TY - JOUR
AB - Saturday, 05 May 2012, 08:00–13:30 Location: Poster Area P554 Risk factors of acute myocardial infarction in young adults B Bugan1, T Celik2, M Celik3, S Firtina2, Y Gokoglan2, UC Yuksel2, E Yildirim2, A Iyisoy2 1Malatya Military Hospital, Department of Cardiology, Malatya, Turkey, 2Gulhane Military Medical Academy and Faculty, Department of Cardiology, Ankara, Turkey, 3van military hospital, division of cardiology, van, Turkey Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: The main aim of this study was to determine the risk factors of young patients (age ≤ 45 years) with acute myocardial infarction compared with healthy individuals. Methods: Between January 2008 and June 2010, 68 young adult patients (mean age=36.75 ± 6.39 (20-45 age), 62 men) with acute myocardial infarction and 69 healthy individuals (56 men) were recruited the study. Clinical data (risk factors, and laboratory findings) of the patient and healthy group were collected and compared. Results: Compared to healthy group, the significant differences among all of the risk factors in young adults were: history of hypertension (%17.6 versus%4.3, p = 0.013), heart rate (79.04 ± 14.92 versus 73.42 ± 8.76, p = 0.008), homocysteine (14.45 ± 5.50 versus 11.17 ± 3.79, p < 0.0001), low HDL-C (37.24 ± 8.60 versus 43.13 ± 10.06, p < 0.0001), and high triglyceride (157.00 (117.50-224.50) versus 136.00 (85.50-187.50), p = 0.029) levels (table 1). Conclusion: There were few risk factors of acute myocardial infarction for young people. History of hypertension, heart rate, homocysteine, low HDL-C, and high triglyceride levels were independent factors for acute myocardial infarction in the young patients. Table 1 Patient (n = 68) Healthy (n = 69) P Age 36.75 ± 6.39 35.14 ± 5.85 0.101 Sex (male), n(%) 62 (91.2) 56 (81.2) 0.090 Heart rate 79.04 ± 14.92 73.42 ± 8.76 0.008 Systolic blood pressure (mmHg) 127.18 ± 19.10 127.49 ± 9.70 0.903 Diastolic blood pressure (mmHg) 77.51 ± 13.32 78.87 ± 6.22 0.446 BMI, (kg/m2) 27.59 ± 2.56 26.74 ± 3.04 0.082 Hypertension, n (%) 12 (%17.6) 3 (%4.3) 0.013 Diabetes mellitus, n (%) 4 (%5.9) 1 (%1.4) 0.167 Smoking, n (%) 35 (%51.5) 33 (%47.8) 0.670 Family history, n (%) 21 (%30.9) 18 (%26.1) 0.534 Homocysteine (µmol/L) 14.45 ± 5.50 11.17 ± 3.79 <0.0001 Total cholesterol (mg/dl) 192.03 ± 45.74 191.52 ± 30.92 0.939 LDL-cholesterol (mg/dl) 120.50 ± 36.57 119.57 ± 28.03 0.867 HDL-cholesterol (mg/dl) 37.24 ± 8.60 43.13 ± 10.06 <0.0001 Triglyceride (mg/dl) 157.00(117.50-224.50) 136.00(85.50-187.50) 0.029 Patient (n = 68) Healthy (n = 69) P Age 36.75 ± 6.39 35.14 ± 5.85 0.101 Sex (male), n(%) 62 (91.2) 56 (81.2) 0.090 Heart rate 79.04 ± 14.92 73.42 ± 8.76 0.008 Systolic blood pressure (mmHg) 127.18 ± 19.10 127.49 ± 9.70 0.903 Diastolic blood pressure (mmHg) 77.51 ± 13.32 78.87 ± 6.22 0.446 BMI, (kg/m2) 27.59 ± 2.56 26.74 ± 3.04 0.082 Hypertension, n (%) 12 (%17.6) 3 (%4.3) 0.013 Diabetes mellitus, n (%) 4 (%5.9) 1 (%1.4) 0.167 Smoking, n (%) 35 (%51.5) 33 (%47.8) 0.670 Family history, n (%) 21 (%30.9) 18 (%26.1) 0.534 Homocysteine (µmol/L) 14.45 ± 5.50 11.17 ± 3.79 <0.0001 Total cholesterol (mg/dl) 192.03 ± 45.74 191.52 ± 30.92 0.939 LDL-cholesterol (mg/dl) 120.50 ± 36.57 119.57 ± 28.03 0.867 HDL-cholesterol (mg/dl) 37.24 ± 8.60 43.13 ± 10.06 <0.0001 Triglyceride (mg/dl) 157.00(117.50-224.50) 136.00(85.50-187.50) 0.029 Characteristics of the patient and healthy group Open in new tab Table 1 Patient (n = 68) Healthy (n = 69) P Age 36.75 ± 6.39 35.14 ± 5.85 0.101 Sex (male), n(%) 62 (91.2) 56 (81.2) 0.090 Heart rate 79.04 ± 14.92 73.42 ± 8.76 0.008 Systolic blood pressure (mmHg) 127.18 ± 19.10 127.49 ± 9.70 0.903 Diastolic blood pressure (mmHg) 77.51 ± 13.32 78.87 ± 6.22 0.446 BMI, (kg/m2) 27.59 ± 2.56 26.74 ± 3.04 0.082 Hypertension, n (%) 12 (%17.6) 3 (%4.3) 0.013 Diabetes mellitus, n (%) 4 (%5.9) 1 (%1.4) 0.167 Smoking, n (%) 35 (%51.5) 33 (%47.8) 0.670 Family history, n (%) 21 (%30.9) 18 (%26.1) 0.534 Homocysteine (µmol/L) 14.45 ± 5.50 11.17 ± 3.79 <0.0001 Total cholesterol (mg/dl) 192.03 ± 45.74 191.52 ± 30.92 0.939 LDL-cholesterol (mg/dl) 120.50 ± 36.57 119.57 ± 28.03 0.867 HDL-cholesterol (mg/dl) 37.24 ± 8.60 43.13 ± 10.06 <0.0001 Triglyceride (mg/dl) 157.00(117.50-224.50) 136.00(85.50-187.50) 0.029 Patient (n = 68) Healthy (n = 69) P Age 36.75 ± 6.39 35.14 ± 5.85 0.101 Sex (male), n(%) 62 (91.2) 56 (81.2) 0.090 Heart rate 79.04 ± 14.92 73.42 ± 8.76 0.008 Systolic blood pressure (mmHg) 127.18 ± 19.10 127.49 ± 9.70 0.903 Diastolic blood pressure (mmHg) 77.51 ± 13.32 78.87 ± 6.22 0.446 BMI, (kg/m2) 27.59 ± 2.56 26.74 ± 3.04 0.082 Hypertension, n (%) 12 (%17.6) 3 (%4.3) 0.013 Diabetes mellitus, n (%) 4 (%5.9) 1 (%1.4) 0.167 Smoking, n (%) 35 (%51.5) 33 (%47.8) 0.670 Family history, n (%) 21 (%30.9) 18 (%26.1) 0.534 Homocysteine (µmol/L) 14.45 ± 5.50 11.17 ± 3.79 <0.0001 Total cholesterol (mg/dl) 192.03 ± 45.74 191.52 ± 30.92 0.939 LDL-cholesterol (mg/dl) 120.50 ± 36.57 119.57 ± 28.03 0.867 HDL-cholesterol (mg/dl) 37.24 ± 8.60 43.13 ± 10.06 <0.0001 Triglyceride (mg/dl) 157.00(117.50-224.50) 136.00(85.50-187.50) 0.029 Characteristics of the patient and healthy group Open in new tab P555 Coronary morphology:the key to prevention in patients with elevated cardiovascular risk U Ulrich Steiger1 1praxis, zurich, Switzerland Atherosclerosis/CAD (Prevention & Epidemiology) Background: Even with declining prevalence of Coronary artery disease (CAD) in western countries the individual burden remains high and the course in a given patient is often unpredictable. It is important to know if we deal with risk or with an early state of disease. So we have to refer to imaging. Method: In 100 patients with elevated global risk but without signs of manifest CAD at non-invasive cardiologic testing a computed tomography-Angiography (CT) was performed. The 10Years global risk (GR) was calculated online from Swiss AGLA calculator. 5-10% was considered as slight, 10-20% as intermediate and >20% as high risk. Cardiovascular (CV) testing included electrocardiogram, Echocardiography, Bicycle-Stress-Test and Stress-Echocardiography. Computed tomography was done if Ca-score was < 400 Agatstone (A) with 64-multi-slice technology from Sensation Cardio 64 Siemens. Results: Coronary arteriosclerosis (CA) was found in 84/100 of all test-negative patients with elevated GR. In accordance to negative CV-testing no stenosis in any vessel was >50%. In 18 patients Ca-Score was >400A, so no computed tomography was performed. 53 patients with GR >10% showed mixed plaques. 7 patients with Ca-score=0 had soft (lipid) plaques alone. 13 patients with slight GR between 5-10% had positive computed tomography. In 16 patients with GR from >10% to >20% computed tomography was negative. Discussion: in the majority (84%) of 100 cardiologic test negative patients with elevated GR non-invasive computed tomography detects subclinical CA documented by high calcium score (>400A) or soft or mixed plaques < 50% of coronary lumen i.e. haemodynamic insignificant. There is no apparent correlation between size of GR and extent of sclerosis. That means the key to a rational strategy in an individual patient at CV risk is coronary morphology. Without this knowledge we achieve only blind strategies. Ether we treat all patients with GR >5% with respect to the high prevalence of subclinical CA in this group: than we may do some harm to 16% of patients with elevated GR but with clean coronary arteries. Or we may treat patients not aggressively enough especially those 7% with soft i.e. potentially vulnerable plaques alone. So imaging of coronary arteries should be done in all patients with intermediate or high GR. Computed tomography had been discussed largely because of costs and exposure to radiation. With respect to coronary angiography or intravascular ultrasound computed tomography is much cheaper and with newer gating technology the radiation is minimised. The early diagnosis of CAD is important because of the potent tools in modern prevention. Conclusion: Coronary morphology is the key to rational prevention strategy in patients with intermediate or high global risk. P556 Physical activity, sedentary behaviour and coronary artery calcification in healthy older adults M Hamer1, SM Venuraju2, A Lahiri2, A Steptoe1 1University College London, London, United Kingdom, 2Wellington Hospital, London, United Kingdom Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Physical activity (PA) is related to lower risk of cardiovascular disease but data relating to coronary lesions has been conflicting. These inconsistencies may in part be due to unreliable assessment of PA and limitations imposed by self-reported data. The purpose of this study was to examine the association of self-reported and objectively measured PA with coronary artery calcium (CAC). Methods: Participants were 443 healthy men and women (mean age=66 ± 6 yrs), without history or objective signs of coronary heart disease, drawn from the Whitehall II epidemiological cohort. PA was objectively measured using accelerometers worn during waking hours for 7 consecutive days. Self-reported PA data was averaged across two previous phases (1997/ 2004) of the main Whitehall II study in order to obtain a better estimate of chronic exposure. Assessment of CAC was performed in 2010 (at the same time point as objective PA measurements) using electron beam computed tomography and was quantified according to the Agatston scoring system. Results: There was moderate correlation between self-reported and objective PA in various domains, including light (Pearson's r = 0.14, p = 0.004), moderate (r = 0.10, p = 0.034), and vigorous intensity activity (r = 0.10, p = 0.037). Agatston scores ranged from zero to 3510 (median=10.8, SD=364.7), and 283 participants (63.9%) had detectable CAC. In multivariate models, the risk factors associated with detectable CAC were age (Odds ratio [OR] per year = 1.09, 95% CI, 1.05-1.15), male gender (OR = 3.37, 2.04-5.59), use of statins (OR = 4.43, 2.23-8.67), and previous/current smoker (OR = 1.70, 1.06-2.71). Despite associations between counts/min and several conventional risk factors, there was no cross-sectional association between objectively assessed PA or sedentary time and presence of detectable CAC. After adjustment for age and sex, participants with zero detectable CAC recorded 36.0 ± 2.0 min/d moderate - vigorous PA; those with CAC >0<100 recorded 38.5 ± 1.9 min/d; those with CAC 100 - 400 recorded 35.4 ± 3.0 min/d; and those with CAC > 400 recorded 35.4 ± 3.8 min/d (p-trend = 0.72). There was also no longitudinal association between self-reported moderate to vigorous PA and detectable CAC (OR in highest PA tertile =1.52, 95% CI, 0.87 - 2.64). Conclusion: Our results confirm no association between PA and CAC, which is partly consistent with previous studies. The null findings suggest that the cardio-protective effects of PA might act through alternative mechanisms. Since CAC measures cannot reliably identify more vulnerable lesions, further studies are required to examine associations of PA and plaque stability. P557 Relationship between ankle-brachial index, coronary artery disease severity and left ventricular diastolic dysfunction in subjects with type 2 diabetes mellitus C J Caroline Jane Magri1, A Cassar1, H Felice1, S Fava1, A Fenech1 1Mater Dei Hospital, Msida, Malta Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Various studies have reported a close correlation between low ankle-brachial index and various cardiovascular risk factors. However, there is little data regarding the relationship between ankle brachial index (ABI) and severity of coronary artery disease in subjects with type 2 diabetes mellitus, and there is no data regarding the relation between ABI and left ventricular diastolic dysfunction. The aim of the study was to analyse factors associated with ABI in a type 2 diabetic population undergoing elective coronary angiography. Methods: Eighty-one type 2 diabetic patients with a mean (± SD) age of 63.8 years (± 8.8 years) and suspected coronary artery disease in clinical practice were investigated. All participants were assessed by questionnaires, clinical examinations, blood sampling, echocardiography and coronary angiography. Ankle-brachial index was assessed using conventional Doppler device. Subjects with ABI <0.9 were diagnosed with peripheral arterial disease (PAD). The exclusion criterion was medial arterial calcification. Severity of coronary artery disease (CAD) was assessed using Syntax score. Diastolic dysfunction was assessed using Doppler imaging echocardiography, according to the European Society of Cardiology recommendations. Statistical analysis was performed using SPSS version 18.0. Results: Sixteen subjects (19.8%) were found to have peripheral artery disease while 57 subjects (70.4%) had significant coronary artery disease on coronary angiography. No association was found between presence of peripheral artery disease and CAD. However, subjects with peripheral artery disease had higher Syntax scores of 15 (6.75-25.25) [median (interquartile range)] as compared to subjects without peripheral artery disease with median score of 5 (0-16) (p = 0.051). In the study population, ABI was found to be associated with weight (p = 0.002, r = 0.35), body mass index (p = 0.011, r = 0.28), uric acid levels (p < 0.001, r = 0.56) and glycaemic control (assessed by glycated haemoglobin levels) (p = 0.018, r = −0.29). Gender (p = 0.052) and diastolic dysfunction (p = 0.052) were found to be of borderline significance. There was a non-significant association between ABI and severity of CAD, as assessed using Syntax score (p = 0.072). Regression analysis revealed that uric acid (p < 0.001) and left ventricular diastolic dysfunction (p = 0.028) were significant independent predictors of ABI. Conclusion: In a type 2 diabetic population, ABI is not a useful tool for predicting the occurrence of CAD though a low ABI does indicate more severe CAD, as assessed by the Syntax score. The novel association between low ABI and diastolic dysfunction merits further investigation. P558 Paraoxonase 1 Gene (Gln192-Arg) Polymorphism and the Risk of Coronary Artery Disease in Type II Diabetes Mellitus M F Mohamed Fahmy Elnoamany1, A Dawood1, R Azmy1, M Elnajjar1 1Menoufiya Faculty of Medicine, Shebeen El-Koom, Egypt Atherosclerosis/CAD (Prevention & Epidemiology) Background: Paraoxonase 1 (PON1) is reported to have an antioxidant & cardioprotective properties. Recently, an association of glutamine (Gln) or (type A)/arginine (Arg) or (type B) polymorphism at position 192 of PON1 gene has been suggested with coronary artery disease (CAD) among patients with diabetes mellitus (DM). However, conflicting results have also been reported. Objectives: To investigate relationship between of PON1 gene (Gln192-Arg) polymorphism & presence, extent & severity of CAD in type II diabetes mellitus. Methods: The study comprised 180 patients recruited from those undergoing coronary angiography for suspected CAD, divided according to presence or absence of CAD & diabetes mellitus into 4 groups; Group I (n = 40 patients) nondiabetic subjects without CAD, Group II (n = 45 patients) diabetic patients without CAD, Group III (n = 47 patients) non diabetic patients with CAD & Group IV (n = 48 patients) diabetic patients with CAD. PON1(Gln192-Arg) genotype was assessed using polymerase chain reaction (PCR) followed by AlwI digestion. Results: The frequency of Gln allele (Type A) was significantly higher in group I & group II compared to group III & group IV (62.5%, 60% versus 38.3, 31.25% respectively, p < 0.001) while the frequency of Arg allele (Type B + Type AB) was significantly higher in ischemic groups (III, IV) compared to non ischemic groups (I,II) (61.7%, 68.75% versus 37.5, 40% respectively, p < 0.001). Patients with CAD & diabetes mellitus (group IV) have significantly higher severity score & vessel score than those with CAD only (group III) (9.7 ± 2.97, 2.44 ± 0.56 versus 6.99 ± 3.71, 1.67 ± 0.89 respectively, p < 0.001) Patients with vessel score 3 had significantly higher severity score & higher Arg allele frequency than patients with vessel score 2, the latter group had also significantly higher severity score & Arg allele frequency than patients with vessel score 1 (8.9 ± 2.79 versus 5.21 ± 2.13 & 80.49% versus 67.86%), (5.21 ± 2.13 versus 3.11 ± 0.89 & 67.86% versus 53.85%), p < 0.001 for all. In multivariate regression analysis, age [OR 2.99, CI (1.11-10.5), P < 0.01], smoking [OR 4.13, CI (1.37-11.7), P < 0.001], low density lipoprotein (LDL) cholesterol > 100 mg/dL [OR 4.31, CI (1.25-12.5), P < 0.001], high density lipoprotein (HDL) cholesterol < 40 mg/dL [OR 5.11, CI (1.79-16.33), P < 0.001] & PON1 192 Arg allele [OR 4.62, CI (1.79-13.57), P < 0.001] were significantly independent predictors of CAD. Conclusion: Arg allele of PON1 192 gene polymorphism is an independent risk factor for CAD & it is associated not only with the presence of CAD but also with its extent & severity and its impact is clearly more pronounced in diabetic patients. P559 Prognostic value of ankle-brachial index in patients with acute coronary syndrome N Nuno Moreno1, A Da Silva Castro1, A Cruz1, A Andrade1, P Pinto1 1Hospital Centre do Tamega e Sousa, Penafiel, Portugal Atherosclerosis/CAD (Prevention & Epidemiology) Background: Patients (pts) with peripheral arterial disease (PAD) of the lower limbs are among the highest risk vascular patients. peripheral artery disease is an indicator of diffuse atherosclerotic disease in other vascular territories and is present in 3-10% of the population. Values lower than 0.9 in the ankle-brachial index (ABI) shows a limitation of flow propagation, being an independent predictor of cardiovascular risk. Purpose: To evaluate the prognostic value of ABI in a sample of patients hospitalized for acute coronary syndrome and which clinical parameters are related with indexes =0.9. Methods: Prospective study of 110 pts hospitalized for acute myocardial infarction (AMI) and unstable angina, underwent assessment of ABI during hospitalization. An ABI lower than or equal to 0.9 was considered abnormal. We compared the proportion of ABI=0.9 in any of the members in the following categorical variables: gender, meanage, entry diagnosis (unstable angina, non-ST elevation MI, ST-elevation MI), number of affected coronary arteries and number of stents used. The primary outcome was the composite of non-fatal AMI and death from any cause. We performed Kaplan-Meier survival analysis with stratification for ABI categories. Results: Mean patient age was 65.7 ± 12.3 years, 64.5% were men. An abnormal ABI was found in 35.5%, 25.6% of whom were symptomatic. Higher mean age (70.8 ± 11.29 vs 62.80 years) was found in the abnormal ABI group, with no other significant differences being found in the remaining studied variables. After a median follow-up of 364.5 days, the frequency of the primary outcome was 20.5% in pts with abnormal ABI and 5.6% in pts with normal ABI. ABI=0,9 was associated with a higher risk of developing the primary outcome (estimated Odds Ratio=4.32, 95%CI 1.21-15.45). Kaplan-Meier analysis showed reduced cumulative survival for patients with abnormal ABI with statistical significant differences between the survival curves (p = 0.018). Conclusion: An abnormal ABI can be found in one-third of this pts, mostly asymptomatic. ABI may be an important predictor of adverse outcomes and of time-to-event. Albeit the limitations of this work our results show that ABI may be a useful tool in identifying a population at higher risk which may be reduced with intensive secondary prevention. P560 Influence of parents education on knowledge of risk factors for atherosclerosis in population of third year medical students D Kalka1, ZA Domagala2, L Rusiecki1, P Koleda1, J Klempous1, A Wieczorek1, T Szawrowicz-Pelka1, M Poreba1, M Wasik1, W Pilecki1 1Wroclaw Medical University, Department of Pathophysiology, Wroclaw, Poland, 2Wroclaw Medical University, Departament of Normal Anatomy, Wroclaw, Poland Atherosclerosis/CAD (Prevention & Epidemiology) Introduction: Disseminating knowledge on the adverse effect on health of risk factors for atherosclerosis (AS) is one of the key goals of prevention. It seems that family home should be one of the places that play a relevant role in building this awareness. Purpose: Assessment of the knowledge of risk factors for AS among third-year medical students and analysis of the influence of their parents' education on this knowledge. Materials and methods: The study was conducted between 2008 and 2011 on a group of 1377 third-year students of Faculty of Medicine in Wroclaw. The questionnaire survey contained a question testing the knowledge of any 5 risk factors for AS and an additional question regarding parents' level of education - including whether they have completed any medical education. Results: Third-year medical students indicated the following risk factors for AS: low physical activity - 1175 respondents (85.3%), cholesterol rich diet - 1161 respondents (84.3%), smoking tobacco - 965 respondents (70.1%), excessive body weight - 744 respondents (54%), genetic factors - 553 respondents (40.2%), hypertension - 354 respondents (25.7%), stress - 245 respondents (17.8%), diabetes - 206 respondents (15%). Five risk factors were correctly indicated by 31.5% students, four by 43.3% students, three by 20.8% students, two by 3.7% students and one by 0 students. Ten students (0.7%) did not indicate correctly any of the risk factors for AS. Higher education of father was marked by 62.37% respondents and it had a statistically significant influence on the knowledge of the significance of low physical activity (p = 0.0007), hypertension (p = 0.0247) and stress (p = 0.0493). Higher education of mother was marked by 65.24% respondents and it had a statistically significant influence on the knowledge of the significance of smoking tobacco (p = 0.0038) and hypertension (p = 0.0256). The remaining levels of education had no significant influence on the knowledge of the risk factors for AS. Medical education of parents was marked by 33.53% respondents and it had no significant influence on the knowledge of the risk factors for AS. Conclusions: 1. Despite the specific nature of medical studies, the knowledge of third-year medical students seems to be relatively too small in relation to the risk associated with atherosclerosis. 2. Only higher education of parents has influence of a significantly higher knowledge of some risk factors for atherosclerosis. 3. Medical education of parents has no significant influence on development of awareness of the significance of risk factors for atherosclerosis. P561 Preliminary results of demographics of ST-elevation myocardial infarction patients presented to a single cardiac centre in mid-west of Ireland from Jan 2011 to Oct 2011 A Hussaini1, I Ihsan Ullah1, T B Meany1, N Hussaini1, E Shannahan1, F A Toor1, J Keaney2, C Ahern1, M A Haq1, F S Khan1 1Mid-Western Regional Hospital, Limerick, Ireland, 2Mater Public Hospital, Dublin, Ireland Atherosclerosis/CAD (Prevention & Epidemiology) Introduction: Studies have shown that every minute of delay in treatment of patients with ST-elevation myocardial infarction does affect 1-year mortality, not only in thrombolytic therapy but also in primary angioplasty (1). Objectives: To analyse and compare the demographics of early ST-elevation myocardial infarction presenters with that of late presenters. Methods: A retrospective analysis was carried out on ST-elevation myocardial infarction patients from Jan-Oct 2011 by filling in questioners. Results: 62 patient's demographics were analysed. 39 patients (63% of total) presented within 3 hours (early), 7 patients (11% of the total) presented within 3- 6 hours, 5 patients (8% of total) presented within 6-12 hours and 11 patients (18% of total) presented > 12 hours (very late). Overall 61% of the patients had a positive family history of MI and females are 7 times more likely to present early than males. Significant differences were found in following demographics: 9%of very late presenter were living alone versus 0% of early presenter, 18% had history of >21 units alcohol/week versus 8%, 9% married versus 33%, 18% had previous history of MI versus 5%, 0% had history of diabetes versus 13%, 72% had family history of ischaemic heart disease versus 54%, 18% felt that this could be cardiac versus 46%, 27% had typical chest pain versus 79%, 64% had less severe pain (1-4 on the scale 0-10) vs 28%, 36% less educated versus 21%,100% +ve TTn versus 90%, 55% had percutaneous coronary intervention versus 76% respectively. (Graph) Conclusion: Preliminary results show that patient demographics have significant impact on the time of presentation, and overall outcome in ST-elevation myocardial infarction patients. This study highlights the need to aggressively educate the population. As a follow-up to this study we have started a large retrospective, multicentre study based on the above mentioned demographics. Ref: 1. G De Luca, H Suryapranata, JP Ottervanger- Circulation, 2004 - Am Heart Assoc Open in new tabDownload slide P562 The prevalence of high-risk carotid disease in patients presenting for routine echocardiography with no known history of vascular disease. M Murray Matangi1, DW Armstrong1, D Brouillard1 1Kingston Heart Clinic, Kingston, Canada Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: To investigate the prevalence of high-risk carotid disease in patients presenting for routine echocardiography who have no known history of vascular disease. Methods: Males aged 40-65 years and females aged 50-65 years referred for routine echocardiography underwent carotid Doppler imaging. Patients were excluded from carotid imaging if they had any prior vascular history such as angina, myocardial infarction, stroke, transient ischaemic attack, percutaneous coronary intervention, coronary artery bypass grafting, peripheral arterial disease, previous peripheral vascular surgery or peripheral angioplasty. Patients were also excluded if they were >65 years of age. 80 consecutive patients were recruited during the study period. Two images were performed of each carotid, one of the common carotid artery (CCA) and one of the carotid bulb and the internal carotid artery. CCA maximal intimal medial thickness (IMT) was measured in the far wall of the CCA using an automated edge detection system. All measurements were performed offline using commercially available software. The presence of carotid plaque was defined using the atherosclerosis risk in communities (ARIC) definition. Patients were considered to be high-risk from a vascular standpoint if they had either carotid plaque or a CCA IMT ≥ 1.20mm. Results: See Table 1. Five patients were recommended to undergo formal carotid imaging because of the visual appearance of a severe stenosis of their internal carotid artery. Conclusions: Of 80 consecutive patients between the ages of 40 and 65 years referred for routine echocardiography, 54% had high-risk carotid disease. This observation emphasizes the high prevalence of carotid disease in patients presenting to our echocardiographic laboratory for cardiac imaging. Our observation suggests that while such a patient is in the ECHO laboratory the opportunity to gather important prognostic information regarding vascular health should not be overlooked. Table 1. N Age (yrs) R) CCA IMT (mm) L) CCA IMT (mm) (%) plaque (%) high-risk Males 40 56.0 ± 7.0 0.88 ± 0.17 0.99 ± 0.39 52.5 55.0 Females 40 58.1 ± 4.6 0.86 ± 0.23 0.88 ± 0.22 50.0 52.5 Total 80 57.1 ± 6.0 0.87 ± 0.20 0.94 ± 0.32 51.3 53.8 N Age (yrs) R) CCA IMT (mm) L) CCA IMT (mm) (%) plaque (%) high-risk Males 40 56.0 ± 7.0 0.88 ± 0.17 0.99 ± 0.39 52.5 55.0 Females 40 58.1 ± 4.6 0.86 ± 0.23 0.88 ± 0.22 50.0 52.5 Total 80 57.1 ± 6.0 0.87 ± 0.20 0.94 ± 0.32 51.3 53.8 CCA = common carotid artery. IMT = intimal medial thickness. Open in new tab Table 1. N Age (yrs) R) CCA IMT (mm) L) CCA IMT (mm) (%) plaque (%) high-risk Males 40 56.0 ± 7.0 0.88 ± 0.17 0.99 ± 0.39 52.5 55.0 Females 40 58.1 ± 4.6 0.86 ± 0.23 0.88 ± 0.22 50.0 52.5 Total 80 57.1 ± 6.0 0.87 ± 0.20 0.94 ± 0.32 51.3 53.8 N Age (yrs) R) CCA IMT (mm) L) CCA IMT (mm) (%) plaque (%) high-risk Males 40 56.0 ± 7.0 0.88 ± 0.17 0.99 ± 0.39 52.5 55.0 Females 40 58.1 ± 4.6 0.86 ± 0.23 0.88 ± 0.22 50.0 52.5 Total 80 57.1 ± 6.0 0.87 ± 0.20 0.94 ± 0.32 51.3 53.8 CCA = common carotid artery. IMT = intimal medial thickness. Open in new tab P563 Determinants of risk factor control in subjects with coronary heart disease EUROASPIRE Group, MT Marie Therese Cooney1, A Dudina1, K Kotseva2, D Wood2, G De Backer3, IM Graham1 1Adelaide & Meath Hospital, Incorporating the National Children's Hospital, Dublin, Ireland, 2Imperial College London, London, United Kingdom, 3Ghent University, Ghent, Belgium Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Guidelines on prevention of cardiovascular disease (CVD) recommend that those with established cardiovascular disease are at greatest risk for subsequent events and should receive the highest priorty for risk factor control. However, the EUROASPIRE audits indicated that, even in this high risk group, risk factor control remains poor. We analysed the EUROASPRE III dataset to establish the factors associated with success or failure in risk factor control in order to inform future risk factor management strategies. Methods: EUROASPIRE III, conducted in 2006 in 22 European countries, audited the risk factor levels in patients with established coronary heart disease. Information was collected through medical chart review, interview, examination and centralised laboratory testing. Standardised methods were used throughout. Logistic regression analysis was used to assess the effect of each characteristic on the achievement of a combination of three risk factor targets: non-smoking status, blood pressure < 140/90mmHg and total cholesterol < 4.5mmol/l, with the addition of HbA1c ≤ 6.5% in diabetics. Results: University education, attendance at a specialist cardiology clinic and participation in a cardiac rehabilitation program (borderline significance) were associated with improved risk factor control. Risk factor control was poorer in women, those with diabetes and in those undergoing coronary artery bypass surgery as opposed to medical therapy or percutaneous coronary intervention. Odds ratios shown in table. Neither increasing age, depression nor anxiety were associated with poorer risk factor control. Conclusions: Special attention should be paid to certain groups when attempting to improve secondary prevention. These include: women, diabetics and those in lower socioeconomic groups. More widespread availability and uptake of cardiac rehabilitation programs may improve secondary prevention. Adj ORs for failing to reach RF targets Characteristic Adjusted hazard ratio (95%CI) Female gender 1.63 (1.37 to 1.93) Primary education vs university education 1.42 (1.15 to 1.76) Not attending at cardiology clinic 1.32 (1.12 to 1.54) Not attending cardiac rehabilitation 1.15 (0.99 to 1.35) Diabetes 3.29 (2.61 to 4.15) Characteristic Adjusted hazard ratio (95%CI) Female gender 1.63 (1.37 to 1.93) Primary education vs university education 1.42 (1.15 to 1.76) Not attending at cardiology clinic 1.32 (1.12 to 1.54) Not attending cardiac rehabilitation 1.15 (0.99 to 1.35) Diabetes 3.29 (2.61 to 4.15) RF: risk factorsAdj ORs: adjusted odds ratios Open in new tab Adj ORs for failing to reach RF targets Characteristic Adjusted hazard ratio (95%CI) Female gender 1.63 (1.37 to 1.93) Primary education vs university education 1.42 (1.15 to 1.76) Not attending at cardiology clinic 1.32 (1.12 to 1.54) Not attending cardiac rehabilitation 1.15 (0.99 to 1.35) Diabetes 3.29 (2.61 to 4.15) Characteristic Adjusted hazard ratio (95%CI) Female gender 1.63 (1.37 to 1.93) Primary education vs university education 1.42 (1.15 to 1.76) Not attending at cardiology clinic 1.32 (1.12 to 1.54) Not attending cardiac rehabilitation 1.15 (0.99 to 1.35) Diabetes 3.29 (2.61 to 4.15) RF: risk factorsAdj ORs: adjusted odds ratios Open in new tab P564 A comparison of the various risk scores with carotid duplex imaging for assessing cardiovascular risk M Murray Matangi1, DW Armstrong1, D Brouillard1 1Kingston Heart Clinic, Kingston, Canada Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: There are multiple risk scores for assessing cardiovascular (CV) risk. Despite excellent validation and physician knowledge very few physicians take the time to calculate any CV risk score because of limited time during patient encounters. Furthermore most risk scores underestimate CV risk, especially in women. Carotid duplex imaging is a validated and simple non-invasive method of assessing the presence or absence of atherosclerosis, an independent marker of CV risk. The purpose of our investigation was to compare the various CV risk scores with carotid duplex imaging. Methods: We compared low and intermediate risk patients using the Framingham Risk Score for coronary events (FRSC), with the expanded Framingham Risk Score for global CV risk (FRSG), the Reynolds Risk Score (RRS) and the JUPITER study criteria with carotid duplex imaging. High risk using the carotid study was deemed to be present if there was plaque present using the atherosclerosis risk in communities (ARIC) definition. Results: There were 113 patients, 57 females aged 66.7 ± 9.4 years and 56 males aged 57.2 ± 10.6. The results are seen in Table 1. Conclusions: As can be seen from the table there is increasing CV risk as one moves from the FRSC to the RRS, the FRSG and finally the JUPITER study criteria. What is much more obvious is that carotid duplex imaging dramatically increases the number of high-risk patients in both men and women. We believe that more patients will be appropriately treated with preventative drug therapy such as Statins if one simply uses carotid duplex imaging and dispenses with the various CV risk scores. Table 1. Females (n = 57) FRSC RRS FRSG JUPITER Carotid study Low risk 48 48 24 40 15 Intermediate risk 9 6 23 0 0 High risk 0 3 10 17 42 Males (n = 56) FRSC RRS FRSG JUPITER Carotid study Low risk 28 37 13 36 26 Intermediate risk 28 17 26 0 0 High risk 0 2 17 20 30 Females (n = 57) FRSC RRS FRSG JUPITER Carotid study Low risk 48 48 24 40 15 Intermediate risk 9 6 23 0 0 High risk 0 3 10 17 42 Males (n = 56) FRSC RRS FRSG JUPITER Carotid study Low risk 28 37 13 36 26 Intermediate risk 28 17 26 0 0 High risk 0 2 17 20 30 FRSC = Framingham risk score coronary, RRS = Reynolds risk score, FRSG = Framingham risk score global. Open in new tab Table 1. Females (n = 57) FRSC RRS FRSG JUPITER Carotid study Low risk 48 48 24 40 15 Intermediate risk 9 6 23 0 0 High risk 0 3 10 17 42 Males (n = 56) FRSC RRS FRSG JUPITER Carotid study Low risk 28 37 13 36 26 Intermediate risk 28 17 26 0 0 High risk 0 2 17 20 30 Females (n = 57) FRSC RRS FRSG JUPITER Carotid study Low risk 48 48 24 40 15 Intermediate risk 9 6 23 0 0 High risk 0 3 10 17 42 Males (n = 56) FRSC RRS FRSG JUPITER Carotid study Low risk 28 37 13 36 26 Intermediate risk 28 17 26 0 0 High risk 0 2 17 20 30 FRSC = Framingham risk score coronary, RRS = Reynolds risk score, FRSG = Framingham risk score global. Open in new tab P565 CRUSADE Bleeding Score: more than a bleeding risk score? F Francisca Caetano1, I Almeida1, J Silva1, L Seca1, A Botelho1, P Mota1, A Leitao Marques1 1Hospital Center of Coimbra, Coimbra, Portugal Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Non-ST elevation myocardial infarction (NSTEMI) affects a heterogeneous group of patients (P) with a variable prognosis, requiring an early strategy of risk (R) stratification. Crusade Bleeding Score (CBS) was validated as a predictor of bleeding R in non ST-elevation myocardial infarction, although we don't know its accuracy for predicting ischemic R. Recognizing the overlap of R factors for ischemic and hemorrhagic events, we intended to evaluate the potential of CBS as a predictor of ischemic R. Methods: Retrospective study of 209 P (67% men, age 68.6 ± 13.3 years) consecutively admitted to a Coronary Unit for non ST-elevation myocardial infarction, without documented bleeding. P were separated in 3 groups (G) according to their bleeding R at admission: G1 (n = 96) - low R, CBS ≤ 30; G2 (n = 41) - moderate R, CBS 31-40 and G3 (n = 72) - high R, CBS > 40. Uni and multivariate analysis was performed with SPSS 17.0. A follow-up (FU) (7.4 ± 5.3 months) regarding major adverse cardio and cerebrovascular events (MACCE) was done. Results: In parallel with increased bleeding R (G1vsG2vsG3), P were older (p < 0.001) and had a higher incidence of high blood pressure (p = 0.010), chronic heart failure (HF) (p < 0.001) and chronic renal disease (p < 0.001). In the same way they presented at admission higher incidence of acute HF (4.2% vs 22% vs 54.2%; p < .001) and atrial fibrillation (p = 0.003); they had lower haemoglobin levels (14.7 ± 1.5 vs 13.2 ± 1.7 vs 11.6 ± 1.9; p < 0.001), glomerular filtration rate (93.3 ± 22.2 vs 68.6 ± 17.7 vs 42.2 ± 21.6; p < 0.001) and higher NT-pro-BNP (p < 0.001). No differences were found among groups in the severity of coronary artery disease. P with higher CBS R (G1vsG2vsG3) less often were submitted to coronariography (p < 0.001); had longer hospitalizations (4.6 ± 2.3vs4.9 ± 2.4vs7.9 ± 6.0; p < 0.001); higher incidence of cardiorenal syndrome (7.3%vs29.3%vs48.5%; p < 0.001), left ventricular dysfunction (p = 0.012), new onset HF (11.6%vs25%vs35.9%; p = 0.001) and in-hospital mortality (p = 0.003). During FU they had more MACCE (8.6%vs27.3%vs48.3%; p < 0.001), with higher mortality (2.2%vs11.8%vs31.7%; p < 0.001) and re-hospitalization for HF (1.1%vs3.1%vs19.0%; p < 0.001). A significant correlation was observed between global registry of acute coronary events R score and CBS (p < 0.001; correlation coefficient 0.631). In multivariate analysis CBS adds prognostic value to Grace Risk Score regarding mortality during FU. Conclusions: In this study, CBS was a surrogate marker of co-morbidities, being associated with a negative prognosis in short and medium term, without being linked with increased bleeding. CBS can add value in the R stratification of non ST-elevation myocardial infarction P. P566 Non-invasive assessment of subclinical atherosclerosis in randomly selected middle-aged danes - A DanRisk substudy I Bjerrum1, N P R Sand1, MK Poulsen2, BL Noergaard3, JJ Sidelmann4, A Johansen5, H Mickley6, ACP Diederichsen6 1Sydvestjysk Hospital, Department of Cardiology, Esbjerg, Denmark, 2Sygehus Lillebaelt Vejle, Department of Cardiology, Vejle, Denmark, 3Aarhus University Hospital, Skejby, Department of Cardiology, Aarhus, Denmark, 4Department of Clinical Biochemistry, Esbjerg, Denmark, 5Odense University Hospital, Department of Nuclear Medicine, Odense, Denmark, 6Odense University Hospital, Department of Cardiology, Odense, Denmark Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Screening of the general population for subclinical atherosclerosis is controversial. We assessed the prevalence of subclinical atherosclerosis in a subset of the danish population by 4 non-invasive modalities. Methods: In 277 randomly selected danish citizens, men and women aged 50 or 60 years, without known cardiovascular disease or diabetes, intima-media thickness/presence of carotid plaques by ultrasound; coronary artery calcification (CAC) by non-contrast enhanced cardiac computed tomography; occurrence of peripheral artery disease (PAD) by ankle brachial index (ABI), and vascular leakage by urine albumin creatinine ratio (ACR), were evaluated. Results: A total of 56% had morphological signs of atherosclerosis in one of the vascular territories; 41% had CAC and 31% a carotid plaque. Among individuals with atherosclerosis, 28% had lesions in both vascular territories. Subclinical atherosclerosis was significantly more frequent in men than women and was associated with age. Signs of peripheral artery disease and microalbuminuria were very uncommon and detected in only 1% of the entire population. No association was found between morphological signs of subclinical atherosclerosis and ABI or ACR. Conclusions: More than half of randomly selected apparently healthy middle aged danes had subclinical atherosclerosis located in the coronary or carotid arteries. P567 Antiplatelet strategies in the secondary prevention in Bulgaria B Borislav Georgiev1, N Gotcheva1, V Baytcheva1, D Gotchev2 1National Heart Hospital, Sofia, Bulgaria, 2Military medical academy, Sofia, Bulgaria Atherosclerosis/CAD (Prevention & Epidemiology) Antiplatelet therapy is an essential part of coronary artery disease (CAD) prevention. As atherothrombotic risks increase, so do the beneficial effects of therapy and increasingly potent regimens seem justified? Barriers such as slow adoption of guidelines and patient nonadherence pose fundamental threats to antiplatelet efficacy. The EUROASPIRE III (European Action on Secondary and Primary Prevention by Intervention to Reduce Events III) trial was aimed to follow the doctors' keeping to the rules of ESC Guidelines for cardiovascular prevention. The studied patients of the CAD group were treated in 3 capital hospitals and followed after the discharge by cardiologists and general practitioners. The BULPRAKT HEART study (BULgarian PRospective Analysis of the physicians' Knowledge and Therapy choice in HEART Disease Treatment And Prophylaxis) was a national study analysing the physicians' knowledge and drug prescription preference. Objectives: The aim of the study was to find out the drugs preferences of the Bulgarian physicians in the field of antiplatelet therapy and to compare these results with the findings of the use of acetylsalicylic acid (ASA) and other antiplatelet drugs in the Bulgarian cohort of EUROASPIRE III - patients with proven coronary heart disease. Methods: In 2005 we interrogated 1322 general practitioners (GPs) and in 2007 259 GPs we interrogated about their drug preferences for cardiovascular prevention by using an anonymous questionnaire. The EUROASPIRE III survey was carried out in 2006-2007. Data collection was conducted by trained research staff, which reviewed patient medical records, interviewed and examined the patients. Results: The results from BULPRAKT HEART study showed that in 2005 75.9% of the GPs prescribed ASA in the CAD prevention strategies. In 2007 almost all of them used ASA (97.7%), but 29.7% of the GPs used also in some patients dipyridamole and about 30% - ticlopidine and clopidorgel. The data from EUROASPIRE III revealed that 88.9% of the patients after discharge received antiplatelet therapy and 85.5% - 1.3 years later during the interview. Anticoagulants were used in about 8% of the patients; about 6% of them were without antiplatelet/anticoagulant drug. Conclusions: The low rate of antiplatelet drug use in Bulgarian CAD patients may be due to physicians or patients barriers. Despite the knowledge of proven prophylactic efficacy of ASA and clopidogrel, some GPs prescribed dipyridamole, not approved for those patients. ASA gastro protective tablets of 75 mg and 100 mg are a good choice for the prevention strategies with low price and low bleeding rate. P568 Role of general practitioners in primary prevention in Germany: a cross sectional study in Berlin 2010-2011 J Mueller Nordhorn1, CH Holmberg1, G Sarganas1 1Berlin School of Public Health (BSPH) at the Charite -University Medicine Berlin, Berlin, Germany Atherosclerosis/CAD (Prevention & Epidemiology) Preventive efforts have the potential to improve lifestyle factors and to reduce cardiovascular risk. This study aimed at exploring the role of general practitioners (GPs) in primary prevention and to assess what primary prevention programmes are offered to patients by their GPs. We conducted a survey between Nov. 2010 and Feb. 2011 with all office-based GPs in Berlin (n = 1168). All GPs received: a covering letter, the questionnaire, a franked envelope, and a franked postcard. Two follow-ups were conducted. Anonymity was warranted as there was no possibility to connect the questionnaire with personal data. Survey items covered characteristics of GPs and their practices, frequency of addressing primary prevention in their practice, their opinion on whose responsibility primary prevention is as well as assumptions and beliefs about primary prevention, knowledge of a partial reimbursement of preventions programmes by the statutory health insurance, and prevention programmes offered. The study was approved by the Ethic Commission from the Charté Universitätsmedizin Berlin. A total of 474 GPs sent back the questionnaire (response rate=41%). Of all respondents, 66% were female and 63% had additional qualifications apart from their GP training. Half of the responders were between 50 and 64 years old, and the GPs mostly had patients from the statutory health insurance companies (87%). Regular physical activity, healthy eating, smoking cessation, and reduction of alcohol consumption were part of GPs' health care recommendations in the majority of the cases they thought it was indicated. 