TY - JOUR AB - P108 Cognitive impairment is more frequent in hypertensive patients with atrial fibrillation than in patients with sinus rhythm M German-Sallo1, E Nemes-Nagy2, RG Tripon2, B Baroti3, T Pal4, D Balint Szentendrey1, K Csomay5, CM Tatar5, Z Preg1 1University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Emergency Clinical County Hospital Târgu Mures, Cardiovascular Rehabilitation Clinic, Targu Mures, Romania 2University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Department of Fundamental Pharmaceutical Sciences, Targu Mures, Romania 3University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Department of Radiology, Targu Mures, Romania 4Emergency Clinical County Hospital Târgu Mures, Targu Mures, Romania 5University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Targu Mures, Romania Funding Acknowledgements: Funding for the study was provided by the Hungarian Academy of Science, contract nr. 0346/26.02.2016 Topic: Atrial Fibrillation - Stroke Prevention Atrial fibrillation (AF) is the most common cardiac arrhythmia. There is growing evidence linking AF with cognitive decline and dementia. Study objective: To study the prevalence of cognitive impairment among hypertensive patients with atrial fibrillation and sinus rhythm admitted to our Cardiovascular Rehabilitation Clinic. Methods: All hypertensive patients admitted after November 2016 to our Cardiovascular Rehabilitation Clinic, were screened for cognitive impairment. Three cognitive tests were used to identify cognitive impairment and dementia: the Montreal Cognitive Asessement (MOCA) questionnaire, the Minimental test, and the General Practician assessment of Cognition test (GPCOG). Mild cognitive impairment was defined as a score under 26 points according to the MOCA and a score above 24 points by Minimental test. Dementia was defined according to Minimental scores as mild 15-23 points, moderate 10-14 points, or severe under 10 points. A total number of 437 patients were screened, average age 66.5 years. Atrial fibrillation (paroxistic, persistent or permanent) was present in 103 patients (23.5%). Depression as a confounding factor was screened with the short 13 item form of the Beck depression inventory. Mann Whitney u test was used for comparing mean cognitive test scores in the atrial fibrillation and sinus rhythm group. Results: Minimental test score under 24 points was detected in 85 patients (19.4%), from these 80 patients (18.3%) had mild dementia, and 5 patients (1.1%) moderate dementia. Mild cognitive impairment was present in 226 patients (51.7%). Depression was detected in 65.6% of the patients. Patients with atrial fibrillation had significantly lower cognitive scores than patients in sinus rhythm: MMSE 21.4 vs 22.7 p=0.012, MOCA 25.2 vs. 26.2 p=0.003, GPCOG 5.7 vs. 6.4 p=0.03. The frequency of low cognitive scores were higher in the atrial fibrillation group compared to the sinus rhythm group: MOCA under 26 points 84% vs 67%, p=0.0005, MMSE score under 24 points 25.2% vs 17.6% p=0.11. Conclusions: Patients with atrial fibrillation have cognitive impairment and dementia more frequently than patients in sinus rhythm. Early detection and effective anticoagulation in atrial fibrillation may prevent cognitive decline and dementia in these patients. P109 Our hopes, our dreams and reality - Control of anticoagulant therapy in atrial fibrillation in real clinical practice A Zarudsky1, AA Gavrilova2 1Belgorod Regional Clinical Hospital of Prelate Ioasafa, Belgorod, Russian Federation 2Belgorod State National Research University, Belgorod, Russian Federation Topic: Atrial Fibrillation - Stroke Prevention Background: Atrial fibrillation is associated with higher mortality mainly due to thromboembolic complications. An important role is given to anticoagulant therapy. Oral anticoagulant therapy should be considered in patients with CHA2DS2-VASc≥2, may be considered in patients CHA2DS2-VASc = 1. We have 2 options of anticoagulant therapy: nonvitamin K antagonist oral anticoagulants (NOACs) or warfarin with target INR. In the perfect world, NOACs should be given in all settings except mechanical valves, mitral stenosis and GFR≤30. Apixaban – for patients with high bleeding risk, dabigatran – for patients with high embolic risk and rivaroxaban – for patients with poor compliance. The aim of this study was to appreciate anticoagulant therapy of AF-patients in real clinical practice. We have named it Control Of Anticoagulant Therapy in Atrial Fibrillation (COAT-AF) Methods: This observational study was made in our Hospital during 2016-2017yy. 429 patients were included in study, 203 women, 226 men 29-98 years old. Patients with mitral stenosis, mechanic valve, and first episode of AF during current hospitalization were excluded. Results:From 429 patients 35 were with a CHA2DS2-VASc = 1, 393 (91.61%) patients had CHA2DS2-VASc≥2. Only 1 patient had CHA2DS2-VASc = 0. At admission 60 patients were taken NOACs, 213 – were taken warfarin, 156 – did not take any oral anticoagulation. From patients on warfarin only 36 had target INR at admission. Therefore, effective anticoagulant therapy were presented only in 22.38% of patients. Analysis at discharge suggested about a great reserve for optimization of anticoagulant therapy mainly with a help of NOACs. Abstract Number: P109 Anticoagulant therapy at admission P110 A study on the prevalence, predictive factors and recurrence of postoperative atrial fibrillation during early cardiac rehabilitation N Homorodi1, L Szuromi2, SZ Szabo2, A Szegedi1, M Clemens1, Z Csanadi1 1University of Debrecen, Cardiology, Debrecen, Hungary 2University of Debrecen, Debrecen, Hungary Topic: Atrial Fibrillation - Stroke Prevention Postoperative atrial fibrillation is one of the most common arrhythmias after cardiac surgery. It is important because it prolonges inpatient hospitalisation and increases the costs of hospital care as well as early and late mortality. Our aim was to investigate the prevalence and possible predictive factors of postoperative atrial fibrillation and detect its recurrence by a telemetric ECG system in patients with previous CABG or cardiac valve surgery. We analysed data from 122 consecutively treated patients who developed atrial fibrillation post-surgery. Exlusion criteria included a history of permanent, persistent or paroxysmal atrial fibrillation. We monitored the prevalence of atrial fibrillation across different types of surgery, and looked for correlation with different clinical parameters (age, sex, CRP, renal function, BMI, left ventricular ejection fraction, left atrial dimensions, comorbidities, pre-and postoperative medications). We compared the results to data from 173 patients in the control group. In both group we used a telemetric ECG system for the detection of late complications occurring at the patient’s home. There was no significant difference between the AF and control group in the prevalence of hypertension and diabetes, and regarding sex distribution, preoperative treatment, left ventricular ejection fraction and pre-and postoperative CRP levels (P<0,05). In the atrial fibrillation group, we detected significantly higher age (68.04±9.52 vs 62.64±9.90; P<0.001), higher pre- (42.78±6.52 vs 39.63±5.90; P<0.001) and postoperative (42.56±5.29 vs 39.54±5.38; P<0.001) left atrial diameters, significantly worse pre- (73.05±17.65 vs 78.66±15.90; P: 0.002) and postoperative (67.84±19.95 vs 77.12±17.73; p<0.001) renal function and significantly lower hemoglobin levels (105.15±9.66 vs 108.99±10.72; P:0.003). Among AF patients, we used the telemetric ECG system in 39 cases (31.96%) and, in 5 cases (12.8%) paroxysmal atrial fibrillation was recorded post-discharge. Our results demonstrate that postoperative atrial fibrillation is significantly more prevalent in those patients with a higher age, decreased renal function, greater left atrial diameter and lower postoperative Hgb levels. It is important to note that additional follow-up is needed if postoperative AF occurs, for which the use of a telemetric ECG system provides great support. P112 Comparing the risk of cerebrovascular events in atrial fibrillation patients without chronic kidney disease or with late stage chronic kidney disease who were treated with warfarin P Buraphat1, A Winijkul1, S Niyomnaitham1 1Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Funding Acknowledgements: This study is supported by Siriraj Research Development Fund (Managed by Routine to Research : R2R, IO R016135020). Topic: Atrial Fibrillation - Stroke Prevention Background: Atrial fibrillation (AF) and late stage chronic kidney disease (late stage CKD) were associated with the increasing risk of cerebrovascular events, especially in elderly. Benefit of warfarin for stroke prevention in late stage CKD patients is controversial. Purpose: To determine the risk of cerebrovascular events in AF patients without CKD or with late stage CKD who were treated with warfarin. Methods: Patients received warfarin between 2014-2017 were retrieved from medical records of the university hospital. Inclusion criteria were: 1) age ≥ 65 years, 2) had AF diagnosis, and 3) received warfarin ≥ 30 days. This study excluded patients with diagnosis of stroke, transient ischemic attack, intracerebral or subarachnoid haemorrhage before day 30 of warfarin. Patients with late stage CKD identified by International Classification of Diseases 10th (ICD-10) of CKD stage 5 or end-stage renal disease were compared with patients without CKD diagnosis. Outcomes were cerebrovascular events including composite events of ischemic stroke and transient ischemic attack (IS/TIA) or intracerebral haemorrhage (ICH). Results: A total of 1,894 patients (81 patients with late stage CKD and 1,813 patients without CKD were included. The relative risk of IS/TIA and ICH in late stage CKD group compared to patients without CKD were 2.32 [1.26-4.28, p = 0.02], and 1.30 [0.17-9.63, p = 0.73], respectively. Conclusions: Late stage CKD patients with AF treated with warfarin for stroke prevention had significantly higher risk of IS/TIA compared to patients without CKD; however, the risk of ICH was not significantly different. P116 Restoration of sinus rhythm improves exercise capacity in patients with persistent af: a meta-analysis C Verdicchio1, A Elliott1, D Lau1, P Sanders1, R Mahajan1 1University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia On Behalf of: Centre for Heart Rhythm Disorders Topic: Arrhythmias, General – Treatment Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the world and is directly associated with an increased risk of stroke, heart failure and mortality. Patients with AF commonly experience a broad range of symptoms including; palpitations, shortness of breath, dizziness, fatigue and a decreased quality of life. Reduced exercise tolerance is another commonly reported symptom of AF. Objective: This meta-analysis assesses the changes in exercise capacity in patients with persistent AF on restoration of sinus rhythm (SR). Methods: MEDLINE/ EMBASE/ COCHRANE were searched for studies reporting changes to exercise capacity following restoration of SR via cardioversion or catheter ablation in patients with persistent AF. From the search 618 articles were identified. After exclusions, 13 studies reporting changes in exercise capacity with or without the restoration of SR were selected. Data was analyzed by a random-effects meta-analysis. Results: Thirteen studies (1,643 individuals with persistent AF, 60±3 years) analyzed change in exercise capacity parameters using oxygen uptake, METs, duration and 6MWT. Exercise capacity significantly improved following successful restoration of SR compared to those who remained in AF (Standardized Mean Difference: 1.91, 95% CI 1.19-2.63, p<0.001, I2=97%). Both treatment modes significantly favor improvements in exercise capacity in SR with moderate effect size with ablation (n=3) (SMD: 0.98, 95% CI 0.03-1.92) over 24±2 weeks and large effect size with cardioversion (n=10) (SMD 2.19, 95% CI 1.30-3.09) over 20±24 weeks. There were significant increases in mean differences across all exercise parameters in SR; oxygen uptake (5ml/kg/min, 95% CI 4.09-5.79), METs (3.2, 95% CI 2.5-3.87), duration (73secs, 95% CI 38.85-106.59) and 6MWT (55.15m, 95% CI 45.37-64.93). Conclusion: Successful restoration of SR results in an objective improvement in exercise capacity and may allow AF patients to engage in more active lifestyles and enhance quality of life. Abstract Number: P116 P117 Medium-long term mortality and change in functional status in elderly patients with pacemaker: retrospective observational study in a single university hospital. P Perez Diaz1, J Jimenez Diaz1, F Higuera Sobrino1, J Piqueras Flores1, R Frias Garcia1, V Mazoteras Munoz2, R Maseda Uriza1, V Arenas Cambronero1, JA Requena Ibanez1, J Martinez Del Rio1, A Moron Alguacil1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2Hospital General de Ciudad Real, Geriatrics, Ciudad Real, Spain On Behalf of: University General Hospital of Ciudad Real, Ciudad Real, Spain Funding Acknowledgements: No sources of funding were provided for this work. Topic: Arrhythmias, General – Treatment Background: The increment in average life expectancy has conditioned an increase in the number of pacemaker implants in last ten years. Nevertheless, benefits in survival and functional status after pacemaker implantation are not well documented in elderly patients. Purpose: We analized death rate of 308 elderly patients with pacemaker, and assessed long-term morbidity, mortality and change in functional status between physiologic and ventricular pacing. Methods: Observational study including pacemaker implants in individual older tan 70 years old in a single university hospital between January 2012 and December 2014. We recorded the baseline characteristics, functional evaluation by Barthel and CRF Index, indication for pacemaker implantation, pacing modes, complications and long-term mortality. We performed a subgroup analysis, including 186 patients older tan 80 years old. The primary outcome was cardiovascular or all cause mortality at the end of the follow-up. Secondary outcomes were all cause mortality at one, two or three years, complications, cardiovascular events and paroxismal atrial fibrillation. The mean follow-up time was 3.5 years. Results: Average-age was higher in ventricular group. 60% of patients were older than 80 years old. A higher rate of mitral and tricuspid regurgitation and pulmonar hypertension were detected in patients with VVI pacemaker. Third-degree atrio-ventricular block (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent ecg abnormalities that lead pacemaker implantation, while bicameral DDD was the sort of pacing our department used the most (38.6%). Death rate in individuals with pacemaker implantation in 2012, 2013 and 2014 was respectively 22.3%, 22.3% and 17.3%, but 8.5% in similar age-sex patients in general population. There was no difference in complications and cardiovascular events between pacing modes. Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (54.2 vs 18.6%, OR 0.2 [IC 95% 0.07 – 0.5]; p=0.001 respectively). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p=0.001) Long-term survival was similar between both groups of patients in Kaplan-Meier analysis. Change in Barthel and CRF index of individuals older tan 80 years old was -17.6 +/- 27.1 and 0.9 +/- 1.3 respectively (p<0.001). No significant improvement in functional status was detected in this subgroup of patients. Conclusions Physiological pacemakers seems to have a long-term survival greater than single-chamber pacing in patients older than 80 years, without significant improvement in functional status three years after implantation. We consider these findings to be really significant, since this particular group of age is underrepresented in the current observational studies and clinical tries described so far. All-cause mortality in octogenarian P118 An analysis of life saving therapies in hypertrophic cardiomyopathy J Basu1, M Cabrera Ramos2, G Parry-Williams1, C Miles1, M Papadakis1, E Behr1, S Sharma1, M Tome1 1St George's University of London NHS Foundation Trust Cardiology Clinical Academic Group, London, United Kingdom of Great Britain & Northern Ireland 2University Hospital Virgen de las Nieves, Granada, Spain Topic: Arrhythmias, General – Treatment Background: Implantable cardioverter defibrillator (ICD) implantation has played a significant role in reducing mortality in hypertrophic cardiomyopathy (HCM). ICD implantation for secondary prevention of sudden cardiac death (SCD) is universally supported. The decision to implant a primary prevention device relies on clinical risk stratification. The HCM-SCD risk calculator, introduced in 2014, utilises several variables to stratify patients according to their 5-year risk of an event; <4% ICD not recommended, 4-6% ICD may be considered and >6% ICD recommended. The potential benefits of device implantation must also be balanced against complication rates. Purpose: To assess the rate of appropriate therapies and complication rates of ICDs in HCM patients. To correlate appropriate therapies in those with a primary prevention device to a retrospectively calculated HCM-SCD risk score. Methods: This retrospective observational cohort study included consecutively evaluated HCM patients who had undergone ICD implantation in a single tertiary centre over the last 10 years. Risk factors at implantation, therapies and complications were recorded. Results: A total of 52 ICDs (67.3% males, 82.7% primary prevention) were implanted. Mean follow up was 3.6 +/- 2.7 years (median 2.8 years, IQR 4). The average age of implantation was 50.5 +/- 17.1 years (median 53, IQR 24). The mean time to the first shock was 6.8 years (95% CI 5.7-7.9). Analysis of the first shock, demonstrated four (7.7%) appropriate and five (9.6%) inappropriate shocks. There was no difference in appropriate therapy (shocks and/or anti tachycardia pacing (ATP) (p=0.18) or inappropriate therapy (p=0.06) between primary and secondary prevention groups. The complication rate was 9.6%. This included ventricular lead fracture, atrial lead failure, ventricular lead extraction for high impedance and threshold, axillary vein thrombosis and painful prepectoral placement requiring re-site. There were no deaths related to ICD implantation. In those patients with primary prevention devices the retrospectively calculated mean risk score was 5.1% +/- 2.3. Five out of the six appropriate therapies (shock and/or ATP)) occurred in patients at low/intermediate risk. There was no significant difference in appropriate therapies according to risk score (p=0.4) Conclusions: In our cohort of HCM patients ICD implantation terminated 4 potentially life threatening arrhythmias. There were no deaths attributable to ICD implantation and complication rates were lower than previously reported. In patients with primary prevention devices, over 80% of appropriate therapies occurred in low and intermediate risk groups. Although the risk calculator serves as an important clinical tool, our results demonstrate the ongoing importance of individualised care in patient selection for device therapy. P119 Progression of atrial fibrillation in hypertensive patients on different treatment strategies V Podzolkov1, A Tarzimanova1, M Pisarev1, R Gataulin1 1I.M. Sechenov First Moscow State Medical University, Therapy department #2, Moscow, Russian Federation Topic: Arrhythmias, General – Treatment Introduction: Atrial fibrillation (AF) is the most common rhythm disorder in adults. Hypertension is an important cause of AF. The main treatment strategies in AF include sinus rhythm maintenance and ventricular rate control. However, the choice of the best treatment option in patients with AF and associated hypertension requires further study. Purpose: To evaluate the progression of arrhythmia in hypertensive patients with paroxysmal AF treated with rhythm- or rate-control strategy in a long-term prospective follow-up study. Methods: Patients with paroxysmal AF and hypertension (n=136) were enrolled into the study. The patients were divided into two groups depending on the treatment strategy: 79 patients (58%) treated with class IC or III antiarrhythmics were included into the rhythm control group (I group); 57 patients (42%) on beta-blockers were designed as the ventricular rate control group (group II). The duration of follow-up was 4 years. The clinical evolution of AF was assessed using incidence of arrhythmia episodes over previous 3 months. Increased frequency of AF paroxysms over this period or development of permanent AF were considered arrhythmia progression. Results: Patients with hypertension and paroxysmal AF had less frequent progression of arrhythmia with rhythm control (38%) than with rate control (56%) strategies (р=0.003). The average arrhythmia progression rate was 7.6±0.5% per year in patients of group I and 10.9±0.6% in group II. There was significant difference in the progression of AF between these groups (р=0.0008). Conclusion: Arrhythmia progression is more often seen in patients with AF and associated hypertension treated with rate-control strategy. P120 Loss of weight and cardiovascular fitness increase predict better outcome in non-permanent atrial fibrillation patients B Jiravska Godula1, B Ryskova2, O Jiravsky3 1Poliklinika Agel, Internal Medicine, Ostrava, Czechia 2Hospital Podlesi, Rehabilitation, Trinec, Czechia 3Hospital Podlesi, Cardiology, Trinec, Czechia Topic: Arrhythmias, General – Treatment Methods Multicenter interventional trial. Patients of heart rhythm disorder clinic of cardiocentre and of internal medicine outpatient clinic. One year program focused on increase of cardiopulmonary fitness prescribed under the EFSMA guidelines. For the first 3 months is the program managed by physiotherapists. Results 47 patients (23 males/24 females) started in program, but finally finished only 36, in the age 67,7+/-11 yrs. Beginning BMI 31,1+/-4,8 decreased to 29,7+/- 4,4 ( p=0,12). Beginning fitness (in METs) 6,5 +/- 2,3 improved to 6,9 +/- 2,4 (p=0,09). Beginning echo parameters did not change (neither LV EF nor IVS diameter nor LA diameter). Beginning BP measured by ABPM 130 (+/-17)/75(+/-10) mmHg persisted in good BP control levels. Beginning AF duration 1960 +/- 3870 min/weak dropped to 1446 +/- 3525 min (p=0,25). We describe improvement in self-assessment of AF measured by AFSS questionnaire. There were a decrease in the duration and severity of AF episodes (p=0,018 and 0,05 respectively). The best result we found in group of patients with more than 5% loss of weight and more than 5 % increase of cardiovascular fitness. Conclusion Our data shows benefit of 12 months upstream therapy treatment in AF patients, especially in duration and severity of AF episodes. The best benefit experience patients with than 5% loss of weight and more than 5 % increase of cardiovascular fitness. Background All published data, including the most recent RACE 3 trial, shows positive influence of risk factors intervention on frequency, intensity and duration of episodes of atrial fibrillation (AF). Purpose To show results of 12 months of intensive upstream therapy in group non-permanent AF patients P123 Effects of insulin on the production of adipokins by adipocities of subcutaneous and epicardial adipose tissue OV Gruzdeva1, YA Dyleva1, EI Palicheva1, DA Borodkina1, EG Uchasova1, EV Belik1, AN Kokov1, NK Brel1, EV Fanaskova1, TYU Penskaya1, VN Karetnikova1, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Topic: Basic Science - Cardiac Diseases Background: At present, adipose tissue is considered as an endocrine organ that produces a number of biologically active substances, among which adipokines are considered as markers of increased cardiovascular risk. Adipokines of epicardial fat are directly secreted into the coronary arteries, provoking atherogenesis and the resulting acute coronary events. It is also of interest to study the adipokine profile of adipocytes of different localizations, and the data on the effect of insulin on adipokin expression are contradictory. Purpose: to study the indicators of adipokine status - the content of leptin, the receptor for leptin SOB-R and adiponectin in the epicardial and subcutaneous adipose tissue, as well as the effect on adipokine insulin profile. Methods: Adipocytes were isolated from the samples of subcutaneous (SAT), epicardial (EAT) and perivascular (PVAT) adipose tissue, and which were taken during coronary artery bypass surgery (n = 44). Isolated adipocytes were cultured with glucose at a concentration of 5.3 mmol / l and various insulin concentrations close to that in vivo (10–8, 10–9, 10–10 Moles). Before and after incubation (24 hours), the content of leptin, its soluble receptor (SOB-R), adiponectin was determined by the ELISA method. All study was carried out in compliance with the Helsinki Declaration, and its protocol was approved by the Ethical Committee of Research Institute. Statistical analysis was performed using Statistica 9.0. All patients gave written informed consent to participate in the study. Results: Subcutaneous and epicardial fat differ in the quantitative content of adipokines. So in epicardial adipocytes, the content of leptin and SOB-R is on average 2 and 2.5 times higher, respectively, than those of subcutaneous fat.At the same time, in adipocytes of epicardial fat, the adiponectin content, on the contrary, is 25% lower compared with subcutaneous adipocytes. The dependence of the content of adipokines on the concentration of insulin was revealed.So with an increase in the concentration of insulin from 10-10 to 10-8 Moles, the content of leptin decreased by 33%, SOB-R by 17.5%; at the same time, adiponectin content, on the contrary, increased by 69%. In adipocytes of subcutaneous fat with an increase in the concentration of insulin from 10-10 to 10-8 Moles, the content of leptin decreased by 28%, SOB-R by 17.5%, the content of adiponectin increased by 14%. Conclusions: Adipocytes of subcutaneous and visceral fat in patients with coronary heart disease have different adipokin status, differing in insulin sensitivity in vitro. An increase in the insulin content more changes the adipokine profile of epicardial adipocytes. Insulin resistance, against the background of which an acute coronary syndrome develops, reduces the cardioprotective effect of adiponectin. P126 Listening to music: a way to increase exercise duration without boosting oxygen consumption E Venturini1, I Volpi1, M Siragusa1, G Magnaghi1, V Venturini2 1Department of Cardiology - Civic Hospital , Cecina (LI), Italy 2University of Pisa, Department of Veterinary Sciences, Pisa, Italy Topic: Basic Science - Cardiac Diseases Background: many people believe that music (M) is beneficial in performing physical activity. There are few studies that suggest the benefits of M on exercise capacity. Aim of this preliminary study was to evaluate the impact of listening to M in young adults during effort ECG. Methods: 16 patients (P), mean age 32.5 years, 50% male, without history of cardiovascular disease (CVD) and diabetes, scheduled for an exercise ECG, were invited to perform the test with headphones so that they could listen to an up-tempo M (latin-american compilation). It was the nurse who decided whether or not the subject should listen to M during the stress test; the doctor was unaware (randomization single-blinded) . Any interaction of the staff with the P was avoided, asking only to indicate, lifting the arm, when he was no longer able to continue the test. Within 72 hours (but never on the same day) the exam was repeated, so that the P performed the exam with and without M. The stress test was performed on the cycle ergometer with a 25 watt step every 2 '. Results: while listening to M, P increased the duration of the exercise ECG significantly. Conversely the amount of oxygen consumed, did not change. Indeed the metabolic equivalent of task (METs) tended to fall although not significantly. The results are shown in the table below. Conclusions: listening to M can increase the duration of the exercise without increasing the energy cost of the effort. It is possible that a dissociative manipulation of attentional focus through M can delay the transition to the associative state during exercise inducing a reduction, more of blood pressure than heart rate, leading to a lower energy cost for the same workload. Larger study are needed to confirm these data, especially in older patients with CVD, to exploit this training mode in the setting of cardiac rehabilitation. No Music Music p Exercise time (seconds) 709±84.5 769,8±83,6 .005 METs 10.5±1.6 10.3±1.7 ns No Music Music p Exercise time (seconds) 709±84.5 769,8±83,6 .005 METs 10.5±1.6 10.3±1.7 ns Open in new tab No Music Music p Exercise time (seconds) 709±84.5 769,8±83,6 .005 METs 10.5±1.6 10.3±1.7 ns No Music Music p Exercise time (seconds) 709±84.5 769,8±83,6 .005 METs 10.5±1.6 10.3±1.7 ns Open in new tab P128 Cognitive function disorders in patients with implantable cardiac pacemaker A Martis1, D Zdrenghea1, B Caloian1, H Comsa1, D Pop1 1Rehabilitation Hospital, Cardiology, Cluj-Napoca, Romania Topic: Basic Science - Cardiac Diseases Introduction: Pacemaker (PM) is indicated in symptomatic patients with sick sinus node syndrome or AV conduction disorder which are diagnosticated by EKG. It has been observed that subjects with bradyarrhythmias develop varying degrees of cognitive decline, secondary to low cerebral flow, favoring the accumulation of intraneuronal active metabolites and inducing apoptosis. However, literature issues related to cognitive function and the presence of cardiac pacemaker are limited and inconclusive, often contradictory. Purpose: The purpose of this study is to evaluate cognitive status in pacemaker patients, compared with a group of patients with similar cardiovascular pathology without pacemaker indication. Methods: The study is observational on 40 subjects divided into 2 groups: the pacemaker group (20 patients) and the control group (20 patients with associated cardiovascular pathology without intracardiac devices). Cognitive evaluation was achieved by applying the MMSE and the Clock Test to improve sensitivity in detecting altered cognitive functions related to visual-space integration. Data collection and statistical analysis were performed using the Excel (descriptive statistics) and SPSS 22 (for analytical statistics with the Student (t) test, and the Spearman correlation). Results: The mean age was 67.5 years for the control group, 68.1 years for the PM group, 47% were women for the control group,and 55% women for the PM group. The distribution of the patients according to the pacemaker mode was: 55% VVI mode, 45% DDD mode. No differences were found by applying cognitive scores between subjects with hypertension, diabetes mellitus, or aFib, or related to the type of pacemaker and cognitive dysfunction. There were no differences in language function, temporal-spatial orientation, and function execution between the two groups. . An inversely weak correlation was observed between age and visual function (r = -0.42). The scores on visual-space function were lower in the PM group (4.5) compared to the control group (4), but without statistical significance (p 0.12). It was observed that pacemaker subjects had statistically significant differences in short-term memory impairment (p<0.00044) and attention deficits with calculation difficulties (p<0.004) compared with the control group. Conclusion: In conclusion, the study reveals that subjects with pacemaker are more likely to develop cognitive dysfunctions such as impaired attention, calculation disorder, and worsening short-term memory compared with subjects with similar cardiovascular diseases other than bradyarrhythmias. Thus, the assessment of cognitive status in patients with pacemaker becomes important. Lack of diagnosis and early treatment has a negative impact on therapeutic compliance, quality of life, and survival. Consider limitations of the study the number of subjects, lack of data on the percentage of pacing, lack of cognitive pre-implant assessment. P130 Different data sources provide different prevalence estimates for obesity, hypertension and diabetes in Finland HK Tolonen1, J Reinikainen1, P Jousilahti1, V Salomaa1, K Borodulin1, P Koponen1, T Laatikainen1 1National Institute for Health and Welfare (THL), Helsinki, Finland Topic: Research Methodology - Other Background: Information about health determinants of population and population sub-groups is needed to support evidence-informed policy making as well as planning and evaluation of preventive activities. Population based health examination surveys can provide highly standardized information but are time consuming and expensive to conduct. Administrative registers such as records of hospitalizations and out-patient visits could provide faster and more economical alternative, if they can provide equally reliable information. Purpose: To estimate how comparable prevalence estimates of obesity, hypertension and diabetes can be obtained from survey data and administrative registers in Finland. Methods: Data from the Finnish national health examination survey (FinHealth 2017) was linked to administrative health registers using personal identity codes of each participant. Following indicators were defined from survey data: obesity as BMI≥30 (measured height and weight); hypertension SBP≥140 mmHg or DBP≥90 mmHg or self-reported use of antihypertensive medications; and diabetes as HbA1c ≥48 mmol/mol or self-reported us of diabetes medications. Corresponding indicators from administrative health registers were: obesity as a reason for visit to health care and treatment, hypertension as a reason for visit to health care and treatment, and diabetes as a reason for visit to health care or having received prescription for diabetes medication (using ICD, ICPC and ATC codes). Results: In survey data, prevalence of obesity was 25% while in the registers it was only 1%. Similarly for hypertension, survey data provided the prevalence of 43% while only 12% of individuals were identified as hypertensives in the register data. The prevalence of diabetes was 9% in both data sources but only 78% of individuals identified as persons with diabetes in survey were identified as diabetic also in administrative registers. Surveys found 22% of additional diabetic individuals which were not included to any health registers, i.e. were most likely non-diagnosed diabetic individuals at the time of the survey. Combinations of different risk factors were more difficult to obtain from the register data. For example, in survey data 14% were both obese and hypertensive, while in administrative registers only 0.4% were identified as obese and hypertensive. This is due to the lower detection rate of obesity through register data. Conclusion: In Finland, register data produces significantly lower prevalence for obesity and hypertension than the survey data. For diabetes, which require regular visits to a doctor, both survey data and administrative registers provide similar population level prevalence but they cover different sections of the population. At the moment, reliable population level information still requires health examination surveys. P131 Automatic analysis of phonocardiogram evaluation in elderly patients with cardiovascular diseases R Olszewski1, W Lejkowski2, K Majka3, T Grycewicz4, AP Dobrowolski2 1National Institute of Geriatrics Rheumatology and Rehabilitation, Warsaw, Poland 2Military University of Technology, Electronics Division, Warsaw, Poland 3Institute of Military Medicine, Warsaw, Poland 4Medical University of Lodz, Department of Interventional Cardiology and Cardiac Arrhythmias, Lodz, Poland Topic: Research Methodology - Other Background: With the development of telemedicine, we face new possibilities of quick diagnostics by the elderly patients themselves, who can record the heart sound of their heart with an electronic stethoscope and send it an unlimited distance for further analysis. The large amount of data transferred requires preliminary analysis by a system based on artificial intelligence. Some of the elements that should be initially rejected are internal and external acoustic artifacts and noise. The aim of the study was to create an advanced algorithm for filtering auscultatory artifacts, both externally related to "room acoustics" as well as internally related to noise associated with shifting the electronic stethoscope to the skin of the body. Methods: The analysis covered 398 records, which were carried out in 55 pts. (age 60-90 years) with different cardiovascular diseases (CVD): coronary heart disease, hypertension, atrial fibrillation and heart failure. In order to determine the quality of the recorded signal, we defined eight parameters presenting information about the quality of the phonocardiogram (PCG) by using Support Vector Machine (SVM), Principal Component Analysis (PCA), Linear Discriminant Analysis (LDA). At the pre-processing stage, the registered signals were subjected to wavelet filtration using Daubechies IV wavelet, and then the appropriate numerical descriptors were determined, which were subjected to the normalization process, after which they were used to define the appropriate classifier. Results: After application of the standard mode of teaching the classifier, using the training set and testing set, the exemplary results of the analysis of the PCA for 27 low-quality signals and 28 good quality signals is shown in Fig. 1.a. For the non-linear function, the classification efficiency was 98.20%, which indicates that for a given group of cases the SVM classifier achieved the best results (Fig. 1.b). LDA for defined eight parameters shows PPV- 92.59%, NPV-96.43%. Conclusion: Evaluation of the quality of PCG will enable the design of an automatic diagnostic system in the CVD for elderly patients, because poor quality signals will be rejected at the outset. Fig: 1. An exemplary result of the analysis of the Principal Component Analysis for 27 low-quality signals (red color) and 28 good quality signals (blue) (a), ROC curves for Support Vector Machine (b) Abstract Number: P131 Fig.1 P132 Rejuvenating rehab protocol - Using experience based co-design to improve engagement with cardiac rehabilitation G L Caughers1, J Bradley1, P Donnelly2, D Fitzsimons1 1Queen's University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland 2South Eastern Health and Social Care Trust, Belfast, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: Public Health Agency Research and Development PhD Fellowship Topic: Research Methodology - Other Background: Cardiovascular disease is the world’s biggest killer and while we know that cardiac rehabilitation reduces mortality and morbidity, it has poor uptake and attendance. Outcomes are sub-optimal with a 1 in 5 risk of major adverse cardiac event within the first year. There is an urgent need to make rehabilitation and prevention of future heart disease more acceptable, more accessible and more appealing to those who traditionally avoid participation; more than half of eligible patients choose not to attend. Unfortunately methods to achieve that objective have proved elusive. This study aims to take the innovative approach of Experience Based Co-Design (EBCD) to involve patients and staff as co-designers of innovative approaches to delivering CR may be an opportunity to greatly improve participation in this life-saving programme. Aim: To explore the current challenges of Cardiac Rehabilitation and using EBCD develop innovative approaches that maximise patient engagement. Methods: There is evidence that patient participation in design has a positive effect on subsequent use of resources. Those patients who do not attend the current CR programme hold the key to understanding the aspects of CR which are unappealing or inaccessible. It is through exploration of their experience that the most tangible evidence for change can potentially be revealed. EBCD will be used along with latest evidence to develop innovative approaches to CR. 1.Structured Literature Review - to evaluate existing approaches to CR delivery and to identify which intervention strategies are most effective and why. 2.Focus groups and interviews. There are 4 main groups of participants; each will discuss their experiences of the current provision of CR and include ideas for change. The study will be conducted in each of the 5 Health and Social Care Trusts. Figures given are per Trust. Group A – Staff (Focus group) n=5 Group B – Patients who have attended most or all CR classes (Focus group) n=10 Group C – Patients who dropped out of CR (Interview) n=10 Group D – Patients who did not attend any CR classes (Interview) n=10 3.Co-Design Workshop. This is a session with participants from Groups A-D, patient representatives, Cardiologists, CR programme leads, Local Cardiac Charities and University supervisors. The workshop will include anonymised quotations and video footage of patient’s experiences portrayed by an actor designed to trigger discussion and responses within the workshop. The goal of the workshop is to co-design innovative approaches which are viable solutions for non-attendance to CR. Outcome: Innovative methods of delivering CR will be identified and will proceed to further testing beyond this study. The study will provide evidence of the benefit of using EBCD and working with patients and staff directly to develop their service. P134 Who is responsible for the public health - Results of the study of studying the opinion of the population and health care workers AV Manshina1, MV Popovich1, EY Zabina1, ES Danilova1, EV Oussova1, VA Zinovyeva1, IS Glasunov1, ML Starovoytov1 1National Research Center for Preventive Medicine, integrated prevention programmes, Moscow, Russian Federation Topic: Research Methodology - Other The question of the degree of human responsibility for their health and the choice of appropriate behavior in comparison with the role of society, which makes this choice possible, has been discussed in the world for several decades. Therefore, it seems interesting to study the opinion of the population about their attitude towards their health. In 2017, the Department of Integrated Prevention Programs of National Medical Research Centre for Preventive Medicine was carried out to study the opinion of the population and health care workers about the responsible attitude to their health and the motivation to lead a healthy lifestyle. Objective: Studying the attitude of the population towards one's health and leading a healthy lifestyle (according to the results of the survey). Methods: The study was conducted using a survey of a focus group of the population, which was 621 people - a response of 95.2% (591 people). Of these, 221 (37.4%) are representatives of the population and 370 (62.6%) are health care workers, including the main non-staff specialists in the medical prevention of subjects of the Russian Federation. A database was created to process and analyze survey results in the form of a statistical combined table in Microsoft Office Excel format. Results: These studies have shown that the responsibility for one's own health, as well as the formation of this responsibility, firstly lies on the person. An important role in the formation of responsibility is borne by the state and the immediate environment (family) of a person. 99% of respondents consider it necessary to form a responsible attitude to their health. The best age in which to begin to form a responsible attitude to health and commitment to a healthy lifestyle is early childhood. There are some criteria, which are responsible for attitude to one’s health: proper nutrition, regular physical activity, absence of bad habits (smoking, alcohol), prophylactic examination and absence of excess weight. Encouragement of citizens who are responsibly related to their health, committed to a healthy lifestyle, fulfilling the recommendations of doctors, is the most acceptable method of motivating influence, which through interest, consciousness directs the will of people to law-abiding behavior, to accomplish the tasks useful for the citizen and society aimed at preserving health. Conclusion: The state policy should promote the development and implementation of laws, national strategies aimed at improving the quality of life of the population, combating noncommunicable diseases, preventing them and having an integrated intersectoral approach to building the people's commitment to a healthy lifestyle and responsibility for their health. The task of society is to give people information about what is a healthy choice, and to provide conditions and support for this choice. P136 Acceptability, barriers and facilitators of a family based cardiovascular risk reduction programme in individuals with family history of premature coronary heart disease: a qualitative study J Panniyammakal1, J Linju2, TR Lekha1, B Dona1 1Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India 2Centre for Chronic Disease Control, New Delhi, India On Behalf of: PROLIFIC Funding Acknowledgements: Wellcome Trust-DBT India Alliance Topic: Public Health and Health Economics - Other Background: Understanding the acceptability, barriers and facilitators to engagement with a lifestyle modification intervention among participants is necessary for informing the scalability of the intervention model. Methods: A purposive sample of 40 adults who have been more than 12 months into the trial were recruited from intervention families. We used a sampling frame to ensure representativeness of the trial participants. Another 10 interviews were conducted among other family members of the participants (who were available at the time of interview). Semi-structured interviews were carried out face to face in participant's home or telephonically by independent researchers who are not involved in the main study. The interviews were audio-recorded, transcribed and analysed using thematic content analysis in WeftQDA software. Findings: Three broad descriptive themes were motivation to participate, perceived benefits and reported challenges. The identified themes were related to participant’s acceptability, facilitators, and barriers of being a part of the trial. Participants described having a prior knowledge of familial cardio vascular diseases (CVD) risk and preventive nature of the programme as appealing and as a facilitator. One of the key drivers of acceptability was the programme delivery by a reputed institution. Involvement of the entire family encouraged many to pursue an active and healthy lifestyle. Monitoring of intermediate risk factors such as blood pressure and blood sugar heightened the interest in dietary and lifestyle changes among participants. Majority of the participants considered easily adoptable dietary changes such as reduced oil and salt as achievable. They have appreciated specific efforts of the non-physician health care workers in achieving reduction in oil and salt and improvements in vegetables and fruits consumption. Home makers expressed difficulty in dealing with varied food choices of family members. Some families stated that the dietary changes were limited to the parents alone. Young adults in the programme particularly noted that dietary changes were affected by eating out and were discouraged to adhere to dietary changes by wanting to fit in with peers. Majority of women perceived their household chores adequate and considered additional exercise as time consuming. Other family members of the participants expressed that the programme was beneficial as they were being monitored by the healthcare workers. Conclusion: The findings suggests that a family based, healthcare worker led lifestyle intervention is acceptable and feasible. However, it highlights the importance of tailoring the lifestyle modifications suited to the participants to maximise programme adoption and utility. P137 The impact of life worth living and self-care agency in patients with acute myocardial infarction Y Mizuguchi1, S Moriyama1, M Maruta1, A Nishimura1, Y Fujiwara1, N Yamashita1, K Kokuhata1, A Takahashi1 1Sakurakai Takahashi Hospital, Kobe, Japan Topic: Public Health and Health Economics - Other Background: Prior studies showed that the high population of patients with Acute Myocardial Infarction (AMI) found to be suffering from symptoms of depression and/ or anxiety. “Ikigai”is a positive psychological Japanese concept including “meaning of life”, “purpose in life” and "self-actualization". The objective of this study was to investigate the factors associated with Ikigai in patients having history of percutaneous coronary intervention for AMI. Methods: Between September 2017 and October 2017, 106 patients with history of PCI for acute myocardial infarction were enrolled in the study during their visit to the outpatient department. Among of them, 11 patients were excluded because of inadequate answer. The ikigai was measured by the Ikigai-9 Questionnaire. We divided these patients into two groups according to the Ikigai-9 score (I9S), namely high I9S group (n=49) or low I9S group (n=46), and evaluated its correlation with patient characteristics and social background including age, gender, number of PCI procedure after index procedure, income, education, smoking, job status, social activity, co-living families, support from others, and Self-Care agency. Results: There were no significant differences in age, gender, number of PCI procedure and job status between low I9S group and high I9S group. Low I9S group was more likely to be current smoker, no social activity, and living alone than high I9S group (88.9 v.s. 60.0 %, p<0.05; 15.7 v.s. 40.0 %, p<0.01, 28.3 v.s. 10.2%, p<0.05, respectively). Especially, high I9S group was more likely to emotionally dependent on medical staff and feel support from medical staff than low I9S group (46.9 v.s. 23.9 %, p<0.05; 71.4 v.s. 34.8 %, p<0.001, respectively). Total SCAQ score was significant lower in low I9S group than high I9S group (112.2 v.s. 125.2, p<0.001). SCAQ score has strong correlation with Ikigai-9 score (r =0.52, p<0.001). Conclusion: In patients with smoking, no social support and no social activity were more likely to be poor Ikigai-feeling. Ikigai has significant correlation with Self-Care agency. The improvement of Ikigai and SCA have an important role in secondary prevention after myocardial infarction. P139 Gender differences in cardiovascular risk factors among apparently healthy young adults in Russia Z Akhmedova1, L Vasil'eva1, N Murashko1, A Bragina1, M Pisarev1, V Podzolkov1 1I.M. Sechenov First Moscow State Medical University, 2nd Internal Medicine (2nd Faculty Therapy) Department, Moscow, Russian Federation Topic: Public Health and Health Economics - Other Background: The results of the ECVD-RF epidemiological study showed that 26.3% of men and 15.7% of women in Russia were not aware of their hypertension. According to the 2018 ESC/ESH Guidelines, the list of factors influencing cardiovascular risk was extended to include hyperuricemia, psychosocial stress, resting heart rate >80 beats/min, early-onset menopause, and family or parental history of early-onset hypertension. Russia is a country with high prevalence of cardiovascular diseases, and many of its inhabitants are unaware of their elevated cardiovascular risk. Aim: To study the prevalence of cardiovascular risk factors among apparently healthy young adults. Methods: 203 healthy volunteers (69 males and 134 females) who were medical university students participated in the study. The mean age was 21.0±2.1 years. There was no significant age difference between the male and female groups. All the participants were asked to complete the HADS (Hospital Anxiety and Depression Scale) and the Scale of Perceived Stress questionnaires. Statistica 10.0 software was used for data management and statistical analysis. Results: Overweight was more prevalent among male participants (24.6% vs 13.4% in females, p=0.047). Gender differences in blood pressure levels were found: among men the optimal blood pressure was registered in 33.3%, normal blood pressure in 36.2%, high normal in 10.1%, and hypertension in 20.4% vs 73.1, 12.7, 3.0, and 11.3% among women, respectively (p=0,000). Smoking prevalence was higher among men (67.5% vs 32.5% in women) which was in accordance with the general population trends (p=0,000). Prevalence of the resting heart rate >80 beats/min and family history of early-onset hypertension was similar between both groups (23.2% vs 25.4% and 30.4% vs 38.1% among men and women, respectively). Sedentary lifestyle was significantly more common among women (52.2% vs 27.5% in men, p=0,000). Women also had higher rates of subclinical/clinical anxiety (32.8/26.1% vs 13/4.4%, p=0,000), subclinical/clinical depression (16.4/6.7% vs 8.7/1.4%, p=0,045), subclinical/clinical stress (41.8/46.3% vs 40.6/14.5%, p=0,000), and abnormal sleep patterns (44% vs 17.4%, respectively, p=0,000). Conclusion: Gender differences in cardiovascular risk factors were found in young apparently healthy Russian individuals. Higher prevalence of elevated blood pressure, smoking and overweight was registered in males whereas sedentary lifestyle and psychosocial stress were more common in females. P141 The effect of various psychological factors on global compliance concerning treatment at the entrance of a cardiovascular rehabilitation program. Results from a 80 cardiac patients cohort. F Cugno1, M Labrunee2 1 Psychologist specialized in health, in a private practice, ALBI, France 2Toulouse Rangueil University Hospital (CHU), Toulouse, France Topic: Public Health and Health Economics - Other Background: Chronic cardiovascular disease involve long-terme treatment and are a major issue of global compliance. The notion of adherence, approached through compliance behaviors corresponds to : use of medication, healthy lifestyle (physical activity and diet), participation to clinical appointments. However, in cardiovascular diseases, we still don't know what are the main determinants of global compliance that could be targeted during their cardiac rehabilitation (CR) program. Purpose: The objective is to study the effects of various psychological factors on correctly following global treatment (drug and non drug related treatment), at the entrance of a CR program. Methods: The patients completed declarative structured questionnaires estimating the global compliance : the Girerd questionnaire assessed drug compliance and another questionnaire, designed for this study, assessed the non-drug compliance (physical activity, diet, toxic consumption). In addition to medical and sociodemographic data, the patients completed eight validated questionnaires measuring their quality of life, the different dimensions of beliefs about the illness and the representation of their treatment, locus of control, mood, coping, personality factors and patient-doctor relationship. Results: 79 patients have been recruited (70 % men, on average 57 years-old, 52 % with coronary heart disease without heart failure, on average 5,5 symptoms and 6 treatments by patient). Based on logistic regression, our results show that the significant predictors of global compliance are : quality of life, number of symptoms, and number of drugs. Conclusions: Global compliance in cardiovascular diseases seems to be associated with specific psychological determinants that should be focused by CR programs. Moreover, CR should improve the clinical signs perceived by the patients, and reduce the number of drugs, and thus allow a better follow-up of the recommendations. P142 Improvement of physical capacity and reduction of dependance on social disability benefis after complex hybrid cardiac telerehabilitation in patients referred by Social Insurance Institution A M Zebrowska1, I Palinka1, K Biniszewska1, J Stachura1, M Buczynski1 1MEDIKAR, Cardiology, Warsaw, Poland Funding Acknowledgements: Social Insurance Institution Topic: Public Health and Health Economics - Other Background: Social Insurance Institution (SII) in Poland uses contemporary method of complex hybryd cardiac telerehabilitation (CHCT) within prevention of loss of professional activity due to cardiovascular disease (CVD). Aim: Evaluation of efficacy of CHCT in improvement of physical capacity in order to return to employment and maintain earning capacity. Methods: The study group comprised 29 ambulatory patients with CVD referred by SII in 2017 for CHCT in disablement pension prevention. Patients (86% males), aged 53,1+ 10,6, LVEF 52+ 8,4, after miocardial inferct 28 (84%), hypertensive 25 (86%), obese BMI 29,7+3,07, type 2 diabetes 7 (24%) smoking tobaco active 27%, in past 95% Complex care of cardiologists, nurses, physiotherapists, psychologist in 24 working day ambulatory treatment included: cardiac consultations, ECG, transthoracic echocardiogram, exercise tests, ECG Holter, 10 days of ambulatory trainings, education, psychotherapy, followed by home-based cardiac telemonitored Northic Walking training. Results: Significant improvement in measured variables after CHCT was seen: growth in maximal workload during exercise test from 8,5 MET (measured in metabolic equivalents) to 9,2 MET p<0,0008; prolongation of tolerated exercise time from 10 min 37s to 11min 15s, p<0,0051; reduction in resting heart rate (RHR): 75/min vs 71/min p< 0,0452; decrease in systolic blood pressure (BP) 129 mmHg vs 122 mmHg p< 0,0001; diastolic BP 85 vs 81 mmHg p< 0,0042. No statistical loss of weight was noted. Percentage of smoking patients reduced from 27 to 23%. Up to 180 patients per year was contracted by SII with our rehabilitation center, only 29 was referred. Unexploited opportunities despite patients appreciation and good adherence to the out-patient followed by home-based telemonitored cardiac rehabilitation is due to lack of referrals, patients choice of health resort, system insuffiency. Women were underrepresented. Follow up 3 months after CHCT was conducted in order to monitor effects was made: 73% patients came back to work vs 18% in the beginning of program (Ryc). Majority of patients continued exercises 1-3 months after the end of rehabilitation. Conclusions: CHCT improves physical capacity of participants, it is also effective in regaining occupation and reduction of dependance on social disability benefis. Men after miocardial infarction are majority among patients referred for CHCT. Many of them can not imagine coming back to physical work. Neither they think about reskilling. Because of beneficial influence of CHCT on exercise tolerance and its efectiveness in returning capability to work it is worth considering referring greater number of patients. Continuation of feasible and safe telemonitoring program may improve and prolog beneficial influence of rehabilitation in order to reduce costs of social benefis. Abstract Number: P142 Employment status P145 Validation of two wrist-worn devices for the assessment of energy expenditure in patients with chronic heart failure and coronary artery disease. C Herkert1, JJ Kraal2, EMA Van Loon1, M Van Hooff3, RWM Brouwers2, HMC Kemps1 1Maxima Medical Centre, Cardiology, Veldhoven, Netherlands (The) 2Maxima Medical Centre, FLOW, Centre for Rehabilitation and Prevention in chronic disease, Veldhoven, Netherlands (The) 3Maxima Medical Centre, SportMáx, Veldhoven, Netherlands (The) Topic: e-Cardiology - Other Introduction: One of the goals of cardiac rehabilitation is improving physical fitness and physical activity (PA) levels. Currently, exercise training programs are usually centre based and evaluation or monitoring of PA is not routinely applied. In order to monitor PA in cardiac patients accurately, non-obtrusive activity trackers, previously validated in healthy subjects, need to be validated in cardiac patients with chronotropic incompetence and beta-blocker medication. The aim of the present study is to validate two wrist-worn activity trackers (Fitbit Charge 2 and Mio Slice), for the assessment of energy expenditure (EE) in cardiac patients. Methods: EE assessed by the activity trackers was compared with oxygen uptake assessed by breath-to-breath analyses using a mobile device (Oxycon Mobile, OM) during an activity protocol. This protocol existed of low-to moderate-intensity daily life activities. The activity trackers were studied in two patient groups: patients with stable coronary artery disease (CAD) with preserved LVEF and patients with heart failure with reduced ejection fraction (HFrEF). Results: We included 19 patients with CAD (age 61.4 ± 6.9, 73.7% male) and 19 patients with HFrEF (age 65.1 ± 6.6, 89.5% male, LVEF 31.8 ± 7.6 %). In the CAD group the mean difference in EE between Fitbit and OM was 61 ± 111 kcals (p=0.03) and between Mio and OM 93 ± 113 kcals (p<0.01). In the HFrEF group the mean difference in EE between Fitbit and OM was 45 ± 58 kcals (p<0.01) and beteen Mio and OM 114 ± 167 kcals (p=0.01). Agreement of the activity trackers was low in both groups (CAD: ICC Fitbit 0.15, ICC Mio 0.11, and CHF: ICC Fitbit 0.37, ICC Mio 0.10). Changes in cycling intensity were moderately detected by Mio and poorly detected by Fitbit, while changes in walking intensity were detected poorly by both activity trackers (table 1). Conclusion: Both activity trackers demonstrated low accuracy in estimating EE in patients with CAD and HFrEF, which is in line with recent studies performed in a healthy population. These results indicate that PA estimation with these devices should be performed with caution. Activity Oxycon Mobile Fitbit Charge 2 Mio Slice CAD Cycling Walking Low vs high intensity 5,4** 2,6 5,1** Low vs high intensity 2,5** 2,6 3,8 HFrEF Cycling Walking Low vs high intensity 3,0** -1,0 4,7* Low vs high intensity 1,5** 0,3 2,2 Activity Oxycon Mobile Fitbit Charge 2 Mio Slice CAD Cycling Walking Low vs high intensity 5,4** 2,6 5,1** Low vs high intensity 2,5** 2,6 3,8 HFrEF Cycling Walking Low vs high intensity 3,0** -1,0 4,7* Low vs high intensity 1,5** 0,3 2,2 Values indicate mean difference in EE (kcals) for different intensities.CAD: coronary artery disease; HFrEF: heart failure with reduced ejection fraction*signifies p<0,05; ** p<0,01 Open in new tab Activity Oxycon Mobile Fitbit Charge 2 Mio Slice CAD Cycling Walking Low vs high intensity 5,4** 2,6 5,1** Low vs high intensity 2,5** 2,6 3,8 HFrEF Cycling Walking Low vs high intensity 3,0** -1,0 4,7* Low vs high intensity 1,5** 0,3 2,2 Activity Oxycon Mobile Fitbit Charge 2 Mio Slice CAD Cycling Walking Low vs high intensity 5,4** 2,6 5,1** Low vs high intensity 2,5** 2,6 3,8 HFrEF Cycling Walking Low vs high intensity 3,0** -1,0 4,7* Low vs high intensity 1,5** 0,3 2,2 Values indicate mean difference in EE (kcals) for different intensities.CAD: coronary artery disease; HFrEF: heart failure with reduced ejection fraction*signifies p<0,05; ** p<0,01 Open in new tab P146 The EXPERT-HeartHab Liaison: bringing grounded exercise guidelines to the patient S Sankaran1, G Rovelo Ruiz1, D Hansen2, P Dendale3, K Coninx1 1Hasselt University- tUL, Expertise Centre for Digital Media, Diepenbeek, Belgium 2Hasselt University, REVAL – Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium 3Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium Funding Acknowledgements: Hasselt University IOF PoC project and PhD grant Topic: e-Cardiology - Other Background: Research provides evidence on the potential of using mHealth solutions for cardiac rehabilitation and self-management. Yet, factors such as lack of personalization and usability issues obstruct the widespread adoption and implementation of such systems. Furthermore, despite the existence of clinical guidelines, studies show that there is a big variance in the way exercise interventions are prescribed to patients. To overcome these implementation challenges using grounded guidelines, we created the EXPERT-HeartHab Liaison: a comprehensive mHealth solution consisting of the EAPC EXPERT-tool and the HeartHab app for self-management of cardiac disease. Methods: The EXPERT-tool is a valuable decision support system for clinicians to provide personalized exercise recommendations grounded on recognised, published guidelines and expert opinions. To seamlessly transfer these recommendations to the HeartHab app for patients, clinicians can directly access the EXPERT-tool from a dedicated dashboard. The training prescription is then presented to patients in an accessible manner using intelligible and persuasive design techniques in HeartHab. We evaluated clinicians' perspectives in a lab test with 6 participants: 3 study nurses, a physiotherapist and 2 cardiologists. The test was scenario driven, evaluating the integration of a dashboard with the EXPERT-tool to generate recommendations for a sample patient case; using the SUS scale, and a semi-structured interview. Additionally, a 4-month crossover trial with 32 CAD patients assessed patients' perspectives on the personalized recommendation and its impact on their motivation. At the end of the study, we conducted semi-structured interviews to collect patient perspectives. Results: All clinicians found it easy to generate exercise recommendations using the EXPERT-tool integrated in the dashboard and perceived it as very useful and valuable. The average usability score on the SUS scale was 79.1 with a grade ranking of 'excellent'. All clinicians were willing to use this guideline-based approach to prescribe exercise interventions. In the crossover trial, 4 patients had to be excluded, 3 did not use the app and one patient did not use the exercise training module. Amongst the remaining 24 patients, 96% achieved their recommended exercise target and 87.5% said that the personalized training goals and intelligible visualizations were motivating. 