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Results: Groups were comparable with regards to baseline characteristics. The duration ofQRS complex was significantly lower in III group (117�28 ms) compared to II group(154�46 ms, p<0.001) and I group (151�30 ms, p<0.001). Left bundle branch block wasmore frequently found in I group compared to III group (65% vs 36%, p¼0.004) and did notdiffer with II group (61%, p¼0.6). The rate of effective biventricular capture was significantlyhigher in III group compared to II group (97�6% vs 88�21%, p¼0.012) and had no dif-ference with I group (95�15%, p¼0.3). The best survival rate calculated by Kaplan-Meiermethod was found in patients of III group. At the end of follow-up period the survival ratewas 60% in I group, 58% in II, 97% in III group (p I-II¼0.46, p I-III¼0.00007, p II-III¼0.0005). Multivariate Cox regression analysis revealed that AVJA was an independentpredictor of lower mortality in patients with CRT (HR 0.035, CI 0.004-0.288, p¼0.002).Conclusion: In real clinical practice in patients with CHF and CRT survival was signifi-cantly better in subjects with AF who underwent AVJA compared to subjects with AFwithout AVJA probably because of the best rate of complete biventricular capture. Patientswith AF and AVJA showed better survival even compared to patients with sinus rhythm.Disclosure of Interest: None Declared

O157

Multipoint left ventricular pacing provides similar acute hemodynamic improvementregardless of QRS duration or lead location in cardiac resynchronization therapypatients

Carlo Pappone1, Zarko Calovic1, Amarild Cuko1, Luke C. Mcspadden2, Kyungmoo Ryu*2,Enrico Romano3, Massimo Saviano1, Raffaele Vitale1, Gabriele Vicedomini1, Vincenzo Santinelli1

1Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA),Italy, 2St. Jude Medical, Sylmar, CA, United States, 3St. Jude Medical, Milan, Italy

Introduction: Patients (pts) with QRS duration <150 ms or non-lateral left ventricular(LV) lead position have low response to conventional cardiac resynchronization therapy(CRT).Objectives: The aim of this study was to investigate if CRT with multipoint left ventricular(LV) pacing (MultiPoint� Pacing [MPP], St. Jude Medical) in a single coronary sinusbranch can produce a similar acute hemodynamic response in pts with QRS duration <150ms vs. �150 ms and in pts with non-lateral vs. lateral LV lead position.Methods: Forty-four consecutive pts receiving a CRT implant (UnifyQuadraMP� orQuadraAssura MP� CRT-D and Quartet� LV lead, St. Jude Medical) underwent LV hemodynamicassessment using a pressure-volume (PV) loop system (Inca, CD Leycom). PV loops wererecorded during biventricular pacingwith each of two conventional CRT (CONV) settings and4-7 MPP settings. Each pacing intervention was performed twice in a randomized order withDDD-mode right ventricular pacing (BASELINE) repeated after every test configuration.Results: Valid recordings were obtained in 42 pts. Pts were separated into groups based onQRS duration (�150 ms: 21 pts vs. <150 ms: 21 pts) and LV lead location (‘lateral’ [lateralor posterolateral]: 32 pts vs. ‘non-lateral’ [anterolateral]: 10 pts). No pts had anterior LVlead location. The hemodynamic improvement with the best MPP configuration over thebest CONV configuration was not significantly different for pts with QRS duration <150ms vs. �150 ms for dP/dtMax (<150 ms: +2.5�3.9%, �150 ms: +2.3�2.8%, p ¼ 0.87, Fig1A), stroke work (SW, <150 ms: +3.6�18.6%, �150 ms: +24.5�34.2%, p ¼ 0.18, Fig1B), stroke volume (SV, <150 ms: +4.1�7.3%, �150 ms: +8.5�16.3%, p ¼ 0.27, Fig 1C),or ejection fraction (EF, <150 ms: +4.1�7.8%, �150 ms: +6.4�13.2%, p ¼ 0.49, Fig 1D).Similarly, the hemodynamic improvement was not significantly different for lateral vs. non-lateral LV lead positions for dP/dtMax (non-lateral: +1.5�3.1%, lateral: +2.7�3.4%, p ¼0.33, Fig 2A), SW (non-lateral: +14.0�17.4%, lateral: +6.0�21.6%, p ¼ 0.29, Fig 2B), SV(non-lateral: +6.4�6.2%, lateral: +6.3�14.2%, p ¼ 0.98, Fig 2C), or EF (non-lateral:+7.4�7.2%, lateral: +4.5�11.7%, p ¼ 0.48, Fig 2D).

