Abstract ID: 39 - nbcc2019.org · All patients participated in the long-term training and monitoring program and had four visits to cardiologist and participated in 4 training modules

Abstract ID: 39

Presentation type(s): Poster, clinical research

Pharmacogenomics of antithrombotic drugs – a novel study design and data collection approach using Finnish biobank data and national registries

Anna-Leena Vuorinen, Smart health, VTT Technical Research Centre of Finland Ltd, Tampere, Finland

Jaakko Lähteenmäki, VTT Technical Research Centre of Finland Ltd, Espoo, Finland, Mika Lehto, Hospital District of Helsinki and Uusimaa, Helsinki, Finland, Kari Harno, University of Eastern Finland, Kuopio, Finland, Maija Wolf, Medaffcon Oy, Espoo, Finland, Mikko Niemi, University of Helsinki, Helsinki, Finland

Aim: With aging population, the need for individualised antithrombotic treatments will expand. Pharmacogenetic studies have established associations between a number of genetic variants and adverse drug responses with antithrombotic drugs. This abstract presents the design of a register linkage study which aims to investigate the clinical and economic feasibility of using genomic data in the context of antithrombotic drug therapy. Methods: This is a retrospective cohort study linking data from three Finnish biobanks (Helsinki Biobank, Auria Biobank and THL Biobank), national registries of National Institute of Health and Welfare (THL) and the Social Insurance Institution (Kela), and laboratory databases to investigate the feasibility of using genotype data in antithrombotic therapy. Based on earlier research, data regarding 23 genetic variants will be used for the analyses. Genotype data generated within the FinnGen project and scheduled to be available for biobank research during 2019 will be used. Individuals with and without specific variant alleles are compared in respect to their response to warfarin therapy measured by the incidence of bleeding complications and the time in therapeutic range (TTR) parameter. Individuals are also analysed in relation to other clinical outcomes and healthcare encounters, and possible interactions with other drugs. Furthermore, the explorative part of the study will employ data-driven classification methods to investigate genotype-phenotype associations for a larger group of antithrombotic drugs, including direct oral anticoagulants, clopidogrel and heparins. Results: Data permit applications to the registry holders have been submitted during the first quarter of 2019. The first results are expected to be available during 2019. The early estimate on sample size indicates that by combining data from three biobanks approximately 2600 adults with genotype data will be available which suffices the predefined power for the study. Beyond the clinical results, the study sheds light on the process of combining data from several biobanks. Such information is expected to be valuable for the ongoing development of centralized register data and biobank services in Finland. Conclusions: The study increases the understanding of pharmacogenomics of antithrombotic drugs in the Finnish population and assesses the need for genotype-guided therapy to improve the outcomes of antithrombotic therapies.

Abstract ID: 40

Presentation type(s): Poster, basic science

Role of melatonin receptors in its antiarrhythmic effects in myocardial ischemia/reperfusion

Jan Azarov, Department of Cardiac Physiology, Institute of Physiology, Komi ScC, RAS, Syktyvkar, Russian Federation

Olesya Bernikova, Institute of Physiology, Komi ScC, RAS, Syktyvkar, Russian Federation, Sergey Kharin, Institute of Physiology, Komi ScC, RAS, Syktyvkar, Russian Federation, Marina Vaykshnorayte, Institute of Physiology, Komi ScC, RAS, Syktyvkar, Russian Federation, Emiliano Diez, National University of Cuyo, Mendoza, Argentina, Ksenia Sedova, Department of Biomedical Technology, Czech Technical University in Prague, Kladno, Czech Republic

Aim. Melatonin is positioned as a promising cardioprotective medication, whose action is thought to be mediated by its antioxidative properties. On the other hand, a role of signaling pathways via MT1/MT2 receptors in the antiarrhythmic effects of melatonin is largely unknown. We aimed at evaluation of a role of MT1/MT2 receptors in melatonin action on myocardial spatiotemporal electrophysiological parameters and ventricular tachyarrhythmia incidence in the experimental ischemia/reperfusion model. Methods. Experiments were performed in 50 anesthetized open-chest rats. Activation and repolarization parameters were determined in 64 epicardial leads arranged in a rectangular 8*8 grid. Unipolar electrograms were recorded in a baseline state, during 5-min left anterior descending coronary artery occlusion and subsequent 10-min reperfusion. Activation time (AT) and end of repolarization time (RT) were measured as dV/dt minimum during QRS complex and dV/dt maximum during T wave, respectively. Dispersion of repolarization (DOR) was measured as a difference between the minimal and maximal RTs. The animals were divided into four groups depending on a substance administered intravenously prior to the reperfusion onset: 1) Control (C, saline, n=17); 2) Melatonin (M, melatonin 4 mg/kg, n=12); 3) Luzindole, a MT1/MT2 receptor blocker (L, luzindole 0.4 mg/kg, n=10); 4) Melatonin plus luzindole (ML, melatonin 4 mg/kg, luzindole 0.4 mg/kg, n=11). Results. Animals given melatonin demonstrated a lower incidence of reperfusion ventricular tachyarrhythmias as compared to controls (M 2/12; C 13/17; p<0.01). MT1/MT2 receptor block with luzindole abolished the antiarrhythmic effect of melatonin (L 6/10; ML 9/11). Ischemia induced local AT prolongation and DOR increase, whereas reperfusion caused opposite changes. The magnitude of these effects at the reperfusion phase prior to arrhythmia development differed between the studied groups: C – DOR: 12.5±4.3 ms, AT: 11.8±1.0 ms; M – DOR: 3.9±2.0 ms, AT: 11.2±1.6 ms; L – DOR: 10.9±3.6 ms, AT: 14.5±3.9 ms; ML – DOR: 5.1±2.3 ms, AT: 15.4±2.6 ms. The animals given melatonin either solely or in combination with luzindole (groups M and ML) demonstrated a lower (p<0.05) DOR as compared with C and L groups. The rats given luzindole (L and ML groups) had longer ATs than the animals from C and M groups (p<0.05). Conclusions. The results demonstrate that the MT1/MT2 receptor block deteriorated the reperfusion-related recovery of activation process, but did not affect DOR. However, this effect was sufficient to abolish the melatonin antiarrhythmic action, which was realized via receptor-dependent mechanism(s). This work was supported by the Russian Science Foundation (RSF 18-15-00309).

Abstract ID: 41

Presentation type(s): Poster, nursing

Quality of life of the Patients with Heart Failure (HF) involved in the Multidisciplinary Program

Rasa Paleckiene, Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Jurate Macijauskiene, Department of Geriatrics, Lithuanian University of Health Sciences, Kaunas, Lithuania, Diana Zaliaduonyte-Peksiene, Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania, Ausra Kavoliuniene, Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Aim: To determine the impact and effectiveness of a specialized service on the quality of life, clinical outcomes for patients with heart failure. Methods and materials: The data of 82 patients discharged from the Department of Cardiology of Lithuanian University of Health Sciences in 2017-2018 after worsening of HF (coded I50 according to ICD-10 (International Classification of the Diseases), chronic either decompensated or de novo cases) were analyzed. All patients participated in the long-term training and monitoring program and had four visits to cardiologist and participated in 4 training modules provided by a heart failure nurse. Sociodemographic, physical assessment data was collected using the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). It contained 21 items using a 6-point (zero to five) Likert scale, with a maximum score of 105. Lower scores indicate better QOL. Data was analyzed using SPSS 20 statistical package. Data was presented using descriptive statistics including frequency, percentage, mean with standard deviation (SD). The chosen significance level of p<0.05. Results: The mean age of the study population was 60±11.86 years. 72 (87.8%) persons were male. Arterial hypertension was presented in 60 (73.2%) patients, dyslipidemia in 48 (58.5%) patients. 31 (37.8%) patient had history of myocardial infarction, 14 (17.1%) - history of diabetes mellitus, 16 (19.5 %) were smokers and 30 (36.6%) - alcohol users. Overweight and obesity was diagnosed in 27 (32.9%) and 31 (37.8 %) patients, respectively. Clinical symptoms did not change statistically significant through the follow-up period (after four outpatient consultations): dyspnea (34.7% vs 25.3%, p=0.265), orthopnea (6.7% vs 4%, p=0.688), paroxysmal nocturnal dyspnea (18.9% vs 13.5%, p=0.481), fatigue/weakness (54.7% vs 44.0%, p=0.201), while heartbeat sensing decreased (40.0% vs 20.0 %, p<0.001). The changes of quality of life and clinical parameters are presented in Table 1 and 2. Conclusions: Significant improvement of health status and quality of life of heart failure patient was observed after the period of 4 outpatient consultations which were given by cardiologist and specialized HF nurse.

Abstract ID: 43


The validity of hospital discharge register data on Non-ST-Elevation and ST-Elevation Myocardial Infarction in Finland.

