NYHA Stage Research Articles

Who are patients classified within the new terminology of heart failure from the 2016 ESC guidelines?

AimsThe main terminology used to describe heart failure (HF) is based on measurement of the left ventricular ejection fraction (LVEF). LVEF in the range of 40–49% was recently defined as HF with mid‐range EF (HFmrEF) by the 2016 European Society of Cardiology guidelines. The purpose of our study was to assess the clinical profile and prognosis of patients with HF according to this new classification.Methods and resultsA total of 482 patients referred for HF were retrospectively included over a period of 1 year. There were 258 (53%), 115 (24%), and 109 (23%) patients with HF with reduced EF (HFrEF), HFmrEF, and HF with preserved EF (HFpEF), respectively. Patient age increased, whereas left block bundle branch, brain natriuretic peptide level, and the use of beta‐blocker and furosemide decreased from HFrEF to HFpEF. After adjustment for the age, patients with HFpEF and HFmrEF were more likely to have NYHA stage 2 dyspnea, had a higher systolic blood pressure, were less likely to have spironolactone, had lower furosemide dose, and had lower haemoglobin than those with HFrEF. Cardiovascular risk factors and medical history were similar in the three groups of patients. There was a 33% death rate after a mean follow‐up of 32.2 ± 14.3 months. The survival was the same among patients whatever the group of HF (P = 0.884).ConclusionsPatients with HFrEF, HFmrEF, and HFpEF share the same cardiovascular risk factors, medical history, and prognosis. Patients with HFmrEF have a different clinical profile, which is nearly the same as patients with HFpEF, except for sex. These results question the relevance of this new classification of HF to stimulate research into this new group of patients.

Septal alcoholization in hypertrophic cardiomyopathy: about 11 cases.

Outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy are not enough studied in all centers. The purpose of this study was to determine the outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy in our hospital. A retrospective and prospective descriptive study focused on all patients aged at least 18 years treated by alcohol septal ablation between July 2005 and June 2010 in the cardiology unit of Clermont-Ferrand teaching Hospital. The inclusion criteria were, hypertrophic obstructive cardiomyopathy with left ventricular outflow tract obstruction ≥ 50 mmHg, symptomatic despite optimal medical therapy. The clinical, paraclinical data and the results of alcohol ablation were collected from medical records of patients and a telephone conversation with the patients or their physicians. These data were analyzed by EPI info 6.04. Eleven patients with average age of 56.27 ± 15, 83 were included of which 81.8% of men. The main indications of alcohol septal were dyspnea stage NYHA II-IV (45.5%), lipothymia (18.2%) and invalidating angina (18.2%). Main electrocardiographic abnormalities were left ventricular hypertrophy and disorders of repolarization with 72.7% each. Minor conductive disorders were found in 45.5% of the cases. The left ventricular outflow tract obstruction was 98.18 ± 25.93 mmHg before alcohol septal ablation and 18.91 ± 31.97 mmHg after a follow-up of 25.64 ± 21.97 months. The success rate was 81.8%. Conductive disorders (45.5%) required the establishment of a definitive pacemaker in 36.4% of the patients. A cardiac defibrillator was implanted at 27.3%. Septal alcoholization was succesful.

HOVON 104; Results of First 25 Patients from a Multicenter, Multinational, Prospective Phase II Study of Bortezomib Based Induction Treatment Followed By Autologous Stem Cell Transplantation in Patients with Newly Diagnosed Al Amyloidosis

HOVON 104; Results of First 25 Patients from a Multicenter, Multinational, Prospective Phase II Study of Bortezomib Based Induction Treatment Followed By Autologous Stem Cell Transplantation in Patients with Newly Diagnosed Al Amyloidosis

Feasibility and accuracy of gated blood pool SPECT equilibrium radionuclide ventriculography for the assessment of left and right ventricular volumes and function in patients with left ventricular assist devices

