Accepted on 26 Sep 2022            Submitted on 26 Sep 2022

107880

Modality: E-Poster Researcher – Non-case Report

Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH

Mortality in a 3-Year Follow-Up of Congestive Heart Failure Due to Chagas Disease in Women and Men

ANTONIO DE PADUA MANSUR1, Carlos Henrique Del Carlo1, José Antonio Ramos Neto1, André Barbosa de Abreu1, Airton Roberto Scipioni1, Antonio Carlos Pereira Barreto1

(1) Insituto do Coração – HC FMUSP

Background: Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of congestive heart failure (CHF) in Latin America and carries a high morbidity and mortality burden. Previously, it was believed that there was no epidemiological and clinical evidence of a gender-associated risk of death in patients with CCC.

Purpose: To analyze the mortality of congestive heart failure due to CCC in women and men.

Methods: From February 2017 to September 2020, we followed a cohort of patients with CHF (Framingham criteria) due to CCC in a single-center outpatient clinic. Appropriate serologic tests defined Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier (K-M) method to analyze time-to-event data and the Cox proportional hazards methods to search for predictors of death.

Results: We studied 733 patients, mean of 61.4 ± 12.3 years, 381 (52%) males. Females were older (63.0 ± 11.9 vs. 60 ± 12.4 years; p = 0.01), had a higher baseline mean left ventricular ejection fraction (LVEF) (44.5 ± 14.6% vs. 37.3 ± 14.8%; p < 0.001), and a lower left ventricular diastolic diameter (LVDD) (56.7 ± 8.9 vs. 62.4 ± 9.4 mm; p < 0.001). Over a 3-years follow-up period, 168 (44%) men and 126 (36%) women died (K-M: log-rank p = 0.002; Figure). Women had more implantable pacemakers (PM) (26.1% vs. 16.5%; p = 0.002) and men more implantable cardioverter-defibrillators (ICDs)(20.7% vs. 12.5%; p = 0.003). Heart transplant occurred in 10.8% of men and 7.4% in women (p = NS). Cox regression for death adjusted for age, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, PM, ICD, heart transplant and LVEF, showed, in descending order, previous stroke (HR = 2.4; 95%CL:1.5–3.6), diabetes (HR = 2.0; 95%CL: 1.3–3.1), and CKD (HR = 1.8; 95%CL:1.3–2.6) as the main predictors of death in men, and in women diabetes (HR = 2.2; 95%CL:1.4–3.4), previous stroke (HR = 1.8; 95%CL:1.1–2.9), and CKD (HR = 1.7; 95%CL:1.1–2.7).

Conclusions: Women had a better prognosis than men but similar predictors of death. Control of diabetes and prevention of stroke and CKD could significantly reduce the death rate in CHF due to CCC.

108498

Modality: WHF Abstracts – Young Researcher

Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH

D: 14/10/2022    H: 16:50/17:50

L: Auditório 14

Relationship between Sociodemographic Index and Ischemic Heart Disease in Brazil in the Period of 2000–2019

JOSÉ LUCAS PERES BICHARA1, José Lucas Peres Bichara1, Luiz Antônio Viegas de Miranda Bastos1, Paolo Blanco Villela1, Glaucia Moraes de Oliveira1

(1) Universidade Federal do Rio de Janeiro – UFRJ

Introduction: Cardiovascular diseases (CVD) are the main causes of death in the world and in Brazil, and ischemic heart diseases (IHD) are one of the main responsible for these statistics. Previous studies have already suggested a relationship between the evolution of IHD mortality rates and socioeconomic indicators.

Objective: To relate the evolution of IHD mortality rates and the sociodemographic index (SDI) from 2000 to 2019 in Brazil and in its federative units (FUs).

Methods: Ecological time series study of deaths from IHD in Brazil. Crude and standardized mortality rate for IHD were analyzed by sex, age group and FU between 2000 and 2019. Data were correlated with the SDI. Deaths and population were taken from DATASUS to estimate crude and standardized mortality rates per 100,000 inhabitants (direct method with Brazilian population in 2000). The SDI for each UF was extracted from the Global Health Data Exchange website.

Results: In the period, there were 1,968,160 deaths from IHD in Brazil, 58.19% of which were male. The national SDI ranged from 0.538 in 2000 to 0.64 in 2019, with constant growth in the period. Concomitantly, the age-standardized mortality rate for IHD decreased from 46.12/100,000 inhabitants to 36.42/100,000 inhabitants. Thus, IHD has become the leading cause of mortality in the country. In the FUs, all states in the North and Northeast regions showed improvements in the SDI, however, the best indicators continued to be concentrated in the other regions. In 2000, the highest mortality rates from IHD were found in the South, Southeast and Midwest regions of the country, but they showed a significant reduction. When evaluating the variation of the standardized mortality rate in the period, it was noted that the FUs with the best SDI were responsible for the greatest drops (graph 1).

Conclusion: During the period, the country showed a significant improvement in socioeconomic indicators accompanied by a reduction in IHD mortality rates. When evaluating the FUs, it was noted that those with better socioeconomic indicators were able to obtain a greater reduction in these mortality rates.

108502

Modality: WHF Abstracts – Researcher

Category: NEGLECTED CARDIOVASCULAR DISEASES

D: 14/10/2022    H: 13:50/14:50

L: Auditório 14

Association between Autonomic Denervation, Myocardial Hypoperfusion, Fibrosis and Ventricular Arrhythmias in Chagas Cardiomyopathy

ADRIANA SOARES XAVIER DE BRITO1, Renata Junqueira Moll-Bernardes1, Martha Valeria Tavares Pinheiro1, Paulo Henrique Rosado de Castro1, Gabriel Cordeiro Camargo1, Adriana Pereira Glavam1, Sergio Altino de Almeida1, Fabio Paiva Siqueira1, Marcelo Teixeira de Holanda2, Luiz Henrique Conde Sangenis2, Fernanda de Souza Nogueira Sardinha Mendes2, Andrea Silvestre de Sousa2

(1) D’Or Institute for Research and Education (IDOR), Rio de Janeiro; (2) Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation

Introduction: Chagas disease continues to be an important cause of morbidity and mortality in Latin America. Sudden cardiac death (SCD) represents the most dramatic course of Chagas cardiomyopathy (CC), and it is closely related to the presence of ventricular arrhythmias and myocardial dysfunction. However, there is also a high incidence of SCD when left ventricular ejection fraction (LVEF) is normal or mildly depressed. Unfortunately, despite its significant mortality, there is no clear recommendation for early cardio-defibrillator implantation in patients with CC. Ideally, the risk of SCD should be evaluated in earlier stages of the disease, but important questions remain unresolved regarding its pathophysiological mechanism and the diagnostic tools. New imaging parameters to identify the genesis of arrhythmia such as fibrosis, inflammation and dysautonomia can be a promising strategy.

Purpose: We tested the correlation between the extent of myocardial sympathetic denervation, myocardial perfusion, fibrosis and the severity of the ventricular arrhythmia in patients in the early phase of CC.

