Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Impact of cardiovascular therapy on left ventricular function in her2 positive breast cancer patients who were treated with trastuzumab

Funding Acknowledgements

Type of funding sources: None.

Background

Trastuzumab  prolongs survival in women with HER2-positive breast cancer, but caries the risk of cardiotoxicity.  Cardiac function should be closely monitored, as well as identification of the patients (pts) with risk of  cardiotoxicity.

Purose

To assess the impact  of cardiovascular therapy on the echocardiografic parameters of left ventricular function in patients with HER2 positiv breast cancer  during trastuzumab therapy.

Methods

96 pts with HER2 positive breast cancer (mean age, 59.57 ± 9.6 years) were studied. All pts were on sequential therapy with anthracyclines (IV to VI cycles) within the FAC regimen (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2) on day 21, and after that trastuzumab therapy (6 mg/kg of body weight on day 21, for the period of one year).  The echocardiographic parameters: left ventricular ejection fraction (LVEF%), fractional shortening (FS%), end-diastolic diameter (EDD, mm); left ventricular mass (LVM, g) were assesed at the beginning and after the therapy with trastuzumab in all pts.

Out of 96 studied pts, 44 pts (45.85%) were treated with beta-blockers, 35 pts with ACE inhibitors (36.45%), 12 pts (12.5%) with calcium antagonists and 5 pts (5.2%) with sartans.

Results

At the end of trastuzumab therapy patients who were on beta-blockers therapy, showed the reduction of LVEF by 3.28% (p = 0.005), while patients on ACE inhibitors (by 2.80%; p = 0.016) and calcium antagonists (by 2.80%; p = 0.012) had the lowest decrease in LVEF. Patients on sartans therapy showed decreased of LVEF by 4,76% (p = 0.461) compared to baseline values.

Patients on beta-blockers had the lowest decrease of FS (0.68%; p = 0.448) while the highest decrease of FS had patients on calcium antagonist therapy (3.05%, p = 0.022). The highest increase in EDD (by 3.28 mm; p = 0.194) was detected in pts on sartans therapy. In patients on beta-blockers therapy, there was an increase in LVM by 16.36 g (p = 0.012). The highest increase in LVM (by 17.56 g, p = 0.141) was observed in patients on sartans therapy.

Conclusion

The results of our study showed that after trastuzumab treatment in patients with HER2  positive breast cancer, the least reduction of LVEF was in pts who were on therapy with ACE inhibitors or calcium antagonists, while the least decrease in FS was in pts on beta-blockers therapy. The highest increase in EDD and LVM was in patients who were on sartans therapy.

Impact of Adiponectin Resistance on Coronary Artery Disease Severity

Background

The serum adiponectin level (AD), adiponectin resistance (AD-R) may reflect the degree of metabolic syndrome (MetS). The role parameter AD-R, The Homeostasis Model Assessment-Adiponectin (HOMA-AD) index on the coronary artery disease (CAD) severity is not still understood.

Objective

To determine adiponectin concentration and HOMA-AD index in patients with CAD with/without MetS and to evaluate their prognostic importance on severity of CAD.

Methods

This cross-sectional study involved selected 130 examinees which were divided into three groups: CAD+MetS, CAD-MetS, control group (no CAD/MetS). In all examinees values of biochemical and anthropometric parameters were determined. We analyzed the severity of coronary artery lesions from coronary angiography. Total serum adiponectin concentration was measured by ELISA. We calculated atherogenic Gensini scoring system, Duke prognostic index, and HOMA-AD-index.

Results

Serum adiponectin level was significantly lower in the group with CAD+MetS (p < 0.001) and in CAD-MetS group (p < 0.01), compared to the control group. The HOMA-AD index showed statistically significant positive correlation with the key parameters of MetS, as well as with the parameters of CAD, number of CAD and modified Gensini score. After applying logistic regression analysis the best predictors for CAD were: adiponectin, blood pressure, HOMA-IR index, and HOMA-AD index. The cut-off values of adiponectin ≤1506.38 pg/mL, HOMA-IR index ≥3.91 and HOMA-AD index ≥0.67 were associated with a higher risk of CAD.

Conclusion

Patients with CAD with or without MetS had low adiponectin levels and this hypoadiponectinemia indicates that AD and HOMA-AD index may be a useful marker for identifying patients at risk for CAD.