75% patients were willing to use the HeartHab app in a long-term self-management context. Conclusion: The proposed EXPERT-HeartHab Liaison is a first step in closing the gap between clinicians and patients. It facilitates clinicians to generate grounded recommendations for exercise interventions in an easy-to-use and seamless manner. The personalized training goals motivate patients to adhere to rehabilitation recommendations and increases their willingness to use such mHealth solutions for self-management. P148 PATHway-I: feasibility and preliminary efficacy of a technology-enabled home-based cardiac rehabilitation system. J Claes1, V Cornelissen2, C Mcdermott3, C Mccormack3, A Gillain2, N Cornelis2, K Moran3, N Pattyn2, A Sheerin4, C Woods5, N Moyna3, R Buys1 1KU Leuven, Cardiovascular sciences, Leuven, Belgium 2KU Leuven, Rehabilitation sciences, Leuven, Belgium 3Dublin City University (DCU), Health and human performance, Dublin, Ireland 4Mater Misericordiae University Hospital , Dublin, Ireland 5University of Limerick, Physical education and sport, limerick, Ireland Funding Acknowledgements: This project has received funding from the European Union’s Horizon 2020 Framework Programme for Research and Innovation Action no. 643491 Topic: e-Cardiology - Other Background: The incidence of cardiovascular diseases (CVD) is increasing. Secondary prevention of CVD can effectively be achieved by cardiovascular rehabilitation (CR). Despite the proven effectiveness of CR, only 30% of eligible patients participate in hospital-based CR programmes and only 50% of patients remain physically active for more than six months after completing an ambulatory hospital-based CR programme. Therefore, new innovative and cost-efficient strategies are needed that result in increased uptake and long-term adherence to physical activity (PA) and a healthy lifestyle. Purpose: In this study we evaluate the feasibility, acceptability and short-term effectiveness of the PATHway system, an internet-enabled and home-based CR platform. Methods: In a multicenter randomized controlled pilot feasibility trial, patients with CVD were randomized on a 1:1 basis to the PATHway intervention group (PW) or usual care control group (UC). Assessments at completion of hospital-based CR and three and six months follow-up included PA (Actigraph GT9X link), physical fitness (peak oxygen uptake, handgrip strength, isometric and isokinetic upper leg strength, 30-second sit-to-stand test), modifiable cardiovascular risk factors (body mass index, fat mass, waist-hip ratio, blood pressure, biochemical markers), endothelial function (flow mediated dilatation of the right brachial artery), intima-media thickness of the common carotid artery and quality of life (SF-36). PATHway usage and usability were evaluated in PW. Between-group effects over time were analysed using a mixed-model ANOVA with Bonferroni adjustment. Missing values were handled by an intention-to-treat analysis using the last-value-carried-forward approach. Statistical significance was set at a two-sided alpha level of 0.05. Data are reported as mean ± SD. Results: A convenience sample of 120 CVD patients (60.3 ± 9.2 years, 22 women) completing hospital-based phase II CR, was randomised. The PATHway system was successfully deployed in the homes of the 60 participants randomised to PW. Mean system usability score was 65.7 ± 19.7 (scale 5-100), which indicates average usability by participants. Significant differences between groups from baseline to 6 months follow-up were established for average minutes of moderate to vigorous intensity PA per day (PW: 127 ± 58 min to 141 ± 69 min, UC: 146 ± 66 min to 143 ± 71 min; p=0.039), cardiovascular risk score (PW: 15.9 ± 10.4 to 15.5 ± 10.5 %, UC: 14.5 ± 9.70 to 15.7 ± 10.9 %; p=0.032) and diastolic blood pressure (PW: 79 ± 11 to 79 ± 10 mmHg, UC: 78 ± 9 to 83 ± 10 mmHg; p=0.004). A significantly lower number of uploaded exercise sessions in the final two months pointed to a decline in the use of the PATHway system over time. Conclusions: This pilot study demonstrated the feasibility, acceptability and efficacy of a technology-enabled, home-based CR programme, yet several challenges were identified that could influence adoption of PATHway. P149 Influence of sociodemographic factors and medical history on cardiac-based e-learning usage in ischemic heart disease patients S Smeets1, L Degryse1, S Orole1, I Frederix2, T Vandenberk3, A Geurden4, L Janssen4, L Hermans5, S Puts1, J Bielen1, M Dendale4, M Scherrenberg4, M Govaerts4, P Vandervoort3, P Dendale2 1Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium 2Virga Jesse Hospital, Department of Cardiology, Hasselt, Belgium 3Hospital Oost-Limburg (ZOL), Department of Cardiology, Genk, Belgium 4University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium 5Hasselt University, I-Biostat, Diepenbeek, Belgium Topic: e-Cardiology - Other Background: Despite effectiveness of cardiac rehabilitation (CR) in ischemic heart disease (IHD) patients, time and travel required to attend CR in specialized centres severely impede participation rates. E-learning may be the first step to offer CR to patients at home and may also be a qualitative memory support in addition to on-site educational lectures. Several studies suggest that online learning and CR may improve self-care behaviour. Purpose: This study investigates whether sociodemographic factors and medical history influence cardiac-based e-learning usage. This may be useful in daily clinical practice to identify IHD patients who are more likely to use e-learning and have the possible benefits of it. Methods: This substudy of a randomised controlled trial contained 508 IHD patients and was conducted in two Belgian hospitals. All patients received one-month access to an online cardiac-based e-learning platform containing sixty videos, in addition to conventional cardiac care. In these 1-2-minute videos, (para)medics and patients lectured about different topics concerning living with IHD. The explored sociodemographic and medical patient variables comprised age, gender, educational attainment, vocational status, smoking, in-centre CR participation, type of cardiac pathology, treatment of IHD, diabetes mellitus, peripheral artery disease, arterial hypertension, hyperlipidemia, family history of IHD and ejection fraction. The primary endpoint was the proportion of patients who watched videos on the e-learning platform. The secondary endpoint comprised the time they spent watching videos. By modelling multiple logistic and linear regressions, the influences of the explored variables on the outcome measures were investigated. Multiple imputation was used to handle missing patient variables. Results: Half (50.4%) of the subjects opened the e-learning videos and the median time they watched the videos was 23’17". Regression analyses with all variables included show that in-centre CR participation (p=0.0130) and educational attainment (p=0.0228) significantly affect the probability that a patient uses the e-learning platform after receiving free access. Of the subjects who attended in-centre CR 53.8% used the platform, while this was only 35.2% for subjects who never attended in-centre CR. Depending on the educational attainment, 44.0% (primary education), 46.4% (secondary education), 64.7% (higher education) or 50.6% (university) of the subjects watched videos. Furthermore, there seems to be a significant negative influence of age (p=0.0498) on the logarithm of the time patients spent watching videos. All other variables had no significant effect on the outcome measures. Conclusions: This study suggests that in-centre CR participation, educational attainment and age may influence cardiac-based e-learning usage in IHD patients. Future research should assess if the investigated factors also influence the clinical effectiveness of e-learning. P150 Lumii.cardiac rehabilitation software.let us shake things up. A Farag1, J Eichhoefer2 1Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain & Northern Ireland 2Lancashire Cardiac Centre, Blackpool, United Kingdom of Great Britain & Northern Ireland Topic: e-Cardiology - Other Introduction: Despite its proven cost effectiveness, cardiac rehabilitation (CR), participation and completion rates in the UK remain static at around 50%. The use of smartphone technology to increase CR penetration and uptake rate is promising. Aim: To increase CR participation and completion rates through rebranding and modernising the current CR process. Methods: Two UK National Health Service (NHS) interventional cardiologists initiated the idea and partnered with health investors to develop the software. Working closely alongside NHS IT security leads, patients’ groups, CR teams (across multiple NHS test sites), the British Association of Cardiovascular prevention and rehabilitation (BACPR), the British Heart Foundation (BHF) and the National Audit of Cardiac Rehabilitation (NACR) to develop the software. Results: The resulting software application is a comprehensive three-armed cardiac rehabilitation software aimed at: 1-Patients; facilitating access to digitised cardiac rehabilitation information, communication with the cardiac rehabilitation team and offering a social networking feature where patients can share their experiences and challenged not only with health care professionals but with patients who have been through a similar experience. It utilises information from wearables and breaks language barriers. 2-Cardiac rehabilitation teams; allowing a more streamlined on boarding process, easier communication and response to patients’ queries, personalising CR programs including home based programs, and improving data flow and management. The software allows for easier access and recollection of patients’ data. 3-National Audit of Cardiac Rehabilitation (NACR) ; pushing notifications and reminders to patients on their mobile devices to fill in the NACR survey in a timely manner. The use of machine-based learning, allows us to capture wider patient groups, get patients more involved and engaged with the CR process and offer an individualised cost effective solution to patients. The software will also allow long term follow up and engagement with patients beyond the current CR 6-12 weeks period. The data will be hosted securely on NHS servers and will comply with the GDPR laws. Conclusion: This software is a comprehensive user centred CR software aimed at complementing and modernising the current CR process. Its development is led by 2 NHS cardiologists, hosted on NHS servers, and complies with NHS data protection laws. P152 Impact of a tailored e-learning approach during cardiac rehabilitation C Bonneux1, S Sankaran1, P Dendale2, K Coninx1 1Hasselt University-tUL, Expertise Centre for Digital Media, Diepenbeek, Belgium 2Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium Funding Acknowledgements: PhD Grants Hasselt University/BOF Topic: e-Cardiology - Other Background: Observing the current trend towards patient-centred care and shared decision making, patients want to become informed, active participants in their rehabilitation. However, optimal tailoring of e-learning and shared decision making is a challenge, given time constraints of clinicians and disparity between patient needs and caregiver perspectives. As education is one of the core components of cardiac rehabilitation we developed interactive tools to bridge the gaps in clinician-patient perspectives and address the aforementioned challenges. These mobile tools include a tailoring tool for clinicians to select personalized content, an e-learning tool for patients and a supportive tool for informal caregivers (e.g., friends or family of patients). We evaluated the usability of these mobile tools and their impact on enhancing patients' understanding during cardiac rehabilitation. Methods: The tailoring tool was evaluated in a lab study with 4 clinicians- a psychologist, a physiotherapist, a dietician and a cardiac nurse. Clinicians were asked to tailor e-learning content using the tool for 3 patient use cases. Usability, usefulness and relevance of tailoring were ranked on a 5-point Likert scale using a custom questionnaire. A 6-week field study with 5 CAD patients assessed the impact of the tailored e-learning using 3 intermediate questionnaires and a semi-structured interview. A final scenario-based lab study evaluated the usability and perceived usefulness of the informal caregiver tool with 5 participants. They ranked their opinions in a questionnaire using a 5-point Likert scale from 'strongly disagree' to 'strongly agree'. Results: All clinicians unanimously agreed that providing personalized sets of information to patients is a suitable approach. They all 'strongly agreed' with respect to usefulness of the tool to tailor e-learning content. All participating informal caregivers 'agreed' or 'strongly agreed' to being involved in the shared decision making process. However, there were mixed responses for their willingness to use a dedicated tool and the perceived usefulness of the application. At the end of the field study with a mobile app, all patients either 'agreed' or 'strongly agreed' usefulness, relevance and likeability of the tailored e-learning content. All patients mentioned that their knowledge and understanding improved. Three patients reported a reduction in fear and anxiety during self-management. Conclusion: Mobile tools for tailoring e-coaching offer clinicians an opportunity to tailor information for patients in a structured and systematic manner. Tailored e-learning also facilitates in enhancing patients' understanding, confidence and reducing fear, which are known factors to promote better adherence to therapy. All stakeholders see the perceived benefits of tailoring e-learning and are willing to use such interactive mobile tools during rehabilitation. P155 The influence of sociodemographic factors on erectile dysfunction of patients with HF A Targos1, IU Izabella Uchmanowicz1 1Wroclaw Medical University, Department of Clinical Nursing , Wroclaw, Poland Topic: Cardiovascular Nursing - Other Sexual dysfunction reduces the quality of life in patients with cardiovascular diseases. Heart failure (HF) is a syndrome caused by providing insufficient amount of oxygenated blood needed for maintaining body metabolism. Erectile dysfunction (ED) has been reported as an impact on sexual functioning in males with HF. Also ED is a consequence of several factors, namely neurological, psychiatric, hormonal and vascular problems and also drug side-effects. Multiple factors are related to erectile dysfunction in men with HF including aging,body mass index, chronic diseases. Drugs such as digoxin, beta- blockers, diuretics and can cause ED. Importance of study: To evaluate clinical and sociodemographic factors on the incidence of erectile dysfunction in patients with heart failure. Methods: In this study a total of 80 men in age M ± SD = 63,36 ± 9,21years with heart failure were studied for presence of erectile dysfunction and associated factors ( demographic and clinical information such as marital status, education, chronic disease with HF, consumed drugs, left ventricular ejection fraction, body mass index). Erectile function was meassured using International Index of Erectile Function - 5 items (IIEF-5). The IIEF-5 included 5 questions which were filled in based on the 5- point Likert scale. The points ranged from 5 to 25 and points below 21 indicated erectile dysfunction. Subjects were categorized based on their points into the following groups: severe erectile dysfunction (5 to 10), moderate erectile dysfunction (11-15), mild erectile dysfunction ( 16 to 20) and normal ( 21 to 25). Results: Regarding to education, 32, 50% of subject had secondary education and 33,75% had university education. 60% of subject were hospitalised one time in last six months. Left ventricular ejection fraction ( LVEF) M ± SD = 39,95 ± 15,07%. 50% of particpants had obesity or overweight. The majority of patients was in NYHA class II ( 33,75%), NYHA class III (27,50%) NYHA class I (26,25%). The most accompanying diseases were hypertension (55% ) and diabetes (50%). 12, 50% of the subjects were treated with digoxin, 32, 50% with diuretics, 18,75% with ACEI/ ARB, 32,50% with beta blockers. 84,42% of subjects had moderate erectile dysfunction. A significant difference was seen in mean erectile dysfunction between aging groups ( P<0,001) and illness duration (P = 0,006). Pearson’s correlation showed a significant relationship between LVEF ( P< 0,001), hypertension ( P= 0,001) and diabetes (P=0,103) with erectile dysfunction. Conclusion: In this study, erectile dysfunction ( ED) was found to be significantly related to aging with the highest rate of ED was found in older patients . Our findings showed that ED was more servere in HF patients with longer illness duration, lower left ventricular ejection fraction ( LVEF) and also suffered form hypertension and diabetes. P157 Do frailty and psychosocial factors play a role in the perception of quality of life in elderly patients with acute coronary syndrome? I Uchmanowicz1, Z Mulik1, MH Lisiak1, M Wleklik1, A Chudiak1, K Lomper1 1Wroclaw Medical University, Department of Clinical Nursing , Wroclaw, Poland Topic: Cardiovascular Nursing - Other Introduction: Cardiovascular diseases (CVD) are one of the greatest challenges in geriatric cardiology. One of the most current problems of an aging population is CVD, including acute coronary syndromes (ACS) and frailty syndrome (FS). There is a lot of evidence that suggests a likely relationship between CVD and FS. The clinical evaluation of elderly patients with ACS in addition to physical assessment should include the psychosocial assessment in the context of both FS and risk factors. Psychosocial components have an important impact on prevention, treatment, outcomes and quality of life (QoL) in cardiac patients. Purpose: The present study aimed to assess frailty and psychosocial factors related to quality of life in elderly patients with ACS. Methods: The study included 100 patients (61 men), aged ≥ 65 hospitalized for ACS. Our own instrument was used to assess socio-demographic data. Additionally, we used Tilburg Frailty Indicator (TFI) (divided into 3 domains: physical, psychological and social) and the QoL of the World Health Organization, QoL BREF (WHOQOL-BREF) to assess the physical, psychosocial domain. Results: The average age was 66.12 (SD=10.92) years. Most patients were married and retired (63% and 66%, respectively). 47% and 21% had secondary education and higher education, respectively. FS occurred in 80% of patients who obtained 5 or more points. Relatively, the most important component of frailty was the psychological domain (on average 2.2 points per 4 possible or 55% of the maximum result). The social domain was on average 1.02 points out of 3 possible or 34% of the maximum result. The patients assessed their QoL as neither poor nor good (3.68, SD=0.71) and their health as neither satisfying nor dissatisfying (2.59, SD=0.98). The assessment of each QoL domain showed that the social domain was the worst evaluated (14.69, SD = 2.25). The social factors affecting the low QoL in studied group are: marital status, low education status, lack of professional work. Furthermore, the social components of FS have a significant impact on the QoL in the psychological (rs -0.238) and social (rs -0.253) domains. These relationships are negative, i.e. the more of these components, the lower the QoL in these areas. Conclusions: FS was common (80%) in patients with ACS. The study showed that some socio-demographic factors (marital status, low education status, lack of professional work) and FS have negative impact on the QoL. There was a negative relationship between social components of TFI and QoL in all domains. The study revealed that an improvement in the identification of FS and psychosocial risk factors may by significant in therapeutic strategies in patients with ACS. P158 Knowledge and awareness of cardio-vascular risk factors as the predictor of therapeutical adherence to antihypertensive treatment N Swiatoniowska1, E Bartosiak1, A Szymanska-Chabowska1, G Mazur1, B Jankowska-Polanska1 1Wroclaw Medical University, Wroclaw, Poland Topic: Cardiovascular Nursing - Other Introduction: The educational interventions in the cardio-vascular patients aim to eliminate or modify the present risk factors by means of their active participation in the therapy. Arterial hypertension is the most common modifiable risk factor of cardio-vascular diseases. The level of awareness of the prevention of cardio-vascular diseases and level of adherence of therapeutical recommendations are extremely unsatisfactory. Understanding people's knowledge about cardiovascular risk factors and its impact on adherence to antihypertensive therapy might contribute effectively to medical staff’ efforts in preventing, treatment, and controlling of the disease. The aim of the study was the evaluation of the knowledge of cardio-vascular risk factors influencing the adherence to antihypertensive therapy. Material and methods. 101 patients (mean age 57.5±13.2) with arterial hypertension (stage I and II according to ESC). In the study the following questionnaires were used: Morisky’s Self-Reported Measure of Medication Adherence (MMAS‑8‑Item), Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone Scale) and The Cardiovascular Disease Risk Factors Knowledge Level Scale (CARRF). Results: 41% of patients presented low level of knowledge of cardio-vascular disease. In comparative analysis there was a significant difference between the level of adherence evaluated by means of MMAS questionnaire and by means of CRRRF questionnaire: the patients with high level of knowledge had the highest levels of adherence, which decreases consequently with the diminishing of the level of knowledge (19.0± 3.5 vs 18.3 ± 3.7 vs 16.6 ± 4.1). The increase of the knowledge (evaluated by means of CARRF-KL scale) by one point accompanies the increase of the adherence MMAS-8 by 0.14 point, on average. The similar relationship between pharmacological adherence (8.3 ± 2.0 vs 10.1 ± 5.0 vs 8.9 ± 3.5; p=0.003) and total score of Hill-Bone questionnaire (19.5 ± 4.4 vs 22.7 ± 7.3) was proved. However, there was no relationship between the knowledge and the adherence to salt intake and follow-up visits. In multiple regression analysis the knowledge was the significant and independent determinant of adherence to pharmacological recommendations MMAS-8 (b= 0.253; p=0.0004). Conclusions: Knowledge of cardio-vascular disease influences the level of adherence to therapeutical recommendations and is a significant independent determinant of good adherence. Patients with better knowledge presented better adherence level to pharmacological antihypertensive treatment. P161 Impact of gender on adherence to therapy in patients with arterial hypertension N Swiatoniowska1, E Bartosiak1, A Szymanska-Chabowska1, G Mazur1, B Jankowska-Polanska1 1Wroclaw Medical University, Wroclaw, Poland Topic: Cardiovascular Nursing - Other Introduction: Non-compliance with therapeutical recommendations in arterial hypertension is a common problem affecting almost half of all the patients. Uncontrolled blood pressure persist as major public health and clinical challenges. Research in the past decade has identified determinants of poor adherence and explored the impact of interventions to address barriers, improve adherence, and ultimately achieve BP control. According to WHO new factors influencing the adherence to therapeutic recommendations should be identified. One of such both important and controversial determinants is the gender of the patients. The aim of the study was to evaluate the impact of gender on the level of adherence to therapeutical recommendations in patients with arterial hypertension. Material and methods: 101 patients (including 59 women), mean age 57.5± 13.2, with arterial hypertension (stage I and II according to ESC) were examined with the questionnaire Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone Scale) and Morisky’s Self-Reported Measure of Medication Adherence (MMAS-8-Item). The socio-clinical data was obtained from medical records. Results: Men received higher score in Hill-Bone scale than women (23.0 ± 6.3 vs 20.8 ± 5.4; p=0.024), which means that they rarely adhere to therapeutical recommendations of arterial hypertension. Men received the worst score in adherence to recommendations regarding salt restrictions in their diet (4.5 ± 1.2 vs 3.9 ± 1.2; p=0.014). Additionally, it was demonstrated that men often discontinue antihypertensive treatment on their own (5% vs 1.8%; p=0,034) whereas women discontinue antihypertensive treatment mainly because they simply forgot about it (88.1% vs 69.0%; p= 0.018). Conclusions: It was proved that male gender negatively influences the level of adherence of non-pharmacological recommendations of antihypertensive therapy. What is more, men often discontinue antihypertensive treatment. A multidisciplinary approach and the development of intervention programs focused on men promoting knowledge and healthy behaviors are significant components of care, contributing to better adherence and control. P165 A novel direct method to evaluate adherence to atorvastatin therapy in coronary prevention - Cut-off values generated in a clinical non-adherence study O Kristiansen1, NT Vethe2, S Bergan2, MW Fagerland3, E Husebye1, J Munkhaugen1 1Drammen Hospital, Department of Medicine, Drammen, Norway 2Oslo University Hospital, Deparment of Pharmacology, Oslo, Norway 3Oslo University Hospital, Section for Biostatistics and Epidemiology, Oslo centre for Biostatistics, Oslo, Norway Funding Acknowledgements: Funded by internal funds from Vestre Viken hospital trust Topic: Cardiovascular Pharmacotherapy Introduction: Poor statin adherence is a prevalent challenge in coronary prevention associated with adverse outcomes. Objective methods to monitor statin adherence in clinical practice are lacking. We have previously established a reliable liquid chromatography tandem mass spectrometry assay for quantification of atorvastatin and its five major metabolites in blood. Cut-off values to discriminate non-adherent from adherent patients are yet to be developed. Purpose: To develop an objective drug exposure variable reflecting the given atorvastatin dose and to establish cut-off values to discriminate adherence, partial adherence and non-adherence to atorvastatin treatment in coronary patients. Methods: The study included 25 coronary patients aged 44-84 years treated with atorvastatin 10 mg (N=5), 20 mg (N=6), 40 mg (N=7) and 80 mg (N=7). All patients were instructed to administer atorvastatin between 7 and 10 AM for at least 7 days prior to study start to ensure steady-state drug concentrations. At the first study day, patients participated in a directly observed atorvastatin therapy (DOT) study without having taken their morning dose. Blood samples were collected 1 hour before DOT and immediately before DOT to detect any unscheduled morning dose. The atorvastatin dose was then administered before additional blood samples were collected after one and 24 hours. After the DOT, half of the patients on each dose level (N=12, test group) were instructed to stop taking atorvastatin and return for additional blood samples the subsequent 3 days. Results: No significant differences in drug exposure immediately before DOT and 24 hour after DOT were observed, confirming complete adherence. The sum of parent drug and metabolites correlated most strongly with the dose taken (Spearman rho= 0.71, 95% CI 0.44-0.87). With respect to demographic and clinical variables, the age correlated significantly with the drug plus metabolites exposure (rho= 0.46, 95% CI 0.07-0.73). As illustrated (Figure), the dose-normalized sum of atorvastatin plus metabolite concentrations were completely separated from the controls at 0.2 (nmol/L)/mg when the test group had omitted tablet intake for 3 days. To reduce the impact of a single apparent outlier and to decrease the risk of identifying adherent patents as partially non-adherent we suggest a cut-off at 0.1 (nmol/L)/mg as a practical approach, providing 100% sensitivity and 91% specificity according to ROC-curve analysis. We suggest defining complete non-adherence as non-detectable concentrations of parent drug and metabolites. Conclusion: A dose-normalized cut-off value for the sum of atorvastatin and metabolites in spot blood samples allows discrimination between adherence and partial adherence to atorvastatin therapy in CHD patients. The present direct method to determine atorvastatin adherence emerges as a useful tool for clinical practice and future interventions. Abstract Number: P165 P166 The relationship of drug treatment safety parameters and adherence to pharmacotherapy in patients with cardiovascular diseases (according to the data of the outpatient registry) YV Lukina1, NA Dmitrieva1, NP Kutishenko1, VP Voronina1, OV Lerman1, SN Tolpygina1, AV Zagrebelniy1, SY Martsevich1 1National Research Center for Preventive Medicine, Department of preventive pharmacotherapy, Moscow, Russian Federation Topic: Cardiovascular Pharmacotherapy Objective: to study the interrelationship of aspects of drug therapy safety and of treatment adherence in patients with chronic cardiovascular diseases (CVD) and CVD risk factors, within the outpatient prospective register Materials and methods: A register method was used (the data of outpatient register of the specialized cardiologic department of the medical research centre), supplemented by two original questionnaires for assessing a treatment adherence and for collecting an information about drug adverse events (AEs) in anamnesis. The 8-item Morisky Medication Adherence Scale (MMAS-8) was applied too. The questioning was conducted during the period from September 1, 2017, to May 31, 2018. Of the 177 completed questionnaires, 162 were suitable for analysis, 80 women and 82 men filled these questionnaires. The average age of patients was 67.2 ± 11.1 years. All eight questions of the MMAS-8 were answered by 130 people. Results: In 46 patients (28.4%) of 162, there were different AEs of pharmacotherapy in anamnesis, half of the patients (88 people; 54.3%) denied the presence of AEs, and 34 patients could not give an answer to this question. Practically all patients (158 of 162 patients, 97.5%) were given medical recommendations (MR) for taking medications, but only 117 patients (74,0%) were fully adherent to MR, 13 people did not take medicines at all, the remaining patients were partially non-adherent. According to the results of the MMAS-8, 77 people (59.2%) were non-adherent to MR, and 53 patients were adherent to MR. Regular visits to the attending physician and informing the patient by the doctor, including information about AEs of taking drugs, significantly increase patients’ adherence to MR (p <0.05). There was no significant relationship between the number of drugs taken and AEs of drug therapy. Patients, who did not have AEs of pharmacotherapy, rarely had feel hassled about sticking of their treatment plan (in only 13% of cases), but among patients with reported AEs, there were twice as many such cases (27.5%) (p = 0.044). In patients independently changing the dose of taking drugs or discontinued to take them, AEs were registered significantly more often (p <0.0001). An absence of AEs in a patient significantly increases the chances that he will be adherent to the recommended drug treatment: OR = 5.2 CI 95% (1.2, 22.9), p = 0.028. Conclusion: The close interrelation of the aspects of drug therapy safety and treatment adherence, confirmed by the results of the study, determine the most promising directions (optimization of doctor-patient relations, increasing patient awareness, rational use of medicines, etc.) in breaking the" vicious circle "of the identified relationships. P167 Focus-group as a qualitative method for study of compliance in cardiovascular disease patients and their doctors O Semenova1, E Naumova1, Y Shvarts1 1Saratov State Medical University, Clinical Hospital n.a. S.R. Mirotvortsev of SSMU, Saratov, Russian Federation On Behalf of: Saratov State Medical University Funding Acknowledgements: Not applicable Topic: Cardiovascular Pharmacotherapy Introduction: Patient’s nonadherence to treatment is one of the most serious issues for modern medicine. WHO experts in the guideline thoroughly analyze the reasons for poor adherence to long-term therapy and outline a wide range of factors influencing adherence to long-term therapy. At that it is emphasized that none of those factors is decisive. One of the reasons of noncompliance can be patient-physician misunderstanding or patient’s lack of trust a patient in his/her physician. Purpose: To study the subjective opinion of patients and doctors about their individual experiences with adherence to treatment for chronic cardiovascular diseases in the group focused interview of patients and their physicians. Material and methods. 3 groups of patients from clinical studies adhering to the doctor's recommendations (focus-group 1) and 3 groups of patients hospitalized for cardiovascular events, not adhering to recommendations after discharge (focus-group 2) and one focus-group of doctors were analyzed. All patients who participated in this study were selected by their attending doctors. Group discussion was performed by a moderator (experienced sociologist, with no medical training who was not familiar with the patients and physicians). This study was based on assumption that noncompliance can be divided into intentional (or deliberate) and unintentional (unwitting) actions of patients. Results: 47 patients (25 (53.2 %) men and 22 (46.8%) women) and 6 doctors participated in the study.The groups were quite comparable. There were more patients with myocardial infarction in the past in focus-group 1 (p=0,00010). There are certain personal characteristics related to social skills of the patients in both groups. Feeling of well-being encourages the patients from the first group to follow recommendations of the physician whereas the patients from the second group discontinue therapy. Paternalistic model of communication with doctors present in the minds of all patients. In patients of the first group this results in a full confidence in the doctor and compliance with all recommendations while in patients of the second group lack of care in the outpatient clinic makes them "offended" by the underestimation of their trust and causes non-compliance. Physicians intuitively divide patients into less and more "attractive" for themselves. This "division" on the one hand may have some predictive value in respect of patients’ adherence to a further treatment, and on the other hand, the "doctors’ prejudice" in relation to the patient may adversely effect the behavior of the patients and failure to follow the recommendations in the future. Conclusion: The significant paternalism on the part of the patient on the one hand increases the responsibility of the physician for his patient, and on the other hand – increases opportunities for his influence on the patients’ behavior. P170 Evaluation of the knowledge of patients about the management of their treatment with vitamin k antagonist drugs: prospective study about 100 patients. M Mouadili1, CM Mbauchy1, SK Karimi1, DB Benzeroual1 1Marrakech University Hospital, cardiology, Marrakech, Morocco Topic: Cardiovascular Pharmacotherapy Introduction: vitamin K Antagonist (VKA), the most widely prescribed oral anticoagulant treatment, has a significant iatrogenic risk, often secondary to insufficient information from patients regarding the management of their treatment Methods: this was a descriptive cross-sectional survey conducted at our Medical Center. A questionnaire (19 items) was administered to patients who had recently been on VKA (for at least one week) on three short assessment visits at approximately one month interval between each. we evaluated their initial level of knowledge then we followed the evolution of their knowledge through three assessment sessions (during this period all patients received their care normally from their attending physician). Duration of the study was 29 months (recruitment and monitoring of patients) - from January 2015 to May 2017. Results: One hundred patients were included in the study (47 men/53 women). The average age was 38 ± 16 years old. Valvular diseases and venous thromboembolism justifying the institution of VKA treatment were found in 35% and 27% of cases, respectively. Thirty-nine percent of patients reported that they did not receive information about their treatment. The names of the VKA and the exact reason for the treatment were known in 25% and 30% of cases respectively at the first consultation. Thirty-six patients cited INR as a laboratory-based monitoring of treatment and only 28 patients were aware of the target values. The majority of patients were unaware of the risks of overdose (60%) and underdosing (52%). Nonsteroidal anti-inflammatory drug self-medication was reported by 26 patients. A positive evolution of knowledge at the end of the study was noted in only 58 patients, but with an average score not exceeding 09 (+/- 2) / 19 items. Conclusion: Patients' knowledge of VKA management was fragmentary and insufficient to ensure safe and effective treatment. At the end of this study we created a booklet of information and monitoring of patients under VKA in two languages (French and Arabic). P172 Adherence to the treatment of cardiovascular diseases: a study in district hospital of the small town and the cardiology department of the University clinic Y Bulaeva1, E Naumova1, O Semenova1 1Saratov State Medical University, Saratov, Russian Federation Topic: Cardiovascular Pharmacotherapy Purpose: was to study the relationship between different factors and adherence of long-term drug therapy to patients with cardiovascular diseases in Saratov regional hospital in a small town and patients of a clinical hospital in Saratov State Medical University and was to conduct a comparative analysis of results patients’ adherence in both hospitals. Method: 12 months-prospective study of patient adherence after discharge from hospital. The research included hospitalized patients. All patients provided informed consent in the study. Criteria for exclusion from the research were any serious diseases which could essentially affect life expectancy of a patient as well as one’s participation in this research. The survey was conducted after the stabilization of patients. Results: 108 patients in the district hospital and 70 in University clinic answered to all the questions of the questionnaire during hospitalization. In 12 months after discharge from the hospital 74(68,5%) patients from the district hospital and 40(57,1%) patients from University clinic were available to reach by telephone call and 28(38%) and 24(50%) of patients continued all prescribed therapy. Identified factors which associated with continuation of long-term treatment as after the 12 months among the patients of both groups. There are: old myocardial infarction (14(78%) patients of the University clinic and 6(60%) patients of the regional hospital, (p<0,01)), stroke in history (6(78%) and 4(75%), (p<0,05)), stable angina pectoris I-III class (22(61%) and 28(44%), (p<0,01)). Continued all prescribed therapy after discharge from the hospital was found in patient who believe that the doctor or relatives were responsible for their health (by 20(60%) patients of the region and 11(63%) in the regional center (p <0.005)). In a comparative analysis of the adherence to the treatment of these groups of patients statistically significant differences between receiving treatment in the small city and regional center, and the further continuation of treatment was not detected (p=0,15613). Conclusion: adherence to long-term treatment after discharge from cardiology hospital did not exceed 50% among patients of both groups. There is a reluctance of patients to take responsibility for the process of therapy and for their own health. P173 Which factors could be associated to iatrogenic adverse events related to vitamin K antagonist? Prospective survey of 150 patients M Mouadili1, C Mbauchy1, S Karimi1, D Benzeroual1, M Elle Hattaoui1 1Marrakech University Hospital, cardiology, Marrakech, Morocco Topic: Cardiovascular Pharmacotherapy Introduction:There is a major public healthcare problem related to the use of vitamin K antagonist( VKA). Because of their narrow therapeutic index, they expose to two major risks: thrombosis and hemorrhage. These risks put the VKA at the top rank of the list of iatrogenic risks. Methods: We have conducted a prospective survey over a 23 months period. All the patients admitted in our cardiology consultation, who were recently put on anticoagulation therapy using VKA, were included. A follow up during a period of one year +/- 3 months (3 to 4 follow up consultations) was done, to detect adverse iatrogenic events related to health care practices of medical doctors and pharmacists and/or to the behavior of patients regarding their treatment. Results:150 patients treated with VKA were included in the survey. 68 of them (45,33%) presented an iatrogenic hemorrhagic 38% (57 patients) or ischemic event 7,33% (11 patients ) during a follow up period of one year +/- 3 months. From amongst the 68 patients, 21 had a prescription of VKA that did not take into account their past medical history (p=0,0003). The prescription of an incorrect dose and/or administration frequency is more common in the group of patients that presented minimal hemorrhage (p<0,0001). The absence of intervention of the pharmacist regarding medical interactions, contra-indications and incorrect doses was observed in 72% of these patients with an iatrogenic incident (p<0,0001). Self-medication, the aleatory VKA use, the insufficient INR control, and the poor compliance to the treatment, rise the iatrogenic risk of vitamin K antagonists (p<0,0001). Discussion and Conclusion: The beneficial effects of VKA treatment rely on the compliance of the prescriptors to the recommendations of use and of the biological testing follow up, especially in the elderly, as well as an efficient intervention of pharmacists whilst delivering the medication, and the implication of the patient in the therapeutical management by a thorough education. P174 Predicting of clinical efficiency of bisoprolol in patients with acute coronary syndrome by polymorphism RS776746 in the gene of CYP3A5 assesment I A Leonova1, S Boldueva1, V Shumkov1, V Petrova1, K Zagorodnikova1 1North-Western Sate Medical University named I.I. Mechnikov, St-Petersburg, Russian Federation Topic: Cardiovascular Pharmacotherapy Introduction: Bisoprolol is a beta-blockers, which has a high selectivity to beta-1-adrenergic receptors of the heart. For the best therapeutic effect of any drug, it is important to reach the effective therapeutic dose as soon as possible. Bisoprolol is a lipo-hydrophilic beta-adrenoblocker and its metabolism occurs in the liver under the action of isoenzymes CYP3A4 and CYP3A5. According to the literature, it is known that CYP3A5 has a similar substrate specificity with CYP3A4, and is characterized by genetic polymorphism. The most common are allelic variants * 1 and * 3. Studies devoted to the study of their role in predicting the efficacy of bisoprolol have not been carried out to date. Purpose: Holter monitor, as a criterion of the clinical efficacy of bisoprolol in patients with acute coronary syndrome (ACS). Materials and methods: The study included patients with ACS who was assigned bisoprolol according to clinical indications. All patients included in the study were Holter monitor on the 10th day of ACS - the minimum, mean, maximum heart rate during the day and the maximum heart rate were assessed at the time of exercise was evaluated against the background of the current therapy. All patients included in the study also underwent molecular genetic testing. The detection of polymorphic variants of T (CYP3A5 * 1) and C (CYP3A5 * 3) at the locus rs776746 of the CYP3A5 gene was carried out by real-time PCR. Results: A total of 102 patients, 62 males and 40 females were included in the study. The average age of patients is 63.52±2.4 years. The allele frequency was: 0.073 for CYP3A5 * 1 and 0.926 for CYP3A5 * 3, which corresponds to its prevalence in the European population. The distribution of genotypes corresponded to the Hardy-Weinberg law. From the analysis excluded 5 patients with atrial fibrillation. By the time of the Holter monitor, both the carriers of the allele * 1 and patients with the genotype * 3 * 3 achieved the same mean heart rate (68 beats / min) and the maximum heart rate at the load (116 and 114 beats / min), which says about the equal effectiveness of beta-blockers at this time. However, to achieve this effect, patients of the two groups required different doses of bisoprolol. Thus, in carriers of at least one allele CYP3A5 * 1 (n = 13), associated with an increased metabolic rate, the dose of bisoprolol on the 10th day of ACS was significantly higher, and amounted to 5.62 mg, and in carriers of the variant CYP3A5 * 3 * 3 - 4.51 mg (p <0.05); when analyzing the dose in mg / kg, the differences were even more pronounced - 0,15 and 0,07, respectively (p <0,01). Conclusion: The results indicate that the carriers of the minor allele * 1 in the CYP3A5 gene need significantly higher doses of bisoprolol to achieve a clinical effect, which makes this genetic polymorphism a useful factor for choosing the optimal initial bisoprolol dosing regimen in patients with ACS. P175 In vivo, ex vivo and in vitro effect of melatonin treatment during antiretroviral therapy. I Webster1, J Van Teylingen1, Y Espach1, C Westcott1, JG Strijdom1 1University of Stellenbosch, Cape Town, South Africa On Behalf of: EndoAFrica Funding Acknowledgements: National Research Foundation, Department of Science and Technology, University of Stellenbosch Topic: Cardiovascular Pharmacotherapy Introduction: Although antiretroviral therapy (ART) has dramatically reduced HIV-associated morbidity and mortality, non-HIV-related comorbidities continue to rise in this population. Cardiovascular disease has been reported to be the leading cause of death in the HIV-positive population receiving ART. ART impairs vascular endothelial function through increased reactive oxygen and nitrogen species (ROS, RNS) production. This study aimed to assess the effects of melatonin - a potent antioxidant -supplementation during ART on rat Aortic Endothelial Cells (AECs), aortas and hearts. Methods: Cells were treated with melatonin and/or ART for 24 hours. Nitric oxide (NO), RNS and necrosis were measured. The effects of melatonin and ART treatment on vascular reactivity was measured by aortic ring isometric tension studies, and heart function and recovery after global ischaemia and infarct size after regional ischaemia, in organs isolated from control male Wistar rats treated for 8 weeks. Signalling proteins were measured by western blot analyses. Results: In AECs ART lead to increased NO, RNS and necrosis compared to controls (p< 0.05). 