Methods: Twenty-nine patients with CC and LVEF >45% prospectively underwent magnetic resonance (MRI), SPECT imaging of myocardial sympathetic innervation using 123Iodine-MIBG (MIBG) and rest myocardial perfusion with 99mTc-sestamibi (MIBI), and were divided into two groups: arrhythmic group (n = 15): >120 ventricular ectopic beats and/or Non-Sustained Ventricular Tachycardia (NSVT) and non-arrhythmic group (n = 14): <120 ventricular ectopic beats without NSVT on 24-h Holter monitoring.

Results: Compared to non-arrhythmic, the arrhythmic group had significantly higher denervation score (mean ± SD 23.2 ± 18.7 versus 5.6 ± 4.9; p < 0.01), higher summed rest perfusion score (mean ± SD 4.7 ± 6.8 versus 0.3 ± 0.6; p < 0.05) as well as the higher mismatch in the innervation/perfusion score between MIBG and MIBI images, which evaluates the extent of denervated but viable myocardium (mean ± SD 18.4 ± 17.5 versus 5.3 ± 4.7; p < 0.01). There was a correlation between myocardium denervation (r 0.555; p < 0.01), hypoperfusion (r 0.562; p < 0.01), and interstitial fibrosis evaluated by extracellular volume at MRI.

Conclusion: The combination of different imaging parameters to assess autonomic innervation, myocardial perfusion and fibrosis may allow better understanding of the pathophysiology and risk stratification for SCD in the early stages of CC.

108593

Modality: WHF Abstracts – Researcher

Category: NEGLECTED CARDIOVASCULAR DISEASES

D: 14/10/2022    H: 13:50/14:50

L: Auditório 14

Progression of Electrocardiographic Abnormalities in Elderly Chagas Disease Patients During 14 Years of Follow-Up: The Bambui Cohort Study of Aging

BRUNO OLIVEIRA DE FIGUEIREDO BRITO1, Bruno Oliveira de Figueiredo Brito1, Emilly Malveira de Lima2, Elsayed Z. Soliman3, Maria Fernanda Lima-Costa4, Antonio Luiz Pinho Ribeiro1

(1) Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; (2) Department of Statistics, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; (3) Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; (4) Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil

The electrocardiogram (ECG) plays a key role in the evaluation of Chagas disease (ChD). The ECG shows progressive abnormalities that indicate worsening myocardial damage. There is no information about the evolution of the ECG of elderly individuals with ChD.

Objective: To compare the evolution of electrocardiographic abnormalities in Trypanosoma cruzi chronically infected individuals to that of the non-infected (NChD) elderly in a follow-up of 14 years of the Bambui Cohort Study of Aging in Brazil.

Methods: A digitally recorded 12-lead ECG of each individual was obtained at the baseline examination in 1997, in 2002 and in 2008, and was classified by the Minnesota Code criteria. The influence of ChD on the ECG evolution was assessed by the semi-competing risks methods considering a new ECG abnormality as the primary event and death the terminal event. The group with ChD was compared with the NChD group. A Cox regression model was conducted separately in ChD and NChD groups, in a landmark point at 5.5 years until the end of follow-up. The individuals of both groups were compared according to the following categories: No major: individuals without major abnormalities in the first and second visits; Maintained major: individuals who had the number of major abnormalities in second visit equal to the first visit, More major: individuals who had major abnormalities in the first visit and gained more abnormalities in the second visit and New major: individuals who had no abnormalities in the first visit and gained any major abnormality in the second visit.

Results: Among the 1,462 participants, 557 had ChD. The median age was 68 years for patients with ChD and 67 for patients without ChD. Chagas disease was independently associated to the occurrence of new major ECG abnormalities in the multivariate analysis HR: 2.89 (95% CI 2.28–3.67). Compared with the group of ChD No major, the risk of death was HR: 2.48 (95% CI 1.43–4.28) for the Maintained, HR: 1.95 (95% CI 1.04–3.69) for the New major, and HR: 2.77 (95% CI 1.57–4.88) for the More Major. Compared with the group of ChD Maintained major, the risk of death was HR: 0.79 (95% CI 0.44–1.42) for the group New Major and HR: 1.11 (95% CI 0.66–1.89) for the group More Major.

Conclusion: Even in advanced ages, the patients with ChD have higher risk than NChD of developing new abnormalities in the ECG. It is enough for individuals with ChD to have ECG abnormalities for their risk of death to increase.

108671

Modality: WHF Abstracts – Young Researcher

Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH

D: 14/10/2022    H: 16:50/17:50

L: Auditório 14

Comparison of Adoption of Guideline-Recommended Medical Therapy for Heart Failure Across Global, National, and State Essential Medicine Lists

GAUTAM SATHEESH1, Mohammad Abdul Salam2

(1) The George Institute for Global Health, Hyderabad, India; (2) The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia

Introduction and/or rationale: Heart failure (HF) is a leading global health burden that disproportionately affects patients in low- and middle-income countries with weaker health systems, such as India. Underutilization of guideline-recommended medical therapy (GRMT)—causing large gaps in evidence and clinical practice—can be mitigated through the adoption of GRMT in the EMLs.

Objectives: To compare the adoption of GRMT across the global (WHO) EML and the national and state EMLs of India.

Methods: We collated a list of medicines recommended by American (American College of Cardiology Foundation, the American Heart Association, and the Heart Failure Society of America; 2017), European (European Society of Cardiology; 2021), and relevant Indian guidelines (Cardiological Society of India; 2018). We assessed the adoption of these medicines in WHO EML (2021), India’s latest national EML (2015), Ministry of Health and Family Welfare’s free medicines list (2020), and 23 Indian state EMLs. We only included ‘evidence-based medicines’, i.e., those supported by relevant randomized controlled trial data for HF. Therefore, we did not include medicines listed as ‘commonly used’ without relevant evidence. We also excluded medicines listed for use in selected patients only (e.g., milrinone, levosimendan, nesiritide etc.).

Results: The adoption of GRMT by WHO EML 2021 was 48% (n = 17), ranging from 75% (beta-blockers) to 0% (SGLT-2 inhibitors). GRMT adoption by Indian EML was 35% (n = 11), ranging from 50% (mineralocorticoid-receptor antagonists) to 0% (SGLT-2 inhibitors). On average, Indian state EMLs contained 36% [18% (Punjab)–53% (Rajasthan)] of GRMT. The lowest adoption (16%; n = 6) was observed in the Ministry of Health’s free medicines list, which omitted several major first-line medicine classes. Newly included GRMT, including angiotensin-receptor neprilysin inhibitors and SGLT-2 inhibitors, are yet to be listed in global and national EMLs. Further, at least one emergency medicine was included in all EMLs.

Conclusion: Inclusion of GRMT for HF remains suboptimal in the global as well as the national and state EMLs of India. EMLs guide medicine selection and procurement in limited-resource settings. Considering India’s increasing cardiovascular disease burden and the potential for EMLs to improve availability and affordability of GRMT, optimizing India’s national and state EMLs and particularly its public sector (free medicines) list, is vital.

