (n=77) patients. In 100% of cases on ECG ST - segment depression>1 mm was observed, dominating in III, aVF (n=169, 52.8%), 16.2% of patients with typical angina and 83.8% with silent myocardial ischemia. Before surgery, the patients had stable hemodynamics. In the postoperative period 54 patients were transferred to the intensive care, of them 32 cases (10%) acute myocardial infarction was diagnosed (Q wave in 9, without Q 23), four of which were fatal. We analyzed data divided the patients into the group where in postoperative period acute myocardial infarction was detected (n = 28), and the group without acute coronary syndrome (n = 266). In both 2 groups there were no significant differences in age, gender, level of cholesterol, smoking. However, systolic blood pressure on admission was higher in group with MI, then without it (174.1±17,8 / 158.7±14.4 mm Hg; p=0.041), fibrinogen 715.4±201.5 / 511.6±159.8 mg% (p<0.001), blood urea 10.8±3,2 / 7.1±of 1.9 mmol/l (p=0,018), blood creatinine 0.09±0,03 / 0.06±0.02 g/l (p=0.02), respectively. HbA1c in patients with acute myocardial infarction was significantly higher (11.9±0.5 / 9.1±1.1%, p=0,012). INR was authentically lower in the patients with myocardial infarction 1.3±0.3 / 1.7±0.4 (p=0.49) in comparison. Conclusions: Prevention of purulent complications and adequate treatment of type 2 diabetes can reduce the risk of myocardial infarction, which was in 10% of patients. P616 Diagnostic and prognostic significance of Tissue Doppler parameters, derived deformation parameters and blood pressure pattern in asymptomatic type 2 diabetic patients A Stevanovic1, M Dekleva2 1Railway Health Care Institute, Belgrade, Serbia 2University Clinical Center Zvezdara, Department of Cardiology, Belgrade, Serbia Topic: Diabetes Type 1/2 (Prevention & Epidemiology) Background: Subclinical left ventricular (LV) systolic and diastolic dysfunction is prevalent in diabetic subjects. In normotensive type 2 diabetic patients ambulatory blood pressure monitoring (ABPM) can show a non-dipping nocturnal pattern of blood pressure. This patients are at risk of cardiovascular morbidity and mortality. Aim: To explore the diagnostic and prognostic role of Tissue Doppler, deformation parameters and nocturnal pattern of blood pressure for the primary cardiac events in normotensive diabetic patients. Methods: The study included 40 asymptomatic normotensive typ 2 diabetic patients and 35 age and sex matched healthy subjects. Tissue Doppler velocities were measured from medial annulus (e, a, s), including isovolumic contraction velocity (IVCv) and acceleration during isovolumic contraction (IVA), acceleration time (tIVA), E/e and Doppler tissue myocardial performance index. Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking. ABPM was performed in all patients. All patients were followed up for three years. The end point was cardiac event (myocardial infarction, coronary revascularization procedures, stabile or nonstabile new-onset angina and heart failure). Results: There was close correlations between values of GLS and E/e (r=0.460, p=0.0003), tIVA (r=-0.369, p=0.001) and IVCv (r=-0.386, p=0.001) with significantly lower values of GLS (-17.9±2.8 vs -26.6±2.9; p=0.0001), IVCv (0.07±0.02m/s vs 0.09±0.03m/s; p=0.03) and tIVA (29.5±9.59 vs 36.5±9.76; p=0.003) and significantly higher value of E/e (9.11±2.24 vs 7.18±1.65; p=0.0001) in group of diabetic patients. Diabetic patients with E/e=12 (Long Rank 6.11, p=0.013) and with IVCv=0.06 (Long Rank 4.25, p=0.039) were at most at risk of cardiac event in the following three years. ABPM showed that 13 diabetic patients (32%) had a non-dipping pattern, despite the fact that they are considered normotensive patients. Non-dipping pattern was associated with E/e (r=-0,326, p=0,004) and GLS (r=-0,290, p=0,012). Also in our study non-dipping of nocturnal blood pressure was of prognostic importance too (Long Rank 12,95, p=0.0003). Conclusions: Nocturnal hypertension is asociated with subclinical LV diastolic and systolic dysfunction in diabetic patinets. Early detection of nocturnal hypertension and subclinical LV dysfunction is very important for preventing cardiac events. IVCv, tIVA and GLS might be simple and helpful indicators in estimation and early detection of LV dysfunction in diabetic patients. E/e and IVCv represents a simple tools for assessing cardiac risk in asymptomatic typ 2 diabetic patients. P617 The observational HDL hypothesis: a useful therapeutic target? A meta-analysis of 117,411 patients in Randomised Controlled Trials D Keene1, C Price1, M Shun-Shin1, D Francis1 1Imperial College London, NHLI, International Centre for Circulatory Health, London, United Kingdom Topic: Lipid Disorders (Prevention & Epidemiology) Background: Epidemiological studies have shown HDL to be a prognostic marker. We undertook a meta-analysis to assess the benefit on cardiovascular outcomes for those patients on pharmacological interventions aimed at increasing HDL. Niacin, fibrates and cholesteryl ester transfer protein inhibitors (CETP-I) were identified as agents that raise HDL levels. Design: We conducted a meta-analysis of HDL raising therapies and reported the outcomes on the following events; all-cause mortality, coronary heart disease mortality, non-fatal myocardial infarction (MI) and stroke. Results: 39 trials randomised 117,411 patients to HDL raising therapy or control. All interventions raised HDL. All-cause mortality was not significantly affected by any pharmacological HDL raising intervention. The reported odds ratios for niacin, fibrates, or CETP-I are (OR), 1.03(95% CI 0.92 to 1.15 p=0.59), 0.98(0.89 to 1.08 p=0.66), and 1.16(0.93 to 1.44 p=0.19) respectively. None of niacin, fibrates, or CETP-I had a significant effect on CHD mortality, OR 0.93(95% CI 0.76 to 1.12 p=0.44), 0.92(0.81 to 1.04 p=0.19) and, 1.00(0.80 to 1.24 p=0.99) respectively. Likewise for stroke no significant effect was seen for niacin, fibrates or CETP-I, OR 0.96(0.75 to 1.22 p=0.72), 1.01(0.90 to 1.13 p=0.84) and 1.14(0.90 to 1.45 p=0.29) respectively. Niacin trials conducted prior to the era of routine statin therapy showed a significant reduction in non-fatal MI, OR 0.69(0.56 to 0.85 p=0.0004), but with background statin there was no significant effect, OR 0.96(0.85 to 1.09 p=0.52). Fibrates behaved similarly. For non-fatal MI, without background statin OR was 0.78(0.71 to 0.86 p<0.00001) but with some or all patients on statin OR was 0.83(0.69 to 1.01 p=0.07). Conclusions: No HDL-raising agents reduced all-cause mortality, coronary heart disease mortality, myocardial infarction or stroke in statin treated patients. The observational hypothesis that raising HDL should reduce cardiovascular events appears to be incorrect. P618 Subjects with low HDL-cholesterol reported higher Cardiovascular Disease (CVD) risk than subjects with high LDL-cholesterol: The Attica study, 5-year follow-up (2001-2006). N Georgousopoulou1, D Panagiotakos1, C Pitsavos2, C Chrysochoou2, I Skoumas2, C Stefanadis2 1Harokopio University, Athens, Greece 2Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece Topic: Lipid Disorders (Prevention & Epidemiology) Introduction: The aggravating role of low HDL-cholesterol on Cardiovascular Disease (CVD) risk has been reported in several studies. Though, low HDL-cholesterol has not been compared with high LDL-cholesterol as far as CVD risk is concerned. Aim of the present study was to compare these two phenotypes regarding their role in CVD. Methodology. Among the 3042 participants of the Attica study, 2101 of them were followed-up for 5 years (2001-2006) and the incidence of CVD (fatal and non-fatal) was reported. The study sample was separated into four categories: 1) normal LDL-cholesterol/normal HDL-cholesterol, 2) high LDL-cholesterol/normal HDL-cholesterol, 3) normal LDL-cholesterol/normal HDL-cholesterol and 4) high LDL-cholesterol/low HDL-cholesterol. The aforementioned categories were associated with CVD risk, after adjusting for potential confounders. Results: 32% of the participants reported both cholesterol clusters within normal range, 38% high LDL-cholesterol and normal HDL-cholesterol, 14% normal LDL-cholesterol and low HDL-cholesterol and 16% high LDL-cholesterol and low HDL-cholesterol. The four phenotypes were associated with 5-year CVD risk, independently of age, sex, body mass index, presence of diabetes mellitus, hypercholesterolemia, hypertension and family history of CVD. Only the group with normal LDL-cholesterol and low HDL-cholesterol had 1.56-fold higher risk (HR=1.56, 95% CI: 1.00, 2.46) as compared with the group having both clusters within normal range. Conclusion. Subjects with low HDL-cholesterol should be the first to undergo lifestyle changes (i.e. healthier diet and exercise). P619 Association between postprandial triglycerides and coronary artery disease detected by coronary computed tomography angiography HL Staniak1, WS Filho2, M Miname2, IM Bensenor1, PA Lotufo1, R Sharovsky1, CE Rochitte2, MS Bittencourt1, RD Santos1 1University Hospital, University of São Paulo, São Paulo, Brazil 2Heart Institute, University of São Paulo, São Paulo, Brazil Topic: Lipid Disorders (Prevention & Epidemiology) Background: Studies have demonstrated the association of severe coronary artery disease (CAD) with postprandial triglycerides (TG). Nevertheless the relationship between less severe atherosclerosis and postprandial triglycerides is less established. Objectives: to study the relationship between postprandial TG and CAD detected by coronary computed tomographic angiography (CTA). Methods: We enrolled 130 patients without previous CAD, (85 with CAD detected by coronary CTA and 45 without); who underwent an oral fat tolerance test. We studied the postprandial lipemia measuring TG from T0h to T6h with 2 hour intervals, and analyzed the TG change over time using a longitudinal multivariable linear mixed effects model with the log normal of the TG as the primary outcome. Results: Patients with CAD were older (56.5 ± 6.8 vs 50.4 ± 7.1 years, p<0.001), predominantly male (68.2% vs 37.8%, p< 0.001) and had lower HDL-C (49 ± 14 vs 54 ± 12 mg/dL, p=0.015). The majority of individuals with CAD had mild non-obstructive atherosclerosis (48.2%). The patients with CAD had a slower clearance of postprandial TG change from 4h to 6h (p< 0.05) compared to patients without CAD (figure 1). Conclusions: Patients with mild and moderate CAD had an impaired postprandial metabolism, with a delayed TG clearance. Open in new tabDownload slide Change in the lnTG over 6h P620 The effects of a low-carbohydrate-high-fat diet on the triad of atherogenic dyslipidaemia E Rostrup1, JE Nordrehaug2 1Haukeland University Hospital, Department of Heart Disease, Bergen, Norway 2University of Bergen, Bergen, Norway Topic: Lipid Disorders (Prevention & Epidemiology) Purpose: Low carbohydrate diets are widely used to manage obesity and the metabolic syndrome. However concerns have been raised about possible dyslipidaemia caused by the increase in dietary fat in these diets. The aim of this study was to examine the effects of a low-carbohydrate-high-fat diet (LCHF) on the triad of atherogenic dyslipidaemia, low HDL cholesterol, small dense LDL and increased triglycerides, in obese individuals. Methods: 22 obese (BMI = 28 kg/m2; fat percentage > 20% for men and 28% for women) and sedentary, but otherwise healthy individuals were put on an ad libitum LCHF diet for 10 weeks during which physical activity level was kept unchanged. Chenges in bodyweight and -composition was analysed and lipids and lipoproteins were measured at baseline and follow-up, both enzymatically and by nuclear magnetic resonance (NMR). Results: Ad libitum energy intake declined from 2591±675 kcal to 1752±382 kcal (p<0.001) resulting in a 7.4% weight reduction from 102.0±14.7 kg to 94.1±13.8 kg (p<0.001). The weight reduction was accompanied by a significant reduction in both total fat percentage and android fat measured by DEXA. Mean dietary composition in percentage of total energy intake was 4±2 % carbohydrates, 71±6% fat and 24±5% protein. After 10 weeks on the diet we observed an increase in total cholesterol from 4.98±0.86 to 5.55±1.76 mmol/l (p=0.025), LDL cholesterol from 3.33±0.69 to 3.92±1.61 mmol/l (p=0.012) and HDL cholesterol from 1.23±0.36 to 1.32±0.33 mmol/l. The ratio between the apolipoproteins B to A1 and between total cholesterol to HDL cholesterol however, did not change significantly. Triglycerides was reduced by 28.9% from 1.15±0.65 to 0.77±0.30 mmol/l (p<0.001). The NMR analysis showed no significant changes in the number of LDL particles, while there were significant changes in LDL subclasses. Large LDL particles increased by 85.4% (p=0.003) while we observed a 79.1% reduction in small LDLs. Further we found a 23.8% reduction in total VLDL and chylomicron particles and the VLDL size was reduced by 11.2% (p<0.001). Conclusions: A weight reducing low-carbohydrate-high-fat-diet resulted in a significant increase in both LDL and HDL cholesterol and a major reduction in triglycerides. While there was no change in the number of LDL particles, we observed a shift from small dense LDL particles towards the larger less dense particles. We conclude that a low-carbohydrate-high-fat diet may positively alter atherogenic dyslipidaemia in obese individuals. P621 Tobacco use in middle-schools students in the north-east region of Greece. T Kyratzoglou1, E Foukarakis1 1Hellenic Cardiological Society, Athens, Greece Topic: Smoking (Prevention & Epidemiology) Purpose: We examine the prevalence of tobacco use among middle-school students in the region of North-East Greece Thrace, trying to indentify factors associated with current smoking. The study was conducted parallel with an effort of Hellenic Cardiological Society to inform middle-school students for the dangerous habit of smoking by performing presentations in schools. Methods: We used anonymous questionnaires which are collected after each presentation. The questionnaire was focused in the habit of smoking of students together with question about age, gender, parental smoking, parental smoking inside house, siblings and friends smoking, and perception of harmfulness of smoking. In total 920 students completed questionnaire (mean age 13.89±1.09, 457 boys) Results: Current smokers 71 (7,7%), past smokers 38 (4,1%). Older students were more often current smokers (p=0.000), where there was no difference for gender, although boys smoke more often every day than girls (4,7% vs 2,5%, p=0.002). Smoking habits of family and friends could seen in table. In logistic regression analysis cigarette smoking was associated with age (OR: 1.36; 95% CI: 1, 06–1.75), friends smoking (OR: 18.62; 95% CI: 8.38–41.77), and siblings smoking (OR:2.08; 95% CI: 1.14–3.79). Smokers wish to stop smoking in a percentage of 73,7% and seek help in order to stop smoking in 62%. Conclusions: The results of our study show that the prevelence of smoking in middle-school students in the region of Thrace in Greece is high. Age, friends and siblings smoking were independently associated with smoking status among students in this Greek region. These results could be evaluated for an anti-smoking strategy. Smoking habits of family and friends Smokers No smokers Total Smoker in the family(%) 79,2* 66,3 67,4 Father(%) 65,1* 50,7 52,2 Mother(%) 37,4 30,1 31,7 Siblings (%) 25,3* 10,3 10,6 Parental Smoking inside the house (%) 73,5* 55,3 57,5 Smoker friends(%) 89,6* 31,9 38,7 *Statistically significant difference Smokers No smokers Total Smoker in the family(%) 79,2* 66,3 67,4 Father(%) 65,1* 50,7 52,2 Mother(%) 37,4 30,1 31,7 Siblings (%) 25,3* 10,3 10,6 Parental Smoking inside the house (%) 73,5* 55,3 57,5 Smoker friends(%) 89,6* 31,9 38,7 *Statistically significant difference Open in new tab Smoking habits of family and friends Smokers No smokers Total Smoker in the family(%) 79,2* 66,3 67,4 Father(%) 65,1* 50,7 52,2 Mother(%) 37,4 30,1 31,7 Siblings (%) 25,3* 10,3 10,6 Parental Smoking inside the house (%) 73,5* 55,3 57,5 Smoker friends(%) 89,6* 31,9 38,7 *Statistically significant difference Smokers No smokers Total Smoker in the family(%) 79,2* 66,3 67,4 Father(%) 65,1* 50,7 52,2 Mother(%) 37,4 30,1 31,7 Siblings (%) 25,3* 10,3 10,6 Parental Smoking inside the house (%) 73,5* 55,3 57,5 Smoker friends(%) 89,6* 31,9 38,7 *Statistically significant difference Open in new tab P622 Varenicline for smoking cessation in coronary patients: a cardiac rehabilitation program experience. R Dalmau Gonzalez-Gallarza1, A Castro Conde1, S Del Prado2, I Ponz2, SO Rosillo2, AM Iniesta2, D Gemma2, MJ Fernandez Aguita3, G Alonso4, JL Lopez Sendon2 1University Hospital La Paz, Department of Cardiology, Cardiac Rehabilitation Unit, Madrid, Spain 2University Hospital La Paz, Department of Cardiology, Madrid, Spain 3Albacete General Hospital, Albacete, Spain 4University Hospital 12 de Octubre, Department of Cardiology, Madrid, Spain Topic: Smoking (Prevention & Epidemiology) Introduction: the use of varenicline in cardiovascular disease patients is controversial. We analyse the experience of a smoking cessation program in a cardiac rehabilitation unit (CRU). Methods: we analysed a cohort of 404 smoker patients referred to a CRU after a recent admission for a cardiac event. Intervention was based on counselling and motivational support, and all patients were offered first line pharmacotherapy for smoking cessation. We compare the outcomes according to the pharmacotherapy use. Tolerance to varenicline and its safety was assessed. Abstinence was confirmed with cooximetry at 3 and 6-month follow-up. Results: 87% were male, mean age 53,9, 93% had a recent admission for acute coronary syndrome, 7% for heart failure. Patients were referred 2-3 weeks after discharge from hospital, in stable condition. Only 20% required drugs to facilitate smoking cessation, varenicline was used in 62% of them, nicotine replacement therapy in 28%, and bupropion in 10%. As can be observed from the table below, patients who required drugs were younger, and they had a stronger dependence and addiction. The abstinence rate at 3 and 6-month follow-up was lower in patients who used drugs. Only 17% of patients who use varenicline completed 12 weeks of treatment. The main reasons for early suspension were lack of motivation (25%), the perception of self-control over abstinence (18%), the cost of the treatment (15%), the lack of relief of abstinence symptoms (10%), nausea (8%) and mood swings (5%). Neither adverse cardiovascular events were reported during varenicline treatment, nor during the 2 weeks after suspension. Conclusions: most smokers are motivated enough to attempt to quit without drugs after an acute cardiac event. Pharmacotherapy use was related to a higher level of dependence and addiction, as well as to a lower abstinence rate. Varenicline was safe in this context, but therapeutic adherence was scarce, thus favoring relapse. Intervention without pharmacotherapy Intervention with pharmacotherapy p Mean age 53,9 50,9 0,016 cigarettes/day 23,1 29,4 <0,001 Pack-year 39,2 47,0 0,028 3-month abstinence rate 82,4% 48,8% <0,001 6-month abstinence rate 75,0% 42,5% <0,001 Intervention without pharmacotherapy Intervention with pharmacotherapy p Mean age 53,9 50,9 0,016 cigarettes/day 23,1 29,4 <0,001 Pack-year 39,2 47,0 0,028 3-month abstinence rate 82,4% 48,8% <0,001 6-month abstinence rate 75,0% 42,5% <0,001 Open in new tab Intervention without pharmacotherapy Intervention with pharmacotherapy p Mean age 53,9 50,9 0,016 cigarettes/day 23,1 29,4 <0,001 Pack-year 39,2 47,0 0,028 3-month abstinence rate 82,4% 48,8% <0,001 6-month abstinence rate 75,0% 42,5% <0,001 Intervention without pharmacotherapy Intervention with pharmacotherapy p Mean age 53,9 50,9 0,016 cigarettes/day 23,1 29,4 <0,001 Pack-year 39,2 47,0 0,028 3-month abstinence rate 82,4% 48,8% <0,001 6-month abstinence rate 75,0% 42,5% <0,001 Open in new tab P624 Smoking increases insuline resistance in patients with acute coronary syndrome R Dalmau1, A Castro1, S Del Prado2, I Ponz2, MJ Fernandez3, G Alonso4, AM Iniesta2, N Montoro2, F De Torres2, JL Lopez Sendon2 1University Hospital La Paz, Department of Cardiology, Cardiac Rehabilitation Unit, Madrid, Spain 2University Hospital La Paz, Department of Cardiology, Madrid, Spain 3Albacete General Hospital, Albacete, Spain 4University Hospital 12 de Octubre, Department of Cardiology, Madrid, Spain Topic: Smoking (Prevention & Epidemiology) Introduction: besides being an important cardiovascular risk factor, smoking is also related to a less favourable metabolic profile. We compare the indicators of insuline resistance in a cohort of patients with a recent acute coronary syndrome (ACS) according to their smoking status. Methods: 611 patients (84,5% male) referred to a cardiac rehabilitation program after an ACS (59,9% STEMI) were analysed. We compared the metabolic profile taken from a fasting blood test performed during admission. Student t-test and Chi-square test were used for continuous and categorical variables respectively. Results: 57,3% were active smokers at the time of admission, on average smokers were 8 years younger. There were no significant differences in the prevalence of diabetes mellitus, but hypertension was more frequent in non-smokers. Despite being younger, smokers were more likely to be sedentary. Obesity tended to be more prevalent in non-smokers, without significant differences. As for metabolic parameters, smokers had higher levels of triglycerides (TG) and LDL-c, and lower levels of HDL-c. The ratio TG/HDL (an indicator of insuline resistance when >3,5) was significantly higher in smokers. However, body mass index (BMI) and abdominal perimeter, were higher in non-smokers. Conclusions: despite the fact that smoking can provide more favourable anthropometric parameters, metabolic indicators of insuline resistance are more prevalent in smokers with a recent ACS. Smoking cessation, correction of unhealthy dietary habits and sedentarism, are cornerstones in secondary prevention programs. Differences in metabolic parameters Smokers (n=350) Non-smokers (n=261) p Mean age 53,6 61,3 <0,001 Fasting glucose mg/dl 110,1 116,2 0,051 LDL-c mg/dl 116,6 105,6 0,001 HDL-c mg/dl 35,5 37,9 0,001 TG mg/dl 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 BMI Kg/m2 27,4 28,6 0,001 Abdominal perimeter cm 98,8 102,3 <0,001 A1C % 6,2 6,2 NS Smokers (n=350) Non-smokers (n=261) p Mean age 53,6 61,3 <0,001 Fasting glucose mg/dl 110,1 116,2 0,051 LDL-c mg/dl 116,6 105,6 0,001 HDL-c mg/dl 35,5 37,9 0,001 TG mg/dl 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 BMI Kg/m2 27,4 28,6 0,001 Abdominal perimeter cm 98,8 102,3 <0,001 A1C % 6,2 6,2 NS Open in new tab Differences in metabolic parameters Smokers (n=350) Non-smokers (n=261) p Mean age 53,6 61,3 <0,001 Fasting glucose mg/dl 110,1 116,2 0,051 LDL-c mg/dl 116,6 105,6 0,001 HDL-c mg/dl 35,5 37,9 0,001 TG mg/dl 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 BMI Kg/m2 27,4 28,6 0,001 Abdominal perimeter cm 98,8 102,3 <0,001 A1C % 6,2 6,2 NS Smokers (n=350) Non-smokers (n=261) p Mean age 53,6 61,3 <0,001 Fasting glucose mg/dl 110,1 116,2 0,051 LDL-c mg/dl 116,6 105,6 0,001 HDL-c mg/dl 35,5 37,9 0,001 TG mg/dl 160,7 137,2 0,002 TG/HDL-c 4,9 3,9 <0,001 BMI Kg/m2 27,4 28,6 0,001 Abdominal perimeter cm 98,8 102,3 <0,001 A1C % 6,2 6,2 NS Open in new tab P625 Smoking behaviour amongst hospital staff and patients at St Vincents Hospital, Melbourne MA Rahman1, A Wilson2, R Sanders3, D Castle2, K Daws3, DR Thompson1, CF Ski1, S Matthews3, C Wright1, L Worrall-Carter1 1Australian Catholic University, Melbourne, Australia 2The University of Melbourne, Melbourne, Australia 3St Vincent's Hospital, Melbourne, Australia Topic: Smoking (Prevention & Epidemiology) Background:A cross-sectional survey was conducted in 2012 to provide a snapshot of smoking behaviour among patients and staff at St Vincent s Hospital Melbourne. Methods:Patients and staff were surveyed using a questionnaire exploring demographics, nicotine dependence, readiness to quit, and preference for different smoking cessation options. Results:A total of 1496 people were screened within two hours, 1301 participated (1100 staff, 199 patients). Mean age was 42 (±17) years; 68% were females. There were 113 (9%) current smokers and 326 (25%) ex-smokers. Seven percent of the staff were current smokers compared to 19% of the patients. Half of the patients were moderately nicotine dependent compared to 21% of staff. One-third of the staff (31%) who smoked did not anticipate health problems related to smoking. Most patients (79%) who smoked did not feel that there was a relationship between smoking and their current health problems. The majority of staff (67%) and patients (61%) intended to quit within the next six months, but 48% of staff and 55% of patients did not prefer to use face to face, telephone, or group counselling, or counselling by local doctors to quit smoking. Multivariate analyses showed that patients were three times more likely (OR 3.0, 95% CI 1.9-4.7) to smoke than staff. Conclusions:The survey reports lower prevalence of smoking among hospital staff compared to the national data. It also indicates an under-appreciation of health effects of smoking, and a preference not to use conventional methods of quitting. P626 Diagnosis of chronic obstructive pulmonary disease in patients with coronary diseases who participated in cardiac rehabilitation program M Andjic1 1Institute for Rehabilitation, Belgrade, Serbia Topic: Smoking (Prevention & Epidemiology) INTRODUCTION: The prevalence of chronic obstructive pulmonary disease (COPD) in patients with coronary artery disease (CAD) is not well known, although both have similar risk factors and pathophysiological determinants. AIM: To define the prevalence of COPD in CAD patients on cardiac rehabilitation program. Methods: Medical records of 199 patients who participated in cardiac rehabilitation program in period January-April 2011 were retrospectively analyzed. One-hunderd-fifty-five had previous myocardial infarction treated with primary percutaneous coronary intervention (MIpPCI), and 44 underwent coronary artery bypass surgery (CABG). The diagnosis of COPD was confirmed on clinical and spirometry findings in 33 patients (17%), 22 with MIpPCI, and 11with CABG. Of them, 27 (82%) were men; mean age 63±9 years, FEV1 75±21%, and FEV1/FVC 61±9%, respectively. COPD was newly diagnosed in 25 (76%) patients. Compared to those without COPD, patients with COPD were more likely to be smokers (p=0,003), but with no significant difference in age and prevalence of cardiovascular risk factors (hypertension, diabetes and dyslipidemia). CONCLUSION: COPD appears to be relatively frequent in CAD patients. Pulmonary function test should be recommended to smokers with CAD, what would help in establishing of early diagnosis and treatment of COPD, and subsequent improvement in their prognosis. P627 Risk factor awareness in a coronary population and the association with health-related quality of life outcomes D De Smedt1, E Clays1, L Annemans1, K Kotseva2, D De Bacquer1 1Ghent University, Department of Public Health, Ghent, Belgium 2Imperial College London, National Heart and Lung Institute (NHLI), London, United Kingdom Topic: Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: The purpose of this study was to investigate the risk factor level awareness in coronary patients and to assess its associations with health-related quality of life (HRQoL) outcomes. Methods: Data from the EUROASPIRE III (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) survey was used. 8743 coronary patients from 22 European countries were interviewed and examined at least 6 months after their acute event. Patients were asked to complete EQ-5D, SF-12 and HADS instruments. Furthermore risk factor level awareness was assessed during interview. Results: 81.7% of patients indicated to be aware of their own blood pressure level, whereas only 46.6% of patients indicated to be aware of their cholesterol level. Furthermore, 43.7% of patients were aware of their blood glucose level, whereas in diabetes patients blood glucose level awareness reached 81.8%. Risk factor level awareness was significantly associated with HRQoL, with patients being unaware of their risk factor levels having worse HRQoL outcomes. The relationship between awareness and HRQoL seemed to be partly driven by the attempt of patients to adopt a healthier behaviour, nevertheless, there was also a direct link between awareness and HRQoL. Conclusions: Insufficient risk factor level awareness in coronary patients is associated with worse HRQoL outcomes, independent from patients risk factor profile. Health care workers should be encouraged to inform their patients about the importance of their coronary risk factors, the actual level and their personal target. P628 The ability of music to prevent pain and anxiety during invasive cardiology procedures: a randomized control study A Dritsas1, I Dimtsia1, I D Laoutaris1, G Poulos1, T Maounis1 1Onassis Cardiac Surgery Center, Athens, Greece Topic: Psychosocial factors/Quality of life (Prevention & Epidemiology) Purpose: To examine the effects of relaxing music on patient (pt) perception of anxiety and pain during invasive cardiological procedures. Methods: One hundred pts scheduled for various invasive cardiology interventions (pacemaker and/or defibrillation implantation, ablation for arrhythmia, diagnostic electrophysiology, right heart catheterization) were randomized to a music listening group (MG) (n=50) or to a non-music listening control group (CG) (n=50) prior to the intervention. Pre-selected relaxing instrumental music was delivered from a USB-mp3 player via high quality earphones in the MG. All pts completed the State Anxiety Inventory Questionnaire (STAI) at baseline and post intervention. In addition all pts provided their subjective perception of Anxiety and Pain by marking a visual analogue scale (10 cm) following the procedure. Pts were not given any intravenous anesthetic or other anxioalgolytic medication during all interventions. Results: There was no difference in age (67±10 vs 64±18 yrs, p=ns) or the duration of the procedure (83±54 vs 76±40 min, p=ns) between MG and CG respectively. Both measures of Anxiety (1.65±2.1 vs 5.62±3.0, p=0.005) and Pain (2.17±1.6 vs 5.9±2.4, p=0.029), were significantly reduced in MG compared to CG. A significant additive benefit for state anxiety change (as expressed by STAI score) compared to baseline was observed in the MG vs CG (p=0.008 by ANOVA). Conclusions: Music listening reduces pain and anxiety during invasive procedures and thus may be used as an effective method to help pts coping with cardiac interventions. P629 Verification of the SCORE model for cardiovascular death risk in the Polish population W Piotrowski1, M Polakowska1 1Institute of Cardiology, Warsaw, Poland Topic: Other risk factors (Prevention & Epidemiology) Purpose: Verify the SCORE algorithm in the Polish population. Material and Methods: Within the frame of the National Multicenter Health Survey (WOBASZ), a representative sample of Polish population aged 20-74 was screened in 2003-2005 and prospectively followed up until 2011. The average follow up time was 7.4 years. For the analysis, the groups 4084 men and 4516 women aged 35-54, were included. Were observed 126 CVD deaths in men and 36 deaths in women. For each patient the value of SCORE index was calculated, using the SCORE algorithm, and according to the multivariate proportional hazards model (Cox), the personal index (Cox-PI) was calculated for each patients, using these same risk factors as in SCORE model (age, smoking, cholesterol level and SBP). Values of SCORE and Cox-PI indexes were classified into quartile groups. In the each quartile group of SCORE and PI separately, the frequencies of CVD deaths were calculated. The sum of the differences between frequencies in all quartile groups defines the deviation between the two algorythms. All analysis for men and women were made separately. Results: In the multivariate Cox model level of cholesterol was dependent factor for age, smoking and SBP. The frequencies of CVD death in quartile groups of SCORE I PI are included in table. Deviation between SCORE and Cox-PI in men is 1.32%, and in women is 0.41%. Conclusions: The SCORE index is compatible with Cox Personal Index estimated in Polish population, although Polish data were not included to the estimation process of SCORE algorithm. The frequency of CVD death in quartiles Algorithm I quartile II quartile III quartile IV quartile Men SCORE 1.21% 1.21% 2.63% 7.27% Cox-PI 1.31% 1.71% 2.72% 6.64% Women SCORE 0.19% 0.46% 0.28% 2.32% Cox-PI 0.09% 0.55% 0.36% 2.18% Algorithm I quartile II quartile III quartile IV quartile Men SCORE 1.21% 1.21% 2.63% 7.27% Cox-PI 1.31% 1.71% 2.72% 6.64% Women SCORE 0.19% 0.46% 0.28% 2.32% Cox-PI 0.09% 0.55% 0.36% 2.18% Open in new tab The frequency of CVD death in quartiles Algorithm I quartile II quartile III quartile IV quartile Men SCORE 1.21% 1.21% 2.63% 7.27% Cox-PI 1.31% 1.71% 2.72% 6.64% Women SCORE 0.19% 0.46% 0.28% 2.32% Cox-PI 0.09% 0.55% 0.36% 2.18% Algorithm I quartile II quartile III quartile IV quartile Men SCORE 1.21% 1.21% 2.63% 7.27% Cox-PI 1.31% 1.71% 2.72% 6.64% Women SCORE 0.19% 0.46% 0.28% 2.32% Cox-PI 0.09% 0.55% 0.36% 2.18% Open in new tab P630 Data mining approach for in-hospital mortality prediction of patients presented with STEMI after primary PCI M Sladojevic1, S Tadic1, K Pavlovic1, N Cemerlic-Adjic1, T Popov1, M Petrovic1, B Vujin1, S Sladojevic2 1Institute of Cardiovascular Diseases Vojvodina, Novi Sad, Serbia 2Faculty of technical sciences, University of Novi Sad, Novi Sad, Serbia Topic: Other risk factors (Prevention & Epidemiology) Purpose: To design an in-hospital mortality prediction model for patients presented with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (pPCI) by performing data mining techniques. Methods: A total of 1495 patients (aged 61.47+/-11.83 years, 65.2% males), hospitalized from December 2009 to December 2011 were included in this study. Each patient was described using 45 attributes: anamnestic data (hypertension history, diabetes, hyperlipidemia, family history of myocardial infarction, smoking, alcohol), clinical and demographic characteristics (systolic and diastolic blood pressure (BP), heart rate, gender, age), biochemical analysis of blood parameters (erythrocytes, hemoglobin, leukocytes, total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol, blood sugar, troponin, urea, creatinine, C-reactive protein, fibrinogen, and echocardiographic parameters. A number of machine learning algorithms available within Waikato Environment for Knowledge Discovery were evaluated and the most successful was chosen. Ten-fold cross validation was used for model validation. Results: The in-hospital mortality was 8.96%. The best prediction results were achieved using Alternating Decision Tree (ADTree) classifier, 88.9% accuracy (AUC=0.90). ADTree