A prospective longitudinal study of health-related quality of life and psychological wellbeing after an implantable cardioverter defibrillator in patients with genetic heart diseases

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NHMRC Project Grant National Heart Foundation Future Leader Fellowship

OnBehalf

Cardio Genomics Program

Introduction

Genetic heart diseases, often affecting young people, can be clinically heterogeneous and pose an increased risk of sudden cardiac death (SCD). The implantable cardioverter defibrillator (ICD) is a lifesaving therapy. Impact on prospective and long-term psychological and health-related quality of life (HR-QoL) after ICD implant in patients with genetic heart diseases is unknown.

Purpose

We aimed to investigate the psychological functioning and HR-QoL over time in patients with genetic heart diseases who receive an ICD and to identify risk factors for poor psychological functioning and HR-QoL.

Methods

A prospective longitudinal design was used. Patients diagnosed with a genetic heart disease for which they received an ICD, were eligible. Anxiety, depression, health-related quality of life and device acceptance were measured using validated questionnaires. Baseline surveys were completed prior to ICD implantation with five-year follow-up after ICD implant.

Results

Forty patients with an inherited cardiomyopathy or arrhythmia syndrome (mean age 46.3 ± 14.2 years; 65.0% males) were included. Mean psychological and HR-QoL measures were within normative ranges during follow-up. We observed significant overall improvements from baseline to first follow-up with variability increasing after 36 months. The presence of comorbidities predicted worse physical HR-QoL (p = 0.014). Other predictors were not statistically significant, although lower education and female gender seemed to be an interesting predictor for higher anxiety and less mental HR-QoL, and the presence of comorbidities for less physical HR-QoL.

Conclusion

While the majority of patients with a genetic heart disease adjust well to their ICD implant, a subset of patients experiences poor psychological and HR-QoL outcomes.

P6427Positive family history of cardiovascular disease and long-term outcomes after coronary artery bypass grafting in younger patients: a genetic paradox?

Background

Parental cardiovascular disease (CVD) is a known risk factor for premature CVD in both men and women. It is unknown whether a positive family history (PFH) of premature CVD also affects long-term outcomes after coronary artery bypass grafting (CABG).

Purpose

We estimated the prevalence of PFH of premature CVD in a large population of CABG patients younger than 60 years of age. We evaluated whether PFH is an independent predictor of survival and freedom from major adverse cardiac and cerebrovascular events (MACCEs) following CABG.

Methods

Data come from a prospective longitudinal study of first, non-emergent, CABG patients consecutively recruited at the Innsbruck Medical University between August 2001 and February 2018 (n=5389). Patients were followed up for a median of 8 years. From this study, 2553 patients with premature CAD undergoing CABG under the age of 60 years were identified. Self-reported PFH data was available for 99.3% of patients; n=2535 patients were eligible for these analyses. In line with the Framingham offspring study, a premature PFH of CVD was defined when a patient's father and/or mother experienced their first CV event at <55 (father) and <65 (mother) years of age, respectively. Adjusted multivariable Cox proportional hazards regression was used to assess the effect of PFH on overall and MACCE-free survival.

Results

Premature PFH was found in 54.2% of patients (n=1375). Within these patients, 66.1% had a father who experienced a premature CV event (n=909), 27.8% a mother (n=382) and 6.1% both a mother and a father (n=84). In the majority of cases the patient's parent had experienced a premature cardiac event (85.9%, n=1181), 14.1% of patients with PFH reported their parent(s) had a premature stroke (n=194). Patients with a PFH had lower rates of smoking, diabetes and renal disease but were more likely to be hypertensive. Following CABG, PFH was associated with improved long-term survival (adjusted HR, 0.66; 95% CI, 0.50–0.91; p=0.011) and MACCE-free survival (adjusted HR, 0.73; 95% CI, 0.68–0.89; p=0.01). Among the covariates adjusted for, age, diabetes, renal insufficiency, peripheral arterial disease, impaired left ventricular function, previous cerebrovascular events and previous mediastinal radiation were associated with poorer outcomes. In contrast, multiple arterial grafting by bilateral internal thoracic arteries improved both survival (adjusted HR, 0.52; 95% CI, 0.36–0.74; p<0.001), and MACCE-free survival (adjusted HR, 0.41; 95% CI, 0.31–0.54; p<0.001).

