ABSTRACTS
Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NWC)
Sessions Session I
20-21 April 2006, Hotel Okura, Amsterdam Sessie 1: Clinical Cardiology: Gender/Guideines
13.30
- 13.45 uur
DETERMINANTS OF DEPRESSIVE SYMPTOMS ARE DIFFERENT FOR HOSPITAUSED HEART FAILURE MEN AND WOMEN Ivonne Lesman-Leegte; Tiny Jaarsma; Robbert Sanderman*; Dirk J. van Veldhuisen Depts. Cardiology and Psychology*, University Medical Center Groningen / University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Purpose: A considerable number of cardiac patients, especially women with Heart Failure (HF) experience symptoms of depression. Depressive symptoms have a negative impact on the treatment of HF and are associated with mortality In this patient group. To intervene effectively, factors related to depressive symptoms need to be identified in male and female patients.
Methods: Depressive symptoms in 921 patients hospitalised for symptomatic HF (61% male; mean age 71 ± 11; mean LVEF 33% + 14, NYHA II-IV) were assessed by the Center for Epidemiological Studies-Depression scale (CES-D). Clinical and demographic variables and data on well being and compliance were collected from patient's chart, Interview and questionnaires. Two separate multivariable logistic regression analyses for men and women were performed.
Results: More than 40% of the patients had symptoms of depression (CES-D 216). Depressive symptoms were more common in women compared to men (46% vs 36%, p130 ms (Mmode), or a septal-to-lateral delay >65 ms (tissue Doppler Imaging). Furthermore, LV function and volumes and functional status were assessed at baseline and after long-term RV pacing.
diseases) with Implantable cardloverter/defibrlllator (ICD). Before ICD implantation and during follow up visitation the functional class of CHF was estimated and the intrinsic QRS duration was measured from the 12 lead ECG.
Results: At baseline all patients had preserved LV function, and in none of the patients LV dyssynchrony was present. However, after chronic RV pacing, 27 patients (49%) had developed LV dyssynchrony. Concomitantly, in these patients LV ejection fraction decreased significantly (from 48 + 7% to 43 ± 7%, p 140 ms and severe CHF (a III).
Conclusions: Chronic RV pacing can induce LV dyssynchrony in almost 50% of patients treated with atrioventricular node ablation for drug-refractory AF. The development of LV dyssynchrony was associated wlth deterioration in heart failure symptoms, systolic LV function and LV dilatation.
4
Nethcrlands Heart Journal, Volume 14, Number 5, May 2006
Cq)C
Sessie II: Heart Failure: Pacing/Resynchronisation
13.30
-
13-45
uur
THE SHORT-TERM FUNCTIONAL AND ECHOCARDIOGRAPHIC EFFECTS OF RIGHT VENTRICULAR OUTFLOW, APICAL AND COMBINED PACING ARE COMPARABLE: RESULTS OF THE PROUST STUDY R. van Tooren, M Stofmeel, J Kelder, C de Cock, W de Voogt, L van Erven, M Sedney, N van Hemel. On behalf of the PROUST investigators, Nieuwegein, NL.
Background: It is documented that right ventricular apical pacing (RVA) can provoke ventricular dysfunction. Right ventricular outflow (RVO) pacing or combined RVA and RVO pacing (RVC) might prevent this complication. The feasibility of alternative pacing sites was examined in the PROUST study.
Methods: A single blind, Dutch multi-center crossover pilot study with 2 month RVA, RVO and RVC pacing was carried out. Pts with persistent AF with 3rd natural or ablated AV block were included. After DDDR PM Implant,RVA was paced 2 months for stabilization. PM datalogging, quality of life (AQUAREL), 6 min walktest, echocardiography, chest X ray were made after consecutive study periods and medication was kept stable.
Reults: 36 pts (25 male), mean age 72 yrs, mean AF history 6.7 yrs, were included: 17 with LVEF>40%o, 19 with LVEF 120 msec. In contrast to what has been reported so far, QRS duration did not stabilize after surgery. The beneficial effect of pulmonary valve replacement on QRS duration was transient and QRS duration retumed to the preoperative value at a mean of 9 years.