identified a subset of nine attributes most relevant to mortality prediction: leukocytes, HDL-cholesterol, blood sugar, fibrinogen, troponin, systolic blood pressure, heart rate, age, and LVEF. Graphical model is shown in Figure 1. Conclusions: The continued high in-hospital mortality, for STEMI patients, provides a compelling indication to apply tools, such as a highly accurate graphical model, derived in this study, to improve the evaluation and, potentially, management and outcomes of these patients. Open in new tabDownload slide Figure 1. Resulting model - ADTree P631 Markers of iron metabolism and metabolic syndrome in swiss adults N Kilani1, G Waeber1, P Vollenweider1, P Marques-Vidal2 1CHUV and Faculty of Biology and Medicine, Department of Medicine, Internal Medicine, Lausanne, Switzerland 2University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland Topic: Other risk factors (Prevention & Epidemiology) Objectives: To assess the association between markers of iron metabolism and metabolic syndrome (MS) and its components. Research design and Methods: Cross-sectional, population-based study on 5,815 participants aged 35 to 75, living in Lausanne, Switzerland. Metabolic syndrome was defined according to ATP-III criteria. Markers of iron metabolism were iron, ferritin, transferrin, CTF and saturation. Results: Men with MS had higher (p<0.001) levels of ferritin (mean±SD: 233±167 vs. 319±301 µg/L for non-MS and MS, respectively), transferrin (231±33 vs. 239±34 mg/dL), CTF (57.7±8.2 vs. 59.6±8.5 µmol/L) and lower (p<0.001) levels of saturation (0.33±0.11 vs. 0.31±0.11). Women with MS also had higher (p<0.001) levels of ferritin (97.4±82.3 vs. 149.5±122.2 µg/L), transferrin (238.2±38.9 vs. 246.5±40 mg/dL) and CTF (59.6±9.7 vs. 61.6±10) and lower (p<0.001) levels of iron (99.4±36.4 vs. 92.2±30.3 µg/dL) and saturation (0.31±0.12 vs. 0.27±0.10). Similar associations were found in both genders for most MS components, but not for abdominal obesity. These findings were confirmed after multivariate adjustment for age, body mass index, CRP, smoking and alcohol: a higher risk of presenting with MS was found for participants in the highest quartile of serum ferritin (multivariate-adjusted Odds ratio and [95% CI]=1.52 [1.14-2.02] for men and 1.46 [1.01-2.10] for women), transferrin (OR=1.47 [1.11-1.95] and 1.80 [1.29-2.51]) and CTF (OR=1.47 [1.11-1.95] and 1.80 [1.29-2.51]). Participants in the highest quartile of saturation had a lower risk of MS (OR= 0.76 [0.57-1.01] for men and 0.58 [0.40-0.83] for women). No association was found for serum iron. Conclusions: Most markers of iron metabolism are independently associated with MS and some of its components. P632 Intergenerational differences in cardiovascular risk factor levels in Switzerland C Pommier1, G Waeber2, G Vollenweider2, P Marques-Vidal1 1University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland 2University Hospital Center Vaudois (CHUV), Department of Internal Medicine, Lausanne, Switzerland Topic: Other risk factors (Prevention & Epidemiology) Background: There is little information regarding trends in cardiovascular risk factors (CVRFs) in Switzerland. Hence, we aimed at assessing generation differences in CVRFs by comparing CVRF levels within selected age groups separated by a 20 year time lag. Design: Two population-based surveys conducted 20 years apart. Methods: Data from MONICA (1984-1986; 551 men and 534 women, mean age 51±12 years) and CoLaus (2003-2006, 3189 men and 3544 women, mean age 52±11 years) surveys. Analyses were stratified by gender and age groups (35-44, 45-54, 55-64 and 65-74 years). Results: No changes were found for body mass index between surveys (26.2±3.4 vs. 26.6±4.0 kg/m2in men and 24.8±4.3 vs. 25.1±4.8 kg/m2in women, for MONICA and CoLaus, respectively). Prevalence of obesity increased slightly from 12.4% to 16.7% in men and from 12.9% to 14.5% in women (p=NS). Prevalence of current smokers decreased from 37.6% to 29.3% in men (p<0.001); and from 29.7% to 24.8% in women (p=NS). Blood pressure decreased in both genders. Prevalence of hypertension increased, due to an increase in antihypertensive treatment from 10.6% to 20.2% in men and from 9.0% to 16.8% in women (p<0.01). After stratifying for age, obesity levels increased in participants aged 35-44 years (from 6.2% to 11.5% in men and from 4.9% to 10.0% in women, p<0.001), but this trend remained significant only in women after multivariate adjustment on education and smoking status. Current smokers decreased in men aged less than 55: 44.0% to 34.9% in age group [35-44] and 39.4% to 28.5% in [45-54] and increased in women aged 44 to 64: 25.9% to 30.1% in age group [45-54] and 17.1% to 22.1% in age group [55-64] (multivariate adjusted p<0.01). Antihypertensive treatment increased in men older than 45 and in women older than 65. Conclusions: Most CV RFs have evolved favorably in the Swiss population.. The increase in obesity levels in the younger age groups and in tobacco smoking among middle aged women calls for targeted preventive measures. P633 Prognostic value of serial measurements of matrix metalloproteinase-9 in arterial hypertension patients after ischemic stroke A Berezin1, O Lisovaya2 1State Medical University, Zaporozhye, Ukraine 2City Hospital 6, Zaporozhye, Ukraine Topic: Other risk factors (Prevention & Epidemiology) The aim of the study was to investigate the predictive value of serial measurements of circulating matrix metalloproteinase-9 level in hypertensive patients during 12 months after ischemic stroke. Methods: 102 patients with mild to moderate arterial hypertension within 3 weeks after ischemic stroke were included in the study. The circulating matrix metalloproteinase-9 (MMP-9) level was assessed at baseline and after six months of baseline. Clinical interviews were conducted every 3 months for 1 year after receiving blood samples. As clinical end-points we determined follow cardiovascular outcomes: recurrent stroke or TIA, ischemic heart disease, sudden death, diabetes mellitus, cardiovascular events, including chronic heart failure and the need for hospitalization for these reasons. Results: One hundred two mild-to-moderate arterial hypertension patients (67 men and 35 women; mean age, 58.38 years [95% CI = 54-72 years]) were included in this study in 3 weeks after first clinical signs of ischemic stroke. All included patients were hypertensive, 45.1% were dyslipemic, 42.2% were smoked, and 14.7% had a history of mild diabetes mellitus. We found right-side injury of brain in 63.7% cases; in 34.3% and 2% left-side and two-side injuries were defined. During observation period 58 cumulative clinical events occurred. They were distributed in 4 deaths, 6 cardiac arrhythmias, 17 cardiac ischemic events, 9 stroke (5 lacunar infarctions, and 2 cardioembolic strokes), 10 diabetes mellitus, 4 chronic heart failure and 7 hospitalisation. Analysis of obtained outcomes have been showed that increased MMP-9 concentration within six months after ischemic stroke has positively associated with incidence of cardiovascular events, when compared with individuals without increased circulating levels of MMP-9. Adjusted odds ratio for the occurrence of cumulative cardiovascular events in hypertension patients with MMP-9 at baseline more 1001.0 ng/ml, when compared with lower concentrations of one was 2.78 (95% CI=2.41-2.95; P=0.001), and an increased sixth month circulating MMP-9 over 956.5 ng/ml, when compared with lower concentrations of one was associated with adjusted odds ratio 3.02 (95% CI=2.72-3.57; P=0.001). In conclusion, we found that circulating MMP-9 level is an independent predictor of 1 year cumulative cardiovascular events in patients with hypertension after ischemic stroke. P634 Cardiovascular risk in women with arterial hypertension and subclinical hypothyroidism M Gvozdyk1, O Mitchenko1 1National scientific center "The M.D. Strazhesko Institute of cardiology", Kyiv, Ukraine Topic: Other risk factors (Prevention & Epidemiology) Aims: to examine influence of subclinical hypothyroidism on cardiovascular risk in women with arterial hypertension. Methods: women (n=134), mean age 57.6±3.2 years) with arterial hypertension were included in this study: 1-st group (n=33) with subclinical hypothyroidism (SH), 2-nd group (n=32) with subclinical hypothyroidism on levothyroxin treatment, 3-rd group (n=34) with overt hypothyroidism and 4-th group (n=35) with euthyroidism. Measurements of body mass index, TSH, FT4, lipids profile, carotid artery intima-media thickness (IMT) and ankle-brachial index (ABI) were made. Also SCORE scales for total cardiovascular risk estimation were used. Results: The plasma concentration of TSH was closely associated with cholesterol levels (r = 0.59; p<0.01) and LDL-cholesterol (r = 0.55; p<0.01). The IMT in the 1-st group was larger (0.98±0.15 mm, p<0.05) than in the 2-nd (0.87±0.14 mm) and the 4-th (0.83±0.11 mm) groups. ABI in the 1-st group (1.04±0.09) was significantly lower compared with 2-rd (1.09±0.08, p<0.01) and the 4-th (1.13±0.11) groups. We found higher prevalence of high and very high risk in women with SH compared with 4-th group (euthyroidism) – 36.4 % vs 11.4 % by SCORE scale. There was no significant difference between prevalence of high and very high risk on 2-nd and 4-th groups - 12.5 % vs 11.4 %. After we reestimated risk including results of sonography examination (IMT and ABI) we found increased prcentage of women with high and very high risk in the 1-st group from 36,7 % to 75.7 %. Conclusions: Our results showed that subclinical hypothyroidism has influence on cardiovascular risk in women with arterial hypertension. Hypothyroidism has association with increased level of total cholesterol, LDL-cholesterol, IMT, decrease ABI. Hypothyroid women with hypertension on levothyroxin treatment have a better lipid profile and lower cardiovascular risk compared with hypothyroid patients without levothyroxine replacement therapy. Total cardiovascular risk estimation which includes assessment of ultrasound markers of atherosclerosis reveals increased percentage of women with high and very high risk at 39.3%. P635 Estimating Shannon ECG entropy in overriding risk for VT in arrhythmogenic right ventricular dysplasia I Vranic1 1Specialized Hospital for Heart diseases Hertz, Belgrade, Serbia Topic: Other risk factors (Prevention & Epidemiology) Purpose: New Task Force criteria in detection of arrhythmogenic right ventricular dysplasia (ARVC/D) published in 2010 by Marcus et al produced narrower and stronger noninvasive parameters that raised sensitivity in establishing diagnosis of this rare condition. We wanted to explore whether non linear dynamics (NLD) analysis in heart rate variability (HRV) raise sensitivity, specificity and positive predictive value in estimating risk for sudden cardiac death (SCD). Methods: Out of the total number of 112 positively diagnosed patients, 44 were enrolled based on following study criteria: normal ECG Holter recordings and no medical treatment according to severity of ARVC/D (Group 1, n=27 and Group 2, n=17) and regarding presence (subgroup A) or absence (subgroup B) of late potentials (noise interval between 0,1-0,3 µV). Group 3 (control) consisted of 44 randomly assigned normal subjects. All participants went through a follow-up with a control Holter within 12 months. The differences between the 3 groups were calculated by ANOVA followed by Bonferroni's post hoc multiple-range tests. Results: NLD methods, as opposed to time and frequency domain parameters, showed significant differences (p<0,005) between investigated groups vs. control. NLD methods by mean of the standard deviations of all NN intervals of sinus beats for all 5-minute segments (SDNN idx) showed prevalence of parasympathetic activity as opposed to control (p<0,05), which was even more obvious through interpolation of data as % of deviation of Mean NN interval in function % frequency (p<0.005). Conclusions: Complex rhythm fluctuations in ARVC/D patients show distinct pattern. Shannon entropy was found to be an accurate parameter in estimating risk for VT as proved by the control Holter. Furthermore, in combination with late potentials they improve sensitivity, specificity and positive predictive value to detect risk for sudden cardiac death. P637 Cardiac function after living kidney donation B Hewing1, F Knebel1, H Dreger1, G Baumann1, K Budde2, F Halleck2 1Charité Universitaetsmedizin Berlin, Campus Mitte, Med. Klinik fuer Kardiologie und Angiologie, Berlin, Germany 2Charité Universitaetsmedizin Berlin, Campus Mitte, Med. Klinik fuer Nephrologie, Berlin, Germany Topic: Other risk factors (Prevention & Epidemiology) Purpose: Living kidney donation (LKD) has become increasingly important over the past years as more patients reach end-stage renal disease. Increases in creatinine levels and blood pressure, both established cardiovascular risk factors, are common after LKD. While safety of the donor is of utmost importance, there is only insufficient data on the impact of LKD on cardiovascular risk and function. Therefore, our study aims at evaluating changes of cardiac function after LKD by echocardiography. Methods: A total of 25 kidney donors (53.3 ± 11.3 years of age at donation, 6 male donors) were evaluated by medical history, physical examination, laboratory testing and echocardiography. Left ventricular (LV) and right ventricular (RV) systolic and diastolic function was assessed by echocardiographic standard indices including global longitudinal 2D strain of the LV (GLPS) and tissue Doppler-derived parameters. Results: Within the median follow-up of 11.0 months (IQR 2.0-21.5) after LKD creatinine levels increased significantly from an average of 0.8 to 1.2 mg/dl (p<0.001), but none of the patients developed substantial proteinuria. There was a trend to higher systolic and diastolic blood pressure after LKD accompanied with a significantly higher intake rate of antihypertensive drugs. However, there were no significant changes in echocardiographic parameters of LV systolic or diastolic function and RV function compared to baseline (Table 1). None of the donors had clinically relevant levels of NTproBNP after LKD. Conclusions: The rise in creatinine levels and blood pressure indicates that patients after LKD are at increased cardiac risk. However, in our pilot study, we found no evidence for detrimental effects of LKD on cardiac function within a relatively short-term follow-up. Pending further long-term data, cardiac function of kidney donors should be monitored by repeat echocardiography. Table 1: Exemplary echo parameters Parameter pre LKD post LKD p GLPS (%) -21.3 ± 2.4 -20.9 ± 2.1 0.255 E/A 1.3 ± 0.5 1.3 ±0.5 0.973 E/E' 7.2 ± 1.7 6.8 ± 1.8 0.142 TAPSE (mm) 25.0 ± 4.2 25.4 ± 3.7 0.566 RV-S' (cm/s) 13.8 ± 2.8 13.2 ± 3.7 0.186 Parameter pre LKD post LKD p GLPS (%) -21.3 ± 2.4 -20.9 ± 2.1 0.255 E/A 1.3 ± 0.5 1.3 ±0.5 0.973 E/E' 7.2 ± 1.7 6.8 ± 1.8 0.142 TAPSE (mm) 25.0 ± 4.2 25.4 ± 3.7 0.566 RV-S' (cm/s) 13.8 ± 2.8 13.2 ± 3.7 0.186 Mean ± SD. Open in new tab Table 1: Exemplary echo parameters Parameter pre LKD post LKD p GLPS (%) -21.3 ± 2.4 -20.9 ± 2.1 0.255 E/A 1.3 ± 0.5 1.3 ±0.5 0.973 E/E' 7.2 ± 1.7 6.8 ± 1.8 0.142 TAPSE (mm) 25.0 ± 4.2 25.4 ± 3.7 0.566 RV-S' (cm/s) 13.8 ± 2.8 13.2 ± 3.7 0.186 Parameter pre LKD post LKD p GLPS (%) -21.3 ± 2.4 -20.9 ± 2.1 0.255 E/A 1.3 ± 0.5 1.3 ±0.5 0.973 E/E' 7.2 ± 1.7 6.8 ± 1.8 0.142 TAPSE (mm) 25.0 ± 4.2 25.4 ± 3.7 0.566 RV-S' (cm/s) 13.8 ± 2.8 13.2 ± 3.7 0.186 Mean ± SD. Open in new tab P638 ICEBERG, does carotid ultrasound provide additional risk information in some low Framingham risk score patients? M Matangi1, DW Armstrong1, D Brouillard1, U Jurt1, AM Johri2 1Kingston Heart Clinic, Kingston, Canada 2Queen's University, Kingston, Canada Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Canadian lipid guidelines allow imaging for atherosclerosis in those patients who are intermediate risk (10-19% 10 year cardiovascular risk) using the global Framingham risk score (FRS). Low FRS patients have a 10 year cardiovascular risk of <10%. The purpose of this analysis is to report the prevalence of carotid atherosclerosis in patients with low FRS <5 compared to 5 to <10. Methods: Consecutive low FRS patients undergoing a routine ECHO for murmur, arrhythmia, hypertension or dyspnea also underwent carotid screening. Patients were males =40 years or females =50 years. All patients were statin naive. Patients with a prior history of a vascular event or diabetes were excluded. Patients were divided into those with a FRS of <5 and those with a FRS of 5 to <10. Our carotid screening involves 2 or 3 images on each side to include the CCA, carotid bulb and ICA. Carotid plaque was defined using the ARIC criteria. CCA IMT was measured offline in the far wall of the CCA. All patients gave signed informed consent. Results: There were 102 consecutive patients with low FRS. Thirty-eight had a FRS <5 (84% female, mean age 53.1±5.6yrs, Maximal CCA IMT 0.78±0.14mm) of which 3 had carotid plaque, prevalence 7.9%. There were 64 patients with FRS of 5 to <10 (73% female, mean age 56.8±7.1yrs, Maximal CCA IMT 0.93±0.24mm) of which 30 had carotid plaque, prevalence 46.9%. The 30 patients with FRS of 5 to <10 are high-risk equivalents, 29 of the 30 had an LDL-cholesterol >2.00mmol/l (mean 3.19±0.73) and would be eligible for Statin therapy. Conclusions: Patients with low FRS of 5 to <10 should undergo carotid ultrasound to assess the presence of carotid plaque. Such patients are at increased risk for cardiovascular events and may benefit from preventative strategies such as Aspirin and Statin therapy. Open in new tabDownload slide % of plaque in low Framingham risk. P639 Primary prevention of cardiovascular disease: are we targeting the right patients ? K Selby1, D Nanchen1, P Marquez-Vidal2, R Auer1, B Gencer3, CM Matter4, TF Luscher4, S Windecker5, F Mach3, N Rodondi6 1Lausanne University Hospital, Department of Ambulatory Care and Community Medicine, Lausanne, Switzerland 2University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland 3University Hospital of Geneva, Department of Cardiology, Geneva, Switzerland 4University Hospital Zurich, Cardiovascular Center, Department of Cardiology, Zurich, Switzerland 5Bern University Hospital, Department of Cardiology, Bern, Switzerland 6Bern University Hospital, Department of General Internal Medicine, Bern, Switzerland Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Background: Guidelines for the primary prevention of cardiovascular disease (CVD) recommend the use of cardiovascular risk calculators to determine which patients are most likely to benefit from medications such as aspirin and statins. Several cardiovascular risk calculators have been calibrated for use in Switzerland, but their ability to predict outcomes such as acute coronary syndromes (ACS) has not been demonstrated. Furthermore, it is not known whether primary prevention guidelines are implemented in Switzerland. Methods: We collected baseline information regarding cardiovascular risk factors and medication use for patients admitted with ACS between 2009 and 2013 to four university hospitals in Switzerland. Cardiovascular risk levels were computed both with the Swiss "Arbeitsgruppe Lipide und Atherosklerose" (AGLA) and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) calculators. Use of aspirin before hospitalization and eligibility for statins was stratified by risk level and compared with the most commonly used CVD guidelines. Results: Of 3,525 patients with complete information, 2573 (73%) patients had no previous history of CVD. Among them 1411 (54%) were classified as low-risk by the AGLA risk score. Only 16% of patients without history of CVD were taking a statin, and this proportion did not vary by AGLA risk score (p=0.26). By contrast, 72% of high-risk patients would have been eligible for a statin in primary prevention. Only 23% of patients at high-risk by the AGLA calculator were taking an anti-platelet medication such as aspirin. Similar figures were found using the ESC/EAS calculator. Conclusions: Among patients presenting with ACS to Swiss hospitals, most have no history of CVD and are classified as low-risk using the recommended score. The use of statins and antiplatelet medications before hospitalization is low in patients presenting with a first ACS, even among those classified at high-risk. Because effective drugs are now available in primary prevention, urgent research is needed to better identify and target high-risk individuals. Open in new tabDownload slide Table 1 P640 Abnormal blood pressure rise post mild exercise and abnormal B-type natriuretic peptide (BNP) or NT pro-BNP are markers for early cardiovascular disease risk stratification in asymptomatic subjects M El Shahawy1, M Entcheva1, A Sabatini2 1Cardiovascular Disease Assessment Center at Cardiovascular Center of Sarasota, Sarasota, United States of America 2Universitá degli Studi di Firenze, School of Medicine and Surgery, Florence, Italy Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Measurement of B-type natriuretic peptide (BNP) or NT pro-BNP has been advocated for cardiovascular disease (CVD) risk stratification. The purpose of this study is to assess the association between the presence of abnormal BNP/pro-BNP combined with abnormal blood pressure rise post mild exercise (BPRPME) in asymptomatic normotensive or hypertensive subjects for early cardiovascular disease risk stratification. Methods: We screened 2223 asymptomatic subjects, age 23-80, for CVD risk using Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS). ECVDRS consists of 10 tests: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post mild exercise (PME), Carotid Intima Media Thickness (CIMT), abdominal aorta and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro-BNP. Normotension (NT) and hypertension (HTN) were defined according to the JNC VII criteria. Abnormal BPRPME was defined as systolic BP rise >30mmHg post 3-min-walk at 7% elevation, 2.5mph. Results: Among the 2223 subjects, 1295 were not taking any CV medication. These subjects were divided into 4 groups: Gr1, Gr2, Gr3 and Gr4 according to resting BP status - normotensive [NT] or hypertensive [HTN], and BPRPME. The subjects with abnormal pro-BNP were further analyzed as far as the presence of LVH and abnormal RRS. Results are shown in table1. Conclusions: Abnormal blood pressure rise post mild exercise combined with abnormal pro-BNP in asymptomatic subjects are significant markers for early CVD risk stratification and clue for early cardiovascular structural abnormalities such as left ventricular hypertrophy, which may justify the need for early therapeutic interventions to avert significant morbidity and mortality. P641 Cardiovascular risk and it relation to hormonal status in perimenopausal A Isayeva1, AV Martynenko2, TA Struk3, OA Beloded3 1Government Institution National Institute of Therapy named after L.T. Malaya of NAMSU, Kharkiv, Ukraine 2Medical Faculty, Kharkiv National University named after V.N. Karazin, Kharkiv, Ukraine 3Kharkiv National Academy of Postgraduate Education, Kharkiv, Ukraine Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Risk of cardiovascular disease dramatically increases in postmenopausal women compared to premenopausal. Despite this fact, majority of cardiovascular risk assessment systems like SCORE, PROCAME QRisk or Reynolds score, do not count menopause as risk factor. In the present work, special importance was given to understanding of woman hormonal state impact, which was measured by the level of follicle-stimulating hormone. The aim of the present study was to evaluate cardiovascular risk in perimenopausal women and to find the period in woman life where hormonal influence on cardiovascular risk is most significant. Materials and methods: In a cross-sectional study were included 219 women without coronary heart disease. To assess cardiovascular risk SCORE scale was used. The level of follicle stimulating hormone (FSH) was measured with enzyme immune-assay method. The serum was obtained on 2 – 5 day of spontaneous cycle in cycling women or randomly in non-cycling women. All patients were evaluated for lipid profiles, ApoA1/ApoB levels, blood pressure, heart rate, ejection fraction. Data were analyzed using parametric and non-parametric statistic; samples that did not meet the criteria of normality were examined using two-factor analysis of variance Friedman rank for related samples with level of significance <0.005. The menopause was diagnosed if FSH was higher than 32 IU/l. Results: Pre- and postmenopausal groups did not differ significantly in any parameters except age, FSH level and SCORE rate. The majority of examined women corresponded to low or moderate cardiovascular risk. All patients were divided in six groups according to SCORE level (SCORE 1, 2, 3.6). Medians of FSH were compared between groups. FSH as well as SCORE rate increased with age rise. It was fond that groups SCORE 3 and SACORE 4 were characterized by the same age median (61 years old). At the same time FSH levels were significantly different in these groups. Moreover, the lower level of FSH was corresponded to lower SCORE level. It was fond that folliculi stimulating hormone could modify SCORE level. The impact of FSH on SCORE was most prominent in the age period 60 – 65 years. Further prospective studies with hard end-points must be done to c check the clinical value of the present theory. Conclusions: the majority of studied patients had low – to moderate cardiovascular risk. There was a connection between female hormonal status and cardiovascular risk assessed with SCORE scale. The influence of folliculi stimulating hormone was most prominent in age period 60 – 65 years. Table 1. Hospital readmission in one yea READMISSION < 1 YEAR NO READMISSION < 1 YEAR Sig. Retinopathy 5 (10%) 34 (66%) p = 0,013 Without Retinopathy 6 (12%) 6 (12%) Diabetic Retinopathy (n=2) Non Proliferative 1 (50%) 1(50%) p > 0,05 Proliferative 0 0 Hypertensive Retinopathy(n=38) I 0 19 (50%) p = 0,034 II 4 (11%) 15 (39 %) Atheroesclerotic Retinopathy(n=36) I 16 (44%) 1 (40%) p = 0,483 II 14 (39%) 3 (8%) III 2 (6%) 0 SYNTAX SCORE FIRST CORONARY ANGIOGRAPHY HOSPITAL READMISSION < 1 YEAR Yes (n= 4) 14,63 ± 15,93 p = 0,02 No (n=44) 4,68 ± 7,17 No (n=46) 4,91 ± 7,416 READMISSION < 1 YEAR NO READMISSION < 1 YEAR Sig. Retinopathy 5 (10%) 34 (66%) p = 0,013 Without Retinopathy 6 (12%) 6 (12%) Diabetic Retinopathy (n=2) Non Proliferative 1 (50%) 1(50%) p > 0,05 Proliferative 0 0 Hypertensive Retinopathy(n=38) I 0 19 (50%) p = 0,034 II 4 (11%) 15 (39 %) Atheroesclerotic Retinopathy(n=36) I 16 (44%) 1 (40%) p = 0,483 II 14 (39%) 3 (8%) III 2 (6%) 0 SYNTAX SCORE FIRST CORONARY ANGIOGRAPHY HOSPITAL READMISSION < 1 YEAR Yes (n= 4) 14,63 ± 15,93 p = 0,02 No (n=44) 4,68 ± 7,17 No (n=46) 4,91 ± 7,416 Open in new tab Table 1. Hospital readmission in one yea READMISSION < 1 YEAR NO READMISSION < 1 YEAR Sig. Retinopathy 5 (10%) 34 (66%) p = 0,013 Without Retinopathy 6 (12%) 6 (12%) Diabetic Retinopathy (n=2) Non Proliferative 1 (50%) 1(50%) p > 0,05 Proliferative 0 0 Hypertensive Retinopathy(n=38) I 0 19 (50%) p = 0,034 II 4 (11%) 15 (39 %) Atheroesclerotic Retinopathy(n=36) I 16 (44%) 1 (40%) p = 0,483 II 14 (39%) 3 (8%) III 2 (6%) 0 SYNTAX SCORE FIRST CORONARY ANGIOGRAPHY HOSPITAL READMISSION < 1 YEAR Yes (n= 4) 14,63 ± 15,93 p = 0,02 No (n=44) 4,68 ± 7,17 No (n=46) 4,91 ± 7,416 READMISSION < 1 YEAR NO READMISSION < 1 YEAR Sig. Retinopathy 5 (10%) 34 (66%) p = 0,013 Without Retinopathy 6 (12%) 6 (12%) Diabetic Retinopathy (n=2) Non Proliferative 1 (50%) 1(50%) p > 0,05 Proliferative 0 0 Hypertensive Retinopathy(n=38) I 0 19 (50%) p = 0,034 II 4 (11%) 15 (39 %) Atheroesclerotic Retinopathy(n=36) I 16 (44%) 1 (40%) p = 0,483 II 14 (39%) 3 (8%) III 2 (6%) 0 SYNTAX SCORE FIRST CORONARY ANGIOGRAPHY HOSPITAL READMISSION < 1 YEAR Yes (n= 4) 14,63 ± 15,93 p = 0,02 No (n=44) 4,68 ± 7,17 No (n=46) 4,91 ± 7,416 Open in new tab P642 Reticard study. follow up to a year of a cohort of patients with chronic ischemic heart disease and retinopathy (hypertensive / atheroesclerotic / diabetic). J Piqueras Flores1, M Marina Breysse1, I Lopez Mesa1, H Estero Serrano De La Cruz1, MT Lopez Lluva1, A Moreno Arciniegas1, N Pinilla Echeverri1, F Lozano Ruiz Poveda1, J Benezet Mazuecos1, I Sanchez Perez1 1Hospital General de Ciudad Real, Ciudad Real, Spain Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Objectives: Assess the relationship between the degree of retinopathy with the incidence of cardiovascular events Methods: Prospective observational cohort study with 54 patients undergoing diagnostic coronary angiography by the first medical indication who underwent ophthalmoscopy. Results: 54 patients with mean age of 64,96 ± 13,93. Risk factors: hypertension (80,4%), DM (31,4%), dyslipidemia (52,9%), smoking (16%), obesity (bmi 29,5 ± 5,3). The 37% had coronary artery disease and 95% had retinopathy. In the one year follow up, there was one death due to noncardiovascular causes. The presence of hypertensive retinopathy was associated with hospital readmission significantly (p = 0.034). With respect to Syntax Score, patients who were readmitted in the first year had a higher score on the initial coronary angiography (14.63 ± 15.93) than those who were not readmitted (4.68 ± 7.17) with significant differences (p = 0.02). Also, the patients requiring new coronary angiography had higher Syntax score in the initial coronariography (18,25 ± 21,5 front 4,91 ± 7,416; p = 0.006). Conclusions: The presence of hiypertensive retinopathy grade II was associated with increased incidence of hospital readmission. It was noted that patients with higher score Syntax likewise showed greater cardiovascular readmission and need for coronary angiography. P643 Incidence and severity of alterations in calcium phosphorus metabolism in patients with multiple cardiovascular risk factors and high framingham score. VD Martire1, MV Martire1, ER Pis Diez1, DO Portillo1 1CESALP. Fundación Horacio Corrada, La Plata, Buenos Aires., Argentina Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Background: Contradictory data refer to the clinical and therapeutical importance of alterations in calcium phosphorus metabolism (CPM) in patients (pts), with multiple cardiovascular risk factors (CVRF) and high Framingham point score (PFS). Objectives: To assess the incidence and severity of CPM alterations on a first model of clinical high risk, through the determination of paratohormone (PTH), Vitamin D (Vit D), plasma calcium (Ca), fasting (F) and postprandial (Pp) phosphatemia (Ph). Material and Methods: Having successively studied 88 pts (61 males, aged 60±9 years old), all of them with FPS = 20, PTH was determined through chemiluminescence (normal reference value (RV): 7-53 pG/ml), Vit D through electrochemiluminescence (RV: 20-100 nG/ml), Ca and Ph through colorimetric, complexometric and UV methods (RV: 8,6-10,2 mgs/dl and 2,5-4,5 mgs/dl respectively), pts with renal clearance < 40ml/min, calcium supplement or Vit D intake, and hypercalciuria remained excluded. Results: A-Incidence. 84/88 patients (95%) presented abnormal determination (elevated) of PTH, 82/88 (93%) severe Vit D deficiency, 0/88 (0%) abnormal Ca, and 88/88 (100%) abnormal postprandial response to dietary Ph:(3 hours after lunch at least 1 gram of dietary Ph). B-Magnitude of monitored alterations. PTH: 91±27 pG/ml, Vit D: 10±6 nG/ml, Ca: 9,01±0,25 mgs/dl, F-Ph: 3,26±0,47 mgs/dl, Pp-Ph: 4,03±0,65 mgs/dl (p< 0,01). (pG: picograms, nG: nanograms, mgs: milligrams, dl: deciliter.) (Graph). Conclusions: In this model of clinical high risk patients, there is evidence of a very high incidence and severity of paratohormone and Vit D alterations, as well as abnormal postprandial management of dietary phosphate, showing the need of new physiopathological and therapeutic strategies. Open in new tabDownload slide P644 Risk factors of cardiovascular diseases among patients and physicians of Ukraine OM Barna1, IM Gorbas2, AY Bazylevych3, HV Svitlyk3, MO Harbar3 1Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine 2National Scientific Center "M.D. STRAZHESKO INSTITUTE OF CARDIOLOGY, MAS OF UKRAINE", Kyiv, Ukraine 3Lviv medical university, Lviv, Ukraine Topic: Atherosclerosis/CAD (Prevention & Epidemiology) The concept of risk factors (RF) is leading in preventive cardiology. Their correction improves health of population and reduce morbidity and mortality. The purpose of our study was to investigate RF of cardiovascular diseases (CVD) and their prevention among both patients and physicians of Ukraine. Methods: Were analyzed data of clinical studies of population, the national program "CV-risk under control" (on which base is created the I National registry for CVD control among the physicians) and postal polls of the population. Among the respondents 938 persons were doctors. We took into account the following RF: hypertension and its control, body mass and regular exercises, level of cholesterol and taking of lipid-lowering drugs, diabetes and determination of glucose, smoking. Results: In Ukraine the cerebrovascular and ischemic heart diseases are cause of death from CVD in 88%. The main RF is hypertension (36% of the population). At the age of 25-34 years, one out of 6 men and one in 20 women have increased level of blood pressure (BP). At the age of 45-54 years, every second person has high BP. 63% of physicians systematically determine their BP. In the population this value is lower - 43.4%. Control of BP in the population still remains an unsolved problem - only 17% of medics and 19% of patients take anti-hypertensive drugs. More than a half of population are overweight. Obesity is common among women by 1.7 times more often. Diet follows 21% of doctors and 17% of patients.The low is the physical activity - regular exercises have 8.3% of patients and 16% of medics. Don't control their cholesterol 42% of physicians and 43% of patients. 40% of doctors and 25% of patients determined it last year. Lipid-lowering drugs take only 1.5% persons. Nearly 1.3 millions (3.1%) have diabetes. Level of glucose last year determined 60% of medics and 40% of patients. 