Does changes of dipeptidyl peptidase-4 and IGF binding protein 1 during cardiac rehabilitation can predict recurrent anginal pain – correlation with nitric oxide response – 3 years follow up

Background

Dipeptidyl peptidase 4 (DPP4) is a proteolytic enzyme, and its expression and activity is increased in coronary artery disease (CAD). Insulin-like growth factor binding protein 1 (IGF BP1) can affect prognosis and mortality from cardiovascular diseases.

Purpose

To evaluate the effects of cardiac rehabilitation on DPP4 and circulating IGF BP1 levels, also on circulating blood marker of endothelial function, nitric oxide (NOx); to assess their relationship and prognostic significance on recurrent chest pain.

Methods

51 subjects; 31 pts with stable CAD (CAD group; 58.4±6.8 years) and 20 healthy controls (C group; 57.4±8.1 years) were studied. All patients underwent a supervised 3 weeks exercise training. At baseline and after 3 weeks in all pts values of DPP4, IGF BP1 and NOx were determined and exercise test was performed. Clinical long-term follow-up (3 years) was performed. All medical therapy were documented, and for this analysis, we focused on recurrent anginal chest pain.

Results

After follow-up period there were no cardiovascular (CV) hard end points (CV death, MI, stroke), however 18 pts (58%) had episodes of typical anginal chest pain while 13 pts (42%) were without anginal chest pain. Baseline value of DPP4 and IGF BP1 was significantly higher in CAD than in C group (P&lt;0.01 and P&lt;0.01), while NOx was lower (58.61±7.64 vs 77.28±29.86 μmol/L P=0.024). After 3 weeks of exercise training DPP4 decreased significantly in CAD group (from 762.32±185.76 to 604.88±206.18 μg/L, P&lt;0.001), as well as IGF BP1 (P=0.018) and NOx inreased (P&lt;0.01). Those changes resulted in no significant difference in DPP4, IGF BP1 and NOx after three weeks between CAD and C group. Exercise capacity (METs) at baseline was significantly lower in CAD than in C group (P&lt;0.001), and it significantly increase in CAD group after exercise period (P&lt;0.001).A positive correlation during exercise period was found between IGF BP1 decrease and NOx increase (r=0.790, P&lt;0.001), between IGF BP1 decrease and DPP 4 decrease (r=0.880, P&lt;0.001), between IGF BP1 decrease and METs increase (r=0.866, P&lt;0.001), between DPP 4 decrease and NOx increase (r=0.975, P&lt;0.001), between DPP 4 decrease and METs increase (r=0.718, P&lt;0.001), and between METs increase and NOx increase (r=0.846, P&lt;0.001). Univaried logistic regression analyses were performed and showed that NOx increase (OR 0.842, CI 0.562–0.944, p&lt;0.01), DPP4 decrease (OR 0.718, CI 0.644–0.826, p=0.01), IGF BP1 decrease (OR 0.695, CI 0.475–0.822, p=0.002) and METS increase (OR 0.924, CI 0.788–0.988, p=0.015) significantly predict a 3 years period without anginal chest pain.

Conclusion

Residential cardiovascular rehabilitation, in patients with stable CAD, improved endothelial function. Patients with higher increase of NOx and METs, and greater reduction in DPP4 and IGF BP1 after 3 weeks of specialized cardiac rehabilitation, during 3 years follow up, were without anginal chest pain and without any CV event.

Funding Acknowledgement

Type of funding source: None

Is there a gender difference in endothelial response on exercise training in heart failure patients with preserved ejection fraction?

Purpose

To examine the reaction of endothelium, assess through changes of circulating blood markers of endothelial function: the stable end products of nitric oxide (NOx), S – nitrosothiols (RSNO – reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) that promotes exercise training in female and male patients (pts) with heart failure with preserved ejection fraction (HFpEF).

Methods

A total of 78 pts with HFpEF were enrolled in the study: 43 male (M group) and 35 female (F group). In all pts, before and after a short-term supervised 3 weeks exercise training at residential center values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed.

