P1101Is there any link between vitamin D deficiency and vasovagal syncope?

Background

This study aimed to investigate serum 25[OH]D levels between patients with vasovagal syncope(VVS) diagnosed by head-up tilt table test (HUTT) and patients who do not develop syncope during the test.

Methods

Sixty-eight consecutive patients [mean age 33.2 ± 14.5 years, 49 females (72.1%)] were categorized based on their HUTT results (positive vs. negative, n = 40 vs. 28).25[OH]D levels were measured by chemiluminescent microparticle immunoassay method in all patients.

Results

There was no difference between the two groups in terms of blood tests, Body Mass Index, gender, echocardiographic findings(p > 0.05).Mean 25[OH]D level was lower in HUTT positive patients when compared to the HUTT negative group(p < 0.05).25[OH]D levels were significantly lower between patients over the age 25 in two groups (mean level 17.9 ± 7.3 vs 26.3 ± 8.5, respectively,p < 0.005).(Table 1) 

Conclusion

We found that patients diagnosed VVS by HUTT test had lower 25[OH]D levels.Measurement of vitamin D level may be an important factor in VVS patients.

Table 1 Head-up Tilt Testing positive (n = 40) negative (n = 28) p value Age (years) 33.2 ± 13.7 33.3 ± 15.9 0.973 Female gender (%) 31 (77.5) 18(64.3) 0.232 BMI (kg/m2) 23.4 ± 3.1 23.0 ± 2.6 0,596 EF (%) 59.2 ± 1.6 59.1 ± 1.3 0.357 LA (mm) 34 ± 2.4 33 ± 2.7 0.715 RA (mm) 32 ± 2.5 31 ± 2.7 0.141 Vitamin D (ng/mL) 16.5 ± 6.6 23.9 ± 9.5 0.001 Vitamin B12 (pg/mL) 355.1 ± 124.6 378 ± 87.0 0.367 TSH (mIU/L) 1.8 ± 0.8 1.7 ± 0.9 0.367 Glucose (mg/dL) 87.0 ± 7.4 90.5 ± 8.1 0.076 Creatinine (mg/dL) 0.6 ± 0.1 0.7 ± 0.1 0..55 Sodium (mmol/L) 139.8 ± 2.0 139.7 ± 2.5 0.931 Potassium (mmol/L) 4.1 ± 0.3 4.1 ± 0.2 0.674 Calcium (mg/dL) 8.9 ± 0.9 8.9 ± 1.1 0.476 Wbc (x103/uL) 7.3 ± 1.6 6.9 ± 1.6 0.339 Hb (g/dL) 13.3 ± 1.3 13.5 ± 1.8 0.664 Age (years) Vitamin D level Vitamin D level 0.132 ≤ 25 (n = 31) 14.8 ± 5.5 21.2 ± 10.2 0.057 > 25 (n = 37) 17.9 ± 7.3 26.3 ± 8.5 0.005 Patients characteristics of Head-up Tilt Testing positive and negative group

P667 Protein supplementation improves left ventricular systolic functions in athletes by 2D speckle tracking echocardiography

Funding Acknowledgements

none

Background

Exercise induced left ventricular remodelling is known for many years. Left ventricular enlargement, hypertrophy, left atrial dilatation are adaptive responsive mechanisms of myocardial tissue to increased physiological demand by exercise. In recent years, strain and strain rate have been used for the assessment of myocardial adaptation in athletes’. In literature, left ventricular and right ventricular deformation is decreased in athletes’, compared to normal healthy individuals. Also left atrial reservoir and contractile functions, which can be measured by speckle tracking echocardiography, decrease in endurance athletes with atrial fibrillation. Athletes have been using protein supplementation frequently in recent years however cardiac effects are largely unknown. There is limited data in the literature about cardiac effects of protein supplementation.

Purpose

In our study, we aim to evaluate the effects of protein supplementation on cardiac functions in athletes with 2D speckle tracking echocardiography. This is the first study in the literature evaluating the effects of protein supplements on echocardiographic parameters.