109112

Modality: WHF Abstracts – Young Researcher

Category: NEGLECTED CARDIOVASCULAR DISEASES

D: 14/10/2022    H: 16:50/17:50

L: Auditório 14

Myocardial Perfusion Disturbance in Experimental Chronic Chagas Disease: The Role of Endothelial Inflammatory Activation

DENISE MAYUMI TANAKA1, Camila Godoy Fabricio1, José A. Marin-Neto1, Antônio Carlos Leite de Barros Filho1, Luciano Fonseca Lemos de Oliveira3, Jorge Mejia4, Rafael Ribeiro Almeida2, Maria de Lourdes Higuchi2, Edecio Cunha Neto2, Minna Moreira Dias Romano1, Marcus Vinícius Simões1

(1) Medical School of Ribeirao Preto – University of São Paulo, Sao Paulo, Brazil; (2) Heart Institute (InCor), Faculty of Medicine – University of Sao Paulo, Sao Paulo, Brazil.; (3) Physiotherapy Department – Federal University of Minas Gerais, Brazil; (4) Hospital Israelita Albert Einstein, Sao Paulo, Brazil.

Background: Microvascular myocardial perfusion defect (MPD) is frequent in chronic Chagas cardiomyopathy (CCC) and may be involved with the progression of left ventricular systolic dysfunction (LVSD). However, the histopathological meaning of MPD in CCC and its correlation with endothelial activation is scarce.

Purpose: To investigate the correlations between MPD detected in vivo with functional and histopathological changes in the model of CCC in hamsters.

Methods: 24 female hamsters were studied 8-months after intraperitoneal infection with 35,000 trypomastigote forms of T. cruzi. All animals were submitted to rest high-resolution 99mTc-Sestamibi-SPECT myocardial perfusion scintigraphy and echocardiography in vivo. The area of MPD was assessed by calculating polar maps using dedicated software (MunichHeart®). After euthanasia, we performed a histopathological study of cardiac inflammation and fibrosis and mRNA expression for TNF-alfa and ICAM to assess inflammation and endothelial activation, respectively.

Results: 17 animals presented MPD (71%) – extension ranging from 1.4 to 30.3% of LV surface. Animals with MPD present lower values of LVEF (38.5 ± 11.2%) when compared with animals without MPD 48.4 ± 9.1%, p = 0.04), and a trend to higher intensity of myocardial inflammation in animals with MPD (540.4 ± 153.6 cell/mm2) vs. without MPD (409.6 ± 130.3 cell/mm2), p = 0.09. In addition, animals with MPD presented a higher ICAM (0.02 ± 0.01) expression when compared with animals without MPD (0.01 ± 0.01, p = 0.02). There was no difference between groups regarding the extent of fibrosis. There was a negative correlation between individual values of MPD with LVEF (R = –0.6, p = 0.001), wall motion score index (WMSi, R = 0.5, p = 0.007), and the number of mononuclear cells (R = 0.5, p = 0.01). Moreover, an analysis based on myocardial segments (n = 312) showed that segments with MPD (n = 54) in comparison to those without MPD (n = 258) presented a higher number of mononuclear cells (608 ± 299.9 cell/mm2 and 478.3 ± 201.1 cell/mm, respectively, p < 0.0001) and higher WMSi (1.8 ± 0.9 and 1.2 ± 0.4, respectively, p < 0.0001.

Conclusions: MPD is a common finding in the experimental model of CCC in hamsters and is correlated with inflammation, endothelial inflammatory activation, and systolic ventricular dysfunction. These results suggest that MPD may be an in vivo surrogate marker for inflammation with potential translational implications for monitoring disease activity.

109166

Modality: WHF Abstracts – Researcher

Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH

D: 14/10/2022    H: 13:50/14:50

L: Auditório 14

Regional Variation in Women’s Awareness of Cardiovascular Disease and its Risk Factors

MELANIE B. TURNER, MPH, FAHA1, Laura L. Hayman, PhD, MSN, FAHA2, Dhruv Kazi, MD, MSc, MS, FAHA3, Laxmi S. Mehta, MD, FAHA4

(1) American Heart Association; (2) University of Massachusetts Boston; (3) Beth Israel Deaconess Medical Center; (4) The Ohio State University Medical Center

Introduction: Cardiovascular disease (CVD) is the leading cause of death (LCOD) in women globally, causing ≈9 M deaths annually. Global community awareness data of CVD and its risk factors are limited.

Objective: Determine global awareness of CVD incidence and risk factors among women and examine regional variation in awareness.

Methods: An online native language survey was administered among nationally representative samples of women ≥18 years of age in 50 countries across 6 global regions. The survey was administered June-July 2021 using the YouGov real time omnibus service. The survey included an open-ended question regarding LCOD for women in the country (coded as CVD, cancer, or other/don’t know), and a multiple choice question on CVD risk factors. Results were weighted by country, then combined by region.

Results: Of 24,100 women, 15.5% reported CVD as LCOD (regional range 6.9–35.0%), 49.4% cancer (23.9–62.9%) and 18.0% other/don’t know (9.1–34.4%). Cancer was perceived as LCOD in all regions except South Asia and Middle East and North Africa where other/don’t know was the most common response. Regarding CVD risk, 69.5% identified family history as a risk (regional range 51.0–77.1%). Most recognized hypertension, overweight, high cholesterol, and stress. Awareness of diabetes as a CVD risk was low (32.0%, 26.5–44.1%).

Conclusions: Awareness of CVD as LCOD among women is low in all global regions. Most women recognize hypertension, high cholesterol, and overweight as risk factors, but awareness of diabetes as a risk factor is low. Efforts are needed in all regions to create awareness of lifetime CVD risk in women, focusing on modifiable risk factors. As an increasingly prevalent global chronic condition, diabetes merits raised attention in community heart health education.

109180

Modality: WHF Abstracts – Researcher

Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH

D: 14/10/2022    H: 13:50/14:50

L: Auditório 14

The Impact of Country- and Individual-Level Socioeconomic Factors on Maternal and Neonatal Outcomes in Women with Peripartum Cardiomyopathy: An Esc Eorp Registry Study

CHARLE ANDRE VILJOEN1, Karen Sliwa1, Peter van der Meer2, Alice M Jackson3, Mark C Petrie3, Cecile Laroche4, Jolien W Roos-Hesselink5, Petar Seferovic6, Alexandra Frogoudaki7, Bassem Ibrahim8, Hasan Al-Farhan9, Johann Bauersachs10

(1) Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa; (2) Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands; (3) Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom; (4) EurObservational Research Programme, European Society of Cardiology, Sophie Antipolis, France; (5) Department Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; (6) University of Belgrade Faculty of Medicine, Belgrade, Serbia; (7) Attikon University Hospital, Athens, Greece; (8) North Cumbria University Hospitals, Carlisle, UK; (9) Iraqi Board of Medical Specilazations, Baghdad Heart Center, Iraq; (10) Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany

Background: Peripartum cardiomyopathy (PPCM) is a global disease associated with substantial morbidity and mortality. The aim of this study was to analyze to what extent country- and individual-level socioeconomic factors were associated with maternal and neonatal outcomes.

Methods: In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual (income and educational attainment) and country-specific (Gini coefficient [GINI], health expenditure [HE] and human developmental index [HDI]) socioeconomic status.