46% of males and 20% of females smoke. It is interesting that 47% of physicians didn't try to stop smoking, in the general population this figure is lower - 31.3%. Recommendations from the general practitioner regarding weight loss received 9% of patients, smoking cessation - 11%, limiting salt intake - 7%, alcohol - 2%, animal fat consumption - 11%, increasing physical activity - 3%. For 56% of respondents main source of information about health is TV. To 47% of persons advisers regarding health are relatives and friends, to 18% - doctors. Thus the situation with the correction of RF of CAD in Ukraine is not favorable. We need more active application of methods of CAD prevention at the population level. And doctors should be example for their patients. P645 Cardiovascular risk factors are associated with subclinical atherosclerosis in healthy individuals - A DanRisk substudy. R Ramanathan1, JJ Sidelmann2, IS Bjerrum3, ACP Diederichsen4, J Jespersen2, JB Gram5, NPR Sand6 1Hospital of South West Denmark, Department of Cardiology, Esbjerg, Denmark 2IST, University of Southern Denmark,Unit for Thrombosis Research, Esbjerg, Denmark 3Department of Internal medicine, Hillerod Hospital, Hillerod, Denmark 4Odense University Hospital, Department of Cardiology, Odense, Denmark 5Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Esbjerg, Denmark 6Institute of Regional Health Services Research, University of Southern Denmark, Esbjerg, Denmark Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Objectice: To characterize subclinical atherosclerosis in healthy, randomly selected, non-medicated middle-aged individuals and to compare these findings with classical cardiovascular risk factors and biochemical markers of inflammation and endothelial dysfunction. Methods: Participants were recruited from the Danish Risk Score Study, DanRisk. A total of 277 individuals, aged 50 or 60 years, without known cardiovascular disease or diabetes were randomly selected from national registries. Of those 209 persons did not receive any medication and represented the study population. Health status was recorded and biochemical analysis was performed. Inflammation (C-Reactive Protein (CRP), fibrinogen and D-dimer) and endothelial dysfunction (von Willebrand factor, tissue-Plasminogen Activator (t-PA), and Plasminogen Activator Inhibitor-1 (PAI-1)) were studied. Patients were separated in 2 groups according to occurrence of subclinical atherosclerosis in 0 (Ath0) or 1 (Ath1) vascular territories as evaluated by non-enhanced cardiac CT and carotid ultrasound. Atherosclerosis in the coronary arteries was defined as an Agatston Score (CAC-score) above 0, while atherosclerosis in the carotids was defined either as thickening of the focal wall at least 50% greater than the thickening of the surrounding vessel wall or as focal region with an Intima Media Thickness (IMT) above 1.5 mm. Results: Age (P<0.001), smoking (P<0.001), systolic blood pressure (P=0.011) and LDL-cholesterol (P=0.019) were significantly associated with subclinical atherosclerosis. Furthermore, t-PA (6.5 (4.7-8.7) in Ath 0 and 8.4 (6.2-10.9) in Ath1; (P=0.002)) and PAI-1 (12.7 (7.8-19.0) in Ath0 and 16.0 (11.1-20.7) in Ath1; (P=0.007)) were significantly different between the atherosclerotic groups. Overall, we found no other significant differences between groups. However, a CAC-score above zero was more frequently seen in men (P=0.002) and coronary calcification was strong correlated to t-PA (P<0.001) and PAI-1 (P=0.005), while fibrinogen was associated with IMT (P=0.024). Logistic multivariate regression revealed that only age (p=0,002), gender (p=0,023) and systolic blood pressure (p=0,039) were associated with CAC. No risk factors were associated with abnormal carotid ultrasound. Conclusions: This study shows that markers of inflammation and endothelial dysfunction are associated with subclinical atherosclerosis in asymptomatic healthy individuals, but these changes are mediated through classical risk factors such as age, smoking etc. Furthermore, differences between coronary and carotid arteries are observed regarding risk factors. P647 Novel cardiovascular biomarkers in women with a history of early preeclampsia. JT Drost1, AHEM Maas2, S Holewijn2, L Joosten2, J Van Eyck1, J De Graaf2, YT Van Der Schouw3 1Isala Hospital, Zwolle, Netherlands 2Radboud University Medical Center, Nijmege, Netherlands 3University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands Topic: Other risk factors (Prevention & Epidemiology) Purpose: Women with a history of preeclampsia (PE) are at increased risk for future cardiovascular disease (CVD). Determination of cardiovascular biomarkers may be useful in these high risk women to further estimate their CVD risk. In this study we analysed novel cardiovascular biomarkers in women with a history of early PE. Methods: We performed a cross-sectional analysis in the Preeclampsia Risk EValuation in FEMales (PREVFEM)-study, a cohort consisting of 339 women with a history of early PE and 332 women after normotensive pregnancy. A subset of 8 different cardiovascular biomarkers were investigated, reflecting inflammatory, metabolic, thrombotic and endothelial dysfunction markers. Associations between these novel biomarkers and PE were analysed by ANCOVA analysis and adjusted for traditional CV risk factors. Results: Mean age of 671 women of the PREVFEM cohort was 39 years and women were on average 10 years post index pregnancy. SE-selectin and PAPPA were significantly associated with PE, whereas ApoB was inversely associated with PE, compared to women with a previous normotensive pregnancy. Adiponectin, leptin, sICAM-1, sVCAM-1 and PAI-1 were not different between both groups. Conclusions: In this cross-sectional cohort analysis we demonstrated an independent association of SE-selectin and PAPPA (markers of vascular dysfunction) with PE, which may contribute to future cardiovascular events in women post PE. However, ApoB (a lipid-marker) was significant lower and could point at a protective mechanism in these women. P648 Coronary calcium score and severity of atherosclerotic disease in a elderly population in a university hospital in Brazil N H Lopes1, LFEG Luis Fernando Escobar Guzman1, SSA Solange De Sousa Andrade1, MCB Marcela Cibien Baratella1, CER Carlos Eduardo Rochitte1, CHN Cesar Higa Nomura1, HP Humberto Pierri1 1Heart Institute of University of Sao Paulo, Sao Paulo, Brazil Topic: Atherosclerosis/CAD (Prevention & Epidemiology) Introduction: The coronary calcium score (CCC) assessed by coronary computed tomography (CCT), has proven predictive value for cardiovascular disease. In special populations such as the elderly large, however, little is known about its value. Our objective was to evaluate the correlation between the degree of calcification and the presence/extent of coronary calcification by CCC in a population of elderly over 65 years. Methods: 1502 elderly > 65 years who underwent CCT coronary diagnosed and / or suspected coronary artery disease (CAD) between 2009- 2012. Of these, 239 and 128 had revascularization with angioplasty prior. The CC was divided into 5 groups : zero, < 100, 100 to 399, > 400 and > 1000 Agatston units. Atherosclerotic burden was ranked no injuries, one-vessel, double or triple vessels, considering injuries as = 50 %. Analyses were stratified by age: > 65-74, 75-79, 80-84 and > 85 years. Results: Of the 1094 CCT without revascularization, 2.92 % presented no coronary lesion and 69.4 %, 16.7% and 10.9 % as one, two and three-vessel disease, respectively. Analysis by sex, frequency of lesions was similar in all categories (p = 0.071). Stratified by age, there was no significant difference between groups in the number of lesions (p = 0.080), even those = 80 years. (p = 0.164). The CCC average was 389.9 + - 733.3, the minimum and maximum values ??were 0 and 8574.0 and median of 900. Only 172 patients had CCC zero. The CCC level distribution by number of affected arteries showed a proportional relationship between the extent of coronary calcification and the number of affected arteries (p < 0.0001). As for the different age groups, there was no significant difference in the distribution of degree of CCC (0.318). Finally, correlation was observed between CCC and severity of CAD (r = 0.464, p <0.0001), however this correlation was higher in the group between 75-79 years (r = 0.528, p< 0.001). About 50 % of the elderly above 80 years had CCC. Conclusions: In patients over 65 years, we observed a correlation between calcium score and severity of coronary artery disease. However, in the oldest population, low values ??of calcium score may have significant coronary arterial obstruction. P649 Chronic obstructive pulmonary disease in the prognosis of patients with heart failure: attention towards its prevention S Petrovic-Nagorni1, S Ciric-Zdravkovic1, D Stanojevic1, L Todorovic1, M Pavlovic1, Z Perisic1, E Dimitrijevic1, T Kostic1, S Dakic1 1Clinic for Cardiovascular Diseases, Nis, Serbia Topic: Heart Failure (Prevention & Epidemiology) Introduction: Chronic obstructive pulmonary disease (COPD) is a common co-morbidity in patients with heart failure (HF). Recent studies suggest that COPD adversely affects the prognosis of these patients leading to systemic inflammation, dysfunction of the right ventricle and pulmonary hypertension. Also in these patients, beta blockers are rarely used and bronchodilators may adversely affect cardiac function. Aims and methods. The aim of our study was to investigate the effect of COPD on in-hospital and one-year prognosis in patients who were treated at the Intensive Care Unit of the Clinic for Cardiovascular Diseases Nis due to acute decompensation of chronic HF. Results: The study included 201 patients, mean age 71.5 ± 10.3 years of whom 60.7 % were male, 23.9 % of patients suffered from COPD. This co-morbidity has had an impact on early mortality (first six months after discharge from the hospital) increasing it even 20.6 times (OR = 20.59; 95%CI: 0.95 - 449.6, p = 0.04), and on one year mortality after hospital discharge increasing it for more than 5 times (OR = 0.18; 95%CI: 0.034 - 0.98, p= 0.04) in the binary logistic regression analysis. Patients with COPD had no significantly different values ??of BNP and troponin I (1352.3 vs.1617 pg/ml; 0.7 vs. 0.5 ng/ml) as well as markers of inflammation compared to other patients (CRP: 31.7 vs. 43.5 ng/L; Le: 11.1 vs 12.8 x 109/L; fibrinogen: 17 vs. 38 g/L). There was no significant difference in left ventricular ejection fraction (LVEF) and NYHA class belonging to a certain class of patients with/without COPD (LVEF: 37.38 vs. 37.4%; most patients belonged to NYHA class 3: 52.1 % vs.54.2 %). From the observed data relevant difference was found only in age (patients with COPD were older): 74.6 vs.70.6 years, p = 0.019. Conclusions: Chronic obstructive pulmonary disease is a common co-morbidity in patients with HF. It adversely affects short-and long-term prognosis in these patients. The exact mechanism of the negative effects of COPD prognosis is still not fully known until then attention should be paid to its prevention. P650 Effects up-titration of beta-blocker dose on uric acid levels in chronic heart failure: results from CIBIS ELD study S Apostolovic1, D Stanojevic1, M Pavlovic1, R Jankovic-Tomasevic1, S Salinger-Martinovic1, D Djordjevic-Radojkovic1, E Tahirovic2, G Gelbrich3, L Musial-Bright2, HD Dungen2 1Clinic for Cardiovascular Diseases, Nis, Serbia 2Charite - Campus Virchow-Klinikum, Department of Internal Medicine-Cardiology, Berlin, Germany 3University of Leipzig, Institute for Medical Informatics, Statistics & Epidemiology, Leipzig, Germany Topic: Heart Failure (Prevention & Epidemiology) Introduction: Uric acid (UA) is the final product of purine catabolism, and it is excreted mainly by the kidneys. Serum UA increases as a function of purine intake, and it varies inversely to uricosuria. Diuretics and beta blockers (BB) elevate UA by elevating its reabsorption in the renal proximal tubule. Uric acid can scavenge reactive oxygen species and reduce oxidative stress, which seems to contribute to the development and progress of various cardiovascular conditions including chronic heart failure (CHF). Consequently, beta blockers by inducing the increase in UA which is a cardiovascular risk factor are to be considered to worsen prognosis in CHF. However, it is well known that BB improves survival in CHF. Purpose: The aim of our study was to determine whether non- or cardioselective BB (carvedilol and bisoprolol) cause significant increase in UA during the dose up-titration in CHF. Methods: We included patients from the CIBIS ELD study: 297 patients from Germany (age 74 years, 46% male, 37% with systolic CHF) and 579 from Southeastern Europe (age 72 years, 71% male, 89% with systolic CHF). Prior to randomization participants had to clinically stable and be BB naive or on =25% of the guideline-recommended target or equivalent dose. We up-titrated BB up to maximum tolerated dose over three months. The estimated glomerular filtration rate (eGFR) was calculated using Cockroft-Gault formula. Results: At the end of the study eGFR decreased (66.08±36.84 vs. 64.57±30.37 mL/min; p=0.28), while UA was significantly increased (351.4±119.6 vs. 361.17±126.2 mmol/L; p=0.02). Percentage of patients with hyperuricemia (UA above the upper referent value) significantly increased irrespectively of the BB selectivity: 24.2% vs. 28%, p<0.001. Meanwhile, left ventricle ejection fraction (LVEF) significantly increased (41.7±13.5 vs. 44.5±12.7%, p<0.001). Conclusions: In the CHF low cardiac output and consequently low renal blood flow may contribute to reduced eGFR. The low renal blood flow can limit the oxygen supply and active UA tubular secretion. In our study LVEF increased and renal perfusion, presumably. It is unlikely that increase of BB dosage alone caused the reduction of UA urinary excretion. Other factors like angiotensin II and reduced distal tubular load of sodium may also reduce the excretion of UA. It is prudent to conclude that using the effective UA lowering drugs we could prevent unwanted cardiovascular events. The cardiovascular implications of the effects of drugs on UA, if any, should be elucidated through further research. P651 Sudden cardiac death in ukraine: ecological aspects of the problems T Solomenchuk1, DD Zerbino1 1Danylo Halytsky Lviv National Medical University, Lviv, Ukraine Topic: Other Heart Disease (Prevention & Epidemiology) Based on the 150 notes accompanying the annual statistical reports received from 25 regional forensic medical examinations between 1999 and 2004, the analysis of the dynamics of sudden death (SD) due to cardiovascular diseases (CVD). Depending on the geographical location and ecological condition of area (level of industrialization index) all districts of Ukraine were divided into 3 regions. First regions consists of 7 districts of Western Ukraine with level of industrialization index: 0.3-0.5, second consists of 13 regions of the North-East, Central and Southern regions - 0.5-0.9, third consists of 5 districts of South-East region – 0.9-1.4. The incidence of SD of CVD was calculated per 100 thousand of population. Results: The incidence of SD due to CVD appeared lowest in first region with the lowest index of industrialization: from 30.61±3.25 (1999) to 45.14±5.06 (2004). In the third region in which a highest level of industrialization and therefore same degree of pollution with xenobiotics, recorded the highest rate of SD with CVD, that is in average 2.5 times reliably exceeded that in the first region (p < 0.001), from 78.39±5.78 cases (1999) to 114.37±8.44 cases (2004). The difference between I and III regions was 2.3-2.7 times or 130-170 % (p < 0.001). SD from the CVD had intermediate position in the the second region with an intermediate level of industrialization index: from 57.91±5.25 (1999) to 92.38 ± 9.63 (2004), in average 1.9 times significantly higher than in first region (p<0.001). Also in the third region its level is reported 25-40 % higher, in comparison with the second region (p<0.05). For the three regions common feature of dynamic test target is a gradual annual increase on average by 8.9%. From 1999 to 2004 the number of cases of SD due to CVD increased in the first region by 47.5% (p < 0.05), in the second - by 59.5% (p<0.01) and in third – 45.9% (p<0,01). Conclusions: Between the level of SD due to CVD and degree of technogenic pollution xenobiotics exists a causal relationship. The greatest number of causes SD due to CVD registered in regions with the highest degree of industrialization and, therefore, the most powerful industrial development, intensification of agriculture, urbanization and worse ecosystem condition. The smallest is in regions with low index of industrialization. The increase of SD in all regions during the six years of observation associated with a gradual deterioration in this period, the ecological situation of the whole territory of Ukraine. P652 B-type natriuretic peptide elevation is more frequent in HIV+ patients compared to the general population N Reinsch1, L Eisele2, T Neumann1, V Holzendorf3, N Brockmeyer4, D Schadendorf5, R Erbel1, S Moebus2, KH Joeckel2, S Esser5 1West German Heart Center Essen Clinic for Cardiology, Essen, Germany 2University of Duisburg-Essen, Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany 3Center for Clinical Trials (KKS), University of Leipzig, Leipzig, Germany 4Ruhr-University Bochum, St. Josef Hospital, Department of Dermatology and Allergology, Bochum, Germany 5Department of Dermatology and Venerology, University of Essen, Essen, Germany Topic: Other Heart Disease (Prevention & Epidemiology) Objectives: B-type natriuretic peptide is commonly used for the diagnosis of heart failure and it has been suggested to improve prediction of coronary events and all-cause mortality. We compared plasma BNP levels of HIV+ patients with the general population in Germany. Methods: The prospective HIV-HEART (HH) study focuses on cardiovascular diseases and risk factors in 1420 HIV-positive patients (HIV +) (20-79 years), while the Heinz Nixdorf Recall Study (HNR) observes a random sample of 4814 subjects aged 45-75 also with regard to cardiovascular risk factors. Plasma BNP levels from baseline evaluation of both studies were dichotomized using a clinically relevant cut-point (<100 pg/ml and >=100 pg/ml). An age restriction of 45-75 years was used and study participants with known cardiovascular disease were excluded. Unconditional logistic regression was used to compute odds ratios adjusted for age, sex, known cardiovascular risk factors and any current medication with thiazide diuretics, ace inhibitors, aldosterone, digitalis, or beta blockers. Results: In 316 HH patients and 3653 HNR participants data for all variables were available. HH patients were younger (mean age: 53.2 ± 7.0) and predominantly male (88.6%) compared to HNR participants (59.5 ± 7.7, 47.8%). Median BNP levels and interquartile ranges (IQR) in the age strata 45-54, 55-64, and 65+ were 11.5 (6.9-21.9), 17.8 (10.6-36.6), and 34.0 (17.2-93.9) in HH and 12.8 (6.9-22.4), 18.0 (10.1-30.9), and 26.3 (14.2-46.5) in HNR. A BNP level >100 was present in 19 (6.0%) HH patients and 86 (2.4%) HNR participants. HIV+ patients had a 7.71-fold higher chance of BNP >100 (OR 7.71, 95%-CI 4.14-14.37, p<0.0001). Conclusions: A clinically relevant BNP elevation was more frequent in HIV+ patients compared to the general population suggesting a myocardial involvement leading to an elevated wall stress in the disease process either by direct viral infection or indirect by the inflammatory as well as the antiretroviral medication. P653 Gender differences of coronary intervention for patients with acute coronary syndrome admitted at a major metropolitan hospital in Melbourne, Australia MA Rahman1, A Macisaac2, E Scruth3, L Worrall-Carter1 1Australian Catholic University, Melbourne, Australia 2St Vincent's Hospital, Melbourne, Australia 3Kaiser Permanente (NCAL) Regional Quality and Regulatory Services, California, United States of America Topic: Other Heart Disease (Prevention & Epidemiology) Background:Literature suggests an ongoing gender disparity in the use of coronary angiography and subsequent interventions among patients with acute coronary syndrome (ACS). Many studies describe women with ACS as being older, with more co-morbidities than men resulting in less coronary interventions. Objectives:To investigate the factors underlying the gender differences for coronary angiogram and revascularization for patients admitted with ACS at a major metropolitan hospital in Melbourne during 2009-12. Methods:Patients, having the primary diagnosis of ACS in the database and admitted for the first time, were selected for analyses. ICD-10 was used for coding of ACS and co-morbidities. ACS was classified as unstable angina (UA), ST-segment elevation myocardial infarction (STEMI) and non-STEMI. For each category, gender differences were analysed on demographics, coronary angiogram, angioplasty, coronary artery bypass grafting (CABG), risk factors and co-morbidities. Results:A total of 2096 patients were included, 624 (30%) were women. Mean age (SD) of the patients was 64.3(13.4) years. Half of them (51%) were diagnosed as NSTEMI, 23% as STEMI and 25% as UA. Women diagnosed with NSTEMI were 24% less likely to have an angiogram than men (60% vs. 67%, p<0.05, odds ratio 0.76, 95%CI 0.58-0.99). Compared to men, women were less likely to have angioplasty if diagnosed with STEMI (57% vs. 72%, p<0.01, odds ratio 0.50, 95%CI 0.33-0.76) and diagnosed with NSTEMI (32% vs. 39%, p<0.05, odds ratio 0.75, 95%CI 0.57-0.98). Women were also less likely to have CABG than men if diagnosed with UA (10% vs. 21%, p<0.01, odds ratio 0.41, 95%CI 0.23-0.72) and diagnosed with NSTEMI (9% vs. 16%, p<0.01, odds ratio 0.51, 95%CI 0.33-0.78). Women of 35-59 years were less likely to have coronary interventions, however, the likelihood of this increased if they were above 70 years of age. There was no gender difference for severe co-morbidities. Current smoking was the only significant risk factor for gender difference and men were more likely to smoke than women. Conclusions:Younger women were less likely to receive coronary intervention in terms of diagnosis and treatment compared to men. Future research investigating symptom presentation of younger women as well as exploring perceptions of health care workers including cardiologists for decisions on coronary intervention could explain the reasons of gender disparity and subsequent gaps in treatment adherence guideline. P655 The effect of morning or evening use of a fixed-dose combination pill (polypill) on LDL-cholesterol, ambulatory blood pressure and adherence in patients with cardiovascular disease M Lafeber1, DE Grobbee1, IM Schrover1, S Thom2, R Webster3, A Rodgers3, FLJ Visseren1, ML Bots1, W Spiering1 1University Medical Center Utrecht, Utrecht, Netherlands 2Imperial College London, London, United Kingdom 3George Institute for International Health, Sydney, Australia Topic: Vascular disease (Prevention & Epidemiology) Aims: Cardiovascular fixed-dose combination (FDC) pills, polypills, are a novel strategy in cardiovascular disease prevention. Typically blood pressure (BP)-lowering agents and aspirin are taken in the morning, while short-acting statins are taken in the evening. Some evidence suggests benefits of taking aspirin and BP-lowering medications in the evening, although adherence is suggested to be optimal during morning use. The study compared the effects of a polypill taken in the evening, in the morning and the individual components taken at their usual times on cardiovascular risk factors, patient adherence and acceptability. Methods: The study was a randomized three-period crossover trial. Seventy-eight patients with established cardiovascular disease rotated through three 6 to 8 week dosing schedules in random sequence: (1) polypill (aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and hydrochlorothiazide 12.5 mg) in the morning, (2) polypill in the evening, (3) the individual agents taken at different time points (Trial:NCT01506505). Adherence was digitally measured with medication event monitoring systems. Results: Use of the polypill in the evening compared to use in the morning resulted in a 0.2 mmol/L (95%-confidence interval (CI): 0.1 to 0.3) lower LDL-cholesterol (LDL-c), but no statistically significant difference in mean 24-hour systolic BP (difference: 0.7 mmHg; 95%-CI: -2.1 to 3.4). Compared to the individual agents, the polypill in the morning resulted in a 0.2 mmol/L (95%-CI: 0.1 to 0.3) higher mean LDL-c, but no statistically significant difference in mean 24-hour BP (difference: 0.4 mmHg; 95%-CI; -1.5 to 2.3). With evening use of the polypill there were no differences in LDL-c (difference: -0.1 mmol/L; 95%-CI: -0.1 to 0.0) or mean 24-hour systolic BP (difference: 1.0 mmHg; 95%-CI; -0.8 to 2.8) compared to use of the individual agents. The adherence was 5.2% (95%-CI: 1.4 to 9.1) higher with morning use and 5.0% (95%-CI: 1.5 to 8.5) higher with evening use of the polypill compared the individual agents. Treatment with the polypill was preferred by 92% of the participants. Conclusions: Use of a polypill in the evening is more effective in lowering LDL-c, and results in similar BP levels compared to use of a polypill in the morning. Treatment with a polypill in the evening is equally effective in lowering LDL-c and BP compared to treatment with the individual polypill components at different times a day, but is associated with an increased adherence and is highly preferred by patients, demonstrating a role for the polypill in the preventive management of patients with cardiovascular disease. P656 Impact of non-fulfillment with dietary-pharmacological objectives for the evolution and complications of carotid disease. VD Martire1, E R Pis Diez1, D O Portillo1 1CESALP. FundaciÓn Horacio Corrada, La Plata, Buenos Aires., Argentina Topic: Vascular disease (Prevention & Epidemiology) Background: Non-Fulfillment with the objectives of dietary and pharmacological control of multiple risk factors for vascular disease, determines a worse outcome and high complication rate in patients with carotid disease (CVD), however, the magnitude of this impact on public health has not been conclusively studied. Objectives: To assess the impact of Non-control in patients (pts) with CVD compared with those who do have control in a clinical and ultrasound follow-up of 3 years. Methods: 312 pts: age: 68 ± 11 years, 113 females, 199 males. Hypertension (56 %), Dyslipidemia (57%), Tobacco (28%), Diabetes mellitus (13%), Overweight/obesity (29%), Cerebrovascular Accident/Stroke (6%), Prior Revascularization (2,5 %) were consecutively studied and followed during that period, with colour Doppler of neck vessels (DNV). Divided into two groups: with Control: Group 1 (170 pts): Myointimal thickening: 102 patients (60%), Non-stenotic plaque: 51 pts (30%), stenotic plaque: 3 pts (1,7%), and Non-Control: Group 2 (142 pts): Myointimal thickening: 77 pts (54%), Non-stenotic plaque: 51 pts (36%), stenotic plaque: 17 pts (12%). Analyzing at 3 years: 1-Conversion from Non-stenotic to Stenotic plaque, and 2-Clinical complications (new plaques, new CVA, revascularization, and death). Results: Group 1: Conversion: 12 pts (7%), Complications: 4 pts (2,4%). Group 2: Conversion: 25 pts (36%) (p: < 0,05). Complications: 18 pts (13%) (p: < 0,01). Conclusions: In this sample of patients followed prospectively for 3 years, non-fulfillment of the objectives of dietary and pharmacological control, has been crucial to rapid conversion of carotid plaques and increased rate of clinical complications. Being hypertension and dyslipidemia risk factors with more evolutive weight. Open in new tabDownload slide Evolution at 3 years. P657 Patient delay in patients suspected of TIA LS Dolmans1, KA Van Son1, AA Vermeulen1, MEL Bartelink1, LJ Kappelle2, AW Hoes1, FH Rutten1 1University Medical Center Utrecht, Consultant Ultrasound Research, Julius Center for Health Science, Utrecht, Netherlands 2University Medical Center Utrecht, Utrecht, Netherlands Topic: Vascular disease (Prevention & Epidemiology) Patient delay in patients suspected of TIA Purpose: Patients who suffer a Transient Ischemic Attack (TIA) have a high short-term risk of developing an ischemic stroke, being highest within the first 48 hours following TIA. Timely reporting of symptoms by patients and adequate diagnosis of TIA by physicians would enable urgent preventive treatment. We want to determine the extent and causes of patient delay in patients suspected of TIA. Methods: We conducted a survey at two rapid-access TIA outpatient clinics in Utrecht, the Netherlands, between July and September 2013. Patients suspected of TIA and referred to the outpatient clinic were interviewed. We determined the exact time from onset of symptoms to contacting a physician, most often the general practitioner. Additionally, we gathered demographic and clinical characteristics of participants, and behavioural aspects and knowledge on TIA of them were assessed. We used logistic regression to analyse predictors of patient delay. Results: A total of 45 patient suspected of TIA were interviewed. The median time until contacting a physician was 19 hours (IQR 0.54-82 h), and in 18 (40%) patients the delay was more than 24 hours. In our preliminary dataset the following factors were associated with a longer delay (>24h): (1) patient did not consider the symptoms being urgent; (2) patient did not consider TIA as a medical emergency; (3) no speech problems. Conclusions: Patients suspected of TIA show substantial delay in contacting a physician, being most often a general practitioner. Both symptoms suggestive of TIA and the disease TIA itself are not considered as being urgent by patients, with as a result postponement of critically important stroke prevention including treatment with antiplatelets. Lay persons need to be informed about the importance of recognizing TIA and early start of treatment. P658 Time for patient-centered health checks? PE Korhonen1, S Jarvenpaa2, H Kautiainen3, P Mantyselka4 1University of Turku, Turku, Finland 2MedCare Foundation, Tnekoski, Finland 3Helsinki University Central Hospital, Department of Medicine, Helsinki, Finland 4University of Kuopio, Department of Medicine, Kuopio, Finland Topic: Vascular disease (Prevention & Epidemiology) Purpose: To analyze how healthy – by the view of themselves and by the medical professional – are apparently healthy subjects attending a screening program for cardiovascular risk factors, and in doing so offer an explanation why general health checks do not improve mortality or morbidity. Methods: A targeted screening program identified 462 middle-aged cardiovascular risk subjects without previously diagnosed chronic disease in a Finnish community in 2005-2006. Home blood pressure monitoring, oral glucose tolerance test, estimated glomerular filtration rate, and ankle-brachial index were used to detect previously undiagnosed conditions. Short-Form Health Survey and Beck's Depression Inventory were completed before the diagnostic tests were performed. Results: The prevalence of previously undiagnosed disease was: hypertension 113/462 [24% (95% CI 21% to 29%)], diabetes 19/462 [4% (95% CI 2% to 6%)], renal insufficiency 23/462 [5% (95% CI 3% to 7%)], and peripheral arterial disease 17/462 [4% (95% CI 2% to 5%)]. Of the 139 subjects who regarded their health "fair – poor", 60 (43%) were not truly healthy when diagnostic tests were used to detect previously undiagnosed conditions affecting vasculature. Conclusions: Out of the screen-detected apparently healthy cardiovascular risk subjects, 1 in 3 had previously undetected hypertension, type 2 diabetes, peripheral arterial disease or renal insufficiency. Many subjects with undiagnosed co-morbidities feel ill-health and may seek medical advice beyond the screening programs. P659 prevalence of long QT interval in the spanish population older than forty years. results from the OFRECE study P Awamleh Garcia1, C Graupner2, S Del Castillo2, J Serrano2, JJ Gomez-Doblas3, J Muniz4, JJ Alonso2, E Roig5 1Hospital Universitario de Getafe, Madrid, Spain 2Hospital Universitario de Fuenlabrada, Madrid, Spain 3University Hospital Virgen de la Victoria, Malaga, Spain 4Instituto Universitario de Ciencias de la Salud. Universidad de A Coruña., A Coruña, Spain 5Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Introduction: An abnormal heart rate-corrected QT interval (QTc) is an independent risk factor for sudden cardiac death. However, data about its prevalence in general population are scant Objetive: to analyze the prevalence of prolonged QTc interval in the spanish population older than 40 years. Methods: Cross-sectional study endorsed by the Spanish Society of Cardiology over the Spanish population older than 40 years. Two-stage random sampling was used, where first stage units where primary care physicians randomly selected at every spanish province and second stage units were 20 randomly selected persons drawn from every participating physician's assigned population. There was centralized reading of the electrocardiogram (EKG) recordings. EKGs were evaluated by a two trained cardiologists. In case of disagreement in diagnosis a third cardiologist was consulted and final diagnosis was reached by consensus. QT interval was measured from the start of the QRS complex until the end of the T-wave. The Bazett formula (QTc=QT/vRR) was used to correct the interval for heart rate. Three categories were defined: normal QTc 340-439 miliseconds (ms); borderline 440-469 ms; prolonged QTc = 470 ms. Results: Data from a representative sample of spanish population constituted by 7789 individuals in sinus rhythm and without left bundle branch block were analyzed. We found that 88.87% (7011) of population had a normal QTc; 9.67% of cases were borderline (763) with medium QTc of 449.30 miliseconds (CI95% 448.53-450.07) and 1.22% of population (96) had prolonged QTc. Medium QTc in this group was 484.93 miliseconds (CI95% 480.24-489.61). Independent predictors of prolonged QTc (= 470 ms) were: age, overweight (OR 0.58; CI95% 0.35-0.96) and previous atrial fibrillation (OR 3.46; CI95% 1.32-9.03). Independent predictors of borderline QTc (440-469 ms) were: age, sex, obesity (OR 1.31; CI95% 1.00-1.72), diabetes (OR 1.51; CI95% 1.16-1.98), smoking (OR 1.34; CI95% 1.01-1.77) and hypertension (OR 1.36; CI95% 1.07-1.71) Conclusions: prolonged QTc interval (= 470 ms) is highly prevalent in the spanish adult population over 40 years (1.22%). Age, overweight and previous episodes of atrial fibrillation were independent predictors of having prolonged QTc. P660 VCG Sophie software as patented tool in risk detection of sudden cardiac dying I Vranic1 1UC Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Purpose: For many centuries, mysterious death of prominent proffessional sportsmen, have preoccupied media and doctors attention, especially because deceased athletes previously had achieved extraordinary sports results without having heart problems. The majority of athletes who die suddenly have groundwork for disease development in the sense of structural heart disease, that represents the basis for ventricular fibrillation genesis. Methods: Total number of 112 arrhythmogenic right ventricular cardiomiopathy/dysplasia (ARVC/D) diagnosed patients were enrolled in the study. One control group consisted of 66 patients with atrial septal defect (ASD- type ostium secundum) and the other control group of 72 healthy subjects (professional sportsmen-footballers). ASD was chosen for its adequate isolated diastolic pressure overload of the right ventricle in adults for the reason of vector s shape due to isolated pressure changes in right ventricle and the second control group due to physical exertion requirements of athlete's heart in the attempt to acquire subtle differences regarding right heart, by making distinction between volume overload and/or physical exertion. Both groups were further subdivided on the clinical stage (mild, mid severe, severe). Statistical analysis was done using Chi square, followed by Mc Nemar s test. Results: "VCG Sophie" software was constructed on the basis of vector deflection shape. Maximum vectors were directed more posteriorly and to the left in both groups of patients. The configuration of the ARVC/D loops showed bites in the region of magnitude i.e. vector amplitude deflection with calculated area and it significantly differed between subgroups of ARVC/D patients. The number of bites corresponded to the clinical stage. No bites were observed in the control groups. Conclusions: During research project the working hypothesis proved positive, so brand new "VCG Sophie" software proved capable of detecting the risk for sudden cardiac death with 100% sensitivity and 90% specificity in general population. "VCG Sophie" is based on the results in author s PhD (July 2013) and easy to use. P661 Atorvastatin likewise EPA and DHA exhibit acute antiarrhythmic effects and facilitate termination of ventricular fibrillation in hypertriglyceridemic rats. N Tribulova1, T Benova1, C Viczenczova1, V Knezl2 1Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic 2Slovak Academy of Sciences, Institute of Experimental Pharmacology & Toxicology, Bratislava, Slovak Republic Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Background: It has been reported that atorvastatin and omega-3 fatty acids (omega-3 FA) exhibit antiarrhythmic effects in clinical practice. However, underlying mechanisms are not elucidated yet. We have previously shown that prolonged treatment of hypertriglycerdiemic rats (HTG) with these compounds reduced the incidence of malignant arrhythmias and it was attributed in part to modulation of intercellular connexin-43 channels, which are responsible for electrical coupling and synchronisation. To elucidate further how atorvastatin and omega-3 FA may modulate intercellular coupling, this study was aimed to examine whether these compounds exert acute antiarrhythmic effects. Design and Methods: Experiments were conducted on adult, male and female HTG rats known to be much prone to ventricular fibrillation (VF) than healthy rats. The heart was excised from anesthetized rats and perfused via aorta with oxygenated Krebs-Henseleit solution at constant flow. VF inducibility was tested in control hearts and compared with the hearts, which were perfused during 10 min with Atorvastatin, eicosapentanoic acid (EPA) or docosahexanoic acid (DHA) in concentration 1.5, 7, 15 µmol prior el. stimulation. Results: Sustained VF was induced in all HTG rat hearts without treatment. In contrast, the hearts subjected to atorvastatin, EPA and DHA were less susceptible to inducible VF and incidence of sustained VF was reduced to 33%, 71.4% and 80% in male and to 60%, 75% and 60% in female rats. Atorvastatin suppressed VF inducibility in male rats already in concentration 1.5 µmol while EPA and DHA were efficient at higher 7 and 15 µmol. Moreover, bolus (150 µmol) of EPA and DHA administered directly to fibrillating heart terminated VF in 6 of 6 hearts and atorvastatin in 3 of 6 hearts. Conclusions: Atorvastatin likewise EPA and DHA exhibit clear antifibrillating and defibrillating efficacy when acutely applied. This fact suggests that these compounds might affect directly connexin-43 channels and likely other channel function involved in arrhythmogenesis. Findings point out the importance of pleiotropic effects of statins and diet-related approaches in prevention of malignant arrhythmias. P662 Effectiveness of Omega 3 PUFAs in Preventing Sudden Death and Fatal Arrhythmias in Coronary Artery Disease MB De Guzman1, MF Ramirez1, S Simon1 1Santo Tomas University Hospital, Manila, Philippines Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Almost 90% of patients develop cardiac arrhythmia after an acute myocardial infarction. These include ventricular arrhythmia, which are the major cause of sudden death. The proportion of sudden death from CAD approaches 60%. In the Philippines, according to the NNHeS, the prevalence of angina in adult Filipinos is 12.5%. In 2010, according to the Department of Health Statistics, heart disease is the leading cause of death, accounting for 17.6% of all causes of mortality. This connotes a significant public health burden. For three decades, studies supported the intake of omega-3 PUFAs protecting against fatal ventricular arrhythmia and sudden death, in the setting of CAD. However, recent equivocal, even contrasting, evidences question these cardioprotective properties. This meta-analysis aims to determine the over-all evidence of omega-3 PUFA in the prevention of sudden death and fatal arrhythmia among CAD patients. Systematic literature search was done on PUBMED, Google Scholar, MEDLINE and The Cochrane Central Register of Controlled Trials from inception to October 2013 to identify RCTs that evaluated omega-3 PUFAs in preventing fatal arrhythmia and sudden death in CAD patients. The primary outcome measures included sudden cardiac death and the occurrence of fatal arrhythmia. Secondary outcome measures included all-cause mortality; CV death, and occurrence of major adverse cerebro-vascular and cardiovascular events (MACCE). Eleven RCTs were included. The DerSimonian and Laird random effects method was utilized to pool data when there was significant heterogeneity, while the Mantel-Haenszel fixed effects method was used when heterogeneity was negligible. All tests were considered significant for p values <0.05. Data were analyzed using RevMan 5.2 and STATA Ver10. The effect of omega–3 PUFAs on sudden death and all-cause mortality was not statistically significant (p=0.40; p=0.42 respectively); however, a trend favoring the use of omega–3 PUFAs was observed. While the effect of omega–3 PUFAs on CV death was found to be beneficial (p=0.02), its effects on the occurrence of MACCE was neither harmful nor advantageous (p=0.96). Five studies discussed the effect of omega–3 PUFAs on occurrence of fatal arrhythmia; and showed that in CAD patients, omega–3 PUFAs conferred protection against lethal arrhythmia. This meta-analysis support the use of omega–3 PUFAs in preventing sudden death and fatal arrhythmia among CAD patients. P663 prevalence of inferior early repolarization pattern in spanish population older than forty years. results from the OFRECE study P Awamleh Garcia1, R Jimenez2, A Curcio2, R Cristobal2, JJ Gomez-Doblas3, J Muniz4, JJ Alonso2, E Roig5 1Hospital Universitario de Getafe, Madrid, Spain 2Hospital Universitario de Fuenlabrada, Madrid, Spain 3University Hospital Virgen de la Victoria, Malaga, Spain 4Instituto Universitario de Ciencias de la Salud. Universidad de A Coruña., A Coruña, Spain 5Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Introduction: for decades, early repolarization (ER) has been considered to be a benign finding. However, its presence in the inferior leads has recently been associated with an increased risk of sudden cardiac death in case–control and general population studies. Objetive: to analyze the prevalence of inferior ER pattern in the spanish general population older than 40 years. Methods: Cross-sectional study endorsed by the Spanish Society of Cardiology over the Spanish population older than 40 years. Two-stage random sampling was used, where first stage units where primary care physicians randomly selected at every spanish province and second stage units were 20 randomly selected persons drawn from every participating physician's assigned population. Finally, 8343 consented to participate and completed the study protocol that included a 12–lead-electrocardiogram (EKG). There was centralized reading of the EKGs recordings. EKGs were evaluated by a two trained cardiologists. In case of disagreement in diagnosis a third cardiologist was consulted and final diagnosis was reached by consensus. ER pattern was defined as J-point elevation of at least 0.1 mV in the inferior leads (II, III and aVF). Results: We found 57 cases of inferior ER pattern (global prevalence 0.68%). Majority of them were males (75.1%) with a mean age of 59.19 y.o. (CI 95% 58.63-59.75). Comparative univariate analysis showed that age and sex were significantly associated with ER: young males were more frequently affected. By contrast, obesity, hypercholesterolemia, diabetes mellitus, systolic blood pressure, diastolic blood pressure and peripheral artery disease were significantly less frequent in patients with ER. Conclusions: inferior ER pattern has not a negligible prevalence in the analyzed population (0.68%). This electrocardiographic finding is more common in young men. Individuals with ER had less cardiovascular risk factors than general population. P664 New biomarkers of vascular aging AS Kruglikova1, ID Strazhesko1, ON Tkacheva1, DU Akasheva1, EV Plokhova1, VS Pyhtina1, EN Dudinskaya1, NV Sharashkina1, OU Isaykina1, SA Boytsov1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Vascular disease (Prevention & Epidemiology) Arterial stiffness is one of the most important parameter for vascular aging and predictor for cardiovascular events. Telomere length (TL) has been identified as a marker for cellular aging. Homocysteine, von Willebrand factor and endothelium-dependent vasodilation are markers of endothelial function. We hypothesized, cellular aging and endothelial dysfunction have association with vascular aging and can leads to the earlier development of cardiovascular disease The aim of this study was to determine the role of telomere length and endothelial dysfunction in vascular aging process. Methods: TL was assessed by quantitative polymerase chain reaction in 150 patients free from established cardiovascular diseases, mean age 51,34 ± 12,32 years. Arterial stiffness was appreciated by aortic pulse wave velocity (PWV) measuring with the help of SphygmoCor (AtCor Medical). Homocysteine, von Willebrand factor were measured by routine blood analysis. Endothelial function was determined by ultrasonography and reactive hyperemia induced by 5-minute arm cuff occlusion by. Results see in the table. Conclusions: TL, von Willebrand factor and endothelial function, but not homocysteine level has association with arterial stiffness and can be considered as a new markers of vascular aging. TL Homocysteine (mcmol/l) von Willebrand factor % Endothelial function % RWV (m/s) <12 10,427 13,118 93,430 11,632 RWV (m/s) >12 9,068 13,141 109,787 10,340 p 0,029 0,974 0,008 0,0261 TL Homocysteine (mcmol/l) von Willebrand factor % Endothelial function % RWV (m/s) <12 10,427 13,118 93,430 11,632 RWV (m/s) >12 9,068 13,141 109,787 10,340 p 0,029 0,974 0,008 0,0261 Open in new tab TL Homocysteine (mcmol/l) von Willebrand factor % Endothelial function % RWV (m/s) <12 10,427 13,118 93,430 11,632 RWV (m/s) >12 9,068 13,141 109,787 10,340 p 0,029 0,974 0,008 0,0261 TL Homocysteine (mcmol/l) von Willebrand factor % Endothelial function % RWV (m/s) <12 10,427 13,118 93,430 11,632 RWV (m/s) >12 9,068 13,141 109,787 10,340 p 0,029 0,974 0,008 0,0261 Open in new tab P666 Prenatal diagnosis of complete AV- block in neonates and fetuses as best way to prevent heart failure Single centre experience R Bejiqi1, RR Retkoceri1, NB Bejiqi1 1University Clinical centre Prishtine, Prishtina, Kosovo, Republic of Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Background Complete AV block (CAVB) can have diverse etiology and clinical futures depending from the age of manifestation and diagnosis and caries a significant morbidity and mortality, especially in fetal period of life. CAVB occurs in approximately 1 in 15000 – 18 000 live births and can be as a isolated or associated with complex congenital heart disease (CCHD), when prognosis is much worsens. Method: Reviewing documentations of all patients presented to our Cardiology services with diagnosis of CAVB during the period 2002 - 2012 we investigated etiology, clinical manifestation and outcome of these children in fetal, neonatal period and early childhood. Results: Basing on this data 32 patients were diagnosed with CAVB of which 9 have been diagnosed in antenatal period, 11 were diagnosed in neonatal and 12 during the first year of life. Seven patients had an associated structural heart disease, 6 of them complex anomaly. Among fetal cases, maternal anti-Ro or anti-le antibodies were present in 5. Three fetuses had received prenatally (all in third trimester) Dexamethasone and/or beta mimetic. Total mortality rate was 15.6% (5/32 of which intrauterine and neonatal death was responsible 4. The presence of CCHD, fetal diagnosis, antibody and heart rate lower than 50/bpm was associated with higher mortality. Due to clinical symptoms and echocardiographic findings three children received pacemaker insertion during first year of life. Conclusion CAVB antenataly diagnosed has association with maternal antibodies and CCHD and has poor outcome compared to that diagnosed postnataly. In selected cases steroids and Beta-mimetics may significantly prevent complication and reduce mortality. P667 Prevention of Stroke in Patients with Atrial Fibrillation: From Standards to Practice E Serdechnaya1, S Urieva1 1Northern State Medical University, Arkhangelsk, Russian Federation Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) The aim of the study to analyze the prevalence of risk factors for thromboembolic complications(TEC) in patients with atrial fibrillation (AF) and to assess the compliance with practice guidelines in AF patient management. Materials and methods: Medical records of 634 patients of Arkhangelsk outpatient clinics were analyzed. The risk of thromboembolic complications was assessed with CHADS2and CHA2DS2-VASc scales and each patient?s ongoing antithrombotic therapy was analyzed. Statistical analysis was performed using the program SPSS 15.0. Results: The study included 634 patients: 257(40.5%) men. At the age of 64 years were 168 (26.5%) patients, from 65 to74 years-221(34.9%) patients, 75 years of age and older - 245 (38.6%).The most common TEC risk factor was hypertension, which had 609(96.1%) patients. Vascular disease (myocardial infarction and /or aortic atherosclerotic plaque and / or peripheral artery disease) had 419(66.1%) patients; heart failure had 356(56.1%). Diabetes mellitus was diagnosed in 126 (19.9%??) patients. History of previous stroke, transient ischemic attack(TIA) or systemic thromboembolism had 112(17.7%) patients. In our study, most of the patients had high risk of stroke: 604(95.2%) based on CHADS2scale and 628 (99%)on CHA2DS2-VASc scale. In only one in three patients at high risk of stroke, warfarin was prescribed: 178(28.0%) on CHADS2 scale and 190(30.3%) on CHA2DS2-VASc scale. Aspirin was prescribed in 239 (39.6%) patients at high risk of stroke by CHADS2 scale, and 245 (39%) by CHA2DS2-VASc scale. Patients at high risk of stroke who did not get any ATT were 184 (30.4%) based on CHADS2scale and 193 (30.7%) on CHA2DS2-VAScscale.Time in the therapeutic INR range of 2.0 to3.0 was in 221 (34.8%) patients. Conclusions: Most patients in our population group are at high risk of TEC, however, only 30% of the patients are on anticoagulant therapy and only every third of them has an INR in the target range. P668 prevalence of spontaneous type 1 and type 2 brugada electrocardiographic patterns in spanish population older than forty years. results from the OFRECE study P Awamleh Garcia1, C Graupner2, J Serrano2, P Talavera2, JJ Gomez-Doblas3, J Muniz4, JJ Alonso2, E Roig5 1Hospital Universitario de Getafe, Madrid, Spain 2Hospital Universitario de Fuenlabrada, Madrid, Spain 3University Hospital Virgen de la Victoria, Malaga, Spain 4Instituto Universitario de Ciencias de la Salud. Universidad de A Coruña., A Coruña, Spain 5Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Introduction: Brugada syndrome is a rare, potentially fatal primary channelopathy characterized by typical electrocardiographic patterns. Data about prevalence of these patterns in the general population are scant. Objetive: to analyze the prevalence of spontaneous type 1 and type 2 Brugada electrocardiographic (EKG) patterns in the spanish general population older than forty years. Methods: OFRECE study is a cross-sectional study conducted in the general spanish population older tan 40 years of age. Two-stage random sampling was used, where first stage units where primary care physicians randomly selected at every spanish province and second stage units were 20 randomly selected persons drawn from every participating physician's assigned population. There was a centralized reading of the EKG recordings. EKGs were evaluated by a two trained cardiologists. In case of disagreement in the diagnosis a third cardiologist was consulted and final diagnosis was reached by consensus. Type 1 and type 2 Brugada patterns were defined according to the 2002 Brugada Consensus Report. Results: Overall, 8343 randomized individuals were evaluated. Mean age was 59,2 years 95% CI: 58,6-59,8 (range, 40-104 years), 52,4 % female. We identified 11 cases of type 1 and type 2 Brugada patterns (global prevalence 0.13%) with the following distribution: - Type 1: two cases (0.024%), both were women, 55 and 54 years old. - Type 2: nine cases (0.11%), eight of them were males (88.9%) mean age 52.2 years old. Conclusions: type 1 and type 2 Brugada patterns have a global prevalence of 0.13% in the analyzed population. Type 1 pattern prevalence is only 0.024% in people older than 40 years P669 Parental History of Stroke and Coronary Heart Disease and Incident Atrial Fibrillation According to Hypertension in a General Urban Population: The Suita Study Y Kokubo1, T Kobayashi1, M Watanabe1, K Kusano1, S Kamakura1, K Kawanishi2, Y Miyamoto1 1National Cerebral and Cardiovascular Center, Suita, Japan 2The Suita Medical Association, Suita, Japan Topic: Rhythm Disorders/Sudden death (Prevention & Epidemiology) Background: Emerging evidence indicates that cardiovascular disease (CVD), which was defined as stroke and coronary heart disease (CHD), is an increased risk of atrial fibrillation (AF). However, no prospective study has examined the relation between a parental history of CVD and the incidence of AF in a general population. We assessed the hypothesis that a parental history of stroke and CHD are associated with an increased risk of incident AF according to hypertension in a general urban population. Methods: A total of 6,918 participants (30 to 84 years old) initially free of AF were prospectively followed up for incident AF in the Suita Study. Standard 12-lead electrocardiograms were obtained from all subjects in the supine position. Each record was coded independently by 2 well-trained physicians using the Minnesota Code. Participants were diagnosed with AF if AF or atrial flutter was present on electrocardiograms obtained during a biannual routine health examination or if AF was indicated as a present illness by either annual questionnaires responses or participants medical records. Well-trained nurses obtained information on parental history of CVD and on the participants lifestyle. Blood pressures were taken as the average of the second and third measurements, which were defined by hypertension (=140/90 mm Hg and/or antihypertensive medications). Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed after adjusting for age, sex, body mass index, hypertension, diabetes, hyperlipidemia, smoking, and drinking status at baseline. Results: In 87,341 person-years of follow-up, 245 incident AF events occurred (4.15 and 1.64 per 1,000 person-years for men and women, respectively). Compared with normotensive subjects without a parental history of CHD, the adjusted HRs (95% CIs) of incident AF were 1.41 (0.78-2.59) for normotensive subjects with a parental history of CHD and 2.05 (1.09-3.83) and 1.43 (1.08-1.89) for hypertensive subjects with and without a parental history of CHD, respectively. Furthermore, compared with normotensive subjects without a parental history of stroke, the adjusted HRs (95% CIs) of incident AF were 0.98 (0.62-1.52) for normotensive subjects with a parental history of stroke and 2.04 (1.36-3.06) and 1.40 (1.03-1.91) for hypertensive subjects with and without a parental history of stroke, respectively. Conclusions: A parental history of CVD is a predictor of incident AF among hypertensive subjects. For persons with a parental history of CVD, blood pressure control would be important for AF prevention. P670 Estimating participation factors in a cardiovascular assessment program for general practice patients and job center clients D Guertler1, J Braatz1, F Weymar1, C Meyer1, U John1, J Freyer-Adam2, SB Felix1, M Doerr1, S Ulbricht1 1DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany 2University Medicine Greifswald, Institute of Social Medicine and Prevention, Greifswald, Germany Topic: Health economics (Prevention & Epidemiology) Purpose: For the implementation of interventions to reduce cardiovascular risk factors (CVRFs) sufficient reach of target populations is needed. A proactively addressed and stepwise provided screening and examination program was tested in general medical practice patients and job agency clients regarding feasibility and acceptance. This analysis explored the association of participation in different steps of the program with demographic variables, perceived health status, and CVRFs. Methods: In general medical practices and job agencies all individuals aged 40-60 were addressed by study assistants. The on-site screening included two steps 1) a computerized questionnaire (QS) on CVRFs, 2) blood pressure measurement and blood sample taking (BPBS). Participants of the QS without cardiovascular events (myocardial infarction, coronary intervention, stroke), diabetes, or body mass index >35 were invited to the cardiovascular health examination program (CEP) at the university hospital. Data analysis of participation in the QS included sex and age. Data analysis of participation in BPBS included information from the QS. Results: Among those addressed in the medical practices (N= 544) and the job agencies (N= 982) 57.9% and 33.2% participated in the QS, respectively. Of them, 96.5% and 79.1% participated in at least one of the two BPBS parts. Among those invited to the CEP (209 patients and 223 job center clients) 79.9% and 61.1% participated in the CEP. Multivariate regression analysis revealed that there were no differences between QS participants and nonparticipants in age or sex. Among those who perceived high pressure for health related change, more participated in BPBS than among those who perceived low pressure for health related change, both among patients (odds ratio [OR] 1.4; 95 % confidence interval [CI] 1.1-1.9) and job center clients (OR 1.1; CI 1.0-1.2). Among those who participated in the CEP, there were more current non-smokers than smokers at both screening sites (OR 2.6; CI 1.3-5.3, and OR 1.9; CI 1.0-3.3, respectively). Moreover, general practice patients with fewer years of school education were more likely to participate in BPBS (OR 0.2; CI 0.1-1.0) and CEP (OR 0.5; CI 0.2-1.0) than those with more years. Conclusions: Participation factors could be revealed in both settings. However, the odds of participating in the screening program was much lower in individuals who are assumed to benefit most from cardiovascular prevention, i.e. smokers or individuals with low perceived pressure of change. Thus, strategies for enhancing reach of those individuals are urgently needed. P671 Cardiorespiratory fitness and self-reported physical activity in apparently healthy general practice patients J Braatz1, D Guertler1, F Weymar1, C Meyer1, U John1, J Freyer-Adam2, SB Felix1, M Doerr1, S Kaczmarek1, S Ulbricht1 1DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany 2University Medicine Greifswald, Institute of Social Medicine and Prevention, Greifswald, Germany Topic: Physical Inactivity (Prevention & Epidemiology) Purpose: Cardiorespiratory fitness (CRF) and physical activity level (PAL) are increasingly considered in cardiovascular disease risk assessments. PAL may be targeted by preventive measures. Brief and valid assessment of PAL in daily routine care is crucial for the tailoring of behavioral interventions. Aim of the present study is to explore the association of a self-reported measure of PAL with CRF among apparently healthy general practice patients. Methods: Self-reported physical activity (SRPA) was assessed in a systematic screening of 489 consecutive patients, aged 40-75 years (participation proportion: 55.1 %), recruited in 11 randomly selected general practices. The four-item Godin Leisure-Time Exercise Questionnaire (GLTEQ) on weekly frequencies of light, moderate and strenuous leisure activities and the frequency of sweat-inducing exercise was used. CRF was assessed via cardiopulmonary exercise testing among participants without pre-existing cardiovascular disease, diabetes, or BMI > 35 (n = 230) using a standardized progressive incremental exercise protocol on a cycle ergometer. CRF was defined by peak oxygen uptake (VO2peak). The association between CRF and SRPA was investigated using multiple linear regression analyses with VO2peak as the dependent variable. Six scores of the GLTEQ were used: total leisure activity score, moderate-strenuous leisure activity score, weekly frequency of light, moderate or strenuous leisure activity, and a frequency score of sweat-inducing exercise. Analyses were adjusted for sex, age, body weight, body height, and waist circumference. Results: Twelve participants were excluded from data analyses because of missing values on the GLTEQ or an unknown diabetes status. The remaining 218 participants had a mean age of 55 years (SD = 9.8; 60% women). The mean VO2peak was 1927.3 ml O2/min (SD = 576.5) and the mean total leisure activity score was 52.3 metabolic equivalents/week (SD = 32.6). Analyses revealed a significant association of total leisure activity (B = 2.1, p < 0.05), moderate-strenuous leisure activity (B = 2.5, p < 0.05), and strenuous activity (B = 29.7, p < 0.05) with VO2peak. Further, a significant association between a moderate to high versus a low frequency of sweat-inducing exercise (B = 110.7, and B = 213.0, p < 0.05) with VO2peak was found. Conclusions: GLTEQ scores were significantly associated with CRF as measured by cardiopulmonary exercise testing in a sample of apparently healthy general practice patients. The data suggests that SRPA measures could be a valuable and economical instrument in lifestyle interventions. Horsepower of cars and health aspects. <80 HP 80-120 HP 120-160 HP 160-200 HP >200 HP P value n=114 n=175 n=53 n=18 n=3 (ANOVA) Females [n (%)] 66 (57.9) 70 (60.0) 16 (30.2) 3 (16.7) 0 (0.0) <0,001 Age [years; Mean±SD] 35.6±7.7 37.8±7.7 41.0±8.5 39.5±8.3 38,7±6.8 0.001 Leading position [n (%)] 21 (18.4) 63 (36.0) 25 (47.2) 11 (61.1) 2 (66.7) <0.001 Monthly income [€] 2114±627 2361±834 2798±1110 2889±940 3167±1181 <0.001 Fitness level [1-very good; 5 bad] 2.7±0.9 2.8±0.9 2.8±1.0 3.1±1.0 4,3±0.6 0.028 BMI [kg/m2] 23.0±3.0 23.4±3.1 23.7±3.0 24.1±2.8 28,3±1.6 0.025 Hypercholesteremia [n (%)] 9 (7.9) 13 (7.4) 8 (15.1) 5 (27.8) 1 (33.3) 0.021 <80 HP 80-120 HP 120-160 HP 160-200 HP >200 HP P value n=114 n=175 n=53 n=18 n=3 (ANOVA) Females [n (%)] 66 (57.9) 70 (60.0) 16 (30.2) 3 (16.7) 0 (0.0) <0,001 Age [years; Mean±SD] 35.6±7.7 37.8±7.7 41.0±8.5 39.5±8.3 38,7±6.8 0.001 Leading position [n (%)] 21 (18.4) 63 (36.0) 25 (47.2) 11 (61.1) 2 (66.7) <0.001 Monthly income [€] 2114±627 2361±834 2798±1110 2889±940 3167±1181 <0.001 Fitness level [1-very good; 5 bad] 2.7±0.9 2.8±0.9 2.8±1.0 3.1±1.0 4,3±0.6 0.028 BMI [kg/m2] 23.0±3.0 23.4±3.1 23.7±3.0 24.1±2.8 28,3±1.6 0.025 Hypercholesteremia [n (%)] 9 (7.9) 13 (7.4) 8 (15.1) 5 (27.8) 1 (33.3) 0.021 BMI denotes Body Mass Index; HP denotes Horespower; SD denotes Standard Deviation Open in new tab Horsepower of cars and health aspects. <80 HP 80-120 HP 120-160 HP 160-200 HP >200 HP P value n=114 n=175 n=53 n=18 n=3 (ANOVA) Females [n (%)] 66 (57.9) 70 (60.0) 16 (30.2) 3 (16.7) 0 (0.0) <0,001 Age [years; Mean±SD] 35.6±7.7 37.8±7.7 41.0±8.5 39.5±8.3 38,7±6.8 0.001 Leading position [n (%)] 21 (18.4) 63 (36.0) 25 (47.2) 11 (61.1) 2 (66.7) <0.001 Monthly income [€] 2114±627 2361±834 2798±1110 2889±940 3167±1181 <0.001 Fitness level [1-very good; 5 bad] 2.7±0.9 2.8±0.9 2.8±1.0 3.1±1.0 4,3±0.6 0.028 BMI [kg/m2] 23.0±3.0 23.4±3.1 23.7±3.0 24.1±2.8 28,3±1.6 0.025 Hypercholesteremia [n (%)] 9 (7.9) 13 (7.4) 8 (15.1) 5 (27.8) 1 (33.3) 0.021 <80 HP 80-120 HP 120-160 HP 160-200 HP >200 HP P value n=114 n=175 n=53 n=18 n=3 (ANOVA) Females [n (%)] 66 (57.9) 70 (60.0) 16 (30.2) 3 (16.7) 0 (0.0) <0,001 Age [years; Mean±SD] 35.6±7.7 37.8±7.7 41.0±8.5 39.5±8.3 38,7±6.8 0.001 Leading position [n (%)] 21 (18.4) 63 (36.0) 25 (47.2) 11 (61.1) 2 (66.7) <0.001 Monthly income [€] 2114±627 2361±834 2798±1110 2889±940 3167±1181 <0.001 Fitness level [1-very good; 5 bad] 2.7±0.9 2.8±0.9 2.8±1.0 3.1±1.0 4,3±0.6 0.028 BMI [kg/m2] 23.0±3.0 23.4±3.1 23.7±3.0 24.1±2.8 28,3±1.6 0.025 Hypercholesteremia [n (%)] 9 (7.9) 13 (7.4) 8 (15.1) 5 (27.8) 1 (33.3) 0.021 BMI denotes Body Mass Index; HP denotes Horespower; SD denotes Standard Deviation Open in new tab P672 Physical activity (PA), blood pressure (BP). Heart rate (HR) and Body mass index (BMI) in primary school students E Venturini1, C Marabotti1, R Testa1 1Department of Cardiology - Civic Hospital, Cecina (LI), Italy Topic: Physical Inactivity (Prevention & Epidemiology) Purpose: PA is associated with many health benefits as the prevention of obesity. Childhood overweight/obesity (OW/OB) is now endemic in many countries (39.5% in Italy). Besides, studies in children have reported inconsistent results on the association between BP and PA. Aim of the study was to take a snapshot of the level of PA, OW/OB and BP in primary school students. Methods: 325 students (S) of the class 5○ (10 y) were involved in the project, but valid data were obtained in 291 (129 M, 162 F). Were evaluated BP, HR and BMI. The level of PA was assessed with the Physical Activity Questionnaire (PAQ) that it has been shown to be appropriate for children who are currently in the school system. Using the PAQ a score of 1 indicates low PA, whereas a score of 5 indicates high PA. Results: the BMI was higher in M than in F (18.7±2.7 vs. 17.9±2.5 p<.01), but there were no significant differences for PAQ score (2.67±0.62 vs. 2.61±0.57). The HR instead, was higher in girls (82.9±12.5 vs. 77.5±10.9 p<.001). The results were then analyzed dividing the students in 4 groups: M normal (n: 87) and OW/OB (n: 42, 32.5%), F normal (n:133) and OW/OB (n:29, 17.9%). If the BMI is greater, the lower the PAQ score. The higher the BMI, the higher the level of BP and HR, although the difference is significant only in F (Table 1) Conclusions: M were slightly more active than F. This may explain the lower HR in the latter.The prevalence of childhood overweight-obesity is greater in M than in F as demonstrated in other studies. The prevalence of OW/OB in F is much lower compared with those recorded in other surveys.In OW/OB students the level of PA is lower. It is associated with higher levels of BP and HR. The data are consistent with recent studies showing a causal rela-tionship between higher levels of PA in young children and lower BP and BMI over time. The results provide support for development of interventions to increase PA in young children. Table1 Mnormal MOW/OB p Fnormal FOW/OB p BMI 17.2±1.6 21.9±2 <.001 17±1.6 22.1±1.3 <.001 SBP 109.5±14.5 113.8±12.7 ns 106.3±11.5 116.9±8.7 <.001 DBP 64.4±9.6 67±10.8 ns 66±9.6 72.5±10.3 <.001 HR 77.1±10.7 78.4±11.6 ns 82±11.8 87.5±15.2 <.05 PAQ 2.78±0.59 2.44±0.63 <.001 2.69±0.56 2.20±0.45 <.001 Mnormal MOW/OB p Fnormal FOW/OB p BMI 17.2±1.6 21.9±2 <.001 17±1.6 22.1±1.3 <.001 SBP 109.5±14.5 113.8±12.7 ns 106.3±11.5 116.9±8.7 <.001 DBP 64.4±9.6 67±10.8 ns 66±9.6 72.5±10.3 <.001 HR 77.1±10.7 78.4±11.6 ns 82±11.8 87.5±15.2 <.05 PAQ 2.78±0.59 2.44±0.63 <.001 2.69±0.56 2.20±0.45 <.001 Open in new tab Table1 Mnormal MOW/OB p Fnormal FOW/OB p BMI 17.2±1.6 21.9±2 <.001 17±1.6 22.1±1.3 <.001 SBP 109.5±14.5 113.8±12.7 ns 106.3±11.5 116.9±8.7 <.001 DBP 64.4±9.6 67±10.8 ns 66±9.6 72.5±10.3 <.001 HR 77.1±10.7 78.4±11.6 ns 82±11.8 87.5±15.2 <.05 PAQ 2.78±0.59 2.44±0.63 <.001 2.69±0.56 2.20±0.45 <.001 Mnormal MOW/OB p Fnormal FOW/OB p BMI 17.2±1.6 21.9±2 <.001 17±1.6 22.1±1.3 <.001 SBP 109.5±14.5 113.8±12.7 ns 106.3±11.5 116.9±8.7 <.001 DBP 64.4±9.6 67±10.8 ns 66±9.6 72.5±10.3 <.001 HR 77.1±10.7 78.4±11.6 ns 82±11.8 87.5±15.2 <.05 PAQ 2.78±0.59 2.44±0.63 <.001 2.69±0.56 2.20±0.45 <.001 Open in new tab P673 Doctor, tell me what car you drive and I tell you how healthy you are: Correlations between self-reported horsepower of cars of Austrian physicians and health aspects: results from the TISPLA Study. D Niederseer1, B Steger2, D Neunhaeuserer3, HP Colvin3, C Dankl3, J Rieder4, J Niebauer5, C Datz1 1General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria 2Innsbruck Medical University, Department of Ophthalmology, Innsbruck, Austria 3Paracelsus Private Medical University, Salzburg, Austria 4Innsbruck Medical University, Department of Anesthesiology & Critical Care Medicine, Innsbruck, Austria 5Paracelsus Medical University, Department of Sports Medicine, Salzburg, Austria Topic: Physical Inactivity (Prevention & Epidemiology) Purpose: The horsepower of a car refers to the strength of its engine; more horsepower will usually make a car accelerate faster and reach a higher top speed. So far, the relationship between the horsepower of physician s cars and health aspects have not been investigated. Methods: The Innsbruck and Salzburg Physician Lifestyle Assessment (TISPLA) was a cross-sectional online survey with 170 items among all physicians working in the University Clinics of Innsbruck and Salzburg, Austria. Results: Of 1877 contacts via email, 590 (31.4%) returned their online questionnaire and 363 (19.3%) reported the horsepower of their car: n=363; 37.6±8.0 years of age, 208 (57.3%) males, 155 (42.7%) females. We stratified the sample into five groups according to the reported horsepower of their car: <80 horsepower (n=114); 80-120 horsepower (n=175); 120-160 horsepower (n=53); 160-200 horsepower (n=18); >200 horsepower (n=3). Significant correlations could be found for age, gender, job position, monthly income, self-reported physical fitness, hypercholesteremia and body mass index (see table). No significant correlations were found for everyday physical (in)activity, alcohol consumption, smoking status, arterial hypertension, work stress coping, sexual satisfaction, sexual dysfunction and scientific output of the participating physicians. CONCLUSION: The horsepower of Austrian physician s cars may possibly