Heart failure in patients with diabetes mellitus

Heart failure in patients with diabetes mellitus

SCREEN-HF: Left ventricular dysfunction in an elderly population with elevated B-type natriuretic peptide and other heart failure risk factors Michele...

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SCREEN-HF: Left ventricular dysfunction in an elderly population with elevated B-type natriuretic peptide and other heart failure risk factors Michele McGrady a,∗ , Christopher M. Reid a , Bert Boffa b , Simon Stewart c , Louise Shiel a , Henry Krum a a Monash

University, Australia Benefits Australia, Australia c The Baker Heart Research Institute, Australia b Health

Despite our ability to improve quality of life and survival in patients with established chronic heart failure (HF), we have yet to clearly define those at highest risk and develop effective screening strategies to improve early detection. SCREEN-HF aims to assess the prevalence of left ventricular dysfunction in a high risk (>60 years plus > 1 HF risk factor) asymptomatic population (n = 3500) without a previous diagnosis of HF. Following initial screening, the 700 participants with NT-proB natriuretic peptide (NTproBNP) in the highest quintile are invited to undergo ECG and echocardiogram. To date, 420 participants have been screened and 57 have completed echocardiography. Of the latter group, the mean age was 74.1years (S.D. 7.3years, 61–91years) and 54% were male; the mean NT-proBNP was 95.2 (39.1–414.3) pmmol/L vs. 13.39(1.1–37.8) pmmol/L in the remainder. Atrial fibrillation (AF) was present in 18 subjects (undiagnosed in 3), and 7 were in a paced rhythm. The 32 remaining subjects were in sinus rhythm, one with ventricular bigeminy and two with left bundle branch block. Mean left ventricular (LV) ejection fraction (by Simpson’s biplane) was 51%. Twenty-three (46%) participants had evidence of systolic dysfunction (LVEF < 50%), and six (12%) had evidence of moderate to severe systolic dysfunction (LVEF < 40%). One subject had evidence of clinical HF. Of those with systolic LV dysfunction, 83% had a history of hypertension, 35% coronary artery disease and 39% AF; compared to those with normal systolic function where there was a history of hypertension in 81%, coronary artery disease in 30% and AF in 26%. The preliminary finding of moderate to severe heart failure in 12% of this population is greater than previously reported. However, the population being studied is at higher risk for HF than previous studies being older, with >1 HF risk factor and in the highest quintile of NTproBNP. doi:10.1016/j.hlc.2007.11.082 Need and evolution of need for device therapy in a community heart failure population Habitha Mohammed Sulaiman ∗ , Christina O’Loughlin, Carmel Conlon, Mary Daly, Dermot McCaffrey, Kenneth McDonald St Vincents University Hospital, Ireland Objectives: Assess the need for device therapy and the change in need over time in a community heart failure (HF) population.

Poster Presentations

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Background: New indications for implantable cardiac defibrillators (ICD) and cardiac resynchronisation therapy (CRT) have expanded the potential use for device therapy. The affect of this on a community HF population is unknown. Methods: We reviewed the device need using ESC guidelines. Change in need was assessed by comparing data at least 6 months apart, between an annual review clinic called time point two TP2 and earlier at TP1. Patients who met criteria at TP2 were noted and their change in need between TP1 and TP2 was determined. Results: 210 patients had complete data. Mean age 70 ± 12, 67% male and 54% ischaemic. At TP1, 38% were deemed suitable for ICD and 4% for CRT. At TP2, 22% and 1% were suitable respectively. Of those suitable for ICD at TP1, 19% were no longer suitable at TP2. Nine percent were not suitable for ICD at TP1 but were at TP2. Fifty five percent were neither suitable for ICD at TP1 or TP2. Sixteen percent were suitable for ICD therapy at both time points. CRT change was negligible. Conclusion: ICD need is substantial in a stable HF population but the role for CRT is limited. ICD need also changes significantly over time. Identifying those patients likely to change their need status may optimise ICD utilisation. These data reinforce the need for regular review and specialist assessment of the community HF population. doi:10.1016/j.hlc.2007.11.083 Heart failure in patients with diabetes mellitus Ali Esmaeili Nadimi Rafsanjan University of Medical Sciences, Iran Background: People with diabetes mellitus have an increased risk of heart failure. These patients are two to five times more likely to develop heart failure than those without diabetes, they have higher mortality and morbidity related to heart failure .A few reports have been published about this item. We conducted this study to determine the prevalence of heart failure in our patients with type II diabetes mellitus. Method: We studied 510 older than 40 patients with type II diabetes. According to history, ECG, Chest X ray and finally Echocardiography heart failure was confirmed. Results: The population who studied were 510 patients (193 men and 317 women). Mean age was 59.45 ± 9.21 years and mean duration of diabetes was 8.6 ± 5.57 years. Seventy five percent have been taking oral hypoglycemic agents, hyperlipidemia and smoking were the most common risk factors associated with diabetes. According to echocardiographic findings 42.2% of patients had some degree of heart failure and 74.9% of them had diastolic left ventricular dysfunction. Conclusion: Our study showed very high prevalence of heart failure and because these patients have worse prognosis than those without diabetes, thus detection and

