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Results: All parameters significantly improved at follow up when compared to baselinefor all patients, comparing the 2 groups to each other group A showed statisticallysignificant improvement at follow up in LVES & EF% only (5.15�0.9 & 38.5 �9 forgroup A versus 5.9�0.9 & 31.4�8.8 for group B, P value 0.03 & 0.04 respectively forLVES & EF%). But did not show a statistically significant improvement in LVED(6.62�0.86 for group A VS 6.96�0.7 for group B), QOL (41.6�21.46 VS50.67�20.19) or in six minute walk test (358.67�131.4 VS 265.87�126.2) but therewas a trend for improvement in these parameters which opens the way for moreresearch with more number of patients.Conclusion: Esophageal Doppler can be used to optimize CRT at the time of implant.Optimization only improves some of the Echo parameters.Disclosure of Interest: None Declared

PW067

Diastolic dysfunction in Malaysian population and the association withcardiovascular risk factors

Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli11Cardiology, UiTM, Sungai Buloh, Malaysia

Introduction: Current data shows that heart failure with preserved ejection fraction (HF-PEF) is found in approximately half all patients with congestive heart failure (CHF).Moderate to severe diastolic dysfunction in isolation from left ventricular systolicdysfunction is associated with mortality. The prevalence of diastolic dysfunction and itsassociated risk factors is presented.Objectives: To determine the prevalence of diastolic dysfunction and the association withcardiovascular risk factors in an asymptomatic community.Methods: 1932 subjects were recruited between the years 2007-2011. All subjects hadechocardiographic assessment of systolic and diastolic function. Mitral E/A, IVRT, dece-laration times along with LA volumes were recorded. Demographic data were collectedalong with cardiovascular risk profiles.Results: In this cross-sectional sample, diastolic dysfunction was found in 835 (43.2%) ofscreened subjects.Of these, 383 (45.9%) had impaired relaxation, 133 (16.0%) had pseudonormal filling,

and 318 (38.1 %) had restrictive filling patterns.In subjects with diastolic dysfunction, 15.1%, 34.8%, 31.1%, 19.0% had 0, �1, �2, or

�3 modifiable risk factors respectively.Multiple regression analysis showed that diabetes mellitus, hypertension, hyperlipidemia

and obesity are strong predictors for severe restrictive diastolic dysfunction, but not in mildand moderate diastolic dysfunction. There was no association of the diastolic dysfunctionto age, gender or urban versus rural subjects.Conclusion: In this community of Malaysian subjects, diastolic dysfunction is a commonfinding. The presence of diastolic dysfunction is associated with the presence of othermodifiable risk factors, and the presence of diabetes, hypertension, hyperlipidemia andobesity are strong predictors for severe restrictive diastolic dysfunction.Disclosure of Interest: None Declared

PW073

Is it better ivabradine than beta blockers in symptomatic severe aortic stenosis withcoronary artery disease?

Gustavo A. Cortez Quiroga*1, Carmen Rus Mansilla1, Maria D. C. Duran Torralba1,Jorge Curotto Grasiosi2, Bruno Peressotti2, Luciano Lucas3, María G. Lopez Moyano1,Esther M. Ruiz de Temiño de Andres4, Ana I. Sanchez Floro4, Manuela Delgado Moreno11Cardiologia, Hospital Alto Guadalquivir, Andújar, Spain, 2Cardiologia, Hospital Militar Central601, 3Cardiologia, Hospital Italiano, Buenos Aires, Argentina, 4Cardiologia, Hospital AltaResolución Sierra de Segura, Puente de Genave, Spain

Introduction: Aortic stenosis (AS) is the most common valvular disease in Europe. Aorticvalve surgery and transcatheter aortic valve replacement are the unique treatments thatreduce mortality, but 33% of patients (pts) reject invasive treatment. No medical treatmenthas proved benefits in morbidity and mortality in severe AS. 35% of pts have angina and50% of pts over 75 years old have coronary artery disease. This is the reason why a highpercentage of pts are using beta blockers (BB) in severe AS, a controversial drug in thisdisease. Ivabradine features, negative chronotropic without negative inotropic effect, andhis utility in stable coronary artery disease (SCAD), led us to change BB by ivabradine in ptswith severe AS with angina or SCAD who dismissed intervention.Objectives: Compare the hemodinamyc and clinical effects between BB treatment and thesubstitution by ivabradine in this type of patients.Methods: Prospective interventional case control study. We select pts with symptomaticsevere AS who dismissed invasive treatment. All of them have angina or known SCAD,were in sinus rhytm and ejection fraction (LVEF) greater than 55%. They must be under BBtreatment. We made a baseline echocardiogram, electrocardiogram, six minutes walk test(6MWT) and laboratory. Afterwards, the BB were withdarwn and pts began ivabradine 2,5mg bid. increasing the dose on day 15 th to 5 mg bid. One month after beginning ivab-radine the same studies were repeated.Results: The analysis were completed in 10 patients. There were not significant changes inheart rate (62,5 bpm vs 61 bpm, p:0.26), and left ventricle end-diastolic diameter (4,93 cmvs 4,78 cm, p:0,87), but improve significantly LVEF (69% vs 73,45% p:0.028), systolicvolume (87,39 ml vs 95,82 ml, p:0,007), cardiac output (5,17 l/m vs 5,69 l/m, p: 0.047)and 6MWT distance (251 mts vs 333 mts p: 0,049).

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: Ivabradine had shown to be safe and a more appropriate treatment than betablockers in this study population. Ivabradine increases systolic volume, cardiac output andthe 6MWT distance at same preload conditions.Disclosure of Interest: None Declared

PW074

Clinical and hemodynamic effect of heart rate control in patients with severe aorticstenosis

Gustavo A. Cortez Quiroga*1, María D. C. Duran Torralba1, Carmen Rus Mansilla1,Luciano Lucas2, Bruno Peressotti3, Jorge Curotto Grasiosi3, Maria G. Lopez Moyano1,Ana I. Sánchez Floro4, Esther M. Ruiz de Temiño de Andres4, Manuela Delgado Moreno11Cardiologia, Hospital Alto Guadalquivir, Andujar, Spain, 2Cardiologia, Hospital Italiano,3Cardiologia, Hospital Militar 601, Buenos Aires, Argentina, 4Cardiologia, Hospital AltaResolución Sierra de Segura, Puente Genave, Spain

Introduction: Aortic stenosis (AS) is the most common valvular disease in Europe. Aorticvalve surgery and transcatheter aortic valve replacement are the unique treatments thatreduce mortality, but 33% of patients (pts) reject invasive treatment. No medical treatmenthas shown benefits in morbidity and mortality.Adaptive changes reduced sistolic volume, contractility and increase oxygen consump-

tion, generating symptoms and increase the risk of sudden death. As in other cardiacpathologies, we believe that the reduction in heart rate in severe aortic stenosis with pre-served ejection fraction could be beneficial, increasing the preload can generate an increasein the ejection fraction (LVEF) that would generate an improve in stroke volume.To reduce heart rate we use ivabradine, safe drug without negative inotropic effect.

Objectives: Assess the possible hemodynamic and clinical benefits after reduce heart ratewith ivabradine in this type of patients.Methods: Prospective interventional case control study. We select pts with symptomaticAS who dismissed invasive treatment, all of them were in sinus rhythm and preserveeyection fraction. No patient had beta blockers in home treatment. We made a baselineechocardiogram, electrocardiogram, laboratory and six minute walk test (6MWT). After-wards pts began with ivabradine 2.5 mg bid, increasing the dose on day 15 th to 5 mg bid.One month after beginning ivabradine the same studies were repeated.Results: The analysis was completed in 18 pts, six pts didn’t perform the 6MWT by motorproblems. Ivabradine reduces significantly heart rate (78 bpm vs 62 bpm, p:0.001), in-creases significantly left ventricular end-diastolic diameter (4,68 cm vs 4,91 cm, p:0.004),improves significantly LVEF (69,1% vs 75,15% p:0,01), systolic volume (78,05 ml vs100,74 ml, p:<0.001), Aortic VTI (100,5 cm vs 119,5 cm, p:<0.001) and LV outflow tractVTI (29,9 cm vs 35,8 cm, p:<0.001). The walk distance was improved significantly (383mt vs 424 mt p:<0,004). There was not significant benefit in the cardiac output (6,25 l/mvs 5,88 l/m, p:0,39).Conclusion: Ivabradine was shown to be a safe drug in pts with severe symptomatic ASwho dismissed invasive treatment. The reduction in heart rate increase left ventricularfilling time, left ventricular end-diastolic diameter, LVEF, and by these reasons improvedthe systolic volume and 6MWT distance.Disclosure of Interest: None Declared

PW076

Impaired Long-term Functional Capacity of Survivors of Submassive PulmonaryEmbolism Utilizing the Six-minute Walk Test

Vincent Chow*1, Austin C. C. Ng1, Leigh Seccombe2, Tommy Chung1, Liza Thomas3,David Celermajer4, Matthew Peters2, Leonard Kritharides11Cardiology, Concord Hospital & The University of Sydney, 2Thoracic Medicine, ConcordHospital, 3Cardiology, Liverpool Hospital and University of New South Wales, 4Cardiology, RoyalPrince Alfred Hospital and The University of Sydney, Sydney, Australia

Introduction: The functional capacity of long-term survivors of submassive pulmonaryembolism (PE) is unreported. A six-minute walk distance (6MWD) <350m and heart raterecovery (HRR) <16 beats per minute (bpm) indicate adverse prognosis in various chronicdiseases.Objectives:We sought to assess whether long-term impairment of functional capacity existin apparently well survivors of PE during long-term follow-up.Methods: Long-term survivors of acute PE were prospectively invited to undergo six-minute walk test (6MWT), transthoracic echocardiogram, clinical and biochemical evalu-ation with cardiac biomarkers. The predicted six-minute walk distance (6MWD) wascalculated utilising Enright’s well-validated formula:Predicted 6MWD (males) ¼ (7.57 x heightcm) - (5.02 x age) - (1.76 x weightkg) - 309

metres &Predicted 6MWD (females) ¼ (2.11 x heightcm) - (5.78 x age) - (2.29 x weightkg) + 667

metres. HRR was calculated as the difference between heart rate at 6-minutes and at 1-minute post 6MWT.Results: One-hundred and twenty patients (52 males, age-65�14years) were identified tohave had a prior confirmed PE. Mean (�SD) follow-up was 7.7�1.4years. The 6MWD wassignificantly lower than predicted after adjustment for age, sex, and height (448�114m vs.475�89m, p¼0.005, Figure 1). Importantly, 55% (57/104) demonstrated 85% belowexpected 6MWD, 16% (17/104) had 6MWD<350m and 31% (32/104) had HRR<16bpm.Among patients with no baseline comorbidities at follow-up (defined as Charlsoncomorbidity index of 0), 8% (4/52) had 6MWD<350m and 25% (13/52) hadHRR<16bpm.

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