69% completely agreed that primary prevention is part of their tasks as GPs. 96% believed that primary prevention efforts were a possibility to promote population health and that they can have a positive influence on the quality of life. 67% provided their patients with information about their own courses in primary prevention and 63% were aware that prevention programmes could be partially reimbursed by the statutory health insurance. Only 28% of the responders offered in their consultation prevention programmes which could be reimbursed by the statutory health insurance (medical check-ups, nutrition, and smoking cessation). Adjusting by age, qualification, and consultation structure, female doctors are twice as likely to offer prevention programmes to their patients than male doctors (RR = 1,8; CI: 1,1-3,1; p = 0,03). GPs see themselves as playing an important role in primary prevention. Prevention programmes offered by GPs as well as the awareness of the partially reimbursement of prevention programmes among GPs need to increase. P569 Newly detected abnormal glucose regulation and not only diabetes are related to hospital cardiac adverse events in patients with acute coronary syndrome M Ruscazio1, R Montisci1, A Marini1, L Sau1, P Tiddia1, A Boi1, L Meloni1 1Clinical Cardiology University of Cagliari, Cagliari, Italy Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: Diabetes (DM) is an independent predictor for adverse events in patients with cardiovascular disease. However, few studies have address the role of newly detected diabetes mellitus in comparison to impaired fasting glucose (IGT) or impaired glucose tolerance (IGT) on early cardiac outcome in patients with acute coronary syndrome (ACS). Aim of this study was to investigate the prognostic role of newly detected abnormal glucose regulation and diabetes with hospital cardiac outcomes in patients with acute coronary syndrome. Methods: Four-hundred twenty patientswith acute coronary syndrome (STEMI: n = 209;non ST-elevation myocardial infarction: n = 211) admitted to our Department fom Jannuary2006 to March 2008 were prospectively enrolled into the study. One-hundredsixty four (39%) were excluded because of known diabetes and 256 patients (61%) were finally considered for the study (mean age 64.37 ± 12.4; 199 men and 57 women). Glucose metabolism was based on oral glucose tolerance test (OGTT) with 75gr of glucose and fasting glucose plasma before discharge and was classified according to the World Health Organization and American Diabetes Association criteria (ADA 2003) as normal, IFG, IGT or diabetes mellitus. The primary end point was cardiac death and secondary was a composite end point of cardiovascular death, development or progression of heart failure, cardiogenic shock, re-infarction, angina, ventricular tachicardia, ventricular fibrillation, atrial fibrillation and atrio-ventricular block during hospitalization. Results: Sixty-four patients (43%) had normal glucose regulation, 15 (10%) had IFG, 40 (27%) had IGT and 29 (20%) had diabetes mellitus. Unfavorable outcome was more frequent in patients with IFG (p < 0.02), IGT (p < 0.05) and diabetes mellitus (p < 0.05). Univariate analysis indicated that the CPK peak (p < 0.001), CPK-MB mass peak (p = 0.03), ejection fraction (p < 0.001), WBC (p = 0.03), glucose level on admission (p < 0.0001), total cholesterol (p = 0.01) and low-density lipoprotein colesterol were related to adverse hospital outcomes. Multivariable analysis revealed that only IFG, IGT or diabetes (P < 0.05) and glucose level on admission (p < 0.05) were independent predictors of adverse outcome. Conclusions: Our study demonstrated that in patients with acute coronary syndrome not only newly detected diabetes mellitus but also IFG and IGT are independent predictors for hospital cardiac adverse outcomes. This suggest that newly detected IFG and IGT deserve an aggressive early identification and monitoring in patients presenting with acute coronary syndrome. P570 The trends in mortality from cardiovascular diseases in Kaunas (Lithuania) elderly population during 2000-2010 R Radisauskas1, G Bernotiene1, A Tamosiunas1, D Sidlauskiene1 1Lithuanian University of Health Sciences, Academy of Medicine, Institute of Cardiology, Kaunas, Lithuania Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: The aim of the study was to evaluate the trends in mortality from cardiovascular diseases (CVD) in Kaunas population aged 65-84 years during from 2000 to 2010. Methods. Official mortality data of Kaunas population was the source of the data. The object - all permanent residents of Kaunas aged 65-84 years who died from cardiovascular disease (ICD-10 I00-I99) in 2000-2010. The age-standardized rates were calculated by the direct method and using the European population as a standard. Trends were analysed using the method of linear regression on logarithms of the age-standardized annual rates. Results: According to the official mortality data among Kaunas men aged 65-84 years the average mortality from cardiovascular disease rate was 3006.6, among women - 1615.4/100000 persons in 2000-2010. The biggest mortality rate among men and women was detected in 2002, and accounted 3376.8/100000 and 1839.2/100000, respectively. The lowest mortality rate among men and women was observed in 2010 and accounted 2637.8/100000 and 1334.9/100000, respectively. The mortality from cardiovascular disease rate among Kaunas men tended to decrease (by −1,1%/year; p = 0.07) and among women decreased significantly by −2,6%/year; (p = 0.0005) from 2000 to 2010. Conclusions. The mortality from cardiovascular diseases tended to decrease among elderly Kaunas men and decreased significantly among Kaunas elderly women during the past ten years. P571 Ideal cardiovascular health P Patricia Kearney1, J Harrington1, V Mccarthy1, AP Fitzgerald1, IJ Perry1 1University College Cork, Cork, Ireland Atherosclerosis/CAD (Prevention & Epidemiology) The American Heart Association defines Ideal Cardiovascular Health based on 7 cardiovascular disease risk factors. Prevalence of Ideal Cardiovascular Health in Ireland is unknown. The Mitchelstown cohort is a population based sample of 2047 middle aged Irish adults from a large primary care centre. Baseline assessment completed in 2011 included questionnaire, physical examination and blood sampling. Smoking status and physical activity (international physical activity questionnaire [IPAQ]) are based on self-report. Blood pressure, height, weight, total cholesterol and HbA1c were measured directly. Dietary categories are based on the food pyramid guidelines using data from the FFQ. None of the cohort met all criteria for ideal cardiovascular health. Both individual and population level interventions are required to increase physical activity and improve dietary quality of middle aged Irish adults. Prevalence Ideal Cardiovascular Health Health Metric Definition Total Sample, % Smoking Ideal Never or quit >12 months 81.7 Smoking Intermediate Former <=12 months 2.4 Smoking Poor Current 14.8 Body Mass Index Ideal <25kg/m2 21.9 Intermediate 25-29.99 kg/m2 45.3 Poor ≥ 30 kg/m2 32.8 Physical activity Ideal High category in IPAQ 8.3 Intermediate Moderate category in IPAQ 51.1 Poor Low category in IPAQ 40.6 Healthy diet score Ideal >4 shelves of Food Pyramid 13.3 Intermediate 2-3 shelves of Food Pyramid 66.2 Poor 0-1 shelves of Food Pyramid 20.4 Total cholesterol Ideal <5 mmol/L 40.9 Intermediate 5-6.2 mmol/L 43.6 Poor ≥ 6.2 mmol/L 15.5 Blood pressure Ideal <120/80 mm Hg 25.3 Intermediate SBP120-139 or DBP 80-89 mm Hg 43.7 Poor SBP ≥ 140 or DBP ≥ 90 mmg Hg 31.0 Glycemic Status Ideal HbA1C<6.1 80.6 Intermediate 6.1=HbA1C <6.5 12.1 Poor ≥ 6.5 mmol/L 7.3 Health Metric Definition Total Sample, % Smoking Ideal Never or quit >12 months 81.7 Smoking Intermediate Former <=12 months 2.4 Smoking Poor Current 14.8 Body Mass Index Ideal <25kg/m2 21.9 Intermediate 25-29.99 kg/m2 45.3 Poor ≥ 30 kg/m2 32.8 Physical activity Ideal High category in IPAQ 8.3 Intermediate Moderate category in IPAQ 51.1 Poor Low category in IPAQ 40.6 Healthy diet score Ideal >4 shelves of Food Pyramid 13.3 Intermediate 2-3 shelves of Food Pyramid 66.2 Poor 0-1 shelves of Food Pyramid 20.4 Total cholesterol Ideal <5 mmol/L 40.9 Intermediate 5-6.2 mmol/L 43.6 Poor ≥ 6.2 mmol/L 15.5 Blood pressure Ideal <120/80 mm Hg 25.3 Intermediate SBP120-139 or DBP 80-89 mm Hg 43.7 Poor SBP ≥ 140 or DBP ≥ 90 mmg Hg 31.0 Glycemic Status Ideal HbA1C<6.1 80.6 Intermediate 6.1=HbA1C <6.5 12.1 Poor ≥ 6.5 mmol/L 7.3 Open in new tab Prevalence Ideal Cardiovascular Health Health Metric Definition Total Sample, % Smoking Ideal Never or quit >12 months 81.7 Smoking Intermediate Former <=12 months 2.4 Smoking Poor Current 14.8 Body Mass Index Ideal <25kg/m2 21.9 Intermediate 25-29.99 kg/m2 45.3 Poor ≥ 30 kg/m2 32.8 Physical activity Ideal High category in IPAQ 8.3 Intermediate Moderate category in IPAQ 51.1 Poor Low category in IPAQ 40.6 Healthy diet score Ideal >4 shelves of Food Pyramid 13.3 Intermediate 2-3 shelves of Food Pyramid 66.2 Poor 0-1 shelves of Food Pyramid 20.4 Total cholesterol Ideal <5 mmol/L 40.9 Intermediate 5-6.2 mmol/L 43.6 Poor ≥ 6.2 mmol/L 15.5 Blood pressure Ideal <120/80 mm Hg 25.3 Intermediate SBP120-139 or DBP 80-89 mm Hg 43.7 Poor SBP ≥ 140 or DBP ≥ 90 mmg Hg 31.0 Glycemic Status Ideal HbA1C<6.1 80.6 Intermediate 6.1=HbA1C <6.5 12.1 Poor ≥ 6.5 mmol/L 7.3 Health Metric Definition Total Sample, % Smoking Ideal Never or quit >12 months 81.7 Smoking Intermediate Former <=12 months 2.4 Smoking Poor Current 14.8 Body Mass Index Ideal <25kg/m2 21.9 Intermediate 25-29.99 kg/m2 45.3 Poor ≥ 30 kg/m2 32.8 Physical activity Ideal High category in IPAQ 8.3 Intermediate Moderate category in IPAQ 51.1 Poor Low category in IPAQ 40.6 Healthy diet score Ideal >4 shelves of Food Pyramid 13.3 Intermediate 2-3 shelves of Food Pyramid 66.2 Poor 0-1 shelves of Food Pyramid 20.4 Total cholesterol Ideal <5 mmol/L 40.9 Intermediate 5-6.2 mmol/L 43.6 Poor ≥ 6.2 mmol/L 15.5 Blood pressure Ideal <120/80 mm Hg 25.3 Intermediate SBP120-139 or DBP 80-89 mm Hg 43.7 Poor SBP ≥ 140 or DBP ≥ 90 mmg Hg 31.0 Glycemic Status Ideal HbA1C<6.1 80.6 Intermediate 6.1=HbA1C <6.5 12.1 Poor ≥ 6.5 mmol/L 7.3 Open in new tab P572 The implementation of secondary prevention of coronary artery disease in hospital practice has not changed since 2011 in Cracow P Jankowski1, D Czarnecka1, A Skrzek2, H Denderska3, S Surowiec1, M Brzozowska-Kiszka2, K Kawecka-Jaszcz1, J Nessler4, P Podolec5, A Pajak6 11 st Department of Cardiology and Hypertension, Institute of Cardiology, Jagiellonian University CM, Cracow, Poland, 21st Department of Cardiology and Hypertention University Hospital in Cracow, Cracow, Poland, 3Collegium Medicum Jagiellonian University, Cracow, Poland, 4Department of Coronary Disease, Institute of Cardiology, Cracow, Poland, 5Department of Cardiac and Vascular Diseases, Jagiellonian University, Cracow, Poland, 6Department of Epidemiology and Population Studies, Institute of Public Health, JU CM, Cracow, Poland Atherosclerosis/CAD (Prevention & Epidemiology) Background: In the European guidelines the highest priority for preventive cardiology was given to patients with established cardiovascular disease. The latest version of the European Society of Cardiology preventive guidelines was published in 2007. The impact of publication of this document on the secondary prevention implementation into clinical practice is unknown. Aim: To compare the quality of secondary prevention in Cracow cardiac departments in 2005/2006, and 2010/2011. Methods: Five hospitals serving the area of the city of Cracow and surrounding districts, inhabited by 1,200,000 persons, took part in the surveys. Consecutive patients hospitalized from April 2005 to July 2006 (these subjects took part ion the EUROASPIRE III survey) and from June 2010 to May 2011 due to acute myocardial infarction, unstable angina or for myocardial revascularization procedures, below the age of < 81 years, were recruited and included to the present analysis. All medical records were reviewed by trained reviewers using standardized data collection forms. Results: Medical records of 640 patients hospitalized in 2005/2006 and 466 hospitalized in 2010/2011 were reviewed and analysed. Proportion of medical records with available information of smoking prior to hospitalization decreased (from 93.6% to 90.8%; p < 0.001) whereas of hypertension increased (93.9% versus 98.3%; p < 0.001) from 2005/2006 to 2010/2011. Proportion of medical records with available information of total cholesterol measurement decreased (from 89.8% to 84.0%; p < 0.001) whereas of weight and height measurements increased (from 70.9% to 79.6%; p < 0.001). Beta-blockers prescription rate decreased from 89.7% to 85.2% (p < 0.05), antiplatelets, ACE inhibitors/sartans, and lipid lowering drugs prescription rates at discharge did not changed significantly (97.7% versus 97.2%, 88.6% versus 86.9%, and 95.6% versus 94.4% resp., all p = NS) whereas the prescription rate of drugs used for treatment of tobacco dependence increased from 0.0% to 0.6% (p = 0.05). Conclusions: The implementation of secondary prevention guidelines into clinical practice in the Cracow cardiac departments generally has not improved as compared to 2005/2006. P573 Correlations between scores for evaluation of cardiovascular risk with noninvasive markers of coronary artery disease S Kostic1, D Mijalkovic1, IS Tasic2 1Institute for Therapy & Rehabilitation, Niska Banja, Serbia, 2University of Nis, Medical Faculty, Nis, Serbia Atherosclerosis/CAD (Prevention & Epidemiology) Background: According to the latest recommendations of the European Society of Cardiology assessment of absolute cardiovascular risk using the SCORE system should be done to any adult asymptomatic persons. Objective: To examine whether there are correlations between SCORE for evaluation of cardiovascular risk with non-invasive surrogate markers of atherosclerosis and coronary heart disease (CHD) and also, they had coronary angiography performed. Method: The study included 150 subjects, divided into two groups. The first group consisted of patients with verified coronary heart disease, n = 100. Control group consisted of healthy examinees, n = 50. Based on history and medical records were analysed variable and invariable presence of risk factors for cardiovascular disease: hypertension, hyperlipidemia, smoking, diabetes, obesity, gender, age. Anthropometric measurements were performed that included measurement of body weight, body height, waist and hip circumference, in order to get insight into their nutritional status. Intraluminal lesions of the carotid arteries were determined by B-mode imaging and defined changes in the form of thickening intimal-medial complex (IMC) and the occurrence of plaques as focal thickening of the intima. Ankle- brachial index (ABI) was calculated as the ratio of the ankle systolic blood pressure (SBP) to the the brachial SBP. Results: Univariant logistic regression analysis showed a highly significant correlation between the total risk determined by the SCORE system with the tested parameters. Particularly significant correlations are with ABI (p < 0.001), thickness of IMC (p < 0.05), amount of plaques on the carotid arteries (p < 0.05), the percentage of stenosis of all particular coronary arteries (p < 0.001), sex and age. Multivariant analysis showed significant correlation SCORE with ABI (p = 0.043), age (p <0.001), male gender (p <0.001) and hypertension (p = 0.043). Conclusion: The investigation proved the strong correlation absolute CV risk determined by the SCORE system with non-invasive markers of coronary artery disease special with ABI. P574 Association between apoa1/ApoB ratio and carotid intima-media thickness in coronary artery disease S Sonja Alabakovska1, D Labudovic1, K Tosheska-Trajkovska1, S Jovanova2, J Bogdanska1, M Krstevska1, M Alabakovski3 1Institute of Medical and Experimental Biochemistry, Medical Faculty, Skopje, Macedonia, The Former Yugoslav Republic of, 2University Clinic of Cardiology, Skopje, Macedonia, The Former Yugoslav Republic of, 3Medical School, Skopje, Former Yugoslav Republic Atherosclerosis/CAD (Prevention & Epidemiology) Background: Previous studies show that smaller low-density lipoprotein size is associated with greater atherosclerotic risk. Plasma concentrations of ApoB is a measurement of the total number of low-density lipoprotein particles, and plasma concentrations of ApoA-1 is a measure of the high-density lipoprotein particle number. Carotid artery intima media thickness (IMT) is considered as a marker of atherosclerosis and in prediction of coronary artery disease. Aim: To examine the association between mean carotid atery intima-media thickness and ApoB/ApoA-1 ratio and conventional lipids in CAD patients at baseline and at 1 year follow-up. Methods: Blood pressure, anthropometric characteristics, traditional lipid profile, ApoA-1, Apo-B and carotid artery intima-media thickness were measured in 92 patients with CAD. Results: Prevalence of CAD patients at 1 year follow-up with increased intima-media thickness was higher among subjects with an ApoA-1: Apo-B ratio > 1 compared to those with a ratio < 1 (36.8% vs 18.0%, p < 0.05). The ApoB/apoA-I ratio, LDL-c and diastolic blood pressure correlated with intima-media thickness. Other conventional lipids were not significantly correlated to intima-media thickness. A multivariate logistic regression analysis was conducted with intima-media thickness as the dependent variable and the apoB/apoA-I ratio, LDL-c, total cholesterol, HDL-c and blood pressure as independent variables. Only the apoB/apoA-I ratio (odds ratio 7.3, P < 0.001) and diastolic blood pressure (odds ratio 2,5, p < 0,05) were significantly associated with intima-media thickness. Conclusions: There was a significant association between the apoB/apoA-I ratio and intima-media thickness in CAD patients. The association was independent of conventional lipids and may play an important role in assessment of atherosclerossis. P575 Diagnostic performance of computed tomographic coronary angiography in patients with end-stage renal disease B Borut Jug1, J Papazian2, M Gupta2, J Kadakia2, H Bhatia2, A Derakhshani2, R Karlsberg3, M Budoff2 1Dept. of vascular diseases, University clinical centre, Ljubljana, Slovenia, 2Los Angeles Biomedical Research Institute at UCLA-Harbor Medical Center, Los Angeles, United States of America, 3University of California Los Angeles, David Geffen School of Medicine, Los Angeles, United States of America Atherosclerosis/CAD (Prevention & Epidemiology) Background: End-stage renal disease (ESRD) is characterized by an extremely high rate of cardiovascular events which dictates thorough screening for coronary atherosclerosis, especially in patients undergoing kidney transplant. Therefore, we assessed the diagnostic performance of 64-slice multidetector coronary computed tomographic angiography (CCTA) in patients with ESRD. Methods: We included patients who had been referred for a CCTA and an invasive coronary angiography (diagnostic standard) within 6 months, either as part of clinical work-up in two urban medical centres or as part of the multicentre ACCURACY trial. Results: Thirty-one ESRD patients were included and compared to 588 non-ESRD patients undergoing CCTA and invasive coronary angiography. On a patient-based model, the sensitivity, specificity, and positive and negative predictive values to detect ≥ 50% and ≥ 70% stenosis were 100%, 78%, 92% and 100%, and 100%, 91%, 95% and 100%, respectively for ESRD patients and 97%, 83%, 87% and 96%, and 94%, 87%, 85% and 95%, respectively for non-ESRD controls. There were no statistically significant differences between ESRD and non-ESRD participants in diagnostic performance measures. Conclusion: 64-row multidetector CCTA is highly sensitive and specific in detection of coronary artery stenosis irrespective of ESRD. Our findings suggest that CCTA is a promising diagnostic tool for timely detection and/or exclusion of coronary atherosclerosis in patients undergoing pre-transplant cardiovascular surveillance. P576 Prevalence of cardiovascular risk factors in Poland in 2011 P Piotr Bandosz1, MR Rutkowski1, Z Jakubowski1, A Ignaszewska-Wyrzykowska1, T Zdrojewski1 1Medical University in Gdansk - Dept. of Hypertension and Diabetology, Gdansk, Poland Atherosclerosis/CAD (Prevention & Epidemiology) Purpose: To assess prevalence of classic risk factors of cardiovascular diseases in population of Polish citizens. Methods: Country-representative random sample (n = 2413) was drawn from population of Polish citizens aged 18-79 y. Main classic cardiovascular diseases risk factors: hypertension, hypercholesterolaemia, smoking and obesity were assessed in every subject using questionnaire and measurements. Blood pressure was measured during two separate visits using automatic oscillometric devices. Serum total cholesterol concentration was measured using enzymatic method in central laboratory. Prevalence of risk factors was reported separate in men and women. Results of the survey are presented in Table 1. Conclusion: Hypercholesteroleamia is most prevalent risk factor in Poland and more than half of the subjects have increased total cholesterol level. About one third of the Polish citizens are hypertensive. Smoking is less prevalent than in previous studies, however still more than 30% of men are current smokers. Table 1. Risk factor (prevalence) Men Women point estimate [%] (95% CI) point estimate [%] (95% CI) Hypertension (≥ 140/90 mmHg or treatment) 35.2 (32.1-38.3) 28.9 (25.9-31.8) Hypercholesterolaemia (≥ 190 mg/dL or treatment) 61.1 (57.7-64.5) 60.7 (57.6-63.9) Smoking 30.9 (27.9-33.9) 23.1 (20.5-25.7) Obesity (BMI ≥ 30kg/m2) 23.2 (20.8-25.7) 20.2 (17.8-22.6) Risk factor (prevalence) Men Women point estimate [%] (95% CI) point estimate [%] (95% CI) Hypertension (≥ 140/90 mmHg or treatment) 35.2 (32.1-38.3) 28.9 (25.9-31.8) Hypercholesterolaemia (≥ 190 mg/dL or treatment) 61.1 (57.7-64.5) 60.7 (57.6-63.9) Smoking 30.9 (27.9-33.9) 23.1 (20.5-25.7) Obesity (BMI ≥ 30kg/m2) 23.2 (20.8-25.7) 20.2 (17.8-22.6) Open in new tab Table 1. Risk factor (prevalence) Men Women point estimate [%] (95% CI) point estimate [%] (95% CI) Hypertension (≥ 140/90 mmHg or treatment) 35.2 (32.1-38.3) 28.9 (25.9-31.8) Hypercholesterolaemia (≥ 190 mg/dL or treatment) 61.1 (57.7-64.5) 60.7 (57.6-63.9) Smoking 30.9 (27.9-33.9) 23.1 (20.5-25.7) Obesity (BMI ≥ 30kg/m2) 23.2 (20.8-25.7) 20.2 (17.8-22.6) Risk factor (prevalence) Men Women point estimate [%] (95% CI) point estimate [%] (95% CI) Hypertension (≥ 140/90 mmHg or treatment) 35.2 (32.1-38.3) 28.9 (25.9-31.8) Hypercholesterolaemia (≥ 190 mg/dL or treatment) 61.1 (57.7-64.5) 60.7 (57.6-63.9) Smoking 30.9 (27.9-33.9) 23.1 (20.5-25.7) Obesity (BMI ≥ 30kg/m2) 23.2 (20.8-25.7) 20.2 (17.8-22.6) Open in new tab P577 SURF - SUrvey of Risk Factor Management SURF, MT Marie Therese Cooney1, Z Reiner2, L Ryden3, J De Sutter4, W Sheu5, A Mithal6, N Chung7, YT Lim8, A Dudina1, IM Graham1 1Adelaide & Meath Hospital, Incorporating the National Children's Hospital, Dublin, Ireland, 2University Hospital Centre Zagreb, Zagreb, Croatia, 3Karolinska Institute, Stockholm, Sweden, 4AZ Maria Middelares Hospital, Ghent, Belgium, 5Taichung Veterans General Hospital, Taichung, Taiwan, 6Medanta-The Medicity, New Delhi, India, 7Yonsei University Hospital, Seoul, Korea, Republic of, 8Mount Elizabeth Medical Centre, Singapore, Singapore Atherosclerosis/CAD (Prevention & Epidemiology) Background: Previous audits of risk factor control in thosewith established coronary heart disease in Europe have shown disappointinglyhigh levels of individuals not reaching guideline recommended risk factortargets. Ongoing audits of secondary prevention measures are required tomonitor these trends and develop appropriate strategies for addressing currentdeficiencies. However, detailed risk factor audits may be expensive and timeconsuming. They are often undertaken only in larger centres and results may notbe representative of practice in the country as a whole. Purpose: We aimed to develop a verysimple, quick and economical survey of risk factor management to complementmore detailed audits and to complete a pilot audit secondary prevention measures in Europe and Asia. Methods: Consecutive patients (aged 18 and over) withestablished coronary heart disease attending out-patient cardiology clinics were included. Informationon demographics, previous coronary medical history, smoking history, history ofhypertension, dyslipidaemia or diabetes, physical activity, attendance at cardiac rehabilitation, cardiac medications, lipid and glucose levels (andHbA1c in diabetics) if available within the last year, blood pressure, body mass index, waist circumference and heart rate was collected using a one page datacollection sheet. This information could be easily collected within a 60 to 90second timeframe. Years spent in full time education was added as an additionalquestion during the pilot phase. Results: Three European countries, Ireland (n = 251), Belgium (n = 122) and Croatia (n = 124) and four Asian countries (Singapore (n = 142), Taiwan (n = 334), India (n = 97) and Korea (n = 45), were included in the pilot study. There was poor control of several risk factors including high levels of physical inactivity (43%), 69% were overweight or obese (79% of Europeans), 15% were still smoking. There were lower levels of individuals attending cardiac rehab in Asia. More Europeans reached low-density lipoprotein cholesterol target, <2.5mmol/l; 67% versus 59% of Asians, reflecting differences in medication usage. However, blood pressure control was superior in Asia, with 79% reaching the <140/90mmHg target compared to 68% of Europeans. Conclusion: SURF is simple and easy to complete - thisshould allow for wide application increasing representativeness as well as facilitating frequent repeat audits for monitoring of continuing trends in secondary prevention. P578 Pulmonary arterial hypertension and prognosis in patients with acute heart failure C Clara Bonanad1, J Nunez1, J Sanchis1, V Bodi1, FJ Chorro1, G Minana1, P Palau1, A Llacer1 1University Hospital Clinic, Department of Cardiology, Valencia, Spain Heart Failure (Prevention & Epidemiology) Introduction:The prognostic implications of pulmonary arterial hypertension (PAH) in patients with acute heart failure (AHF) are poorly described. We sought to evaluate the prevalence of pulmonary arterial hypertension and the association with long term all-cause mortality in patients admitted for acute heart failure. Methods: We included 1025 patients consecutive admitted for acute heart failure, we excluded valvular aetiology patients (moderate-severe). Right ventricular tricuspid pressure gradient could be measured for doppler echocardiography that allows PA systolic pressure (PASP) to be estimated from the peak velocity of tricuspid regurgitation. We established 4 categories of PASP according severity: C1: non measurable; C2: 35 to 44 mmHg, C3: 45 to 60 mmHg and C4: >60 mmHg. Results: During a median follow-up of 1.7 years (IQR =  0.8-3) 438 (42.7%) deaths were ascertained. PASP was estimated in 398 (38.8%) patients. Mean value was 49+/−13 mmHg and distribution across the established categories was: 627 (61.2%), 177(17.3%), 145(14.1%) and 76(7.4%) for C1 (non measurable) C2 (35 to 44 mmHg), C3 (45 to 60 mmHg) and C4 (> 60 mmHg), respectively. Mortality across PASP categories were similar for C1, C2 and C3 (1.90, 1.94 and 2.31 per 10 patient-years of follow-up, p = 0.633) but higher for those with PASP>60 mmHg (3.65 per 10 patient-years of follow-up, p = 0.001). In multivariate setting, after adjusting for established risk factors and potential confounders, only patients with PAPs>60 mmHg exhibited an independent increase of all-cause mortality risk (HR =  1.73;CI 95% 1.23-2.45, p = 0.002) respecting C1. No significant interaction were observed for PASP>60mmHg and LVEF status. Conclusions: Severe pulmonary arterial hypertension (PASP>60mmhg) when present in patients with acute heart failure identified a subgroup with high mortality risk. Open in new tabDownload slide P579 Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project A Banerjee1, S Taillandier2, J Olesen3, DA Lane1, B Lallemand2, GYH Lip1, L Fauchier2 1City Hospital, Centre for Cardiovascular Sciences, Birmingham, United Kingdom, 2University Francois-Rabelais, Faculty of Medicine, LABPART (EA3852), Tours, France, 3Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark Heart Failure (Prevention & Epidemiology) Background:Heart failure (HF) increases stroke/thromboembolism (TE) risk in non-valvular atrial fibrillation (NVAF) and is incorporated in stroke risk stratification scores. However, the role of ejection fraction (EF) is unclear in contemporary ‘real world’ NVAF patients. Methods:Among NVAF patients in a 4 hospital-institution between 2000 and 2010, those with history of HF and measured ejection fraction were included. Stroke/TE rates were calculated by ejection fraction, i.e.<35%,35-40%,41-49% and ≥ 50%. HF and normal ejection fraction (HFNEF) was defined as EF ≥ 50%. Risk factors were investigated by Cox regression. Results:Among 7156 NVAF patients,1276 patients with HF and measured ejection fraction were included. In non-anticoagulated patients, the stroke/TE rate per 100 person-years was 1.95(95% CI 0.97-3.49). HFNEF patients were more likely to be female, older and hypertensive, and less likely to have vascular disease compared with patients with EF<35% (p < 0.001). Stroke/TE rates were lower in patients with EF<35%, compared with HFNEF(p = 0.02). There were no differences in mortality rates by ejection fraction. In multivariate analyses, only prior stroke (HR 2.36,95% CI 1.45-3.86) and vascular disease (1.57,1.07-2.30) increased stroke/TE risk amongst NVAF patients with HF, but EF<35% did not (0.75,0.44-1.30). Conclusion:In this large ‘real world’ cohort of NVAF patients with HF, there were differences in rates of stroke/TE (but not death) by ejection fraction, but only prior stroke and vascular disease (not reduced ejection fraction) increased stroke/TE risk in multivariate analyses. Thus, HFNEF is associated with stroke risk similar to HF with reduced ejection fraction, and the increased risk of adverse outcomes associated with HF in NVAF is not influenced by ejection fraction. Stroke/TE by ejection fraction Multivariate HR(95% CI) Hypertension 0.91(0.62-1.43) Age>75 1.37(0.85-2.20) Diabetes 0.94(0.62-1.34) Previous stroke 2.36(1.45-3.86) Vascular disease 1.57(1.07-2.30) Age 65-74 1.06(0.64-1.74) Female 1.43(0.96-2.13) EF<35%* 0.75(0.44-1.30) EF 35-49%* 1.27(0.83-1.93) Multivariate HR(95% CI) Hypertension 0.91(0.62-1.43) Age>75 1.37(0.85-2.20) Diabetes 0.94(0.62-1.34) Previous stroke 2.36(1.45-3.86) Vascular disease 1.57(1.07-2.30) Age 65-74 1.06(0.64-1.74) Female 1.43(0.96-2.13) EF<35%* 0.75(0.44-1.30) EF 35-49%* 1.27(0.83-1.93) * reference as normal ejection fraction Open in new tab Stroke/TE by ejection fraction Multivariate HR(95% CI) Hypertension 0.91(0.62-1.43) Age>75 1.37(0.85-2.20) Diabetes 0.94(0.62-1.34) Previous stroke 2.36(1.45-3.86) Vascular disease 1.57(1.07-2.30) Age 65-74 1.06(0.64-1.74) Female 1.43(0.96-2.13) EF<35%* 0.75(0.44-1.30) EF 35-49%* 1.27(0.83-1.93) Multivariate HR(95% CI) Hypertension 0.91(0.62-1.43) Age>75 1.37(0.85-2.20) Diabetes 0.94(0.62-1.34) Previous stroke 2.36(1.45-3.86) Vascular disease 1.57(1.07-2.30) Age 65-74 1.06(0.64-1.74) Female 1.43(0.96-2.13) EF<35%* 0.75(0.44-1.30) EF 35-49%* 1.27(0.83-1.93) * reference as normal ejection fraction Open in new tab P580 First insights into the role of B-type natriuretic peptide response with peak exercise and symptom reproduction in the new diagnosis of heart failure KJ Kuan Joo Voon1, G Murtagh1, M Badabhagni1, A Patle1, MT Ledwidge1, R O' Hanlon1, KM Mc Donald1 1St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland Heart Failure (Prevention & Epidemiology) Purpose: The diagnosis of heart failure (HF) can be challenging. Symptoms may be non-specific, examination unremarkable and B-type natriuretic peptide (BNP) levels may be inconclusive. In such circumstances, the presence of structural/functional abnormality on Doppler-echocardiography may indicate, but does not confirm HF. We sought to examine the role of BNP response to peak exercise in the evaluation of HF diagnosis in this uncertain group. Methods: We have embarked on a prospective randomized study to assess BNP response to exercise in 90 patients with proven HF (n = 30), non-HF (n = 30) and a group of patients with indeterminate presentation (diagnosis of HF unclear, n = 30) as determined by two heart failure cardiologists. Patients with suspected HF referred to out dedicated new diagnostic HF clinic undergo clinical assessment, electrocardiogram, resting BNP and echocardiography. A modified walk test is performed until peak exercise at minimum BORG 3 dyspnoea. BNP levels and Doppler-echocardiography was obtained in each patient using standard techniques at baseline, peak-exercise and 30 minutes post-exercise. Results were expressed as means ± SD. Results: In this ongoing study, we have to date assessed 38 patients (age 74.3 ± 6.9 years, male 56%). Results show a change in pre- and peak-exercise BNP levels in HF vs non-HF of 71.4 ± 99.6 vs 7.1 ± 4.7 pg/mL. HF patients also demonstrated an increase in lateral wall E/E' compared with non-HF group (0.6 ± 3.2 vs −2.2 ± 1.3). Four of nine indeterminate patients have demonstrated a pattern similar to HF patients. Conclusion: As expected, the initial experience in this ongoing study has demonstrated a different trend in exercise-induced changes in BNP and E/E' between HF and non-HF patients. Within the indeterminate group, two distinct patterns are developing which may help provide a more precise diagnosis to this group. P581 Effects of person-centred care in outpatients above 60 years with chronic heart failure V Larina1, B Bart1, M Mikhaylusova1, M Golovko1 1Russian State Medical University, Moscow, Russian Federation Heart Failure (Prevention & Epidemiology) Chronic heart failure (CHF) is associated with high rate of hospitalization and poor prognosis. In order to improve outcomes of these patients, guidelines recommend to adopt management programs involving structured follow-up through outpatient clinic visits. Aim: to evaluate the effects of a person-centred care and an integrated educational intervention for increasing the personal control over the life situation and evaluate his impact on frequency of hospitalization and outcome of aging patients affected CHF. Methods: 248 outpatients (M:65,7%, F:34,3%), aged 69 (65-74) years (range 60-85) with CHF II-IV FC New York Heart Association were enrolled. The intervention group (n = 146) participated in an integrated care intervention, including regular contact with doctor and counseling teaching. The control group (n = 102) received care as usual. Baseline demographic characteristics did not differ between the groups. Patients had clinical evaluation, electrocardiogram, EchoCG, 6 min walking test (WT) and follow-up 2,35(2,3) years. The intervention was evaluated regarding perceived health (Minnesota living with HF questionnaire), depressive symptoms (Hospital Anxiety and Depression Scale) and perceived control (European HF Self-Care behaviour Scale). Results: perceived control increased significantly over time in both group, but the intervention group had a significantly higher perceived control compared to the control group: patients had high levels of understanding about their condition and held strong beliefs in the controllability of their illness, both through medical treatment and their personal control. Clinical status also improved over time in both the intervention and control group (p < 0,001), but the intervention group had a significantly higher quality of life (p < 0,001) and 6 min WT distance compared to the control group (p < 0,305). The level of depressive symptoms was consistent over the follow-up period and no differences were detected between the groups. During follow-up a significant (28,1%, p < 0,001) in the intervention and non-significant (9%, p = 0,155) in the control group hospital admission rate reduction was observed. Patients of the control group compared with those in the intervention group exhibited higher 2,35-years mortality (p < 0,001, OR 1,86, 95% CI 0,30-0,95). Conclusion: the intervention had a positive influence on perceived control over the follow-up period. Among CHF outpatients perceived control has been found to be able to predict disease progression, hospitalization and quality of life worsening. Increasing the personal control over the life situation is an important component of successful self-care management. P582 Differences in medications to prevent complications of heart failure at the time of first enrolment into a national multidisciplinary outpatient clinic database. Canadian Heart Failure Network, JM Arnold1, MH Leblanc2, A Kaan3, A Ignaszewski3, P Liu4, J Howlett5, M Rajda6, G Marchiori1 1University Hospital, London, Canada, 2Quebec Heart Institute, Laval Hospital, Quebec, Canada, 3St. Paul's Hospital, Vancouver, Canada, 4University Health Network, Toronto, Canada, 5Foothills Medical Centre, Calgary, Canada, 6Dalhousie University, Halifax, Canada Heart Failure (Prevention & Epidemiology) Background: Canadian Cardiovascular Society guidelines for the prevention and treatment of heart failure (HF) were instituted in 1994 with updates in 2001, 2003, 2006 and then yearly. HF remains a major burden on patients and medical resources across Canada which is a multicultural society where CV risk factors are known to differ across the country. The Canadian Heart Failure Network (CHFN) has enrolled 20,035 patients between 1999-2010. We analysed the CHFN database to identify if preventive cardiovascular medications were prescribed in the community prior to referral to a CHFN clinic. Methods: The CHFN includes 26 sites which have treated 20,035 HF patients with documentation of demographic and disease descriptors. At each clinical visit, medications and other relevant HF data are entered into a common national database. For the purposes of this analysis, only data from the first CHFN data were analysed as these should correlate most closely with the community physician practice rather than the specialized multidisciplinary HF clinics. Results: Mean daily doses (sd) of the most commonly used prevention medications (mg) at first CHFN visit were: ACEi - ramipril 8.4 (4.9), lisinopril 19.3 (11.7), enalapril 18.3 (15.4); angiotensin II receptor blockers -candesartan 12.8 (8.2), losartan 67.3 (35.6), valsartan 131.8 (70.5); STATIN - atorvastatin 29.1 (20.9), simvastatin 30.4 (15.4), rosuvastatin 14.6 (9.0)mg. Respective median tablet doses for each drug were: ACEi - ramipril 10, lisinopril 10, enalapril 20; angiotensin II receptor blockers - candesartan 8, losartan 50, valsartan 120; STATIN - atorvastatin 20, simvastatin 30, rosuvastatin 10mg. Conclusion: HF prevention and/or treatment drugs are well prescribed in good doses at the time of first referral to specialized HF clinics. However, practice patterns may also be influenced by available community resources, maturity of educational outreach programs, and other variables. P583 Alkaline phosphatase is associated with sub-clinical diastolic dysfunction in community based men with cardiovascular risk factors. Data from the STOP HF study. The STOP HF Investigators, CM Conlon1, CC Kelleher1, IR Dawkins2, CJ Watson2, E Tallon2, M Ledwidge2, K Mcdonald2 1University College Dublin, School of Public Health, Physiotherapy & Population Science, Dublin, Ireland, 2St Vincent's University Hospital, Heart Failure Unit, Dublin, Ireland Heart Failure (Prevention & Epidemiology) Purpose: Diastolic dysfunction is recognised to be highly prevalent in the community, particularly in older adults, and is an important prognostic indicator for a number of cardiac conditions. Alkaline phosphatase (ALP) is an established marker of cardio-metabolic risk, associated with age, body mass, blood pressure. More recently it has been linked to cardiovascular disease, diabetes, hypertension and cardiovascular mortality. We sought to investigate a potential link between ALP and diastolic function in a primary care cohort at heightened cardiovascular risk. Methods: This is a cross-sectional analysis of 616 participants of the STOP HF study with complete echocardiographic data who have established cardiovascular risk factors and no previously known ventricular dysfunction. Data were also available on medical history, medications, biomarkers of inflammation, lipid, renal and hepatic function and routinely measured clinical parameters. Preliminary analyses were run separately for both genders to establish univariable associates of diastolic dysfunction taking the presence or absence of diastolic dysfunction as the binary outcome. All co-variates with p-values ≤ .2 were introduced to forward multivariable logistic regression models to establish the foremost associates of diastolic dysfunction. Receiver operating characteristics curves were determined to evaluate the predictive performance of ALP to detect diastolic dysfunction across age categories. Results: A high prevalence of diastolic dysfunction (67%) was observed in the cohort. In males, multivariable associates of diastolic dysfunction [Exponential beta-coefficient (95% confidence interval); p-value] were older age [1.132;1.09-1.79:<001], the absence of AIIA therapy [2.547;1.18-5.49:<.02] and higher ALP levels[28.813;1.96-424.39:<.02]. In females, diastolic dysfunction was associated with older age [1.085;1.05-1.12:<.001] and higher GGT levels [4.838;1.47-15.90:.