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I INTERNATIONAL SYMPOSIUM ON CARDIOVASCULAR

EPIDEMIOLOGY

Brazilian Society of Cardiology • ISSN-0066-782X • Volume 101, Nº 2, Suppl. 1 2013www.arquivosonline.com.br

BrazilAdib D. Jatene (SP)Alexandre A. C. Abizaid (SP)Alfredo José Mansur (SP)Álvaro Avezum (SP)Amanda G. M. R. Sousa (SP)André Labrunie (PR)Andrei Sposito (DF)Angelo A. V. de Paola (SP)Antonio Augusto Barbosa Lopes (SP)Antonio Carlos C. Carvalho (SP)Antônio Carlos Palandri Chagas (SP)Antonio Carlos Pereira Barretto (SP)Antonio Cláudio L. Nóbrega (RJ)Antonio de Padua Mansur (SP)Ari Timerman (SP)Armênio Costa Guimarães (BA)Ayrton Klier Péres (DF)Ayrton Pires Brandão (RJ)Barbara M. Ianni (SP)Beatriz Matsubara (SP)Braulio Luna Filho (SP)Brivaldo Markman Filho (PE)Bruce B. Duncan (RS)Bruno Caramelli (SP)Carisi A. Polanczyk (RS)Carlos Alberto Pastore (SP)Carlos Eduardo Negrão (SP)Carlos Eduardo Rochitte (SP)Carlos Eduardo Suaide Silva (SP)Carlos Vicente Serrano Júnior (SP)Celso Amodeo (SP)Charles Mady (SP)Claudio Gil Soares de Araujo (RJ)Cleonice Carvalho C. Mota (MG)Dalton Valentim Vassallo (ES)Décio Mion Jr (SP)Denilson Campos de Albuquerque (RJ)Dikran Armaganijan (SP)Djair Brindeiro Filho (PE)Domingo M. Braile (SP)Edmar Atik (SP)Edson Stefanini (SP)Elias Knobel (SP)Eliudem Galvão Lima (ES)Emilio Hideyuki Moriguchi (RS)Enio Buffolo (SP)

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Scientific Director Luiz Alberto Piva e Mattos

chief eDitor Luiz Felipe P. Moreira

ASSociAteD eDitorS

clinicAl cArDiology José Augusto Barreto-Filho

SurgicAl cArDiology Paulo Roberto B. Evora

interventioniSt cArDiology Pedro A. Lemos

PeDiAtric/congenitAl cArDiology Antonio Augusto Lopes

ArrhythmiAS/PAcemAker Mauricio Scanavacca

non-invASive DiAgnoStic methoDS Carlos E. Rochitte

BASic or exPerimentAl reSeArch Leonardo A. M. Zornoff

ePiDemiology/StAtiSticS Lucia Campos Pellanda

ArteriAl hyPertenSion Paulo Cesar B. V. Jardim

ergometricS, exerciSe AnD cArDiAc rehABilitAtion Ricardo Stein

firSt eDitor (1948-1953) † Jairo Ramos

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A JOURNAL OF BRAZILIAN SOCIETY OF CARDIOLOGY - Published since 1948www.arquivosonline.com.br

Presidents of the Specialized Departaments and Study Groups

Brazilian Society of Cardiology

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I INTERNATIONAL SYMPOSIUM ON CARDIOVASCULAR EPIDEMIOLOGY

Arq. Bras. Cardiol.: 2013; 101 (2 Suppl. 1): 1-18

001 002

003 004

05/21/13 - 05/23/13ABSTRACTS OF I INTERNATIONAL SYMPOSIUM

ON CARDIOVASCULAR EPIDEMIOLOGY

EFFECTS OF 12 WEEKS OF AEROBIC TRAINNG ON INFLAMMATORY BIOMARKERS, ANTHROPOMETRIC AND FUNCTIONAL PARAMETERS IN POSTMENOPAUSAL WOMEN WITH METABOLIC SYNDROMEJuliano Boufleur Farinha1, Daniela Lopes dos Santos1, Flávia Mariel Steckling1, Sílvio Terra Stefanello2, Marta Maria Medeiros Frescura Duarte3, Guilherme Bergamaschi Bresciani2, Félix Alexandre Antunes Soares2

1Depart. de Mét. e Téc. Desportivas, Centro de Ed. Física e Desportos, UFSM, Santa Maria, Rio Grande do Sul, Brazil; 2Depart. de Química, Centro de Ciências Naturais e Exatas, UFSM, Santa Maria, Rio Grande do Sul, Brazil; 3ULBRA, Santa Maria, Rio Grande do Sul, Brazil.

Background: The metabolic syndrome (MS) comprises interrelated risk factors and its prevalence is rising worldwide. Moreover, the MS is strongly associated with the presence of coronary heart disease, abdominal aortic aneurysm and peripheral vascular disease. MS is also closely related to chronic low-grade inflammation, which is associated with atherosclerosis and diabetes and, sedentary postmenopausal women show additional cardiovascular risks. In this sense, physical exercise may be considering the most effective non-pharmacological strategy for the management of MS.

Objectives: To investigate the effects of 12-week moderate aerobic training (AT) on inflammatory, anthropometric and functional parameters of postmenopausal women with metabolic syndrome.

Methods: Eighteen untrained postmenopausal women underwent a series of anthropometric and functional measurements and inflammatory serum parameters. Sessions of AT were performed in treadmills, with intensity and duration ranged from 30-60 minutes and 55-65 % of the heart rate reserve. Participants were encouraged to maintain the habitual dietary intake along the study. All participants signed a written informed consent and Student’s t-test and Wilcoxon Signed Rank Test were used to determine significant differences between before and after AT.

Results: AT resulted in lower levels of interleukin-1 (155.16±37.33 vs. 121.33±13.29 pg/ml, P = 0.003), interleukin-6 (172.66±61.88 vs.125.11±15.27 pg/ml, P = 0.005), tumor necrosis factor-α (190±58.58 vs. 138±15.08 pg/ml, P = 0.001 pg/ml), and higher concentration of interleukin-10 (63±13.07 vs. 93.33±13.49 pg/ml, P < 0.001), high-density lipoprotein (32.72±9.53 vs. 38.38±7.92 mg/dL, P = 0.033) and maximal oxygen uptake values (32.65±6.33 vs. 38.12±5.49 ml/kg-1·min-1, P < 0.001). However, resting blood pressure, glucose, total cholesterol, triglycerides and low-density lipoprotein levels unchanged after the AT. Furthermore, participants exhibited improvements in weight body (73.68±10.63 vs. 72.1±10.76 kg, P < 0.001), body mass index (29.81±4.22 vs. 29.18±4.29 kg/m², P < 0.001), waist circumference (91.49±10.5 vs. 89.01±9.89 cm, P < 0.001), total body fat mass (44.07±4.13 vs. 42.64±4.47 %, P = 0.001) and total lean body mass (52.94±3.76 vs. 54.3±4.07 %, P = 0.002) when compared with baseline values.

Conclusions: Despite no changes in most MS criteria classification, postmenopausal women reported several improvements in inflammation biomarker and anthropometric and functional parameters after 12 weeks of moderate AT.

EFFECTS OF INSPIRATORY LOADING, AEROBIC AND AEROBIC PLUS RESISTANCE EXERCISE ON GLUCOSE VARIABILITY IN TYPE 2 DIABETESFranciele R. Figueira, MSc1,2, Ana P. S. Corrêa, MSc1,3,Daniel Umpierre1,3, MSc1, Karina R. Casali2, Beatriz D. Schaan, MD, ScD 1,2,3

1Exercise Pathophysiology Research Laboratory, HCPA, Porto Alegre, Rio Grande do Sul, Brazil; 2Postgraduate Program in Endocrinology, UFRGS,Porto Alegre, Rio Grande do Sul, Brazil; 3 Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Physical exercise acutely and diaphragm muscle contractions induced by inspiratory loading (IL) can reduce glycemia, but the effects on glucose variability (GV) are unkown.

Aim: To evaluate the effects of IL, aerobic (AER) or aerobic+resistance exercise (COMB) sessions on glucose and GV (continuous glucose monitoring system, CGMS) in diabetic patients.

Methods: Fourteen type 2 diabetic patients, wearing a CGMS, were assigned to AER (cycle ergometer, 70% of peak heart rate/40 min) or COMB sessions (cycle ergometer, 70% of peak heart rate + 4 resistance exercises at 65% 1-RM/40 min); another 6 patients underwent an IL session with inspiratory resistance [breath control/3min; inspiratory muscle loading (60% of PImax)/5 min and handgrip exercise/7 min]. All exercise sessions were one week apart. Glucose levels were evaluated 30 min before and 30 min after the sessions in all modalities of exercises. The GV was evaluated by glucose standard deviation (SD), glucose variance and glucose coefficient of variation (CV) based on glucose oscillations.

Results: Subjects were 56 ± 6 years old, HbA1c 7.9 ± 0.7%. Glucose decreased after all protocols by ~25%, ~11% and ~24%, respectively (AER: 163.9 ± 30.8 vs 126.4 ± 29.4 mg/dL P<0.001; COMB: 152.6 ± 43.7 vs 126.5 ± 23.1 mg/dL P<0.001; IL: 152.8 ± 29.5 vs 106.8 ± 23.7 mg/dL P<0.001). Glucose SD was reduced (P<0.01) by AER (9.77 ± 5.50 vs 3.59 ± 3.03 mg/dL) and IL (13.09 ± 8.15 vs 1.57 ± 1.15 mg/dL), but not by COMB (6.48 ± 5.86 vs 4.22 ± 2.25 mg/dL) sessions. Glucose variance was reduced (P=0.02) by AER (123.60 ± 135.81 vs 21.40 ± 42.92 mg2/dL2) and IL (226.56 ± 205.73 vs 3.55 ± 3.34 mg2/dL2), but not by COMB (73.88 ± 161.32 22.52 ± 20.31 mg2/dL2) sessions. Glucose CV decreased only after IL session (8.83 ± 6.34 vs 1.69 ± 1.46%, P=0.018).

Conclusions: Glucose levels were more markedly reduced by a single bout of AER and IL than by a COMB session in type 2 diabetes patients. The exclusively GV reduction by AER and IL sessions, and not by COMB sessions could result in more benefits of this kind of exercise.

Support: CNPq, FAPERGS, FIPE/HCPA and CAPES

CARDIOVASCULAR RISK FACTORS IN THE UNIVERSITY: AN EVALUATION OF MEDICAL STUDENTS AT THE FEDERAL UNIVERSITY OF PELOTASHickel F1, Fabro BR1, Berto RT1, Szareski EB1, Giongo AL1, Giovanaz A1, Bertoldi EG1.1UFPel, School of Medicine, Rio Grande do Sul, Brazil.

Background: Medical students will have the future responsibility, when acting as healthcare providers, of advising the general public regarding cardiovascular risk factors. Individual behaviors and attitudes can determine the future provider’s ability to influence their patients.

Objectives: To evaluate cardiovascular risk factors and health-risk behaviors in medical students at Federal University of Pelotas (UFPel), through a prevalence study.

Methods: Self-applied questionnaire was proposed to all students from the first to the seventh semester of the UFPel School of Medicine. Variables were described using mean/SD, median/IQR, and total number/percent. Differences among groups were analyzed with Student’s t-test for continuous variables with Gaussian distribution, and the Wilcoxon test for continuous variables with non-Gaussian distribution; for qualitative variables, we used chi-square and logistic regression. P values under 0.05 were considered to indicate statistical significance.

Results: The questionnaire was answered by 298 students, median age 22 years; 58% of participants were female. Table 1 shows the prevalence of health-risk behaviors and cardiovascular risk factors. Regular physical activity was reported by 60% of responders, and excessive sodium consumption by 44%. Alcohol consumption was reported by 88% of participants, without significant variation in different course semesters. Tobacco smoking was reported by 8%, and showed positive correlation with quantity of alcohol consumed (p=0,029). The composite outcome of sedentarism, excessive sodium consumption or smoking was reported by 69% of students.

Conclusions: The prevalence of cardiovascular risk factors and health-risk behaviors is high among medical students of UFPel. Interventions aiming to improve awareness about the benefits of a healthy lifestyle should be sought.

ADHRENCE TO DIET IN ELDERLY PATIENTS WITH METABOLIC SYNDROME ATTENDED IN THE PRIMARY HEALTH CARE IN SOUTHERN BRAZILCamila Bittencourt Jacondino1, Vera Elizabeth Closs1, Maria Gabriela Gottlieb1, Carla Helena Schwanke1, Cássia Helena Santos Alves2

1Instituto de Geriatria e Gerontologia - PUCRS, Porto Alegre, RS, Brasil; 2Faculdade de Fisioterapia - PUCRS, Porto Alegre, RS, Brasil.

Background: Metabolic syndrome (MS) is considered a complex disorder that increases overall mortality by 1,5 times and cardiovascular mortality by 2,5 times. The objective of the treatment for MS is to reduce the cardiovascular risk with lifestyle alterations, such as adherence to a balanced diet.

Aims: Describe the frequency of adherence to diet and association with demografic, socioeconomic variable, biochemical, anthropometric variables and cardiovascular risk (CR) in elderly patients with metabolic syndrome attended in the primary healthcare in southern Brazil.

Methods: Descriptive analytical study, conducted with 110 elderly, diagnosed with MS, according to the National Cholesterol Education Program’s Adult Treatment III (NCEP-ATP III. To assess compliance to diet, a questionnaire was used, based on the recommendations of the First Brazilian Guidelines for Metabolic Syndrome.

Results: The mean age of the sample was 68.3 ± 6.5 years (60-95 years), 36 men (32.7%) and 74 women (67.3%). Of the total sample, n=37 (33,9%) (95% CI=25 to 42.7%) were considered adherent to diet: the reduction of salt consumption was the item with the highest adherence (89.1%), and the item with the lowest adherence (59.7%) was to whole foods. The most cited reason for non-adherence to diet was the lack of persistence (38.9%). It was not verified a statistically significant association between elderly adherent and non-adherent to diet with sex, income, schooling, body mass index, waist circumference, lipid profile, blood glucose and cardiovascular risk.

Conclusions: There was low frequency of adherence to diet by elderly patients with metabolic syndrome, treated in the primary healthcare.

Table 1. Prevalence of health-risk behavior and risk factorsFactor / behavior n (%)Smoking 23 (8%)Alcohol consumption 261 (88%)Sedentarism 119 (40%)Current recreational drug use 17 (6%)Previous recreational drug use 43 (14%)Sodium consumption > 2.3g / day 131 (44%)Sedentarism, excessive sodium consumption or smoking 206 (69%)

1


Abstracts

005PERIOPERATIVE CARDIAC BIOMARKERS IN NONCARDIAC SURGERYFlávia Kessler Borges, MD, ScD1, Mariana Vargas Furtado, MD, MSc2, Ana Paula Webber Rossini, MD2, Carolina Bertoluci, MD2, Vinícius Leite Gonzalez, MD1, Eduardo Gehling Bertoldi, MD, MSc3, Luíza Guazzeli Pezzali, MS4, Daniel Luft Machado, RN2, Denis Maltz Grutcki, MS4, Leandro Gazziero Rech, MS4, Mariana Magalhães, MS4, Bruno Rocha de Macedo, MD1, Karine Michel, MD1 , Carisi Anne Polanczyk, MD, ScDb,4,5

1Internal Medicine Division, HCPA, Brazil; 2Cardiology Division, HCPA, Brazil; 3Cardiology Division, School of Medicine, UFPel, Brazil; 4Department of Internal Medicine, School of Medicine, UFRGS, Brazil; 5Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Elevated cardiac biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin, are related to adverse cardiovascular outcomes in the perioperative setting. Few studies have evaluated the combined prognostic impact of these markers related to overall mortality in patients undergoing noncardiac surgery.

Objectives: To evaluate the prognostic value of perioperative NT-proBNP and cardiac troponin in intermediate and high risk cardiovascular patients undergoing noncardiac surgery.

Methods: 145 patients aged ≥ 45 years, with Revised Cardiac Risk Index ≥ 2 and undergoing intermediate or high risk noncardiac surgery were enrolled prospectively. Levels of NT-proBNP and ultrasensitive troponin I (TnI-us) were measured perioperatively. Primary outcome was defined as total mortality. Patients were followed-up for 6 months after surgery. ROC curves were used to define optimal discriminatory levels of NT-proBNP pre and postoperatively. Cox regression models were constructed to assess the primary outcome.

Results: During follow-up, 17 patients (11.7%) died. The best discriminatory levels of NT-proBNP before and after surgery were 917 and 2962 pg/ml, respectively. Pre- and postoperative NT-proBNP (HR = 7.01, 95% CI 2.26 to 21.76, p = 0.001 and HR 3.95, 95% CI 1.47 to 10.60, p = 0.006, respectively) and peak levels of postoperative TnI-us (HR = 1.78, 95% CI 1.29 to 2.44, p <0.001) were significantly associated with total mortality in univariate analysis. After adjusting for various perioperative variables, preoperative NT-proBNP (adjusted HR = 5.30, 95% CI 1.65 to 17.05, p = 0.005) and TnI-us (adjusted HR = 1.64; 95% CI 1.16 to 2.32, p = 0.005) remained significantly and independently associated with total mortality.

Conclusion: This study confirms that preoperative NT-proBNP and postoperative TnI-us are prognostic markers of total mortality in high risk cardiovascular patients. Although significantly associated with worse outcomes, NT-pro-BNP postoperative levels were less informative than the preoperative levels. The determination of these biomarkers should be considered in current risk assessment in the perioperative setting.

006

007 008SPEED AND GRADE INCREMENT DURING CARDIOPULMONARY TREADMILL TESTING: IMPACT ON EXERCISE PRESCRIPTIONKarlyse C Belli1, Paula Figueiredo1, Jonathan Myers2, Ricardo Stein1,3, Jorge P Ribeiro (in memoriam)1,3

1Exercise Pathophysiology Research Laboratory and Cardiology Division, HCPA, Porto Alegre, Brazil; 2Stanford University, Palo Alto, California, United States of America; 3Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Ventilatory thresholds (VT) have been used as reference points for exercise prescription. We tested the hypothesis that exercise prescription, based on VTs determined by treadmill cardiopulmonary exercise testing (CPX), are influenced by the rate of increase in treadmill work load.

Objective: This study was conducted to compare the effects of two treadmill ramp protocols on the detection of the VT1 and VT2.

Methods: Nine healthy individuals underwent two CPXs, followed by two sessions of submaximal exercise, both in randomized order. For the “speed” protocol, the increment increased by 0.1 to 0.3Km/h every 15s. The “grade” incremental protocol increased 1% every 30s and 0.1Km/h every 45s. This was followed by submaximal exercise sessions lasting 40min at an intensity corresponding to heart rate (HR) between the first and second VT.

Results: The speed protocol resulted in higher first (27.5±2.3vs24.9±1.9mL/(kg.min); P=0.001) and second (32.4±2.9vs29.7±2.1mL/(kg.min); P=0.017) VTs, but there was no effect on maximal oxygen uptake. The target HR for the submaximal exercise sessions was higher (169±9vs156±8bpm; P<0.001) and remained stable during the two steady-state exercise sessions. Blood lactate remained stable during the submaximal exercise sessions, with higher values observed during the speed protocol (6.2±1.6vs4.6±1.9mmol/l; P<0.001).

Conclusions: Compared to a protocol primarily increasing grade, a protocol which primarily increases speed resulted in higher VTs, which significantly affected cardiorespiratory and metabolic responses to prescribed exercise intensity in healthy subjects.

NUTRITIONAL PROFILE OF CHILDREN WITH CONGENITAL HEART DISEASE IN A REFERENCE CLINIC.Daniela Schneid Schuh 1, Lucia Campos Pellanda 2

1Grupo de Cardiologia Pediátrica Preventiva - Instituto de Cardiologia de Porto Alegre; 2UFCSPA, Rio Grande do Sul, Brasil.

Background: Many children with congenital heart disease have a history of developing weight gain, especially in early childhood when eating habits begin to develop. There are few studies assessing the nutritional status of this population. Therefore, their prevalence of obesity, malnutrition and overweight is unknown.

Objectives: To examine the nutritional parameters of children and adolescents with congenital heart disease seen in outpatient pediatric cardiology clinic.

Methods: Cross-sectional study. We included patients from age 2 to 18 with congenital heart disease, seen in the outpatient clinic mentioned above, between May 2011 and May 2012. A review of the medical records, 24-hour dietary recall and anthropometric measurements were made.

Results: We included 85 patients, of whom 55.3% were male. The mean age was 9.8 ± 4.2 years. The mean of daily calorie intake was 2273 kcal (± 761). There was excessive consumption of fat by 41.2% of patients, and carbohydrates for 32.9%. The analysis of the nutritional status show that 4.7% of patients were underweight, 67.1% were normal and 28.2% were overweight. Concerning lipid profile, 5.9% had high serum levels of total cholesterol and borderline in 12.9%. The LDL serum level was high in 7.1% and borderline in 3.5%, triglycerides were high in 3.5% and blood glucose was high in 8.2% of patients.

Conclusions: The proportion of overweight and obesity has increased, calling attention to the need for early prevention for this particular group, which has overlapping risks due to heart disease itself.

CARDIORESPIRATORY RESPONSES OF PREGNANT AND NON PREGNANT WOMEN DURING RESISTANCE EXERCISES WITH TWO DIFFERENT VOLUMES Roberta Bgeginski, M.Sc.1, Bruna Pereira Almada, P.E.1, Luiz Fernando Martins Kruel, Ph.D1.1UFRGS, School of Physical Education, Exercise Research Laboratory, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Pregnancy is associated with changes in cardiorespiratory parameters at rest, in the same way resistance exercises also change these parameters in non-pregnant women. This study evaluates the behavior of cardiorespiratory variables in pregnant women performing resistance exercises.

Objectives: The aim of this study was to verify fetal heart rate and the cardiorespiratory responses in pregnant and non-pregnant women during the execution of resistance exercises for upper and lower body, with two different volumes.