Results: 739 women from 49 countries were enrolled (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]). Women from countries with low HDI had lower income and educational attainment (p < 0.001). Low HDI was associated with greater LV dilatation at time of diagnosis (p < 0.001), but LV ejection fraction (LVEF) did not differ according to HDI, HE or GINI. Countries with low HE prescribed guideline-directed heart failure therapy less frequently (p < 0.001). Low HE was associated with more frequent mortality (p < 0.002), whereas HDI and GINI were not. Women from countries with low HDI and low HE had significantly less recovery of LV function (p < 0.001). Analysis of maternal outcome as per highest level of educational attainment showed significant differences in LVEF at 6 months (43.7 ± 12.9% [primary], 46.5 ± 13.0% [secondary], 48.9 ± 11.7 [tertiary education] respectively, p = 0.022). Low maternal income, irrespective of region of origin, was independently associated with poor outcome (OR 1.99 [95% CI 1.1–3.6] for composite of maternal death, re-hospitalization, or LV non-recovery). Neonatal death was more prevalent in countries with low HE (p = 0.009) and low HDI (p = 0.023) but was not influenced by maternal sociodemographic parameters.

Conclusion: Maternal and neonatal outcomes depended on country-specific socioeconomic characteristics, with a greater prevalence of maternal and neonatal deaths in women from countries with low HE. Globally, women with low income and lower levels of educational attainment had poorer outcomes, irrespective of region. Attempts should be made to improve patient education, and allocation of adequate health resources to improve maternal and neonatal outcomes in PPCM.

111430

Modality: WHF Abstracts – Young Researcher

Category: NEGLECTED CARDIOVASCULAR DISEASES

D: 14/10/2022    H: 16:50/17:50

L: Auditório 14

Factors Associated with Peak End-Tidal Carbon Dioxide Pressure During Exercise in Patients with Chagas Cardiomyopathy and Systolic Dysfunction

WHESLEY TANOR SILVA1, Matheus Ribeiro Ávila1, Pedro Henrique Scheidt Figueiredo1, Lucas Frois Fernandes de Oliveira1, Vanessa Amaral Mendonça1, Ana Cristina Rodrigues Lacerda1, Vanessa Pereira Lima1, Henrique Silveira Costa1

(1) Universidade Federal dos Vales do Jequitinhonha e Mucuri UFVJM

Introduction: In the functional assessment of patients with Chagas cardiomyopathy, peak oxygen consumption (VO2peak) and ventilatory equivalent of carbon dioxide (VE/VCO2 slope) have already been shown to be parameters of clinical and prognostic relevance. However, other variables assessed by the Cardiopulmonary Stress Test need to be investigated. The peak end-tidal carbon dioxide pressure (PETCO2 peak) has been prominent in the therapy of patients with heart failure. However, its behavior is still unknown in patients with Chagas cardiomyopathy and systolic dysfunction.

Objective: To verify, in patients with Chagas cardiomyopathy and systolic dysfunction, the association between peak PETCO2 and functional and echocardiographic parameters.

Methods: Seventy-six patients with Chagas cardiomyopathy and systolic dysfunction (49.9 ± 10.8 years, 60% male, NYHA I to III) were recruited and underwent clinical evaluation, echocardiography and Cardiopulmonary Stress Test. Systolic dysfunction was defined as a left ventricular ejection fraction (LVEF) of less than 52 or 54% for men and women, respectively. The variables of interest were PETCO2 peak, VO2peak and VE/VCO2 slope (on Cardiopulmonary Stress Test) and LVEF and left ventricular diastolic diameter (LVd) (on echocardiogram).

Results: In the sample, the mean peak PETCO2 was 33.6 ± 4.9 mmHg. In the correlation analysis, PETCO2 peak was associated with VO2peak (r = 0.355; p = 0.008), VE/VCO2 slope (r = –0.626; p < 0.001) and with LVEF (r = 0.299; p = 0.029). There was no correlation between peak PETCO2 and VEd.

Conclusion: These results suggest that peak PETCO2 is associated with important clinical and functional parameters of patients with Chagas cardiomyopathy and should be used in the management of patients with Chagas cardiomyopathy.

112213

Modality: WHF Abstracts – Young Researcher

Category: NEGLECTED CARDIOVASCULAR DISEASES

D: 14/10/2022    H: 16:50/17:50

L: Auditório 14

Association of Clinical and Genetic Profile in Adults with Aorthopathy – Retrospective Cohort Study with Prospective Follow-Up

JULIANA DA ROCHA FERREIRA1, Juliana da Rocha Ferreira1, Julia Passarelli Perreira1, Marcelo Machado Melo1, Helena Cramer Veiga Rey1, Glauber Monteiro Dias2

(1) Instituto Nacional de Cardiologia – INC; (2) Universidade Estadual do Norte Fluminense Darcy Ribeiro – UENF

Aortopathies are a silent disease with a high natural fatality rate. Multiple genes have been linked to hereditary aortic thoracic disease (HATD), and it is believed that 30% of people have a deleterious mutation. This study aimed to uncover genetic variations related to aortopathies using genomic and molecular analysis. Seventy-nine people with aortopathies were studied using clinical data, target-NGS (tNGS), and the Sanger sequencing. The ACMG classification was used to find causal variations. This study defined a severe phenotypic population. Aortic dissection occurred in 49.4% of patients diagnosed at 44.59 years old, mainly after 40, and required surgery at 72.2%. Seven pathogenic variants (PV), 4 likely pathogenic variants (LPV), and 22 variants of uncertain significance (VUS) were discovered. tNGS found 10.37 percent of ATDs in this cohort. Direct sequencing of the fibrillin-1 gene (FBN1) yielded 37.5% diagnostic yield for Marfan syndrome suspect individuals, with two PV and one LPV. PV/LPV variants were identified in 6 genes (ACTA2, FBN1, MYLK, SMAD3, TGFB2, TGFBR2), being FBN1 the most prevalent (6 var). Seven PV/LPV are novel variants. Patients with VP/PPV had a younger mean age (39.3 years vs. 44.4 years) and a larger mean aorta diameter (39.3 years vs. 44.4 years) (6.56 vs 5.66 cm), however no statistic significance was achieved. Both groups required surgery (81.8%), with the VP/PVP group having a worse prognosis and severity. An emphasis is placed on clinical suspicion in selecting the genetic test to use and increasing the yield.

111396

Modality: Best Abstracts Oral – Researcher

Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION

D: 14/10/2022    H: 10:40/11:40

L: Auditório 14

Inclusion of Cognitive Measures Improves the Predictive Performance of Score2 for Future Cardiovascular Events

MARTIN BOBAK1, Steven Hageman2, Hynek Pikhart1, Abdonas Tamosiunas3, Andrzej Pajak4, Ruzena Kubinova5, Wentian Lu1

(1) University College London (UCL), United Kingdom; (2) Utrecht University, Utrecht, The Netherlands; (3) Lithuanian University of Health Sciences, Kaunas, Lithuania; (4) Jagiellonian University Medical College, Krakow, Poland; (5) National Institute of Public Health, Prague, Czech Republic

Introduction: The cardiovascular disease (CVD) risk prediction model SCORE2 uses several biomedical and behavioural factors. It is likely that other factors may also contribute to CVD risk prediction. Cognitive impairment and CVD are associated and share some risk factors. While the causality of this relationship remains unclear, adding cognitive measures to risk prediction may be useful for predicting future CVD events.

