S. Kasim

Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI

Objective High-sensitivity troponin (hs-Tn) assays need to be applied appropriately to improve diagnosis and patient outcomes in acute coronary syndromes (ACS). Methods Experts from Asia Pacific convened in 2015 to provide data-driven consensus-based, region-specific recommendations and develop an algorithm for the appropriate incorporation of this assay into the ACS assessment and treatment pathway. Results Nine recommendations were developed by the expert panel: (1) troponin is the preferred cardiac biomarker for diagnostic assessment of ACS and is indicated for patients with symptoms of possible ACS; (2) hs-Tn assays are recommended; (3) serial testing is required for all patients; (4) testing should be performed at presentation and 3 hours later; (5) gender-specific cut-off values should be used for hs-Tn I assays; (6) hs-Tn I level >10 times the upper limit of normal should be considered to ‘rule in’ a diagnosis of ACS; (7) dynamic change >50% in hs-Tn I level from presentation to 3-hour retest identifies patients at high risk for ACS; (8) where only point-of-care testing is available, patients with elevated readings should be considered at high risk, while patients with low/undetectable readings should be retested after 6 hours or sent for laboratory testing and (9) regular education on the appropriate use of troponin tests is essential. Conclusions We propose an algorithm that will potentially reduce delays in discharge by the accurate ‘rule out’ of non-ACS patients within 3 hours. Appropriate research should be undertaken to ensure the efficacy and safety of the algorithm in clinical practice, with the long-term goal of improvement of care of patients with ACS in Asia Pacific.

Prevalence of atrial fibrillation in the Malaysian communities

Background and aim Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. The REDISCOVER (Responding to Increasing Cardiovascular disease prevalence) study is an observational longitudinal community-based study that tracks changing lifestyles, risk factors and chronic disease in urban and rural areas of Malaysia. In this study, we aim to study the prevalence of AF and its associated risk factors. Methods The study was conducted between 2007 and 2014. Participants were required to complete questionnaires on cardiovascular risk factors and medical history, and undergo physical examinations, blood tests, ECG and echocardiography examinations. Demographic variables including weight, height, blood pressure, serum glucose and serum lipid were recorded. Participants with AF were identified from their baseline ECG and at 3-year follow up. Results A total of 10 805 subjects participated in the study. Mean age was 52.6(±11.6) years and 56% were female; 4.4% of subjects had a diagnosis of ischaemic heart disease, 1.3% had a previous stroke, 16.7% had diabetes mellitus and 45.6% had hypertension. There were 53 subjects diagnosed with AF at baseline, giving a prevalence of 0.49%, and 0.54% at 3 years. AF was more prevalent in males (58.5% in the AF group compared to 43.9% in sinus rhythm (SR) subjects; p=0.03) and the older age group. Ischaemic heart disease was more prevalent in AF subjects (22.6%) compared to SR subjects (4.4%) (p<0.001). In the AF group previous stroke had occurred in 1.9% of subjects compared to 1.3% in the SR population (p=0.51), and 24.5% of subjects in the AF group had diabetes compared to 16.6% in the SR group (p=0.12). There was a significant difference in the prevalence of hypertension between the AF group (59.6%) compared to the SR subjects (45.5%) (p=0.04). Conclusions The prevalence of AF in the Malaysian population was low at 0.54% compared to the global average of 1%. We found that AF was associated with older age, male sex, hypertension, and ischaemic heart disease.

Pattern and predictors of outcomes for infective endocarditis in North Kuala Lumpur