Methods: The sample was composed of 20 healthy women, aged between 20-32 years old, being 10 pregnant women (gestational age between 22 and 24 weeks) and 10 non-pregnant women, who performed five experimental sessions: session 1: familiarization with the equipments and the determination of one estimated maximum repetition (1-RM); sessions 2, 3, 4 and 5: determination of the cardiorespiratory responses during resistance exercise on the bilateral leg extension and fly, with 1 and 3 sets of 15 repetitions, 50% of 1-RM. Results were analyzed using ANOVA for repeated measures with two and three factors with Bonferroni correction for post-hoc comparisons (á=0.05) (SPSS vs 13.0).

Results: The blood pressure responses during resistance exercises showed a lower behavior in the pregnant group. When the exercises were performed with a single set, only heart rate and rate-pressure product showed different responses between exercises, with increased values for bilateral leg extension, however, when the exercises were performed with multiple sets the heart rate, systolic, diastolic and mean blood pressure, rate-pressure product, ventilation and oxygen uptake responses were different between exercises, with increased values for bilateral leg extension. There was no occurrence of uterine contractions along this period. The fetal heart rate responses did not presented differences between the exercises and volumes and kept the normality patterns (120-160 bpm).

Conclusions: During the performance of the bilateral leg extension and fly resistance exercises the blood pressure response was lower in the pregnant group. The bilateral leg extension showed higher values for the cardiorespiratory variables compared to fly exercise and the variables responses presented an increase with the addition of the sets performed. The fetal response was not different between exercises and volumes performed.

Support: CNPq and CAPES

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009LIPID ACCUMULATION PRODUCT INDEX (LAP), BODY ADIPOSITY INDEX (BAI), NECK CIRCUMFERENCE AND TYPE-2 DIABETES IN SUBJECTS WITH HYPERTENSIONAline Marcadenti1,2, Flavio Danni Fuchs1,2, Leila Beltrami Moreira1,2, Sandra Costa Fuchs1,2

1Postgraduate Studies Program in Cardiology, School of Medicine, UFRGS, Porto Alegre, RS, Brazil; 2Division of Cardiology, HCPA, and IATS, Porto Alegre, RS, Brazil.

Background: No-traditional anthropometric indexes have been proposed to detect cardiovascular risk factors as type-2 diabetes among general population, since traditional indicators as BMI and waist circumference seems not discriminate visceral adipose tissue (VAT), a fat depot closely associated with cardiovascular disease.

Objectives: To evaluate the association between no-traditional anthropometric indexes - Lipid Accumulation Product Index (LAP), Body Adiposity Index (BAI) and neck circumference - with type-2 diabetes in patients with hypertension.

Methods: 430 patients (145 men and 285 women) with hypertension (systolic and/or diastolic blood pressure ≥ 140/90 mmHg or use of lowering BP agents) were investigated. Type-2 diabetes was diagnosed according to the American Diabetic Association criteria. Weight (kg), height (m), waist, hip and neck circumferences (cm) were measured and body mass index (BMI, kg/m2) was calculated. Serum triglycerides were measured using calorimetric enzymatic method and LAP (cm.mmol.l) was calculated separately for men and women (waist circumference plus serum triglycerides). BAI (%) was evaluated in percentiles and calculated according to formula: hip (cm) / [height (m)1.5]-18. Data were expressed as mean ± standard deviation (SD) or frequencies (%). The associations between anthropometric indexes and type-2 diabetes were analyzed using modified Poisson�s regression and expressed as risk ratio and 95%CI, after the control for confounding factors.

Results: Patients were aged 58.3 ±11.7 years, had SBP 154.2 ±24.9 mmHg, DBP 89.0 ±14.7 mmHg, BMI 30.1±6.0 kg/m2 and overall prevalence of diabetes mellitus was 32.5%. Analyses by gender showed that among men BAI at the 75th Percentile (31.57 %) increased about 60% the risk for type-2 diabetes [RR 1.60 (95%CI 1.04-2.49); P= 0.03], independently of age, physical activity, and smoking. Among women, those in the upper quartile of LAP and neck circumference had increased risk of type-2 diabetes, in comparison to those in the lowest quartile [RR 2.93 (95%CI 1.62-5.28) P< 0.001; RR 3.30 (95%CI 1.78-6.14) P= 0.001, respectively], independently of age, physical activity, smoking, and BMI.

Conclusions: LAP and neck circumference, highly correlated with visceral adipose tissue, were associated to type-2 diabetes among hypertensive women with overweight; BAI (an overall adiposity index) was associated with type-2 diabetes among men.

010EFFECTS OF FTO RS9939906 AND MC4R RS17782313 ON OBESITY, TYPE 2 DIABETES MELLITUS AND BLOOD PRESSURE IN PATIENTS WITH HYPERTENSIONAline Marcadenti1, Flavio Danni Fuchs1,2, Úrsula Matte3, Fernanda Sperb3, Leila Beltrami Moreira1,2, Sandra Costa Fuchs1,2

1Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil; 2Division of Cardiology, HCPA, and IATS, Porto Alegre, RS, Brazil; 3Center for Gene Therapy, HCPA, Porto Alegre, RS, Brazil.

Background: FTO rs9939609 A/T and MC4R rs17782313 C/T SNPs have been associated with overall obesity in general population, and associations with type-2 diabetes are not clear. Individuals with mutations in MC4R gene have lower levels of blood pressure, independently of obesity.

Objectives: To investigate the association between FTO rs9939609, MC4R rs17782313 polymorphisms with anthropometric indicators, blood pressure and type-2 diabetes mellitus among hypertensive patients.

Methods: 217 individuals (86 men and 131 women) with hypertension (systolic and/or diastolic blood pressure ≥ 140/90 mmHg or use of lowering BP agents) were genotyped [TaqMan-based assays (Applied Biosystems Inc., Foster City, CA)]. Type-2 diabetes was diagnosed according to the American Diabetic Association. Weight (kg), height (m), waist, hip and neck circumferences (cm) were measured and body mass index (BMI, kg/m2) was calculated. BAI (%) was evaluated according to formula: hip (cm) / [height (m)1.5]-18. Data were expressed as mean ± SD or frequencies (%). Analysis of covariance models (ANCOVA) and modified Poisson’s regression were used to analyze associations with genotype, blood pressure and type-2diabetes.

Results: Mean age of all participants was 59.8 ± 11.2 years, systolic blood pressure 152.1 ± 20.6 mmHg and diastolic blood pressure of 87.7 ± 13.0 mmHg. Prevalence of type-2 diabetes mellitus was 44.7%. Rare allele frequencies were 0.40 for A for FTO rs9939609 and 0.18 for C for MC4R rs17782313 (Hardy-Weinberg equilibrium P= 0.8 for both). After adjustment for age and BMI, risk allele C for MC4R was associated with type-2 diabetes in women [RR 1.5 (95% CI 1.1 – 2.2); P= 0.03]. We found a positive effect of FTO rs9939609 on neck circumference among men and women and on BAI among women; MC4R rs17782313 has a positive effect on neck among women. In contrast, we found a negative effect of MC4R rs17782313 on systolic (TT 154.2 ±20.3, TC/CC 144.2 ±20.3; P= 0.05) and diastolic (TT 90.1 ±12.2, TC/CC 83.2 ±12.1; P= 0.03) blood pressure in men, independently of age and BMI.

Conclusions: Common genetic variants in FTO and MC4R have positive effects on obesity and type-2 diabetes mellitus and a negative one over blood pressure among patients with hypertension.

011ASSOCIATION BETWEEN SMOKING AND OBESITY IN THE ELDERLY OF PUBLIC HEALTH CARE SYSTEM OF SOUTHERN BRAZILCamila Bittencourt Jacondino1, Maria Gabriela Valle Gottlieb1, Vera Elizabeth Closs1, Laura Rosemberg1, Irenio Gomes da Silva Filho1, Carla Helena Augustin Schwanke1.1Institute of Geriatrics and Gerontology: PUCRS, Porto Alegre - RS - Brazil.

Introduction: Cigarette smoking is the most modifiable cardiovascular risk factors, previous studies show that cigarette, increasing insulin resistance, thus increasing cardiovascular risk. Objective: Investigate the association between smoking, insulin levels, anthropometric and biochemical variables.

Methods: Cross-sectional study with 348 elderly (individuals over the age of 60 years) treated in the Brazilian Primary Health Care System. To obtain data on the lifestyle, and smoking, a questionnaire was given general information with demographic data, to obtain anthropometric measures were verified waist circumference (CC) establishes the following points cutoff man or equal to ≥ 102 cm and women ≥ or equal to 88 cm according to the Guidelines for Metabolic Syndrome, and body mass index (BMI), and the bridges cut for underweight and overweight, respectively, BMI below 22kg / m2 and above 27kg/m2 biochemical variables studied total cholesterol, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), triglycerides, glucose and insulin.

Results: The sample consisted of 134 (38.5%) men and 214 (61.5%) women, mean age 69.19 ± 6.8. Of the total sample, 75 (21.6%) were current smokers and 273 (78.4%) were non-smokers or had stopped smoking. No association was found between smoking and sex (p = 0.286). The mean insulin levels of elderly smokers was 7.27 ± 8.442 and nonsmokers was 13.80 ± 24.083, where there was no statistically significant difference between groups (p = 0.066), as well as the association between smoking and biochemical variables, no significant associations were found between p> 0.005. The statistically significant associations is given in the correlations between body mass index and smoking (smokers = 26.18 ± 5.277; nonsmokers or former smokers = 29.15 ± 5.333) and CC (smokers = 91.80 ± 11.681; nonsmokers or former smoking = 97.37 ± 11.511), p <0.001.

Conclusion: The results show that elderly smokers on average have a lower body mass index, and waist circumference than seniors who do not smoke. These data suggest that smoking may perhaps be associated with a higher risk of nutrition disturbances in the elderly.

012EFFECTS OF A FLAVONOID-RICH DIET ON OXIDATIVE STRESS, INFLAMMATION AND LIPID PROFILE AFTER CORONARY ANGIOPLASTY WITH STENT PLACEMENT: CLINICAL TRIAL Magda Ambros Cammerer1, Sandro Cadaval Gonçalves2, Michael Everton Andrades2,3, Amanda Lopes3, Marco Vugman Waisntein1,2

1Programa de Pós-graduação em Ciências Cardiovasculares: UFRGS; 2HCPA; 3Centro de Pesquisa Experimental.

Background: Intake of antioxidant-rich foods may decrease oxidative stress and have a direct impact on atherosclerosis by reducing oxidized LDL.

Objectives: To assess the impact of a flavonoid-rich diet on oxidative stress, inflammatory response, and lipid profile in patients with cardiovascular disease after coronary angioplasty and stent placement.

Methods: Thirty-three patients who had undergone coronary angioplasty with stent placement were randomly allocated to follow a control diet (based on NCEP III recommendations) or an antioxidant diet (AOX) food sources rich in flavonoids, for 6 months. Dietary intake was recorded at the start, at 3 months, and at the end of the follow-up period, as were oxidative stress (FRAP and protein sulphydril) levels and markers of inflammation (C-reactive protein), weight, waist circumference, Body Mass Index (BMI), total cholesterol, HDL cholesterol and LDL cholesterol.

Results: Dietary guidance led to a reduction in energy, carbohydrate, and lipid intake in the AOX group, as well as increased flavonoid intake. There were no changes in oxidative stress markers (FRAP and total sulfhydryl) or C-reactive protein in the AOX group, but there was a significant decrease in LDL cholesterol levels as compared with those of the control group considered the follow-up time (time*group interaction P = 0.046).

Conclusion: The findings of this study suggest that a flavonoid-based, antioxidant-rich diet is not associated with reductions in oxidative stress or inflammatory markers after coronary angioplasty with stent placement, despite improvements in lipid profile.

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013HEALTH CARE DEMAND INDUCED BY MEDICAL EVALUATION PRIOR TO SUPERVISED EXERCISE PROGRAMEduardo Miguel Kühr1, Carisi Anne Polanczyk2,3

1UFRGS- HCPA; 2IATS, Porto Alegre, Brasil; 3Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Medical evaluation is usually recommended among pre-participation screening strategies for risk stratification of adverse events during exercise, but there are limited information about induced health care demand of this intervention.

Objectives: Describe the impact of pre-participation medical evaluation in a supervised exercise program admission in inducing additional health care demand as interdisciplinary consult referrals.

Design: Cross-sectional study into secondary database analysis. Methods: We analyzed 6,254 pre-participation medical evaluations conducted from 2008 to 2012 among healthcare private plan users in a supervised exercise program of a cardiac rehabilitation center facility. Subjects were included into 4 different exercise programs (phase II to IV cardiac rehabilitation, pulmonary rehabilitation and supervised exercise program) according to their risk profile established in the pre-participation evaluation. Additional health care demands as nutritional, psychological and physiotherapy consults referrals were also described in this pre-participation medical evaluation results. We used chi-square test for association analysis.

Results: In phase II cardiac rehabilitation 276 (4,4%) subjects were allocated; 969 (15.5%) started exercise program in cardiac rehabilitation phase III; 2,475 (39.5%) in phase IV and 2,544 (40.6%) were addressed for supervised exercise program (SEP). For nutrition, psychology and physiotherapy consults were referred 1,578 (25.2%), 357 (5.7%) and 831 (13.3%) of subjects assessed, respectively. Individuals allocated in high-risk for adverse events as phase II group had higher rates of physiotherapy referrals (54.0% versus 17.1% of phase III, 14.1% of phase IV and 6.5% of SEP, p<0,05). But for nutritional and psychological referrals, the phase IV group, with lower risk of adverse events had higher demand as 32 % nutritional and 8 % psychological consults versus respectively 22.7% and 4.9% in phase III group (p<0.05).

Conclusions: Users allocated into exercise programs with higher supervision had higher demand for physiotherapy referrals, but not for nutritional and psychological consults. Patients allocated into lower supervision exercise programs groups, with multiple cardiac risk factors but without established chronic diseases were identified as with greater demand for health care on nutritional and psychological care.

014PREDICTORS OF STROKE IN PATIENTS UNDERGOING CARDIAC SURGERYRaupp-da-Rosa P, MD1,2; Santos HN, ScD1; Magedanz EH, ScD1; Santos NN, AN1; Albuquerque LC, PhD1;Goldani MA, MD1,3,; Petracco JB, MD ScD1, Guaragna JCVC, ScD1,4 , Bodanese JC, MD ScD1.1Post Operatory Cardiac Surgery Program, Cardiology Division, Hospital São Lucas - PUCRS; 2Post-Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, UFRGS; 3Chief of Cardiovascular Surgery Division, Hospital São Lucas - PUCRS; 4Chief of Cardiology Division, Hospital São Lucas - PUCRS.

Background: Given the disease burden of strokes, prevention is an important public health concern because of its high morbimortality index. To determine the risk factors related to the development of stroke in patients undergoing cardiac surgery.

Methods: We conducted a longitudinal cohort study in 4626 adult patients who underwent coronary bypass surgery (CABG), heart valve replacement surgery alone or combined with CABG between January 1996 and December 2011 at Hospital São Lucas. Logistic Regression was used to assess the effect.

Results: The incidence of stroke was 3% in our study. After logistic regression the following predictors for stroke were found: age superior to 66 years old (OR=3.22), urgency and emergency surgery (OR=2.03), aortic valve disease (OR=2.32), atrial fibrillation (OR=1.88), peripheral artery disease (OR=1.81), history of previous stroke (OR=3.42) and cardiopulmonary bypass time>110 minutes (OR=1.71). We found that the most important modifiable risk factors for stroke are related with the surgery as urgency and emergency surgery and cardiopulomary by-pass time.

Conclusion: Cerebral vascular accident seems to be one of the worst complications of cardiac surgery and many are the predictors of this event. Knowing the risk factors could help to diminish the incidence of stroke at cardiac surgery population.

015ACUTE AND LONG TERM USE OF SILDENAFIL IN HEART FAILURE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALSRaupp-da-Rosa P, MD1; Almeida ED, MD1; Ziegelman PK, PhD2; Goldraich LA, MD1, Beck-da-Silva L, MD, ScD1; Clausell N, MD PhD1,3; Rohde LE, MD ScD1,3; Biolo A, MD ScD1,3.1Heart Failure and Cardiac Transplant Program, Cardiology Division, HCPA; 2Department of Statistics, UFRGS; 3Post-Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, UFRGS.

Background: Sildenafil is a selective inhibitor of type 5 phosphodiesterase (PDE5) with favorable hemodynamic effects in patients with heart failure. However, evidence of benefit is limited to small size studies.

Methods and Results: We conducted a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) of sildenafil therapy in patients with heart failure. A systematic search was realized by two independent reviewers using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (1966-2012), and reports from scientific meetings (2005-2012). Reviewers determined methodological quality of studies and extracted descriptive and outcome data. Nine RCTs enrolling 262 patients with heart failure were included. Compared to placebo, sildenafil therapy resulted in significant improvements in systolic pulmonary arterial pressure (PAP) (-10.58 mmHg, 95% CI -11.22 to -9.93, p<0.001), LV ejection fraction (+2.30%, 95% CI 1.73 to 2.88, p<0.001), peak VO2 (+3.48 ml.kg−1.min−1, 95% CI 2.90 to 4.06, p<0.001) and the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope), (-5.02, 95% CI -5.93 to -4.10, p<0.001). Subgroup analysis showed a time-dependent improvement in systolic PAP and VE/VCO2 slope, both more pronounced with long-term treatment. Finally, pooled analysis showed a significant reduction in all-cause hospitalizations with sildenafil treatment (RR 0.27, 95% CI 0.11 to 0.67, p=0.005).

Conclusions: Sildenafil use appears to have benefits on reducing pulmonary hypertension and improving left ventricular and exercise performance in patients with stable heart failure. Pooled data also showed a benefit on reducing hospitalizations. Adequately powered RCTs are needed to evaluate its role on heart failure survival.

016STUDY OF HEART RATE, BLOOD PRESSURE AND DOUBLE-PRODUCT IN CONTINUOUS AEROBIC AND COUNTER-RESISTANCE EXERCISES OF INTELLECTUALLY DISABLED INDIVIDUALS

Marinei Lopes Pedralli1, Regina Schmidt Lotthammer1

1ULBRA, Department of Physical Education, Adapted Motor Activity Program, Torres, RS, Brazil.

Introduction: Double-Product (DP) is an indirect predictor of myocardial O2 consumption, consisting of cardiovascular risk in exercise. Objective: To correlate systolic (SBP) and diastolic (DBP) blood pressure, Heart Rate (HR) and DP during Counter-resistance (CR) and Moderate Intensity Aerobic (MIA) dynamic exercises in Intellectually Disabled individuals (ID) in a non-syndromic framework.

Methods: A sample of 14 subjects of both genders, aged 14 to 20 years, all volunteers, after signing the TCI (Protocol No. 484H-2010) performed strength tests with 1-RM, 6RM and 20RM (knee extension) and submaximal aerobic (20min, 75-80% HR reserve). CR measures were recorded between the two last repetitions. For MIA (time = 5, 10, 15 and 20 min) we used ANOVA, post-hoc Scheffé (p ≤ .05).

Results: HR increased with exercise compared to rest (p ≤ .01). At rest, the average was 97bpm while, at 6RM and 20RM, it was 107bpm and 133bpm respectively. At the times measured, aerobic activity was: 154, 167, 169 and 172bpm. SBP was significantly different in the 20RM exercises and aerobic activity, compared to rest (p ≤ .01). 1RM and 6RM exercises did not show any significant difference. Mean resting SBP was 122mmHg; at 1Rm it was 131mmHg, 6RM (137mmHg) and 20RM (158mmHg). At MIA, the SBP was 173, 188, 188 and 189mmHg. No significant variation was observed in DBP. At rest, DP was 9132; at 1RM it was 12709; at 6RM, 14663; and at 20RM, 20997. In the aerobic activity, the time values were 26706, 31250, 31740, and 31812. We found that the demand imposed on the myocardium, when compared to CR and MIA exercises, is significantly different at the aerobic activity (p ≤ 0.01). DP stabilizes after the first 5 minutes of aerobic activity (p ≤ .05).

Conclusion: a) resistance exercises, regardless of intensity, have imposed lower cardiac demand than aerobic activity; b) DP in resistance exercises was more strongly associated with repetitions than with intensity, whereas intensity proved to be more important than the duration of the activity in aerobic exercises.

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017SLEEP DURATION AND MORTALITY IN THE ELDERLY: A SYSTEMATIC REVIEW AND META-ANALYSISAndressa Alves da Silva1, Camila Wohlgemuth Schaan2, Renato Gorga Bandeira de Mello2, Flávio D. Fuchs2,3, Sandra C. Fuchs2,3

1Postgraduate Studies Program in Epidemiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil, 2Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil, 3HCPA, Division of Cardiology, and IATS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Increasing evidence suggests an association between both short and long duration of habitual sleep with adverse health outcomes. Although sleep problems are prevalent among the elderly, the association between sleep duration and mortality in this population is scarcely described to date.

Objective: To summarize the evidence from population-based longitudinal data about the association between either short or long sleep duration and mortality in elderly individuals.

Methods: Cohort studies published between 1980 and 2011, without language restriction, were independently identified by two reviewers, in PubMed, Embase, LILACS, and IBECS electronic databases. Unpublished studies were identified in the Brazilian electronic database of PhD theses and Master’s dissertations (CAPES). Eligible studies met all the following criteria: (a) participants: age greater or equal 60 years; (b) exposures: assessment of sleep duration as 24-hour, nighttime and daytime sleep; (c) outcomes: evaluation of all-cause and cause-specific mortality; (d) design: population-based cohort studies, conducted on representative samples. Data were extracted serially in a standardized manner and analyzed using random effect models in the second version of the Comprehensive Meta-AnalysisTM software. Heterogeneity and consistency were evaluated through Cochran’s Q and the I2 statistics, respectively. We also conducted sensitivity analyses and assessed publication bias.

Results: Overall, 17 cohort studies were selected, comprising 44,522 elderly individuals, followed-up for 5 to 35 years. Sleep duration was assessed by questionnaire and outcomes through death certificate. In a pooled analysis, long sleep duration was associated with increased all-cause mortality (RR: 1.36; 95%CI 1.21-1.52), compared to the reference category (seven hours in most of the studies), with moderate heterogeneity among studies (I2 = 67.6%). Short sleep duration and daytime sleep duration greater or equal two hours were not associated with all-cause mortality (RR: 1.07; 95%CI 0.99-1.14 and RR: 1.34; 95%CI 0.95-1.90, respectively). For cardiovascular mortality, the pooled RRs were 1.25 (95%CI 0.73-2.16) for short sleep, and 1.33 (95%CI 0.95-1.79) for long sleep.