Marjo Okkonen, Research Unit of Internal Medicine, Oulu University Hospital, Oulu, Finland

Aki S. Havulinna, National Institute for Health and Welfare, THL, Helsinki, Finland, Olavi Ukkola, Research Unit of Internal Medicine, Oulu University Hospital, Oulu, Finland, Heikki Huikuri, Research Unit of Internal Medicine, Oulu University Hospital, Oulu, Finland, Matti Ketonen, North Karelia Central Hospital, Joensuu, Finland, Juha Mustonen, North Karelia Central Hospital, Joensuu, Finland, Juhani Airaksinen, Heart Center, Turku University Hospital, Turku, Finland, YA Kesäniemi, Research Unit of Internal Medicine, Oulu University Hospital, Oulu, Finland, Veikko Salomaa, National Institute for Health and Welfare, THL, Helsinki, Finland

Aim: To examine the validity of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) diagnoses in Finnish nation-wide hospital discharge register (HDR). Methods: In the first stage of the study, we sampled 180 patients treated in 1996-2012 for MI in three different hospitals, Oulu university hospital, Turku university hospital and North Karelia Central hospital, 60 patients in each hospital. A cardiology resident classified the patients on the basis of ECG finding into following categories: NSTEMI, STEMI or not classifiable myocardial infarction (NCMI). In the second stage of the study, we sampled altogether 270 additional patients i.e, 90 patients per hospital. Patients were treated between 2012-2014 for STEMI (n=3 x 30), NSTEMI (n= 3 x 30) and NCMI (n=3 x 30). The ECGs of these patients were independently evaluated by the cardiology resident and a senior cardiologist and compared with the HDR diagnosis. We also analyzed the sensitivity and specificity for STEMI and NSTEMI diagnoses in HDR compared with classification of the cardiology resident. Results: In the first stage of the study the agreement between the ECG coding of the cardiology resident and the HDR diagnoses was poor. Cohen’s kappa coefficient 0.38 (95% CI 0.10-0.32). In the second stage, the agreement remained at the same poor level. Cohen’s kappa =0.22 (95% CI 0.11-0.03). The agreement between the cardiology resident and the senior cardiologist was, however, good. Cohen’s kappa = 0.75 (95% CI 0.65-0.85). The overall sensitivity of HDR diagnoses compared with the classification of cardiology resident was low for both STEMI and NSTEMI. The Sensitivity and specificity for both stages of the study are shown in table 1. Conclusions: Our results show that the division of MI diagnoses to STEMI and NSTEMI is not reliable in the Finnish HDR. These diagnoses should not be used as outcomes in scientific research without additional verification from the original ECGs.

Abstract ID: 44

Presentation type(s): Case report

Power Cut - serious complication for LVAD patient

Marjo Okkonen, Research Unit of Internal Medicine, Oulu University Hospital, Oulu, Finland

Abstract ID: 45


Treatment trends and health-related quality of life outcomes in routine care of stable coronary artery disease

Harriet Stenvall, Cardiology, Helsinki University Hospital, Helsinki, Finland

Mika Laine, Cardiology, Helsinki University Hospital, Helsinki, Finland, Risto Roine, Helsinki University Hospital, Helsinki, Finland

Aim: To observe treatment trends, clinical outcomes and health-related quality of life (HRQoL) in routine care of stable coronary artery disease. Methods: Prospective, observational one-year follow-up of stable unselected coronary artery disease patients entering elective coronary angiography in 2002-2003 (cohort 1. n=300) or 2011-2013 (cohort 2. n=337). HRQoL determined with the 15D instrument at baseline and 6 months after undergoing treatment with either coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), or medical therapy (MT). Results: Patients underwent CABG significantly less often in the cohort 2. compared to cohort 1. (34 % vs. 18 %) whereas the use of both PCI and MT increased (PCI 31 % to 39 %, MT 35 % to 43 %, p<0.001). Patients in all treatment groups were older in cohort 2. (63.8 vs. 67.3 years, p<0.001). The prevalence of smoking decreased from 37 % to 15 %, p<0.001. Fewer patients in cohort 2. had a history of coronary artery disease (37 % vs. 52 %, p=0.001) or history of myocardial infarction (16 % vs. 37 %, p<0.001). The percentage of patients with previous PCI increased significantly from 14 % to 21 %, p=0.013. Guideline recommended optimal medical therapy (OMT) at discharge increased from 28 % to 44 %, p<0.001. In OMT treated MT patients HRQoL score improved over 6 months in cohort 2., whereas it detoriated in the earlier cohort 1. (p = 0.066). The baseline HRQoL score was higher in cohort 2. (0.812 vs 0.820, p=0.033). The improvement in the HRQoL score was greater during cohort 2. both in the PCI group (from 0.822 to 0.857 vs. 0.813 to 0.845) and in the CABG group (from 0.828 to 0 879 vs. 0.828 to 0.870) although the differences were not statistically significant. There was no difference in all-cause 12-month mortality between the cohorts (cohort 1. n=5 and cohort 2. n= 7, p =0.777). Conclusions: The number of patients treated with CABG declined over time in favour of PCI and MT. Patients in cohort 2. were older in all treatment groups and had equal or better HRQoL at baseline compared to cohort 1. Invasive treatment improved short-term HRQoL in both cohorts. The use of OMT at discharge was more prevalent in the later cohort.

Abstract ID: 46


The relationship between posttraumatic growth and cardiac rehabilitation (phase 2a and 2b) in patients with coronary artery disease

Tone Merete Norekvål, Heart Disease, Haukeland University Hospital, Bergen, Norway

Merete Drønen, Heart Disease, Haukeland University Hospital, Bergen, Norway, Trond Røed Pettersen, Haukeland University Hospital, Bergen, Norway, Bengt Fridlund, Haukeland University Hospital, Bergen, Norway, Irene Drotningsvik, Haukeland University Hospital, Bergen, Norway, Tore Wentzel-Larsen, Centre for mental health& Traumatic stress studies, Oslo, Norway

Aim: Struggling with major life crises can paradoxically result in positive psychological changes, identified as post traumatic growth (PTG). Knowledge about PTG in relation to patients with coronary artery disease (CAD) is scarce, and no study has scrutinized PTG after participation in a cardiac rehabilitation (CR) programme. Therefore, the aim of the study was to determine PTG changes in patients with CAD pre and post CR intervention, and 1 month thereafter, and whether the changes were stable after adjustment for clinical and sociodemographic characteristics. Method: An intervention study with a longitudinal follow-up of patients with CAD undergoing CR (phase 2a and 2b) was conducted in Western-Norway between 2013 and 2019. CR duration was three days a week for 5 weeks and consisted of individual and group-based psychosocial sessions, informational sessions, risk-factor management and exercise training. Patient-reported outcomes were collected at baseline, at end of CR and 1 month thereafter using the 10-item Post Traumatic Growth Inventory Short Form (PTGI-SF). Sum score was calculated by half rule, ranging from 0-100. Clinical characteristics were obtained at baseline and at the end of CR, and sociodemographic data were collected by self-report. Changes in total PTGI-SF score were assessed by mixed effects models by time, with adjustment for clinical and sociodemographic variables. The study was registered with ClinicalTrials.gov (NCT03810599). Results: In all, 884 patients were included in the study, of which 63 % had experienced a myocardial infarction (n=558), 80 % were men and mean age was 60 years (SD 9.9). Most were married (78 %) and living with their spouse/cohabitant (76 %). PTG was positively related to CR, as PTG increased by 5 % during 5 weeks of CR (p<0,001). However, PTG decreased slightly one month thereafter to 2.5 % (p<0,001). Nevertheless, PTG scores were still better than baseline (p<0,001). There was no significant relation between PTG and sex, cohabital status or age, but a lower educational level was found to be positively associated with PTG (p<0.001). Conclusion: Focusing on positive psychological outcomes in CR can enhance PTG in patients with CAD. Investigating associations with general and cardiac health, as well as the development of PTG in the long term, is a path for future research.

Abstract ID: 49


Outcomes and treatment approach to venous thromboembolism in cancer patients

Valdis Gibietis, Department of Internal Medicine, Riga Stradins University, Riga, Latvia

Dana Kigitovica, Riga Stradins University, Riga, Latvia, Sintija Strautmane, Riga Stradins University, Riga, Latvia, Kitija Meilande, Riga Stradins University, Riga, Latvia, Verners Roberts Kalejs, Riga Stradins University, Riga, Latvia, Anastasija Zaicenko, Riga Stradins University, Riga, Latvia, Kristine Make, Riga Stradins University, Riga, Latvia, Andris Skride, Riga Stradins University, Riga, Latvia

Aim. To assess the impact of treatment approaches and pulmonary embolism (PE) clot location on the outcomes of patients with venous thromboembolism (VTE) and cancer. Methods. The prospective cohort study included consecutive patients in a single centre from June 2014 till April 2018 presenting with venous thromboembolism confirmed by imaging tests. All patients were followed up for at least 90 days or till death. Active cancer was defined as newly diagnosed cancer, metastatic disease or cancer undergoing treatment. Central PE – emboli in central, main, lobar pulmonary arteries; peripheral – segmental, subsegmental. Results. The observational study included 341 patients, 96.5% (n=329) had pulmonary embolism (PE), 12 had isolated deep vein thrombosis. Active cancer was present in 10.3% (n=35). Most prevalent primary cancer sites were colorectal – 20.0% (n=7); lung – 17.1% (n=6); prostate – 11.4% (n=4); 60% (n=21) had metastases. Median follow-up was 363 days. Mortality in cancer patients was 68.6% vs 18.0% in patients without cancer, p<0.001, HR 6.09 (95% CI 3.74-9.93). Central PE was present in 76.5% of patients with cancer vs 61.0% without cancer, p=0.078. Clot location of PE was not associated with mortality (p=0.722). Among patients who received long-term anticoagulation (>10 days), selection of drug class was similar regardless of the presence of cancer (p=0.223) – direct oral anticoagulants (DOACs) were administered to 65.4% of these patients with cancer vs 67.0% in non-cancer patients; long-term low-molecular-weight heparins were used in 15.4% vs 6.6%, respectively. Mean estimated survival time in cancer patients was 270 days (95% CI 155-385) vs 1123 days (952-1293) in non-cancer patients, p<0.001. In cancer patients, death rates were similar among anticoagulant classes (p=0.394). Recurrent VTE was numerically more prevalent in patients with cancer – 11.4% (n=4) vs 3.6% (n=11), p=0.056. Rate of major or clinically relevant non-major bleeding was similar in both groups, p=0.776. Conclusions. Mortality rate in patients with active cancer and venous thromboembolism is high. Clot location in PE or selection of long-term anticoagulant class was similar to non-cancer patients and did not seem to affect mortality in cancer patients. Contradictory to guidelines, most cancer patients received DOACs in long-term treatment. VTE recurrence rate tended to be higher in cancer patients.

