APSC2015-1025 Acute Beta Blockade at Peak Stress: Will It Alter the Sensitivity of Dobutamine Stress Echocardiography in Patients With Normal Resting Wall Motion? Wail Nammas1, Zeinab Abdel-Salam*1 Cardiology Department, Ain Shams University, Cairo, Egypt
Background: We compared the accuracy of recovery phase images following intravenous propranolol with peak stress images, for detection of coronary artery disease (CAD) in patients with no resting wall motion abnormalities (WMA) undergoing dobutamine stress echocardiography (DSE). Methods: We enrolled 100 consecutive symptomatic patients referred for diagnostic evaluation of CAD, who had no resting WMA. Patients underwent dobutamine stress echocardiography (DSE) and a bolus of 5 mg propranolol was injected intravenously within one minute of termination of dobutamine infusion. Positive peak stress images were deﬁned as the induction of WMA in 2 contiguous non-overlap segments at any stage of dobutamine infusion before the injection of propranolol. Positive recovery phase images were deﬁned as maintenance or worsening of WMA induced at peak stress, or appearance of new WMA during the recovery phase. Signiﬁcant coronary stenosis was deﬁned as 50% luminal obstruction of 1 sizable coronary artery by coronary angiography. Results: The mean age of the study cohort was 53.4 8.4 years; 56% were males, 36% diabetic. Seventy-two patients (72%) had signiﬁcant CAD. Analysis of peak stress images revealed a sensitivity, speciﬁcity, positive and negative predictive values of 80.6%, 85.7%, 93.5%, 63.2%; overall accuracy was 82%. Analysis of the recovery phase images revealed a sensitivity, speciﬁcity, positive and negative predictive values of 91.7%, 75%, 90.4%, 77.8%; overall accuracy was 87%. Conclusion: In patients with suspected CAD referred for DSE who have no resting WMA, acute beta blockade during DSE improved the sensitivity of recovery phase images for detection of signiﬁcant CAD, versus peak stress images; with a reduced speciﬁcity. Disclosure of Interest: None Declared Keywords: Dobutamine Stress Echocardiography; Beta Blocker; Coronary Artery Disease APSC2015-1178 Depression and Anxiety in Adult Filipinos With Congenital Heart Disease Using the Validated Filipino Version of the Hospital Anxiety and Depression Score (HADS) Jaime M. Aherrera*1, Lauro Abrahan1, Geraldine Racaza1, Christine Train1, Raul Jara1 1 Section of Cardiology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines Synopsis: Adult congenital heart disease (CHD) is a major global concern. Formal assessment for anxiety and depression in patients with adult CHD is not routinely done in our center. The Hospital Anxiety and Depression Scale (HADS) is a simple self-administered instrument for detecting anxiety and depression for use in medical practice. HADS-P (“P” for Pilipino) is the validated Filipino version. Objectives: To determine the prevalence of anxiety & depression in Filipinos with CHD & its association with disease and sociodemographics. Methods: Adults with CHD were asked to answer the HADS-P, consisting of 14 questions (7 each for anxiety and depression). A score of at least 8 was considered “suggestive”, while a score of at least 11 was considered “probable” for anxiety (or depression). Results: 171 patients (81 patients with CHD & 90 controls) with a mean age of 33 years were recruited. Majority had an atrial septal defect, ventricular septal defect, and patent ductus arteriosus (in decreasing frequency). 13% had a complex CHD, 25% were cyanotic (right to left shunt and/or Eisenmenger physiology), and 18% had corrected defects. The proportion of cases with anxiety and depression were higher among those with CHD (66% and 33% respectively, p<0.001), compared to controls. On multiple logistic regression, poor functional capacity (6-minute walk <300 meters) was associated with anxiety; while advanced functional class and Eisenmenger physiology were associated with depression. Sociodemographic factors were also associated with anxiety and/or depression. Conclusion: This cohort of Filipinos with CHD has higher HADS-P scores, suggestive of a higher prevalence of depression and anxiety compared to healthy subjects. Factors associated with anxiety and/or depression were related to their underlying CHD & sociodemographic proﬁle. Screening for emotional disorders is of paramount importance to provide holistic care for this vulnerable population. Disclosure of Interest: None Declared Keywords: Congenital heart disease
