Framingham Criteria Research Articles

Long-term mortality in older patients discharged after acute decompensated heart failure: a prospective cohort study

BackgroundData are available on short- and intermediate-term mortality rates after discharge for acutely decompensated heart failure (ADHF). However, few studies specifically addressed ADHF outcomes in patients aged 75 years or over, who contribute more than half of all ADHF admissions. Our objectives here were to estimate the long-term mortality of patients aged 75 years or over who were discharged after admission for ADHF and to identify factors, especially geriatric findings, independently associated with 2-year mortality.MethodsThis prospective cohort study in five French hospitals included consecutive patients aged 75 years or older and discharged after emergency-department admission for ADHF meeting Framingham criteria (N = 478; median age, 85 years; 68% female). Kaplan-Meier 1-year and 2-year survival curves were plotted. Admission characteristics independently associated with overall 2-year mortality were identified using multivariable Cox proportional-hazards regression.ResultsMortality was 41.7% (95% confidence interval [95% CI], 37.2%–53.5%) after 1 year and 56.0% (95% CI, 51.5%–60.7%) after 2 years. By multivariable analysis, independent predictors of 2-year mortality were male sex (hazard ratio [HR], 1.36; 95% CI, 1.00–1.82), age >85 years (HR, 1.57; 95% CI, 1.19–2.07), higher number of impaired activities of daily living (HR, 1.11 per impaired item; 95% CI, 1.05–1.17), recent weight loss (HR, 1.61; 95% CI, 1.14–2.28), and lower systolic blood pressure (HR, 0.86 per standard deviation increase; 95% CI, 0.74–0.99). Creatinine clearance ≤30 mL/min showed a trend toward an association with 2-year mortality (HR, 1.36; 95% CI, 0.97–2.00).ConclusionFunctional impairment before admission is associated with higher long-term mortality in patients ≥75 years admitted for ADHF. This study focused on geriatric markers not traditionally collected in heart-failure patients but did not analyse all cardiologic parameters associated with outcomes in other studies. Nevertheless, our findings may contribute to identify those patients admitted for ADHF who have the worst prognosis.

Comparative Study of Risk Stratifications Scores for Acute Heart Failure Patients in the Emergency Department, Egypt

Introduction: diagnosis of heart failure according to Framingham criteria which is. a) Major criteria. b) Minor criteria for establishing a definite diagnosis of HF, two major or one major and two minor criteria had to be present. In this study two risk stratification models will be used among heart failure patients who present to emergency room, The Seattle heart failure model and the Canadian predictor mortality of HF model. Aim: comparison will be done according to accuracy and easiness in predicting risk of death in 48hr and 28day from hospital admission among HF patient. Methods: This study is cross-sectional, observational study on adults presenting to the emergency department with Acute Heart Failure with short term follow up in cardiology care unit (CCU) and Cardiology inpatient ward for MACE. Patients will be divided into two groups. Each group will include 30 patients their cardiac risk determined by one of the two methods of risk stratification utilizing findings on presentation. Results: The studied patients in Canadian model was 20.0%, acute renal failure was 23.3%, stroke was 10.0%, cardiogenic shock was 36.7% and significant arrhythmia was 10.0%. While according Seattle heart failure model, 57% of the patients were at very high risk, 16.7% were at high risk, 16.7% were at intermediate risk and 10% were at low risk of mortality Conclusion: Sensitivity, specificity and +PV of Seattle heart failure model was significantly higher than Canadian predictive model with very high area under the ROC curve ( AUC) and very low standard error (SE).

Pulmonary hypertension in heart failure with preserved ejection fraction: a plea for proper phenotyping and further research.

Heart failure (HF) with preserved ejection fraction (HFpEF) is a common disease affecting the elderly in particular. Up to 80% of these patients develop pulmonary hypertension (PH), which is associated with worse symptoms and increased mortality.1 It is a matter of concern that drugs approved for pulmonary arterial hypertension (PAH) are sometimes used in such patients despite insufficient data for their safety and efficacy. On the other hand, the impact of PH and right ventricular (RV) dysfunction on morbidity and mortality in HFpEF call for proper attention both at the clinical and scientific level. Here we discuss the clinical problem, pathophysiology, diagnostic shortfalls, gaps in evidence, and future strategies for PH-HFpEF. HFpEF is currently the dominant form of HF in aging societies globally. Epidemiologic trends over the past two decades showed that HFpEF increased relative to HF with reduced ejection fraction (HFrEF).2 Overall mortality did not improve over time, with more than 50% dead in 5 years from diagnosis.2 Differences between epidemiologic and trial populations of HFpEF reflect potential selection bias and lack of uniformity of diagnostic criteria. Epidemiologic studies utilize the most widely applicable definition of HFpEF: (i) clinically diagnosed HF (e.g. by Framingham criteria) and (ii) preserved EF (e.g. ≥50%).2 While such definitions capture the broad unselected population with the syndrome of HFpEF, they are rarely specific enough for clinical trials since the accurate diagnosis relies on symptoms and signs of HFpEF, both non-discriminating particularly in elderly patients with multiple comorbidities. The ESC guidelines included additional criteria, i.e. elevated levels of natriuretic peptides or objective evidence of left ventricular (LV) hypertrophy, left atrial enlargement, and/or LV diastolic dysfunction.3 Yet, the diagnosis of HFpEF remains difficult as many presumably healthy elderly patients fulfil at least some of these echocardiographic criteria. Invasive demonstration of increased pulmonary …