6
Netherlands Heart Journal, Volume 14, Number 5, May 2006
C
Sessie III: Cardiomyopathy: Valvular Disease/Cong. Heart Disease
13.30
-
13-45
uur
LONGITUDINAL STRAIN OF THE RIGHT VENTRICULAR FREE WALL DECREASES WITH THE ELEVATION OF PULMONARY ARTERIAL PRESSURE AND RESISTANCE IN SYSTEMIC SCLEROSIS Ahmed A Hassan,, Jan Constandse, Madelon C Vonk, Madelijn H Sander, Arie P van Dijk Department of cardiology and reumatology, Radboud University Medical Center, Nijmegen, The Netherlands
Purpose: to assess right ventricular (RV) function using RV free wall Strain (S) and Strain rate (Sr) in systemic sclerosis (SSc) patients with pulmonary hypertension (PHT).
Methods: retrospective study in SSc patients, who underwent right heart catheterisation (RHC), the RV free wall was imaged in the 4chamber view using second harmonic imaging using Vivid 7. In the EchoPAC PC software package, 2D Strain was used for image analysis in the basal, middle and apical segments of the RV free wall. Longitudinal maximum strain (SL Peak G), maximum systolic strain rate (Sr Peak S), maximum early filling strain rate (Sr Peak E), late filling strain rate (Sr Peak A) and maximum transverse (radial) systolic displacement (DT Peak S) were derived. RV myocardial performance Index (RVMPI) was also measured. All patients underwent RHC measuring pulmonary arterial (PA) pressures, cardiac output and pulmonary vascular resistance (PVR). Results: 39 systemic sclerosis patients age 60 ±12 yr, 74°/o female, were investigated. PHT was present in 34 patients (mean PA pressure 38 * 13 mmHg) and absent in 5 patients (mean PA pressure 17 i 2 mmHg). There was a significant difference (p < 0.05) between the two groups with and without PHT in the measurements of the SL Peak G of the apical (-17 * 9,9 resp. -32 i 8,1), SL Peak G of the middle segment ( -19 +8,8 resp. -29 * 5,6) and RVMPI (0,47 i 0,22 resp. 0,25 *0,08). SL Peak G of the middle segment showed the strongest correlation with the PA systolic, diastolic and mean pressure (Spearman's rho was resp. 0,560, 0,648 and 0,597 p < 0,001). There was also a strong correlation with the PVR ( Spearman's rho =0,621 p < 0,001).
Conclusion: RV free wall longitudinal systolic function decreases with increasing afterload. Peak systolic strain (SL Peak G) of the middle segment of the RV free wall is strongly correlated with PA pressures and PVR and might be used for PA pressure estimation.
Sessie III: Cardiomyopathy: Vaivular Disease/Cong. Heart Disease
14.00
-
14.15
uur
LONG-TERM EFFECT OF PULMONARY VALVE REPLACEMENT ON QRS DURATION LQQOoterQ, HW Vliegen, F] Meijboom, AH Zwinderman, B) Bouma, BJM Mulder. Academic Medical Centre, Amsterdam, Erasmus Medical Centre, Rotterdam, Leiden University Medical Centre, Leiden.
Purpose: After pulmonary valve replacement, QRS duration decreases in patients with corrected tetralogy of Fallot. However it is unknown, if QRS duration stabilizes after this improvement. To analyze long-term course of QRS duration after pulmonary valve replacement in patients with a previous correction for tetralogy of Fallot. Methods: In a retrospective study, adult patients with a diagnosis of tetralogy of Fallot, who had undergone a first pulmonary valve replacement after initial total correction in childhood, were identified from the CONCOR registry. Digital stored ECG's were obtained for QRS duration. A mixed linear regression model was used to analyze the course of QRS duration over time and to identify risk factors for increase in QRS duration over time.