Synopsis: Inﬂammation plays a key role in atherosclerosis by mediating every stage of the atheroma development. The neutrophil-lymphocyte ratio (NLR) is believed to be associated with the complexity of coronary artery disease (CAD), but there is paucity of data in the local setting. The SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score is an angiographic tool used in grading the complexity of coronary artery disease. Objectives: We aim to investigate the association between the neutrophil-lymphocyte ratio (NLR) and severity of CAD using the SYNTAX scoring system among adult Filipinos. Methods: Adult patients believed to have CAD referred for coronary angiogram were screened. All patients with infections, acute coronary syndromes, malignancies, and other inﬂammatory or underlying hematologic conditions were excluded. The NLR on admission was computed (neutrophil divided by lymphocyte count). The severity of CAD was determined by two blinded cardiologists using the SYNTAX scoring system. The primary outcome was severe CAD (SYNTAX score of > 32). Results: A total of 169 patients with a mean age of 57 years were included. 32% had a previous myocardial infarction. 20% were found to have severe CAD based on a SYNTAX score of >32. The NLR, neutrophil, and lymphocyte count correlated with SYNTAX score using Pearson’s correlation coefﬁcient. The optimal cutoff value of NLR to predict high syntax score is 2.51, with sensitivity of 72.7% and speciﬁcity of 73.5%. Simple logistic regression determined that the NLR, presence of diabetes, and ejection fraction as significant predictors of a high SYNTAX score. On multiple logistic regression, a high NLR was associated with a SYNTAX score > 32 (OR 6.61, 95% CI 2.6–16.7, p < 0.001), controlling for the effect of other variables. Conclusion: The NLR is a useful tool to predict severity of multi-vessel disease using the SYNTAX scoring system among adult Filipinos. Disclosure of Interest: None Declared Keywords: Coronary artery disease APSC2015-1176 Risk of Death and Adverse Outcomes in Adult Filipinos Admitted for Infective Endocarditis: A Prospective Cohort Jaime M. Aherrera*1, Lauro Abrahan1, Maria Margarita Balabagno1, Antonio Faltado1, Paul Ferdinand Reganit1, Felix Eduardo Punzalan1 1 Section of Cardiology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines Background: Infective endocarditis (IE) is an evolving disease. Advances in medical science have provided new insights to its pathophysiology, diagnosis, and treatment. For our local setting, this study will give a better understanding on factors associated with adverse outcomes in IE. Objectives: We aim to describe the proﬁle of endocarditis admitted at the Philippine General Hospital (PGH) and to determine the factors associated with adverse outcomes. Methods: This is a prospective cohort conducted at the PGH. All adult patients with a diagnosis of deﬁnite endocarditis based on the Modiﬁed Duke’s were included and followed up throughout their admission. The primary adverse outcome was mortality. Secondary adverse outcomes include heart failure, arrhythmias, and any embolic phenomenon. Results: 51 patients with deﬁnite endocarditis with a mean age of 40 years old were included. Majority had valvular and congenital heart disease as an underlying endocardial disease. Culture-negative endocarditis was the most common diagnosis; while the most common isolated pathogen was Streptococcus viridans. Overall mortality occurred in 49%. Hypotension on admission [OR 10.8; p < 0.001], higher New York functional class of IIIIV [OR 6.66; p < 0.001], and the occurrence of embolic events [OR 3.88; p 0.008] and arrhythmias [OR 23.08; p 0.002] during admission were signiﬁcantly correlated with death. 33% experienced cardioembolic events and the most common site of embolism is the central nervous system. Atrial ﬁbrillation [OR 4.15; p 0.032] and a vegetation mean area > 18mm2 [OR 4.67; p 0.033] were the only variables associated with embolic events. Conclusion: We have described the evolving clinical proﬁle of endocarditis in the adult Filipino. Knowledge of the data presented is of paramount importance to give guidance in management. Anticipation of adverse outcomes in endocarditis must be made in adults with the aforementioned risk factors. Disclosure of Interest: None Declared Keywords: Cardioembolism, Infective endocarditis APSC2015-1172 Incidence of Contrast-Induced Nephropathy After Coronary Procedures in the United Arab Emirates: A Single Center Study Ahlam Al Awadhi*1, Samir Al Jabbari2, Abdulmajeed Al Zubaidi2, Alawi Alsheikh-Ali2 Internal Medicine Residency Program, 2Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
Introduction: Contrast induced nephropathy (CIN) is a major cause of morbidity and mortality in patients undergoing coronary procedures. The reported incidence of CIN ranges from w 3 to 30%. The proﬁle of patients undergoing coronary procedures in the United Arab Emirates (UAE) differs from those included in published reports of CIN, and the incidence of CIN after coronary procedures in the UAE remains unknown. Methods: We conducted a retrospective analysis of all adult patients who underwent coronary procedures at SKMC (the largest tertiary care facility in the UAE) in 2013. Patients on dialysis or missing creatinine values (n¼28) were excluded. CIN was deﬁned as an increase of creatinine of 44 umol/L within 48-72 hrs after coronary procedures.
The Neutrophil-Lymphocyte Ratio Predicts Severity of Coronary Artery Disease Using the Syntax Score Jaime M. Aherrera*1, Lowe Chiong1, Christine Train1, Marcelyn Fusilero1, Paul Ferdinand Reganit1, Felix Eduardo Punzalan1, Wilfredo Dee1, John Anonuevo1, Ramon Abarquez1 1 Section of Cardiology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
GHEART Vol 10/2S/2015
POSTER/20th Asian Paciﬁc Society Cardiology Congress Posters