be associated with some parameters of health. P674 Self-reported physical activity in a multi-ethnic cohort: preliminary findings of the healthy life in suriname study SM Baldew1, A Jarbandhan1, V Cornelissen1, J Toelsie2, G Oehlers3, L Vanhees1 1Catholic University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium 2Anton de Kom University of Suriname, Faculty of Medical Sciences, Paramaribo, Suriname 3Academic Hospital Paramaribo, Paramaribo, Suriname Topic: Physical Inactivity (Prevention & Epidemiology) Background and aim: In the prevention and treatment of cardiovascular diseases, physical activity (PA) has been shown to be an important modifiable risk factor. So far, there are no data on PA in Suriname. Therefore the aim of this study was to describe PA within the capital of Suriname, Paramaribo. Methods: The HEalthy LIfe in SURiname (HELISUR) study is an ongoing cohort study that started in April 2013. Participants are men and women between the ages of 18-70 years from randomly selected households. Physical activity was assessed by means of the International Physical Activity Questionnaire (IPAQ). For the current study, we used only self-reported leisure-time PA (LTPA). Participants who were physically active on a moderate or vigorous level, based on the IPAQ guidelines, were combined in the moderate to vigorous PA (MVPA) group and participants who did not meet these criteria were classified as sedentary. Subsequently, PA behavior was compared across different ethnic groups (Creole, Hindustani, Javanese or others) and different age groups (18-27, 28-39, 40-51, 52= yrs). Comparisons between groups were made with the chi-square test. Results: So far we were able to include data of 942 participants (35.8% men, median age 39 yrs. and range 18-70yrs.) of which 42.3% were Creole, 34.9% Hindustani, 6.5% Javanese and 16.3% from another ethnic group. Only 18.3% (n=172) of the individuals was physically active on a moderate to vigorous level. There were no differences across the different ethnic groups with regard to levels of PA, irrespective of sex or age group (p>0.05). Overall, men were more active than women (P<0.001) and older individuals were less active than the younger participants (P<0.005). However, this decrease in PA with increasing age remained only significant for the group of men (P=0.001) whereas there were no differences in levels of PA between younger and older women (P=0.517). Conclusions: The present results show that, across all ethnic groups, only a small percentage of participants can be considerd as physically active at a moderate to vigorous level, with men being somewhat more active compared to women. This warrants further investigation into the prevalence and incidence of cardiovascular risk factors and diseases in Suriname as well as their relation with PA. P676 Eighteen months of mediterranean diet counseling and high intensity interval training improved and maintained body composition, cardiometabolic and exercise parameters in obese patients. M Gayda1, G Lapierre1, T Leandro1, M Juneau1, V Guilbeault1, E Latour1, A Nigam1 1Montreal Heart Institute affiliated with the University of Montreal, Montreal, Canada Topic: Obesity (Rehabilitation & Implementation) Objectives: To study the impact of 18 months of intensive lifestyle intervention including high-intensity interval training (HIIT) and mediterranean diet nutritional counseling on body composition, cardiometabolic and exercise parameters in obese patients. Methods: Twenty-seven obese subjects (54±7 years, WC:113±13 cm) participated in an intense lifestyle intervention program for 18 months that included nutritional counselling on mediterranean diet principles and HIIT 2 to 3 times/week. Body composition, blood analysis, cardiometabolic and exercise parameters were measured at baseline, after 9 and 18 months of program. Results: Body composition parameters were significantly improved after 9 and 18 months (p<0.0001 for all parameters) and included body mass (9 months: -5.89±5.75 kg, 18 months: -6.48 ± 6.91 kg), waist circumference (9 months: -5.67±5.64 cm, 18 months: -6.79±6.96 cm), total fat mass (9 months: -4.52±4.13 kg, 18 months: -5.51± 4.98 kg) and trunk fat mass (9 months: -2,03±2.28 kg, 18 months: -2.66±2.89 kg). LDL cholesterol was also significantly reduced at 9 and 18 mo (p<0.05). VO2peak (METs) was improved significantly (p<0.0001) after 9 and 18 months (9 months: +1.41±0.81 METs, 18 months:1.87±1.28 METs). Significant improvements after 9 and 18 months were also found for diastolic blood pressure (p<0.05), resting heart rate (p<0.01), heart rate reserve (p<0.05), heart rate recovery (p<0.01) and leg and abdominal muscle endurance (p<0.0001). Conclusions: Intensive lifestyle intervention of 18 months combining HIIT and mediterranean diet nutritional counseling improved body composition, LDL-cholesterol, diastolic blood pressure, heart rate parameters, VO2peak and muscle endurance in obese patients. Body composition improvement was maintained after 18 months of program. The maintenance of an intensive lifestyle modification in obese patients may have important clinical benefits in the preservation of an improved body composition, cardiometabolic profile and physical fitness. table 1 Baseline 9 months 18 months Anova P value Body mass (kg) 99.8 ± 20.5 93.0 ± 19.7 a § 93.3 ± 20.4a § <0.0001 WC (cm) 112 ± 13 106 ± 11a § 105 ± 13a § <0.0001 Total fat mass (kg) 42.9 ± 11.3 37.7 ± 10.8a § 37.4 ± 11.5a § <0.0001 Trunk fat mass (kg) 22.7 ± 5.4 20.4 ± 6.0a § 20.0 ± 6.2a § <0.0001 Baseline 9 months 18 months Anova P value Body mass (kg) 99.8 ± 20.5 93.0 ± 19.7 a § 93.3 ± 20.4a § <0.0001 WC (cm) 112 ± 13 106 ± 11a § 105 ± 13a § <0.0001 Total fat mass (kg) 42.9 ± 11.3 37.7 ± 10.8a § 37.4 ± 11.5a § <0.0001 Trunk fat mass (kg) 22.7 ± 5.4 20.4 ± 6.0a § 20.0 ± 6.2a § <0.0001 Open in new tab table 1 Baseline 9 months 18 months Anova P value Body mass (kg) 99.8 ± 20.5 93.0 ± 19.7 a § 93.3 ± 20.4a § <0.0001 WC (cm) 112 ± 13 106 ± 11a § 105 ± 13a § <0.0001 Total fat mass (kg) 42.9 ± 11.3 37.7 ± 10.8a § 37.4 ± 11.5a § <0.0001 Trunk fat mass (kg) 22.7 ± 5.4 20.4 ± 6.0a § 20.0 ± 6.2a § <0.0001 Baseline 9 months 18 months Anova P value Body mass (kg) 99.8 ± 20.5 93.0 ± 19.7 a § 93.3 ± 20.4a § <0.0001 WC (cm) 112 ± 13 106 ± 11a § 105 ± 13a § <0.0001 Total fat mass (kg) 42.9 ± 11.3 37.7 ± 10.8a § 37.4 ± 11.5a § <0.0001 Trunk fat mass (kg) 22.7 ± 5.4 20.4 ± 6.0a § 20.0 ± 6.2a § <0.0001 Open in new tab P677 Statins in the increased risk of diabetes R Cadenas Chamorro1, D Iglesias1, A Garcia1, E Martinez1, M Larrondo1, I Hortelano1, J De Juan1, B Paredes1, O Salvador1, I Plaza1 1Hospital Infanta Sofia, Department of Cardiology, Madrid, Spain Topic: Diabetes Type 1/2 (Rehabilitation & Implementation) INTRODUCTION. Since its discovery statins have been shown useful in primary and secondary prevention of ischemic heart disease. This is because they inhibit cholesterol synthesis but also for other purposes independent of cholesterol synthesis. This results in decreased ischemic heart disease death. However, statins have been shown to increase the number of new cases of diabetes. PURPOSE Study in a sample of patients in a Cardiac Rehabilitation Program(CRP), whether taking statins increases glycated haemoglobin(GH) or whether this effect is cushioned by the exercise and the changes in lifestyle that are learned through the program. METHOD Analyzed the 72 patients enrolled in the CRP between June 2011 and February 2013. 6 patients were excluded in which the type and dose of statin was equal before and after the CRP. The remainder were divided into two group: the patient group before making the CRP did not take any kind of statin(group 1) and the group of patients who were already taking statins but they increase the dose(group 2). Of all patients were attempted glycated hemoglobins collect pre-start treatment with statins and GH at two months of taking them, at 6 months and a year and a half. RESULTS Was obtained a sampled with a mean age of 57, laños. 23 belonged to group 1 and 43 to group2. In both groups did not increase not only GH but that there was a tendency to decline after two months (p=0,057). However GH increase and half year although not statistically significant(p= 0,50). In those not taking statins the mean GH before taking statins was 6.08 (±0,88) and two months 5,97(± 0.63). In group 2 GH before climbing the satin dose was on average 6,12(± 0,94) and two months was 6,03(± 0,78). In group 1, the percentage of patients whose GH increase at some point of follow up was 13.4% and in group 2 was 31.8%.CONCLUSION:In our sample, oral administration of statins not only did not increase glycated haemoglobin but showed a tendency to decrease. However more studies are needed with larger number of patients and longer follow-up, in order to clarify the role of statins in the increased risk of diabetes in a CRP. P678 Influence of dry red wine on glucose, HbA1c BP levels in patients with Diabetes Type 2 R Durgaryan1, GOHAR Babayan1 1No 13 Polyclinic, Yerevan, Armenia Topic: Diabetes Type 1/2 (Rehabilitation & Implementation) Purpose: As it has been shown consumption of red wine or de-alcoholized red wine increases plasma total antioxidant capacity (TEAC), nuclear factor-?B (NF-?B) activity and F2-isoprostanes (8-iso-PGF2a) in healthy men, as well as it is associated with a lower risk for cardiovascular disease, and also improves diabetes. Our aim to study influence of red wine on glucose, glycated hemoglobin /Hb A1c/and BP level in patients with Type 2 Diabetes. Methods: 39 not treated type 2 Diabetic men have been divided into 2 groups – Group 1 18 patients have been involved /control Group/ taking antidiabetic and antihypertensive treatment without red wine and Group 2 - 21 patients taking antidiabetic and treatment with 100ml dry red wine every day 20 minutes before dinner. These 2 groups have been adjusted by age, BMI, waist circumference, ASAT, ALAT, GGT, creatinine, glucose, Hb A1c, BP levels, as well as by antidiabetic and antihypertensive treatment /both group patients were taking Gliclazide 60 mg, Metmorfin 1000mg, as well as metaprolol 100mg, lizinopril 10mg/. Glucose, Hb A1c, BP levels have been compared 8 weeks later. Results: Mean initial levels of glucose, Hb A1c, systolic, diastolic BP levels in Group 1 have been 12,2±0.3 mmol/L, 82,2 ±1.9mmol/mol, 149.2 ±1.1mmHg, 88.9 ±0,9 mmHg respectively, and in Group 2- 12,9±0.4mmol/L, 82,9 ± 2.1mmol/mol, 148,4 ±1.1mmHg, 89,7 ±0,7 mmHg respectively. After 8 weeks the following readings have been obtained - in Group 1 10.3 ±0.2 mmol/L, 64,2 ±1.5mmol/mol, 139.8 ±1.2mmHg, 85.7 ±0,6 mmHg P=0,09; 0,068, 0,078, 0,67 respectively, and in Group 2- 8,1±0.3mmol/L, 53,6 ± 1.3mmol/mol, 123,3 ±0.5mmHg, 81,3 ±0,4 mmHg respectively, P<0,001: Conclusions: As obtained data show moderate consumption of red dry wine with antidiabetic and antihypertensive treatment in type 2 diabetic patients with arterial hypertension improves both glucose, HbA1c and blood pressure within 8 weeks, compare to patients with the same antidiabetic and anti hypertensive treatment without red wine. So it may also help to decrease the risk for cardiovascular diseases in diabetic patients. P679 Gender differences in the approach of smoking cessation in patients with ischemic heart disease. F De Torres Alba1, R Dalmau Gonzalez Gallarza1, S Del Prado Diaz1, I Ponz De Antonio1, S Rosillo Rodriguez1, D Gemma1, A Iniesta Manjavacas1, N Montoro Lopez1, A Castro Conde1, JL Lopez-Sendon1 1University Hospital La Paz, Department of Cardiology, Madrid, Spain Topic: Smoking (Rehabilitation & Implementation) Introduction and Aims: Consumption pattern of female smokers tend to progressively resemble those of male smokers. Our aim was to analyze gender differences in the approach of smoking cessation in patients with a recent acute coronary syndrome (ACS) referred to a cardiac rehabilitation program (CRP). Methods: We analyzed a cohort of 368 smokers referred to a CRP after a recent admission for ACS. An intervention based in motivational support and first-line drugs for smoking cessation, as well as advice on diet, exercise and weight control was performed. Gender differences in smoking patterns and outcomes of the intervention were compared. Results: 321 patients were male (87.2%). No significant differences in mean age or risk profile were found. Female smokers showed a high level of consumption of tobacco, comparable to those of men (consumption of >1 pack/day: 72.3 % of women and 76.6 % of men). However, a significantly higher proportion of women requested specific treatment to facilitate smoking cessation (31.9% women vs. 19.9% men, p <0.05). Abstinence was confirmed at 3 and 6 months with co-oximetry, without significant differences between genders. Women were significantly more likely to gain weight with smoking cessation (48.9 % of women gained weight, 29.3% of men, p < 0.05) Conclusions : Female smokers with recent ACS have a high level of consumption, similar to that of men, but they need more pharmacological interventions to approach cessation, achieving similar abstinence rates. Weight gain is more common in women, and this may condition long-term abstinence. Gender differences in smoking patterns Men Women p Age (years) 53.3 55.2 NS HTN 41.1% 40.4% NS Dyslipidemia 60.4% 59.6% NS DM 24.3% 10.6% NS Obesity 27.4% 21.3% NS Sedentarism 65.7% 66.0% NS Consumption (cig/d) 25 21.4 NS Years smoking (years) 35.4 35.1 NS Packs-year 42.4 38.0 NS Abstinence at 6 months 76.0% 70.2% NS Men Women p Age (years) 53.3 55.2 NS HTN 41.1% 40.4% NS Dyslipidemia 60.4% 59.6% NS DM 24.3% 10.6% NS Obesity 27.4% 21.3% NS Sedentarism 65.7% 66.0% NS Consumption (cig/d) 25 21.4 NS Years smoking (years) 35.4 35.1 NS Packs-year 42.4 38.0 NS Abstinence at 6 months 76.0% 70.2% NS Open in new tab Gender differences in smoking patterns Men Women p Age (years) 53.3 55.2 NS HTN 41.1% 40.4% NS Dyslipidemia 60.4% 59.6% NS DM 24.3% 10.6% NS Obesity 27.4% 21.3% NS Sedentarism 65.7% 66.0% NS Consumption (cig/d) 25 21.4 NS Years smoking (years) 35.4 35.1 NS Packs-year 42.4 38.0 NS Abstinence at 6 months 76.0% 70.2% NS Men Women p Age (years) 53.3 55.2 NS HTN 41.1% 40.4% NS Dyslipidemia 60.4% 59.6% NS DM 24.3% 10.6% NS Obesity 27.4% 21.3% NS Sedentarism 65.7% 66.0% NS Consumption (cig/d) 25 21.4 NS Years smoking (years) 35.4 35.1 NS Packs-year 42.4 38.0 NS Abstinence at 6 months 76.0% 70.2% NS Open in new tab P680 Impact of a cardiac rehabilitation program on cardiovascular risk factor profile. A Ramirez Moreno1, M Noureddine-Lopez2, JR Siles-Rubio1, JC Salas-Serantes1, J Munoz-Bellido1, L Inigo-Garcia3, P Chinchurreta3, L Fernandez-Lopez3, FJ Martinez-Garcia3, R Bravo-Marques3 1Cardiology Department. Hospiten,, Estepona, Spain 2Servicio de Medicina Interna. Hospiten, Estepona, Spain 3Hospital Costa del Sol, Marbella, Spain Topic: Other risk factors (Rehabilitation & Implementation) Introduction: Cardiac rehabilitation (CR) is a useful tool for secondary prevention in pts with coronary artery disease (CAD). We aimed to examine the effect of a CR program on cardiovascular risk factor (CVRF) profile, the magnitude of improvement, and to identify patients (pts) likely to benefit of a more aggressive and specifically directed approach. Methods: The study involved pts with CAD who completed a phase 2 CR program between September 2009 and November 2012. CR program included education and counseling, aggressive treatment of CVRF, psychological intervention and twice-weekly sessions of physical reconditioning. Sociodemographic, clinical, laboratorial and functional parameters were collected. We compared the proportion of pts achieving secondary prevention goals at the beginning versus 3 to 6 months after termination of CR, using McNemar test. Qui-Square and Student s t-test were used to compare differences between pts who improved or not after CR. Results: We enrolled 249 pts, mean age 54 ± 10 years, 89% men. Most pts (85%) were from Cardiology ward and referred after a ST elevation myocardial infarction (47%). Active tobacco consumption was present in 78% pts, 76% had overweight, 52% dyslipidemia, 38% hypertension, 20% diabetes mellitus (DM) and 21% had previous known CAD. The proportion of pts achieving secondary prevention goals improved significantly after CR program, for all CVRF. Conclusions: CR is an effective tool in secondary prevention in pts with CAD. Although CVRF profile improves globally after CR program, some parameters (namely, LDL levels and weight control) need an even more aggressive directed approach, to ensure adequate CVRF control. The differences found between groups raise the possibility of multiple mechanisms involved in CRF response to exercise. Open in new tabDownload slide Figure P681 Intensive lifestyle program combining mediterranean diet counseling and high intensity interval training improves glycemic control, cardiometabolic and fitness parameters in obese patients. M Gayda1, G Marquis Gravel1, M Juneau1, V Guilbeault1, E Latour1, A Nigam1 1Montreal Heart Institute affiliated with the University of Montreal, Montreal, Canada Topic: Obesity (Rehabilitation & Implementation) Objectives: High-intensity interval training program (HIIT) or mediterranean diet improves glycemic control and insulin sensitivity in patients with high CV risk but their combination has been poorly studied. We aimed to study the effects of a longer-term intensive lifestyle intervention combining HIIT and mediterranean diet counseling on glycemic control, cardiometabolic and exercise parameters in obese patients. Methods: Sixty five obese patients (50 women; age: 52±8 years) participated in a 9-months intensive lifestyle intervention program combining mediterranean diet nutritional counselling and supervised HIIT 2 to 3 times/week. Glycemic control, cardiometabolic, exercise parameters and body composition were measured at baseline and after 9 months of program. At baseline, fasting plasma glucose (FPG) =7.0 mmol/L was present in 6 patients (group 1), FPG: 5.6-6.9 mmol/L in 19 patients (group 2), and FPG<5.6 mmol/L in 40 patients (group 3). As baseline, insulin resistance (HOMA-IR =2.6) was present in 37 patients and 28 patients were insulin sensitive. Results: After the program, 1 patient had a FPG =7.0 mmol/L (-7.69 %, p=0.05), 14 had a FPG: 5.6-6.9 mmol/L (-7.69 %, p=0.31) and 50 had a FPG<5.6 mmol/L (+15.39%, p=0.05). After the program, insulin resistance was present in 27 patients (p=0.07). Significant improvements in FPG (pre: 5.5±0.9; post: 5.2±0.5 mmol/L, p<0.0001), fasting insulin (pre: 98±56; post: 81±43 pmol/L, p=0.0044), HOMA-IR (pre: 3.64±2.56; post: 2.76±1.58, p=0.0011) were observed after the program, whereas HbA1C did not change (pre: 5.7±0.5%; post: 5.6±0.4%, p=0.38). In groups 1, 2 and 3, respectively, FPG decrease was: -1.76±0.82, -0.50±0.46, and -0.04±0.35 mmol/L (Group 1 and 2: p<0.01). HOMA-IR decrease was -4.58±3.85, -1.04±1.84, and -0.24±1.05 (Group 1 and 2: p<0.05). HbA1C decrease was -0.583±0.519%, -0.007±0.263%, and -0.031±0.262% (Group 1: p<0.05). As well, body mass, waist circumference, fat mass, blood pressure, VO2peak (METs) and muscle endurance were all significantly improved (p<0.01). Conclusions: Among obese patients, an intensive lifestyle intervention combining HIIT and mediterranean diet nutritional counseling improves glycemic control parameters as well as body composition, blood pressure and fitness. Fasting glycemia and insulin resistance were improved in patients with impaired glycemia (IFG) or diabetes and HbA1C in patients with diabetes only. Positive longer-term clinical benefits were demonstrated after HIIT and mediterranean diet nutritional counseling on glycemic control parameters among obese patients, particularly those with an IFG or diabetes P682 Achievement of lipid goals in very high risk patients after a cardiac rehabilitation program D Iglesias Del Valle1, A Garcia1, E Martinez1, M Agudo1, M Larrondo1, I Hortelano1, A Berjillos1, R Cadenas1, MB Paredes1, I Plaza1 1Hospital Infanta Sofia, San Sebastian de los Reyes, Spain Topic: Lipid Disorders (Rehabilitation & Implementation) INTRODUCTION: The objectives of lipid profile in secondary prevention are becoming increasingly stringent. Primary treatment target for subjects at very high risk is LDL cholesterol level of <70 mg/dl and secondary target is non-HDL cholesterol level of <100 mg/dl. Cardiac rehabilitation programs represent the perfect setting for the implementation of main lipid control strategies that have proven effectiveness in preventing events in these patients, such as statin therapy, dietary education and physical training. The aim of this study is to analyze the degree of compliance of this targets in the very high risk patients who complete a cardiac rehabilitation program. Methods: The study enrolled all very high risk patients included in the cardiac rehabilitation program since June 2011. Information was collected prospectively on a computerized database, including analytical data of the lipid profile at the beginning and the end of the program. We analyzed the change in LDL and non-HDL cholesterol levels and the achievement of the established targets in very high risk patients. Results: A total of 118 very high risk patients completed the program, with the following indications: NSTE-ACS 66 (55.9%), STEMI 31 (26.3%) and stable angina 21 (17.8%). Upon finishing the cardiac rehabilitation program mean LDL levels dropped from 68.8 to 65.3 mg/dl (P=0.02) and non-HDL levels from 89.9 to 86.4 mg/dl (P=0.11). At the end of the program only 62.7% of very high risk patients reached the LDL cholesterol target. This figure rises to 78.8% for the non-HDL cholesterol target. From the very high risk patients who did not achieve the goal of LDL <70 mg/dl, 71.4% had been treated with maximum doses of statins (Atorvastatin 80 mg). Conclusions: Cardiac rehabilitation programs are effective in achieving the objectives of lipid control in most patients at very high risk. However, a considerable percentage fails to achieve such a lower level of LDL cholesterol. It would be necessary to find out new treatment strategies, associated with a reduction in the rate of cardiovascular events, which facilitate the achievement of these objectives. P683 Optimal education of educators of adults with Coronary Heart Disease: Health professionals' views MH Svavarsdottir1, A Steinsbekk1, AK Sigurdardottir2 1Norwegian University of Science and Technology, Department of Public Health and General Practice, Trondheim, Norway 2University of Akureyri, School of Health Sciences, Akureyri, Iceland Topic: Other risk factors (Rehabilitation & Implementation) Purpose: To investigate health care professionals views and recommendations for education in patient education for adults with Coronary Heart Disease (CHD). Methods: This was a qualitative study, using individual interviews with health professionals (Icelandic and Norwegian nurses, physiotherapists and physicians), with experience from patient education in cardiac care. The focus of the interviews was informants views on optional education and training, in patient education for CHD patients. The interviews were analyzed with systematic text condensation. Results: The informants were 2 males and 17 females with a mean age of 42 years and average work experience of 12 years in cardiac care. The informants felt that a good knowledge of instructional theory was important for providers of education for adults with CHD. This enables them to manage patient centered education and better understand the process of behavioral changes. They discussed the need to include training in patient education in the curriculum of health professionals, as this would increase competence and skills in patient education. The need for development of continuing educational programs and training opportunities for advanced educators was discussed by many. It was a common view that this could be in the form of courses and supervised clinical training, with support and guidance from experienced mentors. Workshops and reflective discussions groups, visitorships and easy access to written instructions and clinical guidelines about patient education were also suggested. Topics considered suitable for educational courses included theoretical review of CHD, instructional theory and interpersonal skills. The need for training in communication and counseling was highly emphasized, including training in capturing and meeting patients learning needs and facilitating an effective dialog. Conclusions: According to health care professionals with experience from patient education, training in patient education should be included in basic education of health professionals and supplemented with structured continuing education. Optimally, theoretical courses and supervised clinical training should complement each other. The results from this study can by a useful base in implementation of continuing educational programs in patient education to CHD patients. P685 Improvement in exercise tolerance after cardiac rehabilitation in post acute ST elevation myocardial infarction survivors received different modes of revascularization in Hong Kong CC Tam1, R Chan1, L Li1, KB Lam1, YY Ho1, YM Fong1, KL Wong1, A Wong1, A Yung1, S Lee1 1Queen Mary Hospital, Department of Medicine, Division of Cardiology - The University of Hong Kong, Hong Kong, Hong Kong SAR, People's Republic of China Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Background: Cardiac rehabilitation (CR) is a Class I indication in clinical practice guidelines for post myocardial infarction (MI) survivors. However, the management of MI has changed considerably in recent decades and the value of CR in modern era of emergency revascularization has come into question. We aim to evaluate the improvement of exercise capacity in post MI survivors after CR who received different modes of reperfusion therapy. Methods: This is a retrospective study in a single center in Hong Kong. The data is from 1990 to 2012 and post ST elevation MI survivors were selected for analysis. Exercise capacity parameters such as six minute walk distance (6MW) and treadmill exercise test were gathered at baseline, after Phase 2 (twice weekly exercise program lasting for 8 weeks) and Phase 3 (community-based home exercise program lasting for 6 months) of CR. Results: Of 921 post ST elevation MI survivors, 240 received primary percutaneous intervention (PPCI), 364 received thrombolytics and 317 did not receive immediate reperfusion therapy. All three groups of patient demonstrated improved exercise tolerance after CR. The degree improvement of exercise parameters in patients received PPCI is not less than that from other groups. (See Table) Conclusions: Post MI survivors received PPCI show similar improvement in exercise capacity after CR as with those received thrombolytic or no immediate reperfusion therapy. PPCI %Δ Thrombolytic %Δ No immediate reperfusion %Δ 6MW(m), mean+/- SD Baseline 412±100 414±95 405±100 Post phase 2 470±109 17 463±96 14 453±105 18 Post phase 3 460±125 16 464±100 13 455±109 18 METS, mean+/- SD Baseline 6.83±3.04 5.52±3.02 5.99±3.39 Post phase 2 9.05±3.07 47 7.49±3.29 52 7.45±3.62 39 Post phase 3 8.31±3.99 45 7.49±3.39 51 7.73±3.59 39 PPCI %Δ Thrombolytic %Δ No immediate reperfusion %Δ 6MW(m), mean+/- SD Baseline 412±100 414±95 405±100 Post phase 2 470±109 17 463±96 14 453±105 18 Post phase 3 460±125 16 464±100 13 455±109 18 METS, mean+/- SD Baseline 6.83±3.04 5.52±3.02 5.99±3.39 Post phase 2 9.05±3.07 47 7.49±3.29 52 7.45±3.62 39 Post phase 3 8.31±3.99 45 7.49±3.39 51 7.73±3.59 39 %?: mean percentage change compared with baseline6MW: Six minute walk; METS: metabolic equivalents achieved on treadmill exercise Open in new tab PPCI %Δ Thrombolytic %Δ No immediate reperfusion %Δ 6MW(m), mean+/- SD Baseline 412±100 414±95 405±100 Post phase 2 470±109 17 463±96 14 453±105 18 Post phase 3 460±125 16 464±100 13 455±109 18 METS, mean+/- SD Baseline 6.83±3.04 5.52±3.02 5.99±3.39 Post phase 2 9.05±3.07 47 7.49±3.29 52 7.45±3.62 39 Post phase 3 8.31±3.99 45 7.49±3.39 51 7.73±3.59 39 PPCI %Δ Thrombolytic %Δ No immediate reperfusion %Δ 6MW(m), mean+/- SD Baseline 412±100 414±95 405±100 Post phase 2 470±109 17 463±96 14 453±105 18 Post phase 3 460±125 16 464±100 13 455±109 18 METS, mean+/- SD Baseline 6.83±3.04 5.52±3.02 5.99±3.39 Post phase 2 9.05±3.07 47 7.49±3.29 52 7.45±3.62 39 Post phase 3 8.31±3.99 45 7.49±3.39 51 7.73±3.59 39 %?: mean percentage change compared with baseline6MW: Six minute walk; METS: metabolic equivalents achieved on treadmill exercise Open in new tab P686 Effectiveness of inpatient cardiac rehabilitation in patients with coronary artery disease after coronary revascularization E Milinaviciene1, J Skibarkiene2, D Zigmantiene2 1Lithuanian University of Health Sciences, Kaunas, Lithuania 2Virsuziglis Hospital of Rehabilitation, affiliate of Hospital of Lithuanian University of Health, Virsuziglis, Lithuania Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Objectives: to evaluate the effectiveness of inpatient rehabilitation programme on functional status in patients with coronary artery disease (CAD) after coronary revascularization Materials-Methods: 238 pts with stable CAD after percutaneous transluminal coronary angioplasty (PTCA) PTCA with stent implantation or coronary artery bypass grafting (CABG) surgery were studied. At the beginning and at the end of rehabilitation the patient's cardiovascular functional capacity classes (based on New York Heart Association - NYHA), assessing of the six-minute walk test, left ventricular (LV) systolic function and changes in exercise capacity were evaluated. Results: After PTCA with stent implantation were 168 patients (111 men, 57 women). After CABG surgery were 37 patients (21 men, 16 women). Patients after CABG surgery suffered more frequently from heart rhythm disorders, pleural effusion, respiratory tract infection, anemia (p<0.05). Patients after PTCA with stent implantation more frequently experienced heart failure, respiratory failure exacerbations (p<0.05). Improvement of functional and clinical status was observed in all study groups (p<0.05). After PTCA with stent implantation, measured by the NYHA, increase was observed in class I and class III subjects experienced decrease after rehabilitation (p<0.05). Exercise tolerance of patients increased in both treatment groups after six-minute walk test (p<0.05): patients after PTCA with stent implantation - from 304.8 ± 147.3 meters to 432.2 ± 168.5 meters and among patients after CABG surgery - from 237.1 ± 135.2 meters to 300.02 ± 112.3 meters. After PTCA with stent implantation LV systolic function increased from 45,7 to 47,3 % (p<0.05). After CABG surgery improvement of LV systolic function was no statistically significant. Conclusions: After CABG surgery and PTCA with stent implantation during rehabilitation patients clinical and functional status improved: an increase in exercise capacity and left ventricular systolic function was observed. Among patients with PTCA with stent implantation physical activity during rehabilitation is higher than among patients after CABG surgery. P687 The influences of the intensity of a six-month trial of cardiac rehabilitation on changes in resting heart rate in patients suffering from ischemic heart disease D Kalka1, ZA Domagala2, J Gebala3, A Rakowska4, J Wojcieszczyk5, P Koleda1, M Syrycki2, K Womperski6, L Rusiecki1, W Pilecki1 1Wroclaw Medical University, Department of Pathophysiology, Wroclaw, Poland 2Wroclaw Medical University, Department of Normal Anatomy, Wroclaw, Poland 3Centre for Men's Health, Wroclaw, Poland 4Centre of Cardiac Prevention and Rehabilitation "Creator", Wroclaw, Poland 5Wroclaw University School of Physical Education, Faculty of Physiotherapy, Wroclaw, Poland 6Hospital of Ministry of Interior, Cardiac Rehabilitation Unit, Glucholazy, Poland Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) An elevated value of resting heart rate (RHR) is an independent risk factor for mortality due to cardiovascular incidents. The trial performed as part of cardiac rehabilitation (CR) included an intensification of physical activity which decreases the RHR in patients suffering from ischemic heart disease (IHD). Aim of study: A prospective evaluation of the correlation between the intensity of the endurance training and the changes in RHR in a group of IHD patients. Material and Methods: The study group included 136 patients (mean age 61,21±8,89), who underwent a trial of CR. The control group consisted of 35 patients, who did not take part in the rehabilitation program. The CR trial has been conducted according to the ESC recommendations. The intensity of the durability training has been evaluated according to the training work (KJ), which is a derivative of the burden (W), which underlies change during training and the time of its duration (s). The analyzed data included the intensity of the workload at the beginning of the training, at the end as well as delta of the work during training sessions and a mean work of the sessions. The RHR has been assesed twice during the six-month trial in all of the analyzed patients. A mean value has been obtained from three values measured in the beginning of the trial (RHR1) and in its end (RHR2). ?RHR has been assesed as the difference in RHR1 and RHR2. Result: The comparative analysis of the RHR values of both study and control group showed no significant differences in the beginning of the study. After a six-month trial the significant decreases in RHR values (69.02±4.09/min vs 65.77±4.67/min, p<0.01) in patients belonging only to the study group have been noted. In comparison to the control group, the mean ?RHR value in the trial group demonstrated statistically significant increases. In the analyzed group of patients, ?RHR was only linked to the statistically significant Pearson correlation (r=0,316, p<0.01) with regard in the RHR values obtained in the beginning of the trials. The workload put on patients during the training sessions in the beginning as well as in the end of the trial and additionally its increase ans the mean workload during training sessions were not significantly related to the statistical values of ?RHR. Conclusions: A six-month trial of CR decreased the RHR value significantly. The intensity of the training had no influence on the changes in the value, which has been achieved by physical activity. The biggest benefits out of the applied trial, have been achieved by patients who characterized themselves by the highest RHR values. P688 Characteristics and evolution of young patients with severe left ventricular dysfunction after an acute coronary syndrome J Caro Codon1, F De Torres Alba1, Z Blazquez Bermejo1, I Ponz De Antonio1, R Dalmau Gonzalez-Gallarza1, A Castro Conde1, SO Rosillo Rodriguez1, D Gemma1, S Del Prado Diaz1, JL Lopez Sendon1 1University Hospital La Paz, Department of Cardiology, Madrid, Spain Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Purpose: Data about young patients with severe ventricular dysfunction after an acute coronary syndrome (ACS) are lacking. We evaluate in this study the risk profile of patients under 50 years with left ventricular ejection fraction (LVEF) < 35% after an ACS and its prognostic implications. METHODS AND Results: We analyzed 119 patients with severe ventricular dysfunction (LVEF <35 %) after an ACS included in a cardiac rehabilitation program (CRP). Patients were categorized into two groups according to their age: less than 50 years and 50 years or older. There were 36 patients in the younger group, with a mean age of 40.1 +/- 10.6 years. 