<.01]. Receiver operating characteristics analyses demonstrated that ALP is significantly associated with diastolic dysfunction in males, particularly in younger age categories (p < .02), however, the AUC values moderate (.600 in older groups, increasing to.679 in younger groups). Conclusions: This analysis demonstrates for the first time that ALP levels are a marker of early sub-clinical diastolic dysfunction in males. Its' association is superior to the more established risk factors and biomarkers such as BNP in this setting. This link between ALP and diastolic dysfunction draws further attention to the emerging issue of cardio-metabolic risk and impending heart failure in the community. P584 The prognostic value of a new tissue Doppler parameter in patients with heart failure C Cristian Mornos1, D Cozma1, L Petrescu1, A Mornos1, D Gaita1 1Institute of Cardiovascular Diseases, Timisoara, Romania Heart Failure (Prevention & Epidemiology) It has been shown that a new Tissue Doppler index, E/(E' × S'), is able to predict a high level of left ventricular (LV) end-diastolic pressure (E = early diastolic transmitral velocity, E' = early diastolic mitral annular velocity and S' = systolic mitral annular velocity). The purpose of our study was to investigate whether E/(E' × S') could be a predictor of cardiac events in patients with heart failure (HF). Methods: Echocardiography was performed in 158 consecutive hospitalized patients with HF. Patients were excluded from the study if any of the following was present: inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular heart disease, acute coronary syndrome at inclusion, coronary artery bypass grafting during follow-up, severe pulmonary disease or renal failure. The other 113 patients formed our study group. E/E' and E/(E' × S') were calculated: medial, lateral and the average of the velocities from the medial and lateral site of the mitral annulus. The primary end-point consisted of cardiac death or readmission due to HF worsening. Results: During the follow-up period (35.7 ± 11.2 months) cardiac events occurred in 70 patients (62%): 18 cardiac deaths (16%) and 52 readmissions for HF (46%). Using the area under receiver operating characteristic (ROC) curves (AUC), the medial E/(E' × S') index was the best predictor of cardiac events (AUC = 0.90, p = 0.001). The average E/(E' × S'), lateral E/(E' × S'), average S' or medial E/E' were also significant for predicting cardiac events (AUC were 0.89, 0.87, 0.85 and 0.83, respectively, each p = 0.001). Average and lateral E/E', lateral and medial S', lateral, medial or average E', left ventricle ejection fraction, indexed left atrial volume and pulmonary artery systolic pressure presented a lower value for AUC. A statistical comparison of the receiver operating characteristics curves demonstrates no significant differences between medial E/(E' × S'), average E/(E' × S') or lateral E/(E' × S'), each p > 0.05. The optimal cut-off value for medial E/(E' × S’) ratio to predict cardiac events was 1.76 with 81% sensitivity and 83% specificity. Kaplan-Meier analysis showed that the cardiac event-free survival rate during follow-up was significantly higher in the group of patients with medial E/(E' × S') ≤ 1.76 than in the rest with medial E/(E' × S')> 1.76 (72% versus 11%, p < 0.001, log-rank). Conclusions: The medial E/(E' × S') index is a powerful predictor of the clinical outcome in patients with HF in sinus rhythm. P585 The impact of inflammatory markers on adverse cardiovascular events in patients with ishemic chronic heart failure S Radovanovic1, I Zivanovic1, A Djokovic1, A Djordjevic-Dikic2, M Krotin1, M Zdravkovic1, M Dekleva3, T Simic4 1Bezanijska Kosa Medical Centre, Belgrade, Serbia, 2 Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia, 3Clinical Hospital Center Zvezdara, Belgrade, Serbia, Belgrade, Serbia, 4Institute of Biochemistry, University of School of Medicine, Belgrade, Serbia, Belgrade, Serbia Heart Failure (Prevention & Epidemiology) Background: According to the recent prospective studies, there are strong indications that markers of inflammation play a critical role in the progression of atherosclerosis and can be used to predict the future adverse cardiovascular events. Still, there are few data, whether these markers are truly independently associated with impaired outcome or progression of the ishemic chronic heart failure (CHF). Methods and results: We assessed the follow-up of 120 consecutive patients with ischemic CHF in which markers of inflammation [high sensitive-C reactive protein (hs-CRP), vascular cell adhesion molecule-1(VCAM-1) and intracellular cell adhesion molecule-1(ICAM-1)] were determined. The primary endpoint was defined by cardiac death, hospitalization due to worsening of heart failure. Cox regression analysis was used to determine whether hs-CRP, VCAM and ICAM were associated with these heart failure-related events. During a median follow-up of 18.4 months 9 patients were hospitalized due to worsening of heart failure, 7 for new episodes of non-stable angina pectoris, 11 patients died for cardiac reasons. Cox regression analysis demonstrated that hs-CRP, (OR = 1.06, CI:1.02-1.11; p < 0.02), was independent predictive factor for cardiac death. Receiver operating characteristics curve was drawn to evaluate the reliability of hs-CRP as marker of mortality (AUC=0.68, CI:0.51-0.85, p < 0.02). The best balanced threshold was 3.3mg/l with 63.6% sensitivity and 63.3% specificity. VCAM-1 was significantly correlated with repeated hospitalization (r = 0.185, p < 0.04) and total number of cardiovascular events (r = 0.22, p < 0.02). Conclusion: Levels of hs-CRP are independently associated with both mortality and morbidity in patients with ischemic chronic heart failure. That is why the ability of treatments to reduce CRP levels, may be important for slowing the progression of atherosclerosis and improve the prognosis of ishemic CHF. P586 Correlation of hs-CRP and levels of adhesion molecules (s-ICAM-1 and s-VCAM-1) in different stages of ischemic chronic heart failure S Radovanovic1, I Zivanovic1, A Djokovic1, A Djordjevic-Dikic2, M Krotin1, V Bisenic1, S Djordjevic1, M Dekleva3, A Savic-Radivojevic4, T Simic4 1Bezanijska Kosa Medical Centre, Belgrade, Serbia, 2 Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia, 3Clinical Hospital Center Zvezdara, Belgrade, Serbia, Belgrade, Serbia, 4Institute of Biochemistry, University of School of Medicine, Belgrade, Serbia, Belgrade, Serbia Heart Failure (Prevention & Epidemiology) Background: There are a few lines of basic research, that indicate that vessel wall inflammation plays a critical role in the initiation and progression of atherosclerosis, as well as in the conversion of stable plaques to unstable lesions. Aim: Our aim was to investigate whether subjects with chronic heart failure (CHF) had higher plasma levels of soluble cell adhesion molecules (s-VCAM-1 and s-ICAM-1) than controls and if they correlate with other markers of inflammation. Methods: 120 consecutive CHF patients, with angiographically demonstrated CAD, divided into four groups according to New York Heart Association classification (NYHA) and 69 subjects as a control group were included in this study. Circulating levels of ICAM-1 and VCAM-1 were assayed using a specific sandwich ELISA kit. As inflammation indexes, Tumor necrosis factor α(TNFα) and High sensitive C reactive protein (hs-CRP) were evaluated. Results:In comparaison to healthy sex- and age- matched controls, CHF patients had significantly higher levels of s-ICAM-1 (367.8 ± 138.1 ng/ml versus 281.3 ± 188.4 ng/ml, p = 0.001). Significant difference was also found in the levels of s-VCAM-1 (1171.3 ± 386.1 ng/ml versus 860.2 ± 340.9 ng/ml, p = 0.001) in these groups. VCAM-1 was significantly correlated with hs- CRP levels, (r = 0,189; p = 0,039) but no significant relationship was noted between VCAM-1 and ICAM-1 and TNFα. Conclusion: Patients with ischemic heart failure have increased levels of plasma adhesion molecule, and there is significant correlation of VCAM-1 and ICAM-1 with New York Heart Association Class. Circulating levels of VCAM-1 also correlated with one of the most important inflammatory marker, hs-CRP. The clinical significance of our findings warrants further investigation. P587 Community management of cardiovascular risk in Stage A/B heart failure: six month follow-up of the COMPARE-HF Cohort. STOP-HF Investigators, S Horgan1, E Tallon1, I Dawkins1, C Conlon1, C Watson1, J Baugh2, K Whyte2, S Miwa1, K Mcdonald1, M Mark Ledwidge1 1St Vincent's University Hospital, Dublin, Ireland, 2University College Dublin, Dublin, Ireland Heart Failure (Prevention & Epidemiology) Background: Current guidelines for heart failure describe Stage A/B heart failure, or pre-heart failure, as predominantly community dwelling and warranting careful risk factor management. This study evaluates the cardiovascular risk factor profile and risk score over six months of the COMPARE-HF population, a community based population with established Stage A/B heart failure. Methods: The Community Programme with CardiovAscular Risk Evaluation for prevention of HF (COMPARE-HF) population is a cohort of community patients with a confirmed diagnosis of at least one of hypertension, diabetes and obesity. We compared blood pressure, cholesterol, glucose, body mass index (BMI) and lifestyle risk factors as well as total cardiovascular risk in the patient cohort at baseline and follow-up. Results: A total of 4296 patients, average age 61 ± 12 years, 2086 (48.6%) male, were identified with confirmed Stage A/B heart failure at baseline. The cohort comprised 2936 (68.3%),1695 (39.5%) and 375 (8.7%) patients with hypertension, obesity and diabetes respectively. A total of 1431 (33.3%) were current or ex-smokers, 3185 (74.1%) were overweight, 2569 (59.8%) took no daily cardiovascular exercise and 3130 (72.9%) consumed alcohol regularly. Of the cohort, 1871 (43.6%) had a normal cholesterol (population average 5.15 ± 1.15 mmol/L) and 1277(29.7%) had sitting blood pressure below 140/90 mmHg (population average 139.6/82.0 ± 18.9/10.6 mmHg). Average body mass index was 29.0 ± 5.5 Kg/M2 and average plasma glucose was 5.75 ± 1.95 mmol/L. Median time to reassessment was 6.2 months (interquartile range 3.3-12.1) and at follow-up there were no differences in population rates of smoking and overweight. Exercise rates and alcohol intake improved modestly. Significant reductions in population blood pressures (−1.5/-1.0 ± 15.7/9.8 mmHg systolic and diastolic respectively), cholesterol (−0.29 ± 1.02 mmol/L) and glucose levels (−0.06 ± 1.67 mmol/L) were observed (all p < 0.0001). However, 3184 (74.1%) of the population remained overweight, 2702 (62.9%) had blood pressure above 140/90 mmHg and 1932 (45%) had elevated total cholesterol levels. Overall Framingham risk score increased from 6.13 ± 5.77% at baseline to 6.22 ± 5.88% at follow-up (p = 0.002). Conclusion: Overall cardiovascular risk profile of Stage A/B heart failure remained high in this community based risk factor intervention programme. Programmes such as the ongoing STOP-HF study which involve a shared care approach with specialist support may be needed to modify the course of Stage A/B heart failure in at-risk community populations. P588 Impact of Obstructive Sleep Apnea on Heart Rate, Heart Rate Recovery, and QTc and P-wave Dispersion in newly diagnosed untreated patients Baskent University School Of Medicine, D Davran Cicek1, H Lakadamyali1, S Gokay1, I Sapmaz1, H Muderrisoglu2 1Baskent University Antalya Hospital, Antalya, Turkey, 2Baskent University, Faculty of Medicine, Ankara, Turkey Other Heart Disease (Prevention & Epidemiology) Background: Obstructive sleep apnoea syndrome (OSAS) is associated with autonomic dysfunction. Elevated heart rate (HR), heart rate recovery time (HRR-1), QT corrected interval (QTc), and P-wave dispersion (Pd) are associated with cardiovascular events. We sought to clarify the influence of the severity of obstructive sleep apnea syndrome on these parameters. Methods: Ninety-one newly diagnosed untreated obstructive sleep apnea syndrome patients who underwent overnight polysomnography, cardiopulmonary exercise testing including HRR-1, echocardiography (ECHO), 24-h Holter electrocardiography, a surface electrocardiogram (ECG), and measurement of several metabolic parameters were examined. The patients were divided into the following 4 groups: 26 with AHI < 5, 11 with 5 ≤ AHI < 15, 20 with 15 ≤ AHI < 30, and 33 with AHI ≥ 30. QTc and Pd were calculated in all leads of the surface electrocardiogram. Mean HR was measured by 24-h Holter electrocardiogram, and the HRR-1 was measured by cardiopulmonary exercise testing. Results: QTc was increased in moderate-severe OSA patients. Pd was significantly increased compared to patients without OSA and Pd was related to AHI, hence to the severity of the disease. Mean HRs over a period of 24 h during wakefulness and sleep correlated significantly with AHI and the lowest SpO2 in patients with OSA, and HRR-1 was inversely correlated to the severity of obstructive sleep apnea syndrome, as expressed by AHI. Conclusion: The present results showed that heart rate, Pd, HRR-1, and QT corrected time are correlated with the severity of OSA. Further studies are required to investigate the prognostic impact of HRR-1, Pd, heart rate, and QTc in obstructive sleep apnea syndrome. electrocardiogram parameters of the patients with OSA GROUPA GROUPB GROUPC GROUPD P HR (pulse/min) 72.7 ± 15.9 71.5 ± 14.3 74.8 ± 11.4 80 ± 13.6 0.0002 Pd (m/s) 42.9 ± 10.2 39.3 ± 10.6 49.4 ± 10.9 59.7 ± 9.5 0.0001 HRR-1 (bpm) 30.9 ± 7.1 35.4 ± 14.1 24.1 ± 14.8 17.0 ± 8.7 0.0001 QTc (m/s) 422 ± 26.6 427 ± 16.5 436 ± 47 437 ± 41.5 0.003 GROUPA GROUPB GROUPC GROUPD P HR (pulse/min) 72.7 ± 15.9 71.5 ± 14.3 74.8 ± 11.4 80 ± 13.6 0.0002 Pd (m/s) 42.9 ± 10.2 39.3 ± 10.6 49.4 ± 10.9 59.7 ± 9.5 0.0001 HRR-1 (bpm) 30.9 ± 7.1 35.4 ± 14.1 24.1 ± 14.8 17.0 ± 8.7 0.0001 QTc (m/s) 422 ± 26.6 427 ± 16.5 436 ± 47 437 ± 41.5 0.003 Table 3 Electrocardiographic parameters of the patients with severe obstructive sleep apnoea (OSA) determined using AHI Open in new tab electrocardiogram parameters of the patients with OSA GROUPA GROUPB GROUPC GROUPD P HR (pulse/min) 72.7 ± 15.9 71.5 ± 14.3 74.8 ± 11.4 80 ± 13.6 0.0002 Pd (m/s) 42.9 ± 10.2 39.3 ± 10.6 49.4 ± 10.9 59.7 ± 9.5 0.0001 HRR-1 (bpm) 30.9 ± 7.1 35.4 ± 14.1 24.1 ± 14.8 17.0 ± 8.7 0.0001 QTc (m/s) 422 ± 26.6 427 ± 16.5 436 ± 47 437 ± 41.5 0.003 GROUPA GROUPB GROUPC GROUPD P HR (pulse/min) 72.7 ± 15.9 71.5 ± 14.3 74.8 ± 11.4 80 ± 13.6 0.0002 Pd (m/s) 42.9 ± 10.2 39.3 ± 10.6 49.4 ± 10.9 59.7 ± 9.5 0.0001 HRR-1 (bpm) 30.9 ± 7.1 35.4 ± 14.1 24.1 ± 14.8 17.0 ± 8.7 0.0001 QTc (m/s) 422 ± 26.6 427 ± 16.5 436 ± 47 437 ± 41.5 0.003 Table 3 Electrocardiographic parameters of the patients with severe obstructive sleep apnoea (OSA) determined using AHI Open in new tab P589 Every day dark chocolate intake decreases the cardiometabolic risk A I Andra Iulia Suceveanu1, AP Suceveanu1, L Mazilu1, RI Prepa1, D Catrinoiu1 1Ovidius University of Constanta, Faculty of General Medicine, Constanta, Romania Other Heart Disease (Prevention & Epidemiology) Background: Approximately 1/5 of worldwide adults are likely to have a metabolic syndrome or a cardiovascular disease and there are scientific proves that chocolate consumption might be beneficial in the prevention of cardiometabolic disorders. Aim. We aimed to asses if there is any association between chocolate intake and the risk for cardiometabolic disorders in geographic area of the Constanta County. Material and method. We studied 85 patients hospitalized in Internal Medicine Units of Emergency Hospital of Constanta County split into two groups according to chocolate consumption: never or more than once per day. Patients were matched by age, sex, body mass index, physical activity, smoking and other dietary factors (fats, saturated lipids, etc). All types of chocolate consumption were reported: dark, sweet, milk or white chocolate. We compared the risk of cardiometabolic diseases between the two groups. Results. Our study results showed that only dark chocolate, with content of cocoa > 35% according to European rules, had cardiometabolic benefits. Every day dark chocolate intake reduced the risk of coronary heart disease with 23% (RR 0.57; 95% CI 0.23-0.71), of cardiovascular disease mortality with 19% (RR 0.56; 95% CI 0.37-0.80) and the risk of any cardiovascular disease with 38% (RR 0.67; 95% CI 0.48-0.93). Every day dark chocolate consumption also showed reduction of the risk of incident diabetes in 28%, regardless the gender of patients (RR 0.65; 95% CI 0.46-0.93). Conclusions. Dark chocolate consumption once per day decreases the cardiometabolic disorders risk and mortality in patients of Constanta County. P590 Contemporary children with congenital heart disease are not limited in their submaximal exercise performance but still represent reduced peak oxygen uptake in comparison to healthy peers J Mueller1, B Boehm2, J Hess3, R Oberhoffer1, A Hager3 1German Heart Center and Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany, 2Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany, 3German Heart Center, Hospital rechts der Isar at the Technical University of Munich, Munich, Germany Other Heart Disease (Prevention & Epidemiology) Objective: Peak oxygen uptake is limited in patients with congenital heart disease (CHD). However, medical approach, improvement in aftercare and the encouragement to an active lifestyle and sport activities might have improved the exercise performance of those patients. This study tries to investigate the difference regarding exercise performance between children with coronary heart disease and their healthy counterparts and to determine whether limitations are associated with cardiac functioning. Patients and Methods: In the year 2010, eighty-eight children age eleven to fourteen years (12.7 years, 52 male) with various congenital heart diseases performed a cardiopulmonary exercise test in our institution. Those children were matched for age and gender with healthy peers, who underwent the same procedure and compared regarding their exercise performance. Results: Children with coronary heart disease had a normal submaximal exercise performance (oxygen uptake at ventilatory threshold; CHD: 20.6 ml/min/kg versus controls: 21.5 ml/min/kg; p = .675) in comparison to healthy counterparts albeit their peak oxygen uptake was diminished (CHD: 35.5 (31.3; 41.0) ml/min/kg versus controls: 42.4 (36.1; 47.3) ml/min/kg; p < .001) corresponding to 87.1% (CHD) and 99.5% (Controls) of the reference value, respectively. In children with coronary heart disease peak oxygen uptake was positively associated with oxygen pulse (r = .541; p < .001) and peak heart rate (r = .429; p < .001). On the other hand, peak oxygen uptake in healthy subjects was not related to peak heart rate. Moreover, peak oxygen uptake decreased with the severity of the heart defect (r = −.410; p < .001). Conclusions: Children with coronary heart disease are not limited in their submaximal exercise performance in comparison to healthy counterparts. However, it still persist a reduction in peak oxygen uptake due to chronotropic incompetence. P591 The role of restricted physical activity in the prevention of recurrent idiopathic pericarditis E Siniorakis1, S Spyridon Arvanitakis1, N Pantelis1, N Marinakis1, G Psatheris1, P Pelonis1, D Marinis1, K Roussou1, D Giannopoulos1, S Limberi1 1Sotiria Regional Chest Diseases Hospital, Athens, Greece Other Heart Disease (Prevention & Epidemiology) Purpose: Recurrence occurs, on average, in 25% of idiopathic pericarditis cases, despite adequate pharmaceutical approach. We hypothesized that abstinence from intense physical activity, during the convalescence period, when prescribed with conventional treatment, would reduce the rate of recurrence. Methods: Thirty nine professionally active patients (12% manual workers, Male = 14, Female = 25, age = 54 ± 15 years), hospitalized with acute idiopathic pericarditis, were recruited. Upon discharge, all patients were prescribed acetyl-salicylic acid 650mg per os, three times daily, with colchicine 0.5mg daily, for a total period of two months. Restricted physical activity was also suggested for the above convalescence period. Follow up lasted for two years and recurrence was validated when at least two of the following manifestations reappeared: pain, fever, friction rub, new or worsened pericardial effusion in the echocardiogram. Fifteen patients complying with limited physical activity during the first two months, constituted group A, while the remaining patients, unwilling to follow restricted activity, constituted group B. The recurrence rate of pericarditis between the two groups was compared by the t-test. Results: Age, sex distribution and admission values of C-reactive protein (14.6 vs 16.8 mg/dl, p = NS) were similar between the groups. Pericarditis recurred in 13% of group A patients vs 33% of group B (p < 0.0001). Attacks per patient per month were 0.06 in group A vs 0.15 in group B (p < 0.001). Every recurrence was treated with a new administration of acetyl-salicylic acid plus colchicine, with gradual tapering after a period of 4 weeks. Corticosteroids were avoided until the end of the follow-up. Conclusions: Restricted physical activity during the acute phase of idiopathic pericarditis should be strongly recommended, as an auxiliary tool for recurrence prevention. P592 Ischaemic stroke mortality rapidly declines in the netherlands, though incidence is increasing I Ilonca Vaartjes1, M O' Flaherty2, S Capewell2, ML Bots1 1University Medical Center Utrecht - Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands, 2University of Liverpool, Liverpool, United Kingdom Other Heart Disease (Prevention & Epidemiology) Background: The decline in ischaemic stroke (IS) mortality in the Netherlands briefly slowed in the 1990s, but then accelerated in the new millennium. IS mortality is strongly related to IS incidence. In the present study we determined nationwide IS incidence from 1997 to 2005. Methods: First hospitalized IS patient were identified through linkage of the national hospital discharge register and the population register using ICD-9 codes 434 and 436. Out-of-hospital deaths for IS were identified in the national cause of death register using ICD-10 code I63 and I64. We calculated age-sex specific incidence rates and age standardized incidence rates for every year. We identified trends in time series using Mann-Kendall tests. Results: Between 1997 and 2005 we identified 173,293 new IS cases (45% men). Twenty-six percent were out-of-hospital deaths. The age standardized incidence rate increased from 111 per 100,000 in 1997 to 119 per 100,000 in 2005 in men and from 90 per 100,000 in 1997 to 105 in 2005 in women (figure 1). In both men and women this increase in incidence over time was significant. The increase in age-sex specific incidence rate over time was significant in men aged 1 to 54 years and 75 to 94 years and in women aged 45 to 64 years and 75 to 84 years. Conclusions: Ischaemic stroke mortality rapidly declined in the new millennium while IS incidence increased between 1997 and 2005. The decline in IS mortality can not be explained by the changes in incidence. Therefore, investigation of trends in case fatality and secondary prevention after IS is needed for further explanation. Furthermore, risk factor trends should be investigated to explain the worrisome increasing trend in IS incidence. Open in new tabDownload slide P593 Immunochemotherapy-induced cardiovascular complications in patients with B-cell chronic lymphocytic leukemia: response to carvedilol B Borys Samura1 1Zaporozhye State Medical University, Zaporozhye, Ukraine Other Heart Disease (Prevention & Epidemiology) Purpose: The aim of this study was to determine the protective effect of carvedilol in Immunochemotherapy-induced cardiomyopathy. The natural history of immunochemotherapy-induced cardiomyopathy, as well as its response to cardiovascular therapy, remains poorly defined. Hence, evidence-based recommendations for management of this form of cardiomyopathy are still lacking. Carvedilol is a nonselective that also blocks alpha1-adrenergic receptors and is a potent antioxidant. Alemtuzumab is a monoclonal antibody to CD52 that has activity in leukemia and lymphoma. This study aims to describe the complications and outcomes of a subset of patients with B-cell chronic lymphocytic leukemia who were treated with Immunochemotherapy. Methods: Patients with B-cell chronic lymphocytic leukemia in whom alemtuzumab, fludarabin and cyclophosphamide therapy was planned were enrolled in the study. We included in the study 11 patients in carvedilol and 10 patients in control groups. In the carvedilol group, 12.5 mg once-daily oral carvedilol was given during 6 months. The patients were evaluated with echocardiography before and after chemotherapy. Left ventricular ejection fraction (EF) and systolic and diastolic diameters were calculated. Results: At the end of 6 months of follow-up, 1 patient in the carvedilol group and 3 in the control group had died. Control ejection fraction was below 50% in 1 patient in the carvedilol group and in 4 in the control group. The mean ejection fraction of the carvedilol group was similar at baseline and control echocardiography (65.1 versus 64.8, respectively; p = 0.2), in the control group the mean ejection fraction at control echocardiography was significantly lower (64.9 versus 48.1; p < 0.001). Both systolic and diastolic diameters were significantly increased compared with basal measures in the control group. In Doppler study, whereas E velocities in the carvedilol group decreased, E velocities and E/A ratios were significantly reduced in the control group. Conclusions: Prophylactic use of carvedilol in patients with B-cell chronic lymphocytic leukemia receiving immunochemotherapy may protect both systolic and diastolic functions of the left ventricle. P594 Towards a reliable toolbox for a practical non-invasive differentiation of normally functioning from dysfunctional aortic valve replacements: the effective prosthetic opening area F Frank Van Buuren1, D Horstkotte1, L Faber1, KP Mellwig1, C Prinz1, N Bogunovic1 1Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany Other Heart Disease (Prevention & Epidemiology) Purpose: Dysfunction of heart valve prostheses (VP) is a life-threatening complication and the proper diagnosis remains difficult. Our task was to improve the easy detection of dysfunctional VP by optimising the application of single parameters, in this study the prosthetic effective orifice area (VA), by introducing the minimal expected normal VA (VAexpected). Methods: We investigated 1369 normally functioning aortic valve replacements (AVP), echocardiographically. VA, transprosthetic peak (PPG) and mean pressure gradient (MPG) were evaluated to gain reference values depending on prosthetic construction and size. The results were compared with those of 65 dysfunctional AVPs. Results: In normally functioning prostheses, VAs were not significantly different between biological, monodisc, and bileaflet models sized 19-26 mm. In prostheses sized 27-31 mm, the bileaflet AVPs demonstrated the best haemodynamics followed by monodisc and biological prostheses. To estimate VAexpected of prostheses, an empirical developed formula was applied as threshold between normal and dysfunctional stenotic AVP. This formula showed a proper estimation of VAexpected in 87% of all normally functioning and 100% of dysfunctional stenotic VPs. Conclusion: As nearly independent from stroke volume and in consideration of VAexpected, VA seems to be one of the preferable parameters to detect pathological stenotic AVPs echocardiographically. PPG/MPG and other parameters are additionally useful to judge prostheses with relevant isolated regurgitation. Open in new tabDownload slide P595 Increased control possibilities over coronary risk degree by the automated programs RI Vorobyev1, VA Leschenko2, TV Verchinina2, I Irina Osipova1 1Altay State Medical University, Barnaul, Russian Federation, 2The Altay Regional Diagnostic Centre, Barnaul, Russian Federation Other Heart Disease (Prevention & Epidemiology) Purpose: To estimate 10-year-old fatal risk SCORE at the organized population, defined by the developed computer program. Research methods: 5228 persons from the organized city population - 1351 men (40,53 + 12,39 years) and 3877 women (40,79 + 13,28 years) have been surveyed. All patients have been divided into some groups - the first group persons age from 20 till 29 years have made, the second group at the age of 30-39 years, in 3rd - 40-49 years, in 4th - 50-59 years, 5th - is more senior 60 years. Besides, in all age groups patients have been divided on a sex. Risk factors of cardiovascular diseases were determined by questioning (age, smoking), anthropometrical (growth, weight of a body with calculation of body mass index, waist circle) and measurement of arterial pressure were done. Laboratory research included definition of the serum total cholesterol with standard set of reagents on the biochemical analyser. At patients the 10-year-old fatal risk on the international scale SCORE specially developed computer program. Results: In the general group of men and women (55%) had low risk, 35% - the moderate, 10% - high and very high risk. It was found that at women the low risk (73%) prevailed, the group of moderate risk was 20% of surveyed, with high and very high risk was revealed - 7%. Among men 78% had moderate risk, 1% - low and 21% - high and very high risk level. It was revealed that women in age groups before 60 years had value of cardiovascular complications risk from 0 to 10%, at age more than 60 years risk was from 1% to 13%. Thus the risk size gradually raised with the years on the average from 0,06% to 5,31%. Men in age groups of 20-29 years, 30-39 years and 40-49 years had a risk from 1% to 10%, 50-59 years to 22%, more than 60 years - 35%. So the tendency identical to women - the increasing of absolute risk values with age was observed (from 1,13% to 11,12%). Conclusions: Definition of risk with the help of the developed computer program 10-year-old fatal risk on the international scale SCORE has allowed to survey quickly considerable contingents of patients, store results in a database, to form groups of the directed preventive measures and is effective for risk factors observation. P596 Low socioeconomic status relates to short-term mortality risk after acute myocardial infarction, especially in men. L Van Oeffelen1, C Agyemang2, C Koopman1, L Van Rossem1, ML Bots1, K Stronks2, I Vaartjes1 1University Medical Center Utrecht - Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands, 2Academic Medical Center, Amsterdam, Netherlands Other Heart Disease (Prevention & Epidemiology) Introduction: Previous studies show poorer short-term prognosis after an acute myocardial infarction (AMI) in subjects with a low socioeconomic status (SES). Yet, the magnitude of these relations may differ by age and sex. Data on these issues are scarce. Furthermore, studies stratifying by age and sex use SES data on neighborhood level which gives rise to misclassification. Methods: A Dutch cohort of first AMI patients between January 1st 1998 and December 31st 2007 was identified through linkage of national registers. SES was defined as the standardized disposable income on household level in the year before the AMI. For every SES quintile, age- and sex- specific short-term mortality rates were quantified. Logistic regression models were used to estimate differences between SES quintiles in out-of-hospital mortality and 28-day case-fatality. Results: We identified 76,351 first AMI patients with income data available, of which 52,224 were men and 24,127 were women. There were strong inverse associations between SES and both short-term mortality outcomes when comparing the lowest with the highest income quintile (out-of-hospital mortality: Odds Ratio (OR) 1.25; 95% Confidence Interval (95% CI) 1.18-1.33), 28-day case-fatality: OR 1.22; 95% CI 1.13-1.32). In men, strong inverse relations of the same magnitude were shown with both short-term mortality outcomes, whereas in women these were only shown for out-of-hospital mortality. There was no evidence for differences between age categories. Conclusion: The results indicate an increased risk of out-of-hospital mortality after a first AMI in subjects with a low SES, independent of age. Men, but not women, with a low SES have an increased risk of dying within 28 days after a first AMI hospitalization. P597 Decline in coronary heart disease mortality in Portugal (1995-2008) M Pereira1, K Bennett2, N Lunet1, A Azevedo1, S Capewell3 1Faculdade de Medicina; Inst. Saúde Pública U Porto, Porto, Portugal, 2Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland, 3Division of Public Health, University of Liverpool, Liverpool, United Kingdom Other Heart Disease (Prevention & Epidemiology) Purpose: Coronary heart disease (CHD) mortality has declined substantially in Portugal over the last two decades. The aim of this study was to quantify the contribution of changes in risk factors and evidence based treatments to the coronary heart disease mortality fall in Portugal between 1995 and 2008. Methods: The previously validated IMPACT coronary heart disease mortality model was used in all calculations, for the adult population aged 25-84 years. We included age- and sex-stratified data on population size and coronary heart disease mortality obtained from the National Institute of Statistics. Estimates of the risk factors were obtained from a systematic review or from the National Health Survey 1995/1996 for 1995, and from a national study of the prevalence of the metabolic syndrome for 2008. Medical treatment data were available from the National Registry of Acute Coronary Syndromes, national hospital discharge registry and community-based epidemiologic studies. Results: In 2008, there were 2135 fewer coronary heart disease deaths in men and 1625 in women than expected if 1995 mortality rates had remained unchanged. In men and women, we observed a higher contribution of the change in treatments (men approximately 51%; women 57%), compared with risk factors (men 37%; women 42%). Among treatments, primary and secondary prevention for acute coronary syndromes and treatment of angina made the highest contribution (between 10 and 15% each), followed by treatment of chronic heart failure in the community (men: 5%; women: 10%) and primary prevention with statins to lower cholesterol/LDL (8% in both sexes). Among risk factors, the largest contributions came from decreasing cholesterol (men 14%;women 24%) and blood pressure (men approximately 18%; women 21%), followed by smoking among men (11%). Worrying adverse trends were observed for body mass index and diabetes among men and for body mass index and smoking among women, contributing to an increase in coronary heart disease deaths of up to 5% each. Conclusions: In this low-risk population, future coronary heart disease control strategies should actively promote primary prevention based on lifestyle changes, and should also maximize the population coverage of effective treatments. P598 Time trend of main cardiovascular diseases prevalence in the Italian adult population: preliminary data from the Italian health examination survey C Donfrancesco1, L Palmieri1, F Dima1, C Lo Noce1, P De Sanctis Caiola1, S Vannucchi1, D Vanuzzo2, S Giampaoli1 1Istituto Superiore di Sanità, Rome, Italy, 2ASS4 “Medio Friuli”, Centre for Cardiovascular Prevention, Udine, Italy Other Heart Disease (Prevention & Epidemiology) Background: Despite cardiovascular diseases (CVD) are the leading causes of death and hospitalization in nearly all countries in Europe, there are paucity, weak quality and comparability of data. The periodic Health Examination Survey (HES) represents in Italy the major source of information on cardiovascular disease at national level thanks to the adoption of standardized methodologies throughout the country. The aim is to present differences in trends of cardiovascular disease prevalence in the Italian adult population from 1998 to 2008. Methods: Randomized population samples stratified by age and sex were examined. In 1998, 9,712 men and women aged 35-74 years were enrolled in all Italian regions; ongoing screening started in 2008 is enrolling 9,020 persons. A standardized questionnaire investigates cardiovascular disease and pharmacological treatments. The anamnesis is positive when clinical diagnosis has been made by a physician. Electrocardiograms read in Minnesota code are also used to define previous myocardial infarction. Results: Data are from 12 regions in the North, Center, and South of Italy: 3,704 men and women in 1998 and 3,479 persons in 2008 are compared. In men, prevalence of cerebrovascular events decreases from 1.5% (95% confidence interval: 1.0-1.9%) in 1998 to 0.6 (0.3-0.9%) in 2008; in women, prevalence results stable: 0.9% in 1998 (0.5-1.3%) and 0.7% in 2008 (0.4-1.1%). Prevalence of myocardial infarction results stable both in men and women: in 1998, 1.9% in men (1.4-2.4%) and 0.6% in women (0.3-0.9%), and in 2008, 2.0% (1.4-2.7%) and 0.6% (0.3-0.9%) respectively; angina pectoris results stable as well: in 1998, 2.2% in men (1.7-2.8%) and 3.9% in women (3.1-4.6%), and in 2008, 3.2% (2.5-4.0%) and 4.5% (3.6-5.4%) respectively. Prevalence of bypass or angioplasty surgery increases in men: 2.4% (1.8-3.0%) in 1998, and 4.5% (3.6-5.4%) in 2008; in women increasing is not significant: from 0.2% (0.0-0.4%) in 1998 to 0.7% (0.3-1.1%) in 2008. Stratifying data by geographical area (North, Center, South and Island) all comparisons become not significant; in men only, cerebrovascular decreasing and bypass or angioplasty surgery increasing trends tend to be confirmed in all three areas. Conclusions: Trends between 1998 and 2008 decrease in cerebrovascular events and increase in prevalence of bypass or angioplasty surgery, especially in men. Stable prevalence resulted for myocardial infarction and angina pectoris. Cerebrovascular decreasing trend is in line with smoking prevalence and mean of blood pressure decreasing in the country. Further analyses considering data from all Italian regions are needed to confirm results. P599 Prevalence of transient loss of consciousness in patients referred to a sub-acute care unit after traumatic falls L Dalla Vecchia1, L Bagnara1, L Beltrami1, V De Grazia1, A Lucini1, V Mansi1, F Zilli1, L Zingale1 1Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Milan, Milan, Italy Other Heart Disease (Prevention & Epidemiology) Purpose: The Sub-Acute Care Unit represents a new approach for management of patients who, after an acute severe illness, need further in-hospital care to complete the process of recovery, manage comorbidities, restore functional capacity and define prognosis and follow-up. During the first year of this innovative clinical activity, we found that about 10% of admissions were represented by a diagnosis of mild to severe injury caused by a fall without a clear aetiology, often occurring in elderly patients and defined as likely accidental. Aim of the present study was to identify the cause of the falls and/or the presence of true loss of consciousness (T-LOC) among these patients. Methods: We enrolled 100 consecutive patients with diagnosis of accidental fall associated with bone fractures (46%) or mild (27%), moderate (24%), severe (3%) contusion. Patients received “initial evaluation”, as recommended by ESC-Guidelines for syncope (careful medical history, complete clinical examination, orthostatic blood pressure measurements, standard electrocardiogram); in addition a Mini Mental State Examination (MMSE) was performed. electrocardiogram monitoring (Holter), two-dimensional echocardiographic and colour Doppler examination (Echo), carotid sinus pressure (CSP) were scheduled in selected cases. Results: 80% of the patients were transferred from surgical wards, 20% from medical departments. Age was 78 ± 12 years (range 25-96); MMSE value was 22 ± 7 (n.v.