1nM melatonin decreased necrosis from control (p<0.05). When combined, 1nM melatonin + ART decreased necrosis compared to ART (p<0.05). Western blot analyses showed that ART increased nitrotyrosine levels, but decreased p22 PHOX and cleaved caspase-3 expression (p<0.05). In aortas from treated rats, all groups showed a pro-contractile response compared to control. Western blots showed that ART decreased cleaved caspase-3 expression (p<0.05). No differences were seen in infarct size or function in isolated hearts. Conclusion: Decreased necrosis shows the protective effect of melatonin. Further investigations are needed to elucidate this mechanism. ART induced anti-apoptotic effects and increased RNS production, but not NADPH-oxidase activity. ART treatment does not affect vasorelxation. P176 Adverse events of pharmacotherapy according to an outpatient register, sources of information and data collection difficulties NA Dmitrieva1, YV Lukina1, NP Kutishenko1, SY Martsevich1 1National Research Center for Preventive Medicine, Moscow, Russian Federation Topic: Cardiovascular Pharmacotherapy Background: For analyzing a safety of pharmacotherapy in observational studies and patients registries, it is important to collect full information on adverse events to treatment. Purpose: is to compare the possibilities of collecting information on adverse events (AE) according to the data of a patient survey and on the registration cards of the outpatient register PROFILE. Materials and methods. The register PROFILE is the outpatient register of the specialized cardiological unit of the research center. Data of 1531 patients were collected for the period from January 2011 to August 2015. The information about AEs was collected from two sources. The first of them was a registration card, which was filling by physician. The card includes information about the drugs taken by patients, doses of drugs, and the regularity of taking and availability of AE. The second data source was a patient questionnaire, including questions on the assessment of tolerability of drugs, determined by the patients themselves. The survey involved 487 patients included in the outpatient registry. Results: According to the data of cards, total 301 adverse drug reactions (ADR) were registered in 223 patients. According to the survey data there were 139 ADR in 115 patients. Various allergic reactions and symptoms of gastrointestinal disorders were leaders in the structure of AEs both in register cards and the survey data. Only 46 patients had the same data in both sources of information. When analyzing the data on NLR statins in patients who filled in the original questionnaire, doctors reported 13 such cases of NLR, patients noted the occurrence of 14 NLR, but the coincidence of the data was consistent with both registration cards and questionnaires for only 3 patients. Conclusion: the results of the study demonstrate a similar structure of AEs in pharmacotherapy according to the doctors (register card) and patients (questionnaires), however, a significantly smaller number of AEs are observed according to the results of the survey. P177 Factors associated with non-adherence during therapy with nicorandil in patients with stable angina pectoris YV Lukina1, NA Dmitrieva1, NP Kutishenko1, VP Voronina1, OV Lerman1, SY Martsevich1 1National Research Center for Preventive Medicine, Department of preventive pharmacotherapy, Moscow, Russian Federation Topic: Cardiovascular Pharmacotherapy Purpose: To study a treatment adherence and factors associated with non-adherence in patients with stable angina pectoris (SA) at the beginning of treatment and during long-term administration of nicorandil. Material and methods. The study design is a prospective, observational and multicenter. Totally, 590 patients with SA were included: 261 (44,2%) females, 329 (55,8%) males. All patients, in addition to the standard antianginal treatment, were prescribed nicorandil 20 mg per day. For assessing levels of potential and actual adherence and factors, affecting them, the original questionnaire was applied. After 1 and 3 months of follow-up, the data of 552 patients were collected. All these patients were divided into 3 groups, according to their adherence to nicorandil use during 3 months of observation (1)immediately refused to take the drug (n=150, non-adherent); (2)started, but then stopped taking nicorandil within this period (n=75, partially non-adherent); (3)taking nicorandil for all 3 months (n=327; adherent). Results: Potentially adherents (have an intention to take nicorandil) were 582 out of 590 (98.6%) patients. Actually adherents (taking the drug) were only 327 of 552 patients (59.2%). The main reason for immediately refusing nicorandil was polypharmacy (36% of all the reasons given). Discontinuation of nicorandil therapy within the first month of follow-up was more often due to adverse events (50% of all causes). Main reasons for termination of long-term therapy were polypharmacy (25% of all reasons) and lack of nicorandil effect (27%). Conclusion: Factors related to the treatment adherence at the beginning of therapy and during long-term administration of nicorandil in patients with SA are different. The leading cause of non-adherence at the start of therapy is polypharmacy; in later stages of treatment, the leading causes of cessation of nicorandil therapy are side effects and lack of efficacy. P179 Typical diagnostic mistakes in the ECG of athletes caused by the aberrant right bundle branch conduction V Pavlov1, ZG Odzhonikidze1, VA Badtieva1, YM Ivanova1, AS Rezepov2, AV Pachina1, VV Deev1, GS Isaeva3, MV Gvinianidze1, OS Volkova4, DN Koledova4 1Moscow scientific and practical center medical reabilitation and sport medicine - Sportmed Clinic, Moscow, Russian Federation 2Professional soccer club "Arsenal", Tula, Russian Federation 3Al-Farabi Kazakh National Medical University, Almaty, Kazakhstan 4Profi-Clinic, Vladivostok, Russian Federation Topic: Cardiovascular Disease in Special Populations - Other Taking into account the eccentric nature of myocardial hypertrophy, with an emphasis on remodeling and volume overload of the right heart, athletes in endurance sports have aberrant right bundle branch conduction. Purpose: To identify the percentage of false-positive ECG diagnoses in athletes associated with aberrant conduction in the right bundle branch. Materials and methods. An expert assessment was made of 189 ECG-conclusions of athletes who suggested the presence of pathology - 96 ECG diagnosed with "complete blockade of right bundle branch"; 10 ECG with a diagnosis of "WPW-phenomenon"; 15 ECG diagnosed with signs of myocardial ischemia; 68 ECG with a diagnosis of ventricular premature beats. Results: In case the aberrant right bundle branch conduction on the ECG is usually found the large QRS-complex and the signs of incomplete blockade are detected. This phenomenon has practical significance, as it is the cause of diagnostic mistakes. Mistakes evaluation of the incomplete right bundle branch block bundle as complete block. Of the 96 ECG diagnoses with "complete right bundle branch block," only 4 were correct in cases (≈96% error). The reason for this was that the rSR pattern and the large QRS-complex in the right chest leads ≥0,12 s (the complete block criterion is the width of QRS for an athlete ≥0, 14 s). Simulation of the ∆-wave by a modified aberrant complex, which, in combination with a short PQ interval (for example, during AV dissociation), can simulate a picture of a WPW phenomenon. Of the 10 ECG with WPW-phenomenon, in 3 cases the diagnosis was false positive (30% of errors). Secondary ECG-repolarization changes (negative T wave, etc.), especially in combination with the so-called juvenile ECG changes (negative T waves in V1-V3 in children and adolescents), are able to simulate a more serious disorders, such as ischemic changes. In the analysis of 15 ECGs with suspected ischemia, in 9 cases, the cause was secondary changes in repolarization in the right thoracic leads, associated with right bundle branch conduction, including the load test (60% errors). Assessment of aberrant supraventricular extrasystoles (wide QRS complex), as ventricular. So, 68 athletes with a diagnosis of premature ventricular complex, in 46 of them, with careful analysis, had more reason to consider them aberrantly conducted premature supraventricular complex (68% of errors). Conclusion: 1. When analyzing an athlete's ECG, it is necessary to take a very careful approach to the phenomenon of aberrant right for removal from sports, and related changes, since they can imitate more serious conditions. 2. In connection with the fact that the ECG diagnosis of "incomplete right bundle branch block" usually raises doubts among sports physicians regarding the organic pathology of the athlete's heart, and may be a reason for removal from sports, it is preferable to consider the formulation «slow right bundle branch conduction» Abstract Number: P179 Secondary ECG changes in the right block P180 6 month life-style intervention program in breast cancer patients during and after chemotherapy S Gebhard1, M Haykowsky2, K Esefeld1, B Spanier1, M Martignoni3, M Halle1 1Technical University of Munich, Prevention and Sports Medicine, Munich, Germany 2College of Nursing and Health Innovation, Arlington, United States of America 3Hospital Rechts der Isar, Surgery, Munich, Germany Funding Acknowledgements: None Topic: Cardiovascular Disease in Special Populations - Other Background: Exercise and nutritional counseling during rehabilitation of breast cancer patients has shown to have beneficial effects on quality of life by improving fatigue symptoms and exercise capacity. However, exercise interventions during the acute phase of radiation and chemotherapy are scarce. Methods: Between 2011 and 2016, 231 patients diagnosed with breast cancer participated in a life-style intervention program of nutritional counseling and supervised exercise training for six months. A subset of 84 patients (age 49±9 y; curative therapy approach n=77, metastasis n=7, radiation therapy at baseline n=52; Karnofsky Performance Scale (KPS) 90±5) met inclusion and exclusion criteria. Parameters of cardiopulmonary exercise testing (CPET) were compared between patients 1.) without chemotherapy, 2.) during and 3.) after chemotherapy at baseline as well as 3 and 6 months of intervention. Results: Overall maximal exercise capacity (VO2peak) increased significantly from baseline (24.5±6.2 ml/kg/min) to 6 months (26.1±6.4 ml/kg/min; p<0.01) as was observed for maximal work load during ergometry (baseline: 122±31 Watts; 6 mo: 13±30 Watts; p<0.01). These improvements were not significantly different between groups. Patients with metastatic disease started with lower VO2peak, but improved to a similar extent as non-metastatic patients. Conclusion: Our data reveal that exercise training improves fitness parameters in breast cancer patients independent of stage of therapy, i.e. during chemotherapy, after chemotherapy, without chemotherapy. Also patients with metastatic disease reveal similar improvements. P182 Microvascular coronary function in athletes with abnormal exercise test results DAJP Van De Sande1, PC Barneveld2, J Hoogsteen1, PA Doevendans3, HMC Kemps1 1Máxima Medical Center, Cardiology, Veldhoven, Netherlands (The) 2Jeroen Bosch Hospital, Nuclear Medicine, 's-Hertogenbosch, Netherlands (The) 3University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The) Topic: Cardiovascular Disease in Special Populations - Other Background: In asymptomatic athletes, abnormal exercise test (ET) results have a poor positive predictive value. It is unknown whether abnormal ET results in absence of obstructive coronary artery disease (CAD) in these subjects are related to microvascular dysfunction (MVD), whether they should be considered false positive ET results or as a consequence of physiological adaptation to sport. Purposes: To evaluate if athletes with abnormal ET results and documented myocardial ischemia in the absence of obstructive CAD have an attenuated microvascular function and whether MVD is related to endothelial dysfunction. Methods: Athletes with concordant abnormal ET and myocardial perfusion scintigraphy (MPS) results without obstructive CAD were compared with age- and gender-matched individuals with a low-to-intermediate a priori risk of CAD. Coronary flow reserve (CFR) was assessed by 82-Rubidium Positron Emission Tomography (PET)-imaging. Endothelin-1 (ET-1) concentrations were measured to evaluate endothelial function. Results: CFR was significantly lower in athletes (3.3 ± 0.8 versus 4.2 ± 0.6, p = 0.014 respectively). ET-1 levels were significantly higher in athletes (1.3 ± 0.2 pg/mL versus 1.0 ± 0.2 pg/mL, p = 0.012 respectively). There was no correlation between ET-1 concentrations and mean global CFR (R = 0.12). Conclusion: Athletes with abnormal ET and MPS outcomes indicative for myocardial ischemia and without obstructive CAD have a lower coronary flow reserve (CFR) when compared with non-athletes with low-to-intermediate a priori risk of CAD, suggesting an attenuated microvascular function. Higher ET-1 concentrations in athletes suggest that endothelial-dependent dysfunction is an important determinant of the attenuated microvascular function. P186 Effect of three months exercise training on heart rate recovery in patients with rheumatoid arthritis: a longitudinal study A Osailan1, J Veldhuijzen Van Zanten2, J Duda2, S Fenton2, P Rouse3, N Ntoumanis4, G Kittas5, G Metsios6 1Prince Sattam Bin Abdulaziz University, Rehabilitation sciences- physical therapy department , Alkharj, Saudi Arabia 2University of Birmingham, School of Sports Exercise and Rehabilitation Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland 3University of Bath, Department for Health, Bath, United Kingdom of Great Britain & Northern Ireland 4Curtin University, School of Psychology and speech pathology, Curtin, Australia 5Dudley Group of Hospitals NHS Trust, Department of Rheumatology, Dudley, United Kingdom of Great Britain & Northern Ireland 6University of Wolverhampton, Department of Physical Activity Exercise and Health, Wolverhampton, United Kingdom of Great Britain & Northern Ireland On Behalf of: PARA study Funding Acknowledgements: Medical Research council UK Topic: Cardiovascular Disease in Special Populations - Other Introduction: Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Poor parasympathetic function has been suggested as a factor contributing to the increased risk of CVD in RA. Heart rate recovery (HRR) following maximal exercise testing is a non-invasive assessment for parasympathetic function. Exercise has been shown to reduce the overall risk for CVD in RA, but the effects on HRR are unknown. Therefore, this study aimed to investigate the effect of 3-month exercise programme on HRR in patients with RA. Methods: 97 RA patients enrolled in a 3-month exercise programme consisting of two semi-supervised sessions and one session at home. Out of 97, 62 RA patients (55.5 ± 12.7 years, 67.7% women) completed baseline and post intervention assessments including exercise tolerance test (ETT). At baseline and post intervention, heart rate recovery (HRR) was measured: HRR1 and HHR2 were defined as the absolute change from heart rate (HR) peak during ETT to HR 1 minute post HR peak and 2 minutes post HR peak, respectively. Cardiorespiratory fitness (VO2 peak), individual CVD risk factors, 10 years CVD risk, serological markers of inflammation, and measures of wellbeing were measured at baseline and post intervention. Results: ANOVA revealed no significant changes in HRR1 (p=.31), HRR2 (p=.67), and VO2 peak (p=.17) after the 3-month exercise training programme. There were significant improvements in systolic blood pressure (p=.01), diastolic blood pressure (p=.001), Qrisk2 (p=.04) and vitality (p=.02) post intervention. Additional analyses revealed that patients who improved HRR at both time point post intervention were the ones with poorer HRR as well as CVD risk profile at baseline. Conclusion: Three semi-supervised exercise training sessions per week for three months was not sufficient to improve parasympathetic function and cardiorespiratory fitness in patients with RA, however, there were improvement in blood pressure, Qrisk2, and vitality post the intervention. P187 Association between cardiovascular and cerebral manifestations in patients with systemic lupus erythematosus M Gegenava1, HJL Beaart1, GM Steup-Beekman1, LJJ Beaart-Van De Voorde1, TWJ Huizinga1 1Leiden University Medical Center, Rheumatology, Leiden, Netherlands (The) Topic: Cardiovascular Disease in Special Populations - Other Background: In patients with systemic lupus erythematosus (SLE), previous studies have demonstrated that valvular heart disease (VHD) is associated with cerebral infarcts on magnetic resonance imaging (MRI) and this association is more significant in neuropsychiatric SLE patients (NPSLE). Purpose: The objective of our study was to determine if cardiovascular manifestations and especially VHD in patients with SLE is associated with additional brain injury such as white matter lesions on MRI in patients with and without cerebral symptoms. Methods: All clinical data were collected retrospectively from the patients files. We selected all patients who were referred to the NPSLE evaluation clinic. Next we selected the group who underwent echocardiography and MRI examination. This resulted a total 45 patients and among them 21 patients had confirmed diagnosis of NPSLE. Results: In SLE patients it revealed association between aortic valve insufficiency (AoI) and cerebral infarction (p<0.048) as well as with white matter lesions (p=0.014) according to MRI findings. Valvular heart disease in SLE patients was associated with anti-phospholipid antibodies In NPSL group there was no association between aortic valve insufficiency and white matter lesion (p=0.228), but in NPSLE patients cerebral infarct was significantly associated with aortic valve insufficiency (p<0.028). In NPSLE group of the patients valvular heart disease was also associated with elevated level of anti-phospholipid antibodies. In NPSLE group valvular heart disease was associated with elevated level of lupus anticoagulants (LAC). Conclusions: This study shows a clear associations with cerebral (old) infarct and valvular heart disease in SLE and in patients with neuropsychiatric events, also white matter lesions was associated with aortic valve insufficiency in SLE patients. In addition our results show association between valvular heart disease and anti-phospholipid antibodies in our study group. Coexistence of cardiovascular and brain manifestations in SLE and NPSLE patients makes possible to take into the consideration, that these organ damage are sharing common pathophysiologic mechanism in SLE and NPSLE patients, which leads to future complications. Abstract Number: P187 Figure #1 P188 Difficulty with activities of daily living predicts cardiovascular events in patients undergoing maintenance haemodialysis T Watanabe1, T Kutsuna2, M Harada1, Y Suzuki3, S Yamamoto3, Y Matsunaga4, Y Isobe3, K Imamura3, R Matsuzawa5, K Kamiya1, A Yoshida6, A Matsunaga1 1Kitasato University Graduate School of Medical Sciences, Rehabilitation Sciences, Sagamihara, Japan 2Tokyo University of Technology, School of Health Sciences, Ota, Japan 3Kitasato University Graduate School of Medical Sciences, Department of Functional Restoration Science, Sagamihara, Japan 4Kitasato University Graduate School of Medical Sciences, Department of Sleep Medicine, Sagamihara, Japan 5Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan 6Sagami Circulatory Organ Clinic, Hemodialysis Center, Sagamihara, Japan Funding Acknowledgements: This research was supported by JSPS KAKENHI Grant Numbers 23500614 and 26350631. Topic: Cardiovascular Disease in Special Populations - Other Background/introduction Impaired activities of daily living (ADLs) have been shown to cause reduced physical activity and can predict the occurrence of cardiovascular events in older community-dwelling adults. Recently, in addition to the life expectancy, the percentage of elderly Japanese patients undergoing maintenance haemodialysis (HD) has increased. Although >50% of patients undergoing HD retain the ability to perform ADLs without assistance, most patients undergoing HD report difficulties with performing ADLs related to mobility. To our knowledge, no study has investigated the association between difficulties with ADLs and cardiovascular events in patients undergoing HD. Purpose: This study investigated the association between difficulties with ADLs and cardiovascular events in patients undergoing HD. Methods: This study included 300 outpatients (178 men, 122 women, mean age 64.1±10.9 years) undergoing maintenance HD thrice a week at an HD centre. Exclusion criteria for the study were hospitalisation ≤3 months prior to study enrolment, and the need for assistance with walking. Baseline clinical characteristics including age, sex, body mass index, the Geriatric Nutritional Risk Index, the primary cause of end-stage renal disease, time of initiation of HD, comorbidities, and haemoglobin and serum albumin levels were recorded. Difficulties with ADLs were assessed using a questionnaire describing perceived difficulty with mobility among patients undergoing HD . Patients were instructed to rate the perceived difficulty in performing 12 tasks related to mobility on a scale of 1–5 (1=not possible, 2=severe difficulty, 3=moderate difficulty, 4=mild difficulty, and 5=ease with performing task). Patients were classified into 3 groups based on tertiles of the ADL difficulty score (low, middle, and high difficulty groups). The log-rank test, Kaplan–Meier analysis, and Cox proportional hazards regression analysis were used to investigate the association between difficulties with ADLs and cardiovascular events. Results: During the follow-up period (median duration 52 months), 54 patients (18.0%) demonstrated cardiovascular events. Of these 54 patients, 12 (22.2%), 19 (35.2%), and 23 (42.6%) patients were from the low, middle, and high difficulty groups, respectively. Kaplan–Meier analysis followed by the log-rank test showed that the incidence of cardiovascular events in the high difficulty group was significantly higher than that in the low difficulty group (P <0.01). After adjusting for the effects of clinical characteristics, the hazard ratio for the incidence of cardiovascular events in the high difficulty group was 2.28 (95% confidence interval 1.08–4.82, P=0.03) compared with the low difficulty group. Conclusions: Difficulties with ADLs were significantly associated with cardiovascular events in clinically stable patients undergoing HD. Abstract Number: P188 Kaplan–Meier analysis P189 Subclinical vascular damage in naive treatment digestive cancer patients E C Buzdugan1, A Grosu1, D Crisan1, L Avram1, D Radulescu1 1University of Medicine and Pharmacy, Cluj Napoca, Romania Funding Acknowledgements: - Topic: Cardiovascular Disease in Special Populations - Other Background: Different cytostatic drugs used in cancer therapy may produce cardiac damage. Protection against this side-effect and predictability of cardiac vulnerability due to chemotherapy are today major concerns. Recent data has drawn attention on possible cardiac dysfunction in cancer patients before starting chemotherapy. Elevated values of cardiac biomarkers or left ventricular (LV) dysfunction, as indicators of myocardial damage, were found in patients with different malignancies, including digestive. Increased arterial stiffness represents an early, subclinical damage of the arterial system, with impact on cardiovascular mobidity and mortality. We hypothesed that in patients with newly diagnosed digestive cancer, before starting any cancer related therapy, both cardiac and vascular alteration may already be present. Methods: During 12 month period all patients newly diagnosed with digestive cancer in Gastroenterology Department of our hospital, and without any personal history of cardiovascular disease, underwent transthoracic 2D echocardiography for LV function assessment. We also determined vascular age, assessed through arterial stiffness, using digital photopletismography and according to Framingham score also. All patients were assessed for infraclinical myocardial damage using high-sensitive-Troponin T (hs-TnT), creatin phosphokinase-MB (CK-MB), and N-terminal-proB-type natriuretic peptid (NT-proBNP). Results: Sixty one patients were included in the study. The median age was 54 (CI: 49.00-65.00) years, 41 (68.3%) males. The sistolic cardiac function of the enroled patients was normal: LV ejection fraction (LVEF)=60.50 (58.03-64.96)%. The parameters of diastolic function were also normal: E=69.00 (63.60-74.78), A=67.00 (56.82-74.39), E/A=1.1(0.98-1.36), IVRT=84.00 (75.66-92.33) ms. Vascular age assessed through arterial stiffness was significantly higher in comparison with real age (62.00 (47.58-69.00) vs. 54.00 (49.00-65.00), p=0.03), at a stiffness index (SI) median value of 10.41(8.79-11.19)m/s. Vascular age assessed using Framingham score was also significantly increased compared to real age (60.50 (55.48-67.25) vs 54.00 (49.00-65.00), p=0.002). The myocardial dammage assessed biochemicaly proved to be absent, as shown by hs-TnT (6.27 (4.63-7.20) pg/l, MB-CK (17.00 (15.00-18.00)) UI/l and NT-proBNP (85.02 (66.48-141.11))pg/mL levels. Conclusions: In patients newly diagnosed with digestive cancer, without any personal history of cardiovascular disease, we did not find any imagistic or biochemical proof of cardiac dysfunction. On contrary, vascular age assessed through arterial stiffness exceeded not only real age, but Framingham vascular age also. This finding might suggests a subclinical vascular damage in naive treatment digestive cancer patients due to, at least partially, tumoral effect on arterial wall. P190 Level of physical activity performed by patients with pulmonary hypertension group I and IV M P Sanz Ayan1, L Gonzalez Saiz2, C Fiuza Luces2, M Lopez Saez1, B Rojo Lopez1, S Garcia De Las Penas1, A Flox Camacho1, A Juano Bielsa1, J Cuesta Gascon1, V Toribio Rubio1, EM Petriman3, JI Castillo Martin1, P Escribano Subias1, A Lucia2 1University Hospital 12 de Octubre, Madrid, Spain 2University Hospital 12 de Octubre, RESEARCH OF INSTITUTE HOSPITAL 12 DE OCTUBRE, Madrid, Spain 3University Hospital Gregorio Maranon, Madrid, Spain Topic: Cardiovascular Disease in Special Populations - Other Introduction: Recently, measuring physical activity (PA) has become particularly important in different pathologies to assess the significance of this activity in the evolution and prognosis of syndromes and diseases. Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg, measured by a right cardiac catheterization performed under resting conditions. PH affects both pulmonary and cardiac vascular system. It means an increase in pulmonary vascular resistance (PVR) due to the remodeling of the small pulmonary arteries which cause increased pulmonary arterial pressure, right ventricle insufficiency and premature death. Objective Evaluating PA levels in PH patients living in the area of Madrid, by means of an accelerometry. Analysing whether these patients obey the recommendations of PA stablished by the WHO. Evaluating whether PA levels performed by these patients condition the prognosis of this disease. Material and method: The study protocol was approved by the ethical committee (14/347) and followed the principles of the Helsinki Declaration. All participants gave their written consent. The data of this research was obtained from 2 groups: 75 patients with PH and 107 patients without PH. PA levels were measured through the use of an Actigraph Triaxial Accelerometer GT3X (Actigraph, Pensacola, FL, USA). The patients used the accelerometer for 5-10 consecutive days. The acceleration data and the percentage of people who complied with the international recommendations was compared. Fishers test was used, and Student’s t-test was applied for unpaired data. Atypical accelerometry values were eliminated using box plots and bar charts. Results: With the exception of vigorous PA (with very low values in both groups), all accelerometry data showed significant differences between patients and controls. Lower PA levels and fewer individuals meeting minimum requirements of PA guidelines, but higher inactivity time, in the former. Notably, the odds ratio (OR) of having a "low-risk" value of 6-minute walking distance (≥464 m) or ventilatory equivalent for carbon dioxide (≤39) was higher in patients following moderate-vigorous PA (MVPA) guidelines than in their less active peers [OR =4.3, 95% confidence interval (CI), 1.6–11.6, P=0.005, and OR =4.5, 95% CI, 0.9–21.1, P=0.054]. Discussion and Conclusions:Accelerometry was demonstrated as a simple and practical tool to quantify and to know the levels and patterns of PA in subjects with PH. The levels of PA daily performed by a representative sample of Spanish patients with PH were too low, not accomplishing the minimum recommendations stablished by the WHO (MVPA≥150 min / week). The pattern of physical inactivity shown by this population can contribute to further compromise their already poor physical exercise capacity and even affecting their survival. Abstract Number: P190 Actigraph Triaxial Accelerometer GT3X P191 Outcomes of pregnancy in women with congenital heart disease PM Araujo1, S Nunes2, V Ribeiro1, C Cruz1, AP Machado3, MJ Maciel1 1Sao Joao Hospital, Cardiology, Porto, Portugal 2Hospital Center of Tras-os-Montes and Alto Douro, Obstetrics/Gynecology, Vila Real, Portugal 3Sao Joao Hospital, Obstetrics/Gynecology, Porto, Portugal Topic: Cardiovascular Disease in Special Populations - Other Introduction: The population of women with Congenital Heart Disease (CHD) arriving at childbearing age is increasing. Cardiologists will increasingly manage these patients (pts), whom poses some challenges. The incidence of maternal complications and the neonatal outcomes are highly variable. Purpose: Evaluate the obstetric and cardiac outcomes of pregnancy on women with CHD and neonatal incidence of cardiac defects. Methods: Retrospective evaluation of pregnant women with CHD, being followed-up in a CHD tertiary care center, who gave birth between December 2014 and June 2017. Only women that were continuously evaluated during and after pregnancy were included in the analysis. All pts were submitted to fetal echocardiogram (FEC). Results: A total of 28 patients (pts) were included in the analysis, with a mean age of 29.6±5 years. The CHD were: Atrial Septal Defect (n=3; 10.7%), Ventricular Septal Defect (n=2; 7.1%), Coarctation of the Aorta (n=4; 14.3%), Valvular diseases (n=3; 10.7%), Tetralogy of Fallot (n=6; 21.4%), Transposition of the Great Arteries (n=7; 25%) and other mixed defects (n=3; 10.7%). Maternal cardiovascular risk groups (modified WHO classification) were: 10.7% - class I (n=3); 53.6% - class II (n=15); 35.7% - class III (n=10). Obstetric complications occurred in 8 pts (28.6%). There were 2 cases of pregnancy induced hypertension (7.1%) and 1 of preeclampsia (3.6%). There were no contraindications to vaginal delivery because of the congenital heart disease. However, caesarean sections were performed in 28.6% of the cases (n=8). At birth, mean gestational age was 38±2 weeks and mean weight was 2723±484 grams. FEC revealed cardiac defects in 3 neonates (10.7%). During pregnancy and peripartum, only 1 pt (3.6%) had cardiac complications (supraventricular tachycardia and acute heart failure). Postpartum period was well tolerated in all pts and at 6 months post-discharge follow-up, there were no cases of cardiac complications or onset of symptoms. Conclusion: In this population, pregnancy and postpartum were well tolerated in the majority of pts, without cardiac deterioration. However, the rate of obstetric complications and the incidence of cardiac defects in neonates were not negligible. This emphasizes the importance of follow-up of this women in a tertiary center with a multidisciplinary team care. P193 O2 pulse patterns in male master athletes with normal and abnormal exercise tests DAJP Van De Sande1, T Schoots1, J Hoogsteen1, PA Doevendans2, HMC Kemps1 1Máxima Medical Center, Cardiology, Veldhoven, Netherlands (The) 2University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The) Topic: Cardiovascular Disease in Special Populations - Other Background: The clinical relevance of abnormal exercise testing (ET) results (at least 0.1 mV ST-segment depression measured during exercise or recovery in three consecutive beats) in athletes without obstructive coronary artery disease (CAD) is not well understood. It is unknown whether this phenomenon reflects a physiological adaptation to sport or a truly ischemic response and a concomitant attenuated stroke volume (SV) response. Purpose: The aim of this study was to investigate if athletes with abnormal ET results without obstructive CAD showed signs of an attenuated SV response using cardiopulmonary exercise testing (CPET) parameters. Methods: 78 male master athletes with abnormal ET results without obstructive CAD underwent CPET. ∆O2 pulse/∆Work rate (WR), ∆VO2/∆WR and ∆Heart rate (HR)/∆WR were assessed and compared with data from 78 male master athletes with normal ET results, matched for age, sports characteristics and exercise capacity. Results: The ∆O2 pulse/∆WR ratio beyond AT in athletes with abnormal ET results was lower than in athletes with normal ET results (0.73 ± 0.41 versus 1.12 ± 0.54 respectively, p<0.001). The ∆VO2/∆WR ratio was also lower in athletes with abnormal ET results (0.9 ± 0.2 versus 1.0 ± 0.3, p = 0.041 respectively). Furthermore, these athletes showed a greater increase in heart rate in the last 2 minutes of exercise (∆HR/∆WR ratio: 1.19 ± 0.5 versus 0.80 ± 0.6, p<0.001). Conclusion: Athletes with abnormal ET results without obstructive CAD showed an attenuated O2 pulse slope, decreased ∆VO2/∆WR ratio and increased ∆HR/∆WR ratio beyond AT when compared with athletes with a normal ET result. These results support the hypothesis that at least a part of the athletes with an abnormal ET in absence of obstructive CAD have an attenuated stroke volume response at high-intensity exercise. P194 Changes in carotid intima-media thickness and epicardial fat after replacement and cytoprotective therapy in patients with non-alcoholic fatty liver disease and subclinical hypothyroidism O V Kolesnikova1, A Radchenko1 1L.T.Malaya Institute of Therapy, Cardiology, Kharkiv, Ukraine Topic: Cardiovascular Disease in Special Populations - Other Introduction: The contribution of subclinical hypothyroidism (SH) in patients with non-alcoholic fatty liver disease (NAFLD) to the development of cardiometabolic changes and methods of drug therapy remain the subject of discussion. Objective: To assess the relationship between NAFLD, SH and early development of atherosclerosis and their potential changes during replacement (levothyroxine) and cytoprotective (arginine and betaine) therapy. Methods: A prospective cohort study including 178 patients with NAFLD and SH and 106 euthyroid patients with NAFLD as controls was conducted from 2016 to 2018. Clinical, anthropometrical, biochemical, and ultrasonographic parameters were assessed at baseline and after one year of therapy. Results: At baseline, patients with NAFLD and SH had significantly greater values of total cholesterol (p=0.015), VLDL cholesterol (p=0.0038), epicardial fat (p=0.0018) and carotid intima-media thickness (p=0.026) as compared patients with NAFLD. Total cholesterol, VLDL cholesterol, epicardial fat, carotid intima-media thickness showed a significant (p=0.001) and positive correlation with TSH levels. After one year of therapy, patients with NAFLD and SH showed changes in total cholesterol (p=0.014), VLDL cholesterol (p=0.028), TSH (p=0.0052), carotid intima-media thickness (p=0.018). Conclusions: The presence of subclinical hypothyroidism in patients with NAFLD is characterized by an increased risk of cardiovascular diseases. In these patients, replacement and cytoprotective therapy for one year is associated with a decrease in dyslipidemia and an improvement in markers of subclinical atherosclerosis. P195 The role of echocardiography (EchoCG) in the diagnosis of congenital asymptomatic heart disease in young athletes V Pavlov1, AS Sharykin1, YM Ivanova1, VA Badtieva1, AV Pachina1, DN Koledova1 1Moscow scientific and practical center medical reabilitation and sport medicine - Sportmed Clinic, Moscow, Russian Federation Topic: Cardiovascular Disease in Special Populations - Other Purpose: Assess the role of echocardiography (EchoCG) in the diagnosis of structural congenital heart disease in young athletes. Material and methods. Of the 3,000 young athletes aged 15.6–1.8 that were examined before the shading, 440 (14.7%) had a retrospective assessment of echocardiograms performed in connection with the suspected heart defect. In this group, 11 kinds of sports were represented - from team play to individual strength. The duration of the training was 6.4 ± 2.5 years on average. 44% were engaged in game types, 33.5% - in martial arts, 10.3% - in water disciplines, 5.5% - in rhythmic gymnastics, 4.2% - power types, 2.5% - in other sports. We compared the frequency of heart disease, resulting from EchoCG, with the frequency according to clinical data ECG. Results: Congenital abnormalities of the heart structure were diagnosed in 238 (according to EchoCG in 54.1% and according to clinical data in 7.9%, p = 0.0000) cases. Minor pathology with localization in the right parts of the heart (atrial septum aneurysm, Hiari network, moderate pulmonary stenosis, significant tricuspid insufficiency) Was detected in 44 (10.0% and 1.6%, respectively, p = 0.0000), malformations with bleeding from left to right (atrial ventricular septal defect, ventricular septal defect, open arterial duct) - in 71 (16.1 and 2.3%, p = 0.0000), aortic valve dysfunction and aortic root dilatation - in 120 ( 27.3 and 3.8%, p = 0.0000), mitral valve prolapse in 3 (0.7 and 0.2%, p = 0.2682) people. Heart murmur was absent in 160 (67.2%) children with a diagnosis of congenital heart disease, confirmed by EchoCG. In 114 (47.8%) of 238 athletes, the existing pathology in combination with sports loads led to dilatation of the chambers of the heart or aortic root, exceeding the 99-th percentile for a given body surface area or myocardial hypertrophy, due to which they had limited and training intensity. In 3 patients, surgical intervention was performed - two catheter embolization of the open arterial duct and one occluderous closure of the atrial septal defect. Conclusion: Congenital heart disease in asymptomatic young athletes may be present in a significant percentage of cases. The use of EchoCG allows to increase the detectability of congenital heart defects by 7 times, in comparison with physical examination in combination with an ECG. Even with moderately pronounced malformations, there may be consequences in the form of significant dilatation of the chambers of the heart and aorta, as well as myocardial hypertrophy, which can potentially lead to disability or sudden death. At the same time, the fact itself of the presence of congenital heart defects is not a contraindication to sports, it is necessary to assess the hemodynamic disturbances and structural changes associated with this defect. P198 Rising coronary artery disease in premenopausal women myth vs reality. S Bansal1, S R Mahapatra1 1Safdarjung Hospital, New Delhi, India Funding Acknowledgements: INDIAN GOVERNMENT FUNDS THE ANGIOGRAPHY IN OUR HOSPITAL Topic: Cardiovascular Disease in Special Populations - Other INTRODUCTION It has been long believed that CAD is primarily a "man’s disease". This notion however, appears to be slowly eroding. Centre for Disease Control (CDC) reveals that 38% of all deaths in women are related to CAD as compared with 22% resulting frin younger women.om cancer. Media articles hype the CAD in younger women. METHODS Prospectively, 1000 consecutive patients admitted to our department with standard indications for coronary angiography for CAD were included in this study . Detailed analysis of observations was done. RESULTS There were 300 females and 700 males . Out of 300 female patients, 251(83.7%) were postmenopausal and 49(16.3%) were premenopausal . Of these, 208/300 (69.4%) women had Obstructive CAD (OCAD). 72.9% postmenopausal women and 52% premenopausal women had OCAD and the difference was statistically significant. Effectively 25/ 1000 patients were premenopausal women with OCAD. Premenopausal women more commonly had single vessel disease. Compared to men disease occurred later in women. 85% women were from urban areas. 61.9% had sedentary lifestyle, 53% were dyslipidemic, 48.7% were obese, 46.1% hypertensive, 38.3% diabetic, 14.3% smoker and 2.3% had family history of premature CAD. Smoking, sedentary lifestyle and family history were more important factors in premenopausal women. As compared to men hypertension, diabetes and family history were more common while smoking and obesity were less common. CONCLUSION The fears of large number of premenopausal women in India getting CAD appear unfounded, as only 2.5% of those from the highly select group of those undergoing Coronary Angiography have it. Since nearly 2/3 CAD patients come from developing countries, our study has widespread relevance. CLINICAL IMPLICATIONS Reassures clinicians about low incidence CAD in premenopausal women P199 Chronic kidney disease and ambulatory blood pressure monitoring: any pattern to recognize? M Ferreira Fonseca1, J Farinha1, S Goncalves1, R Marinheiro1, A Esteves1, R Rodrigues1, R Caria1 1Hospital Center of Setubal, Cardiology, Setubal, Portugal Topic: Cardiovascular Disease in Special Populations - Other Introduction: Chronic kidney disease (CKD) is an important health problem nowadays, and it is intimately related with arterial hypertension, which can be at its origin. From another point of view, CKD itself affects blood pressure (BP) profile, although the correlation between the values obtained in ambulatory blood pressure monitoring (ABPM) and the different stages of CKD is not well defined. Purpose: To assess the values of pulse pressure (PP), systolic and diastolic blood pressure (SBP and DBP respectively) and circadian variability obtained in ABPM of hypertensive patients with CKD. We also pretend to correlate those values obtained with the presence or not of left ventricular hypertrophy (LVH). Methods: We evaluated 224 consecutive patients, with arterial hypertension, that underwent ABPM to evaluate their blood pressure profile. We excluded the patients in whom creatinine value had not been determined previously, and those that did not had an echocardiographic evaluation with determination of left ventricular mass. We also excluded patients that were on haemodialysis. Filtration glomerular rate was estimated using the "Modification of diet in renal disease" (MDRD) formula. The presence of CKD was defined as a GFR<60mL/min/1,73m2. Results: We studied 224 patients (54% of them were male) with a mean age of 63±11 years and a mean GFR of 75±21mL/min/1,73m2. Fifty patients (22%) had CKD. In these group of patients we registered higher values of mean PP (60±16mmHg vs 50±17mmHg, p<0,001), diurnal PP (61±16mmHg vs 51±17mmHg, p<0,001), nocturnal PP (59±17mmHg vs 49±17mmHg, p<0,001) and nocturnal SBP (121±25mmHg vs 117±15mmHg, p=0,038). Dipper profile, reflecting the adequate circadian variability of BP, was more prevalent in patients without CKD (48% vs 32%, p=0,05). Patients with CKD also presented more frequently LVH (46% vs 28%, p=0,017). Conclusion: Patients with CKD present higher values of PP and nocturnal SBP as well as loss of the normal circadian variability of BP (dipper pattern). Those changes reflect themselves in a higher percentage of LVH. P200 Features of cognitive status of patients with chronic heart failure and comorbidity EV Efremova1, AM Shutov1, MV Menzorov1, NV Chindina1, NV Shebalina1, IA Sabitov1, AS Podusov1, IYU Troshina1 1Ulyanovsk State University, Ulyanovsk, Russian Federation Topic: Cardiovascular Disease in Special Populations - Other Cognitive functions are crucial to ensure a decent quality of life and adherence to treatment of cardiac patients. However, the data defining the impact of comorbidity on cognitive status of patients with chronic heart failure (CHF), underrepresented. The aim of this study was to investigate the cognitive status of comorbidity patients with CHF. Materials and methods: 200 patients with CHF (130 males and 70 females, mean age was 61,8±9,6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, 2016. Charlson comorbidity index (CCI) was calculated. The studied patients were divided into 3 groups: I group (low comorbidity) with an index of ≤ 3 points; II group (moderate comorbidity) with an index of 4−5 points - III group (high comorbidity) with an index of ≥ 6 points. The Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) were used to assess the cognitive functions of patients with CHF. Results: Charlson's comorbidity index was 5.0 ± 2.1 points. The results obtained using MMSE did not contradict the results obtained using the CDR in patients with CHF. Pre-mental cognitive impairment was detected in 110 (55%) patients with CHF, mild dementia in 46 (23%). There were no significant differences by gender in the analysis of cognitive impairment in patients with CHF. Considering that the presence of dementia is included in the CCI, naturally, patients with high comorbidity had dementia more often compared with patients with moderate comorbidity (χ2 = 6,05; P III-II = 0.01) and with low comorbidity (χ2 = 24.9; P III-I <0.0001).However, Pre-mental cognitive impairment was not taken in CCI, and there were no significant differences between groups of patients with CHF with varying degrees of comorbidity (χ2 = 0.01; P = 0.98). Patients with CHF performed tasks to assess the orientation in time and place by 98%; perception - 99%; attention by 61%; memory - by 41%, speech and reading - by 90%. With an increase in comorbidity (dementia was not included in the scale), memory deterioration (r = -0.34; p <0.001) and attention (r = -0.43; p <0.001) was observed. Conclusions: Changes in cognitive status are characteristic of patients with CHF. The presence of pre-mental cognitive impairment in patients with CHF does not depend on the level of comorbidity. memory and attention levels deteriorate with an increase in comorbidity. P203 Comparison of cardiovascular risk in people with bachelors and masters degree P Nadrowski1, A Pajak2, W Drygas3, W Bielecki4, A Tykarski5, T Zdrojewski6, M Skrzypek7, W Wojakowski1, K Kozakiewicz1 1Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland 2Jagiellonian University Medical College, Epidemiology and Population Studies Department, Institute of Public Health, Krakow, Poland 3Institute of Cardiology, Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion,, Warsaw, Poland 4Medical University of Lodz, Department of Social and Preventive Medicine, Lodz, Poland 5Poznan University of Medical Sciences, Department of Hypertension, Angiology and Internal Medicine, Poznan, Poland 6Medical University of Gdansk, Department of Arterial Hypertension and Diabetology, Gdansk, Poland 7Medical University of Silesia, Department of Biostatistics, School of Public Health, Katowice, Poland On Behalf of: WOBASZ II Study Investigators Funding Acknowledgements: National Program of Equalization the Accessibility to Cardiovascular Disease Prevention and Treatment for 2010–2012 POLKARD Topic: Cardiovascular Disease in Special Populations - Other Background: Many epidemiological studies demonstrated significant differences in cardiovascular disease (CVD) risk factors distribution according to education level with lower CVD risk in a high education comparing to elementary or secondary education. However, there is no data on differences within particular education group, especially in people with high education who are expected to be more aware of healthy lifestyle. Aim: Comparison of CVD risk in people with bachelor's and master’s degree. Methods: Study population consisted of randomly screened Polish residents aged 20+ participating in WOBASZ II Study. A sample of 15 200 people was drawn. The selection was made as a three stage sampling, stratified according to administrative units, type of urbanization and gender. Presented analysis covered a group of 4569 people, 2036 men (44.5%) and 2533 women (55.5%). In each subject questionnaire data by face-to-face interview (age, sex, smoking habits, education level), anthropometric data (height, weight), blood pressure measurements as well as blood glucose and lipids were obtained. Risk of CVD death according to SCORE algorithm was calculated. Then in selected high education groups: bachelor's (N=109) and master’s degree (N=893) we analysed incidence of CVD risk factors and high CVD risk (SCORE ≥5%). Results: Master’s Degree education comparing to Bachelor's degree is associated with a higher prevalence of almost all analysed CVD risk factors (except of smoking) and higher CVD risk based on SCORE. Conclusion: Study suggests differences in CVD risk profile between people with bachelor's and master’s degree. Bachelor's degree (%) Master’s Degree (%) P value Hypertension 11.0 25.6 <0.0001 Former smoking 24.7 20.4 <0.0001 Actual smoking 24.8 16.8 <0.0001 BMI 25-30 kg/m2 33.9 35.2 <0.0001 BMI >30 kg/m2 9.2 16.8 <0.0001 Diabetes 1.8 3.7 <0.0001 Hypercholesterolemia 45.9 52.9 <0.0001 Hypertriglyceridemia 18.3 20.0 <0.0001 Increased LDL-Cholesterol 42.2 44.8 <0.0001 Decreased HDL-Cholesterol 18.3 17.7 0.01 High CVD risk (SCORE ≥5%) 2.1 10.4 <0.0001 Bachelor's degree (%) Master’s Degree (%) P value Hypertension 11.0 25.6 <0.0001 Former smoking 24.7 20.4 <0.0001 Actual smoking 24.8 16.8 <0.0001 BMI 25-30 kg/m2 33.9 35.2 <0.0001 BMI >30 kg/m2 9.2 16.8 <0.0001 Diabetes 1.8 3.7 <0.0001 Hypercholesterolemia 45.9 52.9 <0.0001 Hypertriglyceridemia 18.3 20.0 <0.0001 Increased LDL-Cholesterol 42.2 44.8 <0.0001 Decreased HDL-Cholesterol 18.3 17.7 0.01 High CVD risk (SCORE ≥5%) 2.1 10.4 <0.0001 BMI - body mass index; CVD - cardiovascular Open in new tab Bachelor's degree (%) Master’s Degree (%) P value Hypertension 11.0 25.6 <0.0001 Former smoking 24.7 20.4 <0.0001 Actual smoking 24.8 16.8 <0.0001 BMI 25-30 kg/m2 33.9 35.2 <0.0001 BMI >30 kg/m2 9.2 16.8 <0.0001 Diabetes 1.8 3.7 <0.0001 Hypercholesterolemia 45.9 52.9 <0.0001 Hypertriglyceridemia 18.3 20.0 <0.0001 Increased LDL-Cholesterol 42.2 44.8 <0.0001 Decreased HDL-Cholesterol 18.3 17.7 0.01 High CVD risk (SCORE ≥5%) 2.1 10.4 <0.0001 Bachelor's degree (%) Master’s Degree (%) P value Hypertension 11.0 25.6 <0.0001 Former smoking 24.7 20.4 <0.0001 Actual smoking 24.8 16.8 <0.0001 BMI 25-30 kg/m2 33.9 35.2 <0.0001 BMI >30 kg/m2 9.2 16.8 <0.0001 Diabetes 1.8 3.7 <0.0001 Hypercholesterolemia 45.9 52.9 <0.0001 Hypertriglyceridemia 18.3 20.0 <0.0001 Increased LDL-Cholesterol 42.2 44.8 <0.0001 Decreased HDL-Cholesterol 18.3 17.7 0.01 High CVD risk (SCORE ≥5%) 2.1 10.4 <0.0001 BMI - body mass index; CVD - cardiovascular Open in new tab P206 Feasibility of home-based cardiac rehabilitation in frail patients MS Terbraak1, L Verweij1, FH De Haan1, HT Jorstad2, M Van Der Schaaf2, S Kremers3, RHH Engelbert1 1Amsterdam University of Applied Sciences, Achieve, Amsterdam, Netherlands (The) 2Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The) 3Maastricht University, Maastricht, Netherlands (The) Funding Acknowledgements: ZonMw – Tussen Weten en Doen, (Grant no. 520002002) Topic: Cardiovascular Disease in Special Populations - Other Background: Cardiac rehabilitation (CR) in frail patients is challenging, and current guidelines do not include specific recommendations for this population. Furthermore, participation rates of frail patients in CR are low. An important barrier to participation is that most CR programmes are hospital-based. Home-based CR has been suggested as an alternative, but feasibility has not been studied in frail patients. Purpose: To study perceptions of physical therapists (PTs) on feasibility and required adaptations to home-based CR in frail patients with cardiovascular disease. Methods: This pilot study consisted of structured observations and semi-structured interviews. Thirty PTs in primary care were selected, based on experience in cardiovascular disease, home-based treatment or geriatric patients. PTs were trained to perform an in-house developed home-based CR-programme in frail patients. Patients were selected during hospital admission for cardiac disease or cardio-thoracic surgery, admission of 48 hours or longer and safety risk score (VMS) ≥ 1 for age 80+ and ≥ 2 for age 70+. To evaluate adherence and adaptations to the programme we observed treatment sessions by PTs. Afterwards, we interviewed these PTs to assess their perceptions on feasibility of the programme. Two researchers separately coded observations and interviews into categories based on a theoretical framework (Gurses 2010) and supplemented with open coding (Grounded theory). We used axial and selective coding to look for central themes. Data saturation was reached after six interviews. Results: We observed and interviewed eight PTs, mean age 43.1 years (SD 17.2), mean work experience 19.3 years (SD 15.6), experienced in: CR (n=4), geriatric treatment (n=7), home-based treatment (n=8) and multidisciplinary work (n=7). All PTs reported home-based CR to be feasible and reported no adverse events. In addition PTs said these patients wouldn’t have participated in hospital-based CR, thereby forfeiting its benefits. We identified three main themes for tailoring home-based CR to frail patients: adaptations to exercise intensity and exercise testing, stimulating patients’ motivation and self-regulation and structural monitoring of risks for readmissions. In addition, PTs described facilitators (e.g. financial support) and barriers (e.g. limited time) for long-term implementation. Conclusion:Home-based cardiac rehabilitation for frail patients seems to be a feasible alternative to hospital-based cardiac rehabilitation. Our study is a first step in improving care for frail patients with cardiac disease and can be used to tailor home-based cardiac rehabilitation to frail patients. Abstract Number: P206 Theoretical framework Gurses 2010 P207 Effect of atorvastatin on the metabolic status and the glomerular filtration rate in nondiabetic patients with chronic kidney disease KH Semegen-Bodak1, T Solomenchuk1, OYU Buchko1, V Bodak2 1Danylo Halytsky Lviv National Medical University, Lviv, Ukraine 2Lviv Regional Clinical Hospital, Lviv, Ukraine Topic: Cardiovascular Disease in Special Populations - Other Purpose: To trace the dynamics of kidney functional ability, lipid metabolism, level of glycosylated haemoglobin (HbA1c) and uricemia during administration of atorvastatin with combination of standard treatment of chronic kidney disease (CKD) nondiabetic origin. Materials and methods. The study involved 54 patients (41 men and 13 women, average age - 60,19±1,50 years) with CKD glomerular or hypertensive origin. Depending on the level of glomerular filtration rate (GFR) all patients were divided into 2 groups: 1st group included 31 patients with GFR <60 ml/min (average age - 60,19±2,19 years), 2nd group - 23 persons with GFR ≥60 ml/min (mean age - 60,17±1,98 years). All patients received standard therapy (ACE inhibitors or ARBs, platelet inhibitors). Patients of the 1st group additionally received atorvastatin 20 mg per day. At baseline and after 6 months of treatment determined blood pressure (BP) levels - systolic (SBP), diastolic (DBP) and pulse (PBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), uricemia level, HbA1c and GFR (Cockcroft-Golt formula). Results: On the onset of treatement the increased level of the BP (mm Hg) was exposed in 100% patients of the 1st group: SBP - 162,90±4,21, DBP - 97,42±1,57, PBP - 65,48±3,20; in 95.7% patients of the 2nd group: SBP - 162,26±3,16, DBP - 96,17±1,11, PBP - 66,09±2,51. After treatment there was a significant decrease in BP in both groups, but the levels of SBP and PBP (mmHg) were lower in 1st group than in 2nd group (p<0,01): SAT - 128,52±1,22 (I) and 133,00±1,14 (II), PBP - 42,77±1,34 (I) and 47,78±1,14 (II). Patients in 1st group had a significant reduction of atherogenic lipid fractions (mmol/l): TC - from 6,49±0,15 to 5,05±0,07 (p<0,001), LDL-cholesterol from 4,22±0,15 to 3,23±0,15 (p<0,001). Also, there was a positive influence of adding atorvastatin on carbohydrate and purine metabolism. Particularly, the levels of HbA1c (%) decreased from 7,13±0,13 to 6,44±0,15 (p<0,001) in the 1st group, uricemia levels - from 0,32±0,02 to 0,23±0,01 (p<0,001), while in the 2nd group, these figures have not changed (HbA1c (%) - from 6,41±0,22 to 6,29±0,31, uricemia - from 0,29±0,02 to 0,28±0,02). After 6-month therapy, patients of the 1st group stated significant improvement of renal function - increased GFR (ml/min) from 54,09±2,50 to 84,20±5,60 (p<0,001), while in patients who did not take statins the level of GFR (ml/min) used to decrease – from 95,90±5,82 to 83,85±7,37. Conclusions: Adding atorvastatin to the treatment of CKD in nondiabetic patients reduces the levels of SBP and PBP, atherogenic lipid fractions (TC, LDL-cholesterol), HbA1c and uricemia that can help to low the high cardiovascular risk. 6-month therapy including atorvastatin leads to evidenced increasing of GFR in 1,5 times in patients with a baseline of GFR level <60 ml/min. P210 Modifying ergometric habits in Chagas disease I Davolos1, C Bucay1, R Aguero1, M Arioni1, M Ortiz1, CS Berensztein1 1Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina Topic: Cardiovascular Disease in Special Populations - Other Objectives: Both basal bradycardia and chronotropic incompetence are considered markers of autonomic dysfunction of Chagas disease (ChD) and are thought to provide additional prognostic information for the risk stratification of these patients. 1) Describe the baseline ergometric characteristics and the cardiovascular risk profile of a population with ChD; 2) Compare the utility of calculating the chronotropic index (ICr) over the percentage of maximum heart rate (HR) reached; 3) Describe the importance of vagal tone recovery. Material and method: A descriptive and comparative cross-sectional study was carried out. We included patients with ChD who performed an ergometric test in our hospital, between the months of August 2015 and October 2018; pacemaker carriers, coronary heart disease, dilated cardiomyopathy, diabetes, altered fasting glycemia, medicated with beta-blockers and /or amiodarone were excluded. It was defined as ICr under calculation: maximum HR - baseline HR / 220 - age - baseline HR = less than 0.81. It was also considered insufficient, to the percentage lower than 85% of the maximum HR reached for age (maximum HR = 220 - age and 210 - age, for men and women, respectively). Chi2 was used for the statistical analysis of discrete variables and Student's test for continuous variables. A value of p <0.05 was considered significant. Results: 82 P of a total of 110 PEG were included (Kushnir 0 and 1). Average age was 54.5 years (SD 14.1). 