Echocardiographic screening for non-ischaemic stage B heart failure in the community.

Incident heart failure (HF) continues to pose a common and serious problem. We sought to examine the value of echocardiographic predictors of new HF in a community-based elderly population at risk for HF, independent of and incremental to clinical evaluation. Asymptomatic patients ≥65 years old, with ≥1 HF risk factor (hypertension, type 2 diabetes, or obesity) were recruited from the community; patients with valve disease, reduced ejection fraction (EF), and atrial fibrillation (AF) were excluded. Patients underwent standard clinical evaluation including calculation of the Charlson co-morbidity score and a comprehensive echocardiography including global longitudinal strain (GLS). Functional capacity was assessed by 6 min walk test. New HF and cardiovascular death were assessed after a mean follow-up of 14 ± 4 months by three independent cardiologists using Framingham criteria. Of 410 subjects (median age 70 years; 48% men), the prevalence of stage B HF was 13% [by LV hypertrophy (LVH)], 12% (by abnormal E/e'), 33% (by impaired GLS), and 31% [by left atrial enlargement (LAE)]. New HF symptoms developed in 49, and 2 died of cardiovascular causes, giving an event rate of 104/1000 person-years. These patients were older (P = 0.012), had a higher Charlson co-morbidity score (P < 0.001), larger LV mass and left atrium, higher E/e', and lower GLS (P < 0.05). LAE, LVH, abnormal GLS, and E/e' were independent predictors of new HF. In sequential models, LV mass and GLS added incremental information to clinical parameters. GLS significantly reclassified individuals (P = 0.002), but no reclassification improvement was identified using LV mass index, E/e', and left atrial volume index. Echocardiographic assessment (especially GLS and LV mass) provides incremental value in predicting incident HF.

UJI DIAGNOSTIK NT pro NATRIURETIC PEPTIDE (NTpro BNP) GAGAL JANTUNG KONGESTIF

Congestive Heart Failure (CHF) is a syndrome associated with disturbances of heart structure and function, as a result of various cardiovascular diseases. These disturbances decrease ventricle ability to pump or fill blood in physiological pressure, which causes limitation on the ability to excercise or daily activities without dyspnea and fatigue.Early diagnosis is important to initiate prompt treatment that can prevent further disease development. To measure heart hormone in this case, NT pro Natriuretic Peptide (NT pro BNP) can be use as a more ideal examination for early detection of CHF. The aim of this study is to investigate the clinical performance of NT pro BNP and assess the cut-off point 125 pg/mL compared to clinic (Framingham criteria) and or echocardiogram in the diagnosis CHF.The diagnostic test was carried out using clinical (Framingham criteria) and or echocardiography as reference methods. The subject of this research was patients with cardiac and blood vessel disorders complaints at risk of developing congestive heart failure, who came to the Emergency Department at Dr. Sardjito Hospital Yogyakarta, supported by clinical data, radiology, other laboratory test, electrocardiography and echocardiography. The diagnosis of CHF was obtained by conducting investigation toward echocardiography examination reading in patient's medical record. Receiver Operating Characteristics (ROC) curve analysis was conducted using SPSS 13.0 program. Sensitivity, specificity, positive and negative predictive value, accuracy and likelihood ratios were measured with 2x2 table by CAT marker program. Forty-six of fifty-seven specimens were from congestive heart failure (CHF). At 125 pg/mL as a cut-off point, regardless the interval between the onset of the symptoms and taking of blood samples, the sensitivity, specificity, positive and negative predictive value and diagnostic accuracy are 96%, 36%, 86%, 67%, 84% respectively. Likelihood ratios for positive and negative results are 1.50 and 0.12. NT pro BNP measuring is expected to give more benefit than the conventional signal, so that an early diagnosis can be achieved accurately in a timely manner.