83 patients were 50 or older, with a mean age of 63.3 +/- 7.72 years. Young patients had a significantly less prevalence of diabetes (11.8% vs. 33.3%, p < 0.05) and smoking rate was significantly higher (4.3% vs 52.7%, p <0.05). There was a trend toward a higher prevalence of hypertension, but not other risk factors, such as dyslipidemia, obesity or chronic kidney disease. Young patients had better functional capacity in the exercise stress test, both at the beginning and end of the program (7.7 vs 5.3 mets at the start of the CRP; and 11.3 vs 8.7 mets at the end of CRP, p < 0.05 in both cases). In terms of long-term outcome, young patients achieved significantly greater improvements in LVEF, most often reaching normal ventricular function (defined as EF> 50%) at follow-up (59.4 % vs. 40.6%, p <0.05). Conclusions: Young patients (< 50 years) with severe ventricular dysfunction after an ACS have a higher smoking prevalence than older patients, which is a main secondary prevention objective in a CRP. Our series also highlights two facts: LVEF evolves better than in older patients and, for the same degree of ventricular dysfunction, young patients have a better functional status both before and after end of the CRP. P689 Undertreatment for lifestyle change therapy during cardiac rehabilitation: influence of anxiety and depression symptoms M M Van Engen-Verheul1, HMC Kemps2, RA Kraaijenhagen3, NF De Keizer1, NB Peek1 1Academic Medical Centre, University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands 2Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands 3Committee for Cardiovascular Prevention and Rehabilitation of the Netherlands Society of Cardiology, Utrecht, Netherlands Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Background: Lifestyle change therapy is a crucial part of multidisciplinary cardiac rehabilitation and secondary prevention (CRSP). However, many CRSP patients do not participate in this therapy. As patients after a cardiac incident or intervention often have symptoms of anxiety and depression, we hypothesized that this influences their willingness to participate. Purpose: To assess the influence of anxiety and depression symptoms on the selection of lifestyle change therapy in a cohort of patients admitted to Dutch CRSP clinics. Methods: The cohort consisted of 13 clinics participating in a national CRSP registry. Only clinics that assessed anxiety with the Generalized Anxiety Disorder scale (GAD-7) and depression with the Patient Health Questionnaire (PHQ-9) were included. Within these clinics, we selected patients starting their rehabilitation between July 2012 and November 2013. Logistic regression analysis was performed to measure (i) concordance to national guidelines with respect to the selection of lifestyle change therapy in the rehabilitation plan and (ii) the influence of anxiety and depression symptoms on this selection, correcting for case mix (age, gender, diagnosis, intervention and cardiovascular risk profile). Results: Data of 2.508 patients from 9 clinics were selected. Of these patients 2.231 (89.0%) had an indication for lifestyle change therapy; for 794 patients (35.6%) this therapy was actually selected. Mean age of the patients with an indication was 63.3 ±11.5 years, 73.2% were male, 58.1% were diagnosed with an ACS and underwent coronary revascularisation (CABG or PCI), 9.1% were diagnosed with an ACS without an intervention, and 15.7% had a chronic cardiovascular disease (stable AP or HF). Furthermore, 28.7% were smokers, 17.3% had diabetes (5.8% insulin dependent), mean BMI was 27.7 ±4.6 kg/m2, mean systolic blood pressure was 130.9 ±23.2 mmHg, mean total cholesterol was 4.9 ±1.2 mmol/L, mean GAD-7 was 3.9 ±4.6 and mean PHQ-9 was 5.0 ±4.7. Neither anxiety (OR 1.01 95% CI 0.98–1.04) nor depression scores (OR 1.00 95% CI 0.97–1.03) were associated with selection of lifestyle change therapy. Factors associated were age (OR 0.81 95% CI 0.74–0.89), BMI (OR 1.17 95% CI 1.06–1.31), systolic blood pressure (OR 0.93 95% CI 0.89–0.97) and a chronic diagnosis (OR 1.54 95% CI 1.13–2.08). Conclusions: Anxiety and depression symptoms did not influence selection of the lifestyle change therapy in CRSP programmes. Factors that were associated with undertreatment for lifestyle change therapy included older age, lower BMI, higher systolic blood pressure and absence of a chronic diagnosis. P690 Weight changes and cardiovascular risk factors control in overweight and obese patients after an acute coronary syndrome: results from a Swiss prospective multicenter cohort P Meyer1, B Gencer1, F Sittarame1, R Auer2, L Raber3, H Saner4, CM Matter5, TF Luescher6, N Rodondi7, F Mach1 1University Hospital of Geneva, Department of Cardiology, Geneva, Switzerland 2University of California San Francisco (UCSF), San Francisco, United States of America 3Bern University Hospital, Department of Cardiology, Bern, Switzerland 4Bern University Hospital, Cardiovascular Prevention and Rehabilitation, Bern, Switzerland 5University Hospital Zurich, Zurich, Switzerland 6University Hospital Zurich, Cardiovascular Center, Department of Cardiology, Zurich, Switzerland 7Bern University Hospital, Department of General Internal Medicine, Bern, Switzerland Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) PURPOSE Current cardiac rehabilitation (CR) guidelines recommend a 5-10% weight reduction in overweight/obese patients after an acute coronary syndrome (ACS). However, few prospective data are available on weight changes after an ACS. We examined weight changes in overweight/obese patients and their association with recommended cardiovascular risk factors (CVRF) targets achievement one year after an ACS. METHODS We prospectively included 1750 patients admitted with an ACS in 4 Swiss University hospitals. Baseline weight was recorded during hospitalization and measured at the one-year clinical visit. Baseline overweight was defined as a body mass index (BMI) of 25.0-29.9 kg/m2and obesity as a BMI =30.0 kg/m2. The prospective weight changes in overweight/obese patients were categorized in 3 groups: (1) no reduction (2) 0-4.9% reduction and (3) =5% reduction. The association of weight changes with recommended CVRF targets achievement at one year was assessed using odds ratios (OR) and 95% confidence intervals (CI) adjusted in a multivariate model including age, gender, referral to CR and drug therapy. RESULTS At baseline, 825 (47.1%) patients were overweight, 369 (21.1%) were obese and 556 (31.8%) had an optimal BMI (<25.0 kg/m2). Only 19.4% of overweight and 23.0% of obese patients achieved the minimal recommended 5% weight reduction during the year. Compared to the group with no weight reduction, the group with =5% weight reduction was more likely to achieve all CVRF targets at one year (Table 1). Conclusions Weight reduction after an ACS improves CVRF control, but few overweight/obese patients achieve the recommended weight reduction. Table 1 No Weight Decrease 0-5% Weight Decrease >5% Weight Decrease OR (95% CI)* OR (95% CI)* OR (95% CI)* LDL-C <1.8 mmol/l 1 (Ref) 1.32 (0.97-1.79) 1.62 (1.13-2.31) Glucose <5.6 mmol/l in non diabetics 1 (Ref) 1.08 (0.80-1.46) 1.71 (1.19-2.46) HbA1c <7% in diabetics 1 (Ref) 1.11 (0.57-2.14) 2.36 (1.10-5.07) Systolic Blood Pressure <140 mmg Hg 1 (Ref) 1.58 (1.17-2.12) 1.64 (1.14-2.35) No Weight Decrease 0-5% Weight Decrease >5% Weight Decrease OR (95% CI)* OR (95% CI)* OR (95% CI)* LDL-C <1.8 mmol/l 1 (Ref) 1.32 (0.97-1.79) 1.62 (1.13-2.31) Glucose <5.6 mmol/l in non diabetics 1 (Ref) 1.08 (0.80-1.46) 1.71 (1.19-2.46) HbA1c <7% in diabetics 1 (Ref) 1.11 (0.57-2.14) 2.36 (1.10-5.07) Systolic Blood Pressure <140 mmg Hg 1 (Ref) 1.58 (1.17-2.12) 1.64 (1.14-2.35) Adjusted Odds Ratios for One Year Secondary Prevention Target Achievement According To Weight Decrease in Overweight and Obese Patients (N=1194) Open in new tab Table 1 No Weight Decrease 0-5% Weight Decrease >5% Weight Decrease OR (95% CI)* OR (95% CI)* OR (95% CI)* LDL-C <1.8 mmol/l 1 (Ref) 1.32 (0.97-1.79) 1.62 (1.13-2.31) Glucose <5.6 mmol/l in non diabetics 1 (Ref) 1.08 (0.80-1.46) 1.71 (1.19-2.46) HbA1c <7% in diabetics 1 (Ref) 1.11 (0.57-2.14) 2.36 (1.10-5.07) Systolic Blood Pressure <140 mmg Hg 1 (Ref) 1.58 (1.17-2.12) 1.64 (1.14-2.35) No Weight Decrease 0-5% Weight Decrease >5% Weight Decrease OR (95% CI)* OR (95% CI)* OR (95% CI)* LDL-C <1.8 mmol/l 1 (Ref) 1.32 (0.97-1.79) 1.62 (1.13-2.31) Glucose <5.6 mmol/l in non diabetics 1 (Ref) 1.08 (0.80-1.46) 1.71 (1.19-2.46) HbA1c <7% in diabetics 1 (Ref) 1.11 (0.57-2.14) 2.36 (1.10-5.07) Systolic Blood Pressure <140 mmg Hg 1 (Ref) 1.58 (1.17-2.12) 1.64 (1.14-2.35) Adjusted Odds Ratios for One Year Secondary Prevention Target Achievement According To Weight Decrease in Overweight and Obese Patients (N=1194) Open in new tab P691 Effect of cardiac rehabilitation in the rate of cardiovascular events in patients with ischemic heart disease E Otero Chulian1, P Fernandez Garcia1, P Sanchez Millan1, M Pajares Vinardell1, L Gheroghe1, E Chueca Gonzalez1, M Fernandez Garcia1, R Del Pozo Contreras1, R Vazquez Garcia1 1Puerta del Mar University Hospital, Cadiz, Spain Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Introduction: Cardiac rehabilitation is an essential component to control cardiovascular risk factors and promotion of healthy lifestyles. Methods: The aim of our study was to analyze the rate of cardiovascular events in patients who had myocardial ischemic event remitted or not to the cardiac rehabilitation program during follow-up two years. It is a descriptive, observational and retrospective study including 583 patients, with inclusion criteria; 285 patients referred and 298 patients not referred to cardiac rehabilitation, analyzing baseline characteristics of both groups and evaluating posterori cardiovascular event rate with logistic regression analysis (mortality, readmissions and major cardiac events). Results: The mean age was 56.7 years in the group referred to the program and 62.7 in non- remitted, not statistically significant. The percentage of men and women was similar in both groups (p=0.049). In the group of non-rehabilitated, there was a higher percentage of persons obese and hypertensive (p<0.05). In the rehabilitation group had more smokers (p = 0.003). Slight predominance of diabetics and dylipidemia in the not remitted to the program (not statistically significant). After multivariate analysis, the groups were not comparable in age, ejection fraction, smoking, obesity and hypertension. The mortality rate, heart failure, arrhythmias and need for surgery was very low (non significant). If there were large differences in the rate of readmissions, new acute ischemic myocardial events and angina in the cardiac rehabilitation group (p<0.05). Conclusions: The rate of cardiovascular events was lower in the group of patients undergoing cardiac rehabilitation, with statistically significant differences in readmissions, acute coronary syndrome and angina. P692 Beneficial effects of enhanced external counterpulsation therapy in patients with angina pectoris and congestive heart failure T Tak1, H Ramsey1, D Haberman1, C Cagin1 1Mayo Health System, Franciscan Skemp Healthcare, La Crosse, United States of America Topic: Atherosclerosis/CAD (Rehabilitation & Implementation) Background: The incidence of angina pectoris and congestive heart failure (CHF) continues to increase in the United States and in the rest of the world. EECP therapy is a novel and potentially beneficial adjunct clinical tool which is used in the treatment of patients (pts) who remain symptomatic despite maximum therapy. Purpose: The study was undertaken to evaluate the beneficial results of EECP therapy in pts who remained symptomatic despite maximum medical management. Methods: 84 consecutive pts referred for EECP were included; of this cohort, 52 pts were recruited and 42 completed a full course of therapy (35 sessions). Pre and post treatment results for changes in functional capacity and severity of symptoms was evaluated. A paired t-test was utililized to evaluate significance of results. A p-value of <0.05 was considered statistically significant. The McNemar's test was applied to 2 groups of patients with Angina pectoris Class 1-2 (mild) and compared with those having Class 3-4 (moderate to severe) symptoms per Canadian Cardiovascular Society (CCVS) classification. Likewise, CHF symptoms were graded per New York Heart Association (NYHA) classification; class 1-2 were grouped as mild, and class 3-4 as moderate to severe. Results:The mean age of the pts was 72 years (range: 49-94 years). We looked at the 6 minute walk test (6MWT), Duke activity score index (DASI), exercise tolerance in METS, mean anginal episodes per week, systolic blood pressure (SBP), diastolic blood pressure (DBP), and functional class of CHF and angina pectoris. The McNemar's test for comparison of CCVS/NYHA functional class was performed by combining functional class 1 and 2 (mild) and functional class 3 and 4 (moderate to severe). Pre and post treatment results were obtained. 6MWT: 386.1 vs 426.8 (SE: 7.9), p<0.0001; DASI:4.10 vs 6.3(SE:0.57), p<0.0003; exercise tolerance in METS 2.90 vs. 4.0 (SE 0.23), p<0.0001; mean anginal episodes 12.3 vs. 2.4, (SE:2.18), p<0.0001; NTG use 2.45 vs. 0.47, (SE: 0.78), p<0.01; SBP: 117 vs. 114, (SE:1.5), p<0.05; DBP: 67 vs 66 (SE:0.687), p=NS; Angina Pectoris and CHF(CCVS /NYHA) functional class: 95 percent vs 25 percent, p<0.0001 Conclusions: There was significant improvement of anginal and CHF symprtoms in pts completing a full course of EECP therapy. In addition, there was statistically significant improvement in number of anginal episodes, DASI, decreased NTG use, increased exercise tolerance in METS, mild decrease in SBP and improvement of angina pectoris/CHF functional class. However, no significant difference in DBP was observed. More research is needed to confirm these findings. P693 Effect of cardiac rehabilitation program on oscillatory ventilation pattern in heart failure patients F Yamauchi1, H Adachi1, J Tomono1, S Oshima1 1Gunma Prefectural Cardiovascular Center, Division of Cardiology, Maebashi, Japan Topic: Heart Failure (Rehabilitation & Implementation) Background and Purpose: Heart failure patient is well known to have abnormal ventilation. Oscillatory ventilation is one of them. Incidence of oscillatory ventilation is reported to be greater as the status of heart failure becomes severer. Although, the amplitude and the cycle length of oscillatory ventilation is various, it is not well studied yet as for the relationship between these factors and the severity of heart failure. Cardiac rehabilitation is nowadays an established maneuver of heart failure treatment. Even though cardiac rehabilitation program is reported to ameliorate the severity of heart failure, its effect on oscillatory ventilation is not well reported. Hereby we aimed to evaluate the effect of cardiac rehabilitation program on oscillatory ventilation pattern in patients with heart failure. Methods: Consecutive 27 heart failure subjects with oscillatory ventilation who were participated in the cardiac rehabilitation program were enrolled. Cardiac rehabilitation program consisted of 30 to 60 minute exercise session and 30minutes education program, and was held 3 times per week, for 5 months. Evaluation of plasma BNP level and cardiopulmonary exercise testing were performed twice, at the entry date and 5 months later. Patients basal disease was dilated cardiomyopathy, ischemic cardiomyopathy, hypertensive heart disease and valvular heart disease. Average exercise tolerance was as follows: anaerobic threshold; 60.7±16.2%, peak oxygen uptake; 55.0±14.4%, VE vs. VCO2 slope; 38.8±9.6. Average plasma BNP was 968±773 pg/mL. Oscillatory ventilation was defined as usual. Average amplitude and cycle length of ventilation were 18.6±11.9 L/min and 69.8±14.5sec. Results: Neither amplitude nor cycle length were strongly related with peak oxygen uptake (r=-0.22, -0.37, respectively), while they showed moderate positive correlation with VE vs. VCO2 (r=0.63, 0.47, respectively) and BNP (r=0.58, 0.39, respectively). Improvement ratio (pre*100/post) of amplitude and cycle length of ventilation showed no correlation with improvement of VE vs. VCO2 slope (r=0.30 and 0.23, respectively). On the other hand, improvement of BNP related strongly with that of amplitude (r=0.78) although with cycle length, there was no correlation (r=0.16). Conclusions: Cardiac rehabilitation program was revealed to improve both the amplitude and cycle length of oscillatory ventilation. Improvement of oscillatory ventilation was revealed to relate with that of BNP. P694 Burden of ischemic mitral regurgitation on severe left ventricular dysfunction in patients following a cardiac rehabilitation program I Ponz De Antonio1, MJ Fernandez Anguita2, S Del Prado Diaz1, R Dalmau Gonzalez-Gallarza1, A Castro Conde1, JL Lopez Sendon1 1Hospital La Paz, Madrid, Spain 2Hospital and University Complex of Albacete, Albacete, Spain Topic: Heart Failure (Rehabilitation & Implementation) Introduction: Ischemic mitral regurgitation (MR) is a frequent complication of left ventricular (LV) remodelling due to coronary artery disease, and worsens prognosis. It is said that the poor prognosis of these patients depends on the severity of LV systolic dysfunction (LVSD), but the importance of MR itself remains controversial. Methods: We enrolled patients with severe MR after an acute coronary syndrome following a cardiac rehabilitation (CR) program. All patients underwent a laboratory test, an echocardiography and an ergometry the day they were included in the program and during follow up. Results: 33 of 864 patients had severe ischemic MR, 88,9% male, mean age 60,8 years. Echocardiographic characteristics are shown in Table1. After a Heart Team evaluation, 6 patients underwent mitral valve surgery: 5 valvuloplasty and 1 valve replacement. Pharmacotherapy was according to guidelines. After a mean follow-up of 14,4 months, ejection fraction (EF) worsened in 16,6%, remained the same in 23,4% and improved in 60%, and the proportion of severe LVSD was halved. On average, EF improved a 12% regarding the baseline echocardiography. MR got better in 66,6% of the patients and remained severe in 33,3%, regardless of the management (surgical vs medical treatment). Improvement in MR was associated with a greater increase of EF than persistent severe MR (p 0,005). Mean EF in patients with severe LVSD was 26,36%, their functional capacity (FC) at baseline was low (4,9 METS on average). During follow up, EF increased in 10,8%, and FC in 3,5 METS on average. Patients with severe MR and severe LVSD had a worse outcome than those with severe LVSD without MR: EF at baseline was 23,4% and improved 12,8%; FC at baseline was 5,6 METS and increased in 4 METS. Conclusions Patients with severe ischemic LVSD have worse outcome when it associates severe MR. But despite the poor prognosis of ischemic MR, optimization of medical treatment combined with an intense CR program may be able to improve functional recovery. Table 1 Echocardiographic findings Baseline Follow-up EF 38,3% 44,5% LVSD (EF < 50%) 71,4% 54,3% severe LVSD (EF = 30%) 42,4% 18,1% severe MR 100% 33% Baseline Follow-up EF 38,3% 44,5% LVSD (EF < 50%) 71,4% 54,3% severe LVSD (EF = 30%) 42,4% 18,1% severe MR 100% 33% Open in new tab Table 1 Echocardiographic findings Baseline Follow-up EF 38,3% 44,5% LVSD (EF < 50%) 71,4% 54,3% severe LVSD (EF = 30%) 42,4% 18,1% severe MR 100% 33% Baseline Follow-up EF 38,3% 44,5% LVSD (EF < 50%) 71,4% 54,3% severe LVSD (EF = 30%) 42,4% 18,1% severe MR 100% 33% Open in new tab P696 Cardiopulmonary exercise testing in patients with pulmonary hypertension: distinct profile of results compared to heart failure S Katano1, A Hashimoto2, T Fujito2, E Iwamoto3, T Neki3, M Katayose3, K Tsuchihashi4, T Miura2 1Okhotsk Medical Treatment Environment Research Course, Sapporo Medical University, Sapporo, Japan 2Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan 3Department of Physical Therapy, Sapporo Medical University, Sapporo, Japan 4Department of Health Care Administration and Management, Sapporo Medical University, Sapporo, Japan Topic: Other Heart Disease (Rehabilitation & Implementation) Purpose Although cardiopulmonary exercise testing (CPX) is an established method for assessment of exercise capacity in patients with heart failure (HF), its clinical utility for patients with pulmonary hypertension (PH) remains unknown. The aim of this study was to clarify which parameters in CPX are determinants of exercise capacity in patients with PH. In addition, we examined how profiles of CPX parameters are different between patients with PH and HF. Methods Thirteen patients with PH aged 37±11 years (mean pulmonary arterial pressure, mPAP: 34±14 mmHg) and 26 patients with HF aged 59±12 years (left ventricular ejection fraction: 40±17%) underwent symptom-limited CPX on a treadmill ergometer. Oxygen uptake (VO2), carbon dioxide output (VCO2), minute ventilation (VE) and end-tidal pressure of CO2 (PETCO2) were obtained breath-by-breath techniques. Oxygen pulse (O2 pulse), ventilatory equivalents for CO2 output (VE/VCO2) and the slope of the VE/VCO2 relationship (VE/VCO2-slope) were calculated. Indication for termination of CPX was pre-determined as respiratory quotient being 1.1 or larger. PH patients underwent hemodynamic assessment in right heart catheterization (RHC) and echocardiography (TTE). Results No patients completed CPX protocols with adverse events (peak respiratory quotient: 1.15±0.13). In PH patients, peak VO2 (r=.70, p=.011), VE/VCO2 at anaerobic threshold (AT) (r=-.78, p=.003), VE/VCO2-slope (r=-.66, p=.019) and PETCO2 at AT (r=.76, p=.004) were significantly correlated with cardiac index obtained from RHC. VE/VCO2 slope was significantly correlated with mPAP (r=.84, p=.001) and pulmonary vascular resistance (PVR) (r=.66, p=.019) in RHC in PH patients. VE/VCO2 slope was significantly correlated with the ratio of tricuspid valve regurgitant pressure gradient to velocity time integral of right ventricular outflow tract in TTE (r=.64, p=.019), which reflects PVR. Peak O2 pulse (6.6±1.5 vs. 9.6 ± 3.0 mL/beat, p=.002) and PETCO2 at AT (34±5 vs. 38±5 mmHg, p=.009) were significantly lower in PH patients than those in HF patients who had equally exercise intolerance (60±6 vs. 68±13 % of predicted peak VO2, p=.146). VE/VCO2 at AT (41±6 vs. 36±6, p=.043) and VE/VCO2-slope were significantly higher (35±7 vs. 30±5, p=.023) in PH patients than those in HF patients. Conclusion PH is characterized by low peak O2 pulse and low PETCO2 at AT, which reflected low cardiac output and underlying ventilation-perfusion mismatch. The close correlation between VE/VCO2-slope and pulmonary vascular resistance indicates that CPX is useful for assessing the severity of PH. P697 Analysis of physiotherapy needs of bedridden patients admitted in cardiology rehabilitation after acute event A Mazza1, A Maestri1, F Camera1, P Longoni1, M Ceresa1, A Gualco1, C Opasich1, S Priori1 1IRCCS Salvatore Maugeri Foundation, Pavia, Italy Topic: Other Heart Disease (Rehabilitation & Implementation) Background. A growing number of patients (pts) with impaired functional status and serious complications, often bedridden, were admitted to Cardiac Rehabilitation (CR). We have implemented a protocol for physical evaluation (Opasich e al,EJCPR 2010) which allowed us to classify the degree of fragility to assess the risk of falling and to personalize the training. This protocol is usually quite effective in identifying frailty but there is a group of pts which do not correspond to the criteria, because their clinical improvement is achieved in less time than predicted. Purpose: To determine if our protocol for assessing frailty which allows us to identify and initiate a course of physiotherapy suitable for pts who are still bedridden admitted in the CR. Population: We selected pts who were not able to perform the walking test (WT) within the first 4 days after admission (410 patients, 307 men and 103 women, mean age 77 ± 5 years). The impairment was evident with the scales of Morse and Stratify which was combined with a specific assessment of the risk of falling (Tinetti scale). Methods: We divided the pts into 3 groups based on the performance of the initial WT, taking account of specific tables (Opasich e al, Chest 2004): 1 ○ group WT <130 meters (134 pts), 2○ group WT between 130-250 meters (152 pts) and 3○group 3 WT> 250 meters (124 patients). We also tested 39 patients (G1 and G2) with GDS to assess wheter different degrees of depression could affect the functional recovery, but pts of the two groups at a lower functional capacity showed similar levels of depression. Results: The three groups were found to be have been admitted in the CR with the same timing after the acute event (11 ± 13 days, P 0.16) but had no statistically significant differences for days of hospitalization(p=0.005), for WT discharge(p <0.0001), for CIRS admission and discharge (p <0.0001)and EF (p = 0.02). All three groups had improved between admission and discharge for meters walked in WT: p <0.001 and p = 0.001 for CIRS score. Conclusions: The pts we classified as VSF are well suited to our evaluation algorithm and also benefited from our physiotherapy program adapted according to the fragility level. We observed, however, that a large proportion of these pts appeared to be "forcibly" included in this class of high complexity and fragility. We believe that movement difficulties can be due to psychological factors (known in the literature as Vital Exhaustion?) and not just physical impairments acquired during forced bed rest often characteristic of acute hospitalization. P698 Preliminary findings of healthy life in suriname (HeLiSur) study: the self-reported risk profile of stroke patients A V Jarbandhan1, SM Baldew1, GP Oehlers2, F Diemer2, J Toelsie3, HEJ Veeger4, L Vanhees1 1Catholic University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium 2Academic Hospital Paramaribo, Department of Cardiology, Paramaribo, Suriname 3Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname 4VU University, Faculty of Human Movement Sciences, Amsterdam, Netherlands Topic: Vascular disease (Rehabilitation & Implementation) Purpose: The burden of stroke is high in low and middle income countries. Circulatory diseases are the primary cause of death in Suriname (45.5%), but data on the prevalence of stroke and impact of risk factors is lacking. The prevalence of and the impact of risk factors on stroke and coronary artery disease (CAD) were therefore investigated. Methods: This study is part of healthy life in Suriname (HeLiSur) study, a representative cohort of 1800 inhabitants in Paramaribo, in which we report on the first 1193 respondents, interviewed in the period March-September 2013. The patients with a history of CVA and TIA (stroke group) were compared with a group of CAD patients and the remaining subjects (reference group) regarding their reported risk profile. Data were analyzed using SPSS. Significance level was set at. 05. Results: The stroke group was significantly younger than the reference group and also relatively younger compared to stroke patients from the USA. A prevalence of 4.9% was found for stroke, which is higher compared to USA statistics. In both stroke and CAD groups diabetes mellitus, hypertension and hypercholesterolemia were statistically more present. Smoking and sedentary lifestyle were significantly more present in the stroke group alone. In addition, a higher prevalence of CAD was found in asian-indians in comparison to other ethnic groups. Conclusions: All reported risk factors are more present in stroke survivors. The higher incidence of stroke in Suriname, the relatively young age and the risk profiles in the stroke group, indicates that a healthier lifestyle should be targeted in Surinamese stroke survivors. Risk factors stroke group (n=59) CAD group (n=26) reference group (n=1108) median age (interquartile range) 50(40-57)2.3 38(27-50) 57(41-63) gender (m/f) 25/34 13/13 401/707 diabetes mellitus 36%2 43%2 17% hypertension 58%2 64%2 31% hypercholesterolemia 27%2.3 71%2 14% smoking 38%2 26% 22% sedentary lifestyle (n=942) 100%2 94% 80% Risk factors stroke group (n=59) CAD group (n=26) reference group (n=1108) median age (interquartile range) 50(40-57)2.3 38(27-50) 57(41-63) gender (m/f) 25/34 13/13 401/707 diabetes mellitus 36%2 43%2 17% hypertension 58%2 64%2 31% hypercholesterolemia 27%2.3 71%2 14% smoking 38%2 26% 22% sedentary lifestyle (n=942) 100%2 94% 80% 2=statistically significant difference with reference group, 3=statistically significant difference with CAD group. Open in new tab Risk factors stroke group (n=59) CAD group (n=26) reference group (n=1108) median age (interquartile range) 50(40-57)2.3 38(27-50) 57(41-63) gender (m/f) 25/34 13/13 401/707 diabetes mellitus 36%2 43%2 17% hypertension 58%2 64%2 31% hypercholesterolemia 27%2.3 71%2 14% smoking 38%2 26% 22% sedentary lifestyle (n=942) 100%2 94% 80% Risk factors stroke group (n=59) CAD group (n=26) reference group (n=1108) median age (interquartile range) 50(40-57)2.3 38(27-50) 57(41-63) gender (m/f) 25/34 13/13 401/707 diabetes mellitus 36%2 43%2 17% hypertension 58%2 64%2 31% hypercholesterolemia 27%2.3 71%2 14% smoking 38%2 26% 22% sedentary lifestyle (n=942) 100%2 94% 80% 2=statistically significant difference with reference group, 3=statistically significant difference with CAD group. Open in new tab P699 Evaluation of health benefits and safety of early comprehensive cardiac rehabilitation in patients with an implantable cardioverter-defibrillator (ICD) J Smialek1, JM Majewski2 1John Paul II Hospital, Krakow, Poland 2Jagielonion University Electrocardiology Department, Krakow, Poland Topic: Rhythm Disorders/Sudden death (Rehabilitation & Implementation) The aim of the study was to evaluate the safety and benefits of complex cardiac rehabilitation (CCR) early after ICD implantation. The study group consisted of 45 patients (28 male, mean age 62,2 y) introduced to the program of CCR at 6 weeks after ICD implantation. CCR included two phases: I- 2-weeks inpatient, II- 12 weeks outpatient. Before and after completion of CCR the pt were examined with transthoracic echocardiogram, treadmill exercise test- spiroergometry according to modified Naughton protocol, SF-36 questionnaire for quality of life (QOL) and Beck inventory for depressive symptoms (BDI). Results There were no deaths during the study or complications or adverse events during rehabilitation or exercise testing. After CCR BMI decreased (26,98 ±4,13 vs. 26,37±3,66; p=0.003), left ventricle ejection fraction increased (30,09±12,75 vs. 35,43±13,4%; p=0.002), peak VO2 increased (21,3±9,2 vs 24,2±10,3 ml/kg/min; p 0.007). BDI decreased (14,81±9,27 vs 12,83±10,75; p 0.020). QOL improved (SF-total, physical index of QOL and SF-2). NYHA class improved (p<0,001). The improvement of peak VO2 was associated with better QOL (SF-total; r=-0,34). There was also a correlation between the alleviation of depressive symptoms (BDI) and improvement of QOL: SF- total(r=0,52), SF- physical index(r=0,42), SF-2(r=0,35), SF-6(r=0,498), SF-7(r=0,3). Conclusions Early CCR in patients after ICD implantation is safe and results in improvement of left ventricular systolic function, exercise capacity and QOL. Correlation Parameters SF - 36 DBDI DSF -1 DSF - 2 DSF - 6 DSF - 7 DSF - Total DSF - fizyczny Dpeak VO2 (ml/kg/min) R -0,405 -0,144 -0,096 -0,299 -0,339 -0,364 -0,219 P 0,021 0,433 0,602 0,096 0,058 0,041 0,214 DHR max (n/min) R -0,106 -0,050 -0,194 -0,150 -0,222 -0,145 -0,405 0,572 0,790 0,297 0,420 0,231 0,437 0,020 DBDI R 0,326 0,351 0,498 0,386 0,521 0,419 1,000 0,060 0,042 0,003 0,024 0,002 0,014 --- Parameters SF - 36 DBDI DSF -1 DSF - 2 DSF - 6 DSF - 7 DSF - Total DSF - fizyczny Dpeak VO2 (ml/kg/min) R -0,405 -0,144 -0,096 -0,299 -0,339 -0,364 -0,219 P 0,021 0,433 0,602 0,096 0,058 0,041 0,214 DHR max (n/min) R -0,106 -0,050 -0,194 -0,150 -0,222 -0,145 -0,405 0,572 0,790 0,297 0,420 0,231 0,437 0,020 DBDI R 0,326 0,351 0,498 0,386 0,521 0,419 1,000 0,060 0,042 0,003 0,024 0,002 0,014 --- SF-36 questionnaire for quality of life (QOL) Beck inventory for depressive symptoms (BDI) R - correlation ratio Open in new tab Correlation Parameters SF - 36 DBDI DSF -1 DSF - 2 DSF - 6 DSF - 7 DSF - Total DSF - fizyczny Dpeak VO2 (ml/kg/min) R -0,405 -0,144 -0,096 -0,299 -0,339 -0,364 -0,219 P 0,021 0,433 0,602 0,096 0,058 0,041 0,214 DHR max (n/min) R -0,106 -0,050 -0,194 -0,150 -0,222 -0,145 -0,405 0,572 0,790 0,297 0,420 0,231 0,437 0,020 DBDI R 0,326 0,351 0,498 0,386 0,521 0,419 1,000 0,060 0,042 0,003 0,024 0,002 0,014 --- Parameters SF - 36 DBDI DSF -1 DSF - 2 DSF - 6 DSF - 7 DSF - Total DSF - fizyczny Dpeak VO2 (ml/kg/min) R -0,405 -0,144 -0,096 -0,299 -0,339 -0,364 -0,219 P 0,021 0,433 0,602 0,096 0,058 0,041 0,214 DHR max (n/min) R -0,106 -0,050 -0,194 -0,150 -0,222 -0,145 -0,405 0,572 0,790 0,297 0,420 0,231 0,437 0,020 DBDI R 0,326 0,351 0,498 0,386 0,521 0,419 1,000 0,060 0,042 0,003 0,024 0,002 0,014 --- SF-36 questionnaire for quality of life (QOL) Beck inventory for depressive symptoms (BDI) R - correlation ratio Open in new tab P700 Predictores of performance, centile curves and normative data in incremental shutle walk test in cardiac patients at entry in cardiac rehabilitation FM Fonseca Cardoso1, M Almodhy1, G Pepera2, GRH Sandercock1 1University of Essex, Department of Biological Sciences, Centre for Sports and Exercise Science, Colchester, United Kingdom 2Technological Educational Institute (TEI) of Sterea Hellas, Sterea Hellas, Greece Topic: Exercise/Exercise training (Rehabilitation & Implementation) Background: The Incremental Shuttle-Walk Test (ISWT) is used in cardiac rehabilitation to predict cardiorespiratory fitness and functional capacity. However, Vo2peak accounts for only 63% of the variance in test performance and non-clinical variables (BMI, height) may account for ~20% of variance in performance. The aim of this study was to identify additional predictors of ISWT performance in sample large enough to investigate male and female cardiac patients separately and produce centile curves and normative data for performance pre-CR. Methods: We accessed clinical records of n=548 (80% male) patients (63.1 ± 11.3 years) who completed outpatient cardiac rehabilitation at four UK hospitals and extracted clinical data and details of 10 m ISWT