=30). Holter was obtained in 12 pts, Echo in 16 and CSP in 4. Three groups of patients were identified: 1) 27 pts with a clear accidental fall: compared to the other groups age was lower, MMSE was higher, a witness was often available (55%); 2) 37 pts with unclear findings; 3) 36 pts with history and/or findings highly suggestive of T-LOC. In the latter group, causes were identified in 33 patients (89%): orthostatic hypotension (19 pts, iatrogenic in 10), rapid paroxysmal atrial fibrillation (2 pts), ventricular tachycardia (1 pt), sick sinus syndrome or complete atrioventricular block (3 pts), severe aortic stenosis (1 pt), neurally mediated syncope (2 pts), severe pulmonary hypertension (1 pt), severe anemia (2 pts), severe hypothyroidism (1 pt), sudden death (1 pt). Conclusions: the diagnosis of T-LOC in elderly patients with history of falls is easily underestimated; cognitive impairment may represent a limitation at medical interview. However, the application of the recommended guidelines for syncope may identify a transient loss of consciousness in a significant number of patients and guide further clinical monitoring and specific tests to define aetiology and proper management. P600 Usefulness of tilt table testing in patients with suspected epilepsy I Ines Rangel1, J Freitas1, A Lebreiro1, A Sousa1, AS Correia1, M Paiva1, C Sousa1, MJ Maciel1 1Sao Joao Hospital, Porto, Portugal Other Heart Disease (Prevention & Epidemiology) Background: About 20% to 30% of epileptic patients may have been misdiagnosed and vasovagal syncope (VVS) often seems to be the mistaken cause. Objective: We sought to assess the role of head up tilt testing (HUTT) in diagnosing VVS and in modifying therapeutic orientation, in patients previously suspected of having epilepsy. Methods: We retrospectively analysed clinical records of 107 patients with apparent epilepsy and medicated with antiepileptic drugs, who were referred for head-up tilt test, in the period from January 2000 to December 2010. Results: Among all, 73 (68%) patients were women and the mean age was 38 ± 17 years. Head-up tilt test was positive in 67 (63%) patients (vasodrepressor response in 38, cardioinhibitory in 3, mixed in 26). Thirty-one (29%) patients previously diagnosed with epilepsy were found to be misdiagnosed. Twenty-nine (27%) patients had dual diagnoses of VVS and epilepsy. There was no significant difference in the type of head-up tilt test response between the misdiagnosed group and the dual diagnosis group (p > 0,05). The misdiagnosed patients had stopped taking antiepileptic medication and all positive head-up tilt test patients were counseled about recognizing their prodromes and to perform counterpulsation and postural maneuvers to abort syncope. Conclusion: VVS is an important and common differential diagnosis of epilepsy. Furthermore, epileptic patients often have VVS, increasing the diagnostic complexity. This study shows that head-up tilt test is highly relevant, helping to make an accurate diagnosis and to select the most appropriate treatment in patients presenting with undiagnosed convulsive blackouts. Thus, head-up tilt test should be considered early in the management of these patients. P601 Secondary prevention prescribing and socioeconomic group of patients with peripheral arterial disease JH Park1, C Ruiz1, D Orr1, D Shields1 1Peripheral Vascular Unit, Western Infirmary, Glasgow, United Kingdom Vascular disease (Prevention & Epidemiology) Purpose: Patients with peripheral arterial disease (PAD) should receive secondary preventative medication in primary care. We assessed the prescribing of such drugs in peripheral artery disease patients referred to vascular clinics and correlated this with socioeconomic grouping. Methods: 391 consecutive patients referred to Greater Glasgow vascular services over a two month period were analysed retrospectively. Rates of prescribing, a previous diagnosis of coronary artery/cerebrovascular disease (CAD/CVD), smoking status and socioeconomic group using Carstairs Deprivation Score (DepCat) was noted. Data were analysed using Chi-Square test for dichotomous data and non-parametric testing for continuous data. Results: Secondary prevention prescribing was low with 64% receiving antiplatelets or statins and 47% receiving ACE inhibitors/angiotensin receptor blockers (ACEi/ARB). 212 (54%) patients had no history of CAD/CVD and were significantly less likely to be prescribed antiplatelets (47% versus 83%), statins (45% versus 86%) or ACEi/ARBs (29% versus 68%) (all p < 0.05). 58% versus 42% of patients respectively were current smokers (P < 0.05). Most patients were from lower socioeconomic groups. Those with lower DepCat scores presented younger (median age DepCat 7: 63, 1-2: 74.5, p < 0.0001), were more likely to be referred with claudication rather than critical ischaemia (DepCat 7: 79%, 1-2: 72%, p = 0.056) and were more likely to smoke (DepCat 7: 66%, 1-2: 24%, p < 0.0001). Secondary prevention prescribing did not differ significantly between socioeconomic groups. Conclusion: Secondary prevention prescribing in patients with suspected peripheral artery disease is inadequate across all socioeconomic groups and is significantly lower in those without a previous diagnosis of CAD/CVD. This shows a lack of appreciation of the high cardiovascular risk associated with peripheral artery disease. Deprivation and secondary prevention DepCat 1-2 (46 patients) DepCat 3-4 (92 patients) DepCat 5-6 (110 patients) DepCat 7 (143 patients) p-value Age (Median, IQR) 74.5 (67-81.5) 67.5 (58-75.3) 67.5 (58.3-77) 63 (55-70.5) <0.0001 Intermittent claudication 33 (72%) 61 (66%) 87 (79%) 113 (79%) 0.056 Current Smoker 11 (24%) 45 (48%) 51 (46%) 95 (66%) <0.0001 Antiplatelets 31 (67%) 53 (58%) 66 (60%) 99 (69%) 0.302 Statins 29 (63%) 54 (59%) 69 (63%) 97 (68%) 0.257 ACEi/ARBs 25 (54%) 36 (39%) 54 (49%) 68 (48%) 0.907 DepCat 1-2 (46 patients) DepCat 3-4 (92 patients) DepCat 5-6 (110 patients) DepCat 7 (143 patients) p-value Age (Median, IQR) 74.5 (67-81.5) 67.5 (58-75.3) 67.5 (58.3-77) 63 (55-70.5) <0.0001 Intermittent claudication 33 (72%) 61 (66%) 87 (79%) 113 (79%) 0.056 Current Smoker 11 (24%) 45 (48%) 51 (46%) 95 (66%) <0.0001 Antiplatelets 31 (67%) 53 (58%) 66 (60%) 99 (69%) 0.302 Statins 29 (63%) 54 (59%) 69 (63%) 97 (68%) 0.257 ACEi/ARBs 25 (54%) 36 (39%) 54 (49%) 68 (48%) 0.907 DepCat - Carstairs Deprivation Score; ACEi/ARBs - Angiotensin converting enzyme inhibitor/angiotensin receptor blocker Open in new tab Deprivation and secondary prevention DepCat 1-2 (46 patients) DepCat 3-4 (92 patients) DepCat 5-6 (110 patients) DepCat 7 (143 patients) p-value Age (Median, IQR) 74.5 (67-81.5) 67.5 (58-75.3) 67.5 (58.3-77) 63 (55-70.5) <0.0001 Intermittent claudication 33 (72%) 61 (66%) 87 (79%) 113 (79%) 0.056 Current Smoker 11 (24%) 45 (48%) 51 (46%) 95 (66%) <0.0001 Antiplatelets 31 (67%) 53 (58%) 66 (60%) 99 (69%) 0.302 Statins 29 (63%) 54 (59%) 69 (63%) 97 (68%) 0.257 ACEi/ARBs 25 (54%) 36 (39%) 54 (49%) 68 (48%) 0.907 DepCat 1-2 (46 patients) DepCat 3-4 (92 patients) DepCat 5-6 (110 patients) DepCat 7 (143 patients) p-value Age (Median, IQR) 74.5 (67-81.5) 67.5 (58-75.3) 67.5 (58.3-77) 63 (55-70.5) <0.0001 Intermittent claudication 33 (72%) 61 (66%) 87 (79%) 113 (79%) 0.056 Current Smoker 11 (24%) 45 (48%) 51 (46%) 95 (66%) <0.0001 Antiplatelets 31 (67%) 53 (58%) 66 (60%) 99 (69%) 0.302 Statins 29 (63%) 54 (59%) 69 (63%) 97 (68%) 0.257 ACEi/ARBs 25 (54%) 36 (39%) 54 (49%) 68 (48%) 0.907 DepCat - Carstairs Deprivation Score; ACEi/ARBs - Angiotensin converting enzyme inhibitor/angiotensin receptor blocker Open in new tab P602 The radial artery amplification index reflects risk factors accumulation and general atherosclerotic burden D Rosenbaum1, F Rached2, E Bruckert2, P Giral2, X Girerd2 1Unité de prévention cardiovasculaire - AP-HP - Hospital Pitie-Salpetriere, paris, France, 2AP-HP - Hospital Pitie-Salpetriere, Paris, France Vascular disease (Prevention & Epidemiology) Purpose: Diminution of the arterial compliance and atherosclerotic lesions have been correlated with cardiovascular morbidity. Amplification Index (AI) increases with wall rigidity and therefore evaluates arterial functions. Our goal was to determine the relevance of AI measurement in addition to usual cardiovascular parameters and atherosclerotic lesions in patients with hypertension and/or cardiovascular risk factors (RF). Methods: We included 477 patients and all underwent routine biological and clinical assessment. AI was measured by radial artery multicaptor tonometry and normalized for age, sex and heart rate (75bpm). AI values were divided into 4 groups according to nomograms given by the manufactor: group 1 < 95th percentile, group 2 between inferior 95th percentile and median, group 3 between median and 95th percentile and group 4 >95th percentile. Plaques presence and femoral and carotid intima media thickness (IMT) were assessed by Doppler. A cardiovascular risk score was obtained by summing RF (current smoking, hypertension, diabetes and dyslipidemia) and patients were classified into 4 groups: 0, 1, 2 and 3 or more RF. Results: Men represented 56% of the population and the mean age was 57 years old. Thirteen percent were treated for diabetes, 48% for dyslipidemia and 49% for hypertension (of which 83% were controlled). Cardiovascular RF groups from 0 to 3 represented 8%, 42%, 37% and 13% respectively. Mean intima-media thickness was 0.66mm and 16% of patients had an IMT > 0.9mm. Twenty seven percent had no atherosclerosis, 35% showed 1 or 2 plaques and 38% more than 3 different plaques. AI groups 1, 2, 3 and 4 accounted respectively for 6%, 20%, 44% and 20% of the population. Patients with blood pressure (BP) > 140/90 mmHg, current and former smokers had significantly more elevated AI values (p < 0.01). Type of hypertensive therapy didn't influence AI values but patients with treated and controlled hypertension had the same AI values distribution than untreated normotensives. AI was associated with the presence of total femoral and carotid plaque number but not with IMT elevation (p < 0.001). Patients with the higher cardiovascular risk scores had significantly increased AI values (p < 0.01) but no relationships were found between AI and pulse pressure, diabetes, HbA1c, or dyslipidemia parameters. Conclusions: An elevated AI measured at radial artery and adjusted for sex, age and heart rate reflects elevated blood pressure and is strongly associated to cardiovascular RF addition and atherosclerotic lesions. This study suggests that AI could be an integrator of vascular damages. P603 Mortality trends in patients hospitalized for ischaemic stroke O Mayer1, J Vanek1, J Bruthans2 12nd Dept. of Internal Medicine, University Hospital, Plzen, Czech Republic, 2Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czech Republic Vascular disease (Prevention & Epidemiology) Purpose: The stroke mortality in Czech Republic showed persistently decreasing trend. We aimed to establish whether this reflect decrease in incidence or improved survival in secondary prevention. Methods: The data were collected from hospital information system of University Hospital Pilsen. The vital status was ascertained at 30.09.2011. Results: The total of 4020 ischaemic stroke hospitalisation (mean age 72.2 ± 11.9, 48.5% females) was done between 1.1.2003 and 31.12.2010. 89.4% of events were 1st strokes. In total, 1848 patients (46.0%) died during follow-up (9117.2 patients/years). The in-hospital fatality was 7.0%, while 30, 180 and 360 days mortality 13.2%, 24% and 29%, resp. No differences were found between patients with 1st and recurrent event. No significant trends in these standardized mortalities appeared between 2003 and 2010. The positive predictors of death were age (beta = 0.364, p < 0.0001) and recurrent event (beta = 0.029, p < 0.0001), the negative male gender (beta = −0.028, p < 0.021) and hospitalization on department equipped with stroke unit (beta = −0.096, p < 0.0001). Conclusion: Despite global decrease in specific stroke mortality in Czech population we did not observed any significant change in mortality trends in patients hospitalized for stroke. The most effective proceeding to reduce the global burden of strokes remained primary prevention. P604 Evaluation of end-user satisfaction among employees participating in a web-based health risk assessment with tailored feedback EK Laan1, S Vosbergen2, BE Colkesen3, MAJ Niessen3, RA Kraaijenhagen3, K Stronks1, ML Essink-Bot1, N Peek2 1Academic Medical Center, University of Amsterdam, Department of Public Health, Amsterdam, Netherlands, 2Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands, 3NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, Netherlands Vascular disease (Prevention & Epidemiology) Purpose: Web-based health risk assessment (HRA) with tailored feedback is a commonly used instrument for health promotion. End-user satisfaction is an important determinant of the potential impact of HRAs, as it influences program uptake and adherence to the health advice. The aim of this study was to evaluate end-user satisfaction with a web-based HRA with tailored feedback, applied in worksite settings, using mixed (quantitativeand qualitative) methods. Methods: Employees of 7 companies in the Netherlands participated in a commercial, web-based HRA with tailored feedback. The HRA consisted of 4 components: 1) an electronic health and lifestyle questionnaire, 2) biometric evaluation, 3) laboratory evaluation and 4) tailored feedback consisting of a personal health risk profile and health recommendations, communicated through a web portal. Participants of the HRA received an evaluation questionnaire after 6 weeks. Satisfaction with different parts ofthe HRA was measured on 5-point Likert scales. A free text field provided the opportunity to express additional comments. Results: In total, 2,289 employees participated in the HRA program, of which 638 (27.9%) completed the evaluation questionnaire. The quantitative data showed mainly positive evaluations of the different parts of the HRA. Participants were most positive about the planning for biometric evaluation and the health and lifestyle questionnaire. The open text field was used by 192 respondents (30.1%). In total, 318 separate remarks were made. The qualitative evaluation of these data resulted in critical remarks by the end-users. Respondents felt restricted in the response options of the health and lifestyle questionnaire, which resulted in the feeling that the corresponding health plan could only give a superficial, sometimes overly negative representation of their health. Some respondents received the health plan as unnecessary alarming, and suggested to provide more explanation, reference values and a justification of the advice given. The opportunity to discuss the results (health risks and options to improve on these) with a health professional was highly valued. Conclusion: Although overall satisfaction with the HRA was high, a selection of end-users made critical remarks with regard to the HRA. To improve end-user satisfaction, transparency in the generation of the health plan is important. Furthermore, expectations of end-users regarding the nature of the health advice should be managed. Finally, confidence in the results of the HRA may be enhanced by involving trusted health professionals in the implementation of web-based HRAs. P605 Comparison efficacy and safety anti platelet Prophylaxis of Aspirin plus Heparin with Heparin alone on asymptomatic perioperative deep vein thrombosis was diagnosed by lower limb colour Doppler in pts SJ Mirhoseini1, SK Forouzannia1, SMY Mostafavi Pour Manshadi2, N Naderi2, S Sayegh3 1Shahid Sadooghi University of Medical Sciences, Afshar Hosp., Dpt of Cardiovascular Research Center, Yazd, Iran (Islamic Republic of), 2Ali ben Abitaleb Medical Collage, Islamic Azad University, Yazd, Iran (Islamic Republic of), 3Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (Islamic Republic of) Vascular disease (Prevention & Epidemiology) Introduction: Little evidence exists about the risk of venous thrombosis after coronary artery bypass graft (CABG) surgery. According to available studies, about one fifth of coronary artery bypass grafting patients develop symptomatic or asymptomatic deep vein thrombosis, whereas less than 1% of patients suffer from clinically evident pulmonary embolism. Deep vein thrombosis (DVT) and pulmonary embolism may influence the outcome of coronary revascularization in terms of morbidity and mortality in the short and medium-term, but unfortunately no clear consensus still exists regarding proper thromboprophylaxis measures. This study was designed that test hypothesis of comparison prophylaxis anticoagulant protocol of Aspirin plus Heparin with Heparin alone on perioperative deep vein thrombosis about efficacy and safety of these protocols. Methods & Materials: 120 patients undergoing off pump coronary artery bypass grafting were randomly to receive heparin (Hep) or heparin plus aspirin (Hep-Asp). The heparin group received routine dose of heparin after initiation of standing in hospital until time of freedom of hospital and the Hep-Asp group received routine dose of heparin and dose of Asp 80 mg daily oral, same duration preiperative to Hep group. We evaluated Post-coronary artery bypass grafting variables, including: deep vein thrombosis was diagnosed by lower limb colour Doppler (LLCD) and laboratory data such as HGB-HCT-PLT and side effects such as bleeding, pulmonary embolism. Primary LLCD was done in the time of admission and secondary LLCD was done in the time of freedom of hospital. We used SPSS v.15 to analysis data. Results: The mean age of the patients was 62.10 ± 10.71 years and males to females ratio was 2.24. Asymptomatic deep vein thrombosis occurred in 12 (10%) patients undergoing coronary artery bypass grafting. Significantly difference in the incidence of deep vein thrombosis was found between the heparin (16.7%) and heparin plus aspirin group (3.3%) [p = 0.015]. New Anticoagulant protocol Heparin plus Aspirin can reduce significantly thrombosis compared with heparin alone. No statistical difference between two groups about laboratory data such as HGB, HCT and PLT [P = 0.95, P = 0.68, P = 0.32]. Evaluation of side effects of these protocols such as bleeding and pulmonary embolism (PE) indicate that all of patients have not PE at all in this research. No statistical difference between two groups about bleeding. Conclusion: Aspirin plus heparin reduces deep vein thrombosis significantly and this prophylaxis intervention better than heparin alone about anticoagulant efficacy and safety in blood data and side effects in patients underwent elective off pump coronary artery bypass grafting surgery. These results need to future studies about detecting of efficacy and safety of these protocols exactly again. P606 Positive interactions between hemoglobin and high-sensitivity c-reactive protein in the development of coronary spasm in patients without obstructive coronary artery disease none, M-Y Ming-Yow Hung1, KH Hsu2, MJ Hung3 1Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan, 2Chang Gung University, Tao-Yuan, Taiwan, 3Chang Gung Memorial Hospital Keelung, Graduate Institute of Clinical Medical Sciences, Keelung, Taiwan Vascular disease (Prevention & Epidemiology) Purpose: The benefit of modest anemia, although well known in cerebral spasm, is unclear in coronary spasm (CS). We sought to assess interactions between hemoglobin and high-sensitivity C-reactive protein (hs-CRP) in patients with CS. Methods: Patients undergoing diagnostic coronary angiography with proven coronary vasospasm (>70% vessel diameter reduction during intracoronary methylergonovine infusion as compared to the diameter following intracoronary nitroglycerin) but without coronary stenosis >50% were evaluated. A total of 871 subjects were analysed. The levels of hs-CRP measured immediately before coronary angiography were examined in a subset of 524 patients. Results: In 343 women, patients with CS were likely to have high levels of hemoglobin, hematocrit and hs-CRP. In 528 men, patients with CS were likely to be older, current smokers and have high levels of hs-CRP. In women, hemoglobin and hs-CRP level were associated with CS, with hs-CRP level being the most significant factor (odds ratio [OR]=1.14, 95% confidence interval [CI]=1.05-1.24, p = 0.002). In men, age and smoking were independently associated with CS. Among women with high hemoglobin level, the ORs from the lowest to the highest tertiles of hs-CRP were 1.33, 2.14, and 6.14 (CI = 1.51-24.95, p = 0.011). In women with low hemoglobin level, an elevated risk was found from the middle to the highest tertiles of hs-CRP; OR from 0.73 to 3.64 (CI = 1.46-9.05, p = 0.005). This relationship was not observed in men. Conclusions: The relationship between hemoglobin and hs-CRP in CS differed between women and men. There is a positive interaction between hemoglobin and hs-CRP in women with this disease. Open in new tabDownload slide P607 Cardiovascular health benefits of moderate-to-vigorous and vigorous physical activity in healthy adolescents T Thomas Radtke1, S Kriemler2, K Khattab1, H Saner1, M Wilhelm1 1Bern University Hospital, Cardiovascular Prevention and Rehabilitation, Bern, Switzerland, 2University of Basel, Swiss Tropical and Public Health Institute, Basel, Switzerland Vascular disease (Prevention & Epidemiology) Purpose: Physical activity (PA) is inversely associated with clustering of cardiovascular disease (CVD) risk factors in children and adolescents. We examined the impact of PA on surrogate markers of cardiovascular health in healthy adolescents. Methods: In a prospective, cross-sectional study, 52 adolescents (28 females, mean age 14.5 ± 0.7 years, BMI 20.1 ± 2.5 kg/m2) were investigated. Microvascular function was assessed by peripheral arterial tonometry to determine the reactive hyperemic index (RHI). Autonomic tone was assessed by time-domain analysis of heart rate variability and vagal activity was measured using the root mean square of successive normal-to-normal intervals (RMSSD). Cardiopulmonary exercise testing was performed to determine peak oxygen uptake (VO2peak) and maximum power output. PA was assessed by accelerometry for 8 consecutive days. We applied two different models and dichotomized the cohort into two activity groups (low versus high) based on the daily time spent in moderate-to-vigorous PA (MVPA, 3000-5200 counts·min−1, model 1) and vigorous PA (VPA, >5200 counts·min−1, model 2). Data were adjusted for age, sex, skinfold, and pubertal status. Results: In a multivariate regression analysis MVPA was an independent predictor for RMSSD (beta = 0.416, P = 0.022), and VPA was independently associated with maximum power output (beta 0.310, P = 0.009). In model 1, the high MVPA group exhibited a higher vagal tone (RMSSD 49.9 ± 12.9 versus 38.4 ± 12.4 ms, P = 0.006) and a lower systolic blood pressure (106.7 ± 9.8 versus 113.2 ± 7.0 mmHg, P = 0.031). In comparison, in model 2, the high VPA group had higher maximum power output values (3.8 ± 0.6 versus 3.5 ± 0.6 watt·kg−1, P = 0.010). In both models, no significant differences were observed for RHI, VO2peak and body composition. Conclusions: In healthy normalweight adolescents, PA intensity reveals different beneficial effects on cardiovascular health-related parameters. In particular, MVPA had favourable effects on vagal tone and systolic blood pressure, whereas VPA contributes to an improvement in exercise capacity. P608 The sensitivity, specificity and accuracy of the toe-brachial index for the diagnosis of peripheral arterial disease. M Murray Matangi1, DW Armstrong1, C Tobin1, D Brouillard1 1Kingston Heart Clinic, Kingston, Canada Vascular disease (Prevention & Epidemiology) Purpose: The toe-brachial index (TBI) is usually only recommended if the ankle-brachial index (ABI) is high, (≥ 1.30). We routinely perform the TBI on all patients and believe that the TBI provides very useful information. The purpose of our investigation was to compare the TBI with the ABI which is currently the standard for the diagnosis of peripheral arterial disease (PAD). Methods: Our cardiology database was searched for all patients who had both the ABI and TBI measured. There were 4,690 lower limbs. An abnormal ABI was ≤ 0.90 and an abnormal TBI was ≤ 0.70. A scattergram of ABI versus TBI was performed and the sensitivity, specificity, accuracy, negative predictive, positive predictive value, positive likelihood ratio and negative likelihood ratio (−LR) were calculated. Results: See Table 1 and Figure 1. Conclusions: A normal TBI has a very high sensitivity and negative predictive value which virtually excludes a diagnosis of peripheral artery disease. The low -LR indicates that a patient without peripheral artery disease is 10 tens more likely to have a normal TBI compared to a patient with peripheral artery disease. Table 1. Abnormal ABI ≤ 0.90 Normal ABI >0.90 Abnormal TBI ≤ 0.70 767 832 48% PPV Normal TBI >0.70 56 3035 98% NPV 93% 79% 81% Accuracy Sensitivity Specificity (+)LR = 4.34, (−)LR = 0.08 Abnormal ABI ≤ 0.90 Normal ABI >0.90 Abnormal TBI ≤ 0.70 767 832 48% PPV Normal TBI >0.70 56 3035 98% NPV 93% 79% 81% Accuracy Sensitivity Specificity (+)LR = 4.34, (−)LR = 0.08 LR = likelihood ratio. PPV = positive predictive value. NPV = negative predictive value. TBI = toe-brachial index. ABI = ankle-brachial index. Open in new tab Table 1. Abnormal ABI ≤ 0.90 Normal ABI >0.90 Abnormal TBI ≤ 0.70 767 832 48% PPV Normal TBI >0.70 56 3035 98% NPV 93% 79% 81% Accuracy Sensitivity Specificity (+)LR = 4.34, (−)LR = 0.08 Abnormal ABI ≤ 0.90 Normal ABI >0.90 Abnormal TBI ≤ 0.70 767 832 48% PPV Normal TBI >0.70 56 3035 98% NPV 93% 79% 81% Accuracy Sensitivity Specificity (+)LR = 4.34, (−)LR = 0.08 LR = likelihood ratio. PPV = positive predictive value. NPV = negative predictive value. TBI = toe-brachial index. ABI = ankle-brachial index. Open in new tab Open in new tabDownload slide P609 Defining the normal range for the ankle-brachial index. DW Armstrong1, C Tobin1, D Brouillard1, M Murray Matangi1 1Kingston Heart Clinic, Kingston, Canada Vascular disease (Prevention & Epidemiology) Purpose: The current abnormal ankle-brachial index (ABI) of ≤ 0.90 is based on the correlation between the ABI with the corresponding peripheral angiographic data. An ABI of ≤ 0.90 has a high sensitivity and specificity for the detection of a proximal stenosis (≥ 50%) in the corresponding lower limb. This is useful information for a vascular surgeon. However, for clinicians who are now focused on early diagnosis of vascular disease and the implementation of preventative therapies an ABI of ≤ 0.90 is not an ideal cut-off. The purpose of our investigation was to attempt to define a normal range for the ABI and determine a more clinically relevant cut-off. Methods: Our cardiology database was searched for all peripheral artery disease patients who underwent exercise testing with measurement of their ABIs in recovery. Our protocol calls for a series of 5 ABI measurements to be recorded as quickly as possible following the completion of exercise. Patients were excluded from analysis for, a history of claudication, abnormal peripheral foot pulses, iliac bruits, femoral bruits, claudication during the exercise protocol or any decrease in ABI <0.95 following exercise. Patients had to complete the exercise protocol of 5 minutes at 2mph and an incline of 12%, without symptoms. The limits for the normal range for the resting ABI were set at ± 2SD from the mean ABI. ANOVA was used to assess differences between the mean values. Tukey-Kramer intercomparisons testing was only performed if the p value for ANOVA was <0.05. Results: There were 40 males and 9 females with a mean age of 61.8 ± 13.5 years. Results are seen in Table 1. There was a minor but non-significant fall in the first ABI following exercise. However, the second and in all subsequent measurements the ABI had returned to baseline. Conclusion: The normal range for the ABI as defined for our population is 0.97 to 1.37 on the right and 0.96 to 1.36 on the left. We believe that a cut-off of ≤ 0.96 should be used as the threshold to suspect the diagnosis of peripheral artery disease. Those patients with an ABI between 0.90 and 0.96 should undergo measurement of their ABIs following exercise to see if one can unmask evidence of latent peripheral artery disease. Resting and post exercise ABI in normals ABI Rest Ex 1 Ex 2 Ex 3 Ex 4 Ex 5 P value ANOVA Right 1.17 ± 0.10 1.13 ± 0.10 1.16 ± 0.12 1.17 ± 0.13 1.18 ± 0.12 1.17 ± 0.12 0.3468 Left 1.16 ± 0.10 1.13 ± 0.11 1.17 ± 0.13 1.17 ± 0.13 1.17 ± 0.13 1.18 ± 0.13 0.4149 ABI Rest Ex 1 Ex 2 Ex 3 Ex 4 Ex 5 P value ANOVA Right 1.17 ± 0.10 1.13 ± 0.10 1.16 ± 0.12 1.17 ± 0.13 1.18 ± 0.12 1.17 ± 0.12 0.3468 Left 1.16 ± 0.10 1.13 ± 0.11 1.17 ± 0.13 1.17 ± 0.13 1.17 ± 0.13 1.18 ± 0.13 0.4149 Open in new tab Resting and post exercise ABI in normals ABI Rest Ex 1 Ex 2 Ex 3 Ex 4 Ex 5 P value ANOVA Right 1.17 ± 0.10 1.13 ± 0.10 1.16 ± 0.12 1.17 ± 0.13 1.18 ± 0.12 1.17 ± 0.12 0.3468 Left 1.16 ± 0.10 1.13 ± 0.11 1.17 ± 0.13 1.17 ± 0.13 1.17 ± 0.13 1.18 ± 0.13 0.4149 ABI Rest Ex 1 Ex 2 Ex 3 Ex 4 Ex 5 P value ANOVA Right 1.17 ± 0.10 1.13 ± 0.10 1.16 ± 0.12 1.17 ± 0.13 1.18 ± 0.12 1.17 ± 0.12 0.3468 Left 1.16 ± 0.10 1.13 ± 0.11 1.17 ± 0.13 1.17 ± 0.13 1.17 ± 0.13 1.18 ± 0.13 0.4149 Open in new tab P610 Ethnic group differences in cardiovascular risk estimates using JBS2 and QRISK2 risk scores: national cross-sectional study A R H Andrew Robert Howard Dalton1, RA Bottle1, M Soljak1, A Majeed1, C Millett1 1Imperial College London, London, United Kingdom Vascular disease (Prevention & Epidemiology) Introduction: There are wide ethnic group inequalities in cardiovascular disease (CVD) incidence and outcomes. Cardiovascular disease risk scores are increasingly being used in preventative medicine and should aim to accurately reflect differences between ethnic groups. Ethnicity can be accounted for in risk scores using two methods, either directly incorporating it into the algorithm or through a post hoc adjustment. Methods: Using data from the Health Survey for England, we measured ethnic group differences in risk estimation between the QRISK2, which includes ethnicity and Joint British Societies 2 (JBS2) algorithm, which uses a post hoc risk adjustment factor for south Asian men. Results: The QRISK2 score produces lower mean estimates of cardiovascular disease risk than JBS2 overall (11.0% [10.8-11.2] compared with 13.0% [12.8-13.2]). Differences in mean risk scores are significantly greater in south Asian men (9.7% [CI = 9.2-10.3]) compared with white men (3.3% [3.1- 3.4]). Using QRISK2, 19.1% [16.2-22.0] fewer south Asian men are designated at high risk compared with 8.8% [5.9-7.8] fewer in white men. Across all ethnic groups, women had a 0.5% [0.4-0.6] absolute lower mean QRISK2 score, although relatively more (2.0% [1.4-2.6]) were at high risk than with JBS2. Discussion: Ethnicity is an important factor in cardiovascular disease risk estimation. Reducing ethnic group inequalities in cardiovascular disease incidence and outcomes is a key priority in many countries. Current scoring tools produce significantly different estimates of cardiovascular risk within ethnic groups, particularly in south Asian men. Work to accurately estimate cardiovascular disease risk in ethnic minority groups is important if cardiovascular disease prevention programmes are to address health inequalities. With cardiovascular disease risk scores becoming more systematically used in primary prevention programmes, it is important that these accurately account for the ethnic differences in risk. Recalibration of risk scores is possible; however, data presented here shows risk multiplication factors can create differences in risk prediction. Risk scores derived from large, national routine datasets will allow ethnicity to be directly included in cardiovascular disease risk scores, especially with improvements in ethnicity recording in medical records. P611 Age- and gender-related gradient of flow-mediated dilation and reference values in East European population The HAPIEE Group, S K Sofia Malyutina1, A Ryabikov2, M Ryabikov1, S Ivanov1, E Veryovkin1 1Institute of Internal Medicine SB RAMS, Novosibirsk, Russian Federation, 2Novosibirsk State Medical University, Novosibirsk, Russian Federation Vascular disease (Prevention & Epidemiology) Purpose: The sonographic index of brachial flow-mediated dilation (FMD) is discussed among predictors of cardiovascular risk. The values of flow mediated dilatation differ by age, sex, ethnicity and population-specific characteristics. Up-to-date the reference values for flow mediated dilatation in East European population were not published. We aimed to study the distribution of flow mediated dilatation by age and sex in a typical Russian population. Methods: In population studies of cardiovascular disease (HAPIEE, EPOGH) we examined a random sample of men and women aged 18-69 years in Novosibirsk, Russia (n = 673). Flow mediated dilatation was measured by high-resolution ultrasound in the brachial artery. The percentile distribution of flow mediated dilatation values was assessed by sex and age decades: under 40, 40-49, 50-59, 60-69 years old. We applied ANOVA and linear regression models for analysis. Results: The average value of brachial flow mediated dilatation in men was 7.6%(SE0.25) and in women 12.6%(0.30). The mean values of flow mediated dilatation insignificantly declined with age from 9.2% in the youngest group to 8.2% in the oldest group in men, from 13.8% to 11.9% in women. In crude and multivariate adjusted regression models the relationship of flow mediated dilatation with age was not linear (p = 0.314 and p = 0.343 in men and women). After controlling for vascular stiffness index we revealed significant declining of flow mediated dilatation with age in range of 40-69 years (p = 0.047) in men. Flow mediated dilatation percentiles by age groups are shown in Table. Conclusions: The values of brachial flow mediated dilatation differ by sex, age, ethnicity etc. and we found the non-linear relationship between flow mediated dilatation and age. These facts advocate the population-specific, age- and gender stratified percentiles as reference values for flow mediated dilatation assessment, assuming the values below 25th percentile might be indicative for increased cardiovascular disease risk. However direct risk estimates in our East European cohort are warranted to clarify population-specific predictive values of flow mediated dilatation and impact to cardiovascular disease risk stratification. The study was assisted by IC15-CT98-0329-EPOGH, LSHM-CT-2006-037093-InGenious HyperCare, the Wellcome Trust (081081/Z/06/Z), the NIA (1R01 AG23522-01). FMD in Novosibirsk population Age, y/percentiles Men Women <40 40-49 50-59 60-69 <40 40-49 50-59 60-69 25 6.9 6.0 6.2 5.7 9.5 8.3 6.4 4.7 50 9.4 10.2 8.5 8.0 12.7 10.3 12.0 10.0 75 11.6 13.0 11.8 10.4 15.9 15.2 18.6 12.5 Age, y/percentiles Men Women <40 40-49 50-59 60-69 <40 40-49 50-59 60-69 25 6.9 6.0 6.2 5.7 9.5 8.3 6.4 4.7 50 9.4 10.2 8.5 8.0 12.7 10.3 12.0 10.0 75 11.6 13.0 11.8 10.4 15.9 15.2 18.6 12.5 FMD (%) percentiles in Novosibirsk population (men and women, 18-69) Open in new tab FMD in Novosibirsk population Age, y/percentiles Men Women <40 40-49 50-59 60-69 <40 40-49 50-59 60-69 25 6.9 6.0 6.2 5.7 9.5 8.3 6.4 4.7 50 9.4 10.2 8.5 8.0 12.7 10.3 12.0 10.0 75 11.6 13.0 11.8 10.4 15.9 15.2 18.6 12.5 Age, y/percentiles Men Women <40 40-49 50-59 60-69 <40 40-49 50-59 60-69 25 6.9 6.0 6.2 5.7 9.5 8.3 6.4 4.7 50 9.4 10.2 8.5 8.0 12.7 10.3 12.0 10.0 75 11.6 13.0 11.8 10.4 15.9 15.2 18.6 12.5 FMD (%) percentiles in Novosibirsk population (men and women, 18-69) Open in new tab P612 Smoking in women has the strongest impact on arterial stiffness in menopausal transition. J Jan Pitha1, T Adamek2, S Adamkova1, 0 Auzky1, E Babkova2, M Lejskova3 1Institute of Clinical and Experimental Medicine, Prague, Czech Republic, 2Thomayer University Hospital, Department of Medicine I, Prague, Czech Republic, 3Institute for Postgraduate Medical Education, Prague, Czech Republic Vascular disease (Prevention & Epidemiology) Background: In our previous cross-sectional study in population sample of middle aged women we demonstrated that smoking increased progression of subclinical atherosclerosis mainly during menopausal transition. After 6 years we re-examined the same population of women to confirm this finding. Methods: We analysed change of ankle brachial blood pressure index (ABI) in 27 smoking women (mean age 54.3 ± 2.5 years) and 69 non-smoking women (mean age 54.8 ± 1.9 years) that during the study underwent transition from premenopausal to menopausal status. As a control group, change of ABI was analysed in 56 smoking women (mean age 57.1 ± 2.1 years) and 102 non-smoking women (mean age 57.3 ± 2.4 years) that during the whole study were menopausal. Other traditional cardiovascular risk factors were also analysed. Results: In the whole group of 254 women we surprisingly detected significant mean increase of ABI (0.13 ± 0.21; p < 0.0001) potentially reflecting increased arterial stiffness. In women that underwent transition from premenopause to menopause, ABI increased significantly more in current smokers than in non-smokers (0.23 ± 0.26 versus 0.11 ± 0.16; p = 0.013). In contrast, no such difference between smokers and non-smokers was found in already menopausal women (0.10 ± 0.23 versus 0.14 ± 0.24; p = 0.3). Conclusion: In women smokers, ABI, potentially reflecting increased arterial stiffness, increased substantially more in women undergoing menopausal transition than in already menopausal women. These data confirm our previous findings that in women smokers the menopausal transition is the critical period for artery damage. P613 Patent foramen ovale as a risk factor for ischemic stroke and transitory ischemic attack M Marina Fernandes1, VH Pereira1, J Guardado1, F Canario-Almeida1, I Quelhas1, A Pereira1, A Lourenco1 1Alto Ave Hospital Center, Guimaraes, Portugal Vascular disease (Prevention & Epidemiology) Purpose: The authors intended to estimate de prevalence of Patent Foramen Ovale (PFO) in a population under 55 years old who suffered an ischemic stroke or a transitory ischemic attack (TIA), and to determine the influence of this predisposing condition and the other known risk factors. Methods: This was a retrospective study that enrolled 40 adult patients under 55 years old who suffered a cerebral ischemic event and performed a transesophageal echocardiogram for this reason. The presence of other risk factors, besides patent foramen ovale and atrial septal aneurysm, was documented, namely diabetes, hypertension, inherited and acquired thrombophilias, disritmias and drugs. The authors also searched if there were only one or multiple ischemic lesions on magnetic resonance imaging or computed tomography-scan. Results: The median age of the patients was 45 years old (ranging from 23 to 55); 60% from the feminine sex, 77.5% had ischemic stroke and 22.5% transient ischaemic attack, 10 patients (25%) had identifiable patent foramen ovale and12.5% had atrial septal aneurysm. When regarding other risk factors, 12.5% were diabetic, 30% had hypertension, 10% identifiable thrombophilias and 2.5% had documented atrial fibrillation or flutter. There was no statistically significant difference between the patients with or without patent foramen ovale when regarding the cardiovascular risk factors tested. The patients with patent foramen ovale had a higher incidence of multiple lesions on imaging studies than expected. Conclusion: patent foramen ovale and its closure is still a matter of controversy, as new and safer devices coalesce. In our study population we didn't find any statistically significant relation between patent foramen ovale and cerebral ischemic events, as other risk factors are equally distributed between these two groups. When patent foramen ovale is present, the lesions are usually multiple. Wider studies are needed to a deeper understanding and more strong recommendations about the therapeutic strategies available. P614 Reducing cardiovascular risk in black and minority ethnic groups the MyAction Westminster team, S Susan Connolly1, K Kotseva1, SJ Clements1, J Jones1, C Jennings1, A Mead1, A Brown2, P Barrett1, DA Wood1 1Imperial College London, London, United Kingdom, 2Inner North West London Cluster, London, United Kingdom Vascular disease (Prevention & Epidemiology) Background: We set up a vascular prevention programme (MyAction) in areas of high BME prevalence (black and minority ethnic groups) and social deprivation in Westminster, London. We previously demonstrated the effectiveness of this programme in a mainly white affluent population. Here we describe the results of the programme in a more challenging ethnically diverse population. Methods: Patients at high cardiovascular disease risk were referred from hospital or by their general practitioner and were invited with their partners to attend the 16 week programme. Measurements were made at the initial assessment (IA) and end of programme (EOP) and included lifestyle, anthropometry, functional capacity, blood pressure and lipids. Results: 48% of those attending for an IA were from BME groups (mainly Arabic, South Asian and black). The programme completion rate was 60% (n = 314) and did not differ significantly between white and BME groups. Table 1 shows the main changes achieved by the programme. Conclusion: The MyAction programme was effective in both white and BME groups in improving lifestyle and cardiovascular risk factors thus demonstrating the effectiveness of the programme in more diverse populations. Changes between IA and EOP by ethnicity White White BME BME IA EOP IA EOP Mediterranean Diet Score (mean) 6.1 (2.6) 7.8 (2.0) 7.0 (2.1) 8.3 (1.8) Mean change +1.7 (1.5, 2.1); p < 0.001 +1.3 (1.0, 1.6); p < 0.001) Waist circumference, cm (mean) 101.8 (14.5) 99.5(13.4) 96.9 (11.1) 95.4 (10.1) Mean change −2.3 (−2.9, −1.7); p < 0.001 −1.5 (−2.3,−0.7); p < 0.001 Physical activity target (%) 20 54.8 18.5 54.6 Change +34.8 (25, 44.6); p < 0.001 +36.2 (26.6, 45.7) Estimated Mets Max, mean 7.8 (1.8) 8.6 (1.9) 7.9 (1.9) 8.7 (2.1) Mean change +0.8 (0.6, 1.0), p < 0.001 +0.8 (0.5, 1.0), p < 0.001 Blood pressure at target (%) 39.5 72.8 42.9 73.6 Change +33.3 (24.5, 42.6); p < 0.001 +30.7 (20.5, 40.9); p < 0.001 Lipids at target (%) 52.5 76.5 56.2 73.6 Change +24.1 (16.2, 31.9); p < 0.001 +24.1 (15.1, 33); p < 0.001 White White BME BME IA EOP IA EOP Mediterranean Diet Score (mean) 6.1 (2.6) 7.8 (2.0) 7.0 (2.1) 8.3 (1.8) Mean change +1.7 (1.5, 2.1); p < 0.001 +1.3 (1.0, 1.6); p < 0.001) Waist circumference, cm (mean) 101.8 (14.5) 99.5(13.4) 96.9 (11.1) 95.4 (10.1) Mean change −2.3 (−2.9, −1.7); p < 0.001 −1.5 (−2.3,−0.7); p < 0.001 Physical activity target (%) 20 54.8 18.5 54.6 Change +34.8 (25, 44.6); p < 0.001 +36.2 (26.6, 45.7) Estimated Mets Max, mean 7.8 (1.8) 8.6 (1.9) 7.9 (1.9) 8.7 (2.1) Mean change +0.8 (0.6, 1.0), p < 0.001 +0.8 (0.5, 1.0), p < 0.001 Blood pressure at target (%) 39.5 72.8 42.9 73.6 Change +33.3 (24.5, 42.6); p < 0.001 +30.7 (20.5, 40.9); p < 0.001 Lipids at target (%) 52.5 76.5 56.2 73.6 Change +24.1 (16.2, 31.9); p < 0.001 +24.1 (15.1, 33); p < 0.001 Open in new tab Changes between IA and EOP by ethnicity White White BME BME IA EOP IA EOP Mediterranean Diet Score (mean) 6.1 (2.6) 7.8 (2.0) 7.0 (2.1) 8.3 (1.8) Mean change +1.7 (1.5, 2.1); p < 0.001 +1.3 (1.0, 1.6); p < 0.001) Waist circumference, cm (mean) 101.8 (14.5) 99.5(13.4) 96.9 (11.1) 95.4 (10.1) Mean change −2.3 (−2.9, −1.7); p < 0.001 −1.5 (−2.3,−0.7); p < 0.001 Physical activity target (%) 20 54.8 18.5 54.6 Change +34.8 (25, 44.6); p < 0.001 +36.2 (26.6, 45.7) Estimated Mets Max, mean 7.8 (1.8) 8.6 (1.9) 7.9 (1.9) 8.7 (2.1) Mean change +0.8 (0.6, 1.0), p < 0.001 +0.8 (0.5, 1.0), p < 0.001 Blood pressure at target (%) 39.5 72.8 42.9 73.6 Change +33.3 (24.5, 42.6); p < 0.001 +30.7 (20.5, 40.9); p < 0.001 Lipids at target (%) 52.5 76.5 56.2 73.6 Change +24.1 (16.2, 31.9); p < 0.001 +24.1 (15.1, 33); p < 0.001 White White BME BME IA EOP IA EOP Mediterranean Diet Score (mean) 6.1 (2.6) 7.8 (2.0) 7.0 (2.1) 8.3 (1.8) Mean change +1.7 (1.5, 2.1); p < 0.001 +1.3 (1.0, 1.6); p < 0.001) Waist circumference, cm (mean) 101.8 (14.5) 99.5(13.4) 96.9 (11.1) 95.4 (10.1) Mean change −2.3 (−2.9, −1.7); p < 0.001 −1.5 (−2.3,−0.7); p < 0.001 Physical activity target (%) 20 54.8 18.5 54.6 Change +34.8 (25, 44.6); p < 0.001 +36.2 (26.6, 45.7) Estimated Mets Max, mean 7.8 (1.8) 8.6 (1.9) 7.9 (1.9) 8.7 (2.1) Mean change +0.8 (0.6, 1.0), p < 0.001 +0.8 (0.5, 1.0), p < 0.001 Blood pressure at target (%) 39.5 72.8 42.9 73.6 Change +33.3 (24.5, 42.6); p < 0.001 +30.7 (20.5, 40.9); p < 0.001 Lipids at target (%) 52.5 76.5 56.2 73.6 Change +24.1 (16.2, 31.9); p < 0.001 +24.1 (15.1, 33); p < 0.001 Open in new tab P615 Cardiovascular fitness is associated with venous compliance in healthy subjects I Leinan1, Ä Groennevik2, A Stolen3, U Wisloff1, T Karlsen1 1Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway, 2Norwegian University of Science and Technology, Trondheim, Norway, 3St. Olavs Hospital, Department of Cardiology, Trondheim, Norway Vascular disease (Prevention & Epidemiology) Reduced venous outflow (VOF) is negatively associated with 6 minutes walk test performance in heart failure patients when compared to healthy age matched subjects, indicating that exercise intolerance may be linked to an insufficiency in venous circulation. Purpose: Compare the relationship between venous compliance (VC) and cardiovascular fitness measured as maximal oxygen uptake (VO2max) in healthy subjects. Methods: Twenty-eight healthy subjects 20-70 years of age (46.4 ± 16.2 years, 72.8 ± 13.7 kg, 174 ± 8.4 cm, men n = 16, women n = 12) were recruited to a cross sectional study. VO2max was measured during an individual ramp treadmill protocol. Resting venous and arterial flow and diameters were measured with ultrasound during a 10-minute occlusion protocol aiming to alter arterial and venous in- and outflow in the brachial vein and artery. Occlusion of VOF was achieved by occluding the upper arm to 7mmHg below diastolic blood pressure, and alternation in arterial inflow by occluding the wrist at 240mmHg. Vascular measures were normalized for dimensional scaling due to difference in subjects body composition. Measured diameters were scaled with fat free mass (FFM)−0.33, and measured VOF with FFM−0.67. Compliance (cross- sectional area/venous pressure) was expressed as the difference between resting and maximal occlusion compliance. Total blood, plasma volume and red cell mass were measured after the vascular examination with the improved CO-rebreathing method. Results: Mean VO2max was 3.38 ± 0.8 L/min, delta VC 16.57 ± 7.6 mm2/mmHg/kg FFM−0.33 and blood volume 5.95 ± 1.3 L. VO2 max (L/min) was positively correlated with delta VC (mm2/mmHg/kg FFM−0.33) (r = 0.542 and p = 0.004) and VOF (cm/s FFM0.67) (r = 0.554 and p = 0.006). Additionally, a significant correlation was found between delta VC (mm2/mmHg/kg FFM−0.33) and total plasma (r = 0.598 and p = 0.002) and total blood volume (r = 0.638 and p = 0.001). Conclusion: VO2max is positively correlated with delta VC in the investigated population of healthy subjects. Additionally, there is a positive correlation between VO2max and VOF and total plasma volume. As VO2max and arterial flow mediated dilatation previously have been positively correlated, the present result may indicate that exercise intolerance may also be linked to venous circulation. P616 Determinants of cardiovascular events in a stroke cohort from a primary care setting. ST-BAR study Barbanza Investigators, R C Rafael Carlos Vidal Perez1, F Otero-Ravina1, MJ Eiris Cambre1, M Sanchez Loureiro1, L Vaamonde Mosquera1, D Fabeiro Romero1, G Gutierrez Fernandez1, JL Gomez Vazquez1, JR Gonzalez-Juanatey1 1University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Vascular disease (Prevention & Epidemiology) Purpose: Little is known about the cardiovascular events of stroke patients followed in the community. The aim of our study was to evaluate the cardiovascular (CV) events of a cohort of stroke patients (p) followed by primary care physicians (PCP). Methods: ST-BAR was a cross-sectional study made with collaboration of 33 PCP. The PCP included during February 2009, patients that fulfil the inclusion criteria: Cerebrovascular events with diagnosis clear established (stroke-S, transient ischaemic attack-transient ischaemic attack, or both) in a discharge summary from neurology department. Follow-up was done by clinical review or telephone contact and death or CV events were recorded, as well as the cause of death. Results: 473p were included, the prior event was S in 305p (65%), transient ischaemic attack in 128p (27%) or both in 40p (8%). The main aetiology of stroke was ischaemic (57%). Dependent status after event in 29%. Time since first cerebrovascular event 6.6 ± 5.5 years. Mean age 75 ± 10 years, 52% male, 79% hypertension, 29% diabetes, 65% dyslipidaemia, 12% current smoker, 11.2% chronic kidney disease, 18,9% anaemia. Cardiac related conditions: coronary artery disease 18% (10% myocardial infarction), 22% atrial fibrillation, 10% previous heart failure (HF), 12% valvular disease, 5,9% myocardial disease. Prior cardiovascular admissions 14%. Only 39% had a echocardiography. The mean follow-up was 8.2 ± 2.3 months, 5.3% had a CV hospitalisation (mainly HF-1.9%), 5% died and 3.2% had a CV death (new stroke-1.9%, 0.2%-sudden death, 0.2%-heart failure). Multivariate analysis for the 7.2% of CV events (death or hospitalisation) is shown in the table. Conclusions: The patients with a previous cerebrovascular event must be followed carefully in the primary care settings because they have an important CV annual mortality and not only related with new strokes. Multivariate analysis for CV events HR 95%CI p-value Prior Heart Failure 2.74 1.3-5.9 0.010 Myocardial disease 3.32 1.4-8.2 0.009 Anaemia 3.09 1.6-6.2 0.001 Chronic Kidney disease 2.40 1.0-5.6 0.044 Dependent status 2.57 1.3-5.7 0.010 Prior cardiovascular admissions 3.05 1.5-6.4 0.003 HR 95%CI p-value Prior Heart Failure 2.74 1.3-5.9 0.010 Myocardial disease 3.32 1.4-8.2 0.009 Anaemia 3.09 1.6-6.2 0.001 Chronic Kidney disease 2.40 1.0-5.6 0.044 Dependent status 2.57 1.3-5.7 0.010 Prior cardiovascular admissions 3.05 1.5-6.4 0.003 95%CI-95% Confidence interval Open in new tab Multivariate analysis for CV events HR 95%CI p-value Prior Heart Failure 2.74 1.3-5.9 0.010 Myocardial disease 3.32 1.4-8.2 0.009 Anaemia 3.09 1.6-6.2 0.001 Chronic Kidney disease 2.40 1.0-5.6 0.044 Dependent status 2.57 1.3-5.7 0.010 Prior cardiovascular admissions 3.05 1.5-6.4 0.003 HR 95%CI p-value Prior Heart Failure 2.74 1.3-5.9 0.010 Myocardial disease 3.32 1.4-8.2 0.009 Anaemia 3.09 1.6-6.2 0.001 Chronic Kidney disease 2.40 1.0-5.6 0.044 Dependent status 2.57 1.3-5.7 0.010 Prior cardiovascular admissions 3.05 1.5-6.4 0.003 95%CI-95% Confidence interval Open in new tab P617 Cystatin C as a cardiovascular predictor: also useful in diabetic patients or not? I Campos Moreira De Almeida1, F Caetano1, L Seca1, J Silva1, P Mota1, A Leitao-Marques1 1Hospital Center of Coimbra, Coimbra, Portugal Vascular disease (Prevention & Epidemiology) Purpose: Cystatin C (CysC) is reportedly a better endogenous marker of glomerular filtration rate (GFR) than serum creatinine. Its prognostic value in patients with acute coronary syndrome (ACS) has been demonstrated. Some studies showed that the baseline value is increased in diabetic patients, regardless of the GFR, raising the question of its specificity in this population. Our purpose was to evaluate the prognostic value of CysC in diabetic patients with acute coronary syndrome, regarding adverse events and mortality during hospitalization and follow-up. Methods: Prospective study of 119 diabetic patients (age 69.5 ± 11.2 years, 63.9% male) admitted for acute coronary syndrome to a Coronary Unit Care, during 18 consecutive months. Patients were divided in 2 groups according the value of CysC, determined in the first 48 hours: CYS- (=0.95mg/L, n = 45) and CYS+ (>0.95mg/L, n = 74). Results: CYS+ patients were older (72.5 ± 9.89 vs 64.67 ± 11.5, p < 0.001) and had higher prevalence of hypertension (91.2% vs 71.1%, p = 0.003), chronic renal disease (45.9% vs 2.3%, p < 0.001) and heart failure (28.4% vs 6.7%, p = 0.004). On admission, more CYS+ patients presented with non ST-elevation myocardial infarction (44.6% vs 26.7% p = 0.05), with a higher incidence of Killip-Kimball ≥ 2 (43.2% vs 13.6%, p = 0.001) and a tendency to a higher Grace risk score (152.6 ± 42.9 vs 137.8 ± 38.6, p = 0.053). They had longer hospitalizations (6.86 ± 5.07 vs 4.80 ± 2.56, p = 0.004), higher incidence of cardiorenal syndrome (56.8% vs 15.6%, p < 0.001) and contrast nephropathy (50.0% vs 19.5%, p = 0.002). At discharge, they had more left ventricular systolic impairment (moderate to severe: 21.9% vs 7.3%, p = 0.048). There were no differences in the severity of coronary disease or intra-hospital mortality. However, in the follow-up (FU, 6.6 ± 5.3 months), CYS+ patients had higher mortality (21.5% vs 0.0%, p = 0.001). On multivariate analysis, Cys-C showed a better predictive value of mortality in FU than creatinine (OR 3,166, p = 0.008), with a sensibility of 100% and a specificity of 46.7%. Conclusion: CysC also has prognostic value in diabetic patients, even using the reference value. However, new studies might be needed to define the best cut-off value for CysC in diabetic population. P618 Epidemiological survey on atrial fibrillation prevalence in Bulgaria M Panikyan-Latifyan1, TD Daskalov2 1Sanofi-Aventis EOOD BULGARIA, Sofia, Bulgaria, 2University National Heart Hospital, Sofia, Bulgaria Rhythm Disorders/Sudden death (Prevention & Epidemiology) National retrospective multicentre noninterventional registry, based on the data collected through the daily practice of 24 general practitioners and routinely used the software programme developed by the National Health Insurance Fund. The complete patients lists of the 24 GPs contain 35 987 Bulgarians 18 years old (27 270 - urban population; 8 714 - rural population, similar to publish ratio of the National Statistic Institute). The primary endpoint was to assess the prevalence of atrial fibrillation in the general population. The secondary endpoints were to assess the incidence of the known risk factors in atrial fibrillation group and the prevalence of atrial fibrillation per age decades, per gender, per type of atrial fibrillation etc. The study was conformed to the principles of the Declaration of Helsinki of the World Medical Association, of the Good Epidemiological Practice Statistical correlation analysis ascertains the significant positive correlation between age, rheumatism and permanent atrial fibrillation prevalence. No correlation between other risk factors (hypertension, diabetes, thyroid disease) and atrial fibrillation (all types). Statistical regression analysis determines significant positive correlation between age, rheumatism, heart insufficiency and permanent atrial fibrillation and no correlations between risk factors and paroxysmal and persistent atrial fibrillation. Make more precise the correlation between theoretically admissible risk factors and the inquiry (atrial fibrillation) requires future survey with new quantitative factors and characteristics (unused till now). Prevalence age n paroxismal AF persistent AF permanent AF all AF 18 - 40 11 536 6 (0,05%) 0 1 (0,01%) 7 (0,06%) 41 - 50 5 833 17 (0,29%) 5 (0,09%) 6 (0,10%) 28 (0,48%) 51-60 6 526 51 (0,78%) 36 (0,55%) 20 (0,31%) 107 (1,64%) 61-70 6 002 133 (2,22%) 111 (1,85%) 100 (1,67%) 344 (5,74%) 71-80 4 391 127 (2,89%) 131 (2,96%) 190 (4,33%) 448 (10,28%) >81 1 699 44 (2,59%) 53 (3,12%) 99 (5,83%) 196 (11,54%) total 35 987 378 (33,45%) 336 (29,73%) 416 (36,82%) 1 130 age n paroxismal AF persistent AF permanent AF all AF 18 - 40 11 536 6 (0,05%) 0 1 (0,01%) 7 (0,06%) 41 - 50 5 833 17 (0,29%) 5 (0,09%) 6 (0,10%) 28 (0,48%) 51-60 6 526 51 (0,78%) 36 (0,55%) 20 (0,31%) 107 (1,64%) 61-70 6 002 133 (2,22%) 111 (1,85%) 100 (1,67%) 344 (5,74%) 71-80 4 391 127 (2,89%) 131 (2,96%) 190 (4,33%) 448 (10,28%) >81 1 699 44 (2,59%) 53 (3,12%) 99 (5,83%) 196 (11,54%) total 35 987 378 (33,45%) 336 (29,73%) 416 (36,82%) 1 130 Open in new tab Prevalence age n paroxismal AF persistent AF permanent AF all AF 18 - 40 11 536 6 (0,05%) 0 1 (0,01%) 7 (0,06%) 41 - 50 5 833 17 (0,29%) 5 (0,09%) 6 (0,10%) 28 (0,48%) 51-60 6 526 51 (0,78%) 36 (0,55%) 20 (0,31%) 107 (1,64%) 61-70 6 002 133 (2,22%) 111 (1,85%) 100 (1,67%) 344 (5,74%) 71-80 4 391 127 (2,89%) 131 (2,96%) 190 (4,33%) 448 (10,28%) >81 1 699 44 (2,59%) 53 (3,12%) 99 (5,83%) 196 (11,54%) total 35 987 378 (33,45%) 336 (29,73%) 416 (36,82%) 1 130 age n paroxismal AF persistent AF permanent AF all AF 18 - 40 11 536 6 (0,05%) 0 1 (0,01%) 7 (0,06%) 41 - 50 5 833 17 (0,29%) 5 (0,09%) 6 (0,10%) 28 (0,48%) 51-60 6 526 51 (0,78%) 36 (0,55%) 20 (0,31%) 107 (1,64%) 61-70 6 002 133 (2,22%) 111 (1,85%) 100 (1,67%) 344 (5,74%) 71-80 4 391 127 (2,89%) 131 (2,96%) 190 (4,33%) 448 (10,28%) >81 1 699 44 (2,59%) 53 (3,12%) 99 (5,83%) 196 (11,54%) total 35 987 378 (33,45%) 336 (29,73%) 416 (36,82%) 1 130 Open in new tab P619 Clinical profile of patients evaluated by a syncope unit M A Miguel Angel Ramirez-Marrero1, I Vegas-Vegas1, D Gaitan-Roman1, JL Delgado-Prieto1, G Ballesteros-Derbenti1, M De Mora-Martin1 1Regional Hospital Carlos Haya, Malaga, Spain Rhythm Disorders/Sudden death (Prevention & Epidemiology) Introduction and aims: Syncope is a frequent reason for hospital emergency care, associated with a fatal prognosis according to their origin. Our objective was to analyse the clinical profile of patients evaluated by a Syncope Unit (US) since its inauguration. Material and methods: Prospective analysis of all patients consecutively referred to the US, from June 2009 to October 2011. We studied clinical and epidemiological variables, established diagnosis and indicated treatment. Results: We included 303 patients, 47.5% women, mean age 56.7 ± 20.6 years (14-91 years). 46.3% had hypertension, 17.2% diabetes mellitus, 9.7% a history of ischaemic heart disease, 4% prior coronary revascularization procedure and a low comorbidity associated (Comorbidity Charlson Index 0.81 ± 1.63). There was prodrome in 69% of cases, with recurrent syncope in 33.7%. The baseline electrocardiogram was normal in 70.2%. Among electrocardiogram abnormalities, the prevailing existence of AV block (31.3%), followed by bundle branch block (25%) and signs of left ventricular enlargement (20.8%). Holter EKG was performed in 56.8% of the cases, being normal in 90.7%. 97.7% of the patients had no structural heart disease by echocardiography. Cardiac treadmill test was performed in 13 patients (normal result) and tilt test in 50, with positive results in 59.6% (type I response in two-thirds). Implantable loop recorders were required in 3 patients, one of them established the diagnosed. It was established the diagnosis of neutrally-mediated reflex syncope in 67.8% of cases, 8.2% neurological or psychogenic syncope, 6.6% orthostatic, 7.7% cardiogenic syncope and 9.8% is still unknown. 10 patients received a pacemaker. Cardiogenic syncope was associated with an increased prevalence of age ≥ 40 years (100% versus 0%, p = 0.01), male gender (71.4% versus 28.6,%, p = 0.05) and baseline abnormal electrocardiogram (85.7% versus 14.3%, p = 0.0001). After adjustment, male sex and the presence of an abnormal electrocardiogram predicted an increased risk of cardiac origin of syncope (OR 4.22, 95% CI, 0.86 to 10.74 and OR 3.12, 95%, 2, 78 to 6.69, respectively). Conclusions: Patients evaluated by a Syncope Unit have a heterogeneous clinical profile. The neutrally-mediated reflex syncope is the most frequent diagnosis. Cardiogenic syncope is associated with male gender, age over 40 years and baseline electrocardiogram pathology. P620 Evaluation of left atrial function by two-dimensional Speckle Tracking Echocardiography in subjects at high risk for atrial fibrillation M Anifanti1, E Kouidi1, S Mochlas2, G Parharidis2, A Deligiannis1 1Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 2Aristotle University of Thessaloniki, AHEPA University Hospital, 1st Department of Cardiology, Thessaloniki, Greece Rhythm Disorders/Sudden death (Prevention & Epidemiology) Atrial fibrillation (AF) is a major public health problem. Thus, primary prevention strategies are essential to identify individuals at high risk for atrial fibrillation. The aims of the present study were to detect early morphological and functional changes of left atrium (LA) that predispose to atrial fibrillation in subjects at risk for atrial fibrillation and to detect potential correlations between the echo results and the presence of atrial premature complexes (APC). The study comprised 25 male elite aerobic trained athletes (group A, aged 44.2 ± 3.1 yrs), 25 patients with essential hypertension without medication, (group B, aged 46.9 ± 4.1 yrs) 25 patients with lone atrial fibrillation (group C, aged 45.4 ± 4.5 yrs) and 25 age-matched healthy sedentary controls (group D). All subjects underwent 24-h ambulatory electrocardiogram monitoring, as well as standard, tissue Doppler, and speckle tracking echocardiography (STE) imaging. Global strain (ε) and strain rate (SR) at the LA phases were measured. Group A showed the greatest indexed maximum LA volume compared to all groups and minimum LA volume compared to groups B and D. Group B showed the highest active LA emptying fraction, while group A the highest passive emptying fraction. Moreover, group C showed the lowest active LA emptying fraction. Results from STE are shown in the table (mean values ± SD). APC were recorded in the 23% of the subjects. Specifically, the 52% of group A, 16% of B, 20% of C and 4% of group D had APC (χ2 = 17.79, p = 0.000). APC were found to be significantly correlated to the absolute and indexed left atrial diameters and maximum volume. Our results indicated that the newer echo techniques can assist to a detailed evaluation of LA structure and function and to a reliable detection of its early disorders. Thus, their use in clinical practice will help to a better identification and management of patients at risk for atrial fibrillation and to a prevention of its complications. Phases Parameter Group A Group B Group C Group D Contractile Globalε(%) −7.8 ± 3.7a,b,c −12.0 ± 1.2 −4.5 ± 1.0a,c −11.0 ± 2.1 Global SR (s−1) −2.11 ± 0.2b,c −2.14 ± 0.1c −1,52 ± 0.1a,c −1.96 ± 0.2 Reservoir Globalε(%) 42.4 ± 6.7a,b,c 33.2 ± 2.6c 37.8 ± 2.0a 39.3 ± 2.5 Global SR(s−1) 2.0 ± 0.3b 1.9 ± 0.1 1.6 ± 0.1a,c 2.0 ± 0.3 Conduit Globalε (%) −4.0 ± 2.1a,b 0.94 ± 2.8c −1.6 ± 3.0a −3.1 ± 2.3 Global SR(s−1) −3.7 ± 0.5a,b,c −1.9 ± 0.2c −1.7 ± 0.1c −2.4 ± 0.3 Phases Parameter Group A Group B Group C Group D Contractile Globalε(%) −7.8 ± 3.7a,b,c −12.0 ± 1.2 −4.5 ± 1.0a,c −11.0 ± 2.1 Global SR (s−1) −2.11 ± 0.2b,c −2.14 ± 0.1c −1,52 ± 0.1a,c −1.96 ± 0.2 Reservoir Globalε(%) 42.4 ± 6.7a,b,c 33.2 ± 2.6c 37.8 ± 2.0a 39.3 ± 2.5 Global SR(s−1) 2.0 ± 0.3b 1.9 ± 0.1 1.6 ± 0.1a,c 2.0 ± 0.3 Conduit Globalε (%) −4.0 ± 2.1a,b 0.94 ± 2.8c −1.6 ± 3.0a −3.1 ± 2.3 Global SR(s−1) −3.7 ± 0.5a,b,c −1.9 ± 0.2c −1.7 ± 0.1c −2.4 ± 0.3 a p < 0.05 vs B, b p < 0.05 vs C, c p < 0.05 vs D Open in new tab Phases Parameter Group A Group B Group C Group D Contractile Globalε(%) −7.8 ± 3.7a,b,c −12.0 ± 1.2 −4.5 ± 1.0a,c −11.0 ± 2.1 Global SR (s−1) −2.11 ± 0.2b,c −2.14 ± 0.1c −1,52 ± 0.1a,c −1.96 ± 0.2 Reservoir Globalε(%) 42.4 ± 6.7a,b,c 33.2 ± 2.6c 37.8 ± 2.0a 39.3 ± 2.5 Global SR(s−1) 2.0 ± 0.3b 1.9 ± 0.1 1.6 ± 0.1a,c 2.0 ± 0.3 Conduit Globalε (%) −4.0 ± 2.1a,b 0.94 ± 2.8c −1.6 ± 3.0a −3.1 ± 2.3 Global SR(s−1) −3.7 ± 0.5a,b,c −1.9 ± 0.2c −1.7 ± 0.1c −2.4 ± 0.3 Phases Parameter Group A Group B Group C Group D Contractile Globalε(%) −7.8 ± 3.7a,b,c −12.0 ± 1.2 −4.5 ± 1.0a,c −11.0 ± 2.1 Global SR (s−1) −2.11 ± 0.2b,c −2.14 ± 0.1c −1,52 ± 0.1a,c −1.96 ± 0.2 Reservoir Globalε(%) 42.4 ± 6.7a,b,c 33.2 ± 2.6c 37.8 ± 2.0a 39.3 ± 2.5 Global SR(s−1) 2.0 ± 0.3b 1.9 ± 0.1 1.6 ± 0.1a,c 2.0 ± 0.3 Conduit Globalε (%) −4.0 ± 2.1a,b 0.94 ± 2.8c −1.6 ± 3.0a −3.1 ± 2.3 Global SR(s−1) −3.7 ± 0.5a,b,c −1.9 ± 0.2c −1.7 ± 0.1c −2.4 ± 0.3 a p < 0.05 vs B, b p < 0.05 vs C, c p < 0.05 vs D Open in new tab P621 A new index in predicting future development of atrial fibrillation in patients with heart failure C Cristian Mornos1, L Petrescu1, D Gaita1, A Mornos1, S Pescariu1 1Institute of Cardiovascular Diseases, Timisoara, Romania Rhythm Disorders/Sudden death (Prevention & Epidemiology) Onset of atrial fibrillation (AF) in patients with heart failure (HF) is usually associated with a high occurrence of cardiovascular complications. E/(E' × S') ratio (E=early diastolic transmitral velocity, E'=early mitral annular diastolic velocity and S'=systolic mitral annulus velocity) has been shown to be an independent predictor of cardiac outcome. Purpose: We investigate whether E/(E' × S') determined at the medial corner of the mitral annulus could be a predictor of new-onset atrial fibrillation in patients with HF. Methods: We analysed 113 consecutive hospitalized patients with HF, in sinus rhythm, after appropriate medical treatment. Patients with histories of atrial fibrillation, inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular disease, acute coronary syndrome, coronary revascularization during follow-up, severe pulmonary disease or renal failure were not included. E/(E' × S') was determined at the medial corner of the mitral annulus. The primary study end-point was the new-onset atrial fibrillation. Results: During the follow-up period (35.7 ± 11.2 months), 33 patients (29.2%) developed atrial fibrillation. Mean E/(E' × S') was 3.85 ± 1.92 in these patients, while it was 2.06 ± 1.74 in the rest (p = 0.008). The optimal E/(E' × S') cut-off to predict new-onset atrial fibrillation was 2.4 (89% sensitivity, 78% specificity). There were 63 patients (55.7%) with E/(E' × S') ≤ 2.4 and 50 (44.3%) with E/(E' × S')>2.4. In patients with E/(E' × S') ≤ 2.4, atrial fibrillation event-free rate was markedly higher than in the rest with E/(E' × S') >2.4 (93.7% versus 42%, p <0.001, log-rank)(figure 1). Conclusions: Medial E/(E' × S') is a powerful predictor of new-onset atrial fibrillation in patients with HF. Open in new tabDownload slide P622 The CHADSVASc score for non-valvular atrial fibrillation dramatically increases the need for either warfarin or dabigatran. M Murray Matangi1, DW Armstrong1, D Brouillard1 1Kingston Heart Clinic, Kingston, Canada Rhythm Disorders/Sudden death (Prevention & Epidemiology) Purpose: The CHADS score is widely used to determine the type of antithrombotic treatment given to patients with non-valvular atrial fibrillation. Patients with a CHADS score of 0 or 1 usually receive Aspirin, although with a CHADS score of 1 there is the option to use either Aspirin, Warfarin or Dabigatran. A CHADS score of >1 should receive Warfarin or Dabigatran. More recently the CHADSVASc score has been incorporated into the European atrial fibrillation guidelines. The CHADSVASc score has major advantages over the CHADS score. The CHADSVASc score takes into account the increased risk of both the very elderly (≥ 75 years) and women. These patients have an increased thromboembolic risk with non-valvular atrial fibrillation. A further advantage of the CHADSVASc score is that a score of 0 has virtually no risk of thromboembolism. Such is not the case for the CHADS score. The purpose of our study was to determine the change, if any, in antithrombotic therapy of patients with a CHADS score of 0 or 1 when recalculated using the new CHADSVASc score. Methods: Our cardiology database was searched for all patients with non-valvular atrial fibrillation who had a CHADS score of either 0 or 1. There were 206 patients. The CHADSVASc scores were then calculated for each patient. We assumed that a CHADSVASc score of 0 or 1 would receive Apririn and a score >1 would receive either Warfarin or Dabigatran. Results: Of the 206 patients, 86 had a CHADS score of 0 and 120 a CHADS score of 1. Of the 86 with a CHADS score of 0, 13 had a CHADSVASc score of 2 and 1 had a CHADSVASc score of 3. Indicating that 16.3% of patients with a CHADS score of 0 would require either Warfarin or Dabigatran based on their CHADSVASc score. Of the 120 patients with a CHADS score of 1, 61 had a CHADSVASc score of 2, 27 a CHADSVASc score of 3 and 3 a CHADSVASc score of 4. Indicating that 75.8% of patients with a CHADS score of 1 would now require Warfarin or Dabigatran. Overall 51% of patients previously given the option of treatment with Aspirin would now be treated with either Warfarin or Dabigatran. Conclusions: Our data indicate that use of the CHADSVASc score in patients with non-valvular atrial fibrillation would lead to an extra 51% of patients receiving either Warfarin or Dabigatran who would otherwise be given the option of treatment with Aspirin. Given the high percentage of CHADS 1 patients who by CHADSVASc are ≥ 2 (75.8%) one can make the case that physicians who continue to use the CHADS score should be advised that it would be more appropriate to treat all patients with a CHADS score of ≥ 1 with either Warfarin or Dabigatran. P623 Assessment of knowledge level about anticoagulation therapy in patients with atrial fibrillation and its relation to INR goal attainment. I Trikilis1, K Konstantinos Farsalinos1, A Spyrou1, A Kostopoulou1, M Savvopoulou1, V Voudris1 1Onassis Cardiac Surgery Center, 2nd Department of Cardiology, Athens, Greece Rhythm Disorders/Sudden death (Prevention & Epidemiology) Purpose: Chronic use of anticoagulant therapy has important implications in daily life of patients. Specific dietary habits should be implemented, multiple drug interactions should be considered and regular assessment of INR levels is mandatory so that the goals of preventing thromboembolic phenomena and avoiding hemorrhagic complications are met. The goal of this study was to assess the knowledge level in patients with atrial fibrillation receiving chronic anticoagulant therapy and to determine its role in INR goal attainment. Methods: Patients receiving acenocoumarol for at least 3 months that presented to our department for routine measurement of INR levels were included in the study. They answered a questionnaire consisting of 9 questions concerning food and drug interactions, knowledge about target INR levels and precautions during dental procedures and intramuscular injections. One point was assigned for each correct answer. Patients were also asked to report if cardiologists or other physician subspecialties were responsible for monitoring their INR levels and adjusting medication dose. INR was measured at the day of questionnaire answering in all patients. Results: A total of 202 patients with atrial fibrillation (aged 62 ± 5 years) participated in the study. Only 55.4% of the patients reported that they felt adequately informed about the use of acenocoumarol by their physician. The vast majority (92.6%) correctly named atrial fibrillation as the condition associated with the use of anticoagulant therapy. Treatment supervision by cardiologists was reported by 27.7% of patients. The knowledge score was 3.5 ± 1.2 in the study sample. By multivariate regression analysis, university education (OR = 1.59, 95% CI = 1.11-2.27, p = 0.011) and treatment supervision by cardiologist (OR = 1.66, 95% CI = 1.15-2.38, p = 0.006) were independently associated with higher knowledge score. Target INR levels were found in 71.3% of the patients. By multivariate regression analysis, knowledge score (OR = 1.55, 95% CI = 1.14-2.11, p = 0.005), treatment supervision by cardiologist (OR = 3.18, 95% CI = 1.31-7.7, p = 0.01) and university education (OR = 2.71, 95% CI = 1.22-6.04, p = 0.015) were associated with target INR levels. Conclusions: Knowledge level about anticoagulation therapy is low in patients with atrial fibrillation. Since it is an independent predictor of good anticoagulation control, more effort is needed for proper and adequate education of patients, especially in those with lower level of education. Cardiologists seem to perform better in educating patients and achieving target INR levels compared to other subspecialties. P624 Evaluation of Early Intraoperative Intravenous Amiodarone as Prophylaxis Against Ventricular Arrhythmias for Patients with Aortic Stenosis Undergoing Aortic Valve Replacement H Hisham Abdelwahab1, AF Attaallah2, M Abuldahab1, T Salahuddin1 1Cairo University, Cairo, Egypt, 2Department of Anesthesiology, West Virginia University, Morgantown, WV, USA Rhythm Disorders/Sudden death (Prevention & Epidemiology) Background: Ventricular arrhythmias is well documented in patients with severe aortic stenosis. Ventricular fibrillation accounts for up to 20% of early mortality after aortic valve replacement and remains the second most common cause of postoperative death in this population. We designed this study to evaluate the role of amiodarone prophylaxis against ventricular arrhythmias in patients with aortic stenosis undergoing valve replacement surgery. Methods: Thirty patients undergoing aortic valve replacement were randomly assigned to two groups; patients in the first group received a 2.5 mg/kg bolus of amiodarone intravenously after induction of anaesthesia and patients in the other group served as control. The incidence of ventricular arrhythmias (defined as any episode of ventricular fibrillation, haemodynamically unstable ventricular tachycardia, or any ventricular tachycardia lasting more than 30 seconds), the number of shocks and the total energy dose needed for cardioversion, and the length of intensive-care unit stay were recorded and compared between the two groups. Results: 11 patients (73.3%) in the amiodarone group experienced ventricular arrhythmias during separation from the cardiopulmonary bypass. On the other hand, 14 patients (93.3%) in the control group experienced ventricular arrhythmias. Although the incidence of ventricular arrhythmias in the patients who received a prophylactic dose of amiodarone was less than controls, 20% difference, yet establishment of statistical significance was not achieved (p = 0.165). Moreover, the patients in the amiodarone group responded to a lesser number of direct-current cardioversion shocks when compared to controls (1.36 vs 2.36, p = 0.033) and needed less total dose of energy (21.33 vs 51.33 joules, p = 0.013). All patients in the amiodarone group had a less eventful intensive-care unit course and did not experience any ventricular arrhythmias during the postoperative intensive-care unit period, while 5 patients (33.3%) in the control group experienced ventricular arrhythmias (p = 0.021). Patients in the amiodarone group had an almost statistically significant shorter intensive-care unit stay when compared to controls (2.8 vs 4.13, p = 0.05). Conclusion: Early intra-operative low doses of intravenous amiodarone seem to improve the ventricular arrhythmias response to direct-current cardioversion therapy, when given to patients with aortic stenosis undergoing aortic valve replacement. In addition, amiodarone decreased the incidence of ventricular arrhythmias in the immediate postoperative period. P625 Head-up tilt testing in pediatric age: a retrospective observational study I Ines Rangel1, J Freitas1, C Sousa1, M Paiva1, AS Correia1, A Sousa1, A Lebreiro1, MJ Maciel1 1Sao Joao Hospital, Porto, Portugal Rhythm Disorders/Sudden death (Prevention & Epidemiology) Background: Syncope is a common clinical problem in children and adolescents. Head-up tilt testing (HUTT) is a valuable diagnostic tool to investigate unexplained syncope, but limited data is available in pediatric population. The aim of this study was to assess the usefulness of head-up tilt test in pediatric unexplained syncope patients. Methods: We retrospectively analysed clinical records of 100 patients aged less than 18 years, undergoing head-up tilt test from January 1997 through June 2011. Information about their episodes, prodromes, triggers, as well as the head-up tilt test outcomes was evaluated. Results: From the 100 patients enrolled, 66 were female, average age 15 years. In 76 patients, prolonged standing up was the major reported trigger. Dizziness (82%) and blurred vision (63%) were the most experienced prodromal symptoms. Asthenia (63%) and skin pallor (68%) were the major manifestations in the recovering phase. Eighty-two of 100 had a positive test (vasodepressor response in 46, cardioinhibitory in 8, mixed in 28). There was no significant difference between the two outcome groups (positive versus negative head-up tilt test) regarding prodromes, frequency of recent syncope episodes (in the 12 months preceding head-up tilt test), triggers and recovery manifestations (p > 0,05 for all the variables). All positive head-up tilt test patients were reassured, counseled about recognizing their prodromes, and to perform counterpulsation and postural maneuvers to abort syncope. Conclusions: The clinical manifestations associated with syncopal episodes reported in pediatric patients are nonspecific and none of them predict neurocardiogenic syncope. Head-up tilt test gives potentially useful information about syncope, enabling the etiological diagnosis of the vast majority of pediatric patients (82% in this population). P626 The evaluation of novel waveforms used for internal cardioversion of atrial fibrillation in porcine models. D David Brody1, R Di Maio1, P Crawford1, A Mcintyre1, C Navarro1, JMC Anderson1, AAJ Adgey2 1HeartSine Technologies Ltd., Belfast, United Kingdom, 2Royal Victoria Hospital, Regional Medical Cardiology Centre, Belfast, United Kingdom Rhythm Disorders/Sudden death (Prevention & Epidemiology) Introduction: Atrial fibrillation (AF) is a chaotic breakdown of electrical activity in the upper chamber of the heart with consequent deterioration of atrial mechanical function. Atrial fibrillation is the most common arrhythmia in clinical practice, accounting for approx. one-third of hospitalizations for cardiac rhythm disturbances. Current atrial fibrillation defibrillation energies are reported to cause pain and discomfort in some patients. The use of defibrillation waveforms that enable low energy cardioversion is an area of considerable interest for the treatment of this condition. The aim of this study was to investigate if the energy required to internally defibrillate atrial fibrillation could be reduced by using novel defibrillation waveforms. Methods: Ethical approval was granted for this porcine study from the NI home office. Defibrillation leads were placed transvenously into the coronary sinus and the right atrial appendage of 6 (90 ± 5kg) porcine models. The leads were connected to a modified defibrillator containing R- wave synchronisation circuitry. Sustained atrial fibrillation (>30 seconds) was induced using rapid atrial pacing (100 Hz, duration 2 ms, 50 V for 5 sec.; Grass S44 stimulator) in 5 of the 6 animals. Cardioversion was attempted via 2 atrial defibrillation leads using a number of different voltages, pulse widths and waveforms. A maximum of 80 shocks were delivered to each animal. Results: The results of this study showed that Chopped Biphasic Waveforms are comparable to Biphasic Waveforms for the treatment of atrial fibrillation in porcine models, possibly at lower energies. Successful conversions were seen at energies as low as 0.25J using the Chopped Biphasic Waveform, which is below the pain threshold in humans. The results were negatively impacted by model variation. No life-threatening arrhythmias (e.g. VF, VT) were induced using these novel waveforms. Conclusions: These findings are of interest for transvenous internal cardioversion of chronic persistent atrial fibrillation. Further examination of these waveforms, with minimised model variation and in an improved model of atrial fibrillation, may prove that the waveforms may be clinically relevant and preferable to those higher energy waveforms used in current commercially available implantable cardioverter-defibrillators. P627 Health Centers - New preventive unit in the primary care system of the Russian Federation N Nana-Goar Pogosova1, I D Sapunova1, S A Boytsov1 1National Center for Preventive Medicine, Moscow, Russian Federation Health economics (Prevention & Epidemiology) Noncommunicable diseases (NCDs) are the leading cause of death and disability in developed and developing countries. In order to strengthen prevention of non-communicable diseases and policies on healthy lifestyles in the Russian Federation were developed health centres (HCs) - new preventive units in the primary care public health system. HCs activities are directed mainly at health promotion and disease prevention, estimation of risk factors in healthy and high risk subjects and increasing people responsibility towards their health and motivation to give up unhealthy habits, including smoking and excessive alcohol intake. Materials and methods: In 2009-2010 502 HCs for adults were opened across the Russian Federation. Each HC, equipped equally, provides preventive service for 200 thousands of population on free of charge basis. The standard health status study in the HCs includes measurement of height, weight (body mass index), blood pressure, ankle brachial index by means of ultrasound dopplerography, total cholesterol and glucose, spirometry, determination of CO in the exhaled air, leads electrocardiogram (6 standard leads), prophylactic dental examination and ophthalmometry. Based on the results of the standard health status study visitors of HCs are given personal recommendations on lifestyle modification. HCs provide educational programs and supervised exercise training. Results: In 2010-2011 more than 2,5 million people in Russia have visited HCs. Less than 500 000 who came for a visit were considered to be healthy. Hypertension was diagnosed in 60% (prevalence of hypertension in population is about 40%). 68% of HCs visitors were overweight (>25kg/m2), 58% had low level of physical activity, 45% - hypercholesterolemia, 20% - hyperglycemia. 