Heart Failure Predictors in a Group of Patients with Myocardial Infarction.

AIM:The present study considers of the prevalence of heart failure (HF) in patients suffering from acute myocardial infarction (AMI) in the University Hospital Centre of Tirana (UHCT) “Mother Theresa”; the demographic and clinical characteristics of the sample during hospitalization; and the main predictors of heart failure occurrence inside the group of patients suffering an AMI.MATERIAL AND METHODS:During a period of study from 2013-2015 we studied demographic and clinical data from 587 consecutive patients presenting with AMI; Framingham criteria were adopted for classifying patients with HF upon admission.RESULTS:A Killip class ≥ 2 was the main diagnostic criterion of HF during hospitalisation. HF was identified in 156 patients (26.6%). The subgroup with HF had significant differences when compared with the other patients with regard to age, sex (male), heart rate upon admission, systolic blood pressure on admission, previous episodes of AMI, glycemia on admission, previous antihypertensive treatment, previous revascularization procedures, peripheral vascular disease, chronic renal disease, ejection fraction (EF), anemia, and atrial fibrillation presence. Independent predictors for HF occurrence in the logistic regression model were EF, previous revascularization, peripheral vascular disease, age, sex, previous AMI, systolic blood pressure upon admission, and anaemia.CONCLUSION:As a conclusion, HF seems to be a common occurrence after AMI, in spite of changes in the epidemiological profile of the acute coronary syndrome. An increase in the incidence is registered as well, parallel to a decrease in the mortality following AMI. Attention must be shown for highly risked subpopulations, aged persons, patients with the previous coronary disease, and concomitant conditions.

High-Output Heart Failure: A 15-Year Experience

BackgroundHigh-output heart failure (HF) is an unusual cause of cardiac failure that has not been well-characterized. ObjectivesThis study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of high-output HF in the modern era. MethodsWe performed a retrospective analysis of all consecutive patients referred to the Mayo Clinic catheterization laboratory for hemodynamic assessment between 2000 and 2014. Subjects with definite HF, as defined by the Framingham criteria, were compared to controls of similar age and sex. ResultsThe most common etiologies of high-output HF (n = 120) were obesity (31%), liver disease (23%), arteriovenous shunts (23%), lung disease (16%), and myeloproliferative disorders (8%). Compared with controls (n = 24), subjects with high-output HF displayed eccentric left ventricular remodeling, greater natriuretic peptide activation, higher filling pressures, pulmonary hypertension, and increased cardiac output, despite similar ejection fraction. Elevated cardiac output in high-output HF patients was related to both lower arterial afterload (decreased systemic vascular resistance) and higher metabolic rate. Mortality was increased in high-output HF as compared with controls (hazard ratio: 3.4; 95% confidence interval: 1.6 to 7.6). Hemodynamics and outcomes were poorest amongst patients with the lowest systemic vascular resistance. ConclusionsHigh-output HF is an important cause of clinical HF in the modern era that is related to excessive vasodilation, and most frequently caused by obesity, arteriovenous shunts, and liver disease. Given the high mortality and increasing prevalence of these comorbidities in Western countries, high-output HF must be considered in the differential diagnosis of patients presenting with dyspnea, congestion, and a normal ejection fraction.

Amino-terminal pro–B-type natriuretic peptide, inferior vena cava ultrasound, and biolectrical impedance analysis for the diagnosis of acute decompensated CHF

BackgroundBoth Framingham criteria and natriuretic peptides (NPs) may worsen their diagnostic validity for acute decompensated heart failure (ADHF) in elderly patients with comorbidities, mainly renal failure. Ultrasound of inferior vena cava (IVCu) and bioelectrical impedance analysis (BIA) are useful tools for detecting ADHF, although their utility compared with NP is not fully established. Methods and ResultsWe conducted a prospective study with 96 patients who presented at the emergency department with dyspnea and were classified as ADHF and non-ADHF groups. Inferior vena cava ultrasonography measured maximum and minimum inferior vena cava diameters and collapsibility index (CIx), whereas BIA calculated resistance (Rz) and reactance (Xc). The primary goal was to compare amino-terminal pro–B-type NP (NT-proBNP), IVCu, and BIA for identifying ADHF. The ADHF group showed significantly (P<.001) higher NT-proBNP values (5801 vs 599 pg/mL), higher maximum IVC diameter (2.26 vs 1.58 cm), higher minimum IVC diameter (1.67 vs 0,7 cm), and lower CIx (27% vs 59%), as well as lower Rz (458.8 vs 627.1 Ohm) and lower Xc (23.5 vs 38.4 Ohm) compared with the non-ADHF group. The estimated area under the curve for ADHF diagnosis was 0.84 for NT-proBNP, 0.90 for maximum IVC diameter, 0.93 for minimum IVC diameter, and 0.90 for CIx, as well as 0.83 and 0.80 for Rz and Xc respectively, without finding significant difference. Cutoff values for diagnosis of ADHF with IVCu and BIA are proposed. Amino-terminal pro–B-type NP values significantly varied in patients with renal impairment, independently of ADHF status, whereas neither IVCu nor BIA did. ConclusionsInferior vena cava ultrasonography and BIA analysis are as useful as NT-proBNP to ADHF diagnosis, validated in an elderly population with kidney disease.

Cardiovascular effects of the addition of nilotinib to standard therapy for acute myeloid leukemia.

e18505 Background: Angina, arrhythmias and QT prolongation have been cardiac adverse effects reported in clinical trials with nilotinib, which inhibits the tyrosine kinase activity of BCR-ABL and KIT. The objective of this study was to assess cardiac events in acute myeloid leukemia (AML) patients treated with standard therapy (an anthracycline plus cytarabine or 7+3) versus KIT positive AML patients treated with 7+3 plus nilotinib as part of a clinical trial. Methods: After IRB approval, 100 consecutive patients treated for newly diagnosed AML at Mayo Clinic who consented to the use of their medical records for research were identified and a retrospective chart review performed. The primary endpoint was heart failure defined by the modified Framingham criteria. Secondary endpoints included cancer therapeutics-related cardiac dysfunction (CTRCD) defined as a drop in ejection fraction of > 10% to < 53%, arrhythmias defined as a new rhythm abnormality other than sinus bradycardia or tachycardia resulting in a change to therapy or transfer to a higher level of care, and acute coronary syndromes (ACS) diagnosed by a cardiologist. Between group differences were assessed using t-tests, Wilcoxon tests, or Fisher’s exact tests. Results: Thirteen patients (13%) received nilotinib plus 7+3 and 87 patients (87%) received 7+3. No patients had a prior exposure to nilotinib. Median follow-up was 73 weeks (55-87) in the nilotinib plus 7+3 group and 83 weeks (30-139) in the 7+3 group. Groups were similar with respect to age, sex, comorbidities and baseline medical therapy. No significant difference was observed between those who did versus did not receive nilotinib respectively in the incidence of heart failure (8% vs. 14%), CTRCD (15% vs. 16%), ACS (0 vs. 3%) and arrhythmias (0 vs. 16%)(all p > 0.1). Conclusions: The addition of nilotinib to standard therapy for AML was not associated with an increase in cardiac events for at least 1 year of follow up. This finding is important as the use of tyrosine kinase inhibitors in combination with other chemotherapeutic agents may increase in the future with personalized medicine. However, the follow-up was insufficient to detect late onset cardiac toxicity and studies with longer follow-up are needed.

Atherosclerotic Burden and Heart Failure After Myocardial Infarction.

Whether the extent of coronary artery disease (CAD) is associated with the occurrence of heart failure (HF) after myocardial infarction (MI) is not known. Furthermore, whether this association might differ by HF type according to preserved or reduced ejection fraction (EF) has yet to be determined. To evaluate in a community cohort of patients with incident (first-ever) MI the association of angiographic CAD with subsequent HF and to examine the prognostic role of CAD according to HF subtypes: HF with reduced EF and HF with preserved EF. A population-based cohort study was conducted in 1922 residents of Olmsted County, Minnesota, with incident MI diagnosed between January 1, 1990, and December 31, 2010, and no prior HF; study participants were followed up through March 31, 2013. The extent of angiographic CAD was determined at baseline and categorized according to the number of major epicardial coronary arteries with 50% or more lumen diameter obstruction. The primary end point was time to incident HF. The primary exposure variable was the extent of CAD as expressed by the number of major coronary arteries with significant obstruction (0-, 1-, 2-, or 3-vessel disease) obtained from coronary angiograms performed no more than 1 day after the MI. Heart failure was ascertained by the Framingham criteria and classified by type according to EF (50% cutoff). Of the 1922 participants, 1258 (65.4%) were men (mean [SD] age, 64 [13] years). During a mean follow-up period of 6.7 (5.9) years, 588 patients (30.6%) developed HF. With death and recurrent MI modeled as competing risks, the cumulative incidence rates of post-MI HF among patients with 0 or 1, 2, and 3 diseased vessels were 10.7%, 14.6%, and 23.0% at 30 days; and 14.7%, 20.6%, and 29.8% at 5 years, respectively (P < .001 for trend). After adjustment for clinical characteristics in a Cox proportional hazards regression model, the hazard ratios (95% CIs) for HF were 1.25 (0.99-1.59) and 1.75 (1.40-2.20) in patients with 2 and 3 vessels vs 0 or 1 occluded vessel, respectively (P < .001 for trend). The increased risk with a greater number of occluded vessels was independent of the occurrence of a recurrent MI and did not differ appreciably by HF type. The extent of angiographic CAD is an indicator of post-MI HF regardless of HF type and independent of recurrent MI. These data underscore the need to further investigate the processes taking place in the transition from myocardial injury to HF.

