Cases Of CHD Research Articles

P225 Carcinoid heart disease: report of a case in a patients with trombocytopenia absent radius

Abstract Background The carcinoid syndrome is characterized by extensive and several clinical manifestations. The diarrhea, the cutaneous flushing are the most frequents symptoms while cardiac manifestations (carcinoid heart disease) (CHD) occurs in a mean of 40%. Nowadays, the number of cases of CHD is lower than 20%, as a consequence of the widespread use of somatostatin analogues. At present, there is a mean delay in diagnosis of CHD of 1.5 years from the time of carcinoid syndrome detection. Hence, CHD is associated with a poor prognosis for clinical management. Case report We present a case of 45-years-old active woman, with Thrombocytopenia absent radius (TAR). This is characterized by a bilateral absence of the radio with the presence of both thumbs and thrombocytopenia. Our patient was attended for dyspnea of medium efforts, history of diarrhea, cutaneous flushing with tachycardia and elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) (89,6 mg/24 (2,0-9,0)). The Transthoracic echocardiography showed morphologic changes that affected the tricuspid valve: diminished curvature of the leaflets, altered dynamic motion of the leaflets during diastole, fused and shortened chordae retraction and reduced excursion of the valve. A moderate to severe tricuspid regurgitation and tricuspid stenosis with gradient media de 5 mmHg was observed. In addition, the right ventricle was dilated, a severe pulmonary hypertension, a right pleural effusion and a minor pericardial effusion circumference were detected. All these findings were consistent with CHD. Conclusions This report describes an unusual case of CHD in TAR patient. In fact, the interest of this case is the role played by the echocardiogram in the differential diagnosis for tricuspid valve diseases. Tricuspid stenosis is an infrequent condition and it is usually related with rheumatic disease associated with mitral valve disease. Although the carcinoid syndrome is infrequent, any changes in the anatomical structure of the tricuspid valve (thickening, fibrosis and rigidity associated with stenosis and tricuspid regurgitation) should alert us to the suspicion of CHD Abstract P225 Figure.

Risk factors of formation of congenital heart diseases

The authors conducted investigation to study the influence of risk factors on the frequency and structure of congenital heart defects of children in the Bukhara region. It has been established that the frequency of CHD is 4.72 cases for every 1000 births, 4 times more common in children living in rural conditions. Analysis by cities and districts of the Bukhara region showed that CHD is more common in industrialized regions of the region. Consequently, there is a high rate of a trend towards an increase in the birth rate and mortality of children with CHD. The fact, established about the high mortality rate of children under 5 years old without surgical correction, proves the need for timely surgical treatment of viable children in the first year of life. Among the significant factors determining the indicators of morbidity and mortality of the population is congenital developmental pathology (CDP), which is a serious medical and social problem. Significant differences in the incidence of CDP, including their individual forms, in different regions, even within the same state, depend on historical, ethnic, demographic, environmental and other factors. The cause of many congenital malformations remains unknown. This group of defects includes predominantly rarely occurring congenital malformations due to chromosome disorders. Cases of CHD with chromosomal syndromes are up to 4%. Various variants of CHD are characteristic of such chromosomal syndromes as Down syndrome, Shereshevsky-Turner syndrome, Patau and Edwards's syndrome. It should be noted that in the period under consideration in Bukhara, children with CHD in different numbers were born annually. However, on average, 167.6 cases of birth of newborns with CHD are registered annually.