performance at entry to rehabilitation. We assessed differences in performance using independent t-test and used multivariates stewise regression to indentified predictors of performance. Using the Generalized Additive Models for Location, Scale and Shape (GAMLSS), we will generate normative data and centile curves of performance. Results: Men walked 395 (±165)m while women achieved 269 (±118) m (t=9.5, p<0.001) Multivariate stepwise regression showed that men s performance (m) was predicted by: Age; B=-5.87 (95%CI-7.1 to -4.6), Height; β=5.0 m (95% CI 3.1 to 6.8), BMI; B= -5.09 m (95%CI -7.94 to -2.24), Diabetes; -48.7 m (95% CI-17.3 to -80.2). In women the predictors were: Age; B=-4.8 m (95%CI-6.3 to -3.3), Height; B=2.8 m (95%CI0.11 to 5.47); Diabetes, -80 m (-39.5 to 120.5). Conclusions: As age was the best predictor in both sexes. Practitioners should, therefore, account for this non-modifiable patient characteristic when interpreting ISWT performance. Expressing ISWT performance as a percentile of age- and sex-specific norms allows a more objective and useful interpretation functional capacity at entry to cardiac rehabilitation. normative data for iswt performance Male, age C3 C50 C97 mean 40 216 519 977 538 50 181 459 858 475 60 150 399 738 411 70 120 339 621 348 80 92 279 506 285 Male, age C3 C50 C97 mean 40 216 519 977 538 50 181 459 858 475 60 150 399 738 411 70 120 339 621 348 80 92 279 506 285 Performance in ISWT according with age and gender Open in new tab normative data for iswt performance Male, age C3 C50 C97 mean 40 216 519 977 538 50 181 459 858 475 60 150 399 738 411 70 120 339 621 348 80 92 279 506 285 Male, age C3 C50 C97 mean 40 216 519 977 538 50 181 459 858 475 60 150 399 738 411 70 120 339 621 348 80 92 279 506 285 Performance in ISWT according with age and gender Open in new tab P701 Feasibility of an outpatient cardiac rehabilitation program in primary care. The Norwegian Ullevaal model. BB Nilsson1, P Lunde2, E Jarstad3 1Norwegian Research Center for Active Rehabilitation, Oslo, Norway 2Berge University College, Bergen, Norway 3Norwegian Research Center for Active Rehabilitation, NIMI, Oslo, Norway Topic: Exercise/Exercise training (Rehabilitation & Implementation) Maximal peak oxygen uptake (VO2max) is regarded as the gold standard for assessing aerobic capacity. In earlier observational studies, one metabolic equivalent (MET; 1 MET ~3.5 ml/kg/min) increase in aerobic capacity translates to a 12-13% improvement in survival in men with and without coronary heart disease and a 17 % improvement in survival in women. Based on these results, it appears that exercise based cardiac rehabilitation (CR) programs gives at least 3.5 ml/kg/min improvements in VO2max are beneficial. Purpose: Outcomes evaluation is a critical component in outpatient CR. The goal of this project was to evaluate an exercise based CR program (the Norwegian Ullevaal model) regarding the characteristics of the participants, their exercise capacity and health-related quality of life (HRQoL) to help facilitate quality improvement in primary care. Methods: The Oslo Heart EX study is an ongoing cohort study including all cardiac patients referred for out-patient CR in a primary care clinic in Oslo. A one-group follow-up design was used. The main efficacy variable is the change in VO2max as a primary prognostic measure of successful rehabilitation. HRQoL was measured by self-report using the COOP/WONCA questionnaire. Preliminary results: First data collection includes pre- and post outcomes from 99 patients referred to exercise based CR, two times per week in 12 weeks. Mean age was 56 ±9 years, 85% were men. Mean resting blood pressure at baseline was 132±20 mm Hg systolic and 80±11 med mer Hg diastolic. BMI, 26.6±3.5 and resting heart rate 70±3.5.Training habits (hours per week) before cardiac event were 0,85±1 The patients showed clinical improvement in VO2max from 30±7 ml/kg/min at baseline to 34±8 after CR and in all health-related quality life domains (physical functioning, mental health, performance of daily activities, overall health, and perceived improved health). Conclusions: Our findings suggest that the Norwegian Ullevaal model is a feasible and effective model for CR in primary care. P702 Right ventricle disfunction predicts lower exercise tolerance in elderly patients undergoing cardiac rehabilitation after CABG. G Caminiti1, V D'antoni1, R Giorgi1, J Murugesan1, D Battaglia1, M Volterrani1 1IRCCS San Raffaele Pisana Hospital, Rome, Italy Topic: Exercise/Exercise training (Rehabilitation & Implementation) Aim: to evaluate the impact of right ventricle disfunction on exercise tolerance of elderly patients undergoing cardiac rehabilitation after CABG. Methods: Data of 220 patients with coronary artery disease undergoing cardiac rehabilitation early (<1 week) after CABG were collected. Median age 77±6; M/F 130/90. Right ventricle function was evaluated at admission by echocardiography using tricuspid annular plane systolic excursion (TAPSE). All subjects attended an aerobic exercise training program at 60-70% of heart rate reserve lasting 4-weeks.Exercise tolerance was evaluated at admission and at discharge by six minute walking test (6MWT). Patients were divided into two groups according to the presence of right ventricle disfunction (TAPSE value < 16). Group 1=TAPSE<16; Group 2=TAPSE>16. Results: Seventy-four out of 220 (30%) patients had TAPSE lower than 16. Considering the overall population, patients of group 1 were more often males (M/F= 2.1 vs 1.2, p 0.02) had a lower ejection fraction (42.4±6 vs 51.8±7 p 0.003), walked a lower distance at 6MWT both at admission (88.4±13 m vs 111±26 m) and at discharge (88.4±13 m vs 111±26 m) compared to group 2. The correlation between TAPSE and distance walked at 6MWT was significant for patients of group 1(r 0.24; p 0.01) but weak in group 2 (r 0.16; p 0.07). TAPSE resulted significantly related to distance walked at 6MWT both at admission (r 0.46; p 0.001) and at discharge (r 0.39: p 0.003) in males. Conversely TAPSE was poorly related to distance walked at both 6MWTs in females. Conclusions: TAPSE is a marker of lower exercise tolerance in elderly patients undergoing cardiac rehabilitation. This relation is stronger for male subjects with right ventricle disfunction. P703 Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: preliminary results of the FIT@Home study J J Kraal1, N Peek1, M E Van Den Akker-Van Marle2, H M C Kemps3 1Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands 2Leiden University Medical Center, Department of Medical Decision Making, Leiden, Netherlands 3Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands Topic: Exercise/Exercise training (Rehabilitation & Implementation) Purpose: Home-based exercise training in cardiac rehabilitation (CR) has the potential to improve CR uptake, decrease costs and increase self-management skills. The FIT@Home study evaluates a home-based CR program with telemonitoring guidance. In this interim analysis we provide short term results on physical fitness and training adherence of the first 21 patients included in the FIT@Home study. Methods: This RCT compares a 12-week home-based (HB) with a 12-week centre-based (CB) training program in low to moderate risk patients entering CR. The home-based group receives three supervised training sessions, before they start training with a heart rate monitor in their home environment. Training is performed at 70-85% of maximal heart rate (HRmax) for 45-60 minutes, 2-3 times per week. Patients receive individual coaching by telephone once a week, based on objective training data uploaded on internet. The CB group receive a training program of similar duration and intensity under direct supervision of a physical therapist. Physical fitness was assessed by peak VO2, training adherence by the number of training sessions and duration of training sessions. Results: Both HB (N=10) and CB (N=11) showed a significant improvement in peak VO2 and peak workload after 12 weeks (Table). There were no significant between-group differences for physical fitness and training adherence. Average training intensity of the HB group was 71% (± 3.7) of HRmax. Conclusions: This interim analysis shows that HB training has similar short term effects on physical fitness as CB training in CR patients. Table 1 CB Group n=11 HB group n=10 Total n=21 Baseline Age (years) 62 ± 9 61 ± 9 62 ± 8 Diagnosis (CABG/ACS) 4/7 2/8 6/15 Peak Workload (Watt) 171 ± 49 181 ± 66 176 ± 56 Peak VO2(mL.min-1.kg-1) 23.7 ± 1.8 23.9 ± 1.9 23.8 ± 1.3 12 weeks Peak Workload (Watt) 194 ± 68* 205 ± 74* 199 ± 69* Peak VO2(mL.min-1.kg-1) 26.8 ± 2.6* 28.1 ± 2.7* 27.4 ± 1.9* Sessions per week 1.7 ± 0.5 1.9 ± 0.7 1.8 ± 0.6 Minutes per session 60 ± 0 62 ± 17 61 ± 11 CB Group n=11 HB group n=10 Total n=21 Baseline Age (years) 62 ± 9 61 ± 9 62 ± 8 Diagnosis (CABG/ACS) 4/7 2/8 6/15 Peak Workload (Watt) 171 ± 49 181 ± 66 176 ± 56 Peak VO2(mL.min-1.kg-1) 23.7 ± 1.8 23.9 ± 1.9 23.8 ± 1.3 12 weeks Peak Workload (Watt) 194 ± 68* 205 ± 74* 199 ± 69* Peak VO2(mL.min-1.kg-1) 26.8 ± 2.6* 28.1 ± 2.7* 27.4 ± 1.9* Sessions per week 1.7 ± 0.5 1.9 ± 0.7 1.8 ± 0.6 Minutes per session 60 ± 0 62 ± 17 61 ± 11 * p<0.05, within group difference. Open in new tab Table 1 CB Group n=11 HB group n=10 Total n=21 Baseline Age (years) 62 ± 9 61 ± 9 62 ± 8 Diagnosis (CABG/ACS) 4/7 2/8 6/15 Peak Workload (Watt) 171 ± 49 181 ± 66 176 ± 56 Peak VO2(mL.min-1.kg-1) 23.7 ± 1.8 23.9 ± 1.9 23.8 ± 1.3 12 weeks Peak Workload (Watt) 194 ± 68* 205 ± 74* 199 ± 69* Peak VO2(mL.min-1.kg-1) 26.8 ± 2.6* 28.1 ± 2.7* 27.4 ± 1.9* Sessions per week 1.7 ± 0.5 1.9 ± 0.7 1.8 ± 0.6 Minutes per session 60 ± 0 62 ± 17 61 ± 11 CB Group n=11 HB group n=10 Total n=21 Baseline Age (years) 62 ± 9 61 ± 9 62 ± 8 Diagnosis (CABG/ACS) 4/7 2/8 6/15 Peak Workload (Watt) 171 ± 49 181 ± 66 176 ± 56 Peak VO2(mL.min-1.kg-1) 23.7 ± 1.8 23.9 ± 1.9 23.8 ± 1.3 12 weeks Peak Workload (Watt) 194 ± 68* 205 ± 74* 199 ± 69* Peak VO2(mL.min-1.kg-1) 26.8 ± 2.6* 28.1 ± 2.7* 27.4 ± 1.9* Sessions per week 1.7 ± 0.5 1.9 ± 0.7 1.8 ± 0.6 Minutes per session 60 ± 0 62 ± 17 61 ± 11 * p<0.05, within group difference. Open in new tab P704 Utilizing community fitness center for cardiac rehabilitation - the First trial in Japan Y Matsuo1, RF Funada1, NT Takama1, NK Koitabashi1, MK Kurabayashi1, KS Shirakura2 1Gunma University School of Medicine, Department of Cardiovascular Medicine, Maebashi, Japan 2Gunma University Graduate School of Medicine, Maebashi, Japan Topic: Exercise/Exercise training (Rehabilitation & Implementation) Purpose: Cardiac rehabilitation is definite evidence-based treatment and physical training has numerous beneficial effects on cardiovascular disease (CVD) management. In current Japanese insurance system, the government covers 150 days of cardiac rehabilitation. But after this certain period, patient should keep physical training by themselves. Continuation rate of home based training is very low. Therefore we first investigated non-hospital based phase III cardiac rehabilitation using fitness center in Japan. In this way, we aim to improve long-term continuation rate of physical training, safety and effectiveness. In addition, we aim to compare costs of this strategy with hospital based cardiac rehabilitation. Methods: This randomized controlled trial compares 12-week fitness center based training program (10 patients) and control group (10 patients) who already finished 150 days of hospital based training program. Fitness center group continued exercise program at GUNZE-sports (Maebashi, Japan) or CURVES (Maebashi, Japan). Control group had just a recommendation of exercise training continuation at home. Results: Fitness center group achieved novel rate of exercise continuation. In contrast, control group had only 30% of continuation rate of the training. Also, in physical examination by CPX showed significantly decreased exercise capacities in control group. In addition there was marked decrease in medical cost in fitness-center group compared to hospital based phase. We had no cardiac event nor hospitalized patient during the study. Conclusions: Fiteness-center based exercise training in CVD patients with certain medical check is safe. This study will increase insight in long-term effectiveness and costs of fitness center based cardiac rehabilitation in Japan. This method is in line with the trend to shift non-hospital based healthcare services towards patients self care environments. P705 Impact of training methods and patient characteristics on exercise capacity during inpatient cardiac rehabilitation H Voeller1, A Salzwedel2, R Reibis1, S Kaminski1, H Buhlert1, K Wegscheider3 1Klinik am See, Ruedersdorf, Germany 2University of Potsdam - University Outpatient Clinic, Institute of Sports Medicine, Potsdam, Germany 3University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany Topic: Exercise/Exercise training (Rehabilitation & Implementation) Purpose: Exercise training is a core component of Cardiac Rehabilitation (CR). We aimed to identify factors associated with increase of training volume (TV) and fitness during CR. Methods: We analyzed sociodemographic and clinical data from a prospective registry of 557 patients (mean age 51.7±6.9 years, 87.9% men), who were referred to inpatient CR between 06/2009 to 12/2011, predominantly after PCI (62.5%), CABG (16.2%) and heart valve replacement (9.5%). At admission, patients underwent a bicycle exercise stress test to determine exercise intensity. TV as a product of exercise intensity (Watt) and time (min) was collected at admission and end of CR. Cardiopulmonary exercise testing (CPX) was performed at discharge for defining fitness according to VO2peak. Results: Training frequency was 11.3±2.7/3 weeks and intensity 90.7±9.7% of maximum heart rate (81% continuous, 19% interval training, 64% additional strength training). Increase of TV by an average of 784.3± 623.4 Watts x min was significantly associated with smoking, blue or white collar work, and exercise capacity at entry of CR (Figure). Fitness at the end of CR was influenced by age, gender, exercise capacity at entry, training method, and indication for CR. Conclusions: Patients were trained with high intensity and most of them reached a considerable increase of their training volume. Because fitness at the end of CR was influenced by age, exercise capacity at admission and increase of TV during CK, especially patients from the age of 50 should continue training in aftercare programs to preserve work ability. Open in new tabDownload slide Parameters of training volume increase P706 Skeletal muscle oxygen saturation improves after high intensity interval training in patients with chronic heart failure V M Niemeijer1, R F Spee1, P F F Wijn2, H M C Kemps1 1Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands 2Maxima Medical Centre, Department of Medical Physics, Veldhoven, Netherlands Topic: Exercise/Exercise training (Rehabilitation & Implementation) Purpose: Oxygen availability in skeletal muscle can be decreased in chronic disease. This is especially true for severe chronic heart failure (CHF) due to derangements in the cardiovascular system. Low oxygen stores are detrimental to skeletal muscle functioning and thus exercise capacity. We sought to determine the effect of high intensity interval training (HIT) on skeletal muscle oxygen saturation determined by Near Infrared Spectroscopy (NIRS) in CHF patients. Methods: Eleven stable CHF patients (NYHA II-III) were included in a randomized semi-crossover study. Five subjects performed a twelve-week high intensity interval program on a stationary bicycle with three sessions per week with four bouts of four minutes at 85-95% of peakVO2 separated by three minutes of active recovery. Six subjects served as controls for twelve weeks, four of them subsequently also performed the exercise program; training results of these subjects were pooled with the intervention group. At baseline, and after the control/training periods subjects performed a symptom limited exercise test with gas analysis preceded by two minutes of rest. Tissue Saturation Index (TSI) was assessed simultaneously during the baseline resting period by means of a portable Spatially Resolved Spectroscopy (SRS) NIRS device at the vastus lateralis muscle. Results: Baseline values of peak oxygen uptake did not differ between groups (control 17.9 ± 5.2 versus HIT 18.0 ± 5.0 ml/min/kg, p=0.89) nor did values for resting TSI (control 67.0 ± 3.9 versus HIT 66.5 ± 5.0 %, p=0.82). Peak oxygen uptake improved in the HIT group (within group difference p=0.09), while there was little change in the control group (+2,5 ± 3.8 versus +0.1 ± 4.3 ml/min/kg, between group ns). The improvement in exercise capacity with HIT was associated with an average rise in baseline TSI values of 3,4 % (± 4.9), while an average reduction of 1,2 % (± 3.4) occurred in the control group (between group p=0.04). Furthermore, an increasing TSI baseline was associated with a rise in peakVO2 (Spearman s rho: 0,496, p=0.06). Conclusions: The present study shows that high intensity exercise training improves resting oxygen saturation in skeletal muscle in CHF patients. This finding may be highly relevant for the ability to perform repetitive daily physical activities, since a larger skeletal muscle oxygen pool enables higher oxygen extraction and thus a decrease in oxygen deficit at onset of submaximal exercise. Future research is needed to confirm this hypothesis. P707 Benefits of in -hospital cardiac rehabilitation program following cardiac surgery: Exercise training and supervised mobilization I Burazor1, M Lazovic1 1Cardiology department, Institute for rehabilitation, Belgrade, Serbia Topic: Other Heart Disease (Rehabilitation & Implementation) Background: In many cases, recovery time after open heart surgery may span six to eight weeks. Because each case is different, once should adhere to the specific guidelines provided by surgeon and cardiologist. While bed rest is important, it is equally important to perform low level activity during the recovery phase. The aim of this study was to evaluate the exercise training and mobilization following cardiac surgery during our in hospital cardiac rehabilitation program. Patients and Methods: Out of 1500 patients who were admitted to our three weeks in- hospital rehabilitation program, we analyze a total of 105 patients who were admitted early after cardiac surgery (4 to 12 postoperative days). The majority of patients were males (67%). The oldest patient was 82 years of age. We noted postoperative complications (pericardial effusion, pleural effusion, pseudo membranous colitis). Patients were selected for exercise training such as free walking and crossing over Nyllin steps as soon as the surgical suture was removed. Results: The main rationale of cardiac rehabilitation treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to two treatment sessions were given by a physiotherapist. During weekends, therapy was given on Saturdays. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered rehabilitation necessary after cardiac surgery. In 10% pericardial effusion was detected and only one patient was send to see the surgeon for pericardiocentesis. Silent ischemia was registrated by telemetry in 12% while crossing over Nyllin steps. All patients fulfilled cardiac rehabilitation program. Six minutes walking test was performed and the total distance walked ranged from 230 to 360 meters. Conclusions: Benefits of in-hospital cardiac rehabilitation program following cardiac surgery are of great importance and improve the well being and the quality of life. Practical activities such as walking, even at a slow pace, are important for staving off the negative effects of both the surgery and bed rest (i.e., muscle atrophy, muscle and joint stiffness, loss of balance and coordination). P708 Myocardial performance in breast cancer survivors athletes L Stefani1, I Corsani1, V Di Tante1, G Innocenti1, G Galanti1 1University of Florence, Florence, Italy Topic: Exercise/Exercise training (Rehabilitation & Implementation) Background: The upper limbs edema in breast cancer survivors is a frequent side effect, often controlled with sport activity as Dragon Boat. Few information are available on the cardiovascular performance when this sport is regularly practiced. The study aims to evaluate in a group of survivors breast cancer women (BC), the effects of Dragon Boat sport on the myocardial performance during 4 years of follow up. Methods :Since 2006 to 2010, one year after the diagnosis of breast cancer, a group of 55 women, previously treated with adijuvant therapy without evidence of metastasis, has been consecutively enrolled in a Dragon Boat competitive team. They were yearly submitted to an ergometric test, and to an 2D echocardiographic exam (MayLab 50 -ESAOTE) to evaluate the hemodynamic, morphological and functional cardiac parameters. All data have been matched with a group of 36 healthy women (HW) Results: Both groups have maintained a normal systolic function during all the period, despite the CMi and BMI and EF values were higher in HW. At the onset of the study, the diastolic function of the BC group turns out to be compatible with an initial diastolic dysfunction, if compared with the HW group. After 4 years of sport Dragon Boat activity, the diastolic parameters resulted to be improved in both, but specially in BC group (A peak: from 68.5±15.1 cm/sec to 50±14.1 cm/sec with p<0.05 ; E : from 9.3±2 cm/sec to 11.89±1.7 cm/sc with p<0.001). The data obtained from the ergometric test showed in both normal values despite in HW group, the data were significantly higher than in BC (Double Product 23870±3190 in HW vs BC 22785.8±276 with p<0.005) Conclusions: The results obtained demonstrate significant improvement of the diastolic function in BC survivors after four years of Dragon Boat sport training with an excellent effort's tolerance. Competitive sport activity, does not seem to have any negative impact on the myocardial performance in patients previously treated with chemotherapy. P710 Upper limits and clinical correlates of blood pressure response to exercise in Olympic athletes S Caselli1, B Di Giacinto1, R Assorgi1, F Quattrini1, R Ciardo1, F Di Paolo1, C Pisicchio1, A Spataro1, A Pelliccia1 1Institute of Sport Medicine and Science, CONI, Rome, Italy Topic: Hypertension (Sports Cardiology) Purpose: to define the upper limits of blood pressure response in elite athletes and describe clinical and morphologic characteristics of those with higher values. Methods: 1140 athletes, divided according to type of sport (skill, power, mixed and endurance) underwent cardiac evaluation, with echocardiography and maximal bicycle exercise test before 2008 and/or 2012 Olympic Games. Results: Peak Systolic and Diastolic Blood Pressure (SBP and DBP) were 190±21 mmHg and 76±7 mmHg respectively and the 95th percentile 220 and 85 mmHg respectively; 102 athletes (9%) had either SBP and/or DBP above the 95th percentile. Clinical and echocardiographic characteristics of these are shown in table; they were predominantly male, while no differences were detected among type of sport. Stepwise regression analysis showed that: peak SBP was explained by maximum workload (R2=0.34, p<0.001) with basal SBP, left ventricular wall thickness and body surface area (BSA) showing lower additional value (R2=0.47, p<0.001). Peak DBP was explained by basal DBP (R2=0.20; p<0.001) with a lower additional value for age, BSA and maximum workload (R2=0.27; p<0.001). Conclusions: the present study provides specific upper limits for SBP and DBP that could be implemented in athletes' evaluation to identify hypertensive individuals. Normal exercise BP High exercise BP p value Age (years) 26 ± 6 28 ± 6 0.001 Gender (male, %) 631 (61%) 93 (91%) <0.001 BSA (m2) 1.9 ± 0.2 2.1 ± 0.2 <0.001 Basal SBP (mmHg) 116 ± 10 127 ± 11 <0.001 Basal DBP (mmHg) 75 ± 6 80 ± 7 < 0.001 Max Heart Rate (bpm) 166 ± 11 165 ± 11 0.205 Max workload (Watts) 245 ± 60 286 ± 58 <0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.5 ± 1.2 <0.001 LV diameter (mm) 53 ± 5 56 ± 4 <0.001 EF (%) 64 ± 5 64 ± 6 0.943 LA diameter (mm) 35 ± 4 37 ± 4 <0.001 Aortic root (mm) 30 ± 4 33 ± 3 <0.001 E/A 1.9 ± 0.5 1.8 ± 0.4 0.089 Normal exercise BP High exercise BP p value Age (years) 26 ± 6 28 ± 6 0.001 Gender (male, %) 631 (61%) 93 (91%) <0.001 BSA (m2) 1.9 ± 0.2 2.1 ± 0.2 <0.001 Basal SBP (mmHg) 116 ± 10 127 ± 11 <0.001 Basal DBP (mmHg) 75 ± 6 80 ± 7 < 0.001 Max Heart Rate (bpm) 166 ± 11 165 ± 11 0.205 Max workload (Watts) 245 ± 60 286 ± 58 <0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.5 ± 1.2 <0.001 LV diameter (mm) 53 ± 5 56 ± 4 <0.001 EF (%) 64 ± 5 64 ± 6 0.943 LA diameter (mm) 35 ± 4 37 ± 4 <0.001 Aortic root (mm) 30 ± 4 33 ± 3 <0.001 E/A 1.9 ± 0.5 1.8 ± 0.4 0.089 Open in new tab Normal exercise BP High exercise BP p value Age (years) 26 ± 6 28 ± 6 0.001 Gender (male, %) 631 (61%) 93 (91%) <0.001 BSA (m2) 1.9 ± 0.2 2.1 ± 0.2 <0.001 Basal SBP (mmHg) 116 ± 10 127 ± 11 <0.001 Basal DBP (mmHg) 75 ± 6 80 ± 7 < 0.001 Max Heart Rate (bpm) 166 ± 11 165 ± 11 0.205 Max workload (Watts) 245 ± 60 286 ± 58 <0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.5 ± 1.2 <0.001 LV diameter (mm) 53 ± 5 56 ± 4 <0.001 EF (%) 64 ± 5 64 ± 6 0.943 LA diameter (mm) 35 ± 4 37 ± 4 <0.001 Aortic root (mm) 30 ± 4 33 ± 3 <0.001 E/A 1.9 ± 0.5 1.8 ± 0.4 0.089 Normal exercise BP High exercise BP p value Age (years) 26 ± 6 28 ± 6 0.001 Gender (male, %) 631 (61%) 93 (91%) <0.001 BSA (m2) 1.9 ± 0.2 2.1 ± 0.2 <0.001 Basal SBP (mmHg) 116 ± 10 127 ± 11 <0.001 Basal DBP (mmHg) 75 ± 6 80 ± 7 < 0.001 Max Heart Rate (bpm) 166 ± 11 165 ± 11 0.205 Max workload (Watts) 245 ± 60 286 ± 58 <0.001 LV Wall thickness (mm) 9.6 ± 1.2 10.5 ± 1.2 <0.001 LV diameter (mm) 53 ± 5 56 ± 4 <0.001 EF (%) 64 ± 5 64 ± 6 0.943 LA diameter (mm) 35 ± 4 37 ± 4 <0.001 Aortic root (mm) 30 ± 4 33 ± 3 <0.001 E/A 1.9 ± 0.5 1.8 ± 0.4 0.089 Open in new tab P711 Correlation between blood pressure and left ventricular mass in elite professional male athletes M Zdravkovic1, S Mazic2, T Acimovic2, M Djelic2, M Antic3, I Nedeljkovic4, M Dekleva5 1University Hospital Center Bezanijska Kosa, Belgrade, Serbia 2University of Belgrade, School of Medicine, Institute of Medical Physiology, Belgrade, Serbia 3Institute of Sport, Belgrade, Serbia 4Institute for Cardiovascular Diseases, Belgrade, Serbia 5University Clinical Center Zvezdara, Department of Cardiology, Belgrade, Serbia Topic: Hypertension (Sports Cardiology) Introduction: Exeggarated blood pressure (BP) response during exrcise is associated with increased risk of worsening hypertension in normotensives, as well as in athletes with high normal blood pressure. To date, conflicting data have been reported concerning the nature (physiologic versus pathologic) of left ventricular hypertrophy (LVH). Objectives: The aim of the study was to evaluate the influence of the rest and maximal exercise BP values to the LVH in professional athletes. Methods: A total of 585 men professional athletes from a variety of sports were examined. BP levels were divided according to the ESH/ESC giudelines in 4 groups (gruop I- optimal: <120/80, group II – normal: 120/80-129/84, group III – high normal: 130/85-139/89 and group IV - hypertension: >140/90 mm Hg). Maximal exercise and recovery characteristics were obtained during a graded treadmill test until exhaustion: maximal oxygen uptake (VO2 max), heart rate (HRmax) and blood presure (TA max). Standard echoacrdiographic measurements were obtained and left ventricular mass index (LVMI) was calculated according to the recommendations. Results: The players mean age was 21,5 years (13-58), rest heart rate 62 ± 10 bpm, and mean rest BP 115/73 ± 10/8 mmHg. 462 (79,2%) athletes had optimal blood presure, 83 (14,2%) had normal BP, while groups III and IV counted 32 (5,5%) and 6 (1%) athletes respectively. No significant corrrelations between LVMI and rest values of BP were detected. However, significant correlations were described between LVMI and maximal diastolic BP (p=0.047), systolic BP after the first minute in maximal exercise (p=0.04), diastolic BP after the first minute in maximal exercise (p=0.009) and diastolic BP after the third minute in maximal exercise (p=0.041). Conclusions: Rest BP does not influence LVMI in normotensive athletes. However, athletes with normal and high normal BP have significantly higher BP values after exercise and they are strongly linked to the elevated LVMI. P712 The ventilatory inefficiency coefficient is a reproducible and feasible exercise parameter in chronic heart failure M Nicolaije1, VM Niemeijer1, RF Spee1, HMC Kemps1 1Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands Topic: Heart Failure (Sports Cardiology) Ventilatory inefficiency coefficient is a reproducible and feasible exercise parameter in the CHF population Purpose: The response of ventilation and oxygen uptake to increasing workload is determined by pulmonary, cardiovascular and skeletal muscle properties. Current tests such as the oxygen uptake efficiency slope (OUES) and VE-vs-VCO2-slope are influenced by the ventilatory anaerobic threshold (VAT) in such a way that validity of the parameter is lower with less than maximal effort during incremental exercise. In this study we aim to demonstrate that the ventilatory inefficiency coefficient (VIC), representing the slope of the relation between minute ventilation (VE) and oxygen uptake (VO2) during changes in workload below the ventilatory anaerobic threshold (VAT), is a reproducible and feasible exercise parameter in the chronic heart failure (CHF) population that reflects the integrated physiological adaptation to changes in workload, is sensitive to interventions that influence this adaptation (i.e. exercise training) and discriminates between health and disease (i.e. CHF). Methods: A randomised prospective observational study with combined prospective intervention trial is currently undergoing in a Dutch clinical hospital. It will include seventy patients with stable systolic CHF (left ventricular ejection fraction = 40%) and twenty age- and BMI-matched healthy control subjects who are able and motivated to perform cycling exercise. Forty patients with CHF will perform submaximal exercise test on two separate days for purposes of reproducibility. Healthy subjects will perform one submaximal exercise test only. Additionally, thirty CHF patients will perform a twelve week exercise training program. Results: So far fifty CHF patients and twenty healthy subjects have participated in cycling exercises. The mean VO2 / VE for patients with CHF was 0.0385 with a standard deviation of 0.0091, where healthy subjects show a mean VO2 / VE of 0.0435 with a standard deviation of 0.0056 (p=0.0192). Conclusions: With not yet completed results there is already a significant difference in VO2 / VE between patients with CHF and healthy subjects, indicating that the test can show a difference between health and disease. Pending on the final results of this stage we will continue with further study into sensitivity to intervention. P713 Gender differences of the autonomic nervous system in endurance athletes: A study in elite Norwegian, Russian and Swiss cross-country skiers D Schaefer1, L Trachsel1, F Schaufelberger1, GF Gjerdalen2, EE Solberg3, M Khokhlova4, V Badtieva4, T Radtke1, H Saner1, M Wilhelm1 1University Hospital of Bern, University Clinic for Cardiology, Bern, Switzerland 2Oslo University Hospital, Department of Vascular Investigations, Oslo, Norway 3Diakonhjemmet Hospital, Oslo, Norway 4Moscow University, Department of Public Health, Moscow, Russian Federation Topic: Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: Sudden cardiac deaths in sports occur with a striking male predominance. A high vagal tone may prevent exercise induced ventricular arrhythmias. We hypothesized that the female autonomic nervous system is cardioprotective. Methods: We performed a longitudinal study in female (n=21) and male (n=17) elite cross-country skiers from Norway (n=18), Russia (n=4) and Switzerland (n=16) during their summer training. Markers of the autonomic nervous system were assessed by weekly measures of heart rate variability with a training computer (Polar RS800CX). In the morning on a day that follows a low-intensity training, four minutes segments were recorded in supine position and after an orthostatic load with controlled breathing and analyzed with an autoregressive spectrum. Two spectral components were distinguished: High frequency (HF) power in absolute (ms2) and normalized units (n.u.), and low frequency (LF) power in n.u. Training was recorded daily and average weekly training load and training strain were calculated using the method of Foster et al. (J Strenght Cond Res 2001). Two training periods were distinguished: preparation period 1 (PP1) from week 19-31 and preparation period 2 (PP2) from week 32-44. An average of weekly measures was calculated for each training period. Primary endpoint was the LF/HF power ratio after an orthostatic load as a surrogate of the sympathovagal balance. Results: Mean age was 25 ± 4 years in female and 23 ± 4 years in male athletes. No significant gender differences were observed for average weekly training load (mean ± standard deviation 442 ± 135 and 528 ± 195 for PP1 and 452 ± 139 vs. 518 ± 186 for PP2) or training strain (5466 ± 1745 vs. 6089 ± 2713 in PP1 and 5508 ± 2031 vs. 6947 ± 3953 in PP2). Compared to male athletes, female athletes showed significant lower LF/HF power ratios in both training periods [median (IQR) 6.7 (7.8) vs. 14.8 (14.6); p=0.036 for PP1 and 7.7 (7.3) vs. 15.4 (14.6); p=0.044 for PP2]. In female athletes, HF power (n.u.) was significantly higher in PP2, and showed a non-significant trend in PP1 (66.0 ± 11.9 vs. 57.3 ± 11.5; p=0.073 for PP1 and 67.0 ± 12.5 vs. 54.0 ± 9.0; p=0.009 for PP2). No gender differences were observed for HF power in absolute units (ms2). Conclusions: For a comparable amount of training and in different training periods, female athletes exhibited lower markers of sympathetic and higher markers of vagal activity. The autonomic nervous system may explain part of the gender differences of sports-related sudden cardiac deaths. P714 sports-related sudden death in Germany - preliminary data from a nation-wide registry P Bohm1, T Meyer1 1Department for Sports Medicine and Prevention, Saarbr?, Germany Topic: Rhythm Disorders/Sudden death (Sports Cardiology) Purpose: Despite recent scientific interest the prevention of sports-related sudden death (SRSD) remains an imminent issue. Past estimates of SRSD incidence vary widely and in terms of aetiology there seem to be differences between various countries. This indicates a need for prospective national registries. Methods: In May 2012, under the auspices of the German Society of Cardiology, a prospective registry on SRSD was established to examine the incidence and etiology of SRSD in Germany. It is a web-based database to record SRSD cases. Reporting of cases is possible for observers such as relatives, other athletes, coaches and journalists as well as for medical doctors. We simultaneously started a cooperation with 15 regional institutes of forensic medicine in Germany. To maximize case detection, we used systematic web-based media monitoring via Press-Monitoring-Screening (PMG), the largest German-speaking press database, on a weekly basis. SRSD was defined as death occurring during sports activity or up to 1 hour after its cessation, independent of successful resuscitation. We included subjects regardless of competition level. Results: After 16 months of observation, a total of 59 SRSDs was recorded; of these 14 were reported to the online database and 45 were found via press screening. Apart from one exception all cases occurred in men. The mean age of the SRSD subjects was 46.4 years (range: 15 to 79 years). SRSDs occurred in 86.5% during sports activity and in 13.5% within 1 hour after cessation of sports activity. 