Conclusions: Long sleep duration is a predictor of mortality in elderly individuals, but short and daytime sleep duration were not.

018RELATION BETWEEN BIOMECHANICS AND METABOLIC PARAMETERS IN GAIT IN HEART FAILURE: PRELIMINARY RESULTSRenata L. Bona, MSc1,2, Paula Figueiredo da Silva, MSc1,2, Artur Bonezi, MSc3, Jorge Storniolo3, Marcela Sanseverino3, Ruy Silveira Moraes, MD, ScD 1, Leonardo Alexandre Peyre Tartaruga, MD, ScD3, , Nadine O. Clausell, MD, ScD 2,3,

1Exercise Pathophysiology Research Laboratory, HCPA, Porto Alegre, Rio Grande do Sul, Brazil; 2Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; 3Postgraduate Program in sciences of human movement, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Heart failure is a syndrome with high incidence and poor prognosis, characterized by fatigue, dyspnea and exercise limitation. Some interventions may minimize these symptoms, such as exercise training and rehabilitation programs, improving quality of heart failure patients. However, there are no studies analyzing the relationships in this population.

Aim: The purpose of this study was to provide preliminary results comparing biomechanical and metabolic parameters of gait from patients with chronic heart failure (CHF) to healthy controls.

Methods: Patients and controls were matched for age and sex. Maximal incremental test was performed to determine peak oxygen uptake (VO2 peak). Walking stability, evaluated by co-contraction in stance phase using Electromyography (EMG) and cost of transport (C) were evaluated during 5 randomized walking speeds including self select walking speed (SSWS), 40% and 20% below SSWS, and 20%, and 40% above SSWS.

Results: CHF due to left ventricular dysfunction (1 female and 2 males, EF= 25±7 %, mass 69±12 kg, height 161±16 cm, VO2 peak 24,03±7 ml.kg-1.min-1, C at SSWS 4.01 ±0.6 J.kg-1.m-1); control group: 1 female and 2 males, mass 67±5 kg, height 169±13cm, VO2 peak 38.06±7 ml.kg-1.min-1, C at SSWS 2.5 ±0.1 J.kg-1.m-1). The speed correspondent to the lowest C was identified at SSWS (controls 2.96 J.kg-1.m-1, CHF 4.61 J.kg-1.m-1, p=0.03) in controls, and at 40% above SSWS (controls 2.98 J.kg-1.m-1, CHF 3.53 J.kg-1.m-1, p=0.05) in CHF. CHF patients had more co-contraction between anterior tibialis (TA) vs lateral gastrocnemius (GL), and rectus femoris (RF) vs biceps femoris (BF) than controls (TA X GL controls 22.8%, CHF 45.87% p= 0.001; RF X BF controls 38.9%, CHF 49.27% p= 0.001). Co-contraction was lower at speed 40% above SSWS in CFH (p=0.03) and at SSWS in controls (p=0.02).

Discussion: According to the literature, controls present higher walking economy at intermediate speeds (4 – 5 km.h-1). As expected, CHF patients presented a higher walking economy above their SSWS. The major finding is that, the percentual of co-contraction in CHF patients was higher at speed with lower walking economy.

019PHYSICAL ACTIVITY INTERVENTIONS FOR CHILDHOOD OBESITY: META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS Claudia Ciceri Cesa1, Graciele Sbruzzi1,2 , Rodrigo Antonini Ribeiro3, Sandra Mari Barbiero1, Rosemary de Oliveira Petkowicz1, Bruna Eibel1, Natássia Bigolin Machado1,4, Renata das Virgens Marques1,4, Gabriela Tortato1,4, Tiago Jerônimo dos Santos1, Carina Leiria1, Beatriz D’Agord Schaan1,5, Lucia Campos Pellanda1,4

1Instituto de Cardiologia do Rio Grande do Sul / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil; 2UFRGS, School of Physical Education, Porto Alegre, Rio Grande do Sul, Brazil; 3Hospital Moinhos de Vento, Institute of Education and Research, Porto Alegre, Rio Grande do Sul, Brazil; 4UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil; 5Endocrine Division, HCPA, Medical School, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Effectiveness of physical activity interventions to prevent or treat obesity and other cardiovascular risk factors in childhood remains unclear.

Objectives: Through a systematic review and meta-analysis of randomized clinical trials (RCTs), the objective of this review is to assess the effects of physical activity interventions in preventing or treating obesity and other cardiovascular risk factors in childhood.

Methods: A search of online databases (PubMed, EMBASE and Cochrane CENTRAL) and published studies was conducted from inception until July 2012, with no language restrictions. RCTs enrolling children 6-12 years old conducted physical activity interventions longer than 6 months, assessing their effect on body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), total cholesterol (TC) and triglycerides (TG). Data analysis was performed using a random-effects model.

Results: Of 20 480 articles retrieved, 11 RCTs (10 748 subjects) were included. Physical activity interventions were not associated with reductions of BMI when compared to no intervention or less intensive interventions [-0.03kg/m2 (95%CI -0.16, 0.13) I2 0%]. However, there was an association between the interventions and reduction of SBP [-1.25 mmHg (95%CI -2.47, -0.02) I2 0%], DBP [-1.34mmHg (95%CI -2.57, -0.11) I2 43%] and TG [-0.09mmol/L (95%CI -0.14, -0.04) I2 0%], and increase of TC [0.14mmol/L (95%CI 0.01, 0.27) I2 0%].

Conclusions: As physical activity intervention programs lasting longer than 6 months are associated with reductions in blood pressure levels and triglycerides, they should be considered to be included in prevention programs for cardiovascular diseases in schoolchildren.

020IMPACT OF ANKLE-BRACHIAL INDEX SCREENING ON HYPERTENSIVE PATIENTS’ RISK ASSESSMENT Jeruza L Neyeloff, MD, PhD 1,2,; Leila B Moreira, MD, PhD 1, 3; Luciano P Marcelino 4; Miguel Gus, MD, PhD 1, 3; Gerson Nunes, MD, MSc 3; Sandra C P C Fuchs, MD, PhD 1, 3; Flavio D Fuchs, MD, PhD 1, 3.1Graduate Program of Cardiology, UFRGS, Brazil; ²HTANALYZE, Rio Grande do Sul, Brazil; 3HCPA, UFRGS, Brazil; 4 School of Medicine, UFRGS, Brazil.

Introduction: Lower extremity peripheral artery disease (PAD) is strongly associated with increased cardiovascular risk. Screening patients using the ankle brachial index could identify higher risk patients and lead to prescription changes. Previous studies suggested that calculating the ABI using the lower of the ankle pressures instead of the higher could improve sensitivity, with little loss to specificity. Objective: We sought to determine the prevalence of PAD in a hypertensive population, and assess impact on statin prescription. Methods: A random sample of patients from a reference hypertension outpatient clinic was selected and had ABI measured by two trained examiners. ABI was calculated considering both the higher (HAP) and lower (LAP) ankle pressures. In a subset of patients the ABI was performed by both examiners to assess agreement. Results: 222 patients were included in the study (85.6% of those invited to participate). Most participants were females (71.7%), with a mean age of 64 ± 11.2. Prevalence of PAD was 14.9% (10.8% – 19.0%) considering HAP and 33.8% (28.3% – 39.3%) considering LAP. Agreement was satisfactory by all assessments. Among the subset of patients eligible for risk reassessment, 6.5% would change prescription after ABI screening considering HAP (2.25% of the total sample). However, using the LAP calculation, 29.9% would change prescription (10.4% of the total sample). A summary of our findings is depicted in figure 1. Conclusions: PAD prevalence is high among hypertensive patients. Screening this population with the ABI can lead to significant change in care, particularly if the lower ankle pressure is considered.

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021METABOLIC SYNDROME AND ALCOHOL CONSUMPTION IN POSTMENOPAUSAL WOMEN TREATED AT A CLINIC IN SOUTHERN BRAZILAna Paula Dullius¹, Karina Giane Mendes², Heloísa Theodoro³, Maria Teresa A. Olinto4

¹Curso de Especialização em Nutrição Clínica, UCS, Caxias do Sul, RS, Brasil; ²Curso de Nutrição / Especialização em Atenção Integral à Saúde da Mulher, UCS, Caxias do Sul, RS, Brasil. Programa de Pós-Graduação em Ciências Médicas: Endocrinologia. UFRGS, Porto Alegre, RS, Brasil; ³Programa de Pós Graduação em Saúde Coletiva, UNISINOS, São Leopoldo, RS, Brasil. Curso de Nutrição, UCS, Caxias do Sul, RS, Brasil; 4Programa de Pós Graduação em Saúde Coletiva, UNISINOS, São Leopoldo, RS, Brasil. UFCSPA. Porto Alegre, RS, Brasil.

Background: In the last two decades, the combination of obesity, hypertension, dyslipidemia and hyperglycemia and increased alcohol consumption has become a major risk factor for the occurrence of premature deaths and disabilities in the world, among them cardiovascular disease.

Objective: To investigate the metabolic syndrome and its components relating to the consumption of alcohol.

Methods: We conducted a cross-sectional study with women 40-65 years seen in outpatient Menopause and Gynecological Surgery during the period January 2010 to May 2011. MS was evaluated by each of its components: waist circumference, blood pressure, blood glucose, serum HDL-cholesterol and triglycerides. To assess alcohol consumption among women interviewed, was asked if she consumed alcohol.

Results: Alcohol consumption was more frequent in those with 40-45 years (37.3%), unmarried (34.2%) had a family income of more than 5 minimum wages (40.5%), normal weight (41 1%) without abdominal obesity (38.9%) and without metabolic syndrome (36.4%). multivariate analysis, it is observed that with increasing age, decreased alcohol consumption. Being married was associated with lower alcohol consumption when compared to the unmarried. There was a direct relationship between income and alcohol consumption. The consumption of alcohol presents itself as a protective factor for obesity.

Conclusion: The results of this study suggest that light alcohol consumption is associated with a lower risk of developing obesity. However, alcohol consumption is directly associated with other pathologies, and the protective effect of obesity does not overcome the risks that the consumption of it can provide.

022INDEPENDENT IMPACT OF DIABETES ON MORTALITY OF PATIENTS TREATED IN A HOSPITAL BASED COHORT IN SOUTHERN BRAZILGuilherme Watte1,2, Juvenal Soares Dias–da–Costa1, Maria Teresa Anselmo Olinto1, Vera Maria Vieira Paniz1, Ruth Liane Henn1.1Post-Graduation Program in Collective Health, UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil; 2Post-Graduation Program in Chest Medicine Sciences, UFRGS, Porto Alegre, Brazil.

Background: Cardiovascular diseases are the leading causes of death and hospitalization in diabetics in the world.

Objectives: To evaluate the independent impact from diabetes on mortality in a group of patients followed up to six months.

Methods: This is a prospective cohort study among patients with more than 30 years with acute coronary syndrome or cerebrovascular disease who fulfilled the criteria for inclusion and were selected in a south Brazilian hospital. The analysis consisted of distribution of measurements, analysis of independent variable on the presence of diabetes, and testing of Cox regression model agreement.

Results: The diabetes prevalence was 29,7% (CI95%: 25,2 – 34,1). Thirty-six (8,7%; CI95%: 6,0 – 11,5) among 411 individuals died during 180 days. A mortality risk three times higher was found among diabetic patients (HR: 2,99; CI95%: 1,51 – 5,92; p=0,001), adjusted for age, smoking, statins and acetylsalicylic acid use, intensive care unit admission rate. The analysis model evidenced Harrell`s C: 82,2% (CI95%: 74,99 – 89,88; p<0,001), Somers’ D: 64,4% (CI95%: 47,68 – 76,59; p<0,001).

Conclusions: These data suggest the obvious importance of diabetes control strategies and reinforcers effective for this studied population.

023HOSPITALIZATIONS FOR DISEASES OF THE CIRCULATORY SYSTEM IN THE STATE OF RIO GRANDE DO SUL, BRAZIL (1998 – 2007)Guilherme Watte123a, Juvenal Soares Dias–da–Costa1, Jose da Silva Moreira2, Luiz Carlos Severo23, Roberto Guidotti Tonietto2, Flavio de Mattos Oliveira3, Gabriela Roncato4, Juliana Watte5.1Post-Graduation Program in Collective Health, UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil; 2Post-Graduation Program in Chest Medicine Sciences, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; 3Mycology Laboratory, Santa Casa Sisters of Mercy Hospital, Porto Alegre, Rio Grande do Sul, Brazil; 4Programa de Pos-Graduação em Ciências da Saúde, UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil; 5Department of Dentistry, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: The main cause of mortality in the world today are diseases of the circulatory system leading this group of individuals to a high number of hospitalizations.

Objectives: To compare the rates of hospitalizations for diseases of the circulatory system (DCS) in the districts headquarters of coordinating health of Rio Grande do Sul, in the period between 1998 and 2007, reflecting the effectiveness of primary care in disease management.

Methods: Ecological study of hospitalization rates for DCS in individuals of both sexes of all ages. The rates were analyzed using Poisson regression coefficients with robust variance (PR: 1,02, CI95%: 1,01 – 1,03).

Results: Most municipalities had increased rates of hospitalization for cardiovascular diseases, as well causing the increase in the rates confirmed, irrespective the mode of management structure of healthcare counties.

Conclusions: The data show high rates of hospitalization for DCS in all the cities, revealing low effect upon the changes of life and the need to higher qualification in the primary care level.

024PHYSICAL ACTIVITY OR STRUCTURED EXERCISE TRAINING AND ASSOCIATION WITH BLOOD PRESSURE IN TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSISFelipe V. Cureau, MSc 1, Franciele R. Figueira, MSc 1,2, Daniel Umpierre, ScD 2, Alessandra T. N. Zucatti, MSc 2, Mériane B. Dalzochio, PED 1, Cristiane B. Leitão, MD, ScD 1 and Beatriz D. Schaan, MD, ScD 1,3,4

1Postgraduate Program in Health Sciences: Endocrinology, and 2Exercise Pathophysiology Research Laboratory, UFRGS, HCPA, Porto Alegre, Brazil; 3Endocrinology Division, and 4Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Hypertension is a common comorbidity of type 2 diabetes. Regular exercise improves blood pressure (BP) levels in general population, but the association of different exercise training interventions or physical activity advice (PA) on BP in patients with diabetes is unclear.

Objective: To conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing association of exercise training regimens (aerobic, (AER), resistance, (RES), or both, (combined) and PA on changes in BP levels in type 2 diabetic patients.

Methods: A search was conducted in MEDLINE, Cochrane CENTRAL, EMBASE, ClinicalTrials.gov and LILACS databases from January 1980 through April 2013. Independent reviewers conducted data extraction of RCTs of ³8 weeks consisting of structured exercise or PA vs. no intervention that reported BP changes in type 2 diabetic patients.

Results: Forty RCTs of structured exercise (n=1255) and 21 of PA (n=3805) were included. Overall, structured exercise was associated with a decline in systolic BP (SBP) (-4.11mmHg; CI95%: -5.75, -2.74; I2, 86.7%) and diastolic BP (DBP) (-2.07mmHg; CI95%: -3.01, -1.13; I2, 86.8%) vs. controls. Aerobic training (SBP: -4.57mmHg; CI95%:-6.90, -2.25; I2, 80.3%; DBP: -2.06mmHg; CI95%: -3.28, -0.84; I2, 73.9%), and RES training (SBP: -4.44mmHg; CI95%: -6.75, -2.11; I2, 55.7%; DBP: -2.84mmHg; CI95%: -3.88, -1.81; I2, 30.3%) were associated with declines in BP vs. controls. Combined training was not associated with BP changes. Structured exercise for more than 150min/wk (SBP: -6.80mmHg) was associated with greater BP reductions than lower exercise volumes. Previous diagnosis of hypertension was associated with greater BP lowering effect by AER and RES. Overall, PA were associated with reduction on BP (SBP: -2.97mmHg; CI95%: -4.52, -1.43; I2, 79.5%; DBP: -1.41mmHg; CI95%: -1.94, -0.88; I2, 27.0%) vs. controls. Heterogeneity was explained by body mass index change and weekly exercise volume (AER), by baseline SBP and aerobic weekly exercise volume (combined), and by baseline SBP and intensive advice (PA).

Conclusions: AER and RES exercise training are associated with BP reduction in patients with type 2 diabetes, especially if more than 150min/wk is performed, and if BP is high at baseline. Physical activity is associated with decline in BP.

Support: CAPES, CNPq.

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025BIOELECTRICAL IMPEDANCE VECTOR ANALYSIS IN ACUTE DECOMPENSATED HEART FAILUREFernanda Donner Alves1, Gabriela Corrêa Souza2, Graziella Badin Aliti3, Eneida Rejane Rabelo3, Luis Eduardo Rohde2,4, Nadine Clausell2,4, Andréia Biolo2,4

1Post-Graduate Program on Cardiovascular Sciences, UFRGS, Porto Alegre, Brazil; 2Department of Internal Medicine, UFRGS, Porto Alegre, Brazil; 3School of Nursing, UFRGS, Porto Alegre, Brazil; 4 Division of Cardiology, HCPA, Brazil.

Background: Acute decompensated heart failure (ADHF) is associated with important changes in hydration status. Bioelectrical impedance vector analysis (BIVA) might be useful method for the assessment of congestion and nutritional status in these conditions.

Objectives: The purpose of this study was to evaluate variations in BIVA during hospitalization for ADHF and in clinical stability (after 3 months).

Methods: Patients admitted to ADHF were evaluated at admission, discharge and after clinical stability for dyspnea, weight, brain natriuretic peptide (BNP) and bioelectrical impedance parameters: resistance and reactance (BIVA).

Results: Fifty-seven patients were included: mean age was 61 ± 13, 65% male, LVEF was 25 ± 8% and 48% had ischemic etiology. During hospitalization, the average weight loss was -5.7 ± 5 kg and there was a significant reduction in dyspnea and BNP (p<0.05). There was an increase in BIVA parameters: resistance and reactance (p<0.001). Neither clinical nor BIVA parameters changed between discharge and chronic stability. BIVA reflected the changes in hydration status in the 3 moments (proportion of patients with over-hydration: 65% at admission, 21% at discharge, 33% at clinical stability).

Conclusions: The BIVA method was able to detect significant changes in hydration status during episodes of ADHF, which paralleled clinical course of recompensation, both acutely and chronically.

026MEASUREMENT OF THE AORTIC ROOT USING CARDIOVASCULAR MAGNETIC RESONANCE IMAGING IN PATIENTS WITH A BICUSPID AORTIC VALVEFelipe S. Torres, MD 1,2, Jonathan D. Windram, MRCP 3, Timothy J. Bradley, MBCHB 4, Bernd J. Wintersperger, MD 1,5, Ravi Menezes, PHD 1, Andrew M. Crean, MD 1,3, Jack M. Colman, MD 3, Candice K. Silversides, MD 3, Rachel M. Wald, MD 1,3,4

1Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada; 2Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil; 3Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; 4Division of Pediatric Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; 5Department of Clinical Radiology, University Hospitals Munich, Ludwig-Maximilians-University Munich, Munich, Germany.

Background: Aortic root asymmetry is commonly seen in patients with a bicuspid aortic valve (BAV). Range of possible aortic root measurements provided by cardiovascular magnetic resonance imaging (CMR) and the reproducibility of these in the BAV population have not been well studied. Objectives: To compare CMR measurements with standard echocardiographic measurement and to evaluate the impact of aortic root asymmetry on the relationship between these modalities. Methods: Steady-state free-precession cine images from 68 consecutive patients (65% male) with BAV were retrospectively analyzed. Maximal cross-sectional aortic root measurements at the level of the sinuses of Valsalva using CMR, in systole and diastole, were made and included cusp-commissure diameters, cusp-cusp diameters and aortic root areas. Intra and inter-reader reproducibility of CMR measurements were calculated using the intra-class correlation coefficient. The degree of aortic root asymmetry on CMR was expressed using the coefficient of variance of the root diameters in each dimension for an individual (CoeffVi) as compared with the median of the entire population (CoeffVp). Asymmetry of the aortic root was defined as CoeffVi > CoeffVp. Values obtained from CMR were compared with standard root measurements using transthoracic echocardiography (TTE) from contemporary studies (48 patients, 71%) using t-test and Bland-Altman plots. Results: CMR measures of aortic root diameters were found to have excellent intra-reader (intra-class correlation coefficient [ICC] ≥0.98) and moderate inter-reader (ICC range 0.37-0.95) reproducibility. However, aortic root areas yielded the most reproducible results (inter/intra-reader ICC ≥0.94). Despite reasonable agreement between CMR and TTE, echocardiography systematically underestimated aortic root dimensions (systematic error 1-3.9 mm) in comparison with CMR. The greatest offset occurred in asymmetric roots with cusp-cusp measurements made in systole (systematic error 4.9 mm). Best agreement between modalities existed in symmetric roots with cusp-commissure measurements made in diastole (systematic error -0.01 mm). Conclusions: CMR-derived aortic root diameters are reproducible and the aortic root area has the best reproducibility within and between readers. Standard echocardiography consistently underestimates maximum aortic root diameter in adults with a bicuspid aortic valve, and aortic root asymmetry further decreases the agreement between CMR and TTE measurements.

027MINIMUM OXYGEN SATURATION, BUT NOT TIME IN HYPOXIA PREDICT BLOOD PRESSURE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEACintia Zappe Fiori, MSc1; Camila Gosenheimer Righi, MSc1; Emerson Martins, MSc1; Roberto Pacheco da Silva, MSc1; Fernando Pellisoli, MSc1; Débora Simões, MSc2; Carolina Caruccio Montanari3; Micheli Fagundes4; Gabriela Raimann5; Denis Martinez, MD PhD1,2,6

1Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Porto Alegre, RS, Brazil; 2Graduate Program in Medical Sciences, UFRGS, Porto Alegre, RS, Brazil; 3Undergraduate Program in Nursing, UFCSPA, Porto Alegre, RS, Brazil; 4Undergraduate Program in Biology, ULBRA, Porto Alegre, RS, Brazil; 5Undergraduate Program in Medicine, UFRGS, Porto Alegre, RS, Brazil; 6Cardiology Division, HCPA, Porto Alegre, RS, Brazil.