Conclusion: The acute hemodynamic benefit of MPP is similar in pts with QRS duration<150 ms vs. �150 ms and in pts with non-lateral vs. lateral LV lead position. Additionalstudies are needed to validate these findings in a larger population.

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Disclosure of Interest: C. Pappone: None Declared, Z. Calovic: None Declared, A. Cuko:None Declared, L. Mcspadden Shareholder of: St. Jude Medical, Employee from: St. JudeMedical, K. Ryu Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, E.Romano Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, M. Saviano:None Declared, R. Vitale: None Declared, G. Vicedomini: None Declared, V. Santinelli:None Declared

O158

Wave reflection from aortic coarctation augments carotid pressure: Insights from acomputer model and wave intensity analysis

Jonathan P. Mynard*1, Remi Kowalski1,2,3, Joseph J. Smolich1,3, Michael M. Cheung1,2,31Heart Research, Murdoch Childrens Research Institute, 2Department of Cardiology, RoyalChildren’s Hospital, 3Department of Paediatrics, University of Melbourne, Parkville, VIC,Australia

Introduction: Cerebral aneurysms are approximately five times more common in patientswith aortic coarctation than the general population (Connolly, HM et al, Mayo Clin Proc,78:1491-1499, 2003). Although genetic factors may be involved, it is thought that hy-pertension, which is commonly associated with aortic coarctation, may lead to increasedrisk of aneurysm formation. Another possibility that has not been widely considered is thatthe presence of aortic coarctation may directly influence cerebral haemodynamics, forexample, through transmission of a reflected wave into the cerebral vasculature.Objectives: With the aid of a computer model, to assess the direct haemodynamic in-fluence of aortic coarctation on common carotid artery (CCA) haemodynamics and therebyprovide clues to a possible mechanistic link between cerebral aneurysm formation and thepresence of coarctation per se.

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Methods: A computer model of the entire cardiovascular system of a normal neonate(Mynard JP, PhD Thesis, University of Melbourne, 2011) was modified to incorporateaortic coarctation. CCA haemodynamics and wave intensity were assessed for coarctationseverities between 0% and 90%. Augmentation index (AI) was calculated by dividing thetotal pressure rise following the initial inflection point by overall pulse pressure. To eval-uate the effect of elevated arterial stiffness, wave speed of all precoarctation arteries wasincreased by up to 250%.Results: Simulated pressure and wave intensity in the CCA are shown in Fig. 1 for anormal aorta and for 90% coarctation. A single forward compression wave (FCW1) waspresent in the case of a normal aorta. Coarctation led to partial reflection of the FCW1, andthe reflected wave was partially transmitted into the CCA, giving rise to a second forwardcompression wave (FCW2) whose wave area increased progressively with coarctationseverity (Fig. 2). The FCW2 augmented CCA pressure (Fig. 1), producing an increase in AIfrom 0.22 for 0% coarctation to 0.50 for 90% coarctation, with the most prominent riseoccurring when the severity was >50%. Increasing wave speed reduced the FCW1-FCW2

time delay (Fig. 2) and the two waves merged at high wave speeds.Conclusion: Computer modelling data suggest that a reflected wave arising from the site ofaortic coarctation may be transmitted into the carotid artery and lead to a substantialpressure augmentation. These wave dynamics may play a role in the higher risk of cerebralaneurysm formation in patients with aortic coarctation.Disclosure of Interest: None Declared

O160

Prospective memory in chronic heart failure

Tina Habota*1, Jan Cameron2, Skye N. McLennan1, Chantal F. Ski2, David R. Thompson2,Peter G. Rendell11School of Psychology, 2Cardiovascular Research Centre, Australian Catholic University,Melbourne , Australia