BackgroundLeft ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Because the RV is not assisted, its function is a critical determinant of the hemodynamic and contributes significantly to postoperative morbidity and mortality. We evaluated the feasibility and the accuracy of tomographic-equilibrium radionuclide ventriculography (t-ERV) for the assessment of patients with LVADs. MethodsTwenty-four patients with LVAD underwent t-ERV. Because of the limited acoustic window, transthoracic echocardiography (TTE) was only feasible in 19 patients. Functional evaluation including six-minute walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac multidetector computed tomography (MDCT). Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later. ResultsReliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume, and RV ejection fraction (RVEF) was 0.900 (P = .001), 0.911 (P = .001), 0.765 (P = .021), 0.728 (P = .042), 0.875 (P = .004), and 0.781 (P = .023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = .027). A cut-off value of 40% for RVEF measured by t-ERV could discriminate patients with poor functional status (P = .048 for NYHA stage; P = .016 for 6MWT and P = .007 for POC). Conclusiont-ERV is a simple, reproducible, and an accurate technique for the assessment of RV function in patients with LVADs and warrants consideration in the evaluation and monitoring of symptomatic patients.

Endocardite infectieuse compliquée d’insuffisance cardiaque

BackgroundAlthough the progress of antibiotic prophylactic field, infective endocarditis remains a frequent pathology. Heart failure represents his main complication. AimThe aim of the study was to determine the various characteristics of patients suffering from heart failure complicated by infective endocarditis and to define its impact on the mortality. Patients and methodsFrom the infective endocarditis register of our service comparing 241 patients and responding to criteria of DURAK DUKE University which collected retrospectively, we included patients with heart failure on admission, namely dyspnea greater or equal to NYHA stage II. A total of 85 patients were enrolled in the heart failure (35.2% of register). ResultsHeart failure complicating infective endocarditis of native valve had occurred in 66 cases (77.6%). The microbiological investigation was positive in 43.5% of cases with a predominance of staphylococcus. The using of surgery was necessary in 65.8% of cases. Hemodynamic instability was the main indication. The total mortality in our registry was 19.5%, but higher in the group with heart failure (28.2% vs. 14.7%; P=0.006). In the multivariate analysis we found, as predictive factors for mortality of infective endocarditis complicated by heart failure group, the significant influence of anemia (OR=5.2; 95% CI: [1.6–24]; P=0.02), infection by Staphylococcus aureus (OR=5.7; 95% CI: [0.8–29.8]; P=0.03) and surgery delay (OR=3.1 ; 95% CI: [1.1–14.7]; P=0.01). ConclusionHeart failure is the most frequent complication of infectious endocarditis, and its first cause of death.

SPECT equilibrium radionuclide ventriculography for the assessment of ventricular volumes and function in patients with left ventricular assist devices

Objectives Left ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Transthoracic echocardiography (TTE) is limited by acoustic window and cardiac multidetector computed tomography (MDCT) is considered as the best tool to monitor patients with LVADs. We evaluated the feasibility and the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the assessment of LV and RV volumes and function in patients with LVADs. Materials and methods Twenty-four patients with LVAD (23 HeartMate II and 1 HeartWare) underwent ERV. Because of limited acoustic window, TTE was only feasible in 19 patients. Functional evaluation including six-minutes walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac MDCT. Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later for inter-scan reliability assessment. Results Reliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume and RV ejection fraction (RVEF) was 0.900 (P = 0.001), 0.911 (P = 0.001), 0.765 (P = 0.021), 0.728 (P = 0.042), 0.875 (P = 0.004) and 0.781 (P = 0.023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = 0.027). A cut-off value of 40% for RVEF measured by ERV could discriminate patients with poor functional status (P = 0.048 for NYHA stage; P = 0.016 for 6MWT and P = 0.007 for POC). Intra-, inter-rater and inter-scan reliabilities were over 0.9 for the assessment of LV and RV volumes and function by t-ERV. Conclusions t-ERV is a simple, reproducible and accurate technique for the assessment of RV function in patients with LVADs. Because of its good correlation with functional parameters and good inter-scan reliability, t-ERV warrants consideration in the evaluation and monitoring of symptomatic patients with LVADs.