Congenital heart defects in West Virginia: Preliminary findings from an ecological study of effects of an industrial watershed on increased incidence

ObjectiveCongenital anomalies are the leading cause of infant death, with congenital heart (CHD) defects the most common type. The study objective was to evaluate the incidence of fetal CHD in a tertiary care medical center’s obstetric population in West Virginia and map areas of possible environmental exposure. MethodsThis was an observational study of patients with positive ultrasound screen for CHD from 1/1/2007-8/31/2016. An Optimized Hot Spot analysis and Ripley’s K- Function was constructed to understand the effect of CHD in relation to proximity to chemical and coal extraction sites. ResultsOf the 16,871 obstetric pregnancies, 206 (1.2%) had fetal CHD with ventriculoseptal defects the most common (88; 42.7%). The majority of cases of CHD followed the industrial watershed of the Kanawha River in West Virginia. Direct point source exposure suggests a relationship in cases of CHD within Kanawha River and surrounding areas. The observed K was significantly above the expected K across all 10 distance bands. The fourth distance band exhibited the larger difference at (37914), between the expected verses the observed K function. ConclusionThrough spatial analysis, there appears to be a direct point source exposure for observed cases of f CHD along the industrial watershed of Kanawha County, West Virginia

Congenital heart defects in the Valencian Region 2007–2014: The population-based registry of congenital anomalies

IntroductionCongenital heart defects (CHDs) are the most prevalent and severe type of major congenital anomalies (CAs). The objective of this study was to determine the frequency and distribution of CHDs in the Valencian Region from 2007 to 2014, describing common characteristics of the patients and their mothers. Material and methodsWe retrieved data on CHDs in live births, stillbirths and cases of termination of pregnancy for foetal anomaly between 2007 and 2014 (codes Q20–Q26 in the 10th Revision of the International Classification of Diseases-British Paediatric Association, ICD10-BPA) from the population-based registry of congenital anomalies of the Valencian Region. We calculated the prevalence per every 10000 births of CHDs overall and by subtype, analysed temporal trends and the geographic distribution of cases, and documented the presence of associated noncardiac malformations. ResultsWe identified 3671 cases of CHD, corresponding to 38.6% of all CAs. The prevalence was 91.1/10000 (IC 95%: 88.1–94.0) with a predominance of septal defects, chiefly atrial septal defect (48.5/10000; IC 95%: 46.4–50.6) and ventricular septal defect (36.1/10000; IC 95%: 34.3–38.0). We found the highest prevalence in the province of Castellon (137.8/10000; IC 95%: 127.5–148.1). The sex distribution was 47.3% male and 44.3% female. Of all cases, 90.9% corresponded to live births and 65.6% were diagnosed at birth. The most frequent associated extracardiac malformations were musculoskeletal, and 19.2% of patients had syndromes. The most frequent maternal diseases were diabetes mellitus, hypothyroidism and urinary tract infections. ConclusionsThe prevalence of CHD and atrial septal defects was higher compared to European data, while the prevalence of ventricular septal defects was similar. Musculoskeletal malformations were the noncardiac CAs most frequently associated with CHDs.

Increased Nut Consumption and Subsequent Cardiovascular Disease Risk Among U.S. Men and Women: Three Large Prospective Cohort Studies (OR17-08-19)

ObjectivesTo evaluate the association of changes in total consumption of nuts and in specific type of nuts (e.g., walnuts, other tree nuts, peanuts) and subsequent risk of incident cardiovascular disease (CVD) in three large prospective cohorts of U.S. men and women. MethodsWe included 34,222 men from the Health Professionals Follow-up Study (1986–2012), 77,957 women from the Nurses’ Health Study (1986–2012), and 80,756 women from the Nurses’ Health Study II (1991–2013). We assessed nut consumption every 4 years using validated food frequency questionnaires. We used multivariable Cox proportional regression models to examine the association between 4-year changes in nut consumption and risk of confirmed CVD endpoints (composite nonfatal myocardial infarction, fatal coronary heart disease [CHD], and nonfatal or fatal stroke) in the subsequent 4 years with a median follow-up of 17.2 years. Models were adjusted for age, sex, race, family history of CVD, intake of nuts at beginning of each-4 year and simultaneous changes of correlated dietary and lifestyle confounders. ResultsDuring 2818,760 person-years of follow-up, we documented 8478 cases of incident CVD, including 4989 cases of CHD and 3489 cases of stroke. Per 0.5 serving/day (1 serving = 28 g) increase in total consumption of nuts was associated with a lower risk of CVD (RR = 0.92, 95% CI = 0.88–0.96), CHD (0.94, 0.89–0.99), and stroke (0.89, 0.83–0.95) (Figure 1).For each 0.5 serving increase per day, the RR for CVD in the subsequent 4 years was 0.86 (0.76–0.98) for walnuts, 0.93 (0.86–1.02) for other tree nuts, and 0.92 (0.86–0.99) for peanuts, respectively.We evaluated the joint association of initial and final nut consumption over 4 years with the subsequent risk of CVD, CHD and stroke. Compared with individuals who remained non-consumers, individuals who consistently had a high nut consumption (≥0.5 serving/day) had a significantly lower risk of CVD (0.75, 0.67–0.84), CHD (0.80, 0.69–0.93), and stroke (0.68, 0.57–0.82) (Figure 2). ConclusionsIncreasing intake of total nuts, including walnuts, other tree nuts, or peanuts, was associated with a subsequent lower risk of CVD. Funding SourcesNIH: UM1 CA186107, UM1 CA176726, UM1 CA167552.Partly funded by The Peanut Institution and the California Walnut Commission.The funders had no role in study design, data collection, analyses, interpretation and publication. Supporting Tables, Images and/or Graphs▪▪