69.5% female. Hypertension and dyslipemia 28% each, former smoker 11%. Right bundle branch blockage 14%. The comparison of insufficient tests according to the definition used is shown in Table. The low ICr in a control population (without ChD, without cardiovascular risk factors and of similar average age) did not correlate with basal bradycardia. Conclusions: 1) Individuals with low ICr may not have baseline bradycardia, 2) The low ICr would include a greater number of patients with chronotropic incompetence, 3) The recovery of vagal tone at the third minute post-stress did not correlate with a lower baseline HR. Low CI n=38 p Low %CF n=18 p Age (years) 57.4/51.9 0.07 56.5/53.9 0.48 Basal CF 71.9/76.1 0.16 64.5/76.9 0.0003 Max CF 127.4/161 <0.001 113.5/154.4 <0.001 Slow HRR 1min 7% vs 6% 0.85 16% vs 4% 0.08 Slow HRR 3min 52% vs 13% <0.001 61% vs 23% 0.002 METS 5.5/8.7 <0.001 5.1/7.8 0.002 Low CI n=38 p Low %CF n=18 p Age (years) 57.4/51.9 0.07 56.5/53.9 0.48 Basal CF 71.9/76.1 0.16 64.5/76.9 0.0003 Max CF 127.4/161 <0.001 113.5/154.4 <0.001 Slow HRR 1min 7% vs 6% 0.85 16% vs 4% 0.08 Slow HRR 3min 52% vs 13% <0.001 61% vs 23% 0.002 METS 5.5/8.7 <0.001 5.1/7.8 0.002 Open in new tab Low CI n=38 p Low %CF n=18 p Age (years) 57.4/51.9 0.07 56.5/53.9 0.48 Basal CF 71.9/76.1 0.16 64.5/76.9 0.0003 Max CF 127.4/161 <0.001 113.5/154.4 <0.001 Slow HRR 1min 7% vs 6% 0.85 16% vs 4% 0.08 Slow HRR 3min 52% vs 13% <0.001 61% vs 23% 0.002 METS 5.5/8.7 <0.001 5.1/7.8 0.002 Low CI n=38 p Low %CF n=18 p Age (years) 57.4/51.9 0.07 56.5/53.9 0.48 Basal CF 71.9/76.1 0.16 64.5/76.9 0.0003 Max CF 127.4/161 <0.001 113.5/154.4 <0.001 Slow HRR 1min 7% vs 6% 0.85 16% vs 4% 0.08 Slow HRR 3min 52% vs 13% <0.001 61% vs 23% 0.002 METS 5.5/8.7 <0.001 5.1/7.8 0.002 Open in new tab P211 Subclinical vascular markers in patients with various rheumatological diseases compared to patients with asymptomatic atherosclerosis E Kolesova1, O Rotar1, A Maslyanskyi2, M Boyarinova1, A Alieva1, A Erina1, A Konradi3 1Federal Almazov Medical Research Centre, Research Laboratory of Epidemiology of non-communicable diseases, Saint Petersburg, Russian Federation 2Federal Almazov Medical Research Centre, Rheumatology, Saint Petersburg, Russian Federation 3Federal Almazov Medical Research Centre, The Deputy Director General of Science, Saint Petersburg, Russian Federation Topic: Cardiovascular Disease in Special Populations - Other Background: Mechanisms of high cardiovascular morbidity in patients with rheumatologic diseases are now actively exploring. The aim of the present study was to assess subclinical vascular markers in patients with various rheumatological diseases in comparison with patients with increased intima-media thickness (IMT) without cardiovascular diseases (CVD). Methods: The study included 130 patients with rheumatological diseases: 50 patients with systemic sclerosis (SSc), 40 patients with rheumatoid arthritis (RA) and 40 patients with ankylosing spondylitis (AS). Control group consisted of 50 patients with 3 or more traditional cardiovascular risk factors and subclinical carotid atherosclerosis (carotid IMT more than 0.9 mm) without clinical signs of coronary artery disease. Arterial stiffness was assessed by SphygmoCor device (AtCor, Australia) with determination of the pulse wave velocity (PWV) and augmentation index (AI). Endothelial function was detected by EndoPat2000 (reactive hyperemia index (RHI) less than 1.6 was considered as dysfunction). Hypercholesterolemia was determined at a total cholesterol level> 4.9 mmol/L or statins intake. Hypertension was detected in patients with systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg or antihypertensive medication intake. Conclusions: In patients with rheumatologic diseases arterial stiffness was lower comparing with group of asymptomatic atherosclerosis. Maximum number of patients with increased arterial stiffness among rheumatological patients was found in the group of rheumatoid arthritis. Patients with systemic scleroderma are characterized more significant endothelial dysfunction, but patients with ankylosing spondylitis – better arterial stiffness. SSc (1) RA (2) AS (3) Comparison group (4) Significant difference with р<0,05 is presented Male/female 1/49 6/34 24/14 16/34 Age, years 52 (41-60) 54 (45-59) 39 (31-46) 52 (46-56) 2 vs 3 Hypercholesterolemia, n % 33 (66,0%) 20 (50,0%) 11 (27,5%) 29 (58,0 %) 3 vs 1,4 Hypertension, n (%) 30 (60,0%) 14 (35,0%) 12 (30,0%) 15 (30,0%) 1 vs 3,4 Smoking, n (%) 12 (24,0%) 12 (30,0%) 20 (50,0%) 11 (22,0%) 1,4vs 3 PWV, m/s(Ме) 7,3 (6,3-9,4) 7,5 (6,7-9,3) 6,6 (6,1-7,6) 7,9 (7,2-9,0) 4 vs3 PWV>10 m/s,n(%) 10 (2,0%) 9 (22,5%) 2 (5,0%) 5 (10%) 1 vs 2,3,4 and 2 vs 3 AI 75(Ме) 27,5 (22-36) 31,0 (25-36) 14,0 (3,5-23,9) 24,0 (18-33) 1,2 vs3and 3 vs4 RHI(Ме) 1,46 (1-1,84) 2,0 (1,6-2,3) 2,08 (1,67-2,5) 1,87 (1,6-2,3) 1 vs2, 3, 4 RHI<1,6n(%) 25 (50%) 11 (27,5%) 9 (22,5%) 14 (28%) 1 vs2, 3, 4 SSc (1) RA (2) AS (3) Comparison group (4) Significant difference with р<0,05 is presented Male/female 1/49 6/34 24/14 16/34 Age, years 52 (41-60) 54 (45-59) 39 (31-46) 52 (46-56) 2 vs 3 Hypercholesterolemia, n % 33 (66,0%) 20 (50,0%) 11 (27,5%) 29 (58,0 %) 3 vs 1,4 Hypertension, n (%) 30 (60,0%) 14 (35,0%) 12 (30,0%) 15 (30,0%) 1 vs 3,4 Smoking, n (%) 12 (24,0%) 12 (30,0%) 20 (50,0%) 11 (22,0%) 1,4vs 3 PWV, m/s(Ме) 7,3 (6,3-9,4) 7,5 (6,7-9,3) 6,6 (6,1-7,6) 7,9 (7,2-9,0) 4 vs3 PWV>10 m/s,n(%) 10 (2,0%) 9 (22,5%) 2 (5,0%) 5 (10%) 1 vs 2,3,4 and 2 vs 3 AI 75(Ме) 27,5 (22-36) 31,0 (25-36) 14,0 (3,5-23,9) 24,0 (18-33) 1,2 vs3and 3 vs4 RHI(Ме) 1,46 (1-1,84) 2,0 (1,6-2,3) 2,08 (1,67-2,5) 1,87 (1,6-2,3) 1 vs2, 3, 4 RHI<1,6n(%) 25 (50%) 11 (27,5%) 9 (22,5%) 14 (28%) 1 vs2, 3, 4 Open in new tab SSc (1) RA (2) AS (3) Comparison group (4) Significant difference with р<0,05 is presented Male/female 1/49 6/34 24/14 16/34 Age, years 52 (41-60) 54 (45-59) 39 (31-46) 52 (46-56) 2 vs 3 Hypercholesterolemia, n % 33 (66,0%) 20 (50,0%) 11 (27,5%) 29 (58,0 %) 3 vs 1,4 Hypertension, n (%) 30 (60,0%) 14 (35,0%) 12 (30,0%) 15 (30,0%) 1 vs 3,4 Smoking, n (%) 12 (24,0%) 12 (30,0%) 20 (50,0%) 11 (22,0%) 1,4vs 3 PWV, m/s(Ме) 7,3 (6,3-9,4) 7,5 (6,7-9,3) 6,6 (6,1-7,6) 7,9 (7,2-9,0) 4 vs3 PWV>10 m/s,n(%) 10 (2,0%) 9 (22,5%) 2 (5,0%) 5 (10%) 1 vs 2,3,4 and 2 vs 3 AI 75(Ме) 27,5 (22-36) 31,0 (25-36) 14,0 (3,5-23,9) 24,0 (18-33) 1,2 vs3and 3 vs4 RHI(Ме) 1,46 (1-1,84) 2,0 (1,6-2,3) 2,08 (1,67-2,5) 1,87 (1,6-2,3) 1 vs2, 3, 4 RHI<1,6n(%) 25 (50%) 11 (27,5%) 9 (22,5%) 14 (28%) 1 vs2, 3, 4 SSc (1) RA (2) AS (3) Comparison group (4) Significant difference with р<0,05 is presented Male/female 1/49 6/34 24/14 16/34 Age, years 52 (41-60) 54 (45-59) 39 (31-46) 52 (46-56) 2 vs 3 Hypercholesterolemia, n % 33 (66,0%) 20 (50,0%) 11 (27,5%) 29 (58,0 %) 3 vs 1,4 Hypertension, n (%) 30 (60,0%) 14 (35,0%) 12 (30,0%) 15 (30,0%) 1 vs 3,4 Smoking, n (%) 12 (24,0%) 12 (30,0%) 20 (50,0%) 11 (22,0%) 1,4vs 3 PWV, m/s(Ме) 7,3 (6,3-9,4) 7,5 (6,7-9,3) 6,6 (6,1-7,6) 7,9 (7,2-9,0) 4 vs3 PWV>10 m/s,n(%) 10 (2,0%) 9 (22,5%) 2 (5,0%) 5 (10%) 1 vs 2,3,4 and 2 vs 3 AI 75(Ме) 27,5 (22-36) 31,0 (25-36) 14,0 (3,5-23,9) 24,0 (18-33) 1,2 vs3and 3 vs4 RHI(Ме) 1,46 (1-1,84) 2,0 (1,6-2,3) 2,08 (1,67-2,5) 1,87 (1,6-2,3) 1 vs2, 3, 4 RHI<1,6n(%) 25 (50%) 11 (27,5%) 9 (22,5%) 14 (28%) 1 vs2, 3, 4 Open in new tab P212 Can cardio pulmonary exercise test derived markers predict mortality in heart transplant patients? A retrospective study L Van Maroey1, L Van Den Bosch1, K Wuyts2, N Possemiers2, P Plaeke1, P J M Beckers2 1University of Antwerp, Antwerp, Belgium 2University of Antwerp Hospital (Edegem), Antwerp, Belgium Topic: Cardiovascular Disease in Special Populations - Other Introduction and Aim: The current knowledge regarding prognostic markers after heart transplantation (HTX) is still limited. This is the first study designed to detect whether long term outcome variables, specifically prognostic markers as derived from cardiopulmonary exercise testing (CPET) in heart failure patients, are also clinically relevant for the prognosis after heart transplantation. Methods: We retrospectively gathered data from the total cohort of adult post- HTX patients referred to our centre. Following CPET derived markers were assessed at baseline and at the end of an 8-month rehabilitation programme: peak oxygen consumption (PeakVO2), ventilatory efficiency (VE/VCO2slope), end tidal CO2 pressure (PETCO2) at rest and at peak exercise, time to half PeakVO2 (T½PeakVO2), oxygen uptake efficiency slope (OUES), heart rate recovery (HRR), circulatory power (CP), oxygen pulse (O2 pulse), equivalent of VE/CO2 (EqCO2) and the cardiac optimal point (COP). Results: 82 HTX patients (Age 53.7 ± 10.7 Years.; 77% Male) were included. Over a period of 20 years 27 patients died. Statistical analysis of the baseline CPET variables showed a significant (p=0.046) higher PETCO2 at peak exercise being 34.5 mmHg (SD ± 1.8) in the deceased adult HTX patients vs. 30.9 mmHg (SD ± 5.0) in the survivors. There was also a trend (p= 0.08) of a lower VE/VCO2slope of 30.9 (SD ± 2.3) in the deceased vs. 35 (SD ± 6.6) in the survivors. Analyses of CPET as performed at the end of the cardiac rehabilitation showed a significant difference in PeakVO2 (p=0.02) between survivors and non-survivors. Mean PeakVO2 of deceased subjects was 21.6 mL/kg/min (SD ± 1.4) vs 24.9 mL/kg/min (SD ± 6.3) in survivors. Conclusion: In the group of HTX patients, referred to our rehabilitation centre, those with a low PETCO2 at peak exercise and a high VE/VCO2slope during CPET at the start of a cardiac rehabilitation programme had a better prognosis. Low PeakVO2 during the CPET at the end of rehabilitation could also be an important indicator of mortality in this population. Other CPET derived variables included in the study were not found to be significantly associated with a worse prognosis in these adult HTX patients. P213 Survival analysis patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty or mitral valves surgery in a low-middle-income country A Ambari1 1University of Indonesia, Jakarta, Indonesia Topic: Cardiovascular Disease in Special Populations - Other Introduction: Objectives: To Investigate survival analysis patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty (PBMV) or mitral valve surgery (MVS). To assess if PBMV survival is better than MVS. This is related to limited health care funds for mitral stenosis patients in developing countries, so with this study, they can choose the best, appropriate and inexpensive mitral stenosis (MS) modality treatment. Methods: The study evaluated 329 patients who underwent percutaneous balloon mitral valvuloplasty (PBMV) and 142 patients who underwent mitral valves surgery (MVS) between January 1, 2011, and December 31, 2016. The rates of cardiovascular death and or hospitalization were determined over a median follow-up of 24 months in PBMV (mean SD 25,67 ± 17,66 month) and 27 months in MVS (mean SD 31,79 ± 19,47 month). Results: The observed event-free survival was similar for both groups, and the hazard ratio for the clinical events after mitral valves surgery (MVS) compared with percutaneous balloon mitral valvuloplasty (PBMV) was 0,631 (95% confidence interval, 0,376-1,058; P 0,081). This study showed a higher event-free survival in the mitral valve surgery group, but was statistically non-significant. Conclusions: Percutaneous balloon mitral valvuloplasty (PBMV) is noninferior compared with Mitral valves surgery (MVS) in event free survival. P214 In the community-dwelling population, clinical characteristics of octogenarians with heart failure and relevance to ADL/QOL and effect of cardiac rehabilitation: the J-REHACHF-ELD Study K Hashimoto1, H Obata1, K Yamaguchi1, Y Hasegawa2, N Kagawa2, W Mitsuma2, H Honma3, K Suzuki3, S Noto4, T Izumi1 1Niigata Minami Hospital, Niigata, Japan 2Shinrakuen Hospital, Niigata, Japan 3Sado General Hospital, Niigata, Japan 4Niigata University of Health and Welfare, Niigata, Japan On Behalf of: J-REHACHF-ELD Study Funding Acknowledgements: the Japan Agency for Medical Research and Development (No. JP17ek0210058) Topic: Cardiovascular Disease in Special Populations - Other Background: Japan has the highest proportion of elderly people in the world; 27.7% of the total are aged 65 years or above. As a matter of course, the number of elderly patients with heart failure has been abruptly increasing. A pandemic of super-elderly heart failure has occurred in community. In addition to medical interventions for heart failure, appropriate cardiac rehabilitation is required for these patients. Therapeutic goals should be set not only for extension of life but also for improvement of their ADL and QOL. To clarify the medical and care burden as well as the effects of rehabilitation, we are conducting a multicenter prospective registry study enrolling all patients aged 65 years or older with heart failure in the dwelling population. Methods: We registered 622 hospitalized patients at three community based hospitals between Feb. 2017 and Mar. 2018. All patients were successfully followed up at discharge, and 195 are being followed up every six months. Baseline demographic data of clinical and social status and factors associated with ADL (Barthel index) and QOL (EQ-5D-5L) at discharge were investigated. Also, we evaluated short-term clinical outcomes using survival analyses. Results: The median age of patients was 86 years, with 76% of patients aged 80 or older, namely octogenarian. Clinical and social characteristics of these patients included lean constitutions with BMI of 21.5, malnutrition was observed in 80%, high comorbidity including non-cardiac diseases, heart failure with preserved ejection fraction was observed in 58.1%, primary nursing care at the time of hospitalization was needed for 44.5%. The in-hospital mortality rate was 16.3%, and 67.0% of patients were discharged to their own house. Patient ADL at the hospital life decreased significantly (Barthel index; BI=39.2), and 67.4% were treated with cardiac rehabilitation. The mean hospitalization period was 34.2 days. In the 154 patients who were eligible for the rehabilitation and not severely impaired ADL (BI>40), QOL scores significantly improved (0.68 vs. 0.81, p<0.01). Factors correlating with QOL at discharge were the physical indices of ADL and walking speed. The cardiovascular indices including BNP and LVEF exhibited no correlation with the QOL improvement. The mortality rate within 6 months after discharge was 22.1%; 40.6% of patients were subsequently rehospitalized. After adjustment for sex and age in multivariable Cox proportional hazard models, higher ADL patients (BI>60) exhibited significantly higher adverse risks of all-cause death (HR 2.62, 95%CI 1.52–4.63, P=0.001) and rehospitalization (HR 2.00, 95%CI 1.31–3.04, P=0.001) compared with lower ADL patients (BI=40-60). Conclusions: In the dwelling population, main subject of heart failure patients was octogenarian. Patient ADL decreased significantly at the hospital life but their QOL was improved by cardiac rehabilitation. The effect seemed to be reflected at least in the short term prognosis. P216 Cardiovascular risk factors depending on the vascular endothelium damage in patients with comorbid course of arterial hypertension and subclinical hypothyroidism V Nemtsova1, O Bilovol1, V Zlatkina1 1Kharkiv National Medical University, Clinical Pharmacology and Internal Diseases, Kharkiv, Ukraine Topic: Cardiovascular Disease in Special Populations - Other Introduction: In 2014 stratification of risk factors for cardiovascular disease (CVD) suggested that the the influence of combination of hypothyroidism and CVD on the degree of cardiovascular risk (CVR) can be compared with the influence of such factors as diabetes, hyperlipidemia, hypertension, renal failure. The comorbid course of hypertension (H) and hypothyroidism, including subclinical (SH), has a negative effect on each other and significantly worsens the course of these diseases, which can also be associated with endothelial dysfunction. Purpose: To study metabolic parameters and CVR factors depending on the vascular wall endothelium damage (VWED) in patients with hypertension and SH. Methods: Depending on the blood count of desquamated circulating endothelial cells (DCELs) the as a marker of VWED 96 patients (37 males and 59 females) aged from 45 to 65 with H stage II and SH were randomized into 2 groups: 1 group - with a moderately VWED (less than 10 cells/ml), 2 group - with a markedly VWED (more than 10 cells/ml). The diagnosis of SH was established in the presence of two-fold with an interval of 3 or 6 months detection of the TSH levels exceeding the upper limit of the reference range (4.0 mIU / l) on the background of normal levels of fT4 and fT3. Indexes of carbohydrate, lipid metabolism, insulin resistance index (HOMA-IR), the blood levels of DCELs, sensitive C-reactive protein (sCR-P) were determined. Carotid intima-media thickness (IMT) was measured by ultrasound. Results: 39 individuals formed the 1st group (8.19±1.03 cells/ml), 57 patients - the 2nd group (14.57±2.19 cells/ml), against the background of increasing of sCR-P plasma levels (p<0.05) and increased IMT (p<0, 05). The group 2 had more pronounced dyslipidemia (p<0.05), hyperglycemia, HOMA-IR (p<0.05), females were almost double more than males, regardless of the duration of H and SH. Conclusions: Patients with H and SH have a predominantly high degree of endothelial damage which is associated with significant dyslipidemia, insulin resistance and confirms a higher CVR. P219 Association between left ventricle longitudinal strain and strain rate and cardiometabolic diseases in a general population sample V Guseva1, A Ryabikov2, E Voronina1, YU Palekhina2, S Shakhmatov2, N Yasyukevich1, M Stylidis3, H Schirmer4, D Leon5, S Malyutina1 1Research Institute of Internal and Preventive Medicine - Branch of IC&G SB RAS, Novosibirsk, Russian Federation 2Novosibirsk State Medical University, Novosibirsk, Russian Federation 3UiT The Arctic University of Norway, Department of Community Medicine, Tromso, Norway 4University of Oslo, Institute of Clinical Medicine, Oslo, Norway 5London School of Hygiene and Tropical Medicine, London, United Kingdom of Great Britain & Northern Ireland On Behalf of: Know Your Heart Funding Acknowledgements: Wellcome Trust (100217); UiT; Norwegian Institute of Public Health Topic: Cross-Modality and Multi-Modality Imaging Topics Background: Ultrasound assessment of myocardial strain allows non-invasive identification of early stages of heart failure with preserved ejection fraction. There is an evidence of a decline of global longitudinal strain (GLS) of the left ventricle (LV) in overt cardiovascular diseases such as hypertension (HT), coronary heart disease (CHD), cardiomyopathy. However, data on the relationship between longitudinal strain and cardiometabolic diseases in a general population is scarce. Objective: To study the relationship between peak systolic GLS and strain rate (GSR) of LV and HT and BP control, CHD and diabetes mellitus (DM) in a general population sample. Methods: In the frame of International Project of Cardiovascular Diseases in Russia (Know Your Heart) the cross-sectional surveys were conducted in Novosibirsk and Arkhangelsk (about 4500 subj.aged 35-69). This interim analysis is limited to a random sample (n=2179, 35-69, Novosibirsk). We conducted echocardiography (Vivid q, GE) and evaluated GLS and GSR of LV by speckle tracking technique, 2043 records (m.861/w.1182) were adequate for strain measurement. Medical history of CVD and risk factors were assessed by standard methods. Results: The mean GLS value was - 18.2% (SD2.74), it was lower in men than in women (-17.9% vs -19.4%, p<0.001). The mean GSR value was -0.96 s-1 (0.17), did not differ by sex. The prevalence of HT in the studied sample was 58.8%, history of DM - 15.1%, and history of CHD (hospitalized) – 3.9%. The absolute value of GLS in HT was lower than in normotensives: -18.2% (2.74) vs -19.3% (2.75), p<0.001; independent of age, sex, BMI, LV myocardium mass index (IMM), smoking, DM and CVD, p=0.017. In HT groups, the GLS among those "untreated" was significantly lower versus normotensives independently of other factors (p=0.004). The absolute value of GSR in HT was lower than in normotensive subjects: -0.98 s-1 (0.18) vs -0.94 s-1 (0.18), p<0.001 independently of age, sex, BMI (p=0.023). There was no significant difference in GSR by HT treatment. In subjects with CHD, the GLS was lower compared to those without CHD: -16.2% (2.72) vs -18.7% (2.69) independently of age, sex, BMI, SBP, IMM, smoking and DM (p<0.001). GSR values were -0.83 s-1 (0.17) and -0.96 s-1 (0.19) in CHD and non-CHD subjects independently of other factors (p=0.010). In subjects with DM, the GLS was lower compared to those without DM: -17.9% (2.78) vs -18.8% (2.77), p<0.001, but association disappeared when adjusted to other factors. GSR absolute values were higher in those with DM than in counterparts. Conclusion: In the studied population sample of wide age range, GLS and GSR of LV were inversely associated with HT, CHD and DM. In hypertensives, the lowest GLS were found among uncontrolled HT. The findings might reflect the initial reduction of systolic ventricular function in cardiometabolic diseases such as HT, CHD and DM, and particularly in hypertensives with inadequate control of BP. P220 Long-term risk factor exposure and MRI-derived cardiac function and structure in the community R Lorbeer1, S Rospleszcz2, CL Schlett3, SD Heber4, J Machann4, B Thorand2, C Meisinger5, W Rathmann6, M Heier2, RS Vasan7, F Bamberg4, A Peters2, W Lieb8 1University Hospital, LMU, Department of Radiology, Munich, Germany 2Helmholtz Center Munich - German Research Center for Environment and Health, Munich, Germany 3University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany 4Eberhard Karl University, Department of Diagnostic and Interventional Radiology, Tübingen, Germany 5LMU Munich UNIKA-T, Chair of Epidemiology, Augsburg, Germany 6German Diabetes Center, Department of Biometrics and Epidemiology, Düsseldorf, Germany 7Boston University School of Medicine and Framingham Heart Study, Preventive Medicine & Epidemiology Section, Framingham, United States of America 8Christian-Albrechts-University Kiel, Kiel, Germany Topic: Cross-Modality and Multi-Modality Imaging Topics Objectives: We explored the association of long-term exposure to cardiovascular risk factors and MRI-measures of cardiac structure and function in a community-based sample. Methods: Cardiac MRI examinations were conducted in 349 participants (143 women; aged 39 to 73 years) of the KORA study at the third examination cycle (14-years follow-up) using a 3 Tesla machine. Systolic and diastolic blood pressure (BP), waist circumference (WC), HbA1c, and LDL-cholesterol were measured at the baseline examination, and at the 7-years and 14-years follow-up examinations. Individual risk factor levels (at the different examination cycles) and trajectory clusters of these risk factors were associated with the following cardiac MRI-measures: stroke volume, myocardial mass, myocardial filling and ejection rates as well as with epicardial and pericardial fat. Results: Average levels of WC (90.6cm-98.4cm) and LDL-cholesterol (133mg/dl-138.9mg/dl) and the prevalence of hypertension (29%-33%) increased over the 14 years study period. High levels of diastolic BP, WC, and LDL-cholesterol, across all three examination cycles, were statistically significantly adversely associated with cardiac function and structure, especially with lower left ventricle stroke volume (baseline: β[diastolicBP]=-0.18 ml/m2; β[WC]=-0.12 ml/m2; β[LDL]=-0.05 ml/m2) and higher epicardial fat (baseline: β[diastBP]=0.10; β[WC]=0.11). Multivariable risk trajectory clusters demonstrated a graded association with most cardiac parameters, most strongly and inverse associated with left ventricular stroke volume (middle-level cluster: β=-5.63 ml/m2; high-level cluster: β=-7.87 ml/m2). Conclusion: Cardiovascular risk factor levels, measured repeatedly over a 14-years’ time period were associated with subclinical MRI-derived measures of cardiac structure and function. Multivariable trajectory clustering allows identification of individuals at high risk for cardiac remodelling. P222 Volumes of the left ventricle and left atrium assessed by 3-dimensional echocardiography in endurance trained middle-aged women A Malmgren1, P Gudmundsson2, M Stagmo3, M Dencker1 1Skane University Hospital, Department of Medical Imaging and Physiology, Malmo, Sweden 2Malmo University, Department of Biomedical Laboratory Science, Malmo, Sweden 3Skane University Hospital, The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Lund, Sweden Topic: Cross-Modality and Multi-Modality Imaging Topics Background: The physiologic cardiac adaptation as a consequence of regular, intense and long-term exercise is a well-known phenomenon also known as the athlete heart. However, there are few studies performed on middle-aged women who still practice endurance exercise and take part in competition. The aim of the present study was to assess left ventricular and left atrial volumes as well as left ventricular mass in this group of women. Methods: The present study was a cross-sectional study of 37 endurance trained women compared with 36 matched sedentary women. The participants were examined with 3-dimensional echocardiography. The data were analysed offline using Philips QLAB 10.7 software. Left ventricular volumes, left ventricular mass and left atrial volumes were quantified. Systolic left ventricular function was also evaluated. Inter-group differences were compared using unpaired t-test. Values are presented as mean ± standard deviation. Results: Mean age was 58 ± 3 years. The trained women exercised in average 7.2 ± 2.6 (range 4-13) hours per week. When adjusted for body surface area all volumes and left ventricular mass were significantly (p<0.05) larger in endurance trained women. No significant difference between the two groups were found in left ventricular ejection fraction, cardiac output and cardiac index. However, endurance trained women had significantly lower heart rate and larger stroke volume as well as larger stroke volume index (p<0.01). Conclusion: As have been shown in several previous studies, though there have been few studies on endurance trained middle-aged women as in the present study, long-term endurance exercise has an effect on cardiac size, left ventricular mass and left ventricular systolic function. P225 Cardiovascular magnetic resonance and electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in young competitive endurance athletes R De Bosscher1, M Claeys1, C Dausin2, A La Gerche3, J Bogaert4, O Ghekiere5, L Herbots6, H Heidbuchel7, G Claessen1, R Willems1 1University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium 2KU Leuven, Leuven, Belgium 3Baker IDI Heart and Diabetes Institute, Cardiology, Melbourne, Australia 4University Hospitals (UZ) Leuven, Radiology, Leuven, Belgium 5Virga Jesse Hospital, Radiology, Hasselt, Belgium 6Virga Jesse Hospital, Cardiology, Hasselt, Belgium 7University of Antwerp Hospital (Edegem), Cardiology, Antwerp, Belgium Topic: Sports Cardiology Background: Endurance training leads to cardiac remodeling consisting of left ventricular hypertrophy (LVH). Isolated electrocardiographic (ECG) voltage criteria for LVH is a normal finding in athletes as mentioned in the Seattle criteria. Cardiovascular magnetic resonance (CMR) is considered the gold standard for the assessment of cardiac structure. However, the diagnostic performance of CMR for LVH and the correlation with ECG voltage criteria in young competitive endurance athletes are unknown. Purpose: The goal was to correlate different ECG criteria for LVH with indexed left ventricular mass (LVMi) as determined by CMR in the pro@heart study. This is a longitudinal cohort study in elite endurance athletes to phenotype the structural and functional cardiovascular adaptations associated with high volume exercise. Methods: We analysed data from 81 young competitive endurance athletes. As ECG criteria for LVH we assessed Cornell voltage and product, Sokolow-Lyon voltage and product, Peguero criterion, Gubner-Ungerleider voltage, Framingham-adjusted Cornell voltage, Perugia score, Framingham criterion and Romhilt-Estes Score System. LVMi was quantified by CMR. The CMR reference values for LVMi, as published by Petersen et al. were used to define LVH. The relationship between ECG criteria and LVMi was assessed by correlation analysis. We assessed both the diagnostic performance of the various ECG criteria for LVH with CMR as the standard and the diagnostic performance of CMR criteria for LVH with the Perugia score as the standard as proposed by Speranza et al . Results: Our study included 62 male (76.5%) and 19 female athletes. The mean age was 17.7±1.8 years. The mean LVMi was 72.1±11.9 g/m². Male athletes compared to females had a higher LVMi (75.7±10.5 vs 60.6±8.4 g/m², p<0.001). LVH as defined by CMR was diagnosed in 52 athletes (64.2%). In 54 athletes (66.7%) at least one ECG criterion was positive. The following ECG criteria showed statistical significant correlation (p<0.05) with LVMi: Sokolow-Lyon product (ρ=0.444, R²=0.21), Framingham-adjusted Cornell voltage (ρ=0.430, R²=0.22), Romhilt-Estes Score System (ρ=0.385, R²=0.15), Sokolow-Lyon voltage (ρ=0.380, R²=0.17) and Gubner-Ungerleider (ρ=0.372, R²=0.09). When using CMR as the standard for LVH the greatest diagnostic performance was obtained using Sokolow-Lyon voltage (sensitivity 48.1%, specificity 65.5%). Gubner-Ungerleider voltage, Framingham-adjusted Cornell voltage and Framingham criterion had 0% sensitivity. When using Perugia score as the standard for LVH CMR had a sensitivity of 60.9% and a specificity of 34.5%. Conclusion: ECG criteria for LVH correlate poorly with LVMi as quantified by CMR. Given the high prevalence of LVH as defined by CMR in this healthy population, altered CMR cut-off values for the diagnosis of pathologic LVH should be considered in young competitive endurance athletes. P226 Prevalence and characteristics of the Brugada ECG pattern in a young population M Moreira1, CJ Miles1, H Maclachlan1, B Gray1, G Finocchiaro1, B Ensam1, E Papatheodorou1, E Carruthers1, S Tapp1, A Sanga1, J Brown1, S Sharma1, EH Behr1, M Papadakis1 1St George's University of London NHS Foundation Trust Cardiology Clinical Academic Group, London, United Kingdom of Great Britain & Northern Ireland Topic: Sports Cardiology Background: Brugada Syndrome (BrS) is a rare inherited cardiac channelopathy that can cause sudden death (SD). It is diagnosed by a spontaneous type 1 Brugada ECG pattern (BrEP) in leads V1 and V2 with an estimated prevalence of 0.05%. The non-diagnostic type 2 BrEP is more common and may raise suspicion of the condition, prompting potentially unnecessary investigations and anxiety. A consensus report has redefined the type 2 BrEP but the exact prevalence in a cardiac screening population is unknown. Purpose: 1) Establish the prevalence of BrEP in a young screening population and assess the impact of the revised ECG criteria. 2) Explore competitive sports participation in those with BrEP. Methods: 24,056 consecutive individuals aged 14-35 years were evaluated with a health questionnaire and a 12-lead ECG. We examined leads V1 and V2 in ECGs for a type 1 BrEP or the presence of a second R-wave (r’). Two study investigators then determined those meeting criteria for a type 2 BrEP (r’ ≥2 mm in leads V1-V2, ST-elevation with saddle-back morphology >0.5 mm, positive T wave in lead V2). The ‘revised’ type 2 BrEP was classified by a duration of the base of the triangle of r’ at 5 mm from the high take-off >3.5 mm. Symptoms, family history, and participation in competitive sport were prospectively recorded. Results: No individuals exhibited a type 1 BrEP. A r’ was detected in 998 (4%), 69 of whom were identified with a type 2 BrEP (0.3%, k=0.84): mean age 22.6±6.8 years, 90% male. Of these, 33 (48%) were participants in competitive sport. Twelve (36%) competed at national or international level, the majority were rugby players (36%) or cyclists (18%), with 10 hours of training per week on average. Among athletes, eight (24%) self-reported syncope, and two (6%) had a family history of SD under 50 years. Among athletes with a type 2 BrEP, the mean QRS duration was 109.12±12ms, PR interval 159.3±22.4ms, ST elevation 1.13±0.7ms, r’ amplitude 3.19±1.4 mm, and ‘base of triangle’ 1.69±0.9mm. Five individuals in the overall cohort (5/24056: 0.02%) fulfilled "revised" criteria for a type 2 BrEP, two of whom were competitive athletes. Conclusions: The prevalence of type 1 BrEP in young individuals undergoing cardiac screening is lower than expected. A r’ may raise suspicion of BrS but is too common to be a useful sign. A type 2 BrEP is, however, less common, and rarer using ‘revised’ criteria. Its diagnostic significance remains to be determined. Abstract Number: P226 P227 Allometrically normalised reference values and z-scores of right ventricle size in male arab and black paediatric athletes G Mcclean1, NR Riding1, G Pieles2, V Watt3, C Adamuz3, A Shaw3, A Harkness4, A Johnson5, K George6, M Wilson1, D Oxborough6 1Aspetar Orthopaedic Sports Medicine Hospital, Athlete Health and Perfromance Research Centre, Doha, Qatar 2Bristol Royal Hospital for Children, Bristol, United Kingdom of Great Britain & Northern Ireland 3Aspetar Orthopaedic Sports Medicine Hospital, Sports Medicine, Doha, Qatar 4Colchester Hospital, Colchester, United Kingdom of Great Britain & Northern Ireland 5Aspire Academy, Aspire Academy Sports Medicine Centre, Doha, Qatar 6Liverpool John Moores University, Research Institute for Sport and Exercise Science, Liverpool, United Kingdom of Great Britain & Northern Ireland Topic: Sports Cardiology Background: Physiological right ventricle (RV) remodelling in the scholar athlete, has been found to mimic phenotypic features of arrhythmogenic RV cardiomyopathy (ARVC). Recent evidence highlighted that ARVC is responsible for 33% of sudden cardiac deaths in previously screened paediatric soccer players in the UK. This may, in part, be a consequence of the lack of normal ranges of RV structure in paediatric athletes. Aim: Establish allometrically normalised RV reference values and Z-scores to body surface area (BSA) in male paediatric Arab and black athletes, accounting for the impact of ethnicity, chronological and biological age. Methods: 348 (264 Arab, 84 black) male paediatric (11-18 years) athletes, were evaluated by 2D echocardiography of the RV in accordance with European Society of Cardiology guidelines. Biological age was assessed by radiological wrist X-ray. An Allometric (a*BSA^b) model with nonlogarithmic BSA or measurement transformations was employed, to normalise RV structure to BSA. Preliminary analysis revealed nonconstant variance (heteroscedasticity) of residual values across BSA for most structural variables. Accordingly, regressed SD, was calculated by linear regression of the scaled absolute value (multiplied by √(2/π)) Results: Residual linear regression, revealed normalised measures to be independent of BSA and chronological age. RV outflow tract dimension (parasternal long-axis), revealed residual association to biological age (-0.29, p=0.04). Black athletes presented significantly larger RV basal inflow (mean difference: 1.15, p=0.03). The Z-score for an athlete with a specific BSA (Figure 1) is calculated from Table 1: z=(observed measure-(a*BSA^b))/c+(d*BSA)). Conclusion: For the first time, we present allometrically normalised reference values and Z-scores for RV size to BSA, with no impact of chronological age in male Arab and Black paediatric athletes. Biological age and ethnicity, respectively, had small effects on only one variable, and therefore were considered not clinically important. Parameter RVOTPLAX, mm RVOT1, mm RVOT2, mm RVD1, mm RVD2, mm RVD3, mm RVDarea, cm2 Predicted Mean Parameters a 21.55 22.10 18.85 33.11 23.83 63.71 16.14 b 0.39 0.41 0.32 0.31 0.38 0.36 0.59 Regressed Standard Deviation c 2.05 2.06 2.18 4.36 0.59 -2.65 1.74 d 0.76 0.78 0.12 -0.06 2.11 5.95 1.16 Parameter RVOTPLAX, mm RVOT1, mm RVOT2, mm RVD1, mm RVD2, mm RVD3, mm RVDarea, cm2 Predicted Mean Parameters a 21.55 22.10 18.85 33.11 23.83 63.71 16.14 b 0.39 0.41 0.32 0.31 0.38 0.36 0.59 Regressed Standard Deviation c 2.05 2.06 2.18 4.36 0.59 -2.65 1.74 d 0.76 0.78 0.12 -0.06 2.11 5.95 1.16 Cm, centimeters; mm, millimeters; RVOTPLAX, right ventricular outflow tract, long axis; RVOT1, proximal RVOT(short axis); RVOT2, distal RVOT(short axis); RVD1, RV basal; RVD2, RV mid-ventricular; RVD3, RV longitudinal dimensions. RVDarea, RV end-diastolic area Open in new tab Parameter RVOTPLAX, mm RVOT1, mm RVOT2, mm RVD1, mm RVD2, mm RVD3, mm RVDarea, cm2 Predicted Mean Parameters a 21.55 22.10 18.85 33.11 23.83 63.71 16.14 b 0.39 0.41 0.32 0.31 0.38 0.36 0.59 Regressed Standard Deviation c 2.05 2.06 2.18 4.36 0.59 -2.65 1.74 d 0.76 0.78 0.12 -0.06 2.11 5.95 1.16 Parameter RVOTPLAX, mm RVOT1, mm RVOT2, mm RVD1, mm RVD2, mm RVD3, mm RVDarea, cm2 Predicted Mean Parameters a 21.55 22.10 18.85 33.11 23.83 63.71 16.14 b 0.39 0.41 0.32 0.31 0.38 0.36 0.59 Regressed Standard Deviation c 2.05 2.06 2.18 4.36 0.59 -2.65 1.74 d 0.76 0.78 0.12 -0.06 2.11 5.95 1.16 Cm, centimeters; mm, millimeters; RVOTPLAX, right ventricular outflow tract, long axis; RVOT1, proximal RVOT(short axis); RVOT2, distal RVOT(short axis); RVD1, RV basal; RVD2, RV mid-ventricular; RVD3, RV longitudinal dimensions. RVDarea, RV end-diastolic area Open in new tab Abstract Number: P227 Scatter plots and Z-score boundaries P228 Aortic root remodeling in life long veteran endurance athletes. B Ibrahim1, S Papatheodorou1, A Merghani1, G Parry-Williams1, K Saidmeerasah1, A Baklakos1, P Bulleros1, Z Fanton1, H Maclachlan1, M Papadakis1, A Malhotra1, S Sharma1, M Tome1 1St George's University of London, Cardiology Clinical Academic Group, St George's Hospitals NHS Foundation Trust, UK, London, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: Cardiac Risk in the Young, and Robert Luff Foundation Topic: Sports Cardiology Background: There is limited data on the impact of life long endurance exercise on aortic root remodeling although it is theoretically possible that loss of elasticity in the aortic wall with advancing age, may be associated with greater increases in aortic root diameter compared with those reported in young elite athletes aortic root of ≥40mm in male, 1.3% and ≥34mm in females, 0.9%, (Pellicia, 2010, circ). Purpose: To investigate the distribution of aortic dimensions in a large cohort of male and female veteran athletes, assess the relationship between aortic root diameter and several demographic factors (age, sex, size, and years of exercise) in relation to hemodynamic response to exercise. Methods and Results. We studied 410 veteran athletes (65% runners) without acquired cardiovascular risk factors including 166 females (40%), aged mean 53.5±8.1 years (range, 40-85). The results were compared with 76 controls of similar age. All subjects underwent two dimensional echocardiography and a cardiopulmonary exercise test using an upright cycle ergometer with systolic blood pressure readings taken during peak V02. Aortic root dimeter was measured at the level of the sinus of Valsalva from the parasternal long axis view. Exercise induced hypertension (EIH) was defined as a systolic blood pressure (BP) > 220 mm Hg in males and > 190 mm Hg in females. Athletes revealed a larger mean aortic diameter compared with controls (31.9.0±3.3mm v 31±3. 2mm; p 0.04), (Fig1). Among athletes males had a larger diameter compared with females (33.3±3.1mm v 29.9±2.6 mm), (Fig2). Zscore (-0.72±1.1 males vs -0.55±0.98 females). Aortic root was enlarged > 40 mm in 3 (1.2%) males and > 34 mm in 5 (3%) females. None of the male or female athletes revealed an aortic root > 43 mm and 36 mm respectively. None of the athletes with dilated aortic root met the Ghent criteria for Marfan syndrome. Aortic root diameter correlated moderately with height (r= 0.42, p= <0.0001) and body surface area (BSA) (r= 0.41, p= <0.0001). There was no correlation between aortic dimensions and age, years of exercise or blood pressure response to exercise. Conclusion: Lifelong endurance veteran athletes are more likely to show an aortic root dimension exceeding upper limits compared with the young athlete’s data (1-3% vs 0.5%). Aortic dimensions in our cohort correlate with height but not age, years of training or EIH. Our observations indicate that aortic remodeling beyond 40 mm in male or 36 mm in female veteran athletes are uncommon, therefore such measurements should prompt further investigations. Abstract Number: P228 Figure 1 and 2 P229 Efficacy of the international recommendations in adolescent athletes A Malhotra1, H Dhutia1, S Gati1, TJ Yeo1, G Finocchiaro1, E Papatheodorou1, C Miles1, T Keteepe-Arachi1, J Basu1, G Parry-Williams1, H Maclachan1, I Bashir1, M Tome1, M Papadakis1, S Sharma1 1St George's University of London, Cardiac and Vascular Sciences Research Centre, London, United Kingdom of Great Britain & Northern Ireland Topic: Sports Cardiology Background: Competitive adolescent athletes comprise the largest cohort of exercising individuals in society and constitute an increasing number of athletes competing at national and international level. Although exercise-related sudden cardiac death is uncommon, a recent study reported an incidence of 6.8/100,000 among UK-based adolescent athletes which is considerably higher than previous estimates. Paradoxically, data relating to the adolescent athlete’s ECG are sparse and most ECG interpretation criteria are derived from and evaluated in adult athletes. Recently, the international recommendations were devised by a group of American and European experts with the overarching aim of unifying the recommendations for interpretation of the athlete’s ECG. This study compared the effectiveness of the international recommendations with previous ECG criteria for young athletes, in a large group of adolescent soccer players. Aim: This study investigated the efficacy of the recently published international recommendations for ECG interpretation in young athletes in a large cohort of white and black adolescent soccer players. Methods: 11,168 soccer players (mean age 16.4±1.2 years) were evaluated with a health questionnaire, ECG and echocardiogram, of which 10,581 (95%) were males and 10,163 (91%) were white. ECGs were retrospectively analysed according to the 2010 European Society of Cardiology (ESC) recommendations, Seattle criteria, refined criteria and the international recommendations for ECG interpretation in young athletes. Results: The ESC recommendations resulted in a higher number of abnormal ECGs compared with the Seattle, refined and international criteria (13.2%, 4.3%, 2.9% and 1.9% respectively; figure). All four criteria were associated with a higher prevalence of abnormal ECGs in black athletes compared with white athletes (ESC: 16.2% v 12.9%; Seattle: 5.9% vs. 4.2%; refined: 3.8% vs. 2.8%; international 3.6% vs. 1.7%; p < 0.001 each). Compared with ESC recommendations, the Seattle, refined and international criteria reduced the number of abnormal ECGs by 67%, 78% and 86% respectively. All four criteria identified 36 (86%) of 42 athletes with serious cardiac pathology. Compared with ESC recommendations, the Seattle criteria improved specificity from 87% to 96% in white athletes and 84% to 94% in black athletes. The international recommendations demonstrated the highest specificity for white (99%) and black (97%) athletes and a sensitivity of 86%. Conclusions: The international recommendations for ECG interpretation in young athletes can be applied to adolescent athletes for the detection of serious cardiac disease. These recommendations perform more effectively than previous ECG criteria in both white and black adolescent athletes. Abstract Number: P229 Figure P230 The inflammatory cytokine response during a seven-day alpine trail-running competition in healthy athletes S Dinges1, K Esefeld1, J Hambrecht1, F Roeschenthaler2, S Holdenrieder2, J Scharhag1, M Halle1 1Hospital Rechts der Isar, Department of Prevention, Rehabilitation and Sports Medicine, Munich, Germany 2German Heart Center of Munich, Department of Laboratory Medicine, Munich, Germany Topic: Sports Cardiology Background: Excessive endurance exercise induces a release of several immunological signaling proteins (cytokines) depending on exercise duration and intensity. Increased blood cytokine levels can lead to a systemic inflammation, which is hypothesized to play a role in cardiovascular damage. However, not much is known about the course of inflammatory mediators at consecutive and intensive exercise periods over multiple days. The purpose of this work was the evaluation of the exercise-induced inflammatory cytokine response during the Gore-Tex Transalpine-Run 2017 (TAR), a seven-day alpine trail-running competition (264 km total distance, 15463 hm altitude ascent/descent). Methods: 17 healthy participants (12 males; aged 36.5±8 yrs) were examined during the TAR 2017. Blood samples were collected at examination time point baseline T0 (one week before TAR), immediately after finishing the 1st, 3rd and 7th stage of TAR (T1, T3, T7) and one day post race (T8). Samples were analyzed for inflammatory mediators TNF-α, IL-1β, IL-1Ra, IL-6, IL-8, IL-10, IL-12p70, MCP-1 and MIP-1α with a multiplex electrochemiluminescence ELISA. Additionally, the acute phase protein CRP and the CK as a marker for muscle damage were determined. Magnetic resonance imaging (MRI) was performed at T0 and T8 to examine a possible occurrence of myocardial edema and fibrosis. Results: 12 participants (8 males) were able to finish all seven stages, the values from drop-outs did not varied significantly from the finishers. There were significant changes in cytokine levels during the competition (all p< 0.02) as well as significant increases after T1 in IL-6 (14-fold, p< 0.001), IL-10 (4.2-fold, p= 0.004), IL-1Ra (3.5-fold, p= 0.007) and MCP-1 (2-fold, p< 0.001). In the following measurements, the concentrations decreased or remained at a similar level. The CK also showed a significant increase (3.2-fold, p= 0.012) after T1 and the CRP increased delayed after T3 (9-fold, p= 0.005), both with significant changes over time course (p< 0.001). The pro-inflammatory cytokines IL-1β, TNF-α, MIP-1α and IL-8 showed no significant changes over the course of the study. For IL-12p70 no measured values above the lower detection limit could be determined. An influence of gender on the course of the systemic concentrations could only be found in CRP (p= 0.004) with higher values in men. No clinically relevant alterations in MRI could be observed. Conclusion: The results suggest that, after a significant increase at T1 the cytokine response quickly adapts to the repeated exercise. Thus, the cytokine changes show no accumulation during consecutive days but an observable decrease over the following time points. Observed changes occurred in myokines and anti-inflammatory but not in pro-inflammatory cytokines, suggesting a feedback-loop inducing an inhibition of a systemic inflammation. P231 Subclinical coronary artery disease in veteran athletes: is a new pre-participation methodology required? H Dores1, PA Araujo Goncalves2, JC Monge1, R Costa1, A Malhotra3, L Tata1, N Cardim2, N Neuparth4, S Sharma3 1Armed Forces Hospital, Cardiology, Lisbon, Portugal 2Hospital da Luz, Cardiology, Lisbon, Portugal 3St George's University of London NHS Foundation Trust Cardiology Clinical Academic Group, London, United Kingdom of Great Britain & Northern Ireland 4NOVA Medical School, Lisbon, Portugal Topic: Sports Cardiology Objectives: Pre-participation evaluation of veteran athletes should focus on accurate cardiovascular (CV) risk stratification and subclinical detection of coronary artery disease (CAD), which is the main cause of sudden cardiac death in this population. We aimed to investigate the effectiveness of current pre-participation methodology used to identify veteran athletes with high coronary atherosclerotic burden. Methods: A total of 105 male asymptomatic athletes aged ≥40 years old, with low to moderate CV risk (SCORE <5%) and trained ≥4 hours/week during at least the last 5 years, were studied. The screening protocol included clinical evaluation, electrocardiogram, transthoracic echocardiogram and exercise testing. Cardiac computed tomography (CT) was performed to detect CAD, defined as a high atherosclerotic burden according coronary artery calcium (CAC) score and angiography (CCTA). Results: The majority of the athletes (N=88) were involved in endurance sports, with median volume of exercise of 66 [44; 103]METs/h/week. Exercise testing was abnormal in 13 (12.4%) athletes, six (5.7%) withelectrocardiographic criteria for myocardial ischemia and seven (6.7%) with exercise-induced ventricular arrhythmias. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes, of which 11 (40.7%) had CV risk factors, and six had abnormal exercise tests, including three that were positive for myocardial ischemia. Conclusions: Conventional methodology used in pre-participation evaluation of veteran athletes, based on clinical CV risk factors and exercise testing, was poor at identifying significant subclinical CAD. The inclusion of more objective markers, particularly data derived from cardiac CT, is promising for more accurate CV risk stratification of these athletes. Abstract Number: P231 P232 Influence of a consecutive excessive endurance exercise on cardiac biomarkers in athletes during a seven day alpine-trail-running competition K Esefeld1, S Dinges1, J Hambrecht1, F Roeschenthaler2, S Holdenrieder2, M Rasper3, J Nadjiri3, J Scharhag1, M Halle1 1Technical University of Munich, Department of Prevention, Rehabilitation and Sports Medicine, Munich, Germany 2German Heart Center of Munich, Department of Laboratory Medicine, Munich, Germany 3Hospital Rechts der Isar, Department of Interventional and Diagnostic Radiology, Munich, Germany Topic: Sports Cardiology Background: Intensive physical exercise such as a marathon competition is suggested to increase cardiac biomarkers as a possible sign of cardiac damage and dysfunction. The aim of our study was to investigate the effects of consecutive excessive endurance exercise (CEEE) on the changes of cardiac biomarkers in endurance athletes (EA) during the Transalpine-Run (TAR), a seven day trail-running competition with a total distance of 264 km and altitude ascent/descent of 15463 hm. Methods: 17 EA (12 males; age 37±8 yrs; BMI 22±1 kg/m2; total training years 12±8; weekly training volume 11±5 h, 73±24 km) were examined. Blood samples were obtained for biomarker analyses (highsensitive-Troponin T (hs-TnT), NT-proBNP, suppression of tumorigenicity-2 protein (ST2) at baseline (T0) one week before the TAR, within 15 minutes after finishing each exercise stage (T1-T7) and 24 to 48 hours post race (T8). In addition, echocardiography was performed at T0, T3, T5, T7, as well as magnetic resonance imaging (MRI) at T0 and T8 to relate increases in cardiac biomarkers to possible cardiac function and damage. Results: 12 participants (8 males) were able to finish all seven stages completely. All cardiac biomarkers showed a mild increase from T0 to T1: hs-TNT: 2.7-fold from 8 [IQR 1] pg/ml to 23 [IQR 16] pg/ml; p=0.098, NT-proBNP: 3.6-fold from 27 [IQR 43] ng/l to 75 [IQR 138] ng/l; p=0.146 and ST2 1.2 fold from 28 [IQR 8] ng/ml to 35 [IQR 6] ng/ml; p=0.828 with no further significant increases in following measurements. Over the time course of the race the concentrations of the biomarkers remained at a similar elevated level and completely returned to physiological levels at T8. No clinically relevant alterations in echocardiography and MRI could be observed. Conclusion: These results suggest, that the influence of CEEE with mild to moderate intensity does not induce clinically relevant pathological increases in healthy endurance athletes. In addition, echocardiography and MRI results confirm that CEEE seems not to cause cardiac damage and dysfunction. P233 The acute impact of a high altitude ultra-trail race on arrhythmias F D'ascenzi1, A Zorzi2, F Anselmi1, A Ibrahim1, L Spera1, C Ceccon1, S Mondillo1, D Corrado3, F Antonini-Canterin4, L Pagliani4 1University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy 2University of Padova, Department of Cardiac, Thoracic, Vascular and Public Health sciences, Padua, Italy 3University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy 4Ospedale Riabilitativo, Department of Cardiology, Motta di Livenza, Italy Topic: Sports Cardiology Background:Ultra-endurance competitions are becoming increasingly popular but the consequences of ultra-endurance sports activity on the heart rhythm is still a debated issue. Some authors demonstrated that athletes engaging in ultra-endurance sports show a transient rise in cardiac biomarkers and right ventricular dysfunction after a competition, suggesting the possibility of an adverse arrhythmic remodeling and an increased risk of sudden cardiac death. The aim of our study was to evaluate the effects on heart rhythm of an ultraendurance high-altitude race. Methods:The study was performed during the 2018 North Face® Lavaredo Ultra Trail mountain run (Cortina D’Ampezzo, BL, Italy). We recorded the ECG with the FDA-approved MyDiagnostick device. Recordings were performed at baseline the day before the run and immediately after the run in the available athletes. The ECG was analyzed for heart rate, QRS duration, QT interval duration corrected according to the Bazett formula and presence of at least one beat of presumed ventricular origin (PVB). Results: A total of 545 athletes (83% males, mean age: 40±9 years), 241 running the 120 Km race and 304 running the 50 Km race, were included in the study. At baseline, athletes showed a mean heart rate of 64±14 bpm and a mean QRS duration of 92±18 ms. Three (0.5%) showed at least one PVB. Analysis of QTc interval duration showed a mean value of 412±25 ms. After the race, athletes showed a higher heart rate (91±13 bpm, p<0.001), a similar QRS duration (94±16 ms, p=0.32) and a longer QTc interval duration (447±25 ms, p<0.001), as compared to baseline data. The number of athletes showing at least 1 PVB significantly increased to 18 (3.3%, p=0.004) as compared to pre-race evaluation. Athletes engaged in the 120 Km run showed a slightly longer post-run QTc interval (450±24 versus 444±25 ms, p=0.009) while the post-run QRS duration was similar between the two groups. The presence of PVBs after the race was not correlated with the duration of QTc interval. Conclusions:In this study we found an increased number of PVBs and a prolonged QTc duration after an ultra-endurance competition. Increased ventricular ectopic activity and QT prolongation recorded shortly after an intense and prolonged exercise could contribute to the increased risk of arrhythmias occurring after the finish line. P234 Cardiac magnetic resonance with parametric mapping in long-term ultra-marathon runners LA Malek1, M Barczuk-Falecka2, K Werys3, A Czajkowska4, A Mroz5, K Witek5, W Bakalarski5, D Nowicki4, D Roik2, M Brzewski2 1Józef Pilsudski University of Physical Education, Faculty of Rehabilitation, Warsaw, Poland 2Medical University of Warsaw, Department of Pediatric Radiology, Warsaw, Poland 3University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland 4Józef Pilsudski University of Physical Education, Faculty of Tourism and Recreation, Warsaw, Poland 5Józef Pilsudski University of Physical Education, Faculty of Physical Education, Warsaw, Poland Funding Acknowledgements: The study was financed by a statutory grant of the Józef Piłsudski University of Physical Education in Warsaw (DS-296). Topic: Sports Cardiology Background: There is a direct, reverse dose-effect relationship between the amount of physical training and cardiovascular risk. It is unknown whether this is true for extreme, persistent endurance training. The aim of the study was to assess structural changes of the heart in long-time ultra-marathon runners with special focus on local and diffuse myocardial fibrosis. Methods: We studied a group of 30 healthy, male ultra-marathon runners (mean age 40.9±6.6 yrs, median 9 yrs of running with frequent competitions) and 10 matched sedentary controls. All of them underwent cardiac magnetic resonance (CMR) with 3T scanner including T1-mapping, late gadolinium enhancement (LGE) and extracellular volume (ECV) calculation. Results: Runners had larger heart chambers, higher left ventricular (LV) mass and unchanged systolic function with LV geometry shift towards eccentric remodelling in 50% of them. Increase of ventricular size was so marked, that 73.3% of athletes fulfilled volumetric criteria for dilated cardiomyopathy and/or major Task Force criteria for arrhythmogenic right ventricular cardiomyopathy. Non-ischemic, small LGE was found in 8 athletes and in 1 control (27% vs. 10%, p=0.40). It was localised in insertion points (5 athletes, 1 control) or in the septum/infero-lateral wall (3 athletes) (Figure). Athletes with insertion point LGE had higher right ventricular end-diastolic volume index in comparison to athletes without LGE (p=0.04). There were no differences between athletes and non-athletes in terms of pre- and post- contrast T1 mapping and ECV values (Table), including the remote myocardium in those with LGE. Conclusions: Ultra-marathon runner’s hearts demonstrate high degree of structural remodelling. This seems to be a part of positive adaptation to extensive physical activity, as there is no significant increase of focal or diffused myocardial fibrosis. Ultra-marathon runners, n=30 Controls, n=10 p Pre-contrast T1 (ms) 1200±59 1214±32 0.33 Post-contrast T1 (ms) 675±46 663±33 0.38 ECV (%) 26.1±2.9 25.0±2.5 0.29 Ultra-marathon runners, n=30 Controls, n=10 p Pre-contrast T1 (ms) 1200±59 1214±32 0.33 Post-contrast T1 (ms) 675±46 663±33 0.38 ECV (%) 26.1±2.9 25.0±2.5 0.29 Open in new tab Ultra-marathon runners, n=30 Controls, n=10 p Pre-contrast T1 (ms) 1200±59 1214±32 0.33 Post-contrast T1 (ms) 675±46 663±33 0.38 ECV (%) 26.1±2.9 25.0±2.5 0.29 Ultra-marathon runners, n=30 Controls, n=10 p Pre-contrast T1 (ms) 1200±59 1214±32 0.33 Post-contrast T1 (ms) 675±46 663±33 0.38 ECV (%) 26.1±2.9 25.0±2.5 0.29 Open in new tab Abstract Number: P234 Figure. Patterns of focal fibrosis P235 BEAT-IT: a de novo screening programme for causes of sudden cardiac death in maltese adolescents M Abela1, S Xuereb2, W Camilleri2, J Fleri Soler2, E Abela2, A Callus2, J Bonello2, M Farrugia2, L Buttigieg2, K Yamagata2, T Felice2, M Burg2, MA Sammut2, M Papadakis1, S Sharma1 1St George's University of London, MSc Sports Cardiology, Cardiology clinical academic group, London, United Kingdom of Great Britain & Northern Ireland 2Mater Dei Hospital of Malta, Cardiology, Msida, Malta On Behalf of: BEAT-IT Investigators Funding Acknowledgements: Research, Innovation and Development Trust [University of Malta] Topic: Sports Cardiology Introduction: Screening for conditions predisposing to Sudden Cardiac Death (SCD) in athletes is recommended by a number of scientific and sporting organisations. The ethics of limiting screening to athletes has been challenged as identifying high-risk individuals early on may allow life-saving interventions, irrespective of athletic ability. Objectives: To investigate the feasibility, diagnostic yield and associated costs of a de novo, national screening program aimed at detecting cardiac conditions in Maltese adolescents. Methodology: All year 11 students [14-16 years] were offered cardiac screening with a questionnaire and 12-lead electrocardiogram (ECG). The questionnaire explored demographics, symptoms, family history of SCD and athletic ability. ECGs were carried out on-site and transferred digitally to a secure online platform. ECG interpretation was based on the International criteria. The project was approved by the data protection agency, research ethics committee, ministry of education and the department of cardiology. Consent was sought from the subjects and individuals’ parents. Results: A total of 4155 students were eligible for participation across 49 schools in Malta. 