Monday, 1 September 2008 - European Heart Journal

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$Heart failure with preserved ejection fraction - European Heart Journal$

258 Can we predict atrial fibrillation? / Thromboembolic risks and therapeutic approaches in atrial fibrillation patients with paroxysmal AF, (11.90±4.79 ng/ml vs. 14.98±6.28 ng/ml, p=0.03 and 154.90±44.91 ng/ml vs. 129.75±37.92 ng/ml, p
Thromboembolic risks and therapeutic approaches in atrial fibrillation / Healthy bone marrow for a healthy heart 259 Conclusions: In patients with short-term AF TEE revealed left atrial thrombi in 1.4% and dense spontaneous echo contrast in 10% of patients. Patients with TEE-guided cardioversion of short-term AF had an 8-fold reduced incidence of stroke/death after 1 month than patients undergoing conventional approach without TEE. Thus, in patients with AF < 48 hours, TEE-guided electrical cardioversion might be useful to reduce the embolic risk. 1612 Beta-fibrinogen 455 G/A gene polymorphism is associated with the left atrial thrombus and severe spontaneous echo contrast in atrial fibrillation V. Bozdemir, O. Kirimli, B. Akdeniz, A. Aslan, V. Kala, E. Ozel, O. Senaslan, S. Guneri. Dokuz Eylul University Cardiology, Cardiology, Izmir, Turkey Purpose: The detection of genetically abnormalities related with the thrombogenic factors may aid to determine the risk of thromboembolism and mechanism of thrombus formation in atrial fibrillation (AF). In this study, we aimed to investigate the effect of the presence of beta fibrinogen gene polymorphism or glycoprotein IIIa gene polymorphism on the development left atrial (LA) thrombus or spontaneous echo contrast (SEC) in patients with atrial fibrillation. Methods: Forty-seven patients with persistent AF, which were scheduled for cardioversion, in whom transesophageal echocardiography was performed for the detection of LA thrombus and SEC were included in the study. Patients were divided in two groups; those with LA thrombus or severe SEC (n=27) consisted to group I and those without thrombus or severe SEC were in group II (n=20). All patients were also evaluated in terms of mitral regurgitation (grading were made according to ASE criteria) and presence of mild to moderate SEC and gene polymorphism. DNA analysis was conducted to determine the beta-fibrinogen 455 G/A polymorphism and glycoprotein IIIa PlA1/A2 polymorphism, blood samples were taken from the peripheral venous route. Results: There were no significance difference regarding to demographic (age, sex) and clinical characteristics (LA size, LVEF, the prevalence of hypertension, diabetes etc.) between groups. The frequency of beta-fibrinogen 455 G/A polymorphism was significantly higher (44.4%) in group I compared to group II (10%) (p=0.01). Glycoprotein IIIa Pl A1/A2 polymorphism was not different between groups (22.2% in group I and 25% group II; p=0.82). In patients with left atrial thrombus, comparing to those without thrombus, mitral regurgitation score was tend to be lower (p=0.08) and the prevalence of SEC (mild to severe) was found to be significantly higher (p=0.03). Conclusion: This cross-sectional study revealed that, beta-fibrinogen 455 G/A gene polymorphism in patients with atrial fibrillation is associated with the presence of left atrial thrombus and severe SEC, whereas the glycoprotein IIIa PlA1/A2 polymorphism is not. Beta-fibrinogen 455 G/A gene polymorphism may be a promising marker for the prediction of thromboembolism risk in patients with atrial fibrillation. 1613 Prevalence and clinical impact of left atrial thrombus and dense spontaneous echo contrast in patients with atrial fibrillation and low CHADS2 score T. Kleemann, T. Becker, M. Strauss, S. Schneider, K. Seidl. Herzzentrum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany Aim of the study was to evaluate the prevalence and clinical impact of left atrial thrombus and dense spontaneous echo contrast (SEC) in patients with atrial fibrillation (AF) and low CHADS2 score. Methods and results: A total of 295 consecutive patients with nonvalvular AF and a CHADS2 score of 0 or 1 from the prospective single center registry ANTIK who underwent transoesophageal echocardiography (TEE) before cardioversion were analysed. Median follow-up was 5 years. Left atrial thrombus was present in 3% and dense SEC in 8% of