Results: In total, 99 patients (570/o Male, mean age at surgery 29+11 years) were identified. Mean follow-up after PVR was 5.2*3.8 years, and 75% of the patients were free from adverse events after 10 years. When QRS duration before surgery was lower than 120msec, no change in QRS duration was observed after surgery (mean increase 1.3 msec, p=0.65) and, afterwards, QRS duration remained stable over time (mean increase 0.01 msec per year,
p=0,98). In patients with a preoperative QRS duration of more than 120 msec, a mean decrease of 9.5 msec (p 120 msec. In contrast to what has been reported so far, QRS duration did not stabilize after surgery. The beneficial effect of pulmonary valve replacement on QRS duration was transient and QRS duration returned to the preoperative value at a mean of 9 years.
Sessie III: Cardiomyopathy: Valvular Disease/Cong. Heart Disease
13.45
-
14.00
uur
EPIDEMIOLOGY OF PULMONARY ARTERIAL HYPERTENSION IN PATIENTS WITH CONGENITAL HEART DISEASE MG] Duffleis, PM Engelfriet1, RMF Berger2, ET van der Velde3, P Bresser4, BJM Mulder'. 'De-partment of Cardiology and 4Department of Pul-monology, Academic Medical Center, Amsterdam; 2Department of Paediatric Cardiology, Univer-sity Medical Center Groningen; 3Department of Cardiology, Leiden University Medical Center.
Purpose: This study was designed to determine the prevalence and clinical characteristics of patients with pulmonary arterial hypertension (PAH) among adult patients with congenital heart disease included in a national registry. Methods: Patients with PAH associated were identified from the registry. Gender, age, and NYHA classification were recorded. PAH was defined as a systolic pulmonary arterial pressure (sPAP) above 40 mmHg, estimated by means of echocardiographical evaluation.
Results: The prevalence of PAH among all 5970 registered adult patients with congenital heart disease was 4.2%. Of 1824 patients with a sep-tal defect, 112 patients (6.1%) had PAH. Median age of these patients was 38 years (range 18-81 years, 40% male). Of these patients, 58% had the Eisenmenger syndrome. Of the females, 83% were in NYHA class II and III compared to 54% of the male patients (p=0.02). Female sex (Odds ratio= 1.5, p=0.001) and sPAP (Odds ratlo= 0.04, p
Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NWC)
Sessions Session I
20-21 April 2006, Hotel Okura, Amsterdam Sessie 1: Clinical Cardiology: Gender/Guideines
13.30
- 13.45 uur
DETERMINANTS OF DEPRESSIVE SYMPTOMS ARE DIFFERENT FOR HOSPITAUSED HEART FAILURE MEN AND WOMEN Ivonne Lesman-Leegte; Tiny Jaarsma; Robbert Sanderman*; Dirk J. van Veldhuisen Depts. Cardiology and Psychology*, University Medical Center Groningen / University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Purpose: A considerable number of cardiac patients, especially women with Heart Failure (HF) experience symptoms of depression. Depressive symptoms have a negative impact on the treatment of HF and are associated with mortality In this patient group. To intervene effectively, factors related to depressive symptoms need to be identified in male and female patients.
Methods: Depressive symptoms in 921 patients hospitalised for symptomatic HF (61% male; mean age 71 ± 11; mean LVEF 33% + 14, NYHA II-IV) were assessed by the Center for Epidemiological Studies-Depression scale (CES-D). Clinical and demographic variables and data on well being and compliance were collected from patient's chart, Interview and questionnaires. Two separate multivariable logistic regression analyses for men and women were performed.
Results: More than 40% of the patients had symptoms of depression (CES-D 216). Depressive symptoms were more common in women compared to men (46% vs 36%, p130 ms (Mmode), or a septal-to-lateral delay >65 ms (tissue Doppler Imaging). Furthermore, LV function and volumes and functional status were assessed at baseline and after long-term RV pacing.
diseases) with Implantable cardloverter/defibrlllator (ICD). Before ICD implantation and during follow up visitation the functional class of CHF was estimated and the intrinsic QRS duration was measured from the 12 lead ECG.
Results: At baseline all patients had preserved LV function, and in none of the patients LV dyssynchrony was present. However, after chronic RV pacing, 27 patients (49%) had developed LV dyssynchrony. Concomitantly, in these patients LV ejection fraction decreased significantly (from 48 + 7% to 43 ± 7%, p 140 ms and severe CHF (a III).
