IHD Group Research Articles

The influence of sex on heart failure mortality.

Little research has investigated how sex may affect the prognosis of patients with chronic heart failure (HF). The present study was aimed at exploring sex-specific differences in prognosis in a cohort of patients with chronic HF, categorized according to severity of left ventricular dysfunction (HFrEF, HFmrEF and HFpEF), right ventricular (RV) dysfunction and ischemic (IHD) or nonischemic (no-IHD) etiology. This retrospective analysis included 1640 HF patients of whom 24% were females, 759 patients had IHD, 1110 patients had HFrEF, 147 patients had HFmrEF and 383 patients had HFpEF. The median follow-up period was 63 months (25th-75th 27-93). In the no-IHD group, no statistically significant sex differences emerged regarding survival, regardless of age and severity of cardiac dysfunction. In contrast, in the IHD group, females had a significantly lower event rate than males in the age group between 65 and 79 years [hazard ratio (HR) 0.39; 95% confidence interval (CI): 0.86-0.18; P < 0.01]; in addition, a lower event rate was observed in females compared with males among patients with HFrEF (HR 0.47; 95% CI: 0.88-0.25; P < 0.01), among patients without RV dysfunction (HR 0.58; 95% CI: 1.02-0.33; P = 0.048) and among patients without diabetes (HR 0.44; 95% CI: 0.84-0.23; P < 0.01). In nonischemic patients there was no difference between males and females in terms of survival whereas in patients with ischemic etiology survival was better in females among elderly patients, in HFrEF patients, in the absence of RV dysfunction and in the absence of diabetes.

Quantification of myocardial scar of different etiology using dark- and bright-blood late gadolinium enhancement cardiovascular magnetic resonance

Dark-blood late gadolinium enhancement (LGE) has been shown to improve the visualization and quantification of areas of ischemic scar compared to standard bright-blood LGE. Recently, the performance of various semi-automated quantification methods has been evaluated for the assessment of infarct size using both dark-blood LGE and conventional bright-blood LGE with histopathology as a reference standard. However, the impact of this sequence on different quantification strategies in vivo remains uncertain. In this study, various semi-automated scar quantification methods were evaluated for a range of different ischemic and non-ischemic pathologies encountered in clinical practice. A total of 62 patients referred for clinical cardiovascular magnetic resonance (CMR) were retrospectively included. All patients had a confirmed diagnosis of either ischemic heart disease (IHD; n = 21), dilated/non-ischemic cardiomyopathy (NICM; n = 21), or hypertrophic cardiomyopathy (HCM; n = 20) and underwent CMR on a 1.5 T scanner including both bright- and dark-blood LGE using a standard PSIR sequence. Both methods used identical sequence settings as per clinical protocol, apart from the inversion time parameter, which was set differently. All short-axis LGE images with scar were manually segmented for epicardial and endocardial borders. The extent of LGE was then measured visually by manual signal thresholding, and semi-automatically by signal thresholding using the standard deviation (SD) and the full width at half maximum (FWHM) methods. For all quantification methods in the IHD group, except the 6 SD method, dark-blood LGE detected significantly more enhancement compared to bright-blood LGE (p < 0.05 for all methods). For both bright-blood and dark-blood LGE, the 6 SD method correlated best with manual thresholding (16.9% vs. 17.1% and 20.1% vs. 20.4%, respectively). For the NICM group, no significant differences between LGE methods were found. For bright-blood LGE, the 5 SD method agreed best with manual thresholding (9.3% vs. 11.0%), while for dark-blood LGE the 4 SD method agreed best (12.6% vs. 11.5%). Similarly, for the HCM group no significant differences between LGE methods were found. For bright-blood LGE, the 6 SD method agreed best with manual thresholding (10.9% vs. 12.2%), while for dark-blood LGE the 5 SD method agreed best (13.2% vs. 11.5%). Semi-automated LGE quantification using dark-blood LGE images is feasible in both patients with ischemic and non-ischemic scar patterns. Given the advantage in detecting scar in patients with ischemic heart disease and no disadvantage in patients with non-ischemic scar, dark-blood LGE can be readily and widely adopted into clinical practice without compromising on quantification.

#4298 DOES STARTING RENAL REPLACEMENT THERAPY WITH INCREMENTAL HAEMODIALYSIS WORSEN OUTCOMES?