Abstract ID: 50


Results of Coronary Artery Bifurcation Treatment Registry. Latvian Center of Cardiology

Ilja Podolskis, Faculty of Medicine, University of Latvia, Riga, Latvia

Arnis Laduss, Faculty of Medicine, Riga Stradins University, Riga, Latvia, Evija Camane, University of Latvia, Riga, Latvia, Gustavs Latkovskis, Paul Stradins Clinical University Hospital, Riga, Latvia, Andrejs Erglis, Paul Stradins Clinical University Hospital, Riga, Latvia, Karlis Trusinskis, Paul Stradins Clinical University Hospital, Riga, Latvia, Ainars Rudzitis, Paul Stradins Clinical University Hospital, Riga, Latvia, Kristine Dombrovska, Paul Stradins Clinical University Hospital, Riga, Latvia, Andis Dombrovskis, Paul Stradins Clinical University Hospital, Riga, Latvia, Aigars Lismanis, Paul Stradins Clinical University Hospital, Riga, Latvia, Inga Narbute, Paul Stradins Clinical University Hospital, Riga, Latvia, Dace Sondore, Paul Stradins Clinical University Hospital, Riga, Latvia, Sanda Jegere, Paul Stradins Clinical University Hospital, Riga, Latvia, Ieva Briede, Paul Stradins Clinical University Hospital, Riga, Latvia, Indulis Kumsars, Paul Stradins Clinical University Hospital, Riga, Latvia

Aim. Percutaneous coronary intervention (PCI) for the treatment of coronary artery bifurcation lesions remains challenging and have a higher risk of procedural and in-hospital complications. The study compares frequency of PCI complications and assesses in-hospital outcomes of intervention with one-stent versus two-stent techniques for the treatment of true coronary bifurcation lesions. Methods. In this retrospective study, a total of 264 patients with true coronary bifurcation lesions (side branch diameter ≥ 2.5mm) were included (from January 1, 2017 till December 31, 2018). Patients with left main coronary artery stenosis and ST segment elevation myocardial infarction in the last 24 hours were excluded. The patients were divided into provisional one-stent group and systematic two-stent group. Main branch and side branch occlusions, periprocedural myocardial infarction (MI), perforation, cardiogenic shock, stroke, transistor ischemic attack (TIA), intraprocedural or in-hospital death, and stent thrombosis were compared between both groups. Postoperatively, routine creatine kinase MB fraction (CK-MB) tests were performed. Results. 225 (85%) patients underwent PCI using provisional one-stent technique and 39 (15%) with systematic two-stent technique. PCI complications were side branch occlusion (1-stent 1.8% (n=4) vs 2-stent 0% (n=0), p=0.401), periprocedural MI (1-stent 4.4% (n=10) vs 2-stent 5.1% (n=2), p=0.850) and vessel perforation (1-stent 0% (n=0) vs 2-stent 2.6% (n=1), p=0.016). In-hospital BARC bleeding type-2 was detected in 3 cases. No cases of main branch occlusion, cardiogenic shock, death, stent thrombosis, stroke or TIA were detected in both groups. Conclusions. This study demonstrates that there was no significant difference in procedural and in-hospital complication rates between provisional one-stent and two-stent groups undergoing PCI for the treatment of true coronary bifurcation lesions.

Abstract ID: 51


Preoperative physical activity and sleep profiles are associated with atrial fibrillation after cardiac surgery: Preliminary data from the PACO trial (NCT03470246)

Ville Vasankari, Heart Center, Kuopio University Hospital, KYS, Finland

Viivi Vilkki, Heart Center, Turku University Hospital, Turku, Finland, Jari Halonen, Heart Center, Kuopio University Hospital, Kuopio, Finland, Tarja Tuomainen, Heart Center, Kuopio University Hospital, Kuopio, Finland, Henri Vähä-Ypyä, UKK Institute for Health Promotion Research, Tampere, Finland, Kari Tokola, UKK Intitute for Health Promotion Research, Tampere, Finland, Samuli Jaakkola, Heart Center, Turku University Hospital, Turku, Finland, Vesa Anttila, Heart Center, Turku University Hospital, Turku, Finland, Juhani Airaksinen, Heart Center, Turku University Hospital, Turku, Finland, Tommi Vasankari, UKK Institute for Health Promotion Research, Tampere, Finland, Juha Hartikainen, Heart Center, Kuopio University Hospital, Kuopio, Finland

Aim: Atrial fibrillation (AF) is a common postoperative complication among patients recovering from cardiac surgery. We aimed to study whether accelerometer-derived preoperative physical activity (PA) and sleep profiles are associated with postoperative AF. Methods: This study is based on preliminary baseline data from the PACO trial (NCT03470246), a multicenter eHealth intervention study of cardiac surgery patients in the Heart Centers of Kuopio and Turku University Hospitals. Sixteen patients, scheduled for elective coronary artery bypass grafting, aortic valve replacement or/and mitral valve repair, were included. Preoperative PA and sleep profiles were monitored with triaxial accelerometer measurements (lasting ≥3 days) during the last preoperative month. Mean Amplitude Deviation and Angle for Posture Estimation –algorithms were then used to calculate the average daily step count and the average daily duration of deep sleep for each patient from raw acceleration data. The incidence of postoperative AF was assessed with 3-channel continuous electrocardiographic recordings in the postoperative ward. Mann-Whitney U –test was used to study the associations of PA and sleep profiles with postoperative AF. Results: A total of nine (60 %) patients developed AF after surgery. The patients with postoperative AF had on average 17 % lower preoperative daily step count than the patients without AF (4526 vs. 5468 steps, p=0.25, respectively). Furthermore, AF patients had on average 19 % lower preoperative daily duration of deep sleep than their non-AF peers (2 h 7 min vs. 2 h 37 min, p=0.41, respectively). Conclusions: Patients with postoperative AF had lower accelerometer-derived preoperative PA and daily duration of deep sleep than their non-AF peers, which is considered potentially relevant in designing preventive actions for postoperative AF. Novel research with more inclusive sample size is required to confirm these results.

Abstract ID: 52


Increased plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients with severe aortic stenosis.

Elisa Koljonen, Sydänkeskus, Kuopio University Hospital, Kuopio, Finland

Background: Calcific aortic valve disease (CAVD) is a slowly progressive disorder that ranges from mild valve thickening (aortic sclerosis) to severe calcification of valves ie. aortic stenosis. Aortic stenosis is the most common form of valvular heart disease and the second-leading cause of cardiovascular mortality, present in 2-4 % of people over the age of 65 years. Echocardiography is the key diagnostic tool in aortic stenosis. B-type natriuretic peptide (BNP) has been described as a potential indicator of disease severity in AS. Aim: To assess if fasting plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are associated with the development of CAVD. Methods: The study population consisted of three groups: aortic stenosis (mean age 77±8, n=73), aortic sclerosis (mean age 73±7, n=43), and control group (mean age 54±9, years n=89) groups. All patients had clinical evaluation and Doppler echocardiographic assessment. Aortic stenosis was defined as mean pressure gradient of >30 mmHg) and aortic sclerosis as peak pressure gradient of <25 mmHg and in healthy individuals the peak gradient had to be <10 mmHg. All participants provided written informed consent, and the study was approved by The Research Ethics Committee of the Northern Savo Hospital District. Overnight fasted plasma NT-proBNP levels were measured according to standard procedures. SPSS (version 25.0) was used for statistical analyses. Due to non-normality, fasting plasma concentration of NT-proBNP was transformed with the natural logarithm and the values were adjusted for age and sex. For the comparison of statistical significance one-way analysis of variance followed by a least significant difference (LSD) post hoc test. A P value of <0.05 was considered statistically significant. Correlations were estimated by using the Spearman correlation coefficient. Results: Plasma NT-proBNP levels were significantly elevated in patients with AS (1237 ng/l) compared to those with aortic sclerosis (324 ng/l; P<0.001) and healthy controls (65 ng/l; P<0.001), There was no significant change in NT-proBNP concentration between patients with aortic sclerosis and healthy individuals. The was a significant correlation between maximum pressure gradient and NT-proBNP (r=0.737, P<0.001). Conclusions: Patients with severe aortic stenosis or aortic sclerosis had significantly elevated NT-proBNP concentration. The values of NT-proBNP could be useful when evaluating which patient benefits from echocardiographic assessment.