Conclusions: Chronic RV pacing can induce LV dyssynchrony in almost 50% of patients treated with atrioventricular node ablation for drug-refractory AF. The development of LV dyssynchrony was associated wlth deterioration in heart failure symptoms, systolic LV function and LV dilatation.
4
Nethcrlands Heart Journal, Volume 14, Number 5, May 2006
Cq)C
Sessie II: Heart Failure: Pacing/Resynchronisation
13.30
-
13-45
uur
THE SHORT-TERM FUNCTIONAL AND ECHOCARDIOGRAPHIC EFFECTS OF RIGHT VENTRICULAR OUTFLOW, APICAL AND COMBINED PACING ARE COMPARABLE: RESULTS OF THE PROUST STUDY R. van Tooren, M Stofmeel, J Kelder, C de Cock, W de Voogt, L van Erven, M Sedney, N van Hemel. On behalf of the PROUST investigators, Nieuwegein, NL.
Background: It is documented that right ventricular apical pacing (RVA) can provoke ventricular dysfunction. Right ventricular outflow (RVO) pacing or combined RVA and RVO pacing (RVC) might prevent this complication. The feasibility of alternative pacing sites was examined in the PROUST study.
Methods: A single blind, Dutch multi-center crossover pilot study with 2 month RVA, RVO and RVC pacing was carried out. Pts with persistent AF with 3rd natural or ablated AV block were included. After DDDR PM Implant,RVA was paced 2 months for stabilization. PM datalogging, quality of life (AQUAREL), 6 min walktest, echocardiography, chest X ray were made after consecutive study periods and medication was kept stable.
Reults: 36 pts (25 male), mean age 72 yrs, mean AF history 6.7 yrs, were included: 17 with LVEF>40%o, 19 with LVEF 120 msec. In contrast to what has been reported so far, QRS duration did not stabilize after surgery. The beneficial effect of pulmonary valve replacement on QRS duration was transient and QRS duration retumed to the preoperative value at a mean of 9 years.
6
Netherlands Heart Journal, Volume 14, Number 5, May 2006
C
Sessie III: Cardiomyopathy: Valvular Disease/Cong. Heart Disease
13.30
-
13-45
uur
LONGITUDINAL STRAIN OF THE RIGHT VENTRICULAR FREE WALL DECREASES WITH THE ELEVATION OF PULMONARY ARTERIAL PRESSURE AND RESISTANCE IN SYSTEMIC SCLEROSIS Ahmed A Hassan,, Jan Constandse, Madelon C Vonk, Madelijn H Sander, Arie P van Dijk Department of cardiology and reumatology, Radboud University Medical Center, Nijmegen, The Netherlands
Purpose: to assess right ventricular (RV) function using RV free wall Strain (S) and Strain rate (Sr) in systemic sclerosis (SSc) patients with pulmonary hypertension (PHT).
Methods: retrospective study in SSc patients, who underwent right heart catheterisation (RHC), the RV free wall was imaged in the 4chamber view using second harmonic imaging using Vivid 7. In the EchoPAC PC software package, 2D Strain was used for image analysis in the basal, middle and apical segments of the RV free wall. Longitudinal maximum strain (SL Peak G), maximum systolic strain rate (Sr Peak S), maximum early filling strain rate (Sr Peak E), late filling strain rate (Sr Peak A) and maximum transverse (radial) systolic displacement (DT Peak S) were derived. RV myocardial performance Index (RVMPI) was also measured. All patients underwent RHC measuring pulmonary arterial (PA) pressures, cardiac output and pulmonary vascular resistance (PVR). Results: 39 systemic sclerosis patients age 60 ±12 yr, 74°/o female, were investigated. PHT was present in 34 patients (mean PA pressure 38 * 13 mmHg) and absent in 5 patients (mean PA pressure 17 i 2 mmHg). There was a significant difference (p < 0.05) between the two groups with and without PHT in the measurements of the SL Peak G of the apical (-17 * 9,9 resp. -32 i 8,1), SL Peak G of the middle segment ( -19 +8,8 resp. -29 * 5,6) and RVMPI (0,47 i 0,22 resp. 0,25 *0,08). SL Peak G of the middle segment showed the strongest correlation with the PA systolic, diastolic and mean pressure (Spearman's rho was resp. 0,560, 0,648 and 0,597 p < 0,001). There was also a strong correlation with the PVR ( Spearman's rho =0,621 p < 0,001).