Abstract Background and Aims Most patients start maintenance haemodialysis (HD) with a fixed dose of 3 HD sessions per week (3HD/Wk), regardless of their residual kidney function (RKF). This intense schedule is considered the “standard” or “conventional” modality (cHD). It is widely accepted, and no randomised controlled trial (RCT) has examined whether other less frequent schedules are inappropriate or harmful. Thus, the optimal modality for incident patients is currently unknown. Incremental HD (iHD), on the other hand, adjusts the frequency of sessions to the RKF, increasing their number to compensate for any subsequent reduction in RKF. While iHD approaches precision medicine by customising the number of sessions, it raises concerns about long intersession periods and the risk of under-dialysis. Pending ongoing RCTs [1], our aim is to analyse the efficacy and safety of iHD in our incident patients. Method The policy of our Centre is to try to start with iHD in incident patients who are clinically stable and with RKF. We start with 1 session (1HD/Wk) if the RKF is above 4 ml/min/1.73 m2 and with 2 sessions (2HD/Wk) if the RKF is between 4 and 2.5 ml/min/1.73 m2. We progress from 1HD/Wk to 2HD/Wk and from 2 to 3HD/Wk depending on the RKF and ultrafiltration rates required, which are assessed at least monthly. Since 2012, we have treated 186 incident patients with iHD, of whom 168 had a follow up ≥ 90 days. 72% (128 patients) started with 1HD/Wk and the remaining 28% (40 patients) with 2HD/Wk. We compared the results with 410 incident patients who from baseline receive 3 sessions/Wk (cHD) and with 80 incident patients on Peritoneal Dialysis (PD). We also analysed 27 iHD patients who after 60 days were already dialysed with 3 sessions (3HD/Wk/60d group). We calculated the mortality rate (deaths/365 days in %) in each group and survival in the iHD technique (sessions not performed). Results The mean age in the iHD group was higher than in cHD or PD (Table 1). Mortality in iHD patients was similar to cHD patients, although the latter were younger. Patients who stayed less time in iHD (3HD/Wk/60d group) had the highest mortality rate (Table 1). Survival in technique (time in which 50% of patients remain on iHD) was 12 months, avoiding 86 sessions/patient. The cost reduction was €17,200/patient (session + transport = €200). Conclusion iHD is efficient, as it considerably reduces the number of sessions performed and thus costs, thereby improving quality of life. It is safe, as it has a similar mortality rate to cHD. Being on iHD for more than 60 days does not worsen the results. On the contrary, requiring 3 weekly sessions at the beginning of HD treatment may be associated with a poor prognosis.

Adaptive immune response in patients with atherosclerosis before and after coronary bypass surgery

Objective: to assess changes in the immune status before and after coronary bypass surgery. Materials and methods: included 70 male patients with coronary atherosclerosis (group 1) and 30 volunteers (group 2) without signs of coronary artery disease comparable in age to group 1. Immunity parameters were studied before surgery, after 4–5, 9–10 and 28–30 days by the method of phenotyping of CD3+ populations; CD3+CD4+; CD3+CD8+; CD3+CD25+; CD3+CD45+; CD3+CD95+; CD4+CD25+; CD4+CD154+; CD19+, CD19+CD40+. The levels of Ig A, M, G were assessed by the method of radial immunodiffusion in the gel. Serum precipitation in polyethylene glycol was used to determine circulating immune complexes. Statistical analysis of the study results was performed using the Statistica 12.0 program (StatSoft, USA). Statistical significance was considered significant at p&lt;0.05. Results: in patients of the IHD group, uncoupling of the processes of T-lymphocyte activation, their maturation and apoptosis was noted; suppression of immunoregulation and activation of intercellular cooperation. After CABG, in dynamics, these processes reflect the multidirectional changes. Conclusions: in patients with coronary atherosclerosis, there is a discoordination of the processes of T-lymphocyte activation, their maturation and apoptosis. Suppression of immunoregulation and activation of intercellular cooperation. In the dynamics after CABG, immunity parameters differ in different directions in different periods of observation and demonstrate different degrees of involvement of adaptive mechanisms of immune defense.

Serum leptin level as a cardiovascular risk factor in type 2 diabetic patients

Type 2 diabetes mellitus ( T2DM ) is a metabolic disease that is associated with an increased risk for atherosclerosis. Leptin is a hormone – like cytokine that is derived mainly from adipose tissue and has multiple functions. Recently, many vascular and atherogenic effects for leptin have been demonstrated. The aim was to study serum leptin level and its relationship with some cardiovascular risk factors in T2DM patients. Forty diabetic males with ischemic heart disease (IHD group), aged ≥ 40 years old, were compared with 40 diabetic males of similar ages who had no clinical history of IHD (DM group). Each main study group was divided into two subgroups according to the presence or absence of metabolic syndrome. The IHD group was also subdivided according to their clinical endpoints into stable angina pectoris (angina group), significant coronary artery disease on angiography (angiography group ) and myocardial infarction (MI group ). In addition to anthropometric measurements; serum lipid profile, thiobarbituric acid -reactive substances (TBARS) and leptin levels as well as plasma fibrinogen level were quantified .A highly significant increase of mean serum leptin level was observed in IHD group iin comparriison wiitth tthatt off DM grroup (11.56  10.27 vs. 7.39  3.54 ng /3ml, p&lt;0.01). IIHD pattiientts showed a hiighlly siigniiffiicantt iincrrease iin serrum llevell offTBARS iin comparriison wiitth tthatt off DM grroup ((9.00  3.61vs. 6.65  2.41 mol (MDA)/L, P&lt;0.001). The mean plasma level of fibrinogen is significantly higher in IHD group than in DM group (3.30  0.65 vs. 2.99  0.63 g/dl, p &lt; 0.05). Serum leptin level was significantly higher in (angiography group) but not in (angina group) while the level was even lower in (MI group) when compared with that of DM group. A significant increase of mean serum leptin level was observed in IHD subgroup with non-metabolic syndrome in comparison with the D.M subgroup with non-metabolic syndrome (13.06  11.01 vs. 7.06  3.08 ng/ml, P&lt;0.05). In IHD group, serum leptin level showed a positive correlation with BMI ,W/h ratio, serum TBARS, and plasma fibrinogen. In DM group, serum leptin level showed a positive correlation with BMI, W/h ratio, and plasma fibrinogen, while insignificantly correlated with TBARS. In conclusion, T2DM patients with IHD have an elevated serum leptin level that is associated with oxidative stress, inflammation and active or worsening ischemic heart disease independent of metabolic syndrome. Thus, serum leptin level could be an additional factor to assess cardiovascular risk

Ethanolic Root Extract of Urtica dioica Exhibits Pro-fertility and Antioxidant Activities in Female Albino Rats

Aims: To determine the effect of ethanolic extract of Urtica dioica roots on reproductive hormones and antioxidant enzymes in female Wistar rats.&#x0D; Study Design: Experimental Research.&#x0D; Place and Duration of Study: Department of Biochemistry, Lagos State University, Lagos Nigeria between November 2019 and February 2020.&#x0D; Methodology: A total of 40 rats used, were divided into eight groups of 5 rats. The study was carried out for a period of 21 days, the rats were induced with levonorgestrel for 7 days after which Urtica dioica extract was administered for 14 days and were compared against vehicle, levonorgestrel and extract controls. Hormonal level estimation (Progesterone, estradiol, prolactin and testosterone) and in-vivo antioxidant enzyme activity (catalase and alkaline phosphatase activity) were estimated using standard procedures.&#x0D; Results: The administration of the extract showed no statistically significant difference in estradiol levels across all groups. Progesterone levels decreased significantly (p&lt;0.05) compared to the controls while prolactin and testosterone levels also decreased, although not significant. The extract increased catalase and alkaline phosphatase activities significantly in IHD group compared to the control.&#x0D; Conclusion: The ethanolic extract of Urtica dioica roots exhibits pro-fertility and antioxidant activities.

Abstract 188: Ischemic Heart Disease Burden On Clinical Outcomes After Percutaneous Left Atrial Appendage Closure In Patients With Atrial Fibrillation In The United States

Background: Percutaneous left atrial appendage closure (PLAAC) is an alternative to anticoagulants for atrial fibrillation patients with elevated stroke risk and contraindication to anticoagulation. We examined the burden of IHD on clinical outcomes after PLAAC. Methods: We identified patients from the Nationwide Readmission Database who underwent PLAAC with a Watchman device between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of IHD. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Multivariable regression was conducted for 30 days readmission adjusting for patient demographics,hospital characteristics, and Elixhauser Comorbidity Index. Results: A total of 18,348 Watchman recipients were identified, of which 8,504 had IHD while 9,844 had no ischemic heart disease (NIHD). Length of stay and cost were not different between groups. However, significant differences were noted in terms of the number of frequent index admission complications between the IHD vs. NIHD group, including transient ischemic attack/Stroke (3.5% Vs. 1.6%, P&lt;0.0001) (Table 1). Although the 30 days readmission rate was higher in the IHD group (7.5% Vs. 6%, P=0.003), there was no difference in mortality. Most frequent causes of readmissions for IHD Vs. NIHD were Acute Kidney Injury (AKI) (26% Vs. 17.3%, P=0.009) and acute heart failure (HF) (24.1% Vs. 17%, P=0.015) (Table 1). In multivariate analysis, ICM PLAAC recipients had higher odds of 30-day readmission compared to NICM (OR=3.7, P=0.4). Renal failure patients have higher odds of 30-day readmission compared to non-renal failure ( OR=1.4, P=0.001). Conclusion: Thirty-day readmission rate in patients who underwent PLAAC was higher in the IHD group. However, no difference was noted in mortality between both groups. AKI and acute HF were significant causes of readmission in patients with IHD who underwent PLAAC. Further studies exploring these differences may help to prevent these readmissions.

Continuous renal replacement therapy versus intermittent hemodialysis as first modality for renal replacement therapy in severe acute kidney injury: a secondary analysis of AKIKI and IDEAL-ICU studies

BackgroundIntermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) are the two main RRT modalities in patients with severe acute kidney injury (AKI). Meta-analyses conducted more than 10 years ago did not show survival difference between these two modalities. As the quality of RRT delivery has improved since then, we aimed to reassess whether the choice of IHD or CRRT as first modality affects survival of patients with severe AKI.MethodsThis is a secondary analysis of two multicenter randomized controlled trials (AKIKI and IDEAL-ICU) that compared an early RRT initiation strategy with a delayed one. We included patients allocated to the early strategy in order to emulate a trial where patients would have been randomized to receive either IHD or CRRT within twelve hours after the documentation of severe AKI. We determined each patient’s modality group as the first RRT modality they received. The primary outcome was 60-day overall survival. We used two propensity score methods to balance the differences in baseline characteristics between groups and the primary analysis relied on inverse probability of treatment weighting.ResultsA total of 543 patients were included. Continuous RRT was the first modality in 269 patients and IHD in 274. Patients receiving CRRT had higher cardiovascular and total-SOFA scores. Inverse probability weighting allowed to adequately balance groups on all predefined confounders. The weighted Kaplan–Meier death rate at day 60 was 54·4% in the CRRT group and 46·5% in the IHD group (weighted HR 1·26, 95% CI 1·01–1·60). In a complementary analysis of less severely ill patients (SOFA score: 3–10), receiving IHD was associated with better day 60 survival compared to CRRT (weighted HR 1.82, 95% CI 1·01–3·28; p < 0.01). We found no evidence of a survival difference between the two RRT modalities in more severe patients.ConclusionCompared to IHD, CRRT as first modality seemed to convey no benefit in terms of survival or of kidney recovery and might even have been associated with less favorable outcome in patients with lesser severity of disease. A prospective randomized non-inferiority trial should be implemented to solve the persistent conundrum of the optimal RRT technique.

A study of lipid profile abnormalities among patients with hypertension attending tertiary care teaching hospital

Background: High blood pressure has been associated with elevated atherogenic blood lipid fractions. A better understanding of the relation between blood pressure and blood lipids may provide insight into the mechanisms where by hypertension is associated with increased risk of coronary heart disease.Methods: The serum lipid profiles of 100 hypertensive patients was studied and compared with those of healthy controls. The serum lipid profiles (TC, TGL.HDL, VLDL, LDL, TC/ HDL, LDL/HDL ratios) were studied with respect to various clinical profiles like age, sex, type, incidence etc. Study group consisted of patients with hypertension as identified by history, clinical examination, and other relevant examinations. Results: Serum TC, TGL, VLDL, LDL, TC/ HDL, LDL/HDL were significantly elevated in hypertensive group as compared to healthy controls. Serum HDL was low in patients with hypertension as was compared with controls, which was statistically significant. The LDL was raised in obese compared to non-obese patients, which is statistically very significant. TC/ HDL and LDL /HDL were also raised in obese patients which is statistically significant. TC is raised in CVA group, which is statistically highly significant. LDL is raised in CVA group, which is statistically very significant. TC/ HDL and LDL/HDL are raised in CVA group compared to non-CVA group, which is statistically very significant. TC is raised in IHD group, which is statistically significant. LDL is raised in IHD group, which is statistically very significant. LDL/HDL is raised in men, which is statically significant.Conclusion: There is significant alteration of lipid profile in hypertensive patients as compared to controls. Total cholesterol, LDL cholesterol, triglycerides, VLDL, TC/HDL and LDL/HDL ratios are significantly elevated in patients with hypertension. HDL is significantly reduced in hypertensive patients. Hyperlipidemia is seen in majority of cases of hypertension with Type IIa pattern being the most frequent. Mean TC, LDL, TC/HDL, LDL/HDL were higher in obese. Mean TC, LDL, TC/HDL and LDL/HDL ratios are raised in CVA group. Mean TC and LDL are raised in IHD group.

The Correlation of Epicardial Fat Thickness with Ischemic Heart Disease among Patients Consulting Merjan Medical City in Babil

Introduction: Epicardial fat thickness (EFT) is regarded as marker of cardiovascular risk.Aim of Study: To show if there is correlation between EFT with ischemia and its correlation with othervariable as age, sex, hypertension, Diabetes, smoking and Body mass index.Patients and Method: We studied 100 patients who consulting merjan medical city in Babylon provincefor the period from December 2017 to May 2018. Transthoracic echocardiography was done for all patients;we measure wall motion score and EFT. 50 patients hadischemic heart disease (IHD). EFT measured at freewall of RV at end systole both group from short axis view and long axis view and wall motion score alsomeasured according to this formula.Results: Mean age was (58.67±13.3), 50% had hypertension, 45% had diabetes .74 patient were male 37%are smoker regardingbody mass index, 31.87% are obese, 31.87% over weight 36.2% are normal body massindex. PT with no IHD had normal wall motion score 16/16 While IHD group PT had higher than 16-wallmotion score. EFT had significant correlation with high ischemic score, EFT was higher among smokerpatients(p value 0.001) and diabetic patients(p value 0.005) and hypertensive patients (p value 0.002).Patients with increasing BMI had higher EFT(p value 0.001).Conclusions: This study concludes that patients with higher EFT had higher ischemic score, so it is ariskfactor of IHD. EFT more than 5.5 in male and 5.7 in female associated with ischemia. Epicardial fat increasewith higher BMI and more in smoker,HT and diabetic patients.

Comparison Visfatin level between Obese and Non Obese, Hypertensive and Normotensive patients with Ischemic Heart Disease

In the current study, seventy of patients who suffering of IHD and the control group was composed of 20 healthy. The samples were collected from the Coronary Care Unit (CCU) in Al-Sadder Teaching Hospital in Al-Najaf province/ Iraq, during the period from September till December 2018. The ages of patients and control ranged from 30 to 69 years old. The Patients groups are divided into subgroup according blood pressure and Body mass index. The results of current study revealed significant differences between IHD group and healthy group, significantly increased (p 0.05) in VF concentration among different BMI. The result indicated positive correlation between BMI, W.C.) and (VF). Conclusion: The current study concluded that visfatin level were good marker for detection and diagnosis of ischemic heart disease, and visfatin highly related with risk factors of ischemic heart disease such as hypertensive blood pressure and obesity.

Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks

BackgroundIntermittent hemodialysis (IHD) is the modality of choice in the extracorporeal treatment (ECTR) of acute methanol poisoning. However, the comparative clinical effectiveness of intermittent versus continuous modalities (CRRT) is unknown. During an outbreak of mass methanol poisoning, we therefore studied the effect of IHD versus CRRT on mortality and the prevalence of visual/central nervous system (CNS) sequelae in survivors.MethodsThe study was designed as prospective observational cohort study. Patients hospitalized with a diagnosis of acute methanol poisoning were identified for the study. Exploratory factor analysis and multivariate logistic regression were applied to determine the effect of ECTR modality on the outcome.ResultsData were obtained from 41 patients treated with IHD and 40 patients with CRRT. The follow-up time in survivors was two years. Both groups of patients were comparable by age, time to presentation, laboratory data, clinical features, and other treatment applied. The CRRT group was more acidemic (arterial blood pH 6.96 ± 0.08 vs. 7.17 ± 0.07; p < 0.001) and more severely poisoned (25/40 vs. 9/41 patients with Glasgow Coma Scale (GCS) ≤ 8; p < 0.001). The median intensive care unit length of stay (4 (range 1–16) days vs. 4 (1–22) days; p = 0.703) and the number of patients with complications during the treatment (11/41 vs. 13/40 patients; p = 0.576) did not differ between the groups. The mortality was higher in the CRRT group (15/40 vs. 5/41; p = 0.008). The number of survivors without sequelae of poisoning was higher in the IHD group (23/41 vs. 10/40; p = 0.004). There was a significant association of ECTR modality with both mortality and the number of survivors with visual and CNS sequelae of poisoning, but this association was not present after adjustment for arterial blood pH and GCS on admission (all p > 0.05).ConclusionsIn spite of the faster correction of the acidosis and the quicker removal of the toxic metabolite in intermittent dialysis, we did not find significant differences in the treatment outcomes between the two groups after adjusting for the degree of acidemia and the severity of poisoning on admission. These findings support the strategy of “use what you have” in situations with large outbreaks and limited dialysis capacity.

Application of Principal Component Analysis (PCA) to Medical Data

Objectives: To apply Principal Component Analysis to medical data to explore the factors thought to be very important in increasing the risk of Ischemic Heart Diseases. Methods/Statistical Analysis: PCA was performed in R-mode using correlation and covariance for medical data. Variables pertaining to chemical tests of blood namely cholesterol, high density lipoprotein, triglyceride, Apo protein A-1, Apo protein B, low density lipoprotein, phospholipids, total lipid, glucose and uric acid, are undertaken to know the relationship between them and membership of group variable. Findings: The results indicated that among these factors cholesterol, triglyceride, Apo protein B, low density lipoprotein, phospholipids, total lipid, and uric acid were recorded to be higher in IHD group compared to those of control group. High density lipoprotein and Apo protein A-1 were recorded to be lower in IHD group, whereas found higher in control group. Cholesterol was highly correlated with low density lipoprotein and moderately correlated with total lipid. Cholesterol, Apo protein B and low density lipoprotein belonged to component 1, Apo protein A-1, phospholipids and uric acid belonged to component 2, triglycerides and total lipid belonged to component 3 and high density lipoprotein and glucose belonged to component 4. The first four components have explained 60.67 percent component variability. Improvements/Applications: The end results showed that the average cholesterol level, which is considered as the main risk factor of Ischemic Heart Disease, was found higher even in control group. Keywords: Application, Ischemic Heart Diseases, PCA

LIPOPROTEIN(A) MEANING AS AN ADDITIONAL MARKER OF CARDIOVASCULAR RISK IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA

Aim. To analyze the relation of Lp(a) and atherosclerosis development in familial hypercholesterolemia (FHCE). Material and methods. Totally, 81 patient with definite FHCE studied, mean age 39,1±0,4 y. o. The participants were selected to two groups: first — with increased level of Lp(a) &gt;0,3 g/L (n=34); mean age — 44,5±0,3; second — with normal Lp(a) &lt;0,3 g/L (n=47, 58,1%); mean age — 37,5±0,3 y. o. Results. Mean level of Lp(a) in various age persons did not differ significantly. In both subgroups in about a half of all participants there was arterial hypertension (AH) revealed (50,8% and 42,6%, respectively), obesity was diagnosed in one third of both groups, number of smokers was higher in higher Lp(а) group (11,8% and 8,5%). IHD had 25,9% of participants. Revalence of IHD in IHD group was 44, 4%, in non-smoker group — 25,8% (RR 1,72 (0,75; 3,99)), acute myocardial infarction prevalence (MI) in smoking subgroup was — 44,6% versus 13,5% (RR 3,26 (1,26; 8,43)). Among lipid profile parameters LDL level was definitive for IHD development (p=0,012). Presence of obesity increased MI risk 2,54 times in FHCE (OR 2,4 (1,05; 5,63)). With increase of Lp(a) IHD was diagnosed more commonly: 32,4% versus 19%, non-significant (p=0,47). Prevalence of MI in the first group was higher than in the second: 8 (23,5%) and 4 (8,5%), respectively, (OR 3,3 (1,1; 9,8), р=0,03). Conclusion. In FHCE, the risk of IHD was influenced by traditional RF (smoking, obesity, LDL level).

COMPARATIVE ANALYSIS OF THE CALCULATION MODELS FOR ISCHEMIC HEART DISEASE OVERALL RISK IN RAILROAD WORKERS

Aim. To conduct a comparison of IHD risk prediction with the SCORE, PROCAM andFraminghamscores, as novel developed models of IHD risk in cohort of the railroad workers. Material and methods. Totally, 106 patients included — workers of locomotive crews, who had been under medical observation during 2006-2015 years with regular scheduled physician observations, incl. preflight, in-depth investigation during in-patient cardiological hospitalization. IHD diagnosis was set if documentarily confirmed signs of coronary ischemia of myocard were found, or coronary atherosclerosis (by angiography, MDCT). Individual total vascular risk was estimated by SCORE, PROCAM, Framingham scores and IHD prediction models developed with the principal components approach (PCA), probabilistic neural networks (PNN), Decision Trees based upon a complex of parameters (including body mass, low density lipoproteids, triglycerids, pulse BP, etc.). Quality of the models was assessed via the parameters of sensitivity, specificity, mean absolute prediction bias, square under ROC-curve (AUC). Results. Dispersion to the categories of low, moderate and high by SCORE, PROCAM andFraminghamwas controversial. In IHD group with low risk by these scores, cardiovascular events (myocardial infarction and/or coronary surgery) happened in 51,9%, 5,56% and 42,6%, respectively. AUCs for SCORE, PROCAM andFraminghamin “IHD” subclass were 0,72, 0,65 and 0,69, resp., but for subclass “Myocardial infarction” — just 0,34, 0,42 and 0,32. AUC for PNN on “IHD” was 0,55, “Myocardial infarction” — 0,60. Mean absolute prediction bias for high IHD risk by SCORE, PROCAM and PNN was 0,88, 0,56, 0,46, resp. Conclusion. SCORE, PROCAM andFraminghamscores are inconsistent for the assessed IHD risk category and are not sufficiently precise for prediction of myocardial infarction in cohort of adult men, workers on railroad, that reduces applicability of the scores. Novel developed model of PNN shows the prediction bias lower in models with added parameters as pulse pressure, platelets, triglycerides, myocardial mass index and other).

130 Reproducibility of T1 and T2 Mapping in Health and Disease, and Assessment of T2 Variability Across the Normal Myocardium

BackgroundT1 and T2 mapping detect myocardial fibrosis and oedema respectively. T1 values show segmental variation in mid ventricular SAX slice, making the identification of regional pathology difficult.We tested the reproducibility...

Inferior vena cava parameters predict re‐admission in ischaemic heart failure

The clinical history of heart failure (HF) is usually characterized by frequent hospitalizations for decompensation. Therefore, several markers of subclinical hemodynamic congestion are under investigation for predicting early rehospitalization. In this field, the potential of ultrasound inferior vena cava (IVC) assessment has been recently investigated in HF but not yet assessed in the different aetiological categories. Forty-eight patients admitted for decompensated HF (n = 25 with ischaemic heart disease [IHD] and n = 23 non-IHD) underwent biochemical examination (including NT-proBNP), echocardiography and IVC assessment by hand-carried ultrasound (HCU). During 60-day follow-up after discharge, the re-hospitalization rate for HF was recorded to investigate the predictive power of NT-proBNP and IVC assessment among the two study groups. IHD and non-IHD patients with HF were similar except for gender distribution. During follow-up, 16·7% of patients were rehospitalized for decompensated HF, with higher prevalence in IHD group (28% vs. 4·3% P = 0·031). IVC assessment at discharge significantly predicted re-admission in the overall population and in IHD group, whereas NT-proBNP failed to predict rehospitalization in IHD group. In adjusted hazard ratio, only IVC min and the changes of IVC from admission significantly predicted re-admission. ROC analysis confirmed the change in IVC min as the best predictor of rehospitalization in patients with IHD. This pilot study showed a higher early re-admission rate in patients with HF due to IHD. In addition, the change in IVC min diameter from admission to discharge was the best predictor of re-admission in patients with IHD.