Conclusion

In this cohort of high-risk patients undergoing CABG under 60 years of age, PFH was highly prevalent. Whilst it is evident that a PFH increases the risk of requiring CABG at younger ages, this study shows that PFH is also, paradoxically, protective regarding long-term outcomes; PFH is associated with both improved overall and MACCE-free survival following CABG.

P1738Pre-hospital delay in patients with suspected myocardial infarction: a prospective observational study in the Russian Federation

Background

Russia has one of the highest mortality rates from cardiovascular disease (CVD) in the world. For patients with acute myocardial infarction (AMI), longer pre-hospital delays are associated with increased complications and mortality.

Purpose

Identify risk factors for prolonged pre-hospital delay and its components (patient decision time delay and transport time delay) in the Russian Federation for AMI patients.

Methods

A total of 1128 hospitalised patients with suspected AMI were recruited in a prospective observational study with a representative sample of suspected AMI patients from 16 hospitals in 13 regions of Russia. Data were collected from both patient questionnaires and clinical records, 251 patients were excluded due to missing data and/or having MI while already hospitalised (n=6). Pre-hospital delays analysed include total pre-hospital delay ≥2hrs, patient decision time (≥1 hr) and transport time (≥1). Logistic regression models were used to identify patient (sociodemographic, socioeconomic, previous medical history), symptom and admission related predictors of prolonged delays.

Results

The median total pre-hospital delay was 4.83 hrs (IQR 2.64–10.82), decision time 1.25 hrs (IQR 0.38–4.5), and transport time 2.03 hrs (IQR 1.23–4.5). No age or sex differences were found across total, decision or transport delay. The odds of admission within 2 hours from symptom onset (total prehospital delay) significantly decreased with poorer wealth status, indirect route to hospital (first medical contact elsewhere) and symptom onset between 12–6am. Additionally, taking aspirin was associated with lower odds of arriving within 2hrs. Whilst symptom presentation and co-morbidity was not significantly associated with total delay, patients who correctly associated symptoms to a heart problem were more likely to reach the hospital within 2 hours (OR1.65, 95% CI 1.03–2.62). Odds of transport delay >1hr were significantly greater for patients travelling indirectly but also significantly lower for male patients. Odds of decision time >1 hr were significantly greater among patients that did not attribute their symptoms to a heart problem and patients with symptoms starting overnight (12–6am). Sociodemographic, socioeconomic and comorbid status were not significantly associated with decision time.

Conclusion

Pre-hospital delay in the Russian Federation is protracted, particularly when patients travel indirectly to their definitive health facility. Symptom characteristics (time of onset and attribution to heart) are important for all components of pre-hospital delay in the Russian Federation. There is initial evidence that male patients experience reduced transport times, but further analyses are required to understand why. Tractable areas for improvement exist; reducing patient decision time and increasing use of EMS.

Acknowledgement/Funding

Ministry of Health and Care Services, Norway, Norwegian Institute of Public Health, The University of Tromsø - Norway, the Wellcome Trust

Abstract P6-06-04: Targeting replication stress in triple negative breast cancer treatment regimen: An emerging approach