Introduction: Chronic heart failure (CHF) is a debilitating condition that often results in poorquality of life, reduced survival rates, frequent hospitalisation, and psychopathology. Globalcognitive impairment is prevalent in this group.However, no study has investigated one of thearguably most relevant specific memory processes: prospective memory (PM). This is thememory to carry out future intentions and is involved in a range of important daily tasks suchas taking medication, and may therefore be particularly important for CHF patients.Objectives: To assess the PM abilities of CHF patients compared to healthy controls.Methods: The CHF group, attending a nurse-led management program at one of threehospital sites in Metropolitan Melbourne, included predominantly male adults (n¼29;mean age¼69.93, SD¼12.08). The healthy control group was recruited from the generalcommunity and matched to the CHF group on age, gender, years of education, and pre-morbid intelligence. Testing of controls is ongoing (currently n¼11). All participants werescreened for dementia. Participants underwent a battery of neuropsychological testing; theprimary assessment tool was the well-established behavioural measure of PM, VirtualWeek. In a computerised board game that simulates daily activities, participants were askedto remember to perform tasks that closely represent PM tasks in daily life. Two key taskdistinctions were assessed – whether a task is completed at a set time or at a specific event,and whether there were low or high memory demands for the content of the task.Results: Preliminary findings using t-tests indicated that, compared to controls (M¼.70,SD¼.22) the CHF group (M¼.51, SD¼.27) had significantly lower proportions of correctPM responses, overall (Cohen’s d¼.76). The deficits were substantial for the time-basedtasks and modest for tasks cued by an event. Deficits in tasks involving high memorydemands were also substantial compared to low memory demands.Conclusion: Preliminary findings indicated that the CHF group have deficits in PM thatvary according to the task type. In this group, poorest performance was evident in tasksrequiring time-monitoring. However, minimising demands of the task content was foundto reduce deficits.Disclosure of Interest: None Declared

O161

Using DCE to assess adherence and treatment preferences for combination therapiesfor cardiovascular disease

Tracey-Lea Laba*1, Kirsten Howard2, John Rose3, Stephen Jan1, PEAK team1Health Economics, The George Institute for Global Health, 2School of Public Health, 3Institutefor Transport and Logistics, University of Sydney, Sydney, Australia

Introduction: Discrete Choice Experiment (DCE) is a preference elicitation method used tovalue healthcare technologies. Kanyini-GAP (KGAP), a pragmatic clinical trial, assessed apolypill-based strategy on patient adherence to cardiovascular disease (CVD) treatment inIndigenous and non-Indigenous Australians. In this context DCE could help understandpatient preferences for treatment, assisting with clinical evidence translation.Objectives: To assess the influence of treatment attributes and patient characteristics ontreatment adherence in CVD prevention.Methods: A DCE was administered to KGAP patients completing end-of-study visitsinvolving choices between two unlabelled treatment options of equivalent efficacy and sideeffects, as recommended for CVD prevention. Respondents made a choice between thetreatments or no treatment given a high CVD risk diagnosis. Treatment preferences wereassessed for out-of-pocket costs ($AUD), tablet number, administration time, and prescribervisit frequency. Odds ratios for preferring treatment to no treatment, trade-off betweentreatment attributes, and the predicted probability of treatment uptake were evaluated.Results: 332 of 487 eligible patients completed a survey (response 68%, mean age 65(SD ¼11)). Adherence to treatment was chosen 93% compared to no treatment. Preference

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to adhere decreased with increased out-of-pocket treatment costs (OR¼0.95 95%CI 0.94-0.96) and tablet number (OR¼0.83 95%CI 0.71-0.98), but decreased frequency of pre-scriber visits (OR¼0.84 95%CI 0.75-0.94). In valuing individual treatment attributes,respondents were willing to pay up to $136.65 per month and accept up to 3 additionaltablets per dose to reduce administration frequency, with no clear preference for morningover night administration. Respondents with a weekly household income of $400-799 andthose with a university-related higher education were less likely to prefer treatment. Thepredicted probability of uptake of a polypill was greater than for standard individualisedcombination therapy. Previous experience with CVD medication, including the polypill-based strategy increased adherence preference.Conclusion: Given the scenario in which respondents were at a high CVD risk, mostexpressed a preference for preventive treatment. Assuming equal efficacy and toxicity oftreatment options, a polypill-based strategy should increase CVD preventive therapy uptakeespecially in treatment-experienced patients. Additional strategies targeting specific socio-economic groups are warranted.Disclosure of Interest: None Declared

O162

Effect of a periodontal intervention on pulse wave velocity in Indigenous Australianswith periodontal disease: the PerioCardio randomized controlled trial