0110: Predictive factors of tolerance to carvedilol in systolic heart failure

Heart failure experiencing exponential growth in Algeria. Among the recommended therapeutic, the b blockers are largely under prescribed. The objective of this study was to determine predicting factors of tolerance to carvedilol in systolic heart failure. Carvedilol has been introduced in 100 consecutive patients hospitalized with systolic heart failure. Clinical parameters, the BNP levels and echocardiographic indices were measured blind to admission to the first and second week. The average age of patients was 66±1 year. The FE: 31±1%, the NYHA 2.8±0.1, BNP 620±48pg/mL, E/A: 1 8±0.3, TDE 160±7, E/E’,9.1±0.3, PAPS: 36±0.4, VCI: 15+1mm. An acute decompensation episode occurred in 21patients and b blocker was arrested at 9 of them without the possibility of reintroduction. In univariate analysis, the values on admission NYHA stage, the plasma level of BNP, the TDE and reports E/A and E/E’ predicted the occurrence of acute decompensation. The combination of NYHA class 4 to a BNP level greater than 410pg/mL or at elevated filling pressures predicted the occurrence of decompensation in 100% of cases. Despite the directives of learned societies, b blockers remain largely under prescribed in systolic heart failure. The combined use of BNP or echocardiographic indices to NYHA stage allows to accurately predict the occurrence of acute decompensation.

0446: Impact of body mass index on prognosis in systolic heart failure patients: Moroccan profile

Higher body mass index (BMI) is associated with incident chronic heart failure (CHF) but it is paradoxically associated with better prognosis. The objective of the study was to analyze the relationship between body mass index and HF in a Moroccan profil. We enrolled 685 patients admitted to the Therapeutic Unit of Chronic Heart Failure (TUHF) from 2006 to 2013 as follow: under-weight (BMI <18.5kg/m 2 , n=35), normal (18.5 ≤BMI<25, n=349), overweight (25≤BMI <30, n=200) and obese (BMI ≥30, n=101) and compared the results from their clinical data, laboratory tests and echocardiography. The prevalence of obesity and overweight in CHF were 15 and 29% respectively. Obese group had a higher prevalence of obesity-related comorbidity (hypertension: p=0.0001, diabetes mellitus: p=0.0001 and dyslipidemia: p=0.001). Age, Ischemic heart disease, strock attack, stage NYHA, heart rate, hospitaliszation rate for cardiac decompensation, left right ventricular systolic function did not differ among the groups. However male sex, anemia and diastolic dysfunction were higher in the underweight group than in the other groups (p<0.0001 and p=0.03 respectively). High body mass index (overweigh and obesity) was frequent in chronic heart failure and it was not predictor of cardiac decompensations and hospitalizations. Furthermore, lower BMI was associated with diastolic dysfunction.

E-Health: A promising solution for optimizing management of chronic diseases. Example of the national e-Health project E-care based on an e-platform in the context of chronic heart failure

Summary Background Monitoring patients with heart failure by using telemedicine systems is a potential means for optimizing the management of these patients and to facilitate the job of health care professionals. We report the experience of the deployment of such a monitoring platform, through the E-care project. Methods The national e-heath project E-care has developed an “intelligent” communicative platform enabling the monitoring of patients with NYHA stages III and IV heart failure using non-invasive sensors. This project has been deployed since October 2013 in the Strasbourg University Hospital (in Strasbourg, France). Results To date, more than 180 patients have been included. The patient profile included was: elderly patient, with several chronic diseases (>90%), chronic heart failure in more than 60% of cases, total loss of autonomy in 25%. The E-care system operated perfectly and the experimental phase enabled us to validate the technological choices. A qualitative survey helped to positively assess the system's ergonomics. A preliminary analysis of the relevance of alerts with our inference engine design resulted in no malfunction. Conclusion Preliminary results following the deployment of E-care system in hospitals appear to show that this platform will assist health care professionals, especially patient nurse or doctor, by providing an automated processing of these sensors’ transmitted data in order to early detect and report signs of cardiac impairment.