Methods

Eighty-three athletes (mean age = 29.7 ± 7.9) without history of cardiac disease or other chronic diseases such as hypertension, diabetes mellitus, kidney failure were prospectively included in our study. 73.5% (n = 61) of them were male. Participants were divided into two groups; participants who use protein supplementation regularly was defined as group 1 (n = 33); did not use protein supplementation was defined as group 2 (n = 50). In addition to Standard 2D echocardiographic measurements, left ventricle global longitidunal strain (LvGLS), right ventricle global longitidunal strain (RvGLS), right ventricle free wall strain (RvFWS), left atrium strain and strain rate were analyzed with Vivid E9, offline using a customized software package (Echo Pac for PC, GE Vingmed) (Figure 1).

Results

Diameter of interventricular wall was higher in group 1 (10.1 ± 1.0 vs 9.5 ± 1.2, p = 0.022). Systolic peak ejection velocity of the mitral valve medial annulus is higher in group 1 than group 2 (0.09 ± 0.1 vs 0.08 ± 0.1, p < 0.001). Late diastolic velocity of the mitral valve medial annulus is higher in the group 1 (0.09 ± 0.02 vs 0.08 ± 0.02, p = 0.015). LvGLS which was the indicator of left ventricular deformation was significantly higher in the group 1 (-19.49 ± 1.9 vs -18.45 ± 2.2, p = 0.030). Although RvGLS was higher in the group 1, there was no statistically significant difference (-22.93 ± 4.52 vs -21.07 ± 5.02, p = 0.083).

Conclusion

In recent years protein supplementation usage increases in young adults and athletes. In our study, although there was no statistically significant difference with left ventricular ejection fraction, LvGLS which is the early indicator of LV systolic functions better in the athletes who used protein supplementation. Further studies are needed to evaluate the long term effects of protein supplements on the heart.

P777 Effects of chronic cigarette smoking on left ventricle, left atrium and right ventricle strain parameters with 2D speckle tracking echocardiography

Funding Acknowledgements

None

Background

Cigarette smoking effects myocardium with several mechanisms such as sympathetic nervous system activation, oxidative stress and endothelial dysfunction. Chronic smokers have an increased risk of morbidity and mortality associated with adverse cardiac events. Echocardiography is the well-established non-invasive diagnostic tool for the assessment of cardiac systolic and diastolic functions. 2D speckle tracking echocardiography (STE) has been widely used for this purpose in recent years.

Purpose

The aim of this study is to compare the left ventricle, left atrium and right ventricle systolic functions with 2D speckle tracking echocardiography in chronic smokers and non-smoker healthy population.

Method

40 healthy participant (mean age 33.4 ± 10.0) without smoking history, 42 healthy participant (mean age 33.9 ± 9.2) who had smoking history at least 3 years without history of cardiac disease or any other chronic diseases such as hypertension, diabetes mellitus, kidney failure were prospectively included. In addition to Standard 2D echocardiographic measurements, left ventricular global longitidunal strain (LvGLS), right ventricular global longitidunal strain (RvGLS), left atrial strain and strain rate were analyzed with Vivid E9, offline using a customized software package.

Results

Smokers had lower peak early diastolic velocity (E) and E/A (late diastolic velocity) ratio in mitral inflow (0.70 ± 0.13 vs 0.77 ± 0.13, p = 0.023; 1.47 ± 0.44 vs 1.73 ± 0.44, p = 0.011; respectively). Peak early diastolic velocity of mitral valve medial annulus and E’/A’ ratio (0.11 ± 0.02 vs 0.12 ± 0.02, p = 0.023; 1.20 ± 0.37 vs 1.40 ± 0.46, p = 0.039; respectively) was lower in smokers. LvGLS and RvGLS were significantly impaired in smokers (-17.65 ± 3.01 vs -19.21 ± 2.52, p = 0.013; -18.96 ± 4.47 vs -21.06 ± 4.58, p = 0.039; respectively). Although εs, reservoir phase strain of left atrium; εe, conduit phase strain of left atrium; εa, contractile phase strain of left atrium were similar between two groups, εe/εa was significantly lower in smokers than non-smokers (1.32 ± 0.59, 1.63 ± 0.63, p = 0.026).