Triple-negative breast cancers (TNBCs) represent aggressive heterogeneous subtype of breast cancer with poor clinical outcome. TNBCs have been reported to have high levels of replication stress due to i) various oncogene activations (C-myc or EGFR) ii) germline BRCA mutations iii) “BRCAness” in the absence of BRCA mutations in sporadic TNBCs. Replication stress is known to cause genomic instability, promote tumorigenesis and plays a critical role in therapy resistance in TNBCs. Therefore, targeting replication stress has emerged as an effective approach for better TNBC treatment through further downregulation of the remaining checkpoints to induce catastrophic failure of TNBC cells proliferation. Herein, we evaluated the anticancer efficacy of Carbazole Blue (CB), a synthetic analogue of Carbazole, on TNBC cells growth and progression. Our results demonstrated that CB inhibits short and long term viability of TNBC (MDA-MB-231, MDA-MB-468 and BT549) cells in a dose dependent manner without affecting normal mammary epithelial (MCF-10A) cells. In addition, CB treatment significantly reduced proliferation of TNBC cells, as evidenced by the BrdU proliferation assay. Consistent with this, our results further demonstrated that CB treatment induced G1/S cell cycle arrest and apoptosis in TNBCs. Importantly, systemic delivery of CB using nanoparticle-based delivery approach suppressed breast cancer growth without inducing toxicity, in preclinical orthotopic xenograft and PDX mouse models of TNBC. Furthermore, our gene microarray analysis revealed that CB treatment modulates the expression and activity of several genes known to be involved in DNA replication (CDC6, CDT1, MCMs, Claspin, POLE and PCNA) and associated DNA repair machinery such as (XRCC3, Exo1 and RAD51), which play pivotal roles in replication stress. Our results for the first time highlight the potential use of CB as a novel and potent therapeutic agent for treating TNBCs. As exploiting replication stress to treat cancer is gaining major interest, compound/s that may induce replication stress and inhibit DNA repair ability of cancer cells, has immense translational potential.

Citation Format: Rajamanickam S, Park JH, Bates K, Timilsina S, Eedunuri VK, Onyeagucha B, Subbarayalu P, Abdelfattah N, Jung KH, Favours E, Mohammad TA, Chen H-IH, Vadlamudi RK, Chen Y, Kaipparettu BA, Arbiser JL, Rao MK. Targeting replication stress in triple negative breast cancer treatment regimen: An emerging approach [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-06-04.

Abstract 1116: Targeting replication stress by carbazole blue- A novel strategy to treat triple negative breast cancers

Background: Triple-negative breast cancers (TNBC) are the most aggressive forms of breast cancer and almost 60% of patients with TNBCs develop chemo-resistance, leading to recurrence, poor prognosis and poor survival. TNBCs have been reported to have high levels of replication stress, which plays pivotal role in genomic instability, and therapy resistance. Targeting replication stress is an emerging approach for better TNBC treatment. Here, we evaluated the anticancer efficacy of carbazole blue (CB), a synthetic analogue of carbazole that we recently synthesized on TNBC cells growth and progression.

Experimental Design: The effect of CB on breast cancer growth was assessed in vitro as well as in orthotopic mouse xenograft and PDX-models of breast cancer. In addition, the therapeutic efficacy and safety of CB was determined in long term toxicity studies in mice and also in ex-vivo explants from breast cancer patients. The mechanism of action of CB was evaluated by performing gene expression, cell cycle, apoptosis and DNA repair studies as well as proteins involved in the above mentioned mechanisms.

Results: Our results demonstrated that CB inhibits short and long term viability of TNBC cells in a dose dependent manner without affecting normal mammary epithelial cells. We show that the systemic delivery of CB using nanoparticle-based delivery approach suppressed breast cancer growth without inducing toxicity in preclinical and PDX mouse models of triple negative breast cancer. Our long term toxicity studies reveled that CB treatment did not induce any toxicity in Balb/c mice. Using ex-vivo explants from breast cancer patients, we demonstrated that CB modulated breast cancer growth. Consistent with that, our results revealed that CB treatment induced G1/S cell cycle arrest and apoptosis in TNBCs. Interestingly, our gene expression analysis revealed that CB modulates expression and activity of several genes known to be involved in DNA replication and DNA repair machinery.

Conclusions: Our results for the first time showed the CB can serve as a novel and potent therapeutic agent for treating breast cancer in general and TNBC in particular. These findings highlight the potential of CB to be applied as a safe regimen for treating breast cancer patients. As exploiting replication stress to treat cancer is gaining major interest, compound/s that may induce replication stress and inhibit DNA repair ability of cancer cells, has immense translational potential.