2708 [68%] students agreed to undergo screening. A total of 102 [3.7%] individuals were referred for further evaluation. A third [32%] of those referred were athletic individuals. The majority of referrals were for an abnormal ECG [69.6%], with 20.6% reporting symptoms. Nine (0.3%) adolescents were diagnosed with a disease linked to SCD (n=1 HCM, n=1 LQTS, n=5 WPW, n=2 Coronary Anomalies). In addition, 27 [1.0%] are under surveillance, 38 [1.4%] need a repeat ECG in 1 year, with 25 [0.92%] reassured and discharged after secondary evaluation. The total cost of the screening program was €135,107, which averaged to a cost of €50 per person screened or €15,012 per serious condition identified. Conclusion: Our results indicate that a national screening program is feasible on a wider scale, provided an adequate network with the necessary expertise are available. P236 Additional yield and challenges of transthoracic echocardiography as a first-line screening tool; experience from a national cardiac screening programme in elite cricketers H Maclachlan1, H Roth1, B Ibrahim1, J Basu1, C Miles1, G Parry-Williams1, H Dhutia1, K Boden2, A Malhotra1, N Peirce2, S Sharma1, M Papadakis1 1St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland 2Loughborough University, ECB National Performance Centre. National Centre for Sports and Exercise Medicine , Loughborough, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: Cardiac Risk in The Young Topic: Sports Cardiology Background: The routine inclusion of echocardiography as a screening tool is primarily limited by cost. In 2008, an electrocardiogram-based cardiac screening programme was introduced by The England Cricket Board (ECB) for all elite cricketers in England and Wales. A select number of athletes underwent additional evaluation with transthoracic echocardiography (TTE) despite normal findings on their health questionnaire (HQ) and electrocardiogram (ECG). We sought to evaluate the diagnostic yield of TTE and the cost-effectiveness of this screening strategy. Methods: Between 2008 and 2018, 822 cricketers aged ≥ 14 years underwent cardiac screening. We selected 554 cricketers (mean age of 22.4 ± 5.5 years, 90 % male, 93% Caucasian) who were evaluated with a TTE as a first-line screening tool, despite normal HQ and ECG on the same day. Athletes were referred for secondary evaluation as deemed necessary. TTE findings were categorized as ‘major’ if associated with sudden cardiac death (SCD) or requiring cardiac intervention. The additional cost of the TTE was calculated as £200 per athlete based on the tariff of the screening provider. Results: Of the 554 athletes screened, 34 athletes (6.1%) required further evaluation due to the TTE findings: 1 with a severely dilated aorta and aortic regurgitation requiring surgical intervention and 36 (6.4%) athletes with other findings of which 32 (5.8%) required regular surveillance (14 within the grey zone of athlete’s heart versus cardiomyopathy, 5 with bicuspid aortic valve, 5 with mitral regurgitation, 1 with mitral valve prolapse, 4 with dilated aorta, 3 with aortic regurgitation). The additional cost of TTE to the cardiac protocol was £110,800 which identified a life-threatening condition. The cost per minor condition identified was £6,156. No players experienced adverse cardiac events during a mean follow up of 44.5months ± 5.6 months. Conclusion: TTE has the potential to identify aortic and valvular disease at an incremental cost. Such conditions require follow-up as they may confer increased risk later in life, particularly in the context of sustained competitive sport. TTE did not identify any cardiomyopathies in the context of asymptomatic cricketers with no significant family history or ECG. On the contrary, it raised suspicion of cardiomyopathy in a significant proportion of athletes resulting to potentially unnecessary investigations and follow-up. P237 Preliminary electrocardiographic insights from a prospective registry of singapore national athletes T J Yeo1, M Wang2, R Grignani2, J Mckinney3, LP Koh1, F Tan4, G Chan4, SP Chan1, CH Lee1, AM Richards1 1National University Heart Centre, Department of Cardiology, Singapore, Singapore 2National University Hospital, Singapore, Singapore 3University of British Columbia, SportsCardiologyBC, Vancouver, Canada 4Singapore Sports Institute, Singapore, Singapore Funding Acknowledgements: National University of Singapore Clinician Scientist Program Grant Topic: Sports Cardiology Introduction: Evolving criteria for electrocardiographic (ECG) interpretation in athletes have highlighted unique differences due to ethnicity and gender. Whereas Caucasian and African-Caribbean athletes currently have well-defined ECG characteristics, there is paucity of data for athletes in Asia. Purpose: To describe ECG characteristics of Singapore national athletes as part of a prospective sports cardiology registry. Methods: All able-bodied Singapore national athletes aged ≥18 years regardless of sport are eligible for recruitment into the registry. A questionnaire comprising demographic information, training and medical history is administered, together with resting 12-lead ECG and echocardiogram. Results: ECGs of 150 consecutive athletes (50% female, 88% Chinese ethnicity, mean age 26.1 ± 5.7 years, mean training duration 19.3 ± 8.8 hrs/week, mean competitive experience 8.5 ± 4.7 years) from 32 different sports [101 (67.3%) high dynamic component (>70% maximum oxygen uptake)] were analysed. Sinus bradycardia (65.3%), early repolarization (46%) and sinus arrhythmia (25.3%) were the commonest training-related changes. In males, early repolarization (ER) (70.7 vs 21.3%, p<0.0001) and voltage criteria for left ventricular hypertrophy (LVH) (17.3 vs 4%, p<0.02) were more common compared to females. Athletes in sports with high dynamic component demonstrated more sinus bradycardia (75.2 vs 44.9%, p<0.0001), ER (54.5 vs 28.6%, p=0.003) and voltage criteria for LVH (15.8 vs 0%, p<0.001) compared to those with low to moderate dynamic component. The number of abnormal ECGs was reduced from 30 (20%) using European Society of Cardiology 2010 criteria, to 12 (8%) using Seattle criteria, to 9 (6%) using International criteria. Of the final 9 abnormal ECGs, one showed 2 premature ventricular contractions, one had QRS duration of 140 msec and 7 showed anterior T wave inversions (ATWI) beyond lead V2 (6 female, 100% Chinese, 8% prevalence among female athletes). Paired echocardiograms for all 9 abnormal ECGs revealed structurally normal hearts. Conclusion: Contemporary ECG interpretation criteria appear effective in reducing abnormal ECGs in Singaporean athletes. The high prevalence of ATWI beyond V2 in female athletes (4 times more than Caucasian female athletes) warrants further validation to differentiate ethnicity-related physiological changes from cardiac pathology. P238 Cardiac dimension and function during a seven day alpine-trail-running competition (Gore-Tex Transalpine-Run) in athletes J Hambrecht1, K Esefeld1, S Dinges1, J Nadjiri2, M Rasper2, S Holdenrieder3, F Roeschenthaler3, J Scharhag1, M Halle1 1Hospital Rechts der Isar, Department for Prevention, Rehabilitation and Sports Medicine, Munich, Germany 2Hospital Rechts der Isar, Department of Interventional and Diagnostic Radiology, Munich, Germany 3German Heart Center of Munich, Department of Laboratory Medicine, Munich, Germany Topic: Sports Cardiology Background: Consecutive excessive endurance exercise (CEEE) is hypothesized to induce pathologic cardiac remodeling and function. The purpose of the study was to investigate the effects of CEEE on cardiac dimension and function in endurance athletes (EA) during the Transalpine-Run (TAR), a seven day trail-running competition with a total distance of 264 km and altitude ascent/descent of 15463 hm. Methods: 17 EA (12 males; age 37±8 yrs; BMI 22±1 kg/m2; total training years 12±8; weekly training volume 11±5 h, 73±24 km) were examined. Echocardiography was performed at baseline (T0) one week before, within one hour after finishing the 3rd, 5th, 7th stage of TAR (T3, T5, T7). In seven EA magnetic resonance imaging (MRI) was performed at T0 and 24 to 48 h after the race (T8) to detect myocardial edema and fibrosis. NT-proBNP was measured at T0, within 15 min after finishing each stage (T1-7) and at T8 of TAR. Results: 12 EA finished the TAR with an average total time of 39±9 h. During TAR (T0, T3, T5, T7), left ventricular end diastolic volume (LVEDV), ejection fraction (EF) and diastolic function (E/E‘) did not differ significantly. Right ventricular diastolic area (RVDA) increased from T0 to T3 without a further increase to T5 and T7, whereas fractional area change (RVFAC), tricuspidal annular plane systolic excursion (TAPSE) and RV diastolic function (E‘/A‘) decreased significantly from T0 to T3 (table). MRI only demonstrated a significant but clinically irrelevant increase in mid-ventricular T1-mapping from 1216±24 to 1233±11 ms (p<.05). NT-proBNP increased significantly (29±6 to 365±78 ng/l, p<.001) and correlated moderately with the decrease in TAPSE (r=-.702 p=.011). Conclusion: In EA a competition with CEEE does not induce significant changes on LV dimension and function, whereas RV dimension and function alters initially, but remains stable until the end. In addition, CEEE in EA does not cause myocardial edema or fibrosis. Therefore, even CEEE does not seem to clinically worsen relevantly cardiac dimension and function in EA. T0 T3 T5 T7 p LVEDV [ml] 144±29 150±33 135±27 146±24 0,530 LVEF [%] 55±11 51±5 54±3 54±6 0,531 LV E/E‘ 5,6±1,4 5,8±2,0 6,1±2,4 5,7±2,4 0,406 RVDA [cm2] 26±7 29±4 28±3 30±5 0,016 RVFAC [%] 43±13 31±10 33±7 33±7 0,013 TAPSE [mm] 34±5 27±4 25±4 28±4 <0,001 RV E‘/A‘ 1,0±0,4 0,6±0,3 0,6±0,3 0,8±0,4 0,014 T0 T3 T5 T7 p LVEDV [ml] 144±29 150±33 135±27 146±24 0,530 LVEF [%] 55±11 51±5 54±3 54±6 0,531 LV E/E‘ 5,6±1,4 5,8±2,0 6,1±2,4 5,7±2,4 0,406 RVDA [cm2] 26±7 29±4 28±3 30±5 0,016 RVFAC [%] 43±13 31±10 33±7 33±7 0,013 TAPSE [mm] 34±5 27±4 25±4 28±4 <0,001 RV E‘/A‘ 1,0±0,4 0,6±0,3 0,6±0,3 0,8±0,4 0,014 Open in new tab T0 T3 T5 T7 p LVEDV [ml] 144±29 150±33 135±27 146±24 0,530 LVEF [%] 55±11 51±5 54±3 54±6 0,531 LV E/E‘ 5,6±1,4 5,8±2,0 6,1±2,4 5,7±2,4 0,406 RVDA [cm2] 26±7 29±4 28±3 30±5 0,016 RVFAC [%] 43±13 31±10 33±7 33±7 0,013 TAPSE [mm] 34±5 27±4 25±4 28±4 <0,001 RV E‘/A‘ 1,0±0,4 0,6±0,3 0,6±0,3 0,8±0,4 0,014 T0 T3 T5 T7 p LVEDV [ml] 144±29 150±33 135±27 146±24 0,530 LVEF [%] 55±11 51±5 54±3 54±6 0,531 LV E/E‘ 5,6±1,4 5,8±2,0 6,1±2,4 5,7±2,4 0,406 RVDA [cm2] 26±7 29±4 28±3 30±5 0,016 RVFAC [%] 43±13 31±10 33±7 33±7 0,013 TAPSE [mm] 34±5 27±4 25±4 28±4 <0,001 RV E‘/A‘ 1,0±0,4 0,6±0,3 0,6±0,3 0,8±0,4 0,014 Open in new tab P240 The short PR interval in young athletes G Parry-Williams1, A Malhotra1, H Dhutia2, A Cajucom3, M Papadakis1, S Sharma1 1St George's University of London, Molecular and Clinical Sciences Research, London, United Kingdom of Great Britain & Northern Ireland 2University Hospitals of Leicester NHS Trust, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland 3St George's University of London NHS Foundation Trust Cardiology Clinical Academic Group, London, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: Cardiac Risk in the Young Topic: Sports Cardiology Background: International recommendations for interpreting the athlete’s ECG define a short PR interval as <120ms. Despite the recommendation that asymptomatic athletes do not require further investigation unless an accessory pathway is suspected, athletes are not infrequently referred for further evaluation. The prevalence of a short PR in athletes has not previously been reported. Purpose: To investigate the prevalence of short PR in young athletes and its association with age, gender and ethnicity. Methods: Between 2011-2014, 15,572 athletes aged 14-35 underwent cardiac screening including an ECG. An athlete was defined as an individual participating in sport ≥6hrs/wk. ECGs were analysed by 2 independent experts. Athletes in whom the PR interval was not fixed were excluded. A short PR was defined as <120ms. Results: Amongst 15,572 athletes (mean age 18.6 years, 92% white, 80% male), the mean PR interval was 151msec and shorter in females vs. males, white vs. non-white and adolescent (≤16 years) vs. older (17-35 years) athletes (Table 1). An isolated short PR was present in 765 (4.9%) athletes and was more common in females vs. males (6.2% vs. 4.2%; p<0.0001). The prevalence of short PR in athletes reduced significantly with advancing age, present in 9% of 14 year olds but only 3.2% of 17-35 year olds (p<0.0001). The prevalence of short PR was similar between ethnic groups (4.7% white vs 4.2% non-white; p=0.55). The overall prevalence of the Wolff-Parkinson-White pattern was 0.08%. Conclusions: A short PR interval is a fairly frequent finding in this cohort with a predilection for younger and female athletes. Possible explanations for shorter conduction time include anatomically smaller hearts, higher sympathetic tone or enhanced resting AV node conduction. The high frequency of short PR in young athletes suggests that in the absence of an accessory pathway or symptoms its presence should not prompt further investigation. Long-term follow-up studies are required in order to draw definitive conclusions. Variable Mean ± SD p value Sex Male 151.57 +/- 23.88 <0.0005 Female 146.27+/-22.10 Ethnicity White 149.96+/-23.30 <0.0005 Non-White 144.67+/-21.10 Age (years) 14-16 144.67+/-21.10 <0.0005 17-35 156.22+/-24.55 Variable Mean ± SD p value Sex Male 151.57 +/- 23.88 <0.0005 Female 146.27+/-22.10 Ethnicity White 149.96+/-23.30 <0.0005 Non-White 144.67+/-21.10 Age (years) 14-16 144.67+/-21.10 <0.0005 17-35 156.22+/-24.55 Table demonstrating the mean, standard deviations and p-values according to sex, ethnicity and age. Open in new tab Variable Mean ± SD p value Sex Male 151.57 +/- 23.88 <0.0005 Female 146.27+/-22.10 Ethnicity White 149.96+/-23.30 <0.0005 Non-White 144.67+/-21.10 Age (years) 14-16 144.67+/-21.10 <0.0005 17-35 156.22+/-24.55 Variable Mean ± SD p value Sex Male 151.57 +/- 23.88 <0.0005 Female 146.27+/-22.10 Ethnicity White 149.96+/-23.30 <0.0005 Non-White 144.67+/-21.10 Age (years) 14-16 144.67+/-21.10 <0.0005 17-35 156.22+/-24.55 Table demonstrating the mean, standard deviations and p-values according to sex, ethnicity and age. Open in new tab Abstract Number: P240 Short PR prevalence according to age P241 Large individual variation in exercise-induced cTn response: potential implications for clinical use M Bjorkavoll-Bergseth1, O Kleiven1, T Wiktorski2, O Skadberg3, V Froysa1, C Bjorkvik1, K Moberg Aakre4, S Orn1 1Stavanger University Hospital, Department of cardiology, Stavanger, Norway 2University of Stavanger, Department of Mathematics and Natural sciences, Stavanger, Norway 3Stavanger University Hospital, Departement of Biochemistry, Stavanger, Norway 4Haukeland University Hospital, Department of Biochemistry, Bergen, Norway On Behalf of: NEEDED Funding Acknowledgements: Grant from ConocoPhillips, PhD fellowship Helse Vest Topic: Sports Cardiology Background: Cardiac Troponins (cTn) are markers of myocardial injury. However, following strenuous exercise there is a cTn increase in healthy subjects. This increase is thought to reflect a physiological response to exercise. The mechanisms causing this physiological cTn increase remain to be determined. Purpose: The purpose of this study was to determine if the exercise-induced cTn response differs between individuals. Methods: The present study compared the repeated cTn response to exercise in subjects with either a high or a normal cTn response to exercise. Study subjects were recruited from a pool of healthy recreational cyclists without obstructive coronary artery disease, that had participated in the NEEDED study. All subjects completed the 91-km mountain bike North Sea Race (NSR) twice, either in 2013 or 2014 and in 2018. High-sensitive cTnI was measured before, and 3- and 24-hours following the races. Exercise characteristics during the race were assessed by power meters and heart rate monitors (2018). Additionally, a cardio-pulmonary exercise test (CPx) were undertaken in all subjects, hs-cTnI were measured before, 3 and 24 hours after the test. Depending upon the maximum cTnI concentration following the race in 2013/2014, subjects were categorized either as High-responder (cTnI >200 ng/L) or Control (cTnI <200 ng/L), and the variation in cTnI response was compared. Results: A total of 52 healthy subjects were included: 73% males, 50 (±9) years old. The High-responder group included 38 subjects whereas the Control group included 24 subjects. There was no difference between the two groups with regard to demographics, training condition, blood pressure, Vo2 max, power at anaerobic threshold, average power during the race, race duration or heart rate during the CPx test or during the race in 2018. There was a highly significant increase in cTnI both after the CPx-test and after the race with maximal values 3 hours following exercise. Comparing the cTn levels with the work performed in the CPx test (0.7 hours), the 2018 race (4.2 hours) and the 2014 race (3.7 hours), cTn levels were significantly higher following the race in 2014 (p<0.001). The High-responder group had significantly (p<0.001) higher cTnI levels than the Control group after the race in 2018 (Figure1). Troponin values were also higher in the High-responder group at 3 hours following the CPx test, but did not reach significant difference at 24 hours following the test. Conclusion: Our findings demonstrate that the exercise induced cTn response differs between healthy individuals. These findings suggest that individual reference values must be established if the exercise induced cTn response is to be used in a diagnostic setting. Abstract Number: P241 P242 QT interval duration, long QT pattern and changes over time in children practicing sport F D'ascenzi1, F Anselmi1, F Graziano1, B Berti2, A Franchini2, E Bacci1, C Ceccon1, M Capitani3, M Bonifazi2, S Mondillo1 1University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy 2University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy 3Center for Sports Medicine, Siena, Italy Topic: Sports Cardiology Background: Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of adult athletes, providing information about life-threatening cardiovascular diseases such as long-QT syndrome. However, changes induced by development challenge the interpretation of ECG in the paediatric population, particularly for the repolarization phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration during preadolescence. Methods: A final population of 1473 children practising sport (mean age: 12.0±1.8 years, interval 7-15 years) was analysed. Each athlete was evaluated at baseline, mid-term and end of the study with a mean follow-up of 3±1 years. QT interval was corrected with Bazett (B) and Fridericia (F) formulae. Results: At baseline QTcB was 412±25ms and QTcF 387±21ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In children with QTc≥480ms confirmed both by Bazett and Fridericia formulae, QT duration persisted abnormal during the follow-up and children were disqualified. Conversely, children with borderline QTc intervals (>460 and <480ms) were not disqualified and we found a normalization of QT interval during the development. Mean difference in the calculation of QT between the two formulae was 25±11ms, p<0.0001. For HR values higher than 80 bpm, the QTcF resulted with low fluctuations around the mean was independent from HR values. Conversely, the QTcB revealed significant growing trend as the HR increased and showed higher variability than Fridericia correction. Conclusions: QT duration does not change over time in children with normal duration. A minority of children has a QT≥480ms; in these subjects QT interval remains prolonged during the follow-up. Conversely, in children with borderline QT, mid-term follow-up is useful to identify a normalization during the growth. Clinicians should take into account that the use of Bazett and Fridericia correction formulae is not interchangeable and that Fridericia formula should be preferred when resting HR is higher than 80 bpm. Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24 * 346±25 * <0.0001 RR (ms) 599±111 711±111 * 721±119 *^ <0.0001 QTc Bazett (ms) 412±25 (371 - 449) 411±25 (367 - 449) 409±25 (367 - 446) 0.10 QTc Fredericia (ms) 387±21 (355 - 418) 387±20 (353 - 419) 387±20 (353 - 418) 0.59 Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24 * 346±25 * <0.0001 RR (ms) 599±111 711±111 * 721±119 *^ <0.0001 QTc Bazett (ms) 412±25 (371 - 449) 411±25 (367 - 449) 409±25 (367 - 446) 0.10 QTc Fredericia (ms) 387±21 (355 - 418) 387±20 (353 - 419) 387±20 (353 - 418) 0.59 FU, follow up; *p<0.0001 vs. baseline; §p<0.0001 vs. mid-term FU; ^ p<0.05 vs. mid-term FU. Open in new tab Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24 * 346±25 * <0.0001 RR (ms) 599±111 711±111 * 721±119 *^ <0.0001 QTc Bazett (ms) 412±25 (371 - 449) 411±25 (367 - 449) 409±25 (367 - 446) 0.10 QTc Fredericia (ms) 387±21 (355 - 418) 387±20 (353 - 419) 387±20 (353 - 418) 0.59 Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24 * 346±25 * <0.0001 RR (ms) 599±111 711±111 * 721±119 *^ <0.0001 QTc Bazett (ms) 412±25 (371 - 449) 411±25 (367 - 449) 409±25 (367 - 446) 0.10 QTc Fredericia (ms) 387±21 (355 - 418) 387±20 (353 - 419) 387±20 (353 - 418) 0.59 FU, follow up; *p<0.0001 vs. baseline; §p<0.0001 vs. mid-term FU; ^ p<0.05 vs. mid-term FU. Open in new tab P243 The value of blood pressure during physical activity in young elite athletes. V Komoliatova1, L Makarov1, D Besportochnii1, I Kiseleva1, N Fedina1 1Centre for Syncope & Cardiac Arrhythmias in Children & Adolescents of the Federal Medical-Biolo, Moscow, Russian Federation Topic: Sports Cardiology Background: It has been shown in athletes the maximum systolic blood pressure (SBP) in physical activity depends on gender and it is 220 mmHg among men and 200 mmHg among women (Caselli S, 2016). In children the value of SBP depends on height. But this aspect does not consider at the load. Propose: to determine the BP in young elite athletes depending on height. Methods: we examined 2305 (age 16±1.3 years, 45% men) young elite athletes of the members of the National teams with normal BP at the rest. The men's height was 179±13 cm and women's 168±10 cm. All of them were conducted bicycle ergometry using the PWC170 protocol with an initial load of 1 W/kg with a subsequent load increase every 3 minutes by 25 W until the pulse 170 bpm or physical fatigue. BP was measured manually at maximum load. Results: The tolerance of physical exercise in men was higher than in women (2.5±0.4 W/kg vs 2.2±0.4 W/kg, p<0.001). The maximum heart rate (HR) were reached in 38% (873, 41% men), 62% did not reach it, there HR - 155±11 bpm in men and 154±11 bpm in women. The values of the maximum BP were significantly higher in men: SBP 195±25 vs 175±20 mmHg, p<0.001; diastolic blood pressure (DBP) 80±11 vs 80±10 mmHg, p<0.05. We revealed correlations between BP at height (SBP: r=0.55, p<0.001; DBP: r=0.18, p<0.001). The percentile values of the maximum SBP in young elite athletes depending on height presented in table. Conclusion: In young elite athletes the maximum value of BP during physical activity depends not only on gender, but also on height. Men cm 140-149 (n=26) 150-159 (n=55) 160-169 (n=308) 170-179 (n=326) 180-189 (n=326) 190-199 (n=167) 200-209 (n=37) 95% 188 188 208 233 234 240 251 75% 158 171 192 208 214 221 224 50% 150 159 178 195 202 207 209 25% 138 144 164 181 190 196 195 5% 122 132 142 160 171 174 171 Women cm 140-149 (n=31) 150-159 (n=195) 160-169 (n=500) 170-179 (n=375) 180-189 (n=149) 190-199 (n=22) 200-209 (n=1) 95% 184 191 206 211 216 211 75% 168 177 187 191 194 202 50% 153 164 174 179 185 188 233 25% 138 151 162 167 172 176 5% 119 130 138 149 152 168 Men cm 140-149 (n=26) 150-159 (n=55) 160-169 (n=308) 170-179 (n=326) 180-189 (n=326) 190-199 (n=167) 200-209 (n=37) 95% 188 188 208 233 234 240 251 75% 158 171 192 208 214 221 224 50% 150 159 178 195 202 207 209 25% 138 144 164 181 190 196 195 5% 122 132 142 160 171 174 171 Women cm 140-149 (n=31) 150-159 (n=195) 160-169 (n=500) 170-179 (n=375) 180-189 (n=149) 190-199 (n=22) 200-209 (n=1) 95% 184 191 206 211 216 211 75% 168 177 187 191 194 202 50% 153 164 174 179 185 188 233 25% 138 151 162 167 172 176 5% 119 130 138 149 152 168 Open in new tab Men cm 140-149 (n=26) 150-159 (n=55) 160-169 (n=308) 170-179 (n=326) 180-189 (n=326) 190-199 (n=167) 200-209 (n=37) 95% 188 188 208 233 234 240 251 75% 158 171 192 208 214 221 224 50% 150 159 178 195 202 207 209 25% 138 144 164 181 190 196 195 5% 122 132 142 160 171 174 171 Women cm 140-149 (n=31) 150-159 (n=195) 160-169 (n=500) 170-179 (n=375) 180-189 (n=149) 190-199 (n=22) 200-209 (n=1) 95% 184 191 206 211 216 211 75% 168 177 187 191 194 202 50% 153 164 174 179 185 188 233 25% 138 151 162 167 172 176 5% 119 130 138 149 152 168 Men cm 140-149 (n=26) 150-159 (n=55) 160-169 (n=308) 170-179 (n=326) 180-189 (n=326) 190-199 (n=167) 200-209 (n=37) 95% 188 188 208 233 234 240 251 75% 158 171 192 208 214 221 224 50% 150 159 178 195 202 207 209 25% 138 144 164 181 190 196 195 5% 122 132 142 160 171 174 171 Women cm 140-149 (n=31) 150-159 (n=195) 160-169 (n=500) 170-179 (n=375) 180-189 (n=149) 190-199 (n=22) 200-209 (n=1) 95% 184 191 206 211 216 211 75% 168 177 187 191 194 202 50% 153 164 174 179 185 188 233 25% 138 151 162 167 172 176 5% 119 130 138 149 152 168 Open in new tab P244 Evaluation of oxidative stress and antioxidant status in Georgian elite athletes with overtraining syndrome L Maskhulia1, T Kajaia1, K Chelidze1, M Matiashvili1, Z Kakhabrishvili1, T Chutkerashvili1, A Gogelia1, N Tskhvediani1, L Akhalkatsi1 1Tbilisi State Medical Unversity, Tbilisi, Georgia Topic: Sports Cardiology Background: Progress of performance as a result of athletic training is achieved through increased training loads. Inadequate recovery time or an abrupt increase in training load may produce overloading. If overloading is extreme and combined with an additional stressor, non-functional overreaching(NFO), and then overtraining syndrome(OTS) may result. Oxidative stress(OS) has been suggested as one of the causes of OTS. OS could occur due to an imbalance between oxidant production and the antioxidant capacity(AC) of the tissue. Impaired AC and increased OS, where the production of reactive oxygen species overwhelms antioxidant defence, could be predisposing factors to overtraining. Purpose of the study was to examine the relationship between oxidative stress and overtraining syndrome in Georgian elite athletes by evaluation in serum oxidative and antioxidant status. Methods: Diagnosis of OTS was based on the checklist provided by the consensus statement of the European College of Sports Science and the American College of Sports Medicine. In 43 athletes with NFO/OTS and 40 athletes without NFO/OTS–control athletes (CA), diacron-reactive oxygen metabolites (d-ROMs) and biological antioxidant potential(BAP) in serum, as well as ratio of d-ROMs and BAP test measurements-marker of OS, were assessed. OS assessment was performed by means of an integrated analytical system(FRAS4, H&D s.r.l., Italy) using d-ROMs and BAP test kits(Diacron International s.r.l., Italy). Baseline data collection performed in both groups of athletes-with NFO/OTS and CA, followed by data collection in athletes with NFO/OTS after 28 days of rest. In athletes suspicious for OTS all measurements were performed after 2 more months of rest. Results of the study showed higher baseline d-ROMs in NFO/OTS athletes than in CA(340,1±41,5 vs. 296±32,6 CARR U, p<0,05), whereas antioxidant potential in CA was significantly higher, than in NFO/OTS athletes(3205±375,3 vs. 2147,8±411,7μmol/L p<0.01). After 28 days of rest there was significant decrease in d-ROM values in both: athletes with NFO and with OTS, to 291±26,7 and 302,5±22,0 CARR U respectively, as well as normalization of antioxidant status in athletes with NFO (2536±346,4μmol/L). Total 3 month of rest showed improvement in the oxidative status of athletes with OTS, reaching normal values(276,5±23,1 CARR U, p=0,005), though antioxidant status remained without significant improvement, showing subnormal BAP values(1965,7±173,1μmol/L) and decreased BAP/d-ROM ratio(7,1±0,9). The results demonstrate increased OS in overtraining state, creating disbalance between d-ROM production and AC. Conclusions: Prolonged imbalance between oxidant production and antioxidant protection via attenuation of AC can be a cause of overtraining in highly trained athletes. Monitoring physiological responses to long-term physical exercise, including OS and AC, could be useful additional tool to determine the need for adequate recovery to avoid OTS in athletes. P245 Coronary angiography characteristics of out-of-hospital sudden cardiac arrest occurring in sport-related acute myocardial infarction F Chague1, G Porot1, R Robert1, A Avondo2, P Ray2, A Gudjoncik1, F Bichat1, D Brunet3, JC Beer1, M Maza1, Y Cottin1, M Zeller4 1University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France 2University Hospital Center, Emergency Department, Dijon, France 3Hopital Privé Dijon Bourgogne, Cardiology Department, Dijon, France 4Université de Bourgogne Franche Comté, PEC2, EA7460, Dijon, France On Behalf of: RICO SURVEY Funding Acknowledgements: CHU DIJON AND ARS BOURGOGNE FRANCHE COMTE Topic: Sports Cardiology Background: Although out-of-hospital sudden cardiac arrest (OHSCA) frequently occurs in sport-related acute myocardial infarction (AMI), contemporary clinical and coronary angiography (CA) findings remains poorly described. Purpose: In a large retrospective study at a French regional scale, we aimed to investigate clinical and CA characteristics of patients who experienced OHSCA in sport-related AMI. Methods: From the RICO database, a French regional AMI survey, we retrospectively analysed the consecutive patients admitted in cardiology intensive care unit of a single university hospital from January 2011 to January 2018 for sport-related AMI and who underwent CA (n = 100). Data from patients with OHSCA (OHSCA+) were compared with patients without OHSCA (OHSCA-). Results: Among the study population, 20% had OHSCA. Main characteristics are presented in Table (Median or %) Conclusions: AMI patients with OHSCA were 13 y older, and are characterized by a higher rate of culprit lesion involving LAD, and had much poorer hospital outcome. CAD extent and proximal distribution of lesions showed a trend toward a more severe profile. Whether the CAD burden of OHSCA are driven by age remains to be investigated. Characteristics OHSCA+ N=20 OHSCA- N=80 p Age (y) 69 56 <0.001 Male (%) 85 86 Prior CAD (%) 15 9 0.830 Prodromal symptoms (%) 15 33 0.340 STEMI (%) 45 56 0.515 Hospital death 10 0 <0.001 Angiographically normal CA (%) 15 13 SYNTAX Score 12(7-15) 8(4-13) 0.057 Culprit Proximal lesion (%) 71 41 0.059 LAD culprit lesion (%) 77 34 <0.005 RCA culprit lesion (%) 6 49 <0.005 Three-vessels lesions (%) 45 36 0.570 Pre-PCI TIMI 0 flow (%) 41 59 0.307 Characteristics OHSCA+ N=20 OHSCA- N=80 p Age (y) 69 56 <0.001 Male (%) 85 86 Prior CAD (%) 15 9 0.830 Prodromal symptoms (%) 15 33 0.340 STEMI (%) 45 56 0.515 Hospital death 10 0 <0.001 Angiographically normal CA (%) 15 13 SYNTAX Score 12(7-15) 8(4-13) 0.057 Culprit Proximal lesion (%) 71 41 0.059 LAD culprit lesion (%) 77 34 <0.005 RCA culprit lesion (%) 6 49 <0.005 Three-vessels lesions (%) 45 36 0.570 Pre-PCI TIMI 0 flow (%) 41 59 0.307 Legend: NS (p ≥ 0.05); CAD: coronary artery disease; PCI: percutaneous coronary intervention; STEMI: ST elevation Myocardial infarction; LAD: left anterior descending coronary artery; RCA: right coronary artery Open in new tab Characteristics OHSCA+ N=20 OHSCA- N=80 p Age (y) 69 56 <0.001 Male (%) 85 86 Prior CAD (%) 15 9 0.830 Prodromal symptoms (%) 15 33 0.340 STEMI (%) 45 56 0.515 Hospital death 10 0 <0.001 Angiographically normal CA (%) 15 13 SYNTAX Score 12(7-15) 8(4-13) 0.057 Culprit Proximal lesion (%) 71 41 0.059 LAD culprit lesion (%) 77 34 <0.005 RCA culprit lesion (%) 6 49 <0.005 Three-vessels lesions (%) 45 36 0.570 Pre-PCI TIMI 0 flow (%) 41 59 0.307 Characteristics OHSCA+ N=20 OHSCA- N=80 p Age (y) 69 56 <0.001 Male (%) 85 86 Prior CAD (%) 15 9 0.830 Prodromal symptoms (%) 15 33 0.340 STEMI (%) 45 56 0.515 Hospital death 10 0 <0.001 Angiographically normal CA (%) 15 13 SYNTAX Score 12(7-15) 8(4-13) 0.057 Culprit Proximal lesion (%) 71 41 0.059 LAD culprit lesion (%) 77 34 <0.005 RCA culprit lesion (%) 6 49 <0.005 Three-vessels lesions (%) 45 36 0.570 Pre-PCI TIMI 0 flow (%) 41 59 0.307 Legend: NS (p ≥ 0.05); CAD: coronary artery disease; PCI: percutaneous coronary intervention; STEMI: ST elevation Myocardial infarction; LAD: left anterior descending coronary artery; RCA: right coronary artery Open in new tab P246 Left ventricular remodelling is related to training years with dynamic component in adolescent athletes A Vaquer Segui1, G Grazioli2, M Sanz-De La Garza2, S Montserrat2, B Vidal2, A Doltra2, G Sarquella-Brugada3, M Bellver4, R Canal5, JA Gutierrez6, M Sitges2 1Fundació Clínic, Hospital Clínic de Barcelona, Cardiovascular Institute, Barcelona, Spain 2Hospital Clinic de Barcelona, Cardiovascular Institute, Barcelona, Spain 3University Hospital Sant Joan de Deu, Esplugues De Llobregat, Spain 4Consorci Sanitari de Terrassa, Centre d'Alt Rendiment (CAR), Sant Cugat Del Valles, Spain 5Fútbol Club Barcelona, Barcelona, Spain 6Catalan Sports Council, Barcelona, Spain Topic: Sports Cardiology Background and aim The physiological, morphologic and functional changes in the heart due to exercise stimulus are well-known in adults. However, data is scarce regarding ventricular geometry in teenage athletes. The aim was to analyse geometric changes of the left ventricle (LV) in different age groups of adolescent athletes. Methods: 1013 teenage competitive athletes (59% men) in 24 different disciplines were included. 2D echocardiography was performed according to current recommendations. LV mass index was calculated using Z-score measurement, using a cut-off of +2 standard deviation to define LV hypertrophy (LVH). LV geometry was classified as normal, concentric remodelling, concentric LVH and eccentric LVH. Results were analyzed based on the dynamic and static components of each sport in concordance with Mitchell’s classification. Results: We compared three groups according to age: group 12-13 y, n= 186, group 14-15 y, n=444, and group 16-17 y, n= 382. Table 1 shows the LV measurements and geometry type in each group. LV dimensions were larger as the age increased. There were no differences between groups in terms of LV geometry patterns and LV systolic function. We observed a weak correlation between the years of training and LV mass index z-score (R=0.117, p<0.05) and Relative Wall thickness (RWT) (R=0.131, p<0.05), respectively. Sports with a higher dynamic component were associated with higher LV remodelling in group 2 and 3, but not in group 1. Conclusions: With increasing age and training years, LV remodelling develops, particularly in those subjects involved in disciplines with a dynamic component. Parameters 12-13 yo 14-15 yo 16-17 yo P LV end-diastolic diameter, mm 48.23± 3.94* 48.88± 4.52^ 49.75 ± 4.1 <0.05 LV end-systolic diameter, mm 29.91± 3.39* 30.28 ± 3.79^ 30.86 ± 3.78 <0.05 Interventricular septum, mm 8.66 ± 1.37*† 8.92± 1.37^ 9.3 ± 1.2 <0.05 Posterior wall thickness, mm 8.48 ± 1.33* 8.71± 1.33^ 9.13 ± 1.24 <0.05 Indexed LV mass Z-score -0.17± 1.14* -0.28±1.32 ^ 0.08±1.15 <0.05 RWT 0.35 ± 0.06* 0.36±0.05^ 0.37 ± 0.05 <0.05 LV Ejection Fraction,% 67.49±7.12 67.68± 6.99 67.47± 7.33 0.90 LV normal geometry, N,% 165 (88.7) 383(86.1) 314 (82.2) 0.31 Concentric remodelling, N, % 20 (10.8) 53 (11.9) 54 (14.1) 0.31 Eccentric LVH, N, % 1 (0.5) 6 (1.3) 9 (2.4) 0.31 Concentric LVH, N, % 0 (0) 3 (0.7) 5 (1.3) 0.31 Parameters 12-13 yo 14-15 yo 16-17 yo P LV end-diastolic diameter, mm 48.23± 3.94* 48.88± 4.52^ 49.75 ± 4.1 <0.05 LV end-systolic diameter, mm 29.91± 3.39* 30.28 ± 3.79^ 30.86 ± 3.78 <0.05 Interventricular septum, mm 8.66 ± 1.37*† 8.92± 1.37^ 9.3 ± 1.2 <0.05 Posterior wall thickness, mm 8.48 ± 1.33* 8.71± 1.33^ 9.13 ± 1.24 <0.05 Indexed LV mass Z-score -0.17± 1.14* -0.28±1.32 ^ 0.08±1.15 <0.05 RWT 0.35 ± 0.06* 0.36±0.05^ 0.37 ± 0.05 <0.05 LV Ejection Fraction,% 67.49±7.12 67.68± 6.99 67.47± 7.33 0.90 LV normal geometry, N,% 165 (88.7) 383(86.1) 314 (82.2) 0.31 Concentric remodelling, N, % 20 (10.8) 53 (11.9) 54 (14.1) 0.31 Eccentric LVH, N, % 1 (0.5) 6 (1.3) 9 (2.4) 0.31 Concentric LVH, N, % 0 (0) 3 (0.7) 5 (1.3) 0.31 Post hoc analysis: * vs group 16-17 yo, p<0.05; ^vs group 16.17 yo; p<0.05; † vs group 14-15 yo p= 0.07 Open in new tab Parameters 12-13 yo 14-15 yo 16-17 yo P LV end-diastolic diameter, mm 48.23± 3.94* 48.88± 4.52^ 49.75 ± 4.1 <0.05 LV end-systolic diameter, mm 29.91± 3.39* 30.28 ± 3.79^ 30.86 ± 3.78 <0.05 Interventricular septum, mm 8.66 ± 1.37*† 8.92± 1.37^ 9.3 ± 1.2 <0.05 Posterior wall thickness, mm 8.48 ± 1.33* 8.71± 1.33^ 9.13 ± 1.24 <0.05 Indexed LV mass Z-score -0.17± 1.14* -0.28±1.32 ^ 0.08±1.15 <0.05 RWT 0.35 ± 0.06* 0.36±0.05^ 0.37 ± 0.05 <0.05 LV Ejection Fraction,% 67.49±7.12 67.68± 6.99 67.47± 7.33 0.90 LV normal geometry, N,% 165 (88.7) 383(86.1) 314 (82.2) 0.31 Concentric remodelling, N, % 20 (10.8) 53 (11.9) 54 (14.1) 0.31 Eccentric LVH, N, % 1 (0.5) 6 (1.3) 9 (2.4) 0.31 Concentric LVH, N, % 0 (0) 3 (0.7) 5 (1.3) 0.31 Parameters 12-13 yo 14-15 yo 16-17 yo P LV end-diastolic diameter, mm 48.23± 3.94* 48.88± 4.52^ 49.75 ± 4.1 <0.05 LV end-systolic diameter, mm 29.91± 3.39* 30.28 ± 3.79^ 30.86 ± 3.78 <0.05 Interventricular septum, mm 8.66 ± 1.37*† 8.92± 1.37^ 9.3 ± 1.2 <0.05 Posterior wall thickness, mm 8.48 ± 1.33* 8.71± 1.33^ 9.13 ± 1.24 <0.05 Indexed LV mass Z-score -0.17± 1.14* -0.28±1.32 ^ 0.08±1.15 <0.05 RWT 0.35 ± 0.06* 0.36±0.05^ 0.37 ± 0.05 <0.05 LV Ejection Fraction,% 67.49±7.12 67.68± 6.99 67.47± 7.33 0.90 LV normal geometry, N,% 165 (88.7) 383(86.1) 314 (82.2) 0.31 Concentric remodelling, N, % 20 (10.8) 53 (11.9) 54 (14.1) 0.31 Eccentric LVH, N, % 1 (0.5) 6 (1.3) 9 (2.4) 0.31 Concentric LVH, N, % 0 (0) 3 (0.7) 5 (1.3) 0.31 Post hoc analysis: * vs group 16-17 yo, p<0.05; ^vs group 16.17 yo; p<0.05; † vs group 14-15 yo p= 0.07 Open in new tab P247 Effects of endurance training on left ventricular diastolic function and right ventricular parameters in peripubertic athletes D Szabo1, D Nagy2, C Melczer2, P Acs2, A Cziraki1, Z Sarszegi1 1University of Pécs, Heart Institute, Pécs, Hungary 2University of Pécs, Faculty of Health Sciences, Institute of Physiotherapy and Sport Science, Pécs, Hungary Funding Acknowledgements: GINOP 2.3.2-15-2016-00047 grant Topic: Sports Cardiology Introduction: In the last few years several studies examined the echocardiographic parameters of peripubertic athletes focusing on the left ventricle. Normal values are defined, showing significant differences from adult athletes. In contrast, there are less data about the diastolic function and the right ventricular (RV) parameters, especially in this age group. There are no specific normal values of these young athletes making differentiation of athlete’s heart from pathological conditions challenging. Purpose, methods: The aim of our study was to examine the specific diastolic and RV parameters of peripubertic athletes and compare them to the normal values of adult athletes or healthy non-athletes. We examined 70 children and young adults (athletes, triathletes, soccer players, basketball players) between the age of 9 and 20 years (50 males, 20 females, 16,5 ±2,8 years). 12 leads ECG, specific 2D and tissue Doppler echocardiographic examinations were performed. Results: Examining the left ventricular (LV) structure and function we did not find any significant differences between our results [end-diastolic-diameter (47,1±4,5 mm), end-systolic-diameter (29,4±3,9 mm), LV mass (189,7±60,6 g)] and the latest normal LV values in different age groups. According to the latest studies we also detected a significant positive correlation between the examined LV parameters, age and lean body mass (LBM). We measured significant higher lateral e’ (19,8±3,8 cm/s) and septal e’ (15,2±2,4 cm/s) values and significant lower E/e’ ratio (5,25±1,5) of peripubertic athletes compared to healthy adults, however there were no significant differences between our results and age-matched non-athlete’s. Moreover, we found a negative correlation between lateral and septal e’ values and age. These results are suggesting that endurance training has no significant impact on the diastolic function in healthy young athletes. Examining the right ventricle we found significant lower structural [RV end-diastolic diameter RVEDD (33,5±3,6 mm)] and functional parameters [ventricular end-diastolic - RVED area (20,5±4,8 cm2), right ventricular end-systolic - RVES area (12,6±3,5 cm2), right ventricular fractional area change (37,8±13%), inferior vena cava diameter [14,5±1,9 mm], tricuspid annular plane systolic excursion – TAPSE (22,7±3,4 mm)] compared to the results of adult athletes. Furthermore, we found significant positive correlations between LBM, RVEDD, RVED area, RVES area and TAPSE. Conclusion: There are no clearly defined normal values of diastolic functional and RV parameters in peripubertic athletes, despite echocardiographic changes could have potentially be found in these population. Well-defined normal ranges can help in daily routine to differentiate physiological changes from pathological heart diseases in young athletes. P248 A new method to correct the structural and functional myocardium changes, mediated by stress and over-training L A Balykova1, LM Makarov2, SA Ivyansky3, OM Soldatov4, AV Krasnopolskaya1, AA Shirokova1, KM Varlashina1 1Medical Institute of the Mordovian State University, Saransk, Russian Federation 2Center for Syncope & Cardiacs Arrhythmias in Children & Adolescents of Federal Medical-Biol. Agency, Moscow, Russian Federation 3National Research Ogarev Mordovia State University, Medical Institute, Saransk, Russian Federation 4Children's Clinical hospital 2 of Mordovian Republic , Saransk, Russian Federation Topic: Sports Cardiology Introduction: Highly intensive and prolonged physical training led to formation «athletes heart» in a half of sportsmen and in some of them cardiac remodeling became non-physiologic and associated with over-training syndrome. The approaches to pathogenetic correction of these changes have not yet been established. Purpose: To study the prevalence and manifestation of over-training cardiac remodeling and to develop the new method of its pharmacological correction in young athletes. Methods: Study consisted in 2 parts: experimental and clinical and was approved by local ethic committee. Animal study followed the "Principles of laboratory animal care" (1985) and national law if applicable. Morphological manifestation of over-training heart was studied in 30 mice underwent everyday 2 weeks course of swimming "till exertion". The myocardial ultrastructure was studied by electron microscopy by the end of experiment in 2 groups of mice: control group (n=14, without any pharmacological support) and study group (n=16) received 2-weeks course of creatine phosphate (CP). The state of the cardiovascular system was studied in 189 young footballers (12-16 years) sport-school attendants, who had non-common changes on standard ECG. All the athletes underwent complex examination. Athletes with over-trained myocardium signs were enrolled into a clinical trial and randomized into 2 groups in 1:1 ratio: control and CP. The dynamics of cardiac remodeling and physical working capacity was analyzed after 4 weeks. Results: By the end of experiment stress-induced and overtraining myocardium hypertrophy (MH) and dystrophy developed in all the mice and 30% of mice died. Ultrastructural cardiac changes manifested as marked cell polymorphism and cell damage. CP enhanced physical capacity, reduced myocardial hypertrophy, limited the cardiomyocytes damaging, preserved the number and structure of mitochondria and prevented lethality in all the mice. Non-physiological myocardial remodeling was identified in 24-43 (12.7-23.8%) of young footballers. It manifested as cardiac rhythm and conduction disturbances, heart cavities dilatation (>98 percentyle), MH (left ventricle myocardium mass index >51g/m2.7), systolic (ejection fraction <55%), diastolic (E/A >2) disfunction, elevation of myocardial enzymes and stress hormones level (>1.5 norms) and abnormal QT reaction on physical exertion and recovery. In 40 (20.2%) of young athletes over-trained heart was diagnosed. CP using contributed to a rise of physical working capacity in PWC170 test by 9% to the original level, significant reduced (by 32-87%) or eliminated the structural and functional signs of myocardium over-training and normalization of myocardium repolarization reaction on exercise stress. Conclusion: Every 5 of the young athletes develops non-physiologic over-trained «athletes heart» signs. which effectively reduce by CP. P249 The diagnostic value of 24-hours blood pressure monitoring and exercise tests in hyper-tension evaluation in young athletes L A Balykova1, AV Krasnopolskaya1, AA Shirokova1, SA Ivyansky2, KM Varlashina1, DV Lazareva1, YUO Soldatov3 1National Research Ogarev Mordovia State University, Medical Institute, Saransk, Russian Federation 2Medical Institute of the Mordovian State University, Saransk, Russian Federation 3Children's Clinical hospital 2 of Mordovian Republic , Saransk, Russian Federation Topic: Sports Cardiology Introduction: Increased blood pressure (BP) is one of the most prominent cardiovascular problems in adult athletes, engaged in high static sport. The prevalence of hypertension (HTN) in young athletes is under discussion. Aim: To determine the prevalence of HTN in young athletes according to routine measurement and additional examination. Methods: 82 children 11-16 years (40 young athletes with sport experience in at least 3 years, exercise intensity 8-9 hours per week) and 50 healthy untrained children of the same age and gender were examined using 24-hours ambulatory blood pressure monitoring (ABPM) and physical exercise test (ET) by Bruse protocol with BP measurement. Results: Routine measurement of BP revealed pre-HTN in 13 (15.9%) and HTN stage I in 2 (2.4%) of young athletes. According to ABPM `white coat` HTN was detected in 7 (8.5%) athletes. Average daily BP measurements tended to increase in the group of athletes with a significant static component and tended to decrease among biathlonres in comparison to the untrained. The average BP level at night had a strong positive relationship with the left ventricular myocardium mass index (LVMI) and the serum level of norepinephrine and cortisol. HTN was detected in 9.8% of athletes (8 adolescents), including 7 cases of nonsustained HTN. Sustained hypertension was diagnosed in only one biathloner. Inappropriate decrease in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) at night was observed in 6 children and adolescents (7.3 %) involved in gymnastics and game sports. High SBP variability occurred in 14 (17.1 %) athletes (predominantly engaged in biathlon and cross sectional sky) and correlated with high heart rate variability (pNN50%). In the initial stages of ET and recovery period BP level did not differed in athletes and untrained children. But since the submaximal load (50-75 W), the athletes showed a more significant increase in SBP. However, at the peak of exercise (153±17.5 Wt for athletes and 121±14.8 Wt for untrained children respectively) SBP level was similar in these groups. A more rapid and complete restoration of BP and heart rate to baseline level was observed for children-sportsmen in the early recovery period. We defined that the norm values of BP reactions on ET in children of 11-16 years (98 percentile for SBP) was 221mm.Hg. Hypertensive type of BP reaction to ET was diagnosed in 12.2% (10 athletes). It is notice that in 3 of them an increased BP was combined with a high level of LVMI, and in 4 out of them - with a decrease in physical working capacity by ET. The hypertensive type of BP reaction on ET correlated with the plasma noradrenaline level (r=0.62). Conclusions: The additional ABPM using and BP measuring during ET can improve the accuracy of arterial hypertension diagnostics in young athletes. These methods should be included in periodic assessment of young athletes, engaged in high-intensity static and dynamic sports. P250 Heart rate variability changes in healthy students after a voice therapy breathing exercise as compared to squat-stand manoeuvres A N Kovalenko1, IV Kastyro1, VI Torshin1, AD Sedelnikova1, D Grosu1, KN Sedov1, MK Melikyan1, AA Skopich1, AZ Sadegh1 1Peoples Friendship University of Russia (RUND University), Moscow, Russian Federation Topic: Sports Cardiology Introduction: To improve voice, voice therapists use breathing exercises meant for changing breathing patterns in a person. It is well known that there is heart rate variability (HRV) in synchrony with respiration called respiratory sinus arrhythmia (RSA). Therefore, breathing exercises may influence not only voice but also cardiovascular system. Purpose: Our goal was to investigate changes that a breathing exercise could make to heart rate and to compare them to those after squat-stand manoeuvres using short-term ECG recording. Methods: 13 healthy students (8 women, 5 men) aged from 18 to 20 participated in our study. The following design was used to assess HRV alterations in students: 5-minute supine rest ECG recording Breathing exercise ECG recording 30-minute rest, questionnaire survey ECG recording Physical exercise ECG recording Squat-stand were performed as follows: frequency – 0.17 Hz (3 s squatting, followed by 3 s standing) for 3 min. Periodic loud pronunciation of /s/ sound was used as breathing exercises. It was performed in the same manner: 0.17 Hz (3 s breathing out on loud /s/, followed by 3 s of usual breathing) for 3 min. 3-minutes ECG records were obtained by Biopac MP30B-CE and analysed by Kubios HRV 2.1 software. As the most relevant parameters, rMSSD, LF, HF, LF/HF were extracted from ECG records. The Beck Anxiety Inventory (BAI), Positive and Negative Affect Schedule (PANAS) and The Arousal Predisposition Scale (APS) were used to estimate the psychological dimension of sympathovagal balance. Results: It was observed that participants who showed an increase of rMSSD values after breathing exercise tended to show their decrease after squat-stand manoeuvres and vice versa. Differences of rMSSD values after and before breathing exercise – d(sp-rMSSD) and physical exercise – d(ex-rMSSD) were calculated. Linear regression analysis showed a negative correlation (R2 = 0.61) between d(ex-rMSSD) and d(sp-rMSSD). Participants were divided into 2 groups. Group1 consisted of those with negative d(ex-rMSSD) and positive d(sp-rMSSD) values (3 men, 4 women). Group2 contained participants with positive d(ex-rMSSD) and negative d(sp-rMSSD) values (2 men, 4 women). Intergroup comparison of initial rMSSD, lnLF, lnHF, LF/HF, BAI, PANAS, APS values was made by means of the Mann–Whitney U test. A difference was only found for PANAS negative affect scale (p<0.05, Mean±SD): Group1 – 26.9±6.4, Group2 – 19.5±4.9. Conclusion(s): rMSSD values increase post training is related by some authors to raised cardiac parasympathetic modulation and is considered a highly favourable adaptation. In our study, we found two types of cardiovascular response based on rMSSD. The first type associated with post-squat-stand rMSSD decrease and post-breathing rMSSD increase. The second type is manifested in opposite effects. Unfortunately, obtained data didn’t let to uncover causes these phenomena. P252 Usefulness of percent-predicted oxygen uptake efficiency slope to detect patients with real functional capacity impairment and submaximal cardiopulmonary exercise test A Berenguel1, U Valencia Fernandez2, R Chamon Sanchez De Los Silos1, G Lozano Lazaro1, K Villelabeitia Jaureguizar3, M Rubio Mellado1, M Lazaro Salvador1, M Abeytua Jimenez4, JI Castillo Martin5, M Baquero Alonso1, P Sanchez-Aguilera Sanchez-Paulete1, A Martinez Camara1, H Contreras Marmol1, A Cebollada Carmeo1, L Rodriguez Padial1 1Hospital Virgen de la Salud, Unit of Cardiac Rehabilitation and Secondary Prevention. Cardiology Department, Toledo, Spain 2Hospital Nacional Carlos Alberto Seguín Escobedo, Cardiology Department, Arequipa, Peru 3Hospital Infanta Elena, Rehabilitation Department, Valdemoro, Spain 4University Hospital Gregorio Maranon, Unit of Cardiac Rehabilitation and Secondary Prevention. Cardiology Department, Madrid, Spain 5University Hospital 12 de Octubre, Rehabilitation Department, Madrid, Spain Topic: Exercise Testing Background: The number of patients with heart disease who fail to achieve maximal criteria in a cardiopulmonary exercise test (CPX) is significant. In these cases, the peak oxygen uptake value (VO2) is limited and submaximal parameters must be used. One of them is the oxygen uptake efficiency slope (OUES), which has been classically used as an absolute value (OAV), with a cut-off point of 1.4, below which it is considered abnormal. Since OUES is influenced by several factors such as sex, age, weight, height, smoking, respiratory status or treatment with beta-blocker, it is worthwhile to study its potential utility as percent-predicted (OPP). Therefore, our aim was to analyze the real incidence of functional capacity impairment in submaximal CPX, estimated by OPP, and to compare its sensitivity with OAV Methods: From a population of 588 patients (male 85,9%, age 56,5, LVEF 0.48, heart failure 6%, beta-blockers 83,8%) who underwent a CPX before cardiac rehabilitation, we selected those who performed a submaximal test (peak RER <1.1), resulting in a total of 310 patients (52.7% of the total). Among them, 127 (41.0%) patients presented a VO2 peak <80%. OAV, OUES and OPP were measured or calculated in all of them. The number of patients who had an OAV <1.4 and those with an OPP <80% were calculated. Both differences are compared by a Chi-square test Results: From the total number of patients with RER <1.1 and VO2 <80%, 41.7% showed an OPP <80%, while only 21.3% had an OAV <1.4. These differences were statistically significant (p <0.001) Conclusions: OPP is more sensitive than OAV to detect patients with real functional capacity impairment in patients with low VO2 and who fail to perform a maximum test. Its use should be extended routinely in this type of patients N % ALL PATIENTS 588 100,00% . . . . VO2 < 80% 196 33% . . . . RER < 1.1 310 52,7% . . . . VO2 < 80% and RER < 1.1 127 41,0% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 80% 53 41,7% . . . . OUES > 80% 74 58,3% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 1.4 27 21,3% . . . . OUES > 1.4 100 78,7% N % ALL PATIENTS 588 100,00% . . . . VO2 < 80% 196 33% . . . . RER < 1.1 310 52,7% . . . . VO2 < 80% and RER < 1.1 127 41,0% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 80% 53 41,7% . . . . OUES > 80% 74 58,3% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 1.4 27 21,3% . . . . OUES > 1.4 100 78,7% Open in new tab N % ALL PATIENTS 588 100,00% . . . . VO2 < 80% 196 33% . . . . RER < 1.1 310 52,7% . . . . VO2 < 80% and RER < 1.1 127 41,0% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 80% 53 41,7% . . . . OUES > 80% 74 58,3% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 1.4 27 21,3% . . . . OUES > 1.4 100 78,7% N % ALL PATIENTS 588 100,00% . . . . VO2 < 80% 196 33% . . . . RER < 1.1 310 52,7% . . . . VO2 < 80% and RER < 1.1 127 41,0% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 80% 53 41,7% . . . . OUES > 80% 74 58,3% PATIENTS WITH VO2 < 80% and RER < 1.1 127 . . . . OUES < 1.4 27 21,3% . . . . OUES > 1.4 100 78,7% Open in new tab Abstract Number: P252 P253 Is cardiac rehabilitation useful in preventing a recurrence of atrial fibrillation or the need for a second ablation within 1 year after the first ablation? K Hoffbauer1, G Geebelen1, P Dendale2, I Frederix3, M Scherrenberg2 1University of Leuven, Leuven, Belgium 2Virga Jesse Hospital, Hasselt, Belgium 3University of Antwerp Hospital (Edegem), Antwerp, Belgium Topic: Rehabilitation: Outcomes Background: Treatment of atrial fibrillation (AF) with catheter ablation is frequently associated with recurrences. This study aimed to assess if cardiac rehabilitation is effective in preventing a recurrence of AF or the need for a second ablation within 1 year after the first ablation. Methods: A non-randomized, retrospective cohort study was performed. Patients treated with an ablation for AF were included. Patients in the intervention group chose to participate in the cardiac rehabilitation program. The control group only received standard care. The primary objective was examining whether cardiac rehabilitation is useful in reducing the time to or the risk of a recurrence of AF or the need for a second ablation within 1 year after the first ablation, using a Kaplan-Meier analysis. Results: 693 patients (average age 60,7 years ± 9,9; 73,7% males) were included. 