Abstracts

Posters

FEASIBILTY OF IMMEDIATE HOME BASED INTRA-VENOUS DIURETIC THERAPY IN NYHA CLASS III/IV CHF-PATIENTS H van de Weterinol, W Wijtenhorst', WJS Lourdtz', G Hoogvliet', F]M Bongers3. AW] van 't Hof'.I Dept of Cardiology, 2Dept of Transmural Care, Isala klinieken, Zwolle, 3General practitioner, Dalfsen. Purpose: To investigate the feasibility and effects of immediate home-based administration of intravenous [IV] diuretics by Advanced Practice Nurses [APN] or Clinical Nurse Specialists [CNS]. The intention is to replace the traditional hospitalisation and to improve Quality Of Life [QOL] in NYHA-class III/IV, Chronic Heart Failure

[CHF]pts. Methods: In a non-randomised, single centre design, CHF-pts with known aetiology and an indication for IV-diuretic treatment were screened in the emergency room. Pts who met the in- and exclusion criteria and gave their informed consent received immediate homebased IV-therapy. In case of deterioration of the CHF-situation, after successful initial treatment, pts received repeated home-based IVtherapy until six months after inclusion. Two weeks after initial treatment and two-monthly thereafter, or more frequent when needed, the effect of the medication regime was reassessed and education and support was given to optimise the CHF-situation on the APN/CNS co-ordinated heart failure outpatient clinic. Additionally, 24/7 telephonic back-up by a senior cardiologist was available.

Results: Twenty-two pts (14 men, 8 women) were consecutively enrolled in the study. Mean age was 69 yrs (* 17). NYHA Class III: 73%, Class IV: 18%. Mean left ventricular ejection fraction was 25% (+ 12.5). The initial home-based treatment succeeded in 12 pts (55%). Mean duration of the initial home-based treatment was 8.1 (+ 3.6) days. Mean number of house calls was 9.9 (* 6.2). Eight pts had to be hospitalised; 5 due to insufficient response to the diuretic treatment and 3 for non-cardiac reasons. One pnt withdrew informed consent. Two pts died; one suddenly at home, probably due to cardiac arrest and one in hospital due to cardiogenic shock. The initial poor QOL, on the Minnesota Living with Heart Failure questionnaire, with a total score of 60 (37-70) (dimensions: physical 30.5 (24-34) and emotional 10 (5-15.5)), improved at the one month follow-up by 9.5 points (total score 52 (23-57.5), dimensions: physical 27 (11.5- 34.7) and emotional 12 (3-18)).

Conclusions: Immediate home-based administration of IV-diuretics by APN/CNS in CHF-pts is a feasible, patient friendly and safe alternative to the usual in-hospital care and has a positive effect on QOL. To assess efficacy, this pilot is now followed by a trial with randomisation to either hospital admission or home-based treatment.

THE YIELD OF MOLECULAR GENETIC TESTING IN PRIMARY ELECTRICAL HEART DISEASE Nynke Hofman, Irene M. van Langen, Hanno L. Tan, Marcel M.A.M Mannens, Arthur A.M. Wilde, Academic Medical Centre Amsterdam, Netherlands.

Purpose: The yield of molecular genetic testing in primary arrhythmia syndromes, including congenital long QT syndrome (LQTS), Brugada syndrome (BS) and Catecholaminergic polymorphic ventricular tachycardia (CPVT). Methods and results: In 1996-2003, we counseled 158 probands with a clinical diagnosis of primary electrical heart disease in our outpatient cardiogenetic clinic. In 51% (n=80) a molecular diagnosis was made: LQTS 61% (60/98), BS 37% (13/41), CPVT 32% (7/19). In these families, mutation screening was performed in 659 relatives; 381 relatives could be reassured, while the familial mutation was identified in 278 (3.5 per family). After establishing the genotype, presymptomatic treatment (drugs, pacemaker, ICD) was initiated in 196 of 278 mutation carriers (70%). In the remaining mutation carriers, treatment was not started for various reasons, among which age. In familial cases (>1 affected individual or a family history of young unexplained sudden death), the diagnostic yield in LQTS probands was 89% (48/54), in BS probands 38% (6/16) and in CPVT probands 86% (6/7). In isolated cases these numbers were 27% (12/44), 28% (7/25) and 8% (1/12), respectively. In typical cases of LQTS probands (prominent QT prolongation and typical symptoms or family history); the yield was 76% (53/70), but only 25% (7/28) in atypical cases. Sensitivity and specificity of the electro-cardiographic test to predict the genotype was measured in relatives: they vary between 70% and 90% in the various diseases.