Abstract ID: 53


Necklace-embedded ECG for detection of atrial fibrillation

Onni Santala, Doctoral School, University of Eastern Finland, Kuopio, Finland

Jukka Lipponen, Department of Applied Physics, University of Eastern Finland, Kuopio, Finland, Helena Jäntti, School of Medicine, University of Eastern Finland, Kuopio, Finland, Tuomas Rissanen, Heart Center, North Karelia Central Hospital, Joensuu, Finland, Jari Halonen, School of Medicine, University of Eastern Finland, Kuopio, Finland, Indrek Kolk, Heart Center, Kuopio University Hospital, Kuopio, Finland, Hanna Pohjantähti-Maaroos, Heart Center, Kuopio University Hospital, Kuopio, Finland, Eemu-Samuli Väliaho, Doctoral School, University of Eastern Finland, Kuopio, Finland, Tero Martikainen, Department of Emergency Care, Kuopio University Hospital, Kuopio, Finland

Aim: Atrial fibrillation (AF) is the major cause of stroke since approximately 20-25% of all strokes are cardioembolic origin. AF is often symptomless and intermittent, making its detection challenging. Wearable ECG devices could enable repetitive rhythm surveillance over a long term and thus improve the probability of AF detection. Wearable devices have the advantage of being easily available. However, they also need to be reliable and their design should appeal customers. Our aim was to study the suitability and reliability of novel measurement technique (necklace-ECG, Figure1) for the diagnosis of AF. Methods: The study population consisted of 90 adult volunteers (preliminary results) in Kuopio University Hospital emergency department (35 AF and 53 sinus rhythm (SR), two other rhythms (excluded), diagnosed from Holter-ECG). Thirty-second ECG was recorded with the necklace-ECG device placed between palms. Two cardiologists interpreted independently in a blinded fashion necklace-ECG recordings and Holter-ECG which served as golden standard for final rhythm diagnosis. Results: The quality of necklace-ECG was sufficient for cardiologists to make rhythm diagnosis in 89% (Doc1) and 85% (Doc2) of the cases. Cardiologist diagnosed correct rhythm from interpretable ECG’s in 28/28 (Doc1), 28/29 (Doc2) of AF subjects and 50/50, 46/46 of SR subjects. The automatic AF-detection algorithm found 90% of ECG recordings interpretable, resulting in AF detection sensitivity of 100% (28/28 AF) and specificity of 100% (51/51). Conclusions: The self-monitoring necklace-ECG device was able to produce ECG recording with sufficient quality for the detection of AF at good sensitivity and specificity as evaluated both by cardiologist and automated AF-detection algorithms. This wearable measuring device made for customers provides a new and easy method for screening, identifying and diagnosing AF.

Abstract ID: 55


The effects of AAV2VEGF-B186 on myocardial perfusion, ventricular function and neovascularization in the bottleneck stent model of chronic myocardial ischemia in the domestic pig

Jussi Nurro, A.I.Virtanen -Institute, University of Eastern Finland, Kuopio, Finland

Henna Korpela, University of Eastern Finland, Kuopio, Finland, Jaakko Lampela, University of Eastern Finland, Kuopio, Finland, Juho Pajula, University of Eastern Finland, Kuopio, Finland, Olli-Pekka Hätinen, University of Eastern Finland, Kuopio, Finland, Kaisa Valli, University of Eastern Finland, Kuopio, Finland, Jonna Räisänen, University of Eastern Finland, Kuopio, Finland, Tommi Heikura, University of Eastern Finland, Kuopio, Finland, Seppo Ylä-Herttuala, University of Eastern Finland, Kuopio, Finland

Aim: The aim of the study was to find out if novel self-complimentary adeno-associated viral (scAAV2) vector mediated VEGF-B186 gene transfer produces long and robust gene expression and how does it affect the ventricular function, myocardial perfusion and neovascularization in a large animal model. New large-scale manufacturing methods have made it possible to produce AAV vectors in large quantities for large animal studies and clinical trials. AAV vectors produce transgene expression in the tissue lasting for many months. If the transduction efficacy of this scAAV2 vector proves to be effective in the myocardium, in combination with an on/off switch mechanism for the transgene expression currently in the development, this gene therapy method might provide a very viable and controllable way to enhance myocardial function. Methods: The effects of the gene transfer were tested in the bottleneck stent model of chronic myocardial ischemia in the domestic pig (n = 24). In addition to the treatment VEGF-B186 group, LacZ and GFP marker gene groups were used as a control. The total dose of 10E13 viral genomes per animal was given as intramyocardial injections into viable myocardium around the ischemic regions using electroanatomical targeting. The gene transfer was made 2 weeks after the ischemia procedure. Follow up times were 4 weeks, 3 months and 6 months. A subgroup of animals was imaged with PET radiowater perfusion and FDG viability. Ejection fraction was used as a measurement of ventricular function and neovascularization was analyzed histologically. Results: Gene transfer with a marker gene showed that the AAV2 mediated transgene was expressed in the ischemic myocardium. In addition, AAV2 mediated VEGF-B186 gene transfer induced angiogenesis in the ischemic myocardium 4 weeks after the gene transfer. Data from longer timepoints, PET imaging and functional measurements are still currently underway. Conclusions: AAV2 mediated gene transfer with a high dose, comparable to those given earlier to rodents, seems to be safe. It provides a long term and robust gene expression. This study gives rationale for the development of new gene therapies with long expression times when a switch mechanism to turn the gene expression off and back on has been developed.

Abstract ID: 56


A comparative study of the angiogenic effects of VEGF-B and its isoforms

Henna Korpela, A.I. Virtanen Institute, Molecular Medicine, University of Eastern Finland, Kuopio, Finland

Olli-Pekka Hätinen, University of Eastern Finland, Kuopio, Finland, Pyry Toivanen, University of Eastern Finland, Kuopio, Finland, Rahul Mallick, University of Eastern Finland, Kuopio, Finland, Johanna Lähteenvuo, University of Eastern Finland, Kuopio, Finland, Seppo Ylä-Herttuala, University of Eastern Finland, Kuopio, Finland

Aim The aim of this study was to uncover the underlying mechanisms of vascular endothelial growth factor B (VEGF-B186) binding and to find out how its isoforms’ angiogenic effects differ. VEGF-B186 induces angiogenesis and increases perfusion in the myocardium, which would make it a potential candidate for myocardial gene therapy for coronary heart disease. The major reason for refraining from clinical trials is the elusive mechanism of action. VEGF-B186 splices into VEGF-B127 and binds to Neuropilin 1 (Nrp-1) and VEGF receptor 1 (VEGFR-1) but via this receptor binding profile the mechanism of angiogenesis is unexplainable. Methods We produced adenoviral (Ad) vectors containing different isoforms of VEGF-B that have different receptor binding profiles and studied their effects in normoxic and ischemic porcine myocardium. Adenoviral gene transfers were given endovascularly as intramyocardial injections into the porcine posterolateral wall of the left ventricle (n=20). Angiography was performed and ventricular function measured before the gene transfer and six days later. Myocardial perfusion was measured by positron emission tomography (PET) radiowater imaging from a subgroup of animals. Results AdVEGF-B186 and AdVEGF-B186R127S, which is unspliceable form of VEGF-B, induced angiogenesis in normoxic porcine myocardium increasing the microvascular area 1.9-fold in both groups (95% CI 1.4 to 2.3 and 1.3 to 2.5). AdVEGF-B127 had no angiogenic effects compared to control group. Results from PET perfusion and ischemic animals are still underway. Conclusions VEGF-B186R127S had a similar angiogenic effect as VEGF-B186 while the isoform VEGF-B127 had no angiogenic effect. Thus can be concluded, that VEGF-B186 is angiogenic only before splicing into VEGF-B127. This also implies, that the angiogenic effects of VEGF-B are not wholly mediated through the only currently known receptors, Nrp-1 and VEGFR-1, since their binding sites are in the VEGF-B127. Therefore, there must yet be an unknown receptor of VEGF-B that is responsible for the angiogenic effects.

Abstract ID: 57


Impact of the mechanical heart valve sound on symptoms of anxiety and depression.