160 patients (23,1%) and 533 patients (76,9%) were part of the intervention group and the control group respectively. In the intervention group 26 patients (16,3%) and in the control group 107 patients (20,1%) experienced a recurrence of AF or needed a second ablation within 1 year after the first ablation. The Kaplan-Meier analysis showed a significant effect (logrank test: P=0,018; t=5,626 and Breslow test: P=0,016; t=5,809) of cardiac rehabilitation on preventing a recurrence of AF or the need for a second ablation (figure 1). Conclusion: This study showed a significant effect of cardiac rehabilitation in preventing a recurrence of AF or the need for a second ablation within 1 year after the first ablation. NCT03389633 Abstract Number: P253 Figure 1: Survival functions P254 Improvement of 6-minute walking distance after phase II cardiac rehabilitation program in postoperative grown-up congenital heart (GUCH) disease patients: a 10-year experience 1National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia On Behalf of: National Cardiovascular Center Harapan Kita Funding Acknowledgements: National Cardiovascular Center Harapan Kita Topic: Rehabilitation: Outcomes Background: Phase II cardiac rehabilitation (CR) has been extensively studied in coronary and valvular heart disease patients. In contrast, studies of CR among postoperative grown-up congenital heart (GUCH) disease patients have been scarce. This study aims to determine the influence of phase II CR on 6-minute walking distance (6MWD) in postoperative GUCH disease patients during 10-year experience. Method: This single-center, retrospective, observational study involved postoperative GUCH disease patients (above 18 years old) from February 2009 to June 2018 who underwent phase II cardiac rehabilitation. Phase II CR consists of 12 sessions of 60-minute aerobic training designed for cardiovascular patients after surgery. Each patient underwent 6-minute walking distance (6MWD) test before and after phase II CR to assess the functional capacity. Results: 717 postoperative GUCH disease patients who underwent phase II CR were evaluated. Of these, 601 (83.8%) had acyanotic GUCH diseases. In the acyanotic group, most patients (74%) had atrial septal defect (ASD) or ASD with concomitant valve diseases. Among cyanotic patients, 54 patients (46.5%) were diagnosed with Tetralogy of Fallot. The median age was 31 years old (range 18-72 years) with body mass index 19 kg/m2 (range 11-40 kg/m2) and ejection fraction (EF) 66% (range 23-91%). There was no significant difference between groups in terms of gender, blood pressure, heart rate, weight, height, EF, and atrial fibrillation occurrence (p>0.05). A significantly higher 6MWD was found after completion of phase II CR (378(63) vs 294(70) m, p<0.01). The post-phase-II-CR 6MWD was observed better in acyanotic group (380(63) m) vs cyanotic group (367(61) m), but this result was not statistically significant (p=0.11). Conclusion: Phase II CR in postoperative GUCH disease patients results in 6MWD improvement. This implies that tailoring phase II CR to postoperative GUCH disease patients may yield further improvement in patients’ functional capacity. B Dwiputra1, AM Ambari1, AS Santoso1, BS Purwowiyoto1, B Radi1 P255 Holistic effects in multi-modal comprehensive short-term cardiac rehabilitation - preliminary results from the OutCaRe-registry A Salzwedel1, B Zoch-Lesniak1, A Schlitt2, J Glatz3, C Bongarth4, S Sporl-Donch5, K Schroder6, J Nothroff7, R Westphal8, R Schubmann9, M Wrenger10, E Langheim3, R Marx11, M Schikora12, H Voller13 1University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany 2Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany 3Reha-Zentrum Seehof, Teltow, Germany 4Clinic Hohenried, Bernried, Germany 5Frankenklinik, Bad Neustadt a. d. Saale, Germany 6ZAR Stuttgart, Stuttgart, Germany 7MediClin Reha-Zentrum Spreewald, Burg, Germany 8Segeberger Clinics, Bad Segeberg, Germany 9Klinik Möhnesee, Möhnesee, Germany 10Caspar Heinrich Klinik, Bad Driburg, Germany 11Mediclin Fachklinik Rhein/Ruhr, Essen, Germany 12Brandenburg Klinik, Bernau bei Berlin, Germany 13Klinik am See, Rudersdorf bei Berlin, Germany On Behalf of: Outcome of Cardiac Rehabilitation (OutCaRe) study group Funding Acknowledgements: German pension insurance Topic: Rehabilitation: Outcomes Introduction: In Germany, cardiac rehabilitation (CR) is carried out as a standardized comprehensive program. Physical capacity and cardiovascular risk factors as well as psychosocial aspects of cardiovascular disease are to be positively affected simultaneously. Due to the lack of suitable clinical measures, the immediate success of this approach is not sufficiently investigated. We aimed to evaluate several outcome parameters of CR that were prespecified in a previous Delphi-expert survey. Methods: In the prospective multicentric registry, 1586 patients (54±7 years, 77% men) were enrolled in 2017/2018. General data (e.g. age, gender, diagnoses) and parameters of risk factor management (e.g. smoking, lifestyle change motivation, hypertension, LDL cholesterol), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance), occupational medicine (pension desire, self-assessment of occupational prognosis, work ability) and subjective health (depression (PHQ9), anxiety, health-related quality (SF12), WHO5 well-being index, indicators of rehabilitation state: IRES24) were documented at admission to and discharge from CR. The assessment of feasibility and modifiability of parameters was based on the missing data proportion, statistical significance and standardized effect sizes (SES). An exploratory factor analysis (EFA) was performed to reveal the underlying structure of tested parameters. Results: The majority of patients (n=1319, 83%) was enrolled in CR after an acute cardiac event (e.g. acute coronary syndrome (22%) or heart valve surgery (12%)) within 17 days after discharge from hospital, while 267 patients (17%) were referred to CR due to chronic disorders (e.g. ischemic heart disease). Additionally, 9% of patients suffered from heart failure, 11.1% rhythm disturbances and 15.8% Diabetes mellitus. CR was mostly performed in-patients (90.6%) with a mean duration of 23 ± 5 days. Smoking behaviour, motivation for lifestyle modification, blood pressure, exercise load, self-assessment of occupational as well as health prognosis, PHQ9, IRES24 and WHO5 showed p-values <0.001 and moderate SES >0.35 for the change during CR with missing data proportion less than 15%. Four basic dimensions were identified by EFA: (1) mental health scale (IRES24), psychological sum score (SF12), WHO5 and PHQ9 sum score, (2) physical sum score (SF12), pain and somatic health scale (IRES24), (3) blood pressure, (4) subjective occupational prognosis, confidence in returning to work and planning a retirement request. Conclusion: These preliminary results indicate the suitability of at least one tested parameter of each of domains physical performance, risk factors, occupational medicine, and subjective health to represent the immediate CR outcome. In the next step, the predictive value of the parameters for occupational reintegration will be determined. P256 A lifestyle and self-care focused smartphone application can improve risk factor outcomes in cardiac rehabilitation for patients after myocardial infarction I Sjolin1, H Ogmundsdottir Michelsen1, M Back2, T Tanha1, M Gonzalez3, C Sandberg4, A Olsson1, A Schiopu1, M Leosdottir1 1Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University, Malmo, Sweden 2Linkoping University, Department of Medical and Health Sciences, Division of Physiotherapy, Linkoping, Sweden 3Commonwealth Scientific Research and Industrial Organization, Brisbane, Australia 4Umea University, Heart centre and Department of Public Health and Clinical Medicine, Cardiology, Umea, Sweden Funding Acknowledgements: The study is funded Lund University, the Department of Coronary Care at Skåne University Hospital and Cross Technology Solutions Topic: Rehabilitation: Outcomes Background: The fulfilment of guideline recommended cardiac rehabilitation (CR) targets in patients after acute myocardial infarction (AMI) is currently unsatisfactory. eHealth i.e. the use of electronic communication in healthcare, offers a new array of possibilities to provide clinical care and improve outcomes. Purpose: To assess the efficacy of a web-based smartphone application designed to support adherence to lifestyle advice and self-control of risk factors, as a complement to traditional CR for improving risk factor outcomes, self-rated health and aerobic capacity in patients after AMI. Methods: In this multi-centre randomized controlled trial, we included 150 patients with AMI (81% men, 60.4 ±8.8 years) who subsequently participated in CR. Additionally, patients randomized to the intervention group received access to the web-based smartphone application. Changes (delta) in dietary and smoking habits, self-rated health, weight, blood pressure (BP) and lipid profile between baseline, 2-weeks and 2-months follow-up were assessed on an intention-to-treat basis using linear and logistic regression analysis adjusted for age, sex and baseline risk factors. Additionally, changes in self-rated physical activity and submaximal aerobic capacity (W) on a bicycle ergometer test, as a measure of fitness, between 2-weeks and 6-months follow-up were assessed. Results: Patients randomized to the intervention group achieved a larger reduction in BP than patients in the control group at 2-weeks (systolic BP -28 ±27 vs -16 ±24 mmHg, p=0.01) and 2-months follow-up (systolic BP -25 ±27 vs -16 ±27 mmHg, p=0.02; diastolic BP -13 ±16 vs -9 ±13 mmHg, p=0.046). Patients in the intervention group who smoked at baseline were significantly more often abstinent from smoking at 2-months follow-up, compared to smoking patients in the control group (76% vs 36%, p=0.03). While patients in the intervention group consumed significantly more fish and fruit at 2-weeks follow-up, there was no difference between the groups at two months post-AMI (Figure 1). There was no difference between the intervention and control groups in delta values for lipid levels, weight, self-rated health or self-rated physical activity. Both groups increased their submaximal aerobic capacity between 2-weeks and 6-months follow-up (intervention 13.6 ±19.9 W vs control 10.3 ±16.1 W, p=0.4). Conclusion: Complementing traditional CR with a web-based smartphone application supporting adherence to lifestyle advice and self-control of risk factors has the potential to improve blood pressure and tobacco abstinence after an AMI. Abstract Number: P256 Figure 1 P257 The effect of high intensity interval training on left atrial volume index in heart failure patients ACGB Lima1, NT Silva1, AOV Lira1, EM Negrao1, LBO D Avilla1, G Cipriano Jr1 1University of Brasilia, Health Sciences and Technologies, Brasilia, Brazil Topic: Rehabilitation: Outcomes Background: Cardiovascular rehabilitation (CR) is recognized as an important modality of treatment for patients with cardiovascular disease, and high intensity interval training (HIIT) has been focus of literature discussion. Left atrial volume index (LAVI) is an important independent predictor of all-cause of mortality in heart failure (HF) patients, providing additional prognostic information, beyond left ventricular systolic and diastolic function. Objective: The aim of the study was to access the effect of high intensity interval training (HIIT) in the echocardiogram parameters (left ventricular ejection fraction (LVEF, %); LAVI (ml.m-2); and on cardiorespiratory fitness (peak oxygen consumption (peak VO2, ml.kg-1.min-1), peak workload (Power, Watts) and safety on HF patients. Methods: This prospective study evaluated 25 HF patients (60% male, 48% ischemic etiology, 56 ± 9.8 years, LVEF 39.5 ± 15.5%, peakVO2 13.4 ± 5.3 ml.kg-1.min-1) allocated into two programs: HIIT and control. HIIT group (16 patients) performed 36 sessions training sessions (10 min warming up below first ventilatory threshold (VT), 4 min work above critical power, 3 min recovery below first VT (total duration 38 min) on cicloergometer and control group (CT) (11 patients) (home stretching exercises, muscle strengthening activities for 10 minutes and aerobic activity for 20 minutes at 60 to 80% of maximal heart rate, associated with 5 monthly lectures and follow-up of the weekly activity report). All patients underwent two-dimensional echocardiographic evaluation with transthoracic Doppler and maximum cardiopulmonary test at the beginning and at the end of the protocol. Results: HITT group presented improvement in peak VO2(pre: 11 ± 5.1 and post: 13.6 ± 5.0 ml.kg-1.min-1, p<0.0001) and power (pre: 75.3 ± 33.7 and post: 90.6 ± 34.6 W) and reduction in LAVI (pre: 45.9 ± 19.4 and post: 39.4 ± 18.4, p = 0.04). There was no improvement in LVEF (pre: 43.5 ± 17.6% and post: 46.2 ± 16.2%, p = 0.15) and ventilatory efficiency (VE/VCO2 slope) (pre: 36.5 ± 7.4 and post: 35.2 ± 7.3, p = 0.57). No changes were observedin the control group. No cardiovascular eventsoccurred during 342 hours of training and compliance of this group was greater than 80%. Conclusions: HITT demonstrated a significant reduction in LAVI, as well as improvement on oxygen consumption, demonstrating its capacity for reverse remodeling, as well as enhancement of exercise capacity, which can be translated into benefits in the mortality and quality of life of this population. P258 Increasing incidence of associated cardiovascular risk factors at 1 year of cardiac rehabilitation therapy after cardiac surgery S Radu1, A Nedelcu1, M Caraus-Filimon1, O Mitu2, M Leon1, M Mitu1, M Floria2, F Mitu1 1Clinical Rehabilitation Hospital, Cardiology, Iasi, Romania 2University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania Topic: Rehabilitation: Outcomes Background: Following cardiovascular surgery, inclusion in a cardiac rehabilitation therapy program is of a paramount importance in what concerns post-operative patient’s evolution, having shown to significantly decrease rates of hospitalization and mortality. Purpose: The purpose of the study was to assess whether cardiovascular surgery patients show any benefit from the inclusion in a cardiac rehabilitation therapy 1 year after the intervention. Methods: We retrospectively included 332 patients that underwent cardio-vascular procedures from January 2016 to May 2018. We included patients over 18 years-old that underwent myocardial revascularization (coronary artery by-pass - CABG or percutaneous transluminal coronary angioplasty - PTCA), valve replacement/plasty or left atrial appendage occlusion. Results: 332 patients were enrolled, with a mean age of 65.2 ± 10 years (p=0.04). The mean hospital stay was 10.3 ± 3.5 days. At admission, heart failure (HF) was more prevalent in men as compared to women (71.5 vs 57.5%, p= 0.03), class II NYHA being the most frequent in both groups. Mean exercise capacity was 89.3 ± 25.3 W, p=0.01, left ventricular ejection fraction (LVEF) was 54.58% ± 12.2% p= 0.5, hemoglobin of 11.5 ± 1.5 g/dL, p= 0.2. 172 (51.81%) patients underwent myocardial revascularization, 138 (41.6%) CABG and 38 (19.2%) PTCA, 84 (25.3%) valve replacement, the majority having had aortic valve surgery 71 (21.4%). 76 (22.9%) underwent other procedures, either valvuloplasty or left atrial appendage occlusion. Patients with myocardial revascularization had shown the most significant improvement in LVEF at 1 year follow up, from 52.4 ± 12.9 % to 61% ± 14.5, p=0.66. In contrast, patients with valve replacement procedures had a LVEF of 56 ± 11.2% and 57% at 1 year, p= 0.458, while patients’ LVEF with valvuloplasty and left atrial appendage occlusion declined from 54.4 ± 11.13% to 50.5 ± 13.07 % at 1 year follow up. Patients with valve replacement had a better improvement in LVEF at 6-months (56.01 ± 11.2% compared to 64.04 ± 4.13%, p=0.45). Exercise capacity also increased in patients with myocardial revascularization (84.63±29.34 W compared to 114.5± 17.9 W, p=0.034). Hb levels tended to be higher at 1 year (11.5 ± 1.5 g/dL compared to 12.7 ± 1.82 g/dL, p=0.087). Interestingly, the incidence of arterial hypertension, dyslipidemia, HF/ HF class increased. Conclusion: Patients undergoing myocardial revascularization procedures benefit most from cardiac rehabilitation therapy, having shown the greatest improvement in both LVEF and exercise capacity. Another explanation for their improvement may be the correction of post-operative anemia. Patients undergoing valve replacement surgeries showed a marked improvement in LVEF at 6-months. We also noted that at 1-year follow up, the incidence of associated cardiovascular risk factors increased, most probably due to a drop in therapeutic adherence. P260 Effects of prehabilitation program on quality of life and adherence to therapy in patients undergoing coronary artery bypass grafting Y Argunova1, SA Pomeshkina1, EG Moskin1, N Sogoyan2, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation 2Federal State Budgetary Educational Institution of Higher Education “Kemerovo State University”, Kemerovo, Russian Federation Funding Acknowledgements: The study was supported by a grant from the President of the Russian Federation for state support of young Russian scientists - candidates of sciences Topic: Rehabilitation: Outcomes Aim: To evaluate clinical efficacy of high-intensity exercise training included in the prehabilitation program for elective coronary artery bypass grafting (CABG). Methods: 38 male patients were included in the study before on-pump CABG. After fulfilling the inclusion/exclusion criteria, patients were randomized into two groups: Group 1 patients (n = 20) underwent supervised treadmill exercise, and Group 2 patients (n = 18) were referred to surgery without any exercise training. Patients underwent a 7-day exercise training with daily measurements of hemodynamic parameters and electrocardiogram (ECG) monitoring. The load intensity was measured with cardiopulmonary exercise testing and accounted for 80% of the maximal oxygen uptake. Postoperative complications were recorded in the in-hospital period and analyzed. Quality of life indicators were measured by the SF-36 standard version 7-10 days prior to surgery and on days 7-10 of the postoperative period. Adherence to drug and non-drug therapy was assessed during the 6-month follow-up. Results: There was a significantly lower incidence of postoperative complications during the in-hospital period in patients undergoing prehabilitation program with supervised high-intensity exercise training, compared with patients without any exercise training (p = 0.002). Group 1 patients had reliably better mental health (MH) scores compared with Group 2 patients (48.9±7.60 vs. 39.1±6.80 scores, respectively; p = 0.03) on days 7-10 after CABG. Six months after the CABG, patients who underwent prehabilitation exercise training were less likely to resume smoking than patients without any exercise training (p = 0.04). The tendency towards improved adherence to drug therapy and compensation in arterial hypertension has been determined among Group 1 patients. Conclusion: Exercise training included in the prehabilitation program proved to be safe and effective in terms of improved clinical outcomes after CABG, quality of life and adherence to treatment in this group of patients. P261 Comparison of perceived exertion scales in cardiac rehabilitation M L Zuccotti1, GM Maglio1 1IRCCS, Policlinico San Donato, Cardiac Rehabilitation Unit, San Donato Milanese, Italy Topic: Rehabilitation: Outcomes Background: The exertion perceived by the cardiac patient is essential during exercise training. It can be measured using psychophysical scales that are often been tested on young healthy subjects. To set exercise intensity of cardiac patients there are absolute mode through percentage of measured or estimated (220-age) maximum heart rate (%HRmax), or relative mode through RPE Borg scale. The high variability in age, education, cognitive impairment, and linguistic barriers of the current patients admitted in cardiac rehabilitation (CR) do not allow to propose a single tool of evaluation of the subjective rate of perceived exertion (RPE) to modulate workload during exercise training. In the literature there are different alternative scales such as Borg CR10, OMNI-cycle scale and Color Borg. Purpose: The aim of this study is to assess which RPE scale has a greater concordance with %HRmax in CR. Methods: 213 measurements of different scales were administered at 88 patients, 64% cardiac surgery and 36% with heart failure (F 13.6%, age 58.2±15.2), at the peak of effort in six minute walk test (6MWT) and aerobic exercise training by ergometer or treadmill. The concordance (Chi-square test) was obtained comparing %HRmax and RPE according to the criteria taken in literature and summarized in Table 1. Results: The analysis of the data shows that there is no agreement between %HRmax achieved at peak of 6MWT and exercise trainings with peak of RPE scales of the same test or training session (RPE BORG r=0.2, p=0.1550; CR10 r=0.2, p=0.1087; OMNI-cycle Scale r=0.13, p=0.2340; Color BORG r=0.13, p=0.8090). Figure 1 shows when each RPE correlates with %HRmax (OK), when is overestimates (OVER), when is underestimated (UNDER); 4.5% of patients wasn’t able to answer (NE). Better concordance values (36%) result in a visual analogue scale like OMNI-cycle Scale. Conclusions: The scales examined do not seem to be effective in detecting RPE values that agree with the HR during maximal effort in cardiac inpatients. It is necessary collect more data or to find alternative validated or experimental new tool for patients in CR. LIGHT MODERATE VIGOROUS %HRmax 50%-63% 64%-76% 77%-93% CR10 2-4 5-6 7-8 OMNI-cycle SCALE 2-4 5-6 7-8 COLOR BORG 10-11 12-13 14-16 RPE BORG 10-11 12-13 14-16 LIGHT MODERATE VIGOROUS %HRmax 50%-63% 64%-76% 77%-93% CR10 2-4 5-6 7-8 OMNI-cycle SCALE 2-4 5-6 7-8 COLOR BORG 10-11 12-13 14-16 RPE BORG 10-11 12-13 14-16 Open in new tab LIGHT MODERATE VIGOROUS %HRmax 50%-63% 64%-76% 77%-93% CR10 2-4 5-6 7-8 OMNI-cycle SCALE 2-4 5-6 7-8 COLOR BORG 10-11 12-13 14-16 RPE BORG 10-11 12-13 14-16 LIGHT MODERATE VIGOROUS %HRmax 50%-63% 64%-76% 77%-93% CR10 2-4 5-6 7-8 OMNI-cycle SCALE 2-4 5-6 7-8 COLOR BORG 10-11 12-13 14-16 RPE BORG 10-11 12-13 14-16 Open in new tab Abstract Number: P261 Figure 1 P263 Do patients over 65 years benefit from the cardiac rehabilitation program? Evaluation of functional capacity, analytical markers and cardiovascular risk factors N G Uribe Heredia1, LG Piccone Saponara2, R Arroyo Espliguero3, H Alvaro Fernandez1, J Benitez Peyrat3, C Solorzano Guillen3, ME Jimenez Martinez3, E Novo Garcia3, ME Viana Llamas3, B Tarancon Zubimendi3, S Moreno Reviriego3, C Toran Martinez3, JL Garcia Gonzalez3, A Castillo Sandoval3, JL Balaguer Recena3 1University Hospital of Guadalajara, Cardiac Rehabilitation Unit, Guadalajara, Spain 2Hospital General de Ciudad Real, Nefrology, Ciudad Real, Spain 3University Hospital of Guadalajara, Department of Cardiology, Guadalajara, Spain Topic: Rehabilitation: Outcomes Introduction: Age is an important non-modifiable risk factor for presenting ischemic heart disease, being greater with the increase in life expectancy. The main objective of our study was to determine whether patients older than 65 years benefited from the cardiac rehabilitation program (CR) as well as the minor ones. Methods: Prospective observational study. 47 patients older than 65 years consecutively (March/2015-February/2018), who presented an acute coronary syndrome between 1-2 months prior to phase II of a conventional CR with a duration of 2 months, were included. The functional class before and after CR was evaluated by ergometry with expired gas analysis, as well as demographic variables, coronary angiography, echocardiography, cardiovascular risk factors and comorbidities. Results: 47 patients were analyzed, mean age was 69.4±2.8 years, 12.8% women, mean LVEF 56.9±8.5%, average of diseased coronary vessels 1.79±0.8, 31% patients with partial revascularization, 44.6% were in functional class II-III (NYHA) prior to CR, 66% HBP, 76.6% dyslipidemia, 25.5% diabetes and 34% obese. At the end of the CR the percentage of functional class II-III was reduced to 8.5%. Study variables are depicted in Table 1. Conclusions: In our study, patients older than 65 years with ischemic heart disease benefited from the cardiac rehabilitation program, improving their functional capacity evaluated with both direct and indirect measures, with reduction of BMI, better control of blood pressure, lipid profile and even inflammatory prognostic markers such as CRP. PARAMETERS PRE CR PHASE II P BMI 27,8+3,6 27,4+3,3 <0,001 LDL (mg/dL) 82,7+28,3 72,8+23,3 0,04 HDL (mg/dL) 42,3+12,1 44,5+11,6 0,04 CRP (mg/L) 4,1+5,6 2,1+2,0 0,03 METS (indirect) 7,6+1,9 9,3+1,9 <0,001 SBP rest (mmHg) 131,1+18,9 123,8+14,3 0,02 DBP rest (mmHg) 76,1+8,9 70,4+6,9 0,002 HR at maximum charge (bpm) 123,8+20,2 126,3+19,4 0,36 RER 1,06+0,09 1,08+0,10 0,47 VO2 peak (ml/kg/min) 18,6+4,8 20,5+4,9 <0,001 Foretold VO2 (%) 80,0 + 17,3 88,5 + 17,2 <0,001 V-slope 34,1+5,8 33,2+3,9 0,34 PARAMETERS PRE CR PHASE II P BMI 27,8+3,6 27,4+3,3 <0,001 LDL (mg/dL) 82,7+28,3 72,8+23,3 0,04 HDL (mg/dL) 42,3+12,1 44,5+11,6 0,04 CRP (mg/L) 4,1+5,6 2,1+2,0 0,03 METS (indirect) 7,6+1,9 9,3+1,9 <0,001 SBP rest (mmHg) 131,1+18,9 123,8+14,3 0,02 DBP rest (mmHg) 76,1+8,9 70,4+6,9 0,002 HR at maximum charge (bpm) 123,8+20,2 126,3+19,4 0,36 RER 1,06+0,09 1,08+0,10 0,47 VO2 peak (ml/kg/min) 18,6+4,8 20,5+4,9 <0,001 Foretold VO2 (%) 80,0 + 17,3 88,5 + 17,2 <0,001 V-slope 34,1+5,8 33,2+3,9 0,34 Open in new tab PARAMETERS PRE CR PHASE II P BMI 27,8+3,6 27,4+3,3 <0,001 LDL (mg/dL) 82,7+28,3 72,8+23,3 0,04 HDL (mg/dL) 42,3+12,1 44,5+11,6 0,04 CRP (mg/L) 4,1+5,6 2,1+2,0 0,03 METS (indirect) 7,6+1,9 9,3+1,9 <0,001 SBP rest (mmHg) 131,1+18,9 123,8+14,3 0,02 DBP rest (mmHg) 76,1+8,9 70,4+6,9 0,002 HR at maximum charge (bpm) 123,8+20,2 126,3+19,4 0,36 RER 1,06+0,09 1,08+0,10 0,47 VO2 peak (ml/kg/min) 18,6+4,8 20,5+4,9 <0,001 Foretold VO2 (%) 80,0 + 17,3 88,5 + 17,2 <0,001 V-slope 34,1+5,8 33,2+3,9 0,34 PARAMETERS PRE CR PHASE II P BMI 27,8+3,6 27,4+3,3 <0,001 LDL (mg/dL) 82,7+28,3 72,8+23,3 0,04 HDL (mg/dL) 42,3+12,1 44,5+11,6 0,04 CRP (mg/L) 4,1+5,6 2,1+2,0 0,03 METS (indirect) 7,6+1,9 9,3+1,9 <0,001 SBP rest (mmHg) 131,1+18,9 123,8+14,3 0,02 DBP rest (mmHg) 76,1+8,9 70,4+6,9 0,002 HR at maximum charge (bpm) 123,8+20,2 126,3+19,4 0,36 RER 1,06+0,09 1,08+0,10 0,47 VO2 peak (ml/kg/min) 18,6+4,8 20,5+4,9 <0,001 Foretold VO2 (%) 80,0 + 17,3 88,5 + 17,2 <0,001 V-slope 34,1+5,8 33,2+3,9 0,34 Open in new tab Abstract Number: P263 P264 Women with ischemic heart disease included in a cardiac rehabilitation unit C Rus Mansilla1, G Cortez Quiroga1, MC Duran Torralba1, C Recuerda Casado1, MG Lopez Moyano1 1Hospital Alto Guadalquivir, Cardiology, Andújar, Jaén, Spain Topic: Rehabilitation: Outcomes Introduction: ischemic heart disease is considered a men disease, despite the fact that cardiovascular diseases are the main cause of mortality in women. This disease has different characteristics in women, with a not as well known prognosis as in men. In addition, treatment is usually more conservative and tends to undertreat patients. The objective of this study is to describe the particularities of female patients in a Cardiac Rehabilitation and Secondary Prevention Program (CRP) and their prognosis by comparison with men. Methods: Patients included in the Cardiac Rehabilitation Unit (CRU) from 2008 to 2018 were evaluated, and a comparative analysis was performed between patients of both gender. Results: We included 399 patients, 79 (19%) were women. Women were older (63 years versus 59 in men, p <0.01), more hypertensive (65.8% versus 52% in men, p <0.05), and fewer smokers (26.3% versus 57.3% in men, p <0.001). The percentage of coronary angiograms performed was lower in women (94.7% versus 98.8%, p <0.05), although high in both groups, and also, revascularization was lower in females (85% versus 94% p <0, 01). Despite these data, at the end of the CRP, women receive the same optimal medical treatment (OMT), with a similar percentage of high intensity statins, of 90% and 91%, respectively. There were no differences in mortality or in the number of events between women and men. Conclusions: the inclusion of women in a CRP make both gender equal, giving a OMT and a similar risk factor control and benefit to male patients. WOMEN MEN p Patients (n) 79 320 Age (years old) 63±12 59±10 p<0,01 Hypertension (%) 65,8 52,0 p<0,05 Dyslipemia (%) 56,6 63,2 p=n.s. Diabetes (%) 38,2 30,0 p=n.s. Smokers (%) 26,3 57,3 p<0,001 Coronary angiography (%) 94,7 98,8 p<0,05 Revascularization (%) 85 94 p<0,01 WOMEN MEN p Patients (n) 79 320 Age (years old) 63±12 59±10 p<0,01 Hypertension (%) 65,8 52,0 p<0,05 Dyslipemia (%) 56,6 63,2 p=n.s. Diabetes (%) 38,2 30,0 p=n.s. Smokers (%) 26,3 57,3 p<0,001 Coronary angiography (%) 94,7 98,8 p<0,05 Revascularization (%) 85 94 p<0,01 Open in new tab WOMEN MEN p Patients (n) 79 320 Age (years old) 63±12 59±10 p<0,01 Hypertension (%) 65,8 52,0 p<0,05 Dyslipemia (%) 56,6 63,2 p=n.s. Diabetes (%) 38,2 30,0 p=n.s. Smokers (%) 26,3 57,3 p<0,001 Coronary angiography (%) 94,7 98,8 p<0,05 Revascularization (%) 85 94 p<0,01 WOMEN MEN p Patients (n) 79 320 Age (years old) 63±12 59±10 p<0,01 Hypertension (%) 65,8 52,0 p<0,05 Dyslipemia (%) 56,6 63,2 p=n.s. Diabetes (%) 38,2 30,0 p=n.s. Smokers (%) 26,3 57,3 p<0,001 Coronary angiography (%) 94,7 98,8 p<0,05 Revascularization (%) 85 94 p<0,01 Open in new tab P265 Results of a teaching program of cardiopulmonary resuscitation in patients and relatives of a cardiac rehabilitation group. I Sainz1, J Vallejo1, I Estevez1, R Caballero1, N Pirla1, A Lopez1, M Collado1 1University Hospital of Virgen del Rocio, Cardiac Rehabilitation Unit, Seville, Spain Topic: Rehabilitation: Education Introduction: Cardiac rehabilitation (CR) is a multidisciplinary therapy in the area of physical exercise, physiotherapy and attitude learning to cope with cardiovascular disease. We believe that the acquisition of this knowledge in our patients is important. A cardiopulmonary resuscitation (CPR) learning program has been carried out on patients and relatives of those attending an RC program, evaluating their results. Purpose: Demonstrate that the learning of cardiopulmonary resuscitation improves the psychological parameters of patients and family members who carry out the program. Material and methods. In 50 patients and family members (N =50, mean age 56 ± 12 years, 40 men), a 3-hour basic cardiopulmonary resuscitation course was given by an instructor accredited by the national CPR Plan. The course includes one hour of theory and two hours of practice with dummies, with learning of mouth-to-mouth breathing, cardiac massage and defibrillation with semiautomatic devices. All the patients had carried out a CR program of 24 sessions according to conventional protocols. Each patient was invited to attend the CPR teaching with a close family member who was also instructed. In order to evaluate the results, an anonymous 4-item survey was created by the Psychologist of the CR program, focusing on the self-perception of: the resolutive capacity, fear, anxiety and negative thoughts,ability to help and provide solutions in an emergency situation, emotion of fear in an emergency situation, negative thoughts in an emergency situation and possibility of acting in an emergency situation. 50 surveys were received. To assess the learning outcome, the survey was conducted before and after the CPR course in both patients and family members. Each question-item was scored from 1 to 5. Results: After the CPR program, the average of favorable scores, understood as ≥16 points in the test, went from 13% before doing the course to 64% after it (OR 11.8, p <0.001). the sample had previously done CPR courses, the improvement was independent of this factor since in this subgroup the average of favorable scores also rose from 17% to 64% (OR 8.7, p = 0.02). The median of the test increased from 14 to 16 points after the course (p = 0.04). Conclusion: The incorporation of a basic CPR program in patients and relatives of the CR program improves the capacity for self-perception of the performance, anxiety and negative thoughts in a critical situation, so these courses could be incorporated into the CR program with good results. P266 Cardioprotective effects of exercise trainings prior to coronary artery bypass grafting Y Argunova1, SA Pomeshkina1, AN Kokov1, OL Barbarash1 1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Topic: Rehabilitation: Exercise Programmes Purpose: To evaluate cardioprotective effects of high intensity prehabilitation for patients with coronary artery disease (CAD) prior to elective on-pump coronary artery bypass grafting (CABG). Methods: 38 male patients with stable CAD referred to on-pump CABG were randomized into two groups based on the prehabilitation program. Group 1 patients (n = 20, the mean age 57.9 ± 7.15 years) underwent high intensity treadmill exercises. Group 2 patients (n = 18, the mean age 60.4 ± 7.01 years) underwent routine preoperative management without prehabilitation. Group 1 patients underwent exercise trainings under hemodynamic control and ECG monitoring (30 minute workouts per 1 day for 7 days). The training power of workout was calculated based on cardiopulmonary exercise test performed before preoperative exercises, and was estimated as 80% of the maximal oxygen consumption obtained during the exercise test. Adenosine loading single-photon emission computed tomography (SPECT) was used to measure myocardial perfusion before preoperative exercises and on days 5-7 after CABG in both study groups. Myocardial perfusion was assessed using the QPS program (Cedars Sinai Medical Center (USA)) with the construction of 17 segment polar map. All patients underwent direct myocardial revascularization under extracorporeal circulation. Statistical analysis was performed using the Statistica 10.0 software packages (Statsoft, USA). Results: Both study groups were comparable in the main clinical and demographic as well as main intraoperative clinical. Moreover, the parameters of the cardiopulmonary exercise test and SPECT were similar in both study groups. There were no cases of complications during prehabilitation. All patients had good exercise tolerance. The following parameters were assessed: the rate of accumulation of radiopharmaceutical in each sector (%), as well as integral indices of myocardial damage: SRS (Summed Rest Score) - the sum of individual scores during rest, SSS (Summed Stress Score) – the sum of scores characterizing the extent and severity of stress perfusion abnormality, SDS (Summed Difference Score) - the sum of scores representing the extent and severity of stress-induced ischemia. The analysis of myocardial perfusion parameters demonstrated that patients who had undergone preabilitation had significantly higher accumulation of radiopharmaceutical than those in the control group in basal segments (74.9 ± 3.98% vs. 70.3 ± 7.40% p = 0.04), middle (86.7 ± 5.24% vs. 79.6 ± 10.43%, p = 0.03) and apical (85.8 ± 5.03% vs. 79.0 ± 8,67%, p = 0.02) myocardium. The stress-induced ischemia (SDS) was less pronounced in Group 1 compared to Group 2 (0 scores and 0.9 ± 0.53 scores, respectively, p = 0.04). Conclusion: High intensity preoperative exercises in the routine preoperative management of patients referred to elective CABG improves myocardial perfusion in the postoperative period. P267 Combined high intensity aerobic and strength training after heart transplantation has a significant favourable effect on various from cardio pulmonary exercise test derived prognostic markers L Van Den Bosch1, L Van Maroey1, K Wuyts2, N Possemiers2, P Plaeke1, P J M Beckers2 1University of Antwerp, Antwerp, Belgium 2University of Antwerp Hospital (Edegem), Antwerp, Belgium Topic: Rehabilitation: Exercise Programmes Introduction and Aim: The benefit of cardiac rehabilitation after heart transplantation (HTX) is well known. However, whether long-term outcome variables, specifically prognostic markers as derived from cardiopulmonary exercise testing (CPET) in heart failure patients, can also change by exercising these HTX patients is still unknown. In this study, we investigated the effect of a combined high intensity aerobic and strength training on these variables. Methods: We retrospectively gathered data from the total cohort of adult post- HTX patients referred to our centre. Following CPET derived markers at baseline were compared to CPET at the end of an 8-month rehabilitation programme: peak oxygen consumption (PeakVO2), ventilatory efficiency (VE/VCO2 slope), end tidal CO2 pressure (PETCO2) at rest and at peak exercise, time to half PeakVO2 (T½PeakVO2), oxygen uptake efficiency slope (OUES), heart rate recovery (HRR), circulatory power (CP), oxygen pulse (O2pulse), equivalent of VE/CO2 (EqCO2) and the cardiac optimal point (COP). Results: 82 HTX patients (Age 53.7 ± 10.7 Yrs.; 77% Male) were included. Paired Samples T-Test showed a significant improvement of following CPET derived markers due to exercise training: PeakVO2 +5.2 mL/kg/min (95%CI +4.1, +6.3; p<0.001), VE/VCO2 slope -3.9 (95%CI -2.5, -5.3; p<0.001), PETCO2 at peak exercise +3.2 mmHg (95%CI +1.8, +4.6; p<0.001), T½PeakVO2 -19 seconds (95%CI -5, -33; p=0.006), OUES +0.37 LO2/min/LogL/min (95%CI +0.24, +0.49; p<0.001), CP +1417mmHg.mL.kg-1.min-1 (p<0.001), O2pulse +2.2 mL/beat (p=0.001), EqCO2 -3.5 (p <0.001), and COP -3.9 (95% CI -2.5, -5.3; p<0.001). PETCO2 at rest +1.1 mmHg (95% CI +0.2, +2.4; p=0,107) did not change. HRR +5 beats/min changed inversely (p<0.001). Conclusion: Combined high intensity aerobic and strength training after HTX has a significant favourable effect on various from CPET derived prognostic markers such as PeakVO2, VE/VCO2 slope, PETCO2 at peak exercise, OUES, CP, EqCO2 and COP. The effect on prognosis has been analysed in a separate paper. P268 A pilot observational study of the impact of rehabilitation in patients with pulmonary hypertension -Tthe first centre in our country G Girithari1, S Miguel1, O Santos1, G Araujo1, M Ramalhinho1, D Morais1, N Lousada1 1Hospital Pulido Valente - Centro Hospitalar Lisboa Norte, Physiotherapy and Medical Rehabilitation Department, Lisbon, Portugal Funding Acknowledgements: None Topic: Rehabilitation: Exercise Programmes Introduction: Pulmonary hypertension (PH) is a rare cardio-pulmonary disorder that is caused by unusually high pulmonary artery pressure. Exercise was limited for many years in PH due to concerns of right heart failure aggravation. Recently however,guidelines have recommended supervised exercise training as an addition to PH therapy. Purpose: To evaluate the impact of cardiorespiratory training, including sessions of aerobic, resistance and breathing exercises on functional outcomes. Methods: This pilot observational study was held at the PH outpatient section of the Cardiac Rehabilitation Center consisting of 12 weeks of progressive physical exercise on 28 patients above the age of 18 years diagnosed with PH belonging to WHO functional classes II and III of which 17 patients met the study criteria. The study comprised of three phases of assessment: before the commencement of the rehabilitation program (T0/ baseline evaluation), at the end of the program (T1) and at 3 months after completing the program (T2). The multiple primary endpoints were the 6-minute walk test (6MWT), Timed Up and Go test (TUG), Frailty and Injuries: Cooperative Studies of Intervention Techniques test (FICSIT- 4), upper and lower limb muscle strength, inspiratory volumes, International Physical Activity Questionnaire (IPAQ), withstanding distances of cycle ergometer and treadmill walking exercises, N-terminal portion of the type B natriuretic peptide (NT-proBNP) value, levels of pulmonary systolic arterial pressure (PSAP) and tricuspid annular plane systolic excursion (TAPSE). Results: Pre- and post-rehabilitation observed a significant mean increase of 59.9 meters (p=0.006) in 6MWT in addition to a mean increase of TUG at 8.7 seconds (SD 3.2) and 7.2 seconds (SD 3.6, p=0.04) respectively. Baseline FICSIT of 22.5 (SD 5.8) increased to 25.4 points (SD 3.2,p=0.017) at T1. Bicycle distance had positively reported a mean increase in distance from 5.6 km (SD 2.6) to 9.8 km (SD 1.7,p=0.007) prior and after rehabilitation. Furthermore, the difference of distance from baseline walking treadmill distance to T1 registered a significant mean extension of 484.7 m (p= 0.07) with a mean velocity of 2.6 km/h (SD 0.8) to 1.3km/h(p=0.007). Inspiratory volumes observed a slight rise from 1.7 L (SD 1.1) to 2.0L (SD 1.3, p = 0.003). There was also muscular strength growth. Baseline IPAQ mean value of 680.4 (SD 659.1) noted an increase of 1578.2 (SD 1021.7, p = 0.000) at the end of the program. No changes were seen in the values of NT-proBNP, TAPSE and PSAP. All primary endpoint values reported decreased values at T2. Conclusion: Cardiorespiratory training significantly improves functional outcomes on PH patients. Evaluation at three months after program completion had decreased values in the absence of physical training. Stagnant values of NT-proBNP, TAPSE and PSAP indicated that the level of cardiac structures was not influenced by the presence of exercise. P270 Exercise intensity and volume differentially impact on innate and adaptive immunity in patients with metabolic syndrome K Lechner1, P Von Korn1, S Kia2, A Duvinage1, J Scherr1, U Landmesser2, M Halle1, N Kraenkel2 1Technical University of Munich, Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Munich, Germany 2Charite - Campus Benjamin Franklin, Depertment of Cardiology, Berlin, Germany Funding Acknowledgements: DZHK (German Centre for Cardiovascular Research) Topic: Rehabilitation: Exercise Programmes Background: Moderate continuous exercise training – the standard of care - reduces systemic and vascular inflammation in patients with cardiometabolic diseases. Alternative exercise protocols with higher volume, and/or intensity may modulate the type of immune response, especially in patients with metabolic diseases, which may have an impact on clinical outcome. Methods: 29 patients with metabolic syndrome (MetS)(9 females/20 males, median age: 67.0 y, median BMI 30.7 kg/m2) were randomized 1:1:1 to one of three exercise regimens with a duration of 16 weeks: (1) moderate continuous training (MCT) with high volume, (2) high-intensity interval training (HIIT) with low volume and (3) HIIT with high volume. Leukocyte counts and morphology, leukocyte-platelet aggregates, endothelial- and leukocyte-derived microvesicles as a measure of cell activation, and cytokines were quantified at baseline and upon completion of the exercise programme. Results: Peak oxygen uptake (VO2peak) improved from baseline to follow-up (median 21.3 to 23.1) in all regimens. MCT resulted in a relative increase of alternatively activated monocytes and a decrease of neutrophils and T cells – mainly CD4+ effector and regulatory subsets. T-cell-platelet and monocyte-platelet-aggregates were decreased in MCT, while neutrophil-platelet-aggregates were slightly increased. Low volume-HIIT reduced monocytes – mainly classical and intermediate subsets –, NK cells, CD8+ and regulatory CD4+ T cells, as well as monocyte-platelet-aggregates. High-volume HIIT increased the proportion of the alternatively activated monocyte subset, CD8+ and naïve/central memory CD4+ T cells, and decreased the proportion neutrophils among all leukocytes. Monocyte-platelet- as well as T-cell-platelet-aggregates were reduced in high-volume HIIT, while neutrophil-platelet-aggregates were increased. No changes in leukocyte size and granularity were observed in any exercise programme. Both, MCT and HIIT, at high volumes reduced endothelial microvesicle counts and increased interleukin-10 levels. High-volume HIIT reduced overall leukocyte microvesicle counts, increased the relative representation of T-cell microvesicles among all leukocyte-derived microvesicles and increased IL-6 levels. MCT moreover led to increased levels of IL-8, and IL-13, while only low volume-HIIT reduced interleukin-1 beta levels. Conclusion: In patients with MetS, exercise volume and intensity differentially affected release and activation of leukocytes of the innate versus the adaptive immunity. Based on these findings, future studies need to establish how exercise volume and intensity can be adjusted in personalized exercise programmes in order to optimize metabo-inflammatory cardiovascular outcome parameters. P271 The impact of high-intensity interval training early after ST-elevation myocardial infarction on biomarkers of myocardial strain and injury AJ Zimmermann1, D Herzig1, T Marcin1, DA Herrsche1, M Dysli1, LD Trachsel1, P Eser1, M Wilhelm1 1Bern University Hospital, Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, Bern, Switzerland Topic: Rehabilitation: Exercise Programmes Background: Safety and effectiveness of high-intensity interval training (HIIT) has been studied in patients with chronic ischemic cardiomyopathy. Purpose: To assess the safety of a HIIT protocol early after ST-elevation myocardial infarction (STEMI) compared to an established moderate-intensity continuous exercise (MICE) training. Methods: Patients after primary percutaneous coronary intervention (PCI) for STEMI were recruited for a comprehensive 12-week ambulatory cardiac rehabilitation (CR) program. After a three-week run-in phase with optimization of medical therapy and three MICE trainings per week, patients were randomized to a HIIT group (two HIIT and one MICE training per week) and a MICE group (three MICE trainings per week) for another nine weeks' training. NT-pro-brain natriuretic peptide (NTproBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were determined at randomization (T0), within one hour after a HIIT/MICE training in the first week (T1) and last week (week nine, T2) of the program, and during the follow-up examination at the end of the CR program (T3). Systolic myocardial function was analysed using left ventricular global longitudinal strain (LVGLS) from 2D transthoracic echocardiography at T0 and T3. Peak oxygen uptake (peakVO2) was measured on a bicycle with an open-circuit spirometer. Results: Fifteen patients (100% male) were included in the study (Table). CR was started within 10 [8; 12] days after the event. LVGLS at T0 was associated with NTproBNP (spearman’s rank correlation, rs=0.68; p<0.01) and hs-cTnT (rs=0.81; p<0.01). There were significant decreases in NTproBNP and hs-cTNT over time (both p<0.01), with no significant differences between the training modalities (p=0.64 and p=0.77, respectively). LVGLS remained stable over time without significant between-group differences. Conclusion: In this pilot study, markers of myocardial strain and injury were associated with systolic function early after STEMI, but were not affected by HIIT or MICE during the 9-week training intervention. HIIT group MICE group N 8 7 Age (years) 67 [51.8; 68.8] 60 [54; 62] Body mass index (kg/m²) 25.8 [23.5; 28.3] 26.8 [25.7; 30.3] VO2peak (ml/min/kg) 28.2 [21.4; 37.2] 28.3 [26.5; 35.2] LVGLS (%) -17.1 [-14.2; -21.9] -17.8 [-16.4; -18.4] NT-proBNP (pg/mL) 180 [116; 628] 225 [160; 445] hs-cTnT (ng/L) 16 [8; 40] 12 [11; 20] HIIT group MICE group N 8 7 Age (years) 67 [51.8; 68.8] 60 [54; 62] Body mass index (kg/m²) 25.8 [23.5; 28.3] 26.8 [25.7; 30.3] VO2peak (ml/min/kg) 28.2 [21.4; 37.2] 28.3 [26.5; 35.2] LVGLS (%) -17.1 [-14.2; -21.9] -17.8 [-16.4; -18.4] NT-proBNP (pg/mL) 180 [116; 628] 225 [160; 445] hs-cTnT (ng/L) 16 [8; 40] 12 [11; 20] Data are presented as median values [inter-quartile range]. Open in new tab HIIT group MICE group N 8 7 Age (years) 67 [51.8; 68.8] 60 [54; 62] Body mass index (kg/m²) 25.8 [23.5; 28.3] 26.8 [25.7; 30.3] VO2peak (ml/min/kg) 28.2 [21.4; 37.2] 28.3 [26.5; 35.2] LVGLS (%) -17.1 [-14.2; -21.9] -17.8 [-16.4; -18.4] NT-proBNP (pg/mL) 180 [116; 628] 225 [160; 445] hs-cTnT (ng/L) 16 [8; 40] 12 [11; 20] HIIT group MICE group N 8 7 Age (years) 67 [51.8; 68.8] 60 [54; 62] Body mass index (kg/m²) 25.8 [23.5; 28.3] 26.8 [25.7; 30.3] VO2peak (ml/min/kg) 28.2 [21.4; 37.2] 28.3 [26.5; 35.2] LVGLS (%) -17.1 [-14.2; -21.9] -17.8 [-16.4; -18.4] NT-proBNP (pg/mL) 180 [116; 628] 225 [160; 445] hs-cTnT (ng/L) 16 [8; 40] 12 [11; 20] Data are presented as median values [inter-quartile range]. Open in new tab P272 Effects of hybrid assistive limb (HAL) on muscle strength in patients with heart failure H Kato1, A Koike2, L Wu2, H Watanabe3, H Kubota4, H Konno1, I Nishi5, H Kawamoto3, A Sato2, A Matsumura6, K Aonuma2, Y Sankai3, M Ieda2 1Tsukuba University Hospital, rehabilitation, Tsukuba, Japan 2Tsukuba University, Cardiology, Tsukuba, Japan 3Tsukuba University, Center for Cybernics Research, Tsukuba, Japan 4Tsukuba University, Graduate School of Comprehensive Human Sciences, Tsukuba, Japan 5Tsukuba University Hospital, Cardiology, Tsukuba, Japan 6Tsukuba University, Neurosurgery, Tsukuba, Japan Funding Acknowledgements: This work was supported by JSPS KAKENHI (JP17K09485) and ImPACT Program (2017-PM05-03-01). Topic: Rehabilitation: Exercise Programmes Background: Hybrid assistive limb (HAL), which assists voluntary control of joint motion, has been reported to improve walking function in patients with muscular dystrophy. We evaluated the effects of a lumbar-type HAL as a tool of exercise therapy, focusing on the lower limb strength and dynamic balance in patient with heart failure. Methods: Fifteen heart failure patients (73.1 ± 15.7 years) who have difficulties in standing up by themselves or walking at ordinary speed were enrolled. They were randomly assigned to sit-to-stand exercise with HAL or to sit-to-stand exercise without HAL. As a program of cardiac rehabilitation, sit-to-stand exercise was performed as many as possible for 6 to 10 days. The short physical performance battery (SPPB), 30-sec chair stand test (CS-30), and knee extension strength were measured before and after the completion of cardiac rehabilitation. Results: Although there was no significant difference in the number of days of exercise therapy between the two groups, the total number of sit-to-stand exercise tended to be high in the HAL group (509 ± 251 vs 353 ± 196). The SPPB score (6.00 ± 2.83 vs 7.90 ± 3.81, p<0.05), CS-30 (4.60 ± 5.46 vs 7.10 ± 6.03, p=0.06), and knee extension strength (15.2 ± 6.8 vs 18.5 ± 9.1 kgf, p<0.05) were improved by cardiac rehabilitation in the HAL group. However, there were no significant changes in these indices in the group without HAL. Conclusion: The present findings suggest that the use of lumbar-type HAL during sit-to stand exercise has beneficial effects on the lower limb strength and dynamic balance in patients with heart failure. P273 Feasibility and short-term effectiveness of an additional resistance and balance training in cardiac rehabilitation for older patients after valve surgery: results of a pilot study E Prasciene1, N Icking2, E Kisieliute3, R Kubilius1, B Bjarnason-Wehrens2 1Lithuanian University of Health Sciences, Rehabilitation department, Kaunas, Lithuania 2German Sports University Cologne, Institute for Cardiology and Sports Medicine, Dep. Preventive and Rehabilitative Sport Medicine and , Cologne, Germany 3Hospital of Lithuanian University of Health Sciences, Kulautuva rehabilitation hospital, Kaunas, Lithuania Topic: Rehabilitation: Exercise Programmes Introduction: The number of surgically treated elderly patients with valvular heart disease (VHD) is increasing. This group of patients has special needs regarding exercise based cardiac rehabilitation (CR), but until now, only few CR-studies have focused on this group. Purpose: To evaluate the feasibility and short-term effects of an additional resistance and balance training compared to usual care CR-program, to improve functional capacity muscular strength and physical performance in patients after valve surgery or intervention. Methods: A pilot study of a prospective, single-center, randomized controlled trial carried out in inpatient CR setting. Inclusion criteria were: age ≥65 years, valve surgery or intervention, ability to start CR within 4 weeks post-surgery, 6-minute walking distance (6-MWD) ≥100- ≤350 m, written patient’s agreement. Patients (Pts) (N=29, 74,72±7,9 years, 51,7% female) were randomly stratified for gender assigned (1:1 ration) to intervention group (IG n=14) or control group (CG n=15). All pts completed comprehensive 3 week exercise based CR program including aerobic endurance training on cycle ergometer (30 min, 5 days/week), additional aerobic exercise (sitting or standing) (30 min, 5 day/week) and respiratory exercises ( 15 min, 7 days/week). Patients of the IG participated in additional exercise session 3 days/week including 15 min balance training and 30 min resistance training. Functional capacity and mobility using 6MWD the short physical performance battery (SPPB), frailty was assed using 5 meters walking test and muscular strength was assed by repetition maximum (1RM) for leg-press. Patients were assed twice: before and after CR program. Results: At the beginning of CR no significant differences were observed between groups (age: IG 72.8±2 y. vs. CG 76.5±2.1 y., p=0.354; gender IG were 6 (40%) females vs. CG 9 (60%), p=0.464; 6MWD IG 239.3±28.6 m. vs. CG 242.3±32.1, p=0.906; 1RM IG 54.1±5.5 kg vs. CG 43 ±6.7 kg, p=0.427; SPPB score IG 8.35±0.62 vs. CG 7.53±0.62, p=0.357). Prevalence of frailty was similar in both groups (IG 9 (60%) vs. CG 10 (67%), p=0.544). As a result of the CR functional capacity, muscle strength and mobility improved significantly with no statistical significance between groups (6MWT (IG 359±27.1m (+120m) vs. CG 341.8±30.3m (+100m), p=0.677;1RM IG 66.3±6.9 (+12 kg) vs. CG 54.5±7. 