92% of smokers who have visited HCs are willing to quit smoking. Conclusion: The algorithm of health status study in CHs aimed to identify risk factors of non-communicable diseases is highly effective. The methodology of risk factors reduction and appropriate lifestyle changes need further improvement. P628 Structure of cardiovascular mortality in Russian Federation: factors reducing its reliability and validity MU Yankin1, AA Selivanov2, AU Yankin3, SA Maksimov1, MU Ogarkov1, GV Artamonova1 1Siberian Branch RAMS Institution Scientific-Research Institute for Complex Problems of Cardiov. Dis., Kemerovo, Russian Federation, 2Novokuznetsk Department of Morbid Anatomy, Novokuznetsk, Russian Federation, 3Novokuznetsk Institute of Postgraduate Education, Novokuznetsk, Russian Federation Health economics (Prevention & Epidemiology) Background: Previous studies have shown low reliability and validity of mortality statistics in the Russian Federation, especially regarding cardiovascular (CV) mortality. However, there is little information concerning the reasons for this problem. Purpose: The objective of this study was to analyse the structure of CV mortality and identifythe factors reducing its reliability and validity in a typical industrial city of the Russian Federation. Methods: The study sample consisted of 8805 cases of CV death that occurred in Novokuznetsk between 2009 and 2010 in a representative sample of 563500 people. A database of deaths was obtained from Novokuznetsk Civil Registry Office; all the causes of deaths are classified in ICD-10 and obtained from medical death certificates. The immediate causes of death (Line 1(a)) were analysed. Results: The main causes of CV death were: cerebral infarctions (I63; 19.3%), other cerebral diseases (I67;19.2%), other forms of acute ischaemic heart decease (IHD) (I24.8;12.5%), chronic ischaemic heart disease (I25;12.4%), myocardial infarctions (I21-23; 5.9%), intracerebral hemorrhages (I61; 5.9%). Three fourths of deaths occurred outside health facilities: I63-58.8%, I67 -88.2%, I24.8 -91.8%, I25 -72.6%, I21-23 -21.9%, I61-51.1%. Less than a third of deaths that occurred outside health facilities were confirmed by autopsy: I63-2%, I67-0.2%, I24.8 -89.7%, I25 -18.5%, I21-23 -67.5%, I61-19.5%. In 40.1% cases when the death occurred outside health facilities, the cause of death was detected by a general practitioner, who had never contacted the decedent. The rate of cerebral infarctions among those who deceased outside health facilities and had no autopsy performed, increased with the age: 55-64 yrs -17.3%,65-74 yrs -20.2%, over 74 yrs -21.0%; at the same time therate of myocardial infarctions decreased, respectively: 2.8%; 0.7%; 0.6%. Conclusions: The reliability and validity of the CV mortality structure is low due to a high number of cases of out of hospital deaths, low percentage of autopsies and a preconceived belief of general practitionersthat the most frequent cause of death in elderly people is cerebrovascular diseases. P629 Nurse-coordinated lifestyle counselling in primary care is an effective and low-cost service R Zingerle1, M Rundgren2, J Joep Perk1 1Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden, 2Kalmar County Public Health Institute, Oskarshamn, Sweden Health economics (Prevention & Epidemiology) Introduction: Nurse-coordinated lifestyle counselling programmes among patients in primary care have demonstrated positive preventive effects on common riskfactors for cardiovascular disease (CVD). However, the economic demands of establishing this service on a broad scale are not well documented which may limit its wider application. Aims and Methods: Nurse-coordinated lifestyle counselling (LSC) was introduced in 2004 in Kalmar county (Sweden), a rural area with 26 primary care centres and a population of ¼ milj. inhabitants. A primary care team, led by a family doctor and coordinated by a trained nurse provided counseling and support for patients with newly diagnosed hypertension, diabetes mellitus type II, smokers, overweight patients and other cases of the metabolic syndrome. The service was extended to all primary care centres in 2007 and all changed into primary health centres. The goal of the present retrospective study was to evaluate the county-wide extension over a period of 4 years including 2997 patients. We studied age/gender distribution, the outcome of cardiovascular disease risk factors (blood pressure, smoking cessation, lipids and blood glucose. We calculated the resources used for the service as a part of the total primary care budget. Results: Between 2007 and 2010 3937 patients (0,4% of all primary care patients) visited the LSC units with a steady increase from 139 in 2007 to 1996 in 2010. Of these 65% were women and 61% were above the age of 50 years. Main causes for counselling were overweight, physical inactivity, smoking and newly diagnosed hypertension or diabetes mellitus II. We observed a lowering of blood pressure: systolic pressure median lowering −3% and diastolic pressure median −2,9%), blood glucose (median −2,75%) and blood lipids (cholesterol median −4,5%, high-density lipoprotein median +4,3%, low-density lipoprotein median −6,25%, triglyceride median −4,1%). There was a moderate effect on smoking: 11% of previous smokers had stopped smoking after 1 year. The labour resource for the LSC nurse varied from 0,89-5,26% of the total amount of nurse resources with an average level of 2%. The cost analysis showed a unexpectedly low level of 0,23-1,35% and with the average 0,6% of the entire primary healthcare centres annual budget. Conclusion: This study showed a positive effect of countywide lifestyle counselling on common cardiovascular disease risk factors in a similar degree as in previous studies. The cost analysis demonstrates clearly that establishing nurse coordinated lifestyle counselling puts only limited demands on strained health care resources and might therefore well be highly cost-effective. P630 Healthcare costs associated with smoking in Russian Federation A Anna Kontsevaya1, A Kalinina1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Health economics (Prevention & Epidemiology) The aim: To study healthcare costs, associated with smoking in Russian Federation. Methods: We analysed the official statistics of the Ministry of health of Russian Federation on disease prevalence and incidence, numbers of hospitalizations, ambulatory visits and emergency care on cardiovascular diseases, cancer and chronic obstructive pulmonary disease (COPD) and the costs of medical care in Russian Federation in 2009. For calculating the share of resource utilization associated with smoking we used relative risks from international surveys and meta-analysis, as Russian relative risks of morbidity, associated with smoking are unavailable. The calculations did not include the costs of medications outside the hospitals, as relevant data not available. Results: Smoking associated with a huge number of chronic diseases in Russian Federation. For example smoking provided 101 253 new cases of cancer, including 49 362 new cases of lung cancer in 2009, 483 936 new cases of cardiovascular diseases, including 140 672 new cases of coronary heart diseases, 65 284 - myocardial infarction and 83 994 - stroke; also 223 693 new cases of smoking were attributable to smoking. In 2009 the number of hospital days associated with smoking was 3 149 412 in cancer patients (without lung cancer), 1 635 405 in lung cancer patients, 9 452 972 in cardiovascular patients, including 5 598 851 in coronary heart disease, 1 083 052 in myocardial infarction and 1 337 894 in stroke. Also there were 3 778 773 hospital days of chronic obstructive pulmonary disease patients associated with smoking. In 2009 total health care costs, associated with smoking exceeded 35.8 billions of rubles (1.2 billion US$). From these 26.2 billion of rubles (873 million US$) accounted for the costs of hospitalizations, 1.4 billion (47 million US$) - emergency care, 8.2 billion of rubles (273 million of US$) - outpatient care. 62.2% of costs of healthcare associated with smoking were determined by cardiovascular diseases, 20.2% - by cancers and 17.8% by chronic obstructive pulmonary disease. Conclusion: In Russia smoking is associated with substantial health care utilization and costs. It is one of the important arguments for active measures for smoking decreasing. There is the lack of the data necessary for detailed and exhaustive calculations of the healthcare costs, associated with smoking in Russian. It is necessary to conduct the prospective surveys in order to obtain Russian relative risks of morbidity, age-standardized morbidity and pharmacoepidemiology data. P631 The economic burden of acute coronary syndrome (ACS) in Turkey DR Tokgozoglu1, DR Ertas2, DR Caglayan3 1Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey, 2Ankara University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey, 3AstraZeneca Turkey, Istanbul, Turkey Health economics (Prevention & Epidemiology) Purpose:There are 390,000 acute coronary syndrome events in Turkey (TR) each year, which along with the subsequent health care (HC), impose a significant cost on the Turkish HC system. In 2010, myocardial infarction (MI) & unstable angina (UA) were the causes of 337,000 hospitalizations and 100,000 deaths in TR. Deaths due to MI&UA represent approximately 20% of the total number of deaths in TR, making it the leading cause of death. Aim of the study was to determine the total burden of acute coronary syndrome on the Turkish economy and society. Methods: In order to determine the total burden, direct and indirect costs were calculated. Direct costs included hospitalization (diagnostic & investigational procedures, days on ward, staff fees, pharmaceuticals, administrative costs); physician visits, and primary care drugs costs. Direct HC expenditure was estimated based on the fee schedules of the Social Security Institution and information obtained through expert panels. Indirect cost comprised productivity losses due to acute coronary syndrome and costs due to decrease of life expectancy and deterioration of quality of life. Productivity losses can be classified as losses due to morbidity and mortality. Costs due to decrease of life expectancy and deterioration of quality of life were defined as societal costs. Results: In 2010, average cost of an acute coronary syndrome hospitalization per patient was 3,015.0 TL and total hospitalization costs for acute coronary syndrome were 1 billion TL. Treatment guidelines suggest that patients are prescribed a range of medications to address risk factors for acute coronary syndrome. Expenditure on all pharmaceuticals for the long-term management of acute coronary syndrome totaled to 340 million TL. Finally, physician visits for acute coronary syndrome represented a cost of approximately 6 million TL. Totally, 1.4 billion TL was spent on direct HC costs. Acute coronary syndrome is responsible for an estimated 2.4 million days of sick leave per year in Turkey. Cost of lost productivity due to premature retirement and temporary work absenteeism associated with acute coronary syndrome was 670 million TL in total. Together with productivity losses due to premature death, this amounts to a 4.2 billion TL loss to the Turkish economy. Societal costs representing the individual based losses can be quantified to 13.9 million TL for unstable angina and 58.7 billion TL for MI. Direct and indirect costs summed to 5,537 million TL, over 14,000 TL for each acute coronary syndrome event. Conclusions: Hospitalizations accounted for the largest share (75%) of direct medical costs. Of the total HC costs, lost productivity losses due to acute coronary syndrome related mortality account for the highest, the greatest cost to the Turkish economy. These findings once again highlight the importance of prevention to avoid acute coronary syndrome. P632 Intensive, exercise based, cardiac rehabilitation in patients with jarvik 2000 ventricular assist device N Russo1, L Compostella2, T Setzu2, E Covolo1, V Tarzia3, G Arpesella4, G Sani5, U Livi6, G Gerosa3, F Bellotto1 1University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy, 2Institute Codivilla Putti, Cortina D'ampezzo, Italy, 3University of Padua, Department of Cardiac, Thoracic and Vascular Sciences/Cardiac Surgery, Padua, Italy, 4Sant'Orsola-Malpighi Polyclinic, Department of Cardiac Surgery, Bologna, Italy, 5University of Siena, Department of Cardiothoracic Surgery, Siena, Italy, 6University Hospital “Santa Maria della Misericordia”, Department of Cardiopulmonary Sciences, Udine, Italy Heart Failure (Rehabilitation & Implementation) Introduction: In the last decade there was an expanding application of ventricular assist devices (VAD) due to a shortage of donor organs combined with the efficacy of these mechanical circulatory supports. The Jarvik 2000 is one of the most used worldwide. We report our experience of in-hospital intensive phase cardiac rehabilitation (CR) in pts who underwent Jarvik 2000 ventricular assist device implantation as destination therapy. Methods: In the period 2009-2011, 18 pts (3 females, mean age 66.6 ± 5.8 yo) had been admitted to our CR unit, 65 ± 52 [20-205] days after operation. They followed a structured rehabilitation programme that included 3 daily sessions on 6 days/week of respiratory exercises, aerobic training, calisthenics, plus physiotherapy and treatment of specific deficiencies, as well as psychological and dietary support. When possible, a six-minute walking test (6MWT) and a symptom limited cardiopulmonary exercise test (CPET) were performed at admission and at discharge. The Barthel scale (BI), measured at entry and at discharge, was used as autonomy index. Results: During the CR stay (mean 19 ± 7 [5-39] days) 2 pts suffered of major gastrointestinal bleedings, requiring repeated blood transfusions, and had to be transferred before completing the rehabilitation protocol (both pts in the first year); in the last 3 years no major complications occurred in the CR unit and all pts completed the program. A mild hemolytic anemia was recognized in all pts (mean Hb level at discharge 10.2 ± 1.3 g/dl). At the end of the CR period all pts enhanced independence and mobility (mean ΔBI + 11%) and were able to walk at least with the assistance of a stick. A 6MWT could be performed in 72% of pts (after 8 ± 8 days) with a mean increment in the distance walked of 70.2 ± 21.3 mt (p < 0.05). In the same pts, the CPET demonstrated that they were able to sustain a light intensity work load (35.7 ± 11.9 W; range 20-54 W), with a low maximum O2 consumption (12.4 ± 3.4 ml/kg/min; range 7.4-19.8), close to the anaerobic threshold (11,3 ± 2,8 ml/kg/min). Conclusions: Our experience with Jarvik 2000 ventricular assist device indicate that CR is feasible and safe in these patients allowing them to improve self autonomy and functional capacity; In this particular setting of patients, who usually have a lot of comorbidities and long periods of hospital stay before ventricular assist device implantation, It's also a good tool to monitor the complications in the delicate phase after discharge from the acute departments. P633 A clinical pathway to provide early rehabilitation in congestive heart failure M Miyako Mabuchi1, D Okamura1, S Ohde1, GA Deshpande1, A Mizuno1 1St Lukes International Hospital, Tokyo, Japan Heart Failure (Rehabilitation & Implementation) Purpose: During the acute phase of congestive heart failure (CHF) treatment, patients are often kept on bed rest, resulting in immobility that leads to muscle weakness and physical de-conditioning. To improve the management of CHF, we designed a clinical pathway which involves early rehabilitation from October 2010. The purpose of this study is to examine the feasibility of pathway implementation and the effect of early rehabilitation on return to previous function for CHF patients on this clinical pathway. Methods: We conducted a retrospective chart review of patients diagnosed with CHF and compared the rehabilitation outcome before and after implementation of the clinical pathway. The non-pathway group (NPG, n = 54, age; 81.7 ± 8.9), hospitalized between October 2009 and July 2010, received usual rehabilitation without use of the clinical pathway. The pathway group (PG, n = 62, age; 77.7 ± 12.6), hospitalized between October 2010 and July 2011, received early rehabilitation per the clinical pathway. Patients not requiring rehabilitation and cases with in-hospital mortality were excluded. The outcome measured were time to initiation of rehabilitation, time to regain a pre-hospital functional level and rate of regaining pre-hospital functional level. Functional level was classified into 6 categories: ability to climb stairs or walking fully, walking independently for <15 meters, walking with assistance, standing only, sitting up only, and bed rest. Independent t-test and chi-square tests were used to compare groups. Result: The mean length of stay was not significantly different between groups (13.3 ± 8.5 days in PG vs 15.3 ± 9.1 in NPG; p = 0.219, respectively). The mean time to initiation of rehabilitation among PG was significantly shorter than that for NPG (2.8 ± 1.9 days vs 4.7 ± 3.9, p = 0.002). No significant difference was found in the time to regain a pre-hospital functional level between PG and NPG subjects (5.7 ± 4.6 days vs 5.3 ± 3.5, p = 0.609). The rate of regaining a pre-hospital functional level was modestly higher in PG groups, but not significantly (PG;77.4% vs NPG;70.4%, p = 0.387) Conclusions: Our clinical pathway provided earlier rehabilitation for hospitalized CHF patients. Therefore, the clinical pathway will enable more patients to regain a pre-hospital functional level and will shorten hospital length of stay. P634 Effect of cardiac rehabilitation with exercise training on fasting plasma glucose and hba1c in patients with chronic heart failure. A An Stevens1, J Berger2, D Hansen2, B Op 'T Eijnde3, P Dendale2 1Hasselt University, Hasselt, Belgium, 2Rehabilitation and health centre, heart centre, Jessa hospital, Hasselt, Belgium, 3Rehabilitation & Healthcare Research Center, Dept. of Healthcare, PHL-University College, Hasselt, Belgium Heart Failure (Rehabilitation & Implementation) Purpose: It has long been recognized that chronic heart failure (CHF) and glucose abnormalities are linked. However, the effect of physical exercise training on glucose metabolism in CHF has not been extensively investigated. The aim of the presented analysis is to describe a large cohort of CHF patients that engaged in rehabilitation in terms of exercise tolerance, fasting plasma glucose and HbA1c. Methods: Data concerning cardiopulmonary exercise testing, blood analysis and training were extracted from medical files. Maximal exercise testing with gas analysis was performed on a bicycle ergometer, venous blood samples were taken in a fasting state at the start and after 6 weeks of rehabilitation. Results: In total, 124 CHF patients were included in rehabilitation, of which 38 (31%) dropped out of the programme before the second exercise test after 6 weeks of training. The dropouts did not differ significantly in terms of age, left ventricular ejection fraction and percentage of predicted peak oxygen uptake. The prevalence of diagnosed diabetes was 10% in the dropout group (vs 23%). Nevertheless, baseline glucose (113 ± 39 vs 103 ± 18) and HbA1c (6.07 ± 1.07 vs 5.91 ± 0.66) tended to be higher in the dropout group, although the difference was not statistically significant. Eighty-six patients finished a second exercise test after 6 weeks, of which 20 patients had diagnosed diabetes (table 1). The diabetic group did not differ significantly in terms of age (66.4 ± 9.7 years vs 62 ± 12.3 years, p = .101), left ventricular ejection fraction (29 ± 13% vs 32 ± 13%, p = .422) and body mass index (28.1 ± 5.2 kg/m2 vs 27.1 ± 5.5 kg/m2, p = .48). Although both groups had a significant increase in peak oxygen uptake (+8.3 ± 8.1% predicted in diabetics, p < .001 vs +9.45 ± 14.3% predicted in non-diabetics, p < .0001), this was significantly lower at both tests in the diabetic group (p < .05). Fasting plasma glucose in the diabetic group was unaltered after training (−0.1 ± 41.5 mg/dL, p = .935), but tended to increase in the non-diabetic group (+4.1 ± 18.7, p = .222). HbA1c tended to decrease after training in both groups (−0.28 ± 0.47, p = .091 in the diabetic group vs −0.08 ± 0.29, p = .239 in the nondiabetic group). Conclusions: The prevalence of diabetes is considerable in a CHF population engaged in rehabilitation. Patients without diagnosed diabetes also showed high fasting plasma glucose, which did not decrease after exercise training. Further study will show what is the role of cardiac rehabilitation in improving glycemic control and what would be the best method to detect changes in glycemic control after intervention. P635 Dose-response relationship of baroreflex sensitivity and heart rate variability to individually-tailored exercise training in patients with heart failure F Iellamo1, V Manzi1, G Caminiti1, B Sposato1, G Marazzi1, E Lippi1, G Rosano1, M Volterrani1 1IRCCS San Raffaele Pisana, Rome, Italy Heart Failure (Rehabilitation & Implementation) Purpose: Heart Rate Variability (HRV) and Baroreflex Sensitivity (BRS) are impaired in patients with Chronic Heart Failure (CHF) and carry negative prognosis. Exercise training improves these parameters. However, the relationship between exercise training with heart rate variability and BRS has been investigated without regard for individual training loads. We tested the hypothesis that in CHF patients changes in heart rate variability and BRS are dose-response related to individual volume/intensity training load (TL). Methods: Twenty patients with stable postinfarction CHF under optimal medical treatment were randomized to either aerobic continuous training (ACT) or aerobic interval training (AIT) for 12 weeks. Individualized TL was monitored by the Training Impulses (TRIMPi) method, which was determined using the individual HR and lactate profiling determined during a treadmill test at baseline. Heart rate variability (standard deviation of mean R-R interval) and BRS were assessed at rest before training and 3 weeks apart, throughout the study. Results: Heart rate variability, BRS and R-R interval increased significantly with training, being very highly correlated (P < 0.001), to the dose of exercise with a second-order regression model, resembling a bell-shaped in the ACT, and an asymptotic-shaped curve in the AIT groups, respectively (Fig.1). These changes were accompanied by a significant increase in functional capacity, as determined at the same time intervals by the 6min walking test and by peak oxygen uptake before and after training. No significant differences were detected between ACT and AIT in any variable. Conclusions: These results suggest that improvements in heart rate variability and BRS by exercise training in CHF patients are dose related to TL in a non-linear fashion on an individual basis, with optimal results at moderate doses of exercise. Open in new tabDownload slide P636 Nordic walking as a safe and potentially more effective training method than walking without poles in patients with HF. A Lejczak1, K Krystian Josiak2, K Wegrzynowska-Teodorczyk1, E Rudzinska1, W Banasiak2, EA Jankowska2, M Wozniewski1, P Ponikowski2 1University School of Physical Education, The Faculty of Physiotherapy, Wroclaw, Poland, 2Centre for Heart Disease - Clinical Military Hospital - Department of Cardiology, Wroclaw, Poland Heart Failure (Rehabilitation & Implementation) Background: Aerobic training in patients with heart failure (HF) improves exercise capacity and quality of life, and reduces HF-related hospitalizations. Nordic walking (NW), a walking technique with poles mimicking arm motions of cross-country skiing, has already been applied as a rehabilitation method in post-MI patients. We compared haemodynamic response and oxygen consumption during walking with (NW) and without poles in patients with HF and in healthy athletes. Methods: We examined 9 healthy persons (age: 30+\−10; 5 men, median peak VO2: 29.3 ml/kg/min) and then 12 men with stable systolic HF (age: 63+/−11 years, all New York Heart Association class II, median LVEF 30%, median peak VO2: 18.2 ml/kg/min). All participants completed 2 randomly assigned submaximal walking tests (1 with poles and 1 without poles) conducted on a level treadmill for 6 minutes at a constant speed of 5 km/h. Results: In the healthy group NW in comparison to walking without poles was related with higher O2 consumption (VO2) (median increase of 39%, 5.2 ml/kg/min), higher peak heart rate (HR; +20 bpm), higher maximal systolic blood pressure (BP; +15 mmHg), and greater fatigue (+2 points) - all p < 0.05. In patients with HF, NW was found to increase VO2 (+14.7%; +2.9 ml/kg/min), peak HR (+15 bpm), maximal BP (+10 mmHg), and fatigue level (+2 points) - all p < 0.05. No signs of cardiac ischaemia and no significant arrhythmias during tests were noted. Conclusions: Applying a NW technique in comparison to walking without poles safely increases the intensity of training and haemodynamic responses to it, and thus, may provide additional training benefits to HF patients. P637 Reduced benefits of physical training in patients with heart failure are related to cognitive impairment F Ranghi1, G Caminiti1, D Battaglia1, A Franchini1, V Cioffi1, R Di Carlo1, M Volterrani1 1IRCCS San Raffaele Pisana Hospital, Rome, Italy Heart Failure (Rehabilitation & Implementation) Purpose: To determine whether the presence of cognitive impairment (CI) affects physical recovery of patients with heart failure (HF) undergoing a physical training program (PTP) after a recent episode of acute decompensation. Methods: The study enrolled 80 patents with CHF (M/F=52/26) and ejection fraction (EF) <40% consecutively admitted to our cardiac rehabilitation centre after an episode of acute decompensation. CI was evaluated by means of the Mini-Mental State Examination (MMSE), with a score of <24 indicating impairment; Exercise tolerance was evaluated by six minute walking test (6mwt) performed at admission and at the end of PTP. All patients underwent an intensive 8-week program of aerobic PTP at 70% oxygen uptake. At admission patients were divided into two group according to their MMSE (group A > 24; group B<24) Results: Overall 43 patients (54%) had MMSE <24. The score obtained at MMSE resulted significantly related to ejection fraction (r 0.42; p 0.03), and it was inversely related to creatinine levels (r −0.36 p 0.04) and atrial fibrillation rate (r 0.34; p 0.07). At the end of PTP patients of group B had a lower increase of distance walked at 6MWT than group A (98 ± 16 m and 131 ± 28 m respectively, p 0.008). Moreover patients of B group had a longer in-hospital stay and needed more pharmacological interventions than group B. 2/80 patients (2.5%) died during the hospitalization all of which were in the B group. In a multivariate logistic regression model, including age, gender, renal failure, ejection fraction and diabetes, MMSE<24 predicted a reduced performance at 6MWT in the overall population (OR 1.4, 95% CI 1.7 to 2.4) and in women (OR 1.31; 95% CI 1.20-1.62), while it was not predictive in males. Conclusions: CI is a marker of advanced HF. CI is an independent predictor of lower exercise capacity in female gender with HF. P638 Safety and efficacy of exercise training in moderately symptomatic hypertrophic cardiomyopathy patients R Robert Klempfner1, M Arad2, T Kamerman1, A Nahshon1, I Hay1, I Goldenberg1 1Chaim Sheba Medical Center, Cardiac Rehabilitation Institute, Tel Hashomer, Israel, 2Chaim Sheba Medical Center, Leviev Heart Center, Tel Hashomer, Israel Heart Failure (Rehabilitation & Implementation) Purpose: Exercise training (ET) is highly beneficial in heart failure patients and has been suggested to confer significant symptomatic and functional improvements in patients with diastolic dysfunction. Accordingly, the aim of this pilot study was to examine the safety and feasibility of a structured ET program in symptomatic hypertrophic cardiomyopathy patients. Methods: We prospectively enrolled 15 hypertrophic cardiomyopathy patients with New York Heart Association functional class II (47%) or III (53%) in a structured ET program at cardiac heart failure rehabilitation centre. Detailed medical examination, echocardiography study and pre-enrolment symptom limited exercise stress test (EST), were preformed prior to enrolment. Exercise prescription was based on heart rate reserve (HHR) obtained during EST and intensity was gradually increased on following training sessions. Results: Enrolled patients (mean age 62 ± 13.2) had an LVEF of 51% ± 15.8, and an average septum size of 16.36 ± 5.6 mm. Left ventricular outflow gradient was present at rest in eight patients (mean gradient 42.5 ± 29 mmHg). Patients completed a total of 322 hours of mainly aerobic ET. No adverse events or sustained ventricular arrhythmias occurred during the training program. Functional capacity, as assessed by the percent change in maximally attained METS, improved significantly by 46% from 4.12 ± 1.9 to 6.02 ± 2.2 METS p = 0.01 (fig. 1). New York Heart Association class improved from baseline by ≥ 1 grade in 6 patients (40%), while none experienced a deterioration in functional class during follow-up. Conclusions: The present study is the first to show that moderately symptomatic patients with hypertrophic cardiomyopathy can safely exercise in a cardiac rehabilitation program. Our findings suggest that symptomatic and functional gains are attainable in this high risk population. Further evaluation through a larger randomized study is necessary. Open in new tabDownload slide P639 Acute haemodynamic effects to finnish sauna and cold water immersion in patients with heart failure T Thomas Radtke1, D Poerschke1, M Wilhelm1, HU Tschanz2, F Matter2, D Jauslin1, H Saner1, JP Schmid1 1Bern University Hospital, Cardiovascular Prevention and Rehabilitation, Bern, Switzerland, 2Berner Rehazentrum Heiligenschwendi, Heiligenschwendi, Switzerland Heart Failure (Rehabilitation & Implementation) Purpose: Finnish sauna is popular in heart patients, however the haemodynamic response to this type of heat exposure and subsequent cold-water immersion (CWI) in patients with heart failure is unknown. Methods: Haemodynamic response to two consecutive Finnish sauna (80°C) exposures for 10 minutes each, followed by a final head-out CWI (12°C) was measured in 37 male participants: 12 with chronic heart failure (CHF) (61.8 ± 9.2 yrs, EF 30.6 ± 7.3%, New York Heart Association class II-III), 13 with coronary artery disease and preserved ejection fraction (CAD, 61.2 ± 10.6 yrs, ejection fraction 57.7 ± 7.7%) and 12 control subjects (60.9 ± 8.9 yrs, ejection fraction 64.2 ± 3.6%). Cardiac output (CO, inert gas rebreathing system, Innocor®) and heart rate were measured prior to and immediately after the first sauna exposure as well as after CWI, respectively. Blood pressure was measured before, twice during (3 and 6 min) and after sauna. Results: Sauna and CWI were well tolerated by all subjects. CO and heart rate significantly increased in all groups after sauna and CWI (p < 0.05), except for CAD patients after sauna exposure. Systolic blood pressure during sauna decreased significantly in all groups with a minimal value after 6 minutes (133.5 ± 16.5 mmHg to 119.8 ± 13.5 mmHg in controls, 113.4 ± 11.0 mmHg to 99.1 ± 15.5 mmHg in CAD and 101.2 ± 11.3 to 93.6 ± 13.6 mmHg in CHF patients, all p < 0.05). CWI significantly increased systolic blood pressure in all groups (117.4 ± 13.1 mmHg to 133.7 ± 12.6 mmHg in controls, 97.0 ± 14.3 to 118.3 ± 13.6 mmHg in CAD and 94.0 ± 15.7 to110.1 ± 20.8 mmHg in CHF patients, all p < 0.05). Conclusions: Acute exposure to Finnish sauna and subsequent CWI increases CO and HR in CHF patients similarly to control subjects. Blood pressure decreases modestly during heat exposure without eliciting symptoms. P640 The safety of long term physical training of patients with moderate and severe chronic heart failure R Kubilius1, DA Vasiliauskas1 1Kaunas Medical University Hospital, Kaunas, Lithuania Heart Failure (Rehabilitation & Implementation) Chronic heart failure The aim of study. To evaluate the safety of long-term exercise training of patients with moderate and severe chronic heart failure. During 2007-2009, 164 patients participated in the study: 145 men (88.4%) and 19 women (11.6%). Patients were randomized to active and control groups. 144 patients finished the whole program, 72 in each group. Patients in active group were trained according to methods of aerobic physical training. We evaluated all observed adverse events, which included any cardiovascular events occurred in 1 hour after physical exercise. Hospitalization for any cardiovascular condition, death from any cause and surgery (heart transplantation) were also regarded as adverse events. No significant differences in groups were observed comparing number of deaths from any cause, heart transplantations and hospitalizations separately. However, there was significant difference in combined endpoint of cardiovascular hospitalizations (worsening of heart failure, angina or acute arrhytmias) and lethal outcomes between study groups. There were fewer such events in active group compared to control group, 19 and 33 events (p = 0,01) respectively. After 6 months of different management strategies, there were also significant differences in hospitalizations for any cause and transplantations between study and control groups, 16 and 27 events, respectively (table 1). The most common cause of hospitalization, accounting for 92% all cases in control group, was worsening of heart failure. There was significant difference in hospitalization for this cause between groups. Conclusion: Long term physical training is safe for patients with moderate and severe HF: during study period there were significantly fewer deaths and cardiovascular hospitalizations. P641 Significance of post coronary revascularization positive exercise stress test: do we need to be alarmed? A Khan1, AM Mcgowan1, RB Boner1, E Joyce1, P Nash1, J Crowley1, B Mcneil1, K Daly1 1University Hospital Galway, Galway, Ireland Other Heart Disease (Rehabilitation & Implementation) Purpose: Exercise stress test (EST) is a tool which can be used to collect baseline and follow-up data that allows evaluation of progress in cardiac rehabilitation program participants after coronary revascularization. The purpose of our study was to compare the progress of patients, with an electrocardiographically positive EST, with patients who had a normal EST prior to enrolment in cardiac rehabilitation. Methods: We performed a retrospective analysis of 116 patients who underwent coronary revascularization and subsequent cardiac rehabilitation program in a tertiary care cardiac unit. 58 patients had a positive pre rehab Exercise Stress Test (EST) while 58 patients had negative EST. Demographics, Male to female ratio, co morbidities and angiogram findings were compared. Pre and post rehab EST in both groups were analysed and the following parameters were compared: heart rate, blood pressure, presence of angina, maximal ST-segment depression, and exercise duration. Exercise stress tests were classified as positive or negative according to ACC guidelines. Results: In the positive EST group, 24(41%) patients managed to achieve target heart rate with 27(46.5%) having symptoms. In comparison, 22(38%) patients in the negative stress test group achieved target heart rate with 21(36%) reporting symptoms on the treadmill. Out of 31(53%) patients who were asymptomatic in the positive pre rehab EST, 25 (81%) remained symptom free in the post rehab EST. Meanwhile in the negative EST group 43(74%) patients remained symptom free in the post rehab EST. 1 patient in each group was unable to complete the rehab program.2 (3.4%) patients in the positive EST group, who had early positive symptomatic EST, needed repeat revascularization. Conclusion: Our study clearly shows that patients with asymptomatic positive EST (based on electrocardiogram criteria), post coronary revascularization, perform similar or better than patients with negative EST in the cardiac rehabilitation program. In addition, only early positive EST with presence of chest pain permitted us to identify patients with restenosis or a new lesion. The results of this study also supports the ACC/AHA guidelines that exercise treadmill testing should not be used routinely after percutaneous coronary intervention in asymptomatic patients. In these times of economical crises, savings can be made by judicious use of these modalities. P642 Failure of the vaccination program during the H1N1 pandemic 2009 in patients with severe congenital heart disease A Alfred Hager1, K Ortmann1, U Bauer2, J Hess1 1Deutsches Herzzentrum München, Munich, Germany, 2Competence Network for Congenital Heart Defects, Berlin, Germany Other Heart Disease (Rehabilitation & Implementation) During the H1N1 pandemic in 2009 there was an invocation to the general public for immunization with a vaccine designed for that influenza strain. With a lack of vaccine chronically diseased people should be privileged. This study aimed to evaluate the time course of that vaccination and any reasons for delay. Patients and methods: In cooperation with the National Register for Congenital Heart Defects, 998 patients older than 10 years, who were currently cyanotic, had pulmonary hypertension, transposition of the great arteries after atrial redirection, or a Fontan circulation, were contacted and asked to fill a questionnaire about the timing of their H1N1 vaccinations and to give reasons for delay or being not vaccinated. Results: The response of 286 patients (29%) showed that 92% stuck to the regular vaccinations (like tetanus) whereas the pandemic H1N1 immunization was only given to 30% of the patients. As the main reason for being not vaccinated the patients claimed that they were not informed properly and the feared the side effects published in the lay press. Those, that had been vaccinated complained a delay because of supply bottleneck. In the investigated patients group 4% reported that the had H1N1 influenza in 2009/2010. In addition, the authors know at least one death on H1N1 in a patient with congenital heart disease during the pandemic. Conclusions: The H1N1 pandemic vaccination program was implemented neither timely nor in a sufficient magnitude. For future pandemics new concepts have to be developed to address this high risk groups in time. P643 Predictors of sildenafil effects on exercise capacity in adults with Fontan circulation A Alfred Hager1, R Weber1, J Mueller1, J Hess1 1Deutsches Herzzentrum München, Munich, Germany Other Heart Disease (Rehabilitation & Implementation) A single dose of sildenafil improves exercise capacity in Fontan patients. However, several studies failed to show a long-term effect of sildenafil. This study evaluated, whether subgroups with an enhanced sildenafil effect exist. Patients and methods: We studied 36 patients (16-42 years, 14 female) with univentricular heart after various modifications of the Fontan surgery (26 APA, 34 AVA, 14 TCPC) in childhood. They performed two cardiopulmonary exercise tests, with at least 120 minutes rest and a single dose of 50 mg sildenafil in-between. The change in peak oxygen uptake was correlated to various variables from anthropometry, the previous course of disease (time of surgery, type of surgery), the current clinical condition (baseline peakVO2, NT-pro-BNP), as well as the current physical activity measured by accelerometers. Results: After sildenafil administration patients improved their peak oxygen uptake from 64.5%pred. to 67.3%pred. (p = 0.0003) without change in VE/VCO2 slope, SpO2 at rest and peak exercise, RER, or systolic blood pressure at exercise. There was a moderate negative correlation to the baseline peakVO2 without sildenafil (r = −.395; p = .017). Conclusions: In Fontan patients there is a improvement in exercise capacity on a single dose of sildenfil. Patients with a bad baseline exercise capacity profit most. P644 Safety and outcome of residential cardiac rehabilitation (RCR) in transcatheter aortic valve implantation (TAVI) patients compared to biological aortic valve replacement (AVR) for aortic stenosis F Franco Tarro Genta1, Z Bouslenko1, M Tidu1, F Bertolin1, C Taglieri1, P Giannuzzi2 1Salvatore Maugeri Foundation, IRCCS - Institute of Turin, Turin, Italy, 2Salvatore Maugeri Foundation, IRCCS, Division of Cardiology Rehabilitation, Veruno, Italy Other Heart Disease (Rehabilitation & Implementation) Purpose: to describe exercise training safety and outcome of transcatheter aortic valve implantation patients (TAVIp) as compared to aortic valve replacement patients (AVRp) attending RCR after implantation. Methods: from January 2010 to March 2011 24 consecutive TAVIp (21% male, age 82 ± 4, 14 Edwards, 10 CoreValve) and 24 consecutive AVRp aged ≥ 75 (45% male, age 78 ± 3) were admitted at RCR. They underwent disability (Barthel Index) (BI), co-morbidity (CIRS-CI) profile and Echocardiographic assessment. Logistic Euroscore (LE) was derived from records before implantation. All patients underwent 3 weeks supervised tailored exercise training program (TP) (walking, up to 30 minutes of cycling exercise daily session). Six minute walking test distance (6MWT) was evaluated on admission and at discharge. Results:compared to AVRp, TAVIp were significantly older, with lower left-ventricular ejection fraction, higher LE and proportion of left ventricle branch block. All patients attended TP with no complication related to exercise. TAVIp had significantly lower 6MWT both on admission and discharge than AVRp; anyway 6MWT gain between test was similar in both groups. BI was lower in TAVIp on admission but on discharge there were no differences between groups (Table). At 1 year follow-up there were no statistical difference in death occurrence (P = 0.054). Conclusion: compared to AVRp, TAVIp attending RCR are more disabled with higher cardiac risk profile and lower exercise capacity; despite this RCR is safe, well tolerated and leads to exercise capacity improvement and BI value similar to AVRp which generally favors a safe discharge and a relatively independent life at home. Table TAVIp AVRp P LE (M ± DS) 24 ± 9 8 ± 4 <0,01 CIRS-CI(M ± DS) 5,1 ± 1 3,6 ± 1 <0,01 BI admission (M ± DS) 62 ± 29 84 ± 15 <0,01 BI discharge (M ± DS) 84 ± 19 96 ± 5 NS 6MWT admission m (M ± DS) 120 ± 53 190 ± 80 <0,01 6MWT discharge m (M ± DS) 220 ± 77 320 ± 35 <0,01 Differences 6WT 123 ± 85 139 ± 73 NS LVEF % (M ± DS) 55 ± 9 62 ± 5 <0,01 Left ventricle branch block(%) 61 8 <0,01 TAVIp AVRp P LE (M ± DS) 24 ± 9 8 ± 4 <0,01 CIRS-CI(M ± DS) 5,1 ± 1 3,6 ± 1 <0,01 BI admission (M ± DS) 62 ± 29 84 ± 15 <0,01 BI discharge (M ± DS) 84 ± 19 96 ± 5 NS 6MWT admission m (M ± DS) 120 ± 53 190 ± 80 <0,01 6MWT discharge m (M ± DS) 220 ± 77 320 ± 35 <0,01 Differences 6WT 123 ± 85 139 ± 73 NS LVEF % (M ± DS) 55 ± 9 62 ± 5 <0,01 Left ventricle branch block(%) 61 8 <0,01 CIRS-CI: cumulative illness rated state-comorbility index. LVEF: left ventricle ejection fraction Open in new tab Table TAVIp AVRp P LE (M ± DS) 24 ± 9 8 ± 4 <0,01 CIRS-CI(M ± DS) 5,1 ± 1 3,6 ± 1 <0,01 BI admission (M ± DS) 62 ± 29 84 ± 15 <0,01 BI discharge (M ± DS) 84 ± 19 96 ± 5 NS 6MWT admission m (M ± DS) 120 ± 53 190 ± 80 <0,01 6MWT discharge m (M ± DS) 220 ± 77 320 ± 35 <0,01 Differences 6WT 123 ± 85 139 ± 73 NS LVEF % (M ± DS) 55 ± 9 62 ± 5 <0,01 Left ventricle branch block(%) 61 8 <0,01 TAVIp AVRp P LE (M ± DS) 24 ± 9 8 ± 4 <0,01 CIRS-CI(M ± DS) 5,1 ± 1 3,6 ± 1 <0,01 BI admission (M ± DS) 62 ± 29 84 ± 15 <0,01 BI discharge (M ± DS) 84 ± 19 96 ± 5 NS 6MWT admission m (M ± DS) 120 ± 53 190 ± 80 <0,01 6MWT discharge m (M ± DS) 220 ± 77 320 ± 35 <0,01 Differences 6WT 123 ± 85 139 ± 73 NS LVEF % (M ± DS) 55 ± 9 62 ± 5 <0,01 Left ventricle branch block(%) 61 8 <0,01 CIRS-CI: cumulative illness rated state-comorbility index. LVEF: left ventricle ejection fraction Open in new tab P645 Travel habits and complication rates in patients treated with vitamin k antagonists - a survey in german speaking countries H Heinz Voeller1, M Lehmann2, N Niemeyer2, I Seifert2, J Strobel2, R Eckstein2, A Daubmann3, K Wegscheider3, A Salzwedel1, J Ringwald2 1Klinik am See, Ruedersdorf, Germany, 2Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany, 3University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany Other Heart Disease (Rehabilitation & Implementation) Introduction. Travel-related conditions have impact on oral anticoagulation therapy (OAT) with vitamin K-antagonists (VKA). Although VKA are more than 50 years on the market neither data about patients travel habits nor hemorrhagic or thromboembolic complication rates are available. Methods: From 10/2009 to 10/2010 a standardized questionnaire with 27 items was sent to 2500 patients who have been on longterm OAT for at least 2 years. Demographic data, indication for OAT, INR target range, type of monitoring (patient self-management [PSM] or physician control), travel habits before/after onset of OAT, especially frequency, duration and destination of journey, and hemorrhagic or thromboembolic complications were documented and analysed by multivariate logistic regression. Results: By a responder rate of approx. 