Citation Format: Subapriya Rajamanickam, Kaitlyn Bates, Santosh Timilsina, JunHyoung Park, Benjamin Onyeagucha, Panneerdoss Subbarayalu, Nourhan Abdelfattah, Kwang Hwa Jung, Edward Favours, Tabrez A. Mohammad, Hung-I Harry Chen, Benny A. Kaipparettu, Yidong Chen, Jack L. Arbiser, Manjeet K Rao. Targeting replication stress by carbazole blue- A novel strategy to treat triple negative breast cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1116. doi:10.1158/1538-7445.AM2017-1116

Anaplasma phagocytophilum in central and western Wisconsin: a molecular survey

Anaplasma phagocytophilum is an obligate intracellular bacterium that is transmitted to humans through the bite of Ixodes spp. ticks, and causes a febrile disease known as human granulocytic anaplasmosis. The presence of A. phagocytophilum in Wisconsin white-tailed deer blood and in deer ticks was assessed using PCR and DNA sequencing. Sampling sites in the western part of the state (Buffalo County) and central region (Waushara, Waupaca, and Green Lake counties) were used. In Buffalo County, 5.6% of deer and 8.9% of ticks were infected. At Hartman Creek State Park (Waupaca County), 11.5% of ticks were infected, while the observed prevalence in deer from counties to the south of the park (Waushara and Green Lake) reached 19-26%. Based on 16S rRNA sequences, A. phagocytophilum strains associated and not associated with human infections were identified. Furthermore, two novel A. phagocytophilum variants were found in deer blood samples. Transmission of Lyme disease has been documented in both the Western and Central regions we sampled, and the presence of A. phagocytophilum in naturally occurring tick populations could present an additional risk of disease to humans that enter tick habitats.

Protein markers for Alzheimer disease in the frontal cortex and cerebellum

OBJECTIVE

To compare proteins related to Alzheimer disease (AD) in the frontal cortex and cerebellum of subjects with early-onset AD (EOAD) with or without presenilin 1 (PS1) mutations with sporadic late-onset AD (LOAD) and nondemented control subjects.

METHODS

Immunohistochemistry, immunoblot analysis, and ELISA were used to detect and assess protein levels in brain.

RESULTS

In EOAD and to a lesser extent in LOAD, there was increased amyloid beta (Abeta) deposition (by immunohistochemistry), increased soluble Abeta (by immunoblot analysis), and specific increases in Abeta40 and Abeta42 (by ELISA) in the frontal cortex and, in some cases, in the cerebellum. Surprisingly, immunoblot analysis revealed reduced levels of PS1 in many of the subjects with EOAD with or without PS1 mutations. In those PS1 mutation-bearing subjects with the highest Abeta, PS1 was barely, if at all, detectable. This decrease in PS1 was specific and not attributable solely to neuronal loss because amyloid precursor protein (APP) and the PS1-interacting protein beta-catenin levels were unchanged.

CONCLUSIONS

This study shows that in the frontal cortex and cerebellum from Alzheimer disease patients harboring certain presenilin 1 mutations, high levels of amyloid beta are associated with low levels of presenilin 1. The study provides the premise for further investigation of mechanisms underlying the downregulation of presenilin 1, which may have considerable pathogenic and therapeutic relevance.

DNA sequence and analysis of human chromosome 9

Chromosome 9 is highly structurally polymorphic. It contains the largest autosomal block of heterochromatin, which is heteromorphic in 6-8% of humans, whereas pericentric inversions occur in more than 1% of the population. The finished euchromatic sequence of chromosome 9 comprises 109,044,351 base pairs and represents >99.6% of the region. Analysis of the sequence reveals many intra- and interchromosomal duplications, including segmental duplications adjacent to both the centromere and the large heterochromatic block. We have annotated 1,149 genes, including genes implicated in male-to-female sex reversal, cancer and neurodegenerative disease, and 426 pseudogenes. The chromosome contains the largest interferon gene cluster in the human genome. There is also a region of exceptionally high gene and G + C content including genes paralogous to those in the major histocompatibility complex. We have also detected recently duplicated genes that exhibit different rates of sequence divergence, presumably reflecting natural selection.