Background: One of the possible mechanisms for obstructive sleep apnea (OSA) to cause hypertension is the cyclic hypoxia and arousals, leading to repeated blood pressure surges. The intermittent hypoxia leads to endothelial oxidative stress, which may explain arteriolar remodelling. In the polysomnography the severity of OSA is measured by the apnea-hypopnea index (AHI) and the degree of hypoxia is usually assessed by minimum arterial oxygen saturation (SaO2min) or percent of total sleep time with SaO2 below 90% (ST<90). The remodeling of arteriolar media may lead to fixed hypertension. The AHI reflects the frequency of repetitions of vasoconstriction and the severity of hypoxia, reflects the mechanical and oxidative load that will, eventually, cause arteriolar hypertrophy.

Objective: To test the hypothesis that patients with longer periods of hypoxia have higher blood pressure levels.

Methods: We included a total of 5724 patients with ages between 18 and 60 years, of both genders, who underwent baseline polysomnography in a sleep clinic. They were grouped according with the AHI severity in non-OSA (AHI < 5; n= 1539), mild-moderate OSA (AHI 5-30; n= 2667), and severe OSA (AHI > 30; n= 1518). Regression models to predict systolic blood pressure, using natural log of AHI, SaO2min, and ST90 as regressors were attempted for each severity category.

Results: In the regression model to predict systolic blood pressure in the non-OSA group (n= 1539) only the AHI is significant. In the mild-moderate OSA group, AHI and SaO2min are significant. In the severe OSA group, all three regressors are significant, being the beta for ST90 (0.09; P= 0.008) larger than for SaO2min (-0.06; P= 0.048). In the non-OSA group, none of the individuals has a ST90 greater than zero. In the mild-moderate OSA group, 1619 (61%) had a ST90 greater than zero, in the severe group, 1450 (96%). Therefore, ST90 is strategic to predict OSA outcomes only in the severe group.

Conclusions: Only in severe OSA, the duration of the hypoxia is a stronger predictor of systolic blood pressure than the minimum saturation. This may have implications in the pathogenesis of vascular remodelling and hypertension.

028STUDY OF FEASIBILITY OF RENAL SYMPATHETIC DENERVATION WITH IRRIGATED CATHETER IN THE TREATMENT OF RESISTANT HYPERTENSION: REPORT OF A INITIAL EXPERIENCERodrigo V. Wainstein1, Leandro Zimerman1, Miguel Gus1, Sandro C. Gonçalves1, Gustavo G. Szortyka1, Luis Carlos Bergoli1, Maurício Pimentel1, Flávio D. Fuchs1 e Marco V. Wainstein1

1Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Porto Alegre, RS, Brazil.

Introduction: Despite significant advances in the treatment of hypertension, a significant proportion of patients has resistant hypertension, defined as systolic blood pressure ≥ 160 mmHg (≥ 150mmHg in diabetic patients) in the use of at least three antihypertensive one being a diuretic. Renal sympathetic denervation is emerging as a promising therapy for resistant hypertension. The Simplicity 2 was a randomized clinical trial that compared renal denervation using a device specially developed for the procedure versus standard therapy in patients with resistant hypertension and showed a reduction of 32 mmHg in systolic and 12 mmHg in diastolic blood pressure at 6 months. The aim of this study is to demonstrate the feasibility of renal sympathetic denervation with an irrigated catheter. Material and

Methods: Prospective experimental study. Patients with resistant hypertension followed at the outpatient hypertension clinic of the Hospital de Clinicas de Porto Alegre. Patients with secondary hypertension were excluded. Patients undergo ABPM before the procedure and 6 months after. The procedure was performed with irrigated electrophysiology catheter (Cordis). Follow-up with measurement of blood pressure, serum creatinine and electrolytes was performed monthly until the sixth month after the procedure.

Results: 6 patients underwent the procedure (5 women and 1 man). The procedure did not present technical difficulties and lasted less than 90 minutes in all cases. Mean age was 54 years and mean body mass index of 29kg/m2. Patients were taking an average of 6.5 antihypertensive drugs at study entry. ABPM pre-procedure demonstrated mean systolic blood pressure of 154mmHg and diastolic blood pressure of 90mmHg. ABPM post-procedure was performed in 3 patients and demonstrated mean systolic blood pressure of 159 mmHg and mean diastolic blood pressure of 88mmHg. There was no significant change in the number of antihypertensive drugs, renal function or electrolytes. There was a complication associated with the procedure (occlusion of a sub-branch of the left renal artery, which was corrected with stenting), without any repercussion on renal function.

Conclusion: The procedure proved to be technically feasible and without deleterious effects on renal function. With the completion of the planned series, it shall initiate the randomized clinical trial.

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029BLOOD PRESSURE-LOWERING EFFECT OF CPAP IN PATIENTS WITH RESISTANT HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA: PRELIMINARY RESULTS OF A RANDOMIZED CONTROLLED TRIALAna Claudia Tonelli de Oliveira1, Daniela Massierer1, Denis Martinez1, Flávio Danni Fuchs1

1Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Porto Alegre, RS, Brazil.

Background: Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. Obstructive sleep apnea (OSA) is the most common condition associated with resistant hypertension. It is unknown if continuous positive airway pressure (CPAP), the main treatment of OSA, improve blood pressure (BP) control in these patients. Objectives: To assess the effect of CPAP on 24 hour ambulatory BP monitoring values in patients with truly resistant hypertension and OSA. Methods: This is a double blind, randomised, placebo controlled trial of 46 consecutive patients with resistant hypertension, defined as uncontrolled BP despite the concurrent use of 3 or more antihypertensive agents, including a diuretic, with adherence to treatment and without white phenomenon. All participants should have a diagnosis of OSA, defined by AHI > 15 in a portable monitoring sleep exam. Patients were assigned to therapeutic CPAP (n=22) or placebo CPAP (n = 22) for two months. The main outcome was changes in 24 hour ambulatory blood pressure monitoring values from baseline to two months of therapeutic CPAP or placebo CPAP. Results: Most patients were men (58%); with a mean age of 59.3 ± 7,8 years, a BMI of 29.9 ±4.4 and AHI of 27 ±13.9. Characteristics of participants were similar at baseline. Compared with placebo and analyzed by intention to treat, the mean 24 hour blood pressure monitoring measures are shown in table 1. Conclusions: The results of this ongoing clinical trial show that there is a trend for BP control with the use of CPAP in patients with resistant hypertension.

030ASSESMENT OF THE SYSTEMIC ARTERIAL HYPERTENSION AND OTHER CARDIOVASCULAR RISK FACTORS IN A POOR COMUNITY IN PORTO ALEGRE, SOUTHERN BRAZIL Eduardo Antoniolli¹, Andre Guzzon1, Marli Boniatti Colle2

¹HCPA, UFRGS, Porto Alegre, Brasil; 2ESF Osmar Freitas, UFRGS, Porto Alegre, Brasil.

Background: Systemic Arterial Hypertension (SAH) is largely neglected in our primary health care system. SAH and other cardiovascular risk factors are responsible for X% of the deaths in our country, but do not receive neither the attention nor the necessary resources for prevention and treatment.

Objectives: Our goal was to measure cardiovascular risk in a low-income community in Porto Alegre city. Meanwhile, we indicated the patients whom arterial blood pressure was greater than 140/90mmHg or with high cardiovascular risk to medical care.

Methods: A questionnaire was applied to 167 individuals in ESF Osmar Freitas community. We recorded cardiovascular risk factors and two blood pressure (BP) readings: 5min of rest before first measurement and 10min interval until the second. We conducted the interviews in the patient’s home in the company of health agents. Data were analyzed with SPSS 19.0.

Results: Thirty-eight respondents (22%) already had a diagnosis of hypertension and were on drug therapy - only 20 presented with a mean BP<140/90mmHg -, showing the ineffectiveness of the treatment. In one hundred twenty-nine non-hypertensive individuals, 36 (27.9%) presented a mean BP>140/90mmHg and were referred for evaluation at ESF Osmar Freitas. Hypertensive patients who already had a diagnosis added to those whom our study investigated, amounted to 74 (44%) hypertensive individuals, a value close to that expected for the age group studied.

Conclusion: Hypertension, a cardiovascular mortality factor, is far from receiving the necessary attention to early diagnosis and appropriate treatment.

031CIRCUIT WEIGHT TRAINING IMPROVES BLOOD PRESSURE LEVELS: A RANDOMIZED TRIALRafael Cechet1,3, Marcelo Dias Camargo1,3, Ricardo Stein1,2,3

1Exercise Cardiology Research Laboratory, HCPA, Porto Alegre, Rio Grande do Sul, Brazil; 2Cardiology Division, HCPA, Porto Alegre, Rio Grande do Sul, Brazil; 3Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Circuit weight training (CWT) increases maximal oxygen consumption (peak). In view of the causal relation between blood pressure (BP) and aerobic training (AET), there is the possibility that CWT promotes a reduction of the BP indexes similar to that observed with AET.

Objective: To evaluate the alterations in the blood pressure caused by CWT in normotensive, sedentary and without apparent disease subjects.

Methods: This is a randomized clinical trial (RCT) that evaluated 20 normotensive men aged 30 ± 5 years, sedentary, divided into 3 groups: control (n=7), AET (n=6) and CWT (n=7) for 12 weeks. Clinical evaluations were performed before and after the intervention period.

Results: Decrease of systolic BP (SBP) in the AET group (122 ± 2 to 116 ± 2 mmHg) and CWT (124 ± 4 to 117 ± 2 mmHg) vs. control (121 ± 2 to 120 ± 2 mmHg), (p<0.05). There were no differences for diastolic blood pressure (DBP) between the groups. Increased by 12% at peak (p<0.05) with AET and CWT, but there was no change in control.

Conclusions: The CWT was effective in reducing SBP and had the same magnitude presented by those randomized to AET. The findings of this RCT suggest that in previously sedentary men without apparent disease, both the CWT and the AET can reduce SBP, as well as increase the peak.

3º lugar

032HOME BLOOD PRESSURE MONITORING IS BETTER PREDICTOR OF CARDIOVASCULAR OUTCOMES THAN OFFICE BLOOD PRESSURE: A SYSTEMATIC REVIEW AND META-ANALYSISSandra C. Fuchs, MD, PhD1,2, Renato G. B. de Mello, MD, PhD1, Felipe C. Fuchs, MD, PhD3 1Postgraduate Studies Program in Cardiology, School of Medicine, UFRGS, Porto Alegre, RS, Brazil; 2IATS, HCPA, Porto Alegre, RS, Brazil; 3Division of Cardiology, University Health Network / Mount Sinai Hospital, University of Toronto, ON, Canada.

Background: Blood pressure (BP) has been measured in the physician’s office by mercury or aneroid sphygmomanometers. However, home BP monitoring (HBPM) allows getting more readings and provides lower BP levels than office blood pressure (OBP) measurements. When interpreted together with OBP or ambulatory BP monitoring, HBPM permits the detection of the white-coat effect and masked hypertension. Available evidence, albeit rare, indicates the superiority of HBPM vs. OBP to predict cardiovascular (CV) outcomes. However, studies assessed several clinical outcomes and some did not reach statistical power. Therefore, a summary estimate updating previous meta-analyses can be useful.

Objective:To update the evidence of HBPM vs. OBP as predictors of CV outcomes, including articles published from 2012 to 2013.

Methods: We performed a systematic review with meta-analysis to assess the efficacy of HBPM vs. OBP as predictors of all-cause mortality, CV death, and target organ damage. Two reviewers independently performed the literature search in various databases. A meta-analysis with a fixed-effect model was conducted, and the heterogeneity and inconsistency indices were assessed.

Results: The search identified 291 articles, of which 10 were eligible and five articles published in 2012 were included in the meta-analysis. There was no substantial change in the correlation coefficient between left ventricular mass index (LVMI) and HBPM than those coefficients previously detected. HBPM was better correlated with LVMI than OBP as well as proteinuria with HBPM (r=0.31) versus OBP (r=0.19). Another article showed a 22% increase in the risk of silent cerebrovascular disease per one standard deviation increase of systolic BP measured at home, but the risk for OBP was not significant. A previous meta-analysis summarized data from mostly recent and some older articles, showing the superiority of HBPM over OBP to predict all-cause mortality, CV mortality, and CV events. Another systematic review evaluated target organ damage and left ventricular mass index (LVMI) demonstrating that HBPM was better correlated with LVMI than OBP. Moreover, proteinuria was significantly correlated with HBPM but not with OBP.

Conclusion: The results of our meta-analysis confirm that HBPM is a better predictor of CV outcomes and target organ damage than OBP.

Table 1: Adjusted diferences between BP change according to the treatment assignedPressure Group Baseline Follow up Difference Between Groups (CI 95%), Adjusted* PSBP 24h CPAP(22) 151.0 ± 19.0 140.9 ± 20.4 -7.5 0.15 Placebo(22) 146.2 ± 18.0 144.6 ± 24.1DBP 24h CPAP (22) 89.2 ± 13.1 83.2 ± 14.1 -4.6 0.10 Placebo(22) 88.6 ± 13.1 87.0 ± 17.1Daytime SBP CPAP(22) 154.9 ± 144.7 ± 22.2 -6.8 0.21 Placebo(22) 21.3 148.9 ± 19.5 147.0 ± 22.4Daytime DBP CPAP(22) 92.4 ± 14.6 86.3 ± 15.7 -5.5 0.07 Placebo(22) 90.6 ± 14.7 89.2 ± 16.1Night time SBP CPAP(22) 142.2 ± 16.4 132.0 ± 19.4 -6.8 0.22 Placebo(22) 138.1 ± 12.4 136.3 ± 21.3Night time DBP CPAP(22) 82.3 ± 10.3 76.2 ± 12.8 -4.2 0.28 Placebo(22) 81.9 ± 10.9 79.9 ± 16.1* ANCOVA adjusted for correspondent baseline BP and time used CPAP or Placebo CPAP.

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033MEDICAL VERSUS MULTIPROFESSIONAL CARE IN AN OUTPATIENT CLINIC FOR DYSLIPIDEMIC PATIENTS: A RANDOMIZED CONTROLLED TRIALCosta AF1, Eizerik DP1, Chiaradia V1, Ziegelmann P2, Moriguchi EH3, Picon PD3.1Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, UFRGS, Porto Alegre, RS, Brasil; 2Professora de Estatística da UFRGS e do Programa de Pós-Graduação em Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares; 3Professores de Medicina da UFRGS e do Programa de Pós-Graduação em Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares.

Background: Although statin treatment for dyslipidemia is well established and there are strong evidences for the prevention of cardiovascular events, the rates of statin use and lipid control are still low. Although some studies suggest that multiprofessional approach may be more effective in increasing patients’ adhesion to treatment, studies in this area are controversial.

Objectives: This study compared the differences of results between a multiprofessional approach vs. traditional medical assistance in a specialized outpatient clinic for dyslipidemia. The primary objective was to evaluate the lipid and glicemic control of patients undergoing in one or other approach. Secondary objectives included health related quality of life and incidence of clinical events in the different settings.

Methods: High cardiovascular risk patients with dyslipidemia were randomized to standard medical care or multiprofessional care including physician, nutritionist and / or pharmacist. The primary outcome was change in lipid and glucose control. We also assessed the variation of the Framingham risk score and quality of life with WHOQOL-bref.

Results: 44 patients were allocated to medical care and 85 for multiprofessional care. Although we have not observed significant differences in total cholesterol, LDL and non-HDL cholesterol, the multiprofessional group showed better performance for HDL cholesterol (increase of 1 mg/dl versus decrease of 2 mg/dl, P = 0.013), triglycerides (decrease of 17 mg/dL versus increase of 24 mg/dl, P = 0.02), glycated hemoglobin (decrease of 0.6% versus 0.3% increase, P = 0.029), weight (reduction of 0.4 kg versus an increase of 1.4 kg, P = 0.021) and BMI (decrease of 0.1 versus increase of 0.5). There was also improvement in the psychological and environmental domains of Whoqol-bref quality of life questionnaire.

Conclusions: The results of this study demonstrate a benefit in laboratory outcomes (HDL, triglycerides and glycated hemoglobin) as well as quality of life. The effect size can be considered clinically relevant, requiring an analysis of cost-effectiveness to assess the feasibility of implementing such a strategy in public health.

034RECOMMENDED USE OF DRUGS IN SECONDARY PREVENTION OF ACUTE CORONARY SYNDROMEMari Ângela Gaedke1, Rosângela Uebel2, Marcelo Felipe Nunes2, Monique Motta2, Juvenal Soares Dias da Costa2, Maria Teresa Anselmo Olinto2, Euler Roberto Fernandes Manenti3

1Programa de Pós-Graduação em Saúde Coletiva, UNISINOS, São Leopoldo, Rio Grande do Sul, Brasil; 2Programa de Pós-Graduação em Saúde Coletiva, UNISINOS, São Leopoldo, Rio Grande do Sul, Brasil; 3Instituto de Medicina Vascular do Hospital Mãe de Deus - Porto Alegre, Rio Grande do Sul, Brasil.

The objective of the study was to determine a prevalence of drugs recommended for the secondary prevention of Acute Coronary Syndrome in patient discharge and follow-up of a six months and one year period. We used data from a cohort study which included patients 30 years old or older, of both genders, discharged of hospital in southern Brazil. The outcome was the simultaneous use of drugs recommended by scientific evidence for secondary prevention: antiplatelet agents, beta-blocker, statin and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Among the 138 people included in the study, 36.2% (CI 95% 28.2 to 44.3) were prescribed the four drugs simultaneously at discharge. When comparing the follow-up periods there were no differences observed in the prevalence of use. However when investigating who kept the use in all the follow-ups, it was possible to observe that around 50% of patients kept the use during the follow-up periods, resulting in a poor adherence to the recommended treatment. On the other hand, among those who during discharge weren’t prescribed the four groups of medicine, it was verified in the two analyzed periods that about 30% of patients began using the recommended therapy, justifying the maintenance of prevalence around 36%. The most commonly prescribed group of medication during discharge was antiplatelets (91.3%). There were no differences observed in the prevalence of the use of each drug separately throughout the follow-ups, except for antiplatelets, which showed a significant decrease in use between discharge and the follow-up periods, both in relation to the use of acetylsalicylic acid, P2Y12 receptor inhibitor or double blockage, contradicting the recommendations established by the guidelines. The prevalence of simultaneous use drugs, both discharge and in the follow-ups, pointed to an under-utilization of this therapy in clinical practice. Most studies conducted on this subject have shown this same situation. The study showed the obstacles that seem to exist between the evidences and the effectiveness of these treatments in clinical practice, we emphasize that intervention strategies are needed to improve the quality of care provided to patients that should extend beyond the hospital discharge, a critical transition point in patient care.

035INCIDENCE OF COMPLICATIONS OF ACUTE CORONARY SYNDROME IN A COHORT STUDYRosângela Uebel1, Mari Ângela Gaedke2, Cícero Weber2, Marcelo Felipe Nunes2, Monique Motta2, Juvenal Soares Dias da Costa2, Maria Teresa Anselmo Olinto2

1Programa de Pós-Graduação em Saúde Coletiva, UNISINOS, São Leopoldo, Rio Grande do Sul, Brasil; 2Programa de Pós-Graduação em Saúde Coletiva, UNISINOS, São Leopoldo, Rio Grande do Sul, Brasil.

Introduction: Patients that have shown consequences of atherothrombosis, such as myocardial ischemia, have got a great risk of developing manifestations on another vascular layer, such as stroke. The components of the Acute Coronary Syndrome are among the main death causes and are of relevant prevalence. We point out the reinfarction, heart failure and the possibility of a cerebrovascular diseases among complications of the Acute Coronary Syndrome, which means, serious diseases that may cause death.

Goal: Describing the incidence of complications on the Acute Coronary Syndrome in a Cohort Study.

Methodology: We have developed a Cohort Study with thirty-year-old-or-older patients of both sexes, diagnosed with Acute Coronary Syndrome and cerebrovascular disease in Porto Alegre (RS) Hospital. The patients were revisited in thirty days, in six months and in one year after hospital discharge. The information has been collected through phone interviews. We have tried to check the incidence of the main complications of Acute Coronary Syndrome in each follow-up. The chi-square for trend has been applied.

Results: We have included 479 individuals in entrance. The incidence rate of death due to diseases on circulatory system was 1461.4 for 100000 before hospital discharge; 1511.9 within 30 days; 2888.9 within 6 months and 2836.9 within 1 year (chi-square for trend = 0,07). The incidence rate of stroke was 2.2 for 1000 within 30 days; 11.1 within 6 months and 26.0 within 1 year (chi-square for trends <0.01). The reinfarction rate at 6 months was 13.3 for 1000 and 16.5 for 1000 in 1 year. The incidence of heart insufficiency was 2.2 for 1000 at 30 days, 20.0 for 1000 at 6 months and 28.4 for 1000 at 1 year (p<0,001).

Discussion: We have noticed a growing increase on mortality for complications after Acute Cororonary Syndrome regarding the entrance and one-year follow-up. The inabilities generated by cardiovascular morbidities are an important Public Health problem and represent the highest costs in medical assistance. These data constitute the understanding for the need of implementation of secondary preventive measurements and of the quality of assistance given to a high magnitude and transcendence group of diseases.

036RISK PROFILE OF PATIENTS WITH ICD FOR PRIMARY PREVENTION IN A PUBLIC UNIVERSITARY HOSPITAL IN SOUTHERN BRAZILMaurício Pimentel1, Gabriel Bondar1, André Zimerman1, Adriano Nunes Kochi1, Geris Mazzutti1, Diego Chemello1, Leandro Zimerman1. 1Postgraduate Program in Cardiovascular Science, UFRGS, Cardiology Division, Hospital de Clínicas de Porto Alegre.

Background: Implantable cardioverter-defibrillator (ICD) is recommended for primary prevention of sudden cardiac death (SCD) in patients with cardiomiopathy and low ejection fraction (EF). Despite this recommendation, few patients receive this therapy in real clinical scenario, particularly in developing countries. Previous studies suggest that ICDs are particularly effective in certain subgroup of patients.

Objectives: The present study was designed to evaluate the risk profile of patients who underwent ICD implantation for primary prevention of SCD in a public teaching hospital.