Objective: To test the hypothesis that including simple measures of cognitive functions improve the prediction of SCORE2 for future CVD events.

Methods: We used data on 13,391 Polish, Lithuanian and Czech adults without CVD at baseline (45–69 years) from the Health, Alcohol and Psychosocial factors In Eastern Europe cohort. Incident cases of myocardial infarction (MI), stroke, CVD mortality and composite (fatal and non-fatal) CVD events were identified over a 10-year follow-up. Baseline cognitive measures included immediate and delayed word recall (verbal memory and learning), animal naming (verbal fluency) and letter cancellation (attention, mental speed and concentration). Using competing-risks regression, relationships between cognitive functions and CVD outcomes were examined. Improvement in Receiver Operating Characteristic (ROC) was used to compare predictive performance for CVD events of models including SCORE2 variables combined with cognitive tests vs SCORE2 alone.

Results: Incidence rates of MI, stroke, CVD mortality and composite CVD events were 5%, 4%, 4% and 11%, respectively. All four cognitive measures were inversely associated with CVD outcomes; e.g. one standard deviation increase in immediate word recall score was associated with a 28% and 17% reduction in risk of CVD mortality and composite CVD events, respectively. Adding cognitive measures to SCORE2 variables improved the ROCs for prediction of MI, CVD mortality and composite CVD events. E.g. for the composite CVD measure, inclusion of all four cognitive measures increased the ROC area from 0.6948 to 0.7030 (p < 0.001) and similar improvement was seen for word recall.

Conclusion: Including even a single (and simple) cognitive test in assessment of cardiovascular health can improve prediction of future CVD risk and it may be potentially feasible to do so in general practice.

110777

Modality: Best Abstracts Oral – Researcher

Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT

D: 14/10/2022    H: 10:40/11:40

L: Auditório 14

Acute Heart Failure in Patients with Chagas’ Cardiomyopathy in Comparison to Other Etiologies: Results of the I Brazilian Heart Failure Registry (Breathe)

MARCUS VINICIUS SIMÕES1, Pedro Gabriel Barros e Silva2, Denilson Campos Albuquerque3, Renato Delascio Lopes4, Luis Eduardo Paim Rohde5, Lidia Zytinsky Moura6, Fabiana Goulart Marcondes-Braga3, Evandro Tinoco Mesquita3, José Albuquerque de Figueiredo Neto7, Ricardo Mourille Rocha8, João David de Souza Neto9, Mucio Tavares Oliveira Junior10

(1) Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, SP, Brasil; (2) Brazilian Clinical Research Institute (BCRI), Sao Paulo, Brazil; (3) Sociedade Brasileira de Cardiologia, Departamento de Insuficiência Cardíaca – DEIC, Rio De Janeiro, Brazil; (4) Duke Clinical ResearchInstitute, Durham, United States of America; (5) Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; (6) Santa casa, Curitiba, Brazil; (7) Centro de Pesquisa Clínica doHospital Universitário da Universidade Federal do Maranhão (CEPEC-HUUF, Sao Luis, Brazil; (8) PedroErnesto University Hospital, Rio De Janeiro, Brazil; (9) Messejana Hospital, Fortaleza, Brazil; (10) Heart Institute (InCor), University of São Paulo Medical School, Brazil

Background: Chagas cardiomyopathy (CC) is a prevalent cause of heart failure in Latin America countries. Studies describing clinical manifestations and outcomes of heart failure associated to CC are scarce.

Purpose: Report the results of the I Brazilian Heart Failure Registry (BREATHE) addressing the clinical and laboratorial characteristics, and outcomes of patients with acute heart failures (AHF) due to CC in comparison to other etiologies.

Methods: BREATHE was a multicenter nationwide prospective registry, enrolling 3,013 adult patients hospitalized with AHF, median follow-up of 346 days. We proceeded the comparative analysis between 261 (8.7%) patients with CC and 2,752 (91.3%) patients with other etiologies, concerning clinical, demographic, cardiac structure/function on Echocardiogram, death rate or heart transplantation during hospital stay and death rate at 3, 6 and 12 months after discharge. The categorical variables were compared by using Fisher Exact test and the continuous variables were compared by using Mann-Whitney test. A multivariate logistic model was used to estimate the odds ratio of CC in 12-month mortality adjusted for clinically relevant variables.

Results: CC patients, in comparison to other etiologies, were younger (60.6 ± 13.9 vs 65.7 ± 15.7 y.o., p < 0.001), presented lower systolic blood pressure (108.3 ± 26.1 vs 128.3 ± 30.3 mmHg, p < 0.001), lower heart rate (77.3 ± 22.1 vs 88.5 ± 23.2 bpm, p < 0.001), higher rate of jugular vein distension (54.8% vs 38.9%, p < 0.001) and hepatomegaly (47.9% vs 25.6%, p < 0.001), higher rate of “cold and wet” clinical hemodynamic profile (27.2 vs 10.6%, p < 0.001); larger diastolic left ventricular (LV) diameters (65 [57–72.8] vs 59 [51–66] mm, p < 0.001), and lower LV ejection fraction (25.4 [19–36]% vs 37 [27–54]%, p < 0.001), with higher rates of dobutamine use (23.8% vs 6.8%, p < 0.001); presented higher rate of death or heart transplantation during hospital stay (11.1% vs 17.4%, p = 0.004), and higher cumulative death rate after discharge at 3-months (16.5% vs 10.8%, p = 0.017, at 6-months (25.7% vs 17.5%, p = 0.006, and at 12-months (40.8% vs 27.8%, p < 0.001). In a multivariate analysis, CC was independently associated with 12-month mortality risk with odds ratio = 2.02 [95% IC: 1.47;2.77].

Conclusions: Patients hospitalized with AHF with CC etiology, in comparison to other etiologies, presented higher-risk profile that was associated with a poorer outcome during hospital stay and after discharge.

111321

Modality: Best Abstracts Oral – Researcher

Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS

D: 14/10/2022    H: 10:40/11:40

L: Auditório 14

In-Hospital Program to Systematize Chest Pain Protocol (In-Hope)

PEDRO GABRIEL MELO DE BARROS E SILVA1, Ana Amaral3, Antonielle Figueiredo Macedo4, Celso Musa Correa5, Eduardo Zincone6, Marcelo Paiva Cury7, Gustavo Augusto Lopes Rosa8, Alexandre de Matos Soeiro9, Carlos Alexandre Lemes de Oliveira10, Augusto Celso De Araujo Lopes Junior11, Adriana Bertolami7, Renato Delascio Lopes12

(1) Hospital Samaritano Paulista; (2) Cardiologia Americas; (3) Hospital Pro-cardíaco; (4) Hospital da Luz; (5) Americas Medical City; (6) Hospital Santa Helena; (7) Metropolitano Lapa; (8) Ipiranga Mogi; (9) Incor HC FMUSP; (10) Hospital Paulistano; (11) Hospital Monte Klinikum; (12) Brazilian Clinical Research Institute

Background: Chest pain is a major cause of medical evaluation at emergency department (ED) and demands observation in order to exclude the diagnosis of acute myocardial infarction (AMI). Recent algorithms using high-sensitivity cardiac troponin assays at 0 h and 1 h are accepted as a rule-out/rule-in strategy but there is a lack of validation in specific populations.

Methods: IN-HOPE was a multicentre prospective study that included patients admitted to the ED due to suspected symptoms of AMI at 16 sites in Brazil. All patients followed the standard approach of 0–3h but, in addition, blood samples were also collected at 0 and 1 hour and sent to a core laboratory to measure high sensitivity troponin T (hs-cTn T) Elecsys (Roche). Troponin <12 ng/L with a delta <3 was considered rule out while a value ≥52 and/or a delta ≥5 was considered rule in for AMI. The main objective of the study was to assess the accuracy of 0–1 h rule-out/rule-in algorithm in comparison to the standard of care (0–3h). All patients were followed for 30 days. In addition to the prospective cohort, a retrospective analysis was performed assessing all patients with hs-cTn T measured during 2021 but not included in the prospective cohort.

Results: A total of 5.497 patients were included (583 in the prospective and 4.914 in the retrospective analysis). The prospective cohort had a mean age of 57.3 (±14.8) and 45.6% of females with a mean HEART score of 4.0 ± 2.2. By the core lab analysis, 71.6% would be eligible for a rule-out approach while 7.3% would fit the rule-in criteria. At 30 days, no death or AMI occurred in the rule-out group while 64.9% of the patients in the rule-in group were considered as AMI. In the retrospective analysis, 1.091 patients had a troponin value <5 ng/L without cardiovascular deaths in this group. Among all 4.914 patients, the 30-day risk of AMI or cardiovascular death increased according to the level of troponin: 0% in the group <5 ng/L, 0.6% between 5 and 14 ng/L, 2.2% between 14 and 42 ng/L, 6.3% between 42 and 90 ng/L and 7.7% in the level ≥90 ng/L.

Conclusions: In this large multicentre Brazilian study, a 0–1h algorithm was effective for classifying as rule in or out almost 80% of the patients. The rule-out protocol had high negative predictive value regardless clinical risk scores. Categories of levels of hs-cTn T also showed good accuracy in discriminating risk of the patients with a very favourable prognosis for the group with values <5 ng/L.

112023

Modality: Best Abstracts Oral – Researcher

Category: CARDIOVASCULAR SURGERY

D: 14/10/2022    H: 10:40/11:40

L: Auditório 14

Perioperative Cardiovascular Events and Mortality After Cardiac Surgery Across the Spectrum of Chronic Kidney Disease

LUIS EDUARDO PAIM ROHDE1, Marcio R. Martins1, Luis E. Rohde1, Flávia K. Borges2, Andre Lamy2, Richard Whitlock2, P. J. Devereaux2, Carisi A. Polanczyk1

(1) Hospital de Clinicas de Porto Alegre, Post Graduate Program in Cardiovascular Sciences and Cardiology, UFRGS; (2) McMaster University, Hamilton Health Sciences

Background: Previous studies addressing the association of chronic kidney disease (CKD) and prognosis after open-heart surgery had limited sample sizes and retrospective designs.

Methods: We investigated the association of preoperative renal function and in-hospital mortality, and major cardiac and cerebrovascular events (MACCE) in patients enrolled in the prospective multicentric VISION Cardiac Surgery Study. Patients were divided in 5 CKD stages according to preoperative estimated glomerular filtration rate (eGFR in mL/min/1.73 m2): Stage I(>90; n = 1914), Stage II(60 to 89; n = 8122), Stage III(30 to 59; n = 3406), Stage IV(<30; n = 352) and Stage V(dialysis; n = 227).

Results: 15,837 were included in the current analysis (71% male, 66% hypertensive and 20% >75 y.o.). Mortality and MACCE during the first 30 days occurred in 480(3%) and 1727(11%) patients, respectively. Logistic regression models adjusted for EuroSCORE demonstrated increased 30-day mortality in CKD Stage III (odd ratio[OR], 1.82; 95% confidence internal[CI], 1.36–2.41), CKD Stage IV (OR, 2.62; 95% CI, 1.66–4.15) and in patients in dialysis (OR, 3.56; 95% CI, 2.17–5.85) In analysis across the whole spectrum of renal function (Figure), mortality was increased particularly when eGFR was <45 mL/min/1.73 m2, while MACCE risk was observed in less severe stages of CKD.

Conclusion: In this contemporary cohort, CKD was significantly associated with morbidity and mortality after open-heart surgery.

112135

Modality: Best Abstracts Oral – Researcher

Category: DIGITAL HEALTH/INNOVATION

D: 14/10/2022    H: 10:40/11:40

L: Auditório 14

Combining Short- and Long-Term Predictive Windows Improve Risk Estimation of Adverse Cardiovascular Outcomes Among Individuals with Premature Acute Coronary Syndromes

LUIZ SÉRGIO FERNANDES DE CARVALHO1, Gustavo Alexim5, Ana Claudia Cavalcante Nogueira3, Marta Duran Fernandez1, Tito Barbosa Rezende4, Sandra Avila4, Ricardo Torres Bispo Reis6, Alexandre Anderson Munhoz Soares3, Andrei Carvalho Sposito4

(1) Clarity: Inteligência em Saúde; (2) Universidade Católica de Brasília; (3) Instituto Aramari Apo; (4) UNICAMP; (5) Hospital de Base do Distrito Federal; (6) Universidade de Brasília

Introduction: Among individuals with premature acute coronary syndromes (prACS, <55 years-old), prevalent risk factors and the magnitude of their impact on recurrent ischemic events critically differ from older subjects. In that sense, it is plausible to develop risk prediction rules specific for young individuals. Our aim was to evaluate potential improvements in risk prediction quality among prACS by (i) developing models specifically in prACS subjects versus in the global cohort; (ii) splitting predictive rules into two models (short- and long-term prediction windows [STWm and LTWm]) versus a global follow-up model (GFm).

Methods: Consecutive individuals with ACS who undergone coronarography up to 48h after hospital admission from January/2011 to February/2020. 6341 subjects (2242 with prACS) admitted into public hospitals in Brasília (Brazil). The observation window in STWm and GFm included the first 48h upon hospital admission, and LTWm included all in-hospital information. prACS cohort was divided into train/validation-set (70%, n = 1569) and test-set (30%, n = 673); global cohort was divided in training/validation-set (70%, n = 4439) and test-set including the 673 prACS subjects. Models were repeated over five cross-validation folds and then assessed in the test-set. C-statistics was the evaluation metric for STWm and time-dependent concordance (Ctd-index) for LTWm. STWm evaluated the occurrence of in-hospital cardiovascular deaths and recurrent ACS (MACE) and LTWm estimated events occurring post-discharge from index ACS hospitalization considering time-to-event with competing risks (MACE versus non-cardiovascular deaths).

