Topic category: Prevention

Abstract

Topic category: Prevention European Journal of Cardiovascular Prevention and Rehabilitation, 2007, 14 (suppl 1):S47–S77 011 Type-D personality but not ICD indication is associated with impaired health-related quality of life 3 months post implantation S.S. Pedersen, D.A.M.J. Theuns, A. Muskens-Heemskerk, R.A.M. Erdman, L. Jordaens CoRPS-Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands Objectives Indications for the implantation of an implantable cardioverter defibrillator (ICD) have expanded since the device was first introduced, with current guidelines recommending its use in both primary and secondary prevention. Although the superiority of device therapy compared to anti-arrhythmic drugs for the primary prevention of sudden cardiac death in high-risk patients is well established, little is known about the impact of ICD indication on health-related quality of life (HRQL). Indication may also interact with psychological factors, such as personality. Using a prospective design, we examined whether ICD indication and type-D personality (i.e. experiencing increased negative emotions paired with emotional non-expression) serve as modulators of HRQL at baseline and 3 months post-implantation. Methods Consecutively implanted ICD patients (n = 154) completed the Type-D Scale (DS14) at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3 months. Results Of all patients, 82 (53%) received an ICD due to prophylactic reasons; the prevalence of type-D was 23%. ANOVA for repeated measures showed that indication had no influence on HRQL (p = 0.75). Further stratification by personality showed a main effect for type-D personality (p < 0.001), with type-D patients generally experiencing poorer HRQL; there was no main effect for indication (p = 0.45) nor was the interaction effect indication by type-D significant (p = 0.22). However, there was a significant improvement in HRQL over time (p = 0.001). Adjusting for clinical factors and shocks during follow-up, Type-D remained an independent predictor of impaired HRQL (p < 0.001), although there was no longer a significant change in HRQL over time (p = 0.099). Conclusions Type-D personality but not ICD indication was associated with impaired HRQL at the time of implantation and at 3 months, with type-D exerting an effect on HRQL independent of shocks and other risk factors. In the quest for enhancing risk stratification in clinical practice, personality factors, such as type-D, should not be ignored, as both type-D and poor HRQL have been associated with increased risk of mortality in cardiac patients. 014 Low density lipoprotein subclass distribution in children with renal diseases S. Alabakovska, D. Labudovic, K. Tosheska, M. Alabakovski, B. Todorova Medical Faculty, Department of Medical Biochemistry, Skopje, Macedonia Background LDL lipoproteins are heterogeneous and composed of several subclasses. Small LDL3 and LDL4 particles are more atherogenic than larger LDL1 and LDL2 subclasses, and their frequency may depend on plasma lipid and apoprotein levels. Because there is not enough literature data presenting LDL subclass distribution in childhood, the aim of this study was to examine LDL subclass profile in children with renal diseases compared with healthy children. Methods Plasma LDL subclasses in 100 healthy and 30 children with renal diseases aged 9-18 years were analyzed using non-denaturing polyacrilamide gradient (3-31%) gel electrophoresis. Plasma lipid and apoprotein parameters affecting LDL size were determined as well. Results In 89% of the healthy children bigger LDL subclasses were dominant (phenotype A), whereas 11% of the children belong to phenotype B (small LDL3, LDL4). In children with chronic renal failure on haemodialysis the frequency of phenotype B was increased (58, 5%), and the mean LDL diameter was smaller (p < 0,0005) compared with control group. In patients with renal diseases who were not on haemodialysis the frequency of phenotype B was even more increased (88%) and the mean LDL diameter was smaller (p < 0,0001) compared with control group. In all patients significant negative correlation between LDL diameter and plasma triglycerides (p < 0,0001) and Apo B concentration (p < 0,0001) was noted. Conclusion Children with chronic renal diseases are at high risk for atherosclerosis, especially in the patient not going on haemodialysis. Determination of LDL subclasses distribution in healthy children population and in patients may help prevent and reduce the risk for atherosclerosis. 015 Cytotoxin-associated gene-A bearing strains of Helicobacter pylori and atrial fibrillation due to ischemic origin. Is there a link? H. Badran, M. Mahfouz Menoufiya University Tanta University, Tanta, Egypt Objectives Previous studies suggested an association between infection by cytotoxic CagA bearing Helicobacter pylori (Hp) strains and atherosclerosis. We hypothesized that CagA strains could increase the risk for atrial fibrillation (AF) in patients with chronic coronary heart disease (CHD) by induction of systemic inflammatory reactions. Our aims were: (1) to verify the association between CagA strains and CHD, (2) to attest the presence of Cag A strains in AF due to ischemic etiology. Methods and subjects Serological status for Hp cagA by a semi quantitative commercial (ELISA) kit against the p120 antigen of CagA, C-reactive protein, total leucocytic count and atrial size using echocardiography were determined in 185 patients with proved CHD. Patients were assigned to CHD and AF (Group A, n = 82) or CHD with sinus rhythm (Group B, n = 103). Eighty subjects from the same geographical area free of clinical cardiovascular disease matched for age and sex were assigned to a control group. Results 52(63%) patients were seropositive for Hp Cag A in Group A versus 40(39%) in Group B (odds ratio 3.95 with 95% confidence interval 1.94-6.0). Only 21(26%) of the control were seropositive. A significant association between seropositivity for Hp Cag A and having previous myocardial infarction (68 versus 53%, odds ratio 2.04 with 95% CI: 1.022.82, P = 0.034) was perceived. These findings remained valid in a multivariate analysis including possible confounding factors (for instance age, sex, smoking and hypertension; odds ratio 2.35 with 95% CI 2.014.83). Left atrial dimension and CRP were significantly increased in 1741-8267 c 2007 The European Society of Cardiology Copyright © European Society of Cardiology. Unauthorized reproduction of this article is prohibited. Cage A seropositive compared with seronegative subgroups 4.31 ± 0.66 vs 3.1 ± 0.58 cm & 3.32 ± 0.86 vs 1.79 ± 0.72 mg/l in group A and 3.7 ± 0.62 vs 2.85 ± 0.66 cm & 2.5 ± 0.54 vs 1.62 ± 0.5 mg/l in group B respectively (P < 0.01). Conclusions This study provides further support for the hypothesis that there is a causal relationship between chronic infection with Hp and CHD especially if AF arises. The positive association between Hp (Cag A) with elevated CRP and increased atrial size in patients having CHD and AF may reflect the inflammatory changes in the atrial structure that promotes the development or persistence of AF.