Methods: Cross-sectional study including all patients who receive ICD for primary prevention in a public teaching hospital. The risk profile was defined based on a score model derived from the MADIT II trial. The score comprised 5 clinical factors: NYHA functional class > 2, age > 70 years, blood urea > 56mg/dl, QRS duration > 0.12 seconds and atrial fibrillation. Patients were classified as low risk (absence of clinical factors), intermediate risk (1 or 2 clinical factors), and high risk (> 3 clinical factors).

Results: Ninety-nine patients were included in the study. The mean age was 61±12 years, and 78% were male. The mean EF was 33±16%, and ischemic heart disease was the cause of low EF in 46.5%. Based on clinical factors, 67 (67.5%) patients were classified as intermediate risk and 32 (32.5%) as high risk. No patients were classified as low risk. In comparison with intermediate risk group, high risk group had higher left ventricular end systolic diameter (60.6±11.7mm versus 50.8±14.2; p=0.001) and end diastolic diameter (70.2±9.6mm versus 62.2+11.1; p=0.001). The EF was lower in the high risk group (25±9% versus 37±17%, p<0.001). Regarding pharmacological treatment, 83% were on beta-blockers and 87% on angiotensin-converting enzyme inhibitors, with no statistical difference between groups.

Conclusion: In a public teaching hospital, patients who underwent ICD implantation for primary prevention of SCD had an intermediate risk profile. According to previous studies, the intermediate-risk patients are those who present the greatest survival benefit from ICD implantation. Our data probably indicates an adequate selection of patients for such high-cost treatment modality.

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Abstracts

037EFFECT OF DIACEREIN ON METABOLIC CONTROL AND ACUTE INFLAMMATORY PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES TREATED WITH ANTI-HYPERGLICEMIC DRUGS – A STUDY PROTOCOL FOR A RANDOMIZED CONTROLE TRIALTres GS1,2, Piovesan F1,2, Fuchs SCC1, HRK Lisboa2, Palma ME2, Fuchs FD1, Moreira LB1

1Postgraduate Program in Cardiovascular Science, UFRGS, Cardiology Division, Hospital de Clínicas de Porto Alegre; 2UPF, Passo Fundo, RS, Brazil.

Background: Inflammatory mediators have a role in the pathogenesis of obesity and insulin resistance. Adipocytes express pro-inflammatory cytokines such as TNF-α, IL-1β, IL6 causing β-cell apoptosis, decrease insulin secretion and increase resistance resulting in hyperglycemia. The IL-1 β has been a therapeutic target for preserving the β cell mass and its function. The Diacerein, used in the treatment of osteoarthritis, is a derivative of anthraquinon that inhibits IL-1 β and TNF-α and may be a new therapeutic option for type 2 diabetes mellitus (T2DM).

Objectives: To evaluate the effect of diacerein on glycemic control (fasting blood glucose, glycosylated hemoglobin (A1C)) and inflammatory mediators in patients with T2DM.

Methods: This placebo-controlled, double-blind, parallel group randomized clinical trial will include T2DM patients, ≥ 30 years old, A1C between 7.5% and 10%, treated with oral hypoglycemic drugs and /or insulin without micro \ macroalbuminuria and/or nephropathy. The exclusion criteria are use of pioglitazone, chronic inflammatory diseases, pancreatitis, liver disease, or hypersensitivity to rhein and anthraquinon derivatives, pregnancy and lactation. Patients will be randomly assigned (Random Allocation Software) to three groups: Group A: diacerein 50mg + placebo; Group B:diacerein 50mg + diacerein 50 mg and Group C : placebo + placebo in the morning and at night respectively. Follow up will be conducted in seven, 30, 60 and 90 days. For a delta in A1C of 1.5%, it was estimated that a sample of 23 subjects for each group would provide alpha of 0.05 and power of 80%. The study was approved by institutional review board and is funded by CNPq, receiving support from Passo Fundo University. Diacerein and placebo will be provided by TRB PHARMA.

Results: We identified 600 potentially eligible patients from outpatient clinic of the Medicine School (University of Passo Fundo). A pilot study was conducted to test instruments and aiming staff training. It is planned to include patients from August 2013 until January 2014.

Conclusion: We presented the study protocol for a randomized controlled trial aiming to test the effect of diacerein over metabvolic controls and inflammatory mediators in patients with DM2.

038GENE EXPRESSION STUDY OF IN-STENT RESTENOSIS THROUGH MRNA ANALYSIS OF CORONARY ATHEROMATOUS PLAQUES (GENESIS-R STUDY)Juliane S. Rossato1, Marco A. Costa2, Alcides J. Zago1, Bruno S. Matte1, German Iturry-Yamamoto1, Ricardo Savaris1, Mariano Albertal3, Cristiane S. Rocha4, Aileen M. Healy5, Russell Walker5, Tahara Satoko2, Daniel I. Simon2 Alexandre C. Zago1,2

1HCPA – UFRGS, Porto Alegre, RS, Brazil; 2UH Hospitals – Case Western University, Cleveland, OH, USA; 3Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentine; 4Campinas State University (Unicamp), Campinas, SP, Brazil; 5Millennium Pharmaceuticals, Cambridge, MA, USA.

Background: In-stent restenosis (ISR) is a poorly understood phenomenon that remains a challenge even in the drug eluting stent era. There is limited data about its genetic basis and practically null evaluating the link between de novo lesions and ISR. This study sought to identify overexpressed genes in human de novo coronary plaques in relation to ISR that may work as novel therapeutic targets.

Methods and Results: Forty de novo coronary atheromatous plaques were retrieved from patients with symptomatic obstructive coronary artery disease through directional atherectomy prior to bare-metal stent implantation. RNA profiling analysis of more than 22,000 genes was successfully performed in 28 of 40 samples using the Affymetrix GeneChip microarray system. All patients underwent intravascular ultrasound assessment at six-month follow-up for stent volumetric analysis. The correlation between gene expression of de novo coronary atheromatous plaque and in-stent neointimal volume was evaluated. Several overexpressed genes related to oxidative stress, inflammation, cell proliferation, and structure and function of smooth muscle cell were identified having correlation with in-stent neointimal volume.

Conclusion: De novo coronary lesions present several overexpressed genes associated to future in-stent neointimal proliferation emerging as novel therapeutic targets.

039RELIABILITY OF THE DIETARY SODIUM RESTRICTION QUESTIONNAIRE IN PATIENTS WITH HYPERTENSION Marcela Perdomo Rodrigues1, Eneida Rejane Rabelo-Silva1,2, Sandra Costa Fuchs1, 2, Flávio Danni Fuchs1, 2, Leila Beltrami Moreira1, 2

1Postgraduate Studies Program in Cardiology, UFRGS, Brazil; 2HCPA, Division of Cardiology, Porto Alegre, RS, Brazil.

Background: Dietary recommendations to reduce salt consumption are effective to control hypertension but difficult to follow. The Dietary Sodium Restriction Questionnaire was validated to evaluate the adherence to these recommendations among patients with heart failure. This questionnaire may be useful for patients with hypertension as well, but it was not evaluated in this context.

Objective: To evaluate the reliability of the Dietary Sodium Restriction Questionnaire (DSRQ) in patients with arterial hypertension.

Methods: This study was done with a convenience sample of patients with hypertension under care in the outpatient clinic of our Institution. The DSRQ has three subscales: attitude, subjective norm and perceived behavioral control. The reliability was evaluated by internal constancy of its items using the Cronbach’s alpha coefficient.

Results: 94 patients were included, with age between 41 and 80 years old, 73% women and with 7± 4 years of education in the average. Systolic blood pressure was 141± 24.5 mmHg and diastolic blood pressure 81± 13.2 mmHg. The Cronbach’s alpha coefficient for all the three subscales was 0.775; and for the subscales of attitude, subjective norm and perceived behavioral control was 0.748, 0.409 e 0.852, respectively. The item total correlation in the most items was over 0.30.

Conclusions: The Dietary Sodium Restriction Questionnaire is reliable to evaluate the attitudes, beliefs and barriers of patients with hypertension. The demonstration of its validity requires studies with direct determination of salt consumption.

040KNOWLEDGE OF RISK FACTORS FOR HYPERTENSION AMONG USERS OF PUBLIC PHARMACY IN SOUTHERN BRAZILFabiane Raquel Motter1, Vera Maria Vieira Paniz1 , Maria Teresa Anselmo de Olinto1Programa de Pós Graduação em Saúde Coletiva: UNISINOS, São Leopoldo, Rio Grande do Sul, Brasil.

Background: Hypertension (HTN) is a chronic medical condition characterized by elevated and sustained levels of blood pressure (BP). It is known that patients’ knowledge of HTN risk factors can contribute to the control of BP, taking into consideration that some of them are modifiable.

Objective: To evaluate knowledge of risk factors for HTN in hypertensive patients and associated factors.

Method: Cross sectional study was carried out, with adults aged 20 years or older, who were using antihypertensive captopril dispensed by the Public Pharmacy of São Francisco de Paula/RS. The HTN was evaluated through a score (0-5) with questions about some of the risk factors for hypertension: excessive consumption of salt and alcoholic beverages, sedentarism, overweight and tobacco smoking. Multiple Linear Regression was to investigate the relationship between the patients’ knowledge and demographic, socio economic, behavioural, health and use of health services characteristics, adopting a significance level of p<0,05.

Results: 376 hypertensive patients were interviewed. 67,7% were women, 48,8% had up to four years of study and 33,8% were 65 years old or more. It was observed that three quarters of the patients were sedentary and half of them were overweight/ obese. The mean score of knowledge was 4,48 (DP=0,75). Lower age (p=0,003), higher schooling (p≤0,001) and better self-reported health (p=0,04) were associated with higher knowledge scores. Almost all of the interviewees (> 90%) responded correctly that tobacco smoking, overweight, excessive consumption of salt and alcoholic beverages can elevate BP levels, while a smaller proportion (75%) knew that regular physical activity is not a risk factor for HTN.

Conclusion: Patient´s knowledge of risk factors about HTN is elevated. However, high prevalence of sedentarism and overweight was observed, proving that knowledge is not enough for behavioural change. A higher score of knowledge was associated with younger and more educated people, revealing that strategies that are aiming to increase this knowledge should, above all, favour older and less educated patients. In general, the number of consultations was not associated to the score of knowledge, which shows the necessity of multi professional monitoring of these individuals by health professionals of basic attention.

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Abstracts

041PREDICTORS OF REHOSPITALIZATION IN PATIENTS WITH HEART FAILURE IN A TERTIARY PUBLIC HOSPITAL IN BRAZILAndré Wajner1,5, Fernando Starosta de Waldemar2,Eduardo de Oliveira Fernandes3, Janete Salles Brauner3, Ana Laura Didonet Moro4, Marcio Fernando Spagnól4, Fernanda Musa Aguiar4, Pedro Salomão Dias4, Carisi Anne Polanczyk5

1,2,3,4Internal Medicine Departament, Hospital Nossa Senhora, Porto Alegre, Rio Grande do Sul; 5Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Heart failure is the major cause of cardiovascular morbidity at hospitals. Despite its relevance, there are few studies on Latin America about predictors of rehospitalization in patients with heart failure.

Objective: Describe the characteristics of patients hospitalized with heart failure in a tertiary public hospital in Brazil and identify factors related to hospital readmissions and emergency visits in 30 days.

Methods: We conducted a historic cohort study using secondary data, which included 2070 hospitalized patients with heart failure identified by Charlson Comorbidity Index (CCI) in 2009 and 2010. We collected demographic data, performance measures and hospital outcomes.

Results: There was, on the whole sample, a high median CCI (5.0) and a long hospital stay (14 days), with 13% of hospital death rate and 8% of readmission. Cerebrovascular disease (RR:1,63; IC95%:1,12-2,36; p=0,01), a higher CCI (RR:1,09; IC95%:1,02-1,16; p=0,02) and a shorter length of stay (RR 0,95; IC95%:0,94-0,97; p<0,001). Readmissions and emergency visits in 30 days was higher in patients with an increased Charlson Comorbidity Index and lower in patients with an increased length of stay.

Conclusions: Hospitalized patients with HF in Brazilian public hospital setting have higher morbidity and mortality rates when compared to international literature. Shorter hospital stay and higher Charlson Comorbidity Index were predictors of hospital readmissions and emergency visits in 30 days.

042EFFECTS OF AEROBIC AND RESISTANCE EXERCISE ON VASCULAR REACTIVITY AND ENDOTHELIAL PROGENITOR CELLS IN PATIENTS WITH TYPE 1 DIABETES MELLITUSGustavo Waclawovsky1,2, Daniel Umpierre1,2, Franciele R. Figueira1,2

, Eliandra S. de Lima1, Laiana Schneider1, Letícia R. Bimbi1, Ana P. Alegretti3, Ursula S. Matte4, Ticiana C. Rodrigues5,9, Jorge P. Ribeiro1,2,6 (In Memoriam), Beatriz D. Schaan5,6.1Exercise Pathophysiology Research Laboratory, 2Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil, 3Department of Clinical Pathology, 4Molecular and Protein Analysis Unit, 5Division of Endocrinology and 6Cardiology of the HCPA.

Introduction: Circulating levels of endothelial progenitor cells (EPC) were shown to be a surrogate marker of endothelial function. Little is known about the effect of exercise on these variables in patients with type 1 diabetes mellitus (T1DM).

Objective: To evaluate the acute effect of aerobic exercise (AER) and resistance exercise (RES) on blood flow, reactive hyperemia, vascular resistance and release of EPCs in patients with T1DM.

Methods: Twelve patients with T1DM (30 ± 5 yrs, HbA1c 7.9 ± 0.8%) randomly performed 40 min of AER session (60% peak oxygen consumption, VO2peak) and RES session (60% one repetition maximum; 4x12 reps, 90-sec rest), on different days. Venous occlusion plethysmography (forearm blood flow, FBF and reactive hyperemia) was performed before and after the sessions. Venous blood was collected before and 10 minutes after the sessions for separation of the mononuclear cells (Ficoll-Hipaque). Endothelial progenitor cells were quantified by flow cytometry (CD34+/KDR+). International Physical Activity Questionnaire was used to assess the level of habitual physical activity and calculate energy expenditure of participants.

Statistics: Two-way ANOVA and Pearson correlation. Results: Forearm blood flow and vascular resistance were not changed by both exercise protocols (P=0.80; P=0.73, 2-way ANOVA). Reactive hyperemia increased by 30% after AER and 36% after RES (P<0.001); with no difference between the exercise protocols. There were no changes in the proportion of EPCs after AER (0.046 ± 0.081% vs. 0.046 ± 0.078%, P=0.12) and RES sessions (0.025 ± 0.043% vs. 0.023 ± 0.035%, P=0.14). Energy expenditure and VO2peak were not correlated with blood flow, vascular resistance and reactive hyperemia. Age was correlated with the response of reactive hyperemia after AER (r=0.61, p=0.03), but not after RES (r=0.39, P=0.21).

Conclusion: A single session of AER and RES increases reactive hyperemia, independently of changes in FBF and circulating EPCs in patients with T1DM. We underscore that such acute effects of lower-limb exercises may contribute to systemic vascular adaptation induced by regular exercise training. The unchanged number of EPCs after both exercise protocols might indicate an inability of the bone marrow to release more EPCs after an stimulus.

Support: CNPq, CAPES, FIPE, FAPERGS

043EFFECTS OF ABDOMINAL PRESSURE DYNAMICS ON MODULATION OF LOWER LIMB VENOUS RETURN IN HEALTHY SUBJECTS AND PATIENTS WITH HEART FAILUREFernanda M. Balzan, MSc1,2, Régis C. da Silva3, Angela M. V. Tavares, ScD 1, Danton P.S. Junior, MSc4, Paulo R. S. Sanches, ScD4, Nadine O. Clausell, MD, ScD 1,2

1Exercise Pathophysiology Research Laboratory, HCPA, Rio Grande do Sul, Porto Alegre, Brazil; 2Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; 3Postgraduated in Intensive Care Unit, Institute of Education and Research, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil; 4Department of Biomedical Engineering, HCPA, Porto Alegre, Rio Grande do Sul, Brazil.

Respiratory muscles have modulatory effects on lower limb venous return in healthy controls (CTRLs), it is unknown whether this exists in heart failure patients (HFpatients).

Aim: To assess effects of diaphragm breathing (DB) compared to ribcage breathing (RB) at rest (AR) and during knee-extension exercise (KEE) in femoral venous, arterial blood flow (Qfv,Qfa) and central hemodynamics in CTRLs and HFpatients.

Methods: In ten CTRLs and nine HFpatients, esophageal and gastric pressure (Pga) were evaluated to estimate intrathoracic and abdominal pressure. During RB, subjects inhaled using ribcage muscles (∆Pga ≤ 5 cmH2O), and DB (∆Pga ≥ 6 cmH2O). Qfv and Qfa were measured using ultrasound Doppler; Stroke Volume (SV) and Systemic Vascular Resistance (SVR) using impedance cardiography. Subjects alternated between RB and DB for 5-min periods AR and during low and moderate KEE. Randomized breathing was performed by reversing trial order.

Results: Qfv and SV in CTRLs were higher in DB than RB (Qfv=0.11±0.02; 0.06±0.008 L/min, P ≤ 0.05; SV=53±4; 45±4 ml, P ≤ 0.05). In HFpatients, Qfv and SV were not significant, but SVR was higher in DB than RB (SVR=2558±143; 2328±131 d.s/cm5, P ≤ 0.05). SV correlated with ∆Pga in DB CTRLs (r=0.93, P ≤ 0.05). Low KEE in CTRLs: increased Qfa in RB and DB compared to AR (Qfa= 0.26 ± 0.04; 0.08 ± 0.01 l/min, P ≤ 0.05; Qfa= 0.28 ± 0.1; 0.09 ± 0.02 l/min, P = 0.01), and SV in DB versus RB (SV=56.6±3.5; 49.5±4.5, P ≤ 0.05). Low KEE in HFpatients increased SV in RB versus DB (SV=51±4; 45.7±3.5, P ≤ 0.05), and correlated SV and ∆Pga (r=-0.76, P ≤ 0.05). Moderate KEE in HFpatients increased Qfa in DB (Qfa=0.29 ± 0.07; 0.17 ± 0.03 l/min, P ≤ 0.05). Qfv increased in DB versus RB (Qfv= 0.236 ± 0.7; 0.11 ± 0.04, P =0.05), SV increased in RB versus DB (SV=51±4.5; 45±4.5, P ≤ 0.05) and SVR increased in DB versus RB (SVR= 2041±141; 1837±77, P ≤ 0.05).

Conclusions: In CTRLs, modulatory effects on venous return depended on abdominal pressure dynamics. HFpatients showed lower SV and higher systemic vascular resistance during KEE and DB.

Support: FAPERGS, FIPE/HCPA and CAPES

044AUTONOMY IN PEDAGOGICAL ACTION: AN ESSAY ON METHODOLOGICAL ISSUES OF TEACHING-LEARNING AND TEACHER-RESEARCHER TRAINING IN HEALTH SCIENCESLopes, Carla P 1, Manfroi, Waldomiro C 2

1LaFiEX - Laboratory of Pathophysiology of Exercise: PhD Candidate at the Graduate Program in Cardiology and Cardiovascular Sciences (HCPA-UFRGS), Professor at ULBRA/RS, Brasil; 2PhD, Cardiology and Cardiovascular Sciences (UFRGS), Project Coordinator at the FAMED Graduate Program in Education and Health (UFRGS), Professor at HCPA-UFRGS, Brasil.

Background: Continuing education is based on four pillars: learning to know, learning to do, learning to live together and learning to be (Delors, Jacques; UNESCO Report: 1996). Discussing autonomous learning methods in operational situations that aim at teacher/student training in health-related degree courses in the XXI century is one of the current challenges of teaching and educational institutions.

Method: Advisory descriptive bibliography of current pedagogical actions, formatted as theoretical references on Health Sciences education and training, during multidisciplinary subject-matter studies in the FAMED-UFRGS Graduate Program in Cardiology and Cardiovascular Sciences.

Results: Underlying the baseline for pedagogical actions, one finds that learning to think or encouraging critical thinking on facilitating learning has its theoretical guidelines in the Brazilian law; however, on the surface, that is, operationally, mainstream education is traditional, and change depends upon a personal, experimental and / or institutional initiative. In the referred Program, qualitative methods, teaching techniques and interactive pedagogical actions stimulate questionings as well as interdisciplinary group and personal decisions in the search of problem-solving strategies.

Final Considerations: Recognizing students’ active role in promoting interactive pedagogical approaches in health, and institutionally organizing teaching / learning models that allow collaborative construction in situations involving multidisciplinary teams may primarily benefit teaching, and secondly benefit action building in clinical practice and research as well. Group questionings and problem-solving actions both in the classroom and in patient care rooms may foster the effective construction of a teaching program toward competence formation by encouraging learners’ autonomy.

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Abstracts

045KNOWLEDGE OF HYPERTENSION AMONG USERS OF ANTIHYPERTENSIVE MEDICINEFabiane Raquel Motter1, Vera Maria Vieira Paniz1, Maria Teresa Anselmo de Olinto1

1Programa de Pós Graduação em Saúde Coletiva: UNISINOS, São Leopoldo, Rio Grande do Sul, Brasil.

Background: Control of blood pressure (BP) in hypertensive patients is an important factor for the reduction of cardiovascular mortality. The literature reveals that knowledge about the target BP (systolic BP <140 mmHg and diastolic <90 mmHg) and that “high blood pressure (HBP) is a lifelong disease” can contribute to adherence to pharmacological treatment, therefore, to control the PA.

Objective: To evaluate the prevalence of knowledge about target BP and chronicity of hypertension in patients on antihypertensive treatment.

Method: A cross-sectional study was conducted in adults aged 20 years or older who were on antihypertensive treatment with Captopril, dispensed by the public pharmacy of San Francisco de Paula, RS, between November/2010 and February/2011. The outcome was categorized as individuals who did not know the aspects evaluated, those who knew one, and those who knew two or more. Multinomial regression was used in the analysis, considering the individuals who did not know, as the reference category, to assess the association between demographic, socioeconomic, behavioral, health and use of health services with knowledge. A P value <0.05 was considered statistically significant.

Results: In total, 376 respondents were users of Captopril, 67.7% were women, 48.8% had completed four years at school, and 33.8% were 65 years or older. Most hypertensive patients (80.6%) knew some of the aspects evaluated, 55.0% knew only one, while 2.7% met all three. In the total sample, 70% correctly answered that HTN is a chronic condition, while only a third knew at least one of the target values of BP. Being female, having higher education, the time of diagnosis and receive continuous medical attention were characteristics associated with knowledge.

Conclusion: Limited knowledge of target BP and HTN chronicity is of concern since these aspects are necessary for active participation of the patient in BP control, as well as to prevent lack of adherence or interruption of the drug treatment in order to achieve normal BP. Health team participation and awareness of the professionals regarding the importance and quality of information given to hypertensive patients about the BP target and chronicity of hypertension is fundamental.

046BLOOD PRESSURE VARIABILITY AND ITS ASSOCIATION WITH ECHOCARDIOGRAPHIC PARAMETERS IN HYPERTENSIVE DIABETIC PATIENTSDaniela Massierer1,3, Liana F. Leiria1, Mateus D. Severo2, Priscila D. Ledur2, Alexandre D. Becker2, Fernanda M. Aguiar4, Eliandra Lima2, Valéria C. Freitas1, Beatriz D. Schaan2,3, Miguel Gus1,3

1Cardiology Division, HCPA, Porto Alegre, Brazil; 2Endocrine Division, HCPA, Porto Alegre, Brazil; 3Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; 4UFCSPA, Porto Alegre, Brazil.

Background: Blood pressure (BP) variability changes are associated with target organ damage in hypertensive and diabetic patients. The gold standard methods to measure BP variability are not suitable for clinical practice, therefore, 24h ambulatory blood pressure monitoring (24-ABPM) had been proposed as a surrogate evaluation for BP variability through various indexes such as: standard deviation of mean BP (SD), coefficient of variation (CV), and more recently, BP variation over time (“time-rate” index).

Objectives: To evaluate the association between BP variability measured by different indexes of ABPM and echocardiographic variables in the evaluation of hypertensive diabetic patients. Methods: This was a cross-sectional study. Subjects were submitted to a clinical evaluation, 24-ABPM and echocardiography and then classified into two groups defined by the median (0.55 mmHg/min) of time-rate of systolic BP (SBP) and classified as low and high variability. Multiple linear regression models were used to evaluate the association between BP variables with echocardiographic variables.

Results: 305 patients were analyzed. Age was 57.3 ± 6.2 years, 196 (64.3%) were female. Diabetes duration was 10 (5.0- 16.2 years) and HbA1c was 8.2 ± 1.9%. No differences in baseline clinical characteristics were documented between low (n=148) and high (n=157) variability groups. Office SBP and systolic 24-ABPM were higher in the high variability group (139.9 mmHg vs 146.0 mmHg, p=0.006 and 128.3 mmHg vs 132.9 mmHg, P= 0.019, respectively). Time rate SBP index, SD and CV were higher in high variability group (P<0.001; P<0.001 and P=0.003, respectively). The echocardiographic measurements did not differ between groups. The time-rate index was not independently associated with the echocardiography’s variables in multiple linear model when adjusting for age, 24-ABPM, diabetes duration and HbA1c. Age was independently associated with all the echocardiographic parameters and 24-ABPM was independently associated with the left ventricular hypertrophy parameters (septum and posterior wall thickness; and relative wall thickness (RWT), defined as “septum + posterior wall thickness” divided by “left ventricular diastolic diameter”).

Conclusions: Blood pressure variability estimated by 24-ABPM is not independently associated with echocardiographic parameters in hypertensive diabetics patients.

Support: CNPq, FIPE, Fapergs

047ECONOMIC IMPACT OF VARYING STRATEGIES FOR DIAGNOSING HYPERTENSION IN THE PUBLIC HEALTH SYSTEMEduardo G. Bertoldi1, Izolete A. S. Dummel2, Rodrigo Ribeiro2, Carlos Alberto Machado3, Carisi A. Polanczyk1,2, Flávio D Fuchs1, Sandra C. Fuchs1,2

1Programa de Pós-Graduação em Ciências da Saúde - Cardiologia e Ciências Cardiovasculares, UFRGS, Porto Alegre, RS, Brazil; 2Programa de Pós-graduação em Epidemiologia, UFRGS, Porto Alegre, RS, Brazil; 3Disciplina de Cardiologia, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil.

Background: Hypertension, leading preventable cause of morbidity and mortality, requires blood pressure (BP) measurement using adequate technique, cutoff points, and classification. Objectives: To evaluate costs and effectiveness of hypertension diagnosis in the Brazilian Public Health System (PHS). Methods: Decision-analytic model with two strategies for diagnosing hypertension; the usual care was derived from a nationwide cross-sectional study, performed in a random sample of 50 centers, supported by the Brazilian Ministry of Health. It addressed BP measurement, availability of properly sized cuff and calibrated sphygmomanometers, and use of correct cutoff points to detect hypertension. The guideline-recommended strategy was defined as adherence to all recommendations. For each inadequacy in measurement and classification of hypertension, a 6% reduction in diagnostic effectivenesswas estimated. Results: Data on BP measurement and classification were obtained from 100 physicians and 93 nurses (Table 1). Correct classification of hypertension status was achieved in 82.3% of patients with the guideline-recommended strategy vs. 77.2% in the usual care strategy. Incremental cost-effectiveness ratio (ICER) was R$ 51.70 per correct diagnosis. In sensitivity analysis, cost of office visits and frequency of visits and measurements had the greatest impact on results, but even with wide parameter variation, ICER remained below R$ 100 per correct diagnosis. Conclusions: From the perspective of the Brazilian PHS, the modelled guideline-recommended strategy for diagnosis of hypertension yielded a very attractive cost per correct diagnosis. Widespread implementation of these simple measures would improve quality of care at affordable prices, and should be considered by decision-makers.

048LACK OF EXERCISE ENHANCES THE SEVERITY OF APNEA: A CASE-CONTROL STUDYRoberto Pacheco da Silva1, Fernando Pellisoli1, Cintia Zappe Fiori1, Camila Gosenheimer Righi1, Emerson Martins1, Débora Simões2, Pedro Lopez3, Micheli Fagundes4, Denis Martinez 1,2,5

1Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Brazil; 2Graduate Program in Medical Sciences, UFRGS, Brazil; 3Undergraduate Program in Nursing, UFRGS, Brazil; 4Undergraduate Program in Biology, ULBRA, Canoas, RS, Brazil; 5Cardiology Division, HCPA.

Background: An active life style is recommended to improve quality of life and health. Exercise is a simple, inexpensive, and safe way to reduce cardiac events and to improve sleep quality and duration. Sedentarism is associated with obstructive sleep apnea (OSA) severity. Increases in physical activity reduce the apnea-hipopnea index (AHI) in OSA patients.

Objective: The present study tested the hypothesis that the reported amount of exercise in patients with suspected sleep apnea predicts the OSA severity measured during the polysomnography.

Methods: After sample size calculation, 413 patients that underwent full-night, baseline polysomnography to assess suspected sleep apnea were prospectively interviewed. The physical activity level was graded as sedentary and regular activity. The AHI and the maximum, mean, and minimum oxygen saturation levels and the time with saturation below 90% were used as indices of OSA severity.

Results: The sample, aged 46±14 years, was constituted by 169 (41%) women. The mean AHI was 27±25 event/hour; the maximum saturation was 99%, the mean 96%, and the minimum 71%. The patients that reported sedentary habits (53%) were the cases and the ones who performed regular exercise were the controls. Of the controls, 66% undergo activity of moderate intensity and had significantly lower body weight (88±22 vs. 81±16 Kg; P=0.01), body mass index (31±7 vs. 29±10 Kg/m2; P=0.03), heart rate (84±15 vs. 81±14 bpm; P=0.04), and hip and neck circumference (104±16 vs. 97±14 cm; P<0.001, 40±6 vs. 39±4 cm P=0.009, respectively) than sedentary patients. The polysomnographic data for sedentary and regular exercise groups were similar: AHI (28±25 vs. 25±24 events/hour; P=0.2); minimum saturation (83±10 vs. 84±9%; P=0.2). Time with saturation below 90% was significantly lower in controls than in the sedentary group (25±52 vs. 15±29 minutes; P=0.02). In multiple regression analyses controlling for usual confounders, this difference did not remain significant.

Conclusion: A significant association was found between sedentarism and one index of OSA severity, but it is fully explained by gender, age, and body mass index.

Table 1. Frequency of guideline-recommended conducts encountered in the usual care strategyGuideline-recommended items FrequencyBP measured in every visit 99.5%Cuff size available – eutrophic adult 72.3%Cuff size available – obese adult 12.4%Annual calibration of sphygmomanometer 69.9%HTN cutoff used ≥ 140/90 mmHg 74.3%HTN defined with 2 measurements in at least 2 visits 85.9%BP = blood pressure; HTN = hypertension

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049DIAGNOSTIC PERFORMANCE OF THE STOP-BANG QUESTIONNAIRE IN HYPERTENSIVE AND NORMOTENSIVE PATIENTS: CROSS-SECTIONAL ANALYSIS IN SLEEP CLINICCamila Gosenheimer Righi¹, MSc; Cintia Zappe Fiori¹, MSc; Emerson Martins¹, MSc; Roberto Pacheco da Silva¹, MSc; Fernando Pellisoli¹, MSc; Débora Simões², MSc; Bárbara Peukert³; Pedro Lopez da Cruz4, Rodrigo da Rosa de Camargo5, Denis Martinez1, 2,6, MD, PhD.1Graduate Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil; 2Graduate Program in Medical Sciences, UFRGS, Porto Alegre, RS, Brazil; 3Graduate Program in Physiotherapy, IPA, Porto Alegre, RS, Brazil; 4Undergraduate Program in Nursing, UFRGS, Porto Alegre, RS, Brazil; 5Undergraduate Program in Medicine, UFRGS, Porto Alegre, RS, Brazil; 6Division of Cardiology, HCPA, Porto Alegre, RS, Brazil.

Background: Obstructive sleep apnea (OSA) is the most common cause of hypertension and of resistant hypertension. One criteria for assessing the risk for apnea in several questionnaires is the presence of hypertension. In the cardiology setting, however, the prevalence of hypertension may be so high as to invalidate this criterion. The STOP-BANG questionnaire is composed of eight items to identify the risk for apnea. The STOP items are: snoring (S), tiredness (T), observed apneas (O), and high blood pressure (P). The BANG items are: body mass index (BMI)> 35 kg/m² (B), age> 50 years (A), neck circumference (NC)> 40 centimeters (N), and male gender (G).

Objective: To test the diagnostic performance of the STOP-BANG in hypertensive as compared to normotensive patients using polysomnography (PSG) as gold standard.

Methods: Cross-sectional study of 1.721 patients of the both genders recruited in sleep clinic aged 18 to 84 years, with or without hypertension. OSA was categorized as present when the apnea-hypopnea index (AHI)>5 and as severe when AHI>30. The questionnaire STOP-BANG including and excluding the pressure item (STO-BANG) was tested using cut-points of 3 and 4 positive answers.

Results: The 681 cases with hypertension were 61% men, aged 53±14 years, with BMI 33±16 kg/m², NC 42±7 cm and AHI 27±28/hour. The 1040 normotensive patients were 62% men, aged 42±7 years, BMI 29±7 kg/m², NC 39±7 cm and AHI 19±21/hour. Excluding the item pressure (STO-BANG) always caused a small non-significant reduction of the diagnostic accuracy for AHI>5. Using the cut-point of 3 positive answers for the detection of AHI>5, in the 1721 patients, both versions of the questionnaire showed higher accuracy (74% and 73%) than when using the cut point of 4 (65% and 63%; P<0.0001). In hypertensive patients, using the cut-point of 4, the exclusion of the item pressure reduces the accuracy from 71% to 65% (P=0.02).

Conclusions: The fact of this population having a high pretest probability has inflated the accuracy of the STOP-BANG questionnaire. Nevertheless, with the standard cut point of 3 positive answers, it exhibits adequate performance for the screening of apnea risk (AHI>5) in both hypertensive and normotensive patients.

050IS THE ADHERENCE TO ANTIHYPERTENSIVE TREATMENT AFFECTED BY THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE?Camila Gosenheimer Righi¹, MSc; Cintia Zappe Fiori¹, MSc; Emerson Martins¹, MSc; Roberto Pacheco da Silva¹, MSc; Fernando Pellisoli¹, MSc; Débora Simões², MSc; Martina Madalena Pedroso ³; Carolina Caruccio Montanari4, Rodrigo Matias Freitas da Silva4 , Denis Martinez1, 2,5, MD, PhD.1Graduate Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil; 2Graduate Program in Medical Sciences, UFRGS, Porto Alegre, RS, Brazil; 3Graduate Program in Physiotherapy, UFSM, Santa Maria, RS, Brazil; 4Undergraduate Program in Nursing, UFCSPA, Porto Alegre, RS, Brazil; 5Division of Cardiology, HCPA, Porto Alegre, RS, Brazil.

Background: The knowledge about the determinants of adherence to antihypertensive treatment is controversial. Several reports associate the use of complementary and alternative medicine (CAM) by patients and poor levels of adherence to treatment, especially in the elderly and in those of African ethnicity.

Objective: To test the association of CAM with levels of adherence to treatment in hypertensive patients.

Methods: Cross-sectional study of 418 hypertensive outpatients of the both genders, older than 18 years. CAM was defined by The CAM questionnaire with questions about the use of food, supplements, herbs, and relaxation techniques. The CAM use was positive when the response to one or more questions was positive. Hypertension was considered uncontrolled when blood pressure>140/90 mm Hg. Non-adherence to treatment was established when the patient responded positively to one or more questions of the Morisky four-item scale.

Results: The 416 cases included were aged 65±12 years, with BMI of 30±6 kg/m², 32% men. The 209 (50%) non-adherent patients were aged 64±12 years, of African (21%) and European (76%) ethnicity, 29% men. The 207 patients with adherence were aged 66±11 years, of African (9%) and European (87%) ethnicity, 34% men The percentage of users of CAM in the groups with non-adherence and adherence was, respectively, 22% and 16% (odds ratio: 1.5; P=0.11). The prevalence of CAM in the group with uncontrolled and controlled hypertension was respectively, 19% and 18% (P=0.7). The use of CAM increases non-significantly the risk of non-adherence by 46% (P=0.14) when controlling for gender, age>50 years (P=0.04), and African (P=0.002) and European ethnicity.

Conclusions: The present results suggest that the use of complementary and alternative medicine does not affect the adherence to treatment in a population attending the hypertension outpatient clinic of a university hospital. This is in disagreement with studies that identified a negative effect of CAM use on levels of adherence. The size of our sample is relatively small and lacks the power to conclude about the possible influence of CAM on adherence to treatment in hypertensive patients.

051ASSOCIATION BETWEEN BLOOD PRESSURE PROFILES BASED ON ANKLE-BRACHIAL INDEX AND ECHOCARDIOGRAPHIC VARIABLES OF LEFT VENTRICULAR HYPERTROPHY AND DIASTOLIC FUNCTIONEstefania Inez Wittke1, Sandra Cristina Pereira Costa Fuchs1,2, Leila Beltrami Moreira1,2, Murilo Foppa1,2, Flávio Danni Fuchs1,2, Miguel Gus1,2

1Programa de Pós-graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, UFRGS, Brasil; 2Serviço de Cardiologia, Unidade de Hipertensão, HCPA, Brasil.

Background: The ankle-brachial index (ABI) is useful in the diagnosis of peripheral arterial occlusive disease (PAOD), being recognized as a marker of systemic atherosclerosis and could be incorporated in the risk stratification of hypertensive patients.

Objectives: Evaluate the association between blood pressure (BP) profiles of hypertensive patients based on ABI and echocardiographic variables of LHV and diastolic function.

Methods: Cross-sectional study that included patients from outpatient hypertensive clinic. ABI was measured by doppler vascular and the cutoff point for the diagnosis of PAOD was ≤ 0.90. Patients were classified in four hypertensive profiles: controlled blood pressure (BP) with and without PAOD and uncontrolled BP with and without PAOD.

Results: Analysis included 458 patients: 67% female, 68% white, mean age 58 ± 12 years, 44% were smokers or ex-smokers and 32.6% were diabetic. Abnormal ABI was detected in 106 patients (23%). The inclusion of this index in the evaluation of hypertensive patients allowed to identify a differentiated phenotype in 24 patients with controlled BP (20%) and 82 with uncontrolled BP (35%). Among the echocardiographic variables, only diastolic function had a statistically significant difference between groups of both normal and abnormal ABI among patients with controlled BP as those with uncontrolled BP. There were no differences between hypertensive profiles and measurements of left ventricular hypertrophy. In the logistic regression model, the association between diastolic function and altered ABI lost statistical significance. Age and pulse pressure remained significantly associated with diastolic function: OR = 1.02 (95% CI: 1.003 to 1.03, p = 0.02) and OR = 1.05 (95% CI: 1.02 to 1.07, p <0.001), respectively.

Conclusions: The results of this study indicate that 23% of hypertensive patients evaluated in an outpatient hypertension clinic have PAOD assessed by ABI. Among patients with controlled and uncontrolled BP, 20% and 35%, respectively, could be reclassified as higher cardiovascular risk. However, the inclusion of ABI in the routine initial evaluation of hypertensive patients did not add information to a better risk stratification considering echocardiography parameters of LHV and diastolic function.

052IS INSOMNIA ASSOCIATED WITH INCREASED BLOOD PRESSURE?Emerson Ferreira Martins, MSc1; Cintia Zappe Fiori, MSc1; Camila Gosenheimer Righi, MSc1; Roberto Pacheco da Silva, MSc1; Fernando Pellisoli, MSc1; Débora Simões, MSc2; Carolina Caruccio Montanari3; Gabriela Baum4; Simone Cristina Jabounski5; Denis Martinez, MD PhD1,2,6.1Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Porto Alegre, RS, Brazil; 2Graduate Program in Medical Sciences, UFRGS, Porto Alegre, RS, Brazil; 3Undergraduate Program in Nursing, UFCSPA, Porto Alegre, RS, Brazil; 4Undergraduate Program in Biology, UFRGS, Porto Alegre, RS, Brazil; 5Undergraduate Program in Physiotherapy, URI, Erechim, RS, Brazil; 6Cardiology Division, HCPA, Porto Alegre, RS, Brazil.

Background: Insomnia has been associated with hyperarousal, anxiety, and increased sympathetic activation. Nighttime systolic blood pressure was reported as 9 mmHg higher in insomniacs than in good sleepers. About one third of the insomniacs have obstructive sleep apnea, which might cause sympathetic hyperactivity, confounding the relationship between insomnia and high blood pressure. Most of these studies included small numbers of subjects and in some the results do not describe the apnea-hypopnea index (AHI).

Objective: The present study was performed to test the hypothesis that the sleep respiratory disturbance has a stronger influence on elevated blood pressure than the heart rate.

Methods: Patients undergoing polysomnography to investigate complaints of insomnia were included as cases and were divided by the AHI>5 (Insomnia-Apnea group) and AHI<5 (Insomnia-NoApnea group). Snorers with AHI<4 and sleep efficiency>85% constituted the control group. The blood pressure was measure at rest immediately before the polysomnography. The heart rate was measured before and during the examination. Sleep stages were scored based on the EEG, EOG, EMG channels.

Results: The control group included 411 individuals (50% women), mean age 37±10 years, body mass index 27,4±4,7 kg/m2. The Insomnia-NoApnea group included 1160 (67% women), mean age 40±12 years, body mass index of 24,5±4 kg/m2 and the Insomnia-Apnea group included 1051 patient (45% of women), mean age 50±12 years, body mass index of 27,4±4.5 kg/m2. The blood pressure was higher in Insomnia-Apnea group than in Insomnia-NoApnea group (125±15 vs. 119±12 mmHg), but the difference is explained when adjusted for sex, age, BMI and AHI. Measurements of heart rate during wakefulness and sleep did not show significant differences among the groups.

Conclusion: Presence of sleep apnea is associated with higher blood pressure in insomniacs, but this association is fully explained by gender, age, and BMI. This has to be taken into consideration when studying the cardiovascular status of patients with insomnia. Further research using ambulatory monitoring of blood pressure is required.

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053COMPARING THE PREVALENCE OF OBESITY IN PATIENTS WITH CHRONIC HEART FAILURE BY DIFFERENT DIAGNOSTIC CRITERIAJuliana Gil Thome1, Amanda Veiga Cheuiche2, Karina Sanches Machado d`Almeida1, Vanessa Laubert Laporta2, Gabriela Souza2, Luiz Eduardo Rohde1, Nadine Clausell1, Andreia Biolo1

1Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Porto Alegre, RS, Brazil; 2 UFRGS, Porto Alegre, RS, Brazil.

Background: While obesity is a risk factor for heart failure, patients with heart failure and high body mass index (BMI) have better prognosis. Most studies assess obesity by using BMI, which does not evaluate body composition. The bioelectrical impedance analysis (BIA) distinguishes body compartments such as lean and fat mass, allowing for a better evaluation of adiposity and nutritional status. Therefore, the use of BIA might help in the study of the paradoxical association between obesity and heart failure.

Objectives: To compare the prevalence of obesity in patients with chronic heart failure using two different criteria: BMI (≥ 30 kg/m2) or percentage of fat by BIA (>25% in men and >35% in women).

Methods: Cross-sectional study. Patients with chronic heart failure, ejection fraction (EF) <45%, without pacemaker or defibrillator and with no evidence of decompensated heart failure and were included. The device used was a tetrapolar bioimpedance of Biodynamics, model 450. Statistical analysis was performed using SPSS software, using the chi-square test for categorical variables and t test for quantitative variables.

Results: We included 176 patients (age 60±15 years, EF 31.5±8.5%). Using BMI criteria, 49.7% of patients were considered obese, compared to 22.7% when the criteria for obesity was fat percentage (p<0.001). Compared with obese patients detected by BMI, those detected by BIA had higher proportion of females (37.1% vs. 22.4 p=0.006) and lower prevalence of segmental left ventricular changes in echocardiography (26.5 x 39.7%, p=0.006), as well as a tendency to higher prevalence of hypertension (74.3 x 61.8%, p=0.093) and hypertensive etiology HF (42.9 x 31.6%, p=0.091 ). There was no difference in age, EF or diabetes.