0082: Multimodality imaging in cardiac amyloidosis: respective contributions of echocardiography, MRI and scintigraphy

Amyloidosis(A) prognosis is determined by cardiac involvement.The main types of A are immunoglobulin light chain(AL) and transthyretin-related(TTR), which can be mutated(TTRm) or senile(TTRwt). Specific treatments can’t be administrated unless A has been typed histologically.Literature suggests echocardiography, 99m Tc DPD scintigraphy and cardiac MRI could help typing A. We described these imaging modalities to assess these potential tools for an uninvasive typing. We analysed these imaging modalities in patients examined at Cardiomyopathies Competence Center(CCC) of La Timone Hospital in Marseille, with an histologically proven diagnosis of cardiac A(CA). We included 75patients examined between September 2006 and March 2014 at CCC, with a strongly suspected diagnosis of CA.CA could be histologically confirmed and typed in 45 patients(10 TTRm, 4 TTRwt, 6 TTR undeterminated; 19 AL;6 of other type).In 11 patients, CA was confirmed but untyped.No statistically significant difference was found between TTR and AL patients for the various imaging modalities.We observed 71% of men, aged 66, NYHA stage 2,4 on average.In all patients, cardiac biomarkers rates were increased. Myocardic mass and interventricular septal thickness were increased (199g/m² and 19mm), restrictive filling pattern was observed in 83% of patients.Despite a relatively preserved left ventricular ejection fraction, Global Longitudinal Strain was impaired at – 11%, with an apical sparing. Scintigraphy showed a frequent myocardic fixation (69%), slightly more intense in TTR patients.Cardiac MRI showed a constant late gadolinium enhancement, more extended in AL patients. We didn’t observe the differences described between CA types, probably because of a lack of statistical power.This encouraged us to develop a protocol for multidisciplinary evaluation of CA, to improve the management of this disease, and to keep on evaluating the diagnostic accuracy of these imaging modalities.

Functional Capacity Assessment in Patients with Chronic Heart Failure through the Six-minute Walk Test in the Cardiology Department of Yalgado Ouédraogo University Hospital, Burkina Faso

Functional Capacity Assessment in Patients with Chronic Heart Failure through the Six-minute Walk Test in the Cardiology Department of Yalgado Ouedraogo University Hospital, Burkina Faso Objectives: We aim to evaluate functional capacity in patients with chronic heart failure, using the six-minute walk test in the cardiology department of Yalgado Ouedraogo University Hospital. Patients and methods: We conducted a prospective study from December 1st 2013 to March 31st 2014. Hospitalized patients with chronic heart failure who gave their informed consent were included. Functional exercise capacity was assessed through the six-minute walk test and quality of life appreciated through the SF- 36 questionnaire which was filled at the time of discharge and at six weeks post discharge. Results: We included sixty one patients in our study and 32 of them were female (52%). The mean age was 46.9 ± 14.1 years old. Seventy percent of patients had NYHA stage II dyspnea. The mean ejection fraction was 32.4 ± 8.2% (extremes: 13 and 45%). The mean distance walked during the six-minute walk test was 336.3 ± 65 m at the time of discharge and 367.9 ± 68.7 m six weeks later. The mean gain between these measurements was 23.7 ± 31.5 m. The distance walked was 347.1 m for patients who had NYHA class I - II dyspnea and 303.3 for those ranked NYHA class III (p<0.05) at the time of enrollment. The overall physical component’s score in quality of life assessment was 54.3 ± 9.3 points at the time of enrollment. This score was impaired in 29% of patients. A minor statistically significant positive correlation was noticed between the mean distance walked during the six-minute walk test and quality of life linked to physical health. (r=0.18; p=0.017). Conclusion: Functional capacity in patients with chronic heart failure was severely impaired at discharge and was persistent six weeks later in the absence of cardiovascular rehabilitation program.

Self-rated health is associated with the length of stay at the intensive care unit and hospital following cardiac surgery.