Compliance with Antibiotic Dosing Guidelines in Critically Ill Patients Receiving Renal Replacement Therapy

Background: Compliance with antibiotic dosing guidelines and achievement of target serum concentrations in patients with infection who are on renal replacement therapy (RRT) is complex, essential for supportive care, and not well studied. Objective: To determine adherence rates to antibiotic dosing guidelines in the setting of RRT in the intensive care unit (ICU). Methods: We conducted a retrospective, single-center, cohort study evaluating antibiotic dosing in all patients in the ICU receiving RRT between July 2007 and June 2009. Appropriate dosing was determined by comparing dose administered with established guidelines. Dosing was denoted as accurate if adjustment occurred prior to the third administered dose or, if appropriate dosing is every 12 hours or more, within 24 hours. We compared rates according to modality of RRT (intermittent hemodialysis [IHD] vs continuous veno-venous hemodialysis [CVVHD]), indication for RRT (acute kidney injury [AKI] vs end-stage renal disease [ESRD]), and presence of a clinical pharmacist on rounds. Results: Adherence rates of 546 patients receiving RRT, with 1761 individual antibiotic prescriptions, were analyzed. Dosing errors were more common in the group receiving CVVHD than in the IHD group (58.1% vs 49.5%; p &lt; 0.001). Frequency of dosing errors did not differ significantly between patients receiving RRT for AKI versus those with ESRD (55.4% vs 51.3%; p = 0.24) or in ICUs with or without a pharmacist on rounds (53.0% vs 54.6%; p = 0.67). Underdosing occurred less frequently with a clinical pharmacist on rounds (18.7% vs 31.3%; p &lt; 0.001). However, in-hospital mortality was not significantly different in underdosed individuals compared with the rest of the cohort (52.3% vs 51.6%; p = 0.92). Conclusions: Antibiotic underdosing is common. Increased awareness of dose adjustment guidelines for CVVHD and having a clinical pharmacist on rounds may improve rates of underdosing.

ASSA13-05-4 Preliminary Clinical Investigation of 99mTc-MIBI Washout Rate in Detection of Multivessel Coronary Artery Disease

ObjectiveMyocardial perfusion imaging (MPI) may underestimate the extent of disease in patients with multivessel coronary artery disease (CAD), the aim of this study was to investigate the changes of 99mTc-MIBI...

Actual conditions of implantable defibrillation therapy over 5 years in Japan

PurposeThe aim of this study was to describe the recent conditions associated with implantable defibrillation therapy for individual underlying heart diseases. MethodsTen thousand six hundred and five patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds) that were implanted from 2006 to 2010 were selected from the Japan Cardiac Device Therapy Registry database. They were divided into 12 disease categories and further divided into either primary or secondary prevention of sudden cardiac death. ResultsThe major underlying diseases of the patients in this cohort were ischemic heart disease (IHD, 35%), dilated cardiomyopathy (DCM, 25%), hypertrophic cardiomyopathy (HCM, 8%), and Brugada syndrome (Brugada, 8%). There were no structural heart diseases in this cohort; the incidence of IHD was relatively lower than that of western countries, while the incidence of cardiomyopathy was higher. The percentage of primary prevention (% primary) among the individual diseases varied. IHD was the most prevalent underlying condition in the patient cohort; however, the % primary was 33%, which was relatively lower than that of the other structural heart diseases. The % primary was relatively higher in patients with DCM (57%) and Brugada (47%). Over 5 years, the % primary gradually increased in patients with DCM, IHD, and HCM, with a particularly dramatic increase in those with DCM. A decrease in the % primary among patients with Brugada began in 2008. ConclusionsIn patients that underwent implantable defibrillation therapy, there was a relatively lower % primary in the IHD group, and a substantial increase in the % primary in patients with DCM.