Conclusion

Impaired RV deformation was found in chronic cigarette smokers. Besides standardized diastolic dysfunction parameters εe/εa might be used for the early indicator of diastolic dysfunction. Although there was no statistically significant difference with left ventricular ejection fraction between smokers and non-smokers, LvGLS which is the early indicator of LV systolic dysfunction in chronic smokers might be used for the early assesment of LV systolic impairment.

Abstract P777 figure 1

Effect of statins on coronary blood flow after percutaneous coronary intervention in patients with stable coronary artery disease

Aims

Statins have favourable effects on the vascular system. However, few data are available regarding the effect of these drugs on patients undergoing percutaneous coronary intervention (PCI). We sought to determine the impact of prior statin use on coronary blood flow after PCI in patients with stable coronary artery disease (CAD) by using the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC).

Methods

A total of 80 consecutive eligible patients (mean age: 60 ± 7 years, 65 % male) with the diagnosis of stable CAD who were hospitalised for elective PCI were retrospectively enrolled in our study. The study population was divided into two groups according to statin use at least 6 months before PCI. Group 1 comprised of 51 patients (67 % male; mean age: 58 ± 4 years) taking statins and group 2 comprised of 29 patients (62 % male; mean age: 60 ± 3 years) not taking statins. PCI was applied to de novo type A lesions. CTFC was calculated for the treated vessels at baseline and after PCI.

Results

The two groups had similar characteristics in terms of age, sex, concomitant medications, lesion characteristics, pre-procedural CTFC, lipid parameters, and risk factors for CAD. Post-PCI CTFC (16 ± 3 vs. 22 ± 5, p = 0.01) and hs-CRP (2.1 ± 0.7 mg/l vs. 6.1 ± 2 mg/l, p = 0.01) in patients receiving statins before PCI were significantly lower than in patients without statin therapy. Multiple logistic regression analysis showed that statin pre-treatment (OR 2.5, 95 % CI 1.2 to 3.8, p < 0.001) and hs-CRP level (OR 1.8, 95 % CI 1.2 to 2.4, p = 0.001) were independent predictors of post-PCI CTFC.

Conclusions

In patients with stable CAD undergoing PCI, receipt of long-term statin therapy was associated with improvement in epicardial perfusion after PCI.

Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure

OBJECTIVES

Levosimendan is a novel positive inotropic calcium sensitiser agent used in acute left heart failure. In this study, the effect of levosimendan on the right ventricular systolic and diastolic functions was evaluated by tissue Doppler comparing them with dobutamine in patients with ischaemic heart failure.

METHODS

Patients having an acute decompensated heart failure with ischaemic cardiomyopathy and left ventricular ejection fraction <40% were included in the study. Before and 24-h after treatment, peak systolic (Sa), peak early (Ea), peak late (Aa) diastolic annular velocities and Ea/Aa ratio from tricuspid lateral annulus by tissue Doppler and systolic pulmonary artery pressure (SPAP) were measured.

RESULTS

Sa, Ea and the Ea/Aa ratio were significantly increased in the levosimendan group whereas SPAP was significantly reduced. In the dobutamine group, no significant differences were observed in the Sa, Ea, Aa and Ea/Aa ratio in spite of a significant reduction in SPAP. Decrease in SPAP was greater in the levosimendan group (p=0.002).

CONCLUSION

Levosimendan improves right ventricular systolic and diastolic functions.

Transbrachial coil occlusion of unligated thoracic side branch of arterial graft of internal mammary artery leading to silent ischemia in a diabetic patient

There is not an established consensus on the treatment of coronary steal syndrome caused by unligated thoracic side branches of internal mammary artery. Occlusion of thoracic side branch is not recommended without objective evidence of ischemia. This case report presents transbrachial coil occlusion of thoracic side branch of left internal mammary artery causing silent ischemia in a diabetic patient with atypical chest pain and palpitation.