7 kg (+11 kg), p=0.308; SPPB score (IG 9.6±0.65 (+1,25) vs. CG 8.4±0.69 (+0.87), p=0.202). The additional training was feasible and safe for the IG and no adverse effects or events occurred causing premature termination of the study. Conclusions: The results demonstrated, that the additional balance and resistance training, was well accepted and tolerated by older patients. The results show a tendency of better results in the IG. No significant differences between groups were observed, probably to the small sample size. P274 Dose-response between physical activity and improvements in health-related physical fitness in active patients with coronary artery disease M Lemos Pires1, R Pinto1, V Angarten1, V Santos1, X Melo2, J Machado Rodrigues3, H Santa-Clara1 1Faculdade de Motricidade Humana - Universidade de Lisboa, CIPER - Centro Interdisciplinar de Estudo da Performance Humana, Lisboa, Portugal 2Ginásio Clube Português, GCP Lab., Lisboa, Portugal 3Faculdade de Medicina - Universidade de Lisboa, Lisboa, Portugal Topic: Rehabilitation: Exercise Programmes Introduction: regular physical activity is effective in the secondary prevention of cardiovascular disease and in attenuating the risk of premature death among men and women. Most international guidelines recommend a goal of 150 min/week of moderate-to-vigorous intensity physical activity (MVPA), which indicate the minimum volume of activity required for benefits in health-related physical fitness. For additional benefits, 300 min/week are recommended. However, no work to date has designated qualitative assessments of the amount of physical activity required for these benefits in patients with CAD. Purpose: to quantify the dose-response relationship between objectively measured physical activity and changes in health-related physical fitness in patients with CAD who underwent a 6-month exercise-based Cardiovascular Rehabilitation (CR) program. Methods: we examined levels of physical activity as predictors of changes in health-related fitness among thirty patients with CAD (mean age 64.7 ± 8.3 years) who completed a 6-month exercise-based CR program consisting of 3x60-min sessions per week (aerobic exercise: 30 min at 60-70% heart rate reserve; resistance exercise: 2x8-12 repetition maximum in 6 major muscle groups). Patients were grouped by physical activity level: 1) Active group (AG): ≥ 150 minutes and < 300 minutes MVPA per week (n=16, 11 male); 2) Very active group (VAG): ≥ 300 minutes MVPA per week (n=14, 13 male) and had their: 1) cardiorespiratory fitness assessed by an incremental symptom-limited cycling cardiopulmonary exercise test; 2) body composition estimated by dual-energy X-ray absorptiometry; and 3) muscular strength determined by a 1 maximum repetition in 6 major muscle groups, at baseline and after completion of the exercised-based CR program. Level of physical activity was assessed using an accelerometer. Differences between groups were determined using independent t-tests. Results: patients with CAD engaging in ≥ 300 minutes MVPA per week had superior changes in upper body strength (VAG: 6.9±5.4% vs AG: 1.4±8.2%, p=0.043). However, the AG and the VAG, had similar changes in peak oxygen consumption (VAG: 6.7±14.5% vs AG: 10.6±11.7%, p=0.417), lean body mass (VAG: 1.3±2.3% vs AG: 1.6±3.4%, p=0.739), body fat (VAG: -2.1±6.2% vs AG: -1.2±5.3%, p=0.688) and lower body strength (VAG: 16.2±13.6% vs AG: 15.7±21.4%, p=0.954). Conclusions: these findings provide qualitative data supporting that greater levels of physical activity might lead to additional benefits in promoting health-related physical fitness in patients with CAD and enhance the importance of an outpatient CR program to promote long term MVPA levels to maintain their quality of life and ability to perform daily activities. P275 Feasibility, safety, and effectiveness of a novel mobile application in cardiac rehabilitation I Nabutovsky1, S Ashri1, A Nachshon1, R Tesler2, Y Shapiro2, B Vadasz3, E Wright3, O Amir4, L Grosman-Rimon4, R Klempfner1 1Chaim Sheba Medical Center, Cardiac Rehabilitation Institute, Tel Hashomer, Israel 2Ariel University, The Department of Health Systems Management, Faculty of Health Sciences, Ariel, Israel 3Technion - Israel Institute of Technology, Haifa, Israel 4Baruch Padeh Medical Center, Tiberias, Israel Topic: Rehabilitation: Exercise Programmes Background: Cardiac rehabilitation (CR) is underutilized globally despite evidence of clinical benefit. Major obstacles for wider adoption, include distance, travel-time and interference with daily routine. Tele-rehabilitation can potentially address some of these limitations, enabling patients to exercise in their home environment or community. The aim of this study was to evaluate the clinical and physiological outcomes as well as adherence to tele-cardiac rehabilitation (tele-CR) in patients with low cardiovascular risk. Methods: A total of 22 patients with established coronary artery disease participated in a 6-month tele-CR program. Datos Health, a novel digital health application and care-team dashboard were used for remote monitoring, communication and management of the patients. The primary objective of the study was to assess exercise capacity as determined by exercise stress test before and following the 6-month intervention. Results:Following the 6-month tele-CR intervention, there was a significant improvement in exercise capacity, assessed by estimated Metabolic Equivalents (METS) with an increase from 10.6±0.5 to 12.3±0.5 (P=0.002). High-density lipoproteins (HDL) levels significantly improved, whereas low-density lipoproteins (LDL), triglyceride (TG) glycosylated hemoglobin (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure levels were not significantly changed. Exercise adherence was consistent among patients, with more than 63% of patents who participated in a program of moderately intense exercise for 150 minutes per week. Conclusion:Patients who participated in tele-CR adhere well to the exercise program and attained clinically significant functional improvement. Tele-CR program is a viable option for populations that cannot, or elect not to participate in center based tele-CR programs. Abstract Number: P275 P276 Acute increase in peak systolic blood pressure in patients following ascending aortic surgery during moderate intensity resistance training - A descriptive single center intervention study R Gottlieb1, KA Nielsen1, M Henriksen1, FC Pott1, EIB Prescott1, CH Dall1 1Bispebjerg University Hospital, Copenhagen, Denmark Topic: Rehabilitation: Exercise Programmes Background: Aortic aneurysms or dilatations are conditions with increased mortality that may lead to ascending aortic surgery (AAS). Strict control of blood pressure (BP) is strongly recommended after AAS (<130/80 mmHg) and acute BP elevations are presumed to increase the risk of new aortic dissection or rupture. There are no guidelines for resistance training for AAS patients. These patients are recommended to follow the guidelines for Chronic Heart Failure patients NYHA II-III, i.e. training at low or moderate intensity (40-60% of maximum strength). However, the acute hemodynamic response to resistance training for this patient group is unknown. Purpose: The aim of this study was to investigate peak systolic BP in AAS patients during moderate intensity resistance training (leg press), and to examine whether the peak systolic BP increases beyond a pragmatically set maximum of 200 mmHg. Methods: Peak systolic BP was measured continuously with a non-invasive method in 24 AAS patients. Three sets of leg-press at moderate intensity (approximately 15 - repetition maximum (RM)) with a 60-second break between each set were performed. Results: The 24 patients (14 males) had a mean age of 60.5 years and a mean of 16.3 months since AAS with a range from 4.5 to 39.5 months since AAS. Mean baseline systolic BP was 115.7 mmHg (SD 13.5). Peak systolic BP increased from the first to the third set (pressure load summation). During the first set of leg-press mean peak systolic BP was 148.6 mmHg (SD 19.9), 153.3 mmHg (SD 22.6) in the second set and 156.6 mmHg (SD 23.9) in the third set. None of the participants reached a systolic BP > 200 mmHg. The highest peak systolic BPs registered were; 188.0 mmHg (first set), 187.2 mmHg (second set) and 190.4 mmHg (third set). Conclusion: The findings indicate that acute systolic BP in AAS patients does not increase beyond 200 mmHg during 3 sets of moderate intensity resistance training (leg-press) and can thus be considered safe in this population. The results are based on a small sample and are limited to AAS patients. Abstract Number: P277 P277 Comparison of modifiable disease risk factors in men and women with low, moderate and high levels of cardiorespiratory fitness following completion of phase II cardiac rehabilitation 1Dublin City University (DCU), School oh Health & Human Performance, Dublin, Ireland 2Dublin City University (DCU), Insight Centre for Data Analytics, Dublin, Ireland 3KU Leuven, Department of Cardiovascular Sciences , Leuven, Belgium 4University of Limerick, Department of physical education and sports science , limerick, Ireland On Behalf of: Beamount Cardiac Rehab Unit, Mater Cardiac Rehab Unit Funding Acknowledgements: This project has received funding from the European Union’s Horizon 2020 Framework Programme for Research and Innovation Action under Grant Agreement Topic: Rehabilitation: Exercise Programmes Background/Introduction: Cardiorespiratory fitness (CRF) is one of the most widely examined physiological variables. It is highly related to functional capacity and is a strong independent predictor of all-cause and disease-specific mortality. Purpose: The purpose of this study was to compare selected modifiable disease risk factors in men and women with low, moderate and high levels of CRF following completion of phase II (hospital-based) cardiac rehabilitation (CR). Methods: Men (n=98) and women (n=22) (mean ± SD), age 60.3 ± 9.2 yr, and V̇O2 peak (mL/kg/min) 24.13 ± 6.32 were recruited during induction to a home-based exercise referral program following completion of phase II CR. CRF level was classified as low (≤ 4.9 METs), moderate (5.0-7.9 METs) and high (≥ 8.0 METs). Outcome measures assessed included physical fitness (peak oxygen uptake, handgrip strength, isometric and isokinetic upper leg strength, 30-sec sit-to-stand test), physical activity (PA) (step count, daily minutes of light, moderate and vigorous PA), anthropometrics (body mass index (BMI), fat mass, waist and hip circumference), blood pressure, blood glucose and blood lipids. Results: BMI, fat mass, and waist and hip circumstance were significantly higher in low and moderate CRF than high CRF. There was a differences (p<0.005) in systolic blood pressure between low CRF (127.2 ± 19.1 mm Hg) and high CRF (118.6 ± 11.4 mm Hg), and in circulating levels of triglycerides between moderate CRF (1.28 ± 0.6 mmol/L) and high CRF (0.95 ± 0.6 mmol/L). Handgrip strength, isometric and isokinetic upper leg strength and performance in the 30-second sit-to-stand test were significantly lower in low and moderate CRF than high CRF. There was no significant difference in circulating levels of insulin, glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, daily step count and minutes of light, moderate or vigorous intensity PA between groups. There was an inverse relation (p<0.001) between MET level and all anthropometric measures and a positive relation (p<0.001) between MET level and all measures of upper and lower body strength and endurance. Conclusion: A CRF level > 8 METs at completion of phase II CR is associated with a lower BMI, fat mass, waist circumference, hip circumference, and a higher upper and lower body strength and endurance. C Mc Cormack1, C Mc Dermott1, S Kelly1, A Mc Carren2, L Mc Dermott2, O O'shea2, J Claes3, R Buys3, N O'connor2, N Mc Caffrey1, D Susta1, C Woods4, V Cornelissen3, K Moran2, N Moyna1 P278 Comparison of selected health indices in Irish and Belgian participants commencing a home-based, technology enabled cardiac rehabilitation program 1Dublin City University (DCU), School of Health and Human Performance, Dublin, Ireland 2Dublin City University (DCU), School of Computing, Dublin, Ireland 3KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium 4Dublin City University (DCU), School of Electronic Engineering, Dublin, Ireland 5University of Limerick, Department of Physical Education and Sports Science, limerick, Ireland On Behalf of: PATHway research group (DCU,UL, KUL, Mater misericordiae university hospital, Beaumont Hospital) Funding Acknowledgements: European Unions Horizon 2020 Framework, Programme for Research and Innovation Action under Grant Agreement no.643491 Topic: Rehabilitation: Exercise Programmes C Mcdermott1, C M Mccormack1, L Mcdermott1, O O'shea1, S M Kelly1, A Mccarren2, J Claes3, R Buys3, N O'connor4, N Mccaffrey1, D Susta1, C Woods5, V Cornelissen3, K Moran1, N M Moyna1 Background/Introduction: Despite strong evidence for cardiac rehabilitation (CR) in secondary prevention of CVD, both uptake and long-term adherence is low. Innovative, patient-centered and cost-effective delivery models based on advances in digital technology/communications have the potential to increase both uptake and long-term adherence to CR. PATHway is an individualized self-management home-based CR program involving an internet-enabled, sensor-based platform designed for men and women with CVD living in Ireland and Belgium. Purpose: The purpose of this study was to compare selected health indices of Irish and Belgian participants entering the PATHway program. Methods: In a multicentre randomized controlled pilot trial, 120 patients (men = 82%), ranging in age from 40-80 yr, completing a hospital-based CR program in Belgium or Ireland were randomized (1:1) to PATHway or standard care. Anthropometric measures, vascular health, cardiorespiratory fitness (CRF), strength, physical activity and blood parameters were assessed using identical protocol in both the Irish and Belgian centres. Results: The study participants (mean age ± SD = 60.3 ± 9.2 yr) were classified as overweight (BMI = 28.2 ± 4.0 kg/m²). Two thirds (n=81) of the participants were referred to CR following percutaneous coronary intervention, 16 following coronary artery bypass graft, 6 following valve surgery and 17 for other cardiac conditions. The Irish participants expended more calories per day (p = 0.001) than their Belgium counterparts (1871.2 ± 688.9 kcal/d vs. 1456.0 ± 427.8 kcal/d). Cardiorespiratory fitness level was significantly higher (p <0.01) in the Belgian (25.5 ± 6.3 ml/kg/min vs. 22.7 ± 6.1 ml/min/kg) than the Irish participants. Measures of upper and lower body strength were significantly higher in the Belgian than the Irish participants. Conclusion: The Irish cohort were significantly more active than the Belgian group. However, the Belgian group had higher levels of CRF and both upper and lower body strength than their Irish counterparts. P279 The behavior of cardiorespiratory capacity after a semi-supervised cardiovascular rehabilitation program in heart failure patients - A pilot study ACGB Lima1, NT Silva1, AOV Lira1, EM Negrao1, G Cipriano Jr1 1University of Brasilia, Health Sciences and Technologies, Brasilia, Brazil Topic: Rehabilitation: Exercise Programmes Background: Cardiovascular rehabilitation (CR) is an important strategy in the treatment of heart failure (HF). Semi-supervised cardiac rehabilitation (SSCR), although it does not provide benefits of the same magnitude, is an option able to attend a larger number of patients and generates a lower cost. However, its ability to maintain the effects of the supervised CR (SCR), SSCR is not yet a consensus in the scientific literature. Objective: To evaluate the behavior of cardiorespiratory variables (oxygen consumption at the anaerobic threshold - VO2 AT, ml.kg-1.min-1, and peak oxygen consumption - peak VO2, ml.kg-1.min-1) after 36 sessions of SCR program followed by a 6-month SSCR program in HF patients. Methods: Twenty-six patients with HF (54.9 ±10.2 years, 63% men, 49% ischemic etiology, 45% NYHA functional class III, left ventricular ejection fraction 36.4 ± 12.8%) were randomized to high intensity interval training program - HIIT (9 patients), 4 min - above 90% of maximal HR, followed by 3min - below 1o threshold HR or circuit resistance training (CRT) (17 patients), resistance exercises in pneumatic pressure force machines, 60 to 80% of 1-RM; followed by an SSCR program (20 patients), home stretching exercises, muscle strengthening activities for 10 minutes and aerobic activity for 20 minutes at 60 to 80 % of the maximum HR, associated with 5 monthly lectures and follow-up by weekly activity report. Patients were assessed at the beginning and the end of each phase using the cardiopulmonary test. Results: SCR promoted an improvement in VO2AT (pre: 9.0 ± 4.1 vs. post: 11.6 ± 4.1 ml.kg-1.min-1, p = 0.03) and peak VO2(pre: 14.3 ± 5.6 vs. post: 17.2 ± 4.8 ml.kg-1.min-1, p = 0.05). After 6 months, we observed the maintenance of the cardiorespiratory parameters (VO2AT: 11.6 ± 2.8 ml.kg-1.min-1, p = 0.92 and peak VO2: 15.7 ± 4.0 ml.kg-1.min-1, p = 0.26). Conclusion: The SSCR was able to maintain cardiorespiratory capacity after 6 months of an SCR program. SSCR can be an effective strategy to optimize compliance and increase the availability of cardiac rehabilitation programs for HF patients. P281 The effect of exercise training on blood pressure in african and asian populations: a systematic review and meta-analysis of randomized controlled trials M Bersaoui1, SM Baldew1, N Cornelis2, J Toelsie1, VA Cornelissen2 1Anton de Kom University of Suriname, Paramaribo, Suriname 2KU Leuven, Leuven, Belgium Topic: Cardiovascular Rehabilitation Background: Current international guidelines recommend exercise as a first line treatment in the prevention and management of hypertension (HT). These recommendations are primarily based on meta-analyses involving data collected in predominantly Caucasian populations. However, in line with the various responses to pharmacological blood pressure (BP) lowering interventions in patients of different ethnic origin, we hypothesize that the change in BP following exercise training might be different in non-Caucasian populations; and thus requiring different exercise prescriptions. However, studies evaluating the efficacy of exercise training as a non-pharmacological intervention in the BP management of non-Caucasian populations are limited and inconclusive. Purpose: To systematically summarize the available literature on the efficacy of exercise interventions on BP in healthy adults (age ≥ 18 years) of African- or Asian-origin by means of meta-analytic techniques. Methods: We conducted a search in three electronic databases and performed a systematic review and meta-analysis of randomized controlled trials investigating the effect of exercise training on BP among African- and Asian-origin adults with optimal BP, high BP or HT as per the latest ACC/AHA guidelines, and published in a peer-reviewed journal up to May 2018. Random effect models were fitted to estimate the effect sizes. We reported data as weighted means and 95% confidence intervals (CI). Results: We identified 30 studies, involving 25 trials conducted in a population of Asian-origin (n=903; mean age: 44.1 years; 42% male) and 5 trials in a population of African-origin (n=510; mean age: 56.7 years; 80% male). The trials consisted of 17 aerobic, 8 resistance and 5 combined training groups. Overall, significant reductions (p<0.0001) were observed for systolic BP (SBP) and diastolic BP (DBP). Comparison among the ethnic groups showed a significantly larger net change in SBP among the African- population compared to the Asian-origin population (p=0.005), but not for DBP (p=0.95). Endurance training reduced SBP more in the African-origin population (-14.96 vs -5.89 mmHg; p<0.0001), whereas the reduction in DBP was larger in the Asian-origin population (-2.07 vs -5.79 mmHg; p<0.0001). In the subgroup of hypertensive participants (n=1088) significantly larger net change in SBP was observed in the African- compared to the Asian-origin population (p<0.01), but not for DBP (p=0.64). Conclusions: We found significant different BP responses to aerobic training between the populations of African- and Asian-origin. However, the overall low number of studies performed among the populations of African-origin and the limited data with regard to resistance training in both ethnic groups calls for more research in the field of exercise therapy in non-Caucasian populations. P282 Cardiac rehabilitation provision in portugal: comparative results from the global survey of programs P Morais1, M Supervia2, K Turk-Adawi3, J Ruivo1, F Lopez-Jimenez4, A Abreu1, S Grace5 1University Hospital De Santa Maria, Lisbon, Portugal 2University Hospital Gregorio Maranon, Madrid, Spain 3Qatar University, Doha, Qatar 4Mayo Clinic, Rochester, United States of America 5Norfolk and Norwich University Hospital, Norwich, United Kingdom of Great Britain & Northern Ireland Topic: Cardiovascular Rehabilitation Aims: To update our understanding of cardiac rehabilitation (CR) provision in Portugal from our 2013-2014 survey, and how it compares to Europe and Southern European subreagion. Methods and Results: A first-ever survey of CR programs worldwide was conducted online from February 2016 to July 2017. National cardiac associations and local champions facilitated CR programme identification. The main provision measures considered were CR availability, programme volume (number of patients served annually), national capacity (median number of patients a program could serve annually by number of programs in a country), density (national capacity per annual national incidence of ischemic heart disease (IHD)), and financial structuring. To compute density, the 2017 reports from the "European Cardiovascular Disease Statistics" and from "Programa Nacional para as Doenças Cérebro-Cardiovasculares" were used for IHD incidence estimation in Portugal. Overall, 21 (91%) of 23 Portuguese programs participated in the survey. It was determined that CR was available in 39 (89%) of European countries; data were collected in 37 (95%). Results from Portuguese surveys were compared to the 455 (30%) of 1538 responding programs from those countries. In the Southern European subregion, which included 10 (90.9%) responding countries out of 11 with CR programs, there were 152 (44%) participating centres out of 346. Programme volumes averaged 109.1 patients per year in Portugal, compared to 307.9 in the Southern Europe nations, and 531.3 across Europe. Density-wise, there was 1 CR spot for every 4.35 IHD patients in Europe, per 6.46 IHD patients in Southern Europe and per 11.30 IHD patients in Portugal, with an estimated unmet need of 23,699 CR spots in Portugal per year. Most programs were state-funded: 75% across Europe, 76% in Southern Europe, and only 52% in Portugal. The average program cost per patient was 1846.56€ across Europe, 2163.73€ in Southern Europe and 491.33€ in Portugal. Assuming a stable proportion of diagnoses/indications for CR in the Portuguese centres since the 2013-2014 national survey (51.8% of CR spots were occupied by post-myocardial infarction patients), we estimate that, in 2016-17, 10.3% of myocardial infarction patients could participate in CR programs, which signifies a 2.3% growth in the 4-year period. However, even if the maximum national CR capacity was used exclusively for myocardial infarction patients, only 20% of those patients would be rehabilitated. Conclusion: Portuguese CR provision is steadily growing but still limited, behind European mean standards, even when compared with the socioeconomically similar Southern European countries. P283 Cardiac rehabilitation in the elderly in 8 rehabilitation units in Europe. Baseline data from the EU-CaRE study E Prescott1, N Mikkelsen1, P Eser2, M Wilhelm2, C Pena Gil3, M C Iliou4, S Schneider5, U Zeymer5, E P Meindersma6, D Ardissino7, L F Prins8, A E Van Der Velde9, A W J van't Hof9, E De Kluiver9 1Bispebjerg Hospital of the Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark 2Bern University Hospital, Preventive Cardiology & Sports Medicine, Bern, Switzerland 3University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain 4Assistance Publique Hopitaux de Paris, Department of Cardiac Rehabilitation, Paris, France 5Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany 6Radboud University Medical Centre, Department of Cardiology, Nijmegen, Netherlands (The) 7University Hospital of Parma, Department of Cardiology, Parma, Italy 8Diagram B.V., Zwolle, Netherlands (The) 9Isala Heart Centre, Zwolle, Netherlands (The) On Behalf of: The EU-CaRE study group Funding Acknowledgements: Horizon2020 grant Topic: Cardiovascular Rehabilitation Background/introduction: Due to the progressive deconditioning, comorbidities and higher risk of complications with prolonged hospital stays, elderly patients are in particular need of cardiac rehabilitation (CR). Purpose:To compare baseline among elderly patients (65+) participating in CR across Europe. Methods:The EU-CaRE study is a prospective study with 8 participating CR units in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Consecutive patients with ACS, stable CAD and heart valve replacement were included. Results:1633 patients participated, 54% with ACS, 33% stable CAD and 13% following valve replacement. Median age was 72.9, 23% were women, 4% (range 0-12%, p<0.001) were of non-European ethnic origin and 16% (range 4-32%, p<0.001) were living alone. Median time from index event to start of CR varied from 11 to 49 days (p<0.001). Overall Medical treatment was adequate: 93% received a statin, 82% a beta-blocker and 70% an ACEi/ARB. However, risk factor goals were not achieved in a large proportion of patients (table). In 58% (44-69%, p<0.001) 3 or more risk factors were uncontrolled. Mean VO2peak was relatively low (mean 16.0 mL/kg/min) and varied significantly by participating centre. This was largely unaffected by multivariable adjustment. Conclusion:EU-CaRE provides a snapshot of the elderly population with heart disease in Western Europe. Risk factors and exercise capacity indicate the need of CR. Of concern, the proportion of patients of other ethnic origin is disproportionately low and the lag-time to start of CR needs improvement in many centres. Total Zwolle Copenhagen Paris Bern Santiago Ludwigshafen Parma Nijmegen P-value N=1633 N=220 N=237 N=219 N=203 N=247 N=228 N=247 N=32 Smoker (%) 10 0.9 8 8 18 8 7 17 13 <0.001 BMI (mean) 27.2 27.8 27.2 25.1 27.2 29.2 27.2 26.4 27.7 <0.001 Exercise <5 days/week (%) 56 17 47 76 51 80 61 61 29 <0.001 Mediterranean diet score <5 (%) 22 44 22 10 47 0 34 7 26 <0.001 Systolic BP>140 mmHg (%) 19 24 25 21 16 24 18 3 38 <0.001 LDL>1.8 (%) 61 68 50 59 66 54 67 62 55 <0.001 Depression moderate/severe (%) 18 6 15 23 11 23 13 35 14 <0.001 VO2peak (mean) 16.0 18.1 17.3 14.5 17.8 16.1 14.0 14.1 17.7 <0.001 VO2peak %pred (mean) 75.9 87.0 83.6 65.6 83.6 77.0 65.4 67.5 86.0 <0.001 Total Zwolle Copenhagen Paris Bern Santiago Ludwigshafen Parma Nijmegen P-value N=1633 N=220 N=237 N=219 N=203 N=247 N=228 N=247 N=32 Smoker (%) 10 0.9 8 8 18 8 7 17 13 <0.001 BMI (mean) 27.2 27.8 27.2 25.1 27.2 29.2 27.2 26.4 27.7 <0.001 Exercise <5 days/week (%) 56 17 47 76 51 80 61 61 29 <0.001 Mediterranean diet score <5 (%) 22 44 22 10 47 0 34 7 26 <0.001 Systolic BP>140 mmHg (%) 19 24 25 21 16 24 18 3 38 <0.001 LDL>1.8 (%) 61 68 50 59 66 54 67 62 55 <0.001 Depression moderate/severe (%) 18 6 15 23 11 23 13 35 14 <0.001 VO2peak (mean) 16.0 18.1 17.3 14.5 17.8 16.1 14.0 14.1 17.7 <0.001 VO2peak %pred (mean) 75.9 87.0 83.6 65.6 83.6 77.0 65.4 67.5 86.0 <0.001 Distribution of risk factors before cardiac rehabilitation among 1633 elderly patients (>=65 years) in 8 European CR centres Open in new tab Total Zwolle Copenhagen Paris Bern Santiago Ludwigshafen Parma Nijmegen P-value N=1633 N=220 N=237 N=219 N=203 N=247 N=228 N=247 N=32 Smoker (%) 10 0.9 8 8 18 8 7 17 13 <0.001 BMI (mean) 27.2 27.8 27.2 25.1 27.2 29.2 27.2 26.4 27.7 <0.001 Exercise <5 days/week (%) 56 17 47 76 51 80 61 61 29 <0.001 Mediterranean diet score <5 (%) 22 44 22 10 47 0 34 7 26 <0.001 Systolic BP>140 mmHg (%) 19 24 25 21 16 24 18 3 38 <0.001 LDL>1.8 (%) 61 68 50 59 66 54 67 62 55 <0.001 Depression moderate/severe (%) 18 6 15 23 11 23 13 35 14 <0.001 VO2peak (mean) 16.0 18.1 17.3 14.5 17.8 16.1 14.0 14.1 17.7 <0.001 VO2peak %pred (mean) 75.9 87.0 83.6 65.6 83.6 77.0 65.4 67.5 86.0 <0.001 Total Zwolle Copenhagen Paris Bern Santiago Ludwigshafen Parma Nijmegen P-value N=1633 N=220 N=237 N=219 N=203 N=247 N=228 N=247 N=32 Smoker (%) 10 0.9 8 8 18 8 7 17 13 <0.001 BMI (mean) 27.2 27.8 27.2 25.1 27.2 29.2 27.2 26.4 27.7 <0.001 Exercise <5 days/week (%) 56 17 47 76 51 80 61 61 29 <0.001 Mediterranean diet score <5 (%) 22 44 22 10 47 0 34 7 26 <0.001 Systolic BP>140 mmHg (%) 19 24 25 21 16 24 18 3 38 <0.001 LDL>1.8 (%) 61 68 50 59 66 54 67 62 55 <0.001 Depression moderate/severe (%) 18 6 15 23 11 23 13 35 14 <0.001 VO2peak (mean) 16.0 18.1 17.3 14.5 17.8 16.1 14.0 14.1 17.7 <0.001 VO2peak %pred (mean) 75.9 87.0 83.6 65.6 83.6 77.0 65.4 67.5 86.0 <0.001 Distribution of risk factors before cardiac rehabilitation among 1633 elderly patients (>=65 years) in 8 European CR centres Open in new tab P284 PROBE multicentre study, to compare long-term adherence of secondary prevention measures, after an acute coronary syndrome, of an intensive cardiac rehabilitation program vs a standard program A Castro Conde1, R Gonzalez-Gallarza1, V Arrarte Esteban2, F Garza Benito3, P Caravaca Perez4, R Hidalgo Urbano4, R Vidal Perez5, M Abeytua Jimenez6, J Torres Maques7 1University Hospital La Paz, Department of Cardiology, Madrid, Spain 2General University Hospital of Alicante, Alicante, Spain 3Hospital Nuestra Señorade Gracia, Unidad de Rehabilitación Cardiaca, Zaragoza, Spain 4Hospital Universitario Virgen Macarena, Sevilla, Spain 5University Hospital Lucus Augusti, Lugo, Spain 6University Hospital Gregorio Maranon, Madrid, Spain 7Hospital Son Llatzer, Palma de Mallorca, Spain Funding Acknowledgements: Menarini Spanish Group assists in the funding of this study Topic: Cardiovascular Rehabilitation Background: Studies evaluating optimal duration of cardiac rehabilitation programs (CRP) are missing. Protocols cover duration between 8 to 12 weeks at present, based on low level of evidence. Methods: Basal visit: patients were randomized to one of the study groups. An initial evaluation was performed in both groups.Group 1: intervention: intensive cardiac rehabilitation program; 2 weeks, 5 days a week, and reinforcement sessions at 3, 6 and 9 months.Group 2: no intervention: standard cardiac rehabilitation program according to standard clinical practice.Final visit: one year after the start of the CRP; the blinded evaluator evaluated the patients. Adherence to the mediterranean diet, psychological state, tobacco habit, pharmacological treatment, functional capacity, quality of life, biochemiucal analysis of cardiometabolic parameters, anthropometric parameters, cardiovascular events and mortality from any cause, were assessed. Results: 509 patients were included among 8 Spanish public centres. Distribution of patients in the two study groups did not present statistically significant differences (p = 0.959). Most of the participants included in the study were men (87.7%), although the distribution of patients according to gender in both CRP groups was homogeneous (p = 0.494). Nor statistically significant differences were established between the two groups in the type of ACS suffered by the participants before they were included in the study (p = 0.085). The results for the primary endpoints of the study show that the intensive CRP has similar effectiveness on patients as the standard program, thus no significant differences between both groups. (Table 1) Conclusion: Intensive programs with periodic reminder sessions are just as effective as standard programs. Therefore, and according to the means available in each center, intensive programs be offered to patients and adjusted to their personal and clinical characteristics. Conventional Program Intensive Program P Tobacco abstention (Cooximetry) 90,6% 91,2% 0,876 Physical exercise adherence (METS) 93,0% 94,2% 0,804 Mediterranean diet adherence (>=9) Assessed questionnaire, “Modified Trichopoulou A Costacou T,Bamia C,Trichopoulou D” 85,2% 89,7% 0,187 Treatment adherence AAS 88,5% 88,9% >1,000 2º AA 46,0% 46,6% 0,928 Betablockers 72,8% 78,2% 0,174 Statins 84,3% 88,2% 0,240 4 treatment groups together 38,7% 39,3% 0,164 Conventional Program Intensive Program P Tobacco abstention (Cooximetry) 90,6% 91,2% 0,876 Physical exercise adherence (METS) 93,0% 94,2% 0,804 Mediterranean diet adherence (>=9) Assessed questionnaire, “Modified Trichopoulou A Costacou T,Bamia C,Trichopoulou D” 85,2% 89,7% 0,187 Treatment adherence AAS 88,5% 88,9% >1,000 2º AA 46,0% 46,6% 0,928 Betablockers 72,8% 78,2% 0,174 Statins 84,3% 88,2% 0,240 4 treatment groups together 38,7% 39,3% 0,164 Open in new tab Conventional Program Intensive Program P Tobacco abstention (Cooximetry) 90,6% 91,2% 0,876 Physical exercise adherence (METS) 93,0% 94,2% 0,804 Mediterranean diet adherence (>=9) Assessed questionnaire, “Modified Trichopoulou A Costacou T,Bamia C,Trichopoulou D” 85,2% 89,7% 0,187 Treatment adherence AAS 88,5% 88,9% >1,000 2º AA 46,0% 46,6% 0,928 Betablockers 72,8% 78,2% 0,174 Statins 84,3% 88,2% 0,240 4 treatment groups together 38,7% 39,3% 0,164 Conventional Program Intensive Program P Tobacco abstention (Cooximetry) 90,6% 91,2% 0,876 Physical exercise adherence (METS) 93,0% 94,2% 0,804 Mediterranean diet adherence (>=9) Assessed questionnaire, “Modified Trichopoulou A Costacou T,Bamia C,Trichopoulou D” 85,2% 89,7% 0,187 Treatment adherence AAS 88,5% 88,9% >1,000 2º AA 46,0% 46,6% 0,928 Betablockers 72,8% 78,2% 0,174 Statins 84,3% 88,2% 0,240 4 treatment groups together 38,7% 39,3% 0,164 Open in new tab P285 Effects of pharmacological and non-pharmacological treatments on cardiorespiratory parameters in chronic heart failure patients with exercise oscillatory ventilation: a systematic review GS Ribeiro1, C Gargnin1, P Dal Lago1, D Hansen2, P Agostoni3, M Karsten4 1Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil 2Universiteit Hasselt, Hasselt, Belgium 3Università Degli Studi di Milano, Milano, Italy 4Universidade do Estado de Santa Catarina, Florianópolis, Brazil On Behalf of: Research Group on Cardiovascular Health and Exercise (gepCARDIO) Funding Acknowledgements: Brazilian National Council for Improvement of Higher Education (CAPES) Topic: Cardiovascular Rehabilitation Background: Exercise oscillatory ventilation (EOV), described as ventilatory oscillation cycles with or without interposed apnea, is associated with worse prognosis in chronic heart failure (CHF) patients. Studies show a 4-fold higher risk for adverse cardiovascular events in patients with EOV. Purpose: To synthesize the effects of pharmacological and non-pharmacological treatment on oxygen uptake (VO2 peak) and ventilatory efficiency (VE/VCO2 slope) in CHF plus EOV patients. Methods: Searches were performed on the several databases. There was no restriction on study design, but only studies published after 2008 were selected. Inclusion criteria: adult patients (40 years old or older) with EOV diagnosis concomitant to CHF. Intervention: all non-invasive therapies designed to improve symptomatology and prognostic factors for a period longer than 6-weeks. Outcomes: any measure of hemodynamic or cardiopulmonary capacity and EOV parameters. A meta-analysis of treatment effect on oxygen uptake and ventilatory efficiency was done. Results: One case study, one cohort study and four clinical trials were identified. Overall, 127 EOV patients were evaluated: 16 patients in pharmacological treatment and 111 patients in non-pharmacological treatment. Briefly, the pharmacological therapy (phosphodiesterase 5 inhibition) was done per 12-month, the adaptive servo-ventilation treatment was done per 12-weeks, and exercise was done per 15 ± 1 weeks. The studies characteristics and the main findings are presents in Table 1. Meta-analysis shown that the pharmacological and non-pharmacological treatments were associated with a significant improvement in Peak VO2 (SMD 0.50 [0.75, 0.25], p<0.001) and VE/VCO2 slope (SMD -0.63 [-0.13, -1.14], p=0.01). Conclusions: Pharmacological and non-pharmacological treatments improve cardiorespiratory and EOV parameters, leading to improvement in the symptoms and prognostic factors in CHF patients with EOV. Besides that, exercise intervention is so effective as pharmacologic treatment to reduce EOV. Study (year) Treatment n Follow-up Main findings Guazzi (2012) PDE5 16 12-months Reversal in 93% of EOV cases Kazimierczak (2011) ASV 12 12-weeks Reversal in 86% of EOV cases Castro (2010) Exercise 1 16-weeks Reversal of EOV Zurek (2012) Exercise 52 12-weeks Reversal in 71% of EOV cases Yamauchi (2016) Exercise 26 20-weeks Decrease of EOV amplitude Panagopoulou (2017) Exercise 20 12-weeks Decrease of EOV duration Study (year) Treatment n Follow-up Main findings Guazzi (2012) PDE5 16 12-months Reversal in 93% of EOV cases Kazimierczak (2011) ASV 12 12-weeks Reversal in 86% of EOV cases Castro (2010) Exercise 1 16-weeks Reversal of EOV Zurek (2012) Exercise 52 12-weeks Reversal in 71% of EOV cases Yamauchi (2016) Exercise 26 20-weeks Decrease of EOV amplitude Panagopoulou (2017) Exercise 20 12-weeks Decrease of EOV duration PDE5, phosphodiesterase 5 inhibition. EOV, exercise oscillatory ventilation. ASV, adaptive servo-ventilation. Open in new tab Study (year) Treatment n Follow-up Main findings Guazzi (2012) PDE5 16 12-months Reversal in 93% of EOV cases Kazimierczak (2011) ASV 12 12-weeks Reversal in 86% of EOV cases Castro (2010) Exercise 1 16-weeks Reversal of EOV Zurek (2012) Exercise 52 12-weeks Reversal in 71% of EOV cases Yamauchi (2016) Exercise 26 20-weeks Decrease of EOV amplitude Panagopoulou (2017) Exercise 20 12-weeks Decrease of EOV duration Study (year) Treatment n Follow-up Main findings Guazzi (2012) PDE5 16 12-months Reversal in 93% of EOV cases Kazimierczak (2011) ASV 12 12-weeks Reversal in 86% of EOV cases Castro (2010) Exercise 1 16-weeks Reversal of EOV Zurek (2012) Exercise 52 12-weeks Reversal in 71% of EOV cases Yamauchi (2016) Exercise 26 20-weeks Decrease of EOV amplitude Panagopoulou (2017) Exercise 20 12-weeks Decrease of EOV duration PDE5, phosphodiesterase 5 inhibition. EOV, exercise oscillatory ventilation. ASV, adaptive servo-ventilation. Open in new tab P286 Glucose tolerance after cardiac surgery: impact on functional recovery and prognosis N Russo1, A La Spada2, M Marini1, A Spadoni1, G Ciliberti3, M Ciuffi1, GP Fadini4, M D'eusanio3, S Iliceto4, L Carotti1, A Avogaro4 1Villa Serena Hospital, Jesi (AN), Italy 2University of Bari, Bari, Italy 3Marche Polytechnic University of Ancona, Ancona, Italy 4University Hospital of Padova, Padua, Italy Topic: Cardiovascular Rehabilitation Background and aim: Diabetes is a leading cause of cardiovascular morbidity and mortality worldwide and the increased risk for adverse events is already apparent in pre-diabetic conditions in a pathologic continuum. Very little is known about the influence of glucose tolerance early after cardiac surgery: therefore the aim of the present study was to assess the role of glucose tolerance on functional recovery after cardiac surgery. Methods: Between Jan 2016 and March 2018, 703 consecutive patients (mean age 70.9±9.7 years, male 61.3%) were transferred to our centre for a 3 week, in-hospital, exercise-based cardiac rehabilitation, immediately after (median 8 days, IQR 7,12 days) cardiac surgery (CABG 44.1%, Mitral surgery 19.6%, Aortic surgery 46.3%, Ascending aorta surgery 14.3%). The glucose tolerance was assessed by fasting glucose and glycated haemoglobin (HbA1c) determination. The whole population was divided into 3 groups: normoglicemic (fasting glucose<100 mg/dL, HbA1c<6.0), pre-diabetic (fasting glucose between 100 mg/dL and 125.9 mg/dl or HbA1c ≥ 6.0 and<6.5), diabetic (patients being treated with insulin or oral anti-diabetic drugs or HbA1c > 6.5). Functional capacity was assesed by a six-minute walking test (6MWT) at admission and at discharge. A telephonic interview was also carried on in order to evaluate one year rate of death and new hospitalizations. Results: Glucose intolerance was highly prevalent in our patients after cardiac surgery (diabetic 27.0%, prediabetic 19.8%). Fifty-three patients (7.5%) were not able to complete the programme due to non fatal complications. All the remaining patients improved their exercise capacity at the end of the programme (mean 6MWT gain 98±58 m, p<0.05), with no significant differences among groups. The follow up could be completed in 141 patients. Overall, cardiac and all-cause mortality resulted 1.7% and 4.1% after 1 year, respectively. Diabetic patients were older, had worse clinical conditions, an absolute lower exercise capacity and a worse prognosis. Prediabetic patients had intermediate characteristic in term of physical capacity and percentage of adverse events at follow up. Conclusions: An abnormal glucose tolerance is highly prevalent after cardiac surgery. Patients with either prediabetes or diabetes have a lower exercise capacity and a worse prognosis compared to normoglycemic counterpart. Despite a clear reduction in exercise capacity, an impaired glucose tolerance does not preclude increments in cardiac performance in the short term during an intensive, exercise-based cardiac rehabilitation, showing the same safety and efficacy profile as in normoglycemic patients. P287 Post-myocardial infarction outpatient cardiac rehabilitation in patients older than 65 years of age M Novakovic1, T Vizintin Cuderman1, B Krevel1, U Rajkovic2, Z Fras1, B Jug1 1University Medical Centre Ljubljana, Department of Vascular Diseases, Ljubljana, Slovenia 2University of Maribor, Faculty of Organisational Sciences, Kranj, Slovenia Topic: Cardiovascular Rehabilitation Background: Cardiac rehabilitation improves cardiovascular health after myocardial infarction (MI). However, data on the effects of cardiac rehabilitation in patients after MI older than 65 are scarce. Methods: Consecutive patients older than 65 years attending outpatient cardiac rehabilitation after MI at a dedicated university centre were included. Exercise testing was performed at inclusion and after completion of a 12-week comprehensive cardiac rehabilitation programme. Data on risk factors and prescribed drugs were systematically collected. Results: Of the 146 patients included, 109 (75%) were men, the mean age was 70 years (from 65 to 84). Improvement of exercise performance was significant after cardiac rehabilitation program, from 6.2 to 8.1 MET (p<0.001). On multivariable analysis, male gender (adjusted odds ratio [OR] 3.7, confidence interval [CI] 1.24-11.3, p=0.020), younger age (OR per 1 year of age 0.90, CI 0.81-0.99, p=0.033) and baseline exercise performance (OR per 1 MET 0.70, CI 0.54-0.93, p=0.012) emerged as independent predictors of improved exercise capacity, defined as >2 MET increase from baseline. Additionally, the number of attended cardiac rehabilitation sessions showed a trend towards significance (OR per 1 attended session 1.03, CI 1.00-1.07, p=0.079). Conclusion: Cardiac rehabilitation in patients older than 65 years is safe and effective. However, current rehabilitation programmes seem to provide more pronounced exercise capacity improvements in men, and further studies are needed to introduce/examine optimal programmes for women older than 65 years. P288 Predictors of non-participation and dropout during outpatient cardiac rehabilitation RWM Brouwers1, VJG Houben1, JJ Kraal1, HMC Kemps1 1Maxima Medical Centre, Flow - Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Veldhoven, Netherlands (The) Topic: Cardiovascular Rehabilitation Background: Despite well-studied clinical benefits, still too few patients participate and complete outpatient cardiac rehabilitation (CR) after acute myocardial infarction (AMI). In order to improve CR referral, enrolment and completion rates it is important to understand why, on which moments and how many patients drop out of CR. Purpose: In this study we aim to assess at which moment between hospital discharge and CR completion patients drop out of a CR programme, and to assess which patient-related characteristics can predict dropout. Methods: In a retrospective cohort study, we selected patients who were hospitalised in our centre between January 1st 2015 and December 31st 2016 with a non-ST segment elevation myocardial infarction (NSTEMI) or ST segment elevation myocardial infarction (STEMI). Patients were selected anonymously based on reimbursement codes in the Electronic Health Record (EHR) using the CTcue EHR Data Platform. Using CTcue, we extracted baseline demographic, geographic and clinical characteristics and data on CR referral, enrolment and completion for each patient. We used multivariable logistic regression to assess which characteristics predict dropout. Results: Between 2015 and 2016, 666 patients were hospitalised with a NSTEMI (64.9%) or STEMI (35.1%). Patients were predominantly male (65.9%) with a mean age of 69.0 ± 12.8 years. Of 640 patients discharged and not participating in outpatient CR at the moment of hospitalisation, 201 patients (31.4%) were not referred for CR. Characteristics independently associated with non-referral were female sex, NSTEMI, no coronary revascularisation, diabetes mellitus, a prior history of coronary artery disease (CAD), a negative family history for CAD, and the absence of hypercholesterolemia (c-statistic 0.92). Once referred, 5.5% did not attend the intake procedure, 9.0% did not start any treatment modules, and 12.6% did not attend the evaluation procedure, meaning 27.1% dropped out of the CR programme. Characteristics independently associated with not completing CR were higher age and a longer duration of hospitalisation (c-statistic 0.71). Conclusion: In patients discharged after AMI, the main cause for not participating in CR was non-referral. After referral, dropout at each subsequent step in the CR programme was low. Optimisation of CR participation should aim to improve referral rates by targeting women, patients with NSTEMI, patients who are not revascularised, and patients with diabetes or a prior manifestation of coronary artery disease. Abstract Number: P288 Non-participation and dropout during CR P289 Diaphragm dysfunction following cardiac surgery: role of ultrasound imaging for initial and follow-up assessment during cardiac rehabilitation F Maranta1, I Cartella2, A Pistoni2, L Cianfanelli2, D Cianflone2 1San Raffaele Scientific Institute, Milan, Italy 2University Vita-Salute San Raffaele, Milan, Italy Topic: Cardiovascular Rehabilitation Background Diaphragm dysfunction is a common, but underdiagnosed complication of cardiac surgery. Ultrasonography (US) is an emerging technique for the assessment of diaphragm function. In cardiac surgery, few trials have been conducted using US and no clear data exist on the recovery of diaphragm function after surgery. Purpose The aim of this study is to evaluate post-cardiac surgery diaphragm dysfunction using US and to assess the impact of an inpatient cardiovascular rehabilitation (CR) programme on its functional recovery. Methods We performed a single-centre prospective cohort study, enrolling 97 consecutive patients hospitalised in our CR Unit. 38 patients underwent mitral valve repair or replacement, 14 aortic valve replacement, 14 coronary artery bypass grafting (CABG), 22 combined surgery, and 9 other surgical interventions. Diaphragm US was performed at admission and after 10 rehabilitative sessions. We assessed the following parameters: thickening fraction (TF) in B-mode on the right intercostal projections, and excursion, time of inspiration, time of a respiratory cycle and contraction velocity in M-mode on right anterior subcostal projections. Results Following cardiac surgery, the incidence of diaphragm dysfunction and paralysis were 60% and 1%, respectively. Patients with TF <20% at admission gained an important benefit from rehabilitation, with significant improvement in TF (13.30%, IQR 8.69 – 17.39 vs 27.27%, IQR 21.05 – 31.58; p<0.001), excursion (1.67cm, IQR 1.3 – 2.1 vs 2.23cm, IQR 1.9 – 2.7; p<0.001), time of inspiration (0.9s, IQR 0.9 – 1.07 vs 1.01s, IQR 0.87 – 1.13; p=0.005), time of a respiratory cycle (2.67s, IQR 2.38 – 3.05 vs 3.07s, IQR 2.68 – 3.35; p<0.001) and velocity (1.81cm/s, IQR 1.14 – 2.33 vs 2.24cm/s, IQR 1.92 – 2.76; p<0.001). Conversely, in patients with a TF>20%, no additional improvement was observed. In both groups, there was a significant improvement in the parameters of physical performance. Patients with TF<20% showed an increase of the 6-minute-walking-test distance (300m, IQR 205 – 370 vs 555m, IQR 450 - 612; p<0.001) and the corresponding METS (2.60, IQR 2.13 – 2.92 vs 4.09, IQR 3.44 – 4.50; p<0.001) and a reduction of the perception of exertion (Borg Scale 11, IQR 11 – 13 vs 13, IQR 12 - 13; p=0.011). At the final assessment, in 51.5% of the total population diaphragm function recovered, whilst 48.5% had a failure of recovery (TF relative change between admission and discharge<60%). The multivariate analysis identified CABG as an independent predictor of failure of diaphragm recovery (OR 5.44; CI 1.10 - 26.84, p=0.037). Conclusion US might be a valuable part of routine clinical practice for initial and follow-up assessment of patients after cardiac surgery. Rehabilitation showed to be an effective strategy to improve diaphragm parameters in patients with post-surgical dysfunction. Progressive evaluation of diaphragm function may drive personalised rehabilitation programmes. P290 Predictors for baseline exercise capacity in elderly coronary artery disease patients of seven European countries: the EU-CaRE study MW Wilhelm1 1Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne, Berne, Switzerland On Behalf of: EU-CaRE study group Funding Acknowledgements: Horizon2020 Topic: Cardiovascular Rehabilitation Background: The aim of the present study was to determine factors associated with peak exercise capacity inelderly coronary artery disease (CAD) patients enrolling in cardiac rehabilitation (CR) from several European countries. Methods: Elderly (≥65 yrs) CAD patients enrolling in CR were recruited in eight centers from seven European countries (Denmark, France, Germany, the Netherlands, Italy Spain and Switzerland) for the purpose of the EU-CaRE study. Predictors of VO2 peak at the start of CR were sought from anthropometric, demographic, and clinical data by linear regression models. Results: Data was available from 1127 patients with a mean age of 72.9 years. The model with the significant independent variables as listed in Table 1 explained 61.7% of the total variance in VO2 peak. Unique (independent) variances were small, with center having the greatest unique variance (6%), followed by weight (3.7%), and forced expiratory volume in the first second (FEV1, 3.2%). Conclusions: In this population of elderly CAD patients, VO2 peak was associated mainly with FEV1 and hemoglobin. Center differences could not be accounted for by the available measured parameters but are likely due to differences in patient populations. Parameter Estimate Std. Error p-value Unique variance Intercept 32.77 190.14 0.863 Center 2.2e-16 0.064 Weight 6.96 0.68 2e-16 0.037 FEV1 133.47 14.83 2e-16 0.032 Hemoglobin 68.90 7.57 2e-16 0.020 Sex 146.21 22.22 7.2e-11 0.016 Physical score SF36 6.21 1.01 1.2e-9 0.015 Age -7.28 1.45 6.2e-7 0.009 Resting heart rate -2.57 0.64 6.6e-5 0.008 NYHA class 0.008 Resp. exchange ratio 306.92 74.80 4.4e-5 0.006 Beta-blocker -62.30 19.32 0.001 0.004 Peripheral arterial disease -90.72 29.44 0.002 0.004 Diabetes mellitus -53.32 18.53 0.004 0.003 Nephropathy -75.79 29.36 0.010 0.003 Parameter Estimate Std. Error p-value Unique variance Intercept 32.77 190.14 0.863 Center 2.2e-16 0.064 Weight 6.96 0.68 2e-16 0.037 FEV1 133.47 14.83 2e-16 0.032 Hemoglobin 68.90 7.57 2e-16 0.020 Sex 146.21 22.22 7.2e-11 0.016 Physical score SF36 6.21 1.01 1.2e-9 0.015 Age -7.28 1.45 6.2e-7 0.009 Resting heart rate -2.57 0.64 6.6e-5 0.008 NYHA class 0.008 Resp. exchange ratio 306.92 74.80 4.4e-5 0.006 Beta-blocker -62.30 19.32 0.001 0.004 Peripheral arterial disease -90.72 29.44 0.002 0.004 Diabetes mellitus -53.32 18.53 0.004 0.003 Nephropathy -75.79 29.36 0.010 0.003 Unique variances were derived from the difference of explained variance between the full model and the model leaving this particular variable out. Open in new tab Parameter Estimate Std. Error p-value Unique variance Intercept 32.77 190.14 0.863 Center 2.2e-16 0.064 Weight 6.96 0.68 2e-16 0.037 FEV1 133.47 14.83 2e-16 0.032 Hemoglobin 68.90 7.57 2e-16 0.020 Sex 146.21 22.22 7.2e-11 0.016 Physical score SF36 6.21 1.01 1.2e-9 0.015 Age -7.28 1.45 6.2e-7 0.009 Resting heart rate -2.57 0.64 6.6e-5 0.008 NYHA class 0.008 Resp. exchange ratio 306.92 74.80 4.4e-5 0.006 Beta-blocker -62.30 19.32 0.001 0.004 Peripheral arterial disease -90.72 29.44 0.002 0.004 Diabetes mellitus -53.32 18.53 0.004 0.003 Nephropathy -75.79 29.36 0.010 0.003 Parameter Estimate Std. Error p-value Unique variance Intercept 32.77 190.14 0.863 Center 2.2e-16 0.064 Weight 6.96 0.68 2e-16 0.037 FEV1 133.47 14.83 2e-16 0.032 Hemoglobin 68.90 7.57 2e-16 0.020 Sex 146.21 22.22 7.2e-11 0.016 Physical score SF36 6.21 1.01 1.2e-9 0.015 Age -7.28 1.45 6.2e-7 0.009 Resting heart rate -2.57 0.64 6.6e-5 0.008 NYHA class 0.008 Resp. exchange ratio 306.92 74.80 4.4e-5 0.006 Beta-blocker -62.30 19.32 0.001 0.004 Peripheral arterial disease -90.72 29.44 0.002 0.004 Diabetes mellitus -53.32 18.53 0.004 0.003 Nephropathy -75.79 29.36 0.010 0.003 Unique variances were derived from the difference of explained variance between the full model and the model leaving this particular variable out. Open in new tab P291 Impact of cardiac rehabilitation program on lifestyle changes and quality of life in coronary heart disease patients: findings from Polaspire survey S Sinnadurai1, PIOTR Jankowski2, ZBIGNI Gasior3, KOSIOR Dariusz4, MACIEJ Haberka3, DANUTA Czarnecka2, A Pajak2, K Szostak-Janiak3, M Setny5, A Krzykwa5, M Zalewska1, PAWEL Sowa1, KAROL Kaminski1 1Medical University of Bialystok, Department of Population Medicine and Civilization Diseases Prevention, Bialystok, Poland 2Jagiellonian University Medical College, Cracow, Poland, Poland 3Medical University of Silesia, Katowice, Poland 4Mossakowski Medical Research Centre, Warsaw, Poland 5Department of cardiology and Hypertension, CSK MSWiA, warsaw, Poland On Behalf of: Polaspire survey Topic: Cardiovascular Rehabilitation Background: Cardiac rehabilitation (CR) is a cost-effective way to cause significant lifestyle changes and impact on all-cause and CVD mortality in patients. Purpose: The study aimed to determine the lifestyle changes in patients with ischemic heart disease after participating in a cardiac rehabilitation program. Method: A cross-sectional survey was carried out in 13 hospitals from 4 regions from 2016 to 2017. Eligible patients were identified through hospital medical records and invited to attend a study visit dated 6 to 18 months after hospitalization for CHD (coronary bypass grafting, angioplasty, myocardial infarction, ischemia). Patients were questioned on lifestyle, medication, and quality of life during this interview. Logistics regression analysis was used to assess the factors associated with CR participation. Risk factor control and quality of life were compared between patients who participate in CR and who did not participate in CR by adjusting for significant predictors in the multivariable model. Results: A total of 1,236 patients were interviewed and 1,009 patients were found to be eligible. Overall, 36.6% were advised to participate in a cardiac rehabilitation program and 84.1% of them attended at least half of their total recommended sessions; this proportion accounting for 29.9% of the total study population. Notably, patients who were older, unemployed, enrolled with percutaneous coronary intervention and unstable angina, or those with a past history of unstable angina and heart failure, hypertension, or abnormal glucose at the time of treatment discharge were less likely to be advised to participate in the cardiac rehabilitation program. It was demonstrated that male (OR 0.28, 95% CI 0.10 to 0.74) or highly educated (OR 0.42, 95% CI 0.18 to 0.99) patients were less likely to participate in CR. In multivariable logistics regression analysis, patients who participated in CR had achieved significantly better glucose control ( OR 1.53, 95% CI 1.06 to 2.22) and quality of life (EuroQoL) (OR 1.01. 