40% 997 records could be analysed. The patients (63.6% male, aged 62.0 + 12.9) had been on OAT for 102.4 + 75.8 months (mechanical heart valve prosthesis [33.9%], atrial fibrillation [33.6%] and thrombophilia [28.4%]). 77.5% performed PSM. 37.1% changed travel habits (more destinations with well developed health care system [36.5%], less frequent [38.3%] or for shorter periods [32.1%]). 54/834 patients (6.5%) suffered from hemorrhagic and 7/834 (0.84%) thromboembolic events. In multivariate analysis PSM (OR 8.6; 95% CI 4.4-16.9), destination e.g. tropics (OR 3.9; 95%CI 2.0-7.7), employment e.g. retired versus employed (OR 1.9%; 95% CI 1.1-3.0) and former bleeding complications (OR 1.7; 95% CI 1.2-2.4) were predictive of complications on travel. Conclusions: Despite restrained travel habits OAT complications are not uncommon. Travelling recommendations are required for patiens with longterm OAT. The choice of destination and medical history should be considered. P646 Six-minute walking test and left ventricular ejection fraction in cardiac rehabilitation program M Abeytua Jimenez1, J Castillo-Martin2, A Fernandez-Gonzalez2, T Martinez-Castellanos1, MA Ortega-Ordunez1, C Davalillo2, C Torres-Alvarez1, D Ruiz-Molina2, F Fernandez-Aviles1 1University General Hospital Gregorio Maranon, Department of Cardiology, Madrid, Spain, 2University General Hospital Gregorio Maranon, Department of Rehabilitation, Madrid, Spain Other Heart Disease (Rehabilitation & Implementation) Background and aims: The 6-minute walking test is simple, reliable and reproducible. It has been correlated with New York Heart Association functional capacity, peak oxygen consumption, quality of life, dyspnea, survival and daily life activities. Its use is spreading in the evaluation of patients in cardiopulmonary rehabilitation program (CRP). Distances less than 350 meters is an indicator of increased risk of mortality. The increase in 50 meters is considered indicator of clinically significant change before and after treatment. The aim of this study is to assess whether the ejection fraction (LVEF) modifies the values obtained in this test in patients undergoing a rehabilitation program. Methods: 255 patients completed a cardiopulmonary rehabilitation programs (CRP) during 2010. They were divided into three groups by left ventricular ejection fraction (LVEF): Group A (GrA) ≤ 35% left-ventricular ejection fraction, group B (GrB) between 36 and 49% and group C (GrC) ≥ 50%. We measured the distance covered during the test at the beginning and end of CRP. Results: GrA: N° = 51 patients (p), mean age 61,02 (26-85), 8 female, mean BMI 28,08 (20,57-38,67). Hypertension 58.8%, dyslipidemia 54.9%, diabetes 19.6% and smoking 47.1%. GrB: N° = 43 p, mean age 60,57 (26-85), 2 female, mean BMI 27,19 (21.8-34,19). Hypertension 58.1%, dyslipidemia 72.1%, diabetes 14% and smoking 48,8%. GrC: N° = 161 p, mean age 60,18 (34-88), 15 female, mean BMI 28,02 (19-31,13). Hypertension 51.6%, dyslipidemia 60.2%, diabetes 21.1% and smoking 35.4%. There was significant differences in the distance reached pre-post CRP (p < 0.0001) GrA: 75.02 m (56.59-93.46). GrB: 66.26 m (47.63-84.89). GrC: 57.38 m (48.76-66). There was a bigger increase in walked distance in GrA compared to GrB and GrC (p < 0.0001). Also significant differences (p < 0,0001) were found between the number of patients who exceeds 50 m in three groups: 33 patients 64.7% in the first, 31 patients 72.09% in second and 92 patients 59.6% in the third group. Conclusion: The results show that CRP significantly improved the distance achieved by patients in the 6-minute walking test. Those patients with LVEF ≤ 35% achieved better results. P647 Oxygen uptake after 12 weeks of a Tai Chi Chuan program for pacients after a recent myocardial infarct: a randomized clinical trial Grupo de Pesquisa em Cardiologia do Exercício, RMN Rosane Nery1, MZ Zanini1, MDC Camargo1, RPS Schimitt1, ATNZ Zucatti1, JNF Ferrari1, JBL Lima1, RS Stein1 1Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil Other Heart Disease (Rehabilitation & Implementation) Purpose: Most of the pacients with a recent myocardial infarct (rMI) suffers an functional ability decrease, in which is expressed by the objective reduction of the Maximum Oxygen Uptake (VO2max) measured in Cardiopulmonary Exercise Test (CPET). Any study so far has avaluated the Tai Chi Chuan (TCC) effect in the aerobic capacity of pacients after (rMI). Objective: Avaluate the impact of the TCC on the VO2max in pacients after rMI. Methods: Randomized clinical trial with 41 pacients enrolled in two Brazilian public hospital. All participants have done the cardiopulmonary exercise testing in treadmill between 14 and 21 days after the rMI (TCC = 18; Control (C) = 23). The average age was about 59 ± 10 years old in the TCC group and 58 ± 9 years old in the C group. The average of body mass index was 26.09 ± 3.93 in the TCC group and 27 ± 2.73 in the C group. The TCC group has had 3 classes a week of 60 minutes each (Yang style) and the C group has had 2 classes of stretching, both having a 12 week follow-up. Results: The groups presented an interaction effect along the time. While the TCC group increased the VO2max from 21,2 to 24,9 (ml/kg/min) with 95% CI (18.9-23.5) and (22.6-27.2) repectevely. The C group decreased from 22.1 to 20.2 (ml/kg/min) with 95% CI (20.1-24.1) and (18.2-22.2) respectevely; P < 0.0001 between the two groups after 12 weeks. Conclusion: The TCC promoted a significant increase in the VO2max in pacients after rMI, so this could be a new possibility to rehabilitation for the pacients mentioned in this study. (Support FIPE/HCPA e CNPq). P648 relation of exercise capacity assessed with cardiopulmonary exercise test and aminoterminal pro-brain natriuretic peptide in asymptomatic adults with transposition of the great arteries G Gemma Salerno1, G Scognamiglio1, A D'andrea1, B Sarubbi1, G Pacileo1, M D'alto1, G Limongelli1, R Gravino1, MG Russo1, R Calabro1 1Second University of Naples - Monaldi Hospital, Department of Cardiology, Naples, Italy Other Heart Disease (Rehabilitation & Implementation) The right ventricle (RV) of patients affected by transposition of the great arteries (TGA) following the Mustard procedure or congenitally corrected, is subjected to systemic afterload. Although the majority of patients are asymptomatic, reduced exercise capacity and cardiac dysfunction in response to exercise have been reported. Assessment of cardiac function during exercise with cardiopulmonary exercise testing (CPET) may disclose cardiac dysfunction, which may not be apparent at rest. Purpose: to evaluate cardiovascular function during exercise using CPET in asymptomatic or minimally symptomatic patients with atrially corrected transposition of the great arteries or congenitally corrected transposition of the great arteries and to correlate CPET variables with aminoterminal pro-brain natriuretic peptide (NT-pro-BNP) levels. Methods: Twenty patients (9 M/11F; 28 ± 11 years) with systemic right ventricle (14 pts with atrial repair for transposition of the great arteries and 6 with congenitally corrected transposition) were studied. All transposition of the great arteries patients underwent a bicycle symptom-limited CPET and blood sampling for NT-pro-BNP levels determination. Results: CPET indexes revealed significantly impaired exercise capacity (mean Watts performed 43,15 ± 8,44% predicted value) and functional capacity (mean peak oxygen consumption, VO2peak = 14,31 ± 8 ml/Kg/min; 48% of the predicted value) in the study population. NT-pro-BNP values (mean value:151 ± 109 pg/ml) were mostly increased and inversely correlated with heart rate (HR) (r = −0,71, p < 0.05), peak circulatory power (peak.C.P) (r = −0.564, p < 0.05), work load (r = −0,49, p < 0.05) and VO2peak (r = −0.472, p < 0.05). The correlation between HR and NT-pro-BNP remained significant even in multivariate analysis (B = −0.72, C.I.-31.9-9.4). Conversely, no correlations were observed among indexes of ventilatory response (i.e. VE/VCO2 slope, VD/Vt) and NT-pro-BNP values. Moreover, we showed that, at multivariate analysis, the best predictor of oxygen uptake peak was peak C.P. (B = 0.720 - CI 2.2-5.05). Conclusions: The exercise capacity of patients with transposition of the great arteries is, in general, compromised, most strikingly because of chronotropic incompetence and the lack of increase mean stroke volume (expressed by peak C.P) during exercise. Increased serum NT-pro-BNP levels were associated with poor exercise tolerance and aerobic inability. Close monitoring of biomarkers and CPET assessment in transposition of the great arteries patients can predict poorly functioning at-risk group to develop right ventricle dysfunction and progressive clinical deterioration. P649 Rehabilitation outcome after transcatheter aortic valve implantation compared to conventional aortic valve replacement M Matthias Hermann1, D Moormann1, I Fauchere1, A Redding2, G Noll1 1University Hospital Zurich, Zurich, Switzerland, 2Zürcher Höhenklinik Wald, Faltigberg-Wald, Switzerland Vascular disease (Rehabilitation & Implementation) Transcatheter aortic valve implantation (TAVI) is an established method for the treatment of patients with a very high surgical risk. Until now, mainly the morbidity andmortality results have been analysed. We investigated whether there are differences in the course of rehabilitation between patients treated with transcatheter aortic valve implantation and patients operated by the conventional method (control group). Methods: We included 34 transcatheter aortic valve implantation patients between January 2008 and December 2010 who were hospitalized in our rehabilitation centre. We compared them to 78 sex-matched patients, who were conventionally operated (control group) in the same period with regard to baseline data (including EURO score and STS score), 6-minute walking test (6MWT) on admission and discharge, FIM scores on admission and discharge, HADS score at admission and discharge and length of stay. Results: We found significant differences in age between transcatheter aortic valve implantation patients and control group (81.9 ± 4.59 vs 78.1 ± 5.85; p = 0.001), EURO score (26.20 ± 13.94 vs 11.60 ± 8.88; p <0.001), STS Mortality score (26.2 ± 13.94 vs 11.6 ± 8.88; p = 0.007) and STS Stroke Score (7.52 ± 2.58 vs 5.38 ± 1.75; p < 0.001). In addition, the presence of coronary heart disease, pulmonary hypertension, renal insufficiency, previous stroke, previous percutaneous coronary intervention was higher in transcatheter aortic valve implantation patients. Both patient groups showed comparable improvements concerning the 6MWT (91.52 ± 68.38 vs 88.85 ± 62.09; p = 0.852), total FIM score (9.542 ± 6.338 vs 12.235 ± 10.899; p = 0.265), length of stay (19.24 ± 6.396 vs 19.60 ± 5.084; p = 0.750) the HADS score A(−0.08 ± 1.44 vs −0.68 ± 2.77; p = 0.465), HADS D score (−0.08 ± 2.06 vs −1.32 ± 2.44; p = 0.114). Even after adjusting for the significant differences in the baseline groups, there were no significant differences in the endpoints. Conclusion: Although patients treated with transcatheter aortic valve implantation were a much sicker and older, there were no significant differences in the outcome during rehabilitation regarding the improvement of the 6-minute walking test, the FIM and HADS scores and length of stay. P650 Effects of a multidisciplinary rehabilitation program in diabetics patients with peripheral arterial disease. C Freyssin1, F Prieur2, C Verkindt3, P Benaich1, S Maunier1, P Blanc1 1Centre de rééducation, Unité de réadaptation et réhabilitation cardio-vasculaire et respiratoire, Sainte Clotilde, Reunion, 2Laboratoire AMAPP, EA 4248, Université d'Orléans, Orléans, France, 3CURAPS - DIMPS(EA4075), Université de la Réunion, Le tampon, France Vascular disease (Rehabilitation & Implementation) Purpose: Diabetes is a very important cardiovascular risk factor. Peripheral arterial disease (PAD) is a peripheral arterial complication resulting in a decrease in the arterial calibre. Despite the importance of its prevalence and morbid-mortality, peripheral artery disease remains too often underestimated and is insufficiently managed. Rehabilitation is recommended as a reference treatment during peripheral artery disease. This study examines the impact of a multidisciplinary rehabilitation program on some vascular and haemodynamic parameters, on glycemic control and on levels of anxiety and depression in peripheral artery disease patients. Methods: 58 patients (age: 63 ± 10 years, 30 men and 18 women) with peripheral arterial disease (PAD) were enrolled in a 6 week tailored multidisciplinary cardiac rehabilitation program. All patients presented heart coronary, diabetic and peripheral arterial disease. The cardiac rehabilitation programme includes medical supervision, educational sessions (7 hours per week) and adapted physical activity (13 hours per week). Glycated haemoglobin, fasting blood glucose, small artery elasticity index, ankle brachial index, distance performed during a 6 min walk test, performance during progressive exercise on treadmill and the level of anxiety and depression were measured before and at the end of their cardiac rehabilitation. Results: The cardiac rehabilitation program increased significantly distance performed at the 6 min walk test (p = 0.038), performance during the progressive exercise (p = 0.005), the ankle brachial index right (p = 0.003) and left (p = 0.001), small artery elasticity index (p < 0.001), and decreased significantly glycated haemoglobin (p = 0.008), fasting blood glucose (p = 0.003), level of anxiety (p < 0.001) and the level of depression (p = 0.002). Conclusion: The cardiac rehabilitation program had a significant positive effect on some vascular and haemodynamic parameters, the control of glycaemia and the levels of anxiety and depression of peripheral artery disease patients. These parameters are considered prognosis, so these results highlight the interest of a multidisciplinary rehabilitation program. In view of our results and recent data from the literature, we can think that exercise in rehabilitation could be involved in development of collateral circulation. P651 Skeletal muscle electrostimulation in chronic pulmonary disease patients with subclinical peripheral atherosclerosis: effects on muscle status and exercise performance A N Alexey Sumin1, EV Nedoseykina2, OG Arhipov2 1RAMS Scientific-Research Institute for Complex Studying of Cardiovascular Diseases, Kemerovo, Russian Federation, 2Sanatorium Topaz, Mysky, Russian Federation Vascular disease (Rehabilitation & Implementation) Background: Pulmonary disease patients are reported to have higher incidence of cardiology disorders, which might worsen the outcome. Subclinical peripheral atherosclerosis (PAD) is one of the earliest signs of cardiovascular disease and its diagnosis allows define a group of patients at higher risk for cardiovascular events. The aim of our study was to investigate the influence of the EMC course on muscular status and exercise tolerance in patients with chronic lung disease in combination with subclinical peripheral atherosclerosis. Design and methods: 51 patients, aged 61,2 ± 6,3 years with chronic lung disease and subclinical peripheral atherosclerosis were randomized into the EMS treatment group (n = 25) or control group (n = 26). All the patients underwent colour duplex scan of lower extremity arteries to verify the presence of atherosclerotic peripheral arterial disease. At baseline and after 3 weeks of the rehabilitation, all patients underwent 6MWT and estimation of muscles status. Training was conducted on the apparatus “Mioritm-040” with 4-channel stimulation. EMS sessions were carried out 2 times a day for 30 minutes within 10 days. In the control group performed standard pulmonary rehabilitation program. Results: The EMS therapy resulted in 6 MWD increase (p = 0.000001). EMS therapy resulted in the strength increase both of lower extremity extensors (from 13.2 ± 3.9 to 18.2 ± 4.1kg; p = 0.000012) and flexors (from 10.6 ± 3.9 to 15.7 ± 4.2kg; p = 0.000012). Additionally, the endurance of the same muscle groups was enhanced: the work rate of the lower extremity extensors and flexors with weight load increased (from 447 ± 282 to 756 ± 337kg*sec; p = 0.000001 and from 166 ± 87 to 400 ± 308 kg*sec; p = 0.0005). Similar dynamic changes were observed in the grip strength: the grip strength of the right hand increased by 11.6% (p = 0.000001) and by 11.8% of the left hand (p = 0.000001). Remarkedly, respiratory muscle strength also increased by 18.5% (p = 0.000001). The control group did not demonstrate any relevant changes. Conclusion: The EMS of lower extremity muscles in chronic pulmonary disease patients with subclinical atherosclerosis significantly improved exercise performance. EMS group showed a significantly improved strength and endurance not only of lower extremity muscles but also of forearm and respiratory muscles compared to the control group. The present study emphasizes the use of the EMS treatment in patients with co-morbid pathology. The EMS treatment allows avoid potential limitations for co-morbid disease patients to take part in rehabilitation programs. P652 The reliability and validity of Barnason Efficacy Expectation Scale (BEES): cardiac surgery version for Turkey S Sevcan Avci1, AZIZE Karahan1 1Baskent University, Faculty of Medicine, Ankara, Turkey Vascular disease (Rehabilitation & Implementation) This study was developed in a methodological manner to determine the validity and reliability of the Barnason Efficacy Expectation Scale (BEES) Cardiac Surgery Version for the Turkish Society. The original scale was developed by Susan Barnason in 2002 and consists of 15 items and a single factor. The study was conducted on 120 patients at the cardiovascular intensive care unit of a University Hospital at an Inner Anatolian province. The patients had undergone coronary artery bypass graft surgery. A questionnaire directed toward determining the descriptive features of the patients was used besides the scale in the study. The scale and questionnaire were administered again four weeks later. The scale was presented for a specialist opinion once language validity was ensured and the content validity index was calculated as 0.85. Analysis revealed that the scale contained five factors that were different from the original, that it was suitable to obtain a total scale score by addition and that there was no need to remove any of the items A correlation was present between the test-retest scores for all scale items (r = 0.818; p = 0.000). The internal reliability coefficient (Cronbach α) was 0.837 for the scale and 0.75-0.79 for the subscales. The mean score from all items of the scale was 47.26 with a range of 30 to 60. The mean BEES scores were higher in males, patients aged 34 to 59, those with previous hospitalization experience, and those with more than 8 years of education (p < 0.05). In conclusion, we determined that the BEES Cardiac Surgery Version was a valid and reliable scale for the Turkish society. We suggest that the scale be used in larger and different samples and new studies be performed to increase the self-efficacy of patients who have undergone coronary artery bypass grafting in the postoperative period. P653 An exploration of the feasibility of using the nintendo wii to improve physical activity during home based stroke rehabilitation. Research Institute for Sport and Exercise Sciences, R Rebecca Murphy1, T Hilland1, G Stratton1 1Liverpool John Moores University, Liverpool, United Kingdom Vascular disease (Rehabilitation & Implementation) Mortality following stroke is an issue of significant public health importance. Physical activity can result in increased independence in activities of daily living; however levels are reportedly low during “outpatient” rehabilitation. The development and evaluation of interventions that address specific barriers to engaging in physical activity during stroke rehabilitation are urgently required (Morris and Williams, 2009). Using professional and patient perspectives, this research aimed to explore the feasibility of using an exergaming console to promote physical activity during home based stroke rehabilitation. Specifically, to explore the experiences and perspectives of practitioners and patients when utilising the exergaming console as an adjunct to rehabilitation. A multi-method approach combined qualitative research (semi-structured interviews) with objective physical activity measurement (accelerometers). Twenty six stroke patients (from two hospital trust sites) were given a console for a 6-week period during early supported, home based rehabilitation. All patients took part in a semi-structured interview at the start and upon completion of the six week period, and in addition wore an accelerometer for a 3 day period at both time points. Fifteen stroke care practitioners (n = 15) took part in a semi-structured interview to explore their experiences and perspectives. Practitioners cited benefits related to patient outcomes (physical, psychological and cognitive) and the process of rehabilitation (social advantages such as enhanced social engagement, stimulation and interaction with family members). Patients articulated a holistic range of benefits from using the console (themed in terms of physical, social, cognitive and psychological factors) and trends in physical activity increased. In addition patients articulated feelings of enjoyment, success and improvement when using it as an adjunct to their rehabilitation activities. In contrast to such positive perspectives, findings are also suggestive that console use during rehabilitation may be more feasible in patients who are more capable of using technology and who already have a good level of physical activity. In addition, the pace and feedback provided by such games may need to be modified to meet the needs of this clinical population. Morris, J.H. and Williams, B. (2009) Optimising long-term participation in physical activities after stroke: exploring new ways of working with physiotherapists. Physiotherapy, 95, 227-233. P654 Intensity of cardio training in modification of erectile dysfunction and physical fitness in male patients treated invasively due to ischaemic heart disease D Kalka1, ZA Domagala2, J Wojcieszczyk3, L Rusiecki4, P Koleda4, A Janocha5, M Pilot6, M Poreba4, M Rusiecka7, W Pilecki4 1Wroclaw Medical University and Creator Centre of Cardiac Rehabilitation and Prevention, Wroclaw, Poland, 2Wroclaw Medical University, Departament of Normal Anatomy, Wroclaw, Poland, 3Ostrobramska Medical Center, Magodent, Department of Cardiology, Warsaw, Poland, 4Wroclaw Medical University, Department of Pathophysiology, Wroclaw, Poland, 5Wroclaw Medical University, Department of Physiology, Wroclaw, Poland, 6County Center of Cardiac Rehabilitation and Prevention, Glucholazy, Poland, 7Wroclaw Medical University, Wroclaw, Poland Vascular disease (Rehabilitation & Implementation) Purpose: Analysis of the influence of cardio training intensity on the physical efficiency and erectile dysfunction intensity in patients with ischaemic heart disease (IHD). Material and Methods: The analysis has been conducted on 151 patients with ischaemic heart disease treated invasively that suffered from erectile dysfunction (ED) [IIEF-5 test ≤ 21 points]. The study group consisted of 116 patients (average age 62.06 ± 8.70 years old) subjected to six months cycle of cardiac rehabilitation (CR) and the control group comprised 31 patients (average age 61.43 ± 8.68) not subjected to CR. Training sessions were five days a week - two days of general rehabilitation exercises and three days of cycle ergometer training (system er 900, Ergoline). Loads of the cycle ergometers were set at 4-minute intervals and were interrupted by 2-minute rest periods with maintained load of 5-10 W. Each training session lasted 45 minutes. The intensity of strength exercises was presented using parameters describing the size of the load used. The value of the mean work were analysed. All patients filled in an IIEF-5 questionnaire twice, at the interval of six months, and were subjected to the treadmill test twice. Results: A comparative analysis of physical efficiency and ED intensity at the beginning of CR cycle between the study group and the control group has not shown any statistically significant differences. As a result of CR, in the study group there was a statistically significant increase in the value of metabolic equivalent scores (7.19 ± 1.95 versus 9.34 ± 2.46; p < 0.01) which was not observed in the control group (7.26 ± 1.87 vs 7.57 ± 2.16, NS). ΔMET in study group amounted 2.15 ± 1.03. There were revealed a significant increase in the IIEF5 test scores (12.51 ± 5.98 versus 14.41 ± 6.85, p < 0.01) in the study group whereas the IIEF5 test scores did not differ between the begining and the end of CR (12.26 ± 5.83 vs 12.43 ± 5.67, NS) in the control group. The study group ΔED was 1.9 ± 1.39. Mean work of the cardiac training was 84.78 ± 18.02 KJ. This parameter was associated with ΔMET by statistically significant Pearson's correlation coefficient of r = 0.360 and by statistically insignifficant Pearson's correlation coefficient of r = 0.156 with ΔED. Conclusions: CR cycle led to a significant positive modification of erectile dysfunction intensity and an improvement of physical capacity of patients with ischaemic heart disease. Cardiac training intensity was associated significantly only with the improvement of patients' physical efficiency and did not determine the reduction of ED symptoms. P655 Safety and efficacy of outpatients cardiovascular rehabilitation in patients with Stanford type A acute aortic dissection M Masakazu Saitoh1, N Morotomi1, M Nagayama1, H Itoh1 1Sakakibara Heart Institute, Fuchu, Japan Vascular disease (Rehabilitation & Implementation) Backgrounds: The long-term mortality for patients with type A acute aortic dissection has decreased over the last decade. The in-hospital period in postoperative patient with type A acute aortic dissection is often prolonged, and may lead to reduce physical function. Therefore, it was important to participate in outpatient cardiovascular rehabilitation (phase CR). However, it was not clear whether phase CR lead to progression of dissection or aortic dilatation, aneurysm formation, and rupture. The aim of study was assessed safety and efficacy of outpatients cardiovascular rehabilitation program (phase CR) for postoperative patients with acute type A acute aortic dissection (AAD). Methods: We studied consecutive 310 patients (125 females and 185 males, mean age 65 ± 12 years) who underwent emergency surgery for Stanford type A AAD from January 2006 through December 2009. The subjects were divided into two groups, 54 phase CR group who participated in 3 month phase CR (37 males and 17 females, mean age 60 ± 12 years), and 256 control group (147 males and 109 females, mean age 66 ± 13 years). Phase CR group was measured exercise capacity using cardiopulmonary exercise test at the beginning and end of phase CR. The end points of present study were enlargement of aorta or re-dissection and re-operation of enlargement or re-dissection of aorta. Follow-up was obtained by a review of hospital charts, and mean follow-up periods was 48 months. We obtained ethics approval from Sakakibara Heart Institute Ethics Committee. Results: AT and peak oxygen uptake were significantly improved in phase CR group (p<0.05 for both). On the other hand, event free survival rate was not significant difference between phase CR group and control group (enlargement of aorta,12.5% vs 17.1%; p = 0.404), (re-dissection of aorta, 3.0% vs 1.4%; p = 0.119) and (all event, 16.7% vs 18.6%; p = 0.519). Moreover, re-operation of aorta also did not show significant difference between phase CR group and control group (Log rank test; p = 0.960). Discussion: Phase CR improved exercise capacity in postoperative patients with Stanford type A AAD. Moreover, we confirmed the participation of phase CR under strict blood pressure control did not lead to aortic event including enlargement or re-dissection of aorta. P656 Improvement of baroreflex sensitivity and cardiovascular neural regulation after carotid endarterectomy for monolateral stenosis: a 4 month follow-up. L Laura Dalla Vecchia1, F Barbic2, A Porta3, M Pisacreta4, R Gornati4, T Porretta4, R Furlan5 1Salvatore Maugeri Foundation, IRCCS - Center of Milan, Milan, Italy, 2Internal Medicine, Syncope Unit, Bolognini Hospital, Seriate (BG), Italy, 3Department of Health Technology, University of Milan, Milan, Italy, 4Vascular Surgery Unit, L. Sacco Hospital, Milan, Italy, 5Internal Medicine, Syncope Unit, Bolognini Hospital, University of Milan, Seriate (BG) and Milan, Italy Vascular disease (Rehabilitation & Implementation) Purpose: While the beneficial effect of carotid endarterectomy (CEA) on the recurrence rate of ischemic stroke in selected patients is well known, the influence of carotid endarterectomy on baroreflex sensitivity (BRS) and neural control of cardiovascular system has not been completely understood. Studies carried out on patients undergoing carotid endarterectomy have assessed BRS changes during surgery, in the early and late postoperative period, providing different and to some extent contradictory results. Aim of the present study was to address the effects of carotid endarterectomy on the cardiovascular neural regulation in a homogeneous group of patients with monolateral carotid stenosis after a mid-term 4 month follow-up. Methods: We enrolled 20 consecutive patients (4 women, 16 men; age 72 ± 2 ys) undergoing carotid endarterectomy for monolateral, symptomatic and >70% stenosis. BRS was evaluated in the frequency domain by assessing the instantaneous relationship between arterial pressure and RR interval oscillation, thus providing a quantitative estimate of the efficiency of baroreceptor mechanisms, the index α. Spectral analysis of heart rate (HR) and systolic arterial pressure (SAP) variability provided indices of sympathetic (LF) and vagal activity (HF). A time domain analysis was also performed using the modified Oxford technique to assess BRS. Plasma catecholamine (NE, E) levels were also measured. Data were acquired the day before surgery and 126 ± 9 days after, during rest and tilt test. Results: No significant differences in the haemodynamic parameters nor in plasma NE and E levels were found before and after surgery. At rest, cardiovascular autonomic profile was remarkably modified by carotid endarterectomy. Indeed, LFRR and LF/HF ratio significantly (p < .02) decreased from 53 ± 6 to 39 ± 5 nu and from 4.7 ± 2.4 to 1.4 ± 1.2, respectively, HFRR increased from 28 ± 6 to 36 ± 5 nu and LFSAP declined from 13 ± 4 to 3 ± 1 mmHg2 after surgery. Before surgery, tilt test induced no significant changes in LFRR and HFRR, as well as in LFSAP compared to rest. After surgery, tilt test significantly increased LFRR to 73 ± 3 nu and LF/HF ratio to 8.9 ± 2.1, decreased HFRR to 14 ± 2 nu, and enhanced LFSAP to 19 ± 5mmHg2. Both index α and BRS were significantly higher after surgery (α: 9 ± 1.4 vs 5.9 ± .9 ms/mmHg; BRS: 2.46 ± .64 vs 5.65 ± 1.1 ms/mmHg). Conclusions: 4 months after carotid endarterectomy profound modifications in the cardiovascular autonomic modulation could be observed in patients with monolateral carotid stenosis both while supine and during the gravitational stimulus. These findings may have important clinical implications as an improved autonomic profile is known to be associated to a better cardiovascular prognosis. P657 Atrial depolarization dispersion on Holter monitoring is an useful marker of atrial fibrillation after cardiac surgery F Maslowsky1, S Sarzi Braga1, RFE Pedretti1, R Tramarin2 1Salvatore Maugeri Foundation IRCCS Medicine and Cardiopulmonary Department, Tradate, Italy, 2European Foundation for Biomedical Research - Onlus, Cardiac Rehabilitation Unit, Cernusco, Italy Rhythm Disorders/Sudden death (Rehabilitation & Implementation) Purpose: Atrial fibrillation (AF) is a frequent complication of cardiac surgery (CS), occurring in up to 65% of patients (pts) and has been associated with a higher morbidity and long-term mortality. At present, no risk stratification strategy has been clearly identified. This study is aimed to test the association between post CS atrial fibrillation and temporally morphologic variation pattern (TMVP) of P wave, a measure of atrial depolarization dispersion evaluated by a new 24 hour Holter monitoring algorithm. Method: In this analysis, 117 consecutive pts admitted to a cardiac rehabilitation program (CR) after CS were enrolled. Seventeen were excluded because of preoperative atrial fibrillation or permanent pacemaker stimulation. All remaining 100 pts (mean age 67+/−11 years, 49% women, 43% coronary surgery, 32% valvular surgery and 25% combined CS) underwent Holter monitoring 15+/−7 days after CS and TMVP was determined. Data about atrial fibrillation occurring in surgery department and during CR were collected. Atrial fibrillation occurred in 52 pts (52%) during CS stay or during rehabilitation. Age, gender, body mass index and left ventricular ejection fraction were not significantly different between the 2 groups of pts, with and without atrial fibrillation. TMVP was found in 42 pts (80%) with atrial fibrillation and in 11 (32%) without. TMVP sensitivity for atrial fibrillation was 81%, specificity 77%, positive and negative predictive values 79% and 78% respectively (Relative Risk 3.72, 95% CI[2.11-6.57], p < 0.001). Conclusions: According to this preliminary data TMVP seems to be significantly associated with post-CS atrial fibrillation. These results, if confirmed in a larger study population, may be useful in tailoring a personalized approach for a more efficient prophylaxis of post-CS atrial fibrillation. P658 Return to professional working activity after myocardial infarction: real life data Z Zdravko Babic1, M Ostric1, M Pavlov1, V Nikolic Heitzler1 1UH Sestre milosrdnice, Zagreb, Croatia Health economics (Rehabilitation & Implementation) Purpose: According to relatively low number of studies, today even more than 80% of patients return to work after myocardial infarction. Patients (pts) are generally advised to return to full normal activities, including work, 6 to 8 weeks after acute myocardial infarction, but those with low risk for future cardiac events could return at 2 weeks. Return to work is especially associated with some variables: younger age, shorter duration of hospitalization, cardiovascular rehabilitation, absence of symptoms after and higher patients income prior to the acute infarction. Some public and corporate policies could promote their return to work. Methods: Authors investigated factors that influenced return to work, socio-economic and quality of life aspects in 150 pts who suffered acute ST-elevation myocardial infarction and were treated with primary percutaneous coronary intervention. Results: Average hospitalisation duration was 11 days, average follow-up 857 days. All pts were employed and under 60 years of age, 15% finished elementary, 70% secondary, 5% high school, and 10% had university degree. Acute ST-elevation myocardial infarction was complicated with ventricular fibrillation/flutter in 4% of pts, no pts suffered cardiogenic shock, and 29% of them had MACE (restenosis, re-MI, rehospitalization, coronary artery bypass grafting, stroke, death) during follow-up. Average return to work was 136 days after ST-elevation myocardial infarction or 121 days after hospital discharge. New sick-leave during follow-up was revealed in 20% of pts because of cardiac and in 16% because of non-cardiac disorders. Termination of employment experienced 4% of investigated pts and 26% were retired (especially older pts. and those with govermental employment, p < 0.01). Income after return to work was lower in 16% of investigated pts, equal in 73%, and enhanced in 1% of them. Quality of life after acute ST-elevation myocardial infarction was worse in 46% of investigated pts, enhanced in 27% and equal in 27% of them. Conclusion: Our study revealed lot of space in shortening of sick-leave and improvement of socio-economic and quality of life aspects in pts after acute ST-elevation myocardial infarction, even when they are treated with the most up-to-date invasive cardiology methods. P659 Cardiac rehabilitation in the elderly: outcome measurement, quality enhancement and centre comparison H Heinz Voeller1, A Salzwedel1, M Nosper2, S Linck-Eleftheriadis2, B Roehrig2, G Strandt3 1Klinik am See, Ruedersdorf, Germany, 2Medizinischer Dienst der Krankenversicherung Rheinland-Pfalz, Alzey, Germany, 3Techniker Krankenkasse, Hamburg, Germany Health economics (Rehabilitation & Implementation) Purpose: Quality management in cardiovascular rehabilitation focussed so far mainly on the structural and process quality. In contrast, the outcome quality addressed insufficient attention. Therefore, centres were not directly comparable. The aim of this study was to identify rehabilitation-related parameters for the objective evaluation of rehabilitation outcomes and thus to allow comparing rehabilitation centres. Methods: From 01/2009 to 06/2010, 1253 consecutive patients (70,9 ± 7,0 years, 78.1% men) in 12 rehabilitation centres were enrolled. Socio-demographic data, impairment group (surgical respectively percutaneous coronary intervention [PCI]), cardiovascular risk factors, structural and functional parameters, and subjective health were documented based on software (EVA-Reha® Kardio). The parameters were tested on measurability, sensitivity to change and whether they can be affected by the rehabilitation. Clinically relevant changes of suitable indicators were categorized in four levels (worsens, unchanged, improved, very improved). The multiple result criterion (MEK Kardio), formed from the sum of the change values, was adjusted for hospital-independent factors (e.g. age, gender, disease severity) by multiple regression. Results: The majority of patients (61.1%) was referred to rehabilitation after cardiac surgery (coronary artery bypass grafting, valve replacement or aortic surgery), 38.9% after percutaneous coronary intervention due to acute coronary syndrome. 49.2% of the patients had comorbidities (diabetes mellitus, stroke, pAVK, COLD) and 12% had a left ventricular dysfunction. 