patients. Independent predictors for the presence of thrombus or dense SEC were ejection fraction (EF) < 40% and left atrial diameter > 50mm. In anticoagulated patients thrombus and dense SEC were not independently associated with an increased risk for stroke or death during the 5-year follow-up (OR 1.73, 95% CI 0.65-4.63). Table 1. Clinical characteristics of patients with AF and CHADS2 score of 0/1: left atrial thrombus or dense SEC versus no thrombus/SEC Thrombus or dense SEC No thrombus and no dense SEC p-value (n=30) (n=265) Age (years) 62 (55-72) 61 (54-68) 0.23 Male 77% 78% 0.86 NYHA II+ 50% 21% 0.01 Hypertension 23% 31% 0.41 Diabetes 3% 0.8% 0.18 EF < 40% 30% 11% < 0.01 LA dimension > 50mm 30% 8% < 0.001 LVEDD > 60mm 11% 7% 0.56 Conclusions: Despite a low CHADS2 score of 0/1 3% of patients have left atrial thrombus and 8% dense SEC. Independent predictors for the presence of thrombus and dense SEC were EF < 40% and left atrial dimension > 50mm. Thus, echocardiography might be a useful tool for further risk stratification in patients with low CHADS2 score. 1614 Thromboembolic risk assessment in persistent atrial flutter: is it different from atrial fibrillation? A singlecenter TEE study on 483 consecutive patients A. Cresti, G. Miracapillo, F. Cesareo, A. Costoli, L. Addonisio, S. Severi. Division of Cardiology, Misericordia Hospital, Cardiology, Grosseto, Italy Objectives: despite a lack of clear evidence, risk assessment and embolic prophylactic treatment of atrial flutter (AFL) is similar to that of atrial fibrillation (AF). Recent studies evidenced lower embolic risk in AFL and Transesophageal Echocardiography (TEE) has been recently considered redundant before cardioversion (CV) in unselected pts. Aim of our study was to evaluate the presence of auricular thrombosis risk by TEE in a large series of AFL pts. Methods: in the period 2000-07, 483 consecutive pts, referred for multiplane TEE before medical or electrical CV for AF (Group 1, N=382, 79%) or AFL (Group 2, N=101, 21%), were included. Basal clinical characteristics were the following: male 60%, mean age 70±10 yrs, hearth disease: valvular 49.4%, hypertensive 25%, ischemic 18.5%, idiophatic dilatative 5.4%, others 1.7%; EF 50±11%, left ventricular end diastolic diameter (LVED) 52±6 mm, left atrial parasternal diameter (LA) 49±7 mm, history of cerebral accidents 5.2%, type of arrhythmia: persistent 85.3%, paroxysmal 4.8%, permanent 9.9%. Anticoagulation was recommended according to standard protocols. Thrombosis risk assessment was evaluated according to the presence of left or right atrial thrombus, severe spontaneous echocontrast (SSE) in the left atrium or in the auricle and left atrial appendage Doppler velocities (LAADV) < 20 cm/sec. Results: TEE was performed in all pts without complications. Basal clinical characteristics of Group 1 (AF) vs Group 2 (AFL) were the following: male 56 vs 75%(p=0.000), mean age 69±10 vs 72±9 yrs (p=0.005), EF 52±11 vs 46±11%(p=0.002), LVED 52±6 vs53±7mm (p=0.54), LA 49±7 vs48±6 mm (p=0.34), hearth disease: valvular 50.8 vs 44.7%(p=0.59), hypertensive 26.9 vs 18.4%(p=0.33), ischemic 14.6 vs 31.6%(p=0.04), idiophatic dilatative 6.2 vs 2.6%(p=0.39), others 1.5 vs 2.6%(p=0.67); history of cerebral accidents 5.8 vs 3.0%(p=0.26); type of arrhythmia: persistent 82.4 vs 95.9%(p=0.29), paroxysmal 5.4 vs 2.7%(p=0.36), permanent 12.3 vs 1.4% (p=0.009); LAADV: 36.1±15.8 vs 46.1±10.8 cm/sec (p=0.000). Thrombosis risk factors of Group 1 vs Group 2 resulted respectively: presence of left or right atrial thrombus 9.8 vs. 2.0%(p=0.012), SSE in the left atrium or in the auricle 4.6 vs 3.0%(p=0.49), LAADV
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Page 3: CAN WE PREDICT ATRIAL FIBRILLATION?
Page 7 and 8: Healthy bone marrow for a healthy h
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Page 11 and 12: CI 0.2-1.6, p=0.32) after epinephri
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Page 23 and 24: (n=574) served as the cohort where
Page 25 and 26: Using Cox’s proportional hazards
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Page 29 and 30: Multimodality imaging of coronary h
Page 31 and 32: Conclusions: EVH is a strong indepe
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Page 35 and 36: oxidases decreased O2- by 16±3.1%
Page 37 and 38: Fig. 1. Five types of merge errors.