Conclusion: In patients with heart failure, the prevalence of obesity, as well as clinical characteristics of those detected as obese, differ when using different diagnostic criteria. The relationship between heart failure and obesity/adiposity should be better assessed through other methods of nutritional assessment in addition to BMI.

054COST EFFECTIVENESS OF DRUG ELUTING STENTS IN THE PERCUTANEOUS TREATMENT OF STABLE CORONARY ARTERY DISEASE IN BRAZIL Steffan Frosi Stella, MD1,2, Carisi Anne Polanczyk, MD, ScD2,3

1Post Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Brazil; 2IATS, HCPA, Brazil; 3Cardiology Division, HCPA, Brazil.

Background: Although Drug Eluting Stents (DES) have been widely incorporate into clinical practice in development countries, several countries restrict their broadly use mainly based on their high cost and unfavorable incremental cost-effectiveness ratios (ICER). Objectives: To evaluate the ICER of DES as an alternative to bare metal stents (BMS), in the Brazilian public health system (SUS) scenario, for treatment of coronary artery disease (CAD), considering updated effectiveness and costs of commercially available stents. Methods: An analytic Markov model was built to simulate short-term (within 1 year) and long-term (lifetime) outcomes and costs after a percutaneous procedure with BMS or one of the following: sirulimus(SES), paclitaxel(PES), everolimus(EES) or zotarolimus(ZES). It was considered a cohort of patients with symptomatic, single-vessel CAD that could undergo any of the five strategies. Model parameters were extracted from the medical literature and cost data were based on SUS reimbursement list. A CAD patient’s cohort in tertiary hospital was retrieved for outpatients’ costs and utilities. Primary endpoints were ICER for 1-year target vessel revascularization (TVR) avoided and quality-adjusted life-year (QALY) gained. Economic values of one GDP/capita (R$23,750) for TVR avoided and three GDP/capita for QALY were used as willingness-to-pay thresholds. Results: Main base-case and SA results are reported in table 1. In the probabilistic SA there was a 10% probability of EES being a cost-effective strategy. Conclusion: As valued in the Brazilian market, DES is not a good value for money for QALY and for TVR avoided in comparison with BMS. DES should cost less than twice of BMS price, in order to be a cost-effective alternative.

055HYPERTENSION MANAGEMENT IN BRAZIL: USUAL PRACTICE IN PRIMARY CARE – A SYSTEMATIC REVIEW WITH META-ANALYSIS Rafael V. Picon1, Flávio D. Fuchs1, Sandra C. Fuchs1.

1Postgraduate Studies Program in Cardiology, UFRGS, RS, Brazil.

Background: Understanding how hypertension (HT) is usually managed - the status quo (usual clinical practice) - is crucial for health economical evaluations.

Objective: To establish the status quo in the diagnosis, risk stratification, and treatment of HT in the primary care of the Brazilian national Healthcare System (SUS), through systematic review with meta-analysis.

Methods: Studies conducted in Brazil, including adults with blood pressure (BP) ≥140/90 mmHg or in use of BP lowering medication were eligible. Meta-analyses were carried out including re-analysis of the databases: population-based studies of representative samples of a capital state and a countryside city, a nationwide cross-sectional study among industry workers (SESI study), and a nationwide register of hypertensive and diabetic patients treated in SUS’ primary care facilities. Industrial workers are SUS users, but all other databases provided information on hypertensive patients. Articles found in PubMed, Embase, and the Brazilian Virtual Health Library, with no language restriction, were also eligible. Analyses were performed through random or fixed effects models, with heterogeneity measured by Cochran’s Q, and inconsistency by the I2 statistic.

Results: The search retrieved 31 results; PubMed (n=18) and Embase (n=31). After removal of overlapping (n=11), narrative reviews (n=12), guidelines (n=3), point of view (n=1), and adding 4 studies from a previous systematic review, 8 studies were included. The paucity of publications contrasts with huge amount of data on patient management. Among men, the registry showed higher prevalence of DM [21.87% (95%CI: 19.84–24.04)], followed-up by the population-based studies [13.46% (95%CI: 12.53–14.44)] than among the workers study [5.6% (95%CI: 4.20–7.00)]. Smoking prevalence rate was more evenly distributed across databases. On average, an adult with HT had 2.6 ±2.37 medical appointments per year, and 51.2% (95%CI: 46.1–56.2) sought medical appointments provided by the SUS. Among 4523 hypertensive adults, 42.7% (95%CI: 28.6-58.1) uses one and 33.0% (95%CI: 23.7-43.9) two BPLM, and thiazide was the most frequently (46.1% 95%CI: 33.2-59.6) single or combined medication used.

Conclusions: The status quo of HT treatment is mostly based on a single or combined medication, with a prominent role for thiazides among those who seek medical assistance through the SUS.

056EFFECT OF DIACEREIN IN RENAL FUNCTION, METABOLIC CONTROL, AND INFLAMMATORY MARKERS IN TYPE 2 DIABETIC PATIENTS WITH NEPHROPATHYFabiana Piovesan1,2, Glaucia S. Tres1,2, Gustavo Levinski2, Hugo R. K. Lisboa2, Leila B. Moreira1, Flávio D. Fuchs1, Sandra C. Fuchs1

1Postgraduate Studies Program in Cardiology, UFRGS, RS, Brazil; 2UPF, Passo Fundo, RS, Brazil.

Background: Chronic inflammation seems to be involved in the pathogenesis of the diabetic nephropathy (DN) and anti-inflammatory agents have been suggested as adjuvant treatment. Diacerein is anthraquinone derivative, which inhibits the synthesis of interleukin-1 and TNF-α, and can be an alternative to the anti-inflammatory agents.

Objective: To evaluate the effect of Diacerein on inflammatory markers in patients with type 2 diabetes mellitus (T2DM) with DN.

Methods: A randomized clinical trial placebo-controlled, double-blind, with parallel groups was designed to enroll T2DM patients, aged 30 years or older, with DN. Patients with fasting blood glucose ≥126 mg/dl, A1C between 7.5-10%, using oral anti-diabetic agents or insulin will be eligible whether had DN confirmed by albuminuria and/or chronic kidney disease (GFR >60 ml/min). Patients with chronic inflammatory diseases, pancreatitis, hypersensitivity to renin derivatives, on use of anti-inflammatory agents or pioglitazone will be excluded. Patients will be assigned using a software (Random Allocation Software) in random blocks. They will be allocated to Diacerein (50 mg) or Placebo in the morning and evening, according to three different schemes: 1: Placebo+Placebo; 2: Diacerein+Placebo; 3: Diacerein+Diacerein, and followed-up for 90 days. The sample size calculation was based on estimate assuming a 16% reduction in the proteinuria level between groups, with an alpha of 0.05 and power of 80%, resulting in 23 patients per group. The protocol was registered in the Plataforma Brasil; the Research Ethics Committee approved the protocol and all patients will sign a consent form. The study was supported by CNPq, Universidade de Passo Fundo, and laboratory TRB PHARMA, which will provide Diacerein and placebo.

Results: We identified 600 potentially eligible patients, from the outpatient clinic of School of Medicine of the University of Passo Fundo. A pilot study was conducted to test the instruments and procedures for implementation of the study, which will enroll patients from August 2013 to January 2014, and will assess the outcome until March 2014.

Conclusions: The details of the project and approval of regulatory agencies have been made in the last 10 months, while the funding was requested 14 months ago. Now all requirements are ready to start.

Table 1. x1,000R$/QALY gained x1,000R$/TVR avoided SES PES EES ZES SES PES EES ZESBase-Case 217 443 139 dominate 43 67 44 68 dSA BMS 1,000 279 557 178 dominate 55 84 57 86cost(R$) d(2,034) DES 4,000 89 196 57 dominate 17 29 18 29cost(R$) d(6,500) TVR(%) 7.5 353 851 188 dominate 96 141 99 144 d(15.7) 30 101 197 78 420 20 35 21 36ST*(%) 0.0 338 492 287 5500 43 67 44 68(0.2) 1.0 86 313 42 dominate 43 67 45 69 d*Stent | Thrombosis

2º lugar

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057BLOOD PRESSURE MEASUREMENTS IN CHILDREN: THE INFLUENCE OF THE ALERT REACTION AND REGRESSION TO THE MEANWania E. Cechin1, Giovana B. Donato1, Flávio D. Fuchs1, Sandra C. Fuchs1

1Programa de Pós Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, UFRGS , Porto Alegre, RS, Brasil.

Background: Usual blood pressure (BP) is commonly determined through repeated measurements. ABPM-24h (Ambulatory Blood Pressure Monitoring ) or HBPM (Home Blood Pressure Measurement) are other alternatives to overcome the alert reaction in adults. However, in children there is scarce information about the occurrence of alert reaction in the measurement of blood pressure.

Objectives: This study aims to evaluate the behavior of repeated blood pressure measurements in children.

Methods: Children, seven to nine years old, born from teenage mothers and young adults, had four repeated BP measurements in the same day. Blood pressure was assessed using a standardized technique, validated oscillometric monitor (OMRON, model CP-705) and the appropriate cuff sizes for arm circumference, with five minutes intervals. The mean (± SD) systolic (SBP) and diastolic blood pressure (DBP) at each reading of the four measurements was assessed using General Linear Model and analysis of variance for repeated measurements was used to compare the first with the averages of subsequent readings. Afterward patients were classified into two groups, according to the measurement values of the first SBP and DBP, larger or smaller than the average pressures. Variance analysis of global systolic and diastolic BP and in each subgroup was performed by ANOVA for repeated measures using the Bonferroni test.

Results: Children (n=448) aged 8.0 ±0.5 years, 52.5% males were investigated. The mean of SBP decreased from the first to the 4th reading: 109.9 ±15.2 vs. 107.5 ±14.0 mmHg; F = 3.8, P <0.001. The reduction of DBP did not reach statistical significance (F = 1.7; P =0.16). The first systolic BP measurement (109.9 ±15.2) was significantly higher than the average of the following measurements (107.6 ±11.7; P = 0.001).

Conclusions: Systolic blood pressure decreases with repeated measurements in children, particularly due the high value of the first measurement. Regression to the mean and the alert reaction are likely explanations for these findings. Despite to having low implication for diagnostic purpose, this phenomenon should be taken into account in studies of tracking of blood pressure. Further reduction of blood pressure in the measurement of blood pressure in other days requires additional investigation.

058ASSOCIATION OF BIRTH WEIGHT WITH ADIPOSITY AND BLOOD PRESSURE IN CHILDHOODWania E. Cechin1, Giovana B. Donato1, Sandra C. Fuchs1

1Programa de Pós Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, UFRGS , Porto Alegre, RS, Brasil.

Background: Several studies suggested that low birth weight is a cardiovascular risk factor. However, there is scarce information regarding the effects of birth weight on longitudinal trends on anthropometric parameters and blood pressure in childhood.

Objectives: To evaluate the association of birth weight with adiposity and blood pressure in school children.

Methods: Cohort study was conducted in Passo Fundo, RS, in children of teenage and young adult mothers, evaluated after birth and aged 7 to 9 years through questionnaires and anthropometric measures taken in 2001 and 2008-10. Weight, height and circumferences of neck, waist and hip were measured. Blood pressure was verified using automated equipment (OMRON, model CP-705) and calculated the averages of systolic and diastolic blood pressure in three measurements, discarded the first. Children were classified according to birth weight in under 2500 grams, between 2500 and 3499 grams and 3500 grams and over, as well as the appropriate weight for gestational age in small (SGA), appropriate (AGA) and large (GIG). The analysis of the birth weight, anthropometric characteristics and blood pressure was performed by ANOVA, and linear regression was used to test the associations adjusting for confounding factors.

Results: In the follow-up visit 451, out of 664 children, were re-examined, 52.5% boys. At the baseline 3.4% were SGA and 12% GIG, born to mothers with 12-15 (6%), 16-19 years (50%) and 20-24 years (54%). The average birth weight did not differ between groups based on ethnicity, maternal age and sex. The circumference of the neck, waist and hip in the follow-up visit showed a strong correlation with each other and were significantly associated with birth weight (P <0.001) and the adequacy of birth weight for gestational age. In the multivariate analysis, birth weight was positively associated with adiposity measures, independently of gender, gestational age, current age, and obesity.

Conclusions: Birth weight is associated with measures of adiposity in school age children.

059INSPIRATORY MUSCLE EXERCISE REDUCES LIPOPEROXIDATION IN OBESE AND HEALTHY SUBJECTSLeandro Chaves1, Fernando Porto1, Loani Maldaner1, Letícia Donato1, Amanda Spring1, Roberta Cattaneo1, Carine Cristina Callegaro1

1Physiology Research Laboratory, UNICRUZ, Cruz Alta, RS, Brazil.

Background: High-intensity inspiratory exercise seems to increase oxidative stress in healthy subjects. Although obesity is related to impaired inspiratory muscle function, the acute effects of the inspiratory exercise remain unclear in obese subjects.

Objective: To investigate the effect of inspiratory exercise on the lipoperoxidation in obese and healthy subjects.

Methods: We studied 10 obese (35 ± 3 kg/m²; 32 ± 6 years old) and 10 healthy subjects (23 ± 2 kg/m²; 24 ± 5 years old). Maximal inspiratory pressure (PImax) was assessed by a pressure transducer. Blood sample was collected to assess Thiobarbituric Acid Reactive Substances (T-BARS) before and after the inspiratory exercise performed in different days at 30% PImax during 30 min and at 60% PImax maintained until reach the task failure.

Results: Inspiratory muscle strength was similar in obese and healthy subjects. Inspiratory exercise performed at 60% PImax reduced T-BARS in obese (from 6 ± 2 nmol MDA/mL to 4 ± 2 nmol MDA/mL) and healthy subjects (from 7 ± 4 nmol MDA/mL to 5 ± 3 nmol MDA/mL, ANOVA: Time= 0,003; Group= 0,52; Interaction= 0,98). As expected, inspiratory exercise performed at 30% PImax did not change T-BARS.

Conclusion: This study shows that acute inspiratory exercise may reduce lipoperoxidation in humans.

060TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION IMPROVES VASCULAR CONDUCTANCE AFTER CORONARY ARTERY BYPASS GRAFT SURGERY Paulo J. C. Vieira4, Jorge P. Ribeiro4,6 (in memorian), Gerson Cipriano Jr1, Ross Arena2, Larry Cahalin3, Julio Zago4, Adriana M. Güntzel5, André L. M. Winter4, Gaspar R. Chiappa4,6 1Physical Therapy Department, University of Brasilia, Brazil; 2Division of Physical Therapy, Department of Orthopedics and Rehabilitation and Division of Cardiology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA; 3Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami; 4Exercise Pathophysiology Research Laboratory and Cardiology Division, HCPA, Porto Alegre, Brazil; 5Intensive Care Unit, HCPA, Brazil; 6Postgraduate Program in Cardiology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.

Introduction: Studies have shown that transcutaneous electrical nerve stimulation (TENS) may improves blood flow and suppress sympathetic nervous system (SNS) activation. There is evidence that TENS reduces episodes of angina, electrocardiographic signs of ischemia, and nitroglycerin intake.

Objective: We tested the hypothesis that TENS could attenuate peripheral vasoconstriction and improve blood flow redistribution during handgrip exercise in acute myocardial infarction (AMI) patients who underwent a coronary artery bypass graft (CABG). In addition, we posited this 5-day TENS applied in a cervical region would facilitate the reduction of postoperative pain and consequently improve clinical outcome.

Methods: Thirty-eight patients were randomized to a 5-day TENS program (n = 20; 4 times/day; 30 min/session) or to placebo-TENS (P-TENS, n = 18), both applied on cervical region (C7-T4). Acute sympathetic stimulation by the cold pressor test (CPT), maximal voluntary contraction (MVC), femoral blood flow (FBF), femoral vascular conductance (FVC) and the 6-minute walk test (6-MWT) were primary outcome measures pre and post-CABG. Inspiratory and expiratory muscle strength (PImax and PEmax), □-endorphin, the amount of opioid analgesics used and pain intensity measured throughout at first 24 h after CABG (immediately, 6, 12 and 24 h) were also assessed.

Results: The reduction of FVC after handgrip exercise decreased significantly with TENS (TENS, -90 ± 7 and -56 ± 5% and P-TENS, -84 ± 5 and -67 ± 6 %; P < 0.001). Also with TENS, the 6-MWT, PImax and PEmax significantly increased. □-endorphin level increased only in the TENS group (TENS, 478 ± 20 before and 589 ± 59 after; Control 478 ± 27 before and 456 ± 26 after; P < 0.001). TENS elicited a significant reduction in the amount of analgesic used and pain intensity during the postoperative period, (TENS, 7 ± 2 before and 1 ± 0.45 after; P-TENS 8 ± 3 before and 7 ± 2 after; P < 0.001).

Conclusion: A 5-day TENS intervention resulted in a number of clinically relevant improvements in a cohort undergoing CABG. Future research is needed to validate the potential clinical utility of TENS in patients with cardiovascular disease.

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Abstracts

061PREDICTORS OF CARDIOVASCULAR DISEASE IN ADULTS, ELDERLY AND VERY ELDERLY IN SOUTHERN BRAZIL: A POPULATION-BASED STUDYRenato Gorga Bandeira de Mello1, Flávio Danni Fuchs1, Leila B. Moreira1, Sandra Costa Fuchs1

1Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil.

Background: The association of hypertension, diabetes mellitus, sedentary lifestyle and obesity with CVD in elderly and very elderly individuals is controversial and has been poorly described.

Objectives: The aim of this study was to evaluate the association of risk factors for cardiovascular disease with clinical disease in adults (40-59 years), elderly (60-69 years) and very elderly (≥70 years) of a representative sample of the city of Porto Alegre, Brazil.

Methods: A cross-sectional population-based study identified individuals through a multistage sampling. Data on socio-demographic, lifestyle, and health history were collected through a standardized questionnaire. Four blood pressure measurements were carried out using an oscillometric monitor, and anthropometric measurements were taken in duplicate. Hypertension was diagnosed by blood pressure ≥140/90 mmHg or use of BP-lowering drugs. Central obesity was determined by waist circumference ≥ 102 (men) or 88 (women) cm, and body mass index categorized as <25.0, 25.0 to 29.9, and ≥ 30.0 kg/m2. Diabetes was defined by previous medical diagnosis and/or use of anti-diabetic drugs. Cardiovascular disease was identified by medical history of myocardial infarction, coronary artery bypass grafting or percutaneous coronary intervention, heart failure (HF), or stroke.

Results: A total of 1210 participants were interviewed, being 611 adults, 300 elderly and 299 very elderly individuals. Cardiovascular disease was identified in 6.9% of adults, 17.3% of the elderly and 28.8% of the very elderly. Among adults, hypertension was the highest predictor of CVD (RR=7.8; 95%CI: 3.4-18.2; P<0.001). Among elderly aged 60 to 69 years, male gender (RR=1.9; 95%CI: 1.1-3.3; P=0.03), overweight (RR=2.3; 95%CI= 1.0-5.2; P=0.05), and diabetes mellitus (RR=2.3; 95%CI: 1.2-4.4; P=0.008) were independently associated with CVD. In the very elderly, physical inactivity (RR=1.8; 95%CI: 1.2-2.6; P=0.003), overweight (RR=2.2; 95%CI: 1.2-4.0; P=0.02) and obesity (RR=1.9; 95%CI95 1.0-3.6; P=0.02) were significantly associated with CVD, and there was a trend for hypertension (RR=1.9; 95%CI: 0.9-4.0; P=0.08).

Conclusion: In conclusion, hypertension was the highest predictor of CVD in adults. Among the elderly, male gender, overweight and diabetes were associated with CVD. Even in the very elderly it was possible to identify physical inactivity, overweight and obesity as independent risk factors for CVD.

062PREVALENCE OF OBESITY AMONG BRAZILIAN ELDERLY: A META-ANALYSIS OF POPULATION-BASED STUDIESRenato Gorga Bandeira de Mello1, Francisca Mosele2, Flávio Danni Fuchs1, Leila B. Moreira1,2, Sandra Costa Fuchs1,2

1Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil; 2Postgraduate Studies Program in Epidemiology, UFRGS, Porto Alegre, RS, Brazil.

Background: Population surveys in the United States and Europe show a high prevalence of obesity in the elderly. There are few representative studies of the Brazilian elderly population about this subject, but none nationwide representative survey.

Objective: The study aimed to identify the prevalence of obesity in the elderly population and trends in the last decades through a systematic review.

Methods: A Systematic review with meta-analysis of population-based studies, conducted in Brazil, between 1980 and 2012, was carried out. Searches were conducted in the PubMed, Embase, Lilacs and SciELO databases by two independent reviewers. Unpublished studies were identified through the theses bases of CAPES.

Results: 14 studies were identified, including 26,325 elderly participants. As shown in Figure 1, the prevalence of obesity was 18.9% (95% CI 11.3 to 30.0), higher in the 2000’s than in the 90’s. The risk of obesity was higher among women (RR 2.7, 95% CI 1.48 to 4.93, P = 0.001). Furthermore metaregression for gender showed that in men, there was a trend for increase in obesity over the years (slope = 0.064, P = 0.06), but not for women.

Conclusion: The prevalence of obesity among the elderly has increased in recent decades. Risk was higher among women, but there was considerable increase among men.

063EARLY MANIPULATION OF ARTERIAL BLOOD PRESSURE IN ACUTE ISCHEMIC STROKE: DESIGN, FEASIBILITY AND SAFETYMAPAS TRIAL INVESTIGATORS: MANIPULATION OF ARTERIAL BLOOD PRESSURE IN ACUTE ISCHEMIC STROKENasi LA1, Martins S2, Almeida AG2, Weiss G2, Rebello LC2, Brondani R2, Valença MJM2, Wirt L2, Nunes G2, Dalpizzol A2, Valer L2, Gus M1. 1Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil; 2UFRGS, Porto Alegre, RS, Brazil.

Introduction: The data from the trials are too limited to provide reliable guidance on whether it is feasible and safe actively lower or raise BP during the acute phase of Ischemic Stroke (IS).