Results

After 3 weeks of exercise training NOx increased significantly in both groups: in M group (from 34.4±7.5 to 42.3±9.5 μmol/l, P&lt;0.001), and in F group (from 31.3±6.8 to 41.5±7.2 μmol/l, P&lt;0.001), as well as RSNO: In M group RSNO increased from 3.6±1.7 to 4.6±1.9 μmol/l (P&lt;0.05) and in F group from 3.1±1.5 to 4.2±2.2 μmol/l (P&lt;0,05). Increase in NOX and RSNO after exercise training was higher in F than in M group: NOx 32,6% vs 22,9%; RSNO 35,1% vs 27%. Value of ADMA as well of SDMA decreased in both groups after 3 weeks: ADMA in M group from 0.315±0.09 to 0.278±0.12 μmol/l (by 11.7%; ns), and in F group from 0.342±0.08 to 0.297±0.13 μmol/l (by 13.1%; ns); SDMA in M group from 0.269±0.08 to 0.234±0.09 μmol/l (by 13%; ns), and in F group from 0.285±0.09 to 0.245±0.10 μmol/l (by 14%; ns). After 3 weeks, level and duration of exercise test were significantly higher in M (both P&lt;0,001), as well as, in F group (both P&lt;0.001), compared to baseline values.

Conclusions

There was no gender difference in the way of endothelial response on exercise training in pts with HFpEF. Exercise training induced favorable modification of endothelial function, expressed through significant increased of NOx, RSNO and decreased of ADMA, SDMA in male as well as in female pts. Those positive changes in endothelial function were associated with significant improvement in exercise capacity. Some higher percentage of NOx and RSNO increase in women suggests that they have more pronounced benefit of exercise training than men.

Funding Acknowledgement

Type of funding source: None

P197 Assesment of cardiac function during trastuzumab therapy in HER2 positive breast cancer patients

Background

Although trastuzumab has benefits in treatment of HER2 positive breast cancer, it also carries the risk of cardiotoxicity. It is very important to evaluate the cardiac status before and after therapy with trastuzumab, as well as monitoring of electrocardiografic and echocardiographic parameters.

The aim of this study was to assess of cardiac function during trastuzumab therapy in HER2 positive breast cancer patients.

Method

Ninety six HER2 positive female breast cancer patients (mean age, 59.57 ± 9.6 years) were enrolled in the study. At the time, they were on sequential therapy with anthracyclines (IV to VI cycles) within the FAC regimen (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2) on day 22, and after that trastuzumab therapy (6 mg/kg of body weight on day 21, for the period of one year). In all patients (pts) blood pressure (BP), heart rate (HR), electrocardiografic and echocardiographic parameters (left ventricular ejection fraction–LVEF(%); fractional shortening–FS(%); end-diastolic diameter–EDD(mm); left ventricular mass – LVM (g)) were assesed at the beginning and after the therapy with trastuzumab.

Results

There was no significant changes in arterial BP before and after trastuzumab in examined pts (systolic BP119.90 ± 16.04 mmHg vs 121.30 ± 13.06 mmHg; diastolic BP 75.89 ±7.25 mmHg vs 76.30 ± 7.65 mmHg) ns and HR (68.78 ± 7.69/min vs 67.92 ± 7.90/min) ns. All pts at the beginning and after the last therapy with trastuzumab on the electrocardiogram (ECG) were in sinus rhythm, one pts has LBBB and one RBBB. During therapy ectopic beats were registred in 11 pts, SVES in 7 (7.29%), VES in 4(4.16%). In the most of this patients with PSR in the middle of treatment period with trastuzumab sinus tachycardia was recorded as well. At the end of trastuzumab therapy in examined group LVEF was decreased by 1.73% (from 65.49 ± 5.82% to 63.76 ± 6.43%; p = 0.007), FS by 0.86% (from 36.18 ± 5.10% to 35.32 ± 4.91%; p = 0.123) ns, EDD increased by 1.26 mm (from 47.53 ± 4.48 mm to 48.80 ± 5.19 mm; p = 0.005) and LVM increased by 173.68 g (from 161.55 ± 43.76 g to171.15 ± 47.88 g; p = 0.031). Cardiotoxicity is registred in 4 (4.17%) patients, according to the criteria of EACVI and ASE.

Results

Tratsuzumab has not significant effect on BP and ECG changes.The rate of cardiotoxicity after trastuzumab therapy was low and was expressed through reduction of left ventricle ejection fraction, the increase in the end-diastolic diameter and the left ventricular mass.