Lena Dehli, Department of Intensive Care, University Hospital of North Norway, Tromsø, Norwa, tromsø, Norway

Tone Merete Norekvål, Haukeland University Hospital, Bergen, Norway., Bergen, Norway, Kjersti Oterhals, Haukeland University Hospital, Bergen, Norway., Bergen, Norway

Aim: Patients with symptomatic aortic valve stenosis are treated with surgical valve replacement, using either a biological or mechanical valve. The treatment is effective regarding symptoms of aortic stenosis. Still, for some patients with mechanical valve prosthesis, the metallic clicking sound may be problematic. The aim of the study was to investigate if the sound of the mechanical valve is perceived as disturbing, and the association between noise disturbance and symptoms of anxiety and depression. Methods: All patients who had undergone aortic valve replacement at one tertiary university hospital during 2000-2012 were invited by mail to participate in this cross-sectional study. Data were registered from the postal questionnaire and the hospital’s electronic patient data system. The primary variables were assessed using a valve specific questionnaire and the Hospital Anxiety and Depression Scale (HADS). Results: In all, 1191 patients were invited, and 912 (77%) completed the questionnaire. Of these, 245 patients had mechanical prosthesis. Twenty-four percent were women, the mean (SD) age was 61 (11) years, and the mean (SD) interval time since surgery was seven (3) years. The valve-specific questionnaire showed that 84% of the patients could sometimes or often hear the valve sound. The overall subjective disturbance measured by noise index from 0-10 (zero = no disturbance; 10 = strong disturbance) was 1.7 (SD 2.2), and six (2.6 %) patients had a noise index> 7.5. The perceived disturbance decreased by age and years since surgery. A total of 36 (15%) patients had HADS-anxiety score ≥8 indicating possible symptoms of anxiety, and 29 (12%) patients had HADS-depression score ≥ 8, indicating possible symptoms of depression. A moderate positive correlation was found between the valve noise disturbance and anxiety, r = 0.35 (p = 0.001), and between noise disturbance and depression, r = 0.27 (p = 0.001). There were no gender differences. Conclusion: This study shows a correlation between valve disturbance and symptoms of anxiety and depression, and highlights the importance of preparing all patients about the valve sound of the mechanical valves that occurs after surgery.

Abstract ID: 58


Evaluation of catheter ablation long term effectiveness in paroxysmal tachycardias (A single center experience in Latvia)

Rudolfs Vilde, Internal medicine, Riga Stradins University, Riga, Latvia

Kristine Jubele, Pauls Stradins Clinical University hospital, Riga, Latvia, Kaspars Kupics, Pauls Stradins Clinical University hospital, Riga, Latvia, Maija Baturevica, Pauls Stradins Clinical University hospital, Riga, Latvia, Zane Silina, Pauls Stradins Clinical University hospital, Riga, Latvia, Ginta Kamzola, Pauls Stradins Clinical University hospital, Riga, Latvia, Irina Cgojeva-Sproge, Pauls Stradins Clinical University hospital, Riga, Latvia, Sandis Sakne, Pauls Stradins Clinical University hospital, Riga, Latvia, Oskars Kalejs, Pauls Stradins Clinical University hospital, Riga, Latvia, Andrejs Erglis, Pauls Stradins Clinical University hospital, Riga, Latvia

Objectives Supraventricular paroxysmal arrhythmias are common heart rhythm disorders. Current treatment strategy consists of antiarrhythmic drug therapy and radio frequency catheter ablation as a first-line therapy. Aim The aim was to evaluate the effectiveness of RFCA, prevalence of adverse effects, cardiovascular events and change in self-assessed quality of life after the RFCA. Analysis of a single center experience. Methods 244 patients diagnosed with either AVNRT or WPW syndrome and hospitalized for RFCA from 10/2014 to 12/2016 were included. The study includes a retrospective data base analysis and consecutive follow-up and reevaluation of patients. Results 186 patients with AVNRT were included, 160(86%) of them were reached for follow-up. The number reporting symptoms decreased from 158(98.8%) prior the treatment to 44(27.5%) after treatment (p < 0.001). 58 WPW syndrome patients were included, 44(75.9%) reached for follow-up. Right side accessory pathway ablation was performed in 26, while left - in 31 cases. The number of patients reporting symptoms decreased from 43(97.7%) to 11(25%) after RFCA (p < 0.001). 3(6.8%) patients treated for WPW and 4(2.5%) AVNRT patients experienced relapses, which is compatible with major studies. The procedure was curative in 93.2% of the cases for WPW syndrome and 97.5% for AVNRT. Adverse effects were noticed in 8(5%) AVNRT patients with 3(1.9%) having AV conduction delay, 1(0.63%) requiring pacemaker. After RFCA for WPW syndrome, only 1 patient had minor complications. Cardiovascular events were registered in 7 cases. Self – assessed quality of life improved from 5(IQR 6-4) to 9(IQR 9-8) out of 10 among AVNRT (p < 0.001) and to 8.5(IQR 9-7) among WPW patients (p < 0.001). Conclusions The assessed efficiency, subsequent CVE and frequency of relapses coincides with the tendencies in major studies, shows better outcomes in safety and complication rate. The procedure can be said to be safe, effective, furthermore, it improves the health-related quality of life significantly. RFCA performance in the center is compatible with the other centers evaluated in published studies, surpasses them in periprocedural safety.

Abstract ID: 59


One-year clinical outcomes of thoracoscopic left atrium fragmentation for the patients with long-standing persistent atrial fibrillation

Sergey Vachev, Cardiac Surgery, Federal Research Clinical Center, Moscow, Russian Federation

Alexander Zotov, Federal Research Clinical Center, Moscow, Russian Federation, Margarita Stepanova, Federal Research Clinical Center, Moscow, Russian Federation, Olga Drobyazko, Federal Research Clinical Center, Moscow, Russian Federation, Alexander Troitskiy, Federal Research Clinical Center, Moscow, Russian Federation, Robert Habazov, Federal Research Clinical Center, Moscow, Russian Federation

Aim: The aim of the study was to assess the one-year results of a thoracoscopic epicardial left atrium (LA) fragmentation in patients with long-standing persistent atrial fibrillation (LSP AF). Methods: Between April 2017 and April 2018, 21 consecutive patients with LSP AF underwent a thoracoscopic epicardial LA fragmentation. There was no atrial flutter, sinus node weakness or previous transcatheter pulmonary vein isolation in our patients. The median AF duration before procedure was 75 months (range, 12-238 months). In the start of series, 5 patients underwent surgical ablation of AF with the thoracoscopic “box lesion” procedure (GALAXY). The MAPS device used to confirm the conduction block in each case. Incomplete block was detected in all 5 patients. That's why the GALAXY protocol was modified. The total number of ablation lines increased to 40 and the jaws of the ablation device inverted 4 times during procedure. This maneuver allows creating additional many times criss-crossed ablation lines. Thus, we made not only “box lesion”, but the fragmentation of the LA. LA appendage removed in all patients via stapler. Results: Postoperative course was uneventful in all patients. The median procedural time was 137 min (range, 118-193 min). One patient required the change of the antiarrhythmic therapy due to AF paroxysms at 90 days interval. In rest of our patients amiodarone was discontinued 3 months after the procedure. After 180 days all patients (100%) were in sinus rhythm, as documented by 24-hour monitor and antiarrhythmic therapy stopped. 12 months after procedure all patients examined. Only two patients, who does not follow recommendation about weight loss and arterial pressure stability return to atrial fibrillation, but into paroxysmal form. Conclusion: Multiple change of the ablation device position and increased number of ablations lead to achieve the fragmentation of the LA, not only “box lesion”. In the series of consecutive patients fragmentation of the LA allow to achieving complete isolation of the posterior wall of the LA and the ostia of the pulmonary veins with achievement of a blockage in 100% of patients. The fragmentation of the LA is an effective operation that provides absence of AF recurrence up to 12 months after procedure, without antiarrhythmic drugs in those patients, who follow the recommendation.

Abstract ID: 60


Systolic hypertension 10 years after treatment for native coarctation of the aorta in children – a population based study

Mari Ylinen, Pediatric Cardiology, Helsinki University Hospital, Children`s hospital, Helsinki, Finland

Jaana Pihkala, Pediatric Cardiology, Helsinki University Hospital, Children`s hospital, Helsinki, Finland, Jukka Salminen, Pediatric Cardiology, Helsinki University Hospital, Children`s hospital, Helsinki, Finland, Taisto Sarkola, Pediatric Cardiology, Helsinki University Hospital, Children`s hospital, Helsinki, Finland

Aim: Hypertension after coarctation of the aorta (CoA) repair has been reported to be common and related with diminished life-expectancy. We evaluated the prevalence of hypertension and associated perioperative factors 10 years after primary CoA-repair Methods: We collected the most recent blood pressure and growth data of the 304 patients with isolated native CoA treated either by surgery or cath at the Helsinki Children’s Hospital in 2000-2012 from patient records. Systolic blood pressure (SBP) z-scores were generated for children. Absolute blood pressure values were analyzed for young adults. Systolic hypertension was defined as systolic blood pressure ≥ +2SD for children and ≥ 140mmHg for adults. Arm-leg-SBP-gradients were calculated as the difference between right arm and ankle. Results: In all, we received the follow-up data of 278/304 (91,4%) patients originally treated by surgery (n=233) or balloon angioplasty/stent (n=33/12). The median follow-up time from first procedure was 9,6 years (range 3,3-18,1) and median age at follow-up was 11,6 years (range 3,3-29,5). Blood pressure medication was prescribed in 25/278 (9,0%) patients. Among <18y patients, median SBP was +0,8SD (-1,6-3,8) and 25/247 (10,1%) had SBP-hypertension. Among ≥18y median SBP was 135 mmHg (104-167) and 11/31 (35%) had SBP-hypertension. Hypertension was more common in later treated patients (≥10y, Figure). Further, in the SBP-hypertension group the patients were older (median 13,9 years, range 4,0-27,0) at last follow-up visit compared to those without hypertensive SBP (11,1 years, range 3,3-29,5, p<0,01). However, the duration from the first treatment was not associated with hypertensive SBP-values. Arm-leg-SBP-gradients at last visit were higher in those with hypertensive SBP (+0,37mmHg±14,2SD) compared to those without hypertension, (-6,7±11,1SD p=0,02). In logistic regression, only arm-leg-SBP-gradient at last visit remained as an independent predictor of SBP-hypertension. Conclusions: Hypertension is common after CoA treatment, specifically if treated later in childhood. In the present cohort, hypertension was at least partly explained by arm-leg-SBP-gradient.