Conclusions: Genetic testing in suspected primary electrical heart disease probands reveals a molecular substrate in 61% (LQTS), 37% (BS) and 32% (CPVT). In contrast to isolated cases the yield in familial cases is almost 90% in LQTS and CPVT and 40% in BS. Sensitivity and specificity of electro-cardiographic appearance is over 70% in all disease (sub) entities. Cascade screening results in identification of a mean of 3.5 mutation carriers per family allowing for timely treatment.

8

BREAST ARTERIAL CALCIUM IS NOT ASSOCIATED WITH CORONARY HEART DISEASE RISK FACTORS, BUT WITH PREGNANCY AND LACTATION Angela H.E.M. Maas, MD *, Yvonne T. van der Schouw, PhD l, David Beijerinck,MD 2, Jan J.Deurenberg, MD, PhD 2, Willem P.Th.M.Mali, MD, PhD 3, Yolanda van der Graaf, MD, PhD I *Department of Cardiology, Isala klinieken, Zwolle ' Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. 2 Preventicon Breast Cancer Screening Center, Utrecht 3 Department of Radiology, University Medical Center Utrecht. Purpose: Caicifications in arteries are closely related to age and atherosclerotic disease, while the aetiology and clinical significance of calcification in the arterial wall in mammograms is yet unresolved.

Materials and methods: The presence of breast arterial calcium (BAC) was studied in mammograms of 1736 participants within the European Prospective Investigation into Cancer and nutrition cohort (Prospect-EPIC), a breast cancer screening population of women aged 49-70 years. Cardiovascular risk factors and reproductive factors were examined for their independent effect on the prevalence of BAC. Results: BAC was present in 194 of 1736 women (11%) and increased with age to 20 % in the highest quartile of age (mean 66 years). The OR was 4.7 in the highest vs lowest quartile of age (95% CI 2.9-7.6). After adjustment for age, no significant association was found between BAC and traditional cardio-vascular risk factors. BAC was prevalent in 2.5 % of nulliparous women, in 9 % of women with 1 or 2 children and in 17 % of women with 3 or more children (OR 7.2 95% CI, 2.9-18.0). Breastfeeding after pregnancy was also significantly associated with BAC in women who ever were pregnant (OR 2.2, 95% CI 1.4-3.6) (table).

Conclusion: Calcifications in the arteries on mammograms are strongly and independently associated with increasing age, pregnancy and lactation, but not with traditional cardiovascular risk factors. Veriabe, .4ueodfora Psrous yes 1-2 children 2 3 children

OR

95% ci

5.3

2.2-13.2 1.9- 12.0 2.9-18.0

4.8 7.2

Breastfeeding,yes

2.2

1.4 - 3.6

Hypertension

0.9

0.6 -1.3

LDL- Chdoester

1.1

0.7 1.8

COMPROMISED LCAT FUNCTION IS ASSOCIATED WITH INCREASED ATHEROSCLEROSIS G. Kees Hovingh, Barbara A. Hutten, Adriaan G. Holleboom, Patrick Rol, Anton Stalenhoef, Aeilko H Zwinderman, Eric De Groot, John 1P. Kastelein, And Jan Albert Kuivenhoven. Departments Of Vascular Medicine And Clinical Epidemiology And Biostatistics, Academic Medical Center, Amsterdam, The Netherlands; Department Of Medicine, University Medical Centre Nijmegen, The Netherlands. Purpose: Prospective epidemiological studies have shown that low plasma levels of high-density lipoprotein cholesterol (HDL-c) are associated with an increased risk for cardiovascular disease (CVD). Despite nearly 40 years of research, it is, however, unclear whether this also holds true for individuals with severely reduced levels of HDL-c due to mutations in lecithin:cholesterol acyltransferase (LCAT). Better insight into CVD risk in these individuals may provide clues toward the potential of LCAT as a pharmaceutical target to raise HDL-c levels.

Methods: Lipids, lipoproteins, CRP, and carotid artery intima media thickness (IMT) were determined in 47 heterozygotes for LCAT gene mutations and 58 family controls. Results: Compared to controls, the heterozygotes presented with a mean 36% decrease in HDL-c levels (p15mm (3.6% vs. 1.9%, p=0.06), with Killip class >1 at presentation (6.0% vs. 2.5%, p=0.01), with pre-PCI TIMI flow

Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NVVC): 21-22 April 2005, Hotel Okura, Amsterdam, Part I.

Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NVVC): 21-22 April 2005, Hotel Okura, Amsterdam, Part I. - PDF Download Free
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