Kostas Kapellas*1, Louise J. Maple-Brown2, Peter M. Bartold3, Alex Brown4, Kerin O’Dea5,Gary D. Slade6, David S. Celermajer7, Lisa M. Jamieson1, Michael R. Skilton8, on behalf ofPerioCardio Study1ARCPOH, School of Dentistry, University of Adelaide, Adelaide, 2Division of Medicine, RoyalDarwin Hospital, Darwin, 3CACDRC, School of Dentistry, University of Adelaide, 4AboriginalHealth, South Australian Health and Medical Reseach Institute, 5Sansom Institute, University ofSouth Australia, Adelaide, Australia, 6Department of Dental Ecology, University of NorthCarolina, Chapel Hill, United States, 7Depatrment of Medicine, 8Boden Institute of Obesity,Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia

Introduction: Indigenous Australians have high rates of premature cardiovascular diseaseand high prevalence of periodontitis, an inflammatory disease of the tissues surroundingteeth. Periodontitis has been associated with arterial stiffening and incident cardiovascularevents and. periodontal bacteria have been isolated from atheromatous plaques.If periodontitis contributes causally to cardiovascular disease, periodontal treatment may

confer important benefits to the health of Indigenous Australians.Objectives: To determine if a single episode of periodontal treatment improved arterialstiffness in otherwise healthy Indigenous Australian adults.Methods: Participants were 273 Indigenous Australian adults (57% male; age 40.3years[SD 10.2]) with moderate or severe periodontal disease in the Northern Territory, Australia.Participants were randomized into intervention (n¼138) or control (n¼135) groups. Theintervention involved removal of sub- and supra-gingival calculus and plaque biofilm byscaling and root-planing once, at randomization. Pulse wave velocity (PWV) was assessedby applanation tonometry (SphygmoCor- PVMx device, AtCor Medical, Sydney, Australia)between the carotid and dorsalis pedis arteries, at baseline and again 3-months (n¼169)and 12-months (n¼171) post randomization. Comparison of randomized groups was bycomplete case analysis using ANCOVA adjusted for baseline measures.Results: At baseline, the average carotid-dorsalis pedis PWV was 8.34 m/s (SD 1.25). Themean reduction in periodontal pocketing from enrollment to 3-months was 0.14 mmgreater [95% CI 0.24 to 0.05] in the intervention group compared to control, P¼0.004).This was less marked at 12-months, mean reduction in periodontal pocketing 0.09 mmgreater [95% CI -0.01 to 0.18] in the intervention versus control, P¼0.08). In contrast, theintervention did not affect PWV at 3-months [the primary endpoint] (between-groupdifference in means +0.06 m/s [95% CI -0.17 to 0.29] intervention vs. control, P ¼ 0.59),although there was some evidence that the intervention increased PWV at 12-months, thiswas not statistically significant (between-group difference in means +0.21 m/s [95% CI-0.01 to 0.43] intervention vs. control, P¼0.06).Conclusion: A single episode periodontal intervention in Indigenous Australians withperiodontal disease provides short-term improvement in periodontal health, but did notsignificantly influence arterial stiffness as measured by pulse wave velocity.Disclosure of Interest: None Declared

O163

Post-discharge ECG Holter monitoring in recently hospitalised individuals withchronic atrial fibrillation to enhance therapeutic monitoring and identify potentiallyhigh risk phenotypes

Jocasta Ball*1, Melinda Carrington1, David Thompson2, John Horowitz3, Simon Stewart1, onbehalf of the SAFETY Study Investigators1Preventative Health, Baker IDI Heart and Diabetes Institute, 2Cardiovascular Research Centre,Australian Catholic University, Melbourne, 3The Queen Elizabeth Hospital, Adelaide, Australia

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia managed inclinical practice. Maintenance of intended AF control (rate or rhythm) following an acutehospitalisation is a key therapeutic goal.Objectives: To determine the value of post-discharge ECG Holter monitoring to assessmaintenance of intended AF control and enhance the management of patients with AF.Methods: Sub-study of a multicentre randomised controlled trial of AF-specific post-discharge management in typically older individuals with chronic AF. Continuous 24-hourECG Holter monitoring was undertaken at a home visit 7-14 days post-discharge. Intendedversus detected rate and rhythm control was compared to ECG Holter data. Frequency

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals