You are on page 1of 2

Acute Heart Failure (AHF) / Prevention – General 511

cantly increase or decrease myocardial perfusion or aortic stiffness and was con- respiratory disease and orthopaedic problems and 45% of patients had more than
sidered safe up to 180 days following the infusion. two comorbidities.
Acknowledgement/Funding: This study was funded by Novartis Pharma AG, Conclusions: In our center, HFC allowed to significantly reduce the rehospitali-
Basel, Switzerland sation rate in a paediatric population.

P2472 | BEDSIDE P2474 | BEDSIDE


Liver stiffness is associated with congestion by bioimpedance vector Validity and reliability of the mutuality scale in heart failure patient and
analysis in patients with decompensated heart failure caregiver dyads
A. Soloveva, M. Bayarsaikhan, I. Garmash, S. Villevalde, Z. Kobalava. RUDN F. Dellafiore 1 , M. Paturzo 1 , A. Petruzzo 1 , F. Dagostino 2 , C. Barbaranelli 3 ,
University, Moscow, Russian Federation R. Caruso 4 , R. Alvaro 1 , E. Vellone 1 . 1 University of Rome Tor Vergata, Depart-
ment of Biomedicine and Prevention, Rome, Italy; 2 S.Giovanni Calibita Fatebene-
Objective: Over the last several years the relationship of liver stiffness (LS) with
fratelli Hospital, Rome, Italy; 3 Sapienza University of Rome, Department of
congestion in decompensated heart failure (DHF) have been discussed. We in-
Psychology, Rome, Italy; 4 IRCCS, Policlinico San Donato, Health Professions
vestigated LS by the transient elastography (TE) and its associations with hydra-
Research and Development Unit, San Donato Milanese, Italy
tion status assessed by bioimpedance vector analysis (BIVA) and weight dynam-
ics in patients with DHF. Background: The relationship between heart failure (HF) patients and their infor-
Methods: LS was measured using TE in 94 patients with DHF on admission and mal caregivers (e.g., a spouse or an adult child) is important for HF outcomes. An
discharge (60 male, 72±10 years (M±SD), arterial hypertension 96%, myocardial aspect of this relationship is mutuality, which was defined as the positive quality
infarction 55%, atrial fibrillation (AF) 63%, diabetes mellitus 45%, known chronic of the relationship between a caregiver and a care-receiver. One of the most used
kidney disease 29%, chronic anaemia 30%, left ventricular ejection fraction (EF) scale to measure mutuality is the Mutuality Scale (MS). The MS measures mu-
40±14%, EF <40% 28%, NYHA IV 41%). Ten valid measurements were required tuality from caregiver and patient perspective and includes four dimensions: “love
with success rate of >60%. LS≤5.8 was considered normal and LS ≥5.9, 7.2, and affection”, “shared pleasurable activities”, “shared values”, and “reciprocity”.
9.5 and 12.5 kPa were considered fibrosis (F1-F3 METAVIR score) and cirrhosis So far, no study has tested the MS in HF patient and caregiver dyads.
(F4) according to thresholds in studies with chronic liver disease. Purpose: The aim of this study was to test the validity and reliability of the MS in
Hydration status was assessed by BIVA using resistance (R) and reactance (Xc), patients with HF and their caregivers.
standardized by height (h). Results have been graphically depicted. Deviation Methods: An observational, cross-sectional and correlational study design was
from the 50th, 75th and 95th vector percentile of the healthy reference popula- used. Patients and caregivers completed the MS and a sociodemographic ques-
tion was considered as mild, moderate and severe hyperhydration. Mann-Whitney tionnaire. Patients’ clinical information was abstracted by their medical records.
test, Wilcoxon test, Spearman correlation tests were performed. P<0.05 was con- Confirmatory Factor Analysis was used to analyze the factorial validity of MS;
sidered significant. Cronbach’s alpha and model-based internal consistency index were used to de-
Results: Normal LS was observed in 16% of patients. Abnormal LS ≥5.9, 7.2, termine the internal consistency of MS. The intraclass correlation coefficient was
9.5 and 12.5 kPa occurred in 8.5, 14, 10.5 and 51% of patients respectively. Mild, used to determine test-retest reliability.
moderate and severe hyperhydration were revealed in 23, 34 and 43% of patients Results: A convenience sample of 323 HF patients (mean age 71.48 years, SD
respectively. In patients with mild, moderate and severe hyperhydration by BIVA 12.75; 57.3% men) and 323 HF caregivers (mean age 53.73 years, SD 15.34;
the median LS was 6.1 (4.4; 18.4), 14.8 (11.4; 21.7) and 17.5 (12.3; 34.3) kPa, 74% women) was enrolled in the study. Patients were mainly in NYHA class II
p<0,05. In patients with LS <5.6, ≥5.9, 7.2, 9.5 and 12.5 kPa parameters R/h and (60.1%) and III (31.9%) and had several comorbidities (hypertension 73.8%, my-
Xc/h were 314±76 and 28±6, 286±64 and 25±4, 277±41 and 26±10, 239±41 and ocardial infarction 38% and atrial fibrillation 33.4%). The mean ejection fraction
20±5, 235±55 and 18±6 Om/m, respectively. Decrease of R/h and Xc/h means was 39.25 (DS 10.29) and the mean month of illness was 64.80 (DS 74.22).
increase of severity of hyperhydration. Confirmatory Factor Analysis supported the factorial validity of the MS in its pa-
Statistically significant correlations between LS and BIVA parameters of hyperhy- tient (CFI=0.94; RMSEA=0.061) and caregiver (CFI=0.92; RMSEA=0.073) ver-
dration on admission were revealed (r=-0.32 for R/h and r=-0.37 for Xc/h, p<0.05). sion. Cronbach’s alphas and model-based internal consistency index were >0.94.
During hospitalisation the following changes were oserved: the median value of Test-retest reliability resulted with an intraclass correlation coefficient ranging be-
LS decreased from 17.1 (interquartile range 10.2; 34.8) to 11.6 (6.4; 19.6) kPa tween 0.55 to 0.79.
(LS=-5.5 (-12;-0.1) kPa), p<0.001. R/h and Xc/h increased from 242±55 to Conclusion: Our analysis showed that the MS has good factorial validity and
286±59 Om/m and from 19±5 to 23±6 Om/m (R/h 25 (10; 72) Om/m, Xc/h internal consistency and test-retest reliability in HF patient and caregiver dyads.
4.4 (1.1; 7.5) Om/m), p<0.001 for both comparisons. Patients weight decreased The instrument can be used in clinical practice and research to measure mutuality
from 89±23 to 79±20 kg, p<0.001 (weight -5.4±4.8). LS was negatively cor- in this population.
related with  R/h (r=-0.48), Xc/h (r=-0.46) and  weight (r=-0.54).
Conclusions: LS was associated with congestion by BIVA. During hospitalization
absolute decrease of LS correlated with absolute decrease of weight and increase PREVENTION – GENERAL
of BIVA parameters.
P2475 | BEDSIDE
A randomized controlled trial of telemonitoring home-based training
P2473 | BEDSIDE versus center-based in coronary heart disease: short-term results of
Heart failure clinic in paediatric population: a comparative analysis of the tele-rehabilitation in coronary heart disease (TRiCH) study
outcome
A. Avila 1 , J. Claes 1 , K. Goetschalckx 2 , L. Vanhees 1 , V. Cornelissen 1 . 1 KU
R. Adorisio, N. Cantarutti, A. Baban, G. Calcagni, S. Giannico, G. Grutter, Leuven, Rehabilitation Sciences, Leuven, Belgium; 2 KU Leuven, Cardiovascular
F.S. Iorio, F. Drago. Bambino Gesu Childrens Hospital, Paediatric Cardiology, Imaging and Dynamics, Leuven, Belgium
Rome, Italy
Introduction: Cardiovascular diseases (CVD) remain the leading contributor to
Background: It has been reported that heart failure clinic (HFC) can improve the global mortality and morbidity. Cardiac rehabilitation (CR) is an essential part of
outcome of adult heart failure patients, in terms of reduction of rehospitalisation, contemporary coronary heart disease (CHD) management that aims to optimize
adherence to therapy and improvement in quality of life. cardiovascular risk reduction, facilitate adoption and adherence to healthy behav-
Purpose: The aim of current study was to determine whether a specific HFC is iors, reduce disability and promote active lifestyles. However, studies have shown
effective also in a paediatric population. that patients exiting a center-based CR have difficulty retaining the positive effects
Methods: Since 2013, a specific HFC including two cardiologists and 1 dedicated that were derived from their weeks of participation. Therefore, there is a need for
nurse has been developed in our Department. A multidisciplinary approach and innovative rehabilitation methods focused on sustained effects on health related
specific disease protocols have been applied. Children affected by: 1) left ventric- physical fitness.
ular ejection fraction <45% in case of dilated cardiomyopathy or after surgery, 2) Purpose: The purpose of the TRiCH study was to compare the short and longer-
restrictive and 3) hypertrophic cardiomyopathy 4) Fontan failure and 5) pulmonary term clinical effects of a home-based (HB) CR program with telemonitoring guid-
hypertension have been referred to our HFC. To evaluate the impact on mortality, ance to a center-based (CB) CR and a control group (CG) on physical fitness and
rehospitalisation, analysis of comorbidities and compliance to therapy, we made other secondary outcomes in patients with coronary artery disease (CAD) in the
a comparative analysis on 291 children followed between 2011 and 2015, before maintenance phase (WHO Phase III).
and after the specific program. Methods: Between February 2014 and August 2016, 90 coronary artery disease
Results: Our population (11.2+ 5 years old; 52% male) was represented by: 45% patients (61.7±7.7yrs, 89% males, 1.73±0.7m, 82.8±13kg, 27.5±3.3kg/m2 ), who
patients affected by cardiomyopathies, 50% CHD with ventricular dysfunction or successfully completed a three month ambulatory cardiac rehabilitation program
Fontan failure. After the introduction of this program, a significant reduction of (phase II) at the hospital, were randomly allocated to one of three groups: HB
new urgent rehospitalisation was observed (2011 vs 2014 75% vs 33%, p<0.001; (=30), CB (=30) or a Control (CG) (=30) on a 1:1:1 basis. HB patients received
2011 vs 2015 75% vs 12%, p<0.001; 2011 vs 2016 75% vs 14%, p<0.001). Acute a telemonitoring exercise intervention, CB patients participated in the in-hospital
HF admissions were significantly reduced over the time (2011 vs 2016 52% vs CR exercise program and CG patients received the standard advice on physical
13%, p<0.001). No differences in terms of mortality have been observed. Major activity. Peak oxygen uptake (PVO2; primary outcome) and secondary outcomes
reasons for rehospitalisation were: respiratory (52%), gastroenterological infec- (blood pressure, anthropometrics, blood lipids, glucose, quality of life, muscle
tion (33%), arrhythmias (12%). Major comorbidities included: nutritional aspects, strength) were assessed at baseline and after the 12 week intervention period.

Downloaded from https://academic.oup.com/eurheartj/article-abstract/38/suppl_1/ehx502.P2475/4089195


by edi.supriadi5@gmail.com
on 04 January 2018
512 Prevention – General

Results: Basic characteristics of the groups at baseline were similar. There was a collected from August to December 2016 worldwide with more than 90% of users
drop out of 4 patients in the CG (13%), 2 in the HB group (7%). After 12 weeks of from US, Canada, Europe, Japan, and China. To identify users that had reduced
intervention, there was a significant increase in exercise capacity in the CB group their PWV we calculated the percent change in PWV between August and De-
of 1.3mL·kg–1 ·min–1 (95% CI -0.09, 2.49; P=0.034), and of 1.1mL·kg–1 ·min–1 cember averages and set a threshold of -10%. We used a Welch’s t-test for eval-
(95% CI -0.04, 2.51; P=0.043) in the HB group, whereas in the CG the exercise uating whether there was a difference in the levels of self-measurement and ac-
capacity decreased 0.20mL·kg–1 ·min–1 (95% CI -2.01, 0.59; P=0.28). No signifi- tivity between users who reduced their PWV and other users. To evaluate the dif-
cant differences were found for the secondary outcomes. ference in weight change from August to December between users who reduced
Conclusion: After completion of a phase II program, a HB is equally effective as their PWV and other users we performed a linear regression for each group and
a CB CR program to further increase exercise capacity. compared the slopes with a Student t-test.
Acknowledgement/Funding: The Joint Doctorate Program “MOVE-AGE”, is Results: 960 users had reduced their PWV by more than 10% from August to
funded by the European Commission as part of the Erasmus Mundus program December. These users measured themselves 25.7 times per month on average,
which is significantly more often than others at 18.1 times per month with a p-
value less than 10–10 . The activity level of users who reduced their PWV was
P2476 | BEDSIDE significantly higher than that of others at an average of 6065 daily steps versus
Assessment and control of physical activity by step counters and 5763 respectively with a p-value of 1.6x10-6 . Users who reduced their PWV also
online documentation in secondary prevention after myocardial reduced their weight by 0.31 kg/month while other users gained weight during
infarction the 4-month year-end period at a rate of 0.22 kg/month, a difference which is
statistically significant with a p-value less than 10–10 .
H. Wienbergen 1 , T. Backhaus 1 , S. Michel 1 , J. Stehmeier 1 , K. Kraemer 1 ,
Conclusions: This study suggests that a reduction in PWV and thereby an im-
J. Schmucker 1 , S. Meyer 2 , J. Meyer 3 , H. Haase 4 , A. Elsaesser 2 , R. Hambrecht 1 .
1 proved cardiovascular health can be brought about over the course of 4 months
Klinikum Links der Weser, Bremer Institut für Herz- und Kreislaufforschung, Bre-
through frequent self-measurement, an increased activity level, and weight reduc-
men, Germany; 2 Oldenburg Hospital, Oldenburg, Germany; 3 OFFIS - institute for
tion. The results can form the basis of recommendations used in medical practice
information technology, Oldenburg, Germany; 4 RehaZentrum, Bremen, Germany
to improve cardiovascular health. This study further demonstrates the value of au-
Background: Physical inactivity is an important modifiable risk factor in sec- tomatically collected self-measurement PWV data, enabled by connected scales.
ondary prevention. It was the purpose of this study to investigate feasibility and
effects of step counters and online documentation of steps to prevent physical
inactivity after myocardial infarctions. P2478 | BEDSIDE
Methods: The randomized IPP study investigates the effects of an intensive Intermittent hypoxia-hyperoxic training as a new method of
longterm prevention program (IPP) compared with usual care (UC) after acute cardioprotection during coronary artery bypass surgery
myocardial infarctions. As part of the prevention program step counters were of-
D. Tuter, P. Kopylov. I.M. Sechenov First Moscow State Medical University,
fered to all patients of the IPP group. The patients were requested to document
Moscow, Russian Federation
the number of steps in a study online portal, feedback was given by the study
center. Introduction: The rate of complications during coronary artery bypass surgery,
Results: 103 patients (81.1%) of the 127 patients in the IPP group documented particularly in cases of using of heart-lung machine, is still high. An impor-
steps, 91 patients (71.7%) for >6 months. tant task is to find new methods of heart protection from damaging effects
The mean number of daily steps increased with growing time interval from my- of ischemia/reperfusion during surgery. Proposed technique of cadioprotection
ocardial infarction (Table). involves achieving of myocardial preconditioning effect using short alternating
In patients that increased the number of daily steps >30% during 6 months, an episodes of hypoxia (O2 concentration of 12%) and hyperoxia (O2 concentration
improvement of the clinical parameters body mass index (BMI) [-1.1±1.7 kg/m2 of 35%). Total time of breathing with hypoxic gas mixture during one procedure is
(-3.9%), p<0.01], blood pressure [-6.7±13 mmHg (-4.9%), p 0.01] and LDL- 20–30 minutes, total time of one procedure is 40–50 minutes. The final training -
cholesterol [-3.5±22 mg/dl (-4.9%), p 0.39] was observed. on the day before surgery.