POSTER PRESENTATIONS

Heart, Lung and Circulation 2008;17S:S4–S53

S34 POSTER PRESENTATIONS

Heart, Lung and Circulation 2008;17S:S4–S53

Poster Presentations

control of heart failure has an important role in diabetic patients. doi:10.1016/j.hlc.2007.11.084 Effect of atorvastatin on paraoxonase (pon) gene family and oxidative stress in a hypercholesterolemiac Thai population Amar Nagila ∗ , Surerrut Porntadavity The School of Pharmaceutical and Biomedical Sciences, Department of Clinical Chemistry, Faculty of Medical Technology, Mahidol University, Thailand The paraoxonase (PON) gene family consists of three members, PON1, PON2 and PON3. PON reduces oxidative stress in plasma and tissues, thus protecting against cardiovascular diseases. The aim of this study is to investigate the effect of atorvastatin on PON levels and the influence of PON polymorphisms on the therapeutic response of atorvastatin in hypercholesterolemia Thai population. Atorvastatin significantly reduced TC (24.5%, P < 0.001), LDL (22.4%, P < 0.001), TG (24.4, P < 0.05), CD (4.4%, P < 0.05), MDA (15.2%, P < 0.01) and total peroxide (13.0%, P < 0.01) levels whereas, TAS level was significantly increased (27.3%, P < 0.001). Interestingly, there were significant increases in serum PON1 activity towards paraoxon (13.4%, P < 0.05) and PON3 activity towards P-NO2 butyrate (13.2%, P < 0.05), but PON2 activity in monocytes were not significantly changed after atorvastatin treatment. There were no significant differences of basal PON1 and PON2 activity according to PON1 and PON2 polymorphisms were observed. However, PON1T107C polymorphisms affected the therapeutic response of PON1 levels to atorvastatin therapy (P = 0.03). Taken together, atorvastatin treatment not only reduces atherogenic lipids but also reduced lipid oxidation and only PON1T-107C influence therapeutic response which may be via an increasing PON1 and PON3 enzyme activity. doi:10.1016/j.hlc.2007.11.085 Inflammatory markers (TNF-alpha, IL-6, CRP), BNP and spiroergometric stress test parameters in patients with heart failure and atrial fibrillation Bohdan Nessler a,∗ , Jadwiga Nessler a , Mariusz b , Andrzej Gackowski a , Wies3 awa Piwowarska a ˜ Kitlinski a Institute of Cardiology, Jagiellonian School of Medicine, Poland b Department of Cardiology, University Hospital, Malmoe, Sweden

Background: Heart failure frequently coexists with atrial fibrillation. There are only a few reports on concentrations of inflammatory markers (TNF-alpha, IL-6, CRP), BNP and exercise capacity evaluated by cardiopulmonary testing (CPX) in this group of patients. Aim: to compare concentrations of TNF-alpha, IL-6, CRP, BNP and CPX parameters in heart failure patients with atrial fibrillation and sinus rhythm.

Material and methods: 106 patients with heart failure in NYHA class II and III (AF group – 26 patients with atrial fibrillation and SR group – 80 patients with sinus rhythm). We analyzed functional capacity according to NYHA, concentrations of TNF-alpha, IL-6 and CRP, BNP, echocardiographic parameters (LVDd, LVEDV, EF) and CPX and gas exchange (tmax, HRs, HRmax, VO2peak % N, VO2peak). Results: LVEF was comparable between groups. In AF group as compared with SR group we found significantly higher CRP (21.13 ± 20.06 mg/dl vs. 13.2 ± 11.28 mg/dl; p = 0.04) and IL-6 (13.55 ± 10.94 pg/ml vs. 8.6 ± 7.33 pg/ml; p = 0.05), BNP (582.75 ± 179.35 pg/ml vs. 442.94 ± 213.75 pg/ml; p = 0.03). In AF patients there was a negative correlation between IL-6 and test duration (r = −0.24, p = 0.5) and MET (r = −0.24, p = 0.05). Conclusions: Patients with heart failure and atrial fibrillation have higher IL-6 and CRP, BNP indicating increased inflammatory reaction in this group. Atrial fibrillation significantly reduces exercise tolerance and peak oxygen consumption in patients with heart failure. doi:10.1016/j.hlc.2007.11.086 Impact of sleep disordered breathing severity on the hemodynamics, functional status and autonomic function of chronic heart failure patients Chin Chwan Austin Ng a,∗ , Chin Moi Chow b , Helen Wong a , Andrew Sindone a , Glen Davis b , Saul Freedman a a Cardiology

Department, Concord Hospital, The University of Sydney, Australia b Discipline of Exercise and Sport Science, The University of Sydney, Australia Background: Despite advances in medical therapy, sleep disordered breathing (SDB) remains highly prevalent in patients with chronic heart failure (CHF). We explored whether severity of the SDB impacts on the clinical profile of a contemporary cohort of heart failure patients. Methods: A cohort of 13 (12 males) consecutive ambulatory patients with stable CHF and SDB, confirmed on polysomnograph, were prospectively enrolled from a tertiary referral heart failure clinic. Patients underwent standard hemodynamic and functional assessments, treadmill cardiopulmonary testing, with gas exchange and heart rate variability (HRV) analyses. Results: Mean age was 66 ± 10 years; left ventricular ejection fraction 37 ± 9%; New York Heart Association functional class 2.1 ± 0.3. Majority were on chronic betablocker, angiotensin-converting enzyme inhibitor and/or angiotensin-II-receptor blocker. All had evidence of SDB: mean apnoea-hypopnoea index (AHI) 32 ± 19, with predominantly hypopnoea rather than apnoea events. Anthropomorphic measurements correlated positively with increasing AHI severity (P < 0.05). There was an inverse relationship between apnoea-hypopnoea duration (shorter) and mean SaO2 desaturation (greater) with