Abstract ID: 61 Presentation type(s): Poster, clinical research The effect of heart rate on brachial and central blood pressure in longterm beta-blocker therapy. Martin Serg, Heart Clinic, University of Tartu, Tartu, Estonia Teeäär Tuuli, Heart Clinic, University of Tartu, Tartu, Estonia, Eha Jaan, University of Tartu, Tartu, Estonia, Zilmer Mihkel, University of Tartu, Tartu, Estonia, Kals Jaak, University of Tartu, Tartu, Estonia, Kampus Priit, University of Tartu, Tartu, Estonia Aim Increased resting heart rate (HR) contributes to higher cardiovascular risk. We have previously shown that a conventional beta-blocker (BB) metoprolol and a vasodilating BB nebivolol equally reduce brachial blood pressure (BP) and HR, only nebivolol reduces central (aortic) BP. However, recent short-term studies have proposed that baseline HR values as well as change in HR with BB may augment central BP. Therefore, the use of BB as antihypertensive drugs remains controversial. We aimed to study whether baseline HR level determines the change in brachial and central BP in long-term BB therapy in hypertensive patients. Methods We conducted a randomized, double-blind study in 80 hypertensive patients, who received either nebivolol 5 mg or metoprolol succinate 50-100 mg daily for one year. We performed brachial and central BP measurements at baseline and at the end of the study. The patients in each treatment arm were then divided into subgroups by their baseline HR (<65 bpm and ≥65 bpm). Results After 1 year of treatment brachial BP was reduced in all subgroups. In patients with baseline HR <65 bpm there was no change in HR and central BP in the metoprolol group, whereas nebivolol significantly reduced HR and central systolic BP(130±15 vs. 120±14 mmHg; p<0.01) and pulse pressure (49±10 vs.43±8 mmHg; p=0.01). In patients with baseline HR ≥65 bpm both, metoprolol and nebivolol reduced HR significantly, but there was a significant reduction in central systolic BP (136±17 vs. 125±11 mmHg; p<0.05) only in the nebivolol group. Conclusions Our study suggests that despite HR and brachial BP reduction with BBs there is no additional augmentation of central BP. Vasodilating BB nebivolol reduces brachial and central BP regardless of baseline HR level.

Abstract ID: 63


The status of heart failure three months after sinus rhythm restoration in the patients with non-paroxysmal forms of atrial fibrillation

Sergey Vachev, Cardiac Surgery, Federal Research Clinical Center, Moscow, Russian Federation

Alexander Zotov, Federal Research Clinical Center, Moscow, Russian Federation, Margarita Stepanova, Federal Research Clinical Center, Moscow, Russian Federation, Olga Drobyazko, Federal Research Clinical Center, Moscow, Russian Federation, Alexander Troitskiy, Federal Research Clinical Center, Moscow, Russian Federation, Robert Habazov, Federal Research Clinical Center, Moscow, Russian Federation

Aim: Evaluation of the chronic heart failure status three months after sinus rhythm restoration in the patients who characterized by the presence of: a. Non-paroxysmal form of atrial fibrillation; b. Manifestation of the heart failure symptoms occurred after manifestation of the atrial fibrillation. Methods: in the period from April 2017 to December 2018 18 patients with conformity to the inclusion criteria was performed thoracoscopic radiofrequency fragmentation of the left atrium and destruction of Marshall ligamentum. 5 patients was in persistant and 13 was in long-standing persistant atrial fibrillation. All of them was in the NYHA III status despite of adequate drug therapy. Before procedure median of ejection fraction was 45 (38; 50) %; median of the indexed left atrium volume was 46 (38; 50) ml/m2. Mitral valve regurgitation 2 degree – 10 patients, 1 degree – 8 patients. Tricuspid valve regurgitation 2 degree – 11 patients, 3 degree – 7 patients. Anamnesis of the sinus rhythm absence was 48 (8; 160) months. Median of the pre-surgery NT-proBNP was 1492 (872; 2286) pg/ml. Results: There was no lethal outcomes and major complications such as bleeding, stroke, myocardial infarction, pneumothorax and the respiratory insufficiency because of diaphragm paresis. All of the patients examined after at minimum 3 months period after procedure and everybody of them have sinus rhythm. The 6-minute walking distance test 3 months after surgical procedure allow us to state decrease heart failure status to the NYHA I in all patients. NT-proBNP decreased to 284 (216; 482) pg/ml, increasing of the left ventricle ejection fraction up to 52 (50; 60)%. Conclusion 1) Restoration of sinus rhythm have a key role in stopping the progression of chronic heart failure in patients, who presented in this study. 2) After sinus rhythm restoration with thoracoscopic left atrium fragmentation regression of the degree of heart failure from NYHA III to NYHA I was achieved during first 3 months in patients presented in this study.

Abstract ID: 64


Metabolic syndrome as an informativity for HATCH score scale

Oskars Kalejs, Cardiology, Pauls Stradinš Clinical University Hospital, Riga, Latvia

Dana Augustova, Pauls Stradinš Clinical University Hospital, Riga, Latvia, Lelde Gaspersone, Pauls Stradinš Clinical University Hospital, Riga, Latvia, Anastasija Zaicenko, Pauls Stradinš Clinical University Hospital, Riga, Latvia

Aim: Atrial fibrillation(AFib) and metabolic syndrome (MetS) nowadays are endemic diseases. The MetS is based on 5 criteries that are not directly included in already known risk scales such as the SCORE or the HATCH. MetS can potentiate severity of other AFib etiologic factors such as heart failure, myocardial infarction and sleep apnea,what progression as general may give reason to improve HATCH scale, what could provide a more reliable prognosis for AFib progression. Methods: In this pilot project study we examine 82 patients from the Latvian Center of Cardiology who have been already diagnosed with AFib. Patients where selected randomized and with voluntary participation. Results: From 82 patients with AFib, MetS was found in 47 (57,3%) patients. ECG was done to 76 patients, it showed that sinus rhythm was not found in ¾ of cases. Excluding 22 patients with BBB, research showed that from parox-AFib pacients, MetS were diagnosed for 23 (54.76%) pacients. Median of QRS complex in parox-AF patients reached 89 ms, but in patients with both diseases - increased till 98ms. Comparing AFib groups, it showed progressive dynamic of dyslipidemia- in parox-AFib group dyslipidemia was diagnosed in 46,34 % pacients, in persistent AFib gorup – 47,37% and long-standing AFib group showed 72,73%. Also, the presence of MetS has been increased by 23.3 % from parox-AFib till long-standing persistent AFib. LAVI index is higher in group with both diseases- AFib and MetS (LAVI index median for AFib group - 31 ml/m2 , AFib group with MetS - 41 ml/m2). As well IVSd showed that this group has a little higher tendency to hypertrophy. Left ventricular EDD and ESD is with better values, if the patients has just AFib, what shows that MetS can decrease these indicators. AoV regurgitation was detected in 22 patients, MV- 45, TV - 44 and 3 patients had PV regurgitation. Grade 2 MV regurgitation was observed 3 times more in AFib patients with MetS. Conclusion: Patient with AFib combined with MetS has several changes in ECG and Echo. There is tendency for QRS complex to get wider. LAVI, which is powerful forecaster of the recurrence of AFib , increases , if the patient has MetS. Higher grade valvular regurgitation may be more common among patients with AFib and MetS. Informativity about MetS may be an important improvement for the HATCH scale, it would provide greater benefit in the preventive phase of AFib treatment.

Abstract ID: 66


Magnesium, calcium, phosphate, albumin and vitamin D and their association to future surgery for aortic valve stenosis

Anja Isacsson, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

Bengt Johansson, Department of Public Health and Clinical Medicine, Umeå University, Sweden, Johan Hultdin, Department of Medical Biosciences, Umeå University, Umeå, Sweden, Ingvar Bergdahl, Department of Biobank Research, Umeå University, Umeå, Sweden, Johan Ljungberg, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, Anders Holmgren, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, Ulf Näslund, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden, Stefan Söderberg, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

The valves of patients with calcified aortic stenosis (AS) contains biological hydroxyapatite (Ca10(PO4)6(OH)2) as well as amorphous hydroxyapatite (Ca5(PO4)x OH) and CaHPO4. The aim of this study was to see if plasma levels of calcium and phosphate, as well as metabolically associated magnesium, albumin and vitamin D3, associate with future aortic valve replacement (AVR) due to aortic stenosis (AS). Previous studies have mainly been cross-sectional and showed incoherent results. In this nested case-referent study, we identified 336 patients that underwent AVR after prior participation in large populations surveys in northern Sweden. Referents without known AS were matched. Uni- and multivariable conditional logistic regression analyses were used to calculate the risk of developing AS requiring surgery (odds ratio [95% confidence interval]) related to one standard deviation increase in plasma magnesium, calcium, phosphate, albumin and vitamin D3. Median age [interquartile range] was 59.5 [10.2] years at survey and 66.4 [13.2] years at surgery, and 41.3 % were women. The median time between survey and surgery was 10.9 (9.3) years. Elevated plasma levels of magnesium at survey were associated with reduced risk for AVR (0,82 [0.71-0.95]. In contrast, elevated levels of phosphate were associated with increased risk for AVR (1,13 [0.98-1.30]). Total and albumin-corrected calcium and vitamin D3 were not associated with future AVR. In conclusion, circulating levels of magnesium were associated with reduced risk for future AVR, whereas high levels of phosphate were related to increased risk. These intriguing findings should be tested in more studies and if repeated, this indicates possible medical treatment options.