P638High intensity interval exercise training improves endothelial function in patients with heart failure with preserved ejection fraction

Background

Cardiac rehabilitation has traditionally invoved low-to moderate intensity continuous exercise training (MICT). There is growing evidence that high intensity interval exercise training (HIIT) shows similar or greater efficacy compared with MICT. However, the relationship between the training modality and its effects on endothelial function still remains to be elucidated.

Purpose

To evaluate the impact of high intensity interval exercise training versus low-to moderate intensity continuous exercise training on circulating blood markers of endothelial function: the stable end product of nitric oxide (NOx), S–nitrosothiols (RSNO–reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in patients (pts) with heart failure with preserved ejection fraction (HFpEF).

Methods

A total of 43 pts with HFpEF (mean age 57.5±6.8y) admitted at residential rehabilitation center were enrolled in the study. Patients were randomized to HIIT, (HIIT group, n=20) and MICT, (MICTgroup, n=23). At baseline and 3 weeks later, in all pts values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed.

Results

After 3 weeks NOx increased significantly in both groups: in HIITgroup (from 34.7±7.5 to 48.5±8.3 μmol/l, P<0.0001), in MICTgroup (from 35.0±9.5 to 42.5±10.0 μmol/l, P<0.05), and value of NOx after 3 weeks was higher in HIIT than in MICT group (P<0.05). Value of ADMA as well of SDMA decreased in both groups after 3 weeks, and this decrease was significant in HIIT group: ADMA in HIIT group (from 0.305±0.055 to 0.250±0.077 μmol/l, P<0.005) and in MICT group (from 0.325±0.069 to 0.280±0.140 μmol/l, ns); SDMA in HIIT group (from 0.285±0.050 to 0.240±0.060 μmol/l, P<0,005) and in MICT group (from 0.270±0.080 to 0.247±0.063 μmol/l, ns). Value of RSNO significantly increased in both groups, with higher increase in HIIT group: in HIIT group (from 3.0±1.5 to 5.1±1.7 μmol/l, P<0.001), in MICTgroup (from 3.2±1.7 to 4.5±2.3 μmol/l, P<0.05). Compared to the baseline, at the end of the study, exercise capacity (METs) was significantly higher in both groups (P<0.0001). Higher increase in METs in HIIT group during exercise training (by 39.8%), compared to increase in MICT group (by 27.2%), resulted in significantly higher exercise tolerance in HIIT than in MICT group at the end of the study (P<0.02). In both groups, adverse events during or after exercise training, were not occurred.

Conclusions

In pts with HFpEF high intensity interval exercise training as well as low-to moderate intensity continuous exercise training induced favorable modification of endothelial function, expressed through increase of NOx and RSNO, and decrease of ADMA and SDMA. More significant increase of NOx and RSNO, and significant decrease of ADMA and SDMA gives an advantage to HIIT over MICT exercise training in patients with HFpEF.

Wild fire impact on copper, zinc, lead and cadmium distribution in soil and relation with abundance in selected plants of Lamiaceae family from Vidlic Mountain (Serbia)

Fire has been considered as an improving factor in soil quality, but only if it is controlled. Severe wild fire occurred in the summer 2007 on the Vidlic Mountain (Serbia) overspreading a huge area of meadows and forests. Main soil characteristics and content of heavy metals (Cu, Pb, Cd, Zn) in different fractions obtained after sequential extraction of soil from post-fire areas and from fire non disturbed areas were studied. In four plant species of Lamiaceae family (Ajuga genevensis L., Lamium galeobdolon (L.) L., Teucrium chamaedrys L., Acinos alpinus (L.) Moench.), that grow in typical habitats of the mountain, distribution of heavy metals in aerial parts and roots was investigated too. For all samples from post-fire area cation exchange capacity and soil organic matter content are increased while rH is decreased. Fire caused slightly increased bioavailability of the observed metals but more significant rise happened in metal amounts bound to oxides and organics. The plants showed variable behavior. T. chamaedrys collected on the post-fire area contained elevated concentrations of all analyzed metals. A. alpinus showed higher phytoaccumulation for Zn and Cd, while the other two plant species for Pb and Cd in the post-fire areas.