Results: Median follow-up of 6.7 years (95%CI 5.6–7.2). Among prACS and older subjects, respectively, in-hospital MACE occurred in 180 and 493 individuals, post-discharge MACE in 454 and 881; and post-discharge non-cardiovascular death in 47 and 285. The best strategy was to design models specifically in prACS individuals combining STWm and LTWm. Among prACS subjects STWm and LTWm, respectively, TabNet and DeepHit yielded the best C-statistics [0.921 (95%CI 0.889–0.953)] and Ctd-index [0.722 (95%CI 0.678–0.760)], while the best Ctd-index in GFm was 0.681 (95%CI 0.654–0.703). There was very low concordance among top predictors of MACE for prACS versus global cohort, as well as for STWm versus LTWm.

Conclusions: Risk prediction in ACS is optimized by using specific rules for prACS and combining short-term and long-term prediction windows.

109042

Modality: Best Abstracts Oral – Young Researcher

Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE

D: 14/10/2022    H: 09:00/10:00

L: Auditório 14

Landscape of Heart Proteome Changes in Exercised Aortic Stenosis Rats

GUSTAVO AUGUSTO FERREIRA MOTA 1, Sérgio Luiz Borges de Souza1, Danielle Fernandes Vileigas2, Vitor Loureiro da Silva1, Paula Grippa Sant’Ana1, Licia Carla Silva Costa3, Silméia Garcia Zanatti Bazan1, Marília Afonso Rabelo Buzalaf4, Lucilene Delazari dos Santos5, Marina Politi Okoshi1, Mariana Gatto1, Antonio Carlos Cicogna1

(1) São Paulo State University, UNESP, Botucatu Medical School, Brazil; (2) University of São Paulo, USP, Institute of Chemistry, Brazil; (3) University of Campinas, UNICAMP, Institute of Biology, Brazil; (4) University of São Paulo, USP, Bauru Dental School, Brazil; (5) São Paulo State University, UNESP, Biotechnology Institute, Brazil

Introduction: The beneficial effect of aerobic exercise training (ET) on cardiac remodeling induced by aortic stenosis (AS) has been observed in experimental studies. However, the mechanisms involved in cardiac function improvement are not fully understood. In this study we investigated the myocardial proteoma in rats with AS subjected to ET.

Methods: Wistar rats (n = 60, 21 days) were divided into 2 groups: operated control (C) and supravalvar aortic stenosis (AS). AS was induced by the insertion of a stainless-steel clip, 0.60 mm, around the ascending aorta. Two weeks after surgery, rats were assigned into 4 groups: C, exercised C (C-Ex), AS and exercised AS (AS-Ex). Exercised rats underwent treadmill exercise 5 days a week for 4 months, at 60% of the maximal functional capacity. Two and 18 weeks after surgery, rats were subjected to echocardiogram. Functional capacity was analyzed by treadmill maximum exercise testing and blood lactate concentration. Myocardial proteome was assessed by label-free shotgun approach using mass spectrometry. Protein expression was quantified by Western blotting. Statistical analysis was performed by ANOVA or Kruskal-Wallis; significance level of 5%.

Results: Two weeks after AS induction, AS rats had diastolic and systolic dysfunction and concentric hypertrophy. At the end of the protocol, AS maintained the same remodeling pattern; the AS-Ex group presented lower left atrium diameter-to-aortic diameter and lactate concentration; and higher E/E’ ratio, percentage of midwall fractional shortening, and functional capacity than AS. After enrichment analysis by Gene Ontology, myocardial proteome analysis showed higher expression of proteins related to glycolytic pathway, oxidative stress, and inflammation, and lower expression of proteins associated with beta-oxidation in AS than C. The AS-Ex had higher expression of proteins related to mitochondrial biogenesis and lower expression of proteins related to oxidative stress and inflammation than AS. Expression of proteins of physiological and pathological hypertrophic pathways did not differ between groups, except for p-p38, which was higher in the AS than C group.

Conclusion: Aerobic exercise training improves cardiac remodeling and mitochondrial biogenesis, and attenuates oxidative stress and inflammation in rats with ascending aortic stenosis. Financial support: CNPq, FAPESP, and UNESP.

108618

Modality: Best Abstracts Oral – Young Researcher

Category: PHYSICAL EDUCATION

D: 14/10/2022    H: 09:00/10:00

L: Auditório 14

Coronary Inflammation by Computed Tomography Pericoronary Fat Attenuation in Young Male Anabolic Androgenic Steroids Users

FRANCIS RIBEIRO DE SOUZA1, Carlos Eduardo Rochitte1, Douglas Carli Silva1, André Matheus Rodrigues Gomes1, Marcelo Rodrigues dos Santos1, Guilherme Wesley Peixoto da Fonseca1, Antonio Carlos Battaglia Filho1, Kelly Thayane Souza Correa1, Maurício Yonamine2, Rosa Maria Rodrigues Pereira3, Carlos Eduardo Negrão1, Maria Janieire de Nazaré Nunes Alves1

(1) Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (InCor, HCFMUSP); (2) Faculdade de Ciências Farmacêuticas da Universidade de São Paulo (FCF/USP); (3) Laborátorio de Reumatologia e Metabolismo Ósseo da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

Background: The illicit use of anabolic androgenic steroids (AAS) has been associated with diminished cholesterol efflux mediated by HDL, remarkable decrease in high-density lipoprotein (HDL) plasma concentration and subclinical coronary artery disease (CAD). Inflammation is the key to the atherogenic process associated with atherosclerotic plaque vulnerability. The pericoronary mean fat attenuation (pFAM) has emerged as a marker of coronary inflammation and can predict future cardiovascular events, which is measurable from standard coronary computed tomography angiography (CCTA). However, whether AAS abuse has a role in pFAM in young male AAS users is unknown.

Purpose: The aim of this study was to evaluate whether AAS abuse could leads to higher pFAM and premature coronary inflammation in young male AAS users.

Methods: Twenty strength-trained AAS users (AASU) age 29 ± 5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled in this study. Coronary inflammation was assessed by pFAM-CCTA in the right coronary artery (RCA), left anterior descending artery (LDA) and left circumflex coronary artery (Cx).

Results: pFAM in RCA was significantly higher in AASU compared with AASNU and SC (–64.59 ± 9.45 vs. –79.21 ± 6.67 vs. –80.97 ± 7,91 Hounsfield Units (HU), respectively, p < 0.001]. Also, the pFAM in the LAD was higher in AASU compared with AASNU and SC (–72.83 ± 7.21 vs. –79.41 ± 6.72 vs. –80.97 ± 7.72 HU, p = 0.006). However, no difference to pFAM in the Cx between AASU, AASNU and SC (–74.30 ± 5.85 vs. –79.77 ± 7.13 vs. –78.19 ± 5.82 HU, respectively, p = 0.069) was found.

Conclusion: This study indicates that AAS abuse may be associated with higher pFAM and premature coronary inflammation in the RCA and LAD. In addition, the higher pFAM may be linked to early development of CAD in young AAS users.