Context: Infective endocarditis (IE) still carries significant mortality and morbidity ever since 1835. Despite improvement in medical technologies, mortality outcome remains unchanged. We sought to analyze the pattern of presentation, treatment, and outcomes predictors for patient presenting to our hospital. This study will explore some of the factors that could be associated with the outcome of a patient diagnosed with IE for a better guidance in management. Subjects and Methods: This is a retrospective dual center cohort study from North Kuala Lumpur from January 2012 to December 2013. Fifty patients with definite IE based on modified Dukes criteria were recruited into the study. Clinical presentation, risk factors, biochemical markers, echocardiography, and outcome were obtained through chart review, clinic data, and telephone call. Simple logistic regression was utilized for inferential statistic. Results: A total of 50 patients, 37 (74%) males and 13 (26%) females were included in the study. The mean age was 42 ± 16.4. Most patients (80.39%) were diagnosed within the 1st week of admission. Staphylococcus aureus was the most common pathogen (38%) and the mitral valve was predominantly affected (68%). Complication was common and in-hospital mortality remains high (28%). Nearly 20% of the patients who had surgical intervention survived and discharged alive. Presence of complications predicts poor outcome (odds ratio [OR]: 5.5 P = 0.02), whereas surgical intervention predicts good outcome (OR: 1.56 P = 0.027). Conclusions: Mortality remains relatively high in patient with IE. Those who presented with complications are at 5.5-fold risk of mortality. Surgical intervention showed an association with good outcome within this cohort.

[PP.LB02.09] UTILISING PULSE WAVE VELOCITY IN ASSESSING ARTERIAL STIFFNESS IN PATIENTS WITH MILD-TO-MODERATE RENAL IMPAIRMENT

Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease stage 2 to 4 and normal renal function. Design and method: Patients with confirmed chronic kidney disease stage 2 to 4 were recruited from various clinics in the Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia from 1st August 2015 until 31th January 2016. Sociodemographic and anthropometric indices were recorded at recruitment. Each patient underwent a carotid-femoral (aortic) PWV measurement to determine the arterial stiffness. Results: We studied a cohort of 174 patients: 87 patients with chronic kidney disease stage 2–4 and 87 control patients. The mean age was 47 ± 5.4 years. CKD patients had a higher mean PWV (7.8 ± 1.7) than healthy controls (5.6 ± 1.0) (p < 0.001, 95% CI −2.59,−1.77). There is significant difference of mean PWV between control (5.6 m/s ± 1.0) and CKD stage 2 (7.6 ± 1.5) (p < 0.001, 95% CI −2.40,−1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p < 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, ± 1.5) and stage 4 (9.0 m/s, ± 0.8) was 1.43 (p < 0.001, 95% CI −2.50, −0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s ± 1.8) and non-DM (7.3 m/s ± 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI −1.50,−0.12). There was a significant positive asssociation between DM and PWV (&bgr; = 0.81, r2 = 0.06, p = 0.022). However, no significant association was found on the multivariate analysis beween DM and PWV. Mutiple linear regression analysis showed only age (&bgr; = 0.078, p = 0.014), mean arterial pressure (MAP) (&bgr; = 0.031,p = 0.007) and diuretics usage as the combination antihypertensive medication (&bgr; = 0.839,p = 0.018) were independently associated with PWV (r2 = 0.249, p < 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population.

111 CARDIOVASCULAR RISK PROFILE IN NEWLY DIAGNOSED HYPERTENSION

Background: Understanding a patients overall cardiovascular risk factor (CVRF) profile is of great importance in management of hypertension.1 Early diagnosis and treatment of associated risk factors could reduce overall cardiovascular mortality.2 The objective of this study was to determine the CVRF profile among newly diagnosed hypertension (NDHT). Method: This is a community-based study involving 10892 subjects adult subjects carried out in Malaysia between 2005 and 2011. The subjects had waist and hip circumferences measured, mean of two resting blood pressure readings recorded and fasting blood samples drawn for glucose and lipid profiles. Result: Hypertensive (HPT) subjects were older (mean 58.10±9.62 years) compared to NDHT (mean 54.08±11.22 years) and normotensives subjects (mean 47.79±10.65 years). 27% had NDHT with 67% had stage 1 hypertension. Figure 1 and table 1 show NDHT subjects had undesirable CVRF profile compared to normotensives (p<0.0001). Compared to HPT subjects, they had similar CVRF profile except for total cholesterol and low HDL cholesterol. FIGURE 1. CVRF profiles in NDHT, HPT and normotensive subjects Conclusion: NDHT subjects in Malaysia have significant prevalence of co-existing CVRF. This emphasises the importance of early detection of hypertension. Preventive measure and goal of therapy should be aimed at improving multivariate risk profile. References:Kannel WB. Fifty years of Framingham Study contributions to understanding hypertension. J Hum Hypertens 2000 Feb;14(2):83-90Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure related disease, 2001. Lancet 2008 May;371(9623):1513-8