In patients that did not increase the number of daily steps >30%, no improve- Objective: Development of new methods of heart protection, decreasing of com-
ment of the clinical parameters was found [BMI: ±0.0±3.9 kg/m2 (±0.0%), p 0.98, plication rates in coronary artery bypass surgery.
blood pressure: +2.0±15 mmHg (+1.5%), p 0.31, LDL-cholesterol: +1.2±26 mg/dl Research methods: 80 patients, who underwent aorto- and/or internal mam-
(+1.6%), p 0.24]. mary coronary artery bypass surgery, were included in the study, of them 40
patients were included in the main group and 40 in the control group (groups
Table 1 were matched by sex, age, extent of coronary artery disease and number of co-
Study start (n=91) 3 months (n=91) 6 months (n=91) P morbidities). Patients of the main group had 4-day course of intermittent hypoxia-
Number of steps/day (MV ± SD) 8015±3834 8826±4102 9480±3627 <0.01 hyperoxic training (IHHT) before surgery, patients of the control group 4-day train-
ing course simulating IHHT (supplied air contained usual oxygen level). Opera-
Conclusions: Acceptance of step counters and online documentation as part tions were carried out in conditions of cardiopulmonary bypass and cold cardio-
of a longterm prevention program was good and the number of steps increased plegia. Monitoring of Troponin I and lactate levels was performed for all patients
significantly during study course. Patients with an increase of steps >30% dur- immediately before surgery, 2 and 24 hours later.
ing 6 months improved the clinical parameters BMI, blood pressure and LDL- Results: Statistically significant decreased mean level of Troponin I were seen
cholesterol, while patients without increased steps did not. in the IHHT group on the day after surgery in comparison with the control group
The data underline the value of step counters and online documentation as a (2.16 ng/mL and 3.44 ng/mL, respectively; p=0.012). Difference between values
strategy to prevent physical inactivity after myocardial infarctions. of Troponin I before surgery and two hours later was not statistically significant.
Acknowledgement/Funding: Deutsche Herzstiftung e.V., Stiftung Versorgungs- Also values of lactate are significantly different after surgery (1.96 mmol/L in the
forschung der ALKK e.V., Handelskrankenkasse Bremen, Stiftung Bremer Wert- IHHT group and 2.35 mmol/L in the control group, p=0.04). Lactate levels before
papierbörse surgery are the same in both groups. By the number of complications downward
trend in the number of paroxysmal atrial fibrillation in the perioperative period
was noticed in the IHHT group compared with the control group (8 (20%) and 12
P2477 | BEDSIDE (30%) episodes, respectively). In addition, 2 cases of ventricular fibrillation (5%)
Assessing self-measurement, activity, and weight change behaviors of were seen in the control group only, one of which occurred on the background of
connected scale users who reduced their pulse wave velocity over 4 intraoperative myocardial infarction with transition to asystole, which caused the
months death of the patient. Rate of other complications was the same in both groups.
Conclusions: Although rate of complications between two groups did not reach
E. Roitmann, A. Chieh. Withings, Paris, France
tests of significance (that can be attributed to a small number of patients included
Introduction: Pulse wave velocity (PWV) is widely known as a marker of cardio- in the study), lower levels of Troponin I and lactate in the IHHT group after coro-
vascular risk. As a preventive measure against cardiovascular events it is desir- nary artery bypass surgery indicates the increased resistance of the myocardium
able to reduce the PWV. While there are many cross-sectional analyses describ- to the damaging effects of ischemia/reperfusion in the course of operation.
ing the association between cardiovascular risk and PWV, little research has eval-
uated longitudinal changes and the behaviors associated with a PWV reduction.
PWV measurements have until recently been limited mostly to research and med- P2479 | BEDSIDE
ical centers because measurements required the use of expensive and complex Behaviours of French amateur rugby players, lifestyle of the younger
devices. The new connected scales that permit self-measurement of the PWV at higher risk for their heart?
makes it possible to analyze the PWV of large cohorts with a high measurement
F. Chague 1 , M. Zeller 2 , J. Petit 3 , C. Guenancia 1 , P. Aviat 4 , Y. Laurent 3 ,
frequency.
A. Gudjoncik 1 , J.C. Perrin 4 , J.P. Hager 4 , V. Gremeaux 3 , Y. Cottin 1 . 1 University
Purpose: The study aims to leverage the availability of high-frequency PWV self-
Hospital of Dijon, Cardiology department, Dijon, France; 2 University of Bour-
measurements of a large number of connected scale users to determine the be-
gogne Franche-Comté, Laboratory PEC 2, Dijon, France; 3 University Hospital
haviors of users who reduce their pulse wave velocity over the course of 4 months.
of Dijon, Rehabilitation department, Dijon, France; 4 French Rugby Federation,
Methods: The study was conducted on anonymous data from a pool of 99,327
Marcoussis, France
users of connected scales that measure both weight and PWV. 59,497 of these
users also track their daily steps with wearable activity trackers. The data was Background: Sudden cardiac death during sport remains a major problem. In

Downloaded from https://academic.oup.com/eurheartj/article-abstract/38/suppl_1/ehx502.P2475/4089195


by edi.supriadi5@gmail.com
on 04 January 2018