Monday, 1 September 2008 - European Heart Journal

300 Perspectives in heart failure treatment
of negative inotropy which increases FMR through coaptation force reduction.
After 3 month effects of B and I on FMR were comparable, but after 6 month FMR
incidence and severity were less in B with better exercise tolerability probably due
to improved contractility through better myocardial response to catecholamines
after long term use.
P1953 Rapid carvedilol up-titration in hospitalized patients
with systolic heart failure
M. Martinez-Selles, T. Datino, M. Alhama, F. Fernandez-Aviles.
Madrid, Spain
Background: Carvedilol rapid up-titration in patients with systolic
heart failure could have important clinical benefits, however its safety is unknown.
Methods: To evaluate if carvedilol can be safely up-titrated before hospital discharge,
we studied 372 consecutive patients, with left ventricular ejection fraction
(LVEF) 50 mg. Variables related to the discharge dose were also
related to the dose at the end of follow-up except in the case of previous betablockers
use.
Table 1. Discharge dose and dose at the end of follow-up
Carvedilol discharge dose* Carvedilol dose at p Carvedilol >50 mg daily at p
mg daily (n – %) the end of follow-up** the end of follow-up**
(mean±SD, mg daily) n (%)
0 (23 – 6%) 22.7±20.3 50% were randomized to 3 groups (n=40) in order to receive ramipril 10
mg/day (R), losartan 50 mg/day (LL) or losartan 100 mg/day (LH). Transmitral E
wave deceleration time (EDT), IVRT, duration of reversal in the pulmonary vein
(RPV) and transmitral A wave (RPV – A), index of left atrial volumes (LAVI) and
EF (LAEF) were obtained by TEE in 1, 30, 180 day follow up.
Results: Baseline characteristics were comparable between groups. In 30 day
EDT, IVRT and RPV - A were better in R, compare to LL and LH (EDT: R 133±11
ms* vs LL 122±10 ms vs LH 124±9 ms,*p< 0.05; IVRT R 52±6 ms* vs LL
42±4 msvs45±3 ms,*p< 0,05, RPV – A: 24±5 ms* vs 32±3 msvs29±2 ms;
*p < 0.05). In 180 day all parameters were better in LH and comparable between
R and LL (EDT: R 132±12 ms vs LL 129±13 ms vs LH 138±9 ms*,*p< 0.05;
IVRT R 52±6 msvsLL48±4 msvsLH58±5 ms*,*p< 0,05, RPV – A: R 22±4
ms vs LL 26±3 msvsLH18±3 ms*;*p< 0.05, LAVI: R 28±5 ml/m 2 vs LL 32±4
ml/m 2 vs LH 21±5 ml/m 2 *; *p < 0.01, LAEF: R 35±16% vs LL 33±12% vs LH
41±12%*, *p < 0.01)
Conclusion: Thus higher doses of L favorably alter diastolic function parameters
in DHF with decreased compliance probably through better RAAS control.
P1955 Medication adherence and aspects of heart failure
management-a cross sectional study in South Africa
V. Ruf 1 ,S.Stewart2 ,S.Pretorius3 , M. Kubheka3 ,
C. Lautenschlaeger1 ,P.Presek1 , K. Sliwa3 . 1Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany; 2Baker Heart
Research Institute, Melbourne, Australia; 3Soweto Cardiovascular Research
Unit, Department of Cardiology, Soweto, Johannesburg, South Africa
Purpose: Despite its clinical importance there is a paucity of data on treatment
adherence in patients with heart failure (HF) in the African context. We examined
the pattern of treatment adherence in a large cohort of HF patients from Soweto,
South Africa.
Material and methods: The "Patient Compliance and Knowledge on Heart Failure
Survey" was initially developed, validated and then applied to 200 consecutive
HF patients with a left ventricular ejection fraction