Gene-environment interaction impacts on heart development and embryo survival.

Congenital heart disease (CHD) is the most common type of birth defect. In recent years, research has focussed on identifying the genetic causes of CHD. However, only a minority of CHD cases can be attributed to single gene mutations. In addition, studies have identified different environmental stressors that promote CHD, but the additive effect of genetic susceptibility and environmental factors is poorly understood. In this context, we have investigated the effects of short-term gestational hypoxia on mouse embryos genetically predisposed to heart defects. Exposure of mouse embryos heterozygous for Tbx1 or Fgfr1/Fgfr2 to hypoxia in utero increased the incidence and severity of heart defects while Nkx2-5+/- embryos died within 2 days of hypoxic exposure. We identified the molecular consequences of the interaction between Nkx2-5 and short-term gestational hypoxia, which suggest that reduced Nkx2-5 expression and a prolonged hypoxia-inducible factor 1α response together precipitate embryo death. Our study provides insight into the causes of embryo loss and variable penetrance of monogenic CHD, and raises the possibility that cases of foetal death and CHD in humans could be caused by similar gene-environment interactions.

Dietary nitrate consumption and risk of CHD in women from the Nurses' Health Study.

The consumption of nitrate-rich vegetables can acutely lower blood pressure and improve mediators shown to optimise vascular health. However, we do not yet understand the impact of long-term habitual dietary nitrate intake and its association with CVD. Therefore, the aim of this investigation was to examine the relationship between habitual dietary nitrate intakes and risk of CHD in women from the Nurses' Health Study. We prospectively followed 62 535 women who were free from diabetes, CVD and cancer at baseline in 1986. Information on diet was updated every 4 years with validated FFQ. The main outcome was CHD defined by the occurrence of non-fatal myocardial infarction or fatal CHD. Cox proportional hazard regression models were used to estimate the relative risks (RR) and 95 % CI. During 26 years of follow-up, 2257 cases of CHD were identified. When comparing the highest quintile of nitrate intake with the lowest quintile, in aged-adjusted analysis there was a protective association for CHD (RR=0·77, 95 % CI 0·68, 0·97; P=0·0002) which dissipated after further adjustment for smoking, physical activity, BMI and race (RR=0·91; 95 % CI 0·80, 1·04; P=0·27). This magnitude of association was further attenuated once we adjusted for the Alternative Healthy Eating Index excluding vegetable and fruit consumption (RR=1·04, 95 % CI 0·91, 1·20; P=0·34). Dietary nitrate intake was not related to the risk of CHD after adjustment for other lifestyle and non-vegetable dietary factors in a large group of US women.