The DNA sequence and comparative analysis of human chromosome 10

The finished sequence of human chromosome 10 comprises a total of 131,666,441 base pairs. It represents 99.4% of the euchromatic DNA and includes one megabase of heterochromatic sequence within the pericentromeric region of the short and long arm of the chromosome. Sequence annotation revealed 1,357 genes, of which 816 are protein coding, and 430 are pseudogenes. We observed widespread occurrence of overlapping coding genes (either strand) and identified 67 antisense transcripts. Our analysis suggests that both inter- and intrachromosomal segmental duplications have impacted on the gene count on chromosome 10. Multispecies comparative analysis indicated that we can readily annotate the protein-coding genes with current resources. We estimate that over 95% of all coding exons were identified in this study. Assessment of single base changes between the human chromosome 10 and chimpanzee sequence revealed nonsense mutations in only 21 coding genes with respect to the human sequence.

The DNA sequence and analysis of human chromosome 13

Chromosome 13 is the largest acrocentric human chromosome. It carries genes involved in cancer including the breast cancer type 2 (BRCA2) and retinoblastoma (RB1) genes, is frequently rearranged in B-cell chronic lymphocytic leukaemia, and contains the DAOA locus associated with bipolar disorder and schizophrenia. We describe completion and analysis of 95.5 megabases (Mb) of sequence from chromosome 13, which contains 633 genes and 296 pseudogenes. We estimate that more than 95.4% of the protein-coding genes of this chromosome have been identified, on the basis of comparison with other vertebrate genome sequences. Additionally, 105 putative non-coding RNA genes were found. Chromosome 13 has one of the lowest gene densities (6.5 genes per Mb) among human chromosomes, and contains a central region of 38 Mb where the gene density drops to only 3.1 genes per Mb.

The DNA sequence and analysis of human chromosome 6

Chromosome 6 is a metacentric chromosome that constitutes about 6% of the human genome. The finished sequence comprises 166,880,988 base pairs, representing the largest chromosome sequenced so far. The entire sequence has been subjected to high-quality manual annotation, resulting in the evidence-supported identification of 1,557 genes and 633 pseudogenes. Here we report that at least 96% of the protein-coding genes have been identified, as assessed by multi-species comparative sequence analysis, and provide evidence for the presence of further, otherwise unsupported exons/genes. Among these are genes directly implicated in cancer, schizophrenia, autoimmunity and many other diseases. Chromosome 6 harbours the largest transfer RNA gene cluster in the genome; we show that this cluster co-localizes with a region of high transcriptional activity. Within the essential immune loci of the major histocompatibility complex, we find HLA-B to be the most polymorphic gene on chromosome 6 and in the human genome.

Spatial pattern of microchannel formation in fused silica irradiated by nanosecond ultraviolet pulses

We present numerical simulations of propagation of ultraviolet pulses through fused silica using a model that allows for the accumulative action of compaction back on the light. Compaction-induced self-focusing causes the light field to develop into a pattern of hot spots around the incident aperture that correlates with the damage patterns observed during marathon experiments designed to determine the onset of microchannel formation.