Conclusion: RV free wall longitudinal systolic function decreases with increasing afterload. Peak systolic strain (SL Peak G) of the middle segment of the RV free wall is strongly correlated with PA pressures and PVR and might be used for PA pressure estimation.
Sessie III: Cardiomyopathy: Vaivular Disease/Cong. Heart Disease
14.00
-
14.15
uur
LONG-TERM EFFECT OF PULMONARY VALVE REPLACEMENT ON QRS DURATION LQQOoterQ, HW Vliegen, F] Meijboom, AH Zwinderman, B) Bouma, BJM Mulder. Academic Medical Centre, Amsterdam, Erasmus Medical Centre, Rotterdam, Leiden University Medical Centre, Leiden.
Purpose: After pulmonary valve replacement, QRS duration decreases in patients with corrected tetralogy of Fallot. However it is unknown, if QRS duration stabilizes after this improvement. To analyze long-term course of QRS duration after pulmonary valve replacement in patients with a previous correction for tetralogy of Fallot. Methods: In a retrospective study, adult patients with a diagnosis of tetralogy of Fallot, who had undergone a first pulmonary valve replacement after initial total correction in childhood, were identified from the CONCOR registry. Digital stored ECG's were obtained for QRS duration. A mixed linear regression model was used to analyze the course of QRS duration over time and to identify risk factors for increase in QRS duration over time.
Results: In total, 99 patients (570/o Male, mean age at surgery 29+11 years) were identified. Mean follow-up after PVR was 5.2*3.8 years, and 75% of the patients were free from adverse events after 10 years. When QRS duration before surgery was lower than 120msec, no change in QRS duration was observed after surgery (mean increase 1.3 msec, p=0.65) and, afterwards, QRS duration remained stable over time (mean increase 0.01 msec per year,
p=0,98). In patients with a preoperative QRS duration of more than 120 msec, a mean decrease of 9.5 msec (p 120 msec. In contrast to what has been reported so far, QRS duration did not stabilize after surgery. The beneficial effect of pulmonary valve replacement on QRS duration was transient and QRS duration returned to the preoperative value at a mean of 9 years.
Sessie III: Cardiomyopathy: Valvular Disease/Cong. Heart Disease
13.45
-
14.00
uur
EPIDEMIOLOGY OF PULMONARY ARTERIAL HYPERTENSION IN PATIENTS WITH CONGENITAL HEART DISEASE MG] Duffleis, PM Engelfriet1, RMF Berger2, ET van der Velde3, P Bresser4, BJM Mulder'. 'De-partment of Cardiology and 4Department of Pul-monology, Academic Medical Center, Amsterdam; 2Department of Paediatric Cardiology, Univer-sity Medical Center Groningen; 3Department of Cardiology, Leiden University Medical Center.
Purpose: This study was designed to determine the prevalence and clinical characteristics of patients with pulmonary arterial hypertension (PAH) among adult patients with congenital heart disease included in a national registry. Methods: Patients with PAH associated were identified from the registry. Gender, age, and NYHA classification were recorded. PAH was defined as a systolic pulmonary arterial pressure (sPAP) above 40 mmHg, estimated by means of echocardiographical evaluation.
Results: The prevalence of PAH among all 5970 registered adult patients with congenital heart disease was 4.2%. Of 1824 patients with a sep-tal defect, 112 patients (6.1%) had PAH. Median age of these patients was 38 years (range 18-81 years, 40% male). Of these patients, 58% had the Eisenmenger syndrome. Of the females, 83% were in NYHA class II and III compared to 54% of the male patients (p=0.02). Female sex (Odds ratio= 1.5, p=0.001) and sPAP (Odds ratlo= 0.04, p