Nutritional Status in Patients with Congenital Heart Diseases Tikrit Teaching Hospital

This is an observational cross-sectional study has been conducted in Tikrit Teaching Hospital in which a total (204) CHD cases. The questionnaire was developed to collect all personal and demographic data relevant to the objectives of study. The study includes interviewer administration of questionnaire, anthropometric measurements, CXR, ECG and Echo finding. All cases of CHD which were diagnosed by echocardiography. Results: the total No. of cases were 204 case, female was106 case, male 98 cases, most common defect was VSD, male: female ratio 1: 1.08. Most of cases were VSD 72 case (35.2%) and most common was large VSD, followed by TOF, 29 case (14.2%), least CHD, TAPVR and AP window. Total cases of VSD was (72). The frequency of types of VSD were as follows; small VSD (24 cases), moderate VSD (22 cases), and large VSD (29% cases). The age distribution of CHD was as follows; neonate (11%), infants (18), (1–5 years) (44%), and children > 5 years (27%). The sex distribution of CHD was as follows; CHD in female was (106 case), in males (98 case), with male to female ratio =1: 1.08 (table 3). Most of cases were underweight [127of cases (62.25%) underweight, 77 (37.75%) normal weight].

Habitual Glucosamine Use is Associated with a Reduced Risk of Cardiovascular Disease, a Prospective Study in the UK Biobank

Background: Glucosamine is a common supplement for treating osteoarthritis, while its effectiveness on osteoarthritis and joint pain continues to be debated. Recently emerging evidence from animal studies and cross-sectional studies in humans suggest that glucosamine may have potential benefits on reduction of cardiovascular disease (CVD) and mortality; however, evidence from prospective studies is lacking. Methods: In the UK biobank cohort study, a total of 466,039 participants without CVD at baseline completed the questionnaire on supplement use, including glucosamine, were analyzed in this study. These participants were enrolled from 2006 to 2010 and followed up to 2016. Cox proportional hazards models were used to compare hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD events in participants who did and did not use glucosamine. Findings: During a median of 7·0 years of follow-up, we documented 10,204 incident cases of CVD events, 3,060 cases of CVD death, 5,745 cases of CHD and 3,263 cases of stroke. After adjustment for age, sex, body mass index, race, lifestyle factors, dietary intakes, medication use and other supplements use, glucosamine use was associated with significantly reduced risks of total CVD events (HR: 0·85: 95% confidence interval [CI], 0·80-0·90), CVD death (HR: 0·78: 95% [CI], 0·70-0·87), CHD (HR: 0·82: 95% [CI], 0·76-0·88) and stroke (HR: 0·91: 95% [CI], 0·83-1·00). In addition, the associations of glucosamine use with risks of total CVD events and CHD were more pronounced in smokers than non-smokers (P-interaction=0·018 and 0·004, respectively). Interpretation: Beyond its original use for treating osteoarthritis, habitual use of glucosamine supplement was associated with significantly reduced risks of CVD events, especially among smokers. Further investigations in both prospective cohorts and clinical trials are warranted to verify our findings. Funding: The study was supported by grants from the National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383, DK078616). Declaration of Interest: We declare no competing interests. Ethical Approval: All participants provided written informed consent and the study was approved by the NHS National Research Ethics Service. The present analysis was approved by the Tulane University (New Orleans, Louisiana) Institutional Review Board. Data from 502, 616 participants were available for our study.

Study of congenital heart diseases in neonates

Background: Congenital heart disease defined as an abnormality in cardio circulatory structure or function that is mostly present at birth; even it is discovered much later. Recognition of congenital heart disease in newborn is important as this group abnormality constitutes a significant proportion of congenital malformation that present in the neonatal life, and their early detection is important for appropriate management and good outcome. Objectives of present study were to evaluate clinical profile and outcome of various CHDs identified during neonatal period and to study effect of paracetamol used for pharmacological closure of PDA in preterm neonates.Methods: The study was conducted prospectively in NICU, Dhiraj hospital, Department of Pediatrics and Neonatology from January 2016 to June 2017 (1.5 years span). Echocardiography screening of all neonates suspected of having CHD was done. Details of all neonates having CHD diagnosed by echocardiography were noted in the prescribed Performa and their incidence, clinical profile and outcome was studied.Results: Total 69 cases of CHD diagnosed by Echocardiography in neonatal period were studied. Incidence of CHD among neonates born at Dhiraj hospital was 8.48 per 1000 live birth. Male: female ratio of all CHD cases was 1.38:1. Risk of neonate with CHD is highest (18.18%) in extremely low birth weight neonates. Incidence of CHD was 4.08% in preterm < 34 weeks, 3.47% in late preterms and 0.51% in full term neonates. 86.95% were diagnosed within first week of life. 26.09% babies had associated anomalies. Presenting problem of neonates was breathing difficulty 42 (60.87%), feeding difficulty 36 (52.17%) and cyanosis 5 (7.25%). 8 (11.59%) neonates were asymptomatic. The most common presenting sign was murmur 46 (75.71%). 56 (81.16%) had Acyanotic CHD and 13 (18.84%) had Cyanotic CHD. Amongst 56 (81.16%) Acyanotic CHD cases, commonest was PDA in 44 (78.5%), followed by VSD in 18 (32.14%), ASD in 5 (12.5%) either in isolation or in combination with other lesions. Amongst Cyanotic Congenital Heart Disease, maximum incidence was of Tricuspid Atresia (TA) in 4 (30.76%) cases; followed by TGA in 3 (23.07%). 20 preterm neonates with PDA received paracetamol for PDA closure. 9 (45.0%) responded to paracetamol while 11 (55%) did not respond. 47(68.12%) were discharged, 10(14.49%) went left against medical advice, 7(10.14%) were referred to higher centre for surgery and 5(7.25%) babies expired.Conclusions: Early recognition of congenital heart disease during neonatal life is important as its appropriate and timely management can result in good outcome.

The association between an endothelial nitric oxide synthase gene polymorphism and coronary heart disease in young people and the underlying mechanism.

With the development of molecular biological technology, the association between genes and diseases has drawn increasing attention of researchers; the endothelial nitric oxide synthase (eNOS) gene has been reported to be a candidate gene for cardiovascular disease (CHD). The present study aimed to investigate the association between a polymorphism of eNOS and the risk of CHD in young people (≤40years old), in addition to the underlying mechanism. A total of 234cases of CHD in young individuals were collected as the CHD group and 228cases of healthy individuals as the control group. Peripheral blood was collected and the genotype of the eNOS G894T polymorphism was identified by polymerase chain reaction-restriction fragment length polymorphism, the gene frequency was calculated and the distributions of genotype and allele frequency between the two groups were compared. Bioinformatics tools were employed to analyze the differences in the local protein structures of the eNOS G894T polymorphism and the biological mechanism was preliminary discussed. The results demonstrated that there were significant differences in the distribution of genotype frequency and allele frequency of the eNOS G894T gene polymorphism between the CHD group and control group (P<0.05). The risk of CHD in GT and TT genotypes were higher compared with the GG genotype (P<0.05). The G894T polymorphism led to Glu298Asp mutation of encoded protein, which is within the active site of eNOS, and partial structures of the protein were converted from random coil to α‑helix. In conclusion, the eNOS G894T gene polymorphism was associated with the occurrence and development of CHD in young people. The potential mechanism is that the G894T polymorphism leads to altered protein structure, which affects the function of eNOS in generating nitric oxide and cardiovascular diastole. The results of the present study suggested a potential target gene for the prevention and treatment of CHD in young people (≤40years old).

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Aims/hypothesisSleep duration is a risk factor for incident diabetes mellitus and CHD. The primary aim of the present study was to investigate, in sex-specific analyses, the role of incident diabetes as the possible biological mechanism for the reported association between short/long sleep duration and incident CHD. Considering that diabetes is a major risk factor for CHD, we hypothesised that any association with sleep duration would not hold for cases of incident CHD occurring before incident diabetes (‘non-diabetes CHD’) but would hold true for cases of incident CHD following incident diabetes (‘diabetes-CHD’).MethodsA total of 6966 men and 9378 women aged 45–73 years from the Malmö Diet Cancer Study, a population-based, prospective cohort, who had answered questions on habitual sleep duration and did not have a history of prevalent diabetes or CHD were included in the analyses. Incident cases of diabetes and CHD were identified using national registers. Sex-specific Cox proportional hazards regression models were stratified by BMI and adjusted for known covariates of diabetes and CHD.ResultsMean follow-up times for incident diabetes (n = 1137/1016 [men/women]), incident CHD (n = 1170/578), non-diabetes CHD (n = 1016/501) and diabetes-CHD (n = 154/77) were 14.2–15.2 years for men, and 15.8–16.5 years for women. In men, short sleep duration (< 6 h) was associated with incident diabetes (HR 1.35, 95% CI 1.01, 1.80), CHD (HR 1.41, 95% CI 1.06, 1.89) and diabetes-CHD (HR 2.34, 95% CI 1.20, 4.55). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.35, 95% CI 0.98, 1.87). Long sleep duration (≥ 9 h) was associated with incident diabetes (HR 1.37, 95% CI 1.03, 1.83), CHD (HR 1.33, 95% CI 1.01, 1.75) and diabetes-CHD (HR 2.10, 95% CI 1.11, 4.00). Long sleep duration was not associated with incident non-diabetes CHD (HR 1.33, 95% CI 0.98, 1.80). In women, short sleep duration was associated with incident diabetes (HR 1.53, 95% CI 1.16, 2.01), CHD (HR 1.46, 95% CI 1.03, 2.07) and diabetes-CHD (HR 2.88, 95% CI 1.37, 6.08). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.29, 95% CI 0.86, 1.93).Conclusions/interpretationThe associations between sleep duration and incident CHD directly reflect the associations between sleep duration and incident diabetes. Incident diabetes may thus be the explanatory mechanism for the association between short and long sleep duration and incident CHD.

Immunohistochemical study of CD15 expression in CD30+ classical Hodgkin's lymphoma

defined B-cell neoplasm that includes two distinct types of disease, classical and nodular lymphocyte-predominant. Aim of the study: To evaluate the immunohistochemical expression of CD15 in CD30+ classical Hodgkin’s lymphoma. Patients and Methods: This retrospective study included revision of 52 lymph nodes specimens from patients newly diagnosed with HL from January 2005 to September 2010.These samples were collected from Al-Yarmouk Teaching Hospital, Baghdad Medical City and Al-Atheer private laboratory. Only well-preserved samples that stood a retrospective confirmatory morphological revision and revealed IHC CD30 stain {from DAKO} positive reactivity were included in this study. All biopsies were formalin-fixed and paraffin embedded. A 4 micron sections obtained and stained with hematoxylin and eosin and CD15 monoclonal antibody {from DAKO} according to thekit-included instructions.Results: This study revealed that the CD15 positive classical HL are 24 (75%), 10 (100%), 6 (100%) and 0 (0%) for MC, NS, LD and LR respectively.Conclusions: All cases of cHD should undergo immunophenotypic analysis for CD15 in addition to CD30 antigen.

A HAND to TBX5 Explains the Link Between Thalidomide and Cardiac Diseases

Congenital heart disease is the leading cause of death in the first year of life. Mutations only in few genes have been linked to some cases of CHD. Thalidomide was used by pregnant women for morning sickness but was removed from the market because it caused severe malformations including CHDs. We used both in silico docking software, and in vitro molecular and biochemical methods to document a novel interaction involving Thalidomide, TBX5, and HAND2. Thalidomide binds readily to TBX5 through amino acids R81, R82, and K226 all implicated in DNA binding. It reduces TBX5 binding to DNA by 40%, and suppresses TBX5 mediated activation of the NPPA and VEGF promoters by 70%. We documented a novel interaction between TBX5 and HAND2, and showed that a p.G202V HAND2 variant associated with CHD and coronary artery diseases found in a large Lebanese family with high consanguinity, drastically inhibited this interaction by 90%. Similarly, thalidomide inhibited the TBX5/HAND2 physical interaction, and the in silico docking revealed that the same amino acids involved in the interaction of TBX5 with DNA are also involved in its binding to HAND2. Our results establish a HAND2/TBX5 pathway implicated in heart development and diseases.

Coronary Heart Disease risk profile among women attending Tertiary Care Hospital in Southern Karnataka, India

Background: Present study was conducted to assess the risk factors of CHD in women who had undergone Coronary Angiography for CHD evaluation. Objectives of the study were to assess the CHD Risk profile among women attending Tertiary Care Hospital at Mysore city and to enlist the clinical presentation of women admitted to tertiary care Hospital. Settings and Design: Hospital based cross sectional study. Methods: All the women who were admitted to the Department of Cardiology from April 2015 to January 2016 were interviewed using pre structured proforma. Details of the female patients who had undergone Angiography from September 2013 to March 2015 were also collected from Medical Record Section of the Hospital. Statistical Analysis: Proportion and mean were used for relevant univariate analysis and significance of association was tested using appropriate tests of significance. Results: 17% of women were known cases of CHD. 87.4% of women were admitted with the symptom of chest pain. 44% of women who presented with IHD belonged to normal and underweight BMI category. Among the clinically suspected or diagnosed to be cases of CHD, 75% had blocks in their coronaries. Single artery block (29.7%) and triple artery block (22.5%) were predominant. Left anterior descending artery had significant block (&gt;70%) in 36% of women. Left circumflex artery and right coronary arteries showed significant blocks in 26% and 22.5% participants. Conclusions: Earlier age of presentation, higher proportion of coronary blocks in majority of study women belonging to normal or underweight BMI category are alarms of changing pattern of CHD in Indian women.

Abstract MP034: Muscle strength and Short-term Risk of Cardiovascular Outcomes in Community-dwelling Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Muscle weakness has been shown to predict mortality in older adults. However, its contribution to different cardiovascular disease (CVD) subtypes is not well known. Methods: Among 5,484 participants (age 67-91 years) in the ARIC Study at visit 5 (2011-13), we quantified the associations of grip strength (measured by Jamar Hydraulic Hand Dynamometer) with the risk of coronary heart disease (CHD including myocardial infarction or coronary death), stroke, and heart failure (HF) using Cox models. Results: Over a median follow-up of 1.7 years, there were 119 cases of CHD, 47 cases of stroke, and 168 cases of HF. In crude models, the lowest sex-specific quartile of grip strength demonstrated significantly higher risk of CHD and HF compared to the highest quartile (Table). After accounting for potential confounders such as diabetes, body mass index, and blood pressure, the significant association was only observed for HF (HR 2.09 [95% CI 1.25-3.50] between the lowest vs. highest quartile). Conclusion: Weaker muscle strength was significantly associated with CVD risk in community-dwelling older adults, but its independent association was most evident for HF. Our results suggest the pathophysiological link between skeletal muscle function and HF as well as potential usefulness of grip strength to classify HF risk in older adults.

Management of complex CHD at the National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Enugu: the role of foreign cardiac missions in 3.5 years.

CHD is defined as structural defect(s) in the heart and proximal blood vessels present at birth. The National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital (UNTH), Enugu, through the aid of visiting Cardiac Missions has managed a significant number of patients within the last 3.5 years. Aim/Objective The objective of this study was to review surgical options and outcome of complex CHD among patients attending UNTH, Enugu, Enugu. Materials and Method During the period of 3.5 years (March, 2013 to June, 2016), a total of 20 cases of complex CHD were managed by cardiac missions that visited UNTH, Enugu. Their case notes and operating register were retrieved, reviewed, and analysed using SPSS version 19 (Chicago). There were eight females and 12 males, with a ratio of 2:5. The age range was from 5 months to 34 years with a mean of 1.7. Among all, five patients died giving a mortality rate of 25%. The operative procedures ranged from palliative shunts to complete repair. The outcome was relatively good. Complex CHD are present in our environment. Their surgical management in our centre is being made possible by periodic visits of foreign cardiac missions.

Electrophysiology Updates in Adult Congenital Heart Disease.

Electrophysiology Updates in Adult Congenital Heart Disease.

Pattern of congenital heart diseases in a tertiary care teachinghospital, Chinna Kakani, Guntur

Objective: To evaluate the spectrum and pattern of congenital heart diseases in NRI general hospital, a tertiary care teaching hospital, Chinna Kakani, Andhra Pradesh. Methods: A retrospective hospital based analysis of children attending pediatric department over a period of two years during January, 2014 to December, 2015 was performed. Patients suspected to have cardiac symptoms or cardiac murmurs were referred for 2D echo and colour Doppler to confirm the diagnosis. Prevalence rate per 1000 patients was calculated. Relative frequencies of individual CHD types as a proportion of total CHDs were also calculated. Results: A total of 174 Echo confirmed cases of CHDs were identified from a total of 60,000 patients attending the hospital over a two year period with a calculated prevalence of 2.9/1000 patients. Of total cases 96 were female and 78 were male children. A total of 149 Acyanotic CHD cases (86.5%) were identified of which, Isolated ASD were 52 (35%), Isolated VSD were 42(28%), AVCD were 2 (1.34%), PS were 12(8%),AS were 4(2.7%), COA were 2(1.34%), PDA were22(14.7%), combination of ASD + VSD were 10(6.7%) and Dextrocardia with situs inversus were 3(2%). A total of 25 cases of Cyanotic CHD were identified, of which TOF and its variants were 16(64%), DORV+VSD+PS were 2(8%), rare complex CHDs like DORV+HLHS, TAPVC, Ebstien Anomaly, Cortriatrium, were one case(4%) each and TGA were 3(12%) cases. Conclusion: The calculated prevalence of CHD at 2.9 /1000 among hospital attending patients could be an underestimation of actual disease burden in our community. The maximum numbers of children with CHD were identified by 5 years of age. The most commonly found Acyanotic CHDs were ASD, VSD and PDA. The most common cyanotic CHD was TOF.

Abstract MP44: Lifetime Marijuana Use is Not Associated with Incident Cardiovascular Disease in Middle-Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Marijuana is the most frequently used illicit drug in the US. Its use is expected to rise given recent state policies that relax criminalization and permit medicinal use. Although several mechanisms exist by which marijuana might contribute to chronic cardiovascular conditions, few data are available. We sought to determine the association of lifetime marijuana use with the development of incident CHD and CVD. Methods: Participants were 5,114 white and black adults aged 18-30 years in 1985-86 from the multicenter, community-based CARDIA Study who have been followed for over 25 years. We estimated cumulative years of exposure in “marijuana-years,” with one marijuana-year equal to 365 days of marijuana use using repeated assessments every 2-5 years. Incident CHD included fatal or nonfatal myocardial infarction, angina, or CHD death. Incident CVD included CHD, stroke, hospitalized heart failure, and intervention for peripheral arterial disease. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. Lifetime marijuana use and all time-varying covariates were entered as time-dependent variables. Results: Approximately 16% of the cohort were lifetime never users of marijuana, while 35%, 22%, 14%, and 13% reported lifetime use of &lt;0.5, 0.5-&lt;2, 2-&lt;5, and ≥5 marijuana-years, respectively. During a median of 26.9 years of follow-up (132,120 person-years), there were 104 and 216 cases of CHD and CVD, respectively. Compared to never use, categories of lifetime marijuana use showed no evidence for a higher or lower risk for CHD or CVD, regardless of the level of multivariable adjustment (Table). Findings did not vary significantly by age, sex, race, family history, 10-year risk of CVD, or use of other illicit drugs (p-interaction &gt;0.3, for all). Conclusions: In this long-term follow-up study of young adults at baseline, lifetime use of marijuana at these levels was not associated with incident CHD or CVD in middle-age.