Abstract ID: 67


A novel in silico model of the electrophysiology of human ventricular cardiomyocytes to improve the state-of-the-art of cardiac simulations

Michelangelo Paci, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland

Chiara Bartolucci, University of Bologna, Cesena, Italy, Jari Hyttinen, Tampere University, Tampere, Finland, Elisa Passini, University of Oxford, Oxford, United Kingdom, Stefano Severi, University of Bologna, Cesena, Italy

AIM We aim to develop a new model of the human ventricular cardiomyocyte, based on the O’Hara-Rudy model (ORd), to improve the simulation of specific mechanisms, in particular the action potential duration (APD) dependence on the extracellular Ca2+ concentration (Cao). Moreover, the new model must reproduce all the available experimental data on APD rate dependence, restitution, drug block effects, etc., when the same extracellular conditions are carefully replicated in simulations. In fact, the original ORd showed a positive APD-Cao dependence. However, this is in contrast with experiments showing an inverse APD-Cao relationship. Furthermore, mechanisms such as APD rate dependence and restitution were simulated at extracellular K+ (Ko)=5.4mM, but compared to in vitro experiments obtained at Ko=4mM. METHODS The Bartolucci2019 model differs from Ord for: - a novel markovian formulation of the L-type Ca2+ current (ICaL) - the markovian rapid delayed rectifier K+ current (IKr), published by the US Food and Drug Administration (FDA) - a new formulation of the Ca2+ release (Irel) from the sarcoplasmic reticulum, to break the direct mathematical link between Irel and ICaL - a complete fine retuning of the model parameters. RESULTS The Bartolucci2019 model simulates all the experimental data considered by ORd, with correct Ko, together with a correct inverse APD-Cao relationship. In addition, we used the Bartolucci2019 model as baseline to generate an experimentally calibrated population of 1431 in silico ventricular cells, to study the occurrence of repolarization abnormalities in response to a strong block of IKr. We obtained 89 models developing early after-depolarizations and 88 models failing to repolarize. ANOVA showed significant differences among the normally repolarizing models and those showing repolarization abnormalities, in particular for the maximum conductances/currents of ICaL, the slow delayed rectifying (IKs) and the inward rectifying K+ current (IK1), and the N+/K+ pump (INaK). We also challenged our in silico population with high rate pacing to assess alternans occurrence, obtaining full adaptation in 899 models, while 101 models developed alternans and 311 models failed to adapt to increasing pacing rate. CONCLUSIONS Our Bartolucci2019 model successfully improved ORd, one of the most detailed and used models in computational cardiology, by reproducing the APD-Cao relationship while keeping all the original model features tested in the appropriate experimentally-matched conditions. Furthermore, the Bartolucci2019 is suitable as baseline for in silico populations.

Abstract ID: 68


A noninvasive dye dilution method can be used as an indicator for decision of closing an atrial septal defect

Muroke Valtteri, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland

Mikko Jalanko, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland, Piia Simonen, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland, Markku Ventilä, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland, Juha Sinisalo, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland

Background Atrial septal defect (ASD) is the most common congenital heart defect in adults. ASD creates a left-to-right shunt at the atrial level and, when significant, results in volume overload of the right atrium and ventricle. The decision to close ASD is based on a large (≥1.5) shunt ratio (Qp/Qs), on the enlargement of the right side of the heart, and on the size of the defect. The golden standard of ASD size assessment is the semi-invasive transesophageal ultrasound (TEE) examination. The diagnostic accuracy of shunt size determination in atrial septal defects has been suboptimal with the most common current noninvasive methods. Purpose We studied the efficacy of shunt size calculation using a noninvasive dilution dye method with indocyanine green solution injected into antecubital vein. The appearance of the dye was detected with an earpiece densitometer. Methods Consecutive ASD patients (n= 102) were assessed using dye dilution method and TEE. We compared the calculated shunt size to both native ASD size measured by TEE, and invasively with a balloon and stop-flow technique in patients undergoing ASD closure. Results The patients were otherwise relatively healthy with normal left ventricular ejection fraction (62 ± 9%). The mean size of the ASD measured on TEE was 15 ± 6 mm. The dye dilution method proved to be a robust method to assess left-to-right shunt size with good correlation between calculated shunt and measured ASD size (Figure 1). It also correlated with transthoracic right ventricle plus right atrium size (cm2) (r= 0.326, p<0.001), but not with tricuspid valve insufficiency gradient (r= 0.121, p= 0.24), or age (r= -0.117, p= 0.17). Conclusions The dye dilution method with densitometer recording is a clinically feasible and reliable method to assess shunt size in atrial septal defects.

Abstract ID: 69


Switching from one direct oral anticoagulant to another one

Francesco Bernardini, Department of Psychology, University of Bologna, Bologna, Italy

Gabriello Marchetti, Cardiology, Bellaria Hospital, Bologna, Italy, Stefano Urbinati, Director of Cardiology, Bellaria Hospital, Bologna, Italy

Aim: Little is known about the crossover between direct oral anticoagulants (DOACs). The purpose of this study was to evaluate the switch from a DOAC to another DOAC, the reasons and the clinical events which happened after the switch. Method: Through the database of pharmaceutical prescription, we extracted the data of 300 patients from December 2018 to February 2019 in our anticoagulant center. We identified clinical events preceding the switch of DOACs and clinical events which happened after it in patients with non valvular atrial fibrillation (AF). Chi-square test was used to equate dichotomous variables. Results: The mean age was 79.29 (SD=8.50). 46.3% were female. The average weight was 78.03 (SD=16.02). 105 pts (35%) were on rivaroxaban, 91 pts (30.3%) on apixaban, 63 pts (21%) on edoxaban and 41 pts (13.7%) on dabigatran. More than 70% of DOACs users were naive patients and 29.5% had switched from VKA. During clinical observation time, 12.7% of the whole group switched from initial prescribed DOAC to another DOAC. Among all observed DOACs switches, 15.4% switched from rivaroxaban to apixaban, 7.7% from rivaroxaban to edoxaban, 2.6% from rivaroxaban to dabigatran, 7.7% from edoxaban to apixaban, 7.7% from edoxaban to rivaroxaban, 23.1% from dabigatran to apixaban, 7.7% from dabigatran to edoxaban, 10.3% from apixaban to edoxaban, 7.7% from apixaban to dabigatran and 2.6% from apixaban to rivaroxaban. The main causes of the crossover were minor bleeding (23.7%), gastrointestinal disorders (21.1%) and allergic reactions (18.4%): most of them cleared up after the switch. Major bleeding events (one with rivaroxaban) and gastric hemorrhage (one with dabigatran and one with rivaroxaban) were also reported as causes of the crossover. There were significant differences in the causes of the switch among DOACs (x²=52.99, p<0.05). 87.5% of gastrointestinal disorders that caused the switch were due to dabigatran. Allergic reactions were mainly caused by dabigatran (42.9%) and edoxaban (42.9%). After the crossover between DOACs, major thromboembolic events did not occur and only 3% of gastric hemorrhage with rivaroxaban was reported. 84.9% did not have any collateral effects after the switch, 9.1% had a worsening of renal functioning and 3% minor bleeding. Conclusion: Switching between DOACs is not rare and is not associated with thromboembolic events and stroke. Most of the gastrointestinal disorders, allergic reactions and minor bleeding cleared up after the switch.

