E.R. Rinaldi

AB0216 Activation of the renin angiotensin sistem in a population of patients with rheumatoid arthritis and low severity comorbidity in therapy with dmards and/or anti-tnf alfha

Background Rheumatoid arthritis(RA) is a chronic autoimmune inflammatory disease. The inflammatory process causes joint destruction and disability. Patients have a shorter life expectancy and a relative risk of cardiovascular (CV) disease ranging from 1.5 to 4.0 with an increase in CV morbidity and mortality of 1.5 fold compared with the general population. The chronic inflammation seen in RA have its main effectors in factor alfa tumor necrosis (TNF) and interleukin 6 (IL-6) that, in addition to playing a key role in the initiation of joint damage and progression of atherosclerotic disease, are also potent inducers of the renin angiotensin system (RAS). The latter could contribute in these patients to the development of an early and accelerated CV damage. Objectives To evaluate the possible presence of hyperactivation of RAS and its association with the activity parameters of RA, with traditional risk factors and premature CV organ damage Methods there were evaluated 17 (F) patients (pts) with RA receiving stable therapy (3 months) with DMARDs or anti-TNF alpha, in the absence of previous CVevents and/or traditional risk factors. All pts underwent a visit with rheumatologic evaluation of patient history, activity of RA (DAS28), pain (VAS), quality of life (HAQ), patient GH. Blood samples were collected for the evaluation of: lipid profile, indices of insulin resistance (HOMA-IR), indices of activity of rheumatoid arthritis (autoantibodies, inflammatory markers) and CV risk according to risk charts based on the Framinghamstudy. The CV organ damage was assessed by imaging techniques such as Pulse Wave Velocity (PWV) and Augmentation Index (AIx), Intima-media thickness (IMT) and ankle-brachial index (ABI). From a sample of the patient’s blood leukocytes were separated and subsequently extracted RNA to perform Real time qPCR to verify the expression of Angiotensin II and AT1 and AT2 receptors. The mean disease duration was 9 ±7 years; the mean age (pts all female) was 55 ± 12 years. FR was positive in 49%, antiCC and ANA respectively in 64% and 59% Results data, though preliminary, showed a statistically significant correlation between the density of receptors for angiotensin II (AT1R and AT2R) and, respectively, the values of ABI(p <0.05, p 0.043), serum uric acid values (p <0,014, p <0016) and the index of insulin resistance (HOMA-IR) (p <0,034, p <0.033). This seems to indicate a very strong correlation between markers of early atherosclerosis and expression of the RAS, although the sample did not have additional CV risk factors. Conclusions The results obtained so far make attractive and plausible the initial assumption and could, if confirmed in further continuation of the study, help to explain the paradoxical development of vascular disease in patients with RA and apparent low CV risk with important therapeutic implications Disclosure of Interest None Declared

ECHOCARDIOGRAPHY IN PATIENTS WITH HEART FAILURE: REDUCED AND PRESERVED LEFT VENTRICULAR FUNCTION: PP.1.14

Introduction: Patients (pts) with heart failure (HF) can show reduced (r) or preserved (p) left ventricular ejection fraction (EF) and both these groups share the same morbility and mortality, even if theres still a tendency to consider more at stake pts with reduce EF. Objective: Our aim was to observe if pts with pEF or rEF show different echocardiographic geometric pattern and if there was any difference among E/A ratio, left ventricular isovolumetric time relaxation (IVRT) and deceleration time (DT) of early Doppler mitral valve flow velocity between the two groups. Methods and Results: We evaluated 205 consecutive pts with HF, defined by ACC/AHA guidelines, admitted to our Out-patients Clinic for the Management of Heart Failure after discharge from hospital where they had been admitted for acute HF. Each pts underwent echocardiography performed by the same operator. 119 pts were men and represent the 54% of pts with HF with pEF and the 71% of pts with HF with rEF. Average age was 70 ± 10 years (28–98) without significative differences in pts with or without pEF. HF ethiopathogenesis was due to hypertension in 95% of pts with pEF and 67% in pts with rEF. Figure 1. No caption available. Concentric remodelling is the geometric pattern prevalent in pts with pEF whereas eccentric hypertrophy is more common among pts with rEF. If we analyse echocardiographic data in each different geometric pattern group, we find that in pts with normal geometry, DT is significantly reduced if EF<50 (0,22 ± 0,05 vs 0,16 ± 0,06, p < 0.05). We obtained similar results also when using RWT>0.42 as pathologic cut off value. Conclusions: Even if pts with pEF is mostly NYHA 0 or I in comparison to pts with rEF (mostly in NYHA II or III), they came from the same population of pts discharged from hospital with diagnosis of acute HF. These two different kinds of pts show a different echocardiographic geometric pattern.

EFFECT OF AN INTEGRATED APPROACH TO CARE ON HEART FAILURE PATIENTS WITH HYPERTENSION: PP.1.11

Background: Heart Failure(HF) might represents the conclusive clinical event of hypertensive disease(HBP) and its complications. Considering its increasing prevalence, HF is an important clinical and economic challenge often needing integrated and specialistic management programs. Purpose: Aim of the present study was to assess the effect of 1 year dedicated and integrated program care,comprehensive of systematic assessment and management,counselling,educational,on progression of NYHA class and rate of hospital admissions in patients with hypertension-related HF. Methods: Patients with history of hypertension and clinical,radiological or echocardiographic evidence of HF have been enrolled in the study. At entry and after 12 months we evaluated: physical signs,NYHA class,LV function(LVEF%),neuro-humoral profile,on-going therapy. Main objective was the number of and hospital admissions after 6–12 months of intensive approach compared with those in the previous 12 months. Results: In a 5 year period we evaluated 438 consecutive HF patients, of which 170(75%) had at least 1 year control (108 M and 62 F,mean age 76 years,range 40–90). At entry, 103 pts(32%) had at least 1 hospital admission for HF,and 53 patients(17%) had > = 3 admissions,whereas after 1 year 17 patients(5%) were admitted once and 30 patients(9.1%) had >=3 readmissions (p < .0001);15 patients died. At baseline visit, 57% patients were in NYHA class I,30% in NYHA class II,12,5% in NYHA class III and 0,5% patients were in NYHA class IV. At 12 month of follow up,12 % worsened NYHA class pts,40% unchanged pts and 48% ameliorated pts(p < .001 for improving trend). At entry and after 1 year respectively 44 and 46% of patients received ACE-inhibitors, 32,4 and 60 % Angio II-inhibitors, 51 and 73% B-blockers, 65 and 71% diuretics, 11 and 8% digoxin, 24 and 22% calcium channel blockers, 15 and 21% nitrates and 17 and 21% aldosterone receptor antagonists. Conclusions: The specific care and educational/support intervention program was effective in reducing readmission and ameliorating NYHA class of HF and HBP patients without any significant variation in pharmacological therapy.