Versatile polychromatic dynamic testbed for optical disks

A dynamic testbed for the evaluation of optical disks has been designed and constructed. The system is achromatic within the wavelength range 440-690 nm, allowing any light source in this range to be utilized for read-write-erase experiments. In addition, the system accepts disks with substrate thicknesses ranging from 0 to 1.7 mm. The polarization handling capabilities of the testbed are such that, with the turn of a knob, one can generate either linearly polarized or circularly polarized light at the disk surface. This feature permits the testing of both magneto-optical and phase-change disks, in addition to compact disks and digital versatile disks, without any modifications to the system. A leaky polarizing beam splitter (LPBS) has been specially designed and built for this tester. The LPBS allows continuous adjustment of the ratio between p- and s-polarized components of the reflected beam that reach the detectors. This feature is especially useful for magneto-optical disks, where one can achieve an optimum signal-to-noise ratio by adjusting the relative amounts of the two components of polarization at the detection module. Focus-error detection is based on the astigmatic method, and the primary track-error detection scheme is the push-pull method, although other focusing and tracking schemes may also be implemented. The rf data signal and the focusing and tracking servo signals are all derived from the same detectors, thus allowing the optical power returning from the disk to be used in its entirety for these multiple purposes. The detection channel consists of two high-speed quad detectors mounted on the two arms of a differential detection module. By combining the various outputs of these detectors it is possible to generate the astigmatic focus-error signal, the push-pull track-error signal, the differential magneto-optical readout signal, the conventional sum signal for phase-change disk readout, and the differential edge-signal for mark-edge detection on various types of optical media.

Costing and competition

Working for patients established a new system of contracts between providers and purchasers of healthcare, with prices based on full costs, avoiding cross-subsidization. The new regime necessitates greatly improved costing systems, to improve the efficiency of service provision by creating price competition between providers. Ken Bates and Stan Brignall argue that non-price competition also occurs, with providers 'differentiating' on quality of service/product, flexibility or innovation.

Characterization of a novel focusing/tracking technique with increased feedthrough immunity for optical-disk applications: the double-astigmatic method

The astigmatic-focusing/push-pull tracking-error detection method is an elegant and sensitive optical servo technique. Unfortunately the formation of error signals far from either line focus of the astigmat (for relaxing alignment tolerances and broadening the servo's acquisition range) gives rise to undesired diffraction effects in the focus servo channel owing to track crossings of the pregrooved disk by the optical stylus, especially if certain aberrations are present. These undesired effects are given several names: pattern noise, optical servo cross talk, and feedthrough. By combining two astigmatic lenses and their associated detectors, one can configure a differential variant of the astigmatic technique. This double-astigmatic method greatly reduces pattern noise caused by the presence of spurious astigmatism oriented with its line foci at ±45° to the disk tracks. In this paper we present numerical modeling and experimental data that demonstrate the effectiveness of this focusing/tracking technique in feedthrough suppression.

Comorbid mental and substance disorders among older psychiatric patients

OBJECTIVE

To investigate the rate and configurations of current comorbid mental and substance disorders among older psychiatric patients.

DESIGN

A descriptive, retrospective study.

SETTING

A non-acute, public residential psychiatric treatment facility for adults 55 years of age and older (mean length of stay: 3 months).

PATIENTS

128 patients discharged during a 2-year period.

MEASURES

DSM-III-R diagnoses, demographic and history data.

RESULTS

The overall prevalence rate of concurrent mental and substance disorders during the present treatment episode was 21%. This is comparable to the 6-month rate of 19.8% found in the Epidemiological Catchment Area Study among adults in treatment (all ages). Nearly 50% of the dually diagnosed subsample received more than two diagnoses, with 60% of the subsample receiving a personality disorder diagnosis. Concurrent affective, alcohol, and personality disorder diagnoses were common.

CONCLUSION

Older patients with comorbid substance-use and mental disorders may differ substantively from comorbid younger patients. Among older patients in an intermediate-term psychiatric facility, the triple occurrence of alcoholism personality disorder and depression was common.

Comparison of two oestrogen receptor assays in the prediction of the clinical course of patients with advanced breast cancer

We have examined two new oestrogen receptor (ER) assays--an enzyme immunoassay (EIA) and an immunocytochemical assay (ICA) in a large series of primary breast tumours to compare their potential as predictors of (1) response to endocrine therapy and (2) survival in patients developing advanced breast cancer. Response to endocrine therapy was categorised at 6 months (UICC criteria). ER-ICA appears the better predictor of response to endocrine therapy than ER-EIA. Combining ICA and EIA results did not improve the prediction of response. With both assays patients with ER positive tumours survived longer from the time of diagnosis of advanced disease than those with ER negative tumours. The predictive power of these assay for progression of disease appears slightly better for the ER-ICA.