BackgroundRecently, a considerable amount of evidence suggested that anxiety, depression and other psychosocial variables might influence the outcomes of cardiac surgery. This study investigated the relationship between length of stay at the intensive care unit (ICU) and hospital after surgery and different psychosocial variables (e.g. depression, anxiety, self rated health, happiness, satisfaction).MethodsWe enrolled prospective patients who were waiting for elective cardiac surgery (N = 267) and consented to take part in the study. We collected data of sociodemographic, medical and perioperative factors as well as psychosocial questionnaires completed 1.56 days (standard deviation [SD] = 0.7) before surgery. The primary clinical endpoint was an ICU stay of at least 3 days and the secondary was hospital stay of at least 10 days.ResultsTwo hundred sixty-seven patients participated in this study. Four patients (1.5%) died in the hospital and 38 patients (14.5%) spent more than 3 days in the ICU and 62 patients (23.2%) spent more than 10 days in the hospital. After controlling for medical and sociodemographic factors, lower self rated health (Adjusted Odds Ratio [AOR]: 0.51, 95% confidence interval [CI]: 0.28-0.95; p = 0.03), lower rate of happiness (AOR: 0.76, 95% CI: 0.59-0.97, p = 0.03), postoperative cardiac failure (AOR: 7.09, 95% CI:1.21-41.54; p = 0.03) and postoperative complications (AOR: 9.52, 95% CI: 3.76-24.11; p < 0.001) were associated with longer ICU stay. More than 10 days of hospital stay was associated with higher occurrence of COPD (AOR 4.56, CI: 1.95-10.67, p < 0.001), NYHA stage (AOR 6.76, CI: 2.57-17.79, p < 0.001), operation time (AOR 1.45, CI: 1.19-1.76, p < 0.001), female gender (AOR 2.16, CI: 1.06-4.40, p = 0.034) and lower self-rated health (AOR 0.63, CI: 0.41-0.99, p = 0.044).ConclusionsLower happiness and self-rated health may influence the outcome of cardiac surgery. Therefore, these variables should be assessed in patients.

TCTAP C-018 Simple Transradial Intervention Becomes Complex

### Patient initials or identifier number AS ### Relevant clinical history and physical exam A young man of 38 years presented with gradual onset of exertional chest discomfort NYHA stage |||. He was known diabetic and hypertensive. On examination o/e pulse 70/min.blood pressure 150/100 mmhg.

Epidemiological study of dilated cardiomyopathy from eastern India with special reference to left atrial size

Background: Dilated cardiomyopathy (DCM) is a common cause of emergency visit in our country. The disease is often misdiagnosed and mistreated. There are very few studies on DCM from India. We undertook a small study on DCM patients from Eastern India to find the demographic and echocardiographic characteristics. Patients and methods: We undertook this study in a tertiary care Medical College of Eastern India. All patients coming to the emergency with dyspnea were evaluated for cardiac dysfunction. Emergency echocardiography was done to diagnose dilated cardiomyopathy. Patients with DCM were then evaluated as per protocol. After stabilization, echocardiography was repeated to note the study parameters like left atrial diameter. Standard statistical tests were used. Results: we had a total of 70 patients in our study with a male: female ratio of 43:27. Most patients were aged over 40 years. Patients with COPD, history of radiation, malignancy or drug abuse were excluded. Most patients (47%) were on NYHA stage 3 at the time of presentation. In our patient cohort, 24% were alcoholic and 46% were smokers. Atrial fibrillation was present in 15.7% of the patients and right and left bundle branch block had been present in 8 and 15 patients respectively. In echocardiography, increased left atrial (LA) size (>40 mm) was found in 45 patients. Many patients had valvular regurgitation, mitral, aortic or tricuspid. LA size was positively correlated with left ventricular systolic diameter (r=0.403) and negatively correlated with ejection fraction (r= -0.23). Analysis and conclusion: different ECG abnormalities like bundle branch block and arrhythmias like atrial fibrillation are quite common in DCM. In echocardiography, left atrial size is an important prognostic marker and correlates with left ventricular function.

SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery (CABG). Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese Coronary Artery Bypass Grafting Registry. This database was randomly divided into developmental and validation subsets (9:1). The data in the developmental dataset were used to develop the model using logistic regression. Calibration and discrimination characteristics were assessed using the validation dataset. Thresholds were defined for each model to distinguish different risk groups. After excluding 275 patients with incomplete information, the overall mortality rate of the remaining 9564 patients was 2.5%. The SinoSCORE model was constructed based on 11 variables: age, preoperative NYHA stage III or IV, chronic renal failure, extracardiac arteriopathy, chronic obstructive pulmonary disease, preoperative atrial fibrillation or flutter (within 2 weeks), left ventricular ejection fraction, other elective surgery, combined valve procedures, preoperative critical state, and BMI. In the developmental dataset, calibration using a Hosmer-Lemeshow (HL) test was at P = 0.44 and discrimination based on the area under the receiver operating characteristic curve (ROC) was 0.80. In the validation dataset, the HL test was at P = 0.34 and the area under the ROC (AUC) was 0.78. A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China.

MitraClip® via direct right atrial access in case of a missing inferior vena cava

The presence of mitral regurgitation (MR) in patients with heart failure represents an independent predictor of mortality. Until now, the standard therapy for severe MR has been cardiac surgery in order to perform mitral valve replacement or mitral valve repair. With the introduction of the MitraClip® system (Abbott Vascular - Structural Heart, Menlo Park, CA, USA) in 2008, there is now an alternative percutaneous treatment option available for high-risk patients. We report on an 84-year-old male patient who was admitted to the emergency room with increasing shortness of breath due to severe functional MR, at stage NYHA III. In the following days the patient developed cardiogenic shock due to failure of the diuretic medication. The case first described here demonstrates an alternative transseptal route of access via a direct atrial puncture of the RA in a patient with absent inferior vena cava. This approach was successfully used to perform a MitraClip® procedure in this patient with functional MR and cardiogenic shock. It was possible to treat mitral regurgitation and the consecutive cardiogenic shock by implanting two MitraClips®.

Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital : cardiovascular topics

Rheumatic heart disease (RHD) frequently occurs following recurrent episodes of acute rheumatic fever (ARF). Benzathine penicillin (benzapen) is the most effective method for secondary prophylaxis against ARF whose efficacy largely depends on adherence to treatment. Various factors determine adherence to therapy but there are no data regarding current use of benzapen in patients with RHD attending Mulago Hospital. The study aims were (1) to determine the levels of adherence with benzapen prophylaxis among rheumatic heart disease patients in Mulago Hospital, and (2) establish the patient factors associated with adherence and, (3) establish the reasons for missing monthly benzathine penicillin injections. This was a longitudinal observational study carried out in Mulago Hospital cardiac clinics over a period of 10 months; 95 consecutive patients who satisfied the inclusion criteria were recruited over a period of four months and followed up for six months. Data on demographic characteristics and disease status were collected by means of a standardised questionnaire and a card to document the injections of benzapen received. Most participants were female 75 (78.9%). The age range was five to 55 years, with a mean of 28.1 years (SD 12.2) and median of 28 years. The highest education level was primary school for most patients (44, 46.3%) with eight (8.4%) of the patients being illiterate. Most were either NYHA stage II (39, 41.1%) or III (32, 33.7%). Benzathine penicillin adherence: 44 (54%) adhered to the monthly benzapen prophylaxis, with adherence rates ≥ 80%; 38 (46%) patients were classified as non-adherent to the monthly benzapen, with rates less than 80%. The mean adherence level was 70.12% (SD 29.25) and the median level was 83.30%, with a range of 0-100%; 27 (33%) patients had extremely poor adherence levels of ≤ 60%. Factors associated with adherence: higher education status, residing near health facility favoured high adherence, while painful injection was a major reason among poor performers. The level of non-adherence was significantly high (46%). Residence in a town/city and having at least a secondary level of education was associated with better adherence, while the painful nature of the benzapen injections and lack of transport money to travel to the health centre were the main reasons for non-adherence among RHD patients in Mulago.