109119

Modality: Best Abstracts Oral – Young Researcher

Category: DIGITAL HEALTH/INNOVATION

D: 14/10/2022    H: 09:00/10:00

L: Auditório 14

Utilizing Automated Machine Learning for Rheumatic Heart Disease Detection in Doppler Echocardiography

KELSEY BROWN1, Pooneh Roshanitabrizi, PhD3, Alison Reese, MS1, Andrea Beaton, MD2, Emmy Okello, PhD4, Joselyn Rwebembera, MMed4, Peter Lwabi, MMed4, Emma Ndagire, MMed4, Craig Sable, MD1, Marius George Linguraru, DPhil3

(1) Children’s National Hospital; (2) Cincinnati Children’s Hospital Medical Center; (3) Sheikh Zayed Institute for Pediatric Surgical Innovation; (4) Uganda Heart Institute

Introduction: Rheumatic heart disease (RHD) is the number one cause globally of morbidity and mortality from heart disease in children and young adults. The mitral regurgitation (MR) jet length on color Doppler echocardiography is an important index for diagnosis, but its measurement and interpretation are variable.

Objective: Develop an automatic machine learning approach to identify and measure the MR jet length on color Doppler for RHD detection. Methods/Design: We used 316 echocardiograms in video format from 95 children (mean age 12 ± 2 years; range 5 to 17 years) with DICOM color Doppler images of the mitral valve taken from parasternal long axis (PLAX) and apical 4 chamber (AP4) views. All echocardiograms were independently reviewed by an adjudication panel which consisted of four expert pediatric cardiologists to determine maximum MR jet length and diagnosis (RHD positive or not). Among 95 cases, 29 were normal and 66 had RHD. Our automated method included. (1) Selection of frames during ventricular systole using a convolutional neural network architecture based on the ResNet-50. (2) Localization of left atrium using convolutional neural networks with LinkNet structure. (3) Measurement of MR jet length using image color analysis. (4) Detection of RHD by applying a generalized regression model based on the maximum MR jet length measured on each view and maximizing the balanced accuracy using cross validation.

Results: Machine learning selected the correct systolic frame with an average accuracy of 0.95 (sensitivity 97%/specificity 93%) and 0.94 (sensitivity 94%/specificity 94%) for the AP4 and PLAX view, respectively. It localized the atrium with an average Dice coefficient of 0.89 and 0.9 for the AP4 and PLAX view, respectively. We estimated the length of the MR jet with an average absolute error of 0.33 ± 0.4 cm (p-value = 0.15 compared to manual measurements). Our deep learning approach performed similar to or better than previously published manual methods for categorization of RHD positive vs negative. The accuracy of RHD detection was 0.84 (sensitivity 86%/specificity 79%).

Conclusion: Our automatic method has the potential to reliably detect RHD as accurately as expert cardiologists. This innovative approach holds promise to scale echocardiography screening for RHD and greatly expand prophylaxis to prevent progression of RHD globally.

109213

Modality: Best Abstracts Oral – Young Researcher

Category: CARDIO-ONCOLOGY

D: 14/10/2022    H: 09:00/10:00

L: Auditório 14

Impact of High-Intensity and Moderate-Intensity Training on Cardiometabolic Variables in Oncological Patients with Newly Diagnosed Cardiovascular Disease. Randomized Clinical Trial

JAVIER ELIECER PEREIRA RODRIGUEZ1, Fernando Rivera-Theurel2, Jorge Antonio Lara-Vargas3, Devi Geesel Peñaranda-Florez1, Pedro Pereira-Rodriguez4, Karla Dominguez-Gomez1, Kelly Perez-Diaz1, Dafne Palacios-Toledo1, Hiady Rivera-Lopez1, Alondra Mijangos-Dolores1, Isaias Sánchez-García1

(1) Centro de Estudios e Investigación FISICOL; Colombia; (2) University of Toronto; Canada; (3) Cardiofit; México; (4) Clínica Medical Duarte; Colombia

Introduction: Cardio-Oncology aims to prevent and treat cardiac dysfunction induced by anti-oncological therapies. One emergent strategy is the physical activity, which has been considered an important strategy to improve quality of life and outcomes in the susceptible population.

Objective: Determine the cardiovascular effects of Moderate Intensity Continuous Training (MICT) and High Intensity Interval Training (HIIT) on oncological patients newly diagnosed with cardiovascular disease (CVD).

Methodology: Randomized controlled trial with sample of 690 with oncological patients with a new diagnose of CVD (heart failure and ischemic heart disease) distributed in 3 groups (MICT, HIIT and control group). We identified the echocardiogram, cardiac biomarkers, stress test, clinical and hemodynamic parameters, hematological samples were identified. In addition, 6-minute walk, anthropometry, quality of life, fatigue, sarcopenia. The tests were performed pre and post 36 sessions of 70-minute training. Then, descriptive statistics were carried out to estimate, the normality of the data was assessed by the Kolmogorov-Smirnov test and the indication of specificity was evident for all analyzes. Also, the ANOVA analysis of variance (one-way analysis of variance) was used, and subsequently, post hoc tests with Tukey test. In all cases, a significance level was 5% (p = <0.05).

Results: After an structured exercise program, there was an increase in left ventricular ejection fraction (LVEF) (EG1: 40 ± 5 vs 44 ± 4%; EG2: 41 ± 4 vs 47 ± 3%; CG: 40 ± 3 vs 40 ± 1%; p < 0.05). In fact, higher values of functional capacity (VO2peak) were noted in the experimental group 2-HIIT (7.0 ± 5.2 vs 9.7 ± 3.7) compared to experimental group 1-MICT (8.0 ± 4 vs 8.5 ± 3) and control group (9.0 ± 5.0 vs 9.2 ± 4.0). Other parameters results incuded systolic blood pressure (135 ± 10 vs 127 ± 2 mmHg), diastolic blood pressure (85 ± 5 vs 80 ± 2 mmHg), maximum heart rate (166 ± 10 vs 179 ± 5bpm) and quality of life (106 ± 8 vs 73.2 ± 11). It was possible to show significant changes in all variables comparing HIIT vs MICT groups (p = <0.05), and also compared to the control group.

Conclusions: HIIT and MICT in oncological patients with newly diagnosed CVD improved the LVEF, functional capacity (VO2peak), hemodynamic parameters (systolic and diastolic blood pressure), exercise tolerance, depression, anxiety, strength, Cancer related fatigue improved as well as other specific cancer variables such as sarcopenia, and quality of life.

109929

Modality: Best Abstracts Oral – Young Researcher

Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION

D: 14/10/2022    H: 09:00/10:00

L: Auditório 14

Effectiveness of Influenza Vaccination as a Secondary Prevention Therapy for Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

LETICIA MARA DOS SANTOS BARBETTA1, Letícia Mara dos Santos Barbetta1, Eduardo Thadeu de Oliveira Correia1, Ronaldo Altenburg Odebrecht Curi Gismondi1, Antônio José Lagoeiro Jorge1, Evandro Tinoco Mesquita1

(1) Universidade Federal Fluminense; (2) Instituto Cardiovascular do Complexo Hospitalar de Niterói; (3) Centro de Educação e Treinamento Edson Bueno – UnitedHealth Group; (4) Hospital Niterói D’Or

Introduction: Previous randomized trials showed conflicting results regarding the effectiveness of influenza vaccination on cardiovascular outcomes in patients with coronary artery disease (CAD). These studies were not adequately powered to show the effectiveness of influenza vaccine on major adverse cardiovascular events (MACE); all-cause mortality or cardiovascular mortality. Therefore, this up-to-date meta-analysis combines data from