Community Screening for Nonischemic Cardiomyopathy in Asymptomatic Subjects ≥65 Years With Stage B Heart Failure

A process to identify and target a selected population at risk of heart failure (HF) could facilitate screening and prevention. We sought to develop an effective screening process from clinical characteristics, functional capacity, and electrocardiogram (ECG). Asymptomatic subjects ≥65years, with ≥1 HF risks were recruited from the community. Subjects with valvular disease, ejection fraction <40%, and atrial fibrillation were excluded. All underwent clinical evaluation including assessment of HF risk using Framingham HF score and Atherosclerosis Risk in Communities (ARIC) score, ECG, echocardiography, and 6-minute walk (6MW) test. After 14 ± 4months, new HF was assessed using Framingham criteria. A randomly selected derivation cohort was used to integrate ARIC score and 6MW in a classification and regression tree (CART) analysis, with the remaining population used for validation. Of the 419 subjects (age 70 ± 5; 48% men), 52 developed HF. ARIC was more effective than the Framingham HF score (area under the curve 0.65 vs 0.53, p= 0.01). CART selected ARIC (>9.5%) and 6MW (<501 m) as cutoffs to define low-, intermediate-, and high-risk groups. Abnormal ECG further divided the intermediate group into high and low risks. The 134 subjects identified as high risk by a combined clinical and electrocardiographic strategy showed more echocardiographic features of cardiac dysfunction including LV mass, mitral e', mitral E/e', and longitudinal strain (p <0.01). New HF was significantly more frequent than in the remaining patients (20% vs 10%, p= 0.003; hazard ratio 2.08, 95% confidence interval 1.21 to 3.57, p= 0.008). Thus, initial clinical risk and electrocardiographic assessment facilitate effective HF screening by identifying a high-risk group.

Chronic Kidney Disease Awareness in the Population of Moderate and High Cardiovascular Risk

Background: Among the recommendations for the prevention of high cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) enhanced surveillance, detection and awareness of this condition include; which are mainly targeting populations with increased risk. Yet despite a high prevalence of CKD in these patients, there is limited knowledge of the disease in populations at high cardiovascular risk, especially in developing countries. To determine the awareness of CKD in the population of moderate and high cardiovascular risk. Methods: A prevalence study, multicenter was developed; the sample corresponds to adults over 18 with moderate or high cardiovascular risk (defined as Framingham criteria), treated at the outpatient clinic for health institutions in the city of Cartagena from April 2013 to October 2014. Statistical analysis: descriptive univariate and bivariate analyzes were performed using measures of central tendency and dispersion for continuous variables and proportions for qualitative variables. The association between variables was established by The Chi square test and Fisher's exact test. Results: 653 patients were included, the prevalence of CKD was 34.8% and overall awareness of it was 70.9% and 48.2% by the health system and the patient respectively. There was no association between awareness of CKD both the health system and the patient and the level of cardiovascular risk (p=0.916 and p=0.772). In unconscious patients with CKD have a higher proportion of women compared with patients with CKD awareness (95% CI for the difference, 4.3 to 29.7 66.1% vs 49.1%) was found. There was a significant association between CKD awareness, adherence to lifestyle (p ≤ 0.0001) and medication adherence (p=0.041), was determined that unconscious patients had lower compliance healthy lifestyles (22,9% vs 64.5%; 95% CI for the difference, 29.9 to 53.3) and pharmacological (92.4% vs 98.2%; 95% CI for the difference, 2.7 to 11.3) than patients aware for the disease. Conclusions: This study demonstrates the high prevalence of CKD in patients with moderate and high cardiovascular risk, highlighting the inadequate consciousness we have of it in this population.