Beneficial Effects of Angiotensin (1–7) On Dysfunctional CD34+ Endothelial Progenitor Cells (EPC) from Patients with Heart Failure

Endothelial dysfunction is well established in heart failure (HF) and thus HF individuals can be benefitted from autologous cell therapy. In HF patients, the numbers of circulating EPCs vary with NYHA stage. We hypothesized that CD34+ EPCs are dysfunctional in heart failure (HF) patients which can be corrected by angiotensin 1–7 (Ang‐(1–7)). Peripheral blood was collected from control (n=10) and NYHA class II‐IV HF patients (n=15). CD34+ cells were enumerated by flow cytometry and were assessed for migratory potential, NO generation, ROS levels with and without Ang1–7. HF patients showed 63% reduction in number of CD34+cells, 60% reduction in BFU‐E, 74% increase in CFU‐GEMM colonies, reduced expression of ACE2, MAS1 and IL‐10 whereas increased expression of TNF‐α and IL‐6 compared to controls. Migratory potential of CD34+ cells in HF patients were reduced by 77%. Additionally, CD34+ cells from class III donors had 44% reduction in NO/ROS ratio due to increased ROS and reduced NO. Ang‐(1–7) treatment improved their migratory response, reduced ROS and increased NO which resulted in a 54% increase in NO/ROS ratio. These data support that CD34+ cells isolated from HF individuals are dysfunctional, with a reduction in number, colony forming ability, migratory potential, NO generation and increased oxidative stress and these dysfunctions can be corrected by Ang‐(1–7), which suggests therapeutic potential of Ang‐(1–7).This work was supported by HL56921

Impact of Demographic and On-Pump Factors on Post-Transplant Survival Following Support with the HVAD System

Purpose Cardiac Transplantation remains one of the best therapeutic options for patients with advanced heart failure who fail optimal medical therapy. However, limited donor availability leads to extended wait-list time and the possibility of continued deterioration. We reviewed post-transplant survival following HeartWare® continuous flow ventricular assist device (HVAD) implantation, as well as the impact of several variables on post-transplant survival. Methods and Materials A review of patients with advanced heart failure enrolled in the ADVANCE Bridge to Transplant (BTT, n=140) and an additional 192 patients enrolled under the continued access protocol (CAP) to receive a continuous flow HVAD Pump as BTT revealed a total of 160 patients (48%) who were transplanted or explanted for recovery. Analyses included descriptive statistics, survival by simple proportion and Kaplan-Meier analysis, and a multivariable analysis including 41 risk factor variables. Results Of 160 patients who were transplanted or explanted for recovery, survival was 90% at 180 days and 89% at 1 year. Average time on HVAD support prior to transplant was 251 + 188 days (range 23 to 839 days). Baseline characteristics at HVAD implant revealed 96% of patients with NYHA Stage IV heart failure, 22% female, and 37% having heart failure of ischemic origin. Post-transplant survival was greater in patients ≤60 years (range 22 to 60) than in patients >60 years (range 61 to 69), 94% vs 78% at 180 days ( P =0.011) and 91% vs 66% at 1 year ( P =0.005), respectively. Survival was statistically similar regardless of time on HVAD support prior to transplant. Etiology of heart failure, sex, and bleeding or infection events while on HVAD support did not influence survival. A multivariable analysis revealed BMI≥30 as a predictive factor for survival 6 months post-transplant. Conclusions Post-transplant survival in patients supported with a continuous-flow LVAD such as the HVAD Pump is excellent, suggesting consideration should be given to developing strategies to optimize donor organ allocation.

GRP-002 A Case Report: Management of Pain After Subcutaneous Injection of Treprostinil

BackgroundTreprostinil is a prostacyclin analogue indicated for the treatment of Pulmonary Arterial Hypertension (PAH) for patients with functional NYHA class III. The administration is a continuous subcutaneous infusion. It is...