98.3% of SRSD cases occurred during leisure time activites (45.8%) or competition sports below the elite level (52.5%). Most SRSDs were observed during soccer (28.8%), running (22.0%) or swimming (10.1%). Among the cases in which it was possible to ascertain the cause of death with clinical certainty or from forensic investigations (n = 16), causes were of cardiovascular origin in all but 2 cases (87.5%). Myocardial infarction was the main cardiac finding (56.3%, average age 42.7 years), followed by myocarditis (31.3%, average age 23.6 years). No cardiomyopathies were observed. Conclusions: In Germany, a significant proportion of SRSDs occurs during leisure time activities or competitive sports without elite character. Team sports like soccer or endurance sports like long-distance running place the athletes at highest risk of sudden death. Gender seems to be a highly relevant risk factor. In the majority of cases the cause of SRSD was of cardiovascular origin. The distribution of the different cardiac diseases seems to vary within European countries. P715 Dynamic changes in left atrial reservoir, conduit, and active volumes in top-level athletes during the season F D'ascenzi1, A Pelliccia2, BM Natali1, M Cameli1, M Lisi1, M Focardi1, D Corrado3, M Bonifazi4, S Mondillo1 1University of Siena, Department of Cardiovascular Diseases, Siena, Italy 2Institute of Sport Medicine and Science, CONI, Rome, Italy 3University Hospital of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy 4University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy Topic: Exercise/ Exercise training (Sports Cardiology) Purpose: Left atrial (LA) enlargement is a component of athlete s heart. However, LA total and phasic volumes have not been yet investigated and longitudinal data collected within the season are not available. We sought to investigate whether differences in LA reservoir, conduit, and active volumes exist between athletes and controls and whether they vary with training. Methods: Twenty-six top-level athletes and 23 controls were enrolled. In athletes, LA volumes were measured at pre-, mid-, end-season, and post-detraining time point. Results: Maximum, minimum, and pre-P LA volumes were greater in athletes than in controls (p<.0001, see figure). Total emptying and passive emptying volumes were higher in athletes (p<.05) while active emptying volume was comparable between athletes and controls (see figure). During the season, maximum, minimum, and pre-P volumes (p<.0001), LA total (p<.005) and passive (p<.05) emptying volumes increased while LA active emptying did not vary. E/e ratio did not change. After detraining, no differences were observed between pre-season and post-detraining data. Mid-season and end-season left ventricular (LV) mass indexes (B=0.55, p<.05; B=0.74, p<.005) were independent predictors of mid-season and end-season maximum volumes. ? LV stroke volume was independent predictor of ? minimum LA volume (B=0.65, p<.05). Conclusion. The left atrium of top-level athletes exhibits a peculiar mechanical function, with higher reservoir and conduit volumes as compared with controls. Furthermore, maximum, minimum, pre-P, and phasic LA volumes did change during the season. Exercise-induced LA adaptation is accompanied by LV remodeling and regresses after detraining, suggesting a physiological adaptation to intensive training. Open in new tabDownload slide Left atrial phasic volumes:athl vs contr P716 Prevalence and clinical significance of inferior T-wave inversions in competitive athletes H Dores1, A Malhotra2, N Sheikh2, H Dhutia2, L Millar2, A Merghani2, RC Narain2, M Papadakis2, S Sharma2 1St George's University of London, Cardiac and Vascular Sciences Research Centre/Hospital Santa Cruz, Lisbon, Portugal 2St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom Topic: Exercise/ Exercise training (Sports Cardiology) Background: A considerable proportion of athletes exhibit T-wave inversions on their 12-lead ECG triggering further evaluation after pre-participation screening. Although T-wave inversions in the lateral leads have been associated with underlying cardiomyopathy, the significance of inferior T-wave inversions is less well established. The aim of this study was to investigate the prevalence and significance of T-wave inversions in the inferior leads in competitive athletes. Methods: This study included 3423 athletes aged between 14 and 35 years old (72.1% male; 90.2% Caucasian), who underwent pre-participation ECG screening. T-wave inversions were considered significant if present in two contiguous leads and were reported by ECG region, with emphasis placed in the inferior leads II, III and aVF. Results: T-wave inversions in at least one of the inferior leads were present in 869 (25.4%) athletes, with the majority (n=813; 94%) involving lead III in isolation. Of the 56 (1.6%) athletes with T-wave inversions in two inferior leads, the majority (n=41) did not have additional ECG anomalies. Only 5 had deep (>2mm) T-wave-inversions. Multivariate analysis did not demonstrate any significant association between any of the demographic parameters or type and intensity of sport with the presence of inferior T-wave inversions. Further evaluation identified one case of hypertrophic cardiomyopathy in an athlete with additional ECG anomalies. Conclusions: Inferior T-wave inversions in athletes are relatively rare. Although in our cohort isolated T-wave inversions in the inferior leads were not associated with the presence of pathology, further longitudinal data are required to establish their exact significance. Open in new tabDownload slide P717 Correlation between resting heart rate and early left ventricular remodeling in preadolescent athletes M Zdravkovic1, S Mazic2, S Prijic3, V Vukomanovic3, S Krotin1, S Dimkovic1, G Koracevic4, D Lovic5, S Radovanovic6, J Saric6 1University Hospital Medical Center Bezanijska Kosa, University of Belgrade, School of Medicine, Belgrade, Serbia 2University of Belgrade, School of Medicine, Institute of Medical Physiology, Belgrade, Serbia 3Institute for Mother and Child Healtcare, Belgrade, Serbia 4Clinical Center, Clinic for Cardiology, Nis, Serbia 5Clinic for internal medicine Intermedica, Nis, Serbia 6University Hospital Center Bezanijska Kosa, Belgrade, Serbia Topic: Exercise/ Exercise training (Sports Cardiology) Purpose: Regular intensive physical training is connected to increased vagal tonus, leading to diminished heart rate in professional athletes. Considering the lacking data, he aim of the study was to evaluate correlation of the rest heart rate and early left ventricle remodeling in preadolescent professional footballers. Methods: 94 teenage footballers were screened by ECG at rest and echocardiography at a tertiary referral cardio sport centre. They were from national professional football league (at least 7 training hours/week). Control group consisted of 47 age-matched healthy volunteers with sedentary life style (less than 2 training hours/week). All athletes and volunteers from control group had no symptoms, none of them had syncope and physical findings were normal. All the echocardiographic findings were adjusted to BSA(-0.5), while left ventricle mass (LVM) was additionally adjusted to BSA(-1.5). Echocardiographic reference ranges were defined as values of 5-95th centile according to the mean values in both groups. The proportions of the footballers with LV dimensions outside expected ranges were additionally noted.Heart rate frequency and its correlation with echocardiographic parameters (aorta – AO, enddyastolic-EDDLV, endsystolic dimension-ESDLV, left atrial dimension-LA, ejection fraction -EF, fraction of shortening - FS and left ventricle wall thickness, left ventricle mass –LVM and left ventricle mass index -LVMI) was compared in these two groups. Results: None of the players and participants had bradicardia. However, resting heart rate as well as ECG –monitored heart rate before exercise testing were significantly higher in the group of footballers (72/min vs. 90/min, p<0.001 and 83/min vs. 89/min, p<0.001). The data indicate significant increases in absolute values of LV dimensions, aortic root size and left atrium (p<0.001) in preadolescent professional footballers compared with the values expected for age-matched controls, whereas there are no differences in absolute values of ventricular septal and posterior wall thickness, LV wall thickness and LVM (p>0.05). Upon body-size adjustments, significant increases were observed in all echocardiographic parameters (p<0.001). There was a strong correlation between heart rate and all echocardiographic parameters, except left ventricular wall thickness. Our data indicate that rest heart rate is a strong predictor of early cardiac remodeling, already apparent in preadolescence, even after a short period of training P718 Is there an association between different morphological BAV patterns and LV dimensions in athletes from different kinds of sports ? L Stefani1, G Innocenti1, R Mercuri1, G Galanti1 1University of Florence, Florence, Italy Topic: Exercise/ Exercise training (Sports Cardiology) Purpose: BAV is a common congenital cardiac disease. It is normally represented in two different morphologies: "typical (raphe) or atypical(no- raphe) ". It has been demonstrated as specially in regularly trained athletes, BAV can be associated to a progressive enlargement of the LV chamber. The exact prevalence of the two BAV patterns in athletes and the possible association with the increase of the LV dimensions in them, is not yet investigated. The study aims to verify in a large group of BAV athletes from different kinds of sports, and mild valve dysfunction, the prevalence of the two main morphological BAV patterns and the eventual association with the LV dimensions. Methods: from 2000 to 2011, a group of 292 BAV subjects, (athletes, sedentary and ex- athletes), were investigated. All they were submitted to an 2D echo exam (MayLab 50 -ESAOTE) to classify the BAV morphology and to measure the standard LV sisto-diastolic parameters (LV diameters, wall thickness and CMI). T Student Test and ANOVA test were used to compare the data with a significance at P<.005 Results: The typical BAV was more represented in all the groups (68%,67%,63%) than atypical. Within the typical BAV pattern the form due to the fusion of the right cusp with the left one, was more common (70%,73%,62%) in all the groups. In athletes only, typical BAV was found in 51% of soccer players, in 10% of basketball players, in 8% of cyclists, 6% swimmers, and 15% rugby players. All the echo parameters didn t show any statistical differences with respect of the different morphological BAV patterns and also to the different kind of sports. Conclusions : The results are in agreement with the current literature and confirm the prevalence of BAV in athletes is similar to the general population. Despite the LV diameters found were at the upper limits of the normal range, however there are no significant differences for this aspect among the diverse BAV patterns associated P720 Active video games for physical activity promotion in obese youth: possibilities and risks B Boehm1, H Boehm2, R Oberhoffer1, CP Bauer3 1Technische Universität München, Institute of Preventive Pediatrics, Munich, Germany 2Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Aschau im Chiemgau, Germany 3Fachklinik Gaissach der Deutschen Rentenversicherung Bayern Süd, Gaissach, Bad Tölz, Germany Topic: Obesity (Exercice & Translational Science) Purpose: Physical inactivity among children and adolescents is a major contributor to diseases with obesity. Obese youth prefer sedentary lifestyles and it has been stated that high levels of screen time are contributory factors that promote sedentary lifestyles. Many attempts have been made to encourage people to be more physically active. New forms of interactive gaming (e.g. exergames of active video gaming) have emerged. The purpose of this study is to investigate an active video game and the possible impact on the cardiovascular and the musculoskeletal system in comparison to different walking speeds. The first hypothesis was that active video gaming caused higher cardiovascular intensity than walking and second, generates lower skeletal load than running in obese adolescents. Methods: Eight obese adolescents (4 females) age 15 ± 1 years, BMI 31.5 ± 5.4 kg/m2 volunteered to participate in the study. Participants played EyeToy Kinetic (Sony Corporation, Jpn), walked and ran, each for 10 min in randomized order. Heart frequency (HF) (Polar systems S 625) and biomechanical 3D movement analysis was measured for each situation. Knee load was calculated using inverse dynamics. Results: Cardiovascular load (HF) during gaming was moderate with 140 ± 9 beats/minute. The mean maximal HF increased to 159 ± 11 beats/min. The HF corresponds to the individual running speed of 7 ± 2 km/h. The knee joint load was 1.50 ± 30 % body weight higher during gaming than during running (1.30 ± 5 % body weight). Discussion: The cardiovascular intensity of the active game was moderate and effective, as it meets the current guidelines for physical activity intensities of the American College of Sport Medicine (ACSM, 2000). Therefore, the first hypothesis is true, however contrary to what was expected, the mechanical load on the knee joint during gaming was even higher than during running. In conclusion, active gaming is effective in terms of cardiovascular intensity however joint load was not reduced so that for obese population with high risk for knee arthrosis, active gaming in a standing position did not meet guidelines and should be played under supervision of sport scientists to guarantee optimal movement technique. P721 Restricted blood flow training - affordable method for cardiac rehabilitation Y Matsuo1, TN Nakjima2, KF Fukumura2, TY Yasuda2, YS Sato3, RF Funada1, TN Takama1, NK Koitabashi1, MS Kurabayashi1, KS Shirakura4 1Gunma University School of Medicine, Department of Cardiovascular Medicine, Maebashi, Japan 2The University of Tokyo, Graduate School of Medicine, Tokyo, Japan 3Kaatsu International University, Battaramulla, Sri Lanka 4Gunma University Graduate School of Medicine, Maebashi, Japan Topic: Psychosocial factors/Quality of life (Exercice & Translational Science) Purpose: Previous studies have shown restricted blood flow training (RBFT) is effective to increase muscle size and maintenance of atrial compliance in healthy subjects. However, there are no published data investigating chronic heart failure patients. Methods: Twenty chronic heart failure patients (aged 64-85) in the cardiac rehabilitation group were investigated. All patients had participated in standard cardiac rehabilitation consisted of aerobic and resistance training for >12-week prior to the study. Subjects in the control group continued their 30 minutes moderate intensity bicycle ergometer training (70% of highest measured heart rate, ie, peak heart rate), and 10 subjects had RBFT program. During the RBFT program, subjects wore a specially designed elastic pressure cuff (KAATSU Master, Sato Sports Plaza, Tokyo, Japan) around the most proximal portion of the both legs. The cuff pressure was set at 250 mmHg according to previous studies to provide blood flow restriction. Immediately after following training, the pressure cuff was removed. The amount of time under blood flow restriction was approximately 12-min and moderate intensity bicycle ergometer training (70% of peak heart rate) was done for 10-min. Both groups had their program twice per week for 12-week. Results: The physiological improvements measured by CPX or echocardiogram had no significant difference comparing both groups. Interestingly, quality of life measured with MacNew global score for quality of life in cardiovascular disease improved markedly in the RBFT group. Conclusions: We showed that 12-week RBFT improved exercise capacity as well as continuous aerobic training with less exercise duration without any medical-problem. In addition, RBFT achieved improvement in quality of life. This training could be another effective training method in chronic heart failure patients. P722 Effect of high intensity interval training on exercise haemodynamics in patients with chronic heart failure R Spee1, VM Niemeijer1, PFF Wijn2, PAF Doevendans3, HM Kemps1 1Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands 2Eindhoven University of Technology, Department of Applied Physics, Eindhoven, Netherlands 3University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands Topic: Heart Failure (Exercice & Translational Science) Background and Purpose: high intensity interval training (HIT) improves exercise capacity. Moreover in a landmark study with CHF patients, changes in resting haemodynamics (reverse remodelling) were shown after HIT. It is not known whether HIT also improves exercise haemodynamics. Yet, this provides direct insight in cardiac (dys)function during exercise. In particular, the Cardiac Reserve ((CR) peak minus baseline Cardiac Output) resembles the ability of the heart to increase CO during exercise and is a powerful marker of prognosis. We evaluated the effect of HIT on exercise haemodynamics in CHF patients. Methods: in a non randomised, pilot study setting, 15 CHF patients (NYHA II-III) underwent a 12 week HIT program, using a 4x4 protocol at 85-95% of peakVO2. All patients performed maximal cardiopulmonary exercise test (CPET) before and after HIT. Exercise haemodynamics were simultaneously determined, using a radial artery pulse contour analysis (LidCO, London, UK). Resting cardiac function and dimensions, before and after HIT, were analyzed using echocardiography or cMR. Results: all patients (13 male, 2 female) completed the HIT program without adverse events. Mean age was 64 (SD+/-9.5). Peak VO2 significantly increased after HIT (p=0.008). No significant changes were observed in resting haemodynamics. CR showed a trend towards significant increase. Change in VO2 was correlated with a significant change in CR (r=0.56, p=0.05). Conclusions: the results of this pilot study confirmed the increase in exercise capacity after HIT. This was associated with a change in cardiac reserve, suggesting that HIT has a positive effect on exercise haemodynamics in moderately impaired CHF patients. CPET and haemodynamic parameters n=15 Before HIT (+/- SD) After HIT (+/-SD) p value Peak Power (W) 140 (+/- 58) 158 (+/-65) 0.001 Peak Vo2 (ml/min/kg) 20(+/-6.4) 22.3(+/-7.5) 0.008 Peak CO (l/min) 11.7 (+/-8.9) 13.4 (+/-10.5) 0.24 CR (l/min) 7.7 (+/- 5.9) 10.2 (+/-7.1) 0.055 EF (%) 30.6(+/- 12.3) 31.2 (+/-12) 0.84 ESV (ml) 179(+/- 112) 182(+/-122) 0.68 EDV(ml) 231(+/-119) 236(+/-126) 0.58 n=15 Before HIT (+/- SD) After HIT (+/-SD) p value Peak Power (W) 140 (+/- 58) 158 (+/-65) 0.001 Peak Vo2 (ml/min/kg) 20(+/-6.4) 22.3(+/-7.5) 0.008 Peak CO (l/min) 11.7 (+/-8.9) 13.4 (+/-10.5) 0.24 CR (l/min) 7.7 (+/- 5.9) 10.2 (+/-7.1) 0.055 EF (%) 30.6(+/- 12.3) 31.2 (+/-12) 0.84 ESV (ml) 179(+/- 112) 182(+/-122) 0.68 EDV(ml) 231(+/-119) 236(+/-126) 0.58 VO2= oxygen consumption, CO= cardiac output, CR= cardiac reserve, EF= ejection fraction, ESV= endsystolic volume, EDV = enddiastolic volume Open in new tab CPET and haemodynamic parameters n=15 Before HIT (+/- SD) After HIT (+/-SD) p value Peak Power (W) 140 (+/- 58) 158 (+/-65) 0.001 Peak Vo2 (ml/min/kg) 20(+/-6.4) 22.3(+/-7.5) 0.008 Peak CO (l/min) 11.7 (+/-8.9) 13.4 (+/-10.5) 0.24 CR (l/min) 7.7 (+/- 5.9) 10.2 (+/-7.1) 0.055 EF (%) 30.6(+/- 12.3) 31.2 (+/-12) 0.84 ESV (ml) 179(+/- 112) 182(+/-122) 0.68 EDV(ml) 231(+/-119) 236(+/-126) 0.58 n=15 Before HIT (+/- SD) After HIT (+/-SD) p value Peak Power (W) 140 (+/- 58) 158 (+/-65) 0.001 Peak Vo2 (ml/min/kg) 20(+/-6.4) 22.3(+/-7.5) 0.008 Peak CO (l/min) 11.7 (+/-8.9) 13.4 (+/-10.5) 0.24 CR (l/min) 7.7 (+/- 5.9) 10.2 (+/-7.1) 0.055 EF (%) 30.6(+/- 12.3) 31.2 (+/-12) 0.84 ESV (ml) 179(+/- 112) 182(+/-122) 0.68 EDV(ml) 231(+/-119) 236(+/-126) 0.58 VO2= oxygen consumption, CO= cardiac output, CR= cardiac reserve, EF= ejection fraction, ESV= endsystolic volume, EDV = enddiastolic volume Open in new tab P723 Endothelial function as measured by peripheral arterial tonometry is not related to body composition, exercise capacity and insulin sensitivity in overweight patients with coronary artery disease A Jurs1, LR Pedersen1, RH Olsen1, SB Haugaard2, E Prescott1 1Bispebjerg Hospital of the Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark 2Amager Hospital, Department of Internal Medicine, Copenhagen, Denmark Topic: Vascular disease (Exercice & Translational Science) Background: Peripheral arterial tonometry (PAT) is marketed as an easy and operator independent non-invasive way to assess endothelial function, which is impaired in patients with noninsulin-dependent diabetes mellitus, obesity and coronary artery disease (CAD) and can be improved by exercise. We wished to determine if endothelial function as measured by PAT was correlated to measures of body composition, exercise capacity and insulin sensitivity in overweight patients with CAD. Methods: 70 overweight patients with CAD diagnosed minimum 6 months prior to inclusion and BMI 28-40 kg/m2 were recruited. Endothelial function was measured by PAT resulting in a reactive hyperaemia index (RHI). Participants underwent an oral glucose tolerance test (OGTT), a cardiopulmonary exercise test and whole body dual-energy X-ray absorptiometry (DXA). Results: Median RHI was 1.95 (IQR 1.68-2.32) and n=15 (21%) had an abnormal RHI (RHI<1.67). RHI was not correlated to age and no difference in RHI was found between genders. Further univariate correlations are presented in table 1. No between-group differences were found between abnormal RHI versus normal RHI considering the same parameters as listed in table 1. Conclusions: In a study population with known cardiovascular disease and expected endothelial dysfunction n=15 (21%) had an abnormal RHI. RHI was not correlated with body composition, exercise capacity and insulin sensitivity, which are normally associated with endothelial function. This suggests PAT measurements to be physiological different from conventional methods of evaluating endothelial function. P724 Heart rate response after the onset of exercise is associated with arrhythmic events in ARVC patients S Castelletti1, B Mist1, S Jenkins1, P Syrris2, WJ Mckenna1, A Pantazis1 1The Heart Hospital, University College London, Inherited Cardiac Diseases Unit, London, United Kingdom 2University College London, Institute of Cardiovascular Science, London, United Kingdom Topic: Rhythm Disorders/Sudden death (Exercice & Translational Science) Background and Aim: Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is an inherited cardiomyopathy associated with an increased risk of life threatening arrhythmia or heart failure. The diagnosis is based on ECG features, clinical and family history, tissue characterization. Few studies have been published about the value of the exercise test in ARVC. The increase of HR after the onset exercise as well as the HR recovery after termination of exercise are well known markers of the autonomic system. It has already been demonstrated that vagal reflexes, assessed through the extent of HR reduction after exercise, are a marker for the risk stratification in other diseases. The aim of this study is to assess the HR response after the onset of exercise in patients who fulfill ARVC diagnostic criteria and its correlation with symptoms and genetic substrate. Methods: We studied 57 ARVC genotype-positive patients, some of them on and the rest off beta-blockers (bb), who underwent a cardiopulmonary test using an incremental bicycle protocol. Arrhythmic events are defined as: syncope, cardiac arrest, NSVT, VT, ICD events. During CPEX, increase of HR was calculated at the end of the first and second minute of exercise. These variables were dichotomized at the upper tertile of their distribution for association analysis. Genotype was provided from direct sequencing of the 5 principle desmosomal genes. Results: Symptomatic patients, both in the bb and off of bb groups, had a significant lower ?HR1min compared with the asymptomatic patients. In particular, among the 22 patients not in bb, 83% symptomatic had ?HR1min=9bpm vs 50% asymptomatic (p=0.0009). In the group in bb: 75% had ?HR1min=6bpm vs 43% of the asymptomatic group. Same results were obtained considering the ?HR2min: in the group not on bb, ?HR2min=22bpm was observed in 75% symptomatic patients vs 50% asymptomatic; in the group on bb, ?HR2min=18bpm was observed in 77% symptomatic compared with 57% asymptomatic patients. In the group not on bb, those with a lower ?HR1min had an higher prevalence of multiple desmosomal variants when compared with patients with an higher ?HR1min (47% vs 29%). This result was confirmed in the group in bb: 36% vs 18%. Conclusions: Patients with arrhythmic events have a lower HR response at the first and second minute of exercise. The lower increase of HR patients have a higher prevalence of multiple desmosomal variants, known factor of worst phenotypic expression. The ?HR1min and the ?HR2min reflect the level of basal vagal tone and may provide a simple tool for risk stratification in ARVC patients. Table 1: Univariate correlations Correlation between body composition and exercise capacity versus hyperaemia index (RHI) n=70 Correlation between insulin sensitivity and reactive hyperaemia index (RHI) n=70 r p-value r p-value Body mass index (BMI) -0.05 0.66 HbA1c (%) 0.11 0.37 Body fat mass (%) 0.08 0.47 Fasting glucose (FPG) (mmol/L) -0.07 0.58 Central-to-peripheral fat ratio -0.06 0.59 2h OGTT plasma glucose (mmol/L) 0.14 0.24 Waist/hip-ratio 0.002 0.99 Homeostasis model assessment of insulin resistance (HOMA-IR) 0.10 0.43 Exercise capacity (VO2peak) -0.03 0.81 Insulin sensitivity index (ISIcomposite, ad modem Matzuda) 0.03 0.82 Correlation between body composition and exercise capacity versus hyperaemia index (RHI) n=70 Correlation between insulin sensitivity and reactive hyperaemia index (RHI) n=70 r p-value r p-value Body mass index (BMI) -0.05 0.66 HbA1c (%) 0.11 0.37 Body fat mass (%) 0.08 0.47 Fasting glucose (FPG) (mmol/L) -0.07 0.58 Central-to-peripheral fat ratio -0.06 0.59 2h OGTT plasma glucose (mmol/L) 0.14 0.24 Waist/hip-ratio 0.002 0.99 Homeostasis model assessment of insulin resistance (HOMA-IR) 0.10 0.43 Exercise capacity (VO2peak) -0.03 0.81 Insulin sensitivity index (ISIcomposite, ad modem Matzuda) 0.03 0.82 Open in new tab Table 1: Univariate correlations Correlation between body composition and exercise capacity versus hyperaemia index (RHI) n=70 Correlation between insulin sensitivity and reactive hyperaemia index (RHI) n=70 r p-value r p-value Body mass index (BMI) -0.05 0.66 HbA1c (%) 0.11 0.37 Body fat mass (%) 0.08 0.47 Fasting glucose (FPG) (mmol/L) -0.07 0.58 Central-to-peripheral fat ratio -0.06 0.59 2h OGTT plasma glucose (mmol/L) 0.14 0.24 Waist/hip-ratio 0.002 0.99 Homeostasis model assessment of insulin resistance (HOMA-IR) 0.10 0.43 Exercise capacity (VO2peak) -0.03 0.81 Insulin sensitivity index (ISIcomposite, ad modem Matzuda) 0.03 0.82 Correlation between body composition and exercise capacity versus hyperaemia index (RHI) n=70 Correlation between insulin sensitivity and reactive hyperaemia index (RHI) n=70 r p-value r p-value Body mass index (BMI) -0.05 0.66 HbA1c (%) 0.11 0.37 Body fat mass (%) 0.08 0.47 Fasting glucose (FPG) (mmol/L) -0.07 0.58 Central-to-peripheral fat ratio -0.06 0.59 2h OGTT plasma glucose (mmol/L) 0.14 0.24 Waist/hip-ratio 0.002 0.99 Homeostasis model assessment of insulin resistance (HOMA-IR) 0.10 0.43 Exercise capacity (VO2peak) -0.03 0.81 Insulin sensitivity index (ISIcomposite, ad modem Matzuda) 0.03 0.82 Open in new tab P725 Six minutes walking test and energy activity expenditure in cardiac rehabilitation programs after cardiac surgery F Maslowsky1, RFE Pedretti1, S Sarzi Braga1, R Tramarin2 1IRCCS Foundation Salvatore Maugeri, Department of Cardiology, Tradate, Italy 2European Foundation for Biomedical Research - Onlus, Cardiac Rehabilitation Unit, Cernusco, Italy Topic: Exercise/ Exercise training (Exercice & Translational Science) Introduction: Physical activity energy expenditure (AEE) is a determinant of body weight, risk factors and prognosis in adults. Few information is available on physical AEE in cardiac rehabilitation populations, in particular in the large number of patients enrolled in cardiac rehabilitation programs (CR) after cardiac surgery (CS). Nowadays clinically validated wearable devices are available, allowing continuous recording of physical activity and metabolic monitor on a day-to-day basis. These devices act as a metabolic continuous monitor and can also be used to measure AEE during specific physical activities, i.e. the 6 minutes walking test (6mWT). Aim of the study: To evaluate whether physical training improves energy efficiency after CS. Methods: A 6mWT was performed in 46 male patients (mean age 65±7 yrs, range 51-80; left ventricular ejection fraction 50±9%, range 22-65%) at 10±2 days after CS (coronary by pass graft and/or valve replacement). In all patients the test was repeated 16±3 days after, at the end of a supervised rehabilitation program based on aerobic exercises settled at low energy expenditure (500-700 kCal/week). AEE during the 6mWT was measured using a wearable armband and Borg scale value, heart rate and blood pressure were measured at the end of the test. Results: After the physical rehabilitation program a significant improvement of the AEE per Kg of body weight was observed. Consistent with this, a significant reduction of AEE needed to walk 100 meters was observed (see Table). Conclusions: A rehabilitation program consisting of aerobic exercises at low energy expenditure after CR, increases energy yield, potentially optimizing energy consumption. Since pressure rate product seems to be not significantly changed, this energy consumption optimization may be related to a favourable peripheral adaptation. P726 Use of pulsed magnetic field in the treatment of arterial obliterative disease L Gaspar1, I Gasparova1, P Gavornik1 1University Hospital Bratislava, Bratislava, Slovak Republic Topic: Vascular disease (Exercice & Translational Science) Purpose: To document the effect of pulsed magnetotherapy on the blood flow in lower limbs using the method of transcutaneous oxymetry in a group of patients with peripheral arterial obliterative disease (PAOD). Patients and Methods: In our study group were included 20 patients (13 men and 7 women) with average age of 58 years. All of them had symptomatic PAOD in II. stadium of classification by Fontaine. The ankle-brachial index (ABI) was in the range of 0,8 – 0,9 in 15 members and above 1,3 in 5 members with diagnosis of medialcalcinosis. To monitor the changes of microcirculation of skin in the leg region we used the method of transcutaneous oxymetry with transcutaneous partial oxygen pressure (TcPO2) recording (Hellige SMK 367 Germany, device). Application device of pulsed magnetotherapy was in form of full body mattress type BNM (manufacturer Oxford Medical Instruments, UK) and application programe P3, frequence 10 Herz, was used 2 x 20 minutes a day during 10 days application period. The time till appearance of claudication symptomatology in patients was determined while exercising on a stepper. Results: The average levels of TcPO2 significantly increased from 52,45 mmHg to 66,05 mmHg. Levels of ABI remained unchanged during the treatment. The period till appearance of claudication symptomatology extended from 432 seconds to 456 seconds, the difference was statistically not significant. Conclusions: In a group of 20 people with PAOD in II. stadium of classification by Fontaine we detected a statistically significant increase of TcPO2 values after application of pulsed magnetotherapy as a manifestation of microcirculation improvement. Transcutaneous measurement of oxygen tension provides a non-invasive and continuous information on skin oxygenation, using the basic electrodes of conventional blood gas machine. We recommend pulsed magnetotherapy as part of complex therapy of lighter forms of PAOD. table 1 Weight (Kg) Hb (g/dl) 6mWT (m) Pressure Rate Product AEE (kCal) Borg Scale AEE/Kg (kCal/Kg) AEE/100m (kCal/100m) 1st 6mWT 78.1+/-12.8 10.39+/-1.31 384.6+/-60.3 13273+/-3258 28.7+/-5.19 11.62+/-1.44 0.368+/-0.04 7.64+/-1.88 2nd 6mWT 74.4+/-11.6 10.57+/-1.02 476.8+/-65.4 13422+/-4054 30.26+/-4.86 11.51+/-1.77 0.410+/-0.06 6.41+/-1.07 p value ns ns <0.05 ns ns ns <0.05 <0.05 Weight (Kg) Hb (g/dl) 6mWT (m) Pressure Rate Product AEE (kCal) Borg Scale AEE/Kg (kCal/Kg) AEE/100m (kCal/100m) 1st 6mWT 78.1+/-12.8 10.39+/-1.31 384.6+/-60.3 13273+/-3258 28.7+/-5.19 11.62+/-1.44 0.368+/-0.04 7.64+/-1.88 2nd 6mWT 74.4+/-11.6 10.57+/-1.02 476.8+/-65.4 13422+/-4054 30.26+/-4.86 11.51+/-1.77 0.410+/-0.06 6.41+/-1.07 p value ns ns <0.05 ns ns ns <0.05 <0.05 Open in new tab table 1 Weight (Kg) Hb (g/dl) 6mWT (m) Pressure Rate Product AEE (kCal) Borg Scale AEE/Kg (kCal/Kg) AEE/100m (kCal/100m) 1st 6mWT 78.1+/-12.8 10.39+/-1.31 384.6+/-60.3 13273+/-3258 28.7+/-5.19 11.62+/-1.44 0.368+/-0.04 7.64+/-1.88 2nd 6mWT 74.4+/-11.6 10.57+/-1.02 476.8+/-65.4 13422+/-4054 30.26+/-4.86 11.51+/-1.77 0.410+/-0.06 6.41+/-1.07 p value ns ns <0.05 ns ns ns <0.05 <0.05 Weight (Kg) Hb (g/dl) 6mWT (m) Pressure Rate Product AEE (kCal) Borg Scale AEE/Kg (kCal/Kg) AEE/100m (kCal/100m) 1st 6mWT 78.1+/-12.8 10.39+/-1.31 384.6+/-60.3 13273+/-3258 28.7+/-5.19 11.62+/-1.44 0.368+/-0.04 7.64+/-1.88 2nd 6mWT 74.4+/-11.6 10.57+/-1.02 476.8+/-65.4 13422+/-4054 30.26+/-4.86 11.51+/-1.77 0.410+/-0.06 6.41+/-1.07 p value ns ns <0.05 ns ns ns <0.05 <0.05 Open in new tab © The European Society of Cardiology 2014 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2014
TI - Poster Session 4 – Afternoon
JF - European Journal of Preventive Cardiology
DO - 10.1177/2047487314534585
DA - 2014-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-4-afternoon-JTI07mC7S3
SP - S118
EP - S150
VL - 21
IS - 1_suppl
DP - DeepDyve
ER -