95 CI 1.00-1.01) compared to those did not participate in CR. Conclusion: Cardiac rehabilitation may yield a better quality of life in coronary heart disease patients. However, additional patient data may be necessary to fully elucidate the effectiveness of this program. Only 40% were referred for and only one-third of all analyzed IHD patients had attended a cardiac rehabilitation program. Therefore, additional multidisciplinary approaches are necessary to properly incentivize CR program adherence in general and to measure their impact on benefits and drawbacks associated with them Table 1 Participants in CR and changes Table 1 Participants in CR and changes Open in new tab Table 1 Participants in CR and changes Table 1 Participants in CR and changes Open in new tab P292 Digital cardiac rehabiltation programs: the future of patient-centred medicine IRENE Nabutovsky1, A Nachshon1, ROBERT Klemphner1 1Sheba Medical Center, Heart Rehabilitation center, Ramat Gan, Israel Topic: Cardiovascular Rehabilitation Background: The low participation rate in cardiac rehabilitation programs is the major reason for re-hospitalization, morbidity and mortality. Home-based cardiac rehabilitation by technological means is an essential component of "patient-centered" approach, which capable to enhance the participation rate in CR programs. Introduction: Aim of the present research is to examine attitudes, perceptions and behavioral intentions towards Remote Digital Cardiac Rehabilitation (RDCR) with respect to factors like age, education, smoking, exercise habits, technological illiteracy and mobile phone behavior. METHODS AND MATERIALS: Cross-sectional study of 200 adult patients discharged from hospital following an acute coronary syndrome, cardiac surgery or percutaneous coronary intervention. All patients answered an anonymous Technology Usage Questionnaire (TUQ) to examine the relationships between their willingness to participate in RDCR and various parameters. The survey was done in July-November 2017 at our medical center in Israel. Results: Overall, 83% of all participants were interested to participate in RDCR program. Patients with heart failure had a greater interest in RDCR (100%; p<0.05), while patients after coronary bypass surgery had a lower interest in the program (71.1%; p<0.05). Level of attitude towards healthy lifestyle found as a significant predictor of willingness to participate in RDCR (OR 2.26; p=0.01). Socio-demographic characteristics, lifestyle, habits, technological knowledge, age and gender were not found as a significant predictors of interest in RDCR. Conclusions: RDCR program is acceptable to most cardiac patients including the elderly population, and is a potential solution for patients who avoid traditional rehabilitation programs in medical centers. Abstract Number: P292 Figures 2&5 P293 The long-term effects on cardiorespiratory fitness, muscular strength and body composition in trained older individuals with and without coronary artery disease R Pinto1, V Angarten1, M Lemos Pires1, M Borges1, V Santos1, X Melo2, P Sousa3, J Machado Rodrigues4, H Santa Clara1 1Faculdade de Motricidade Humana – Universidade de Lisboa , Lisbon, Portugal 2Ginásio Clube Português, GCP Lab, Lisbon, Portugal 3Centro Hospitalar Lisboa Norte, EPE/Hospital Pulido Valente, Lisbon, Portugal 4Faculdade de Medicina - Universidade de Lisboa , Lisbon, Portugal Topic: Cardiovascular Rehabilitation Background: the benefits of cardiac rehabilitation (CR) participation for those with coronary artery disease (CAD) are well established and include reduced cardiovascular mortality, reduced risk of hospital admissions, improved cardiorespiratory fitness and health-related quality of life. Aging is associated with declines in muscle mass, strength performance, and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and to maintain independent functioning. The majority of exercise intervention studies in patients with CAD examined the effects of short-term (up to 3 months) CR programs and have focused on middle-age individuals. Long term CR interventions in older adults remains unclear. Purpose: to compare cardiorespiratory fitness, muscular strength and body composition response to exercise in older active adults with CAD versus a control group (CG) of healthy active age- and gender-matched individuals. Both groups did at least 6 months the following exercise training (ET) prescription, 3 d/wk x 60min: aerobic exercise, 30 min at 60-70% heart rate reserve and resistance exercise, 2x8-12 repetition maximum (RM) in 6 major muscle groups. Methods: forty participants aged and gender matched (age: 62.6±7.6 years; 80% men; n=20 per group) completed the following assessments: 1) cardiorespiratory fitness was assessed by an incremental symptom-limited cycling cardiopulmonary exercise test; 2) body composition was estimated by dual-energy X-ray absorptiometry; and 3) muscular strength was determined by a one RM in 6 major muscle groups. Differences between CAD and CG groups at the end of the ET prescription were tested using ANOVA. Results: Patients with CAD had lower systolic and diastolic blood pressure at peak exercise (CAD: 184±24, CG: 199±19 mmHg, p<0.01; CAD: 82±10, CG: 90±14 mmHg, p<0.01, respectively), lower peak VO2 (CAD: 24.1 ± 5.2, CG: 29.5 ± 6.8 ml/kg/min, p<0.01) and lower peak exercise heart rate (CAD: 131 ± 18, CG: 144 ± 18 bpm, p<0.05) compared to CG. VE/VCO2 slope was higher in patients with CAD (CAD: 36.3 ± 4.5, CG: 31.3 ± 4.4, p<0.01). At ventilatory threshold, patients with CAD had significantly lower VO2 compared to the CG (CAD: 16.2 ± 4.5, CG: 19.5 ± 3.72 ml/kg/min, p<0.05). In contrast, there were no differences between groups on muscular strength and body composition. Conclusions: older active patients with CAD participating in an outpatient CR program for at least 6 months had lower cardiorespiratory fitness compared to their age - and gender-matched active healthy peers. However, older patients with CAD had similar muscular strength and body composition when compared to their age- and gender-matched active healthy peers. These findings suggest that participation in a long-term community-based CR program facilitates the maintenance of muscular strength and body composition that may play an important role in reducing disability and prolonging independent living in older adults with CAD. P294 The effects of intense physical exercise on the left ventricular diastolic function and change in the level of NTproBNP peptide concentration in the treatment of patients after acute coronary syndrome J Kapusta1, R Irzmanski1 1Medical University, Clinic of Internal Medicine and Cardiac Rehabilitation, Lódz, Poland Topic: Cardiovascular Rehabilitation Introduction: Cardiovascular diseases, despite preventive measures being undertaken, are the most common cause of death in most European countries. The achievements of modern medicine, bringing with them more and more effective treatment, give hope for improving the functioning of patients. Systematic physical activity adjusted individually for each patient can improve the clinical course of the disease. Aim of the study: The aim of the study was to evaluate the effects of controlled physical exercise on the left ventricular diastolic function and change in the level of NT-proBNP peptide concentration in patients after an acute coronary event. Material and methods: The study involved 73 patients, aged from 39 to 85 years, after having acute coronary syndrome. The patients were qualified for the second stage of cardiac rehabilitation and divided into three groups. Group I consisted of 25 patients who were qualified for a 2-week cardiological rehabilitation program. Group II consisted of 30 patients undergoing a 4-week program. The rest were qualified to group III. Patients from group I and II participated in a rehabilitation program including: interval training conducted on cycling cycloergometers and breathing, relaxation and isometric exercises of small muscle groups. Group III has been subject to an individually tailored program. The training consisted of breathing exercises, isometric exercises of small muscle groups and relaxation groups. In all subjects, echocardiography for EF, LVEdD and plasma NT-proBNP were performed. The tests were carried out before, after and after 6 months from the end of the cardiac rehabilitation cycle. Results: In group I and II EF statistically significantly improved in group I by 3.5% (p =, 0076) and in group II by 3.1% (p =, 0032). In group III, the change was statistically insignificant. End-diastolic space of the left ventricle, in group I increased by 3.3 mm (p =, 0033), in group II by 1.4 mm (p =, 0473), and in group III by 3.9 mm ( p =. 0019). In all three groups, regardless of the intensity of the rehabilitation program, the NT-proBNP concentration was reduced. Conclusions: There is a relationship between the values of the diastolic function of the heart and the concentration of NT-proBNP, before and after cardiac rehabilitation. The results indicate the important role of intense physical effort and duration of training, the diastolic function of the left ventricle and the change in the NT-proBNP peptide concentration in the treatment of patients after acute coronary syndrome. This can help other researchers, physicians, rehabilitators and the whole rehabilitation team dealing with cardiac patients in changing rehabilitation programs implemented in their centers. P295 Predictors of good functional capacity in patients with valvular heart disease post-heart valve surgery who had undergone cardiac rehabilitation R Setiani1, E Zuhri1, A Median Ambari1, B Dwiputra1, D Sarvasti2, A Santoso1, A Agassi Tsalitsa1, F Defina1, R Istisakinah1, B Radi1, D Kusmana1, B Setianto1 1Harapan Kita Hospital, Jakarta, Indonesia 2Faculty of Medicine Widya Mandala, Department of Cardiology, Surabaya, Indonesia Topic: Cardiovascular Rehabilitation Introduction:: Patients with valvular heart disease, in contrast to coronary artery bypass graft (CABG) patients, often experience cardiac abnormalities and decreased functional capacity for years before surgery. Functional capacity after surgery is very important because good functional capacity is strongly associated with good quality of life, morbidity, and mortality in the years to come. Therefore, predicting functional capacity after valve surgery is essential in determining the prognosis. Currently, there is still few data about functional capacity on valvular heart disease after heart valve surgery. Objective: To determine the predictors of good functional capacity after heart valve surgery based on pre-operative characteristics. Methods: A retrospective study was performed with multivariate regression analysis of medical record data of patients with heart valve disease undergoing heart valve surgery and cardiac rehabilitation from September 2009 until June 2018 in a National Cardiovascular Center. Factors that predict good functional capacity (METs ≥ 6.00) were assessed based on patient’s pre-operative characteristics, such as gender, age, body mass index (BMI), left ventricular ejection fraction (LVEF), diabetes mellitus, hypertension, concomitant coronary artery disease, and electrocardiogram (ECG) result. Result: The developmental dataset had 418 patients. From 418 patients, 78 (18.7%) patients had aortic valve disease, 269 (64.4%) patients had mitral valve disease, and 71 (16.9%) patients had mitral and aortic valve diseases. The type of valve involved did not significantly affect the functional capacity (p=0.073). The multivariate regression analysis showed five variables that can significantly predict functional capacity. Four variables, that were male (OR 0.15, 95%CI 0.08 to 0.27, p<0.001), hypertension (OR 0.47, 95%CI 0.23 to 0.96, p=0.038), BMI ≥ 25 kg/m2 (OR 0.40, 95%CI 0.20 to 0.78, p=0.007), and atrial fibrillation (OR 0.22, 95%CI 0.13 to 0.37, p<0.001), predicted poor outcome in functional capacity (METs < 6.00). One variable, preserved LVEF (OR 2.08, 95%CI 1.08 to 3.99, p=0.028), predicted good outcome in functional capacity (METs ≥ 6.00). Conclusion: Female gender, no hypertension, no obesity, preserved LVEF (≥50%), and sinus rhythm predicted good functional capacity (METs ≥ 6.00) after heart valve surgery. P296 Do primary care physicians assess physical activity and propose exercise in patients with different cardiovascular diseases? An italian pilot study G Foccardi1, D Neunhaeuserer1, G Quinto1, E Biancato1, K Coninx2, GR Ruiz2, D Hansen2, A Ermolao1 1University of Padova, Padua, Italy 2University of Hasselt, Hasselt, Belgium Topic: Cardiovascular Rehabilitation Introduction: Every current guideline underlines physical activity cardinal role in both prevention and rehabilitation of patients with cardiovascular diseases (CVD). Despite exercise guidelines are available, the EAPC (European Association of Preventive Cardiology) EXPERT (Exercise Prescription in Everyday practice & Rehabilitative Training) working group recently described a large variance in exercise prescription between clinicians involved in CV rehabilitation. Therefore, the EXPERT tool, a digital training and decision support system, was developed. Purpose: The aim of this pilot study is to analyse Italian primary care physicians’ clinical routine on prescribing exercise training in patients with CV risk factors. Methods: A standard survey is submitted to primary care physicians (PCP): participants are requested to provide their professional experience, to report the number of CV patients they weekly examine, and if they regularly assess physical activity level. The survey explores how exercise prescription is carried out and if the compliance is verified. Finally, CPC are asked to evaluate their current exercise prescriptions and the possible utility of a guidelines-based tool. Results: Currently, 20 PCP (55% males, age 58.2±10.4, years of work 25.5±13.4) who regularly manage CV patients replied to the survey. 100% of PCP consider exercise prescription useful, 85% assess the physical activity level of patients and 95% regularly prescribe exercise training. 37% based their prescription on specific tests (43% exercise testing, 14% CPET, 43% a combination of different tests), and only 11% provide it in written format. 90% of CPC declare to tailor exercise prescription to patients specifying weekly frequency (73.7%), session duration (78.9%) and descriptive intensity (59.7%). On the other hand, the type of exercise, heart rate-based intensity and program duration are stated in less than half of cases; strength training is rarely promoted (5%). Patients’ compliance is verified in 89% but a clinical revaluation is only performed in 12%. 63% of PCP adjust the prescription during follow-up. Overall, more than 79% of PCP acknowledged clinical benefits of their exercise prescriptions, but 95% considered their current prescription as, at best, sufficient and 90% would welcome a guidelines-based digital tool. Conclusions: This ongoing study emphasises that Italian primary care physicians believe in the cornerstone role of exercise training in CV patients. On the other hand, the current management of exercise prescription and its adherence are variegated and considered inadequate by PCP. Our preliminary data stress out the need for specific education and standardized prescription methods. Within the next months we aim to considerably increase the sample. Subsequent steps will request CPC to prescribe exercise to standardized clinical cases, evaluating the inter-physician variance and thus the usefulness of the EXPERT tool as training support. P297 An isolated 30-minute comedy session increases systolic volume and cardiac output in patients with stable ischemic heart disease A Donelli Da Silveira1, R Petry Buhler1, R Cechet De Oliveira1, T Lima Horn1, M Zanini1, RM Nery2, R Stein1 1Federal University of Rio Grande do Sul, Porto Alegre, Brazil 2Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Funding Acknowledgements: FIPE/HCPA and CNPq Topic: Cardiovascular Rehabilitation Introduction: During a genuine laughter several muscle groups are activated, with increased oxygenation and cardiac work. Studies demonstrate a possible inverse association between sense of humor and coronary artery disease (CAD), suggesting that laughter exerts a cardioprotective effect. However, to date the hemodynamic effects of laughter therapy during a comedy session are unknown. Purpose: To compare the behavior of cardiac output (CO) and systolic volume (SV) during a comedy session in relation to a neutral documentary in patients with stable CAD. Methods: Randomized clinical trial. Individuals were allocated to watch a 30-minute self-selected comedy or neutral documentary of the same duration. In order to provoke more laughter, the comedy episode was selected by the patient from a collection. In turn, the documentary was selected so as not to arouse any emotion (usually tourism). The CO and SV were monitored in real-time during the entire session through Signal Morfology Impedance Cardiography (SM-ICGTM). All patients were on optimized pharmacological therapy. Results: Twenty-two subjects (14 men, 62 ± 9 years) were evaluated, 11 in each group. Those exposed to comedy (63 ± 31 genuine laughs) achieved maximum SV (21.2 ml; 24.8%) and higher CO (1.6 L / min; 27.1%) values compared to those who watched the documentary (p<0.05). Conclusion: A single 30-minute comedy session significantly increased hemodynamic parameters in patients with stable CAD. To know more deeply the behavior of the cardiovascular system during episodes of spontaneous laughter can help in the consolidation of laughter therapy as a complementary strategy for the rehabilitation of these individuals. P298 Effects of high-intensity interval training on cardiac autonomic control: a systematic review of randomized clinical trials R Martins De Abreu1, PRS Rehder-Santos1, RPS Polaquini Simoes1, AMC Maria Catai1 1Federal University of São Carlos, Department of Physical Therapy, São Carlos, Brazil On Behalf of: Cardiovascular Physical Therapy Laboratory Funding Acknowledgements: São Paulo Research Foundation - FAPESP (2017/13402-0) Topic: Cardiovascular Rehabilitation Introduction: The high-intensity interval training (HIIT) has been emerged as an alternative method to promote greater adherence of patients, undergoing to cardiovascular rehabilitation programs, since it covers shorter training sessions when compared to conventional continuous training of moderate intensity. However, little is known about the effect of this training modality on cardiac autonomic control, as well as its application in the rehabilitation or prevention of pathologies that present autonomic imbalance as clinical characteristics. Purpose: To conduct a systematic review to evaluate the effects of HIIT on cardiac autonomic control in humans, evaluated by heart rate variability (HRV). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to conducted and reported this review. Electronic databases PEDro, SCOPUS and PubMed were searched from the inception to March 29th, 2018. The eligibility criteria were determined using the Patient/Population, Intervention, Comparison/Comparator, Outcome (PICO) format. Thus, the selected studies had looked at: adults with or without cardiovascular disease (P); who carried out a HIIT program (I); comparisons with other interventions was not included in this systematic review (C); our results of interest were measurements of cardiac autonomic control through HRV indexes (O). Moreover, the PEDro scale was applied to verify the methodological quality from all eligible clinical trials. Finally, data were reported through descriptive analysis and complementary the deltas of HRV indexes (post minus pre) were calculated. Results: The initial search strategy resulted in 339 citations and 2 additional citations were identified through other sources. After the screening and deleting of the duplicate articles, 6 randomized clinical trials were included. The mean score of PEDro was 6 (ranging from 5 to 8), with 3 studies of high and 3 studies of low methodological quality. Overall, the results showed an improvement in parasympathetic and/or sympathetic modulation after HIIT, when evaluated by linear and non-linear indexes of HRV. Conclusion: In according to current state of the art, the HIIT seems to be a promisor method to improve the cardiac autonomic control, especially in healthy individuals and patients with metabolic syndrome, considering the risk of bias of the included studies. P299 Laughter therapy increases functional capacity in patients with coronary artery disease: a randomized clinical trial R Stein1, A Donelli Da Silveira1, D Do Santos Macedo1, J Beust De Lima1, J Maia Delfino1, L Tolfo Franzoni1, M Aurelio Lumertz Saffi2, RM Nery2 1Federal University of Rio Grande do Sul, Porto Alegre, Brazil 2Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Funding Acknowledgements: FIPE/HCPA and CNPq Topic: Cardiovascular Rehabilitation Background: The impact of a laugher therapy cardiac rehabilitation (LTRehab) program for patients with coronary artery disease (CAD) has yet to be assessed. Purpose: To evaluate the potential effect of LTRehab (comedy sessions) on functional capacity in stable CAD patients Methods: A single-blind randomized clinical trial (RCT) was conducted. The researchers who performed the tests were blinded to group allocation. Peak oxygen uptake (VO2peak) was measured by a maximal cardiopulmonary exercise testing (CPET). Patients allocated to LTRehab (n=12) watched two weekly sessions of a self-selected comedy and the control group (n=12) watched two weekly sessions of a neutral documentary (24 movies per group). ANCOVA was performed to estimate VO2peak main effect adjusted to baseline values. Results: Twenty-four CAD individuals (70% male; 64±10 years) were included. After 12 weeks of intervention, VO2peak increased significantly in LTRehab group (10%) compared to control (19.4 ± 2.9 to 21.4 ± 3.4vs 23.2 ± 6.3 to 22.2 ± 7.1 mL.kg-1.min-1, pre and post intervention, respectively; P=0.005). All CPET reached maximal criteria (R>1.10). Conclusion: This is the first RCT to evaluate LTRehab in CAD patients. It was associated with an increase in VO2peak and may constitute an effective form of cardiac rehabilitation in this patient population. P300 A study of acceptability for exercise telerehabilitation in patients with coronary heart disease Y Song1, WEI Zhao1 1Peking University Third Hospital, Beijing, China Topic: Cardiovascular Rehabilitation Background Cardiac telerehabilitation is an important measure to improve rehabilitationcompliance and effects of patients with coronary heart disease. Researches on this aspect in China still need further development. Purpose To investigate the acceptability and influencing factors of exercise telerehabilitation in patients with coronary heart disease in China. Methods A questionnaire survey was conducted among 600 patients with coronary heart disease who were hospitalized in the Department of Cardiology of our Hospital and followed-up clinics after percutaneous coronary intervention. Results The response rate was 92.17% (553/600). The acceptance rate of exercise telerehabilitation was 39.42% (218/553) in all the responders, 41.76% (208/498) in those who used smart phones. There was a significantly statistical correlation between the acceptance rate of exercise telerehabilitation and patients’ educational background, fluency in using smart phones and exercise habits (p= 0.048, <0.0001 and <0.0001, respectively), however, there is no significantly statistical correlation between the acceptance rate of exercise telerehabilitation and their gender, age or diseases (p=0.800, 0.256 and 0.587, respectively). Among the patients who accepted exercise telerehabilitation, only 65.38% (136/208) thought they would do exercise training according to the program provided by physicians completely, but 76.44% (159/208) thought they would take encouragement from the program. More than half (65.17%) of the patients who rejected the program did not have regular exercise habits or considered it unnecessary to have a monitor. Conclusion The acceptance of exercise telerehabilitation in patients with coronary heart disease is affected by many factors. Medical staffs should take different interventions for different groups of patients with different characteristics, so as to improve the prognosis of patients. P301 Changing the paradigm in the clinical management for patients referral to cardiac rehabilitation J A Alarcon1, C Sarasqueta1, C Del Bosque1, J Reparaz1, A Rengel1, I Sanz1, F De La Cuesta1 1Donostia Hospital, Donostia, Spain Topic: Cardiovascular Rehabilitation Introduction: Although the benefits of cardiac rehabilitation (CR) in terms of morbidity and mortality are widely known, these units (CRUs) are generally underutilized, largely due to lack of interest or low knowledge of the physicians who should refer patients. The "automatic referral-only" also has high not-enrollment in CR. Purpose : We present the referral data of the patients with recent diagnosis of Acute Coronary Syndrome(ACS) to our CRU in the period December 2008-June 2013 ( "P" period) vs in the year 2017' ("A" period), after changing the method for referral of them in 2014. Methods: In "P" period the method of referral to our CRU was "Passive": request from the responsible physician (usually from the recent admission itself, pre-hospital discharge). In "A" period, patients are recruited in an "Active" manner from the CRU, through the daily review of all hospital discharges with diagnosis of ACS from our Cardiology Department by the cardiologist Medical Director of CRU(also staff of Cardiology Department and using the Hospital's computer system for identify patients discharges, with coded diagnoses).After review of them (it takes an average of 6 minutes /day, range 4-8 min), patients with indication for CR are accepted and this new list is passed from the cardiologist to the nurse or the physiotherapist of the CRU, which explain the CR program to the patients (at bedside or via telephone at 24 h of discharge) and inform them that they must enter it. Results: In P period, 2,355 patients with ACS were discharged alive in our hospital, of which 756 patients were referred to our CRU,32% of the total. Of these, 598 patientes enrolled the program( 25% of the total 2355 patients; 79% of referred patients).:45% low risk, 55% medium/high risk (AACVPR risk criteria ). 55% STEMI. Mean 58 years old (29-82a). DM 26%. In A period, 354 patients with ACS were discharged alive in our hospital, of which 338 had indication for the program and were referred (95% of the total vs 32% in P period, p<0,01- vs median 51% for Europe in EuroAspire IV vs 9% in RE-uRECA National Registry-Spain2016´). Finally 273 enrolled the CR program (77% of the total 354 patients- vs 25% in P Period, p<0,01-, and 80% of the referred ones): 51% low risk, 49% medium/high risk(p 0,1 vs P period); 47% STEMI( vs 55% in P period, p 0,1). Mean 60 years old (34-80).No differences between periods in % of women referred. DM 22%( vs 26% in P period, p 0,3). Conclusions: It is very necessary to optimize the referral of patients to the CRUs. The most " active involvement " of these CRUs in the referral of patients, also using the new Hospital´s computer systems to identify candidates for the programs-not time consuming-, and promoting liaison with the patient peri-discharge is essential to achieve a clear improvement in the referral to CR. Once patients are referred, majority of them enroll the CR program. P302 Determinants of depression in patients with comorbid depression following cardiac rehabilitation S Sever1, A Harrison1, S Golder1, P Doherty1 1University Of York, York, United Kingdom of Great Britain & Northern Ireland Funding Acknowledgements: This research was supported by a grant from the British Heart Foundation (R1680901). Topic: Cardiovascular Rehabilitation Background: History of depression prior to an indexed heart event, also referred to as comorbid depression, is associated with increased mortality rates among cardiovascular disease (CVD) patients. However, the determinants of an acute index event depression among patients with prior history are not clear. Purpose: To explore what determines cardiac rehabilitation (CR) depression outcomes in patients with comorbid depression (history of depression). Methods: An observational study of routine practice was conducted using the UK National Audit of Cardiac Rehabilitation (NACR) data between April 2012 and March 2017. CR participants with comorbid depression were constituted study population. CR Hospital Anxiety and Depression Scale (HADS) depression measurement was used for the analysis and the clinical cut off point of 8 was used to categorize patients into low level depression (<8) and higher level depression (≥8) groups. Baseline characteristics were examined with independent samples t-test and chi-square test. A binary logistic regression was used to predict change in depression outcome following cardiac rehabilitation. Results: The analysis included 2715 CR participants with depression history. The determinants associated with the levels of HADS depression measurement after CR were having a higher total number of comorbidities (OR: 0.914, 95%CI: 0.854 to 0.979), a higher HADS anxiety score (OR: 0.883, 95%CI: 0.851 to 0.917), physical inactivity (OR: 0.707, 95%CI: 0.514 to 0.971), not currently smoking at baseline (OR: 1.774, 95%CI: 1.086 to 2.898), and male gender (OR: 0.721, 95%CI: 0.523 to 0.992). Age, weight and marital status were not significantly associated with HADS depression outcome. Conclusion: This study has shown that clinical and demographic variables determine depression outcomes among CR participants with a history of depression. Baseline characteristics of patients with comorbid depression such as higher anxiety, higher total number of comorbidities, smoking, physical inactivity, and male gender were predictors of their depression levels following CR. CR programmes need to be aware of comorbid depression and related patient characteristics (e.g. anxiety, smoking, and physical inactivity) associated with CR outcomes. P303 Cardiac rehabilitation in patients after percutaneous mitral valve reconstruction - First experiences in Germany T Schmidt1, HG Predel2, M Hadzic3, S Eichler3, H Voeller3, B Bjarnason-Wehrens2, J Sindermann1, G Moennig1, N Franz1, M Kowalski1, A Salzwedel3, N Reiss1 1Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany 2German Sports University Cologne, Cologne, Germany 3University of Potsdam, Potsdam, Germany Topic: Cardiovascular Rehabilitation Background: In recent years, the number of percutaneous mitral valve procedures using the MitraClip-device has significantly increased. To ensure ingrowing of the clip and to avoid possible clip detachments patients are requested to avoid heavy physical activities in the first time after implantation and thus most patients are discharged home without attending cardiac rehabilitation (CR) program. However, CR has the potential to make an important contribution in this multimorbid and often muscularly deconditioned patient group. Nevertheless, currently there are no experiences on the feasibility and safety of CR in patients after MitraClip implantation available. Methods: Retrospective monocentric survey: The results of 10 patients (73±12 yrs, BMI 25±3, 50% female, LVEF 44±15 %, MI grade 3.35±0.45 EuroScore 37±21 %) were included, who started inpatient CR in the last year following MitraClip implantation. Therapeutic treatments and possible complications during CR were documented. At the beginning and end of CR echocardiography, 6MWT, Handgrip-Strength-Test and Berg-Balance-Scale were performed. The dependent t-test was used for statistical evaluation of mean values. Results: MitraClip-device implantation was successful and MI decreased significantly to grade 1.15±0.6 (p<0.01) with a mean gradient of 3.6±1.15 mmHg. Barthel Index was at 94±10 points. CR could be started 14±13 days after implantation and took mean 21±7 days. Most common comorbidities were arterial hypertension (100%), renal failure (60%), orthopedic problems (60%) or coronary artery disease (50%). CR had to be terminated early in one patient due to cardiac decompensation; all other patients were able to complete CR without severe or device-related complications (MI stable, gradient stable, no clip detachments). Therapeutic treatments during rehabilitation program included e.g. chair gymnastics, bicycle training under blood pressure control or strength endurance training. Accompanying social-medical and psychological consultations were also offered and used by the patients. 6MWD increased during CR descriptive from 269±51 to 287±38 m and hand grip from 42±25 to 48±26 lbs. Results from Berg-Balance-Scale improved significantly from 52.9 to 54.5 points (p<0.05). During CR the dependence on rollator walker could be reduced from 4 patients at the beginning to 2 patients at the end of hospital stay. Conclusion: Preliminary results indicate that an adapted CR is beneficial and can be performed safely in selected patients after MitraClip implantation. Within the context of therapeutic treatments no clip-specific complications were observed. Patients benefited from CR both at functional level and also at social-medical level. In the future, controlled and larger studies are needed to confirm these findings. In addition, the special needs of this target group during CR should be systematically examined in order to further improve the current aftercare situation of these patients. P304 Are there predictors of increase in exercise capacity one year after cardiac rehabilitation? M Scherrenberg1, K Bonne2, P Dendale1 1Virga Jesse Hospital, Cardiology , Hasselt, Belgium 2Virga Jesse Hospital, REGO, Hasselt, Belgium Topic: Cardiovascular Rehabilitation Background:The advantages of physical activity after a myocardial infarction are well established. However little is known about maintenance of exercise capacity and other cardiovascular risk factors like cholesterol, blood pressure and obesity one year after cardiac rehabilitation (CR). The aim of this study was to assess maintenance of exercise capacity one year after completing a CR program. Methods:A non-randomized, prospective cohort study was performed. Patients who participated in a center-based CR in 2017 were invited back to the rehabilitation center in October 2018 for some additional tests. The tests include Rockport Fitness Walking Test, assessment of body mass index (BMI) and blood pressure measurement. The primary objective was to examine the evolution of exercise capacity after stopping CR. As secondary outcomes we looked for the best predictors for the exercise capacity one year later. Results:45 patients (average age 65.9 years ± 12.1; 75.6% males) were present for additional tests. 39 patients (86.7%) had ischemic heart disease as indication for CR and 6 patients (13.3%) had valve surgery as indication. Mean cholesterol at the end of the CR program was 138.4 ± 31.7 mg/dL. VO2 peak was significantly higher one year later than after completion of the CR program (VO2peak one year later: 28.3 ±10.4; VO2peak after CR: 23.0 ± 6.2; Paired T-test: P <0.0001). Systolic blood pressure (SBP) (SBP one year later: 122.4 ± 13.8; SBP after CR: 134.5 ±18.2; Paired T-test: P <0.0001) was significantly lower and BMI (BMI one year later: 26.8 ± 3.5; BMI after CR: 26.4 ± 3.2; Paired T-test: P=0.011) was significantly higher a year after CR. Diastolic blood pressure (DBP) was not significant different between completion of the CR program and one year later. (DBP one year later: 76.6 ± 7.7 DBP after CR: 73.3 ±8.3; Paired T-test: P=0.054).Multiple logistic regression analysis showed that none of the variables measured at the end of the CR program could significantly predict an increase in VO2 (ml/kg/min). Conclusion:This study showed that the exercise capacity significantly increased since the end of CR. SBP also evolved favourably. However DBP was not significantly different one year after CR. BMI was significantly higher one year after the CR program. This suggests that there is still some work to do in the prevention of obesity and the maintenance of BMI. None of the measured variables at the end of a CR program were able to predict the evolution of exercise capacity one year later. P305 Risk profile of the cardiac rehabilitation patients in the Croatian centre of excellence for cardiac rehabilitation V Persic1, D Raljevic2, D Travica Samsa1, R Miskulin1, I Brajkovic2, M Komosar Cvetkovic2, I Kuzet Miokovic2, K Knezevic2, M Njegovan2, A Trobonjaca2, P Soric2 1University of Rijeka, Department of Medical Rehabilitation, Rijeka, Croatia 2Clinical Hospital Thalassotherapia Opatija, Opatija, Croatia Topic: Cardiovascular Rehabilitation Background : to report on results of the current status of risk factor control, lifestyle factors, and use of cardio protective medications in coronary artery disease patients regarding to the European Guidelines on cardiovascular disease prevention in clinical practice 2016. Methods: The sample was collected in 2016 from patients in line with their CR appointments ordet, which in Croatia by its regulations lasts 21 days. Patients having the diagnosis of coronary artery diseases (N=314) were examined after their coronary event. Patient’s data were collected from the medical history record, and blood samples collected and pressure measured. Ergospirometry and echocardiography were performed. Hospital Anxiety and Depression Scale was completed. Frequencies of patients' risk factors were categorized by the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Results : Average age of patients was 60(10) years with BMI of 28.6 kg/m2. Almost half (47%) of the patients were smokers. The average systolic and diastolic blood pressure was 121.8/76 mmHg. Around sixty percent of patients had AMI with the ST segment elevation, 20% had AMI without of ST segment elevation. 138(44%) patients were admitted after coronary artery bypass surgery. One third of patients were diabetic and 81% had hypertension, majority was either overweight or obese (80%). Optimal blood pressure level was measured in 38% of patients, 11% of the patients had blood pressure level between hypertension grade I-III. Almost quarter of the patients had cholesterol values ≥4.5 mmol/l; 34% of the patients achieve target LDL cholesterol level <1.8 mmol/L. High risk HDL values was measured in 45% of patients and almost 30% percent of them had high risk triglycerides values. More than 80% of diabetic patients had inadequate control of diabetes. The ejection fraction of the left ventricle was moderately lower in value and VO2max of the patients was 19.0 (ml/kg/min). Anxiety and depression scores were elevated in 20% and 13% of patients respectively. Conclusions: Primary and secondary prevention of cardiovascular diseases requires a systematic, multidisciplinary approach involving all stakeholders, healthcare workers in primary and secondary health care, public health workers, and of course, the mandatory involvement of state health insurance investing in prevention directed towards life style changes that still remain permissible for risk behavior and persistent risk factors such as smoking, obesity, inadequate control of lipid parameters and diabetes consistent with the recommended target values of the European Guidelines for the Prevention of Cardiovascular Diseases in 2016. P306 How many patients with coronary artery disease are not enrolled in an established cardiac rehabilitation program? N Santaularia1, B Gonzalez1, P Corzan1, C Campoamor1, V Martinez1, G Vazquez1 1Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain Funding Acknowledgements: PERIS grant Topic: Cardiovascular Rehabilitation Introduction: The guidelines of the European Society of Cardiology on acute myocardial infarction and prevention state that cardiac rehabilitation (CR) should be considered in all patients with coronary artery disease (CAD). However, utilisation of CR is highly variable and relatively low, with an uptake of less than 40% in Europe. In recent years research has focused on innovations to improve referral and uptake. It is important to know the implementation of CR in real clinical practice and describe possible areas for improvement. Purpose: To analyse the participation of patients to CR and possible reasons for non-participation in a local hospital. Methods: A retrospective chart review was performed. Between January 1 to December 31, 2017, 402 hospital discharges with a primary diagnosis of CAD were identified in the hospital database. Each electronic clinical record was reviewed to register when patients had been recruited and what follow-up they received. Results: Of the total 402 hospital discharges, 301 were from cardiology service. Of them, 60 were not candidates to cardiac rehabilitation program (CRP) for different reasons (such as comorbidity, pending surgery or transfer to another hospital), 10 refused to participate in CRP and 10 did not record information about it. After evaluation, 55 patients were not considered to be candidates in the supervised physical exercise program, 47 refused it for different reasons (such as transport difficulty, personal problems or carry out the exercise on their own) and 29 attended educational visits without supervised physical exercise sessions. Finally, 90 (30%) attended to supervised physical exercise program. Conclusions: In an established CRP, only 30% of potential candidates are finally rehabilitated. In our study, we have observed that we have to give more information about the importance of assist to supervised physical exercise program during the follow-up. Abstract Number: P306 Participation of patients to CRP P307 Information needs in patients receiving cardiac rehabilitation N C C W Tenbult - Van Limpt1, SJC Traa2, JJ Kraal1, HMC Kemps3 1Maxima Medical Center, FLOW, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Veldhoven/Eindhoven, Netherlands (The) 2VieCuri Medical Center, Department of Medical Psychology, Venlo, Netherlands (The) 3Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands (The) Topic: Cardiovascular Rehabilitation Introduction: Cardiac rehabilitation (CR) consists of multi-disciplinary interventions aiming at physical, psychological and social recovery of cardiac patients. Additional goals include lifestyle changes and improvement of medication adherence. Educational interventions are part of CR-programs and although these were proved beneficial for cardiac patients, little is known on specific information needs and seeking behaviour. We aim to study the information needs of patients entering CR regarding lifestyle and medication. Methods: We included 259 patients entering cardiac rehabilitation in our Medical Center. Main endpoints were level and type of information needs concerning disease and treatment, and concerning lifestyle such as physical activity, smoking, dietary, mood and medication. Measurements were performed at baseline. Results: Patients were predominantly men (76%), had a mean age of 64.8±10.4, and a BMI of 27.1±4.9. A total of 176 patients were diagnosed by MI (68%), and 163 patients underwent PCI (63%), 71 patients CABG (27%) and 22 patients were treated by medication alone (9%). At baseline 19 patients were current smokers (8%). Concerning illness and treatment, we found that 56% (n=146) wanted as much information as possible, both positive and negative aspects. Most patients (80%) wanted to be involved in the decision making process at the start of CR. We found that 66% had information needs on at least one aspect of lifestyle or medication. Information needs were highest for physical activity (38%, table 1). We found a significant association between information needs on the different aspects of lifestyle, except for medication and mood (p=0.13) and medication and dietary issues (p=0.05). Conclusion: A large group of patients have no information needs concerning lifestyle or medication. However, patients with information needs on one aspect are likely to have information needs on other aspects. This knowledge may contribute to the development of more efficient educational interventions, tailored to the patients’ needs using an individual approach. N (total = 259) % Questions concerning medication 75 29.0 Questions concerning physical activity 97 37.5 Questions concerning smoking 7 of 22 31.8 Questions concerning dietary 76 29.3 Questions concerning mood 66 25.5 N (total = 259) % Questions concerning medication 75 29.0 Questions concerning physical activity 97 37.5 Questions concerning smoking 7 of 22 31.8 Questions concerning dietary 76 29.3 Questions concerning mood 66 25.5 Open in new tab N (total = 259) % Questions concerning medication 75 29.0 Questions concerning physical activity 97 37.5 Questions concerning smoking 7 of 22 31.8 Questions concerning dietary 76 29.3 Questions concerning mood 66 25.5 N (total = 259) % Questions concerning medication 75 29.0 Questions concerning physical activity 97 37.5 Questions concerning smoking 7 of 22 31.8 Questions concerning dietary 76 29.3 Questions concerning mood 66 25.5 Open in new tab P308 Impact of a cardiac rehabilitation program in patients with left main disease MR Caballero Valderrama1, A Abril Molina1, AJ Wals Rodriguez1, I Sainz Hidalgo1, AM Lopez Lozano2, MO Gonzalez Oria2, J Vallejo Carmona1 1University Hospital of Virgen del Rocio, Cardiology Department, Seville, Spain 2University Hospital of Virgen del Rocio, Rehabilitation Department, Seville, Spain Topic: Cardiovascular Rehabilitation Introduction: The benefits of cardiac rehabilitation programs in patients with coronary artery disease (CAD) are widely described in the literature. In patients with CAD, the location that causes more mortality is the left main disease with stenosis greater than 50%. Purpose: To analyze the characteristics of patients with left main disease before and after completing a cardiac rehabilitation program and its prognostic implications. Methods: Observational, retrospective and unicentric study carried out through the database of the Cardiac Rehabilitation Unit in our Hospital. The inclusion criteria were patients with significant left main disease who have completed the cardiac rehabilitation program in 2016 (15 sessions). Quantitative and qualitative variables were analyzed before and after the rehabilitation program. The incidence of complications during the program and the recurrence of events were analysed. Results: During 2016, sixteen patients had left main disease and completed a cardiac rehabilitation program. The median age was 65 years (59.3-69.8) and 81.3% were male. Prevalence of smoking was 43.8%, hypertension 68.8%, diabetes 25%, dyslipidemia 62.5%, obesity 25% and chronic kidney disease (grade ≥ 3) 18.8%. The reason for hospital admission was NSTEMI in 31.3% of the patients, unstable angina in 50% and stable angina in 18.8%. There was multivessel disease in 81.3% of the patients, the most frequent combination (31.3%) was left main disease with left anterior descending coronary artery and circumflex artery disease. The left ventricle ejection franction was preserved in 75%, there were mild systolic dysfunction in 18.8% and moderate in 6.3%. The median values for the variables at the beginning and the end of the cardiac rehabilitation program, respectively, were: body mass index 26.8 and 26.6 kg/m2; exercise time 7 and 9 minutes; functional capacity 7.8 and 9.9 METS; heart rate (HR) recovery 13 and 18 bpm; functional class (NYHA) II and I. Anxiety and depression tests (measured using Goldberg test) at baseline were positive in 56.3% and 18.8% and at the end in 18.8% and 31.1% respectively. There was a statistically significant improvement in HR recovery and anxiety (p = 0.016 and p =0.031). There were no complications during the cardiac rehabilitation program. 12.5% of the patients had recurrence of coronary events in a 2 years follow up. Conclusions: In our Cardiac Rehabilitation Unit in 2016 we had 378 patients who completed the training program, and sixteen of them (4,2%) had left main disease, being most of them men with unstable angina, cardiovascular risk factors and multivessel disease in a high percentage. Our training program brought on an improvement in the parameters evaluated before and after the program, except for depression, with a statistically significant improvement in HR recovery and anxiety. P309 Effectiveness of home-based cardiac rehabilitation in functional capacity: a pilot study in a middle-income country RR Britto1, AP Lima1, IO Nascimento1, RC Malagoli1, AEP Santos1, TS Nogueira1, ACA Oliveira1, DAG Pereira1 1Universidade Federal de Minas Gerais, Physiotherapy, Belo Horizonte, Brazil Funding Acknowledgements: Brazilian government grants: CNPq and CAPES (Finance Code 001) and Minas Gerais grants (FAPEMIG) Topic: Cardiovascular Rehabilitation Background: Cardiovascular diseases are the leading cause of mortality in the world. Cardiac rehabilitation (CR) is an established model of care for secondary prevention. Despite the benefits, CR programs are still underused specially in low and middle-income countries, in part because of barriers to participants' adherence. Thus, the objective of this study was to evaluate the effect on functional capacity of an alternative CR program based on patient education and exercise provided mainly at home. Methods: It is a pilot of a randomized controlled trial in which patients with coronary disease were randomized into two groups, one undergoing CR mainly at a distance and another under the usual center based CR protocol. The two groups were evaluated pre and post 12-week of CR in regard to functional capacity (Incremental Shuttle Walking Test) and the results compared using t Student test considering significance when p <0.05. Results: The sample consisted of 26 individuals, 13 in each group. The home-based CR group showed a mean age of 58.45±10.82 years, the majority were male (81.8%) with low risk to exercise (81.8%) similar with the traditional CR group [55.92± 9.81 years, 92.3% male with low risk to exercise (84.6%)]. The post-rehabilitation difference in the distance walked (in meters) during the incremental shuttle walk test was significant in both groups (p = 0.002) without difference between groups (46.36±53.90 home-based vs 89.00±114.64 traditional, p=0.282). Conclusion: The results suggest that the home-based CR was a viable alternative for improving functional capacity of coronary disease patients with low risk to exercise and could contribute to improve participation in CR. The clinical study will also report adherence data, an important parameter for the maintenance of the benefits. P310 Cardiac rehabilitation for heart failure patients - A service long overdue M Abela1, L Buttigieg1, JC Vella1, J Micallef1, R Abela1, MA Gauci1, J Desira1, S Attard1, J Caruana1, AM Moore1, RG Xuereb1 1Mater Dei Hospital of Malta, Cardiology, Msida, Malta Funding Acknowledgements: Nothing to declare Topic: Cardiovascular Rehabilitation Introduction Evidence supporting a multi-disciplinary approach in the management of heart failure [HF] patients is substantial. Exercise training [ET] sessions for HF patients are now available locally as of 2018. This study aimed to look at patient satisfaction in those referred to the program, whilst also looking at a number of health outcomes. Method Cardiovascular Information System [CVIS] and Isoft software were used for demographic, clinical and biochemical data collection. A telephone-based interview was used for data collection with respect to patient satisfaction and NYHA class and after completing the program. Results In total, 26 HF patients were referred, with a mean Ejection Fraction 36.19±9.1% and a mean age of 62±9.2years. The majority were male [62%], suffering from ischaemic cardiomyopathy [54%]. The majority of those referred were NYHA 2 [50%]. To date, 24 subjects completed the program, with 25% of these attending all 12 ET sessions [Median 10]. Two patients [8%] that were referred were unwilling to attend the ET program. There was a significant improvement in lifestyle modification at the end of the program [p=0.02]. By the end of the program, 33% took up exercise more frequently, irrespective to the number of ET sessions attended [p=0.85] or NYHA class [p=0.91]. A third had an improvement in NYHA class at the end of the program [p=0.08]. There was no statistical difference in NT-proBNP levels before and after ET sessions [p=0.67]. The majority [87%] felt that the program met or exceeded their expectation, 58% were very satisfied with the programme and 87% reported they felt better. Conclusion HF patients attending ET sessions were extremely satisfied and had a significant improvement in lifestyle modification in terms of exercise. 33% had an improvement in NYHA class. P311 Different patterns of cardiac rehabilitation program results among surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) patients L Bradichanski1, E Goldhammer2, E Goldhammer1, E Radzishevsky1 1Bnai Zion Medical Center, Department of Cardiology, Haifa, Israel 2Bnai Zion Medical Center, Haifa, Israel Topic: Cardiovascular Rehabilitation Aim – Comparison of cardiac rehabilitation (CR) program results in post TAVI and AVR patients. Background - Since TAVI was introduced it has become an established therapy for AS. While AVR remains the gold standard therapy, TAVI has been identified as an alternative in elderly, inoperable, higher surgical risk patients, and as a treatment option in bioprosthetic valve failure patients who face repeat surgery with increased risk. TAVI bears less leaks, strokes and bleeding, however up to 50% of patients have increased blood pressure after procedure. Methods – 12 TAVI, age – 81.5 +/- 5.38 & 35 AVR patients, age – 66.2 +/- 7.3 who joined aerobic exercise based CR program, 1.1.2016 – 1.2. 2018 were studied retrospectively. Follow up - 9 months. TAVI group - 4 with Evolute self expandable & 8 Sapien balloon expandable valves, one had valve in valve procedure, AVR group - 22 bioprosthetics, and 13 mechanical valves, 5 (14.3%) had bicuspid valve pre-op. Mean gradient on admission – 13.1+/- 1.8 in AVR & 8.3 +/- 1.2sd in TAVI, p<0.05. Age, gender, CSHA clinical frailty scale, risk factors prevalence, adherence time to program, and major adverse events were compared. Results: Age was significantly higher in TAVI group as well as hypertension and hyperlipemia, 81.5 ys+/- 5.38 vs 66.2ys +/- 7.3, 91.7% vs 65.7%, and 66.7% vs 40% respectively, p<0.05, while diabetes and CAD were more frequent in AVR group, p<0.05. AVR patients joined earlier CR, 28+/- 3 days than TAVI patients, 60.5 +/- 7 days following procedure, p<0.01. Program adherence time was longer in TAVI group, 99 days +/- 6.5 vs 37.3 days +/- 4.1, p<0.01. > mild paravalvar leak in 1 TAVI and 3 AVR patients, none needing intervention, p= ns. Hospitalizations = 1 in TAVI group (CHF) and 6 in AVR, P<0.05, 2-pacemaker implantations = 2- CHF, 1-SBE & 1 - TIA. No unexpected fall was noticed during exercise sessions. Only 1 TAVI patient had an hypertensive rebound requiring treatment adjustment. CSHA scale showed similar improvement results in both groups. Conclusions: TAVI patients were more motivated than the younger AVR patients, adhere longer time to CR program which resulted feasible and safe for this old and relatively frail cohort. P312 Atrial fibrillation reduces 6MWT distance in mitral stenosis rheumatic heart disease patients with mitral valve surgery after early phase two cardiac rehabilitation program A Ambari1 1University of Indonesia, Jakarta, Indonesia Topic: Cardiovascular Rehabilitation Introduction : Atrial fibrillation (AF) is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. AF is reportedly associated with the physical activity level. Six-minute walk test (6MWT) is an easy and measurable method of exercise capacity assessment in patients after cardiac surgery. Currently, there is a few studies on 6MWT distance after early phase two cardiac rehabilitation (CR) program in mitral stenosis rheumatic heart disease (RHD) patients with mitral valve surgery. Objectives : Our study was to investigate the effects of AF on 6MWT distance after early phase two CR program in mitral stenosis RHD patients with mitral valve surgery. Methods : This study analyzed 276 patients after early phase two CR program with mitral stenosis rheumatic heart disease between July 2009 – June 2018. Patients divided in 2 groups based on electro cardiogram (ECG): AF (n = 138) and non AF (n = 138). We perform 6MWT pre-and post-early phase two CRp rogram. Results : From the analysis after early phase two cardiac rehabilitation program both groups have increasing on 6MWT distance. We found that 6 MWT distance was significantly associated with AF (p < 0.001) in mitral stenosis rheumatic heart disease patients with mitral valve surgery. In this study, it is showed that patients with AF have 6MWT distance 50.62 meters and patients with sinus rhythm 67.81 meters. In multivariate analysis, we showed that confounder variables of 6MWT distance and AF are ages and the use of statin. A comparison of 6MWT distance in these patient categories showed that patients with AF had a lower 6MW distance than patients with sinus rhythm after early phase two cardiac rehabilitation program. Conclusion : Patients with AF have lower 6MWT distance after early phase two cardiac rehabilitation program in mitral stenosis rheumatic heart disease patients with mitral valve surgery. P313 Cardiac telerehabilitation combines near-universal accessibility with expert oversight: protocol for the SCRAM randomised controlled trial J Rawstorn1, K Ball1, B Oldenburg2, C Chow3, S Mcnaughton1, K Lamb4, L Gao5, M Moodie5, J Amerena6, V Nadurata7, C Neil8, R Maddison1 1Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia 2University of Melbourne, Nossal Institute for Global Health, Melbourne, Australia 3University of Sydney, Sydney Medical School, Sydney, Australia 4Royal Children's Hospital, Murdoch Children’s Research Institute, Melbourne, Australia 5Deakin University, Deakin Health Economics, Melbourne, Australia 6Barwon Health, Cardiology Research Unit, Geelong, Australia 7Bendigo Health, Cardiology, Bendigo, Australia 8Western Health, Cardiology, Melbourne, Australia Funding Acknowledgements: Australian National Health and Medical Research Foundation Topic: Cardiovascular Rehabilitation Background: Cardiac rehabilitation (CR) saves lives and improves wellbeing but key accessibility barriers prevent many people from participating—especially outside metropolitan/urban areas where access to face-to-face programs is lowest. Our cutting edge telerehabilitation intervention (SCRAM) remotely connects people with CR specialists to receive evidence-based support regardless of their location. This abstract describes the protocol for a randomised controlled trial (RCT) that will compare the effects and costs of SCRAM with usual care CR. Methods: A multi-centre, single-blind, parallel arm RCT will compare the effects and costs of SCRAM with usual care CR among 220 people with coronary heart disease living in urban, regional, and rural areas of Victoria, Australia. All participants will retain access to usual care CR and half will also receive SCRAM—a 24 week dual-phase intervention comprising real-time remotely supervised exercise training and behaviour change support delivered via a bespoke telerehabilitation platform. Outcomes assessed at 0, 12 and 24 weeks will include maximal exercise capacity (primary outcome at 24 weeks), medical and lifestyle risk factors, program delivery costs, and cost-effectiveness. A mixed-methods process evaluation will assess user experiences. Results: Recruitment began in October 2018 and is ongoing. Conclusion: SCRAM overcomes key accessibility barriers while retaining a high level of oversight and support from CR specialists. If proven cost-effective this world-leading delivery model could greatly increase the impact of CR by reaching many people who currently have limited access to traditional face-to-face services. © The European Society of Cardiology 2019 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 2019 TI - Poster Session 1 JF - European Journal of Preventive Cardiology DO - 10.1177/2047487319860046 DA - 2019-06-01 UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-1-nxqPO3yZvq SP - S1 EP - S51 VL - 26 IS - 1_suppl DP - DeepDyve ER -