Abstract ID: 70


Changes of left ventricle function during stress in patients with asymptomatic primary mitral regurgitation

Ruta Zvirblyte, Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Agne Saniukaite, Lithuanian University of Health Sciences, Kaunas, Lithuania, Egle Tamulenaite, Lithuanian University of Health Sciences, Kaunas, Lithuania, Ieva Merkyte, Lithuanian University of Health Sciences, Kaunas, Lithuania, Jolanta Justina Vaskelyte, Lithuanian University of Health Sciences, Kaunas, Lithuania

The aim of the study was to evaluate changes of left ventricle (LV) systolic, diastolic functions and myocardial deformation parameters obtained by speckle tracking echocardiography (STE) in patients with asymptomatic primary mitral regurgitation (MR) during stress echocardiography. Methods: 50 patients with preserved LV ejection fraction (EF) at rest – 27 (54%) patients with moderate (grade 2-3) MR (MR group) and 23 (46%) patients without significant heart valves disease (control group) – were included in the prospective study. Subjects with coronary artery disease were excluded from the study. Conventional 2D echocardiography, stress (veloergometry as per protocol 25+25 W every 3 minutes) echocardiography and 2D STE offline analysis were performed to all of them. Statistical analyses were performed using the SPSS 20.0 software. The value of p<0.05 was considered as statistically significant. Results: There were no significant differences of sex, anthropometric and clinical characteristics, blood pressure, heart rate between control and MR groups. Patients with MR used higher heart rate reserve than controls (60.50±14.19% vs. 42.29±19.85%, p=0.04) although achieved maximal load (watts and metabolic units) did not differ in both groups. LV EF, global longitudinal strain (GLS) and parameters of diastolic function (E/A, E/e’, left atrium volume index, maximal velocity of tricuspid regurgitation) at rest were similar in both groups (Table 1.). Diastolic function during peak stress was significantly better in controls than in MR group (Table 1). Changes of LV EF from rest to peak stress were significantly lower in MR group (0.07±8.61 vs. 2.85±7.39; p=0.010) while changes of GLS did not differ from healthy subjects (p=0.498). LV contractile reserve was higher in subjects with MR however difference was not significant enough (p=0.0556). Conclusions: Patients with asymptomatic moderate mitral regurgitation and preserved left ventricle ejection fraction at rest had worsening parameters of diastolic function and lower response of left ventricle ejection fraction during stress.

Abstract ID: 71


Using wrist photoplethysmography to detect atrial fibrillation. A study on post-cardiac surgery patients

Adrian Tarniceriu, -, PulseOn SA, Neuchatel, Switzerland

Vilma Vuohelainen, Department of Cardiothoracic Surgery, Tampere University Hospital, Tampere, Finland, Serj Haddad, PulseOn SA, Neuchatel, Switzerland, Tuomas Halkola, PulseOn Oy, Espoo, Finland, Jakub Parak, PulseOn Oy, Espoo, Finland, Jari Laurikka, Department of Cardiothoracic Surgery, Tampere University Hospital, Tampere, Finland, Antti Vehkaoja, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland

Aim: Atrial fibrillation (AF) is the most common cardiac arrhythmia, associated with high risks of ischemic stroke. The prevalence of AF is above 10% after 75 years of age, significantly increasing the morbidity and mortality risks. If timely detected and treated, the risk of strokes can be decreased by ~70%. Traditional AF detection techniques are based on ECG, but suffer from several drawbacks: short-term in-hospital ECG recordings can miss paroxysmal AF, and, if worn for longer durations, the electrodes can cause skin irritation. This study evaluates the efficiency of a wrist-worn photoplethysmografic (PPG) device in monitoring the beat-to-beat cardiac rhythm and detecting AF. Compared to ECG techniques, it does not require electrodes and can provide comfortable 24/7 monitoring. Methods: The data collection took place in the Cardiac surgery ward at Tampere University Hospital. 30 subjects (9 female, 21 male, 69.3 ± 6.9 years old) were monitored for 24 hours with a wrist-worn PPG monitor (PulseOn Oy, Espoo, Finland). The subjects went through cardiac surgery 2-to-4 days before the recording and were mostly staying in bed, but also taking short walks. The study was approved by the local ethical committee. The guidelines of the Declaration of Helsinki were followed. The PPG data was processed to extract inter-beat intervals (IBI), which were further used to detect the presence of AF. Because IBI estimation from optical signals is not reliable in the presence of excessive movement or other types of noise, an algorithm to automatically detect unreliable IBI was also implemented. Reference ECG data was measured with Faros 360 Holter device (Bittium Biosignals Oy), and analyzed by specialists to identify AF intervals. Results: The wrist-recorded data was classified as AF/non-AF based on 5-minute intervals. 87.68% of the total 697.3 hours of recorded data were classified. The amount of noise and interference coupled with the wrist device signal prevented the decision making for the remaining 12.32% of the data. 3 out of the 30 subjects experienced AF during the monitoring period, leading to a total duration of ~22 hours of AF data. In these cases, all the classified intervals were labelled as AF, for a sensitivity of 100%. The non-AF data was labelled as non-AF in 96.1% of the cases. This may seem low at a first glance, but is explained by the presence of long series of ectopic beats (more than 10 per minute). Ignoring these intervals, the false positive rate becomes 0.26%, partially explained by subjects with particularly high heart rate variability. Conclusions: This study proves that optical heart rate monitoring is a reliable alternative to ECG techniques for AF detection and monitoring. In addition, it is more comfortable than ECG and, therefore, more suitable for continuous long-term monitoring. Thus, it may provide an efficient alternative for the detection of paroxysmal and asymptomatic atrial fibrillation.

Abstract ID: 72


evaluation of modified QRS score for diagnosis of coronary artery disease in women: The Finnish Cardiovascular Study

Serkalem Beyene, Biomedical Sciences and Engineering, Tampere University, Tampere, Finland

Mika Kähönen, Clinical Physiology and Faculty of Medicine and Health, Tampere University Hospital, Tampere, Finland, Terho Lehtimäki, Clinical Chemistry and Faculty of Medicine and Health, Tampere University Hospital, Tampere, Finland, Kjell Nikus, Heart Center and Faculty of Medicine and Health Te, Tampere University Hospital, Tampere, Finland, Jari Viik, Biomedical Sciences and Engineering, Tampere University, Tampere, Finland

Aim: Studies revealed that composite QRS score has better sensitivity and specificity for coronary artery disease (CAD) detection than individual depolarization change of Q, R, and S waves. The purpose of this study was to evaluate the performance of modified QRS score in women. Methods: Two female groups from the Finnish Cardiovascular study (FINCAVAS) were included in the study: 77 subjects with angiographically proven CAD (age 62.99±9.317, mean±SD) and 65 women with low likelihood (LLH) of CAD (age 46.63±13.929). We measured the amplitude of the R and S waves and ST-segment from the leads aVF and V5. The R, S and ST changes and the modified score were determined by subtracting the R, S and ST-segment amplitudes immediately after the maximal exercise changes from their rest values (Δ). Receiver operating characteristic (ROC) analysis was used to evaluate the overall diagnostic performance of the parameters to predict CAD. Results: The areas under the ROC curve for ΔRaVF, ΔRV5, ΔSaVF, ΔSV5, ΔSTaVF, ΔSTV5 and (ΔRaVF-ΔSaVF+ΔRV5-ΔSV5) were 0.779, 0.747, 0.627, 0.623, 0.656, 0.760 and 0.716 respectively. Conclusions: Exercise induced R-amplitude changes in aVF and V5 have a similar overall diagnostic performance in the CAD detection as ST-segment change in V5. Inclusion of S changes with R changes does not improve the performance of CAD detection in women in this study sample. Key words: Modified QRS score, Coronary artery disease, Women

Abstract ID: 73


Icelandic cardiac transplantation recipients – indications and outcome

AS Valgardsson1, ThHrafnkelsdottir2,3, HFriðdjonsdottir2, G Dellgren4,TGudbjartsson1,3 1Departments of 1Cardiorhoracic Surgery and 2Cardiology, Landspitali University Hospital, Reykjavik, Iceland, 3Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 4Department of Cardiothoracic Surgery and TransplantInstitute, Sahlgrenska University Hospital, Gothenburg, Sweden.

Introduction: End-stage heart failure is a common condition that severely impacts the quality and survival of those affected. When medical therapy is exhausted some patients are eligible for cardiac transplantation. These procedures are not performed in Iceland but have for decades been performed overseas, mostly in Gothenburg in Sweden. We studied all Icelandic cardiac transplant recipients; focusing on indications, incidence and the outcome of the procedures, including long-term survival. Methods: Patient information was gathered from the Landspitali Transplantation Clinic where all Icelandic cardiac- and lung transplant recipients are followed. Medical records from Landspitali and transplant-centers abroad were reviewed from the first operation in Jan 1988 to the end of March 2019. Overall survival (Kaplan-Meier) was estimated with a mean follow-up time of 10.7 yrs. Results: Altogether 23 Icelanders (78% males, mean age 37 yrs, range: 4.5-65) received a donor heart; with one individual receiving two hearts, 15 years apart. The operations were performed in Gothenburg (n=19), London (n=3) and Copenhagen (n=2). Three patients had simultaneous cardiopulmonary transplant and two received transplantation of both heart- and kidney concomitantly. The age-adjusted incidence was 2.4 heart-TX pmp/year for the whole period, and since 2009 4.7 heart-Tx pmp/year. Indications were dilated cardiomyopathy (n=16), congenital heart diseases (n=4), ischemic coronary artery disease (n=2), hypertrophic cardiomyopathy (n=1) and re-transplantation (n=1). Five patients had a ventricular assist device (VAD) preoperatively as a bridge-to-transplant. At follow-up, 5 out of 23 patients had passed away, with a 9.7 yrs. median survival after transplantation (range: 1 mo-24 yrs.). One- and five-year survival was 96% and 90%, respectively, and the median survival after transplantation was 24.2 years. Conclusions: This population-based study confirms that the outcome of heart transplantation in Icelanders is comparable to large transplant-centers abroad. Still, however, the age-standardized incidence of cardiac transplantation is in the lower range compared to neighboring countries

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Abstract ID: 39 - nbcc2019.org · All patients participated in the long-term training and monitoring program and had four visits to cardiologist and participated in 4 training modules