Acute Heart Failure (AHF) / Prevention – General 511
cantly increase or decrease myocardial perfusion or aortic stiffness and was con- respiratory disease and orthopaedic problems and 45% of patients had more than
sidered safe up to 180 days following the infusion.
Acknowledgement/Funding: This study was funded by Novartis Pharma AG,
Basel, Switzerland
P2472 | BEDSIDE
Liver stiffness is associated with congestion by bioimpedance vector
analysis in patients with decompensated heart failure
A. Soloveva, M. Bayarsaikhan, I. Garmash, S. Villevalde, Z. Kobalava. RUDN
University, Moscow, Russian Federation
Objective: Over the last several years the relationship of liver stiffness (LS) with
congestion in decompensated heart failure (DHF) have been discussed. We in-
vestigated LS by the transient elastography (TE) and its associations with hydra-
tion status assessed by bioimpedance vector analysis (BIVA) and weight dynam-
ics in patients with DHF.
Methods: LS was measured using TE in 94 patients with DHF on admission and
discharge (60 male, 72±10 years (M±SD), arterial hypertension 96%, myocardial
infarction 55%, atrial fibrillation (AF) 63%, diabetes mellitus 45%, known chronic
kidney disease 29%, chronic anaemia 30%, left ventricular ejection fraction (EF)
40±14%, EF <40% 28%, NYHA IV 41%). Ten valid measurements were required
with success rate of >60%. LS≤5.8 was considered normal and LS ≥5.9, 7.2,
9.5 and 12.5 kPa were considered fibrosis (F1-F3 METAVIR score) and cirrhosis
(F4) according to thresholds in studies with chronic liver disease.
Hydration status was assessed by BIVA using resistance (R) and reactance (Xc),
standardized by height (h). Results have been graphically depicted. Deviation
from the 50th, 75th and 95th vector percentile of the healthy reference popula-
tion was considered as mild, moderate and severe hyperhydration. Mann-Whitney
test, Wilcoxon test, Spearman correlation tests were performed. P<0.05 was con-
sidered significant.
Results: Normal LS was observed in 16% of patients. Abnormal LS ≥5.9, 7.2,
9.5 and 12.5 kPa occurred in 8.5, 14, 10.5 and 51% of patients respectively. Mild,
moderate and severe hyperhydration were revealed in 23, 34 and 43% of patients
respectively. In patients with mild, moderate and severe hyperhydration by BIVA
the median LS was 6.1 (4.4; 18.4), 14.8 (11.4; 21.7) and 17.5 (12.3; 34.3) kPa,
p<0,05. In patients with LS <5.6, ≥5.9, 7.2, 9.5 and 12.5 kPa parameters R/h and
Xc/h were 314±76 and 28±6, 286±64 and 25±4, 277±41 and 26±10, 239±41 and
20±5, 235±55 and 18±6 Om/m, respectively. Decrease of R/h and Xc/h means
increase of severity of hyperhydration.
Statistically significant correlations between LS and BIVA parameters of hyperhy-
dration on admission were revealed (r=-0.32 for R/h and r=-0.37 for Xc/h, p<0.05).
During hospitalisation the following changes were oserved: the median value of
LS decreased from 17.1 (interquartile range 10.2; 34.8) to 11.6 (6.4; 19.6) kPa
(LS=-5.5 (-12;-0.1) kPa), p<0.001. R/h and Xc/h increased from 242±55 to
286±59 Om/m and from 19±5 to 23±6 Om/m (R/h 25 (10; 72) Om/m, Xc/h
4.4 (1.1; 7.5) Om/m), p<0.001 for both comparisons. Patients weight decreased
from 89±23 to 79±20 kg, p<0.001 (weight -5.4±4.8). LS was negatively cor-
related with  R/h (r=-0.48), Xc/h (r=-0.46) and  weight (r=-0.54).
Conclusions: LS was associated with congestion by BIVA. During hospitalization
absolute decrease of LS correlated with absolute decrease of weight and increase
of BIVA parameters.
P2473 | BEDSIDE
Heart failure clinic in paediatric population: a comparative analysis of
outcome
R. Adorisio, N. Cantarutti, A. Baban, G. Calcagni, S. Giannico, G. Grutter,
F.S. Iorio, F. Drago. Bambino Gesu Childrens Hospital, Paediatric Cardiology,
Rome, Italy
Background: It has been reported that heart failure clinic (HFC) can improve the
outcome of adult heart failure patients, in terms of reduction of rehospitalisation,
adherence to therapy and improvement in quality of life.
Purpose: The aim of current study was to determine whether a specific HFC is
effective also in a paediatric population.
Methods: Since 2013, a specific HFC including two cardiologists and 1 dedicated
nurse has been developed in our Department. A multidisciplinary approach and
specific disease protocols have been applied. Children affected by: 1) left ventric-
ular ejection fraction <45% in case of dilated cardiomyopathy or after surgery, 2)
restrictive and 3) hypertrophic cardiomyopathy 4) Fontan failure and 5) pulmonary
hypertension have been referred to our HFC. To evaluate the impact on mortality,
rehospitalisation, analysis of comorbidities and compliance to therapy, we made
a comparative analysis on 291 children followed between 2011 and 2015, before
and after the specific program.
Results: Our population (11.2+ 5 years old; 52% male) was represented by: 45%
patients affected by cardiomyopathies, 50% CHD with ventricular dysfunction or
Fontan failure. After the introduction of this program, a significant reduction of
new urgent rehospitalisation was observed (2011 vs 2014 75% vs 33%, p<0.001;
2011 vs 2015 75% vs 12%, p<0.001; 2011 vs 2016 75% vs 14%, p<0.001). Acute
HF admissions were significantly reduced over the time (2011 vs 2016 52% vs
13%, p<0.001). No differences in terms of mortality have been observed. Major
reasons for rehospitalisation were: respiratory (52%), gastroenterological infec-
tion (33%), arrhythmias (12%). Major comorbidities included: nutritional aspects,
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two comorbidities.
Conclusions: In our center, HFC allowed to significantly reduce the rehospitali-
sation rate in a paediatric population.
P2474 | BEDSIDE
Validity and reliability of the mutuality scale in heart failure patient and
caregiver dyads
F. Dellafiore 1 , M. Paturzo 1 , A. Petruzzo 1 , F. Dagostino 2 , C. Barbaranelli 3 ,
R. Caruso 4 , R. Alvaro 1 , E. Vellone 1 . 1 University of Rome Tor Vergata, Depart-
ment of Biomedicine and Prevention, Rome, Italy; 2 S.Giovanni Calibita Fatebene-
fratelli Hospital, Rome, Italy; 3 Sapienza University of Rome, Department of
Psychology, Rome, Italy; 4 IRCCS, Policlinico San Donato, Health Professions
Research and Development Unit, San Donato Milanese, Italy
Background: The relationship between heart failure (HF) patients and their infor-
mal caregivers (e.g., a spouse or an adult child) is important for HF outcomes. An
aspect of this relationship is mutuality, which was defined as the positive quality
of the relationship between a caregiver and a care-receiver. One of the most used
scale to measure mutuality is the Mutuality Scale (MS). The MS measures mu-
tuality from caregiver and patient perspective and includes four dimensions: “love
and affection”, “shared pleasurable activities”, “shared values”, and “reciprocity”.
So far, no study has tested the MS in HF patient and caregiver dyads.
Purpose: The aim of this study was to test the validity and reliability of the MS in
patients with HF and their caregivers.
Methods: An observational, cross-sectional and correlational study design was
used. Patients and caregivers completed the MS and a sociodemographic ques-
tionnaire. Patients’ clinical information was abstracted by their medical records.
Confirmatory Factor Analysis was used to analyze the factorial validity of MS;
Cronbach’s alpha and model-based internal consistency index were used to de-
termine the internal consistency of MS. The intraclass correlation coefficient was
used to determine test-retest reliability.
Results: A convenience sample of 323 HF patients (mean age 71.48 years, SD
12.75; 57.3% men) and 323 HF caregivers (mean age 53.73 years, SD 15.34;
74% women) was enrolled in the study. Patients were mainly in NYHA class II
(60.1%) and III (31.9%) and had several comorbidities (hypertension 73.8%, my-
ocardial infarction 38% and atrial fibrillation 33.4%). The mean ejection fraction
was 39.25 (DS 10.29) and the mean month of illness was 64.80 (DS 74.22).
Confirmatory Factor Analysis supported the factorial validity of the MS in its pa-
tient (CFI=0.94; RMSEA=0.061) and caregiver (CFI=0.92; RMSEA=0.073) ver-
sion. Cronbach’s alphas and model-based internal consistency index were >0.94.
Test-retest reliability resulted with an intraclass correlation coefficient ranging be-
tween 0.55 to 0.79.
Conclusion: Our analysis showed that the MS has good factorial validity and
internal consistency and test-retest reliability in HF patient and caregiver dyads.
The instrument can be used in clinical practice and research to measure mutuality
in this population.
PREVENTION – GENERAL
P2475 | BEDSIDE
A randomized controlled trial of telemonitoring home-based training
versus center-based in coronary heart disease: short-term results of
the tele-rehabilitation in coronary heart disease (TRiCH) study
A. Avila 1 , J. Claes 1 , K. Goetschalckx 2 , L. Vanhees 1 , V. Cornelissen 1 . 1 KU
Leuven, Rehabilitation Sciences, Leuven, Belgium; 2 KU Leuven, Cardiovascular
Imaging and Dynamics, Leuven, Belgium
Introduction: Cardiovascular diseases (CVD) remain the leading contributor to
global mortality and morbidity. Cardiac rehabilitation (CR) is an essential part of
contemporary coronary heart disease (CHD) management that aims to optimize
cardiovascular risk reduction, facilitate adoption and adherence to healthy behav-
iors, reduce disability and promote active lifestyles. However, studies have shown
that patients exiting a center-based CR have difficulty retaining the positive effects
that were derived from their weeks of participation. Therefore, there is a need for
innovative rehabilitation methods focused on sustained effects on health related
physical fitness.
Purpose: The purpose of the TRiCH study was to compare the short and longer-
term clinical effects of a home-based (HB) CR program with telemonitoring guid-
ance to a center-based (CB) CR and a control group (CG) on physical fitness and
other secondary outcomes in patients with coronary artery disease (CAD) in the
maintenance phase (WHO Phase III).
Methods: Between February 2014 and August 2016, 90 coronary artery disease
patients (61.7±7.7yrs, 89% males, 1.73±0.7m, 82.8±13kg, 27.5±3.3kg/m2 ), who
successfully completed a three month ambulatory cardiac rehabilitation program
(phase II) at the hospital, were randomly allocated to one of three groups: HB
(=30), CB (=30) or a Control (CG) (=30) on a 1:1:1 basis. HB patients received
a telemonitoring exercise intervention, CB patients participated in the in-hospital
CR exercise program and CG patients received the standard advice on physical
activity. Peak oxygen uptake (PVO2; primary outcome) and secondary outcomes
(blood pressure, anthropometrics, blood lipids, glucose, quality of life, muscle
strength) were assessed at baseline and after the 12 week intervention period.
 512 Prevention – General
Results: Basic characteristics of the groups at baseline were similar. There was a
drop out of 4 patients in the CG (13%), 2 in the HB group (7%). After 12 weeks of
intervention, there was a significant increase in exercise capacity in the CB group
of 1.3mL·kg–1 ·min–1 (95% CI -0.09, 2.49; P=0.034), and of 1.1mL·kg–1 ·min–1
(95% CI -0.04, 2.51; P=0.043) in the HB group, whereas in the CG the exercise
capacity decreased 0.20mL·kg–1 ·min–1 (95% CI -2.01, 0.59; P=0.28). No signifi-
cant differences were found for the secondary outcomes.
Conclusion: After completion of a phase II program, a HB is equally effective as
a CB CR program to further increase exercise capacity.
Acknowledgement/Funding: The Joint Doctorate Program “MOVE-AGE”, is
funded by the European Commission as part of the Erasmus Mundus program
P2476 | BEDSIDE
Assessment and control of physical activity by step counters and
online documentation in secondary prevention after myocardial
infarction
H. Wienbergen 1 , T. Backhaus 1 , S. Michel 1 , J. Stehmeier 1 , K. Kraemer 1 ,
J. Schmucker 1 , S. Meyer 2 , J. Meyer 3 , H. Haase 4 , A. Elsaesser 2 , R. Hambrecht 1 .
1 proved cardiovascular health can be brought about over the course of 4 months
Klinikum Links der Weser, Bremer Institut für Herz- und Kreislaufforschung, Bre-
men, Germany; 2 Oldenburg Hospital, Oldenburg, Germany; 3 OFFIS - institute for
information technology, Oldenburg, Germany; 4 RehaZentrum, Bremen, Germany
Background: Physical inactivity is an important modifiable risk factor in sec-
ondary prevention. It was the purpose of this study to investigate feasibility and
effects of step counters and online documentation of steps to prevent physical
inactivity after myocardial infarctions.
Methods: The randomized IPP study investigates the effects of an intensive
longterm prevention program (IPP) compared with usual care (UC) after acute
myocardial infarctions. As part of the prevention program step counters were of-
fered to all patients of the IPP group. The patients were requested to document
the number of steps in a study online portal, feedback was given by the study
center.
Results: 103 patients (81.1%) of the 127 patients in the IPP group documented
steps, 91 patients (71.7%) for >6 months.
The mean number of daily steps increased with growing time interval from my-
ocardial infarction (Table).
In patients that increased the number of daily steps >30% during 6 months, an
improvement of the clinical parameters body mass index (BMI) [-1.1±1.7 kg/m2
(-3.9%), p<0.01], blood pressure [-6.7±13 mmHg (-4.9%), p 0.01] and LDL-
cholesterol [-3.5±22 mg/dl (-4.9%), p 0.39] was observed.
In patients that did not increase the number of daily steps >30%, no improve-
ment of the clinical parameters was found [BMI: ±0.0±3.9 kg/m2 (±0.0%), p 0.98,
blood pressure: +2.0±15 mmHg (+1.5%), p 0.31, LDL-cholesterol: +1.2±26 mg/dl
(+1.6%), p 0.24].
Table 1
Study start (n=91) 3 months (n=91) 6 months (n=91)
Number of steps/day (MV ± SD) 8015±3834 8826±4102 9480±3627
Conclusions: Acceptance of step counters and online documentation as part
of a longterm prevention program was good and the number of steps increased
significantly during study course. Patients with an increase of steps >30% dur-
ing 6 months improved the clinical parameters BMI, blood pressure and LDL-
cholesterol, while patients without increased steps did not.
The data underline the value of step counters and online documentation as a
strategy to prevent physical inactivity after myocardial infarctions.
Acknowledgement/Funding: Deutsche Herzstiftung e.V., Stiftung Versorgungs-
forschung der ALKK e.V., Handelskrankenkasse Bremen, Stiftung Bremer Wert-
papierbörse
P2477 | BEDSIDE
Assessing self-measurement, activity, and weight change behaviors of
connected scale users who reduced their pulse wave velocity over 4
months
E. Roitmann, A. Chieh. Withings, Paris, France
Introduction: Pulse wave velocity (PWV) is widely known as a marker of cardio-
vascular risk. As a preventive measure against cardiovascular events it is desir-
able to reduce the PWV. While there are many cross-sectional analyses describ-
ing the association between cardiovascular risk and PWV, little research has eval-
uated longitudinal changes and the behaviors associated with a PWV reduction.
PWV measurements have until recently been limited mostly to research and med-
ical centers because measurements required the use of expensive and complex
devices. The new connected scales that permit self-measurement of the PWV
makes it possible to analyze the PWV of large cohorts with a high measurement
frequency.
Purpose: The study aims to leverage the availability of high-frequency PWV self-
measurements of a large number of connected scale users to determine the be-
haviors of users who reduce their pulse wave velocity over the course of 4 months.
Methods: The study was conducted on anonymous data from a pool of 99,327
users of connected scales that measure both weight and PWV. 59,497 of these
users also track their daily steps with wearable activity trackers. The data was
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collected from August to December 2016 worldwide with more than 90% of users
from US, Canada, Europe, Japan, and China. To identify users that had reduced
their PWV we calculated the percent change in PWV between August and De-
cember averages and set a threshold of -10%. We used a Welch’s t-test for eval-
uating whether there was a difference in the levels of self-measurement and ac-
tivity between users who reduced their PWV and other users. To evaluate the dif-
ference in weight change from August to December between users who reduced
their PWV and other users we performed a linear regression for each group and
compared the slopes with a Student t-test.
Results: 960 users had reduced their PWV by more than 10% from August to
December. These users measured themselves 25.7 times per month on average,
which is significantly more often than others at 18.1 times per month with a p-
value less than 10–10 . The activity level of users who reduced their PWV was
significantly higher than that of others at an average of 6065 daily steps versus
5763 respectively with a p-value of 1.6x10-6 . Users who reduced their PWV also
reduced their weight by 0.31 kg/month while other users gained weight during
the 4-month year-end period at a rate of 0.22 kg/month, a difference which is
statistically significant with a p-value less than 10–10 .
Conclusions: This study suggests that a reduction in PWV and thereby an im-
through frequent self-measurement, an increased activity level, and weight reduc-
tion. The results can form the basis of recommendations used in medical practice
to improve cardiovascular health. This study further demonstrates the value of au-
tomatically collected self-measurement PWV data, enabled by connected scales.
P2478 | BEDSIDE
Intermittent hypoxia-hyperoxic training as a new method of
cardioprotection during coronary artery bypass surgery
D. Tuter, P. Kopylov. I.M. Sechenov First Moscow State Medical University,
Moscow, Russian Federation
Introduction: The rate of complications during coronary artery bypass surgery,
particularly in cases of using of heart-lung machine, is still high. An impor-
tant task is to find new methods of heart protection from damaging effects
of ischemia/reperfusion during surgery. Proposed technique of cadioprotection
involves achieving of myocardial preconditioning effect using short alternating
episodes of hypoxia (O2 concentration of 12%) and hyperoxia (O2 concentration
of 35%). Total time of breathing with hypoxic gas mixture during one procedure is
20–30 minutes, total time of one procedure is 40–50 minutes. The final training -
on the day before surgery.
Objective: Development of new methods of heart protection, decreasing of com-
plication rates in coronary artery bypass surgery.
Research methods: 80 patients, who underwent aorto- and/or internal mam-
mary coronary artery bypass surgery, were included in the study, of them 40
patients were included in the main group and 40 in the control group (groups
were matched by sex, age, extent of coronary artery disease and number of co-
P morbidities). Patients of the main group had 4-day course of intermittent hypoxia-
<0.01 hyperoxic training (IHHT) before surgery, patients of the control group 4-day train-
ing course simulating IHHT (supplied air contained usual oxygen level). Opera-
tions were carried out in conditions of cardiopulmonary bypass and cold cardio-
plegia. Monitoring of Troponin I and lactate levels was performed for all patients
immediately before surgery, 2 and 24 hours later.
Results: Statistically significant decreased mean level of Troponin I were seen
in the IHHT group on the day after surgery in comparison with the control group
(2.16 ng/mL and 3.44 ng/mL, respectively; p=0.012). Difference between values
of Troponin I before surgery and two hours later was not statistically significant.
Also values of lactate are significantly different after surgery (1.96 mmol/L in the
IHHT group and 2.35 mmol/L in the control group, p=0.04). Lactate levels before
surgery are the same in both groups. By the number of complications downward
trend in the number of paroxysmal atrial fibrillation in the perioperative period
was noticed in the IHHT group compared with the control group (8 (20%) and 12
(30%) episodes, respectively). In addition, 2 cases of ventricular fibrillation (5%)
were seen in the control group only, one of which occurred on the background of
intraoperative myocardial infarction with transition to asystole, which caused the
death of the patient. Rate of other complications was the same in both groups.
Conclusions: Although rate of complications between two groups did not reach
tests of significance (that can be attributed to a small number of patients included
in the study), lower levels of Troponin I and lactate in the IHHT group after coro-
nary artery bypass surgery indicates the increased resistance of the myocardium
to the damaging effects of ischemia/reperfusion in the course of operation.
P2479 | BEDSIDE
Behaviours of French amateur rugby players, lifestyle of the younger
at higher risk for their heart?
F. Chague 1 , M. Zeller 2 , J. Petit 3 , C. Guenancia 1 , P. Aviat 4 , Y. Laurent 3 ,
A. Gudjoncik 1 , J.C. Perrin 4 , J.P. Hager 4 , V. Gremeaux 3 , Y. Cottin 1 . 1 University
Hospital of Dijon, Cardiology department, Dijon, France; 2 University of Bour-
gogne Franche-Comté, Laboratory PEC 2, Dijon, France; 3 University Hospital
of Dijon, Rehabilitation department, Dijon, France; 4 French Rugby Federation,
Marcoussis, France
Background: Sudden cardiac death during sport remains a major problem. In