13 appropriate rehabilitation-related parameters were identified in 3 dimensions: risk factors (blood pressure, low-density lipoprotein cholesterol, triglyceride), exercise capacity (resting heart rate, maximal exercise capacity in watts, maximum 6-minute walk distance, heart failure and angina pectoris) and subjective health (IRES-24 pain, somatic an mental status as well as depression and anxiety). With an average rating level “improved”, the range from low to high rehabilitation success is approximately normal distributed in the MEK, whereby also worsened and very improved patients are shown selective. In centre comparison, the majority of the centres achieved average results, while 3 of them were significantly worse and one significantly better. Conclusions: With the identification of the appropriate indicators of the dimensions cardiovascular risk factors, exercise capacity and subjective health, rehabilitation outcomes can be comprehensibly represented. After adjustment for confounder it is possible to compare rehabilitation centres and to identify differences in quality. P660 Sex and ethnicity specific electrocardiographic differences in elite athletes: relevance to pre-participation cardiovascular evaluation S Gati1, S Ghani1, N Sheikh1, A Zaidi1, M Papadakis1, L Chen2, M Reed1, S Sharma1 1St George's University of London, London, United Kingdom, 2Univeristy Hospital Lewisham, London, United Kingdom Athlete's heart (Sports Cardiology) Purpose: The athlete's electrocardiogram is affected by several demographic factors but there is a paucity of data relating to the impact of the athlete's sex and ethnicity. The ESC guidelines for electrocardiogram interpretation in athletes are derived predominantly from male cohorts. Extrapolating such criteria to athletes of African/afro-Caribbean origin and female athletes may lead to erroneous interpretation. Methods: Between 2001 and 2011, 1378 highly trained athletes (55% males, 81% Caucasian) (mean age 21.6 ± 5.43 years); range 14-35 years, underwent cardiac evaluation including 12-electrocardiogram and echocardiography. Electrocardiograms were analysed for training related (group 1) and training-unrelated (group 2) changes, according to the ESC guidelines. Results: Males demonstrated a higher prevalence of Group 1(89% vs 61%;p = <0.0001) and Group 2 electrocardiogram changes (26%vs 16%;p = 0.0001) compared with females. Of the group 1 changes, isolated left ventricular hypertrophy (42%), early repolarisation patterns (ST elevation > 0.1 mV) (61%), first-degree AV block (10%) were more prevalent in males compared to 14%, 45% and 4.7% females respectively (p = 0.0001). Of the group 2 changes, T-wave inversion in leads V1-V4 were more prevalent in female athletes (12%) particularly black females (17%) compared to male athletes (4%; p = 0.0001), whereas, T-wave inversion in the inferior leads were more common in males (3.3% vs 0.6%) irrespective of ethnicity. Males demonstrated a higher prevalence of axis deviation (6.7% vs 2.1%; p = 0.0001), atrial enlargement (4.2% vs 1.0%; p = 0.0002) and right ventricular hypertrophy (RVH) (8.3% vs 2.6%; p = 0.0001) compared with females. Caucasian athletes exhibited greater group 1 changes compared with black athletes (73%vs 65%;p = 0.0161). Black athletes exhibited a higher prevalence of group 2 electrocardiogram changes compared with Caucasian athletes (34% vs 21%; p = <0.0001) with 15% of black athletes exhibiting T-wave inversion, 4.5% left atrial enlargement 14% right atrial enlargement and 12% demonstrating RVH compared to 9%, 0.9%, 0.09% and 4.1% of Caucasian athletes respectively. There was no correlation between any electrocardiogram parameter and cardiac chamber size. Conclusions: Male sex and black ethnicity equated to a higher prevalence of Group 1 & 2 electrocardiogram changes compared with female sex and Caucasian ethnicity. However, anterior T wave inversion was significantly more common in females, being present in over 10% of athletes irrespective of ethnicity than previously reported. The precise incidence and significance of anterior T-wave inversion in female athletes requires further assessment. P661 Pre-participation cardiovascular screening in school student athletes: feasibility of large scale school screening program in United Kingdom S Ghani1, N Sheikh1, N Neminathan1, H Raju1, A Zaidi1, S Gati1, M Muggenthaler1, S Sharma1 1St George's University of London, London, United Kingdom Athlete's heart (Sports Cardiology) Purpose: Pre-participation cardiovascular screening (PPS) has been shown to reduce the incidence of sudden cardiac death (SCD) by early identification of cardiomyopathies and heart rhythm disorders. Large-scale PPS programs are not state sponsored in UK, and the impact of adopting the European screening model in school screening programs is not known. Methods: 1,475 school students aged ≥ 12 years underwent PPS using health questionnaire, physical examination and 12-lead electrocardiogram between February and October 2011. The electrocardiogram were analysed using the European Society of Cardiology recommendations for electrocardiogram interpretation in athletes. Persistent juvenile pattern was defined as inverted, biphasic or notched T-wave in leads V1-V3 in individuals aged ≤ 16yrs. A transthoracic echocardiogram (TTE) was performed if indicated, and referral for further investigations recommended as appropriate. Results: Of the 1,475 participants (aged 15.8 ± 2.3 yrs), 81% were males; there were 87% Caucasian, 6.5% South Asian, and 1.5% Afro-Caribbean; 73% participated in sports or exercised on average 6.9 hrs/wk. Persistent juvenile pattern was observed in 83 (5.6%) school students (7.9% of cohort aged ≤ 16yrs) with no statistically significant gender difference. After electrocardiogram and health questionnaire, TTE was performed in 117 (7.9%) students; 5.6% due to electrocardiogram and 2.3% due to questionnaire. The electrocardiogram changes warranting TTE included left atrial dilatation (2.5%), left/right axis deviation (1.7%), right bundle branch block (0.3%), right ventricular hypertrophy (0.3%), ventricular extra-systole (0.2%), and T-wave inversion (1.4%). Electrocardiogram revealed 3 cases of Wolff-Parkinson-White (WPW) and 1 case of prolonged QT interval. Transthoracic echocardiogram identified 1 student with bicuspid aortic valve (AV), 1 with quadricuspid AV, and 1 with coarctation of aorta. This reflects a diagnostic yield of 0.45% with electrocardiogram. After TTE, 79 students were cleared; false positive rate was 5.3% (3.3% due to electrocardiogram, 2% due to questionnaire). After electrocardiogram and TTE, 38 (2.6%) students were referred for further evaluation or surveillance. To date, no significant abnormalities have been identified in this group after additional investigations; some cases require follow-up studies. Conclusion: Pre-participation cardiovascular screening in school student athletes, when conducted in an expert setting, results in a relatively small false positive rate. Close monitoring of persistent juvenile pattern, in isolation and in asymptomatic individuals, can reduce the need for further investigations in first instance. Implementation of such school cardiac screening programs may be feasible. P662 Prevalence and morphological characterization of early repolarization patterns in young healthy individuals: impact of gender, ethnicity and physical activity S Di Fino1, A Gravina1, S Saqib Ghani1, A Zaidi1, N Sheikh1, S Gati1, M Muggenthaler1, S Sharma1 1St George's University of London, London, United Kingdom Athlete's heart (Sports Cardiology) Purpose: Early repolarization (ER) is commonly observed in athletes and young healthy individuals. Recently, ER in the inferior and lateral leads has been associated with sudden cardiac arrest from idiopathic ventricular fibrillation. We studied the prevalence, distribution and morphology of ER patterns in inferior and lateral leads in young healthy individuals. Methods: 12-leads electrocardiogram (ECG) was performed at rest in 1237 young healthy individuals (age range 13-38 years) between February and September 2011. We evaluated the impact of gender, ethnicity and physical activity on ER. Individuals were divided into physically-active (exercise > 2 hours/week) and sedentary. Early repolarization was defined as notched or slurred J-point elevation of at least 0.1mV from baseline, in ≥ 2 contiguous inferior or lateral leads; anterior ER patterns were not considered in this study. The morphology of ST-segment was classified as horizontal/descending or rapidly ascending/up sloping. Results: The mean age of participants was 18.2 ± 4.3 years, of which 979 (79%) were male, 981 (79%) were physically active and 91% were Caucasians. ER pattern was present in a total of 232 (18.7%) cases; of these 42% were in the inferior leads, 31% in lateral leads and 27% in both. Notched ER was more prevalent (64% inferior, 83% lateral, 76% infero-lateral) compared to slurred morphology, and more commonly associated with ascending/upsloping ST-segment elevation. ER was significantly more prevalent in males compared to females (20% vs 12%, p = 0.003), in physically-active people compared to sedentary (20% versus 13%, p = 0.0194), and in Afro-Caribbeans compared to Caucasians (48% versus 17%, p = 0.0001). In addition, voltage criteria for left ventricular hypertrophy and sinus bradycardia were a common associated finding in individuals with ER pattern compared with those without (p = 0.0001 and 0.002 respectively). Only 5% of individuals with ER had J-point elevation of > 0.2mV. Conclusion: Early repolarization is a common finding in young healthy individuals, and is more prevalent in males, physically-active individuals and those with Afro-Caribbean ethnicity. Notched ER with ascending ST-segment elevation in inferior leads was the most commonly observed morphological pattern. More research is required to understand precise long term implications of such repolarization changes in young individuals. P663 Cardiovascular abnormalities in potential British olympic squad: impact of IOC recommendations for cardiovascular evaluation prior to 2012 olympics S Saqib Ghani1, A Zaidi1, S Gati1, N Sheikh1, R Howes2, B Mullins1, H Raju1, S Sharma1 1St George's University of London, London, United Kingdom, 2Cardiac Risk in the Young (CRY), London, United Kingdom Athlete's heart (Sports Cardiology) Purpose: Pre-participation cardiovascular screening (PPS) has been associated with a reduction in the incidence of sudden cardiac death through identification of cardiomyopathies and heart rhythm disorders. Whereas cardiac and sporting bodies advocate PPS in athletes, there is debate over the most effective method. Methods: We aimed to demonstrate the efficacy of PPS using 12-lead electrocardiogram in elite athletes, mostly potential participants of 2012 Olympics. Transthoracic echocardiogram (TTE) was performed in all athletes in addition to electrocardiogram. As per European Society of Cardiology (ESC) recommendations, electrocardiogram changes were classified as training-related (Group 1) or training-unrelated (Group 2). Results: Between 2007 and 2011, 1000 competitive athletes competing in 30 sporting disciplines (mean age 21.2 ± 5.8 years; BSA 1.86 ± 0.23m2) underwent PPS with health questionnaire, electrocardiogram and TTE. Of these, 52% were males, and 88% were Caucasians. In 10% athletes, Group-2 electrocardiogram changes were seen in isolation or in combination. In total, 14 athletes were identified with cardiac abnormality; electrocardiogram revealed 1 athlete with Wolff-Parkinson-White syndrome, and 2 with prolonged QT-interval; TTE identified 1 athlete with dilated aortic root and aortic incompetence (returned to competetive sport following cardiac surgery), 5 with bicuspid aortic valve, 4 with mitral valve prolapse, and 1 with pulmonary stenosis. Minor valve abnormalities included 7 mild aortic regurgitation and 1 mild-moderate mitral regurgitation. The mean left ventricle wall thickness, left ventricle mass and cavity dimensions were significantly greater in males compared to females (9.78mm versus 8.52mm, p = 0.0001; 230.9gm versus 161.5gm, p = 0.0001; 52.9mm versus 48.4mm, p = 0.0001 respectively). After electrocardiogram and TTE, 5.7% athletes were referred for further investigations (24-hour electrocardiogram, exercise stress test, cardiac magnetic resonance imaging) or surveillance studies. Further evaluation did not demonstrate any significant abnormality. The false positive rate for electrocardiogram was 7.2% using ESC criteria; false negative rate for electrocardiogram was 1% and entirely due to valvular heart disease. Conclusion: Pre-participation cardiovascular screening with electrocardiogram results in a relatively small number of athletes requiring further investigations. Echocardiography can identify structural abnormalities not detected by electrocardiogram. The prevalence of cardiac abnormalities in young athletes is low; however early identification can lead to effective treatment, and appropriate follow-up. P664 Diastolic function in professional American football players with increased left ventricular septal wall thickness RT Hurst1, TL Wiedenbeck1, MM Kansal1, P Jiamsripong1, M Belohlavek1, Q Wu1, CP Appleton1, LM Hurst1, SJ Lester1 1Mayo Clinic, Division of Cardiovascular Diseases, Scottsdale, United States of America Athlete's heart (Sports Cardiology) Purpose: Whether left ventricular (LV) hypertrophy in high level athletes is purely physiologic or has pathologic implications is unknown. We hypothesized that diastolic function is impaired in athletes with increased left ventricle septal wall thickness (SWT) compared to those without. Standard measures of diastolic function and a novel parameter of diastolic filling efficiency, the vortex formation time (VFT) were assessed. Methods: 81 professional American football players (AT) and 17 age-matched normal controls were studied by 2-D echocardiography. Septal and posterior wall thickness along with left ventricle mass index (LVMI), left ventricle systolic and diastolic dimensions, early diastolic annular tissue velocity (E') and left atrial volume index (LAVI) were assessed. The VFT was calculated as VFT = TVI/D (D = maximum average mitral valve annular diameter in diastole and TVI = time-velocity integral of the mitral inflow E-wave Doppler signal. An optimal range was previously defined as 3.3 - 4.5. Results: AT with SWT > 12 mm had higher mean-arterial pressure (96.1 (7.86) v. 87.8 (7.43), p = 0.0001), resting heart rate (64.8 (7.50) v. 60.4 (9.28), p = 0.0074) and body-mass index (34.8 (5.13) v. 29.6 (3.16), p < 0.0001) than those with SWT < 12 mm. LAVI (38.1 (10.53) v. 30.9 (8.09), p = 0.0063) and LVMI (111.8 (15.38) v. 85.6 (15.77), p < 0.0001) were also higher in AT > 12 mm. Left ventricle ejection fraction was not significantly different between groups (59.0 (4.54) v. 59.0 (4.54), p = 0.2703). Deceleration time (221.4 (42.71) v. 206.2 (37.52), p = 0.1221)), E' (10.5 (1.66) v. 11.5 (2.22), p = 0.0921), E/E' (7.9 (2.22) v. 7.4 (1.56), p = 0.4901), isovolemic relaxation time (76.6 (16.22) v. 80.8 (18.93), p = 0.2693), and b-type natriuretic peptide (BNP) (12.5 (7.93) v. 12.8 (8.33), p = 0.9736) were not significantly different between AT > 12 mm and AT < 12 mm. The VFT was also not significantly different (4.1 (1.18) v. 4.4 (0.96), p = 0.2055). E/A ratio was a slightly lower in AT > 12 mm (1.9 (0.60) v. 2.1 (0.51)). Overall, athletes had no difference in diastolic filling parameters from normal controls Conclusions: Although athlete's with left ventricle SWT > 12 mm were larger, had higher blood pressure, increased LAVI and LVMI than athletes with normal SWT, there was no significant difference in common measures of diastolic function, VFT or BNP between these 2 groups. There was also no difference between diastolic or systolic left ventricle function in the athletes and normal controls. The VFT of all groups were within the optimal range. Although outcome data is needed, this research supports the concept that left ventricle geometric change in high level athletes does not negatively affect diastolic function. P665 Right ventricular dilatation with preserved function is common in elite professional cyclists M Muggenthaler1, M Reed1, D Oxborough2, R Howes1, A Zaidi1, H Raju1, E Behr1, S Sharma1 1St George's University of London, Division of Cardiac and Vascular Sciences, London, United Kingdom, 2University of Leeds, Leeds, United Kingdom Athlete's heart (Sports Cardiology) Endurance cycling results in the greatest increase in left ventricular cavity dimension and wall thickness due to a combination of endurance training (cycling) and isometric exercise (with the arms). The purpose of this study was to evaluate the electrocardiogram and ECHO characteristics including assessment of the right ventricle of elite professional cyclists. We evaluated 34 professional cyclists in 2010 and 2011 with electrocardiogram and Echo. A subgroup (n = 23) also underwent Signal Averaged electrocardiogram (SAECG). Mean values for demographic and electrocardiogram details: age 28 years, height 181 cm, weight 72 kg, hours trained per week 25, HR 55+/−10 bpm, PR interval 183+/−32 ms, QRS duration 101+/−8 ms, QTc interval 414+/−22 ms. 32% of the cyclists displayed enlarged LVED (>59mm, up to 72 mm) and 50% had increased left ventricle wall thickness (WT) (>12 mm, up to 14 mm). Right ventricle inflow, outflow and length were increased in 85%, 62% and 91% respectively. One cyclists displayed a prolonged QTc interval of 465 ms, however in the absence of a family history and symptoms this is not considered indicative of LQT syndrome. All cyclists showed evidence for late potentials on the SAECG with prolonged filtered QRS durations which could be a sign of myocardial fibrosis. This finding would be consistent with a recent study that demonstrated a high prevalence of myocardial fibrosis on magnetic resonance imaging scans in lifelong, veteran endurance athletes and deserves further evaluation. A significant proportion of cyclists showed increased LVED and WT and the majority showed increased right ventricle dimensions. The enlarged left ventricle and right ventricle dimensions were associated with normal right ventricle and left ventricle function as FS of the left ventricle, left-ventricular outflow tract VTI and TAPSE were normal in almost all (97% respectively). Our study shows that right ventricle dilatation with preserved function is very common in elite professional cyclists. mean+/−SD range LVES (mm) 37+/−3 31-45 LVED (mm) 59+/−4 51-72 IVSd (mm) 12.1+/−0.9 11-14 PWd (mm) 12.0+/−1.6 9-14 RV inflow diametre (mm) (normal<43) 47+/−4 39-53 RV outflow diametre (mm) (normal <36) 37+/−4 30-48 RV length (mm) (normal <87) 96+/−6 81-106 mean+/−SD range LVES (mm) 37+/−3 31-45 LVED (mm) 59+/−4 51-72 IVSd (mm) 12.1+/−0.9 11-14 PWd (mm) 12.0+/−1.6 9-14 RV inflow diametre (mm) (normal<43) 47+/−4 39-53 RV outflow diametre (mm) (normal <36) 37+/−4 30-48 RV length (mm) (normal <87) 96+/−6 81-106 Open in new tab mean+/−SD range LVES (mm) 37+/−3 31-45 LVED (mm) 59+/−4 51-72 IVSd (mm) 12.1+/−0.9 11-14 PWd (mm) 12.0+/−1.6 9-14 RV inflow diametre (mm) (normal<43) 47+/−4 39-53 RV outflow diametre (mm) (normal <36) 37+/−4 30-48 RV length (mm) (normal <87) 96+/−6 81-106 mean+/−SD range LVES (mm) 37+/−3 31-45 LVED (mm) 59+/−4 51-72 IVSd (mm) 12.1+/−0.9 11-14 PWd (mm) 12.0+/−1.6 9-14 RV inflow diametre (mm) (normal<43) 47+/−4 39-53 RV outflow diametre (mm) (normal <36) 37+/−4 30-48 RV length (mm) (normal <87) 96+/−6 81-106 Open in new tab P666 Cardiovascular screening with electrocardiogram in young athletes is feasible at low cost. Intermediate results of a prospective study. A Andrea Menafoglio1, M Di Valentino1, P Siragusa2, M Maggi2, G Romano2, R Pezzoli2, G Moschovitis3, A Gallino1 1Hospital of San Giovanni, Department of Cardiology, Bellinzona, Switzerland, 2Locarno Regional Hospital, Locarno, Switzerland, 3Lugano Regional Hospital, Lugano, Switzerland Health economics (Sports Cardiology) Purpose: adding 12-lead electrocardiogram (ECG) to cardiovascular screening in young athletes is controversial mainly because of low specificity of electrocardiogram depending of criteria utilized. The 2010 recommendations of the European Society of Cardiology (ESC) for interpretation of electrocardiogram in athletes should increase specificity but prospective data are limited. The aim of this study was to assess the number of additional cardiac examinations and the total costs of a program of cardiovascular screening with electrocardiogram in young athletes in Switzerland using the 2010 ESC criteria for interpreting electrocardiogram. Methods: in this observational prospective study, competitive athletes from 14 to 35 years were examined following ESC 2005 proposal. Electrocardiogram was interpreted based on the ESC 2010 recommendations. The costs of the screening and of all subsequent examinations were calculated for each athlete according to the official Swiss medical fees. We present here the intermediate results of this study. Results: from 02/2011 to 10/2011 672 athletes were examined. Mean age was 20.6 ± 6.6 years, 74% were men, 98% were Caucasians. Soccer (28%) and ice hockey (15%) were the most often sports represented. Mean weekly training's hours were 8.1 ± 5.0 for a mean period of 9.4 ± 5.8 years. About 67% of athletes were competing at regional level and 33% at national or international level. A total of 36 athletes (5.4%) required further examinations: 33 echocardiograms, 32 exercise stress tests, 13 24-hour Holter monitoring, 5 cardiac magnetic resonances, 5 family screening with electrocardiogram, 4 ambulatory blood pressure monitoring, 4 electrocardiogram with pharmacological exposure and 1 signal averaged electrocardiogram. A total of 4 idiopathic ventricular arrhythmia, 3 Wolff-Parkinson-White electrocardiogram-pattern, 1 mitral valve prolapse with mild regurgitation, 1 bicuspid aortic valve with mild regurgitation and 1 systemic hypertension stage 1 were found. Mean cost per athlete was 136 Swiss Francs (102-1581). Conclusion: preliminary data of our study indicate that cardiovascular screening with electrocardiogram in young athletes is feasible with few subsequent examinations and accordingly at low cost. These data, when confirmed, should aid the implementation of this policy at large scale. P667 Acute effect of exercise on skeletal muscle microcirculation in heart failure patients C Manetos1, S Dimopoulos1, C Kapelios2, V Agapitou1, V Sousonis2, G Tzanis1, M Koutroumpi1, L Karatzanos1, J Terrovitis2, S Nanas1 1University of Athens, Evgenideio Hosp., Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, Athens, Greece, 2University of Athens, Faculty of Medicine, 3rd Department of Cardiology, Athens, Greece Heart Failure (Exercice & Translational Science) Background: Patients with chronic heart failure (CHF) present several tissue microcirculation abnormalities. In this study, we investigated peripheral muscle microcirculation adaptations after maximal exercise in CHF patients by Near Infra-Red Spectroscopy (NIRS) assessment. Methods: Nine stable mild-moderate CHF patients (8 males, mean age 62 ± 9 years, body mass index 26.5 ± 3.6 kg/m2) and 8 healthy subjects matched for age, gender and body mass index underwent NIRS with 3-min Vascular Occlusion Technique (VOT) before and after a symptom-limited CPET on a cycle-ergometer. Tissue oxygen saturation (StO2, %) defined as the percentage of hemoglobin saturation in the microvasculature compartments was measured on the thenar muscle by NIRS before and after 3-minute occlusion of the brachial artery. Measurements included StO2 at rest, oxygen consumption rate (OCR, %/min) as the first degree slope of the desaturation of haemoglobin during 3-min brachial artery occlusion. Results: StO2 at rest before CPET was significant higher compared to StO2 after CPET in CHF patients (72 ± 10 vs 66 ± 12, p < 0.01). No significant difference was noted in healthy subjects (81 ± 5 vs 80 ± 7, p = ns). There was a statistical significant difference between the 2 groups (−9.1 ± 6.9 vs −0.5 ± 3.4, %, p < 0.05). OCR after CPET was significant lower compared to OCR before CPET in CHF patients (−35 ± 9 vs −42 ± 13, p < 0.05) and in healthy subjects (−36 ± 7 vs −42 ± 6, p < 0.05) with no statistical difference between the 2 groups (p = ns). Conclusions: In CHF patients, acute maximal exercise causes significant changes in tissue microcirculation assessed by NIRS, possibly due to increased tissue perfusion, peripheral microcirculation recruitment and increased skeletal muscle metabolism. P668 Hospital training and its continuation at home with central telemonitoring significantly improves exercise capacity and echocardiographic parameters in heart failure patients after cardiac resynchronisation therapy implantation E Edyta Smolis-Bak1, R Dabrowski1, E Piotrowicz1, T Chwyczko1, B Kazimierska1, I Kowalik1, B Dobraszkiewicz-Wasilewska1, R Smolis1, R Piotrowicz1, H Szwed1 1National Institute of Cardiology, Warsaw, Poland Heart Failure (Exercice & Translational Science) Introduction: Chronic Heart Failure (CHF) is one of the major issues in the healthcare. It is also an important social and economic problem for the patients. Objectives: The aim of the study was the evaluation of the effectiveness of in-hospital and centrally telemonitored training of patients with CHF treated with cardiac resynchronization therapy. Methods: The study included 47 patients (5W/42M), 52-75 (av. 62 ± 9,3) years old, with CHF (NYHA III) of ischemic and noninschemic aetiology. All patients were treated with cardiac resynchronization therapy (CRT-D) and had optimal pharmacotherapy. 20 patients (group A, mean age 61,9 ± 9 years) went through 3 weeks of in-hospital rehabilitation period and 8 weeks (5 exercises sessions per week) of home rehabilitation, which was telemonitored by the physicians and rehabilitants at hospital. 27 patients were in the control group (group B, 62,5 ± 8,9 years). Patients performed cardiopulmonary treadmill exercise test (CPX) with Naughton protocol, before cardiac resynchronisation therapy-defibrillator implantation and 3 months after the procedure. Echocardiography (two-dimensional and Doppler) and Nt-proBNP measurement were also performed. Results: In CPX studies pts results, before and after 3 months, were: oxygen uptake peak [ml/kg/min]:: group A 12,2 ± 2,7 vs 14,6 ± 2,7, (p < 0,05); group B 10,9 ± 3,8 vs 11,9 ± 4,0, (ns); VCO2 [ml/kg/min]: group A 1,1 ± 0,3 vs 1,3 ± 0,2, (p < 0,05); group B 0,9 ± 3,8 vs 1,0 ± 0,4,(ns); VE/VO2 slope: group A 38,7 ± 7,5 vs 30,0 ± 4,6, (p < 0,005); group B 38,0 ± 9,7 vs 35,2 ± 10,6, (ns); VE/VCO2 slope: group A 35,7 ± 6,4 vs 34,5 ± 5,6, (ns); group B 41,0 ± 10,8 vs 37,2 ± 14,3 (ns); VE max [l/min]: group A 52,7 ± 7,2 vs 51,8 ± 9,2, (ns); group B 44,7 ± 12,0 vs 45,7 ± 15,5, (ns); METs: group A 3,5 ± 0,9 vs 4,3 ± 0,6, (p < 0,001); group B 2,8 ± 0,9 vs 3,3 ± 1,1, (p < 0,05). In the echocardiographic examination significant reduction of LVsD in both groups was observed (group A: 5.1 ± 1.0 vs 4.6 ± 0; p < 0.05; group B 5.5 ± 1.1 vs 4.9 ± 1.0; p,0<0.05)., and nonsiginificant improvement of ejection fraction in both groups: group A: 25,2% vs 29,7%,(ns), group B: 24,8% vs 28,9%, (ns). Nt-proBNP did not change in group A: 1558 ± 1582.9 vs 1447.9 ± 1597 pg/ml (ns), there was significant reduction in group B: 2861.2 ± 3301.1 vs 2400.1 ± 3277.5 pg/ml (p < 0.05). Conclusion: Systematically applied centrally telemonitored home exercise training considerably improves physical efficiency in chronic heart failure patients treated with cardiac resynchronization therapy. It constitutes an effective, safe adjunctive therapy in this group of patients. P669 Does an ergometer test in upright position equals a bicycle test in semi-supine position: a comparison using ventilatory gas analysis C Catherine De Maeyer1, P Beckers1, V Conraads1 1University of Antwerp, Antwerp, Belgium Other Heart Disease (Exercice & Translational Science) Background: Cardio-pulmonary exercise testing (CPET) with ventilatory gas analysis is currently accepted as the gold standard to assess exercise capacity and prognosis in cardiovascular patients. Recently, exercise testing in a semi-supineposition (allowing simultaneous echocardiographic imaging) has been introduced. Up to now, exercise derived parameters on the semi-supine bicycle have not been compared to the standard upright bicycle test. Objective: To compare spirometric parameters derived from an upright bicycle test (UBT) to those generated during a bicycle test in semi-supineposition (SBT). Methods: 30 patients (11 controls (CO), 9 patients with coronary artery disease (CAD) and preserved left-ventricular function, 10 patients with systolicheart failure - EF<35% (HF)) (mean age 48,7 +/− 15,7) performed both a symptom-limited UBT and SBT with ventilatory gas analysis within 1 week (but separated by at least 48hrs). Results: No adverse events were reported. In 59/60 ergometer tests, RER reached 1.1 or higher (mean peak RER of 1.262+/− 0,07 and 1.261 +/− 0,11 for UBT and SBT, respectively). At VT1 and VT2 no significant differences in oxygen uptake (VO2), heart rate (HR) and workload (WL) were identified. Peak WL and % predicted peak WL were similar between both tests. Peak HR didn't differ significantly between the two tests, but HR at 50% of maximum WL was significantly higher in the UBT group (p = 0,012). Peak oxygen uptake and % predicted peak oxygen uptake were significantly higher during UBT (both in the total group and for the 3 subgroups, p < 0.05). Although higher stroke volume might have been a plausible explanation, oxygen pulse was not higher during UBT. As a consequence, peak workefficiency (p < 0.01; both in the total group and in the CAD and HF groups) and at VT2 were lower during UBT (p < 0,05). This difference was especially striking in the HF groupe (p = 0.012). More adequate stabilisation of the abdominal musculature during SBT, optimising contractility of the leg musculature, may explain this finding. HF patients tend to have less peripheral muscle mass and could benefit especially from the semi-supine position. Conclusion: CPET with ventilatory gas analysis in an upright and in a semi-supine position is safe and feasible. Both tests are reliable in determing VT1, VT2, and peak workload, both in healthy, CAD and HF patients. Peak oxygen uptake values were higher during the UBT, but workefficiency was lower compared to the test in semi-supine position. Echocardiographywas performed during the semi-supine bicycle test; further analysis of the echocardiography results will help explaining the results of this study. P670 Ventilatory efficacy for VO2 and VCO2 during exercise in atrial septal defect (ASD) patients T Maeda1, H Haruki Itoh1, K Tanaka1, S Takanashi1, M Nagayama1, T Sumiyoshi1, H Tomoike1 1Sakakibara Heart Institute, Tokyo, Japan Other Heart Disease (Exercice & Translational Science) Background and Purpose: Both of VE versus VCO2 slope and oxygen uptake efficacy slope (OUES) are used to evaluate the cardiac function during exercise. VE versus VCO2 slope depends on the pulmonary blood flow while OUES depends on systemic blood flow (cardiac output) during exercise. We hypothesized that VE versus VCO2 is maintained in L-R shunt disease in which the pulmonary blood flow increase, and does not reflect the improvement of exercise capacity after the surgical treatment. Method: Fourteen adult patients with atrial septal defect were performed cardiopulmonary exercise tests using a cycle ergometer with ramp protocol before and 1 year after the atrial septal defect closure. Breath by breath data of oxygen uptake, VCO2, and VE from start of ramping up to respiratory compensation point were analysed. VE versus VCO2 slope was obtained by linear regression for VE versus VCO2 plots and OUES was calculated by liner regression for oxygen uptake versus log VE plots. Results: Peak oxygen uptake increased from 17.9 ± 3.7 to 20.7 ± 3.7 ml/min/kg by the operation. Both of VE versus VCO2 slope and OUES showed significant correlation with peak oxygen uptake before and after the operation. VE versus VCO2 slope before the operation was 29.6 ± −3.7 and was not change after the operation (29.6 ± 4.4). On the other hand, OUES was improved from 1560 ± 473 to 1653 ± 371 by the operation (p < 0.05). Conclusion: These results suggest that OUES is a useful parameter even in L-R shunt disease while VE versus VCO2 slope was affected. It is important to understand physiological background in interpretation of these parameters. Open in new tabDownload slide P671 A novel triple-line sonographic pattern of carotid wall remodelling and its determinants The HAPIEE Group, A Ryabikov1, S Malyutina2, J Halcox3, M Bobak4, M Marmot4 1Novosibirsk State Medical University, Novosibirsk, Russian Federation, 2Institute of Internal Medicine SB RAMS, Novosibirsk, Russian Federation, 3Cardiff University, Cardiff, United Kingdom, 4University College London, London, United Kingdom Vascular disease (Exercice & Translational Science) Background: Carotid intima-media thickness (IMT) and plaques are markers of atherosclerosis and predict cardiovascular events. A specific triple-line sonographic pattern (TLP) in the carotid wall has been previously identified in different uncommon clinical conditions. TLP origin and clinical significance in unselected population are unknown. We aimed to evaluate the prevalence and determinants of TLP in a general population. Methods: In Russian cohort from HAPIEE project (9,363 men and women aged 45-69 in Novosibirsk) we performed ultrasonography of carotid arteries in a random sub-sample of 418 men. We measured carotid intima-media thickness (IMT) and identified the presence of carotid plaques and triple-line sonographic pattern in the carotid wall. Standard epidemiological methods were used to measure cardiovascular risk factors. Results: A triple-line sonographic pattern of carotid wall (instead of typical double-line one) was represented totally in 21% of men. We were specifically concerned about potential artifacts mimicking TLP and changed insonating frequency and beam orientation to avoid reverberation and verify genuine alteration of carotid wall layering. In multivariable models TLP was associated with intima-media thickness (OR = 9.53 per 1SD, p < 0.001) and the presence of plaques (OR = 2.42, p = 0.002). Multivariable- adjusted predictors of TLP included age (p = 0.001), systolic blood pressure (p = 0.045), total cholesterol (p = 0.05) and smoking (p = 0.039). TLP was less strongly associated with prevalent clinical conditions (hypertension, ischaemic heart disease, diabetes mellitus). Additionally, TLP was associated with infrequent consumption of high amounts of alcohol which doubled the risk of triple pattern. Further adjusting for intima-media thickness or presence of plaques did not attenuate this association. Conclusion: Our study has found a high prevalence of triple line pattern of carotid wall in a general population sample, in Russia. This type of vascular remodelling in men was strongly associated with most cardiovascular risk factors and diseases, established markers of atherosclerosis (carotid intima-media thickness and plaques) and with episodic, but not regular, heavy drinking. The study was assisted by the Wellcome Trust (081081/Z/06/Z), the NIA (1R01 AG23522-01). P672 Interferential Electrical Stimulation Improves Peripheral Vasodilatation in Healthy Individuals: A Randomized Crossover Study V Z M Vinicius Silva1, FV Santos2, GR Chiappa3, PJC Vieira3, D Umpierre3, JN Branco2, E Buffolo2, A Sanchez1, GC Jr1 1University of Brasilia, Brasilia, Brazil, 2Federal University of Sao Paulo (UNIFESP), Department of Cardiology/Invasive Cardiology, Sao Paulo, Brazil, 3Federal University of Rio Grande do Sul - Hospital Clinicas of Porto Alegre, Porto Alegre, Brazil Vascular disease (Exercice & Translational Science) Background: Interferential electrical stimulation (IES) increases cutaneous blood flow. It is not known whether increases in blood flow may be mediated by muscle metaboreflex activity. Objective: The purpose of this study was to determine the effect of IES on metaboreflex activation in healthy individuals. Design. Acute intervention study with randomized design. Setting. Cardiovascular research laboratory. Patients. Eleven healthy subjects (age 25 ± 1.3 years). Intervention. Interferential electrical stimulation or placebo stimulus (same protocol without electrical output) applied at the ganglion region previously to exercise. Measurements. Mean blood pressure (MBP), Heart Rate (HR), calf blood flow (CBF) and calf vascular resistance (CVR) were measured throughout exercise protocols (submaximal static handgrip exercise), and recovery periods with or without Postexercise Circulatory Occlusion (PECO+ and PECO−, respectively). Muscle metaboreflex control of calf vascular resistance was estimated by subtracting the area under the curve when circulation was occluded from the AUC without circulatory occlusion. Results: At the exercise peak, increases in mean blood pressure were attenuated by IES (p < 0.05), which persisted during PECO+ and PECO-. IES promoted higher CBF and lower CVR during exercise and recovery. Likewise, IES induced a reduction in the estimated muscle metaboreflex control in subjects (Placebo: 21 ± 5 units versus IES: 6 ± 3, p < 0.01). Limitations. No stimulation was provided as a placebo stimulus, since we are unaware of any device to promote a sham intervention without any level of neuromodulation. Conclusions: Acute application of IES previously to exercise attenuates blood pressure and vasoconstrictor responses during exercise and metaboreflex activation in healthy subjects. P673 New generation dynamic, wireless and remote cardiac monitorization platform: a feasibility study. L Perez De Isla1, V Lennie1, M Quezada1, J Guinea1, C Arce1, P Abad1, A Saltijeral2, J Crespo3, B Gonzalvez3, A Macia3 1Hospital Carlos III, Madrid, Spain, 2Hospital del Tajo, Aranjuez, Madrid, Spain, 3Smart Solutions Technologies SL, Madrid, Spain Rhythm Disorders/Sudden death (Exercice & Translational Science) A new generation of dynamic electrocardiogram, proprietary wireless remote monitoring platform, which consists of a non-invasive and single-lead dynamic electrocardiogram system that incorporates biomedical e-textile technology has been developed. Our aim was to assess the feasibility of using this new system during exercise echocardiography and to compare the results obtained with the new system system with the results obtained by means of the conventional treadmill system. Methods: Thirty-one consecutive patients underwent an exercise echocardiography test. They were monitorized by the conventional treadmill system and at the same time with the new system. Electrocardiographic and echocardiographic variables were recorded during the test. Inter-methods agreement was evaluated by means of the Intra-class Correlation Coefficient (ICC) and Kappa index. Differences were considered significant if P value < 0.05. Results: Main results are shown in table below. These results depict the good inter-methods agreement between the two techniques for the evaluation of the more common electrocardiographic parameters evaluated in an exercise test. Furthermore, the new shirt allows the echocardiographic imaging acquisition before and immediately after the test. Conclusions: the new dynamic electrocardiogram is able to obtain similar results to conventional treadmill system during exercise test and allows to obtain echocardiographic images but in an easier and more comfortable manner. Inter-methods agreement ICC 95% CI p Baseline heart rate 0.97 0.94 - 0.99 <0.001 Peak heart rate 0.36 −0.01-0.64 0.03 Time to reach 85% APMHR 0.99 0.996-0.999 <0.001 Kappa Index 85% APMHR 1 <0.001 ST segment depression 0.84 <0.001 APC 1 <0.001 PVC 0.83 <0.001 Adequate baseline electrocardiogram 1 <0.001 Adequate peak electrocardiogram 0.24 0.16 ICC 95% CI p Baseline heart rate 0.97 0.94 - 0.99 <0.001 Peak heart rate 0.36 −0.01-0.64 0.03 Time to reach 85% APMHR 0.99 0.996-0.999 <0.001 Kappa Index 85% APMHR 1 <0.001 ST segment depression 0.84 <0.001 APC 1 <0.001 PVC 0.83 <0.001 Adequate baseline electrocardiogram 1 <0.001 Adequate peak electrocardiogram 0.24 0.16 95% CI: 95% confidence interval; APMHR: age predicted maximum heart rate; ICC: intra-class correlation coefficient. APC: atrial premature complex; PVC: premature ventricular contraction Open in new tab Inter-methods agreement ICC 95% CI p Baseline heart rate 0.97 0.94 - 0.99 <0.001 Peak heart rate 0.36 −0.01-0.64 0.03 Time to reach 85% APMHR 0.99 0.996-0.999 <0.001 Kappa Index 85% APMHR 1 <0.001 ST segment depression 0.84 <0.001 APC 1 <0.001 PVC 0.83 <0.001 Adequate baseline electrocardiogram 1 <0.001 Adequate peak electrocardiogram 0.24 0.16 ICC 95% CI p Baseline heart rate 0.97 0.94 - 0.99 <0.001 Peak heart rate 0.36 −0.01-0.64 0.03 Time to reach 85% APMHR 0.99 0.996-0.999 <0.001 Kappa Index 85% APMHR 1 <0.001 ST segment depression 0.84 <0.001 APC 1 <0.001 PVC 0.83 <0.001 Adequate baseline electrocardiogram 1 <0.001 Adequate peak electrocardiogram 0.24 0.16 95% CI: 95% confidence interval; APMHR: age predicted maximum heart rate; ICC: intra-class correlation coefficient. APC: atrial premature complex; PVC: premature ventricular contraction Open in new tab P674 Omega-3 fatty acids intake attenuates arrhythmogenic distribution of myocardial gap junctions and reduces malignant arrhythmias in diseased rat hearts. T Benova1, J Radosinska2, B Bacova1, V Knezl3, T Soukup4, J Slezak1, N Narcisa Tribulova5 1Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic, 2Comenius University, Faculty of Medicine, Bratislava, Slovak Republic, 3Slovak Academy of Sciences, Institute of Experimental Pharmacology & Toxicology, Bratislava, Slovak Republic, 4Academy of Sciences of the Czech Republic, Institute of Physiology, Prague, Czech Republic, 5Slovak Academy of Sciences, Bratislava, Slovak Republic Rhythm Disorders/Sudden death (Exercice & Translational Science) Background and Purpose: Cardiac gap junctions (GJ) ensure via connexin (Cx) channels electrical and molecular signal propagation between cardiomyocytes that is necessary for synchronized heart function. In turn, GJ/Cx remodelling has been implicated in the impairment of myocardial synchronization and occurrence of life-threatening arrhythmias. Antiarrhythmic potential of omega-3 fatty acids (omega-3) has been reported in clinical and experimental setting while cellular mechanisms are poorly understood. We investigated whether omega-3 may affect myocardial topology of GJ and distribution of dominant Cx43 in diseased rat hearts as well as its propensity to ventricular fibrillation (VF). Design and Methods: Experiments were conducted on two models mimicking human disease, i.e. spontaneously hypertensive rats (SHR) and hereditary hypertriglyceridemic rats (HTG). Age-matched healthy male rats were used as well. Omega-3-treated (200mg/day for 2 month) rats were compared with untreated ones. Left ventricular tissue was processed for Cx43 immunostaining and electron microscopic examination to detect myocardial Cx43 distribution and subcellular localisation of GJ. Isolated working heart preparation was used to examine its susceptibility to electrically-induced ventricular fibrillation/flutter. Key Results: Both hypertension and hypertriglyceridemia resulted in myocardial structural remodelling (hypertrophy and/or fibrosis) that was accompanied by Cx43 remodelling. It was characterized by enhanced immunostaining of Cx43 on lateral surfaces of the cardiomyocytes and increased number of laterally localized GJs. Moreover, severely disordered distribution and loss of Cx43 at the area of fibrosis as well as internalization of GJ were found. These changes were associated with increased susceptibility of the heart to ventricular fibrillation/flutter compared to healthy rats. On the contrary, ventricular fibrillation/flutter occurrence was significantly suppressed due to omega-3 intake in HTG and SHR hearts. Whereby dietary omega-3 apparently attenuated of abnormal GJ and Cx43 distribution and enhanced Cx43 expression, as revealed quantitative image examination. Conclusions: Results indicate that omega-3 supplementation exert clear cut antiarrhythmic effect in rats suffering from hypertension and hypertriglyceridemia to, at least in part, attenuation myocardial maladaptive gap junctions remodelling. This work was supported by VEGA 2/0046/12 and GACR 304/08/0256. © The European Society of Cardiology 2012 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 2012
TI - Poster session 4
JF - European Journal of Preventive Cardiology
DO - 10.1177/2047487312448015
DA - 2012-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-4-cIGloyUASP
SP - S106
EP - S137
VL - 19
IS - 1_suppl
DP - DeepDyve
ER -