Page 39 and 40: manent AF were studied. The number
Page 41 and 42: P1933 Left atrial appendage dominan
Page 43 and 44: hydrolysable, it would dissipate be
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Page 53 and 54: =0.31, p=0.0003) and QUICKI (r=0.29
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P1989 Hormonal mechanisms of cachex
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or more of the following ECG change
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P2004 Association between cardiovas
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P2012 Correlations between the degr
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disease. Familial study was recomen
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P2027 MRI for the detection of rest
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P2035 Oxidized low density lipoprot
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P2042 Persistent under representati
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P2049 Addition of B-type natriureti
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P2058 Genetic variation in CYP2C19
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p=0.003). Minor bleeding was also l
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Avidin, a protein found in hen eggs
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flow, and
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(PCWP) were recorded. In 16 patient
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Methods: A prospective, consecutive
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over paclitaxel-eluting stent (PES)
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which proved to be safe and effecti
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Comparison of neointimal growth amo
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patients between October 2006 and J
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P2139 Inverse relation of baseline
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tive. We sought to determine the ef
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P2155 A very high prevalence of low
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P2163 The influence of estradiol on
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2nd year of follow-up, respectively
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P2179 Symptoms of atrial fibrillati
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P2187 The relationships of ambulato
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tension (WCHT) to vascular damage i
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in the postero- and midseptal regio
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elevation myocardial infarction (AM
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assigned to receive either unselect
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was injected. Left ventricular func
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of MACE in patients with LGE and de
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P2243 Blood oxygenation level-depen
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P2250 Prognostic value of revascula
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needed to achieve 90% of age-predic
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presence/absence of VIVC assessed u
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2341 Telemonitoring in an elderly,
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Heart failure with preserved systol
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the most dilated, LA mostly influen
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Conclusion: In patients with stable
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2388 Magnitude of glycaemia variati
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patients with RV > 30 ml this corre
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BIOMARKERS: NEW KIDS ON THE BLOCK 2
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the importance of calling the emerg
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Sudden death, devices and public aw
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Bone marrow progenitors: filling th
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2566 Esophageal capsule endoscopy i
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(7.0%) patients receiving aliskiren
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P2600 Final aggregation response is
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Results: Female patients (27.7%) we
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with atrial fibrillation (AF) under
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e feasible and safe. This approach
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coagulant therapy (P=0.038; OR=2.42
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ison between responders and nonresp
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Table 1. Systolic, diastolic and dy
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Syncope and cardiac pacing: miscell
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their downstream effector, myosin h
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Understanding determinants of hemod
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the abundance of profibrotic CCN2 p
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parison with IL-8 as well as the ex
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and EF (-0.5%) which significantly
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of effects on systemic BP and cardi
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Conclusion: Compared to previously
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P2723 Differential virus-associated
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Methods: During 2007, 10 patients (
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cardiomyocyte apoptosis was highest
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higher for NT-proBNP (area under th
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or higher) in 85 patients (4.2%). M
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teria as a final Thrombolysis In My
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cantly correlated to in-hospital de
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nosis in patients with myocardial i
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lesion classification, stent type u
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Prognosis in ST-elevation myocardia
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P2802 In-hospital and long-term mor
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P2810 Long-term clinical results fo
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Percutaneous coronary intervention;
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vessels (DES 16.7%, BMS 6.7%, p=0.0
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patients receiving a DES and the ra
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Results: The two groups had similar
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among their non-DM counterparts (HR
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tigated the long-term consequences
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culogenesis. Reduction of VPC and E
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y echo-tracking technique calibrate
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P2885 Statins are effective in redu
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Conclusions: The patient-centred he
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P2900 Should left ventricular hyper
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P2908 Telmisartan up-regulates the
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important sex-based differences in
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Hypertension: regional and ethnic p
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whether the selective mineralocorti
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THE ENDOTHELIUM: AT THE HEART OF VA
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P2951 Reproducibility of endothelia
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P2959 Brachial flow-mediated dilati
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P2966 Detection of late enhancement
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tissue as an enhanced area. On the
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dial dysfunction is critical for th
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for testing the load dependence. Th
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diastolic velocity (-12.3±4.9 vs -
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Monday, 1 September 2008 - European Heart Journal

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