Objectives: Present the design, feasibility and safety to maintain three levels of pre specified Systolic Blood Pressure (SBP) during the first 24hours in subjects with acute IS. Design: randomized, prospective, single center clinical trial Intervention: Intravenous (IV) esmolol, sodium nitroprusside or norepinephrine to target three levels of SBP: Group (1) 140 to 160mmHg, Group (2) 161 to 180mm Hg and Group (3) 181 to 200 mmHg.

Method: Non thrombolized acute IS patients with less than 12 hours of symptoms onset were randomized. The SBP was maintained in each target Group using: no intervention when the SBP was in the randomized range; IV bolus of saline solution 0.9% (500 to 1000ml) followed by norepinephrine when the SBP was lower than the randomized range and; IV esmolol or nitroprusside when the SBP was higher than the randomized range. The SBP was recorded noninvasively hourly during the treatment.

Results: 196 patients, age 69 ±11 years, 56% male with acute ischemic stroke were allocated. Sixty six in Group (1), 68 in the Group (2) and 62 in the Group (3) and the mean SBP achieved during the first 24h were 152 ± 9, 162 ± 11 and 176 ± 14 (P<0.00001) respectively. Hypertension (88%) and diabetes (31%) were the most prevalent risk factors. Large-vessel atherothrombotic infarct, small vessel lacunar infarct, cardioembolic and others or undetermined stroke occurred in 23%, 18%, 20% and 37% respectively. Symptomatic hemorrhagic transformation was observed in none patients in Group (1), 3% in Group (2) and 8% in Group (3) (p=0.15), and the mortality at 3 month were 12%, 18% and 8% respectively (p=0.26). Four patients increased serum troponin and one presented symptomatic bradycardia with norepinephrine.

Conclusion: Aggressive manipulation of SBP in the first 24 hours of ischemic stroke is possible and well tolerated. The neurological impact of different levels of blood pressure in the first 24h on three month Ranking score of needs further studies.

064ADHERENCE TO DASH DIET AND LEVELS OF AGES AND VASCULAR AND SYSTEMIC INFLAMMATION MARKERS IN PATIENTS WITH PRE- AND HYPERTENSIONFrancisca Mosele1; Renato G. B. de Mello2, Flavio D. Fuchs2, Sandra C. Fuchs1,2

1Postgraduate Studies Program in Epidemiology, UFRGS, Porto Alegre, RS, Brazil; 2Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil.

Background: The DASH diet has been shown to be efficient in reducing blood pressure. Its effect is independent of calorie and sodium restriction, possibly associated to a nutritional mediator. Advanced glycation end products (AGEs) have been suggested as a mediator of endothelial inflammation, involved in the deregulation of arteriolar and blood pressure control. There are no clinical studies investigating the association between dietary patterns and the generation of AGES in hypertensive patients.

Objectives: Assess the impact of adherence to DASH-type diet on plasmatic levels of AGEs and markers of vascular and systemic inflammation in patients with pre- and hypertension.

Methods: This protocol is a sub-project of the PREVER study, a randomized clinical trial registered in the database: clinical trial.gov (no. NCT00970931; NCT00971165). This protocol is a quasi-experiment, conducted in Hospital de Clínicas de Porto Alegre and approved by the Research Ethics Committee (no.08-621). A total of 400 prehypertensive and hypertensive participants, men and women, aged 30-70 years were enrolled after signing a consent form. All eligible participants received a lifestyle intervention based on the American Heart Association recommendations, including a DASH-diet pattern, stop smoking, lose weight, and exercise at least 150 minutes per week, being reassessed three months later. Participants were interviewed regarding socio-demographic, lifestyle, and previous morbidity using a standardized questionnaire. Anthropometric measurements were taken in duplicate and blood pressure four times, using a validated oscillometric monitor. Dietary intake was evaluated through a group food frequency questionnaire (FFQ) developed and validated to be used in the PREVER trial. The adherence to the eating plan, will be assessed through a score based on recommended number of servings per day. Plasma levels of AGEs will be determinated by ELISA essay method and adhesion molecules, selectin and markers of systemic inflammation by Multiplex Panel. Pearson chi-square test will be used to analyze categorical variables, and t test or analysis of variance for continuous (SPSS v.17). The analysis will be carried out using Poisson regression and Cox hazard regression models, which allow controling for confounding factors.

Conclusions: The evaluation of the pattern DASH diet on plasma levels of AGEs can provide additional information to reduce blood pressure through dietary pattern, already recommended. It can also provide data on the inflammatory response that occurs in the genesis and progression of hypertension.

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Abstracts

065PREVENTION OF CARDIOVASCULAR DISEASE IN PATIENTS WITH PREHYPERTENSION: PREVER PREVENTION TRIAL – PRELIMINARY FINDINGS OF THE LYFESTYLE INTERVENTION PHASEFlávio Danni Fuchs1,2, in name of the PREVER Study investigators http://www.trialsjournal.com/content/12/1/65/1Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, Porto Alegre, RS, Brazil; 2Cardiology Division, HCPA, Porto Alegre, RS, Brazil.

Background: Individuals with blood pressure within prehypertensive levels are at higher risk of developing hypertension and presenting cardiovascular disease. The effectiveness of interventions to preventing these outcomes was scarcely investigated to date.

Objective: The aim of this study was describe the preliminary findings of the enrollment phase of the PREVER prevention trial.

Methods: PREVER prevention is a double blind, multicenter, randomized clinical trial of effectiveness of non-drug and drug treatment to prevent hypertension and target organ damage among individuals with prehypertension. It was conducted in 22 centers distributed in 10 Brazilian states. Participants were selected through several approaches (media advertisings, screening in factories, personnel from hospital, universities, shopping centers) and had blood pressure within prehypertensive levels (120 to 139 mmHg of systolic blood pressure or 80-89 mmHg of diastolic blood pressure) confirmed in two visits in the clinics of the study. Socio-demographic, lifestyle, and health history were collected through a standardized questionnaire. BP measurements were carried out using an oscillometric monitor, and anthropometric measurements were taken in duplicate. Lifestyle intervention (LSI) was applied to all participants for three months. Participants with target organ damage were excluded. A second assessment of BP was taken 15 days after, and individuals with values <120/80 mmHg or ≥140/90 mmHg were also excluded. Individual confirmed as prehypertensive after LSI were randomized to receive chlorthalidone + amiloride (12.5 + 5 mg) or placebo.

Results: 4.867 volunteers were screened and 1.516 were evaluated for enrollment. Of those 256 (16.8%) were excluded for BP ≥140/90 mmHg, 119 (7.8%) for BP <120/80 mmHg and 57 (3.7%) for other reasons. In total, 1.084 volunteers were enrolled in LSI phase. After revaluation, 348 were excluded: 121 (11.1%) had abnormal laboratory results, 89 (8.2%) developed hypertension, and 138 (12.7%) had their BP <120/80 mmHg. A total of 736 participants (67.9% of those enrolled on the LSI phase) were randomized.

Conclusion: Two thirds of volunteers enrolled in the lifestyle intervention phase of the PREVER prevention trial were randomized. Approximately 20% of the participants became hypertensive or had blood pressure reduced to less than 120/80 mmHg after three months of lifestyle intervention.

066CARDIORESPIRATORY REPERCUSSIONS OF PHYSIOTHERAPY IN PATIENTS IN SEPTIC SHOCKBlattner C1, Saldanha R1, Dias F1, Vieira S2

1PUCRS, Porto Alegre, RS, Brasil; 2UFRGS, Porto Alegre, RS, Brasil.

Questions: What are the cardiorespiratory repercussions resulting from applying standard respiratory physiotherapy to patients in septic shock? Does the technique provide an immediate clinical benefit?

Design: Prospective experimental study. Participants: patients diagnosed with septic shock and using vasopressors in an Intensive Care Unit.

Outcome: The cardiorespiratory variables (HR –heart rate), MAP – mean arterial pressure, pHA hydrogen ion potential, PaO2 – partial pressure of oxygen , PaCO2 – partial pressure of carbon dioxide -, SaO2 – oxygen saturation, HCO3 – sodium bicarbonate) were collected 5 minutes before the intervention and immediately afterwards.

Results: The PaO2, HR and SaO2 levels rose significantly after physiotherapy (0.001; 0.017; 0.048). On the other hand, the PaCO2 levels were significantly reduced (0.003).

Conclusion: The respiratory physiotherapy approach in patients in septic shock in an Intensive Care Unit was safe and well-tolerated and did not present deleterious efects and hemodynamic deterioration with clinical decompensation during care.

067EXERCISE TEST-INDUCED ST SEGMENT DEPRESSION IN THE PRESENCE OF RESTING RIGHT BUNDLE BRANCH BLOCKAnderson Donelli da Silveira1, Victor Froelicher2, Ricardo Stein1

1Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil; 2Stanford University, Palo Alto, E.U.A.

Background: During clinical stress testing exercise-induced ST segment depression (EI-STdep) is a known marker for myocardial ischemia and confers an increase in risk for mortality. However, little is known about EI-STdep in patients with resting right bundle branch block (R-RBBB).

Objective: To longitudinally evaluate, in a male Veterans population, the prognostic significance of EI-STdep in patients with R-RBBB. Additionally, we compared all individuals with R-RBBB to those with normal and abnormal ST responses to exercise testing.

Methods: Consecutive patients from 1987 to 2007 were clinically tested on a treadmill. R-RBBB and R-RBBB plus EI-STdep patients were identified. Outcomes and demographics were compared between individuals with normal electrocardiographic findings, and those with ≥1.0 mm horizontal or down-sloping ST-segment depression. Kaplan Meier with log-rank testing and age-adjusted Cox proportional hazards regression analyses were performed.

Results: In this prospective cohort of 9,072 individuals evaluated, 5922 subjects had normal resting and exercise ECG findings, 1,781 had abnormal ST-segment depression, 295 had R-RBBB alone and 74 had R-RBBB with EI-STdep. EI-ST depression occurred at similar rates in those with and without R-RBBB (20%). The average follow-up was 8.8 years. R-RBBB was noted in 4.1% and the annual mortality rate was 3.8%. The annual mortality rate in subjects with R-RBBB who exhibited EI-STdep was 2.2%. Patients with RRBBB were older (65.4 vs 62.5 y) and presented more anterior Q waves (6.1% vs 4.1%). Individuals with RRBBB plus EI-STdep had more diabetes (26.2% vs 13.6 %) and more heart failure (21.6% vs 10.8%).

Conclusions: The occurrence of EI-STdep in individuals with RRBBB is associated with lower mortality in comparison to subjects with RRBBB who do not exhibit EI-STdep. Differences in clinical features including age and presence of disease did not explain this result. A plausible explanation for this intriguing finding is awaits further investigation.

068YOGA AND BREATHING TECHNIQUES TRAINING IN THE MANAGEMENT OF HEART FAILURE PATIENTS: A RANDOMIZED NON-INFERIORITY CLINICAL TRIAL Carla Pinheiro Lopes1, Luiz Cláudio Danzmann2, Ruy Silveira Moraes Filho3, Jorge Pinto Ribeiro4, Andreia Biolo5

1LaFiEX – Laboratory of Pathophysiology of Exercise: PhD Candidate at the Graduate Program in Cardiology and Cardiovascular Sciences (HCPA-UFRGS), Professor at ULBRA / RS; 2 Co-advisor. HF Ambulatory Care Clinic at Ulbra UH-Mãe de Deus; PhD, Cardiology (UFRGS) Professor at ULBRA-RS; 3 Contributor. HCPA Chief of noninvasive methods; PhD, Cardiology (UFRGS), Professor at UFRGS;4 Advisor - In memoriam; 5 Advisor – HCPA HF Ambulatory Care Clinic; PhD, Health Sciences: Cardiology (UFRGS) - PPG Cardiology Professor (UFRGS). Background: Current therapies for heart failure (HF) bring together strategies to improve quality of life, increase exercise tolerance and to reduce morbidity and mortality. Studies in the literature describe that some HF patients present changes in the musculoskeletal system and inspiratory muscle weakness. Inspiratory muscle training performed with equipment is commonly used for strength restoration in individuals with inspiratory muscle weakness. This training results in an increase in respiratory muscle strength and endurance, in maximum oxygen consumption (VO2), functional capacity, respiratory responses to exercise and improved quality of life (Ribeiro, JP et al. Curr Heart Fail Rep. 2009; 6 : 95-101). Yoga therapies in HF patients have shown results in their quality of life, in inflammatory markers, and VO2 peak (Pullen, PR et al. Medsci Sports Exerc. 2009; 42:651-7). However, studies that show the effects of different yoga breathing techniques in the management of HF patients are non-existent.

Objective: To investigate the effects of Yoga and specific breathing techniques in inspiratory muscle responses, VO2 peak, distinct features of the Autonomic Nervous System, BNP and quality of life in Heart Failure with Preserved Ejection Fraction (HFpEF) patients.

Methods: A multicenter (HCPA HF Ambulatory Care Clinic and ULBRA-Mãe de Deus University Hospital Ambulatory Care Clinic - Canoas / RS), randomized, non-inferiority trial. Sample of 48 patients previously diagnosed with HFpEF. Follow-up of 8 weeks (16 sessions).

Outline: After signing informed consent and pre-test intervention, patients are randomized into 3 groups: (1) Yoga – active breathing technique; (2) Yoga’s passive breathing technique – pranayama; (3 ) Control group (standard pharmacological treatment). The post-intervention tests are performed at the end of each intervention period (2 months) for analysis of outcomes. Interventions occur continuously at HCPA ( Physiotherapy sector) and at ULBRA UH (Education sector) according to patients’ enrollment.

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Abstracts

069PEAK OXYGEN PULSE IS AN INDEPENDENT PREDICTOR OF DEATH IN A COHORT OF HEART FAILURE PATIENTS EVALUATED BY CARDIOPULMONARY EXERCISE TESTINGAnderson Donelli da Silveira1,2, Marcio Garcia Menezes1, Rafael Cechet1,2 , Ricardo Stein1,2. 1HCPA, Porto Alegre, RS, Brasil; 2Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil.

Background: Several variables measured by cardiopulmonary exercise testing (CPET) have been shown to have prognostic significance in patients with heart failure (HF). The oxygen pulse, a ratio between peak oxygen consumption (peak VO2) and heart rate, can be a surrogate of stroke volume, reflecting cardiac inotropism and having prognostic value in HF.

Objectives: To evaluate the prognostic value of different variables assessed by CPET in a cohort of HF patients followed in a specialized clinic of a public university hospital.

Patients and Methods: Retrospective cohort study. All patients were evaluated by a maximal CPET performed by experienced professionals. Primary outcome was death by any cause. Cox regression was performed to assess the independent impact of different variables on survival, adjusting to follow-up time and possible confounding variables.

Results: A total of 207 patients were included, 141 (62%) male and with 55 ± 12 years-old (mean ± SD). After an average follow-up of 3,1 ± 1,9 years, 27 deaths occurred (12%). Average peak VO2 was 17,4 ± 5,5 ml.kg-1.min-1 . Peak ventilatory power (HR 0.68 CI95% 0.5-0.9), VE/VCO2 slope (HR 1.04 CI95% 1.01-1.06) and peak oxygen pulse (HR 0.77 CI95% 0.67-0.88) were associated with fatal outcomes on univariate analysis. However, after multivariate analysis and covariates adjustment, peak oxygen pulse remained the only independent predictor of adverse outcomes s (HR 0.69 CI95% 0.55-0.86), aggregating 31% death risk for each 1ml/beat below 10.5 ml/beat.

Conclusions: In this HF patients cohort, peak oxygen pulse was independently associated with survival. More attention should be given to this variable, including it in the HF severity algorithms.

070PROGNOSTIC VALUE OF ANGINA IN PATIENTS WITH CHRONIC STABLE CORONARY ARTERY DISEASE AND DIABETES MELLITUS Fernando Schmidt Fernandes¹, Gabriel Tesche Roman¹, Nicolas Peruzzo¹, Andrea Ruschel Trasel¹, Clarissa Both Pinto¹, Vinicius Mac Cord Lanes Baldino¹, Christiane Carvalho Faria¹, Luis Felipe Silva Smidt¹, Mariana Vargas Furtado¹, Carisi Anne Polanczyk¹,2.

¹Ambulatório de Cardiopatia Isquêmica HCPA, IATS, HCPA, Porto Alegre, Brasil; 2Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil.

Introduction: Angina as a prognostic factor in patients with diabetes mellitus (DM) has been studied.

Objective: To evaluate the prognostic value of angina, graded according to the Canadian Cardiovascular Society (CCS) classification, in patients with stable CAD and DM.

Methods: 217 patients in outpatient treatment were enrolled for a cohort study from 1998 to 2012. Patients were stratified as symptomatic if they attended at least one of these criteria: presence of significant angina (CCS 2, 3 or 4) at the beginning of the monitoring, or presence of significant angina in more than 30% of the medical assessments. Cox regression was used for survival analysis. Mortality and composition of acute coronary syndrome, stroke, and death from cardiovascular causes (MACCE) were used as outcomes.

Results: Among the patients, 37.5% had angina at the beginning of follow-up; 46.4% had angina in over 30% of medical assessments; the mean age was 62 ± 10 years; 49.8% were men; and 11,1%, were chronic renal patients. In the stratification of patients in the group with angina in over 30% of the medical assessments, angina was identified in 39.6% of men and 53.7% women (p <.05). In the stratification of patients in groups with or without symptoms at baseline, there was no difference between the groups regarding the presence of angina in relation to demographic characteristics. The presence of angina at baseline (HR 2.14, 95% CI 0.70 to 6.57) or in more than 30% of medical assessments (HR 1.19, CI 95 0.53 to 2.67%), were not predictors of overall mortality. Renal disease was an independent factor in both analyzes (HR 3.98, 95% CI 1.47 to 10.77 and HR 4.00, 95% CI 1.73 to 9, 30, respectively). Presence of angina at baseline (HR 0.85, 95% CI 0.39 to 1.84) or in more than 30% of medical assessments (HR 0.58, 95% CI 0 0.31 to 1: 17) were not predictors of the MACCE outcome.

Conclusion: In this study the presence of significant angina at the beginning or during follow-up did not predict mortality or cardiovascular outcomes, demonstrating the need for other clinical parameters to assess prognosis in these patients.

071EFFICIENCY EVALUATION OF NONINVASIVE DIAGNOSTIC ROUTINE IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE WITHOUT VENTRICULAR DYSFUNCTION AND ELEVATED B-NP: A RANDOMIZED NON-BLINDED UNICENTERLuis Smidt1, Andrea R. Trasel1, Guilherme Fernandes1, Julia Saldanha1, Carisi Polanczyk1,2

1Serviço de Cardiologia, HCPA, Porto Alegre-RS, Brasil; 2Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil.

Introduction: The B-NP (b-type natriuretic peptide) is a natriuretic hormone that has been studied as a prognostic marker for cardiovascular disease. The elevation of B-NP has shown association with outcome of death, cardiovascular events and positivity of noninvasive evaluation of ischemia in chronic stable coronary artery disease (CAD). There are no data indicating that an early evaluation guided by B-NP can reduce cardiovascular outcomes.

Objectives: Analyze if the strategy of early noninvasive evaluation of CAD driven by increased B-NP is associated with lower incidence of major cardiovascular outcomes in the short follow-up (6 months) and medium term (1 year).

Methods: Randomized clinical trial in parallel, non-blinded, single-center. Included CAD patients with EF> = 40% consecutively treated in ischemic heart disease clinic in a referral hospital. B-NP will be collected on all patients. Those with value ≥ 100 pg / ml will be randomized or not to early non invasive strategy. B-NP patients without BNP value ≥ 100 pg / ml will be followed in parallel to the clinical trial.

072DETERMINATION OF LDL-CHOLESTEROL: COMPARISON BETWEEN THE DIRECT MEASUREMENT AND ESTIMATION USING THE FRIEDEWALD FORMULAPedro Lima Vieira1, Luis Smidt1, Rafael Beltrame1, Andrea Ruschel Trasel1, Guilherme Fernandes1, Luciane Restelatto1, Mariana Furtado1, Emilio Moriguchi1,2, Carisi A Polanczyk1,2

1Serviço de Cardiologia, HCPA, Porto Alegre-RS, Brasil; 2Postgraduate Studies Program in Cardiology, UFRGS, Porto Alegre, RS, Brazil.

Introduction: The calculation of LDL cholesterol (LDL-c) using the Friedewald formula (TC-HDL-TG / 5) has become standard since the 1970s, when the direct measurement was not possible. Currently, more reliable and inexpensive methods of direct measurement of LDL are available. The correlation of these values in different clinical scenarios with current laboratory methods has not been tested.

Objective: To evaluate the correlation between LDL measured by the direct method (LDLD) with LDL-C in patients with different clinical and laboratory characteristics. Methods: Cross-sectional with 466 stable patients in a tertiary hospital – monitoring from March 2008 to November 2012. Patients with triglycerides (Tg)> 400 were excluded for comparison. The measurement of LDL-d was made with an homogeneous enzyme assay (LDL-Plus, Roche). The statistical analysis used to compare the groups was the Pearson correlation and Bland Altman.

Results: A total of 466 patients with a mean age of 63.9 (± 13.3) years, 43.2% male, was included in the study. The presence of DM (46.1%) and statin (76.5%) demonstrates high cardiovascular risk in this population. A general comparison between the d-LDL and LDL-c (r 0.9, 2.1 BA Bias, LS 35.3 - LI -31, p <0.001) showed results similar to the original study. However, when analysis was performed according Tg levels, those with levels between 201 to 300 (r 0.78, 7.7 BA bias, LS 54.6 - LI -39.2 p <0.001) and> = 300 (r 0.8; bias BA 13.1, 56.1 LS - LI -29.8 p <0.001) showed more variation and worse correlation result. The presence of DM, when poorly controlled (gluc Hb> 8), shows greater variation in results (r 0.89; Bias 5, LS 36.0 - LI -28, p <0.001) than in patients with stable disease (r 0.87, 1.93 bias, LS 42.7 - LI -38.9 p <0.001).

Conclusion: Despite good correlation in the general population, LDL-c has limitations in some subgroups. In patients with Tg> 200, for example, shows a significant decrease in the correlation. The variation in key subgroup in cardiovascular disease, such as diabetic patients, is a major limitation of its use.

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I INTERNATIONAL SYMPOSIUM ON … · Antonio Carlos Pereira Barretto (SP ... Depart. de Mét. e...

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