P1552 Dobutamine stress echocardiography as a screening tool for coronary artery disease detection in patients with end-stage liver disease awaiting transplantation

Indroduction

The prevalence of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) is unknown. However, patients with CAD and ESLD are at increased perioperative risk during liver transplantation. Currently there is no standard protocol for CAD screening in patients with ESLD awaiting orthotopic liver transplantation. We present preliminary data of our experience with dobutamine stress echocardiography in those patients.

Methods

Fifty patients (26 males, mean age of 59 years) with end-stage liver disease awaiting transplantation and no history of CAD underwent dobutamine stress echo. The etiology of their hepatic disease was hepatitis B (6 patients), hepatitis C (6 patients), primary billiary cirrhosis (10 patients), sclerosing cholangitis (8 patients), alcoholic hepatitis (10 patients) and polycystic disease (2 patients), while 8 patients had end-stage liver disease of unknown etiology. Twenty-six patients had risk factors for CAD. Eighteen patients had one risk factor and only 8 patients had 2 risk CAD factors. All patients received dobutamine infusion (at escalating doses of 5, 10, 20, 30 and 40 μgr/kg/min), targeting a 85% or more of their age-predicted maximum heart rate. Atropine was administered in 6 patients.

Results

All 50 patients had normal inotropic response of left ventricle, without evidence of ischemia (100% studies were negative for ischaemia). No patient had major intolerance to dobutamine. Eight patients experienced hypotension responded to infusion of normal saline. One patient developed paroxysmal supraventricular tachycardia, which was treated with intravenous bolus of adenosine.

No patient had cardiovascular events during a follow-up ranging from 1 to 18 months. Twelve patients underwent liver transplantation without any periprocedural cardiovascular events.

Conclusions

Dobutamine stress echocardiography is a safe and reliable method for CAD screening in the labile patients with ESLD who are candidates for orthotopic liver transplantation. It seems that the prevalence of significant CAD in this high-risk population is low.

P926 High prevalence of left ventricular systolic dysfunction assessed by speckle tracking in asymptomatic HIV patients

Background

Cardiomyopathy presenting in people living with HIV (PLWHIV) has been attributed to the effect of inflammation, opportunistic infections, myocyte invasion and cardiac steatosis, while peripheral artery disease (PAD) is linked to immune activation, abnormalities in lipid metabolism, and traditional risk factors. The diagnosis of subclinical myocardial dysfunction and PAD could enable prompt implementation of therapeutic measures. However, data available to date on the specific topic are limited.

Μethods:We investigated the association between global longitudinal strain (GLS) and a) patient history, b) baseline characteristics, c) carotid intima-media thickness (IMT) and presence of carotid atheromatic plaque(s) d) temperature difference (ΔT) along each carotid artery, measured by microwave radiometry (MWR) and e) basic blood panel measurements, including high-sensitivity troponin-T(hsTnT) and NT-proBNP in PLWHIV and no history of cardiovascular disease.

Results

We prospectively enrolled forty asymptomatic PLWHIV on long-term highly active antiretroviral therapy. Thirty-seven (93%) were men, while mean age was 52 ± 13 years. Subclinical left ventricular systolic dysfunction(SLVSD), defined as a value of GLS> -18.7%, was present in 35% of patients. GLS value was significantly associated with age (r = 0.410,P = 0.013), history of hyperlipidemia (r = 0.370,P = 0.026), body mass index (r = 0.462,P = 0.005), waist circumference (r = 0.471,P = 0.007) and right bulb IMT (r = 0.390,P = 0.036). hs-TnT levels were significantly associated with age (r = 0.513, P = 0.001), CD4 count (r=-0.357,P = 0.025), serum creatinine (r = 0.338,P = 0.035) and the presence of carotid plaque (r = 0.374,P = 0.038). NT-proBNP levels were significantly associated with history of diabetes (r = 0.336,P = 0.048) and serum creatinine (r = 0.548,P = 0.001). No significant associations were demonstrated between carotid ΔΤ and other parameters.

Conclusion

Our results indicate that apart from age, a dysmetabolic component, expressed by higher BMI and history of hyperlipidemia, may be implicated in the pathogenesis of SLVSD, which may lead to cardiomyopathy, in PLWHIV.

Uric acid in-hospital changes predict mortality in patients with acute myocardial infarction

BACKGROUND AND AIMS

The prognostic impact of admission uric acid (UA) levels in patients with acute myocardial infarction (AMI) is controversial. We assessed the prognostic role of in-hospital UA changes in patients with AMI.

METHODS AND RESULTS

We studied 375 consecutive patients (320 males, mean age 62.6 years) with AMI (232 with ST elevation MI) within 12 h of symptoms' onset. UA levels were daily measured throughout hospitalization and their admission and peak values were recorded. End-points were 30-day and 1-year mortality. Mortality rate at 30 days was 7.2% and at 1 year 10.9%. Patients who died within 30 days exhibited higher peak UA (10.24 mg/dl vs. 7.06 mg/dl, p < 0.001) and absolute UA elevation (1.7 mg/dl vs. 0.7 mg/dl, p < 0.001). Optimal values for predicting 30-day mortality were 9.65 mg/dl for peak UA and 2.35 mg/dl for UA elevation. Concerning 1-year mortality, deceased patients had higher peak UA levels (9.71 mg/dl vs. 7 mg/dl, p < 0.001) and absolute UA elevation (1.5 mg/dl vs. 0.6 mg/dl, p < 0.001). Optimal values for predicting 1-year mortality were 9.55 mg/dl for peak UA and 1.1 mg/dl for UA elevation. With Cox regression analysis peak UA (adjHR 1.157, p = 0.030) and UA elevation (adjHR 1.288, p = 0.009) were independent predictors of 30-day mortality. Similarly, peak UA levels (adjHR 1.204, p = 0.001) and UA elevation (adjHR 1.213, p = 0.001) predicted 1-year mortality.

CONCLUSIONS

In patients with AMI peak rather than admission UA levels, and absolute in-hospital UA elevation predict both 30-day and 1-year mortality. Serial in-hospital UA measurements add prognostic information in AMI patients.