Feasibility of assessing the awareness of cardiovascular risk through Health Passport approach: A pilot study

Background: The risk of cardiovascular disorders is high among the Indian population; however, the awareness about it seems to be a concern. Aim: It was intended to study the feasibility of assessing the awareness of cardiovascular risk at a community level and providing the related information about remedial measures through a Health Passport approach. Methods: Consecutive 38 individuals attending health camp were assessed for specific personal and family history of obesity, hypertension, diabetes, and heart disease. Current risk factors such as exercise, smoking, drug use, stress, and depression were ascertained, and body mass index (BMI), waist circumference (WC), blood pressure were measured to assess the cardiovascular risk based on Framingham criteria. The individualized information along with some key health facts were provided to the participants in a document termed as Health Passport for their reference. Results: There was a general lack of awareness regarding the cardiovascular risk factors in the studied sample. Most participants were above the threshold for blood pressure (65.8%), BMI (71.1%), and WC (73.7%) requiring specific action and more than half (57.9%) had higher cardiovascular risk. The assessment completed in a community set up with basic facilities could provide information regarding the existing risks prompting health actions. The participants considered the Health Passport as a comprehensive initial step toward improving their awareness. Conclusion: It was feasible to assess the awareness about cardiovascular risk and provide individualized health-related information through the Health Passport approach which appears adaptable in health care setups and may improve the awareness.

Concordant and Discordant Cardiac Magnetic Resonance Imaging Delayed Hyperenhancement Patterns in Patients with Ischemic and Non-Ischemic Cardiomyopathy.

Background and ObjectivesThe diagnosis of ischemic (ICM) and non-ischemic cardiomyopathy (NICM) is conventionally determined by the presence or absence of coronary artery disease (CAD) in the setting of a reduced left systolic function. However the presence of CAD may not always indicate that the actual left ventricular (LV) dysfunction mechanism is ischemia, as other non-ischemic etiologies can be responsible. We investigated patterns of myocardial fibrosis using delayed hyperenhancement (DHE) on cardiac magnetic resonance (CMR) in ICM and NICM.Subjects and MethodsPatients with systolic heart failure who underwent a CMR were prospectively analyzed. The heart failure diagnosis was based on the modified Framingham criteria and LVEF <35%. LV dysfunction was classified as ICM or NICM based on coronary anatomy.ResultsA total of 101 subjects were analyzed; 34 were classified as ICM and 67 as NICM. The DHE pattern was concordant with the conventional diagnosis in 27 (79.4%) of the patients with ICM and 62 (92.5%) of the patients with NCIM. A discordant NICM DHE pattern was present in 8.8% of patients with ICM, and an ICM pattern was detected 6.0% of the patients with NICM. Furthermore, 11.8% of the patients with ICM and 1.5% of those with NICM demonstrated a mixed pattern.ConclusionA subset of patients conventionally diagnosed with ICM or NICM based on coronary anatomy demonstrated a discordant or mixed DHE pattern. CMR-DHE imaging can be helpful to determine the etiology of heart failure in patients with persistent LV systolic dysfunction.

Prevalence of electrocardiographic abnormalities in heart failure patients attending Gujarat Adani institute of medical science, Kutch, Gujarat, India: a retrospective study

Background: The ECG is a non-invasive and comparatively simple bedside test to perform. It is mostly utilized cardiovascular diagnostic test, and it is performed by cardiologists and other physicians who are not cardiologists. The ECG is an essential test in the evaluation of patients with heart failure. The aim was to establish the prevalence of electrocardiogram (ECG) abnormalities with heart failure patients attending department of medicine, Gujarat Adani Institute of medical science, Bhuj, Kutch, Gujarat, India.Methods: It was a retrospective study carried out department of medicine, Gujarat Adani Institute of medical science, Bhuj, Kutch, Gujarat, India. Simple random sampling technique was applied for medical records of 400 patients diagnosed with heart failure. The demographic, clinical, chest X-ray and 12-lead resting electrocardiographic (ECG) data of the patients were examined. Heart failure was diagnosed, by the modified Framingham criteria for the diagnosis of heart failure. Analysis was done using SPSS version 15 (SPSS Inc. Chicago, IL, USA) level of confidence interval and p value was set at 95% and 5% respectively.Results: The ECGs were abnormal in 92 % of the patients, and normal in 8% of the patients. The main ECG abnormalities included: left ventricular hypertrophy (42.9%), left axis deviation (39.8%), left bundle branch block (19.4%), and left atrial enlargement (25.80%). Arrhythmias seen included: ventricular extrasystoles (11.8%), atrial fibrillation (9.1%), complete heart block (5.7), and ventricular tachycardia (3.9%).Conclusions: ECG abnormalities are very frequent with heart failure patients in Bhuj, Kutch, Gujarat, India. The ECG is very helpful not merely in the analysis and etiology of heart failure but also it assists in recognizing significant complications of heart failure that might manipulate the option of treatment.

Ten-Year Coronary Artery Disease Risk in 1571 Newly Presenting Hypertensive Black Subjects

Background: Although hypertension is highly prevalent in Nigeria, coronary artery disease (CAD) remains relatively uncommon. This may well change due to epidemiological transition. To ascertain the future role of CAD in Nigeria, we risk stratified every consecutive hypertensive subject referred to the Cardiology unit of the University of Abuja Teaching Hospital over 7 years. Hypothesis: A significant proportion of the study population will fall within the intermediate or high risk category. Methods: It is a prospective, observational study. 1571 hypertensive subjects were risk stratified according to the Framingham 10-year Risk Score. Results: 834(53.1%) of the subjects were female while 737(46.9%) were male. The mean age, mean body mass index and mean arterial pressure of the subjects were 50.9 ± 11.4 years, 28.1 ± 9.4 kg/m2 and 116.23 ± 13.1 mmHg respectively. According to Framingham criteria, 1263(80.4%) of the study population were low risk individuals, 286(18.2%) were medium risk, 22(1.4%) were high risk individuals. When the age of the subjects was hypothetically increased by an additional 10 years, the high risk group increased from 1.3% to 21.3%. Conclusions: According to the Framingham risk score, the majority of subjects with hypertension presenting to a large teaching hospital in Nigeria have a low risk of developing CAD in the near future, which contrasts with the risk profile seen in hypertensive subjects in Europe and North America. Nonetheless, approximately one in four subjects were classified as intermediate or high risk emphasizing the importance of lifestyle modification and the need to consider absolute risk stratification to guide management in countries undergoing epidemiological transition.

Hyperuricemia and Its Prognostic Value in Patients with Rheumatic Heart Disease

BACKGROUND: Hyperuricemia has recently been linked to cardiovascular diseases, such as coronary artery disease and heart failure, as a marker of disease activity for prognostication. However, there are no studies correlating uric acid levels with heart failure among patients with rheumatic heart disease (RHD). METHODOLOGY: This is a prospective cohort study correlating the increase in uric acid levels with the development of heart failure symptoms in patients with RHD. Fifty-one subjects with RHD and with good functional capacity (New York Heart Association [NYHA] Class I) were included in the study. The subjects were followed up for one year, in which 24 subjects fulfilled the Framingham criteria for heart failure and 27 remained in NYHA Class I. RESULTS:Mean baseline uric acid levels were similar between the two groups (heart failure 390±82 umol/L; no heart failure 388±134 umol/L; p=0.964). The mean difference between the baseline and endpoint serum uric acid levels in those without heart failure was not statistically significant (baseline 388±134 umol/L vs. endpoint 391±134 umol/L; p=0.77). In those who developed heart failure, the mean endpoint serum uric acid levels became significantly higher from baseline (baseline 390±82 umol/L vs. endpoint 437±106umol/L; p=0.0007). There was a significantly greater increase in serum uric acid levels in patients who eventually developed heart failure symptoms (heart failure 47.1±59.1 umol/L vs. no heart failure 2.6±46 umol/L; p=0.004). An increase in serum uric acid level by 30 umol/L from baseline had a sensitivity of 70.83% and a specificity of 74.07% for predicting the occurrence of heart failure symptoms. CONCLUSION: Increasing serum uric acid levels are associated with the development of heart failure symptoms in patients with RHD. KEYWORDS: rheumatic heart disease, mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, congestive heart failure, uric acid, hyperuricemia

METABOLIC SYNDROME AND CARDIOVASCULAR RISK IN PATIENTS WITH SCHIZOPHRENIA, BIPOLAR DISORDER AND SCHIZOAFFECTIVE DISORDER

patients with severe mental ilness such as schizophrenia, schizoaffective disorder and bipolar disorder die at least 20 years earlier than general population. Despite preventive strategies, cardiovascular disease is the first cause of death. analyse the percentage of patients with a high body mass index, metabolic syndrome and their cardiovascular risk at 10 years in patients with a diagnosis, based in DSM-IV criteria for schizophrenia, schizoaffective disorder or bipolar disorder. These patients were hospitalized because and acute condition of their mental ilness in the Brief Hospitalization Unit of Hospital Universitario de Móstoles between November of 2014 and June of 2015. in 53 patients, 34 with a diagnosis of schizophrenia, 16 with a diagnosis of bipolar disorder and 3 with a schizoaffective disorder, weight, size abdominal perimeter measures and blood pressure were collected. The body mass index was assesed. Blood tests were taken and we use sugar, triglycerides, total cholesterol and HDL cholesterol levels as paramethers for the ATP III and Framingham criteria. We also review the clinical history of the patients and lifestyle and use of toxic substances were registered. 51% of the patients were men and 49% were women. The average age was 40. 38% of the patients were overweighed, 22% obese and 4% had morbid obesity. 26% of the patients had metabolic syndrome, the clinical evolution of the majority of these patients was of more tan 10 years and they also have been treated with different antypsychotics and antidepressants. Using the Framingham criteria, 11% of the patients had a cardiovascular risk higher than 10 % in the next 10 years. overweight and its consequences in patients with a severe mental ilness are intimately related with their lifestyle, disparities in the access to health resources, the clinical evolution of the disease and pharmacotherapy. Strategies to promote physical health in these patients in the spanish health sistme are insufficient.

Abstract 12205: Prediction of Heart Failure Symptoms Using Framingham and ARIC Scores in Patients With Non Ischemic Risk Factors at 1 Year Follow up

Background: The Framingham heart failure score (FHS) and ARIC heart failure (HF) risk calculator are risk prediction tools that might facilitate the targeting of prevention strategies in pts with HF risk factors. We sought to compare their performance of predicting new HF symptoms in pts with risk factors. Method: Subjects ≥65 yo, with ≥ 1 HF risk (hypertension, type 2 diabetes, obesity, previous chemotherapy, family history of HF or previous cardiac history) were recruited from the local community. Absolute risk of incident HF risk was calculated using ARIC and FHS risk scores at baseline. Subjects underwent standard questionnaire, electrocardiogram, comprehensive echocardiogram and 6-minute walk (6MW) test. New HF based on Framingham criteria were assessed after a follow-up of 14±4 months. Results: Among 308 subjects (age 71±5 y; 50% men), median (IQR) 4 year risk of FHS and ARIC score were 4.0 (2-6.5) % and 6.2 (3.6-11.4) %, respectively. 19 participants developed new HF signs and symptoms (Framingham criteria). Compared with those remaining asymptomatic, those with new HF had higher ARIC score (p&lt;0.001), more impaired GLS (p=0.036), larger left atrium volume (p=0.05) and left ventricular (LV) mass (p=0.049. They also had significant baseline 6MW test distance (p=0.003). There was no difference between their FHS score (p=0.325) and other conventional diastolic measures including LV ejection fraction, mitral E/A, e’ and E/e’ (p=0.108-0.804). AUC of ARIC and FHS were 0.74 (p=0.001) and 0.63 (p=0.057), respectively. The AUC of 6MW was 0.698 (p=0.005) (figure). Conclusion: The ARIC score appears to be more predictive than FHS score in prediction of new HF symptoms in non-ischemic stage A HF. 6MW test maybe used as an effective screening tool in community based process.

Abstract 15191: Left Atrial Volume as an Independent Predictor of Congestive Heart Failure in Patients With Atrial Fibrillation

Backgound: Left atrial (LA) enlargement has been proposed as a barometer of diastolic dysfunction and a predictor of congestive heart failure (CHF) in patients with sinus rhythm. Whether LA volume predicts CHF in patients with atrial fibrillation (AF) is not well known. Methods: To determine the clinical importance of LA volume in the prediction of CHF in patients with AF, AF patients referred for clinically-indicated echocardiogram, without a history of significant mitral valve disease, congenital heart disease, pacemaker, or cardiac surgery, in 2007-2008 were prospectively included and followed forward them up to September 2014. LA volume was measured using the biplane area-length formula. CHF was ascertained using the Framingham criteria. Cox proportional hazards modeling was used to assess the risk factors of CHF development. Results: Of 456 AF patients who met all study criteria (mean 70 ± 10 year-old, 67% men, 62% hypertension, 26% diabetes, LV ejection fraction 68 ± 13%, LA volume 52 ± 24 mL/m 2 ), 46 (10%) developed CHF events during a mean follow-up of 44 ± 31 months. CHF events were significantly increased with advancing age (HR 1.4, 95%CI 1.0-2.0, P&lt;0.05), but not with sex. In a multivariate Cox proportional hazards model, greater indexed LA volume (per 10 mL/m 2 ; HR 1.2, 95% CI 1.1-1.3, P&lt;0.01) was independent of age (HR 1.04, 95% CI 1.01-1.07, P=0.03), sex (P=0.77), history of CHF (P=0.58), hypertension (P=0.38), diabetes (P=0.89), and LV ejection fraction (HR 0.95, 95% CI 0.93-0.96, P&lt;0.001) for the prediction of CHF development. The Kaplan-Meier estimate of cumulative CHF-free survival by indexed LA volume was shown (Fig.). Conclusions: In our cohort with AF, LA volume predicted CHF developments, independent of LV systolic function and other cardiovascular comorbidities, which appears to be clinically useful information for risk stratification.